scholarly journals 131 Cancer and takotsubo syndrome: clinical features, outcome, and inflammatory patterns. Results from a multicentre prospective registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Enrica Vitale ◽  
Francesco Santoro ◽  
Alessandra Leopizza ◽  
Adriana Mallardi ◽  
Massimo Iacoviello ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Clinical Features ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Patients With Cancer ◽  
History Of ◽  
Inflammatory Pattern ◽  
History Of Cancer ◽  
Long Term Mortality

Abstract Aims Cancer represents one of the major determinants of prognosis in patients with Takotsubo Syndrome (TTS). Aim of this study was therefore to compare clinical features, short- and long-term outcome and inflammatory pattern among TTS patients with history of cancer. Methods and results 412 consecutive patients with TTS were enrolled in a multicentre prospective registry from July 2007 to February 2021. Clinical features, in and out of hospital MACE, laboratory and imaging data were collected. A sub-analysis evaluating serum interleukins levels among 12 patients with cancer vs. a propensity score matched cohort was performed. Prevalence of history of cancer was 12% (N = 51 pts). Patients with history of cancer were older (77 vs. 72 years, P = 0.01), with a higher percentage of male (23.5% vs. 8.8%, P = 0.01). Diabetes, dyslipidemia, and obesity were more prevalent in patients with cancer (29% vs. 22%, 49% vs. 42%, 25.5% vs. 18.5%, P = 0.01 respectively), while a similar prevalence was found for hypertension and smoke. Left ventricular ejection fraction (LVEF) at admission and discharge was lower in patients with history of cancer (33% vs. 37%, 44% vs. 50%. P = 0.03 respectively). Patients with cancer showed higher incidence of in hospital events (41% vs. 33%, P = 0.01) mainly driven by cardiogenic shock (21.5% vs. 8.5% P = 0.01), in hospital death (13.7% vs. 4.7%, P = 0.01), left ventricular thrombi (9.8% vs. 3.3%, P = 0.01) and ventricular arrhythmias (13.7% vs. 7.4%, P = 0.01). The long-term mortality was higher in patients with history of cancer (31.3% vs. 11.3%, P = 0.01). A distinct inflammatory pattern was found in cancer patients: at admission there were higher levels of IL 2 and VEGF levels (IL-2 3.3 vs. 0.7 pg/ml, P = 0.05, VEGF 476.3 vs. 249.5 pg/ml, P = 0.03); at discharge IL-4 was lower (1.17 pg/ml vs. 2.49 pg/ml, P = 0.04) while VEGF remained higher in subjects with TTS and cancer (406 vs. 128 pg/ml, P = 0.03). Conclusions Cancer patients with TTS are characterized by different clinical features, epidemiological characteristics, worse prognosis and higher long-term mortality when compared to patients with TTS without history of malignancy. A distinct inflammatory pattern can be found in this subset of TTS patients.

scholarly journals Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

2021 ◽  
Author(s):  
Ibrahim El‐Battrawy ◽  
Victoria L. Cammann ◽  
Ken Kato ◽  
Konrad A. Szawan ◽  
Davide Di Vece ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
The United States ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Takotsubo Syndrome ◽  
Clinical Correlates ◽  
History Of ◽  
Long Term Mortality

Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher ( P <0.001), and there were fewer women ( P =0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower ( P =0.001), and cardiogenic shock was more often observed ( P <0.001) in the AF group. Both in‐hospital ( P <0.001) and long‐term mortality ( P <0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P <0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01947621.

scholarly journals 776 A History of Cancer Does Not Predict Long Term Mortality in Patients With Severe Aortic Stenosis

2020 ◽  
Vol 29 ◽  
pp. S386
Author(s):  
A. Murphy ◽  
R. Subramanian ◽  
A. Enayati ◽  
A. Koshy ◽  
P. Kunniardy ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
History Of ◽  
History Of Cancer ◽  
Long Term Mortality

scholarly journals Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome

2020 ◽  
Vol 9 (12) ◽  
pp. 3882
Author(s):  
Thomas Stiermaier ◽  
Kira Busch ◽  
Torben Lange ◽  
Toni Pätz ◽  
Moritz Meusel ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Prognostic Information ◽  
Long Term Mortality

Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS −11.28%, TT-GLS −11.45%, and fast manual LAS −10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > −11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > −11.45% (20.0% versus 5.4%; p = 0.016), and LAS > −10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.

