Purpose: We aimed to determine the association between sepsis and long-term cardiovascular events. Methods:We conducted a systematic review of observational studies evaluating post-sepsis cardiovascular outcomes in adult sepsis survivors. MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception until April 21st, 2021. Two reviewers independently extracted individual study data and evaluated risk of bias. Random-effects models estimated the pooled crude cumulative incidence and adjusted hazard ratios (aHRs) of cardiovascular events compared to either non-septic hospital survivors or population controls. Primary outcomes included myocardial infarction, stroke, and congestive heart failure; outcomes were analysed at maximum reported follow-up (from 30 days to beyond 5 years post-discharge).Results: Of 12,649 screened citations, 27 studies (25 cohort studies, 2 case-crossover studies) were included with a median of 4,289 (IQR 502-68,125) sepsis survivors and 18,399 (IQR 4,506) controls per study. The pooled cumulative incidence of myocardial infarction, stroke, and heart failure in sepsis survivors ranged from 3 to 9% at longest reported follow-up. Sepsis was associated with a higher long-term risk of myocardial infarction (aHR 1.77 [95% CI 1.26 to 2.48]; low certainty), stroke (aHR 1.67 [95% CI 1.37 to 2.05]; low certainty), and congestive heart failure (aHR 1.65 [95% CI 1.46 to 1.86]; very low certainty) compared to non-sepsis controls.Conclusions: Surviving sepsis may be associated with a long-term, excess hazard of late cardiovascular events which may persist for at least 5 years following hospital discharge.

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Advances in catheter-based ultrasound imaging technology allow for a unique opportunity to develop two-dimensional intracardiac echocardiography, an imaging method that could have significant clinical applications. In this study, we evaluated the potential of a new, percutaneous, 9-Fr prototype intracardiac echocardiographic catheter with a 12.5-MHz rotating crystal in 13 dogs. In all dogs, we were able to easily advance the intracardiac echocardiographic catheter into the right and left hearts percutaneously and obtain dynamic images of cardiac structures in various imaging planes. With the intracardiac echocardiographic catheter in the right atrium, the whole chamber could be visualized. Minor manipulation allowed visualization of the right atrium, right ventricle, and tricuspid valve in a two-chamber view; further maneuvering yielded four-chamber views. With advancement of the catheter into the right ventricle and pulmonary artery, the right ventricular cavity, right ventricular outflow tract, and pulmonary artery could be imaged. The intracardiac echocardiographic catheter in the aortic root allowed visualization of the pulmonary artery and its bifurcation, superior portions of the atria, interatrial septum, aortic valve, and the proximal left coronary artery. With the intracardiac echocardiographic catheter in the left ventricle, short-axis images of the whole left ventricle were obtained. Manipulating the catheter tip within the left ventricle, we could visualize the left ventricle, left atrium (LA), and the mitral valve in the long axis. We were also able to visualize and identify experimentally-induced ischemic regional left ventricular dyskinesis (four of of five dogs), aortic valvular tear (five out of five dogs), and pericardial effusion with right atrial collapse (two out of two dogs). Intracardiac echocardiography was not associated with any complications. We conclude that percutaneous, low-frequency intracardiac echocardiography with a 12.5-MHz, 9-Fr catheter yields cardiac images in many imaging planes with a good depth of field, allows identification of valvular, myocardial, and pericardial abnormalities, and has excellent clinical potential in the assessment of many cardiovascular disorders.

A man in his eighties with acute heart failure and cardiorenal syndrome developed severe hypernatraemia with diuresis. In this situation, palliation is often considered when renal replacement therapy is inappropriate. The literature to guide treatment of dysnatraemia in this setting is limited. Diuretics often worsen hypernatraemia and fluid replacement exacerbates heart failure. We describe a successful approach to this clinical Catch-22: sequential nephron blockade with intravenous 5% dextrose. Seemingly counterintuitive, the natriuretic effect of this combination had not previously been compared with diuretic monotherapy for heart failure. Yet this immediately effective strategy generated a high natriuresis-to-diuresis ratio and functioned as a bridge to cardiac resynchronisation therapy (CRT). In conjunction with a low salt diet, CRT facilitated the maintenance of sodium homeostasis and fluid balance. Thus, by improving the underlying pathophysiology (ie, inadequate cardiac output), CRT may enhance the outcomes of patients with cardiorenal syndrome and hypernatraemia.