Coronary artery calcium (CAC) is a cornerstone of cardiovascular risk stratification but reflects cumulative plaque burden rather than active coronary inflammation. Pericoronary fat attenuation index (FAI) has emerged as a coronary computed tomography angiography (CCTA)-derived biomarker of vascular inflammation.
To evaluate combinations of FAI and CAC phenotypes and their prognostic value.
We studied adult patients undergoing CCTA for suspected coronary artery disease (CAD) between 2009 and 2013, with follow-up through January 2026. The primary endpoint was major adverse cardiovascular events (MACE). Cox regression and Kaplan–Meier analyses evaluated associations of FAI and CAC combinations with outcomes.
A total of 439 patients were included. During follow-up, 45 patients (8.1%) experienced MACE. High FAI (≥78.89 HU) independently predicted MACE (adjusted hazard ratio [aHR]: 2.19; 95% confidence interval [CI]: 1.15–4.17; p=0.017), as did high CAC (≥100) (aHR: 2.76; 95% CI: 1.325.77; p=0.007). FAI remained independently associated with MACE after adjustment for CAC, age, and sex (aHR: 2.25; 95% CI: 1.18–4.29; p=0.014). In low-CAC (<100) patients, elevated FAI identified increased risk (HR: 2.50; p=0.033). Combined high FAI/high CAC conferred the highest risk (HR: 6.86; p<0.001).
Combining FAI with CAC improves long-term cardiovascular risk stratification and understanding of disease staging.
Lior Segev-Steinbuch BSc BMSc, Shahar Peleg BMSc, Yoav Perez MD, Jonathan Gross MD-PhD, Yaron Arbel MD, Tomer Ziv-Baran PhD, Shmuel Banai MD, Galit Aviram MD
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Noise-induced hearing loss (NIHL) is the most common occupational impairment. Workplaces are obligated to implement hearing loss prevention programs that limit exposure duration and intensity. In the Israeli Air Force (IAF), the ground and air crews encounter noise levels of approximately 100 dB. The common hearing protection device in the IAF is disposable foam earplugs (DFE), which theoretically provide approximately 29 dB of attenuation. However, actual attenuation often falls short due to suboptimal insertion.
To evaluate earplug attenuation levels during intuitive insertion, to assess the impact of on-site training, and to examine the effects of prior training on attenuation.
Data were collected from subjects who were routinely evaluated at the IAF Aeromedical Center between 2020 and 2022. Noise reduction achieved with earplugs was measured using the 3M E-A-Rfit Dual-Ear Validation System. Participants who did not achieve at least 20 dB noise reduction (out of the maximum 29 dB declared by the manufacturer) were instructed on proper earplug use by the examiner and re-examined.
A total of 183 IAF personnel participated (mean age of 22.84±6.23 years). Less than 50% of study participants had been previously instructed on proper earplug use, and less than 40% properly used the earplugs. Participants without prior training achieved statistically significantly lower initial attenuation value (16.52 dB) compared to those who had been previously instructed (19.47 dB, P =0.002). Among participants who initially failed to achieve the target attenuation, individualized on-site instruction improved their average attenuation by approximately 8.10 dB (P <0.001).
Proper use of DFE is not intuitive or straightforward. Precise instruction on the use of earplugs greatly improves the attenuation level and may reduce noise-induced hearing loss, which is of great concern to military personnel.
Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization, with diabetes mellitus (DM) complicating management. While earlier studies reported a DM-associated mortality gap, contemporary therapies may be reducing this disparity.
To compare clinical profiles and outcomes between ADHF patients with and without DM and to identify independent predictors of mortality within the diabetic cohort.
Comparison of ADHF patients with and without DM (n=238 vs. n=172). Primary outcomes were length of stay (LOS) and in-hospital mortality. Predictors within the DM subgroup were identified using multivariable Cox regression.
DM prevalence was 58%. Diabetic patients had higher clinical burden, including higher BMI (31±6 vs. 28±6 kg/m2, p=0.014), ischemic heart disease, and renal failure (p=0.001). DM was associated with longer LOS (6±7 vs. 5±5 days, p=0.036), but no differences were observed in-hospital (8% vs. 10%) or one-year mortality (29% vs. 25%, p=0.372). In the DM subgroup, potassium levels at admission predicted in-hospital mortality (aHR = 4.893, p=0.003), regardless of baseline SGLT2i use (p=0.579). Median troponin at admission was higher in DM patients and non-survivors (p<0.05). HFrEF predicted one-year mortality (aHR = 4.137, p=0.002), while acute glycemic markers did not.
In ADHF, DM increases clinical burden through longer LOS but does not independently predict mortality, suggesting a narrowing mortality gap. Prognosis is driven by cardio-renal stress and HFrEF phenotype rather than acute glycemic markers. Risk stratification should prioritize neurohormonal and renal stabilization over intensive inpatient glycemic control.
