AB0422 LEFT VENTRICULAR ABNORMALITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS FOLLOWED BY SEQUENTIAL ECHOCARDIOGRAPHY

Background:Cardiovascular disease (CVD) is detected in up to 50% of systemic lupus erythematosus (SLE) patients1and major cause of death2. Even clinically silent SLE patients can develop left ventricular (LV) diastolic dysfunction3. Proper echocardiographic follow up of SLE patients is required.Objectives:To clarify how the prevalence of LV abnormalities changes over follow-up period and identify the associated clinical factors, useful in suspecting LV abnormalities.Methods:29 SLE patients (24 females and 5 men, mean age 52.8±16.3 years, mean disease duration 17.6±14.5 years) were enrolled. All of them underwent echocardiography as the baseline examination and reexamined over more than a year of follow-up period(mean 1075±480 days) from Jan 2014 to Sep 2019. Patients complicated with pulmonary artery hypertension, deep venous thrombosis or pulmonary embolism and underwent cardiac surgery during the follow-up period were excluded. Left ventricular(LV) systolic dysfunction was defined as ejection fraction (EF) < 50%. LV diastolic dysfunction was defined according to ASE/EACVI guideline4. LV dysfunction (LVD) includes one or both of LV systolic dysfunction and LV diastolic function. Monocyte to HDL ratio (MHR) was calculated by dividing monocyte count with HDL-C level.Prevalence of left ventricular abnormalities was analysed at baseline and follow-up examination. Clinical characteristics and laboratory data were compared among patient groups as follows; patients with LV dysfunction (Group A) and without LV dysfunction (Group B) at the follow-up echocardiography, patients with LV asynergy at any point of examination (Group C) and patients free of LV abnormalities during the follow-up period (Group D).Results:At the baseline examination, LV dysfunction (5/29 cases, 13.8%), LV asynergy (6/29 cases, 21.7%) were detected. Pericarditis was detected in 7 patients (24.1%, LVD in 3 patients, LV asynergy in 2 patients) and 2 of them with subacute onset had progressive LV dysfunction, while 5 patients were normal in echocardiography after remission induction therapy for SLE. At the follow-up examination, LV dysfunction (9/29 cases, 31.0%, 5 new-onset and 1 improved case), LV asynergy (6/29 cases, 21.7%, 2 new-onset and 2 improved cases) were detected. Though any significant differences were observed between Group A and Group B at the baseline, platelet count (156.0 vs 207.0, p=0.049) were significantly lower in LV dysfunction group (Group A) at the follow-up examination. Group C patients had significantly higher uric acid (p=0.004), monocyte count (p=0.009), and MHR (p=0.003) than Group D(results in table).Conclusion:LV dysfunction is progressive in most of patients and requires regular follow-up once they developed. Uric acid, monocyte count and MHR are elevated in SLE patients with LV asynergy. Since MHR elevation was reported as useful marker of endothelial dysfunction5, our future goal is to analyse involvement of monocyte activation and endothelial dysfunction in LV asynergy of SLE patients.References:[1]Doria A et al. Lupus. 2005;14(9):683-6.[2]Manger K et al. Ann Rheum Dis. 2002 Dec;61(12):1065-70.[3]Leone P et al. Clin Exp Med. 2019 Dec 17.[4]Nagueh SF et al. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314.[5]Acikgoz N et al. Angiology. 2018 Jan;69(1):65-70.Numbers are median (interquartile range), Mann-Whitney u test were performed, p value less than 0.05 was considered statistically significant.Disclosure of Interests: :None declared

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Low-voltage-area ablation in paroxysmal atrial fibrillation: Extended follow-up results of the VOLCANO trial

10.22541/au.161661216.67499040/v1 ◽

2021 ◽

Author(s):

Masaharu Masuda ◽

Mitsutoshi Asai ◽

Osamu Iida ◽

Shin Okamoto ◽

Takayuki Ishihara ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Low Voltage ◽

Recurrence Rates ◽

Group A ◽

C 32 ◽

Group B ◽

Group D

Introduction: The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (AF) patients with LVAs. To compare long-term AF/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts during a > 2-year follow-up period. Methods: An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with paroxysmal AF, divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, p=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, p<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, p<0.0001), especially biatrial tachycardia (20% vs. 0%, p=0.01). Conclusion: Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate iatrogenic ATs.

