scholarly journals Aortic plaques in patients with atrial fibrillation: an often-forgotten risk factor for thromboembolism

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A.F Esteves ◽  
L Parreira ◽  
M Fonseca ◽  
J.M Farinha ◽  
J Ferreira ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
P Value ◽  
Af Ablation ◽  
Aortic Plaques ◽  
Af Recurrence

Abstract Background CHA2DS2-VASc risk score is the main determinant for maintaining anticoagulation after atrial fibrillation (AF) ablation, irrespective of the procedure outcome. The presence of aortic plaques is included in the score, but isn't regularly assessed previously to AF ablation. This way, risk factors for coronary artery disease (CAD) other than arterial hypertension and diabetes mellitus may influence stroke risk in patients with AF, albeit not being included in the CHA2DS2-VASc score. Purpose We sought to evaluate the prevalence of aortic plaques diagnosed during transesophageal echocardiography (TOE) in patients submitted to AF ablation and to assess its determinants and clinical impact on the CHA2DS2-VASc score. Methods Retrospective study of patients submitted to AF ablation that performed TOE prior to the procedure, with assessment of aortic plaques. CHA2DS2-VASc risk score was evaluated in the pre-ablation patient evaluation and reassessed after TOE. Demographic, clinical and echocardiographic data, including cardiovascular risk factors, were analyzed. We assessed AF recurrence rate, cerebrovascular events and death during follow-up. Results 120 patients were submitted to TOE prior to AF ablation from November 2015 to December 2020, mean age 66.6 (±9.55) years, 48% male. In 30 (25%) patients aortic plaques were identified in TOE. Mean CHA2DS2-VASc was 2.2 (±1.47) in pre-ablation evaluation and 2.5 (±1.69) post-TOE, increasing in all patients with aortic plaques and prompting beginning of oral anticoagulation in 5 patients. AF was paroxysmal in 74% and persistent in 26% of patients, mean duration of 6.28 (±3.76) years. Arterial hypertension was present in 79 (66%) of patients, type 2 diabetes mellitus in 24 (20%) and dyslipidemia in 67 (56%). 17 (14%) patients had a prior stroke. During a mean follow-up of 30 (±18.3) months, 32 (27%) patients had AF recurrence and 10 (8%) were submitted to redo procedures. 107 (89%) patients remained under oral anticoagulation, stroke occurred in 1 patient and 2 patients died. In univariate analysis, age, type 2 diabetes mellitus and dyslipidemia predicted an increase in CHA2DS2-VASc score after TOE (respectively, OR 1.113, 95% CI 1.041–1.190, p-value 0.002; OR 2.907, 95% CI 1.145–7.379, p-value 0.025; and OR 2.442, 95% CI 1.016–5.868, p-value 0.046). In multivariate analysis, age is the only independent predictor of increased CHA2DS2-VASc score after TOE (OR 1.095, 95% CI 1.013–1.185, p-value 0.023). No risk factor for CAD was independently associated with the presence of aortic plaques (Table 1). Conclusion In this population, single CAD risk factors were not independent predictors of aortic plaques. If TOE had not been performed prior to AF ablation, 25% of patients would have had an underestimated CHA2DS2-VASc score and would be off anticoagulation after the procedure, unprotected from thromboembolic events. FUNDunding Acknowledgement Type of funding sources: None. Table 1

P1026Risk factors for the occurrence of stroke after atrial fibrillation ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H E Lim ◽  
J Ahn ◽  
S J Han ◽  
J Shim ◽  
Y H Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Regression Analysis ◽  
Creatinine Clearance ◽  
Clearance Rate ◽  
Epicardial Adipose Tissue ◽  
P Value ◽  
Af Ablation ◽  
Af Recurrence

