Background:Pediatric dilated cardiomyopathy (DCM) is a rare, progressive heart disease with variable outcomes that range from recovery to heart transplantation. To date, there are no prognostic biomarkers for children with DCM. Identifying circulating biomarkers that are associated with clinical outcomes is critical for personalized management.Methods:miRNAs were identified by RNA-seq, whereas proteins were identified by SomaScan®. Machine learning methodologies were used to explore the predictive ability of circulating factors identified from serum samples collected at the time of presentation with acute heart failure.Results:Thirty patients experienced poor outcomes (cardiac transplantation, mechanical circulatory support, or death) and 19 patients recovered left ventricular function. Distinct miRNA and protein signatures differentiated outcomes groups. Top candidate proteins (COL2A1, CXCL12, and ADGRF5) and miRNAs (miR-874-3p, miR-335-3p, miR-323a-3p) demonstrated strong discriminatory performance within the study cohort (recovered vs poor outcomes; Area Under the Curve of 0.92). Ingenuity Pathway Analysis implicates cardiac remodeling, fibrosis, and inflammatory signaling as central pathways differentiating patient outcomes.Conclusions:Circulating miRNA and protein signatures at presentation identify a circulating molecular signature associated with divergent clinical trajectories in pediatric DCM. These findings support the potential utility of multi-omic biomarkers for early risk stratification and provide insight into mechanisms underlying divergent outcomes.

Abstract Background Heart failure with reduced ejection fraction (HFrEF) is associated with endothelial dysfunction, arterial stiffness, and impaired ventricular function, contributing to poor outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), such as empagliflozin, have demonstrated cardioprotective effects beyond glucose control, including potential benefits on vascular and myocardial function. However, their short-term impact in acute decompensated HF remains insufficiently explored. Purpose This study aimed to evaluate the short-term effects of empagliflozin on endothelial function, arterial stiffness, and indices of systolic and diastolic left ventricular (LV) function in patients hospitalized with acute or de novo HFrEF, independent of diabetes status. Methods Thirty-four patients with acute or newly diagnosed HFrEF were prospectively enrolled and randomized to receive either standard guideline-directed medical therapy (GDMT) alone (n=14) or with empagliflozin 10 mg daily (n=20) initiated within 24–72 hours of admission. GDMT included ACE inhibitors/ARNI, beta-blockers, mineralocorticoid receptor antagonists, and diuretics. Echocardiographic measures (LV ejection fraction (LVEF), LV global longitudinal strain (LV-GLS), E/e’, left atrial (LA) strain), endothelial function (flow-mediated dilation (FMD)), and arterial stiffness parameters (pulse wave velocity (PWV), augmentation index (Aix)) were assessed at baseline, one month, and two months. Results Baseline clinical characteristics and imaging parameters were comparable between groups. After two months, the empagliflozin group exhibited significant improvements in LV systolic (LVEF, LV-GLS) and diastolic function (E/e’, LA strain) compared to controls (Figure 1). Endothelial function, measured by FMD, significantly improved in the empagliflozin group (p=0.02) but remained unchanged in the control group (p-interaction=0.04). Arterial stiffness parameters (PWV, Aix) showed no significant differences between groups. Significant correlations were observed between ΔFMD-ΔLVEF (R=0.40, p=0.04) and ΔPWV-ΔE/e’ (R=0.44, p=0.03) (Figure 2). Conclusion Early initiation of empagliflozin in acute decompensated HFrEF significantly improved both left ventricular systolic and diastolic function with parallel improvement in endothelial function. Importantly the association between endothelial function improvement and LV systolic function suggests a potential mechanistic link between vascular and myocardial benefits. These findings underscore empagliflozin’s therapeutic potential beyond glycemic control, reinforcing its role in cardiovascular protection through endothelial-ventricular interaction in acute heart failure.Figure 1 Figure 2

