Citations

AbstractIntroductionThe use of intracardiac echocardiography (ICE) is beneficial during the ablation of atrial fibrillation (AF). Evidence is conflicting regarding the clinical impact of using ICE on arrhythmia recurrence and mortality.MethodsPatients undergoing catheter ablation of AF during 2010–2017 were identified using the International Classification of Diseases‐9th and 10th Revision‐Clinical Modification (ICD‐9‐CM and ICD‐10‐CM) from the Nationwide Readmissions Database. Propensity matching was used to generate a control group. Patient demographics, Charlson comorbidity indexes, time from discharge to readmission, and the reason of readmission were extracted.ResultsFrom 2010 to 2017, 51 129 patients were included in the analysis out of which ICE was used in 8005 (15.7%) patients. The in‐hospital mortality at readmission was significantly higher in the patients without ICE use (2.9% vs. 1.7%, p = .02). The length of stay (LOS) at readmission was significantly higher in non‐ICE arm (median [interquartile range, IQR]: 3 [2–6] vs. 2 [3–5] days, p < .0001) with similar healthcare‐associated cost (HAC) in both the groups (median [IQR]: US$7507.3 [4057.8–15 474.2] vs. 7339.4 [4024.8–15 191.6], p = .43). Freedom from readmission was 12% higher (hazard ratio [HR] [95% confidence interval, CI]: 0.88 [0.83–0.94], p < .0001) with the use of ICE at 90‐day follow‐up, which was driven by 24% reduction in heart failure (HF) at follow‐up (HR [95% CI]: 0.76 [0.60–0.96], p = .02).ConclusionsICE use during AF ablation procedure reduces readmissions at 90 days by 12%, driven by a 24% decrease in HF‐related admissions. The non‐ICE arm showed a significantly higher LOS which offsets marginally higher HAC in the ICE arm.

Background Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting multiple systems, particularly the cardiovascular system. The leading causes of death in MFS are aortopathies and valvular disease. We wanted to identify the frequency of arrhythmia and postural orthostatic tachycardia syndrome, length of hospital stay, health care–associated costs (HAC), and in‐hospital mortality in patients with MFS. Methods and Results The National Inpatient Sample database from 2005 to 2014 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ) codes for MFS and arrhythmias. Patients were classified into subgroups: supraventricular tachycardia, ventricular tachycardia (VT), atrial fibrillation, atrial flutter, and without any type of arrhythmia. Data about length of stay, HAC, and in‐hospital mortality were also abstracted from National Inpatient Sample database. Adjusted HAC was calculated as multiplying HAC and cost‐to‐charge ratio; 12 079 MFS hospitalizations were identified; 1893 patients (15.7%) had an arrhythmia; and 4.9% of the patients had postural orthostatic tachycardia syndrome. Median values of length of stay and adjusted HAC in VT group were the highest among the groups (VT: 6 days, $18 975.8; supraventricular tachycardia: 4 days, $11 906.6; atrial flutter: 4 days, $11 274.5; atrial fibrillation: 5 days, $10431.4; without any type of arrhythmia: 4 days, $8336.6; both P =0.0001). VT group had highest in‐patient mortality (VT: 5.3%, atrial fibrillation: 4.1%, without any type of arrhythmia: 2.1%, atrial flutter: 1.7%, supraventricular tachycardia: 0%; P <0.0001) even after adjustment for potential confounders (without any type of arrhythmia versus VT; odds ratio [95% CI]: 3.18 [1.62–6.24], P =0.001). Conclusions Arrhythmias and postural orthostatic tachycardia syndrome in MFS were high and associated with increased length of stay, HAC, and in‐hospital mortality especially in patients with VT.

