Abstract P187: Prognostic Importance of Type D Personality and Shocks in Patients with an Implantable Cardioverter-Defibrillator

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Johan Denollet ◽  
Fetene Tekle ◽  
Susanne S Pedersen ◽  
Pepijn H van der Voort ◽  
Marco Alings ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Real World ◽  
Cardiac Death ◽  
Type D Personality ◽  
Younger Patients ◽  
Cardioverter Defibrillator ◽  
Type D ◽  
Increased Risk ◽  
Age Dependent ◽  
Appropriate Shocks

Background . Implantable cardioverter defibrillator (ICD) treatment has been studied primarily in clinical trials. We examined the age-dependent importance of shocks and psychological distress in patients seen in clinical care, and the importance of these factors among younger patients in particular. Methods . This real-world study (n=589) included 134 older (>70y, m=74.3) and 455 younger (≤70y, m=59.1) ICD patients. At baseline, vulnerability for psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression analyses were used to examine the importance of shocks and distress; endpoints were all-cause and cardiac death. Results . After a median follow-up of 3.2 years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Appropriate shocks (HR=2.60, 95%CI 1.47-5.58, p=0.001) and Type D personality (HR=1.85, 95%CI 1.12-3.05, p=0.015) independently predicted an increased mortality risk, adjusting for covariates. Other predictors were age, cardiac resynchronization therapy (CRT) and diabetes. Appropriate shocks and Type D personality also predicted an increased risk of cardiac death. Inappropriate shocks were not associated with all-cause (p=0.52) or cardiac (p=0.99) death. Older patients had more advanced heart failure, and CRT and diabetes were the only prognostic factors in this age group. In younger patients, however, appropriate shocks and Type D personality predicted an increased risk of all-cause and cardiac death, adjusting for covariates. Conclusion . This real-world study confirmed the importance of ICD shocks, showed that Type D personality has incremental prognostic value, and revealed important age-dependent differences in risk.

scholarly journals Age-Related Differences in the Effect of Psychological Distress on Mortality: Type D Personality in Younger versus Older Patients with Cardiac Arrhythmias

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Johan Denollet ◽  
Fetene B. Tekle ◽  
Pepijn H. van der Voort ◽  
Marco Alings ◽  
Krista C. van den Broek
Keyword(s):  
Psychological Distress ◽  
Older Patients ◽  
Type D Personality ◽  
Cardiac Resynchronization ◽  
Cardiac Mortality ◽  
Cardiovascular Research ◽  
Younger Patients ◽  
Type D ◽  
Age Related ◽  
General Psychological Distress

Background.Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients.Methods.The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y,. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09–3.34) and 2.26 (95% CI 1.16–4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking.Conclusion.Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk.

scholarly journals The Heritability of Type D Personality by an Extended Twin-Pedigree Analysis in the Netherlands Twin Register

2020 ◽  
Author(s):  
Ruifang Li-Gao ◽  
Dorret I. Boomsma ◽  
Eco J. C. de Geus ◽  
Johan Denollet ◽  
Nina Kupper
Keyword(s):  
The Netherlands ◽  
Variance Components ◽  
Genetic Model ◽  
Additive Genetic Variance ◽  
Type D Personality ◽  
Continuous Measure ◽  
Genetic Covariance ◽  
Type D ◽  
Genetic Components ◽  
Increased Risk

Abstract Type D (Distressed) personality combines negative affectivity (NA) and social inhibition (SI) and is associated with an increased risk of cardiovascular disease. We aimed to (1) validate a new proxy based on the Achenbach System of Empirically Based Assessment (ASEBA) for Type D personality and its NA and SI subcomponents and (2) estimate the heritability of the Type D proxy in an extended twin-pedigree design in the Netherlands Twin Register (NTR). Proxies for the dichotomous Type D classification, and continuous NA, SI, and NAxSI (the continuous measure of Type D) scales were created based on 12 ASEBA items for 30,433 NTR participants (16,449 twins and 13,984 relatives from 11,106 pedigrees) and sources of variation were analyzed in the ‘Mendel’ software package. We estimated additive and non-additive genetic variance components, shared household and unique environmental variance components and ran bivariate models to estimate the genetic and non-genetic covariance between NA and SI. The Type D proxy showed good reliability and construct validity. The best fitting genetic model included additive and non-additive genetic effects with broad-sense heritabilities for NA, SI and NAxSI estimated at 49%, 50% and 49%, respectively. Household effects showed small contributions (4–9%) to the total phenotypic variation. The genetic correlation between NA and SI was .66 (reflecting both additive and non-additive genetic components). Thus, Type D personality and its NA and SI subcomponents are heritable, with a shared genetic basis for the two subcomponents.

scholarly journals MELAS Syndrome with Cardiac Involvement: A Multimodality Imaging Approach

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Sara Seitun ◽  
Laura Massobrio ◽  
Anna Rubegni ◽  
Claudia Nesti ◽  
Margherita Castiglione Morelli ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Cardiac Death ◽  
Ventricular Hypertrophy ◽  
Cardiac Involvement ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Gene Diagnosis ◽  
Cardioverter Defibrillator ◽  
Increased Risk ◽  
Imaging Approach

A 49-year-old man presented with chest pain, dyspnea, and lactic acidosis. Left ventricular hypertrophy and myocardial fibrosis were detected. The sequencing of mitochondrial genome (mtDNA) revealed the presence of A to G mtDNA point mutation at position 3243 (m.3243A>G) in tRNALeu(UUR) gene. Diagnosis of cardiac involvement in a patient with Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes syndrome (MELAS) was made. Due to increased risk of sudden cardiac death, cardioverter defibrillator was implanted.

