Risultati per: Cardio-oncology: rivista open access

Circulation, Volume 146, Issue Suppl_1, Page A15812-A15812, November 8, 2022. Introduction:In October 2018, the heart allocation policy for adult heart transplant (OHTx) in the United States was changed, with the goal of reducing waitlist mortality and providing broader sharing of donor organs within the United States. The aim of this study was to assess the effect of this policy change on access to OHTx vs LVAD, overall and among key sociodemographic subgroups, in the US from 2016 to 2019.Hypothesis:We hypothesized that the UNOS heart allocation policy would increase OHTx volume overall as well as use of temporary mechanical circulatory support.Methods:We identified all patients receiving OHTx or LVAD between 2016-2019 using the National Inpatient Sample. Controlling for medical comorbidities, trends over time, and within hospital-year effects, we fit a dynamic logistic regression model to evaluate patient and hospital factors associated with receiving OHTx vs LVAD pre- versus post-policy change.Results:We identified 2264 patients who received OHTx and 3157 who received LVADs during the study period. Overall, there was a 4.16% increase in OHTx receipt, compared to LVAD, in the post-period (p=0.006). Among OHTx recipients, the frequency of use of tMCS changed from 15.61% in the pre period to 42.55% in the post period (p-value < 0.0001). While the policy change was associated with differences in the odds of receiving an OHTx versus LVAD between different regions of the country, there were no significant changes based on age, gender, race/ethnicity, insurance status, or rurality.Conclusions:The UNOS policy change on access to OHTx was associated with slightly higher rates of OHTx overall, and higher rates of use of temporary support prior to transplant, but no differential change in access among key demographic groups. Shifts in regional allocation were not significant overall, though certain regions appeared to have a relative increase in their use of OHTx.

Circulation, Volume 146, Issue Suppl_1, Page A13115-A13115, November 8, 2022. Introduction:Socioeconomic status (SES) and remoteness of residence (RoR) impact access to care and outcomes in congenital (CHD) and acquired (AHD) pediatric heart disease. Whether the universal, centralized Canadian healthcare system mitigates such inequities is unclear. We examined associations between SES and RoR on age at cardiac diagnosis (ACD), time to first intervention (TFI), and annual primary care (PCV) and cardiology (CV) visits as evidence of healthcare access in Alberta.Methods:All children born and diagnosed in Alberta with CHD or AHD from 2005-2017 were included. CHD was classified as mild, moderate, and severe base on the Bethesda Task Force definitions. Geospatial modelling was used to determine drive times (180 minutes) to 1 of 2 provincial cardiac programs. Cox proportional hazards regression models were used to examine relationships between RoR and SES with ACD and TFI, and Poisson models using generalized estimating equations for annual PCV and CV.Results:Of 12,542 children, 9347 had mild, 1733 moderate and 717 severe CHD and 745 AHD. Most (8,833, 70.4%) lived

Circulation, Volume 146, Issue Suppl_1, Page A14442-A14442, November 8, 2022. Introduction:The longitudinal trends of cardio-oncology healthcare disparities is unknown.Methods:We performed the first nationally representative longitudinal analysis using Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) and the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset.Results:Among 101,521,656 hospitalizations from 2016-2018, 3,233,249 (3.18%) were female with active cancer, 18,310 (0.57%) had STEMI, 4,670 (0.14%) received LHC, 3,360 (0.10%) received PCI, and 160 (0.005%) received percutaneous heart pump (Impella). The most common active primary malignancies significantly differed for females (lung [15.19%], breast [14.10%], uterus [10.60%], leukemia [8.88%], and non-Hodgkin lymphoma [NHL] [6.92%]) versus males (prostate [15.56%], lung [15.21%], leukemia [10.05%], NHL [8.50%], and colon [6.57%]) (p

Circulation, Volume 146, Issue Suppl_1, Page A10423-A10423, November 8, 2022. Introduction:Nationwide broadband internet access is a major federal priority. The bipartisan infrastructure law invested $65 billion into equitable broadband expansion, driven by concern that broadband access is a social determinant of health. However, the difference in health outcomes between counties with low vs. higher broadband access has not been studied, and could provide insights on the implications of expansion efforts.Objectives:We evaluated demographic factors, health resources, and cardiovascular disease (CVD) burden in counties with low broadband access compared to those with higher access.Methods:We assessed all 3,142 US counties in 2019 and identified those with low broadband access, defined as 25 Mbps download / >3 Mbps upload, using the US Broadband Usage Percentages Dataset. We linked these data to the American Community Survey, American Health Resource File, PLACES, and CDC WONDER for demographic, health resource, CVD risk factor and outcomes, and mortality data respectively.Results:There were 461 counties with low broadband access and 2,650 counties with higher access. Compared to those with higher broadband access, counties with low broadband access had lower high school graduation rates (47% vs 54%, p

