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Serebruany V, Tanguay JF, Cabrera-Fuentes HA, Gurvich ML, Marciniak T. Impact of the reporting source on Platelet Inhibition and Treatment Outcomes (PLATO) trial deaths. Discoveries (Craiova) 2023; 11:e174. [PMID: 38405426 PMCID: PMC10890813 DOI: 10.15190/d.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Platelet Inhibition and Clinical Outcomes (PLATO) was a multicenter, randomized double-blind trial assessing efficacy and safety of ticagrelor versus clopidogrel in patients with acute coronary syndrome. The reported mortality benefit of ticagrelor in the PLATO trial has been challenged for over decade, and never confirmed in later trials. OBJECTIVE To compare if there were any differences when deaths were reported to the FDAby the sponsors or by independent Contract Research Organizations (CRO). METHODS We obtained the complete PLATO deaths dataset reported to the FDA and revealed that some events were inaccurately reported favoring ticagrelor. The entire FDA list contains precisely detailed 938 PLATO deaths. The CRO reported outcomes from the USA, Russia, Georgia, and most of Ukraine, while sites in 39 other countries were controlled by the trial sponsors. We compared vascular- (code "11"), non-vascular- (code "12"), and unknown (code "97") deaths triaged by the reporting source. RESULTS Overall, most PLATO deaths were vascular (n=677), less non-vascular (n=159) andunexpectedly many of "other" (n=7) or "unknown" (n=95) origin reported either by sponsors (n=807) or CRO (n=131). The trial sponsors reported more clopidogrel deaths from vascular (313 vs.239), non-vascular (86 vs.58) and unknown (53 vs. 26) causes.In contrast, CRO-monitored sites reported significantly (72 vs. 53; p<0.01) more ticagrelordeaths than after clopidogrel from vascular (51 vs.39), non-vascular (8 vs.7) and unknown (10 vs. 4) causes. CONCLUSION Deaths were reported differently by sponsors and CRO within the same trial. Since some deaths were misreported by PLATO sponsors, only the CRO data seems mostly reliable. Among all countries, the CRO - reported PLATO-USA outcomes represent the largest and most realistic dataset of realistic evidence suggesting ticagrelor inferiority to clopidogrel for all primary endpoint components including vascular death.
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Affiliation(s)
- Victor Serebruany
- Johns Hopkins University, Department of Neurology, Baltimore, MD, USA
| | | | - Hector A. Cabrera-Fuentes
- Research Center, Faculty of Medicine UNAM-UABJO, Autonomous University “Benito Juárez” of Oaxaca (UABJO), Oaxaca, Mexico
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Uğur S, Acarel M, Yapıcı N. CASUS and APACHE II score in predicting mortality after coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:343-351. [PMID: 37664771 PMCID: PMC10472474 DOI: 10.5606/tgkdc.dergisi.2023.24787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 09/05/2023]
Abstract
Background This study aims to compare Cardiac Surgery Score (CASUS) and the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring systems for predicting mortality in patients undergoing isolated coronary artery bypass grafting. Methods Between January 2019 and March 2019, a total of 204 patients (166 males, 38 females; mean age: 60.5±0.7 years; range, 59.2 to 61.9 years) who underwent isolated coronary artery bypass grafting and were monitored at least for 24 h in the intensive care unit postoperatively were included. Pre-, intra-, and postoperative data were recorded. The CASUS and APACHE II scores were calculated using the most abnormal values for each variable during the first 24 h, postoperatively. Clinical outcomes were seven-day mortality and 30-day mortality, need for reintubation, readmission to the intensive care unit, length of intensive care unit stay and length of hospital stay. Results The 30-day overall mortality was 4.9% (n=10). The CASUS scores were significantly higher for patients developing mortality within 30 days postoperatively (p=0.030) and for patients needing reintubation (p=0.003). In the receiver operating characteristic curve analysis predicting seven-day mortality and prolonged intensive care unit stay, the area under curve was higher for CASUS scoring compared to APACHE II (0.90 vs. 0.72 and 0.82 vs. 0.76). Conclusion The CASUS may prove to be a more reliable scoring system than APACHE II for predicting mortality and morbidity in patients undergoing isolated coronary artery bypass grafting.
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Affiliation(s)
- Sümeyye Uğur
- Department of Anesthesiology and Intensive Care Medicine, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Murat Acarel
- Department of Anesthesiology and Intensive Care Medicine, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Nihan Yapıcı
- Department of Anesthesiology and Intensive Care Medicine, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
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3
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Richie RC. Mortality Statistics in Asthma. J Insur Med 2023; 49:244-249. [PMID: 37074876 DOI: 10.17849/insm-49-04-244-249.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
This article summarizes the mortality associated with asthma and was created from a presentation given at the 130th AAIM Annual Meeting.
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Anbari K, Amiri MM, Heidari-Soureshjani S, Sherwin CM, Kasiri K. A Systematic Review and Meta-analysis on the Role of Statins in the Prevention of Mortality Following Pancreatic Cancer. Anticancer Agents Med Chem 2023; 23:2073-2082. [PMID: 37622694 DOI: 10.2174/1871520623666230824095226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pancreatic cancer (PC) is a type of cancer with a high incidence and case-fatality rate. OBJECTIVE This study aimed to evaluate the role of statins in preventing mortality following PC based on scientific evidence with systematic review and meta-analysis method. METHODS This meta-analysis considered studies published from 1980 till the end of 2022 in ISI Web of Science, Scopus, PubMed, Cochrane, Science Direct, Google Scholar, and Embase databases. Funnel diagrams and Begg's and Egger's tests were used to assess the publication bias. RESULTS In general, this meta-analysis has included 19 studies (13 cohort studies, 4 case-control, and 2 randomized clinical trials (RCTs)) and a total of 100,888 patients with PC. The risk of mortality of PC in statin users in total was 0.86 (95% CI: 0.80 - 0.92, P-value <0.001); in the case-control studies, it was equal to 0.53 (0.34-0.83); in the cohort studies, it was equal to 0.87 (0.82-0.92, P-value <0.001); in RCTs, it was equal to 1.19 (0.99-1.42, P-value <0.001); in studies with good quality score category, it was equal to 0.92 (0.86-0.99, P-value <0.001), and in articles of the moderate quality score category, it was equal to 0.73 (0.64-0.84, P-value <0.001). The results of statistical tests indicated the existence of publication bias (Begg's test (P-value = 0.002) and Egger's test (P-value = 0.004)). CONCLUSION Statins reduce the risk of mortality in patients with PC. However, no significant relation has been observed in RCTs. Therefore, it is necessary to be cautious in interpreting the results.
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Affiliation(s)
- Khatereh Anbari
- Department of Community Medicine, School of Medicine, Social Determinant of Health Research Center, Lorestan University of Medical Science, Khorramabad, Iran
| | - Mehdi Mohammadian Amiri
- Department of Emergency Medicine, School of Medicine, Babol University of Medical Sciences, Mazandaran, Iran
| | | | - Catherine Mt Sherwin
- Pediatric Clinical Pharmacology and Toxicology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, One Children's Plaza, Dayton, Ohio, USA
| | - Karamali Kasiri
- Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Vijayaraman P, Rajakumar C, Naperkowski AM, Subzposh FA. Clinical Outcomes Of Left Bundle Branch Area Pacing Compared To His Bundle Pacing. J Cardiovasc Electrophysiol 2022; 33:1234-1243. [PMID: 35488749 DOI: 10.1111/jce.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND His bundle pacing (HBP) is the most physiologic form of pacing and has been associated with reduced risk for heart failure hospitalization (HFH) and mortality compared to right ventricular pacing. Left bundle branch area pacing (LBBAP) is a safe and effective alternative option for patients needing ventricular pacing. OBJECTIVE The aim of this study was to compare the clinical outcomes between LBBAP and HBP among a large cohort of patients undergoing permanent pacemaker implantation. METHODS This observational registry included consecutive patients with AV block/AV node ablation who underwent de novo permanent pacemaker implantations with successful LBBAP or HBP between April 2018 to October 2020. The primary outcome was the composite endpoint of time to death from any cause or HFH. Secondary outcomes included the composite endpoint among patients with prespecified ventricular pacing burden and individual outcomes. RESULTS The study population included 359 patients who met the inclusion criteria (163 in the HBP and 196 in the LBBAP group). Paced QRSd during LBBAP was similar to HBP (125 ± 20.2 vs 126 ± 23.5 ms, p=0.643). There were no statistically significant differences in the primary composite outcome in LBBAP (17.3%) compared to HBP (24.5%) (HR 1.15, CI 0.72-1.82, p = 0.552). Secondary outcomes of death (10 vs 17%; HR 1.3, CI 0.73-2.33, p=0.38) and HFH (10 vs 12%; HR 1.02,CI 0.54-1.94, p=0.94) were not different among both groups. CONCLUSIONS There were no statistically significant differences in the clinical outcomes of death or HFH in LBBAP when compared to HBP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Wilkes Barre, PA.,Geisinger Commonwealth School of Medicine, Scranton, PA
| | | | | | - Faiz A Subzposh
- Geisinger Heart Institute, Wilkes Barre, PA.,Geisinger Commonwealth School of Medicine, Scranton, PA
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Gupta AK, Kerr LD, Stretton B, Kovoor JG, Ovenden CD, Hewitt JN, Chan JC. Trends in the Extracorporeal Membrane Oxygenation Literature: A Bibliometric Analysis in the COVID-19 Era. J Extra Corpor Technol 2022; 54:19-28. [PMID: 36380822 PMCID: PMC9639694 DOI: 10.1182/ject-19-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/16/2022] [Indexed: 06/16/2023]
Abstract
Extracorporeal Membrane Oxygenation (ECMO) was first used in the 1970s. Its use is increasingly common in critical care and perioperative settings and has gained newfound prominence during COVID-19. To guide future research, we conducted a bibliometric analysis of ECMO literature. Thomson Reuters Web of Science was searched to March 7, 2021. Articles were ranked by total number of citations. Data was extracted from the 100 most cited papers relevant to ECMO for study design, topic, author, year, and institution. Journal impact factor for 2019 and Eigenfactor scores were also recorded. Our search retrieved a total of 18,802 articles. Median number of citations for the top 100 articles was 220 (range 157-1,819). These were published in 34 journals, with first authors originating from 15 countries. The Annals of Thoracic Surgery had the highest number of articles (n = 9) while Lancet publications had the most citations (n = 3,191). Use of ECMO was most commonly observed in cardiogenic shock or acute respiratory distress syndrome. United States had the greatest article output (n = 49). With 10 publications, 2013 was the most prolific year. Using linear regression, when controlled for time since publication, there was no statistically significant relationship between 2019 journal impact factor and number of article citations (p = .09). Top articles in the ECMO literature are of considerable impact and quality. As the United States produced the bulk of the prominent evidence base, and most data were regarding respiratory issues, outsized advances in ECMO may be possible within the United States during the COVID-19 era.
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Affiliation(s)
- Aashray K. Gupta
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lachlan D. Kerr
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Joshua G. Kovoor
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; and
| | - Christopher D. Ovenden
- Discipline of Surgery, University of Adelaide, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - Joseph N. Hewitt
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; and
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Cakir E, Gok G, Erel O, Turan IO. Thiol/Disulfide Homeostasis as an Early Biomarker to Differentiate Sepsis from Pneumonia in Intensive Care Units. Comb Chem High Throughput Screen 2021; 24:1446-1452. [PMID: 33135606 DOI: 10.2174/1386207323999201029120333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is possible that patients with pneumonia may also have sepsis and the separation of these two clinical entities may cause some trouble to clinicians. OBJECTIVE In order to separate a patient with pneumonia and a patient with sepsis, we qualify thiol/disulfide homeostasis as a potential biomarker. METHODS This study was designed between February 2018 - February 2019 prospectively. All patients in the intensive care unit with pneumonia and sepsis were enrolled in the study. At the time of hospitalization, thiol/disulfide homeostasis was measured. Patients diagnosed with sepsis and pneumonia were compared, in regards to thiol/disulfide homeostasis. RESULTS During research period, 103 patients with sepsis and 120 patients with pneumonia were enrolled into the study. When we compared native-thiol, total-thiol, and disulfide levels in both sepsis and pneumonia patients, we had similar results (p>0.05). In sepsis group, index-1 (disulfide/native thiol ratio) and index-2 (disulfide/total thiol ratio) were found to be statistically higher than the pneumonia group, and index-3 (native thiol/total thiol ratio) was statistically lower than the pneumonia group (p=0.020, p= 0.021, p=0.021, respectively). CONCLUSION In this study, we showed that thiol/disulfide homeostasis could be used as new markers in the early period in order to separate patients with sepsis and patients with pneumonia.
