Association Class Research Articles

Heart failure: Clinical manifestations, Etiology, Risk factors, Diagnosis and Treatment in adults

Background: Heart failure, a complex cardiac condition, arises when the heart’s ability to pump blood diminishes, leading to insufficient oxygen and nutrients delivery to the body’s organs and tissues. In this paper, we discussed about heart failure disease, its symptoms, etiology and risk factors, epidemiology, pathophysiology, diagnosis, and treatment. Methods: I have to discuss about heart failure disease, its symptoms, etiology and risk factors, epidemiology, pathophysiology, diagnosis, and treatment. Results: Heart failure, often a late-stage consequence of various processes, especially ischemic heart disease, carries a poor prognosis, with mortality rates similar to common cancers. Diagnosis relies on history and physical assessment, while imaging and lab findings assist in confirmation. The New York Heart Association classification may be employed. Conclusion: Heart failure is a severe condition where the heart can’t pump blood effectively due to causes like coronary artery disease or hypertension. Treatment includes lifestyle changes, meds, and surgery. Early diagnosis and treatment are essential for improving quality of life. Keywords: Congestive heart failure, symptoms, etiology, risk factors, treatment

Clinical and Radiographic Outcomes Following Volar-Locked Plating Versus Dorsal Bridge Plating for Distal Radius Factures

PurposeDistal radius fractures indicated for operative intervention are most commonly treated with volar locked plating (VLP), however dorsal bridge plating (DBP) has been utilized as an alternative fixation method. The purpose of this study was to utilize a propensity score to match and compare the radiographic and clinical outcomes of patients undergoing isolated VLP or DBP for distal radius fractures. MethodsWe performed a retrospective, propensity score-matched analysis of patients undergoing isolated VLP or DBP treatment for isolated distal radius fractures from 2015 to 2022 at a single level-1 trauma center. Patients were propensity score matched by a total of 8 demographic and comorbidity factors, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Our primary outcomes included postoperative complications, wrist and forearm range of motion, grip strength, and radiographic measurements, including radial height, radial inclination, volar tilt, and articular step-off. ResultsOverall, 415 DBP and 2075 VLP were successfully propensity score matched and included in this study. Grip strength and range of motion measurements at 6-month follow-up, including wrist flexion, wrist extension, forearm pronation, forearm supination, radial deviation, and ulnar deviation, were increased in the VLP compared to DBP (p<0.05). Complication rates among both groups were relatively low, however, the rate of malunion and nonunion was significantly higher among the DBP group (p<0.05). Radial height, radial inclination, and articular step-off were improved in the VLP group compared to the DBP group (p<0.05), however, volar tilt was similar between groups. PROMIS Upper Extremity (UE) and Physical Function (PF) were significantly higher among the VLP group (p<0.05). There was no significant difference in PROMIS PI between groups. ConclusionsWhen compared to DBP, patients undergoing VLP are more likely to have improved clinical and radiographic outcomes. While improvement in wrist and forearm range of motion and radiographic parameters is statistically significant, it may not be clinically relevant.

Case Report: Evaluation of Patient Diagnosed Perianal Fistula According to Abdellah's 21 Nursing Problems Model

This case report aimed to provide nursing care to the patient diagnosed with Perianal Fistula for the nursing diagnoses in Faye Abdellah's "21 Nursing Problem Theory and North American Nurses Association (NANDA) classification system. Material and Methods: Verbal and written consent was obtained from the patient and the attending physician for the research. Results: He was married at the age of 62. The patient, who has four children and had perianal fistula surgery in 2002, was admitted to the Gastroenterohepatology Polyclinic of a training and research hospital due to increased rectal discharge and constipation recently. disease. There is no known disease in the family history. There is no known history of drug use and known allergy. Conclusion and Suggestions: The case was examined based on Faye Abdellah's "21 Nursing Problem Theory" and the North American Nurses Association (NANDA) Nursing care was given by using the nursing diagnoses in the classification system.

