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Blood Cancer Journal Mar 2022Extramedullary involvement (or extramedullary disease, EMD) represents an aggressive form of multiple myeloma (MM), characterized by the ability of a clone and/or... (Review)
Review
Extramedullary involvement (or extramedullary disease, EMD) represents an aggressive form of multiple myeloma (MM), characterized by the ability of a clone and/or subclone to thrive and grow independent of the bone marrow microenvironment. Several different definitions of EMD have been used in the published literature. We advocate that true EMD is restricted to soft-tissue plasmacytomas that arise due to hematogenous spread and have no contact with bony structures. Typical sites of EMD vary according to the phase of MM. At diagnosis, EMD is typically found in skin and soft tissues; at relapse, typical sites involved include liver, kidneys, lymph nodes, central nervous system (CNS), breast, pleura, and pericardium. The reported incidence of EMD varies considerably, and differences in diagnostic approach between studies are likely to contribute to this variability. In patients with newly diagnosed MM, the reported incidence ranges from 0.5% to 4.8%, while in relapsed/refractory MM the reported incidence is 3.4 to 14%. Available data demonstrate that the prognosis is poor, and considerably worse than for MM without soft-tissue plasmacytomas. Among patients with plasmacytomas, those with EMD have poorer outcomes than those with paraskeletal involvement. CNS involvement is rare, but prognosis is even more dismal than for EMD in other locations, particularly if there is leptomeningeal involvement. Available data on treatment outcomes for EMD are derived almost entirely from retrospective studies. Some agents and combinations have shown a degree of efficacy but, as would be expected, this is less than in MM patients with no extramedullary involvement. The paucity of prospective studies makes it difficult to justify strong recommendations for any treatment approach. Prospective data from patients with clearly defined EMD are important for the optimal evaluation of treatment outcomes.
Topics: Humans; Multiple Myeloma; Neoplasm Recurrence, Local; Plasmacytoma; Prospective Studies; Retrospective Studies; Tumor Microenvironment
PubMed: 35314675
DOI: 10.1038/s41408-022-00643-3 -
Asian Cardiovascular & Thoracic Annals Sep 2022Primary and metastatic primitive neuroectodermal tumors of the pericardium are uncommon. Two cases are presented and discussed.
OBJECTIVE
Primary and metastatic primitive neuroectodermal tumors of the pericardium are uncommon. Two cases are presented and discussed.
METHODS
The cases of a 17- and 38-year-old male patients with neuroectodermal tumors of the pericardium are presented. In addition, a systematic review was performed according to the Preferred Reporting Items and checklist for Systematic reviews and Meta-Analyses (PRISMA). All selected articles' quality assessment was done using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports.
RESULTS
The systematic review yielded 29 patients with primary or metastatic PNET. Two patients underwent cardiac transplantation. It seems that unlike considering total resection in other organs, pericardiectomy in PNET patients with pericardial origin may lead to further invasion of the lesions, and it is not recommended. The average disease-free follow-up was 10 months. The combination of neoadjuvant and adjuvant chemotherapy along with surgery and radiotherapy offered the best disease-free outcomes.
CONCLUSION
Neuroectodermal heart tumors are rare, aggressive tumors requiring chemotherapy and radiotherapy in association with tumor resection surgery to have the best disease-free duration.
Topics: Adolescent; Adult; Chemotherapy, Adjuvant; Disease-Free Survival; Humans; Male; Neoplasms, Second Primary; Neuroectodermal Tumors, Primitive, Peripheral; Sarcoma, Ewing; Treatment Outcome; Young Adult
PubMed: 35306869
DOI: 10.1177/02184923221083434 -
Journal of Interventional Cardiology 2022Implantation of the MitraClip is a safe and effective therapy for mitral valve repair in patients ineligible for surgery or at high risk of adverse surgical outcomes.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Implantation of the MitraClip is a safe and effective therapy for mitral valve repair in patients ineligible for surgery or at high risk of adverse surgical outcomes. However, only limited information is available concerning sex differences in transcatheter mitral valve repair. We therefore sought to conduct a comprehensive meta-analysis of studies that investigated differences between men and women in outcomes following MitraClip implantation.
