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Background Based on the severity of cardiovascular disease (CVD) and sensory impairment in China and the lack of research on this, the aims of our study were to assess the impact of hearing impairment (HI), visual impairment (VI), and concurrent HI and VI (termed dual sensory impairment) on CVD in elderly people, based on a representative sample of China. Methods and Results We used data from the CHARLS (China Health and Retirement Longitudinal Study) for our survey of 11 332 participants. We calculated hazard ratios (HRs) and 95% 95% CIs for CVD, stroke, and cardiac events by using Cox proportional hazards models. HI and VI status were collected through self‐reported questions. During the 7‐year follow‐up, a total of 2156 participants experienced CVD (including 745 stroke and 1605 cardiac events). Compared with the reference, individuals with VI had higher risk of CVD (HR, 1.24 [95% CI, 1.09–1.40]). Individuals with HI also had higher risk of CVD than those without HI (HR, 1.20 [95% CI, 1.09–1.33]). Compared with participants without VI and HI, individuals with dual sensory impairment had a 1.35‐fold increased risk of CVD (HR, 1.35 [95% CI, 1.16–1.57]). In addition, individuals with dual sensory impairment also had increased risk of stroke and cardiac events. Conclusions Our study shows that HI and VI have a combined effect on the incidence of CVD. Based on the high prevalence of CVD around the world, early detection of sensory disorders and the adoption of appropriate measures may contribute to prevent CVD and reduce the burden of clinical diagnosis and treatment of CVD.

This study explores narratives of sixteen individuals who have experienced a traumatic cardiac event, defined in this study as an event that has caused damage to the heart and required medical attention. Using narrative theory, this study found that individuals demonstrate tension between information that was given and received regarding their cardiac event, leading participants to work through both chaos and quest narratives but never reaching restitution. The findings suggest that the conceptualization of quest narratives be broadened to incorporate health narratives that will not reach a restitution and begin exploring how individuals can communicate different narrative types simultaneously. [ABSTRACT FROM AUTHOR]

Background Temporal trends and risk factors of perioperative cardiac events (PCEs) in patients over 80 years old with coronary artery disease (CAD) undergoing noncardiac surgery are still unclear. Methods We retrospectively reviewed 1478 patients over 80 years old, with known CAD undergoing selective noncardiac surgery in a single center (2014–2022). Patients were divided into three equal time groups based on the discharge date (2014–2016, 2017–2019, and 2020–2022), with 367, 473, and 638 patients in Groups 1–3, respectively. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCEs intraoperatively or during hospitalization postoperatively, defined as any of the following events: myocardial infarction, heart failure, nonfatal cardiac arrest, and death. Results PCEs occurred in 180 (12.2%) patients. Eight independent risk factors were associated with PCEs, including four clinical factors (body mass index < 22 kg/m2, history of myocardial infarction, history of heart failure, and general anesthesia) and four preoperative laboratory results (hemoglobin < 110 g/L, albumin < 40 g/L, creatinine > 120 μmol/L, and potassium <3.6 mmol/L). Significant rising trends were seen over the 9-year study period in the incidence of PCEs and independent risk factors including history of myocardial infarction, history of heart failure, general anesthesia, preoperative hemoglobin < 110 g/L, preoperative albumin < 40 g/L, and preoperative creatinine > 120 μmol/L (P for trend <0.05). Conclusion The incidence and independent risk factors of PCEs in patients over 80 years old with CAD undergoing noncardiac surgery showed significant rising trends over the last 9-year period.   What is already known on this topic   1) Ever-increasing noncardiac surgeries are performed in patients over 80 years old with coronary artery disease (CAD). 2) This population have high risk of perioperative cardiac events (PCEs). What this study adds   1) The incidence of PCEs in patients over 80 years old with CAD undergoing noncardiac surgery showed significant rising trends over the last 9-year period. 2) Eight independent risk factors were associated with PCEs, including body mass index, history of myocardial infarction, history of heart failure, general anesthesia, and four preoperative laboratory results (hemoglobin, albumin, creatinine, and potassium). 3) Significant rising temporal trends were seen in the independent risk factors. How this study might affect research, practice, or policy   More comprehensive preoperative evaluation and regular perioperative monitoring would be necessary to reduce the occurrence of PCEs in this high-risk population. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) poses significant perioperative risks, yet limited research exists to quantify these complications. Aims and Objectives: The study aims to fill this gap by investigating a variety of perioperative complications in OSA patients. The primary objective was to assess the types and prevalence of perioperative complications across diverse surgical procedures. Materials and Methods: A cohort of 100 OSA patients undergoing different surgical interventions was monitored prospectively. Descriptive statistics, Chi-square tests, independent t-tests, and logistic regression were employed to evaluate the data. Results: In this cohort study involving 100 OSA patients, 57% experienced at least one perioperative complication, most commonly postoperative hypoxemia (23%), cardiac events (18%), and delirium (12%). The mean age for those with complications was 56 years, significantly higher than the 52 years for those without complications (P60) were more prone to delirium (P

Kimberly Daniels,1 Stephan Lanes,1 Arlene Tave,1 Michael F Pollack,2 David M Mannino,3 Gerard Criner,4 Amanda Neikirk,1 Kirsty Rhodes,5 Norbert Feigler,2 Clementine Nordon5 1Safety and Epidemiology, Carelon Research, Wilmington, DE, USA; 2Global Medical Affairs, AstraZeneca, Wilmington, DE, USA; 3College of Medicine, University of Kentucky, Lexington, KY, USA; 4Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 5BioPharmaceuticals Medical, AstraZeneca, Cambridge, UKCorrespondence: Kimberly Daniels, Safety and Epidemiology, Carelon Research, 123 Justison Street, Suite 200, Wilmington, DE, 19801, USA, Tel +1 443-812-1731, Email Kimberly.Daniels@carelon.comPurpose: This study estimated the magnitude and duration of risk of cardiovascular events and mortality following acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and whether risks varied by number and severity of exacerbation in a commercially insured population in the United States.Methods: This was a retrospective cohort study of newly diagnosed COPD patients ≥ 40 years old in the Healthcare Integrated Research Database from 2012 to 2019. Patients experiencing exacerbations comprised the “exacerbation cohort”. Moderate exacerbations were outpatient visits with contemporaneous antibiotic or glucocorticoid administration; severe exacerbations were emergency department visits or hospitalizations for AECOPD. Follow-up started on the exacerbation date. Distribution of time between diagnosis and first exacerbation was used to assign index dates to the “unexposed” cohort. Cox proportional hazards models estimated risks of a cardiovascular event or death following an exacerbation adjusted for medical and prescription history and stratified by follow-up time, type of cardiovascular event, exacerbation severity, and rank of exacerbation (first, second, or third).Results: Among 435,925 patients, 170,236 experienced ≥ 1 exacerbation. Risk of death was increased for 2 years following an exacerbation and was highest during the first 30 days (any exacerbation hazard ratio (HR)=1.79, 95% CI=1.58— 2.04; moderate HR=1.22, 95% CI=1.04— 1.43; severe HR=5.09, 95% CI=4.30— 6.03). Risks of cardiovascular events were increased for 1 year following an AECOPD and highest in the first 30-days (any exacerbation HR=1.34, 95% CI=1.23— 1.46; moderate HR=1.23 (95% CI 1.12— 1.35); severe HR=1.93 (95% CI=1.67— 2.22)). Each subsequent AECOPD was associated with incrementally higher rates of both death and cardiovascular events.Conclusion: Risk of death and cardiovascular events was greatest in the first 30 days and rose with subsequent exacerbations. Risks were elevated for 1– 2 years following moderate and severe exacerbations, highlighting a sustained increased cardiopulmonary risk associated with exacerbations.Keywords: COPD, cardiopulmonary, cardiac events, epidemiology, longitudinal studies

