Non-cardiac Disorders Research Articles

P-2004. Risk Factors for Death in Children with Multisystem Inflammatory Syndrome in Children — United States, 2020-2022

Abstract Background Although multisystem inflammatory syndrome in children (MIS-C) incidence has decreased, cases continue to occur and can have notable morbidity and mortality. This investigation evaluates clinical and demographic risk factors for death from MIS-C.Table 1.Demographic and clinical risk factors for death in children with Multisystem Inflammatory Syndrome in Children, United States, 2020-2022 Methods We evaluated children reported to CDC national MIS-C surveillance with illness onset February 2020–December 2022 and known illness outcome. We performed multivariable logistic regression to estimate odds of death compared with survival for patient characteristics and MIS-C organ involvement. Model covariates were selected a priori including age at MIS-C onset, date of MIS-C onset, race and ethnicity, and presence of any underlying medical condition. To compare risk of death across the pandemic we evaluated patients with date of MIS-C onset in five pandemic waves corresponding to peaks of MIS-C activity.Table 2.Organ system involvement risk factors for death in children with Multisystem Inflammatory Syndrome in Children, United States, 2020-2022 Results Of 8,767 MIS-C cases reported, there were 76 (9%) deaths (Table 1). Compared with children aged 5–11 years, children < 1 year and 16–20 years had increased odds of death (aOR 4.8 [1.7–13.6], p< 0.01, and 8.2 [4.6–14.8], p< 0.001, respectively). American Indian/alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) children had increased odds of death compared with White non-Hispanic children (aOR 5.4 [1.4–20.9, p=0.01 and 5.9 [1.5–23.1, p=0.01, respectively). Children with MIS-C illness onset after wave 1 had decreased odds of death compared with those during wave 1. Presence of >1 underlying medical condition was associated with higher odds of death (aOR 2.3 [1.5–3.7, p< 0.001); diabetes, congenital heart disease, neurologic, immunosuppressive/autoimmune, and noncardiac congenital disorders were all independently associated with death. Cardiovascular, respiratory, neurologic, and renal MIS-C organ involvement increased odds of death while children with mucocutaneous involvement had decreased odds (Table 2). Conclusion Younger (< 1 year) and older (16-20 years) age, AIAN and NHPI race and ethnicity, MIS-C early in the pandemic, and underlying medical conditions are risk factors for death from MIS-C. Cardiovascular, respiratory, neurologic, and renal involvement increased risk of death. Identifying risk factors associated with death may help clinicians with management and prognosis. Disclosures Regina Simeone, PhD, Pfizer: Stocks/Bonds (Private Company)

Neutrophil lymphocyte coefficient as a tool for assessing the risk of cardiac complications in elderly patients with type 2 diabetes mellitus

An elevated neutrophil-to-lymphocyte ratio (NLR) is an indicator of inflammatory processes and predicts the development of various cardiac diseases and non-cardiac disorders. Objective. To evaluate the relationship between NLR and various indices of glucose control in elderly patients with type 2 diabetes mellitus (DM2). Materials and methods. The observational study was conducted from September 2022 to February 2023. The study included 330 patients with DM2, were randomly assigned to three groups based on disease control: group 1 – glycated hemoglobin (HbA1c) level ≤7% (excellent control); group 2 – HbA1c from 7.0 to 9.0% (poor control); group 3 – HbA1c ≥9% (critical control). Patients' condition was assessed based on complete blood count and C-reactive protein levels. Results. When compared with the excellent control group (group 1), patients with the worst control (group 3) had significantly higher leukocyte (p < 0.001) and neutrophil (p < 0.003) counts, as well as lower lymphocyte (p = 0.44) levels. At the same time, no significant differences were found among patients with poor control (group 2) with patients with excellent disease control (group 1). The NLR parameter increased significantly in the worst control group (group 3) compared with the poor (group 2) and excellent (group 1) diabetes control groups: 4.3±2.8, 2.7±1.0, and 2.0±0.5, respectively (p < 0.001). NLR was found to be an independent predictor of poor diabetes control, along with fasting glucose and C-reactive protein. Conclusions. An increase in NLR is associated with an increase in HbA1c and inadequate glycemic control in patients with DM2. This indicator can serve as a useful tool for health monitoring in the process of monitoring patients with DM.

