Cause Of Cardiovascular Death Research Articles

Anatomically aware dual-hop learning for pulmonary embolism detection in CT pulmonary angiograms

Pulmonary Embolisms (PE) represent a leading cause of cardiovascular death. While medical imaging, through computed tomographic pulmonary angiography (CTPA), represents the gold standard for PE diagnosis, it is still susceptible to misdiagnosis or significant diagnosis delays, which may be fatal for critical cases. Despite the recently demonstrated power of deep learning to bring a significant boost in performance in a wide range of medical imaging tasks, there are still very few published researches on automatic pulmonary embolism detection. Herein we introduce a deep learning based approach, which efficiently combines computer vision and deep neural networks for pulmonary embolism detection in CTPA. Our method brings novel contributions along three orthogonal axes: (1) automatic detection of anatomical structures; (2) anatomical aware pretraining, and (3) a dual-hop deep neural net for PE detection. We obtain state-of-the-art results on the publicly available multicenter large-scale RSNA dataset.

The role of echocardiography in pulmonary embolism for the prediction of in-hospital mortality: a retrospective study.

Pulmonary Embolism (PE) is the third leading cause of cardiovascular death, following myocardial infarction and stroke. The latest European Society of Cardiology (ESC) guidelines on PE recommend short-term prognostic stratification based on right ventricular (RV) overload detected by transthoracic echocardiography (TTE) or contrast-enhanced chest CT. The aim of the study is to find out which of the signs of right ventricular dysfunction best predicts in-hospital mortality (IHM). This is a monocentric, retrospective study including adult patients admitted from the emergency department with a c-e cCT confirmed diagnosis of PE between January 2018 and December 2022 who underwent a TTE within 48h. 509 patients (median age 76years [IQR 67-84]) were included, with 7.1% IHM. At univariate analysis, RV/LV ratio > 1 (OR 2.23, 95% CI 1.1-4.5), TAPSE < 17mm (OR 4.73, 95% CI 2.3-9.8), the D-shape (OR 3.73, 95% CI 1.71-8.14), and LVEF < 35% (OR 5.78, 95% CI 1.72-19.47) resulted significantly correlated with IHM. However, at multivariate analysis including also haemodynamic instability, PESI class > II, and abnormal hs-cTnI levels, only LVEF < 35% (OR 5.46, 95% CI 1.32-22.61) resulted an independent predictor of IHM. Despite the recognised role of TTE in the early management of patients with circulatory shock and suspected PE, signs of RV dysfunction have been shown to be poor predictors of IHM, whereas severely reduced LVEF is an independent risk factor for in-hospital death.

The autonomic nerves around the vein of Marshall: apostmortem study with clinical implications.

This study aims to analyze the vein of Marshall (VOM) in human autopsy hearts and its correlation with clinical data to elucidate the morphological substrates of atrial fibrillation (AF) and other cardiac diseases. Twenty-three adult autopsy hearts were studied, assessing autonomic nerves by immunohistochemistry with tyrosine hydroxylase (sympathetic nerves), choline acetyltransferase (parasympathetic nerves), growth-associated protein 43 (neural growth), and S100 (general neural marker) antibodies. Interstitial fibrosis was assessed by Masson trichrome staining. Measurements were conducted via morphometric software. The results were correlated with clinical data. Sympathetic innervation was abundant in all VOM-adjacent regions. Subjects with a history of AF, cardiovascular cause of death, and histologically verified myocardial infarction had increased sympathetic innervation and neural growth around the VOM at the mitral isthmus. Interstitial fibrosis increased with age and heart weight was associated with AF and cardiovascular cause of death. This study increases our understanding of the cardiac autonomic innervation in the VOM area in various diseases, offering implications for the development of new therapeutic approaches targeting the autonomic nervous system.

Multimodality imaging of acute and chronic pulmonary thromboembolic disease.

