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Pubblicazioni recenti - pediatric cardiac
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Radiofrequency catheter ablation of ventricular tachycardia using combined endocardial techniques in patients with structural heart disease improves procedural effectiveness and reduces arrhythmia episodes.
Kardiol Pol2022 Dec;():. doi: 10.33963/KP.a2022.0278.
Karkowski Grzegorz, Z?bek Andrzej, Szotek Micha?, Dru?bicki ?ukasz, Lelakowski Jacek, Legutko Jacek, Gosnell Marc, Kuniewicz Marcin,
Abstract
INTRODUCTION:
Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is by evidence, safe and effective. However, arrhythmia recurrence is still relatively high and the optimal procedural strategy is unclear. In clinical practice, several combinations of mapping and ablation techniques are used to improve VT ablation efficacy.
AIM:
The study aimed to evaluate and provide evidence of the efficiency and safety of a systematized combination of VT ablation (mapping) techniques in patients with SHD.
METHODS:
From 2016 to 2019, 47 patients (54 procedures) with SHD (89% heart failure, 94% ischemic heart disease, 37% VT storm) who underwent RFCA of VT were retrospectively analyzed from a group of 58 consecutive patients. During RFCA of VT, different combinations of three techniques, (activation mapping (AM), pace-mapping (PM), and substrate-based mapping (SbM), were used. The procedures were performed using the CARTO® 3 (Biosense Webster Inc., Diamond Bar, CA, US) electro-anatomical mapping system.
RESULTS:
During a median (interquartile range [IQR]) follow-up of 25.5 months (11.75?52.25), VT-free survival after ablation was 68.5% (n = 37/54 procedures). Acute procedural success was achieved in 85% (n = 46/54 procedures). The number of induced VT morphologies, induction of non-clinical or unsustained VT after ablation and less VT mapping techniques used during procedure were related to decreasing VT free-survival.
CONCLUSIONS:
VT ablation strategy based on combined systematized techniques is effective and safe in long-term follow-up patients with SHD.
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Vascular Rings Are Common.
World J Pediatr Congenit Heart Surg -
Dilated Cardiomyopathy in Children: Early Detection and Treatment.
Cureus2022 Nov;14(11):e31111. doi: e31111.
Mallavarapu Amrita, Taksande Amar,
Abstract
Cardiomyopathy is segregated into primary and secondary categories, leading to different phenotypes, including dilated, hypertrophic, and restrictive patterns. Dilated cardiomyopathy (DCM) is a mixed bag of heart diseases with the unique features of cardiac dilatation and subnormal to poor myocardial contractility. Dilated cardiomyopathy in the pediatric age group is generally characterized by unobstructed, dilated, and contracting left ventricular chamber defects and is associated with heart failure. Other causes include genetic juvenile-onset cardiomyopathy, drug-induced cardiomyopathy, stress-induced cardiomyopathy, hemochromatosis, endocrine causes (thyroid disorder and pheochromocytoma), autoimmune diseases, and nutritional deficiencies (selenium and thiamine). It is characterized by thinning of the left ventricle, a dilated left ventricle or biventricular dilatation, left ventricular systolic dysfunction, left ventricular diastolic dysfunction, global hypokinesia, and cardiomegaly (seen on a chest X-ray). Decreased cardiac output leads to fatigue, cachexia, narrow pulse pressure, dicrotic pulse/hypokinetic pulse, dyspnea, cool extremities, decreased blood supply to the brain (cognitive dysfunction), and reduced blood supply to the kidney (renal failure). Left ventricular diastolic dysfunction can result in dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Cardiomyopathy can also occur with or without left ventricular dysfunction, as in left ventricular non-compaction cardiomyopathy (LVNC), which is a rare heart disease occurring due to two (likely) pathogenic nonsense mutations: DSG2-p.S363X and TBX20-p.D278X. The study of familial forms of LVNC is helpful for risk prediction and genetic counseling of relatives. Right ventricular chamber failure can be identified on the electrocardiogram as sinus tachycardia and non-specific ST/T changes. The complications include arrhythmia (atrial fibrillation) and thromboembolism (left ventricular mural thrombosis). It is of utmost importance in the field of heart transplantation as the definitive treatment of the disease. Heart transplantation is now an acceptable treatment option for patients with dilated cardiomyopathy. This short review highlights different methods for the detection and diagnosis of dilated cardiomyopathy and the treatment modalities available for the same.
Copyright © 2022, Mallavarapu et al.