Cardiac intensive care unit: where we are in 2023

Cardiac intensive care has been a constantly evolving area of research and innovation since the beginning of the 21st century. The story began in 1961 with Desmond Julian's pioneering creation of a coronary intensive care unit to improve the prognosis of patients with myocardial infarction, considered the major cause of death in the world. These units have continued to progress over time, with the introduction of new therapeutic means such as fibrinolysis, invasive hemodynamic monitoring using the Swan-Ganz catheter, and mechanical circulatory assistance, with significant advances in percutaneous interventional coronary and structural procedures. Since acute cardiovascular disease is not limited to the management of acute coronary syndromes and includes other emergencies such as severe arrhythmias, acute heart failure, cardiogenic shock, high-risk pulmonary embolism, severe conduction disorders, and post-implantation monitoring of percutaneous valves, as well as other non-cardiac emergencies, such as septic shock, severe respiratory failure, severe renal failure and the management of cardiac arrest after resuscitation, the conversion of coronary intensive care units into cardiac intensive care units represented an important priority. Today, the cardiac intensive care units (CICU) concept is widely adopted by most healthcare systems, whatever the country's level of development. The main aim of these units remains to improve the overall morbidity and mortality of acute cardiovascular diseases, but also to manage other non-cardiac disorders, such as sepsis and respiratory failure. This diversity of tasks and responsibilities has enabled us to classify these CICUs according to several levels, depending on a variety of parameters, principally the level of care delivered, the staff assigned, the equipment and technologies available, the type of research projects carried out, and the type of connections and networking developed. The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have detailed this organization in guidelines published initially in 2005 and updated in 2018, with the aim of harmonizing the structure, organization, and care offered by the various CICUs. In this state-of-the-art report, we review the history of the CICUs from the creation of the very first unit in 1968 to the discussion of their current perspectives, with the main objective of knowing what the CICUs will have become by 2023.

Delta of Egypt Atrial Fibrillation Registry Phase Two

Background: Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia found in clinical practice. The assessed frequency of AF in adults is between 2% and 4%, with greater incidence and frequency rates in developed nations [1,2]. AF prevalence increases with advancing age, and with some cardiac and non-cardiac disorders, also it may exist in the absence of any conditions [2]. We aimed to determine case characteristics, practice patterns, management strategies and outcomes of atrial fibrillation in the delta area of Egypt.
 Methods: This registry-based cross-sectional study included 1000 atrial fibrillation patients (with any AF patterns) who were allowed to enter ER in cardiac centers and hospitals in middle Delta of Egypt from April 2020 to March 2021.
 Results: 267 patients (26.7%) were unstable. Heart failure, hypertension, and coronary disease were still prevalent comorbidities in our AF dataset, where hypertension accounts for over 50% of all AF cases. Rheumatic valvular heart disorder was a major underlying disease for the development of AF, still about 25.5% by echocardiography. Lone AF still high 20.6%. CHA2DS2VASc score ≥2 is 83.5%. A high proportion of cases were treated with pharmaceuticals for rate control nearly 52.7% of the cases and nearly 30.3% of the cases were given pharmacological medications for the cardioversion to the sinus rhythm and a small proportion of the cases were given electrical cardioversion nearly 7%.
 Conclusions: Coronary disease, hypertension, and heart failure were still usual comorbidities in AF. Rheumatic valvular heart disease is still about 25.5% of the total registry. Amiodarone is the most prevalent antiarrhythmic medications (AAD) used. lone AF still high 20.6%. minimal use of novel oral anticoagulant (OAC).

Hemodynamic changes associated to increments of PEEP in mechanically ventilated patients admitted into the cardiac intensive care unit

