Explore the vast range of titles available.

Previous studies have reported that a high neutrophil-to-lymphocyte ratio (NLR) is associated with disease severity and poor prognosis in COVID-19 patients. We aimed to investigate the clinical implications of NLR in patients with COVID-19 complicated with cardiovascular diseases and/or its risk factors (CVDRF). In total, 601 patients with known NLR values were selected from the CLAVIS-COVID registry for analysis. Patients were categorized into quartiles (Q1, Q2, Q3, and Q4) according to baseline NLR values, and demographic and clinical parameters were compared between the groups. Survival analysis was conducted using the Kaplan–Meier method. The diagnostic performance of the baseline and follow-up NLR values was tested using receiver operating characteristic (ROC) curve analysis. Finally, two-dimensional mapping of patient characteristics was conducted using t-stochastic neighborhood embedding (t-SNE). In-hospital mortality significantly increased with an increase in the baseline NLR quartile (Q1 6.3%, Q2 11.0%, Q3 20.5%; and Q4, 26.6%; p < 0.001). The cumulative mortality increased as the quartile of the baseline NLR increased. The paired log-rank test revealed significant differences in survival for Q1 vs. Q3 (p = 0.017), Q1 vs. Q4 (p < 0.001), Q2 vs. Q3 (p = 0.034), and Q2 vs. Q4 (p < 0.001). However, baseline NLR was not identified as an independent prognostic factor using a multivariate Cox proportional hazards regression model. The area under the curve for predicting in-hospital death based on baseline NLR was only 0.682, whereas that of follow-up NLR was 0.893. The two-dimensional patient map with t-SNE showed a cluster characterized by high mortality with high NLR at follow-up, but these did not necessarily overlap with the population with high NLR at baseline. NLR may have prognostic implications in hospitalized COVID-19 patients with CVDRF, but its significance depends on the timing of data collection.

As the quality of image generation by deep learning increases, it is becoming difficult to discern its authenticity from the image alone. Currently, generative models represented by generative adversarial networks (GAN) are increasingly utilized in the research field of cardiology, and their potential risks are also being pointed out. In this context, we assessed whether expert cardiologists can detect synthesized myocardial perfusion images (MPI) generated by GAN as fake. A total of 1448 polar maps collected from consecutive patients who underwent MPI for known or suspected coronary artery disease from January 2020 to December 2021 were used for the analysis. A deep convolutional GAN was trained on the polar maps to synthesize realistic MPI. The realism of the generated images in terms of human perception was evaluated by the visual Turing test (VTT) on our original website. The average correct answer rate of the VTT was only 61.1% with a standard deviation of 21.5, but this improved to 80.0±15.8 (%) in the second trial when given the clue information. In the era of machine intelligence and virtual reality, digital literacy is becoming more necessary for healthcare professionals to identify deepfakes.

Background Cardiac amyloidosis (CA) mimics left ventricular hypertrophy (LVH). It is treatable, but its prognosis is poor. A simple screening tool for CA would be valuable. CA is more precisely diagnosed with echocardiographic deformation parameters (e.g., relative apical sparing pattern [RASP]) than with conventional parameters. We aimed to 1) investigate incremental benefits of echocardiographic deformation parameters over established parameters for CA screening; 2) determine the resultant risk score for CA screening; and 3) externally validate the score in LVH patients. Methods We retrospectively studied 295 consecutive non-ischemic LVH patients who underwent detailed diagnostic tests. CA was diagnosed with biopsy or 99m Tc-PYP scintigraphy. The base model comprised age (≥65 years [men], ≥70 years [women]), low voltage on the electrocardiogram, and posterior wall thickness ≥ 14 mm in reference to the literature. The incremental benefit of each binarized echocardiographic parameter over the base model was assessed using receiver operating characteristic curve analysis and comparisons of the area under the curve (AUC). Results Fifty-four (18%) patients had CA. RASP showed the most incremental benefit for CA screening over the base model. After conducting multiple logistic regression analysis for CA screening using four variables (RASP and base model components), a score was determined (range, 0–4 points). The score demonstrated adequate discrimination ability for CA (AUC = 0.86). This result was confirmed in another validation cohort (178 patients, AUC = 0.88). Conclusions We developed a score incorporating RASP for CA screening. This score is potentially useful in the risk stratification and management of LVH patients.

