Mayo Clinic proceedings最新文献

Objective: To evaluate sex-associated differences in the short- and long-term outcomes of patients with hypertrophic cardiomyopathy (HCM) undergoing septal myectomy and alcohol septal ablation.

Methods: This retrospective cohort study used electronic health record data from the TriNetX research database. International Classification of Diseases, Ninth Revision and Tenth Revision diagnosis and procedure codes were used to identify patients with HCM who underwent septal myectomy and alcohol septal ablation in the United States between January 2002 and March 2023. The outcomes were long-term mortality and postprocedural complications (<30 days), including death, stroke, major bleeding, and renal failure. Multivariable adjusted Cox models were used to assess the association of outcomes by sex, taking female patients as reference.

Results: Of 11,680 adults (32.0% female; median age, 63 [interquartile range, 54 to 71] years), 1916 (16.4%) and 9764 (83.6%) underwent septal myectomy and alcohol septal ablation, respectively. For those who underwent septal myectomy, sex was not associated with short-term (adjusted hazard ratio [HR_adj], 1.57 [0.64 to 3.87]) and long-term (HR_adj, 1.05 [0.87 to 1.26]) mortality. Male patients had a higher risk of acute renal failure compared with female patients after septal myectomy (HR_adj, 1.69 [1.33 to 2.15]). Of those who underwent alcohol septal ablation, male patients (HR_adj, 1.07 [0.99 to 1.16]) had a similar risk of long-term mortality to that of female patients. Compared with female patients, the risk of acute renal failure was higher in male patients (HR_adj, 1.23 [1.02 to 1.48]) after alcohol septal ablation.

Conclusion: This nationwide study found that the risk of short- and long-term mortality was similar for male and female patients undergoing septal myectomy and alcohol septal ablation for HCM. The sex-based differences in the clinical presentation should not prevent consideration of septal reduction therapies.

Historically, research on pulmonary embolism (PE) management has focused on short-term outcomes, such as acute cardiovascular collapse, change in right ventricular function, and in-hospital mortality. However, long-standing functional impairments from acute PE occur in up to half of all patients. This chronic syndrome has been termed the post-PE syndrome, which describes patients who have persistent or worsening symptoms, functional limitations, and cardiorespiratory impairment not explained by a comorbid condition. Diagnosis and management are challenging, and post-PE syndrome remains an underrecognized and undertreated condition. This review seeks to increase awareness of the syndrome that affects a significant portion of PE survivors. The epidemiology, pathophysiology, and clinical features are discussed, followed by a description of imaging findings and management options across the entire spectrum of post-PE syndrome.

Objective: To determine the prevalence of portopulmonary hypertension in patients referred for liver transplant evaluation.

Methods: Medical records were reviewed for 986 consecutive patients referred for liver transplant evaluation who were screened for pulmonary hypertension with echocardiography from February 1, 2021, to January 31, 2022, across 3 liver transplant centers.

Results: Of 934 patients eligible for analysis, mean (SD) age was 57 (11) years, 558 (59.7%) were men, and 859 (92.0%) were White. Alcoholic cirrhosis and nonalcoholic steatohepatitis represented 640 (68.5%) of the liver diseases. Right ventricular systolic pressure estimated by echocardiography was 35 mm Hg or greater in 147 (15.7%) and less than 35 mm Hg in 475 (50.9%; unable to estimate in 312 [33.4%]). Right-sided heart catheterization was performed in 42 (4.5%) patients; hemodynamic profiles revealed that 12 (28.6%) did not have pulmonary hypertension, 15 (35.7%) had postcapillary venous pulmonary hypertension, 7 (16.7%) had portopulmonary hypertension, 6 (14.3%) had unclassifiable pulmonary hypertension, and 2 (4.8%) had combined pre- and postcapillary pulmonary hypertension.

Conclusion: The percentage of portopulmonary hypertension in patients referred for liver transplant was considerably lower, 7 of 934 (0.7%), than in previous studies, but the reason was unclear.

Objective: To assess demographic characteristics, public health measures, and health beliefs or behaviors that differentiate participants with a history of the coronavirus disease 2019 (COVID-19) infection from those with no history of COVID-19.

Methods: A cross-sectional survey-based study nested within a larger prospective cohort study of a community-based sample of 2511 adults was conducted to assess the incidence of viral infections. Community-based adults aged 50 years and older residing in southeast Minnesota who were assessed and self-reported history of COVID-19 infection during the early to mid phase of the COVID-19 pandemic were included; 1758 participants completed the survey between June 6, 2021, and February 7, 2022. Participants were asked to complete a questionnaire containing 42 items related to COVID-19. Odds ratios were calculated for history of COVID-19 to compare sociodemographic factors, current and future health behaviors, and health beliefs, including effective preventive measures and modes of transmission.

Results: We found that certain sociodemographic features and health behaviors (eg, adherence to public health measures, such as COVID-19 vaccination) are associated with protection against COVID-19 infection and that strong beliefs in effective COVID-19 protective measures and modes of transmission (eg, types of social distancing) differentiated those without from those with a history of COVID-19.

Conclusion: Depending on the communicability, virulence, and pathogenicity of future COVID-19 variants, local, state, and federal governments must continue to consider the risks and benefits of public health initiatives that take into consideration these protective factors.