Octogenarians fare better under local anesthesia for elective endovascular aortic aneurysm repair

ObjectiveWith an aging patient population, an increasing number of octogenarians are undergoing elective endovascular abdominal aortic aneurysm repair (EVAR) in the United States. Multiple studies have shown that, for the general population, use of local anesthetic (LA) for EVAR is associated with improved short-term and long-term outcomes as compared with performing these operations under general anesthesia (GA). Therefore, this study aimed to study the association of LA for elective EVARs with perioperative outcomes, among octogenarians. MethodsThe Vascular Quality Initiative database (2003-2021) was used to conduct this study. Octogenarians (Aged ≥80 years) were selected and sorted into two study groups: LA (Group I) and GA (Group II). Our primary outcomes were length of stay and mortality. Secondary outcomes included operative time, estimated blood loss, return to operating room, cardiopulmonary complications, and discharge location. ResultsOf the 16,398 selected patients, 1197 patients (7.3%) were included in Group I, and 15,201 patients (92.7%) were in Group II. Procedural time was significantly shorter for the LA group (114.6 vs 134.6; P < .001), as was estimated blood loss (152 vs 222 cc; P < .001). Length of stay was significantly shorter (1.8 vs 2.6 days; P < .001), and patients were more likely to be discharged home (LA 88.8% vs GA 86.9%; P = .036) in the LA group. Group I also experienced fewer pulmonary complications; only 0.17% experienced pneumonia and 0.42% required ventilator support compared with 0.64% and 1.02% in Group II, respectively. This finding corresponded to fewer days in the intensive care unit for Group I (0.41 vs 0.69 days; P < .001). No significant difference was seen in 30-day mortality cardiac, renal, or access site-related complications. Return to operating room was also equivocal between the two groups. Multivariate regression analysis confirmed GA was associated with a significantly longer length of stay and significantly higher rates of non-home discharge (adjusted odds ratio [AOR], 1.59; P < .001 and AOR, 1.40; P = .025, respectively). When stratified by the New York Heart Association classification system, classes I, II, III, and IV (1.55; P < .001; 1.26; P = .029; 2.03; P < .001; 4.07; P < .001, respectively) were associated with significantly longer hospital stays. ConclusionsThe use of LA for EVARs in octogenarians is associated with shorter lengths of stay, fewer respiratory complications, and home discharge. These patients also experienced shorter procedure times and less blood loss. There was no statistically significant difference in 30-day mortality, return to operating room, or access-related complications. LA for octogenarians undergoing EVAR should be considered more frequently to shorten hospital stays and decrease complication rates.

Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study

Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients who underwent reoperation for a failed surgical aortic bioprosthesis. Long-term data on patients who underwent TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk who underwent TAV-in-SAV. Outcomes at 5 years were analyzed by SAV failure mode (stenosis, regurgitation, or combined). Echocardiographic outcomes are site-reported. TAV-in-SAV was attempted in 226 patients with a mean age of 76.7 ± 10.8 years; 63.3% were male, the Society of Thoracic Surgeons predicted risk of mortality score was 9.0 ± 6.7%, and 87.5% had a New York Heart Association classification III or IV symptoms. Most of the failed surgical bioprostheses were stented (81.9%), with an average implant duration of 10.2 ± 4.3 years. The 5-year all-cause mortality or major stroke rate was 47.2% in all patients; 54.4% in the stenosis, 37.6% in the regurgitation, and 38.0% in the combined groups (p = 0.046). At 5 years, all-cause mortality was higher in patients with versus without 30-day severe prosthesis-patient mismatch (51.7% vs 38.3%, p = 0.026). The overall aortic valve reintervention rate was 5.9%; highest in the regurgitation group (12.6%). The mean aortic valve gradient was 14.1 ± 9.8 mm Hg and effective orifice area was 1.57 ± 0.70 at 5 years. Few patients had >mild paravalvular regurgitation at 5 years (5.5% moderate, 0.0% severe). TAV-in-SAV with supra-annular, self-expanding TAVR continues to represent a safe and lasting intermediate option for extreme-risk patients who have appropriate sizing of the preexisting failed surgical valve. Clinical and hemodynamic outcomes were stable through 5 years.

Effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture

To explore the safety and effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation in the treatment of ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. A clinical data of 20 patients with ankylosing spondylitis kyphosis combined with acute thoracolumbar spine fracture, who were treated with one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation between April 2016 and January 2022, was retrospectively analyzed. Among them, 16 cases were male and 4 cases were female; their ages ranged from 32 to 68 years, with an average of 45.9 years. The causes of injury included 10 cases of sprain, 8 cases of fall, and 2 cases of falling from height. The time from injury to operation ranged from 1 to 12 days, with an average of 7.1 days. The injured segment was T 11 in 2 cases, T 12 in 2 cases, L 1 in 6 cases, and L 2 in 10 cases. X-ray film and CT showed that the patients had characteristic imaging manifestations of ankylosing spondylitis, and the fracture lines were involved in the anterior, middle, and posterior columns and accompanied by different degrees of kyphosis and vertebral compression; and MRI showed that 12 patients had different degrees of nerve injuries. The operation time, intraoperative bleeding, intra- and post-operative complications were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the low back pain and quality of life, and the American spinal cord injury association (ASIA) classification was used to evaluate the neurological function. X-ray films were taken, and local Cobb angle (LCA) and sagittal vertical axis (SVA) were measured to evaluate the correction of the kyphosis. All operations were successfully completed and the operation time ranged from 127 to 254 minutes (mean, 176.3 minutes). The amount of intraoperative bleeding ranged from 400 to 950 mL (mean, 722.5 mL). One case of dural sac tear occurred during operation, and no cerebrospinal fluid leakage occurred after repair, and the rest of the patients did not suffer from neurological and vascular injuries, cerebrospinal fluid leakage, and other related complications during operation. All incisions healed by first intention without infection or fat liquefaction. All patients were followed up 8-16 months (mean, 12.5 months). The VAS score, ODI, LCA, and SVA at 3 days after operation and last follow-up significantly improved when compared with those before operation ( P<0.05), and the difference between 3 days after operation and last follow-up was not significant ( P>0.05). The ASIA grading of neurological function at last follow-up also significantly improved when compared with that before operation ( P<0.05), including 17 cases of grade E and 3 cases of grade D. At last follow-up, all bone grafts achieved bone fusion, and no complications such as loosening, breaking of internal fixation, and pseudoarthrosis occurred. One-stage posterior eggshell osteotomy and long-segment pedicle screw fixation is an effective surgical procedure for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. It can significantly relieve patients' clinical symptoms and to some extent, alleviate the local kyphotic deformity.

Correlates of malnutrition in patients with heart failure: the role of social support.

Heart failure (HF) is a major public health challenge. Malnutrition has a significant effect on HF prognosis. Understanding the impact of social and clinical factors on the risk of malnutrition is necessary because it may aid in improving the health status of HF patients. Three hundred twenty patients with HF who were hospitalized in a heart centre in Shiraz, Iran, from March to November 2022 were studied. Two validated questionnaires were used to evaluate malnutrition and social support: (1) Mini-Nutritional Assessment Short Form and (2) Medical Outcomes Study Social Support Survey. The participants were then divided into three groups: those with normal nutritional status (scores 12-14), those at risk of malnutrition (scores 7-11), and those who were malnourished (scores 0-6). The potential correlates of malnutrition (including socio-demographic, clinical, comorbidities, and laboratory factors) were included in the study. Then, ordinal logistic regression was used to investigate the correlates of malnutrition. The mean age of the participants was 64.2±11.2years, and more than half were male and married. Normal nutritional status was seen in 110 (34.4%) participants, 151 (47.2%) were at risk of malnutrition, and 58 (18.1%) were malnourished. The mean social support score of the participants was 61.65±12.91. According to the adjusted odds ratios (95% confidence intervals) obtained from multivariate analysis, increased risk of malnutrition was associated with having a lower social support score [0.95 (0.93-0.97), P-value≤0.001], lower body mass index [0.91 (0.86-0.97), P-value=0.004], higher New York Heart Association classification [1.26 (1.02-1.56), P-value=0.03], longer duration of disease [1.006 (1.001-1.01), P-value=0.006], and lower serum albumin level [0.25 (0.08-0.75), P-value=0.01]. Besides the clinical conditions affecting the risk of malnutrition in patients with HF, social support may play an important role. Including this factor in HF guidelines and developing educational programmes may help improve HF patients' health.

Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study.

Central Illustration : Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study LVEF: left ventricular ejection fraction; HR: hazard ratio; CI: confidence interval; NYHA: New York Heart Association; VO 2: oxygen consumption. The accuracy of the New York Heart Association (NYHA) classification to assess prognosis may be limited compared with objective cardiopulmonary exercise test (CPET) parameters in heart failure (HF). To investigate the prognostic value of the NYHA classification in addition to Weber class. Adult outpatients with HF undergoing CPET in a Brazilian tertiary care center were included. The physician-assigned NYHA class and the CPET-derived Weber class were stratified into "favorable" (NYHA I or II; Weber A or B) or "adverse" (NYHA III or IV; Weber C or D). Patients with one favorable class and one adverse class were defined as "discordant." The primary endpoint was time to all-cause mortality. A 2-sided p value < 0.05 was considered statistically significant. A total of 834 patients were included. Median age was 57 years; 42% (351) were female, and median left ventricular ejection fraction was 32%. Among patients with concordant NYHA and Weber classes, those with adverse NYHA and Weber classes had significantly higher all-cause mortality compared to those with favorable classes (hazard ratio [HR]: 5.65; 95% confidence interval [CI]: 3.38 to 9.42). Among patients with discordant classes, there was no significant difference in all-cause mortality (HR: 1.38; 95% CI: 0.82 to 2.34). In the multivariable model, increments in NYHA class (HR: 1.55 per class increase; 95% CI: 1.26 to 1.92) and reductions in peak VO 2 (HR: 1.47 per 3 ml/kg/min decrease; 95% CI: 1.28 to 1.70) significantly predicted mortality. Physician-assigned NYHA class and objective CPET measures provide complementary prognostic information for patients with HF.

Enhanced Associative Memory, Classification, and Learning with Active Dynamics

Enhanced Associative Memory, Classification, and Learning with Active Dynamics

Second radioiodine treatment in patients with differentiated thyroid carcinoma: Causes and effects

IntroductionPatients with incomplete response to initial therapy of thyroid cancer can be managed with ongoing observation or potentially additional therapies.Our aim was to assess the effect of a second radioactive iodine treatment (RAIT) and its relationship with causes and clinical variables. Material and methodsPatients undergoing a second RAIT for biochemical or structural incomplete response to initial therapy of DTC were retrospectively included (n=120). They were categorised based on the American Thyroid Association (ATA) classification of response to initial therapy.Patients were reclassified in the following 6–18 months after second RAIT based on imaging findings and measurements of thyroglobulin and antithyroglobulin antibody levels.The associations of a downgrading of response category and progression-free survival (PFS), and the related variables, were evaluated. ResultsSixty-six patients (55%) had a downgrading on ATA response category after second RAIT. A significant interdependence of causes for second RAIT and outcomes was found (χ2=29.400, p=0.001), with patients with neck reoperation showing a higher rate of indeterminate or excellent responses.A significant association between ATA response to second RAIT and absence of structural progression was found (χ2=44.914, p<0.001), with less structural progression in patients with downgrading on ATA response (χ2=30.914, p<0.001). There was also significant interdependence to some clinical variables, such as AJCC stage (χ2=8.460, p=0.015), ATA risk classification (χ2=10.694, p=0.005) and initial N stage (χ2=8.485, p=0.004). ConclusionsIn selected cases, a second RAIT could lead to more robust responses with a potential improvement in prognosis in patients with incomplete response to initial DTC treatment.

