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Mitral stenosis is classically caused by rheumatic disease (RMS). However, degenerative mitral stenosis (DMS) is increasingly encountered, particularly in developed countries with aging populations. The aim of this study was to compare clinical and echocardiographic characteristics between the 2 entities. One hundred fifteen patients with DMS were identified from an echocardiographic database in the United States and compared with 510 patients with RMS from Seoul, Korea. All subjects had a mitral valve area (MVA) ≤2.5 cm2 by continuity equation but were otherwise unselected. Patients with DMS were older and had more hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease than those with RMS. Atrial fibrillation was more common in RMS patients. Mean mitral valve gradient was slightly lower in DMS versus RMS (7.63 ± 3.67 vs 8.50 ± 4.23 mm Hg, p = 0.04) but MVA was strikingly higher in the DMS group (1.35 ± 0.41 vs 0.95 ± 0.38 cm2, p less then 0.0001). This appeared to be due to greater stroke volume in the DMS patients (70.4 ± 19.7 vs 55.7 ± 15.5 ml, p less then 0.0001). read more Indexed left atrial volume was greater in RMS (82.1 ± 40.3 vs 57.9 ± 21.4 ml, p less then 0.0001) while estimated pulmonary artery systolic pressure was greater in DMS (49.3 ± 16.5 vs 39.4 ± 13.6 mm Hg, p less then 0.0001). In conclusion, DMS patients are older and have more comorbidities than RMS patients. DMS presents with greater MVA relative to mean mitral valve gradient than RMS. This appears due to a higher stroke volume in DMS patients. The outcome of transfemoral transcatheter aortic valve implantation (TF-TAVI) with a self-expanding (SEP) versus a balloon-expandable prosthesis (BEP) in patients with a reduced ejection fraction (rEF, ≤40%) has not been previously investigated. Patients with rEF have an increased risk of death after TF-TAVI compared to patients with a preserved ejection fraction (pEF), and prosthesis choice might influence the outcome of these patients. We, therefore, sought to compare all-cause mortality of patients with rEF using a SEP versus a BEP. We retrospectively analyzed data of 679 single-center TF-TAVI patients. Patients were censored at death or completion of 1-year follow-up, whichever occurred first. Patients with rEF (n = 141, 21%) had an increased 1-year mortality compared to patients with pEF (28% vs 19%, p = 0.007). SEP were implanted in 149 patients (49 with rEF, 33%), while BEP were implanted in 530 patients (92 with rEF, 17%). In patients with pEF, 1-year mortality was similar after SEP- and BEP-implantation (16% vs 19%, p = 0.516). In patients with rEF, however, 1-year mortality was higher after SEP- than after BEP-implantation (43% vs 21%, p = 0.004). These patients had a higher incidence of new permanent pacemaker implantation (26.5% vs 13%, p = 0.046) and paravalvular leak ≥II° (21% vs 10%, p = 0.07), but both factors could not explain the excess mortality after SEP-implantation in the multivariate analysis. In patients with rEF, the use of a SEP was an independent predictor of 1-year mortality (HR 2.44, 95% CI 1.27 to 4.27, p = 0.007). In conclusion, patients with rEF had a higher 1-year mortality after TF-TAVI when a SEP instead of a BEP was used. Many echocardiographic measures have been proposed as potential predictors of outcome following ST-elevation myocardial infarction (STEMI). We hypothesized that combining multiple echocardiographic measures in a risk model provides more prognostic information than individual echocardiographic measures. We prospectively included 373 STEMI patients which constituted our derivation cohort. We also identified 298 STEMI patients from a clinical registry that constituted our validation cohort. Echocardiogram was performed at a median of 2 days after infarction. The echocardiogram consisted of conventional and advanced measures. The end point was a composite of heart failure and/or cardiovascular death. During a median follow-up of 5.4 years, we observed 80 events in our derivation cohort. A stepwise backward Cox regression including all echocardiographic parameters identified global longitudinal strain, wall motion score index (WMSI), E/e', and E/global strain rate e (E/GLSRe) as significant predictors of outcome. A Classification and Regression Tree analysis outlined a risk model with WMSI, GLSRe, and E/e' as key echocardiographic parameters. Patients with WMSI ≥ 2.22 were at high risk, patients with WMSI less then 2.22, GLSRe less then 0.82s-1 and E/e'≥7.6 at intermediate risk, and patients with WMSI less then 2.22 and GLSRe ≥ 0.82s-1 or GLSRe less then 0.82s-1 and E/e' less then 7.6 at low risk of heart failure and/or cardiovascular death. When compared with the low-risk group, an incremental risk was observed (intermediate group HR = 2.52 [1.24;5.11], p = 0.011; high-risk group HR = 4.37 [1.40;13.66], p = 0.011). The risk model was validated in the validation cohort (C-statistic 0.71). In conclusion, we devised an echocardiographic risk model for STEMI patients suggesting advanced and conventional measures of systolic function and filling pressures to be important for the prognosis. BACKGROUND High-flow, heated, and humidified nasal oxygen therapy (HFNO) is frequently used in critical care and perioperative settings for a range of clinical applications. Much of the benefit of HFNO is attributed to generation of modest levels of positive airway pressure. Concern has been raised that this positive airway pressure may cause gastric insufflation, potentially increasing the risk of regurgitation and aspiration in an unprotected airway. METHODS A prospective, interventional, assessor-blinded study was undertaken to evaluate the effects of HFNO on gastric content and gastric distension in healthy fasted adult volunteers assessed by ultrasonography. The primary outcome was the volume of gastric secretions. The secondary outcomes were the incidence of gastric air insufflation and the distribution of gastric antral grades. RESULTS Sixty subjects were enrolled. No subject was found to have air gastric distension either at baseline or after treatment with HFNO. All subjects had either a Grade 0 or Grade 1 antrum, with similar distribution of antral grades and similar volume of gastric secretions before and after treatment with HFNO.
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