Abstract Funding Acknowledgements Type of funding sources: None. Background Current evidence suggests that incremental levels of PEEP generate an increase in right intracavitary pressures, diminishing venous return and consequently lessening left ventricular preload and stroke volume, resulting in a significant decrease of cardiac output. Nonetheless, most studies regarding these interactions have been done in patients requiring mechanical ventilation for non-cardiac disorders or in animals. We studied the effects of incremental levels of PEEP on cardiac intracavitary pressures and hemodynamics in mechanically ventilated patients admitted into the Cardiac Intensive Care Unit. Purpose We aimed to model how increments in PEEP alter cardiac output and other hemodynamic variables in patients with cardiac disfunction. Methods We included 14 mechanically ventilated patients admitted into a Cardiac Intensive Care Unit from 2018 to 2020. Data on intracavitary pressures and hemodynamics were recorded via Swan-Ganz catheterization and echocardiographic imaging. We documented measurements for all variables of interest at three different levels of PEEP: 5cmH2O, 10cmH2O and 15cmH2O. We conducted general descriptive statistics, mean comparison tests for paired data and linear regression models with Stata version 12.0 (StataCorp LP, College Station, TX). Results 7 (50%) patients admitted in the study had cardiogenic shock, 11 (79%) patients were mechanically ventilated in a volume-controlled setting and 3 (21%) were on pressure support ventilation. Seven (50%) patients needed vasoactive drugs during the study. Only 1 (7%) patient required an intra-aortic balloon pump. Seven (50%) patients had a visual left ventricular ejection fraction lesser than 40% and 3 (21%) had a moderate-severe mitral regurgitation. Paired mean testing by groups associated to gains of PEEP revealed statistically significant increments in Mean Pulmonary Artery Pressure (mPAP), Pulmonary Capillary Wedge Pressure (PCWP) and Central Venous Pressure (CVP). Inversely, increments of PEEP were linked to significant decrements in Cardiac Output (CO) [Figure 1 & Table 1]. Conclusions In mechanically ventilated patients admitted into the Cardiac Intensive Care Unit, rises in PEEP are associated to increments in intracavitary cardiac pressures, and inversely, with decrements in cardiac output. Although our findings are statistically significant, we have yet to clarify whether these are clinically meaningful, specifically within PEEP increments of 5 to 10cmH2O, the usual range in clinical practice.

Assessment of heart rate variability (HRV) in SN rotenone-induced lesion Parkinson's disease rat model

Parkinson’s disease (PD) is a progressive neurodegenerative disorder caused by loss of dopaminergic neurons in the substantia nigra (SN). While PD is clinically characterized by motor deficits, non-motor symptoms such as autonomic dysfunction that can lead to deficits in cardiovascular function are common in early PD. Autonomic dysfunction is an imbalance in sympathetic (SNS) and parasympathetic (PNS; vagal) tone, which directly impacts cardiovascular function and responsiveness, leading to alterations in heart rate variability (HRV). HRV is the fluctuation in time intervals between consecutive heartbeats, and reduced HRV has been linked to increased risk for cardiovascular morbidity and mortality in both cardiac and non-cardiac disorders, including those associated with PD. To gain further insight into the influence of PD on autonomic balance, we investigated measures of HRV quantified from a 20-min segment of basal ECG activity recorded in a rat model of PD generated by unilateral injection of the pesticide rotenone (ROT; n=8) into the SN; SN injection of vehicle (VEH) in a separate group of rats (n=7) served as a control. At 2-weeks after SN injection, ECG activity was recorded in urethane-anesthetized adult female Sprague-Dawley rats using needle electrodes inserted into each forepaw, RR interval data were obtained from the ECG records, and HRV was quantified using time-domain analysis to obtain SDRR and RMSSD, frequency-domain analysis to obtain spectral power in the low (LF) and high (HF) frequency bands and the LF/HF ratio, and non-linear Poincaré plot analysis to obtain SD1, SD2, and the SD1/SD2 ratio, with all data presented as mean±SE. Evaluation of mixed SNS/PNS tone measures showed that SDRR (2.89±1.09 vs 2.60±0.98 ms), relative LF power (49.9±18.9 vs 44.8±16.9% (nu)), and SD2 (4.25±1.60 vs 3.38±1.27 ms) were similar in ROT- and VEH-injected rats while evaluation of PNS tone measures showed that RMSSD (3.59±1.36 ms vs 2.00±0.75 ms) and SD1 (2.55±0.96 vs 1.42±0.53 ms) were slightly but not significantly higher in ROT-injected rats albeit relative HF power (50.1±18.9 vs 55.2±20.9% (nu)) was similar in both groups. Evaluation of sympatho-vagal balance measures showed that LF/HF ratio (1.05±0.40 vs 1.52±0.58) and SD1/SD2 ratio (0.56±0.21 vs 0.46±0.17) were similar in ROT- and VEH-injected rats albeit both measures appeared to favor slightly enhanced PNS tone in ROT-injected rats. Qualitative evaluation of Poincaré plot histogram data revealed that ROT-injected rats exhibited multiple modal clusters of beat-to-beat RR interval behaviors, suggesting that alterations in HRV are likely present. While our preliminary data show some slight alterations in HRV in ROT-injected rats, additional data are needed to improve statistical power of our comparisons as well as to better capture changes in sympatho-vagal balance and identify underlying mechanisms responsible for autonomic dysfunction in PD. Thomas Hartman Center for Parkinson's Disease Research at Stony Brook University This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Systemic inflammation markers and the prevalence of hypertension: A NHANES cross-sectional study.