Management of isolated calf vein thrombosis in cancer patients

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 64-69
Author(s):  
Anand S Brahmandam ◽  
Kirstyn Brownson ◽  
Laura Skrip ◽  
Terri Parker ◽  
Jeffrey Indes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Modalities ◽  
Vein Thrombosis ◽  
History Of ◽  
Calf Vein ◽  
History Of Cancer

The treatment of isolated calf vein thrombosis remains widely debated. This study highlights the characteristics of isolated calf vein thrombosis in cancer patients and compares to isolated calf vein thrombosis in patients without history of cancer. Between July 2013 and April 2014, a retrospective chart review of consecutive patients with isolated calf vein thrombosis was performed recording patient risk factors, ultrasound characteristics of the thrombus, treatment modalities, long-term recurrence of venous-thromboembolism, incidence of bleeding, and mortality. Of 131 patients with isolated calf vein thrombosis, 53 (40.1%) had history of cancer. Isolated calf vein thrombosis occurred at an older age in cancer patients (66.7 vs 58.5 years, p = 0.004). The anatomical characteristics of isolated calf vein thrombosis on ultrasound were comparable in both groups. Isolated calf vein thrombosis in cancer patients was less likely to be treated with anticoagulation (60.4% vs 80.8%, p = 0.018). However, a trend towards higher incidence of bleeding after initiation of anticoagulation for isolated calf vein thrombosis in cancer patients (11.3% vs 6.4%, p = 0.351) was noted. Mortality in cancer patients was higher (37.7% vs 9.00%, p < 0.001) but was unrelated to isolated calf vein thrombosis or its treatment. In conclusion, the risks of bleeding seem to exceed the benefits of anticoagulation in approximately 50% of cancer patients with isolated calf vein thrombosis. The management of isolated calf vein thrombosis does not seem to impact the survival of cancer patients.

scholarly journals Glasgow Aneurysm Score: a predictor of long-term mortality following endovascular repair of abdominal aortic aneurysm?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anıl Özen ◽  
Metin Yılmaz ◽  
Görkem Yiğit ◽  
İsa Civelek ◽  
Mehmet Ali Türkçü ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Fold Increase ◽  
Abdominal Aortic ◽  
History Of ◽  
Group 2 ◽  
History Of Cancer ◽  
Long Term Mortality ◽  
Group 1

Abstract Background To evaluate the value of Glasgow Aneurysm Score (GAS) in predicting long-term mortality and survival in patients who have undergone endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Methods A retrospective single-center study of 257 patients with non-ruptured AAA undergoing EVAR between January 2013 and 2021. GAS scores were compared between the survivors (group 1) and the long-term mortality (group 2) groups. Cox regression analysis was used to determine independent predictors of late mortality. Receiver operating characteristic curve (ROC) analysis was used to determine the optimum cut-off values of GAS values to determine the effect on late-mortality. Survival analysis was conducted using Kaplan-Meier. Results The study included 257 patients with a mean age of 69.75 ± 7.75 (46–92), who underwent EVAR due to AAA. Average follow up period was 18.98 ± 22.84 months (0–88). Fourty-five (17.8%) mortalities occured during long-term follow-up. A past medical history of cancer resulted in a 2.5 fold increase in risk of long-term mortality (OR: 2.52, 95% CI 1.10–5.76; p = 0.029). GAS values were higher in group 2 compared to group 1 (81.02 ± 10.33 vs. 73.73 ± 10.46; p < 0.001). The area under the ROC curve for GAS was 0.682 and the GAS cut-off value was 77.5 (specificity 64%, p < 0.001). The mortality rates in patients with GAS < 77.5 and GAS > 77.5 were: 12.8% and 24.8% respectively (p = 0.014). Every 10 point increase in GAS resulted in approximately a 2 fold increase in risk of long-term mortality (OR: 1.8, 95% CI 1.3–2.5; p < 0.001). Five year survival rates in patients with GAS < 77.5 and > 77.5 were 75.7% and 61.7%, respectively (p = 0.013). Conclusions The findings of our study suggests that an increase in GAS score may predict long-term mortality. In addition, the mortality rates in patients above the GAS cut-off value almost doubled compared to those below. Furthermore, the presence of a past history of cancer resulted in a 2.5 fold increase in long-term mortality risk. Addition of cancer to the GAS scoring system may be considered in future studies. Further studies are necessary to consolidate these findings.