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A Comparative Evaluation of the Anxiolytic Effect of Oral Midazolam and a Homeopathic Remedy in Children During Dental Treatment.
Cureus2022 Nov;14(11):e31041. doi: e31041.
Agrawal Akshat, Rathi Nilesh V, Thosar Nilima R,
Abstract
Background Midazolam is recommended by many health standards. However, there is no compelling evidence that midazolam has anti-anxiety effects in children. Homeopathy can be one of the mainstays for effective child management while reducing negative side effects. The aim of the study was to evaluate the anxiolytic efficacy of midazolam (oral) and homeopathic remedies in children during dental treatments. Methodology The current ex-vivo study was conducted in the department of Pedodontics and Preventive Dentistry department of a private dental institution. A total of 48 children aged four to 14 years were selected based on the inclusion and exclusion criteria. The participants were evenly and randomly divided into groups A and B using the lottery method. Group A: 20 minutes previous to the treatment, a right blend of an equal volume of 0.5mg/kg injectable solution of midazolam hydrochloride. Group B: Received Aconite napellus (homeopathic remedy). Results During anxiety, the hypothalamic pituitary adrenal axis gets activated which causes a release of body fluids including salivary cortisol levels. Salivary amylase also responds quickly during stress and anxiety by increasing its levels. Midazolam is used in Dentistry to reduce anxiety as it is able to reduce salivary cortisol and amylase levels. Aconite napellus being homeopathic remedy is useful in Dentistry to reduce salivary cortisol and amylase levels which is observed in the present study. There was a decrease in salivary cortisol and amylase concentrations following midazolam (8.51 ± 6.7) (41.48 ± 23.8) and Aconite napellus (homeopathic remedy) (7.53 ± 5.2) (37.08± 22.8) administration, as well as a decrease in heart rate, systolic and diastolic blood pressure. Furthermore, all of the differences were statistically significant (p
Copyright © 2022, Agrawal et al.
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A Rare Variant and Unusual Presentation of Holt Oram Syndrome in a Child.
Cureus2022 Nov;14(11):e31076. doi: e31076.
Reddy Rasagnya M, Lakra Mahaveer S, Meshram Revat J, Taksande Amar, Wanjari Mayur B,
Abstract
Holt Oram syndrome is a rare genetically inherited disorder characterized by various skeletal abnormalities of the upper limb with an underlying structural heart defect. Family history and conduction defects may or may not be there. The diagnosis is often clinical; if the criteria are not fulfilled, then genetic studies may be required. This syndrome can also occur with complex congenital heart defects, heart blocks, and arrhythmias. The correlation between the severity of cardiac and skeletal manifestations was not studied, and in severe conditions and acute presentation, the patient may have atrial, supraventricular, and ventricular fibrillation. The association of radius with hand deformity and the cardiac defect is well reported, but this disease's involvement of the humerus and Supraventricular tachycardia (SVT) is rare. Here, we are reporting a case of Holt Oram syndrome in a five-year male child with unusual skeletal hypoplastic humerus who presented with breathlessness, palpitations, and supraventricular tachycardia and suffered a total of three episodes which were managed with adenosine and cardioversion successfully. The involvement of the humerus, along with symmetrical bilateral radial defect with Atrial septal defect (ASD) and Supraventricular tachycardia (SVT), is a unique feature of Holt Oram syndrome seen in our case.
Copyright © 2022, Reddy et al.
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Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis.
World J Pediatr Surg2022 ;5(3):e000391. doi: e000391.
Camporesi Anna, Diotto Veronica, Zoia Elena, Rotta Simone, Tarantino Federica, Eccher Laura Maria Giuditta, Calcaterra Valeria, Pelizzo Gloria, Gemma Marco,
Abstract
OBJECTIVE:
Infantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010-2019. The secondary objective is to evaluate the risk factors for postoperative apnea.
METHODS:
This is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate
RESULTS:
Of 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea.
CONCLUSIONS:
Postoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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A comparison of anesthetic efficacy between dorsal penile nerve block (DPNB) with lidocaine and eutectic mixture of local anesthetics (EMLA) cream during neonatal circumcision.
World J Pediatr Surg2022 ;5(3):e000348. doi: e000348.
