Topic: Congenital

Abstract
<div><h4>Clinical prediction tool to identify children at risk of pulmonary embolism.</h4><i>Tiratrakoonseree T, Charoenpichitnun S, Natesirinilkul R, Songthawee N, ... Vaewpanich J, Sirachainan N</i><br /><b>Introduction</b><br />The diagnosis of pediatric pulmonary embolism (PE) is often delayed due to non-specific symptoms, and clinical prediction tools designed for adults are unsuitable for children. This study aimed to create a PE predictive model and to evaluate the reported tools in the Thai pediatric population.<br /><b>Materials and methods</b><br />A multi-center retrospective study from 4 university hospitals included children ≤18 years of age undergoing computed tomography pulmonary angiogram from 2000 to 2020 with the suspicion of PE. Patients\' clinical presentations and risk factors of venous thromboembolism (VTE) were compared between the PE-positive and PE-negative groups. Significant risk factors from univariate and multivariate logistic regression were included to create a clinical prediction tool. The performance of the model was demonstrated by sensitivity, specificity, area under the curve (AUC), Hosmer Lemeshow test, ratio of observed and expected outcomes and bootstrapping.<br /><b>Results</b><br />Of the 104 patients included, 43 (41.3 %) were grouped as PE-positive and 61 (58.7 %) as PE-negative. Five parameters, including congenital heart disease/pulmonary surgery, known thrombophilia, previous VTE, nephrotic syndrome and chest pain showed significant differences between the two groups. Score ≥ 2 yielded a 74.4 % sensitivity and a 75.4 % specificity with an AUC of the model of 0.809. The model performance and validation results were within satisfactory ranges.<br /><b>Conclusion</b><br />The study created a clinical prediction tool indicating the likelihood of PE among Thai children. A score ≥2 was suggestive of PE.<br /><br />Copyright © 2024 Faculty of Medicine Ramathibodi Hospital, Mahidol University. Published by Elsevier Ltd.. All rights reserved.<br /><br /><small>Thromb Res: 01 Feb 2024; 234:151-157</small></div>
Tiratrakoonseree T, Charoenpichitnun S, Natesirinilkul R, Songthawee N, ... Vaewpanich J, Sirachainan N
Thromb Res: 01 Feb 2024; 234:151-157 | PMID: 38241765
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Abstract
<div><h4>Association of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality.</h4><i>Zinchuk A, Srivali N, Qin L, Jeon S, ... Koo B, Yaggi HK</i><br /><b>Background</b><br />Obstructive sleep apnea is a well-established risk factor for cardiovascular disease (CVD). Recent studies have also linked periodic limb movements during sleep to CVD. We aimed to determine whether periodic limb movements during sleep and obstructive sleep apnea are independent or synergistic factors for CVD events or death.<br /><b>Methods and results</b><br />We examined data from 1049 US veterans with an apnea-hypopnea index (AHI) <30 events/hour. The primary outcome was incident CVD or death. Cox proportional hazards regression assessed the relationships between the AHI, periodic limb movement index (PLMI), and the AHI×PLMI interaction with the primary outcome. We then examined whether AHI and PLMI were associated with primary outcome after adjustment for age, sex, race and ethnicity, obesity, baseline risk of mortality, and Charlson Comorbidity Index. During a median follow-up of 5.1 years, 237 of 1049 participants developed incident CVD or died. Unadjusted analyses showed an increased risk of the primary outcome with every 10-event/hour increase in PLMI (hazard ratio [HR], 1.08 [95% CI, 1.05-1.13]) and AHI (HR, 1.17 [95% CI, 1.01- 1.37]). Assessment associations of AHI and PLMI and their interaction with the primary outcome revealed no significant interaction between PLMI and AHI. In fully adjusted analyses, PLMI, but not AHI, was associated with an increased risk of primary outcome: HR of 1.05 (95% CI, 1.00-1.09) per every 10 events/hour. Results were similar after adjusting with Framingham risk score.<br /><b>Conclusions</b><br />Our study revealed periodic limb movements during sleep as a risk factor for incident CVD or death among those who had AHI <30 events/hour, without synergistic association between periodic limb movements during sleep and obstructive sleep apnea.<br /><br /><br /><br /><small>J Am Heart Assoc: 06 Feb 2024; 13:e031630</small></div>
Zinchuk A, Srivali N, Qin L, Jeon S, ... Koo B, Yaggi HK
J Am Heart Assoc: 06 Feb 2024; 13:e031630 | PMID: 38240208
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