Arrhythmic risk in elderly patients candidates to transcatheter aortic valve replacement. predicative role of repolarization temporal dispersion

Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). In eighty-one elderly patients with AS we calculated several short-period RRand QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRNU) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14–2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40–3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576–0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648–0.954, p < 0.05). In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reductionof thearrhythmicburdenin thissettingofpatients isworthytobe investigated

Procalcitonin Reveals Early Dehiscence in Colorectal Surgery: The PREDICS Study

Objectives: We designed a multicentric, observational study to test if Procalcitonin (PCT) might be an early and reliable marker of anastomotic leak (AL) after colorectal surgery (ClinicalTrials.govIdentifier:NCT01817647). Background: Procalcitonin is a biomarker used to monitor bacterial infections and guide antibiotic therapy. Anastomotic leak after colorectal surgery is a severe complication associated with relevant short and long-term sequelae. Methods: Between January 2013 and September 2014, 504 patients underwent colorectal surgery, for malignant colorectal diseases, in elective setting. White blood count (WBC), C-reactive protein (CRP) and PCT levels were measured in 3rd and 5th postoperative day (POD). AL and all postoperative complications were recorded. Results: We registered 28 (5.6%) anastomotic leaks. Specificity and negative predictive value for AL with PCT less than 2.7 and 2.3 ng/mL were, respectively, 91.7% and 96.9% in 3rd POD and 93% and 98.3% in 5th POD. Receiver operating characteristic curve for biomarkers shows that in 3rd POD, PCTand CRP have similar area under the curve (AUC) (0.775 vs 0.772), both better than WBC (0.601); in 5th POD, PCT has a better AUC than CRP and WBC (0.862 vs 0.806 vs 0.611). Measuring together PCT and CRP significantly improves AL diagnosis in 5th POD (AUC: 0.901). Conclusions: PCTand CRP demonstrated to have a good negative predictive value for AL, both in 3rd and in 5th POD. Low levels of PCT, together with low CRP values, seem to be early and reliable markers of AL after colorectal surgery. These biomarkers might be safely added as additional criteria of discharge protocols after colorectal surgery

CRP Predicts Safe Patient Discharge after Colorectal Surgery: Reply

Letter answering the question arises from a previous articl

Role of cardiac123I-mIBG imaging in predicting arrhythmic events in stable chronic heart failure patients with an ICD

Background. Despite therapeutic improvement, the prognosis of chronic heart failure (CHF) remains unfavorable partly due to arrhythmia and sudden cardiac death (SCD). This prospective study evaluated myocardial 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy as a predictor of arrhythmic events (AE) in CHF patients. Methods. 170 CHF patients referred for implantable cardioverter-defibrillator (ICD) implantation for both primary and secondary prevention were enrolled. All patients underwent planar and SPECT imaging. Early and late heart-to-mediastinum (H/M) ratio, 123I-mIBG washout (WO), early and late summed SPECT scores were calculated The primary endpoint was an AE: sustained ventricular tachycardia, resuscitated cardiac arrest, appropriate ICD therapy or SCD. The secondary endpoint was appropriate ICD therapy. Results. During a median follow-up of 23.3 months, 69 patients experienced an AE. Early summed score (ESS) was the only independent predictor of AE [HR 1.023 (1.003-1.043)]. Focussing on only patients with an ICD for primary prevention, ESS was the only independent predictor of AE [HR 1.028 (1.007-1.050)]. 123I-mIBG-derived parameters failed to be independent predictors of appropriate ICD therapy. However there was a ‘‘bell-shaped’’ relation between 123I-mIBG scintigraphy-derived parameters and AE and appropriate ICD therapy, i.e., those with intermediate 123I-mIBG abnormalities tended to be at higher risk of events.Conclusion. Although SPECT 123I-mIBG scintigraphy was associated with AE in CHF patients with ICD implantation for primary and secondary prevention, no association was found between 123I-mIBG scintigraphy-derived parameters and appropriate ICD therapy

Multimodality imaging in ICD implantation decision making: 123-iodine metaiodobenzylguanidine imaging and cardiac magnetic resonance imaging

