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Pubblicazioni recenti - pediatric cardiac
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Significant Improvements in Mortality after the Fontan Operation in Children with Down Syndrome.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31381-5.
Sarno Lauren A, Walters Henry L, Bondarenko Igor, Thomas Ronald, Kobayashi Daisuke,
Abstract
BACKGROUND:
Down syndrome (DS) is considered a risk factor for mortality associated with the Fontan operation. The objective was to show the contemporary short-term outcome of the Fontan operation for a functionally univentricular heart in patients with DS and non-DS, along with an analysis of significant predictors for in-hospital mortality.
METHODS:
This was a retrospective study using the Society of Thoracic Surgeons Congenital Database to assess in-hospital mortality and its predictors in patients with DS and non-DS undergoing the Fontan operation over 16 years (2001-2016). The primary outcome was in-hospital mortality. Statistical analysis was performed using univariable and multivariable logistic regression models.
RESULTS:
Our study cohort consisted of 12,074 patients (81 DS and 11,993 non-DS). The overall in-hospital mortality rate significantly improved in the recent era (2009 - 2016): 2.4% to 1.3%, p<0.001. The DS group had a higher in-hospital mortality rate (12.3% vs. 1.6%, p<0.001) with an odds ratio of 8.6 [95% confidence interval: 4.4 to 17.0]. The DS group had a higher 30-day mortality rate, a longer median post-operative length of stay, and a higher incidence of post-operative complications. The multivariable model showed that DS was the strongest predictor of in-hospital mortality with an odds ratio of 11.6 [95% confidence interval 5.1 to 26.4], adjusted for other significant variables including era effect, weight and primary cardiac diagnosis.
CONCLUSIONS:
The in-hospital mortality for the Fontan operation significantly improved in the contemporary era. Down syndrome was a significant risk factor for in-hospital morbidity and mortality associated with the Fontan operation.
Copyright © 2019. Published by Elsevier Inc.
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Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance.
Am J Med2019 Sep;():. doi: S0002-9343(19)30766-1.
Mahajan Shiwani, Gu Jianlei, Lu Yuan, Khera Rohan, Spatz Erica S, Zhang MaoZhen, Sun NingLing, Zheng Xin, Zhao Hongyu, Lu Hui, Ma Zheng J, Krumholz Harlan M,
Abstract
BACKGROUND:
Blood pressure is a physiologic measure that reflects cardiac output and systemic vascular resistance. Classification by these components could be useful in characterizing subtypes of hypertension which may have a role in selecting treatment strategies. However, hemodynamic phenotypes of a large, stable, outpatient population with hypertension remain unknown.
METHODS:
We included 34,238 people, with systolic blood pressure of ?130mmHg, who underwent impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between 2012 and 2018. Hemodynamic parameters measured included: stroke volume, stroke volume index, heart rate, cardiac output, cardiac index, systemic vascular resistance, and systemic vascular resistance index. We characterized these by systolic blood pressure categories and assessed patient characteristics associated with the ratio of cardiac index to systemic vascular resistance index.
RESULTS:
Among the study cohort (n=33,414; mean age 52±13years; 36.6% female), 49%, 40%, and 11% had systolic blood pressure130-139, 140-159, and?160mmHg, respectively. Among patients with systolic blood pressure 140-159mmHg, 9353 (70%) had high systemic vascular resistance index but normal/low cardiac index, 1949 (15%) had high cardiac index but low/normal systemic vascular resistance index, and 2053 (15%) had low/normal cardiac index and systemic vascular resistance index. Using multivariable analysis, we found that cardiac index to systemic vascular resistance index ratio was negatively associated with age and body mass index (all P<0.05; R-square 0.16, 0.12 and 0.09 for systolic blood pressure 130-139, 140-159 and?160mmHg, respectively).
CONCLUSIONS:
Different hemodynamic blood pressure phenotypes were identified across all hypertensive blood pressure categories. While individual characteristics were associated with the cardiac index to systemic vascular resistance index ratio, they only weakly explained the variation.
Copyright © 2019. Published by Elsevier Inc.
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Maternal folic acid supplementation does not counteract the deleterious impact of prenatal exposure to environmental pollutants on lipid homeostasis in male rat descendants.
J Dev Orig Health Dis2019 Sep;():1-11. doi: 10.1017/S2040174419000497.