Pulmonary embolism (PE) is a pathological entity characterised by venous thromboembolism in the pulmonary arteries. It is a common entity in daily clinical practice and is the third most common cause of cardiovascular death. Correct diagnostic work-up is pivotal to ensure timely institution of appropriate therapy. This requires recognition of the characteristic imaging findings and awareness of the role and peculiarities of the different imaging techniques involved in the diagnostic and therapeutic process. This review aims to showcase the most commonly encountered imaging findings associated with pulmonary thromboembolism for each imaging modality, outline their advantages and disadvantages, and define the specific role of these techniques in the clinical setting. The latest innovations concerning the diagnostic work-up of PE will be also briefly discussed, yielding a perspective on the future developments and challenges that the radiologist will have to face in the coming years.

The role of health policy in the prevention of venous thromboembolism in the UK National Health Service—Learning from the past, looking to the future

Venous thromboembolism is the third most common cause of cardiovascular death globally and many diagnoses are preventable. The UK NHS has led international efforts to reduce VTE, particularly hospital-associated VTE, through coordinated national policy action and world-leading research. Despite this, VTE remains an important cause of morbidity and mortality in the UK, as underlined by the recent COVID-19 pandemic. Future reductions in VTE incidence/deaths will require progress on several fronts: a better understanding of case mix; revisiting VTE risk assessment, focussing on thromboprophylaxis failure and improving awareness of VTE amongst clinicians and the public. Changes to healthcare delivery, with care increasingly delivered outside of hospital, alongside changing disease patterns, including the rise in obesity, have huge implications for VTE and will dramatically alter prevention. The UK, with its nationalised healthcare model and long history of policy action on VTE, provides a unique lens through which to study past successes and future priorities for VTE prevention.

A Saddle Pulmonary Embolism at Transthoracic Echocardiography: A Case Report

Acute Pulmonary embolism (PE) is a life-threatening disease and is considered the third major cause of cardiovascular death with higher incidence and mortality rates. Identifying a saddle PE between the left and the right pulmonary trunk in transthoracic echocardiography (TTE) is rare, and helps to make a rapid diagnosis to avoid complications. Clinical presentation, electrocardiogram, and X-ray guide the diagnosis but are not specific. TTE is helpful and confirms the diagnosis especially when the CT is not available or in other situations when it is not realizable. Visualizing a pulmonary artery thrombus in TTE is unusual. It can be identified in the right cardiac chambers in less than 5% of patients with PE. The severity of acute PE is determined by its hemodynamics, the sudden pulmonary hypertension, and the development of obstructive shock. Anticoagulation therapy is the cornerstone of PE management and should be initiated as soon as possible.

Formulation and Evaluation of Polyherbal Extract Used in the Prognosis of Pulmonary Embolism

Pulmonary embolism (PE) is a common and potentially deadly form of venous thromboembolic disease. It is the third most common cause of cardiovascular death and is associated with multiple inherited and acquired risk factors as well as advanced age. It is the condition in which one or more arteries in the lungs become blocked by a blood clot causing various chronic symptoms is said to be pulmonary embolism and there are various allopathic medications are currently available on the management of the emboli including the various clot dissolvers( thrombolytics ) and blood thinners ( anticoagulants ) also surgical processes are performed according to the sevearity. But there is a herbal aspects which is useful as well in case of prognosis of the various kind of emboli including pulmanary emboli and it shows numerous health benefits along with its physiological activity with minimum or less side effects