Introduction: According to guidelines, implantable cardioverter defibrillator (ICD) is recommended in prevention of sudden cardiac death (SCD) in heart failure (HF) patients (pts). Guidelines have several limitations because ICD indication is based mainly on left ventricular ejection fraction (EF). Recently, 123-iodine metaiodobenzylguanidine imaging (123-I MIBG) seems to identify, independently from EF, pts at high risk of SCD (heart/mediastinum (H/M) ratio < 1.6 and a summed score (SS)> 26). Hypothesis: Our aim is to assess the role of 123-I MIBG combined with cardiac MRI to predict malignant ventricular tachyarrhythmia in HF pts. Methods: we enrolled 69 pts, consecutively admitted to our hospital with diagnosis of HF and EF<35%, NYHA class II and III, who underwent 123-I MIBG imaging and cardiac MRI. Summed score (SS) of 26 was used as cut-off to identify high risk (group 1) versus low risk (group 2) pts. Late gadolinium enhancement (LGE) and number of segments with scars were evaluated in the 2 groups. All pts underwent to ICD implantation. We assessed ventricular arrhythmic (VA) events at 18 months follow-up. Results: 21 pts were included in group 1 and 48 pts in group 2. All baseline characteristics were similar in 2 groups. In group 1, H/M ratio was 1.47± 0.24 and in group 2 21.63 ± 0.27 (p=0.015). The percentage of the pts with LGE was 70.9 % in group 1 vs 39.1 % in group 2 (p=0.023). At 18 months follow-up VA events in group 1 were 19.05% vs 4.17% in group 2 (p < 0.037). Moreover VA events were statistically recorded greater in pts with both SS > 26 and LGE compared to pts with only SS >26 (46.7% vs 19.6%, p= 0.046). Conclusions: Our results seem to confirm that reduced 123-I MIBG uptake (H/M and SS) and presence of LGE are associated with the occurrence of life-threatening ventricular arrhythmias in HF patients independently from EF. The use of integrated imaging could be a useful tool in the future to increase the specificity of the selection of pts for ICD therapy

Measurement of the double-differential inclusive jet cross section in proton-proton collisions at s\sqrt{s} = 5.02 TeV

International audienceThe inclusive jet cross section is measured as a function of jet transverse momentum $p_\mathrm{T}$ and rapidity $y$. The measurement is performed using proton-proton collision data at $\sqrt{s}$ = 5.02 TeV, recorded by the CMS experiment at the LHC, corresponding to an integrated luminosity of 27.4 pb$^{-1}$. The jets are reconstructed with the anti-$k_\mathrm{T}$ algorithm using a distance parameter of $R$ = 0.4, within the rapidity interval $\lvert y\rvert$$\lt$ 2, and across the kinematic range 0.06 $\lt$$p_\mathrm{T}$$\lt$ 1 TeV. The jet cross section is unfolded from detector to particle level using the determined jet response and resolution. The results are compared to predictions of perturbative quantum chromodynamics, calculated at both next-to-leading order and next-to-next-to-leading order. The predictions are corrected for nonperturbative effects, and presented for a variety of parton distribution functions and choices of the renormalization/factorization scales and the strong coupling $\alpha_\mathrm{S}$

Search for Z' bosons decaying to pairs of heavy Majorana neutrinos in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search for the production of pairs of heavy Majorana neutrinos (N$_\ell$) from the decays of Z' bosons is performed using the CMS detector at the LHC. The data were collected in proton-proton collisions at a center-of-mass energy of $\sqrt{s}$ = 13 TeV, with an integrated luminosity of 138 fb$^{-1}$. The signature for the search is an excess in the invariant mass distribution of the final-state objects, two same-flavor leptons (e or $\mu$) and at least two jets. No significant excess of events beyond the expected background is observed. Upper limits at 95% confidence level are set on the product of the Z' production cross section and its branching fraction to a pair of N$_\ell$, as functions of N$_\ell$ and Z' boson masses ($m_{\mathrm{N}_\ell}$ and $m_\mathrm{Z'}$, respectively) for $m_\mathrm{Z'}$ from 0.4 to 4.6 TeV and $m_{\mathrm{N}_\ell}$ from 0.1 TeV to $m_\mathrm{Z'}$/2. In the theoretical framework of a left-right symmetric model, exclusion bounds in the $m_{\mathrm{N}_\ell}$-$m_\mathrm{Z'}$ plane are presented in both the electron and muon channels. The observed upper limit on $m_\mathrm{Z'}$ reaches up to 4.42 TeV. These are the most restrictive limits to date on the mass of N$_\ell$ as a function of the Z' boson mass