P253 Withdrawal of beta- blockers and ACE inhibitors after left ventricular systolic function recovery in patient with dilated cardiomyopathy randomized control trial

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Bakhsh ◽  
G Thanassoulis ◽  
J C Engert ◽  
E Elstein ◽  
T Huynh ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Medical Therapy ◽  
Primary Endpoint ◽  
Ace Inhibitors ◽  
Systolic Function ◽  
Treatment Withdrawal ◽  
P Value ◽  
The Mean ◽  
Randomized Control ◽  
Lv Systolic Function

Abstract Funding Acknowledgements The Rosenfeld Heart Fund Introduction recovery of left ventricle (LV) systolic function with normalization of ejection fraction (LVEF) occurs in 10 - 27% of patients with 80% maintaining recovery. However, the need for medical therapy after recovery is often questioned. Previous randomized studies of treatment withdrawal were small, not selected for non-ischemic dilated cardiomyopathy (DCM) and had a reference of improved or recovered EF to > 40% or > 10% change from LVEF at time of diagnosis.  Hypothesis: In patients with DCM with recovery of the LV systolic function to an EF (>50%), medical therapy withdrawal is possible without rebound LV systolic dysfunction. Method: This was a pilot randomized control open-label trial with 2:1 randomization for withdrawal of b-blockers and ACE inhibitors in patients with recovered LV systolic function. Patients’ medication discontinuation occurred in 2 phases with a six-month interval and patients were followed for one year. The primary endpoint was LVEF reduction (< 40%). Results: There were 22 patients (10 females) enrolled. The mean age was 60 ± 12y. The mean LVEF at enrollment was 58 ± 5% with no significant difference in the mean LVEF in both groups. Sixteen patients were assigned to the withdrawal group and 6 assigned to the control group. The primary endpoint occurred in 31% of the withdrawal group compared to none of the control. The rate of 1ry outcome after withdrawal of medical therapy was 19%, p-value 0.15. The mean LVEF at 1 year for the treatment withdrawal group was 46.8 ± 12% and control 55 ± 6%, p-value 0.15. In the medication withdrawal group, the mean LVEF reduction was 10.6 ± 11% and the difference between the mean LVEF at enrollment and at 1 year was 10.6 ± 11% with 95% CI (4.6,16.49), p-value 0.0017. Conclusion: In DCM patients with recovery of LV systolic function, we observed worsening of LVEF after withdrawal of b-blockers and ACE inhibitors. Abstract P253 Figure.

P337Natural history, reversibility and arrhythmias associated with truncating titin variants in dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C R Vissing ◽  
T B Rasmussen ◽  
M S Olesen ◽  
L N Pedersen ◽  
A Dybro ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Medical Therapy ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Absolute Increase ◽  
The Mean

Abstract Background Truncating genetic variants in titin (TTNtv) are identified in 15–25% of patients with primary dilated cardiomyopathy (DCM). Previous genotype/phenotype studies have reported conflicting results regarding disease severity and pathologic features associated with TTNtv. Purpose To investigate the natural history, reversibility and burden of arrhythmias associated with TTNtv in a Danish cohort with long-term follow-up. Methods Patients with DCM, recruited from two Danish tertiary centers, were included based on the presence of a TTNtv in a cardiac expressed titin exon. Data on patients' medical history including symptoms, demography, family history, comorbidities, treatment, ECG features, and echocardiograms were registered. Outcome data including all-cause mortality, need of heart transplantation (HTX) or left ventricular assist device (LVAD), and presence of ventricular and supraventricular arrhythmias were registered. Left ventricular reverse remodeling (LVRR) was defined as an absolute increase in left ventricular ejection fraction (LVEF) ≥10% points or normalization. Results A total of 104 patients (71 men, 69%; 72 probands) with definite TTNtv-DCM were included. The mean age at DCM diagnosis was (mean±SD) 45±13 years (43±13 for men; 49±14 for women, p<0.04) and median follow-up was 8.1 years. The mean LVEF was 28±13% at time of diagnosis (26±12% for men; 30±13% for women, p=0.173). During follow-up, 31 patients (30%; 24 men) died or needed HTX/LVAD. Medical therapy was associated with LVRR in 79% of patients 3.6 years after diagnosis. LVRR was maintained long-term in 64% of patients. Women had a better response to medical therapy compared to men (mean LVEF increase 19%; vs 15% in men, p<0.04). Atrial fibrillation/flutter was observed in 40% of patients and ventricular arrhythmias in 23% of patients. Men had an earlier occurrence of both supraventricular and ventricular arrhythmias (p=0.005) with half of the men having experienced an arrhythmia at the age of 54 years. Freedom from arrhythmias with age Conclusion TTNtv leads to a DCM phenotype associated with a marked gender-difference in age at DCM diagnosis and high burden of both supraventricular and ventricular arrhythmias. Importantly, the DCM-TTNtv phenotype was associated with a high degree of reversibility of systolic function following medical therapy.

