scholarly journals 146 Prognostic significance of unexplained left ventricular hypertrophy in patients undergoing carpal tunnel surgery

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Aldostefano Porcari ◽  
Linda Pagura ◽  
Francesca Longo ◽  
Enrico Sfriso ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Prognostic Significance ◽  
Pacemaker Implantation ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Carpal Tunnel Surgery ◽  
All Cause Mortality ◽  
Red Flag ◽  
New Onset

Abstract Aims Carpal tunnel (CT) syndrome is a recognized red-flag of cardiac amyloidosis (CA) and increased cardiovascular (CV) morbidity. We designed this study to characterize the CV profile of patients with CT syndrome at the time of first surgery and to identify high-risk presentations. Methods and results We retrospectively reviewed 643 patients who underwent CT surgery between 2007 and 2019. Of them, 130 patients (77 years, 45% males, LVEF 62%) with available CV characterization within ±12 months from CT surgery were included. Abnormal loading conditions causing cardiac hypertrophy (LVH) were investigated to distinguish explained LVH (Ex-LVH) from unexplained LVH (Un-LVH). The primary outcome of the study was all-cause mortality. The secondary outcome measures were the occurrence of (i) new-onset heart failure (HF) or worsening HF requiring hospitalization (HHF) or (ii) pacemaker implantation. New-onset HF was defined as the development of HF signs and symptoms requiring an unplanned cardiologic examination or hospitalization. Median follow-up was 63 months [interquartile range (IQR): 30–95]. LVH was found in 65 (50%) patients, 33% of them presented Un-LVH. Compared to the others, Un-LVH patients were older (77, 75 vs. 70 years in Un-LVH, Ex-LVH, and non-LVH, respectively; P = 0.002), had higher rates of ECG-echo discrepancy (70%, 14.3% and 1.6%, respectively; P < 0.001) and of echocardiographic findings of CA (24%, 7%, and 0%, P < 0.001). Among Un-LVH patients, 9 (43%) experienced death and 7 (33%) developed HF at 3.8 and 2.4 years from CT surgery, respectively. Compared to the others, death and HF development rates were higher in Un-LVH patients both at unadjusted (P = 0.01 and P = 0.02, respectively) and adjusted analysis for age, gender, and renal insufficiency (P = 0.00038 and P = 0.050, respectively). Conclusions At the time of CT surgery, Un-LVH was found in more than 30% of patients with LVH and 24% of them showed echocardiographic features suggesting an underdiagnosed CA. Un-LVH was associated with higher all-cause mortality and HF development.

New onset left bundle branch block after transcatheter aortic valve implantation and the effect on long-term survival – a UK wide experience

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.S Arri ◽  
A Myat ◽  
I Malik ◽  
N Curzen ◽  
A Baumbach ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
New Onset

