Cardiac Comorbidities Research Articles

Bedside transfontanelle drain placement reduces the need for operative intervention in infants with subdural fluid collections.

Subdural fluid collection is a common neurosurgical condition in the pediatric population. Patients requiring surgical intervention have historically been managed with subdural drains, subdural-subgaleal shunting, subdural-peritoneal shunting, and mini-craniotomies. An alternative procedure for patients with an open anterior fontanelle is bedside transfontanelle drainage. This study aims to evaluate the efficacy of the transfontanelle angiocatheter drain placement including complications and the need for any further surgery. We performed a single-center retrospective review of all patients who underwent placement of transfontanelle drain to treat subdural fluid collections from January 2013 to June 2023. Data points collected included demographics, comorbidities, mechanism of subdural collection, neurologic status on presentation, subdural size, amount of drainage, complications, and need for further intervention. We identified 28 patients who underwent bedside transfontanelle subdural angiocatheter placement between January 2013 and June 2023. The patient age range was 0-11months (avg 3.96). Twenty-three patients were male (82%). Nineteen patients (68%) had new seizures on presentation or during hospitalization. Eighteen patients (64%) suffered non-accidental trauma. The subdural on the side of the drainage ranged from 4 to 18mm in size. On average, a total of 590mL (22-1648) of fluid was drained over 3.5 (1-9) days. One medically complex patient on aspirin for cardiac comorbidities had post-procedural complication of new hemorrhage and one patient developed meningitis. Nineteen patients did not require any further treatment. Six patients underwent subsequent subdural-peritoneal shunting, two required subsequent placement of surgical subdural drains, and one underwent bilateral burr hole craniotomies with subdural drain placement. Patients who suffered NAT were more likely to not need further intervention than those with other mechanisms of subdural fluid collections. This retrospective review demonstrates that bedside transfontanelle drain placement is an effective practice to reduce the need for operative intervention in infants with an open anterior fontanelle. The procedure can be performed expeditiously in the emergency room, ICU, or floor setting without the need for general anesthesia. While future larger prospective studies are warranted, our series documented this practice to be performed safely.

Plasma microRNAs as Biomarkers for Predicting Radiotherapy Treatment-Induced Cardiotoxicity in Lung Cancer

Background: Lung cancer is the second most common malignancy and stands as a leading cause of cancer-related deaths worldwide. Currently, one of the main treatment options for lung cancer is radiotherapy, but this treatment is associated with complications, such as an increased risk of cardiac-related morbidity and mortality. However, currently available methods for predicting radiation-induced heart disease (RIHD) remain suboptimal. Methods: In this pilot study, using the RT-qPCR method, we analyzed the expression levels of six miRNAs (miRNA-1-3p, miRNA-21-5p, miRNA-24-3p, miRNA-29a-3p, miRNA-34a-5p, and miRNA-222-3p). Results: Fourteen pairs of locally advanced non-small-cell lung cancer patients’ plasma samples, taken before and after radiotherapy, were examined. It was observed that miRNA-1-3p, miRNA-21-5p, miRNA-24-3p, miRNA-29a-3p, and miRNA-222-3p were downregulated, while miRNA-34a-5p was upregulated in lung cancer patients’ plasma after treatment. Additionally, after definitive radiotherapy, patients with an increased NT-proBNP value displayed a statistically significant difference in miRNA-222-3p levels compared to the normal range of this indicator. The panel of the combined four miRNAs for assessing the risk of cardiac comorbidities demonstrated an AUC of 0.79, sensitivity of 71.43%, and specificity of 100%, with further improved values upon integration with clinical biomarker NT-proBNP. Conclusions: This pilot study shows that the identification of changes in miRNA expression levels in lung cancer patients’ plasma before and after radiotherapy could be used for the early diagnosis of RIHD.

DESCRIPCIÓN COMPLETA DE LOS MARCAPASOS CARDÍACOS. FUNCIÓN, TIPOS Y APLICACIONES CLÍNICAS.

