A new study shows that magnetic resonance imaging (MRI) scans are the safest and most effective way to identify high risk patients with cardiac chest pain.
The research, funded by the British Heart Foundation (BHF), showed that cardiac MRI was better overall at predicting serious events, such as death or heart attack, following chest pain suspected to be angina.
The researchers from the University of Leeds carried out a five-year follow-up study in 750 people, to find out the best way of separating patients based on whether they were at high- or low-risk of serious heart events.
They compared MRI scans, a non-invasive test which does not use potentially dangerous radiation, with SPECT, a procedure which uses ionizing radiation and is commonly used in the diagnosis of coronary heart disease.
Coronary heart disease (CHD), the world’s biggest killer, is responsible for nearly 70,000 deaths in the UK each year, an average of 190 people each day, or one death around every eight minutes.
Most deaths from CHD are caused by a heart attack. CHD occurs when the vital arteries which serve the heart are narrowed or blocked by a build-up of fatty tissues. This can cause chest pain, or angina, which can lead to a heart attack if left untreated.
When a person has suspected angina, they are most likely to be tested with either an X-ray angiogram, an invasive procedure which uses a type of radio-opaque dye to image the inside of the arteries, or SPECT, a non-invasive procedure which also involves ionizing radiation. Ionizing radiation is damaging to living cells.
In contrast, MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body, and are already widely used to help diagnose other medical conditions.
The paper resulted from a large five year follow-up study and follows a series of papers from the original CE-MARC (Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease) study.
These papers have contributed to the growing body of evidence that cardiac MRI is the best option for the diagnosis and management of patients with coronary heart disease.
Earlier evidence from this BHF-funded study also showed that MRI is more cost-effective than SPECT in the diagnosis of coronary heart disease.
This research is expected to inform future clinical guidelines for the investigation of stable coronary heart disease. In doing so it could ease pressure on the NHS as only one hospital appointment is required for MRI, compared with two for SPECT.
Professor John Greenwood from the School of Medicine, who led the research, said: ‘Although SPECT is currently more widely available than MRI, the use of MRI across a wide spectrum of diseases means that it will be much more readily available for heart disease investigation in coming years.

University of Leeds http://tinyurl.com/z7cc2ny

Agfa HealthCare has joined the Watson Health medical imaging collaborative, a global initiative comprised of more than fifteen leading health systems, academic medical centres, ambulatory radiology providers and imaging technology companies. The collaborative aims to bring cognitive imaging into daily practice to help doctors address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease and related conditions, such as stroke.
Members of the collaborative plan to put Watson to work to extract insights from previously invisible’ unstructured imaging data and combine that with a broad variety of data from other sources. In doing so, the efforts may help physicians make personalized care decisions relevant to a specific patient while building a body of knowledge to benefit broader patient populations. This information may include data from electronic health records, radiology and pathology reports, lab results, doctors’ progress notes, medical journals, clinical care guidelines and published outcomes studies.
Initial plans include training Watson and evaluating potential new offerings in a variety of patient care environments ranging from stand-alone ambulatory settings to integrated health delivery networks. The aim in doing so is to gather data based on diverse real-world experience and to share findings to inform how the medical community might reduce operational and financial inefficiencies, improve physician workflows, and adopt a patient-focused approach to improving patient care and outcomes.
‘With an ability to draw insights from massive volumes of integrated structured and unstructured data sources, cognitive computing could transform how clinicians diagnose, treat and monitor patients,’ said Anne Le Grand, vice president of Imaging for Watson Health. ‘Through IBMs medical imaging collaborative, Watson may create opportunities for radiologists to extract greater insights and value from imaging data while better managing costs.’
James Jay, Vice President Imaging IT and Integrated Care Solutions businesses at Agfa HealthCare, elaborates: ‘We are very excited about the opportunity to collaborate with IBM and Watson. Healthcare systems are under enormous pressure to improve productivity; our combined expertise has the capability to harness the untapped power of technology to deliver the gains that have so far only been achieved in isolated use cases. Together we will look for ways to advance our customers’ ability to leverage the analytics power of Watson united with our own Enterprise Imaging platform, to assure that the right knowledge is available, at the right time, to help diagnose and treat their patients. We will be diving into specific use cases to turn the power of big data into real, tangible applications focused on specific improvements in either speed or accuracy of decisions.’
Watson is the first commercially available cognitive computing capability representing a new era in computing. The system, delivered through the cloud, analyses high volumes of data, understands complex questions posed in natural language, and proposes evidence-based answers. Watson continuously learns, gaining in value and knowledge over time, from previous interactions. In April 2015, the company launched IBM Watson Health and the Watson Health Cloud platform. The new unit will help improve the ability of doctors, researchers and insurers to innovate by surfacing insights from the massive amount of personal health data being created and shared daily. The Watson Health Cloud allows this information to be de-identified, shared and combined with a dynamic and constantly growing aggregated view of clinical, research and social health data.

