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? 

A one-year-old previously healthy child presented to the general practitioner (GP) with a history of fever, diarrhea, and cold for five days, and erythema at the BCG inoculation site for one-day duration. She had been initially treated as bacillary dysentery with oral cotrimoxazole. While on treatment, she developed strawberry tongue and swelling of hands and feet along with the appearance of conjunctivitis and persistent high fever. The child was admitted only on day 12 of illness with suspicion of Steven Johnson syndrome secondary to cotrimoxazole. Further, the child had poor feeding and watery discharge from her right ear. She had age-appropriate immunization and there was no history of allergy to drugs, food, and environmental allergens.  Physical examination revealed that she was ill, febrile (above 102 F), irritable, dehydrated, and had bilateral conjunctivitis without discharge. There was cervical lymphadenopathy measuring 2 cm in size. Feet and hands were swollen. Lips were cracked with beefy red tongue and a well-defined erythematous reaction was evident at the BCG inoculation site. Other systems examination was normal apart from having mild right hypochondrial tenderness. 

Investigations revealed a high white blood count (18x103 /cumm (normal range - 6x103 -17x103/cumm) with neutrophil 75%), low haemoglobin (8.9 g/dl - normal range 11.3 g/dl - 14.1 g/dl), normal platelets (350x103/cumm), high C-reactive protein (CRP-148 mg/dl - normal range - less than 5 mg/dl ), and high ESR (120 mm/hour).  

Blood picture showed evidence of either infection or inflammation with the left shift of neutrophils. Urinalysis showed microscopic haematuria (5-8/HPF) and pyuria (10-14/HPF).  

The cerebrospinal fluid analysis revealed normal findings including cultures apart from showing slightly high protein (60mg/dL). Serum sodium was 134meq/l, and potassium was 4.2meq/l. Serum total protein was 60mg/dl, and albumin was 35mg/dl. Aspartate transaminase (154 IU/l) and alanine transaminase (104 IU/L) were elevated. Alkaline phosphatase was normal (300 IU/L). Renal functions had been normal except for elevated blood urea (70mgdl). Throat swab showed no organisms, and blood and urine cultures were sterile. Rheumatoid factor was negative. Antistreptolysin O titer (ASOT) was less than 200 IU/L. antibody to leptospira, mycoplasma, Epstein Barr virus, and scrub typhus were negative. Chest X-ray was normal. Ultrasound abdomen showed hydrops of the gall bladder, and otherwise findings were normal. Echocardiogram and electrocardiogram revealed normal findings with no evidence of coronary aneurysms. The ophthalmological examination had been normal.  What do you think?

The latest meeting of the U.S. Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) has been postponed indefinitely to allow time for public comments to be collected, according to federal health officials, Reuters has reported.

ACIP usually holds multiple meetings each year to review scientific data and make recommendations to the director of the CDC. This particular meeting, originally scheduled for Feb. 26 to 28, was to include several important votes, including one about how a key government vaccine distribution program should handle influenza inoculations. The draft agenda also indicated reviews of the GSK meningococcal vaccine and AstraZeneca flu shot.

According to the U.S. Department of Health and Human Services, the public is normally allowed time to submit written comments in advance of ACIP meetings through a federal portal. Prior to the inauguration of President Trump last month, the CDC had posted a formal notice of the February ACIP meeting, noting that comments could be submitted between Feb. 3 and 17. However, a letter to the newly appointed Secretary of the U.S. Department of Health and Human Services, Robert F. Kennedy Jr., signed by more than 50 medical experts and organizations, states that the portal has been "absent," Reuters reported. The signatories also requested the "critical" meeting be rescheduled.

The American College of Physicians echoed that sentiment. "Our country is currently facing the worst epidemic of influenza in several decades, a measles outbreak in Texas, and an ongoing national outbreak of pertussis," Isaac O. Opole, M.B.Ch.B., Ph.D., president of the American College of Physicians, said in a statement. "The CDC must promptly reschedule this critical meeting. We call on Secretary Kennedy and other officials to ensure that the advice of epidemiologists, researchers, physicians, and other experts in disease and immunizations remains primary in helping to ensure the public's health."