Cardiac pacemakers are essential medical devices designed to manage arrhythmias by delivering electrical impulses to regulate heart rhythm. This comprehensive review explores their function, types, and clinical applications, emphasizing their role in improving patient outcomes. Modern pacemakers consist of a pulse generator and leads that transmit electrical signals to the myocardium, ensuring adequate cardiac output. The classification of pacemakers includes single-chamber, dual-chamber, and biventricular devices, each tailored to specific clinical needs. Single-chamber pacemakers stimulate either the atrium or ventricle, while dual-chamber devices coordinate atrial and ventricular contractions to mimic natural heart rhythm. Biventricular pacemakers, or cardiac resynchronization therapy (CRT) devices, are employed in patients with heart failure and ventricular dyssynchrony to improve systolic function and reduce symptoms. Indications for pacemaker implantation range from bradyarrhythmias, such as sick sinus syndrome and atrioventricular block, to advanced heart failure requiring CRT. Advances in technology have led to the development of leadless pacemakers and devices with extended battery life, offering minimally invasive options and reducing complications like lead fracture and infection. Additionally, some modern pacemakers incorporate remote monitoring capabilities, allowing clinicians to track device performance and patient status in real-time. Clinical decision-making regarding pacemaker selection and programming depends on patient- specific factors, including underlying cardiac pathology, comorbidities, and lifestyle. While the benefits of pacemakers are well-documented, potential complications, such as infection, lead dislodgement, or device malfunction, necessitate careful follow-up and management.

Complexity of the Therapeutic Regimen in Older Adults with Cancer: Associated Factors.

Population aging is a worldwide phenomenon and is often associated with multimorbidity and polypharmacy. Complex medication regimens are common among older adults and contribute to the occurrence of harmful health outcomes. Age is one of the main risk factors for cancer. This study aimed to determine and characterize the therapeutic complexity in older patients with cancer, and analyze the factors associated with high complexity and the impact of the oncological context. A cross-sectional study with patients aged ≥65 years with cancer was conducted in three hospitals in northern Portugal. Data collection was obtained using self-reports. The medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI). Descriptive and association statistical analysis were performed. Logistic, linear, simple and multiple regression analysis were conducted, with and without automatic variable selection. A total of 552 patients were included (median age, 71; IQR, 68-76). The mean MRCI before the oncological context was 18.67 (SD 12.60) and 27.39 (SD 16.67) after the oncological context, presenting a statistically significant difference in the values obtained (p < 0.001). An elevated complexity was significantly associated with polypharmacy, chronic diseases and with the administration of high-risk medications (p < 0.05). High MRCI values showed a relationship with the occurrence of potential drug interactions (p < 0.001). There was no relationship with the existence of cardiac risk comorbidity. This study demonstrated the existence of high therapeutic complexity in older patients with cancer, suggesting the need for intervention to prevent medication-related problems in this vulnerable population.

Abstract Su906: Patient and Arrest Characteristics Associated with Rearrest and Mortality Following Out of Hospital Cardiac Arrest

Background: Cardiac rearrest post-return of spontaneous circulation (ROSC) is a critical concern in emergency care, as it is associated with worse outcomes. Patient characteristics and arrest factors associated with rearrest remain poorly understood, making predicting rearrest after out of hospital cardiac arrest (OHCA) challenging. Aim: To examine rearrest patterns, identify patient-specific risk factors for rearrest, and assess the impact of rearrest on patient outcomes. Hypothesis: Patients that experience rearrest after OHCA will have greater cardiac comorbidities, unfavorable arrest characteristics, and greater mortality. Methods: We performed an observational single-site clinical trial of consecutive adult EMS OHCA patients with ROSC (1/01/2018 to 3/31/24). EMS reports, continuous EMS ECG recordings, and electronic health records were analyzed to determine rearrest occurrence at any time during EMS and ED care. Patient demographics, comorbidities, and arrest/rearrest characteristics were determined. The primary outcome was survival at 6 months. Statistical significance was determined using Chi-square and logistic regression (LR) analyses. Results: We examined 344 patients with OHCA and ROSC, of whom 173 patients rearrested and 171 did not. Patients experiencing rearrest were older (p&lt;0.003) and more likely to be female (p&lt;0.013). They were also more likely to have ED resuscitation medications and interventions (epinephrine, amiodarone, lidocaine, defibrillation, all p&lt;0.001) and a higher incidence of underlying cardiovascular comorbidities, including HTN and CAD (p&lt;0.03). Notably, PEA and asystole were the most common rearrest rhythms, and time from arrest to ROSC was greater (30±16 vs. 25±15 min, p&lt;0.007) in rearrest patients vs. those who did not rearrest. Patients with rearrest were less likely to receive TTM (p&lt;0.003) and importantly, had higher rates of in-hospital and six-month mortality (both p&lt;0.001). In a LR model, no rearrest (OR 2.4, 1.1-5.2), shockable arrest rhythm (OR 9.3, 4-22), female sex (OR 3.3, 1.6-6.5), and therapeutic hypothermia (OR 3.3, 1.7-6.4), were associated with survival (all p&lt;0.04). Conclusions: Rearrest is independently associated with mortality. Increased age, male sex, and underlying cardiac comorbidities were associated with rearrest. Patient and arrest characteristics may predict rearrest. Improved understanding of why these factors promote rearrest will be important to prevent rearrest to enhance OHCA outcomes.

