Young Asymptomatic Patients Research Articles

Reimagining Colorectal Cancer Screening: Innovations and Challenges with Dr. Aasma Shaukat.

Colorectal cancer (CRC) currently ranks as the third most common cancer and the second leading cause of cancer-related deaths worldwide, posing a significant global health burden to the population. Recent studies have reported the emergence of a new clinical picture of the disease, with a notable increase in CRC rates in younger populations of <50 years of age. The American Cancer Society (ACS) now recommends CRC screening starting at age 45 for average-risk individuals. Dr. Aasma Shaukat's Keynote Conference highlights the critical need for updated screening strategies, with an emphasis on addressing the suboptimal adherence rates and the effective management of the growing burden of CRC. Lowering the adenoma detection screening age can facilitate early identification of adenomas in younger asymptomatic patients, altering the epidemiologic landscape. However, its implications may not be as profound unless a drastic shift in the age distribution of CRC is observed. Currently, various screening options are available in practice, including stool-based tests like multitarget stool DNA (mtDNA) tests, fecal immunochemical testing (FIT), and imaging-based tests. In addition to existing screening methods, blood-based tests are now emerging as promising tools for early CRC detection. These tests leverage innovative techniques along with AI and machine learning algorithms, aiding in tumor detection at a significantly earlier stage, which was not possible before. Medicare mandates specific criteria for national coverage of blood-based tests, including sensitivity ≥ 74%, specificity ≥ 90%, FDA approval, and inclusion in professional society guidelines. Ongoing clinical trials, such as Freenome, Guardant, and CancerSEEK, offer hope for further advancements in blood-based CRC screening. The development of multicancer early detection tests like GRAIL demonstrates a tremendous potential for detecting various solid tumors and hematologic malignancies. Despite these breakthroughs, the question of accessibility and affordability still stands. The ever-evolving landscape of CRC screening reflects the strength of the scientific field in light of an altered disease epidemiology. Lowering screening age along with the integration of blood-based tests with existing screening methods holds great potential in reducing the CRC-related burden. At the same time, it is increasingly important to address the challenges of adaptation of the healthcare system to this change in the epidemiologic paradigm.

Does coronary artery calcium screening help cardiovascular risk stratification in asymptomatic young patients with diabetes mellitus? A knowledge gap.

Does coronary artery calcium screening help cardiovascular risk stratification in asymptomatic young patients with diabetes mellitus? A knowledge gap.

(256) Effect of Early Varicocelectomy Intervention on Male Hormone Levels in Adolescent Males

Abstract Introduction Varicoceles can be found in approximately 15% of the adult male population and are known to impact male fertility. Varicoceles may develop during adolescence and increase in size as these males undergo puberty. According to current guidelines, it is recommended to monitor young asymptomatic patients and consider surgical intervention if they develop testicular size discrepancies, fertility issues, abnormal semen analyses, or experience significant pain. However, the effect of varicoceles on sex hormones and management in young males is poorly understood. Objective To evaluate the impact of early surgical intervention for varicoceles with a microsurgical varicocelectomy on hormone levels and safety profiles in adolescent males. Methods A retrospective review was conducted on 67 patients between the ages of 10 and 17 years old who had a grade 2 (G2) or grade 3 (G3) varicocele, and underwent microsurgical varicocelectomy between November 2021 and May 2023. Patient demographics, varicocele laterality and grade, surgical data, and pre-and post-operative hormone levels were collected as well as post-operative complications. Hormonal panel was collected before 11AM using LCMS and included total testosterone (TT), free testosterone (FT), percent free testosterone (%FT), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (P), and sex hormone-binding globulin (SHBG). Statistical analyses were conducted using SAS System. Results A total of 67 patients had complete data (96% had G3 varicoceles). Preoperative FT was statistically significant between varicocele grades 2 and 3 (p=0.03) with G3 varicoceles having lower preop FT levels. Pre-operative hormone levels for G2 varicoceles were: TT 550ng/dL (std 177ng/dL), FT 126ng/dL (std 27), E2 33 (std 2.64), FSH 3.53 (std 1.27) and LH 5.06 (std 3.53). Pre-op levels for G3 varicoceles: TT 437ng/dL (std 199ng/dL), FT 71.3 (std 42.2), E2 25.2 (std 9.64), FSH 4.34 (std 3.3) and LH 3.73 (std 1.9). Post operatively TT levels improved in G3 varicocelectomy patients with a postop mean TT 445ng/dL (std 109ng/dL), however this did not meet statistical significance. There was no statistically significant difference between postoperative hormone panel labs between varicocele grades. There were no complications in any of the patients and no recurrence of varicoceles. Conclusions Our study evaluated the impact of early surgical intervention for G2 and G3 varicoceles on hormone levels in adolescent males. The results showed a significant difference in preoperative Free T levels between G2 and G3 varicocele patients possibly indicating the impact of varicocele grade on FT levels in adolescents. Early surgical intervention for G3 varicoceles appears to be safe with resultant improvements in TT levels with no increased risk of complications. Further investigations to explore the potential benefits of early surgical treatment in adolescent patients with varicoceles evaluating hormonal profiles in larger cohorts. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast and BK Ultrasound.

Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy: A Prospective Randomized Study

OBJECTIVES: To determine whether it is safe to use a conservative packed red blood cell transfusion hemoglobin (Hgb) threshold (5.5 g/dL) compared with a liberal transfusion threshold (7.0 g/dL) for asymptomatic musculoskeletal injured trauma patients who are no longer in the initial resuscitative period. METHODS: Design: Prospective, randomized, multicenter trial. Setting: Three level 1 trauma centers. Patient Selection Criteria: Patients aged 18–50 with an associated musculoskeletal injury with Hgb less than 9 g/dL or expected drop below 9 g/dL with planned surgery who were stable and no longer being actively resuscitated were randomized once their Hgb dropped below 7 g/dL to a conservative transfusion threshold of 5.5 g/dL versus a liberal threshold of 7.0 g/dL. Outcome Measures and Comparisons: Postoperative infection, other post-operative complications and Musculoskeletal Functional Assessment scores obtained at baseline, 6 months, and 1 year were compared for liberal and conservative transfusion thresholds. RESULTS: Sixty-five patients completed 1 year follow-up. There was a significant association between a liberal transfusion strategy and higher rate of infection (P = 0.01), with no difference in functional outcomes at 6 months or 1 year. This study was adequately powered at 92% to detect a difference in superficial infection (7% for liberal group, 0% for conservative, P &lt; 0.01) but underpowered to detect a difference for deep infection (14% for liberal group, 6% for conservative group, P = 0.2). CONCLUSIONS: A conservative transfusion threshold of 5.5 g/dL in an asymptomatic young trauma patient with associated musculoskeletal injuries leads to a lower infection rate without an increase in adverse outcomes and no difference in functional outcomes at 6 months or 1 year. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Lingual thyroid in a young asymptomatic female patient with hypothyroidism: Case report

Introduction. Lingual thyroid is a rare condition where thyroid tissue is abnormally located at the base of the tongue due to embryological development issues. The precise prevalence is uncertain, as many asymptomatic individuals do not undergo clinical examination. Case report. We present a case of a 28-year-old woman with a history of hypothyroidism. The patient exhibited no symptoms indicative of lingual thyroid. A neck ultrasound identified hypoplastic thyroid tissue centrally in the neck and a solitary nodule in the submandibular region. Further evaluation with an oropharyngeal examination revealed a solid mass at the base of the tongue. A technetium-99m pertechnetate thyroid scintigraphy, performed with single photon emission computed tomography on a hybrid gamma camera, demonstrated functional thyroid tissue at the tongue?s base, measuring 16 mm in diameter, with no functional glandular tissue in the central neck region. Conclusion. Asymptomatic lingual thyroid can be diagnosed through oropharyngeal examination, neck ultrasound and technetium-99m pertechnetate thyroid scintigraphy using a hybrid gamma camera, which provides both functional and anatomical data. Management should be individualized based on the patient?s symptoms and thyroid hormone levels.

Correlation of Cardiac Function by Transthoracic Ultrasound and State of Inflammation in Asymptomatic Young Patients (18-40 Years), with Hemodialysis: A Single-Center Experience

Correlation of Cardiac Function by Transthoracic Ultrasound and State of Inflammation in Asymptomatic Young Patients (18-40 Years), with Hemodialysis: A Single-Center Experience

Revisiting Age Criterion for Surgery in Asymptomatic Primary Hyperparathyroidism.

