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Abstract Several studies suggested the utility of artificial intelligence (AI) in screening left ventricular hypertrophy (LVH). We hence conducted systematic review and meta-analysis comparing diagnostic accuracy of AI to Sokolow–Lyon’s and Cornell’s criteria. Our aim was to provide a comprehensive overview of the newly developed AI tools for diagnosing LVH. We searched MEDLINE, EMBASE, and Cochrane databases for relevant studies until May 2023. Included were observational studies evaluating AI’s accuracy in LVH detection. The area under the receiver operating characteristic curves (ROC) and pooled sensitivities and specificities assessed AI’s performance against standard criteria. A total of 66,479 participants, with and without LVH, were included. Use of AI was associated with improved diagnostic accuracy with summary ROC (SROC) of 0.87. Sokolow–Lyon’s and Cornell’s criteria had lower accuracy (0.68 and 0.60). AI had sensitivity and specificity of 69% and 87%. In comparison, Sokolow–Lyon’s specificity was 92% with a sensitivity of 25%, while Cornell’s specificity was 94% with a sensitivity of 19%. This indicating its superior diagnostic accuracy of AI based algorithm in LVH detection. Our study demonstrates that AI-based methods for diagnosing LVH exhibit higher diagnostic accuracy compared to conventional criteria, with notable increases in sensitivity. These findings contribute to the validation of AI as a promising tool for LVH detection.

Introduction: While atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to evaluate the efficacy and safety of cryoballoon AF ablation in patients with HFrEF. Method: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2022. Studies that reported the outcomes of freedom from atrial arrhythmia, complications, NYHA functional class (NYHA FC), and left ventricular ejection fraction (LVEF) after Cryoballoon AF ablation in HF patients were included. Data from each study were combined with a random-effects model. Result: A total of 9 studies observational studies with 1414 HF patients were included. Five studies had only HF with reduced ejection fraction (HFrEF), 1 study with HF with preserved ejection fraction (HFpEF), and others with mixed HF types. Freedom from AA in HFrEF at 12 months was 64% (95% CI 56–71%, I2 58%). There was a significant improvement of LVEF in these patients with a standard mean difference of 13% (95% CI 8.6–17.5%, I2 99% P

Introduction Recent studies suggested that the energy delivered by the mechanical ventilator to the lungs termed the mechanical power can induce and increase the risks of ventilator induced lung injury. The components of the mechanical power include the variables delivered by the ventilator: tidal volume, respiratory rate, inspiratory flow, airway pressure. Adaptive Ventilator Mode-2 (AVM-2) is a pressure-controlled mode with an optimal targeting scheme based on the inspiratory power equation that adjusts the respiratory rate and tidal volume to achieve a target minute ventilation. This mode conceptually should reduce the mechanical power delivered to the patients and thus reduce the incidence of ventilator induced lung injury. Methodology A bench study using a lung simulator (TTL, Michigan Instruments, Michigan, USA) was conducted. We constructed a passive single compartment normal respiratory mechanics model with compliance of 50 ml/cmH2O, and resistance of 10 cmH2O/L/s, with IBW 70 kg. We compared three different ventilator modes: Adaptive Ventilation Mode-2 (AVM-2), Pressure Regulated Volume Control (PRVC), and Volume Controlled Ventilation (VCV) in four different scenarios: 2 levels of minute ventilation 7 and 10.5 Lit/min (Experiment 1 and 2 respectively), each with 2 different PEEP levels 5 and 10 cmH2O (Experiment A and B respectively) termed Experiments 1A, 1B, 2A, and 2B respectively. The AVM-2 mode automatically selects the optimal tidal volume, and respiratory rate per the dialed percent minute ventilation with an I:E ratio of 1:1. In the PRVC, VCV we selected target tidal volume 6ml/kg/IBW (420 ml), and respiratory rate adjusted to match the minute ventilation for the AVM-2 mode. I:E ratio was kept 1:2 to avoid intrinsic PEEP. The study was conducted using a bellavista™ 1000 e Ventilator (Vyaire Medical, Illinois, USA). The mechanical power delivered by the ventilator for each mode was computed and compared between the three modes in each experiment. Statistical analysis was done using Kruskal-Wallis test to analyze the difference between the three modes, post HOC Tukey test was used to analyze the difference between each mode with the confidence intervals, P < 0.05 was considered statistically significant. Results There were statistically significant differences between all the three modes regarding the ventilator delivered mechanical power. The AVM-2 mode delivered significantly less mechanical power than VCV which in turn was less than PRVC. Experiment 1A: AVM-2 8.76 土 0.05, VCV 9.78 土 0.04, PRVC 10.82 土 0.08, P < 0.001 Experiment 1B: AVM-2 11.27 ± 0.09 VCV 12.81 ± 0.05, PRVC 13.88 ± 0.06, P < 0.001. Experiment 2A: AVM-2 14.76 ± 0.05, VCV 15.79 ± 0.05, PRVC 18.29 ± 0.07, P < 0.001, Experiment 2B: AVM-2 18.76 ± 0.04, VCV 20.56 ± 0.04, PRVC 21.17 土 0.03, P < 0.001. Conclusion AVM2 mode delivered less mechanical power compared to two conventional modes using low tidal volume in a normal lung model. This might reduce the incidence of ventilator induced lung injury. Results need to be validated in more clinical studies.

