Diseases (Basel, Switzerland)最新文献

{"title":"Diffusion Tensor Imaging Magnetic Resonance Imaging Assessment in a Clinical Trial of Autologous Dendritic Cell Transfer for Diabetic Kidney Disease: A Molecular Approach.","authors":"Ernaldi Kapusin, Aditya Pratama Lokeswara, Yudo Rantung, Bhimo Aji Hernowo, Jonny Jonny, Chrismis Novalinda Ginting, Terawan Agus Putranto","doi":"10.3390/diseases13050159","DOIUrl":"10.3390/diseases13050159","url":null,"abstract":"<p><strong>Background: </strong>Continuous rise of type 2 diabetes mellitus (T2DM) global prevalence, has led to a subsequent increase in the prevalence of diabetic kidney disease (DKD). DKD is associated with higher levels of inflammation and impaired kidney function. Many patients do not receive adequate treatment for this condition. This research aims to evaluate the therapeutic impact of autologous dendritic cell transfer by examining its effects on renal microstructural changes as assessed through Diffusion Tensor Imaging (DTI) MRI, alongside the analysis of key inflammatory biomarkers, namely Matrix Metalloproteinase-9 (MMP-9) and Intercellular Adhesion Molecule-1 (ICAM-1).</p><p><strong>Methods: </strong>A clinical trial with an open-label design was performed with 25 DKD patients receiving outpatient care at Gatot Soebroto Army Hospital. Each participant was administered a single injection of autologous dendritic cells. Evaluations were conducted both prior to and one month following the treatment. The primary measurements included Diffusion Tensor Imaging (DTI) MRI-derived Fractional Anisotropy (FA) scans and the inflammatory biomarker MMP-9.</p><p><strong>Results: </strong>A notable increase in FA was observed, rising from 242.57 ± 63.97 at baseline to 305.61 ± 152.32 one month after the dendritic cell injection. However, there were no significant changes in MMP-9 and ICAM-1 levels. Additionally, a negative correlation was found between FA and MMP-9 (r = -0.324, <i>p</i> = 0.025).</p><p><strong>Conclusion: </strong>The transfer of autologous dendritic cells significantly enhanced FA, which correlates with a reduction in the inflammatory biomarker MMP-9, suggesting a potential impact on renal repair in DKD.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Second-Generation Deep Learning Technique for Noise Reduction in Myocardial T1-Mapping Magnetic Resonance Imaging.","authors":"Shungo Sawamura, Shingo Kato, Naofumi Yasuda, Takumi Iwahashi, Takamasa Hirano, Taiga Kato, Daisuke Utsunomiya","doi":"10.3390/diseases13050157","DOIUrl":"10.3390/diseases13050157","url":null,"abstract":"<p><strong>Background: </strong>T1 mapping has become a valuable technique in cardiac magnetic resonance imaging (CMR) for evaluating myocardial tissue properties. However, its quantitative accuracy remains limited by noise-related variability. Super-resolution deep learning-based reconstruction (SR-DLR) has shown potential in enhancing image quality across various MRI applications, yet its effectiveness in myocardial T1 mapping has not been thoroughly investigated. This study aimed to evaluate the impact of SR-DLR on noise reduction and measurement consistency in myocardial T1 mapping.</p><p><strong>Methods: </strong>This single-center retrospective observational study included 36 patients who underwent CMR between July and December 2023. T1 mapping was performed using a modified Look-Locker inversion recovery (MOLLI) sequence before and after contrast administration. Images were reconstructed with and without SR-DLR using identical scan data. Phantom studies using seven homemade phantoms with different Gd-DOTA dilution ratios were also conducted. Quantitative evaluation included mean T1 values, standard deviation (SD), and coefficient of variation (CV). Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement.</p><p><strong>Results: </strong>SR-DLR had no significant effect on mean native or post-contrast T1 values but significantly reduced SD and CV in both patient and phantom studies. SD decreased from 44.0 to 31.8 ms (native) and 20.0 to 14.1 ms (post-contrast), and CV also improved. ICCs indicated excellent inter-observer reproducibility (native: 0.822; post-contrast: 0.955).</p><p><strong>Conclusions: </strong>SR-DLR effectively reduces measurement variability while preserving T1 accuracy, enhancing the reliability of myocardial T1 mapping in both clinical and research settings.