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1.
Heliyon ; 10(5): e27577, 2024 Mar 15.
Article in English | MEDLINE | ID: mdl-38463776

ABSTRACT

Assessing soil quality marks the initial step in precision farming and agricultural management. Developing countries like Egypt face numerous hurdles in ensuring food security due to increasing populations and limited agricultural resources. A geographic information system (GIS) and multivariate analysis were utilized in the current work to evaluate and map a soil quality index (SQI). Moreover, the land suitability of the land for two plantations of the tree's oak (Quercus robur), and pine (Pinus silvestris), respectively was assessed using a parametric approach. A total of 82 soil profiles were selected to fulfill the objectives of the study. Based on the samples' PC scores, and agglomerative hierarchical clustering (AHC, the data was divided into two clusters: Cluster I and Cluster II, which collectively account for approximately 57% and 43% of the total data, respectively.. . The findings indicated that land suitability for planting Q. robur planted identified 2.14% of the research area as highly suitable (S1), 37.98% as moderately suitable (S2), and 59.89% as not suitable (N). Furthermore, the assessment of suitability for P. silvestris indicated that 50.88% of the investigated area was classified into: S1, 48.73% as S2, and 0.39% as N, which means it is not suitable for conservation activities. The research identified that soil depth beside excessive salinity and calcium carbonate as the primary soil constraints in the area in both clusters. The average soil depth, ECd and CaCO3 were 113.62 ± 12.41, 17.27 ± 10.23, 16.83 ± 6.57 in Cluster 1 and 45.43 ± 15.21, 22.42 ± 12.43, 21.55 ± 5.63 in Cluster II. The study demonstrates that integrating multivariate analysis with GIS enables a precise and streamlined assessment of the Soil Quality Index (SQI). Soil suitability modelling underscores the importance of implementing efficient management practices to attain agricultural sustainability in arid regions, particularly amidst intensive land utilization pressures.

2.
Sci Rep ; 14(1): 5846, 2024 03 10.
Article in English | MEDLINE | ID: mdl-38462662

ABSTRACT

The expression of ACE2 is linked to disease severity in COVID-19 patients. The ACE2 receptor gene polymorphisms are considered determinants for SARS-CoV-2 infection and its outcome. In our study, serum ACE2 and its genetic variant S19P rs73635825 polymorphism were investigated in 114 SARS-CoV-2 patients. The results were compared with 120 control subjects. ELISA technique and allele discrimination assay were used for measuring serum ACE2 and genotype analysis of ACE2 rs73635825. Our results revealed that serum ACE2 was significantly lower in SARS-CoV-2 patients (p = 0.0001), particularly in cases with hypertension or diabetes mellitus. There was a significant difference in the genotype distributions of ACE2 rs73635825 A > G between COVID-19 patients and controls (p-value = 0.001). A higher frequency of the heterozygous AG genotype (65.8%) was reported in COVID-19 patients. The G allele was significantly more common in COVID-19 patients (p < 0.0001). The AG and GG genotypes were associated with COVID-19 severity as they were correlated with abnormal laboratory findings, GGO, CXR, and total severity scores with p < 0.05. Our results revealed that the ACE2 S19P gene variant is correlated with the incidence of infection and its severity, suggesting the usefulness of this work in identifying the susceptible population groups for better disease control.


Subject(s)
COVID-19 , Humans , Angiotensin-Converting Enzyme 2/genetics , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/genetics , Egypt/epidemiology , Patient Acuity , Peptidyl-Dipeptidase A/genetics , Peptidyl-Dipeptidase A/metabolism , Polymorphism, Genetic , SARS-CoV-2/metabolism
3.
Nanomaterials (Basel) ; 14(4)2024 Feb 16.
Article in English | MEDLINE | ID: mdl-38392742

