P198 Long-term outcomes after mitraclip implantation

Abstract Background Mitraclip implantation (MI) is a well-established option for patients (P) with severe mitral regurgitation (MR) noneligible to surgery. Its impact on long term prognosis is being addressed by several recent studies. Purpose To identify predictors of morbidity and mortality in P undergoing MI and evaluate if the COAPT, Everest and MITRAFR exclusion criteria (EC) had any impact on the outcome of our population. Methods prospective study of P who underwent MI between 2013 and 2018 in one medical center. EC: COAPT: LVEF < 20%, LV end-diastolic diameter > 70mm or pulmonary artery systolic pressure > 70mmHg; Everest: LVEF < 25% or LV end-systolic diameter (LVESD)>55mm; MITRA-FR: LVEF < 15% or >40% or primary MR. An univariate analysis was performed followed by a multivariate Cox analysis to evaluate overall mortality (M), overall mortality/ heart failure hospitalization (MH) and mortality in the first year post-MI(M1). Survival analysis using Kaplan-Meier plots. p < 0.05 were considered significant. Results 40P, 60% male, mean age 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months. 67.5% presented with MR grade IV and 75% had functional MR. Successful implantation in 97.5%, with 55% presenting mild MR post-procedure. Overall mortality was 30% (12P), mostly due to cardiovascular causes, with 9P dying in the first year (30%). There was no difference between pts with functional and primary MR: M- 33%vs20% (p = 0.6); MH– 53.3%vs30% (p = 0.5). P who met the COAPT exclusion criteria (N-22) presented an inferior 1Ysurvival (64.5%vs86.7%, p = 0.046). The overall outcome was comparable between P who matched and didn"t match Everest and MITRA-FR exclusion criteria. Basal BNP value (p = 0.037), mean preprocedural MAGGIC score (p = 0.040) and EROA (p = 0.039) were associated to M1. Multivariate Cox analysis revealed that basal BNP was an independent predictor of M (p = 0.017), whereas a higher distance in the pre-procedural 6 minute walk test (p = 0.008) and the "reduction in the MR severity and PASP" (p = 0.008) presented a protective effect. LVESD > 55mm was an independent predictor of MH (p = 0.017), but MR of grade 2 or less after procedure was protective (p = 0.006). Conclusion There was no M difference between P with functional and primary MR. P with COAPT exclusion criteria had worse 1Ysurvival. A higher distance in 6MWT and a reduction in MR severity and PASP were protective. An LVESD > 55 mm had a worse prognosis. Careful P selection may be crucial to improve MI"s results Abstract P198 Figure. Kaplan-Meier Plots

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Mid- and long-term efficacy of surgical treatment of Vancouver B2 and B3 periprosthetic femoral fractures

BMC Surgery ◽

10.1186/s12893-020-00891-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jian-Ning Sun ◽

Yu Zhang ◽

Ye Zhang ◽

Jia-Ming Zhang ◽

Xiang-Yang Chen ◽

...

Keyword(s):