METHODS
The PubMed and Embase databases were searched until November 2019 for studies reporting outcomes after MitraClip implantation in women versus men. Outcomes included all-cause mortality and major complications at 30 days and one year of follow-up.
RESULTS
Six studies ( = 1,109 women; = 1,743 men) were analyzed. At 30 days, women had a similar risk of postoperative complications, such as stroke, major bleeding, and pericardium effusion, without differences in all-cause mortality, procedure success, or MitraClip usage. At one year, the all-cause mortality, the reduction of mitral regurgitation, and the risk of rehospitalization for heart failure were also comparable between male and female patients.
CONCLUSION
Gender disparity was not found in complications or prognosis of patients undergoing MitraClip implantation. This study suggests that gender should not be considered as a critical factor in the selection of patients as candidates for MitraClip implantation of concern during follow-up.
Topics: Cardiac Catheterization; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Sex Factors; Treatment Outcome
PubMed: 35281587
DOI: 10.1155/2022/5488654 -
Journal of Cardiac Surgery Jan 2022Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet... (Review)
Review
BACKGROUND
Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet little is known about their use in cardiac surgery. The study presented here provides the first major systematic review of adhesion barriers in cardiac surgery.
METHODS
Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria were clinical studies on human subjects, and exclusion criteria were studies not published in English and case reports. Risk of bias was evaluated with the Cochrane Risk of Bias Tool. Barrier efficacy data was assessed with Excel and GraphPad Prism 5.
RESULTS
Twenty-five studies were identified with a total of 13 barriers and 2928 patients. Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier (13 studies, 67% of patients) with adhesion formation rate of 37.31% and standardized tenacity score of 26.50. Several barriers had improved efficacy. In particular, Cova CARD had a standardized tenacity score of 15.00.
CONCLUSIONS
Overall, the data varied considerably in terms of study design and reporting bias. The amount of data was also limited for the non-PTFE studies. PTFE has historically been effective in preventing adhesions. More recent barriers may be superior, yet the current data is nonconfirmatory. No ideal adhesion barrier currently exists, and future barriers must focus on the requirements unique to operating in and around the heart.
Topics: Cardiac Surgical Procedures; Humans; Pericardium; Polytetrafluoroethylene; Postoperative Complications; Tissue Adhesions
PubMed: 34661944
DOI: 10.1111/jocs.16062 -
The Heart Surgery Forum Sep 2021Although epicardial adipose tissue (EAT) has been proven to be related to atrial fibrillation (AF) and post-ablation AF recurrence, the association between EAT and AF... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although epicardial adipose tissue (EAT) has been proven to be related to atrial fibrillation (AF) and post-ablation AF recurrence, the association between EAT and AF after cardiac surgery (AFACS) remains unclear.
OBJECTIVE
This study was a systematic review and meta-analysis that assessed the relationship between EAT and AFACS.
METHODS
Electronic databases were systematically searched for "atrial fibrillation" and "epicardial adipose tissue." The analysis was stratified according to the EAT measurement into three meta-analyses as (1) total EAT volume, (2) left atrial (LA)-EAT volume, and (3) EAT thickness. Standardized mean difference (SMD) was estimated using a random effects model.
RESULTS
Eight articles with 10 studies (546 patients) were included. The meta-analysis revealed that EAT was higher in those with AFACS irrespective of the EAT measurement (total EAT volume: SMD = 0.56 mL, 95% confidence interval, CI = 0.56-1.10 mL, I2 = 0.90, P = .04; EAT thickness: SMD = 0.85 mm, 95% CI = 0.04-1.65 mm, I2 = 0.90, P = .04; LA-EAT volume: SMD = 0.57 mL, 95% CI = 0.23-0.92 mL, I2 = 0.00, P = .001).
