•Risk scores predicting mortality in hospitalized COVID-19 patients were validated.•Although results did not differ greatly, the 4C mortality score performed best.•Updating the model to the local ...population might be necessary before use.
The coronavirus disease 2019 (COVID-19) presents an urgent threat to global health. Prediction models that accurately estimate mortality risk in hospitalized patients could assist medical staff in treatment and allocating limited resources.
To externally validate two promising previously published risk scores that predict in-hospital mortality among hospitalized COVID-19 patients.
Two prospective cohorts were available; a cohort of 1028 patients admitted to one of nine hospitals in Lombardy, Italy (the Lombardy cohort) and a cohort of 432 patients admitted to a hospital in Leiden, the Netherlands (the Leiden cohort). The endpoint was in-hospital mortality. All patients were adult and tested COVID-19 PCR-positive. Model discrimination and calibration were assessed.
The C-statistic of the 4C mortality score was good in the Lombardy cohort (0.85, 95CI: 0.82−0.89) and in the Leiden cohort (0.87, 95CI: 0.80−0.94). Model calibration was acceptable in the Lombardy cohort but poor in the Leiden cohort due to the model systematically overpredicting the mortality risk for all patients. The C-statistic of the CURB-65 score was good in the Lombardy cohort (0.80, 95CI: 0.75−0.85) and in the Leiden cohort (0.82, 95CI: 0.76−0.88). The mortality rate in the CURB-65 development cohort was much lower than the mortality rate in the Lombardy cohort. A similar but less pronounced trend was found for patients in the Leiden cohort.
Although performances did not differ greatly, the 4C mortality score showed the best performance. However, because of quickly changing circumstances, model recalibration may be necessary before using the 4C mortality score.
The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a ...pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced "endothelitis" triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. "Overlapping commonalities" between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a "syndemic." Another challenging issue is the persistence of the symptoms, the so-called "long COVID" whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.
Aim
we sought to test the inter‐center reproducibility of 16 echo laboratories involved in the EACVI‐Afib Echo Europe.
Methods
This was done on a dedicated setting of 10 patients with sinus rhythm ...(SR) and 10 with persistent atrial fibrillation (AF), collected by the Principal Investigator. Images and loops of echo‐exams were stored and made available for labs. The tested measurements included main echo‐Doppler parameters, global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS).
Results
Single measures interclass correlation coefficients (ICCs) of left ventricular mass and ejection fraction were suboptimal in both patients with SR and AF. Among diastolic parameters, ICCs of deceleration time were poor, in particular in AF (=.50). ICCs of left atrial size and function, besides optimal in AF, showed an acceptable despite moderate concordance in SR. ICC of GLS was .81 and .78 in SR and AF respectively. ICCs of PALS were suitable but lower in 4‐chamber than in 2‐chamber view. By depicting the boxplot of the 16 laboratories, GLS distribution was completely homogeneous in SR, whereas GLS of AF and PALS of both SR and AF presented a limited number of outliers. GLS mean ± SE of the 16 labs was 19.7 ± .36 (95% CI: 18.8‐20.4) in SR and 16.5 ± .29 (95% CI: 15.9‐17.1) in AF, whereas PALS mean ± SE was 43.8 ± .70 (95% CI: 42.3‐45.3) and 10.2 ± .32 (95% CI: 9.5‐10.9) respectively.
Conclusion
While the utilization of some standard‐echo variables should be discouraged in registries, the application of GLS and PALS could be largely promoted because their superior reproducibility, even in AF.
In cancer, a patient is considered a survivor from the time of initial diagnosis until the end of life. With improvements in early diagnosis and treatment, the number of cancer survivors (CS) has ...grown considerably and includes: (1) Patients cured and free from cancer who may be at risk of late-onset cancer therapy-related cardiovascular toxicity (CTR-CVT); (2) Patients with long-term control of not-curable cancers in whom CTR-CVT may need to be addressed. This paper highlights the importance of the cancer care continuum, of a patient-centered approach and of a prevention-oriented policy. The ultimate goal is a personalized care of CS, achievable only through a multidisciplinary-guided survivorship care plan, one that replaces the fragmented management of current healthcare systems. Collaboration between oncologists and cardiologists is the pillar of a framework in which primary care providers and other specialists must be engaged and in which familial, social and environmental factors are also taken into account.
