Abstract 17010: Predicting Risk of Sudden Death With QT Interval-Prolonging Medications

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nanki Chugh ◽  
Sol Bloomfield ◽  
Oliver Leitner ◽  
Audrey Uy-Evanado ◽  
Sumeet Chugh ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Qt Interval ◽  
Stepwise Logistic Regression ◽  
Clinical Tool ◽  
Unexpected Death ◽  
Qt Interval Prolongation ◽  
Increase Risk ◽  
Unit Increase ◽  
History Of ◽  
Artery Disease

Background: The ongoing pandemic has re-emphasized how QT-prolonging drugs can increase risk of sudden cardiac death (SCD), but azithromycin and hydroxychloroquine are only 2 of many such medications. There remains a critical need to identify individuals who are at high risk of SCD based on their demographic and clinical profile. Hypothesis: A modified Tisdale Score (TS), originally designed to assess risk of QTc (corrected QT interval) prolongation with QT-prolonging drugs, could also predict risk of SCD. Methods: From the ongoing Oregon Sudden Unexpected Death Study (ORESUDS), we identified a subgroup of SCD patients with coronary artery disease (CAD) and controls (individuals with and without CAD but no history of SCD) on at least one QT-prolonging medication enrolled between 2002 and 2020. Analysis was restricted to subjects with available pre-arrest medical history, including ECGs with QT interval available and details of prescribed medications. We identified QT prolonging drugs from the comprehensive list at crediblemeds.com. Our TS included age, sex, use of loop diuretics, serum potassium levels, history of acute myocardial infarction, history of heart failure, and number of QT prolonging drugs. We used a univariate logistic regression to determine the predictive power of the modified TS for SCD. We performed a backwards stepwise logistic regression considering race/ethnicity, diabetes, and hypertension in addition to TS to improve SCD prediction. Results: A total of 964 cases (60% male, mean age 68 years) and 668 controls (62% male, mean age 67 years) met inclusion criteria. TS ranged from 0 to 12 and mean TS was 5.86 ± 2.93 in cases and 4.29 ± 2.74 in controls (p < 0.001). A 1-unit increase in the modified TS was a significant predictor of SCD (odds ratio (OR) 1.21, 95% confidence interval, 1.17 to 1.26). In the multivariable model predicting SCD, both the modified TS (OR 1.20, 95% CI, 1.15 to 1.25) and diabetes (OR 1.42, 95% CI, 1.14 to 1.78) were significant independent predictors of SCD. Conclusion: A modified Tisdale Score predicts SCD, and history of diabetes could potentially enhance the utility of this user-friendly clinical tool. These findings have implications for prescription of QT-prolonging drugs, especially during the ongoing pandemic.

Abstract P014: Cardiovascular Risk Factors Associated with Low Dehydroepiandrosterone Sulfate

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Monik C Jimenez ◽  
JoAnn E Manson ◽  
Kathryn M Rexrode
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Heart Disease ◽  
Dehydroepiandrosterone Sulfate ◽  
Stepwise Logistic Regression ◽  
Postmenopausal Hormone ◽  
Reactive Protein ◽  
Unit Increase ◽  
History Of ◽  
Hormone Use

Introduction: Low dehydroepiandrosterone sulfate (DHEAS) levels recently have been related to elevated risk of ischemic stroke. However, the association between DHEAS and traditional cardiovascular risk factors remains unclear. Methods: Blood samples were collected in 1989-1990 among 32,826 participants of the Nurses’ Health Study. Samples were assayed for DHEAS, lipids, and other biomarkers as part of a nested case control study evaluating risk of ischemic stroke and 340 stroke-free controls with complete data were available. Lifestyle covariates were ascertained in 1988. Stepwise logistic regression models were used to evaluate the association of between CVD risk factors and low DHEAS (<42 μ g/dL), while stepwise linear regression was used to evaluate the association with continuous DHEAS. Stepwise models utilized an entry threshold of α=0.20 and exit criterion of α=0.10. Results: The mean level of DHEAS was 78.38 μ g/dL (s.d. 50.02; median=67.03) in this population of women aged 43-69 years (median=62). Age was strongly associated with lower DHEAS. Women with history of heart disease and higher total/HDL cholesterol were more likely to have low DHEAS. In stepwise logistic regression analyses, age (OR=2.94; 95%CI: 1.73-5.00 for 10 yrs) and history of heart disease (OR=1.84; 95% CI: 0.91-3.70) were identified as risk factors for low DHEAS. In stepwise linear regression modeling, age, postmenopausal hormone use, history of heart disease and C-reactive protein (CRP) were associated with lower DHEAS levels while alcohol use was associated with higher DHEAS levels (Table 1). Body mass index, smoking, diabetes, glycosylated hemoglobin and lipids were not associated with low DHEAS. Conclusions: In this population of healthy women, lower levels of DHEAS were associated with older age, history of heart disease, postmenopausal hormone use, higher CRP and lower levels of alcohol consumption. Further research is needed to explore these associations. Table 1 Multivariable * adjusted estimates for DHEAS by cardiovascular disease risk factors DHEAS (continuous μ g/dL) β † 95%CI Age ‡ −28.40 −36.75, -20.05 History of Heart disease −18.76 −39.23, 1.71 Postmenopausal Hormone Therapy Use & −12.01 −21.99, -2.04 CRP £ (mg/L) −0.66 −1.37, 0.04 Alcohol # (g/day) 2.95 0.46, 5.45 * All variables mutually adjusted for one another † Estimated from stepwise logistic regression model ‡ per 10 year increase in age & Ref = No use of postmenopausal hormone therapy £ per 1 unit increase in C-reactive protein (CRP- mg/L) # per 5 unit increase in alcohol consumption (g/day)

