University College Hospital at Westmoreland Street, named The Heart Hospital until refurbished and renamed in 2015, was a specialist cardiac hospital located in London, United Kingdom until 2015. It is part of the University College London Hospitals NHS Foundation Trust and is closely associated with University College London (UCL). After the 2015 refurbishment the hospital now provides thoracic surgery, and urology services.Before the 2015 refurbishment the Heart Hospital conducted over 1,000 surgical heart operations each year, had 95 in-patient beds, and was one of the largest cardiac centres in the UK. It treated around 1,700 new outpatients, 5,500 follow-up outpatients and 1,200 inpatients each year. It was a centre for cardiac research, home to the UCL Centre for Cardiology in the Young, and part of the UCLH/UCL Biomedical Research Centre and the UCL Partners academic health science centre.
BACKGROUND:Sarcopenia and delirium are two highly prevalent clinical syndromes among hospitalized elderly patients, both independently associated with adverse outcomes such as increased risk of falls, disability and mortality. Although a correlation between sarcopenia and delirium has been previously reported, past studies have often relied on less reliable surrogate markers for sarcopenia, leading to potential inaccuracies in diagnosis and assessment. This study aims to address these limitations by utilizing a more precise and reliable diagnostic tool for sarcopenia, specifically, muscle ultrasound (US) to measure the quadriceps femoris muscle and its pennation angle, to accurately evaluate the correlation between sarcopenia and delirium in acutely admitted geriatric patients. METHODS:We used muscle US to measure sarcopenia with reliable markers, specifically the Ultrasound Sarcopenia Index (USSI). This index evaluates the ratio between vastus lateralis thickness and fascicle length (L/f), offering a detailed view of muscle structure that is not affected by sex or body size. RESULTS:In 194 patients (mean age 86.5 years; 46.4% women; 81.4% with delirium), USSI correlated with MMSE (r = -0.619, p < 0.001), 4AT (r = 0.844, p < 0.001), ADL/IADL (r ≈ -0.32, p < 0.001), BMI, grip strength and muscle thickness (all p < 0.001). Women had higher USSI and worse cognitive/frailty scores; patterns were consistent across sexes. CONCLUSION:Our findings are expected to support the implementation of more targeted assessments and interventions, emphasizing the crucial role of accurate sarcopenia diagnosis in improving outcomes for elderly patients and highlighting its interconnectedness with delirium in comprehensive geriatric care.
Background: Out-of-hospital cardiac arrest (OHCA) remains a major clinical challenge with high morbidity and mortality. The cardiac arrest hospital prognosis (CAHP) score is a validated tool for predicting neurological and survival outcomes in patients achieving return of spontaneous circulation (ROSC). This study aimed to validate the prognostic performance of the CAHP score in a cohort of OHCA patients in Qatar, with a focus on survival, neurological outcomes, and the impact of bystander-initiated cardiopulmonary resuscitation (CPR). Methods: We conducted a retrospective cohort study of adult OHCA patients admitted alive to Hamad Medical Corporation, Qatar, between June 2022 and October 2023. Patients without ROSC were excluded, as CAHP scoring requires survival to admission. Data included demographics, clinical history, coronary findings, and CAHP scores (documented vs. auditor-calculated). Outcomes assessed were 30-day survival and neurological status. Statistical tests included Chi-square and Pearson correlation. Results: Ninety-two patients were included (mean age 51 ± 12.6 years, 91.3% male). Cardiac etiology was identified in 64.1% (59/92), with ST-elevation myocardial infarction (STEMI) present in 97% of these cases. Thirty-day survival was 71.7% overall and 73.7% among STEMI patients; however, 33.7% of survivors exhibited hypoxic brain injury. Auditor-calculated CAHP scores differed significantly from documented values (P < 0.001). Low-risk patients (CAHP < 150) demonstrated the best survival with good neurological outcomes (93.6%), compared to 57.5% in intermediate and 10.5% in high-risk groups. Bystander CPR, reported separately from the CAHP score, was performed in 66.3% of cases and was positively associated with 30-day survival (R = 0.217, P = 0.038). Conclusion: The CAHP score is a reliable predictor of survival and neurological outcomes in OHCA patients admitted alive in Qatar. Accurate score calculation is essential, as documentation may underestimate patient risk. Bystander CPR remains a critical determinant of survival, highlighting the importance of community CPR training. These findings support integrating CAHP-based stratification into local OHCA management guidelines.