To revisit the current age criterion (50 years) for surgical candidacy in patients diagnosed with asymptomatic primary hyperparathyroidism (PHPT). A predictive model relying on past publications using the electronic databases "PubMed," "Embase," "Medline,"and "Google Scholar." Hypothetical large cohort. A Markov model was constructed, based on relevant literature, to compare 2 potential treatment algorithms for asymptomatic PHPT patients, parathyroidectomy (PTX), and observation. The various potential health states were characterized for the 2 treatment options and included potential surgical complications, end-organ deterioration, and death. A 1-way sensitivity analysis was performed to calculate the quality-adjusted life year (QALY) gains of both strategies. A Monte-Carlo simulation for 30,000 subjects was performed and cycled per annum. On the basis of the model's assumptions, the QALY value for the PTX strategy was 19.17 versus17.82 for the observation strategy. The incremental QALY gains for various ages according to the sensitivity analyses for PTX in comparison to observation were: 2.84 QALY for 40-year-old patients, 2.2 QALY for 50-year-old patients, 1.81 QALY for 55-year-old patients, 1.35 QALY for 60-year-old patients, and 0.86 QALY for 65-year-old patients. The incremental QALY is below 0.5 after the age of 75 years. This study found PTX to be advantageous for asymptomatic PHPT patients older than the current age criterion of 50 years. The calculated QALY gains support a surgical approach for medically fit patients in their 50s. The current guidelines for the surgical treatment of young asymptomatic PHPT patients should be revisited by the next steering committee.

533 MOBITZ TYPE I AND HIGH-DEGREE ATRIO-VENTRICULAR BLOCK AS LATE SEQUELAE OF ASYMPTOMATIC COVID-19 INFECTION: A CASE REPORT

Abstract Background It is now well-acknowledged that patients with overt COVID-19 are at increased risk of a broad range of acute cardiovascular disorders including myocardial infarction, myocarditis, pericarditis, pulmonary embolism, vasculitis and thromboembolic disease. However, long-term cardiac sequelae of COVID-19 are still poorly understood, especially in young asymptomatic patients. Case summary A 40 years-old man, with a history of COVID-19 infection 8 weeks earlier, was admitted to the Emergency Department for detection of type 2 atrio-ventricular block (AVB) Mobitz I at 12-lead ECG during regular medical checkup. The patient was asymptomatic and hemodynamically stable (resting blood pressure 125/75 mmHg). An ECG performed 10 weeks earlier showed no conduction abnormalities. At echocardiographic examination, a preserved left ventricular ejection fraction, no abnormal regional wall motion and no valvular abnormalities were found. Routine laboratory tests showed normal values of blood count, electrolytes, thyroid hormones, C-reactive protein and no elevation in high-sensitivity troponin-I levels. Renal function was preserved. A maximal ECG treadmill test was performed using the Bruce protocol that showed no ectopy during exercise, no ST segment changes during exercise or recovery. During the exercise, the patient remained asymptomatic and the AVB disappeared at stage IV and came back at the end of the test. During in-hospital stay, a paroxysmal high-grade AVB was also detected at ECG telemetry monitoring. The electrophysiological study revealed normal HV conduction and intranodal Wenckebach AVB. A cardiac magnetic resonance (CMR) was performed which revealed myocardial edema and septal fibrosis. At the end, the patient underwent a loop recorder implantation and was prescribed 600 mg of ibuprofen twice a day and dexamethasone 1 mg with progressively decreasing doses for a total of 4 weeks. At 3-month follow-up the patient remained asymptomatic and a persistence of type 2 AVB Mobitz I yet no events of high-grade AVB, were recorded at loop recorder monitoring. In addition, the 3-month follow-up CMR showed no signs of edema or fibrosis. Discussion Myocardial injury and conduction disorders have been well-described to complicate the acute COVID-19 infection. However, this is the first report of an atrioventricular conduction block as isolated long-term consequence of COVID-19 in asymptomatic patient. The persistence of AVB during follow-up could be probably explained by microscopic affection of conduction system non detectable at CMR imaging. To date, there is no long-term data to suggest whether such isolated conduction abnormalities are temporary or permanent. The decision of implanting a definitive pacemaker should be based on accurate analysis aimed at evaluating the reversible nature of arrhythmia, especially in young patients. In our case, at 3-month follow-up, CMR showed no macroscopic edema/fibrosis of the myocardium and the high grade AVB disappeared. Serious conduction disorders following asymptomatic or mild COVID-19 may occur and a tailored management is advisable.

