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AbstractBackgroundThere is limited information on diurnal variation in pulmonary artery pressures (PAP) in ambulatory heart failure (HF) patients. We aimed to study the variation in morning and night-time PAP in HF patients with an implanted CardioMEMS®sensor.MethodsIn this prospective, single centre study we enrolled patients who had a cardioMEMS sensor and consented to participate (End stage renal disease and recent hospitalisation for acute HF were exclusions). Subjects were asked to transmit PAP and non-invasive blood pressure information in morning and at night-time for 7 consecutive days. Categorical and continuous variables were reported as percentages and mean ± SD respectively. Repeated measure ANOVA was used to compare the diurnal changes in PAP among different subgroups. Pierson correlation coefficient was performed to assess correlation between diurnal variation of PAP and left ventricular ejection fractionResultsThirty subjects were included in analysis. There was a significant nocturnal rise in PASP and mPAP compared to morning readings (+2.59 mmHg, p = 0.003 and +1.24 mmHg with p = 0.02 respectively) while night-time PADP did not change significantly (+0.48 mmHg, p = 0.18) without significant change in systemic blood pressure or pulse rate.ConclusionThe described diurnal changes in PAP should be considered when managing ambulatory HF patients based on these readings. PADP can be used reliably without concern for the time of day the readings were recorded.HighlightsThere is a diurnal variation in PAP in ambulatory heart failure patientsPulmonary artery systolic and mean pulmonary artery pressures are higher at night-time than in morning.Pulmonary artery diastolic pressures do not vary significantly with time of day.These findings should inform clinical decisions in management of these patients about the time of the day readings are taken

Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.

As utilization of veno-arterial extracorporeal life support (VA-ECLS) in treatment of cardiogenic shock (CS) continues to expand, clinical variables that guide clinicians in early recognition of myocardial recovery and therefore, improved survival, after VA-ECLS are critical. There remains a paucity of literature on early postinitiation blood pressure measurements that predict improved outcomes.

Purpose: The purpose of the study is to probe the influence of individual social entrepreneurship orientations (ISEO) and SE education (SEE) which could affect social entrepreneurial intentions (SEI) among students. Design/methodology/approach: The data were gathered from 241 entrepreneurship discipline university students. The data were analyzed with structural equation modeling. Findings: Findings suggest that ISEO plays a vital role in stimulating SEI; moreover, SEE further moderates ISEO and SEI's relationship among students. Practical implications: Based on the results, academia should focus on SEE and the government should devise policies to encourage social entrepreneurial ventures to aid in social problems solution. Originality/value: This study validates the relationship of different factors (orientations and intentions) of the theory of planned behavior in the SE domain and confirms the significance of SEE.

Coronavirus disease 2019 (COVID-19) has been reported to cause worse outcomes in patients with underlying cardiovascular disease, especially in patients with acute cardiac injury, which is determined by elevated levels of high-sensitivity troponin. There is a paucity of data on the impact of congestive heart failure (CHF) on outcomes in COVID-19 patients.

Pivotal CAR-T registrational trials for the six CAR-T therapies currently FDA approved have excluded those with heart failure (HF), defined either by low ejection fraction (EF) or clinical symptoms of HF (NYHA functional classification). This has created a real-world dilemma for clinicians desiring to treat this patient population. To that end, in this study, we provide our real-world, single-institution experience with CAR-T therapy in patients with medically optimized HF with reduced ejection fraction (HFrEF) prior to date of apheresis.

We performed a retrospective review comparing outcomes between traditional ice storage (ICE) with short ischemic times (<3 hours) to SherpaPak Cardiac Transport System (SCTS) with long ischemic times (>4 hours) using data from the GUARDIAN registry, a retrospective observational trial. To minimize baseline differences, propensity-matched (PSM) cohorts for site and era were performed. SherpaPak Cardiac Transport System travel distance was almost 10-fold greater than ICE (82 miles ICE vs. 765 miles SCTS). There was no significant difference in primary graft dysfunction (PGD) (20.8% vs.18.2%, p= 0.58), length of stay (LOS) (24.7 vs.24.8, p= 0.98), posttransplant mechanical circulatory support (MCS) (25.1% vs.20.3%, p= 0.34), and 30 day survival (100% vs.98.6%, p= 0.20). SherpaPak Cardiac Transport System showed statistically significant reduction in 24 hour inotrope scores (17.6 vs.13.6, p= 0.007) and right ventricular (RV) dysfunction (31.1% vs.15.7%, p= 0.002). Propensity-matched cohorts showed statistically similar rates of MCS utilization and PGD, but SCTS trended toward less RV dysfunction (26.0% vs.16.2%, p= 0.11) and lower inotrope scores (16.5 vs.12.9, p= 0.06) despite almost double the ischemic time. In conclusion, donor heart preservation with SCTS continues to be effective in prolonged ischemic times without sacrificing postheart transplantation clinical outcomes. This may aid in expanding donor organ geography.

