The Prevalence and Impact of Obesity on the Outcomes of Patients Undergoing Transcatheter Mitral Valve Repair using MitraClip - A National Inpatient Sample Analysis 2016 to 2020.

Background: Low Body Mass Index (BMI) is associated with poor outcomes in patients who undergo various cardiac interventions. Studies on patients with elevated BMI have produced mixed results. Our study aims to evaluate the impact of obesity on the in-hospital outcomes of patients undergoing transcatheter mitral valve repair using MitraClip in the United States. Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify patients who underwent transcatheter mitral valve repair using MitraClip. Patients less than 18 years, with protein-energy malnutrition and rapid weight loss, were excluded. Our final study population was classified into Obese (BMI ≥ 30 Kg/m2) and Non-obese (Normal/Overweight) (BMI 0f 18.5 -29.9 Kg/m2) cohorts based on their Body Mass Index (BMI). The primary outcomes were the prevalence of obesity and in-hospital mortality. Secondary outcomes were the rate of periprocedural complications, including cardiogenic shock, cardiac arrest, myocardial infarction, and acute kidney injury. Result: 40,950 patients underwent transcatheter mitral valve repair (MitraClip) during our study period. 7.8% were identified as obese. Obese patients were more likely to be female (50.6% vs. 43.9%, p Conclusions: Our study suggests obesity does not influence short-term in-hospital outcomes in patients undergoing transcatheter mitral valve repair using MitraClip

Teprasiran, a Small Interfering RNA, for the Prevention of Acute Kidney Injury in High-Risk Patients Undergoing Cardiac Surgery

Background: Acute kidney injury (AKI) affects up to 30% of patients undergoing cardiac surgery, leading to increased in-hospital and long-term morbidity and mortality. Teprasiran is a novel small interfering RNA that temporarily inhibits p53-mediated cell death that underlies AKI. Methods: This prospective, multicenter, double-blind, randomized, controlled phase 2 trial evaluated the efficacy and safety of a single 10 mg/kg dose of teprasiran versus placebo (1:1), in reducing the incidence, severity, and duration of AKI after cardiac surgery in high-risk patients. The primary end point was the proportion of patients who developed AKI determined by serum creatinine by postoperative day 5. Other end points included AKI severity and duration using various prespecified criteria. To inform future clinical development, a composite end point of major adverse kidney events at day 90, including death, renal replacement therapy, and ≥25% reduction of estimated glomerular filtration rate was assessed. Both serum creatinine and serum cystatin-C were used for estimated glomerular filtration rate assessments. Results: A total of 360 patients were randomly assigned in 41 centers; 341 dosed patients were 73±7.5 years of age (mean±SD), 72% were men, and median European System for Cardiac Operative Risk Evaluation score was 2.6%. Demographics and surgical parameters were similar between groups. AKI incidence was 37% for teprasiran- versus 50% for placebo-treated patients, a 12.8% absolute risk reduction, P=0.02; odds ratio, 0.58 (95% CI, 0.37-0.92). AKI severity and duration were also improved with teprasiran: 2.5% of teprasiran- versus 6.7% of placebo-treated patients had grade 3 AKI; 7% teprasiran- versus 13% placebo-treated patients had AKI lasting for 5 days. No significant difference was observed for the major adverse kidney events at day 90 composite in the overall population. No safety issues were identified with teprasiran treatment. Conclusions: The incidence, severity, and duration of early AKI in high-risk patients undergoing cardiac surgery were significantly reduced after teprasiran administration. A phase 3 study with a major adverse kidney event at day 90 primary outcome that has recently completed enrollment was designed on the basis of these findings (NCT03510897)

Amyloidosis Is Associated with Increased Risk of Atrial Fibrillation. A Forgotten Link between Uncommon and Common Cardiac Conditions. Analysis from the National Inpatient Sample

