A 19-year-old college student presented with recurrent episodes of palpitations, dizziness, and shortness of breath lasting several minutes. He denied chest pain or syncope. On examination, his heart rate and rhythm were normal. A 12-lead ECG revealed a shortened PR interval and a delta wave. No structural abnormalities were noted on echocardiography. What is the ECG abnormality? 

The annual International Stroke Conference of the American Heart Association/American Stroke Association was held from Feb. 5 to 7 in Los Angeles and drew participants from around the world, including cerebrovascular research and practice experts. The conference featured presentations that emphasized basic, clinical, and translational medicine and provided insight into the prevention, management, and treatment of stroke.

In one study, Bernard Ofosuhene, of UMass Chan Medical School in Worcester, and colleagues identified a strong association between electrocardiogram (ECG)-age and cognitive performance, which could lead to ECG-age serving as a potential biomarker for detecting cognitive decline.

The authors evaluated 63,800 participants between August 2023 and July 2024 as part of the U.K. Biobank, a large and ongoing study of more than 500,000 volunteers in the United Kingdom who enrolled between 2006 and 2010. Participants went through a number of cognitive tests to determine ECG-age. Based on the results, participants were divided into three categories: normal aging; accelerated ECG-aging (older than their chronological age); and decelerated ECG-aging (younger than their chronological age). Compared with the normal-aging group, the researchers found that participants within the decelerated ECG-aging category performed better on six of eight cognitive tests, while those within the accelerated ECG-aging category performed worse on six of eight cognitive tests.

"In conclusion, this research leverages our understanding on how ECG data could be utilized by artificial intelligence as a potential diagnostic tool for cognitive impairment," Ofosuhene said. "Using ECG data to access cognitive functioning could lead to rapid diagnosis and timely intervention compared to the traditional cognitive tests."

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In another study, Tamara N. Kimball, M.D., of the Henry and Allison McCance Center for Brain Health at Massachusetts General Hospital in Boston, and colleagues found that adopting healthier lifestyles and improving modifiable risk factors might mitigate some of the negative effects of shorter telomeres, which reflect adverse lifestyle choices and social and environmental determinants of health earlier in life.

The authors examined data from more than 356,000 participants as part of the U.K. Biobank and found that individuals with shorter leukocyte telomere length (LTL) had an increased risk for age-related brain diseases, including stroke, dementia, and late-life depression. In addition, improved modifiable risk factor profiles appeared to mitigate the impact of LTL on these diseases.

"This study suggests that telomere length reflects broader biological stressors such as senescence and inflammation, acting more as a surrogate marker of these processes rather than a direct cause of age-related brain diseases," Kimball said. "Future research should explore the mechanisms linking LTL to disease processes and evaluate how lifestyle and therapeutic interventions influence the cellular aging processes for which LTL serves as a marker."

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Gabriela Trifan, M.D., of the University of Illinois in Chicago, and colleagues found that a Mediterranean diet independently improves brain health, and even small changes in diet can lead to long-term brain health benefits.

As part of the Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary study, the authors evaluated approximately 2,800 participants who completed 24-hour dietary recalls of predefined food and nutritional categories at baseline (2008 to 2011) and again approximately 30 days later. Diffusion tensor imaging and fluid-attenuated inversion recovery were utilized to investigate microscopic and visible changes in the brain, and the American Heart Association's Life Simple 7 score components were used to assess cardiovascular health. The researchers found that following a Mediterranean diet led to a healthier brain, as defined by lesser volumes of white matter hyperintensity (WMH) on magnetic resonance imaging and by improved white matter microstructural integrity (i.e., higher general fractional anisotropy and lower peak width of skeletonized mean diffusivity) as seen on diffusion tensor imaging.

"These results were not entirely explained by higher cardiovascular health scores (measured using the Life's Simple 7 score), suggesting that there are noncardiovascular mechanisms directly impacting the brain structure and function. These mechanisms likely play a key role in protecting against neurodegeneration and cognitive decline," Trifan said. "Our results are of clinical significance as it shows that even a small decrease in WMH volume could be clinically relevant, particularly for cognitive health."

