Performance of automated single-lead ECG atrial fibrillation screening is associated with patient characteristics

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
MD Zink ◽  
B Freedman ◽  
K Mischke ◽  
A Keszei ◽  
C Rummey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Automatic Measurement ◽  
Patient Characteristics ◽  
Receiver Operating Curve ◽  
Signal Quality ◽  
Good Prediction ◽  
Factors Associated

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The investigators received and unrestricted research grant by Pfizer/BMS. Pfizer/BMS was not involved in the planning, conduction, analysis, or interpretation of the data. Introduction Screening for atrial fibrillation (AF) with a single-lead electrocardiogram device is on the rise. However, little is known about influence of automated AF screening performance related to patient characteristics. Aim We tested the accuracy of automated AF detection of a single-lead ECG device and identified factors associated with diagnostic performance. Methods In 6482 subjects of community-pharmacies a single-time point AF screening was performed. All ECGs were analyzed by blinded human overread and compared to the automated results in context of patient characteristics. Results Automated screening showed good prediction of AF with an area under the receiver operating curve of 0.89; sensitivity 80%; specificity 98%; positive predictive value 71%; negative predictive value 99%. Good ECG signal quality was highly associated with correct measurement, while low signal quality leads to incorrect measurements. In a multivariate model we determined factors associated with excellent signal quality and as counterexample incorrect automatic AF identification. The Odds’ ratio (OR) for excellent signal quality was strongly associated with female sex, lower age, lower height, and higher body weight index (table). Conclusion The performance of automated AF screening is influenced by sex, age, height and body mass index. Potential target population groups, with high AF prevalence, have a higher chance of incorrect automatic measurement. We recommend an expert over-read, at least for all AF positive ECG recordings. Table 1 Excellent signal quality Incorrect measurement Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis Parameter OR 95% CI P OR 95% CI P OR 95% CI P OR 95% CI P Sex [Female] 2.33 1.97-2.75 <0.001 1.92 1.53-2.41 <0.001 0.64 0.49-0.84 0.001 0.57 0.43-0.76 <0.001 Age [years] 0.97 0.96-0.98 <0.001 0.97 0.96-0.98 <0.001 1.07 1.04-1.09 <0.001 1.06 1.04-1.09 <0.001 Height [cm] 0.96 0.95-0.97 <0.001 0.98 0.97-0.99 0.003 1.01 0.99-1.03 0.068 Weight [kg] 0.99 0.99-1.00 0.418 0.99 0.98-0.99 0.003 BMI [kg/cm2] 1.04 1.03-1.06 <0.001 1.04 1.03-1.06 <0.001 0.91 0.88-0.95 <0.001 0.91 0.87-0.94 <0.001 CHADSVASC 1 0.95-1.06 0.912 1.06 0.97-1.17 0.205 Heart failure 0.62 0.41-0.93 0.022 1.86 1.13-3.05 0.015 Hypertension 0.96 0.83-1.11 0.58 1.06 0.80-1.39 0.689 Diabetes mellitus 0.85 0.68-1.07 0.159 0.82 0.54-1.25 0.359 Stroke / TIA 0.82 0.66-1.01 0.066 1.19 0.83-1.69 0.341 Vascular disease 0.89 0.75-1.07 0.213 1.31 0.98-1.77 0.70 OR – odd’s ratio, CI – confidence interval

Abstract 17: Prehospital Deterioration During Transport by Emergency Medical Services for Stroke Patients: A Population-Based Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sabreena J Gillow ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moonmaw ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Onset Time ◽  
Population Based ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Hospital Arrival ◽  
Neurologic Deterioration