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Treatment of Major Laparoscopic Bile Duct Injury: A Long-Term Follow-up Result

The American Surgeon ◽

10.1177/000313481107701226 ◽

2011 ◽

Vol 77 (12) ◽

pp. 1584-1588 ◽

Cited By ~ 3

Author(s):

Xiao Dong Xu ◽

You Cheng Zhang ◽

Pen Gao ◽

Farah Bahrani-Mougeot ◽

Ling Yi Zhang ◽

...

Keyword(s):

Bile Duct ◽

Bile Duct Injury ◽

Tertiary Care ◽

Secondary Operation ◽

Significant Difference ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Group D

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.

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Cardiac evaluation of Covid-19 patients with post-discharge dyspnoea

International Journal of Medical Research and Review ◽

10.17511/ijmrr.2020.i06.11 ◽

2020 ◽

Vol 8 (6) ◽

pp. 432-437

Author(s):

Dr. Sibaram Panda ◽

◽

Dr. Sunil Kumar Sharma ◽

Keyword(s):

Cardiac Function ◽

Diastolic Dysfunction ◽

Systolic Dysfunction ◽

Post Discharge ◽

Multiple Risk Factors ◽

Cardiac Evaluation ◽

Group A ◽

Group B ◽

Lv Diastolic Dysfunction ◽

High Level

Background: Dyspnoea is one of the common symptoms in COVID-19 patients after discharge fromthe hospital. So evaluation of cardiac function becomes necessary in COVID patients after hospitaldischarge. AIM: To study the cardiac function of COVID 19 patients presenting with dyspnoea afterdischarge from hospital within 3 months of symptom onset. Materials and methods: 245 post-hospital discharge COVID-19 patients enrolled in the study. The patients with abnormalechocardiography are further divided into three groups, A) patients with PAH±RVD, B) patients withLV diastolic dysfunction C) patients with LV systolic dysfunction. Data of the three groups werecompared. Results: Out of 245 patients, 64% (157) patients show abnormal echocardiogram.75(30.6%) patient show PAH±RVD,61(24.8% ) patients shows LV diastolic dysfunction and 21(8.57%)patients shows LV systolic dysfunction. patients with ventricular dysfunction significantly associatedwith multiple risk factors and comorbidity. Grade 1,2,3,4 diastolic dysfunction seen in27.8%,34.4%,29.5%,8.1% in group B respectively. LV systolic dysfunction is mild in 13 (61.9%),moderate in6(28.5%), severe in 1 (4.7 %) in group C patients. Ntprobnp, tropnin significantlyhigher in all groups. Also, CRP, D dimer significantly higher in group A, but non significantly higher ingroup B, C. Conclusion: RV dysfunction is the most common pattern seen in around 30% ofpatients. LV diastolic dysfunction is not uncommon, seen in ¼ the patients. Patients with cardiacdysfunction have a high level of cardiac and inflammatory biomarkers, which can lead to grievouscardiovascular complications. So close follow up required.

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Prognostic value of non-ischemic ring-like left ventricular scar pattern in patients with apparently idiopathic ventricular arrhythmias: a CMR imaging study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0207 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Nucifora ◽

D Muser ◽

S Castro ◽

R Casado Arroyo ◽

D Benhayon ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Prognostic Significance ◽

Imaging Study ◽

Left Ventricular ◽

High Rate ◽

Life Threatening ◽

History Of ◽

Group A ◽

Group B

Abstract Background The presence of left ventricular (LV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has been correlated to life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). Aim of the present study was to investigate the prognostic significance of a specific LV-LGE phenotype characterized by a subepicardial/midmyocardial “ring-like” pattern of fibrosis. Methods Out of a total of 518 consecutive patients with apparently idiopathic VAs who underwent CMR study, 79 (15%) had evidence of LV-LGE. Of these, 23 (4%) patients had LV LGE with ring-like pattern, defined as subepicardial or midmyocardial LGE involving at least 3 contiguous segments in the same slice (group A), while 56 (11%) patients had LV LGE with no ring-like pattern (group B). The remaining 439 patients had no LGE (group C). The end-point of the study was a composite SCD, resuscitated cardiac arrest and nonfatal episodes of ventricular fibrillation or documented sustained ventricular tachycardia. Results Group A patients were more frequently males compared to groups B and C (96% vs. 79% vs. 52%; p<0.01) and had more frequently a family history of SCD and/or cardiomyopathy (30% vs. 11% vs. 5%; p<0.01). All patients in Group A showed VAs with a predominant RBBB morphology vs. 38 (68%) patients in Group B and 65 (15%) in Group C (p<0.01). During a follow-up of 63±39 months, the composite outcome occurred in 13 patients (57%) in Group A vs. 11 (20%) in Group B and 2 (1%) in Group C (p<0.01). Conclusion In patients with apparently idiopathic VAs, a nonischemic LV-LGE with a ring-like pattern at CMR is associated with a high rate of malignant arrhythmic events during follow-up. Funding Acknowledgement Type of funding source: None

