scholarly journals Impact of Mitral Annular Dilation on Edge-to-Edge Therapy With MitraClip-XTR

2021 ◽  
Author(s):  
Felix Kreidel ◽  
Syed Zaid ◽  
Alexander R. Tamm ◽  
Tobias F. Ruf ◽  
Andres Beiras-Fernandez ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Left Atrial Volume ◽  
Characteristic Analysis ◽  
Vena Contracta ◽  
3 Dimensional ◽  
Suboptimal Outcome ◽  
Annular Dilation ◽  
The Impact

Background: Mitral annular dilation has been shown to challenge successful edge-to-edge therapy with earlier MitraClip generations. Recently, third-generation MitraClip-XTR with extended clip arm length was introduced. We assessed the impact of annular dilation on residual mitral regurgitation (MR) after MitraClip-XTR repair and sought to identify cutoffs associated with suboptimal MR reduction. Methods: We included 107 patients (78.9±6.7 years; 40.2% female) with symptomatic severe MR (46.7% primary MR; 53.3% secondary MR) undergoing MitraClip-XTR repair. Annular dimensions were retrospectively assessed by 2-dimensional and 3-dimensional-transesophageal echocardiography including a semiautomated analysis. Impact of annular diameters and area on suboptimal reduction defined as ≥2+MR on transthoracic echocardiography at discharge was assessed and predictive cutoff values identified. Previously identified predictors of suboptimal outcome after MitraClip therapy were included in multivariable analysis. Results: Technical success was achieved in 93%, 1-year mortality was 23%. Suboptimal MR reduction was observed in 26% and associated with higher 1-year mortality (odds ratio, 4.5 [1.5–14.1]). End-systolic anteroposterior and intercommissural annular diameters, annular area and further vena-contracta width, effective regurgitant orifice area and left atrial volume were associated with suboptimal outcomes. Independent predictors of suboptimal reduction were end-systolic annular area (odds ratio, 1.36 [1.08–1.71] per cm 2 ) and vena-contracta width (odds ratio, 1.47 [1.04–2.09] per mm). On receiver operating characteristic analysis, 3-dimensional-transesophageal echocardiography end-systolic anteroposterior diameter >40.5 mm, intercommisural diameter >40.5 mm, and annular-area >12.50 cm 2 were the most predictive thresholds for suboptimal reduction. If all 3 annular measurements exceeded the determined threshold values, the risk for suboptimal reduction increased by 17-fold. Conclusions: Annular dilation was found to challenge successful edge-to-edge therapy also with extended-reach MitraClip-XTR. Our proposed thresholds for preprocedural annular dimensions may serve as guidance for improved patient selection in edge-to-edge repair.

PREDICTORS OF CEREBRAL INFARCTION IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2007 ◽  
Vol 60 (4) ◽  
pp. 658-667 ◽  
Author(s):  
Sherise Ferguson ◽  
R. Loch Macdonald
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Odds Ratio ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariable Analysis ◽  
Double Blind ◽  
Poor Outcome ◽  
Symptomatic Vasospasm ◽  
Explained Variance ◽  
The Impact

Abstract OBJECTIVE Cerebral infarction would be expected to be associated with poor outcome after aneurysmal subarachnoid hemorrhage (SAH), although there are few data on which to base this assumption. The goals of this study were to determine the impact of cerebral infarction on outcome and to examine predictors of infarction in these patients. METHODS Univariate and multivariable statistical methods were used to examine the impact of cerebral infarction on the Glasgow Outcome Scale score 3 months after SAH among 3567 patients entered into four prospective, randomized, double-blind, placebo-controlled trials of tirilazad conducted in neurosurgical centers around the world between 1991 and 1997. Patient demographics, clinical variables, radiographic characteristics, and treatment variables associated with cerebral infarction were also determined by the same methods. RESULTS Seven hundred and seven (26%) out of 2741 patients with complete data had cerebral infarction on computed tomographic scans 6 weeks after SAH. Multivariable logistic regression showed that cerebral infarction increased the odds of unfavorable outcome by a factor of 5.4 (adjusted odds ratio, 5.4; 95% confidence interval, 4.2–6.8; P < 0.0001), which was a higher odds ratio than all other factors associated with outcome. The proportion of explained variance in outcome was also highest for cerebral infarction and accounted for 39% of the explained variance. Multivariable analysis found that cerebral infarction was significantly associated with increasing patient age, worse neurological grade on admission, history of hypertension or diabetes mellitus, larger aneurysm, use of prophylactically or therapeutically induced hypertension, temperature more than 38°C 8 days after SAH, and symptomatic vasospasm. CONCLUSION Cerebral infarction was strongly associated with poor outcome after aneurysmal SAH. The most important potentially treatable factor associated with infarction was symptomatic vasospasm.

