Exercise-optimized programming after S-ICD implantation contributes to a lower risk of inappropriate shocks in the latest generation S-ICDs

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter-defibrillator (ICD) therapy is associated with the risk of inappropriate shocks (IAS). IAS, defined as any shock on a different rhythm than VT or VF, cause psychological stress, decrease the quality of life and may provoke ventricular arrhythmias. In the subcutaneous ICD (S-ICD) the majority of IAS are caused by T-wave oversensing (TWOS), often during exercise. Exercise-optimized programming during an exercise ECG test (X-ECG) after implantation has shown to be successful in reducing IAS in patients known with TWOS. In recent years, new discrimination algorithms in the latest generation S-ICDs have significantly reduced the risk of TWOS. The benefit of performing an X-ECG in these latest generation S-ICDs to reduce IAS is unclear. Purpose We aim to describe the effect of exercise-optimized programming after S-ICD implantation on inappropriate shock rate in the latest generation S-ICDs. Methods In this retrospective multicenter study, data were collected from two experienced S-ICD hospitals in the Netherlands. All patients underwent an S-ICD implantation of second or third generation between February 2015 and December 2020. Patients younger than 21 years were excluded. Patients with an X-ECG after implantation were compared with patients without X-ECG after implantation. Total number of patients with IAS and cause of the first IAS were evaluated. Results In total, 262 patients were included in the X-ECG group and 61 in the no X-ECG group. The median follow-up time was 22 months in the X-ECG group (IQR 9-33) and 23 months in the no X-ECG group (IQR 12-33, P = 0.9). Mean age was 51 ± 15 years and 61 ± 15 years respectively (P< 0.001). Primary prevention indication was similar in both groups (56% for the X-ECG group versus 49% for the no X-ECG group, P = 0.4). A total of 8 patients (3.1%) experienced IAS in the X-ECG group; 3 first shocks (1.15%) were due to TWOS, 2 (0.8%) were given on a SVT and 3 (1.15%) on other non-cardiac activity. In the no X-ECG group, 6 patients (9.8%) experienced IAS; 1 first shock (1.6%) was due to TWOS, 4 (6.6%) were given on a SVT and 1 (1.6%) on other non-cardiac activity. Patients with an X-ECG had a significantly lower risk of IAS compared to patients in the no X-ECG group (hazard ratio 0.32; 95% CI 0.1 to 0.9; P = 0.027). The Kaplan-Meier estimate of IAS-free survival for the X-ECG group was 61 months (95% CI 59 to 62) and 50 months (95% CI 46 to 55) for the no X-ECG group. Results are shown in the figure. Conclusion This study shows that, in the latest generation S-ICDs, exercise-optimized programming after S-ICD implantation results in a significantly lower risk of IAS in adults. Patients with an X-ECG after S-ICD implantation were younger, which may have affected the outcome. Further prospective data with more equal groups is necessary. Until then, we recommend considering exercise testing after S-ICD implantation in the latest generation S-ICDs. Abstract Figure.

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The Wearable Cardioverter/ Defibrillator: retrospective analysis of efficacy, safety and adherence

European Heart Journal ◽

10.1093/ehjci/ehaa946.0407 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Ehmsen ◽

H Keller ◽

C Stoellberger

Keyword(s):

Systolic Function ◽

Detection Algorithm ◽

Shock Rate ◽

Information Network ◽

Independent Data ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Wearable Cardioverter Defibrillator ◽