Circulation, Volume 146, Issue Suppl_1, Page A12319-A12319, November 8, 2022. Global reports describe several cases of disseminatedMycobacterium chimaerarelated to surgical field contamination by specific 3T heater-cooler units utilized in open cardiothoracic procedures. Eventual diagnosis leads to aggressive multidrug regimens and possible surgery, resulting in a high, yet potentially avoidable overall mortality rate. A years-long latency period between a patient’s initial exposure and clinical presentation can make this infection extremely challenging to diagnose. A 68-year-old-male with coronary artery disease (CAD) and a bicuspid aortic valve (BAV) suffered from shortness of breath and palpitations for eight years. An extensive cardiac work-up, including a cardiac MRI, revealed aortic root dilatation and significant CAD involving the left anterior descending coronary artery. The patient underwent an elective BAV repair, aortic root replacement, and single vessel coronary artery bypass surgery without any acute post-operative complications. Approximately four years later, he began experiencing fevers, night sweats, and vision changes. Eventually, he was ultimately diagnosed with disseminatedM. chimaeraconfirmed by tissue biopsy. His treatment course of linezolid, moxifloxacin, ethambutol, and rifabutin, was complicated by adverse effects and complex resistance patterns. The complications he experienced secondary to this disease would eventually include long-standing bacteremia, encephalitis, splenic lesions, and aortic root abscess, which ultimately required open sternotomy for AV replacement and aortic root exchange. This patient remains the sole survivor from his home hospital among several other patients who also underwent cardiac surgeries and subsequently developed disseminatedM. chimaera.He has since developed additional spinal involvement described as destructive osteomyelitis/discitis and confirmed via biopsy. As he continues to combat this clinically devastating bacterial pathogen, his multi-system complications with such an insidious presentation serve as a reminder to maintain a high clinical suspicion for the possibility of disseminated mycobacterial and other similar infectious processes in the differential diagnoses of all cardiothoracic surgical patients.

Circulation, Volume 146, Issue Suppl_1, Page A253-A253, November 8, 2022. Introduction:Previous analysis of emergency medical services manual defibrillator recordings suggests that the proportion of patients with initial shockable rhythms during out-of-hospital cardiac arrest is decreasing over time. This analysis aims to determine if this decline also occurs in public access defibrillator data.Methods:Worldwide post-market data from HeartSine SAM PAD public access defibrillators was collected between 2012 and 2022. Presence of an initial shockable rhythm (ventricular fibrillation or ventricular tachycardia) was determined by the device algorithm decision and clinical overread. The proportion of patients who presented an initial shockable rhythm each year was calculated. Data was analysed using Minitab. Summary statistics were calculated for patient age and gender, and a logistic regression model was used to examine the proportion of initial shockable rhythm over time.Results:A total of 5404 patient events were collected. Seventy-four percent were male, and mean (SD) age was 61.2 (18.2) years. Proportion of initial shockable rhythm as a response to year was assessed, and occurrence of shockable rhythms decreased by approximately 6% per year [OR: 0.94, 95%CI (0.91, 0.96), p

Circulation, Volume 146, Issue Suppl_1, Page A08-A08, November 8, 2022. Introduction:Adequate cerebral blood flow (CBF) during open cardiac massage (OCM) in cardiac arrest is critical for survivors to be neurologically intact. Cerebral perfusion is known to be poor during OCM but has not been quantified using a brain perfusion technique. The aim of this study is to measure CBF in swine undergoing OCM in hypovolemia and normovolemia using computed tomography perfusion (CTP) scanning.Methods:Anesthetized swine underwent instrumentation with right atrial and aortic pressure catheters. A pigtail catheter placed in the ascending aorta was used to administer iodinated contrast and CTP imaging acquired. Brain parenchymal attenuation was measured over time from which CBF (mL/100g of brain) and time to peak (TTP; secs) were derived. Animals were then euthanized exsanguination (hypovolemic group) or potassium chloride injection (normovolemic group). Animals were subject to a clamshell thoracotomy, OCM and repeated CTP. Data pertaining to peak coronary perfusion pressure (pCPP; mmHg) was collected and % CPP >15mmHg (% CPP; secs) calculated post hoc.Results:Normovolemic animals achieved superior pCPP compared to the hypovolemic animals (pCPP: 39.3 vs 12.3, p