Navarro Pauline, Dalvai Mathieu, Charest Phanie L, Herst Pauline M, Lessard Maryse, Marcotte Bruno, Mitchell Patricia L, Leblanc Nadine, Kimmins Sarah, Trasler Jacquetta, MacFarlane Amanda J, Marette André, Bailey Janice L, Jacques Hélène,
Abstract
Prenatal exposure to persistent organic pollutants (POPs) has been associated with the development of metabolic syndrome-related diseases in offspring. According to epidemiological studies, father's transmission of environmental effects in addition to mother's can influence offspring health. Moreover, maternal prenatal dietary folic acid (FA) may beneficially impact offspring health. The objective is to investigate whether prenatal FA supplementation can overcome the deleterious effects of prenatal exposure to POPs on lipid homeostasis and inflammation in three generations of male rat descendants through the paternal lineage. Female Sprague-Dawley rats (F0) were exposed to a POPs mixture (or corn oil) +/- FA supplementation for 9 weeks before and during gestation. F1 and F2 males were mated with untreated females. Plasma and hepatic lipids were measured in F1, F2, and F3 males after 12-h fast. Gene expression of inflammatory cytokines was determined by qPCR in epididymal adipose tissue. In F1 males, prenatal POPs exposure increased plasma lipids at 14 weeks old and hepatic lipids at 28 weeks old and prenatal FA supplementation decreased plasma total cholesterol at 14 weeks old. Prenatal POPs exposure decreased plasma triglycerides at 14 weeks old in F2 males. No change was observed in inflammatory markers. Our results show an impact of the paternal lineage on lipid homeostasis in rats up to the F2 male generation. FA supplementation of the F0 diet, regardless of POPs exposure, lowered plasma cholesterol in F1 males but failed to attenuate the deleterious effects of prenatal POPs exposure on plasma and hepatic lipids in F1 males.
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Ratings of Perceived Exertion During Walking Predicts Endurance Independent of Physiological Effort in Older Women.
J Strength Cond Res2019 Sep;():. doi: 10.1519/JSC.0000000000003268.
Hunter Gary R, Neumeier William H, Chandler-Laney Paula C, Carter Stephen J, Borges Juliano H, Hornbuckle Lyndsey M, Plaisance Eric P, Fisher Gordon,
Abstract
Hunter, GR, Neumeier, WH, Chandler-Laney, PC, Carter, SJ, Borges, JH, Hornbuckle, LM, Plaisance, EP, and Fisher, G. Ratings of perceived exertion during walking predicts endurance independent of physiological effort in older women. J Strength Cond Res XX(X): 000-000, 2019-This study aimed to determine whether ratings of perceived exertion (RPE) and physiological effort at different exercise intensities relate to exercise endurance. Ninety-eight sedentary women (older than 60 years) completed 3 submaximal locomotion tasks: (a) stair climbing, (b) flat walking at 2 mph, and (c) grade walking at 2 mph. Maximal treadmill endurance was measured at least 3 days before the submaximal tests. Oxygen uptake was measured during all tests, and RPE were collected for the submaximal tasks. Ratings of perceived exertion during moderate-intensity exercise (walking on the flat at 43% V[Combining Dot Above]O2max, partial R = -0.35, p < 0.01), but not higher intensity exercise (grade walk at 59% V[Combining Dot Above]O2max, p = 0.49, and stair climbing at 67% V[Combining Dot Above]O2max, p = 0.17), were related to endurance even after adjusting for aerobic capacity and physiological effort (composite of maximal heart rate, ventilation, and respiratory exchange ratio). However, physiological effort was significantly related to endurance for the higher intensity exercise (both grade walk and stair climbing partial R >-0.24, p < 0.02). Similar to previous findings that subjective ratings of fatigue at rest were related to RPE during low/moderate-intensity exercise, but not higher intensity exercise, these data further support Ekkekakis's dual-mode hypothesis that cognitive factors influence RPE during low/moderate-intensity exercise. A practical application is that the coach and personal trainer should know that physiological effort seems to play a greater role in influencing endurance than RPE as intensity of exercise increases.
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Cleft lip repair: are outcomes between unilateral and bilateral clefts comparable?
J Plast Surg Hand Surg2019 Sep;():1-4. doi: 10.1080/2000656X.2019.1661848.
