Galasso, Francesca

Introduction Advancements in transplant care have led to an increasing number of women with solid organ transplantation (SOT) living through peri- and postmenopause. Menopause can significantly impact quality of life, and the added burden of SOT may exacerbate symptoms. Few studies have evaluated the menopausal experience in this population, and existing data rarely use validated questionnaires. Research Question This study aimed to characterize menopausal symptoms and menopausal hormone therapy (MHT) use in peri- and postmenopausal SOT recipients using validated measures. Design A cross-sectional survey study of female patients ≥18 years who underwent SOT between 2018 and 2023 was conducted at a tertiary transplant center. A reproductive and sexual health questionnaire incorporating validated instruments, including the Menopause Rating Scale (MRS), was administered. Results Among peri- and postmenopausal SOT recipients ( n = 192), 8.9% reported use of MHT. The median MRS total score was 8.0, consistent with mild-to-moderate symptom severity overall. Symptom severity differed by menopausal status for vasomotor symptoms ( P =.03), sleep disturbances ( P = .04), depressive mood ( P = .04), and anxiety ( P <.001), with perimenopausal participants generally reporting more symptoms in these domains than postmenopausal participants. Despite these differences, overall symptom severity remained mild to moderate in both groups. Conclusion Menopausal symptoms among female SOT recipients are common but generally mild to moderate, with low utilization of MHT. The lack of increased vasomotor burden compared to prior literature may reflect under-recognition or misattribution of symptoms to transplant-related factors. Incorporating menopause-specific screening into transplant care may improve symptom recognition, quality of life, and long-term health outcomes.

Abstract Introduction Sexually transmitted viruses (STVs), including Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), Herpes Simplex Virus (HSV), and Hepatitis B Virus (HBV), present major public health challenges due to their high prevelance, chronicity, and transmission rates. Extending beyond immediate health impacts, these viruses affect sexual health and function through mechanisms including chronic inflammation, psychological stress, social stigma, and adverse effects of treatment. While the link between STVs and sexual disorders is acknowledged, it is underexplored in the literature, particularly concerning female sexual health. Current research largely focuses on male sexual dysfunction, especially erectile disorder and its treatment. This review investigates the relationship between STVs and female sexual disorders, examining physiological, psychological, and social factors contributing to sexual health concerns. Enhancing our understanding of this relationship could support clinicians in identifying sexual health concerns in female patients with STVs and providing targeted interventions to optimize sexual health outcomes. Objective This systematic review aims to examine existing literature on the relationship between STVs and female sexual disorders, identifying specific dysfunctions (e.g., pain, desire, arousal, and satisfaction) associated with each virus, underlying mechanisms, and discussing clinical and research implications. Methods A comprehensive literature search was conducted in September 2024 across four databases: Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science. A total of 523 references were identified, with 139 duplicates removed, leaving 384 studies for screening based on inclusion and exclusion criteria. Searches combined MeSH (Medical Subject Headings) terms and keywords to capture relevant studies. MeSH terms included “Sexual Dysfunction, Physiological,” “Sexual Dysfunction, Psychological,” “Papillomavirus Infections,” “Herpesvirus 2, Human,” “Hepatitis B,” and “HIV.” Additional keywords included “sexual dysfunction,” “HSV,” “hepatitis,” “HPV,” “woman,” “women,” and “female.” The search was limited to English-language studies. Results A total of 384 studies met the inclusion criteria, with findings revealing associations between specific STVs and various types of female sexual dysfunction. HSV was notably associated with dyspareunia during outbreaks due to genital ulcers, as well as with psychosexual issues linked to concerns about transmissibility and the stigma of visible lesions, negatively affecting intimate relationships. HIV was associated with multifactorial sexual dysfunction, encompassing psychological impacts such as fear of transmission and health-related anxiety, as well as physiological effects like decreased sexual desire from antiretroviral therapy and lipodystrophy. HPV’s relationship with sexual disorders was variable, with some studies connecting it to heightened depression and anxiety following diagnosis, which diminished sexual desire. For HBV, sexual dysfunction correlated with the severity of liver dysfunction, as chronic liver disease in women impairs hormone metabolism and increases sex hormone-binding globulin (SHBG) levels, leading to suppression of the hypothalamic–pituitary-gonadal axis. Conclusions This review highlights a notable relationship between STVs and female sexual dysfunction, emphasizing the need for comprehensive care that addresses both management of the infection and sexual health concerns. Routine screening for sexual health concerns in women with STVs is recommended, along with interdisciplinary approaches to address these complex impacts. Improved recognition and management of sexual disorders in this context can enhance both sexual health outcomes and overall quality of life in affected individuals. Disclosure No.

