True left bundle branch block and long-term mortality in cardiac resynchronisation therapy patients

Background: Left bundle branch block (LBBB) is an important qualification criterion and determinant of prognosis in cardiac  resynchronisation therapy (CRT) patients.  Aims: Our goal was to investigate the long-term mortality and morbidity in a sizable cohort of patients with CRT with regard to the new strict LBBB definition proposed by Perrin.  Methods: We performed a longitudinal cohort study that included consecutive CRT patients. Primary endpoint (all-cause death) and secondary endpoint (all-cause death and hospitalisation for heart failure) were analysed. All preimplantation elec- trocardiograms were categorised as LBBB or non-LBBB according to the new definitions/criteria analysed.  Results: The survival analysis comprised 552 patients with CRT. The Perrin criteria, CRT guidelines class I indication criteria, and Strauss criteria were fulfilled in 38.9%, 79.4%, and 62.3% of all LBBB patients, respectively. During the nine-year study period, 232 patients died and the combined endpoint was met by 292 patients. The Perrin “true LBBB” definition criteria were inferior to the Strauss “complete” LBBB definition criteria in predicting survival as reflected by Kaplan-Meier survival curves (C-statistics). Multivariate Cox regression models showed that both LBBB definitions predicted mortality, however, the Perrin definition had a higher hazard ratio (HR 0.67) compared to the Strauss definition (HR 0.51).  Conclusions: It seems that the Perrin “true LBBB” criteria are not well-suited for the selection of CRT candidates. Perhaps they do not reflect the presence of a true/complete LBBB or exclude too many patients who, despite some residual conduction in the left bundle branch, responded well to CRT.

The role of stress hyperglycemia and hyperlactatemia in non-diabetic patients with myocardial infarction treated with percutaneous coronary intervention

Background: Stress hyperglycemia and lactates have been used separately as markers of a severe clinical condition and poor outcomes in patients with myocardial infarction (MI). However, the interplay between glucose and lactate metabolism in patients with MI have not been sufficiently studied. The aim in the present study was to examine the relationship of glycemia on admission (AG) and lactate levels and their impact on the outcome in non-diabetic MI patients treated with percutaneous coronary intervention (PCI).  Methods: A total of 405 consecutive, non-diabetic, MI patients were enrolled in this retrospective, observational, single-center study. Clinical characteristic including glucose and lactate levels on admission and at 30-day mortality were assessed. Results: Patients with stress hyperglycemia (AG ≥ 7.8 mmol/L, n = 103) had higher GRACE score (median [interquartile range]: 143.4 (115.4–178.9) vs. 129.4 (105.7–154.5), p = 0.002) than normoglycemic patients (AG level < 7.8 mmol/L, n = 302). A positive correlation of AG with lactate level (R = 0.520, p < 0.001) was observed. The coexistence of both hyperglycemia and hyperlactatemia (lactate level ≥ 2.0 mmol/L) was associated with lower survival rate in the Kaplan-Meier estimates (p < 0.001). In multivariable analysis both hyperglycemia and hyperlactatemia were related to a higher risk of death at 30-day follow-up (hazard ratio [HR] 3.21, 95%, confidence interval [CI] 1.04–9.93; p = 0.043 and HR 7.08; 95% CI 1.44-34.93; p = 0.016, respectively) Conclusions: There is a relationship between hyperglycemia and hyperlactatemia in non-diabetic MI patients treated with PCI. The coexistence of both hyperglycemia and hyperlactatemia is associated with lower survival rate and are independent predictors of 30-day mortality in MI patients and these markers should be evaluated simultaneously

CHADS2 and CHA2DS2-VASc scores predict long-term mortality in patients with typical atrial flutter after catheter ablation

Background: The CHADS2 and CHA2DS2-VASc scores were shown to predict mortality in patients with atrial fibrillation. However, pathophysiology and treatment outcomes of atrial fibrillation and typical atrial flutter (AFL) differ. Consequently, the prognosis of patients with AFL can also be different. Aims: The aim of the study was to assess CHADS2 and CHA2DS2‑VASc scores as mortality predictors in patients with typical AFL. Methods: Large cohort of consecutive patients with typical AFL who underwent catheter ablation was retrospectively analyzed. The CHADS2 and CHA2DS2‑VASc were calculated using hospital record data. All-cause mortality data was obtained from the registry of national personal identification numbers. The Kaplan–Meier method and multivariable Cox proportional hazard models were applied for survival and hazard ratio analyses, respectively. Results: A total of 469 patients hospitalized for typical AFL ablation were enrolled (mean [SD] age, 63.7 [12.2] years; male sex, 69.1%). Patients were followed from 2 to 12 years resulting in 2974 patient‑years of follow‑up. The Kaplan–Meier survival analysis revealed a negative impact of each component of the CHADS2 and CHA2DS2‑VASc scores on survival with the exception of stroke (not significant) and female sex (related to abetter survival). Consequently, higher scores were predictive of higher all‑cause mortality rates (2.7%–54% at 10 years); the CHA2DS2‑VASc score was equally predictive as the CHADS2 score. Conclusions: In patients referred for typical AFL ablation, the CHADS2 score can be applied for prognostic assessment. A successful AFL ablation procedure should not divert the attention from recognizing and addressing other medical issues that have an impact on long‑term mortality, which remains very high in this population of patients