Emordi Victor Chekwube, Osifo David Osarumwense, Evbuomwan Iyekeoretin,
Abstract
OBJECTIVE:
Circumcision is often performed in neonates and is associated with significant pain. This study was conducted to compare the anesthetic efficacy of two methods of local anaesthesia for neonatal circumcision: topical eutectic mixture of local anesthetics (EMLA) cream and dorsal penile nerve block (DPNB) with lidocaine.
METHODS:
Male neonates who presented for circumcision and met the eligibility criteria were recruited for the study and were randomly assigned to one of the two methods of anesthesia before the procedure. Anesthetic efficacy was compared by pain assessment during four standardized steps of the procedure (clamping, crushing, tying, and cutting of the foreskin, respectively) using the modified Neonatal Infant Pain Scale (NIPS), changes in transcutaneous oxygen saturation (SpO), heart rate (HR), and preoperative and postoperative salivary cortisol levels. Patients also were evaluated after 24 hours to assess for complications.
RESULTS:
Totally, 138 babies were recruited. Significantly higher NIPS scores were observed among babies who had EMLA cream during tying (p=0.019) and cutting (p=0.043). The rise in mean HR from baseline was statistically significant throughout the procedure in the EMLA group. In the DPNB group, there was no significant rise in mean HR during crushing (p=0.919) and cutting (p=0.197). There was a significant decrease in mean SpO from baseline in both groups. Salivary cortisol showed significant increase in mean levels in both groups. No significant untoward effects were observed.
CONCLUSION:
DPNB with lidocaine has a better pain control compared with EMLA cream during neonatal circumcision. Both methods are safe in neonates.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Comparison of dorsal penile nerve block alone and in combination with lidocaine-prilocaine cream in neonates undergoing circumcision: a randomized controlled study.
World J Pediatr Surg2022 ;5(4):e000470. doi: e000470.
Ogundele Ibukunolu Olufemi, Nwokoro Chigbundu Collins, Adedeji Tewogbade Adeoye, Igwe Arua Obasi, Adumah Collins Chijioke, Talabi Ademola Olusegun, Shonubi Aderibigbe Modupe, Sowande Oludayo Adedapo,
Abstract
BACKGROUND:
Suboptimal neonatal circumcision analgesia causes a significant stress response. There is continued search for more effective analgesia for neonatal circumcision. We aimed to determine whether lidocaine-prilocaine cream (LPC) prior to dorsal penile nerve block (DPNB) offers better analgesia than DPNB alone.
METHODS:
A prospective randomized study of 72 neonates undergoing plastibell circumcision was randomized into two groups of 36 each. Group I received DPNB alone with 4?mg/kg plain lidocaine. Group II had 1?g LPC applied to the phallus 1?hour before DPNB. Serum cortisol levels were measured 30?min preoperatively and 30?min postoperatively. Heart rate (HR) and peripheral arterial oxygen saturation (SpO) were noted at 30?min preoperatively, after DPNB injection, after excising the prepuce, and at 30?min thereafter. The primary outcome measure was change in serum cortisol levels, while secondary outcomes were changes in HR and SpO.
RESULTS:
Both groups had increased mean serum cortisol levels, decreased mean SpO and increased mean HR from baseline. The rise in mean serum cortisol level was significantly lower in group II (8.09±4.53?µg/dL) than that in group I (11.42±7.83?µg/dL) (p=0.034). Changes in SpO and HR were significantly less in group II than that in group I patients (p
CONCLUSION:
These data suggest that neonates who received LPC prior to DPNB experienced significantly less pain from plastibell circumcision than those who had DPNB alone.
TRIAL REGISTRATION NUMBER:
PACTR201906554747665.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Influenza A virus modulates ACE2 expression and SARS-CoV-2 infectivity in human cardiomyocytes.
iScience2022 Dec;():105701. doi: 105701.
Wu Qian, Kumar Naresh, Lafuse William P, Santiagonunez Ahumada Omar, Saljoughian Noushin, Whetstone Elizabeth, Zani Ashley, Patton Ashley K, El Refaey Mona, Webb Amy, Pietrzak Maciej, Yu Lianbo, Kc Mahesh, Peeples Mark E, Ganesan Latha P, Yount Jacob S, Rajaram Murugesan V S,
Abstract
Influenza A virus (IAV) and SARS-CoV-2 virus are both acute respiratory viruses currently circulating in the human population. This study aims to determine the impact of IAV infection on SARS-CoV-2 pathogenesis and cardiomyocyte function. Infection of human bronchial epithelial cells (HBEC), A549 cells, lung fibroblasts (HLF), monocyte derived macrophages (MDMs), cardiac fibroblasts (HCF) and hiPSC-derived cardiomyocytes with IAV enhanced the expression of ACE2, the SARS-CoV-2 receptor. Similarly, IAV infection increased levels of ACE2 in the lungs of mice and humans. Interestingly, we detected heavily glycosylated form of ACE2 in hiPSC-CMs and poorly glycosylated ACE2 in other cell types. Also, prior IAV infection enhances SARS-CoV-2 spike protein binding and viral entry in all cell types. However, efficient SARS-CoV-2 replication was uniquely inhibited in cardiomyocytes. Glycosylation of ACE2 correlated with enzymatic conversion of its substrate Ang II, induction of eNOS and nitric oxide production, may provide a potential mechanism for the restricted SARS-CoV-2 replication in cardiomyocytes.
