Duygu Kocyigit

Aims: Sex differences in prognosis of functional mitral regurgitation (FMR) associated with ischaemic cardiomyopathy (ICM) demonstrate the need to identify sex differences in cardiac remodelling. This study aimed to characterize sex differences in cardiac remodelling associated with FMR in the setting of ICM, sex interactions with cardiac remodelling and FMR severity, and predictors of all-cause mortality or heart transplantation using cardiac magnetic resonance (CMR) imaging. Methods and results: Consecutive patients with ICM referred to CMR between 2002 and 2017 were reviewed. Eligible 790 patients [mean age: 62.0 (standard deviation = 11.2] years and 24.7% females] were evaluated over a median follow-up of 5.8 years. There were 773 subjects with complete data for survival analysis, with 449 primary events. Coronary artery disease risk factors, medications, and previous coronary revascularization were similar in females and males (all P > 0.05). Indexed left ventricular and right ventricular (LV and RV) volumes were larger in males (P < or =0.005 for all comparisons) with similar slope of increasing LV and RV volumes in the setting of increasing FMR (all P > 0.05, for interactions). However, indexed left atrial volume was similar in males and females (P = 0.696), after adjusting for FMR severity. After adjusting for medical risk factors and post-CMR procedural interventions, females demonstrated increased risk of primary clinical composite point with enlarging LV volumes [hazard ratio: 1.04 (95% confidence interval: 1.01–1.06), P = 0.034]. Conclusion: Because females with increasing LV size and FMR severity demonstrated significantly increased risk of adverse outcomes, our findings suggest the importance of deriving sex-specific CMR selection criteria for therapeutic management of FMR in the setting of ICM.

Pathophysiology and prognostic implications of right ventricle (RV) dysfunction in heart failure are complex and incompletely elucidated. Cardiac magnetic resonance imaging (CMR) is the reference standard for RV quantification, but its clinical implications in non-ischaemic cardiomyopathy (NICM), in the context of myocardial fibrosis and functional mitral regurgitation are not well defined. We evaluated predictors, prognostic impact, and thresholds for defining significant RV dysfunction in NICM. NICM patients (n = 624) undergoing CMR assessment during 2002–2017 were retrospectively studied. CMR’s quantification of right ventricular ejection fraction (RVEF) was evaluated against the primary outcome of all-cause mortality, heart transplant, and/or left ventricular assist device implantation in threshold and multivariable analyses. Mean RVEF was 43 ± 13%, and factors associated with reduced RVEF were male sex, New York Heart Association (NYHA) class III-IV, right bundle branch block, lower left ventricular ejection fraction, higher mitral regurgitant fraction (MR-RF) and right ventricle size in NICM. RVEF per 5% increase was independently associated with the primary endpoint hazards ratio (95% confidence interval) 0.80 (0.73–0.88), P < 0.001. RVEF ≤40% was the optimal threshold associated with worse prognosis, regardless of late gadolinium enhancement (LGE) or MR-RF quantification. On the other hand, higher LGE was associated with primary endpoint in patients with RVEF ≤40% only, while risk associated with MR-RF was significant dampened after adjusting for RVEF. RVEF provides powerful risk stratification, with RVEF ≤40% defining significant RV dysfunction associated with adverse outcomes in NICM. The integration of quantitative CMR measurements for RVEF, LGE, and MR-RF provides comprehensive NICM risk prognostication. Impact of right ventricular ejection fraction (RVEF) on the primary endpoint in non-ischaemic cardiomyopathy patients, including by late gadolinium enhancement (LGE) or mitral regurgitant fraction (MR-RF) categories. Top figure—A) Cubic spine curve of the relative hazards of the primary endpoint by RVEF, adjusted for pre-specified covariates, with optimal threshold of P-values are pairwise comparisons using log-rank test adjusted for multiplicity using Bonferroni-Holm method

