Search

Introduction: Left bundle branch area pacing is an alternative to biventricular pacing. In this study, we aim to summarize the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP). Objectives: The study summarizes the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP). Background: Cardiac resynchronization therapy (CRT) reduced mortality and hospitalizations in heart failure (HF) patients with a left ventricular ejection fraction (LVEF) ≤ 35% and concomitant LBBB. Recently LBBAP has been studied as a more physiological alternative to achieve CRT. Method: A search of PubMed, EMBASE, and Cochrane databases were performed to identify studies examining the role of LBBAP for CRT in heart failure. Comprehensive meta‐analysis version 4 was used for meta‐regression to examine variables that contribute to data heterogeneity. Result: Eighteen studies, 17 observational and one randomized controlled trial (RCT) were examined. A total of 3906 HF patients who underwent CRT (2036 LBBAP vs. 1870 biventricular pacing [BVP]) were included. LBBAP was performed successfully in 90.4% of patients. Compared to baseline, LBBAP was associated with a reduction in QRS duration (MD: −47.23 ms 95% confidence interval [CI]: −53.45, −41.01), an increase in LVEF (MD: 15.22%, 95% CI: 13.5, 16.94), and a reduction in NYHA class (MD: −1.23, 95% CI: −1.41, −1.05). Compared to BVP, LBBAP was associated with a significant reduction in QRS duration (MD: −20.69 ms, 95% CI: −25.49, −15.88) and improvement in LVEF (MD: 4.78%, 95% CI: 3.30, 6.10). Furthermore, LBBAP was associated with a significant reduction in HF hospitalization (odds ratio [OR]: 0.44, 95% CI: 0.34, 0.56) and all‐cause mortality (OR: 0.67, 95% CI: 0.52, 0.86) compared to BVP. Conclusion: LBBAP was associated with improved ventricular electrical synchrony compared to BVP, as well as better echocardiographic and clinical outcomes. [ABSTRACT FROM AUTHOR]

Coronavirus Disease 2019, caused by the virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), is a pandemic first discovered in Wuhan, China which has claimed over 1.7 million lives to date across the globe as of 24 December 2020. As the virus spreads across the world affecting millions of patients, there has been a massive movement to discover readily available and effective treatment options including vaccines. One of the limiting factors in treating the disease is its varied presentation and effect in patients, ranging from asymptomatic patients to those left in intensive care units, intubated and fighting for their lives. There are numerous clinical trials and small-scale studies underway to investigate potential treatment options. However, very few studies and drugs demonstrated efficacy while many more are under investigation, leaving care teams dependent on supportive care coupled with experimental treatment options. In this review, we summarize the various treatment options explored to treat COVID-19, discussing possible the mechanisms of fighting the virus. [ABSTRACT FROM AUTHOR]

Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED)‐related infections and may lead to device‐related endocarditis, so preventing them is key. We present a case of CIED‐related pocket infection due to Mycobacterium fortuitum which highlights the challenges in management of such infections. [ABSTRACT FROM AUTHOR]

B INTRODUCTION: b Mycobacterium Avium Complex (MAC) infection usually presents as a fibrocavitory or an endobronchial lesion; MAC infection related Immune reconstitution inflammatory syndrome (IRIS) commonly manifests as localized lymphadenitis or endobronchial mass lesions. None of the pulmonary nodules were accessible for interventional radiology-guided biopsy and hence cardio-thoracic surgery performed a right upper lobe wedge biopsy through right video-assisted thoracoscopic surgery, mini-thoracotomy along with chest tube placement. B CONCLUSIONS: b Multiple pulmonary nodules are rarely seen in MAC/ MAC related IRIS infections. [Extracted from the article]

Objective evidence of decreased RV strain was found among 60% (n=6) patients (2 on right heart catheterization and 4 on echocardiogram. Following CDT, 1 patient had worsened heart failure and one developed basilic vein thrombosis. Eight patients were denied CDT for either low platelets, presence of pulmonary infarct, evidence of concomitant infection, significant co-morbidities. [Extracted from the article]

The incidence of primary outcomes was 27.9% (12/43) in patients with high pro-BNP/BNP vs 8.6% (5/58) in the normal pro-BNP/BNP (p=0.01). B CONCLUSIONS: b Pro-BNP/BNP is an important prognostic marker in PE patients. [Extracted from the article]

B Learning Objectives: b Hyperthyroidism is known to cause arterial thrombosis, it has been implicated in rare cases of myocardial infarction. Emergent cardiac catheterization revealed a large thrombus extending from left main to left anterior descending artery (LAD) with 80% occlusion of the proximal LAD not amenable to intervention. B Results: b We believe that hyperthyroid state due to autoimmune thyroiditis and heterozygous variant of C677T may have precipitated a pro-thrombotic state leading to an imminent occlusion of LAD which hence forth led to a STEMI in a young female with no obvious risk factors. [Extracted from the article]

