Age- and gender-related differences in the evolution of psychological and cognitive status after the lockdown for the COVID-19 outbreak: a follow-up study

Background Death associated with coronary heart disease (CHD) depends in part on the time since the myocardial infarction (MI) and modification of risk factors. Methods This observational, retrospective 4-year follow-up study consisted of 804 patients (628 men). The participants completed a questionnaire reporting diet, demographic factors, personal behavior (smoking, physical activity), anthropometry, prior medical conditions (hypertension, diabetes mellitus), and recent medication. Results During 48 months of follow-up, 12% of men and 15% of women died. Older age, longer duration of smoking, and frequency of exercise were significantly different between survivors and the deceased ( P = .014, P = .014, P = .001, respectively). Multivariate analysis revealed associations with years of smoking (odds ratio, OR: 1.10, P = .025), treatment with nitrates (OR: 4.81, P = .024), and increased frequency of exercise (OR: 0.42, P = .013), adjusting for age and gender. Conclusions We should emphasize cessation of smoking and increased physical activity in MI survivors. Antismoking programs should start at an early age.

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Mortality in acromegaly: a 20-year follow-up study

Endocrine Related Cancer ◽

10.1530/erc-16-0106 ◽

2016 ◽

Vol 23 (6) ◽

pp. 469-480 ◽

Cited By ~ 46

Author(s):

Elina Ritvonen ◽

Eliisa Löyttyniemi ◽

Pia Jaatinen ◽

Tapani Ebeling ◽

Leena Moilanen ◽

...

Keyword(s):

Causes Of Death ◽

Age And Gender ◽

Follow Up Study ◽

All Cause Mortality ◽

Long Term Follow Up ◽

Standardized Mortality Ratios ◽

And Gender ◽

Causes Of Deaths

Objective It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort. Patients and methods We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly (n=333) compared with age- and gender-matched controls (n=4995). Results During 20 (0–33) years follow-up, 113 (34%) patients (n=333, 52% women) and 1334 (27%) controls (n=4995) died (P=0.004). SMR (1.9, 95% CI: 1.53–2.34, P<0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2–2.2, P<0.001) were increased in acromegaly. Overall distribution of causes of death (P<0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma (n=5), breast (n=4), lung (n=3) and colon (n=3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P<0.001) and death (67 vs 76 years, P=0.0015). Compared with controls, women (36% vs 25%, P<0.01), but not men (31% vs 28%, P=0.44), had increased mortality. Conclusions In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.

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LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

European Heart Journal ◽

10.1093/eurheartj/ehab724.025 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Khanna ◽

I Wen ◽

A Gupta ◽

A Thakur ◽

A Bhat ◽

...

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Autoimmune Encephalitis ◽

Left Ventricular ◽

Major Adverse Cardiovascular Events ◽

Age And Gender ◽

Immunological Disorders ◽

Significant Difference ◽

And Gender

Abstract Background Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF). Purpose The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up. Methods Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF <50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). Results A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p<0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis. Conclusions Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon. FUNDunding Acknowledgement Type of funding sources: None.

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Caregiver Satisfaction with a Video Telehealth Home Safety Evaluation for Dementia

International Journal of Telerehabilitation ◽

10.5195/ijt.2020.6337 ◽

2020 ◽

Vol 12 (2) ◽

pp. 35-42

Author(s):

Megan E. Gately ◽

Linda Tickle-Degnen ◽

Scott A. Trudeau ◽

Nathan Ward ◽

Keren Ladin ◽

...

Keyword(s):

Contextual Factors ◽

Safety Evaluation ◽

Descriptive Study ◽

Cognitive Status ◽

Home Safety ◽

Age And Gender ◽

Caregiver Satisfaction ◽

Field Notes ◽

And Gender ◽

Person With Dementia

Family caregivers are vital to telehealth-delivered dementia care. The objective of this mixed methods descriptive study conducted in the VA Bedford Healthcare System was to examine caregiver satisfaction with a video telehealth dementia home safety occupational therapy evaluation. Ten caregivers of Veterans with dementia participated. Ratings of caregiver satisfaction, measured by nine Likert scale items including ability to see and hear, were examined in relation to person and visit-related contextual factors extracted from RA field notes, to develop an in-depth understanding of caregiver experience. Person factors included caregiver age and gender and Veteran cognitive status. Visit-related contextual factors included occurrence of technical glitches. Caregiver visit satisfaction was overall positive, with exceptions related to technological glitches and the presence of the person with dementia during the visit. Veteran cognitive status appeared to influence caregiver satisfaction. Implications of the study are that proactively addressing technical glitches and incorporating dementia stage-specific approaches may optimize caregivers’ telehealth experience.