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

BackgroundFew reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR) are currently available. Further, no present studies compare patients with new onset LBBB with those with pre-existing LBBB. ObjectivesThis study aimed to investigate the association between pre-existing or new onset LBBB and clinical outcomes after TAVR. MethodsUsing data from the Japanese multicenter registry, 5,996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB, and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportional hazards models and propensity score analysis to adjust the differences in baseline characteristics. ResultsOf 5,996 patients who underwent TAVR, 280 (4.6%) had pre-existing LBBB, while 1,658 (27.6%) experienced new onset LBBB. Compared with the no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated not only with a higher 2-year all-cause (adjusted HR: 1.39; 95% CI: 1.06-1.82; P = 0.015) and cardiovascular (adjusted HR: 1.60; 95% CI: 1.04-2.48; P = 0.031) mortality, but also with higher all-cause (adjusted HR: 1.43, 95% CI: 1.07-1.91; P = 0.016) and cardiovascular (adjusted HR: 1.81, 95% CI:1.12-2.93; P = 0.014) mortality than the new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group. ConclusionsPre-existing LBBB was independently associated with poor clinical outcomes, reflecting an increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.

Risk Stratification and Management of Intermediate-Risk Acute Pulmonary Embolism.

Pulmonary embolism (PE) is the third most common cause of cardiovascular death and necessitates prompt, accurate risk assessment at initial diagnosis to guide treatment and reduce associated mortality. Intermediate-risk PE, defined as the presence of right ventricular (RV) dysfunction in the absence of hemodynamic compromise, carries a significant risk for adverse clinical outcomes and represents a unique diagnostic challenge. While small clinical trials have evaluated advanced treatment strategies beyond standard anticoagulation, such as thrombolytic or endovascular therapy, there remains continued debate on the optimal care for this patient population. Here, we review the most recent risk stratification models, highlighting differences between prediction scores and their limitations, and discuss the utility of serologic biomarkers and imaging modalities to detect right ventricular dysfunction. Additionally, we examine current treatment recommendations including anticoagulation strategies, use of thrombolytics at full and reduced doses, and utilization of invasive treatment options. Current knowledge gaps and ongoing studies are highlighted.

The paradigm shift in treatment of severe venous thromboembolism.

Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).

Association Between Use of Sodium-Glucose Cotransporter-2 Inhibitors or Angiotensin Receptor-Neprilysin Inhibitor and the Risk of Atherosclerotic Cardiovascular Disease With Coexisting Diabetes and Heart Failure.

This study was to investigate the association between the use of Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) or angiotensin receptor-neprilysin inhibitor (ARNI; ie, Sacubitril + valsartan, Product name ENTRESTO) and the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with coexisting diabetes and heart failure. Specifically, the study compared outcomes between patients using SGLT2i or valsartan + sacubitril and those not using these medications. This study utilized data from the National Health Insurance Research Database (NHIRD) from 2017 to 2018. The case group consisted of 8691 patients with coexisting diabetes and heart failure who did not use SGLT2i or Entresto, while the control group consisted of 8691 patients with coexisting diabetes and heart failure who used SGLT2i or Entresto. The primary outcome was ASCVD, including a composite of cardiovascular death and hospitalization for worsening heart failure. Secondary outcomes included all-cause death, cause of cardiovascular death, and recurrence of heart failure, non-fatal myocardial infarction, non-fatal stroke (including ischemic stroke and hemorrhagic stroke) and new renal replacement therapy. The study found that the use of SGLT2 inhibitors or ARNI was associated with a lower risk of ASCVD in patients with coexisting diabetes and heart failure. The study suggests that the use of SGLT2 inhibitors, alone or in combination with Entresto, may be effective in reducing the risk of ASCVD and its associated adverse outcomes in patients with diabetes and heart failure. This finding has important implications for the management of these conditions.

Comparison of grace, timi risk scores for prediction of major adverse cardiac events in patients with acute myocardial infarction, Vietnam

Acute myocardial infarction (MI) is one of the leading causes of cardiovascular death and can experience many events during illness. Therefore, many risk prediction scales have been established to stratify patients with acute MI, in which TIMI and GRACE scores are common. We conducted this study to compare the predictability of GRACE and TIMI scores in patients with acute MI within 12 months. A prospective cohort study was performed on 195 patients with acute MI, of which 86 patients had ST elevation (STEMI) and 109 patients without ST elevation (NSTEMI). The study looked at five major events including death, coronary re-intervention, bleeding due to drug use, re-hospitalization, and stroke. As a result, the heart rate in the STEMI group was 83.06 ± 14.78, higher than the heart rate of the NSTEMI group at admission (78.59 ± 10.63), the difference was significant with p = 0.015. The study has not shown the predictive effect of GRACE and TIMI scores on the occurrence of events in patients with acute MI within 12 months. However, the study showed that GRACE can better ability to stratify the risk for the group of subjects that had not yet occurred.

