Aims Previous studies have established an association between exercise intolerance and increased morbidity and mortality in congenital heart disease patients. We aimed to clarify if exercise ...intolerance is associated with poor outcome in Fontan patients and to identify risk factors for mortality, transplantation, and cardiac-related hospitalization. Methods and results A total of 321 Fontan patients (57% male, mean age 20.9 ± 8.6 years) who underwent cardiopulmonary exercise testing (CPET) at four major European centres between 1997 and 2008 were included. During a median follow-up of 21 months, 22 patients died and 6 patients underwent cardiac transplantation (8.7%), resulting in an estimated 5-year transplant-free survival of 86%. Parameters of CPET were strongly related to increased risk of hospitalization, but—with the exception of heart rate reserve—unrelated to risk of death or transplantation. In contrast, patients with clinically relevant arrhythmia had a 6.0-fold increased risk of death or transplantation (P < 0.001). Furthermore, patients with atriopulmonary/-ventricular Fontan had a 3.7-fold increased risk of death or transplantation compared with total cavopulmonary connection patients (P= 0.009). The combination of clinically relevant arrhythmia, atriopulmonary/-ventricular Fontan, and signs of symptomatic or decompensated heart failure was associated with a particularly poor outcome (3-year mortality 25%). Conclusion On short-term follow-up, most parameters of CPET are associated with increased risk of hospitalization but not death or transplantation in contemporary Fontan patients. Only decreased heart rate reserve and a history of clinically relevant arrhythmia, atriopulmonary/-ventricular Fontan, and/or heart failure requiring diuretic therapy are associated with poor prognosis, potentially identifying patients requiring medical and/or surgical attention.
Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for ...the relief of symptoms of acute heart failure. The drug’s impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.
Nailfold videocapillaroscopy (NVC) changes in systemic sclerosis (SSc) are correlated with vascular complications, such as pulmonary arterial hypertension (PAH), supporting a potential link between ...peripheral and internal organ vasculopathy. The current stage of knowledge regarding NVC and PAH is discussed, focusing on the assessment of peripheral microangiopathy and a potential relationship with functional, echocardiographic, and haemodynamic markers of cardiac dysfunction. A comprehensive literature search was carried out to identify all studies focusing on NVC findings in patients with PAH, diagnosed with right heart catheterization. The majority of the studies examined NVC findings in patients with SSc-PAH, while three studies reported NVC abnormalities in patients with idiopathic PAH. Besides the pulmonary vasculature, a systemic component of microangiopathy seems to be involved in PAH. Well-designed prospective trials are warranted to validate NVC as a biomarker, with clinical implications in the diagnostic evaluation, risk stratification, and overall management of PAH in the daily clinical setting.
Aim
To present the application and the outcome of the regenerative endodontic therapy (RET) in a series of symptomatic immature mandibular molars with pulp necrosis and apical periodontitis and to ...review the relevant literature for the documentation of the procedure as a potential treatment option.
Methods
Three young male patients were referred with pain in the left mandibular region resulting from pulp necrosis and apical periodontitis of the first permanent molar. Regenerative endodontic approach was performed for the complete resolution of the lesions and the thickening of the apical root canal walls. The databases of Medline, Pubmed and Google Scholar were also searched for articles in which a regenerative approach has been undertaken for the endodontic management of immature permanent molars with pulp necrosis and apical periodontitis.
Results
Follow-up examinations showed that the teeth remained functional without any signs or symptoms. Final radiographic examination at 12, 18 and 36 months, respectively, revealed complete resolution of the lesions and complete apical closure in the two out of three cases. The search of the literature revealed the existence of only 25 clinical articles in which necrotic immature molars were treated by the regenerative approach. The total number of the treated teeth were 46.
Conclusions
Regenerative endodontic approach may be applied in posterior non-vital molar teeth with a possible favorable outcome. However, the literature support for the documentation of the procedure as a predictable and reproducible treatment option in posterior immature molar teeth is at present limited.