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P1243Comparison of long-term clinical course and outcome of MYBPC3 - versus MYH7 - related hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0201 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Fumagalli ◽

E Fedele ◽

M Beltrami ◽

N Maurizi ◽

S Passantino ◽

...

Keyword(s):

Heart Failure ◽

Hypertrophic Cardiomyopathy ◽

Diastolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Septal Myectomy ◽

Lv Dysfunction ◽

Instrumental Records

Abstract Introduction The presence of sarcomere mutations is a powerful predictor of heart failure-related outcomes in Hypertrophic Cardiomyopathy (HCM). However, whether the prevalence of left ventricular (LV) dysfunction differs in patients with mutations in the two most prevalent HCM-associated genes (i.e. MYBPC3 and MYH7) is unclear. Purpose To ascertain lifetime trends in prevalence of LV dysfunction in HCM associated with pathogenic or likely-pathogenic MYBPC3 versus MYH7 mutations. Methods Clinical and instrumental records of 402 HCM patients with MYBPC3 (N=251) or MYH7 (N=151) mutations were retrospectively reviewed. Presence of systolic dysfunction (ejection fraction [EF] <50%) and diastolic dysfunction (Grade II and III) were assessed for each patient. In vitro analysis of septal myectomy samples was performed to further compare electro-mechanic properties of MYBC3 and MYH7 patients. Results Patients were diagnosed at a mean age of 39±17 years and 63% were men. At first evaluation MYBPC3-HCM patients were less frequently obstructive (15% vs 26% in MYH7; p=0.005) and had lower LVEF (61±11% vs 64±9%; p=0.01). Prevalence of diastolic dysfunction increased with age and was lowest in MYBPC3 patients <40 years at diagnosis (19.5% vs 35.4% in MYH7, p=0.043). At a mean follow-up (FU) of 13±11 years, patients developed comparable left atrium enlargement (MYBPC3 52±29 ml/m2 vs 41±18 at baseline, p<0.001; MYH7 54±25ml/m2 vs 45±22, p=0.003). Prevalence of diastolic dysfunction was also similar. MYBPC3 patients had lower LVEF at final evaluation (61±11% vs 64±9% in MYH7, p=0.01) with greater prevalence of overt systolic dysfunction (EF<50%, MYBPC3 vs MYH7: 15% vs 5%, OR: 2.3 95% CI: 1.2–5.8, p=0.013). No significant differences were observed in terms of NYHA class change, atrial fibrillation, stroke, heart failure, appropriate ICD intervention or cardiovascular death. However, prevalence of NSVT was higher for MYBPC3 (39% vs 14% in MYH7, p<0.0001). At Cox multivariable analysis independent predictors of systolic dysfunction at follow-up were MYBPC3 positive status (HR 2.53 95% CI: 1.09–5.82, p=0.029) and age at initial evaluation (HR 1.03 95% CI 1.00–1.06, p=0.027). In vitro cross-sectional evaluation of myocardial samples taken during septal myectomy at different ages showed a decline in contraction-relaxation properties after age 40 in MYPBC3 carriers, but preserved function in MYH7 patients (Figure). Kinetic of myosin cross-bridges Conclusions In HCM patients, mutations in the MYBPC3 gene and early diagnosis are associated with slowly progressing systolic impairment leading to overt dysfunction in 15% compared to 5% in MYH7-HCM. However, outcome was similar in the two subsets. These differences in lifetime myocardial performance between the two most common HCM-associated genes suggest diverse pathways of disease progression, potentially amenable to requiring different molecular approaches.

