Hypertension in African Americans with Heart Failure: Progression from Hypertrophy to Dilatation; Perhaps Not

Abstract Aim Concentric hypertrophy is thought to transition to left ventricular (LV) dilatation and systolic failure in the presence of long standing hypertension (HTN). Whether or not this transition routinely occurs in humans is unknown. Methods We consecutively enrolled African American patients hospitalized for acute decompensated volume overload heart failure (HF) in this retrospective study. All patients had a history of HTN and absence of obstructive coronary disease. Patients were divided into those with normal left ventricular ejection fraction (LVEF) and reduced LVEF. LV dimensions were measured according to standard ASE recommendations. LV mass was calculated using the ASE formula with Devereux correction. Results Patients with normal LVEF HF were significantly older, female and had a longer duration of HTN with higher systolic blood pressure on admission. LV wall thickness was similarly elevated in both groups. LV mass was elevated in both groups however was significantly greater in the reduced LVEF HF group compared to the normal LVEF HF group. Furthermore, gender was an independent predictor for LV wall thickness in normal LVEF HF group. Conclusion In African American patients with HF our study questions the paradigm that concentric hypertrophy transitions to LV dilatation and systolic failure in the presence of HTN. Genetics and gender likely play a role in an individual's response to long standing hypertension

Matched Cohort Study of Convalescent COVID-19 Plasma Treatment in Severely or Life Threateningly Ill COVID-19 Patients.

BACKGROUND: The utility of convalescent coronavirus disease 2019 (COVID-19) plasma (CCP) in the current pandemic is not well defined. We sought to evaluate the safety and efficacy of CCP in severely or life threateningly ill COVID-19 patients when matched with a contemporaneous cohort. METHODS: Patients with severe or life-threatening COVID-19 were treated with CCP according to Food and Drug Administration criteria, prioritization by an interdisciplinary team, and based on CCP availability. Individual-level matched controls (1:1) were identified from patients admitted during the prior month when no CCP was available. The safety outcome was freedom from adverse transfusion reaction, and the efficacy outcome was a composite of death or worsening O RESULTS: Study patients (n = 94, 47 matched pairs) were 62% male with a mean age of 58, and 98% (90/94) were minorities (53% Hispanic, 45% Black, non-Hispanic) in our inner-city population. Seven-day composite and mortality outcomes suggested a nonsignificant benefit in CCP-treated patients (adjusted hazard ratio [aHR], 0.70; 95% CI, 0.23-2.12; CONCLUSIONS: In this short-term matched cohort study, transfusion with CCP was safe and showed a nonsignificant association with study outcomes. Randomized and larger trials to identify appropriate timing and dosing of CCP in COVID-19 are warranted. TRIAL REGISTRATION:  ClinicalTrials.gov Identifier: NCT04420988

Impact of serious mental illness on the treatment and mortality of older patients with locoregional high‐grade (nonmetastatic) prostate cancer: retrospective cohort analysis of 49 985 SEER‐Medicare patients diagnosed between 2006 and 2013

Abstract Background The influence of serious mental illness (SMI) on the treatment and survival of patients with high‐grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer‐specific mortality of SEER‐Medicare patients with locoregional high‐grade (nonmetastatic) prostate cancer with and without preexisting SMI. Methods We identified SEER‐Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high‐grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan‐Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5‐year cancer‐specific survival. Results Among 49 985 patients with locoregional high‐grade (nonmetastatic) prostate cancer, 523 (1.1%) had SMI and 49 462 (98.9%) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95% CI: 0.49‐0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95% CI: 0.67‐0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5‐year cancer‐specific death (HR = 1.41, 95% CI: 1.06‐1.89) after accounting for competing risks of non‐cancer death. Conclusion Among SEER‐Medicare patients with locoregional high‐grade (nonmetastatic) prostate cancer, those with preexisting SMI—relative to those without these conditions—were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer‐specific survival 5 years after diagnosis