CJC Open最新文献

Background

Methods

Results

Conclusions

Background

Methods

Results

Conclusions

Background

Methods

Results

Conclusions

Background

The prevalence of infective endocarditis (IE) and its associated mortality rates remain high, despite medical advances. In recent years, treatment options for IE have expanded, but they are yet to be widely utilized. The current study aimed to compare in-hospital outcomes of high-risk tricuspid valve (TV) IE patients, by treatment strategy.

Methods

Patients from the National Inpatient Sample 2017-2019 database who had TV IE were grouped by therapy type—percutaneous aspiration, surgical, or conservative management. Patients were considered to be at high risk if they underwent mechanical intervention or if they had right ventricle failure or septic emboli.

Results

The analyzed cohort consisted of 28,495 patients—1.7% were treated with percutaneous aspiration, 13.5% with surgery, and 84.6% conservatively. Patients treated with percutaneous aspiration had the highest prevalence of septic shock and acute respiratory failure (P < 0.001). The overall in-hospital mortality rate was 7%. Patients treated conservatively had higher in-hospital mortality rates (7.5%) compared to those of the surgical group (4.4%) and the percutaneous aspiration group (4.1%; P < 0.001). In a multivariate analysis, conservative management was associated with an increased risk of in-hospital mortality (odds ratio 2.853, 95% confidence interval 1.748-4.659, P < 0.001), and no significant difference was found between the aspiration and surgical groups (P = 0.346). Benefits were pronounced in younger patients and those with septic shock or respiratory failure. Patients in the aspiration group had the highest rate of home discharge with self-care, of the various patient dispositions (P < 0.001).

Conclusions

Among high-risk patients with TV IE, an invasive approach is associated with a significantly lower in-hospital mortality rate than is a conservative approach, particularly in younger and unstable patients.

Background

Heart donation (HD) by those with death determination by circulatory criteria (DDCC) has been proposed as a method to increase the heart donor pool in response to the growing need for heart transplantation (HT). However, the potential level of HD after DDCC in the province of Québec has not yet been reported. This study aims to assess the suitability for HD among donors with DDCC, and to estimate its impact on HT activity.

Methods

Donation records by those with DDCC in the province of Québec, from January 2016 to December 2020, were retrospectively reviewed for donor and predonation characteristics. Predetermined exclusion criteria were used to evaluate eligibility for HD.

Results

Of the 122 patients with DDCC who were included, 42 (34%) were identified as potentially-eligible heart donors. The median age of potentially-eligible donors was 52 years; 60% were female; and the most prevalent causes leading to organ donation in this group were medical aid in dying (26%), traumatic brain injury (26%), and anoxia (24%). A 19% increase (42 of 225) in potential HT activity was estimated using strict criteria. In only one case did functional warm ischemia time exceed the 30-minute limit.

Conclusions

Using those with DDCC as a new source of heart donors can significantly increase the volume of heart donation in the province of Québec. Implementing an HD program for those with DDCC in Québec may reduce waiting time and increase the number of heart recipients.

Background

Risk stratification in inherited arrhythmia syndromes is challenging. Implantable cardioverter defibrillators (ICDs) are effective in the prevention of sudden cardiac death but are associated with significant complications. We aimed to determine the value of long-term implantable loop recorder (ILR) monitoring to determine risk factors for arrhythmias in inherited arrhythmia patients.

Methods

We conducted a prospective multicentre study between 2015 and 2020 recruiting inherited arrhythmia probands and family members at intermediate arrhythmic risk, with no class 1 indication for ICD implantation. The primary endpoint was the detection by ILR of nonsustained ventricular tachycardia over ≥ 10 consecutive beats. Secondary endpoints included ICD insertion during follow-up, all-cause mortality, and ILR complication rates.

Results

A total of 45 individuals (30 female participants) were enrolled in the study. The most common diagnoses were long-QT syndrome (28%), Brugada syndrome (26%), and arrhythmogenic cardiomyopathy (11%). Following ILR insertion (mean follow-up 633 days; range, 387-969), cardiac symptoms occurred in 19 of 45 patients (42%), 5 of whom had nonsustained ventricular tachycardias (11%), which were symptomatic in 3 individuals. This situation led to ICD implantation based on ILR in 5 of 45 patients (11%). Fifty percent of symptomatic events occurred in ARVC patients. The median time from ILR insertion to ICD implantation was 152 days (interquartile range (25th, 75th percentiles) 55 of 209). No patient experienced sudden cardiac death.

Conclusions

ILRs enable the detection of high-risk arrhythmic features and facilitate selection of ICD candidates in inherited arrhythmia patients with borderline indications.

Background

Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.

Methods

Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.

Results

A total of 5,841,453 people, representing 23.0% (95% confidence interval [CI] 21.7%-24.2%) of Canadian adults, were hypertensive. The adjusted odds ratio (aOR) of having hypertension treated and controlled was higher in people with the following conditions, as compared to people without these conditions: a prior heart attack or stroke (aOR 3.15; 95% CI 2.31-4.31); dyslipidemia (aOR 2.51; 95% CI 1.96-3.21); obstructive sleep apnea (aOR 1.95; 95% CI 1.19-3.21); overweight or obesity (aOR 1.51; 95% CI 1.18-1.94); chronic kidney disease (aOR 1.49; 95% CI 1.13-1.95); and diabetes (aOR 1.44; 95% CI 1.12-1.86). Individuals without any of these comorbidities were less likely to have BP that is treated and controlled (aOR 0.34; 95% CI 0.25-0.48). Moreover, the prevalence of BP treatment and control was low among many people without prior heart attack or stroke, even those with a moderate (aOR 0.25; 95% CI 0.17-0.37) or high (aOR 0.10; 95% CI 0.06-0.16) Framingham risk.

Conclusions

Large differences in levels of BP control exist across comorbidity profiles, and the greatest gaps are seen in individuals without recognized comorbidities, even those who have a moderate-to-high Framingham risk. Efforts to optimize BP control and narrow care gaps, especially in individuals without recognized comorbidities, are necessary to reduce the burden of cardiovascular disease and premature death in Canada.

Background

Many clinicians consider thermodilution (TD) as a means to measure cardiac output (CO) to be unreliable in patients with tricuspid regurgitation (TR). No systematic appraisals of this clinical issue have been conducted. We hypothesized that the level of inaccuracy of using TD in patients with TR, compared to the direct Fick (DF) method, to determine CO, is overstated.

Methods

We performed a systematic search of 6 major literature databases for the period from 1946 to July 2023. Studies were included if they included CO measurements determined with both TD and the DF method in patients with vs without TR. Meta-analysis of the correlation between the measurements determined by TD vs the DF method was performed, stratified by the presence of TR.

Results

A total of 1064 studies were identified, of which 8 met the inclusion criteria. Four of the studies were included in the pooled analysis. The presence of TR did not affect the correlation between CO measurements determined by TD vs the DF method (moderate-to-severe TR: r = 0.90, 95% confidence interval 0.76, 0.96; mild or no TR, r = 0.86, 95% confidence interval 0.71, 0.93). Many studies had high levels of heterogeneity and risk of bias.

Conclusions

The accuracy of CO measurements made using TD, compared to the gold-standard DF method, may not be meaningfully affected by the presence of moderate-to-severe TR. Given the high levels of heterogeneity and risk of bias of the included studies, these findings should be replicated in a modern cohort.