BackgroundDespite the well-documented adverse health effects of tobacco smoking, it remains prevalent worldwide. Chronic tobacco smoking is associated with significant cardiovascular effects, including an increased risk of cardiovascular disease and vascular dysfunction. In recent years, the use of electronic cigarettes (ECs) has increased, with many former tobacco cigarette smokers switching to ECs to aid in smoking cessation. To date, no systematic review has synthesized prospective evidence on key vascular and cardiovascular outcomes among adult smokers who quit or switch to ECs, with the specific aim of identifying early and clinically meaningful indicators of vascular recovery.ObjectiveThis systematic review aims to summarize the current prospective studies on the vascular effects of switching to exclusive EC use and the overall effects of smoking cessation on regular tobacco cigarette smokers. The review will focus, in particular, on early indicators of vascular improvement, such as measures of vascular function, including arterial stiffness and endothelial function, as well as on heart rate, blood pressure, nonfatal myocardial infarction, nonfatal stroke, sudden cardiovascular death, and acute heart failure.MethodsThe review will be reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search was performed in PubMed and Scopus on January 12, 2025, without restrictions on the publication date. Studies will be included if they focus on cardiovascular outcomes, with study designs, including clinical trials (randomized controlled trials, observational studies), prospective cohort studies, and case-control studies. Studies involving regular smokers, aged 18 years and older, and those reporting on smoking cessation or switching to ECs will be considered. Data will be extracted using a standardized form and synthesized qualitatively. Risk of bias will be assessed using Joanna Briggs Institute’s critical appraisal tools, with results informing sensitivity analyses and interpretation.ResultsAs of January 2025, the preliminary search retrieved 1479 records across PubMed and Scopus. At the time of this protocol’s publication, the first manuscript on vascular function outcomes was completed in July 2025 and is currently under peer review. Each subsequent review will include an updated search before completion.ConclusionsThis review will provide a comprehensive landscape of current literature on the long-term vascular effects of smoking cessation and switching to exclusive EC use. The findings will help identify early indicators of vascular damage reversal, gaps in the current evidence base, and inform future research directions. By disseminating the results through peer-reviewed journals, conferences, and digital platforms, the review aims to enhance the understanding of smoking cessation’s impact on vascular health and support public health efforts in reducing tobacco-related harm.Trial RegistrationPROSPERO CRD420251016878; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251016878International Registered Report Identifier (IRRID)PRR1-10.2196/74949

3: Public Health Agency, Belfast, Northern Ireland Introduction: Hospital at Home (H@H) services have been in development for 10-15 years in both Scotland and Northern Ireland. They aim to provide hospital level, acute care for patients within their own home for a range of conditions that would usually require hospitalization such as severe respiratory infections, acute heart or kidney failure. Potential benefits of H@H include improved patient experience, reduced length of stay, and an increase in bed capacity in acute hospitals. The emerging evidence is particularly strong for patients living with frailty syndromes and at risk of delirium, deconditioning and falls. As services matured in capability and capacity, both Scotland and Northern Ireland at country-level find themselves with similar themed challenges around quality assurance and maintaining safety and effectiveness, longer term funding and investment and maximising the contributions of these highly-skilled multidisciplinary teams. Target community: Older adults with acute care needs which can be provided in the community. Who did you involve and engage with? We convened regular high level engagement forums between the policy and senior leadership groups at NHS Scotland and the Department of Health Northern Ireland. This included senior clinical and operational leaders working within the offices of the Chief Nursing Officer in Northern Ireland and that of the Deputy Chief Medical Officer for Scotland. What did you do? We explored key themes. Progress in embedding and developing H@H teams. How best to assure ourselves that the focus remains on managing acute rather than subacute or primary care matters. How to develop the workforce, secure funding and strategic attention in a competitive and busy health and social care landscape full of constraints. How to develop the scope and contribution of these teams for the future. What results do you have? Since mid 2020, there has been particular focus on H@H. In Scotland there has been a 294% increase in the number of patients managed by these services and in Northern Ireland we estimate almost 10% of all acute care admissions for this group are now being managed by H@H services. We are developing consensus on core features of Hospital at Home services, the best approaches to monitor acuity and risk to ensure these are proportionate and appropriate. We are standardizing reporting arrangements to compare between our nations. This will provide a platform for critique, encouragement and development as we seek to develop these services further. What is the learning for the international audience? Learning between clinical teams and organisations are well established practices that yield benefits for individual patients and organisations. What is less well practiced are granular discussions at country level – shared challenges and opportunities, including tacking pragmatically issues that in isolation might otherwise be filed under ‘too difficult’. What are the next steps? Building on our alliance and learning system that demonstrates clarity of purpose, agreed measures, venues for convening, mutual coaching and applying a critical friend mindset. Collaborative working across the 2 nations will continue to raise the profile of H@H, and allow us to overcome challenges. Q+A thereafter.

