scholarly journals Elevated echocardiographic markers for left atrial stiffness and fibrosis in patients with paroxysmal atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Bastos ◽  
F Al-Khalili ◽  
M Back ◽  
A Manouras ◽  
J Engdahl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Matched Control ◽  
P Wave ◽  
Volume Index ◽  
Intensity Difference ◽  
Control Group ◽  
Activation Time ◽  
Matched Control Group ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Danderyds Hospital Background Atrial fibrillation (AF) is associated with atrial disease expressing left atrial (LA) structural remodeling with increased fibrosis and stiffness. Transthoracic echocardiography (TTE) is the first imaging modality of choice for the evaluation of LA volume index (LAVI) and function. However TTE allows new approaches for LA anatomical and functional analysis such as LA stiffness index (LASI) calculation based on LA global longitudinal strain (GLS), LA activation time and LA Integrated Backscatter (IBS). LA activation time is a novel parameter, considered as an echocardiographic surrogate analysis for LA fibrosis. Echocardiographic derived IBS can noninvasively quantify myocardial fibrosis in the left ventricle, allowing a similar alternative analysis for LA fibrosis. Purpose To investigate potential  LA structural and functional changes in paroxysmal AF patients by measuring LA activation time, LASI and LA IBS compared with age-matched control group. Methods In total, 75 paroxysmal AF patients and 99 age-matched control group patients (mean age 77 ± 0.4) were enrolled from STROKESTOP2 study. Patients with paroxysmal AF were included from a subgroup of newly screened-diagnosed AF. TTE examinations were analyzed retrospectively offline using dedicated software. NTproBNP levels ( ≤ 900 ng/L) was an enrollment criterium. LA activation time was acquired by measuring the time delay between the onset of the P-wave on ECG and the peak of the Á –wave on the Tissue Doppler (TD) tracing in the lateral LA wall. LASI was calculated as the ratio of E/é to LA-GLS. LA IBS was obtained as the intensity difference between the LA lateral wall and the pericardium, at QRS peak. Results There was a significant increase of LASI (0.53 ± 0.21 vs. 0.41 ± 0.22, P < 0.05) and LA IBS (14 ± 7.1 dB vs. 11 ± 6.3 dB, P < 0.05) in the AF group compared to the control group. Feasibility for LASI resulted as 64 %, respectively 91 % for LA IBS. LA activation time was significantly prolonged in the AF group (157 ± 34 ms vs. 134 ± 18 ms, P < 0.05) with a feasibility of 44 %. In the AF group, 45 patients (60 %) expressed normal LAVI <34 ml/m2. No significant difference was revealed concerning LAVI (P > 0.05) between the groups (AF group with normal LAVI). Although LASI, LA IBS and LA activation time remained significant increased in the AF group (P < 0.05). No significant difference was shown regarding NT-proBNP levels. (P > 0.05) between the AF group 243 (179-420) ng/L and the control group 219 (160-317) ng/L. Conclusions Indices reflecting LA stiffness and echocardiographic parameters associated with LA fibrosis, were elevated in patients with paroxysmal AF compared to age-matched controls. These findigs might non-invasively provide additional information in paroxysmal AF patients with normal LA size.

P2450The atrial electromechanical conduction delay with ultrasound based two-dimensional speckle-tracking predicts very late recurrence following catherter ablation for atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Fujii ◽  
K I Inoue ◽  
M K Kinoshita ◽  
T N Nagai ◽  
Y S Sasaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Late Recurrence ◽  
P Wave ◽  
Volume Index ◽  
Reverse Remodeling ◽  
Conduction Delay ◽  
Echocardiographic Image ◽  
Significant Difference