Chouairi Fouad, Mets Elbert J, Torabi Sina J, Alperovich Michael,
Abstract
This study sought to compare patient demographics, operative course, and peri-operative outcomes between unilateral and bilateral cleft patients. Primary cleft lip repairs were isolated from the National Surgical Quality Improvement Program Pediatric Database (NSQIP-P). Unilateral and bilateral cases of primary cleft lip were identified by ICD codes. Demographics, comorbidities, and post-operative outcomes were compared between cohorts. Patients were propensity matched to control for differences before repeating the analysis. About 4550 cleft lip repairs were evaluated over the 5-year period. Of the cases where the cleft type was identifiable, 75.5% were unilateral clefts and 24.5% were bilateral clefts. The bilateral cleft population had significantly more comorbidities including higher rates of ventilator dependence (1.0% versus 0.4%, ?=?0.02), asthma (1.6% versus 0.7%, ?=?0.011), tracheostomy (1.6% versus 0.5%, ?
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Medic One Pediatric (MOPed) cards: standardising paramedic paediatric resuscitation.
BMJ Open Qual2019 ;8(3):e000534. doi: 10.1136/bmjoq-2018-000534.
Woods Brandon, Lang Benjamin, Blayney Carolyn, O'Mahony Lila, Vander Tuig Amanda, Rea Tom, Carlbom David, Sayre Michael, King Mary,
Abstract
Objective:
Paediatric resuscitation is highly stressful, technically challenging and infrequently performed by paramedics. Length-based equipment selection, weight-based medication dosing and less familiar paediatric clinical scenarios create high cognitive load. Our project aimed to decrease cognitive load and increase paramedic comfort by providing standardised paediatric resuscitation cards across an entire Emergency Medical Services (EMS) system.
Methods:
After 2 years of collaboration between EMS and regional paediatric subspecialists, we created and implemented a novel set of length-based, colour-coded cards: Medic One Pediatric (MOPed) cards. MOPed cards standardise the approach to paediatric scenarios, such as rapid sequence intubation (RSI), seizure management and cardiac arrest. We standardised drug concentrations across all five EMS agencies to allow for volume-based dosing, removing medication calculations, simplifying the process of medication administration and potentially decreasing both calculation error and time to intervention. We consolidated medications on MOPed cards to the 12 most commonly used in Paediatric Advanced Life Support scenarios. We surveyed 240 EMS personnel before and after implementation to determine use and effect on paramedic comfort.
Results:
After 12 months of implementation, 97% of respondents reported using the new cards as their primary reference, and 94% reported improved speed and accuracy of medication administration. Specifically, RSI medication administration received the greatest improvement in comfort (p=0.001). Additionally, paramedics increased the use of MOPed cards when selecting endotracheal tubes: 45% of the respondents had done so by 6 months, and 60% had done so after 12 months of implementation (p=0.01).
Conclusions:
MOPed cards were well adopted across a large EMS system, with improvement in paramedic comfort in managing some paediatric resuscitation scenarios.
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Rare Conduction Abnormality in a Four-year-old Child with Carbamazepine Acute Poisoning.
Maedica (Buchar)2019 Jun;14(2):165-168. doi: 10.26574/maedica.2019.14.2.165.
Vivisenco Cristina Iolanda, Ulmeanu Coriolan Emil,
Abstract
Cardiac conduction abnormalities are reported after ingestion of a toxic dose of carbamazepine. We describe the case of a four-year-old child with carbamazepine acute poisoning who developed reversible synoatrial block along with neurological toxic signs, despite a serum level of carbamazepine close to the upper limit of the therapeutic range. Although carbamazepine-induced sinoatrial block has been reported in the literature even at therapeutic doses in adult patients, our personal research has not identified any record of this cardiac conduction abnormality in acute carbamazepine poisoning at pediatric age. The electrocardiogram is indispensable in the assessment and monitoring of pediatric cases with acute poisoning with carbamazepine.
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Building Resilience Against the Sequelae of Adverse Childhood Experiences: Rise Up, Change Your Life, and Reform Health Care.
Am J Lifestyle Med;13(5):470-479. doi: 10.1177/1559827619839997.