Introduction: Stroke patients can experience neurological change in the prehospital setting. We sought to identify factors associated with prehospital neurologic deterioration. Methods: Among the Greater Cincinnati/Northern Kentucky region (pop. ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke, and included patients with age ≥20 and complete EMS records. Glasgow Coma Scale (GCS) at hospital arrival was compared with GCS evaluated by EMS, with decrease ≥2 points considered neurologic deterioration. Data obtained included age, sex, race, medical history, antiplatelet or anticoagulant use, stroke subtype [ischemic (IS), ICH, or SAH] and IS subtype (e.g., small vessel, large vessel, cardioembolic), seizure at onset, time from symptom onset to EMS arrival, time from EMS to hospital arrival, blood pressure and serum glucose on EMS arrival, and EMS level of training. Univariate analysis was completed using Wilcoxon rank sum test for continuous measures and chi-square or Fisher’s exact test for categorical measures. Multivariate analysis was completed on variables with p ≤ 0.20 in the univariate analysis. Results: Of 2708 total stroke patients, 1097 (870 IS, 176 ICH, 51 SAH) had EMS records (median [IQR] age 74 [61, 83] years; 56% female; 21% black). Onset to EMS arrival was ≤4.5 hours for 508 cases (46%), and median time from EMS to hospital arrival was 26 minutes. Neurological deterioration occurred in 129 cases (12%), including 9.1% of IS and 22% of ICH/SAH. In multivariate analysis, black race, atrial fibrillation, ICH or SAH subtype, and ALS transport were associated with neurological deterioration. Conclusion: Atrial fibrillation may predict prehospital deterioration in stroke, and preferential transport of patients with acute worsening to centers capable of managing hemorrhagic stroke may be justifiable. Further studies are needed to identify why race is associated with deterioration and potential areas of intervention.

scholarly journals Language Delay Is Not Predictable from Available Risk Factors

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Philip Wilson ◽  
Fiona McQuaige ◽  
Lucy Thompson ◽  
Alex McConnachie
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Male Gender ◽  
Language Delay ◽  
Predictive Capacity ◽  
Factors Associated ◽  
Health Visitors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families.Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed.Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant.Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

scholarly journals Aspicular Bone Marrow Aspiration: A Common, but Not a Minor Problem

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5841-5841
Author(s):  
Jose Angel Hawing ◽  
Olga Graciela Cantu Rodriguez ◽  
Andrés Gómez-De León ◽  
Consuelo Mancias ◽  
Luz del Carmen Tarín Arzaga ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Flow Cytometry ◽  
Multivariate Analysis ◽  
Complete Blood Count ◽  
Univariate Analysis ◽  
Poor Quality ◽  
University Hospital ◽  
Operator Experience ◽  
Factors Associated ◽  
Morphological Diagnosis

