Purpose: In a preclinical study using a swine myocardial infarction (MI) model, a delayed enhancement (DE)-multi-detector computed tomography (MDCT) scan was performed using a hybrid system alongside diagnostic invasive coronary angiography (ICA) without the additional use of a contrast agent, and demonstrated an excellent correlation in the infarct area compared with histopathologic specimens. In the present investigation, we evaluated the feasibility and diagnostic accuracy of a myocardial viability assessment by DE-MDCT using a hybrid system comprising ICA and MDCT alongside diagnostic ICA without the additional use of a contrast agent. Materials and Methods: We prospectively enrolled 13 patients (median age: 67 years) with a previous MI (>6 months) scheduled to undergo ICA. All patients underwent cardiac magnetic resonance (CMR) imaging before diagnostic ICA. MDCT viability scans were performed concurrently with diagnostic ICA without the use of additional contrast. The total myocardial scar volume per patient and average transmurality per myocardial segment measured by DE-MDCT were compared with those from DE-CMR. Results: The DE volume measured by MDCT showed an excellent correlation with the volume measured by CMR (r=0.986, p<0.0001). The transmurality per segment by MDCT was well-correlated with CMR (r=0.900, p<0.0001); the diagnostic performance of MDCT in differentiating non-viable from viable myocardium using a 50% transmurality criterion was good with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 87.5%, 99.5%, 87.5%, 99.5%, and 99.1%, respectively. Conclusion The feasibility of the DE-MDCT viability assessment acquired simultaneously with conventional ICA was proven in patients with chronic MI using DE-CMR as the reference standard.

Background and Objectives: Although various cardiac parameters on echocardiography have clinical importance, their measurement by conventional manual methods is time-consuming and subject to variability. We evaluated the feasibility, accuracy, and predictive value of an artificial intelligence (AI)-based automated system for echocardiographic analysis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The AI-based system was developed using a nationwide echocardiographic dataset from five tertiary hospitals, and automatically identified views, then segmented and tracked the left ventricle (LV) and left atrium (LA) to produce volume and strain values. Both conventional manual measurements and AI-based fully automated measurements of the LV ejection fraction and global longitudinal strain, and LA volume index and reservoir strain were performed in 632 patients with STEMI. Results: The AI-based system accurately identified necessary views (overall accuracy, 98.5%) and successfully measured LV and LA volumes and strains in all cases in which conventional methods were applicable. Inter-method analysis showed strong correlations between measurement methods, with Pearson coefficients ranging 0.81–0.92 and intraclass correlation coefficients ranging 0.74–0.90. For the prediction of clinical outcomes (composite of all-cause death, re-hospitalization due to heart failure, ventricular arrhythmia, and recurrent myocardial infarction), AI-derived measurements showed predictive value independent of clinical risk factors, comparable to those from conventional manual measurements. Conclusions Our fully automated AI-based approach for LV and LA analysis on echocardiography is feasible and provides accurate measurements, comparable to conventional methods, in patients with STEMI, offering a promising solution for comprehensive echocardiographic analysis, reduced workloads, and improved patient care.

Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. Case: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam’s involvement. The patient was discharged without complications. Conclusions: This case challenges our understanding of remimazolam’s dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.

Background and Objectives: Although various cardiac parameters on echocardiography have clinical importance, their measurement by conventional manual methods is time-consuming and subject to variability. We evaluated the feasibility, accuracy, and predictive value of an artificial intelligence (AI)-based automated system for echocardiographic analysis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The AI-based system was developed using a nationwide echocardiographic dataset from five tertiary hospitals, and automatically identified views, then segmented and tracked the left ventricle (LV) and left atrium (LA) to produce volume and strain values. Both conventional manual measurements and AI-based fully automated measurements of the LV ejection fraction and global longitudinal strain, and LA volume index and reservoir strain were performed in 632 patients with STEMI. Results: The AI-based system accurately identified necessary views (overall accuracy, 98.5%) and successfully measured LV and LA volumes and strains in all cases in which conventional methods were applicable. Inter-method analysis showed strong correlations between measurement methods, with Pearson coefficients ranging 0.81–0.92 and intraclass correlation coefficients ranging 0.74–0.90. For the prediction of clinical outcomes (composite of all-cause death, re-hospitalization due to heart failure, ventricular arrhythmia, and recurrent myocardial infarction), AI-derived measurements showed predictive value independent of clinical risk factors, comparable to those from conventional manual measurements. Conclusions Our fully automated AI-based approach for LV and LA analysis on echocardiography is feasible and provides accurate measurements, comparable to conventional methods, in patients with STEMI, offering a promising solution for comprehensive echocardiographic analysis, reduced workloads, and improved patient care.

Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. Case: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam’s involvement. The patient was discharged without complications. Conclusions: This case challenges our understanding of remimazolam’s dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.

Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. Case: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam’s involvement. The patient was discharged without complications. Conclusions: This case challenges our understanding of remimazolam’s dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.

Background and Objectives: Although various cardiac parameters on echocardiography have clinical importance, their measurement by conventional manual methods is time-consuming and subject to variability. We evaluated the feasibility, accuracy, and predictive value of an artificial intelligence (AI)-based automated system for echocardiographic analysis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The AI-based system was developed using a nationwide echocardiographic dataset from five tertiary hospitals, and automatically identified views, then segmented and tracked the left ventricle (LV) and left atrium (LA) to produce volume and strain values. Both conventional manual measurements and AI-based fully automated measurements of the LV ejection fraction and global longitudinal strain, and LA volume index and reservoir strain were performed in 632 patients with STEMI. Results: The AI-based system accurately identified necessary views (overall accuracy, 98.5%) and successfully measured LV and LA volumes and strains in all cases in which conventional methods were applicable. Inter-method analysis showed strong correlations between measurement methods, with Pearson coefficients ranging 0.81–0.92 and intraclass correlation coefficients ranging 0.74–0.90. For the prediction of clinical outcomes (composite of all-cause death, re-hospitalization due to heart failure, ventricular arrhythmia, and recurrent myocardial infarction), AI-derived measurements showed predictive value independent of clinical risk factors, comparable to those from conventional manual measurements. Conclusions Our fully automated AI-based approach for LV and LA analysis on echocardiography is feasible and provides accurate measurements, comparable to conventional methods, in patients with STEMI, offering a promising solution for comprehensive echocardiographic analysis, reduced workloads, and improved patient care.

Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. Case: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam’s involvement. The patient was discharged without complications. Conclusions: This case challenges our understanding of remimazolam’s dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.

Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. Case: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam’s involvement. The patient was discharged without complications. Conclusions: This case challenges our understanding of remimazolam’s dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.

Background and Objectives: Although various cardiac parameters on echocardiography have clinical importance, their measurement by conventional manual methods is time-consuming and subject to variability. We evaluated the feasibility, accuracy, and predictive value of an artificial intelligence (AI)-based automated system for echocardiographic analysis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The AI-based system was developed using a nationwide echocardiographic dataset from five tertiary hospitals, and automatically identified views, then segmented and tracked the left ventricle (LV) and left atrium (LA) to produce volume and strain values. Both conventional manual measurements and AI-based fully automated measurements of the LV ejection fraction and global longitudinal strain, and LA volume index and reservoir strain were performed in 632 patients with STEMI. Results: The AI-based system accurately identified necessary views (overall accuracy, 98.5%) and successfully measured LV and LA volumes and strains in all cases in which conventional methods were applicable. Inter-method analysis showed strong correlations between measurement methods, with Pearson coefficients ranging 0.81–0.92 and intraclass correlation coefficients ranging 0.74–0.90. For the prediction of clinical outcomes (composite of all-cause death, re-hospitalization due to heart failure, ventricular arrhythmia, and recurrent myocardial infarction), AI-derived measurements showed predictive value independent of clinical risk factors, comparable to those from conventional manual measurements. Conclusions Our fully automated AI-based approach for LV and LA analysis on echocardiography is feasible and provides accurate measurements, comparable to conventional methods, in patients with STEMI, offering a promising solution for comprehensive echocardiographic analysis, reduced workloads, and improved patient care.