Background: Right ventricular failure (RVF) is a cause of major morbidity and mortality after left ventricular assist device (LVAD) implantation. It is, therefore, integral to identify patients who may benefit from biventricular support early post-LVAD implantation. Our objective was to explore the performance of risk prediction models for RVF in adult patients undergoing LVAD implantation. Methods: A systematic search was performed on Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until August 2019 for all relevant studies. Performance was assessed by discrimination (via C statistic) and calibration if reported. Study quality was assessed using the Prediction Model Risk of Bias Assessment Tool criteria. Results: After reviewing 3878 citations, 25 studies were included, featuring 20 distinctly derived models. Five models were derived from large multicenter cohorts: the European Registry for Patients With Mechanical Circulatory Support, Interagency Registry for Mechanically Assisted Circulatory Support, Kormos, Pittsburgh Bayesian, and Mechanical Circulatory Support Research Network RVF models. Seventeen studies (68%) were conducted in cohorts implanted with continuous-flow LVADs exclusively. The definition of RVF as an outcome was heterogenous among models. Seven derived models (28%) were validated in at least 2 cohorts, reporting limited discrimination (C-statistic range, 0.53–0.65). Calibration was reported in only 3 studies and was variable. Conclusions: Existing RVF prediction models exhibit heterogeneous derivation and validation methodologies, varying definitions of RVF, and are mostly derived from single centers. Validation studies of these prediction models demonstrate poor-to-modest discrimination. Newer models are derived in cohorts implanted with continuous-flow LVADs exclusively and exhibit modest discrimination. Derivation of enhanced discriminatory models and their validations in multicenter cohorts is needed.
crotal infection with Mycobacterium tuberculosis is unusual, occurring in about 7% of patients with tuberculosis, 1 although its incidence is increasing worldwide in association with human immunodeficiency virus infection. We report a rare case of tuberculous orchiepididymitis in a patient who received intravesical instillation therapy with BCG vaccine after bladder tumor resection and describe the benefits of Doppler sonography for the study of orchiepididymitis.Received March 16, 2007, from the Radiology Service (E.M.B.-G., A.G.-P., G.A.-B., I.A.-M., M.M.M.) and Emergency (R.S.-V.) and Pathology (V.M.-R.) Departments, Carlos Haya Hospital, Malaga, Spain. Manuscript accepted for publication March 26, 2007. Address correspondence to Eva M. Briceño-García, MD, C/ Lingüista Manuel Seco 3, 29016 Malaga, Spain. E-mail: evambriceno@hotmail.com Case ReportThe patient was a 75-year-old man who underwent transurethral resection of a bladder tumor (grade 3, noninvasive papillary urothelial carcinoma) and benign prostatic nodular hyperplasia. One month later, he started adjuvant therapy with intravesical instillations of BCG: an induction phase of 1 instillation weekly for 4 weeks with 25 mg of InmuCyst (Aventis Pasteur, Lyon, France) followed by monthly booster instillations. Two weeks after the first booster dose, he had pain and tumefaction of the right scrotum. Conventional treatment was given with nonsteroidal anti-inflammatory drugs and antibiotics, ciprofloxacin for 2 weeks and amoxicillin-clavulanic acid for another 2 weeks, resulting in slight improvement of the symptoms and the inflammation, although the testicle and epididymis remained enlarged. The patient underwent a sonographic study with a Philips SD800 7.5-MHz transducer (Philips Medical Systems, Bothell, WA), which showed an enlarged right epididymis, especially the tail, with heterogeneous hypoechogenicity (Figure 1). A hypoechoic nodule was detected on its head. The lower portion of the testicle was also hypoechoic, with the epididymal tail poorly outlined. Color Doppler imaging showed no notable increase in the vascularization of the nodules.
Objectives: Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods: Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results: One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion: The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes. Arch Endocrinol Metab. 2017;61(2):122-9.
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