Risk Of Cardiac Complications Research Articles

Seronegative Neonatal Lupus: Case Report

Neonatal lupus erythematosus (NEL) is a rare autoimmune disease characterized by transplacental transmission of maternal antibodies, primarily directed against SSA/Ro or SSB/La proteins. Clinical manifestations include cutaneous, hematologic, hepatic, and cardiac symptoms, including congenital atrioventricular block (cAVB). Although cutaneous symptoms are often reversible and treated with topical steroids, cardiac complications, such as cAVB, are considered irreversible and can be fatal. Pregnant women with specific antibodies should be screened, and fetal echocardiography is recommended for prenatal screening. Traditional treatments include corticosteroids, although hydroxychloroquine and intravenous immunoglobulin (IVIG) may be effective alternatives to reduce the risk of cardiac complications in newborns.

A Machine Learning Approach to Gene Expression in Hypertrophic Cardiomyopathy

Background/Objectives: Hypertrophic cardiomyopathy (HCM) is a common heart disorder characterized by the thickening of the heart muscle, particularly in the left ventricle, which increases the risk of cardiac complications. This study aims to analyze the expression of apoptosis-regulating genes (CASP8, CASP9, CASP3, BAX, and BCL2) in blood samples from HCM patients, to better understand their potential as biomarkers for disease progression. Methods: Quantitative real-time PCR (qPCR) was used to evaluate gene expression in blood samples from 93 HCM patients. The correlation between apoptosis-regulating genes was conducted and clinical parameters were integrated for feature importance and clustering analysis. Results: Most patients exhibited significant downregulation of CASP8, CASP9, and CASP3. In contrast, BAX expression was elevated in 71 out of 93 patients, while BCL2 was increased in 55 out of 93 patients. Correlation analysis revealed weak negative correlations between the BAX/BCL2 ratio and CASP gene expression. Conclusions: These findings suggest that reduced expression of apoptotic genes may indicate a protective cellular mechanism, which could serve as a biomarker for disease progression. Further studies are needed to investigate the potential for therapeutic modulation of these pathways to improve patient outcomes.

Artificial intelligence enabled interpretation of ECG images to predict hematopoietic cell transplantation toxicity

AbstractArtificial intelligence (AI)–enabled interpretation of electrocardiogram (ECG) images (AI-ECGs) can identify patterns predictive of future adverse cardiac events. We hypothesized that such an approach would provide prognostic information for the risk of cardiac complications and mortality in patients undergoing hematopoietic cell transplantation (HCT). We retrospectively subjected ECGs obtained before HCT to an externally trained, deep-learning model designed to predict the risk of atrial fibrillation (AF). Included were 1377 patients (849 autologous [auto] HCT and 528 allogeneic [allo] HCT recipients). The median follow-up was 2.9 years. The 3-year cumulative incidence of AF was 9% (95% confidence interval [CI], 7-12) in patients who underwent auto HCT and 13% (10%-16%) in patients who underwent allo HCT. In the entire cohort, pre-HCT AI-ECG estimate of AF risk correlated highly with the development of clinical AF (hazard ratio [HR], 7.37; 95% CI, 3.53-15.4; P < .001), inferior survival (HR, 2.4; 95% CI, 1.3-4.5; P = .004), and greater risk of nonrelapse mortality (NRM; HR, 95% CI, 3.36; 1.39-8.13; P = .007), without increased risk of relapse. Association with mortality was only noted in allo HCT recipients, where the risk of NRM was greater. The use of cyclophosphamide after transplantation resulted in greater 90-day incidence of AF (13% vs 5%; P = .01) compared to calcineurin inhibitor–based graft-versus-host disease prophylaxis, corresponding to temporal changes in AI-ECG AF prediction after HCT. In summary, AI-ECG can inform risk of posttransplant cardiac outcomes and survival in HCT patients and represents a novel strategy for personalized risk assessment.

