Status Symptoms Research Articles

Unilateral and bilateral PVP for thoracolumbar OVCF with distant lumbosacral pain: a single-center retrospective analysis.

Previous studies have found that percutaneous vertebroplasty (PVP) can effectively improve the local pain of the affected vertebra caused by thoracolumbar osteoporotic vertebral compression fracture (OVCF) regardless of unilateral or bilateral puncture, but there are few reports on whether it is equally effective for the accompanying distant lumbosacral pain. To analyze the clinical effect of unilateral or bilateral PVP on thoracolumbar OVCF with distant lumbosacral pain. The clinical data of patients with single-stage OVCF treated with PVP in our hospital from March 2019 to March 2023 were retrospectively analyzed. According to different intraoperative puncture methods, the whole cohort of patients were divided into unilateral puncture group (52 cases) and bilateral puncture group (40 cases). Preoperative, postoperative, and final follow-up were evaluated using a visual analogue scale (VAS) to assess the degree of local pain in the fractured vertebrae and distant lumbosacral pain, respectively. The Oswestry Disability Index (ODI) was used to evaluate functional impairment. At the last follow-up, the proportion of patients who achieved the minimum clinical importance difference and acceptable symptom status on these measures was evaluated. The average follow-up time of the 92 patients was (20.1±7.6) months, and the local pain, lumbosacral pain VAS score and ODI index at 3 days after surgery and the last follow-up were significantly improved compared with those before surgery, with statistical differences (P < 0.05), but there was no statistical difference between the above indexes at 3 days after surgery and the last follow-up (P > 0.05). There were no significant differences in local pain, lumbosacral pain VAS scores and ODI scores between unilateral puncture group and bilateral puncture group at different time points after surgery (P > 0.05). At the last follow-up, there were no statistically significant differences in the minimum clinical significance of local pain, lumbosacral pain VAS score and ODI index and the rate of patients achieving acceptable symptom status between the two groups (P > 0.05). PVP can not only improve the local pain and ODI index of the responsible vertebra of OVCF in the thoracolumbar region, but also improve the accompanying distant lumbosacral pain symptoms, and the puncture approach does not affect the improvement of postoperative pain and function.

Defining Thresholds for Meaningful Health Status Changes Following Transfemoral Carotid Artery Stenting.

Evaluating health status changes following transfemoral carotid artery stenting (TF-CAS) is essential for assessing procedural success, but meaningful clinical changes are unknown. We aimed to determine minimal clinically important differences (MCIDs) and quantify health status improvement or worsening rates after TF-CAS using the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) registry data. The SAPPHIRE registry included patients undergoing TF-CAS from 2010 to 2014 for both symptomatic and asymptomatic carotid stenosis. Baseline and 30-day health status were assessed using the SF-36 (2010-2012) for mental and physical component scores (MCS and PCS) and the EQ-5D (2012-2014) for 3 L Index and Visual Analog Scale (VAS) scores. For each score, we calculated the 30-day distribution-based MCID (0.5*standard deviations of baseline health status) by symptom status and the overall cohort (symptom-weighted MCIDs). The changes were then categorized as improved, deteriorated, or unchanged based on these MCIDs. Health status was assessed using the EQ-5D in 3930 patients and the SF-36 in 3018 patients (27.7% and 30.5% symptomatic, respectively). The MCIDs by symptom status were close, hence weighted MCIDs of 0.09 (Index), 11.00 (VAS), 4.70 (PCS), and 5.40 (MCS) were established. Across all subscales, 21.2%-26.1% of patients improved, 10.5%-16.7% worsened, and 57.2%-66.1% unchanged. We established thresholds for meaningful health status changes after TF-CAS using common generic instruments. At 30 days after TF-CAS, 70%-80% of patients no change or worsened, while 20%-30% improved. Carotid artery disease-specific instrument would provide better insights into of TF-CAS effects on health status.

Mobile Health for Obsessive-Compulsive Disorder: Patients' Preferences and Perception of Patient-Centeredness.

