Clinical impact of transoesophageal echocardiography in acute brain ischaemia: who should we select?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
M Fonseca ◽  
C Costa ◽  
JM Farinha ◽  
AF Esteves ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Screening Method ◽  
Transoesophageal Echocardiography ◽  
Holter Monitoring ◽  
Clinical Impact ◽  
Superior Cerebellar Artery ◽  
Visual Field Defects ◽  
Brain Ischaemia ◽  
Younger Patients ◽  
Baseline Characteristics

Abstract Funding Acknowledgements Type of funding sources: None. Background Stroke is a prevalent disease and is still the leading cause of death in Portugal. Transoesophageal echocardiography (TOE) is a sensitive test often performed to detect embolic sources. However, since its most common findings such as patent foramen ovale (PFO) and atheroma plaques do not necessarily mandate a change in treatment, there is still debate over its clinical impact in the context of brain ischaemia (BI) and which patients (pts) should be submitted to it.  Purpose To assess the clinical impact of TOE following BI and to identify clinical and diagnostic testing results that could help predict which pts benefit from it. Methods A retrospective study was conducted including all pts submitted to TOE in our hospital after acute BI in 2018 and 2019. Clinical and testing data (brain, vascular and cardiac imaging and 24h-Holter monitoring) was analysed and compared between 2 groups: the pts who had findings in TOE compatible with a source of embolism which resulted in a change in treatment ("relevant TOE" group) vs all other pts who had no such findings or whose findings did not result in change in treatment ("others"). Predictors of relevant TOE were also analysed. Results  Of the 87 pts (mean age of 57 and maximum of 83) included in the study, 51 (59%) had findings compatible with a potential source of embolism in TOE, PFO being the most common (n = 42). In only half of them did these findings result in a change in treatment (the relevant TOE group: n = 25; 29% of the overall population). Age and other baseline characteristics did not significantly differ between groups. Pts with a relevant TOE presented more often with visual-field defects (32% vs 10%, p = 0.020) and were more likely to have visible acute lesions on brain imaging (96% vs 76%, p = 0.032) compared with the others. There was also a borderline significant association between the presence of infarct in the territory of the superior cerebellar artery and a relevant TOE (p = 0.054). On the contrary, the presence of significant lesions in extracranial arteries was negatively associated with a relevant TOE (p = 0.016). Considering the whole population, there were no transthoracic echocardiography (TTE) predictors of a relevant TOE but when analysing only younger patients (age < 50), the presence of any abnormality in TTE became associated with a relevant TOE (OR 8.5, CI 1.1-63.9; p = 0.044). We found no predictors of relevant TOE in 24h-Holter results. Conclusions TOE commonly identified potential sources of brain embolism, which proved relevant in half the cases. In the impossibility of submitting all BI patients to TOE, this study suggests that brain and vascular imaging rather than age or other baseline characteristics may be useful in predicting a relevant result. Moreover, TTE does not seem to be an adequate screening method to select patients for TOE, except possibly in younger patients. Studies with larger samples are needed to confirm these results.

Acute Myeloid Leukemia: The Outcome Is Determined By Age, Genetic Group, White Blood Cell Count, Lactate Dehydrogenase, Rather Than By Chemotherapy Intensity

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1447-1447
Author(s):  
Thomas Buchner ◽  
Wolfgang E. Berdel ◽  
Utz Krug ◽  
Claudia Haferlach ◽  
Susanne Schnittger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lactate Dehydrogenase ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
Standard Dose ◽  
High Dose ◽  
Blood Cell Count ◽  
Younger Patients ◽  
Baseline Characteristics

