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Background: Pre‐left ventricular assist device (LVAD) pectoralis muscle assessment, an estimate of sarcopenia, has been associated with postoperative mortality and gastrointestinal bleeding, though its association with inflammation, endotoxemia, length‐of‐stay (LOS), and readmissions remains underexplored. Methods: This was a single‐center cohort study of LVAD patients implanted 1/2015–10/2018. Preoperative pectoralis muscle area was measured on chest computed tomography (CT), adjusted for height squared to derive pectoralis muscle area index (PMI). Those with PMI in the lowest quintile were defined as low‐PMI cohort; all others constituted the reference cohort. Biomarkers of inflammation (interleukin‐6, adiponectin, tumor necrosis factor‐α [TNFα]) and endotoxemia (soluble (s)CD14) were measured in a subset of patients. Results: Of the 254 LVAD patients, 95 had a preoperative chest CT (median days pre‐LVAD: 7 [IQR 3–13]), of whom 19 (20.0%) were in the low‐PMI cohort and the remainder were in the reference cohort. Compared with the reference cohort, the low‐PMI cohort had higher levels of sCD14 (2594 vs. 1850 ng/mL; p = 0.04) and TNFα (2.9 vs. 1.9 pg/mL; p = 0.03). In adjusted analyses, the low‐PMI cohort had longer LOS (incidence rate ratio 1.56 [95% confidence interval 1.16–2.10], p = 0.004) and higher risk of 90‐day and 1‐year readmissions (subhazard ratio 5.48 [1.88–16.0], p = 0.002; hazard ratio 1.73 [1.02–2.94]; p = 0.04, respectively). Conclusions: Pre‐LVAD PMI is associated with inflammation, endotoxemia, and increased LOS and readmissions. [ABSTRACT FROM AUTHOR]

Background: The use of glucagon‐like‐peptide 1 receptor agonists (GLP1‐RA) has dramatically increased over the past 5 years for diabetes mellitus type 2 (T2DM) and obesity. These comorbidities are prevalent in adult heart transplant (HT) recipients. However, there are limited data evaluating the efficacy of this drug class in this population. The aim of the current study was to describe cardiometabolic changes in HT recipients prescribed GLP1‐RA at a large‐volume transplant center. Methods: We retrospectively reviewed all adult HT recipients who received GLP1‐RA after HT for a minimum of 1‐month. Cardiometabolic parameters including body mass index (BMI), lipid panel, hemoglobin A1C, estimated glomerular filtration rate (eGFR), and NT‐proBNP were compared prior to initiation of the drug and at most recent follow‐up. We also evaluated for significant dose adjustments to immunosuppression after drug initiation and adverse effects leading to drug discontinuation. Results: Seventy‐four patients were included (28% female, 53% White, 20% Hispanic) and followed for a median of 383 days [IQR 209, 613] on a GLP1‐RA. The majority of patients (n = 56, 76%) were prescribed semaglutide. The most common indication for prescription was T2DM alone (n = 33, 45%), followed by combined T2DM and obesity (n = 26, 35%). At most recent follow‐up, mean BMI decreased from 33.3 to 31.5 kg/m2 (p < 0.0001), HbA1C from 7.3% to 6.7% (p = 0.005), LDL from 78.6 to 70.3 mg/dL (p = 0.018) and basal insulin daily dose from 32.6 to 24.8 units (p = 0.0002). Conclusion: HT recipients prescribed GLP1‐RA therapy showed improved glycemic control, weight loss, and cholesterol levels during the study follow‐up period. GLP1‐RA were well tolerated and were rarely associated with changes in immunosuppression dosing. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is common in patients with transthyretin cardiac amyloidosis (ATTR-CA). The optimal strategy to prevent strokes in patients with ATTR-CA and AF is unknown. To compare outcomes in patients with ATTR-CA and AF treated with warfarin versus novel oral anticoagulants (NOACs). This study was a retrospective analysis of patients with ATTR-CA stratified by presence or absence of AF and anticoagulation therapy. The primary outcome included a time to event analysis for the combined outcomes of stroke, transient ischaemic attack (TIA), major bleed, or death. Of 290 patients, 217 patients (74.8%) had AF. Of those with AF (n = 217), 78 (35.9%) patients received warfarin compared with 116 (53.5%) patients who received NOACs. There were 17 thrombotic events, all in those diagnosed with AF compared with none in the patients without AF (p =.01). Over a mean follow-up of 2.4 years (range 0.1–12) there was no difference in primary outcome between those with AF treated with warfarin compared with NOACs (p =.35). Patient with ATTR-CA and AF are at increased risk for stroke compared to patients with ATTR-CA and without AF. Thrombotic events and major bleeds did not differ between those who received warfarin and NOACs. [ABSTRACT FROM AUTHOR]

