scholarly journals P1764 A unifying concept for the quantitative definition of functional mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Bartko ◽  
H Arfsten ◽  
G Heitzinger ◽  
N Pavo ◽  
A Toma ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Cox Regression ◽  
Expert Consensus ◽  
Functional Mitral Regurgitation ◽  
Complex Nature ◽  
P Value ◽  
Intermediate Risk ◽  
Cox Regression Analysis ◽  
Definition Of ◽  
Quantitative Definition

Abstract Background Diverging guideline definitions for the quantitative assessment of severe secondary mitral regurgitation (sMR) reflect the lacking link of the sMR spectrum to mortality and has introduced a source of uncertainty and continuing debate. Objectives The current study aimed to define improved risk-thresholds specifically tailored to the complex nature of sMR that provide a unifying solution to the ongoing guideline-controversy. Methods We enrolled 423 heart failure patients under guideline directed medical therapy and assessed sMR by effective regurgitant orifice area (EROA), regurgitant volume (RegVol) and regurgitant fraction (RegFrac). Results Measures of sMR severity were consistently associated with 5-year mortality with a HR for a 1-SD increase of 1.42 (95%CI 1.25-1.63, P < 0.001) for EROA, 1.37 (95%CI 1.20-1.56, P < 0.001) for RegVol and 1.50 (95%CI 1.30-1.73, P < 0.001) for RegFrac. Results remained statistically significant after bootstrap- or clinical confounder-based adjustment. Spline-curve analyses (Figure 1A-C) showed a linearly increasing risk enabling to stratify in low-risk (EROA < 20mm2 and RegVol < 30ml), intermediate-risk (EROA 20-30mm2 and RegVol 30-45ml) and, high-risk (EROA≥30mm2 and RegVol≥45ml). In the intermediate-risk group, a RegFrac ≥50% as indicator for hemodynamic severe sMR was associated with poor outcome (P = 0.017). A unifying concept based on combined assessment of the EROA, the RegVol, and the RegFrac (Figure 1D) showed a significantly better discrimination compared to the currently established algorithms (Table 1). Conclusions Risk-based thresholds tailored to the pathophysiological concept of sMR provide a unifying solution to the ongoing guideline controversy. An algorithm based on the combined assessment of the unifying cut-offs for EROA, RegVol and RegFrac improves risk prediction compared to currently established grading. Table 1 Definition of severe sMR Cox regression analysis ROC analysis IDI analysis HR (95%CI) P-Value ROC P-Value-for-comparison IDI P-Value Unifying concept 3.76 (2.71-5.23) <0.001 0.63 –- –- –- ACC/AHA definition 3.20 (2.14-4.78) <0.001 0.57 <0.001 0.06 <0.001 ESC/EACTS definition 1.52 (1.10-2.09) 0.01 0.55 <0.001 0.13 <0.001 ACC/ASE expert consensus 1.89 (1.40-2.56) <0.001 0.59 0.04 0.08 <0.001 Comparison of the unifying concept with the ACC/AHA, ESC/EACTS and ACC/ASE expert consensus definitions of sMR by Cox regression, ROC, and IDI demonstrated the most powerfull prediction by the unifying concept with significantly higher ROC area under the curve and better discriminatory power by IDI. Abstract P1764 Figure 1 A-D

P6492Quantitative definition of severe functional mitral regurgitation - A matter of intercontinental debate

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Goliasch ◽  
G Heitzinger ◽  
H Arfsten ◽  
N Pavo ◽  
G Spinka ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Significant Proportion ◽  
Functional Mitral Regurgitation ◽  
Term Outcome ◽  
True Nature ◽  
Long Term Outcome ◽  
Reduced Ejection Fraction ◽  
Definition Of ◽  
Quantitative Definition