Abstract Background/Introduction Long-term efficacy following catheter ablation (CA) of atrial fibrillation (AF) remains unknown. Left atrial (LA) reverse remodeling following CA may be important to reduce the risk of very late recurrence (VLR). Purpose We hypothesize that improved mechanical conduction delay with myocardial strain is associated with LA reverse remodeling indicates efficacy following AF ablation. This study aimed to investigate the clinical utility of mechanical conduction delay to predict VLR in patients with AF undergoing CA. Methods We enrolled 114 consecutive patients undergoing initial CA in patients with AF from January 2012 to February 2014. 20 patients were excluded due to poor echocardiographic image quality. 38 patients had AF recurrence within 12 months after CA. Finally, 54 patients (age 62 years, 13 female, 15 persistent AF) were analyzed. Trans-thoracic echocardiography (TTE) was performed within 24 hours as baseline, and every 6–12 months following the initial CA as follow-up. We compared the TTE data with baseline and latest test when sinus rhythm was maintained. To assess atrial electromechanical conduction delay, we adopted a parameter based on speckle tracking echocardiography (EMT-ε), which was defined as the interval from the P- wave onset to the peak late diastolic longitudinal strain in the basal lateral wall of LA (Figure). Results Eleven patients had VLR after CA. In patients with VLR, left atrial volume index (LAVI) at baseline was significantly higher than those without VLR (49±17 vs 35±14 ml/m2, P<0.05). EMT-ε had no significant difference between two groups (225±52 vs 208±49 ms, P=NS). During 58±22 months, LAVI and EMT-ε were significantly improved (LAVI: 38±16 vs 33±14 ml/m2, EMT-ε: 215±48 vs 197±45 ms, P<0.05, respectively). The change of LAVI had no significant difference between two groups (−2 (−10, 4) vs 33 (−13, 6) ml/m2, P=NS). EMT-ε shortening was significantly greater in AF-free patients than patients with VLR (−27 (−66, −3) vs 23 (−1, 79) ms, P<0.01). At a cut-off value of −9 ms, the change of EMT-ε predicted VLR with sensitivity (100%) and specificity (68.9%). Conclusion(s) The atrial electromechanical conduction delay could predict VLR after CA in patients with AF.

scholarly journals Echocardiographic speckle tracking provides incremental value for left atrial function in patients with paroxysmal atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Bastos ◽  
F Al-Khalili ◽  
M Back ◽  
A Manouras ◽  
J Engdahl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Early Detection ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Volume Index ◽  
Control Group ◽  
Significant Difference ◽  
Echocardiographic Parameters

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Danderyds Hospital Background Atrial fibrillation (AF) is associated with progression of left atrial (LA) structural and functional changes. It is well acknowledged that AF over time promotes LA enlargement. Transthoracic echocardiography (TTE) is important in decision making for further treatment. Initially, new onset of AF such as paroxysmal AF can occur in the absence of LA enlargement. Therefore assessment of LA volume index (LAVI) as follow-up can mislead LA evaluation. LA global longitudinal strain (LA-GLS) is a novel parameter assessed with two-dimensional (2D) speckle tracking (ST). LA-GLS allows quantification of LA myocardial deformation by measuring reservoir function which reflects LA compliance during left ventricular systole. Purpose Our aim is to study potential differences in LA myocardial deformation as assessed by LA-GLS in paroxysmal AF patients compared with aged-matched control group. Methods A total of 75 paroxysmal AF patients and 99 control aged-matched patients (mean age, 77 ± 0.4) were enrolled from STROKESTOP2 study. Patients with paroxysmal AF were included from a subgroup of newly screened-diagnosed AF. TTE examinations were analyzed retrospectively offline using dedicated software. NT-proBNP ≤ 900 ng/L was an inclusion criteria. Besides conventional echocardiographic parameters, LA-GLS was measured using 2D-ST in biplane during systole. Results There was a significant LA-GLS reduction in the paroxysmal AF group compared to the control group (19 ± 6.1 % vs. 28 ± 7.2 %, P &lt; 0.001) with a feasibility of 70 %. In the AF group, 45 patients (60 %) expressed normal LAVI &lt;34 ml/m2. No significant difference was revealed concerning LAVI (P &gt; 0.05) between the groups (AF group with normal LAVI), yet LA-GLS remained significant reduced in the AF group (P &lt; 0.001). No significant difference was shown regarding NT-proBNP levels (P &gt; 0.05) between the AF group 243 (179-420) ng/L and the control group 219 (160-317) ng/L. Conclusion LA-GLS allows early detection of LA myocardial deformation dysfunction before LA enlargement in patients with paroxysmal AF. This findig provides incremental information to conventional echocardiographic parameters of LA. Whether early detection of LA dysfunction using LA-GLS can contribute to better risk stratification and cardiac therapy improvement requires to be further investigated.