According to current guidelines by the American Heart Association (AHA), the European Respiratory Council (ERC), and the European Society of Intensive Care Medicine (ESICM), the diagnosis of congestive heart failure is based on physical examination, laboratory assessment, and technological tests including echocardiography and chest X-ray. However,depending on different clinical variables, the assessment of BNP/NT-proBNP is generally recommended as the most sensitive method in making the diagnosis of congestive heart failure. Despite its high clinical utility, the measurement of BNP/NT-proBNP provides no information on the underlying pathophysiology or the hemodynamic state of the patient presenting. Impedance cardiography (ICG) enables clinicians to perform non-invasive continuous hemodynamic measurements to gain a more comprehensive view of the dynamics of heart failure. This systematic review and meta-analysis intend to investigate the relationship between different hemodynamic parameters measured with a bioimpedance device and levels of BNP/NT-proBNP to assess the usefulness of ICG in patients with acute heart failure.The present work was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P2015) guidelines. Electronic databases including PubMed, EMBASE, and GoogleScholar were searched for prospective studies investigating the relationship between BNP/NT-proBNP measurements and hemodynamic parameters in patients with heart failure. Statistical analysis including calculation of effect sizes, assessment of heterogeneity, and publication bias was performed using the software jamovi (jamovi project, 2024).From the initially identified 270 records, a total count of 11 articles met the eligibility criteria of the systematic review, of which nine studies were included inthe meta-analysis. Summarizing the correlations between ICG parameters and BNP/NT-proBNP levels, a statistically significant relationship between the thoracic fluid content (TFC) (CC: 0.332, 95% CI: 0.184; 0.479, p0.001), the cardiac index (CI)(CC: -0.312, 95% CI: -0.469; -0.155, p<0.001), stroke volume index (SVI) (CC: -0.369, 95% CI: -0.655; -0.083), and systolic time ratio(STR) (CC: 0.230, 95% CI: 0.117; 0.342, p<0.001) were observed.By summarizing the existing data on the relationship between hemodynamic parameters measured with ICG and levels of BNP/NT-proBNP, we could find substantial evidence for the utility of ICG in the diagnosis of heart failure.It seems to be particularly useful in differentiating shock states and guiding hemodynamic stabilization treatment with inotropes and vasopressors.

ABSTRACTIntroductionRight diaphragmatic excursion is a reliable and reproducible technique used in intensive care to assess diaphragmatic function. The aim of this study was to investigate the relationship between the appearance of diaphragmatic motion and the etiological diagnosis of patients admitted to the emergency department with acute respiratory failure (ARF).MaterialsA prospective, observational, and multicenter pilot study was conducted. All adult patients admitted in the emergency department with ARF were included. The different visual patterns of diaphragmatic motion were analyzed according to the three main etiologies of ARF encountered in emergency departments.ResultsA total of 39 adult patients were included. We observed a different visual pattern in patients with pneumonia. A sum of plateau times of less than 0.2 s predicted that the main diagnosis was pneumonia, with sensitivity = 89% 95%CI [52%; 100%], specificity = 87% 95%CI [69%; 96%].ConclusionOur study seems to show that the shape of diaphragmatic motion in patients with ARF secondary to pneumonia is different from that in patients with exacerbation of chronic obstructive pulmonary disease or acute heart failure.Trial Registration:ClinicalTrials.gov: NCT04591509

