Abstract 5892: Therapy For Device-determined Ventricular Arrhythmias Decrease As Biventricular Pacing Percentage Increases In Heart Failure Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Bruce A Koplan ◽  
Andrew J Kaplan ◽  
Paul W Jones ◽  
Milan Seth ◽  
Shelly A Christman
Keyword(s):  
Ventricular Arrhythmias ◽  
Biventricular Pacing ◽  
Patient Characteristics ◽  
Mode Switch ◽  
Similar Frequency ◽  
History Of ◽  
Post Hoc ◽  
Baseline Covariates ◽  
Or History

Introduction: CRT-D improves cardiac function and quality of life, and decreases HF hospitalization and death for many patients. However, impact on therapy delivered for ventricular arrhythmias is less clear. Methods: Device-determined VT and VF episodes with therapy (n = 1835) from CRT-D patients in two trials (CRT RENEWAL & REFLEX; n = 1698) were analyzed in a post hoc fashion. Patients were divided into lifetime biventricular (BiV) pacing percentage quartiles. Zero-inflated Poisson regression models were used to evaluate impact of pacing on VT/VF incidence and frequency, adjusting for baseline covariates including lifetime ATR mode switch percentage. Results: Patient characteristics: 69 ± 11 years, 73% male, 68% CAD. Dividing patients in quartiles resulted in the following pacing breakdown: 0–92% (n = 445), 93–97% (n = 445), 98–99% (n = 482), and 100% (n = 326). There were no differences in gender, NYHA, or history of diabetes, MI, CAD or hypertension among the groups. Patients paced 0–92% and 93–97% had similar VT/VF therapy incidence (24.72% vs. 24.27%) and frequency (17.05% vs. 16.00%). Patients paced 98–99% had lower VT/VF therapy incidence (15.15%) than patients paced ≤ 97% (p < 0.001) but similar frequency after adjusting for incidence. Patients paced 100% had similar VT/VF therapy incidence (13.80%) and frequency (6.45%) to patients paced 98–99%. The figure shows the time to first therapy for VT/VF. Conclusions: For CRT-D patients in this analysis, incidence and frequency of therapy delivered for VT/VF is significantly decreased when lifetime BiV pacing percentage is above 97%.

Experiences with a Direct Accelerator-Adsorption Test

1932 ◽  
Vol 5 (3) ◽  
pp. 429-441
Author(s):  
F. H. Amon ◽  
R. K. Estelow
Keyword(s):  
Carbon Black ◽  
Adsorption Properties ◽  
Dilute Solution ◽  
Carbon Blacks ◽  
Separate Control ◽  
History Of ◽  
Or History

Abstract A method for determining the accelerator adsorption properties of carbon blacks is described. This method is novel in that an extremely dilute solution of diphenylguanidine in benzene is employed. Application of the test to a large number of carbon blacks has revealed its practical value as a measure of those variations in adsorption properties which are of teal significance to the rubber manufacturer. The method has been employed in several separate control laboratories and it has been found to be of distinct value in indicating quality of production. Since the results can be interpreted without knowledge of source or history of the particular carbon black being tested, the test can be employed for control purposes by the rubber manufacturer as well as by the carbon black manufacturer.

Patient selection, pacing indications, and subsequent outcomes with de novo leadless single-chamber VVI pacing

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1686-1693 ◽  
Author(s):  
Jonathan P Piccini ◽  
Kurt Stromberg ◽  
Kevin P Jackson ◽  
Robert C Kowal ◽  
Gabor Z Duray ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Selection ◽  
Primary Outcome ◽  
De Novo ◽  
Patient Characteristics ◽  
Pacemaker Syndrome ◽  
History Of ◽  
Leadless Pacing ◽  
To Receive ◽  
Or History