Ortiz Robin,
Abstract
A reformed approach to health care tackles health at its roots. Adverse childhood experiences (ACEs) in those exposed to them may contribute significantly to the root causes of many diseases of lifestyle. ACEs are traumatic experiences, such as physical and emotional abuse and exposure to risky family environments. In 1998, a ground-breaking study found that nearly 70% of Americans experience at least 1 ACE in their lifetime, and graded exposure is associated with the presence of mental health disorders, heart disease, cancer, and other chronic diseases. Over the past 20 years, evidence has demonstrated further disease risk, outcomes, and epigenetic underpinnings in children and adults with ACEs. Building resilience-the capacity to adapt in healthy ways to traumatic experiences-through lifestyle modification offers potential to combat the negative health effects associated with ACEs. Emerging research demonstrates resilience is cultivated through individual skills (emotional intelligence, coping, and fostering healthy lifestyle choices), and nurturing supportive relationships. Being mindful of the impact and prevalence of ACEs and diversity of individuals' experiences in society will help build resilience and combat the root cause of chronic disease. This review aims to cultivate that awareness and will discuss 3 objectives: to discuss the effects and hypothesized pathophysiological underpinnings of traumatic experiences in childhood on health and wellbeing throughout life, to present ways we can promote resilience in our daily lives and patient encounters, and to demonstrate how advocacy for the reduction of ACEs and promotion of resilient, trauma-informed environments are fundamental to health care reform.
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Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1-Adult patients.
J Heart Lung Transplant2019 Aug;():. doi: S1053-2498(19)31632-8.
Lorusso Roberto, Raffa Giuseppe Maria, Alenizy Khalid, Sluijpers Niels, Makhoul Maged, Brodie Daniel, McMullan Mike, Wang I-Wen, Meani Paolo, MacLaren Graeme, Kowalewski Mariusz, Dalton Heidi, Barbaro Ryan, Hou Xiaotong, Cavarocchi Nicholas, Chen Yih-Sharng, Thiagarajan Ravi, Alexander Peta, Alsoufi Bahaaldin, Bermudez Christian A, Shah Ashish S, Haft Jonathan, D'Alessandro David A, Boeken Udo, Whitman Glenn J R,
Abstract
Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.
Copyright © 2019 International Society for Heart and Lung Transplantation. All rights reserved.
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Impact of Chronic Thrombocytopenia on Outcomes After Transcatheter Valvular Intervention and Cardiac Devices Implantation (From a National Inpatient Sample).
Am J Cardiol2019 Aug;():. doi: S0002-9149(19)30951-8.
Shokr Mohamed, Adegbala Oluwole, Elmoghrabi Adel, Saleh Mohammed, Ajam Mustafa, Ali Abdelrahman, Yassin Ahmed S, Ando Tomo, Eperjesiova Bianka, Aly Ahmed, Pahuja Mohit, Ashraf Said, Abubakar Hossam, Ahmed Abdelrahman, Subahi Ahmed, Lieberman Randy, Afonso Luis,
Abstract
To evaluate the impact of chronic thrombocytopenia (cTCP) on outcomes of transcatheter valvular procedures such as aortic valve implantation (TAVI), MitraClip, permanent pacemaker (PPM), implantable-cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), left atrial appendage closure, and pericardiocentesis. Impact of cTCP on clinical outcomes following TAVI, Mitraclip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis procedures is not well described. Utilizing the National Inpatient Sample and (ICD-9-CM) procedural codes, we evaluated patients (age ?18 years) who underwent these procedures, from January 1, 2009 to December 31, 2014, with or without cTCP as a chronic condition variable indicator. Propensity score matching model implemented to derive 2 matched groups. Propensity score matching created 47,292 and 47,351 hospitalizations matched pairs with and without cTCP, respectively. Patients with cTCP were older (mean age, 74.27 vs 72.26 years; absolute standardized differences [ASD]?=?15.6) and less likely to be female (36.76% vs 43.74%, ASD?=?-14.31). They experienced higher in-hospital mortality (3.0% vs 2.0%; odds ratio [OR], 1.53; 95% confidence interval [CI], 1.27 to 1.83) and higher odds of vascular injury requiring surgery (2.63% vs 1.10%; OR, 2.43; 95% CI, 1.93 to 3.05). Postoperative hematoma and bleeding were 2-fold higher (4.57% vs 2.24%; OR, 2.08; 95% CI, 1.77 to 2.45) and 3-fold higher (6.34% vs 2.45%; OR, 2.69; 95% CI, 2.31 to 3.13) respectively among cTCP patients. They had greater health-care cost ($47,163 vs $35,763, p <0.0001) and longer hospital stay (mean 9.26 days vs 6.84 days, p <0.0001). In conclusion, cTCP patients had higher risk of complications after TAVI, MitraClip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis, including a 1.5-fold increased risk of in-hospital mortality.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Parental reactions, distress, and sense of coherence after prenatal versus postnatal diagnosis of complex congenital heart disease.
