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  • Ovid Technologies (Wolters Kluwer Health)  (4)
  • 2020-2024  (4)
  • 2022  (4)
  • 1
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    Online Resource
    Abstract 10551: Air-Ortitis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Vascular graft infections (VGI) are serious complications of open and endovascular types of surgery with 30-60% perioperative mortality and 40-60 % morbidity. High index of suspicion is necessary in patients with multiple risk factors for graft infection to ensure early detection and intervention. This is a patient who presented with occult graft infection 4 years after endovascular aortic aneurysm repair (EVAR). Case: A 79M with DM, hypertension, coronary artery disease s/p bypass surgery and angioplasty, and abdominal aortic aneurysm s/p EVAR 4 years ago, presented with mild central abdominal pain associated with nausea and loss of appetite. He denied change in bowel habits, fever, or rectal bleeding. Initial workup showed WBC 10,000/ml with left shift of 90%, together with anemia of 7g/dl. Urinalysis showed pyuria and initial blood cultures grew gram negative bacilli later revealed to be Klebsiella pneumonia. Abdominal CT then showed an aortoiliac stent in place with an air-fluid level in the native aortic aneurysm, 6.4 cm in diameter. There was immediate concern for an aorto-enteric fistula and the patient underwent exploratory laparotomy which instead revealed an infected endograft with purulent drainage to the aortic sac. The post operative period was complicated with respiratory failure, requiring intubation for a few days. Tissue culture isolated multidrug resistant Klebsiella pneumoniae necessitating a 6-week course of meropenem. After a long hospital stay, his family opted for comfort care and was discharged to a hospice facility. Conclusions: Surgical treatment of VGI is challenging and involves debridement of infected periprosthetic tissues, excision of the infected graft and secondary revascularization usually in a critically ill patient. VGI have exceedingly high mortality rates; thus, early identification, and screening of high-risk patients with infectious focus for VGI is needed.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.10551
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Abstract 15382: Geriatric HFpEF: When It Isn’t Hypertensive Heart Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Transthyretin amyloid cardiomyopathy (ATTR) is thought to be a rare cause of HF, but recent studies showed this is the cause of 30% of HFpEF patients older than 75. With new treatments for amyloidosis, timely diagnosis has become critical. Case: A 78-female with HFpEF, HTN, and diabetes followed for progressive functional decline and hospitalizations for HFpEF exacerbations. EKG at baseline showed LBBB with normal QRS voltages. Serial echocardiogram (echo) showed an ejection fraction (EF) of 60-70%, mild LVH, and moderate TR with RVSP 〉 50 mmHg. Latest echo showed progressive LA enlargement, MR, a new small pericardial effusion, and EF 50%. Regadenoson nuclear scan showed normal perfusion with preserved LVEF. Despite adequate control of her HTN, dyspnea continued to worsen. Because of this, the diagnosis of Cardiac amyloidosis was considered. Further review revealed a history of Carpal Tunnel Syndrome (CTS) and speckled pattern within the ventricular wall on echo. A technetium pyrophosphate scintigraphy ( 99m Tc-PYP) confirmed ATTR with grade three uptake, AL amyloid was ruled out with normal SPEP/UPEP, and she was started on Tafamidis. Discussion: Cardiac amyloidosis should be considered in HFpEF patients with functional decline despite medical optimization. It can mimic LVH caused by HTN on echo and easily dismissed in patients with traditional risk factors, but presence of CTS or lumbar spinal stenosis can be supportive. Traditionally ATTR is associated with low-voltage EKG, however this patient presented with normal QRS voltages for years, making the diagnosis more elusive. Conclusion: Advances in noninvasive imaging and treatments allow for early diagnosis of cardiac amyloidosis, reducing morbidity and mortality. Diagnosis is often delayed or missed, as features could be subtle and mimic other more common cardiac disease. Screening & nbsp; 99m Tc-PYP for elderly patients with HFpEF could translate to improved outcomes
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.15382
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Online Resource
