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Data on coronary revascularization in patients with cirrhosis are scarce because it is often deferred in the setting of significant comorbidities and coagulopathies. It is unknown whether patients with cardiac cirrhosis have a worse prognosis. The National Inpatient Sample was surveyed to identify patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) from 2016 to 2018. Those with and without liver cirrhosis were propensity score–matched and compared within the PCI and CABG cohorts. Primary outcome was in-hospital mortality. Patients with cirrhosis were further classified into cardiac and noncardiac cirrhosis and their in-hospital mortalities were compared. A total of 1,069,730 PCIs and 273,715 CABGs were performed for ACS, of which 0.6% and 0.7%, respectively, were performed in patients with cirrhosis. In both the PCI cohort (odds ratio = 1.56; 95% confidence interval, 1.10–2.25; P = 0.01) and the CABG cohort (odds ratio = 2.34; 95% confidence interval, 1.19–4.62; P = 0.01), cirrhosis was associated with higher in-hospital mortality. In-hospital mortality was greatest in cardiac cirrhosis (8.4% and 7.1%), followed by noncardiac cirrhosis (5.5% and 5.0%) and no cirrhosis (2.6% and 2.3%) in PCI and CABG cohorts, respectively. Higher in-hospital mortality and periprocedural morbidities should be considered when performing coronary revascularization in patients with cirrhosis.

The prevalence and incidence of end-stage renal disease (ESRD) has been increasing. However, data on inpatient outcomes of hypertensive emergencies in patients with ESRD are lacking. We performed a retrospective study using the largest inpatient database in the United States. Hospitalizations for hypertensive emergency between 2016 and 2018 were identified from the National Inpatient Sample. Propensity score matching was performed between those with and without ESRD. The primary outcome was in-hospital mortality, and secondary outcomes included end-organ complications of hypertensive emergency. Multivariable logistic regression was used to identify potential risk factors of in-hospital mortality. Of 105,565 hospitalizations for hypertensive emergency, 15% occurred in patients with ESRD. Hospitalizations for hypertensive emergency in patients with ESRD were associated with higher odds of cardiac arrest (odds ratio [OR] 4.52, 95% confidence interval [CI] 1.53–13.3, P = 0.01) and acute pulmonary edema (OR 2.80, 95% CI 2.15–3.65, P

Introduction: Immune checkpoint inhibitors (ICIs) have become the cornerstone for treatment of advanced malignancies and have led to long-term tumor responses and improved survival. The body’s immune response to ICIs can lead to unintended consequences (immune-related cardiovascular adverse effects) sometimes involving the heart. Methods: Embase, Ovid, PubMed, and Scopus were searched for ICI randomized phase II or III clinical trials reporting adverse cardiovascular events with combination or monotherapy ICIs (experimental arm) and placebo or standard of care chemotherapy (control arm). The primary outcome was cumulative incidence of cardiovascular adverse effects, and secondary outcomes were isolated incidence of hypertension, myocardial infarction, myocarditis and pericardial effusion. Statistical heterogeneity was quantified using I 2 statistics. Publication bias was assessed with Egger’s regression test. P-value of 0.05 was deemed as statistically significant. Results: Twenty studies (N=13,525) met the inclusion criteria. The studies included 1 small cell and 8 non-small cell lung, 3 renal cell, 1 head & neck, 1 colorectal and 1 prostate cancer with 2 malignant melanoma, 2 multiple myeloma, and 1 mesothelioma. There were 7434 (54.96%) and 6091 (45.04%) patients in the ICI and non-ICI arms, respectively. There was no statistically significant difference in reported cardiovascular toxicity with ICI compared to placebo or standard of care (OR 0.953 95% CI 0.542-1.675, I 2 =89.49 p2 =94.98, P2 =0%, P=0.613), MI (OR 0.76, 95% CI 0.76-3.298 I 2 0%, P=0.83) and myocarditis (OR 2.12, CI 0.638-7.055, I 2 =0%, P=0.185). Conclusions: This meta-analysis demonstrates no significant difference in cardiovascular adverse effects in ICI group when compared to placebo or standard of care.

Background The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. Methods Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be “high,” “moderate,” “low,” or “critically low.” Results Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of “critically low quality” and two were of “low quality.” These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). Conclusions The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2’s rating rules.