Cardiol Young2019 Sep;():1-7. doi: 10.1017/S1047951119001781.
Bratt Ewa-Lena, Järvholm Stina, Ekman-Joelsson Britt-Marie, Johannsmeyer Antje, Carlsson Sven-Åke, Mattsson Lars-Åke, Mellander Mats,
Abstract
INTRODUCTION:
A diagnosis of congenital heart disease (CHD) in offspring triggers psychological distress in parents. Results of previous studies have been inconsistent regarding the psychological impact of a prenatal versus a postnatal diagnosis. The aim of this study was to evaluate the influence of the time of diagnosis on levels of parental distress.
METHODS:
Pregnant women and their partners with a fetus diagnosed with complex CHD, parents of children with postnatally diagnosed CHD, and pregnant women and their partners with uncomplicated pregnancies were invited to participate. Data were collected during pregnancy and 2-6 months after delivery using the Hospital Anxiety and Depression Scale, sense of coherence, life satisfaction, and Dyadic Adjustment Scale.
RESULTS:
During pregnancy, the prenatal group scored lower sense of coherence compared to controls (p=0.044). Postnatally the prenatal group scored lower on sense of coherence compared to the postnatal group and controls (p=0.001; p=0.001). Postnatally, the prenatal and postnatal groups had higher levels of anxiety compared to controls (p=0.025; p=0.0003). Life satisfaction was lower in the prenatal group compared to that in the postnatal group and in controls (p=0.000; p=0.0004).
CONCLUSION:
Parents with a prenatal diagnosis of CHD in offspring report a low sense of coherence already during pregnancy which decreased further at follow-up. The same group reported a lower satisfaction with life compared to parents of a child with postnatal diagnosis of CHD and parents of a healthy child. This motivates further efforts to improve counselling and support during pregnancy and for parents after a prenatal diagnosis.
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Early assessment of cardiac troponin I predicts the postoperative cardiac status and clinical course after congenital heart disease surgery.
Heart Vessels2019 Sep;():. doi: 10.1007/s00380-019-01497-9.
Kojima Takuro, Toda Koichi, Oyanagi Takayuki, Yoshiba Shigeki, Kobayashi Toshiki, Sumitomo Naokata,
Abstract
Cardiac troponin I (cTnI) is a regulatory protein with a high sensitivity and specificity for cardiac injury. Preoperative and postoperative elevations of cTnI are usually considered predictors of the mortality and morbidity. However, little is known about the relationship between the cTnI and postoperative course after the congenital heart disease (CHD) operation. Sixty-five consecutive patients who underwent cardiac surgery for CHD at our institution between March 2016 and January 2017 were included. The cTnI was measured after the operation. Also, the association between the cTnI and duration of the catecholamine use, ICU stay, aortic cross clamp time, and other clinical parameters were assessed. The cTnI level on postoperative day 1 was positively correlated with the duration of the catecholamine use (p?
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Respiratory Sinus Arrhythmia Attenuation via Targeted Lung Denervation in Sheep and Humans.
Respiration2019 Sep;():1-6. doi: 10.1159/000501623.
Valipour Arschang, Mayse Martin L, Peterson Alexander D, Johnson Philip J, Rouw Kristina T, Asadi Sherwin, Hummel James P,
Abstract
BACKGROUND:
Targeted lung denervation (TLD) is a novel bronchoscopic therapy that disrupts parasympathetic pulmonary nerve input to the lung. Parasympathetic input to the heart originating from the lungs contributes to respiratory sinus arrhythmia (RSA) and disruption of pulmonary nerves via TLD may impact RSA.
OBJECTIVE:
The aim of this study was to assess the potential of TLD to affect RSA in sheep and humans.
METHODS:
TLD was performed in 5 sheep and 9 humans using a novel lung denervation system (Nu-vaira Inc., Minneapolis, MN, USA) with an electrocardiogram collected before and after the procedure. Frequency domain analysis of heart rate variability was performed in 5 sheep and 6 humans with presence of RSA approximated as high-frequency power (HF power).
RESULTS:
HF power decreased in 3 of 5 sheep with 1 animal reaching less than 7% of its baseline HF power 30 days after TLD. The average treatment location was more distal in the remaining 2 animals, which did not exhibit RSA attenuation, suggesting diminished denervation. HF power decreased in 5 of 6 humans, with 3 subjects reaching less than 50% of their baseline HF power 90 days after TLD.
