Kulthamrongsri, Narathorn

Background/Objectives: In the United States, HF prevalence is projected to progressively rise by 2030. Prior research suggests a strong association between reduced sleep duration and increased cardiovascular disease and HF risk. This study introduces an alternative parameter, the weekend sleep recovery (WSR), measured by the weekend-to-weekday sleep duration ratio (SDR), to evaluate its association with HF risk. Methods: We conducted a cross-sectional analysis of NHANES (National Health and Nutrition Examination Survey) 2017–2023 to examine self-reported sleep patterns. Participants were classified as WSR (SDR > 1) or non-WSR (SDR ≤ 1). Multivariate logistic regression assessed the association between WSR and HF, adjusting for demographics and comorbidities. Results: Among 8320 participants included in the fully adjusted analysis, WSR was associated with lower odds of HF compared with non-WSR (adjusted OR 0.73, 95% CI 0.55–0.96; p = 0.026). A significant interaction was observed between WSR and weekday sleep duration (P for interaction = 0.003), whereas no interaction was found with weekend sleep duration. In exploratory subgroup analyses, nominally significant associations were observed in several clinical subgroups; however, after correction for multiple comparisons, only participants without dyslipidemia retained statistical significance. No significant effect modification by race/ethnicity was observed (P for interaction = 0.436). Conclusions: Weekend sleep recovery was associated with lower odds of HF in this cross-sectional study. The association varied according to weekday sleep duration but was generally consistent across racial/ethnic groups. Given the observational design, these findings should be interpreted as associative rather than causal and warrant confirmation in prospective studies.

Myoma uteri is the most common benign tumour in women, but myomatous erythrocytosis syndrome (MES) is rare. MES is characterised by erythrocytosis, a myomatous uterus and blood normalization after hysterectomy or myomectomy. It increases the risk of thromboembolic events, making early recognition crucial. A premenopausal, nulliparous woman in her 50s with dyslipidaemia and obesity presented with a 20-week-sized abdominopelvic mass but no abnormal uterine bleeding. CT imaging revealed a large right adnexal mass. Lab tests showed isolated erythrocytosis with normal tumour markers and serum erythropoietin (Epo). Hysterectomy and bilateral salpingo-oophorectomy confirmed multiple uterine myomas, the largest measuring 19.5 cm, along with a right ovarian haemorrhagic cyst. Postoperatively, her blood levels normalised, confirming MES. The exact mechanism remains unclear but may involve Epo production. While Epo is often linked to myomas, some cases, like ours, show normal levels, highlighting the need for further research to understand MES and develop targeted treatments.

Background: Left atrial (LA) strain is a marker of atrial myopathy and remodeling. While echocardiographic LA strain is increasingly used to assess atrial function, the prognostic value of change in LA strain before and after catheter ablation (CA) for atrial fibrillation (AF) remains underexplored. Objective: To evaluate the association between quartiles of LA strain parameters—including pre-ablation strain, post-ablation strain, and change in strain—with atrial fibrillation recurrence, stratified by ejection fraction (EF). Methods: This retrospective study encompassed AF patients who underwent their first CA at Mayo Clinic Arizona from Oct 2018 to Feb 2022. Transthoracic echocardiography parameters, including the three LA strain (LAS) phases—contraction, conduit, and reservoir—were collected using TOMTEC software on the closest date before the CA procedure. Logistic regression analysis was used to evaluate the association between LAS parameters and AF recurrence post-CA, adjusted for clinical covariates including age, gender, hypertension, diabetes, coronary artery disease, dyslipidemia, obstructive sleep apnea, thromboembolism, TIA/stroke, chronic kidney disease, and AF type. Results: Out of 335 patients who underwent CA, 222 had both pre- and post-ablation LA strain data. Among these, 71 of 222 patients (31.98%) experienced AF recurrence after CA. The mean age at time of procedure was 66.9 ± 10.3 years; 150 (67.57%) were male, and 83 (37.39%) had persistent AF. Significant associations were observed between specific quartiles of LA strain and AF recurrence. In patients with EF >50%, Q4 of contraction strain change (pre- vs. post-ablation) was strongly associated with increased recurrence risk (OR 8.80; 95% CI 1.80–42.98). Similarly, post-ablation contraction strain Q4 was associated with higher recurrence in both the overall group (OR 6.36; 95% CI 1.47–27.53) and the EF>50% subgroup (OR 8.80; 95% CI 1.80–42.98). In contrast, reservoir strain change Q2 (OR 0.10; 95% CI 0.01–0.86), and post-ablation reservoir strain Q3 (OR 0.09; 95% CI 0.01–0.69) and Q4 (OR 0.10; 95% CI 0.02–0.70) were protective. Conclusions: Greater increases in contraction strain post-ablation and higher post-ablation contraction strain were strongly associated with AF recurrence, particularly in those with preserved EF. Conversely, favorable reservoir strain post-ablation was protective. LA strain may offer key prognostic value in risk-stratifying AF patients undergoing ablation.

