Clinical predictors of outcome in survivors of out-of-hospital cardiac arrest treated with hypothermia

AbstractBackgroundOut-of-hospital cardiac arrest (OHCA) is a leading cause of death and severe neurological disability. The objective of this study was to identify clinical predictors of early neurological outcome in survivors of OHCA managed according to recent recommendations for OHCA care.MethodsData from survivors of OHCA, admitted to a tertiary cardiac intensive care unit and treated with hypothermia in a 22 months period (n=46, age 60±13 years, 74% males) were retrospectively evaluated. At 1-month follow-up, patients were classified according to the best achieved Glasgow–Pittsburgh cerebral performance categories (CPC 1–5) and factors affecting the outcome were analysed.ResultsAt 1-month follow-up, 23 patients (50%) had favourable outcome (CPC 1–2), while 23 patients (50%) had poor outcome (CPC 3–5), including 19 with in-hospital death (41% of total). Patients with good outcome were younger (55±13 years vs. 66±10 years; P=0.003), had more often myocardial infarction as the cause of arrest (63% vs. 30%; P=0.018) and ventricular fibrillation/tachycardia as an initial rhythm (78% vs. 39%; P=0.007). Both groups differed by lactate level on admission (4.0±4.6 vs. 7.3±4.1mmol/l, P=0.02), after 12h (2.5±1.1 vs. 4.3±3.2mmol/l, P=0.04) and after 24h (1.9±1.2 vs. 3.2±1.9mmol/l, P=0.04). Logistic regression revealed the following independent outcome predictors: age, acute myocardial infarction and admission lactate level.ConclusionFavourable outcome was observed in a half of OHCA survivors. Young age, acute myocardial infarction as underlying aetiology of cardiac arrest, and low lactate level on admission were the best predictors of favourable outcome

Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation

Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved

Role some genetic factors in bodyweight changes

The aim of the study was to determine the role of certain genetic factors on the ability to maintain weight loss, as well as to reduce the health risks associated with obesity in a group of about 300 obese patients followed for 2.5 years. The first part dealt with monitoring the impact of P73T polymorphism of the neuromedin gene on body weight reduction and its relation to certain metabolic and psychobehavioral factors. In the group of obese men, T allele non-carriers achieved significant reduction in waist circumference at the end of the follow-up. This waist circumference reduction was accompanied by a significant reduction in energy intake and by a significant decrease in the Beck depression score, while dietary restraint score increased. In the group of obese women, no significant differences between carriers and non-carriers of the T allele were observed. The significant reduction in total energy intake and macronutrient consumption was achieved in obese women regardless the genotype. In the second part, the effect of the Leu162Val of PPAR and Pro12Ala of PPAR gene polymorphisms on body weight reduction and on metabolic and psychobehavioral factors was studied in a group of 246 obese women. At baseline, non-carriers compared to carriers of the minor Val-allele of PPAR gene exhibitied a favorable effect..

Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm

<div><p>Aims</p><p>To investigate predictors of long-term outcomes after catheter ablation (CA) for ventricular tachycardia (VT) and the impact of electrical storm (ES) prior to index ablation procedures.</p><p>Methods</p><p>We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88% males; 72% ischaemic cardiomyopathy; LVEF: 32±12%) who had undergone CA. According to presenting arrhythmia at baseline, they were divided into ES (n = 93, 28%) and non-ES groups. Clinical predictors of all-cause mortality were investigated and a clinically useful risk score (SCORE) was constructed.</p><p>Results</p><p>During a median follow-up of 927 days (IQR: 564–1626), 67% vs. 60% of patients (p = 0.05) experienced VT recurrence in the ES vs. the non-ES group, respectively; and 41% vs. 32% patients died (p = 0.02), respectively. Five factors were independently associated with mortality: age >70 years (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.1–2.4, p = 0.01), NYHA class ≥3 (HR: 1.9, 95% CI: 1.2–2.9, p = 0.005), a serum creatinine level >1.3 mg/dL (HR: 1.6, 95% CI: 1.1–2.3, p = 0.02), LVEF ≤25% (HR: 2.4, 95% CI: 1.6–3.5, p = 0.00004), and amiodarone therapy (HR: 1.5, 95% CI: 1.0–2.2, p = 0.03). A risk SCORE ranging from 0–4 (1 point for either high-risk age, NYHA, creatinine, or LVEF) correlated with mortality. ES during index ablation independently predicted mortality only in patients with a SCORE ≤1.</p><p>Conclusions</p><p>Advanced LV dysfunction, older age, higher NYHA class, renal dysfunction, and amiodarone therapy, but not ES, were predictors of poor outcomes after CA for VT in the total population. However, ES did predict mortality in a low-risk sub-group of patients.</p></div

Baseline characteristics of the study population.

<p>Baseline characteristics of the study population.</p

Univariate survival analysis.

<p>Univariate survival analysis.</p

All-cause mortality—impact of clinical risk score.

<p>Kaplan-Meier survival curves for the population categorised by clinical risk score (Panel A) and in sub-groups defined by the combination of the main study groups (ES/non-ES) and dichotomised clinical risk scores (≤1 or ≥2) (Panel B).</p