ABSTRACTIntroduction: Human papillomavirus (HPV) vaccine coverage in Australia is 80% for females and 76% for males. Attitudes may influence coverage but surveys measuring attitudes are resource-intensive. The aim of this study was to determine whether Twitter-derived estimates of HPV vaccine information exposure were associated with differences in coverage across regions in Australia.Methods: Regional differences in information exposure were estimated from 1,103,448 Australian Twitter users and 655,690 HPV vaccine related tweets posted between 6 September 2013 and 1 September 2017. Tweets about HPV vaccines were grouped using topic modelling; an algorithm for clustering text-based data. Proportional exposure to topics across 25 regions in Australia were used as factors to model HPV vaccine coverage in females and males, and compared to models using employment and education as factors.Results: Models using topic exposure measures were more closely correlated with HPV vaccine coverage (female: Pearson’s R = 0.75 [0.49 to 0.88]; male: R = 0.76 [0.51 to 0.89]) than models using employment and education as factors (female: 0.39 [−0.02 to 0.68]; male: 0.36 [−0.04 to 0.66]). In Australia, positively-framed news tended to reach more Twitter users overall, but vaccine-critical information made up higher proportions of exposures among Twitter users in low coverage regions, where distorted characterisations of safety research and vaccine-critical blogs were popular.Conclusions: Twitter-derived models of information exposure were correlated with HPV vaccine coverage in Australia. Topic exposure measures may be useful for providing timely and localised reports of the information people access and share to inform the design of targeted vaccine promotion interventions.

ABSTRACTSocial media platform, particularly Twitter, is a rich data source that allows monitoring of public opinions and attitudes toward vaccines.Established behavioral models like the 5C psychological antecedents model and the Health Belief Model (HBM) provide a well-structured framework for analyzing shifts in vaccine-related behavior. This study examines if the extracted data from Twitter contains valuable insights regarding public attitudes toward vaccines and can be mapped to two behavioral models. This study focuses on the Arab population, and a search was carried out on Twitter using: ’ تلقيحي OR تطعيم OR تطعيمات OR لقاح OR لقاحات’ for two years from January 2020 to January 2022. Then, BERTopicmodeling was applied, and several topics were extracted. Finally, the topics were manually mapped to the factors of the 5C model and HBM. 1,068,466 unique users posted 3,368,258 vaccine-related tweets in Arabic. Topic modeling generated 25 topics, which were mapped to the 15 factors of the 5C model and HBM. Among the users, 32.87%were male, and 18.06% were female. A significant 55.77% of the users were from the MENA (Middle East and North Africa) region. Twitter users were more inclined to accept vaccines when they trusted vaccine safety and effectiveness, but vaccine hesitancy increased due to conspiracy theories and misinformation. The association of topics with these theoretical frameworks reveals the availability and diversity of Twitter data that can predict behavioral change toward vaccines. It allows the preparation of timely and effective interventions for vaccination programs compared to traditional methods.

ABSTRACTWhile vaccines have played a pivotal role in the fight against infectious diseases, individuals engage in online resources to find vaccine-related support and information. The benefits and consequences of these online peers are unclear and mainly cause a behavioral shift in user sentiment toward vaccination. This scoping review aims to identify the community and individual factors that longitudinally influence public behavior toward vaccination. The secondary aim is to gain insight into techniques and methodologies used to extract these factors from Twitter data. We followed PRISMA-ScR guidelines to search various online repositories. From this search process, a total of 28 most relevant articles out of 705 relevant studies. Three main themes emerged including individual and community factors influencing public attitude toward vaccination, and techniques employed to identify these factors. Anti-vax, Pro-vax, and neutral are the major communities, while misinformation, vaccine campaign, and user demographics are the common individual factors assessed during this reviewing process. Twitter user sentiment (positive, negative, and neutral) and emotions (fear, trust, sadness) were also discussed to identify the intentions to accept or refuse vaccines. SVM, LDA, BERT are the techniques used for topic modeling, while Louvain, NodeXL, and Infomap algorithms are used for community detection. This research is notable for being the first systematic review that emphasizes the dearth of longitudinal studies and the methodological and underlying practical constraints underpinning the lucrative implementation of an explainable and longitudinal behavior analysis system. Moreover, new possible research directions are suggested for the researchers to perform accurate human behavior analysis.