Abstract Background Risk factors for the occurrence of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated. Our aim was to assess incidence of ES during long-term follow-up following AF ablation and to identify predicting factors associated with post-ablation ES. Methods We enrolled patients who experienced ES after AF ablation and body mass index-matched controls from AF ablation registries. Epicardial adipose tissue (EAT) was assessed using multislice computed tomography prior to ablation. Results A total of 3,464 patients who underwent AF ablation were recruited. During a mean follow-up of 47.2 months, ES occurred in 47 patients (1.36%) with a mean CHA2DS2-VAS score of 2.15 and overall incidence of ES was 0.34 per 100 patients/year. Compared with control group (n=190), ES group had more higher prior thromboembolic event and AF recurrence rates, larger LA size, lower creatinine clearance rate (CCr), and greater total and periatrial EAT volumes although no differences in AF type, CHA2DS2-VASc score, ablation extent, and anti-thrombotics use were found. On multivariate regression analysis, a prior history of thromboembolism, CCr, and periatrial EAT volume were independently associated with ES occurrence after AF ablation. Cox regression analysis Risk factor Univariate Multivariate HR (95% CI) p value HR (95% CI) p value Age 1.017 (0.984–1.051) 0.31 Prior thromboembolism 2.488 (1.134–5.460) 0.023 2.916 (1.178–7.219) 0.021 CHA2DS2-VASc score 1.139 (0.899–1.445) 0.282 CCr 0.984 (0.970–0.999) 0.038 0.982 (0.996–0.998) 0.029 LA diameter (mm) 1.070 (1.012–1.130) 0.017 1.072 (0.999–1.150) 0.054 EAT_total (ml) 1.020 (1.010–1.029) <0.001 1.008 (0.993–1.023) 0.297 EAT_periatrial (ml) 1.085 (1.045–1.126) <0.001 1.065 (1.005–1.128) 0.032 PVI + additional ablation 0.846 (0.460–1.557) 0.592 No anticoagulant use 0.651 (0.346–1.226) 0.184 Recurrence 2.011 (1.007–4.013) 0.048 1.240 (0.551–2.793) 0.603 CCr, creatinine clearance rate; EAT, epicardial adipose tissue; LA, left atrium; PVI, pulmonary vein isolation. K-M curve for stroke-free survival Conclusions Incidence of ES after AF ablation was lower than expected rate based on CHA2DS2-VASc score even though anticoagulants use was limited. Periatrial EAT volume, a prior thromboembolism event, and CCr were independent factors in predicting ES irrespective of AF recurrence and CHA2DS2-VASc score in patients who underwent AF ablation.

scholarly journals Perkembangan Diabetes Melitus Tipe 2 dari Prediabetes di Bogor, Jawa Barat

2018 ◽  
pp. 59-69 ◽  
Author(s):  
Eva Sulistiowati ◽  
Marice Sihombing
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Plasma Glucose ◽  
Central Obesity ◽  
Fasting Glucose ◽  
Diabetes Melitus

