Non-cardiovascular Complications Research Articles

Occurrence of bacteremia, bacteriuria and bacteriuria-related bacteremia in dogs and cats with chronic kidney disease. A pilot study

In human medicine, major infections are the most significant and critical non-cardiovascular complications in patients affected by chronic kidney disease (CKD), with bacteriuria being the primary source of bloodstream infections and its evolution toward sepsis. The availability of data on prevalence of bacteremia and its association with bacteriuria in dogs and cats with CKD is limited. The aim of this observational cross-sectional study was to determine the occurrence of bacteremia, bacteriuria, and bacteriuria-related bacteremia in dogs and cats affected by CKD. Client-owned dogs and cats with a documented history of CKD undergoing disease follow-up were enrolled. Each included animal underwent a comprehensive physical examination, clinico-pathological and microbiological analyses of blood and urine, along with molecular detection of the 16S rRNA bacterial gene in blood. Aseptically collected blood and urine were obtained through jugular venipuncture and cystocentesis, respectively. After collection, blood and urine samples underwent bacteriological culture within one hour. In the population enrolled, 2/47 dogs and 1/41 cats presented bacteriemia. Moreover, 8/47 dogs and 6/41 cats presented a positive urine culture. Additionally, in one out of the 47 dogs, the same pathogen was identified from blood and urine samples, with a final diagnosis of urosepsis. No instances of bacteriuria-related bacteriemia were observed in the cat population. In conclusion, this study shows a low prevalence of bacteremia and confirms a high prevalence of bacteriuria in companion animals affected by CKD. Moreover, a low prevalence of bacteriuria-related bacteremia was also found.

In-hospital outcomes of transcatheter aortic valve replacement in patients with chronic and end-stage renal disease: a nationwide database study

BackgroundChronic kidney disease (CKD) and end-stage renal disease (ESRD) have been associated with worse outcomes after transcatheter aortic valve replacement (TAVR). With TAVR indications extending to a wider range of patient populations, it is important to understand the current implications of chronic renal insufficiency on clinical outcomes. We aim to determine the impact of CKD and ESRD on in-hospital outcomes after TAVR.MethodsWe queried the National Inpatient Sample for TAVR performed between 2016 and 2020 using International Classification of Diseases-10th Revision codes. We compared in-hospital mortality and clinical outcomes between three groups: normal renal function, CKD and ESRD. The association between CKD/ESRD and outcomes was tested with multivariable logistic regression analyses, using normal renal function as baseline.ResultsIn the five-year study period, 279,195 patients underwent TAVR (mean age 78.9 ± 8.5 years, 44.4% female). Of all patients, 67.1% had normal renal function, 29.2% had CKD, and 3.7% had ESRD. There were significant differences in age, sex, and prevalence of comorbidities across groups. In-hospital mortality was 1.3%. Compared to patients with normal renal function, patients with renal insufficiency had higher in-hospital mortality, with the highest risk found in patients with ESRD (adjusted odds ratio: 1.4 [95% confidence interval: 1.2–1.7] for CKD; adjusted odds ratio: 2.4 [95% confidence interval: 1.8–3.3] for ESRD). Patients with CKD or ESRD had a higher risk of cardiogenic shock, need for mechanical circulatory support, and vascular access complications, compared to those with normal renal function. In addition, patients with ESRD had a higher risk of cardiac arrest and periprocedural acute myocardial infarction. The incidence of conversion to open heart surgery was 0.3% and did not differ between groups. Post-procedural infectious and respiratory complications were more common among patients with CKD or ESRD.ConclusionPatients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.