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Most children with multisystem inflammatory syndrome in children (MIS-C) recover quickly, according to a study published online Jan. 13 in JAMA Pediatrics.

Dongngan T. Truong, M.D., from the University of Utah and Primary Children's Hospital in Salt Lake City, and colleagues characterized the frequency and time course of cardiac dysfunction (left ventricular ejection fraction [LVEF] <55 percent), coronary artery aneurysms, and noncardiac involvement through six months after MIS-C in a cohort study with 1,204 participants.

The researchers found that 45.9 percent of the participants required vasoactive support, 1.4 percent required extracorporeal membrane oxygenation, and 0.3 percent died during hospitalization. Overall, 42.3 percent of 322 participants with echocardiograms reviewed by the echocardiography core laboratory had LVEF <55 percent during hospitalization; all but one of those with follow-up normalized by six months. The lowest LVEF was seen in association with Black race, higher C-reactive protein, and abnormal troponin level. At any time point, 15 participants had coronary artery z scores of ≥2.5; one had a large/giant aneurysm. Twelve of 13 with z scores ≥2.5 during hospitalization had normalized by six months. At two weeks and six months, a return to greater than 90 percent of pre-MIS-C health status was reported by 83.6 and 95.1 percent, respectively. The most common symptom reported at two weeks was fatigue (15.9 percent), which decreased to 3.4 percent by six months.

"Results suggest that cardiovascular and noncardiovascular morbidities were rare by six months after hospital discharge, despite severe illness in many patients during the acute phase," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Persistent smoking from age 10 through 24 years is associated with increased odds of premature cardiac and structural injury, according to a study published online Dec. 11 in the Journal of the American College of Cardiology.

Andrew O. Agbaje, M.D., M.P.H., Ph.D., from the University of Eastern Finland in Kuopio, examined the longitudinal association of tobacco smoking with structural and functional cardiac injury. A total of 1,931 young adults with complete smoking and echocardiographic measures at age 24 were included.

Agbaje found that at ages 10, 13, 15, 17, and 24 years, the prevalence of smoking was 0.3, 1.6, 13.6, 24, and 26.4 percent, respectively. From 17 to 24 years, there were increases in the prevalence of left ventricular (LV) hypertrophy (from 2.8 to 7.5 percent) and LV diastolic dysfunction (from 10.4 to 16.9 percent). After full adjustment for covariates, persistent smoking from 10 through 24 years was associated with increased LV mass indexed for height (LVMI). In both unadjusted and adjusted models, persistent smoking from childhood was associated with an increase in LVMI from ages 17 to 24 years. Higher odds of LV hypertrophy, high relative wall thickness, LV diastolic dysfunction, and high LV filling pressure at 24 years were seen in association with persistent smoking from childhood through young adulthood in a fully adjusted model (odds ratios, 1.52, 1.38, 1.33, and 1.35, respectively).

"The current findings provide data for policymakers, clinicians, and public health practitioners on crucial timing for preventing smoking and its early consequences in youth," Agbaje writes.

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For asymptomatic rheumatoid arthritis (RA) patients, a new radiation-free screening protocol can identify suspected interstitial lung involvement (ILI), according to a study published online Nov. 23 in BMC Pulmonary Medicine.

Frank Reichenberger, M.D., from Augustinum Hospital Munich, and colleagues proposed a noninvasive, radiation-free approach to ILI screening using pulmonary function tests (PFT) and pleuro-pulmonary transthoracic ultrasound (LUS) with additional cardiopulmonary exercise tests with electrocardiography and echocardiography. The study included 67 consecutive patients with a confirmed diagnosis of seropositive RA, without symptoms for or known cardiovascular disease. When significant LUS abnormalities and additional PFT changes were present, interstitial lung disease (ILD) was suspected.

