As Artificial Intelligence (AI) plays an increasingly prominent role in society, its application in clinical cardiology is gaining traction by providing innovative diagnostic, prognostic, and therapeutic solutions. Electrocardiogram (ECG), as a ubiquitous diagnostic tool in cardiology, has emerged as the leading data source for Deep Learning (DL) applications. A recent study from our group used ECG-based DL model to identify cardiac wall motion abnormalities and outperformed expert human interpretation. Motivated by this work and that of many others, we aim to discuss advances, limitations, future directions, and equity considerations in DL models for ECG-based AI applications.
Surgical Cardiac Sympathetic Denervation (CSD) has gained traction as a promising neuromodulatory therapy for Refractory Ventricular Tachyarrhythmias (RVT), particularly in patients with channelopathies and Ischemic (ICM) and Non-Ischemic Cardiomyopathies (NICM) who are refractory to conventional treatment. This mini review examines the pathophysiological role of the sympathetic nervous system in RVT and assesses the efficacy of Bilateral CSD (BCSD) through a literature review. Historical perspectives have traced the evolution of CSD from its initial use in intractable angina to its current application in ventricular arrhythmias. BCSD is associated with improved outcomes for refractory ventricular arrhythmias, with studies demonstrating approximately 60% reductions in implantable cardioverter defibrillator shocks and over 50% shock-and transplant-free survival at 1 year after BCSD. Notably, the 2017 AHA/ACC/HRS guidelines recommend Left CSD (LCSD) for certain etiologies of RVT, including congenital long QT syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), and VT/VF storm. Both Video-Assisted Thoracoscopic Surgery (VATS) and Robot-Assisted Thoracoscopic Surgery (RATS) BCSD are performed, with shorter operative times for RATS. Yet, most RVT CSD studies have a small sample size; therefore, complications may be underreported because the studies are underpowered. Although BCSD has superior reported outcomes with respect to left CSD, there may be confounding factors due to the selection of healthier patients for BCSD. Additional comparative effectiveness and cost-effectiveness data are needed to guide clinical practice. In conclusion, BCSD can restore the quality of life of severely impacted RVT patients; however, the benefits must be weighed against procedure-related risks, and further research should clarify the impact on long-term morbidity and mortality.
Acute coronary syndrome resulting from paradoxical coronary embolism is a known and dreaded entity. It should be suspected in all patients who present with acute coronary syndrome with normal coronary arteries on angiography, irrespective of age. We report a case of an 80 year old male with unstable angina with atrial septal defect and 95% acute thrombotic occlusion of the right coronary artery with rest of the coronaries being normal on coronary angiography.
Spontaneous coronary artery dissection (SCAD) is an uncommon etiology of Acute Coronary Syndrome (ACS); however, appropriate treatment based on early diagnosis can improve outcomes. We screened medical records of all ACS patients who were admitted to one of 8 different centers (Cardiovascular Research Consortium-8 Universities) and underwent emergent coronary angiography from January 2001 to December 2014. From these ACS patients, we selected the patients with SCAD based on a review of the results of coronary angiography. Patient demographics, treatment, and in-hospital and long-term outcomes were determined from a review of medical records and angiographic findings. Of the 9377 ACS patients, 20 (0.21%) were diagnosed with SCAD. In these 20 SCAD patients, the mean age was 48.6 ± 12.0 years old, and 19 patients were female (95.0%). In 3 patients (15%), SCAD was associated with pregnancy. Coronary spasm was associated with SCAD in 2 patients (10%). Two patients (10%) were treated conservatively, and percutaneous coronary intervention was performed in 18 patients (90%). Two patients (10.0%) received target lesion revascularization, and one patient (5%) received coronary artery bypass grafting (CABG). SCAD recurred in one patient (5%), and there was in-hospital death in one patient (5%) after CABG. The patient demographics and outcomes in this study were compatible with recent reports of SCAD, except for the trigger of coronary spasm. SCAD should be suspected in middle-aged female ACS patients, and conservative treatment is recommended when there is no ongoing ischemia or left main trunk dissection. In addition, close follow-up is important.
Background: In patients with venous thromboembolism (VTE), deep vein thrombosis and pulmonary embolism are important causes of disability and death in hospitalized patient. This study aimed at assessing venous VTE risks and prophylaxis and outcome in hospitalized patients to medical wards of Tikur Anbessa Specialized Hospital (TASH). Material and methods: A retrospective cross sectional study involving 200 patients' chart review in those who admitted to medical wards of TASH was conducted using the instrument from TASH guideline on VTE prophylaxis and treatment. Data was entered by EPI Info 7 and then exported to SPSS 21 version software database for analysis. Results: Out of 200 medically admitted patients, 186 (93%) of them had at least two risk factors for VTE development. Only 75 (40%) patients received thromboprophylaxis and VTE was prevented in 61 (32.8%) patients who received prophylaxis. However, 11 (5.5%) of high and highest risk categories study population, developed VTE during their stay at hospital. In 128/200 (64%) study participants, the status of VTE outcome was not known since such information was not documented on patents’ charts. Among 14 variables associated with occurrence of VTE, multivariable logistic regression analysis revealed that patients aged ≥ 60 years, AOR=6.55 (95% CI [1.40-30.74]), AMI, AOR=83.22 (95% CI [3.07-225.90]), lung diseases including pneumonia, AOR=9.55 (95% CI [11.62-56.40]) and having stroke within one last month, AOR=1.61 (95% CI [9.16-16.8]) were independent predictors for development of VTE events. Conclusion: In this study, all patients have at least one risk factor for VTE. Only 37.5% of patients received TP. There is a need for implementation of existing evidence based guidelines proposed by TASH.
Giant Cell Myocarditis (GCM) is a form of fulminant cardiomyopathy caused by a lymphocytic inflammatory response. Prompt diagnosis, hemodynamic stabilization and initiation of therapy are essential steps in the management of this disease. We report a case of fulminant GCM in which rapid implementation of Venous-Arterial Extracorporeal Membrane oxygenation (VA-ECMO) and subsequent addition of a percutaneous biventricular mechanical support with an Impella LP 5.0 (Abiomed, Danvers, MA) and a PROTEK Duo (TandemLife, Pittsburgh, PA) while administering immunosuppressants improved the patient clinical status as well biventricular cardiac function. We concluded that the addition of modern percutaneous biventricular supports to VA-ECMO is important to promote cardiac function recovery by offloading the ventricles and we provided a treatment algorithm incorporating mechanical support in the management of these patients.
ACS: Acute Coronary Syndrome; AMI: Acute Myocardial Infarction; CMR: Cardiac Magnetic Resonance; ECV: Extracellular Volume Fraction; FPP: First-Pass Perfusion; LGE: Late Gadolinium Enhancement; LV: Left Ventricle; LVEF: Left Ventricle Ejection Fraction; MI: Myocardial Infarction; MVO: Microvascular Obstruction; RV: Right Ventricle; SD: Standard Deviation; T2-STIR: T2-Weighted Short-Tau Inversion Recovery; T2W: T2-Weighted; TTS: Takotsubo Syndrome; WMA: Wall Motion Abnormalities