ABSTRACT

Studying the impact of residual soil nanomaterials is a promising challenge for sustainable agricultural development to improve soil health and crop productivity. The objective of this study is to assess the long-term impacts of 50, 100, and 250 mg kg-1 soil of nanobiochar (nB) and nano-water treatment residues (nWTR) on the fertility, biological activity, and yield of maize (Zea mays L.) growing in heavy metal-contaminated soils. The results showed that when nB and nWTR were added in larger quantities, the concentrations of lead (Pb), nickel (Ni), cadmium (Cd), and cobalt (Co) extracted with DTPA decreased. With the addition of nB or nWTR, it also showed a significant increase in exchangeable cations, cation exchange capacity (CEC), soil fertility, soil organic matter (OM), microbial biomass carbon (MBC), and a decrease in soil salinity and sodicity. Catalase and dehydrogenase activities rose as nB addition increased, while they decreased when nWTR addition increased. In comparison to the control, the addition of nB and nWTR greatly boosted maize yield by 54.5-61.4% and 61.9-71.4%, respectively. These findings suggest that the researched nanomaterials' residual effect provides an eco-friendly farming method to enhance the qualities of damaged soils and boost maize production. Our research suggested that adding recycling waste in the form of nanoparticles could immobilize heavy metals, improve soil characteristics, and increase the soil's capacity for productivity.

5.
Basic Clin Androl ; 33(1): 34, 2023 Dec 05.
Article in English | MEDLINE | ID: mdl-38049720

ABSTRACT

BACKGROUND: Premature ejaculation (PE) is considered to be the most common male sexual disorder affecting 20% to 66% of sexually active men. Most of the patients had already tried on demand dapoxitine with no improvement. We aimed in the current study to assert the efficacy and safety profile of daily intake of 30 mg duloxetine in treating patients with lifelong premature ejaculation (LPE) as well as patients with acquired premature ejaculation (APE). RESULTS: The current study showed significant improvement in intravaginal ejaculatory latency time (IELT) after intake of duloxetine. All participants had a median Arabic index of premature ejaculation (AIPE) of 26, median IELT of 180 s, median male sexual quality of life (SQOL) of 43 after being treated with duloxetine (p value < 0.001 for all). While median AIPE after placebo was 19, median IELT after placebo was 60 s and median male SQOL after placebo was 21. Paired comparison of AIPE, IELT (Secs), inter quartile range (IQR) and male SQOL in group (A) patients at baseline and after duloxetine intake showed statistically significant improvement among treated patients (p values < 0.001 for all). Paired comparison of AIPE, IELT (Secs), IQR and male SQOL in group (A) patients at baseline and after placebo treatment showed no significant improvement of male SQOL. Furthermore, AIPE and IELT returned to baseline scores after discontinuation of duloxetine (p values 0.729; 0.892, respectively). Paired comparison of AIPE, IELT (Secs), IQR and male SQOL in group (B) patients at baseline and after placebo treatment showed almost same scores of patients in group (A) who received placebo for 2 months after a 2 month washout period (p values 1.000 for all). Paired comparison of AIPE, IELT (Secs), IQR and male SQOL in group (B) patients at baseline and after duloxetine treatment showed statistically significant improvement among all treated patients (p values < 0.001 for all). CONCLUSION: Duloxetine is an effective drug for treatment of LPE and APE patients. Further, larger studies are needed to compare duloxetine to different known therapeutic modalities for PE to assert it's efficacy and superiority.