Inappropriate Shocks ◽

High Adherence

Abstract Background The use of the Wearable Cardioverter Defibrillator (WCD) is recommended in national, European and American guidelines. However, there are almost exclusively data from the manufacturer's own data network. Independent data on the experience with the WCD are rare. Objective The aim of the retrospective study from one cardiologic department was to record efficiency, safety and compliance of the WCD. Patients and methods The study included all patients, to whom a WCD was described between 1.11.2010 and 1.5.2018 at one cardiologic department. Clinical data were obtained from the patients' records and the data about the WCD from the information network of the manufacturer. Results This study enrolled 66 patients, 51 males (77%) and 15 females (23%). The median age was 55 years (IQR: 45–63). They suffered from ischemic cardiomyopathy (n=33; 49%), dilated cardiomyopathy (n=12; 18%), myocarditis (n=7; 11%), explantation of an implantable cardioverter/defibrillator (ICD; n=5; 8%) and other indications (n=6; 9%). The median wearing time of the WCD was 73 days (interquartile range-IQR: 39–126), with median daily use of 22.91 h (IQR: 19.58–23.61). Among 38 patients with LVEF ≤35%, LVEF improved to ≥35% in 19 patients (50%) during WCD therapy. Over 1600 times the WCD detected a VT falsely. Four patients (8%) suffered from 212 non-sustained VT. One patient was successfully shocked because of ventricular fibrillation (appropriate shock rate: 1.5%). There were no inappropriate shocks. All patients, who wore the WCD, survived and one patient died when he did not wear the WCD. At the end of therapy 32 patients (48%) received an ICD. In terms of wearing time and events (shocks, arrhythmias, artifacts) there were no significant differences between patients receiving ICD and those who did not receive an ICD. Patients who received an ICD had a significantly lower LVEF after 3 months than patients who did not receive an ICD. Conclusion Our data confirm, that the WCD is safe and that the patients, who wear a WCD, have a high adherence. More than half of the patients with reduced LVEF improved their systolic function during WCD therapy, thus obviating the need for ICD implantation. Questions about the effectiveness of the detection algorithm remained open. Funding Acknowledgement Type of funding source: None

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Gender-related differences in patient selection for and outcomes after pace and ablate for refractory atrial fibrillation: insights from a large multicenter cohort

EP Europace ◽

10.1093/europace/euab116.172 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

T Baumgartner ◽

M Kaelin-Friedrich ◽

K Makowski ◽

F Noti ◽

B Schaer ◽

...

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Patient Selection ◽

Funding Sources ◽

Kaplan Meier ◽

Number Of Patients ◽

Male Patients ◽

Selection For ◽

Av Junction Ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background A pace & ablate strategy may be performed in cases of severe refractory atrial arrhythmias. Purpose We aimed to assess gender related differences in patient selection and clinical outcomes after pace & ablate. Methods In a retrospective multicenter study, patients undergoing AV-junction-ablation between 2011 and 2019 were studied. Gender-related differences in terms of baseline characteristics, device-related complications, heart failure (HF) hospitalisations and death were assessed. Results Overall, 513 patients underwent AV-junction-ablation (median age 75 years, 50% males). At baseline, male patients were younger (72 vs. 78 years, p < 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), a lower LVEF (35% vs. 55%, p < 0.001) and more often received biventricular stimulation (75% vs. 25%, p < 0.001). Interventional complications were rare in both gender (1.2% vs 1.6%, p = 0.72). Following AV-junction-ablation, improvement of EHRA-class by ≥1 and of LVEF by ≥5% occurred in 44% and 19% of patients respectively, without gender differences (p = 0.66 and p = 0.38). Patients were followed for a median of 42 months in survivors (IQR 22-62). Lead-related complications (11 patients, 2.1%), infections (1 patient, 0.2%) and upgrade to ICD or CRT (18 patients, 3.5%) were rare. In Kaplan Meier analysis, HF hospitalisations during 4 years of follow-up were more common in men (22% vs 11%, p = 0.02), as were death (28% vs 21%, p = 0.02) and the combination of death or HF hospitalisation (37% vs. 26%, p = 0.008, Figure). Gender remained an independent predictor of the combined endpoint of death or HF hospitalisation after adjustment for age, LVEF and type of stimulation. Conclusion A Pace & Ablate strategy is safe and results in improvement of EHRA class and LVEF in a substantial number of patients. We found significant gender differences in patient selection for pace & ablate. Female patients had a more favorable clinical course after AV-junction-ablation, which was independent of age, EF and type of stimulation. Abstract Figure. Comb. endpoint of death or heart failure

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Stroke in acute coronary syndrome: predictors and prognosis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.055 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Santos ◽

H Santos ◽

I Almeida ◽

H Miranda ◽

C Sa ◽

...