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P1783 Concealed structural abnormalities detected by 2D speckle tracking strain echocardiography persist post ablation in patients with idiopathic ventricular arrhythmias

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1139 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Trivedi ◽

S Kumar ◽

L Thomas

Keyword(s):

Ventricular Arrhythmias ◽

Speckle Tracking ◽

2D Strain ◽

Structural Abnormalities ◽

2D Speckle Tracking ◽

Group A ◽

Group B ◽

Group D ◽

Strain Echocardiography

Abstract Background Idiopathic ventricular arrhythmias (IVA) occurs in patients without overt heart disease. 2D speckle tracking strain echocardiography parameters, including global longitudinal strain (GLS) and mechanical dispersion (MD), have been shown to predict ventricular arrhythmias. It is unclear if the abnormalities are due to structural substrate abnormality, or substrate abnormality consequent to electrical alterations. Aim: We sought to assess whether patients with IVA have impaired left ventricular (LV) strain indices, and if so, whether these persist following successful treatment with radiofrequency ablation (i.e. correction of electrical alteration). Methods: 2D strain analysis was performed (in sinus rhythm) in 23 consecutive patients with IVA (no structural heart disease by cardiac magnetic resonance imaging (MRI); Group A) prior to electrophysiological mapping/ablation, and compared to 23 age and gender matched healthy controls (Group B). Follow up echocardiography and multiday Holter monitoring was performed 12 months post ablation. Results: Baseline characteristics were similar for indexed LV end diastolic volume (EDV) and ejection fraction (EF) (p = 0.1 for both) (Table 1). LV GLS was lower (p = 0.03) and LV MD was increased (p = 0.002) in the IVA group prior to treatment. At follow up, 18 patients (78%) (Group C) remained free of ventricular arrhythmias – in these patients, LV GLS improved and was similar to controls (p = 0.217); however, LV MD remained significantly increased at 12 months compared to controls (p = 0.009). In the 5 patients (22%) (Group D) that continued to have ventricular arrhythmias at follow up, both LV GLS (p = 0.04) and LV MD (p = 0.008) remained significantly impaired compared to controls. Conclusion: Despite demonstrable absence of structural abnormalities with cardiac MRI, 2D strain can detect subtle alterations in myocardial contraction heterogeneity. Furthermore, 12 months post successful ablation treatment, the increase in MD persists. This suggest the presence of subtle substrate abnormality that results in IVA. In uncured patients, both myocardial deformation parameters remain impaired, suggesting the need for close future surveillance of these patients. Long term follow up with greater number of patients is required to further validate these findings. Table 1. Echocardiographic parameters Group Indexed LVEDV (ml/m2) LVEF (%) LV GLS (%) LV MD (ms) IVA (Group A) 55 ± 15 61 ± 5 -19.9 ± 3* 44 ± 12* Controls (Group B) 54 ± 14 64 ± 7 -21.2 ± 2 33 ± 9 Group C 12 months follow up -21.7 ± 3 42 ± 11* Group D 12 month follow up -19.8 ± 2* 43 ± 11* * denotes p < 0.05

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Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

Journal of International Medical Research ◽

10.1177/147323000503300411 ◽

2005 ◽

Vol 33 (4) ◽

pp. 454-459 ◽

Cited By ~ 3

Author(s):

M Ozkan ◽

O Baysan ◽

K Erinc ◽

C Koz ◽

M Yokusoglu ◽

...

Keyword(s):

Aortic Regurgitation ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Control Group ◽

Vena Contracta ◽

Group A ◽

Male Patients ◽

Group B ◽

Chronic Aortic Regurgitation ◽

Group D

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 ± 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild ( n = 16); group C, ≥ 3 and < 6 mm, moderate ( n = 26); group D, ≥ 6 mm, severe ( n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.

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Natural history of the enlarged ascending thoracic aorta: an observational long term study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2321 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Schroeder ◽

B Bihin ◽

M Buche ◽

P.H Eucher ◽

J Felix ◽

...

Keyword(s):