CONCLUSION
EAT was higher in patients with AFACS, measured either as volume or thickness.
Topics: Adipose Tissue; Atrial Fibrillation; Cardiac Surgical Procedures; Humans; Pericardium; Risk Factors; Tomography, X-Ray Computed
PubMed: 34623252
DOI: 10.1532/hsf.3975 -
European Journal of Radiology Oct 2021The aim of our work was to systematically review and meta-analyze epicardial adipose tissue (EAT) density values reported in literature, assessing potential correlations... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of our work was to systematically review and meta-analyze epicardial adipose tissue (EAT) density values reported in literature, assessing potential correlations of EAT density with segmentation thresholds and other technical and clinical variables.
METHOD
A systematic search was performed, aiming for papers reporting global EAT density values in Hounsfield Units (HU) in patients undergoing chest CT for any clinical indication. After screening titles, abstract and full text of each retrieved work, studies reporting mean and standard deviation for EAT density were ultimately included. Technical, clinical and EAT data were extracted, and divided into subgroups according to clinical conditions of reported subjects. Pooled density analyses were performed both overall and for subgroups according to clinical conditions. Metaregression analyses were done to appraise the impact of clinical and technical variables on EAT volume.
RESULTS
Out of 152 initially retrieved works, 13 were ultimately included, totaling for 7683 subjects. EAT density showed an overall pooled value of -85.86 HU (95% confidence interval [95% CI] -91.84, -79.89 HU), being -86.40 HU (95% CI -112.69, -60.12 HU) in healthy subjects and -80.71 HU (95% CI -87.43, -73.99 HU) in patients with coronary artery disease. EAT volume and lower and higher segmentation thresholds were found to be significantly correlated with EAT density (p = 0.044, p < 0.001 and p< 0.001 respectively).
CONCLUSIONS
Patients with coronary artery disease appear to present with higher EAT density values, while the correlations observed at metaregression highlight the need for well-established, shared thresholds for EAT segmentation.
Topics: Adipose Tissue; Coronary Angiography; Coronary Artery Disease; Humans; Pericardium; Risk Factors; Tomography, X-Ray Computed
PubMed: 34482178
DOI: 10.1016/j.ejrad.2021.109902 -
Cells Aug 2021(1) Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) reduce adipose tissue and cardiovascular events in patients with type 2 diabetes (T2D). Accumulation of... (Meta-Analysis)
Meta-Analysis
(1) Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) reduce adipose tissue and cardiovascular events in patients with type 2 diabetes (T2D). Accumulation of epicardial adipose tissue (EAT) is associated with increased cardio-metabolic risks and obstructive coronary disease events in patients with T2D. (2) We performed a systematic review and meta-analysis of SGLT2-i therapy on T2D patients, reporting data on changes in EAT after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A random effects or fixed effects model meta-analysis was then applied. (3) Results: A total of three studies ( = 64 patients with SGLT2-i, = 62 with standard therapy) were included in the final analysis. SGLT2 inhibitors reduced EAT (SMD: -0.82 (-1.49; -0.15); < 0.0001). An exploratory analysis showed that HbA1c was significantly reduced with SGLT2-i use, while body mass index was not significantly reduced with this drug. (4) Conclusions: This meta-analysis suggests that the amount of EAT is significantly reduced in T2D patients with SGLT2-i treatment.
Topics: Adipose Tissue; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Outcome Assessment, Health Care; Pericardium; Randomized Controlled Trials as Topic; Risk Factors; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 34440918
DOI: 10.3390/cells10082150 -
Journal of the Intensive Care Society Aug 2021Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of... (Review)
Review
INTRODUCTION
Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant.
OBJECTIVES
We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality.
RESULTS
All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome.
CONCLUSION
Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.
