Electrical Substrate Ablation for Refractory Ventricular Fibrillation: Results of the AVATAR Study

Background - Refractory ventricular fibrillation (VF) is a challenging clinical entity, for which ablation of triggering premature ventricular complexes (PVCs) is described. When PVCs are infrequent and multifocal, the optimal treatment strategy is uncertain. Methods - We prospectively enrolled consecutive patients presenting with multiple ICD shocks for VF refractory to antiarrhythmic drug therapy, exhibiting infrequent (≤3%), multifocal PVCs (≥3 morphologies). Procedurally, VF was induced with rapid pacing and mapped, identifying sites of conduction slowing and rotation or rapid focal activation. VF electrical substrate ablation (VESA) was then performed. Outcomes were compared against reference patients with VF who were unable or unwilling to undergo catheter ablation. The primary outcome was a composite of ICD shock, electrical storm, or all-cause mortality. Results - VF was induced and mapped in 6 patients (60±10 y, LVEF 46±19%) with ischemic (n=3) and nonischemic cardiomyopathy. An average of 3.3±0.5 sites of localized reentry during VF were targeted for radiofrequency ablation (38.3±10.9 minutes) during sinus rhythm, rendering VF non-inducible with pacing. Freedom from the primary outcome was 83% in the VF ablation group versus 17% in 6 non-ablation reference patients at a median of 1.0 years (IQR 0.5-1.5 years, p=0.046) follow-up. Conclusions - VESA is associated with a reduction in the combined endpoint compared with the non-ablation reference group. Additional work is required to understand the precise pathophysiologic changes which promote VF in order to improve preventative and therapeutic strategies.

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Efficacy and safety of IL-6 inhibitors in patients with COVID-19 pneumonia: a systematic review and meta-analysis of multicentre, randomized trials

Annals of Intensive Care ◽

10.1186/s13613-021-00941-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alessandro Belletti ◽

Corrado Campochiaro ◽

Marilena Marmiere ◽

Valery Likhvantsev ◽

Andrey Yavorovskiy ◽

...

Keyword(s):

Adverse Events ◽

Randomized Trials ◽

Primary Outcome ◽

Meta Analysis ◽

Group Versus ◽

Control Group ◽

Open Label ◽

Secondary Infections ◽

All Cause Mortality

Abstract Purpose COVID-19 is characterized by dysregulated immune response, respiratory failure and a relevant mortality rate among hospitalized patients. Interleukin-6 (IL-6) is involved in COVID-19-associated cytokine storm, and several trials investigated whether its inhibition could improve patients’ outcome. We performed a meta-analysis of randomized trials (RCT) to test this hypothesis. Materials and methods Two independent investigators searched PubMed, Scopus, ClnicalTrials.gov and medRxiv up to September 1st, 2021. Inclusion criteria were: administration of tocilizumab or sarilumab; COVID-19 adult patients with pneumonia; and being a RCT. Primary outcome was mortality at the longest follow-up. Secondary outcomes included intubation rate and incidence of adverse events. Two independent investigators extracted data from eligible trials. Results Of the 763 studies assessed, 15 RCTs were included (9,320 patients), all were multicentre, and the majority open-label vs standard treatment. IL-6 inhibitors were associated with reduced all-cause mortality at the longest follow-up (1315/5,380 [24.4%] in the IL-6 inhibitors group versus 1080/3,814 [28.3%] in the control group, RR = 0.90; 95% CI 0.84 to 0.96; p for effect = 0.003, I2 = 0%, with 13 studies included), with reduction in 28/30-day mortality and intubation rates, and with no increase in adverse events and secondary infections. Conclusion IL-6 inhibitors reduced longest follow-up mortality and intubation in COVID-19 patients. Findings need to be confirmed in high-quality RCTs.

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Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm

Cardiovascular Ultrasound ◽

10.1186/s12947-020-00231-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

João Ferreira ◽

Valdirene Gonçalves ◽

Patrícia Marques-Alves ◽

Rui Martins ◽

Sílvia Monteiro ◽

...

Keyword(s):

Aortic Valve ◽

Left Atrial ◽

Primary Outcome ◽

Severe Aortic Stenosis ◽

Heart Team ◽

Pump Function ◽

Volumetric Assessment ◽

All Cause Mortality ◽

Echocardiography Laboratory

Abstract Background Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up. Methods We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up. Results A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81–0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20–31.19, P < 0.001 and HR 3.40, 95%CI 1.57–7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20–26.40, P < 0.001 and HR 3.59, 95%CI 1.65–7.78, P = 0.001, respectively). Conclusions In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.

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Canadian Registry of Electronic Device Outcomes: remote monitoring outcomes in the Abbott battery performance alert—a multicentre cohort

EP Europace ◽

10.1093/europace/euab025 ◽

2021 ◽

Author(s):

Sharath Kumar ◽

Jason Davis ◽

Bernard Thibault ◽

Iqwal Mangat ◽

Benoit Coutu ◽

...