Abstract 4138507: Uncovering Risk Factors for Myocarditis and Cardiac Arrhythmia in Youth Post-SARS-CoV-2 Infection: Insights from the N3C Database and Advanced Machine Learning

Background: SARS-CoV2 infection has been associated with cardiovascular consequences, including myocarditis and cardiac arrhythmias. Myocarditis secondary to SARS-CoV2 infection and cardiac arrhythmias may often go unrecognized and can present with late and nonspecific symptoms. Predicting those at risk allows for prompt treatment and prevention of their potentially life-threatening consequences. Methods: The National COVID Cohort Collaborative (N3C) database was used to identify patients aged 0-30 years with COVID-19 index date between 1/1/2020 and 3/31/2022, whose sites provided data for at least six months beyond the index date. Outcomes included myocarditis and new arrythmias within 6 months of the index visit. Patients with known cardiac comorbidities were excluded. Predictors included gender, race, COVID severity as an ordinal scale, vaccination status, clinical comorbidities, and Area Deprivation Index (ADI). The data were stratified by age groups (0-4, 5-17, 18-30). Random forest models were used for data analysis and SHapley Additive exPlanations (SHAP) method was applied to optimize results. These analyses were conducted using the NCATS N3C Data Enclave. Results: Of the 1,487,741 patients in our study population, 4,105 (0.28%) had the measured outcomes; 404 had myocarditis only, 3,634 had arrhythmia only and 67 had both. Severity of COVID (SHAP 0.2344 for 0-4 years, 0.2114 for 5-17, 0.1370 for 18-30) was identified as the most important risk factor for de-novo myocarditis and arrhythmias overall. Increase in ADI (indicating lower socioeconomic status) was the second most important risk factor for the 0-4 and 5-17 age groups (SHAP: 0.0370, 0.0223). Among the 18-30 age group, race (SHAP 0.0321) and gender (SHAP 0.0289) were the second and third most important risk factors, with White and Black patients more likely to develop an event and Hispanic patients less likely. Women were less likely to develop a cardiac outcome than men. Conclusion: The severity of COVID was identified as the most important risk factor for the occurrence of myocarditis or cardiac arrhythmia within 6 months of infection. ADI, race, and gender were also identified as important, though less influential, risk factors.

Abstract Su1205: The Effect of Targeted Temperature Management on Five-Year Mortality in Comatose Out-of-Hospital Cardiac Arrest Survivors: A Real-World Experience

Background: Hypothermia-Induced Targeted Temperature Management (TTM) is a neuroprotective treatment after the return of spontaneous circulation (ROSC) in comatose survivors of out-of-hospital cardiac arrest (OHCA). However, its effectiveness in all patient subpopulations is debated. While short-term survival has been well studied, the impact of TTM on long-term survival is still unknown. Methods: In a prospective cohort study, 98 comatose survivors of non-traumatic OHCA were recruited from four tertiary-level hospitals in Buffalo, Western New York and followed up for five years. Patients with active cancer, infection, cardiac pathology or surgery in three-month prior to presentation, were excluded. Cardiac arrest characteristics, demographics, comorbidities, and therapeutic interventions were recorded. According to TTM protocols, a target body temperature of 33°C was reached and maintained for 24 hours using either an intravascular cooling catheter or a surface cooling system. This was followed by gradual controlled rewarming over 12-24 hours to normothermia. Factors associated with the receipt of TTM were determined. The effect of TTM on five-year survival was studied using cox-regression analysis. Results: Among comatose patients with mean age of 60.1±14.9 years, 49% received TTM. Females were significantly less likely to receive TTM (35.1% vs 59.3%, p=0.021). In TTM group, the time to ROSC was significantly longer: median [IQR] 14.5 mins (5-19.7) vs 20 mins (12-27), p=0.018. TTM group was more likely to have a history of coronary artery disease (CAD) (12.5% vs 35.4%, p=0.009). Overall, 5-year mortality did not differ significantly between TTM vs. non-TTM: 72.9% vs 66.0%, (HR: 1.134, 95% CI: 0.705-1.826, p=0.603) in univariate and multivariate Cox-regression analysis (Table 1). Conclusion: While females are less likely to receive TTM treatment, TTM is more likely to be used in patients with a longer time to ROSC and a history of CAD. The overall five-year survival remains high in both treatment groups in all eligible patients, as well as in shockable and non-shockable rhythm groups studied separately. Larger cohort studies are needed to determine the patients who may benefit most from TTM.