The increasingly fast development of mobile health technologies holds significant value for individuals dealing with mental health conditions. However, inadequate consideration of patients' preferences and expectations undermines real-world outcomes, including sustained adherence. Driven by the belief that specific characteristics, such as youth and higher education, of individuals with obsessive-compulsive disorder make them suitable for digital adoption, we investigated mHealth-related desirability factors within this patient group. Fifty-one conveniently selected adults with obsessive-compulsive disorder filled in a self-report questionnaire about symptom self-management preferences, with an emphasis on assessing mobile health options and perceptions of patient-centeredness. The smartphone phone app emerged as the top choice of most of the sample for receiving information about symptom status (82.4%), obtaining general information about obsessive-compulsive disorder (74.5%), and symptom self-registration (66.7%), with no significant effect of sex or living location. Although only 23.5% of participants were using a health-related app, most expressed interest in using it for receiving symptom management tips (98.1%), medical advice (94.2%), symptom evolution updates (90.2%), lifestyle information (92.2%), medication tracking (88.2%) and short symptom self-reports (90.2%). Median expectations regarding mobile health's impact on patient-centeredness, satisfaction, and adherence were positive or very positive. Our data confirm that individuals with obsessive-compulsive disorder exhibit strong inclinations and optimistic expectations toward technology-based solutions. We highlight some of the preferences within this patient group, which can inform the design of practical, real-world applications.

Trajectory of depressive symptoms in a longitudinal stroke cohort.

Knowledge of the trajectory of post-stroke depression is important to identify high-risk patients, develop precise management programs and enhance prognosis. We aimed to characterise the course of depressive symptoms within the first year post-stroke and to evaluate associations with time. Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) within the first week, and at 3 and 12 months post-stroke. Scores were dichotomised into symptoms 'present' (MADRS ≥ 7) or 'absent' (MADRS < 7). The course of depressive symptoms within individuals was mapped and categorised using a trajectory diagram. The association between time and the presence of depressive symptoms was investigated using random effects logistic regression. Logistic regression was also used to assess the likelihood of participants having depressive symptoms later, given their status at earlier time points. Of 142 ischaemic stroke survivors included for analysis, almost half (47.9%) experienced a change in depressive symptom status over time. Depressive symptoms were common at each timepoint (35-43%), although an association between time and frequency of depressive symptoms was not evident. Stroke survivors with depressive symptoms at 3 months were more likely to have depressive symptoms at 12 months, compared to those without symptoms at 3 months. Our findings provide evidence for a dynamic trajectory of depressive symptoms in individuals in the first year post-stroke. The importance of repeated screening for depression is highlighted, though most necessary at 3 months post-stroke.

Household transmission of SARS-CoV-2 in five US jurisdictions: Comparison of Delta and Omicron variants.

Households are a significant source of SARS-CoV-2 transmission, even during periods of low community-level spread. Comparing household transmission rates by SARS-CoV-2 variant may provide relevant information about current risks and prevention strategies. This investigation aimed to estimate differences in household transmission risk comparing the SARS-CoV-2 Delta and Omicron variants using data from contact tracing and interviews conducted from November 2021 through February 2022 in five U.S. public health jurisdictions (City of Chicago, Illinois; State of Connecticut; City of Milwaukee, Wisconsin; State of Maryland; and State of Utah). Generalized estimating equations were used to estimate attack rates and relative risks for index case and household contact characteristics. Data from 848 households, including 2,622 individuals (median household size = 3), were analyzed. Overall transmission risk was similar in households with Omicron (attack rate = 47.0%) compared to Delta variant (attack rate = 48.0%) circulation. In the multivariable model, a pattern of increased transmission risk was observed with increased time since a household contact's last COVID-19 vaccine dose in Delta households, although confidence intervals overlapped (0-3 months relative risk = 0.8, confidence interval: 0.5-1.2; 4-7 months relative risk = 1.3, 0.9-1.8; ≥8 months relative risk = 1.2, 0.7-1.8); no pattern was observed in Omicron households. Risk for household contacts of symptomatic index cases was twice that of household contacts of asymptomatic index cases (relative risk = 2.0, 95% confidence interval: 1.4-2.9), emphasizing the importance of symptom status, regardless of variant. Uniquely, this study adjusted risk estimates for several index case and household contact characteristics and demonstrates that few characteristics strongly dictate risk, likely reflecting the complexity of the biological and social factors which combine to impact SARS-CoV-2 transmission.

Carpal Tunnel Syndrome Incidence In Teachers and Employees at SMP Negeri 1 Pematangsiantar

