Potential Risk Stratification Tool Research Articles

Prediction of disease-free survival using strain elastography and diffuse optical tomography in patients with T1 breast cancer: a 10-year follow-up study

BackgroundEarly-stage breast cancer (BC) presents a certain risk of recurrence, leading to variable prognoses and complicating individualized management. Yet, preoperative noninvasive tools for accurate prediction of disease-free survival (DFS) are lacking. This study assessed the potential of strain elastography (SE) and diffuse optical tomography (DOT) for non-invasive preoperative prediction of recurrence in T1 BC and developed a prediction model for estimating the probability of DFS.MethodsA total of 565 eligible patients with T1 invasive BC were enrolled prospectively and followed to investigate the recurrence. The associations between imaging features and DFS were evaluated and a best-prediction model for DFS was developed and validated.ResultsDuring the median follow-up period of 10.8 years, 77 patients (13.6%) developed recurrences. The fully adjusted Cox proportional hazards model showed a significant trend between an increasing strain ratio (SR) (P < 0.001 for trend) and the total hemoglobin concentration (TTHC) (P = 0.001 for trend) and DFS. In the subgroup analysis, an intensified association between SR and DFS was observed among women who were progesterone receptor (PR)-positive, lower Ki-67 expression, HER2 negative, and without adjuvant chemotherapy and without Herceptin treatment (all P < 0.05 for interaction). Significant interactions between TTHC status and the lymphovascular invasion, estrogen receptor (ER) status, PR status, HER2 status, and Herceptin treatment were found for DFS(P < 0.05).The imaging–clinical combined model (TTHC + SR + clinicopathological variables) proved to be the best prediction model (AUC = 0.829, 95% CI = 0.786–0.872) and was identified as a potential risk stratification tool to discriminate the risk probability of recurrence.ConclusionThe combined imaging-clinical model we developed outperformed traditional clinical prognostic indicators, providing a non-invasive, reliable tool for preoperative DFS risk stratification and personalized therapeutic strategies in T1 BC. These findings underscore the importance of integrating advanced imaging techniques into clinical practice and offer support for future research to validate and expand on these predictive methodologies.

Cardiac Magnetic Resonance Imaging as a Risk Stratification Tool in COVID-19 Myocarditis.

The aim of this retrospective study was to identify myocardial injury after COVID-19 inflammation and explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. This study included 139 patients who were enrolled between January and June 2021, with a mean age of 46.7 ± 15.2 years, of whom 68 were men and 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work-up, laboratory analysis, cardiac ultrasound, and CMR on a 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients, late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE (4.3 ± 0.23 vs. 3.2 ± 0.14 g/L, p < 0.05, respectively), as well as D-dimer (1.8 ± 0.3 vs. 0.8 ± 0.1 mg/L FEU). Also, troponin was statistically significantly higher in patients with myocardial LGE (13.1 ± 0.4 ng/L) compared to those with normal myocardium (4.9 ± 0.3 ng/L, p < 0.001). We demonstrated chest pain, fatigue, and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be a predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis.

Abstract P2119: Effect Of PCI On QTd And QT Interval Compared To Control/other Treatments For Myocardial Infarction

Background: QT dispersion measurement is a potential risk stratification tool but is a conflict in the literature on how PCI and other procedures affect it. We aimed to compare PCI with other procedures like Streptokinase, PCI plus thrombectomy, and coronary artery bypass graft (CABG) on QT interval. Methods: We conducted a systematic review and meta-analysis on the association between PCI and QTd through a literature search in three electronic databases, Science Direct, PubMed, and Google Scholar, for empirical studies published in English. Random effects model was used. Results: Eleven studies were found in total. We found significant differences in QTc between pre and post PCI and a significant reduction in QTc across all the studies (SMD 2.57, 95% CI 1.22 to 3.92; p&lt;0.05). Five studies compared the efficacy of PCI and control (other procedures) in reducing QTd after 24 hours of treatment procedures. The mean change from baseline in QTd is more significant in the PCI group (post-PCI) compared to the control group, although there is no statistically significant difference between the two groups (SMD -0.30, 95% CI -1.25 to 0.65; I2 = 96%). A significant reduction in QTd corresponding to a statistically significant difference between QTd prior and post-PCI intervention for QTd at 2hrs, 24hrs, and 2-7 days, was found. The estimated overall effect measure reveals statistical significance (SMD 1.18, 95% CI 0.70 to 1.65; P &lt; 0.05). Conclusion: QTd difference was significant post-PCI. Future studies on evaluating it as a predictor to various outcomes could illustrate it's benefit in clinical practise.

