Left ventricular dysfunction is characterized by systolic and diastolic parameters, leading to heart failure (HF) with reduced or preserved ejection fraction (EF), respectively. The goal of this ...study is to examine the impact of left ventricular systolic and diastolic dysfunction (DD) on patient outcomes.
Two cohorts were used in this analysis: Cohort A included 136 455 patients with EF ≥50%, stratified by the presence and grade of DD. Cohort B included 16 850 patients with EF <50%, stratified by EF quartiles. Patients were followed to the end points of all-cause death and cardiovascular, HF, or cardiac arrest hospitalizations. Over a median follow-up of 3.42 years, 23 946 (16%) patients died and 31 113 (20%), 13 305 (9%), and 1269 (1%) were hospitalized for cardiovascular, HF, or cardiac arrest causes, respectively. With adjustment for comorbidities, the risk of all-cause mortality and of cardiovascular and HF hospitalizations increased steadily with increasing grade of DD in patients with normal EF, and even more so in patients with worsening EF. The risk of hospitalization for cardiac arrest in patients with grade III DD, however, was comparable to that of patients with EF <25% (hazard ratio, 1.00 95% CI, 0.98-1.01) and worse than that of patients in better EF quartiles.
Although systolic dysfunction is associated with a greater risk of overall death and HF hospitalizations than DD, the risk of cardiac arrest in patients with grade II and III DD is comparable to that of patients with moderate and severe systolic dysfunction, respectively. Future studies are needed to examine treatment strategies than can improve these outcomes.
Adults with congenital heart disease (CHD) may be at increased risk of acquired cardiovascular disease (CVD). Understanding the prevalence of CV risk factors (CVRF) in this population is an important ...step in developing strategies to mitigate long-term risk.
The Oregon All Payer All Claims database for the years 2010–2017 was queried for adults with CHD International Classification of Diseases (ICD) codes. The prevalence of CVRF was measured, and we then evaluated the association with patient characteristics.
There were 13,896 individuals with CHD. 72.8% (99% CI: 71.8–73.7) had at least one RF and 52.3% (99% CI: 51.2–53.4) had ≥2 RF. The prevalence of ≥1 RF increased with age (18–24: 39.6% (99% CI: 37.0–42.1) vs. 93.6% (99% CI: 92.6–94.6) in those 55–65). Hypertension (aOR 1.49 (99% CI: 1.36–1.63)), diabetes (aOR 1.24 (99% CI: 1.13–1.36)), sleep apnea (aOR 1.40 (99% CI 1.26–1.55)) and kidney disease (aOR 1.33 (99% CI:1.14–1.54)) were more prevalent in moderate-complex as opposed to simple CHD. When compared with a matched non-CHD population, there was higher prevalence of CVRF in ACHD (≥1 RF: 76.1 vs. 64.1%, OR 1.79 (99% CI: 1.69–1.89); ≥2 RF: 52.6 vs. 36.5%, OR 1.92 (99% CI: 1.83–2.03).
To our knowledge, this is the first comprehensive attempt to measure both traditional and non-traditional CVRF in US adults with CHD. We show that CVRF are common even in young adults. Given the additive effect of acquired CVD on CHD, addressing RF should be an important priority for in ACHD.
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) is a multiorgan syndrome with rare and heterogenous cardiac manifestations. We present the case of a man ...with pericardial effusion complicated by cardiac tamponade, new onset atrial fibrillation, and high-degree atrioventricular block leading to a diagnosis of POEMS syndrome. (Level of Difficulty: Advanced.)
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Abstract only Introduction: Previous studies examining the prevalence of cardiovascular risk factors in adults with congenital heart disease (CHD) were mainly based on single center data or ...non-United States (US) populations. Adults with CHD may be at increased risk of acquired cardiovascular disease (CVD) for a variety of reasons. Understanding the prevalence of non-traditional and traditional cardiovascular risk factors in this population is an important first step in developing strategies to mitigate long-term risk. Methods: The Oregon All Payer All Claims database for the years 2010-2017 was queried for adults 18 to 65 years of age with ICD codes consistent with CHD. CVD risk factors were identified using ICD-9 or ICD-10 codes. The prevalence of risk factors in any year were measured and averaged over the 7 year period. Results: 13,896 individuals with ICD codes consistent with CHD were identified ( Table 1 ). 53.2% had at least one risk factor for acquired CVD and 31.1% had ≥ 2 risk factors. The prevalence of ≥ 1 risk factor increased with age (18-24: 19% vs. 77% in those 55-65). The most common risk factor was hypertension (31.7%). Non-traditional risk factors were uncommon (hypertensive disorder of pregnancy: 1.5%, rheumatoid arthritis: 1.5%, lupus: 1.1%, HIV: 0.28%). Risk factors were more prevalent in men than women and in rural-dwelling individuals as compared to urban-dwelling individuals. Conclusions: To our knowledge, this is the first comprehensive, population-level attempt to measure both traditional and non-traditional cardiovascular risk factors in adults with CHD in the US. Our data shows that the prevalence of one or more traditional cardiovascular risk factors is high even in the young, and that men and rural-dwelling individuals are at increased risk. Given the potentially additive effect of acquired CVD on CHD with respect to adverse cardiovascular events, identifying and addressing risk factors should be an important priority for adult CHD providers and patients.
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Background:
Myeloid sarcomas (MS) are rare extramedullary tumors composed of mature or immature myeloid cells. The heart is an uncommon site for this neoplasm.