RéSUMé: CONTEXTE: L'éjaculation précoce (EP) est considérée comme le trouble sexuel masculin le plus courant, touchant 20% à 66% des hommes sexuellement actifs. La plupart des patients avaient déjà essayé la dapoxitine à la demande sans amélioration. Dans la présente étude, nous avons cherché à déterminer l'efficacité et l'innocuité de l'apport quotidien de 30 mg de duloxétine comme traitement de patients atteints d'éjaculation précoce de longue durée et de patients atteints d'éjaculation précoce acquise. RéSULTATS: La présente étude a montré une amélioration significative du temps de latence éjaculatoire intravaginal (IELT) après la prise de duloxétine. Tous les participants avaient un indice médian de l'éjaculation précoce (AIPE) de 26, un IELT médian de 180 secondes, et une médiane de la qualité de vie sexuelle masculine (SQOL) de 43 après avoir été traités par la duloxétine (p < 0,001 pour tous). Après placebo, l'AIPE médian était de 19, l'IELT médian de 60 secondes et la médiane de la SQOL masculine de 21. La comparaison appariée de l'AIPE, de l'IELT, de l'intervalle interquartile (IQR) et de la SQOL masculine chez les patients du groupe (A) au départ et après la prise de duloxétine a montré une amélioration statistiquement significative chez les patients traités (p < 0,001 pour tous). La comparaison appariée de l'AIPE, de l'IELT, de l'IQR et de la SQOL masculine chez les patients du groupe (A) au départ et après traitement par placebo n'a montré aucune amélioration significative de la SQOL masculine. De plus, l'AIPE et l'IELT sont revenus aux scores de base après l'arrêt de la duloxétine (respectivement p 0,729; 0,892). La comparaison appariée de l'AIPE, de l'IELT, de l'IQR et de la SQOL masculine chez les patients du groupe (B) au départ et après traitement par placebo a montré presque les mêmes scores que les patients du groupe (A) qui ont reçu un placebo pendant 2 mois après une période de sevrage thérapeutique de 2 mois (p 1,000 pour tous). La comparaison appariée de l'AIPE, de l'IELT, de l'IQR et de la SQOL masculine chez les patients du groupe (B) au départ et après le traitement par la duloxétine a montré une amélioration statistiquement significative chez tous les patients traités (p < 0,001 pour tous). CONCLUSIONS: La duloxétine est un médicament efficace pour traiter des patients atteints d'éjaculation précoce de longue durée, et ceux atteints d'éjaculation précoce acquise. D'autres études de plus grande envergure sont nécessaires pour comparer la duloxétine aux différentes modalités thérapeutiques connues de l'éjaculation précoce, afin de déterminer son efficacité et sa supériorité. MOTS-CLéS: Ejaculation précoce de longue Durée; Ejaculation précoce acquise; Duloxétine; Qualité de Vie sexuelle masculine.

6.
Am J Mens Health ; 17(3): 15579883231181861, 2023.
Article in English | MEDLINE | ID: mdl-37341390

ABSTRACT

This study aimed to detect the impact of bacteriospermia on semen parameters and sperm DNA fragmentation. This prospective case-control study was conducted over a period of 9 months. Samples were collected from andrology outpatient clinic attendants of Cairo University Hospitals. We enrolled 68 semen samples divided into two groups: a study group (34 semen samples with bacteriospermia) and a control group (34 semen samples without bacteriospermia). The characteristics of the semen, including morphology, motility, count, liquefaction, viscosity, pH, volume, and appearance, were evaluated according to the standard protocols. Patients with and without bacteriospermia had a comparable liquefaction time (p = .343), semen appearance and color (p = 1.00), semen pH (p = 1.00), velocity (p = .163), and total sperm count (p = .451). Patients with bacteriospermia were associated with lower progressive motility (p = .001), nonprogressive motility (p = .032), total motility (p = .001), and normal forms (p = .001). The prevalence of abnormal semen analysis was 64.71% in the study group compared with 35.29% in the control group. Staphylococcus aureus (67.6%) and Escherichia coli (14.7%) were the most commonly detected organisms. Samples from which Methicilin-resistant Staphylococcus aureus was isolated showed significant abnormalities in both progressive motility and normal morphology of sperm. Bacteriospermia has deteriorative effects on sperm quality parameters, such as semen volume, sperm motility, and sperm normal morphology.


Subject(s)
Infertility , Methicillin-Resistant Staphylococcus aureus , Male , Humans , Semen , Case-Control Studies , Egypt , Sperm Motility
9.
JACC Clin Electrophysiol ; 9(2): 246-254, 2023 02.
Article in English | MEDLINE | ID: mdl-36858692