Abstract Aims Cardiac amyloidosis (CA) is common in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Cardiac amyloidosis has poor outcomes, and its assessment in all TAVR patients is costly and challenging. Electrocardiogram (ECG) artificial intelligence (AI) algorithms that screen for CA may be useful to identify at-risk patients. Methods and results In this retrospective analysis of our institutional National Cardiovascular Disease Registry (NCDR)-TAVR database, patients undergoing TAVR between January 2012 and December 2018 were included. Pre-TAVR CA probability was analysed by an ECG AI predictive model, with &gt;50% risk defined as high probability for CA. Univariable and propensity score covariate adjustment analyses using Cox regression were performed to compare clinical outcomes between patients with high CA probability vs. those with low probability at 1-year follow-up after TAVR. Of 1426 patients who underwent TAVR (mean age 81.0 ± 8.5 years, 57.6% male), 349 (24.4%) had high CA probability on pre-procedure ECG. Only 17 (1.2%) had a clinical diagnosis of CA. After multivariable adjustment, high probability of CA by ECG AI algorithm was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.01–1.96, P = 0.046] and higher rates of major adverse cardiovascular events (transient ischaemic attack (TIA)/stroke, myocardial infarction, and heart failure hospitalizations] (HR 1.36, 95% CI 1.01–1.82, P = 0.041), driven primarily by heart failure hospitalizations (HR 1.58, 95% CI 1.13–2.20, P = 0.008) at 1-year follow-up. There were no significant differences in TIA/stroke or myocardial infarction. Conclusion Artificial intelligence applied to pre-TAVR ECGs identifies a subgroup at higher risk of clinical events. These targeted patients may benefit from further diagnostic evaluation for CA.

Introduction: Cardiac amyloidosis (CA) has been suggested to be common (up to 16%) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). CA has poorer outcomes and its assessment in all TAVR patients may be costly and challenging. Hypothesis: CA may be screened for with an artificial intelligence (AI) clinical predictive model applied to pre-TAVR ECGs, and high probability (>50%) for CA may be associated with worse clinical outcomes. Methods: In this retrospective analysis of the Mayo institutional National Cardiovascular Disease Registry (NCDR)-TAVR, patients undergoing a TAVR between Jan-2012 and Dec-2017 were included. Pre-TAVR ECGs were analyzed by the AI predictive model for CA embedded in the EMR. EMRs were reviewed to assess for a clinical diagnosis of CA in those identified as high probability (>50%) by the AI tool. Clinical outcomes on 1 year follow-up were extracted from the NCDR-TAVR database and Kaplan-Meier curves were created to compare patients with high CA probability (≥50%) versus those with low probability (<50%). Results: Of 1070 patients who underwent TAVR (mean age 81.1± 8.5 years, 58.2% male), 263 (24.6%) had ≥50% probability for CA on pre-procedure ECG. Only 18 (1.7%) of these had clinical diagnosis of CA. In the survival analysis, high probability of CA by AI tool was associated with higher all-cause mortality (HR 1.60, 95%CI 1.09-2.34, p=0.01) and greater HF admissions (HR 1.59, 95%CI 1.08-2.35, p<0.01). Neither TIA/stroke nor myocardial infarction were statistically significant. MACE (TIA/stroke, myocardial infarction, heart failure admissions) was higher in the ≥50% CA probability group (HR 1.68, 95%CI 1.17-2.40, p<0.01), (Figure) . Conclusion: CA is clinically underdiagnosed in patients undergoing TAVR. AI applied to pre-TAVR ECGs suggesting higher probability for CA identifies a subgroup at higher risk of clinical events, who may benefit from further diagnostic evaluation for CA.