A left ventricular pseudoaneurysm is a rare but life-threatening complication after myocardial infarction. Because untreated pseudoaneurysms have a 30%-45% risk of rupture, surgery is the preferred therapeutic option. However, its diagnosis is sometimes challenging, as a pseudoaneurysm presents with non-specific symptoms that can mimic myocardial infarction or heart failure. We report a male patient with a history of aortic dissection surgery who presented with recurrent chest pain probably due to acute coronary syndrome. Transthoracic echocardiography revealed a cavity at the apex of the left ventricle, indicating a mechanical complication after myocardial infarction. As the coronary angiography was considered difficult because of the patient's anatomical problem, contrast-enhanced computed tomography (CT) was performed. CT angiography revealed multiple nodular cavities continued from within the left ventricle. It seemed that the pseudoaneurysm was formed in stages in the adherent pericardium after myocardial infarction, resulting in a bead-like appearance. Emergent pseudoaneurysmectomy and left ventricular wall repair were performed, and the patient was discharged without any complications. This case illustrates the utility of cardiac CT to establish the diagnosis of left ventricular pseudoaneurysm and coronary artery atherosclerosis.

Tolvaptan (TLV) is an oral selective vasopressin 2 receptor antagonist that acts on the distal nephrons, causing a loss of electrolyte-free water. To date, its early administration in very elderly patients after repeat hospitalizations for acute decompensated heart failure (ADHF) despite receiving optimal medical therapy has not been evaluated. Fifty-six ADHF patients who were >80 years old and had been repeatedly hospitalized were retrospectively enrolled in this study. Twenty-five patients (14 men; mean age 86.7 ± 5.3 years; control group) received standard therapy and 31 patients (15 men; mean age 85.5 ± 4.5 years; TLV group) received oral TLV within 24 h of admission. The rate of worsening renal function was significantly lower in the TLV group than in the control group (13 vs. 40%, P < 0.05). The duration of the return to body weight at a steady state was significantly shorter in the TLV group (5.3 ± 2.8 days) than in the control group (13.9 ± 9.2 days, P < 0.01). Consequently, the hospitalization period in the TLV group (13.5 ± 5.9 days) was significantly shorter than that in the control group (24.7 ± 12.3 days, P < 0.01). In conclusion, the early administration of TLV to very elderly patients who underwent repeat hospitalizations for ADHF resulted in immediate decongestion and thus reduced the hospitalization period with a lower incidence of worsening renal function.

BACKGROUND The aim of this study was to investigate the effect of sex on the correlation between arterial stiffness and left ventricular (LV) diastolic function in a healthy population without significant atherosclerosis. METHODS Subjects (n = 446) who had simultaneous echocardiography and arterial stiffness recordings were enrolled. From these subjects, 95 men and 72 age-matched women without atherosclerotic risk factors (hypertension, dyslipidemia, and diabetes mellitus) were included in the analysis. We measured brachial-ankle pulse wave velocity (baPWV) and carotid augmentation index (AIx) as arterial stiffness parameters. RESULTS Peak early diastolic mitral annular velocity (e′) was significantly correlated with baPWV (men: r = −0.428, P < 0.001; women: r = −0.515, P < 0.001) and carotid AIx (men: r = −0.295, P = 0.004; women: r = −0.558, P < 0.001). The ratio of early diastolic mitral flow velocity to e′ (E/e′) was significantly correlated with both arterial stiffness parameters in women but not men. Multivariable regression analysis revealed carotid AIx (β = −0.257; P = 0.02) was a significant independent predictor of e′ in women but not men. CONCLUSIONS These results suggest that the correlation between AIx and LV diastolic function is stronger in women than men in a healthy population.