Bone marrow (BM) aspiration plays an important role in hematologic malignancies diagnosis. Access and cost of diagnostic flow cytometry remains a problem in low and middle-income countries. In this context, morphological diagnosis by BM smear often represents the only means to rapidly diagnose our patients. Therefore, in this context obtaining the highest quality sample possible during the procedure is paramount. Despite being a well-known problem, evidence-based recommendations to improve BM aspirate quality are few, with studies evaluating factors associated with poor quality samples lacking. Objectives To determine factors associated with poor quality BM aspirates defined by an aspicular or hemodiluted sample in a hematology referral center. Materials and methods We conducted a retrospective study in our University Hospital and analyzed the BM smear samples stored in our center performed from October 2014 to December 2018. We collected and analyzed data based on diagnosis, age, gender, recent chemotherapy, and the variables of a complete blood count performed just before each BM aspiration. The quality of the BM smear was defined in any of the following: aspicular (without spicules), pauciaspicular (1-3 spicules), spicular (> 3 spicules), defining aspicular BM smear as non-diagnostic samples. Univariate analysis was performed looking for diferences between operators (in a 3-year residency program). In the other hand, in the multivariate analysis we seek to reveal the factors associated with obtaining hemodiluted (aspicular) bone marrow aspirate-smears. Results A total of 1,073 BM aspirates were evaluated. Hematology fellows performed 97% of BM aspirates; the remaining 3% were performed by attending physicians. In our analysis, 301 aspirates were aspicular, constituting 28.1% of the total number of aspirate smears. Most BM aspirates were performed for a diagnostic evaluation (66.3%) with the rest of the procedures for subsequent hematologic malignancy response assessments. In the univariate analysis, no differences were observed between operators. In a multivariate analysis the presence of an age >65 years (OR 3.1, 95% CI 2.3 to 4.1) and hemoglobin <6.0 g/dL (OR 2.7, 95% CI 1.4 to 4.5) at the time of the procedure were significantly associated to obtaining a non-diagnostic sample. Diagnosis, WBC count, platelet count, operator experience or other variables did not show statistical relevance. In our center, 18.81% of diagnostic patient samples that had acute leukemia were diagnosed without flow cytometry and through BM aspirate morphology alone. A second procedure to reach a diagnosis was necessary in 7.97% of the patients due to aspicular samples, obtaining a mean of diagnostic-treatment delay of 18.3 days (±5.7 days). Conclusions We found no differences between operators, emphasizing that there are other factors to consider in addition to a correct BM aspiration technique or operator experience. We believe this is crucial to recognize, especially in developing countries where morphological diagnosis remains the only means for the diagnosis or response evaluation of our patients. BM aspirate sample quality is multifactorial, being age and hemoglobin important factors. In addition, obtaining aspicular or hemodiluted samples represents not only a diagnostic challenge, but also delays the treatment of our patients. Disclosures Gomez-Almaguer: Celgene: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Teva: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau.

scholarly journals Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

2019 ◽  
Vol 130 (5) ◽  
pp. 1692-1698 ◽  
Author(s):  
Mitchell P. Wilson ◽  
Andrew S. Jack ◽  
Andrew Nataraj ◽  
Michael Chow
Keyword(s):  
Multivariate Analysis ◽  
Quality Of Care ◽  
Readmission Rate ◽  
Univariate Analysis ◽  
Surrogate Marker ◽  
Readmission Rates ◽  
Factors Associated ◽  
Neurosurgical Patients ◽  
Avoidable Readmissions

OBJECTIVEReadmission to the hospital within 30 days of discharge is used as a surrogate marker for quality and value of care in the United States (US) healthcare system. Concern exists regarding the value of 30-day readmission as a quality of care metric in neurosurgical patients. Few studies have assessed 30-day readmission rates in neurosurgical patients outside the US. The authors performed a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate.METHODSA retrospective review was performed assessing 30-day readmission rates after discharge to home in all neurosurgical patients admitted to a single academic neurosurgical center from January 1, 2011, to December 31, 2011. The primary outcomes included rates of all-cause, unplanned, and avoidable readmissions within 30 days of discharge. Secondary outcomes included factors associated with unplanned and avoidable 30-day readmissions.RESULTSA total of 184 of 950 patients (19.4%) were readmitted to the hospital within 30 days of discharge. One-hundred three patients (10.8%) were readmitted for an unplanned reason and 81 (8.5%) were readmitted for a planned or rescheduled operation. Only 19 readmissions (10%) were for a potentially avoidable reason. Univariate analysis identified factors associated with readmission for a complication or persistent/worsening symptom, including age (p = 0.009), length of stay (p = 0.007), general neurosurgery diagnosis (p < 0.001), cranial pathology (p < 0.001), intensive care unit (ICU) admission (p < 0.001), number of initial admission operations (p = 0.01), and shunt procedures (p < 0.001). Multivariate analysis identified predictive factors of readmission, including diagnosis (p = 0.002, OR 2.4, 95% CI 1.4–5.3), cranial pathology (p = 0.002, OR 2.7, 95% CI 1.4–5.3), ICU admission (p = 0.004, OR 2.4, 95% CI 1.3–4.2), and number of first admission operations (p = 0.01, OR 0.51, 95% CI 0.3–0.87). Univariate analysis performed to identify factors associated with potentially avoidable readmissions included length of stay (p = 0.03), diagnosis (p < 0.001), cranial pathology (p = 0.02), and shunt procedures (p < 0.001). Multivariate analysis identified only shunt procedures as a predictive factor for avoidable readmission (p = 0.02, OR 5.6, 95% CI 1.4–22.8).CONCLUSIONSAlmost one-fifth of neurosurgical patients were readmitted within 30 days of discharge. However, only about half of these patients were admitted for an unplanned reason, and only 10% of all readmissions were potentially avoidable. This study demonstrates unique challenges encountered in a publicly funded healthcare setting and supports the growing literature suggesting 30-day readmission rates may serve as an inappropriate quality of care metric in neurosurgical patients. Potentially avoidable readmissions can be predicted, and further research assessing predictors of avoidable readmissions is warranted.

