Right heart strain in arrhythmogenic right ventricular cardiomyopathy: Implications for cardiovascular outcome.

INTRODUCTION: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular events. AIMS: To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS)) in patients with definite ARVC and its association with adverse events during follow-up. METHODS: RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint (sustained ventricular arrhythmia and cardiovascular death) was determined. RESULTS: Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (-11.5 [-13.3 - -10.2]%) versus the no-event group (-15.8 [-17.1 - -14.5]%, P < 0.001), and so was RAGLS (22.8 [21.4 - 27.4]% vs. 31.5 [25.1 - 39.6]%, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fit was improved when RVGLS and RAGLS were applied together rather than alone. CONCLUSIONS: RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC.

Right vs. left ventricular longitudinal strain for mortality prediction after transcatheter aortic valve implantation.

Introduction: This study aims at exploring biventricular remodelling and its implications for outcome in a representative patient cohort with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods and results: Pre-interventional echocardiographic examinations of 100 patients with severe AS undergoing TAVI were assessed by speckle tracking echocardiography of both ventricles. Association with mortality was determined for right ventricular global longitudinal strain (RVGLS), RV free wall strain (RVFWS) and left ventricular global longitudinal strain (LVGLS). During a median follow-up of 1,367 [959-2,123] days, 33 patients (33%) died. RVGLS was lower in non-survivors [-13.9% (-16.4 to -12.9)] than survivors [-17.1% (-20.2 to -15.2); P = 0.001]. In contrast, LVGLS as well as the conventional parameters LV ejection fraction (LVEF) and RV fractional area change (RVFAC) did not differ (P = ns). Kaplan-Meier analyses indicated a reduced survival probability when RVGLS was below the -14.6% cutpoint (P < 0.001). Lower RVGLS was associated with higher mortality [HR 1.13 (95% CI 1.04-1.23); P = 0.003] independent of LVGLS, LVEF, RVFAC, and EuroSCORE II. Addition of RVGLS clearly improved the fitness of bivariable and multivariable models including LVGLS, LVEF, RVFAC, and EuroSCORE II with potential incremental value for mortality prediction. In contrast, LVGLS, LVEF, and RVFAC were not associated with mortality. Discussion: In patients with severe AS undergoing TAVI, RVGLS but not LVGLS was reduced in non-survivors compared to survivors, differentiated non-survivors from survivors, was independently associated with mortality, and exhibited potential incremental value for outcome prediction. RVGLS appears to be more suitable than LVGLS for risk stratification in AS and timely valve replacement.

Nonpharmacological home remedies for upper respiratory tract infections: a cross-sectional study of primary care patients in Switzerland and France.

BACKGROUND: Many patients might be tempted to use nonpharmacological home remedies (NPHRs) to relieve upper respiratory tract infection (URTI) symptoms. However, primary care physicians (PCPs) rarely recommend NPHRs due to a lack of knowledge in this field. We conducted a questionnaire-based survey among primary care patients in Switzerland and France to explore which NPHRs they use and consider effective for 3 common URTI symptoms: sore throat/cough/common cold. METHODS: Using official physician registries, we randomly selected 50 PCPs in Geneva (Switzerland) and Lyon/Grenoble (France). Seven research assistants were involved in the recruitment of consecutive patients from the waiting rooms of these PCPs (20-25 patients per practice). Patients were asked to complete a paper-based questionnaire to assess the use and perceived effectiveness of 72 NPHRs for URTI symptoms. The list of NPHRs was developed by our research team with the help of 97 patients. Remedies were considered effective if patients reported that they were effective/very effective. Data were analysed descriptively. RESULTS: Of the 1,198 eligible patients, 1,012 agreed to participate (84.5%). The 4 most frequently used NPHRs were honey/lemon/thyme/herbal teas. Most patients using these NPHRs considered them as effective (between 77% of patients for onion syrup for cough and 94% of patients for thyme inhalations for common colds). CONCLUSIONS: Many patients reported using honey/lemon/thyme/herbal teas for URTI symptoms, and generally considered these treatments to be effective. Future research should explore the extent to which these remedies can be safely proposed as alternatives for the symptomatic treatment of ear/nose/throat complaints in primary care.

Tissue Doppler echocardiography and outcome in arrhythmogenic right ventricular cardiomyopathy.

AIMS: This study aimed at investigating whether tissue Doppler imaging (TDI) is associated with adverse events in arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS AND RESULTS: Transthoracic echocardiography was performed in 72 patients with definite (n = 63) or borderline (n = 9) ARVC diagnosed according to the 2010 Task Force Criteria and included in the prospective Zurich ARVC registry. Myocardial peak systolic tissue velocity (S') was measured by TDI at lateral tricuspid (tricuspid S'), medial mitral (septal S'), and lateral mitral annulus (lateral S'). Association of echocardiographic parameters with outcome was assessed by univariable Cox regression. During a median follow-up of 4.9 ± 2.6 years, 6 (8.3%) patients died of cardiovascular cause or received heart transplantation and 21 (29.2%) patients developed sustained ventricular arrhythmia. Tricuspid, septal, and lateral S' were lower in patients who died (p = 0.001; p < 0.001; p = 0.008; respectively), while tricuspid and septal S' were lower in those with ventricular arrhythmia (p = 0.001; p = 0.008; respectively). There was a significant association of tricuspid, septal, and lateral S' with mortality (HR = 1.61, p = 0.011; HR = 2.15, p = 0.007; HR = 1.67, p = 0.017; respectively), while tricuspid and septal S' were associated with ventricular arrhythmia (HR = 1.20, p = 0.022; HR = 1.37, p = 0.004; respectively). Kaplan-Meier analyses demonstrated a higher freedom from mortality with tricuspid S' >8 cm/s (p = 0.001) and from ventricular arrhythmia with S' >10.5 cm/s (p = 0.021). CONCLUSIONS: This study demonstrates that TDI provides information on the ARVC phenotype, is associated with adverse events in ARVC patients, and differentiates between patients with and without adverse events.

