Cumulative Mortality Research Articles

Spatiotemporal Ecologic Analysis of COVID-19 Vaccination Coverage and Outcomes, Oklahoma, USA, February 2020-December 2021.

Data on COVID-19 cases, deaths, hospitalizations, and vaccinations in Oklahoma, USA, have not been systematically described. The relationship between vaccination and COVID-19-related outcomes over time has not been investigated. We graphically described data collected during February 2020-December 2021 and conducted spatiotemporal modeling of monthly increases in COVID-19 cumulative death and hospitalization rates, adjusting for cumulative case rate, to explore the relationship. A 1 percentage point increase (absolute change) in the cumulative vaccination rate was associated with a 6.3% (95% CI 1.4%-10.9%) relative decrease in death outcome during April-June 2021, and a 1.9% (95% CI 1.1%-2.6%) relative decrease in death outcome and 1.1% (95% CI 0.5%-1.7%) relative decrease in hospitalization outcome during July-December 2021; the effect on hospitalizations was driven largely by data from urban counties. Our findings from Oklahoma suggest that increasing cumulative vaccination rates might reduce the increase in cumulative death and hospitalization rates from COVID-19.

Mortality for Alzheimer's disease during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) negatively impacts the progression of Alzheimer's disease. The aim of this study was to determine whether mortality from Alzheimer's disease has changed during the COVID-19 pandemic. We searched the WONDER database, to obtain cumulative and sex-specific age-adjusted death rates of Alzheimer's disease between the years 2018 and 2022. Cumulative age-adjusted mortality rate displayed a peak in 2020, followed by gradual decline thereafter. The data for both sexes mirror that of total population, peaking in 2020, followed by a decline thereafter. The relative increase in age-adjusted mortality for Alzheimer's disease in 2020 compared to 2019 was + 8.7% in the total population, + 6.1% in men and + 10.1% in women. Frail people, such as those with Alzheimer's disease, may be more vulnerable to the risk of dying during an outbreak of infectious disease, paving the way for increased preventive and protective measures in the unfortunate event of the next pandemic.

Lecanicillium attenuatum infection and effects on the reproduction of Frankliniella occidentalis

ABSTRACT Frankliniella occidentalis, western flower thrips, is an invasive pest that seriously damages economic crops such as vegetables, flowers, and fruit trees because of its high fecundity, short generation cycle, and strong adaptability. Lecanicillium is an important entomopathogenic fungus, characterised by its wide host range, high pathogenicity, and environmental safety. It plays an important role in the environmentally friendly management of F. occidentalis. This study clarifies whether L. attenuatum infects F. occidentalis and affects its reproduction. The results of scanning electron microscope showed that conidia of L. attenuatum were attached to many parts of thrips adult after 1 h of treatment with 10^8 conidia/mL, and most F. occidentalis were covered by hyphae after 72–120 h. The cumulative mortality rate of the second instar larvae of the F1, F2, and F3 generations exceeded 60% on the seventh day post-infection and that of female adults was higher than 90% when treated by L. attenuatum with 10^8 conidia/mL. Simultaneously, L. attenuatum had strong sublethal effects on the surviving thrips. Indeed, the number of eggs deposited and the lifespan of female adults decreased considerably after the second instar larvae of F. occidentalis were treated with L. attenuatum, and had the impaction on the thrips offspring too. Altogether, our data suggested that L. attenuatum not only exhibited a high degree of pathogenicity towards F. occidentalis second instar larvae and adults but also affected the longevity and reproduction of surviving thrips.

Identification, functional analysis of chitin-binding proteins and the association of its single nucleotide polymorphisms with Vibrio parahaemolyticus resistance in Penaeus vannamei

Chitin-binding proteins (CBPs) play pivotal roles in numerous biological processes in arthropods, including growth, molting, reproduction, and immune defense. However, their function in the antibacterial immune defense of crustaceans remains relatively underexplored. In this study, twenty CBPs were identified and characterized in Penaeus vannamei. Expression profiling highlighted that the majority of CBPs were highly expressed in the intestine and hepatopancreas and responded to challenge by Vibrio parahaemolyticus. To explore the role of these CBPs in innate immunity, six CBPs (PvPrg4, PvKrtap16, PvPT-1a, PvPT-1b, PvExtensin and PvCP-AM1159) were selected for RNAi experiments. Silencing of only PvPrg4 and PvKrtap16 significantly decreased the cumulative mortality of V. parahaemolyticus-infected shrimp. Further studies demonstrated that inhibition of PvPrg4 and PvKrtap16 resulted in a marked upregulation of genes associated with the NF-κB and JAK-STAT signaling pathways, as well as antimicrobial peptides (AMPs), in both the intestine and hepatopancreas. These results collectively suggested that PvPrg4 and PvKrtap16 potentially promote V. parahaemolyticus invasion by negatively regulating the JAK-STAT and NF-κB pathways, thereby inhibiting the expression of AMPs. In addition, SNP analysis identified three SNPs in the exons of PvPrg4 that were significantly associated with tolerance to V. parahaemolyticus. Taken together, these findings are expected to assist in the molecular marker-assisted breeding of P. vannamei associated with anti-V. parahaemolyticus traits, as well as expand our understanding of CBP functions within the immune regulatory system of crustaceans.