Background: Obstructive sleep apnea (OSA) poses significant perioperative risks, yet limited research exists to quantify these complications. Aims and Objectives: The study aims to fill this gap by investigating a variety of perioperative complications in OSA patients. The primary objective was to assess the types and prevalence of perioperative complications across diverse surgical procedures. Materials and Methods: A cohort of 100 OSA patients undergoing different surgical interventions was monitored prospectively. Descriptive statistics, Chi-square tests, independent t-tests, and logistic regression were employed to evaluate the data. Results: In this cohort study involving 100 OSA patients, 57% experienced at least one perioperative complication, most commonly postoperative hypoxemia (23%), cardiac events (18%), and delirium (12%). The mean age for those with complications was 56 years, significantly higher than the 52 years for those without complications (P<0.05). Abdominal surgeries were particularly associated with hypoxemia (P<0.05), while preexisting cardiac conditions predisposed to cardiac events (P<0.01). Older patients (>60) were more prone to delirium (P<0.05). Complication severity varied, with 29 mild, 20 moderate, and 8 severe cases requiring an intensive care unit. Diabetes and hypertension emerged as significant predictors, with odds ratios of 2.5 and 2.8, respectively (P<0.05). Conclusion: This study highlights the substantial risk of perioperative complications among OSA patients, especially those with certain pre-existing conditions, older age, or undergoing specific types of surgeries. The findings suggest the need for specialized perioperative care plans for these patients to mitigate the risks. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular events, including heart failure and arrhythmias, following chimeric antigen receptor (CAR) T‐cell therapy are increasingly recognized. Although global longitudinal strain (GLS) has demonstrated prognostic utility for other cancer therapy‐related cardiac dysfunction, less is known regarding the association of GLS with adverse cardiac events following CAR T‐cell therapy. Objectives: To determine the association of baseline GLS with adverse cardiovascular events in adults receiving CAR‐T cell therapy. Methods: Patients who had an echocardiogram within 6 months prior to receiving CAR T‐cell therapy were retrospectively identified. Clinical data and cardiac events were collected via chart review. Echocardiograms were analyzed offline for GLS, left ventricular ejection fraction, and Doppler parameters. Multivariable logistic regression was used to determine the association between adverse cardiovascular events and echocardiographic parameters. Results: Among 75 CAR T‐cell therapy patients (mean age 63.9, 34.7% female), nine patients (12%) experienced cardiac events (CEs) including cardiovascular death, new/worsening heart failure, and new/worsening arrhythmia within 1 year of treatment. In univariable models, higher baseline GLS (OR 0.78 [0.63, 0.96], p =.021) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.40 [1.08, 1.81], p =.012) was associated with a higher risk of CE. After adjusting for age and LDH, higher baseline GLS (OR 0.65 [0.48–0.88], p = <.01) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.56 [1.06, 2.29], p =.024) was associated with a higher risk of CE. Conclusion: Lower GLS and higher mitral E/e' on a baseline echocardiogram were associated with higher risk for CEs in patients receiving CAR T‐cell therapy. [ABSTRACT FROM AUTHOR]

Background: Assessment of left ventricular ejection fraction (LVEF) and myocardial deformation with global longitudinal strain (GLS) has shown promise in predicting adverse cardiovascular events. The aim of this study was to evaluate whether artificial intelligence (AI) calculated LVEF and GLS is associated with major adverse cardiac events (MACE) and all‐cause mortality in patients presenting with chest pain. Methods: We studied 296 patients presenting with chest pain, who underwent transthoracic echocardiography (TTE). Clinical data, downstream clinical investigations and patient outcomes were collected. Resting TTE images underwent AI contouring for automated calculation of LVEF and GLS with Ultromics EchoGo Core 2.0. Regression analysis was performed to identify clinical and AI calculated parameters associated with MACE and all‐cause mortality. Results: During a median follow‐up period of 7.8 years (IQR 6.4, 8.8), MACE occurred in 34 (11.5%) patients and all‐cause mortality in 60 (20%) patients. AI calculated LVEF (Odds Ratio [OR].96; 95% CI.93–.99 and.96; 95% CI.93–.99) and GLS (1.11; 95% CI 1.01–1.21 and 1.08; 95% CI 1.00–1.16) were independently associated with MACE and all‐cause mortality, respectively. According to Cox proportional hazards, a LVEF < 50% was associated with a 3.7 times MACE and 2.8 times all‐cause mortality hazard rate compared to those with a LVEF ≥ 50%. Those with a GLS ≥ 15% was associated with a 2.5 times MACE and 2.3 times all‐cause mortality hazard rate compared to those with a GLS ≤ 15. Conclusion: AI calculated resting LVEF and GLS is independently associated with MACE and all‐cause mortality in high CVD risk patients. These results may have significant clinical implications through improved risk stratification of patients with chest pain, accelerated workflow of labour‐intensive technical measures, and reduced healthcare costs. [ABSTRACT FROM AUTHOR]

Liver diseases affect the heart and the vascular system. Cardiovascular complications appear to be a leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and cirrhosis. The predominant histological changes in the liver range from steatosis to fibrosis to cirrhosis, which can each affect the cardiovascular system differently. Patients with cirrhotic cardiomyopathy (CCM) and NAFLD are at increased risk of impaired systolic and diastolic dysfunction and for suffering major cardiovascular events. However, the pathophysiological mechanisms behind these risks differ depending on the nature of the liver disease. Accurate assessment of symptoms by contemporary diagnostic modalities is essential for identifying patients at risk, for evaluating candidates for treatment, and prior to any invasive procedures. This review explores current perspectives within this field. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the causal role of venous thrombolism mediating sodium-glucose cotransporter 2 (SGLT2) inhibition in death due to cardiac causes using Mendelian randomization (MR).MethodsA two-sample two-step MR was used to determine (1) the causal effects of SGLT2 inhibition on death due to cardiac causes; (2) the causal effects of venous thrombolism on death due to cardiac causes; and (3) the mediation effects of venous thrombolism. Genetic proxies for SGLT2 inhibition were identified as variants in the SLC5A2 gene that were associated with both levels of gene expression and hemoglobin A1c. Additionally, employing MR to investigate the causal association between SGLT2 inhibition and cardiac arrest as well as coronary heart disease (CHD).ResultsSGLT2 inhibition was associated with a lower risk of death due to cardiac causes (odds ratio [OR] = 0.983, [95% CI = 0.972, 0.993], P = 0.0016). Venous thrombolism was associated with death due to cardiac causes ([OR] = 1.031, [95% CI = 1.005, 1.057], P = 0.0199). Mediation analysis showed evidence of indirect effect of SGLT2 inhibition on death due to cardiac causes through venous thrombolism [β = −0.0015, (95% CI = −0.0032 −0.0002), P = 0.042], with a mediated proportion of 8.9% (95% CI = 1.2%, 18.7%) of the total. Furthermore, SGLT2 inhibition was linked to a lower risk of cardiac arrest ([OR] = 0.097, [95% CI = 0.013, 0.742], P = 0.025). SGLT2 inhibition was linked to a lower risk of CHD ([OR] = 0.957, [95% CI = 0.932, 0.982], P = 0.0009).ConclusionsOur study identified the causal roles of SGLT2 inhibition in venous thrombolism. SGLT2 inhibition may influence death due to cardiac causes through venous thrombolism. Additionally, SGLT2 inhibition was associated with reduced risk of cardiac arrest and CHD.

