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Objective: While the disease course of stress-induced cardiomyopathy (SIC) is usually benign, it can be fatal in some cases. The prognostic factors to predict poorer outcome are not well established, however. We analyzed the Acute Physiology And Chronic Health Evaluation (APACHE) II score to assess its value for predicting poor prognosis in patients with SIC. Method: Thirty-seven consecutive patients with SIC were followed prospectively during their hospitalization. Clinical factors, including APACHE II score, coronary angiogram, echocardiography and cardiac enzymes at presentation were analyzed. Result: Of the 37 patients, 27 patients (73%) were women. The mean age was 66.1 ± 15.6 years, and the most common presentation was chest pain (38%). Initial echocardiographic left ventricular ejection fraction (EF) was 42.5 ± 9.3%, and the wall motion score index (WMSI) was 1.9 ± 0.3. Six patients (16%) expired during the follow-up period of hospitalization. Based on the analysis of characteristics and clinical factors, the only predictable variable in prognosis was APACHE II score. According to ROC curve by this result, we divided patients into two groups (APACHE II score > 20, and ≤20). The patients with APACHE II score greater than 20 had tendency to expire than the others (P = 0.001). Conclusion: Based on present study, APACHE II score more than 20, rather than cardiac function, was associated with mortality in patients with SIC.

IntroductionSignificant paravalvular leak (PVL) is estimated to occur in at least 1–2% of patients undergoing surgical aortic and/or mitral valve replacement, and 3–4% of patients undergoing percutaneous aortic valve replacement (TAVR). Surgery for repair of PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL has emerged as an alternative to surgical repair.MethodsUsing a prospective registry, we sought to examine the clinical outcomes of patients treated with percutaneous closure of PVL at a tertiary referral hospital in Ireland.ResultsA total of 21 patients (mean age 68 ±13 years, 76% male) were treated for PVL. Heart failure (HF) and haemolysis (HL) were the presenting symptoms in 62% and 24% of patients, respectively. The remaining 14% of patients presented with both HF and HL. Of the 21 prosthetic valves treated, 9 were in the mitral position, and 12 were in the aortic position. A total of 26 PVL procedures were performed in the 21 patients (mean of 1.2 procedures/patient). The mean number of plugs used per patients was 1.9 (range 0–4). There was one (3.8%) major adverse procedural complication (stroke) and two minor (7.7%) procedural complications (both vascular access complication treated with endovascular techniques). Among patients with HF as the presenting symptom (n=16), the mean NYHA class before and after percutaneous PVL closure was 2.6 ±0.62 versus 1.5 ± 0.63. None of these patients have required repeat surgery over a median follow-up of 20 months (IQR 9.5–32). Among patients with HL, clinical success was achieved in 2 of 5 patients (40%). A total of 6 deaths (28%) occurred in the patient cohort over a mean follow-up of 22 ±13.4 months. Thirty-day mortality was 0%. Figure 1 shows the Kaplan Meier Estimate of survival.ConclusionsPatients with PVL represent a high-risk patient cohort. Percutaneous PVL offers a safe alternative to surgical PVL repair, and appears particularly effective in those patients who present primarily with HF as their presenting symptom.[Figure]

Objective: Compare plasma concentrations of BNP in children with congenital cardiac defects causing left to right shunt with that of normal healthy children. And to correlate patients levels with echocardiographic and catheterization hemodynamic data. Method: Prospective case controlled short-term follow up study done over 2 years. All patients with left-to-right shunt undergoing cardiac catheterization were included in the study. All the studied groups (58 cases & 48 healthy controls) had full clinical examination and full echocardiographic study. For patients with cardiac defect, cardiac catheterization for hemodynamic study was done. Device occlusion of the defect was carried out for suitable cases. BNP was measured in all the studied groups and also three months post catheterization in cases with defect occlusion. Result: The mean BNP level was significantly higher (p value= 0.006) in our study patients (34.9Â ± 12.5 pg/ml) compared to that of the control group (9.85 ± 6.67 pg/ml). Girls in the pre-pubertal period (> 10 years) had a significant higher BNP levels than boys both in patients (50.5Â ± 8.4 pg/ml in girls versus 33.2Â ± 6.3pg/ml in boys) and in controls (14.6Â ± 4.7 versus 9.1Â ± 6.1 pg/ml) with P value (0.01 and 0.04 respectively). BNP levels in PDA & VSD patients were positively correlated with the z-score of echocardiographic left ventricle end diastolic dimension with P value 0.01 and 0.001 respectively. BNP levels were positively correlated with the volume overload represented by the (Qp/Qs) with P value 0.001 in VSD & PDA and 0.034 in ASD patients. In patients with successful defect occlusion, mean BNP levels decreased significantly after follow-up period of three months when correlated to the pre-catheterization data (32.9 versus 16.7 in PDA, 34.1 versus 17.5 in VSD and 30.8 versus 14.8 in ASD patients) with P value < 0.01 each, however the follow-up measurements were still significantly higher than the mean control level. Conclusion: BNP measurement is a good indicator for evaluating volume overload cardiac defect and further studies regarding BNP level correlation with pressure overload or other hemodynamics derangements in congenital heart disease are required.