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Background and Objectives: MitraClip® (MC) placement has been extensively used as an intervention for mitral transcatheter edge-to-edge repair (mTEER) for functional mitral regurgitation (FMR). The aim of our study is to analyze the association between the pre-procedural echocardiographic parameters of diastolic function (DF) and one-year outcomes after MC placement. Materials and Methods: The study was designed in a retrospective longitudinal cross-sectional format. In total, 224 patients who underwent MC placement between January of 2021 and March of 2024 were included in the study. The Primary Efficacy Endpoint (PEE) was determined by an absence of heart failure hospitalizations requiring Intravenous Diuretics or cardiac-related death in the one-year follow-up period. Multivariate regression analysis was carried out to identify the pre-procedural echocardiographic parameters of DF that had a significant association with a failure to reach the PEE. A two-tailed p-value < 0.05 was used to determine statistical significance. Results: Of the 224 patients included in the study, 85 patients (37.94%) failed to reach the PEE or had worsening symptoms. The mean mitral valve (MV) deceleration time was 176.88 ms (164.14–189.62) in the symptom-worsening group compared to 201.53 ms (186.01–217.07) in the symptom-improvement group. The mean of the E/A ratio (MV peak E velocity/A velocity) was noted to be 2.35 (1.97–2.74) in the symptom-worsening group compared to 1.90 (1.68–2.13) in the symptom-improvement group. After multivariate regression analysis, the E/A ratio was found to have a significant association with a failure to reach PEE: Odds Ratio (OR): 1.61 (1.13–2.29), p-value: 0.008. The area under the curve (AUC) analysis for the E/A ratio was calculated at 0.603 (0.50–0.69) for the symptom-worsening group. Conclusions: Patients that failed to reach the PEE had a lower pre-procedural MV deceleration time of 176.88 ms (164.14–189.62); however, no association was observed between MV deceleration time and a failure to reach the PEE in the multivariate regression analysis. The pre-procedural E/A ratio had a significant association with symptom worsening after multivariate regression analysis: OR: 1.61 (1.13–2.29). The AUC for the E/A ratio in the symptom-worsening group was 0.603, making it a more moderate predictor than random guessing for the failure to reach the PEE.

Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8–27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.

Background: Pulsed field ablation (PFA) is a novel non-thermal modality for catheter ablation (CA) in atrial fibrillation (AF) and has been replacing traditional thermal modalities. There have been studies in the past comparing fluoroscopic (FL) versus intracardiac echocardiogram (ICE) guidance for thermal ablation modalities. However, there have not been studies that compare outcomes for PFA performed under ICE versus FL guidance. Methods: This study was designed in a longitudinal cross-sectional format. A total of 196 patients who underwent PFA for AF at Prisma Health Richland were selected for the retrospective analysis. Patients were divided into two groups: those who underwent PFA under FL guidance (103 patients) versus ICE guidance (93 patients). The recurrence of atrial arrhythmias in the six-month follow-up period was studied. Multivariate regression analysis was performed to assess the difference in the association of either modality with recurrence of atrial arrhythmias. Bayesian non-inferiority models were used to analyze the non-inferiority between the modalities. Results: A total of 31 patients (30.1%) in the fluoro group had documented atrial arrhythmias in the six months following ablation. While 23 patients (24.7%) in the ICE group had documented atrial arrhythmias in the six-month follow-up period. The recurrence of AF was noted in 22.3% (22 patients) in the fluoro group and 14% (13 patients) in the ICE group. After running the multivariate regression analysis models, PFA under fluoroscopic guidance did not differ from ICE guidance, in terms of the recurrent atrial arrhythmias in the six-month follow-up (Adjusted Odds Ratio: 0.964; 95% CI: 0.336–2.772). The fluoro and ICE groups also did not differ in terms of six-month atrial fibrillation recurrence (Adjusted Odds Ratio: 2.43; 95% CI: 0.649–9.19). Non-inferiority analysis with Bayesian model was carried out, comparing the fluoro group and the ICE group in terms of freedom from arrhythmias in the six-month follow-up, and no inferiority was proved (95% confidence interval: −0.18–0.053), with a 61.03% chance of ICE-guided PFA being superior to fluoro guidance in terms of recurrence free interval, but statistical significance was not reached. Conclusions: Mean fluoroscopic time in the FL guidance group was 15.9 min, while no radiation exposure was documented in the ICE group. CA performed under FL versus ICE guidance did not differ statistically in terms of six-month recurrence of atrial arrhythmias in general and AF in particular.