Background. Median nerve compression at the wrist (carpal tunnel syndrome) is the most common disorder affecting the median nerve and is the most common nerve compression syndrome. Problems usually arise from excessive hand use and work microtrauma. Objectives. To determine the incidence, severity, characteristics of respondents detected, and risk factors that allow for CTS. Methods. The study was an analytic-descriptive study with a cross-sectional approach. Using 70 samples of data from educators and employees at SMP Negeri 1 Pematangsiantar. Data were analyzed using univariate and bivariate analysis. Results. This study involved 70 educators and employees, 59 (84.3%) were found with the majority of respondents experiencing complaints with asymptomatic symptom severity 46 people (65.7%), mild 22 people (31.4%), and moderate 2 people (22.9%). Of the 59 respondents detected, 50 people (71.4%) had mild functional symptom status. The majority of respondents detected with CTS were female (74.6%) and were in the age range of 51-60 years (44%). Respondents detected with CTS had nutritional status type I obesity (34%). Of the 59 respondents detected with CTS, 54 people (91.5%) were educators who had a working duration of ≥8 hours a day (52.5%) and experienced complaints in the left hand (69.5%). Conclusion. Most predominantly female in the age range of 51-60 years who worked as educators with a working duration of ≥8 hours and the majority experienced complaints in the left hand. Keywords: Carpal tunnel syndrome, educators, incidence

Determinants of physical function, as measured using PROMIS PF-10a, in patients with rheumatoid arthritis: results from the international COVID-19 Vaccination in Autoimmune Diseases (COVAD) study

Abstract Objectives Physical function in RA is largely influenced by multiple clinical factors; however, there is a growing body of evidence that psychological state and other comorbidities also play an essential role. Using data obtained in the COVAD study, an international self-reported e-survey, we aimed to a) explore the predictive ability of sociodemographic and clinical variables on PROMIS physical function short form-10a (PROMIS PF-10a) in RA and b) to investigate variation in disease activity and functional outcomes based on country-level socio-economic parameters. Methods Patient demographics, disease characteristics including current symptom status, functional status and treatment variables as well as income level of the country of residence, were extracted from survey responses. PROMIS PF-10a scores were compared across country income levels. The influence of extracted variables on reversed PROMIS PF-10a scores were investigated using negative binomial univariable- and multi-variable regression. Results A total of 1,342 RA patients were included in this analysis. In the optimised parsimonious predictive model for reversed PROMIS PF-10a, older age, female gender, disease duration, fatigue and pain levels were independently associated with worse physical function, whereas Asian ethnicity, higher overall physical health ratings, ability to carry out everyday activities, and residing in a country with an upper-middle or high-income level were independently associated with better physical function. Conclusion Our study highlights that clinical factors remain strong predictors of physical function in RA, irrespective of individual and country-level socioeconomic differences. Interestingly, high country-level income was associated with better physical function, irrespective of individual sociodemographic and clinical factors.

Prevalence and patterns of anxiety, depressive, hyperactivity, and inattention symptoms among secondary and high school students: A cross-sectional study

This study aimed to examine the prevalence of anxiety, depression, hyperactivity, and inattention symptoms among secondary school and high school students. The research specifically focused on understanding the status of these mental health symptoms in the adolescent population. This cross-sectional study involved 529 students (40.5% males, 59.5% females) aged 12--18 years who were selected via a convenience sampling method from various secondary and high schools. Four separate questionnaires were developed to measure anxiety, depression, hyperactivity, and inattention symptoms via a 4-point Likert scale. Descriptive statistics were applied to analyze the data. The findings indicated that anxiety, depression, hyperactivity, and inattention symptoms were generally low, with overall mean scores falling at the "Never" level for most symptoms. However, some symptoms, particularly inattention, were present at the "sometimes" level, suggesting occasional challenges in focus and concentration. Anxiety symptoms, such as difficulty concentrating and persistent worry, were also notable. Depressive symptoms, such as self-criticism and sadness, although less common, were observed. While severe mental health symptoms are not consistently observed, the presence of certain anxiety, depression, and inattention symptoms suggests the need for early intervention. Schools should implement mental health support programs to address these occasional symptoms, which can affect academic performance and overall well-being.

Palliative status of patients with chronic heart failure: relationship with body composition parameters, clinical and laboratory parameters

Objective: to determine the relationship between parameters body composition, clinical status, laboratory parameters and severity of painful symptoms in patients with chronic heart failure.Materials and methods: the study involved 298 patients with CHF. The body composition was assessed: the presence of sarcopenia and obesity (with the calculation of the muscle mass index IMM/BMI), functional class, left ventricular ejection fraction, markers galectin-3, hsСRP, Na-proBNP, Bartel index. A 10-point Edmont scale was used to assess the severity of painful symptoms. A factor analysis was performed, as well as a Pearson correlation analysis.Results: the study revealed 5 components: A factor of adequacy of muscle functions, a factor of systolic dysfunction, a factor of impaired functional status, a factor of functional activity, and an age factor. The conducted correlation analysis showed the presence of links between the components and the severity of painful symptoms of moderate and mild severity.Conclusion: the body composition of patients is associated with the severity of painful symptoms in patients with CHF who need palliative care. It is necessary to take into account body composition when developing algorithms for managing patients with CHF at the stage of palliative care.