Abstract Background Recent divergence between AHA/ACC and ESC/EACTS guidelines of the quantitative definition for severe functional mitral regurgitation (sFMR) introduced uncertainty, inconsistency and continuing debate. The relation of each threshold with long-term outcome, in patients under guideline directed therapy (GDT) remains however uncertain. Methods We enrolled 269 heart failure patients with reduced ejection fraction (HFrEF) and graded sFMR according to both guideline-recommendations [AHA/ACC: effective regurgitant orifice area (EROA) ≥40mm2 or regurgitant volume (RegVol) ≥60ml/beat and ESC/EACTS: EROA ≥20mm2 or RegVol ≥30ml/beat]. All-cause mortality was defined as the primary endpoint. Result According to AHA/ACC guidelines sFMR occurred in 17% by EROA with a median EROA of 0.5mm2 (IQR 0.4–0.6) and in 13% by RegVol with a median RegVol of 76ml/beat (IQR 69–101). According to ESC/EACTS guidelines sFMR occurred in 53% by EROA with a median EROA of 0.4mm2 (IQR 0.2–0.4)and 40% according to RegVol with a median RegVol of 51ml/beat (IQR 37–69). During 8-years follow-up, 165 patients died. We observed a significant association with outcome for sFMR according to AHA/ACC guidelines quantified by EROA (HR 1.66, 95% CI 1.13–2.43, P=0.009; Figure 1A) as well as RegVol (HR 2.02, 95% CI 1.34–3.05, P=0.001; Figure 1A). In contrast, the ESC/EACTS definition of sFMR was related with outcome exclusively if quantified by RegVol (HR 1.46, 95% CI 1.05–2.05, P=0.026; Figure 1B) but not for EROA (HR 1.30, 95% CI 0.91–1.86, P=0.15; Figure 1B). Figue 1 Conclusion In this contemporary HFrEF cohort under GDT there is significant association of the ACC/AHA proposed cut-off for severe FMR and long-term mortality. The ESC/EACTS definitions are associated with mortality exclusively for the RegVol. The lack of association between sFMR based on ESC/EACTS EROA cut-offs with mortality potentially results from incorporating patients where the regurgitant burden may still be compensated and has not yet become a driving force of disease progression. Contemporary definition of sFMR entails decision making for surgical/transcatheter repair. Cut-offs need to account for the competing risks of the procedure versus the potential benefit of reducing mortality. Lower thresholds may expose a significant proportion of patients to unnecessary risk of futile procedures and higher thresholds may withhold potentially life-extending therapies. The disagreement between the two guidelines does not only convey a source of uncertainty for treating physicians but also lead to inconsistent treatment allocation thereby hindering comprehensive and comparable research. Future studies need to approximate to the true nature of severe functional mitral valve disease in an attempt to facilitate a unifying definition of sFMR.

scholarly journals Prognostic Significance of PD-L1 and mTOR Expression in Oral Squamous Cell Carcinoma

2020 ◽  
Author(s):  
Nattinee Charoen ◽  
Kitti Jantharapattana ◽  
Paramee Thongsuksai
Keyword(s):  
Squamous Cell Carcinoma ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Oral Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cox Regression ◽  
Prognostic Significance ◽  
P Value ◽  
Cox Regression Analysis

Objective: Programmed cell death ligand 1 (PD-L1) and mammalian target of rapamycin (mTOR) are key players in host immune evasion and oncogenic activation, respectively. Evidence of the prognostic role in oral squamous cell carcinoma (OSCC) is conflicting. This study examined the associations of PD-L1 and mTOR expression with 5-year overall survival in OSCC patients. Material and Methods: The expressions of PD-L1 and mTOR proteins were immunohistochemically evaluated on tissue microarrays of 191 patients with OSCC who were treated by surgery at Songklanagarind Hospital, Thailand from 2008 to 2011. Cox regression analysis was used to determine independent prognostic factors. Results: PD-L1 expression was observed in 14.1% of cases while mTOR expression was present in 74.3% of cases. Females were more likely to have tumors with PD-L1 (p-value=0.007) and mTOR expressions (p-value=0.003) than males. In addition, lower clinical stage and well differentiated tumor are more likely to have mTOR expression (p-value= 0.038 and p-value<0.001, respectively). Cox regression analysis showed that age, tumor stage, nodal stage, combined surgical treatment with radiation or chemoradiation therapy, surgical margin status, PD-L1 expression and mTOR expression are independent prognostic factors. High PD-L1 expression (hazard ratio (HR) 3.14, 95% confidence interval (CI), 1.26–7.79) and high mTOR expression (HR 1.69, 95% CI, 1.00–2.84) are strong predictors of poor outcome. Conclusion: A proportion of OSCC expressed PD-L1 and mTOR proteins. Expression of PD-L1 and mTOR proteins are strong prognostic factors of OSCC.