Left atrial (LA) enlargement is an early sign of hypertensive heart disease. Insulin resistance and obesity, integral components of metabolic syndrome, are closely associated with the development of hypertension. However, few echocardiograhic studies have assessed the relations of insulin resistance and obesity to LA size in hypertensive patients. We enrolled 106 never-treated hypertensive patients (57 men and 49 women) to assess the possible relations of insulin resistance and obesity to LA size. Insulin resistance was estimated using the homeostasis model assessment (HOMA) formula. Echocardiographically determined LA dimension, left ventricular (LV) mass and relative wall thickness (RWT) were measured as markers of LA size, LV hypertrophy and LV geometry. The E / A ratio estimated by transmitral flow velocity was measured as a marker of LV diastolic function. In addition, body mass index (BMI) was calculated as weight (kg) divided by height (m) 2 as a marker of obesity. Multivariable regression analyses showed that BMI was the strongest independent predictor of LA size ( P <0.0001), followed by the HOMA value ( P =0.0003). However, LV mass, RWT and the E / A ratio did not bear significant relations to LA size. There were no sex-specific differences in the relations of HOMA value or BMI to LA size. In conclusion, LA size is influenced by insulin resistance and obesity, integral components of the metabolic syndrome, independently of LV hypertrophy, LV geometry or LV diastolic function in nondiabetic Japanese hypertensive patients.

Adaptive servo-ventilation (ASV) therapy is a novel modality of noninvasive positive pressure ventilation and is now widely utilized to treat patients with chronic heart failure (CHF). However, there has been no clinical study of the effect of ASV therapy on readmission and cost-effectiveness for the treatment of CHF. The present study was conducted to evaluate the clinical efficacy and cost-effectiveness of home ASV therapy in 45 patients with a history of two or more admissions a year for worsening CHF. Seven patients refused to undergo chronic ASV therapy and three died. Thus, 35 patients were eventually enrolled in the present study. New York Heart Association class (2.8 ± 0.4 versus 2.3 ± 0.5, p < 0.001), log plasma B-type natriuretic peptide level (2.53 ± 0.44 versus 2.29 ± 0.40 pg/mL, p < 0.0001), left atrial dimension (47.5 ± 7.0 versus 44.9 ± 7.6 mm, p = 0.014), and mitral regurgitation area ratio (20.3 ± 12.1 versus 16.9 ± 8.9%, p = 0.007) decreased significantly after 12 months of ASV therapy. The frequency of hospitalization after ASV was significantly lower than before ASV (1.0 ± 1.0 versus 2.3 ± 0.5 times/year/patient, p < 0.0001). ASV also decreased the duration of hospitalization from 64.4 ± 46.5 to 22.8 ± 27.5 days/year/patient (p < 0.0001). Consequently, the total medical costs were reduced by 37% after ASV (1.95 ± 1.37 versus 3.11 ± 1.75 million yen/patient, p = 0.003). ASV therapy reduced readmissions and medical costs in patients with CHF.

A 65-year-old male in the dilated phase of hypertrophic cardiomyopathy and with persistent atrial fibrillation was admitted to our hospital because of an episode of ventricular fibrillation following an appropriate shock from an implantable cardiac defibrillator (ICD). At admission, electrocardiography showed a normal sinus rhythm. He had complained of back pain 7 days after the ICD shock. Renal infarction was suspected, although computed tomography and magnetic resonance imaging could not be performed because of chronic renal failure and the presence of his ICD. We, therefore, used contrast-enhanced ultrasonography with a contrast agent to evaluate his acute kidney injury. This showed the left kidney contained a wedge-shaped area that was not enhanced by the contrast agent, indicating an area of infarction.