Echocardiographic predictors of outcome after isolated tricuspid valvular surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular (RV) function is one factor influencing outcome after isolated tricuspid valve surgery (ITVS). As it is highly load dependant, its echocardiographic assessment requires a multiparametric analysis. Purpose To assess prognostic value of RV echocardiographic parameters among patients undergoing ITVS. Methods Preoperative echocardiograms were retrospectively reviewed in 75 patients (mean age 54 ± 17 years) who underwent ITVS between 2007 and 2020. We assessed classical parameters of RV load, morphology and function, and calculated a load-remodeling-function index (LRFI) combining load (using tricuspid regurgitation time-velocity integral), remodeling (using ratio of RV diameter / length) and function (using strain rate (SR)). Those parameters were compared between alive and dead patients at 1-year follow-up. Results Mortality rate was 17.3% at 1 year and 22.7% at 5 years. Among standard RV function parameters, only S’ and SR were significantly lower in dead than in alive patients at 1 year. LRFI was significantly higher in dead patients at 1-year. By analysis of ROC curve, LRFI (AUC 0.823 [0.678-0.968]; p = 0.002) was the best predictor of death at 1 year. When associating a clinical variable (pre-existing right heart failure (RHF)) and LRFI, Kaplan Meier curves showed significantly higher mortality in patients with both RHF and altered LRFI. Conclusion Global RV analysis using a parameter combining load, remodeling and function may help in the prognostic assessment of patients undergoing ITVS, in addition to the presence of RHF. </jats:sec

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way. The task force emphasizes that the use of brain imaging in this context is in a discovery phase, but has the potential to increase our understanding of the neural underpinnings of chronic pain, inform the development of therapeutic agents, and predict treatment outcomes for use in personalized pain management. The task force proposes standards of evidence that must be satisfied before any brain imaging measure can be considered suitable for clinical or legal purposes. The admissibility of such evidence in legal cases also strongly depends on laws that vary between jurisdictions. For these reasons, the task force concludes that the use of brain imaging findings to support or dispute a claim of chronic pain - effectively as a pain lie detector - is not warranted, but that imaging should be used to further our understanding of the mechanisms underlying pain