A Randomised Trial Comparing Drug Coated Balloons and Conventional Balloons for the Treatment of Stent Graft Stenosis in Dialysis Vascular Access.

OBJECTIVE: Previous studies on arteriovenous fistulas have demonstrated the potential benefit of drug coated balloons (DCBs) in maintaining the patency of dialysis access. However, stenoses involving stent grafts were excluded from these studies. Therefore, the aim was to evaluate the effectiveness of DCBs in treating stent graft stenosis. METHODS: This was a prospective, single blinded, randomised controlled study. From March 2017 to April 2021, 40 patients with dysfunctional vascular access owing to stent graft stenosis were randomised to treatment with a DCB or conventional balloon. Clinical follow up was scheduled at one, three, and six months, and angiographic follow up was performed six months after the intervention. The primary outcome was angiographic late luminal loss at six months, and secondary outcomes included target lesion and access circuit primary patency at six months. RESULTS: Thirty-six participants completed follow up angiography. The DCB group had a superior mean late luminal loss at six months compared with the control group (1.82 mm ± 1.83 mm vs. 3.63 mm ± 1.08 mm, respectively, p = .001). All 40 patients completed clinical follow up. The DCB group had a superior six month target lesion primary patency compared with the control group [hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.07 - 0.71; p = .005). Additionally, the DCB group had a numerically higher six month access circuit primary patency rate than the control group, although the difference was not statistically significant (HR 0.54, 95% CI 0.26 - 1.11, p = .095). CONCLUSION: Conventional balloon angioplasty is not durable in stent graft stenosis treatment. Treatment with DCBs provides less angiographic late luminal loss and potentially superior primary patency of the target lesion than treatment with conventional balloons. [ClinicalTrials ID: NCT03360279.].

Minimal Fluoroscopic Catheter Ablation for Adult Patients with Paroxysmal Supraventricular Tachycardia without the Assistance of Intracardiac Echocardiography.

Background: Radiation exposure during fluoroscopic procedures increases the risk of cancer for both patients and operators. Objectives: The aim of this study was to investigate the safety and efficacy of adopting a three-dimensional electroanatomical mapping (3D EAM) system during ablation for paroxysmal supraventricular tachycardia (PSVT), without the assistance of intracardiac echocardiography (ICE), for both right- and left-chamber cardiac procedures. Methods: We retrospectively enrolled all patients with PSVT from September 2018 to December 2020. The patients were grouped according to the use of the 3D EAM system (3D-guided group, n = 102 vs. conventional group, n = 226). Results: The acute success rates were high in both groups (100% vs. 99.1%). The fluoroscopy time was significantly lower in the 3D-guided group than in the conventional group (2.4 ± 4.4 vs. 19.0 ± 10.8 min); the procedure time was significantly increased in the 3D-guided group (104.5 ± 29.9 vs. 94.0 ± 31.9 min), and this was associated with the post-electrophysiology test diagnosis after adjustment for multiple variables [standardized B coefficient (ß) 0.188]. There was no learning curve for each electrophysiologist in terms of fluoroscopy and procedure times. Conclusions: The 3D EAM system, without the assistance of ICE, was safe and effective in guiding PSVT ablation in both left- and right-chamber ablation.

Association of Frailty With Thrombosis of Hemodialysis Vascular Access: A Prospective Taiwanese Cohort Study.

RATIONALE & OBJECTIVE: Frailty, a multidimensional construct, has been associated with poor outcomes in patients receiving maintenance dialysis. This study assessed the association of frailty with dialysis vascular access patency. STUDY DESIGN: Multicenter prospective cohort study. SETTING & PARTICIPANTS: 761 prevalent patients receiving hemodialysis at 9 centers in Taiwan as of January 2018. EXPOSURE: Performance-based frailty was defined as 3 of the following: unintentional weight loss, weakness, exhaustion, low physical activity, and slow gait speed. Patients were categorized as prefrail if they had 1 or 2 of these characteristics. OUTCOME: Rate of and time to dialysis access thrombosis. Data regarding vascular access events were collected for 30 months after enrollment through December 31, 2020. ANALYTICAL APPROACH: Logistic regression analysis was used to estimate the association of clinical characteristics with frailty. Cox proportional hazards regression analysis was used to estimate the association of frailty with vascular access thrombosis adjusted for known clinical risk factors. RESULTS: The patients' mean age was 66 years, 46% were female, 18% had synthetic graft accesses, and 82% arteriovenous fistulas. Overall, 31% were frail, 35% were prefrail, and 34% were not frail. The frailty phenotype was associated with age, female sex, low body mass index, diabetes mellitus, and prior stroke. During a median follow-up of 731 days, 161 patients (21%) had access thrombosis events (not frail, 14%; prefrail, 20%; frail, 30%; P < 0.001). Frail patients had a higher risk of vascular access thrombosis than nonfrail patients (HR, 2.31 [95% CI, 1.55-3.39], P < 0.001). After multivariable adjustment for age and comorbidities, frailty remained significantly associated with access thrombosis for both fistulas and grafts. LIMITATIONS: Limited generalizability and potential residual confounding. CONCLUSIONS: Frailty is associated with an increased risk of vascular access thrombosis. These findings highlight the risks of access failure experienced by frail patients receiving hemodialysis.

