Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic Cardiomyopathy

BACKGROUND

The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM.

METHODS

Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m², n = 538), stage II (eGFR 60-89 mL/min/1.73 m², n = 953), and stage III-V (eGFR < 60 mL/min/1.73 m², n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates.

RESULTS

Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III-V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39-5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21' 95% CI, 1.23-3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23-5.58; P = 0.012) was significantly increased.

CONCLUSION

This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60-89 mL/min/1.73 m²) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.

Increased risk of incident atrial fibrillation in young adults with mental disorders: A nationwide population-based study

BACKGROUND

Mental disorders and cardiovascular diseases are closely related. However, a paucity of information on the risk of incident atrial fibrillation (AF) in patients with mental disorders exists.

OBJECTIVE

We aimed to assess the association between mental disorders and the risk of AF, particularly in young adults.

METHODS

Using the Korean National Health Insurance Database between 2009 and 2012, we identified adults aged 20-39 years without a history of AF and who have been diagnosed with mental disorders. Mental disorders were defined as having one of the following diagnoses: depression, insomnia, anxiety disorder, bipolar disorder, or schizophrenia. The primary outcome was new-onset AF during follow-up.

RESULTS

A total of 6,576,582 subjects (mean age 30.9 ± 5.0 years; 3,919,339 [59.6%] men) were included. Among the total population, 10% had mental disorders. During the follow-up period, 8932 incident AF events occurred. Patients with mental disorders showed a higher AF incidence than did those without (25.4 per 100,000 person-years vs 17.7 per 100,000 person-years). After multivariable adjustment, mental disorders were associated with a significantly higher risk of AF (adjusted hazard ratio 1.526; 95% confidence interval 1.436-1.621). Patients with bipolar disorder or schizophrenia had a 2-fold higher risk of AF and those with depression, insomnia, and anxiety disorder had a 1.5- to 1.7-fold higher risk of AF than did those without mental disorders.

CONCLUSION

Young adults diagnosed with mental disorders have a higher risk of incident AF. Awareness for AF in high-risk populations should thus be considered.

Impact of mental disorders on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study

BACKGROUND

It is unclear whether mental disorders are an independent risk factor for atrial fibrillation (AF) in patients with diabetes. We aimed to investigate whether patients with diabetes who have mental disorders have an increased risk for AF.

METHODS

Using the Korea National Health Insurance Service database, we enrolled 2,512,690 patients diagnosed with diabetes without AF between 2009 and 2012. We assessed five mental disorders: depression, insomnia, anxiety, bipolar disorder, and schizophrenia. Newly diagnosed AF was identified during the follow-up period, and multivariate Cox regression analysis was performed.

RESULTS

Among the 2,512,690 patients (mean age 57.2 ± 12.3 years; 60.1% men), 828,929 (33.0%) had mental disorders. Among the five mental disorders, anxiety (68.1%) was the most common, followed by insomnia (40.0%). During a median follow-up duration of 7.1 years, new-onset AF was diagnosed in 79,525 patients (4.66 per 1,000 person-years). Patients with diabetes who had mental disorders showed a higher risk for AF (adjusted hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.17-1.21; p-value < 0.001). Depression, insomnia, and anxiety were significantly associated with higher risk for AF (adjusted HR [95% CI]: 1.15 [1.12-1.17], 1.15 [1.13-1.18], and 1.19 [1.67-1.21], respectively; all p-values < 0.001), whereas bipolar disorder and schizophrenia were not.

CONCLUSIONS

Mental disorders, especially depression, insomnia, and anxiety, were associated with an increased risk for AF in patients with diabetes. Greater awareness with a prompt diagnosis of AF should be considered for patients with both DM and mental disorders.

Successful treatment of angioinvasive aspergillosis causing diaphragmatic rupture with bowel perforation and cerebral aspergillosis in a patient with FLT3-mutated acute myeloid leukemia: A case report

RATIONALE

Throughout the clinical course of acute myeloid leukemia (AML), aspergillosis infection remains a significant determinant of treatment outcomes and survival. To emphasize the importance of early diagnosis and appropriate application of integrated therapeutic approaches, we present a case of AML patient who survived through angioinvasive aspergillosis infection causing diaphragmatic rupture with bowel perforation and cerebral aspergillosis during active AML treatment.