ABSTRACT

BACKGROUND: Prolongation of the QTc interval is associated with the risk of torsades de pointes. Determination of the QTc interval is therefore of critical importance. There is no reliable method for measuring or correcting the QT interval in atrial fibrillation (AF). OBJECTIVES: The authors sought to evaluate the use of a convolutional neural network (CNN) applied to AF electrocardiograms (ECGs) for accurately estimating the QTc interval and ruling out prolongation of the QTc interval. METHODS: The authors identified patients with a 12-lead ECG in AF within 10 days of a sinus ECG, with similar (±10 ms) QRS durations, between October 23, 2001, and November 5, 2021. A multilayered deep CNN was implemented in TensorFlow 2.5 (Google) to predict the MUSE (GE Healthcare) software-generated sinus QTc value from an AF ECG waveform, demographic characteristics, and software-generated features. RESULTS: The study identified 6,432 patients (44% female) with an average age of 71 years. The CNN predicted sinus QTc values with a mean absolute error of 22.2 ms and root mean squared error of 30.6 ms, similar to the intrinsic variability of the sinus QTc interval. Approximately 84% and 97% of the model's predictions were contained within 1 SD (±30.6 ms) and 2 SD (±61.2 ms) from the sinus QTc interval. The model outperformed the AFQTc method, exhibiting narrower error ranges (mean absolute error comparison P < 0.0001). The model performed best for ruling out QTc prolongation (negative predictive value 0.82 male, 0.92 female; specificity 0.92 male, 0.97 female). CONCLUSIONS: A CNN model applied to AF ECGs accurately predicted the sinus QTc interval, outperforming current alternatives and exhibiting a high negative predictive value.


Subject(s)
Atrial Fibrillation , Torsades de Pointes , Humans , Female , Male , Aged , Algorithms , Neural Networks, Computer , Software
10.
Heart Rhythm ; 20(6): 808-814, 2023 06.
Article in English | MEDLINE | ID: mdl-36863636

ABSTRACT

BACKGROUND: Established electroanatomic mapping techniques for substrate mapping for ventricular tachycardia (VT) ablation includes voltage mapping, isochronal late activation mapping (ILAM), and fractionation mapping. Omnipolar mapping (Abbott Medical, Inc.) is a novel optimized bipolar electrogram creation technique with integrated local conduction velocity annotation. The relative utilities of these mapping techniques are unknown. OBJECTIVE: The purpose of this study was to evaluate the relative utility of various substrate mapping techniques for the identification of critical sites for VT ablation. METHODS: Electroanatomic substrate maps were created and retrospectively analyzed in 27 patients in whom 33 VT critical sites were identified. RESULTS: Both abnormal bipolar voltage and omnipolar voltage encompassed all critical sites and were observed over a median of 66 cm2 (interquartile range [IQR] 41.3-86 cm2) and 52 cm2 (IQR 37.7-65.5 cm2), respectively. ILAM deceleration zones were observed over a median of 9 cm2 (IQR 5.0-11.1 cm2) and encompassed 22 critical sites (67%), while abnormal omnipolar conduction velocity (CV <1 mm/ms) was observed over 10 cm2 (IQR 5.3-16.6 cm2) and identified 22 critical sites (67%), and fractionation mapping was observed over a median of 4 cm2 (IQR 1.5-7.6 cm2) and encompassed 20 critical sites (61%). The mapping yield was the highest for fractionation + CV (2.1 critical sites/cm2) and least for bipolar voltage mapping (0.5 critical sites/cm2). CV identified 100% of critical sites in areas with a local point density of >50 points/cm2. CONCLUSION: ILAM, fractionation, and CV mapping each identified distinct critical sites and provided a smaller area of interest than did voltage mapping alone. The sensitivity of novel mapping modalities improved with greater local point density.


Subject(s)
Catheter Ablation , Tachycardia, Ventricular , Humans , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/surgery , Retrospective Studies , Electrophysiologic Techniques, Cardiac/methods , Catheter Ablation/methods
11.
J Interv Card Electrophysiol ; 66(2): 323-331, 2023 Mar.
Article in English | MEDLINE | ID: mdl-35314904

