Delayed Diagnosis of Cardiac Amyloidosis Masked by Chronic Coronary Artery Disease and Ischemic Cardiomyopathy: A Case Report of an Overlooked and Underdiagnosed Etiology.

Cardiac amyloidosis (CA) is an infiltrative disease of the heart characterized by the deposition of insoluble protein aggregates in the myocardium. There are two subtypes of CA, and they are named after the misfolded protein. Transthyretin cardiac amyloidosis (ATTR-CA) is caused by the accumulation of the tetrameric transthyretin protein produced in the liver, and light-chain cardiac amyloidosis (AL-CA) occurs due to circulating abnormal light-chain deposition. Disease manifestation can be very non-specific, and there can be overlap with other cardiac processes. This often leads to a delay in diagnosis and a poor prognosis. Here, we present a case of delayed diagnosis of CA spanning over several years that required a multidisciplinary approach but ultimately resulted in fatality six years after the initial diagnosis.

Feasibility of Outpatient Stem Cell Transplantation in Multiple Myeloma and Risk Factors Predictive of Hospital Admission.

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of care for multiple myeloma (MM) patients. Although outpatient ASCT has been shown to be safe and feasible, the procedure is overall rare with most patients in the US undergoing inpatient ASCT. Furthermore, hospitalization rates for patients that undergo outpatient ASCT remain high. Adequate markers that predict hospitalization during outpatient ASCT are lacking, yet would be of great clinical value to select patients that are suited to outpatient ASCT. In this study we aimed to elucidate differences between planned outpatient and inpatient ASCT and further evaluated clinical characteristics that are significantly associated with hospitalization during planned outpatient hospitalization. Factors that were significantly associated with a planned inpatient ASCT included an advanced MM disease stage, worse performance status as well as non-Caucasian race, while low albumin levels and female gender were significantly associated with hospitalization during outpatient ASCT. The results of this analysis provide crucial knowledge of factors that are associated with planned inpatient ASCT and hospitalization during outpatient ASCT and could guide the treating physician in decision-making and further facilitate outpatient transplantation.

Is heart rate in post-hematopoietic stem cell transplant patients clinically relevant?

Patients with hematological malignancies undergoing hematopoietic stem cell transplantation (HSCT) have become a critical treatment option in the treatment of many hematological malignancies, myeloproliferative disorders, and some solid tumors.Although HSCT has the potential of offering either a cure or minimizing disease burden while improving overall survival, HSCT is associated with some morbidity and mortality, particularly hypertension, diabetes, dyslipidemia, and renal disease with an increased cumulative incidence of cardiovascular (CVD) complications.Aside from the usual heart failure and arrhythmias, a less described complication is sinus tachycardia. The latter was once considered an innocuous finding in post-HSCT patients and mostly attributed to dehydration, low counts, deconditioning, chemotherapy, and/or infection.However, new data has shown that a number of these post-HSCT patients may harbor inappropriate sinus tachycardia, which can be associated with the eventual development of heart failure if not identified and treated.We believe that discussion of this topic not only is needed to raise awareness of this condition as patients might no longer be under the care of their oncologists but, most importantly, could be seen at any age, and general health practitioners might otherwise not be aware of this literature.

Effectiveness of lock down to curtail the spread of corona virus: A mathematical model.

In this paper, we have considered a mathematical model that deals with the effectiveness of the measures that may be helpful for reducing the spread of the COVID-19 virus in the society. Here we have illustrated the importance of lock down in controlling and maintaining the spread of the COVID-19 virus. The impact of the virus on the susceptible population has been considered in the model. Also, we have taken into account the susceptible population, which by taking preventive measures viz., by having strong immunity, maintaining social distancing, wearing PPE kits and masks etc., is able to reduce the possibility of getting infected from the virus. Local as well as global stability of the equilibrium points of the model have been studied using Lyapunov function and the geometrical approach techniques. Basic reproduction number has also been obtained by using the next generation matrix. To show the effectiveness of the model, different cases obtained by varying the parameters involved in the model have been considered. A comparison between the actual number of infected cases in India and that obtained by the proposed model, showing the effectiveness of the proposed model, has also been carried out.