Radiation Implication in Pediatric Second Primary Thyroid Malignancy (SPTM) Cumulative Incidence and Mortality in the United States: Large Cohort Evidence

Objective: To assess racial and sex variances in second primary thyroid malignancy (SPTM) cumulative incidence and temporal trends and the radiation exposure effect in pediatric SPTM. Materials and Methods: A retrospective cohort study, a non-experimental epidemiologic design, was used to assess the cumulative incidence (CmI) and temporal trends as well as the exposure effect of radiation in SPTM among children, 0–19 years, in the Surveillance, Epidemiology, and End Results (SEER) registry, National Cancer Institute (NCI), USA. Percent change (PC) and annual percent change (APC) were used to examine CmI rates and temporal trends, while chi-square statistics and binomial regression models were used to examine variable distribution by race and to determine the exposure effect of radiation on SPTM as well as mortality, respectively. Results: The frequency of pediatric thyroid cancer was (n = 3457) between 1973 and 2013/14, while the PC was 151.2 for all races but 99.8 among whites. Of all pediatric thyroid cancers diagnosed during this period, SPTM accounted for 3% (n = 99). Compared to whites, blacks/AA were 60% less likely to present with SPTM, adjusted risk ratio, aRR = 0.40, 99% CI 0.06–2.47, while other races were 18% more likely to develop SPTM, aRR = 1.18, 99% CI 0.48–2.87. Additionally, females relative to males were 63% less likely to be diagnosed with SPTM, aRR = 0.37, 99% CI 0.22–0.61. With respect to urbanicity, compared to children in rural areas, those in urban areas were 21% less likely to develop SPTM, aRR = 0.79, 99% CI, 0.12–5.35, while children in metropolitan areas were 40% less likely to develop SPTM, aRR = 0.60, 99% CI, 0.10–3.59. Although imprecise, there was a 5% increased risk of SPTM, with radiation as an exposure effect, aRR = 1.05, 99% CI 1.01–1.75. Conclusions: There are increasing temporal trends in pediatric SPTM with blacks relative to whites having observed lower incidence, despite an increasing percent change among blacks/AA, indicative of the disproportionate burden of this malignant neoplasm. SPTM risk was higher among males and in rural areas, while radiation as a risk for SPTM was clinically and biologically meaningful, albeit an observed statistically insignificant inference due to sampling variability, requiring intervention mapping in radiation exposure margination among children.

Enriched Diet With Orange Essential Oil Citrus sinensis for Tambaqui Colossoma macropomum Promotes Growth Performance and Resistance Against Aeromonas hydrophila.

The objective of this study was to evaluate the effect of dietary supplementation with Citrus sinensis (L.) Osbeck essential oil on the growth, immune system, and resistance to Aeromonas hydrophila infection in Colossoma macropomum fingerlings. The experiment was conducted with five treatments (control diet, Tween80 diet, and diets supplemented with 200, 400, and 800 mg L-1 of C. sinensis essential oil) with four replicates. At the end of the experimental period, growth parameters were measured, and blood samples were collected for thrombogram, leukogram, and phagocytic activity analysis. A bacterial challenge with A. hydrophila was conducted for 96 h. C. macropomum fingerlings that were fed with 400 and 800 mg L-1 of C. sinensis essential oil had the highest growth parameters, with final weights of 533.18 ± 2.03 mg and 531.91 ± 2.67 mg, respectively, and an increase in the number of thrombocytes, lymphocytes, monocytes, and neutrophils, as well as higher phagocytosis rates compared to the control group. Regarding the challenge, fish in the 400 and 800 mg L-1 treatments also exhibited the lowest cumulative mortality rate (26.66% ± 3.33%). Therefore, supplementation with C. sinensis essential oil promotes growth, improves health, and enhances resistance to A. hydrophila in C. macropomum fingerlings.

Spatially varying associations between community-level predictors and COVID-19 outcomes in NYC

Abstract Background The cumulative impacts of COVID-19 on hospitalization and mortality were not uniformly distributed across New York City (NYC). To better understand potential drivers of this observed geospatial disparity, we explored the associations between community-level sociodemographic characteristics and cumulative COVID-19 hospitalizations and mortality using geographically weighted Poisson regression (GWPR). Methods Cumulative COVID-19 hospitalization and mortality rates in 177 NYC modified ZIP code tabulation areas as of Dec 2022 were taken from the NYC Department of Health and Mental Hygiene, and sociodemographic predictors were taken from the 2018 American Community Survey. GWPR was applied using both non-multiscale (single bandwidth) and multiscale (flexible bandwidth) models to assess which predictors were significant and which associations varied spatially (allowing them to potentially act as both risk and protective factors, depending on the location). Results Multiscale GWPR models outperformed non-multiscale models in rendering residual spatial autocorrelation insignificant. Although multiscale GWPR allowed flexible bandwidths for each predictor, most yielded global bandwidths, suggesting geographically consistent effects. For mortality, the percent of residents without health insurance acted solely as a risk factor. Similarly, for hospitalizations, the percent of residents with a disability acted solely as a risk factor. The percent of residents with a bachelors degree or higher acted solely as a protective factor against both outcomes. Conclusions Even when associations were allowed to vary spatially in GWPR models, we still found geographically consistent associations between many sociodemographic predictors and cumulative COVID-19 outcomes in NYC. Consistent risk factors, such as prevalence of disability, or protective factors, such as prevalence of higher education, highlight potential areas for city-wide policies to reduce the burden of future epidemics. Key messages • For cumulative COVID-19 outcomes across NYC communities, geographically consistent risk factors include disability prevalence for hospitalization and lack of health insurance for mortality. • Increasing prevalence of higher education acted as a geographically consistent protective factor against both hospitalization and mortality due to COVID-19.