Despite all the advancements in science, medical knowledge, healthcare, and the healthcare industry, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The main reasons are the inadequacy of preventive health services and delays in diagnosis due to the increasing population, the failure of physicians to apply guide-based treatments, the lack of continuous patient follow-up, and the low compliance of patients with doctors’ recommendations. Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are systems that support complex decision-making processes by using AI techniques such as data analysis, foresight, and optimization. Artificial intelligence-based CDSSs play an important role in patient care by providing more accurate and personalized information to healthcare professionals in risk assessment, diagnosis, treatment optimization, and monitoring and early warning of CVD. These are just some examples, and the use of AI for CVD decision support systems is rapidly evolving. However, for these systems to be fully reliable and effective, they need to be trained with accurate data and carefully evaluated by medical professionals.

Objective: In this study, we aimed to identify the reasons for and perceived challenges associated with the use of digital health technologies (DHT) in cardiology. Method: We distributed an online survey to Turkish Society of Cardiology member cardiologists (n = 2789) between January 10 and March 3, 2022. Results: A total of 308 subjects responded (27.6% females, 62.0% aged 30-44 years). Of these, 42.5% worked at university hospitals, and 44.8% at state hospitals. Smart devices were used by 44.2% (136/308) for personal health monitoring. Additionally, 40.3% (117/290) used social media to provide medical information to patients, while 64.6% (193/299) did so for communication with other physicians. The self-reported recommendation frequencies of and teleconsultation/televisit technologies were lower than the proportion of respondents who found DHT beneficial for both patients and physicians. The most frequently mentioned barriers for physicians were increased work burden and responsibilities (78.8%, 193/245), lack of financial compensation (66.9%, 164/245), and lack of relevant training (66.5%, 163/245). 197/245), and low affordability (79.6%, 195/245) were the most frequently mentioned barriers. Additionally, the cost of technologies (69.4%, 170/245), concerns regarding data privacy and security (57.6%, 141/245), and data storage challenges (48.2%, 118/245) were the most significant technical impediments. Conclusion: The findings suggest that although the majority of physicians believe DHT to be beneficial for both themselves and their patients, the frequency of recommendations to patients remains low. A large-scale joint effort is required to address these issues and facilitate the integration of DHT into clinical practice.

BACKGROUND: The severity classification of functional mitral regurgitation (FMR) remains controversial despite adverse prognosis and rapidly evolving interventions. Furthermore, it is unclear if quantitative assessment with cardiac magnetic resonance can provide incremental risk stratification for patients with ischemic cardiomyopathy (ICM) or non-ICM (NICM) in terms of FMR and late gadolinium enhancement (LGE). We evaluated the impact of quantitative cardiac magnetic resonance parameters on event-free survival separately for ICM and NICM, to assess prognostic FMR thresholds and interactions with LGE quantification. METHODS: Patients (n=1414) undergoing cardiac magnetic resonance for cardiomyopathy (ejection fractionP =0.034) in ICM and 1.09 (1.02–1.16; P =0.011) in NICM. Optimal mitral regurgitation-fraction threshold for moderate and severe FMR were ≥20% and ≥35%, respectively, in both ICM and NICM, based on the prediction of the primary outcome. Similarly, optimal LGE thresholds were ≥5% in ICM and ≥2% in NICM. Mitral regurgitation-fraction×LGE emerged as a significant interaction for the primary end point in ICM ( P =0.006), but not in NICM ( P =0.971). CONCLUSIONS: Mitral regurgitation-fraction and LGE are key quantitative cardiac magnetic resonance biomarkers with differential associations with adverse outcomes in ICM and NICM. Optimal prognostic thresholds may provide important clinical risk prognostication and may further facilitate the ability to derive selection criteria to guide therapeutic decision-making.

Academia, coronavirus disease 2019, COVID-19, gender, gender gap, women in cardiology

Cardiac autonomic functions,heart rate recovery,lung cancer,lymphoma,Radiotherapy