scholarly journals Factors associated with asthma expression in adolescents

2018 ◽  
Vol 44 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Silvia de Souza Campos Fernandes ◽  
Dirceu Solé ◽  
Paulo Camargos ◽  
Cláudia Ribeiro de Andrade ◽  
Cássio da Cunha Ibiapina
Keyword(s):  
Multivariate Analysis ◽  
Public Schools ◽  
Care Center ◽  
Univariate Analysis ◽  
Health Care Facilities ◽  
Tobacco Smoke Exposure ◽  
Farm Animals ◽  
Analysis Model ◽  
Factors Associated ◽  
Asthma Symptoms

ABSTRACT Objective: To evaluate risk factors associated with asthma symptoms in adolescents in the 13- to 14-year age bracket. Methods: This was a cross-sectional study involving adolescents enrolled in randomly selected public schools in the city of Belo Horizonte, Brazil, and conducted with the use of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and its supplementary module for risk factor assessment. The ISAAC questionnaire was completed by the students themselves, whereas the supplementary questionnaire was completed by their parents or legal guardians. Variables showing p ≤ 0.25 in the univariate analysis were included in the multivariate analysis. Stepwise regression with backward elimination was used for variable selection. Results: We evaluated 375 adolescents, 124 (33.1%) of whom had asthma symptoms. The final multivariate analysis model revealed that asthma symptoms were associated with birth weight < 2,500 g (p < 0.001), day care center or nursery attendance (p < 0.002), maternal history of asthma (p < 0.001), contact with animals during the first year of life (p < 0.027), current contact with animals outside the home (dogs, cats, or farm animals; p < 0.005), and more than 20 cigarettes per day smoked by parents or other household members (p < 0.02). Conclusions: Exposure to animals in and outside the home is associated with asthma symptoms, as is environmental tobacco smoke exposure. Families, health professionals, and administrators of health care facilities should take that into account in order to prevent asthma and reduce asthma morbidity.

Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery

2016 ◽  
Vol 130 (7) ◽  
pp. 669-673 ◽  
Author(s):  
R W A Hone ◽  
T Tikka ◽  
A I Kaleva ◽  
A Hoey ◽  
V Alexander ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Neck Dissection ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Fourfold Increase ◽  
Factors Associated ◽  
Needle Aspiration Cytology ◽  
Associated Risk Factors

AbstractBackground:Inadvertent (or incidental) parathyroidectomy can occur during thyroidectomy. However, the factors associated with inadvertent parathyroidectomy remain unclear. This study aimed to report the rate of inadvertent parathyroidectomy during thyroidectomy and associated risk factors.Methods:Variables including fine needle aspiration cytology findings, age, sex, thyroid weight, concurrent neck dissection, extent of thyroidectomy, and the presence of cancer and parathyroid tissue within the specimen were recorded for 266 patients. The incidence of post-operative hypocalcaemia was also recorded. Univariate and multivariate analysis were performed to identify factors associated with inadvertent parathyroidectomy.Results:The inadvertent parathyroidectomy rate was 16 per cent. Univariate analysis revealed that cancer and concurrent neck dissection predicted inadvertent parathyroidectomy. On multivariate analysis, only concurrent neck dissection remained an independent predictor of inadvertent parathyroidectomy: it was associated with a fourfold increase in inadvertent parathyroidectomy.Conclusion:The inadvertent parathyroidectomy rate was 16 per cent and concurrent neck dissection was identified as an independent predictor of inadvertent parathyroidectomy.