Abstract Aims Patient selection is a key component of securing optimal patient outcomes with leadless pacing. We sought to describe and compare patient characteristics and outcomes of Micra patients with and without a primary pacing indication associated with atrial fibrillation (AF) in the Micra IDE trial. Methods and results The primary outcome (risk of cardiac failure, pacemaker syndrome, or syncope related to the Micra system or procedure) was compared between successfully implanted patients from the Micra IDE trial with a primary pacing indication associated with AF or history of AF (AF group) and those without (non-AF group). Among 720 patients successfully implanted with Micra, 228 (31.7%) were in the non-AF group. Reasons for selecting VVI pacing in non-AF patients included an expectation for infrequent pacing (66.2%) and advanced age (27.2%). More patients in the non-AF group had a condition that precluded the use of a transvenous pacemaker (9.6% vs. 4.7%, P = 0.013). Atrial fibrillation patients programmed to VVI received significantly more ventricular pacing compared to non-AF patients (median 67.8% vs. 12.6%; P < 0.001). The overall occurrence of the composite outcome at 24 months was 1.8% with no difference between the AF and non-AF groups (hazard ratio 1.36, 95% confidence interval 0.45–4.2; P = 0.59). Conclusion Nearly one-third of patients selected to receive Micra VVI therapy were for indications not associated with AF. Non-AF VVI patients required less frequent pacing compared to patients with AF. Risks associated with VVI therapy were low and did not differ in those with and without AF.

Abstract WP35: Thrombectomy Techniques and Patient Characteristics Associated With Complete TICI 3 Reperfusion After Stroke Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Elizabeth Baraban ◽  
Tamela Stuchiner ◽  
Renee Ovando ◽  
Rob Darflinger ◽  
Samuel Hou ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Interaction Effects ◽  
Combined Approach ◽  
Asian Patients ◽  
Stent Retrieval ◽  
History Of ◽  
Grade 3 ◽  
Combination Approach ◽  
Retrievable Stent ◽  
Or History

Introduction: Prior randomized trials have defined substantial reperfusion for stroke thrombectomy as TICI 2b or TICI 3. However, recent data suggest that complete TICI 3 reperfusion results in more favorable patient outcomes than partial reperfusion with TICI 2b. We have multiple effective techniques for thrombectomy, but it is not clear which are most likely to achieve TICI 3 rather than TICI 2b reperfuson. Methods: Retrospective data from 15 hospitals were used for patients age 18 or over discharged from January 2014 to May 2019 with a primary or secondary diagnosis of ischemic stroke who received a thrombectomy and achieved TICI reperfusion grade of 2b or 3. Primary outcome was TICI grade 3, defined as complete reperfusion, versus TICI 2b. Multivariate logistic regression was conducted to determine if procedure technique (retrievable stent only, distal aspiration only or a combination approach with both) was associated with achieving TICI 3 versus 2b adjusting for sex, age ≥70 vs ≤69, race/ethnicity, history of chronic renal insufficiency or diabetes, history or newly diagnosed atrial fibrillation or flutter, previous anticoagulation medication. Interaction effects between technique and clinical variables were also tested. Results: The analysis included 787 patients, 67.9% (n=534) TICI 3 and 32.1% (n=253) TICI 2b. While, main effect of procedure technique was not a significant predictor of achieving TICI 3 (p=.451), interaction effects showed superiority of the combination approach in several patient populations. Specifically, the combined approach increased the likelihood of TICI 3 compared to stent retrieval alone for older patients (Adjusted Odds Ratio (AOR) =1.79, p=.007), those with a history of diabetes (AOR=1.56, p=.045) and Asian patients (AOR=4.41, p=.010). Among AFIB/flutter patients, the combined approach also increased the odds of complete reperfusion compared to stent retriever alone (AOR=1.76, p=.005) or distal aspiration alone (AOR=1.38, p=.034). Conclusion: The combined approach of retrievable stent and distal aspiration was a significant predictor of achieving TICI 3 in certain patient subgroups including patients who were older, Asian, had a history of diabetes or history of or current AFIB/flutter.

Abstract 12585: Antianginal Efficacy of Ivabradine in Patients With History of Coronary Revascularization

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ioannis Zarifis ◽  
Violetta Grammatikou ◽  
Emmanouil Kallistratos ◽  
Apostolos Katsivas
Keyword(s):  
Quality Of Life ◽  
Coronary Revascularization ◽  
Symptomatic Treatment ◽  
History Of ◽  
Β Blocker ◽  
Study Completion ◽  
Artery Disease ◽  
Revascularization Procedures ◽  
Post Hoc