scholarly journals Clinical Value of lncRNA LUCAT1 Expression in Liver Cancer and its Potential Pathways

2019 ◽  
Vol 28 (4) ◽  
pp. 439-447 ◽  
Author(s):  
Yan Jiao ◽  
Yanqing Li ◽  
Bai Ji ◽  
Hongqiao Cai ◽  
Yahui Liu
Keyword(s):  
Liver Cancer ◽  
Roc Curve ◽  
Cox Regression ◽  
Gene Set Enrichment Analysis ◽  
The Cancer Genome Atlas ◽  
Cancer Prognosis ◽  
Rank Test ◽  
P Value ◽  
Rna Seq ◽  
Cox Regression Analysis

Background and Aims: Emerging studies indicate that long noncoding RNAs (lncRNAs) play a role as prognostic markers in many cancers, including liver cancer. Here, we focused on the lncRNA lung cancer-associated transcript 1 (LUCAT1) for liver cancer prognosis. Methods: RNA-seq and phenotype data were downloaded from the Cancer Genome Atlas (TCGA). Chisquare tests were used to evaluate the correlations between LUCAT1 expression and clinical features. Survival analysis and Cox regression analysis were used to compare different LUCAT1 expression groups (optimal cutoff value determined by ROC). The log-rank test was used to calculate the p-value of the Kaplan-Meier curves. A ROC curve was used to evaluate the diagnostic value. Gene Set Enrichment Analysis (GSEA) was performed, and competing endogenous RNA (ceRNA) networks were constructed to explore the potential mechanism. Results: Data mining of the TCGA -Liver Hepatocellular Carcinoma (LIHC) RNA-seq data of 371 patients showed the overexpression of LUCAT1 in cancerous tissue. High LUCAT1 expression was associated with age (p=0.007), histologic grade (p=0.009), T classification (p=0.022), and survival status (p=0.002). High LUCAT1 patients had a poorer overall survival and relapse-free survival than low LUCAT1 patients. Multivariate analysis identified LUCAT1 as an independent risk factor for poor survival. The ROC curve indicated modest diagnostic performance. GSEA revealed the related signaling pathways, and the ceRNA network uncovered the underlying mechanism. Conclusion: High LUCAT1 expression is an independent prognostic factor for liver cancer.

Abstract 6023: The Need for Blood Transfusion Is an Independent Predictor of Incident Cardiovascular Events and All-Cause Mortality among Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jasper Jan Brugts ◽  
Nestor Mercado ◽  
Joachim Ix ◽  
Michael G Shlipak ◽  
Simon R Dixon ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Transfusion ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Independent Predictor ◽  
P Value ◽  
Transfusion Rate ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality

Periprocedural bleeding is one of the most frequent complications of percutaneours coronary interventions. We assessed the relation between blood transfusion and all-cause mortality or incident cardiovascular events (death, MI, stroke) among 6103 patients of the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events (EXCITE)-trial. Subjects were followed for 7 months after enrollment for the occurrence of events. Multivariate Cox-regression analysis evaluated the independent association of blood transfusion with each outcome adjusted for age, gender, race, diabetes mellitus, hypertension, hypercholesterolemia, history of MI, PCI, CABG, heart failure, LVEF<30%, use of beta-blockers, statins, ACE-inhibitors, platelet inhibitors and allocation to treatment with xemolifiban. In addition, propensity score analyses were performed (ROC 0.80). Mean age was 59.2 years, 21.7% were female, and 18.9% had diabetes mellitus. Of the169 patients who received blood transfusion, 14 (8.3%) died and 42 (24.9%) experienced a CVD event. Of the 5934 patients without transfusion, 65 (1.1%) died (p-value: <0.001) and 555 (9,4%) experienced a CVD event (p-value: <0.001) In multivariate analysis, blood transfusion was associated with a 5.3 fold increased risk of mortality (HR 5.3; 95% CI 2.8 –10.2), and a 2.5 fold increased risk of incident CVD (HR 2.5; 95% CI 1.7–3.4.) Noteworthy, patients who were US citizens had a higher transfusion rate then non-US citizens (OR 1.45, 95%CI 1.02–2.06) The need of blood transfusion is a strong and independent predictor of all-cause mortality and incident CVD events among patients undergoing PCI.