OP147 Measuring Health Technology Assessment Impact On The Introduction Of Transcatheter Aortic Valve Replacement In A Private Healthcare System

IntroductionAortic stenosis is an insidious disease that has a high mortality rate when it becomes symptomatic. Surgical valve replacement is the treatment of choice and has predictable risks. Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to surgery, which is indicated for high-risk patients.Complications after TAVR include paravalvular leak, cerebrovascular events, and the need for pacemaker implantation. A health technology assessment report carried out by the Health Technology Assessment Unimed-BH group in 2018, two years before it became part of the National Supplementary Health Agency, recommended the introduction of TAVR with the following criteria: indications provided by a group of specialists; forwarding of a report with detailed clinical data; results of imaging exams; and follow-up results for up to one year after the procedure. After the introduction of TAVR with the agreed criteria, it was possible to access TAVR results from the private healthcare system of Unimed-BH.MethodsAdministrative data were collected from the Unimed-BH database. All patients who received a TAVR implant from 2013 to 2017 were included by virtue of a court injunction, and after 2018 by operator concession and within agreed criteria.ResultsFrom July 2013 to June 2019, 83 patients underwent TAVR implantation by Unimed BH. The median age of patients was 83.4 years (interquartile range 66.5 to 97.9), most of whom were women (56%). There was a predominance of patients in New York Heart Association classification III (50%) and IV (29%). There were 36 patients who underwent TAVR before 2018 and 47 patients within the agreed criteria. In the period prior to the agreed criteria, 28 percent needed a pacemaker, compared with 23 percent after 2018. During the follow-up period, 39 patients died: 18 (50%) before 2018 and 11 (23%) after 2018.ConclusionsThe agreement made with the providers, which included the obligation of having a team of specialists responsible for the indication and access to clinical data through the report, improved patient outcomes. This may be due to having a better indication for the procedure or to the greater experience of the professionals involved in its delivery.

Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature.

Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures. PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors' known articles. The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence. Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.

A brief overview of the diabetic neuropathies

The diabetic neuropathies represent the commonest long-term complications of diabetes, and may be the presenting feature of Type 2 diabetes. In clinical practice, distal symmetrical polyneuropathy (DSPN) and the autonomic neuropathies are the most frequently seen forms of diabetic neuropathy. The 2017 American Diabetes Association classification system for the neuropathies of diabetes are in general use. Treatment challenges remain and the need for revised recommendations and further discussion of management of severely painful DSPN that does not fully respond to conventional medical management is clear, especially in light of the recent opioid crisis in the USA.

Heart failure 'the cancer of the heart': the prognostic role of the HLM score.