The researchers found that 40 percent of patients had noticeable changes in LUS, 24 percent with a pattern compatible with ILD. LUS abnormalities and additional PFT changes were present in 16 percent of cases, and ILI was suspected. Obstructive lung disease; subpleural consolidation, including one confirmed lung cancer; minimal pleural effusion; and ischemic cardiac disease were included as additional findings (11, six, six, and two patients, respectively). Pulmonary vascular involvement was not seen in any of the patients.

"Our study supports the growing evidence and experience in using LUS for screening for RA-ILD," the authors write. "We propose LUS as an appropriate imaging tool in combination with PFT for ILD screening in RA."

The study was funded by Boehringer Ingelheim.

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Machine learning can he;p identify individuals with diabetes at high risk for diabetic cardiomyopathy (DbCM), according to a study published online Sept. 6 in the European Journal of Heart Failure.

Matthew W. Segar, M.D., from the Texas Heart Institute in Houston, and colleagues developed and validated a machine learning-based clustering approach to identify high-risk DbCM based on echocardiographic and cardiac biomarker parameters. The training model included 1,199 individuals with diabetes participating in the Atherosclerosis Risk in Communities cohort who were free of cardiovascular disease. The model was validated using data from 802 participants in the Cardiovascular Health Study and a separate cohort of 5,071 electronic medical records.

The researchers found that phenogroup-3, the high-risk DbCM phenotype (324 patients), had significantly higher five-year heart failure incidence than other phenogroups (12.1 versus 4.6 percent for phenogroup 2 and 3.1 percent for phenogroup 1). For the high-risk DbCM phenotype, key echocardiographic predictors included higher N-terminal pro-B-type natriuretic peptide levels, increased left ventricular mass and left atrial size, and worse diastolic function. In the validation cohorts, the deep neural network classifier identified 16 and 29 percent of participants with DbCM, respectively. Participants with the high-risk DbCM phenotype in the external validation cohorts had a significantly higher incidence of heart failure.

"A machine learning-based clustering approach to identify DbCM may promote a risk-based approach for the use of effective but potentially expensive heart failure preventive therapies among the highest-risk subgroup of individuals with diabetes who are more likely to benefit," the authors write.

Several authors disclosed ties to the pharmaceutical and biotechnology industries.

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In yet another sign that childhood vaccinations can't be taken for granted, new government data show that a record number of kindergartners were exempted from the required shots during the last school year.

That leaves more than 125,000 new students without the protection of at least one childhood vaccine, even as measles vaccination rates among kindergartners have already fallen below a federal target for four years running, the U.S. Centers for Disease Control and Prevention reported.

Meanwhile, by July of this year U.S. measles cases were already triple that of all of 2023.

“Public health officials are concerned about decreased vaccination rates in kindergarteners. Childhood vaccines are safe and effective and have made a profound difference in reducing suffering and death from what were once dreaded infectious diseases,” Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, told CNN.

Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, echoed that worry.

“The broader story is that vaccination coverage decreased in 35 states, and 14 states out of those 35 had at least one full percentage point drop,” Freeman told CNN. "What that translates to is about 280,000 students without proof of complete vaccinations.”

“But the more you consider local communities and neighborhoods, the more the risk can be different, because you see these larger pockets of vaccine-hesitant communities,” she said. “We often see congregations of the same people together in these communities, and disease can spread rapidly because they all have similar beliefs.”

How big is the dip in measles vaccination rates?

The U.S. Department of Health and Human Services has set a goal that at least 95% of children in kindergarten get two doses of the measles-mumps-rubella (MMR) vaccine, a threshold that helps prevent outbreaks of the highly contagious disease.

However, coverage dipped during the pandemic and it hasn't rebounded. The measles vaccination rate fell again last year, to 92.7% coverage for kindergartners in the 2023-24 school year, the CDC data showed.

Rates for other state-mandated vaccinations -- including diphtheria, tetanus and acellular pertussis, known as DTaP, and polio -- also dropped.

