Almani, Muhammad Usman

We report the rare coexistence of extensive coronary-cameral fistulas (CCFs) with aneurysmal dilatation of coronary arteries and an incidental left ventricular papillary fibroelastoma (PFE) in a female in her early 70s who presented with chest pain and lower extremity oedema. Multimodality imaging, including transoesophageal echocardiography, cardiac CT and coronary angiography, confirmed the diagnosis. The PFE was surgically resected to prevent embolic complications, while the CCFs were managed conservatively due to their haemodynamic insignificance. This case demonstrates that even extensive CCFs may be haemodynamically insignificant, while a small PFE can pose a significant embolic threat, justifying disparate management strategies guided by multimodality imaging and haemodynamic assessment.

Background: Despite obesity being a major cardiovascular risk factor, studies in heart failure populations have reported an inverse association between body mass index and mortality—a phenomenon termed the "obesity paradox." However, the consistency and shape of this relationship across different HF phenotypes and clinical subgroups remain unclear. This meta-analysis aimed to quantify the dose-response relationship between BMI and mortality in HF patients and assess potential variations across subgroups. Hypothesis: Higher BMI is associated with reduced mortality in patients with heart failure, and that this relationship varies across clinical subgroups and U-shaped relationship. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search strategy was developed, and studies were extracted from Cochrane and PubMed databases through December 2023. The main outcomes were all-cause mortality, cardiovascular deaths, and heart failure hospitalizations. Data were summarized as hazard ratios with 95% confidence intervals, and a spline model was used to assess non-linear relationships, with 21.7 kg/m2 as the reference point in the dose-response curve. PROSPERO: CRD42023455124 Results: Thirty-three studies (457,124 person-years) showed that each 5 kg/m2 increase in BMI was significantly associated with a 6% reduction in all-cause mortality (HR 0.94; 95% CI 0.92–0.96). Significant reductions were observed in acute decompensated heart failure (7%), HFpEF (9%), HFrEF (8%), diabetes (9%), males (9%), and females (8%). Cardiovascular mortality declined by 5% per 5 kg/m2 increase. Non-linear analysis revealed a significant U-shaped relationship, with lowest all-cause mortality between BMI 21.7 and 39 kg/m2. Subgroup analysis showed significant non-linear all-cause mortality reductions in acute decompensated heart failure (23.5–26 kg/m2), HFpEF (21.7–31 kg/m2), HFrEF (21.7–43 kg/m2), females (24–25.5 kg/m2), diabetes (21.7–36 kg/m2), and non-diabetics (21.7–33 kg/m2). Conclusion: Higher BMI is significantly associated with lower all-cause and cardiovascular mortality in patients with heart failure, supporting the presence of an obesity paradox. This protective effect was consistent across clinical subgroups, including HFpEF, HFrEF, males, females, and individuals with diabetes. The BMI paradox was evident in patients with acute decompensated heart failure, HFpEF, HFrEF, females, and both with and without diabetes.

ABSTRACT Background Patients with hypertrophic obstructive cardiomyopathy (HOCM) were excluded from all major trials for transcatheter aortic valve replacement (TAVR). “Suicide left ventricle” occurring after TAVR is postulated to occur as a result of chronic pressure overload from fixed obstruction that is acutely relieved after the valve deployment resulting in worsening left ventricular outflow tract obstruction. Aims The aim of this study was to determine the clinical and readmission outcomes in HOCM patients undergoing TAVR. Methods Data was extracted from the National Inpatient and National Readmission 2016−2020 Databases. We performed multivariable Logistic regression analysis to determine the odds of in‐hospital mortality and other relevant clinical outcomes in patients undergoing TAVR with and without comorbid HOCM. Multivariable Cox regression analysis was used to assess 30‐day hospital readmission in HOCM patients undergoing TAVR. Results We identified 296,670 patients who underwent TAVR, of whom 534 (0.2%) had comorbid HOCM. The patients undergoing TAVR with comorbid HOCM had more than threefold higher risk of in‐hospital mortality (adjusted odds ratio: 3.47, 95% CI 1.37–8.81, p = 0.009) when compared to patients without HOCM. Additionally, patients undergoing TAVR with comorbid HOCM had a higher risk of atrioventricular blocks, cardiogenic shock, acute kidney injury, and the need for intubation. There was no difference in readmission outcomes post‐TAVR among patients with and without HOCM. Conclusion Our analysis of a large, real‐world cohort of patients undergoing TAVR showed that patients with HOCM have a significantly higher risk of in‐hospital mortality and procedural complications when compared to patients without HOCM.