Systemic inflammation markers have been highlighted recently as related to cardiac and non-cardiac disorders. However, few studies have estimated pre-diagnostic associations between these markers and hypertension. In the National Health and Nutritional Examination Survey from 1999 to 2010, 22,290 adult participants were included for analysis. We assessed associations between four systemic inflammation markers based on blood cell counts: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and hypertension prevalence in multivariate logistic regression analysis with odds ratio (OR) and 95% confidence interval (CI). To further explore their associations, subgroup and sensitivity analyses were performed. In continuous analyses, the ORs for hypertension prevalence per ln-transformed increment in SII and NLR were estimated at 1.115 and 1.087 (95% CI: 1.045-1.188; 1.008-1.173; respectively). Compared to those in the lowest tertiles, the hypertension risks for subjects in the highest SII and NLR tertiles were 1.20 and 1.11 times, respectively. Conversely, we found that PLR and LMR were negatively associated with hypertension prevalence in continuous analyses (1.060, 0.972-1.157; 0.926, 0.845-1.014; respectively), and the highest PLR and LMR tertiles (1.041, 0.959-1.129; 0.943, 0.866-1.028; respectively). Also, subgroup and sensitivity analyses indicated that SII had a greater correlation to hypertension. In conclusion, we find positive associations between SII and NLR and the prevalence of hypertension in this cross-sectional study. Our findings highlight that SII may be a superior systemic inflammation warning marker for hypertension.

Congenital Scoliosis and Tetralogy of Fallot With Neurodevelopment Delay: A Case Study and Literature Review

As the most common congenital heart malformation, tetralogy of Fallot (TOF) produces cyanosis. Patients with TOF suffer from a higher frequency of major noncardiac congenital disorders. Its association with congenital scoliosis influences vital and functional overcomes, restricting physical activity and lowering life expectancy. An 8-month-old female child was reported with admitted cough, fever, and ruled-out pneumonia. The child was diagnosed with heart disease at 2-month-old when cyanosis was apparent. After being admitted to a hospital, history and physical examination showed mild neurodevelopmental delays, such as an inability in rolling and crawling. Her chest x-rays revealed congenital spine abnormalities thoracic vertebral at T3-T8 levels and bilateral segmented-bar sacral vertebrae. Given that patients with TOF routinely undergo chest radiographs, physicians examining TOF patients’ chest radiographs should be aware of the potential for congenital scoliosis to provide early diagnosis and referral for orthopedic evaluation and treatment.

Evaluation of the influential factors on the mortality of patients with acute myocardial infarction

Introduction: Death caused by myocardial infarction (MI) usually occurs during the first hours after the onset of symptoms. Therefore, to manage, treat and decrease the mortality rate of these patients, early hospital admission is important. Objectives: We aimed to investigate the impact of the influential factors on mortality of patients with MI. Patients and Methods: In this case-control study, MI patients who were referred to the Ardabil Alavi Hospital, Ardabil university of medical sciences, Ardabil, Iran between April 2017 and April 2018 were included. The patients that had died due to MI were considered as the case group (n=27) and 27 matched patients that had died due to other causes were selected as the control group. Linear logistic regression was employed to analyze the data. Results: The mean age of the patients in the case group was significantly higher than in the control group (75.1±11.7 versus 63.;1±11.6, P=0.001). The history of non-cardiac diseases in the case group (44.4%) was significantly higher than in the control group (7.4%; P=0.002). The number of PCIs (percutaneous coronary interventions) that were conducted in the case group (40.7%) was significantly lower than in the control group (74.1%; p=0.013). The time distance between hospital admission and PCI performance in the case group (110.9 minutes) was significantly higher than in the control group (56 minutes; P=0.001). However, the mean of delay time from the onset of symptoms to hospital admission (the patient delay) and from hospital admission to receiving treatment (the health system delay) was similar between the two groups. Conclusion: This study showed that the number of performed PCIs, history of non-cardiac disorders and the interval between the onset of symptoms and PCI performance are significantly associated with the morality of MI patients.