Abstract Background Data on benefit and toxicity by treatment intensification for AML are now available and allow rediscussing current dosing. Methods In a multicenter trial involving patients between 16 and 86 years of age, patients below 60 years received uniform double induction by the 1st course with standard dose araC/ daunorubicin (60mg/m²x3)/ thioguanine followed by the 2nd course with high-dose araC (3g/m²x6)/ mitoxantrone (10mg/m²x3), or randomly two high-dose courses. As age adaption patients of 60y or older received the 2nd course only in case of persistent blasts, and high-dose araC at 1 instead of 3g/m². Post remission treatment was consolidation and maintenance or randomly autologous stem cell transplantation in younger patients. Results 3369 patients entered the trial with 1843 patients 60y or older. A multivariate analysis identified age as continuous variable, favorable cytogenetics/ molecular genetics, unfavorable cytogenetics, white blood cell count and lactate dehydrogenase as categorical variables to be risk factors predicting complete remission, overall survival as well as relapse free survival. To separate the age effect from the treatment effect, two subgroups of similar age and baseline characteristics but different treatment were compared. Thus, the 239 patients aged 57-59 and the 336 patients aged 60-62 years shared not only similar age but also similar baseline characteristics, while their treatment by protocol and age adaption differed substantially. The difference as expressed by the cumulative araC dosis amounted to a factor of 3.6, which however did not translate into a different overall survival (equally 28%) or relapse rate (equally 70%) at 5 years. In contrast to different treatment, different age had a strong effect on outcome. Thus, the survival in patients aged 16-46y was 65% at 5 years versus 40% in those of 47-59y receiving the same treatment (p< 0.001). A corresponding age related difference was also found between the patients of 60-66y and those of 67-86y (p< 0.001) receiving the same age adapted treatment. As shown by others in patients of 18-60y doubling an intermediate cumulative dose of araC produced excessive toxicity without therapeutic benefit (Löwenberg B et al. NEJM 2011; 364: 1027-36), while high dose daunorubicin (90mg/m²) instead of standard dose (45mg/m²) improved the remission rate and survival in younger patients (Fernandez H et al. NEJM 2009; 361: 1249-59) and older patients of 60-65y (Löwenberg B et al. NEJM 2009; 361: 1235-48). No comparable data are available about daunorubicin 60mg/m² the standard in present study. Conclusion Age and disease biology rather than chemotherapy intensity are the main determinants of outcome in AML. Once a certain intensity and antileukemic effect has been achieved, a further escalation does not seem to overcome the age factor in AML. Present data require rediscussing current chemotherapy dosing and treatment alternatives. Disclosures: No relevant conflicts of interest to declare.

D313Y mutation in the differential diagnosis of white matter lesions: Experiences from a multiple sclerosis outpatient clinic

2016 ◽  
Vol 22 (11) ◽  
pp. 1502-1505 ◽  
Author(s):  
Jana Becker ◽  
Arndt Rolfs ◽  
Nesrin Karabul ◽  
Peter Berlit ◽  
Markus Kraemer
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Neurological Disorders ◽  
Lysosomal Storage Disorder ◽  
White Matter Lesions ◽  
Clinical Impact ◽  
Lysosomal Storage ◽  
Younger Patients ◽  
Neural Damage ◽  
The Central Nervous System

White matter lesions (WML) in younger patients might be due to a variety of neurological disorders. Fabry disease (FD), an x-linked inherited lysosomal storage disorder, happens to be misdiagnosed as multiple sclerosis (MS). In two middle-aged female patients, presenting bilateral WML, diagnosis of MS turned out to be doubtful. Human genetic analysis presented the Fabry mutation D313Y, in which clinical impact is still unclear. Disease manifestations outside the central nervous system were not detected. Our findings support the suspicion that Fabry mutation D313Y may be involved in neural damage resulting in WML.