Syed Omair Adil,1,2 Fareed Uddin,3 Kamarul Imran Musa,1 Asima Khan,4 Areebah Shakeel,5 Kashif Shafique,2 Md Asiful Islam6 1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, 16150, Malaysia; 2School of Public Health, Dow University of Health Sciences (DUHS), Karachi, Pakistan; 3National Institute of Diabetes & Endocrinology, DUHS, Karachi, Pakistan; 4Public Health Department, Baqai Institute of Diabetology & Endocrinology, Karachi, Pakistan; 5Department of Research, Children Hospital Karachi, Karachi, Pakistan; 6WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UKCorrespondence: Md Asiful Islam, WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK, Email m.a.islam@bham.ac.uk Syed Omair Adil, Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Malaysia, Email omair.adil@student.usm.myPurpose: The presence of metabolic syndrome (MetS) is linked to an increased risk of cardiovascular disease (CVD) development. In this study, CVD risk was calculated among individuals with newly diagnosed MetS using the Framingham Risk Score (FRS) and Globorisk Score. The FRS and Globorisk score are particularly relevant in predicting CVD risk as these scores include key MetS-related risk factors like blood pressure, cholesterol levels, and age.Patients and Methods: A community-based cross-sectional study was conducted at various sites in Karachi, Pakistan, from February 2022 to August 2022. Newly diagnosed cases of MetS with no physical disability, known illness, and not taking any regular medication were recruited. MetS was defined based on the definition of International Diabetes Federation. The major outcome was 10-year risk for CVD using the FRS and Globorisk Score.Results: Of 304 patients, 59.2% were classified as low risk according to FRS, while 20.4% were classified as moderate and high risk each. Using the Globorisk score, 44.6% of 224 patients were classified as low risk, 34.4% as moderate risk, and 21.0% as high risk. A moderate positive correlation was observed between the two CVD risk scores (r = 0.651, 95% CI 0.58– 0.71). Both risk scores have reported age, gender, and current smokers as significant risk factors in predicting CVD in 10-years (P < 0.05).Conclusion: The outcome of both CVD risk scores predicted moderate-to-high risk of CVD in 10-years in almost half of the newly diagnosed patients with MetS. In particular, the risk of development of CVD in 10-years in newly diagnosed MetS is higher with increasing age, in male gender, and current smokers.&#x00A0Keywords: cardiometabolic syndrome, diabetes, hypertension, obesity, dyslipidemia, cardiac events

Homelessness is associated with excess cardiovascular morbidity and mortality. This study reports on the long-term effects of a Canadian housing first initiative, compared to treatment as usual, on major cardiovascular events among adults experiencing homelessness and mental illness. Over the 7-year follow-up period, 34 of 527 participants (6.5%) experienced at least one cardiovascular event. There was no significant difference in the incidence of cardiac events between the housing first and treatment as usual groups. Strengths of this study include its randomized controlled design and use of comprehensive administrative databases to ascertain cardiac events. However, a relatively small sample size limited power to determine whether housing reduced the incidence of major adverse cardiovascular events. Notwithstanding these limitations, additional interventions aimed at improving cardiovascular outcomes are likely to be beneficial for patients undergoing a housing intervention. Trial registration: ISRCTN.org identifier: ISRCTN42520374. [ABSTRACT FROM AUTHOR]

Background: Global longitudinal strain (GLS) imaging is a multifaceted modality that has been utilized in various fields of clinical cardiology in the recent past; however, its implementation for the assessment of ischemia has been limited. Objectives: This study aimed to document the functional changes in GLS secondary to acute myocardial ischemia in patients with chronic chest pain. Methods: In this unblinded, single-center, investigator-initiated, prospective pilot study, the functional changes in GLS at baseline, during, and immediately following coronary percutaneous intervention were monitored in 10 ambulatory patients who underwent elective catheterization. The exclusion criteria included a low ejection fraction, or a history of chemoradiation, myopathy, and congenital heart disease. Results: The average GLS at baseline, during the balloon intervention (BI), and 1–2 min after BI was −15.4 % ± 3.3 %, −10.2 % ± 3.6 %, and −16.1 % ± 4.2 %, respectively. The average GLS decreased significantly by 5.1 % (95 % CI, −7.9 % to −2.3; P = 0.0013) from baseline to BI, increased by 6.3 % (95 % CI, 3.7 % to 8.9 %; P

Coronary computed tomography angiography (CCTA) can identify high-risk coronary plaque types. However, the inter-observer variability for high-risk plaque features, including low attenuation plaque (LAP), positive remodelling (PR), and the Napkin-Ring sign (NRS), may reduce their utility, especially amongst less experienced readers. In a prospective study, we compared the prevalence, location and inter-observer variability of both conventional CT-defined high-risk plaques with a novel index based on quantifying the ratio of necrotic core to fibrous plaque using individualised X-ray attenuation cut-offs (the CT-defined thin-cap fibroatheroma - CT-TCFA) in 100 patients followed-up for 7 years. In total, 346 plaques were identified in all patients. Seventy-two (21%) of all plaques were classified by conventional CT parameters as high-risk (either NRS or PR and LAP combined), and 43 (12%) of plaques were considered high-risk using the novel CT-TCFA definition of (Necrotic Core/fibrous plaque ratio of >0.9). The majority (80%) of the high-risk plaques (LAP&PR, NRS and CT-TCFA) were located in the proximal and mid-LAD and RCA. The kappa co-efficient of inter-observer variability (k) for NRS was 0.4 and for PR and LAP combined 0.4. While the kappa co-efficient of inter-observer variability (k) for the new CT-TCFA definition was 0.7. During follow-up, patients with either conventional high-risk plaques or CT-TCFAs were significantly more likely to have MACE (Major adverse cardiovascular events) compared to patients without coronary plaques (p value 0.03 & 0.03, respectively). The novel CT-TCFA is associated with MACE and has improved inter-observer variability compared with current CT-defined high-risk plaques. • We define a novel high-risk coronary plaque, the CT-TCFA based on the CT-defined ratio of necrotic core to fibrous plaque. • CT-TCFA significantly overlap with current CT-defined high-risk coronary plaque with a predilection to proximal coronaries. • The inter-observer variability of CT-TCFAs is lower than conventional CT-defined high-risk coronary plaques. • The presence of CT-TCFA is associated with increased MACE over long term follow up. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of COVID-19 positivity on outcomes and resource utilization in the trauma population. Introduction: COVID-19 infection worsens outcomes of trauma patients, but it is not known if asymptomatic COVID-19 trauma patients have different outcomes from COVID-19-negative patients. Methods: All trauma patients admitted to an urban level 1 trauma center between March 2020 and October 2021 were collected and reviewed for COVID-19 status. COVID-19-positive patients with symptoms or initial chest radiographs consistent with infections were excluded. Propensity score model 1:3 matched asymptomatic COVID-19-positive to COVID-19-negative trauma patients for their age, body mass index, MOA, injury severity score, SBP<90, GCS<9, and comorbidities. Outcomes included mortality, complications, and resource utilization. Results: A total of 185 asymptomatic COVID-19-positive patients were matched with 554 COVID-19-negative patients. Asymptomatic COVID-19 -positive patients had higher rates of myocardial infarction and cardiac arrest (3.2% vs. 0.9%, P =0.023), higher ventilator days (3.33 vs. 1.49 days, P <0.001), ICU-length of stay [LOS (4.92 vs. 3.41 d, P =0.034)], overall LOS (11.41 vs. 7.24 d, P <0.001), and hospital charges ($ 176.505.80 vs. 107.591.93, P =0.002). Conclusion: Asymptomatic COVID-19 trauma patients have significantly higher rates of cardiac events, longer LOS, and higher hospital charges when compared with similar trauma patients who are COVID-19-negative. [ABSTRACT FROM AUTHOR]