Keyword(s):

Logistic Regression ◽

Left Ventricle ◽

Past History ◽

Female Gender ◽

Arterial Disease ◽

Study Data ◽

Coronary Syndrome ◽

Funding Sources ◽

Kaplan Meier ◽

St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Stroke is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of stroke in the setting of ACS. Objective To evaluate predictors and prognosis of stroke in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without stroke; GB - pts with stroke during hospitalization. Logistic regression was performed to assess predictors of stroke in ACS. Survival analysis was evaluated through Kaplan Meier curve. Results Population – 25711 pts with ACS, CA occurred in 154 (0.6%). Regarding epidemiological factors and past history, GB was older (72 ± 12 vs 67 ± 14, p < 0.001), had higher rates of females (53.2% vs 27.5%, p < 0.001), diabetes (43.9% vs 31.5%, p < 0.001), previous stroke (13.3% vs 7.2%, p = 0.004), peripheric arterial disease (9.2% vs 5.5%, p = 0.044) and dementia (6.8% vs 1.7%, p < 0.001), and had lower rates of smoking (16.6% vs 26.7%, p = 0.005), dyslipidaemia (53.5% vs 61.6%, p = 0.047) and previous ACS (12.7% vs 20.6%, p = 0.017. GB had longer times from first symptoms to admission (340min vs 240min, p = 0.011). The groups were similar regarding diagnosis, namely non-ST-elevation myocardial infarction (MI) (p = 0.345) and ST-elevation MI (p = 0.541). GB had higher heart rate (HR) (84 ± 24 vs 77 ± 19, p = 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (28.0% vs 15.1%, p < 0.001), in atrial fibrillation (AF) (16.4% vs 7.1%, p < 0.001) and with higher brain-natriuretic peptide levels (545 vs 180, p < 0.001). The groups were similar regarding culprit lesion and number of lesions. GB had more left ventricle (<50%) dysfunction (51.4% vs 39.1%, p < 0.001) and needed more frequently mechanical ventilation (10.4% vs 1.9%, p < 0.001) and provisory pacemaker (8.4% vs 1.5%, p < 0.001). Logistic regression confirmed that older age (p = 0.018, OR 1.69, CI 1.10-2.60), female gender (p < 0.001, OR 2.09, CI 1.38-3.15), diabetes (p = 0.002, OR 1.91, CI 1.27-2.86), dementia (p = 0.047, OR 2.13, CI 1.01-4.50), AF (p = 0.024, OR 1.87, CI 1.09-3.21) and lower left ventricle function (p = 0.002, OR 2.01, CI 1.29-3.15) were predictors of stroke in the setting of ACS. Event-free survival was higher in GA than GB (79.9% vs 70.5%, OR 1.58, p < 0.001, CI 1.36-1.83). Conclusion As expected, stroke in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the occurrence of stroke during hospitalizations, therefore allowing an earlier identification and prompt treatment.

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Prognostic impact of subcutaneous implantable cardioverter-defibrillator appropriate and inappropriate shocks

EP Europace ◽

10.1093/europace/euab116.413 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

L Oliveira ◽

D Cavaco ◽

G Rodrigues ◽

D Matos ◽

MS Carvalho ◽

...