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The association of tissue doppler E/e' ratio with poor survival is modified by gender and is attenuated with advanced age

European Heart Journal ◽

10.1093/eurheartj/ehab724.012 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Y Wasserstrum ◽

R Gilead ◽

R Kuperstein ◽

S Ben-Zekry ◽

O Vatury ◽

...

Keyword(s):

Cox Regression ◽

Mitral Annulus ◽

Tissue Doppler ◽

Outcome Data ◽

Poor Survival ◽

Age And Gender ◽

Risk Of Death ◽

Increased Risk ◽

And Gender

Abstract Introduction Contemporary guidelines recommend a universal cutoff of 14 for the ratio between early mitral flow wave and early diastolic mitral annulus velocity measured by tissue doppler (E/e' ratio). While age-dependent normal E/e' values have been suggested, outcome data is lacking. Purpose We sought to evaluate the modification effect of age and gender on the prognostic value of the E/e' ratio. Methods Consecutive patients who underwent echocardiographic evaluation between 2009 and 2021 (N=104,315) in a single tertiary cardiovascular center. Patients with left or right ventricular dysfunction, any significant valvular disease, structural heart disease or evidence of pulmonary hypertension were excluded. Cancer and mortality data were available for all subjects from national registries. Patients with a metastatic malignancy at baseline or during follow up were excluded. Cox regression models were applied. Results Overall, 44,541 patients were included in the final analysis. Mean age was 55±17, 59% were male and 63% of the exams were performed in an outpatient setting. An elevated E/e' ratio above 14 was documented in 2,598 (7%) patients. During a median follow-up of 5.7 (IQR 2.8–9.1) years, 5,015 (11.3%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death at 6 years was 23.4% (21.6–25.3) among patients with elevated E/e' ratio compared with 9.7% (9.3–10.0) among patients with E/e'<14 (p Log rank <0.001). This difference was less significant as age progressed (figure 1). Multivariate cox-regression model yielded consistent results such that an elevated E/e' ratio was associated with 2.66-fold increased risk of death during follow up (95% CI 2.44–2.89, p<0.001), and there was a decline in the increased risk and significant as age advanced in both genders (figure 2). Interaction analysis was significant for both gender and age such the association of elevated E/e' ratio with poor survival was more significant among men compared with women and among young vs. older subjects. Among women, elevated E/e' was associated with 2.4-fold increased risk of death versus 2.7-fold increased risk among men. Similarly, the hazard ratio for death associated with elevated E/e' was 2.29 (95% CI 1.74–3.02), 1.8 (95% CI 1.5–2.1), 1.13 (95% CI 0.97–1.31) and 1.07 (95% CI 0.92–1.25) for the age groups of <60, 60–70, 70–80 and >80, respectively. In a sensitivity analysis, similar findings were seen in when excluding patients with mild hypertrophy (maximal wall thickness >12mm) and without any mitral annulus calcification. Conclusion In apparently normal hearts, an elevated E/e' ratio is independently associated with increased mortality. This association is more pronounced among men and is attenuated with increased age. This study supports the need for gender-specific and age-specified outcome data with respect to measures of diastolic dysfunction. FUNDunding Acknowledgement Type of funding sources: None. Survival by age and gender groups E/e' >14 and mortality by age and gender

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Risk of stroke in patients with Chagas cardiomyopathy is associated with depressed LV function but not with LV myocardial fibrosis or apical aneurysm: a study using cardiovascular magnetic resonance

European Heart Journal ◽

10.1093/ehjci/ehaa946.2151 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Schmidt ◽

