The latest medical research on Intensive Care Medicine

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This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability.

We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics.

Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), -3.89, 95% CI -6.14, -1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: -3.33, 95% CI -4.71, -1.95, P < .001.

LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

Apical hypertrophic cardiomyopathy (ApHCM) and apical displacement of papillary muscles (ADPM) are two different pathologies with a number of simil...

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Regular physical activity is associated with cardiovascular health; however, intensive exercise can have harmful effects on the heart. Two-dimensional (2D) speckle tracking echocardiography (STE) is a well-established diagnostic tool to evaluate subclinical myocardial dysfunction and has been widely used in athletes in recent years. This study is designed to evaluate whether low-intensity exercise has beneficial effects on myocardial performance. We aimed to evaluate systolic and diastolic functions of myocardium derived from STE in sports practitioners in a low-intensity exercise training program.

Eighty-four sports practitioners and eighty-two sedentary healthy controls were prospectively included in our study. In addition to standard 2D echocardiographic measurements, left ventricular (LV) global longitudinal strain (GLS), right ventricular (RV) GLS, RV-free wall strain (FWS), left atrium (LA) strain, and strain rate were analyzed.

Mean LV GLS was significantly higher in sports practitioners compared with sedentary population (-19.21 ± 2.61% vs -18.37 ± 2.75%, P = .044). RV GLS was significantly higher in sports practitioners than sedentary population (-21.82 ± 4.86% vs -20.04 ± 4.62%, P = .016). Longitudinal strain and strain rate of LA conduit phase were significantly higher in sports practitioners than sedentary participants (-23.60 ± 6.83% vs -20.20 ± 6.64%, P = .001; -2.45 ± 0.81 L/s vs -2.10 ± 0.89 L/s, P = .010; respectively). Also, LA conduit phase strain/contraction phase strain and conduit phase strain rate/contraction phase strain rate ratios were higher in sports practitioners (1.88 ± 0.93 vs 1.48 ± 0.63, P = .001; 1.42 ± 0.65 vs 1.16 ± 0.53, P = .005; respectively).

The findings in the current study suggest that regular low-intensity exercise may have a beneficial effect on both systolic and diastolic functions of the myocardium.

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Although several echocardiographic parameters have different values according to sex, there are no studies in echocardiographic variables of aortic stenosis (AS) severity. Our aim was to evaluate the sex-related prognosis of several echocardiographic parameters in AS.

Two hundred and twenty-five patients with at least moderate AS (effective orifice area [EOA] ≤ 1.50 cm2 ) were prospectively enrolled. EOA was normalized to body surface area (BSA), height, and body mass index (BMI). Receiver operating characteristic curves, in women and men separately, were plotted to determine the best cutoff value for predicting cardiovascular death.

The largest area under the curve (AUC) to predict cardiovascular death was EOA in men (AUC 0.74, P < .001) and EOA/height in women (AUC 0.81, P < .001). An EOA/height cutoff value of 0.55 cm2 /m in women had a sensitivity of 100% and specificity of 61%; a cutoff of 0.50 cm2 /m in men obtained a sensitivity of 92% and a specificity of 56%. During a mean follow-up of 247 ± 183 days, there were 33 cardiovascular deaths. Women with EOA/height ≤ 0.55 cm2 /m had higher cardiovascular mortality (22% vs 0%, P < .001) and men with EOA/height ≤ 0.50 cm2 /m (21% vs 2%, P < .001). One-year survival in women with EOA/height ≤ 0.55 cm2 /m was 67 ± 8% and 100 ± 0% in EOA/height > 0.55 cm2 /m (P < .001). In men, 1-year survival was 70 ± 8% in EOA/height ≤ 0.50 cm2 /m, and 93 ± 6% in EOA/height > 0.50 cm2 /m (P = .004).

Normalization of EOA is useful in AS, especially in women. We recommend using an EOA/height cutoff value of 0.55 cm2 /m in women, and 0.50 cm2 /m in men to identify a subgroup with higher cardiovascular risk.