PATIENT CONCERNS

A 39-year old male with FLT3-mutated AML was transferred to our hospital due to persistent fever after induction therapy.

DIAGNOSIS AND INTERVENTIONS

During voriconazole treatment for his invasive pulmonary aspergillosis, the patient was diagnosed with colon perforation at splenic flexure and suspected perforation of left diaphragm with communication with left pleural space. Although pancytopenic, emergency laparotomy was performed with granulocyte transfusion. Also, dual antifungal therapy with voriconazole and micafungin was applied. With supportive care, he was able to successfully complete 3 cycles of consolidation using tyrosine kinase inhibitor. However, 80 days after the last chemotherapy, the patient experienced seizure caused by a single 1.5 cm sized enhancing mass in the right occipital lobe. Diagnostic and therapeutic mass removal was carried out, and pathology-confirmed cerebral aspergillosis was diagnosed.

OUTCOMES

The patient's neurologic symptoms are resolved and he is leukemia free, but remains on voriconazole for his cerebral aspergillosis till this day.

CONCLUSIONS

Our case highlights the importance of timely integrated intervention and adequate underlying disease control in treatment of invasive aspergillosis in immunocompromised patients. Such rigorous efforts can save even the most seemingly dismal case.

The association between serum ferritin and 25-hydroxyvitamin D and metabolic syndrome in Korean women: the Korea National Health and Nutrition Examination Survey 2010-2012

The present study was conducted to assess the association between serum ferritin and 25-hydroxyvitamin D [25(OH)D] and metabolic syndrome (MetS) in Korean women. The data of a total of 9,256 adults (6,960 women without MetS and 2,296 women with MetS) aged ≥20 years from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010–2012) were analyzed. A covariance test adjusted for covariates was performed for serum ferritin levels in relation to vitamin D (vitamin D deficiency, 25(OH)D <10.0 ng/ml; vitamin D insufficiency, 25(OH)D ≥10.0, <20.0 ng/ml; vitamin D sufficiency, 25(OH)D ≥20.0 ng/ml). The key study results were as follows: First, in women without MetS, after adjusting for related variables (smoking, alcohol drinking, regular exercise, current menstruation, hormonal contraceptives, hormone-replacement therapy, SBP, DBP, BMI, WM, TC, TGs, HDL-C, FPG, AST, ALT, and age), vitamin D was positively associated with serum ferritin levels (p<0.001). Second, in women with MetS, after adjusting for related variables (except age), vitamin D was positively associated with serum ferritin levels (p = 0.041). However, when further adjusted for age, vitamin D was not associated with serum ferritin levels (p = 0.293). In conclusion, vitamin D was positively associated with serum ferritin levels in women without MetS but not in women with MetS.

The association between serum ferritin and 25-hydroxyvitamin D and metabolic syndrome in Korean women: the Korea National Health and Nutrition Examination Survey 2010-2012

The present study was conducted to assess the association between serum ferritin and 25-hydroxyvitamin D [25(OH)D] and metabolic syndrome (MetS) in Korean women. The data of a total of 9,256 adults (6,960 women without MetS and 2,296 women with MetS) aged ≥20 years from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010-2012) were analyzed. A covariance test adjusted for covariates was performed for serum ferritin levels in relation to vitamin D (vitamin D deficiency, 25(OH)D <10.0 ng/ml; vitamin D insufficiency, 25(OH)D ≥10.0, <20.0 ng/ml; vitamin D sufficiency, 25(OH)D ≥20.0 ng/ml). The key study results were as follows: First, in women without MetS, after adjusting for related variables (smoking, alcohol drinking, regular exercise, current menstruation, hormonal contraceptives, hormone-replacement therapy, SBP, DBP, BMI, WM, TC, TGs, HDL-C, FPG, AST, ALT, and age), vitamin D was positively associated with serum ferritin levels (p<0.001). Second, in women with MetS, after adjusting for related variables (except age), vitamin D was positively associated with serum ferritin levels (p = 0.041). However, when further adjusted for age, vitamin D was not associated with serum ferritin levels (p = 0.293). In conclusion, vitamin D was positively associated with serum ferritin levels in women without MetS but not in women with MetS.