Interprofessional collaboration in the cardiovascular management of Marfan syndrome: A qualitative study based on interviews with professionals

Background and AimPatients with Marfan syndrome, who present with a variety of symptoms and complex psychosocial problems, require interprofessional collaboration in their care. However, it is unclear how health care providers contribute to interprofessional collaboration for these patients. The purpose of this study was to determine the characteristics of interprofessional collaboration for patients with Marfan syndrome in the cardiovascular field. MethodsSemi-structured interviews were conducted with health care specialists (5 physicians, 2 nurses, and 3 certified genetic counselors) were analyzed qualitatively. ResultsBased on the medical collaboration for the management of cardiovascular complications in patients and their relatives, interprofessional collaboration was identified, such as collaboration and cooperation between physicians and certified genetic counselors, and nursing practice to facilitate interprofessional collaboration. In addition, issues such as difficulties in dealing with and coordinating medical care for noncardiovascular complications, lack of specialist physicians, and lack of opportunities to collaborate with nurses were identified. ConclusionsEffective interprofessional collaboration requires the acquisition of Marfan syndrome and genetic knowledge by healthcare providers and the development of a healthcare delivery system based on departments that can provide leadership. In addition, the assignment of nurses to work across organizational boundaries and effective collaboration between genetic counselors and nurses should be considered.

Integrated care in cardiac intensive care unit for noncardiovascular complications in children after open-heart surgery: A comprehensive review

Abstract Congenital heart defects (CHDs), the most common major birth defects, undergo effective surgical care in the last decade, enhancing survival. After heart surgery, mechanical, infectious, and noninfectious causes induce pediatric pulmonary problems. Necrotizing enterocolitis and feeding intolerance are frequent digestive issues. Diuretics relieve fluid excess, but early dialysis may help in cardiac intensive care unit (CICU) patients. Cumulative insulin dosages improve postoperative hyperglycemia. Noncardiac organ system problems are common in current pediatric cardiac intensive care units including seizures needing anti-epileptics. While, managing the patients in CICU, one must consider noncardiac organ system integrity and function.

Impact of congenital heart disease on outcomes among pediatric patients hospitalized for COVID-19 infection

BackgroundCOVID-19 infection is generally regarded as an acute self-limiting illness in children, but it can cause significant morbidity and mortality in both healthy and high-risk children. There are limited data on the outcomes of children with congenital heart disease (CHD) and COVID-19. This study aimed to examine the risks of mortality, in-hospital cardiovascular and non-cardiovascular complications in this patient population.MethodsWe analyzed data from hospitalized pediatric patients from 2020 using the nationally representative National Inpatient Sample (NIS). Children hospitalized for COVID-19 were included, and weighted data were used to compare in-hospital mortality and morbidities between children with and without CHD.ResultsOut of 36,690 children admitted with a diagnosis of COVID-19 infection(ICD-10 code:U07.1 and B97.29) during calendar year 2020, 1240 (3.4%) had CHD. The risk of mortality in children with CHD was not significantly higher than those without CHD(1.2% vs. 0.8%, p = 0.50), with adjusted OR (aOR) of 1.7 (95% CI: 0.6–5.3). Tachyarrhythmias and heart block were more likely in CHD children with an aOR of 4.2 (95% CI: 1.8–9.9) and aOR of 5.0 (95% CI: 2.4–10.8), respectively. Similarly, respiratory failure [aOR = 2.0 (1.5–2.8)], respiratory failure requiring non-invasive mechanical ventilation [aOR = 2.7 (1.4–5.2)] and invasive mechanical ventilation [aOR = 2.6 (1.6-4.0)], and acute kidney injury [aOR = 3.4 (2.2–5.4)] were all significantly higher among patients with CHD. Median length of hospital stay in children with CHD was longer than those without CHD [5 days (IQR: 2–11) vs. 3 days (IQR: 2–5), p = < 0.001].ConclusionsChildren with CHD hospitalized with COVID-19 infection were at increased risk of serious cardiovascular and non-cardiovascular adverse clinical outcomes. They also had increased length of hospital stay and utilization of healthcare resources.

