Changes in serum biomarker profiles after percutaneous mitral valve repair with the MitraClip system

Background: Mitral regurgitation (MR) is one of the most common valvular diseases. Percu­taneous mitral valve repair with the MitraClipTM system is a novel percutaneous mitral valve repair (PMVR) technique for high-surgical-risk patients. However, the effect of PMVR on cir­culating cardiac or inflammatory biomarkers and their association with individual functional, echocardiographic and clinical outcomes is poorly investigated. Methods: A group of 144 patients with functional or degenerative MR (age, 75 ± 11 years; 41% females) underwent PMVR with the MitraClip system at the University Heart Center Zu­rich. Serum biomarkers as N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and creatinine were obtained from venous sampling at baseline and follow-up of 3–6 months. Results: Median NT-proBNP decreased insignificantly from 2,942 (IQR 1,596–5,722) to 2,739 (IQR 1,440–4,296) ng/L, p = 0.21. NT-proBNP changes did not correlate with baseline left ventricular (LV) ejection fraction or LV dimensions, with New York Heart Association class on follow-up, or with clinical events on follow-up. CRP levels reached a peak on the third postoperative day at 34.0 mg/L with a subsequent slow decrease over the ensuing days. Conclusions: Despite successful PMVR, NT-proBNP remain fairly unchanged on follow-up and changes in NT-proBNP levels are poor predictors of functional improvement or clinical outcome after MitraClip treatment

Changes in serum biomarker profiles after percutaneous mitral valve repair with the MitraClip system

BACKGROUND Mitral regurgitation (MR) is one of the most common valvular diseases. Percu-taneous mitral valve repair with the MitraClipTM system is a novel percutaneous mitral valve repair (PMVR) technique for high-surgical-risk patients. However, the effect of PMVR on cir-culating cardiac or inflammatory biomarkers and their association with individual functional, echocardiographic and clinical outcomes is poorly investigated. METHODS A group of 144 patients with functional or degenerative MR (age, 75 ± 11 years; 41% females) underwent PMVR with the MitraClip system at the University Heart Center Zu-rich. Serum biomarkers as N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and creatinine were obtained from venous sampling at baseline and follow-up of 3-6 months. RESULTS Median NT-proBNP decreased insignificantly from 2,942 (IQR 1,596-5,722) to 2,739 (IQR 1,440-4,296) ng/L, p = 0.21. NT-proBNP changes did not correlate with baseline left ventricular (LV) ejection fraction or LV dimensions, with New York Heart Association class on follow-up, or with clinical events on follow-up. CRP levels reached a peak on the third postoperative day at 34.0 mg/L with a subsequent slow decrease over the ensuing days. CONCLUSIONS Despite successful PMVR, NT-proBNP remain fairly unchanged on follow-up and changes in NT-proBNP levels are poor predictors of functional improvement or clinical outcome after MitraClip treatment

Rest and Dobutamine stress echocardiography in the evaluation of mid-term results of mitral valve repair in Barlow's disease

BACKGROUND: Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up. METHODS AND RESULTS: Twenty patients selected for the study (12 men and 8 women, mean age 60 ± 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 ± 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed. CONCLUSION: Basal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

The role of networks to overcome large-scale challenges in tomography : the non-clinical tomography users research network

Our ability to visualize and quantify the internal structures of objects via computed tomography (CT) has fundamentally transformed science. As tomographic tools have become more broadly accessible, researchers across diverse disciplines have embraced the ability to investigate the 3D structure-function relationships of an enormous array of items. Whether studying organismal biology, animal models for human health, iterative manufacturing techniques, experimental medical devices, engineering structures, geological and planetary samples, prehistoric artifacts, or fossilized organisms, computed tomography has led to extensive methodological and basic sciences advances and is now a core element in science, technology, engineering, and mathematics (STEM) research and outreach toolkits. Tomorrow's scientific progress is built upon today's innovations. In our data-rich world, this requires access not only to publications but also to supporting data. Reliance on proprietary technologies, combined with the varied objectives of diverse research groups, has resulted in a fragmented tomography-imaging landscape, one that is functional at the individual lab level yet lacks the standardization needed to support efficient and equitable exchange and reuse of data. Developing standards and pipelines for the creation of new and future data, which can also be applied to existing datasets is a challenge that becomes increasingly difficult as the amount and diversity of legacy data grows. Global networks of CT users have proved an effective approach to addressing this kind of multifaceted challenge across a range of fields. Here we describe ongoing efforts to address barriers to recently proposed FAIR (Findability, Accessibility, Interoperability, Reuse) and open science principles by assembling interested parties from research and education communities, industry, publishers, and data repositories to approach these issues jointly in a focused, efficient, and practical way. By outlining the benefits of networks, generally, and drawing on examples from efforts by the Non-Clinical Tomography Users Research Network (NoCTURN), specifically, we illustrate how standardization of data and metadata for reuse can foster interdisciplinary collaborations and create new opportunities for future-looking, large-scale data initiatives

