Effects of Ivabradine on 6-Minute Walk Test and Quality of Life in Patients With Previously Implanted CRT-D

Background: We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment. Background: &nbsp; We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment. Methods: &nbsp; Fifteen men and 14 women with a median age of 63 years (range, 48 &nbsp; Y79 years) were studied. Twenty-one patients were in New York Heart Association class II (8 patients were in class III), CRT-D implanted previously, and with resting heart rates greater than 70 beats per minute with sinus rhythm despite conventional medication. Patients were given 2.5- to 7.5-mg ivabradine orally twice a day, and drug dosage was titrated to decrease the patients&rsquo; average heart rate to 70 beats per minute. Before and 3 months after ivabradine treatment, all patients underwent extensive clinical, echocardiographic, and laboratory evaluation. Results: &nbsp; Ivabradine treatment produced dose-dependent reductions in heart rate at rest and at peak exercise (91.9 &nbsp; T 6.3 to 71.7 T 4.8 and 114.4 T 7.6 to 96.8 &nbsp; T 4.8; P = 0.001 and P = 0.001, respectively). There were also significant improvements in life quality score (52.4 &nbsp; T 9.5 to 37.9T7.8; P &nbsp; = 0.001) and 6-minute walking distance (278.7 T 85.8 to 373.3 T 94.0; P &nbsp; = 0.001) of patients. All patients with New York Heart Association class III became class II after 3 months of ivabradine treatment. Conclusion: &nbsp; Heart rate reduction in a short-term period by ivabradine produced significant improvements in exercise capacity and life quality in patients with CRT-D and conventional therapy.</p

Urinary HSP70 improves diagnostic accuracy for urinary tract infection in children: UTILISE study [Article]

Background: The accuracy of conventional urinalysis in diagnosing urinary tract infection (UTI) in children is limited, leading to unnecessary antibiotic exposure in a large fraction of patients. Urinary heat shock protein 70 (uHSP70) is a novel marker of acute urinary tract inflammation. We explored the added value of uHSP70 in discriminating UTI from other infections and conditions confused with UTI. Methods: A total of 802 children from 37 pediatric centers in seven countries participated in the study. Patients diagnosed with UTI (n = 191), non-UTI infections (n = 178), contaminated urine samples (n = 50), asymptomatic bacteriuria (n = 26), and healthy controls (n = 75) were enrolled. Urine and serum levels of HSP70 were measured at presentation in all patients and after resolution of the infection in patients with confirmed UTI. Results: Urinary (u)HSP70 was selectively elevated in children with UTI as compared to all other conditions (p 0.0001). uHSP70 predicted UTI with 89% sensitivity and 82% specificity (AUC = 0.934). Among the 265 patients with suspected UTI, the uHSP70 > 48 ng/mL criterion identified the 172 children with subsequently confirmed UTI with 90% sensitivity and 82% specificity (AUC = 0.862), exceeding the individual diagnostic accuracy of leukocyturia, nitrite, and leukocyte esterase positivity. uHSP70 had completely normalized by the end of antibiotic therapy in the UTI patients. Serum HSP70 was not predictive. Conclusions: Urine HSP70 is a novel non-invasive marker of UTI that improves the diagnostic accuracy of conventional urinalysis. We estimate that rapid urine HSP70 screening could spare empiric antibiotic administration in up to 80% of children with suspected UTI. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information [Figure not available: see fulltext.] © 2022, The Author(s), under exclusive licence to International Pediatric Nephrology Association.Istanbul ÜniversitesiWe gratefully acknowledge that UTILISE was supported by Scientific Research Projects Coordination Unit of Istanbul University, by the European Society for Pediatric Nephrology (ESPN), by the Society for Children’s Kidney Health, and by Istanbul Faculty of Medicine Foundation. We are also very thankful to children participating in this study, our dedicated chemist Orhan Tepeli, and diligent students of Istanbul University Istanbul Faculty of Medicine Zeynep Sakur, Sevgi Ipar, and Isıl Gul for their great help and assistance.UTILISE study was supported by Scientific Research Projects Coordination Unit of Istanbul University, by the European Society for Pediatric Nephrology (ESPN), by the Society for Children’s Kidney Health, and by Istanbul Faculty of Medicine Foundation