Introduction:Pivotal CAR-T registrational trials for the six CAR-T therapies currently FDA approved have excluded those with heart failure (HF), defined either by low ejection fraction (EF) or clinical symptoms of HF (NYHA functional classification). This has created a real-world dilemma for clinicians desiring to treat this patient population. There is concern that those with HF may not tolerate the physiologic and hemodynamic stressors associated with cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) and thus have increased risk of severe morbidity or death. The emerging concept of permissive cardiotoxicity seeks to allow for an acceptable level of cardiac toxicity to allow for treatment with highly efficacious but potentially cardiac toxic treatments like CAR-T therapy. To that end, in this study, we provide our real-world, single-institution experience with CAR-T therapy in patients with medically optimized HF with reduced EF (HFrEF) prior to date of apheresis.

•Game theory applied to travel behavior interaction for urban traffic control.•Behavioral interaction applied to various aspects of road transport networks.•A comparative criticism of available game theoretic model of travel behavior.•Research directions for researchers, engineers, policymakers, and industries.

ABSTRACTBackgroundVaccination programs are effective only when a significant percentage of people are vaccinated. Social media usage is arguably one of the factors affecting public attitudes toward vaccines.ObjectiveThis study aims to identify if the social media usage factors can predict Arab people’s attitudes and behavior toward the COVID-19 vaccines.MethodsAn online survey was conducted in the Arab countries, and 217 Arab nationals participated in this study. Logistic regression was applied to identify what demographics and social media usage factors predict public attitudes and behavior toward the COVID-19 vaccines.ResultsOf the 217 participants, 56.2% (n = 122) were willing to get the vaccines, and 41.5% (n = 90) were hesitant. This study shows that none of the social media usage factors were significant enough to predict the actual vaccine acceptance behavior. However, some social media usage factors could predict public attitudes toward the COVID-19 vaccines. For example, compared to infrequent social media users, frequent social media users were 2.85 times more likely to agree that the risk of COVID-19 was being exaggerated (OR = 2.85, 95% CI = 0.86–9.45, p = .046). On the other hand, participants with more trust in vaccine information shared by their contacts were less likely to agree that decision-makers had ensured the safety of vaccines (OR = 0.528, 95% CI = 0.276–1.012, p = .05).ConclusionInformation shared on social media may affect public attitudes toward COVID-19 vaccines. Therefore, disseminating correct and validated information about the COVID-19 vaccines on social media is important to increase public trust and counter the impact of incorrect misinformation.

ABSTRACTWith the success of COVID-19 vaccines in clinical trials, vaccination programs are being administered for the population with the hopes of herd immunity. However, the success of any vaccination program depends on the percentage of people willing to get vaccination which is influenced by social, economic, demographic, and vaccine-specific factors. Thus, it is important to understand public attitudes and perceptions toward vaccination. This study aims to measure public attitude toward vaccines and vaccinations before and during the COVID-19 pandemic, using public data from Twitter. A total of 880,586 tweets for 57,529 unique users were included in the study. Most of the tweets were posted in five languages: French, English, Swedish, Dutch, and Italian. These tweets were divided into two time periods: before COVID-19 (T1) and during COVID-19 (T2). This study observed the shift in the sentiments of the public attitude toward vaccines before and during COVID-19 pandemic. Both positive and negative shifts in sentiments were observed for the users of various languages but shifts toward positive sentiments were more prominent during the COVID-19 pandemic.