Spinal Cord injury is a disabling condition which affects the respiratory system. The most affected neurological level is the cervical spine. Many patients with cervical spinal cord injury are unable to sustain independent ventilation and require mechanical ventilation. Long term use of mechanical ventilation is associated with poor quality of life, increased morbidity, and mortality. In patients with intact phrenic nerve, diaphragmatic pacing can be used to help wean the patients off mechanical ventilation. In this review, we summarize the indications, contraindications, benefits, safety, and effectiveness of diaphragmatic pacing. We also report a brief case of a 62-year-old male with quadriplegia secondary to C2-C3 fracture who was intubated after drowning but was extubated with the help of diaphragmatic pacing.

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is commonly initiated for adults experiencing cardiac arrest within the cardiac catheterization lab or the intensive care unit. However, the potential benefit of ECPR for these patients in the emergency department (ED) remains undocumented. This study aims to assess the benefit of ECPR initiated in the ED for patients with out-of-hospital cardiac arrest (OHCA).MethodsWe conducted a systematic review and meta-analysis of studies comparing ECPR initiated in the ED versus conventional CPR. Relevant articles were identified by searching several databases including PubMed, EMBASE, Web of Science, and Cochrane collaborations up to July 31, 2022. Pooled estimates were calculated using the inverse variance heterogeneity method, while heterogeneity was evaluated using Q and I2 statistics. The risk of bias in included studies was evaluated using validated bias assessment tools. The primary outcome was a favorable neurological outcome at hospital discharge, and the secondary outcome was survival to hospital discharge or 30-day survival. Sensitivity analyses were performed to explore the benefits of ED-initiated ECPR in studies utilizing propensity score (PPS) analysis. Publication bias was assessed using Doi plots and the Luis Furuya-Kanamori (LFK) index.ResultsThe meta-analysis included a total of eight studies comprising 51,173 patients. ED-initiated ECPR may not be associated with a significant increase in favorable neurological outcomes (odds ratio [OR] 1.43, 95% confidence interval [CI] 0.30-6.70, I2 = 96%). However, this intervention may be linked to improved survival to hospital discharge (OR 3.34, 95% CI 2.23-5.01, I2 = 17%). Notably, when analyzing only PPS data, ED-initiated ECPR demonstrated efficacy for both favorable neurological outcomes (OR 1.89, 95% CI 1.26-2.83, I2 = 21%) and survival to hospital discharge (OR 3.37, 95% CI 1.52-7.49, I2 = 57%). Publication bias was detected for primary (LFK index 2.50) and secondary (LFK index 2.14) outcomes.ConclusionThe results of this study indicate that ED-initiated ECPR may not offer significant benefits in terms of favorable neurological outcomes for OHCA patients. However, it may be associated with increased survival to hospital discharge. Future studies should prioritize randomized trials with larger sample sizes and strive for homogeneity in patient populations to obtain more robust evidence in this area.

Background: COVID-19 has recently been associated with the development of Takotsubo cardiomyopathy (TCM). This scoping review aims to summarize the existing evidence regarding TCM in COVID-19 and offer future direction for study. Methods: Following the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including “Takotsubo”, “Stress-induced cardiomyopathy” and “COVID-19” from their inception to September 25, 2021. Results: A total of 40 articles with 52 cases were included. Patients with TCM and COVID-19 showed only slight female predominance (59.6%), median age of 68.5 years, and were mostly of the apical subtype (88.6%). All-cause mortality was 36.5%. The median LVEF was 30%. Compared to those without TCM, those with TCM in COVID-19 had more critical illness, higher mortality, lower LVEF, and higher cardiac and inflammatory biomarkers. Notably, the diagnostic criteria of TCM were considerably different between case reports and observational studies. Conclusion: This scoping review identifies that TCM in COVID-19 may have distinct features that distinguish this condition from TCM without COVID-19. Future studies are warranted to help describe risk factors, determine the utility of inflammatory biomarkers and serum catecholamine levels, and establish disease-specific diagnostic criteria.