Spontaneous type-1 Brugada patterns are associated with an elevated risk of major arrhythmic events, yet the relationship between varying degrees of pattern burden and the occurrence of a first major arrhythmic event remains unclear. This retrospective cohort study included 64 adult patients with a spontaneous type-1 Brugada pattern, who were identified at Mayo Clinic sites and followed for ≥12 months after the initial diagnosis. All patients underwent at least three 12-lead electrocardiograms (ECGs) within the first year. Individuals with prior major arrhythmic events were excluded. The percentage of ECGs showing a type-1 pattern was calculated and categorized as paroxysmal (<50%), persistent (50–99%), or permanent (100%). During a median follow-up of 92 months, seven patients (11%) experienced their first major arrhythmic event. Of these, one had paroxysmal, four had persistent, and two had permanent spontaneous type-1 Brugada patterns. Although statistical significance was not reached, the hazard ratios suggested a trend toward increased risk with persistent and permanent patterns compared to paroxysmal patterns. No sudden cardiac deaths occurred during follow-up. These findings suggest that a higher burden of spontaneous type-1 Brugada patterns may be associated with increased arrhythmic risk.

Abstract Background Acute pancreatitis, a prevalent gastrointestinal condition, frequently necessitates hospitalization and is associated with potential adverse in-hospital outcomes. Recent data showed the detrimental effects of COVID-19 infection on acute pancreatitis, particularly in patients with severe COVID-19 infections. However, limited information exists on the specific impacts of COVID-19 infection in patients hospitalized for acute pancreatitis. Methods We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted due to acute pancreatitis. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Statistical significance was established at a P value of 0.05. Results We identified 252,435 patients with a primary discharge diagnosis of acute pancreatitis. The mean age was 50.1 years; 48.6% were female. Caucasians accounted for 41%, followed by Hispanics. Of these, 1.05% (2,675/252,435) had a concurrent diagnosis of COVID-19 infection. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.71; 95% CI 2.01, 6.84, P &lt; 0.001), prolonged length of stay (β LOS 1.05; 95% CI 0.46, 1.64, P &lt; 0.001), increased hospitalization charge ( β charge 9,327; 95% CI 820, 17834, P &lt; 0.001), and acute respiratory failure (aOR 2.49; 95% CI 1.75, 3.53, P &lt; 0.001), We observed non-significant, but increased, risks of shock, acute kidney injury (AKI), pancreatic pseudocyst, acute respiratory distress syndrome (ARDS), and mechanical ventilation in COVID-19 positive patients. Conclusion In conclusion, our study underscores that COVID-19 infection is associated with higher in-hospital mortality, prolonged hospital stays, and increased incidence of acute respiratory failure in patients diagnosed with acute pancreatitis. Future longitudinal studies are warranted to comprehensively assess the long-term health sequelae in this population. Disclosures All Authors: No reported disclosures

Leuprolide acetate is commonly used to reduce the size of myomas before surgery. Initially, it stimulates pituitary gonadotropin secretion, followed by sustained suppression of gonadal function. However, the impact on pregnancy outcomes from inadvertent exposure remains unclear. This case involves a woman in her 30s, multiparous, with a 20-week-sized leiomyoma, who received two doses of 3.75 mg subcutaneous leuprolide acetate, 15 days after menstruation, 4 weeks apart. An ultrasound, conducted 2 weeks after the last dose, accidentally revealed a viable intrauterine pregnancy at 8+6 weeks gestation. Her pregnancy progressed without complications, culminating in a term caesarean delivery without fetal anomalies. She opted for a total hysterectomy with bilateral salpingectomy 6 months later. Despite unclear teratogenic effects, evidence suggests that leuprolide acetate does not significantly impact pregnancy outcomes.

Background: Revascularization of small vessel coronary artery disease (SvCAD) is still challenging despite the extensive use of drug-eluting stents (DESs), mainly because of an increase in target vessel failure. Drug-coated balloon (DCB) has emerged as an alternative strategy in SvCAD. However, the safety and efficacy of DCB in SvCAD is still controversial. We conducted a meta-analysis comparing the clinical outcomes of DCB and DES in SvCAD patients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published randomized control trials (RCTs) that compared major adverse cardiac events (MACE), target-lesion revascularization (TLR), and target-vessel revascularization (TVR) between DCB and DES in SvCAD patients. Data from each study were combined using the random-effects model. Results: Six RCTs were included in this meta-analysis involving 1,534 SvCAD patients (775 underwent revascularization with DCB and 759 with DES). There was no difference in MACE, TLR, and TVR between DCB and DES groups ([OR] 1.14, 95% CI 0.64-2.00, I 2 =58.2%, p=0.657, [OR] 1.34, 95% CI 0.56-3.23, I 2 =48.5%, p=0.516, and [OR] 1.09, 95% CI 0.59-2.01, I 2 =49.6%, p=0.795, respectively) (Figure 1). There was no publication bias observed in Funnel plot as well as no small-study effect observed in Egger’s test. Conclusions: As compared to DES, our study showed that DCB was associated with similar clinical outcomes and could be a potential alternative strategy in SvCAD patients.

