Background: Chronic kidney disease (CKD) may be associated with fatal cardiovascular diseases (CVDs). We aim to identify CVD‐related mortality trends in patients with CKD in the US, examining the variation by sex, race, and region, and compare them to CVD‐related mortality trends in general.Methods: The CDC‐WONDER database was used to obtain age‐adjusted mortality rates (AAMRs) per 100,000 population. Annual percent change (APC) and average APC (AAPC) in these rates were calculated using Joinpoint regression and comparisons were done using pairwise comparison.Results: From 1999 to 2020, a total of 605,384 CVD‐related deaths were observed in patients with CKD. The AAMR was almost double in males (11.0) than females (6.3). NH (Non‐Hispanic) Blacks or African Americans displayed the highest overall AAMR while NH Asians or Pacific Islanders displayed the lowest. AAMRs also varied substantially by region (Midwest: 8.8; West: 8.6; South: 8.0; Northeast: 7.3). States with the highest AAMR was the District of Columbia. Nonmetropolitan regions exhibited a slightly higher AAMR (8.6) than metropolitan regions (8.1). The AAPC for CVD‐related deaths in patients with CKD differed significantly from that of the general population for the entire cohort, across both sexes, as well as among NH Whites, NH Black or African Americans, and Hispanics or Latinos. Regional differences were also observed in the Midwest, Northeast, and West.Conclusion: Significant differences in CVD‐related deaths in patients with CKD were observed. These high‐risk groups should be the point of focus for targeted interventions to reduce CVD‐related mortality in CKD patients.

Khat, derived from the Catha edulis plant, is widely consumed in East Africa and the Arabian Peninsula, where it holds significant socio-cultural importance. This review examines the multifaceted effects of khat, particularly focusing on its cardiovascular implications. Khat’s active constituents, notably cathinone and cathine, exhibit stimulant and psychoactive properties akin to amphetamines, leading to heightened alertness and euphoria. However, chronic consumption is associated with adverse effects, including cardiovascular diseases such as hypertension, myocardial infarction, and cardiomyopathy. The review highlights the pharmacokinetics of khat, with cathinone being rapidly absorbed and leading to sympathomimetic effects. Studies indicate a correlation between chronic khat use and increased risks of hypertension, acute coronary syndromes, and cardiomyopathy. These cardiovascular conditions are exacerbated by prolonged hemodynamic stress, catecholamine release, and oxidative stress induced by khat’s active compounds. Additionally, khat’s impact extends beyond the cardiovascular system, affecting neurological, reproductive, and gastrointestinal health. Despite its legality in certain regions, khat is classified as a controlled substance in many countries, emphasizing the need for global awareness of its health risks. This review calls for longitudinal studies to elucidate the pathophysiological mechanisms of khat-induced cardiomyopathy and to identify potential biomarkers for its early detection. Furthermore, it advocates for culturally sensitive public health initiatives and clinical guidelines to mitigate the adverse health effects of khat consumption, especially among immigrant populations in developed nations. Recognizing and addressing khat’s cardiovascular implications is crucial for improving patient outcomes and guiding effective clinical practice.

