Experiential Narratives of Factors Limiting and Boosting Access to Support Services for Women with Obstetric Fistula in Southeast Nigeria.

PURPOSE: Obstetric fistula is a chronic health condition that leaves affected women battered and traumatized, thereby exposing them to social recluse life as a result of associated discomfort and odor. Support services to those with challenging health conditions are reputed to help cushion the adverse effects on them; thus women with fistula and other chronic diseases receiving adequate support will help them to cope and recuperate from such illnesses. This study explores the factors limiting and boosting access to support services for those with obstetric fistulainNigeria. MATERIALS AND METHOD: Focus Group Discussions and In-depth Interviews were employed to obtain data from 44 participants. The thematic data analysis method was deployed in analyzing the data collected. RESULTS: Factors like the limited number of fistula specialist doctors, poor funding, withdrawal from seeking help, long distance, and discrimination limit patients' access to support services and adequate fistula care. The study highlighted that community involvement in fistula care, adequate funding, training, and retraining of professionals will boost support services for fistula patients. CONCLUSION: The study recommends the adoption of a multidisciplinary approach in the management of obstetric fistula patients including the involvement of not only medical personnel but also social workers, families, groups, and community leaders.

Obstetric Fistula: Connecting the Interface between Social Work and Social Support Services for the Management and Reintegration of Victims in Ebonyi State, Nigeria.

Obstetric fistula is a chronic health condition that leaves affected women medically, socially, physically, and psychologically battered and traumatized. Those with the health condition live their lives as a social recluse because of the unpleasant smell the disease produces in them thereby making people avoid them. Adequate social support to those affected by the disease from all quarters has helped in the management and prevention of the health condition. This study, therefore, aims at exploring and connecting the link between social work and social support in the management of obstetric fistula in Nigeria and the reintegration of survivors into the society. The study adopted a qualitative approach using interviews and focus group discussions to collect data from 51 participants, and the data were thematically analyzed. The results of the study highlighted the potential roles of social workers in enhancing social support for the management and reintegration of victims of obstetric fistula in Nigeria. The findings also revealed challenges confronting social workers in enhancing social support in fistula victims. Findings from the study have implication for policy development, hence, the full involvement and expansion of the coverage of social workers in maternal and public health is recommended.

Potential of some microbial isolates on diesel hydrocarbons removal, bio surfactant production and biofilm formation.

Potential of Arthrobacter citreus B27Pet, Bacillus thuringiensis B48Pet and Candida catnulata to produce biosurfactant using four different carbon sources (naphthalene, hexadecane, diesel and petroleum crude oil) was investigated. Removal of petroleum crude oil from aqueous culture and degradation of diesel were also determined using single and mixed culture of strains. The biofilm existence in single and mixed culture of strains was considered using naphthalene, hexadecane and diesel in culture medium. Cell surface hydrophobicity of A. citreus was higher than other isolates which also showed maximum surface tension reduction and emulsification index. As a whole, remarkable biosurfactant production occurred using petroleum crude oil as a carbon source in medium. A. citreus was found to be more robust than other tested strains in removal efficiency of crude oil due to its biosurfactant production capability. Statistically significant positive correlation was observed between biofilm existence and surface tension using diesel and hexadecane as carbon source. Overall diesel biodegradation efficiency by the mix culture of three applied strains was about 75% within a short period of time (10 days) which was accompanied with high biofilm production.

MMP-2 Associates With Incident Heart Failure and Atrial Fibrillation: The ARIC Study.

