Medical History Research Articles

Prognostic significance of oxygen saturation/fraction of inspired oxygen 3 days after initiation of tocilizumab treatment in patients with COVID-19

BackgroundTocilizumab is effective in treating severe coronavirus disease 2019 (COVID-19). However, the specific time point it acts as a valid indicator of treatment efficacy remains unclear. This study aimed to determine the optimal day for assessing the prognostic value of the oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) and ratio of respiratory rate-oxygenation (ROX) index in patients receiving tocilizumab for COVID-19. MethodsAll patients admitted to our hospital from March 2020 to July 2021 who received tocilizumab for COVID-19 were retrospectively identified from hospital charts. Biodata, medical history, and laboratory tests results were obtained from medical records. The prognostic values of the SpO2/FiO2 and ROX index for predicting mortality were assessed. Cox proportional hazard and receiver operating characteristic curve models were utilized. ResultsOf the 84 included patients, 34 died within 7 days after discharge. The patients who recovered had a mean age of 65 years and were younger than those who died. The multivariate analysis indicated that multiple comorbidities, cancer history, CURB-65 score, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and lactate dehydrogenase levels were higher in those who died compared with those who survived. No significant differences were found in dyspnea or total bilirubin levels between the two groups. The SpO2/FiO2 at 3 days post-tocilizumab initiation was strongly associated with survival. ConclusionsThe SpO2/FiO2 on day 3 post-tocilizumab initiation was a predictor of COVID-19 prognosis, which could be employed in determining clinical decisions. Prompt alternative interventions should be considered when this ratio does not improve.

Pancreatic cystic neoplasms

Pancreatic cystic lesions represent achallenging heterogeneous entity with a potential risk of malignant transformation. The diagnostics include in particular medical history taking with collection of relevant clinical information and high-resolution imaging, preferably using magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) and/or endoscopic ultrasonography. A differentiation between different cystic entities and identification of risk factors are crucial for making appropriate treatment decisions. Only a small proportion of pancreatic cystic neoplasms require surgery. Pancreatic cystic lesions with a relevant risk of malignancy, such as main duct intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN) and general cystic pancreatic lesions with risk factors regardless of the entity, should be resected, whereas an individualized approach is required for branch duct IPMN and serous cystic neoplasms (SCN) and dysontogenetic cysts require no treatment. Parenchyma-sparing and minimally invasive resection techniques should be preferred whenever possible for resecting pancreatic cystic tumors. Approximately 10% of patients develop recurrences over time.

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS.

Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

LEFT VENTRICULAR NON COMPACTION CARDIOMYOPATHY ASSOCIATED WITH MITRAL VALVE PROLAPSE

Left ventricular non compaction (LVNC) is a rare condition characterized by prominent ventricular trabeculations and intertrabecular recesses,Mitral regurgitationwhen present is usually a result of annular dilation, mitral valve prolapse due to chordae tendinae rupture is quite rare.We present the case of a 48 year old male with no medical history who presented with worsening exertional dyspnea classified as NYHA class III. The physical examination found a systolic murmur heard at the apex. Transthoracic echocardiography and cardiac magnetic resonance confirmed the diagnosis of Left ventricular non compaction associated with posterior mitral valve prolapse with severe mitral regurgitation and preserved ventricular function who was successfully operated and found asymptomatic during the follow up.

CASE REPORT: GIANT HYDATID CYST OF THE LIVER IN A YOUNG PATIENT: SURGICAL MANAGEMENT AND LONG-TERM FOLLOW-UP

Hydatid disease, caused by the parasite Echinococcus granulosus, remains a significant public health issue in endemic areas, especially in rural settings. This report presents the case of an 18-year-old female patient residing in a rural area, with no significant medical history, who developed a symptomatic hepatic hydatid cyst. The patient was treated surgically without preoperative antiparasitic therapy and was placed on postoperative albendazole. The case highlights the importance of timely surgical intervention and long-term follow-up to prevent recurrence.