Surgical Treatment ◽

Survival Rate ◽

Femoral Fractures ◽

First Year ◽

Femoral Prosthesis ◽

Term Efficacy ◽

Kaplan Meier ◽

Sf 36

Abstract Background The incidence of fractures around the femoral prosthesis among patients undergoing hip arthroplasty is increasing and has become the third leading cause of hip revision. While numerous methods for the surgical treatment of periprosthetic femoral fractures (PFFs) have been proposed, only few reports have examined the long-term efficacy of surgical treatment. This study aims to examine the mid-and long-term efficacy of surgical treatment among patients with Vancouver B2 and B3 PFFs. Methods This retrospective study evaluated the surgical outcomes of patients with Vancouver B2 and B3 PFFs between 2007 and 2011. The minimum follow-up time was eight years. Fracture healing, prosthesis stability, complications, patient quality of life SF-36 score, and survival rate were evaluated during the follow-up assessments. Results A total of 83 patients were included and had an average follow-up period of 120.3 months. Among these patients, 69 were classified as Vancouver B2 and were treated with a distal fixation stem, whereas 14 cases were classified as Vancouver B3 and were treated with modular femoral prosthesis by using a proximal femoral allograft technique. A total of 15 patients underwent secondary revision surgery, and prosthesis dislocation was identified as the main cause of secondary revision. 80 (96.4%) cases of fractures were clinically healed. The mortality rate in the first year after surgery was 8.4% (7/83). The overall 5-year Kaplan–Meier survival rate for these patients was 75.9%. Meanwhile, the 5-year Kaplan–Meier survival rate for the implants was 86.9%. The final follow-up SF-36 score of the patients was 48.3 ± 9.8. Conclusions Patients with Vancouver B2 and B3 PFFs show high mortality in the first year after their surgery, and the Kaplan–Meier analysis results showed that such mortality tends to plateau after 5 years. Prosthesis dislocation was identified as the primary cause of secondary revision.

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Immediate impact of percutaneous transvenous mitral commissurotomy on right ventricular function

Nepalese Heart Journal ◽

10.3126/njh.v14i2.18498 ◽

2017 ◽

Vol 14 (2) ◽

pp. 19-24

Author(s):

Bishal KC ◽

Rabi Malla ◽

Ram Kishore Shah ◽

Anish Hirachan ◽

Binay Kumar Rauniyar ◽

...

Keyword(s):

Right Ventricular ◽

Clinical Symptoms ◽

Longitudinal Velocity ◽

Prognostic Significance ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Tei Index ◽

Long Term Outcome ◽

Rv Function

Background and Aims: Abnormal Right Ventricular (RV) function affects the long term outcome and clinical symptoms in patients with mitral stenosis (MS). This study evaluates the immediate effect of Percutaneous Transmitral Commisurotomy (PTMC) on RV function.Methods: An observational, cross sectional study was done on 50 patients with rheumatic MS who underwent PTMC at Shahid Gangalal National Heart Center from Dec 2015 –Dec 2016. All underwent clinical evaluation and echocardiogram before and immediately after PTMC.Results: There was female preponderance with 66% being female. The mean age was 37.26 ± 10.63 years. There was immediate increase in the mitral valve area (MVA) from 0.87 ± 0.12cm2 to 1.54 ± 0.27cm2(p< 0.001). There was significant decrease in mean mitral diastolic gradient from 16.4 ± 8.8mmHg to 5 ± 1.5mmHg (p< 0.001), in the pulmonary artery systolic pressure 53.6 ± 21.83mmHg to 39.5 ± 14.67mmHg (p< 0.001), in the RV Tei index from 0.56 ± 0.08 to 0.40 ± 0.08 (p< 0.001). There was significant increase in TAPSE from 16.0 ± 1.50 to 18.6 ± 1.70 mm, (p<0.001) and the longitudinal velocity of excursion of the RV at the tricuspid annulus (RV S’) from 13.69 ± 3.33 cm/sec to 15.31 ± 3.07 cm/sec (p< 0.001)Conclusions: Successful PTMC can improve RV function as shown by the improvement in PASP, RV Tei index, TAPSE and RV S’. Further larger population studies are required to confirm the findings. Long term studies are important to determine the prognostic significance of improvement in RV function.Nepalese Heart Journal 2017; 14(2): 19-24

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Nonthyroidal Illness Syndrome in Ischaemic Stroke Patients is Associated with Increased Mortality

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-0915-2015 ◽

2019 ◽

Vol 128 (12) ◽

pp. 811-818 ◽

Cited By ~ 1

Author(s):

Saulius Taroza ◽

Daiva Rastenytė ◽

Aurelija Podlipskytė ◽

Henrikas Kazlauskas ◽

Narseta Mickuvienė

Keyword(s):