Left ventricular mass index and prognosis of symptomatic severe aortic stenosis in women and men

Abstract Background Symptomatic severe aortic stenosis (AS) requires surgical (SAVR) or transcatheter aortic valve replacement (TAVR), and many patients are on the procedure waiting list. The diagnosis of severe AS is based on clinical and echocardiographic criteria, such as left ventricular ejection fraction (LVEF), aortic valve area (AVA), mean transvalvular gradient, and peak aortic jet velocity. However, there is a gap in knowledge regarding the influence of left ventricular mass on the prognosis of these patients, especially considering differences between women and men. Purpose To evaluate the influence of left ventricular mass index (LVMi) on the mortality of women and men with severe AS awaiting SAVR or TAVR. Methods A prospective study analysed the death rate in 531 outpatients with symptomatic severe AS with mean transvalvular gradient ≥40 mmHg, AVA ≤1.0 cm2, or peak aortic jet velocity ≥4.0m/s at echocardiography with the indication for TAVR or SAVR in the period from April 2020 to February 2024. Baseline data included analysis of clinical characteristics, echocardiographic variables, and the presence of coronary artery disease (CAD). Statistical analyses were performed using the Kaplan-Meier (K-M) and Cox proportional hazards methods to analyze mortality rates in women and men. Results The mean age was 74.7±11.6 years, with 283 (53.3%) men. Over a follow-up period of 2.67±1.22 years, death occurred in 165 (31.1%), 148 (86%) due to cardiovascular disease, and 152 (92%) had heart failure (HF) NYHA II to IV, 51 (9,6%) had angina, and syncope in 11 (2.1%) of the patients. Patients who died had lower LVEF (61.4%±8.9% vs. 58.8%±10.8%; p=0.008) and higher LVMi (125.3±32.5 g/m2 vs. 115.5±29.3 g/m2; p=0.001). Angina, syncope, hypertension, dyslipidemia, diabetes, smoking, atrial fibrillation, and CAD prevalence were similar in living patients and in those who died. Both groups had similar echocardiographic data, such as left atrial volume, mean transvalvular gradient, and peak jet velocity. TAVR and SAVR were done in 111 (20.9%) and 162 (30.5%) patients. Of these, 21 (18.9%) and 20 (12.4%) died during follow-up, respectively. Cumulative mortality of all patients was higher with LVMi >115 g/m2 compared to ≤115 g/m2 (p=0.008)(Figure). In women but not in men, cumulative mortality was higher with LVMi >115 g/m2 compared to ≤115 g/m2 (p=0.046). Cox multivariate analysis, adjusted for LVEF, LVMi, CAD, and age, showed LVMi as an independent variable for death [HR=1.50 (95%CI: 1.10-2.05); p=0.011]. LVEF [HR=0.97 (95%CI: 0.95-0.99); p=0.009] and LVMi [HR=1.75 (95%CI: 1.10-2.79); p=0.016] were independent variables for death in women, but not in men. Conclusion Women with higher LVMi and lower LVEF should have valve intervention prioritized.Figure

Influence of persistent atrial fibrillation on the prognosis of heart failure with preserved, mildly reduced, and reduced ejection fraction in women and men