Keyword(s):

Large Scale ◽

Prognostic Impact ◽

Implantable Cardioverter Defibrillators ◽

Icd Implantation ◽

Inappropriate Shocks ◽

Funding Sources ◽

Idiopathic Cardiomyopathy ◽

Common Etiology ◽

Cardioverter Defibrillators

Abstract Funding Acknowledgements Type of funding sources: None. Background Previous studies have shown an adverse prognosis for patients with transvenous implantable cardioverter-defibrillators (ICD) who receive both appropriate and inappropriate shocks. There is a paucity of data regarding the prognosis of inappropriate shocks in patients with a subcutaneous ICD (S-ICD). Purpose To assess and characterize S-ICD appropriate (AS) and inappropriate shocks (IAS) and their impact on mortality. Methods Single center observational registry of 162 consecutive patients who underwent S-ICD implantation for primary and secondary prevention between November 2009 and September 2020. Only follow-up data of at least 6 months was analysed to identify predictors of both IAS and AS and their mortality impact. Results A total of 144 patients were included in the analysis. Mean age was 42.2 ± 16.6 years and 75% of the patients were male. One hundred and four patients (72.2%) implanted the S-ICD in primary prevention. The most common etiology was ischemic cardiomyopathy (22.9%) followed by hypertrophic cardiomyopathy (18.8%) and dilated idiopathic cardiomyopathy (14.6%). During a mean follow-up of 42.3 ± 29.9 months a total of 48 patients (33.3%) experienced at least one S-ICD shock. Twenty-nine (20.1%) patients received AS due to VT/VF and 31 patients (21.5%) received IAS. Eighteen (58.1%) of the IAS were due to oversensing/noise/discrimination errors and the remaining due to supraventricular tachycardia. Overall, patients with AS (HR 4.93, 95% CI 1.58-15.36, p = 0.006) and higher number of total AS (HR 1.10, 95% CI 1.00-1.20, p = 0.044) were associated with higher mortality during follow-up. S-ICD IAS therapy did not affect overall mortality (HR 1.71, 95% CI 0.21-14.0, p = 0.616). Conclusions: In patients with S-ICD, those who receive AS, in contrast to IAS, seem to have a worse prognosis. Large scale studies are needed to confirm this hypothesis and to explain this findings. Abstract Figure. Survival curves for AS and IAS

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Acute heart failure: does etiology matter?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.021 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Santos ◽

H Santos ◽

I Almeida ◽

S Paula ◽

H Miranda ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Acute Heart Failure ◽

Previous History ◽

Real Life ◽

Study Data ◽

Post Discharge ◽

Funding Sources ◽

Kaplan Meier ◽

Revascularization Procedures

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (pts) with acute heart failure (AHF) are a heterogeneous population. The etiology of the heart disfunction may play a role in prognosis. Risk stratification at admission may help predict in-hospital complications and needs. Objective To explore predictors of in-hospital mortality (IHM), post discharge early mortality [1-month mortality (1mM)] and late mortality [1-year mortality (1yM)] and early and late readmission, respectively 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from patients (pts) admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. The pts were divided in 3 groups: ischemic etiology (IE), valvular etiology (VE) and other etiologies (OE), which included hypertensive and idiopathic cardiomyopathies). Statistical analysis used non-parametric tests and Kaplan-Meyer survival analysis. Results We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. The heart failure was of IE in 45%, VE in 22.7% and of OE in 32.3% of the cases. There were no significant differences between groups regarding body mass index, Killip-Kimball class, systolic blood pressure at admission, blood tests aspects at admission (namely, creatinine, sodium or urea), inotropes’ usage or need of non-invasive or invasive ventilation. However, IE group had higher percentage of males comparing to VE e OE (83.0% vs 55.9% vs 70.1%, respectively, p < 0.001), higher rates of prior revascularization procedures (68.9%, vs 19.1%, vs 7.2%, p < 0.001) and higher rates of traditional cardiovascular risk factors, namely hypertension (74.1% vs 55.9% vs 57.7%, p = 0.014), diabetes mellitus (48.1% vs 27.9% vs 27.8%, p = 0.002) and dyslipidaemia (48.9% vs 30.9% vs 40.2%, p = 0.022). OE group was younger compared to IE and VE (63.9 ± 13.5 vs 68.9 ± 11.1 vs 69.5 ± 13.0 years old, respectively, p = 0.003). VE group had less left ventricle disfunction comparing to IE and VE groups (left ventricle ejection fraction 40.8 ± 14.1 vs 32.2 ± 9.8 vs 31.6 ± 12.8%, respectively, p < 0.001). The groups showed no significant differences regarding IHM (IE 5.2% vs VE 8.8% vs OE 2.1%, p = 0.146), 1mRA (IE 8.1&, VE 7.4%, OE 3.1%, p = 0.276) or 1yRA (IE 55.6%, VE 54.4%, OE 47.4%, p = 0.449). However, VE group had higher rates of 1mM (VE 13.2% vs IE 8.9% vs OE 3.1%, p = 0.05) and 1yM compared to IE and OE (33.8% vs 30.4% vs 17.5%, respectively, p = 0.34). These aspects are represented in Kaplan Meier survival curves. Conclusion In our population, the etiology of heart failure was predictor of early and late post-discharge mortality but not readmission.

