Detektion und Graduierung intrakranieller Stenosen – eine vergleichende Analyse der transkraniellen Farbduplexsonographie, CT-Angiographie und time of flight-MR-Angiographie

Intrakranielle Stenosen (IS) der Hirnbasisarterien gehören weltweit zu den häufigsten Schlaganfallursachen. Das Schlaganfallrisiko steigt dabei mit dem Stenosegrad. Die transkranielle Duplexsonographie (TCCS), die CT-Angiographie (CTA) und die time-of-flight MR-Angiographie (TOF-MRA) werden im klinischen Alltag mit Abstand am häufigsten zur Beurteilung IS durchgeführt. Aussagekräftige Studien, bei denen die TCCS im Hinblick auf IS direkt mit der CTA oder MRA verglichen wurde, existieren bisher kaum. Insofern ist die für den Kliniker wichtige Frage, ob die drei Verfahren problemlos alternativ eingesetzt werden können oder eher als komplementäre Methoden mit spezifischen Stärken und Schwächen anzusehen sind, bisher nicht beantwortet. Ziel der vorliegenden Arbeit ist es, die TCCS im Hinblick auf Detektion und Graduierung IS aller Hirnbasisarterien direkt mit der CTA und TOF-MRA zu vergleichen. Eingeschlossen wurden 137 Patienten mit Verdacht auf akuten Schlaganfall, die bei Aufnahme eine CTA oder TOF-MRA und binnen 24h eine TCCS erhielten. Im Einzelnen wurden folgende intrakranielle Arterien (Segmente) untersucht: Arteria cerebri media (M1- und M2-MCA), Arteria cerebri anterior (A1-ACA), Arteria carotis interna (C1-C6-ICA), Arteria cerebri posterior (P1- und P2-PCA), Arteria vertebralis (V4-VA) und Arteria basilaris (BA). Bei allen Methoden fand eine Graduierung der IS in mild (< 50%), moderat (50-70%) und hochgradig (≥ 70%) nach anerkannten Kriterien statt. Bei der CTA wurde zwischen der Routine-Befundung (CTA-1) und einer späteren gesonderten verblindeten Beurteilung (CTA-2) durch Fachärzte der Neuroradiologie differenziert. Es wurden erhebliche Unterschiede zwischen den Untersuchungsmethoden gefunden, die sowohl die Detektion der IS selbst als auch deren Graduierung betreffen. Die Unterschiede betreffen insbesondere mild klassifizierte IS. In bestimmten Gefäß-segmenten (C1-C6, V4) scheint es mittels TCCS generell schwieriger zu sein, IS zu detektieren. Auch die Ergebnisse der CTA-1 und CTA-2 divergierten erheblich, in der CTA-2 wurden deutlich mehr IS beschrieben und es ließen sich im Gegensatz zur CTA-1 alle Stenosen graduieren. Dadurch konnte gezeigt werden, wie untersucherabhängig diese Methode ist. Aufgrund eines fehlenden Goldstandards lassen sich allerdings keine Aussagen zu Sensitivität und Spezifität der einzelnen Methoden treffen. Zusammenfassend legen die hier präsentierten Ergebnisse nahe, sich insbesondere bei ungeklärter Schlaganfall-ätiologie im Zweifelsfalle nicht auf eine der Methoden unkritisch zu verlassen, sondern diese als komplementäre Verfahren u.U. kombiniert einzusetzen.Intracranial stenosis (IS) of the intracranial arteries is one of the most common causes of stroke worldwide. The risk of stroke increases with the grade of IS. Transcranial duplexsonography (TCCS), CT angiography (CTA) and time-of-flight MR angiography (MRA) are widely used in daily clinical routines to assess IS. But significant data, where the examination of IS by TCCS is compared with the other two methods, are rare. It is still unclear whether the three clinical methods can be used as alternative methods with similar results or rather as complementary methods, each with its pros and cons. The aim of this study was to compare the detection and grading of all cerebral arteries using TCCS with a contemporary performed CTA or MRA. 137 patients with an acute ischemic stroke were included. TCCS as well as CTA or MRA were both performed within 24 hours after admission. The following segments of each intracranial arteries were examined: MCA (M1, M2) ACA (A1), ICA (C1-C6), PCA (P1,P2), VA (V4) and BA. Each method graded IS in mild (< 50%), moderate (50-70%) and high-grade (≥ 70%) according to accepted criteria. The results of the CTA were evaluated twice, the first time in line with the routine clinical diagnostics in the daily routine (CTA-1) and the second time blinded by specialists of neuroradiology (CTA-2). The results showed substantial differences between the clinical methods in detection as well as grading of IS. The differences were particularly apparent in mild IS. It was also apparent that in some vascular segments (C1-C6, V4), the detection of IS by TCCS was less reliable. The examinations of CTA-1 and CTA-2 differed considerably. More IS was detected in the CTA-2 examination and all of them could be graded, in contrast to the CTA-1. In conclusion, these findings underline the dependency of the examiner on CTA. Because a gold standard method is lacking no comparison can be made, therefore conclusions to the sensitivity and specificity of each method are not possible. Nevertheless, the findings reveal that especially in cases when the aetiology of stroke is unclear, one should not rely on a single method as the only available option, but rather combine methods that could be complementary to each other