High systemic inflammation score is associated with adverse survival in skull base chordoma.

BackgroundThe systemic inflammation score (SIS), based on preoperative lymphocyte to monocyte ratio (LMR) and albumin (ALB), was recently developed and is demonstrated to be a novel prognostic indicator in several cancers. However, data discussing the utility of SIS in chordoma are lacking. We aimed to investigate the distribution and the prognostic role of SIS in primary skull base chordoma patients undergoing surgery.Material and methodsPreoperative SIS was retrospectively collected from 183 skull base chordoma patients between 2008 and 2014 in a single center. Its associations with clinical features and overall survival (OS) were further analyzed. The SIS-based nomogram was developed and evaluated by the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).ResultsThe numbers of patients in the SIS 2, 1, and 0 group were 29 (15.8%), 60 (32.8%), 94 (51.4%), respectively. High SIS was associated with older age (p = 0.008), brainstem involvement of tumors (p = 0.039), and adverse OS (p < 0.001). Importantly, multivariate Cox analysis showed that high SIS independently predicts adverse OS. Furthermore, the nomogram based on SIS and clinical variables showed eligible performance for OS prediction in both training and validation cohorts.ConclusionsThe SIS is a promising, simple prognostic biomarker, and the SIS-based nomogram serves as a potential risk stratification tool for outcome in skull base chordoma patients.

OC-040 RETAINER I (RETENTION OF URINE AFTER INGUINAL HERNIA ELECTIVE REPAIR), A PROSPECTIVE, INTERNATIONAL, MULTICENTRE COHORT STUDY

Abstract Aim Post-operative urinary retention (POUR) is a recognised complication of inguinal hernia repair (IHR). Reported incidence is variable, and reporting of risk factors, contradictory. We aimed to report the rate, risk factors and impact of POUR post IHR. Methods A prospective international observational study was performed with 4 week data collection from each centre (March-November 2021). Patients undergoing elective open/minimally-invasive IHR were eligible. Exclusion criteria included a urethral catheter at baseline. Preoperative/intraoperative/postoperative variables were analysed and data recorded via REDCap. Multivariate analysis was performed with a primary outcome of development of POUR. Secondary outcomes were risk factors for, and implications of, POUR. Results 4,153 patients (205 centres; 35 countries) were registered. Mean age was 54.7 years (18–95) and BMI 26.5 (16–6). 80.4% (n=3167) were performed open and 17% (n=674) minimally-invasively. The overall rate of POUR was 5.8% (n=225) and increasd &amp;gt;9% in male patients aged &amp;gt;65 years old. Risk factors associated with POUR included: higher preoperative IPSS scores (mean 9.4 vs 5.6 in non-POUR cohort, p&amp;lt;0.001), diagnosis of BPH (p&amp;lt;0.001), pre-operative constipation (p=0.009) defined as no bowel opening for two days pre-operatively and pre-operative post void residual volumes (&amp;lt;0.001). 37% of patients developing POUR required an unplanned hospital admission. Conclusion This study suggests a global POUR rate of approximately 5% following elective IHR and confirm a significant impact of POUR on patients and hospital services. Findings highlight several risk factors and confirm the IPSS score as a potential risk stratification tool.

Construction of a tumor immune infiltration macrophage signature for predicting prognosis and immunotherapy response in liver cancer.