Outcomes following pancreaticoduodenectomy for octogenarians: a systematic review and meta-analysis

BackgroundAn increasing number of elderly patients are being diagnosed with pancreatic cancer, with increasing need to consider pancreatic surgery. This study aims to provide an updated systematic review and meta-analysis to evaluate the outcomes following pancreaticoduodenectomy in octogenarians. MethodsA systematic review and meta-analysis was performed via a search of Medline, PubMed and Cochrane databases. Studies comparing outcomes of patients >80 years to younger patients undergoing PD were included. Results26 studies were included. This included 22481 patients, with 20134 (89.6%) aged <80 years old, and 2347 (10.4%) octogenarians. Octogenarians were associated with higher rates of mortality (OR 2.37 (95%CI 1.91-2.94, p < 0.00001)), all-cause morbidity (OR 1.60 (95%CI 1.30-1.96), p<0.00001) and re-operation (OR 1.41 (95%CI 1.13-1.75), p = 0.002). Octogenarians had a two-fold risk of cardiac complications and respiratory complications (OR 2.13 (95%CI 1.67-2.73), p < 0.00001), (OR 2.38 (95%CI 1.72-3.27), p < 0.0001). There was no difference in postoperative pancreatic fistula, post-pancreatectomy hemorrhage or delayed gastric emptying. Younger patients were more likely to return to adjuvant therapy (OR 0.20 (95%CI 0.12-0.34), p < 0.00001). ConclusionsOctogenerians are associated with higher mortality rate, postoperative complications, and reduced likelihood to undergo adjuvant therapy. Careful preoperative assessment and selection of elderly patients for consideration of pancreatic surgery is essential.

Factors Affecting the Effectiveness of DIBH (Deep Inspiratory Breath Hold) in Patients with Left Breast Cancer: A Narrative Review

Deep Inspiratory Breath Hold (DIBH) has become a valuable technique in left-breast cancer radiotherapy, offering the possibility to reduce radiation exposure to organs at risks (OARs) and minimize the risk of cardiac complications. This treatment method involves stopping the breathing of patients during irradiation in order to temporarily distance the heart from the radiation field, which reduces potential cardiac risks and other complications. To identify factors that may affect the effectiveness of DIBH treatment, we analyzed the most important 5-year studies published in the PubMed database. Research shows that DIBH reduces the radiation dose to the heart and lungs. However, the effectiveness of DIBH is determined by a variety of factors, including the patient’s training, cooperation, anatomical features, age, and choice of radiotherapy technique. Additionally, cardiovascular risk factors, such as diabetes, smoking, and hypertension, can be impactful to the effectiveness and potential complications of DIBH. Moreover, if a patient has a substantial level of depression or anxiety, then they may be potentially disqualified from the DIBH treatment method. In addition to this, a lack of consent and/or fear may also disqualify a patient from DIBH treatment. Careful patient selection, comprehensive training, and optimization of treatment parameters are essential to maximize the benefits of DIBH whilst minimizing any potential side effects. DIBH enhancement techniques, such as IMRT and VMAT, also have an important role to play. The purpose of this narrative review article is to summarize the factors affecting the efficacy and side effects of DIBH in radiation therapy for left-breast cancer, with the aim of optimizing its clinical application while minimizing side effects. Patients who are likely to benefit most from DIBH are young women in good medical condition, able to cooperate with the procedure, and with smaller breasts. The increase in the estimated 10-year patient survival is significantly influenced by cardiovascular problems, so patients without diabetes and metabolic syndrome, and non-smokers, will benefit the most. An estimated 50–70% of breast cancer patients are likely to benefit from DIBH, and in the best case, it can result in a 50% reduction in the risk of cardiac problems after photodynamic therapy (PDT).

Higher modified frailty index score is associated with 30-day postoperative complications following simultaneous bilateral total knee arthroplasty

BackgroundThere is no clear consensus regarding patient populations at highest risk for complications from simultaneous bilateral total knee arthroplasty (TKA). The purpose of this study was to determine whether the comorbidities comprising the modified Frailty Index (mFI) were correlated with poor outcomes following simultaneous bilateral TKA. MethodsFrom 2006 to 2019, patients undergoing bilateral TKA aged 50 years or older were identified in a national database. The 5-item mFI was calculated based on the presence of five comorbidities: diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent functional status. Chi-squared and multivariable regression analyses were used to evaluate the association of mFI scores with postoperative complications. ResultsThe study analyzed 8,776 patients with an average age of 65 years. After adjustment on multivariable regression analysis, compared to patients with a mFI score of 0, those with a score of 1 had an increased risk of pulmonary complication (OR 3.14; p = 0.011), renal problem (OR 12.86; p = 0.022), sepsis complication (OR 2.82; p = 0.024), postoperative transfusion (OR 1.19; p = 0.012), and non-home discharge (OR 1.17; p = 0.002).Patients with a score of 2 compared to 0 had similar complications when compared. These patients had an increased risk of cardiac complication (OR 4.84; p = 0.009) and prolonged hospital stay (OR 4.06; p < 0.001). ConclusionIncreased mFI scores were associated with significantly higher complication rates in patients undergoing simultaneous bilateral TKA compared to unilateral TKA. Our results can be used to identify which patients may need a staged bilateral TKA or preoperative optimization to safely undergo a simultaneous bilateral TKA.Level of Evidence: III.