scholarly journals Emergency room resource utilization by patients with low-back pain

2016 ◽  
Vol 24 (5) ◽  
pp. 686-693 ◽  
Author(s):  
Doniel Drazin ◽  
Miriam Nuño ◽  
Chirag G. Patil ◽  
Kimberly Yan ◽  
John C. Liu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
African American ◽  
Low Back Pain ◽  
Back Pain ◽  
Emergency Room ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Low Back ◽  
Factors Associated ◽  
Risk Of Mortality

OBJECTIVE The objective of this study was to determine factors associated with admission to the hospital through the emergency room (ER) for patients with a primary diagnosis of low-back pain (LBP). The authors further evaluated the impact of ER admission and patient characteristics on mortality, discharge disposition, and hospital length of stay. METHODS The authors conducted a retrospective analysis of patients with LBP discharged from hospitals according to the Nationwide Inpatient Sample (NIS) between 1998 and 2007. Univariate comparisons of patient characteristics according to the type of admission (ER versus non-ER) were conducted. Multivariate analysis evaluated factors associated with an ER admission, risk of mortality, and nonroutine discharge. RESULTS According to the NIS, approximately 183,151 patients with a primary diagnosis of LBP were discharged from US hospitals between 1998 and 2007. During this period, an average of 65% of these patients were admitted through the ER, with a significant increase from 1998 (54%) to 2005 (71%). Multivariate analysis revealed that uninsured patients (OR 2.1, 95% CI 1.7–2.6, p < 0.0001) and African American patients (OR 1.5, 95% CI 1.2–1.7, p < 0.0001) were significantly more likely to be admitted through the ER than private insurance patients or Caucasian patients, respectively. Additionally, a moderate but statistically significant increase in the likelihood of ER admission was noted for patients with more preexisting comorbidities (OR 1.1, 95% CI 1.0–1.2, p < 0.001). An 11% incremental increase in the odds of admission through the ER was observed with each year increment (OR 1.1, 95% CI 1.0–1.2, p < 0.001). Highest income patients ($45,000+) were more likely to be admitted through the ER (OR 1.3, 95% CI 1.1–1.6, p = 0.007) than the lowest income cohort. While ER admission did not impact the risk of mortality (OR 0.95, 95% CI 0.60–1.51, p = 0.84), it increased the odds of a nonroutine discharge (OR 1.39, 95% CI 1.26–1.53, p < 0.0001). CONCLUSIONS A significant majority of patients discharged from hospitals in the US from 1998 to 2007 with a primary diagnosis of LBP were admitted through the ER, with more patients being admitted via this route each year. These patients were less likely to be discharged directly home compared with patients with LBP who were not admitted through the ER. Uninsured and African American patients with LBP were more likely to be admitted through the ER than their counterparts, as were patients with more preexisting health problems. Interestingly, patients with LBP at the highest income levels were more likely to be admitted through hospital ERs. The findings suggest that socioeconomic factors may play a role in the utilization of ER resources by patients with LBP, which in turn appears to impact at least the short-term outcome of these patients.

scholarly journals The pattern of distant metastasis and clinicopathological factors associated with de-novo metastatic cervical cancer: a retrospective analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 191
Author(s):  
J. Kannan ◽  
Amit Saklani ◽  
Srigopal Mohanty ◽  
Kiranmayee Narapaneni ◽  
Deepak George ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Cancer Patients ◽  
Distant Metastasis ◽  
Primary Tumor ◽  
De Novo ◽  
Univariate Analysis ◽  
High Grade ◽  
Newly Diagnosed ◽  
Factors Associated