Introduction: Accurate diagnosis of pulmonary hypertension (PH) is made using invasive right heart catheterization (RHC). Prior studies have shown the utility of imaging techniques like computerized tomography (CT) as alternatives to predict PH. Hypothesis: To determine the predictive ability of CT measured main pulmonary artery diameter (PA) to aortic diameter (AO) ratio in identifying PH. Methods: A retrospective observational study conducted in 211 consecutive patients who had RHC and CT chest within 6 months of each other between the years 2012-2015. Two expert radiologists measured main PA diameter at the bifurcation and AO diameter from the same CT image. Furthermore, we conducted a sub-group analysis to see if the ratio performs better in assessing PH in chronic kidney disease patients. Linear correlation and logistic regression analysis was used to examine the association between PA:AO ratio by CT scan with invasive hemodynamics. Receiver operator characteristic analysis was used to evaluate the ability of using PA:AO ratio to predict PH. Resting PH was defined as mean pulmonary artery pressure of ≥25 mmHg. CKD was defined as GFR between 15- 60 mL/min/ 1.73 m2 and no indication for dialysis. Results: Mean time between CT and RHC 3 days with minimum of 5.06 months (-152 days) to 5.56 months (167 days). Intraclass correlation coefficient between the two radiologists was 0.86 (95% CI of 0.75-0.92) with a P <0.01. CT measured PA:AO is highly correlated with mPAP after adjustment of age, race and gender (r=0.37, P <0.001). In a multivariate logistic model, every 0.15 U (1±SD) increase in PA:AO ratio was associated with 2.99 times higher (95% CI 1.99-4.49, P <0.01) odds of having PH , while in CKD subgroup, every 0.15 U (1±SD) increase in PA:AO ratio was associated with 11.9 times higher odds of having PH (95% CI 2.10-67.6, P =0.005), adjusting for age, race and gender. Conclusion: CT derived PA:AO ratio is predictive of PH. [ABSTRACT FROM AUTHOR]

Objectives: The global COVID‐19 pandemic has caused rapid and monumental changes around the world. Older people, who already experience higher rates of social isolation and loneliness, are more susceptible to adverse effects as a result of the social distancing protocols enacted to slow the spread of COVID‐19. Based on prior outbreaks, we speculate the detrimental outcomes and offer solutions. Methods: Reviewing the literature on the detrimental effects of social isolation and loneliness and higher mortality in the older population. Utilizing psychological study outcomes from prior major outbreaks such as in SARS, Ebola, H1N1 influenza, and Middle East respiratory syndrome offer predictions and the susceptibility in the geriatric age group. Results: Organizations such as the WHO, Centers for Disease Control, and American Association of Retired Persons have put measures in place to provide networking on a local, regional, and national level. These efforts are designed to start mitigating such detrimental effects. A necessary follow‐up to this pandemic will be gathering data on unique populations such as the geriatric community, to better mitigate adverse outcomes given the certainty that COVID‐19 will not be the last global viral outbreak. Conclusions: The results of worsened social isolation and loneliness is associated with significantly increased morbidity and mortality in the geriatric population. Various solutions including virtual interactions with loved ones, engaging in physical activity, continuing any spiritual or religious prayers remotely, and community services to provide aid for the older population are all efforts to minimize social isolation and loneliness. [ABSTRACT FROM AUTHOR]

