Risultati per: Le cause della polmonite nei bambini

Objective
To investigate the association of fat and lean mass in specific regions with all-cause and cardiovascular-related mortality.

Design
Population based cohort study.

Setting
US National Health and Nutrition Examination Survey (2003–2006 and 2011–2018).

Participants
22 652 US adults aged 20 years or older.

Exposures
Fat and lean mass in specific regions obtained from the whole-body dual-energy X-ray absorptiometry.

Main outcome measures
All-cause and cardiovascular-related mortality.

Results
During a median of 83 months of follow-up, 1432 deaths were identified. Associations between body composition metrics and mortality risks were evident above specific thresholds. For all-cause mortality, Android fat mass showed elevated HRs above 2.46 kg (HR: 1.17, 95% CI 1.02 to 1.34), while Android lean mass (ALM) had similar trends above 2.75 kg (HR: 1.17, 95% CI 1.03 to 1.33), and Android total mass above 5.75 kg (HR: 1.08, 95% CI 1.01 to 1.16). Conversely, lower HRs were observed below certain thresholds: Gynoid fat mass (GFM) below 3.71 kg (HR: 0.72, 95% CI 0.56 to 0.93), Gynoid lean mass below 6.44 kg (HR: 0.77, 95% CI 0.64 to 0.92), and Gynoid total mass below 11.78 kg (HR: 0.76, 95% CI 0.70 to 0.84). Notably, below 0.722 kg, the HR of visceral adipose tissue mass (VATM) was 1.25 (95% CI 1.04 to 1.48) for all-cause mortality, and above 3.18 kg, the HR of total abdominal fat mass was 2.41 (95% CI 1.15 to 5.05). Cardiovascular-related mortality exhibited associations as well, particularly for Android fat mass (AFM) above 1.78 kg (HR: 1.22, 95% CI 1.01 to 1.47) and below 7.16 kg (HR: 0.50, 95% CI 0.36 to 0.69). HRs varied for Gynoid total mass below and above 10.98 kg (HRs: 0.70, 95% CI 0.54 to 0.93, and 1.12, 95% CI 1.02 to 1.23). Android per cent fat, subcutaneous fat mass (SFM), AFM/GFM, and VATM/SFM were not statistically associated with all-cause mortality. Android per cent fat, Gynoid per cent fat, AFM/GFM, and VATM/SFM were not statistically associated with cardiovascular-related mortality. Conicity index showed that the ALM/GLM had the highest performance for all-cause and cardiovascular-related mortality with AUCs of 0.785, and 0.746, respectively.

Conclusions
The relationship between fat or lean mass and all-cause mortality varies by region. Fat mass was positively correlated with cardiovascular mortality, regardless of the region in which they located. ALM/GLM might be a better predictor of all-cause and cardiovascular-related mortality than other body components or body mass index.

Nasce progetto Pet Co-therapy, visita dei calciatori del Bologna

Nasce progetto Pet Co-therapy, visita dei calciatori del Bologna

Domani la Giornata Mondiale della Prematurità

Circulation, Volume 148, Issue Suppl_1, Page A13855-A13855, November 6, 2023. Background:The American Heart Association recommended Life’s Essential 8 (LE8) as a simple cardiovascular health (CVH) metric. While optimal LE8 scores are associated with greater CVH and longevity, the mechanisms underlying these associations are unclear.Objective:To characterize the associations between LE8, epigenetic age scores, CVD, and all-cause mortality.Methods:LE8 scores were calculated for 5,669 participants in the Framingham Heart Study. Mixed proportional hazard models were used to evaluate the associations between LE8 score and CVD and all-cause mortality. We conducted mediation analyses to calculate the proportion of the association between LE8 score and CVD and all-cause mortality that is mediated by DNA methylation-based epigenetic age markers (GrimAge and PhenoAge). We performed stratified mediation analyses based on median-dichotomized polygenic risk score (PRS) of epigenetic age markers.Results:Higher LE8 scores, indicating better CVH, were associated with lower risk of CVD. One standard deviation (SD) increase in LE8 score was associated with a 35% decreased risk of CVD (95% CI: 27%, 41%,p=1.8E-15). One SD increase in LE8 was also associated with a 29% decreased risk of all-cause mortality (95% CI: 22%, 35%,p=7.0E-15). These associations were partly mediated by epigenetic age: the mean proportions of mediation by GrimAge and PhenoAge were 21% and 2% (p=0.23) for CVD and 67% and 6% for all-cause mortality, respectively. In our stratified analysis, potential mediation effects of GrimAge and PhenoAge were more profound in participants with a higher PRS. For GrimAge, the proportion of mediation for the association between LE8 and CVD was 39% (95% CI: 14%, 80%,p=8.8E-04) for participants in the upper half of higher GrimAge PRS whereas there was no significant mediation for those with low GrimAge PRS values. For the association between LE8 and all-cause mortality, the proportion of mediation by GrimAge was 81% (95% CI: 48%, 100%,p