Liver cancer is an extraordinarily heterogeneous malignant disease. The tumor microenvironment (TME) and tumor-associated macrophages (TAMs) are the major drivers of liver cancer initiation and progression. It is critical to have a better understanding of the complicated interactions between liver cancer and the immune system for the development of cancer immunotherapy. Based on the gene expression profiles of tumor immune infiltration cells (TIICs), upregulated genes in TAMs and downregulated genes in other types of immune cells were identified as macrophage-specific genes (MSG). In this study, we combined MSG, immune subtypes, and clinical information on liver cancer to develop a tumor immune infiltration macrophage signature (TIMSig). A four-gene signature (S100A9, SLC22A15, TRIM54, and PPARGC1A) was identified as the TAM-related prognostic genes for liver cancer, independent of multiple clinicopathological parameters. Survival analyses showed that patients with low TIMSig had a superior survival rate than those with high TIMSig. Additionally, clinical immunotherapy response and TIMSig was observed as highly relevant. In addition, TIMSig could predict the response to chemotherapy. Collectively, the TIMSig could be a potential tool for risk-stratification, clinical decision making, treatment planning, and oncology immunotherapeutic drug development.

The impact of bortezomib-based induction in newly diagnosed multiple myeloma with chromosome 1q21 gain

Introduction:Bortezomib has been reported to favourably impact the outcomes of t(4;14) and del(17p) in multiple myeloma (MM), but its impact on gain 1q (+1q) is unknown.Methods:To address this, 250 patients treated with bortezomib-based induction were analysed. All myeloma samples had fluorescence in situ hybridization (FISH) performed on CD138-sorted bone marrow aspirate, and plasma cells were analysed using DNA probes specific for the following chromosomal aberrations: del(13q14), del(17p), t(14;16), t(4;14), and +1q. Presence of +1q was defined as the presence of at least three copies of 1q21 at the cut off level of 20% of bone marrow plasma cells.Results:+1q identified in 167 (66.8%) and associated with t(4;14) and high lactate dehydrogenase (LDH). +1q was not associated with response rate but shorter event-free survival (EFS) (median EFS 35 vs 55 months, p = 0.05) and overall survival (OS) (median OS 74 vs 168 months, p = 0.00025). Copy number and clone size did not impact survival. Multivariate analysis showed +1q was an independent adverse factor for OS together with International Staging System (ISS)3, high LDH, del(17p) and t(4;14). When a risk score of 1 was assigned to each independent adverse factor, OS was shortened incrementally by a risk score from 0 to 4. Post-relapse/progression survival was inferior in those with +1q (median 60 vs 118 months, p = 0.000316). Autologous stem cell transplantation (ASCT) improved OS for those with +1q (median OS 96 vs 49 months, p = 0.000069).Conclusion:+1q is an adverse factor for OS in MM uniformly treated with bortezomib-based induction but was partially mitigated by ASCT. A risk scoring system comprising +1q, LDH, high-risk FISH, and ISS is a potential tool for risk stratification in MM.

Sarcopenia in high acuity liver transplantation: Does it predict outcomes?

Sarcopenia has gained momentum as a potential risk-stratification tool in liver transplantation (LT). While LT recipients recently have more advanced end-stage liver disease, the impact of sarcopenia in high acuity recipients with a high model for end-stage liver disease (MELD) score remains unclear. We retrospectively assessed sarcopenia by calculating skeletal muscle index (SMI) from cross-sectional area at third lumbar vertebra (cm2 ) and height (m2 ) in 296 patients with a CT ≤ 30 days prior to LT. Sex-specific SMI cut-offs were developed, and its impact was assessed in patients with MELD ≥ 35. In patients with MELD ≥ 35 (n=217), men with a SMI<30 cm2 /m2 had significantly higher rates of bacteremia (P=.021) and a longer hospital stay (P<.001). Women with a SMI<34 cm2 /m2 had a longer hospital stay (P=.032). There were no relationships between SMI and survival in men and women with MELD ≥ 35. This series examined sarcopenia with a focus on high MELD patients. Although decreased SMI contributed to higher post-LT hospital stay, it did not impact patient survival, suggesting that while SMI alone may not aid in patient selection for LT, it certainly may guide perioperative care-planning in this challenging patient population.