Measuring Self-Efficacy for Concussion Recovery: Psychometric Characteristics of the Progressive Activities of Controlled Exertion-Self-Efficacy Scale.

Control over symptoms postconcussion is central to an active self-directed recovery process. Therefore, assessing a patient's confidence in controlling their symptoms and facilitating their concussion recovery is an important component of treatment. Previously, no measures existed to assess symptom-specific self-efficacy (SE) in pediatric concussion recovery. SE is an individual's belief or confidence in their capabilities to execute action plans necessary to perform certain behaviors. Based on this definition, we developed the Progressive Activities of Controlled Exertion-Self-Efficacy (PACE-SE) scale to measure a patient's SE related to pediatric concussion recovery-specific activities. The aim of this article is to present the psychometric characteristics (evidence of reliability, validity) of the PACE-SE scale. The 17-item PACE-SE was administered to children and adolescents, 10-18 years of age, recovering from a diagnosed concussion as part of a standard clinical evaluation. Results revealed a four-factor structure producing the following scales: Managing My Stress, Managing My Activity, Seeking Adult Assistance, and Maintaining Positive Outlook. The PACE-SE scores indicated excellent internal consistency reliability with reasonable test-retest reliability over time. Evidence for the association between recovery status and greater confidence and control over recovery-related activities as measured by the PACE-SE was supported by: (1) an inverse association with symptom status reflecting lower confidence for managing recovery with higher symptom load, (2) greater reported problems with school performance associated with lower SE, (3) positive change in SE ratings across two clinic visits associated with symptom improvement, and (4) a significant difference in SE ratings evident between recovered and nonrecovered patients. The psychometric evidence supporting the PACE-SE scale provides the clinician with a measure to understand the child/adolescent patient's self-confidence in facilitating their concussion recovery.

Abstract 4136745: How do sleep quality and heart failure symptoms impact functional status among patients with heart failure?

Background: Patients with heart failure (HF) frequently experience poor sleep quality and multiple HF symptoms, both of which are linked to diminished functional status. Poor sleep quality can manifest as prolonged latency, short duration, low efficiency, or difficulty staying asleep. HF symptoms encompass different dimensions: presence, frequency, severity, and distress of HF symptoms. Different dimensions of sleep quality and HF symptoms may uniquely influence functional status, necessitating tailored interventions, yet how individual dimensions of sleep quality and HF symptoms impact functional status remains unexplored. Research Question: how do individual dimensions of sleep quality and HF symptoms impact functional status in patients with HF? Methods: We studied 197 adults with HF (male: 66%, age: 62±11 yrs). The Pittsburgh Sleep Quality Index was used to assess seven dimensions of sleep quality: subjective sleep quality, latency, duration, efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month. Four dimensions (i.e., presence, frequency, severity, distress) of 7 HF symptoms (e.g., shortness of breath, fatigue, swelling) were assessed using the Symptom Status Questionnaire-HF. Functional status was measured using the Duke Activity Status Index. Correlations and two multiple linear regression models (1 st model: 7 dimensions of sleep quality on functional status, and 2 nd model: 4 dimensions of HF symptoms on functional status) were conducted for data analysis. Results: Worse subjective sleep quality, longer latency, more sleep disturbances, use of sleeping medications, and higher levels of daytime dysfunction were correlated with poor functional status. All four dimensions of HF symptoms were negatively correlated with functional status. In the 1 st multiple linear regression model, more sleep disturbances (B=-3.91, p =.006) and higher daytime dysfunction (B=-5.70, p &lt;.001) were predictive of poor functional status (model R 2 =0.23, p &lt;.001). In the 2 nd multiple linear regression model, only higher frequency of HF symptoms (B=-.70, p =.022) predicted poor functional status (model R 2 =0.34, p &lt;.001). Conclusion: Increased sleep disturbances, daytime dysfunction, and frequency of HF symptoms were associated with poorer functional status in patients with HF. These findings underscore the importance of developing tailored interventions to address individual sleep problems and HF symptoms to improve functional status.