CONCLUSIONS:
TLD appeared to attenuate RSA in both sheep and human cohorts of this sub-study. Further confirmation in humans is necessary to allow for RSA attenuation to be used as a marker of successful lung denervation via TLD.
© 2019 S. Karger AG, Basel.
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The Many Faces of Early Repolarization Syndrome:A Single Center Case-Series.
Heart Rhythm2019 Sep;():. doi: S1547-5271(19)30834-3.
Voskoboinik Aleksandr, Hsia Henry, Moss Joshua, Vedantham Vasanth, Tanel Ronn E, Patel Akash, Wojciak Julianne, Downs Natalie, Scheinman Melvin M,
Abstract
BACKGROUND:
Early repolarization syndrome (ERS) is a rare but increasingly recognized cause of malignant ventricular arrhythmias.
OBJECTIVE:
To characterize the presentations and treatments of ERS at our institution.
METHODS:
We performed a retrospective chart review of all patients presenting to our institution between 2008-2019 with ERS. Exclusion criteria included Brugada syndrome, positive provocative testing with class I antiarrhythmics, metabolic disturbances or structural heart disease.
RESULTS:
Of 10 patients identified with ERS, 8 were male with age 30±17 years at diagnosis. Documented arrhythmias included ventricular fibrillation in 7/10, polymorphic ventricular tachycardia (VT) in 3/10 and monomorphic VT in 3/10 patients. Atrial fibrillation was diagnosed in 3/10 and AV block was seen in 2/10. J waves and/or electrocardiographic early repolarization patterns were dynamic in 7/10. Arrhythmias occurred at rest in 8/10 and with exertion in 2/10. Only 1 patient had a family history of sudden death and 4/10 patients had variants of uncertain significance on genetic testing. Quinidine effectively suppressed arrhythmias in 5/5 patients, but required dose escalation to >1g/day in 3/5 patients. Abnormal epicardial electrograms were recorded over the inferolateral left ventricle in 2 patients who underwent mapping and were successfully ablated. Premature ventricular contraction (PVC) triggers were also targeted for ablation in 3 patients.
CONCLUSION:
ERS is a heterogeneous condition and may be associated with both atrial and ventricular arrhythmias, AV block, dynamic electrocardiographic changes and variable triggers. In addition to targeting PVC triggers, mapping and ablation of abnormal epicardial electrograms may be a potential future treatment strategy.
Copyright © 2019. Published by Elsevier Inc.
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Difficulties with Invasive Risk Stratification Performed Under Anesthesia in Pediatric Wolff-Parkinson-White Syndrome.
Heart Rhythm2019 Sep;():. doi: S1547-5271(19)30832-X.
Shwayder Mark H, Escudero Carolina A, Etheridge Susan P, Dechert Brynn E, Law Ian H, Blaufox Andrew D, Perry James C, Dubin Anne M, Sanatani Shubhayan, Collins Kathryn K,
Abstract
BACKGROUND:
Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI).
OBJECTIVE:
Our aim was to determine how closely measurements made in the electrophysiology lab in patients with WPW compared to the SPERRI obtained during an episode of clinical pre-excited atrial fibrillation (Clinical-SPERRI).
METHODS:
This is a subgroup analysis of a multicenter study of children with WPW. Subjects in our study (n=49) were included if they had a Clinical-SPERRI measured in addition to one or more of three surrogate measurements: SPERRI obtained in the EP lab (EP-SPERRI), accessory pathway effective refractory period (APERP), or shortest pre-excited paced cycle length with 1:1 conduction (SPPCL).
RESULTS:
Seventy percent of EP measurements were made under general anesthesia. Clinical-SPERRI moderately correlated with EP-SPERRI (r=0.495, p=0.012). However, 24% of our patients with Clinical-SPERRI ?250ms would have been misclassified as having a low risk pathway based on an EP-SPERRI of >250ms. Clinical-SPERRI did not correlate with APERP or SPPCL (r<0.3, p>0.1). Mean EP-SPERRI, APERP and SPPCL were all greater than Clinical-SPERRI.
CONCLUSIONS:
EP lab measurements of pathway characteristics made under general anesthesia do not correlate well with Clinical-SPERRI. Of APERP, SPPCL, and EP-SPERRI, only EP-SPERRI has a moderate correlation with Clinical-SPERRI. In addition, this study questions the predictive ability of invasive risk stratification under general anesthesia, given that 24% of patients with a high risk Clinical-SPERRI (?250ms) had an EP-SPERRI that may be considered low risk (>250ms).