Hybrid coronary revascularization: promising, but yet to take off

Hybrid coronary revascularization (HCR) combines arterial coronary artery bypass surgery (most commonly minimally invasive) and percutaneous coronary intervention in the treatment of a particular subset of multivessel coronary artery disease. It was first introduced in the mid-1990s, and aspired to bring together the "best of both worlds": the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only one small randomized controlled trial comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role and generalizability. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations and procedural challenges

Customer Satisfaction: spunti per l'analisi in automatico di reclami o di lamentele su prodotti/servizi

A chi non è capitato di esprimere un giudizio nei riguardi di un certo prodotto, senza trovare un "interlocutore" disposto ad ascoltare o in grado di comprendere? Diversamente, a chi non è capitato di "subire" reclami o proteste, da parte di soggetti che non abbiano una minima conoscenza del problema lamentato, perché sprovvisti delle competenze necessarie a coglierne ogni aspetto? Entrambe le situazioni sono piuttosto comuni e, in estrema sintesi, costituiscono uno dei maggiori inconvenienti che un ente/azienda, implicato nel monitoraggio della Customer Satisfaction, debba evitare. Episodi di questo tipo, all'interno di uno scenario economico caratterizzato da un alto livello competitivo, richiedono di essere fronteggiati e limitati in misura sempre maggiore. Lo studio della Soddisfazione del Cliente e delle sue aspettative è di fatto uno strumento fondamentale di valutazione dei prodotti/servizi erogati dalle aziende. Per soddisfare il cliente è necessario in primo luogo ascoltarlo, rilevando la cosiddetta Voice of Costumer, in modo da rendere i suoi bisogni noti all'azienda. È fondamentale la conoscenza del cliente e delle sue aspettative (qualità attesa); del grado di soddisfazione e di percezione della qualità del prodotto/servizio offerto (qualità percepita dal cliente). Dal confronto tra i due tipi di informazioni scaturisce la possibilità di avviare programmi di miglioramento sui prodotti/servizi, o di istituirne di nuovi che meglio si avvicinino ai bisogni reali dei clienti. Nel lavoro si rivolge l'attenzione ad una particolare attività, svolta in seno ai servizi di Costumer Care: l'esame dettagliato delle lamentele espresse dai client

Customer Satisfaction: spunti per l’analisi in automatico di reclami o di lamentele su prodotti/servizi

A chi non è capitato di esprimere un giudizio nei riguardi di un certo prodotto, senza trovare un “interlocutore” disposto ad ascoltare o in grado di comprendere? Diversamente, a chi non è capitato di “subire” reclami o proteste, da parte di soggetti che non abbiano una minima conoscenza del problema lamentato, perché sprovvisti delle competenze necessarie a coglierne ogni aspetto? Entrambe le situazioni sono piuttosto comuni e, in estrema sintesi, costituiscono uno dei maggiori inconvenienti che un ente/azienda, implicato nel monitoraggio della Customer Satisfaction, debba evitare. Episodi di questo tipo, all’interno di uno scenario economico caratterizzato da un alto livello competitivo, richiedono di essere fronteggiati e limitati in misura sempre maggiore. Lo studio della Soddisfazione del Cliente e delle sue aspettative è di fatto uno strumento fondamentale di valutazione dei prodotti/servizi erogati dalle aziende. Per soddisfare il cliente è necessario in primo luogo ascoltarlo, rilevando la cosiddetta Voice of Costumer, in modo da rendere i suoi bisogni noti all'azienda. È fondamentale la conoscenza del cliente e delle sue aspettative (qualità attesa); del grado di soddisfazione e di percezione della qualità del prodotto/servizio offerto (qualità percepita dal cliente). Dal confronto tra i due tipi di informazioni scaturisce la possibilità di avviare programmi di miglioramento sui prodotti/servizi, o di istituirne di nuovi che meglio si avvicinino ai bisogni reali dei clienti. Nel lavoro si rivolge l’attenzione ad una particolare attività, svolta in seno ai servizi di Costumer Care: l’esame dettagliato delle lamentele espresse dai clienti