Thoracic Aorta ◽

Cumulative Incidence ◽

Z Score ◽

Mean Diameter ◽

Group A ◽

The Mean ◽

Group B ◽

Group D

Abstract To assess the long-term outcome of patients with an enlarged ascending thoracic aorta (ATA), a retrospective study was performed. Methods Inclusion criteria: ATA diameter of 38 mm or more by ETT (813 consecutive cases). Inclusion period: 1.1.2003–31.12.2016. Results At baseline, the mean diameter of the ATA was 42±3 mm, the mean Z-score was 2.7±0.8. In the subgroup of patients with 2 ETT examinations (and no surgical cure of the ATA), the mean diameter was 41.9±4.8 mm, the mean Z-score 2.4±1.1 after a mean follow-up of 6 years. During the follow-up, 52 patients had an intervention on the ATA, 26 patients were operated within the first 3 months after the diagnostic echocardiogram. 26 patients were operated during FU. In the 791 remaining patients (without early intervention), the event rate (death, intervention on the ATA) were assessed by the competing risk model. In the group of patients with a baseline ATA diameter of less than 41 mm (Group A: n=254), the cumulative incidence of death at 5 and 10 y was 34% and 61%; in the group of patients with an ATA diameter of 41–42 mm (Group B: n=238) the incidence was 34% and 61% respectively, in the group of patients with an ATA diameter of 43–44 mm (Group C: n=147), the incidence was 32% and 58%, in the group of patients with a diameter of 45 and more (Group D: n=150), the incidence was 31.1% and 61% (NS). The cumulative incidence of surgical interventions on the ATA at 5 and 10 years was 0.4% and 1% in group A, 1.3 and 1.8% in group B, 0.7 and 1.4% in group C and 9.8 and 12.9% in group D (p<0.05). Similar results were observed in patients according to the Z-scores. In the group of patients (221) with a Z-score >3, the incidence of intervention at 5 and 10 y was respectively 7.6% and 10.7% (p=0.01). Conclusions – The mean diameter of the enlarged ATA remained nearly unchanged over a period of 6 years. – No impact of the enlarged ATA on survival was observed. – Only patients with an ATA diameter of 45 mm and more (or a Z-score of 3 and more) needed an intervention on the ATA at a rate of ± 10% at 10 y after the initial echocardiographic diagnosis. Funding Acknowledgement Type of funding source: None

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636 Global cardiovascular assessment in patients with PH+ chronic myeloid leukaemia treated with TKI: long-term follow-up

European Heart Journal Supplements ◽

10.1093/eurheartj/suab130.002 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Elisabetta Demurtas ◽

Maurizio Cusma Piccione ◽

Francesca Parisi ◽

Paolo Vinciguerra ◽

Rodolfo Caminiti ◽

...

Keyword(s):

Chronic Myeloid Leukaemia ◽

Left Atrial ◽

Longitudinal Strain ◽

Cardiac Toxicity ◽

Lv Dysfunction ◽

Echocardiographic Parameters ◽

Group A ◽

Global Work ◽

Group B

Abstract Aims Patients affected by Philadelphia chromosome+ chronic myeloid leukaemia (Ph+CML) undergoing to therapy with tyrosine kinase inhibitors (TKIs) are prone to develop cardiovascular complications, which have relevant prognostic implications. Speckle-tracking echocardiography, allowing strain and myocardial work analyses, can be useful in the early detection of cardiac toxicity. Aim of our study was to assess the cardiotoxic effects of TKIs. Methods We evaluated, at baseline and during FU, 20 patients affected by Ph+ CML (59.7 ± 12.2 years, 13 males), treated Imatinib (52.6%), Nilotinib (36.8%), Ponatinib (5.3%), Dasatinib (5.3%). We measured systolic and diastolic blood pressure (SBP-DBP) and calculated corrected QT interval (QTc). In addition, we analysed echocardiographic parameters including left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), and peak left atrial longitudinal strain (PALS). Cardiovascular (CV) events that we considered were symptomatic or asymptomatic LV dysfunction, acute coronary syndrome (ACS), peripheral artery disease (PAD), and arrhythmias. Results Follow-up (FU) time was 3.4 ± 1 years. Most of patients (63.2%) had cardiovascular risk factors, including arterial hypertension (50%), type2 diabetes mellitus (15%), dyslipidaemia (40%) and cigarette smoking (15%). At the end of FU, SBP was unchanged (128.9 ± 19.6 mmHg vs. 129.1 ± 9.8 mmHg; P=NS) whereas DBP increased (69.4 ± 8.5 mmHg vs. 75 ± 7.7 mmHg; P = 0.004); moreover QTc was longer than baseline (404.4 ± 20.1 ms vs. 424.3 ± 29.8 ms; P < 0.001) and LVEF showed a significant decrease (62.2 ± 3.9% at baseline vs. 59.3 ± 4.8% at FU; P = 0.003); similarly, GCW (2444.1 ± 540mmHg% vs. 2234.7 ± 179.4 mmHg%; P = 0.034), GWI (2158.1 ± 589.6 mmHg% vs. 1923.1 ± 174.5 mmHg%; P = 0.022) and PALS (36.3 ± 17.1% vs. 32.8 ± 9.7%; P = 0.002) decreased during cancer therapy. On the other hand, GLS (−18.6 ± 3.1% vs. −19.4 ± 1.1%; P=NS), GWE (94.3 ± 4.1% vs. 93.6 ± 3.6%; P=NS) and GWW (120.6 ± 94.3 mmHg% vs. 106.3 ± 68.9 mmHg%; P=NS) did not change significantly. CV events were observed in 66.7% of the study population. These were mostly represented by ACS, atrial arrhythmias and symptomatic LV dysfunction (30.7% for each) and, to a lesser extent, PAD (7.6%). By comparing patients with events (group A) with those without events (group B) we found that differently from group B, group A showed during FU a significant increase of DBP (from 66 ± 5.2 mmHg to 71.2 ± 6.1 mmHg, P = 0.010; vs. group B= from 76 ± 12.mmHg to 78 ± 4.1 mmHg, P=NS) and a significant QTc prolongation (from 415.7 ± 16.1 ms to 441 ± 29.8 ms, P < 0.001; vs. group B= from 390.4 ± 19.3 ms to 405.6 ± 23.3 ms, P=NS); as to echocardiographic parameters, we found, in patients with CV events, a significant decrease of: LVEF (from 62.7 ± 4.7% to 58.8 ± 4.3%, P = 0.004; vs. group B from 61.4 ± 2.8% to 60 ± 1.7%, P=NS), GCW (from 2566.2 ± 669.6 mmHg% to 2230.1 ± 199.4 mmHg%, P = 0.021, vs. group B 2194 ± 167.5 mmHg% to 2212.6 ± 160mmHg%, P=NS) and PALS (from 36.1 ± 17% to 29.6 ± 6.6%, P = 0.022 vs. group B from 32.7 ± 8% to 35 ± 8.5%, P = 0.003). Of these parameters, only PALS was significant independent predictor of CV events on logistic regression analysis (OR 0.82 CI 95 0.69–0.98, P = 0.034). Conclusions Advanced echocardiographic parameters, including myocardial work and left atrial strain analysis, are particularly valuable in the early detection of TKI-induced cardiac toxicity. PALS could be an useful tool to predict outcome in these patients.