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Degenerative Biomarkers in Females with Patellofemoral Pain: A Cross-Sectional Analysis with 6-Month Progression.","authors":"Lori A Bolgla, Tiana V Curry-McCoy, Maya Giddens, Madelyn Overton, Bryaunna Barrera, Jasmine Crockett, Monte Hunter","doi":"10.3390/diseases13050155","DOIUrl":"10.3390/diseases13050155","url":null,"abstract":"<p><strong>Background/objectives: </strong>Patellofemoral pain (PFP) is considered a risk factor for knee osteoarthritis (OA) onset. The purpose of this study was to compare degenerative biomarkers in females with and without PFP and to determine changes in these levels, along with pain and function, over 6 months.</p><p><strong>Methods: </strong>All subjects received a knee x-ray to ensure that none had degenerative changes. Urine and serum were collected and analyzed for C-telopeptide fragments of type II collagen (CTX-II) and C-propeptide II (CP-II); these were then expressed as a cartilage degradation: cartilage synthesis ratio (CTX-II:CP-II). Subjects with PFP rated pain using a 10 cm visual analog scale, and function using the Knee injury and Osteoarthritis Outcome Scores-Patellofemoral (KOOS-PF) questionnaire. Subjects with PFP were tested at baseline and at 6 months.</p><p><strong>Results: </strong>Females with PFP had higher levels of CTX-II:CP-II than controls (<i>p</i> < 0.001) and these remained elevated at 6 months (<i>p</i> = 0.82). Females with PFP reported similar levels of pain (<i>p</i> = 0.30) but higher function at 6 months (<i>p</i> = 0.002). However, the 9.0-point increase in KOOS-PF values did not exceed the minimum important change.</p><p><strong>Conclusions: </strong>Females with PFP but no evident structural changes had more elevated biomarkers than controls. This finding suggests that this cohort may have excessive cartilage turnover which may contribute to knee OA.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curcumin Reverses Antibiotic Resistance and Downregulates Shiga Toxin Expression in Enterohemorrhagic <i>E. coli</i>.","authors":"Martin Zermeño-Ruiz, Mirian Cobos-Vargas, Mauro Donaldo Saucedo-Plascencia, Rafael Cortés-Zárate, Leonardo Hernandez-Hernandez, Teresa Arcelia Garcia-Cobian, Teresa Estrada-Garcia, Araceli Castillo-Romero","doi":"10.3390/diseases13050154","DOIUrl":"10.3390/diseases13050154","url":null,"abstract":"<p><strong>Background: </strong>Enterohemorrhagic <i>Escherichia coli</i> (EHEC) is a considerable public health concern associated with several foodborne outbreaks of bloody diarrhea (BD) and the potentially lethal hemolytic uremic syndrome (HUS), the pathophysiology of which is attributable to the Shiga toxin (Stx) produced by this bacterium. In most patients, supportive treatment will be sufficient; however, in some cases, antibiotic treatment may be necessary. Most antibiotics are not recommended for EHEC infection treatment, particularly those that kill the bacteria, since this triggers the release of Stx in the body, inducing or worsening HUS. Azithromycin, which prevents the release of Stx and is a weaker inducer of the SOS system, has been successfully used to reduce EHEC shedding. It is necessary to identify compounds that eliminate EHEC without inducing Stx release. The use of natural compounds such as curcumin (CUR), a polyphenol derived from turmeric, has been highlighted as an alternative bactericidal treatment approach.</p><p><strong>Objective: </strong>The objective of this study was to establish the effect of CUR and its interactions with selected antibiotics on resistant EHEC O157/H7/EDL933.</p><p><strong>Methods: </strong>Bacterial cultures were exposed to CUR at three different concentrations (110, 220, and 330 µg/mL) and 1.2% DMSO, and the antimicrobial activity of CUR was assessed by measuring the optical density at 600 nm (OD600). The synergy of CUR and the antibiotics was determined with the FIC method. RT-PCR was performed to determine the expression levels of the <i>bla_CTX-M-15</i>, <i>catA1</i>, <i>acrAB-tolC stx2A</i>, and <i>stx2B</i> genes.</p><p><strong>Results: </strong>Our data indicate that CUR did not affect the growth of EHEC, but when combined with the antibiotics, it acted as a bacterial resistance breaker. Synergistic combinations of CUR and cefotaxime or chloramphenicol significantly reduced colony counts.</p><p><strong>Conclusions: </strong>Our findings support the potential of CUR as a sensitizer or in combination therapy against EHEC.