Recent advances in cardio-oncology:a report from the 'Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019'

While anti-cancer therapies, including chemotherapy, immunotherapy, radiotherapy, and targeted therapy, are constantly advancing, cardiovascular toxicity has become a major challenge for cardiologists and oncologists. This has led to an increasing demand of cardio-oncology units in Europe and a growing interest of clinicians and researchers. The Heart Failure 2019 meeting of the Heart Failure Association of the European Society of Cardiology in Athens has therefore created a scientific programme that included four dedicated sessions on the topic along with several additional lectures. The major points that were discussed at the congress included the implementation and delivery of a cardio-oncology service, the collaboration among cardio-oncology experts, and the risk stratification, prevention, and early recognition of cardiotoxicity. Furthermore, sessions addressed the numerous different anti-cancer therapies associated with cardiotoxic effects and provided guidance on how to treat cancer patients who develop cardiovascular disease before, during, and after treatment

Heart failure with preserved ejection fraction according to the HFA-PEFF score in COVID-19 patients: clinical correlates and echocardiographic findings

Aims: Viral-induced cardiac inflammation can induce heart failure with preserved ejection fraction (HFpEF)-like syndromes. COVID-19 can lead to myocardial damage and vascular injury. We hypothesised that COVID-19 patients frequently develop a HFpEF-like syndrome, and designed this study to explore this. Methods and results: Cardiac function was assessed in 64 consecutive, hospitalized, and clinically stable COVID-19 patients from April-November 2020 with left ventricular ejection fraction (LVEF) ≥50% (age 56 ± 19 years, females: 31%, severe COVID-19 disease: 69%). To investigate likelihood of HFpEF presence, we used the HFA-PEFF score. A low (0-1 points), intermediate (2-4 points), and high (5-6 points) HFA-PEFF score was observed in 42%, 33%, and 25% of patients, respectively. In comparison, 64 subjects of similar age, sex, and comorbidity status without COVID-19 showed these scores in 30%, 66%, and 4%, respectively (between groups: P = 0.0002). High HFA-PEFF scores were more frequent in COVID-19 patients than controls (25% vs. 4%, P = 0.001). In COVID-19 patients, the HFA-PEFF score significantly correlated with age, estimated glomerular filtration rate, high-sensitivity troponin T (hsTnT), haemoglobin, QTc interval, LVEF, mitral E/A ratio, and H2 FPEF score (all P < 0.05). In multivariate, ordinal regression analyses, higher age and hsTnT were significant predictors of increased HFA-PEFF scores. Patients with myocardial injury (hsTnT ≥14 ng/L: 31%) vs. patients without myocardial injury, showed higher HFA-PEFF scores [median 5 (interquartile range 3-6) vs. 1 (0-3), P < 0.001] and more often showed left ventricular diastolic dysfunction (75% vs. 27%, P < 0.001). Conclusion: Hospitalized COVID-19 patients frequently show high likelihood of presence of HFpEF that is associated with cardiac structural and functional alterations, and myocardial injury. Detailed cardiac assessments including echocardiographic determination of left ventricular diastolic function and biomarkers should become routine in the care of hospitalized COVID-19 patients