    Abstract 15353: Identifying Different Clinical Phenotypes in Peripartum Cardiomyopathy by Latent Class Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Peripartum cardiomyopathy (PPCM) is a heterogeneous disorder whose pathophysiology remains poorly understood. To better understand the heterogeneity of PPCM, we used latent class analysis (LCA) to explore the different clinical phenotypes in a large sample of PPCM patients. Methods: Using the National Inpatient Sample (NIS) database, we identified 917 patients admitted to hospitals in 2017-2019 with a primary diagnosis of PPCM. We performed LCA based on 8 risk factors: age ( 〈 30 vs 〉 30), race (African American (AA) vs non-AA), hypertension in pregnancy (HIP) (preeclampsia, gestational hypertension, or chronic hypertension), diabetes mellitus (DM), obesity, tobacco use, cannabis use, and psychiatric disorders (anxiety, depressive, bipolar, or schizophrenia spectrum disorders). We then compared in-hospital outcomes among the different clusters identified by LCA. Data were analyzed using Stata version 17 for descriptive analysis and Mplus version 8.8 for LCA. Results: Four patient clusters were identified. C1 (n=471, 51.4%) had no AA or cannabis users and members had the lowest probability of having HIP (0.387), DM (0.27), and obesity (0.17). C2 (n=328, 35.8%) were all AA who did not use cannabis and had the lowest probability of using tobacco (0.076), and having psychiatric disorders (0.084). C3 (n=31, 3.4%) was the youngest group all of whom used tobacco and cannabis and had the largest probability of having psychiatric disorders (0.484). On the other hand, C4 (n=87, 9.5%) was the oldest group none of whom used cannabis but members had the highest probability being obese (0.664), having HIP (0.825), and DM (0.642). Among all clusters, C3 had the lowest in-hospital mortality (0.0%) and hospital charges ($57,357). C4 had the highest in-hospital mortality 1.1% and longest hospital length of stay (5.4 ± 7.0 days). Conclusions: Using LCA, we identified four clinically distinct classes PPCM with varying in-hospital outcomes. These may reflect different additional underlying mechanisms in PPCM. Our findings may help identify treatment targets and patient selection for future clinical trials.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.15353
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 4
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    Online Resource
    High Dimensional Multiomics Reveals Unique Characteristics of Early Plasma Administration in Polytrauma Patients With TBI
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Annals of Surgery Vol. 276, No. 4 ( 2022-10), p. 673-683
    Details
    In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 276, No. 4 ( 2022-10), p. 673-683
    Abstract: The authors sought to identify causal factors that explain the selective benefit of prehospital administration of thawed plasma (TP) in traumatic brain injury (TBI) patients using mediation analysis of a multiomic database. Background: The Prehospital Air Medical Plasma (PAMPer) Trial showed that patients with TBI and a pronounced systemic response to injury [defined as endotype 2 (E2)], have a survival benefit from prehospital administration of TP. An interrogation of high dimensional proteomics, lipidomics and metabolomics previously demonstrated unique patterns in circulating biomarkers in patients receiving prehospital TP, suggesting that a deeper analysis could reveal causal features specific to TBI patients. Methods: A novel proteomic database (SomaLogic Inc., aptamer-based assay, 7K platform) was generated using admission blood samples from a subset of patients (n=149) from the PAMPer Trial. This proteomic dataset was combined with previously reported metabolomic and lipidomic datasets from these same patients. A 2-step analysis was performed to identify factors that promote survival in E2-TBI patients who had received early TP. First, features were selected using both linear and multivariate-latent-factor regression analyses. Then, the selected features were entered into the causal mediation analysis. Results: Causal mediation analysis of observable features identified 16 proteins and 41 lipids with a high proportion of mediated effect ( 〉 50%) to explain the survival benefit of early TP in E2-TBI patients. The multivariate latent-factor regression analyses also uncovered 5 latent clusters of features with a proportion effect 〉 30%, many in common with the observable features. Among the observable and latent features were protease inhibitors known to inhibit activated protein C and block fibrinolysis (SERPINA5 and CPB2), a clotting factor (factor XI), as well as proteins involved in lipid transport and metabolism (APOE3 and sPLA(2)-XIIA). Conclusions: These findings suggest that severely injured patients with TBI process exogenous plasma differently than those without TBI. The beneficial effects of early TP in E2-TBI patients may be the result of improved blood clotting and the effect of brain protective factors independent of coagulation.
    Type of Medium: Online Resource
    ISSN: 0003-4932
    URL: Article
    DOI: 10.1097/SLA.0000000000005610
    RVK:
    XA 23900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2002200-1
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