Abstract Introduction Heart failure (HF) is one of the leading causes of death from cardiovascular disease. Persistent atrial fibrillation (PAF) is associated with a worse prognosis in HF. However, little is known about the influence of AF on mortality in women and men with heart failure with preserved (HFpEF ≥50%), mildly reduced (HFmrEF 41% to 49%), and reduced ejection fraction (HFrEF ≤40%). Purpose to analyze the characteristics and influence of PAF on the prognosis of different HF phenotypes. Methods From February 2017 to September 2020, we analyzed hospitalizations, emergency admissions, and mortality of different HF phenotypes with and without PAF. Baseline data included clinical features and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) and Cox proportional hazards methods to analyze mortality rates. Results We studied 11,543 patients, with a mean of 64.1±14.0 years: 55.1% male, 42% with HFrEF, 12.8% with HFmrEF, and 45.1% with HFpEF. PAF was associated with higher mean age (67.6±14.3 vs. 62.8±13.4 years, p<0.001) and more prevalent in men (21% vs. 19%; p=0.019) and in patients with valvular and Chagas etiologies, chronic kidney disease (CKD), stroke, and anemia. The prevalence of PAF in women and men was, respectively, 12.4% vs. 18.3% (p<0.001) in HFrEF, 18.1% vs. 22.2% (p=0.029) in HFmrEF, and 23.3% vs. 23.9 (p=NS) in HFpEF. The overall mortality was 21.6%, with mortality being 2.4 times higher in patients with PAF (40.9% vs. 16.7%, p<0.001) compared to sinus rhythm but similar in women and men with PAF (39.5% vs. 41.9%; p=NS), respectively. The hospitalization (30.3% vs 19.4%, p<0.001) and emergency admissions (38.4% vs 25.7%, p<0.001) were higher in patients with AF. Cumulative mortality was higher in patients with PAF in all HF phenotypes: HFrEF (36.6%), HFmrEF (16.8%), HFpEF (46.6%; p<0.001). Men had higher cumulative mortality in HFrEF (18.3% vs. 12.4%; p<0.001) and in HFmrEF (22.2% vs. 18.09%; p=0.029), but not for HFpEF (23.9% vs. 23.3%; p=NS). In the multivariate analysis, adjusted for age, sex, previous myocardial infarction and stroke, diabetes, CKD, PAF, Cardiac surgery, and electronic device implantation, PAF was an independent predictor of death in all HF phenotypes: HFrEF [HR=1.78(95%CI:1.57-2.02); p<0.001], HFmrEF [HR=2.14(95%CI:1.74-2.65); p<0.001], HFpEF [HR=2.08(95%CI:1.82-2.37); p<0.001]. Conclusion PAF is a frequent comorbidity in HF and is associated with a worse prognosis in all HF phenotypes. Women with PAF had a better prognosis than men with AF in HFrEF and HFmrEF. Sex-specific strategies to maintain sinus rhythm in HF patients on the overall risk of death are needed.

Renal hyperfiltration as risk factor of major adverse cardiovascular events in patients with acute myocardial infarction

Abstract Objectives While the interaction between heart and kidney potentially contributes the development of renal hyperfiltration (RHF), its clinical consequence of is not clear in patients with acute myocardial infarction (AMI). Methods A total of 9,561 AMI patients with estimated GFR (eGFR) ≥60 mL/min/1.73 m² were enrolled from a large nationwide, multi-center, prospective, observational cohort between November 2011 and December 2015. RHF was defined as eGFR >90th percentile after multiple adjustments. The primary endpoint was a combination of 3-year major adverse cardiovascular events (MACEs) after AMI treatment. Results The cumulative event rate of MACEs was significantly higher in patients with RHF. In multivariable Cox-regression analysis, RHF increased the 1.34-fold risk of MACE (95% confidence interval [CI] 1.12-1.62) compared to those without RHF. Patients with RHF had a significantly higher risk of all-cause mortality (hazard ratio [HR] 1.64; 95% CI 1.25-2.14) and cardiac death (HR 1.78; 95% CI 1.26-2.51). There was a linear correlation between the adjusted risk of MACEs and eGFR, with the risk increasing as eGFR exceeded approximately 100 mL/min/1.73 m². In the 1:1 propensity-score matched population, the cumulative event rate of MACEs, all-cause mortality, and cardiac death were consistently higher in patients with RHF (all p <0.05). Conclusion RHF was significantly associated with an increased risk of MACEs, all-cause mortality, and cardiac death following AMI compared to patients without RHF. Our study offers new insights into the risk stratification of AMI patients presenting with RHF.

Prognostic value of C-reactive protein / albumin ratio for amputation and/or mortality after lower extremity revascularization in haemodialysis patients with peripheral artery disease

Abstract Background Hypoalbuminemia, a manifestation of protein-energy wasting (PEW) or malnutrition, which is commonly observed in patients with chronic kidney disease, is associated with increasing cardiovascular risk. Recently, C-reactive protein (CRP) / albumin ratio has been developed as a newly surrogate marker of the PEW because the PEW seems to result not only from an inadequate diet but also rather be induced by chronic inflammatory status. The aim of this study was to clarify whether pre-procedural CRP/albumin ratio levels could predict amputation and/or mortality after lower extremity revascularization for peripheral artery disease (PAD) in patients on haemodialysis (HD). Methods A total of consecutive 1,850 HD patients successfully undergoing lower extremity revascularization (494 bypass surgery and 1,356 endovascular therapy) were enrolled in this study. Patients were divided into tertiles according to pre-procedural CRP/albumin ratio levels; low (<0.6, n=619), middle (0.6-3.7, n=609) and high tertile (>3.7, n=622). They were followed up for up to 8-year. The primary endpoint was defined as amputation and/or mortality. Results During follow-up period (median of 53 months), 162 major amputation (8.8%) was performed and 508 patients (27.5%) died. Cumulative incidence rates of amputation and/or mortality at 8-year were 47.4%, 56.2% and 70.0% in low, middle and high tertile of CRP/albumin ratio, respectively (p<0.0001). After adjustment for male, age, traditional risk factors, body mass index, history of coronary artery disease or stroke, procedure (bypass vs. endovascular therapy), infrapopliteal disease and ulcer/gangrene, the CRP/albumin ratio was identified as an independent predictor for amputation and/or mortality [adjusted hazard ratio (aHR) 1.39, 95% confidence interval (CI) 1.12-1.72, p=0.0028 for middle vs. low tertile, and aHR 2.53, 95% CI 2.07-3.09, p<0.0001 for high vs. low tertile, respectively]. Similar results were also observed even for major amputation and mortality, respectively (aHR 2.73, 95% CI 1.77-4.31 for amputation and aHR 2.32, 95% CI 1.82-2.97 for mortality with p<0.0001 for high vs. low tertile in both, respectively, Figure). Conclusion Pre-procedural CRP/albumin ratio could predict both of amputation and mortality after lower extremity revascularization, and could stratify the risk in HD patients with PAD. Measurement of CRP/albumin ratio in such high-risk population may be useful because this newly surrogate marker of the PEW is simple and can be easily obtained in daily practice.

