Search

[Display omitted] • Sepsis triggers are frequent, concerning almost 12% of unselected CS cases. • Sepsis trigger can be exclusive (2/3 cases) or associated with other CS triggers. • The other triggers are ischaemia, arrythmias or iatrogenesis. • Sepsis-triggered CS was more profound, with more severe organ dysfunction. • Sepsis-triggered CS required more use of vasopressors/inotropes and organ support. • Sepsis-triggered CS was associated with higher short- and long-term death rates. Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock. FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1 year. Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; P = 0.16), norepinephrine (72.5% vs. 50.8%; P < 0.01), renal replacement therapy (29.7% vs. 14%; P < 0.01), non-invasive ventilation (36.3% vs. 24.4%; P = 0.09) and invasive ventilation (52.7% vs. 35.9%; P = 0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36–2.76; P < 0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32–2.33; P < 0.01) all-cause death rates. No significant difference was found at 1 year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32–1.64; P = 0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death. The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy. [ABSTRACT FROM AUTHOR]

[Display omitted] • CKD was present in 21.3% of unselected cardiogenic shock patients. • CKD patients were older with more comorbidities and previous cardiac disease. • CKD was independently associated with higher 1-month and 1-year all-cause death. • Acute kidney injury requiring de-novo RRT is a strong predictor of death. Chronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs – the so-called "cardiorenal syndrome". Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce. FRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors. CKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9 years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1 month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01–1.9; P = 0.04) and 1 year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09–1.77; P < 0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1 month and 1 year regardless of baseline CKD status. Cardiogenic shock and CKD are frequent "cross-talking" conditions with limited therapeutic options, resulting in higher rates of death at 1 month and 1 year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff's familiarity with existing guidelines. An online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated. Respondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters. Improvements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff. [ABSTRACT FROM AUTHOR]

Rates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation. This was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012–31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people. There were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02–1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15–1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7–13.2 months). Rates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised. [ABSTRACT FROM AUTHOR]

Cardiac uptake on technetium-99m whole-body scintigraphy (WBS) is almost pathognomonic of transthyretin cardiac amyloidosis. The rare false positives are often related to light-chain cardiac amyloidosis. However, this scintigraphic feature remains largely unknown, leading to misdiagnosis despite characteristic images. A retrospective review of all WBSs in a hospital database to detect those with cardiac uptake may allow the identification of undiagnosed patients. The authors sought to develop and validate a deep learning–based model that automatically detects significant cardiac uptake (Perugini grade ≥2) on WBS from large hospital databases in order to retrieve patients at risk of cardiac amyloidosis. The model is based on a convolutional neural network with image-level labels. The performance evaluation was performed with C-statistics using a 5-fold cross-validation scheme stratified so that the proportion of positive and negative WBSs remained constant across folds and using an external validation data set. The training data set consisted of 3,048 images: 281 positives (Perugini grade ≥2) and 2,767 negatives. The external validation data set consisted of 1,633 images: 102 positives and 1,531 negatives. The performance of the 5-fold cross-validation and external validation was as follows: 98.9% (± 1.0) and 96.1% for sensitivity, 99.5% (± 0.4) and 99.5% for specificity, and 0.999 (SD = 0.000) and 0.999 for the area under the curve of the receiver-operating characteristic curves. Sex, age <90 years, body mass index, injection-acquisition delay, radionuclides, and the indication of WBS only slightly affected performances. The authors' detection model is effective at identifying patients with cardiac uptake Perugini grade ≥2 on WBS and may help in the diagnosis of patients with cardiac amyloidosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Severe aortic stenosis (AS) has been associated with bleeding. However, there is a lack of prospective assessment of bleeding events and their clinical significance in a large population of outpatients with variable degree of AS severity. To assess the incidence, source, determinants, and prognostic impact of major bleeding in patients with variable degree of AS severity. Between May 2016 and December 2017, consecutive outpatients were included. Major bleeding was defined as type ≥3 bleed using the Bleeding Academic Research Consortium definition. Cumulative incidence was calculated with death as the competing event. Data was censored at time of aortic valve replacement. Among 2,830 patients, 46 major bleeding events occurred (0.7%/year) during a median follow-up of 2.1 years (interquartile range: 1.4-2.7). Most frequent sites of bleeding were gastrointestinal (50%) and intracranial (30.4%). Major bleeding was significantly associated with all-cause mortality (hazard ratio: 5.93 (95% confidence interval 3.64-9.65); P <.001). AS severity was associated with major bleedings (P =.041). By multivariable analysis, severe AS was an independent determinant of major bleeding (hazard ratio vs mild AS: 3.59 [95% confidence interval 1.56-8.29]; P =.003). The increased risk of bleeding associated with severe AS was significantly exacerbated in patients using oral anticoagulation. In AS patients, major bleeding is rare but a strong independent predictor of death. AS severity is a determinant of bleeding events. Severe AS and oral anticoagulation should be identified as an association at very high risk of major bleeding. [Display omitted] [ABSTRACT FROM AUTHOR]