scholarly journals Association between Social-Cognitive Factors and Sexual Intention towards Pre-Marital Sex Activity among School-Going Late Adolescents in Kuantan, Pahang

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Fa'iza Abdullah ◽  
Nur Akmanidar Zainuddin ◽  
Samsul Draman ◽  
Nor Azlina A.Rahman
Keyword(s):  
Logistic Regression ◽  
Social Norms ◽  
Social Cognitive ◽  
Cognitive Factors ◽  
Late Adolescent ◽  
Permissive Attitude ◽  
Increase Risk ◽  
Unit Increase ◽  
Sexual Intention ◽  
Marital Sex

Introduction: The Theory of Planned Behavior (TPB) is determined by four main domains of social-cognitive factors; attitudes, social-norms, self-efficacy and sexual intention. This study aim to identify the socio-demographic and socio-cognitive factors associated with sexual intention towards premarital sex among school-going late adolescent. Materials and method:  Cross-sectional study was conducted in nine government secondary schools in Kuantan district between January-July 2018. A total of 466 self-administered validated Youth Sexual Intention Questionnaires(YSIQ) data are collected among unmarried students aged 18-19-year-old. Statistical analyses were done using IBM SPSS version 22.0. Results: Out of 466 participants, 67.4%, 68.2%, 64.4% are Malays, Females and Muslims. Simple logistic regression showed for every one unit increase in permissive attitude, social-norms and selfefficacy scores, there were 1.424, 1.303 and 1.215 times increase risk of having sexual intention, with  p -value of 0.001 each and 95% CI of odds ratio(OR) 1.2681.600, 1.191-1.425 and 1.066-1.386 respectively. Multivariate logistic regression showed that female had lower risk of having sexual intention( p=0.001, OR=0.163, CI=0.058-0.462). Non-Malays and ever-smoker students had higher risk compared to Malay and non-smoker towards having sexual intention with p=0.001 (OR=5.110,CI=1.881-13.886) and  p =0.019 (OR=3.288, CI=1.218-8.875) respectively. For every unit increase in permissive attitude score, there was 1.236 times increase risk of having sexual intention with p=0.002 (95%CI, OR=1.084-1.410). Conclusion: The study showed the risk of having sexual intention was higher among males, nonMalay, ever-smoker students; and those with higher permissive attitude scores. Peer education intervention programs are necessity for school-going students to improve the permissive attitude in averting risk behavior that may lead to sexual intention towards pre-marital sex activity. The study should be expanded to adolescent who are no longer in school or in suburban areas.

Abstract 717: An Association between Frontal Non-hemorrhagic Stroke and Atrial Fibrillation.