scholarly journals Intra-Aortic Balloon Pump Bridging to Heart Transplantation

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Lauren V. Huckaby ◽  
Laura M. Seese ◽  
Michael A. Mathier ◽  
Gavin W. Hickey ◽  
Arman Kilic
Keyword(s):  
Heart Transplantation ◽  
Policy Change ◽  
Odds Ratio ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Cox Regression Analysis ◽  
Post Transplant ◽  
Baseline Characteristics ◽  
The Impact

Background: This study evaluates the impact of the 2018 allocation policy change on outcomes of orthotopic heart transplantation (OHT) in patients bridged with intra-aortic balloon pumps (IABPs). Methods: Adult (≥18 years) patients undergoing OHT between 2013 and 2019 who were bridged with an IABP were stratified based on temporal relation to the policy change. Univariate analysis was used to compare baseline characteristics and postoperative outcomes. Multivariate Cox regression analysis was used to estimate risk-adjusted predictors of post-transplant mortality. Results: A total of 1342 (8.6%) OHT patients were bridged with an IABP during the study period. Rates of bridging with IABP to OHT increased significantly after the policy change (7.0% versus 24.9%, P <0.001). The mean recipient age was 54.1±12.1 years with 981 (73.1%) patients being male. Baseline characteristics were similar between the 2 groups whereas post–policy change patients spent fewer days on the waitlist (15 versus 35 days, P <0.001), had longer ischemic times (3.5 versus 3.0 hours, P <0.001), and received organs from a greater distance (301 versus 105 miles, P <0.001). By multivariable analysis, days on the waitlist (for every 30 days; odds ratio, 1.01 [95% CI, 1.00–1.02], P =0.031) and diabetes mellitus (odds ratio, 1.87 [95% CI, 1.16–3.02], P =0.011) emerged as significant predictors of post-transplant mortality. After the policy change, waitlisted patients requiring IABP support were more likely to survive to transplant (76.4 versus 89.8%, P <0.001). Conclusions: IABP utilization has increased over 3-fold since the 2018 policy change with improved waitlist outcomes and comparable post-OHT survival. Thus, bridging patients to OHT with IABPs appears to be an effective strategy in the current era.

scholarly journals Association between recovered acute kidney injury within 48hours and mortality in patients following coronary angiography: a cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Q Li ◽  
S Q Chen ◽  
H Z Huang ◽  
L W Liu ◽  
W H Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Odds Ratio ◽  
Baseline Level ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Funding Sources ◽  
All Cause Mortality ◽  
The Impact

Abstract Background The association of recovered acute kidney injury (AKI) with mortality was controversial. Our study aims to investigate the impact of recovered AKI on mortality in patients following coronary angiography (CAG). Methods Our study retrospectively enrolled 3,970 patients with pre-operative serum p creatinine (Scr) and twice measurements within 48hours after procedure. Recovered AKI defined as the diagnosis of AKI (Scr &gt;0.3 mg/dL or &gt;50% from the baseline level) on day 1 when Scr failed to meet the criteria for AKI on the day 2. Maintained AKI was defined as AKI not meeting the definition for recovered AKI. The primary outcome was 1-year all-cause mortality. Multivariable logistic regression was used to assess the association between recovered AKI and 1-year mortality. Results Among 3,970 participants, 861 (21.7%) occurred AKI, of whom 128 (14.9%) was recovered AKI and 733 (85.1%) was maintained AKI. 312 (7.9%) patients died within 1-year after admission. After multivariable analysis, recovered AKI was not associated with higher 1-year mortality (adjusted odds ratio [aOR], 1.37; CI, 0.68–2.51) compared without AKI. Among AKI patients, Recovered AKI was associated with a 52% lower 1-year mortality compared with maintained AKI. Additionally, maintained AKI was significantly associated with higher 1-year mortality (aOR, 2.67; CI, 2.05–3.47). Conclusions Our data suggested that recovered AKI within 48h was a common subtype of AKI following CAG, without increasing mortality. More attention need to be paid to the patients suffering from maintained AKI following CAG. FUNDunding Acknowledgement Type of funding sources: None. Association of AKI and mortality Subgroups analysis

scholarly journals Is mild hypernatremia an independent predictor of poor clinical outcome in neurocritically ill patients?

