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IntroductionSimulation technology has an established role in teaching technical skills to cardiology fellows, but their impact on teaching trainees to interpret coronary angiographic (CA) images has not been systematically studied. The aim of this randomized controlled study was to test whether structured simulation training in addition to traditional methods would improve CA image interpretation skills in a group of novices to advanced medical trainees.MethodsWe prospectively randomized 105 subjects comprising of medical students (N=20), residents (N=68) and fellows (N=17) from the University of Arizona. Subjects were randomized into a simulation training group which received simulation training in addition to didactic teaching (n=53) and a control training group which received didactic teaching alone (n=52). The change in pre and post-test score (delta score) was analyzed by a two-way ANOVA for education status and training arm.ResultsSubjects improved in their post-test scores with a mean change of 4.6 ± 4.0 points. Subjects in the simulation training arm had a higher delta score compared to control (5.4 ± 4.2 versus 3.8 ± 3.7, p=0.04), with greatest impact for residents (6.6 ± 4.0 versus 3.5 ± 3.4) with a p=0.02 for interaction of training arm and education status.ConclusionsSimulation training complements traditional methods to improve CA interpretation skill, with greatest impact on novice trainees. This highlights the importance of incorporating high-fidelity simulation training early in cardiovascular fellowship curricula.

Takotsubo cardiomyopathy (TC) develops in patients who are under significant emotional, psychosocial, or sudden biochemical stress. However, the added burden of TC on the patients receiving chemotherapy has never been studied. We aimed to describe the additional clinical and economic burden, along with the potential predictors of TC and related in-hospital mortality in patients receiving chemotherapy using the largest inpatient cohort. We identified chemotherapy-related adult hospitalizations using the National Inpatient Sample databases (2010 to 2014). Primary end points were the incidence of TC and the odds of in-hospital mortality. Secondary end points were gender-based incidence differences, length of stay (LOS), hospital charges, and discharge disposition. We identified 1,067,977 chemotherapy-related hospitalizations, of which, 562 hospitalizations revealed TC incidence. Other co-morbidities were also significantly higher in the TC cohort. In unmatched analyses, the LOS (median 17 days vs 5 days) and total hospital charges (median $162,825 vs $46,335) were significantly higher in the TC group. A propensity-matched analysis confirmed the increased healthcare burden. Multivariate analysis revealed over 2-times higher odds (odds ratio [OR] 2.17) of in-hospital mortality in the TC group. Female gender (OR 2.48), and nonelective (OR 2.26), and nonfederal government hospital (OR 2.68) admissions had more than twice the odds of developing TC. An advanced age, Asian race, urban-teaching hospital, and complications such as septicemia, fluid-electrolyte disorders, cardiogenic shock, and respiratory failure independently raised mortality odds in the TC group. In conclusion, we observed an overall increasing nationwide trend in TC incidence in patients receiving chemotherapy, which adds to significantly increased in-hospital mortality, LOS, and healthcare charges.