Current Problems in Cardiology最新文献

Background

Cardiomyopathy (CDM) in pregnancy is associated with maternal morbidity and mortality.

Objectives

To explore trends and clinical outcomes in CDM subtypes during delivery hospitalizations.

Methods

We used the National Inpatient Sample database to identify delivery hospitalizations between 2005-2020 by CDM subtypes: peripartum (PPCM), dilated (DCM), hypertrophic (HCM), and restrictive (RCM). Maternal and fetal outcomes were identified using International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes. Baseline characteristics and temporal trends of CDM subtypes were analyzed. Maternal cardiovascular, pregnancy, and fetal outcomes were evaluated by CDM subtype using univariate logistic regression. The primary outcome was in-hospital mortality.

Results

During 2005-2020, 37,125 out of 61,811,842 delivery hospitalizations were complicated by CDM. Among CDM-related delivery hospitalizations, the most prevalent were DCM (46%), followed by PPCM (45.6%), HCM (4.6%), and RCM (3.9%). The rates of in-hospital mortality (1.7%), adverse cardiovascular events such as acute heart failure (17%), cardiogenic shock (3.4%), and cardiac arrest (3.1%), and adverse pregnancy outcomes such as preeclampsia (14.2%) and preterm labor (11%), were highest among PPCM (all p < 0.0001). The prevalence of PPCM (49.1% to 38.5%) decreased while the prevalence of HCM (2.7% to 8.8%) and DCM (48% to 52.2%) increased over time.

Conclusions

Over a 15-year period, PPCM had higher rates of in-hospital mortality, cardiovascular events, and adverse pregnancy outcomes compared to other CDM subtypes. While the prevalence of PPCM decreased over time, the prevalence of HCM and DCM increased. Hence, further research on cardiomyopathies during pregnancy and prospective studies on this vulnerable patient cohort are urgently needed.

Background

Methods

Results

Conclusion

Background

The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population.

Methods

Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region.

Results

Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile.

Conclusion

HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S.

Background

Pulmonary arterial hypertension (PAH) is a major concern in patients with Down syndrome (DS) and congenital heart disease (CHD). Understanding the unique characteristics of PAH in these populations is essential for developing tailored management strategies. This review examines differences in PAH between DS and non-DS (nDS) patients with CHD, focusing on pathophysiology, clinical presentation, hemodynamic profiles, and treatment outcomes.

Methods

A retrospective analysis of 93 adults with PAH was conducted, including 18 with DS and 75 with CHD but without DS (nDS). Data on demographics, clinical presentations, comorbidities, and hemodynamic parameters were collected using echocardiography and right heart catheterization. Statistical analyses included Mann–Whitney U tests, Student's t-tests, and Kaplan–Meier survival analysis to compare the DS and nDS groups.

Results

DS patients presented with PAH at a younger age (mean age 25.06 years) compared to nDS patients (mean age 42.4 years; p < 0.001). Hypothyroidism was more prevalent in DS patients (61.1 %) than in nDS patients (29.3 %; p = 0.012). Hemodynamic assessments showed lower mean arterial pressure (MAP) in DS patients (76.24 ± 11.6 mmHg) versus nDS patients (93.95 ± 15 mmHg; p < 0.001), and a higher TAPSE/PASP ratio (0.41 vs. 0.23; p = 0.009), suggesting less severe right ventricular dysfunction. DS patients had a significant survival advantage over nDS patients (p = 0.043).

Conclusions

DS patients have distinct clinical and hemodynamic profiles in PAH, requiring personalized management. Early detection and tailored treatment are crucial for improving outcomes. Further research should refine these strategies and explore new therapies.

Objectives

Health and social factors show large heterogeneity across regional cultural geographies and influence oral health as well. The purpose of this study is to confirm associations between county-level general health, behaviors, social factors, and oral health indicators and to further analyze the patterns of distribution of oral health indicators across dominant regional cultures in the United States (US) as defined by the American Nations model.

Methods

We calculated a Lifestyle Health Index (LHI) from the 2023 PLACES database using county-level, age-adjusted health data and merged it with (a) 2020 Social Vulnerability Index (SVI) database, (b) dominant regional cultures from Nationhood Lab's American Nations model, (c) dentist visits and teeth lost data from the 2023 PLACES database, and (d) access to dentistry data from the County Health Rankings database.

Results

Correlation coefficients between the LHI (and sub scores), SVI (and sub scores), and dental variables showed strong associations. ANOVA post-hoc test results revealed significant differences for dental visits and teeth lost for LHI, SVI and access to dentists. Prevalence of dental visits and teeth lost showed clear heterogeneity across regional cultures.

Conclusions

Oral health is strongly linked to lifestyle health factors, social vulnerability, access to dentistry, and cultural norms and belief systems. Within the US, significant heterogeneity exists in the distribution of oral health indicators across dominant regional cultural geographies. Oral health communications and policy solutions focused on health-related behaviors (e.g., tobacco, diet), disease-specific considerations (e.g., diabetes), and the social environment (e.g., poverty, housing) should be tailored to regional cultures rather than a single US-based culture to improve dental care and oral health outcomes.