Study Objective: To validate the use of an innovative navigation method for sacrospinous fixation in surgery-like conditions as a new teaching tool and surgical method.Design: Two-month experimental prospective pilot study between July and August 2021.Setting: Biomechanics laboratory academic research.Patients: A total of 29 participants took part in the study: 9 gynecological surgeons and 20 participants with no medical background.Interventions: All participants used the 2 mocks-up.Measurements and Main Results: The experiment was composed of 2 training phases dedicated to improving the hand-eye coordination and suture skills on a training mock-up and of a suturing phase on a pelvic mock-up designed to recreate the surgery-like conditions of a sacrospinous fixation. The surgeons provided qualitative feedback on the bio-accuracy of the mock-ups and evaluated the ease of use of the navigation software. Nonsurgeons were included to assess the progression of the suture performance between 2 experiments performed 1 week apart (session 1 and 2). The main objective for participants was to reach a virtual target and to stitch sacrospinous ligaments. For session 1, an overall comfort score of 7.2 of 10 was attributed to the tool; 14 (42%) surgeon suture attempts and 63 (65%) nonsurgeon suture attempts were accurate (i.e., below the 5-mm threshold). Twenty-two (67%) surgeon suture attempts and 28 (34%) nonsurgeon suture attempts were fast (i.e., in the first 2 quantiles of the duration dataset). An improvement in the nonsurgeon performance was observed between the 2 sessions in terms of duration (session 1: 46 ± 20 s; session 2: 37 ± 18 s; p = .047) and distance (session 1: 3.8 ± 1.3 mm; session 2: 3.2 ± 1.4 mm; p = 10-5) for the last suturing exercise.Conclusion: This new motion capture-based navigation method for sacrospinous fixation tested under surgery-like conditions seemed to be accurate and effective. The next step will be to design a pelvis model more adapted to the constraints of a sacrospinous fixation and to validate the benefits of this method compared with current techniques. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old. 30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording. Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years. We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome. • Outcome of neonates with HIE remains uncertain. • Adding EEG and EP data after rewarming to clinical data improved the accuracy of a prediction model. • EEG and EP should be performed after withdrawal of TH to predict the outcome of neonates with HIE. [ABSTRACT FROM AUTHOR]

Several pulmonary arterial hypertension (PAH) risk assessment tools (i.e. risk of all-cause death) exist. Yet their performances within a cohort of heart failure (HF) patients with post-capillary pulmonary hypertension (pcPH) have never been explored. To assess the discrimination performance of usual PAH risk assessment tools in a cohort of pcPH patients. HF patients with stable left heart disease and the need for right heart catheterization at rest were enrolled from 2010 to 2018 and followed-up in this prospective multicenter study. pcPH was defined as a mPAP > 20 mmHg with a PAWP > 15 mmHg according to the 2022 ESC guidelines. The following PAH risk assessment tools were used: REVEAL 2.0 (3-strata and continuous score system), REVEAL Lite (abredged version of REVEAL), COMPERA 2.0 (4-strata) and the French method. Three-years all-cause death was the primary outcome. In total, 519 HF patients were enrolled (59% male, median age 62 yo, mPAP averaged 37 mmHg): 441 (85%) had at least the 7-requested variables for REVEAL2.0 calculation and 319 (61%) the 3-requested variables for COMPERA2.0 or the noninvasive French method calculation. For each of the methods, the higher the score, the better the long-term survival (log-rank P < 0.001, Figures 1 and 2). Each of the method had fair to good discrimination performance. REVEAL2.0 continuous score depicted the highest c-index (0.66, 95%CI [0.62–0.72]) followed by REVEAL2.0 3-strata system (0.63, 95%CI [0.60–0.70]), REVEAL Lite (0.59, 95%CI [0.56–0.62]), COMPERA2.0 (0.59, 95%CI [0.54–0.64]) and the French method (0.54, 95%CI [0.51–0.57]). PAH risk assessment tools may be used for pcPH risk assessment with fair-to-good discrimination power, especially REVEAL2.0. Further research should be focused on risk assessment in this particular population of HF patients. [ABSTRACT FROM AUTHOR]

Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of non-ischemic cardiomyopathy (NICM) worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on one-year outcomes after CS in IDCM and non-IDCM patients. FRENSHOCK was a prospective registry including 772 CS patients from 49 centers. One-year outcomes (rehospitalizations, mortality, heart transplantation [HTx], ventricular assist devices [VAD]) were analysed, adjusted on independent predictive factors. Within 772 CS included, 78 occurred in IDCM (10.1%) (Fig. 1). IDCM patients had more frequent history of chronic kidney failure and ICD implantation. No difference was found in 1-month all-cause mortality between groups (28.2 vs. 25.8% respectively for IDCM and others, aHR 1.14 [0.73–1.77], P = 0.57). Non-IDCM were more frequently treated with non-invasive ventilation and IABP. At 1-year, IDCM led to higher rates of death or cardiovascular rehospitalizations (aOR 4.77 [95% CI 1.13–20.1], P = 0.03) and higher rate of HTx or VAD for individuals under 65 years old (aOR 2.68 [1.21–5.91], P = 0.02). CS in IDCM is a very common scenario and is associated with a higher rate of 1-year death or cardiovascular rehospitalizations, and a more frequent recourse to HTx or VAD for individuals < 65 years old, encouraging to consider it as a red flag for myocardial decline, urging to closer follow-up and earlier evaluation for advanced heart failure therapies. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)