Venous Blood ◽

Serum Levels ◽

Thyroid Stimulating Hormone ◽

First Year ◽

Free Triiodothyronine ◽

Kaplan Meier ◽

Index Stroke ◽

Thyroid Axis ◽

Changes Over Time ◽

Overall Mortality

Abstract Background Results of studies on associations between triiodothyronine serum levels and mortality after acute ischemic stroke (AIS) are inconsistent. Therefore, the aim of this prospective study was to evaluate links between serum levels of thyroid axis associated hormones and all-cause mortality during 1 year after AIS. Methods and results This study involved 255 patients with AIS. Patients were divided into two groups: those who survived 1 year after their index stroke and those who not, and by quartiles of free triiodothyronine (FT3) and ΔFT3 (difference between basal FT3 and repeated FT3 on discharge) hormone serum concentrations. To assess serum levels of thyroid stimulating hormone (TSH), FT3 and free tetraiodothyronine (FT4), venous blood was taken from all included patients on admission to hospital. On discharge, blood tests were repeated for 178 (69.8%) patients. Study endpoints were overall mortality within 30, 90 and 365 days after AIS. Results Compared with the survivals, those who died had significantly lower mean FT3, FT3/FT4 ratio in all periods and lower median TSH within 30 days. Higher FT3 serum levels versus lower, even after adjustment for included important variables, remained significant for lower odds of death within 365 days after AIS (OR=0.57; 95% CI: 0.33–0.97, p=0.04), but added insignificant additional predictive value to the NIHSS score or age. Kaplan–Meier survival curves demonstrated that the first FT3 quartile was significantly associated with increased mortality compared with all other quartiles within 365 days after AIS. With ΔFT3 quartiles no such association was found. Conclusions. Higher FT3 levels on admission versus lower are significantly associated with lower mortality within 365 days after AIS. FT3 serum levels changes over time didn’t show any association with mortality within first year.

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Abstract 2868: Long-Term Prognostic Predictors of Isolated Significant Tricuspid Regurgitation

Circulation ◽

10.1161/circ.118.suppl_18.s_789 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jeong-Woo Lee ◽

Jong-Min Song ◽

Jae Won Lee ◽

Myung-Zoon Yi ◽

Eun Sun Jin ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Pulmonary Vascular Disease ◽

Proportional Hazard ◽

Cardiac Mortality ◽

Long Term Outcomes ◽

Cox Proportional Hazard

Background: Long-term outcomes of isolated significant tricuspid regurgitation (TR) without significant left-side heart disease remain to be clearly demonstrated. Methods: We enrolled 547 consecutive patients (age: 64 ± 14 years) with isolated significant TR. The patients with atrial septal defect, significant pulmonary or pulmonary vascular disease, right ventricular dysplasia and constrictive pericarditis were excluded. Initial clinical and echocardiographic characteristics and clinical outcomes were analyzed for 5.6 ± 2.1 years. Results: Survival rate was not different between 39 patients who underwent tricuspid valve (TV) surgery and 508 patients who did not (p=0.48). Of 508 patients without TV surgery, 32 patients (6.3%) died with cardiac cause during the follow-up period. Those patients were older (71 ± 16 vs. 64 ± 13 years, p<0.05) and showed initial larger TR jet area (15 ± 7 vs. 12 ± 4 cm 2 , p<0.05), and higher pulmonary artery systolic pressure (PASP, 46 ± 22 vs. 39 ± 16 mmHg, p<0.05). By adjusting other baseline characteristics using Cox proportional hazard model, age (HR; 1.045, 95% CI: 1.013 – 1.078), initial TR jet area (HR; 1.110, 95% CI; 1.061 – 1.160), and PASP (HR; 1.025, 95% CI; 1.009 – 1.042) were independent predictors of cardiac mortality. Mortality rates did not differ between patients with organic and functional TR. Initial TR jet area ≥12 cm 2 and PASP ≥36 mmHg were best cut-off values for predicting cardiac mortality (Figure ). Conclusions: Severity of TR and pulmonary hypertension are prognostic factors independent of age in medically-managed patients with isolated significant TR. The results may suggest an optimal surgical timing in these patients.