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Affiliation(s)
- Esra Cakir
- Department of Anesthesiology and Clinical of Critical Care, Health Sciences University, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Gamze Gok
- Department of Biochemistry, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Ozcan Erel
- Department of Biochemistry, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Isil Ozkocak Turan
- Department of Anesthesiology and Clinical of Critical Care, Health Sciences University, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Gunduz Y, Karacan A, Karabay O, Erdem AF, Kindir O, Ozturk MH. Could chest CT findings taken on admission in symptomatic patients with COVID-19 be related to the prognosis and clinical outcome of the disease? Curr Med Imaging 2021; 18:658-665. [PMID: 34082689 DOI: 10.2174/1386207324666210603154426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
AIM Initial chest CT findings of patients were compared by grouping them according to the clinical outcome of the infection and those which could predict clinical outcome, prognosis and mortality were investigated. BACKGROUND Published studies on chest CT in COVID-19 infection do not go beyond describing the characteristics of the current period. Nevertheless, comparative analysis of chest CT findings on hospital admission among patients in different clinical outcomes is scarce. OBJECTIVE 198 consecutive symptomatic patients with COVID-19 infection confirmed by positive polymerase chain reaction (PCR) and who had undergone chest CT were enrolled in this retrospective study. METHOD According to their clinical outcomes, we divided them (n:98) into 3 groups. Group 1 (n: 62) involved patients discharged from the service, group 2 (n: 60) included patients hospitalized in the intensive care unit, and group 3 (n: 76) comprised patients who died despite any treatment. RESULTS Clinical characteristics involving age, dyspnea, hypertension, and chest CT findings of mediastinal lymphadenopathy, pleural effusion, and pericardial effusion, were determined as poor prognosis and mortality predictors, and halo sign in chest CT finding was a good prognosis predictor in multivariate analysis. CONCLUSION It was seen that some CT findings were significantly correlated to the patients' endpoints, such as discharge, hospitalization in the intensive care unit, and as a worst consequence, death. These findings support the role of CT imaging for potentially predicting the clinical outcomes of these patients with COVID-19.
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Affiliation(s)
- Yasemin Gunduz
- Radiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Alper Karacan
- Radiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Oguz Karabay
- Infectious diseases and clinical microbiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Ali Fuat Erdem
- Anesthesiology and reanimation Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Osman Kindir
- Radiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
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Alawneh D, Younis M, Hamarshi MS. The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis. Curr Diabetes Rev 2021; 17:e110320187540. [PMID: 33143629 DOI: 10.2174/1573399816999201103141726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND According to the Center for Disease Control and Prevention, diabetic ketoacidosis (DKA) hospitalization rates have been steadily increasing. Due to the increasing incidence and the economic impact associated with its morbidity and treatment, effective management is key. We aimed to streamline the management of DKA in our intensive care units (ICU) by implementing a Best-Practice Advisory (BPA) that notifies providers when DKA has resolved. METHODS A BPA was implemented on 9/15/2018. We conducted a retrospective review of patients admitted to the ICU with DKA a year before and after 9/15/2018. Adults (≥18 age) meeting DKA criteria on admission and treated with continuous insulin infusion (CII) were included. Pre-intervention group included patients admitted before BPA implementation and post-intervention group included patients admitted after. Summary and univariate analyses were performed. RESULTS A total of 282 patients were included; 162 (57%) pre-intervention and 120 (43%) post-intervention. Mean (±SD) age of the patients was 44 (±17) years. There was no significant difference in baseline characteristics such as age, sex, race, BMI, HbA1c, initial blood glucose, anion gap or bicarbonate concentration between both the groups (p>0.05). Mean (±SD) total time on CII in hours was significantly lower in the post-intervention group {14.8 (±7.7) vs. 17.5 (±14.3) p=0.041, 95% CI: 0.11-5.3}. The incidence of hypoglycemia was lower in the post-intervention group {n=4 (3%) vs. 17 (10%), p=0.024}. There was no significant difference in hypokalemia, mortality, LOS or ICU stay between both the groups (p>0.05). CONCLUSION The BPA introduced in our DKA management algorithm successfully reduced the total time on insulin and the incidence of hypoglycemia.
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Affiliation(s)
- Diala Alawneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, 64110, Missouri, United States
| | - Moustafa Younis
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, 64110, Missouri, United States
| | - Majdi S Hamarshi
- Critical Care, Saint Luke's Health System, Kansas City, MO, 64111, Missouri, United States
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Pan KL, Wu YL, Lee M, Ovbiagele B. Catheter Ablation Compared with Medical Therapy for Atrial Fibrillation with Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Med Sci 2021; 18:1325-1331. [PMID: 33628087 PMCID: PMC7893556 DOI: 10.7150/ijms.52257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The optimal strategy for patients with coexisting atrial fibrillation (AF) and heart failure (HF) was not settled. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of catheter ablation compared with medical therapy for AF on mortality, HF hospitalization, left ventricular (LV) function, and quality of life among patients with HF and AF. Materials and Methods: We searched Pubmed (1966 to September 20, 2019), EMBASE (1966 to September 20, 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials with a comparison of catheter ablation for AF with medical therapy among patients with coexisting AF and HF. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used as a measure of the effect of catheter ablation versus medical therapy on endpoints. Our final analysis included 6 randomized control trials with 775 patients. Results: Pooled results from the random-effects model showed that compared with medical therapy for AF, catheter ablation was associated with reduced all-cause mortality (RR 0.52, 95%Cl, 0.35 to 0.76) and HF hospitalization (RR 0.56, 95%Cl, 0.44 to 0.71), as well as increased LV ejection fraction (LVEF), distance walked in six minutes, and improvements in quality of life. Conclusions: This updated meta-analysis showed that compared to medical therapy, catheter ablation for AF was associated with significant benefits in several key clinical and biomarker endpoints, including reductions in all-cause mortality and HF hospitalization.
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Affiliation(s)
- Kuo-Li Pan
- Division of Cardiology, Department of internal medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Heart Failure Center, Chang Gung Memorial Hospital, Chiayi branch, Taiwan
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Meng Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi Branch, Taiwan
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, California, USA.,San Francisco VA Healthcare System, San Francisco, California, USA
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Shehab A, Bhagavathula AS, Al-Rasadi K, Alshamsi F, Al Kaab J, Thani KB, Mustafa R. Diabetes and Mortality in Acute Coronary Syndrome: Findings from the Gulf COAST Registry. Curr Vasc Pharmacol 2020; 18:68-76. [PMID: 30360744 DOI: 10.2174/1570161116666181024094337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND The prevalence of traditional risk factors such as diabetes mellitus (DM) and obesity are increasing in patients with acute coronary syndrome (ACS). Furthermore, outcomes after ACS are worse in patients with DM. The high prevalence of DM and an early age at onset of ACS have been described in prior publications from the Gulf Coast Database. AIMS We aimed to define the effect of DM on total mortality following ACS presentation at 30-days and 1 year based on the Gulf COAST registry database. METHODS The Gulf COAST registry is a prospective, multinational, longitudinal, observational cohort study conducted among Gulf citizens admitted with a diagnosis of ACS. The outcomes among patients with DM following ACS were stratified into 2 groups based on their DM status. Cumulative survival stratified by groups and subgroup categories was assessed by the Kaplan-Meier method. RESULTS Of 3,576 ACS patients, 2,730 (76.3%) presented with non ST-segment elevation myocardial infarction (NSTEMI) and 846 (23.6%) with STEMI. Overall, 1906 patients (53.3%) had DM. A significantly higher in-hospital (4.8%), 30-day (6.7%) and 1-year (13.7%) mortality were observed in patients with DM compared with those without DM. The Kaplan-Meier survival curve showed significant differences in survival of ACS patients with or without DM, with a short period of time-to-event for DM patients with STEMI (30-days) and the longest (1-year) for NSTEMI patients without DM. CONCLUSION DM patients presenting with ACS-STEMI have poor short-term outcomes while DMNSTEMI patients have poor long-term outcomes. This highlights the need for strategies to evaluate DM control and integration of care to control vascular risk among this high-risk population.
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Affiliation(s)
- Abdulla Shehab
- Department of Internal medicine, United Arab Emirates University- College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Akshaya Srikanth Bhagavathula
- Department of Internal medicine, United Arab Emirates University- College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fayez Alshamsi
- Department of Internal medicine, United Arab Emirates University- College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Juma Al Kaab
- Clinical affairs Internal Medicine, United Arab Emirates University - College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | | | - Ridha Mustafa
- Department of Medicine, Ministry of Health, Al-Adan, Kuwait
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Mahmoudvand H, Khalaf AK, Beyranvand M. In Vitro and Ex Vivo Evaluation of Capparis spinosa Extract to Inactivate Protoscoleces During Hydatid Cyst Surgery. Curr Drug Discov Technol 2020; 18:e18082020185049. [PMID: 32814534 DOI: 10.2174/1570163817999200819091336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hydatidosis is one of the most dangerous zoonosis diseases in the world caused by the larval stage of the broad-worm or Echinococcus granulosus parasite. Today, cysts' rupture or content leakage during surgery and involvement of organs adjacent to the organ involved, and consequently secondary cysts, are the major concern for hydatid cyst surgeons. Therefore, using scolicidal substances such as hypertonic saline 20%, silver nitrate and formalin has been considered to reduce the risk of protoscoleces spread and recurrence of disease in recent years. The current work was designed to assess the antiparasitic effects of Capparis spinose L. extract against hydatid cyst protoscoleces. METHODS Collected protoscoleces from liver fertile hydatid cysts of infected sheep were exposed to the different concentrations of the essential oil (150, 300, 600 mg/mL) for 5-60 min in vitro and ex vivo. Then by using the eosin exclusion assay, the viability of protoscoleces was studied. The primary phytochemical analysis of the C. spinosa extract was done to assess the presence of tannins, alkaloids, saponins, flavonoids, terpenoids and glycosides. RESULTS C. spinosa extract exhibited a powerful protoscolicidal activity in vitro so at the dose of 300 and 600 mg/ml, it entirely eliminated the parasite after 10 and 5 minutes; whereas at lower doses, it demonstrated weak protoscolicidal activity. In ex vivo assay, no similar effect to in vitro assay was observed, so more time was required to show a potent protoscolicidal activity. C. spinosa extract, at the concentrations of 300 and 600 mg/mL after an exposure time of 20 and 12 min, killed 100% of protoscoleces within the hydatid cyst, respectively. The findings of primary phytochemical screening of the C. spinosa extract demonstrated the existence of flavonoids, tannins, terpenoids, glycosides and alkaloids in this plant. CONCLUSION The obtained results in vitro and ex vivo exhibited potent protoscolicidal effects of C. spinosa extract particularly at the concentrations of 600 and 300 mg/ml, which entirely eliminated the parasite after 5-20 min exposure. However, more supplementary works are required to verify these findings through assessing in animal models and clinical subjects.