Outcomes of daytime nurse practitioner-staffed versus resident-staffed nonsurgical intensive care units: A retrospective observational study.

BACKGROUND: Rapid developments in medical care-such as monitoring devices, medications, and working hours restrictions for intensive care personnel-have dramatically increased the demand for intensive care physicians. Therefore, nurse practitioner (NP)-staffed care is becoming increasingly important. This study was aimed to compare the outcomes of daytime NP-staffed and daytime resident-staffed nonsurgical intensive care units (ICU). METHODS: We retrospectively assessed patients admitted to a nonsurgical ICU from March 2017 to December 2017. We collected basic patient data, including age, sex, admission diagnosis, transferring unit, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Primary endpoints were ICU mortality, hospital mortality, and 30-day mortality. Secondary endpoints were 48-h readmission, discharge to nonhome locations, and lengths of ICU and hospital stay. RESULTS: A total of 838 subjects were analysed: 334 subjects in the NP-staffed group and 504 in the resident-staffed group. The NP-staffed group was more likely to come from inpatient units (38.3% vs 16.5% for resident-staffed group; p < 0.001) and had lower disease severity (APACHE II score, 13.9 ± 8.4 vs 15.1 ± 8.2 for resident-staffed group; p = 0.047). After adjusting for age, sex, location before ICU admission, APACHE II score, and significantly different basic characteristics, there were no differences in ICU mortality, hospital mortality, or 30-day mortality between the two groups. Secondary analysis showed the NP-staffed group had a lower discharge rate to nonhome locations (2.1% vs 6.3%; p = 0.023) and shorter hospital stay (12.1 ± 14.1 vs 14.2 ± 14.3 days; p = 0.015). CONCLUSIONS: We observed no difference in mortality between daytime NP-staffed and resident-staffed nonsurgical ICUs. Daytime NP-staffed care is an effective, safe, feasible method for staffing nonsurgical ICUs.

Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment.

Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia. Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute. Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest. Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively). Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.

Catheter-Based Techniques of Transvenous Intracardiac Tumor Biopsy Without Echocardiography Guidance.

Transthoracic, transesophageal, and intracardiac echocardiography are applicable imaging tools used for increasing the accuracy of tumor positioning during transvenous intracardiac tumor biopsy. However, incorporating echo-images in the extremely rare procedures is usually not easy. By using a contralateral catheter for simultaneous contrast injection and tip positioning, we demonstrated tumor biopsy safely and effectively in 4 cases without the guidance of echocardiography.

The Association between Physical Activity and Cardiovascular Implantable Electronic Device-Detected Atrial High Rate Episodes.

BACKGROUND: Atrial fibrillation is the most common arrhythmia and it is associated with a higher risk of mortality and morbidity. The goal of this study was to assess the correlation between physical activity (PA) and atrial high rate episodes (AHREs) detected by cardiovascular implantable electronic devices (CIEDs). METHODS: We prospectively collected data from 81 patients from March 2017 to June 2019. Device-detected PA (hours per day) through an accelerometer and occurrence/burden of AHREs were determined at each outpatient clinic visit. Modest AHREs and long AHREs were defined as at least 1 episode of AHREs lasting ≥ 12 hours and 24 hours, respectively. The percentage of total AHREs in the follow-up period was defined as the burden of AHREs. Generalized estimating equations were used to explore the association between PA and occurrence/burden of AHREs to account for repeated measures within a participant. RESULTS: The patients had 336 follow-up visits (mean 4.1 visits each). The prevalence rates of device-detected modest AHREs and long AHREs were 4.8% and 3.9%, respectively. More PA (hours per day) was associated with a lower risk of modest AHREs [odds ratio (OR) 0.671, 95% confidence interval (CI) 0.452-0.997, p = 0.048] and long AHREs (OR 0.536, 95% CI 0.348-0.824, p = 0.004) after adjusting for age, sex, and basic characteristics. More PA had a trend of association with fewer AHREs (ß -0.255, 95% CI -0.512 to 0.001, p = 0.051). CONCLUSIONS: More PA was associated with a lower risk of AHREs detected by CIEDs in older patients. PA may reduce the risk of AHREs.

