RESUMO
The prognostic value of pulmonary hypertension (PH) estimated by echocardiography in unselected patients with acute decompensated heart failure (ADHF) is poorly studied. Between November 2014 and September 2018, 657 patients were recruited in a prospective registry of ADHF (ClinicalTrials.gov NCT02444416). The probability of pulmonary hypertension was based on European Society of Cardiology (ESC) guidelines for echocardiographic evaluation. The median survival without all-cause mortality or readmission was 7 months. During the median follow-up period of 15 months, there were 450 events including 185 deaths. In multivariate analysis, the hazard ratio (HR) of all-cause mortality or readmission for patients with a high probability of PH was 1.67 (95% CI 1.29-2.17, p < 0.001) as compared to patients with a low or intermediate probability. The left ventricular ejection fraction (LVEF) and right ventricular function (RVF) were not associated with the primary outcome-HR 1.02 (95% CI 0.81-1.29; p = 0.84) and 0.96 (95% CI 0.76-1.23; p = 0.77) respectively. In patients admitted for ADHF, a high probability of PH as evaluated by echocardiography provided the highest independent prognostic value for mortality and readmission, whereas LVEF and RVF were not associated with prognosis. The identification of patients at high risk of PH by non-invasive measurement conveys important prognostic information and may guide management.
RESUMO
Sudden death of young athletes is often the first clinical manifestation of underlying cardiac pathology. It is defined as an unexpected natural, non traumatic and non iatrogenic event. International screening policies and recommendations to avoid sudden cardiac death vary considerably. Certain studies suggest a benefit from systematic screening of young adults (1235 years old) engaging in sports. We chose to evaluate the current approach to screening for lethal pathologies in athletes in Geneva, as well as the interest of introducing a standard screening procedure in the future. In line with the current position of the European Society of Cardiology and Swiss recommendations, a majority of the selected physicians advocate a history, physical exam and 12-lead ECG to screen athletes.
La mort subite du jeune sportif représente souvent la première manifestation clinique d'une pathologie cardiaque sous-jacente. Elle est définie comme un événement naturel, non traumatique, non iatrogène, et inattendu. Les pratiques en matière de prévention et de consignes pour la prise en charge de la santé des sportifs varient de pays en pays, sans réel consensus. Certaines études suggèrent un bénéfice d'un dépistage systématique sur la prévention des morts subites des jeunes athlètes (1235 ans), en incluant notamment rigoureusement l'ECG. Nous avons voulu évaluer l'état des lieux à Genève sur la prévention et les pratiques dans ce domaine au niveau des organisations sportives ainsi que chez les médecins concernés. En accord avec les recommandations européennes et suisses, la majorité de l'échantillon des médecins préconisent une anamnèse ciblée, examen clinique et ECG.