Abstrak Prediabetes merupakan kondisi gula darah puasa 100-125mg/dL (Impaired Fasting Glucose/IFG) atau kadar gula darah 2 jam setelah pembebanan 75 g glukosa 140-199 mg/dL (Impaired Glucose Tolerance/IGT). Prediabetes meningkatkan risiko terjadinya Diabetes Mellitus tipe 2 (DM tipe 2). Tujuan analisis ini untuk mengetahui terjadinya DM Tipe 2 pada responden dengan prediabetes dalam follow-up 2 tahun. Prospektif studi dalam 2 tahun pada 3344 responden Studi Kohor Faktor Risiko PTM non-DM tipe 2. Data yang dikumpulkan meliputi wawancara, pemeriksaan fisik (BB, TB, lingkar perut, tekanan darah), dan laboratorium (GDP, GDPP, Kolesterol total, HDL, LDL, Trigliserida). Kadar glukosa darah untuk DM Tipe 2 dan prediabetes mengacu pada kriteria ADA 2011. Analisis deskriptif tentang karakteristik, life tabel perkembangan DM Tipe 2 dari prediabetes. Prediabetes yang terjadi sebesar 24,6% (IFG 2,3%; IGT 19,2% dan mix IFG/IGT 2,8%) dan 13,4% mengalami DM tipe 2 dalam kurun waktu 2 tahun. Progresivitas terjadinya DM dari IFG, IGT dan mix TGTmasing-masing 6,21; 6,12 dan 14,6 per 100 orang per tahun. Faktor risiko yang mempengaruhi terjadinya DM tipe 2 antara lain: umur (40-54 tahun RR=1,97; CI 95%:1,02-3,82), 55-65 tahun (RR=2,74; CI 95%: 1,34-5,58), obesitas sentral (RR=4,42; CI 95%: 2,36-8,29), hipertensi (RR= 1,99; CI 95%: 1,29-3,06) dan hipertrigliserida (RR=1,83; CI 95%: 1,18-2,83). Proporsi prediabetes dan terjadinya DM tipe 2 di Bogor Tengah dalam pengamatan 2 tahun, meningkat dengan bertambahnya umur dan dipengaruhi oleh obesitas sentral, hipertensi, hipertrigliserida. Pengendalian faktor risiko dan pemeriksaan gula darah secara rutin dapat mencegah terjadinya DM tipe 2. Perlu ditunjang dengan posbindu PTM aktif di masyarakat, lingkungan kerja maupun sekolah. Kata kunci: Prediabetes, Diabetes Melitus tipe 2 (DM tipe 2), Bogor Tengah Abstract Prediabetes is a condition that fasting plasma glucose 100-125 mg/dL (Impaired Fasting Glucose/IFG) or blood glucose 2 hours after loading 75 g glucose 140-199 mg/dL (Impaired Glucose Tolerance/IGT). Prediabetes increases the risk of type 2 Diabetes Mellitus (T2DM). This analysis is to determine the progression rate to T2DM in prediabetes respondents during 2 years follow up. This is an two years prospective study in 3344 respondents Cohort Study of Risk Factors NCD without T2DM. The data collected included interviews, physical examination (body weight, height, abdominal circumference, blood pressure), and laboratory (fasting plasma glucose/FPG, plasma glucose 2 hours after loading 75 g glucose, total cholesterol, HDL, LDL, triglycerides). Blood glucose levels for DM and prediabetes refers to ADA criteria 2011. Data analisized by descriptive about characteristics, life table of T2DM development from prediabetes. Prediabetes occurred at 24.6% (IFG 2.3%, IGT 19.2% and mix IFG / IGT 2.8%) and 13.4% experienced type 2 diabetes within 2 years. The progression of DM from IFG, IGT and mix TGT is 6.21; 6.12 and 14,6 per 100 person per year respectively. The risk factors of T2DM are age (40-54 years old (RR=1,97; CI 95%:1,02-3,82), 55-65 years old (RR=2,74; CI 95%:1,34-5,58), central obesity (RR=4,42; CI 95%:2,36-8,29), hypertension (RR=1,99; CI 95%:1,29-3,06) and hypertriglyceride (RR=1,83; CI 95%:1,18-2,83). The proportion of prediabetes and progression T2DM in Central Bogor at 2 years follow up is quite high, increasing with age and influenced by central obesity, hypertension and hypertriglyceride. Controlling risk factors and checking blood glucose regularly can prevent T2DM. Need to be supported by posbindu PTM active in the community, work environment and school. Keywords: Prediabetes, type 2 Diabetes Mellitus (T2DM), Central Bogor

scholarly journals Prognostic Value of Secreted Frizzled-Related Protein 5 in Heart Failure Patients With and Without Type 2 Diabetes Mellitus

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Jiandi Wu ◽  
Haoxiao Zheng ◽  
Xinyue Liu ◽  
Peisong Chen ◽  
Yunlong Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Related Protein