A 35-year-old man with history of recurrent arrhythmias presented for pulmonary vein isolation. He underwent pre-procedural screening for thromboem...

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Studies suggest cardiac time intervals to be associated with cardiac ischemia. A novel method to assess cardiac time intervals by tissue Doppler echocardiography has been proposed. Cardiac time intervals can assess the myocardial performance index (MPI), which quantifies the proportion of time spent contributing effective myocardial work. We hypothesized that MPI associates with coronary artery lesions detected by cardiac computed tomography (CT) in patients suspected of coronary artery disease (CAD).

We investigated patients referred for cardiac CT under suspicion of CAD who had an echocardiogram performed. Curved m-mode tissue Doppler imaging was used to measure cardiac time intervals and MPI. The outcome was coronary artery lesions, defined as a calcium score > 400 and/or coronary artery stenosis (>70% luminal narrowing). Logistic regression was applied with multivariable models including: (a) SCORE chart risk factors and (b) SCORE chart risk factors, body mass index, dyslipidemia, familial history of CAD, diabetes mellitus, LVEF, and left ventricular mass index.

Of 404 patients, 41 (10%) had a coronary artery lesion. Overall, 42% were male, mean age was 58 years, and LVEF was 58%. Patients with coronary artery lesions exhibited higher MPI than those without (0.52 vs. 0.44, P < .001). MPI associated with coronary artery lesions in unadjusted analyses (OR = 1.69 [1.30-2.19], per 0.1 increase), and this association persisted when adjusted for SCORE chart risk factors (OR = 1.55 [1.16-2.07], P = .003, per 0.1 increase), and additional risk factors (OR = 1.64 [1.11-2.41], P = .013, per 0.1 increase).

Curved m-mode-derived MPI is associated with coronary artery lesions detected by cardiac CT in suspected CAD patients.

Shone's syndrome is a rare congenital heart disease that includes 4 cardiovascular anomalies: supravalvular mitral ring, parachute mitral valve, su...

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Aberrant lung remodeling in idiopathic pulmonary fibrosis (IPF) is characterized by elevated MMP9 expression but the precise role of this matrix metalloproteinase in this disease has yet to be fully elucidated.

Quantitative genomic, proteomic, and functional analyses both in vitro and in vivo were used to determine MMP9 expression in IPF cells and the effects of MMP9 inhibition on profibrotic mechanisms.

In the present study, we demonstrate that MMP9 expression was increased in airway basal-like cells (ABC-like) from IPF lungs compared with ABC cells from normal lungs. Inhibition of MMP9 activity with an anti-MMP9 antibody, andecaliximab blocked TGF-β1-induced Smad2 phosphorylation. However, in a subset of IPF patients, TGF-β1 activation in their ABC-like cells was unaffected or enhanced by MMP9 blockade (i.e. Non-Responders). Further analysis of Non-Responder ABC-like cells treated with andecaliximab revealed an association with the expression of type 1 IFN expression, and the addition of IFNα to these cells modulated both MMP9 expression and TGF-β1 activation. Finally, inhibition of MMP9 ameliorated pulmonary fibrosis induced by Responder lung cells, but not a Non-Responder in a humanized immunodeficient mouse model of IPF.

Together, these data demonstrate that MMP9 regulates the activation of ABC-like cells in IPF and targeting this MMP might be beneficial to a subset of IPF patients who show sufficient expression of type 1 IFNs.

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Glucagon-like peptide-1 receptor (GLP-1R) agonists are approved to treat type 2 diabetes mellitus and obesity. GLP-1R agonists reduce airway inflammation and hyperresponsiveness in preclinical models.

To compare rates of asthma exacerbations and symptoms between type 2 diabetic adults with asthma prescribed GLP-1R agonists and those prescribed sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, sulfonylureas or basal insulin for diabetes treatment intensification.

Electronic health records-based new-user, active comparator, retrospective cohort study of patients with type 2 diabetes and asthma newly prescribed GLP-1R agonists or comparator drugs, January 2000-March 2018. Primary outcome was asthma exacerbations; secondary outcome was encounters for asthma symptoms. Propensity scores were calculated for GLP-1R agonist and non-GLP-1R agonist use. Zero-inflated Poisson regression models included adjustment for multiple covariates.