Copyright © 2019. Published by Elsevier Inc.
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Estimated Ventricular Size, Asthma Severity and Exacerbations: The SARP III Cohort.
Chest2019 Sep;():. doi: S0012-3692(19)33744-4.
Ash Samuel Y, Vegas Sanchez-Ferrero Gonzalo, Schiebler Mark L, Rahaghi Farbod N, Rai Ashish, Come Carolyn E, Ross James C, Colon Alysha G, Cardet Juan Carlos, Bleecker Eugene R, Castro Mario, Fahy John V, Fain Sean B, Gaston Benjamin M, Hoffman Eric A, Jarjour Nizar N, Lempel Jason K, Mauger David T, Tattersall Matthew C, Wenzel Sally E, Levy Bruce D, Washko George R, Israel Elliot, San Jose Estepar Raul, ,
Abstract
BACKGROUND:
Relative enlargement of the pulmonary artery (PA) on chest computed tomography (CT) is associated with respiratory exacerbations in patients with chronic obstructive pulmonary disease or cystic fibrosis. We sought to determine if similar findings were present in patients with asthma and if they were explained by differences in ventricular size.
METHODS:
We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI and eETVVI respectively). Associations between the cardiac and PA measures (PA to aorta ratio (PA/A), eERVVI to eELVVI ratio (eRV/eLV), eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed using Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated using multivariable linear and zero-inflated negative binomial regression.
RESULTS:
Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m smaller eETVVI than healthy controls (p=0.003) and 14.1 mL/m smaller eETVVI than those with mild/moderate disease (p=0.011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow up than those with eETVVI greater than the median (p=0.020). Neither PA/A nor eRV/eLV were associated with asthma severity or exacerbations.
CONCLUSIONS:
In asthmatics, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations.
Copyright © 2019. Published by Elsevier Inc.
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CHADS-VASc Score for Identifying Patients at high risk of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-analysis.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31380-3.
Chen Yun-Lin, Zeng Mengying, Liu Yuan, Xu Yanping, Bai Yang, Cao Li, Ling Zhiyu, Fan Jinqi, Yin Yuehui,
Abstract
BACKGROUND:
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, resulting in an increased risk of morbidity and longer hospital stay. Pharmacologic prophylaxis has been recommended to improve outcome in patients at high risk of developing POAF after cardiac surgery. Several studies have applied CHADS-VASc score in the risk stratification of POAF but yielded contradicting results. This study aims to determine the association between CHADS-VASc score and POAF, and further to explore its discriminative ability for the prediction of POAF.
METHODS:
We systematically searched the Medline, Embase, Cochrane library and other data sources with key terms "CHADS-VASc", "atrial fibrillation" and "cardiac surgery". Studies were designed for CHADS-VASc score in stratifying the risks for POAF in patients undergoing cardiac surgery were included. Statistical analyses were performed using R 3.5.1 and STATA 13.0.
RESULTS:
721 studies were identified, out of which 12 studies with 18,086 patients were finally included in our analysis. The CHADS-VASc score was found to be an independent predictor of POAF following cardiac surgery (OR 1.46, 95% CI 1.25 to 1.72), and exhibited a relatively strong specificity (0.70, 95% CI 0.61 to 0.78) and sensitivity (0.72, 95% CI 0.54 to 0.85) for predicting POAF. The bivariate model-based pooled area under the ROC was estimated to be 0.76 (95% CI 0.72 to 0.79).
CONCLUSIONS:
The CHADS-VASc score has relatively good performance in predicting POAF after cardiac surgery and may help identify the patients at high risk of POAF.
Copyright © 2019. Published by Elsevier Inc.
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Utilization of Age-Adjusted Shock Index in a Resource-Strained Setting.
J Pediatr Surg2019 Aug;():. doi: S0022-3468(19)30561-5.
Traynor Michael D, Hernandez Matthew C, Clarke Damian L, Kong Victor Y, Habermann Elizabeth B, Polites Stephanie F, Laing Grant L, Bruce John L, Zielinski Martin D, Ishitani Michael B, Moir Christopher R,
Abstract
BACKGROUND:
Identification of injury severity and appropriate triage are critical to effective surgical care, especially where medical and surgical resources are strained. We hypothesized that pediatric age-adjusted shock index (SIPA) would outperform traditional shock index (SI) in a middle-income country (MIC) setting.