Background:Role of MitraClip as rescue therapy in patients with severe mitral regurgitation (MR) in the setting of ruptured chordae with profound cardiogenic shock in hypertrophic obstructive cardiomyopathy (HOCM) is not well known.Case:60-year-old male presented with profound cardiogenic shock requiring ECMO with severe lactic acidosis. Past medical history included HOCM s/p septal ablation and ICD, mild MR, a-fib s/p watchman, and CKD stage 3.Transesophageal echocardiogram demonstrated a flail posterior mitral valve leaflet due to ruptured chordae tendineae with anteriorly directed jet of severe MR (figure 1A). VA-ECMO was initiated for profound hypotension. 3 MitraClips were required as rescue strategy as the patient was deemed too critical to undergo surgical repair. Post procedure, MR was mild with a mean MV gradient of 4 mmHg at the end of the procedure (figure 1B). 15 months post-hospitalization, patient reported dyspnea on exertion. Exercise stress echo revealed a mean MV resting gradient of 7 mmHg that increased to 16 mmHg at 50 W exercise (figure 1C). Invasive hemodynamics showed a mean gradient of 12 mmHg between LV end-diastolic pressure and pulmonary capillary wedge pressure (figure 1D) confirming severe mitral stenosis. The patient is currently being evaluated for surgical MV replacement.Discussion:Transcatheter edge-to-edge mitral valve repair (TMVr) has been studied extensively in patients with dilated cardiomyopathy, and chronic stable severe MR. There is limited data to show that TMVr can be used as salvage therapy in patients with acute torrential MR with underlying HOCM while being supported with ECMO. However, long-term sequelae needs meticulous follow up and prospective studies to establish short and long-term outcomes and safety. This case highlights potential role of TMVr in acute MR settings in the extreme case of profound cardiogenic shock requiring VA-ECMO leading to candidacy for mitral valve replacement in ambulatory setting.

Introduction:Despite the advancement in the left ventricular assist devices (LVADs), right heart failure (RHF) remains a challenging adverse event after LVAD implantation and is associated with increased morbidity and mortality. Cardiac magnetic resonance (CMR)-derived right ventricular ejection fraction (RVEF) is a promising surrogate of the right ventricular function and is an independent predictor of major cardiovascular events. In this study, we aim to assess the role of CMR-derived RVEF in predicting the risk of post-LVAD RHF.Methods:We retrospectively assessed adult patients (>18 years) who underwent CMR prior to LVAD implantation at our center from 2016 to 2021. Overall baseline characteristics and clinical outcomes were compared between the patients who developed post-LVAD RHF and those who did not.Results:A total of 42 patients were included in this study. Nine patients (21%) developed RHF; four had early post-implant RHF, and five had late RHF. The mean age was 47±14 years, and 76% were males. Most of the patients were on milrinone infusion at LVAD implantation (69%). The mean cardiac index (using the thermodilution method) was 1.5±0.8 ml/kg/m2, and CMR-derived LVEF was 17±7%. About half of the patients were on destination therapy, and half were on a bridge-to-transplant strategy. The mean CMR-derived RVEF was 25±13%, with no statistically significant difference between the two groups. The mean of the CMR-derived right ventricular volume index trend was higher in those with post-LVAD RHF but did not achieve statistical significance (76±28 ml/m2 vs. 65±25 ml/m2; p=0.31). Patients with post-LVAD RHF had lower mean arterial pressure (MAP) at the time of the right heart catheterization (77±10 vs. 85±12 mmHg; p0.039) and had more HF hospitalizations (2.7±2.2 vs. 0.7±1.5 hospitalizations; p=0.001).Conclusions:In patients who underwent CMR prior to LVAD implantation, CMR-derived RVEF was not an independent predictor of post-LVAD RHF. Larger multicenter studies are needed to confirm this finding.