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Affiliation(s)
- Hossein Mahmoudvand
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Amal Khudair Khalaf
- Department of Microbiology, College of Medicine, Thiqar University, Thiqar, Iraq
| | - Mania Beyranvand
- Department of Surgery, Lorestan University of Medical Sciences, Khorramabad, Iran
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13
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Al-Thani H, El-Matbouly M, Al-Sulaiti M, Al-Thani N, Asim M, El-Menyar A. Does Perioperative Hemoglobin A1c Level Affect the Incidence, Pattern and Mortality of Lower Extremity Amputation? Curr Vasc Pharmacol 2020; 17:354-364. [PMID: 29359671 DOI: 10.2174/1570161116666180123112529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA). METHODS A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively. RESULTS The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control. CONCLUSION The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Vascular and Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | | | - Noora Al-Thani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Vascular and Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Vascular and Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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14
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Ghanavati M, Rahmani J, Rinaldi G, Zand H. Fasting Insulin and Risk of Cancer Related Mortality in Non-diabetic Adults: A Dose-response Meta-analysis of Cohort Studies. Curr Diabetes Rev 2020; 16:357-363. [PMID: 31490761 DOI: 10.2174/1573399815666190906130544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Insulin is known to have direct and indirect effects on cell cycle progression, proliferation and metastatic activities. We performed a dose-response meta-analysis to investigate the association between hyperinsulinemia and all-cause cancer related mortality. METHODS A systematic literature search was conducted on MEDLINE and SCOPUS databases to include all published articles up to January 2019. Combined hazard ratios (HRs) with 95% Confidence Intervals (CIs) were estimated using DerSimonian and Laird random-effects models. A dose-response analysis was also conducted to further explore insulin's relationship with cancer-related mortality. RESULTS We identified seven studies, with a total of 23,990 participants, who reported the association between hyperinsulinemia and cancer-related mortality. Results from the eligible studies indicated that higher fasting insulin levels were not associated with an increased risk of cancer mortality (pooled HR: 1.14, 95% CI: 0.99-1.32), however, significant heterogeneity was present (I2 = 60.3%, P heterogeneity = 0.001). A subgroup analysis based on gender demonstrated a significant association between fasting insulin level and cancer mortality in men (pooled HR: 1.92, 95% CI: 1.23-3.01, P heterogeneity = 0.281). CONCLUSION This dose-response meta-analysis showed a direct significant association between fasting insulin level and cancer mortality in men.
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Affiliation(s)
- Matin Ghanavati
- Student Research Committee, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamid Zand
- Department of Cellular and Molecular Nutrition, Faculty of Nutrition Science and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Oliverius M, Gojda J, Hajer J, Souček P, Šturma J, Mohleníková-Duchoňová B, Gürlich R. Oncosurgery in older patients. Cas Lek Cesk 2020; 159:26-30. [PMID: 32290670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Population aging is one of the most significant health problems of the 21st century and has led to an increased need for surgery in elderly patients. Only chronological age should not be decisive when indicating patients for elective procedures. Other objective findings should be taken into account too. The complex geriatric examination is an optimized, detailed and accurately defined method, which leads to better postoperative outcomes in elderly patients. In everyday practice it is sufficient to evaluate the mental, physical and nutritional state of the patient. The goal of our study was to evaluate the perioperative morbidity and mortality of elderly patients undergoing hepatopancreatobiliary procedures. In our retrospective study we evaluated prospectively collected data of patients who underwent surgical procedures between 2015 and March 2019. In total 245 patients underwent pancreatic procedures and 156 underwent hepatic procedures. Morbidity and mortality were evaluated in the first 75 postoperative days and classified according the Clavien-Dindo classification. Our results show that when surgical procedures are correctly indicated in elderly patients, acceptable postoperative morbidity and mortality can be achieved. Since the year 2018 we have been actively using prerehabilitation in our center and it has led to improved postoperative outcomes in elderly and high-risk patients.
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Ruggieri V, Gómez JLC, Martínez MM, Arberas C. Aging and Autism: Understanding, Intervention and Proposals to Improve Quality of Life. Curr Pharm Des 2019; 25:4454-4461. [PMID: 31801450 DOI: 10.2174/1381612825666191204165117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The population with autism spectrum disorder (ASD) has been increasing and is currently estimated to be 1 in 58 births. The increased prevalence of ASD together with the lack of knowledge on the processes of aging in this population, the support needed at this stage of life, and the associated risk factors, have led to an urgent need for further research. METHODS This study provides a review of the literature on social- and health-related conditions that may appear when persons with ASD grow old. RESULTS In addition to the autism-related conditions, different neurological, genetic, and environmental factors may be involved in the process of aging. In this complex setting, this study provides proposals that may guide the development of support services that may improve the quality of life for aging people with ASD. CONCLUSION Aging in ASD is emerging as a growing problem, which requires immediate planning and targetted treatment development.
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Affiliation(s)
- Victor Ruggieri
- Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | | | | | - Claudia Arberas
- Hospital de Niños, Dr. R. Gutiérrez, Buenos Aires, Argentina
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17
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Parizadeh SM, Jafarzadeh-Esfehani R, Ghandehari M, Parizadeh SMR, Hassanian SM, Rezayi M, Ghayour-Mobarhan M, Ferns GA, Avan A. Circulating Exosomes as Potential Biomarkers in Cardiovascular Disease. Curr Pharm Des 2019; 24:4436-4444. [PMID: 30569849 DOI: 10.2174/1381612825666181219162655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/20/2018] [Accepted: 12/29/2019] [Indexed: 11/22/2022]
Abstract
Cardiovascular disease (CVD) is the first leading cause of morbidity and mortality in developing and developed countries. Circulating exosomes have recently been identified as extracellular transporters, detectable in biological fluids. Exosomes have established a new era in diagnosing diseases, especially CVD. Determination of exosome profiles, e.g., miRNAs, for different health states such as myocardial injury still requires further studies. In this review, we will discuss the role of exosomes as a potential biomarker in CVD, with particular emphasis on recent advances in the methods to study exosomes, isolation, detection, and characterization.
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Affiliation(s)
| | - Reza Jafarzadeh-Esfehani
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Ghandehari
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | | | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Rezayi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, United Kingdom
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Modern Sciences and Technologies; Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Hu D, Peng F, Lin X, Zhang H, Xia Y, Lin J, Zheng X, Niu W. The risk trajectory between preoperative fasting glucose and common digestive tract cancer-specific mortality in the FIESTA cohort involving 6865 Chinese patients. J Cancer 2019; 10:4596-4602. [PMID: 31528223 PMCID: PMC6746143 DOI: 10.7150/jca.31184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/21/2019] [Indexed: 12/25/2022] Open
Abstract
Backgrounds: High blood glucose or hyperglycemia is an established risk factor for the development and progression of cancer at many sites, whereas data on the relevance between low blood glucose or hypoglycemia and cancer survival are lacking. Aims: We aimed to assess the shape of risk trajectory between preoperative fasting glucose and postoperative digestive cancer-specific mortality in Chinese. Methods: In total, 6865 patients who underwent radical surgery for esophageal cancer (n=2535), gastric cancer (n=3012) and colorectal cancer (n=1318) during 2000-2010 were followed up as of December 2015. All patients received neither chemotherapy nor radiotherapy before and after the surgery. Optimal cutoff points were determined using survival tree analysis. Results: The median follow-up time was 44.9 months (range: 0.5-188.9 months), with 1065 deaths from esophageal cancer, 1331 from gastric cancer and 412 from colorectal cancer. Using fasting glucose (4.36, 6.09] mmol/L as the reference group, hazard ratios for fasting glucose ≤4.36, (6.09, 8.95], (8.95, 11.5] and >11.5 mmol/L were 1.35 (95% confidence interval: 1.19, 1.54), 2.82 (2.57, 3.11), 3.56 (3.10, 4.08) and 4.27 (3.67, 4.97), respectively (p<0.001). Conclusions: Our findings indicate a U-shaped risk trajectory between preoperative fasting glucose and digestive tract cancer-specific mortality in Chinese. Further external validation is warranted.
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Affiliation(s)
- Dan Hu
- Department of Pathology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiandong Lin
- Department of Radiobiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Hejun Zhang
- Department of Pathology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Yan Xia
- Department of Pathology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Jinxiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiongwei Zheng
- Department of Pathology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
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19
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Zulfiqar AA, Hajjam A, Andrès E. Focus on the Different Projects of Telemedicine Centered on the Elderly In France. Curr Aging Sci 2019; 11:202-215. [PMID: 30836931 PMCID: PMC6635422 DOI: 10.2174/1874609812666190304115426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 11/22/2022]
Abstract
Telemedicine is now in vogue, allowing computer and communication tools to be deployed in different fields of health, such as Cardiology, Dermatology, areas in which it has received interest, and in international studies. As the population ages, older people are increasingly concerned about this innovative practice. This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of geriatric subjects in France. Since the beginning of the 2000's, several telemedicine projects and trials focused on chronic heart failure have been developed in the elderly, and also in the field of dermatology. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and the number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects. We take a look at telemedicine projects in France concerning the elderly.
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Affiliation(s)
- Abrar A. Zulfiqar
- Address correspondence to this author at the Department of Geriatrics, University Hospital of Rouen, Rouen, France; Tel: 0627102493;, E-mail:
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20
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Reddy S, Lee KS. Role of Cardiac Catheterization Lab Post Resuscitation in Patients with ST Elevation Myocardial Infarction. Curr Cardiol Rev 2018; 14:85-91. [PMID: 29769006 PMCID: PMC6088447 DOI: 10.2174/1573403x14666180517080828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/30/2018] [Accepted: 04/25/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Cardiac arrest remains a common and lethal condition associated with high morbidity and mortality. Even with improving survival rates, the successfully resuscitated post cardiac arrest patient is also at risk for poor neurological outcomes, functional status and long- term survival if not managed appropriately. Given that acute coronary occlusion has been found to be the leading cause of cardiac arrest, long-term prognosis is good in selected patients after successful out-of-hospital resuscitation and ST elevation myocardial infarction who are taken for immediate coronary angiography, treated with primary percutaneous coronary intervention and hypothermia when indicated. Conclusion: A priority should therefore be placed in diagnosing as quickly as possible patients who have an acute coronary occlusion (i.e. ST elevation myocardial infarction) and implementing the appropriate and timely therapeutic strategy, which will require close chain of survival co- ordination and the services of the cardiac catheterization lab. Here we review previous and current guidelines as well as associated evidence.
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Affiliation(s)
- Sridhar Reddy
- Sarver Heart Center, University of Arizona, Tucson, AZ, United States
| | - Kwan S Lee
- Sarver Heart Center, University of Arizona, Tucson, AZ, United States
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21
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Winkel P, Jakobsen JC, Hilden J, Jensen G, Kjøller E, Sajadieh A, Kastrup J, Kolmos HJ, Larsson A, Ärnlöv J, Gluud C. Prognostic value of routinely available data in patients with stable coronary heart disease. A 10-year follow-up of patients sampled at random times during their disease course. Open Heart 2018; 5:e000808. [PMID: 30228904 PMCID: PMC6135459 DOI: 10.1136/openhrt-2018-000808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 01/17/2023] Open
Abstract
Objective To characterise the long-term prognosis of patients with stable coronary artery heart disease by means of 'standard predictors' defined as demographic, clinical and biochemical quantities routinely available in general practices and ascertained at an interview not prompted by renewed cardiac complaints. Methods This is an observational study based on data from 2199 Copenhagen placebo patients from the 'clarithromycin for patients with stable coronary heart disease' trial of patients with stable coronary heart disease. In the trial, we compared the effects of 14 days of clarithromycin treatment versus placebo. The predictors were based on the interview forms and blood samples collected at entry, along with demographic information from hospital files.We studied 'standard predictors' of a composite outcome (myocardial infarction, unstable angina, cerebrovascular disease or all-cause death) and of all-cause death. Using Cox regression, we compared predictions of status at 3, 6 and 9 years without and with the use of 'standard predictors' and used receiver operating characteristic statistic. Results Few 'standard predictors' were associated (p<0.01) with the composite outcome or with all-cause death. When no 'standard predictors' were included, 63.2% of the model-based predictions of the composite outcome and 79.9% of death predictions were correct. Including all 'standard predictors' in the model increased the figures to 68.4% and 83.4%, respectively. C indices were low, except when all-cause death was assessed as a single outcome where C was 0.79. Conclusion 'Standard predictors' routinely available in general practices contribute only modestly to risk assessment in consecutively sampled patients with stable coronary heart disease as ascertained at a contact not prompted by renewed cardiac complaints. Novel biomarkers may improve the assessment. Trial registration number NCT00121550.