The aim of this study is to analyze the difference in hospital outcomes for infective endocarditis (IE) admissions with and without comorbid congestive heart failure (CHF). The National Inpatient Sample (NIS) was the database we used to find and sort patient data from inpatient hospitalizations. We then used logit probit regression to analyze the association between patients admitted for IE with and without CHF and their all-cause mortality rates. After collecting our sample population, we used propensity score matching to create our comparative cohorts of IE patients which were then analyzed to determine if there was an association between inpatient hospital outcomes and the presence of CHF. Among the patients admitted for IE, there was a statistically significant association between comorbid CHF diagnoses and an increase in all-cause mortality during hospital admission. The proportion of mortality was 7.8% during the hospitalization for IE admissions with comorbid CHF, while the proportion was 4.16% for the subset of IE admissions without comorbid CHF. The association of comorbid CHF and all-cause mortality during the hospital stay for IE admissions was significant with an odds ratio of 3.197 (2.089-4.891) after adjusting for age, sex, race, income, and other comorbidities. The association between the requirement for either temporary or continuous pacing during the hospital stay and co-existing CHF diagnosis in IE admissions was also significant with an odds ratio of 2.86 (1.720-4.761). Among the propensity-matched cohort analysis, there was a significantly higher proportion of IE admissions with co-existing CHF needing pacing (either temporary or continuous), 5.74% (3.96%-8.25%) compared to the IE cohort without comorbid CHF: 1.48% (0.71%-3.09%). With the results of our analyses proving a significant association between the presence of CHF and adverse in-hospital outcomes in IE admissions, it calls for further prospective and real-world studies to analyze the finer aspects of the association. This becomes important for clinicians in stratifying at-risk patients for a higher level of care and prognostication aspects of the treatment. Our study results prove a causative association between the presence of CHF and heart block in IE admissions. This could be useful for clinicians in planning appropriate management plans in the event of initial signs of bradycardia and hypotension developing in this patient population.

Background/Objectives: The main aim of this study is to analyze the outcomes of NSTEMI admissions and test the relevance of TIMI as a risk score in a real-world setting. We also examine any potential social or health care disparities involved with outcomes of NSTEMI admissions. This study also investigates factors associated with mortality in NSTEMI admissions and its correlation with heart catheterization during admission. Methods: NSTEMI admissions were analyzed using the National Inpatient Sample. TIMI scores were calculated for the admissions and their association with all-cause mortality was studied. Differences in mortality outcomes based on heart catheterization during admission were studied in the subgroup with a TIMI score > 2. Correlations between time to heart catheterization and all-cause mortality in NSTEMI admissions were analyzed. Results: No significant social or healthcare disparities were noted among outcomes for NSTEMI admissions. NSTEMI admissions with a calculated TIMI score > 2 had a statistically significant association with all-cause mortality during admission: odds ratio 1.33 (95% CI 1.23–1.43, p value: 0.00). The prevalence of mortality among NSTEMI admissions with a calculated TIMI score > 2 who did not undergo heart catheterization was higher with statistical significance (6.23%; 95% CI: 5.84–6.65%), when compared to admissions who underwent heart catheterization (2.41%; 95% CI: 2.25–2.59%). NSTEMI admissions with a calculated TIMI score > 2 who underwent catheterization on or beyond the fourth day of hospitalization had a statistically significant association with all-cause mortality during admission: odds ratio: 2.56 (95% CI: 2.31–2.83, p value: 0.00). Age at admission, presence of CKD and CHF were associated with mortality in NSTEMI admissions, with statistical significance. Conclusions: Based on the results of our analysis, no disparities in terms of race/sex/hospital location, etc., were seen for NSTEMI in-hospital outcomes. Admissions with a TIMI score > 2 had a statistically significant association with in-hospital mortality, after accounting for confounders. Among NSTEMI admissions with a TIMI score > 2, those who did not undergo heart catheterization during admission were found to have a higher prevalence of in-hospital mortality. No social or healthcare disparities were seen among admissions with TIMI score > 2 who did not undergo heart catheterization during admission. We also noted that NSTEMI admissions with a TIMI score > 2 who underwent heart catheterization on or beyond Day 4 of the initial admission were associated with higher mortality.

AIM: The aim of our study was primarily to analyze hospital outcomes for acute decompensated heart failure (ADHF) admissions with a comorbid diagnosis of chronic liver disease (CLD). METHODS: The NIS was used to select ADHF admissions. The population characteristics of general ADHF admissions were compared with ADHF admissions with a comorbid diagnosis of CLD. Multivariate probit logistic regression was used to analyze the association between a documented diagnosis of CLD/alcoholic liver disease and all-cause mortality in ADHF admissions. Confounders were accounted for. Propensity scoring and nearest neighbor matching were conducted to select a matched cohort with and without CLD from ADHF admissions to further look at mortality outcomes. RESULTS: ADHF admissions with a comorbid diagnosis of CLD had a significantly higher proportion of all-cause mortality, 0.054 (0.053–0.057), a higher length of hospital stay, 6.95 days (6.84–7.06), and a higher mean of total hospital charges, USD 88,068.1, when compared to ADHF admissions without a comorbid diagnosis of CLD: all-cause mortality, 0.045 (0.044–0.046); length of hospital stay, 6.18 days (6.13–6.23); and mean total hospital charges, USD 79,946.21. A comorbid diagnosis of CLD had a significant association with all-cause mortality in ADHF admissions: OR 1.23 (1.17–1.29) after accounting for confounders. In the propensity-matched cohorts, the cohort with a diagnosis of CLD from the ADHF admissions had a higher proportion of all-cause mortality, 0.042 (0.036–0.049), when compared to the cohort without a diagnosis of chronic liver disease, 0.027 (0.022–0.033). CONCLUSIONS: In analyzing the mortality and healthcare utilization outcomes for ADHF admissions, the comorbid diagnosis of CLD is shown to have significantly higher all-cause mortality, higher length of hospital stay, and higher mean total charges when compared to ADHF admissions without a diagnosis of CLD. A documented diagnosis of CLD had a statistically significant association with all-cause mortality in ADHF admissions after accounting for confounding factors.

Background and GoalsPeptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting.MethodsRetrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients’ demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis.ResultsA total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs.ConclusionsThe ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.