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An Analysis of Dental Implants Survival and Success

Revista de Chimie ◽

10.37358/rc.18.9.6554 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2465-2466

Author(s):

Iustin Olariu ◽

Roxana Radu ◽

Teodora Olariu ◽

Andrada Christine Serafim ◽

Ramona Amina Popovici ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Medical History ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Demographic Data ◽

Kaplan Meier ◽

Number Of Patients ◽

Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

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Heart failure in Acute Coronary Syndrome: predictors and prognosis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.053 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Santos ◽

H Santos ◽

I Almeida ◽

H Miranda ◽

C Sa ◽

...

Keyword(s):

Heart Failure ◽

Artery Bypass ◽

Study Data ◽

Multivessel Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Coronary Syndrome ◽

Funding Sources ◽

Previous Stroke ◽

St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF. Objective To evaluate predictors and prognosis of HF in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization. Results HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p < 0.001), had more females (36.3% vs 26.2%, p < 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p < 0.001), dyslipidaemia (64.4% vs 61.1%. p < 0.001), previous ACS (25.6% vs 19.7%, p < 0.001,), previous HF (16.4% vs 4.1%, p < 0.001), previous stroke (11.9% vs 6.4%, p < 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p < 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p < 0.001) and longer times from first symptoms to admission (268min vs 238min, p < 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p < 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p < 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p < 0.001), namely anterior STEMI (58.1% vs 44.9%, p < 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p < 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p < 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p < 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p < 0.001), left bundle branch block (7.5% vs 3.1%, p < 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p < 0.001), amiodarone (2.2% vs 1.4%, p < 0.001) and digoxin (2.8% vs 0.7%, p < 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p < 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p < 0.001), reduced left ventricle function (72.3% vs 33.4%, p < 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p < 0.001), non-invasive ventilation (8.7% vs 0.5%, p < 0.001) and provisory pacemaker (4.5% vs 1.0%, p < 0.001). Logistic regression confirmed females (p < 0.001, OR 1.42, CI 1.29-1.58), diabetes (p < 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p < 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p < 0.001, OR 1.35, CI 1.16-1.57), CKD (p < 0.001, OR 1.76, CI 1.50-2.05), COPD (p < 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p < 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p < 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p < 0.001, CI 2.09-2.56). Conclusion As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

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Pulmonary embolism during the COVID-19 pandemic

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.183 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

BV Silva ◽

T Rodrigues ◽

N Cunha ◽

J Brito ◽

P Alves Da Silva ◽

...