A Screening Method for Chiasmal Visual-Field Defects

1981 ◽  
Vol 99 (2) ◽  
pp. 264-271 ◽  
Author(s):  
J. D. Trobe ◽  
P. C. Acosta ◽  
J. P. Krischer
Keyword(s):  
Visual Field ◽  
Screening Method ◽  
Visual Field Defects ◽  
Field Defects

Poster 280: The Opioid Utilization Study (OPUS) in Chronic Noncancer Pain: Baseline Characteristics of Older and Younger Patients

PM&R ◽  
2009 ◽  
Vol 1 ◽  
pp. S225-S226
Author(s):  
◽  
Steven Stanos ◽  
Xiaojun Hu ◽  
R. Amy Puenpatom ◽  
Timothy W. Victor
Keyword(s):  
Chronic Noncancer Pain ◽  
Younger Patients ◽  
Baseline Characteristics ◽  
Noncancer Pain

scholarly journals Laboratory Methods for COVID-19 Diagnosis

2021 ◽  
pp. 1-7
Author(s):  
Jonathan Nyebuchi ◽  
Emeji, Roseline ◽  
Konne Felix Eedee
Keyword(s):  
Rna Virus ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Screening Method ◽  
Laboratory Diagnosis ◽  
Laboratory Methods ◽  
Gold Standard Method ◽  
Laboratory Techniques ◽  
Primary Focus ◽  
And Control

Coronaviruses are a group of related RNA viruses that cause disease in mammals and birds. Covid-19 infection occurs due to an RNA virus which is single-stranded, called SARS-CoV-2; this virus is similar to SARS-CoV. This review throws light on the available laboratory techniques used for testing coronavirus. Certain challenges are encountered during the development of a diagnostic test for a novel pathogen, which depends on sensitivity of the method, that is, the potential in detecting very low pathogen level for early laboratory diagnosis, produce little or no interference with other strains of the virus, and produce results rapidly. Since the time of incubation and clinical manifestation of the infection are relatively the same with SARS, the widespread and effect of COVID-19 globally serve as the basis why the development of quick and reliable laboratory methods are necessary. Samples that could be collected for covid-19 testing includes blood (especially for screening purpose), nasal and throat swab. Currently, the gold standard method for laboratory diagnosis of Covid-19 infection is RT-PCR, which serves as a confirmatory method for Covid-19 testing. EIA and SVN laboratory techniques are other techniques used in detecting the viral infection. In addition, Rapid Diagnostic Testing (RDT) are currently developed for point-of-care testing, and often used as a screening method of Covid-19 infections. Early detection of the virus remains the primary focus for the treatment and control of SARS-CoV-2 infections. Therefore, this review was aimed at the available laboratory methods used in the diagnosis for coronavirus infection.

P765 Does detection of thrombus in left atrial appendage increase risk of ischemic stroke and mortality?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Kagawa ◽  
M Kato ◽  
N Oda ◽  
E Kunita ◽  
M Nagai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Anticoagulation Therapy ◽  
Transoesophageal Echocardiography ◽  
Atrial Appendage ◽  
Increase Risk ◽  
Baseline Characteristics ◽  
Free Rate