Keyword(s):

Remote Monitoring ◽

Primary Outcome ◽

Electronic Device ◽

Electronic Devices ◽

Cardiac Resynchronization ◽

Device Performance ◽

Cardiac Implantable Electronic Devices ◽

All Cause Mortality ◽

Multicentre Cohort

Abstract Aims Cardiac implantable electronic devices with device advisories have the potential of device malfunction. Remote monitoring (RM) of devices has been suggested to allow the identification of abnormal device performance and permit early intervention. We sought to describe the outcomes of patients with and without RM in devices subject to the Abbott Premature Battery Depletion (PBD) advisory with data from a Canadian registry. Methods and results Patients with an Abbott device subject to the PBD advisory from nine implantable cardioverter defibrillator (ICD) implanting centres in Canada were included in the registry. The use of RM was identified from baseline and follow-up data in the registry. The primary outcome was detection of PBD and all-cause mortality. A total of 2666 patients were identified with a device subject to the advisory. In all, 1687 patients (63.2%) had RM at baseline. There were 487 deaths during follow-up. At a mean follow-up of 5.7 ± 0.7 years, mortality was higher in those without a remote monitor compared with RM at baseline (24.7% vs. 14.5%; P < 0.001). Pre-mature battery depletion was identified in 36 patients (2.1%) with RM vs. 7 (0.7%) without RM (P = 0.004). Time to battery replacement was significantly reduced in patients on RM (median 5 vs. 13 days, P = 0.001). Conclusion The use of RM in patients with ICD and cardiac resynchronization therapy under advisory improved detection of PBD, time to device replacement, and was associated with a reduction in all-cause mortality. The factors influencing the association with mortality are unknown and deserve further study.

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Intervention for unruptured high-grade intracranial dural arteriovenous fistulas: a multicenter study

Journal of Neurosurgery ◽

10.3171/2021.1.jns202799 ◽

2021 ◽

pp. 1-9

Author(s):

Ching-Jen Chen ◽

Thomas J. Buell ◽

Dale Ding ◽

Ridhima Guniganti ◽

Akash P. Kansagra ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Intervention Group ◽

Group Versus ◽

Symptomatic Improvement ◽

High Grade ◽

Type Ii ◽

Risk Of Death ◽

All Cause Mortality

OBJECTIVE The risk-to-benefit profile of treating an unruptured high-grade dural arteriovenous fistula (dAVF) is not clearly defined. The aim of this multicenter retrospective cohort study was to compare the outcomes of different interventions with observation for unruptured high-grade dAVFs. METHODS The authors retrospectively reviewed dAVF patients from 12 institutions participating in the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR). Patients with unruptured high-grade (Borden type II or III) dAVFs were included and categorized into four groups (observation, embolization, surgery, and stereotactic radiosurgery [SRS]) based on the initial management. The primary outcome was defined as the modified Rankin Scale (mRS) score at final follow-up. Secondary outcomes were good outcome (mRS scores 0–2) at final follow-up, symptomatic improvement, all-cause mortality, and dAVF obliteration. The outcomes of each intervention group were compared against those of the observation group as a reference, with adjustment for differences in baseline characteristics. RESULTS The study included 415 dAVF patients, accounting for 29, 324, 43, and 19 in the observation, embolization, surgery, and SRS groups, respectively. The mean radiological and clinical follow-up durations were 21 and 25 months, respectively. Functional outcomes were similar for embolization, surgery, and SRS compared with observation. With observation as a reference, obliteration rates were higher after embolization (adjusted OR [aOR] 7.147, p = 0.010) and surgery (aOR 33.803, p < 0.001) and all-cause mortality was lower after embolization (imputed, aOR 0.171, p = 0.040). Hemorrhage rates per 1000 patient-years were 101 for observation versus 9, 22, and 0 for embolization (p = 0.022), surgery (p = 0.245), and SRS (p = 0.077), respectively. Nonhemorrhagic neurological deficit rates were similar between each intervention group versus observation. CONCLUSIONS Embolization and surgery for unruptured high-grade dAVFs afforded a greater likelihood of obliteration than did observation. Embolization also reduced the risk of death and dAVF-associated hemorrhage compared with conservative management over a modest follow-up period. These findings support embolization as the first-line treatment of choice for appropriately selected unruptured Borden type II and III dAVFs.