P4631Eosinopenia an inflammatory marker of adverse clinical outcomes in patients presenting with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Alkhalil ◽  
A K Kearney ◽  
M H Hegarty ◽  
C S Stewart ◽  
P D Devlin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Eosinophil Count ◽  
Systolic Function ◽  
P Value ◽  
Diabetic Patients

Abstract Background Inflammation is an indicator of worse clinical outcomes following acute myocardial infarction. Eosinopenia was identified as a surrogate of inflammation in sepsis and obstructive airway disease. Whether this readily-available marker has any impact on long term outcomes following ST-segment elevation myocardial infarction (STEMI) is yet to be determined. Purpose We sought to study the incidence and relationship between eosinopenia and infarct severity and whether low eosinophil had impact on clinical outcomes following STEMI. Methods 606 consecutive STEMI patients undergoing primary PCI from a large volume single centre were enrolled. Low eosinophil count was defined as <40 cells/ml from samples within 2 -hours post reperfusion. Primary endpoint was defined as composite of death, MI, stroke, unplanned revascularisation, re-admission for heart failure over 3.5 years follow up. Results 65% of patients had eosinopenia. Patients in the low eosinophil group had larger infarct size as measured by troponin value [2934 vs. 1177ng/L, P<0.001] and left ventricle (LV) systolic function on echocardiography [48% vs. 50%, P=0.029]. Thehre was a modest correlation between eosinophil count and both troponin (r=−0.25, P<0.001) and ejection fraction (r=0.10, P=0.017). The primary endpoint was higher in eosinopenic patients (28.8% vs. 20.4%, HR 1.49, 95% CI 1.05 to 2.13, P=0.023) (Figure). The difference was mainly driven from higher percentage of unplanned revascularisations (8.2% versus 2.9%, P=0.012) (Table). Low eosinophil count was an independent predictor of adverse cardiovascular events, beyond infarct severity, in elderly, non-diabetic patients (HR 2.04, 95% CI 1.04 to 4.01, P=0.038). Incidence rate of major clinical Clinical characteristics Low eosinophil Normal eosinophil P value Long term clinical events 28.8% (112) 20.4% (42) 0.026 Long term mortality 14.1% (55) 11.1% (23) 0.31 Long term MI 6.9% (27) 4.9% (10) 0.32 Long term unplanned revascularisation 8.2% (32) 2.9% (6) 0.012 Long term re-admission CCF 6.7% (26) 4.9% (10) 0.37 Long term stroke 2.6% (10) 1% (2) 0.19 Conclusions Eosinopenia is a readily-available marker which was associated with a larger infarcts and worse clinical outcomes over long term follow up.

scholarly journals Transthyretin Gene Variants and Associated Phenotypes in Danish Patients with Amyloid Cardiomyopathy

2022 ◽  
Vol 12 (1) ◽  
pp. 1-11
Author(s):  
Torsten B. Rasmussen ◽  
Bertil T. Ladefoged ◽  
Anne M. Dybro ◽  
Tor S. Clemmensen ◽  
Rikke H. Sørensen ◽  
...  
Keyword(s):  
Systolic Function ◽  
Age At Diagnosis ◽  
Cardiac Biomarkers ◽  
P Value ◽  
Cardiac Biomarker ◽  
Gene Testing ◽  
Younger Age ◽  
Reduced Penetrance ◽  
Lv Systolic Function ◽  
Clinical Phenotyping

Genotyping divides transthyretin cardiac amyloidosis (ATTR-CA) in hereditary (ATTRv) and wild type (ATTRwt) forms. This study investigated the prevalence and clinical presentation of ATTRv in a contemporary cohort of consecutive ATTR-CA patients diagnosed at a tertiary Danish amyloidosis center. Age at diagnosis, clinical- and echocardiographic data, and transthyretin (TTR) genotype were recorded. Relatives of ATTRv patients underwent clinical phenotyping and predictive gene testing. Genetic testing in 102 patients identified four TTR variant carriers: p.Pro63Ser, p.Ala65Ser (n = 2) and p.Val142Ile. The mean age of ATTRv index patients was significantly lower compared to ATTRwt patients: 70.2 ± 1.2 versus 80.0 ± 6.2, p-value: 0.005. Evaluation of ATTRv families identified seven TTR variant carriers with a median age of 65 years (range 48–76) and three were diagnosed with ATTR-CA by DPD-scintigraphy. Family members with ATTR-CA were all asymptomatic and had normal levels of cardiac biomarkers. In conclusion, the prevalence of ATTRv in a contemporary Danish ATTR-CA cohort is 4%. ATTRv index patients were significantly younger age at diagnosis than ATTRwt patients. Non-p.Leu131Met TTR variants have reduced penetrance at the age of 65 years in which approximately half of variant carriers have asymptomatic ATTR-CA with normal LV systolic function and cardiac biomarker analyses.