P-062: The impact of Bortezomib-based induction on chromosome 1q21 gained newly diagnosed Multiple Myeloma of Chinese origin

<h3>Background</h3> Bortezomib has been reported to favourably impact the outcome of high risk MM predominantly t(4;14) and in some report 17p- its impact on gain 1q21 is unknown. <h3>Methods</h3> To address this deficit, we have analysed CD138-sorted bone marrow plasma cells in cases treated with bortezomib based induction therapy where age, gender, isotype, ISS, LDH and iFISH were available. <h3>Results</h3> 1q+ was identified in 167 (66.8%) of the series and was associated with t(4;14) and high LDH but not with other HR FISH abnormalities. Gain 1q+ was not associated with response rate but did associate with shorter event free survival (EFS) (median EFS: 35 months vs 55 months, p=0.05) and overall survival (OS) (median OS 74 months vs 168, p=0.00025). Thus 1q+ was an independent adverse factors for OS together with ISS3, high LDH, del(17p) and t(4;14), multivariate analysis showed that. Of the cases with 1q+, 75 (44.9%) had 3 copies and 92 (55.1%) had >3 copies of 1q21. Fifty-four (32.3%) had ≥50% cells harbouring 3 copies (gain 1q), and 57 (34.1%) had ≥50% cells with >3 copies. Copy number and clone size did not impact on survival. When a risk score of 1 was assigned to each of 1q+, high LDH, high risk FISH and ISS III, OS was shortened incrementally by a risk score of 0 to 4. Post-relapse/progression survival was inferior in those with 1q+ (median 60 months vs median 118 months, p=0.000316). ASCT improved OS for those with 1q+ (median OS 96 months vs 59 months, p=0.000069). In conclusion, 1q+ is an adverse risk factor for OS in MM irrespective of the use of bortezomib but was partially mitigated by ASCT. <h3>Conclusions</h3> A risk scoring system comprising 1q+, LDH, HR FISH and ISS is a potential tool for risk stratification in MM.

Frailty Index as a Predictor of Readmission in Patients With Head and Neck Cancer.

To evaluate the predictive utility of the Hospital Frailty Risk Score (HFRS), a stratification tool based on the ICD-10 (International Classification of Disease, Tenth Revision), and other risk factors for 30-day readmissions and mortality in a nationally representative cohort. Retrospective database review. Nationwide Readmissions Database (2017). Patients with head and neck cancer who underwent major surgical procedures were identified from the 2017 Nationwide Readmissions Database, representing 116 medical centers nationwide. Bivariate and multivariable logistic regression methods were used to identify factors associated with unplanned 30-day readmission, 30-day readmission mortality, and increased length of hospital stay. A total of 14,420 patients underwent major head and neck cancer surgery. Unplanned readmission occurred in 11% of patients. The most common reasons for unplanned readmission were procedural complications (26.5%), sepsis (7.3%), and respiratory failure (3.9%). Elevated frailty index (HFRS ≥5) was identified in 22% of patients. Frailty was associated with higher 30-day readmission rates (18.0% vs 9.5%, P < .01), which held on multivariate modeling (odds ratio [OR], 1.59 [95% CI, 1.37-1.85]). Frail patients spent more days in the hospital (8.2 vs 6.8, P = .02) and incurred more charges across hospital stays ($275,000 vs $188,000, P < .01). Patients >75 years old (OR, 1.26 [1.03-1.55]) and patients with electrolyte abnormalities (OR, 1.25 [1.07-1.46] were significantly more likely to be readmitted. In this head and neck cancer surgical population, HFRS significantly predicted unplanned readmission. HFRS is a potential risk stratification tool and should be compared with other methods and explored in other cancer populations. Beyond the challenge of identifying at-risk patients, future work should explore potential interventions aimed at mitigating readmission.

Role of platelet-to-lymphocyte count ratio (PLR), as a prognostic indicator in COVID-19: A systematic review and meta-analysis.