Coronary artery aneurysms caused by Kawasaki disease in an adult: A case report and literature review

BACKGROUNDKawasaki disease (KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin. It predominantly affects children aged < 5 years. KD is the common cause of acquired heart disease in children. We here report a case of KD in an asymptomatic young female patient diagnosed with multiple coronary aneurysms with calcification. CASE SUMMARYA 29-year-old female patient admitted to Hangzhou First People's Hospital with coronary artery abnormality identified for 1 wk. The patient was asymptomatic; however, chest computed tomography occasionally revealed strip-like dense shadows in the coronal sulcus. After coronary angiography and Doppler echocardiography, the final diagnosis was coronary artery aneurysms (CAAs) caused by KD. Although the patient was asymptomatic with no history of KD in childhood, the definitive diagnosis was CAAs caused by KD. The patient was administered anticoagulant, and surgical treatment was recommended.CONCLUSIONKD potentially causes CAAs in 25% of untreated cases, primarily occurring in the proximal portions of the coronary arteries.

Journal-related Activities and Other Special Activities at the 2022 American Society of Anesthesiologists Meeting

Journal-related Activities and Other Special Activities at the 2022 American Society of Anesthesiologists Meeting

Isolated double-chambered right ventricle in a young female – a rare congenital heart disease: Evaluation by transthoracic color echocardiography and cardiac computed tomography

A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive cardiac failure. An anomalous muscle band divides the right ventricle into two cavities, the proximal high-pressure chamber, and distal low-pressurechamber. Its origin is debated. Most cases are diagnosed and treated during childhood. Furthermore, there is tendency for progression, if not treated. Echocardiography is considered useful for diagnosis. About 80–90% patients have associated congenital anomalies, such as ventricular septal defect, pulmonary stenosis, and subaortic stenosis. Isolated DCRV is exceptionally rare. Hence, we are reporting a case of an isolated DCRV in an asymptomatic young female patient.

Ventricular arrhythmia and sudden cardiac death in hypertrophic cardiomyopathy: From bench to bedside.

Patients with hypertrophic cardiomyopathy (HCM) mostly experience minimal symptoms throughout their lifetime, and some individuals have an increased risk of ventricular arrhythmias and sudden cardiac death (SCD). How to identify patients with a higher risk of ventricular arrythmias and SCD is the priority in HCM research. The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) both recommend the use of risk algorithms to identify patients at high risk of ventricular arrhythmias, to be selected for implantation of implantable cardioverters/defibrillators (ICDs) for primary prevention of SCD, although major discrepancies exist. The present SCD risk scoring systems cannot accurately identify early-stage HCM patients with modest structural remodeling and mild disease manifestations. Unfortunately, SCD events could occur in young asymptomatic HCM patients and even as initial symptoms, prompting the determination of new risk factors for SCD. This review summarizes the studies based on patients' surgical specimens, transgenic animals, and patient-derived induced pluripotent stem cells (hiPSCs) to explore the possible molecular mechanism of ventricular arrhythmia and SCD. Ion channel remodeling, Ca2+ homeostasis abnormalities, and increased myofilament Ca2+ sensitivity may contribute to changes in action potential duration (APD), reentry circuit formation, and trigger activities, such as early aferdepolarization (EAD) or delayed afterdepolarization (DAD), leading to ventricular arrhythmia in HCM. Besides the ICD implantation, novel drugs represented by the late sodium current channel inhibitor and myosin inhibitor also shed light on the prevention of HCM-related arrhythmias. The ideal prevention strategy of SCD in early-stage HCM patients needs to be combined with gene screening, hiPSC-CM testing, machine learning, and advanced ECG studies, thus achieving individualized SCD prevention.

The skin is the best alarm bell for recognizing the presence of the Omicron variant in younger asymptomatic patients

The skin is the best alarm bell for recognizing the presence of the Omicron variant in younger asymptomatic patients

Cerebral venous thrombosis in a young asymptomatic COVID-19 patient.

We report an unusual case of cerebral venous thrombosis (CVT temporally associated with an otherwise asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While coronavirus disease 2019 (COVID-19) has been associated with thrombotic events at different sites, most published cases report on symptomatic SARS-CoV-2 infection. We are confident this was an otherwise asymptomatic infection as the patient reported no symptoms and molecular and serological testing was consistent with infection more than 3weeks in the past.We believe this is an important report as it adds to the existing literature on thrombotic events in patients with COVID. It may even inform discussion of COVID vaccines and CVT since our patient, as those reported in association with vaccines, also had thrombocytopenia on admission.

Early Markers of Cardiovascular Disease Associated with Clinical Data and Autosomal Ancestry in Patients with Type 1 Diabetes: A Cross-Sectional Study in an Admixed Brazilian Population.