http://tinyurl.com/hxnrlns

Preeclampsia – the onset of high blood pressure resulting from pregnancy – is a leading cause of death and complications for women in the days following childbirth and discharge from the hospital. The sooner the doctors can detect the condition getting worse after delivery, the greater the chance there is of successful treatment with medication. However, since there is currently no effective way of predicting who is at-risk for increasing blood pressure, by the time worsening conditions are identified, patients often require more intensive care.
Recent ACOG guidelines recommend blood pressure monitoring via routine follow-up office visits within 72 hours of discharge and again at seven to ten days after childbirth. However, as many as 70 percent of patients do not attend these first follow-up appointments. With this in mind, and based on data showing that young women have high rates of cell phone use and text messaging, the Penn team hoped to determine whether implementing a remote blood pressure monitoring system for patients diagnosed with preeclampsia would allow them to identify advanced cases and intervene before hospital readmission is necessary.
‘Platforms that take advantage of telemedicine technology allow clinical care teams to evaluate, diagnose and treat patients remotely, and have been well established as an effective means of delivering care across a variety of specialties,’ said lead author Adi Hirshberg, MD, a fellow in the department of Obstetricics and Gynecology at the Hospital of the University of Pennsylvania. ‘By monitoring blood pressure levels for our postpartum patients who are at home with new babies and can’t always get to office visits, we can provide a convenient and effective way of identifying those who are at risk for complications and may require follow-up care before the situation becomes critical.’
In the study, 32 patients previously diagnosed with preeclampsia were given blood pressure cuffs when discharged from the hospital after childbirth. For seven days following discharge, text messages were sent reminding patients to take a daily blood pressure reading and send the results to their care provider. Patients whose blood pressure was high were then asked to take additional readings. Eighty four percent of participants reported a blood pressure reading within 24 or 48 hours of discharge, and 65 percent continued reporting test results for at least five of the seven days. As a result of the reports, two patients were identified as having elevated blood pressure and were put on oral medications, but none of the participants required readmission to the hospital.
‘Our results show that remote blood pressure monitoring via text messaging is an effective, convenient and patient-centred way of identifying patients who could be at risk of developing potentially life-threatening complications related to the condition,’ said senior author Sindhu Srinivas, MD, MSCE, director of Obstetrical Services at the Hospital of the University of Pennsylvania.

Perelman School of Medicinehttp://tinyurl.com/j6xkp3q

Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Berard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital revealed. Prof. Berard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies. ‘The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role,’ she explained. ‘Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.’
Berard and her colleagues worked with data from the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten. In addition to information about the mother’s use of antidepressants and the child’s eventual diagnosis of autism, the data included a wealth of details that enabled the team to tease out the specific impact of the antidepressant drugs. For example, some people are genetically predisposed to autism (i.e., a family history of it.) Maternal age, and depression are known to be associated with the development of autism, as are certain socio-economic factors such as being exposed to poverty, and the team was able to take all of these into consideration.
‘We defined exposure to antidepressants as the mother having had one or more prescription for antidepressants filled during the second or third trimester of the pregnancy. This period was chosen as the infant’s critical brain development occurs during this time,’ Prof. Berard said. ‘Amongst all the children in the study, we then identified which children had been diagnosed with a form of autism by looking at hospital records indicating diagnosed childhood autism, atypical autism, Asperger’s syndrome, or a pervasive developmental disorder.
Finally, we looked for a statistical association between the two groups, and found a very significant one: an 87% increased risk.’ The results remained unchanged when only considering children who had been diagnosed by specialists such as psychiatrists and neurologists.
The findings are hugely important as six to ten percent of pregnant women are currently being treated for depression with antidepressants.

University of Montreal http://tinyurl.com/zgflp3h