Cardiac complications (arrhythmias and heart failure) in patients with ischemic stroke: A meta-analysis.

In patients with ischemic stroke (pwIS), cardiac complications have been observed in observational studies. We conducted a systematic review and meta-analysis to investigate the arrhythmias and heart failure in pwIS. Up until September 2023, we searched for case-control, cross-sectional, or cohort studies in 4 databases. For case-control/cross-sectional studies, odds ratios (OR) were determined using a random-effects model meta-analysis, while hazard ratios (HR) were calculated for cohort studies, and 95% confidence intervals (CIs) were pooled in the meta-analysis. In the meta-analysis, we incorporated 5 studies: 2 cohort studies, 2 case-control studies, and 1 cross-sectional study. In all, 81,181 controls and 25,544 pwIS were included in this investigation. The combined OR for case-control studies of arrhythmias was estimated to be 1.86 (95% CI: 0.70-4.94, P = .21), HR for cohort studies of arrhythmias to be 4.2 (95% CI: 1.49-12.01, P < .05), and for cohort studies of heart failure to be 2.9 (95% CI: 2.65-3.18, P < .05), suggesting that pwIS may be more likely to experience cardiac complications. Our results revealed that there is a comparatively higher risk of cardiac complications in pwIS; however, more research is needed to evaluate the risk of cardiac complications in pwIS.

The Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in COPD and Non-COPD Cohorts.

Patients with chronic obstructive pulmonary disease (COPD) infected with SARS-CoV-2 indicate a higher risk of severe COVID-19 course, which is defined as the need for hospitalization in the intensive care unit, mechanical ventilation, or death. However, simple tools to stratify the risk in patients with COPD suffering from COVID-19 are lacking. The current study aimed to evaluate the predictive value of the C2HEST score in patients with COPD. A retrospective analysis of medical records from 2184 patients hospitalized with COVID-19 at the University Hospital in Wroclaw from February 2020 to June 2021, which was previously used in earlier studies, assessed outcomes such as mortality during hospitalization, all-cause mortality at 3 and 6 months, non-fatal discharge, as well as adverse clinical incidents. This re-analysis specifically examines the outcomes using a COPD split. In the COPD group, 42 deaths were recorded, including 18 in-hospital deaths. In-hospital mortality rates at 3 and 6 months did not significantly differ among C2HEST strata, nor did their impact on subsequent treatment. However, a notable association between the C2HEST score and prognosis was observed in the non-COPD cohort comprising 2109 patients. The C2HEST score's predictive ability is notably lower in COPD patients compared to non-COPD subjects, with COPD itself indicating a high mortality risk. However, C2HEST effectively identifies patients at high risk of cardiac complications during COVID-19, especially in non-COPD cases.

Low Risk of Cardiac Complications During Long-Term Follow-Up of Opioid Dependence.

To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence. To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up.To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort. From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred from methadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event-14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds.There were 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years. More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4). Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment.

Perioperative complications and in-hospital mortality in radical cystectomy patients with heart-valve replacement

