P1906Modified frailty as a novel factor to predict the effectiveness of electrical cardioversion of atrial fibrillation in the elderly population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Mlynarska ◽  
R Mlynarski ◽  
C Marcisz ◽  
K S Golba
Keyword(s):  
Sinus Rhythm ◽  
Elderly Population ◽  
Independent Predictor ◽  
Area Under The Curve ◽  
Roc Curves ◽  
The Elderly ◽  
Electrical Cardioversion ◽  
Cutoff Value ◽  
Tilburg Frailty Indicator ◽  
Frailty Indicator

Abstract Electrical cardioversion is one of the recognized methods of treatment of atrial fibrillation (AF)/maintenance of sinus rhythm. There are no factors that allow to predict the response to electrical cardioversion in the elderly population. Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults – we hypothesized that frailty can be a factor to predict the effectiveness electrical cardioversion. Methods 199 consecutive patients over 60 years (average age 71.41±6.99; 40.2% W) with AF hospitalized due to electrical cardioversion. The follow-up period for maintenance of sinus rhythm was 180±14 days. The Tilburg Frailty Indicator was used to examine the frailty before cardioversion. A global score of 5 points or more let us to respond the frailty syndrome. Results 174 patients out of 199 (87.4%) were found to have electrical cardioversion be effective. Frailty was recognized in 68 out of the 199 (34.17%). There was 66.2% (45/68) effectiveness in the frailty-affected group, whereas there was 99.2% (130/131) in the robust group; p=0.ehz748.0653. 87.9% patients have maintenance sinus rhythm after 6 months; in the frailty affected group it was 75% vs 94.6% in robust group; p=0.ehz748.0653. In the logistic regression, frailty (OR: 0.41, 95% CI: 0.2870–0.0,5851; p<0.0001) was emerged as an independent predictor of effectiveness of electrical cardioversion. The ROC curves for frailty in the effectiveness electrical cardioversion are presented in the figure below – left panel. The area under the curve is 0.856 (95% CI - 0.799–0.902). The cutoff value for a frailty recognition was 4 (p<0.0001). Similarly, in the logistic regression, frailty (OR: 0.65, 95% CI: 0.5010–0.8330; p=0.0003) was also emerged as an independent predictor of maintenance sinus rhythm. The ROC curves for frailty in the maintenance of sinus rhythm are presented in the figure – right panel. The area under the curve is 0.718 (95% CI - 0.650–0.779). The cutoff value for a frailty recognition in this case was also 4 (p<0.0001). ROC curves Conclusion Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4, improve the prediction of effectiveness of electrical cardioversion as well as maintenance of sinus rhythm.

Muscle strength cut-points for metabolic syndrome detection among adults and the elderly from Brazil

2021 ◽  
Vol 46 (4) ◽  
pp. 379-388
Author(s):  
Tiago Rodrigues de Lima ◽  
David Alejandro González-Chica ◽  
Eleonora D’Orsi ◽  
Xuemei Sui ◽  
Diego Augusto Santos Silva
Keyword(s):  
Metabolic Syndrome ◽  
Muscle Strength ◽  
Lifestyle Modification ◽  
Handgrip Strength ◽  
Area Under The Curve ◽  
Roc Curves ◽  
The Elderly ◽  
Youden Index ◽  
Cross Sectional ◽  
Cut Points

We aimed to determine cut-points for muscle strength based on metabolic syndrome diagnosis. This cross-sectional analysis comprised data from 2 cohorts in Brazil (EpiFloripa Adult, n = 626, 44.0 ± 11.1 years; EpiFloripa Aging, n = 365, 71.6 ± 6.1 years). Metabolic syndrome was assessed by relative handgrip strength (kgf/kg). Metabolic syndrome was defined as including ≥3 of the 5 metabolic abnormalities according to the Joint Interim Statement. Optimal cut-points from Receiver Operating Characteristic (ROC) curves were determined. Adjusted logistic regression was used to test the association between metabolic syndrome and the cut-points created. The cut-point identified for muscle strength was 1.07 kgf/kg (Youden index = 0.310; area under the curve (AUC)) = 0.693, 95% CI 0.614–0.764) for men and 0.73 kgf/kg (Youden index = 0.481; AUC = 0.768, 95% confidence interval (CI) = 0.709–0.821) for women (age group 25 to < 50 years). The best cut-points for men and women aged 50+ years were 0.99 kgf/kg (Youden index = 0.312; AUC = 0.651; 95% CI = 0.583–0.714) and 0.58 kgf/kg (Youden index = 0.378; AUC = 0.743; 95% CI = 0.696–0.786), respectively. Cut-points derived from ROC analysis have good discriminatory power for metabolic syndrome among adults aged 25 to <50 years but not for adults aged 50+ years. Novelty: First-line management recommendation for metabolic syndrome is lifestyle modification, including improvement of muscle strength. Cut-points for muscle strength levels according to sex and age range based on metabolic syndrome were created. Cut-points for muscle strength can assist in the identification of adults at risk for cardiometabolic disease.