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Personalized Approach to Follow-Up Blood Cultures in Gram-Negative Bloodstream Infections: A Narrative Review.","authors":"Renatos-Nikolaos Tziolos, Diamantis P Kofteridis","doi":"10.3390/diseases13050156","DOIUrl":"10.3390/diseases13050156","url":null,"abstract":"<p><p>The utility of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) remains controversial. The lack of randomized controlled trials and guidelines has led to the inappropriate use of unnecessary FUBCs, increasing costs, the length of hospital stays, and antibiotic use. In this review, we aim to evaluate the strengths and limitations of the most significant studies on FUBCs in GN-BSIs, proposing a more personalized approach for using FUBCs in GN-BSIs. FUBCs seem to have a low yield of persistent positive BC in uncomplicated GN-BSIs and no effect on mortality, but some selected patients may benefit. Available studies show different results regarding the mortality and benefit of FUBCs, mainly due to differences in methodology and patient characteristics. However, selected patients with endovascular infections, central venous catheters, unfavorable responses, and no source control seem to benefit the most. Randomized controlled trials are warranted in order to confirm these indications.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine Transplantation: Advances, Challenges, and Future Perspectives.","authors":"Ana Pereira, Flávia Ribeiro, Sandra Soares, Hélder Ferreira","doi":"10.3390/diseases13050152","DOIUrl":"10.3390/diseases13050152","url":null,"abstract":"<p><strong>Background: </strong>Infertility is a multifactorial condition with medical, psychological, demographic, and economic impacts. Around 3-5% of cases are due to uterine dysfunction. Absolute uterine factor infertility (AUFI) refers to infertility caused entirely by the absence or abnormality of the uterus, which prevents embryo implantation or pregnancy viability. Uterus transplantation (UTx) has emerged as a promising treatment for AUFI and has been successfully performed in over 10 countries.</p><p><strong>Objectives: </strong>This study aims to conduct a systematic review of uterus transplantation, evaluating its efficacy and safety, as well as maternal, neonatal, and long-term outcomes. It also explores current challenges and future directions.</p><p><strong>Methods: </strong>The methodology was registered on the PROSPERO platform. A literature search was performed in January 2025 across PubMed, Web of Science, and Scopus for articles published from January 2002 to December 2024 in English or Portuguese. The query was: \"uterus/transplantation AND (pregnancy OR complications OR newborn OR premature OR diseases)\". Study quality was assessed by journal impact factor (IF). Data were analyzed using Microsoft Excel.</p><p><strong>Results: </strong>A total of 10 studies were included: four from Sweden, three from the DUETS group, two from the Czech Republic, and one multi-institutional American study. The UTx success rate was 74.0%; clinical pregnancy rate (CPR) and live birth rates (LBR) per embryo transfer (ET) were 36.3% and 22.0%, respectively. No significant increase in congenital or neurological complications was observed. Adverse psychological outcomes were associated with transplant failure or pregnancy loss.</p><p><strong>Conclusions: </strong>UTx is a promising treatment for AUFI, showing favorable pregnancy and birth outcomes without major fetal or neonatal risks.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertensive Emergency and Atypical Hemolytic Uremic Syndrome Associated with Cocaine Use: A Diagnostic and Therapeutic Challenge.","authors":"Elena Jiménez Mayor, José C De La Flor, André Rocha Rodrigues, Celia Rodríguez Tudero, Rocío Zamora González-Mariño, Jacqueline Apaza, Esperanza Moral Berrio, Javier Deira Lorenzo","doi":"10.3390/diseases13050153","DOIUrl":"10.3390/diseases13050153","url":null,"abstract":"<p><strong>Background: </strong>Atypical hemolytic uremic syndrome (HUS) is a rare form of thrombotic microangiopathy (TMA) characterized by complement dysregulation. Cocaine use has been reported to be a potential trigger of TMA; however, the underlying mechanisms remain poorly elucidated. Proposed hypotheses include direct endothelial injury, activation of the complement cascade, and the unmasking of whether HUS is genetic or acquired.