Circulation, Volume 146, Issue Suppl_1, Page A13094-A13094, November 8, 2022. Extracellular vesicles (EVs) are emerging as promising biomarkers for cardiovascular disease (CVD) and contributors to CVD pathogenesis. Plasma EVs access the endothelium from various vascular beds allowing them to impact endothelial function and inform on the global particulate secretome produced by parenchymal, vascular and immune cells. In this study we examined associations between plasma EVs and biochemical and physiological parameters in a cohort of African American (AA) women at risk for CVD. We also examined EV effect on coronary endothelial function. This study will serve as baseline data for a longitudinal study aimed to determine the effects of exercise on EVs and endothelial function in a similar cohort.A cohort of 24 AA women between 22-71 yrs, with BMI between 26-47 kg/m2and ASCVD risk scores between 2.3-22.1 were included in the study. EVs were isolated from fasted heparinized plasma using size exclusion chromatography. EV size and numbers were determined using nanoparticle tracking analysis. Lipids, inflammatory cytokines, and metabolic panels were measured at the time of blood draw. Human coronary endothelial cells were treated with EVs from participants and endothelial barrier function and migration were measured using ECIS technology. Associations were determined using multivariable linear regression analysis, adjusted for BMI and ASCVD risk.We found a negative association (beta=-0.712, p

Circulation, Volume 146, Issue Suppl_1, Page A15314-A15314, November 8, 2022. Introduction:Mycobacterium chimaera is an emerging pathogen, recognized to cause prosthetic valve infective endocarditis (PVIE) and disseminated infection following open-chest cardiac surgery with certain contaminated heater-cooler systems. Diagnosis is challenging and requires a very high index of suspicion. Data regarding the optimal cardiac imaging evaluation of this condition is limited.Methods:Scopus, PubMed, EMBASE, Ovid and Cochrane were searched for published articles through October 2021, using keywords “Mycobacterium chimaera”, “Prosthetic valve” and “Endocarditis”. 169 articles were found and reviewed for study eligibility. Articles were included if they consisted of Mycobacterium chimaera causing IE, with imaging modalities used to establish diagnosisResults:Thirty-three articles were included, yielding twenty-two cases of Mycobacterium chimaera PVIE. The disease manifested on average thirty months after surgery, with an average patient age of 59 years (90% male). Imaging modalities to establish the diagnosis of prosthetic valve infective endocarditis included: transthoracic echocardiogram in 5 cases, transesophageal echocardiogram (TEE) in nine cases, 18F-FDG-PET/CT in seven cases. A combination of imaging modalities with TEE and 18F-FDG-PET/CT was reported once; TTE, TEE and 18F-FDG-PET/CT was also noted in one case. Lastly there was one instance each of combined use of TTE, TEE, and one of the following: CTA, Cardiac MRI, or standard CT. Nine cases did not specify the imaging modality used to achieve diagnosis. Ten patients died.Conclusions:PVIE due to Mycobacterium chimaera infection is a rare and challenging diagnosis, which requires a high index of suspicion. Accurate diagnosis should be aided by multimodality cardiac imaging, with 18F-FDG-PET/CT being a powerful adjunct imaging modality.

Circulation, Volume 146, Issue Suppl_1, Page A14277-A14277, November 8, 2022. Introduction:Vascular closure devices are commonly used for EP procedures to achieve rapid hemostasis. Different devices using different mechanisms of action are available, but the potential contribution of each type to the incidence of vascular complications is not clear.Methods:This is a single center, prospective study in which 138 contemporaneous patients undergoing EP procedures were categorized according to the vascular closure device type used: Vascade (collagen plug, n=57), Perclose (suture, n=41), and SiteSeal (external compression, n=40). The primary endpoint was access-related major vascular complications. Secondary endpoints included time to ambulation and delayed access-site bleeding requiring additional manual pressure.ResultsMean age and BMI 68±11 years and 29.7±6.2 Kg/m2, 46 (33%) were female, 121 (88%) were on uninterrupted antithrombotic therapy (71% OAC, 14% OAC/APLT, 3% APLT). Femoral vein access was obtained in all, bilaterally in 113 (82%), with a mean of 3±1 access sites per patient and a sheath size ranging from 6- to 23-Fr. Femoral arterial access was obtained in 14 (10%), once per patient, with a sheath size ranging from 5- to 8-Fr.There were no arterial access complications. On the venous side, hematomas occurred in 3/57 (5%) of the Vascade group, 1/41 (2%) of the Perclose group, and 0/40 (0%) of the SiteSeal group (p=ns for all comparisons). Delayed access-site bleeding occurred in 5/57 (9%) of the Vascade group, 5/41 (12%) of the Perclose group, and 7/40 (18%) of the SiteSeal group (p=ns for all comparisons). Time to ambulation was comparable between groups (minutes: 139±51 Vascade, 137±34 Perclose, 123±11 SiteSeal, p=ns).ConclusionVascade, Perclose, and SiteSeal are comparable in term of vascular complications and time to ambulation for patients undergoing EP procedures.

