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Cardiovascular damage is a common complication of sepsis, with an incidence of 10% to 70%. Septic cardiomyopathy (SCM) occurs in ICUs as a reversible myocardial damage in sepsis patients. Despite various proposed diagnostic tools, none are specifically tailored for SCM. This study aims to evaluate different echocardiography-based diagnostic tools and determine the SCM rate in our population. A single-centre, prospective observational study was conducted at a tertiary reference hospital from March to May 2024. Patients meeting Sepsis-3 criteria, aged over 18 years, and treated in the ICU were included. Ethical approval was obtained from the regional ethical committee. Transthoracic echocardiogram (TTE) and hemodynamic measurements were performed within 48 hours of patient identification and repeated within 10 days. A diagnosis of septic cardiomyopathy (SCMP) was evaluated using three different diagnostic tools: left ventricular ejection fraction (LVEF <50% or >10% decrease from baseline), cardiac power output (CPO <0.6W), and afterload-related cardiac performance (ACP <80%) based on values reported in the literature. Demographic and descriptive data were extracted from electronic medical records. Results: Thirty-eight patients (mean age 61±13 years; 63.2% males) were enrolled. The median SOFA score was 9.5 [IQR, 8-11], APACHE II score 19 [16-22], and SAPS II 42 [32-51]. Median lactate levels were 3.1 [2.1-4.9] mmol/L, WBC count 16 [12-21] x10^9/L, PCT 11.2 [3.5–31.7] ng/mL, CRP 300 [179-407] mg/L, and troponin I 214 [47-627] ng/L. The median time between TTEs was 6 [4-9] days. In patients diagnosed with SCMP based on LVEF, seven (19.4%) had SCMP, showing significantly lower velocity time integral (VTI: 13.2±3.3 vs 18.1±4.7 cm, p=0.013) and stroke volume (SV: 50.4±13.8 vs 67.7±18.5 ml, p=0.026), and higher heart rate (HR: 106±14 vs 87±20 bpm, p=0.028) compared to non-SCMP patients (n=31, 80.6%). For CPO-based diagnosis, six patients (20.7%) had SCMP, with significantly lower VTI (13.2±2.8 vs 17.9±4.9, p=0.029), SV (47.2±11.5 vs 67.5±18.5 ml, p=0.015), and cardiac output (CO: 3.9±0.5 vs 6.1±1.7 L/min, p<0.001), and a trend towards lower cardiac index (CI: 1.7±0.5 vs 2.6±0.8 L/min/m2, p=0.07) compared to twenty-nine non-SCMP patients. The prevalence of SCMP based on ACP was higher than in the LVEF or CPO group, with eighteen patients (51.4%) diagnosed with SCMP. Seventeen patients had slightly restricted cardiac function (ACP 60-80%) and one had moderately restricted cardiac function (ACP 40-60%). Comparatively, ACP-based SCMP patients had significantly lower mean arterial pressure (MAP: 98±17 vs 109±12 mmHg, p=0.025), CI (2.2±0.7 vs 2.8±0.8 l/min/m2, p=0.011), CO (4.6 [4.0-5.5] vs 6.4 [5.5-7.1] L/min, p=0.005), and SV (55 [43-66] vs 70 [59-82] ml, p=0.013), but higher central venous pressure (CVP: 15±6 vs 11±6 mmHg, p=0.032) than the seventeen non-SCMP patients. No significant differences were observed in lactate levels, VIS score, and survival rates between SCMP and non-SCMP groups. Based on the three diagnostic tools, the prevalence of SCM in our study group varied from 19.4% to 51.4% and did not differ from the rates reported in the literature. Further analysis is necessary to determine the best diagnostic tool for SCM, requiring a larger sample group. [ABSTRACT FROM AUTHOR]

Background: The Hydra CE study revealed 1-year favorable efficacy of TAVR, showing a large effective orifice area (EOA), low gradient, and acceptable complication rates., Aims: We evaluated the 3-year clinical and hemodynamic outcomes of Hydra self-expanding transcatheter aortic valve (manufactured by Vascular Innovations Co Ltd, Nonthaburi, Thailand; a subsidiary of Sahajanand Medical Technologies Limited, India) in patients with symptomatic severe aortic stenosis at high or extremely high surgical risk., Methods: The Hydra CE study was a prospective, multicenter, single-arm study. A total of 157 patients were enrolled in the study, out of whom 54 patients from two centers (Lithuania and Poland) had provided consent for long-term follow-up at recruitment, with a planned 5-year follow-up period. The primary endpoint was all-cause mortality, and patients were followed up for up to 3 years, with an assessment of clinical and echocardiographic outcomes., Results: Among the 54 patients, the average age was 81.0 ± 4.1 years. The mean STS score was 3.2 ± 2.0%. At 3 years, all-cause mortality had occurred in 14.8% of patients, including 3.7% cardiovascular deaths and 1.9% device-related deaths. There was a progressive enhancement in EOA that is, 0.68 ± 0.15 cm 2 at baseline to 1.97 ± 0.52 cm 2 at 3 years (p < 0.001) as well as significant improvement in the mean aortic valve gradient that is, 53.4 ± 14.24 mmHg at baseline to 8.6 ± 2.80 mmHg at 3 years (p < 0.001). New permanent pacemaker implantation rates up to 3-year follow-up was 12.9%., Conclusion: The 3-year results of the Hydra CE study demonstrated consistent improvements in hemodynamics over time. The study also revealed favorable safety and efficacy trends, along with low occurrences of new permanent pacemaker implantations and paravalvular leaks., (© 2024 Wiley Periodicals LLC.)

Competing Interests: Dr. Eustaquio Maria Onorato is a Consultant for Occlutech, manufacturer of the paravalvular leak closure device used and described in this publication. He also is Co-Principal Investigator for international, multi-center follow-up study monitoring the efficacy and safety of Occlutech PLD in patients with mitral or aortic paravalvular leak. Others authors declare no conflict of interest.

Background: Rapid right ventricular pacing (RRVP) at rates above 200 beats/minute is used to suppress cardiac output during balloon aortic valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI) patients. A risk of inducing myocardial ischemia with RRVP remains, especially in patients with left ventricular dysfunction. Alternatively, a transient cardiac arrest can be achieved with administration of adenosine., Methods: The primary endpoint was successful valvuloplasty defined by complete balloon inflation and deflation across aortic valve during the transient asystole induced by adenosine. Secondary endpoints were defined as the failure of adenosine to induce asystole, the incidence of ventricular ectopic beats (VEB) during balloon inflation or deflation, and balloon displacement., Results: From November 2010 to January 2011, twenty consecutive patients who underwent TAVI were included. A balloon for valvuloplasty was positioned across the aortic valve. A low-dose (24 mg, n = 10) or high-dose (36 mg, n = 10) bolus of adenosine was administrated. A single bolus of adenosine-induced atrioventricular (AV) block (mean duration, 18.6 ± 6.6 seconds) followed by cardiac asystole in 16 patients (80%) (low-dose, n = 9). A successful BAV was achieved in 12 patients (60%) (low-dose, n = 8). Adenosine induced only bradycardia in 4 patients (20%) (low-dose, n = 1). A burst of VEB during BAV occurred in all patients. Balloon displacement occurred in 6 patients (37.5%)., Conclusion: BAV after administration of adenosine is feasible, safe, and may represent an option for high-risk TAVI patients in whom RRVP might not be well tolerated. The occurrence of ventricular ectopic contractions triggered by balloon inflation and deflations accounts for balloon displacement and crossover to RRVP.