© 2022 The Author(s).
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Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation.
World J Pediatr Surg2022 ;5(1):e000271. doi: e000271.
Sun Mingwei, Zong Qing, Ye Li Fen, Fan Yong, Yang Lijun, Lin Ru,
Abstract
BACKGROUND:
Pediatric acute fulminant myocarditis (AFM) is a very dangerous disease that may lead to acute heart failure or even sudden death. Previous reports have identified some prognostic factors in adult AFM; however, there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation (VA-ECMO). This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.
METHODS:
A retrospective analysis was performed in an affiliated university children's hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020. These children were classified into a survivor group (n=33) and a non-survivor group (n=8). Patient demographics, clinical events, laboratory findings, and electrocardiographic and echocardiographic parameters were analyzed.
RESULTS:
Peak serum creatinine (SCr) and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality (p=0.011, AUC=0.962). Based on multivariable logistic regression analysis, peak SCr level during ECMO support was an independent predictor of in-hospital mortality (OR=1.035, 95% CI 1.006 to 1.064, p=0.017, AUC=0.936, with optimal cut-off value of 78 ?mol/L).
CONCLUSION:
Tissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes. The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications. Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Cerebellar infarction risk in a mild COVID-19 case.
Radiol Case Rep2023 Feb;18(2):651-656. doi: 10.1016/j.radcr.2022.11.005.
Kabashi Antigona, Fero Henri, Gjini Artiona, Dhimitri Diana, Spahiu Mimoza, Hyseni Fjolla, Harizi Edlira, Shemsi Kledisa, Vokshi Valon, Decka Arlind, Amin Asm Al, Ataullah Ahm, Capi Livia, Jahanian Sepideh, Nasir Fareeha, Ayala Ivan N, Musa Juna, Shatri Jeton, Dedushi Kreshnike, Leniqi Florim, Hyseni Guri,
Abstract
Thrombotic events in SARS-COV-2 disease patients are frequent, especially in patients with comorbidities such as heart failure, hypertension, cancer, diabetes mellitus, kidney failure, vascular disease, and other pulmonary illnesses. In severe cases, in particular those of hospitalized patients with other comorbidities, the development of thrombotic events in spite of anticoagulation therapy has been observed. The main thrombotic events are pulmonary thromboembolism, cerebral ischemic stroke, and peripheral artery thrombosis. Despite the severity of SARS-COV-2 disease, some patients with the aforementioned comorbidities develop thrombotic events regardless of the severity of their SARS-COV-2 infection. In this setting, the cerebellum makes no exception as an uncommon, but still possible target for thrombotic events.
© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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Is music the food of the anesthesia in children?
World J Pediatr Surg2022 ;5(2):e000328. doi: e000328.
Hekimoglu Sahin Sevtap, Duran Ridvan, Basaran Umit Nusret, Sut Necdet, Colak Alkin, Duran Sedef,
Abstract
BACKGROUND:
The noise in an operating room may have a detrimental effect on human cognitive functions, and it may cause perioperative anxiety with prolonged exposure. The aim of this study was to investigate the effects of music therapy and use of earplugs and normal noise level in the operating room under general anesthesia of pediatric patients on hemodynamic parameters and postoperative emergence delirium.
METHODS:
One hundred and five pediatric patients were involved in this study. The patients were randomly divided into three groups. Group N was exposed to the ambient operating room noise, group S received earplugs from an independent anesthesiologist, and group M used a CD player. The preoperative anxiety levels of children were evaluated with the Modified Yale Preoperative Anxiety Scale (M-YPAS). Mean arterial pressure (MAP) and heart rate were recorded at 30-minute periods until the completion of surgery, end of surgery and postoperatively. During each measurement, noise level recordings were performed using sonometer. Pediatric Anesthesia Emergency Delirium (PAED) score was evaluated after postoperative extubation.