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Daniel Sedhom ◽  
Neil Yager ◽  
Michael Ashamalla ◽  
Ketan Ghate ◽  
Justin Pieper ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Hemorrhagic Stroke ◽  
Normal Sinus Rhythm ◽  
Multivariate Logistic Regression Analysis ◽  
Study Cohort ◽  
History Of ◽  
Artery Disease

Background: Atrial fibrillation is a known risk factor for thromboembolic events. We sought to investigate an association between arrhythmia and stroke location in patients with non-hemorrhagic stroke. Materials and methods: The study cohort included 514 consecutive patients with non-hemorrhagic stroke treated at a single academic center. Stroke location was classified as frontal, occipital, lacunar, brainstem, left or right temporal, left or right parietal, cerebellar and insular. ANOVA, chi-square and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Frontal embolic stroke was noted more frequently in patients with atrial fibrillation (29% vs. 15% in normal sinus rhythm, NSR, p<0.0001). No other anatomic location of the stroke was associated with arrhythmia. Frontal strokes were more likely in patients with history of coronary artery disease (23% vs. 12%, p<0.005). However, there was no association between frontal stroke location and gender, age, history of hypertension, diabetes, dyslipidemia, peripheral vascular disease, or chronic renal insufficiency. In multivariate logistic regression analysis, atrial fibrillation (HR 2.3; 95% CI 1.2-4.5, p=0.018) and history of coronary artery disease (HR 2; 95%CI 1.2-3.4, p=0.012) remained important predictors of frontal strokes. Discussion: Non-hemorrhagic strokes are common in patients with atrial fibrillation. We found increased prevalence of frontal embolic strokes in atrial fibrillation, possible due to the dual blood supply the frontal cerebrum from both the middle and anterior cerebral arteries. This association is intriguing and requires further studies.

Abstract WP257: Therapeutic Anti Coagulation and Ischemic Stroke Mechanism in Atrial Fibrillation Exploring Risk Factors

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ayman Al-Salaimeh ◽  
Bruce Bradley ◽  
Vedant Gupta ◽  
Michael Dobbs ◽  
Nils Henninger ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Statistical Significance ◽  
Categorical Variables ◽  
Stepwise Logistic Regression ◽  
Carotid Disease ◽  
Adequate Treatment ◽  
History Of ◽  
Stroke Mechanism

Background: Ischemic stroke occurs in setting of AF despite adequate treatment because of both cardiac and non-cardiac causes. We hypothesized that certain clinical , and cardiac characteristics would increase the likelihood of cardio -embolic stroke(CES) in therapeutically anticoagulated patients with AF Methods: We reviewed the records of all adults who were adequately anticoagulated with warfarin or a DOAC(if information was available), and admitted to either the University of Kentucky or University of Massachusetts medical School with a diagnosis of ischemic stroke or transient ischemic attack between 01/01/2011 -06/30/2016. Stroke mechanism (CES vs non CES) using ASCOD criteria was determined by a vascular neurologist masked to the echocardiographic results. Categorical variables were analyzed with Chi square or Fisher exact test as appropriate. Continuous variables were analyzed using t test. P value <.05 was considered significant. Stepwise logistic regression was used to identify variable independently associated with CES Results: 110 patients (68 patients with CES and 42 with non- CES ) were identified. In univariable analyses, CHF was more common in CES group (45% vs 23.8%, p=0.026) , EF was lower in CES group (49% vs 60% , p .00008) , history of PAD or Carotid disease were more common in non CES group (78% vs 50%, p .01) , also total cholesterol on admission was higher in the non CES group (158.5 vs 132.3 mg/dl, p .002) .other variables did not reach statistical significance ( see table) on multiple logistic regression only EF , total cholesterol and history of PAD/Carotid disease maintained statistical significance (.043, 0.013, and 0.022, respectively). Conclusion: Patients with CES despite therapeutic anticoagulation had lower EF, were less likely to have extensive atherosclerotic disease , and had lower total cholesterol compared to those with non- CES. Larger prospective studies are required to confirm these findings

scholarly journals Papaverine-induced QT Interval Prolongation and Ventricular Fibrillation in a Patient with a History of Drug-induced QT Prolongation

2014 ◽  
Vol 53 (15) ◽  
pp. 1629-1631 ◽  
Author(s):  
Masayuki Goto ◽  
Masahito Sato ◽  
Hitoshi Kitazawa ◽  
Minoru Takahashi ◽  
Koichi Fuse ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Qt Interval ◽  
Qt Prolongation ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Qt Interval Prolongation ◽  
History Of

Evaluation of traditional and non-traditional risk factors as predictive values for a positive acetylcholine provocation test in patients with ischemia and no obstructive coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Beijderwellen ◽  
R.G.T Feenstra ◽  
M.A.M Beijk ◽  
M.E Wittekoek ◽  
V.E Stegehuis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Independent Predictor ◽  
Obstructive Coronary Artery Disease ◽  
Strong Association ◽  
Predictive Values ◽  
History Of ◽  
Traditional Risk Factors ◽  
Artery Disease