Last school year, vaccine exemptions reached the highest level ever reported, with roughly 3.3% of kindergartners getting an exemption for one or more required vaccines. The vast majority were non-medical exemptions, the data showed.

Not surprisingly, there have already been outbreaks this year of infectious diseases in pockets of communities with low vaccination rates, Freeman said.

There was a measles outbreak last March in Chicago, where at least 57 cases were linked to a migrant shelter, along with a February outbreak at an elementary school in Florida’s Broward County.

Measles is a highly contagious disease that can cause serious health consequences or death, especially for young and unvaccinated children.

General symptoms may include fever, cough, runny nose, watery eyes and a rash of red spots. About 1 in 5 unvaccinated people will be hospitalized, according to the CDC. Roughly 1 in every 20 children will develop pneumonia, and others may develop a dangerous swelling in the brain called encephalitis. Up to 3 of every 1,000 children who become infected with measles may die from respiratory and neurological complications.

“While it’s encouraging to know that more than 9 out of every 10 children ARE receiving their recommended vaccines, the seemingly small decreases [from 93.1% MMR vaccine coverage to 92.7% coverage, for example] can have an outsized negative impact,” Amy Pisani, CEO of Vaccinate Your Family, a nonprofit group, told CNN. “These data points matter because each drop in coverage places all our children at increasing risk of serious infectious diseases that were once a thing of the past.”

More information

The World Health Organization has more on the measles.

SOURCES: U.S. Centers for Disease Control and Prevention, news release, Oct. 3, 2024; CNN

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Junior doctors in the UK are poised to strike again if their demand for "full pay restoration" isn't met, despite recently accepting a 22.3% pay increase over two years, which they view as a compromise rather than a solution. Dr. Vivek Trivedi from the British Medical Association (BMA) emphasized that while the increase marks progress, the journey toward fair compensation is ongoing. He warned that if the government fails to restore doctors' confidence in the pay review process and address pay disparities exacerbated by inflation, disputes could resurface. Other BMA representatives echoed these concerns, highlighting that without significant future commitments from the government, issues like retention and workforce stability in the NHS will persist. Health Secretary Wes Streeting welcomed the pay deal, viewing it as a critical step in addressing NHS challenges, but the BMA remains vigilant about the government’s long-term actions regarding doctors' pay...Read more.

Are these threats justified or are junior doctors holding the NHS hostage? 

GB News 

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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An automated pipeline can identify clinically significant mitral regurgitation (MR) among patients undergoing transthoracic echocardiograms, according to a study published online Aug. 12 in Circulation.

Amey Vrudhula, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues used 58,614 transthoracic echocardiograms (2,587,538 videos) to develop a fully automated deep learning pipeline for identifying apical four-chamber view videos with color Doppler echocardiography and detecting clinically significant MR. The model was tested internally on 1,800 studies from Cedars-Sinai Medical Center and externally in a geographically distinct cohort of 915 studies (80,833 and 46,890 videos, respectively).

The researchers found that the view classifier demonstrated an area under the curve (AUC) of 0.998 in the held-out Cedars-Sinai Medical Center test set and correctly identified 3,452 of 3,539 echocardiography videos as having color Doppler information across the mitral valve (sensitivity and specificity of 0.975 and 0.999, respectively, compared with manually curated videos). The view classifier correctly identified 1,051 of 1,055 manually curated videos with color Doppler information across the mitral valve in the external test cohort (sensitivity and specificity, 0.996 and 0.999, respectively). In the internal test cohort, the AUC was 0.916 and 0.934 for detecting MR moderate or greater in severity and severe MR, respectively; in the external test cohort, the corresponding AUCs were 0.951 and 0.969.

"Mitral regurgitation is a common but often missed valvular heart disease. It can be challenging to precisely assess the disease severity, which is critical to know which patients can take a watch-and-wait approach and which should proceed to an intervention," coauthor David Ouyang, M.D., from the Smidt Heart Institute in Los Angeles, said in a statement.

