Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival

Improving the geomagnetic field modeling with a selection of high-quality archaeointensity data

International audienc

First Archaeomagnetic field intensity data from Ethiopia, Africa (1615 AD)

International audienceFirst archaeointensity determinations have been obtained from Ethiopia. Seven bricks (34 specimens) from the Däbsan archaeological remains were subjected to archaeointensity determination by means of classical Thellier–Thellier experiment including tests for magnetic anisotropy and magnetic cooling rate dependency. The age of the Däbsan Palace is well controlled by historical information: between 1603, when land grants were conceded to the Jesuits and the Catholicism was established as the official religion in Ethiopia, and the age of the Palace foundation in 1626–27. Successful archaeointensity determinations were obtained in 27 specimens from five individual bricks revealing an average field value of 33.5 ± 1.1 μT, which is 11–26% lower than expected values from global geomagnetic models based on historical and archaeomagnetic data.Global models for 1615 AD predict a low in central-southern Africa related to past location of the present Southern Atlantic Anomaly (SAA). Our results suggest that the field intensity in central Africa may have been slightly lower than global model predictions. This would indicate that the low could be probably more extended towards central-eastern Africa (or more intense) than previously considered. Further data from this region are especially welcome to delineate the evolution of the SAA

Initial SCHA.DI.00 regional archaeomagnetic model for Europe for the last 2000 years

International audienceThe available Bayesian European Palaeosecular Variation Curves (PSVC) based on archaeomagnetic data have been used to derive an initial regional model for the geomagnetic field in Europe for the last 2000 years by using the Spherical Cap Harmonic Analysis (SCHA) technique. The resulting SCHA.DI.00 model provides the directional behaviour of the Earth's magnetic field, but no information about intensity is supplied because input data are only directional. The first spherical cap harmonic coefficient, , has been used to normalise the rest of the coefficients. The spherical expansion extends up to Kint = 2 which, given the size of the spherical cap used and the maximum data resolution, is equivalent, in terms of spatial wavelength, to a maximum degree of approximately 5 in the ordinary Spherical Harmonic Analysis (SHA). The SCHA.DI.00 model fits the present archaeomagnetic database for Europe more accurately than global models, although it is necessary to consider that regional SCHA model and global models did not use the same database. Palaeosecular variation curves given by SCHA.DI.00 are compared with available archaeomagnetic data from Bulgaria (Sofia), Italy (Etna) and Austria (Radstadt), not used in the development of the model. The SCHA.DI.00 model improves the fit to these palaeomagnetic data with respect to the CALS7K.2 [Korte, M., Constable, C.G., 2005. Continuous geomagnetic field models for the past 7 millennia: 2. CALS7K. Geochem. Geophys. Geosyst. 6, Q02H16. doi:10.1029/2004GC000801] global model, especially for Italy

Potentiel de l’archéointensité en datation archéomagnétique au haut MoyenÂge et au premier millénaire av. J.-C. : illustration avec cinq fours de Cumes, Mégara Hyblaea et Incoronata (Italie)

International audienceCette communication présente les datations archéomagnétiques de cinq fours mis au jour sur les sites de Megara Hyblaea (Sicile), d’Incoronata (Basilicate) et de Cumes (Campanie). Le contexte archéologique place le fonctionnement de ces fours à l’époque grecque (premier millénaire av. J.-C.) à Mégara Hyblaea et Incoronata et au haut Moyen-Âge à Cumes. Au moins 15 prélèvements par structure ont été effectués suivant la méthode du chapeau de plâtre ou par carottage des parois. Les archéodirections moyennes ont été déterminées après désaimantation thermique et par champ alternatif et les archéointensités par le protocole de Thellier-Thellier avec corrections d’anisotropie et de vitesse de refroidissement. La datation archéomagnétique de ces structures illustre la difficulté du choix du référentiel en Italie méridionale. En effet, les courbes de variation séculaire italiennes demeurent trop imprécises ou incomplètes du fait d’un nombre insuffisant de données de référence (Tema et al., 2006 ; 2013). L’utilisation des courbes d’Europe occidentale, construites à partir d’archéointensités de référence de qualité, est discutable en raison de l’éloignement par rapport au point de référence Paris (1300 à 1600 km). Les référentiels d’Europe de l’Est sont plus proches (800 km), mais le faible nombre d’archéointensités de référence de qualité ne permet pas une datation fiable. Aussi, l’alternative la plus fiable aux courbes italiennes s’avère le modèle européen SCHA.DIF.3k construit après sélection des données d’intensité suivant le protocole de mesure au laboratoire et le nombre d’échantillons (Pavon-Carrasco et al., en révision). Les résultats mettent en évidence le potentiel de datation de l’archéointensité grâce à sa forte variation séculaire au haut Moyen-Âge et au premier millénaire av. J.-C. (Gomez-Paccard et al., 2012 ; Hervé et al., 2013). L’archéointensité affine en effet de 20 à 30% la datation obtenue avec l’archéodirection seule. De nouvelles intensités de référence en Europe permettraient d’optimiser encore ce potentiel

New archeointensity data from NW Argentina (1300-1500 AD)

International audienceA good characterization of the geomagnetic field strength at centennial to millennial time scales in the Southern Hemisphere is particularly crucial to disentangle the long-term evolution of the South Atlantic Anomaly (SAA), an intriguing geomagnetic feature currently observed at the Earth́s surface. Here we present 59 new archeointensities obtained from four well-dated groups of potteries with ages ranging between 1300 and 1500 AD and collected in Northwest Argentina. The new data were obtained in accordance with the Thellier paleointensity method including partial thermoremanent magnetization (pTRM) checks and TRM anisotropy and cooling rate corrections. We have also performed a comparative study of the efficiency of magnetic the susceptibility, ARM and TRM anisotropy tensors to correct the TRM anisotropy effect upon intensity estimates. Our results suggest that the magnetic susceptibility tensor systematically underestimates the TRM anisotropy effect by 10 to 30 %. Our new data, together with a selection of selected archeointensities already published, confirm that the decrease of the geomagnetic field intensity in South America started around 1600-1650 AD, due to the arrival of the SAA

Evidence of high F-18-fluorodeoxyglucose uptake in the subcutaneous adipose tissue of the dorsocervical area in young adults

Diabetes mellitus: pathophysiological changes and therap