Background: Patients with heart failure (HF) with diabetes mellitus have distinct biomarker profiles compared with those without diabetes mellitus. SFRP5 (secreted frizzled-related protein 5) is an anti-inflammatory adipokine with an important suppressing role on the development of type 2 diabetes mellitus (T2DM). This study aimed to evaluate the prognostic value of SFRP5 in patients with HF with and without T2DM. Methods: The study included 833 consecutive patients with HF, 312 (37.5%) of whom had T2DM. Blood samples were collected at presentation, and SFRP5 levels were measured. The primary outcome was the composite end points of first occurrence of HF rehospitalization or all-cause mortality during follow-up. Results: During median follow-up of 2.1 years, 335 (40.2%) patients in the cohort experienced the composite primary outcome. After adjustment for multiple risk factors, each doubling of SFRP5 level was associated with a 21% decreased risk of primary outcomes in the overall study population ( P <0.001). Subgroup analyses showed that the association between level of SFPR5 and primary outcomes may be stronger in patients with T2DM (hazard ratio, 0.69 [95% CI, 0.61–0.79]) than in patients without T2DM (hazard ratio, 0.89 [95% CI, 0.79–1.01]; interaction P =0.006). Similar associations were observed when taking SFRP5 as a categorical variable. Addition of SFRP5 significantly improved discrimination and reclassification of the incident primary outcomes beyond clinical risk factors and N-terminal pro-B-type natriuretic peptide in all patients with HF and those with T2DM (all P <0.01). Conclusions: SFRP5 is an independent novel biomarker for risk stratification in HF, especially in HF with T2DM.

scholarly journals Risk Perception for Developing Erectile Dysfunction among Malaysian Men with Type 2 Diabetes Mellitus

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Anuar Mohamad ◽  
Hizlinda Tohid ◽  
Saharuddin Ahmad ◽  
Seng Fah Tong ◽  
Mahadir Ahmad
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Erectile Dysfunction ◽  
Risk Perception ◽  
Tertiary Education ◽  
Health Clinic ◽  
P Value

Risk perception for developing erectile dysfunction (ED) is an appreciation of the susceptibility to having ED and its severity. This study examined this risk perception and its associated factors among 180 men with type 2 diabetes mellitus (T2DM), who claimed not to have ED. This cross sectional study was conducted at a public health clinic using a validated self-administered questionnaire, which assessed participant characteristics, perceived susceptibility to developing ED, perceived severity of ED, and knowledge on risk factors for ED. About 71.1% had an inaccurate perception of susceptibility to developing ED and their perception on its severity was moderate (median (IQR) score: 10.0 (6.0); range score: 3–15; midpoint: 9). In multiple linear regression, having ED symptoms (p-value < 0.001) and secondary (p-value = 0.045) or tertiary education (p-value: 0.022) significantly contributed to a higher perception of susceptibility. A higher perception of severity was significantly found in Malays (p-value < 0.001), the employed (p-value = 0.026), and those with better knowledge on risk factors for ED (p-value < 0.001). Risk perception for developing ED among men with T2DM appears poor and it was significantly influenced by sociocultural factors, educational attainment, ED symptoms, and knowledge on risk factors for ED. Thus, to improve their risk perception, they should be provided appropriate counseling and education.

scholarly journals Analysis of the Influence of Risk Factors of Type 2 DM on Outpatients at DKT Bandar Hospital Lampung, 2020

2021 ◽  
Vol 4 (2) ◽  
pp. 4-14
Author(s):  
Feby Esmiralda ◽  
Aila Karyus ◽  
Kodrat Pramudho
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Univariate Analysis ◽  
Bivariate Analysis ◽  
P Value ◽  
History Of