Abstract Background Left atrial appendage (LAA) thrombus is one of causes of cardiogenic stroke and detection of LAA thrombus by transoesophageal echocardiography (TOE) strongly suggest cardiogenic stroke. It was reported that cardiogenic stroke patients had higher in-hospital mortality about 19%; however, little is known about LAA thrombus and mortality after indexed detection of LAA thrombus. We investigated LAA thrombus detection and their prognosis including ischemic stroke and survival. Methods The patients who were performed TOE between 2005 and 2016 in our hospital were enrolled in this study. Patients were divided into 2 groups based on thrombus detection in the LAA, and baseline characteristics and outcomes including prevalence of 5-y stroke-free and survival from the indexed TOE were compared. Results Among the 1260 study patients, the follow-up duration was median 971 d (interquartile range 345 d – 2017 d), and 67% of the patients were performing TOE for atrial fibrillation (AF), 20% for cerebral infarction, and 14% for valvular heart disease. Non-valvular AF was seen in 64% of the study patients and rheumatic AF was in 2%. The age (74 y [66 y – 79 y] vs 70 y [62 y – 76 y], p &lt; 0.001), the prevalence of male sex (67% vs 69%, p = 0.63), and hemoglobin level (13.9 g/dl [12.5 – 15.1 g/dl] vs 13.8 g/dl [12.4 – 14.9 g/dl], p = 0.49) were similar between the patients with LAA thrombus and those without. The CHA2DS2-VASc score (p = 0.008), the prevalence of receiving anticoagulation before TOA (34% vs 24%, p = 0.01), those of after TOA (98% vs 66%, p &lt; 0.001), serum creatinine (0.92 mg/dl [0.80 – 1.10 mg/dl] vs 0.85 mg/dl [0.71 – 1.00 mg/dl], p &lt; 0.001), d-dimer level (1.7 mcg/ml [0.9 – 3.5 mcg/ml] vs 0.8 mcg/ml [0.5 – 2.2 mcg/ml], p &lt; 0.001), and plasma brain natriuretic peptide (315 pg/ml [128 – 515 pg/ml] vs 126 pg/ml [47 – 284 pg/ml], p &lt; 0.001) were higher in the patients with LAA thrombus than those without. The 5-y ischemic stroke-free rate was lower in the patients with LAA thrombus than those without (p &lt; 0.001) (Figure, Panel A); however, the 5-y survival was similar between the 2 groups (p = 0.93) (Panel B). Conclusions The patients who were detected thrombus in the LAA had higher incidence of ischemic stroke, but the survival rate were similar. The higher rate of receiving anticoagulation therapy in the patients with LAA thrombus may be the cause of this discrepancy. Further studies are necessary to clarify this issue. Abstract P765 Figure

registHER: Baseline characteristics of a cohort of HER2-positive metastatic breast cancer (MBC) patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20095-20095
Author(s):  
P. Kaufman ◽  
M. Mayer ◽  
S. Paik ◽  
M. Ulcickas Yood ◽  
D. Yardley ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Metastatic Breast ◽  
Phase Iii ◽  
Breast Cancers ◽  
Pivotal Trial ◽  
Her2 Positive ◽  
Estrogen Receptor Positive ◽  
Treatment Data ◽  
Baseline Characteristics ◽  
Study Sites

20095 Background: HER2 is amplified in 25% of breast cancers and is associated with poor survival. registHER captures the natural history, treatment patterns and outcomes in 1000 newly-diagnosed HER2-positive MBC patients (pts) throughout the U.S. This observational study recruits pts in both academic and community centers. Methods: This ongoing prospective cohort study collects clinical, pathologic and treatment data at enrollment, quarterly until death, loss to follow-up or 3 years after the last enrollment. We describe baseline pt and clinical characteristics in registHER compared with HER2-positive MBC pts in the phase III pivotal trial (Slamon DJ, et al. N Engl J Med. 2001;344:783–792). Results: Between December 2003 and September 2005, 813 eligible pts were enrolled at 280 study sites. Most pts were seen at community-based (76%) vs academic (18%) clinics; a few pts did not fall into either category (6%). A comparison of baseline characteristics is shown below. Conclusions: registHER pts tended to have a shorter disease-free interval and more estrogen receptor positive disease than pts in the pivotal trial. Reasons for these differences could reflect trial referral and/or diagnostic testing differences. Fewer registHER patients were white, but other characteristics were similar between the two groups. These findings support the hypothesis that observational studies describe a broad patient population which may not exactly duplicate clinical trials. Within registHER, there was some variation between academic vs community clinics (eg. nodal status and adjuvant therapy). Treatment pattern analyses are ongoing. [Table: see text] [Table: see text]

Myelodysplastic Syndromes in Adolescent Young Adults (AYA)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2898-2898
Author(s):  
Joanna (Asia) Grabska ◽  
Bijal D. Shah ◽  
Najla H. Al Ali ◽  
Eric Padron ◽  
Hanadi Ramadan ◽  
...  
Keyword(s):  
Lower Risk ◽  
Older Patients ◽  
Research Funding ◽  
Advisory Board ◽  
Categorical Variables ◽  
Younger Patients ◽  
Poor Risk ◽  
Disease Biology ◽  
Grant Support ◽  
Baseline Characteristics

