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Abkürzungen
GLS
Global longitudinal strain
WFNS
World Federation of Neurologic Surgeons
Dear Editor,
We very much appreciate Dr. Santonocito's thoughtful comments on our research, titled Myocardial dysfunction assessed by speckle-tracking in good-grade subarachnoid hemorrhage patients (WFNS 1–2): a prospective observational study [1].
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The authors raise two valuable points:
Threshold for defining left ventricular damage We agree that the chosen threshold may have been too high for our specific population. We addressed this issue in our paper by presenting and discussing results for a lower threshold of − 17%. However, it's important to note that the research questioning this common threshold in critical care patients wasn't published at the time our protocol design and clinical trial registration (NCT03761654) were finalized.
Accounting for high afterload We agree that high afterload could influence the results. Note that the S' wave results presented were for the right ventricle. However, we were able to re-analyse the ultrasound images to obtain the value of the lateral S' wave at the mitral level. So, we performed, as asked, further analysis to assess the concordance and correlation between global longitudinal strain and mitral S' wave, providing a more comprehensive picture of left ventricular function in this context.The correlation between S' wave and SLG was very low and not statistically significant (r = − 0.023; p = 0.875). Using a threshold of 6.8 according to the work of Park et al. [2], the concordance rate between GLS and S' wave was 45% for a pathological GLS threshold of − 20% and 79% for a pathological GLS threshold of − 17% (Fig. 1).
Fig. 1
Relationship between left ventricular ejection fraction (LVEF) and Mitral S’ velocity. A Strain threshold of − 20. B Strain threshold of − 17
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These results therefore suggest that mitral S' wave analysis is not a better surrogate for GLS in this population.
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Acknowledgements
Authors thank Catherine Bigotto and Laure Estève for technical support
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee (Ile de France Research Subjects Protection Committee VI—ID RCB: 2018-A02434-51, November 21st, 2018). This study was registered on Clinicaltrials.gov: NCT03761654.
Consent for publication
The manuscript has been read and its submission approved by all co-authors. According to the French law, the patients and/or next of kin were informed about the inclusion of their anonymized data in the database, and none declined participation.
Competing interests
M.B received honoraria from Edwards Lifesciences and Pulsion Medical System as a lecturer. The other authors have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
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Wer ihn je erlebt hat, wird ihn nicht vergessen: den Schmerz, den die beim Öffnen oder Schließen des Reißverschlusses am Hosenschlitz eingeklemmte Haut am Penis oder Skrotum verursacht. Eine neue Methode für rasche Abhilfe hat ein US-Team getestet.
Der optimale Ansatz für die Blutdruckkontrolle bei Patientinnen und Patienten mit akutem Schlaganfall ist noch nicht gefunden. Ob sich eine frühzeitige Therapie der Hypertonie noch während des Transports in die Klinik lohnt, hat jetzt eine Studie aus China untersucht.
Zwar scheint es laut einer Studie aus den USA und Kanada bei der Reanimation von Kindern außerhalb einer Klinik keinen Unterschied für das Überleben zu machen, ob die Wiederbelebungsmaßnahmen während des Transports in die Klinik stattfinden oder vor Ort ausgeführt werden. Jedoch gibt es dabei einige Einschränkungen und eine wichtige Ausnahme.
Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.
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