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Affiliation(s)
- Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital Blegdamsvej, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital Blegdamsvej, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Jørgen Hilden
- Section of Biostatistics, Department of Public Health Research, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Jensen
- Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Kjøller
- Department of Cardiology S, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Kastrup
- Department of Cardiology B, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Jørn Kolmos
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital Blegdamsvej, Copenhagen, Denmark
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Ong DSY, Frencken JF, Klein Klouwenberg PMC, Juffermans N, van der Poll T, Bonten MJM, Cremer OL. Short-Course Adjunctive Gentamicin as Empirical Therapy in Patients With Severe Sepsis and Septic Shock: A Prospective Observational Cohort Study. Clin Infect Dis 2018; 64:1731-1736. [PMID: 28329088 DOI: 10.1093/cid/cix186] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/25/2017] [Indexed: 12/30/2022] Open
Abstract
Background. Metaanalyses failed to demonstrate clinical benefits of beta lactam plus aminoglycoside combination therapy compared to beta lactam monotherapy in patients with sepsis. However, few data exist on the effects of short-course adjunctive aminoglycoside therapy in sepsis patients with organ failure or shock. Methods. We prospectively enrolled consecutive patients with severe sepsis or septic shock in 2 intensive care units in the Netherlands from 2011 to 2015. Local antibiotic protocols recommended empirical gentamicin add-on therapy in only 1 of the units. We used logistic regression analyses to determine the association between gentamicin use and the number of days alive and free of renal failure, shock, and death, all on day 14. Results. Of 648 patients enrolled, 245 received gentamicin (222 of 309 [72%] in hospital A and 23 of 339 [7%] in hospital B) for a median duration of 2 days (interquartile range, 1-3). The adjusted odds ratios associated with gentamicin use were 1.39 (95% confidence interval [CI], 1.00-1.94) for renal failure, 1.34 (95% CI, 0.96-1.86) for shock duration, and 1.41 (95% CI, 0.94-2.12) for day-14 mortality. Based on in vitro susceptibilities, inappropriate (initial) gram-negative coverage was given in 9 of 245 (4%) and 18 of 403 (4%) patients treated and not treated with gentamicin, respectively (P = .62). Conclusions. Short-course empirical gentamicin use in patients with sepsis was associated with an increased incidence of renal failure but not with faster reversal of shock or improved survival in a setting with low prevalence of antimicrobial resistance.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology.,Department of Intensive Care Medicine, and
| | - Jos F Frencken
- Department of Intensive Care Medicine, and.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
| | | | - Nicole Juffermans
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, and
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine & Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Marc J M Bonten
- Department of Medical Microbiology.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
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23
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Violi F, Cangemi R, Falcone M, Taliani G, Pieralli F, Vannucchi V, Nozzoli C, Venditti M, Chirinos JA, Corrales-Medina VF. Cardiovascular Complications and Short-term Mortality Risk in Community-Acquired Pneumonia. Clin Infect Dis 2018; 64:1486-1493. [PMID: 28205683 DOI: 10.1093/cid/cix164] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/15/2017] [Indexed: 12/17/2022] Open
Abstract
Background. Previous reports suggest that community-acquired pneumonia (CAP) is associated with an enhanced risk of cardiovascular complications. However, a contemporary and comprehensive characterization of this association is lacking. Methods. In this multicenter study, 1182 patients hospitalized for CAP were prospectively followed for up to 30 days after their hospitalization for this infection. Study endpoints included myocardial infarction, new or worsening heart failure, atrial fibrillation, stroke, deep venous thrombosis, cardiovascular death, and total mortality. Results. Three hundred eighty (32.2%) patients experienced intrahospital cardiovascular events (CVEs) including 281 (23.8%) with heart failure, 109 (9.2%) with atrial fibrillation, 89 (8%) with myocardial infarction, 11 (0.9%) with ischemic stroke, and 1 (0.1%) with deep venous thrombosis; 28 patients (2.4%) died for cardiovascular causes. Multivariable Cox regression analysis showed that intrahospital Pneumonia Severity Index (PSI) class (hazard ratio [HR], 2.45, P = .027; HR, 4.23, P < .001; HR, 5.96, P < .001, for classes III, IV, and V vs II, respectively), age (HR, 1.02, P = .001), and preexisting heart failure (HR, 1.85, P < .001) independently predicted CVEs. One hundred three (8.7%) patients died by day 30 postadmission. Thirty-day mortality was significantly higher in patients who developed CVEs compared with those who did not (17.6% vs 4.5%, P < .001). Multivariable Cox regression analysis showed that intrahospital CVEs (HR, 5.49, P < .001) independently predicted 30-day mortality (after adjustment for age, PSI score, and preexisting comorbid conditions). Conclusions. CVEs, mainly those confined to the heart, complicate the course of almost one-third of patients hospitalized for CAP. More importantly, the occurrence of CVEs is associated with a 5-fold increase in CAP-associated 30-day mortality.
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Affiliation(s)
| | | | - Marco Falcone
- Department of Public Health and Infectious Diseases, and
| | - Gloria Taliani
- Infectious and Tropical Diseases Unit, Department of Clinical Medicine, Sapienza University of Rome, and
| | - Filippo Pieralli
- Internal and Emergency Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Vieri Vannucchi
- Internal and Emergency Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Nozzoli
- Internal and Emergency Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, and
| | - Julio A Chirinos
- Division of Cardiology, University of Pennsylvania, Philadelphia
| | - Vicente F Corrales-Medina
- Department of Medicine, University of Ottawa, and.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
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Cole SR, Edwards JK, Hall HI, Brookhart MA, Mathews WC, Moore RD, Crane HM, Kitahata MM, Mugavero MJ, Saag MS, Eron JJ. Incident AIDS or Death After Initiation of Human Immunodeficiency Virus Treatment Regimens Including Raltegravir or Efavirenz Among Adults in the United States. Clin Infect Dis 2018; 64:1591-1596. [PMID: 28498892 DOI: 10.1093/cid/cix199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/16/2017] [Indexed: 12/20/2022] Open
Abstract
Background. The long-term effectiveness of human immunodeficiency virus (HIV) treatments containing integrase inhibitors is unknown. Methods. We use observational data from the Centers for AIDS Research Network of Integrated Clinical Systems and the Centers for Disease Control and Prevention to estimate 4-year risk of AIDS and all-cause mortality among 415 patients starting a raltegravir regimen compared to 2646 starting an efavirenz regimen (both regimens include emtricitabine and tenofovir disoproxil fumarate). We account for confounding and selection bias as well as generalizability by standardization for measured variables, and present both observational intent-to-treat and per-protocol estimates. Results. At treatment initiation, 12% of patients were female, 36% black, 13% Hispanic; median age was 37 years, CD4 count 321 cells/µL, and viral load 4.5 log10 copies/mL. Two hundred thirty-five patients incurred an AIDS-defining illness or died, and 741 patients left follow-up. After accounting for measured differences, the 4-year risk was similar among those starting both regimens (ie, intent-to treat hazard ratio [HR], 0.96 [95% confidence interval {CI}, .63-1.45]; risk difference, -0.9 [95% CI, -4.5 to 2.7]), as well as among those remaining on regimens (ie, per-protocol HR, 0.95 [95% CI, .59-1.54]; risk difference, -0.5 [95% CI, -3.8 to 2.9]). Conclusions. Raltegravir and efavirenz-based initial antiretroviral therapy have similar 4-year clinical effects. Vigilance regarding longer-term comparative effectiveness of HIV regimens using observational data is needed because large-scale experimental data are not forthcoming.
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Affiliation(s)
- Stephen R Cole
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - H Irene Hall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | | | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle
| | | | | | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham; and
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill
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Sausen G, Vieceli T, Rodrigues CG, Kipper D, Stein AT, Grezzana GB. Central hemodynamic parameters to predict cardiovascular outcomes and mortality among the elderly: protocol for a systematic review. SAO PAULO MED J 2018; 136:501-504. [PMID: 30569954 PMCID: PMC9897129 DOI: 10.1590/1516-3180.2018.0209050618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/05/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Central blood pressure is a factor that may predict cardiovascular events. However, its use in clinical practice is not well consolidated. Therefore, the aim of our study will be to summarize the use of central hemodynamic parameters to predict cardiovascular-related outcomes and all-cause mortality. DESIGN AND SETTING Protocol for systematic review of longitudinal observational studies conducted in healthcare institutions, as presented in the studies included. METHODS We will perform a systematic search in the electronic databases MEDLINE (via PubMed), EMBASE and LILACS (via Virtual Health Library (VHL)), using health descriptors terms for elderly people and for hemodynamic indices of central blood pressure. We will include articles that evaluated hemodynamic indices and at least one of the following outcomes: all-cause mortality, total cardiovascular death, total non-cardiovascular death, myocardial infarction, stroke, coronary artery restenosis after percutaneous coronary intervention, revascularization and aortic syndromes. Two independent reviewers will conduct analysis on the abstracts selected and on the full-text articles. Two reviewers will independently perform data extraction and evaluate the methodological quality of the articles selected, and a third reviewer will evaluate any divergences. The methodological quality of the studies will be assessed in accordance with the ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions). RESULTS AND CONCLUSIONS Through this systematic review, we intend to summarize evidence that supports the use of central hemodynamic parameters for central blood pressure to diagnose and perform prognostics on arterial hypertension in elderly patients within clinical practice and predict future cardiovascular events in this population. REGISTRATION Prospero - CRD42018085264.
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Affiliation(s)
- Grasiele Sausen
- PhD. Coordinator of the Experimental Research Section, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre (RS), Brazil.
| | - Tarsila Vieceli
- MSc. Medical Student, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil.
| | - Clarissa Garcia Rodrigues
- PhD. Chief Executive Officer, Board of Directors, Global Research and Innovation Network (GRINN), Porto Alegre (RS), Brazil.
| | - Daniel Kipper
- MD. Physician, Clínica Del Cuore, Antonio Prado (RS), Brazil.
| | - Airton Tetelbom Stein
- PhD. Provost of Research and Graduate Programs. Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil.
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Peace A, van Mil A, Jones H, Thijssen DH. Similarities and Differences Between Carotid Artery and Coronary Artery Function. Curr Cardiol Rev 2018; 14:254-263. [PMID: 30198437 PMCID: PMC6300794 DOI: 10.2174/1573403x14666180910125638] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiovascular Disease (CVD) remains one of the leading causes of morbidity and mortality. Strategies to predict development of CVD are therefore key in preventing and managing CVD. One stratergy in predicting CVD is by examining the role of traditional risk factors for CVD (e.g. age, sex, weight, blood pressure, blood lipids, blood glucose, smoking and physical activity). Although these measures are non-invasive and simple to perform, they provide limited information of CVD prediction. Directly examining functional characteristics of arteries that are involved in the pathophysiological changes that contribute to the development of CVD improve prediction of future CVD. Nevertheless, examining the function of arteries susceptible to atherosclortic changes, such as the coronary arteries, is invasive, expensive, and associated with high risk for complications. More accessible arteries can be used as a surrogate measure of coronary artery function. For example, the carotid artery may be a superior surrogate measure of coronary artery function given that, the carotid artery represents a central vessel that shows similarities in vasomotor function and anatomical structure with coronary arteries. CONCLUSION This review summarises the similarities between the carotid and coronary arteries, describes how both arteries respond to specific vasoactive stimuli, and discusses if the easily assessible carotid artery can provide information about vascular function (e.g. vasomotor reactivity to sympathetic stimulation) which is prognostic for future cardiovascular events. Finally, the impact of older age and lifestyle interventions (e.g. exercise training) on carotid artery function will be discussed.