H Turin Moreira ◽

G.J Volpe ◽

M.F Braggion Santos ◽

J.A Marin Neto

Keyword(s):

Atrial Fibrillation ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Age And Gender ◽

Chagas Cardiomyopathy ◽

History Of ◽

And Gender ◽

Apical Aneurysm ◽

Normal Lvef

Abstract Background Chronic Chagas cardiomyopathy (CCC) is classically related to higher occurrence of thromboembolic events, especially stroke, particularly in patients with atrial fibrillation (AF). However, risk factors for stroke in patients with CCC but no atrial fibrillation have not been well established. Purpose We aimed to assess the relationship between left ventricular (LV) structure and function, as evaluated with cardiac magnetic resonance (CMR), with stroke in individuals with CCC. Methods We prospectively collected data from 141 patients with CCC who underwent CMR from October 2009 to December 2013 and who were thereafter followed for a median period of 6.8 years. The outcome was the occurrence of stroke during the follow-up period. The only exclusion criteria were history of previous stroke, AF or use of oral anticoagulant (OAC) at the time of CMR. CMR-derived LV parameters were: LV ejection fraction (LVEF), extension of LV myocardial fibrosis, assessed by late gadolinium enhancement, and presence of LV apical aneurysm. LVEF was classified as follows: (I) normal ≥55%; (II) mid-range <55% and ≥40%; and (III) reduced <40%. Age and gender were covariates in the adjusted Cox proportional hazard model. Results Of the initial 141 CCC participants, 25 subjects were excluded due to previous stroke (n=2), history of AF (n=11), or use of OAC (n=12). The remaining 116 individuals had a mean age of 56±14 years, 51% women. Normal, mid-range and reduced LVEF were found in 48 (41%), 43 (37%), and 25 (22%) patients, respectively. Myocardial fibrosis was detected in 79 of 111 (71%) subjects in whom the detection method was feasible. The extension of LV fibrosis was evaluated as a median of 4.6% [interquartile range: 0–10]. LV apical aneurysm was identified in 36 (31%) patients. During the follow-up (median 6.8 years), stroke was reported in 9 participants. In the univariate analysis, reduced LVEF was significantly associated with higher risk of stroke compared to normal LVEF (HR: 9.2, 95% CI: 1.8–48.4), while there was no significant difference between mid-range and normal LVEF (HR: 1.2, 95% CI: 0.2–8.2). The association of reduced LVEF and stroke remained significant in the multivariable model, adjusted for age and gender (HR: 12.6, 95% CI: 1.9–83.2). Kaplan-Meier curves are presented in figure 1 (logrank p-value <0.001). Neither the extension of LV myocardial fibrosis (HR: 1.0, 95% CI: 0.9–1.1) nor the presence of LV apical aneurysm (HR: 1.9, 95% CI: 0.5–7.2) was related to higher risk of stroke. Conclusion In patients with CCC, reduced LVEF assessed by CMR, but not LV fibrosis or presence of apical aneurysm, was a significant predictor of stroke. Funding Acknowledgement Type of funding source: None

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Metachronous neoplasms in patients with laterally spreading tumours during surveillance

United European Gastroenterology Journal ◽

10.1177/2050640620965317 ◽

2020 ◽

pp. 205064062096531

Author(s):

Roel MM Bogie ◽

Bjorn Winkens ◽

Sean JJ Retra ◽

Chantal MC le Clercq ◽

Mariëlle W Bouwens ◽

...

Keyword(s):

Colorectal Neoplasms ◽

Colorectal Neoplasm ◽

Submucosal Invasion ◽

High Grade Dysplasia ◽

High Grade ◽

Age And Gender ◽

Metachronous Neoplasms ◽

Metachronous Colorectal Cancer ◽

And Gender

Background Laterally spreading tumours represent a major challenge for endoscopic detection and resection. Objective To examine synchronous and metachronous neoplasms in patients with laterally spreading tumours. Methods We prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years’ follow-up. Post-resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared. Results Between 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, P < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, P = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, P < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8–4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients. Conclusion Patients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.

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