Background:Pump thrombosis (PT) remains a dreaded complication of left ventricle assist device (LVAD) implantation. PT immediately after HeartMate 3 (HM3) implantation is rare but should be kelp in mind if early low flow alarms are noted.Case:A 57-year-old male with ischemic cardiomyopathy, Stage D heart failure (LVEF ~20%), INTERMACS category 3 on 5mcg/kg/min Dobutamine drip underwent advanced heart failure therapy evaluation and was deemed suitable candidate for LVAD implant. His ECHO showed LVIDD 6.04 cm and LV Diastolic Volume Index 122 mL. He underwent HM3 implantation via left anterior thoracotomy and upper-hemi sternotomy on 5/24/2022. Surgery was successful and the patient was taken off bypass. Pre-implant some LV trabeculations and debris were removed. However, less than 1 hour from being off bypass, the low flow alarms began which did not resolve after volume and blood pressure optimization. No RV failure was noted on TEE. Decision was made to re-open the sternum. Upon exploration, no compression of the outflow graft was noted, and inlet cannula was not mispositioned. Inspection of LVAD inlet and outlet cannula showed significant amount of white thrombus (Figure 1) and device was ultimately exchanged. Thrombus was confirmed on histopathological analysis. Post-operatively no low flow alarms were noted after pump exchange. Factor V Leiden screen and protein C activity were normal and Antithrombin 3 was falsely low (due to recent thrombus) on post-op day 1.Discussion:This is the second case of HM 3 device thrombosis within 1 hour of implant in the literature. Most of the earlier reported cases were on post-Op Day 3. The etiology of PT is unknown and further investigation is required to elucidate the same. This case will create awareness among physicians to keep PT in differentials when low flow alarms are encountered immediately post-op despite volume and BP optimization.

The use of innocuous naturally occurring compounds to overcome drug resistance and cancer recalcitrance is now in the forefront of cancer research. Thymoquinone (TQ) is a bioactive constituent of the volatile oil derived from seeds of Nigella sativaLinn. TQ has shown promising anti-carcinogenic and anti-tumor activities through different mechanisms. However, the effect of TQ on cell signaling and survival pathways in resistant cancer cells has not been fully delineated. Here, we report that TQ greatly inhibits doxorubicin-resistant human breast cancer MCF-7/DOX cell proliferation. TQ treatment increased cellular levels of PTEN proteins, resulting in a substantial decrease of phosphorylated Akt, a known regulator of cell survival. The PTEN expression was accompanied with elevation of PTEN mRNA. TQ arrested MCF-7/DOX cells at G2/M phase and increased cellular levels of p53 and p21 proteins. Flow cytometric analysis and agarose gel electrophoresis revealed a significant increase in Sub-G1 cell population and appearance of DNA ladders following TQ treatment, indicating cellular apoptosis. TQ-induced apoptosis was associated with disrupted mitochondrial membrane potential and activation of caspases and PARP cleavage in MCF-7/DOX cells. Moreover, TQ treatment increased Bax/Bcl2 ratio via up-regulating Bax and down-regulating Bcl2 proteins. More importantly, PTEN silencing by target specific siRNA enabled the suppression of TQ-induced apoptosis resulting in increased cell survival. Our results reveal that up-regulation of the key upstream signaling factor, PTEN, in MCF-7/DOX cells inhibited Akt phosphorylation, which ultimately causes increase in their regulatory p53 levels affecting the induction of G2/M cell cycle arrest and apoptosis. Overall results provide mechanistic insights for understanding the molecular basis and utility of the anti-tumor activity of TQ.

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Although seen in ∼5% of sarcoidosis patients, cardiac sarcoidosis (CS) accounts for nearly 25% of disease-related deaths. This study aimed to describe characteristics and outcomes among CS patients. Patients diagnosed with CS in 2016–2017 in the US National Inpatient Sample Database were evaluated to study patient characteristics, reasons ascribed to admission, in-hospital outcomes, and complications. A total of 2420 patients (median age 56 years) were included in the analysis. Most admissions occurred due to ventricular tachycardia (12.8%), followed by myocarditis (9.9%) with a mean length of stay of 7±7 days. The overall incidence of in-hospital mortality was 2.5%.

Introduction:Heart transplantation (HT) is a treatment of choice for many patients with advanced heart failure who continue to deteriorate despite optimal medical therapy. Data on patient characteristics, predictors, and readmission rates after HT is limited. We sought to evaluate the causes and predictors of the 30-day readmission rate among HT patients.Methods:Using the Nationwide Readmission Database, we included adult patients (≥18 years old) who underwent HT between January 2016 to November 2018. Patients with dual organ transplants were excluded from the study. Thirty-day readmission rates, causes, and predictors of readmission were assessed.Results:We analyzed 7386 patients who underwent HT and discharged alive during the years 2016 to 2018. The mean age was 53.35 ± 12.97 years and 73% were males. The 30-day readmission rate was 22.4% (n=1647). Heart transplant rejection/failure was the main cause of readmission (16.3%) followed by systemic infections (13.2%), post-procedure transplant complications (10%), acute kidney injury (6.3%), and procedure-related wound infection (4.2%) (Fig 1A). Using multivariate logistic regression the risk of 30-day readmission was higher in patients with high comorbidity burden if Elixhauser score >14 (OR 1.41: 95% CI 1.10-1.79) and in patients who have a length of stay > 30 days during index admission (OR 1.18: 95% CI 1.01-1.39). Female gender was also found to be an independent predictor of readmission (OR 1.33: 95% CI 1.09-1.61) (Fig 1B).Conclusions:Readmission rate is high in orthotopic heart transplant patients and is driven mostly by graft rejection/failure, infections, and post-procedure-related complications. Pre-transplant identification of high-risk patients will help in improving outcomes.