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Affiliation(s)
| | | | | | - Dick H.J. Thijssen
- Address correspondence to this author at the Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street L3 3AF, Liverpool, United Kingdom;
Tel: +441519046264; E-mail:
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Suiter C, Singha SK, Khalili R, Shariat-Madar Z. Free Fatty Acids: Circulating Contributors of Metabolic Syndrome. Cardiovasc Hematol Agents Med Chem 2018; 16:20-34. [PMID: 29804539 DOI: 10.2174/1871525716666180528100002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/23/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
Metabolic syndrome induces an increased cardiovascular morbidity and mortality. Most importantly, the prevalence of metabolic syndrome in adult population is expanding. Both clinical and preclinical studies indicate that increased Free Fatty Acids (FFAs) are involved in the pathogenesis of insulin resistance and subsequent development of metabolic syndrome. The relevance of FFAs in protecting and restoring tissue function is quite vast. The search to correlate the functional deterioration of the tissues within the cardiovascular system and increased plasma concentrations of FFAs has been reported. The importance of reduction in the consumption of dietary fatty acids along with the identification of dysregulated genes responsible for persistent increased FFAs uptake and mitochondrial β-oxidation has been increasingly recognized. This review discusses the current empirical understanding of the different types of fatty acids and their metabolism and functions both in physiological and pathophysiological conditions. We also discuss in detail about the molecular and pathophysiological basis of increased FFAs, which augments Cardiovascular Disease (CVD).
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Affiliation(s)
- Chase Suiter
- Department of Biomolecular Sciences Division of Pharmacology, The University of Mississippi, Mississippi 38677-1848, United States
| | - Santu K Singha
- Department of Biomolecular Sciences Division of Pharmacology, The University of Mississippi, Mississippi 38677-1848, United States
| | - Rozita Khalili
- Department of Biomolecular Sciences Division of Pharmacology, The University of Mississippi, Mississippi 38677-1848, United States
| | - Zia Shariat-Madar
- Department of Biomolecular Sciences Division of Pharmacology, The University of Mississippi, Mississippi 38677-1848, United States
- Research Institute of Pharmaceutical Sciences, University of Mississippi, University, Mississippi 38677-1848, United States
- Light Microscopy Core, University of Mississippi, University, Mississippi 38677-1848, United States
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Xiao Q, Arem H, Pfeiffer R, Matthews C. Prediagnosis Sleep Duration, Napping, and Mortality Among Colorectal Cancer Survivors in a Large US Cohort. Sleep 2017; 40:2979190. [PMID: 28329353 DOI: 10.1093/sleep/zsx010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Study Objectives Prediagnosis lifestyle factors can influence colorectal cancer (CRC) survival. Sleep deficiency is linked to metabolic dysfunction and chronic inflammation, which may contribute to higher mortality from cardiometabolic conditions and promote tumor progression. We hypothesized that prediagnosis sleep deficiency would be associated with poor CRC survival. No previous study has examined either nighttime sleep or daytime napping in relation to survival among men and women diagnosed with CRC. Methods We examined self-reported sleep duration and napping prior to diagnosis in relation to mortality among 4869 CRC survivors in the NIH-AARP Diet and Health Study. Vital status was ascertained by linkage to the Social Security Administration Death Master File and the National Death Index. We examined the associations of sleep and napping with mortality using traditional Cox regression (total mortality) and Compositing Risk Regression (cardiovascular disease [CVD] and CRC mortality). Models were adjusted for confounders (demographics, cancer stage, grade and treatment, smoking, physical activity, and sedentary behavior) as well as possible mediators (body mass index and health status) in separate models. Results Compared to participants reporting 7-8 hours of sleep per day, those who reported <5 hr had a 36% higher all-cause mortality risk (Hazard Ratio (95% Confidence Interval), 1.36 (1.08-1.72)). Short sleep (<5 hr) was also associated with a 54% increase in CRC mortality (Substitution Hazard Ratio (95% Confidence Interval), 1.54 (1.11-2.14)) after adjusting for confounders and accounting for competing causes of death. Compared to no napping, napping 1 hr or more per day was associated with significantly higher total and CVD mortality but not CRC mortality. Conclusion Prediagnosis short sleep and long napping were associated with higher mortality among CRC survivors.
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Affiliation(s)
- Qian Xiao
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA
| | - Hannah Arem
- George Washington Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Ruth Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Charles Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Jang HN, Park HO, Yang TW, Yang JH, Kim SH, Moon SH, Byun JH, Lee CE, Kim JW, Kang DH, Baek KH. Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study. Korean J Crit Care Med 2017; 32:240-246. [PMID: 31723642 PMCID: PMC6786731 DOI: 10.4266/kjccm.2017.00360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. Methods This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). Conclusions Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.
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Affiliation(s)
- Ha Nee Jang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Tae Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Chung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Dong Hun Kang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Kyeong Hee Baek
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
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Meagher T, Filzmaier K. The Medical Underwriting of Transgender Individuals. J Insur Med 2017; 47:43-49. [PMID: 28836906 DOI: 10.17849/insm-47-01-43-49.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As more transgender individuals apply for life insurance, it is important to understand the many health issues that are particular to this population. This article reviews the pathophysiology, diagnosis and treatment of gender dysphoria- the dominant medical problem of transgender individuals. It also reviews the frequent co-morbidities in the transgender population and finishes with a review of the small number of studies that have examined long-term mortality.
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Affiliation(s)
- Timothy Meagher
- Meagher- Vice-President and Medical Director, Munich Re, Montréal; Associate Professor of Medicine, McGill University, Montréal, Québec; Filzmaier- Head of Center of Competence Medical Research & Consulting, Munich Re, Munich, Germany
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Al-Zakwani I, Sulaiman K, Al-Lawati JA, Alsheikh-Ali AA, Panduranga P, Al-Habib KF, Al Suwaidi J, Al-Mahmeed W, Al-Faleh H, Elasfar A, Al-Motarreb A, Ridha M, Bulbanat B, Al-Jarallah M, Bazargani N, Asaad N, Amin H. Impact of Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptors Blockers on Mortality in Acute Heart Failure Patients with Left Ventricular Systolic Dysfunction in the Middle East: Observations from the Gulf Acute Heart Failure Registry (Gulf CARE). Curr Vasc Pharmacol 2017; 16:596-602. [PMID: 28820057 DOI: 10.2174/1570161115666170817164420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs)/ Angiotensin Receptors Blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in Acute Heart Failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East. METHODS AND RESULTS Data was analysed from 2,683 consecutive patients admitted with AHF and Left Ventricular Ejection Fraction (LVEF) (<40%) from 47 hospitals from February to November 2012. Analyses were evaluated using univariate and multivariate statistics. The overall mean age of the cohort was 58±15, 72% (n=1,937) were males, 62% (n=1,651) had coronary artery disease, 57% (n=1,539) were hypertensives and 47% (n=1,268) had diabetes. Overall cumulative mortality at inhospital, 3- and 12-month follow-up was 5.8% (n=155), 12.6% (n=338) and 20.4% (n=548), respectively. Adjusting for demographic and clinical characteristics as well as medication in a multivariate logistic regression model, ACEIs were associated with lower risk of in-hospital mortality (adjusted odds ratio (aOR), 0.48; 95% Confidence Interval (CI): 0.25 to 0.94; p=0.031). At 3-month follow-up, both ACEIs (aOR, 0.64; 95% CI: 0.43 to 0.95; p=0.025) and ARBs (aOR, 0.34; 95% CI: 0.18 to 0.62; p<0.001) were associated with lower risk of mortality. Additionally, at 12-month follow-up, those prescribed ACEIs (aOR, 0.71; 95% CI: 0.53 to 0.96; p=0.027) and ARBs (aOR, 0.47; 95% CI: 0.31 to 0.71; p<0.001) were still associated with lower risk of mortality. CONCLUSION ACEIs and ARBs treatments were associated with lower mortality risk during admission and up to 12-month of follow-up in Middle East AHF patients with left ventricular systolic dysfunction.
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Affiliation(s)
- Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University and Gulf Health Research, Muscat, Oman
| | - Kadhim Sulaiman
- Department of Cardiology, Royal Hospital, and Director General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | - Jawad A Al-Lawati
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Khalid F Al-Habib
- Department of Cardiac Sciences, King Fahad Cardiac Centre, King Saud University, Riyadh, Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Centre, Doha, Qatar
| | - Wael Al-Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Hussam Al-Faleh
- Department of Cardiac Sciences, King Fahad Cardiac Centre, King Saud University, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Department of Adult Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia, and Cardiology Department, Tanta University, Tanta, Egypt
| | - Ahmed Al-Motarreb
- Department of Internal Medicine, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Mustafa Ridha
- Division of Cardiology, Al-Dabous Cardiac Centre, Al Adan Hospital, Kuwait City, Kuwait
| | - Bassam Bulbanat
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Kuwait
| | | | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Nidal Asaad
- Department of Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Centre, Doha, Qatar
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain
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Smitson CC, Scherzer R, Shlipak MG, Psaty BM, Newman AB, Sarnak MJ, Odden MC, Peralta CA. Association of Blood Pressure Trajectory With Mortality, Incident Cardiovascular Disease, and Heart Failure in the Cardiovascular Health Study. Am J Hypertens 2017; 30:587-593. [PMID: 28338937 DOI: 10.1093/ajh/hpx028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/10/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Common blood pressure (BP) trajectories are not well established in elderly persons, and their association with clinical outcomes is uncertain. METHODS We used hierarchical cluster analysis to identify discrete BP trajectories among 4,067 participants in the Cardiovascular Health Study using repeated BP measures from years 0 to 7. We then evaluated associations of each BP trajectory cluster with all-cause mortality, incident cardiovascular disease (CVD, defined as stroke or myocardial infarction) (N = 2,837), and incident congestive heart failure (HF) (N = 3,633) using Cox proportional hazard models. RESULTS Median age was 77 years at year 7. Over a median 9.3 years of follow-up, there were 2,475 deaths, 659 CVD events, and 1,049 HF events. The cluster analysis identified 3 distinct trajectory groups. Participants in cluster 1 (N = 1,838) had increases in both systolic (SBP) and diastolic (DBP) BPs, whereas persons in cluster 2 (N = 1,109) had little change in SBP but declines in DBP. Persons in cluster 3 (N = 1,120) experienced declines in both SBP and DBP. After multivariable adjustment, clusters 2 and 3 were associated with increased mortality risk relative to cluster 1 (hazard ratio = 1.21, 95% confidence interval: 1.06-1.37 and hazard ratio = 1.20, 95% confidence interval: 1.05-1.36, respectively). Compared to cluster 1, cluster 3 had higher rates of incident CVD but associations were not statistically significant in demographic-adjusted models (hazard ratio = 1.16, 95% confidence interval: 0.96-1.39). Findings were similar when stratified by use of antihypertensive therapy. CONCLUSIONS Among community-dwelling elders, distinct BP trajectories were identified by integrating both SBP and DBP. These clusters were found to have differential associations with outcomes.