Abstract 4139117: Epidemiology of Patients Undergoing a Rapid Response within the First 24 Hours of Admission at an Urban Academic Center

Introduction: A Rapid Response Team (RRT) is an inpatient team that aims to resuscitate deteriorating patients in non-critical care settings and reduce inpatient morbidity and mortality. It is not well understood which patients are likely to deteriorate and need a rapid response (RR) within the first 24 hours of admission. Research Question: We sought to identify the most common characteristics for patients who had a RR within 24 hours of admission. Methods: We performed a descriptive analysis evaluating 176 patients who had a RR called within 24 hours of admission to North Shore University Hospital from February 2022 to August 2023. Demographic and clinical variables were assessed, including medical history, admitting diagnosis, and indication for RR. Results: The median age of the population was 73 years; 92 (52.3%) were male, and 91 (51.7%) were white. The most common comorbidities were hypertension (119, 67.6%), coronary artery disease (51, 28.9%), and heart failure (34, 19.3%). Amongst these patients, acute hypoxic respiratory failure (11.6%) was the most common admission diagnosis followed by sepsis (9.7%) (Table 1). The most common reason for the RR was acute mental status change (26.1%) followed by hypotension (25.0%). Average time spent in the ED prior to admission was 6 hours 41 mins. Intensive care unit (ICU) consultation prior to the RRT occurred in 36 patients (20.5%) and 52 patients (29.5%) were transferred to an ICU while 124 (70.5%) remained on the medicine floors. Regarding hospital utilization, 98 (55.7%) patients were admitted within the last year and 47 (26.7%) patients were hospitalized within the last month. 14 (7.9%) patients had an ICU admission in the past year. 38 (21.5%) patients died during the admission post RR. Conclusion: In our cohort of RRs within 24 hours of admission, we observed a high prevalence of cardiac comorbidities and recent hospitalizations, a low prevalence of ICU consults prior to RR, and discordance between admitting diagnoses and reasons for RR. Further studies involving a larger cohort are needed to develop a prediction model for determining patients most at risk of deteriorating after admission and requiring RRs.

High VExUS grades are linked to cardiac function in general ICU patients.

Even though initially considered as a new standard in systemic venous congestion assessment, the semi-quantitative Doppler ultrasound-based Venous Excess Ultrasound Grading System (VExUS) showed inconsistent associations with outcomes in general intensive care unit (ICU) patients. It is unclear why VExUS is so effective in predicting outcomes in some cohorts and not in others. The determinants of higher VExUS have not been studied in a general ICU cohort. The aim of this study was to determine the factors associated with higher VExUS (≥ 2) in a general ICU cohort. We performed a post-hoc analysis of a prospective, observational cohort, including adult patients within 24 hours of ICU admission and expected ICU length of stay longer than 2 days. Collected data included patients' hemodynamic status (including ultrasound evaluation) at several points in time: ICU admission, day 1, day 2, day 5, and the last day of ICU stay. We analyzed 514 hemodynamic evaluations in 145 patients. 96/514 (18.7%) had a VExUS grade ≥ 2. The univariable followed by multivariable mixed-effects logistic regression analyses only found a statistically significant association between VExUS ≥ 2 and right ventricle S wave (OR 0.85 (0.74;0.97), p = 0.02) and left ventricle E/A ratio (OR 2.34, 95% CI (1.27;4.33), p = 0.006). The current study has elucidated that higher VExUS is primarily associated with cardiac comorbidities and ultrasound parameters of left- and right-sided cardiac systolic and/or diastolic function in general ICU patients.

Comparison of low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy in patients with cardiopulmonary comorbidities: a double blinded randomized clinical trial