The Impact of a Handheld Ultrasound Device in a Rheumatic Heart Disease Screening Program in Ethiopia

Background: Rheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis prevents progression in asymptomatic disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, studies are needed to evaluate their performance in these settings.&#x0D; Methods: We conducted a retrospective study comparing the rate of screen positive ultrasounds before and after the use of a handheld ultrasound in an RHD screening program in Ethiopia. We also performed a cross-sectional device comparison in 19 at-risk school-children participating in the rheumatic heart disease screening program.&#x0D; Results: Between March of 2019 and Jan of 2022, 6631 children were screened for rheumatic heart disease of whom 4029 were screened after the introduction of a handheld device. Before the use of the handheld ultrasound device 291 (11.2%) children had a screen positive ultrasounds compared with 167 (4.1%) afterwards (p &lt; 0.001). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p=0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. &#x0D; Conclusions: Our study highlights that the screen-positive rate in a RHD screening program is influenced by the device being used in the screening process.&#x0D;

Trends and Specific Causes of Cardiovascular Mortality after Kidney Transplantation in Finland.

Cardiovascular diseases are an important cause of mortality in patients who have undergone kidney transplantation, but the knowledge on trends of cardiovascular mortality and specific causes of cardiovascular death among these patients is scarce. Our aim was to compare the cardiovascular mortality rates after kidney transplantation in Finland between 1990-1999, 2000-2009, and 2010-2019 using data from the Finnish Registry for Kidney Diseases. We analyzed 1-year and long-term cardiovascular mortality rates as well as the specific causes of cardiovascular death and the trends in them. In total, 4946 patients underwent first kidney transplantation in 1990-2019. During the follow-up time (median 8.3 years, interquartile range 4.0-14.5), there were 1392 deaths, of which 582 were cardiovascular deaths. In an unadjusted Cox regression model, the risk of long-term cardiovascular mortality was similar in the different periods. However, when adjusted for age, sex, duration of dialysis, and cause of kidney disease, the long-term cardiovascular mortality risk was significantly lower in 2000-2009 and 2010-2019 (hazard ratio 0.60 [95% confidence interval, 0.49 to 0.73] and hazard ratio 0.51 [95% confidence interval, 0.39 to 0.66], respectively) compared with 1990-1999. The results were similar regarding 1-year cardiovascular mortality. The distribution of different causes of cardiovascular death remained unchanged during the study period, with coronary artery disease accounting for 47% of deaths. During the first year after transplantation, pulmonary embolisms and arrhythmias were more common than in the long term. Cardiovascular disease remained the most common cause of death in kidney transplant recipients, but adjusted cardiovascular mortality risk has decreased significantly during the past three decades. Coronary artery disease was the most frequent cause of cardiovascular death, and the proportion of coronary artery disease-related cardiovascular deaths increased after the first year after transplantation.