The complex comorbidities of uninsured cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19054-e19054
Author(s):  
Shreni Shah ◽  
Madeline MacDonald ◽  
Yuanyuan Lu ◽  
Smitha Pabbathi ◽  
Abu-Sayeef Mirza
Keyword(s):  
Chronic Disease ◽  
Cancer Patients ◽  
Chronic Conditions ◽  
Retrospective Chart Review ◽  
Free Clinics ◽  
Uninsured Patients ◽  
Cancer History ◽  
Patients With Cancer ◽  
History Of ◽  
History Of Cancer

e19054 Background: Uninsured patients diagnosed with cancer receive fewer screenings, frequently present with later-stage cancer, and are often unable to access standard-of-care treatment when compared to insured patients. We previously performed a study demonstrating that uninsured patients with cancer histories have higher levels of comorbidity. However, there is limited data on long-term studies describing comorbid chronic conditions among uninsured cancer patients. Here we examine socioeconomic factors and comorbid chronic conditions in uninsured patients with a cancer history over a period of three years. Methods: A retrospective chart review was conducted from 10 free clinics around the Tampa Bay region. Patients with any documented history of cancer who utilized a free clinic between 2016 and 2018 were included. Patients with no documentation of cancer history were excluded. Demographics, chronic disease parameters, and Charlson Comorbidity Index (CCI) scores were extracted and analyzed. Results: Between 2016 – 2018, a total of 17,003 uninsured patients were treated at 10 free clinics. Of these patients, 455 (2.7%) had a documented history of cancer, 9021 (53.1%) had no history of cancer, and 7527 (44.3%) had no documentation of cancer in their charts. Cancer patients were mostly women (305, 67.0%) and the average age was 55.2 years. Patients with cancer had significantly higher CCI scores compared to patients without cancer in 2016 (3.0 [2.0 SD] versus 0.94 [1.2 SD]), 2017 (2.71 [2.38 SD] versus 0.93 [1.26 SD]), and 2018 (3.27 [2.22 SD] versus 1.08 [1.26 SD]), p < 0.001. Patients with a cancer history were also more likely to be current drinkers (16.9% versus 13.0%) or smokers (17.8% versus 11.0%) compared to patients without a history of cancer. Conclusions: The results demonstrate that uninsured cancer patients consistently have higher levels of chronic disease and comorbidity compared to uninsured patients without a cancer diagnosis. This study increases awareness of the disease burden and mortality risk specific to uninsured cancer survivors which could inform free clinics and volunteer providers to better address the needs of this vulnerable population.

scholarly journals Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience

2020 ◽  
Vol 12 ◽  
pp. 175883592095680 ◽  
Author(s):  
Nalinie Joharatnam-Hogan ◽  
Daniel Hochhauser ◽  
Kai-Keen Shiu ◽  
Hannah Rush ◽  
Valerie Crolley ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Composite Endpoint ◽  
Time Interval ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Novel Coronavirus ◽  
History Of Cancer ◽  
North London

Background: This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without. Methods: We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilation and/or death] and mortality. Outcomes were compared with consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (1 March–30 April 2020). Patients were matched for age, gender and comorbidity. Results: The median age in both cohorts was 74 years, with 67% male, and comprised of 30 patients with cancer, and 90 without (1:3 ratio). For cohort B, 579 patients without a history of cancer and consecutively admitted were screened from the primary London hospital, 105 were COVID-19 positive and 90 were matched and included. Excluding cancer, both cohorts had a median of two comorbidities. The odds ratio (OR) for mortality, comparing patients with cancer to those without, was 1.05 [95% confidence interval (CI) 0.4–2.5], and severe outcome (OR 0.89, 95% CI 0.4–2.0) suggesting no increased risk of death or a severe outcome in patients with cancer. Cancer patients who received systemic treatment within 28 days had an OR for mortality of 4.05 (95% CI 0.68–23.95), p = 0.12. On presentation anaemia, hypokalaemia, hypoalbuminaemia and hypoproteinaemia were identified predominantly in cohort A. Median duration of admission was 8 days for cancer patients and 7 days for non-cancer. Conclusion: A diagnosis of cancer does not appear to increase the risk of death or a severe outcome in COVID-19 patients with cancer compared with those without cancer. If a second spike of virus strikes, rational decision making is required to ensure optimal cancer care.

scholarly journals Characteristics and Outcomes In Patients With Left-Sided Infective Endocarditis Undergoing Left-Sided Valve Surgery With or Without Concomitant Tricuspid Annuloplasty