ABSTRACT

BACKGROUND: Catheter ablation is an effective treatment for ventricular tachycardia (VT), albeit the decision to undergo this procedure is often influenced by underlying comorbidities. The present study aims at evaluating the effects of chronic kidney disease (CKD) on clinical outcomes of VT ablation. METHODS: We identified 7212 patients who presented between 2016 and 2018 and underwent catheter ablation for VT. Their clinical data were retrospectively accrued from the national readmission database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between patients with chronic kidney disease (CKD group) and patients without. Odds ratios (OR) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS: Compared with patients without CKD, patients in CKD group were older (mean age 67.9 vs. 60.5 years, P < 0.01), had a longer mean length of stay (8.73 vs. 5.69 days, P < 0.01), and higher in-hospital mortality 113 (6.7%) vs. 119 (2.2%) (OR 2.24, 95% confidence interval (CI) (1.29-3.88), P < 0.01). CKD group patients had increased risk of developing acute kidney injury 726 (43%) vs. 623 (11.3%) (3.69 95% CI (2.87-4.74), P < 0.01). CONCLUSION: In patients with CKD, VT ablation is associated with worse clinical outcomes in-hospital mortality, acute kidney injury, mean length of stay, and total hospital charge. This significantly influences the decision-making prior to performing this procedure.


Subject(s)
Catheter Ablation , Tachycardia, Ventricular , Humans , Aged , Retrospective Studies , Patient Readmission , Hospital Mortality , Arrhythmias, Cardiac/surgery , Treatment Outcome , Catheter Ablation/methods
12.
J Interv Card Electrophysiol ; 66(6): 1375-1382, 2023 Sep.
Article in English | MEDLINE | ID: mdl-36445605

ABSTRACT

BACKGROUND: With the growing use of implantable cardiac devices, the need for transvenous lead extraction has increased, which translates to increased procedural volumes. Sex differences in lead extraction outcomes are not well studied. OBJECTIVE: The present study aims at evaluating the impact of sex on outcomes of lead extraction. METHODS: We identified 71,754 patients who presented between 2016 and 2019 and underwent transvenous lead extraction. Their clinical data were retrospectively accrued from the National Readmission Database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between male and female patients. Odds ratios (ORs) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS: Compared to male patients, female patients had higher in-hospital complications including pneumothorax (OR 1.26, 95% CI (1.07-1.4), P < 0.01), hemopericardium (OR 1.39, 95% CI (1.02-1.88), P = 0.036), injury to superior vena cava and innominate vein requiring repair (OR 1.88, 95% CI (1.14-3.1), P = 0.014; OR 3.4, 95% CI (1.8-6.5), P < 0.01), need for blood transfusion (OR 1.28, 95% CI (1.18-1.38), P < 0.01), and pericardiocentesis (OR 1.6, 95% CI (1.3-2), P < 0.01). Thirty-day readmission was also significantly higher in female patients (OR 1.09, 95% CI (1.02-1.17), P < 0.01). There was no significant difference regarding in-hospital mortality (OR 0.99, 95% CI (0.87-1.14), P = 0.95). CONCLUSION: In female patients, lead extraction is associated with worse clinical outcomes and higher 30-day readmission rate.


Subject(s)
Defibrillators, Implantable , Pacemaker, Artificial , Humans , Male , Female , Defibrillators, Implantable/adverse effects , Pacemaker, Artificial/adverse effects , Vena Cava, Superior , Retrospective Studies , Sex Characteristics , Patient Readmission , Device Removal/adverse effects , Treatment Outcome
14.
Int J Cardiol ; 359: 46-53, 2022 07 15.
Article in English | MEDLINE | ID: mdl-35436558

ABSTRACT

AIM: To examine the efficacy of digital health interventions (DHI) versus standard of care among patients with prior heart failure (HF) hospitalization. METHODS: An electronic search of MEDLINE, Cochrane, OVID, CINHAL and ERIC, databases was performed through August 2021 for randomized clinical trials that evaluated the outcomes with DHI among patients with HF. Data were pooled using the random-effects model. The primary outcome was all-cause mortality. RESULTS: 10 randomized trials were included in our analysis, with a total of 7204 patients and a weighted follow up duration of 15.6 months. Compared with the reference group, patients in the DHI group had lower all-cause mortality (8.5% vs. 10.2%, risk ratio-RR 0.80; 95% confidence interval-CI 0.66 to 0.96; P = 0.02), as well as lower cardiovascular mortality (7.3% vs. 9.6%, RR 0.76; 95% CI 0.62 to 0.94; P = 0.01). There was no significant difference in HF-related hospitalizations (23.4% vs. 26.2%, RR 0.82; 95% CI 0.66 to 1.02; P = 0.07) and all-cause hospitalizations (48.3% vs. 49.9%, RR 0.89; 95% CI 0.77 to 1.03; P = 0.11) in the DHI versus reference groups. Patients in the DHI group had fewer days lost due to HF-related hospitalizations (mean difference-MD: -1.77; 95% CI -3.06,-0.48, p = 0.01; I2 = 51), but similar days lost to all-cause hospitalizations (MD: -0.76; 95% CI -3.07,-1.55, p = 0.52; I2 = 69) compared with patients in the reference group. CONCLUSION: Compared with usual care, DHI among patients with HF provided significant reduction of all-cause mortality and cardiovascular mortality and had fewer total days lost to HF hospitalizations. There were no differences in all-cause hospitalizations, and HF hospitalizations.