PurposeTo assess in-hospital mortality and complication rates after radical cystectomy (RC) in patients with history of heart-valve replacement. Materials and methodsUsing the National Inpatient Sample (2000–2019), non-metastatic bladder cancer patients undergoing RC were stratified according to history of heart-valve replacement. Regression models (RM) predicted hospital outcomes. ResultsOf 25,535 RC patients, 250 (1.0%) harbored history of heart-valve replacement. Heart-valve replacement patients were older (median 74 vs. 70 years), more frequently male (87.2 vs. 80.6%), and more frequently had Charlson comorbidity index ≥3 (26.8 vs. 18.9%). In RC patients with history of heart-valve replacement vs. others, 62 vs. 2634 (24.8 vs. 10.4%) experienced cardiac complications, 28 vs. 3092 (11.2 vs. 12.2%) intraoperative complications, 11 vs. 1046 (4.4 vs. 4.1%) infections, <11 vs. 594 (<4.4 vs. 2.3%) perioperative bleeding, <11 vs. 699 (<4.4 vs. 2.8%) vascular complications, 74 vs. 6225 (29.6 vs. 24.7%) received blood transfusions, 37 vs. 3054 (14.8 vs. 12.1%) critical care therapy (CCT), and in-hospital mortality was recorded in <11 vs. 463 (<4.4 vs. 1.8%) patients. In multivariable RM, history of heart-valve replacement independently predicted cardiac complications (odds ratio 2.20, 95% confidence interval 1.62–2.99; p < 0.001). Conversely, no statically significant association was recorded between history of heart-valve replacement and length of stay, estimated hospital cost, intraoperative complications, perioperative bleeding, vascular complications, infections, blood transfusions, CCT use, and in-hospital mortality. ConclusionsRadical cystectomy patients with history of heart-valve replacement exhibited a 2.2-fold higher risk of cardiac complications, but no other complications, including no significantly higher in-hospital mortality.

Perioperative Complications and In-Hospital Mortality in Partial and Radical Nephrectomy Patients with Heart-Valve Replacement

BackgroundIn-hospital mortality and complication rates after partial and radical nephrectomy in patients with history of heart-valve replacement are unknown.Patients and MethodsRelying on the National Inpatient Sample (2000–2019), kidney cancer patients undergoing partial or radical nephrectomy were stratified according to presence or absence of heart-valve replacement. Multivariable logistic and Poisson regression models addressed adverse hospital outcomes.ResultsOverall, 39,673 patients underwent partial nephrectomy versus 94,890 radical nephrectomy. Of those, 248 (0.6%) and 676 (0.7%) had a history of heart-valve replacement. Heart-valve replacement patients were older (median partial nephrectomy 69 versus 60 years; radical nephrectomy 71 versus 63 years), and more frequently exhibited Charlson comorbidity index ≥ 3 (partial nephrectomy 22 versus 12%; radical nephrectomy 32 versus 23%). In partial nephrectomy patients, history of heart-valve replacement increased the risk of cardiac complications [odds ratio (OR) 4.33; p < 0.001), blood transfusions (OR 2.00; p < 0.001), intraoperative complications (OR 1.53; p = 0.03), and longer hospital stay [rate ratio (RR) 1.25; p < 0.001], but not in-hospital mortality (p = 0.5). In radical nephrectomy patients, history of heart-valve replacement increased risk of postoperative bleeding (OR 4.13; p < 0.001), cardiac complications (OR 2.72; p < 0.001), intraoperative complications (OR 1.53; p < 0.001), blood transfusions (OR 1.27; p = 0.02), and longer hospital stay (RR 1.12; p < 0.001), but not in-hospital mortality (p = 0.5).ConclusionsHistory of heart-valve replacement independently predicted four of twelve adverse outcomes in partial nephrectomy and five of twelve adverse outcomes in radical nephrectomy patients including intraoperative and cardiac complications, blood transfusions, and longer hospital stay. Conversely, no statistically significant differences were observed in in-hospital mortality.

Locoregional Anesthesia Has Lower Risks of Cardiac Complications Than General Anesthesia After Prolonged Endovascular Repair of Abdominal Aortic Aneurysms