Elevated pulmonary vascular resistance portends a poor prognosis across interstitial lung disease (ILD), irrespective of the histospecific diagnosis. Currently, no noninvasive surrogate prognostic ...marker exists. We explore the prognostic value of brain natriuretic peptide (BNP) and echocardiography across ILD. ILD patients with BNP concentrations performed during 2005-2007 were reviewed (n = 90). Echocardiography tapes were reviewed by a cardiologist blinded to other results. Outcome was evaluated for survival against BNP and echocardiograph parameters. A priori threshold values and composite markers were evaluated against survival. During follow-up (20±9 months) there were 28 deaths (31%). BNP correlated with right heart echocardiographic indices, including right ventricular systolic pressure (RVSP) (R(2) = 0.18, p = 0.0002) but not with parameters of left heart function. Nonsurvivors had higher BNP and RVSP levels than survivors. BNP ≥20 pmol·L(-1) (hazard ratio (HR) 2.93, 95% CI 1.28-6.73; p = 0.01) and moderate-severe pulmonary hypertension (HR 2.53, 95% CI 1.15-5.57; p = 0.02) were associated with increased mortality, independent of age, sex and pulmonary function. Patients with BNP ≥20 pmol·L(-1) had a 14-fold increased mortality over those with BNP <4 pmol·L(-1). Increased BNP levels and/or echocardiographic markers of right ventricular dysfunction were associated with increased mortality across ILD. The link between vascular parameters and mortality supports the concept that pulmonary vascular disease contributes to the final common pathway seen across ILD.
•Precapillary pulmonary hypertension (PPH) is a disease with poor prognosis.•Patients with precapillary pulmonary hypertension have significantly compromised right ventricular and right atrial strain ...values.•Right ventricular and right atrial global longitudinal strains are independent predictors of clinical failure in patients with precapillary pulmonary hypertension.
The purpose of this study was to investigate right atrial and ventricular strain parameters on cardiac magnetic resonance (CMR) in patients with precapillary pulmonary hypertension (PPH) and whether they can aid in the assessment of PPH prognosis.
Adult patients with groups 1 and 4 PPH were invited to participate in the study. Age- and sex-matched healthy volunteers were also recruited as controls. At baseline, patients underwent clinical examination, N-terminal pro-B-type natriuretic peptide measurement and CMR with feature tracking post-processing (CMR-FT). Healthy controls underwent only CMR-FT. The study's primary endpoint was clinical failure, defined as death, hospitalization or demonstrable clinical deterioration during follow-up. Patients who were unable to perform 6-minute walking test due to musculoskeletal disorders were excluded from the study.
Thirty-six patients (8 men, 28 women; mean age, 50.6±13.8 SD years range: 18.6–78.5years) and 12 healthy control subjects (5 mean, 7 women; mean age, 40.6±13.5 SD years range: 23.1–64.4years) were recruited. Right ventricular global longitudinal strain (GLS) was significantly impaired in PPH patients (−20.2±5.3 SD % range: −28.8 to −9.1% vs. −28.4±3.1% −33.7 to −22.7% respectively, P<0.001). The right atrial GLS was significantly impaired in PPH compared to healthy controls (−19.9±4.5% range: −28.6 to −3.6% vs. −26.5±4.2% range: −32.8 to −15.8% respectively) (P<0.001). Clinical failure occurred in 19 (19/36, 53%) of patients. Right ventricular GLS predicted clinical failure most reliably among CMR parameters (−22.6±3.8 SD % range: −27.6 to −12.7% for patients without clinical failure vs. −18±5.6 SD % range: −28.8 to −9.1% for patients with clinical failure; hazard ratio HR=1.85; P=0.007; area under the AUC curve=0.75). Lower absolute right atrial GLS was significantly associated with clinical failure (−22.7±3.0 SD % range: −28.6 to −17.7% for patients without clinical failure vs. −16.9±5.8 SD % range: −24.2 to −3.6% for patients with clinical failure) (HR=1.53; P=0.035).
CMR feature tracking-derived myocardial strain parameters of both the right atrium and ventricle can assist clinicians in the prognosis of PPH.