A prospective study on etiology and clinical profile of chronic Cor pulmonale

Background: Cor pulmonale accounts for approximately 6% to 7% of all adult heart disease cases in the United States and is involved in 10% to 30% of hospital admissions for congestive heart failure nationwide. Materials and Methods: This prospective study was conducted at Al-Ameen Medical College and Hospital in Vijayapura, adhering to specific inclusion and exclusion criteria. The sample included 73 cases, with detailed medical histories and symptom analyses collected from each participant. A thorough clinical examination was also performed. Results: Among the 73 patients, 25 (34.3%) were aged 40 to 50 years, while another 25 (34.3%) were over 60 years. The majority were male (80.8%), and 50 patients (68.5%) had a history of smoking. All participants presented with symptoms of breathlessness, cough, and swelling of the feet. Physical examinations showed tachypnea, crepitations, and rhonchi in all individuals. Chronic bronchitis and emphysema were identified as the leading causes of chronic cor pulmonale in 44 patients (60.2%). Conclusion: This study found that chronic bronchitis and emphysema were common causes of chronic cor pulmonale, primarily affecting middle-aged and older individuals, with males affected more than females and smoking identified as a major contributing factor. Common symptoms included breathlessness, cough, and lower extremity swelling. Physical examinations frequently revealed tachypnea, crepitations, rhonchi, and notable signs such as epigastric pulsations, loud P2, pansystolic murmur of tricuspid regurgitation, and parasternal heave. Chronic cor pulmonale has a substantial impact on both pulmonary and cardiac function; 53.7% of patients are at risk of readmission within one year of discharge. The condition is generally associated with a poor prognosis. This highlights the importance of early detection of signs and symptoms to enhance management outcomes.

ФАРМАКОЭКОНОМИЧЕСКИЕ ПОДХОДЫ К АНАЛИЗУ СТОИМОСТИ АНТИРЕТРОВИРУСНЫХ ПРЕПАРАТОВ, ПРИМЕНЯЕМЫЕ В ТЕРАПИИ ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ

The legislation in force in the Russian Federation guarantees HIV patients protection of their rights in labor, education and other spheres of life, as well as free counseling, diagnosis and treatment of HIV infection. The continued increase in the number of infected people and, more importantly, the emergence of the HIV epidemic from risk groups into the general population highlights the need for additional improvement in the effectiveness of measures taken to counter the spread of infection. In this regard, it is necessary to use the most rational measures, both from the point of view of efficiency and safety, and from the point of view of costs. The most suitable tool for solving these problems is pharmacoeconomical analysis. At the same time, conducting pharmacoeconomical analysis in the field of HIV infection, as well as in any other nosology, involves the need to take into account certain features at the stages of planning and implementation of the study. It is necessary to highlight some key features of the methodology of pharmacoeconomical analysis in the assessment of healthcare technologies in the field of HIV infection, in particular, cost minimization analysis, which involves choosing a medical technology with minimal costs by comparing the monetary value of alternative technologies, provided the same therapeutic effectiveness. The main object of the study was the documented medical histories of HIV-infected patients, statistical and analytical methods of analysis were used and it was established that in the Russian Federation and in Kuzbass there are all drugs for the treatment of patients with HIV infection included in modern lists of treatment standards according to clinical recommendations. The difference in the cost of antiretroviral drugs at the price of government funding has been established, which affects the costs of treating HIV-infected patients.

Medication Management in Adults With Intellectual and Developmental Disabilities: Psychiatric Pharmacists in Primary Care.

This study describes the role of psychiatric pharmacists (PPs) in medication management at a county-hospital-based primary care clinic serving adults with intellectual and developmental disabilities (IDD). During a 20-week period, PPs provided 308 interventions for 97 patients with IDD, 55% of whom had a concomitant psychiatric/behavioral disorder and 70% of whom were taking at least one psychotropic medication. PP services included medication reviews (48%), medication histories (13%), collaborative care (12%), pharmacotherapy interventions (11%), advisory services (9%), and patient/caregiver education (7%). Psychotropics were involved in 66% of interventions. Our results demonstrate that PPs may address psychotropic-related challenges in this practice setting by performing a variety of services. Additional studies are needed to fully evaluate the impact of this integrative model.

