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BACKGROUNDPulmonary edema is a severe complication in patients with acute myocardial infarction which indicates the development of heart failure (HF) and poor prognosis. However, subclinical pulmonary edema after acute ST-segment elevation myocardial infarction (STEMI) without HF has not received enough attention in clinical practice. We aimed to investigate the prognostic value and associated clinical characteristics of subclinical pulmonary edema after acute STEMI without HF detected by chest computed tomography (CT).METHODSA total of 276 patients with acute STEMI without HF who underwent chest CT were included in this study. K-means clustering analysis was performed to classify the patients into different subgroups based on the mean lung density. Clinical characteristics of the different subgroups were compared and used to establish a machine learning model for discriminating between them. Relative risk (RR) for major adverse cardiovascular events (MACEs) during hospitalization was compared between the subgroups.RESULTSThe patients were classified into two subgroups. Subgroup 2 showed higher mean lung density than subgroup 1 (median [IQR], −727 [−747, −704] vs. −806 [−826, −785] HU, P < 0.001), with significantly higher levels of cardiac enzymes and numbers of inflammatory cells and significantly worse left ventricular function than subgroup 1. In the model analysis, the most important clinical characteristics were the levels of cardiac enzymes, numbers of inflammatory cells, and left ventricular function. The risk for MACEs was higher in subgroup 2 than in subgroup 1 (RR, 2.12; P = 0.002).CONCLUSIONSSubclinical pulmonary edema after acute STEMI without HF was mainly associated with elevated levels of cardiac enzymes, followed by increased numbers of inflammatory cells and worse left ventricular function. In addition, subclinical pulmonary edema provided crucial prognostic information for patients during hospitalization.

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Regimens based on Bruton's tyrosine kinase inhibitors (BTKi) have been increasingly used to treat mantle cell lymphoma (MCL). A real‐world multicenter study was conducted to characterize treatment patterns and outcomes in patients with newly diagnosed MCL by Chinese Hematologist and Oncologist Innovation Cooperation of the Excellent (CHOICE). The final analysis included 1261 patients. Immunochemotherapy was the most common first‐line treatment, including R‐CHOP in 34%, cytarabine‐containing regimens in 21% and BR in 3% of the patients. Eleven percent (n = 145) of the patients received BTKi‐based frontline therapy. Seventeen percent of the patients received maintenance rituximab. Autologous hematopoietic stem cell transplantation (AHCT) was conducted in 12% of the younger (<65 years) patients. In younger patients, propensity score matching analysis did not show significant difference in 2‐year progression‐free survival and 5‐year overall survival rate in patients receiving standard high‐dose immunochemotherapy followed by AHCT than induction therapy with BTKi‐based regimens without subsequent AHCT (72% vs 70%, P = .476 and 91% vs 84%, P = .255). In older patients, BTKi combined with bendamustine plus rituximab (BR) was associated with the lowest POD24 rate (17%) compared with BR and other BTKi‐containing regimens. In patients with resolved hepatitis B at the baseline, HBV reactivation rate was 2.3% vs 5.3% in those receiving anti‐HBV prophylaxis vs not; BTKi treatment was not associated with higher risk of HBV reactivation. In conclusion, non‐HD‐AraC chemotherapy combined with BTKi may be a viable therapeutic strategy for younger patients. Anti‐HBV prophylaxis should be implemented in patients with resolved hepatitis B.

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