Subject(s)
Heart Failure , Heart Failure/diagnosis , Heart Failure/therapy , Hospitalization , Humans , Randomized Controlled Trials as Topic
15.
Int J Biometeorol ; 66(5): 971-985, 2022 May.
Article in English | MEDLINE | ID: mdl-35149894

ABSTRACT

The impacts of climate change and possible adaptations to food security are a global concern and need greater focus in arid and semi-arid regions. It includes scenario of Coupled Model Intercomparison Phase 5 (CMIP-RCP8.5). For this purpose, two DSSAT maize models (CSM-CERES and CSM-IXIM) were calibrated and tested with two different maize cultivars namely Single Cross 10 (SC10) and Three Way Cross 324 (TW24) using a dataset of three growing seasons in Nile Delta. SC10 is a long-growing cultivar that is resistant to abiotic stresses, whereas TW24 is short and sensitive to such harsh conditions. The calibrated models were then employed to predict maize yield in baseline (1981-2010) and under future time slices (2030s, 2050s, and 2080s) using three Global Climate Models (GCMs) under CMIP5-RCP8.5 scenario. In addition, the use of various adaptation options as shifting planting date, increasing sowing density, and genotypes was included in crop models. Simulation analysis showed that, averaged over three GCMs and two crop models, the yield of late maturity cultivar (SC10) decreased by 4.1, 17.2, and 55.9% for the three time slices of 2030s, 2050s, and 2080s, respectively, compared to baseline yield (1981-2010). Such reduction increased with early maturity cultivar (TW24), recording 12.4, 40.6, and 71.3% for near (2030s), mid (2050s), and late century (2080s) respectively relative to baseline yield. The most suitable adaptation options included choosing a stress-resistant genotype, changing the planting date to plus or minus 30 days from baseline planting date, and raising the sowing density to 9 m-2 plants. These insights could minimize the potential reduction of climate change-induced yields by 39% by late century.


Subject(s)
Acclimatization , Zea mays , Climate Change , Desert Climate , Genotype
16.
J Innov Card Rhythm Manag ; 13(10): 5189-5194, 2022 Oct.
Article in English | MEDLINE | ID: mdl-36605292

ABSTRACT

Catheter ablation is indicated for the management of supraventricular tachycardias (SVTs). We investigated the effect of sex on short-term outcomes after catheter ablation for SVTs other than atrial fibrillation (AF). Using the Healthcare Cost and Utilization Project Nationwide Readmission Database for the years 2016-2018, SVT patients who underwent catheter ablation were identified using the appropriate International Classification of Diseases, 10th Revision, codes. The primary outcome was 30-day readmissions. Secondary outcomes included 30-day readmissions for SVT, postprocedural bleeding, acute myocardial infarction, transient ischemic attack, stroke, hemopericardium, cardiac tamponade, length of stay (LOS) in the hospital, and total hospital charges (in USD). Female sex was not associated with an increased risk of the primary outcome (P = .168) but was associated with a significantly decreased risk of postprocedural revascularization (P = .001), LOS (P = .003), and total hospital charges (P = .002). There were no significant differences in other secondary outcomes. Among patients admitted for catheter ablation for SVTs (other than AF), female sex was associated with decreased LOS and total hospital charges, which may be attributed to increased comorbidity rates in men and gender-based biases.