scholarly journals Atrial mechanical hypofunction after electrical cardioversion of persistent or long-lasting persistent atrial fibrillation: a retrospective cohort study

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Renato De Vecchis ◽  
Andrea Paccone ◽  
Marco Di Maio
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Sinus Rhythm ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Color Doppler ◽  
Roc Curves ◽  
Persistent Atrial Fibrillation ◽  
Electrical Cardioversion

In the present retrospective cohort study, we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent AF who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV).  The endpoint of our   study was   the failure to recover the normal mechanics of the left atrium.  Inclusion criterion was the persistent or long-lasting persistent atrial fibrillation successfully treated by means of    ECV , provided that  a pertinent documentation  was made available, comprising ECG, conventional 2D echo-color-Doppler and   speckle tracking echocardiography(STE)  evaluation, with also a STE assessment  of the atria at the days 1, 30 and 90  from the ECV freely available within  the clinical record  of the patient. Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as  22.5% of them did not achieve the normalization of their  atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV.  The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict  both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The   values of 18% and 17% were also calculated  to serve as cut off values, respectively,  for the risk  of atrial mechanical dysfunction and for the risk of AF  relapses over a 12 month follow-up. Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long-standing persistent AF. In this case, a serial STE evaluation could be useful to evaluate the atrial hypofunction over time.

scholarly journals Accuracy and reliability of the Pfeffer Questionnaire for the Brazilian elderly population

2015 ◽  
Vol 9 (2) ◽  
pp. 176-183 ◽  
Author(s):  
Marina Carneiro Dutra ◽  
Raynan dos Santos Ribeiro ◽  
Sarah Brandão Pinheiro ◽  
Gislane Ferreira de Melo ◽  
Gustavo de Azevedo Carvalho
Keyword(s):  
Cognitive Decline ◽  
Roc Curve ◽  
Elderly Population ◽  
Functional Decline ◽  
Area Under The Curve ◽  
The Elderly ◽  
Systematic Difference ◽  
Interclass Correlation ◽  
Brazilian Version ◽  
Examiner Agreement

The aging population calls for instruments to assess functional and cognitive impairment in the elderly, aiming to prevent conditions that affect functional abilities. OBJECTIVE: To verify the accuracy and reliability of the Pfeffer (FAQ) scale for the Brazilian elderly population and to evaluate the reliability and reproducibility of the translated version of the Pfeffer Questionnaire. METHODS: The Brazilian version of the FAQ was applied to 110 elderly divided into two groups. Both groups were assessed by two blinded investigators at baseline and again after 15 days. In order to verify the accuracy and reliability of the instrument, sensitivity and specificity measurements for the presence or absence of functional and cognitive decline were calculated for various cut-off points and the ROC curve. Intra and inter-examiner reliability were assessed using the Interclass Correlation Coefficient (ICC) and Bland-Altman plots. RESULTS: For the occurrence of cognitive decline, the ROC curve yielded an area under the curve of 0.909 (95%CI of 0.845 to 0.972), sensitivity of 75.68% (95%CI of 93.52% to 100%) and specificity of 97.26%. For the occurrence of functional decline, the ROC curve yielded an area under the curve of 0.851 (95%CI of 64.52% to 87.33%) and specificity of 80.36% (95%CI of 69.95% to 90.76%). The ICC was excellent, with all values exceeding 0.75. On the Bland-Altman plot, intra-examiner agreement was good, with p>0.05 consistently close to 0. A systematic difference was found for inter-examiner agreement. CONCLUSION: The Pfeffer Questionnaire is applicable in the Brazilian elderly population and showed reliability and reproducibility compared to the original test.

scholarly journals Increased Systemic Immune-Inflammation Index Is Associated With Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Liuwei Chen ◽  
Sajan Pandey ◽  
Rui Shen ◽  
Yi Xu ◽  
Quanbin Zhang
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Logistic Analysis ◽  
Fisher Grade ◽  
Immune Inflammation