Impacts of perioperative hyponatremia relevant to outcomes and prognosis of non-small cell lung cancer in octogenarians

BackgroundA recent study reported the effect of preoperative hyponatremia on postoperative outcomes of patients with non-small cell lung cancer. However, the influence of postoperative hyponatremia on postoperative outcomes has not been completely investigated. MethodsWe retrospectively studied 75 octogenarians who underwent pulmonary surgery for non-small cell lung cancer between 2009 and 2018. We divided them into hyponatremic and non-hyponatremic groups, depending on preoperative and immediate postoperative serum sodium levels, and investigated their clinicopathological characteristics and outcomes. Disease-specific survival and cumulative incidence of relapse rates between the two groups were calculated and compared using the stratified Kaplan-Meier method. Univariable and multivariable analyses were performed to identify prognostic factors. ResultsPreoperative hyponatremia was associated with 66.7% of postoperative respiratory and 88.9% of non-cardiovascular complications. The long-term prognosis of the postoperative hyponatremic group was significantly worse than that of their counterpart. The 3-year disease-specific survival and 3-year cumulative incidence of relapse rate were 55.9% and 46.2%, respectively, and the median observation period after surgery was 37.4 (interquartile range, 23.7–51.0) months for the entire cohort. Kaplan-Meier curves showed that hyponatremia was associated with worse disease-specific survival and cumulative incidence of relapse. Multivariable analysis identified hyponatremia as a factor that predicted unfavorable disease-specific survival and cumulative incidence of relapse. ConclusionsImmediate postoperative hyponatremia is an independent predictor of non-small cell lung cancer outcomes among octogenarians. Preoperative hyponatremia was associated with a high frequency of postoperative respiratory and non-cardiovascular complications. Surgical indications in older patients with hyponatremia should be carefully considered with follow-up.

Association of opioid use disorder with outcomes of hospitalizations for acute myocardial infarction in the United States

ObjectiveWhile Opioid Use Disorder (OUD) has been linked to inferior clinical outcomes, studies examining the clinical outcomes and readmission of OUD patients experiencing Acute Myocardial Infarction (AMI) remain lacking. The authors analyze the clinical and financial outcomes of OUD in a contemporary cohort of AMI hospitalizations. MethodsAll non-elective adult (≥ 18 years) hospitalizations for AMI were tabulated from the 2016‒2019 Nationwide Readmissions Database using relevant International Classification of Disease codes. Patients were grouped into OUD and non-OUD cohorts. Bivariate and regression analyses were performed to identify the independent association of OUD with outcomes after non-elective admission for AMI, as well as subsequent readmission. ResultsOf an estimated 3,318,257 hospitalizations for AMI meeting study criteria, 36,057 (1.1%) had a concomitant diagnosis of OUD. While OUD was not significantly associated with mortality, OUD patients experienced superior cardiovascular outcomes compared to non-OUD. However, OUD was linked to increased odds of non-cardiovascular complications, length of stay, costs, non-home discharge, and 30-day non-elective readmission. ConclusionsPatients with OUD presented with AMI at a significantly younger age than non-OUD. While OUD appears to have a cardioprotective effect, it is associated with several markers of increased resource use, including readmission. The present findings underscore the need for a multifaceted approach to increasing social services and treatment for OUD at index hospitalization.

Transient ischemic attack events and incident cardiovascular and non-cardiovascular complications: Observations from a large diversified multimorbid cohort.

Transient ischemic attack (TIA) is a strong signal prompting the incidence of future cardiovascular and non-cardiovascular complications, in light of recent debate on the so-called "stroke-heart syndrome." We aimed to investigate the relation of TIAs to incident clinical events. Patients were drawn from three health plans with a wide spectrum of age groups and a wide mix of socio-economic/disability status. Two TIA cohorts in a retrospective design were used to achieve the study specific aims: (i) to investigate the incidence of TIA and associated cardiovascular and non-cardiovascular complications within 30 and 90 days from the onset of incident TIA events; and (ii) to examine the potential risk factors for developing incident TIA events in the general population with/without a history of prior stroke. The incident TIA cohort consisted of 53,716 patients with an average age of 64.2 years (SD 15.2) and 46.1% male. Following TIA, the incidence proportions of ischemic stroke within 30 and 90 days were 2.7% and 3.8%, respectively, and for incident acute coronary syndrome being 0.94 and 1.84, respectively. Ventricular arrhythmia had proportions of 1.2 and 2.14, respectively within 30 and 90 days, with acute heart failure having values of 0.49 and 0.923. About 45% or more of the cardiovascular and non-cardiovascular complications occurred in the first 30 days following the incident TIA cases. About one-third of the recurrent TIA cases followed the incident TIA cases within a span of 30 days. Amongst comorbidities with stroke in the comorbid history, prior stroke provided the strongest risk factor in terms of odds ratio (OR = 8.34, 95% CI 7.21-9.66) for incident TIA events. Age was strongly associated with incident TIA events. Without a prior history of stroke (ischemic stroke/transient ischemic attack/thrombo-embolic events), valvular disease was the strongest risk factor from among the comorbidities (OR-1.87, 95% CI 1.51-2.32). Age also provided strong associations with incident TIA events. Following a TIA, there was a high risk of stroke, acute coronary syndrome, ventricular arrhythmia, acute heart failure, and non-cardiovascular complications.