Circulation, Volume 148, Issue Suppl_1, Page A13000-A13000, November 6, 2023. Description of Case:A 76-year-old female with a past medical history of chronic atrial fibrillation and symptomatic tachycardia and bradycardia status-post dual-chamber pacemaker with right atrial and ventricular leads who presented with dyspnea on exertion. TTE showed normal biventricular function and no significant valvular abnormalities. Upon further evaluation of her pacemaker, she was found to have a very high ventricular capture threshold suggesting RV lead failure. The patient underwent RV lead replacement. The inspection of the pacemaker pocket during the procedure showed manual dislodgement of both tie-down sleeves and the pacemaker leads required untangling. A new RV lead was subsequently placed. Upon further imaging review, displacement of the previous RV lead was evident from initial placement. In addition, the patient had previously had a history of interval diaphragmatic stimulation as well. Overall, the presentation was felt to be consistent with Twiddler’s Syndrome.Discussion:Twiddler’s or Reel Syndrome occurs when conscious or subconscious self-manipulation and spinning of the pulse generator result in lead dislodgement and loss of pacing and pacemaker malfunction. The reeling of the leads around the generator can also cause stimulation of the brachial plexus or phrenic nerve stimulation and subsequent rhythmic arm twitching or diaphragmatic pacing, respectively. It has previously been reported in cases of single- and dual-chamber ICDs, deep brain stimulators, and spinal nerve stimulators with varying presentation. The diagnosis requires clinical suspicion based on history, physical exam, imaging, or surgical inspection suggesting the displacement of leads with evidence of coiling of the wires around the pacemaker. Treatment often requires revision and focus should be maintained on patient education for both primary and secondary prevention of Twiddler’s Syndrome.

Circulation, Volume 148, Issue Suppl_1, Page A15010-A15010, November 6, 2023. Background:Reduction of diastolic blood pressure (DBP) below 70mmHg may decrease perfusion to the heart and worsen cardiovascular (CV) outcomes. However, studies assessing the association between low DBP and clinical outcomes have yielded inconsistent results.Aim:To meta-analyze the association between low DBP and CV outcomes.Methods:We searched the MEDLINE, Scopus, and Cochrane CENTRAL databases up until December 2022 for studies reporting the risk of all-cause mortality (ACM) or CV outcomes in patients with low versus normal DBP. Patients with a DBP of 70-80mmHg were considered the control and were compared to those with a DBP of 60-69mmHg and <60mmHg. Outcomes of interest were all-cause mortality (ACM), major adverse cardiac events (MACE), myocardial infarction (MI), and ischemic stroke. Subgroup analysis was performed to assess whether pre-existing CV disease was an effect modifier. Findings from studies were pooled using a random-effects model to derive hazard ratios (HRs) and 95% confidence intervals.Results:Ten studies (n = 1,998,223 participants) met the eligibility criteria. A mean achieved DBP<60mmHg was associated with a significantly increased risk of ACM (HR: 1.48 [1.26, 1.74]; P < 0.001) compared with a mean achieved DBP of 70-80mmHg (Fig. 1a). This association was significantly stronger in patients with pre-existing CV disease (P-interaction < 0.001). A DBP<60mmHg was also associated with a higher risk of MACE (HR: 1.84 [1.28, 2.65]; P < 0.001) and MI (HR: 1.49 [1.13, 1.97]; P < 0.001). However, a DBP<60mmHg had no significant association with ischemic stroke. A mean achieved DBP 60-69mmHg was associated with a significantly increased risk of ACM (HR: 1.11 [1.03, 1.20]; P < 0.001;Fig. 1b), but not MACE, MI, or ischemic stroke.Conclusion:Reduction of DBP below 70mmHg, particularly below 60mmHg, is associated with an increased risk of mortality. This association is stronger in patients with pre-existing CV disease.