The meaning of the undefined term ‘accident’ in Article 17(1) of the Montreal Convention 1999 (MC99) has been unclear in Chinese cases for several years. In 2020, for the first time, the appellate court in Qatar Airways Group Q.C.S.C. v. Zhao et al. (‘Zhao’) defined ‘accident’ with the meaning almost the same as the one defined by the US Supreme Court in Air France v. Saks, yet concluded that the passenger’s death onboard the aircraft which was not timely detected by the carrier constituted an Article 17 ‘accident’, and held the carrier liable, even if the death caused by the passenger’s acute heart and respiratory failure was due to natural causes. The Zhao ruling also contains unsatisfactory rationales as reflected in the court’s inconsistent and controversial approaches in identifying the ‘accident’. After explaining the representative practice in other MC99 jurisdictions regarding the meaning of ‘accident’, this article introduces the Zhao case and discusses three unresolved issues pertaining to the Zhao ruling, namely the misidentification of death per se as an ‘accident’, the tendency and ambiguity of identifying the carrier’s omissions as de facto ‘accidents’ and, the flawed application of the Saks test in identifying some usual and expected conditions in normal flight activities as de facto ‘accidents’. It concludes that though the Zhao ruling can serve as an example to show the trend of acknowledging the Saks definition in Chinese practice, the meaning of ‘accident’ in a case regarding passenger death onboard the aircraft remains unsettled.

Background: The number of emergency department visits for hypertensive emergency has been increasing and was reported to be 496,894 visits in 2013 1. Current recommendations are to admit these patients to the ICU and start on intravenous blood pressure-lowering medications. This study aims to assess the prevalence of each end organ damage and their effects on the outcomes during hospitalization. Methods: This study analyzed data from the 2016-2020 National Inpatient Sample (NIS) database, focusing on adult hospital admissions. We utilized International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes to identify cases of hypertensive emergency (I16.1) and other relevant comorbidities. The primary objective was to assess the prevalence of end-organ damage and its impact on mortality. We employed multivariable logistic regression to adjust for demographics, comorbidities and other potential confounders. Results: Our comprehensive analysis included 1,032,860 hospitalizations due to hypertensive emergencies, with a notable increase in prevalence from 1,149 to 10,255 cases per 1 million patients between 2016 and 2020. The mean age of the cohort was 62.10 (± 15.97 years), with females constituting 50.7% and whites 44.97%. The most common chronic comorbidities identified were chronic kidney disease (CKD) at 44.87%, diabetes mellitus (DM) at 44.22%, coronary artery disease (CAD) at 42.49%, and congestive heart failure (CHF) at 42.46%. Among end-organ damages, acute kidney injury was most prevalent (33.37%), followed by acute heart failure/pulmonary edema (26.38%), Acute Coronary Syndromes (ACS) (15.33%), ischemic stroke (11.55%), hemorrhagic stroke (9.79%), hypertensive encephalopathy (5.30%), and aortic dissection (1.11%). In patients with hypertensive emergencies, the in-hospital mortality rate was 3.9%, and the median length of stay was 5.96 days (range: 5.91 - 6.01). Subgroup analysis revealed the highest mortality rates in patients with hemorrhagic stroke (20.0%), followed by those with aortic dissection (7.1%). Consistently, hemorrhagic stroke (OR 11.45, 95% CI 10.83-12.10, p&lt;0.001) and aortic dissection (OR 3.11, 95% CI 2.54-3.80, p&lt;0.001) emerged as the most significant predictors of increased in-hospital mortality after adjusting for demographics, comorbidities, and various types of end-organ damage. Conclusions: This study highlights a significant ongoing rise in hospital admissions due to hypertensive emergencies from 2016 to 2020, emphasizing the increasing burden of this condition. Our findings demonstrate prevalent comorbidities, end-organ damages and notable mortality rates among patients admitted with hypertensive emergencies. The study emphasizes the need for personalized patient care, underscoring the vital role of early detection and outpatient management of hypertension to prevent the onset of hypertensive emergencies and improve patient outcomes. With the rising incidence of hypertensive emergencies, it is imperative for healthcare systems to evolve, adopting new protocols and refining risk stratification criteria to effectively meet these emerging challenges.