Objective: This study aims at identifying the relationship between amyloidosis and atrial fibrillation Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased risk of stroke, heart failure, and mortality. Recent advances in cardiac imaging have increased the frequency of diagnosis of cardiac amyloidosis. Data is limited on the role of cardiac amyloid in patients with AF. Methods: This is a retrospective cohort study of patients with amyloidosis from the National Inpatient Sample (NIS) 2014. The primary outcome was diagnosis of AF in the amyloidosis vs. non-amyloidosis population. Logistic regression models were used to assess predictors of AF among the study population. Results: 5, 872,587 health encounters from the NIS were identified. Of these, 4,287 subjects had a diagnosis of amyloidosis. AF was found in 28.7% of the amyloidosis vs. 13.4% % of the non-amyloidosis group, p \u3c 0.001. The average age of the amyloidosis is 71 yrs. old, female represents 55.9% of the study population. Systolic heart failure (8.5% vs. 3.9%, p \u3c 0.001), diastolic heart failure (14.7% vs. 4.6%, p \u3c 0.001), ischemic stroke (6.3% vs. 1.9%, p \u3c 0.001) and chronic kidney disease (42.3% vs. 14.4%, p \u3c 0.001) were more prevalent in the amyloidosis vs. non-amyloidosis group. Amyloidosis was associated with the black ethnicity (19.4% vs. 14.1%, p \u3c 0.001). In addition, diabetes mellitus, hypertension, and obesity were common in the amyloidosis group. On multivariate analysis, amyloidosis was a strong predictor of AF (OR 1.37 (95% CI 1.28-1.47, p \u3c 0.001)) Conclusion: AF and amyloidosis are mutually associated identities. High suspicion should be maintained for the diagnosis of amyloidosis in patients presenting with AF. This may allow early recognition and treatment of underlying amyloidosis in patients with AF

Fetus in fetu : molecular analysis of a fetiform mass

Fetus-in-fetu is a rare condition presenting as a calcified intra- abdominal mass in the newborn infant. Over 50 cases of fetus-in-fetu have been reported since 1800. Karyotype analysis in 8 cases and protein polymorphisms in 4 documented identical findings in the host and fetiform mass. We report a case of fetus-in-fetu in a newborn female including cytogenetic and molecular studies of both the host and mass. Genotypic information from 7 polymerase chain reaction (PCR) assays representing 4 chromosomes demonstrates heterozygous and identical alleles in the infant and fetus-in-fetu at all loci studied. A review of the literature is provided including a discussion regarding the impact of molecular data on present hypotheses of fetus-in-fetu pathogenesis.9 page(s

Toward a Medical Gastric Bypass: Chronic Feeding Studies With Liraglutide + PYY3−36_{3-36} Combination Therapy in Diet-Induced Obese Rats

Background Combination therapies of anorectic gut hormones partially mimic the beneficial effects of bariatric surgery. Thus far, the effects of a combined chronic systemic administration of Glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine 3-36 (PYY$_{3-36}$) have not been directly compared to Roux-en-Y gastric bypass (RYGB) in a standardized experimental setting. Methods High-fat diet (HFD)-induced obese male Wistar rats were randomized into six treatment groups: (1) RYGB, (2) sham-operation (shams), (3) liraglutide, (4) PYY$_{3-36}$, (5) PYY$_{3-36}$+liraglutide (6), saline. Animals were kept on a free choice high- and low-fat diet. Food intake, preference, and body weight were measured daily for 4 weeks. Open field (OP) and elevated plus maze (EPM) tests were performed. Results RYGB reduced food intake and achieved sustained weight loss. Combined PYY$_{3-36}$+liraglutide treatment led to similar and plateaued weight loss compared to RYGB. Combined PYY$_{3-36}$+liraglutide treatment was superior to PYY$_{3-36}$ (p ≤ 0.0001) and liraglutide (p ≤ 0.05 or p ≤ 0.01) mono-therapy. PYY$_{3-36}$+liraglutide treatment and RYGB also reduced overall food intake and (less pronounced) high-fat preference compared to controls. The animals showed no signs of abnormal behavior in OF or EPM. Conclusions Liraglutide and PYY$_{3-36}$ combination therapy vastly mimics reduced food intake, food choice and weight reducing benefits of RYGB

Syncope as the Sole Presentation of Multi-Vessel Coronary Artery Disease

Defining the etiology of syncope can be occasionally challenging. We present a case with no history of coronary artery disease (CAD) who presented exclusively with exertional syncope, and was found to have mildly reduced left ventricular systolic dysfunction on echocardiogram and severe multi-vessel CAD with chronic total occlusion (CTO) of the right coronary artery (RCA). Syncope as the initial presentation of advanced CAD in the absence of classic ischemic symptoms is rather an uncommon presentation in clinical practice