Circulation, Volume 146, Issue Suppl_1, Page A12460-A12460, November 8, 2022. Introduction:There has been a rise in the interest in mobile health technology (mHealth) to support cardiovascular (CV) health; however, the relationship between CV risk and mHealth access/usage is not clear.Methods:We used data from the 2017 to 2020 Health Information National Trends Survey. CV risk factors examined included self-reported hypertension, diabetes mellitus, physical inactivity, current smoking status, and overweight/obesity. Multivariable logistic regression models examined the association between CV risk (we defined low, moderate, and high CV risk as having 0-1, 2-3, and 4-5 risk factors, respectively) and mHealth access/usage, adjusting for age, sex, race, education, income, etc. Analyses were stratified by age

Circulation, Volume 146, Issue Suppl_1, Page A14205-A14205, November 8, 2022. Introduction:Research repositories of adult physiological waveform (PW) data facilitate clinical and methodological advances. Models trained on adult data do not generalize well to pediatric groups. No large, open repository of pediatric PW data is available for research.Methods:PW and vital sign data were downloaded from bedside patient monitoring systems at an academic pediatric hospital from 06/2008-01/2017, de-identified, cleaned, organized, and stored on a research platform managed by Stanford University. Algorithms to process data for deep learning applications were designed, validated, and uploaded to the research platform.Results:WAVES is a single-institution dataset comprising 9 years of high-frequency PW data. WAVES consists of 10.6 million hours of 1 to 20 concurrent types of high-frequency PWs (Table 1). Approximately 1.5 million PW samples were collected over 50,364 unique hospital encounters across various specialized and general units (Table 2). Initial work demonstrated the suitability of the data for training deep learning models by accurately detecting hypotension with data only from electrocardiogram, plethysmography, and respiration waveforms.Conclusions:WAVES is currently the largest pediatric-focused PW dataset available for open-access research and the second largest repository of correlated multi-channel PW data. The WAVES database can enable improvements in pediatric clinical care through machine learning research on PWs from a variety of hospitalized pediatric patients and could facilitate the development of methodological and clinical innovation in the field of pediatric care.

Circulation, Volume 146, Issue Suppl_1, Page A240-A240, November 8, 2022. Introduction:Refractory VF, which is defined as fibrillation that persists after three or more shocks, has been reported to occur in 20% of VF presenting cardiac arrest patients. This analysis was conducted to assess the frequency of shock resistant VF, during OHCA treated with a public access defibrillator (PAD).Methods:Heartsine Samaritan PAD post-market data collected between October 2012 to January 2021 were analyzed; electrocardiography (ECG) is recorded by the PAD and is assessed for shockability immediately after detecting patient impedance and then following each 2-minute period of CPR. Shock success (SS) was determined for each shock. SS was defined as one in which the initial shockable arrhythmia was terminated for at least five seconds. A consecutive shock was defined as a shock delivered after the first analysis mode following a previous shock.Results:Data was analyzed for 1082 patients who received at least one shock during OHCA. First shock success (FSS) was 88.2% (862/977 assessable shocks). At least three consecutive shocks were delivered in 207/1082 (19.1%) patients. Three patients (3/207, 1.4%) had two unsuccessful shocks followed by termination of VF on the third shock. A further thirteen (13/204, 6.4%) patients had VF which was resistant to defibrillation (i.e., three or more consecutive failed shocks with no observed successful shock). In the remaining 191 patients at least one of the three consecutive shocks was successful, or shock success could not be determined.Conclusion:The prevalence of shock resistant VF for OHCA treated with a PAD is much lower (6.4%) than published data. This low prevalence is in part due to the high FSS observed resulting in reduction in the number of possible shock resistant cases.