BackgroundThe benefits of low-pressure laparoscopic cholecystectomy (LPLC) in patients with cardiopulmonary comorbidities remain unclear. This study aimed to explore the feasibility and pulmonary effects of LPLC in patients with cardiopulmonary comorbidities.MethodsThis was a multicenter, parallel, double-blind, randomized controlled trial. Eligible patients included patients with cardiac or pulmonary comorbidities, who were randomly assigned (1:1) to undergo LPLC (10 mmHg) or standard-pressure laparoscopic cholecystectomy (SPLC) (14 mmHg). The primary outcome was postoperative partial pressure of carbon dioxide (CO2). Surgical safety variables, patient recovery, pulmonary function parameters, and surgeon comfort were also compared between groups.ResultsThis study enrolled 144 participants, with 124 participants extracted for the final analysis (62 in LPLC and 62 in SPLC group, respectively). The median postoperative PaCO2 was similar in the LPLC (43.3 mmHg) and SPLC (43.0 mmHg) groups (p = 0.988). Pulmonary parameters including postoperative pH, PaCO2, HCO3, and lactate levels were similar between the two groups. Postoperative base excess was significantly higher in the LPLC group (− 0.6 mmol/L [− 6.9 ~ 7.5] vs. −1.9 mmol/L [− 6.6 ~ 5.4]; p = 0.031). There was no between-group difference regarding intraabdominal operative time, rate of intraoperative bile spillage, blood loss, surgeon comfort during surgery, and conversion rate. Moreover, postoperative major complication rates, the median time to the first flatus, postoperative hospital stay, or mean postoperative visual analog scale score for pain were similar in both groups.ConclusionsThis study found no reduction of partial pressure of CO2 with LPLC compared with SPLC for patients with cardiopulmonary comorbidities. LPLC with a pneumoperitoneum pressure of 10 mmHg may be safe and feasible for these patients when performed by experienced surgeons, although it does not improve pulmonary parameters.RegistrationThe trial is retrospectively registered at ClinicalTrials.gov (NCT04670952) on December 17, 2020.

Airway Management With Congenital Tracheal Stenosis: Surgical and Anesthetic Consideration.

To investigate demographic data and airway management techniques for patients with congenital tracheal stenosis (CTS) during the preoperative, intraoperative, and postoperative periods. A retrospective chart review. This study was a retrospective case series at a single tertiary care pediatric medical center. It encompassed all children diagnosed with CTS who underwent slide tracheoplasty from January 2001 through December 2018. Exclusion criteria were acquired stenosis, tracheomalacia, patients without a confirmed diagnosis of CTS, and those with missing data. Patient demographics and details of airway management were collected and analyzed. A total of 148 patients met the inclusion criteria. The most common etiology of CTS was congenital tracheal rings (90.5%). The median age at surgery was 9 months (interquartile range [IQR] 3.3-35.4), and the median stenosis length was 4.0 cm (IQR 3.5-5.4). The most frequent comorbidities were genetic diseases, prematurity, and preoperative intubation. The most common related cardiac comorbidities were pulmonary artery sling, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of Fallot. Most of the patients with CTS exhibited 50% to 80% stenosis. Most of the patients underwent thoracic approach slide tracheoplasty. Airway management was primarily accomplished using an oral or nasal endotracheal tube preoperatively, cardiopulmonary bypass during surgical repair, and an oral or nasal endotracheal tube during closure and the postoperative period. Slide tracheoplasty is an effective treatment for congenital tracheal stenosis. Coordinated airway management between the anesthesia and surgical teams is crucial. Appropriate planning yields the best patient outcomes. 4 Laryngoscope, 2024.

R-Cmop and Pola-R-CMP Regimes As First-Line Treatment for Diffuse Large B-Cell Lymphoma with Cardiac Comorbidity

R-Cmop and Pola-R-CMP Regimes As First-Line Treatment for Diffuse Large B-Cell Lymphoma with Cardiac Comorbidity

Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments

BackgroundPrevious research has suggested a heightened risk of acute myocarditis after COVID-19 infection. However, it is not clear from existing work whether this risk is higher than would be expected...

Association of risk factors on mortality in ST-elevation myocardial infarction patients with diabetes mellitus: a systematic review and meta-analysis of cohort studies