Background: Patients with transthyretin (TTR) cardiac amyloidosis demonstrate cardiac cachexia with progression of their cardiomyopathy, which is characterised by malnutrition and a heightened inflammatory state. How best to measure this condition is less well characterised. We investigated differences in survival among patients with ATTR cardiac amyloidosis by nutritional status as defined by modified BMI (mBMI) and by inflammatory state as defined by serum uric acid. Methods and results: This study was a retrospective analysis of patients diagnosed with ATTR cardiac amyloidosis at a single tertiary medical centre. Baseline characteristics were compared by nutritional status as measured by mBMI and by inflammatory state as measured by serum uric acid. Kaplan-Meier survival analyses were used to compare nutritional status and inflammatory status for the composite outcome of death. Cox proportional hazards modelling was used to assess predictors of death in this cohort. Three hundred patients (mean age 75 ± 11) years, 84.3% male) were included. Those with low mBMI (<1185 kg/m2 g/L) had shorter time to death (5.4 vs. 6.8 years, log rank p =.045) and those with elevated serum uric acid (>8.8 mg/dL) had shorter time to death (4.9 vs. 7.7 years, log rank p <.0001). Those with both low mBMI and elevated serum uric acid had the shortest time to death (4.3 years, log rank p =.005). In this cohort, mBMI was not a univariate predictor of death though there was a trend towards significance (HR 0.92, per 100 kg/m2 g/L, 95% CI 0.828–1.016, p =.099). Serum uric acid was a univariate predictor of death (HR 1.27 per 1 mg/dL, 95% CI 1.114–1.455, p <.001). In multivariate Cox analysis, this association remained significant (HR 1.31 per 1 mg/dL increase, 95% CI 1.096–1.560, p =.003) as well as in a separate stepwise model controlling for potential confounders including daily diuretic use, uric acid lowering therapy, and renal dysfunction. Conclusions: Both nutritional status as measured by mBMI and inflammation as measured by serum uric acid are associated with survival in patients with TTR cardiac amyloidosis however only serum uric acid is an independent predictor of death. [ABSTRACT FROM AUTHOR]

