Caspersenjohnsen9756
this study, we assessed whether the training activities of Italian urology residents were impacted negatively by a whole year of COVID-19 pandemic (March 2020-March 2021). We also compared our results with those reported in a previous survey evaluating how the coronavirus disease 2019 (COVID-19) pandemic changed the training pattern of urology residents during the peak of the outbreak in March 2020. We found a critical decrease in residents' activities (especially for those in their final years of residency and for surgical procedures) that, even if lower than expected, might negatively impact their education and training in the future.
There are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy.
The goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs.
In this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 31 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators.
Among 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 yend safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.
Adriamycin-associated cardiomyopathy (ACM) can lead to end-stage heart failure requiring advanced heart failure therapies.
This study sought to provide post-cardiac transplant survival data in patients with ACM in the contemporary era of mechanical circulatory support and cardiac transplantation.
Adults (≥18 years of age) who underwent first-time, single-organ heart transplantation were identified from the United Network for Organ Sharing between October 18, 2008, and October 18, 2018. Cardiomyopathy subtypes that could have been supported with a left ventricular assist device (LVAD) including ACM, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM) were included. A multivariable Cox regression analysis was performed to determine the association between cardiomyopathy subtype and post-cardiac transplant survival.
This analysis included 18,270 patients (357 with ACM; 10,662 with DCM; and 7,251 with ICM). Heart transplant recipients with ACM were younger, included more women, and had higher pulmonary vascular resistance at the time of listing. Patients with ACM had a lower percentage of durable LVADs at the time of transplant across all years of the study period. Patients with ACM did not experience an increase in post-cardiac transplant mortality compared to those with DCM (adjusted hazard ratio 0.96; 95% confidence interval 0.79 to 1.40; p=0.764) or ICM (adjusted hazard ratio 0.85; 95% confidence interval 0.6 to 1.2; p=0.304).
Patients with ACM who received heart transplants between 2008 and 2018 had similar post-cardiac transplant survival to those with dilated and ischemic cardiomyopathy. Bridge-to-transplant LVAD use remains lower compared to other cardiomyopathy subtypes.
Patients with ACM who received heart transplants between 2008 and 2018 had similar post-cardiac transplant survival to those with dilated and ischemic cardiomyopathy. Bridge-to-transplant LVAD use remains lower compared to other cardiomyopathy subtypes.
Radiation therapy (RT) results in myocardial changes consisting of diffuse fibrosis, which may result in changes in diastolic function.
The aim of this study was to explore RT-associated changes in left ventricular (LV) diastolic function.
Sixty chemotherapy-naive patients with left-sided, early-stage breast cancer were studied with speckle tracking echocardiography at 3 time points prior to, immediately after, and 3 years after RT. Global and regional early diastolic strain rate (SRe) were quantified, as were parameters of systolic function.
Regional changes in SRe, particularly the apical and anteroseptal segments, were observed over time and were more evident than global changes. The apical SRe declined from a median of 1.24 (interquartile range 1.01 to 1.39) s
at baseline to 1.02 (interquartile range 0.79 to 1.15) s
at 3 years of follow-up (p< 0.001). This decline was associated with the left ventricular maximal radiation dose (β=0.36, p=0.007). The global SRe was<1.00 s
(SRe
) in 11 ly associated with RT dose and cardiovascular comorbidities.
Adult survivors of Hodgkin lymphoma (HL) are at increased risk of cardiovascular (CV) events secondary to mediastinal radiation therapy (RT).
In this group of patients, we assessed the association between cardiopulmonary exercise testing (CPET), as determined by percent-predicted peak Vo
(ppVo
peak), and clinical outcomes, as well as the rate of ppVo
peak decline and sex differences.
All survivors of HL who were >10 years post chest RT and who underwent≥1 CPET were enrolled from a single center. Traditional CV and treatment risk factors, along with CV events, were ascertained.