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BackgroundPediatric liver transplantation is an important modality for treating biliary atresia. The overall survival rate of pediatric liver transplantation has significantly improved. The incidence of perioperative cardiac events was evaluated, and risk factors were also investigated in adult patients undergoing liver transplantation in previous studies. To the best of our knowledge, this is the first case of a cardiac event during a pediatric living-donor liver transplantation.Case summaryOur report describes the management of cardiac events during a liver transplantation in a 7-month-old girl. The ST segment began to increase to 3.0 mm immediately after reperfusion, with peak ST-segment elevation reaching 13.2 mm after 45 min. The procedure ended uneventfully after continuous symptomatic and etiological treatment. It was considered to be the occurrence of an acute air embolism complication during the procedure based on the electrocardiograph and biomarkers. An echocardiogram during follow-up showed a patent foramen ovale with a left-to-right shunt tract width of 2.7 mm.DiscussionPediatric liver transplantation has become a state-of-the-art treatment for children with end-stage liver disease and can improve the quality of life to some extent. These children may be complicated with congenital heart disease, which increases the risk of surgery. Application of echocardiogram, close monitoring, and appropriate management may reduce the incidence of perioperative cardiac events.

AIM: The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease.". METHODS: A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. [ABSTRACT FROM AUTHOR]

The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost–value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. [ABSTRACT FROM AUTHOR]

Recently, electronic gaming has been reported as a precipitant of life-threatening cardiac arrhythmias in susceptible individuals. However, the prevalence of cardiac events in genetic heart diseases (GHDs) in the setting of electronic gaming has not been established. In this study, we sought to define the prevalence of cardiac events occurring in the setting of electronic gaming in GHDs. Retrospective review of all patients evaluated and treated at Mayo Clinic's genetic heart rhythm clinic from July 2000 to November 2022 was performed to identify patients with a history of playing electronic games at the time of their cardiac event. Cardiac event was used to define events occurring before diagnosis, and breakthrough cardiac event (BCE) was used for events occurring after diagnosis. Of the 3,370 patients with a GHD (mean age at first evaluation 27 ± 19 years, 55% female), 1,079 (32%) had a cardiac event before diagnosis, with 5 patients (0.5%) having an electronic gaming–associated event (3 catecholaminergic polymorphic ventricular tachycardia, 1 long QT syndrome, and 1 premature ventricular contraction–triggered ventricular fibrillation). After diagnosis and treatment, 431 patients (13%) experienced ≥1 BCE during follow-up, of which 1 electronic gaming–associated BCE (0.2%) occurred in a patient with catecholamine-sensitive right outflow tract ventricular tachycardia. Although anecdotal cases of electronic gaming–associated life-threatening arrhythmias have been reported, in this largest single-center study to date, we show that these are extremely rare occurrences. While electronic gaming can have adverse health consequences, the threat of electronic gaming–triggered sudden death should not be used to try to curb time spent gaming. [Display omitted] [ABSTRACT FROM AUTHOR]

Aims Post-extubation dysphagia (PED), an often overlooked problem, is a common and serious complication associated with mortality and major morbidity after cardiovascular surgery. Dysphagia is considered an age-related disease, and evaluating its long-term effects is a pressing issue with rapidly progressing ageing worldwide. Therefore, we examined the effect of PED on functional status and long-term cardiovascular events in patients undergoing cardiovascular surgery. Methods and results This single-centre, retrospective cohort study included 712 patients who underwent elective cardiovascular surgery and met the inclusion criteria. Patients were divided into PED and non-PED groups based on their post-operative swallowing status. The swallowing status was assessed using the Food Intake Level Scale. Functional status was evaluated as hospital-associated disability (HAD), defined as a decrease in activities of daily living after hospital discharge compared with preoperative values. The patients were subsequently followed up to detect major adverse cardiac and cerebrovascular events (MACCEs). Post-extubation dysphagia was present in 23% of the 712 patients and was independently associated with HAD (adjusted odds ratio, 2.70). Over a 3.5-year median follow-up period, MACCE occurred in 14.1% of patients. Multivariate Cox proportional hazard analysis revealed HAD to be independently associated with an increased risk of MACCE (adjusted hazard ratio, 1.85), although PED was not significantly associated with MACCE. Conclusion Post-extubation dysphagia was an independent HAD predictor, with the odds of HAD occurrence being increased by 2.7-fold due to PED. Hospital-associated disability accompanied by PED is a powerful predictor of poor prognosis. Perioperative evaluation and management of the swallowing status, and appropriate therapeutic interventions, are warranted. [ABSTRACT FROM AUTHOR]

This prospective study aimed to evaluate whether radiation (RT)-induced myocardial damage by cardiac magnetic resonance (CMR) imaging could be a predictor of cardiac events after chemoradiotherapy (CRT) for esophageal cancer and determine the dose-volume histogram (DVH) parameters of the left ventricle (LV) in predicting cardiac events. CMR imaging was performed before and 6 months after CRT in patients receiving definitive CRT. RT-induced myocardial damage was defined as abnormal CMR findings indicating myocardial fibrosis corresponding to an isodose line of ≥30 Gy. The cutoff values of the LV DVH parameters were calculated using the receiver operating characteristic curve based on the presence of RT-induced myocardial damage. The prognostic factors related to cardiac events of Grade 3 or higher were examined. Twenty-three patients were enrolled in the study. RT-induced myocardial damage by late gadolinium enhancement and/or an increase of 100 ms or higher in native T1 post-CRT was detected in 10 of the 23 patients. LV V45 was the best predictive factor for RT-induced myocardial damage with a cutoff value of 2.1% and an area under the curve of 0.75. The median follow-up period was 82.1 months. The 5- and 7-year cumulative incidences of cardiac events of Grade 3 or higher were 14.7 and 22.4%, respectively. RT-induced myocardial damage and LV V45 were significant risk factors (P  = 0.015 and P  = 0.013, respectively). RT-induced myocardial damage is a significant predictor of cardiac events. LV V45 is associated with RT-induced myocardial damage and subsequent cardiac events. [ABSTRACT FROM AUTHOR]