A Comparison of the Prognosis of SARS-CoV-2 Viral Infection in Patients with and Without Underlying Heart Disease

Background: Since December 2019, a pneumonia outbreak has spread through a viral infection. Originally, the virus pathogen was termed SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). SARS-CoV-2 can cause severe and life-threatening problems. Objectives: The purpose of this study was to describe the prognostic comparison of SARS-CoV-2 viral infection in patients with and without underlying heart disease in our center. Methods: A total of 400 Iranian adult patients with COVID-19 enrolled in this descriptive-analytical research. The study population was categorized into 4 groups: (1) no underlying disorder, (2) only cardiovascular complication, (3) only non-cardiovascular disease (CVD), and (4) cardiovascular and non-cardiovascular complications. The prognosis was adjudicated based on underlying diseases. Anthropometric details were also gathered. Finally, the data were analyzed using SPSS version 25. Results: The mortality rate was almost 4.17 times more in patients suffering from both cardiovascular and non-cardiovascular complications compared with the first group having no underlying disorders. This rate was 3.98 times more than the baseline in patients complicated with CVD alone. Based on a logistic regression model, COVID-19 prognosis was associated with age, underlying disorder type, length of hospitalization, the requirement for the intensive care unit (ICU), length of stay in ICU, the need for intubation, reservoir bag-mask requirement, and some of the life-threatening complications such as pneumonia and sepsis. Conclusions: Cardiovascular underlying disorders (such as myocarditis and deep vein thrombosis) are likely to be linked to the prognosis of COVID-19.

2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards.

2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards.

Acute myocardial infarction in a second-level unit.

Acute myocardial infarction is one of the most frequent causes of admittance and the first cause of death in an intensive care unit from a second-level hospital where the infrastructure, installed capacity and location withheld access to optimal reperfusion treatment. To evaluate mortality, length of stay, complications and mechanical ventilation requirement in patients with myocardial infarction who underwent fibrinolysis against those who did not. Observational, retrospective and analytic study. Patients admitted to the intensive care unit with ST elevated acute myocardial infarction from October 2008 to September 2018 were included. Reperfusion strategy, time to first attention, cardiovascular and non-cardiovascular complications, as well as outcome were evaluated. 244 patients were included with mean age of 59.1 ± 10.7 years and high prevalence of obesity, diabetes and hypertension. 183 patients underwent fibrinolysis. Time to treatment was shorter in those thrombolyzed (5.9 ± 5.8 vs. 20.4 ± 11.0 hours; p < 0.0001), with less requirement of mechanical ventilation (26.2 vs. 52.4%; p = 0.002), less intensive care stay (3.0 ± 2.6 vs. 4.6 ± 4.8 days; p = 0.029), less frequency of complications, and significant difference in death (16.3 vs. 50.8%, p < 0.0001). Fibrinolysis diminished the risk of death, mechanical ventilation requirement, length of stay and cardiovascular and non-cardiovascular complications.