BACKGROUND: MMP (matrix metalloproteinase)-2 participates in extracellular matrix regulation and may be involved in heart failure (HF), atrial fibrillation (AF), and coronary heart disease. METHODS: Among the 4693 ARIC study (Atherosclerosis Risk in Communities) participants (mean age, 75±5 years; 42% women) without prevalent HF, multivariable Cox proportional hazard models were used to estimate associations of plasma MMP-2 levels with incident HF, HF with preserved ejection fraction (≥50%), HF with reduced ejection fraction (<50%), AF, and coronary heart disease. Mediation of the association between MMP-2 and HF was assessed by censoring participants who developed AF or coronary heart disease before HF. Multivariable linear regression models were used to assess associations of MMP-2 with measures of left ventricular and left atrial structure and function. RESULTS: Compared with the 3 lower quartiles, the highest MMP-2 quartile associated with greater risk of incident HF overall (adjusted hazard ratio, 1.48 [95% CI, 1.21-1.81]), incident HF with preserved ejection fraction (1.44 [95% CI, 1.07-1.94]), incident heart failure with reduced ejection fraction (1.48 [95% CI, 1.08-2.02]), and incident AF (1.44 [95% CI, 1.18-1.77]) but not incident coronary heart disease (0.97 [95% CI, 0.71-1.34]). Censoring AF attenuated the MMP-2 association with HF with preserved ejection fraction. Higher plasma MMP-2 levels were associated with larger left ventricular end-diastolic volume index, greater left ventricular mass index, higher E/e' ratio, larger left atrial volume index, and worse left atrial reservoir and contractile strains (all P<0.001). CONCLUSIONS: Higher plasma MMP-2 levels associate with diastolic dysfunction, left atrial dysfunction, and a higher risk of incident HF and AF. AF is a mediator of MMP-2-associated HF with preserved ejection fraction risk.

Interaction of iron and zinc fortification and late-season water deficit on yield and fatty acid composition of Dragon's Head (Lallemantia iberica L.).

Dragon's head (Lallemantia iberica) is a rich source of alpha-linolenic acid, linoleic acid, essential oil, protein, and mucilage. Therefore, the aim of this study was to evaluate the effects of foliar application of three different concentrations of Fe and Zn (control, 4, and 8 g lit-1) at two different developmental stages (vegetative stage (VS) and reproductive stage (RS)) on the quantity and quality of dragon's head seed yield and fatty acid composition in two crop seasons (2018 and 2019) under two environments (normal irrigation as control (NI) and post-anthesis water deficit (WD). In NI, average yields of seed, oil, and protein were 1155, 340, and 183 kg ha-1, respectively, and in the WD, they were 879, 283, and 148 kg ha-1, respectively. By applying Zn and Fe, the mean values of seed, oil, and protein yields in the NI were 1425, 478, and 264 kg ha-1, while in the WD, they were 1011, 354, and 200 kg ha-1, respectively. Furthermore, the application of WD resulted in a significant increase in zinc concentration, protein percentage, and saturated fatty acid percentage in seeds. Unlike WD, iron and zinc treatments decreased the percentage of saturated fatty acids and increased the percentage of unsaturated fatty acids. The number of capsules per plant had the most positive indirect effect on grain yield. The results showed that foliar spraying of Fe and Zn could effectively mitigate the adverse effects of WD on the quality and quantity of seed and oil yield dragon's head.

Cardiac computed tomographic imaging in cardio-oncology: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Endorsed by the International Cardio-Oncology Society (ICOS).

Cardio-Oncology is a rapidly growing sub-specialty of medicine, however, there is very limited guidance on the use of cardiac CT (CCT) in the care of Cardio-Oncology patients. In order to fill in the existing gaps, this Expert Consensus statement comprised of a multidisciplinary collaboration of experts in Cardiology, Radiology, Cardiovascular Multimodality Imaging, Cardio-Oncology, Oncology and Radiation Oncology aims to summarize current evidence for CCT applications in Cardio-Oncology and provide practice recommendations for clinicians.

Demographic and Regional Trends of Infective Endocarditis-Related Mortality in the United States, 1999 to 2019.