Introduction: Coronary revascularization procedures are widely performed for the symptomatic treatment of patients with coronary artery disease (CAD). Even after such procedures, angina symptoms often remain. Hypothesis: To evaluate the antianginal effectiveness and the effect on quality of life of ivabradine co-administered with a β-blocker, during 4-month therapy of CAD patients with a history of coronary revascularization. Methods: This is a post hoc analysis (926 post-revascularization patients) of a Pan-Hellenic, prospective, non interventional study including 2403 patients with CAD and stable angina. Data were recorded at baseline, and at 1 and 4 months after inclusion, while patients’ quality of life was assessed by means of the EQ-5D questionnaire. Results: Of 926 CAD patients who participated in the study, 28 (3%) prematurely discontinued treatment. Addition of ivabradine decreased mean heart rate from 80.3±9.5 bpm (1st visit) to 67.8±7.3 bpm (2nd visit) and 63.9±6.2 bpm (3rd visit) (P<0.001). Mean number of angina attacks and nitroglycerin consumption decreased, respectively, from 2.2±2.3/1.5±2.2 times/week (1st visit) to 0.5±1.0/0.3±0.8 (2nd visit) and 0.3±0.6/0.1±0.4 times times/week (3rd visit) (P<0.001). Moreover, the percentage of patients with angina CCS I (Canadian Cardiovascular Society classification) increased from 36% at baseline to 83% at study completion (P<0.001), while those with angina CCS III-IV decreased from 21% to 2% (P<0.001). All dimensions of the EQ-5D questionnaire were significantly improved after 4 months of treatment with ivabradine (P<0.001) (Table 1). Compliance with ivabradine treatment was high. Throughout the trial, 884 patients (95.5%) were taking their treatment “every day” or “quite often.” Conclusions: These results confirm the antianginal effectiveness as well as the beneficial effect of ivabradine on the quality of life of patients with CAD and a history of coronary revascularization.

Medical and Quality of Life Indications for Splenectomy in Children with Hereditary Spherocytosis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5082-5082
Author(s):  
Sani Mathew ◽  
George R. Buchanan ◽  
Shelley E. Crary
Keyword(s):  
Quality Of Life ◽  
Hereditary Spherocytosis ◽  
Hemoglobin Concentration ◽  
Patient Characteristics ◽  
Aplastic Crisis ◽  
Primary Indication ◽  
History Of ◽  
Medical Indications ◽  
Baseline Hemoglobin

Abstract Abstract 5082 Background Splenectomy has been considered the treatment of choice for patients with “symptomatic” hereditary spherocytosis (HS). However, given the long-term risks associated with asplenia, including sepsis and thrombosis, the risks and benefits of splenectomy in HS require ongoing analysis. To our knowledge, no comprehensive institutional review summarizing the medical and quality of life indications for splenectomy in children with HS has been reported to date. Methods A retrospective record review was performed of 64 children, age ' 18 yrs, having splenectomy for HS at Children's Medical Center Dallas from January 1973 through March 2009. The following patient characteristics were abstracted: age at splenectomy, family history of HS and/or splenectomy, baseline hemoglobin concentration and reticulocyte count prior to splenectomy, degree of splenomegaly, total number of prior transfusions, hyperhemolytic events, and aplastic crisis. Patients were classified based on mean hemoglobin concentration as having mild (≥11.0 g/dL), moderate (8.0-10.9 g/dL), or severe HS ('7.9 g/dL) (Bolton-Maggs PH, et al. Br J Haematol 2004;126:455-74). The primary indication for splenectomy was characterized in each case as either a “quality of life (QOL) indication” or a “medical indication.” QOL indicators included jaundice, pallor, maxillary hyperplasia, poor growth, fatigue, exercise intolerance, and family history of splenectomy for HS which, having been deemed successful, fostered parental preference for splenectomy in their child. Medical indicators included baseline hemoglobin approaching transfusion-dependent threshold, multiple or severe hyperhemolytic events, severe aplastic crisis, symptomatic gallbladder disease, marked splenomegaly, and the need for numerous transfusions. Some patients had both medical and QOL indications but only one was designated as the primary indication for splenectomy based on documentation in the medical record. Results When classifying HS patients by hemoglobin concentration, 16 patients (25%) were mild, 38 (59%) moderate, and 10 (16%) severe. The following table summarizes the patient characteristics. Despite having just mild HS, 16 patients had splenectomy, 6 for QOL indications. Moreover, 11 of 38 moderate HS patients had splenectomy for a primary QOL indication. Medical indications predominated in all 10 patients with severe HS. Of the 17 patients with QOL indications who had splenectomy, 8 (47%) also had documentation of medical indications. Among 45 patients with primary medical indications for splenectomy, 18 (40%) also had QOL issues contributing to the decision. Two patients' indications for splenectomy were unclear. Conclusions Although splenectomy is generally felt to be unnecessary in patients with mild HS and many with moderate HS as well, our experience demonstrates that splenectomy is often performed primarily for QOL indications in both risk categories. A validated assessment tool that incorporates QOL indicators in addition to the traditional medical reasons for splenectomy in patients with HS would be of great value in an evidence-based assessment of the patient's need for splenectomy. We recommend inclusion of QOL indicators when considering splenectomy in patients with mild and moderate HS. Disclosures No relevant conflicts of interest to declare.