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Affiliation(s)
- Christopher C. Smitson
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Bruce M. Psaty
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anne B. Newman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Mark J. Sarnak
- Division of Nephrology, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle C. Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Carmen A. Peralta
- Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
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Alexander EL, Loutit J, Tumbarello M, Wunderink R, Felton T, Daikos G, Fusaro K, White D, Zhang S, Dudley MN. Carbapenem-Resistant Enterobacteriaceae Infections: Results From a Retrospective Series and Implications for the Design of Prospective Clinical Trials. Open Forum Infect Dis 2017; 4:ofx063. [PMID: 28584849 PMCID: PMC5451664 DOI: 10.1093/ofid/ofx063] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials. METHODS This was a retrospective study at 22 centers in 4 countries. Baseline data, treatment, and outcomes were collected in patients with complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bacteremia due to CRE. RESULTS Two hundred fifty-six cases of CRE infection were identified: 75 cUTI/AP, 21 HABP, 20 VABP, and 140 bacteremia. The patient population had significant comorbidities: 32.8% had chronic renal insufficiency, and 26.2% were immunocompromised. Illness severity at presentation was high: 29.3% presented with septic shock. Treatment regimens varied widely; however, a majority of patients received combination therapy. Outcomes were universally poor (28-day mortality was 28.1%) across all sites of infection, particularly in dialysis patients and those with sepsis. CONCLUSIONS The CRE infections occured in patients with substantial comorbidities and were associated with high mortality and low rates of clinical cure with available antibiotics. Patients with these comorbidities are often excluded from enrollment in clinical trials for registration of new drugs. These results led to changes in the inclusion/exclusion criteria of a phase 3 trial to better represent the patient population with CRE infections and enable enrollment. Observational studies may become increasingly important to guide clinical trial design, inform on the existing standard of care, and provide an external control for subsequent trials.
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Affiliation(s)
- Elizabeth L Alexander
- Infectious Diseases Care Global Innovation Group, The Medicines Company, Parsippany, New Jersey
| | - Jeffery Loutit
- Infectious Diseases Care Global Innovation Group, Rempex Pharmaceuticals (a wholly-owned subsidiary of The Medicines Company), San Diego, California
| | - Mario Tumbarello
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Richard Wunderink
- Pulmonary and Critical Care Medicine, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Tim Felton
- Centre for Respiratory Medicine and Allergy, University of Manchester, United Kingdom; and
| | - George Daikos
- First Department of Propedeutic Medicine, University of Athens, Medical School, Greece
| | - Karen Fusaro
- Infectious Diseases Care Global Innovation Group, The Medicines Company, Parsippany, New Jersey
| | - Dan White
- Infectious Diseases Care Global Innovation Group, The Medicines Company, Parsippany, New Jersey
| | - Shu Zhang
- Infectious Diseases Care Global Innovation Group, The Medicines Company, Parsippany, New Jersey
| | - Michael N Dudley
- Infectious Diseases Care Global Innovation Group, Rempex Pharmaceuticals (a wholly-owned subsidiary of The Medicines Company), San Diego, California
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Desjardins MP, Thorin-Trescases N, Sidibé A, Fortier C, De Serres SA, Larivière R, Thorin E, Agharazii M. Levels of Angiopoietin-Like-2 Are Positively Associated With Aortic Stiffness and Mortality After Kidney Transplantation. Am J Hypertens 2017; 30:409-416. [PMID: 28158589 DOI: 10.1093/ajh/hpw208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Angiopoietin-like-2 (ANGPTL2) is a secreted proinflammatory glycoprotein that promotes endothelial dysfunction, atherosclerosis, and cardiovascular disease (CVD). Circulating ANGPTL2 is increased in chronic kidney disease (CKD), where the risk of CVD is amplified. The objectives of the present study were to (i) examine whether kidney transplantation (KTx) reduces ANGPTL2 levels, (ii) identify the determinants of ANGPTL2 after KTx, (iii) study the association of ANGPTL2 with aortic stiffness, and (iv) assess the impact of ANGPTL2 on mortality after KTx. METHODS In 75 patients, serum ANGPTL2 levels were measured at baseline and 3 months after KTx. Aortic stiffness was determined by carotid-femoral pulse wave velocity, glomerular filtration rate was estimated by CKD-EPI formula, and serum cytokines and endothlin-1 levels were determined 3 months after KTx. Survival analysis was performed using Kaplan-Meier and Cox regression after a median follow-up of 90 months. RESULTS After 3 months of KTx, ANGPTL2 levels decreased from 71 ng/ml (53-95) to 11 ng/ml (9-15) (P < 0.001). In multivariate analysis, age, lower renal function, and endothelin-1 were independently associated with higher post-KTx ANGPTL2 levels. ANGPTL2 was positively associated with aortic stiffness after KTx, even when adjusted for mean blood pressure (standardized β = 0.314; P = 0.008). During follow-up, 13 deaths occurred. The group of patients with higher post-KTx ANGPTL2 levels had a hazard ratio for mortality of 3.9 (95% confidence interval: 1.07-14.4; P = 0.039). CONCLUSION KTx significantly reduced serum ANGPTL2 levels. The positive association between post-KTx ANGPTL2, aortic stiffness and mortality, suggests that ANGPTL2 may play a biological role in CKD-related CVD.
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Affiliation(s)
- Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | | | - Aboubacar Sidibé
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Sacha A De Serres
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Richard Larivière
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Eric Thorin
- Université de Montréal, Montreal Heart Institute, Department of Surgery, Montréal, Québec, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
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Chen SY, Giurini JM, Karchmer AW. Invasive Systemic Infection After Hospital Treatment for Diabetic Foot Ulcer: Risk of Occurrence and Effect on Survival. Clin Infect Dis 2016; 64:326-334. [PMID: 28013263 DOI: 10.1093/cid/ciw736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/07/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infection related to DFU (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality risk have not been defined. METHODS We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFUs during a 9-year period. We defined the index ulcer as that present at the first (index) DFU admission to our hospital. We defined DFU-ISI as a nonfoot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors, and mortality risk associated with DFU-ISIs. RESULTS After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISIs, 64% were bacteremia, 13% deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicillin-resistant Staphylococcus aureus (MRSA) caused 57% of the ISIs. Patients with initial DFU cultures yielding MRSA and protracted open ulcers had a high 24-month cumulative probability of DFU-ISI (31%) and all-cause mortality rate (13%). Analysis with Cox regression modeling showed that complicated ulcer healing (hazard ratio, 3.812; 95% confidence interval, 2.434-5.971) and initial DFU culture yielding MRSA (2.030; 1.452-2.838) predicted DFU-ISIs and that DFU-ISIs were associated with increased mortality risk (1.987; 1.106-3.568). CONCLUSIONS DFU-ISIs are important late complications of DFUs. Prevention of DFU-ISIs should be studied prospectively. Meanwhile, clinicians should aggressively incorporate treatment to accelerate ulcer healing and address MRSA into the care of diabetic patients with foot ulcers.
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Affiliation(s)
- Shey-Ying Chen
- Division of Infectious Diseases, Department of Medicine, and
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, Taipei
| | - John M Giurini
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Ozdemir R, Isguder R, Kucuk M, Karadeniz C, Ceylan G, Katipoglu N, Yilmazer MM, Yozgat Y, Mese T, Agin H. A Valuable Tool in Predicting Poor Outcome due to Sepsis in Pediatric Intensive Care Unit: Tp-e/QT Ratio. J Trop Pediatr 2016; 62:377-84. [PMID: 27085180 DOI: 10.1093/tropej/fmw021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the feasibility of 12-lead electrocardiographic (ECG) measures such as P wave dispersion (PWd), QT interval, QT dispersion (QTd), Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in predicting poor outcome in patients diagnosed with sepsis in pediatric intensive care unit (PICU). METHODS Ninety-three patients diagnosed with sepsis, severe sepsis or septic shock and 103 age- and sex-matched healthy children were enrolled into the study. PWd, QT interval, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were obtained from a 12-lead electrocardiogram. RESULTS PWd, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were significantly higher in septic patients compared with the controls. During the study period, 41 patients had died. In multivariate logistic regression analyses, only Tp-e/QT ratio was found to be an independent predictor of mortality. CONCLUSION The ECG measurements can predict the poor outcome in patients with sepsis. The Tp-e/QT ratio may be a valuable tool in predicting mortality for patients with sepsis in the PICU.
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Affiliation(s)
- Rahmi Ozdemir
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Rana Isguder
- Department of Pediatric Intensive Care Unit, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Mehmet Kucuk
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Cem Karadeniz
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Gokhan Ceylan
- Department of Pediatric Intensive Care Unit, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Nagehan Katipoglu
- Department of Pediatric Intensive Care Unit, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Murat Muhtar Yilmazer
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Timur Mese
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Hasan Agin
- Department of Pediatric Intensive Care Unit, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
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Courand PY, Serraille M, Girerd N, Demarquay G, Milon H, Lantelme P, Harbaoui B. The Paradoxical Significance of Headache in Hypertension. Am J Hypertens 2016; 29:1109-16. [PMID: 27093879 DOI: 10.1093/ajh/hpw041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/05/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The cardiovascular prognostic value of various types of headache, particularly migraine, in the general population remains controversial. The aim of the present study was to assess their prognostic value for all-cause, cardiovascular and stroke mortalities in hypertensive patients. METHODS A total of 1,914 hypertensive individuals were first categorized according to the absence or presence of headache and thereafter according to the 3 subtypes of headache: migraine, daily headache, and other headache. RESULTS Multiple regression analysis demonstrated that all headache types were predicted by gender (women), diastolic blood pressure, absence of diabetes, secondary hypertension, and a trend for severe retinopathy. After 30 years of follow-up, 1,076 deaths were observed, 580 of whom were from cardiovascular cause and 97 from acute stroke. In a multivariable Cox model adjusted for major confounders, patients having headache had a decreased risk for all-cause mortality (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.73-0.93) and cardiovascular mortality (HR 0.80; 95% CI 0.68-0.95), but not for stroke mortality (HR 1.00; 95% CI 0.70-1.43). When considering only patients with headache, "daily headache" had a nonsignificant better prognostic value for all-cause and cardiovascular mortality than "other headache" (HR 0.83; 95% CI 0.68-1.01; HR 0.89; 95% CI 0.69-1.16, respectively) and "migraine" (HR 0.85; 95% CI 0.65-1.11; HR 0.78; 95% CI 0.55-1.10, respectively). CONCLUSION Presence of nonspecific headache in hypertensive patients has a paradoxical significance in that it is associated with a high-risk profile but does not result in a worse prognosis over the long term.
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Affiliation(s)
- Pierre-Yves Courand
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France;
| | - Michaël Serraille
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Girerd
- Inserm, Centre d'Investigations Cliniques 9501 & U1116, Université de Lorraine, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Genevieve Demarquay
- Neurology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hugues Milon
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lantelme
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Brahim Harbaoui
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
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Lamelas PM, Mente A, Diaz R, Orlandini A, Avezum A, Oliveira G, Lanas F, Seron P, Lopez-Jaramillo P, Camacho-Lopez P, O Donnell MJ, Rangarajan S, Teo K, Yusuf S. Association of Urinary Sodium Excretion With Blood Pressure and Cardiovascular Clinical Events in 17,033 Latin Americans. Am J Hypertens 2016; 29:796-805. [PMID: 26683344 DOI: 10.1093/ajh/hpv195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information on actual sodium intake and its relationships with blood pressure (BP) and clinical events in South America is limited. The aim of this cohort study was to assess the relationship of sodium intake with BP, cardiovascular (CV) events, and mortality in South America. METHODS We studied 17,033 individuals, aged 35-70 years, from 4 South American countries (Argentina, Brazil, Chile, and Colombia). Measures of sodium excretion, estimated from morning fasting urine, were used as a surrogate for daily sodium intake. We measured BP and monitored the composite outcome of death and major CV events. RESULTS Overall mean sodium excretion was 4.70±1.43g/day. A positive, nonuniform association between sodium and BP was detected, with a significant steeper slope for the relationship at higher sodium excretion levels (P < 0.001 for interaction). With a median follow-up of 4.7 years, the primary composite outcome (all-cause death, myocardial infarction, stroke, or heart failure) occurred in 568 participants (3.4%). Compared with sodium excretion of 5-6g/day (reference group), participants who excreted >7g/day had increased risks of the primary outcome (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.24 to 2.40; P < 0.001), as well as death from any cause (OR 1.87; 95% CI 1.23 to 2.83; P = 0.003) and major CV disease (OR 1.77; 95% CI 1.12 to 2.81; P = 0.014). Sodium excretion of <3g/day was associated with a statistically nonsignificant increased risk of the primary outcome (OR 1.20; 95% CI 0.86 to 1.65; P = 0.26) and death from any cause (OR 1.25; 95% CI 0.81 to 1.93; P = 0.29), and a significant increased risk of major CV disease (OR 1.50; 95% CI 1.01 to 2.24; P = 0.048), as compared to the reference group. CONCLUSIONS Our results support a positive, nonuniform association between estimated urinary sodium excretion and BP, and a possible J-shaped pattern of association between sodium excretion over the entire range and clinical outcomes.