A randomized controlled trial of drug-coated balloon angioplasty in venous anastomotic stenosis of dialysis arteriovenous grafts.

OBJECTIVE: Paclitaxel-coated balloons are used to reduce neointimal hyperplasia in native arteriovenous (AV) fistulas. However, no study specifically evaluated their effect on venous anastomotic stenosis of dialysis grafts. We aimed to compare the efficacy of angioplasty with drug-coated balloons (DCBs) and angioplasty with conventional balloons (CBs) for venous anastomotic stenosis in dysfunctional AV grafts. METHODS: In this investigator-initiated, single-center, single-blinded, prospective randomized controlled trial, we randomly assigned 44 patients who had venous anastomotic stenosis to undergo angioplasty with DCBs (n = 22) or CBs (n = 22) from July 2015 to August 2018. Access function was observed per the hemodialysis center's protocols; ancillary angiographic follow-up was performed every 2 months for 1 year after the interventions. The primary end point was target lesion primary patency at 6 months. Secondary outcomes included anatomic and clinical success after angioplasty, circuit primary patency at 6 months and 1 year, and target lesion primary patency at 1 year. RESULTS: At 6 months, target lesion primary patency in the DCB group was significantly greater than that in the CB group (41% vs 9%; hazard ratio [HR], 0.393; 95% confidence interval [CI], 0.194-0.795; P = .006), as was the primary patency of the entire access circuit (36% vs 9%; HR, 0.436; 95% CI, 0.218-0.870; P = .013). At 1 year, the target lesion primary patency in the DCB group remained greater than that in the CB group (23% vs 9%; HR, 0.477; 95% CI, 0.243-0.933; P = .019) but not the primary patency of the access circuit (14% vs 9%; HR, 0.552; 95% CI, 0.288-1.059; P = .056). No difference in anatomic or clinical success was observed; no major complications were noted. CONCLUSIONS: Angioplasty with DCBs showed a modest improvement in primary patency of venous anastomotic stenosis and all dialysis AV grafts at 6 months. The short-term benefit was not durable to 1 year, and reinterventions were eventually needed.

Direct Comparison of Low-Dose Dabigatran and Rivaroxaban for Effectiveness and Safety in Patients with Non-Valvular Atrial Fibrillation.

BACKGROUND: We aimed to examine the comparative effectiveness and safety between low-dose dabigatran and rivaroxaban in atrial fibrillation (AF) patients. METHODS: Using the National Health Insurance claims database in Taiwan, we conducted head-to-head comparisons among adult non-valvular AF patients prescribed with dabigatran 110 mg or rivaroxaban 15 mg between June 1, 2012 and May 31, 2015. A propensity score was derived using logistic regression to model the probability of receiving different non-VKA oral anticoagulants (NOACs) as a function of potential confounders, and an inverse-probability- of-treatment-weighted (IPTW) pseudo-cohort was created. A Cox proportional hazards model was used to compare clinical outcomes in the IPTW pseudo-cohort as the primary analysis. The propensity score-matched analysis was applied as the secondary analysis. RESULTS: Overall, 13505 dabigatran 110 mg users and 6551 rivaroxaban 15 mgusers were identified. In the primary analysis, the rivaroxaban 15 mg users had a higher risk of all-cause death [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.02-1.38]. In addition, the rivaroxaban 15 mg users had an increased risk of all-cause death (HR 1.25, 95% CI 1.05-1.50) in the secondary analysis. The risks of ischemic stroke, intracranial hemorrhage and gastrointestinal hemorrhage were similar between the 2 study groups in both the primary and secondary analyses. CONCLUSIONS: For non-valvular AF patients, rivaroxaban 15 mg seemed to be associated with an increased risk of all-cause death compared with dabigatran 110 mg. This was a retrospective data analysis and the results should not be over-interpreted to guide the choice of different NOACs.

Agreement Between Automated and Human Measurements of Heart Rate in Patients With Atrial Fibrillation.

