Aim
Infective endocarditis (IE) can be life‐threatening because of various associated adverse events. The quick Sepsis‐related Organ Failure Assessment (qSOFA) score is a straightforward useful ...method for predicting in‐hospital mortality in patients with suspected infections. However, few data exist regarding the clinical impact of the qSOFA score on predicting adverse events in IE during hospitalization. We studied the usefulness of qSOFA score for predicting in‐hospital adverse events in patients with IE.
Methods
We retrospectively analyzed 104 consecutive patients diagnosed with IE on the basis of modified Duke criteria. We defined in‐hospital adverse events as occurrence of any of the following events during hospitalization: death, embolism, hemorrhage, or abscess formation. The high qSOFA group was defined as those with a qSOFA score ≥2. We used Cox regression analysis to estimate the hazard ratio for high qSOFA score on in‐hospital adverse events adjusted for age, sex, and Staphylococcus aureus infection.
Results
We analyzed 83 patients (57 men, mean age 61 ± 18 years) from the total cohort of 104 patients enrolled. Among these, 12 (14.5%) had high qSOFA scores. The high qSOFA group had higher in‐hospital mortality compared to the low qSOFA group (50.0% vs. 4.2%, P < 0.01). In the Cox proportional hazards model, high qSOFA was significantly associated with in‐hospital adverse events (adjusted hazard ratio, 2.29; confidence interval, 1.02–5.12; P = 0.044).
Conclusion
These results showed that high qSOFA score was significantly associated with in‐hospital adverse events in IE patients, although further prospective study is necessary to confirm our results.
We found that high qSOFA score was significantly associated with in‐hospital adverse outcomes in patients with IE. This is the first study to show that qSOFA score might also be a useful tool for risk stratification in IE patients during hospitalization.
Abstract Many Riata (St. Jude Medical, St. Paul, MN, USA) implantable cardioverter defibrillator (ICD) leads have reportedly developed cable externalization. The most likely cause of cable ...externalization is insulation abrasion, which often occurs at the can or between the right ventricular coil and superior vena cava (SVC) coil. We report a rare case of an adult male whose ICD lead cable was externalized at the proximal portion of the SVC coil. This lead became fixed to the wall at the subclavian vein and SVC and became bent between these adhesions. Furthermore, the motion of this lead was affected by pulsation of the aortic arch. The ICD lead might develop inside-out abrasion due to mechanical stress evoked by pulsation of the aortic arch at this site. < Learning objective: Cable externalization of the implantable cardioverter defibrillator lead at the proximal portion of the superior vena cava (SVC) coil has rarely been reported. Externalization might be the result of deformation of the left brachiocephalic vein and the anatomical relationship with the aortic arch. The anatomical pathway of the lead should be carefully considered during the procedure, especially when a dual-coil lead is selected. Moreover, possible cable externalization at both the proximal and distal portions of the SVC coil should be kept in mind during follow-up.>
Abstract A 58-year-old man, in whom an implantable cardiac defibrillator (ICD) had been implanted for Brugada syndrome, suffered rapidly progressive general paralysis. Various diagnostic imaging ...techniques were performed, but the cause could not be determined. Magnetic resonance imaging (MRI) scanning was performed. A 1.5-Tesla MRI system was used, and the ICD was programmed to ODO mode and all tachycardia detection was turned off. MRI was performed safely under electrocardiogram and pulse oximeter monitoring, and appropriate precautions were taken in preparation for an emergency. ICD parameters did not change in post-imaging investigations. MRI revealed an apparent tumor in the patient's medulla and upper cervical spinal cord, which was diagnosed as high-grade astrocytoma. When performing MRI procedures in patients with an ICD under urgent conditions, it is necessary to have complete knowledge of the procedure and to make careful preparations.
Background The number of the elderly patients with atrial fibrillation (AF) is increasing, but the current status of anticoagulation therapy for elderly patients with AF in Japan is not clear. ...Methods and Results Among the patients registered in the "Hokuriku Atrial Fibrillation Trial (HAT) 1", 365 AF patients aged ≥65 years were enrolled in this study. Warfarin was used for significantly less patients in the oldest group aged ≥85 years (36%) than in younger populations, but the percentage of antiplatelet use in this oldest population was largest (40%). The elderly group (≥85 years) was compared with a younger group aged between 75 and 84 years. Warfarin was given to 61% of the younger group compared with 36% in the elderly group. In the younger group, the more thromboembolic risks they had according to CHADS2 score, the more warfarin was used, whereas there was no clear trend in the usage of warfarin in the elderly group. Conclusions The number of elderly Japanese patients with AF taking warfarin is currently low, but because the population of elderly AF patients will increase in the future, there is a need for safe and suitable anticoagulation therapy for elderly patients. (Circ J 2008; 72: 2058 - 2061)
Abstract Functional mitral regurgitation (MR) is a common complication accompanying left ventricular dysfunction. Increasing resting heart rate (HR) is demonstrated to be associated with increased ...mortality in heart failure (HF) patients. Thus, lowering HR is recommended by recent HF management guidelines. However, the hemodynamic effect of changing HR on functional MR remains unclear. We present a patient who demonstrated ischemic cardiomyopathy and was admitted to our hospital. Electrocardiogram showed complete left bundle block with QRS interval of 120 ms and HR of 60 beats/min. Temporal pacing study was performed to confirm the efficacy of cardiac resynchronization therapy. Functional MR was unexpectedly improved by increasing HR with atrial pacing rather than biventricular pacing. Brain natriuretic peptide was reduced from 3642 pg/ml to 435 pg/ml after 2 weeks. Our case indicates that in some HF patients with functional MR, a prolonged diastolic interval may lead to deteriorating MR flow. < Learning objective : When a resting HR >70 beats/min is observed in patients with systolic HF in sinus rhythm, lowering the HR below 70 beats/min is recommended according to the recent guidelines. However, in some HF patients with functional MR, it is possible that a prolonged diastolic interval leads to deterioration in regurgitation flow. Increasing the HR by atrial pacing may provide a favorable outcome in such patients.>
Aims : Measurement of protein S (PS) activity in patients taking direct oral anticoagulants (DOACs) using reagents based on a clotting assay results in falsely high PS activity, thus masking ...inherited PS deficiency, which is most frequently seen in the Japanese population. In this study, we investigated the effect of factor Xa (FXa) inhibitors on PS activity using the reagent on the basis of the chromogenic assay, which was recently developed in Japan. Methods : The study enrolled 152 patients (82 males and 70 females ; the average age : 68.5 +- 14.0 years) receiving three FXa inhibitors (rivaroxaban, edoxaban, and apixaban). PS activity was measured using the reagents on the basis of the clotting and chromogenic assays. Results : PS activity measured by the clotting assay reagents exhibited falsely high values depending on the plasma concentrations of FXa inhibitors in patients taking either rivaroxaban or edoxaban. However, none of the three FXa inhibitors affected PS activity when measured using the chromogenic assay. Conclusion : In patients taking rivaroxaban or edoxaban, inherited PS deficiency is likely missed because the levels of PS activity measured using the reagents based on the clotting assay are falsely high. However, we report that three FXa inhibitors do not affect PS activity measured by the chromogenic assay. When measuring the levels of PS activity in patients undergoing DOACs, the principles of each reagent should be understood. Furthermore, plasma samples must be collected at the time when plasma concentrations of DOACs are lowest or the DOAC-Stop reagent should be used.
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