17.
Int J Cardiol Heart Vasc ; 37: 100908, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34765721

ABSTRACT

BACKGROUND: There is limited information on the long-term outcomes of ICDs in patients with inherited arrhythmia syndromes. METHODS: Prospective registry study of inherited arrhythmia patients with an ICD. Incidence of therapies and complications were measured as 5-year cumulative incidence proportions and analyzed with the Kaplan-Meier method. Incidence was compared by device indication, diagnosis type and device type. Cox-regression analysis was used to identify predictors of appropriate shock and device complication. RESULTS: 123 patients with a mean follow up of 6.4 ± 4.8 years were included. The incidence of first appropriate shock was 56.52% vs 24.44%, p < 0.05 for cardiomyopathy and channelopathy patients, despite similar ejection fraction (61% vs 60%, p = 0.6). The incidence of first inappropriate shock was 13.46% vs 56.25%, p < 0.01 for single vs. multi-lead devices. The incidence of first lead complication was higher for multi-lead vs. single lead devices, 43.75% vs. 17.31%, p = 0.04. Patients with an ICD for secondary prevention were more likely to receive an appropriate shock than those with primary prevention indication (HR 2.21, CI 1.07-4.56, p = 0.03). Multi-lead devices were associated with higher risk of inappropriate shock (HR 3.99, CI 1.27-12.52, p = 0.02), with similar appropriate shock risk compared to single lead devices. In 26.5% of patients with dual chamber devices, atrial sensing or pacing was not utilized. CONCLUSION: The rate of appropriate therapies and ICD complications in patients with inherited arrhythmia is high, particularly in cardiomyopathies with multi-lead devices. Risk-benefit ratio should be carefully considered when assessing the indication and type of device in this population.

18.
Cureus ; 13(6): e15407, 2021 Jun.
Article in English | MEDLINE | ID: mdl-34249555

ABSTRACT

Background Myocardial clefts (MCs) are rare anomalies with debatable clinical significance. Increased use of cardiac magnetic resonance (CMR) has led to the appreciation of subtle left ventricular (LV) wall structural defects, and studies showed varying clinical significance, ranging from asymptomatic incidental findings to being considered a novel imaging marker of hypertrophic cardiomyopathy. Sparse data are available about the utility of two-dimensional echocardiography (2DE) to visualize these anomalies. We describe our institutional experience categorizing MCs using 2DE. Methods The echocardiography database was retrospectively queried for diagnosing MCs using Synapse® Cardiovascular Picture Archiving and Communication System (PACS) (Fujifilm, Tokyo, Japan). Identified patients were admitted to Detroit Medical Center (DMC) between January 2012 and May 2019. MCs were defined as recesses filled with luminal blood, obliterate during systole, and have U, wedge, and tunnel shapes. Images were interpreted by a cardiologist blinded to the data. Baseline demographics and clinical characteristics were documented. The study was descriptive; no intervention was done. Results Sixteen patients with a mean age of 62.43 were included; 68.75% were women, and 81.25% were African American. The prevalence of cardiac comorbidities was primary hypertension 12 (75%), coronary artery disease 5 (31.25%), heart failure with reduced ejection fraction (HFrEF) 4 (25.0%), valvular heart disease 4 (25.0%), arrhythmia/heart block 4 (25.0%), and heart failure with preserved ejection fraction (HFpEF) 2 (12.5%). The indications for 2DE evaluation were heart failure/cardiogenic shock 2 (12.5%), acute coronary syndrome 2 (12.5%), syncope/presyncope 2 (12.5%), atypical chest pain 2 (12.5%), and others 8 (50.0%). Twenty-one MCs were visualized in eight segments of LV walls and septum as follows: basal inferior 7, mid inferoseptal 6, mid inferior 3, mid anteroseptal 2, mid inferolateral 1, mid anterolateral 1, basal inferoseptal 1, apical inferoseptal 1, and apical septal 1. Morphology was classified as tunnel in 66.66%, wedge in 23.8%, and U in 9.5%. Conclusion In various LV and septal walls, MCs detected on 2DE were benign and incidental findings without significant implications for preclinical hypertrophic cardiomyopathy (HCM).

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