[Diagnostic value of high-sensitivity troponin I to predict cardiac causes after syncope/near syncope in emergency department]

AIMS

The objective of this study is to evaluate the diagnostic accuracy of high-sensitivity (hs) troponin I to predict cardiac origin after syncope. The secondary objective is to determine the causes of elevated troponin.

PROCEDURE

Were included hospitalized patients with syncope/near syncope diagnosed in ED. The diagnostic accuracy to predict cardiac origin was evaluated and compared to the "high risk" group, defined by the 2018 European Society of Cardiology guidelines.

RESULTS

A total of 163 patients were enrolled, 26% had a cardiac origin. Positive troponin I hs predict a cardiac origin with a sensitivity of 31%, a specificity of 80%, positive predictive value of 35% and negative value of 77%. These diagnostic performances are not discriminating and lower than the ESC classification. A positive troponine I hs level is associated with 5 times more cardiac failure during the hospitalization.

CONCLUSION

A positive troponin I hs level after syncope/near syncope is not predictive of cardiac origin. It appears to be an early marker of ventricular remodeling in heart failure.

[Impact of a Home Return Assistance Service (PRADO-IC) on the re-hospitalisation rate for heart failure patients]

BACKGROUND

Heart failure is a public health problem. Since 2013, the National Insurance has been offering the PRADO-IC service for the return home of patients hospitalised for cardiac decompensation. The aim of this study was to assess the impact of PRADO on the rate of re-hospitalisation of patients with heart failure at the centre hospitalier de Troyes (CHT).

MATERIAL AND METHODS

This was a 26-month monocentric retrospective study. Patients who were hospitalised for congestive heart failure in the cardiology department of the Troyes Hospital Centre from January 1, 2017 to August 31, 2018, and discharged home with the PRADO-IC service were included in the study. The primary outcome was the assessment of the number of readmissions for heart failure, 6 months before and 6 months after inclusion in the program. Secondary outcomes were the evaluation of the number of all-cause readmissions, the average length of stay and the time to readmission.

RESULTS

The average number of hospitalisations for cardiac decompensation before inclusion in the PRADO decreased from 0.34 to 0.25 (P=0.53) at 6 months. The average number of all-cause hospitalisations before inclusion increased from 0.57 to 0.58 (P=0.50) at 6 months. There was no significant difference in average length of stay and time to re-admission.

CONCLUSION

We did not highlight the impact of PRADO on the rate of re-hospitalisation of heart failure patients.

[Altitude and the right heart]

INTRODUCTION

Altitude is associated with a decrease in partial pressure of oxygen. Hypoxia induces pulmonary vasoconstriction with subsequent fixed increase in pulmonary artery pressure, and eventual right heart failure.

CURRENT KNOWLEDGE

High altitude exposure is associated with an increase in pulmonary artery pressure that is proportional to initial vasoconstriction. Echocardiographic evaluations on a large number of subjects show that the altitude-induced increase in pulmonary pressure is generally modest and does not exceed the 25mmHg that are diagnostic of pulmonary hypertension. This does not greatly increase right ventricular afterload, so that imaging of the right ventricle only shows some alterations of indices of systolic or diastolic function, but preserved contractile reserve during exercise. In less than 1% of cases, hypoxic vasoconstriction is strong and may be a cause of severe pulmonary hypertension and right heart failure.

PERSPECTIVES

The prognostic relevance of altitude-induced pulmonary hypertension and associated cardiac function alterations is not known. Treatment of hypoxic pulmonary hypertension relies on evacuation to a lower altitude, oxygen and pulmonary vasodilators. These treatment strategies have not been rigorously evaluated.

CONCLUSIONS

Altitude may be a cause of right heart failure. This uncommon complication of altitude exposure requires further epidemiological and therapeutic studies.