Rapid 8-Zone Lung Ultrasound Protocol is Comparable to a Full 12-Zone Protocol for Outcome Prediction in Hospitalized COVID-19 Patients.

OBJECTIVES: Safety precautions limit the clinical assessment of hospitalized Coronavirus disease 2019 (COVID-19) patients. The minimal exposure required to perform lung ultrasound (LUS) paired with its high accuracy, reproducibility, and availability make it an attractive solution for initial assessment of COVID-19 patients. We aim to evaluate whether the association between sonographic findings and clinical outcomes among COVID 19 patients is comparable between the validated 12-zone protocol and a shorter, 8-zone protocol, in which the posterior lung regions are omitted. METHODS: One hundred and one COVID-19 patients hospitalized in a dedicated COVID-19 ward in a tertiary referral hospital were examined upon admission and scored by 2 LUS protocols. The association between the scores and a composite outcome consisting of death, transfer to the intensive care unit (ICU) or initiation of invasive or noninvasive mechanical ventilation was estimated and compared. RESULTS: LUS scores in both the 8- and the 12-zone protocols were associated with the composite outcome during hospitalization (hazard ratio [HR] 1.21 [1.03-1.42, P = .022] and HR 1.13 [1.01-1.27, P = .037], respectively). The observed difference in the discriminatory ROC-AUC values for the 8- and 12-zone scores was not significant (0.767 and 0.754 [P = .647], respectively). CONCLUSION: A short 8-zone LUS protocol is as accurate as the previously validated, 12-zone protocol for prognostication of clinical deterioration in nonventilated COVID-19 patients.

Myocardial preservation methods in isolated minimal invasive mitral valve surgery: Society of Thoracic Surgeons (STS) database outcomes.

OBJECTIVE: Minimal invasive mitral valve surgery (MIMVS) has become a commonly used approach for mitral valve surgery. Several techniques of myocardial preservation were described in patients undergoing MIMVS. We aim to evaluate preservation technique and short term outcomes. METHODS: A retrospective analysis of patients who underwent isolated MIMVS and were included in the Society of Thoracic Surgeons (STS) database. RESULTS: The final cohort included 4976 patients. Mean age was 63.1 years (SD, 12.5) and 42.6% were females. Antegrade delivery method (71.3% of the patients) was the most common, follow by antergrade/retrograde (19.9%). Blood, crystalloid solution, and combination of blood-crystalloid were used in 62.4%, 13.2%, and 13.7%, respectively. In multivariate analysis, cardioplegia technique was associated with mortality (P = .011), pleural effusion (P = .045), and length of ICU stay (P < .001). Antegrade-crystalloid (OR, 3.37; 95%CI, 1.70-6.68) and antegrade/retrograde-blood/crystalloid (OR, 3.28; 95%CI, 1.15-9.38) were associated with increased risk for mortality compared with antegrade-blood cardioplegia. Data on postoperative ejection fraction (EF), CPK-MB, and Troponin was available only in 30%, 9%, and 5% of the patients, respectively, and were not included in the analysis. CONCLUSIONS: Ante-grade-blood was the most common preservation technique in MIMVS. Ante-grade-crystalloid and ante-grade/retrograde-blood/crystalloid are associated with increased risk for mortality. The results suggest that using crystalloid solutions for cardioplegia should be carefully considered. The STS database as a source for MIMVS outcome analysis is lacking, both in detailed specification of different surgical technique aspects, and in actual data collection of already existing categories.

Hematological Biomarkers, Mortality, Transfusion and Acute Heart Disease.

BACKGROUND: Patients hospitalized with acute heart disease [acute myocardial infarction (MI); heart disease exacerbation] may require red blood cell (RBC) transfusion. These patients are at increased risk for morbidity and mortality. Hematological biomarkers may help to identify increased mortality risk. The aim of the study was to evaluate the association between hematological biomarkers and survival in these patients. METHODS: A historical cohort study of all patients admitted to an internal medicine department, who were diagnosed with acute heart disease and requiring RBC transfusion, was carried out in a tertiary medical center between 2009-2014. The association between hematological biomarkers and 30-, 90-day and 5-year mortality was studied. RESULTS: A total of 254 patients (median age 80 years, IQR 74-86.25; 40.9% females; acute MI 24.8%), were included. During the 5-year follow-up 212(83.5%) patients died. In a multivariate analysis the lower platelet to neutrophil ratio (PNR) was significantly associated with increased 30-, 90-day and 5-year mortality (p<0.001, 0.041, 0.003 respectively). A higher red cell distribution width (RDW) was significantly associated with 30- and 90-day mortality (p=0.003, 0.023 respectively), while higher neutrophil to lymphocyte ratio (NLR) was associated with increased 30-day and 5-year mortality (p= 0.036, 0.033 respectively). CONCLUSIONS: Hematological biomarkers may help to identify increased mortality risk of acute heart disease patients, receiving RBC transfusions in an internal medicine department.

Family history of coronary artery disease and adverse clinical outcomes in patients suffering from acute ST-segment elevation myocardial infarction.

BACKGROUND: A positive family history (FHx+) of coronary artery disease (CAD) is a well-known risk factor for the development of coronary pathology in first-degree relatives. We sought to evaluate the association between FHx+ of CAD and clinical outcomes in patients presenting with a first ST-elevation myocardial infarction (STEMI). PATIENTS AND METHODS: A historical cohort study of all patients with a first STEMI, who were admitted to cardiac ICU between 2007 and 2016, was carried out. Univariate and multivariate analyses were carried out to compare patients with or without a FHx+ of CAD. In further analysis, propensity score matching was used to reduce differences in baseline characteristics. RESULTS: The study included 1785 patients, 365 (20%) of whom had FHx+ of CAD. FHx+ was associated with decreased in-hospital major adverse events and long-term mortality rates (hazard ratio=0.208, 95% confidence interval: 0.051-0.857; P=0.03). After propensity score matching, patients with FHx+ had decreased long-term mortality rates (hazard ratio=0.105, 95% confidence interval: 0.033-0.33; P<0.001). CONCLUSION: In this large cohort of patients with STEMI, FHx+ was associated with better short-term and long-term outcomes. Understanding the rule of FHx in patients with STEMI is important to evaluate the prognosis and may help to construct a prediction model for patients admitted to cardiac ICU.