scholarly journals Investigating the effect of Sesame Ointment on Wound healing of Episiotomy

2018 ◽  
Vol 9 (3) ◽  
pp. 182-184
Author(s):  
Najmeh Amani Babadi ◽  
Masoomeh Kheirkhah ◽  
Faraz Mojab ◽  
Hamid Haghani
Keyword(s):  
Wound Healing ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Significant Difference ◽  
The Mean ◽  
Randomized Control ◽  
Spss Software ◽  
And Control

Episiotomy is one of the most common midwifery interventions method for preventing injuries to the pelvic floor during the delivery process. Traditional medicine has a special place in improving the quality of postpartum care. Sesame is one of the herbs with anti-inflammatory, anti-bacterial and antioxidant activity.  This study was evaluate the effect of sesame ointment on episiotomy healing. Methods: This randomized control clinical trial was performed on 104 eligible women. The samples were block randomly assigned to one of the groups Intervention and control. Samples were used sesame and placebo ointment for epizootics from 4 hours after delivery for ten days every 8 hours. Clinical evaluation of episiotomy ulcer was performed 4 hours, 7 and 10 days after delivery with using REEDA tool. SPSS software version 16 was used for data analysis. P value less than 0.05 was considered significant. Results: The average of wound healing rate was 7 days after episiotomy in the intervention group 0.09 ± 0.29 and in the control group was 0.73 ± 0.44. Independent t-test showed that the two groups had a significant difference (p <0.001).Healing of the wound 10 days after episiotomy showed that the mean scores in the control group (0.4 ± 0.49) and in the intervention group (0.02 ± 0.13), healing in the intervention group significantly decreased from the control group (p <0.001). Conclusion: Sesame ointment can be used as a pain relief and accelerator for episiotomy healing.  

scholarly journals COMPARISON OF INTRAVENOUS LIGNOCAINE VS NALBUPHINE IN ATTENUATION OF HEMODYNAMIC RESPONSE TO AWAKE TRACHEAL EXTUBATION IN ENT SURGERIES

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S37-41
Author(s):  
Liaquat Ali ◽  
Amim Akhter ◽  
Muhammad Saeed ◽  
Usman Khalid ◽  
Jawad Rehmani
Keyword(s):  
Tracheal Extubation ◽  
Ethics Committee ◽  
Military Hospital ◽  
P Value ◽  
Hemodynamic Parameters ◽  
Operation Theatre ◽  
Duration Of Surgery ◽  
The Mean ◽  
Randomized Control ◽  
Classification Evaluation

Objective: To compare intravenous lignocaine vs. intravenous nalbuphine in terms of mean change in heart rate and mean arterial pressures (MAP) during awake tracheal extubation. Study Design: Randomized control trial. Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Rawalpindi, from May 2016to Dec 2016. Methodology: After approval of the study by the institution’s research ethics committee, the patients meetinginclusion criteria were assigned randomly to one of the two groups by lottery method. On return of spontaneous ventilation, patients in group L received intravenous lignocaine 1.5 mg/kg while group N patients received intravenous Nalbuphine 0.2mg/kg. Data recorded immediately (T1) and 5min after (T2) extubation. Results: After stratification of data in terms of age, gender, duration of surgery and ASA classification, evaluation of hemodynamic parameters (HR and MAP) between the two groups was done. The mean change in HR in group L was 6.66 ± 1.53 bpm and in group N was 4.43 ± 1.35. The mean change in MAP in group L was 4.90 ± 1.49 mm of Hg and in group N was 3.23 ± 1.33. p-value in both parameters was found to be less than 0.05 and thus declared significant.Conclusion: We concluded that intravenous nalbuphine, in the dose of 0.2mg/kg, is a better attenuator ofhemodynamic response to extubation as compared to intravenous lignocaine and provides better stability ofHeart rate and Mean arterial Pressure.