Total resection via right mini-thoracotomy for left atrial myxoma in juvenile Carney complex: a case report

Abstract Background Carney complex is a rare syndrome characterized by skin pigmentation, endocrine disorders, and myxomas. It is particularly notorious for its tendency to exhibit aggressive cardiac myxomas. Herein, we present a case of a juvenile female patient diagnosed with Carney complex who underwent a right lateral mini-thoracotomy. Case presentation A 13-year-old girl presented with sudden-onset left hemiplegia and dysarthria. Magnetic resonance imaging revealed multiple areas of restricted diffusion. Echocardiography identified a tumor in the left atrium, suspected to be related to Carney complex based on her medical history and physical examination findings. Surgery was performed via right lateral mini-thoracotomy, which minimized the risk of embolism and ensured a cosmetically favorable outcome. The left atrial wall defect was repaired with autologous pericardium. At 3 years postoperatively, follow-up echocardiography indicated no tumor recurrence and normal cardiac function. Conclusions Ongoing follow-ups are essential due to the aggressive nature of the Carney complex and its high recurrence rates. Right lateral mini-thoracotomy offers the advantage of avoiding re-sternotomy and minimizing adhesion dissection, making it the optimal choice for this case.

Associations vulvar lichen sclerosus with autoimmune thyroid diseases.

Vulvar lichen sclerosus (VLS) is defined as a chronic inflammatory skin disease that most often involves lesions on the mucous membranes of the vulva with a tendency to progress to the anal skin. The etiopathogenesis of VLS remains unknown and is likely multifactorial. Data emphasize the role of immunological factors - more than 25% of VLS cases coexist with autoimmune diseases. The purpose of the present study was to determine the correlation of the prevalence of anti-thyroid antibodies - IgG class antibodies against thyroid peroxidase and IgG class antibodies against thyroglobulin in women with vulvar lichen sclerosus, and the appropriateness of screening tests for autoimmune thyroid diseases in women with vulvar lichen sclerosus. Fifty women with vulvar lichen sclerosus were enrolled in the study. The control group consisted of 41 healthy women. A detailed medical history was taken with all patients, followed by laboratory determinations - anti-thyroid antibodies - IgG class antibodies against thyroid peroxidase and IgG class antibodies against thyroglobulin. Antibodies to thyroid peroxidase were present in 12% of the study group with vulvar lichen sclerosus and 4.88% of the control group, and this difference was not statistically significant (p = 0.41). Anti-thyroglobulin antibodies were detected in 4% of the patients with vulvar lichen sclerosus and 4.88% of the control group, and this difference was not statistically significant either (p = 0.76). The study did not confirm the association of VLS with autoimmune thyroid diseases. Undoubtedly, based on the data available in the literature, further studies are needed to determine the mechanisms behind the association between vulvar lichen sclerosus and autoimmune thyroid diseases.

Disney to Pixar Transition Causing Epilepsy: A Case Report of Reflex Epilepsy.

This case report describes a rare instance of reflex seizures in a 4-year-old boy with a complex medical history, including total anomalous pulmonary venous connection and developmental disabilities. The patient experienced seizures triggered exclusively by a specific visual stimulus: the transition scene from the Disney castle to the Pixar lamp in Disney-Pixar movies. Video electroencephalography (EEG) revealed biparasagittal rhythmic delta waves and diffuse slowing, suggesting parietal involvement and complex cortical processing. The findings highlight the individualized nature of reflex epilepsy and highlight the need for a nuanced understanding of specific seizure triggers. Effective management included avoiding the identified visual stimulus and adjusting medication based on the patient's response. This case emphasizes the intricate relationship between sensory processing and epileptogenic mechanisms, contributing to our knowledge of cortical excitability and guiding targeted treatment strategies for reflex seizures.