Abstract Introduction: There has been little improvement in cancer survival of adolescent and young adult (AYA) patients, ages 18-39, possibly reflecting different disease biology in this subgroup. Myelodysplastic syndrome (MDS) is mainly a disease of the elderly. The characteristics, outcomes and response to treatment are not well described among AYA population. Patients and Methods: Retrospective review of patients from the Moffitt Cancer Center MDS database. We compared baseline characteristics and outcomes of AYA population to older patients. Descriptive statistics were used for baseline characteristics. Chi-square test was used for categorical variables, and t-test for continuous variables comparison. Kaplan-Meier estimates were used for overall survival (OS), and cox regression method for multivariable analysis. Results: We identified 51 AYA and 1,897 older MDS patients. Table-1 summarizes baseline characteristics. More females and Hispanics were noted in AYA group. The AYA patients had higher risk disease, more circulating myeloblasts and more hypoplastic MDS. Autoimmune disorders were more prevalent in older patients. The median OS was 47 months (mo) in the AYA group versus 40 mo in the older group (p 0.26). The median OS was 47 mo versus 56 months in lower risk (low and intermediate-1(int-1)) IPSS MDS AYA group and older group respectively (p 0.46). In the higher risk IPSS group (int-2 and high), median OS was 82 mo in AYA group compared to 17 mo in older group (p 0.001). Thirty individuals were transplanted in the AYA versus 241 in the older group. The median OS for transplanted patients was 55 mo in the AYA group and 46 mo in the older (p 0.4). Whereas, in the non-transplanted patients median survival was 31 months for AYA and 39 months for the older group (p 0.9). The rate of AML transformation was 37% versus 28% in AYA and older group respectively (p 0.17). No difference in use or response to hypomethylating agents was observed. Lenalidomide therapy was seldom used in younger patients. In AYAs, poor karyotype was the only variable strongly associated with worse outcome. Fifteen patients had poor risk karyotype. The median OS was 47 months, not reached and 29 months among patients with good, intermediate and poor risk cytogenetics, respectively (p 0.035) Conclusion: MDS is rare and tends to be more aggressive in the AYA population. The karyotype was the most important prognostic factor. The differences in underlying disease biology should be further explored. Allogeneic stem cell transplant offered younger patients best outcomes. Table 1. Baseline characteristics of AYA and Older Patient Characteristic AYA (18-39) (N= 51) Older Patients (> 39 years old) (N=1,897) P value Gender Female 25 (49%) 655 (34.5%) 0.025 Race White Black Hispanic Other 34 (66.7%) 2 (3.9%) 13 (25.5%) 2 (3.9%) 1,736 (91.5%) 47 (2.5%) 57 (3%) 41 (2.2%) 0.000 t-MDS Yes 10 (19.6%) 359 (18.9%) 0.902 WHO Subtype RA RARS RCMD Deletion 5q RAEB-1 RAEB-2 AML CML MDS-U MDS/MPN 3 (5.9%) 1 (2%) 22 (43.1%) 0 (0%) 11 (21.6%) 10 (19.6%) 0 (0%) 0 (0%) 1 (2%) 2 (3.9%) 196 (10.4%) 151 (8%) 583 (30.8%) 51 (2.7%) 372 (19.7%) 336 (17.7%) 1 (0.1%) 60 (3.2%) 44 (2.3%) 94 (5%) 0.188 IPSS Lower risk Higher risk 28 (59.6%) 19 (40.4%) 1,264 (68.2%) 590 (31.8%) IPSS-R Very low/low Intermediate High/very high 13 (30.1%) 14 (32.6%) 16 (37.3%) 826 (45.3%) 394 (21.6%) 602 (33%) Hypoplastic BM Yes 11 (23.4%) 178 (9.8%) 0.009 LGL clone Yes 0 (0%) 159 (8.4%) 0.033 Autoimmune disease Yes 8 (15.7%) 500 (26.4%) 0.055 Karyotype Good Intermediate Poor 24 (50%) 9 (18.8%) 15 (31.3%) 1120 (60.4%) 300 (16.2%) 434 (23.4%) 0.324 Peripheral Blasts Yes 14 (29.8%) 246 (13.2%) 0.003 RBC Transfusion Dependent 36 (70.6%) 1274 (67.3%) 0.372 Disclosures Shah: Seattle Genetics: Research Funding; Rosetta Genomics: Other: Grant support; Acetylon: Other: Advisory board; Plexus Communications: Honoraria; Pharmacyclics: Speakers Bureau; Spectrum: Other: Advisory board, Speakers Bureau; Bayer: Honoraria; Celgene: Other: Advisory board, Speakers Bureau; DeBartolo Institute for personalized medicine: Other: Grant support. Lancet:Pfizer: Consultancy; Kalo-Bios: Consultancy; Boehringer-Ingelheim: Consultancy; Amgen: Consultancy; Seattle Genetics: Consultancy; Celgene: Consultancy, Research Funding. List:Celgene Corporation: Honoraria, Research Funding. Komrokji:Celgene: Consultancy, Research Funding; Incite: Consultancy; Novartis: Speakers Bureau; GSK: Research Funding.