Abstract Introduction Despite advancements in medical therapy and revascularization strategies for ST-elevation myocardial infarction (STEMI), diabetes mellitus (DM) remains independently associated with enhanced morbidity and mortality in STEMI. The causes for this are still unknown. Therefore, we aimed to summarise and quantify existing evidence in a systematic review and meta-analysis on the association between risk factors and mortality in STEMI patients with DM from prospective and retrospective cohort studies. Methods The systematic literature search was performed on the database of PubMed, Scopus and the Cochrane library up to July 2022. Relevant data were extracted and the risk of bias (RoB) of each study was assessed by using the Quality In Prognosis Studies (QUIPS) tool. All steps were conducted by two researchers independently. Summarised relative risks (SRR) and 95% confidence interval (CI) were estimated using a random effects model. I² was calculated as a measure of inconsistency. Results Out of 7601 studies, 18 were included after full-text screening, meeting our inclusion criteria. The RoB was moderate for 6 and high for 12 studies. Results of 7 studies reported on in-hospital mortality, 7 on all-cause-mortality up to 72 months, 3 on both outcomes, and 1 on cardiac death followed-up for 3.5 years. We found an increased risk of mortality for female compared to male sex (SRR [95% CI]: 1.56 [1.20; 2.01], n = 3 studies), age per 5 year increase (SRR [95% CI]: 1.26 [1.23; 1.30], n = 10 studies), admission blood glucose ≥ 7,8 mmol/l (SRR [95% CI]: 2.54 [1.60; 4.04], n = 3 studies), insulin treatment (SRR [95% CI]: 1.72 [1.33; 2.21], n = 2 studies), and dedicated Killip classification III-IV (SRR [95% CI]: 2.97 [2.58; 3.41], n = 3 studies) in STEMI patients with DM. Similar findings were observed for pre-existing comorbidities: prior myocardial infarction (SRR [95% CI]: 1.25 [1.06; 1.47], n = 3 studies), and heart failure (SRR [95% CI]: 2.68 [1.83; 3.93], n = 2 studies). Current smoking (SRR [95% CI]: 0.68 [0.52; 0.88], n = 3 studies) and hypercholesterinemia (SRR [95% CI]: 0.67 [0.57; 0.79], n = 2 studies) showed a reduced risk for mortality, while no association was found for multivessel disease (SRR [95% CI]: 1.03 [0.55; 1.92], n = 3 studies). Conclusion We identified specific risk factors of diabetes for mortality after STEMI. Our results confirm higher risk of mortality among STEMI patients with DM, particularly in women, older individuals, those with high admission blood glucose or insulin-dependent diabetes, and cardiac comorbidities. The role of smoking and hypercholesterinemia as a predictor for mortality might be explained by reverse causality and warrants further investigation.

Machine learning approach for detection of valvular heart disease through digital cardiac auscultation: results from multi-center prospective cross-sectional study

Abstract Background Cardiac auscultation, an essential bedside diagnostic tool, often identifies significant valvular heart disease through murmurs. However, its accuracy is contingent upon the clinician's expertise, leading to a growing dependence on expensive imaging techniques. This study aimed to develop and validate a machine learning model for detecting valvular heart disease from cardiac auscultation. Methods The digital cardiac auscultation and associated echocardiograms were prospectively collected from three sites between May 1, 2022, and Dec 31, 2022. We trained, validated, and externally tested a machine learning based model to classify aortic stenosis, mitral stenosis, aortic regurgitation, mitral regurgitation, tricuspid regurgitation, oveall valvular heart disease from cardiac auscultation, age, sex, and comorbidity. We condcted training, and internal testing using datasets for eXtreme Gradient Boosting (XGBoost) machine learning model from hospital one and hospital two. The dataset from hospital three was employed for external testing. We evaluated the area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), accuracy, sensitivity, specificity. Result We selected the cardiac auscultation and echocardiograms of a total of 4,321 patients, excluding those without valvular heart disease information, congenital heart disease, a history of valvular operation, and cardiac auscultation could not be interpreted. The diagnostic performance of heart murmurs for valvular heart disease across the three datasets generally demonstrated high sensitivity and PPV. Specifically, the sensitivity for aortic stenosis was 89.1%, mitral stenosis 88.8%, aortic regurgitation 88.5%, mitral regurgitation 89.8%, tricuspid regurgitation 90.1%, and for any valvular heart disease, it was 95.0%. However, the NPV was consistently lower, with values of 16.4%, 14.2%, 12.2%, 23.1%, 26.2%, and 65.3% for the respective conditions. In XGBoost machine learning model, the AUROC values for internal testing (N=1,403), along with their 95% confidence intervals, were as follows: aortic stenosis (0.93, 0.88–0.97), mitral stenosis (0.91, 0.81–0.97), aortic regurgitation (0.84, 0.79–0.90), mitral regurgitation (0.94, 0.90–0.98), tricuspid regurgitation (0.81, 0.75–0.87), and overall valvular heart disease (0.86, 0.82–0.89). For external testing (N=814), the AUROC values were: aortic stenosis (0.90, 0.83–0.96), mitral stenosis (0.88, 0.79–0.95), aortic regurgitation (0.94, 0.93–0.96), mitral regurgitation (0.93, 0.92–0.95), tricuspid regurgitation (0.89, 0.87–0.91), and overall valvular heart disease (0.92, 0.90–0.94). Conclusion The machine learning based model can accurately classify valvular heart diseases using information from digital cardiac auscultation.Figure 1.Study FlowFigure 2.AUC curve

STATE OF HAEMODYNAMICS AND OXYGEN BUDGET IN THE PERIOPERATIVE PERIOD IN PATIENTS WITH OSTEOARTHRITIS AND CONCOMITANT CARDIAC PATHOLOGY DURING TOTAL HIP ARTHROPLASTY SURGERY DEPENDING ON THE TYPE OF SURGICAL ACCESS

