scholarly journals Implantable loop recorders in patients with heart disease: comparison between patients with and without syncope

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001748
Author(s):  
Amira Assaf ◽  
Rafi Sakhi ◽  
Michelle Michels ◽  
Jolien W Roos-Hesselink ◽  
Judith M A Verhagen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Primary Endpoint ◽  
Underlying Disease ◽  
Clinical Value ◽  
Loop Recorder ◽  
Device Implantation ◽  
Inherited Cardiomyopathy ◽  
Increased Risk ◽  
Group A ◽  
Group B

ObjectivePatients with heart disease are at increased risk for sudden cardiac death. Guidelines recommend an implantable loop recorder (ILR) for symptomatic patients when symptoms are sporadic and possibly arrhythmia-related. In clinical practice, an ILR is mainly used in patients with unexplained syncope. We aimed to compare the clinical value of an ILR in patients with heart disease and a history of syncope versus those with non-syncopal symptoms.MethodsIn this observational single-centre study, we included symptomatic patients with heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to device implantation.ResultsOne hundred and twenty patients (mean age 47±17 years, 49% men) were included. The underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%) and other (18%). Group A consisted of 43 patients with prior syncope and group B consisted of 77 patients with palpitations and/or near-syncope. The median follow-up duration was 19 months (IQR 8–36). The 3-year cumulative event rate was similar between groups with regard to the primary endpoint (38% vs 39% for group A and B, respectively, logrank p=0.54). There was also no difference in the 3-year cumulative rate of device implantation (21% vs 13% for group A and B, respectively, logrank p=0.65).ConclusionIn symptomatic patients with heart disease, there is no difference in the yield of an ILR in patients presenting with or without syncope.

scholarly journals Implantable loop recorders in patients with a structural or electrical heart disease: comparison of the clinical value in patients with and without a history of syncope

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Assaf ◽  
R Sakhi ◽  
M Michels ◽  
JW Roos-Hesselink ◽  
JMA Verhagen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Primary Endpoint ◽  
Clinical Value ◽  
Loop Recorder ◽  
Increased Risk ◽  
Significant Difference ◽  
Electrical Heart Disease ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with structural and electrical heart disease are at increased risk for sudden cardiac death. Guidelines recommend the use of an implantable loop recorder (ILR) in symptomatic patients when symptoms are sporadic and suspected to be related to arrhythmias. In clinical practice, an ILR is mainly used in patients with unexplained syncope. Purpose To compare the clinical value of an ILR in patients with a heart disease and a history of syncope versus those with non-syncopal suspected arrhythmia-related symptoms. Methods In this observational single-center study we included symptomatic patients with structural or electrical heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to implantation of a pacemaker or implantable cardioverter-defibrillator (ICD). Results A total of 120 patients (mean age 47 ± 17 years, 49% men) were included. Underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%), and other structural heart disease (18%).There were 43 patients with a history of syncope (group A) and 77 patients with non-syncopal symptoms (group B) such as palpitations, dizziness and/or near-syncope at baseline. During a median follow-up of 19 months (IQR 8-36), a primary endpoint was reached in 14 patients (33%) of group A, and in 28 patients (36%) of group B (logrank P = 0.54, Figure A). There was also no significant difference in the cumulative rate of cardiac device implantation between group A and B, 14% versus 10%, respectively (logrank P = 0.97, Figure B). Conclusion Our results show no differences in ILR yield in patients with structural or electrical heart disease who present with any suspected arrhythmia-related symptom, including those with non-syncopal symptoms. Abstract Figure.

Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study

2018 ◽  
Vol 39 (11) ◽  
pp. 1355-1359 ◽  
Author(s):  
Martin Kaipel ◽  
Lukas Reissig ◽  
Lukas Albrecht ◽  
Stefan Quadlbauer ◽  
Joachim Klikovics ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Metatarsal Osteotomy ◽  
Anatomical Structures ◽  
Intensive Training ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Percutaneous, transverse distal metatarsal osteotomy with K-wire fixation (the Bösch technique) is an established technique for hallux valgus correction. Nevertheless, the risk of damaging the anatomical structures during the operation is unknown. Methods: Forty fresh-frozen anatomical foot specimens with hallux valgus deformity underwent a percutaneous corrective procedure. Specimens of group A (n = 20) were operated by an experienced surgeon while specimens of group B (n = 20) were done by untrained residents. Results: The dorsal cutaneous nerve was injured in 1 of 20 cases in group A and 6 of 20 cases in group B ( P = .037). There was a significant difference in overall complication rate between specimens of group A and group B ( P = .043). Conclusions: The results show an increased risk of perioperative injury of the dorsal cutaneous branch of the deep peroneal nerve as well as a significant effect of the surgeon’s experience on the overall complication rate. Clinical Relevance: Results of this study are highly relevant for all surgeons who perform percutaneous, minimally invasive hallux valgus surgery to avoid damage to the peripheral nerves. In addition, the data suggest an intensive training for surgeons before minimally invasive hallux valgus surgery is performed without supervision.

scholarly journals Quality of life, clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves' hyperthyroidism undergoing radioiodine therapy: a randomized controlled study

2016 ◽  
Vol 174 (4) ◽  
pp. 491-502 ◽  
Author(s):  
David Taïeb ◽  
Claire Bournaud ◽  
Marie-Claude Eberle ◽  
Bogdan Catargi ◽  
Claire Schvartz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Endpoint ◽  
Radioiodine Therapy ◽  
Controlled Study ◽  
Thyroid Function Tests ◽  
Randomized Controlled ◽  
Sf 36 ◽  
Group A ◽  
Group B

ObjectiveWhile radioiodine therapy is commonly used for treating Graves' disease, a prolonged and clinical hypothyroidism may result in disabling symptoms leading to deterioration of quality of life (QoL) of patients. Introducing levothyroxine (LT4) treatment in the early post-therapeutic period may be an interesting approach to limit this phenomenon.MethodsA multicenter, prospective, open-label randomized controlled trial enrolled 94 patients with Graves' hyperthyroidism randomly assigned to the experimental group (n=46) (group A: early prophylactic LT4treatment) or the control group (n=48) (group B: standard follow-up). The primary endpoint was the 6-month QoL. The secondary endpoints were other QoL scores such as Graves' ophthalmopathy (GO) outcomes, thyroid function tests and safety.ResultsThe primary endpoint at 6 months was achieved: the mental composite score (MCS) of Short Form 36 (SF-36) was significantly higher in group A compared to group B (P=0.009). Four other dimension scores of the SF-36 and four dimension scores of the thyroid-specific patient-reported outcome (ThyPRO) significantly differed between the two groups, indicating better QoL in group A. After adjustment for variables, the early LT4administration strategy was found as an independent factor for only two scores of SF-36: the MCS and the general health (GH) score. There were no differences in GO, final thyroid status and changes in the anti-TSH receptor antibodies (TRAbs) levels between the two groups. No adverse cardiovascular event was reported.ConclusionEarly LT4administration post-radioactive iodine (RAI) could represent a safe potential benefit for patients with regard to QoL. The optimal strategy taking into account administered RAI activities and LT4treatment dosage and timing remains to be determined.

scholarly journals Unifocalization cannot rely exclusively on native pulmonary arteries: the importance of recruitment of major aortopulmonary collaterals in 249 cases†

2019 ◽  
Vol 56 (4) ◽  
pp. 679-687 ◽  
Author(s):  
David J Barron ◽  
Ramesh S Kutty ◽  
John Stickley ◽  
Oliver Stümper ◽  
Phil Botha ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Borderline Cases ◽  
Collateral Arteries ◽  
Increased Risk ◽  
Group A ◽  
Aortopulmonary Collaterals ◽  
Group B ◽  
Late Survival

