The so-called refined criteria (Circulation. 2014 Apr 22;129[16]:1637-49) were designed to improve upon the specificity of the ESC and Seattle criteria by excluding several isolated ECG patterns that have been shown not relevant in black athletes.
When the developers of the refined criteria applied all three sets of criteria to a large population of black and white athletes, including 103 young athletes with HCM, all three showed 98% sensitivity for the detection of HCM. However, the false-positive ECG rate in black athletes improved from 40.4% using the ESC criteria, to 18.4% with the Seattle criteria, to 11.5% using the refined criteria. Among white athletes, the false-positive rates using the three sets of criteria were 16.2%, 7.1%, and 5.3%.
“These new refined criteria should be incorporated into guidelines for the screening of athletes. They provide a 71% reduction in positive ECGs in black athletes, compared with the ESC recommendations,” Dr. Perk said.
Cardiac imaging
“I really think 3-D printing is going to revolutionize every aspect of medicine,” asserted Dr. Luigi Badano of the University of Padua (Italy).
At the ESC congress, his research group presented a study in which they used custom software to create an exact model of a real patient’s tricuspid valve out of liquid resin based on transthoracic echo images. It took 90 minutes.
Bruce Jancin/Frontline Medical News
Dr. Luigi Badano
“This technology allows us to hold the physical structure of the heart in our hands,” he noted. “We can use it to teach anatomy to medical students without a corpse, plan surgical interventions, and communicate with patients, showing them exact structures and revolutionizing the concept of informed consent.”
And that’s just scratching the surface. He noted that investigators at Wake Forest Baptist Medical Center Institute for Regenerative Medicine in North Carolina recently utilized 3-D printing with bio-ink and bio-paper to print 3-D beating cardiac cells clustered into “organoids.” It’s the first step toward creating a prototype beating heart.
“Can you dream about that? The donor heart shortage could in the future be solved by printing a beating heart for insertion into the patient. The investigators predict they’ll have a functional beating heart within 20 years,” Dr. Badano said.
Acute cardiac care
Dr. Maddalena Lettino and her fellow leaders of the European Acute Cardiac Care Association agreed that the breakthrough of the year in their field was validation of a novel 1-hour rule-in/rule-out algorithm using high-sensitivity cardiac troponin T to accelerate management of patients who present to the emergency department with chest pain. According to studies totaling more than 3,000 patients with more than 600 MIs in which the assay and algorithm were tested, roughly 75% of patients can safely and accurately have acute MI ruled out or ruled in within 1 hour.
Dr. Maddalena Lettino
Given that close to 10% of all emergency department visits are for chest pain, adoption of this algorithm will reduce ED overcrowding, speed physician workflow, save health care systems money, and spare patients and families the anxiety that comes with a delayed diagnosis, said Dr. Lettino, director of the clinical cardiology unit at Humanitas Research Hospital in Milan.
Coronary intervention
The 15%-20% of coronary stent recipients who are at high bleeding risk constitute “the forgotten patient population,” said Dr. Philippe Garot of the Paris South Cardiovascular Institute.
He noted that the key question of whether such patients can be managed safely with a mere 1-month course of dual antiplatelet therapy will finally be answered this fall with the release of the LEADERS FREE trial results. This large, randomized double-blind trial compares safety and efficacy outcomes in patients assigned to a bare metal stent or the novel drug-eluting BioFreedom stent.
Stay tuned, because LEADERS FREE could be a game changer in interventional cardiology, he said.
The six presenters indicated they had no relevant financial conflicts.