</p><p><strong>Case report: </strong>We report the case of a 47-year-old man who presented with hypertensive emergency and acute kidney injury following intranasal cocaine use. The laboratory findings were consistent with microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and markedly elevated lactate dehydrogenase (LDH) levels. Renal biopsy (RB) revealed classic features of TMA, including glomerular capillary thrombosis, fibrinoid necrosis, and acute tubular injury. Complement studies demonstrated reduced levels of Factor I, indicative of complement dysregulation. The patient was treated with therapeutic plasma exchange and four weekly doses of eculizumab, resulting in hematologic remission and significant improvement in renal function, without the need for dialysis. Genetic testing for known atypical HUS-associated mutations was negative; therefore, maintenance therapy with eculizumab was discontinued without clinical relapses.</p><p><strong>Discussion: </strong>This case underscores cocaine as a rare but important precipitating factor for atypical HUS in predisposed individuals. Early diagnosis, RB, and complement evaluation were essential in determining the etiology and guiding targeted therapy. Complement inhibition with eculizumab was effective in halting disease progression and preventing long-term renal damage.</p><p><strong>Conclusions: </strong>This case highlights the relevance of considering cocaine use as a potential trigger of complement-mediated TMA. Early identification of aHUS features and prompt initiation of complement inhibition therapy may be critical to preventing irreversible kidney injury.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Inverse Association of Mediterranean Diet with Emotional Eating: A Cross-Sectional Study in Greek Adults.","authors":"Maria Mentzelou, Sousana K Papadopoulou, Aikaterini Louka, Georgia-Eirini Deligiannidou, Evmorfia Psara, Constantinos Giaginis","doi":"10.3390/diseases13050151","DOIUrl":"10.3390/diseases13050151","url":null,"abstract":"<p><strong>Background/objectives: </strong>Emotional eating (EE) is the tendency to overeat in response to negative emotions. Food consumption is influenced by both personal and environmental factors. Emotions are personal factors that can affect food consumption. The objective of this study is to assess the association between Mediterranean diet (MD), a dietary pattern promoting mental health, and emotional eating via the Three-Factor Eating Questionnaire (TEFQ).</p><p><strong>Methods: </strong>This is a cross-sectional survey including 328 adults aged 18-75 years. Appropriate questionnaires were applied for evaluating adherence to the Mediterranean diet (MedDiet score) and types of feeding and the expression of emotional food consumption (TFEQ).</p><p><strong>Results: </strong>A mean MedDiet score equal to 30.97 ± 4.93 and a total TFEQ score equal to 45.40 ± 6.31 were noted. MedDiet score was significantly inversely associated with TFEQ total score (r = 0.23, <i>p</i> = 0.026) as well as with TFEQ emotional score (r = 0.37, <i>p</i> < 0.0001). Fruits and vegetables consumption was positively associated with TFEQ emotional score (r = 0.25, <i>p</i> = 0.014, and r = 0.20, <i>p</i> = 0.049, respectively).</p><p><strong>Conclusions: </strong>In order to produce data showing improvements in eating behavior, our findings have highlighted the significance of conducting large, prospective, well-designed, randomized, interventional clinical studies to confirm the inverse association of MD with EE. The interpretation of the results is complicated due to cross-sectional design, the social desirability bias and the self-report nature of both dietary and emotional assessments.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Insulin Resistance: Comparison of the Commerce vs. Industry Sector and Associated Variables.","authors":"María Pilar Fernández-Figares Vicioso, Pere Riutord Sbert, Ángel Arturo López-González, José Ignacio Ramírez-Manent, José Luis Del Barrio Fernández, María Teófila Vicente Herrero","doi":"10.3390/diseases13050150","DOIUrl":"10.3390/diseases13050150","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance (IR) is a key metabolic alteration that precedes type 2 diabetes and is closely linked to obesity and lifestyle factors. Occupational context may influence IR risk through variations in physical activity, diet, and socioeconomic determinants.