Risk Stratification
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2021 ◽  
pp. 20-25
N. V. Teplova ◽  
G. A. Chervyakova ◽  
A. G. Vardanyan ◽  
S. E. Arakelov ◽  
A. G. Dzheksembekov ◽  

Hypertensive disorders in pregnant women are a significant factor in the development of complications leading to maternal and perinatal mortality. However, most cases of adverse outcomes are preventable. The choice of drug therapy in this group of patients should be made on the basis of a complete analysis and risk stratification.Purpose of work. Consideration of modern classification, diagnostic methods and rational antihypertensive therapy of chronic arterial hypertension on the example of a clinical case of a pregnant patient in a therapeutic hospital.Case description. The presented work describes a case of severe arterial hypertension during the first trimester of pregnancy, poorly amenable to drug correction.Conclusion. The features of this clinical observation are the problems associated with the selection of antihypertensive therapy for severe arterial hypertension during low gestational age pregnancy, taking into account comorbidities

2021 ◽  
Vol 22 (5) ◽  
pp. 364-368
Omer Ozbudak ◽  
Hulya Dirol ◽  
Ilker Onguc ◽  
Hulya Kahraman ◽  

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318258
E Madelief J Marsman ◽  
Pieter G Postema ◽  
Carol Ann Remme

Brugada syndrome (BrS) is an inherited cardiac disorder, characterised by a typical ECG pattern and an increased risk of arrhythmias and sudden cardiac death (SCD). BrS is a challenging entity, in regard to diagnosis as well as arrhythmia risk prediction and management. Nowadays, asymptomatic patients represent the majority of newly diagnosed patients with BrS, and its incidence is expected to rise due to (genetic) family screening. Progress in our understanding of the genetic and molecular pathophysiology is limited by the absence of a true gold standard, with consensus on its clinical definition changing over time. Nevertheless, novel insights continue to arise from detailed and in-depth studies, including the complex genetic and molecular basis. This includes the increasingly recognised relevance of an underlying structural substrate. Risk stratification in patients with BrS remains challenging, particularly in those who are asymptomatic, but recent studies have demonstrated the potential usefulness of risk scores to identify patients at high risk of arrhythmia and SCD. Development and validation of a model that incorporates clinical and genetic factors, comorbidities, age and gender, and environmental aspects may facilitate improved prediction of disease expressivity and arrhythmia/SCD risk, and potentially guide patient management and therapy. This review provides an update of the diagnosis, pathophysiology and management of BrS, and discusses its future perspectives.

2021 ◽  
pp. 2004503
Janine Schniering ◽  
Malgorzata Maciukiewicz ◽  
Hubert S. Gabrys ◽  
Matthias Brunner ◽  
Christian Blüthgen ◽  

BackgroundRadiomic features calculated from routine medical images show great potential for personalized medicine in cancer. Patients with systemic sclerosis (SSc), a rare, multi-organ autoimmune disorder, have a similarly poor prognosis due to interstitial lung disease (ILD).ObjectivesTo explore computed tomography (CT)-based high-dimensional image analysis (radiomics) for disease characterisation, risk stratification, and relaying information on lung pathophysiology in SSc-ILD.MethodsWe investigated two independent, prospectively followed SSc-ILD cohorts (Zurich, derivation cohort, n=90; Oslo, validation cohort, n=66). For every subject, we defined 1′355 robust radiomic features from standard-of-care CT images. We performed unsupervised clustering to identify and characterize imaging-based patient clusters. A clinically applicable prognostic quantitative radiomic risk score (qRISSc) for progression-free survival was derived from radiomic profiles using supervised analysis. The biological basis of qRISSc was assessed in a cross-species approach by correlation with lung proteomics, histological and gene expression data derived from mice with bleomycin-induced lung fibrosis.ResultsRadiomic profiling identified two clinically and prognostically distinct SSc-ILD patient clusters. To evaluate the clinical applicability, we derived and externally validated a binary, quantitative radiomic risk score composed of 26 features, qRISSc, that accurately predicted progression-free survival and significantly improved upon clinical risk stratification parameters in multivariable Cox regression analyses in the pooled cohorts. A high qRISSc score, which identifies patients at risk for progression, was reverse translatable from human to experimental ILD and correlated with fibrotic pathway activation.ConclusionsRadiomics-based risk stratification using routine CT images provides complementary phenotypic, clinical and prognostic information significantly impacting clinical decision-making in SSc-ILD.

