Mayo Clinic proceedings最新文献

{"title":"The American College of Cardology/American Heart Association Heart Failure Staging System Highlights Diagnostic Delay and Predicts Outcome in Transthyretin Cardiac Amyloidosis.","authors":"Mattia Zampieri, Annamaria Del Franco, Giulia Biagioni, Giacomo Tini, Beatrice Musumeci, Emanuele Barbato, Simone Longhi, Elena Biagini, Giulia Saturi, Aldostefano Porcari, Marco Merlo, Gianfranco Sinagra, Camillo Autore, Marco Canepa, Italo Porto, Alessia Argirò, Carlotta Mazzoni, Carlo Fumagalli, Federica Colio, Tullio Catalucci, Iacopo Olivotto, Federico Perfetto, Francesco Cappelli","doi":"10.1016/j.mayocp.2024.11.025","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.025","url":null,"abstract":"<p><strong>Objective: </strong>To apply the American College of Cardiology (ACC) and American Heart Association (AHA) heart failure (HF) staging system to patients with transthyretin cardiac amyloidosis (TTR-CA) in order to assess diagnostic delay and evaluate prognosis.</p><p><strong>Patients and methods: </strong>Consecutive patients with TTR-CA enrolled in an Italian registry were classified according to the ACC/AHA HF staging system at diagnosis. Outcome was assessed as all-cause mortality during a 3-year follow-up.</p><p><strong>Results: </strong>At diagnosis, of 549 patients with TTR-CA, 115 (20.9%) presented with HF stage B, 172 (31.3%) with stage C1, 198 (36.1%) with stage C2, and 64 (11.7%) with stage D. Patients with stages B, C1, C2, and D presented with hierarchically higher prevalence of left ventricular systolic impairment, advanced diastolic dysfunction, advanced New York Heart Association functional class, hospitalization for HF, and N-terminal pro-B-type natriuretic peptide values. At 3 years, the survival rate was 94% in patients with stage B HF, decreasing to 69% with stage C1, 43% with stage C2, and 17% with stage D. At multivariable analysis, considering stage B as the reference, risk increase for all-cause mortality was 4, 5, and 11 for stages C1, C2, and D, respectively.</p><p><strong>Conclusion: </strong>At diagnosis, almost half of patients with TTR-CA present with advanced stages of HF (C2 or D), suggesting marked diagnostic delay. The ACC/AHA HF staging system accurately stratifies prognosis and may be usefully added to the multiparametric evaluation of patients with TTR-CA.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Body Mass Index and Age at End-Stage Renal Disease in Patients With Autosomal Dominant Polycystic Kidney Disease in the United States and Japan.","authors":"Tatsuya Suwabe, Vicente E Torres, Lisa E Vaughan, Chuck D Madsen, Peter C Harris, Yosuke Shimada, Shinya Nakatani, Junichi Hoshino, Saori Nishio, Toshio Mochizuki, Eiichiro Kanda, Norio Hanafusa, Masanori Abe, Satoru Muto","doi":"10.1016/j.mayocp.2024.12.019","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.12.019","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between body mass index (BMI) and age at initiation of renal replacement therapy (RRT) of patients with autosomal dominant polycystic kidney disease (ADPKD) in the United States and Japan, 2 populations with different dietary habits and BMIs.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis using data from the United States Renal Data System (USRDS) and the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) to compare age, BMI, and other clinical characteristics of the patients who initiated RRT in the 2 countries between January 1, 2006, and December 31, 2007.</p><p><strong>Results: </strong>This study included 3556 patients (1877 men and 1679 women) with RRT from the USRDS (n=2491) and JRDR (n=1065). Mean ages at RRT were 56.6±13.1 years in the United States and 61.6±12.5 years in Japan (P<.001). The BMI was 28.2±7.1 kg/m² in the USRDS and 22.0±3.3 kg/m² in the JRDR (P<.001). Japanese participants were the oldest, followed in descending order by Asian Americans, White Americans, and African Americans. Japanese participants had the lowest BMI, followed in ascending order by Asian Americans, White Americans, and African Americans. Univariable and adjusted analyses found that BMI was significantly and inversely associated with age at RRT, both overall and separately in American and Japanese populations.</p><p><strong>Conclusion: </strong>Lower BMI is significantly associated with older age at RRT in patients with ADPKD in both the United States and Japan. Japanese individuals had lower BMI and were older than US people of various ethnicities. Lower BMI in Japan is likely to be associated with a slower progression of ADPKD.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polypharmacy and Potentially Inappropriate Medications in Adults ≥75 Years of Age by Dementia and Frailty Status: The ARIC Study.","authors":"Pamela L Lutsey, Jeffrey R Misialek, Eric A Whitsel, Kamakshi Lakshminarayan, Anna M Kucharska-Newton, B Gwen Windham, Kevin J Sullivan, Alex Secora, Morgan E Grams, Joel F Farley","doi":"10.1016/j.mayocp.2024.11.030","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.030","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the prevalence of polypharmacy (concomitant use of ≥5 medications), hyperpolypharmacy (≥10 medications), and potentially inappropriate medication (PIM) use among older adults according to dementia and frailty status.