The heart failure specialists of tomorrow: a network for young cardiovascular scientists and clinicians

The "Heart failure specialists of Tomorrow" (HoT) group gathers young researchers, physicians, basic scientists, nurses and many other professions under the auspices of the Heart Failure Association of the European Society of Cardiology. After its foundation in 2014, it has quickly grown to a large group of currently 925 members. Membership in this growing community offers many advantages during, before, and after the 'Heart Failure and World Congress on Acute Heart Failure'. These include: eligibility to receive travel grants, participation in moderated poster sessions and young researcher and clinical case sessions, the HoT walk, the career cafe, access to the networking opportunities, and interaction with a large and cohesive international community that constantly seeks multinational collaborations.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The difference in referencing in Web of Science, Scopus, and Google Scholar

Aims How often a medical article is cited is important for many people because it is used to calculate different variables such as the h-index and the journal impact factor. The aim of this analysis was to assess how the citation count varies between Web of Science (WoS), Scopus, and Google Scholar in the current literature. Methods We included the top 50 cited articles of four journals ESC Heart Failure; Journal of cachexia, sarcopenia and muscle; European Journal of Preventive Cardiology; and European Journal of Heart Failure in our analysis that were published between 1 January 2016 and 10 October 2019. We recorded the number of citations of these articles according to WoS, Scopus, and Google Scholar on 10 October 2019. Results The top 50 articles in ESC Heart Failure were on average cited 12 (WoS), 13 (Scopus), and 17 times (Google Scholar); in Journal of cachexia, sarcopenia and muscle 37 (WoS), 43 (Scopus), and 60 times (Google Scholar); in European Journal of Preventive Cardiology 41 (WoS), 56 (Scopus), and 67 times (Google Scholar); and in European Journal of Heart Failure 76 (WoS), 108 (Scopus), and 230 times (Google Scholar). On average, the top 50 articles in all four journals were cited 41 (WoS), 52 (Scopus, 26% higher citations count than WoS, range 8–42% in the different journals), and 93 times (Google Scholar, 116% higher citation count than WoS, range 42–203%). Conclusion Scopus and Google Scholar on average have a higher citation count than WoS, whereas the difference is much larger between Google Scholar and WoS

Sarcopenia and cachexia in chronic diseases : from mechanisms to treatment

Two main manifestations of wasting disorders in chronic disease are cachexia and sarcopenia. Due to shared pathological features, including impairments in systemic inflammatory responses, neurohormonal activity, and metabolic systems, the 2 disorders can present with similar symptoms (tissue depletion, dyspnea, anorexia, asthenia, fatigue, and impaired physical performance). Wasting disorders are associated with reduced quality of life and increased mortality. Cachexia is characterized by systemic tissue depletion with weight loss, and sarcopenia, by skeletal muscle loss accompanied by diminished muscular strength and physical performance. Wasting syndromes can be identified based on clinical criteria as well as with the use of multiple imaging and diagnostic techniques. Additionally, blood biomarkers can be used for diagnosing wasting disorders. In the past decade, intensive research has focused on new therapeutic strategies within a multimodal approach, which embraces nutritional support, physical activity, and targeted pharmacological therapy. Despite some initial promising therapeutic results for selected novel agents, guideline-recommended pharmacotherapy is not yet available for cachexia or sarcopenia. More research is needed to better understand these wasting disorders and learn how to treat them