We sought to identify temporal, geographic, age and sex-based mortality trends of IE in the US over the past 2 decades. This population-based study utilized the CDC WONDER database to identify IE-related deaths occurring within the US between 1999 and 2019. IE-related crude and age-adjusted mortality rates (CMRs and AAMRs, respectively) were determined. Joinpoint regression was used to determine trends in CMR/AAMR using annual percent change (APC) in the overall sample in addition to demographic (sex, race/ethnicity, age) and geographic (rural/urban, statewide) subgroups. Between 1999 and 2019, a total of 279,154 deaths related to IE were reported. The overall AAMR declined from 54.2/1,000,000 in 1999 to 51.4 in 2019. However, AAMRs increased among several sub-groups over the past decade including men [2009-2019 APC = 0.4%, 95%CI, 0.1%-0.6%], non-Hispanic (NH) whites [APC of 0.8% from 2009 to 2019 (95%CI 0.5%-1.1%)], NH American Indians or Alaskan Natives [APC of 1.4% during the study period (95%CI, 0.7%-2.0%)], and those in rural areas [APC of 1.0% from 2009 to 2019 (95%CI 0.5%-1.5%)]. The CMRs increased among subjects 40-64 years old [APC of 2.8% from 2010 to 2019 (95%CI 2.2%-3.5%)] and 15-39 years old [APC of 16.4% from 2010 to 2017 (95%CI 13.5%-19.4%)]. IE-related CMR/AAMR increased among men, NH whites, NH American Indian or Alaskan Natives, those <65-year-old, and those from rural areas. Discerning the reasons for the increase in IE-related mortality among these groups and examining the impact of the social determinants of health may represent important opportunities to enhance care.

Genetic Testing for Hypertriglyceridemia in Academic Lipid Clinics: Implications for Precision Medicine-Brief Report.

BACKGROUND: Severe hypertriglyceridemia is often caused by variants in genes of triglyceride metabolism. These variants include rare, heterozygous pathogenic variants (PVs), or multiple common, small-effect single nucleotide polymorphisms that can be quantified using a polygenic risk score (PRS). The role of genetic testing to examine PVs and PRS in predicting risk for pancreatitis and severity of hypertriglyceridemia is unknown. METHODS: We examined the relationship of PVs and PRSs associated with hypertriglyceridemia with the highest recorded plasma triglyceride level and risk for acute pancreatitis in 363 patients from 3 academic lipid clinics who underwent genetic testing (GBinsight's Dyslipidemia Comprehensive Panel). Categories of hypertriglyceridemia included: normal triglyceride (<200 mg/dL), moderate (200-499 mg/dL), severe (500-999 mg/dL), or very severe (≥1000 mg/dL). RESULTS: PVs and high PRSs were identified in 37 (10%) and 59 (16%) individuals, respectively. Patients with both had increased risk for very severe hypertriglyceridemia compared with those with neither genetic risk factor. Risk for acute pancreatitis was also increased in individuals with both genetic risk factors (odds ratio, 5.1 [P=0.02] after controlling for age, race, sex, body mass index, and highest triglyceride level), but not in individuals with PV or high PRS alone. CONCLUSIONS: The presence of both PV and high PRS significantly increased risk for very severe hypertriglyceridemia and acute pancreatitis, whereas PV or PRS alone only modestly increased risk. Genetic testing may help identify patients with hypertriglyceridemia who have the greatest risk for developing pancreatitis and may derive the greatest benefit from novel triglyceride-lowering therapies.

Trigger related outcomes of takotsubo syndrome in a cancer population.

Background: Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied. Objectives: The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS. Methods: All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to the TTS trigger. The groups were compared with regards to major adverse cardiac events, overall survival and recovery of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after TTS presentation. Results: Eighty one of the 373 cancer patients who presented with ACS met the Mayo criteria for TTS. The triggering event was determined to be "cancer specific triggers" (use of chemotherapy in 23, immunomodulators use in 7, and radiation in 4), and "traditional triggers" (medical triggers 22, and procedural 18 and emotional stress in 7). Of the 81 patients, 47 died, all from cancer-related causes (no cardiovascular mortality). Median survival was 11.9 months. Immunomodulator (IM) related TTS and radiation related TTS were associated with higher mortality during the follow-up. Patients with medical triggers showed the least recovery in LVEF and GLS while patients with emotional and chemotherapy triggers, showed the most improvement in LVEF and GLS, respectively. Conclusion: Cancer patients presenting with ACS picture have a high prevalence of TTS due to presence of traditional and cancer specific triggers. Survival and improvement in left ventricular systolic function seem to be related to the initial trigger for TTS.

The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis.

BACKGROUND: There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. OBJECTIVES: The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). METHODS: The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. RESULTS: In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). CONCLUSIONS: Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a "gatekeeper" for more advanced imaging among patients presenting with CP.

Rhizobacteria modify soil biological indices and induce tolerance to osmotic stress in tomato depending on the salinity level and bacteria species.