Circulation, Volume 148, Issue Suppl_1, Page A12768-A12768, November 6, 2023. Introduction:The impact of recurrent hyperkalemia (rHK) on the time to cardiovascular (CV) outcomes and mortality in patients with chronic kidney disease (CKD) has not been well studied. This real-world study described and compared rates of CV outcomes and all-cause mortality between patients with rHK and matched patients without HK (nonHK).Methods:Patients with rHK were matched 1:1 to nonHK controls via exact and propensity score matching with the date of rHK or nonHK as index. Patients were adults with stage 3 or 4 CKD identified from Optum’s de-identified Market Clarity Data spanning 1/2016 to 8/2022. For each outcome sample, the corresponding CV events in baseline were excluded. CV outcomes included major adverse cardiovascular events plus (MACE+; all-cause mortality or inpatient [IP] heart failure, myocardial infarction, or stroke) and IP cardiac arrhythmia. Rates of CV outcomes and mortality were compared between matched cohorts using cause-specific Cox proportional hazard models and reported as hazard ratios (HR) with 95% confidence intervals (CI). Subgroups analyses were conducted by renin-angiotensin-aldosterone system inhibitor (RAASi) use at index.Results:Of 6,337 matched pairs, mean age was 73.3 years and 47.7% of patients were female. Patients with rHK compared to nonHK had higher rates of CV outcomes, including MACE+ (N = 5,258, HR=1.53 95% CI=[1.43, 1.65]) and IP arrhythmia (N = 5,485, 1.94 [1.74, 2.16]) (all p

Circulation, Volume 148, Issue Suppl_1, Page A15744-A15744, November 6, 2023. Introduction:Women referred for coronary artery bypass grafting (CABG) have worse metabolic disorders. The latter are associated with adverse cardiovascular (CV) events and bear a worse prognosis in women. Yet, our understanding of the sex-specific impact of metabolic disorders on mortality after CABG is limited. Aim: To evaluate the interaction of sex with metabolic abnormalities on mortality after CABG, with the hypothesis that they would lead to higher mortality in women.Methods:In a prospective cohort (2006-19), we selected patients who underwent elective isolated CABG, excluding early (

Circulation, Volume 148, Issue Suppl_1, Page A15052-A15052, November 6, 2023. Background:In 2022, the American Heart Association (AHA) updated the list of modifiable lifestyle factors most important for cardiovascular health to include sleep. Sleep disturbances, such as insomnia and sleep apnea, have been associated with an increased risk of incident cardiovascular disease (CVD). However, the relationship between sleep duration and mortality remains to be fully elucidated.Methods:We used National Health and Nutrition Examination Survey (NHANES) data linked to National Death Index records to examine the association between sleep duration and CVD and all-cause mortality. A representative sample of 37,975 adults aged ≥20 years participated in the survey, which included assessments of social, behavioral, and metabolic factors, including usual weekday sleep duration. Sleep duration was categorized as (1) ideal (6-

Circulation, Volume 148, Issue Suppl_1, Page A11428-A11428, November 6, 2023. Introduction:Effusive-constrictive pericarditis (ECP) is a rare cause of heart failure characterized by impaired cardiac filling due to pericardial compression. Cutibacterium acnes (C. acnes) is an indolent bacteria and uncommon cause of pericarditis, occurring predominantly in older, immunocompromised, and post-surgical patients. This report describes a rare case of ECP due to C. acnes in a young, immunocompetent male.Case Description:A 26 year old male with a history of acne treated with clindamycin wash presented with progressive dyspnea, orthopnea and lower extremity edema. Exam found a pericardial friction rub and knock, and Kussmaul sign. Electrocardiogram met low voltage criteria. Chest CT demonstrated bilateral pleural effusions, pericardial effusion, and ascites. Transthoracic echocardiogram showed a complex pericardial effusion with evidence of tamponade physiology. An emergent pericardial window was performed revealing thickened pericardium, pericardial adhesions, and 200 mL of sanguineous fluid. Pericardial biopsy was consistent with chronic fibrosing pericarditis. Tissue culture isolated C. acnes. Subsequent right heart catheterization confirmed constrictive physiology with diastolic equalization of intracardiac pressures and ventricular interdependence. Cardiac MRI noted intense pericardial enhancement, septal bounce, and biventricular fixation. Rheumatologic, HIV, viral hepatitis, EBV and CMV panels were negative. ESR was normal and CRP mildly elevated. The patient was treated with diuretics, colchicine, metoprolol, and antibiotics. Subsequent imaging showed marked improvement (Figure 1).Discussion:This case demonstrates that ECP due to C. acnes can occur in an immunocompetent patient without traditional risk factors or exposures. Since bacterial pericarditis is associated with a significant risk of mortality, it is important to have a high suspicion for this pathogen to avoid delay of appropriate treatment.