A deep learning model for syncope recognition in the emergency department

Abstract Introduction Syncope is a common presenting symptom in the emergency departments (EDs) and poses challenges in its recognition and differentiation from alternative causes of transient loss of consciousness. Natural Language Processing (NLP) is an artificial intelligence technique that enables the analysis of natural language, such as clinical notes and medical history within electronic medical records (EMRs). The application of NLP into the medical field is surging but its use for the recognition of syncope is still underexplored. Purpose We aimed to develop a NLP-based deep learning model for syncope recognition in the ED. Methods Two models, based on the Italian and Multilingual Bidirectional Encoder Representations from Transformers (BERT) language model, were developed and evaluated using consecutive EMRs from Humanitas Research Hospital ED. The first "triage" model was only based on textual data contained in the "triage" section of the EMR. The second "anamnesis" model also considered textual data contained in the "medical history" section. Performance metrics including area under the curve (AUC), Matthew’s correlation coefficient (MCC) and Brier’s score (BS) were used to compare the discriminative capabilities of different BERT models. Results The models were developed and tested on 15,098 and 15,222 EMRs, respectively. The Multilanguage BERT discriminated patients with syncope with an AUC of 0.85 in the triage model and of 0.92 in the anamnesis model. The Italian BERT identified patients with syncope with a MCC of 0.50 and a BS of 0.02 in the triage model and of 0.64 and 0.01, respectively, in the anamnesis model. Conclusions We propose two NLP-based models that identify syncope patients with a high discriminative capability. The presented algorithm may provide a starting point for the management of syncope patients using machine learning techniques.ROC and calibration curves of modelsFramework for model implementation

Relationships among intensive blood pressure control, morning blood pressure surge and 24-hour blood pressure variability

Abstract Objectives This study aimed to investigate the relationships between cardiovascular outcomes and blood pressure (BP) reduction, 24-hour BP variability (BPV), morning BP surge (MBPS), and visit-to-visit BPV. Methods This study involved 897 participants from the Systolic Blood Pressure International Trial (SPRINT), for whom biochemical and demographic data, medication history, and various blood profile information were collected. Univariate and multivariate linear regression models were used to assess the impact of intensive BP management on 24-hour BPV and the MBPS. Results Among the 897 participants (average age 71.48 ± 9.42 years; 640 males), 453 received intensive treatment. Those in the intensive group were more likely to be on ACE inhibitors, CCBs, or diuretics. This group showed significant reductions in 24-hour systolic and diastolic BP, as well as in both short-term and long-term BPVs, such as average real variability (ARV) and MBPS. The analysis demonstrated strong associations between intensive BP management and improvements in various BPV measures, including systolic ARV, diastolic BP ARV, and cumulative BP loads. A significant correlation was also found between intensive BP lowering and the primary composite outcome of the SPRINT study. Conclusions This study highlighted the significant associations between intensive BP management and reductions in the MBPS and 24-hour BPV, which affect both short-term and long-term health outcomes. The primary benefits of intensive BP control appear to stem from direct BP reduction rather than changes in BPV. However, further extensive randomized controlled trials are needed to confirm these findings.

Comprehensive risk factor analysis for sick sinus syndrome: an analysis of genetic, sociodemographic, clinical and laboratory data from the UK Biobank

Abstract Background Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and interact bidirectionally, often to initiate and perpetuate each other. The polygenic risk score (PRS) assesses the cumulative risk of disease onset based on variations at multiple genetic loci. To date, no specific PRS has been established for SSS. This study investigates the impact of clinical, sociodemographic, laboratory, and genetic factors, which were represented by PRS for AF due to the absence of a specific PRS for SSS on predicting the incidence of SSS. Methods The UK biobank enrolled 502,421 individuals, aged 38 to 73, across 22 centres in the UK locations, from 2006 to 2010. After excluding cases with incomplete data, prior history of AF, and valvular heart disease, 405,869 participants without AF (median age, 58.0 [interquartile range (IQR), 50.0–64.0] years; 213,684 [45.2%] male) were analyzed. Participants were categorized into three groups according to a validated PRS for AF: the first quintile the middle three quintiles, and the fifth quintile. Throughout the observation period, the incidence of SSS event was documented. Results During a follow-up period of 11.9 (IQR 11.1-12.6) years, a total of 769 cases of Sick sinus syndrome were identified. The Kaplan-Meier analysis demonstrated a progressive increase in the incidence of SSS as the quintiles of AF-related PRS increased. (Log-rank: P &amp;lt;0.001) Among 24 variables, statistically significant hazard ratios were observed with age, male sex, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), previous myocardial infarction (MI), history of malignant neoplasm, hypertension, diabetes mellitus, cystatin C, and AF PRS. In the prediction model for Sick Sinus Syndrome, the C-index for the sociodemographic model was 0.753. This increased to 0.764 with the addition of clinical factors, to 0.765 with the inclusion of biomarkers, and further to 0.769 upon adding genetic factors. Conclusion Our study found significant associations between the incidence of SSS and a range of sociodemographic, clinical, laboratory, and genetic factors, including age, male sex, BMI, blood pressure, and medical history. Notably, the AF PRS also showed relevance, suggesting its potential utility in developing one for SSS in the absence of a dedicated PRS for SSS.