Background Heart failure (HF) constitutes a huge public health burden today with acute respiratory infections being among the main precipitating causes for hospitalization. On the other hand, HF is a known risk factor for pneumonia which is the most common cause of adult hospital admissions in the United States. Objective To examine the effect of HF on the in-hospital outcomes of pneumonia Methods The National Inpatient Sample (NIS) database, 2016–2018, was queried for inpatient principal diagnosis of all-cause pneumonia, and the study group was stratified into those with and without HF as a secondary diagnosis, using International Classification of Diseases-10 (ICD-10) codes. Multivariate logistic and linear regression analyses were used to adjust for confounding. Stata 16 software was used for data analysis. Results 1,929,598 adults were hospitalized with the primary diagnosis of pneumonia, of which 499,740 (25.9%) had HF. The incidence of mortality was 4.2% (n=20,785) in those with HF compared to 2.0% (n=28,365) in those without HF. The adjusted odds ratio (aOR) of inpatient mortality for pneumonia patients with HF compared to those without HF was 1.35 (95% CI, 1.29–1.42; p Conclusion In patients hospitalized for pneumonia, HF is associated with increased odds of inpatient mortality and longer LOS. Complications such as arrhythmias, acute hypoxic respiratory failure, acute kidney injury, septic shock, cardiogenic shock and cardiac arrest occur more frequently in pneumonia patients with HF. Funding Acknowledgement Type of funding sources: None. Figure 1

Cardiovascular effects of hypothyroidism include bradycardia, diastolic hypertension, atrial fibrillation, prolonged QT interval leading to torsades de pointes, varying degrees of AV block, accelerated coronary artery disease, and pericardial effusion. Cardiac tamponade is rare in patients with hypothyroidism because of pericardial distensibility and slow accumulation of fluid. The amount and rate of accumulation of pericardial effusion are related to the severity of hypothyroidism. Though rare, significant pericardial effusion can be a manifestation of subclinical hypothyroidism.

The preoperative differentiation of left ventricular aneurysm from pseudoaneurysm is a diagnostic challenge. This distinction is critical as the timing of surgical correction varies; elective for true aneurysm versus urgent for pseudoaneurysm. Our aim is to present a case report demonstrating these difficulties and to review imaging characteristics and the approach to distinguish the two entities.

BRASH syndrome is characterized by bradycardia, renal failure, use of an atrioventricular nodal blocker (AVNB), shock, and hyperkalemia. These symptoms represent an ongoing vicious cycle in a patient with a low glomerular filtration rate taking an AVNB. Decreased clearance of the medication and hyperkalemia associated with renal failure synergize to cause bradycardia and hypoperfusion. This reaction causes renal function to worsen, thereby perpetuating the cycle of BRASH syndrome.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with varied natural history and multisystemic involvement. The pathogenesis is multifactorial and complex precipitating the formation of autoantibodies. One of the main factors in SLE is the interaction between environmental triggers and genetic factors. Genome-wide association study technology has led to the identification of more than 80 loci which produce key proteins that lead to small pathophysiological changes and are associated with SLE. There has been an improvement in the management of the disease with newly standardized scores that have been validated in assessing disease activity and quality of life, and have helped in clinical care as well as research. The last five decades have seen a marked improvement in the prognosis of SLE, thanks to better general care and the development of newer immunosuppressive drugs, more specifically biological agents.

Over ongoing decades, the global demand for potable water is expanding quickly; at the same time, the supply of potable water is restricted due to fast advancement in industrialization, the devastation of trees, less awareness towards the plantation, and population growth. There are numerous freshwater production methods available in this world, in that solar-based still (Solar still) is one of the most normal and least expensive techniques. A lot of examinations have been portrayed experimentally and theoretically on the solar stills for evaluating its performance under different climatic and working environment. Heat and mass transfer are the two key factors that play a vital role in the evaluation of solar still's performance. In this study various experimental and theoretical methodologies that have been utilized to evaluate the heat and mass transfer analysis of solar stills using wick materials are critically reviewed. While looking into consideration, the reviewed articles demonstrate that the efficiency of the solar stills relies upon the various outside and inside working parameters. The result revealed that the wick materials with high porous values are produced better productivity than the low porous wick materials.

A majority of the elderly suffer from chronic pain that significantly alters their daily activities and imposes an enormous burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it a challenge to determine the appropriate drug, dosage, and maintenance of therapy. Opioids are the most commonly used agents for this purpose in the elderly. The aim of this article is to discuss both the current well-established therapies used for managing chronic pain in the elderly and also the emerging newer therapies.