Energy wavelet signal processed ECG and standard 12 lead ECG: Diagnosis of early diastolic dysfunction.

BACKGROUND: Left ventricular (LV) diastolic dysfunction (LVDD) is the result of impaired LV relaxation and identifies those at risk of developing heart failure. Echocardiography has been used as the gold standard to identify early LVDD. The signal processed electrocardiogram (hsECG) has demonstrated effectiveness to detect early LVDD. Whether or not the standard 12­lead electrocardiogram (ECG) can accurately predict early LVDD is not known. METHODS: A standard 12­lead ECG including signal processing (hsECG) was performed in 569 patients. Patients with atrial fibrillation, bundle branch block, pre-excitation, left ventricular hypertrophy or known cardiovascular disease were excluded, leaving 464 examinations for analysis. Early LVDD was diagnosed by established methods using echocardiography. Repolarization abnormalities (T wave discordance) in V1, V6, I and aVL and the hsECG were compared to the echocardiographic findings to establish diagnostic accuracy. RESULTS: A total of 84 (18.1%) patients were diagnosed with early LVDD. A combination of a borderline or abnormal finding on the hsECG produced the best diagnostic model (sensitivity 84.5%, specificity 47.9%). The best performing ECG lead was V1 with a sensitivity of 38.1% and specificity of 92.1%. Regression analysis demonstrated increasing age and V1 to be predictive of LVDD. CONCLUSIONS: The hsECG displayed reasonable ability to detect early LVDD. Other than V1, repolarization abnormalities on the standard 12­lead ECG did not. While lead V1 showed promise in detecting LVDD, whether this or any other simple ECG variable can predict future LVDD would be of further interest.

Secular trends in the utility of SGLT-2 inhibitors in heart failure patients with type 2 diabetes mellitus across Metro South Health hospitals in South-East Queensland.

BACKGROUND: The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT-2is for HF patients with T2DM in our health service is unknown. AIMS: To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT-2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South-East Queensland. METHODS: Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021. RESULTS: A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m2 (SD ± 25). Fifty-four per cent (362/666) had contraindications to SGLT-2is. Among those without contraindications, there was a five-fold increase in the utility of SGLT-2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT-2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01). CONCLUSIONS: During the study period, 54% of our HF patients with T2DM were not on SGLT-2is due to prescribing guidelines/limitations in the Australian context. We observed a five-fold significant increase in the uptake of SGLT-2is before and after implementation of HF guidelines among patients without contraindications to SGLT-2is. There were significantly fewer HF hospitalisations among patients on SGLT-2is compared to those without.

Safety and Efficacy of Scientist Led Exercise Stress Testing for Arrhythmia Provocation and Chronotropic Competence.

For many years, non physician led exercise stress testing performed for the investigation of coronary artery disease has been endorsed by many cardiovascular (CV) societies and associations around the world. The safety guidelines don't currently include the performing of these tests for arrhythmia provocation or chronotropic assessment. Therefore, the aim of this study was to assess the safety and efficacy of non physician led EST performed for suspected arrhythmias, chronotropic competence, long QT, and accessory pathway conduction (APC) assessment. A total of 486 patients performed an exercise stress test for either of the above suspected conditions and were followed for 1.8 years ± 1.5 years. Tests were performed by a trained cardiac scientist with all reports over-read by a consultant Cardiologist. There were no significant adverse events (myocardial infarction, arrhythmia causing hemodynamic compromise or syncope) at time of testing. A total of 12.1% of patients required further follow up consisting of either a cardiac pacemaker, an implantable cardioverter defibrillator, radiofrequency ablation, Direct-Current cardioversion or a change in medications. Interobserver agreement between the Cardiologist and cardiac scientist was 98.4% indicating excellent agreement. In conclusion, the present study demonstrates that cardiac scientists can safely perform non physician led EST for the investigation of suspected arrhythmias, chronotropic competence, long QT, and APC assessment with a diagnostic interpretation equivalent to that of a consultant Cardiologist.

Scientist-led Exercise Testing Is Safe With Diagnostic Interpretation Equivalent to a Cardiologist.

BACKGROUND: The implementation of nonphysician-led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of nonphysician-led EST to physician-led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations. OBJECTIVE: The study aim was to firstly confirm the safety of nonphysician-led EST in a large cohort and secondly compare the interobserver agreement and diagnostic accuracy of cardiac scientist and junior medical officer (JMO)-led EST reports to cardiology consultant overreads. METHODS: All ESTs performed between 1/7/2010 and 30/6/2013 were included in the study for JMO led tests (n = 1332). ESTs performed for the investigation of coronary artery disease between 1/7/2013 and 30/6/2016 were included for scientist-led testing (n = 1904). RESULTS: There was one adverse event, an ST segment myocardial infarction during the recovery phase of a JMO-led EST. Interobserver agreement was superior between the cardiologist and the scientist compared with the cardiologist and the JMO (P < 0.0001). Sensitivity for JMO-led tests differed from the cardiologist overread (86.96% vs. 96.77%, P = 0.03). There were no other significant differences between the cardiologist overread and the JMO- or scientist-led interpretation. CONCLUSIONS: Scientist-led EST is safe in intermediate risk patients and their preliminary reports are equally diagnostic as cardiologist overreads. While JMO-led ESTs are just as safe, the preliminary reports differ significantly from cardiologist overread particularly with respect to sensitivity.