Prognostic value of electrocardiographic criteria for left ventricular hyperthrophy and left ventricular strain in hypertensive patients with symptomatic peripheral artery disease

Periferna arterijska bolest (PAB) aterosklerotska je okluzivna bolest donjih ekstremiteta povezana s povećanim rizikom za nastanak kardiovaskularnih događaja. Uloga elektrokardiografskih kriterija za HLK kao pretkazatelja lošijeg kardiovaskularnog ishoda u bolesnika s cerebrovaskularnom bolesti, koronarnom bolesti i hipertenzijom visokog rizika potvrđena je u brojnim studijama, no nije dosad istraživana u bolesnika s PAB. Retrospektivna studija provedena je na 144 bolesnika sa simptomatskom PAB i očuvanom sistoličkom funkcijom lijeve klijetke (ejekcijska frakcija >50%) hospitalizirana na Klinici od siječnja 2010. do siječnja 2014. godine. Tijekom perioda praćenja od 36 ± 16 mjeseci 49 (34%) bolesnika razvilo je veliki kardiovaskularni događaj. Svi su istraživani elektrokardiografski kriteriji u univarijatnoj analizi bili signifikantno povezani s nastankom velikih kardiovaskularnih događaja. Nakon multivarijatne analize samo su bubrežna funkcija (HR 0,979; 95% Cl 0,965-0,994), Framinghamski bodovni sustav (HR 2,698; 95% Cl 1,205-6,041) te voltažni kriteriji za HLK udruženi sa znakovima opterećenja lijeve klijetke (HR 2,876; 95% Cl 1,463-5,653) bili nezavisno povezani s nepovoljnim kardiovaskularnim ishodom. Zaključno, elektrokardiografski Framinghamski bodovni sustav te kombinacija kriterija za HLK i opterećenje lijeve klijetke nezavisni su pretkazatelji povećanog rizika za pojavu velikog nepovoljnog kardiovaskularnog događaja u hipertoničara sa simptomatskom PAB i očuvanom sistoličkom funkcijom lijeve klijetke.Peripheral artery disease (PAD), an occlusive disease affecting lower extremities, is associated with an increased risk of major adverse cardiovascular events (MACE). The value of electrocardiographic criteria for left ventricular hypertrophy (LVH) as a predictor of MACE has been confirmed in patients (pts) with cerebrovascular disease, coronary disease and high-risk hypertension, but hasn’t yet been investigated in patients with PAD. The retrospective study was conducted on 144 pts with symptomatic PAD and preserved left ventricular ejection fraction (LVEF >50%) at the University Hospital between January 2010 and January 2014. During median follow-up period of 36 ± 16 months 49 (34%) pts experienced MACE. The univariate analysis showed that all of the investigated electrocardiographic criteria were significantly associated with the occurrence of MACE. After multivariate analysis only renal function (HR 0,979; 95% Cl 0,965-0,994), Framingham criteria (HR 2,698; 95% Cl 1,205-6,041) and voltage criteria for LVH combined with left ventricular strain (HR 2,876; 95% Cl 1,463-5,653) were independently associated with adverse cardiovascular outcome. In conclusion, electrocardiographic Framingham criteria and the combination of both the criteria for LVH and left ventricular strain are independent predictors for the occurrence of MACE in hypertensive patients with symptomatic PAD and preserved left ventricular ejection fraction

Prognostic value of electrocardiographic criteria for left ventricular hyperthrophy and left ventricular strain in hypertensive patients with symptomatic peripheral artery disease