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Evaluation of Functional Outcome of Management of Proximal Humerus Fractures by Different Treatment Modalities

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/27961.13830 ◽

2020 ◽

Author(s):

Sudhir Shyam Kushwaha ◽

Ambrish Thakur ◽

Yasir Ali Khan ◽

Amit Verma ◽

Farid Mohammed ◽

...

Keyword(s):

Locking Plate ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Early Mobilisation ◽

Group A ◽

Humerus Fractures ◽

Group B ◽

Group D ◽

Shoulder Score

Introduction: Proximal humerus fractures account for 4-5% of all fractures and could be managed both conservatively and surgically. As much as 85% minimally or non-displaced fractures can be managed conservatively. In spite of early union and exercise programme by conservative treatment, the problem of shoulder stiffness is common. To overcome stiffness, early mobilisation is mandatory which is not possible in conservative treatment before three weeks. Therefore, surgical intervention is needed for early mobilisation and early return of function. Aim: To compare the functional outcome between the four common methods of managing proximal humerus fractures namely locking plate, Joshi External Stabilisation System (JESS), percutaneous K-wire fixation and conservative method. Materials and Methods: Patients with proximal humerus fracture above 18 years of age between August 2011 to August 2013 were included in the study. The study population was divided into four groups viz., Group A, B, C, D depending on the mode of treatment by locking plate, external fixator, K-wire fixation and conservative method of treatment, respectively. The patients were followed-up at 3 weeks, 6 weeks, 12 weeks, 18 weeks and thereafter every 6 weeks’ interval till 9 months. After union, cases were evaluated radiologically and clinically for functional results by using the Swanson Shoulder Score and Constant Scoring System (Modified). Results: At the end of the study there were 17 patients in the Group ‘A’, 7 patients in the Group ‘B’, 7 patients in the Group ‘C’ and 11 patients in Group ‘D’. At 9 months of follow-up according to modified constant shoulder score the percentage of excellent score in group A was maximum. Group B and Group D had maximum number of good scores. The mean constant shoulder score increased in all groups at 9 months of follow-up as compared to 3 months of follow-up except in group D. Similarly, according to Swanson’s shoulder score, group A had the maximum number of excellent scores. Conclusion: From the above study it can be concluded locking plates are an excellent modality of treatment of proximal humerus fractures with excellent union rate and early mobilisation.

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