Cause-specific death in heart failure across the ejection fraction spectrum

Abstract Background Heart failure (HF) is associated with increased cardiovascular (CV) and non-CV mortality, but little data is available on underlying causes of death in HF phenotypes based on ejection fraction (EF). Knowledge about causes of mortality may have implications for healthcare decisions, treatment priorities and clinical trial design. Purpose To examine cause-specific mortality in patients with HF with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF). Methods Patients enrolled in the Swedish Heart Failure Registry between 2000-2021 were included. The causes and incidence rates of death across the EF categories were studied. In addition, to examine the association between EF categories and cardiovascular (CV) and non-CV mortality, sub-distributional hazards models were performed accounting for competing risk of death from other causes and adjusted for age and sex. Results Among 100,584 patients (23% HFpEF, 23% HFmrEF, 53% HFrEF), median age (IQR) was 75.0 (66.0-82.0) and 36.5% were females. Of those who died within 5 years, most deaths were ascribed to CV deaths across all EF categories (65% in HFrEF, 59% in HFmrEF and 58% in HFpEF, respectively). Within 5 years, patients with HFpEF had higher risk of non-CV mortality (adjusted HR 1.38, 95% CI 1.33-1.43, p&amp;lt; 0.001) and lower risk of CV mortality (adjusted HR 0.80, 95% CI, 0.78-0.83, p&amp;lt; 0.001) compared to patients with HFrEF. Ischemic heart disease (IHD) was the most common cause of CV-death while cancer was the most common cause of non-CV death across all EF categories. The incidence rate of CV death due to IHD was higher in HFrEF while the incidence rates of CV death due to pulmonary vascular disease, stroke, valvular heart disease and atrial fibrillation were higher in HFpEF compared to HFrEF and HFmrEF (Figure 1). Patients with HFpEF had higher incidence rate of non-CV deaths due to cancer, respiratory disease, accidents and infections including covid -19 compared with HFrEF and HFmrEF patients (figure 2). Conclusion In this large and contemporary cohort of patients with HF, CV death was more common than non-CV death across all EF categories although the risk of non-CV mortality within 5-years was higher with increasing EF. IHD and cancer were the most common causes of CV and non-CV deaths, respectively, regardless of EF category. Patients with HFpEF had a higher burden of non-CV causes of death than patients with HFrEF and HFmrEF.Incidence rate CV deathIncidence rate non-CV death

Abstract 18959: Glycosphingolipid-Mediated Cardiomyocyte and Immune Cell Dysfunction in Hypoplastic Left Heart Syndrome

Introduction: Hypoplastic Left Heart Syndrome (HLHS) is the leading indication for heart transplant and the most common cause of cardiovascular death in infants. However, the mechanisms associated with heart failure progression in HLHS are poorly understood. Glycosphingolipids (GSLs) have been implicated in a variety of biological and disease processes, however, the role of GSLs in the context of HLHS pathophysiology have not been explored. Here we test the hypothesis that aberrant GSLs drive maladaptive cardiac and immune cell responses and predispose HLHS patients to pathologic remodeling and eventual cardiac dysfunction. Methods: GSL content was measured by mass-spectrometry. To test the direct effect of the specific GSL species, lactosylceramide (LacCer), cardiac and peripheral immune cells (PBMCs) were treated with liposomes containing 3uM LacCer (C18:0 and C24:0). Mitochondrial respiration was assessed using the Seahorse Bioanalyzer (Agilent). Expression of metabolic proteins were assessed by western blot. Statistical analysis between 2 groups was performed using an unpaired T-test. Results: LacCer is significantly increased in heart tissue and in isolated PBMCs from patients with HLHS (A), and isolated mitochondria are highly enriched with LacCer. Moreover, exogenous LacCer is sufficient to impair cardiomyocyte mitochondrial fatty acid beta-oxidation (B), induce ROS generation, and decrease the expression of metabolic proteins Additionally, exogenous LacCer is sufficient to promote inflammation and decrease mitochondrial bioenergetics in PBMCs (C). Conclusions: These data highlight a novel role for LacCer in modulating cardiomyocyte and immune cell phenotypes and suggest aberrant GSLs contribute to the HLHS pathophysiology. Elucidation of the molecular mechanisms involved in impaired immune cell and cardiomyocyte responses in HLHS is crucial and these data suggest a unique avenue for therapeutic intervention in this population.