Periferna arterijska bolest (PAB) aterosklerotska je okluzivna bolest donjih ekstremiteta povezana s povećanim rizikom za nastanak kardiovaskularnih događaja. Uloga elektrokardiografskih kriterija za HLK kao pretkazatelja lošijeg kardiovaskularnog ishoda u bolesnika s cerebrovaskularnom bolesti, koronarnom bolesti i hipertenzijom visokog rizika potvrđena je u brojnim studijama, no nije dosad istraživana u bolesnika s PAB. Retrospektivna studija provedena je na 144 bolesnika sa simptomatskom PAB i očuvanom sistoličkom funkcijom lijeve klijetke (ejekcijska frakcija >50%) hospitalizirana na Klinici od siječnja 2010. do siječnja 2014. godine. Tijekom perioda praćenja od 36 ± 16 mjeseci 49 (34%) bolesnika razvilo je veliki kardiovaskularni događaj. Svi su istraživani elektrokardiografski kriteriji u univarijatnoj analizi bili signifikantno povezani s nastankom velikih kardiovaskularnih događaja. Nakon multivarijatne analize samo su bubrežna funkcija (HR 0,979; 95% Cl 0,965-0,994), Framinghamski bodovni sustav (HR 2,698; 95% Cl 1,205-6,041) te voltažni kriteriji za HLK udruženi sa znakovima opterećenja lijeve klijetke (HR 2,876; 95% Cl 1,463-5,653) bili nezavisno povezani s nepovoljnim kardiovaskularnim ishodom. Zaključno, elektrokardiografski Framinghamski bodovni sustav te kombinacija kriterija za HLK i opterećenje lijeve klijetke nezavisni su pretkazatelji povećanog rizika za pojavu velikog nepovoljnog kardiovaskularnog događaja u hipertoničara sa simptomatskom PAB i očuvanom sistoličkom funkcijom lijeve klijetke.Peripheral artery disease (PAD), an occlusive disease affecting lower extremities, is associated with an increased risk of major adverse cardiovascular events (MACE). The value of electrocardiographic criteria for left ventricular hypertrophy (LVH) as a predictor of MACE has been confirmed in patients (pts) with cerebrovascular disease, coronary disease and high-risk hypertension, but hasn’t yet been investigated in patients with PAD. The retrospective study was conducted on 144 pts with symptomatic PAD and preserved left ventricular ejection fraction (LVEF >50%) at the University Hospital between January 2010 and January 2014. During median follow-up period of 36 ± 16 months 49 (34%) pts experienced MACE. The univariate analysis showed that all of the investigated electrocardiographic criteria were significantly associated with the occurrence of MACE. After multivariate analysis only renal function (HR 0,979; 95% Cl 0,965-0,994), Framingham criteria (HR 2,698; 95% Cl 1,205-6,041) and voltage criteria for LVH combined with left ventricular strain (HR 2,876; 95% Cl 1,463-5,653) were independently associated with adverse cardiovascular outcome. In conclusion, electrocardiographic Framingham criteria and the combination of both the criteria for LVH and left ventricular strain are independent predictors for the occurrence of MACE in hypertensive patients with symptomatic PAD and preserved left ventricular ejection fraction

Cardiovascular risk assessed by reynolds risk score in relation to waist circumference in apparently healthy middle-aged population in Montenegro

Reynolds Risk Score (RRS) is regarded as a good screening tool for cardiovascular disease (CVD) risk. Since CVD is the leading cause of death in Montenegro, we aimed to assess the risk of CVD as assessed by RRS and to examine its association with cardiometabolic parameters in apparently healthy middle-aged population. In addition, we aimed to test whether obesity had an independent influence on RRS. A total of 132 participants (mean age 56.2 +/- 6.73 years, 69% females) were included. Body mass index (BMI), waist circumference (WC), blood pressure (BP) and biochemical parameters (fasting glucose, insulin, lipid parameters, creatinine and high sensitivity C-reactive protein) were determined. Insulin resistance (HOMA-IR) and glomerular filtration rate (eGFR) were calculated. Compared with females, a significantly higher number of males were in the high RRS subgroup (chi(2) =45.9, p lt 0.001). Furthermore, significantly higher fasting glucose (p=0.030), insulin, HOMA-IR, triglycerides (p lt 0.001 all), anthropometric parameters (e.g., BMI and WC; p=0.004 and p lt 0.001, respectively), and creatinine, but lower eGFR and HDL-c (p lt 0.001 both) were recorded in the high-risk subgroup compared with low and medium risk subgroups. In all participants, in addition to LDL-c, diastolic BP and creatinine, WC was independently positively associated with RRS (beta=0.194, p=0.006; lt b> beta=0186, p=0.001; beta=0167, p=0.001; and beta=0.305, p=0.019, respectively), and 40% of variation in RRS could be explained with this model. In conclusion, middle-aged population with higher WC should be screened for RRS in order to estimate CVD risk

Alien pathogens on the horizon: opportunities for predicting their threat to wildlife