scholarly journals Predicting Acute Malnutrition in Rural Twins Before Their Second Birthday: Cohort Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1406-1406
Author(s):  
Franck Garanet
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Cox Regression ◽  
Dietary Supplementation ◽  
Acute Malnutrition ◽  
P Value ◽  
Cox Regression Analysis ◽  
Funding Sources ◽  
Significance Threshold ◽  
Wealthy Household

Abstract Objectives Identify the predictors of acute malnutrition in rural twins in a context of dietary supplementation in Burkina Faso. Methods This is a prospective cohort study. A cox regression was used to investigate predictors of acute malnutrition. A significance threshold of 0.05 was considered. Results Severe acute malnutria was more common in twins compared to non-twins (22.13% vs. 9.98%, P-0.001). Growth retardation was more common in twins compared to non-twins (34.04% vs. 21.49%, P-0.001). Underweight was more common in twins compared to non-twins (1.70% versus 0.43%). This difference was not statically significant (P-0.06). In multi-varied cox regression analysis, the factors significantly associated with acute malnutrition were: being born twins, episodes of fevers, diarrhea, and wealth level. Twins were almost twice as likely to be malnourished compared to single children (HRa −1.82, IC95% - [1.59–2.07] and P-0.001). Children with a fever were 2.54 more likely to be malnourished than other children. (HRa - 2.15, IC95% - [1.74–2.67] and P-0.001). Children with diarrhea were 2.54 more likely to be malnourished than other children. (HRa - 2.05, IC95% - [1.62–2.59] and P-0.001). Children born in a wealthy household were 25% less likely to be malnourished compared to other children (HRa-0.75; IC95%, [0.61–0.92]; P-value-0.007). Conclusions Particular attention should be paid to twins, in order to reduce the risk of acute malnutrition before their second birthday. Funding Sources None.

Gender as a Prognostic Factor in CLL. Biological Pointers to the Improved Outcome of Women.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 957-957 ◽  
Author(s):  
Daniel Catovsky ◽  
Estella Matutes ◽  
Alison Morilla ◽  
Anna Burford ◽  
Vasantha Brito-Babapulle ◽  
...  
Keyword(s):  
Cox Regression ◽  
Randomised Trial ◽  
Lower Proportion ◽  
Response To Therapy ◽  
Response To Treatment ◽  
P Value ◽  
Fish Analysis ◽  
Randomised Trials ◽  
Cox Regression Analysis ◽  
Mutational Status