Abstract 13645: Cardiologist Evaluation of Patients With Type 2 Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Cian P McCarthy ◽  
David S Olshan ◽  
Saad Rehman ◽  
Maeve Jones-O’Connor ◽  
Sean Murphy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Stress Testing ◽  
Massachusetts General Hospital ◽  
Beta Blockers ◽  
Diagnostic Testing ◽  
Baseline Characteristics ◽  
Cardiovascular Testing

Introduction: Type 2 myocardial infarction (T2MI) is common and associated with recurrent cardiovascular events. How often T2MI patients are evaluated by a cardiologist and the association between these evaluations and diagnostic testing and treatments are unknown. Hypothesis: T2MI patients evaluated by a cardiologist are more likely to undergo cardiovascular testing and be placed on therapies for ischemic heart disease (IHD). Methods: We identified adjudicated patients with T2MI at Massachusetts General Hospital between October 2017 and May 2018. We examined baseline characteristics, diagnostic testing performed, and discharge medications, stratified by cardiologist evaluation during their admission. Results: We identified 359 patients with T2MI. During admission, 207 patients (57.7%) were evaluated by a cardiologist; 120 (33.4%) received a cardiology consultation and 87 (24.2%) were admitted to a cardiology service. Patients evaluated by a cardiologist were more likely to have hyperlipidemia (67.1% vs 52%, p=0.005), known CAD (58.9% vs. 38.8%, p<0.001), prior MI (27.1% vs. 14.5%, p=0.006), and HF (56.5% vs. 44.1%, p=0.03). Patients evaluated by a cardiologist were more likely to undergo stress testing (13.5% vs 3.3%, p=0.002), transthoracic echocardiography (80.2% vs. 50.7%, p<0.001), and coronary angiography (21.3% vs. 0%, p<0.001) during their index admission. There was no difference in mortality among those who were or were not evaluated by a cardiologist (11.6% vs. 9.2%, p=0.58). Patients evaluated by a cardiologist were more likely to be discharged on a statin (74.5% vs 64.5%, p=0.04) and a beta blocker (72% vs. 55.9%, p=0.002). Only new prescriptions of beta blockers were more commonly prescribed among those evaluated by a cardiologist (20.3% vs. 7.9%, p=0.002). Among those with available follow-up data (N=289), 111 patients (38.4%) had an outpatient cardiology follow-up visit within 6 months of discharge. Conclusions: Fewer than 60% of patients with T2MI were evaluated by a cardiologist during their admission and those that did were more likely to undergo further cardiovascular testing and to be discharged on therapies for IHD. Most T2MI patients did not have an outpatient cardiology follow-up visit after their event.

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