Digital health interventions constitute a promising supplementary approach for further improvement of the quality and experience of cardiovascular care in patients with heart failure (HF). However, ...concerns about privacy, security, and quality may arise additionally to lack of personal motivation and accessibility to digital resources. Therefore, the proposed system aims to implement innovative technological trends in HF monitoring by recording clinical, biological, and biometric parameters.
The availability and feasibility of the digital platform KardioUp was evaluated in a group of 25 patients with HF (mean age: 60 years) and 15 medical doctors (mean age 40 years) in two University Cardiology Clinics of the country. Connectivity of platform with the application and Android devices, use of alerts in clinical measurements, educational material provided, and total satisfaction by both patients and physicians were also evaluated. Patients with health barriers to understand the use of digital platforms or low eHealth ≤8 (digital unawareness) were excluded.
All patients answered that the upload of measurements of blood pressure, blood glucose, and weight into the application were feasible. Patients mean eHealth score was 32,7. Additionally, the graphics of the application were friendly and educational material was also easily approached. Patients felt that this application can enable real patient-empowerment and self-management support.
KardioUp was evaluated as a non-pharmacological intervention that could promote autonomous living of patients. Thus, possible alterations in daily activities and other parameters will be continuously evaluated providing metrics' monitoring on patients’ performance, adherence to their treatment plan, avoidance of rehospitalizations, and overall health metrics.
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Aim
Spin refers to reporting, interpretation and extrapolation‐related distortion or manipulation of the findings of a study. The aim of this report was to identify the prevalence and extent of spin ...in the s of systematic reviews (SRs) including meta‐analyses in the scientific field of endodontics.
Methodology
A sensitive and inclusive search strategy in PubMed was developed to identify eligible SRs with meta‐analyses in endodontics, supplemented by an electronic search within 3 major specialty journals, from January 1, 2010, to April 16, 2022. Inclusion and extent of spin were recorded, per domain and following issues related to misleading reporting, interpretation and inappropriate extrapolation of meta‐analyses' findings. Association of spin with publication characteristics such as year, journal type, number of authors, continent of authorship, funding, primary study design and significance of the outcome was explored.
Results
A total of 186 SRs with meta‐analyses were retrieved, and inclusion of spin was detected in 125 s (67.2%), for one or more domains. Most s were affected by more than one type of spin (91/125; 72.8%). There was evidence that s of meta‐analyses of non‐significant findings had 60% lower odds for inclusion of spin (odds ratio, OR: 0.40; 95% CI: 0.19, 0.83; p = .04), after adjusting for year, journal type and number of authors.
Conclusions
Misleading reporting and misinterpretation of findings in s of meta‐analyses are evident in endodontic research. Efforts should be reinforced to increase awareness within the scientific and academic community to improve adherence to transparent reporting and interpretation.
The majority of patients with congenital heart disease (CHD), nowadays, survives into adulthood and is faced with long-term complications. We aimed to study the basic demographic and clinical ...characteristics of adult patients with congenital heart disease (ACHD) in Greece.
A registry named CHALLENGE (Adult Congenital Heart Disease Registry. A registry from Hellenic Cardiology Society) was initiated in January 2012. Patients with structural CHD older than 16years old were enrolled by 16 specialized centers nationwide.
Out of a population of 2115 patients with ACHD, who have been registered, (mean age 38years (SD 16), 52% women), 47% were classified as suffering from mild, 37% from moderate and 15% from severe ACHD. Atrial septal defect (ASD) was the most prevalent diagnosis (33%). The vast majority of ACHD patients (92%) was asymptomatic or mildly symptomatic (NYHA class I/II). The most symptomatic patients were suffering from an ASD, most often the elderly or those under targeted therapy for pulmonary arterial hypertension. Elderly patients (>60years old) accounted for 12% of the ACHD population. Half of patients had undergone at least one open-heart surgery, while 39% were under cardiac medications (15% under antiarrhythmic drugs, 16% under anticoagulants, 16% under medications for heart failure and 4% under targeted therapy for pulmonary arterial hypertension).
ACHD patients are an emerging patient population and national prospective registries such as CHALLENGE are of unique importance in order to identify the ongoing needs of these patients and match them with the appropriate resource allocation.
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