Abstract 2868: Long-Term Prognostic Predictors of Isolated Significant Tricuspid Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jeong-Woo Lee ◽  
Jong-Min Song ◽  
Jae Won Lee ◽  
Myung-Zoon Yi ◽  
Eun Sun Jin ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Pulmonary Vascular Disease ◽  
Proportional Hazard ◽  
Cardiac Mortality ◽  
Long Term Outcomes ◽  
Cox Proportional Hazard

Background: Long-term outcomes of isolated significant tricuspid regurgitation (TR) without significant left-side heart disease remain to be clearly demonstrated. Methods: We enrolled 547 consecutive patients (age: 64 ± 14 years) with isolated significant TR. The patients with atrial septal defect, significant pulmonary or pulmonary vascular disease, right ventricular dysplasia and constrictive pericarditis were excluded. Initial clinical and echocardiographic characteristics and clinical outcomes were analyzed for 5.6 ± 2.1 years. Results: Survival rate was not different between 39 patients who underwent tricuspid valve (TV) surgery and 508 patients who did not (p=0.48). Of 508 patients without TV surgery, 32 patients (6.3%) died with cardiac cause during the follow-up period. Those patients were older (71 ± 16 vs. 64 ± 13 years, p<0.05) and showed initial larger TR jet area (15 ± 7 vs. 12 ± 4 cm 2 , p<0.05), and higher pulmonary artery systolic pressure (PASP, 46 ± 22 vs. 39 ± 16 mmHg, p<0.05). By adjusting other baseline characteristics using Cox proportional hazard model, age (HR; 1.045, 95% CI: 1.013 – 1.078), initial TR jet area (HR; 1.110, 95% CI; 1.061 – 1.160), and PASP (HR; 1.025, 95% CI; 1.009 – 1.042) were independent predictors of cardiac mortality. Mortality rates did not differ between patients with organic and functional TR. Initial TR jet area ≥12 cm 2 and PASP ≥36 mmHg were best cut-off values for predicting cardiac mortality (Figure ). Conclusions: Severity of TR and pulmonary hypertension are prognostic factors independent of age in medically-managed patients with isolated significant TR. The results may suggest an optimal surgical timing in these patients.

scholarly journals EP.WE.906Endovascular Repair of Abdominal Aortic Aneurysm – A Retrospective Analysis of Outcomes from a UK Teaching Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Giordano Perin ◽  
Mukesh Garg ◽  
Nandan Haldipur
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Invasive Technique ◽  
Proportional Hazard ◽  
Long Term Outcomes ◽  
Cox Proportional Hazard ◽  
Abdominal Aortic ◽  
Post Operative Survival

Abstract Aims Endovascular Repair of Abdominal Aortic Aneurysm (EVAR) is a minimally invasive technique that has become increasingly popular in the past few years. Recent evidence questioned the long term durability of the technique and highlighted the relevance of long term complications and reinterventions. The aim of this paper is to evaluate long term outcomes of EVAR with a focus on survival and aneurysm related reinterventions. Methods We retrospectively analysed all elective EVAR procedures performed for Abdominal Aortic Aneurysm (AAA) between May 2010 and June 2016 in our institution. Data collected included - comorbidities, post operative survival and post operative aneurysm related interventions. Survival analysis was performed using the Kaplan-Meyer method. We build a Cox Proportional-Hazard model to identify factors associated with increased mortality. Results 182 patients were included in our analysis. Median age was 77 years (50-92). Median follow up was 65 months (31-104). During the follow up period we recorded 41 deaths. 30 day mortality was 0.5% (1), 2 year mortality was 8.7% (16). 17 patients (9.3%) required reintervention during the follow up period (2.4 reinterventions per 100 patient-years). Conclusions Our medium and long term outcomes following EVAR are comparable with what has been reported in the literature. A higher ASA grade and advanced age were associated with increased mortality in our cohort.

scholarly journals Long-Term Outcomes of Cervical Laminoplasty in the Elderly

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Yasushi Oshima ◽  
Kota Miyoshi ◽  
Yoji Mikami ◽  
Hideki Nakamoto ◽  
Sakae Tanaka
Keyword(s):  
Hazard Analysis ◽  
The Elderly ◽  
Neurological Status ◽  
Cervical Laminoplasty ◽  
Long Term Outcomes ◽  
Cox Proportional Hazard ◽  
Age Related ◽  
Upper And Lower Extremities

