Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations.

PURPOSE OF REVIEW: Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. RECENT FINDINGS: Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation

Heart Transplant Outcomes for Patients with Myocarditis

Myocarditis is a known etiology of both acute fulminant heart failure and chronic dilated cardiomyopathy requiring heart transplantation. We sought to evaluate the long-term post-transplant outcomes of pts with myocarditis. We evaluated the UNOS registry for all heart transplant (HT) recipients from 1987 to 2019. Comparisons between pt characteristics of HT recipients with myocarditis (N=649) and HT recipients without a diagnosis of myocarditis (N=62,493) are reported using standard statistical methods including Cox proportional hazards regression for survival analysis. Myocarditis HT recipients were younger (29.6 ± 20.7 vs. 46.8 ± 19.1, p<0.001) and more likely to be female (44.1% vs. 26.0%, p<0.001). Myocarditis HT recipients were less likely to be DM (6.6% vs. 20.7%, p<0.001) and to have undergone prior cardiac surgery (7.6% vs. 18.4%, p<0.001). In terms of transplant related factors, myocarditis HT recipients were likely to receive a younger donor (23.3 ± 15.0 vs. 28.3 ± 13.9, p<0.001) and have shorter ischemic times (p<0.001). Prior to transplant, the myocarditis HT recipients were a sicker cohort and more likely to require ECMO [6.0% vs. 1.0%, p<0.001), VAD support (34.4% vs. 25.0%, p<0.001), and MV (13.4% vs. 4.2%, p<0.001). Median (interquartile range) time on the wait list was significantly shorter for myocarditis HT recipients [37.0 (12.0, 100.0) days vs. 83.0 (26.0, 231.0) days, p<0.001]. There was a lower overall post-transplant mortality in the myocarditis HT recipients (26.0% vs. 34.2%, p<0.001). Myocarditis HT recipients tend to be a younger population with less underlying co-morbidities such as DM and prior cardiac surgery, but they are more likely to be more acutely sick at the time of heart transplantation requiring mechanical ventilation, ECMO, or VAD support. Myocarditis HT recipients have shorter organ wait times and have more favorable transplant related factors, and ultimately have a lower overall mortality compared to recipients without myocarditis

Comparison of Six-Month Outcomes in Patients with Cardiac Amyloidosis before and after the UNOS Allocation System Change

Advanced amyloid cardiomyopathy (ACM) patients have high waitlist (WL) mortality. Given the greater emphasis and clarity for status exceptions for ACM patients in the new allocation system, we sought to assess whether this change in the allocation policy would affect the WL and post-transplant outcomes in ACM pts. Thirty-five patients were identified in the UNOS database that underwent heart transplant (HT) with a prior diagnosis of ACM during a 6-month period immediately before and after the policy change. Comparisons between patient characteristics in the pre (n=24) and post (n=11) policy-change cohorts are reported using standard statistical methods; survival analysis was performed using Cox proportional hazards modeling. The WL statuses of the pre patients were 1A (n=15), 1B (n=5), 2 (n=4) while the WL statuses of the post patients were 2 (n=7), 3 (n=2), 4 (n=2). The recipient age, donor age, gender, ethnicity, diabetes status, and ischemic time were similar for both groups. Total days on WL for pre and post were similar (26.0 days vs 29.0 days, p=0.82). The use of IABP was greater following the policy change (55% post vs 4% pre, p<0.001). Pre-transplant hemodynamic parameters and serum creatinine were similar before and after the policy change. Additionally, there was no difference in 6-month survival between the groups (p=0.58). The heart allocation policy change did not significantly decrease wait list times in ACM patients awaiting heart transplant, however there was significant greater utilization of pre-transplant IABP use. There were overall fewer patients that underwent HT in the 6 months following implementation of the new system, and there was no observed difference in 6-month post-HT survival for patients with ACM in the new allocation system

Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group

Item does not contain fulltextFlow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as 'normal', 'suggestive of', or 'diagnostic of' MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.1 juli 201