METHODS:
Injured children hospitalized in two trauma centers (South Africa and the United States) from 2012 to 2017 were reviewed. Maximum heart rate and minimum systolic blood pressure defined SI. SI?>?0.9 defined elevation. SIPA elevation was based on SI stratified by age: 1-6?years (SI?>?1.22), 7-12?years (SI?>?1.0), and 13-17?years (SI?>?0.9). SI and SIPA were compared using univariate analyses and area under the receiver operating characteristic curves (AUROC).
RESULTS:
1648 patients (741 MIC and 907 high-income country (HIC)) were evaluated with a median [IQR] age of 11 [6-15] years. SI was elevated in 377 (51%) MIC children, whereas SIPA was elevated in 248 (34%). In both the HIC and MIC, elevated SIPA was more associated with ISS???25, ICU admission, and mortality. In MIC patients specifically, elevated SIPA improved discrimination for in-hospital mortality (AUROC 0.66 vs AUROC 0.57, p?
CONCLUSION:
In a multinational cohort including MIC patients, SIPA facilitated identification of injured children with altered physiology, reflecting greater injury severity and poorer outcomes. Use of SIPA has the potential for more effective resource utilization in MICs.
LEVEL OF EVIDENCE:
Level III.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Childhood nosocomial viral acute respiratory tract infections in teaching hospital Anuradhapura, Sri Lanka.
BMC Res Notes2019 Sep;12(1):581. doi: 10.1186/s13104-019-4624-2.
Sampath Jayaweera Jayaweera Arachchige Asela, Reyes Mohammed,
Abstract
OBJECTIVES:
We have assessed the risk factors for the occurrence of hospital-acquired (HA) and community-acquired (CA) viral acute respiratory tract infections (ARTIs) in children. Children (1-60 months) who were having ARTI on admission (CA) and develops ARTI following 48 h after admission or 3 days of discharge (HA) were included. Indirect immunofluorescence assay (IFA) was performed and multivariable analyses were done to determine the risk factors for the development of viral CA and HA-ARTI.
RESULTS:
Total of 818 with ARTIs, 226 (27.6%) RSV cases were detected. Out of 226, 86 (38.0%) HA-RSV cases were detected. CA-viral-ARTI was significantly high (p?
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Small-for-gestational-age birth is linked to cardiovascular dysfunction in early childhood.
Am Heart J2019 Aug;217():84-93. doi: S0002-8703(19)30200-5.
Castagno Matteo, Menegon Veronica, Monzani Alice, Zanetta Sara, Secco Gioel Gabrio, Rosso Roberta, Binotti Marco, Maiuri Luigi, Di Mario Carlo, Gazzolo Diego, Ferrero Federica, Genoni Giulia,
Abstract
BACKGROUND:
The aim of this study was to assess clinical and echographic markers of cardiovascular dysfunction in infants born small for gestational age (SGA) compared to a control group of subjects born adequate for gestational age (AGA).
METHODS:
This was a single-center cross-sectional case-control study. We recruited 20 SGA and 20 gestational age-matched AGA subjects at 24 months of age. The study population underwent anthropometric and Doppler 2-dimensional echocardiographic assessments, and carotid artery intima-media thickness (cIMT) and endothelium-dependent vasodilation evaluation (FMD). The pressure-volume curve during diastole was calculated using the algorithm for the elastance calculation on 1 single beat.
RESULTS:
SGA children showed lower stroke volume, lower left ventricle (LV) dimensions and volume, and greater LV thickness. Diastolic function was impaired in SGA with lower capacitance and higher elastance. Birth weight standard deviation score was positively associated with capacitance and negatively associated with E/E' ratio and elastance, and in SGA infants, the end-diastolic pressure-related volume curve was shifted to the left compared to AGA. cIMT and systemic vascular resistance were significantly higher, while FMD was lower, in SGA compared to AGA; birth weight standard deviation score was directly correlated with FMD and inversely correlated with cIMT. Finally, a longer breastfeeding duration was associated to a lower cIMT even after correction for confounding factors.
CONCLUSIONS:
This study shows that infants born SGA present an early and subtle cardiovascular dysfunction compared to AGA controls. These alterations are strongly related to weight at birth. Finally, breastfeeding exerts an important protective and beneficial cardiovascular effect.
Copyright © 2019. Published by Elsevier Inc.
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