Abstract Gender is not widely regarded as a prognostic indicator in CLL. However, the combined data from three MRC randomised trials, CLL1, 2 and 3, and two observational studies for patients with Binet stage A, CLL2A and 3A, over a period of 20 years (1978-1998) totalling 2370 patients, showed a significant survival advantage for women (2p<0.0001). Cox regression analysis of the three randomised trials showed that gender, age, stage and response to therapy were independent prognostic variables. The response to treatment for women was also better than for men receiving the same therapies. The LRF CLL4 randomised trial, which started in 1999 shows the same trend. Preliminary results in 444 patients Binet stages A progressive, B and C showed the same CR/Nod.PR for both sexes (43.5%) but a higher PR rate in women (45%) vs men (36.5%) and a lower proportion of women non-responders to first line therapy (11.5% vs 20%). A number of laboratory investigations in CLL4, which included FISH analysis with five probes, VH mutational status, CD38 and ZAP-70 expression by flow cytometry, showed differences between the sexes, which were significant for 17p and 11q deletions combined and CD38, always in favour of women, as shown in Tables 1 and 2. The clinical and laboratory results suggest that CLL is biologically more benign in women. Women have a lower incidence of CLL, an overall higher incidence of stage A (41.7%) than men (27.3%) in CLL 1, 2, 2A, 3 and 3A and respond better to treatment in all the trials. These differences may be underlined by a higher proportion of 13q del as sole abnormality, a lower proportion of 17p (p53 locus) and 11q deletions and lower levels of CD38. Data on VH mutations and ZAP-70 point in the same direction but the number of cases studied is still small. An additional factor that may play a role in the better outcome for women relates to the effect of oestrogen derivatives which are known to target selectively superoxide dismutase and induce cell kill (Huang et al, Nature407, 390, 2000). Table 1: FISH analysis by gender (Dohner hierarchical model) Abnormality 17p del 11q del Trisomy 12 13q del Others * = Combined p value < 0.05 (Chi-Square test) Men (286) 12% 19% 10% 34% 25% Women (94) 7% 13% 11% 44% 25% p value * * 0.052 Table 2: Other biological markers CD38 negative (<30%) VH mutated ZAP-70 negative Men 173/335 (52% ) 51/149 (34%) 94/192 (49%) Women 68/100 (68%) 23/52 (44%) 42/68 (62 %) p value <0.005 NS 0.07

Sole Trisomy 8 in AML: Concomitant Molecular Markers, Stability of Genetic Patterns and Impact On Outcome.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2503-2503 ◽  
Author(s):  
Tamara Alpermann ◽  
Claudia Haferlach ◽  
Christiane Eder ◽  
Alexander Kohlmann ◽  
Wolfgang Kern ◽  
...  
Keyword(s):  
Molecular Markers ◽  
Cox Regression ◽  
Normal Karyotype ◽  
Study Groups ◽  
Intermediate Risk ◽  
Trisomy 8 ◽  
Course Of Disease ◽  
Cox Regression Analysis ◽  
Equity Ownership ◽  
Wbc Count