</p><p><strong>Patients and methods: </strong>Cross-sectional data (2016-2017) from 3912 participants aged 71 to 94 years (mean ± SD, 79.6±4.8 years; 59.2% female; 24.5% Black race) from the community-based Atherosclerosis Risk in Communities (ARIC) study were used. Dementia and mild cognitive impairment status was based on comprehensive neurocognitive assessment, informant interviews, and adjudication by an expert panel. Participants were classified as frail, prefrail, or robust according to the Fried frailty phenotype definition. Medication containers were brought to the clinic. The PIMs were defined using a modified version of the Beers Criteria.</p><p><strong>Results: </strong>Polypharmacy, hyperpolypharmacy, and PIM use were prevalent in 67.1%, 18.8%, and 23.9% of participants, respectively, and 7.9% were classified as having dementia and 8.0% as frail. The demographic-adjusted relative risk ratio (95% CI) for participants with dementia vs normal cognition was 1.79 (1.27 to 2.51) for hyperpolypharmacy, and the odds ratio (95% CI) for PIM use was 1.58 (1.21 to 2.06). The relative risk ratios (95% CIs) for hyperpolypharmacy were 8.35 (5.57 to 12.54) for frail and 2.70 (2.14 to 3.41) for prefrail compared with robust.</p><p><strong>Conclusion: </strong>Polypharmacy, hyperpolypharmacy, and PIM use were common in this community-based sample of adults approximately 80 years old. These patterns of use were even more common among participants with dementia and frailty, who are at elevated risk for adverse outcomes.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"78-Year-Old Woman With Altered Mental Status and Hypoxia.","authors":"Lai Jiang, Devika M Das, Allison L Ducharme-Smith","doi":"10.1016/j.mayocp.2024.07.029","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.07.029","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"59-Year-Old Man With Malaise and Vague Chest Discomfort.","authors":"Reid P Schlesinger, Iuri Ferreira Felix, Francisco López-Jiménez","doi":"10.1016/j.mayocp.2024.07.028","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.07.028","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"73-Year-Old Woman With Right Upper Quadrant Pain and Fever.","authors":"Asrita Vattikonda, Carlie A Aurubin, Maoyin Pang","doi":"10.1016/j.mayocp.2024.06.018","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.06.018","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"59-Year-Old Woman With Recurrent Syncope.","authors":"Kevin Stanko, Mitchell Dumais, Michael Cullen","doi":"10.1016/j.mayocp.2024.06.017","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.06.017","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"79-Year-Old Man With Melena and Dyspnea.","authors":"Deandra K Chetram, Saam Dilmaghani, Hannah C Nordhues","doi":"10.1016/j.mayocp.2024.06.016","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.06.016","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"81-Year-Old Man With Shortness of Breath and Weakness.","authors":"Trevor Gauthier, Savannah R Whitfield, Claire E Raphael","doi":"10.1016/j.mayocp.2024.07.027","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.07.027","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Practical Approach to Screening and Management.","authors":"Abdul Hamid Borghol, Bassel Alkhatib, Roaa Zayat, Naveen P G Ravikumar, Fadi George Munairdjy Debeh, Ahmad Ghanem, Jonathan Mina, Michael A Mao, Neera K Dahl, LaTonya J Hickson, Nabeel Aslam, Vicente E Torres, Robert D Brown, Rabih G Tawk, Fouad T Chebib","doi":"10.1016/j.mayocp.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.02.003","url":null,"abstract":"<p><p>Autosomal dominant polycystic kidney disease (ADPKD), the most prevalent genetic kidney disorder, is characterized by diffuse kidney cysts, hypertension, and progressive kidney function decline, often leading to kidney failure by the age of 60 years. Compared with the general population, patients with ADPKD have an increased risk for development of saccular intracranial aneurysms (IAs), which can lead to intracranial bleeding and result in significant disability and mortality. Of both modifiable and nonmodifiable risk factors, the most significant is a family history of IAs or aneurysm rupture. Other contributing factors include hypertension, cigarette smoking, age, and sex. Most IAs currently detected during screening tests are small and located in the anterior circulation. Intracranial aneurysms can be manifested with thunderclap headache, which may be indicative of subarachnoid hemorrhage. Less commonly, IAs cause symptoms related to mass effect with focal neurologic deficits. Subarachnoid hemorrhage is particularly concerning, given its high case-fatality rate, which remains around 35% despite advances in neurologic care. Therefore, control of risk factors, early detection, and treatment when indicated are important to prevent adverse outcomes. Screening for IAs in ADPKD remains controversial and can be approached either universally (screening of all ADPKD patients) or selectively (screening of high-risk patients). The preferred imaging modality is brain magnetic resonance angiography without contrast enhancement or alternatively computed tomography angiography. This review provides a practical guide for medical teams managing patients with ADPKD, detailing the characteristics of IAs and their associated symptoms. It presents an algorithm for risk assessment and screening along with recommendations for treatment and follow-up care.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}