Dynamic recommendation for anticoagulant treatment in patients with atrial fibrillation using deep reinforcement learning method

Abstract Background Recent evidence suggests that the guideline-directed anticoagulant therapy for atrial fibrillation (AF) remains controversial. Widely-used CHA2DS2-VASc score is solely based on limited traditional cardiovascular risk factors, omitting AF characteristics and other markers of thromboembolic risk. A more efficient, safer and more personalized anticoagulant approach is warranted. Purpose To develop a data-driven deep reinforcement learning (DRL) model for guiding dynamic anticoagulant treatment in AF patients to improve cardiovascular outcomes. Methods Participants of this study were enrolled from the multicentred China Atrial Fibrillation (China-AF) Registry between August 2011 and December 2022, who were with regular follow-up every 6 months. We excluded patients on warfarin at baseline due to its declining usage trend in non-valvular AF patients in China. The DRL model was trained in 70% randomly selected patients for optimal dynamic decision-making, and then subsequently tested in the remaining 30%. Data of sociodemographic characteristics, AF characteristics, medical history, lifestyle factors, laboratory examination, and medications were input for model training. Concordance rate between DRL model’s recommendations and physicians’ actual decisions of non-vitamin-K-antagonist oral anticoagulant (NOAC) prescription among all visits before censoring was calculated for each patient. Primary outcome was the composite of cardiovascular death, ischemic stroke, transient ischemic attack or systemic embolism (SSE), and major bleeding. Shapley additive explanation analysis ranked the most important factors affecting decision-making of the DRL model. Results A total of 20068 patients (mean age: 63.0±12.0 years; 36.2% female) were randomly divided into a training cohort of 14050 patients and a testing cohort of 6018 patients. The model’s NOAC recommendations were mostly affected by age, prior NOAC prescription, body mass index, hypertension history and prior statin prescription (Figure 1). Patients with concordance rates of 50.1%-75% and 75.1%-100% had significant risk reductions for the primary outcome (adjusted HR =0.63; 95% CI, 0.46-0.85; P = 0.003 and adjusted HR =0.59; 95% CI, 0.46-0.75; P &amp;lt;0.001, respectively), compared to those with a concordance rate of 0-25%. Similar results were observed for all-cause death, cardiovascular death and SSE outcomes, that patients with the highest concordance rate had a significant lower risk, compared to those with the lowest concordance rate. There was a nonsignificant but similar trend with regard to major bleeding events (Figure 2). Conclusions This modelling study suggests that a data-driven DRL model might provide more efficient, safer and more personalized anticoagulant suggestions, potentially assisting physicians in clinical practice.

The clinical characteristics and prognosis of patients with acute ST-segment elevation myocardial infarction complicated with impaired activity daily living

