Outcome selection and role of patient reported outcomes in contemporary cardiovascular trials: systematic review

Objectives To systematically assess the type of outcomes selected and the prevalence of patient reported outcomes in contemporary cardiovascular trials and to quantify any misuse or underuse of patient reported outcomes using a specially developed tool that would allow estimation of the relevance of such outcomes to clinical decision making

Recreational marathon running does not cause exercise-induced left ventricular hypertrabeculation.

BACKGROUND: Marathon running in novices represents a natural experiment of short-term cardiovascular remodeling in response to running training. We examine whether this stimulus can produce exercise-induced left ventricular (LV) trabeculation. METHODS: Sixty-eight novice marathon runners aged 29.5 ± 3.2 years had indices of LV trabeculation measured by echocardiography and cardiac magnetic resonance imaging 6 months before and 2 weeks after the 2016 London Marathon race, in a prospective longitudinal study. RESULTS: After 17 weeks unsupervised marathon training, indices of LV trabeculation were essentially unchanged. Despite satisfactory inter-observer agreement in most methods of trabeculation measurement, criteria defining abnormally hypertrabeculated cases were discordant with each other. LV hypertrabeculation was a frequent finding in young, healthy individuals with no subject demonstrating clear evidence of a cardiomyopathy. CONCLUSION: Training for a first marathon does not induce LV trabeculation. It remains unclear whether prolonged, high-dose exercise can create de novo trabeculation or expose concealed trabeculation. Applying cut off values from published LV noncompaction cardiomyopathy criteria to young, healthy individuals risks over-diagnosis

The transatlantic evolution in understanding sudden cardiac death in athletes.

From PubMed via Jisc Publications RouterHistory: received 2021-06-29, revised 2021-06-30, accepted 2021-06-30Publication status: aheadofprin

Evaluating treatment options for patients with infective endocarditis:When is it the right time for surgery?

Infective endocarditis remains a life-threatening condition with an unchanging incidence and mortality of nearly 30% at 1 year. Surgery is required in 25–50% of acute infections and 20–40% of patients during convalescence. Operative procedures are often technically challenging and high-risk, often due to coexistent multisystem disease. However, international guidelines provide clear indications for surgical intervention, which are applicable for the majority of patients. These are not, however, supported by particularly robust clinical evidence and decision-making often needs to be tailored to the advancing age of the overall patient cohort, the presence of multisystem disease, comorbidities, prior antibiotic therapy of varying duration and the availability of surgical expertise. Native valve endocarditis will be the initial focus of this article, along with subgroups including prosthetic valve endocarditis. We present the treatment options for patients with infective endocarditis, evaluate the evidence-base that supports current clinical practice and attempt to provide an insight and subsequent recommendations for the timing of surgery. </jats:p

Organic carbon stocks, quality and prediction in permafrost-affected forest soils in North Canada

High-latitude soils store a large amount of the global soil organic carbon (SOC). The SOC stocks in mineral soils under different permafrost conditions, however, are underrepresented in global carbon databases. We sampled mineral forest soils under continuous and discontinuous to sporadic permafrost conditions on the Canadian Boreal and Taiga Plain. We determined the SOC stocks in the upper 60 cm of 94 soil pits across eleven sites (5–9 pits per site) and SOC quality using 13C isotopic signatures, C:N ratios and composition of aliphatic/aromatic and cellulose/lignin-like compounds obtained from mid-infrared spectra analyses. Lastly, we evaluated the prediction of SOC stocks in these soils using mid-infrared spectra and partial least square regression modelling (PLSR). The SOC stocks were on average four times higher in soils under continuous permafrost conditions (93.7–203.8 Mg SOC ha−1 in 0–45 cm) compared to soils under discontinuous to sporadic permafrost conditions (26.7–60.2 Mg SOC ha−1 in 0–60 cm). In addition, the SOC stocks were larger at moist and wet locations compared to dryer locations and varied significantly between sites, stressing the importance of small-scale geomorphic differences in controlling SOC in boreal mineral forest soils. Continuous permafrost SOC had a lower degree of decomposition compared to soils under discontinuous and sporadic permafrost. This indicates a potentially large proportion of SOC in boreal mineral soils to be vulnerable to warming associate increases in decomposition. The combination of mid-infrared with PLSR was suitable to predict the SOC stocks (R2 > 0.8) with an average uncertainty of 14–23%, which was less than the observed spatial variability of the field replicates (29–41%). Mid-infrared spectroscopy can thus offer an alternative to fill SOC data gaps of high latitude mineral forest soils and reduce uncertainties originating from the limited number of currently available SOC observations of Canadian boreal mineral forest soils