Several authors disclosed ties to the pharmaceutical and medical technology industries.

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For patients with atrial functional mitral regurgitation (AFMR), mitral valve (MV) surgery is associated with lower rates of adverse clinical outcomes, according to a study published online Aug. 15 in JAMA Network Open.

Nobuyuki Kagiyama, M.D., Ph.D., from Juntendo University Graduate School of Medicine in Tokyo, and colleagues examined the prevalence, clinical characteristics, and outcomes of MV surgery in AFMR in a retrospective cohort study conducted across 26 Japanese centers.

Overall, 8,867 of the 177,235 patients who underwent echocardiography had moderate or severe MR. Within this group, 11.4 percent were diagnosed with AFMR (80.1 percent had atrial fibrillation). One hundred thirteen of these patients underwent MV surgery, and 81.4 percent received concurrent tricuspid valve surgery. The researchers found that compared with patients who remained under medical therapy, those who underwent surgery were younger, but they had more severe MR (57.5 versus 9.4 percent), a larger mean left atrial volume index (152.5 versus 87.7 mL/m2), and a higher prevalence of heart failure (New York Heart Association class III or IV: 26.5 versus 9.3 percent). Overall, 28.4 percent of patients experienced the primary outcome of heart failure hospitalization and all-cause mortality during a median follow-up of 1,050 days. Only the surgical group had a decrease in natriuretic peptide levels at follow-up and a significantly lower rate of the primary outcome (three-year event rates, 18.3 versus 33.3 percent) despite a more severe disease status.

"Future clinical trials are warranted to investigate the causal relationship between MV surgery and clinical outcomes in patients with severe AFMR," the authors write.

Several authors disclosed ties to the biopharmaceutical and medical device industries.

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For patients with atrial fibrillation (AF), wearable devices are associated with higher AF-specific health care use and informal health care resource use, according to a study published in the Aug. 6 issue of the Journal of the American Heart Association.

Lindsey Rosman, Ph.D., from the University of North Carolina at Chapel Hill, and colleagues conducted a retrospective, propensity-matched study of patients with AF to compare AF-specific health care use and informal health care use between wearable users and nonusers during a nine-month period. Data were included for 172 patients with AF, 83 of whom used a wearable.

The researchers found that wearable users reported higher rates of symptom monitoring and preoccupation than nonusers, and reported more AF treatment concerns. Overall, 20 percent of wearable users experienced anxiety, and in response to notifications of irregular rhythm, they always contacted their doctor. Significantly greater AF-specific health care use was seen among wearable users than nonusers after matching, including significantly higher rates of electrocardiograms, echocardiograms/transesophageal echocardiogram, and ablation. The likelihood of using informal health care resources was also significantly higher for wearable users versus nonusers.

"These findings underscore the need for further investigation into the potential effects of wearable devices on patients' health care use and psychological well-being, as well as the downstream effects on providers, clinic workflow, and health care expenditures," the authors write.

Several authors disclosed ties to the pharmaceutical and medical device industries.

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Generative artificial intelligence (AI) models can help clinicians explain echocardiogram results to patients, according to a research letter published online July 31 in JACC: Cardiovascular Imaging.

Jacob A. Martin, M.D., from the NYU Grossman School of Medicine in New York City, and colleagues examined the performance of ChatGPT, a generative AI model, for creating patient-oriented echocardiogram reports from 100 patients at an academic health system. AI-generated explanations were assessed by five echocardiographers for acceptance, accuracy, relevance, understandability, and representation of quantitative information.

The researchers found that the echocardiographers agreed or strongly agreed that 73 percent of the AI-generated explanations could be sent to patients without modifications. All explanations were rated as all true or mostly correct (84 and 16 percent, respectively). In terms of relevance, 76 percent of explanations were categorized as containing all of the important information, while 15, 7, and 2 percent contained most, about half, and less than half, respectively. Of the explanations with incorrect or missing information, none were rated as potentially dangerous.