Case Presentation:
A ...68-year-old woman with a remote history of acute myeloid leukemia (AML) and allogeneic stem cell transplant presented with dyspnea. Her oxygen saturation was 70% on room air. Transthoracic echocardiography (TTE) revealed a nonhomogeneous intrapericardial mass measuring 6.3 cm by 10.0 cm, invading the right atrium and compressing the right ventricle (Figure 1). Due to persistent hypoxia, additional investigation with agitated saline contrast revealed a right-to-left intra-cardiac shunt. Cardiac magnetic resonance imaging showed invasion of the right and left ventricles, extension into the superior vena cava, and encasement of the right coronary artery. Due to worsening hypoxemia, vasopressin infusion and inhaled epoprostenol were initiated to reduce intracardiac shunting. Direct cardiac mass biopsy was considered prohibitive risk, however, a pericardiocentesis allowed for cytologic analysis of pericardial fluid which revealed atypical white blood cells, and subsequent flow cytometry indicated an aberrant myeloid population with monocytic features consistent with MS. She initiated chemotherapy with decitabine and low dose cytarabine. On day 6 of chemotherapy, she started external beam radiation therapy. A repeat TTE on day 10 of therapy showed a marked reduction in tumor size and intracardiac shunting.
Discussion:
MS can manifest before the development of bone marrow disease, following treatment for bone marrow disease, as relapse or progression of previous myelodysplastic or myeloproliferative neoplasms. With approximately fifty cases reported in the literature, most achieved temporary remission. Our approach to management included chemotherapy with decitabine and cytarabine and subsequent external-beam radiotherapy.
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Introduction:
Previous studies have examined the association of diastolic dysfunction (DD) with cardiovascular (CV) outcomes. Understanding how clinical outcomes for those with a normal ...ejection fraction (EF) and DD compared to those with reduced EF is important in mitigating CV risk and optimizing management.
Methods:
153,305 patients with echocardiograms performed at our institution between 2009 and 2022 were included in this analysis and divided into 2 cohorts: A) Normal EF patients (n=136,455) who were further stratified by grade of DD; and B) low EF (EF<50%, n=16,850) patients who were further stratified by EF into four groups. Patients were followed for CV hospitalization or death.
Results:
Over a median follow up of 3.42 years, 23,946 (16%) patients died. There were 31,113 (20%), 13,305 (9%), and 1,269 (1%) hospitalizations for any CV diagnosis, heart failure (HF), or cardiac arrest (CA), respectively. After adjustment for age, CAD, HF, DM, hypertension, AF and CKD, the risk of all-cause mortality and of CV or HF hospitalizations increased steadily with increasing grade of DD in patients with normal EF (Table). The same was observed in cohort B with worsening EF, to greater extent than in patients with preserved EF (Table). The risk of hospitalization for CA in patients with grade III DD, however, was comparable to that of patients with an EF <25% (HR=0.97, 95% CI 0.58-1.62, p=0.90) and worse than patients in better EF quartiles (p<0.001). Patients with grade II DD had a CA hospitalization risk comparable to those with EF between 36-40% (HR=1.11, 95% CI 0.79-1.57, p=0.54).
Conclusions:
Although systolic dysfunction is associated with worse overall death and HF hospitalizations than DD, the risk of CA in patients with grade II and III DD is comparable to that of patients with moderate and severe systolic dysfunction, respectively. Future studies are needed to examine the mechanisms of CA in DD, and optimal treatment strategies for these patients.
A 44-year-old man presented to the ED with acute massive hemoptysis and hypoxia. His history was notable for 1 year of progressively worsening shortness of breath at both rest and with exertion. He ...denied chest discomfort and endorsed near syncope while driving in recent months. He recently had been treated with antibiotics for two episodes of presumed pneumonia, based on right lower lobe opacification on chest radiography.
Risk of Cardiovascular Events After COVID-19 Tereshchenko, Larisa G.; Bishop, Adam; Fisher-Campbell, Nora ...
The American journal of cardiology,
09/2022, Letnik:
179
Journal Article
Recenzirano
Odprti dostop
We aimed to determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular (CV) events and all-cause mortality. We conducted a retrospective ...double cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection (COVID-19+ cohort) and its documented absence (COVID-19− cohort). The study investigators drew a simple random sample of records from all patients under the Oregon Health & Science University Healthcare (n = 65,585), with available COVID-19 test results, performed March 1, 2020 to September 13, 2020. Exclusion criteria were age <18 years and no established Oregon Health & Science University care. The primary outcome was a composite of CV morbidity and mortality. All-cause mortality was the secondary outcome. The study population included 1,355 patients (mean age 48.7 ± 20.5 years; 770 women 57%, 977 White non-Hispanic 72%; 1,072 ensured 79%; 563 with CV disease history 42%). During a median 6 months at risk, the primary composite outcome was observed in 38 of 319 patients who were COVID-19+ (12%) and 65 of 1,036 patients who were COVID-19− (6%). In the Cox regression, adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk for primary composite outcome (hazard ratio 1.71, 95% confidence interval 1.06 to 2.78, p = 0.029). Inverse probability-weighted estimation, conditioned for 31 covariates, showed that for every patient who was COVID-19+, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19−: average treatment effect on the treated −65.5 (95% confidence interval −125.4 to −5.61) days, p = 0.032. In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period.
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