Salinity is a major abiotic stress that impacts crop productivity globally. Plant growth-promoting rhizobacteria (PGPRs) exploit several mechanisms to not only decrease soil salinity but also improve the systemic tolerance of plants to osmotic stress. In this work, the effect of five PGPR strains was investigated on the growth and physiological responses of tomato plants, including stomatal closure, proline, and K+ and Na+ content under a range of salt stress, 0, 2.5, 5, 7.5, and 10 dS m-1. The effect of PGPR strains and salinity levels on the soil biological characteristics was also investigated. Salt stress affected the plant growth and physiological factors and soil biological factors in a dose-dependent manner. The highest saline stress, 10 dS m-1, reduced shoot and root dry weight and root volume up to 51.3, 41.5, and 51.8%, respectively. It also increased stomatal resistance and proline content 2.01- and 3.66-folds and decreased K+/Na+ ratio 4.16-folds, respectively. It also reduced basal respiration, substrate-induced respiration, and microbial biomass carbon up to 2.25-, 4.83-, and 6.7-folds and increased qCO2 3.18-folds, respectively. PGPR strains were able to modulate salt tolerance mechanisms, improve plant growth factors, and improve soil biological indicators. Bacillus megaterium P2 was the best strain in the balancing K+/Na+ uptake at least at 10 dS m-1. However, the efficiency of strains was dependent on the magnitude of salt stress. Therefore, it is possible to introduce PGPR strains based on soil salt level or exploit rhizobacteria consortia to manage salt stress in different conditions.

Diagnostic accuracy and performance of artificial intelligence in measuring left atrial volumes and function on multiphasic CT in patients with atrial fibrillation.

OBJECTIVES: To evaluate the effectiveness of a novel artificial intelligence (AI) algorithm for fully automated measurement of left atrial (LA) volumes and function using cardiac CT in patients with atrial fibrillation. METHODS: We included 79 patients (mean age 63 ± 12 years; 35 with atrial fibrillation (AF) and 44 controls) between 2017 and 2020 in this retrospective study. Images were analyzed by a trained AI algorithm and an expert radiologist. Left atrial volumes were obtained at cardiac end-systole, end-diastole, and pre-atrial contraction, which were then used to obtain LA function indices. Intraclass correlation coefficient (ICC) analysis of the LA volumes and function parameters was performed and receiver operating characteristic (ROC) curve analysis was used to compare the ability to detect AF patients. RESULTS: The AI was significantly faster than manual measurement of LA volumes (4 s vs 10.8 min, respectively). Agreement between the manual and automated methods was good to excellent overall, and there was stronger agreement in AF patients (all ICCs ≥ 0.877; p < 0.001) than controls (all ICCs ≥ 0.799; p < 0.001). The AI comparably estimated LA volumes in AF patients (all within 1.3 mL of the manual measurement), but overestimated volumes by clinically negligible amounts in controls (all by ≤ 4.2 mL). The AI's ability to distinguish AF patients from controls using the LA volume index was similar to the expert's (AUC 0.81 vs 0.82, respectively; p = 0.62). CONCLUSION: The novel AI algorithm efficiently performed fully automated multiphasic CT-based quantification of left atrial volume and function with similar accuracy as compared to manual quantification. Novel CT-based AI algorithm efficiently quantifies left atrial volumes and function with similar accuracy as manual quantification in controls and atrial fibrillation patients. KEY POINTS: • There was good-to-excellent agreement between manual and automated methods for left atrial volume quantification. • The AI comparably estimated LA volumes in AF patients, but overestimated volumes by clinically negligible amounts in controls. • The AI's ability to distinguish AF patients from controls was similar to the manual methods.

Deep learning model to quantify left atrium volume on routine non-contrast chest CT and predict adverse outcomes.