Context: Although have been proven able to control the prevalence of coronavirus disease-19 (COVID-19), Pfizer-BioNTech and Moderna COVID-19 vaccines are reported to have possible side effects on the heart. Aims: To know the magnitude of adverse events in the cardiac after messenger ribonucleic acid (mRNA)-based vaccination. Methods: An electronic search in PubMed, Web of Science, Scopus, and Ebsco/Cinahl was performed. The keywords were: “COVID-19 vaccine”, “SARS-CoV-2 vaccine”, “myocarditis”, “myopericarditis”, “pericarditis”, “myocardial infarction”, and “myocardial injury”. The electronic search was updated until March 2022. STATA/MP Statistical Software: Release 14 (StataCorp LLC, College Station, Texas) was used in this study to perform a meta-analysis of a random-effect for myocarditis, pericarditis, myocarditis, myocardial infarction, and myocardial injury. Results: Twenty-one case reports/case series studies with a total of 62 individuals who had been vaccinated against COVID-19 mRNA (Pfizer-BioNTech and Moderna) were included in the systematic review. Whereas seven observational cohort studies had 170,053,333 people who had been vaccinated, 245 of whom had myocarditis. In addition, two observational cohort studies with 13,948,595 vaccinated individuals, 16 of whom developed pericarditis. There was only one observational cohort study that had a total of 7,183,889 people who had been vaccinated and 11 had myopericarditis. Based on the pooled incidence, the result is

In this paper, we propose a sparse decomposition of the heart rate during sleep with an application to apnoea–RERA detection. We observed that the tachycardia following an apnoea event has a quasi-deterministic shape with a random amplitude. Accordingly, we model the apnoea-perturbed heart rate as a Bernoulli–Gaussian (BG) process convolved with a deterministic reference signal that allows the identification of tachycardia and bradycardia events. The problem of determining the BG series indicating the presence or absence of an event and estimating its amplitude is a deconvolution problem for which sparsity is imposed. This allows an almost syntactic representation of the heart rate on which simple detection algorithms are applied. [ABSTRACT FROM AUTHOR]

Purpose: Left anterior descending (LAD) coronary artery volume (V) of 15 Gy (V15 Gy) ≥10% has been recently observed to be an independent risk factor of major adverse cardiac events and all-cause mortality in patients with locally advanced non-small cell lung cancer (NSCLC) treated with radiotherapy. However, this dose constraint has not been validated in independent or prospective datasets.Materials/methods: The NRG Oncology/RTOG 0617 dataset from the National Clinical Trials Network (NCTN) was utilized. The LAD coronary artery was manually contoured. Multivariable Cox regression was performed, adjusting for known prognostic factors. Kaplan-Meier estimates of overall survival (OS) were calculated. For assessment of baseline cardiovascular risk, only age, sex, and smoking history were available.Results: There were 449 patients with LAD dose-volume data and clinical outcomes available, as 10 patients were excluded due to unreliable LAD dose statistics. The median age was 64 years. The median LAD V15 Gy was 38% (interquartile range, 15%-62%), including 21% of patients (n=94) with LAD V15 Gy <10% and 79% (n=355) with LAD V15 Gy ≥10%. Adjusting for prognostic factors, LAD V15 Gy ≥10% vs <10% was associated with an increased risk of all-cause mortality (hazard ratio 1.43, 95% CI 1.02-1.99; p=.037), while mean heart dose ≥10 Gy vs <10 Gy was not (AHR, 1.12, 95% CI 0.88-1.43, p=.36). The median OS for patients with LAD V15 Gy ≥10% vs <10% was 20.2 vs. 25.1 months, respectively, with 2-year OS estimates of 47% vs 67% (p=0.004), respectively.Conclusions: In a re-analysis of RTOG 0617, LAD V15 Gy ≥10% is associated with an increased risk of all-cause mortality. These findings underscore the need for improved cardiac risk stratification and aggressive risk mitigation strategies, including implementation of cardiac substructure dose constraints in national guidelines and clinical trials. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to assess the morphological characteristics and prognostic implications of the optical coherence tomography (OCT)-derived lipid core burden index (LCBI). Methods and results OCT-LCBI was assessed in 1003 patients with 1-year follow-up from the CLIMA multicentre registry using a validated software able to automatically obtain a maximum OCT-LCBI in 4 mm (maxOCT-LCBI4mm). Primary composite clinical endpoint included cardiac death, myocardial infarction, and target-vessel revascularization. A secondary analysis using clinical outcomes of CLIMA study was performed. Patients with a maxOCT-LCBI4mm ≥ 400 showed higher prevalence of fibrous cap thickness (FCT) <75 μm [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.03–1.99; P = 0.034], lipid pool arc >180° (OR 3.93, 95%CI 2.97–5.21; P < 0.001), minimum lumen area <3.5 mm2 (OR 1.5, 95%CI 1.16–1.94; P = 0.002), macrophage infiltration (OR 2.38, 95%CI 1.81–3.13; P < 0.001), and intra-plaque intimal vasculature (OR 1.34, 95%CI 1.05–1.72; P = 0.021). A maxOCT-LCBI4mm ≥400 predicted the primary endpoint [adjusted hazard ratio (HR) 1.86, 95%CI 1.1–3.2; P = 0.019] as well as the CLIMA endpoint (HR 2.56, 95%CI 1.24–5.29; P = 0.011). Patients with high lipid content and thin FCT < 75 µm were at higher risk for adverse events (HR 4.88, 95%CI 2.44–9.72; P < 0.001). Conclusions A high maxOCT-LCBI4mm was related to poor outcome and vulnerable plaque features. This study represents a step further in the automated assessment of the coronary plaque risk profile. [ABSTRACT FROM AUTHOR]

Maya R Chilbert,1,2 Dylan VanDuyn,3 Sara Salah,1 Collin M Clark,1,2 Qing Ma1 1Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA; 2Department of Pharmacy, Buffalo General Medical Center, Buffalo, NY, USA; 3Department of Pharmacy, Buffalo Veterans Affairs Medical Center, Buffalo, NY, USACorrespondence: Maya R Chilbert, Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 202 Pharmacy Building, Buffalo, NY, USA, Tel +1 716 829-5172, Fax +1 716-829-6093, Email mayahols@buffalo.eduAbstract: Cardiovascular disease is one of the leading causes of death around the world with various efforts being made to reduce risk in patients through preventive measures. One major method for prevention has been managing cholesterol, particularly low-density lipoprotein to decrease atherosclerotic plaque burden, potentially decreasing future cardiac complications. Statins have been the gold standard therapy for hypercholesterolemia treatment due to their ease of dosing, limited drug interactions, and favorable safety profile. Unfortunately, statin therapy alone is not always effective enough to adequately control a patient’s elevated lipid levels and combination therapy may be warranted. Ezetimibe is commonly added to regimens to help augment cholesterol lowering by inhibiting the absorption of cholesterol. The recent approval of a combination tablet of high-intensity rosuvastatin and ezetimibe has introduced a potentially more beneficial option for cholesterol management in addition to the only available combination of moderate intensity simvastatin and ezetimibe. We aimed to identify potential beneficial effects of ezetimibe by comparing its use in combination with high-intensity rosuvastatin compared to a statin therapy alone or in combination with moderate intensity simvastatin through a literature review. The current evidence indicated that combination therapy outperformed statin monotherapy in reduction of low-density lipoprotein cholesterol and patients were more likely to achieve their target low-density lipoprotein cholesterol goal level. This suggests rosuvastatin/ezetimibe combination holds a potential place in therapy for patients requiring a more aggressive reduction in cholesterol to help prevent atherosclerotic disease.Keywords: hypercholesterolemia, hyperlipidemia, cardiac events, lipid biomarkers, atherosclerosis