Abstract OBJECTIVES: We sought to define the early and late outcomes of unifocalization based on a classification of the native pulmonary artery (nPA) system and major aortopulmonary collateral arteries (MAPCAs) with a policy of combined recruitment and rehabilitation and to analyse the role of unifocalization by leaving the ventricular septal defect (VSD) open with a limiting right ventricle-pulmonary artery (RV-PA) conduit in borderline cases. METHODS: An analysis of 271 consecutive patients assessed for unifocalization at a single institution between 1988 and 2016 was performed. Patients were classified according to the pulmonary blood supply: group A, unifocalization based on nPA only; group B, based on nPA and MAPCAs; group C, MAPCAs only (absent nPAs). RESULTS: Unifocalization was achieved in 249 (91.9%) cases with an early mortality of 2.8%. Group A included 72 (28.9%) patients, group B 119 (47.8%) patients and group C 58 (23.3%) patients with no difference in early survival between groups. Survival at 5, 10 and 15 years was 90.0% (85.9–94.3), 87.2% (83.5–91.2) and 82.3% (75.2–89.9), respectively. Late survival in groups A and B was similar but 10- and 15-year survival in group C decreased to 79.2% (68.2–92.1) and 74.3% (61.1–90.4) (P = 0.02), respectively. A mean of 1.9 (±0.6) MAPCAs were recruited per patient (range 0–6). The VSD was left open with a limiting RV-PA conduit in 97 (39.0%) cases, but subsequently closed in 48 patients, giving a total of 200 (80.3%) patients achieving VSD closure (full repair). Delaying VSD closure was not associated with increased risk for early or late survival. A central shunt to rehabilitate the nPAs was used in 56 (22.5%) cases. This was associated with a reduction in the number of MAPCAs recruited, but still required a mean of 1.8 (±0.5) MAPCAs recruited per patient to achieve unifocalization. In multivariate risk analysis, those suitable for single-stage full repair had the best long-term outcomes. Group C anatomy was associated with poor late survival compared to groups A and B (hazard ratio 2.7). CONCLUSIONS: Survival is maximized by a combined approach of rehabilitation and recruitment. MAPCAs should always be recruited if they supply areas with absent nPA supply. A strategy of leaving the VSD open with a limiting RV-PA conduit is a safe and effective way of managing borderline cases.

scholarly journals Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Reza Hekmat
Keyword(s):  
Cox Regression ◽  
Patient Survival ◽  
Underlying Disease ◽  
Chronic Hemodialysis ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Iranian Patients

Background. Impact of hemodialysis adequacy on patient survival is extensively studied. The current study compares the survival of chronic hemodialyzed, undocumented, uninsured, Afghan immigrant patients with that of a group of insured Iranian patients matched for underlying disease, age, weight, level of education, marital status, income, and number of comorbid conditions. Methods. Eighty chronic hemodialysis patients (mean age 42.8 ± 10.5 years) entered this historical cohort study in Mashhad, Iran, between January 2012 and January 2015. Half of the patients were undocumented, uninsured, Afghan immigrants (Group A) matched with forty insured Iranian patients (Group B). To compare the survival rate of the two patient groups, Kaplan–Meir survival analysis test was used. Results. Group A patients were underdialyzed with a weekly Kt/V which was significantly less in comparison with that of Group B (1.63 ± 0.63 versus 2.54 ± 0.12, p value = 0.01). While Group A’s number of hemodialysis sessions per week was fewer than that of Group B (1.45 ± 0.56 versus 2.8 ± 0.41, p value = 0.04), the mean of Kt/V in each hemodialysis session was higher in them, in comparison with Group B (1.43 ± 0.25 versus 1.3 ± 0.07, p value = 0.045). In Group B and Group A patients, one-year survival was 70% versus 50%, two-year survival was 55% versus 30%, and three-year survival was 40% versus 20%, respectively (p values = 0.04, 0.02 and 0.04, respectively). In Cox regression analysis, hemodialysis adequacy and uninsurance were factors impacting patients’ survival (OR = 1.193 and 0.333, respectively). Conclusions. Undocumented, uninsured, inadequately hemodialyzed, Afghan patients had a significantly lower one-, two-, and three-year survival as opposed to their Iranian counterparts, probably due to lack of insurance.