Abstract 12630: Sex Differences in Patients Hospitalized With Acute Pulmonary Embolism - A Single Center Experience

Background: Acute pulmonary embolism (APE) is the third leading cause of cardiovascular death following stroke and myocardial infarction. Data regarding the impact of sex differences on the presentation, management, and outcomes of patients with (APE) remains limited. This study aimed to identify baseline characteristics and treatment strategies in males (M) versus females (F) from a single center experience. Methods: We retrospectively analyzed patients who underwent evaluation by our institutional pulmonary embolism response team for APE between 3/1/2016 and 1/1/2022. Baseline characteristics, biomarkers, and outcomes of interest were compared using Pearson’s Chi-squared test for categorical variables and Wilcoxon rank sum test for continuous variables. Results: The cohort included 886 patients, of whom 48.6% were females. The mean age was (61 ± 16) years. Males were more likely to be smokers (41% vs. 26 %; p&lt;0.001), have a lower Body Mass Index (BMI) (31 ± 9 kg/m 2 , vs 33 ±10; p=0.01) and were more likely to have a history of prior stroke (12% vs 7.9%; p=0.04). The mean brain natriuretic peptide (BNP) on presentation was significantly higher in females (361 ± 624 pg/ml vs 281 ± 505; p=0.019). The mean d-dimer (F: 7,041 ± 6,438 ng/ml vs M: 9,063 ±11,447; p=0.13), troponin I (F: 1.60 ± 15.58 ng/ml vs M: 0.72±4.11; p=0.3), and lactic acid (F: 2.58 ± 3.20 mm/l vs M: 2.42 ± 2.43; p=0.6) were similar between both groups. PE severity (massive: 5.3% vs 6.4%; submissive: 58% vs: 55%; P=0.8) was similar between females and males. There were also no sex-based differences in the use of advanced therapies or outcomes. (Figure 1) Conclusion: In our APE cohort from a single center tertiary care center, sex differences in comorbidity profile (BMI, tobacco use, history of stroke) were observed. Females had a significantly higher BNP consistent with prior published literature. However, there were no sex-based disparities in PE severity, management, escalation of advanced therapies or outcomes.

Abstract 18319: Regional Disparities in the Cardiovascular Deaths Among Sarcoidosis Patients: A CDC-Wonder Database Analysis From 2005-2020

Background: Sarcoidosis can manifest as “Cardiovascular Death (CVD)” in undiagnosed patients. Regional Impact and Disparities In CVDs among sarcoidosis have not been identified. Methods: We analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database from January 2005, to December 2020. All deaths related to CVS were included from 4 different regions. Data for deaths related to sarcoidosis and CVD were obtained by querying “Sarcoidosis” using ICD 10th Revision code “D86”. Rates per year for trends and disparities were calculated using cumulative CVD. Results: A total of 8211 CVD from 2005-2020 were identified among sarcoid patients- 1666, (20.2%) in north east, 1,697 (20.64%) in midwest, 3,684 (44.81%) in south and 1,164, (14.15%) in west . The CVDs occurred mostly in the ages(55-74) in the northeast, (45-74) in the Midwest, (35-84) in the south and (45-84) in the west. Incidence of cardiovascular death among females with sarcoid was greater than males in all regions .(12.03% vs 8.25% in northeast , 12.65% vs 8.02% in midwest , 8.12 %vs 6.05% in west , 27.13%v/s 17.73% in south ). The South showed a significantly higher population of blacks suffering from CVD (31.3% blacks vs 12.61% whites) whereas in other regions , the rates were comparable. The most common cause of CV death was found to be cardiac arrest (28.8 %) in the north east, cardiomyopathy(27.09%) in the midwest , cardiac arrhythmias (17.13%) in the west and conduction disorders (52.17%) in the south. An increasing trend of CVD was recorded in the south with an increase in rates from 42.5% in 2005 to 45% in 2020. Conclusion: Incidence of CVD related to sarcoidosis is highest in the south and females had higher mortality in all regions. Pulmonary hypertension, cardiac arrest and CHF were the major causes of CVD.