Introduction: Acute pulmonary oedema is a life-threatening condition, and some patients require noninvasive ventilation such as continuous positive airway pressure (CPAP) ventilation and bi-level positive airway pressure (BiPAP) ventilation for improving alveolar ventilation and haemodynamic stability, thus, improving pulmonary oedema. This study aims to determine the efficacy and suitability of the CPAP vs. BiPAP ventilation in patients with acute pulmonary oedema following acute heart failure.Methods: The study was conducted as a randomized prospective clinical trial at the emergency treatment unit of the National Hospital of Sri Lanka and Base Hospital, Panadura. Group A patient received pressure limits of IPAP-8 -20 cm H2O, EPAP-4-10 cm H2O and Group B received CPAP 10 - 15 cm H2O and oronasal mask is used. Patients who do not tolerate CPAP were changed to BiPAP.Results: Our study demonstrated that in addition to the standard medical care, after 2 hours of treatment, both CPAP and BiPAP improve vital parameters, oxygenation / blood gases, and ameliorate respiratory distress, effectively managing acute pulmonary oedema. A few patients (5.8%) stated that Non-Invasive Ventilation (NIV) is quite difficult to tolerate, but more than 60% of patients agreed that NIV was given less discomfort for them. However, patients receiving BiPAP demonstrated higher heart rate (102 ± 9.282) than the CPAP group 84 ± 13.326 at the end of treatment.Conclusions: At the end of the treatment, both CPAP and BiPAP treatment modalities are capable of improving vital parameters and respiratory distress even though BiPAP group demonstrated higher heart rate at the end of treatment. However, the study does not demonstrate any significant difference of clinical benefit of BiPAP vs CPAP.

Drug-related hypophosphatemia: Descriptive study and case/non-case analysis of the French national pharmacovigilance database

Advancing heart failure research using machine learning

Cardiogenic shock (CC) is the most advanced and severe stage of heart failure.&#x0D; Its management requires a rapid diagnosis, an etiological evaluation and the initiation of an adapted treatment as soon as possible.&#x0D; Even if ischemic etiology remains preponderant, the prevalence of other causes, notably valvular, is constantly increasing.&#x0D; In our industrialized countries, aortic stenosis is the most frequent valve disease, followed by mitral insufficiency, aortic insufficiency and mitral stenosis.&#x0D; While the management of these valvulopathies is well codified and has been evolving over the last few years, acute management is less clear.&#x0D; Inotropic treatments and mechanical circulatory support are part of the therapeutic arsenal available, but the correction of the valve disease remains the main problem.&#x0D; Conventional surgery is unfortunately difficult to consider because of its high moribidity and mortality. Percutaneous techniques are therefore an alternative, even if few data are available and their development according to the type of valve disease is uneven.&#x0D; This update provides an overview of the different valve diseases in the context of CC and summarizes the different therapeutic options available in such a critical situation.

Sepsis is one of the leading causes of death worldwide, and no therapy is available other than intensive care treatments. Drug development attempts have mainly focused on controlling inflammation or treating dysfunction, without significant improvement in the last decades. Recently, interest has emerged in β1-adrenergic blockade, which has proved beneficial to both parameters. Unfortunately, the specific underlying mechanisms have not been addressed yet. Our study aimed to investigate on mice (adult Swiss male, 30-45g) lipopolyssacharide or cecal ligature and puncture models the effects of atenolol, a β1-adrenergic blocker, currently used in intensive care units for hypertension and arrhythmia. The results demonstrated a beneficial effect of treatment on survival and a preservation of cardiac function including left ventricular ejection fraction (33±2,8% in sepsis group versus 55±5,1% in sepsis-treated group, p&lt;0,05) at a concentration reducing heart rate by approximately 10%.We wondered if beneficial results obtained with atenolol could be due to a modulation of extracellular traps. These components are essential in pathogen spreading control and are increased during sepsis. However, an excess of their production induces vascular occlusions and acute heart injuries.We demonstrated that neutrophils extracellular traps were increased in heart and blood during sepsis and decreased significantly following atenolol administration (blood: 1.1±0,3% in control group, 13,4±1.8% in sepsis group, 6.9±1.2% in sepsis-treated group). This beneficial effect of atenolol was not associated with other modulations of neutrophil function such as their ability to phagocyte (33,6±3,9% in sepsis group versus 25.6±3.6% in sepsis-treated group, p&gt;0,05), to undergo apoptosis (Annexin V+/ L/D-: 13,2±2.1% in sepsis group versus 14.1±2.9% in sepsis-treated group, p&gt;0,05) or to degranulate. Blood neutrophil phenotypes associated with their maturation state (expression of CD62L and CXCR2) or ability to migrate into tissue (expression of adhesion molecules PSGL1, LFA1, VLA4, PECAM1) was also similar between LPS and LPS-treated groups. Although, the modulation of extracellular traps production by atenolol was also observed in other immune cells population able to extrude chromatin fibers in extracellular space such as macrophages. These results suggest a specific beneficial effect of ß1-adrenergic blockers on extracellular traps formation associated with cardiac function preservation and ultimately survival without detrimental effect on heart rate during widespread inflammation. This work was supported by funding from INSERM and Paris-Saclay University-UVSQ. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