"Most AI-generated explanations were accurate, relevant, and readily communicable to patients, highlighting the potential of AI as a helpful tool, while human oversight remains essential for refinement," the authors write.

Two authors disclosed ties to the biopharmaceutical and medical device industries.

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A considerable proportion of older adults without known valvular heart disease (VHD) have asymptomatic VHD, with age the only parameter associated with significant VHD, according to a study published online June 26 in the European Heart Journal: Cardiovascular Imaging.

Vasiliki Tsampasian, M.D., from Norwich Medical School at the University of East Anglia in the United Kingdom, and colleagues conducted a prospective cohort study between 2007 and 2016 to examine the prevalence and associated factors of asymptomatic VHD in individuals aged 60 years and older. Data were included for 4,237 participants.

The researchers found that VHD was diagnosed in 28.2 percent of patients. The most common types of VHD were regurgitation of the tricuspid, mitral, and aortic valves (13.8, 12.8, and 8.3 percent, respectively). The rate of prevalence of clinically significant VHD was 2.4 percent, with 2.2 and 0.2 percent moderate and severe, respectively. Mitral and aortic regurgitation were the most common. Age was the only parameter associated with significant VHD (odds ratio, 1.07 per one-year increment). To diagnose one clinically significant case of VHD, the number needed to scan was 42 and 15 for individuals aged 60 years and older and 75 years and older, respectively.

"These valuable data can lay the foundation for further epidemiological studies evaluating the burden of VHD in the community and the potential role of echocardiographic screening in the elderly population," the authors write.

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Echocardiography during pregnancy or early postpartum can assist in identifying women with preeclampsia at greater risk of future hypertension, according to a study presented at the American Society of Echocardiography's 35th Annual Scientific Sessions, held from June 14 to 16 in Portland, Oregon.

Anushree Puttur, M.D., from Allegheny General Hospital in Pittsburgh, and colleagues evaluated the echocardiographic changes in women with preeclampsia and subsequent impact on diagnosis of hypertension at follow-up. Analysis included 252 women diagnosed with preeclampsia and with electrocardiogram within three months of delivery.

The researchers found that 47.22 percent of women were subsequently diagnosed with hypertension during a mean follow-up of 2.3 years. A diagnosis of hypertension was significantly associated with elevated Left Ventricular Mass Index (86.28 versus 79.39), increased interventricular septal thickness (1.06 versus 0.97), and higher Lateral e' (3.23 versus 3.06). Additionally, Left Ventricular Mass Index >95 g/m2 was significantly associated with future hypertension.

"Our study used echocardiography to check for specific findings that could identify women who might be at higher risk for high blood pressure after preeclampsia," Puttur said in a statement. "By finding these clues, we hope to improve how we monitor and care for women after they've had preeclampsia."

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THURSDAY, May 16, 2024 (HealthDay News) -- Treatment with the oral selective cardiac myosin inhibitor aficamten results in significantly greater improvement in peak oxygen uptake compared with placebo among patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM), according to a study published online May 13 in the New England Journal of Medicine to coincide with the European Society of Cardiology Heart Failure 2024, held from May 11 to 14 in Lisbon, Portugal.

Martin S. Maron, M.D., from the Lahey Hospital and Medical Center in Burlington, Massachusetts, and colleagues randomly assigned adults with symptomatic obstructive HCM to receive aficamten or placebo for 24 weeks (142 and 140 patients, respectively) with dose adjustment based on echocardiography results in a phase 3, double-blind trial.

The researchers found that the mean change in peak oxygen uptake was 1.8 and 0.0 mL/kg/min in the aficamten and placebo groups at 24 weeks (least-squares mean between-group difference, 1.7 mL/kg/min). For all 10 secondary end points, results improved significantly with aficamten versus placebo. In the two groups, the incidence of adverse events was similar.

"Among patients with symptomatic obstructive HCM, treatment with aficamten resulted in a significantly greater improvement in peak oxygen uptake than placebo," the authors write.

The study was funded by Cytokinetics, the manufacturer of aficamten.

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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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