2020 ◽  
Author(s):  
Yun Im Lee ◽  
Joonghyun Ahn ◽  
Jeong-Am Ryu
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Poor Clinical Outcome ◽  
Neurosurgical Patients ◽  
The Impact

Abstract We investigated the impact of hypernatremia on mortality of neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, the patients who were hospitalized in the ICU for more than 5 days included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. Among 1,146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were analyzed. Hypernatremia group had higher rates of in-hospital mortality compared with non-hypernatremia group in overall and matched population (p < 0.001 and p = 0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 4.58, 95% confidence interval [CI]: 2.15 – 9.75 and adjusted OR: 6.93, 95% CI: 3.46 – 13.90, respectively) compared with the absence of hypernatremia. However, in-hospital mortality was not significantly different between non-hypernatremia and mild hypernatremia groups (p = 0.720). Interestingly, mild hypernatremia group of matched population showed the best survival rate. Eventually, moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, prognosis of the patients with mild hypernatremia was similar with those without hypernatremia.

Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients

2021 ◽  
Author(s):  
Wojciech Dudek ◽  
Waldemar Schreiner ◽  
Mohamed Haj Khalaf ◽  
Horia Sirbu
Keyword(s):  
Primary Tumor ◽  
Multivariable Analysis ◽  
Pulmonary Metastasectomy ◽  
Incomplete Resection ◽  
Continuous Variables ◽  
Characteristic Analysis ◽  
Term Survival ◽  
Primary Tumors ◽  
Wide Range ◽  
The Impact

Abstract Background Despite weak evidence, pulmonary metastasectomy (PM) is widely performed with intent to improve patient survival. Our single-institution analysis aims to evaluate outcomes and to identify factors influencing survival of patients undergoing PM for metastases from wide range of primary tumors. Materials and Methods All patients undergoing curative-intent PM between 2008 and 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on overall survival (OS) was evaluated using univariable and multivariable Cox proportional hazard models. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. Results In this study, 281 patients (178 male, median age 61 years) underwent PM. Two (0.7%) perioperative deaths and 23 (8.2%) major complications occurred. Median interval between the treatment of primary tumor and PM was 21 months. Median size of largest metastasis was 1.4 cm. After the median follow-up of 29 months, 134 patients (47.7%) had died. Five-year OS rate after first PM was 47.1%. Complete resection was achieved in 274 (97.5%) patients. Multivariable analysis identified genitourinary origin (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.15–0.60, p = 0.0008) as independent positive survival prognosticator; incomplete resection (HR: 3.53, 95% CI: 1.40–8.91, p = 0.0077) and age at PM of ≥66 years (HR: 1.97, 95% CI: 1.36–2.85, p = 0.0003) were negative prognosticators. Conclusion The use of PM as a part of multimodal treatment is in selected population justified. Our analysis identified age, primary tumor origin, and completeness of resection as independent survival prognosticators.

scholarly journals The Impact of Hyponatremia on the Severity of Childhood Tuberculous Meningitis

2022 ◽  
Vol 12 ◽  
Author(s):  
Rashid Salih ◽  
Ronald van Toorn ◽  
James A. Seddon ◽  
Regan S. Solomons
Keyword(s):  
Tuberculous Meningitis ◽  
Cranial Nerve ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Communicating Hydrocephalus ◽  
Severe Hyponatremia ◽  
Cell Counts ◽  
Cranial Nerve Palsies ◽  
Brainstem Dysfunction ◽  
The Impact

Introduction: Hyponatremia and/or hypoglycorrhachia are commonly encountered biochemical derangements during the acute stage of childhood tuberculous meningitis (TBM). Few studies have explored the correlation between these derangements and the staging of TBM disease (severity), or explored their role as biomarkers for vascular ischemic events, hydrocephalus, or seizures.Methods: We aimed to identify the prevalence and the correlation between serum hyponatremia (mild, moderate and severe) and/or hypoglycorrhachia in relation to clinical TBM features such as stage of disease, seizures and stroke in children diagnosed with definite and probable TBM, between 1985 and 2015, at Tygerberg Hospital, Cape town, South Africa.Results: The prevalence of hyponatremia was 344 out of 481 (71.5%) patients; 169 (49.1%) had mild hyponatremia, 146 (42.4%) moderate hyponatremia and 29 (8.4%) severe hyponatremia. Children with severe hyponatremia had higher frequency of stroke [odds ratio (OR) 4.36, 95% confidence interval (CI) 1.24–15.35; p = 0.01], brainstem dysfunction (OR 7.37, 95% CI 2.92–18.61; p &lt; 0.01), cranial nerve palsies (OR 2.48, 95% CI 1.04–5.91; p = 0.04) and non-communicating hydrocephalus (OR 2.66, 95% CI 1.09–6.44; p = 0.03). Children with moderate hyponatremia and mild hyponatremia compared to those without hyponatremia similarly were more likely to exhibit signs of brainstem dysfunction (OR 1.91, 95% CI 1.11–3.28; p = 0.02) and hydrocephalus (OR 3.18, 95% CI 1.25–8.09; p = 0.01), respectively. On multivariable analysis only brainstem dysfunction was significantly associated with severe hyponatremia [adjusted odds ratio (aOR) 4.46, 95% CI 1.62–12.30; p &lt; 0.01]. Children with hypoglycorrhachia compared to normoglycorrhachia were more likely to have had longer symptom duration prior to admission (OR 1.87, 95% CI 1.09–3.20; p = 0.02), non-communicating hydrocephalus (OR 1.64, 95% CI 0.99–2.71; p = 0.05), higher cerebrospinal white cell counts (OR 3.00, 95% CI 1.47–6.12; p &lt; 0.01) and higher CSF protein concentrations (OR 2.51, 95% CI 1.49–4.20; p &lt; 0.01). On multivariable analysis raised CSF protein concentration &gt;1 g/L was significantly associated with hypoglycorrhachia (aOR 2.52, 95% CI 1.44–4.40; p &lt; 0.01). Death rates did not differ by sodium level category or presence of hypoglycorrachia, however an increasing trend of children that had demised was noted the more severe the sodium category.Conclusion: Hyponatremia and/or hypoglycorrhachia occur in more than two-thirds of children with TBM. Severe TBM disease complications such as brainstem dysfunction was associated with moderate hyponatremia, while severe hyponatremia was associated with brainstem dysfunction, stroke, cranial nerve palsies and non-communicating hydrocephalus. Cerebrospinal fluid (CSF) glucose depletion correlated with non-communicating hydrocephalus and increased CSF inflammation.