Summary. Aim. To compare the hemodynamic status and oxygen budget in patients with osteoarthritis and comorbid cardiac pathology during total hip arthroplasty, based on the type of surgical approach used. Materials and Methods. The study analyzed the treatment outcomes of 90 patients with stage 3-4 osteoarthritis of the hip who underwent total cemented hip arthroplasty. All patients were divided into two groups according to the surgical approach (traditional posterior or modified posterior). The study was conducted at the following stages: before surgery, immediately after surgery, 24 hours post-surgery, and one week after surgery. The following parameters were recorded: hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and central venous pressure) and oxygen budget parameters (hemoglobin (Hb), lactate, hematocrit (Ht), oxygen saturation of hemoglobin in arterial and venous blood (SaO2 and SvO2), partial pressure of oxygen in arterial and venous blood (paO2 and pvO2)). Based on these data, the following indices were calculated: left ventricular ejection fraction (LVEF), cardiac index (CI); oxygen content in arterial and venous blood (CaO2 and CvO2), arteriovenous oxygen content difference (C(a-v)O2), oxygen transport (TO2), oxygen consumption (VO2); systemic perfusion pressure (SPP), blood flow power (BFP), oxygen reserve (OR), and circulatory reserve (CR). Results. The use of the modified posterior approach positively influenced hemodynamic parameters. After the surgery and on the 7th day post-surgery, SPP was significantly lower with the modified posterior approach. The CI was also significantly affected by the modified posterior approach. Throughout the study, except for the first stage, CI was significantly higher when using the modified posterior approach. LVEF increased significantly with both approaches, but on the 7th day post-surgery, it was significantly higher in the second group. BFP did not statistically differ between the two groups throughout the study, but its energy efficiency was lower, primarily due to the arteriovenous oxygen content difference (C(a-v)O2). C(a-v)O2 was the same before surgery for both approaches. At subsequent stages of the study, the differences between the groups increased, and on the 7th day, they were the most significant, with C(a-v)O2 being lower after using the modified posterior approach. The energy efficiency of blood flow was assessed by calculating OR and CR. Both indicators were significantly higher during the study, except at the preoperative stage, when using the modified posterior approach. Conclusions. Our study clearly demonstrates the benefits of implementing the modified posterior approach in total hip arthroplasty for patients with osteoarthritis and comorbid cardiac pathology. This approach improves hemodynamic and oxygen budget parameters compared to the traditional approach, which can significantly impact treatment outcomes for patients with cardiac comorbidity and reduce the number of postoperative complications.

Cardiac Comorbidity and Exercise Intolerance in Bilateral Lung Transplant Recipients Followed at a Pediatric Center.

Reduced exercise capacity is common in young bilateral lung transplantation (Bi-LTx) recipients, but longer-term data on cardiac comorbidities are limited. We evaluate potential cardiac contributions to long-term exercise intolerance in this population. All Bi-LTx recipients at a single pediatric center, who completed routine clinical post-transplant cardiac assessment, including echocardiogram, cardiac exam, and cardiopulmonary exercise testing (CPET), were included. Cardiac risk factors (CRFs) were assessed by history and laboratory tests. CPET-derived peak and percent-predicted peak myocardial oxygen consumption (VO2 peak, ppVO2 peak) were used to quantitate exercise capacity. Percent-predicted peak oxygen pulse (pp peak O2 pulse) assessed stroke volume. 15 patients (67% M; median age 21.6years, median follow-up from Bi-LTx 7.0years) were included. Almost all patients (14, 93%) had multiple CRFs; hypertension and hyperlipidemia/dyslipidemia were the most common. On CPET, 93% (n = 14) had abnormal (≤ 85%) ppVO2 peak (median 59%). 73% (n = 11) had abnormal pp peak O2 pulse (median 74%). Ten had blunted heart rate response to exercise. Nine had left ventricular diastolic dysfunction (LV-DD) on echocardiogram. Median percent-predicted forced expiratory volume in one second was 70%. One had severe chronic lung allograft dysfunction. Cardiac risk factors and exercise intolerance are common among young Bi-LTx recipients years post-transplant, even among those without significant pulmonary dysfunction. High prevalence of multiple CRFs, LV-DD, chronotropic dysfunction, and abnormal stroke volume suggest cardiac comorbidities may contribute to intolerance. Medical management of CRFs and tailored exercise may decrease cardiac risk and improve functional capacity for Bi-LTx survivors.

Zinc Deficiency and Post-acute Outcomes in Patients With COVID-19: A Six-Month Retrospective Cohort Analysis of 3,726 Patients.

