scholarly journals B-lines by lung ultrasound is associated with pulmonary symptoms and cardiac function in acute malaria: a prospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Wegener ◽  
A Holm ◽  
L Gomes ◽  
K Lima ◽  
L Matos ◽  
...  

Abstract Background Malaria patients are at risk of cardiopulmonary complications, but diagnosis and management are difficult in resource limited environments. B-lines by lung ultrasonography (LUS) can identify pulmonary alterations, however, little is known about the usefulness in malaria. Purpose We aimed to investigate the occurrence of B-lines in acute malaria patients at baseline and at follow-up, and whether they are associated with shortness of breath and impaired left ventricular ejection fraction (LVEF). Methods Adult patients with non-severe acute malaria were prospectively enrolled from June to December 2020 in community healthcare clinics in a remote area. Patients were age- and sex-matched to controls without a prior history of malaria. We examined patients prior to anti-malaria treatment and at follow-up. Malaria treatment was administered according to national guidelines. Patients were excluded if they were pregnant, had concomitant infections or recent chest trauma. Patients underwent LUS (8-zones), echocardiography and peripheral blood smear. Measurements were blinded to clinical variables and outcomes. Results We included a total of 99 patients (median age 40±15 years, 55% men). Patients suffered from Plasmodium vivax (n=75), P. falciparum (n=22), and a mix of the two (n=2) and median parasite density was 1,595 parasites/mL (interquartile range [IQR] 528–6,585/mL). Follow-up was completed in 71 patients and the median follow-up time was 31 days (IQR 27–40 days). Patients with acute malaria had significantly more B-lines at baseline than matched controls (P-value<0.001) and fewer B-lines at follow-up (P-value<0.001) (Figure 1). In acute malaria patients, number of B-lines at baseline correlated significantly with shortness of breath (OR 1.20, [1.04 to 1.39], P-value=0.01) and with LVEF (adjusted for age and sex: +8% [+1% to +15%], P-value=0.016 per 1% decrease in LVEF). There was no correlation between number of B-lines and parasite density (+2% [−5% to +11%], P-value=0.53 per 1000 increase in parasite density). Conclusion B-lines detected by LUS are more frequent in patients with acute malaria than in age- and sex-matched controls and decrease in response to treatment. B-lines also correlate with shortness of breath and lower LVEF at baseline. Because LUS is a quick and accessible examination, it may potentially facilitate risk stratification and therapeutic decisions regarding cardiopulmonary complications in patients with acute malaria. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Danish Heart Association

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
J Gavara ◽  
V Marcos-Garces ◽  
C Rios-Navarro ◽  
MP Lopez-Lereu ◽  
JV Monmeneu ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Background. Cardiovascular magnetic resonance (CMR) is the best tool for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of sequential LVEF assessment for major adverse cardiac event (MACE) prediction after ST-segment elevation myocardial infarction (STEMI) is uncertain. Purpose. We explored the prognostic impact of sequential assessment of CMR-derived LVEF after STEMI to predict subsequent MACE. Methods. We recruited 1036 STEMI patients in a large multicenter registry. LVEF (reduced [r]: <40%; mid-range [mr]: 40-49%; preserved [p]: ≥50%) was sequentially quantified by CMR at 1 week and after >3 months of follow-up. MACE was regarded as cardiovascular death or re-admission for acute heart failure after follow-up CMR. Results. During a 5.7-year mean follow-up, 82 MACE (8%) were registered. The MACE rate was higher only in patients with LVEF < 40% at follow-up CMR (r-LVEF 22%, mr-LVEF 7%, p-LVEF 6%; p-value < 0.001). Based on LVEF dynamics from 1-week to follow-up CMR, incidence of MACE was 5% for sustained LVEF³40% (n = 783), 13% for improved LVEF (from <40 to ³40%, n = 96), 21% for worsened LVEF (from ³40% to <40%, n = 34) and 22% for sustained LVEF <40% (n = 100), p-value < 0.001. Using a Markov approach that considered all studies performed, transitions towards improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to higher incidence of subsequent MACE. Conclusions. LVEF constitutes a pivotal CMR index for simple and dynamic post-STEMI risk stratification. Detection of reduced LVEF (<40%) by CMR at any time during follow-up identifies a small subset of patients at high risk of subsequent events.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 149-149 ◽  
Author(s):  
Peter McSweeney ◽  
Daniel Furst ◽  
Leslie Crofford ◽  
Kevin McDonagh ◽  
Keith Sullivan ◽  
...  