Background: Metastatic cervical cancer carries poor prognosis. The factors associated with distant metastasis in newly diagnosed cervical cancer patients are not clear.Methods: A retrospective analytical study was performed to study the pattern of distant metastasis, and to evaluate the factors associated with de-novo metastatic cervical cancer. Univariate and multivariate analysis (by MANOVA) were used to evaluate the association. P≤0.05 was considered significant.Results: Out of 1321 newly diagnosed cervical cancer patients, 54 (4.1%) had de-novo metastatic disease and most of which (81%) were found at single site. Common sites of distant metastasis were non-regional nodes, followed by liver, lung, peritoneum and bone. Univariate analysis showed the factors associated with de-novo metastasis were non squamous subtype, high grade histology, bulky primary tumor (>4 cm), pelvic/para-aortic lymphadenopathy, and hydroureteronephrosis. Multivariate analysis revealed the factors associated with de-novo metastasis were bulky primary tumor (>4 cm), high grade histology, pelvic/para aortic lymphadenopathy, hydroureteronephrosis.Conclusions: Newly diagnosed cervical cancer patients with bulky primary tumor, high grade histology, pelvic or para aortic lymphadenopathy, hydroureteronephrosis are associated with higher risk of de-novo distant metastasis.

scholarly journals A Study in the Clinical Characteristics of Stenotrophomonas Maltophilia Bacteremia in Hematological Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4631-4631
Author(s):  
Haiyan Bao ◽  
Jia Chen ◽  
Xiaojin Wu ◽  
Xiao Ma ◽  
Chengcheng Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Respiratory Failure ◽  
Stenotrophomonas Maltophilia ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
P Value ◽  
Hematological Diseases ◽  
Factors Associated

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

3224Incremental benefit of left ventricular global longitudinal strain over clinical and left atrial parameters for predicting new-onset atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Kawakami ◽  
S Ramkumar ◽  
F Pathan ◽  
L Wright ◽  
T H Marwick
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Receiver Operating Curve ◽  
Lv Dysfunction ◽  
Echocardiographic Parameters ◽  
New Onset

Abstract Background Although LV hypertrophy and dysfunction are associated with atrial fibrillation (AF), AF often occurs in the absence of LV hypertrophy or reduced ejection fraction. The effect of subclinical LV dysfunction on AF has not been fully studied. Purpose We sought the association between subclinical LV dysfunction (measured with global longitudinal strain, GLS) and new-onset AF. Methods This observational study evaluated 531 consecutive patients (median age, 67 years [interquartile range, 56 to 78]; 56% male), without a history of AF who underwent strain echocardiography after cryptogenic stroke. The CHARGE-AF score was used to calculate the 5-year risk of developing AF. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir strain, pump strain, and conduit strain) and LV strain (GLS). A strain analysis was conducted using a dedicated software package, using R-R gating. The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared. Results Over 2.5 years of follow-up, 61 patients (11%) had new-onset AF. Patients who developed AF were older, had a higher CHARGE-AF score, larger LA volume, worse LA strain, and worse GLS than those who did not. Areas under the receiver-operating curve for GLS (0.84) was comparable to CHARGE-AF (0.79), LA pump strain (0.83), and LA reservoir strain (0.85). In the nested Cox models, GLS demonstrated an independent and incremental predictive value over the clinical and LA parameters (Figure). Moreover, adding GLS to the combined clinical and LA parameters model resulted in a significantly improved reclassification (net reclassification improvement, 0.32; p=0.016). Importantly, the predictive value of GLS was confirmed in patients with abnormal LA volumes (LA volume index≥34ml/m2) but not in patients with normal LA volumes. Figure 1 Conclusion GLS is associated with new-onset AF, especially in patients with abnormal LA volumes. This effect is independent of and incremental to the clinical and LA parameters.

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