PubMed: 34422107
DOI: 10.1177/1751143720936821 -
Current Problems in Cardiology Feb 2022The Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) created a global pandemic that continues to this day. In addition to pulmonary symptoms, the virus can...
The Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) created a global pandemic that continues to this day. In addition to pulmonary symptoms, the virus can have destructive effects on other organs, especially the heart. For example, large pericardial effusion has been observed as a critical and life-threatening finding in Coronavirus disease of 2019 (COVID-19) patients. In this case report based systematic review, we review the reports of moderate to severe pericardial effusion associated with tamponade physiology. Direct cardiomyocyte and pericardium invasion, inflammation and cytokine storms and oxidative stress due to acute respiratory distress syndrome, are the pathogenesis of this phenomenon. The results showed that the manifestations of this finding are variable. Pericardial effusion can be seen as a delayed complication, accompanied by myocarditis or pericarditis, isolated, or with acute respiratory distress syndrome. In most patients, emergency percutaneous pericardiocentesis was performed, and fluid analysis was often exudative in 3 pattern of hemorrhagic, serous, and serosanguinous. Medical treatment and follow-up are recommended, especially in cases of pericarditis.
Topics: Humans; Cardiac Tamponade; COVID-19; Pericardial Effusion; Pericardiocentesis; SARS-CoV-2
PubMed: 34404552
DOI: 10.1016/j.cpcardiol.2021.100933 -
Journal of Magnetic Resonance Imaging :... Mar 2022Recent studies have utilized MRI to determine the extent to which COVID-19 survivors may experience cardiac sequels after recovery.
BACKGROUND
Recent studies have utilized MRI to determine the extent to which COVID-19 survivors may experience cardiac sequels after recovery.
PURPOSE
To systematically review the main cardiac MRI findings in COVID-19 adult survivors.
STUDY TYPE
Systematic review.
SUBJECTS
A total of 2954 COVID-19 adult survivors from 16 studies.
FIELD STRENGTH/SEQUENCE
Late gadolinium enhancement (LGE), parametric mapping (T1-native, T2, T1-post (extracellular volume fraction [ECV]), T2-weighted sequences (myocardium/pericardium), at 1.5 T and 3 T.
ASSESSMENT
A systematic search was performed on PubMed, Embase, and Google scholar databases using Boolean operators and the relevant key terms covering COVID-19, cardiac injury, CMR, and follow-up. MRI data, including (if available) T1, T2, extra cellular volume, presence of myocardial or pericardial late gadolinium enhancement (LGE) and left and right ventricular ejection fraction were extracted.
STATISTICAL TESTS
The main results of the included studies are summarized. No additional statistical analysis was performed.
RESULTS
Of 1601 articles retrieved from the initial search, 12 cohorts and 10 case series met our eligibility criteria. The rate of raised T1 in COVID-19 adult survivors varied across studies from 0% to 73%. Raised T2 was detected in none of patients in 4 out of 15 studies, and in the remaining studies, its rate ranged from 2% to 60%. In most studies, LGE (myocardial or pericardial) was observed in COVID-19 survivors, the rate ranging from 4% to 100%. Myocardial LGE mainly had nonischemic patterns. None of the cohort studies observed myocardial LGE in "healthy" controls. Most studies found that patients who recovered from COVID-19 had a significantly greater T1 and T2 compared to participants in the corresponding control group.
DATA CONCLUSION
Findings of MRI studies suggest the presence of myocardial and pericardial involvement in a notable number of patients recovered from COVID-19.
LEVEL OF EVIDENCE
3 TECHNICAL EFFICACY STAGE: 3.
Topics: Adult; COVID-19; Contrast Media; Gadolinium; Humans; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Myocardium; Predictive Value of Tests; SARS-CoV-2; Stroke Volume; Survivors; Ventricular Function, Left; Ventricular Function, Right
PubMed: 34309139
DOI: 10.1002/jmri.27852