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Affiliation(s)
- Pablo M Lamelas
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada;
| | - Andrew Mente
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Rafael Diaz
- Department of Laboratory Medicine, McMaster University, Hamilton, ON, Canada; Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Andres Orlandini
- Department of Laboratory Medicine, McMaster University, Hamilton, ON, Canada; Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | | | | | | | - Patricio Lopez-Jaramillo
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Fundación Oftalmológica de Santander Medical School, Universidad de Santander, Floridablanca, Colombia
| | - Paul Camacho-Lopez
- Fundación Oftalmológica de Santander Medical School, Universidad de Santander, Floridablanca, Colombia
| | - Martin J O Donnell
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Koon Teo
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Weiss A, Beloosesky Y, Kenett RS, Grossman E. Change in Systolic Blood Pressure During Stroke, Functional Status, and Long-Term Mortality in an Elderly Population. Am J Hypertens 2016. [PMID: 26208674 DOI: 10.1093/ajh/hpv118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Elevated systolic blood pressure (SBP) recorded by 24-hour blood pressure monitoring (24H BPM) on the first day of acute stroke is associated in elderly patients, with an unfavorable outcome. Herein, we assessed, by 24H BPM, the impact of the change in SBP levels during the first week of stroke on short-term functional status and long-term mortality in elderly patients. METHODS One hundred and fifty acute stroke patients (69 males), mean age at admission 83.6±5.5 years, 82% with ischemic stroke, were investigated. 24H BPM was recorded within 24 hours of admission and 1 week later. After 7 days, patients were assessed for functional status according to the modified Rankin scale (mRS) and were subsequently followed for mortality up to 7.5 years (mean 3.16±2.29). RESULTS After 7 days, SBP decreased from 147±21 to 140±20 mm Hg (P < 0.001). Functional status improved and mRS decreased from 4.2 to 3.7. During follow-up, 58 patients (17 males and 41 females) had died. Mortality rate was higher in females (69% vs. 45%; P < 0.01) and in patients with a history of congestive heart failure. The average admission SBP predicted short-term functional status and long-term mortality. However, the change in SBP corrected for admission levels, gender, age and other variables was not associated with short-term functional status and long-term mortality. CONCLUSION There is no evidence of association between change in SBP during the first week of stroke and short-term functional status and long-term mortality in this group of stroke patients.
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Affiliation(s)
- Avraham Weiss
- Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel
| | | | | | - Ehud Grossman
- Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel-Aviv University, Israel.
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Abstract
Pancreatic cysts are more common than before, largely because of widespread abdominal imaging. Pancreatic cystic neoplasms (PCN) are relevant to risk selection on 2 counts: they constitute more than 50% of all pancreatic cysts and, in contrast to the other 2 cyst types, are capable of malignant transformation. The majority of PCNs are benign at time of diagnosis and will follow a benign course. The challenge is to identify those PCNs that are malignant or will undergo malignant transformation with time. The purpose of this article is to provide pointers that can help meet this challenge while also summarizing the ongoing debate about their optimal management.
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Affiliation(s)
- Timothy Meagher
- Meagher: Vice-President and Medical Director, Munich Re, Montreal; Associate Professor of Medicine, McGill University, Montréal, Québec; Armuss: Medical Officer, Munich Re, Munich, Germany
| | - Andreas Armuss
- Meagher: Vice-President and Medical Director, Munich Re, Montreal; Associate Professor of Medicine, McGill University, Montréal, Québec; Armuss: Medical Officer, Munich Re, Munich, Germany
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Veronese N, De Rui M, Bolzetta F, Zambon S, Corti MC, Baggio G, Toffanello ED, Maggi S, Crepaldi G, Perissinotto E, Manzato E, Sergi G. Orthostatic Changes in Blood Pressure and Mortality in the Elderly: The Pro.V.A Study. Am J Hypertens 2015; 28:1248-56. [PMID: 25767137 DOI: 10.1093/ajh/hpv022] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people. METHODS Two thousand seven hundred and eighty six community-dwelling older participants were followed for 4.4 years. Participants were grouped according to whether they had a drop ≤20 mm Hg in systolic, or ≤10 mm Hg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic BP ≥20 (orthostatic hypertension), or normal changes within 3 minutes of orthostatism. RESULTS During follow-up, 640 subjects died, 208 of them for CVD-related reasons. Adjusted Cox's regression analysis revealed that, compared with normal changes, orthostatic hypertension was associated with higher all-cause (HR = 1.23; 95% CI: 1.02-1.39) and CVD-related mortality (HR = 1.41; 95% CI: 1.08-1.74), while orthostatic hypotension was only associated with a higher non-CVD mortality (HR = 1.19; 95% CI: 1.01-1.60). Orthostatic hypertension emerged as a predictor of all-cause mortality for: participants over 75 years old; participants with a BMI below 25 kg/m2; participants with no CVD or disabilities; and those taking less than three medications. Orthostatic hypertension also predicted CVD-related mortality in individuals with no hypertension, heart failure, coronary artery disease, or atrial fibrillation. CONCLUSIONS Orthostatic hypertension and hypotension both seem to be relevant risk factors for mortality in the elderly, orthostatic hypertension correlating with all-cause and CVD-related mortality and orthostatic hypotension with non-CVD mortality.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy;
| | - Marina De Rui
- Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Francesco Bolzetta
- Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Sabina Zambon
- Department of Medicine-DIMED, Clinica Medica 1, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy
| | - Maria Chiara Corti
- Division of Health Care Planning and Evaluation of the Regione Veneto, Venice, Italy
| | | | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Gaetano Crepaldi
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Egle Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy
| | - Enzo Manzato
- Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy
| | - Giuseppe Sergi
- Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy
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Chang CH, Lin JW, Caffrey JL, Wu LC, Lai MS. Different Angiotensin-converting enzyme inhibitors and the associations with overall and cause-specific mortalities in patients with hypertension. Am J Hypertens 2015; 28:823-30. [PMID: 25498540 DOI: 10.1093/ajh/hpu237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/25/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Angiotensin-converting enzyme (ACE) inhibitors have been widely used in the treatment of hypertension, but the comparative effectiveness in reducing mortality among different drugs is seldom reported. METHODS We identified hypertensive patients who started captopril, enalapril, lisinopril, fosinopril, perindopril, ramipril, or imidapril therapy from Taiwan's National Health Insurance database between 1 January 2004 and 31 December 2009. Overall and cause-specific mortalities were ascertained through a linkage to Taiwan's National Death Registry. Patients were followed from the initiation of ACE inhibitors to death, disenrollment, or study termination (31 December 2010). A Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI), using ramipril as the reference group. RESULTS A total of 989,489 hypertensive patients were included, with a mean follow-up ranging from 3.5 years for imidapril to 4.5 years for enalapril. Captopril initiators had the highest overall mortality rate (117.8 per 1,000,000 person-days) as compared to other ACE inhibitors (54.3-79.4 per 1,000,000 person-days). Patients who started captopril therapy had a significantly increased risk of overall mortality (HR: 1.28, 95% CI: 1.24-1.31) when compared with ramipril. Enalapril (HR: 1.08, 95% CI: 1.05-1.11) and fosinopril (HR: 1.08, 95% CI: 1.05-1.12) were also associated with a modestly increased risk. No difference in mortality was found for lisinopril, perindopril, and imidapril, as compared with ramipril. CONCLUSIONS There are differences in the mortality risk associated with different ACE inhibitors. However, potential residual confounding effects might still exist.
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Affiliation(s)
| | - Jou-Wei Lin
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Taiwan;
| | - James L Caffrey
- Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Li-Chiu Wu
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
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Chowdhury EK, Langham RG, Owen A, Krum H, Wing LMH, Nelson MR, Reid CM. Comparison of predictive performance of renal function estimation equations for all-cause and cardiovascular mortality in an elderly hypertensive population. Am J Hypertens 2015; 28:380-6. [PMID: 25239479 DOI: 10.1093/ajh/hpu160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Modifications of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) are 2 equations commonly used to estimate glomerular filtration rate (eGFR). The predictive performance offered by these equations, particularly in relation to clinical outcomes in elderly hypertensive patients, is not clear. METHODS The Second Australian National Blood Pressure Study cohort was used to investigate the predictive performance of these 2 equations for long-term outcomes (median 10.8 years) in elderly treated hypertensive patients. Both equations were used to calculate eGFR in 6,083 patients aged ≥65 years and classified as having chronic kidney disease (CKD) or no CKD (eGFR ≥60ml/min/1.73 m2). RESULTS More patients were classified as having no CKD using the CKD-EPI equation compared with the MDRD equation (72.1% vs. 69.4%; P = 0.001). Both equations performed similarly in risk prediction of all-cause and cardiovascular mortality with decreased eGFR, except for patients with baseline eGFR of 45-59ml/min/1.73 m2, where the CKD-EPI equation predicted higher risk of all-cause mortality compared with those with no CKD. However, the magnitude of difference in risk prediction was too small to be clinically meaningful. Both equations showed similar predictive performance. However, we observed longer survival and no higher risk in those who were reclassified as having no CKD using the CKD-EPI equation, but these patients were classified earlier as having CKD using the MDRD equation. CONCLUSIONS There was no clinically relevant difference in predictive performance for long-term survival by eGFR calculated using either of these equations in this elderly hypertensive population.
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Affiliation(s)
- Enayet K Chowdhury
- Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia
| | - Robyn G Langham
- Department of Nephrology and University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Alice Owen
- Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia
| | - Henry Krum
- Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia
| | | | - Mark R Nelson
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia;
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Whiteside YO, Selik R, An Q, Huang T, Karch D, Hernandez AL, Hall HI. Comparison of Rates of Death Having any Death-Certificate Mention of Heart, Kidney, or Liver Disease Among Persons Diagnosed with HIV Infection with those in the General US Population, 2009-2011. Open AIDS J 2015; 9:14-22. [PMID: 25767634 PMCID: PMC4353126 DOI: 10.2174/1874613601509010014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/28/2015] [Accepted: 02/05/2015] [Indexed: 12/19/2022] Open
Abstract
Objective : Compare age-adjusted rates of death due to liver, kidney, and heart diseases during 2009-2011 among US residents diagnosed with HIV infection with those in the general population. Methods : Numerators were numbers of records of multiple-cause mortality data from the national vital statistics system with an ICD-10 code for the disease of interest (any mention, not necessarily the underlying cause), divided into those 1) with and 2) without an additional code for HIV infection. Denominators were 1) estimates of persons living with diagnosed HIV infection from national HIV surveillance system data and 2) general population estimates from the US Census Bureau. We compared age-adjusted rates overall (unstratified by sex, race/ethnicity, or region of residence) and stratified by demographic group. Results : Overall, compared with the general population, persons diagnosed with HIV infection had higher age-adjusted rates of death reported with hepatitis B (rate ratio [RR]=42.6; 95% CI: 34.7-50.7), hepatitis C (RR=19.4; 95% CI: 18.1-20.8), liver disease excluding hepatitis B or C (RR=2.1; 95% CI: 1.8-2.3), kidney disease (RR=2.4; 95% CI: 2.2-2.6), and cardiomyopathy (RR=1.9; 95% CI: 1.6-2.3), but lower rates of death reported with ischemic heart disease (RR=0.6; 95% CI: 0.6-0.7) and heart failure (RR=0.8; 95% CI: 0.6-0.9). However, the differences in rates of death reported with the heart diseases were insignificant in some demographic groups. Conclusion : Persons with HIV infection have a higher risk of death with liver and kidney diseases reported as causes than the general population.