Randomized phase III study comparing FOLFOX + bevacizumab versus folfoxiri + bevacizumab (BEV) as 1st line treatment in patients with metastatic colorectal cancer (mCRC) with ≥3 baseline circulating tumor cells (bCTCs).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3507-3507 ◽  
Author(s):  
Javier Sastre ◽  
Jose María Vieitez ◽  
Maria Auxilidora Gomez-España ◽  
Silvia Gil Calle ◽  
Antonieta Salud Salvia ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Progression Free Survival ◽  
Phase Iii ◽  
Adequate Treatment ◽  
Poor Prognostic Factor ◽  
Efficacy Analysis ◽  
Secondary Endpoints ◽  
Group A ◽  
Phase Iii Study ◽  
Group B

3507 Background: FOLFOXIRI+BEV has demonstrated a survival benefit compared with FOLFIRI plus BEV (TRIBE Lancet Oncol 2015) in first-line mCRC. Nevertheless, due to its safety profile, this schedule is not recommended for all pts. In addition, we have showed that the detection of ≥3 bCTCs is a poor prognostic factor for survival (MACRO The Oncologist 2012). The VISNU-1 trial compares FOLFOX + BEV vs FOLFOXIRI + BEV in pts with mCRC and ≥3 bCTCs. Progression-free survival (PFS) is the primary endpoint. Secondary endpoints included overall response rate (ORR) and overall survival (OS). Methods: This is an open, multicentric, randomized phase III trial. Patients with mCRC younger than 70 years, ECOG 0-1 were randomized to FOLFOX+BEV (arm A) or FOLFOXIRI+BEV (arm B), stratified per KRAS mutation (mutated vs WT) and number of involved organs (1 vs >1). Results: 349 pts were included in the ITT population; 177 in group A and 172 in group B. Characteristics of the pts, molecular profiling and safety analysis have been previously presented at ASCO 2018 and showed that this schedule had an acceptable toxicity profile. Efficacy analysis in the ITT population is shown in the table. Conclusions: In this population with very bad prognosis, our study met its primary endpoint. Pts who received FOLFOXIRI + Bev benefit for a statistically significative PFS and ORR. OS showed a trend of benefit in the experimental arm. According to these results, FOLFOXIRI-Bev could be considered an adequate treatment option for pts with mCRC and ≥3 bCTCs. Clinical trial information: 2012-000846-37. [Table: see text]

scholarly journals Association between Respiratory Sleep Indices and Cardiovascular Disease in Sleep Apnea—A Community-Based Study in Cyprus

2020 ◽  
Vol 9 (8) ◽  
pp. 2475
Author(s):  
Frangiskos Frangopoulos ◽  
Ivi Nicolaou ◽  
Savvas Zannetos ◽  
Nicholas-Tiberio Economou ◽  
Tonia Adamide ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
Sleep Apnea ◽  
Ischemic Heart Disease ◽  
Supine Position ◽  
Ischemic Heart ◽  
Respiratory Event ◽  
Group A ◽  
Group B

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO2 (p < 0.001). Arrhythmias correlated with mean SaO2 (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO2. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO2. Arrhythmias correlated only with hypoxemia (mean SaO2), whereas heart failure correlated only with REI, especially in the supine position.

scholarly journals COMPARISON OF INTRANASAL DEXMEDETOMIDINE V/S MIDAZOLAM AS A PREMEDICATION IN CHIDREN WITH CONGENITAL HEART DISEASE UNDERGOING CARDIAC SURGERY

2021 ◽  
Vol 9 (01) ◽  
pp. 814-822
Author(s):  
Sanjay Kumar Morwal ◽  
Ajit Singh ◽  
C.K. Vyas ◽  
Neelu Sharma
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Arterial Blood ◽  
Sedative Effects ◽  
Group A ◽  
Child Separation ◽  
Group B ◽  
Intranasal Midazolam

Background: The intranasal route is a reliable way to administer preanaesthetics and sedatives to children. The aim of present study was to compare the anxiolytic and sedative effects of intranasal dexemedetomidine and midazolam as a premedication in children with congenital heart disease undergoing cardiac surgery.. Patients and Methods: Fifty chidrens 2-12 years of age group of either sex with congenital heart disease undergoing cardiac surgery were randomly allocated into two groups. Group A-(n=25) - received intranasal dexmedetomidine as premedication.(0.1 µg/kg diluted in 2ml NS ) Group B- (n=25)- received intranasal midazolam as premedication. (0.2 mg/kg diluted in 2ml NS) Heart rate, mean arterial blood pressure and oxygen saturation were monitored upto30 minute after drug administration. The sedation score, anxiety score and child separation score were recorded until the child taken to the OR. The postoperative agitation score was also observed. Results and Conclusion: Premedication with intranasal dexmedetomidine attained significant and satisfactory sedation with better parental separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam in children with congenital heart disease undergoing cardiac surgery.

scholarly journals Efficacy of citrulline supplementation to decrease the risk of pulmonary hypertension after congenital heart disease surgery. A local experience.