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Association of Body Weight Variability with Adverse Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease

Nutrients ◽

10.3390/nu13103381 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3381

Author(s):

Sang Heon Suh ◽

Tae Ryom Oh ◽

Hong Sang Choi ◽

Chang Seong Kim ◽

Eun Hui Bae ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Body Weight ◽

Kidney Disease ◽

Primary Outcome ◽

Body Weight Gain ◽

Absolute Difference ◽

Composite Outcome ◽

Increased Risk ◽

All Cause Mortality

To investigate the association of body weight variability (BWV) with adverse cardiovascular (CV) outcomes in patient with pre-dialysis chronic kidney disease (CKD), a total of 1867 participants with pre-dialysis CKD from Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) were analyzed. BWV was defined as the average absolute difference between successive values. The primary outcome was a composite of non-fatal CV events and all-cause mortality. Secondary outcomes were fatal and non-fatal CV events and all-cause mortality. High BWV was associated with increased risk of the composite outcome (adjusted hazard ratio (HR) 1.745, 95% confidence interval (CI) 1.065 to 2.847) as well as fatal and non-fatal CV events (adjusted HR 1.845, 95% CI 1.136 to 2.996) and all-cause mortality (adjusted HR 1.861, 95% CI 1.101 to 3.145). High BWV was associated with increased risk of fatal and non-fatal CV events, even in subjects without significant body weight gain or loss during follow-up periods (adjusted HR 2.755, 95% CI 1.114 to 6.813). In conclusion, high BWV is associated with adverse CV outcomes in patients with pre-dialysis CKD.

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A U-Shaped Association between LDL-C/HDL-C Ratio and all-Cause Mortality in Elderly Hypertensive Patients: A Prospective Cohort Study

10.21203/rs.3.rs-52204/v1 ◽

2020 ◽

Author(s):

Yu Yu ◽

Minghui Li ◽

Xiao Huang ◽

Wei Zhou ◽

Tao Wang ◽

...

Keyword(s):

Reference Group ◽

Survival Curve ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Lipid Lowering ◽

Hypertensive Patients ◽

All Cause Mortality ◽

Elderly Hypertensive ◽

Elderly Hypertensive Patients

Abstract Background: Low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking LDL-C/HDL-C ratio to mortality have been inconsistent and limited by short follow-up. Therefore, the aim of the present study was to determine whether LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients.Methods: We selected 6,941 hypertensive patients aged 65 years or older and untreated with lipid-lowering drugs from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between LDL-C/HDL-C ratio and all-cause mortality by using multivariate cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan–Meier survival curve to address.Results: During a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between LDL-C/HDL-C ratio and all-cause mortality. The LDL-C/HDL-C ratio was divided into five groups according to quintiles. Compared to the reference group (Q3: 1.67-2.10), both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios were associated with higher all-cause mortality (<1.67: HR 1.81, 95% CI: 1.08-3.03; ≥2.10: HR 2.00, 95% CI: 1.18-3.39). Compare with lower and higher LDL-C/HDL-C ratio groups, patients with LDL-C/HDL-C ratio of 1.67-2.10 had a significant higher survival probability (log-rank P = 0.038).Conclusion: Our results suggested that there was a U-shaped association between LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.

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Influence of caseload on survival of patients (pts) with localized prostate cancer (PC) after definitive radiation therapy (DRT).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.357 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 357-357

Author(s):

Sarmad Sadeghi ◽

Primo Lara ◽

Denice D. Tsao-Wei ◽

Monish Aron ◽

Jacek K. Pinski ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Primary Outcome ◽

Cox Model ◽

The United States ◽

National Cancer Database ◽

Beam Radiation ◽

All Cause Mortality ◽

The Relationship

357 Background: We recently reported a significant all-cause mortality risk reduction associated with higher annual caseload for radical prostatectomy (RP)- (PMID 31398279). Here we explore this relationship in DRT. Methods: National Cancer Database (NCDB) was used to investigate outcomes of DRT in the United States. Beam radiation (BR), radioactive implant (RI) and both (BRRI) were included in analysis. Using overall survival (OS) as primary outcome, the relationship between facility annual caseload (FAC) for all PC pts and facility annual caseload (FARC) for those requiring DRT were examined using Cox model. Four volume groups (VG) were defined as VG1: <50th, VG2: 50th-74th, VG3: 75th-89th and VG4: top 10 percentile of caseload. Results: Between 2004 and 2014, 355,247 pts underwent DRT. At a median follow up of 70.1 (95% CI: 1.0 - 143.1) months (mo), the median OS was 137.3 mo (136.9, 138.1). Using FAC/FARC, 19/14, 27/24, 24/26, and 30/37 % of pts were treated at VG 1 through 4, respectively. For FARC, median OS was 136.8 mo (134.9, 142.2+) for VG1 and 139.7 (137.7, 141.8+) mo for VG4, adjusted hazard ratio (aHR) 1.06 (1.03-1.09), p <0.001. For FAC, median OS was 135.4 (134.1, 138.7) mo for VG1 and not reached for VG4, aHR 1.13 (1.09, 1.16), p <0.001. In subgroups, FARC aHR for VG1 vs VG4 were 1.20 (1.16-1.25) for BR, 0.99 (0.93-1.05) for RI, and 1.15 (1.02-1.31) for BRRI. These numbers for FAC were 1.10 (1.06, 1.14), 1.12 (1.05, 1.19), and 1.24 (1.12, 1.39), respectively. Conclusions: There is a statistically significant OS advantage to DRT at a high annual caseload facility. This effect is more pronounced for BR and is influenced more noticeably by facility all PC caseload rather than DRT.[Table: see text]