Global longitudinal strain (GLS) and mechanical dispersion (MD), as determined by 2D speckle tracking echocardiography, have been demonstrated to be reliable indicators of prognosis in a variety of cardiovascular illnesses. There are not many papers that discuss the prognostic significance of GLS and MD in a population with non-ST-segment elevated acute coronary syndrome (NSTE-ACS). Our study objective was to examine the predictive utility of the novel GLS/MD two-dimensional strain index in NSTE-ACS patients. Before discharge and four to six weeks later, echocardiography was performed on 310 consecutive hospitalized patients with NSTE-ACS and effective percutaneous coronary intervention (PCI). Cardiac mortality, malignant ventricular arrhythmia, or readmission owing to heart failure or reinfarction were the major end points. A total of 109 patients (35.16%) experienced cardiac incidents during the follow-up period (34.7 ± 8 months). The GLS/MD index at discharge was determined to be the greatest independent predictor of composite result by receiver operating characteristic analysis. The ideal cut-off value was −0.229. GLS/MD was determined to be the top independent predictor of cardiac events by multivariate Cox regression analysis. Patients with an initial GLS/MD > −0.229 that deteriorated after four to six weeks had the worst prognosis for a composite outcome, readmission, and cardiac death according to a Kaplan–Meier analysis (all p < 0.001). In conclusion, the GLS/MD ratio is a strong indicator of clinical fate in NSTE-ACS patients, especially if it is accompanied by deterioration. [ABSTRACT FROM AUTHOR]

Background: Inappropriate and multiple medications affect the prognosis of patients with acute decompensated heart failure (ADHF). However, in ADHF patients with decreased renal function, there have been no reports on prognostic factors, including medication data, or models for predicting cardiac events.Aim: To develop a model including medication data to predict cardiac events in ADHF patients with decreased renal function.Method: This retrospective cohort study included 443 first-time admitted ADHF patients with decreased renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m2 at discharge) in the Showa University Fujigaoka Hospital. The primary outcome was cardiac events within one year after discharge, defined as the composite of HF readmission, HF mortality, and cardiovascular mortality. The model for predicting cardiac events was developed using predictive factors extracted by multivariable analysis. The cardiac events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test.Results: The incidence of cardiac events within one year after discharge was 20.1%. By multivariable analysis, we observed that atrial fibrillation, weight loss < 5%, brain natriuretic peptide ≥ 200 pg/mL, polypharmacy, and beta-blockers use below target dosage were significantly associated with an increased risk of cardiac events. The developed model, the cardiac events rate in the high-risk group was significantly higher than in the low-risk group (41.0 vs. 9.2%, p < 0.001).Conclusion: The developed model for predicting cardiac events will be useful in decision-making to support appropriate early management of ADHF patients with decreased renal function. [ABSTRACT FROM AUTHOR]

Introduction: For the interpretation of myocardial perfusion imaging, considering non-perfusion variables, such as transient ischemic dilatation (TID), are also important in diagnostic and prognostic evaluation of a patient. TID has a relatively high false positive and false negative results, which reduces its diagnostic and prognostic values. In this study, we aimed to compare the accuracy of TID after normalization based on changes in LV wall mass. Methods: Patients referred for dipyridamole myocardial perfusion imaging single-photon emission computed tomography (MPI/SPECT), one to two year prior to the study with TID ratio >1 were enrolled. Patients with any previous history of revascularization and structural heart disease were excluded. Followup was done by phone call. The occurrence of cardiac death, myocardial infarction, revascularization or evidence of abnormal angiography during one year after MPI was considered positive for short-term cardiac events. The corrected TID (cTID) was calculated by the following formula: cTID = TID/(Wallstress/Wallrest). Results: Among 196 participants, 30 (15%) had cardiovascular events during the follow-up. The areas under the receiver operating characteristic (ROC) curve for the short-term prognosis of the cardiac events were 0.57 and 0.50 for cTID and TID with a p-value of 0.17 and 0.92, respectively. Considering the best cut-off points that were achieved by ROC curves, cTID showed significant odds ratio (OR: 2.53) for prediction of short-term cardiac events, while respecting, TID failed to be statistically significant. Conclusion: Making correction on TID using LV wall volumes can improve shortterm prognostic value of this variable. [ABSTRACT FROM AUTHOR]

Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association.

Study objective: This study aimed to investigate whether the incidence of acute myocardial infarction (AMI) and subsequent outcomes over the three years after the Kumamoto earthquake differed from the underlying trend before the earthquake. Design: Quasi-experimental design. Setting: Twenty-one institutions participating from the Kumamoto Prefecture and capable of receiving AMI patients and performing coronary angiography and interventions. Participants: In total 6553 consecutive patients with AMI between 2013 and 2019 were included in this study. Interventions: Interrupted time series analysis. Main outcome measure(s): AMI incidence and following cardiac events after the earthquake. Results: The rate ratio (RR) for AMI incidence after the earthquake was 1.12 (95 % confidence interval [CI]: 1.00–1.25) with reference to that before the earthquake. AMI rates increased among people with diabetes mellitus (RR: 1.20, 95 % CI: 1.01–1.44), those with current smoking (RR: 1.27, 95 % CI: 1.03–1.56), and those with a body mass index >25 kg/m2 (RR: 1.27, 95 % CI: 1.06–1.52). Increased number of AMI patients with onset-to-door time >12 h (RR: 1.46, 95 % CI: 1.02–2.08), a high Killip class on hospital admission (RR: 1.37, 95 % CI: 1.13–1.67), and unperformed emergent coronary angiography (RR: 1.40, 95 % CI: 1.02–1.91) were frequently observed after the earthquake, which may affect following in-hospital cardiac events (RR: 1.49, 95 % CI: 1.03–2.15). Conclusions: The Kumamoto earthquake had an impact on the increase in the incidence of AMI and the following in-hospital cardiac outcomes. Emergency medical care should be ensured in such a way that high-risk patients are managed as usual, especially immediately after earthquake.

In-hospital acute kidney injury (IH-AKI) has been reported in a significant proportion of patients with COVID-19 and is associated with increased disease burden and poor outcomes. However, the mechanisms of injury are not fully understood. We sought to determine the significance of race on cardiopulmonary outcomes and in-hospital mortality of hospitalized COVID-19 patients with AKI. We conducted a retrospective cohort study of consecutive patients hospitalized in Grady Health System in Atlanta, Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. We evaluated the primary composite outcome of in-hospital cardiac events, and mortality in blacks with AKI versus non-blacks with AKI. In a subgroup analysis, we evaluated the impact of AKI in all blacks and in all non-blacks. Of 293 patients, effective sample size was 267 after all exclusion criteria were applied. The mean age was 61.4 ± 16.7, 39% were female, and 75 (28.1%) had IH-AKI. In multivariable analyses, blacks with IH-AKI were not more likely to have in-hospital cardiac events (aOR 0.3, 95% Confidence interval (CI) 0.04–1.86, p = 0.18), require ICU stay (aOR 0.80, 95% CI 0.20–3.25, p = 0.75), acute respiratory distress syndrome (aOR 0.77, 95% CI 0.16–3.65, p = 0.74), require mechanical ventilation (aOR 0.51, 95% CI 0.12–2.10, p = 0.35), and in-hospital mortality (aOR 1.40, 95% CI 0.26–7.50, p = 0.70) when compared to non-blacks with IH-AKI. Regardless of race, the presence of AKI was associated with worse outcomes. Black race is not associated with higher risk of in-hospital cardiac events and mortality in hospitalized COVID-19 patients who develop AKI. However, blacks with IH-AKI are more likely to have ARDS or die from any cause when compared to blacks without IH-AKI.