BACKGROUND: The accuracy of heart rate (HR) measurement by automated blood pressure monitors in patients with atrial fibrillation (AF) remains unclear. The authors investigate the agreement between HR measurements by 2 automated devices and human counting in patients with AF. METHODS: In 47 patients with persistent AF, HR was recorded using 2 automated blood pressure monitors: Omron M5-I and Microlife BPA100 Plus. Human counting of HR by a stethoscope was used as the reference. For each method, 3 readings were made and the mean was calculated for comparison. In addition to Wilcoxon signed rank test, the correlation between HR measurements by automated devices and human counting was determined using Spearman's rank correlation coefficient (r), and the agreement between HR measurements by both devices and human counting was validated by the Bland-Altman plot and intraclass correlation coefficient (ICC). RESULTS: Overall, we found no significant difference in HR measurements between devices and human counting (Omron vs human counting, 81.1 ± 11.1 vs 80.2 ± 10.8 beats per minute [bpm]; P = .21, r = 0.911; ICC, 0.954; Microlife vs human counting, 81.3 ± 10.8 vs 80.2 ± 10.8 bpm; P = .22, r = 0.842; ICC, 0.912). However, in patients with HR greater than 80 bpm, the HR measured by the Microlife device was significantly higher than that measured by human counting (91.1 ± 5.2 vs 87.1 ± 8.6 bpm, P = .034). CONCLUSION: There was a high agreement between HR measurements by 2 automated devices and human counting, but the Microlife device may overestimate HR in AF patients with HR greater than 80 bpm.

Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis.

Current evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the incidence of new atrial fibrillation (AF) in a variety of clinical conditions, including the treatment of left ventricular dysfunction or hypertension. Here we assessed whether ACEIs and ARBs could decrease incidence of new-onset AF in patients with end-stage renal disease (ESRD). We identified patients from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios for new-onset AF. Among 113,186 patients, 13% received ACEIs, 14% received ARBs therapy, and 9% received ACEIs or ARBs alternatively. After a median follow-up of 1524 days, the incidence of new-onset AF significantly decreased in patients treated with ACEIs (hazard ratio 0.587, 95% confidence interval 0.519-0.663), ARBs (0.542, 0.461-0.637), or ACEIs/ARBs (0.793, 0.657-0.958). The prevention of new-onset AF was significantly better in patients taking longer duration of ACEI or ARB therapy. The effect remained robust in subgroup analyses. Thus both ACEIs and ARBs appear to be effective in the primary prevention of AF in patients with ESRD. Hence, renin-angiotensin system inhibition may be an emerging treatment target for the primary prevention of AF.

The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism.

BACKGROUND: Glomerular hyperfiltration has been recently noticed as an important issue in primary aldosteronism (PA) patients. However, its effect on the cardiovascular system remains unknown. METHODS: We prospectively analyzed 47 PA patients including 11 PA patients with estimated glomerular filtration rate (eGFR) > 130 ml/min per 1.73 m2 (group 1), and 36 PA patients with eGFR 90-110 ml/min per 1.73 m2 (group 2). Fourteen essential hypertension (EH) patients with eGFR 90-110 ml/min per 1.73 m2 were included as the control group (group 3). Echocardiography including left ventricular mass index (LVMI) measurement and tissue Doppler imaging (TDI) was performed. Predicted left ventricular mass (LVM) was calculated. Inappropriate LVM was defined as an excess of > 35% from the predicted value. RESULTS: The value of LVMI decreased significantly in order from groups 1 to 3 (group 1>2>3). While group 2 had a significantly higher percentage of inappropriate LVM than group 3, the percentage of inappropriate LVM were comparable in groups 1 and 2. Group 1 had a higher mitral E velocity, E/A ratio than that of group 2. In the TDI study, the E/E' ratio also decreased significantly in order from groups 1 to 3 (group 1>2>3). Group 2 had lower E' than that of group 3, although the E' of group 1 and 2 were comparable. CONCLUSIONS: Although PA patients with glomerular hyperfiltration were associated with higher LVMI, higher mitral E velocity, higher E/E' ratio, they had comparable E' with PA patients with normal GFR. This phenomenon may be explained by higher intravascular volume in this patient group.

Feasibility and Safety of Coronary Procedures via an Arteriovenous Graft Approach in Patients on Maintenance Hemodialysis.