Incidences of cervical laminoplasty in the elderly are increasing; the influence of other age-related complications and neurological status must be considered for justifying surgery. This study identified the aforementioned influence on long-term outcomes of cervical laminoplasty in patients aged ≥75 years. Thirty-seven of 38 consecutive patients aged ≥75 years who underwent cervical laminoplasty were retrospectively evaluated. Minimum 5-year follow-up was acceptable if patients were complication-free. Follow-up was terminated when neurological evaluation was not possible, owing to death or other serious complications affecting activities of daily living (ADL). Postoperative neurological changes and newly developed severe complications were investigated. Postoperatively, one patient died of acute pneumonia, one remained nonambulatory owing to cerebral infarction, and 35 were ambulatory and were discharged. At a mean follow-up of 78 months, three patients died and nine developed serious complications severely affecting ADL. Of the 25 remaining patients, 23 remained ambulatory at mean follow-up of 105 months. Cox proportional hazard analysis revealed that postoperative motor upper and lower extremities JOA scores of ≤2 and ≤1, respectively, were risk factors for mortality or other severe complications. Postoperative neurological status can be maintained in the elderly if they remain complication-free. Poorer neurological status significantly affected their ADL and mortality.

scholarly journals A Prospective Study of Grip Strength Trajectories and Incident Cardiovascular Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Weida Liu ◽  
Runzhen Chen ◽  
Chenxi Song ◽  
Chuangshi Wang ◽  
Ge Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Grip Strength ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
A Prospective Study

Background: A single measurement of grip strength (GS) could predict the incidence of cardiovascular disease (CVD). However, the long-term pattern of GS and its association with incident CVD are rarely studied. We aimed to characterize the GS trajectory and determine its association with the incidence of CVD (myocardial infarction, angina, stroke, and heart failure).Methods: This study included 5,300 individuals without CVD from a British community-based cohort in 2012 (the baseline). GS was repeatedly measured in 2004, 2008, and 2012. Long-term GS patterns were identified by the group-based trajectory model. Cox proportional hazard models were used to examine the associations between GS trajectories and incident CVD. We identified three GS trajectories separately for men and women based on the 2012 GS measurement and change patterns during 2004–2012.Results: After a median follow-up of 6.1 years (during 2012–2019), 392 participants developed major CVD, including 114 myocardial infarction, 119 angina, 169 stroke, and 44 heart failure. Compared with the high stable group, participants with low stable GS was associated with a higher incidence of CVD incidence [hazards ratio (HR): 2.17; 95% confidence interval (CI): 1.52–3.09; P &lt;0.001], myocardial infarction (HR: 2.01; 95% CI: 1.05–3.83; P = 0.035), stroke (HR: 1.96; 95% CI: 1.11–3.46; P = 0.020), and heart failure (HR: 6.91; 95% CI: 2.01–23.79; P = 0.002) in the fully adjusted models.Conclusions: The low GS trajectory pattern was associated with a higher risk of CVD. Continuous monitoring of GS values could help identify people at risk of CVD.

Abstract 17024: Clinical and Echocardiographic Predictors of Death and Hospital Readmission in Patients With Recent Onset Severe Secondary Tricuspid Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Katherine M Nichols ◽  
Andrew Milbridge ◽  
Bruce W Andrus
Keyword(s):  
Tricuspid Regurgitation ◽  
Hospital Readmission ◽  
Delayed Diagnosis ◽  
Systolic Pressure ◽  
Hepatobiliary Disease ◽  
Pulmonary Artery Systolic Pressure ◽  
Recent Onset ◽  
Moderate Disease ◽  
History Of

Introduction: Tricuspid regurgitation (TR) is often asymptomatic leading to delayed diagnosis. Predictors of decompensation and indications and timing for intervention are not well delineated. We studied the clinical and echocardiographic outcomes of patients with recent onset severe, secondary TR to identify risk factors for death, hospital readmission and hepatobiliary disease. Methods: We queried our institutional echo database to identify all patients with severe secondary TR in 2010 and a TTE within the previous two years prior showing less than moderate disease. Baseline and follow up clinical and echocardiographic variables over the subsequent 10 years were collected retrospectively. We analyzed our data for predictors of death, hospital readmission, and hepatobiliary disease. Results: We identified 34 patients. Over 10 years of follow up, 27/34 (79%) of the patients died. Elevated pulmonary artery systolic pressure (PASP) was a significant predictor of death. PASP was 48 mm Hg in those who died compared to 33 mm Hg in those who survived (p=0.02) (Figure 1). Pulmonary hypertension (PH) and pulmonary embolism (PE) were predictors of readmission. A history of PH was present in 7/10 (70%) of patients requiring readmission compared to 7/24 (29%) in those who did not require readmission (p=0.03). A history of PE was present in 2/10 (20%) of those requiring readmission compared to 0/24 (0%) of those who did not require readmission (p=0.02). No patients were diagnosed with hepatobiliary disease. Conclusions: New onset severe, secondary TR is associated with a high ten year mortality rate. Elevated PASP is a predictor of death and history of PE and pulmonary HTN are predictors for hospital readmission.