ObjectivesWhile general anesthesia is the primary anesthesia in endovascular aneurysm repair (EVAR), some studies suggested locoregional anesthesia could be a feasible alternative for eligible patients. However, most evidence was from retrospective studies and was subjected to an inherent selection bias that general anesthesia is often chosen for more complex and prolonged cases. To mitigate this selection bias, this study aimed to compare 30-day outcomes of prolonged non-emergent intact infrarenal EVAR in patients undergoing locoregional or general anesthesia. In addition, risk factors associated with prolonged operative time in EVAR were identified. Designretrospective large-scale national registry study. SettingAmerican College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted database from 2012-2022 Participants4075 out of 16,438 (24.79%) patients had prolonged EVAR. Among patients with prolonged EVAR, 324 (7.95%) were under locoregional anesthesia. There were 3,751 (92.05%) under general anesthesia, where 955 of them were matched to the locoregional anesthesia cohort. InterventionsPatients undergoing infrarenal EVAR were included. Exclusion criteria included age<18 years, emergency cases, ruptured AAA, and acute intraoperative conversion to open. Only cases with prolonged operative times (>157 minutes) were selected. A 1:3 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, and concomitant procedures between patients under locoregional and general anesthesia. Thirty-day postoperative outcomes were assessed. Moreover, factors associated with prolonged EVAR were identified by multivariable logistic regression. Measurements and Main ResultsExcept for general anesthesia contraindications, patients undergoing locoregional or general anesthesia exhibited largely similar preoperative characteristics. After propensity-score matching, patients under locoregional and general anesthesia had a lower risk of myocardial infarction (0.93% vs 2.83%, p=0.04) but comparable 30-day mortality (3.72% vs 2.72%, p=0.35) and other complications. Specific concomitant procedures, aneurysm anatomy, and comorbidities associated with prolonged EVAR were identified. ConclusionsLocoregional anesthesia can be a safe and effective alternative to general anesthesia, particularly in EVAR cases with anticipated complexity and prolonged operative times, as it offers the potential benefit of reduced cardiac complications. Risk factors associated with prolonged EVAR can aid in preoperative risk stratification and inform the decision-making process regarding anesthesia choice.

Management of Ptosis in Kearns-Sayre Syndrome: A Case Report and Literature Review.

Kearns-Sayre syndrome (KSS) is a rare mitochondrial disease that affects young adults, due to a deletion of mitochondrial DNA and characterized by the triad: age of onset lower than 20 years, chronic progressive external ophthalmoplegia, and an atypical pigmentary retinopathy. It is also characterized by other endocrine, neurological, and especially cardiac impairment with a very high risk of cardiac complications during surgical procedures under all types of anesthesia. We report a case of KSS revealed by severe bilateral ptosis and confirmed by a muscle biopsy with "ragged red fibers." The ptosis was surgically managed by cautious Frontal suspension under local anesthesia "Frontal nerve block." Through this case, we discuss challenges in the management of KSS patients.

Abstract WP15: Early Neurological Improvement in Ischemic Stroke and Risk of Cardiac Complications

Introduction: Cardiac complications are seen in 15-20% of acute ischemic strokes (AIS). We hypothesized that early neurologic improvement (ENI) with or without revascularization would be associated with lower risk of cardiac complications after AIS. Methods: We retrospectively screened consecutive AIS patients for elevated initial cardiac troponin (cTn) and ≥1 additional cTn within 48h. Minor strokes (NIHSS≤3) or comorbidities impacting cTn were excluded from primary analysis. ENI was defined as ≥4 pt improvement in NIHSS or 24h NIHSS≤ 1. Post-stroke acute myocardial injury (PSAMI) refers to dynamic cTn pattern (rise/fall&gt;20% in serial cTn levels) in the absence of acute atherosclerotic coronary disease or cardiac death. Secondary analysis assessed full range of NIHSS at baseline and at 24h in relation to cardiac outcomes. Results: Of 2,609 patients screened, 165 (ENI=62, no-ENI=103) were included in our primary analysis. (Fig.1). In patients with ENI, a dynamic cTn pattern and PSAMI were present in 55% (n=34) and 34% (n=21) respectively, compared to 45% (n=46) and 24% (n=25) in the no-ENI group ( P =0.20 and P =0.18). Adjusted regression analysis did not show any statistical association of cardiac outcomes with ENI. Secondary analysis including NIHSS≤3, was associated with a 4-fold greater risk of PSAMI in NIHSS &gt;15 at 24h (Fig.1). Analysis of patients intervened with MT or tPA (n=77) also showed no statistical association between ENI and PSAMI (Fig 1.) Conclusion: SENI was not associated with a lower risk of cardiac complications after AIS. NIHSS at 24 hours was a strong predictor of PSAMI. Larger studies should investigate if revascularization decreases risk of PSAMI.