DM is a chronic metabolic disease characterized by hyperglycemia and cause serious complications with an increasing prevalence rate. Control of risk factors that affect the incidence of DM is needed to prevent the emergence of DM and delay disease complications. The purpose of this study is to determine the risk factors that influence the incidence of type 2 diabetes outpatients at the DKT Bandar Lampung Hospital. This type of research is quantitative observational analytic with a case control approach. The population came from all patients undergoing outpatient treatment at the Internal Medicine Department of the DKT Hospital in Bandar Lampung with 44 case samples and 44 control samples. Data analysis used univariate analysis with percentages, bivariate analysis with Chi Square and multivariate analysis with multiple logistic regression. The results showed that there was a significant influence between the risk factors for age (p value 0.017), hereditary history of diabetes (p value 0.03), physical activity (p value 0.002) and obesity (p value 0.001) with the incidence of type 2 diabetes, while a history of hypertension has no effect on the incidence of type 2 diabetes mellitus (p value 0.135). Meanwhile, the most dominant variable influencing the incidence of outpatient type 2 diabetes mellitus at DKT Bandar Lampung Hospital is physical activity with OR 5.29. Maximum promotive, preventive, curative and rehabilitative efforts are needed to control risk factors for type 2 diabetes

scholarly journals Clinical And Biochemical Outcomes Of Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors In Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A467-A467
Author(s):  
Muhammad Saleem ◽  
Nanik Ram ◽  
Sajjad Ali Khan ◽  
Zafar Aleem Suchal ◽  
Muhammad Mustansir Mehdi Khan
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Standard Deviation ◽  
P Value ◽  
Oral Glucose ◽  
Glucose Lowering

Abstract Background: SGLT-2 inhibitors are a group of oral medications that work independently of insulin working as anti-diabetics by enhancing the excretion of glucose. The purpose of our study was to assess the improvement in terms of HbA1c, weight, blood pressure and BMI and the hepatics and renal effect in terms of SGPT and Creatinine in patients already on three oral glucose lowering agents when SGLT-2 inhibitor was added to their medications. Methods: This retrospective, real world, single center study included 99 patients (mean age [Standard Deviation]: 53.8 [9.63] years) with poorly control type 2 diabetes. Data was recorded at three times, before the addition of SGLT-2 inhibitor and then at 3 and 6 month follow up after the drug had been added in patient’s medications. Physical parameters namely weight, BMI and blood pressure were recorded in the clinic while HbA1c, SGPT and Creatinine were checked by laboratory. Results: Improvement was seen in all parameters at both 3 and 6 month follow up interval. The reduction in HbA1c was statistically significant (P-value &lt; 0.001) with (Mean Reduction [Standard Deviation)) 0.81[1.02] % at 3 months and 1.07[1.11] % at 6 months. Weight was also significantly reduced (P-value &lt; 0.001) with (MR [SD]) 1.83[2.32] kg at 3 and 4.02[6.04] kg at 6 months. Statistically significant reduction (P-value &lt; 0.001) in BMI was also seen with 0.69[0.95] kgm-2 at 3 months and 2.13[3.41] kgm-2 at 6 months of follow up. The systolic blood pressure showed significant reduction (P-value &lt; 0.05) of 5.9[15.76] mmHg at 3 months and 6.37[18.33] mmHg at 6 months. The creatinine and SGPT values of the patient showed minimal variation over the course of these 6 months of follow up. Conclusion: Our study showed that SGPT-2 can be reliably used in patients in which diabetes is not being controlled by other glucose lowering agents and is safe for use in patients in which hepatic and renal function needs to be preserved. Keywords: SGLT-2 inhibitors, Type 2 Diabetes Mellitus, Pakistan

scholarly journals Incidence and prognostic factors for the development of symptomatic and asymptomatic marginal ulcers after Roux-en-Y gastric bypass procedures

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
J Süsstrunk ◽  
L Wartmann ◽  
D Mattiello ◽  
T Köstler ◽  
U Zingg
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Median Time ◽  
Upper Endoscopy ◽  
Independent Risk Factors