RESULTS:
M-YPAS was similar between groups. The MAP at 30 and 60 min intraoperatively, at end of surgery, and at 5, 10, and 15 min postoperatively was significantly lower in group S than in group N. There were no differences in heart rate among the groups. Postoperative PAED score was not significantly different among the groups.
CONCLUSIONS:
The music therapy was not more effective than silence and operating noise room in reducing PAED score postoperatively in pediatric patients.
TRIAL REGISTRATION NUMBER:
ClinicalTrials.gov Registry (NCT03544502).
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Smooth muscle cell fate decisions decipher a high-resolution heterogeneity within atherosclerosis molecular subtypes.
J Transl Med2022 Dec;20(1):568. doi: 10.1186/s12967-022-03795-9.
Zhang Ge, Liu Zaoqu, Deng Jinhai, Liu Long, Li Yu, Weng Siyuan, Guo Chunguang, Zhou Zhaokai, Zhang Li, Wang Xiaofang, Liu Gangqiong, Guo Jiacheng, Bai Jing, Wang Yunzhe, Du Youyou, Li Tao-Sheng, Tang Junnan, Zhang Jinying,
Abstract
BACKGROUND:
Mounting evidence has revealed the dynamic variations in the cellular status and phenotype of the smooth muscle cell (SMC) are vital for shaping the atherosclerotic plaque microenvironment and ultimately mapping onto heterogeneous clinical outcomes in coronary artery disease. Currently, the underlying clinical significance of SMC evolutions remains unexplored in atherosclerosis.
METHODS:
The dissociated cells from diseased segments within the right coronary artery of four cardiac transplant recipients and 1070 bulk samples with atherosclerosis from six bulk cohorts were retrieved. Following the SMC fate trajectory reconstruction, the MOVICS algorithm integrating the nearest template prediction was used to develop a stable and robust molecular classification. Subsequently, multi-dimensional potential biological implications, molecular features, and cell landscape heterogeneity among distinct clusters were decoded.
RESULTS:
We proposed an SMC cell fate decision signature (SCFDS)-based atherosclerosis stratification system and identified three SCFDS subtypes (C1-C3) with distinguishing features: (i) C1 (DNA-damage repair type), elevated base excision repair (BER), DNA replication, as well as oxidative phosphorylation status. (ii) C2 (immune-activated type), stronger immune activation, hyper-inflammatory state, the complex as well as varied lesion microenvironment, advanced stage, the most severe degree of coronary stenosis severity. (iii) C3 (stromal-rich type), abundant fibrous content, stronger ECM metabolism, immune-suppressed microenvironment.
CONCLUSIONS:
This study uncovered atherosclerosis complex cellular heterogeneity and a differentiated hierarchy of cell populations underlying SMC. The novel high-resolution stratification system could improve clinical outcomes and facilitate individualized management.
© 2022. The Author(s).
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Organ damage evaluation in a temperature-controlled circulatory arrest rat model.
BMC Cardiovasc Disord2022 Dec;22(1):527. doi: 10.1186/s12872-022-02955-5.
Xiong Yaoyao, Zheng Quan, Wang Chunle, Yan Wei, He Wei,
Abstract
BACKGROUND:
Deep hypothermic circulatory arrest (DHCA) is commonly used in adult aortic surgery and pediatric complex congenital heart disease, and is associated with pathophysiological changes and postoperative complications. Here, a temperature-controlled circulatory arrest model in rats was established to study the suitable temperature of circulatory arrest by investigating the damage to body organs under different temperatures.
METHODS:
Thirty Sprague?Dawley rats were randomly divided into 5 equal groups for DHCA experiments: I (15-20 °C), II (20-25 °C), III (25-30 °C), IV (normothermic cardiopulmonary bypass), and V (sham operation group). Blood gas analysis, homodynamic parameters, and intervals of cardiac recovery were measured at different time points in all groups. Morphological changes in intestinal tissue were observed under light and electron microscopes. Oxidative stress was measured by MPO activity, MDA, and SOD content. Tissue damage was confirmed by serum detection of ALT, AST, BUN, Cr, and LDH. To examine the inflammatory response, cytokines, including IL-1, IL-4, IL-10, IFN-?, and TNF-?, were detected.