Left ventricular ejection fraction and clinical outcomes after transcatheter aortic valve implantation

Abstract Background Reduced left ventricular ejection fraction (LVEF ≤50%) has been associated with poor prognosis in patients with severe aortic stenosis treated medically or with aortic valve replacement. However, less is known regarding the impact of different degrees of LVEF including moderately to severely reduced LVEF after transcatheter aortic valve replacement (TAVR). Purpose To examine the association between baseline LVEF and clinical outcomes after TAVR. Methods Patients undergoing TAVR between 2008-2021 from the Swedish Transcatheter Cardiac Intervention Registry (SWENTRY) were included. LVEF was estimated from echocardiography before TAVR and categorized as ≥50%, 40-49%, 30-39% and <30%. SWENTRY was linked to the National Patient Registry and Cause of Death Registry for outcome variables. Patients were followed for a median of 3.2 years for the primary outcome heart failure hospitalizations and the secondary outcome all-cause mortality. Cox regression analyses adjusted for age, sex, BMI, atrial fibrillation, eGFR class, diabetes, hypertension, frailty, chronic pulmonary disease and coronary artery disease were performed for the association between LVEF groups and outcome. Results In total, 8686 patients were included (mean age 81 years, 47% female) of whom 5904 (68%) patients had LVEF ≥50%, 1342 (15%) had LVEF 40-49%, 906 (10%) had LVEF 30-39% and 534 (6%) had LVEF <30%. Significant differences were observed across the LVEF groups in the cumulative incidence rates of heart failure hospitalizations (19, 30, 37 and 43%; p<0.001) and all-cause mortality (41, 54, 55, 57%; p<0.001) at five years. In adjusted analyses there was a stepwise increase in the risks of heart failure hospitalizations (Figure 1A) and all-cause mortality (Figure 1B) for each respective LVEF category. Conclusion Reduced LVEF, especially LVEF <30%, was associated with a dramatically increased long-term risk of heart failure hospitalizations and all-cause mortality in patients undergoing TAVR. LVEF should be considered in risk stratification and patient selection for TAVR.

Catheter-induced ostial coronary artery dissection during percutaneous coronary intervention assessed by intravascular ultrasound

Abstract Background Catheter-induced ostial coronary artery dissection is one of the possible complications of percutaneous coronary intervention (PCI), sometimes resulting in serious consequences. The incidence of catheter-induced ostial coronary artery dissection has been assessed by coronary angiography, but rarely by intravascular ultrasound (IVUS). Prognosis of ostial coronary artery dissection is also unclear. Purpose To determine the incidence and prognosis of catheter-induced ostial coronary artery dissection during PCI by IVUS assessment. Methods The study population consisted of 1468 consecutive patients undergoing PCI at our institution between January 2019 and March 2020. Patients who had previously received a stent in the ostial coronary artery to be treated and patients who were scheduled to receive a stent in the ostial coronary artery during the procedure were excluded. The analysis was performed on 246 patients undergoing IVUS assessment of the ostial coronary artery at the end of the procedure. The 1-year cumulative rates of all-cause death, nonfatal myocardial infarction, and any revascularization procedure were compared between patients with and without ostial coronary artery dissection (dissection and nondissection groups). Results Ostial coronary artery dissection was detected by coronary angiography in 13 patients (5.2%) and by IVUS in 49 patients (19.9%). There were no significant differences between the dissection and nondissection groups (49 patients vs. 197 patients) in the percentage of the treated coronary artery (right coronary artery: 34.7% vs. 36.0%, p = 0.86), acute coronary syndrome (30.6% vs. 41.6%, p = 0.15), or the use of a backup catheter (32.7% vs. 20.8%, p = 0.09). The dissection group had more moderate to severe calcified lesions than the nondissection group (42.9% vs. 22.3%, p<0.01). There were no significant differences between the dissection and nondissection groups in the 1-year cumulative incidence of all-cause death (6.1% vs. 6.6%, p = 0.88), nonfatal infarction (6.1% vs. 4.1%, p = 0.54), or any revascularization procedure (10.2% vs. 8.6%, p = 0.72). Eight patients (16%) in the dissection group received additional intervention for ostial coronary artery dissection and had a significantly higher rate of dissection detected by coronary angiography than conservatively treated patients (75.0% vs. 17.1%, p<0.01). In addition, no conservatively treated patients received additional intervention for worsening dissection within one year of the index procedure. Conclusion IVUS may be more useful than coronary angiography in detecting ostial coronary artery dissection. With proper management, ostial coronary artery dissection may not lead to worse 1-year outcomes, and many dissections detected by IVUS may not require additional intervention.