BackgroundIn this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure.MethodsAggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50).ResultsA total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)], less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year.ConclusionsED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies.Graphical abstract

The difficulties of diagnosis and management of patients with alcohol-induced heart lesions, features of the clinic of alcoholic cardiomyopathy are highlighted. Excessive and prolonged alcohol consumption increases the risk of developing acute and chronic heart failure, cardiac arrhythmias and aggravates existing cardiovascular diseases. At the same time, due to insufficient assessment of the origin of cardiac manifestations (patients often hide or downplay the fact of alcohol abuse), patients do not always receive specific treatment. The management of such patients presents significant difficulties, taking into account, among other things, the defeat of the gastrointestinal tract, central and peripheral nervous system and should be carried out jointly with doctors of other specialties.

The optimal management of very small vessel (reference diameter from 2.0 to 2.25 mm) in percutaneous coronary interventions (PCIs) is controversial. We aimed to compare the efficacy and safety of drug-coated balloons (DCBs) and drug-eluting stents (DESs) for de-novo very small vessel interventions. We conducted a retrospective analysis of consecutive patients who received very small vessel PCI with a DCB or DES between January 2018 and March 2021. The outcome measures were the incidence of ischemia-driven target lesion revascularization (TLR) and major adverse cardiac and cerebrovascular events (MACCEs) within 1 year after PCI. MACCEs were defined as the composite of ischemia-driven TLR, all-cause death, non-fatal acute coronary syndrome, stroke, or heart failure requiring hospitalization. A total of 205 patients undergoing PCI with a DCB or DES were enrolled in this study. The procedural complication rate was 2.5% in the DES group and 1.7% in the DCB group (P = 1.000). After 1-year of follow-up, the cumulative incidence of TLR was 7.2% in the DCB group and 4.9% in the DES group (P = 0.530). The cumulative incidence of MACCEs was 10.6% in the DCB group and 12.7% in the DES group (P = 0.769). Only female gender, acute coronary syndrome on presentation, and dual antiplatelet therapy duration < 3 months were significantly associated with MACCEs at 1 year, but the use of DCB or DES was not. The use of DCBs or DESs in de novo very small vessel intervention was not associated with different outcomes at 1 year.

AimTo validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF).DesignQuantitative, prospective, single centre, cohort study.MethodsN-Terminal pro–B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days.Results88 patients were included. The median age of the study population was 75 years (IQR 69–83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08—1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 – 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99—1.03, p = 0.174).ConclusionThis study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population.Trial RegistrationThis study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.

Machine learning is increasingly being used to predict clinical outcomes. Most comparisons of different methods have been based on empirical analyses in specific datasets. We used Monte Carlo simulations to determine when machine learning methods perform better than statistical learning methods in a specific setting. We evaluated six learning methods: stochastic gradient boosting machines using trees as the base learners, random forests, artificial neural networks, the lasso, ridge regression, and linear regression estimated using ordinary least squares (OLS). Our simulations were informed by empirical analyses in patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) and used six data-generating processes, each based on one of the six learning methods, to simulate continuous outcomes in the derivation and validation samples. The outcome was systolic blood pressure at hospital discharge, a continuous outcome. We applied the six learning methods in each of the simulated derivation samples and evaluated performance in the simulated validation samples. The primary observation was that neural networks tended to result in estimates with worse predictive accuracy than the other five methods in both disease samples and across all six data-generating processes. Boosted trees and OLS regression tended to perform well across a range of scenarios.