RESULTS:
The extracorporeal circulation technique caused damage to the body; the degree of the damage caused by the circulatory arrest technique may be related to circulating temperature, with the least amount of damage occurring at 20-25 °C compared to 15-20 °C and 25-30 °C. Ischemia and hypoxia can cause intestinal tissue damage, which manifests primarily as a loss of the intestinal mucosal barrier. Ischemic intestinal damage caused by DHCA was not associated with inflammation.
CONCLUSION:
The study provides new insights into the pathophysiologic mechanisms of DHCA.
© 2022. The Author(s).
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Prognostic value of cardiac magnetic resonance imaging parameters in left ventricular noncompaction with left ventricular dysfunction.
BMC Cardiovasc Disord2022 Dec;22(1):526. doi: 10.1186/s12872-022-02963-5.
Bai Wei, Xu Rong, Li Xiao, Xu Huayan, Fu Hang, Hou Ruilai, Zhou Ziqi, Huang Wei, Wang Yining, Guo Yingkun,
Abstract
BACKGROUND:
Cardiac magnetic resonance (CMR) has been used to diagnose and risk-stratify patients with left ventricular noncompaction (LVNC). The prognostic value of CMR parameters for LVNC, especially feature tracking (CMR-FT), is not well known in LVNC patients with left ventricular dysfunction. The present study aimed to investigate whether the combination of CMR-FT with traditional CMR parameters can increase the prognostic value of CMR for LVNC patients with reduced left ventricular ejection fraction (LVEF).
METHODS:
A total of 123 candidates were retrospectively included in this multicenter study and 55 LVNC patients (mean age, 45.7?±?16.2 years; 61.8% men) remained after applying the exclusion criteria. Clinical features, left ventricular (LV) function parameters, global and segment myocardial strain, and late gadolinium enhancement (LGE) were evaluated. The outcomes include the composite events of cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias.
RESULTS:
After a median follow-up of 5.17 years (interquartile range: 0.17 to 10.58 years), 24 (36.8%) patients experienced at least one major adverse cardiovascular event (MACE). The myocardial strain parameters of patients with events were lower than those of patients without events. In the univariable Cox analysis, LVEF, the presence of LGE, global longitudinal strain (GLS) and segmental strains, including longitudinal strain at the apical level and radial and circumferential strain at the basal level, were significantly associated with MACEs. In the multivariate analysis, LGE (hazard ratio (HR) 3.452, 95% CI 1.133 to 10.518, p?=?0.029) was a strong predictor of MACEs and significantly improved the predictive value (chi-square of the model after adding LGE: 7.51 vs. 13.47, p?=?0.009). However, myocardial strain parameters were not statistically significant for the prediction of MACEs after adjusting for age, body mass index, LVEF and the presence of LGE and did not increase the prognostic value (chi-square of the model after adding GLS: 13.47 vs. 14.14, p?=?0.411) in the multivariate model.
CONCLUSIONS:
The combination of CMR-FT with traditional CMR parameters may not increase the prognostic value of CMR in LVNC patients with reduced LVEF, while the presence of LGE was a strong independent predictor of MACEs and significantly improved the predictive value.
© 2022. The Author(s).
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Role of cardiac mitofusins in cardiac conduction following simulated ischemia-reperfusion.
Sci Rep2022 Dec;12(1):21049. doi: 10.1038/s41598-022-25625-0.
Kwek Xiu-Yi, Hall Andrew R, Lim Wei-Wen, Katwadi Khairunnisa, Soong Poh Loong, Grishina Elina, Lin Kun-Han, Crespo-Avilan Gustavo, Yap En Ping, Ismail Nur Izzah, Chinda Kroekkiat, Chung Ying Ying, Wei Heming, Shim Winston, Montaigne David, Tinker Andrew, Ong Sang-Bing, Hausenloy Derek J,
Abstract
Mitochondrial dysfunction induced by acute cardiac ischemia-reperfusion (IR), may increase susceptibility to arrhythmias by perturbing energetics, oxidative stress production and calcium homeostasis. Although changes in mitochondrial morphology are known to impact on mitochondrial function, their role in cardiac arrhythmogenesis is not known. To assess action potential duration (APD) in cardiomyocytes from the Mitofusins-1/2 (Mfn1/Mfn2)-double-knockout (Mfn-DKO) compared to wild-type (WT) mice, optical-electrophysiology was conducted. To measure conduction velocity (CV) in atrial and ventricular tissue from the Mfn-DKO and WT mice, at both baseline and following simulated acute IR, multi-electrode array (MEA) was employed. Intracellular localization of connexin-43 (Cx43) at baseline was evaluated by immunohistochemistry, while Cx-43 phosphorylation was assessed by Western-blotting. Mfn-DKO cardiomyocytes demonstrated an increased APD. At baseline, CV was significantly lower in the left ventricle of the Mfn-DKO mice. CV decreased with simulated-ischemia and returned to baseline levels during simulated-reperfusion in WT but not in atria of Mfn-DKO mice. Mfn-DKO hearts displayed increased Cx43 lateralization, although phosphorylation of Cx43 at Ser-368 did not differ. In summary, Mfn-DKO mice have increased APD and reduced CV at baseline and impaired alterations in CV following cardiac IR. These findings were associated with increased Cx43 lateralization, suggesting that the mitofusins may impact on post-MI cardiac-arrhythmogenesis.
