Predicting complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy using a risk stratification model and clinical tool.

BACKGROUND: Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5-11% risk of complete heart block (CHB). OBJECTIVE: The aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients. METHODS: Patients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated. RESULTS: Of the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre-ASA left bundle branch block (LBBB), transient procedural high-grade block, post-ASA PR prolongation ≥68 ms, and new bifascicular block. An 11-point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high-risk patients. CONCLUSION: Among patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high-risk patients who may benefit from additional monitoring and therapy.

Errors in Reporting Significant Figures in Surgical and Medical Journals in 2017.

BACKGROUND: The present study was undertaken to ascertain the prevalence of published data with errors in the numerical significant figures in established surgical and medical journals in 2017. The frequency of errors was not only summarized but was also correlated to the published journal impact factor for the seven journals reviewed. METHODS: All original investigations and other analysis reporting quantitative statistical results published in seven surgical and medical journals in 2017 were electronically reviewed for errors in reporting significant figures of the published statistical findings. Errors in significant figures were placed into one of three author defined categories: calculated significant figure errors, interval precision errors, and P value reporting errors. Tests for intraobserver and interobserver reproducibility were conducted blindly to ensure validity and reproducibility between different readers. RESULTS: A total of 1675 articles published in 2017 were identified and reviewed. In total, 730 articles (44%) were reported to have an error in one category, with error rates ranging from 25% to 68% depending on publishing journal. The error rate for each journal were easily reproduced by different observers (κ coefficient range: 0.55-0.81) and correlated with its 2016 impact factor (r = 0.97, R2 = 0.95, P < 0.001). CONCLUSIONS: Published findings are frequently reported incorrectly in the surgical and medical literature and can be potentially misleading. The pervasiveness of errors correlates to fewer citations as measured by the lower impact factor.

Call a Spade a Spade: Missed Diagnosis of Apical Hypertrophic Cardiomyopathy.

Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy characterized by apical hypertrophy, deep T-wave inversions in precordial electrocardiogram (EKG) leads, and a ventriculogram shaped like the "Ace of Spades." Patients are often asymptomatic but sometimes present with atypical chest pain, angina, or atrial fibrillation. The deep T-wave inversions on EKG often mimic acute coronary syndrome. Coronary angiogram in these patients is unrevealing, but the characteristic left ventriculogram establishes this diagnosis. The deep T-wave inversions can appear suddenly or deepen over years, making the diagnosis difficult to establish early in the disease. Transthoracic echocardiogram may miss the hypertrophied apex, but echo contrast imaging or cardiac magnetic resonance imaging can reliably confirm the diagnosis and detect apical aneurysms. We present a case of apical hypertrophic cardiomyopathy which was not evident despite many admissions, EKGs, cardiac catheterizations and echocardiograms until the diagnosis was confirmed with left ventriculogram and cardiac magnetic resonance imaging 20 years after initial presentation.