Circulation, Volume 146, Issue Suppl_1, Page A11823-A11823, November 8, 2022. Background:Besides hard medical outcomes in patients with inherited cardiac conditions (ICC). it is crucial to focus on the patient-reported outcomes (PRO) as well. These patients may have a disease-specific need due to ICC-related distress concerning family members and reproductive choices. We evaluated which PRO scales are currently used in cardiogenetics.Methods:From three datasets (PubMed, PsychINFO, and Web of Science), eligible studies published between 2008-2022 were selected as described in the review protocol (PROSPERO 2021 CRD42021271384). The quality of studies was assessed (https://pubmed.ncbi.nlm.nih.gov/27082055 ) and analyzed for the primary outcome variable of patient-reported outcomes.Results:Eighteen out of 232 articles were selected for data extraction; 9 studies used a cross-sectional design, and population characteristics and outcome measures varied. The risk of bias was high or unclear in 77% of the studies. All studies mainly used two questionnaires in combination or alone: the short form of medical outcomes survey (SF-36), a generic PROM that reports on health status and the Hospital Anxiety and Depression Scale (HADS), a standard measure of psychological well-being. Thirteen studies using SF-36 showed lower scores on the mental health component in patients with ICC versus population norms. Ten studies using HADS showed a prevalence of clinically significant anxiety (17-47%) and depression (8.3% to 28%) which are higher than the population norm (8.3% and 6.3%).Conclusion:Our results from only a few published studies indicate that although psychological morbidity in ICC patients is high, measurements are non-specific, variable, and generic and address overall health, instead of addressing factors specific to ICC, such as heritability. We propose to develop a disease-specific PROM for cardiogenetics to evaluate the heritability factor in patients with ICC to implement in the care pathway and optimize patient-centred care.

Introduction
Sub-Saharan Africa (SSA) region harbours the highest burden of HIV infections in the world. Agricultural work has been reported as one of the occupations with a high prevalence of HIV. Farm workers generally have poor access to health services, which prevents them from receiving proper HIV prevention and care. Furthermore, poor policies and policy implementation, and lack of workplace programmes increases farm workers’ vulnerability to HIV infection. Thus, the aim of this study is to conduct a systematic review to assess HIV prevention and treatment services and national policies governing access to healthcare services by farm workers in SSA.

Methods and analysis
Our systematic review will include studies published from January 1990 to December 2021 within SSA countries. We will use a sensitive search strategy for electronic bibliographic databases and grey literature sources. Databases will include PubMed, CINAHL, Cochrane library, African Index Medicus and Scopus. The main outcomes to be reported will be HIV policy for farmworkers, availability of HIV prevention service(s), availability of treatment and support to farmworkers who are living with HIV, presence of referral structures for farmworkers through the health system and follow-up services for farmworkers who are on antiretroviral therapy. We will synthesise the main characteristics of included studies and use summary measures to describe study characteristics. In a situation where data are not sufficiently homogeneous to perform a quantitative synthesis, we will conduct a narrative synthesis. We will explore themes and relationships between included studies for qualitative data.

Ethics and dissemination
The study will use publicly available data and ethics exemption has been obtained from Human Research Ethics Committees, Faculty of Medicine & Health Sciences, Stellenbosch University. The results of this study will be disseminated through peer-reviewed journals, conference presentations and seminars.

PROSPERO registration number
CRD42021277528.

Introduction
Multiple myeloma is a malignancy of plasma cells with around 6000 new cases per year in the UK. Cyclophosphamide plus prednisolone is considered a standard of care for disease and symptom control in the advanced relapsed or refractory myeloma setting within the UK NHS. The selective nuclear export inhibitor, selinexor, has been relatively well tolerated in previous clinical trials and offers promise when used in combination with a wide range of other anti-cancer treatments. Here, we investigate if the addition of selinexor can improve responses to cyclophosphamide plus prednisolone without adding prohibitive toxicity.

Methods and analysis
MUKtwelve is a UK-based, randomised, controlled, open, parallel group, multicentre phase II trial designed to evaluate clinical efficacy of selinexor in combination with cyclophosphamide and prednisolone (SCP) in patients with relapsed or refractory multiple myeloma. A calibration arm will receive cyclophosphamide and prednisolone alone (CP). Participants who experience disease progression on the CP arm may, if eligible, receive SCP.
The MUKtwelve trial results will be the first to assess clinical efficacy of selinexor with low-dose CP in relapsed/refractory multiple myeloma. It is widely accepted that the relapsing-remitting nature of the disease is accompanied by cellular changes that often result in the requirement for novel agents and drug combinations to regain disease control. Patients also often experience cumulative toxicities throughout their treatments, limiting the treatment intensity that can be given at relapse. Thus, there is a need for novel effective combination therapies with acceptable toxicity profiles.

Ethics and dissemination
Ethics approval is obtained. Results will be submitted for publication in a peer-reviewed journal.

Trial registration number
ISRCTN15028850.