BACKGROUND: Traditionally, a radial or brachial arterial approach is unadvisable in hemodialysis patients. Consequently, coronary angiography or angioplasty is usually performed via a femoral artery approach in these patients, who carry a higher risk of vascular access complications. In hemodialysis patients, arteriovenous grafts (AVG) are created for repeated punctures; however, the feasibility and safety of a trans-AVG approach for coronary angiography or angioplasty remains unclear. METHODS: In our institution, cardiac catheterizations were attempted via AV grafts in hemodialysis patients with a U-shaped forearm AVG. We retrospectively identified coronary angiography or angioplasty procedures in hemodialysis patients from a computer-based database in our hospital. The procedure details and outcomes were obtained from review of the clinical, angiographic and hemodialysis records. RESULTS: From 2008 to 2013, 167 procedures in hemodialysis patients were identified from 2866 diagnostic or interventional coronary procedures in our institution. Out of these, 24 procedures in 17 patients were performed via a trans-AVG approach. In all AVG procedures, a 6F 16-cm or 7F 10-cm sheath was placed from the AVG into the brachial artery. All diagnostic procedures were successfully performed. In 14 procedures, the patients also underwent angioplasty and all of the angioplasty procedures were successful. There was no arterial spasm, arterial dissection, puncture site hematoma, or acute thrombosis of the AVG during or after the procedures. CONCLUSIONS: A trans-AVG approach appears to be a feasible and safe route for coronary angiography or angioplasty in hemodialysis patients with a U-shaped forearm AVG. However, further studies with a larger patient number are necessary. KEY WORDS: Arteriovenous graft; Hemodialysis; Percutaneous coronary intervention.

Effect of prolonged pressure equalization on final drifting during pressure wire studies.

Pressure drifting is a troublesome error in invasive coronary function tests. This study aimed to evaluate the relationship between prolonged and short-time pressure equalizations in pressure drifting. Pressure drifting was defined as the pressure gradient between the mean pressure of the distal wire sensor (Pd) and aortic pressure (Pa) when the wire was withdrawn to the tip of the guiding catheter. Significant drifts 1 and 2 were defined as the absolute values of pressure gradients > 2 and > 3 mmHg, respectively. A logistic regression model was used to evaluate the associations between prolonged pressure equalization and each pressure drifting. The prolonged pressure equalization strategy was associated with a lower incidence of drift 1 than the short-time pressure equalization strategy (6.84% vs. 16.92%, p < 0.05). However, no statistical differences were found in the incidence of drift 2 between the prolonged and short-time pressure equalization strategies (4.27% vs. 7.69%, p = 0.34). In the multivariable regression model, only the prolonged pressure equalization strategy predicted a lower incidence of pressure drift 1. In conclusion, the prolonged pressure equalization strategy was associated with a lower incidence of significant pressure drifting with more stringent thresholds than the short-time pressure equalization strategy.

Contrast-Induced Encephalopathy after Percutaneous Coronary Intervention.

UNLABELLED: Contrast-induced encephalopathy (CIE) is a rare complication that presents with transient neurologic deficits and is caused by neurotoxicity of intravascular contrast media. The prognosis can be extremely favorable even in comatose patients. We reported a 76-year-old woman admitted for scheduled coronary angiography. The total amount of Optiray contrast media used was 150 mL. Immediately after the procedure, the patient developed consciousness disturbance, global aphasia, cortical blindness and right-sided weakness. CIE was diagnosed by computed tomography and subsequent magnetic resonance imaging. The patient recovered completely within 48 hours without any neurological deficits. KEY WORDS: Angioplasty; Contrast-induced encephalopathy; Percutaneous coronary intervention.

ACEI and ARB did not Reduce the Incidence of Dementia in Patients with Atrial Fibrillation: A Nationwide Cohort Study.

PUPOSE: Atrial fibrillation (AF) is associated with increased risk of thromboembolism, and is also a predisposing factor to dementia. Our investigation was a retrospective observational study to evaluate whether the usage of angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) could reduce the incidence of dementia in patients with AF. METHODS: A total of 5221 patients over 20 years of age who had a history of AF as noted in ambulatory and inpatient claims data were enrolled from the National Health Insurance Research Database of Taiwan in 1997 and 1998. Patients with ACEI or ARB were designated as group 1 (4343 patients), and patients without ACEI or ARB were designated as group 2 (878 patients). RESULTS: During a follow-up of 5.90 ± 3.39 years, 135 patients of group 1 (3.1%) and 25 of group 2 (2.8%) developed new-onset dementia. Group 1 and group 2 had similar proportions of new-onset dementia (p = 0.75). The Kaplan-Meier curve demonstrated that patients with ACEI or ARB were not associated with a lower incidence of dementia during the follow-up period (log rank p = 0.91). Cox-regression analysis also showed that usage of ACEI or ARB was not associated with a lower risk of new-onset dementia after adjustment for gender and comorbidities. (Hazard ratio = 0.942, 95% confidence interval 0.589~1.506, and p = 0.80). CONCLUSIONS: ACEI or ARB may be ineffective in reducing the incidence of dementia in patients with AF. KEY WORDS: Angiotensin-converting-enzyme inhibitor; Angiotensin II receptor blocker; Atrial fibrillation; Dementia.