A total of 64 patients (67% female; median age 51 years [range 26 to 70 years]) with a median follow-up time after RT of 23 years (range 11 to 41 years), and 141 CPET studies, were included. Median initial ppVo
peak was 91% (range 58% to 138%). ppVo
peak in survivors declined by 7.5 percentage points every 10-year period after RT, as compared with age- and sex-based norms (
=0.001), even after adjusting for hypertensioImportantly, women developed abnormal ppVo2peak more than 2 decades earlier than male survivors. Abnormal ppVo2peak was associated with an increased risk of CV events in this group of patients.
Post-transplant cyclophosphamide (PT-Cy) has become a standard of care in haploidentical hematopoietic stem cell transplantation (HSCT) to reduce the risk of graft-versus-host disease. However, data on cardiac events associated with PT-Cy are scarce.
This study sought to assess the incidence and clinical features of cardiac events associated with PT-Cy.
The study compared clinical outcomes between patients who received PT-Cy (n=136) and patients who did not (n=195), with a focus on early cardiac events (ECE) occurring within the first 100days after HSCT. All patients had the same systematic cardiac monitoring.
The cumulative incidence of ECE was 19% in the PT-Cy group and 6% in the no-PT-Cy group (p< 0.001). The main ECE occurring after PT-Cy were left ventricular systolic dysfunction (13%), acute pulmonary edema (7%), pericarditis (4%), arrhythmia (3%), and acute coronary syndrome (2%). PD123319 Cardiovascular risk factors were not associated with ECE. In multivariable analysis, the use of PT-Cy was associated with ECE (hazard ratio 2.7; 95% confidence interval 1.4 to 4.9; p=0.002]. Older age, sequential conditioning regimen, and Cy exposure before HSCT were also associated with a higher incidence of ECE. Finally, a history of cardiac events before HSCT and ECE had a detrimental impact on overall survival.
PT-Cy is associated with a higher incidence of ECE occurring within the first 100days after HSCT. Patients who have a cardiac event after HSCT have lower overall survival. These results may help to improve the selection of patients who are eligible to undergo HSCT with PT-Cy, especially older adult patients and patients with previous exposure to Cy.
PT-Cy is associated with a higher incidence of ECE occurring within the first 100 days after HSCT. Patients who have a cardiac event after HSCT have lower overall survival. These results may help to improve the selection of patients who are eligible to undergo HSCT with PT-Cy, especially older adult patients and patients with previous exposure to Cy.
Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences.
This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer.
From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age<65 years) and elderly (age≥65 years). We defined FT if any of the following were present any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost.
The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p< 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR] 1.22; 95% confidence interval [CI] 1.09 to 1.36), inability to pay bills (OR 1.25; 95% CI 1.04 to 1.50), cost-related medication nonadherence (OR 1.28; 95% CI 1.08 to 1.51), food insecurity (OR 1.39; 95% CI 1.17 to 1.64), and foregone/delayed care due to cost (OR 1.17; 95% CI 1.01 to 1.36). The presence of≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p< 0.001). These results remained similar in the elderly population.
Our study highlights that FT is greater among patients with ASCVD compared with those with cancer,with the highest burden among those with both conditions.
Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
Patients with cancer have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the association between cancer type and risk of AF.
This study sought to evaluate the risk of AF according to the type of cancer.
We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2016. Age- and sex-matched noncancer control subjects (12; n=1,633,663) were also selected. Newly diagnosed AF was identified based on the type of cancer.
During a median follow-up of 4.5 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1,000 person-years). In multivariable Fine and Gray's regression analysis, cancer was an independent risk factor for incident AF (adjusted subdistribution hazard ratio [aHR] 1.63; 95% confidence interval [CI] 1.61 to 1.66). Multiple myeloma showed a higher association with incident AF (aHR 3.34; 95% CI 2.98 to 3.75). Esophageal cancer showed the highest risk among solid cancers (aHR 2.69; 95% CI 2.45 to 2.95), and stomach cancer showed the lowest association with AF risk (aHR 1.27; 95% CI 1.23 to 1.32).
Although patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type.
Although patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type.