Background/Objectives: GPT-3.5 and GPT-4 has shown promise in assisting healthcare professionals with clinical questions. However, their performance in real-time clinical scenarios remains underexplored. This study aims to evaluate their precision and reliability compared to board-certified emergency department attendings, highlighting their potential in improving patient care. We hypothesized that board-certified emergency department attendings at Maimonides Medical Center exhibit higher accuracy and reliability than GPT-3.5 and GPT-4 in generating differentials based on history and physical examination for patients presenting to the emergency department. Methods: Real-time patient data from Maimonides Medical Center’s emergency department, collected from 1 January 2023 to 1 March 2023 were analyzed. Demographic details, symptoms, medical history, and discharge diagnoses recorded by emergency room attendings were examined. AI algorithms (ChatGPT-3.5 and GPT-4) generated differential diagnoses, which were compared with those by attending physicians. Accuracy was determined by comparing each rater’s diagnoses with the gold standard discharge diagnosis, calculating the proportion of correctly identified cases. Precision was assessed using Cohen’s kappa coefficient and Intraclass Correlation Coefficient to measure agreement between raters. Results: Mean age of patients was 49.12 years, with 57.3% males and 42.7% females. Chief complaints included fever/sepsis (24.7%), gastrointestinal issues (17.7%), and cardiovascular problems (16.4%). Diagnostic accuracy against discharge diagnoses was highest for ChatGPT-4 (85.5%), followed by ChatGPT-3.5 (84.6%) and ED attendings (83%). Cohen’s kappa demonstrated moderate agreement (0.7) between AI models, with lower agreement observed for ED attendings. Stratified analysis revealed higher accuracy for gastrointestinal complaints with Chat GPT-4 (87.5%) and cardiovascular complaints with Chat GPT-3.5 (81.34%). Conclusions: Our study demonstrates that Chat GPT-4 and GPT-3.5 exhibit comparable diagnostic accuracy to board-certified emergency department attendings, highlighting their potential to aid decision-making in dynamic clinical settings. The stratified analysis revealed comparable reliability and precision of the AI chat bots for cardiovascular complaints which represents a significant proportion of the high-risk patients presenting to the emergency department and provided targeted insights into rater performance within specific medical domains. This study contributes to integrating AI models into medical practice, enhancing efficiency and effectiveness in clinical decision-making. Further research is warranted to explore broader applications of AI in healthcare.

Systemic sclerosis (SSc) is an autoimmune disorder causing immune dysregulation, leading to microvascular damage and fibrosis. Cardiovascular involvement begins with endothelial dysfunction and progresses to vasospasm, ischemia, and fibrosis, impairing cardiac function. Common manifestations include myocardial fibrosis, conduction abnormalities, heart failure, and valvular dysfunction, affecting 15–35% of patients and contributing to 27.2% of SSc-related deaths. High-risk factors include male gender, older disease onset, African American ethnicity, diffuse cutaneous SSc, and poor quality of life. Subclinical cardiac dysfunction is common but underdiagnosed, and cardiovascular complications worsen outcomes. Pulmonary arterial hypertension is a major cause of morbidity and mortality and requires early diagnosis and multidisciplinary management. Treatments include calcium channel blockers, phosphodiesterase inhibitors, endothelin receptor antagonists, and prostacyclin analogs. Imaging (echocardiography, cardiac MRI, stress tests) and biomarkers (troponin, NT-proBNP, endothelin-1) help in diagnosis and monitoring. Early recognition and comprehensive management improve patient outcomes.

BACKGROUND Primary cardiac tumors are not as common as metastatic tumors, and biatrial masses are seldom benign and need differentiation from malignant tumors. Myxomas are usually unilateral, and biatrial myxomas are rare. They can also be associated with Carney complex and its subsets. This case highlights the unusual presentation of massive biatrial myxomas, with minimal symptoms. CASE REPORT A 46-year-old woman with asthma presented with worsening dyspnea and palpitations and was initially treated for asthma exacerbation; however, the symptoms continued to worsen, which led to further investigation. Computed tomography pulmonary angiography was done, which ruled out pulmonary involvement but revealed huge biatrial masses, right atrial component measuring 8.8×6.8 cm, and the left atrial component measuring 5.6×5.2 cm, which were confirmed on the transthoracic echocardiogram, along with low left ventricular ejection fraction (LVEF). Given the high-risk features and high suspicion of malignancy, an open surgical biopsy was done, and the mass turned out to be atrial myxoma. After appropriate staging, extensive surgical resection was done, with subsequent repair of the interatrial septum that was involved by the masses. The patient tolerated the surgery well and on follow-up was found to have symptomatic improvement, decrease in the size of atrial chambers, and normalization of LVEF. CONCLUSIONS Myxomas, although rare, can be biatrial and grow significantly, causing minimal symptoms. Malignancy should always be excluded in such high-risk atrial masses, but myxomas should be included in differential diagnoses for exertional dyspnea.