</p><p><strong>Objective: </strong>To compare the risk of insulin resistance between workers in the commerce and industry sectors and identify associated sociodemographic and lifestyle factors, in order to improve their occupational health.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from 56,856 Spanish workers, assessing four IR-related indices: Triglyceride-Glucose Index (TyG), TyG-BMI (Triglyceride-Glucose Body Mass Index), Metabolic Score for Insulin Resistance (METS-IR), and the Single-Point Insulin Sensitivity Estimator (SPISE-IR). The analysis was stratified by sex and sector (commerce vs. industry) and included assessments of age, education level, physical activity, adherence to the Mediterranean diet, and smoking status. Multinomial logistic regressions were performed to determine the factors associated with high IR scores.</p><p><strong>Results: </strong>Across all IR indicators, industry workers-particularly men-presented higher mean values and greater prevalence of high-risk scores compared to those in commerce. Women showed lower values overall but also reflected sector-based differences. In both sexes, non-physical activity, non-adherence to the Mediterranean diet, and smoking were consistently associated with higher IR risk. Males exhibited significantly higher odds of elevated TyG (OR = 2.59, 95% CI: 2.41-2.78), while physical inactivity and poor diet emerged as the most powerful modifiable predictors across all scales (e.g., OR = 10.45 for TyG, OR = 12.33 for TyG-BMI). Industry sector was independently associated with higher odds of insulin resistance compared to commerce.</p><p><strong>Conclusions: </strong>Insulin resistance is more prevalent among industrial workers, especially men and those with unhealthy lifestyles. Occupational health strategies should target sector-specific risk profiles, emphasizing physical activity and dietary interventions.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database.","authors":"Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Hadrian Hoang-Vu Tran, Olivia Yessin, Harsh Jha, Ashley Mason, Audrey Thu, Simcha Weissman, Adam Atoot","doi":"10.3390/diseases13050149","DOIUrl":"10.3390/diseases13050149","url":null,"abstract":"<p><p><b>Background</b>: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim of our study is to analyze the national trends in TAVR procedures, in-hospital outcomes, major readmission causes, and the association of risk factors for readmissions following TAVR. <b>Methods</b>: We analyzed NIS data (2018-2022) to assess TAVR utilization trends, patient demographics, and in-hospital outcomes. The NRD (2021-2022) was used to evaluate 60-day readmission rates for stroke, complete heart block, and heart failure. Multivariate regression models were employed to identify risk factors having significant association with major readmission causes. <b>Results</b>: TAVR utilization increased from 10,788 cases in 2018 to 17,784 in 2022, with a concurrent decrease in in-hospital mortality (1.33% to 0.90%) and length of stay (3.88 to 2.97 days). Of 123,376 TAVR index admissions in 2021, 28,654 patients had 66,100 readmission events (53.57%) in the 60 days following discharge. Heart failure (17,566 cases, 26.57% of readmissions) was the most common readmission cause, followed by complete heart block (1760 cases, 2.66% of readmissions) and stroke (284 cases, 0.42% of readmissions). Predictors of post-TAVR stroke included uncontrolled hypertension (OR 2.29, <i>p</i> < 0.001) and chronic heart failure (OR 2.73, <i>p</i> < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, <i>p</i> < 0.001) and heart failure readmissions (OR 7.65, <i>p</i> < 0.001). <b>Conclusions</b>: TAVR utilization has increased with improving perioperative outcomes, but post-TAVR readmissions remain significant, particularly for heart failure, stroke, and conduction disturbances. Pre-procedural uncontrolled hypertension, hyperlipidemia, congestive heart failure, and atrial fibrillation were risk factors with significant association with stroke in the 60 days following TAVR. The presence of documented pre-procedural LBB, RBB, as well as BFB were risk factors with significant association with complete heart block following TAVR placements. Pre-procedural LBB, RBB, BFB, and atrial fibrillation were risk factors having significant association with heart failure readmissions in the 60 days following TAVR.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"13 5","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}