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ASA: Intra-Arterial Tenecteplase Beneficial for Large Vessel Occlusion

TUESDAY, Feb. 18, 2025 (HealthDay News) -- For patients with large vessel occlusion presenting between 4.5 and 24 hours, intra-arterial tenecteplase after successful thrombectomy results in improved likelihood of excellent outcome (modified Rankin scale score 0 to 1), according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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ASA: Alteplase Ups Outcomes at 4.5 to 24 Hours After Symptom Onset in Acute Ischemic Stroke

TUESDAY, Feb. 18, 2025 (HealthDay News) -- For patients with acute ischemic stroke whose symptoms began 4.5 to 24 hours earlier, alteplase is associated with a higher percentage of patients achieving a score of 0 or 1 on the modified Rankin scale at 90 days, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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ASA: Mechanical Removal of Clot No Better Than Best Medical Treatment for Medium or Distal Vessel Occlusion

MONDAY, Feb. 10, 2025 (HealthDay News) -- Endovascular thrombectomy does not lead to better outcomes at 90 days compared with usual care or best medical treatment for patients with acute ischemic stroke due to medium vessel occlusion, according to two studies published online Feb. 5 in the New England Journal of Medicine to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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ASA: Mental Health Conditions Common in Pediatric Stroke Survivors

TUESDAY, Feb. 4, 2025 (HealthDay News) -- Mental health disorders represent a significant problem in pediatric survivors of arterial ischemic stroke, according to a study presented at the annual American Heart Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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ASA: Propranolol May Reduce Overall Stroke Risk in Women With Migraine

FRIDAY, Jan. 31, 2025 (HealthDay News) -- Propranolol is associated with a reduced risk for overall stroke among women with migraine, with a more pronounced protective effect for ischemic stroke, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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ASA: Prehospital Blood Test Can Rapidly Differentiate Stroke Types

FRIDAY, Jan. 31, 2025 (HealthDay News) -- Prehospital measurement of glial fibrillary acidic protein can rapidly differentiate intracerebral hemorrhage from ischemic stroke and stroke mimics, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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ASA: Flossing Linked to Lower Risk for Ischemic, Cardioembolic Stroke, A-Fib

FRIDAY, Jan. 31, 2025 (HealthDay News) -- Dental flossing is associated with a lower risk for ischemic and cardioembolic stroke and atrial fibrillation, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

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For patients undergoing treatment for certain types of cancer, artificial intelligence (AI) can use electrocardiographic (ECG) images to define the risk for cardiac dysfunction, according to a study published online Sept. 2 in Circulation: Cardiovascular Quality and Outcomes.

Evangelos K. Oikonomou, M.D., D.Phil., from Yale School of Medicine in New Haven, Connecticut, and colleagues identified 1,550 patients without cardiomyopathy who received anthracyclines and/or trastuzumab for breast cancer or non-Hodgkin lymphoma and had ECG performed 12 months or less before treatment. A validated AI model of left ventricular systolic dysfunction (LVSD) to baseline ECG images was used to define low-, intermediate-, and high-risk groups (AI-ECG LVSD probabilities of <0.01, 0.01 to 0.1, and ≥0.1). The association with early cancer therapeutics-related cardiac dysfunction (CTRCD) or left ventricular ejection fraction (LVEF) <40 percent was explored up to 12 months after treatment.

Of the participants, 5.4, 36.3, and 58.4 percent were classified as high, intermediate, and low risk, respectively, by baseline AI-ECG. The researchers found that the incidence of CTRCD and LVEF <40 percent was higher in association with a high- versus low-risk AI-ECG screen. AI-ECG LVSD probabilities were associated with significantly worse global longitudinal strain among 1,428 temporally linked echocardiograms and ECGs (–19 and –15 percent for <0.1 and ≥0.5, respectively).

"Our findings support the potential utility of AI-ECG monitoring for the cost-effective risk stratification and triage of patients receiving anthracyclines or trastuzumab in the setting of breast cancer or non-Hodgkin lymphoma therapy," the authors write.

Several authors disclosed ties to the biopharmaceutical and health technology industries.

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Routine electrocardiogram (ECG) screening may help to prevent cardiovascular disease (CVD) events, according to a study published online July 1 in JAMA Internal Medicine.

