Explore the vast range of titles available.

IntroductionPalpitations are a common cause of referral to cardiology clinics for specialist assessment. Although some patients experience true arrhythmias, many have benign ectopic beats only. Echocardiography is routinely performed in such patients, but whether it is required in all patients with palpitations is unknown.PurposeTo analyse the echocardiographic findings in patients presenting with palpitations and assessing the relation of normal echocardiogram with normal physical examination & normal resting 12 lead ECG.MethodsIn this single-centre retrospective study, we first obtained a list of all patients seen in the electrophysiology (EP) clinics. Patients with known arrhythmia & known structural heart disease were excluded, as were patients whose presenting complaint was not palpitations (figure 1A). Of the remaining patients, we analysed the notes & clinic letters for physical exam findings and the 12-lead ECG & echocardiogram reports were analysed also. A normal 12-lead ECG was defined by sinus rhythm with normal P-QRS-T waves and intervals. A normal echocardiogram was defined by normal biventricular function, chambers sizes, and valvular morphology and function (including mild mitral and tricuspid regurgitation).ResultsOver 12 months, 1152 patients were seen in our EP clinics, of whom 207 (18.4%) were new patients presenting with palpitations with no known cardiac disorders(figure 1A). A total of 184/207 (89%) patients had echocardiograms. Physical examination findings were documented in 63% and were normal in 93%. A normal 12-lead ECG was found in 63% and a normal echocardiogram in 66%. Echocardiographic abnormalities were found in 62 patients. Of the 74 patients that had both normal physical exam & normal resting ECG, 57 (77%) had a normal echocardiogram – this increased to 82% (45/55) by excluding patients with hypertension or diabetes. Normal examination and normal ECG were found to significantly correlate with normal echocardiogram (73% (p<0.001)) and 76% (P=0.022) respectively) (Table 2). The most common echocardiographic abnormalities were dilated left atrium (74%), left ventricular systolic dysfunction (18%), and left ventricular hypertrophy (16%) (figure 1B).Abstract 144 Figure 1A) Flow chart of the studied patients. B) Echocardiographic abnormalities that were detected with their percentages by the total number of patients that had abnormalitiesAbstract 144 Table 1Patients' demographicsAbstract 144 Table 2Comparisons between normal and abnormal echocardiography patients according to different characteristics.ConclusionIn patients without known cardiovascular disease who present with palpitations, echocardiographic abnormalities are rare in patients with both a normal physical examination and resting 12-lead ECG. Routine requesting of echocardiography in such patients may not be warranted and the role of focussed echocardiography in such patients should be investigated further.Conflict of Interestnone

IntroductionTransthoracic echocardiogram (TTE) is routinely requested in the clinical setting as it is a non-invasive investigation that provides invaluable diagnostic information. However, inappropriate requests impact the quality of service provision to other patients in a timely and effective manner. Rejected TTE (rTTE) requests were evaluated over two months to determine common themes of inappropriate referrals in a tertiary unit.MethodsThe study design utilised both retrospective and prospective methods to analyse rTTE requests from September to October 2021. A collaboration with the local echocardiography unit identified rTTE requests within the aforementioned time frame. A retrospective cohort study was performed in the first month to evaluate the underlying reason of rTTE requests. This was accomplished by entering patient unique identifiable number on the electronic request system to obtain the data. On 01/10/2021, a trust-wide oral presentation aimed at medical practitioners was organised to facilitate the understanding of TTE indications and contraindications in accordance with British Society of Echocardiography (BSE) guidelines. Subsequently, a prospective cohort study observed a similar technique to generate reproducible data in the later half of the study duration. After compiling all anonymous data on a table, this information was translated into pie charts.ResultsA total of 329 rTTE requests were identified in the study. Duplicated requests and lack of indications contributed predominantly to the number of recognised cases, at 115 (34.95%) and 98 (29.79%) cases respectively. Other significant reasons including recent TTE performed (n=31; 9.42%), cancellation by clinician (n=28; 8.51%) and patient death (n=24; 7.29%) also led to similar outcomes. Additionally, trivial reasons formed less than five percent of cases each (table 1). Out of 98 (29.79%) cases as above, cardiac-suspected morbidities or symptoms prompted TTE requests – infective endocarditis (n=39; 39.80%), left or right ventricular failure (n=25; 25.51%) and syncope/arrhythmia (n=19; 19:39%) in that order – but insufficient clinical information entered saw these requests being rejected. The common reasons of rejection in these circumstances were no indications as per modified Duke criteria, normal B-natriuretic peptide (BNP) level and lack of clinical symptoms as per BSE guidelines respectively. Promoting the understanding of TTE indications and contraindications appeared to reduce the number of rTTE requests especially in the domains of duplicated requests and lack of indications, which observed a decrement of 11 (3.3%) and 14 (4%) cases respectively.Abstract 158 Figure 1Reasons of rejected transthoracic echocardiogram requests in September and October 2021Abstract 158 Figure 2Insufficient indication subclassificationConclusionsPromoting the understanding of TTE indications and contraindications amongst clinicians led to reduction of inappropriate referrals. This suggests the overall benefit may be enhanced by implementing a series of questions prior to electronic request submission.Conflict of InterestNone to declare