Abstract Background Previous studies have indicated that activities of daily living (ADL) can influence the prognosis of patients with acute myocardial infarction. The purpose of this study is to delineate the clinical characteristics, treatment regimens, and prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) who have impaired ADL. Methods The data for this study were derived from a Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals from 2010 to 2023. The inclusion criteria encompassed patients with a discharge diagnosis of STEMI.ADL prior to STEMI was evaluated using the Barthel index(BI),a widely used assessment tool for evaluating ADL.The patients' BI were obtained from their resident health records.Patients were categorized into two groups: ADL normal group and ADL impaired group. A comparative analysis was conducted between the two groups regarding clinical characteristics, treatment regimens, and prognosis. Results This study included 24,906 STEMI patients with normal ADL and 1,002 STEMI patients with impaired ADL. Baseline data revealed that patients in the ADL impaired group had a higher proportion of females (43.0% vs. 37.8%, p=0.001), were older (74.0[64.0,81.0] vs. 69.0[65.0,75.0], p&amp;lt;0.001), and had a higher proportion of Killip III and above (24.30% vs. 14.10%, p&amp;lt;0.001). Additionally, the ADL impaired group had a higher prevalence of comorbidities. In terms of treatment, the ADL impaired group had lower proportions of patients undergoing percutaneous coronary intervention (PCI) (43.8% vs. 65.3%, p&amp;lt;0.001) and primary PCI (PPCI) (36.4% vs. 55.1%, p&amp;lt;0.001). Additionally, the ADL impaired group exhibited lower utilization rates of antiplatelet drugs, ACEI/ARB, beta-blockers, ARNI, and statins, but higher rates of diuretics and cardiac glycosides. Regarding prognosis, the ADL impaired group had a higher in-hospital mortality rate (5.69% vs. 2.89%, p&amp;lt;0.001). The median follow-up time was 1,220 days. In the ADL impaired group, the rates of all-cause mortality (52.0% vs. 24.7%, p&amp;lt;0.001), cardiovascular mortality (37.3% vs. 17.3%, p&amp;lt;0.001), recurrent non-fatal myocardial infarction (11.1% vs. 8.30%, p=0.002), and recurrent stroke (11.9% vs. 8.66%, p=0.001) were higher. However, the rate of revascularization was lower in the ADL impaired group (6.69% vs. 9.20%, p=0.008), and the risk of cerebral hemorrhage showed no significant difference (1.00% vs. 0.81%, p=0.631). In a multivariate Cox regression analysis adjusting for age, gender, Killip, medical history, and treatment strategies, impaired ADL remained an independent risk factor for increased all-cause mortality (aHR 1.309, 95% CI: 1.195-1.434, p&amp;lt;0.001). Conclusions Impairment of ADL is associated with adverse clinical outcomes in patients with STEMI.Baseline characteristics of patientsMedications of patients

Do I sound sick? Self-perceived and objectively measured voice impairment in acutely decompensated heart failure: fist insights from the AHF-Voice study

Abstract Introduction Acute heart failure (AHF) is a common reason for recurrent hospitalization. Daily smartphone-based recording of vocal biomarkers appears promising for the early detection of impeding AHF. However, the value of patient-reported outcome measures (PROMs), i.e. self-perceived voice alterations during decompensation, is unknown. Methods AHF-Voice is an ongoing monocentric prospective cohort study focusing on voice alterations in patients hospitalized for AHF. Exclusion criteria: listed for heart transplantation, high output HF, cardiogenic shock, history of vocal fold disease or surgery, or life-expectancy &amp;lt;6 months. During hospitalization, medical history &amp; echocardiogram were taken and routine blood sampling was done. Daily voice recordings including sustained vowels and standardized reading were collected using a specially designed smartphone app under supervision. At admission and discharge, the self-perceived level of voice alteration was assessed by the Voice–Handicap Index-12 (VHI-12, 0-48 points) questionnaire and a global voice scale (Likert scale, 0-3 points). For both scales, higher values indicate a more severe voice impairment. Hypervolemia was quantified by body composition analysis. Preprocessing and feature extraction of voice recordings were performed using Praat software. The association of self-perceived voice impairment with surrogates of congestion and vocal biomarkers was assessed by bivariate correlation and linear regression. Results Between Apr 2023 and Feb 2024, 72 hospitalized patients with AHF were included. Four patients withdrew consent, 5 patients were excluded due to limited voice recording quality. Hence, 63 patients were considered for analysis: mean age 75±10 years, 67% men, 91% were in NYHA class III/IV, 49% de novo HF, mean LVEF was 45±16%, and median value of Charlson comorbidity score was 2 [1, 3]. Both measures of self-perceived voice impairment improved between admission and discharge (Table 1A and Figure). Concomitantly, body weight, hypervolemia, NT-proBNP, and vocal biomarkers (total reading time and shimmer) decreased. Bivariate correlation showed that both self-perceived scales of voice impairment were closely correlated, as expected (Spearman’s rho 0.36). Linear regression identified surrogates of congestion and objective voice impairments as predictors for change in both PROMs (Table 1B). However, the explained variance was low, e.g. for change in volume status and NT-proBNP 14% and 1% (VHI-12), and 4% and 7% (Global voice scale), respectively. Conclusion This preliminary analysis in patients with AHF showed that self-perceived voice impairment was sensitive to change during recompensation. Objectively generated voice measures and congestion only partially explained the observed improvement of these PROMs. This might indicate that the self-perceived voice impairment constitutes a complimentary domain of patient well-being and indicator for congestion that should be explored further.

