Vectorcardiographic QRS area is associated with survival free from heart transplantation and LV assist device implantation in CRT recipients.

The aim of this study was to emphasize the importance of non-surgical treatment for subgroups of patients with spinal epidural abscesses (SEA). From 1988 to 2000, thirty cases of epidural spinal abscesses were retrospectively included in the study. The records and radiological studies were evaluated. Staphylococcus aureus was the most frequent microorganism causing SEA in 18 patients. In 20 patients SEA was secondary to interventional procedures. Predisposing factors were present in 15 cases. Fifty per cent was located in the lumbar region. A total of 22 patients received MRI, which always gave the diagnosis of SEA. Surgical treatment was performed in 20 patients. Conservative treatment with antibiotics was used in 10 patients. Eight patients did not have neurological deficits. One patient was critically ill and another patient was paralysed with an epidural lesion extending over six spinal segments. In all cases, a microorganism was known at the time of diagnosis of ESA. The eight patients without deficits recovered completely following treatment with antibiotics. C-reactive protein was the most reliable inflammatory marker to monitor the effect of the treatment. MRI enables diagnosis of ESA before deficits occur. These can safely be treated with antibiotics if the causative microorganism is known, and the neurological status and laboratory values are monitored. Decompressive surgery is restricted to cases with progressive deficits, when the deficits have lasted for less than 36 h and when the microorganism is not known.

Background: Patients with severe mental illness (SMI) including schizophrenia, bipolar disorder, and severe depression have earlier onset of cardiovascular risk factors, predisposing to worse future heart failure (HF) compared with the general population. We investigated associations between the presence/absence of SMI and long-term HF outcomes. Methods: We identified patients with HF with and without SMI in the Duke University Health System from 2002 to 2017. Using multivariable Cox regression, we examined the primary outcome of all-cause mortality. Secondary outcomes included rates of implantable cardioverter defibrillator use, cardiac resynchronization therapy, left ventricular assist device implantation, and heart transplantation. Results: We included 20 906 patients with HF (SMI, n=898; non-SMI, n=20 008). Patients with SMI presented clinically 7 years earlier than those without SMI. We observed an interaction between SMI and sex on all-cause mortality ( P =0.002). Excess mortality was observed among men with SMI compared with men without SMI (hazard ratio, 1.36 [95% CI, 1.17–1.59]). No association was observed among women with and without SMI (hazard ratio, 0.97 [95% CI, 0.84–1.12]). Rates of implantable cardioverter defibrillator use, cardiac resynchronization therapy, left ventricular assist device implantation, and heart transplantation were similar between patients with and without SMI (6.1% versus 7.9%, P =0.095). Patients with SMI receiving these procedures for HF experienced poorer prognosis than those without SMI (hazard ratio, 2.12 [95% CI, 1.08–4.15]). Conclusions: SMI was associated with adverse HF outcome among men and not women. Despite equal access to procedures for HF between patients with and without SMI, those with SMI experienced excess postprocedural mortality. Our data highlight concurrent sex- and mental health-related disparities in HF prognosis, suggesting that patients with SMI, especially men, merit closer follow-up.