Alcohol is a major cause of hepatocellular carcinoma (HCC), accounting for 30
New-onset atrial fibrillation (NOAF) frequently complicates septic shock and is associated with haemodynamic instability, prolonged intensive care unit stay, and increased mortality. Despite its clinical relevance, guidance on heart rate (HR) management remains limited, particularly regarding the use of ultra-short-acting β₁-blockers. To reduce variability in clinical practice, a European multidisciplinary panel developed a consensus on the management of atrial fibrillation in septic shock, with a focus on landiolol. A modified RAND/UCLA Delphi methodology was applied. Nine European experts in intensive care, anaesthesiology, and cardiology participated in two Delphi rounds. Fifty-five statements across nine thematic areas were evaluated using a 9-point Likert scale. Consensus was predefined as ≥ 80
Introduction End-stage hypertrophic cardiomyopathy (HCM) is a distinct and advanced form of the disease, defined by a left ventricular ejection fraction (LVEF)<50% and associated with a markedly poor prognosis. Cardiovascular magnetic resonance (CMR) has become a key imaging tool, particularly for assessing myocardial fibrosis through late gadolinium enhancement (LGE), a known prognostic marker in earlier stages of HCM. However, evidence on the prognostic relevance of LGE presence and distribution in end-stage HCM remains limited. Objective To evaluate the prognostic value of the “LGE granularity” concept including its extent, location and pattern in end-stage HCM with LVEF<50%. Method All patients referred for CMR assessment of HCM at three French tertiary centers between 2008 and 2024 were retrospectively screened and all patients with HCM confirmed and a LVEF value<50% were included. The concept of “LGE granularity” was defined as a model combining LGE extent (>3 segments), location (septal), and pattern (subepicardial and/or midwall). The primary endpoint was all-cause mortality, obtained from the French National Death Registry. Univariable and multivariable Cox proportional hazards models were used to assess the prognostic value of LGE features. Results Among 2,875 patients with HCM, 691 (53±7 years, 54% male) had a LVEF<50% and were included in the study. After a median follow-up of 8.5 years (IQR 5.9–11.0), 226 patients died (32%). Using CMR, the presence of LGE was detected in 259 patients (37%) and was strongly associated with mortality ((HR 3.37, 95% CI 2.57–4.42, p<0.001, Figure 1), and remained significant after adjustment for known prognostic factors, including LVEF (HR 1.47, 95% CI 1.01–2.04, p=0.047). Each component of the LGE granularity model were all independently associated with mortality after adjustment: LGE extent (HR 1.70, 95% CI 1.11–2.61), midwall pattern (HR 3.97, 95% CI 1.72–9.14), and septal location (HR 1.77, 95% CI 1.13–2.78, and all p<0.001) (Figure 2a, b and c). Conclusion In a large HCM cohort of end-stage HCM, LGE emerged as a strong and independent predictor of all – cause mortality. Moreover, among LGE – positive patients, the individual components of the “LGE granularity” concept were all associated with adverse prognosis.
BK polyomavirus (BKPyV) persists in the renourinary tract of most adults and can replicate under immunosuppression. In kidney transplant recipients (KTR), it may cause BKPyV-associated nephropathy (BKPyVAN), while in hematopoietic stem cell transplant recipients (HSCT), it is more often linked to hemorrhagic cystitis (HC). These clinical differences are generally attributed to the type of graft and immunosuppressive regimen. However, viral factors such as genotype or mutations might also influence tissue tropism and pathogenesis. This study aimed to compare the virological features of BKPyV between KTR and HSCT recipients and to explore possible associations with clinical manifestations. This retrospective study included 101 transplanted patients (66 KTR, 35 HSCT) at Amiens-Picardie University Hospital (France) between 2019 and 2023, with at least one episode of BKPyV DNAuria during post-allograft follow-up. Viral genotyping was performed by Sanger sequencing, while NGS (Next-generation Sequencing) provided complete coding genome sequences for 51 patients. Genotype distribution was similar in both groups, with Ib2 as the most frequent subtype. No genotype or mutation was associated with a specific graft type or complication, except for the small t antigen gene, which appeared to be more frequently mutated in KTRs. Viral replication occurred earlier and at higher levels in HSCT patients (mean peak DNAuria: 9.3 log10 vs 7.4 log10 copies/mL in KTR; p < 0.0001). In KTRs, patients with presumptive BKPyVAN were significantly older than those with asymptomatic replication. These findings suggest that viral genetic determinants play a lesser role in BKPyV replication and its clinical consequences compared to host-related factors.