scholarly journals Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

2020 ◽  
Author(s):  
Shuhong Yu ◽  
Yi Luo ◽  
Tan Zhang ◽  
Chenrong Huang ◽  
Yu Fu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Area Under The Curve ◽  
Characteristic Analysis ◽  
Poor Outcome ◽  
Net Reclassification Improvement ◽  
Potential Biomarker ◽  
The Impact

Abstract Background and PurposeIt has been showed that eosinophils are decreased and monocytes are elevated in patients with ischemic stroke, but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among patients with acute ischemic stroke remains unclear. The aim of this study is to determine the relationship between EMR on admission and three-month poor functional outcome in patients with acute ischemic stroke.MethodsA total of 521 consecutive patients admitted to our hospital within 24 hours after onset of acute ischemic stroke were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission.ResultsAs EMR decreased, the risk of poor outcome increased (P<0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.10; 95% CI, 0.03–0.36; P=0.0004), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.24; 95% CI, 0.10–0.53; Ptrend<0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The area under the curve of EMR for the prediction of poor outcome in receiver operating characteristic analysis was 0.653 (95% CI, 0.603–0.703; P=0.003). Furthermore, the addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 3.54%, P=0.230; integrated discrimination improvement: 2.11%, P=0.001).ConclusionEMR on admission was independently correlated with poor outcome in patients with acute ischemic stroke, suggesting that EMR may be a potential prognostic biomarker for ischemic stroke.

scholarly journals The Impact of HIV on Maternal Morbidity in the Pre-HAART Era in Uganda

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Harriet Nuwagaba-Biribonwoha ◽  
Richard T. Mayon-White ◽  
Pius Okong ◽  
Peter Brocklehurst ◽  
Lucy M. Carpenter
Keyword(s):  
Odds Ratio ◽  
Maternal Morbidity ◽  
Associated Factors ◽  
Formal Education ◽  
Adjusted Odds Ratio ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Febrile Illness ◽  
Major Morbidity ◽  
The Impact

Objective. To compare maternal morbidity in HIV-infected and uninfected pregnant women.Methods. Major maternal morbidity (severe febrile illness, illnesses requiring hospital admissions, surgical revisions, or illnesses resulting in death) was measured prospectively in a cohort of HIV-infected and uninfected women followed from 36 weeks of pregnancy to 6 weeks after delivery. Odds ratios of major morbidity and associated factors were examined using logistic regression.Results. Major morbidity was observed in 46/129 (36%) and 104/390 (27%) of the HIV-infected and HIV-uninfected women, respectively, who remained in followup. In the multivariable analysis, major morbidity was independently associated with HIV infection, adjusted odds ratio (AOR) 1.7 (1.1 to 2.7), nulliparity (AOR 2.0 (1.3 to 3.0)), and lack of, or minimal, formal education (AOR 2.1 (1.1 to 3.8)).Conclusions. HIV was associated with a 70% increase in the odds of major maternal morbidity in these Ugandan mothers.

The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

2019 ◽  
pp. 1-5
Keyword(s):  
Decision Making ◽  
Logistic Regression ◽  
Skin Necrosis ◽  
Regression Models ◽  
Multivariable Analysis ◽  
P Value ◽  
Flap Necrosis ◽  
Single Institution ◽  
Logistic Regression Models ◽  
The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

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