Prognostic predictors are of paramount interest for prompt intervention and optimal utilization of the healthcare system in the ongoing context of the COVID‐19 pandemic. The platelet‐to‐lymphocyte count ratio (PLR), has emerged as a potential tool for risk stratification of critically ill patients with sepsis. The current systematic review explores the utility of PLR as a prognostic predictor of COVID‐19 patients. We screened the electronic databases until May 15, 2021 after enrolling in PROSPERO (CRD42021220269). Studies evaluating the association between PLR on admission and outcomes in terms of mortality and severity among COVID‐19 patients were included. We retrieved 32 studies, with a total of 2768 and 3262 COVID‐19 patients for mortality and disease severity outcomes. Deceased and critically ill patients had higher PLR levels on admission in comparison to survivors and non‐severe patients (mean differences [MD] = 66.10; 95% confidence interval [CI]: 47.75–84.44; p < 0.00001 and MD = 86.74; 95% CI: 67.7–105.7; p < 0.00001, respectively). A higher level of PLR on admission in COVID‐19 patients is associated with increased morbidity and mortality. However, the evidence is of low quality and further studies regarding the cut‐off value of PLR are the need of the hour.

A Study of Red Blood Cell Indices among Covid 19 Individuals in Tertiary Care Triage Centre

Background: SARS-CoV-2 infection is characterized by the development and progression of inflammatoryresponses. The exploration of prognostic predictors for patients with COVID-19 is vital for prompt clinicalintervention. Our study aims to explore the predictive value of hematological parameters in categorizationof patients with COVID-19.We aimed to investigate associations between hematological parameters anddisease severity in patients with SARS-CoV-2infection.The red blood cell distribution width (RDW),an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients.Materials and Methods: Retrospective study after getting approval from Institutional ethics committeewas performed with data obtained from triage OPD in Chengalpattu Medical College &amp; Hospital. Thedemographic, clinical, laboratory profile of COVID 19 positive patients who attended Triage OPD for aperiod of one month were collected. 3000 RT-PCR confirmed COVID positive patients of age group 20to 70 years of both genders were included in the study. COVID 19 positive paediatric cases, antenatal andpostnatal mothers, postoperative cases and sick cases admitted in COVID ICU were excluded from thestudy. Symptoms, associated co-morbidities and severity of COVID 19 were tabulated. Complete BloodCount measured by Automated Sysmex Analyser at the time of reporting to triage was noted. Red bloodcell indices were analysed using SPSS 21.0 version. Results: There was statistically significant increase inRDW and decrease in MCV among patients with co-morbidity and severe illness compared to those withmild disease. There is no statistically significant difference in Red blood cell indices between patients withand without symptoms and patients without co-morbidities. Conclusion: RDW was found to be a screeningtool to identify patients with severe COVID-19 and the results of this study suggest that RDW should be partof routine laboratory assessment and monitoring of COVID-19.

Left ventricular hypertrophy and sudden cardiac death

Sudden cardiac death (SCD) is among the leading causes of death worldwide, and it remains a public health problem, as it involves young subjects. Current guideline-directed risk stratification for primary prevention is largely based on left ventricular (LV) ejection fraction (LVEF), and preventive strategies such as implantation of a cardiac defibrillator (ICD) are justified only for documented low LVEF (i.e., ≤ 35%). Unfortunately, only a small percentage of primary prevention ICDs, implanted on the basis of a low LVEF, will deliver life-saving therapies on an annual basis. On the other hand, the vast majority of patients that experience SCD have LVEF > 35%, which is clamoring for better understanding of the underlying mechanisms. It is mandatory that additional variables be considered, both independently and in combination with the EF, to improve SCD risk prediction. LV hypertrophy (LVH) is a strong independent risk factor for SCD regardless of the etiology and the severity of symptoms. Concentric and eccentric LV hypertrophy, and even earlier concentric remodeling without hypertrophy, are all associated with increased risk of SCD. In this paper, we summarize the physiology and physiopathology of LVH, review the epidemiological evidence supporting the association between LVH and SCD, briefly discuss the mechanisms linking LVH with SCD, and emphasize the need to evaluate LV geometry as a potential risk stratification tool regardless of the LVEF.

Role of red blood cell distribution width, as a prognostic indicator in COVID-19: A systematic review and meta-analysis.

