Hypertrophic cardiomyopathy is the most common genetic heart disease. Biomarkers, molecules measurable in the blood, could inform the clinician by aiding in diagnosis, directing treatment, and predicting outcomes. We present an updated review of circulating biomarkers in hypertrophic cardiomyopathy representing key pathologic processes including wall stretch, myocardial necrosis, fibrosis, inflammation, hypertrophy, and endothelial dysfunction, in addition to their clinical significance.
Objectives The HEART score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of three objective scoring models with the results of noninvasive cardiac testing. Methods Medical records for all patients evaluated in the chest pain center of an academic medical center during a one year period were reviewed retrospectively. Each patient’s history component score was calculated using three models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed. Results 749 patients were studied, 58 of which had an abnormal stress test or CTCA. The mean HEART scores for models 1, 2, and 3 were: 2.97 (SD 1.17), 2.57 (SD 1.25), and 3.30 (SD 1.35), respectively, and were significantly different (p<0.001). However, for each model, the likelihood of an abnormal cardiovascular test did not correlate with higher scores on the symptom component of the HEART score (p=0.09, 0.41 and 0.86, respectively). Conclusions While the objective scoring models produced different distributions of HEART scores, no model performed well with regards to identifying patients with abnormal advanced cardiac studies in this relatively low-risk cohort. Further studies in a broader cohort of patients, as well as comparison with the performance of subjective history scoring, is warranted prior to adoption of any of these objective models.
Background: The wearable-cardioverter defibrillator (WCD) tradename LifeVest has emerged as a temporary alternative to implantable cardioverter-defibrillator therapy. However, patient adherence can be variable. We sought to investigate if standardized device education and patient follow-up phone calls could lead to increased adherence. Methods: Patients prescribed a WCD from July 2017 to July 2018 comprised the pre-intervention group. The initial post-intervention group from January 2019 to May 2019 enrolled 32 patients. Each patient received standardized device education using a video presentation, and we sought to call each patient within 7 days of discharge to answer questions and administer a questionnaire. 14 patients comprised the second post-intervention group from March 2020 to May 2020, which received refined education with both a video presentation and 30-minute, standardized, hands-on training with the LifeVest representative, as well as similar follow-up phone calls for all patients within 7 days of discharge. Results: The pre-intervention group had a median wear time of 19.46 hours/day. In the first post-intervention group, all patients received standardized education; however, only 17 patients were contacted via phone due to time constraints. Patients with standardized education-only had a median wear time 21.55 hours/day, while patients who received both interventions had a median wear time of 23.01 hours/day. The increase in median wear time in pre-intervention compared to post-intervention groups was statistically significant (p= 0.0056) There was no significant difference between the two post-intervention groups (p=0.5485). In the second intervention group, median wear time significantly increased to 22.00 hours/day compared to the pre-intervention group (p=0.0244). Conclusions: Implementing standardized device education can improve median WCD wear time. The addition of post-discharge follow-up phone call did lead to improved mean and median wear times, but this was not statistically significant. Similar strategies could be cheaply and easily adopted at other centers in an effort to improve WCD adherence.
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