© 2022. The Author(s).
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Keep it simple: A novel technique for measuring airflow using a wireless patch.
Sleep Health2022 Dec;():. doi: S2352-7218(22)00188-7.
Zandieh Stephanie, Kirschenbaum Michael A, Greenberg Harly, Ancoli-Israel Sonia,
Abstract
OBJECTIVES:
Despite the growing use of home sleep testing for obstructive sleep apnea (OSA), there are significant barriers that make it difficult for patients. This study aimed to evaluate a new set of wireless patches for the detection of OSA as compared to polysomnography (PSG) respiratory signals. Safety was also evaluated.
METHODS:
Patients (n = 25; mean age = 51.3; SD = 15.6) undergoing standard PSG evaluation for OSA wore 2 device patches applied on the chest and abdomen to provide surrogates of respiratory effort and derived airflow. Two sets of respiratory data (with common SpO2 and heart rate as a reference from PSG) were created, one from PSG and one from the device patches. Data were scored by a Registered Polysomnographic Technologist. Linear regression analyses and Bland-Altman plots were used to compare the two derived apnea-hypopnea indices (AHI). Bench testing was performed to determine whether the device patch respiratory signal accuracy remained consistent for different body characteristics.
RESULTS:
There was a significant correlation for AHI between the device patch and PSG (r = 0.979; P
CONCLUSIONS:
These preliminary results suggest that the device patch may be an effective way to measure respiratory dynamics, including derived airflow, to evaluate OSA. Results show promise as a new innovative method for home sleep testing.
Copyright © 2022. Published by Elsevier Inc.
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Characterization of Neuropsychological Outcomes in a Cohort of Pediatric Patients with Moyamoya Arteriopathy.
Neuropediatrics2022 Dec;():. doi: 10.1055/a-1993-3860.
Gatti John Richard, Peterson Rachel K, Cannon Alicia, Yedavalli Vivek, Malone Laura A, Sun Lisa Renee,
Abstract
INTRODUCTION:
Moyamoya arteriopathy is a severe, progressive cerebral arteriopathy that places affected children at high risk for stroke. Moyamoya has been associated with a range of neuropsychological deficits in adults, but data on many cognitive domains remains limited in the pediatric population and little is known about the neuropsychological profile of children with syndromic moyamoya.
METHODS:
This is a single-center, retrospective cohort study of children with moyamoya arteriopathy followed at our center who underwent neuropsychological testing between 2003 and 2021. Test scores were extracted from neuropsychological reports. Medical records were reviewed with attention to individual neuropsychological test results, medical comorbidities, presence of infarct(s) on neuroimaging, and history of clinical ischemic stroke.
RESULTS:
Of the 83 children with moyamoya followed at our center between 2003 and 2021, 13 had completed neuropsychological testing across multiple cognitive domains. Compared to age-based normative data, children in this sample had lower scores in overall intelligence (p=0.003), global executive functioning (p=0.005), and overall adaptive functioning (p=0.015). There was no significant difference in overall intelligence between children with (n= 6) versus without (n=7) a history of clinical stroke (p=0.368), though children with any radiographic infarct scored lower in this domain (p=0.032).
CONCLUSIONS:
In our cohort, children with moyamoya demonstrated impaired intelligence and executive functioning, even in the absence of clinical stroke. Neuropsychological evaluation should be considered standard of care for all children with moyamoya, even those without a history of clinical stroke.
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The value of modified Ross score in the evaluation of children with severe lower respiratory tract infection admitted to the pediatric intensive care unit.