Introduction: Chronic total coronary occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI vs optimal medical therapy (OMT) are still controversial. We conducted an extensive review and meta-analysis to compare the clinical outcomes between PCI and OMT in CTO. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published cohort (prospective or retrospective) with propensity score matching analysis and randomized trials that reported all-cause death, cardiac death, and myocardial infarction (MI) with PCI and OMT in CTO patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odd ratios and 95% confidence intervals. Results: Sixteen studies, 6 randomized controlled trials (RCTs) and 11 observational studies with propensity score with matching (PSMs), were included in this meta-analysis involving 8,316 CTO patients (4,332 underwent PCI and 4,084 received OMT). In the overall analysis, all-cause death, cardiac death, and MI were significantly reduced in PCI compared to OMT group, respectively ([OR] 0.65, 95% CI 0.55-0.76, I 2 =0.0%, p<0.001, [OR] 0.60, 95% CI 0.49-0.74, I 2 =0.0%, p<0.001, and [OR] 0.72, 95% CI 0.52-0.99, I 2 =19.0%, p=0.041). Conclusions: Our study is the most updated meta-analysis to assess the impact of PCI compared to OMT in patients with CTO, analyzing the data being derived from PSMs and RCTs, that demonstrated significant impact of PCI on all-cause death, cardiac mortality, and MI.

Background: Heavily calcified coronary bifurcation lesions present significant challenges during percutaneous coronary intervention, particularly during atherectomy due to the risk of side branch occlusion from plaque shift. We describe the "Double Guiding Catheter Technique" to minimize side branch closure and wire damage to non-atherectomy vessels during bifurcation orbital atherectomy (OA). Case: A 74-year-old male with a recent NSTEMI presented for elective coronary artery revascularization. A coronary angiogram revealed non-obstructive left coronary arteries and a dominant right coronary artery (RCA) with heavily calcified stenosis at the bifurcation of the right posterolateral (RPL) and right posterior descending (RPD) branches. After placing temporary transvenous pacing and inserting sheaths in the right radial and right femoral arteries, both the RPL and RPD were wired with coronary guidewires. Using a coronary microcatheter, the wire in RPL was replaced with a ViperWire guidewire for OA, while the microcatheter in RPD served as guidewire protection. OA of RPL was successfully performed with the Diamondback 360° OA system (Cardiovascular Systems Inc), followed by multiple dilatations with non-compliant balloons and placement of two drug-eluting stents in the distal RCA to RPL and RPD, achieving good angiographic and IVUS results. Discussion: The Double Guiding Catheter Technique has been described in a few case reports of heavily calcified left main coronary bifurcation atherectomy which is limited to relatively proximal lesions due to the need to pass a second wire to a non-atherectomy vessel outside a guide extension catheter for the main branch. This is the first reported case of OA using this technique in the right coronary artery and a relatively distal part of the coronary artery. The primary advantage of this technique is eliminating the need to withdraw one of the two wires, which can be challenging when recrossing the side branch. The microcatheter can safely protect the other branch wire during atherectomy. Conclusion: By maintaining both wires with a protective microcatheter, OA of coronary bifurcation stenosis can be successfully achieved, potentially reducing the risk of wire transection.

Background: Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), but many patients experience recurrence post-intervention. Evaluating left atrial strain (LAS) to measure LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) could help predict AF recurrence, especially in patients with no evident signs of severe LA myopathy. Goal: This study aims to assess the prognostic value of pre-ablation LAS in both paroxysmal AF (paAF) and persistent AF(peAF) in patients with no evident signs of severe LA myopathy. Methods: This retrospective study encompassed AF patients who underwent their first CA procedure at Mayo Clinic Arizona from October 2018 to February 2022 and had a LAVI <40 ml/m2 and LVEF >55%. Transthoracic echocardiography parameters, including the three LAS phases, were collected using TOMTEC software on the closest date before the CA procedure. Receiver operating characteristic (ROC) curve analysis was used to evaluate the capability of LAS to detect patients with AF recurrence after CA from those without recurrence. Results: Out of 335 AF patients who underwent CA during the study period, 40 cases had LAVI <40 ml/m2 and LVEF >55% (72.5% male; mean age 69.2 ± 8 years). Of these, 15% (6/40) experienced recurrence, while 85% (34/40) maintained sinus rhythm. The mean values of LASr, LAScd, and LASct for all patients were 16.82, 11.23, and 6.87, respectively. ROC analysis indicated that the area under the curve (AUC) for LASr, LAScd, and LASct was 0.582, 0.502, and 0.710, respectively. (Graph 1A, Table 1A) LASct was the only parameter associated with AF recurrence (AUC: 0.71). Additionally, we developed a novel marker termed LAVI-LASct by combining LAVI and LASct values, which demonstrated improved discrimination with an ROC value of 0.74 (Graph 1B). Conclusions: LASct demonstrated predictive capability for AF recurrence in patients with no severe LA dilation and preserved LVEF, potentially due to its ability to detect early atrial dysfunction preceding visible structural changes or myocardial pathology. The addition of LAVI values provided better discrimination for the ROC model. Further research is needed to confirm the clinical relevance of LAS in AF patients undergoing ablation.