Patients initiating GLP-1R agonists (n=448), SGLT-2 inhibitors (n=112), DPP-4 inhibitors (n=435), sulfonylureas (n=2,253) or basal insulin (n=2,692), were identified. At six months, asthma exacerbation counts were lower in persons initiating GLP-1R agonists (reference) compared to SGLT-2 inhibitors (incidence rate ratio [IRR], 2.98 [95% CI, 1.30 to 6.80]), DPP-4 inhibitors (IRR, 2.45 [95% CI, 1.54 to 3.89]), sulfonylureas (IRR, 1.83 [95% CI, 1.20 to 2.77]) and basal insulin (IRR, 2.58 [95% CI, 1.72 to 3.88]). Encounters for asthma symptoms were also lower among GLP-1R agonist users.

Adult asthmatics prescribed GLP-1R agonists for type 2 diabetes had lower counts of asthma exacerbations compared to other drugs initiated for treatment intensification. GLP-1R agonists may represent a novel treatment for asthma associated with metabolic dysfunction.

Monitoring intra-abdominal pressure (IAP) has become a standard in intensive care units. Correlation between the abdominal wall's thickness (AWTh) ...

We test whether a measure based on the directed transfer function (DTF) calculated from short segments of electroencephalography (EEG) time-series ...

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While numerous investigations have described worse outcomes for patients undergoing emergent procedures at night, few studies have investigated the impact of nighttime on the outcomes of emergent endotracheal intubation (EEI). We hypothesized that for patients requiring EEI at night, the outcome of first pass success would be lower as compared to during the day.

We performed a retrospective cohort study of all patients admitted to our institution between January 1st, 2016 and July 17st, 2019 who underwent EEI outside of an emergency department or operating room. Nighttime was defined as between 7:00 pm and 6:59 am. The primary outcome was the rate of first pass success. Logistic regression was utilized with adjustment for demographic, morbidity and procedure related covariables.

The final examined cohort included 1,674 EEI during the day and 1,229 EEI at night. The unadjusted rate of first pass success was not different between the day and night (77.5% vs. 74.6%, unadjusted odds ratio (OR): 0.85; 95% confidence interval (CI): 0.72, 1.0; P = 0.073 though following adjustment for prespecified covariables the odds of first pass success was lower at night (adjusted OR: 0.83, 95% CI: 0.69, 0.99; P = 0.042. Obesity was found to be an effect modifier on first pass success rate for day vs. night intubations. In obese patients, nighttime intubations had significantly lower odds of first pass success (adjusted OR: 0.71, 95% CI: 0.52, 0.98; P = 0.037).

After adjustment for patient and procedure related factors, we have found that the odds of first pass success is lower at night as compared to the day. This finding was, to some degree, driven by obesity which was found to be a significant effect modifier in this relationship.

The latest medical research on Intensive Care Medicine

Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta-analysis.

Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view.

The beneficial effect of low-intensity exercise on cardiac performance assessed by two-dimensional speckle tracking echocardiography.

Outcome implication of sex-related effective orifice area normalized to body size in aortic stenosis.

The proof is in the appendage: A case report of a fenestrated membrane overlying the left atrial appendage.

Myocardial performance index is associated with cardiac computed tomography findings in patients with suspected coronary artery disease.

Echocardiographic diagnosis of Shone's syndrome.

Differential Responses to Targeting Matrix Metalloproteinase 9 in Idiopathic Pulmonary Fibrosis.

Asthma Exacerbations in Type 2 Diabetics with Asthma on Glucagon-like Peptide-1 Receptor Agonists.

Non-invasive indirect monitoring of intra-abdominal pressure using microwave reflectometry: system design and proof-of-concept clinical trial.

Validation of a new approach for distinguishing anesthetized from awake state in patients using directed transfer function applied to raw EEG.

The Impact of Nighttime on First Pass Success During the Emergent Endotracheal Intubation of Critically Ill Patients.

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