Effectiveness of Transdermal Fentanyl Patch for Treatment of Acute Pain Due to Oral Mucositis in Patients Receiving Stem Cell Transplantation

The current study was performed to evaluate the effectiveness and safety of transdermal therapeutic system (TTS) fentanyl in the management of acute pain due to oral mucositis in patients receiving stem cell transplantation. A cohort of consecutive patients with painful oral mucositis were enrolled. Initially, 25 microg/h of TTS fentanyl was administered for the treatment of oral mucositis pain. The pain score, based on a visual analogue scale, and mood and quality of sleep as determined by EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Cancer 30), were all recorded before the treatment, then 2, 6, and 10 days later. Twenty-two patients with hematologic malignancies were enrolled. Three patients were excluded from the response assessment, as their TTS fentanyl treatment was stopped owing to related complaints, including severe dizziness, severe vomiting, and an extensive body rash. The total duration of the treatment was 8 days (range, 6-15 days) and the total amount of TTS fentanyl administered per patient was 2.21 at 25 microg/h and 0.63 at 50 microg/h. Six (31.6%) of the remaining 19 patients required an escalated dose of TTS fentanyl at 50 mug/h. The mean pain scores before treatment and 2, 6, and 10 days later were 6.68, 5.17, 3.42, and 2.13, respectively (P < .001). Eight (42.1%) and seven (36.8%) patients experienced improved sleep and mood after treatment, respectively. The TTS fentanyl was effective in both relieving oral mucositis pain with an excellent tolerability and improving the quality of life for hematological patients receiving high-dose chemotherapy with stem cell transplantation.

Hickman catheter site infections after allogeneic stem cell transplantation: Single-center experience

Hickman catheter site infections are known to increase transplant-related mortality (TRM). A retrospective analysis of 103 patients who received allogeneic SCT (stem cell transplants) was performed to define the incidence and outcomes of Hickman infections. Seventy-six patients received peripheral blood stem cells (PBSCs) (73.8%) and 29 patients (28.2%), nonmyeloablative conditioning. During the median follow-up of 9 months, Hickman infections were observed in 10 patients (9.7%) at a median onset of 32 days posttransplantation (range, 2-102 days). The causative organisms were identified in 5 cases, including Staphylococcus species (n=4) and Pseudomonas aeruginosa (n=1). Six events were successfully resolved with antibiotic treatment, whereas the other 4 events required the removal of the Hickman catheters with subsequent death in 2 cases. The survival duration for the Hickman infection group was shorter than that for the Hickman no infection group (83 days vs 366 days, respectively; P <.001). Myeloid engraftment was delayed in the Hickman infection group (18.0 days vs 15.0 days, respectively; P=.038), plus Hickman infections were more frequent among BMT compared with PBSCT group (22.2% vs 5.3%, respectively, P=.019). Hickman infections were associated with TRM, especially during the first 3 months posttransplantation. As such, the current results emphasize both the importance of Hickman catheter care and the need for surveillance cultures after SCT.

Hickman catheter site infections after allogeneic stem cell transplantation: a single-center experience

Hickman catheter site infections are known to increase transplant-related mortality. A retrospective analysis of 103 patients who received allogeneic stems cell transplants was performed to define the incidence and outcomes of Hickman infections. Seventy-six patients received peripheral blood stem cells (PBSC) (73.8%) and 29 patients (28.2%) nonmyeloablative conditioning. During the median follow-up of 9 months, Hickman infections were observed in 10 patients (9.7%) at a median onset of 32 days posttransplant (range 2 to 102 days). The causative organisms identified in five cases included Staphylococcus species (n = 4) and Pseudomonas aeruginosa (n = 1). Six events successfully resolved with antibiotic treatment, while the other four required the removal of the Hickman catheter with subsequent death in two cases. The survival duration for infected patients was shorter than that for the noninfected group (83 days vs 366 days, P < .001). Myeloid engraftment was delayed in the infected group (18.0 days vs 15.0 days, P = .038) and this complication was more frequently observed among the BMT compared with PBSC group (22.2% vs 5.3%, P = .019). Hickman infections were associated with transplant-related mortality especially during the first 3 months posttransplant. As such, the current results emphasize both the importance of Hickman catheter care and the need for surveillance cultures after stem cell transplantation.