scholarly journals Effects of Nutrient Intake Timing on Post-Exercise Glycogen Accumulation and its Related Signaling Pathways in Mouse Skeletal Muscle

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2555 ◽  
Author(s):  
Takahashi ◽  
Matsunaga ◽  
Banjo ◽  
Takahashi ◽  
Sato ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Muscle Glycogen ◽  
Nutrient Intake ◽  
Matched Control ◽  
Control Group ◽  
Glycogen Depletion ◽  
Post Exercise ◽  
Glycogen Accumulation ◽  
Matched Control Group ◽  
Significant Difference

We investigated the effects of nutrient intake timing on glycogen accumulation and its related signals in skeletal muscle after an exercise that did not induce large glycogen depletion. Male ICR mice ran on a treadmill at 25 m/min for 60 min under a fed condition. Mice were orally administered a solution containing 1.2 mg/g carbohydrate and 0.4 mg/g protein or water either immediately (early nutrient, EN) or 180 min (late nutrient, LN) after the exercise. Tissues were harvested at 30 min after the oral administration. No significant difference in blood glucose or plasma insulin concentrations was found between the EN and LN groups. The plantaris muscle glycogen concentration was significantly (p < 0.05) higher in the EN group—but not in the LN group—compared to the respective time-matched control group. Akt Ser473 phosphorylation was significantly higher in the EN group than in the time-matched control group (p < 0.01), while LN had no effect. Positive main effects of time were found for the phosphorylations in Akt substrate of 160 kDa (AS160) Thr642 (p < 0.05), 5'-AMP-activated protein kinase (AMPK) Thr172 (p < 0.01), and acetyl-CoA carboxylase Ser79 (p < 0.01); however, no effect of nutrient intake was found for these. We showed that delayed nutrient intake could not increase muscle glycogen after endurance exercise which did not induce large glycogen depletion. The results also suggest that post-exercise muscle glycogen accumulation after nutrient intake might be partly influenced by Akt activation. Meanwhile, increased AS160 and AMPK activation by post-exercise fasting might not lead to glycogen accumulation.

P2463Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lacalzada Almeida ◽  
V Armarnani Armarnani ◽  
J Garcia-Niebla ◽  
M M Izquierdo-Gomez ◽  
R Elosua ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cox Regression ◽  
Imaging Techniques ◽  
P Wave ◽  
Control Group ◽  
End Point ◽  
Interatrial Block ◽  
New Onset

Abstract Background The association between advanced interatrial block (aIAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”. There is little information on the prognostic role that new speckle tracking echocardiographic (STE) imaging techniques could play in it. Purpose We have examined the relationship between left atrial (LA) STE and the prediction of new-onset AF and/or stroke in IAB patients. Methods Observational study with 98 outpatients: 55 (56.2%) controls with normal ECG, 21 (21.4%) with partial IAB (pIAB) and 22 (22.4%) with aIAB. The end-point was new-onset AF, ischemic stroke, and the composite of both. Results During a mean follow-up of 1.9 (1.7–2.3) years, 20 patients presented the end-point (18 new-onset AF and 2 strokes): 8 (14.5%) in the control group, 3 (14.3%) in pIAB and 9 (40.9%) in aIAB, p=0.03. In multivariable comprehensive Cox regression analyses, a decrease of strain rate during the booster pump function phase (SRa) was the only variable independently related to the appearance in the evolution of the end-point, in the first model (age, P wave duration and SRa): HR 19.9 (95% CI, 3.12–127.5), p=0.002 and in the second (age, presence of aIAB and SRa): HR 24.2 (95% CI, 3.15–185.4), p=0.002. Conclusions In patients with IAB, a decrease in absolute value of LA SRa with STE predicts new-onset AF and ischemic stroke. Acknowledgement/Funding None

scholarly journals Educational attainment of children born to mothers with epilepsy