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Proportions of Proinflammatory Monocytes Are Important Predictors of Mortality Risk in Hemodialysis Patients

Mediators of Inflammation ◽

10.1155/2017/1070959 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Yachung Jeng ◽

Paik Seong Lim ◽

Ming Ying Wu ◽

Tien-Yu Tseng ◽

Chang Hsu Chen ◽

...

Keyword(s):

Reference Group ◽

Immune Dysfunction ◽

Hemodialysis Patients ◽

Future Prospects ◽

Normal Range ◽

Substantial Evidence ◽

All Cause Mortality ◽

Continuous Progression ◽

Cvd Mortality

Despite the continuous progression in dialysis medicine, mortality and the burden of cardiovascular disease (CVD) among hemodialysis patients are still substantial. Substantial evidence suggests that proinflammatory (CD16+) monocytes contribute to the development of atherosclerosis. A cohort of 136 stable hemodialysis patients (follow-up: 6.25 year) was assessed to investigate the association between the proportion of CD16+ monocytes for all-cause and CVD mortalities. The CD16+ monocytes were associated with both mortalities after adjusting for a preexisting CVD history. Compared to the reference group (CD16+ monocytes within [15.6–18.6], the first and second quartile), patients with CD16+ monocytes above the highest quartile level (>21.5) had an adjusted hazard ratio (HR) of 30.85 (95% confidence interval [CI]: 7.12–133.8) for CVD mortality and 5.28 (2.07–13.49) for all-cause mortality, and those with CD16+ monocytes below the lowest quartile ≤15.6), had significantly elevated death risks after 3.5-year follow-up (HR [95% CI]: 10.9 [2.42–48.96] and 4.38 [1.45–13.24] for CV and all-cause mortalities, respectively). The hemodialysis patients with CD16+ monocyte level in a low but mostly covering normal range also portended a poor prognosis. The findings shed some light for nephrologists on future prospects of early recognizing immune dysfunction and improving early intervention outcomes.

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Functional and cognitive outcomes after COVID-19 delirium

10.1101/2020.06.07.20115188 ◽

2020 ◽

Cited By ~ 2

Author(s):

Benjamin C Mcloughlin ◽

Amy Miles ◽

Thomas Webb ◽

Paul Knopp ◽

Clodagh Eyres ◽

...

Keyword(s):

Functional Outcomes ◽

Primary Outcome ◽

Cognitive Outcomes ◽

Clinical Team ◽

Functional Impairments ◽

College Hospital ◽

Point Prevalence Study ◽

All Cause Mortality ◽

Dsm Iv

AbstractPurposeTo ascertain delirium prevalence and outcomes in COVID-19.MethodsWe conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function.ResultsIn 71 patients, 31 (42%) had delirium, of which only 19 had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium (−39 points on functional scale/166, 95% CI −92 to −21, p=0.01) (Table 2). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample.ConclusionsOur findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium-term.Key summary pointsAimTo investigate functional and cognitive outcomes among patients with delirium in COVID-19.FindingsDelirium in COVID-19 was prevalent (42%) but only a minority had been recognised by the clinical team. At 4-week follow-up, delirium was significantly associated with worse functional outcomes, independent of pre-morbid frailty. Cognitive outcomes were not appreciably worse.MessageThe presence of delirium is a significant factor in predicting worse functional outcomes in patients with COVID-19.

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Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm

10.21203/rs.3.rs-52491/v2 ◽

2020 ◽

Author(s):

João Ferreira ◽

Valdirene Gonçalves ◽

Patrícia Marques-Alves ◽

Rui Martins ◽

Sílvia Monteiro ◽

...

Keyword(s):

Aortic Valve ◽

Left Atrial ◽

Primary Outcome ◽

Severe Aortic Stenosis ◽

Heart Team ◽

Pump Function ◽

Volumetric Assessment ◽

All Cause Mortality ◽

Echocardiography Laboratory

Abstract Background: Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up. Methods: We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up. Results: A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81-0.88, P <0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF <37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20-31.19, P <0.001 and HR 3.40, 95%CI 1.57-7.37, P =0.002, respectively). After adjustment for AVR, excess risk of LAEF <37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20-26.40, P <0.001 and HR 3.59, 95%CI 1.65-7.78, P =0.001, respectively). Conclusions: In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.

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