Abstract Introduction New onset left bundle branch block (LBBB) is the most common conduction disturbance associated with transcatheter aortic valve implantation (TAVI). It has been shown to adversely affect cardiac function and increase re-hospitalisation, although its impact on mortality remains contentious. Methods We conducted an observational cohort analysis of all TAVI procedures performed by 13 heart teams in the United Kingdom from inception of their structural programmes until 31st July 2013. The primary outcome was 1-year all-cause mortality. Secondary outcomes included left ventricular ejection fraction (LVEF) at 30 days and need for a post-TAVI permanent pacemaker (PPM). Results 1785 patients were eligible for inclusion to the study. The primary analysis cohort was composed of 1409 patients with complete electrocardiographic (ECG) data pre- and post-TAVI. Pre-existing LBBB was present in 200 (14.2%) patients. New LBBB occurred in 323 (22.9%) patients post TAVI, which resolved in 99 (7%) patients prior to discharge. A balloon-expandable device was implanted in 968 (69%) patients, whilst 421 (30%) patients received a self-expandable valve. New LBBB was observed in 120 (12.4%) and 192 (45.6%) patients receiving a balloon- or self-expandable prosthesis respectively. Overall 1-year all-cause mortality post TAVI was 18.7%. New onset LBBB was not associated with an increase in 1-year all-cause mortality (p=0.416). Factors that were associated with mortality included an increasing logistic EuroScore (p=0.05), history of previous balloon aortic valvuloplasty (p=0.001), renal impairment (p=0.003), previous myocardial infarction with pre-existing LBBB (p=0.028) and atrial fibrillation (p=0.039). Lower baseline peak and mean AV gradients were also associated with greater mortality at 1 year (p=0.001), likely reflecting underlying left ventricular dysfunction. In the majority of patients, LVEF remained unchanged following TAVI. Interestingly, the presence or absence of new onset LBBB did not affect LVEF improvement at 30 days. 10% of patients required a PPM post TAVI. Predictors of PPM included new LBBB (OR 2.6, p<0.001), pre-TAVI left ventricular systolic impairment (OR 1.2, p=0.037), a self-expandable device (p<0.001), and pre-existing RBBB (OR 4.0, p<0.001). Conclusions These findings suggest that new onset LBBB post TAVI does not increase mortality at 1 year or adversely affect LVEF at 30 days. Funding Acknowledgement Type of funding source: None

scholarly journals Left Ventricular Mass Regression, All-Cause and Cardiovascular Mortality in Chronic Kidney Disease: A Meta-Analysis

2021 ◽  
Author(s):  
Kevin C. Maki ◽  
Meredith L. Wilcox ◽  
Mary R. Dicklin ◽  
Rahul Kakkar ◽  
Michael H. Davidson
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Mass ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Ventricular Mass ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥ 12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 38 trials with duration ≥ 12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 8 of other types of interventions. All-cause mortality was reported in 116/2385 (4.86%) subjects in intervention groups and 161/2404 (6.70%) subjects in control groups. The pooled RR estimate of the 24 trials ≥ 12 months with ≥ 1 event in ≥ 1 group was 0.72 (95% CI 0.57 to 0.91, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥ 6 months (31 trials), ≥ 9 months (26 trials), and > 12 months (9 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.66, 95% CI 0.38 to 1.15. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

scholarly journals Prognostic Significance of B-type Natriuretic Peptide in Patients with Left Ventricular Thrombus

2021 ◽  
Author(s):  
Zhixia An ◽  
Zhichun Gao ◽  
Luyu Wang ◽  
Changchun Hou ◽  
Liying Zhang ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Natriuretic Peptide ◽  
Prognostic Value ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Trend Test ◽  
Systemic Embolism ◽  
Ventricular Thrombus ◽  
All Cause Mortality

Abstract Background: There is sparse information on the prognostic value of B-type natriuretic peptide (BNP) for the outcomes in patients with left ventricular thrombus (LVT). We aimed to determine the prognostic value of BNP in LVT.Methods: Patients diagnosed with LVT by transthoracic echocardiography between November 2009 to July 2020 at our institution were included. The endpoints were all-cause mortality and systemic embolism. Results: Ninety-two subjects were finally included in the study. The mean age of the cohort was 56.73±14.12, and 80.4% of the patients were male. The median BNP (1st quartile- 3rd quartile) was 437.5 (112.74-1317.5). The total all-cause mortality rate was 30.44% (28/92), and the 1-year, 2-year and 3-year cumulative survival rates were 85.4%, 75.5% and 66.5% respectively. Systemic embolism was identified in 10 subjects. COX multivariate analysis showed that Log BNP (HR, 4.96; 95%CI, 2.03-12.13; P=0.000) and LV posterior thickness (HR, 0.71; 95%CI, 0.51-0.97; P=0.034) were significantly associated with all-cause mortality. In addition, patients with BNP levels in the upper median (≥ 437.5pg/ml) had significantly higher all-cause mortality rate compared to those with lower median BNP (<437.5pg/ml; P=0.004). The area under the receiver operating characteristic curve for BNP and all-cause mortality was 0.71. In the linear trend test, BNP quartiles were significantly related to all-cause mortality in all models, and the P values for trend in models 1, 2 and 3 were 0.005, 0.006 and 0.048 respectively.Conclusion: BNP level is a prognostic factor for all-cause mortality in LVT patients, and elevated BNP is indicative of a higher risk of LVT.