Comparison of Efficacy of Intravenous Tramadol versus Normal Saline in Suppression of Postoperative Shivering in Patients undergoing Elective Surgery

2021 ◽  
Vol 15 (8) ◽  
pp. 2006-2009
Author(s):  
Riffat Saeed ◽  
Nasir Ali ◽  
Syed Mehmood Ali ◽  
Iram Qamar ◽  
Amer Latef ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Normal Saline ◽  
Elective Surgery ◽  
Control Group ◽  
P Value ◽  
Thermoregulatory System ◽  
The Mean ◽  
Randomized Control ◽  
One Year

Background: Shivering in the post anesthesia care unit is a common and distressing complication for patients after receiving general or regional anesthesia. Perioperative hypothermia has been associated with an increase in morbidity and mortality. Both central and peripheral thermoregulation is impaired by regional anesthesia. Thermoregulatory system synchronizes with defense system to maintain body’s heat and coolness within the narrow range, thus improving the normal functioning. Objective: To compare the efficacy of intravenous tramadol versus normal saline in suppression of postoperative shivering in patients undergoing elective surgery. Design: It was a randomized control trial. Study Settings: Trial was conducted at Department of Anesthesiology and ICU, Sheikh Zayed Hospital, Lahore, for a period of one year w.e.f 7-11-2019 to 7-11-20. Patients and Methods: A total of 50 patients with age 18 years and above from both the genders undergoing elective surgery under general anesthesia were included in the study and divided into two equal groups randomly. Patients in tramadol group were given tramadol 0.5mg/kg I/V and patients of control group were given 0.9% normal saline 5ml I/V. Results: In tramadol groups the mean age of patients was 27.88±2.79 years while the mean age of the patients from placebo group was 27.84±4.23 years. In this study the efficacy was achieved in 37(74.0%) patients. In control group the efficacy was achieved in 15(60%) patients and in tramadol group the efficacy was achieved in 22(88.0%) patients (p-value<0.05). Conclusion: According to this study the intravenous tramadol is safe and effective drug in suppression of postoperative shivering in patients undergoing elective surgery under spinal anesthesia. Keywords: Intravenous Tramadol, Spinal Anesthesia, Shivering, Elective Surgery.

scholarly journals EFFICACY OF TAMSULOSIN IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA IN TERMS OF TRIAL WITHOUT CATHETER, A RANDOMIZED CONTROL TRIAL

2021 ◽  
Vol 12 (3) ◽  
Author(s):  
Farhan Khan ◽  
Usman Qamar ◽  
Muhammad Saifullah ◽  
Muhammad Sheraz Javed ◽  
Ahsan Ali Arain ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Randomized Control Trial ◽  
Foley Catheter ◽  
Prostatic Hyperplasia ◽  
P Value ◽  
Urological Complications ◽  
The Mean ◽  
Randomized Control ◽  
Trial Without Catheter ◽  
Group B

BACKGROUND & OBJECTIVE: Benign prostatic hyperplasia (BPH) is a prevalent cause of voiding problems in older males and is most commonly associated with acute urological complications, most important of which is acute urinary retention (AUR). α1- antagonists are the treatment of choice for the management of patients with BPH. Our objective was to evaluate the efficacy of tamsulosin for the treatment of patients with AUR due to BPH in terms of trial without catheter (TWOC). METHODOLOGY: This randomized control trial was conducted in a Urology Section, Department of Surgery, SIUT Karachi, from 21-12-2016 to 20-06-2017. Our study included 136 patients who presented AUR due to BPH as per selection criteria. Patients were randomized into two groups. Group A patients received tamsulosin (0.4 mg), and group B patients received placebo drug immediately after insertion of Foley catheter. The success of TWOC was evaluated after 3 days of medical treatment. Statistical analysis was carried out using SPSS v20.0. RESULTS: The mean age of the study patients was 59.45 + 8.05 years. The mean duration of BPH disease was 15.39 + 6.84 months. There were 33 (48.5%) patients in the tamsulosin group in which TWOC was successful and only 22 (32.4%) patients in placebo group in which TWOC was successful (p-value 0.04). There was no effect of age and duration of BPH disease on the outcome of this study. CONCLUSION: Tamsulosin is effective for the treatment of patients with AUR due to BPH.

scholarly journals VIDEO TURP: SURPASSING THE GOLD STANDARD

1969 ◽  
Vol 2 (1) ◽  
pp. 96-99
Author(s):  
Liaqat Ali ◽  
Mir Alam Jan ◽  
Sarhad Khan ◽  
Khursheed Anwar
Keyword(s):  
P Value ◽  
Medical Sciences ◽  
New Approach ◽  
Bladder Irrigation ◽  
Group A ◽  
Key Words Prostate ◽  
The Mean ◽  
Randomized Control ◽  
Group B ◽  
Control Study