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Affiliation(s)
- Y Omar Whiteside
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Richard Selik
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Qian An
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Debra Karch
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Angela L Hernandez
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - H Irene Hall
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Losito A, Del Vecchio L, Del Rosso G, Malandra R. Blood pressure and cardiovascular mortality in dialysis patients with left ventricular systolic dysfunction. Am J Hypertens 2014; 27:401-8. [PMID: 24108864 DOI: 10.1093/ajh/hpt190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In patients chronically treated with hemodialysis, the prevalence of heart failure is high with a consequently poor prognosis. The role played by blood pressure (BP) on cardiovascular (CV) mortality of these patients has not been clearly defined. METHODS In this follow-up study, we investigated the relationship of pre- and postdialysis measurements of BP with CV and all-cause mortality in a cohort of 557 dialysis patients with a left ventricular (LV) ejection fraction <50%. RESULTS During the follow-up (mean = 21.6 ± 8.8 months), 179 deaths were recorded. Ninety-eight patients died from CV causes. By the Cox multivariable analysis, we constructed a predictive model of CV mortality including age, duration on dialysis, diabetes, serum albumin, diffusive dialysis technique, predialysis mean arterial pressure (MAP) (hazard ratio (HR) = 0.978; 95% confidence interval (CI) = 0.956-0.999), and postdialysis MAP (HR = 1.035; 95% CI = 1.010-1.061). The relationship with mortality was inverse for predialysis MAP and direct for postdialysis MAP. In a subsequent analysis, we found that pre- and postdialysis systolic BP, but not diastolic BP, were predictive of CV mortality. Predialysis MAP was in a direct relationship with body mass index. Postdialysis MAP had an inverse relationship with weight loss during dialysis session. CONCLUSIONS CV mortality in dialysis patients with LV dysfunction is associated with both pre- and postdialysis BP interacting in a complex relationship. Nutritional state and fluid balance and removal are possible clues to this relationship.
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Brown RE, Riddell MC, Macpherson AK, Canning KL, Kuk JL. The joint association of physical activity, blood-pressure control, and pharmacologic treatment of hypertension for all-cause mortality risk. Am J Hypertens 2013; 26:1005-10. [PMID: 23690165 DOI: 10.1093/ajh/hpt063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We conducted a study to determine the joint association of physical activity, pharmacologic treatment for hypertension, and the control of blood pressure (BP) on all-cause mortality risk. METHODS The study subjects were 10,665 adults from the Third National Health and Nutrition Examination Survey (NHANES III) and the Continuous NHANES survey (1999-2000 and 2000-2001). Cox proportional hazards analyses were used to estimate differences in mortality risk according to physical activity, pharmacologic treatment for hypertension, and BP control, with physically active, treated, and controlled as the referent category. RESULTS The average follow-up time in the study was 8.6±4.8 years. The main effect of physical activity was significant independently of pharmacologic treatment and BP control (P < 0.001). Physically inactive adults with hypertension had a higher risk of mortality than did physically active adults with treated and controlled hypertension (inactive, treated and controlled hypertension: HR, 1.42; 95% CI, 1.17-1.72; P < 0.01; inactive, treated, and uncontrolled hypertension: HR, 1.55; 95% CI, 1.30-1.84; P < 0.01; inactive, untreated, and uncontrolled hypertension: HR, 1.27; 95% CI, 1.07-1.52, P < 0.01). However, the risk of mortality for physically active adults with hypertension did not differ significantly with or without treatment for hypertension if their hypertension remained uncontrolled (active, treated and uncontrolled hypertension: HR, 1.17; 95% CI 0.98-1.40; P = 0.08; active, untreated and uncontrolled hypertension: HR, 0.90; 95% CI, 0.76-1.08; P = 0.25). Physically active, normotensive individuals had a lower all-cause mortality risk than did the referent group of physically active individuals being treated with antihypertensive medication and who had controlled hypertension (HR, 0.72; 95% CI, 0.60-0.86; P < 0.01), whereas physically inactive, normotensive individuals had a risk of mortality similar to that of the referent group (HR, 1.08; 95% CI, 0.90-1.30; P = 0.42). CONCLUSION Physical activity may be as or even more important than pharmacotherapy for reducing the risk of mortality in adults with hypertension. However, the risk of mortality remained higher for physically active adults with treated and controlled hypertension than did the risk of mortality for physically active normotensive populations. Prevention of hypertension is therefore imperative for reducing the all-cause risk of premature mortality in adults.
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Affiliation(s)
- Ruth E Brown
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, Canada, M3J 1P3
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Adler SP, Best AM, Marshall B, Vetrovec GW. Infection with cytomegalovirus is not associated with premature mortality. Infect Dis Rep 2011; 3:e17. [PMID: 24470914 PMCID: PMC3892592 DOI: 10.4081/idr.2011.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/30/2011] [Indexed: 11/23/2022] Open
Abstract
Over 90% of the world's population acquires a cytomegalovirus (CMV) infection. This infection, although asymptomatic or self-limiting, is a major burden to the immune system. For this reason, and because CMV immunization is possible, determining whether CMV can cause reduced longevity, particularly among those with coronary artery disease, is important and previous reports have been conflicting. Thus our objective was to assess the association between CMV infection as defined serologically and antibody levels against CMV and long-term survival (18 years). We completed a prospective observational cohort study of 915 consecutive patients (mean age 58 years) undergoing coronary angiography. CMV immunoglobulin levels were measured at baseline using either a whole cell CMV antigen or a purified protein antigen (gB). After adjustment for potentially confounding variables (age, race, gender, body mass index, the presence or absence of coronary artery disease, the number of diseased vessels, diabetes, renal disease, hypertension, dialysis, congestive heart failure, and the maximum percent reduction in luminal diameter), Cox's proportional hazards models showed no association between CMV seropositivity or levels of antibodies against CMV by either assay and longevity for both patients with or without coronary artery disease (CAD) nor for those under or over 70 years of age at baseline. Our observations suggest that universal immunization against CMV may not improve longevity.
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Affiliation(s)
- Stuart P Adler
- Division of Infectious Diseases, Department of Pediatrics
| | | | - Beth Marshall
- Division of Infectious Diseases, Department of Pediatrics
| | - George W Vetrovec
- Division of Cardiology, Department of Internal Medicine, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond VA, USA
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Bhanushali M, Taylor TE, Molyneux ME, Sapuwa M, Mwandira E, Birbeck GL. Evoked potentials in pediatric cerebral malaria. Neurol Int 2011; 3:e14. [PMID: 22368773 PMCID: PMC3286154 DOI: 10.4081/ni.2011.e14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 09/28/2011] [Indexed: 11/23/2022] Open
Abstract
Cortical evoked potentials (EP) provide localized data regarding brain function and may offer prognostic information and insights into the pathologic mechanisms of malaria-mediated cerebral injury. As part of a prospective cohort study, we obtained somatosensory evoked potentials (SSEPs) and brainstem auditory EPs (AEPs) within 24 hours of admission on 27 consecutive children admitted with cerebral malaria (CM). Children underwent follow-up for 12 months to determine if they had any long term neurologic sequelae. EPs were obtained in 27 pediatric CM admissions. Two children died. Among survivors followed an average of 514 days, 7/25 (28.0%) had at least one adverse neurologic outcome. Only a single subject had absent cortical EPs on admission and this child had a good neurologic outcome. Among pediatric CM survivors, cortical EPs are generally intact and do not predict adverse neurologic outcomes. Further study is needed to determine if alterations in cortical EPs can be used to predict a fatal outcome in CM.
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Affiliation(s)
- Minal Bhanushali
- US National Institute of Health, 10-CRC Hatfield Research Center, Bethesda, USA
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Baptista R, Jorge E, Sousa E, Pimentel J. B-type natriuretic peptide predicts long-term prognosis in a cohort of critically ill patients. Heart Int 2011; 6:e18. [PMID: 22355485 PMCID: PMC3282435 DOI: 10.4081/hi.2011.e18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 09/19/2011] [Indexed: 02/06/2023] Open
Abstract
B-type natriuretic peptide is an important prognostic marker in heart failure. However, there are limited data for its value in non-cardiac intensive care unit patients, namely regarding long-term prognosis. We investigated the long-term prognostic value of BNP in a cohort of critically ill patients. This was a prospective and observational study, conducted in a tertiary university hospital 20-bed intensive care unit. We included 103 mechanically-ventilated patients admitted for a non-cardiac primary diagnosis; B-type natriuretic peptide samples were obtained on admission. A mean 14 (3–30) month follow up was available in 96.1% of patients who were discharged from hospital. Mean age was 60.7±19.0 years and mean APACHE II score was 16.2±7.2. APACHE II score and renal dysfunction increased with rising B-type natriuretic peptide, with more than 60% of patients having B-type natriuretic peptide levels of 100 pg/mL or over; echocardiography-derived left ventricular ejection fraction was lower in patients with higher B-type natriuretic peptide (P < 0.001). Long-term survivors had lower median B-type natriuretic peptide values (117.5[2–1668] pg/mL) compared with intensive care unit non-survivors (191.0[5–4945] pg/mL), P<0.001. After adjustment to APACHE II score, B-type natriuretic peptide levels of 300 pg/mL or over were independently associated with long-term mortality (odds-ratio 4.1 [95% CI 1.45–11.5], P=0.008). We conclude that in an unselected cohort of intensive care unit patients, admission B-type natriuretic peptide is frequently elevated, even without clinically apparent acute heart disease, and is a strong independent predictor of long-term mortality.
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Charlot M, Torp-Pedersen C, Valeur N, Seibæk M, Weeke P, Køber L. Anaemia and long term mortality in heart failure patients: a retrospective study. Open Cardiovasc Med J 2010; 4:173-7. [PMID: 21160909 PMCID: PMC3002054 DOI: 10.2174/1874192401004010173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 06/14/2010] [Accepted: 06/19/2010] [Indexed: 12/04/2022] Open
Abstract
Background: Anaemia has been demonstrated as a risk factor in patients with heart failure over periods of a few years, but long term data are not available. We examined the long-term risk of anaemia in heart failure patients during 15 years of follow-up. Methods: We evaluated survival data for 1518 patients with heart failure randomized into the Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND) trial. The follow-up time was from 13 to 15 years. After 15 years 11.5% of the patients were still alive. Results: Anaemia was present in 34% of the patients. 264 (17%) had mild, 152 (10%) had moderate and 98 (7%) had severe anaemia. Hazard ratio of death for patients with mild anaemia compared with patients with no anaemia was 1.27 (1.11-1.45, p<0.001), for moderate anaemia 1.48 (1.24-1.77, p<0.001) and for severe anaemia 1.82 (1.47-2.24, p<0.001), respectively. In multivariable analyses anaemia was still associated with increased mortality with hazard ratios of 1.19 (1.04–1.37, p=0.014) for mild anaemia, 1.23 (1.03–1.48, p=0.024) for moderate anaemia and 1.33 (1.07–1.66, p=0.010) for severe anaemia, respectively. In landmark analysis the increased mortality for mild anaemia was only significant during the first 2 years, while moderate anaemia remained significant for at least 5 years. There were too few patients left with severe anaemia after 5 years to evaluate the importance on mortality beyond this time. Conclusion: Anaemia at the time of diagnosis of heart failure is an independent factor for mortality during the following years but loses its influence on mortality over time.
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Affiliation(s)
- Mette Charlot
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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