scholarly journals Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tan Li ◽  
Guangxiao Li ◽  
Xiaofan Guo ◽  
Zhao Li ◽  
Yingxian Sun
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Geometry ◽  
Geometric Patterns ◽  
Concentric Hypertrophy ◽  
All Cause Mortality ◽  
Eccentric Hypertrophy

Abstract Background The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort. Methods We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes. Results Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05). Conclusions Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes.

Abstract P265: Low Hemoglobin Predicts Poor 1-Year Outcome in Acute Coronary Syndrome

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
SMITA NEGI ◽  
Zarina Salt ◽  
Michael Miller Craig
Keyword(s):  
Univariate Analysis ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Index Hospitalization ◽  
Discriminative Ability ◽  
Coronary Syndrome ◽  
Recurrent Angina ◽  
All Cause Mortality ◽  
The Impact ◽  
New Onset

Background There is lack of evidence to assess the impact of hemoglobin level at presentation on long term prognosis after ACS. We investigated if hemoglobin on presentation affected cardiovascular outcomes in ACS over a 12- month period. Methods Clinical data at baseline and over a 12 month period were extracted for 160 consecutive patients admitted with a diagnosis of ACS. Primary endpoints were repeat event and all-cause mortality. Secondary endpoints were recurrence of significant angina (requiring ER visit/hospitalization), new onset left ventricular failure (LVF), new arrhythmia, composite of all cardiovascular complications, prolonged index hospitalization and repeat admission for cardiovascular causes. Results On univariate analysis, low hemoglobin was associated with prolonged index hospitalization (OR: 0.85, 95% CI: 0.74-0.98, p=0.02), repeat admissions (OR: 0.77, 95% CI: 0.66-0.90, p=0.001), composite cardiovascular complications (OR: 0.75, 95% CI: 0.63-0.88, p=0.005), recurrent angina (OR: 0.65, 95% CI: 0.54-0.78, p<0.001) and repeat event (OR:0.75, 95% CI: 0.59-0.97, p=0.03). There was no significant association of low haemoglobin with new-onset LVF (OR: 0.76, 95% CI: 0.60-1.01, p=0.08), new-onset arrhythmias (OR: 0.99, 95% CI: 0.62-1.56, p=.97) and all-cause mortality (OR: 0.84, 95%CI: 0.68-1.04, p=0.1). On a multivariate regression, low hemoglobin retained significant association with repeat admissions (r:0.4, p=0.02), composite cardiovascular complications (r:0.3, p=0.007), recurrent angina (r:0.5, p<0.001) and repeat events (r:0.2, p=0.06). Receiver-operating characteristic (ROC) curves showed significant discriminative ability of low hemoglobin for prolonged index hospitalization (area, 0.67; p=0.002), repeat admissions (area, 0.71; p<0.001), composite complications (area, 0.70; p<0.001), recurrent angina (area, 0.74; p<0.001) and repeat event (area, 0.70; p=0.01). Conclusions Low baseline hemoglobin in ACS patients predicts 12-month risk of repeat admissions, composite cardiovascular complications, recurrent angina and repeat event. This association appears independent of the infarct size and would justify closer follow up for these patients.

P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C N Bang ◽  
A M Greve ◽  
K Boman ◽  
K Egstrup ◽  
M H Olsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Pressure Overload ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Predictor Variables ◽  
All Cause Mortality ◽  
New Onset

Abstract Background Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied. Methods We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF. Results During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05). Figure 1 Conclusions In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.

Sign in / Sign up

Export Citation Format

Share Document