With widespread awareness about the harmful effects of traditional smoking, many people are considering using an e-cigarette. However, many studies have shown that e-cigarettes are not entirely harmless, and their use has been implicated in causing major adverse cardiovascular events. We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to conduct this systematic review. An electronic search was conducted comprehensively through five databases to find the relevant articles. The odds ratio (OR) was used for comparing groups. Meta-analysis was conducted using R statistical software version 3.4.3. A random-effects model was used. A total of 4 studies were included in the analysis incorporating data on 585,306 individuals. Of these, 19,435 were e-cigarettes users, while 1693 used only traditional cigarettes, and 553,095 were non-e-cigarette users. 7.0% of e-cigarettes users suffered an MI (myocardial infarction), while 7.7% and 6.5% of traditional smokers and non-e-cigarettes users suffered an MI. The OR of getting an MI in e-cigarettes (e-cigarettes only or e-cigarettes + traditional smoking) users was 1.33 (95% CI = 1.14–1.56, p -value = 0.01) in comparison to non e-cigarette users (traditional smoking or no smoking). While it is 0.61 (95% CI = 0.40–0.93, p-value 0.02) when compared with traditional smoking. Those using e-cigarettes have higher odds of suffering from an MI in comparison to not using e-cigarettes. However, using e-cigarettes is associated with half risk of the risk of MI in comparison to traditional smoking. • E-cigarettes use is associated with 33% higher risk of myocardial infarction (MI) than no-e-cigarettes users. • However, they are associated with 39% percent less risk of MI when compared to traditional smoking. • E-cigarettes should not be propagated as a healthy alternative of traditional cigarettes smoking. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has altered innumerable lives. Although recent mass vaccinations offer a glimmer of hope, the rising death toll and new variants continue to dominate the current scenario. As we begin to understand more about SARS-CoV-2 infections, the territory of reinfections with COVID-19 remains unexplored. In this review, we will discuss several aspects of reinfection: (a) How is COVID-19 reinfection characterized? (b) Does prior literature differentiate between reinfection and reactivation? (c) What SARS-CoV-2 strains do the vaccines target and can they protect against new strains? Larger and longer timeline studies are needed to understand reinfection risks. With the ongoing distribution of the SARS-CoV-2 vaccines to provide protection, the understanding of the possibility for SARS-CoV-2 reinfection remains critical. Abbreviations CDC: Centers for Disease ControlSARS-CoV-2: Severe acute respiratory syndrome coronavirus 2COVID-19: Coronavirus disease 2019RT-PCR: Reverse Transcription Polymerase Chain ReactionPASC: Post-Acute Sequelae of SARS-CoV-2 infection [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Methods:We outline the evidence of the pathophysiology of COVID-19 in the GI tract, the effects of the virus on the gut and liver, the presence of the virus in stool samples, and the potential for fecal-oral transmission of COVID-19. Most of the literature sources used in this paper are case studies from China following the surge of COVID-19 infection. Results: In patients with COVID-19, GI symptoms such as anorexia, nausea, vomiting, diarrhea, and abdominal pain have presented in conjunction with respiratory symptoms such as fever, shortness of breath, and cough. Evidence also shows acute hepatocellular injury, indicated by elevated liver enzymes such as alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. Fecal-oral transmission of COVID-19 is suspected because of the presence of COVID-19 RNA in stool samples of COVID-19-positive patients. Conclusion: Even without the presence of respiratory symptoms, several GI symptoms are associated with COVID-19 infection, as well as possible fecal-oral transmission. Therefore, COVID-19 infection should be considered for patients presenting with primarily GI symptoms. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has altered numerous lives and accounted for significant mortality and morbidity throughout the world and, especially, the USA. During the pandemic, from mid-March to July 2020, around one-fourth of the US population filed for unemployment benefits. Objective: In this article, we discuss the economic ramifications exposed in the American healthcare system's current model by the COVID-19 crisis. Methods: In this review, we analyze 18 articles to look at how access to health insurance has affected how Americans receive medical care during the coronavirus pandemic. Results: The large-scale job losses related to the pandemic translates directly into millions of Americans also losing employer-sponsored health insurance (ESI) coverage. With the pandemic disproportionately affecting minority populations, these communities now bear the additional toll of not receiving appropriate care. Conclusion: Due to the pandemic, it is probable that a significant portion of Americans that are uninsured are less likely to seek medical care for COVID-19 symptoms. While the disease can manifest as a mild respiratory illness in most, others can experience more severe disease and require acute, intensive medical care. The lack of health insurance in this instance can be potentially fatal. Given that COVID-19 has disproportionately affected minority communities across the USA, it is important to highlight the correlation between access to medical care and COVID-19 infection rates. Communities that are of lower socioeconomic status are less likely to have health insurance and follow up with medical care due to out-of-pocket costs, which in turn leads to a higher case fatality rate due to COVID-19. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), a novel virus that causes COVID‐19 infection, has recently emerged and caused a deadly pandemic. Studies have shown that this virus causes worse outcomes and a higher mortality rate in older adults and those with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease (CKD). A significant percentage of older American adults have these diseases, putting them at a higher risk of infection. Additionally, many adults with hypertension, diabetes, and CKD are placed on angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Studies have shown that these medications upregulate the ACE‐2 receptor, the very receptor that the SARS‐CoV‐2 virus uses to enter host cells. Although it has been hypothesized that this may cause a further increased risk of infection, more studies on the role of these medications in COVID‐19 infections are necessary. In this review, we discuss the transmission, symptomatology, and mortality of COVID‐19 as they relate to older adults, and possible treatments that are currently under investigation. J Am Geriatr Soc 68:926–929, 2020 [ABSTRACT FROM AUTHOR]

B PURPOSE: b Atherogenic index of plasma (AIP) is defined as the logarithmic ratio of molar concentrations of triglyceride & high-density lipoprotein. Data pertaining to demographics, lipid profile including total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) & low-density lipoprotein (LDL) were recorded. Atherogenic index of plasma can be used as a target for lipid-lowering therapy beyond individual lipoprotein and/or TC: HDL ratio. [Extracted from the article]