2018 ◽  
Vol 89 (7) ◽  
pp. 736-740 ◽  
Author(s):  
Arron S Lacey ◽  
William Owen Pickrell ◽  
Rhys H Thomas ◽  
Mike P Kerr ◽  
Cathy P White ◽  
...  
Keyword(s):  
Sodium Valproate ◽  
Matched Control ◽  
In Utero ◽  
Cognitive Testing ◽  
Control Group ◽  
In Utero Exposure ◽  
Minimum Standard ◽  
Matched Control Group ◽  
Significant Difference ◽  
Stage 1

ObjectiveSmall prospective studies have identified that children exposed to valproate in utero have poorer scores on cognitive testing. We wanted to identify whether children exposed to antiepileptic drugs (AEDs) in utero have poorer school performance.MethodsWe used anonymised, linked, routinely collected healthcare records to identify children born to mothers with epilepsy. We linked these children to their national attainment Key Stage 1 (KS1) tests in mathematics, language and science at the age of 7 and compared them with matched children born to mothers without epilepsy, and with the national KS1 results. We used the core subject indicator (CSI) as an outcome measure (the proportion of children achieving a minimum standard in all subjects) and the results in individual subjects.ResultsWe identified 440 children born to mothers with epilepsy with available KS1 results. Compared with a matched control group, fewer children with mothers being prescribed sodium valproate during pregnancy achieved the national minimum standard in CSI (−12.7% less than the control group), mathematics (−12.1%), language (−10.4%) and in science (−12.2%). Even fewer children with mothers being prescribed multiple AEDs during pregnancy achieved a national minimum standard: CSI (by −20.7% less than the control group), mathematics (−21.9%), language (−19.3%) and science (−19.4%). We did not observe any significant difference in children whose mothers were prescribed carbamazepine or were not taking an AED when compared with the control group.ConclusionsIn utero exposure to AEDs in combination, or sodium valproate alone, is associated with a significant decrease in attainment in national educational tests for 7-year-old children compared with both a matched control group and the all-Wales national average. These results give further support to the cognitive and developmental effects of in utero exposure to sodium valproate as well as multiple AEDs, which should be balanced against the need for effective seizure control for women during pregnancy.

Abstract MP77: Associations Between Atrial Cardiopathy and Cerebral Amyloid: The Aric Pet Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Michelle C JOHANSEN ◽  
Thomas Mosley ◽  
David Knopman ◽  
Dean Wong ◽  
Lynne E Wagenknecht ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Standardized Uptake Value ◽  
Left Atrial Volume ◽  
Community Dwelling ◽  
P Wave ◽  
Volume Index ◽  
Older Individuals ◽  
Cross Sectional ◽  
2D Echocardiography

Background: Atrial fibrillation (AF) is a risk factor for cognitive decline, perhaps due to silent cerebral infarction, but it is unknown if it also acts on Alzheimer’s Disease (AD)-specific mechanisms, such as deposition of β-amyloid (Aβ). Left atrial changes in structure or function, or atrial cardiopathy, can lead to AF but may cause infarcts independently, and thus might also impact cognition. We hypothesize that Aβ is associated with AF and atrial cardiopathy, independent of AF, when defined similarly to an ongoing clinical trial (ARCADIA). Methods: 321 participants without dementia from the Atherosclerosis Risk in Communities study underwent florbetapir (FBP) PET, electrocardiogram and 2D echocardiography. Atrial cardiopathy was defined as ≥1 of: 1) left atrial volume index (LAVI) >34 ml/m2; 2) P-wave terminal force >5000 uV x ms and 3) serum NT proBNP>250 pg/mL. Cross-sectional associations between global cortical Aβ (>1.2 standardized uptake value ratio (SUVR)) and adjudicated history of atrial fibrillation and atrial cardiopathy, each, were evaluated using multivariable logistic regression. Results: Participants, with mean age 76 y, were 56% female and 42% black. Odds of elevated FBP SUVR was increased for those with atrial cardiopathy (Model 3) and nearly doubled among those with enlarged LAVI that remained significant after sequential adjustment, including AF (Table). There was no significant association between either P-wave terminal force or NT proBNP and elevated FBP SUVR (Table), nor between elevated SUVR and AF. Conclusions: In this cross-sectional analysis of a cohort of healthy, nondemented community-dwelling older individuals, we report a significant association between atrial cardiopathy as well as LAVI and elevated amyloid, by PET, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede, or occur simultaneously with amyloid deposition.