Abstract Objective Marginal ulcer (MU) is a serious complication after Roux-en-Y gastric bypass (RYGB) procedures. This study reports the incidence, risk factors and treatment outcomes of symptomatic and incidentally, at routine endoscopy diagnosed, MU. Methods All patients undergoing RYGB procedures between 2013 and 2018 at a single center were included. Upper endoscopy was performed in case of symptoms and/or routinely 2 and 5 years postoperatively. Results 568 patients (83.3% female) underwent RYGB procedure with a median age of 40 years and median initial body mass index of 41 kg/m2. Median time to follow-up was 2.99 years. Routine 2- and 5-year upper endoscopy was performed in 256 (55.3%) and 65 (38.0%) eligible patients, respectively. In 86 (15.1%) patients, MU was diagnosed at a median time of 14.2 months (4.58 – 26.2) postoperatively and 24.4% of patients with MU were asymptomatic. 76.7% of MUs were located on the side of the Roux-limb. 88.4% of MUs were treated conservatively; re-operation was necessary in 10 (11.6%) patients. Smoking and type 2 diabetes mellitus were the only independent risk factors for MU development in multivariate analysis with a hazard ratio of 2.65 and 1.18 (HbA1c per unit &gt;6.0), respectively. Conclusion MU is a common complication after gastric bypass surgery with 25% of patients being asymptomatic. Follow-up routine endoscopy is recommended for early MU detection and subsequent accurate therapy, especially in patients with the independent risk factors smoking and type 2 diabetes mellitus.

scholarly journals Prognosis of COVID-19 patients with type 2 diabetes

2021 ◽  
Vol 12 (1) ◽  
pp. 126-139
Author(s):  
Brunda M ◽  
Spandana Peddareddy ◽  
Arushi Moha ◽  
Mahesh DM ◽  
Samriddha Thapa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Comprehensive Analysis ◽  
Control Of Diabetes ◽  
Test Of Significance ◽  
The Mean ◽  
D Dimer

Background: The pandemic of COVID-19, a disease caused by novel coronavirus SARS-CoV-2, is associated with significant morbidity and mortality. Recent data showed that hypertension, diabetes mellitus, cardiovascular diseases, and chronic obstructive pulmonary disease were the most prevalent comorbidities in COVID-19 patients. Additionally, data indicate that hypertension, diabetes and cardiovascular diseases are important risk factors for progression and unfavourable outcome in COVID-19 patients. Poorly controlled Type 2 diabetes mellitus was associated with severe progression of disease. Hence, large studies with comprehensive analysis of all risk factors and longer follow-up are necessary. Methods and analysis: A single-centre retrospective cross-sectional study of 300 patients that were SARS-CoV-2 positive from May to October 2020 was done. Data was entered into Microsoft excel data sheet and was analysed using SPSS 22 version software. Chi-square test or Fischer’s exact test (for 2x2 tables only) was used as test of significance for qualitative data. Independent t test was used as test of significance to identify the mean difference between two quantitative variables. ANOVA (Analysis of Variance) was used as test of significance to identify the mean difference between more than two quantitative variables. P value (Probability that the result is true) of <0.05 was considered as statistically significant after assuming all the rules of statistical tests. Data collected was analyzed in a group of patients who were sub divided into 2 groups diabetics and Non diabetics. The parameters studied included laboratory markers: D dimer, CRP, Lactate Dehydrogenase, Ferritin levels. To assess the glycemic control HbA1C levels were assessed. The outcome parameters considered were Oxygen requirement, assessing the requirement of intensive care and duration of stay in the hospital Conclusion: The patients with higher HbA1c values were found to have higher CRP and D-dimer values and required ICU shift and prolonged hospital stay. Hence, good control of diabetes will reduce the worsening of disease. In a country like India, where most of the population do not have health insurance cover proper control of diabetes, can reduce the burden on family. Hence, large studies with comprehensive analysis of all risk factors and longer follow-up are necessary.

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