Ryuichiro Yagi, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues conducted a nationwide cohort study to examine the association between ECG abnormalities and CVD outcomes in a population of individuals aged 35 to 65 years. A total of 3,698,429 individuals were enrolled in the nationwide health check program: 16.8, 3.9, and 1.5 percent had one minor ECG abnormality, two or more minor ECG abnormalities, and a major ECG abnormality, respectively.

The researchers found that compared with normal ECG, baseline ECG abnormality was independently associated with an increased incidence of the composite end points of overall death and CVD admission during a median follow-up of 5.5 years (incidence rates per 10,000 person-years, 92.7, 128.5, 159.7, and 266.3 for normal ECG, one minor ECG abnormality, two or more minor ECG abnormalities, and major ECG abnormality, respectively; adjusted hazard ratios, 1.19, 1.37, and 1.96, respectively, compared with normal ECG). An increased incidence of developing new major ECG abnormalities was seen in association with the presence and number of minor ECG abnormalities (incidence rates per 10,000 person-years, 85.1, 217.2, and 306.4 for normal ECG, one minor ECG abnormality, and two or more minor ECG abnormalities; adjusted hazard ratios, 2.52 and 3.61, respectively, compared with normal ECG).

"Further studies are needed to elucidate the role of routine ECG screening for early prevention of CVD events, along with optimal follow-up strategies for both major and minor ECG abnormalities," the authors write.

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TUESDAY, May 14, 2024 (HealthDay News) -- A deep learning model using transthoracic echocardiograms (TTEs) can predict patients with active or occult atrial fibrillation (AF), according to a study published online April 13 in npj Digital Medicine.

Neal Yuan, M.D., from the University of California in San Francisco, and colleagues created a two-stage deep learning algorithm using a video-based convolutional neural network model that distinguished whether TTEs were in sinus rhythm or AF and then predicted which of the TTEs in sinus rhythm occurred in patients who had recently experienced AF. The model was trained on 111,319 TTE videos.

The researchers found that in a held-out test cohort, the model was able to differentiate TTEs in AF from those in sinus rhythm with high accuracy (area under the receiver operating characteristic curve [AUC], 0.96; area under the precision-recall curve [AUPRC], 0.91). The model predicted the presence of concurrent paroxysmal AF among TTEs in sinus rhythm (AUC, 0.74; AUPRC, 0.19). In an external cohort of 10,203 TTEs, model discrimination remained similar (AUC, 0.69; AUPRC, 0.34). Performance was similar among patients who were women, were older than 65 years, or had a CHA2DS2VASc score ≥2. Model performance was better than use of clinical risk factors, TTE measurements, left atrial size, or CHA2DS2VASc (AUCs, 0.64, 0.64, 0.63, and 0.61, respectively). Performance was better for an ensemble model in a cohort subset combining the TTE model with an electrocardiogram (ECG) deep learning model than the ECG model alone (AUC, 0.81 versus 0.79).

"Deep learning by TTE may offer additional opportunities to guide patient screening for occult atrial fibrillation by identifying patients who may benefit from more intensive monitoring," the authors write.

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When it comes to detecting coronary artery disease (CAD), there is a lack of consensus regarding the most effective diagnostic strategy. To address this uncertainty, researchers conducted a comprehensive analysis to compare different diagnostic approaches for the initial assessment of suspected stable CAD and evaluate their impact on clinical management and subsequent health outcomes. The study examined randomized clinical trials that compared various diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD, utilizing data from PubMed, Embase, and the Cochrane Central Register of Controlled Trials.

Among the six comparisons analyzed, the strongest evidence was found for three specific comparisons: coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA), CCTA versus exercise electrocardiography (ECG), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). When compared with direct ICA referral, CCTA was associated with similar rates of cardiovascular death and myocardial infarction but resulted in fewer index ICA and index revascularization procedures. Additionally, CCTA demonstrated a reduction in cardiovascular death and myocardial infarction when compared to exercise ECG and SPECT-MPI. However, it was linked to a higher number of index revascularization procedures and a lower need for downstream testing compared to exercise ECG. The available evidence for other comparisons was limited, and most comparisons relied on data from a single study, potentially impacting the statistical power and precision of the findings...Read more

TUESDAY, June 6, 2023 (HealthDay News) -- Coronary computed tomography angiography (CCTA) is associated with a similar risk for cardiovascular death and myocardial infarction as direct invasive coronary angiography (ICA) for initial assessment of suspected stable coronary artery disease (CAD), according to a review published online June 6 in the Annals of Internal Medicine.