The multi-systemic effects of heart failure (HF) resemble the spread observed during cancer. We propose a new score, named HLM, analogous to the TNM classification used in oncology, to assess the prognosis of HF. HLM refers to H: heart damage, L: lung involvement, and M: systemic multiorgan involvement. The aim was to compare the HLM score to the conventional New York Heart Association (NYHA) classification, American College of Cardiology/American Heart Association (ACC/AHA) stages, and left ventricular ejection fraction (LVEF), to assess the most accurate prognostic tool for HF patients. We performed a multicentre, observational, prospective study of consecutive patients admitted for HF. Heart, lung, and other organ function parameters were collected. Each patient was classified according to the HLM score, NYHA classification, ACC/AHA stages, and LVEF assessed by transthoracic echocardiography. The follow-up period was 12months. The primary endpoint was a composite of all-cause death and rehospitalization due to HF. A total of 1720 patients who completed the 12month follow-up period have been enrolled in the study. 520 (30.2%) patients experienced the composite endpoint of all-cause death and rehospitalization due to HF. 540 (31.4%) patients were female. The mean age of the study population was 70.5±12.9. The mean LVEF at admission was 42.5±13%. Regarding the population distribution across the spectrum of HLM score stages, 373 (21.7%) patients were included in the HLM-1, 507 (29.5%) in the HLM-2, 587 (34.1%) in the HLM-3, and 253 (14.7%) in the HLM-4. HLM was the most accurate score to predict the primary endpoint at 12months. The area under the receiver operating characteristic curve (AUC) was greater for the HLM score compared with the NYHA classification, ACC/AHA stages, or LVEF, regarding the composite endpoint (HLM=0.645; NYHA=0.580; ACC/AHA=0.589; LVEF=0.572). The AUC of the HLM score was significantly better compared with the LVEF (P=0.002), ACC/AHA (P=0.029), and NYHA (P=0.009) AUC. The HLM score has a greater prognostic power compared with the NYHA classification, ACC/AHA stages, and LVEF assessed by transthoracic echocardiography in terms of the composite endpoint of all-cause death and rehospitalization due to HF at 12months of follow-up.

Rule-based prediction of diabetes mellitus using a classification based on association rules

Diabetes mellitus, a chronic metabolic disease, is characterised by persistently high blood sugar levels. It is projected that by 2030, the number of individuals with diabetes in developing nations would rise from roughly 84 million to 228 million, placing a substantial strain on healthcare systems. Therefore, there is a need for different predictions that can be used in early diagnosis, follow-up and preventive medicine for this disease. In this study, a data mining algorithm, the association classification approach, is used to classify diabetes on an open source dataset. The performance metrics of the model are accuracy, balanced accuracy, sensitivity, specificity, positive predictive value, negative predictive value and F1-score values of 0.92, 0.78, 0.58, 0.98, 0.85, 0.93, 0.70 respectively. According to these results, the classification model based on association rules is highly successful in classifying diabetes melitus. In addition, as an output of the model, certain rules are proposed that can be used in early diagnosis, treatment and preventive medicine of diabetes mellitus.

Relationship between physical performance and health-related quality of life in patients with heart failure

Introduction and objectivesThis study aims to describe relationship between physical performance (PP) and health-related quality of life in patients with heart failure (HF). MethodsThis study used a cross-sectional design for data collection. Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used as a measurement tool, while the Five Times Sit-to-Stand Test (FTSST) was used to assess PP. The data were processed by Pearson correlation coefficient, t-test, one-way ANOVAs, and Hierarchical multiple regression. ResultsA total of 180 patients with HF participated in this study, with the mean age of respondents being 59.98 (11.86) years old. Among these respondents, 60% were male, with a mean PP of 9.56 (6.94)s and a mean MLHFQ of 43.14 (20.74). The results showed that MLHFQ had a significant correlation with HF medication (r=.16, P<.05), health status (r=.24, P<.01), FTSST (r=.40, P<.01), and MLHFQ was significantly associated with New York Heart Association (NYHA) Classification (F=8.358, P<.001). There were three variables identified as predictors of MLHFQ, namely health status (β=−2.22), NYHA Class III (β=1.27), and FTSST (β=3.03), and were predicted to account for 31.1% of the variance in MLHFQ. ConclusionsEfforts to increase PP from patients with HF can be an asset to improve health-related quality of life. Furthermore, health status and NYHA classifications are factors that can significantly affect health-related quality of life of patients with HF.