BackgroundThe study aimed to investigate the link between burnout symptoms and prosocial behaviour, as well as the role of acute stress and vagally-mediated heart rate variability (vmHRV) on this association.MethodsSeventy men were randomly assigned to either the stress or the control condition of the Trier Social Stress Test for Groups (TSST-G). Prosocial behaviour was assessed via a social decision-making paradigm during the respective TSST-G condition.ResultsCorrelation analyses revealed negative correlations between prosocial behaviour and burnout symptoms. Acute stress was also associated with reduced prosocial behaviour, whereas no interaction effects with burnout symptoms could be revealed. Exploratory analyses showed that vmHRV was negatively correlated with burnout symptoms during the social decision-making paradigm but did not mediate the link between burnout and prosocial behaviour.ConclusionIn conclusion, we report first experimental evidence that burnout symptoms are negatively associated with prosocial behaviour. Further studies are needed to explore the causal relations.

BACKGROUND AND AIMSThe acute effects of the acute kidney injury (AKI) on short-term mortality in patients with novel coronavirus infection (COVID-19) have been studied, but the long-term outcomes after COVID-19-associated AKI are not well understood. Our aim was to evaluate the impact of AKI in acute COVID-19 in the prediction of long-term mortality in a population of hospitalized patients with COVID-19.METHODWe performed a cohort study on 1000 patients hospitalized from April to July 2020 with laboratory-confirmed COVID-19 and lung injury by computer tomography (CT). We excluded patients with re-hospitalization, acute surgical pathology and a single serum creatinine measurement during hospitalization. Definition of AKI was based on KDIGO criteria. According to the ESC guidelines, the term acute decompensated heart failure (ADHF) is used to describe patients with previously history of chronic stable heart failure with the typical symptoms and/or signs of decompensation of HF during hospitalization. Multivariate Cox regression was conducted to explore the potential predictors for long-term mortality. A P-value < 0.05 was considered statistically significant.RESULTSThe prospective part included 691/792 (87%) surviving patients [47% males, mean age 67 (55;78) years, mean Charlson index 3 (2;5), 69% with hypertension (HTN), 50% with obesity, 26% with diabetes mellitus (DM) and 15% with coronary artery disease (CAD)]. And 12.6% of patients were hospitalized in the intensive care unit (ICU).A total of 137 (20%) patients had AKI in acute COVID-19 and discharged from the hospital. The majority of survival patients with AKI had the 1 stage (77%), 17%—the 2 and 6%–the 3. There were no patients who underwent renal replacement therapy during acute COVID-19 in the survivors’ group. Patients with AKI were older [71 (62;78) versus 64 (52;73) years, P < .0001, compared with patients without AKI], had HTN (83% versus 66%, P < .001), DM (33% versus 24%, P = .03), CAD (25% versus 13%, P < .001) and higher Charlson index [4 (3;5) versus 3 (1;4), P < .0001]. Also, AKI patients had more severe lung injury by CT in acute COVID-19 (lung injuries >50%, 38% versus 26%, P = .004) and more frequently were hospitalized in ICU (23% versus 10%, P < .001). A total of 74% patients recovered from AKI at the discharge time.During 180 days of follow-up, 41 (6%) patients died in the whole study group. The most common cause of death was a heart attack or stroke (29%). In the group without AKI, the mortality rate was 4.5%, among patients with AKI—11.8% (P < .001). In multivariate Cox regression, AKI in the acute phase of COVID-19 [hazard ratio (HR) 2.83, 95% confidence interval (95% CI) 1.28–6.26; P = .01] and the Charlson index (HR 1.46, 95% CI 1.19–1.79; P < .001) were independently associated with higher mortality from all causes within 180 days after discharge after adjusting for age, gender, frequency of obesity, HTN, CAD, DM, ADHF, hospitalization in the ICU and lesions of more than 50% lung volume in the acute phase of COVID-19.CONCLUSIONAKI in the acute phase of COVID-19 and the Charlson index are independently associated with higher mortality within 180 days after discharge.Figure 1:A. Different urinary profiles in UPE. 1: Normal profile, 2: Tubular profile, 3: Glomerular profile, 3: Mixed profile. B. Urine protein assay in COVID ARDS patients with and without AKI KDIGO ≥ 2 in univariate analysis.