BackgroundDiscrimination between cardioembolic stroke (CES) and non-CES in undifferentiated stroke subtypes is crucial to guide treatment decisions as these conditions require differing management strategies. In this systematic review and meta-analysis, we sought to identify clinical and structural cardiac parameters associated with clear CES and non-CES subtypes in available stroke populations in the literature.MethodsWe conducted a systematic review of medical databases following PRISMA guidelines, analysing relevant English studies (2000–2023) assessing adult patients with stroke (PROSPERO CRD42023454390) (figure 1). Data was extracted and meta-analysed using a random effects model, with values assessed through an odds ratio (OR) or standardised mean difference (SMD).ResultsTwelve studies were included for analysis, involving a total of 6335 patients. Our meta-analysis showed that CES populations were older (SMD: 0.401, 95% CI: 0.273 to 0.529, p<0.001) with a higher prevalence of heart failure (HF) (OR: 2.528, 95% CI: 1.595 to 4.008, p<0.001). There was no difference in the prevalence of other baseline clinical characteristics. Importantly, CES groups had a significantly lower left ventricular ejection fraction (LVEF) (SMD: -0.430, 95% CI: -0.561 to -0.298, p<0.001) and higher left atrial volume index (LAVI) (SMD: 0.695, 95% CI: 0.556 to 0.834, p<0.001). See table 1.ConclusionBased on available literature, patients with CES tend to be older with more prevalent heart failure, impaired LV function and LA dilatation when compared to non-CES counterparts. Early identification of these parameters in undifferentiated stroke subtypes may aid with further aetiological stroke investigation and subsequent treatment.Abstract 197 Table 1Predictive factors between CES vs non-CES subtypes Outcomes Results 95% CI P-value Age 0.401* 0.273 to 0.529 <0.001 Heart failure 2.528^ 1.595 to 4.008 <0.001 Hypercholesterolemia 0.949^ 0.800 to 1.126 0.551 Diabetes mellitus 0.942^ 0.706 to 1.257 0.686 Coronary artery disease 1.232^ 0.852 to 1.782 0.268 Smoking 0.858^ 0.645 to 1.140 0.291 Mean body mass index -0.0617* -0.220 to 0.0960 0.443 LVEF -0.430* -0.561 to -0.298 <0.001 LAVI 0.695* 0.556 to 0.834 <0.001 ^Odds ratio; *Standardised mean differenceAbstract 197 Figure 1PRISMA flow diagramConflict of InterestNil

In recent years, considerable work has been conducted on the development of synthetic medical images, but there are no satisfactory methods for evaluating their medical suitability. Existing methods mainly evaluate the quality of noise in the images, and the similarity of the images to the real images used to generate them. For this purpose, they use feature maps of images extracted in different ways or distribution of images set. Then, the proximity of synthetic images to the real set is evaluated using different distance metrics. However, it is not possible to determine whether only one synthetic image was generated repeatedly, or whether the synthetic set exactly repeats the training set. In addition, most evolution metrics take a lot of time to calculate. Taking these issues into account, we have proposed a method that can quantitatively and qualitatively evaluate synthetic images. This method is a combination of two methods, namely, FMD and CNN-based evaluation methods. The estimation methods were compared with the FID method, and it was found that the FMD method has a great advantage in terms of speed, while the CNN method has the ability to estimate more accurately. To evaluate the reliability of the methods, a dataset of different real images was checked.

Infective endocarditis (IE) has been increasingly recognized as an important complication of Staphylococcus aureus bacteremia (SAB), leading to a low threshold for echocardiography and extended treatment with anti-staphylococcal agents. However, outside of IE, many indications for prolonged anti-staphylococcal therapy courses are present. We sought to determine the frequency in which findings from a transesophageal echocardiogram (TEE) changed clinical SAB management in a large Canadian health region. Residents (> 18 years) with SAB from 2012 to 2014 who underwent transthoracic echocardiogram (TTE) and TEE were assessed. Patients potentially benefiting from an extended course of anti-staphylococcal agents were defined a priori. Patient demographics, treatment (including surgical), and clinical outcomes were extracted and evaluated. Of the 705 episodes of SAB that underwent a screening echocardiogram, 203 episodes underwent both a TTE and TEE, of which 92.1% (187/203) contained an a priori indication for extended anti-staphylococcal therapy. Regardless of TEE results, actual duration of therapy did not differ in SAB episodes that had ≥ 1 extended anti-staphylococcal therapy criteria (36.7 days, IQR 23.4–48.6 vs. 43.8 days, IQR 33.3–49.5, p = 0.17). Additionally, there were no cases in which TEE was utilized as the sole reason to shorten duration of therapy or proceed to surgery for those with SAB. Routine performance of TEE may be unnecessary in all SAB as many patients have pre-existing indications for extended anti-staphylococcal therapy independent of TEE findings. An algorithm to selectively identify cases of SAB that would benefit from TEE can reduce resource and equipment expenditure and patient risks associated with TEE.

