For ibrutinib-related atrial fibrillation (IRAF), guidelines for anticoagulation do not exist. We sought to describe stroke, bleeding, and anticoagulation rates among patients with IRAF. We performed ...a single-center retrospective review of 168 patients treated with ibrutinib followed from 2013 to 2022. Over a median follow-up of 6.4 years, 44 (26.0%) patients developed IRAF of which 38 (86.4%) had a CHA2DS2-VASc ≥2 and 7 (15.9%) had a HAS-BLED ≥3. Anticoagulation was initiated in 20 (45.5%) without a clear pattern in scores, risk factors, or cumulative dose, besides having another reason for anticoagulation. Few patients with IRAF developed non-hemorrhagic CVA (
= 3, 6.8%) or significant bleeding (
= 3, 6.8%). Among those with each adverse outcome, 2 in each group were anticoagulated and all were older than 65 years old. In conclusion, decisions for anticoagulation vary widely and patients who are elderly or with HTN may be most at risk for CVA or significant bleed.
Relative apical longitudinal sparing (RALS) on echocardiography has become an increasingly used tool to evaluate for cardiac amyloidosis (CA), but the predictive value of this finding remains ...unclear. This is a retrospective analysis at a single tertiary care center across 3 years. Patients were included if they had RALS, defined by strain ratio ≥2.0 on echocardiography, and sufficient laboratory, imaging, or histopathologic workup to indicate their likelihood of CA. Patients were stratified by their likelihood of CA, and contributions of other co-morbidities previously shown to be associated with RALS. Of the 220 patients who had adequate workup to determine their likelihood of having CA, 50 (22.7%) had confirmed CA, 35 (15.9%) had suspicious CA, 83 (37.7%) had unlikely CA, and 52 (23.7%) had ruled-out CA. The positive predictive value of RALS for CA was 38.6% for confirmed or suspicious CA. The remaining 61.4% of patients who were unlikely or ruled out for CA had other co-morbidities such as hypertension, chronic kidney disease, malignancy, or aortic stenosis, 17.0% of this group had none of these co-morbidities. In our tertiary care cohort of patients with RALS pattern on echocardiography, we found that fewer than half of patients with RALS were likely to have CA. Given the increasing use of strain technology, further studies are warranted to determine the optimal strategy for assessing CA in a patient with RALS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The US food supply is dominated by highly-processed packaged food and beverage products that are high in energy, saturated fat, sugar, and salt. We report results of a cross-sectional assessment of ...the 2018 US packaged food and beverage supply by nutritional composition and indicators of healthfulness and level of processing. Data were obtained through Label Insight's Open Data database, which represents >80% of all food and beverage products sold in the US over the past three years. Healthfulness and the level of processing, measured by the Health Star Rating (HSR) system and the NOVA classification framework, respectively, were compared across product categories and leading manufacturers. Among 230,156 food and beverage products, the mean HSR was 2.7 (standard deviation (SD) 1.4) from a possible maximum rating of 5.0, and 71% of products were classified as ultra-processed. Healthfulness and level of processing varied substantially by category (range: HSR 1.1-3.9; 0-100% ultra-processed) and manufacturer (range: HSR 0.9-4.6; 26-100% ultra-processed). The US packaged food and beverage supply is large, heterogeneous, highly processed, and generally unhealthy. The wide variability in healthfulness and level of processing demonstrates that opportunities exist, through reformulation or replacement, for large-scale improvements to the healthfulness of the US packaged food and beverage supply.
Guideline recommendations for mechanical or bioprosthetic (BP) valve for MVR by age remains controversial. We sought to determine bovine pericardial valve durability by age, and risk of ...reintervention.
This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent BP MVR from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration (SVD) were compared by age decile.
Of 1544 available patients, mean age was 66±13 years and 652 (42%) were < 65 years old. Indications for MVR were: MR>2+ 53% n=813; mitral stenosis 44% n=650; endocarditis 18% n=277 and reoperation in 39% n=602. Concomitant procedures were AVR 28% n=426; Tricuspid valve 36% n=550; CAB 19% n=290. Thirty-day mortality was 5.4%. In follow-up (clinical: median IQR 75 25-129 months) reoperation for endocarditis, and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of MV reintervention for SVD among all patients was 6.2% at 10 years 9.0% at 12 years with no statistical difference in SVD among patients between the ages of 40 and 70 years (p=0.1). Among 90 patients with MV reintervention, 30-day mortality after reintervention was 4.7% (n=2) for 43 MViV and 6.4% (n=3) among 47 reoperation patients.
Bovine pericardial MVR is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical MVR may be of benefit to patients. These insights may provide data needed to revise the current guidelines.
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Summary
Wolbachia pipientis, a widespread vertically transmitted intracellular bacterium, provides a tool for insect control through manipulation of host–microbe interactions. We report proteomic ...characterization of wStr, a Wolbachia strain associated with a strong cytoplasmic incompatibility phenotype in its native host, Laodelphax striatellus. In the Aedes albopictus C/wStr1 mosquito cell line, wStr maintains a robust, persistent infection. MS/MS analyses of gel bands revealed a protein ‘footprint’ dominated by Wolbachia‐encoded chaperones, stress response and cell membrane proteins, including the surface antigen WspA, a peptidoglycan‐associated lipoprotein and a 73 kDa outer membrane protein. Functional classifications and estimated abundance levels of 790 identified proteins suggested that expression, stabilization and secretion of proteins predominate over bacterial genome replication and cell division. High relative abundances of cysteine desulphurase, serine/glycine hydroxymethyl transferase, and components of the α‐ketoglutarate dehydrogenase complex in conjunction with above average abundances of glutamate dehydrogenase and proline utilization protein A support Wolbachia genome‐based predictions for amino acid metabolism as a primary energy source. wStr expresses 15 Vir proteins of a Type IV secretion system and its transcriptional regulator. Proteomic characterization of a robust insect‐associated Wolbachia strain provides baseline information that will inform further development of in vitro protocols for Wolbachia manipulation.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
A 21-point risk score for heart failure (HF) has been developed for patients with acute myeloid leukemia (AML), stratifying patients into three groups: low, moderate, and high-risk. In this study, ...193 patients with AML treated with anthracycline-based therapy were stratified using the risk score, and its prognostic utility for HF events and all-cause mortality at one year of follow-up were evaluated. HF occurred in 18% (34/193) of anthracycline-treated patients. Global longitudinal strain (GLS) was more negative among patients without HF events (−19 ± 3 vs. −17 ± 4%). One year incidence of HF was increased in the higher risk groups: 12% of low-risk, 24% of moderate-risk, and 50% of high-risk (p < 0.001). However, a higher risk score was not associated with an increased risk of all-cause mortality. This study provides external validation of a 21-point risk score for HF events but not all-cause mortality at one year in patients with AML.
Background
Cardiovascular events, including heart failure and arrhythmias, following chimeric antigen receptor (CAR) T‐cell therapy are increasingly recognized. Although global longitudinal strain ...(GLS) has demonstrated prognostic utility for other cancer therapy‐related cardiac dysfunction, less is known regarding the association of GLS with adverse cardiac events following CAR T‐cell therapy.
Objectives
To determine the association of baseline GLS with adverse cardiovascular events in adults receiving CAR‐T cell therapy.
Methods
Patients who had an echocardiogram within 6 months prior to receiving CAR T‐cell therapy were retrospectively identified. Clinical data and cardiac events were collected via chart review. Echocardiograms were analyzed offline for GLS, left ventricular ejection fraction, and Doppler parameters. Multivariable logistic regression was used to determine the association between adverse cardiovascular events and echocardiographic parameters.
Results
Among 75 CAR T‐cell therapy patients (mean age 63.9, 34.7% female), nine patients (12%) experienced cardiac events (CEs) including cardiovascular death, new/worsening heart failure, and new/worsening arrhythmia within 1 year of treatment. In univariable models, higher baseline GLS (OR 0.78 0.63, 0.96, p = .021) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.40 1.08, 1.81, p = .012) was associated with a higher risk of CE. After adjusting for age and LDH, higher baseline GLS (OR 0.65 0.48–0.88, p = <.01) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.56 1.06, 2.29, p = .024) was associated with a higher risk of CE.
Conclusion
Lower GLS and higher mitral E/e' on a baseline echocardiogram were associated with higher risk for CEs in patients receiving CAR T‐cell therapy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Nigeria faces an increase in the burden of non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), leading to an estimated 29% of all deaths in the country. Nigeria has an ...estimated hypertension prevalence ranging from 25 to 40% of her adult population. Despite this high burden, awareness (14-30%), treatment (< 20%), and control (9%) rates of hypertension are low in Nigeria. Against this backdrop, we sought to perform capacity and readiness assessments of public Primary Healthcare Centers (PHCs) to inform Nigeria's system-level hypertension control program's implementation and adaptation strategies.
The study employed a multi-stage sampling to select 60 from the 243 PHCs in the Federal Capital Territory (FCT) of Nigeria. The World Health Organization (WHO) Service Availability and Readiness Assessment was adapted to focus on hypertension diagnosis and treatment and was administered to PHC staff from May 2019 - October 2019. Indicator scores for general and cardiovascular service readiness were calculated based on the proportion of sites with available amenities, equipment, diagnostic tests, and medications.
Median (interquartile range IQR) number of full-time staff was 5 (3-8), and were predominantly community health extension workers (median = 3 IQR 2-5). Few sites (n = 8; 15%) received cardiovascular disease diagnosis and management training within the previous 2 years, though most had sufficient capacity for screening (n = 58; 97%), diagnosis (n = 56; 93%), and confirmation (n = 50; 83%) of hypertension. Few PHCs had guidelines (n = 7; 13%), treatment algorithms (n = 3; 5%), or information materials (n = 1; 2%) for hypertension. Most sites (n = 55; 92%) had one or more functional blood pressure apparatus. All sites relied on paper records, and few had a functional computer (n = 10; 17%) or access to internet (n = 5; 8%). Despite inclusion on Nigeria's essential medicines list, 35 (59%) PHCs had zero 30-day treatment regimens of any blood pressure-lowering medications in stock.
This first systematic assessment of capacity and readiness for a system-level hypertension control program within the FCT of Nigeria demonstrated implementation feasibility based on the workforce, equipment, and paper-based information systems, but a critical need for essential medicine supply strengthening, health-worker training, and protocols for hypertension treatment and control in Nigeria.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to ...identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension.
We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence.
From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41–67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested.
This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study.
CRD42021291368.
Protocol registration: PROSPERO 2021 CRD42021291368.
Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368
•This systematic review leveraged a hermeneutic methodology.•Identify and quantify interventions and contextual factors to improve retention.•The hermeneutic methods allowed for the investigation and mapping of retention.•This review presents the most comprehensive findings on retention in hypertension.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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