Acute heart failure in non-cardiac surgery.

More than 64 million people worldwide have heart failure (HF), and these numbers are expected to rise. Acute HF (AHF) is the leading cause of hospitalization in patients over 65 years old and is linked to high mortality and readmission rates. AHF may also be a frequent complication in patients hospitalized for other medical reasons as well as after cardiac or non-cardiac surgery.

Prevalence, phenotypes, and long-term outcomes of cardiac complications after arterial vascular surgery.

Objective: The aim of this study was to i) determine the incidence and phenotypes of cardiac complications after arterial vascular surgery, ii) investigate possible heterogeneity, and iii) assess short- and long-term mortality and major adverse cardiac events (MACE) according to different phenotypes of these cardiac complications.

Design: Prospective diagnostic study with central adjudication METHODS: Consecutive high-risk patients (age >65 years or known cardiovascular disease) undergoing arterial vascular surgery were included between 2014 and 2019. Cardiac complications including perioperative myocardial infarction/injury (PMI) were centrally adjudicated by two independent physicians.

Prediction of hospital mortality in patients with left-sided infective endocarditis using a score in the first hours of admission.

Infective endocarditis is an infection of the endocardium, associated with high morbidity and mortality, particularly when the left heart chambers are involved. Timely diagnosis and appropriate intervention can attenuate these outcomes. The objective of this study was to create and validate the EndoPredict-Px score for early in-hospital mortality prediction in patients with left-sided infective endocarditis.

Robotic process automation to identify patients at high risk for perioperative myocardial infarction or injury: a prospective, blinded, paired reader-controlled single-centre study.

Background: Although current guidelines recommend active surveillance for perioperative myocardial infarction, injury, or both in high-risk patients, implementation remains limited in most institutions worldwide because of a lack of resources.

Methods: We hypothesised that robotic process automation (RPA), a software technology that enables virtual bots to replicate human tasks within digital systems, could accurately replace experienced clinical staff. Manual screening by experienced clinical staff and RPA screening were carried out simultaneously and blinded to identify high-risk patients eligible for active surveillance for myocardial infarction/injury, according to predefined screening criteria.

Clinical and Microbiology Predictors for Therapeutic Failure in Sternal Surgical Site Infections - A Retrospective Cohort Study.

Background: Although sternal surgical site infections (SSI) are an important complication after cardiac surgeries, predictors of treatment failure are poorly studied.

Objectives: The aim of this study is to assess the clinical and microbiology predictors of a sternal SSI therapeutic failure.

Methods: Patients who presented a sternal SSI were retrospectively analyzed.

Clinical implications of sex-specific upper reference limits for high-sensitivity cardiac troponin I in myocardial infarction diagnosis.

Introduction And Objectives: It is unclear whether applying sex-specific rather than uniform upper reference limits (URLs) for high-sensitivity cardiac troponin I (hs-cTnI) improves diagnostic equity between women and men with suspected myocardial infarction (MI). We compared the diagnostic performance of these 2 approaches.

Methods: In an international, prospective, multicenter study of patients presenting with suspected MI, the final diagnosis was centrally adjudicated twice by 2 independent cardiologists using all available information, including serial measurements of hs-cTnI-Architect, once using the uniform URL (26.

Possible Misdiagnosis of Myocardial Infarction Using Regulatory-Approved and Close-to-Bioequivalent Upper Limits of Normal for Cardiac Troponin.

Background: Possible misdiagnosis of acute myocardial infarction (AMI) may occur due to inappropriate upper limit of normal (ULN) for cardiac troponin and has the potential to harm patients. In this observational international multicenter study, we aimed to assess to what extent the novel hs-cTn-assays are affected.

Methods: A total of 6646 patients presenting with suspected AMI to the emergency department were enrolled.

Terminal renal failure as a contributor to high-sensitivity cardiac troponin T elevations: insights from patients undergoing renal transplantation.

