Cardiorenal multimorbidity in hospitalized cardiology patients: The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study.

PURPOSE: Cardiovascular disease is commonly accompanied by renal dysfunction. Multimorbidity in hospitalized patients impacts unfavorably on prognosis and hospital stay. We aimed to illustrate the contemporary burden of cardiorenal morbidity across inpatient cardiology care in Greece. METHODS: The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) used an electronic platform to collect demographic and clinically relevant information about all patients hospitalized on March 3, 2022, in Greece. The participating institutions covered all levels of inpatient cardiology care and most of the country's territories to collect a real-world, nation representative sample. RESULTS: A total of 923 patients (men 68.4%, median age 73 ± 14.8 years) were admitted to 55 different cardiology departments. 57.7% of the participants were aged >70 years. Hypertension was highly prevalent and present in 66% of the cases. History of chronic HF, diabetes mellitus, atrial fibrillation, and chronic kidney disease was present in 38%, 31.8%, 30%, and 26%, respectively. Furthermore, 64.1% of the sample exhibited at least one of these 4 entities. Accordingly, a combination of ≥2 of these morbid conditions was recorded in 38.7%, of ≥3 in 18.2%, whereas 4.3% of the sample combined all 4 in their medical history. The most common combination was the coexistence of heart failure-atrial fibrillation accounting for 20.6% of the sample. Nine of 10 nonelectively admitted patients were hospitalized due to acute HF (39.9%), acute coronary syndrome (33.5%), or tachyarrhythmias (13.2%). CONCLUSION: HECMOS participants carried a remarkable burden of cardio-reno-metabolic disease. HF in conjunction with atrial fibrillation was found to be the most prevalent combination among the studied cardiorenal nexus of morbidities in the whole study population.

Slow continuous ultrafiltration in a patient with anomaly of a persistent left superior vena cava.

This paper describes an uncommon case of a patient with anomaly of a persistent left superior vena cava (PLSVC). A 54-year-old man with a history of chronic kidney disease, heart failure, diabetes mellitus and hypertension was admitted to the hospital for worsening dyspnoea. During his hospital stay, heart failure was further deteriorated and he became anuric. Renal replacement therapy was then required. After multiple unsuccessful attempts of right subclavian vein catheterisation, a catheter was placed in the left subclavian vein. Chest X-ray revealed the catheter in the left side of the thorax. Transthoracic cardiac ultrasound with agitated saline and chest MRI confirmed the diagnosis of PLSVC. The patient had nine sessions of slow continuous ultrafiltration. His heart and renal function were gradually improved. Nephrologists and health care professionals must be aware of this uncommon anatomic variant. Unnecessary manipulations can lead to serious complications, such as cardiac arrhythmias, cardiac arrest and venous sinus thrombosis.

Left ventricular end-systolic stress/diameter relation as a contractility index and as a predictor of survival. Independence of preload after normalization for end-diastolic diameter.

The independence of the slope of the left ventricular (LV) end-systolic stress/end systolic diameter (ESS/ESD) relation of preload (PL) after normalization for end-diastolic diameter (EDD), and the reliability of both the original and the normalized slope as contractility and prognostic indices, were assessed. We studied echocardiographically, hemodynamically, and with carotid pulse tracing, 25 normal subjects, 18 patients with coronary artery disease having a normal ejection fraction (EF), and 30 patients with idiopathic dilated cardiomyopathy (DCM). The arterial pressure was changed with intravenous infusion of phenylephrine. To investigate the effect of PL on the ESS/ESD slope, in 12 normals the PL was decreased with intravenous infusion of 40 mg of furosemide and increased with 1 l isotonic NaCl. The studied population was followed up for 18-61 months. The mean values of the slope after furosemide and after NaCl differed significantly but when the above values were divided by the EDD the differences were nullified. The mean values of the slope differed highly significantly between the three groups. The normalized slope increased the sensitivity in the discrimination. During the follow-up period 10 patients with DCM died. The original and the normalized slopes separated the deceased and survivors significantly (P < 0.002 for both indices) as compared to EF (P < 0.05). The ESS/ESD slope is a very sensitive contractility index and is also superior to EF as a prognostic parameter. The normalization of the slope eliminates its dependence on PL and improves the sensitivity in assessing decreased contractility, although it slightly decreases its prognostic value.

Seasonal distribution of acute myocardial infarction and its relation to acute infections in a mild climate.

BACKGROUND: There is evidence that acute myocardial infraction (aMI) occurs more frequently in certain seasons and months of the year. Recently various infectious agents have been implicated in atherogenesis. In the present study we recorded the seasonal distribution of aMI and evaluated its relation to acute systemic infections (AIs). METHODS: The study included 1196 patients with aMI hospitalized during the years 1988-1998 in the General Hospital of the island of Rhodes and 2976 patients with AI during the years 1993-1998. Foreigners or visitors in the island were excluded to avoid their influence in the annual distribution. We corrected the absolute number of the aMI and AI cases by month and season in such a way that all months and seasons would have standard 30 and 90 days, respectively. RESULTS: During the entire period of the study, more patients with aMI were hospitalized in winter [30.7%, 95% confidence limits (CL) 28.1 to 33.3%]. In spring the percentage of aMI cases hospitalized was 24.5% (CL 22.1-27%), in summer 23.2% (CL 20.1-25.6%) and in autumn 21.6% (CL 19.2 -24%). There were 42.35% more cases hospitalized in winter than in autumn. The monthly distribution showed that March was the month with the most aMI cases (10.83%, CL 9.06-12.6% ) and October with the fewest (6%, CL 4.65-7.35%). The percentage of patients with AI hospitalized in winter was 30.5% (CL 28.8-32.2%), in spring 25.2% (23.6-26.7), in summer 23.5% (CL 22-25%) and in autumn 20.8% (CL 19.4-22.3%). The correlation coefficient (r) between the distribution of aMI and AI was 0.73 (P<0.01). CONCLUSIONS: Our results indicate that (1) there is a seasonal distribution in aMI with the winter being the season of the highest incidence of aMI and autumn of the lowest and (2) there is a significant correlation of the distribution of aMI to AI cases, which is of interest in the understanding of the pathogenesis of acute coronary syndromes.