2021 ◽  
Matti Lauren Gild ◽  
Mico Chan ◽  
Jay Gajera ◽  
Brett Lurie ◽  
Ziba Gandomkar ◽  

2021 ◽  
Vol 11 (1) ◽  
Kimon Stamatelopoulos ◽  
Georgios Georgiopoulos ◽  
Kenneth F. Baker ◽  
Giusy Tiseo ◽  
Dimitrios Delialis ◽  

AbstractAccurate risk stratification in COVID-19 patients consists a major clinical need to guide therapeutic strategies. We sought to evaluate the prognostic role of estimated pulse wave velocity (ePWV), a marker of arterial stiffness which reflects overall arterial integrity and aging, in risk stratification of hospitalized patients with COVID-19. This retrospective, longitudinal cohort study, analyzed a total population of 1671 subjects consisting of 737 hospitalized COVID-19 patients consecutively recruited from two tertiary centers (Newcastle cohort: n = 471 and Pisa cohort: n = 266) and a non-COVID control cohort (n = 934). Arterial stiffness was calculated using validated formulae for ePWV. ePWV progressively increased across the control group, COVID-19 survivors and deceased patients (adjusted mean increase per group 1.89 m/s, P < 0.001). Using a machine learning approach, ePWV provided incremental prognostic value and improved reclassification for mortality over the core model including age, sex and comorbidities [AUC (core model + ePWV vs. core model) = 0.864 vs. 0.755]. ePWV provided similar prognostic value when pulse pressure or hs-Troponin were added to the core model or over its components including age and mean blood pressure (p < 0.05 for all). The optimal prognostic ePWV value was 13.0 m/s. ePWV conferred additive discrimination (AUC: 0.817 versus 0.779, P < 0.001) and reclassification value (NRI = 0.381, P < 0.001) over the 4C Mortality score, a validated score for predicting mortality in COVID-19 and the Charlson comorbidity index. We suggest that calculation of ePWV, a readily applicable estimation of arterial stiffness, may serve as an additional clinical tool to refine risk stratification of hospitalized patients with COVID-19 beyond established risk factors and scores.

Aorta ◽  
2021 ◽  
Shabir H. Shah ◽  
Muhammad A. Shah ◽  
Abudar A. M. Alganadi ◽  
Halia Z. Alshehri ◽  
Mudasir S. Mir ◽  

AbstractGiant ascending aortic aneurysm (AscAA >10 cm) is an uncommon entity with a variable presentation. The size of the aneurysm, rapid expansion, and calcification are associated with an increased risk of rupture. Atherosclerosis is the most common etiology of aortic aneurysm in the elderly population. Multimodality imaging can be wisely used for diagnosis, risk stratification, and follow-up. We herein report a case of successfully repaired giant calcified AscAA with a maximum diameter of 10 cm. We also provide a brief discussion on the role of multimodality imaging.

2021 ◽  
Vol 17 (3) ◽  
pp. 97-105
O. I. Gushchina ◽  
N. G. Lozhkina

In a pandemic, a special group is made up of patients with cardiovascular pathology. Cardiovascular diseases are largely associated with an increase in mortality and an increased risk of complications in patients infected with the SARS-CoV-2 virus. This determines the importance of risk stratification, the choice of optimal personalized therapy and the study of the long-term prognosis of myocardial infarction against the background of infection caused by SARS-CoV-2. Despite the rapidly growing attention to this issue, the mechanisms of the relationship between cardiovascular disease and COVID-19 are not completely clear. We conducted a systematic review to summarize important aspects of COVID-19 for cardiologists. The authors discuss both well-studied factors of the infectious process leading to acute myocardial damage and decompensation of existing chronic cardiac diseases, and new, fundamental, determining prognosis and treatment. Information on the topic was used from publications based on the PubMed, Google Scholar and eLibrary.ru databases. This work was carried out within the framework of a research grant № 67573613 of Pfizer.

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