Understanding Onset, Dynamic Transitions, and Associated Inequality Risk Factors for Adverse Posttraumatic Neuropsychiatric Sequelae After Trauma Exposure

ObjectiveSeveral gaps remain in the understanding of the onset, dynamic transitions, and associated risk factors of adverse posttraumatic neuropsychiatric sequelae (APNS) in the acute post‐trauma window. Based on serial assessments of symptoms from a large cohort study, we identified homogeneous statuses across multiple APNS symptom domains and investigated the dynamic transitions among these statuses during the first 2 months after trauma exposure. Furthermore, we studied how symptom onset and transitions are affected by equity‐relevant characteristics.MethodsThe analysis was based on 2557 participants enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA). APNS symptoms comprised pain, depression, sleep discontinuity, nightmares, avoidance, re‐experience, anxiety, hyperarousal, somatic symptoms, and mental fatigue. We identified the homogeneous status of APNS symptoms at baseline, 1 month, and 2 months, and explored transition probabilities among these statuses using latent transition analysis. Equity‐relevant characteristics included gender, race, education, family income, childhood trauma, and area deprivation.ResultsThree homogeneous statuses–low‐, moderate‐, and severe‐symptom–were identified. While the majority of trauma survivors with severe‐ or moderate‐symptom status maintained the same status over time, some transitioned to a less severe symptom status, particularly within the first month. Specifically, females, non‐whites, and those with higher childhood trauma were associated with a decreased likelihood of transitioning to a less severe symptom status. From one to 2 months, lower income was associated with a decreased likelihood of transitioning from moderate‐to low‐symptom status.ConclusionsThe findings can inform early intervention strategies for APNS, potentially reducing health disparities among trauma survivors.

A Cross-Sectional Study of Unstable Housing and Housing-Related Symptom Content in People With Psychosis Admitted for Inpatient Treatment: A Clinical Record Interactive Search Study.

Rates of psychosis in the homeless population are markedly higher compared to the general population. Understanding potential psychological mechanisms underpinning links between psychosis and homelessness is important for the development of effective care pathways for this highly marginalised group. This study aimed to examine the housing status of a sample of people with psychosis admitted to psychiatric inpatient hospital in one UK mental health trust. We further aimed to examine the presence and relevance of symptoms which were directly related to housing (e.g., persecutory beliefs about neighbours). A cross-sectional study was conducted using an electronic healthcare database, containing anonymised patient records (Clinical Record Interactive Search). Information on housing status, symptoms, and content of symptoms relating to housing were extracted and independently double-coded from clinical notes at the person's admission. 351 service users were in the sample, which covered discharges over a 12-month period (1st April 2021 to 31st March 2022). There was a higher proportion of individuals living without a fixed address in the sample (10%) compared to population estimates (1%-2%). Housing-related thematic content of symptoms was evident in 34% of the sample (e.g., attributing voices to neighbours, feeling under surveillance at home). The only variable significantly associated with housing status was gender, with men at higher odds of unstable housing compared to women. Individuals with concerns directly related to their housing or housing instability were no more likely to have a longer length of admission than those without housing-related concerns. A significant proportion of individuals with psychosis admitted for psychiatric inpatient treatment, experienced housing instability. For some of the sample, symptom content directly related to housing. This raises important considerations for how social needs are assessed on admission to psychiatric hospital. Further research in this area is encouraged.

Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis

Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis. To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia. Asymptomatic patients with severe aortic stenosis and myocardial fibrosis were included. The final date of follow-up was July 26, 2024. Early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management. The primary outcome was a composite of all-cause death or unplanned aortic stenosis-related hospitalization in a time-to-first-event intention-to-treat analysis. There were 9 secondary outcomes, including the components of the primary outcome and symptom status at 12 months. The trial enrolled 224 eligible patients (mean [SD] age, 73 [9] years; 63 women [28%]; mean [SD] aortic valve peak velocity of 4.3 [0.5] m/s) of the originally planned sample size of 356 patients. The primary end point occurred in 20 of 113 patients (18%) in the early intervention group and 25 of 111 patients (23%) in the guideline-directed conservative management group (hazard ratio, 0.79 [95% CI, 0.44-1.43]; P = .44; between-group difference, -4.82% [95% CI, -15.31% to 5.66%]). Of 9 prespecified secondary end points, 7 showed no significant difference. All-cause death occurred in 16 of 113 patients (14%) in the early intervention group and 14 of 111 (13%) in the guideline-directed group (hazard ratio, 1.22 [95% CI, 0.59-2.51]) and unplanned aortic stenosis hospitalization occurred in 7 of 113 patients (6%) and 19 of 111 patients (17%), respectively (hazard ratio, 0.37 [95% CI, 0.16-0.88]). Early intervention was associated with a lower 12-month rate of New York Heart Association class II-IV symptoms than guideline-directed conservative management (21 [19.7%] vs 39 [37.9%]; odds ratio, 0.37 [95% CI, 0.20-0.70]). In asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis-related hospitalization. The trial had a wide 95% CI around the primary end point, with further research needed to confirm these findings. ClinicalTrials.gov Identifier: NCT03094143.