Long-term outcomes of COVID-19 survivors and an exploratory analysis of factors associated with sequela-free survival of patients treated at Leishenshan Hospital in Wuhan, China

PurposeWhile coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, millions of patients with COVID-19 have recovered and returned to their families and work, although the key factors of sequela-free survival remain unknown. Here we determine key factors associated with sequela-free survival of patients with COVID-19.MethodsSequela-free survival is defined as having none of the long-term sequelae measured with the Activity of Daily Living (ADL) Scale, modified Medical Research Council (mMRC) Dyspnoea Scale, New York Heart Association (NYHA) classification, Self-rating Depression Scale (SDS), Carcinologic Handicap Index (CHI) and Modified Telephone Interview for Cognitive Status (TICS-M). Multivariable logistic regression was used to examine the key factors of sequela-free survival.ResultsThe follow-up period for the 464 patients was 10 August to 30 September 2020. Of these, 424 patients completed the assessment of all scales. 30.2% (128 of 424) were categorised as sequela-free at follow-up. The most common sequelae were psychosocial problems (254 [57.7%]), respiratory function abnormality (149 [32.6%]) and cardiac function abnormality (98 [21.5%]). Risk factors associated with COVID-19 sequelae were anaemia on admission, longer duration from the onset of symptoms to admission and increasing of age, whereas anaemia treatment was a protective factor against sequelae. A haemoglobin level of < 113 g/L for female patients or < 92 g/L for male patients at admission discriminated a likely higher risk of any COVID-19 sequelae.ConclusionsOnly one third COVID-19 survivors were sequela-free. Anaemia on admission, longer duration from the onset of symptoms to admission and increasing of age were the risk factors of any long-term sequela. Anaemia treatment was associated with beneficial outcomes in COVID-19 survivors.

A novel hemodynamic index characterizing mitral regurgitation undergoing transcatheter edge to edge repair: the mitral pulse pressure fraction

Abstract Objectives Our study sought to investigate the role of invasive hemodynamic monitoring during Transcatheter Edge to Edge Repair (TEER) procedure on top of transesophageal echocardiographic (TEE) guidance. Background Direct hemodynamic impact of residual MR after TEER is not always univocally measured by TEE assessment alone. When analyzing TEER procedure result operators often encounter discrepancy between TEE guidance and invasive hemodynamic monitoring. Methods We analyzed 78 patients with moderate-to-severe or severe mitral regurgitation (MR) who underwent TEER. Mitral pulse Pressure Fraction (MPF) was extracted from intraprocedural continuous left atrial pressure monitoring. 23 patients with the same grade of MR not undergoing TEER were included as a control group. Results TEER had a significant impact reducing MR burden on both TEE guidance and invasive hemodynamic monitoring. Post-TEER MPF was significantly reduced compared to both pre-TEER setting (p &amp;lt; 0.001) and control group (p = 0.004). MR reduction assessed by TEE guidance was not found to be correlated with improved clinical and functional status at follow-up as assessed by New York Heart Association (NYHA) classification (p = 0.424) and 12-items Kansas City Cardiomyopathy Questionnaire (KCCQ) (p = 0.1). On the contrary, a greater reduction in MPF was associated with a significant amelioration of both NYHA classification (p = 0.003) and 12-items KCCQ (p&amp;lt;0.001) during the follow-up period. Conclusions MPF provides an immediate estimate of the real hemodynamic impact of MR and can offer a prompt prediction of the functional improvement after TEER.