Eur J Pediatr2022 Dec;():. doi: 10.1007/s00431-022-04737-9.
Hassan Enas Saad, Ahmad Salah-Eldin Amry, Mohamad Ismail Lotfy, Ahmad Faisal-Alkhateeb,
Abstract
Heart failure (HF) represents an important cause of morbidity and mortality in children. It is mostly caused by congenital heart disease (CHD) and cardiomyopathy. The Ross HF classification was developed to assess severity in infants and has subsequently been modified to apply to all pediatric ages. The modified Ross classification for children provides a numeric score comparable with the New York Heart Association (NYHA) HF classification for adults. The aim of this work is to investigate the role of modified Ross score in the evaluation of children with severe lower respiratory tract infection admitted to the pediatric intensive care unit (PICU). One hundred and sixty-four children with severe LRTI admitted to the PICU were enrolled in this prospective cohort study, which was carried out at Assiut University Children Hospital, from the start of July 2021 up to the end of December 2021. Sixty patients (36.6%) of studied cases with severe LRTI admitted to PICU had HF. Out of these, 37 (61.7%) had mild HF; 17 (28.3%) had moderate HF, while six cases (10%) had severe HF according to the modified Ross score. The value of modified Ross score was significantly higher in children with heart failure with sensitivity and specificity 100% with cutoff value of 2. Admission to NICU, history of previous ventilation, and prematurity were higher in patients who developed HF. Patients with pulmonary hypertension (PH) and those with raised neutrophil lymphocyte ratio were significantly higher in the group of patients with moderate and severe degree of HF. Conclusion: Modified Ross score is a simple clinical score which may help in assessing and predicting children with severe LRTI. What is Known: ? Hear failure is common complication to lower respiratory tract infection. ? Modified Ross score was used to predict and classify heart failure in adult with lower respiratory infection. What is New: ? Modified Ross score found to be of value in prediction of heart failure in children with lower respiratory tract infection.
© 2022. The Author(s).
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Organ Dysfunction Among Children Meeting Brain Death Criteria: Implications for Organ Donation.
Pediatr Crit Care Med2022 Dec;():. doi: PCC.0000000000003124.
Nickerson Taylor E, Lovett Marlina E, O'Brien Nicole F,
Abstract
OBJECTIVES:
Over 70% of pediatric organ donors are declared deceased by brain death (BD) criteria. Patients with these devastating neurologic injuries often have accompanying multiple organ dysfunction. This study was performed to characterize organ dysfunction in children who met BD criteria and were able to donate their organs compared with those deemed medically ineligible.
DESIGN:
Retrospective cohort study.
SETTING:
PICU at a quaternary care children's hospital.
PATIENTS:
Patients with International Classification of Diseases, 9th Edition codes corresponding to BD between 2012 and 2018 were included.
MEASUREMENTS AND MAIN RESULTS:
Demographics, comorbidities, Pediatric Risk of Mortality (PRISM)-III, and injury mechanisms were derived from the medical record. Organ dysfunction was quantified by evaluating peak daily organ-specific variables. Fifty-eight patients, from newborn to 22 years old, were included with a median PRISM-III of 34 (interquartile range [IQR], 26-36), and all met criteria for multiple organ dysfunction syndrome (MODS). Thirty-four of 58 BD children (59%) donated at least one organ. Of the donors (not mutually exclusive proportions), 10 of 34 donated lungs, with a peak oxygenation index of 11 (IQR, 8-23); 24 of 34 donated their heart (with peak Vasoactive Inotrope Score 23 [IQR, 18-33]); 31 of 34 donated kidneys, of whom 16 of 31 (52%) had evidence of acute kidney injury; and 28 of 34 patients donated their liver, with peak alanine transferase (ALT) of 104 U/L (IQR, 44-268 U/L) and aspartate aminotransferase (AST) of 165 U/L (IQR, 94-434 U/L). Organ dysfunction was similar between heart and lung donors and respective medically ineligible nondonors. Those deemed medically ineligible to donate their liver had higher peak ALT 1,518 U/L (IQR, 986-1,748 U/L) (p = 0.01) and AST 2,200 U/L (IQR, 1,453-2,405 U/L) (p = 0.01) compared with liver donors.
CONCLUSIONS:
In our single-center experience, all children with BD had MODS, yet more than one-half were still able to donate organs. Future research should further evaluate transplant outcomes of dysfunctional organs prior to standardizing donation eligibility criteria.
Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
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