Patients with type 1 diabetes (T1D) have a higher risk of developing cardiovascular disease (CVD), which is a major cause of death in this population. This study investigates early markers of CVD associated with clinical data and autosomal ancestry in T1D patients from an admixed Brazilian population. A cross-sectional study was conducted with 99 T1D patients. The mean age of the study sample was 27.6 years and the mean duration of T1D was 14.4 years. The frequencies of abnormalities of the early markers of CVD were 19.6% in the ankle-brachial index (ABI), 4.1% in the coronary artery calcium score (CACS), and 5% in the carotid Doppler. A significant percentage of agreement was observed for the comparison of the frequency of abnormalities between CACS and carotid Doppler (92.2%, p = 0.041). There was no significant association between the level of autosomal ancestry proportions and early markers of CVD. The ABI was useful in the early identification of CVD in asymptomatic young patients with T1D and with a short duration of disease. Although CACS and carotid Doppler are non-invasive tests, carotid Doppler is more cost-effective, and both have limitations in screening for CVD in young patients with a short duration of T1D. We did not find a statistically significant relationship between autosomal ancestry proportions and early CVD markers in an admixed Brazilian population.

Muscular sarcoidosis in the eyes of 18 F-FDG PET/CT.

The aim of this study was to determine the frequency, symptoms, activity and pattern of muscle sarcoidosis, correlation with laboratory parameters, and to assess its therapy response with 18 F-FDG PET/CT. Study included 90 patients with biopsy confirmed sarcoidosis and symptoms/biochemical/imaging findings suggestive of active disease. The exclusion criteria were: presence of cancer or other diseases that resemble sarcoidosis on PET/CT (Wegener syndrome, tuberculosis, aspergillosis), and the glucose level being greater than 11 mmol/L. All patients were screened for muscle sarcoidosis with 18 F-FDG PET/CT examination. Follow-up examination was done 1 year after the baseline in order to evaluate therapy response. Disease was very rare and present in only 7/90 patients. Most of the patients had polysymptomatic disease, while muscle pain was less frequent, present only in one-third of the patients. The disease was usually present in the lower limbs, upper limbs, and skeletal striated muscles. The most common pattern of disease was nodular. Disease activity estimated with SUVmax was not in correlation with the ACE findings, creatine kinase, and aldolase levels (p > 0.05). Follow-up PET/CT revealed complete remission in one patient and partial remission in two. 18 F-FDG PET/CT can be useful in asymptomatic young patients with nodular pattern of disease, who have easily relapsing form of disease. It can help in further management of these patients and can affect prognosis of the disease, since most of the laboratory parameters in this entity are within normal limits.

Pelvic Examinations in the Adolescent and Young Adult Population: A Commentary on Why and When.

Various professional organizations have weighed in on the practice utility of speculum examinations. The US Preventive Services Task Force (USPSTF), American Academy of Pediatrics (AAP), and American College of Physicians (ACP) have recommended against internal pelvic examinations in asymptomatic patients, whereas the American College of Obstetricians and Gynecologists (ACOG) has encouraged shared decision making. Although a pelvic examination can be a stressful event for adolescents, studies have shown that early discussions and performing the examination in a trusting environment can mitigate the worries and improve the patient-provider relationship. In this commentary, we discuss the literature and conclude that performing a pelvic examination in the asymptomatic adolescent and young adult patient is ultimately a matter of shared decision making. The benefits of conducting the examination in a nonthreatening environment, minimizing "exceptionalization" of the female genitalia, and strengthening the patient-provider relationship should be highlighted during the discussions.

Small fiber neuropathy in the cornea of Covid-19 patients associated with the generation of ocular surface disease

PurposeTo describe the association between Sars-CoV-2 infection and small fiber neuropathy in the cornea identified by in vivo corneal confocal microscopy. MethodsTwenty-three patients who had overcome COVID-19 were recruited to this observational retrospective study. Forty-six uninfected volunteers were also recruited and studied as a control group. All subjects were examined under in vivo confocal microscopy to obtain images of corneal subbasal nerve fibers in order to study the presence of neuroma-like structures, axonal beadings and dendritic cells. The Ocular Surface Disease Index (OSDI) questionnaire and Schirmer tear test were used as indicators of Dry Eye Disease (DED) and ocular surface pathology. ResultsTwenty-one patients (91.31%) presented alterations of the corneal subbasal plexus and corneal tissue consistent with small fiber neuropathy. Images from healthy subjects did not indicate significant nerve fiber or corneal tissue damage. Eight patients reported increased sensations of ocular dryness after COVID-19 infection and had positive DED indicators. Beaded axons were found in 82.60% of cases, mainly in patients reporting ocular irritation symptoms. Neuroma-like images were found in 65.22% patients, more frequently in those with OSDI scores >13. Dendritic cells were found in 69.56% of patients and were more frequent in younger asymptomatic patients. The presence of morphological alterations in patients up to 10 months after recovering from Sars-CoV-2 infection points to the chronic nature of the neuropathy. ConclusionsSars-CoV-2 infection may be inducing small fiber neuropathy in the ocular surface, sharing symptomatology and morphological landmarks with DED and diabetic neuropathy.