Multidisciplinary strategies for cardiotoxicity management in ambulatory care: exploring practices, insights, and prospects for advancement

Abstract Background The management of cardiotoxicity, a significant concern in chemotherapy patients, necessitates a multidisciplinary approach. This study investigates the variability in cardiotoxicity management in outpatient settings across different medical specialties, which may lead to inconsistencies in patient care. Methods An extensive questionnaire-based study was conducted to assess the current practices and viewpoints of cardiologists, oncologists, and gynecologists in the management of cardiotoxicity among patients receiving outpatient chemotherapy in Germany. The survey engaged 1,329 medical professionals through an online platform, with a participation rate of 9.9%, amounting to 132 respondents. Results Respondents reported managing a combined total of 1,905 chemotherapy patients monthly, with individual patient loads ranging from 1 to 200. Notably, only a fraction of these patients – 37% under oncologist care and 48% under gynecologist care – underwent routine cardiological examinations. As shown in Figure 1, the three most common causes of cardiological presentations in patients undergoing chemotherapy were due to acute patient complaints (65.2%), before the start of chemotherapy (91.3%), and after the end of chemotherapy (78.3%). Furthermore, 37% of healthcare providers reported incorporating chemotherapy-induced cardiovascular toxicity risk assessments in their clinical routines. Medical history, ECG, and echocardiography were the most frequent examinations. Notably, 91.3% did not include cardiac biomarker measurements in their follow-up procedures (Figure 2). More than half of the participants (56%) expressed a need for simplified cardio-oncology guidelines. The majority of participants (84% and 83%, respectively) requested tools to assist in cardiovascular toxicity risk assessment and the implementation of appropriate therapeutic measures for patients undergoing chemotherapy. Conclusions The study draws attention to significant interdisciplinary care gaps in managing cardiotoxicity, which may contribute to an increased risk of undiagnosed cardiovascular complications in chemotherapy patients. The evident variability in cardiotoxicity management practices among different medical specialties underscores the critical need for heightened awareness and enhanced collaborative efforts. The implementation of comprehensive interdisciplinary clinical pathways and the establishment of a dedicated cardio-oncology network could potentially address these challenges, particularly in supporting primary care physicians.Figure 1Figure 2

Independent associations of educational attainment and its joint associations with LE8 score for risk of cardiovascular disease incidence and mortality among Chinese people