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Wenxing Cui ◽  
Tian Li ◽  
Yingwu Shi ◽  
Chen Yang ◽  
Shunnan Ge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rank Test ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Proportional Hazard ◽  
Log Rank Test

Abstract Objective: To assess the association between immediate postoperative coagulopathy and the long-term survival of traumatic brain injury (TBI) patients undergoing surgery, as well as to explore predisposing risk factors of immediate postoperative coagulopathy.Methods: This retrospective study included 352 TBI patients from January 1, 2015, to April 25, 2019. The log-rank test and a Cox proportional hazard model were conducted to assess the relationship between immediate postoperative coagulopathy and the long-term survival of TBI patients. Furthermore, a multivariate logistic regression model was performed to identify the underlying risk factors for postoperative coagulopathy.Results: Of the 352 patients analyzed, the median age was 50 (41,60) years, and 82 (23%) patients were female. By May 26, 2019, 117 (33.24%) patients had died, 195 (55.40%) had survived, and 40 (11.36%) had been lost to follow-up. The median follow-up time was 773 days. In the log-rank test, immediate postoperative coagulopathy was significantly associated with the survival of TBI patients (P = 0.002). A Cox proportional hazard model identified immediate postoperative coagulopathy (HR, 1.471; 95% CI, 1.011-2.141; P = 0.044) as an independent risk factor for survival following TBI. According to multivariate logistic regression analysis, abnormal ALT and RBC at admission, intraoperative infusion of crystalloid solution > 2900 mL, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL were identified as independent risk factors for immediate postoperative coagulopathy.Conclusions: Those who suffered from immediate postoperative coagulopathy due to TBI were at higher risk of poor prognosis than those who did not.

scholarly journals Selection bias, interventions and outcomes for survivors of cardiac arrest

Heart ◽  
2018 ◽  
Vol 104 (16) ◽  
pp. 1356-1361 ◽  
Author(s):  
David J Wallace ◽  
Patrick Coppler ◽  
Clifton Callaway ◽  
Jon C Rittenberger ◽  
Cameron Dezfulian ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Selection Bias ◽  
Cardiac Catheterisation ◽  
Cardiac Mortality ◽  
Long Term Outcomes ◽  
Specific Analysis ◽  
All Cause Mortality ◽  
Cardiac Arrest Survival

ObjectiveCardiac catheterisation and implantable cardioverter defibrillator (ICD) insertion are increasingly common following cardiac arrest survival. However, much of the evidence for the benefit is observational, leaving open the possibility that biased patient selection confounds the association between these invasive procedures and improved outcome. We evaluated the likelihood of selection bias in the association between cardiac catheterisation or ICD placement and outcome by measuring long-term outcomes overall and in a cause-specific approach that separated cardiac mortality from non-cardiac mortality.MethodsWe performed a multivariable survival analysis of a clinical cohort between 2005 and 2013, with follow-up through 2015. We included patients who had out-of-hospital or inhospital cardiac arrest that survived to discharge, and evaluated the association between cardiac catheterisation or ICD insertion and all-cause, cardiovascular and non-cardiovascular mortality.ResultsAmong 678 patients who survived cardiac arrest, we observed lower all-cause mortality among patients who underwent cardiac catheterisation (adjusted HR (aHR) 0.40; P<0.01) or ICD insertion (aHR 0.55; P<0.01). However, cause-specific analysis showed that the benefits of cardiac catheterisation and ICD insertion resulted from reduced non-cardiac causes of death (cardiac catheterisation: aHR 0.24, P<0.01; ICD: aHR 0.58, P<0.01), while reduced cardiac cause of death was not associated with cardiac catheterisation (cardiac catheterisation: aHR 0.75, P=0.33).ConclusionsThere is evidence of selection bias in the secondary prevention survival benefit attributable to cardiac catheterisation for patients who survive cardiac arrest. Observational studies that consider its effects on all-cause mortality likely overestimate the potential benefit of this procedure.

scholarly journals O33 Earlier cancer diagnosis after myositis onset is associated with improved long term survival: results from UK, French and Czech cohorts