Right atrial strain and cardiovascular outcome in arrhythmogenic right ventricular cardiomyopathy.

AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive fibro-fatty infiltration of the myocardium and associated with adverse cardiovascular (CV) events. This study aims to examine right atrial (RA) deformation in ARVC and understand its association with CV outcomes. METHODS AND RESULTS: RA strain was determined in 50 patients with definite ARVC, compared with a matched control group of 50 healthy individuals, and analysed for outcome association over a median follow-up duration of 5 years. A subgroup of 30 ARVC patients with normal RA volume (ARVC-N group) was compared with 30 matched controls (Control-N), and the outcome was analysed separately. RA reservoir, conduit, and pump strain were significantly impaired in ARVC vs. control. Similar observations were made in the N-ARVC subgroup. Reservoir strain was associated with an increased risk of atrial arrhythmia (AA) [hazard ratio (HR) 0.88, P < 0.01] and CV events (HR 0.92, P < 0.01). Conduit strain also predicted AA (HR 1.02, P < 0.01), while pump strain predicted CV events (HR 1.09, P = 0.02). Reservoir strain improved the fitness of bivariable models for the association of RV end-diastolic area index, RV fractional area change, and RV global longitudinal strain with CV events. CONCLUSION: ARVC patients display impaired RA strain even when RA volume is normal. Reservoir and pump strain are associated with an increased risk of CV events. Reservoir strain improved model fitness for the association of RVGLS and other echocardiographic parameters with CV events.

[Use of non-pharmacological home remedies in ENT: research informs our practices and those of our patients]. / Emploi des remèdes de grand-mère en ORL : la recherche éclaire nos pratiques et celles de nos patients.

Upper respiratory tract infections (URTIs) are a common presenting condition in family medicine. The vast majority of URTIs are treated symptomatically with pharmacological or non-pharmacological treatments. This article presents some of the results of our research projects to compile a list of non-pharmacological home remedies to relieve symptoms such as sore throat, coughs and colds. Honey, thyme or lemon are often used by patients and considered to be effective. These remedies have few side-effects, and we therefore propose to include them in the range of treatments that can be proposed in family medicine.

Les infections des voies respiratoires supérieures (IVRS) constituent un motif de consultation fréquent en médecine de famille. La grande majorité des IVRS fait l'objet d'un traitement symptomatique pharmacologique ou non pharmacologique. Cet article se base sur une partie des résultats de nos projets de recherche pour constituer une liste de remèdes de grand-mère à proposer aux patients pour soulager des symptômes tels que les maux de gorge, la toux et le rhume. Le miel, le thym ou le citron sont souvent utilisés par les patients et considérés comme étant efficaces. Ces remèdes présentent peu d'effets indésirables et nous proposons donc de les intégrer dans l'arsenal thérapeutique en médecine de famille.

Primary care patients' perspectives on the use of non-pharmacological home remedies in Geneva: a cross-sectional study.

BACKGROUND: Home remedies are anchored in patients' everyday life, but their use in Western cultures remains scarcely explored. Our objectives were to investigate primary care patients' perspectives and use of non-pharmacological home remedies in Geneva (Switzerland). METHODS: In spring 2020, we conducted a cross-sectional survey among adult primary care patients in randomly selected general practices (N = 15). Patients were recruited in the waiting rooms and asked to complete a questionnaire about their sociodemographic characteristics, their home remedy use, and their expectations and reasons for using (or not using) home remedies. We employed descriptive statistics to summarise the data and logistic regression adjusted for clustering within practices to explore associations between home remedy use and participants' sociodemographic characteristics. RESULTS: Three hundred fourteen of three hundred ninety patients agreed to participate in the study (participation rate 80.5%). Home remedies were used by 64.4% of patients. The main reasons given were for preventive purposes (55.3%), self-care (41.0%), as an alternative to conventional medicine (40.5%) and to avoid or delay a medical consultation (38.5%). One-third of patients considered that it was the GP's role to spontaneously inform them about home remedies (36.4%), another third considered that it was the GP's role to inform them, but only upon specific request (32.3%), and the last third of patients declared that it was not the GP's role to provide information about home remedies (30.3%). Patients living in an urban zone (adjusted OR 2.1; 95%CI 1.0-4.4; p 0.05) and those with a tertiary education background (adjusted OR 1.9; 95%CI 1.0-3.6; p 0.05) believed that it was their GP's role to inform them about home remedies. CONCLUSIONS: Home remedies are used by a majority of primary care patients in Geneva. For a comprehensive and safe healthcare management in the context of patient-oriented medicine, more evidence-based research on efficacy and safety of home remedies as well as their place in primary care consultation is required.