Objectives: To compare the resection time and resected volume of the prostate in patients who weresubjected to video Trans-urethral resection of prostate (TURP) and conventional TURP, and to determinethe difference in the duration of bladder irrigation during post-operative period for conventional TURP andvideo TURP. Study Design: Comparative randomized control study. Methods: The study was conducted in the Department of Urology at Pakistan Institute of Medical Sciences(PIMS) Islamabad from Is' March 2002 to 28,h February 2003. Total number of 100 patients were equally Kdivided into two groups. Group ’A’ comprising of 50 patients (Control) were subjected to ConventionalTURP and Group 'B' comprising of 50 patients (Case) were subjected to video TURP respectively. Thesample was randomized by the last digit of the hospital admission number, Even number was allocated togroup 'A' and Odd number to group 'B'. The data was recorded on structured proforma and was analyzed onSPSS. ' ; Results: The mean age of the patients was 65.5 years with the range of 42-96 years. The Mean resection timefor conventional TURP was 36.03 minutes and for video TURP was 37.27 minutes ( P value = 0.068 ). Themean resected volume for conventional TURP was 18.5 gm and for video TURP was 23.65gm ( P value =0.01 ). The post operative irrigation of the bladder with 0.9% saline was required for 3.32 days inconventional TURP, while it was required for 1.57 days in video TURP ( P < 0.05 ). There was no TURPsyndrome recorded in both the groups and the mean hospital stay for both the group was equal i.e. 4th Postoperative day as per protocol of our department. Conclusion: The video TURP has opened up a new Approach in endourology. It is more effective inresection than conventional TURP and bears the same safety of resection time as conventional TURP. Key Words: Prostate,TURP, Endourology, Video TURP

P5499Coronary angioplasty for octogenarian acute coronary syndrome patients? Is it worth it?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Vila Cha Vaz Saleiro ◽  
D Campos ◽  
R Teixeira ◽  
J Lopes ◽  
J P Sousa ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Systolic Function ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
Comorbidity Burden ◽  
St Elevation ◽  
Lv Systolic Function ◽  
The Impact

Abstract Background As the population ages, doctors are being challenged by the decision to offer intervention treatment in increasingly older and fragile patients. The comorbidity burden and performance status should be considered when making the decision. Purpose To assess the impact of optimal medical therapy (OMT) versus percutaneous coronary intervention (PCI) in non-ST elevation acute coronary syndrome (ACS) patients older than 80 years. Methods 182 patients older than 80 years old admitted to a single coronary care unit with a diagnosis of non-ST elevation ACS, who survived hospital stay were included. Clinical, laboratorial and echocardiographic data were evaluated. Two groups were created: Group A (OMT group) N=83; Group B (PCI group) N=99. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer curves and Cox regression were conducted to evaluate the impact of OMT versus PCI on the primary endpoint. The mean time of follow-up was 37±29 months. Results Groups were homogenous regarding gender, cardiovascular risk factors, heart failure diagnosis, left ventricular (LV) systolic function and peak troponin I. OMT group patients were older (85.1±3.7 vs 82.7±3.2 years old, P<0.01), had a higher prevalence of chronic kidney disease (CKD) (61.4% vs 46.5%, P<0.05), a lower haemoglobin (Hb) level (12.0±1.9 vs 12.6±1.7 g/dL, P<0.05) and were less likely to receive double antiplatelet therapy at discharge (80.8% vs 100%, P<0.001). 84 patients met the primary outcome. Kaplan-Meyer curves showed increased survival in the PCI group (36.5% vs 59.3%, Log Rank P<0.001 – Figure 1). Nevertheless, PCI was not associated with long-term mortality (HR 1.05, 95% CI 0.98–1.12) in a model adjusted for age, CKD, peak troponin, LV systolic function and Hb level. Only Hb (HR 0.81, 95% CI 0.73–0.93), peak troponin (HR 1.01, 95% CI 1.00–1.01) and LV function (slightly impaired [HR 1.89, 95% CI 1.03–3,48] and moderate/severely impaired [HR 1.96, 95% CI 1.14–3.36]) remained associated with the outcome. Conclusion Increased survival in older patients receiving PCI after a non-ST elevation ACS may be ascribed to the selection of patients with less comorbidities. This reinforces the idea it may be applied in well-fit patients regardless of age. In our elderly population, lower Hb level, peak troponin and impaired LV systolic function appear to be the main contributors to decreased survival, irrespective of intervention.

Sign in / Sign up

Export Citation Format

Share Document