Background: Systemic immune-inflammation index (SII) is a novel biomarker that reflects the state of a patient's inflammatory and immune status. This study aimed to determine the clinical significance of SII as a predictor of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH).Methods: Retrospective data were collected from aneurysmal SAH patients who had been admitted to our hospital between January 2015 and October 2019. Both univariate and multivariate analyses were performed to investigate whether SII was an independent predictor of DCI. In addition, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were also evaluated.Results: There were 333 patients with aneurysmal SAH included in this study. Multivariate logistic analysis revealed that a modified Fisher grade 3 and 4 score [odds ratio (OR) = 7.851, 95% confidence interval (CI): 2.312–26.661, P = 0.001] and elevated SII (OR = 1.001, 95% CI: 1.001–1.002, P &lt; 0.001) were independent risk factors for DCI. ROC curves showed that SII could predict DCI with an AUC of 0.860 (95% CI: 0.818–0.896, P &lt; 0.001). The optimal cut-off value for SII to predict DCI was 1,424, and an SII ≥ 1,424 could predict DCI with a sensitivity of 93.1% and a specificity of 68.1%. Patients with higher SII value on admission tended to have higher incidence of acute hydrocephalus and DCI, greater modified Fisher and Hunt-Hess scales, and poorer outcomes.Conclusions: SII is an independent predictor of DCI in patients with aneurysmal SAH. The SII system can be implemented in a routine clinical setting to help clinicians diagnose patients with high risk of DCI.

scholarly journals Multidimensional Approach to Frailty among Rural Older People: Applying the Tilburg Frailty Indicator

2019 ◽  
Author(s):  
Mirdavoud Mousavi Sisi ◽  
Seyed Morteza Shamshirgaran ◽  
Hassan Rezaeipandari ◽  
Hossein Matlabi
Keyword(s):  
Older People ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Geriatric Syndrome ◽  
Sociodemographic Characteristics ◽  
Cross Sectional ◽  
Income Status ◽  
Tilburg Frailty Indicator ◽  
History Of ◽  
Frailty Indicator

Introduction: Frailty is a common geriatric syndrome. Studies of frailty and old age have been able to help reduce its underlying causes and complication. Understanding the frailty and its associated factors in developing countries such as Iran, can help gather information on conditions of the elderly and better plan for this age population. Therefore, the present study was implemented to investigate the prevalence and determinants of frailty in the rural elderly population of Shabestar, East Azarbayjan, Iran. Methods: This cross-sectional study was conducted among 565 rural older people in Shabestar, Iran during 2018-2019. The data collection tool was the Tilburg Frailty Indicator. The participants were selected by using stratified and simple random approach. Descriptive statistics, t-test, one-way ANOVA and logistic regression were used to perform data analysis. Results: Of the participants, 46.7% were detected as being frail. The associations between the prevalence of frailty and sociodemographic characteristics such as age, gender, marital status, types of lifestyle, educational level, and income status were statistically significant (p < 0.05). Regression analysis showed that age (β = -0.84, p < 0.05), the number of medications used (β = -2.72, p < 0.001), hypertension (β = -0.633, p < 0.006), diabetes (β = -535, p < 0.045) and the history of fall during the last year (β = -4.21, p < 0.001) were the most important predictors of frailty among non-institutionalized rural older people. Conclusion: The study confirms the importance of common chronic medical conditions and sociodemographic characteristics in the development of frailty syndrome among older adults. The descriptive nature of the study implies observational trials to clarify more deeply relationship between frailty and the determinants found.

Wrist Circumference: An Independent Predictor of Both Insulin Resistance and Chronic Kidney Disease in an Elderly Population

2013 ◽  
Vol 20 (3) ◽  
pp. 323-329 ◽  
Author(s):  
Adina Mitrea ◽  
Andreea Soare ◽  
Simona Georgiana Popa ◽  
Mirela Nicoleta Tudor ◽  
Maria Mota ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Population ◽  
Independent Predictor ◽  
Surrogate Marker ◽  
The Elderly ◽  
Control Group ◽  
Model Assessment ◽  
Wrist Circumference

Abstract Background and aim: It was recently reported that wrist circumference is associated with insulin resistance (IR) both in children and adults. We aimed to evaluate whether wrist circumference is a useful anthropometrical parameter for the evaluation of IR in an elderly population. Material and method: We performed a study on 40 subjects, 20 with type 2 diabetes (T2D) and 20 control subjects. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). We measured the following anthropometrical parameters: weight, height, waist circumference (WC), hip circumference, wrist circumference, waist to hip ratio (WHR), waist to height ratio (WHtR), body mass index (BMI) and body adiposity index (BAI). Results: We found statistically significant differences between the subjects with T2D and the control group for all the analyzed parameters. Statistically significant correlations between all the anthropometrical parameters and HOMA-IR were observed. However, only WC was an independent predictor of IR. Wrist circumference was the only parameter negatively correlated with the estimated glomerular filtration rate (eGFR). Furthermore, this measurement was an independent predictor of chronic kidney disease (CKD) in the studied subjects. Conclusion: Wrist circumference can be used in the general practice as a surrogate marker of IR in the elderly, being both easily determined and a cost-free method

scholarly journals A Comparative Study of 2 Different Segmentation Methods of ADC Histogram for Differentiation Genetic Subtypes in Lower-Grade Diffuse Gliomas