SummaryThe red blood cell distribution width (RDW), an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients with sepsis. Prognostic predictors are of paramount interest for prompt intervention and optimal utilization of the healthcare system in this ongoing context of the Coronavirus Disease 2019 (COVID‐19) pandemic. The current systematic review and meta‐analysis aims to explore the utility of RDW in the prognosis of COVID‐19 patients. A comprehensive screening of electronic databases was performed up to 30th April 2021 after enrolling in PROSPERO (CRD42020206685). Observational studies or interventional studies, evaluating the impact of RDW in COVID‐19 outcomes (mortality and severity) are included in this meta‐analysis.Our search retrieved 25 studies, with a total of 18,392 and 3,446 COVID‐19 patients for mortality and disease severity outcomes. Deceased and critically ill patients had higher RDW levels on admission in comparison to survivors and non‐severe patients (SMD = 0.46; 95%CI 0.31–0.71; I 2 = 88% and SMD = 0.46; 95%CI 0.26–0.67; I 2 = 60%, respectively). In a sub‐group analysis of 2,980 patients, RDW > 14.5 has been associated with increased risk of mortality (OR = 2.73; 95%CI 1.96–3.82; I 2 = 56%). However, the evidences is of low quality. A higher level of RDW on admission in COVID‐19 patients is associated with increased morbidity and mortality. However, further studies regarding the cut‐off value of RDW are the need of the hour.

Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults’ health

ObjectiveCardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG’s role in all-cause and...

ASSOCIATION BETWEEN TERMINAL QRS DISTORSION WITH GRACE SCORE IN ACUTE STEMI PATIENT IN HAJI ADAM MALIK HOSPITAL, MEDAN

Background: Amount of 17.9 million people died from cardiovascular disease in 2016, half were caused by acute myocardial infarct. Terminal QRS distortion is showing the degree of ischemia in patients with severe STEMI. Risk stratification of the current ACS is carried out using the GRACE score as a validated predictor. Objective: The study objective is to determine the association between terminal QRS distortion in STEMI patients and the GRACE score, also to identify the risk of death through an ECG examination. Methods: The study involved STEMI patients who were hospitalized at Haji Adam Malik Hospital from May 2019 to March 2020. The first group was STEMI with terminal QRS distortion, and another group was without distortion. The association between terminal QRS distortion and independent parameters of GRACE score were observed, and monitoring was carried out for the next six months. The Kaplan-Meier curve performed survival analysis. Results: From 60 STEMI patients, 45 patients (75%) with ST-elevation anterior and 26 (43.3%) patients with terminal QRS distortion (first group). It had a significant statistically GRACE score (130.92 ± 38.209, p = 0.001), compared to those without distortion. The GRACE score parameters to terminal QRS distortion were significantly associated (p &lt;0.05). The first group also had poor clinical outcomes (Hazard Ratio 3,596; CI 95%) and the highest mortality rate over six months of follow-up. Conclusion: The association between terminal QRS distortion and the GRACE might be considered as a potential tool for risk stratification in STEMI patients.

N-terminal pro-B-type natriuretic peptide and outcomes in type B aortic dissection in China: a retrospective multicentre study

ObjectivesN-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is an unfavourable factor responsible for poor outcomes in the cardiovascular diseases. Nevertheless, the prognostic role of NT-pro-BNP in type B aortic dissection (TBAD) remains...

A Review of the Role of Breast Arterial Calcification for Cardiovascular Risk Stratification in Women.

Cardiovascular disease continues to be the leading cause of death among women in the United States. One of the barriers to improving cardiovascular disease outcomes in women is the lack of reliable, effective screening modalities. Breast arterial calcification has emerged as a potential risk stratification tool. Localized deposition in the media of the artery, known as Mönckeberg medial calcific sclerosis, is notably different from the intimal atherosclerotic process commonly associated with coronary artery disease. Nonetheless, studies favor a correlation between breast arterial calcification and cardiovascular risk factors or coronary artery disease, defined as coronary artery calcification on computed tomography scan or both nonobstructive and obstructive lesions on angiography. Since a majority of women over the age of 40 undergo yearly breast cancer screening with mammography, measurement of breast arterial calcification may offer a personalized, noninvasive approach to risk-stratify women for cardiovascular disease at no additional cost or radiation. Mammography has the potential to alter the course of the leading cause of death in women, heart disease, through the evaluation of breast arterial calcification and identification of opportunities for prevention. Current evidence supports the universal reporting of breast arterial calcifications and personalized patient-provider discussions to more aggressively treat cardiac risk factors through targeted medical therapies or healthy lifestyle changes.