2021 ◽  
Author(s):  
Zexuan Wu ◽  
Yuanyuan Zhou ◽  
Yili Chen ◽  
Fangfei Wei ◽  
Zi Ye ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Postoperative Complications ◽  
Clinical Features ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Right Atrial ◽  
Average Hospital ◽  
Tricuspid Annuloplasty ◽  
Long Term Mortality

Abstract Background: In patients with left-sided infective endocarditis (LSIE) undergoing left-sided valve surgery (LVS), the effects of concomitant tricuspid annuloplasty (TA) on clinical features and prognosis remain unknown. Methods: This is a single-center retrospective study conducted in a tertiary hospital in China. A total of 207 consecutive patients ≥18 years with a definite LSIE diagnosis who underwent LVS between 2008 and 2017 were included. Patients were divided into two groups: LVS alone (n=157) and LVS+TA group (n=50), to identify differences between the clinical features, echocardiogdraphic parameters and outcomes.Results: The mean age was 44.6±15.6 years and 150 (72.5%) were male. Of the 207 patients, 71 (34.3%) patients had aortic valve involved alone, 115 (55.6%) had mitral valve involved alone and 21 (10.1%) had both valved involved. The average hospital stays were 38±16 days and the median follow-up duration was 34.4 (IQR 19.8-56.3) months. Demographic and baseline characteristics were comparable between the two groups, except that the renal function in LVS alone group was better than LVS +TA group (eGFR 97.2±28.8 vs. 87.6±30.7, P=0.046). Significant reductions in left and right atrial diameter, left ventricular diameter, mitral and tricuspid regurgitation (TR) degree, and pulmonary arterial systolic pressure were reported in both groups, of which the differences were more prominent in LVS+ TA group than LVS alone group (P<0.05). The rate of postoperative complications was higher in LVS+ TA group than that in LVS group (44.0% vs. 23.6%, P=0.005). However, the in-hospital mortality and long-term mortality was similar in both groups. After multi-factor adjustment, concomitant TA was not significantly associated with in-hospital and long-term mortality.Conclusions: Concomitant TA at the time of LVS significantly improved cardiac diameter but increased postoperative complications. It might not be associated with improved survival in LSIE patients.

Abstract 250: Role of First Degree Atrioventricular Block and Long Term Mortality in U.S. Veterans With Atherothrombotic Risk Factors

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Amish Patel ◽  
Jonathan Pollock ◽  
Edward Sam Roberto ◽  
Thein Tun Aung ◽  
Ronald Markert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Common Finding ◽  
Av Block ◽  
Pr Interval ◽  
History Of ◽  
Long Term Mortality

Background: First-degree atrioventricular (AV) block [PR interval exceeding 200 milliseconds (ms)] on a 12-lead electrocardiogram is a common finding. Previous studies suggested that first-degree AVB has a benign prognosis, but more recent reports suggest that first-degree AVB may be associated with adverse outcomes. We investigated the relationship between PR interval and long term morality in U.S. Veterans with atherothrombotic risk factors. Methods: We retrospectively collected and analyzed data from a Veterans Affairs (VA) medical center for consecutive patients (October 2001 to January 2005) who presented for coronary angiography. Results: Of 1193 charts, 1082 had a PR interval reading recorded (mean = 172.5±30.5 ms; median = 168 ms [range 59-334]). Mean follow-up period was 103±52 months. Mean age was 63.2±10.8 years with 98% male. Mean body mass index was 30.0±5.9. The prevalence of selected comorbidities was: hypertension (88%), hyperlipidemia (79%), obstructive coronary artery disease (73%), diabetes mellitus (45%), smoker (39%), history of peripheral vascular disease (17%), and history of cerebrovascular accident (8%). Mean left ventricular ejection fraction was 47%±13%. Eighty-two percent were on beta-blockers (BB), and 25% were on calcium channel blockers (CCB) while intraventricular conduction delay was seen in 6%. In a comparison of patients with PR interval ≤200 ms (n=936) vs. >200 ms (n=146), long term mortality was higher with PR interval >200 ms (58.2% vs. 44.4%, p=0.002). Mortality rate was also higher with patients on BB or CCB vs. not on either (49.8% vs 39.7%, p=0.024). While PR interval was a significant univariate predictor of mortality, it was not significant when adjusted for the covariates listed above [not including BB and CCB] (odds ratio = 1.08 [95% Cl = 0.70 to 1.66], p = 0.73). Conclusion: In this study of US Veterans with atherothrombotic risk factors, the long term mortality rate was higher with first-degree AV block. PR interval has prognostic value within this specific cohort.

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