Real-World Relevance of Manual Electrocardiography QT Interval Measurement

Background: Electrocardiography (ECG) QT interval (QTI) prolongation independently predicts sudden death. Hospitalized patients are commonly exposed to multiple QT-prolonging drugs, and manual measurement of ECG QTI based on identifying the intersection of isoelectricity with the tangent to the terminal phase T-wave slope (QTTTT) is advocated due to inaccuracies in automated detection algorithms that may imprecisely identify QT duration. Purpose: We evaluated the performance of QTTTT compared to a standard automated (12SL, GE Healthcare) method (QT-12SL). Methods: Consecutively obtained ECGs of 250 hospitalized patients were reviewed. The QTI in leads II, aVR, V5 and V6 determined by QT-12SL and QTTTT were compared. ECGs in which QT-12SL and QTTTT differed by \u3e 10 ms were further characterized. Results: The T-wave end was not reliably identified in 6 ECGs (2.4%). Of the remaining 244 ECGs (976 leads), QTTTT differed from QT-12SL by \u3c 10 ms in 52 ECGs (21.3%). QT-12SL differed from QTTTT by \u3e 10 ms in lead II in 140 leads (14.3%), V5 in 149 leads (15.3%), V6 in 152 leads (15.6%) and aVR in 143 leads (14.7%). ECGs with mutually exclusive lead combinations in which QTTTT differed from QT-12SL by \u3e 10 ms were: 1) II, aVR, V5, V6 (39.8%); 2) V5, V6 (7.8%); 3) II, aVR (4.9%); and 4) II, V5, V6 (3.7%). The expected overestimation of QTI by QT-12SL compared to QTTTT exceeded 10 ms in 105 leads (10.8%), related to T-waves with “normal” appearance, or biphasic (negative-to-positive) morphology; U-wave; and TP segment voltage exceeding PR segment voltage. Compared to QTTTT, QT-12SL underestimated QTI in 479 leads (49.1%), in association with biphasic T-waves (positive-to-negative); atrial arrhythmias; downsloping baseline near the T-wave end resulting in TP segment voltage less than PR segment voltage; and slow return of T-wave terminus to baseline. Conclusion: Multiple clinical and electrical phenomena impacted automated QTI determination. QT-12SL and QTTTT were comparable across all analyzed leads in only 1/5 of ECGs. Compared to QTTTT, QT-12SL QTI determinations were discordant in 3/5 of all leads, and underestimated QTI nearly half the time. Perhaps most important, for a given ECG, manual review of any of the analyzed leads identified these differences 2/3 of the time

Effect of pulmonary hypertension on patients with aortic stenosis who undergo transcatheter aortic valve replacement

Background: Pulmonary hypertension (PHTN) is associated with worse outcome after surgical aortic valve replacement. The effect of severe PHTN has not been well-studied in patients who undergo transcatheter aortic valve replacement (TAVR). We compared patients with and without severe PHTN who undergo TAVR. Methods:From January 2012 to September 2013, 46 patients with severe aortic stenosis underwent TAVR at our institution. Right ventricular systolic pressure (RVSP), a surrogate for PHTN, was measured. Outcomes were compared between patients with (RVSP \u3e 50 mmHg) or without (RVSP Results: Of 46 TAVR patients, 18 (39%) had severe PHTN and 28 (61%) did not. The severe PHTN group had more men; all other clinical characteristics, number of interventions required, symptoms and operative mortality (STS score) were similar. Patients with severe PHTN had a larger left atrium and higher right-sided pressure; other echocardiographic and angiographic characteristics were similar. One-year mortality was higher in patients with severe PHTN (50% vs. 14%, log-rank p=0.0075). After adjusting for STS score, PHTN remained a strong predictor of mortality (hazard ratio 6.31, 95% confidence interval 1.68-23.70) (Figure). Patients with severe PHTN required longer use of inotropes; however, length of stay and need for intervention were similar. Conclusion: One-year mortality following TAVR is significantly higher in patients with severe PHTN

Exploring a Secured Socket Python Flask Framework in Real Time Communication System

Communication networks makes it easier to connect internationally in today's world. Chat systems, such as WhatsApp, Twitter, Instagram and others, enable people to connect and chat over the internet. This chat system has evolved into one of the most important intermediate tools for people to exchange information and materials over the internet, thereby requiring secured socket system. In a social cultural environment, communication with a given network goal system necessitates a stress-free method of knowledge delivery. Surfing websites like "My Room" and "Facebook" has become a common occurrence among the younger generation. Nowadays, social networking websites are an important part of people's social, educational, and professional lives. The aim of this study is to create a group communication framework that uses a protected socket browser interface. This architecture was created with a server scripting language, a SQLite database model, and Python web application frameworks in mind

Hypertrophic cardiomyopathy with aortic dilation: a novel observation

AIMS: Our goal was to identify the prevalence of aortic dilation in patients with hypertrophic cardiomyopathy (HCM), the most prevalent (0.2%) heritable, genetic cardiovascular disease. Aortic dilation also represents a spectrum of familial inheritance. However, data regarding the prevalence of aortic dilation in HCM patients is lacking. METHODS AND RESULTS: This is an observational retrospective study of all patients referred to our HCM centre. Aortic dilation was defined based on recent American Society of Echocardiography and European Association of Cardiovascular Imaging published guidelines. Of the 201 HCM patients seen between Jan. 1, 2011 and March 31, 2014, 18 (9.0%) met the definition of aortic dilation. Mean age was 56.3 ± 9.3 years, 77.8% were male, mean ascending aorta diameter was 4.0 ± 0.4 cm in males and 3.8 ± 0.2 cm in females, mean sinuses of Valsalva diameter was 4.2 ± 0.2 cm in males and 3.8 ± 0.4 cm in females, and 13 (72.2%) had left ventricular outflow tract obstruction. HCM patients with dilated aorta were more likely males, less likely hypertensive and had larger left ventricle diameter and more aortic valve regurgitation; remaining characteristics were similar. CONCLUSION: We report a novel observation with 9.0% prevalance of dilated aorta in HCM patients. Further studies are needed to help define the genetic and pathophysiologic basis as well as the clinical implications of this association in a larger group of HCM patients