2020 ◽  
Vol 77 (4) ◽  
pp. 249-253
Author(s):  
Silene Silvera Ruiz ◽  
Carola L Grosso ◽  
Margot Tablada ◽  
Marcelo Cabrera ◽  
Raquel Dodelson de Kremer ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Reference Level ◽  
Plasma Citrulline ◽  
Post Surgery ◽  
Group A ◽  
Group B

Pulmonary hypertension (PH) is a major cause of morbi-mortality among patients with congenital heart disease (CHD) and also a potentially severe complication after surgical repair. Oral citrulline, a precursor to NO synthesis, is safe and efficacious for decreasing the risk of postoperative PH. Objective: The aim of the present study was to investigate in pediatric patients the changes of plasma citrulline, arginine, homocysteine and nitric oxide (NO) metabolites and pulmonary artery pressures (PAP) pre-post cardiac surgery in order to describe our population status with regard to the risk of pulmonary hypertension and look for potential biomarkers for early detection and treatment. Main results/Discussion: 16 Argentine pediatric patients with CHD undergoing cardiopulmonary bypass were randomized in two groups: (A) with and (B) without perioperative citrulline supplementation. We found that plasma citrulline median levels before surgery were lower in both groups respect to referential values, probably due to the poor nutritional status of our patients; only group A surpassed post-surgery the minimum recommended level to avoid PH. Furthermore, none of the patients in group A showed mean PAP higher than 20 mmHg, whereas in group B, 67% of the measurements were ≥ than the reference level. Conclusions: We reaffirm that citrulline supplementation it is effective in reducing postoperative pulmonary hypertension and biomarkers could evidence patient status as a translational medicine application.

scholarly journals Frequency of blood group sub-type in patients with ischemic stroke at Nishtar Hospital Multan.

2019 ◽  
Vol 26 (08) ◽  
pp. 1333-1338
Author(s):  
Muhammad Tahir ◽  
Gohar Ali ◽  
Ali Ismail
Keyword(s):  
Ischemic Stroke ◽  
Blood Group ◽  
Cross Sectional Study ◽  
Blood Groups ◽  
Cross Sectional ◽  
Blood Group A ◽  
Increased Risk ◽  
Study Results ◽  
Group A ◽  
Group B

The objective of this study was to determine the blood groups among the patients presenting with ischemic stroke either AB blood group or O blood group is more common (frequent) among these patients irrespective of other known factors responsible for stroke. Study Design: Descriptive, Cross-sectional study. Setting: Department of Medicine, Nishtar Hospital Multan. Period: January 2015 to August 2015. Materials & Methods: We included total 292 patients (40-70 years of age), with ischemic stroke documented on CT scan brain of both gender (male and female). Blood sample of these patients were sent to the central laboratory of Nishtar hospital for blood group determination using standard techniques. Results: Mean age was 56.26 ± 8.28 years. Out of the 292 patients, 163 (55.82%) were male and 129 (44.18%). Frequency of blood group A, B, AB and O in patients with ischemic stroke was found to be 114 patients having blood group A (39.04%), 53 patients having blood group B (18.15%), 26 patients having blood group AB (8.90%) and 99 patients having blood group O (33.90%) respectively. Conclusion: Our study results concluded that there is an association between ABO blood groups and ischemic stroke, irrespective of other risk factors. Our study results have observed that individuals belonging to non-O blood groups (A, B, or AB) are at an increased risk of ischemic stroke as compared to O blood group carriers however we did not control possible impact of confounders such as diabetes, hypertension and dyslipidemia etc. Many studies proved that persons with AB blood groups are at increased of atherosclerosis but no study showed that these persons have increased risk of ischemic stroke or not.

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