scholarly journals Antianginal Efficacy of Ivabradine in Patients With History of Coronary Revascularization

Angiology ◽  
2016 ◽  
Vol 68 (1) ◽  
pp. 10-18 ◽  
Author(s):  
J. Zarifis ◽  
V. Grammatikou ◽  
M. Kallistratos ◽  
A. Katsivas
Keyword(s):  
Quality Of Life ◽  
Stable Angina ◽  
Coronary Revascularization ◽  
History Of ◽  
Artery Disease ◽  
Noninterventional Study ◽  
Revascularization Procedures ◽  
Post Hoc ◽  
Antianginal Efficacy

Although coronary revascularization procedures are widely performed in patients with coronary artery disease (CAD), angina is often reported, even after such procedures. This study evaluated the antianginal efficacy and effect of ivabradine treatment on quality of life (QOL) in patients with CAD and history of coronary revascularization. This is a post hoc analysis (926 post-revascularization patients) of a prospective, noninterventional study, which included 2403 patients with CAD and stable angina. The data were recorded at baseline, at 1 month and 4 months after inclusion. After ivabradine administration, mean number of anginal events decreased from 2.2 ± 2.3 (median: 2.0, minimum: 0.0, maximum: 21.0, range: 21.0) to 0.3 ± 0.6 (median: 0.0, minimum: 0.0, maximum: 7.0, range: 7.0) times/week ( P < .001), while nitroglycerin consumption decreased from 1.5 ± 2.2 (median: 1.0, minimum: 0.0, maximum: 20.0, range: 20.0) to 0.1 ± 0.4 times/week (median: 0.0, minimum: 0.0, maximum: 5.0, range: 5.0; P < .001). Quality of life improved at study completion compared to baseline ( P < .001). Ivabradine addition on top of optimal individualized dose of β-blockers is associated with decreased anginal events and improvement in QOL in patients with stable angina and history of coronary revascularization.

Probiotics in gastroenterology – from a different angle

2013 ◽  
Vol 154 (8) ◽  
pp. 294-304 ◽  
Author(s):  
György Miklós Buzás
Keyword(s):  
Side Effects ◽  
Beneficial Effect ◽  
Analytical Data ◽  
Well Being ◽  
Gastrointestinal Diseases ◽  
Convincing Evidence ◽  
Probiotic Treatment ◽  
History Of ◽  
Irritable Bowel

After a short overview of the history of probiotics, the author presents the development of human intestinal microflora based on the newest genetic data and the microbiological features of main probiotics. The indications of probiotic administration have been defined and extended in recent years. The author reviews significant results of probiotic treatment in some gastrointestinal diseases based on meta-analytical data. Probiotics are useful in preventing and treating diarrhoea caused by antibiotics and Clostridium difficile caused diarrhoea. In the treatment of Helicobacter pylori infection, preparations containing certain Lactobacillus,Bifidobacterium strains or Saccaromyces boulardii could enhance by 5–10% the rate of successful eradication and reduce the incidence and severity of the side effects. Some symptoms of irritable bowel syndrome and thus the quality of life can be improved by probiotics. Their beneficial effect in ulcerative colitis was proven, while in Crohn’s disease has not yet been defined. The use of probiotics is not included in guidelines, with the exception of the Maastricht IV/Florence consensus. For each disease it is advisable to use probiotics containing strains only with proven beneficial effect. The efficiency of preparations containing mixed strains has not yet been properly investigated. The author reviews the rare but potentially serious side effects of probiotics. In Hungary, there are many probiotic preparations available which can be purchased in pharmacies without prescription: their use is more empirical than evidence-based. The European Food Safety Authority has recently rejected claims for probiotics to be classed as medicines given the lack of convincing evidence on the effects of probiotics on human health and well-being. Clearly, further research is needed to collect evidence which could be incorporated into the international guidelines. Orv. Hetil., 2013, 154, 294–304.

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