According to the Convention on Biological Diversity, by 2020 invasive alien species (IAS) should be identified and their impacts assessed, so that species can be prioritized for implementation of appropriate control strategies and measures put in place to manage invasion pathways. For one quarter of the IAS listed as the “100 of the world's worst” environmental impacts are linked to diseases of wildlife (undomesticated plants and animals). Moreover, IAS are a significant source of “pathogen pollution” defined as the human-mediated introduction of a pathogen to a new host or region. Despite this, little is known about the biology of alien pathogens and their biodiversity impacts after introduction into new regions. We argue that the threats posed by alien pathogens to endangered species, ecosystems, and ecosystem services should receive greater attention through legislation, policy, and management. We identify 10 key areas for research and action, including those relevant to the processes of introduction and establishment of an alien pathogen and to prediction of the spread and associated impact of an alien pathogen on native biota and ecosystems. The development of interdisciplinary capacity, expertise, and coordination to identify and manage threats was seen as critical to address knowledge gaps

Prognostic value of electrocardiographic criteria for left ventricular hyperthrophy and left ventricular strain in hypertensive patients with symptomatic peripheral artery disease

Periferna arterijska bolest (PAB) aterosklerotska je okluzivna bolest donjih ekstremiteta povezana s povećanim rizikom za nastanak kardiovaskularnih događaja. Uloga elektrokardiografskih kriterija za HLK kao pretkazatelja lošijeg kardiovaskularnog ishoda u bolesnika s cerebrovaskularnom bolesti, koronarnom bolesti i hipertenzijom visokog rizika potvrđena je u brojnim studijama, no nije dosad istraživana u bolesnika s PAB. Retrospektivna studija provedena je na 144 bolesnika sa simptomatskom PAB i očuvanom sistoličkom funkcijom lijeve klijetke (ejekcijska frakcija >50%) hospitalizirana na Klinici od siječnja 2010. do siječnja 2014. godine. Tijekom perioda praćenja od 36 ± 16 mjeseci 49 (34%) bolesnika razvilo je veliki kardiovaskularni događaj. Svi su istraživani elektrokardiografski kriteriji u univarijatnoj analizi bili signifikantno povezani s nastankom velikih kardiovaskularnih događaja. Nakon multivarijatne analize samo su bubrežna funkcija (HR 0,979; 95% Cl 0,965-0,994), Framinghamski bodovni sustav (HR 2,698; 95% Cl 1,205-6,041) te voltažni kriteriji za HLK udruženi sa znakovima opterećenja lijeve klijetke (HR 2,876; 95% Cl 1,463-5,653) bili nezavisno povezani s nepovoljnim kardiovaskularnim ishodom. Zaključno, elektrokardiografski Framinghamski bodovni sustav te kombinacija kriterija za HLK i opterećenje lijeve klijetke nezavisni su pretkazatelji povećanog rizika za pojavu velikog nepovoljnog kardiovaskularnog događaja u hipertoničara sa simptomatskom PAB i očuvanom sistoličkom funkcijom lijeve klijetke.Peripheral artery disease (PAD), an occlusive disease affecting lower extremities, is associated with an increased risk of major adverse cardiovascular events (MACE). The value of electrocardiographic criteria for left ventricular hypertrophy (LVH) as a predictor of MACE has been confirmed in patients (pts) with cerebrovascular disease, coronary disease and high-risk hypertension, but hasn’t yet been investigated in patients with PAD. The retrospective study was conducted on 144 pts with symptomatic PAD and preserved left ventricular ejection fraction (LVEF >50%) at the University Hospital between January 2010 and January 2014. During median follow-up period of 36 ± 16 months 49 (34%) pts experienced MACE. The univariate analysis showed that all of the investigated electrocardiographic criteria were significantly associated with the occurrence of MACE. After multivariate analysis only renal function (HR 0,979; 95% Cl 0,965-0,994), Framingham criteria (HR 2,698; 95% Cl 1,205-6,041) and voltage criteria for LVH combined with left ventricular strain (HR 2,876; 95% Cl 1,463-5,653) were independently associated with adverse cardiovascular outcome. In conclusion, electrocardiographic Framingham criteria and the combination of both the criteria for LVH and left ventricular strain are independent predictors for the occurrence of MACE in hypertensive patients with symptomatic PAD and preserved left ventricular ejection fraction

Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy

Background: Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. Methods: We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi-center, registry-based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. Results: Total of 873 patients were included (median age 61 years, IQR 53-66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 ± 50 s, mean overall ACT 295 ± 45 s and total UFH dose 158 ± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 ± 57 and 270 ± 48 vs. 248 ± 42 and 241 ± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 ± 46 and 306 ± 44 vs. 282 ± 37 and 272 ± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 ± 39 and 157 ± 71 vs. 171 ± 52 and 172 ± 70 IU/kg). Conclusion: There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes