The Philadelphia Skating Club and Humane Society is the oldest figure skating club in the United States.
Background Recent data has linked Clostridioides difficile infection (CDI) with adverse clinical outcomes in heart failure patients, including higher mortality and complications. However, its impact on patients with ST-segment elevation myocardial infarction and cardiogenic shock (STEMI-CS) is not well understood. Therefore, we aim to explore this relationship. Methods We utilized the 2020 United States National Inpatient Sample (NIS) database to analyze patients over 18 years old hospitalized with STEMI-CS. We classified patients into cohorts with and without CDI to explore various in-hospital outcomes, including in-patient mortality and system-based complications, using multivariable logistic and linear regression. Results Of 23,540 patients with STEMI-CS, we identified 0.63% (150/23,540) of concurrent CDI. The mean age was 66 years for both cohorts, with and without CDI. Females comprised 43.3% of the CDI cohort compared to 33.4% of the non-CDI cohort. Inpatient mortality rates were similar between the groups, at up to 33% (p=0.960). Utilizing a multivariable regression model adjusted for patient and hospital-level factors, patients with CDI had significantly higher odds of acute respiratory failure (aOR=3.05, 95% CI: 1.16-8.04, p=0.024), a longer hospital stay (βLOS 14.70, 95% CI: 7.96-21.46, p<0.001), higher hospital charges (βTHC $232,712, 95% CI: 67,267-398,157, p=0.006), higher risk of acute kidney injury (aOR=2.96, 95% CI: 1.08-8.07, p=0.034), and higher utilization of intra-aortic balloon pumps (aOR=2.85, 95% CI: 1.39-5.84, p=0.004). Conclusion CDI is associated with a higher risk of acute respiratory failure, extended hospital stays, and increased use of intra-aortic balloon pumps in patients with STEMI-CS. Longitudinal cohort studies are necessary to confirm causality and explore the underlying mechanisms.
Introduction Obesity is associated with poorer outcomes in patients with obstructive hypertrophic cardiomyopathy (HCM). Glucagon-like peptide-1 receptor agonists (GLP1RA) are approved for treatment of overweight/obesity. Mavacamten is a first-in-class cardiac myosin inhibitor approved for treatment of symptomatic obstructive HCM. Patients on mavacamten are being concomitantly treated with GLP1RA in the real world; however, data on their combined use and efficacy in patients with HCM are limited. Methods Single center retrospective study of individuals initiated on mavacamten between April 1, 2022, and January 19, 2025. Clinical characteristics including body mass index (BMI) were collected through maximum follow-up of 108 weeks of mavacamten treatment. Baseline characteristics were summarized as frequencies and percentages for categorical variables, continuous variables as mean (standard deviation [SD]) for normally distributed data. Outcome was percent change in BMI relative to baseline BMI prior to mavacamten initiation. A mixed-effects linear regression was used to evaluate the association between GLP1RA use and this outcome in individuals with BMI ≥ 25 kg/m2, accounting for within-subject correlation with treating random intercepts and slopes for time. Results Of 163 patients identified, 14 patients (8.6%) were on GLP1RA prior to mavacamten initiation. Mean BMI (± SD) was 30.9 kg/m2 (6.0). Fifty-two patients (31.9%) were overweight (BMI 25.0-29.9 kg/m2), and 85 (52.1%) were obese (BMI > 30 kg/m2). Cardiometabolic comorbidities were common: 60.7% hypertension, 23.3% history of atrial fibrillation, 16.0% obstructive CAD. Patients demonstrated improvement in peak resting (53.0 mmHg ± 36.7 to 10.0 mmHg ± 11.0; p<0.001) and Valsalva (79.7 mmHg ± 33.2 to 16.6 mmHg ± 15.4; p<0.001) left ventricular outflow tract (LVOT) gradients with mavacamten, which were sustained through Week 108. Compared with baseline NYHA status, 91% had >1 NYHA class improvement by Week 108. Across the follow up period, 39 (23.9%) patients were exposed to GLP1RA. In mixed-effects linear regression adjusting for age, sex, and race, there was a significant interaction between GLP1RA use and time (p<0.001; Figure). Patients exposed to GLP1RA lost over 3% of BMI relative to baseline through maximum follow-up, whereas patients who were not exposed to GLP1RA did not experience weight loss. Conclusions Despite achieving rapid and sustained improvement in LVOT gradients and NYHA class with mavacamten, patients with symptomatic obstructive HCM who were not exposed to GLP1RA did not experience weight loss, highlighting the challenges in improving cardiometabolic health in these patients.
Background Emerging evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) adversely affects heart failure (HF) patients, elevating the risk of all-cause mortality and HF-related hospitalizations. However, the long-term impact of MASLD on patients who have implanted with cardiac resynchronization therapy (CRT) remains poorly understood. Methods We analyzed data from the Global Collaborative Network in TriNetX from January 2010 to April 2024, with follow-up extending up to five years. Our study focused on patients with heart failure with reduced ejection fraction (HFrEF) who underwent CRT implantation, dividing them into cohorts with and without MASLD. The MASLD cohort was propensity score-matched to the non-MASLD cohort based on age, sex, race, and comorbidities. After CRT implantation, we tracked outcomes, including all-cause mortality, HF rehospitalization, ischemic stroke/systemic embolism, the incidence of ischemic heart disease (IHD), and atrial fibrillation (AF). Results After propensity score matching, we identified 2,879 patients in each cohort, with a mean age of 66.5 years and 30.5% female in both groups. The prevalence of hypertension was 75%, diabetes mellitus 41%, and overweight or obesity 26.5% across both cohorts. In the MASLD cohort, there was no significant difference in 5-year all-cause mortality after CRT implantation compared to the non-MASLD group, with an HR of 0.97 (95% CI: 0.88 to 1.07, p=0.533). However, the MASLD group had a significantly higher risk of HF rehospitalization (HR 1.14, 95% CI: 1.07 to 1.20, p<0.001), ischemic stroke/systemic embolism (HR 1.17, 95% CI: 1.03 to 1.34, p=0.019), IHD (HR 1.12, 95% CI: 1.05 to 1.19, p<0.001), and AF (HR 1.12, 95% CI: 1.05 to 1.19, p=0.001). Conclusion Our study found that patients with comorbid MASLD undergoing CRT implantation faced increased risks of adverse cardiovascular outcomes, including higher rates of HF rehospitalization, ischemic stroke/systemic embolism, IHD, and AF over a 5-year follow-up period. Further research is needed to explore the underlying mechanisms, and targeted interventions are essential to improve their prognosis.
