Use of the T-spot.TB test for the diagnosis of latent tuberculosis infection

Background:Tuberculosis (TB) represents a major health problem both in developing and both in industrialized countries.The identification of individuals latently infected with Mycobacterium tuberculosis (Mtb) play a key role for the efficacy of TB control. These individuals with a latent tuberculosis infection (LTBI), especially those with high risk of reactivation (e.g. HIV + / AIDS-infected individuals, patients undergoing immunosuppressive therapy and children younger than 5 years) could benefit from a preventive treatment with isoniazid reducing the risk of progression from LTBI to active TB. Until recently, detection of LTBI has relied on the tuberculin skin test (TST), but despite the widespread use in clinical practice,TST does not reliably diagnose LTBI because several drawbacks, e.g. lacking in specificity, particularly in who were exposed to non-tuberculous mycobacteria (NTM) or were vaccinated with Bacille Calmette-Guerin (BCG) In addition, in young subjects,TST sensitivity is hampered by impaired T cell function leading frequently to false negative results.These several drawbacks limit the use of TST for the diagnose an LTBI in patients who may benefit from preventive chemotherapy. On the other hand, an accurate diagnosis of LTBI avoid the over-treatment of those patients with a positive TST results but not latently infected with Mtb. Recently, new tests based on the detection of interferon-gamma (IFN-γ) after stimulation with Mtb-specific antigens: Early secretory Antigenic Target-6 (ESAT-6) and Culture Filtrate Protein-10 (CFP-10) have been proposed for the diagnosis of active TB and LTBI. Methods: During the period from January 2009 to June 2009, in our laboratory 70 patients were tested with T-SPOT.TB (Oxford Immunotech, Abingdon, United Kingdom).We enrolled transplant patients and subjects ongoing transplant, patients immigrants from high prevalence TB countries, patients screened for immunosuppressive treatment, HIV / AIDS – infected individuals.We also tested 3 patients with clinical / radiological suspicion of active TB and 3 patients with positive tuberculin skin test and with a positive direct examination for mycobacteria in the urinary sediment. Results: In 2 patients with symptoms suggestive of TB in place,T-SPOT.TB showed a higher response of (IFN-g), more than 100 spots.Among individuals ongoing renal transplant, 6 patients tested T-SPOT.TB positive and 4 subjects were T.SPOT.TB -negative. Two patients with an autoimmune disease showed an high response to Mtb-specific antigens with T-SPOT.TB test tested before to start any treatment.T-SPOT.TB test tested strongly negative in 4 paediatric patients and in one HIV-infected individuals, regardless a positive response to a internal positive response (phytohaemagglutinin (PHA), suggesting a normal immune response. Conclusions:This preliminary data suggest that the T.SPOT.TB showed high sensitivity and specificity, producing a strongly negative response to Mtb-specific antigens in subjects who had a history of previous BCG-vaccination. In addition, T-SPOT.TB test provides, unlike the TST, indication about the potential immunosuppression of tested patient with an internal positive control that can highlight the production of IFN- γ by lymphocytes resulting in the application of this test in immunocompromised patients, e.g. children and transplantated patients and others

The individual relationship between atrial fibrillation sources from CARTOFINDER mapping and atrial cardiomyopathy: the catch me if you can trial

Background Targeting individual sources identified during atrial fibrillation (AF) has been used as an ablation strategy with varying results. Objective Aim of this study was to evaluate the relationship between regions of interest (ROIs) from CARTOFINDER (CF) mapping and atrial cardiomyopathy from late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR). Methods Twenty consecutive patients underwent index catheter ablation for persistent AF (PERS AF). Pre-processed LGE CMR images were merged with the results from CF mapping to visualize harboring regions for focal and rotational activities. Atrial cardiomyopathy was classified based on the four Utah stages. Results Procedural success was achieved in all patients (n = 20, 100%). LGE CMR revealed an intermediate amount of 21.41% ± 6.32% for LA fibrosis. ROIs were identified in all patients (mean no ROIs per patient n = 416.45 ± 204.57). A tendency towards a positive correlation between the total amount of atrial cardiomyopathy and the total number of ROIs per patient (regression coefficient, β = 10.86, p = .15) was observed. The degree of fibrosis and the presence of ROIs per segment showed no consistent spatial correlation (posterior: β = 0.36, p-value (p) = .24; anterior: β = −0.08, p = .54; lateral: β = 0.31, p = 39; septal: β = −0.12; p = .66; right PVs: β = 0.34, p = .27; left PVs: β = 0.07, p = .79; LAA: β = −0.91, p = .12). 12 months AF-free survival was 70% (n = 14) after ablation. Conclusion The presence of ROIs from CF mapping was not directly associated with the extent and location of fibrosis. Further studies evaluating the relationship between focal and rotational activity and atrial cardiomyopathy are mandatory