Cardiac extrinsic compression due to abdominal distension as a cause of electrocardiographic abnormality in a critically ill patient

Anomalies in the ST segment, especially ST-segment elevation, require the ruling out of possible etiologies such as myocardial ischemia or pericarditis. However, other non-cardiac disorders such as increases in intra-abdominal and intrathoracic pressure, may cause ST-segment elevation as well and should be considered as possible etiologies due to the poor prognosis they imply in the clinical evolution of the patient. This is especially important in critically ill patients. In this respect, we herein present a case in which the increase in intra-abdominal pressure and thoracic cavity elevation due to gastric and intestinal distension, which was not present in the first CT, provoked a cardiac and coronary compression resulting in T-shaped dome wave, a QT prolongation and ST segment elevation in the inferior leads of the electrocardiogram, the patient did not present at the time of admission, ruling out other possible etiologies such as ionic imbalance or acute ischemia.

Prevalence of Anxiety Disorders in Patient Presenting to Cardiology Outpatient Department

Psychiatric comorbidities in a cardiovascular condition has been in an increasing ratio. Psychiatric disorders such as depression and anxiety, represent an additional risk for Coronary Artery Disease. As a consequence, the co-existence of physical and psychiatric morbidity negatively affects the course and outcome of both the conditions resulting in increased overall burden of disease. One study conducted in 2001 in Bikaner, India found high prevalence (75%) of Diagnosable psychiatric morbidity among patients attending Cardiac OPD. Most commonly (38.67%) diagnosed disorder was Depressive disorder followed by panic disorder as the diagnosis (38.10%). Psychiatric morbidity among patients attending cardiac outpatient department has been revealed as a significant problem in many studies. The objective of this study was to determine the proportion of psychiatric morbidity among patients attending the cardiology outpatient department in a tertiary care centre. This is a cross-sectional study Convenient sampling technique was used. The aim of this study is to find out the prevalence of psychiatric morbidity in patients attending the cardiology OPD. This will help in planning proper diagnosis and treatment in time of these non-cardiac psychiatric disorders and may reduce mortality, improve quality of life and speed the recovery of patients with cardiac diseases.

Guidelines for the management of myocardial infarction/injury with non-obstructive coronary arteries (MINOCA): aposition paper from the Dutch ACS working group.

Patients with myocardial infarction and non-obstructive coronary arteries (MINOCA), defined as angiographic stenosis <50%, represent a conundrum given the many potential underlying aetiologies. Possible causes of MINOCA can be subdivided into coronary, myocardial and non-cardiac disorders. MINOCA is found in up to 14% of patients presenting with an acute coronary syndrome. Clinical outcomes including mortality, and functional and psychosocial status, are comparable to those of patients with myocardial infarction and obstructive coronary arteries. However, many uncertainties remain regarding the definition, clinical features and management of these patients. This position paper of the Dutch ACS working group of the Netherlands Society of Cardiology aims to stress the importance of considering MINOCA as a dynamic working diagnosis and to guide the clinician in the management of patients with MINOCA by proposing a clinical diagnostic algorithm.

Early Prediction of Non-Cardiac disorders From ECG Using Lab view

The Electrocardiogram (ECG) is one of the most basic cardiological test done for any suspected diseases related to cardiological system. Abnormalities in any other system can also be detected with change in morphology of ECG. In this paper we note the changes in morphology of ECG for prediction of non-cardiac diseases like Emphysema, CNS haemorrhage, Thyroidism, Hypokalemia and Hyperkalemia. ECG is used to predict these diseases as it is a non-invasive technique and also the morphology of ECG wave is repetitive until any abnormality manifests itself through ECG. If any of the above mentioned non-cardiac diseases occur, significant changes appear in ECG signal and with the knowledge of these changes, early clues are provided regarding the diseases which are lifesaving. This paper works on acquisition and segmentation of ECG for extraction of features that are inevitable for the prediction of above mentioned diseases. The extracted features are classified as normal or abnormal based on the comparison with the reference signal. The reference signal contains information about the normal and abnormal morphological conditions of ECG which are segmented, extracted and stored prior in the LabVIEW. The automatic prediction of non-cardiac diseases is carried out with LabVIEW through which a tolerance method is used to correctly compare and predict that particular kind of disease. This will be later extended to real-time acquisition, processing and classification. The basic motive behind this project is to create an awareness and alert the patient before the fatal stage.