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Does Histologic Grade Have a Role in the Management of Head and Neck Cancers?

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.21.4107 ◽

2001 ◽

Vol 19 (21) ◽

pp. 4107-4116 ◽

Cited By ~ 38

Author(s):

André Fortin ◽

Christian Couture ◽

René Doucet ◽

Michele Albert ◽

Josée Allard ◽

...

Keyword(s):

Head And Neck ◽

Independent Predictor ◽

Cox Model ◽

Postoperative Radiotherapy ◽

Distant Metastases ◽

Histologic Grade ◽

Kaplan Meier ◽

N Stage ◽

Grade 3 ◽

Cox Analysis

PURPOSE: High histologic grade is usually associated with a greater propensity to distant metastases (DM). Its role to predict DM in head and neck cancer is not yet defined. The aim of this study is to evaluate the role of histologic grade as an independent predictor of DM and to determine a subgroup of patients who may benefit from systemic chemotherapy. PATIENTS AND METHODS: This is a retrospective study of 1,266 consecutive patients treated by definitive or postoperative radiotherapy between 1989 and 1997. All patients received at least 50 Gy. All stages and subsites of head/neck were included. DM rates were evaluated by the Kaplan-Meier method with a subsequent Cox analysis. RESULTS: There is a strong correlation of grade with N stage (P < .000001). The metastases-free survival (MFS) was 98%, 90%, and 72% for grades 1, 2, and 3, respectively (P < .000001). In patients with N0 stage, MFS is always greater than 90%, whatever the grade. In the 222 N1 patients, MFS was more than 90% in grade 1 and 2 but dropped to 75% for grade 3 (P = .001). In patients with N2 and N3, MFS was 91%, 79%, and 59% for grades 1, 2, and 3, respectively (P = .008). The same conclusion is applicable when only patients with neck control are analyzed. In a Cox model, grade was an independent predictor of DM (P = .000001) as well as T stage (P = .003), N stage (P = .000001), and neck failure (P = .0003). Higher grade was also an independent predictor of survival (P = .02). CONCLUSION: Patients with histologic grade 1 and grade 2 (except N3) are at low risk of DM. Patients with grade 2 and N3 or patients with grade 3 and N1 to N3 have a higher risk of distant metastases and should be considered for systemic treatment.

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Long-term effects of citric acid-based bicarbonate haemodialysis on patient outcomes: a survival propensity score–matched study in western France

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz274 ◽

2020 ◽

Vol 35 (7) ◽

pp. 1228-1236 ◽

Cited By ~ 1

Author(s):

Jacky Potier ◽

Thibault Dolley-Hitze ◽

Didier Hamel ◽

Isabelle Landru ◽

Erick Cardineau ◽

...

Keyword(s):

Regression Analysis ◽

Patient Outcomes ◽

Cox Regression ◽

Univariate Analysis ◽

Long Term Effects ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Statistical Relevance ◽