AbstractHeparin-induced thrombocytopenia (HIT) is suspected much more often than it is confirmed. Technically simple platelet factor 4 (PF4)-polyanion enzyme-linked immunosorbent assays (ELISAs) are sensitive but nonspecific. In contrast, accurate functional tests such as the serotonin release assay, heparin-induced platelet activation assay, and PF4-dependent P-selectin expression assay require fresh platelets and have complex assay end points, limiting their availability to specialized reference laboratories. To enable broad deployment of functional testing, we sought to extend platelet viability significantly by optimizing storage conditions and developed a simple functional assay end point by measuring the release of a platelet α-granule protein, thrombospondin-1 (TSP1), in an ELISA format. Platelet cryopreservation conditions were optimized by freezing platelets at controlled cooling rates that preserve activatability. Several-month-old cryopreserved platelets were treated with PF4 or heparin and were evaluated for their ability to be activated by HIT and vaccine-induced immune thrombotic thrombocytopenia (VITT) antibodies in the TSP1 release assay (TRA). HIT and spontaneous HIT patient samples induced significantly higher TSP1 release using both PF4-treated (PF4-TRA) and heparin-treated cryopreserved platelets relative to samples from patients suspected of HIT who lacked platelet-activating antibodies. This latter group included several patients that tested strongly positive in PF4-polyanion ELISA but were not platelet-activating. Four VITT patient samples tested in the TRA activated PF4-treated, but not heparin-treated, cryopreserved platelets, consistent with recent data suggesting the requirement for PF4-treated platelets for VITT antibody detection. These findings have the potential to transform the testing paradigm in HIT and VITT, making decentralized, technically simple functional testing available for rapid and accurate in-hospital diagnosis.

Objective: Artificial intelligence and machine learning (AI/ML) are increasingly being applied to big clinical data to tackle research questions that cannot be answered with traditional statistical methods. The field is still in its nascent stages and there is a paucity of guidelines for conducting and reporting AI/ML research in hypertension. The objective was to apply the HUMANE checklist to survey the present landscape of AI/ML in hypertension to inform the development of hypertension-specific guidelines and recommendations. Design and method: The HUMANE checklist was developed by global clinical and AI/ML experts through the Delphi method. It assesses the quality of medical AI/ML articles based on whether they cover subjects expected in any peer-reviewed, clinical or AI/ML research publication. A cooping review was carried out to identify articles presenting original research in AI/ML and hypertension published in 2019–2021. Two independent reviewers applied the checklist to each article and in the case of discordance, the response was adjudicated by an AI/ML expert. Results were analysed to assess compliance with the survey (% of papers satisfying checklist requirements). Results: A total of 63 manuscripts was reviewed. A summary of results is shown in Figure 1. Highest compliance was seen for items relating to general article presentation, with compliance ranging from 68% to 98% (description of statistical analysis methods and background context, respectively). Lowest compliance was seen with checklist items relating to clinical research and AI/ML methods. 44% of reviewed articles described the demographics of their dataset and 48% stated their inclusion/exclusion criteria. Nonetheless, datasets were deemed appropriate for investigative aims in 93% of articles. 30% of manuscripts reported their calibration measures, while 73% stated their performance metrics. Internal validation was carried out in 75% of studies, but external validity was assessed in only 14% of cases. Algorithmic bias was addressed in 11% of papers. Conclusions: Application of AI/ML methods in hypertension research is growing, but the majority of current work has major shortfalls in reporting quality, model validation and algorithmic bias. Our study identifies areas of improvement to enable the full realisation of the potential of AI/ML in hypertension.

Kanack and colleagues analyze anti-platelet factor 4 antibodies from 5 patients with vaccine-induced thrombotic thrombocytopenia (VITT) secondary to COVID-19 adenoviral vaccination and antibodies from patients with spontaneous heparin-induced thrombocytopenia (HIT) and classical HIT. VITT antibodies are monoclonal or oligoclonal, similar to spontaneous HIT, whereas classical HIT antibodies are polyclonal. Heparin inhibits antibody-induced platelet activation in VITT, suggesting that heparin should be considered for the treatment of VITT.