Non-technical Skills in Cardiopulmonary Resuscitation: Improvement and Evaluation of a New Course Introduced to the Curriculum at a Medical School in Poland in 2018 to 2019

Non-technical skills (NTS) are important skills in emergency medicine and should be a necessity even at the stage of medical studies. The aim of this study was to assess how increasing the number of non-technical skills hours influenced the results of non-technical competences among medical students. In this investigation, 296 Polish medical students in the sixth year at Medical College in Krakow, Poland were included in the study. The students were divided into two research groups: I in 2018 and II in 2019. The groups differed in the number of total hours that focused on non-technical skills, in 2018: 60 hr, and 2019: 120 total hours. Non-technical competencies were assessed at the Crisis Resource Management station using sudden cardiac arrest scenarios. In 2018, the median was 20 points and the average of the points obtained in this group was 19.53 points (SD 5.39 points). In 2019, the median was 26 points and the average of points was 25.07 points (SD 5.23 points). Students who had more non-technical skills classes (120 hr) scored more points on the OSCE exam than group I (60 hr) ( p  < .001). The median of points in non-technical competences depended on the number of teaching hours in which the main emphasis was on the development of these skills. This investigation demonstrates that more teaching hours dedicated to improving the non-technical skills of students corresponded to better results on the cardiopulmonary resuscitation scenarios

Risk stratification in patients with cardiac resynchronisation therapy: the AL-FINE CRT risk score

Background: Mortality and morbidity in patients with cardiac resynchronisation therapy (CRT) remain very high. Prognostic evaluation of CRT candidates might be useful for the assessment of CRT indications, directing further therapy, counselling, etc. Aim: Our goal was to assess the prognostic value of various parameters in order to construct a risk score that could predict long-term mortality and morbidity during the initial evaluation of CRT candidates. Methods: This was a retrospective, single-centre, large cohort study involving consecutive heart failure patients who underwent CRT device implantation. In order to build a prediction model, 28 parameters were analysed using uni- and multivariate Cox models and Kaplan-Meier survival curves. Results: Data from 552 patients were used for the long-term outcome assessment. During nine years of follow-up, 232 patients met the primary endpoint of death and 128 patients were hospitalised for heart failure. The strongest and clinically most relevant predictors were selected as the final model. AL-FINE is the acronym for these six predictors: Age ( &gt; 75 years), non-Left bundle branch block morphology (according to Strauss criteria), Furosemide dose ( &gt; 80 mg), Ischaemic aetiology, New York Heart Association class ( &gt; III), and left ventricular Ejection fraction ( &lt; 20%). Depending on the number of AL-FINE score points, overall mortality at seven years was in the range of 28% (0–1 points) to 74% (3–6 points). Conclusions: A novel, multiparametric CRT risk score was constructed on the basis of simple and recognised clinical, electrocardiographic, and echocardiographic parameters that show a significant add-on effect on mortality in this specific population

Roles of aldosterone and oxytocin in abnormalities caused by sevoflurane anesthesia in neonatal rats

ABSTRACT Background: The authors sought to determine whether subjects with pathophysiological conditions that are characterized by increased concentrations of aldosterone have increased susceptibility to the side effects of neonatal anesthesia with sevoflurane. Methods: Postnatal day 4 -20 (P4 -P20) rats were exposed to sevoflurane, 6% and 2.1%, for 3 min and 60 -360 min, respectively. Exogenous aldosterone was administered to imitate pathophysiological conditions with increased concentrations of aldosterone. Results: Six hours of anesthesia with sevoflurane on P4 -P5 rats resulted in a more than 30-fold increase in serum concentrations of aldosterone (7.02 Ϯ 1.61 ng/dl vs. 263.75 Ϯ 22.31 ng/dl, mean Ϯ SE, n ϭ 5-6) and reduced prepulse inhibition of the acoustic startle response (F (2,37) ϭ 5.66, P Ͻ 0.001). Administration of exogenous aldosterone during anesthesia with sevoflurane enhanced seizure-like electroencephalogram patterns in neonatal rats (48.25 Ϯ 15.91 s vs. 222.00 Ϯ 53.87 s, mean Ϯ SE, n ϭ 4) but did not affect electroencephalographic activity in older rats. Exogenous aldosterone increased activation of caspase-3 (F (3,28) ϭ 11.02, P Ͻ 0.001) and disruption of prepulse inhibition of startle (F (3,46) ϭ 6.36; P ϭ 0.001) caused by sevoflurane. Intracerebral administration of oxytocin receptor agonists resulted in depressed seizure-like electroencephalogram patterns (F (2,17) ϭ 6.37, P ϭ 0.009), reduced activation of caspase-3 (t (11) ϭ 2.83, P ϭ 0.016), and disruption of prepulse inhibition of startle (t (7) ϭ Ϫ2.9; P ϭ 0.023) caused by sevoflurane