All Cause Mortality

Abstract Background Citric acid–based bicarbonate haemodialysis (CIT-HD) has gained more clinical acceptance over the last few years in France and is a substitute for other acidifiers [e.g. acetic acid (CH3COOH) and hydrochloric acid (HCl)]. This trend was justified by several clinical benefits compared with CH3COOH as well as the desire to avoid the consequences of the corrosive action of HCl, but a nationwide clinical report raised concerns about the long-term safety of CIT-HD. The aim of this study was to assess the long-term effects of CIT-HD exposure on patient outcomes in western France. Methods This is a population-based retrospective multicentre observational study performed in 1132 incident end-stage kidney disease patients in five sanitary territories in western France who started their renal replacement therapy after 1 January 2008 and followed up through 15 October 2018. Relevant data, collected prospectively with the same medical software, were anonymously aggregated for the purposes of the study. The primary goal of this study was to investigate the effects of citrate exposure on all-cause mortality. To provide a control group to CIT-HD one, propensity score matching (PSM) at 2:1 was performed in two steps: the first analysis was intended to be exploratory, comparing patients who received citrate ≤80% of the time (CIT-HD ≤80) versus those who received citrate >80% of the time (CIT-HD >80), while the second analysis was intended to be explanatory in comparing patients with 0% (CIT-HD0) versus 100% citrate time exposure (CIT-HD100). Results After PSM, in the exploratory part of the analysis, 432 CIT-HD ≤80 patients were compared with 216 CIT-HD >80 patients and no difference was found for all-cause mortality using the Kaplan–Meier model (log-rank 0.97), univariate Cox regression analysis {hazard ratio [HR] 1.01 [95% confidence interval (CI) 0.71–1.40]} and multivariate Cox regression analysis [HR 1.11 (95% CI 0.76–1.61)] when adjusted for nine variables with clinical pertinence and high statistical relevance in the univariate analysis. In the explanatory part of the analysis, 316 CIT-HD0 patients were then compared with 158 CIT-HD100 patients and no difference was found using the Kaplan–Meier model (log-rank 0.06), univariate Cox regression analysis [HR 0.69 (95% CI 0.47–1.03)] and multivariate Cox regression analysis [HR 0.87 (95% CI 0.57–1.33)] when adjusted for seven variables with clinical pertinence and high statistical relevance in the univariate analysis. Conclusions Findings of this study support the notion that CIT-HD exposure ≤6 years has no significant effect on all-cause mortality in HD patients. This finding remains true for patients receiving high-volume online haemodiafiltration, a modality most frequently prescribed in this cohort.

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Echocardiographic and clinical outcomes of MitraClip therapy in patients with severe mitral regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.2648 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Rashi ◽

A Turyan Medvedovsky ◽

I Tonchev ◽

A Perez ◽

R Elioz ◽

...

Keyword(s):

Mitral Regurgitation ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Kaplan Meier ◽

Significant Difference ◽

Severe Group ◽

Baseline Characteristics ◽

One Year ◽

Mitraclip Therapy

Abstract Background MitraClip implantation improves mitral regurgitation (MR), however its impact on pulmonary hypertension (PHT) is not fully elucidated. Our hypothesis was that changes in pulmonary pressure after MitraClip implantation might predict outcomes. Methods We studied a cohort of 149 consecutive patients who underwent MitraClip implantation between August 2015 and September 2019. We compared echocardiographic and clinical variables between a group with not-severe PHT and a group with severe PHT according to Pulmonary artery systolic pressure (PASP) >55 mmHg. Results Mean age of the cohort was 73±10 years, 75% were men, and 80% had functional MR. There are no differences in baseline characteristics between the two groups. There was a significant reduction of 13.6 mmHg in PASP at the severe PHT group from 68.2±10.9 mmHg before the procedure to 54.6±14.9 after (P=0.001) compared to the absence of a significant change in the second group. This reduction was maintained in the 6 months follow-up. Although PHT is considered a poor prognostic measure, and the severe PHT group had a baseline PASP higher than the not-severe group (P<0.001), however the Kaplan Meier curve did not show any significant difference in overall survival (p=0.468), and there is also no difference in one-year survival. Conclusions MitraClip therapy improves PASP in patients with severe MR and severe PHT. These patients showed the same survival as patients with not-severe PHT. MitraClip is a safety and effective procedure even for patients with severe PHT, that should not be excluded. Funding Acknowledgement Type of funding source: None

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THE LEVEL OF IgG ANTIBODIES REACTIVE TO TF, Tn AND ALPHAGal POLYACRYLAMIDE-GLYCOCONJUGATES IN BREAST CANCER PATIENTS: RELATION TO SURVIVAL

Experimental Oncology ◽

10.31768/2312-8852.2016.38(2):117-121 ◽

2016 ◽

Vol 38 (2) ◽

pp. 117-121 ◽

Cited By ~ 5

Author(s):

