Current cardiology reports
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Review
Machine Meets Biology: a Primer on Artificial Intelligence in Cardiology and Cardiac Imaging.
An understanding of the basics concepts of deep learning can be helpful in not only understanding the potential applications of this technique but also in critically reviewing literature in which neural networks are utilized for analysis and modeling. ⋯ The term "deep learning" has been applied to a subset of machine learning that utilizes a "neural network" and is often used interchangeably with "artificial intelligence." It has been increasingly utilized in healthcare for computational "learning", especially for pattern recognition for diagnostic imaging. Another promising application is the potential for these neural networks to improve the accuracy in the identification of patients who are at risk for cardiovascular events and could benefit most from preventive treatment in comparison with more conventional statistical techniques. The importance of such tailored cardiovascular risk assessment and disease management in individual patients is far reaching given that cardiovascular disease is the leading cause of morbidity and mortality in the world. Nearly half of myocardial infarctions and strokes occur in patients who are not predicted to be at risk for cardiovascular events by current guideline-based approaches. Equally important are individuals who are not at risk for cardiovascular events and yet are given expensive and unnecessary preventive treatment with potential untoward side effects. The application of powerful artificial intelligence/deep learning tools in medicine is likely to result in more effective and efficient health care delivery with the potential for significant cost savings by shifting preventative treatment from inappropriate to appropriate patient subgroups.
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The present review aims to discuss the recent advances in surgical management of spontaneous intracerebral hemorrhage (ICH), safety and efficacy of minimally invasive surgical techniques, and the existing evidence supporting their use. ⋯ Newer surgical techniques, collectively referred to as minimally invasive surgery (MIS), have been evaluated and studied in management of ICH. Stereotactic evacuation of intracerebral hemorrhage using aspiration-irrigation technique has showed significant reductions in the hematoma volume with minimal intra-operative bleeding. Catheter-based evacuation in combination with use of recombinant tissue plasminogen activator (rt-PA) produces lysis and drainage of spontaneous ICH and intraventricular hemorrhage (IVH) rapidly with minimal major adverse events. Recent advances in the management of spontaneous ICH highlights potential advantages including safety and efficacy in clot lysis and reduction in hematoma volume especially with image-guided catheter-based drainage and concurrent use of rt-PA. Controlled trials are required to conclusively establish standard surgical techniques and rt-PA dosage, before incorporating minimally invasive surgery plus rt-PA, as a standard of care in patients with spontaneous ICH.
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This review aims to summarize and discuss the safety and efficacy of ulnar arterial approach for cardiac catheterization. ⋯ Ulnar access has been found to be as safe and efficacious as radial access. However, the number of access attempts and cross-over rates is higher than with radial access. Ulnar access is an excellent alternative after failed radial access as femoral access is associated with more bleeding and worse clinical outcomes. Future research should focus on ultrasound-guided ulnar access to reduce the number of puncture attempts.
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Review Meta Analysis
ECMO and Short-term Support for Cardiogenic Shock in Heart Failure.
This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure. ⋯ Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The "IMPRESS in severe shock" trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14-52%; p = 0.0008; NNT 3). ECMO is indicated in medically refractory cardiogenic shock. ECMO can be considered in cardiogenic shock patients with estimated mortality of more than 50%. ECMO is probably the MCS of choice in cardiogenic shock with; biventricular failure, respiratory failure, life-threatening arrhythmias and cardiac arrest.
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This review discusses the benefits of a completely percutaneous approach to endovascular aortic aneurysm repair (EVAR), and provides an outline as to how this is performed by a multidisciplinary team of cardiologists and cardiovascular surgeons at a quaternary care community hospital. ⋯ Percutaneous endovascular aortic aneurysm repair (PEVAR) as compared to EVAR utilizing surgical femoral artery exposure is associated with a significant reduction in operation time, length of stay, access site complications, patient discomfort, and procedural cost. Furthermore, PEVAR may be the preferred approach in patients presenting with aneurysm rupture, as the avoidance of general anesthesia has been associated with improved 30-day mortality. Assuming no contraindication based on vascular anatomy, clinical status, or patient preference, these findings suggest that in properly selected patients, PEVAR should be the primary method for abdominal aortic aneurysm repair in both stable and unstable patients.