Non-invasive imaging to guide percutaneous coronary revascularization in chronic total occlusion: a systematic review and meta-analysis

Abstract Background and aims Whether recanalization of coronary chronic total occlusions (CTO) leads to improved patient outcomes is uncertain. We set out to investigate the use of noninvasive imaging modalities to guide patient selection for percutaneous recanalization of coronary chronic total occlusions (CTO-PCI) and its association with outcomes. Methods Systematic review and meta-analysis of studies involving patients undergoing CTO-PCI to detail use of preprocedural non-invasive imaging, change in clinical endpoints and the occurrence of clinical events in these patient cohorts. PubMed and Embase, the Cochrane Database of Systematic Reviews, the PROSPERO database and the Clinical Trials Registry were searched for relevant randomized and observational studies up to May 2023. This study is registered with PROSPERO. The study primary endpoint was a composite of all-cause death and nonfatal myocardial infarction (MI), with a secondary composite endpoint of cardiovascular death, nonfatal MI and target vessel revascularization (TVR). Additional endpoints were individual components of the composite endpoints along with changes in angina burden, LV ejection fraction, ischemic burden, and infarct extent after PCI. Results Of 1264 publications retrieved, 31 studies (26 observational and 5 randomized) were finally included for a total of 7260 patients. Guidance to CTO-PCI varied greatly among included studies, with only a minority implementing routine preprocedural inducible ischemia and myocardial viability assessment. At a median of 3.1 years (range 1-5 years), the primary endpoint occurred at a rate of 3.1 events per 100 patient-years (95%CI: 2.4-3.7). When non-invasive imaging was used to guide CTO-PCI, patients with myocardial ischemia and/or viability, a reduced risk for the primary endpoint was observed (OR 0.3 95%CI 0.2-0.5) compared to CTO-PCI without evidence of myocardial ischemia and/or viability. CTO-PCI was associated with improvements in SAQ summary score, LVEF, reduction of ischemic burden, improvement in myocardial perfusion (all P-values &amp;lt; 0.01), with no change in the burden of myocardial scarring. At meta-regression analysis, a greater improvement in LVEF was observed in studies enrolling patients with lower average baseline LVEF (≤ 45%) (R2 = 63%, p &amp;lt; 0.0001). Conclusions CTO-PCI led to a significant improvement in symptom status (reduction of chest pain) and LV ejection fraction. CTO-PCI guided by the presence of ischemia and/or viability was associated with improved patient outcomes compared with CTO-PCI in the absence of ischemia and/viability, or in patients where non-invasive imaging testing was not performed. Future randomized clinical trials testing whether ischemia and viability-guided CTO-PCI improves clinical outcomes are lacking and warranted.PRISMA Flow diagramGraphical abstract

Prognostic impact of the presence and absence of angina on mortality and cardiovascular outcomes in the ISCHEMIA trial

Abstract Introduction Patients with chronic coronary syndromes (CCS) manifested by myocardial ischemia may present with typical angina or with no anginal symptoms. It is unclear whether symptom status affects prognosis in these patients. Purpose To assess whether the risk of all-cause mortality and other cardiovascular (CV) outcomes varied according to the presence or absence of angina in patients with CCS and moderate to severe myocardial ischemia in the ISCHEMIA trial. Methods The ISCHEMIA data set was obtained from the National Heart, Lung, and Blood Institute under a data use agreement. Subjects were divided into quartiles by baseline Seattle Angina Questionnaire Angina Frequency (SAQ AF) score. Quartile (Q)1 included patients with SAQ AF scores from 1-70 whereas all patients in Q4 had SAQ AF scores of 100, indicating no angina at baseline. Categorical variables were compared using the chi-squared or Fisher’s exact test. Continuous variables were compared using the student T-test or Wilcoxon rank sum test. The cumulative incidence rate of outcomes up to five years was estimated with the Kaplan-Meier method and the rate curves were compared using the log-rank test. Multivariable Cox regression models were used to estimate hazard ratios (HRs) with potential confounders from baseline characteristics, clinical history, and angiographic characteristics included. All tests were two-sided and P&amp;lt;0.05 was considered statistically significant. Results Of the 5,179 patients with CCS and at least moderate ischemia on stress testing, 1,434 were in Q1 and 1,635 were in Q4. Compared to Q1, patients in Q4 were older (66.4 (9.0) vs. 62.8 (9.6); P&amp;lt;0.001), more often male (82% vs. 73%; P&amp;lt;0.001), more often diabetic (43% vs. 38%; P=0.006) and less often current smokers (12% vs. 15%; P=0.001). The estimated glomerular filtration rate was lower in Q4 (82(22) vs. 86 (38); P=0.002). Fewer patients in Q4 had NYHA class II heart failure (37% vs. 62%) and more had Class I symptoms (63% vs. 38%) (P&amp;lt;0.001). Q4 patients had a lower ejection fraction (59% vs. 60%; P=0.002), a lower Duke jeopardy score (4.9(3.5) vs. 5.5 (3.3); P&amp;lt;0.001), less often had severe ischemia (47% vs. 56%), and more often had moderate ischemia (40% vs. 32 %) (P&amp;lt;0.001). The cumulative 5-year event rates for Q4 vs. Q1 were: all-cause death, 10.6% and 6.4% (P=0.002); CV death/MI, 16.3% vs. 13.7% (P=0.97); CV death, 7% vs. 3.7% (P=0.009); MI, 11.4% vs. 11.4% (P=0.2). On multivariable Cox regression, angina quartile (Q4 vs. Q1) was not independently associated with all-cause death (HR 1.34, 95% CI: 0.76-2.31; P=0.33), CV death/MI (HR 0.77, 95% CI: 0.52-1.14; P=0.19), CV death (HR 1.10, 95% CI: 0.50-2.43; P=0.82), or MI (HR 0.70; 95% CI: 0.45-1.08; P=0.11). Conclusion In the ISCHEMIA trial, patients with CCS and moderate to severe myocardial ischemia are at elevated risk for all-cause mortality and other major CV outcomes. This risk is not modified by the presence or absence of angina.