E P Smorodin ◽

B L Sergeyev

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Univariate Analysis ◽

Serum Levels ◽

Igg Antibodies ◽

Breast Cancer Patients ◽

Prognostic Assessment ◽

Kaplan Meier

Background: The serum levels of IgG antibodies reactive to glycoconjugates (TF, Tn and αGal) were found to be associated with prognosis of gastrointestinal cancer patients. Aim: To study the relation between the levels of serum antibodies to TF-pAA, Tn-PAA and αGal-PAA polyacrylamide-based glycoconjugates and survival in breast cancer. Materials and Methods: The preoperative level of IgG antibodies was analysed in the serum of patients (n = 59) using ELISA with polyacrylamide-glycoconjugates namely, TF-pAA (amide-type), and ethanolamide-conjugates Tn-PAA and αGal-PAA. Survival rate and hazard ratio (HR) were assessed by the Kaplan — Meier method and Cox univariate analysis in different pathomorphological groups. Results: Significantly better survival was observed in patients with an increased level of anti-TF-pAA antibodies both for all patients in total and groups in stages II–III; N1–2 and G3 (p = 0.008–0.021, HR = 0.18–0.23, mean survival time in months 164–186 vs 69–121). A trend to worse survival was observed in increased level of anti-Tn IgG (stages II–III) and anti-αGal IgG (G3): p = 0.075, HR = 2.49 and p = 0.066, HR = 3.27, respectively. Conclusion: The method for the determination of circulating anti-TF-pAA IgG may be a useful supplement in long-term prognostic assessment of patients with breast cancer.

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Actuarial Modelling for Patients with Acute Lymphoblastic Leukaemia (ALL) based on CNS1 Status

JOURNAL OF COMMUNICABLE DISEASES ◽

10.24321/0019.5138.202136 ◽

2021 ◽

Vol 53 (03) ◽

pp. 23-32

Author(s):

Parmeet Kumar Vinit ◽

Keyword(s):

Prognostic Factors ◽

Acute Lymphoblastic Leukaemia ◽

Lymphoblastic Leukaemia ◽

Deterministic Model ◽

First Year ◽

Insurance Plan ◽

Term Survival ◽

Long Term Survival ◽

Kaplan Meier

Introduction: Worldwide, Acute Lymphoblastic Leukaemia (ALL) is the most frequent cancer in children. One of the major clinical challenges is adequate diagnosis and treatment of Central Nervous System (CNS) involvement in this disease. CNS relapse has been a barrier to the successful treatment of ALL for many years. Recent studies have shown encouraging results in the survival of these patients for a long time. However, their long-term survival depends upon the cost of therapy toxicity and financial distress. The primitive aim of the paper is to propose a yearly insurance plan to assist these patients financially during the diagnosis period. Method: Based on the CNS status 110 patients are categorised to estimate their long-term survival. Survival times of CNS1 status and for all the patients cumulatively are estimated by Kaplan-Meier and Cox-PH model in presence of the prognostic factors. The survival estimates are used to estimate the premium cost. The premium cost is estimated using a deterministic model which is advantageous for the patient and serviceable for the insurance provider. Result: Both the methods Kaplan-Meier and Cox-PH gave higher survival estimates for ALL patients cumulatively as compared to CNS1. Survival estimate from Cox-PH is 0.998 and 0.997 of first year of follow-up for patients taken cumulatively and in CNS1 respectively. For the fifth year the survival estimates are 0.802 and 0.783 respectively. The estimated premium cost for a 100 rupees of sum insured is rupees 4.7 for the first year and rupees 26.69 for the fifth year for patients taken cumulatively. Same for CNS1, it is rupees 6.24 and 29.42. Conclusion: Cox-PH model for estimating the survival is recommended since it includes the prognostic factors. The insurance plan suggests to opt for the premium as early as possibly since it costs less and increases later.

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