scholarly journals Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001431
Author(s):  
Daniel R Frisch ◽  
Eitan Frankel ◽  
Deanna Gill ◽  
Jad Al Danaf
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
P Wave ◽  
Control Group ◽  
Observation Study ◽  
Intracardiac Electrogram ◽  
Significant Difference ◽  
Wave Morphology ◽  
Step Algorithm ◽  
Experimental Group

ObjectiveCavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.MethodsWe developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a cohort of 50 second-year medical students. Students were paired in a control and experimental group, and each pair received 10 randomly selected ECGs (from a pool of 50 intracardiac electrogram-proven CTI-AFL and 50 AF or atypical AFL cases). The experimental group received a cover sheet with the CTI algorithm, and the control group received no additional guidance.ResultsThere was a statistically significant difference in the mean number of correctly identified ECGs among the students in the experimental and control groups (8.12 vs 5.68, p<0.001). Students who used the algorithm correctly identified 2.44 more ECGs as being CTI-AFL or not CTI-AFL. Using the electrophysiology study as the gold standard, the algorithm had an accuracy of 81%, sensitivity of 81%, specificity of 82%, positive predictive value of 78% and negative predictive value of 84% in identifying CTI-AFL.ConclusionWe developed a three-step ECG algorithm that provides a simple, sensitive, specific and accurate tool to identify CTI-AFL.

scholarly journals Impact of Left Atrial Geometric Remodeling on Late Atrial Fibrillation Recurrence After Catheter Ablation

2021 ◽  
Author(s):  
Fuqian Guo ◽  
Caiying Li ◽  
Lan Yang ◽  
Chen Chen ◽  
Yicheng Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Volume Index ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Af Recurrence

Abstract Purpose: To quantitatively investigate the impact of left atrial (LA) geometric remodeling on atrial fibrillation (AF) recurrence after catheter ablation (CA).Methods: A retrospective analysis of 105 patients with AF who underwent coronary computed tomographic angiography before CA. Risk factors for AF recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.Results: After at least 12 months of follow-up, 30 patients (29%) developed recurrent AF. Patients with recurrence had a higher LA volume, LA sphericity, and a lower LA ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that LA minimal volume index (LAVImin) (OR: 1.280, 95% CI: 1.027–1.594, P = 0.028), LA sphericity (OR: 1.268, 95% CI: 1.071–1.500, P = 0.006) and CHA2DS2-VASc score (OR: 1.326, 95% CI: 1.016–1.732, P=0.038) were independent predictors of AF recurrence. The combined model of the LA sphericity to the LAVImin substantially increased the predictive power for AF recurrence (area under the curve [AUC] = 0.736, 95% CI: 0.627–0.844, P < 0.001), with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.769 (95% CI: 0.666–0.872) and had good internal validity.Conclusion: The CHA2DS2-VASc score, LA sphericity, and LAVImin were significant and independent predictors of AF recurrence after CA. Furthermore, the nomogram had a better predictive capacity for AF recurrence.

scholarly journals The Cavovarus Foot and It’s Association with Fractures of the Fifth Metatarsal

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Fuchs ◽  
Justin Kane ◽  
James Brodsky ◽  
Christian Royer ◽  
Jacob Zide ◽  
...  
Keyword(s):  
Matched Control ◽  
Control Group ◽  
X Rays ◽  
Matched Control Group ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Significant Difference ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
Foot Position