Leaflet thrombosis is usually an incidental finding and Cardiac CT is the gold standard for its diagnosis, but the classic features of hypoattenuation leaflet thickening (HALT) and hypoattenuation affecting motion (HAM) can also be seen on echocardiography and more specifically on trans-esophageal echocardiography. We describe a case of transcatheter aortic valve thrombosis where both the diagnosis and treatment were based exclusively on the echocardiographic evaluation, without the need of cardiac CT, with good outcome for the patient.

ObjectiveThe prognostic value of left atrial (LA) dimensions may differ between patients with and without atrial fibrillation (AF).MethodsMEDLINE and EMBASE were searched for studies that investigated the association between LA echocardiographic parameters measured by transthoracic echocardiography and cardiovascular outcomes in patients with or without AF. Data were independently abstracted by two reviewers and pooled using random-effects meta-analysis. The primary outcome was incident stroke or thromboembolic events. Secondary outcomes were heart failure, all-cause mortality and major adverse cardiac events (MACE).ResultsTwenty-three studies of patients with AF (14 939 patients) and 68 studies of patients without AF (50 720 patients) in this systematic review. Increasing LA diameter was significantly associated with stroke and thromboembolic events in patients without AF (risk ratio (RR) 1.38, 95% CI 1.02 to 1.87; p=0.03), but not in patients with AF (RR 1.02, 95% CI 0.98 to 1.07; p=0.27; p for difference=0.05). Increasing LA diameter index was significantly associated with MACE in patients with AF (RR 1.13, 95% CI 1.09 to 1.17; p<0.001) and in patients without AF (RR 2.98, 95% CI 1.90 to 4.66; p<0.001), with stronger effects in non-AF populations (p for difference <0.001). Greater LA volume index was significantly associated with the risk of MACE in patients with AF (RR 1.01, 95% CI 1.00 to 1.02; p=0.03) and in non-AF populations (RR 1.08, 95% CI 1.05 to 1.10; p<0.001), the association being stronger in individuals without AF (p for difference <0.001).ConclusionsLarger LA parameters were associated with various adverse cardiovascular events. Many of these associations were stronger in individuals without AF, highlighting the potential importance of LA myopathy.

Heart failure is a prevalent cardiovascular condition with significant health implications, necessitating effective diagnostic strategies for timely intervention. This study explores the potential of continuous monitoring of non-invasive signals, specifically integrating photoplethysmogram (PPG) and electrocardiogram (ECG), for enhancing early detection and diagnosis of heart failure. Leveraging a dataset from the MIMIC-III database, encompassing 682 heart failure patients and 954 controls, our approach focuses on continuous, non-invasive monitoring. Key features, including the QRS interval, RR interval, augmentation index, heart rate, systolic pressure, diastolic pressure, and peak-to-peak amplitude, were carefully selected for their clinical relevance and ability to capture cardiovascular dynamics. This feature selection not only highlighted important physiological indicators but also helped reduce computational complexity and the risk of overfitting in machine learning models. The use of these features in training machine learning algorithms led to a model with impressive accuracy (98%), sensitivity (97.60%), specificity (96.90%), and precision (97.20%). Our integrated approach, combining PPG and ECG signals, demonstrates superior performance compared to single-signal strategies, emphasizing its potential in early and precise heart failure diagnosis. The study also highlights the importance of continuous monitoring with wearable technology, suggesting a significant stride forward in non-invasive cardiovascular health assessment. The proposed approach holds promise for implementation in hardware systems to enable continuous monitoring, aiding in early detection and prevention of critical health conditions.

Heart failure with improved ejection fraction (HFimpEF) has better outcomes than HF with reduced EF (HFrEF). However, factors contributing to HFimpEF remain unclear. This study aimed to evaluate clinical and longitudinal characteristics associated with subsequent HFimpEF. This was a single-center retrospective HFrEF cohort study. Data were collected from 2014 to 2022. Patients with HFrEF were identified using International Classification of Diseases codes, echocardiographic data, and natriuretic peptide levels. The main end points were HFimpEF (defined as EF >40% at ≥3 months with ≥10% increase) and mortality. Cox proportional hazards and mixed effects models were used for analyses. The study included 1,307 patients with HFrEF with a median follow-up of 16.3 months (interquartile range 8.0 to 30.6). The median age was 65 years; 68% were male whereas 57% were White. On follow-up, 38.7% (n = 506) developed HFimpEF, whereas 61.3% (n = 801) had persistent HFrEF. A multivariate Cox regression model identified gender, race, co-morbidities, echocardiographic, and natriuretic peptide as significant covariates of HFimpEF (p <0.05). The HFimpEF group had better survival compared with the persistent HFrEF group (p <0.001). Echocardiographic and laboratory trajectories differed between groups. In this HFrEF cohort, 38.7% transitioned to HFimpEF and approximately 50% met the definition within the first 12 months. In a HFimpEF model, gender, co-morbidities, echocardiographic parameters, and natriuretic peptide were associated with subsequent HFimpEF. The model has the potential to identify patients at risk of subsequent persistent or improved HFrEF, thus informing the design and implementation of targeted quality-of-care improvement interventions.