Abstract Abstract 2503 Background: Trisomy 8 belongs to the most frequent cytogenetic aberrations in AML and is classified to intermediate-risk karyotypes if not within favorable or complex karyotypes (Grimwade et al., Blood 2010). Some study groups showed pts with sole trisomy 8 (+8sole) respond poorly to cytarabine-based chemotherapies. In addition, there is dissent whether trisomy 8 is a primary event or a secondary hit in pathogenesis. Aim: Evaluation of pts with +8sole with respect to related molecular markers, stability of cytogenetic and molecular aberrations and impact on outcome. Patients and Methods: 1,181 newly diagnosed adult AML pts with intermediate-risk karyotypes were distributed as follows: +8 (n=117), normal karyotype (NK) (n=801), other intermediate-risk abnormalities (n=263). In detail, 80/117 pts with trisomy 8 (68.4%) showed +8sole. All of these 80 pts were screened for the molecular markers: ASXL1, CEBPA, FLT3- ITD, FLT3- TKD, IDH1, MLL- PTD, NPM1, and RUNX1. WT1 was analyzed in 79 and IDH2 in 78 pts. For comparison we characterized 400 NK pts for all before mentioned molecular markers. Results: Comparing clinical features +8sole pts were older than NK (69.9 vs 63.6 years; p<0.001). No differences were seen for gender, Hb, WBC or PLT counts. Molecular Mutations: +8sole pts harbored more often ASXL1 mut than NK pts (47.5% (38/80) vs 15.0% (60/400); p<0.001) and also more frequently RUNX1 mut (36.3% (29/80) vs. 15.8% (63/400); p<0.001). In contrast, +8sole pts less frequently showed NPM1 mut (16.3% (13/80) vs 49.3% (197/400; p<0.001) or CEBPA mut (5.0% (4/80) vs 14.5% (58/400); p=0.018). All 4 cases with +8sole and CEBPA mut were monoallelic, whereas only 37.7% (23/58) of NK pts with CEBPA mut were monoallelic (p=0.031). Incidences for FLT3- ITD, FLT3- TKD, IDH1, IDH2, MLL- PTD, and WT1 did not differ between +8sole and NK. Genetic Stability: We analyzed relapse samples of 12 pts: 10/12 (83.3%) showed +8sole and their individual molecular marker pattern identical to diagnosis. However, 2/12 did show progress: one with +8sole and NPM1 mut at diagnosis gained FLT3- ITD in relapse. Case 2 habored an ASXL1 mut in addition to +8sole at diagnosis but relapsed with ASXL1 mut and a complex karyotype (including +8). Thus, +8sole as well as the corresponding mutations are stable through course of disease. Furthermore, in 5 pts we analyzed samples from MDS phase preceding AML. Two pts were genetically stable with either ASXL 1mut or MLL- PTD, and +8sole in MDS as well as in s-AML. One patient showed +8sole and ASXL1 mut in MDS and gained RUNX1 mut in s-AML. Interestingly, 2 pts harbored an ASXL1 mut and a NK at diagnosis of MDS, but an ASXL1 mut and +8sole at diagnosis of s-AML. This leads to the hypothesis of ASXL1 mut being first hit, whereas +8sole is gained during course of disease. Comparing overall survival (OS) for all pts with available follow-up data and intensive treatment regimes there was a significantly worse outcome for pts with +8sole (n=38) compared to NK (n=300; 13.0 vs 35.7 mo; p=0.003). Furthermore, we evaluated the total cohort (n=338) for impact of molecular markers. Pts with ASXL1 mut, FLT3-ITD, MLL-PTD, and RUNX1 mut showed worse outcome than pts without the respective marker mutated (p<0.001; <0.001; 0.009; <0.001, respectively). In contrast, pts with NPM1 mut, NPM1 mut/no FLT3-ITD or biallelic CEBPA mut showed better OS (p=0.003; <0.001; 0.044). FLT3- TKD, IDH1, IDH2, WT1, and CEBPA had no impact on OS. Combing markers associated with poor prognosis (ASXL1, FLT3-ITD, MLL- PTD, RUNX1) we detected at least one of these in 75% (60/80) within +8sole but only in 46.3% (185/400) within NK (p<0.001). Therefore we evaluated pts with at least one of these poor prognostic markers (n=147) and found median OS of 12.4 vs 49.6 months for pts with none of these (n=191; p<0.001). For multivariable Cox regression analysis age, WBC count, karyotype, biallelic CEBPA, NPM1 and the combined group of poor prognostic molecular markers were included (all being significant in univariable analysis). Age, WBC count and the combined group of poor prognostic molecular markers were significant (p<0.001, <0.001, 0.026, respectively). +8sole did not show an independent impact on OS. Conclusions: +8sole had poor outcome compared to NK. This is related to the concomitant presence of adverse molecular markers, particularly ASXL1, and RUNX1, or both. Thus, for risk stratification of pts with +8sole ASXL1 and RUNX1 mutation assessment should be considered. Disclosures: Alpermann: MLL Munich Leukemia Laboratory: Employment. Haferlach:MLL Munich Leukemia Laboratory: Equity Ownership. Eder:MLL Munich Leukemia Laboratory: Employment. Kohlmann:MLL Munich Leukemia Laboratory: Employment. Kern:MLL Munich Leukemia Laboratory: Equity Ownership. Haferlach:MLL Munich Leukemia Laboratory: Equity Ownership. Schnittger:MLL Munich Leukemia Laboratory: Equity Ownership.

scholarly journals Joint preoperative transthoracic and intraoperative transoesophageal echocardiographic assessment of functional mitral regurgitation severity provides better association with long-term mortality

2020 ◽  
Vol 32 (1) ◽  
pp. 9-19
Author(s):  
Shyamal R Asher ◽  
Gregory W Malzberg ◽  
Chin Siang Ong ◽  
Raymond J Malapero ◽  
Huan Wang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Mortality ◽  
Functional Mitral Regurgitation ◽  
P Value ◽  
Operative Strategy ◽  
Prediction Of Mortality