Abstract Objective To evaluate long-term outcomes after HDIT and transplantation of autologous CD34+ hematopoietic progenitor cells in severe SSc. Methods: Eligibility required early (<= 4 years) diffuse SSc (modified Rodnan skin score [mRSS] of > 15) together with involvement of lungs, heart or kidneys (estimated median 5 year survival <= 50%). Pulmonary SSc was the most frequent indication for study inclusion. PBSC were obtained by G-CSF mobilization and CD34-selected with a Baxter Isolex 300i system. HDIT included total body irradiation 800 Gy (with lung shielding of the last 25 pts), cyclophosphamide 120 mg/kg and equine anti-thymocyte globulin 90 mg/kg. Follow-up included annual history and physical exams with complete workup for visceral involvement and questionnaires of overall function. Results: Of 33 pts (median mRSS = 30) follow-up includes 25 patients at one year, 19 pts at two years, 13 pts at three years and 5 pts at four years. Progression was defined as further loss of organ function or use of immunosuppressive therapy after HDIT. Ten pts died of which 5 were due to disease progression and 5 to transplant complications. Estimated 3-year overall and progression-free survivals are 79% (95% CI 65–93%) and 52% (95% CI 33–72%), respectively. Three late deaths from progression occurred at 1343, 1511 and 1801 days after HDIT. Four pts are alive with progressive disease. At 1 and 3 years after HDIT there were significant improvements in skin score and function (Table) with lung function indices overall remaining stable. Small increases in serum creatinine and decreases in the left ventricular ejection fraction were found. Five pts developed renal insufficiency and 2 required dialysis. Conclusions: HDIT appears to be a promising therapy for high-risk SSc pts but limitations include transplant toxicities and disease progression in some pts. To more clearly define the role of HDIT in severe SSc, a NIH-supported randomized multicenter study has been initiated in North America to compare HDIT against 12 doses of monthly intravenous cyclophosphamide at 750 mg/m2. Changes at 1 and 3 years after HDIT* Baseline 1 year p value 3 years p value *Values are means and mean changes from baseline. HAQ - health assessment questionnaire; DLCO- carbon monoxide diffusing capacity; FVC-forced vital capacity Skin (mRSS) 30.3 (n=33) −14.8 (n=24) p<0.0001 −23.3 (n=10) p<0.0001 HAQ (function) 1.84 (n=28) −1.06 (n=21) p<0.0001 −1.34 (n=10) p<0.0001 DLCO adj (%) 60.7 (n=33) −5.96 (n=25) p=0.01 −3 (n=13) p=0.56 FVC (%) 71.6 (n=33) +3.44 (n=25) p=0.02 +3.07 (n=13) p=0.05 Se. Creatinine (mg/dL) 0.75 (n=33) +0.30 (n=23) p=0.11 +0.15 (n=13) p=0.05 Ejection Fraction (%) 62.4 (n=30) −2.3 (n=18) p=0.16 −2.3 (n=7) p= 0.06


EP Europace ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. 1864-1872 ◽  
Author(s):  
Giovanni Peretto ◽  
Andrea Barison ◽  
Cinzia Forleo ◽  
Chiara Di Resta ◽  
Antonio Esposito ◽  
...  

Abstract Aims We aimed at addressing the role of late gadolinium enhancement (LGE) in arrhythmic risk stratification of LMNA-associated cardiomyopathy (CMP). Methods and results We present data from a multicentre national cohort of patients with LMNA mutations. Of 164 screened cases, we finally enrolled patients with baseline cardiac magnetic resonance (CMR) including LGE sequences [n = 41, age 35 ± 17 years, 51% males, mean left ventricular ejection fraction (LVEF) by echocardiogram 56%]. The primary endpoint of the study was follow-up (FU) occurrence of malignant ventricular arrhythmias [MVA, including sustained ventricular tachycardia (VT), ventricular fibrillation, and appropriate implantable cardioverter-defibrillator (ICD) therapy]. At baseline CMR, 25 subjects (61%) had LGE, with non-ischaemic pattern in all of the cases. Overall, 23 patients (56%) underwent ICD implant. By 10 ± 3 years FU, eight patients (20%) experienced MVA, consisting of appropriate ICD shocks in all of the cases. In particular, the occurrence of MVA in LGE+ vs. LGE− groups was 8/25 vs. 0/16 (P = 0.014). Of note, no significant differences between LGE+ and LGE− patients were found in currently recognized risk factors for sudden cardiac death (male gender, non-missense mutations, baseline LVEF &lt;45% and non-sustained VT), all P-value &gt;0.05. Conclusions In LMNA-CMP patients, LGE at baseline CMR is significantly associated with MVA. In particular, as suggested by this preliminary experience, the absence of LGE allowed to rule-out MVA at 10 years mean FU.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Burdeau ◽  
G Viart ◽  
E Gandjbakhch ◽  
A Savoure ◽  
B Godin ◽  
...  