Medical management of pulmonary arterial hypertension in pregnancy: A single center experience

BackgroundPulmonary arterial hypertension (PAH) is a disease characterized by increased pulmonary vascular resistance (PVR). Pregnancy in the setting of PAH is associated with significant maternal morbidity and mortality, typically present during labor and the early postpartum. Historically, observed maternal mortality has been as high as 56%. However, with improved recognition, understanding, and treatment of PAH, reassessment of maternal outcomes is of increasing interest. Study designThis is a retrospective observational case series of all women with a diagnosis of moderate to severe World Health Organization Group 1 PAH who had pregnancy managed in our tertiary care center between 2004 and 2018. ResultsTen women (Age 28 [SD 6] years, mean pulmonary artery pressure 48 [SD 16.5] mmHg, PVR 7.5 [SD 4.3] Wood units) were identified and included. Seven women (70%) had an antepartum diagnosis of PAH, 2 women (20%) were diagnosed during pregnancy and 1 (10%) postpartum. Four women (40%) delivered preterm, and 3 women (30%) had a successful vaginal delivery. Cardiovascular complications occurred in 4 women (40%) and non-cardiovascular complications occurred in 5 women (50%). There were no significant changes in right ventricular function or non-invasive assessment of PA pressures at long-term follow-up. All patients are alive to date at a mean follow-up of 8 [SD 4] years. ConclusionIn our single center, 10 women with moderate to severe PAH receiving directed medical therapy survived pregnancy and delivery. Further evaluation and review are required to optimize medical management for women with PAH who pursue pregnancy.

Non-cardiovascular disorders in a contemporary cardiovascular intensive care unit in Japan

BackgroundIn the modern US cardiovascular intensive care unit (CICU), the incidence of non-cardiovascular disorders has increased and non-cardiovascular disorders are associated with an increase in morbidity and mortality. In Japan, however, data regarding the association between non-cardiovascular disorders and outcomes in the CICU are limited. MethodsThis study examined 490 consecutive admissions to a closed CICU at the Nippon Medical School Hospital from January to December 2017. Characteristics, diagnoses, treatments, and outcomes of admitted patients were identified. ResultsThe most common primary diagnosis was acute coronary syndrome (50.4%), followed by acute heart failure (20.0%), arrhythmia (6.7%), and non-cardiovascular diseases (3.7%). The mortality rate and median length of stay (LOS) in the CICU were 4.7% and 4 (interquartile range, 2–8) days, respectively. Of all patients, 42.2% (n = 207) developed non-cardiovascular complications such as acute respiratory failure, acute kidney injury, or sepsis during CICU stay. Multivariate logistic regression analysis revealed that acute respiratory failure and sepsis were significantly associated with mortality in the CICU (odds ratio, 11.014 and 25.678, respectively; both p<0.05). The multiple linear regression analysis showed that acute kidney injury was significantly associated with LOS in the CICU (β=0.144, p = 0.002). ConclusionsApproximately half of patients admitted to the CICU had non-cardiovascular disorders including non-cardiovascular disease and non-cardiovascular complications, which were significantly associated with mortality and LOS in the CICU.

Perioperative risk assessment - focus on functional capacity.

This review examines how functional capacity informs preoperative risk stratification, as well as strengths and limitations of options for estimating functional capacity. Functional capacity (or cardiopulmonary fitness) overlaps with other important characteristics, including muscular strength, balance, and frailty. Poor functional capacity is associated with postoperative morbidity, especially noncardiovascular complications. Both patient interviews and exercise tests are used to assess functional capacity. The usual approach of an unstructured patient interview does not predict outcomes. Structured interviews that incorporate validated questionnaires (Duke Activity Status Index) or standardized questions about physical activity (ability to climb stairs) do predict moderate-or-severe complications and cardiovascular complications. Among exercise tests, cardiopulmonary exercise testing (CPET) has shown the most consistent association with risks of complications. Other tests (6-min walk test, incremental shuttle walk test, stair climbing) might predict complications, but still require further high-quality evaluation. A straightforward way to better assess functional capacity is a structured interview with validated questionnaires or standardized questions about physical activities. Functional capacity can also be assessed by exercise tests, with the strongest evidence supporting CPET. Although some simpler exercise tests have shown promise, more research remains needed to better define their role in preoperative evaluation.