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Fifth metatarsal fractures are the most commonly encountered metatarsal fractures. It is often inferred that fifth metatarsal fractures occur at an increased frequency in patients with cavovarus foot position. In particular, zone 2 and zone 3 fractures are thought to be associated with cavovarus feet. However, limited data exists in the literature to support this claim. The hypothesis of this study is that a cavovarus foot alignment is positively correlated with the incidence of fifth metatarsal fractures. Methods: 298 consecutive fifth metatarsal fractures were compared with a matched control group of 104 patients presenting to an orthopaedic clinic for toe fractures, interdigital neuromas and plantar fasciitis. Radiographic parameters were measured on weight-bearing anteroposterior and lateral x-rays for all patients. An ANOVA test was utilized to compare radiographic parameters between patients with fifth metatarsal fractures and the control group. Parameters that were found to be statistically significant were further analyzed using a Tukey-Kramer test to compare controls and each type of fifth metatarsal fracture (zone 1, zone 2, zone 3, distal oblique diaphyseal, metatarsal neck). Results: All radiographic parameters are listed in table 1. A statistically significant difference (p<0.05) for calcaneal pitch, lateral talocalcaneal angle, AP talo-2nd metatarsal angle, talonavicular coverage angle and AP talocalcaneal angle were detected. All parameters are indicative of increased cavovarus in the fifth metatarsal fracture group when compared with controls. In the subgroup analysis, zone 1, zone 2, zone 3 and distal oblique diaphyseal fractures each had a calcaneal pitch, lateral talocalcaneal angle and AP talocalcaneal angle consistent with a more cavovarus position than the control group (p<0.05). Zone 2 and zone 3 fractures had an AP talo-2nd metatarsal angle more consistent with cavovarus than zone 1 fractures and controls. For all other parameters there were no significant differences between each type of fifth metatarsal fracture. Conclusion: While it is commonly accepted that cavovarus is a risk factor for fifth metatarsal fractures, there’s little evidence in the literature to support this. This study is the first to show that there is a positive correlation between radiographic parameters that reflect cavovarus foot position and the incidence of fifth metatarsal fractures compared to a matched control group of patients with unrelated pathology. Furthermore, while zone 2 and zone 3 fractures are most commonly thought to be associated with cavovarus, each subcategory of fifth metatarsal fractures in this study had radiographic measurements more consistent with cavovarus foot position than controls.

scholarly journals Intact Ligamentum Teres Predicts Superior Prognosis in Borderline Dysplastic Patients: A Matched Pair Controlled Study with Minimum Five-Year Outcomes Following Hip Arthroscopy

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Benjamin Domb ◽  
Sarah Chen ◽  
Rafael Walker-Santiago ◽  
Jacob Shapira ◽  
Philip Rosinsky ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Ligamentum Teres ◽  
Matched Pair ◽  
Controlled Study ◽  
Control Group ◽  
Matched Control Group ◽  
Center Edge ◽  
Significant Difference ◽  
Patient Reported

Objectives: (1) To report minimum five-year patient reported outcomes (PROs) in borderline dysplastic patients with ligamentum teres (LT) tears who underwent hip arthroscopy and (2) to compare these PROs to a pair-matched control group of borderline dysplastic hips without LT tears. Methods: Data was prospectively collected for patients who underwent hip arthroscopy during September 2008 and August 2013. Patients were included if had a preoperative diagnosis of borderline dysplasia [lateral center-edge angle (LCEA) of 18°- 25°] and had preoperative and minimum five-year postoperative modified Harris Hip Scores (mHHS), Non-Arthritic Hip Scores (NAHS), and Visual Analogue Scale for pain (VAS) scores. Exclusion criteria were Tönnis grade osteoarthritis >1, previous hip conditions, any prior ipsilateral hip surgery, or workers’ compensation status. Two borderline dysplastic groups were created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < 0.05. Results: 24 LT tear patients (24 hips) were matched 24 patients (24 hips) without an LT tear. There was no significant difference in age, sex, BMI, or laterality between groups. Mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear group, respectively (P = 0.783). There were 17 (70.8%) and 16 (66.7%) females in the control and LT tear group, respectively and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear group, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures, except for LT treatment. Five-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey Mental Component (VR-12M) (P = 0.041) and Short Format 12 Mental Health (SF-12M) (P = 0.042). The control group exhibited less pain and higher satisfaction with surgery; however, this trend was not significant. Finally, the LT tear group was significantly less likely to achieve the patient acceptable symptomatic state (PASS) for mHHS (P = 0.022). Conclusion: Following hip arthroscopy, patients with borderline dysplasia and LT tears demonstrated favorable PROs at minimum five-year follow-up. Outcomes were similar to a pair-matched control group without LT tears, with the control group showing higher VR-12M and SF-12M scores. Furthermore, borderline dysplastic patients with LT tears were significantly less likely to achieve the PASS for mHHS.

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