Effect of baseline and one-year follow-up anemia status on long-term clinical outcomes in patients with heart failure

Abstract Background Anemia is a significant comorbidity in heart failure (HF), influencing patient prognosis and quality of life. In patients with HF, fluctuations in anemia status can markedly impact long-term outcomes. Purpose The aim of this study was to evaluate the long-term prognosis of HF patients according to change in anemia status at the baseline and one-year follow-up. Methods Data were obtained from a multicenter cohort of patients hospitalized for acute heart failure (AHF) from 10 tertiary university hospitals between March 2011 to February 2014. Out of 5,625 AHF patients, the study population was consisted of 1,798 patients with available data on hemoglobin levels at baseline and one-year follow-up. Anemia is defined as hemoglobin levels below 13 g/dL for men and 12 g/dL for women. These patients were then categorized into four groups: group ‘anemia to anemia’; group 2 ‘no-anemia to anemia’; group 3 ‘anemia to no-anemia’; group4 ‘no-anemia to no-anemia’. Primary outcome was the composite incidence of cardiac death or HF readmission. Results Among 1,798 patients, 718 patients (39.9%) died during follow-up (mean 1169.1 ± 880.7 days, median 1057.5 days) and 816 patients (45.4%) developed primary outcome. The patients with baseline anemia had a worse clinical profile than those without anemia. The development of primary outcome tended to significantly decrease from group 1 to group 4 (55.6% vs. 48.1% vs. 40.2% vs. 36.3%, p for trend <0.001). In addition, the incidence of all-cause death, cardiac death, readmission due to cardiac cause, and HF readmission also tended to decrease significantly toward group 4. The cumulative cardiac death or HF readmission free survival rate showed significantly lowest in the group 1 (log-rank p-value < 0.001), and the survival rate increased from Group 1 to Group 4 (Figure). After adjusting for confounding factors, Cox regression analysis showed that anemia to anemia group was independently associated with a 1.368-fold increased risk of primary outcome compared to no-anemia to no-anemia group during follow-up (Hazard ratio [HR] 1.368, 95% confidence interval [CI] 1.110-1.701, p = 0.005). No-anemia to anemia group had also a 1.376-fold increased risk of primary outcome (HR 1.376, 95% CI 1.043-1.814, p = 0.024) compared with no-anemia to no-anemia group. Conclusions In conclusion, the risk of adverse clinical outcomes including cardiac death and HF readmission increased progressively in groups transitioning from no-anemia to anemia or consistently remaining anemic in AHF patients. Conversely, those who improved from anemia to non-anemia or remained non-anemic exhibited a decreased risk, highlighting the critical role of anemia status as a determinant of long-term prognosis. Clinicians should actively manage and monitor anemia as an essential component of treatment strategies to improve long-term outcomes in patients with HF.Kaplan-Meier Survival curve

Evaluation of renal tubulointerstitial damage as a residual renal risk factor for adverse cardiac events in patients with aortic valve stenosis

Abstract Background Renal dysfunction, defined as a lower eGFR, has been shown to be related to cardiovascular events in patients with aortic stenosis treated with transcatheter aortic valve implantation (TAVI). However, the contribution of renal tubulointerstitial damage to the predictive value for cardiovascular events remains unclear. The aim of this study was to elucidate whether renal tubulointerstitial damage is associated with the occurrence of all death and heart failure patients who have had TAVI. Methods and results In a cohort of 155 patients, urinary beta2-microglobulin (beta2MG) levels were measured. Patients were monitored for less than three years or until experiencing all-cause mortality or hospitalization due to heart failure. The cumulative all-cause mortality was 11.5%, and heart failure admission rate stood at 5.4%. Stratifying outcomes by beta2MG levels revealed significantly lower rates of all-cause mortality and heart failure in patients with beta2MG <0.20 mg/gCre compared to those with beta2MG ≥0.20 mg/gCre (10.2% versus 24.2%, p=0.01). When outcomes were stratified according to the beta2MG levels in combination with eGFR levels, Kaplan-Meier analyses showed that all-cause mortality and heart failure rates increased depending on an increase in the beta2MG levels (p<0.05) even if eGFR is above 60 ml/min. Moreover, multivariate Cox analyses revealed that high levels of beta2MG were an independent predictor of adverse events. Conclusion Renal tubulointerstitial damage is associated with the occurrence of all death and hospitalization for heart failure independent of renal glomerular function.