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Alexander Oldroyd ◽  
Paul New ◽  
Janine Lamb ◽  
William Ollier ◽  
Robert Cooper ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Cancer Diagnosis ◽  
Proportional Hazard ◽  
Term Survival ◽  
Cancer History ◽  
Long Term Survival ◽  
Cox Proportional Hazard ◽  
Female Cohort

Abstract Background The idiopathic inflammatory myopathies (IIMs) are associated with cancer. Cancer screening is advocated in new IIM cases; however no study has investigated if this confers improved long-term survival. This study aimed to investigate if a shorter time between IIM onset and cancer diagnosis is associated with improved survival. Methods Verified adult-onset IIM (dermatomyositis, polymyositis, anti-synthetase syndrome) cases, according to the International Myositis Classification Criteria, were recruited from three separate UK (UKMYONET), France and Czech-based cohort studies. Only cases with cancer diagnosis following IIM onset were included in analysis. The time between IIM onset and cancer diagnosis was calculated for each case. The relationship between survival at the end of follow up and time between IIM onset and cancer diagnosis was quantified via calculation of hazard ratios using a Cox-proportional hazard model, adjusted for age and gender. Results A total of 193 (66% female) IIM cases with a total of 1,395 person-years follow up were included in the analysis (Table 1). Data of 120 UK, 45 Czech and 28 French participants were analysed. Breast was the most common site of cancer (16%), followed by lung (9%) and bowel (6%). Forty six (24%) deaths occurred within the follow up period. The IIM onset to cancer diagnosis time was shorter for those that survived at the end of follow up, compared to those that died: 4.6 years (IQR 1.2, 10.7), vs 5.8 years (IQR 1.6, 13.8), respectively. Cox-proportional hazard modelling, indicated that a longer time between IIM onset and cancer diagnosis was significantly associated with death (HR 1.06 [95% CI 1.02, 1.10]). This significant relationship was only demonstrated in the female cohort when analysed separately: female HR 1.06 (95% CI 1.01, 1.10), male HR 1.08 (95% CI 0.98, 1.18). Conclusion Using data from three international cohorts, this study has, for the first time, identified that earlier cancer diagnosis after IIM onset is associated with improved long term survival. This finding was observed in the female cohort only. This study therefore indicate that cancer screening in newly diagnosed IIM cases without a preceding cancer history should be carried out, especially in female cases. Disclosures A. Oldroyd None. P. New None. J. Lamb None. W. Ollier None. R. Cooper None. K. Mariampillai None. O. Benveniste None. J. Vencovský None. H. Mann None. H. Chinoy None.

scholarly journals Trajectories of cardiovascular disease risk and their association with the incidence of cardiovascular events over 18 years of follow-up: The Tehran Lipid and Glucose study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Fatemeh Koohi ◽  
Nooshin Ahmadi ◽  
Farzad Hadaegh ◽  
Siavash Safiee ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Prevention ◽  
Proportional Hazard ◽  
Cvd Risk ◽  
Cox Proportional Hazard ◽  
Prospective Association

Abstract Background Understanding long-term patterns (trajectories) of cardiovascular diseases (CVD) risk and identifying different sub-groups with the same underlying risk patterns could help facilitate targeted cardiovascular prevention programs. Methods A total of 3699 participants of the Tehran Lipid and Glucose Study (TLGS) (43% men, mean age = 53.2 years), free of CVD at baseline in 1999–2001 and attending at least one re-examination cycle between the second (2002–2005) and fourth cycles (2009–2011) were included. We examined trajectories of CVD risk, based on the ACC/AHA pooled cohort equation, over ten years and subsequent risks of incident CVD during eight years later. We estimated trajectories of CVD risk using group-based trajectory modeling. The prospective association of identified trajectories with CVD was examined using Cox proportional hazard model. Results Three distinct trajectories were identified (low-low, medium-medium, and high-high risk). The high-high and medium-medium CVD risk trajectories had an increasing trend of risk during the time; still, this rising trend was disappeared after removing the effect of increasing age. Upon a median 8.4 years follow-up, 146 CVD events occurred. After adjusting for age, the medium-medium and high-high trajectories had a 2.4-fold (95% CI 1.46–3.97) and 3.46-fold (95% CI 1.56–7.70) risk of CVD compared with the low-low group, respectively. In all trajectory groups, unfavorable increasing in fasting glucose, but favorable raising in HDL and decreasing smoking and total cholesterol happened over time. Conclusions Although the risk trajectories were stable during the time, different risk factors varied differently in each trajectory. These findings emphasize the importance of attention to each risk factor separately and implementing preventive strategies that optimize CVD risk factors besides the CVD risk.

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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