Cumulative effect of chronic dehydration and age on postoperative complications after total shoulder arthroplasty

Dehydration is a modifiable risk factor that should be optimized prior to all surgical procedures. The aim of this study was to determine the effects of dehydration on postoperative complications following total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019 and a total of 16,993 patients were included in this study. The study population was subsequently classified into 3 categories: 8498 (50.0%) nondehydrated patients with blood urea nitrogen/creatinine (BUN/Cr)<20, 4908 (28.9%) moderately dehydrated patients with 20≤BUN/Cr≤25, and 3587 (21.1%) severely dehydrated patients with 25<BUN/Cr. A subgroup analysis involving only elderly patients aged > 65 years and normalized gender-adjusted Cr values was also performed. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between dehydration and postoperative complications. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P<.05). The moderately dehydrated cohort had a greater risk of wound dehiscence (P=.044). Among the elderly, severely dehydrated patients had a greater risk of cardiac complications, postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P<.05). Finally, the elderly moderately dehydrated cohort had a greater risk of postoperative transfusion and nonhome discharge (all P<.05). BUN/Cr ratio is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning.

Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer: A meta-analysis.

The effectiveness of neoadjuvant therapy in esophageal cancer (EC) treatment is still a subject of debate. To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for locally advanced EC (LAEC). A comprehensive search was conducted using multiple databases, including PubMed, EMBASE, MEDLINE, Science Direct, The Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Journal Database, and Chinese Biomedical Literature Database Article. Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected. The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival. The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate (OSR) [odds ratio (OR) = 0.95], complete response rate (OR = 3.15), and R0 clearance rate (CR) (OR = 2.25). However, nCT demonstrated a better 5-year OSR (OR = 1.02) than nCRT. Moreover, when compared to nCRT, nCT showed reduced risks of cardiac complications (OR = 1.15) and pulmonary complications (OR = 1.30). Overall, both nCRT and nCT were effective in terms of survival outcomes for LAEC. However, nCT exhibited better performance in terms of postoperative complications.

The Exploring of Growth Differentiation Factor-15 and H63D Gene Polymorphisms in β-thalassemia Major: Implications for Cardiovascular Risk and Iron Overload

BACKGROUND: β-thalassemia major (βTM) is a genetic disorder characterized by a deficiency in hemoglobin production, ineffective erythropoiesis, chronic hemolysis, lifelong blood transfusions, iron overload, and increased risk of cardiac complications. OBJECTIVE: The study aimed to evaluate the growth differentiation factor-15 (GDF-15) concentration in βTM patients and its correlation with cardiac complications. H63D refers to a specific mutation in the HFE gene, which is associated with hereditary hemochromatosis (HH), a genetic disorder characterized by excessive accumulation of iron in the body. This mutation involves a change of histidine (H) to aspartic acid (D) at position 63 in the HFE protein. This mutation is often only written abbreviated as (H63D). MATERIALS AND METHODS: This case–control study was done on 120 subjects. A total of 60 patient samples were randomly collected from the Genetic Hematology Center at the Babylon Hospital, with an age range of 10–26 years. In addition, 60 samples were collected from healthy children in the same age range as the control group; patients and controls were subdivided into (10–18) and (18–26) year groups. GDF-15 was measured by enzyme-linked immunosorbent assay, and the genotyping of mutation was done by amplification refractory mutation system-polymerase chain reaction technique. RESULTS: The study revealed a significant increase in ferritin (FER) and GDF-15 levels in the patients compared to controls (P &lt; 0.001). GDF-15 showed a direct correlation with age (r = 0.244, P = 0.02) and FER (r = 0.215, P = 0.04). There was a significant difference in H63D mutations between controls and patients (P = 0.044), with a higher proportion of the C-G (heterozygous for the mutant allele) genotype observed in βTM patients (31.67%). Additionally, a notable effect of the H63D mutation on serum ferritin (higher) levels within the βTM group was observed. CONCLUSION: Elevations of the GDF-15 in βTM patients indicate a high risk of cardiovascular complications in patients with βTM. The H63D mutation of the hemostatic iron regulator (HFE) gene is frequently found in βTM. Although a significant effect of the mutation was obtained on serum FER levels, it did not act as a risk factor in βTM patients. However, the frequent presence of the H63D mutation in patients indicated a possible association between single-nucleotide polymorphism and the iron regulation pathway.

Role of feature tracking cardiac magnetic resonance imaging in early detection of cardiac dysfunction in β-thalassemia patients recovered from COVID-19: A cross-sectional study.