Background: False cardiac troponin (cTn) elevations from non-cardiac causes are a major concern. We aimed to assess terminal renal failure as a possible non-cardiac cause of elevated high-sensitivity cTnT (hs-cTnT) concentrations using renal transplantation as an in vivo model of rapid restoration of renal function.

Methods: We analysed consecutive patients with end-stage renal disease (ESRD) undergoing renal transplantation at a single centre.

Early Diagnostic Prediction of Infective Endocarditis: Development and Validation of EndoPredict-Dx.

Background: Infective endocarditis is a life-threatening disease with diverse clinical presentations, making diagnosis challenging and requiring a range of complementary tests. The level of suspicion, based on clinical judgment, guides decisions regarding the initiation of empirical treatment and the selection of appropriate diagnostic tools. This study aimed to develop and validate the EndoPredict-Dx score for early prediction of infective endocarditis diagnosis.

Incremental value of C-reactive protein to the MEESSI acute heart failure risk score.

Aims: We hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) risk score, can be further improved by adding systemic inflammation as quantified by C-reactive protein (CRP).

Methods And Results: In a prospective multicentre diagnostic study (BASEL V), AHF was centrally adjudicated by two independent cardiologists. The MEESSI-AHF risk score was calculated using an established reduced and recalibrated model containing 12 independent risk factors.

Association of preoperative beta-blocker use and cardiac complications after major noncardiac surgery: a prospective cohort study.

Introduction: Cardiac complications after major noncardiac surgery are common and associated with high morbidity and mortality. How preoperative use of beta-blockers may impact perioperative cardiac complications remains unclear.

Methods: In a multicentre prospective cohort study, preoperative beta-blocker use was ascertained in consecutive patients at elevated cardiovascular risk undergoing major noncardiac surgery.

Prognostic value of perioperative high sensitivity troponin in patients undergoing hip and knee arthroplasty.

The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery.

Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades.

Background: Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition.

Methods: Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male.

The Predictive Value of Sepsis Scores for In-Hospital Mortality in Patients with Left-Sided Infective Endocarditis.

Background: As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis.

Methods: Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as "possible" or "definite" endocarditis, according to the Modified Duke Criteria.

Combining glucose and high-sensitivity cardiac troponin in the early diagnosis of acute myocardial infarction.

Glucose is a universally available inexpensive biomarker, which is increased as part of the physiological stress response to acute myocardial infarction (AMI) and may therefore help in its early diagnosis. To test this hypothesis, glucose, high-sensitivity cardiac troponin (hs-cTn) T, and hs-cTnI were measured in consecutive patients presenting with acute chest discomfort to the emergency department (ED) and enrolled in a large international diagnostic study (NCT00470587). Two independent cardiologists centrally adjudicated the final diagnosis using all clinical data, including serial hs-cTnT measurements, cardiac imaging and clinical follow-up.

Prediction of perioperative myocardial infarction/injury in high-risk patients after noncardiac surgery.

Aims: Perioperative myocardial infarction/injury (PMI) is a surprisingly common yet difficult-to-predict cardiac complication in patients undergoing noncardiac surgery. We aimed to assess the incremental value of preoperative cardiac troponin (cTn) concentration in the prediction of PMI.

Methods And Results: Among prospectively recruited patients at high cardiovascular risk (age ≥65 years or ≥45 years with preexisting cardiovascular disease), PMI was defined as an absolute increase in high-sensitivity cTnT (hs-cTnT) concentration of ≥14 ng/L (the 99th percentile) above the preoperative concentration.

Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome.

Aims: The utility of clinical risk scores regarding the prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgement (ICJ) of the treating emergency department (ED) physician.

Methods And Results: Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicentre study.

Implementing screening for myocardial injury in non-cardiac surgery: perspectives of an ad-hoc interdisciplinary expert group.

. Perioperative myocardial injury (PMI) is increasingly recognised as an important complication of non-cardiac surgery, with often clinically silent presentation, but detrimental prognosis. Active screening for PMI, involving the detection of dynamic and elevated levels of cardiac troponin, has recently been advocated by an increasing number of guidelines; however, active PMI screening has not been reflected in clinical practice.