Introduction:Myocarditis is a serious inflammatory process that can result in acute and chronic cardiomyopathy. Data on patient characteristics, predictors and national readmission rates related to myocarditis are limited. We sought to evaluate the causes and predictors of 30-day readmission rate of patients admitted with acute myocarditis.Methods:Using the Nationwide Readmission Database, we included adult patients (age>18 years old) who were hospitalized between January 2016 to November 2018 for acute myocarditis. Thirty-day readmission rates, causes, and predictors of readmission were assessed.Results:We analyzed 9482 patients who were discharged alive with a primary diagnosis of acute myocarditis, without requiring advanced therapies (HTX or LVAD) during the index admission. Within 30 days, 641 (6.8%) were readmitted and half of the readmissions occurred in the first 10 days. The readmitted patients were older (mean age of 50 ± 19 vs 41 ± 17, p =<0.001) and were more females (49 % vs 35%, p= <0.001). Using multivariate logistic regression (Fig 1A), the odds of 30-day readmission was higher in diabetics (OR 1.47: 95% CI 1.05-2.04), smokers (OR 1.39: 95% CI 1.05-1.84), prior MI (OR 2.17: 95% CI 1.36-3.44), chronic lung disease (OR 1.55: 95% CI 1.16-2.07) and renal failure (OR 1.97: 95% CI 1.31-2.96). Recurrent myocarditis (15%), and heart failure (15%) were the most common causes of readmission (Fig 1B).Conclusions:The readmission rate among acute myocarditis patients is high and is driven by recurrent myocarditis and heart failure. Early identification of patients at increased risk for readmission may help develop prevention strategies and improve outcomes in acute myocarditis.

Introduction:Atrial fibrillation (AF) is the leading cause of arrhythmia among hospitalized patients. Altered hemodynamics with new-onset non-valvular atrial fibrillation, especially during sepsis/septic shock, causes decreased organ perfusion, lowers cardiac output, and increases the risk of organ dysfunction leading to increased intensive care unit (ICU) length of stay and mortality. However, little is known about the outcomes of patients hospitalized with septic shock and underlying chronic atrial fibrillation (UCAF).Hypothesis:Does UCAF increase in-hospital mortality in patients who have a diagnosis of septic shock during hospitalization.Methods:This was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with septic shock, and these patients were stratified into those with and without a UCAF. Propensity matching analyses were performed to compare in-hospital mortality and clinical cardiovascular outcomes between the two groups.Results:A total of 353,422 patients with hospitalization for septic shock were identified, 5.8% of whom (n=20,772) had UCAF. After 2:1 propensity matching, 41,438 patients were identified as having septic shock without UCAF, and 20,719 patients were identified as having septic shock with UCAF. In hospital mortality [34.4% vs. 34.1%, p= 0.049], incidence of ischemic stroke [2.5% vs. 2.2%, p = 0.012], acute heart failure [1.8% vs. 1.4%, p < 0.001], length of stay [11.46 days vs. 10.93 days, p< 0.001], mean total charges [$150 4094 vs. $140 4037, p < 0.001] were significantly higher in patients with septic shock and UCAF compared to patients with septic shock without UCAF.Conclusions:The study identified UCAF as an adverse prognosticator for inpatient mortality and severe cardiovascular clinical outcomes. The study suggests the need for future research to improve patient outcomes of patients with septic shock and UCAF.