First clinical experience using the DiamondTemp catheter and a novel omnipolar high-resolution mapping system for atrial fibrillation ablation

Background: The DiamondTemp (DT) radiofrequency ablation (RFA) catheter has been introduced as a new tool for atrial fibrillation (AF) ablation. The new technology allows for temperature-controlled irrigated ablation and real-time lesion assessment. Recently, the EnSite X mapping system became commercially available allowing for omnipolar and ultra-high-resolution mapping. We aimed to assess the feasibility of the new DT RFA catheter in performing AF ablation procedures in conjunction with the novel EnSite X system under routine clinical conditions. Methods: We analyzed data from 10 consecutive patients who underwent AF ablation using the DT RFA guided by EnSite X. Procedural data and short-term follow-up were assessed as well as potential technical issues. Results: Nine out of 10 patients underwent de-novo pulmonary vein isolation (PVI), and one patient underwent repeat ablation. First-pass isolation was observed in 7/10 patients. Total procedure duration (skin-to-skin) was 88.9 ± 30.1 min, and left atrium dwell time was 70 ± 22.3 min. The mean number of RF applications needed for PVI and additional ablation was 70.52 ± 26.70. The HD Grid SE mapping catheter was utilized in 8 patients and the Advisor SE in 2 patients. Bidirectional block of the applied lines was achieved in all patients. No steam pops were observed, and no intraprocedural complications occurred. Conclusions: This first clinical series demonstrated that temperature-controlled irrigated ablation in combination with the novel omnipolar and high-resolution mapping system resulted in rapid, efficient, and durable lesion formation under routine clinical conditions. Randomized controlled trials are needed to elucidate the impact on lesion formation, long-term outcomes, and reproducibility of our initial findings

Atrial Fibrillation and Heart Failure

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and has a strong association with heart failure (HF). It often remains unclear if HF is the cause or consequence of AF due to the complexity of the processes that are involved in both the perpetuation of AF and the development of HF. To date, two therapeutic strategies are accepted as the standard of care in AF patients with heart failure. Rhythm control aims to permanently restore sinus rhythm, whereas a rate-control strategy aims to slow ventricular rate without the termination of AF. In the last 5 years a tremendous number of important studies have been published investigating the optimal therapeutic strategy in HF patients. This review highlights the important studies with respect to the involvement of AF in promoting left-ventricular dysfunction and discusses the optimal strategy in HF patients suffering from AF

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Catheter ablation has emerged as an effective treatment for atrial arrhythmias, and pulmonary vein isolation (PVI) is the cornerstone of ablation strategies. Significant technological evolution and widespread increase in operator experience have facilitated the effectiveness of catheter ablation to achieve durable PVIs in single or multiple ablation procedures. Nevertheless, arrhythmia recurrence is a common problem even after establishing PVI. Data on catheter ablation in these patients are sparse and repeat ablation in this population is highly challenging. In this review we have summarized the available data as well as potential strategies of catheter ablation following the initial PVI

Ablation index-guided catheter ablation of incessant ventricular tachycardia originating from the anterolateral papillary muscle

Remote proctoring by advanced digital technologies may help to overcome pandemic, geographic, and resource-related constraints for mentoring and educating interventional cardiology skills. We present a case series of patients undergoing high-risk percutaneous coronary intervention (HR-PCI) with mechanical circulatory support (MCS) guided by remote proctoring to gain insights into a streaming technology platform with regard to video/audio quality, visibility of all structural and imaging details, and delay in transmission. According to our experience, remote proctoring appears to be a reliable, quick, and resource-conserving way to disseminate, educate and improve MCS-supported HR-PCI with implications far beyond the COVID-19 pandemic

