A case of pulmonary lymphoproliferative disorder presenting rapidly progressive respiratory failure

A 72‐year‐old woman presented with acute onset of shortness of breath and fatigue over several days, and was found to be in acute respiratory failure. Computed tomography of the chest revealed diffuse ground‐glass opacities, crazy‐paving, multiple nodules, and a large mass in the right lower lobe. She was diagnosed with B‐cell lymphoma and a pulmonary lymphoproliferative disorder (PLD). PLD is known to present with a variety of radiographic patterns. The course of PLD is usually one of slow progression, and acute respiratory failure is a rare presentation. Physicians should be aware that acute respiratory failure can be caused by PLD

Comparison of the acceptability and safety of molnupiravir in COVID-19 patients aged over and under 80 years

Background: Molnupiravir is being widely used as a treatment for coronavirus disease 2019 (COVID-19); however, its acceptability and safety in older patients aged ≥ 80 years in real-world clinical practice is not well understood. Methods: We conducted a single-centre retrospective study and assessed the outcome of patients with COVID-19 treated with molnupiravir according to the following criteria: (A) discontinuation rate of molnupiravir; (B) type, frequency, and severity of adverse events; (C) all-cause mortality within 30 days of the diagnosis of COVID-19. Results: Forty-seven patients (46.1%) were aged ≥ 80 years (older patients) and 55 (53.9%) were aged < 80 years (younger patients). There were no significant differences in coexisting diseases and history of vaccination for COVID-19 between older and younger patients. Older patients were significantly more likely to have moderate disease (moderate 1 and 2) according to the Japanese Ministry of Health, Labour and Welfare classification than younger patients. During treatment, 8.5% of older patients and 1.8% of younger patients stopped taking molnupiravir, but the difference was not significant. Adverse events were observed in 39/102 (38.2%) patients. The most common adverse events were diarrhoea (9.8%), exacerbation of coexisting diseases (6.9%), bone marrow suppression (6.9%), liver dysfunction (5.9%), and loss of appetite (4.9%). Most adverse events were minor, ranging from grades 1 to 3. The all-cause mortality rate was 10.8%, and no molnupiravir-related deaths were observed. Conclusions: Molnupiravir treatment is acceptable and safe in older patients with COVID-19 aged ≥ 80 years

Utility of left ventricular ejection fraction in atrial fibrillation patients without pre‐existing heart failure

Abstract Aims Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus has been placed on the prevention of HF in patients with AF. Left ventricular ejection fraction (LVEF) is an established echocardiographic parameter in HF patients. We sought to investigate the association of LVEF with HF events in AF patients without pre‐existing HF. Methods and results The Fushimi AF Registry is a community‐based prospective survey of AF patients in Fushimi‐ku, Japan. In this analysis, we excluded patients with pre‐existing HF (defined as having one of the following: prior HF hospitalization, New York Heart Association class ≥ 2 in association with heart disease, or LVEF  0.05). During the median follow‐up period of 6.0 years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person‐year). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF [mildly reduced LVEF (40–49%): hazard ratio = 2.98, 95% confidence interval = 1.99–4.45 and below normal LVEF (50–59%): hazard ratio = 2.01, 95% confidence interval = 1.44–2.82, compared with normal LVEF (≥60%)] after adjustment by age, sex, type of AF, and CHA2DS2‐VASc score. LVEF  0.05). LVEF had an independent and incremental prognostic value for HF hospitalization in addition to natriuretic peptide levels in AF patients without pre‐existing HF. Conclusions Lower LVEF was significantly associated with the higher incidence of HF hospitalization in AF patients without pre‐existing HF, leading to the future risk stratification for and prevention of incident HF in AF patients

Characteristics and clinical outcomes in atrial fibrillation patients classified using cluster analysis:the Fushimi AF Registry

AIMS: The risk of adverse events in atrial fibrillation (AF) patients was commonly stratified by risk factors or clinical risk scores. Risk factors often do not occur in isolation and are often found in multimorbidity 'clusters' which may have prognostic implications. We aimed to perform cluster analysis in a cohort of AF patients and to assess the outcomes and prognostic implications of the identified comorbidity cluster phenotypes.METHODS AND RESULTS: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. Hierarchical cluster analysis was performed on 4304 patients (mean age: 73.6 years, female; 40.3%, mean CHA2DS2-VASc score 3.37 ± 1.69), using 42 baseline clinical characteristics. On hierarchical cluster analysis, AF patients could be categorized into six statistically driven comorbidity clusters: (i) younger ages (mean age: 48.3 years) with low prevalence of risk factors and comorbidities (n = 209); (ii) elderly (mean age: 74.0 years) with low prevalence of risk factors and comorbidities (n = 1301); (iii) those with high prevalence of atherosclerotic risk factors, but without atherosclerotic disease (n = 1411); (iv) those with atherosclerotic comorbidities (n = 440); (v) those with history of any-cause stroke (n = 681); and (vi) the very elderly (mean age: 83.4 years) (n = 262). Rates of all-cause mortality and major adverse cardiovascular or neurological events can be stratified by these six identified clusters (log-rank test; P &lt; 0.001 and P &lt; 0.001, respectively).CONCLUSIONS: We identified six clinically relevant phenotypes of AF patients on cluster analysis. These phenotypes can be associated with various types of comorbidities and associated with the incidence of clinical outcomes.CLINICAL TRIAL REGISTRATION INFORMATION: https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834.</p