Specific Causes of 30-Day and 1-Year Readmissions in Heart Failure Patients

Background Readmission rates are a major metric used in evaluating the quality of hospital care for heart failure patients, but the specific causes of readmission are uncertain. Much of the existing data focuses on all-cause readmissions or uses ICD classification coding to determine causes for readmission. In this study, we retrospectively review heart failure cases to identify the specific causes of 30-day and 1-year readmission. Methods We identified heart failure patients from the University of Maryland Medical Center with an index hospitalization between January 2017 - March 2017. All charts were reviewed to determine if the index hospitalization was for heart failure. The charts were then reviewed to determine causes of subsequent readmissions. 30-day and 1-year readmissions were recorded. Readmissions were categorized as due to heart failure exacerbation, other cardiac causes, non-cardiac chest pain, infections, GI disorders, neurological disorders, renal disorders, pulmonary disorders, or trauma and surgical conditions. Planned readmissions were excluded. Results A total of 232 patients were identified to have an index heart failure hospitalization in the specified time frame. 21% of patients were readmitted within 30 days. Heart failure exacerbation, other cardiac causes, and infections were the leading causes of 30-day readmission, representing 53%, 16%, and 14% of 30-day readmissions respectively. 53% of the cohort had at least 1 readmission over 1 year. There was a total of 330 readmissions over 1 year. Heart failure exacerbation, infections, and non-cardiac chest pain were the leading causes of 1-year readmission, representing 40%, 16%, and 8% of 1-year readmissions. Discussion Heart failure exacerbation was the leading cause of both 30-day and 1-year readmissions, but infections, other cardiac causes, and non-cardiac chest pain were also significant contributors to readmissions after an index heart failure hospitalization. Prevention of readmissions necessitates addressing non-cardiac causes as well as heart failure status.

The Prognostic Significance of Elevated Cardiac Troponin in Non-Cardiac Medical Disorders. Pilot Study

Troponins are proteins that facilitate contraction of cardiac muscle by binding with actin and tropomyosin. Each troponin (Tn) complex is composed of three subunits - TnC, TnT and TnI. TnC binds calcium and regulates activation during contraction. TnT binds the complex to tropomyosin while TnI inhibits binding in the absence of activation.

Republication- Indian academy of echocardiography guidelines and manual for performance of stress echocardiography in coronary artery disease

Stress echocardiography is one of the most useful non-invasive diagnostic modalities for detection and evaluation of coronary artery disease (CAD). It is also very useful for assessment of cardiac response to hemodynamic stress in a variety of other cardiac and non-cardiac disorders. Given its cost-effectiveness, stress echocardiography is particularly suited for Indian scenario where the incidence of CAD is rising at an alarming rate and the astronomical expenditure required for its management is borne largely by the patients themselves. However, despite its unequivocal diagnostic value, stress echocardiography remains underutilized, particularly in India, due to the lack of adequate exposure and training in this modality. Unfortunately, while there is extensive literature available to document diagnostic accuracy of stress echocardiography, there are very few texts that actually describe how to perform stress echocardiography in real life. This Indian Academy of Echocardiography guideline document aims to fill this very void. This is a comprehensive 'how to do' document prepared with the objective of providing detailed description of the steps involved in performance and interpretation of stress echocardiography so that there is increased adoption of this important and clinically useful diagnostic modality in daily clinical practice. However, while stress echocardiography has several clinical applications, the present document is restricted to its main application, which is evaluation of CAD. Republished with permission from: Dr. Satish Govind, Editor-in-chief (Journal of the Indian Academy of Echocardiography & Cardiovascular Imaging).

Hospital readmission following transcatheter aortic valve implantation in the real world