Introduction: Patients with coronary artery disease (CAD) who make healthy lifestyle changes can greatly impact their disease trajectories. However, the clinical profile of patients more likely to participate in programs aimed at improving lifestyle choices remains uncertain. The objective of this analysis was to examine the baseline clinical profile of patients with CAD motivated to enroll in an eight-week diet study versus those who chose not to enroll. Methods: The study population included patients with angiographically-defined CAD (≥50% lesion in an artery ≥2 mm caliber or prior percutaneous coronary intervention) who provided informed consent to participate in a single-center, prospective, blinded end-point, randomized trial assessing the impact of a vegan versus AHA-recommended diet on inflammatory and glucometabolic profiles. Data collection was obtained by direct interview and exam of patients who chose to enroll in and complete the trial. Electronic medical records were reviewed for patients who provided informed consent but subsequently declined to participate in the study prior to any study intervention, including randomization. Normally distributed and skewed continuous variables were examined by enrollment status with independent samples t-test and Mann-Whitney U test, respectively. Categorical variables were examined by enrollment status by Fisher's exact test or Chi-square test. Results: Of the 90 patients consented, 60 chose to enroll into the study while 30 chose not to enroll. Compared to those who chose to participate in the study, those who chose not to participate were less likely to be of white race (70% (21/30) vs. 85% (51/60), p=0.002). Other demographic variables including age, sex, ethnicity or BMI did not differ by enrollment. Regarding medical history, patients who chose not to participate were more likely to have diagnoses associated with cardiovascular risk, including hypertension (86.7% (26/30) vs. 56.7% (34/60), p=0.005), hyperlipidemia (96.7% (29/30) vs. 71.7% (43/60), p=0.005), and diabetes mellitus (43.3% (13/30) vs. 21.7% (13/60), p=0.048). Analyses of laboratory parameters revealed that patients who did not participate in the study also had poorer risk factor control, including higher hemoglobin A1c (6.0% (IQR 5.7-7.8%) vs. 5.8% (IQR 5.5-6.3%), p=0.043) as well as lower HDL cholesterol levels (42 g/dL (IQR 34-47) vs. 45 g/dL (IQR 37-55), p=0.046). Conclusion: Among this sample of patients with angiographically-defined CAD, those who chose not to participate in an eight week dietary intervention to lower disease risk were more likely to be of a minority race with a higher proportion of poorly controlled cardiovascular risk factors at baseline. This analysis emphasizes the need for health care teams to consider different strategies of encouraging these high-risk patients to enroll in programs aimed at healthy lifestyle changes. [ABSTRACT FROM AUTHOR]

Abstract: Variations in fat preference and intake across humans are poorly understood in part because of difficulties in studying this behavior. The objective of this study was to develop a simple procedure to assess fat discrimination, the ability to accurately perceive differences in the fat content of foods, and assess the associations between this phenotype and fat ingestive behaviors and adiposity. African-American adults (n =317) were tested for fat discrimination using 7 forced choice same/different tests with Italian salad dressings that ranged in fat-by-weight content from 5 to 55%. Performance on this procedure was determined by tallying the number of trials in which a participant correctly identified the pair of samples as “same” or “different” across all test pairs (ranging from 1 to 7). Individuals who received the lowest scores on this task (≤3 out of 7 correct) were classified as fat non-discriminators (n =33) and those who received the highest scores (7 out of 7 correct) were classified as fat discriminators (n =59). These 2 groups were compared for the primary outcome variables: reported food intake, preferences, and adiposity. After adjusting for BMI, sex, age, and dietary restraint and disinhibition, fat non-discriminators reported greater consumption of both added fats and reduced fat foods (p<0.05 for both). Fat non-discriminators also had greater abdominal adiposity compared to fat discriminators (p<0.05). Test–retest scores performed in a subset of participants (n =40) showed moderate reliability of the fat discrimination test (rho=0.53; p<0.01). If these results are replicated, fat discrimination may serve as clinical research tool to identify participants who are at risk for obesity and other chronic diseases due to increased fat intake. [Copyright &y& Elsevier]

This study presents our recent findings on the classification of mean pressure gradient using angular chest movements in aortic stenosis (AS) patients. Currently, the severity of aortic stenosis is measured using ultra-sound echocardiography, which is an expensive technology. The proposed framework motivates the use of low-cost wearable sensors, and is based on feature extraction from gyroscopic readings. The feature space consists of the cardiac timing intervals as well as heart rate variability (HRV) parameters to determine the severity of disease. State-of-the-art machine learning (ML) methods are employed to classify the severity levels into mild, moderate, and severe. The best performance is achieved by the Light Gradient-Boosted Machine (Light GBM) with an F1-score of 94.29% and an accuracy of 94.44%. Additionally, game theory-based analyses are employed to examine the top features along with their average impacts on the severity level. It is demonstrated that the isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) are the most representative features for AS severity.Clinical Relevance- The proposed framework could be an appropriate low-cost alternative to ultra-sound echocardiography, which is a costly method.