ABSTRACTBackgroundTricuspid regurgitation (TR) is a common occurrence in patients with heart failure (HF), and its role in disease progression has gained attention in recent years. Although TR can worsen clinical outcomes in HF patients, the impact of gender, racial, and socioeconomic factors remains largely unexplored. With growing evidence supporting the role of percutaneous interventions for the treatment of significant TR, understanding these disparities is more crucial than ever.MethodsData were extracted from the National Inpatient and National Readmission 2016–2020 Databases. We used ICD‐10 code I50 to identify the patients primarily admitted for HF and subdivided the cohort into two groups based on the presence or absence of TR. We performed multivariable logistic regression analysis to determine odds of the in‐hospital mortality and multivariable Cox regression analysis to assess the 30‐ and 90‐day hospital readmission in HF patients with and without TR. All the analyses were adjusted for age, gender, insurance status, Charlson comorbidity index, and hospital characteristics. STATA 16 software was used for analysis.ResultsThere was no difference in the in‐hospital mortality among HF patients with and without TR (OR: 1.04, 95% CI 0.94–1.16, p = 0.442) except in certain subgroups of HF patients. HF patients with TR were 6% more likely to have HF‐specific readmission in 30 days (HR: 1.06, 95% CI 1.00–1.13, p = 0.044) and 9% more likely to have HF‐specific readmission in 90 days (HR: 1.09, 95% CI 1.03–1.15, p = 0.002). Subgroup analysis revealed significant gender, racial, and socioeconomic disparities in the in‐hospital mortality and the readmission outcomes of HF patients with TR compared to those without TR.ConclusionIn our population‐based survey analysis, we observed significant gender, racial, and socioeconomic disparities in the clinical outcomes of HF patients with TR compared to those without TR.

Background: Tricuspid regurgitation (TR) is a common occurrence in patients with heart failure (HF), and its role in disease progression has gained attention in recent years. While TR can worsen the clinical outcomes in HF patients, its impact on gender, racial and socioeconomic factors remains largely unexplored. With growing evidence supporting the role of percutaneous interventions for the treatment of significant TR, understanding these disparities is more crucial than ever. Methods: Data was extracted from the National Inpatient and National Readmission 2016 - 2020 Databases. We used ICD-10 code I50 to identify the patients primarily admitted for HF and subdivided the cohort into two groups based on presence or absence of TR. We performed multivariable Logistic regression analysis to determine odds of in-hospital mortality and multivariable Cox regression analysis to assess 30- and 90-day hospital readmission in HF patients with and without TR. All the analyses were adjusted for age, gender, insurance status, Charlson co-morbidity index (CCI) and hospital characteristics. STATA 16 software was used for analysis. Results: There was no difference in in-hospital mortality among HF patients with and without TR (OR: 1.04, 95% CI 0.94 – 1.16, p = 0.442) except in certain subgroups of HF patients. HF patients with TR were 6% more likely to have HF-specific readmission in 30-days (HR: 1.06, 95% CI 1.00 – 1.13, p = 0.044) and 9% more likely to have HF-specific readmission in 90-days (HR: 1.09, 95% CI 1.03 – 1.15, p = 0.002). Subgroup analysis revealed significant gender, racial and socioeconomic disparities in in-hospital mortality and readmission outcomes of HF patients with TR compared to those without TR. Conclusion: In our population-based survey analysis, we observed significant gender, racial and socioeconomic disparities in clinical outcomes of HF patients with TR compared to those without TR.

Introduction: Percutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA’s approval in 2015, and has become more of a same-day-discharge procedure. Cancer patients who underwent LAAO are known to have more inpatient complications and longer hospital stay. Readmission data, however, were rarely studied in this patient population. Hypothesis: Readmission burden is relatively high in cancer patients who received LAAO. Methods: Data were derived from the National Readmission Database from 2016 to 2019. Patients with primary diagnosis of atrial fibrillation or flutter admitted for percutaneous LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed inpatient mortality, length of stay, total charges and procedure complications from index hospitalization. We also compared readmission rate and most common readmission reasons. Stata SE 17.0 was used for data analysis. Results: There were 49882 index hospitalizations for LAAO, among which 1545 (3.1%) patients had a secondary diagnosis of cancer. From index hospitalizations, Patients with cancer had higher inpatient mortality (0.65% vs 0.14%, p=0.007), longer length of stay (1.54±0.08 vs 1.31±0.01, p<0.001) and higher total charges (120.25±3.44 vs 117.29±2.40, p<0.001). There was no statistical significance of 30-day readmission rate between patients with cancer and patients without cancer (10.0% vs 9.1%, p=0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding. Conclusions: Readmission utilization is comparable between patients with cancer and patients without cancer who underwent LAAO.