Abstract Background Coronary vasomotor function disorders, such as microvascular angina (MVA) and vasospastic angina (VSA) can be diagnosed in three quarters of all patients with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA). Intracoronary acetylcholine provocation testing (Ach-test) is considered the gold standard for the assessment of VSA and MVA. Our aim is to identify the correlation between a positive Ach-test identifying an abnormal coronary vasomotor response and predictive traditional and non-traditional risk factors in patients with INOCA. Methods In this single centre retrospective cohort study, data from all patients who were referred for an Ach-test between 2002 and 2019 was collected. All patients underwent an invasive test with assessment of the vasomotor responses by intracoronary acetylcholine and assessment of coronary microvascular dysfunction (CMD) by measuring the coronary flow reserve (CFR). VSA and MVA were diagnosed on the basis of the criteria as proposed by the Coronary Vasomotor Disorders International Study Group (COVADIS). The predictive risk factors were analyzed by means of logistic regression. Results A total of 134 patients were included, median age was 57 years and 85.1% were female. The Ach-test revealed VSA in 95 patients (70.9%), MVA in 13 patients (9.7%) and a negative Ach-test in 26 patients (19.4%). A multivariable logistic regression model showed smoking as an independent variable for a positive Ach-test (OR of 3.0 with 95% CI 1.1–8.2; p=0.031) and as an independent predictor for VSA (OR of 2.9 95% CI 1.1–7.9 p=0.039). In addition we showed that migraine (OR of 6.7 95% CI 1.4–32.9 p=0.019) is an independent predictor for MVA and MVA has a strong association with female patients who have a history of recurrent miscarriages (p=0.015). Conclusion MVA and VSA are associated with different risk factors which support a different underlying pathophysiology. Smoking is an independent predictor for a positive Ach-test and an independent predictor for VSA. In addition, we showed that migraine is an independent predictor for MVA and MVA has a strong association with female patients who have a history of miscarriages. MVA and VSA require a different treatment strategy and because there are no clear predictive values for a positive Ach-test, it is important to support identification with an Ach-test. Funding Acknowledgement Type of funding source: None

Abstract 3621: Predicting 90 Day Outcome in Acute Ischemic Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dawn M Meyer ◽  
Rema Raman ◽  
Karin Ernstrom ◽  
Bruce Obviagele ◽  
Thomas Hemmen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
Current Smoker ◽  
Stepwise Logistic Regression ◽  
Stroke Patients ◽  
Prognostic Information ◽  
Acute Ischemic Stroke Patient ◽  
History Of

Background and Purpose- Predictive scales for outcome in intracerebral hemorrhage patients have been used to provide prognostic information on mortality. Valid and reliable scales do not exist for acute ischemic stroke patients. The purpose of this study was to create a statistically valid model on which to predict 90 day functional outcome in acute ischemic stroke patients. Methods- This was a retrospective analysis of prospectively collected data on acute ischemic stroke patients. A univariate logistic regression analysis was done to assess for independent predictor variables. Any variable with a p<0.15 at the univariate level was included in a stepwise logistic regression model and appropriate interaction effects were tested. A model was constructed to predict 90 day stroke outcome. Good outcome was defined as mRS 0-2 and bad outcome was defined as mRS 3-6 at 90 days. Results- 569 patients were included in the analysis. Age ranged from 21-98 (mean 70), baseline NIHSS 0-40 (median 6), 48% of patients were treated with rt-PA (n=277), 10% were black (n=57), and 15% were Hispanic (n=89). In univariate analysis, independent predictors of outcome were age (p<0.0001), weight (p=0.0003), baseline NIHSS (p<0.0001), diastolic blood pressure (p=0.02), treatment with rt-PA (p<0.0001), history of hypertension (p=0.0009), history of CAD/MI (p=0.002), history of stroke (p=0.02), current smoker (p=0.02), and history of atrial fibrillation (p=0.0001). Ethnicity (p=0.09) was included in the model. On stepwise linear regression, age (p<0.001, β-0.03), baseline NIHSS (p<0.001, β -0.15), Hispanic ethnicity (p=0.02, β -0.66) remained as independent predictors of 90 day outcome. Conclusions- A prognostic scale for acute ischemic stroke patient outcome would be clinically useful. This analysis based on sound statistical procedures can serve as a basis for the creation of a valid and reliable scale for predicting 90 day outcome in acute ischemic stroke patients. A scoring system is currently being developed for testing.

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