Erratum to "How to treat left ventricular thrombi- Warfarin or direct oral anti-coagulants?" [Am. Heart J. Plus Cardiol. Res. Pract. 13 (January 2022) 100075].

[This corrects the article DOI: 10.1016/j.ahjo.2021.100075.].

Predicting risk of progression in relapsed multiple myeloma using traditional risk models, focal lesion assessment with PET-CT and minimal residual disease status.

Not available.

Artificial Intelligence, Machine Learning, and Cardiovascular Disease.

Artificial intelligence (AI)-based applications have found widespread applications in many fields of science, technology, and medicine. The use of enhanced computing power of machines in clinical medicine and diagnostics has been under exploration since the 1960s. More recently, with the advent of advances in computing, algorithms enabling machine learning, especially deep learning networks that mimic the human brain in function, there has been renewed interest to use them in clinical medicine. In cardiovascular medicine, AI-based systems have found new applications in cardiovascular imaging, cardiovascular risk prediction, and newer drug targets. This article aims to describe different AI applications including machine learning and deep learning and their applications in cardiovascular medicine. AI-based applications have enhanced our understanding of different phenotypes of heart failure and congenital heart disease. These applications have led to newer treatment strategies for different types of cardiovascular diseases, newer approach to cardiovascular drug therapy and postmarketing survey of prescription drugs. However, there are several challenges in the clinical use of AI-based applications and interpretation of the results including data privacy, poorly selected/outdated data, selection bias, and unintentional continuance of historical biases/stereotypes in the data which can lead to erroneous conclusions. Still, AI is a transformative technology and has immense potential in health care.

Severe Right-Sided Heart Failure and Pulmonary Hypertension with Carfilzomib Treatment in Multiple Myeloma.

Carfilzomib, a second-generation irreversible proteasome inhibitor, is currently considered the preferred therapy for relapsed and refractory multiple myeloma. There are several cardiovascular adverse effects described with carfilzomib chemotherapy most commonly being hypertension, dyspnea and decreased cardiac ejection fraction. We report a case of newonset pulmonary hypertension with right ventricular (RV) heart failure in a patient receiving carfilzomib. Awareness of this rare side effect of this drug is essential for prompt diagnosis and management. We also propose close monitoring of RV and pulmonary artery pressures along with left ventricular function in echocardiographic assessment in patients with carfilzomib chemotherapy.

Metastatic prostate cancer with bone marrow infiltration mimicking multiple myeloma.

Concomitant diagnosis of metastatic prostate cancer and a multiple myeloma in older male patients is challenging as both malignancies are usually associated with bone lesions. Exact knowledge, experience, and an interdisciplinary approach are required in order to differentiate between both malignancies and determine the exact treatment strategy.

Cardiovascular complications of multiple myeloma in the elderly.

INTRODUCTION: Multiple myeloma is a malignant neoplasm characterized by plasma cell proliferation in blood and bone marrow. Approximately two-thirds of the patients with multiple myeloma are >65 years at the time of diagnosis. Patients in this age group often have co-existing cardiovascular diseases. Areas covered: The presence of multiple myeloma adds to the malady by direct deposition of amyloid protein in the heart or via toxicity of chemotherapeutic agents. Cardiac contractile dysfunction, arrhythmias and thromboembolic disorders are the main issues in the management of elderly patients with multiple myeloma. Expert commentary: Assessment of cardiac risk and functional status requires careful evaluation by history, physical examination and imaging studies such as echocardiography and magnetic resonance imaging. The management of cardiovascular disorders in the presence of multiple myeloma is difficult and poses a challenge for the internist, the oncologist, and the cardiologist alike. This review is an overview of the problem of cardiovascular risk in and management of elderly patients with multiple myeloma.

Nasopharyngeal amyloidoma with osteolytic lesions leading to diagnosis of systemic light-chain amyloidosis.

Amyloidomas of the head and neck region are uncommon and generally considered a benign localized form of amyloidosis. Here, we describe "the unusual case of a young man" with a nasopharyngeal mass and osteolytic lesions caused by systemic light-chain amyloidosis treated successfully with a combined surgical and chemotherapy approach.