Circulation, Volume 148, Issue Suppl_1, Page A12041-A12041, November 6, 2023. Introduction:People living with HIV (PLWH) have more subclinical cardiovascular disease than people without HIV (PWOH), but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among this population.Purpose:This study aimed to determine the association between CAC and all-cause mortality among male PLWH and PWOH and to identify a potential interaction with HIV serostatus.Methods:The study population was derived from the MACS, a US prospective observational cohort study including male PLWH and PWOH. Participants underwent cardiac non-contrast computed tomography from July 2004 to November 2013. Men with atrial fibrillation, coronary heart disease, or coronary revascularization were excluded. Cox proportional hazards model was used to calculate adjusted hazard ratios [aHR] for all-cause mortality among men with vs. without baseline CAC (Agatston score >0) and per standard deviation (SD) increment in continuous Agatston score [log (CAC+1)], controlling for demographic and cardiac risk factors. CAC differences by HIV serostatus were evaluated using multiplicative CACхHIV interaction terms.Results:Among 1344 males (mean age 50 years, CAC prevalence 46%, 823 (61%) PLWH), we observed 110 deaths (13%) among PLWH and 41 deaths (8%) among PWOH during the follow-up period (median: 13.4 years). Among PLWH, 62% had an undetectable plasma HIV viral load, the median CD4 cell nadir was 284 cells/μL, and 17% had a history of clinical AIDS. The age-adjusted mortality rate was 13.5 (95% CI: 11.0-16.5) among PLWH and 7.8 (5.4-10.9) among PWOH per 1000 person-years. CAC presence was associated with all-cause mortality among all participants (aHR=1.47, 95% CI: 1.02-2.11, p=0.04), and among PLWH (aHR=1.61, 1.04-2.47, p=0.03). In PWOH, we found no significant association (aHR=1.27, 0.63-2.59, p=0.50), although the interaction was not significant (p= 0.49). Higher log (CAC+1) was also associated with all-cause mortality among all participants (aHR=1.37 per SD, 1.15-1.63, p

Circulation, Volume 148, Issue Suppl_1, Page A15930-A15930, November 6, 2023. Introduction:Primary prevention implantable cardioverter-defibrillators (PP-ICD) are indicated in patients with left ventricular ejection fraction (LVEF) ≤ 35% despite 3 months of maximally tolerated guideline directed medical therapy (GDMT), who are expected to survive at least 1 year. The Seattle Heart Failure Score, commonly used for evaluation of 1 year survival, only addresses heart failure mortality. The Charlson Comorbidity Index (CCI) is a validated model of comorbid conditions used to predict 1-year all-cause mortality.Objectives:We aimed to create a predictive model using the CCI to guide eligibility for PP-ICD based on predicted 1-year all-cause mortality in patients with severe cardiomyopathy.Methods:We analyzed clinical data from the University of Pittsburgh Medical Center, a large multi-hospital system, between January 2010 and July 2021. Patients receiving PP-ICD were included. We used a logistical regression model based on patients’ CCI, age, race, mean number of GDMT medications, the presence of coronary artery disease (CAD), and baseline LVEF.Results:Of the total cohort of 2,864 patients (mean age 67±12 years; Male 69%; White 85%; LVEF 24±7%; CAD 62%), 235 (8.2%) patients died within 1 year. Patients were on average prescribed 2.0±0.8 GDMT agents and had a mean CCI of 1.4± 1.6. CCI was significantly associated with adjusted 1-year mortality (OR 1.41 per standard deviation of CCI, 95% CI 1.35-1.71, p< 0.001). A receiver operator curve was generated (Figure 1) and a CCI cutoff of 1.54, yielded a sensitivity of 71% and a specificity of 59% (AUC 0.70).Conclusions:Our data demonstrate that a model incorporating the CCI can predict 1-year all-cause mortality in PP-ICD recipients with modest accuracy and could therefore assist in shared-decision making around PP-ICD therapy. Future work should focus on refining the model for higher predictive accuracy.

Circulation, Volume 148, Issue Suppl_1, Page A18204-A18204, November 6, 2023. Introduction:Machine learning has been demonstrated to significantly enhance the accuracy of cardiovascular risk prediction across various cardiac diseases.Hypothesis:This study sought to develop a machine learning (ML) framework to predict all-cause mortality in patients with left ventricular assist device (LVAD).Methods:All patients in INTERMACS registry who received an LVAD from June 2006 to December 2017 were screened. The Light Gradient Boosting Machine (LightGBM) algorithm was used to train an ML model for predicting all-cause mortality. Nested ten-fold cross-validation was performed to optimize the model and estimate its performance on unseen data. Model performance was assessed using the receiver operating characteristics (ROC) curves.Results:The final study group consisted of 22,137 patients, with a mean age of 56±13 years, and 21.3% being female. After a median follow-up of 12.4 months (IQR, 4.7 – 27.1 months). The overall all-cause mortality was reported in 7228 patients (32.7%). The proposed LightGBM-based framework had good performance with an area under the receiver operating characteristic curve (AUC-ROC) of 0.74 ± 0.05 on average over the 10 trials. Furthermore, when stratified by gender, the LightGBM-based framework had good performance (AUC-ROC of 0.73 for males and AUC-ROC of 0.70 for females).Conclusions:A ML model using LightGBM can predict all-cause mortality in LVAD patients with good performance.