Abstract Introduction Laminopathy (LMNA) is a group of rare disease caused by a mutation of lamin A/C genes. Heart transplantation (HT) is often required. Cardiac resynchronization therapy (CRT) may be an option to postpone HT. Purpose To describe characteristics and outcome of LMNA patients receiving CRT. Methods All consecutive LMNA patients implanted with a CRT device for conventional indications were included in the study. Clinical and echocardiographic (TTE) data were collected during the follow-up period. Results From 2002 to 2017, 68 LMNA patients had CRT implantation. Despite CRT, 30/68 patients (44%) had HT. Population divided into two groups according to response to CRT. Patients were considered without benefit (WHOB-CRT group) if they experienced severe events (inscription on heart transplantation list or death) within two years after CRT implantation. Other patients were in the WB-CRT group. TTE and clinical parameters are described in Table 1. Table 1 Parameters WB-CRT (n=33) WHOB-CRT (n=35) P-value At implantation   Age (years) 52.3±9.7 50.6±9.5 0.27   Women 9 (27%) 13 (37%) 0.45   NYHA class 2.7±0.6 2.8±0.7 0.45   LVEF (%) 33.2±8.8 31.3±7 0.64   LVEDD (mm) 60±6.9 60±6.9 0.96   TAPSE (mm) 23±3.7 14±4.8 0.002 At last follow up   NYHA class 2.2±0.6 2.9±0.7 <0.001   LVEF (%) 36.4±11 27±9 <0.001   LVEDD (mm) 59±5.5 59±7.7 0.98   TAPSE (mm) 19.9±5.5 12.3±3.3 0.003 Left ventricular ejection fraction (LVEF); Left ventricular end diastolic diameter (LVEDD); Tricuspid annular plane systolic excursion (TAPSE). Conclusion Cardiac resynchronization therapy is less efficient in LMNA patients. An impaired right ventricular stroke function seems to be the only predictive factor leading to poor response to CRT.


Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 216-222 ◽  
Author(s):  
Edimar Alcides Bocchi ◽  
Guilherme Veiga Guimarães ◽  
Luiz Felipe P. Moreira ◽  
Fernando Bacal ◽  
Alvaro Vilela de Moraes ◽  
...  

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Medina-Inojosa ◽  
A Ladejobi ◽  
Z Attia ◽  
M Shelly-Cohen ◽  
B Gersh ◽  
...  

Abstract Background We have demonstrated that artificial intelligence interpretation of ECGs (AI-ECG) can estimate an individual's physiologic age and that the gap between AI-ECG and chronologic age (Age-Gap) is associated with increased mortality. We hypothesized that Age-Gap would predict long-term atherosclerotic cardiovascular disease (ASCVD) and that Age-Gap would refine the ACC/AHA Pooled Cohort Equations' (PCE) predictive abilities. Methods Using the Rochester Epidemiology Project (REP) we evaluated a community-based cohort of consecutive patients seeking primary care between 1998–2000 and followed through March 2016. Inclusion criteria were age 40–79 and complete data to calculate PCE. We excluded those with known ASCVD, AF, HF or an event within 30 days of baseline.A neural network, trained, validated, and tested in an independent cohort of ∼ 500,000 independent patients, using 10-second digital samples of raw, 12 lead ECGs. PCE was categorized as low&lt;5%, intermediate 5–9.9%, high 10–19.9%, and very high≥20%. The primary endpoint was ASCVD and included fatal and non-fatal myocardial infarction and ischemic stroke; the secondary endpoint also included coronary revascularization [Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG)], TIA and Cardiovascular mortality. Events were validated in duplicate. Follow-up was truncated at 10 years for PCE analysis. The association between Age-Gap with ASCVD and expanded ASCVD was assessed with cox proportional hazard models that adjusted for chronological age, sex and risk factors. Models were stratified by PCE risk categories to evaluate the effect of PCE predicted risk. Results We included 24,793 patients (54% women, 95% Caucasian) with mean follow up of 12.6±5.1 years. 2,366 (9.5%) developed ASCVD events and 3,401 (13.7%) the expanded ASCVD. Mean chronologic age was 53.6±11.6 years and the AI-ECG age was 54.5±10.9 years, R2=0.7865, p&lt;0.0001. The mean Age-Gap was 0.87±7.38 years. After adjusting for age and sex, those considered older by ECG, compared to their chronologic age had a higher risk for ASCVD when compared to those with &lt;−2 SD age gap (considered younger by ECG). (Figure 1A), with similar results when using the expanded definition of ASCVD (data not shown). Furthermore, Age-Gap enhanced predicted capabilities of the PCE among those with low 10-year predicted risk (&lt;5%): Age and sex adjusted HR 4.73, 95% CI 1.42–15.74, p-value=0.01 and among those with high predicted risk (&gt;20%) age and sex adjusted HR 6.90, 95% CI 1.98–24.08, p-value=0.0006, when comparing those older to younger by ECG respectively (Figure 1B). Conclusion The difference between physiologic AI-ECG age and chronologic age is associated with long-term ASCVD, and enhances current risk calculators (PCE) ability to identify high and low risk individuals. This may help identify individuals who should or should not be treated with newer, expensive risk-reducing therapies. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Mayo Clinic


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Kavsur ◽  
C Iliadis ◽  
C Metze ◽  
M Spieker ◽  
V Tiyerili ◽  
...  

Abstract Background Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR). Aim We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure. Methods In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation. Results During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p&lt;0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029). Conclusion The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients. Funding Acknowledgement Type of funding source: None


Sign in / Sign up

Export Citation Format

Share Document