Few-shot transfer learning for personalized atrial fibrillation detection using patient-based siamese network with single-lead ECG records.

The proliferation of wearable devices has allowed the collection of electrocardiogram (ECG) recordings daily to monitor heart rhythm and rate. For example, 24-hour Holter monitors, cardiac patches, and smartwatches are widely used for ECG gathering and application. An automatic atrial fibrillation (AF) detector is required for timely ECG interpretation. Deep learning models can accurately identify AFs if large amounts of annotated data are available for model training. However, it is impractical to request sufficient labels for ECG recordings for an individual patient to train a personalized model. We propose a Siamese-network-based approach for transfer learning to address this issue. A pre-trained Siamese convolutional neural network is created by comparing two labeled ECG segments from the same patient. We sampled 30-second ECG segments with a 50% overlapping window from the ECG recordings of patients in the MIT-BIH Atrial Fibrillation Database. Subsequently, we independently detected the occurrence of AF in each patient in the Long-Term AF Database. By fine-tuning the model with the 1, 3, 5, 7, 9, or 11 ECG segments ranging from 30 to 180 s, our method achieved macro-F1 scores of 96.84%, 96.91%, 96.97%, 97.02%, 97.05%, and 97.07%, respectively.

Subclinical myocardial injury increases the risk of heart failure in patients with and without type 2 diabetes post-acute coronary syndrome.

BACKGROUND: Little is known about the effect of subclinical myocardial injury (sMi) on heart failure (HF) risk after acute coronary syndrome (ACS). We examined the frequency patterns of sMi after ACS among patients with and without diabetes mellitus (DM), and the influence of sMis on HF risk at 1 year. METHODS: Fifty patients with ACS who underwent revascularization were prospectively enrolled. After discharge, serial study visits were conducted and high-sensitivity cardiac troponin T (hs-TnT) levels were checked at 3-month intervals for 1 year. sMi was defined as hs-TnT ≥14 ng/L without clinical symptoms. The primary endpoint was a composite of post-ACS chronic HF or significant left ventricular (LV) dysfunction without HF symptoms. A multivariable logistic regression model was used for risk evaluation. RESULTS: The mean patient age was 58 years, and 90% were men. Overall, 44% of patients had DM, and the median LV ejection fraction at discharge was 56%. Patients with DM had a higher incidence of sMi than those without DM (63.6% vs. 32.1%, P < 0.05). sMi occurred at least twice in most patients, and the prevalence declined over time in DM, but not in non-DM. Fourteen patients (28%) met the primary endpoint at 1 year, and the risk was higher in patients with DM (odds ratio: 4.99) and patients with sMi (odds ratio: 6.26). However, sMi was not a mediator of the association between DM and HF risk. CONCLUSIONS: Patients with DM had a higher incidence of sMi. Nonetheless, sMi increased the risk of HF after ACS, irrespective of diabetes status.

Pulmonary artery catheter usage in diagnosis of Shoshin beriberi presented with unexplained lactic acidosis.

Wet beriberi is a rare but fatal disease in modern society. The nonspecific clinical manifestations, including symptoms of heart failure and recalcitrant lactic acidosis, can prevent timely diagnosis. The use of a pulmonary artery catheter can promptly confirm a high cardiac output state and plays a crucial role in rapidly deteriorating cases. Appropriate treatment with intravenous administration of thiamine leads to dramatic recovery within hours. We present two cases of Shoshin beriberi, a fulminant variant of wet beriberi, diagnosed in 2016 and 2022 at our institute. The patients experienced haemodynamic collapse and refractory lactic acidosis, which were successfully diagnosed with the use of a pulmonary artery catheter and reversed by thiamine supplementation. We also reviewed 19 cases of wet beriberi reported between 2010 and 2022.