Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific

Objectives Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era. Methods Hospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005–2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified. Results Of the 396 patients, 43.9% were male with median age 18 years (IQR 10–40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), p<0.001) and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12 to 0.63), p=0.01) were the two most influential factors associated with MACE. Conclusions Newly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis

Thermo-Mechanical Treatment Effects on Stress Relaxation and Hydrogen Embrittlement of Cold-Drawn Eutectoid Steels

The effects of the temperature and stretching levels used in the stress-relieving treatment of cold-drawn eutectoid steel wires are evaluated with the aim of improving the stress relaxation behavior and the resistance to hydrogen embrittlement. Five industrial treatments are studied, combining three temperatures (330, 400, and 460 °C) and three stretching levels (38, 50 and 64% of the rupture load). The change of the residual stress produced by the treatments is taken into consideration to account for the results. Surface residual stresses allow us to explain the time to failure in standard hydrogen embrittlement test