Gender-specific differences in severe tricuspid regurgitation. Finding from a TR multicentre CMR registry

Abstract Background Observational studies have suggested that severe tricuspid regurgitation (TR) is more prevalent in women than in men, although the pathophysiological causes that justify this difference are unknown. Purpose 1) to assess clinical and imaging differences by Cardiac Magnetic Resonance (CMR) between men and women and 2) to examine the relationship between gender and all-cause mortality in a multicentre cohort of patients with at least severe TR. Methods The study-enrolled patients with at least severe TR assessed by 2D echocardiography who underwent a contemporary cardiac magnetic resonance (CMR) study. The primary outcome was all-cause mortality. Results 318 patients with severe TR recruited from 5 tertiary care hospitals were included in this study (70 ± 11 years, 67% female, 73% NYHA I or II). Regarding the etiology, 10% were primary TR, 1% CIED-related TR, 46 % atrial secondary TR and 43% ventricular secondary TR. Women showed a non-significant tend to lower prevalence of comorbidities, lower BNP and significantly lower creatinine values (table). Regarding CMR variables, women showed smaller indexed right ventricle (RV) volumes higher RVEF and lower TR regurgitant volume (table, p<0.05 for all). Left ventricle (LV) volumes were smaller and LVEF higher in women compared to men (p<0.001). During a median follow-up of 28 months (IQR: 10-54 months), there were 61 deaths (19%) with an estimated 5-year survival of 74%. Cumulative all-cause mortality was significantly worse in men compared to women (27% vs. 15%, p<0.001, figure). Male gender was significantly associated with all-cause mortality independently of age, RV volumes, RVEF and LVEF (HR 2,2 [1.34-3,68], p =0.002). Different cut-off values of index RV volumes and EF were predictive of mortality in men and women. In men a RV-EDV >110 ml/m2 and RVEF<57%; in women a RV-EDV >90 ml/m2 and RVEF< 60% were predictive of all-cause mortality (p<0.01). Conclusion Severe TR is more prevalent in women; however, it shows lower RV remodeling, better RV function and lower rate of events compared to men. Different prognostic RV cut-off values are provided based on CMR data.Gender differencesKaplan Meier Curves

Comparison of long-term prognosis between coronary artery disease and peripheral artery disease in haemodialysis and non-dialysis patients

Abstract Background Patients on hemodialysis (HD) have been consistently recognized as a population with a high risk for cardiovascular diseases. However, it has not been clear which vascular disease had more impact on clinical prognosis. The aim of this study was to compare coronary artery disease (CAD) and peripheral artery disease (PAD) among HD and non-HD patients undergoing coronary artery bypass graft (CABG) and lower extremity bypass (LEB) surgery. Methods A total of consecutive 1,867 patients who initially and successfully underwent cardiovascular bypass surgery (242 CABG and 620 LEB in HD patients, 604 CABG and 401 LEB in non-HD patients) were enrolled in this study. They were followed up for up to 10-year. The primary endpoint was all-cause mortality. Results Cumulative mortality rates for 10-year were 15.6%, 21.8%, 38.7% and 58.9% after CABG in non-HD patients, LEB in non-HD patients, CABG in HD patients and LEB in HD patients, respectively (Figure). HD patients consistently had higher risk of mortality after cardiovascular bypass surgery compared to non-HD patients [adjusted hazard ratio (aHR) 3.04, 95% confidence interval (CI) 2.21-4.36, p<0.0001]. Similar results were observed after CABG and LEB in both, respectively (aHR 2.50, 95%CI 1.75-3.61, p<0.0001 for CABG and aHR 3.07, 95%CI 3.07, 95%CI 2.21-4.36, p<0.0001). Also, patients with LED tended to have higher risk of mortality compared to those with CABG (aHR 1.25, 95%CI 1.0.99-1.57, p=0.057) in entire cohort. However, the risk of mortality was significantly higher after LED than CABG in HD patients (aHR 1.34, 95%CI 1.02-1.81, p=0.042) but not in non-HD patients (aHR 1.00, 95%CI 0.67-1.49), p=0.98). In addition, HD patients with LEB had markedly higher risk of mortality compared to non-HD patients with CABG (aHR 3.50, 95%CI 2.62-4.74, p<0.0001). Conclusion Long-term prognosis was consistently poorer after cardiovascular surgery regardless of CABG or LEB in HD patients than in non-HD patients. The risk of mortality was also significantly higher after LEB than CABG in HD patients but not non-HD patients, and HD patients with LEB was considered to have the highest mortality risk in the study. Thus, PAD might be at more advanced atherosclerotic status than CAD in this high-risk population.

Excess all-cause mortality in 21 countries during 2022: COVID-19 impact by C-MOR project

