Background: The aim of this study is to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate only in predicting morbidity and mortality in sepsis patients. Methods: This was a single-center retrospective cohort study. All adult patients above the age of 18 with a diagnosis of sepsis who presented between January 1, 2014 and June 30, 2019 were included. The primary outcome was in-hospital mortality. Results: A total of 1,381 patients were included, 44% were female. Overall in-hospital mortality was 58.4% with the mortalities of sepsis and septic shock being 45.8 and 67%, respectively. 55.5% of patients were admitted to the intensive care unit. The area under the curve value for lactate was 0.61 (95% CI 0.57-0.65, p < 0.001) and for the L/A ratio was 0.67 (95% CI 0.63-0.70, p < 0.001). The cutoff generated was 1.22 (sensitivity 59%, specificity 62%) for the L/A ratio in all septic patients and 1.47 (sensitivity 60%, specificity 67%) in patients with septic shock. The L/A ratio was a predictor of in-hospital mortality (OR 1.53, CI 1.32-1.78, p < 0.001). Conclusion: The L/A ratio has better prognostic performance than initial serum lactate for in-hospital mortality in adult septic patients.

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Introduction: The impact of sex mismatch on outcomes after orthotopic heart transplant (OHT) remains unclear. We aimed to evaluate the change in left ventricle (LV) size based on donor and recipient sex and examine its association with the outcomes. Methods: This was a single institution, retrospective study among OHT recipients between Jan 2015 and Sept 2020. Patients were excluded if they were<18 years old, received OHT for congenital heart disease, had follow-up<6 months or missing donor variables. We collected donor (D) and recipient (R) clinical and echocardiographic characteristics. First and last echo post OHT were collected at least 2 months apart. Donor data was extracted from UNOS database. Primary outcome was the variation in donor heart size based on sex at first and last echo after transplant and the difference in survival or HF hospitalization. Statistical analysis (T test) was performed using Stata 15.1. Results: Among 156 reviewed patients, N=68 were included. Female (F) recipients (R) median age was 51±16 y, 25% were African-American (AA) while male (M) recipients median age was 56±12y and 19% were AA. Pre-transplant, MR had a higher RV and LV predicted heart mass and higher CO, CI by Fick. Aside from a higher prevalence of hypertension in MR, there was no difference in baseline characteristics. OHT allocation was MD/MR (66%); FD/FR (18%); FD/MR (4%); MD/FR (12%). LVEDD was bigger in MR on the first echo and remained on last echo post-transplant. There was no difference in degree of variation of LV parameters (LVEDD, LVESD, LV thickness) in MD/MR vs FD/MR and FD/FR vs MD/FR. Compared to sex matched, sex mismatched cohort had a non-significant trend towards a bigger degree of variation in LV size at first (-9% ± 10% vs -2% ± 21%;p=0.14) and last echo (-8% ± 12% vs -4% ± 14%;p=0.1).There were 18% (66% acute cellular rejection) cases of rejection split in half between sex matched and mismatched cohort. At a follow-up duration up to 6 years, 25% (N=17/68) of patients did not survive. There was no difference in survival or HF hospitalization in MR vs FR, in sex matched vs sex-mismatched. Conclusions: This is one of the first studies to examine the change in LV size and its impact on outcomes post OHT. The potential impact of LV behavior in M vs F is worth exploring on larger cohorts.

Transcatheter treatment is becoming the mainstay treatment for structural heart diseases (SHD) in prohibitive surgical risk patients. Recently with the encouraging results, it is being offered to regular risk patients. Peripheral vascular complications (VCs) are still inherent to these procedures due to the nature of this atherosclerotic high-risk group and the profile of the devices. This is a single-center early first year experience with such events occurring after initiating a SHD program treating severe aortic stenosis, aortic regurgitation, mitral valve prolapse and regurgitation, as well as paravalvular leaks. Out of 33 patients in this time period, 5 developed PV complications which are detailed in this article with their associated risk factors and management. These include access-related complications, closure device issues, arterial rupture post device embolization, and vessel dissection. Vascular complications of those procedures take special interest since they are associated with a worse long-term prognosis. Thus, prevention with proper planning remains of essence along with multidisciplinary management.

Background: Patients with significant coronary artery disease (CAD) are more likely to develop post-liver transplant (LT) cardiac events. We developed the CAD-LT screening score and testing algorithm to predict the risk of significant CAD in LT candidates. Methods: Patients who underwent pre-LT evaluation at Indiana University (2010-2017) were studied retrospectively (n=1814). Stress tests (ST) (n=1677) and cardiac catheterization (CATH) reports (n=1300) were reviewed. CATH was performed in patients with predefined CAD risk factors. Significant CAD was defined as disease requiring percutaneous or surgical intervention. Multivariable estimates (Adjusted Odds Ratio i.e. AOR [95%CI]) with assessment of model performance using Receiver Operating Curve analysis were used to compute a point-based risk score and stratify patients. A 10-fold internal cross-validation (CV) model was done. Results: There were 950 LT and 864 no-LT patients. The risk-adjusted predictors of significant CAD were older age (AOR 1.06 [95%CI 1.03-1.09]), male gender (1.69 [1.13-2.50]), diabetes (1.44 [1.01-2.06]), hypertension (1.50 [1.05-2.15]), current smoking history (1.81 [1.16-2.82]), family history of CAD (1.76 [1.24-2.50]), and personal history of CAD (5.41 [3.48-8.43]). The CAD-LT score is shown in Table 1. Figure 1 is an algorithm for its use. The mean CV Area Under the Curve [95% CI] was 0.75 [0.71-0.79]. The algorithm detected 97% of the patients with significant CAD and would decrease the number of ST by 718 (43%; 671 in high-risk group and 47 in low-risk group) and CATH by 409 (30%). Conclusion: The CAD-LT score identifies LT candidates at high risk for significant CAD and guides pre-LT testing.