Peak VO2 is associated with cardiac functional response and long-term survival in patients with heart failure and atrial fibrillation undergoing catheter ablation

Abstract Background Contemporary guidelines recommend Catheter Ablation (CA) in patients with persistent Atrial Fibrillation (AF) with Heart Failure with reduced ejection fraction (HFrEF). It is challenging to prospectively predict who will respond. We have previously described the long-term survival outcomes of patients in this cohort.(1) However, the clinical characteristics associated with HF response and long-term clinical outcomes have not been reported. Objective To evaluate the association of HF parameters with cardiac functional response to CA and long-term survival after CA. Methods Post-hoc, long-term follow-up of mortality was undertaken in patients enrolled in the CAMTAF and ARC-HF RCTs. Both studies enrolled patients with persistent AF and HFrEF between 2005 and 2012 and randomised to first-time CA or medical therapy alone. Left ventricular ejection fraction (LVEF) and peak VO2 were measured in both studies at baseline and 12-month follow-up. The Universal Definition of HF response (LVEF improves by &amp;gt;10% points or to an LVEF &amp;gt;50%) was used.(2,3) Multi-variate logistic regression was used to determine features associated with HF response and Cox proportional hazards modelling for survival. Results 102 patients underwent randomisation with 52 assigned to CA. The mean age was 60.2 ±10.7 years with 93 (91.2%) male. The mean Baseline LVEF was 31 ±11% and peak VO2 was 1815 ±642mlmin-1. Baseline LVEF did not correlate significantly with Minnesota Living with Heart Failure (MLWHF) score (r=-0.11, p=0.29) whereas baseline peak VO2 did (r=-0.28, p&amp;lt;0.01). In patients randomised to CA, the median (IQR) improvement in LVEF was +8.4% (0, 15%). 22/52 (42.3%) patients were classified as Responders based on the Universal Criteria. Responders were younger (54.7 ±10.6 years vs 61.8 ±11.4, p=0.03) and had a higher mean HR on baseline Holter monitoring (89 ±14bpm vs 79 ±11bpm p&amp;lt;0.01) than non-responders. There was no significant difference in sex, baseline MLWHF scores, BNP levels or LVEF between groups (28±9% vs 31 ±9%, p=0.19). Responders had a significantly higher peak VO2 at baseline than Non-Responders (1972 ±668mlmin-1 vs 1556 ±580mlmin-1, p=0.03). On multivariate analysis, mean heart rate on Holter monitoring and peak VO2 were significantly associated with Responder status post-ablation. (Table 1a) During a median follow-up of 7.8 (3.9 –9.9) years, 34 (33.3%) patients died, including 17 (32.7%) patients in the CA arm. On univariate analysis, baseline peak VO2 was significantly greater of survivors at 5 years (1867 ±624 mlmin-1 vs 1259 ±497 mlmin-1, p&amp;lt;0.01). On multivariate Cox regression analysis, the peak VO2 at baseline was the only significant predictor of survival (Table 1b). Conclusion Peak VO2 at baseline was associated with baseline symptom status, the short-term LVEF response to CA and long-term survival and may be a useful stratification tool to aid patient selection for CA.1a. Regression for 6-month LVEF response1b. Regression for long-term mortality