Background Previous studies have suggested that zinc deficiency (ZD) may increase the risk of short-term mortality in patients with coronavirus disease 2019 (COVID-19). However, the relationship between zinc status and post-acute COVID-19 outcomes remains unclear. This study aimed to determine the association between ZD and long-term outcomes in patients with COVID-19. Methodology We conducted a retrospective cohort study using the TriNetX database, including patients aged 18 years or older diagnosed with COVID-19 between January 1, 2022, and July 31, 2023. Patients had documented serum or plasma zinc levels within three months before COVID-19 diagnosis and were not deceased or hospitalized in the first month of infection. They were categorized into ZD (zinc levels <70 μg/dL) and control (zinc levels ≥70 μg/dL) groups. After 1:1 propensity score matching for demographic and clinical variables, outcomes were assessed from 30 to 180 days post-diagnosis, including all-cause hospitalization, all-cause mortality, and four subphenotypes of post-acute COVID-19. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results After matching, each group included 1,863 patients with balanced baseline characteristics. The ZD group had a higher incidence of all-cause hospitalization (25.3% vs. 20.3%; HR = 1.314; 95% CI = 1.148-1.505; p < 0.001) and all-cause mortality (3.8% vs. 2.2%; HR = 1.735; 95% CI = 1.180-2.551; p = 0.045) compared to the control group during the follow-up period. Among the four subphenotypes, only the cardiac and renal subphenotype showed a significantly higher risk in the ZD group (HR = 1.099; 95% CI = 1.002-1.205; p = 0.004). Conclusions ZD is associated with increased risks of long-term hospitalization, mortality, and increased risk in COVID-19 patients with cardiac and renal comorbidities. Monitoring and managing zinc levels may be important for improving long-term outcomes. Further research is warranted to explore the potential benefits of zinc supplementation in COVID-19 patients with ZD.

Patient-Reported Outcomes Among Adults With Congenital Heart Disease in the Congenital Heart Initiative Registry

In the US, there are more than 1.5 million adults living with congenital heart disease (CHD). The Congenital Heart Initiative (CHI) is a digital, online, patient-empowered registry that was created to advance multicenter research and improve clinical care by gathering patient-reported outcomes (PROs) in adults with CHD. To report the initial findings of the PROs for adults with CHD from the first 3 years of the CHI. The CHI was launched nationally on December 7, 2020, as an observational cohort (survey) study. Data were collected virtually through December 31, 2023, and stored on Health Insurance Portability and Accountability Act-compliant cloud-based servers with restricted access. Adults with CHD were recruited through email, social media, general advertising through advocacy organizations, and targeted outreach (telephone and in-clinic recruitment) by clinical centers. Demographics and validated survey tools on quality of life, mental health, physical activity, and health care utilization were collected at baseline and every 4 months. Descriptive statistics were used to understand the associations between various factors, including the complexity of heart defects, physical activity levels, mental health comorbidities, and socioeconomic and health care access variables. All categorical variables were analyzed using χ2 or Fischer exact test as appropriate. By December 31, 2023, the CHI had enrolled 4558 participants (2530 female [56%]) with a mean (SD) age of 38.5 (13.9) years, representing all 50 states. Approximately 88% of participants (3998 participants) completed at least 1 electronic visit as of December 31, 2023. The most prevalent CHD anatomy included tetralogy of Fallot (883 participants [22%]), transposition of great arteries (452 participants [11%]), and coarctation of the aorta (429 participants [11%]). Approximately 88% of participants (3998 participants) reported at least 1 comorbidity, with arrhythmia (1300 participants [33%]) as the most common cardiac comorbidity and mood disorder (1326 participants [35%]) as the most common noncardiac comorbidity. Among female participants, 45% (1147 participants) reported having had a pregnancy, with 38% (967 participants) resulting in biological children. Participants with complex CHD were less likely than those with moderate CHD to meet recommended physical activity guidelines (χ22 = 15.9; n = 3320; P < .001), a factor that was more pronounced among female participants. Overall health-related quality of life was rated as good or better by 84% of participants who completed the quality of life PROs (2882 participants), with no difference by CHD complexity. In this cohort study of adults living with CHD, many patients reported mood disorders, but most reported good health-related quality of life. The CHI, the largest registry of adults with CHD, is poised to facilitate multicenter research with the goal of improving clinical outcomes for all adults with CHD.

Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database.

The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk. We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles. We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('elderly and AF'), Profile 2 ('young and smoker'), Profile 3 ('young'), Profile 4 ('cardiac comorbidities') and Profile 5 ('hypertension with atherosclerotic comorbidities'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4. Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.