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Several forms of secondary hypertension carry a high risk of cardiac morbidity and mortality. Evaluation of cardiac phenotypes in secondary hypertension provides a unique opportunity to study underlying hormonal and biochemical mechanisms affecting the heart. We review the characteristics of cardiac dysfunction in different forms of secondary hypertension and clarify the mechanisms behind the higher prevalence of heart damage in these patients than in those with primary hypertension. Attention to the specific clinical/biochemical phenotypes of these conditions may assist clinicians to screen for and confirm secondary forms of hypertension. Thereby, early signs of heart damage can be recognized and monitored, allowing individualized treatment to delay or prevent evolution toward more advanced disease. [ABSTRACT FROM AUTHOR]

• This study identified a low rate of major exercise-related AEs in HBCR. • Half of the sample were patients classified with a high risk of exercise-related complications. • There were no cases of exercise-related deaths or hospitalizations in HBCR. • Low rates of AEs represent support for the implementation of HBCR programs. Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR. To examine the incidence and severity of adverse events of HBCR. The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome. Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise. The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies had reported the impact of weight changes in middle age on the incidence of cardiovascular disease (CVD), but the results were inconsistent. In present study, we aimed to investigate the impact of a 4-year weight change on the risk of CVD in middle-aged and elderly Chinese individuals. Methods: Using nationally representative data from the China Health and Retirement Longitudinal Study, 7,530 participants (age: 58.2 ± 8.9 years) were included. Weight change was calculated by subtracting weight at baseline from that at 4-year follow-up. Weight change over 4 years was divided into 5 categories (loss ≥5 kg; loss 2–5 kg; stable (change ≤2 kg); gain 2–5 kg; and gain ≥5 kg). Results: During the follow-up period, a total of 758 respondents experienced CVD (including 319 stroke and 477 cardiac events). The multivariable ORs of CVD for gain ≥5 kg compared to stable weight (change ≤2 kg) was 1.50 (95% CI, 1.14–1.97) versus 1.41(1.09–1.83) for losing ≥5 kg. Multivariable-adjusted logistic regression model with restricted cubic splines showed a U-shaped association between weight change and the risk of CVD (p for nonlinearity <0.001). The significant associations did not change in subgroup and sensitivity analysis. Weight change was also associated with higher risk of stroke and cardiac events. Conclusion: Weight changes (weight gain or loss more than 5 kg) during middle age were associated with an increased risk of CVD in middle-aged and elderly Chinese individuals. [ABSTRACT FROM AUTHOR]

Background: Based on the severity of cardiovascular disease (CVD) and sensory impairment in China and the lack of research on this, the aims of our study were to assess the impact of hearing impairment (HI), visual impairment (VI), and concurrent HI and VI (termed dual sensory impairment) on CVD in elderly people, based on a representative sample of China., Methods and Results: We used data from the CHARLS (China Health and Retirement Longitudinal Study) for our survey of 11 332 participants. We calculated hazard ratios (HRs) and 95% 95% CIs for CVD, stroke, and cardiac events by using Cox proportional hazards models. HI and VI status were collected through self-reported questions. During the 7-year follow-up, a total of 2156 participants experienced CVD (including 745 stroke and 1605 cardiac events). Compared with the reference, individuals with VI had higher risk of CVD (HR, 1.24 [95% CI, 1.09-1.40]). Individuals with HI also had higher risk of CVD than those without HI (HR, 1.20 [95% CI, 1.09-1.33]). Compared with participants without VI and HI, individuals with dual sensory impairment had a 1.35-fold increased risk of CVD (HR, 1.35 [95% CI, 1.16-1.57]). In addition, individuals with dual sensory impairment also had increased risk of stroke and cardiac events., Conclusions: Our study shows that HI and VI have a combined effect on the incidence of CVD. Based on the high prevalence of CVD around the world, early detection of sensory disorders and the adoption of appropriate measures may contribute to prevent CVD and reduce the burden of clinical diagnosis and treatment of CVD.

Abstract Background Whether progressive mild to moderate aortic stenosis in hemodialysis patients influences their prognosis has not been elucidated. This prospective cohort study explored whether progressive aortic stenosis predicted the rate of cardiac events and mortality in those patients. Methods A total of 283 consecutive hemodialysis patients (no aortic stenosis, 248; progressive aortic stenosis, 35) underwent echocardiography for assessment of aortic stenosis, with a median follow-up period of 4.1 years. Study endpoints were cardiac events, all-cause mortality, and cardiac death. Kaplan–Meier analysis and multivariate Cox proportional hazard analysis were performed to estimate cardiac events, all-cause mortality, and cardiac death. Results Cumulative cardiac event rate, all-cause mortality rate, and the rate of cardiac death at 3-year follow-up were 44.9%, 40.5%, and 26.4% in patients with progressive aortic stenosis and 22.1%, 19.0%, and 7.5% in those without aortic stenosis, respectively. Kaplan–Meier analysis demonstrated the cumulative rates of cardiac events and all-cause mortality. And cardiac death was significantly higher in patients with progressive aortic stenosis than in those without aortic stenosis. Multivariate Cox proportional hazard analysis revealed that progressive aortic stenosis was predictive of cardiac events (adjusted hazard ratio 2.47; 95% confidence interval 1.38–4.39) and cardiac death (adjusted hazard ratio 4.21; 95% confidence interval 2.10–8.46). Age, physical activity, C-reactive protein, and serum albumin levels—but not progressive aortic stenosis—predicted all-cause mortality. Conclusions The rates of cardiac events and cardiac death were higher in hemodialysis patients with progressive aortic stenosis than in those without aortic stenosis. Furthermore, progressive aortic stenosis predicted cardiac events and cardiac death. Compared with those without aortic stenosis, patients with progressive aortic stenosis had higher all-cause mortality, which was related to their comorbidities. Trial registration This study was retrospectively registered with University Hospital Medical Information Network Clinical Trials Registry (registration number, UMIN 000024023) at September 12th, 2016.

As we commemorate 50 years since the introduction of classical 7 + 3 induction chemotherapy for acute myeloid leukaemia (AML), we also embark upon new territory with the advent of novel targeted therapeutics, including BH3 mimetics. To date, we do not have much large‐scale longitudinal data regarding the toxicities of such novel therapies. Johnson et al. perform a comprehensive analysis of cardiac toxicities with hypomethylating agents and venetoclax and offer valuable insight into risk–benefit analysis when considering front‐line therapy for AML. Commentary on: Johnson et al. Cardiac events in newly diagnosed acute myeloid leukaemia during treatment with venetoclax + hypomethylating agents. Br J Haematol 2024;204:1232‐1237. [ABSTRACT FROM AUTHOR]