Abstract Background/Introduction Educational attainment is a social determinant of health. Quantifying its associations with risk of cardiovascular disease (CVD) incidence and mortality has public health importance. Recently, the American Heart Association introduced the Life’s Essential 8 (LE8) score to evaluate CVD risk. However, it remains unclear how educational attainment and the LE8 score interact in their joint associations with CVD and mortality. Purpose To examine the associations of educational level with the incidence of CVD, including coronary heart disease (CHD) and stroke, and total mortality. Also, we examined the joint associations of educational level and the LE8 score with CVD incidence and total mortality. Methods We prospectively followed 91,744 Chinese adults from the Kailuan Study (2006-2021), who were free of CVD at baseline. Information on educational level, diet, lifestyle, and health conditions was collected every 2 years. LE8 score was calculated based on eight components: diet quality, physical activity, smoking status, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. We used time-dependent Cox models to assess the associations of educational level with the outcomes as well as the joint associations of educational level and LE8 score, with adjustments for demographics, dietary and lifestyle factors, and medical history. Results During a mean follow-up of 13.1 years, there were 12,916 incident CVD cases and 13,090 deaths. Compared with the participants who only received illiteracy or elementary education, those who received high school education and above had a lower risk of CVD incidence (HR = 0.82, 95% CI = 0.76, 0.88), stroke incidence (0.72, (0.66, 0.79)), and total mortality (0.73, (0.68, 0.77)). Educational level was not associated with risk of CHD. Furthermore, significant additive interactions between educational attainment and LE8 score on the risk of CVD and mortality were observed (all p values for additive interactions &amp;lt;0.01). Compared with the participants who only received illiteracy or elementary education and had a low LE8 score, those who only received illiteracy or elementary education but had a high LE8 score still had a 27%-47% lower risk of CVD and total mortality, while those who received high school education and above and had a high LE8 score had a 51%-74% lower risk of CVD and total mortality. Conclusions Higher educational level was associated with a lower risk of CVD and mortality. These inverse associations were most apparent among participants with both a high educational level and a high LE8 score, while the participants with a low educational level but with a high LE8 score still had a significantly lower risk. These findings highlight the importance of improvement in educational attainment in preventing CVD events and deaths, and suggest that CVD events and deaths attributable to lower levels of education may be reduced by improving LE8 score.

Improvement of endorgan function following tricuspid edge-to-edge repair

Abstract Background/Introduction Subjects with severe tricuspid regurgitation (TR) often suffer from impaired endorgan function. The potential to improve endorgan function is an important goal of treatment. Purpose To assess baseline endorgan function and changes in organ function following transcatheter edge-to-edge repair with the TriClip device in subjects with severe TR from the TRILUMINATE Pivotal randomized controlled trial. Methods Right heart catheterization was required prior to enrollment; medication history was collected. Changes in biomarkers, including MELD-XI, GGT, eGFR, BUN, and TR and KCCQ overall summary score were assessed at baseline and 12-month follow-up for all enrolled subjects. A 15% improvement in biomarker levels was considered clinically relevant. The odds of achieving a 15% improvement in biomarkers between baseline and 12-month follow-up was compared between the Device and Control groups (presented as OR [95% CI]). Results A total of 572 subjects were enrolled and randomized. At baseline, subjects had elevated levels of GGT (83.0±87.7 U/L) and MELD-XI score (10.3±5.2), low eGFR (56.7±21.0 mL/min/1.73m2), and elevated BUN (29.5±16.7 mg/dL). Nearly 90% of subjects were on loop diuretics, with approximately 50% taking these in combination with a thiazide or potassium-sparing diuretic. The average diuretic dosage was 71 mg (furosemide equivalent). Most subjects had normal left ventricle ejection fraction (only 5% with LVEF &amp;lt;40%). Subjects had well-managed blood pressure (systolic: 122±13 mmHg, diastolic: 69±10), slightly elevated central venous pressures (12±6 mmHg), systolic pulmonary artery pressures (40±10 mmHg) and pulmonary capillary wedge pressures (15±4 mmHg), and normal transpulmonary gradients (11±4 mmHg). The odds of achieving a 15% improvement in liver and renal function was higher in TriClip patients compared to control: MELD-XI score (1.79 [1.22, 2.63]), GGT (1.83 [1.21, 2.77]), and eGFR (1.81 [1.18, 2.77]) - Fig 1. The favorable changes in organ function observed were also reflected when stratifying subjects by residual TR severity: The odds of a 15% biomarker improvement favored subjects with moderate or less residual TR for MELD-XI score (2.05 [1.39, 3.00]), GGT (1.91 [1.26, 2.90]), and eGFR (1.83 [1.20, 2.80]) compared with subjects who had severe or worse residual TR. Lastly, improvement in these biomarkers also favored subjects with a 15-point or greater improvement in KCCQ compared with subjects with less than a 15-point KCCQ improvement. Conclusions Use of TriClip in subjects with severe tricuspid regurgitation was associated with improvement in kidney and liver function, and this improvement was associated with reduction in the severity of TR. These data provide the first objective evidence of the physiologic impact of TR reduction obtained in a randomized clinical trial.