Considerations for drug trials in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition with potentially serious manifestations. Management has traditionally comprised therapies to palliate symptoms and implantable cardioverter-defibrillators to prevent sudden cardiac death. The need for disease-modifying therapies has been recognized for decades. More recently, an increasing number of novel and repurposed therapies hypothesized to target HCM disease pathways have been evaluated, culminating in the recent regulatory approval of mavacamten, a novel oral myosin inhibitor. HCM poses several unique challenges for clinical trials, which are important to recognize when designing trials and interpreting findings. This manuscript discusses the key considerations in the context of recent and ongoing randomized trials, including the roles of genotype, phenotype and symptom status in patient selection, the evidence base for clinical and mechanistic outcome measurements, trial duration and sample size.

Influenza Vaccine Effectiveness Against Illness and Asymptomatic Infection in 2022-2023: A Prospective Cohort Study.

Previous estimates of vaccine effectiveness (VE) against asymptomatic influenza virus infection based on seroconversion have varied widely and may be biased. We estimated 2022-2023 influenza VE against illness and asymptomatic infection in a prospective cohort. In the HEROES-RECOVER cohort, adults at increased occupational risk of influenza exposure across 7 US sites provided weekly symptom reports and nasal swabs for reverse transcription-polymerase chain reaction (RT-PCR) influenza testing. Laboratory-confirmed influenza virus infections were classified as symptomatic (≥1 symptom) or asymptomatic during the week of testing. Participants reported demographic information and vaccination through surveys; most sites verified vaccination through medical record and immunization registry review. Person-time was calculated as days from the site-specific influenza season start (September-October 2022) through date of infection, study withdrawal, or season end (May 2023). We compared influenza incidence among vaccinated versus unvaccinated participants overall, by symptom status, and by influenza A subtype, using Cox proportional hazards regression adjusted for site and occupation. We estimated VE as (1 - adjusted hazard ratio) × 100%. In total, 269 of 3785 (7.1%) participants had laboratory-confirmed influenza, including 263 (98%) influenza A virus infections and 201 (75%) symptomatic illnesses. Incidence of laboratory-confirmed influenza illness among vaccinated versus unvaccinated participants was 23.7 and 33.2 episodes per 100 000 person-days, respectively (VE: 38%; 95% CI: 15%-55%). Incidence of asymptomatic influenza virus infection was 8.0 versus 11.6 per 100 000 (VE: 13%; 95% CI: -47%, 49%). Vaccination reduced incidence of symptomatic but not asymptomatic influenza virus infection, suggesting that influenza vaccination attenuates progression from infection to illness.

Major clinical outcomes in symptomatic vs. asymptomatic atrial fibrillation: a meta-analysis.

Current guidelines suggest that asymptomatic atrial fibrillation (AF) is independently associated with increased risks of stroke and mortality compared with symptomatic AF. Considering that recent investigations have provided conflicting results, the present study aimed to evaluate the association between symptom status and clinical outcomes in patients with AF. Medline, Cochrane Library, and Scopus were searched until 25 March 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses. Thirty-six studies (217 850 participants) were included. Based on the frequentist analysis, symptomatic individuals had no significant difference in the risk of all-cause mortality [hazard ratio (HR) .97, 95% confidence interval (CI) .80-1.17], cardiovascular mortality (HR 1.04, 95% CI .72-1.49), thromboembolism (HR 1.06, 95% CI .87-1.28), stroke (HR 1.06, 95% CI .84-1.34), hospitalization (HR 1.34, 95% CI .89-2.02), and myocardial infarction (HR .98, 95% CI .70-1.36), compared to the asymptomatic group. Symptomatic patients had a 33% increased risk of new-onset heart failure (HR 1.33, 95% CI 1.19-1.49) and a 30% lower risk of progression to permanent AF (HR .70, 95% CI .54-.89). The Bayesian analysis yielded comparable results, yet the association between symptom status and new-onset heart failure was not significant (HR 1.27, 95% credible interval .76-1.93; Bayes factor = 1.2). Symptomatic patients had higher odds of receiving antiarrhythmic drugs (odds ratio [OR] 1.64, 95% CI 1.33-2.03) and ablation therapy (OR 1.47, 95% CI 1.06-2.05) compared to asymptomatic cases. The risk of major clinical outcomes did not differ between individuals with and without AF-related symptoms. Asymptomatic patients had a greater hazard of progression to permanent AF.