Background:Pulmonary Hypertension (PHTN) patients typically have chronic multiple comorbidities and are more vulnerable to acute clinical conditions leading to decreased survival. The impact of pulmonary hypertension on outcomes in patients with septic shock remains unknown.Methods:Adult patients with a diagnosis of septic shock were identified in the National Readmissions Database (NRD) between the years 2016-2017. Propensity matched retrospective cross sectional clinical outcomes were compared between patients with and without non-cardiac PHTN using appropriate statistical methods after nearest matching on a 2:1 ratio for several demographic, social and clinical variables. Patients with cardiogenic shock, aortic and mitral valvular heart disease, underlying systolic and combined heart failure (HF), and PHTN due to left heart disease were excluded from the primary analysis. Appropriate ICD-10 codes were used.Results:A total of 13,676 patients diagnosed with non-cardiac PHTN and septic shock were identified with a mean age of 68 years and 58.6% identified as females. Patients with PHTN had higher comorbidities, including hypertension, chronic pulmonary disease, renal failure, diabetes, CAD, and obesity. After matching, patients with septic shock and non-cardiac PHTN were noted to have a higher mortality (33.2% vs 31.3%, p < 0.001), greater vasopressor use (7.9% vs 6.6%, p < 0.001), higher rates of acute heart failure (1.1% vs 0.6%, p < 0.001), longer hospital stay (14.0 days vs 12.7 days, p < 0.001), and higher hospital costs ($196,411 vs $171,537), when compared to patients with septic shock and without PHTN. Rates of AKI were noted to be lower in patients with PHTN. Amongst stroke outcomes, minimal differences in ischemic strokes were noted. There were no MI outcomes observed.Discussion:PHTN is associated with worse mortality, morbidity, and resource utilization outcomes in patients admitted with septic shock, except AKI. These findings should be interpreted carefully given the administrative nature of the database, and the population cohort restricted to readmissions.

•Blockchain may be a trusted ally of healthcare institutions across the globe.•The main features of blockchain that make it useful in the healthcare field are immutability, decentralization, and traceability.•Blockchain may play a crucial role in mitigating the COVID-19 challenges.•Blockchain applications are still immature in the fight against COVID-19.

Introduction:Cardiac sarcoidosis (CS) is clinically manifest in 5% of sarcoidosis patients, though up to 25% have subclinical cardiac involvement. Diagnostic advances have improved detection of CS, but much is unknown regarding its optimal management and outcomes.Objective:Using a large national database, we characterized in-hospital outcomes and 30-day readmissions in CS patients.Methods:The 2016 Nationwide Readmissions Database (NRD), accounting for ~36 million discharges in 27 US states with ~58% of the US population, was queried using International Classification of Diseases, 10threvision codes to isolate adult inpatients admitted with CS. Patient characteristics, reasons for hospitalization, diagnostic and therapeutic procedures, in-hospital outcomes, and 30-day readmission causes were collected. Values of interest were counted and their frequencies computed.Results:A total of 1120 patients were included, of whom 1113 had 30-day follow-up data. Mean age was 56 +11 years with 59% male and 51% white subjects. Nearly 77% had a history of heart failure (HF), 46% had ICDs, 8% had PPMs, and 37% had prior chronic kidney disease. The most common causes for hospitalization were arrhythmias (22%) and HF (19%). Sudden cardiac arrest occurred in 1%. While inpatient, ICDs and PPMs were implanted in 6% and 3%, respectively, while 4% underwent catheter ablation and 4% received advanced HF therapies. In 3% of inpatients, CPR was performed, and in-hospital mortality was 1%. In 30-day follow up, unplanned readmission occurred in 28%, with the most common reasons being ventricular tachycardia (16%) and acute heart failure (12%). Nearly 9% had infectious or hematologic causes of readmission.Conclusions:CS hospitalizations are primarily driven by arrhythmic and HF etiologies with an associated high rate of 30-day readmission for similar reasons. Further study is needed to determine if enhanced risk stratification and timely intervention can improve outcomes.

Over the past five decades, the incidence of intravenous drug use- (IVDU-) associated infective endocarditis (IE) has been on the rise in North America. Classically, IVDU has been thought to affect right-sided valves. However, in recent times a more variable presentation of IVDU-associated IE has been reported. Here, we report a case of a patient with a known history of IVDU who presented with clinical symptoms concerning for right- as well as left-sided endocarditis. In addition, we also discuss what should be considered adequate evaluation for patients with suspected endocarditis, and more specifically, what should be the role of transesophageal echocardiography in patients with IE noted on transthoracic echocardiography.

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