Andrea Zito, M.D., from the Catholic University of the Sacred Heart in Rome, and colleagues compared the effect of clinical management and subsequent health effects of alternative diagnostic strategies for initial assessment of suspected stable CAD. The strongest evidence was available for three comparisons: CCTA versus ICA, CCTA versus exercise electrocardiography (ECG), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI; four, two, and five trials, respectively).

The researchers found that CCTA was associated with no difference in cardiovascular death and myocardial infarction compared with direct ICA referral, but was associated with less index ICA and index revascularization (relative risks, 0.23 and 0.71, respectively). Compared with exercise ECG and SPECT-MPI, CCTA was associated with a reduction in cardiovascular death and myocardial infarction (relative risks, 0.66 and 0.64, respectively). More index revascularization was seen in association with CCTA versus exercise ECG (relative risk, 1.78), but less downstream testing was observed (relative risk, 0.56).

"This meta-analysis provides comparative evidence of the relative performance of individual diagnostic strategies for the initial assessment of patients with suspected stable CAD," the authors write. "Results' uncertainty calls for further research to better assess the relative performance of each diagnostic strategy."

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FRIDAY, April 28, 2023 (HealthDay News) -- Premature contractions detected on wearable-format electrocardiograms (ECGs) are associated with an increased risk for atrial fibrillation (AF) and heart failure among individuals without cardiovascular disease, according to a study published in the March issue of the European Heart Journal: Digital Health.

Michele Orini, Ph.D., from the Institute of Cardiovascular Science at University College London, and colleagues examined the association between premature ventricular and atrial contractions (PVCs and PACs) detected on wearable-format ECGs and cardiovascular outcomes among 54,016 U.K. Biobank participants without cardiovascular disease. Associations with AF, heart failure, myocardial infarction (MI), stroke, life-threatening ventricular arrhythmias (LTVAs), and mortality were examined during a period of 11.5 years.

PVCs and PACs had a prevalence of 2.2 and 1.9 percent, respectively. The researchers found the strongest associations between PVCs and heart failure (hazard ratio, 2.09) and between PACs and AF (hazard ratio, 2.52), with risk further increased with shorter prematurity. There were also associations observed for PVCs and PACs with LTVA. In unadjusted models only, associations with MI, stroke, and mortality were significant. In a separate substudy sample used for independent validation, PACs were associated with AF and PVCs with heart failure after adjustment for risk factors (hazard ratios, 1.80 and 2.32, respectively).

"Our results support future studies to investigate the clinical implication of premature heartbeat detection in mobile health population-based risk assessment through ECG wearable devices," the authors write.

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Previous studies have found that 25% of long covid patients may have dysautonomia and 2-14% will develop postural orthostatic tachycardia syndrome (PoTS). Here is a summary of when PoTS should be suspected, how it should be diagnosed, and ways in which it can be managed.  

When considering dysautonomia as a cause of tachycardia, practitioners should first carefully access red flag symptoms for other cardiac pathologies. Symptoms of PoTS could include palpitations, fatigue, and breathlessness upon standing or with minimal exertion. Investigations, like blood tests (full blood count, renal and kidney function, C reactive protein, vitamin B12, folate, ferritin, thyroid function, glucose, calcium, and morning cortisol), chest x ray imaging, ECG, and 24 hour ambulatory blood pressure and heart rate monitoring, are aimed at excluding other differential diagnoses 

Though evidence on long-covid is limited, treatment options in the first instance should include reassurance and non-pharmacological methods. For example, adequate fluid intake, avoidance of triggers (alcohol, caffeine etc.), waist-high compression hosiery and physical reconditioning. Drugs aimed at controlling heart rate and increasing peripheral vasoconstriction and intravascular volume can be tried if conservative treatment fails...Read more