Anticoagulation in atrial fibrillation

### Learning objectives One in three of us will be diagnosed with atrial fibrillation (AF) at some point in our lives.1 Over 1.2 million individuals in the UK have been...

Association Between Preoperative Statin Use and Respiratory Complications After Noncardiac Surgery: A Retrospective Cohort Analysis.

Statins possess pleiotropic effects, which potentially benefit noncardiovascular conditions. Previous work suggests that statins reduce inflammation and prevent acute respiratory distress syndrome and infections. However, there is a paucity of data regarding potential benefits of statins on respiratory and infectious complications, particularly after noncardiac surgery. We therefore evaluated respiratory and other complications in noncardiac surgery patients taking or not taking statins preoperatively. We obtained data from the Cleveland Clinic Perioperative Health Documentation System and evaluated medical records of 92,139 inpatients who had noncardiac surgery. Among these, 31,719 patients took statins preoperatively. Statin patients were compared to nonstatin patients on incidence of intraoperative use of albuterol and postoperative respiratory complications for primary analysis. Infectious complications, cardiovascular complications, in-hospital mortality, and duration of hospitalization were compared for secondary analyses, using inverse probability of treatment weighting to control for potential confounding. Statin use was associated with lower odds of intraoperative albuterol treatment (odds ratio [OR] = 0.89; 97.5% confidence interval [CI], 0.82-0.97; P = .001; number needed to treat [NNT] = 216). Postoperative respiratory complications were also less common (OR = 0.82; 98.75% CI, 0.78-0.87; P < .001). Secondarily, statin use was associated with lower odds of infections, cardiovascular complications, in-hospital mortality, and shorter duration of hospitalization. The interaction between statin use and sex was significant (with significance criteria P < .10) for all primary and secondary outcomes except intraoperative use of albuterol. Preoperative statin use in noncardiac surgical patients was associated with slightly reduced odds of postoperative respiratory, infectious, and cardiovascular complications. However, the NNTs were high. Thus, despite the fact that statins appeared to be associated with lower odds of various complications, especially cardiovascular complications, our results do not support using statins specifically to reduce noncardiovascular complications after noncardiac surgery.

Intensive Care Unit Management of the Adult with Congenital Heart Disease.

PurposeAdults with congenital heart disease (ACHD) are a rapidly growing population with ever-increasing complexity, and intensive care unit (ICU) management is often necessary. This review summarizes common cardiovascular and non-cardiovascular complications in ACHD and provides a framework for ICU care.Recent FindingsHeart failure is the leading cause of hospitalization and mortality in ACHD. Varied anatomy and repairs, as well as differing physiological complications, limit generalized application of management algorithms. Recent studies suggest that earlier mechanical support in advanced cases is feasible and potentially helpful. Cardiac arrhythmias are poorly tolerated and often require immediate attention. Other complications requiring intensive care include infections such as endocarditis and COVID-19, pulmonary hypertension, renal failure, hepatic dysfunction, coagulopathy, and stroke.SummarySuccessful ICU care in ACHD requires a multi-disciplinary approach with careful consideration of anatomy, physiology, and associated comorbidities. Few studies have formally examined ICU management in ACHD and further research is necessary.

Is bariatric surgery safe in patients with history of cardiac revascularization?