Metabolomic analysis of 92 pulmonary embolism patients from a nested case–control study identifies metabolites associated with adverse clinical outcomes

Background Patients with acute pulmonary embolism (PE) exhibit wide variation in clinical presentation and outcomes. Our understanding of the pathophysiologic mechanisms differentiating low-risk and high-risk PE is limited, so current risk-stratification efforts often fail to predict clinical deterioration and are insufficient to guide management. Objectives To improve our understanding of the physiology differentiating low-risk from high-risk PE, we conducted the first-ever high-throughput metabolomics analysis (843 named metabolites) comparing PE patients across risk strata within a nested case-control study. Patients/methods We enrolled 92 patients diagnosed with acute PE and collected plasma within 24 h of PE diagnosis. We used linear regression and pathway analysis to identify metabolites and pathways associated with PE risk-strata. Results When we compared 46 low-risk with 46 intermediate/high-risk PEs, 50 metabolites were significantly different after multiple testing correction. These metabolites were enriched in the following pathways: tricarboxylic acid (TCA) cycle, fatty acid metabolism (acyl carnitine) and purine metabolism, (hypo)xanthine/inosine containing. Additionally, energy, nucleotide and amino acid pathways were downregulated in intermediate/high-risk PE patients. When we compared 28 intermediate-risk with 18 high-risk PE patients, 41 metabolites differed at a nominal P-value level. These metabolites were enriched in fatty acid metabolism (acyl cholines), and hemoglobin and porphyrin metabolism. Conclusion Our results suggest that high-throughput metabolomics can provide insight into the pathophysiology of PE. Specifically, changes in circulating metabolites reflect compromised energy metabolism in intermediate/high-risk PE patients. These findings demonstrate the important role metabolites play in the pathophysiology of PE and highlight metabolomics as a potential tool for risk stratification of PE.

Prevalence and prognostic relevance of atrial fibrillation in patients with Takotsubo syndrome

BackgroundTakotsubo syndrome (TTS) is associated with a considerable risk of complications during the acute phase and substantial long-term mortality rates. Concomitant atrial fibrillation may have an impact on outcome in these patients. Aim of this study was to assess the prevalence and prognostic relevance of atrial fibrillation in TTS. MethodsWe performed an international, multicenter study including 387 TTS patients consecutively enrolled at 3 centers. Atrial fibrillation was defined as known history before admission or documented episodes during hospital stay. Long-term mortality was evaluated in median 2.9years after the acute event. ResultsAtrial fibrillation was found in 97 TTS patients (25.1%) and was associated with older age (p<0.01), less emotional triggers (p=0.03), higher incidence of cardiogenic shock (p<0.01), lower left ventricular ejection fraction (p<0.01), and a prolonged hospital stay (p<0.01). Determinants of atrial fibrillation at admission (n=34 patients; 9.0%) in multivariate logistic regression analysis were age (p=0.001) and cardiogenic shock (p=0.013). Long-term mortality was significantly higher in TTS patients with as compared to patients without atrial fibrillation (35.2% versus 15.3%; hazard ratio 3.02, 95% confidence interval 1.90–4.78; p<0.001). In multivariate Cox regression analysis atrial fibrillation was identified as an independent determinant of outcome even after adjustment for clinical variables, left ventricular functional parameters (ballooning pattern, ejection fraction), and cardiogenic shock. ConclusionsIn TTS patients, atrial fibrillation is frequent and associated with increased long-term mortality rates. Furthermore, our study identifies atrial fibrillation as an independent predictor of outcome and a potential tool for risk stratification in TTS.