Background: Left ventricular mechanical dyssynchrony (LVMD) induced by exercise stress was reported to be clinically useful in detecting multivessel coronary artery diseases. The aim of this study was to compare the prognostic value of LVMD induced by pharmacological stress with that induced by exercise stress. Methods: We retrospectively examined 918 consecutive patients who underwent exercise (N = 310) or pharmacological stress (N = 608) 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) with normal myocardial perfusion. LVMD was evaluated by phase analysis as the indices of phase bandwidth and phase standard deviation (PSD). Results: During the follow-up period (2.2 ± 1.9 years), 74 major cardiac events (MCEs) occurred (7 cases of cardiac death, 17 cases of heart failure, and 50 cases of coronary intervention). In global patients, the indices of LVMD on rest images were significantly greater in patients with MCEs (bandwidth (°): 51 ± 31 vs 37 ± 21, P =.001, PSD: 14 ± 9 vs 10 ± 6, P =.001). The exercise stress bandwidth was significantly higher in patients with MCEs (62 ± 37° vs 42 ± 21°, P =.026), as was the pharmacological stress bandwidth (57 ± 35° vs 43 ± 24°, P =.006). Multivariate analysis demonstrated the exercise stress bandwidth to be an independent predictor of MCEs (HR 1.017, CI 1.003 to 1.032, P =.019), but the pharmacological stress bandwidth had no influence on MCEs. Conclusions: LVMD induced by exercise stress was an independent predictor of MCEs in patients with normal perfusion SPECT, whereas that induced by pharmacological stress had no association with further events. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac rehabilitation (CR) is a proven therapy for reducing cardiovascular death and hospitalization. Whether CR participation is associated with improved outcomes in patients with chronic kidney disease (CKD) is unknown. Methods: We obtained data on all adult patients in Calgary, Alberta, Canada with angiographically proven coronary artery disease from 1996 to 2016 referred to CR from The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology Rehabilitation. An estimated glomerular filtration rate (eGFR)

Previous genetic, observational, and clinical intervention studies reported that circulating levels of remnant cholesterol was associated with cardiovascular disease (CVD). However, whether remnant cholesterol can predict CVD events in Chinese population was not well characterized. This was a prospective cohort study. We used the data of 9456 Chinese adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS). Estimated remnant cholesterol was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. Cox proportional hazard models and restricted cubic spline models were used to assess the relationships between remnant cholesterol levels and CVD, stroke and cardiac events. During 7 years of follow-up, a total of 886 (9.37 %) respondents experienced CVD, 392 (4.15 %) experienced stroke and 544 (5.75 %) experienced cardiac events. In multivariable-adjusted analyses, the adjusted hazard ratios (95 % confidence interval) for the highest versus lowest quartile of remnant cholesterol were 1.14 (1.02-1.32) for CVD and 1.43 (1.12-1.82) for stroke, and each 1-SD increase of log-transformed remnant cholesterol (2.93 mg/dl) was associated with 5 % and 11 % increased risk of the CVD and stroke, respectively. Remnant cholesterol was not associated with increased risk of cardiac events. Elevated remnant cholesterol levels were positively associated with CVD and stroke in Chinese adult population, suggesting that remnant cholesterol could be considered as a preferential predictor and treatment target of CVD in Chinese population. [ABSTRACT FROM AUTHOR]

In this paper, we propose a sparse decomposition of the heart rate during sleep with an application to apnoea–RERA detection. We observed that the tachycardia following an apnoea event has a quasi-deterministic shape with a random amplitude. Accordingly, we model the apnoea-perturbed heart rate as a Bernoulli–Gaussian (BG) process convolved with a deterministic reference signal that allows the identification of tachycardia and bradycardia events. The problem of determining the BG series indicating the presence or absence of an event and estimating its amplitude is a deconvolution problem for which sparsity is imposed. This allows an almost syntactic representation of the heart rate on which simple detection algorithms are applied.

Rapid advances in the smartphone, wearable sensing, and wireless communication provide an unprecedented opportunity to develop mobile systems for smart health management. Mobile cardiac sensing collects health-related data from individuals and enables the extraction of information pertinent to cardiac conditions. However, wireless sensors in ambulatory care settings operate on batteries. All-time sensing and monitoring will result in fast depletion of the battery in the mobile system. There is an urgent need to develop optimal sensing schemes that will reduce energy consumption while satisfying the requirements in the detection of cardiac events. In this article, we develop a constrained Markov decision process (CMDP) framework to optimize mobile electrocardiography (ECG) sensing under the constraint of the energy budget. We first characterize the cardiac states from ECG signals using the heterogeneous recurrence analysis. Second, we model the stochastic dynamics in cardiac processes as a continuous-time Markov chain (CTMC). Third, we optimize the ECG sensing through a CMDP framework under the constraint of energy budget. Finally, we validate and evaluate the performance of our CMDP policy in both simulation and real-world case studies. Experimental results demonstrate that the proposed CMDP policy significantly outperforms the traditional uniform and mean-time-to-event (MTTE) policies. Specifically, the error of state estimation is reduced by 34.0% in the real-world case study for energy-constrained sensing of cardiac events. Note to Practitioners—This article is motivated by the markedly increasing applications of mobile health (mHealth) in cardiac care. MHealth systems enable the real-time monitoring, tracking, and transmitting of heart-health information but suffer from the problem with limited battery life. This article presents a novel energy-efficient framework for mobile ECG sensing by integrating ECG signal analysis with sensing-policy optimization under the constraint of the energy budget. Experimental results demonstrate the effectiveness of the proposed framework to realize energy-efficient mobile sensing for cardiac events detection. [ABSTRACT FROM AUTHOR]

Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association. [ABSTRACT FROM AUTHOR]

Background: Many studies have investigated treatment-related sequelae in Hodgkin's lymphoma (HL) in high-prevalence areas, but very few have been conducted in low-prevalence areas, including Taiwan and Japan. Materials and methods: We retrospectively reviewed 101 HL patients who had received mediastinal radiotherapy between January 1997 and April 2013. Results: Nine patients had cardiac events and nine patients developed second malignancies. Univariate analysis showed that bulkiness of disease was significantly associated with higher incidence of cardiac events (HR 7.70, 95% CI 1.60–38.00, p = 0.012). Disease stage and cumulative dose of radiotherapy were significantly correlated with incidence of radiation pneumonitis (HR 1.40, 95% CI 1.00–2.10, p = 0.043 and HR 1.10, 95% CI 1.00–1.20, p = 0.009, respectively). All cases of grade III–IV radiation pneumonitis happened in patients receiving a radiation dose higher than 35 Gy and developed within 4 months after radiotherapy. Conclusions: Despite the similar incidence rates of treatment-related sequelae among HL survivors between areas with high and low prevalence of HL, cardiac events and second malignancies cannot be overlooked in HL survivors in low-prevalence areas. [ABSTRACT FROM AUTHOR]

Abstract A prolonged P‐wave in electrocardiography (ECG) reflects atrial remodeling and predicts the development of atrial fibrillation (AF). The authors enrolled 810 subjects in the Japan Morning Surge Home Blood Pressure (J‐HOP) study who had ≥1 cardiovascular (CV) risk factor. The duration of P‐wave was automatically analyzed by standard 12‐lead electrocardiogram. Left atrial (LA) enlargement and left ventricular hypertrophy (LVH) were measured on echocardiography. The primary end points were fatal/nonfatal cardiac events: myocardial infarction, sudden death, and hospitalization for heart failure. The maximum P‐wave duration (Pmax) from the 12 leads was selected for analysis. The authors compared four prolonged P‐wave cutoffs (Pmax = 120, 130, 140, 150 ms) and cardiac events. LA diameter and left ventricular mass index (LVMI) were significantly associated with Pmax (r = 0.08, P = .02 and r = 0.17, P