scholarly journals Short- and long-term outcome of patients with spontaneous echo contrast or thrombus in the left atrial appendage in the era of the direct acting anticoagulants

2021 ◽  
Author(s):  
Julian Felix Backhaus ◽  
Andreas Pflaumbaum ◽  
Christos Krogias ◽  
Fabienne Kreimer ◽  
Andreas Mügge ◽  
...  
Keyword(s):  
Adverse Events ◽  
Confidence Interval ◽  
Primary Endpoint ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Spontaneous Echo Contrast ◽  
Direct Acting

Abstract Background Thrombi and spontaneous echo contrast (SEC) in the left atrial appendage (LAA) are associated with thromboembolic events and poor prognosis. There are very few data on long-term outcome, especially with the use of direct acting anticoagulants (DOAC). Methods In this retrospective study, all transoesophageal echocardiographies performed at a tertiary care university hospital from 2015 to 2020 were analyzed. All patients with thrombus or SEC in the LAA were included. Medical history, laboratory, echocardiographic parameters and medication at discharge were documented. The primary endpoint of the study was a composite endpoint (all-cause mortality, non-fatal stroke or transient ischaemic attack [TIA], non-fatal systemic embolization, non-fatal major bleeding and non-fatal myocardial infarction). Results Of a total of 4062 transoesophageal echocardiographies, thrombi were detected in 51 patients (1.2%) and SEC in 251 patients (6.2%). These patients formed the final study cohort (n = 302). During a mean follow-up period of 956 ± 663 days, 87 patients (29%) suffered the primary point. The following baseline characteristics predicted the primary endpoint: age, haemoglobin, a previous coronary artery bypass grafting, dialysis and choice of anticoagulation. Prescription of apixaban at discharge was associated with lower rate of adverse events (hazard ratio 0.564, confidence interval 0.331–0.960; p = 0.035) while prescription of dabigatran was associated with higher rate of adverse events (hazard ratio 3.091, confidence interval 1.506–6.347; p = 0.002). Conclusion Even in the DOAC era, the occurrence of thrombus or SEC in the LAA is associated with a high rate of MACCE. Our study suggests that the choice of DOAC therapy may have an impact on long-term survival. Graphic abstract

Long-term outcome of left atrial appendage occlusion with multiple devices

2021 ◽  
Author(s):  
Andrea Radinovic ◽  
Giulio Falasconi ◽  
Alessandra Marzi ◽  
Giuseppe D'Angelo ◽  
Luca Limite ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Left Atrial Appendage Occlusion ◽  
Multiple Devices

scholarly journals Eight year, long term outcome after PTCA: Factors associated with adverse events. The NHLBI PTCA registry

1996 ◽  
Vol 27 (2) ◽  
pp. 361 ◽  
Author(s):  
David R. Holmes ◽  
Katherine Detre ◽  
Wan Lin Weh ◽  
Spencer King ◽  
Sheryl Kelsey
Keyword(s):  
Adverse Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Factors Associated

Abstract TP448: High Residual Platelet Reactivity (hrpr) for Adenosine Diphosphate (adp) Stimuli is a Determinant Factor for Long-term Outcomes in Acute Ischemic Stroke With Anti-platelet Agents

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jae-Kwan Cha ◽  
Eun-Kyu Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Primary Endpoint ◽  
Platelet Reactivity ◽  
Large Artery ◽  
Vascular Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Platelet Aggregometry

Background and Purpose: High residual platelet activation (HRPA) after ADP stimuli has associated with recurrent vascular events in acute atherothrombosis with the use of antiplatelet agents (APAs). However, there has been little evidence supporting this association in acute ischemic stroke (AIS). In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. Methods: We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5 days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70% or greater according to OPA after 10 μM ADP stimuli. Results: The primary endpoint was a composite of all causes of death, myocardial infarction, and stroke at the 1-year follow-up. The secondary endpoints were each component of the primary endpoint. The event rate of primary endpoint was 11.3% (109/968). Its rate was significantly higher in the patients with HRPR (16.7%) than in those without (9.7%). HPRP was independently associated with the primary endpoint (OR=1.97, CI 1.22 to 3.18, p<0.01). According to the AIS subtype, the presence of HRPR was independently significant for the occurrence of the primary endpoint in the large artery atherosclerosis (LAA) subtype only (OR=2.26, CI 1.15 to 4.45, P=0.02). Conclusions: In this study, the presence of HRPR after ADP stimuli is associated with a poor long-term outcome after acute ischemic stroke. In particular, the influence of this factor might be more prominent in LAA compared with other types of AIS.

Long-Term Outcome Following Pulmonary Valve Replacement in Repaired Tetralogy of Fallot

2021 ◽  
Vol 12 (5) ◽  
pp. 616-627
Author(s):  
Alqasem Fuad H. Al Mosa ◽  
Sreenath Madathil ◽  
Pierre-Luc Bernier ◽  
Christo Tchervenkov
Keyword(s):  
Adverse Events ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Repaired Tetralogy Of Fallot ◽  
The Mean

Background: Late pulmonary valve replacement following repair of tetralogy of Fallot may become necessary in patients with chronic pulmonary insufficiency. There is limited information on the long-term outcome of these prostheses, which is the focus of this study. Methods: We conducted a retrospective study of patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement from 1990 to 2015 in our institution. We investigated imaging and clinical parameters including mortality and late adverse events (reintervention [surgical or transcatheter]), infective endocarditis, or arrhythmias requiring device implantation or ablation. Results: There were 69 patients divided into 3 groups: Carpentier-Edwards (n = 14), Contegra (n = 40), and pulmonary homograft (n = 15). The mean age at the time of pulmonary valve replacement was 21 ± 12 years. The mean follow-up was 8.5 ± 4.7 years. The mean preoperative and postoperative right ventricular end-diastolic volume index was 210 ± 42 and 120 ± 24 mL/m2, respectively. There were no mortalities. Late adverse events were observed in 23 (33%) patients: 15 (22%) reintervention (surgical or transcatheter), 11 (16%) endocarditis, and 11 (16%) arrhythmias. Overall, 1-, 5-, and 10-year freedom from surgical reintervention was 98.5%, 93.6%, and 79.3%, respectively. The Contegra group had significantly higher pulmonary valve gradients, a higher risk of developing late adverse events compared to Carpentier-Edwards ( P = .046) and pulmonary homograft ( P = .055) in multivariate analysis and increased risk for reintervention in the univariate analysis (hazard ratio: 3.4; 95% CI: 0.92-13; P value.066). Conclusion: Pulmonary valve replacement in patients with repaired tetralogy of Fallot has acceptable short- and intermediate-term outcomes. Contegra prosthesis had a higher risk of late adverse events with higher pulmonary valve gradients.

P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Dinshaw ◽  
M Lemoine ◽  
J Hartmann ◽  
B Schaeffer ◽  
N Klatt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
High Density ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Density Mapping ◽  
Ablation Success

Abstract Introduction Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain. Purpose The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems. Methods A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices. Results Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003). Conclusion Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.

Sign in / Sign up

Export Citation Format

Share Document