β-Thalassemia patients may have cardiac complications due to iron overload, which puts them at higher risk of cardiac complications induced by coronavirus disease 2019 (COVID-19) compared with the normal population. The present study aims to evaluate early cardiovascular complications following iron overload in β-thalassemia patients who had early recovery from COVID-19 by cardiac magnetic resonance imaging (MRI) and feature-tracking technique. Thirty-two confirmed COVID-19-recovered β-thalassemia cases were evaluated within 3 weeks to 3 months after a positive reverse-transcriptase polymerase chain reactionCOVID-19 test. Both the heart and liver of all patients were examined using cardiac MRI. We analyzed 32 patients with mean age of 32.84 ± 6.45 years at baseline. Left ventricular global strain values were significantly associated with myocardial T2*. A cut-off value of -15.08% for global longitudinal strain (GLS) with sensitivity and specificity of 90% and 61.1% (p = 0.017), 32.33% for global radial strain (GRS) with sensitivity and specificity of 80% and 94.4% (p = 0.001) and -16.21 for global circumferential strain(GCS), with sensitivity and specificity of 80% and 89.9% (p = 0.013) may indicate cardiac iron overload. GLS, GRS, and GCS were significantly decreased in patients with myocardial T2* <20 ms (iron overload), while no significant change was observed in the right and left ventricular ejection fraction (RV- and LVEF). Cardiac MRI feature-tracking may be helpful in the early detection of cardiac complications resulting from iron overload in β-thalassemia patients who had early recovery from COVID-19.

Novel Russian guidelines for the assessment and modification of cardiovascular risk in non-cardiac surgery

This year, new domestic recommendations for assessing and correcting the risk of cardiac complications during non-cardiac surgery have been published. These guidelines provide simple and practical key messages to facilitate decision-making in real-life clinical practice. The proposed algorithm for the management of patients before non-cardiac operations, focused on integral risk assessment, assessment of functional status and biomarkers. This review provides a summary of perioperative drug therapy, management of the most common CVDs, and focuses on specific care based on the risk of the patient's preexisting clinical conditions. Finally, the document includes practical recommendations for the management of postoperative complications, and also includes a new section on perioperative myocardial infarction/injury.

Presentation and Outcome of Children with Kawasaki Disease: Experience in A Tertiary Care Hospital in Bangladesh

Background: Kawasaki disease (KD) is an acute difficult-to-diagnose febrile illness in children caused by self limiting vasculitis in medium and small sized arteries.&#x0D; Objetive: This study has been conducted to analyze its presenting symptoms, clinical course, laboratory findings, and therapeutic options in a tertiary hospital in Bangladesh to aid early diagnosis and optimum management.&#x0D; Methods: This is a retrospective study where the medical records of 31 children admitted and diagnosed with Kawasaki Disease (KD) in Evercare Hospital Dhaka between 2009 and 2020, were assessed. Through a structured form, the demographic information, clinical profile, laboratory results, and echocardiographic data were obtained from the hospital records and then entered into a Microsoft Excel sheet. Cleaned and verified data were transferred to SPSS program version 23 and analyzed to obtain descriptive statistics.&#x0D; Results: Out of total 31 patients with KD enrolled, 64.5% of the patients were between six months to five years of age with a median age of three years; 97% had an age below 6 months. Though 68% of patients met all the required criteria for KD, one-third (32%) were diagnosed as incomplete KD with fewer manifestations. Along with high fever in all cases, the most common clinical features were polymorphous rash (90%) and changes in extremities (90%) followed by changes in the lips and oral cavity (77.4%), cervical lymphadenopathy (68%) and conjunctival injection (61%). Common laboratory abnormalities found were anemia (90%), leukocytosis (65%), thrombocytosis especially in the second week (78%), high ESR (100%), and elevated CRP (84%). About 42% of patients had cardiac abnormalities at the onset. Seven children (63.6%) had coronary artery aneurysms (CAA) whereas 18% had coronary dilatations. In subsequent followups, coronary artery changes remained almost the same up to 6-8 weeks. After 3-6 months, 87.5 % of children recovered from cardiac abnormality.&#x0D; Conclusion: A high index of suspicion for KD and an active search for compatible findings in children with unexplained fever can help in early diagnosis. Timely initiation of IVIG treatment is needed to reduce the risk of cardiac complications. Young infants under six months of age need further careful early suspicion and evaluation because of their incomplete presentation and more vulnerability to developing cardiac complications.&#x0D; DS (Child) H J 2022; 38(2): 70-78