Patterns of Rheumatic Heart Disease Among Yemeni Patients in Cardiac Center of Al-Thawra General Hospital

Background: Rheumatic heart disease (RHD) is still a major public health problem and remains the most common cardiovascular cause of death among children and young adults. The recurrent episodes of acute rheumatic heart disease may cause the rapid progressive damage of the heart valves and chronic residual deformity resulting in stenosis or regurgitation or a combination of both stenosis and regurgitation.&#x0D; Methodology: A cross sectional Study, consecutive patients with RHD were enrolled from outpatient cardiac clinics and inpatient department of cardiac center of Al-thawra hospital in Sana’a city, Yemen between January and July 2020. Demographic, clinical, echocardiographic, and coronary angiography characteristics of patients were recorded.&#x0D; Results: 261 consecutive patients with rheumatic heart disease were analyzed with mean age of 33 ± 12.65, female patients represented 62.8% (165), illiterate patients represented 63.6% (166). The majority of the patients about 79.7% (208 patient) had mitral valve disease, 63.6% (166 patient) had aortic valve disease, 10.7% (28 patient) had organic tricuspid valve disease but the Isolated Mitral valve disease 23%( 60) , Isolated Aortic valve disease 10.3% (27) and Isolated organic tricuspid valve disease represent 4.2% (11) , double valve disease (mitral &amp; aortic ) represent 56% (146), triple valve disease (Mitral + Aortic + Tricuspid )represent 6.5% (17).A lot of complications of RHD detected in our study; CHF 36%(94) with low EF &lt;50% in 55.0%(144) and 34% (89) had dilated LV , 33.7%(86) developed AF , 14%(37) of the patient complicated by IE , spontaneous echo contrast 11%(29) but only 7.3%(19) developed Intra cardiac thrombus and new stroke 9.5% ( 25) , pericardial effusion 5.4% (14) and Active ARF 2.3%(6). Conclusion:&#x0D; Rheumatic heart disease is a big medical problem in Yemen and it affects children and young adults of poor and illiterate patients of both genders. The most common valvular lesion reported in our study was multivalvular lesion the predominant pure lesion was Mitral regurgitation followed by Mitral stenosis, Aortic regurgitation, with high organic affection of the tricuspid valve.

PERT era, race-based healthcare disparities in a large urban safety net hospital.

Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the United States. Black Americans have higher incidence, greater clot severity, and worse outcomes than White Americans. This disparity is not fully understood, especially in the context of the advent of PE response teams (PERT), which aim to standardize PE-relatedcare. This retrospective single-center cohort study compared 294 Black and 131 White patients from our institution's PERT database. Primary objectives included severity and in-hospital management. Secondary outcomes included length of stay, 30-day readmission, 30-day mortality, and outpatient follow-up. Clot (p = 0.42), acute treatment (p = 0.28), 30-day mortality (p = 0.77), 30-day readmission (p = 0.50), and outpatient follow-up (p = 0.98) were similar between races. Black patients had a lower mean household income ($35,383, SD 20,596) than White patients ($63,396, SD 32,987) (p < 0.0001). More Black patients (78.8%) had exclusively government insurance (Medicare/Medicaid) compared to White patients (61.8%) (p = 0.006). Interestingly, government insurance patients had less follow-up (58.3%) than private insurance patients (79.7%) (p = 0.001). Notably, patients with follow-up had fewer 30-day readmissions. Specifically, 12.2% of patients with follow-up were readmitted compared to 22.2% of patients without follow-up (p = 0.008). There were no significant differences in PE severity, in-hospital treatment, mortality, or readmissions between Black and White patients. However, patients with government insurance had less follow-up and more readmissions, indicating a socioeconomic disparity. Access barriers such as health literacy, treatment cost, and transportation may contribute to this inequity. Improving access to follow-up care may reduce the disparity in PE outcomes.