Validation of CalECG software for primary prevention heart failure patients: Reducing inter-observer measurement variability.

BACKGROUND: In primary prevention heart failure patients the 12­lead electrocardiogram (ECG) may be useful for the prediction of ventricular arrhythmias. However, inter-observer measurement variability first needs to be identified and any software used, validated. OBJECTIVE: To compare manual ECG measures with CalECG software and to assess the reliability of visual recognition of fragmented QRS (fQRS) by advanced cardiology trainees. METHODS: 30 pre-implant ECGs were assessed on patients who met guidelines for primary prevention Implantable Cardiac Defibrillator. Parameters included RR, PR, QT, QRS duration, axis location, fQRS and T wave peak to T wave end (TpTe). ECGs were analyzed by members of the cardiology department with different levels of experience, and compared to CalECG software. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intraclass correlation coefficients (ICC). Pearson correlation coefficient (r) was used to compare human and software measures. RESULTS: Strong/very strong correlation was recorded across manual ECG measures (ICC = 0.749-0.979, p ≤ 0.0001) with moderate/strong correlation for TpTe (ICC = 0.547-0.765, p ≤ 0.001). Advanced cardiology trainees demonstrated substantial agreement on ECG interpretation (κ = 0.788, p ≤ 0.0001), however, reliability of fQRS assessment was only moderate for identification (κ = 0.5, p ≤ 0.0001) and fair for location (κ = 0.295, p = 0.001). CalECG software showed strong/very strong correlation with manual measurement for standard measures (r = 0.756-0.977, p ≤ 0.001). Concordance between human and software TpTe measurements varied between leads, with V5 showing a non-significant weak correlation (r = 0.197). CONCLUSION: CalECG software showed strong/very strong correlation with standard manual measures which affirms its use in ECG analysis. Advanced cardiology trainees showed greater variability in the identification and location of fQRS.

Prophylactic anticoagulation in sinus rhythm for stroke prevention in cardiovascular disease: contemporary meta-analysis of large randomized trials.

AIMS: Anticoagulation with non-vitamin K oral anticoagulants (NOACs) to prevent stroke is a mainstay of atrial fibrillation (AF) management. However, multiple cardiovascular diseases (CVDs) are associated with elevated ischaemic stroke risk even in sinus rhythm. In this meta-analysis, we assess efficacy and safety of prophylactic NOAC agents for stroke prevention in patients without AF. METHODS AND RESULTS: A search was conducted for randomized controlled trials (RCTs) that evaluated an NOAC and control drug (placebo or antiplatelet) in non-AF patients with mixed CVD. The primary efficacy and safety outcomes were ischaemic stroke and major bleeding, respectively. Results were stratified based on primary- and mini-NOAC doses. Thirteen RCTs were identified with a total of 89 383 patients with CVD in sinus rhythm (53 778 on NOAC, 35 605 on control drug; mean age 65.5 ± 2.7 years). Over a mean follow-up of 18.3 months, 1429 (1.6%) ischaemic strokes occurred. Use of NOAC was associated with 26% reduction in stroke [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.62-0.87; 1.1 vs. 1.8 events per 100 person-years], with numbers needed to treat of 153 patients to prevent one stroke. Major bleeding was increased with NOAC (OR 1.74, 95% CI 1.44-2.09; 2.1 vs. 1.0 events per 100 person-years). The weighted net clinical benefit (wNCB, composite of ischaemic stroke and bleeding) did not suggest a favourable effect with any NOAC dose (wNCB for primary-dose: -0.35; mini-dose: -0.06). CONCLUSION: Current evidence does not support use of NOACs for stroke prevention in non-AF CVD population as risk of major bleeding still exceeds ischaemic stroke benefit.

Correction of a Malpositioned Portico Transcatheter Aortic Valve Using a Snare Maneuver.

A 75-year-old woman with severe aortic stenosis underwent transcatheter aortic valve replacement using a 23-mm self-expanding Portico valve (Abbott). After complete deployment, it was found to be unacceptably low, with significant paravalvular regurgitation. The valve was pulled upward to the correct position successfully by using the snare maneuver. (Level of Difficulty: Advanced.).