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Dan Liu ◽  
Shuai-Xiang Gao ◽  
Hong-Fan Liao ◽  
Jing-Mei Xu ◽  
Ming Wen ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Roc Curves ◽  
Lower Grade ◽  
Histogram Method ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Genetic Subtypes ◽  
Apparent Diffusion ◽  
Diffuse Gliomas ◽  
The Difference

Background. To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) histogram parameters for differentiating the genetic subtypes in lower-grade diffuse gliomas and explore which segmentation method (ROI-1, the entire tumor ROI; ROI2, the tumor ROI excluding cystic and necrotic portions) performs better. Materials and Methods. We retrospectively evaluated 56 lower-grade diffuse gliomas and divided them into three categories: IDH-wild group (IDHwt, 16cases); IDH mutant with the intact 1p or 19q group (IDHmut/1p19q+, 18cases); and IDH mutant with the 1p/19q codeleted group (IDHmut/1p19q−, 22cases). Histogram parameters of ADC maps calculated with the two different ROI methods: ADCmean, min, max, mode, P5, P10, P25, P75, P90, P95, kurtosis, skewness, entropy, StDev, and inhomogenity were compared between these categories using the independent t test or Mann–Whitney U test. For statistically significant results, a receiver operating characteristic (ROC) curves were constructed, and the optimal cutoff value was determined by maximizing Youden’s index. Area under the curve (AUC) results were compared using the method of Delong et al. Results. The inhomogenity from the two different ROI methods for distinguishing IDHwt gliomas from IDHmut gliomas both showed the biggest AUC (0.788, 0.930), the optimal cutoff value was 0.229 (sensitivity, 81.3%; specificity, 75.0%) for the ROI-1 and 0.186 (sensitivity, 93.8%; specificity, 82.5%) for the ROI-2, and the AUC of the inhomogenity from the ROI-2 was significantly larger than that from another segmentation, but no significant differences were identified between the AUCs of other same parameters from the two different ROI methods. For the differentiaiton of IDHmut/1p19q− tumors and IDHmut/1p19q+ tumors, with the ROI-1, the ADCmode showed the biggest AUC (AUC: 0.784; sensitivity, 61.1%; specificity, 90.9%), with the ROI-2, and the skewness performed best (AUC, 0.821; sensitivity, 81.8%; specificity, 77.8%), but no significant differences were identified between the AUCs of the same parameters from the two different ROI methods. Conclusion. ADC values analyzed by the histogram method could help to classify the genetic subtypes in lower-grade diffuse gliomas, no matter which ROI method was used. Extracting cystic and necrotic portions from the entire tumor lesions is preferable for evaluating the difference of the intratumoral heterogeneity and classifying IDH-wild tumors, but not significantly beneficial to predicting the 1p19q genotype in the lower-grade gliomas.

scholarly journals How frail are our elderly? An assessment with Tilburg frailty indicator (TFI) in a rural elderly population of West Bengal

2019 ◽  
Vol 8 (7) ◽  
pp. 2242 ◽  
Author(s):  
Sayanti Bandyopadhyay ◽  
Aparajita Dasgupta ◽  
Lina Bandyopadhyay ◽  
Soumit Roy ◽  
Bobby Paul ◽  
...  
Keyword(s):  
Elderly Population ◽  
West Bengal ◽  
Rural Elderly ◽  
Tilburg Frailty Indicator ◽  
Frailty Indicator

Validity and Reliability of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 145-151
Author(s):  
Mahshid Foroughan ◽  
Zahra Jafari ◽  
Ida Ghaemmagham Farahani ◽  
Vahid Rashedi
Keyword(s):  
Psychometric Properties ◽  
Elderly Population ◽  
Formal Education ◽  
The Elderly ◽  
Cognitive State ◽  
Validity And Reliability ◽  
Internal Reliability ◽  
Dsm Iv ◽  
Test Retest Reliability ◽  
Farsi Version

Abstract. This study examines the psychometric properties of the IQCODE and its applicability in the Iranian elderly population. A group of 95 elderly patients with at least 4 years of formal education who fulfilled the criteria of DSM-IV-TR for dementia were examined by the MMSE and the AMTs. The Farsi version of the IQCODE was subsequently administered to their primary caregivers. Results showed a significant correlation ( p = .01) between the score of the questionnaire and the results of the MMSE ( r = −0.647) and AMTs ( r = −0.641). A high internal reliability of the questionnaire was confirmed by Cronbach’s alpha coefficient (α = 0.927) and test-retest reliability by correlation coefficient ( r = 0.81). This study found that the IQCODE has acceptable psychometric properties and can be used for evaluating the cognitive state in the elderly population of Iran.

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