BACKGROUND: Low-dose computed tomography (LDCT) are performed routinely for lung cancer screening. However, a large amount of nonpulmonary data from these scans remains unassessed. We aimed to validate a deep learning model to automatically segment and measure left atrial (LA) volumes from routine NCCT and evaluate prediction of cardiovascular outcomes. METHODS: We retrospectively evaluated 273 patients (median age 69 years, 55.5% male) who underwent LDCT for lung cancer screening. LA volumes were quantified by three expert cardiothoracic radiologists and a prototype AI algorithm. LA volumes were then indexed to the body surface area (BSA). Expert and AI LA volume index (LAVi) were compared and used to predict cardiovascular outcomes within five years. Logistic regression with appropriate univariate statistics were used for modelling outcomes. RESULTS: There was excellent correlation between AI and expert results with an LAV intraclass correlation of 0.950 (0.936-0.960). Bland-Altman plot demonstrated the AI underestimated LAVi by a mean 5.86 â€‹mL/m2. AI-LAVi was associated with new-onset atrial fibrillation (AUC 0.86; OR 1.12, 95% CI 1.08-1.18, p â€‹< â€‹0.001), HF hospitalization (AUC 0.90; OR 1.07, 95% CI 1.04-1.13, p â€‹< â€‹0.001), and MACCE (AUC 0.68; OR 1.04, 95% CI 1.01-1.07, p â€‹= â€‹0.01). CONCLUSION: This novel deep learning algorithm for automated measurement of LA volume on lung cancer screening scans had excellent agreement with manual quantification. AI-LAVi is significantly associated with increased risk of new-onset atrial fibrillation, HF hospitalization, and major adverse cardiac and cerebrovascular events within 5 years.

Bridging the Gap: Investigating the Role of Social Workers in Supporting Metastatic Breast Cancer Patients in Nigeria.

Cancer is a disease common in every country around the globe with high incidences and deaths. Receiving a breast cancer diagnosis is often associated with a death sentence which makes the individual exhibit self-denial attributes, mixed negative emotions, depression, and anxiety. This study investigated the gap in supportive care and the role of social workers in the management of metastatic breast cancer patients in Nigeria. This study employed a qualitative method using Key Informant Interviews (KII). A total of 12 healthcare professionals in the area of medical social work, palliative care, and medical oncology were engaged in collecting the required information. The result revealed that social workers play significant roles in every aspect of the cancer care continuum - diagnosis, treatment, reintegration, or palliative care. Social workers help metastatic breast cancer patients in Nigeria, however, there are growing challenges to their roles. Most unskilled professionals often present themselves as social workers who do not meet professional standards or perform the best practice.

Investigating olfactory disorders in children with COVID-19 disease admitted to Hazrat Masoumeh Hospital in Qom.

BACKGROUND: One of the most important sensory disorders that usually occur after viral infections, especially human coronaviruses and rhinoviruses, is anosmia or loss of olfactory sense. The aim of the present study was to investigate olfactory disorders in children with COVID-19 disease admitted to Hazrat Masoumeh Hospital in Qom. MATERIALS AND METHODS: This descriptive-analytical study was conducted on 85 children admitted to Hazrat Masoumeh Hospital in Qom by using a convenience random sampling method. Data were collected using a checklist containing demographic data. The collected data were entered SPSS 18 software and were analyzed using descriptive and analytical statistics. RESULTS: In the present study, the results showed that the mean age of participants was 6.59 ± 3.27 years and more patients were Iranian (n = 69, 87.3%), had a history of underlying disease (n = 51, 64.6%), had a history of vaccination (n = 78, 98.7%), and did not have contact with a suspected patient (n = 43, 54.4%). Among the signs and symptoms of the disease, only the symptoms of fever (n = 71, 89.9%), weakness and lethargy (n = 44, 55.7%), and anorexia (n = 44, 55.7%) were observed in most patients. Moreover, 87.3% (n = 69) of the patients did not have olfactory. Furthermore, no association was found between age (P = 0.803), length of hospital stay (P = 0.397), white blood cell (P = 0.624), lymph (P = 0.638), Polymorphonuclear (PMN) (P = 0.493), erythrocyte sedimentation rate (P = 0.507), C-reactive protein (P = 0.085), and O2sat (P = 0.205) and olfactory disorders, but a significant relationship was found between patient weight (P = 0.002) and olfactory disorders. CONCLUSION: According to the results of the study, it can be said that in order to increase the strength of the immune system of children, especially overweight children, appropriate and planned action should be taken to prevent problems in these children.

Genetic testing in ambulatory cardiology clinics reveals high rate of findings with clinical management implications.

