Background:Cardiac size measurements require indexing to body size. Allometric indexing has been investigated in Caucasian populations but a range of different values for the so-called allometric ...power exponent (b) have been proposed, with uncertainty as to whether allometry offers clinical utility above body surface area (BSA)-based indexing. We derived optimal values forbin normal echocardiograms and validated them externally in cardiac patients.Methods and Results:Values forbwere derived in healthy adult Chinese males (n=1,541), with optimalbfor left ventricular mass (LVM) of 1.66 (95% confidence interval 1.41–1.92). LV hypertrophy (LVH) defined as indexed LVM >75 g/m1.66was associated with adverse outcomes in an external validation cohort (n=738) of patients with acute coronary syndrome (odds ratio for reinfarction: 2.4 (1.1–5.4)). In contrast, LVH defined by BSA-based indexing or allometry using exponent 2.7 exhibited no significant association with outcomes (P=NS for both). Cardiac longitudinal function also varied with body size: septal and RV free wall s’, TAPSE and lateral e’ all scaled allometrically (b=0.3–0.9).Conclusions:An optimalbof 1.66 for LVM in healthy Chinese was found to validate well, with superior clinical utility both to that of BSA-based indexing and tob=2.7. The effect of allometric indexing of cardiac function requires further study.
This meta‐analysis aims to evaluate the performance of atrial sensing dipole in single lead implantable cardioverter defibrillator (VDD‐ICD) recipients in particular diagnosing new‐onset atrial ...high‐rate episodes (AHREs) defined as rate threshold of 200 beats per minute, or subclinical atrial fibrillation (SCAF) defined as device‐detected AF without symptoms. We comprehensively searched PubMed, Embase, and ClinicalTrials.gov. Studies comparing contemporary single‐ and dual‐chamber ICD (VVI‐/DDD‐ICD) versus VDD‐ICD were included. Restricted maximum likelihood method for random effect model and Mantel‐Haenszel method for fixed effect model were used to estimate the effect size of new‐onset AHREs, or SCAF detection in each group. Three prospective studies were identified and total of 991 participants were included. There were 330 (33.3%) in VDD‐ICD and 661 (66.7%) in VVI‐/DDD‐ICD. Most (78%) participants were men. Median follow‐up was from 365 days to 847 days. VDD‐ICD has a higher likelihood of detecting AHREs or SCAF as compared to VVI‐/DDD‐ICD (OR random effect : 2.6; 95% CI: 1.2, 5.8; p = .018); I‐squared = 67.8%, p = .019. This difference was more apparently seen in the comparison between VDD‐ICD and VVI‐ICD (OR random effect: 3.8; 95% CI: 2.1, 6.6, p < .001), I‐squared = 0.0%, p = .518. The result is same as fixed effect. Rate of AHREs detection observed in VDD‐ICD was not statistically different when compared to the only group with DDD‐ICD from SENSE trial. In conclusion, this meta‐analysis reveals that the use of floating atrial sensing dipole in VDD‐ICD increases the detection of new‐onset AHREs or SCAF when compared to VVI‐ICD, with similar atrial sensing performance to DDD‐ICD.
This meta‐analysis reveals that the use of a floating atrial sensing dipole in VDD‐ICD increases the detection of new‐onset AHREs or SCAF when compared to VVI‐ICD alone, with similar atrial sensing performance to DDD‐ICD. However, longer follow‐up is needed to determine the reliability of the atrial sensing component in the VDD‐ICD.
BACKGROUND Electrocardiography (ECG) may be performed as part of preparticipation sports screening. Recommendations on screening of athletes to identify individuals with previously unrecognized ...cardiac disease are robust; however, data guiding the preparticipation screening of unselected populations are scarce. T wave inversion (TWI) on ECG may suggest an undiagnosed cardiomyopathy. This study aims to describe the prevalence of abnormal TWI in an unselected young male cohort and the outcomes of an echocardiography-guided approach to investigating these individuals for structural heart diseases, focusing on the yield for cardiomyopathies. METHODS AND RESULTS Consecutive young male individuals undergoing a national preparticipation cardiac screening program for 39 months were studied. All underwent resting supine 12-lead ECG. Those manifesting abnormal TWI, defined as negatively deflected T waves of at least 0.1 mV amplitude in any 2 contiguous leads, underwent echocardiography. A total of 69 714 male individuals with a mean age of 17.9±1.1 years were studied. Of the individuals, 562 (0.8%) displayed abnormal TWI. This was most frequently observed in the anterior territory and least so in the lateral territory. A total of 12 individuals (2.1%) were diagnosed with a cardiomyopathy. Cardiomyopathy diagnoses were significantly associated with deeper maximum TWI depth and the presence of abnormal TWI in the lateral territory, but not with abnormal TWI in the anterior and inferior territories. No individual presenting with TWI restricted to solely leads V
to V
, 2 inferior leads or both was diagnosed with a cardiomyopathy. CONCLUSIONS Cardiomyopathy diagnoses were more strongly associated with certain patterns of abnormal TWI. Our findings may support decisions to prioritize echocardiography in these individuals.
Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine ...program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".
Near-peer teaching is gaining popularity as a teaching modality, as it improves the learner's understanding, is targeted at an appropriate level and promotes familiarisation. This study was initiated ...to evaluate the effectiveness of incorporating near-peer instruction into simulation-based training within a junior residency programme.
42 first-year residents from an internal medicine junior residency programme were recruited. Participants underwent a simulation-based training programme conducted over five weeks. Each week involved either an emergency or acute clinical scenario. A structured questionnaire was administered prior to and after the course to compare participants' perceived knowledge, experience and confidence in managing the clinical scenarios.
In our study, 83% of participants agreed/strongly agreed that the scenarios were realistic. There were improvements in perceived knowledge, experience and confidence after the course. The greatest improvement was seen for experience (post-simulation: median 7.00 interquartile range (IQR) 6.00‒8.00 vs. pre-simulation: median 5.00 IQR 3.00-6.25). 65% of participants were keen to help with future training.
Near-peer simulation training was found to be a viable and valuable method of instruction for first-year residents for increasing experience, instilling confidence and improving perceived knowledge. Integration of such programmes within medical education curricula shows good promise of continuity, with many first-year residents inspired to organise subsequent sessions.
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