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Masjuán J, Sanmartín-Fernández M, Ferreira-González I, Molina C. [Optimizing the detection of subclinical atrial fibrillation after ESUS]. Rev Neurol 2021; 73:26-34. [PMID: 34170005 DOI: 10.33588/rn.7301.2020630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION It has been estimated that approximately 20% of ischemic strokes have a cardioembolic origin and the cause is not detected or there are more than one in 9-25% of ischemic strokes. An adequate diagnostic approach of ESUS would allow an optimization of antithrombotic treatment. OBJECTIVE Narrative update about the available evidence on the best diagnostic and therapeutic approach among patients with ESUS and how to optimize the detection of atrial fibrillation as a potential cause is reviewed. DEVELOPMENT A search was conducted on PubMed (MEDLINE), using the MeSH terms [ESUS] + [atrial fibrillation] + [diagnosis] + [treatment]. Original data from clinical trials, prospective and retrospective studies and reviews were selected. CONCLUSIONS The detection of atrial fibrillation after ESUS is mandatory to optimize the treatment. However, not all patients have the same risk of developing silent atrial fibrillation. There are some factors that increase this risk (left atrium enlargement, elderly, frequent premature supraventricular complexes). In these patients, a more prolonged monitorization could increase the possibility of detecting atrial fibrillation, and consequently, to benefit more from anticoagulant treatment.
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Affiliation(s)
- J Masjuán
- Hospital Universitario Ramón y Cajal, 28034 Madrid, España
| | - M Sanmartín-Fernández
- Hospital Universitario Ramón y Cajal, Madrid, España.,CIBERCV-ISCIII, Madrid, España
| | - I Ferreira-González
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España.,CIBERCV-ISCIII, Madrid, España
| | - C Molina
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
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Schandelmaier S, Conen K, von Elm E, You JJ, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Stegert M, Olu KK, Tikkinen KAO, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Sun X, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Gloy V, Raatz H, Moja L, Rosenthal R, Ebrahim S, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Bucher HC, Guyatt GH, Briel M, Kasenda B. Planning and reporting of quality-of-life outcomes in cancer trials. Ann Oncol 2015; 27:209. [PMID: 26612098 DOI: 10.1093/annonc/mdv559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- S Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland
| | - K Conen
- Department of Oncology, University Hospital of Basel, Switzerland
| | - E von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - J J You
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada
| | - A Blümle
- German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany
| | - Y Tomonaga
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - R Saccilotto
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - A Amstutz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - T Bengough
- Department of Health and Society, Austrian Federal Institute for Health Care, Vienna, Austria
| | - J J Meerpohl
- German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany
| | - M Stegert
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - K K Olu
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - K A O Tikkinen
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - I Neumann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - A Carrasco-Labra
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - M Faulhaber
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - S M Mulla
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - D Mertz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Canada
| | - E A Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Department of Medicine, State University of New York at Buffalo, Buffalo, USA
| | - X Sun
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - D Bassler
- Department of Neonatolgy, University Hospital Zurich, Zurich, Switzerland
| | - J W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesia, McMaster University, Hamilton, Canada Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
| | - I Ferreira-González
- Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital and CIBER de Epidemiología y Salud Publica (CIBERESP), Barcelona, Spain
| | - F Lamontagne
- Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Canada
| | - A Nordmann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - V Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Institute of Nuclear Medicine, University Hospital Bern, Bern, Switzerland
| | - H Raatz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - L Moja
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - R Rosenthal
- Department of Surgery, University Hospital Basel, Switzerland
| | - S Ebrahim
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesia and Pain Medicine, Hospital for Sick Children Research Institute, Hospital for Sick Children, Toronto, Canada Department of Anesthesia, McMaster University, Hamilton, Canada Stanford Prevention Research Center, Stanford University, Stanford, USA
| | - P O Vandvik
- Department of Medicine, Innlandet Hospital Trust-Division Gjøvik, Oppland, Norway
| | - B C Johnston
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesia and Pain Medicine, Hospital for Sick Children Research Institute, Hospital for Sick Children, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - M A Walter
- Institute of Nuclear Medicine, University Hospital Bern, Bern, Switzerland
| | - B Burnand
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - M Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - L G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - H C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland
| | - G H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - M Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Clinical Research, University of Basel, Switzerland
| | - B Kasenda
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Department of Oncology, University Hospital of Basel, Switzerland Department of Medical Oncology, Royal Marsden Hospital, London, UK
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Martínez-Sellés M, Gómez Doblas JJ, Carro Hevia A, García de la Villa B, Ferreira-González I, Alonso Tello A, Andión Ogando R, Ripoll Vera T, Arribas Jiménez A, Carrillo P, Rodríguez Pascual C, Casares i Romeva M, Borras X, Cornide L, López-Palop R. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J Intern Med 2014; 275:608-20. [PMID: 24320176 DOI: 10.1111/joim.12174] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 11/28/2022]
Abstract
OBJECTIVE To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING Transnational registry in Spain. SUBJECTS We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES All-cause death. RESULTS Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
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Affiliation(s)
- M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón y Universidad Europea de Madrid, Madrid, Spain
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