Hepatic Adenomatosis in a Young Asymptomatic but High-risk Patient: An Incidental Diagnosis with Potentially Severe Clinical Implications.

Hepatic adenomatosis (HA) is a very rare condition and defined as the presence of 10 or more adenomas in an otherwise normal liver. HA has an incidence of 10–24% in patient with hepatic adenoma and it is more common in women. Most patients with HA are asymptomatic with a normal liver function test and half of cases are detected incidentally on imaging. Although HA is considered a benign disease, some patients may develop potentially fatal complications, such as hypovolaemic shock due to rupture of the liver lesion or malignant transformation to hepatocellular carcinoma.We report the case of a 29-year-old woman who presented to the emergency room after a car accident. Whole-body computed tomography revealed multiple focal hepatic hypervascular lesions in the right lobe of the liver together with a fatty liver. Subsequent hepatic magnetic resonance imaging suggested the diagnosis of HA with a suspicion of focal nodular hyperplasia (FNH). The patient refused to undergo liver biopsy, so we instituted a 3-month surveillance program, which included clinical assessment, liver function tests, tumour marker assessment and blood tests as well as sonographic evaluation for follow-up of the liver lesions.LEARNING POINTSHepatic adenomatosis is an extremely rare disease which predominantly affects women and is associated with hormone consumption, liver steatosis, glycogen storage disease, obesity, metabolic syndrome, abnormalities of hepatic vasculature and maturity onset diabetes of the young (MODY).The two main differential diagnoses include focal nodular hyperplasia (FNH) and well-differentiated hepatocellular carcinoma. Histological confirmation is required when MRI findings are inconclusive or when a malignancy is suspected.In men, resection of adenomas is mandatory due to the high risk of malignant transformation. In woman, a conservative approach with contraceptive discontinuation and biannual follow-up with MRI and alpha-fetoprotein is recommended; resection is needed in case of positive immunohistochemical staining for β-catenin on biopsy, symptomatic adenomas, adenoma increasing in size, and when malignancy cannot be ruled out.

High risk characteristics in patients with hypertrophic cardiomiyopathy for predicting cardiovascular events

Abstract Aim Sudden cardiac death is the most feared complication of hypertrophic cardiomyopathy due to its tendency to appear in young asymptomatic patients. Although intracardiac defibrillators proved to be most efficient treatment, the selection of patients for primary prevention is controversial due to lack of randomized trials. Current risk algorithms fail to determine all high risk patients. In this study, we aimed to evaluate high risk factors to predict cardiovascular events in our hypertrophic cardiomyopathy population. Method A total of 254 patients who fulfill the criteria of hypertrophic cardiomyopathy by echocardiography between 2011 and 2020 were retrospectively included in the study. Data on recent comprehensive vital clinical and survival status were obtained up to 30th January 2020, by hospital visit or from hospital system. The primary endpoints were described as all-cause mortality, myocardial infarction, cerebrovascular events, appropriate ICD therapy interventions. Results The median follow up in this study was 54.5 months. During follow up 18 (%7.1) all-cause mortality, 4 (%1.6) myocardial infarction, 12 (%4.7) cerebrovascular events, 19 appropriate ICD interventions, 83 (%32.7) hospitalization due to cardiovascular cause were encountered. Median time of the primary end points was 37.5 months. The incidence of ischemic heart disease, atrial fibrillation, syncope, nonsustained ventricular tachycardia were higher in primary end points group. The outcomes and predictors of our study are given in Tables 1 and 2. Conclusion In our study, the primary outcome was observed more frequently in high-risk patients according to the ESC algorithm, but primary outcomes were also observed in a significant portion of low and intermediate risk patients.Therefore, current risk algorithms for sudden cardiac death still have certain limitations in predicting clinical outcomes and new algorithms with high sensitivity and specificity are needed. Funding Acknowledgement Type of funding sources: None. Table 1Table 2