Abstract National published COVID-19 mortality estimates do not fully encompass the extent of the pandemic’s impact on mortality. To address this challenge, calculating excess all-cause mortality at the national level is important. Our focus was on understanding total weekly excess mortality for 2022, by analysing mortality data across 2020-2022, from 21 countries participating in the international consortium (C-MOR), which provided data for examination. Excess mortality was calculated by comparing the weekly 2022 age-standardized mortality rates per 100,000 population against a baseline mortality, estimated using historical data from 2015-2019. Excess cumulative mortality for 2022 was found in all 21 countries. The excess mortality for the total population varied between 8.6 and 116.2, with the minimum excess belonging to Peru and the maximum to Georgia. Australia, Austria, Cyprus, Denmark, Estonia, Georgia, Greece, Israel, and Norway showed a higher excess in 2022 than in 2020, while Australia, Austria, Cyprus, Denmark, Israel, Italy, Norway, Spain, and Sweden also showed a higher excess in 2022 than in 2021. Mauritius showed a significant excess mortality for the first time in 2022. For all countries, but Australia, the % of COVID-19 deaths out of all deaths decreased in 2022 compared to 2021. Contrary to the ‘harvesting effect’, which would expect a decline in mortality rates post-pandemic, our results underscore a sustained excess mortality throughout 2022. The 2022 excess deaths are mainly non-COVID-related, stemming from broader pandemic impacts on healthcare systems and other factors. Conversely, in Australia, international boarders reopened in 2022, resulting in the first community-wide transmission and a substantial rise in excess deaths. Our study reveals nuanced excess mortality dynamics post-vaccination, providing crucial insights for policymakers and stressing the necessity of continued vigilance and adaptive strategies against COVID-19’s diverse impacts. Key messages • All countries investigated experienced continued all-cause excess mortality during 2022, compared to pre-pandemic years. For most, excess mortality in 2022 was higher than in 2021 and 2020. • For all countries, except Australia, the contribution of COVID-19 deaths to the mortality estimates in 2022 is decreased, highlighting the impact of indirect pandemic related effects on mortality.

Relative burden of cancer and noncancer mortality among long-term survivors of differentiated thyroid cancer in the US

BackgroundLimited information is available regarding the relative risks of cancer-specific mortality and noncancer-specific mortality among long-term survivors with differentiated thyroid cancer (DTC).MethodsIn this retrospective study, nationwide data from the Surveillance, Epidemiology, and End Results database (1992-2020) were utilized. The Accelerated Failure Time Model was applied to calculate Survival Time Ratios (TR), with the primary focus on mortality resulting from DTC. The competing risks model was employed to investigate the relative risks of various outcomes in DTC patients with a survival duration of 5 years or more.ResultsIn our cohort, 279 patients succumbed to DTC, while 748 died from other diseases. Notably, in DTC cohorts, noncancer-specific mortality rates were consistently higher than DTC-specific mortality rates across different age groups and genders. The risk of DTC and noncancer-specific mortality varied based on the TNM stage. With more advanced disease stages, the risk of DTC and other cancer-specific mortality gradually increased. The cumulative mortality from other cancer-specific causes was consistently the lowest.ConclusionsIn long-term surviving DTC patients, noncancer-specific mortality outweighed DTC-specific mortality irrespective of age and gender. For stage I and II patients, increased attention should be directed toward noncancer-specific mortality in postoperative follow-ups. Conversely, for stage III and IV patients, greater consideration should be given to DTC-related causes of death. In addition, for stage III and IV DTC patients, the risk of death from other cancers was significantly higher than for stages I and II.

Clinical characteristics and prognostic analysis of adult patients hospitalized with acute myocarditis

Objective: To analyze the clinical characteristics of patients hospitalized with acute myocarditis and explore the relevant factors affecting the prognosis. Methods: This study was a retrospective cohort study. Patients with acute myocarditis hospitalized in the Second Affiliated Hospital of Harbin Medical University from March 2010 to October 2022 were included and divided into severe myocarditis group and non-severe myocarditis group according to clinical diagnosis results, retrospectively. Basic clinical features were collected and followed up in both groups. The primary endpoint was cardiac death and the secondary endpoint was cardiac re-hospitalization. According to the clinical outcome, Kaplan-Meier survival curve was drawn and assessed via log-rank P test. Cox proportional risk model was established to analyze the related factors affecting the prognosis of patients with acute myocarditis. Results: A total of 235 patients with acute myocarditis were included, including 138 males (58.7%), aged (34±16) years, 102 patients (43.4%) in the severe myocarditis group and 133 patients (56.6%) in the non-severe myocarditis group. Compared with the non-severe myocarditis group, the severe myocarditis group was older and had more clinical symptoms of dyspnea, edema, and syncope. At a follow-up of 3.8 (2.8, 4.8) years, cumulative cardiac mortality and cardiac readmissions in patients with acute myocarditis were 4.2% and 9.6%, respectively. Among them, patients with severe myocarditis had a higher risk of cardiac death and cardiac readmission than those without severe myocarditis (9.3% vs. 1.0%, log-rank P=0.004; 13.4% vs. 4.2%, log-rank P=0.021). Multivariate Cox analysis showed that the independent risk factor for cardiac death in patients with acute myocarditis was elevated serum creatinine level at baseline (HR=1.016, 95%CI: 1.003-1.028, P=0.013). Independent risk factors for cardiogenic readmission were increased left ventricular end-diastolic diameter on admission (HR=1.108, 95%CI: 1.035-1.187, P=0.003) and ventricular tachycardia or fibrillation during hospitalization (HR=6.563, 95%CI: 2.138-20.142, P=0.001). Conclusions: The patients with acute myocarditis had more clinical symptoms of dyspnea, edema, and syncope. Elevated serum creatinine level on admission was an independent risk factor for cardiac death in patients with acute myocarditis; increased end-left ventricular diameter on admission and ventricular tachycardia or fibrillation during hospitalization were independently associated with cardiac rehospitalization.