BackgroundThere is limited data on hospital readmissions following transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate hospital readmissions post-TAVI. MethodsData from the Optimized transCathEter vAlvular iNtervention (OCEAN-TAVI) multicenter registry (registration no. UMIN000020423) were collected from 1215 patients who underwent TAVI. Incidence, timing, causes, and predictors of readmission in addition to the impact on patient outcomes were analyzed. ResultsOf 1215 patients, 223 (18.4%) were readmitted within 1 year post-TAVI. Early readmission (≤30 days) occurred in 42 patients, while late readmission (>30 days) occurred in 181 patients. Readmissions were due to cardiac disorders, such as heart failure and arrhythmia, in 77 patients and non-cardiac disorders, such as respiratory disorders, infections, and cerebrovascular events, in 146 patients. Kaplan-Meier analysis revealed that early readmission was associated with a lower 1-year survival compared to non-early readmission (72.4% vs. 89.0%, p < 0.05). Multivariate Cox regression analysis showed that acute kidney injury (hazard ratio [HR], 2.27; p = 0.03) was an independent predictor of early readmission, while anemia (HR, 2.21; p < 0.01), hypoalbuminemia (HR, 1.37; p = 0.04), atrial fibrillation (HR, 1.70; p < 0.01), and more than mild postprocedural aortic regurgitation (HR, 1.62; p < 0.01) were independent predictors of late readmission. ConclusionReadmission occurred in approximately one-fifth of patients post-TAVI and was associated with poor patient outcomes. Early readmission was mainly due to procedural complications, while late readmission was mainly determined by baseline comorbidities including a frailty criterion. Measures should be taken to reduce hospital readmissions and improve patient outcomes post-TAVI.

Neutrophil/lymphocyte ratio and its association with cardiometabolic profile and prevalent chronic complications in type 2 diabetic patients in Douala General Hospital

Introduction: Neutrophil/lymphocyte ratio (NLR) is a simple and affordable marker of subclinical inflammation, reported to be associated with cardiac and non-cardiac disorders. We compared the distribution of NLR in type 2 diabetes mellitus (T2DM) patients and healthy subjects and assessed the association of NLR with glucose control, cardiometabolic parameters and prevalent chronic diabetic complications in T2DM patients receiving care at a tertiary health facility in Cameroon.

Neutrophils to Lymphocytes Ratio is an Easy Non Expensive Marker of Inflammation in Hemodialysis Patients

Background: Patients with end stage renal disease (ESRD) have elevated levels of inflammatory mediators including Creactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Neutrophil to lymphocyte ratio was introduced as a novel inexpensive indicator that reflects the severity and extension of systemic inflammation and atherosclerosis, and predicts adverse clinical outcomes in cardiac and non-cardiac disorders including ESRD. The aim of this study is to evaluate the frequency of subclinical inflammation using neutrophil to lymphocyte ratio (NLR) and its relation to other biochemical parameters in ESRD patients on maintenance haemodialysis (HD) in comparison to high-sensitivity C-reactive protein (hsCRP). Methods: A cross sectional observational study including 100 clinically stable ESRD patients on regular haemodialysis (mean age 48.25 ± 13.67, 57% were males), NLR was calculated from complete blood count and hsCRP was recorded for all patients where 8.2 mg/L indicated inflammation. Results: NLR was positively correlated to hsCRP, using ROC curve (AUC=0.647) and the best cut off point to detect subclinical inflammation in HD patients was calculated with NLR greater than or equal 1.54, with sensitivity 68.25% and specificity 54%. By using univariate and multiple variate analysis in our work to test for independent predictors of hsCRP levels as an indicator for inflammation, it was found that NLR can be used as an independent predictor of hsCRP as an inflammatory marker, with statistically significant correlation (p=0.015). Spearman coefficient (rs=0.220) shows statistically significant (p=0.028) positive correlation between NLR and hsCRP. Conclusion: NLR is an easy, simple and non-expensive method that can be used as a marker of inflammation in HD patients when compared to hsCRP.

Syncope in Pediatric Practice.

Syncope is defined as a sudden, self-limited loss of consciousness and postural tone followed by spontaneous and complete recovery without any neurological sequelae. It is one of the most common paroxysmal disorders in children and adolescents. The three major causes of syncope in children are neural, cardiovascular and other non-cardiovascular causes. The common unifying mechanism is transient global hypoperfusion of the brain. The diagnosis is primarily clinical and objective laboratory investigations add little to the diagnosis in children especially in neurocardiogenic subtype. Specific management depends on the underlying cause of syncope in children. For cardiac causes, management includes early referral to the pediatric cardiology specialist. When paroxysmal non-epileptic events are suspected, child psychology or psychiatry consultation should be sought to identify the stressors and counseling. For neurocardiogenic syncope, the main objective of treatment is to prevent recurrent events to improve the quality of life, psychological stress and school absenteeism by behavior and lifestyle modifications followed by drugs in refractory cases. The prognosis is excellent for neurocardiogenic syncope and is variable based on the underlying pathology in cardiogenic cases. As syncope is not a disease in itself but a symptom of an underlying disorder; hence, all children with syncope require assessment to exclude an underlying life-threatening cardiac or non-cardiac disorder.