PURPOSE: Cardiovascular disease (CVD) is the leading cause of death in adults in the United States, yet the benefits of genetic testing are not universally accepted. METHODS: We developed the "HeartCare" panel of genes associated with CVD, evaluating high-penetrance Mendelian conditions, coronary artery disease (CAD) polygenic risk, LPA gene polymorphisms, and specific pharmacogenetic (PGx) variants. We enrolled 709 individuals from cardiology clinics at Baylor College of Medicine, and samples were analyzed in a CAP/CLIA-certified laboratory. Results were returned to the ordering physician and uploaded to the electronic medical record. RESULTS: Notably, 32% of patients had a genetic finding with clinical management implications, even after excluding PGx results, including 9% who were molecularly diagnosed with a Mendelian condition. Among surveyed physicians, 84% reported medical management changes based on these results, including specialist referrals, cardiac tests, and medication changes. LPA polymorphisms and high polygenic risk of CAD were found in 20% and 9% of patients, respectively, leading to diet, lifestyle, and other changes. Warfarin and simvastatin pharmacogenetic variants were present in roughly half of the cohort. CONCLUSION: Our results support the use of genetic information in routine cardiovascular health management and provide a roadmap for accompanying research.

Greater than expected reduction in low-density lipoprotein-cholesterol (LDL-C) with bempedoic acid in a patient with heterozygous familial hypercholesterolemia (HeFH).

Bempedoic acid is an adenosine triphosphate-citrate lyase (ACL) inhibitor that reduces levels of low-density lipoprotein-cholesterol (LDL-C) in the plasma by inhibition of cholesterol synthesis in hepatic cells, which leads to up-regulation of hepatic LDL receptors. Bempedoic acid is approved as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia (HeFH) who require additional lowering of LDL-C. In this case study, we describe a patient with HeFH who had a prior excellent response to statin but unable to take the same, and a less than expected response to PCSK9i, in whom initiation of bempedoic acid led to a substantial reduction of LDL-C. Our findings suggest that patients who are quite responsive to statins may also be quite responsive to bempedoic acid, a medication that works in the same biochemical pathway as HMG-CoA reductase inhibitors. Additionally, this medication may be particularly effective at lowering LDL-C among individuals not on background statin therapy.

Cardiac Magnetic Resonance Predicting Outcomes Among Patients at Risk for Cardiac AL Amyloidosis.

Introduction: Patients with systemic AL amyloidosis (AL) should be evaluated for cardiac amyloidosis (CA), as prognosis is strongly related to cardiac involvement. We assessed the characteristics of patients referred to cardiac magnetic resonance (CMR) with suspected CA from a cancer center and determine predictors of mortality/heart failure hospitalizations (HFH). Methods: Forty-four consecutive patients referred for CMR with suspected CA were retrospectively included. Variables collected included cardiac biomarkers, in addition to echocardiographic and CMR variables. Survival analyses were performed to determine which variables were more predictive of mortality and HFH. Results: Of the 44 patients included, 55% were females. 73% of patients were diagnosed with CA by CMR; 56% of them had an established diagnosis of AL. Patients with CA by CMR had higher native T1, higher extracellular volume (ECV) fraction, higher T2, less negative GLS by Echo, and higher troponin I and B-type natriuretic peptide (BNP). Kaplan-Meier survival analysis revealed that the following were predictive of mortality: an ECV ≥ 0.50 (p = 0.0098), CMR LVEF < 50% (p = 0.0010), T2/ECV ≤ 100 (p = 0.0001), and troponin I > 0.03 (p = 0.0025). In a stepwise conditional Cox logistic regression model, the only variable predictive of a composite of mortality and HFH was ECV (HR: 1.17, 95% CI = 1.02-1.34 p = 0.030). Conclusion: ECV seems to be an important biomarker that could be a predictor of outcomes in cardiac AL amyloidosis. In combination, CMR and serum cardiac biomarkers might help to establish prognosis in patients with CA.

Ten things to know about ten cardiovascular disease risk factors.

Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The "American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update" is a summary document (updated yearly) regarding CVD risk factors. This "ASPC Top Ten CVD Risk Factors 2021 Update" summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the "ASPC Top Ten CVD Risk Factors 2021 Update" to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.