Frailty prevalence among older decompensated heart failure patients

Abstract Background Frailty is a clinical syndrome characterized by diminished strenght, endurance and reduced physiologic function that increases an individual’s vulnerability. This syndrome often coexists in elderly patients with heart failure and can have a negative impact on their health and well-being. In the last few years four domains of frailty had been described: clinical, functional, psyco-cognitive and social. Purpose To determine the prevalence of frailty in each domain in patients 65 years of age and older with decompensated heart failure (DHF). Methods Prospective and observational study carried out in consecutive patients admitted to hospital due to DHF. Different validated scales were used. Clinical Domain: Charlson Comorbidity Index (CCI), MiniNutritional Assessment (MNA), Clinical Frailty scale CFS), New York Heart Association classification (NYHA); Functional Domain: Timed Up and Go (Up&amp;Go), Short Physical Performance Battery, Fried phenotype (SPPB), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL); Psyco-cognitive Domain: Minimental State Examination (MMSE), Yesevage Geriatric Depression Scale (YGDS); Social Domain: Old American Resources and Services (OARS). All patients signed the informed consent and were evaluated when they were clinically stable. Results 200 consecutive patients were included, aged 81.1 (SD 7.7),108 (54%) were female. Diabetes was present in 89 (44.7%) patients, arterial hypertension in 182 (91.5%), dyslipidemia in 138 (69.3%), active smoking in 8 (4.1 %), chronic obstructive pulmonary disease in 66 (33.5%), apnea 44 (22.4%), neoplasms in 36 (18.3%), chronic renal failure in 48 (24.4%), previous myocardial infarction in 42 (21.3%), stroke in 245 (12.2%), previous heart failure in 145 (73.6%), atrial fibrillation in 132 (66.7%). 10 (5%) lived in a nursing home. The in-hospital all-cause mortality rate was 7 (3.5%). Clinical domain: 125 (65.1%) had high comorbidity (CCI). 60 (43.1%) were malnourished (MNA) and 129 (70.9 %) considered as frail (CFS). 151 (77%) were in NYHA Functional Class III-IV. Functional domain: 165 (99.4 %) (Up&amp;Go) and 170 (97.1 %) (SPPB) were considered at fall risk. 147 (83.5%), frail by the Fried Phenotype. 188 (97.4 %) (ADL) and 173 (89.6 %) (IADL) had some degree of dependence. Psyco-cognitive: 82 (44.8%) had cognitive impairment (MMSE) and 70 (38%) some depression degree (YGDS). Social: 28 (15.4%) considered not to have a good social support (OARS). (See Table for details) Conclusions Patients with DHF are a complex and frail population that needs a holistic approach. The prevalence of frailty is high. In order to know how reversible frailty could be in older patients suffering DHF, clinical, functional, psyco-cognitive and social interventional trials are needed.

Clonal hematopoiesis has prognostic value in dilated cardiomyopathy independent of age and clone size

Abstract Background Clonal hematopoiesis (CH) gives rise to mutated leukocyte clones, that may induce cardiovascular inflammation, and thereby impact the disease course in cardiovascular diseases such as atherosclerosis and ischemic heart failure. The term clonal hematopoiesis of indeterminate potential (CHIP) is used when the variant allele frequency (VAF; a marker for clone size) in blood is ≥2%. The impact of CH clones in non-ischemic dilated cardiomyopathy (DCM) remains largely undetermined. Moreover, the impact of small clone sizes (VAF &amp;lt;0.5%) remains unknown in cardiovascular diseases in general. Objectives To establish the prognostic impact of CH in DCM down to small CH clone sizes. Methods CH was determined using an ultrasensitive single-molecule Molecular Inversion Probe technique that allows detection of clones down to a VAF of 0.01%. Cardiac death and all-cause mortality were predicted using receiver operating characteristic curve-optimized VAF cut-off values. Results 520 DCM patients were included. 109 patients (21%) had CH driver mutations, of which 45 had a VAF of ≥2% and 31 had a VAF of &amp;lt;0.5%. The median follow-up duration was 6.49 years [interquartile range 4.69 - 9.71]. DCM patients with CH had a higher risk of cardiac death (HR 2.33 using a VAF cut-off of 0.36%, 95% confidence interval 1.24 - 4.40) and all-cause mortality(HR 1.72 using a VAF cut-off of 0.06%, 95% confidence interval 1.10 - 2.69), independent of age, sex, left ventricle ejection fraction and New York Heart Association classification. Conclusion CH predicts cardiac death and all-cause mortality in DCM patients with an optimal threshold for clone size of 0.36% and 0.06%, respectively. Therefore, CH may be prognostically relevant independent of clone size in patients with DCM.Clonal hematopoiesis characteristicsClonal hematopoiesis prognosis