A Machine Learning Challenge: Detection of Cardiac Amyloidosis Based on Bi-Atrial and Right Ventricular Strain and Cardiac Function

Background: This study challenges state-of-the-art cardiac amyloidosis (CA) diagnostics by feeding multi-chamber strain and cardiac function into supervised machine (SVM) learning algorithms. Methods: Forty-three CA (32 males; 79 years (IQR 71; 85)), 20 patients with hypertrophic cardiomyopathy (HCM, 10 males; 63.9 years (±7.4)) and 44 healthy controls (CTRL, 23 males; 56.3 years (IQR 52.5; 62.9)) received cardiovascular magnetic resonance imaging. Left atrial, right atrial and right ventricular strain parameters and cardiac function generated a 41-feature matrix for decision tree (DT), k-nearest neighbor (KNN), SVM linear and SVM radial basis function (RBF) kernel algorithm processing. A 10-feature principal component analysis (PCA) was conducted using SVM linear and RBF. Results: Forty-one features resulted in diagnostic accuracies of 87.9% (AUC = 0.960) for SVM linear, 90.9% (0.996; Precision = 94%; Sensitivity = 100%; F1-Score = 97%) using RBF kernel, 84.9% (0.970) for KNN, and 78.8% (0.787) for DT. The 10-feature PCA achieved 78.9% (0.962) via linear SVM and 81.8% (0.996) via RBF SVM. Explained variance presented bi-atrial longitudinal strain and left and right atrial ejection fraction as valuable CA predictors. Conclusion: SVM RBF kernel achieved competitive diagnostic accuracies under supervised conditions. Machine learning of multi-chamber cardiac strain and function may offer novel perspectives for non-contrast clinical decision-support systems in CA diagnostics

Syphilis serology: Seroprevalence in a selected population and considerations on the Euroline WB test

Introduction: The clinical diagnosis of syphilis is always supported by appropriate laboratory tests and the test results are interpreted with reference to the patient’s history. In the diagnosis of syphilis, the use of tests based on antibody search that recognize both treponemal and reaginic antigens increases the diagnostic chances. Our study discusses the various serological and alternative tests currently available along with their limitations, and relates their results to the likely corresponding clinical stage of the disease. Methods: in our laboratory were analyzed 264 sera and 4 liquor (123 Females, 145 Males). 187 patients are subject at low risk for luetic infection, including pregnant woman, patient with organ transplant, outpatients or hospitalized undergoing routine serological, and 81 from patients with confirmed syphilis including 4 pregnant women in antibiotic treatment, patients with suspected disease, HIV positive and patients with autoimmune diseases with Cardiolipin positive. All sera were tested with ELISA Anti-Treponema pallidum Screen (IgG / IgM) and in parallel with agglutination tests VDRL and TPHA. On all positive sera was tested Euroline-WB EUROIMMUN and reading done with the program EuroLineScan. Results: by ELISA Anti-Treponema pallidum Screen IgG / IgM 162 sera were negative and 106 sera positive (39.5%), distributed as follows: 45 (42%) with a value greater than 200 RU / ml, 43 (41% ) with a value> 22 RU / ml and 18 (17%) with a borderline value between> 16 to <22 RU / ml. The execution of the Blot IgG showed: 18 negative sera, 6 with borderline value with one only band of specific antigens (p15, p45, p47 or p17), while 82, including 4 liquor (neurolue), were certainly positive showing more than one band antibody to the treponemal antigens. Only one patient had in place at the time of screening, an initial infection; in fact, there was a single clear positivity in the IgM protein bands, while 7 sera was uncertain values. It is reported 11 positivity for IgM Cardiolipin, while Cardiolipin IgG was detected with a high positivity in 34 sera. The presence of borderline values and / or positivity for a single protein band can be attributed to a unspecific reaction caused by autoimmune diseases or related cross-reactions with other Spirochete or to other Borrelia. Conclusions: The immunoblot test gave useful information at epidemiological and clinical level. The deepening with a confirmation test with proteic antigens and cardiolipin identifies false reactivity, but also indicates the specific reactivity to past infection and a better characteriation in the different stages of disease. In our study in the latent forms there are relevant discrepancies among the various tests. Compare to traditional methods, anti-cardiolipin antibodies positivity in our confirmatory test has the advantage of providing non subjective interpretation, being based upon the EuroLineScan program