The number of patients undergoing bariatric surgery with prior cardiac revascularization (CR) is rising. However, scarce data exist regarding the safety of bariatric procedures in these patients. The aim of this study is to compare postoperative cardiovascular and noncardiovascular outcomes among patients with different CR procedures. Academic hospital, United States. We retrospectively reviewed 2884 patients undergoing bariatric surgery from 2009-2018. Patients with prior CR were included and stratified into groups: coronary artery bypass graft (CABG), percutaneous coronary intervention with stent (PCI), and CABG + PCI. We described patient demographic characteristics, co-morbidities, smoking status, history of myocardial infarction, type of bariatric surgery, number of vessels grafted/stents, time from CR to bariatric surgery, length of stay, and cardiovascular and noncardiovascular 30-day outcomes. A control group composed of patients without prior CR undergoing bariatric surgery was used to compare the rate of complications to the total patients with prior CR. For continuous and categorical variables, t test and χ2 tests were performed, respectively. We identified 76 patients with prior CR undergoing bariatric surgery. The mean patient age was 61.4 ± 7.9 years, the mean body mass index was 41.7 ± 6.5 kg/m2, and male sex was predominant (71.1%). Among these, 50% (n = 38) had PCI, 39.4% (n = 30) had CABG, and 10.5% (n = 8) had CABG + PCI. Early cardiovascular complications rate included ST-segment-elevation myocardial infarction (n = 2), pulmonary embolism (n = 1), supraventricular arrhythmia (n = 2), ventricular arrhythmia (n = 1), and pacemaker/defibrillator-insertion (n = 1). The overall rate of cardiovascular and noncardiovascular complications was 9.2% (n = 7) and 10.5% (n = 8) during the 30 days. Mortality rate was 0%. Comparison of rate of complications between groups did not show any statistical difference; no significant difference was found when comparing patients with prior CR to the 76 patients in the control group (P > .05). Although revascularized individuals have severe co-morbidities and are high-risk patients, bariatric surgery remains safe in this population when outcomes are compared with bariatric patients without prior CR.

Insight into the Pathophysiology of Polycystic Ovarian Syndrome: The Genes are not to Blame?

Polycystic ovarian syndrome (PCOS) is a common and complicated endocrine disorder affecting women of reproductive age group mainly. The characteristics features include an ovulatory menstrual changes, hyperandrogenism and polycystic ovaries. It is diagnosed using various diagnostic criteria but the Rotterdam criteria are the most commonly referenced. PCOS is associated with cardiovascular risk factors such as glucose intolerance, hypertension, obesity and dyslipidaemia. Noncardiovascular complications such as subfertility, endometrial cancer, obstetric complications and psychological disturbance are also significant. The pathophysiology arises from the interactions between the predisposing genes and the environment. The pathophysiologic mechanisms of PCOS such as insulin resistance, altered androgen secretion and action, dysregulated gonadotropin action and chronic subclinical inflammation have genetic bases. The role of genes in the pathophysiology of PCOS is still an evolving concept and efforts are ongoing in gaining further understanding about the disease despite the challenges of genetic studies.

Perioperative outcomes following a hip fracture surgery in elderly patients with heart failure with preserved ejection fraction and heart failure with a mid-range ejection fraction.

To examine the influence of heart failure (HF) with preserved ejection fraction (HFPEF) and HF with mid-range ejection fraction (HFmrEF) on perioperative cardiac and noncardiac outcomes following hip fracture surgery. Data of elderly patients (≥ 65 years) who underwent hip fracture surgery were retrospectively analyzed in this study. Patients with a left ventricular ejection fraction (LVEF) <40% were not included in this study. The definition of preoperative HFPEF (LVEF ≥50%) and HFmrEF (LVEF 40%-49%) was based on clinical documentation of HF in patients' medical records before surgery. The primary outcomes of this study were perioperative adverse events and mortality. The secondary outcome of interest was the length of stay in the hospital. A total of 328 patients (mean age 79.2±8.7 years, and 57.3% female) were enrolled. Of the study population, 250 (76.2%) patients had no HF, 50 (15.2%) patients had HFPEF, and 28 (8.6%) patients had HFmrEF before surgery. The frequency of perioperative cardiovascular and non-cardiovascular complications was similar to a rate of 7.0%. The mean length of hospital stay was 8.1±5.8 days, and the in-hospital mortality rate was 4.6%. Patients with HFPEF and HFmrEF had a longer length of stay and were more likely to experience perioperative complications and death than the patients without HF. Multivariate analyses showed that the presence of HFPEF and HFmrEF were both associated with increased rates of perioperative complications and mortality. Our findings suggest that the presence of HFPEF and HFmrEF may predict perioperative adverse events and mortality in elderly patients undergoing hip fracture surgery.