Influence of Sex-Based Differences in Cardiac Phenotype on Atrial Fibrillation Recurrence in Patients Undergoing Pulmonary Vein Isolation

BackgroundPulmonary vein isolation (PVI) is a commonly engaged therapy for symptomatic atrial fibrillation (AF). Prior studies have documented elevated AF recurrence rates among females vs. males. Sex-specific mechanisms underlying this phenomenon are poorly understood. This prospective cohort study aimed to evaluate the sex-based differences in cardiac phenotype and their influence on (AF) recurrence following first-time PVI.MethodsA total of 204 consecutive patients referred for first-time PVI and 101 healthy subjects were prospectively studied by cardiovascular magnetic resonance (CMR) imaging. Multi-chamber volumetric and functional measures were assessed by sex-corrected Z-score analyses vs. healthy subjects. Patients were followed for a median of 2.6 years for the primary outcome of clinical AF recurrence. Multivariable analyses adjusting for age and comorbidities were performed to identify independent predictors of AF recurrence.ResultsAF recurrence following first PVI occurred in 41% of males and 59% of females (p = 0.03). Females were older with higher prevalence of hypertension and thyroid disorders. Z-score-based analyses revealed significantly reduced ventricular volumes, greater left atrial (LA) volumes, and reduced LA contractility in females vs. males. Multivariable analysis revealed each of LA minimum and pre-systolic volumes and booster EF Z-scores to be independently associated with AF recurrence, providing respective hazard ratios of 1.10, 1.19, and 0.89 (p = 0.001, 0.03, and 0.01).ConclusionAmong patients referred for first time PVI, females were older and demonstrated significantly poorer LA contractile health vs. males, the latter independently associated with AF recurrence. Assessment of LA contractile health may therefore be of value to identify female patients at elevated risk of AF recurrence. Factors influencing female patient referral for PVI at more advanced stages of atrial disease warrant focused investigation

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Early severe coronary artery disease and aortic coarctation in a child with familial hypercholesterolaemia

An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed ‘normally functioning’ bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion

Studying the effect of parenterally administered l-alanyl l-glutamine dipeptide in diabetes and new onset diabetes in liver transplantation

AbstractObjectiveThe objective of this study was to evaluate the efficacy of using alanine–glutamine (Aln–Gln) dipeptide as a supplement to control diabetes in liver transplanted patients.Patients and methodsEighty patients aged >18yr admitted to ICU after receiving right lobe living donor liver transplantation (LDLT), had a previous history of diabetes or had a new onset diabetes (NODM) were enrolled in this prospective randomized double blind study. Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine dipeptide in the dose of 0.5g/kg/d (group AG) or without alanyl-glutamine dipeptide (control group C). This regimen started at day 1 postoperative in diabetic patients or when new onset diabetes has been diagnosed in non-diabetic and continued till day 9 with measuring the incidence of hyperglycemia, hyperglycemic episodes, total insulin requirements/day, infectious episodes, ICU and hospital length of stay, and 6month mortality rate.ResultsThe hyperglycemic episodes were significantly less in AG group patients than in control group patients (29 vs 38). Hyperglycemia requiring insulin therapy in AG group was significantly less (22 vs 28 patients). Also those who required decreasing TPN requirements were significantly lesser in the AG group (7 vs 11 patients). Insulin requirements per day in the AG group were significantly lower (53±11 vs 78±9IU). The number of episodes of nosocomial infection per patient was lower in the AG group than in the control group (20 vs 28). The decrease in nosocomial infections in patients receiving AG was related mainly to a decrease in the incidence of pneumonia (7 vs 11). The ICU length of stay (LOS) was significantly lower in the AG group than in the control group (7.81±2.98 vs 10.43±4.67day)ConclusionOur study showed that using AG supplementation in liver transplanted patients who have either a history of diabetes or NODM, reduces the insulin requirements, hyperglycemic episodes, infectious events and ICU stay

Dexmedetomidine protects against myocardial ischaemia/reperfusion-induced renal damage in rats

Background: Myocardial ischaemia/reperfusion (MI/R) may induce renal damage. Our aim was to investigate the effects of dexmedetomidine (DEX) administration at two different timings either before or after ischaemia on renal damage induced by MI/R. Methods: MI/R injury was induced in a rat model. we ligated the left anterior descending coronary artery for 30 min (ischaemic period), then reperfusion occurred for 2 h (reperfusion period). A single dose of DEX (100 µg/kg) was given intraperitoneally, either 30 min before myocardial ischaemia or 5 min after reperfusion. With the end of reperfusion period, rats were sacrificed, then we collected the blood and removed both kidneys quickly for biochemical and histopathological analysis. Results: MI/R caused an elevation in serum urea and creatinine, significant elevation in malondialdehyde (MDA) release and decrease in superoxide dismutase (SOD) activity in the rat kidney. There were also higher levels of serum tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β). Treatment with dexmedetomidine, 30 min before induction of myocardial ischaemia, succeeded to improve all the tested parameters. The valuable changes in these biochemical parameters were linked with similar enhancement in the histopathological appearance of the kidney. Meanwhile, DEX given 5 min after reperfusion improved serum urea and creatinine only. Conclusion: These findings imply that MI/R plays a fundamental role in kidney damage through increased production of oxygen radicals or deficiency in antioxidants, and DEX given before ischaemia exerts reno-protective effects probably by its radical scavenging antioxidant activity and anti-inflammatory mechanism