Background
Increased Left Ventricular Mass Index (LVMI) is a well known risk factor for cardiac morbidity and mortality. Furthermore, it is widely recognized that clinical evolution and progression ...of established CV diseases are related to a range of psychological characteristics, which may partially explain the spread and recurrence of these diseases. Little is known about LVMI and its association with psychological characteristics in arterial Hypertension (HT) patients. The aim of the current cross- sectional study was to evaluate the association between psychological characteristics and LVMI in a cohort of hypertensive patients.
Table 1
Changes in measure carotid properties with 3.5-year follow-up.
n = 147
ΔcPWV m/s
ΔRWT −
ΔYoung’s-modulus MPa
Mean ± sd
p
Mean ± sd
p
Mean ± sd
p
DecreasedDBP (n = 53)
−0.1 ± 1.4
0.72
0.00 ± 0.04
0.38
−0.01 ± 0.32
0.87
ConstantDBP (n = 67)
+0.6* ± 1.4
<0.001
0.00 ± 0.04
0.18
+0.10* ± 0.26
<0.001
IncreasedDBP (n = 27)
+0.5* ± 1.5
0.029
−0.02*,** ± 0.04
0.002
+0.19*± 0.35
<0.001
Δs calculated as follow-up — baseline. *: p < 0.05 compared to decreasedDBP. **: p < 0.05 compared to constantDBP.
The bold indicates that there is a statistically significant difference between follow-up and baseline.
Methods
A total of 244 outpatients (age 18–80 years) followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential hypertension were recruited. Anamnestic data, clinical BP, and laboratory data and LVMI were evaluated. Patients were asked to complete a battery of psychological questionnaires under the guidance of a psychologist.
Results
At T0 the mean age was 55.9 ± 10.1years, SBP and DBP were 135.6 ± 17.7 and 82.5 ± 9.1 mmHg and PWV was 8.6 ± 2.1m/s. The multivariate stepwise linear regression analysis showed that sex (beta = 0.252, p < 0.001), age (beta = 0.135, p < 0.037), mean BP (beta = 0.178, p = 0.003), family history of CV disease (beta = 0.129, p = 0.027), and Type-A personality (beta = 0.148, p = 0.014) were significantly and independently associated with LVMI.
Conclusion
Among psychological factors, higher levels of Type-A personality is related to higher LVMI, while Type-D personality, anxiety, depression and stress are not associated.
Aortic stenosis (AS) is more than only a degenerative disease, it could be also an atherosclerotic-like process involving the valve instead of the vessels. Little is known about the relation of ...arterial stiffness and AS.
We sought to determine wether pulse wave velocity (PWV), is related to AS severity and to the procedures response, both as surgical aortic-valve-replacement (AVR) and trascatheter-aortic-valve-implantation (TAVI).
30 patients with severe AS were treated (15 AVR, 15 TAVI). Before the procedures (t0) and after 1 week (t1) echocardiography and PWV were evaluated.
On the whole population, subjects with higher PWV showed higher transvalvular pressure gradient at baseline (mean: 56.5 ± 15.1 vs 45.4 ± 9.5; peak: 93.3 ± 26.4 vs 73.3 ± 14.9, p = 0.02) and, a significantly greater response to the procedures (mean: -42.9 ± 17.2 vs -27.9 ± 10.1, peak: -68.7 ± 29.2 vs -42.8 ± 16.4, p = 0.02). When the two different procedures groups were separated, data were confirmed only in the TAVI subgroup.
In patients undergoing procedures for AS, PWV is correlated with transvalvular gradient and, in TAVI subjects, is able to predict the echocardiographic response. Baseline evaluation of PWV in patients candidates to TAVI can help the selection of subjects, even if larger and longer studies are needed before definitive conclusion can be drawn.
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