Real-world outcomes in older adults treated with immunotherapy: A United Kingdom multicenter series of 2,049 patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12026-12026
Author(s):  
Anna Claire Olsson-Brown ◽  
Mark Baxter ◽  
Caroline Dobeson ◽  
Laura Feeney ◽  
Rebecca Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Service ◽  
Adverse Events ◽  
Real World ◽  
Older Patients ◽  
Single Agent ◽  
Receive Combination Therapy ◽  
Younger Patients ◽  
Increased Risk ◽  
The Impact

12026 Background: Immune checkpoint inhibitor (ICI) therapy is now commonly used in a range of tumours and settings. Most data relating to outcomes and rates of immune-related adverse events (irAE) is derived from clinical trial or registry populations and small case series. Limited data exist for patients aged > 75 years. Here we present a multi-centre, real-world analysis of the outcomes and incidence of irAEs in older adults managed within a single comprehensive public health service. We also compare these outcomes to younger patients in the same cohort. Methods: A retrospective analysis of 2049 patients treated with ICIs was undertaken across 12 centres. All patients were managed within the UK National Health Service outside of a trial setting between June 2016 and September 2018. Patients received either ICI monotherapy (MT) or duel combination ICI therapy (CT) for malignant melanoma (MM), non-small cell lung cancer (NSCLC) or renal cell cancer (RCC). Data were collected using a standardised, collection tool. IrAEs ≥ grade 2 or all-grade endocrinopathies were recorded as per the Common Terminology Criteria for Adverse Events (V5) (CTCAE). Statistical analyses were performed using T-tests, Mann-Whitney and Chi-squared. Kaplan-Meier analysis and log-rank test were used for overall survival (OS) analysis. Results: 409 (20%) of patients were aged > 75 years(a), 1413 (69%) aged 50-75(b) and 227 (11.1%) aged < 50(c). There was no difference in sex, ethnicity or PD-L1 status (in the NSCLC cohort) between groups. Older patients were less likely to receive combination therapy (3%(a) v 13%(b) v 34%(c), p < 0.001). There was no difference in median OS across age groups in the cohort as a whole (p = 0.822) or for the individual tumour groups when treated with single agent ICI. Across the total cohort patients aged > 75 had no increased risk of any irAE (35%(a) v 33%(b) v 41%(c),p = 0.074). However there was an increase in irAEs in older patients treated with MT (36%(a) v 26(b) v 25%(c), p = 0.011) However there was no difference in the > 75s with regard to severe (G3/4) toxicity, toxicity type, admission or discontinuation due to toxicity in the aPD-1 group. In the overall cohort younger patients were more likely to develop irAEs and be admitted. Conclusions: Patients aged > 75 years treated with anti-PD1 therapy in the standard of care setting derive similar survival benefit to younger patients. There was no increase in ≥G3 toxicity. Our data support the safety of single agent aPD-1 ICI therapy in older adults and provide reassurance relating to the impact of toxicity.[Table: see text]

Death with an implantable cardioverter-defibrillator: a MADIT-II substudy

EP Europace ◽  
2019 ◽  
Author(s):  
Fernando Chernomordik ◽  
Christian Jons ◽  
Helmut U Klein ◽  
Valentina Kutyifa ◽  
Eyal Nof ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Significant Proportion ◽  
Time Of Death ◽  
Cardioverter Defibrillator ◽  
Mortality Event ◽  
Increased Risk ◽  
Madit Ii

Abstract Aims There are limited data regarding factors that identify implantable cardioverter-defibrillator (ICD) patients who will experience either ventricular tachyarrhythmic (VTA) or non-arrhythmic (NA) mortality, and the commonly used clinical classification of sudden cardiac death (SCD) vs. non-sudden cardiac death (NSCD) may not be accurate enough. We aimed to correlate clinical adjudication of mortality events to device interrogation data and to identify risk factors for VTA mortality in Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). Methods and results Of the 746 patients who received an ICD in MADIT-II, 44 died from cardiac causes and had available interrogation data at the time of death. Sudden cardiac death vs. NSCD was defined by an adjudication committee. Ventricular tachyarrhythmic and NA arrhythmic deaths were categorized by the presence or absence of ventricular tachycardia or fibrillation (VT/VF) during the terminal event. Mode of death was found to be inaccurate when validated by device interrogation for VTA events: 50% patients adjudicated as SCD did not have a VTA event at the time of death; and 25% of adjudicated NSCD were found to have VT/VF during the mortality event. Multivariate analysis showed that factors independently associated with VTA mortality included: VT/VF >72 h prior to the mortality event [hazard ratio (HR) 8.0; P < 0.001], hospitalization for heart failure (HR 6.7; P = 0.001), and a history of hypertension (HR 4; P = 0.04). Conclusion Current classification of SCD vs. NSCD fails to identify VTA events at the time of death in a significant proportion of patients, and simple clinical parameters can be used to identify ICD recipients with increased risk for VTA mortality.

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