Abstract OBJECTIVES Functional mitral regurgitation (MR) is observed with ischaemic heart disease or aortic valve disease. Assessing the value of mitral valve repair or replacement (MVR/P) is complicated by frequent discordance between preoperative transthoracic echocardiographic (pTTE) and intraoperative transoesophageal echocardiographic (iTOE) assessment of MR severity. We examined the association of pTTE and iTOE with postoperative mortality in patients with or without MR, at the time of coronary artery bypass grafting (CABG) and/or aortic valve replacement without MVR/P. METHODS Medical records of 6629 patients undergoing CABG and/or aortic valve replacement surgery with or without functional MR and who did not undergo MVR/P were reviewed. MR severity assessed by pTTE and iTOE were examined for association with postoperative mortality using proportional hazards regression while accounting for patient and operative characteristics. RESULTS In 72% of 709 patients with clinically significant (moderate or greater) functional MR detected by pTTE, iTOE performed after induction of anaesthesia demonstrated a reduction in MR severity, while 2% of patients had increased severity of MR by iTOE. iTOE assessment of MR was better associated with long-term postoperative mortality than pTTE in patients with moderate MR [hazard ratio (HR) 1.31 (1.11–1.55) vs 1.02 (0.89–1.17), P-value for comparison of HR 0.025] but was not different for more than moderate MR [1.43 (0.96–2.14) vs 1.27 (0.80–2.02)]. CONCLUSIONS In patients undergoing CABG and/or aortic valve replacement without MVR/P, these findings support intraoperative reassessment of MR severity by iTOE as an adjunct to pTTE in the prediction of mortality. Alone, these findings do not yet provide evidence for an operative strategy.

scholarly journals Determinants and Outcomes of Mortality among Extremely Preterm Infants From a Tertiary Hospital in Thailand: 15-Year Experience

2021 ◽  
Author(s):  
Waricha Janjindamai ◽  
Anucha Thatrimontrichai ◽  
Supaporn Disneevate ◽  
Gunlawadee Maneenil
Keyword(s):  
Mortality Rate ◽  
Preterm Infants ◽  
Pregnancy Complications ◽  
Cox Regression ◽  
Statistical Significance ◽  
P Value ◽  
Ratio Test ◽  
Cox Regression Analysis ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Objective: It remains unclear if changes in neonatal care have resulted in better outcomes for extremely preterm infants (EPTs). This study was to evaluate neonatal mortality and morbidity in EPTs.Material and Methods: A retrospective cohort study of EPTs at a gestational age (GA) ≤28 weeks, who were admitted to the neonatal intensive care unit between January 2004 and December 2018. The study was divided into 2 periods, from 2004-2010 and 2011-2018. The likelihood ratio test in Multiple Cox regression models were used to determine adjusted hazard ratios (aHR) for differences in mortality among the two periods.Results: A total of 188 EPTs were enrolled. The overall median (interquartile range), GA and birth weight of the enrolled infants were 26 (25, 27) weeks and 780 (667, 875) g, respectively. The mortality rate was 66/188 (35.1%). The mortality rate between 2004-2010 and 2011-2018 decreased from 44.6% to 32.8%, but was not statistically significant (p-value=0.170). Multiple Cox regression analysis of mortality rate demonstrated statistical significance with infants of 23-24 and 25-26 weeks GA VS 27-28 weeks GA [aHR 3.85, 95% confidence interval (CI) (1.95, 7.58), p-value<0.010] and [aHR 1.92, 95% CI (1.09, 3.35), p-value<0.010], respectively. Pregnancy complications [aHR 2.24, 95% CI (0.96, 5.24), p-value=0.040)] and EPTs intubated VS early CPAP at birth [aHR 2.41, 95% CI (1.36, 4.25), p-value<0.010] were statistically significant.Conclusion: The mortality rate of EPTs decreased with advancing GA. Prenatal care of pregnancy complications and improving care practices might reduce the mortality rate.

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