Background Takotsubo cardiomyopathy (TCM) is a reversible cardiomyopathy that mimics acute coronary syndrome and is most commonly observed in postmenopausal women following emotional stress. Presentation in middle-aged men is uncommon, and occupational stress is an increasingly recognized but underreported trigger.Case summary A 55-year-old male with Type 2 diabetes mellitus, hypertension, and dyslipidaemia presented with prolonged mild central chest discomfort following an exceptionally long and stressful workday organizing a sporting event. High-sensitivity troponin T was elevated, and transthoracic echocardiography demonstrated reduced left ventricular ejection fraction with apical and mid-ventricular hypokinesia and basal sparing. Coronary angiography revealed no obstructive coronary artery disease. Repeat echocardiography showed near-complete recovery of left ventricular function within 3 days and complete normalization at 6-month follow-up.Discussion This case illustrates an atypical presentation of TCM in a middle-aged male precipitated by prolonged occupational stress. It underscores the importance of considering TCM in patients presenting with acute coronary syndrome-like symptoms irrespective of sex and highlights work-related stress as a significant non-traditional trigger.
BACKGROUND:Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined. METHODS:Patients enrolled in SYMPHONY-PE were divided into one of 2 groups based on the time from baseline CT pulmonary angiography to mechanical thrombectomy: Early <12 hours versus late ≥12 hours. The primary safety end point was the rate of major adverse events within 48 hours, as adjudicated by an academic independent safety board. The primary efficacy end point was the core-lab assessed mean change in right ventricle-to-left ventricle ratio from baseline to 48 hours. RESULTS:Early thrombectomy was performed in 44% (48/109) of patients and was associated with a larger reduction, approaching statistical significance, in right ventricle-to-left ventricle ratio (0.52±0.50 versus 0.37±0.34; P=0.071). Mean pulmonary artery pressure decreased significantly more in patients receiving early thrombectomy (8.6±5.2 versus 5.8±5.0 mm Hg; P=0.006). The major adverse events rate was similar (P=0.431) between groups, and there were no mortalities. The differences in efficacy outcomes were greatest in higher-risk patients per the Composite Pulmonary Embolism Shock score. CONCLUSIONS:Early mechanical thrombectomy was associated with larger reductions in right ventricle-to-left ventricle ratio and mean pulmonary artery pressure, with no significant differences in safety event rates compared with patients who underwent late thrombectomy. Randomized trials are needed to test these associations. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT06062329.
BACKGROUND:BATMAN (balloon-assisted translocation of the mitral anterior leaflet) is an increasingly adopted technique to modify the anterior mitral leaflet (AML) and prevent left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). OBJECTIVES:The aim of this study was to evaluate the feasibility, efficacy, and safety of the BATMAN technique during transseptal TMVR. METHODS:This was an international, multicenter cohort study of all consecutive patients at high risk for LVOT obstruction undergoing transseptal BATMAN TMVR for valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) at 22 structural heart disease centers in North America and Europe. The primary efficacy endpoint was the rate of successful TMVR free from LVOT obstruction and procedural death. The primary safety endpoint was the in-hospital composite of death, stroke, or major cardiac structural complications. RESULTS:A total of 83 patients were included: 24 undergoing ViV, 39 ViR, and 19 ViMAC procedures. Technical success was achieved in all but 1 case (98.8%) that was converted to tip-to-base LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction). Pre-emptive mechanical cardiocirculatory support was used in 28.9% of cases. The primary efficacy endpoint was met in 95.1% of cases (100% in ViR, 95.8% in ViV, and 84.2% of ViMAC; P = 0.03). The primary safety endpoint occurred in 7.3% of patients and was higher in the ViMAC group (0% in ViR, 8.3% in ViV, and 21.1% in ViMAC; P = 0.02). There was 1 major cardiac structural complication directly attributed to BATMAN in a ViMAC patient. CONCLUSIONS:BATMAN was associated with high technical success and effectiveness in preventing LVOT obstruction and appeared to be safe in ViR and ViV procedures. Adverse events were higher in ViMAC.