Keyword(s):

Physical Activity ◽

Pulmonary Embolism ◽

Hospital Admissions ◽

Reference Group ◽

Group Versus ◽

Pulmonary Angiography ◽

Reference Period ◽

Funding Sources ◽

Clinical Probability

Abstract Funding Acknowledgements Type of funding sources: None. Background During the COVID-19 pandemic many countries have imposed lockdown restrictions to movement. Since the 18th of March in Portugal, thousands of people have been confined to their homes. While hospital admissions for COVID-19 patients increased exponentially, admissions for non-COVID-19 patients decreased dramatically. However, it remains unclear whether lockdown-related immobility can contribute to the increased incidence of pulmonary embolism. Purpose To compare the incidence of pulmonary embolism (PE) during the lockdown period (Abril 1 to May 31, 2020) compared to the reference period in 2019. Methods Retrospective study of consecutive outpatients who presented to the emergency department and underwent computed tomography pulmonary angiography (CTPA) due to suspicion of PE. Results Compared to the same period of 2019, the lockdown period was associated with a significant increase in PE diagnosis (29 versus 18 patients). PE patients during lockdown were older (median age 71 years; interquartile range [IQR][60-85] versus 59 years [44-76]; p = 0.046) and have lower prevalence of active cancer (14% versus 33% in the reference period). Women represent 55% (n = 16) of patients in lockdown group (versus 50% in 2019 group). Clinical probability (GENEVA score) was similar in both groups (median score 2.72 in lockdown group and 2.50 in reference group, p = 0.452). None of the patients with PE was diagnosed with COVID-19. Conclusion We have observed a marked increase (62%) in PE diagnosis during lockdown period compared to the reference period, which can be explained by the reduction in physical activity due to teleworking and closure of gyms and sports activities. These data reinforce the importance of promoting physical activity programs at home. The role of pharmacological or mechanical thromboprophylaxis in this scenario remains unclear.

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Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

The American Surgeon ◽

10.1177/0003134821995060 ◽

2021 ◽

pp. 000313482199506

Author(s):

Youngbae Jeon ◽

Kyoung-Won Han ◽

Won-Suk Lee ◽

Jeong-Heum Baek

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Surgical Treatment ◽

Postoperative Complications ◽

Postoperative Mortality ◽

Nonsurgical Treatment ◽

Perioperative Outcomes ◽

Rank Test ◽

Kaplan Meier ◽

Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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Progress of leukoaraiosis is inhibited by correction of platelet hyper-aggregability

International Psychogeriatrics ◽

10.1017/s104161020500164x ◽

2005 ◽

Vol 17 (4) ◽

pp. 689-698 ◽

Cited By ~ 11

Author(s):

Shigekiyo Fujita ◽

Tetsuro Kawaguchi ◽

Toshiyuki Uehara ◽

Kazuhito Fukushima

Keyword(s):

Group Versus ◽

Adenosine Diphosphate ◽

White Matter Hyperintensity ◽

Number Of Patients ◽

Mri Scans ◽

The Mean ◽

The Difference ◽

Magnetic Resonance Imaging Mri ◽

Observation Period

Background: Platelet hyper-aggregability is an important risk factor for leukoaraiosis. In this study we investigated whether aggravation of leukoaraiosis can be controlled by means of long-term correction of platelet hyper-aggregability.Methods:Twenty-one patients with leukoaraiosis and uncorrected platelet hyper-aggregability were compared with 21 controls matched for age, grade of leukoaraiosis and observation period whose platelet hyper-aggregability was corrected. Platelet aggregability was estimated by an optical analytical method with a nine-stage display using two different concentrations each of adenosine diphosphate (ADP) and collagen (the double ADP method).Results:The mean observation period between two magnetic resonance imaging (MRI) scans for both groups was 4.1 years. In the non-corrected group, moderate to severe aggravation of leukoaraiosis was observed in a large number of patients. In the corrected group, only a small number of patients showed generally mild aggravation of leukoaraiosis. The number of patients showing aggravation of periventricular hyperintensity (PVH) was 7 in 21 in the non-corrected group versus 1 in 21 (p=0.022) in the corrected group, and for aggravation of deep white-matter hyperintensity, these values were 9 in 21 versus 4 in 21, respectively. Thus, the difference was more significant if the degree of aggravation was taken into account.Conclusion:The progress of leukoaraiosis is greatly inhibited by long-term correction of platelet hyper-aggregability.

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