Abstract TP75: Natural History of Incidental Small Paraclinoid Unruptured Aneurysm

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jeong Eun Kim ◽  
Jin Sue Jeon ◽  
Jun Hyong Ahn ◽  
Young-Je Son ◽  
Jae Seung Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Treatment Plan ◽  
Cumulative Survival ◽  
High Risk Factors ◽  
Significant Difference ◽  
History Of ◽  
Aneurysm Growth ◽  
Arterial Branch

Objective: The optimal consensus over treatment of incidental small paraclinoid unruptured intracranial aneurysm (UIA) remains controversial. The aim of this study was to reveal the natural history of small paraclinoid UIA with the goal of informing a treatment plan. Methods: A total of 344 patients harboring 364 paraclinoid UIA (≤5 mm) were retrospectively evaluated during the mean follow-up of 32±17.3 months from September 2001 to May 2011. Barami’s classification was used for categorizing aneurysm location. Univariate and multivariate analyses were used to determine the risk factors of aneurysm growth. The Kaplan-Meier product-limit estimator and generalized Wilcoxon tests were performed to assess the cumulative survival without aneurysm growth. Results: None of the aneurysm ruptures and 12 (3.3%) cases of aneurysm growth were observed during the follow up of 969.7 aneurysm-years. Aneurysm ≥ 4mm (hazard ratio [HR], 6.73; p=0.001) and hypertension (HR, 4.92; p=0.02) were associated with aneurysm growth. Other variables including female (p=0.18), age (p=0.24), arterial branch related location (p=0.47), multiplicity (p=0.11), and smoking (p=0.36) did not differ significantly. The multivariate analysis disclosed that aneurysm ≥4mm (HR, 4.78; p=0.01) and hypertension (HR, 4.20; p=0.03) were significant predictable factors for aneurysm growth. The cumulative survival without aneurysm growth reached a significant difference in aneurysms ≥4mm (p<0.001) and with hypertension (p=0.01). No statistical difference was observed between arterial branch related and unrelated groups (p=0.16). Conclusions: Incidental small paraclinoid UIA can be primarily treated conservatively. Patients with high risk factors including aneurysm ≥4 mm and hypertension must be monitored closely.

scholarly journals Different Contributions of Dyslipidemia and Obesity to the Natural History of Type 2 Diabetes: 3-Year Cohort Study in China

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Lu Liu ◽  
Xiaoling Guan ◽  
Zhongshang Yuan ◽  
Meng Zhao ◽  
Qiu Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Natural History ◽  
Glucose Tolerance ◽  
Serum Triglyceride ◽  
Glycemic Status ◽  
History Of

Aim. It is known that different stages of type 2 diabetes represent distinct pathophysiological changes, but how the spectrum of risk factors varies at different stages is not yet clarified. Hence, the aim of this study was to compare the effect of different metabolic variables on the natural history of type 2 diabetes. Methods. A total of 5,213 nondiabetic (normal glucose tolerance (NGT) and prediabetes) Chinese older than 40 years participated this prospective cohort study, and 4,577 completed the 3-year follow-up. Glycemic status was determined by standard oral glucose tolerance test both at enrollment and follow-up visit. Predictors for conversion in glycemic status were studied in a corresponding subcohort using the multiple logistic regression analysis. Results. The incidence of prediabetes and diabetes of the cohort was 93.6 and 42.2 per 1,000 person-years, respectively. After a 3-year follow-up, 33.1% of prediabetes patients regressed to NGT. The predictive weight of body mass index (BMI), serum triglyceride, total cholesterol, and systolic blood pressure in different paths of conversions among diabetes, prediabetes, and NGT differed. Specifically, BMI was the strongest predictor for regression from prediabetes to NGT, while triglyceride was most prominent for onset of diabetes. One SD increase in serum triglyceride was associated with a 1.29- (95% CI 1.10–1.52; P=0.002) or 1.12- (95% CI 1.01–1.27; P=0.039) fold higher risk of diabetes for individuals with NGT or prediabetes, respectively. Conclusion. Risk factors for different stages of diabetes differed, suggesting personalized preventive strategies for individuals with different basal glycemic statuses.

Long Term Follow-Up of Pediatric Sickle Cell Disease Patients with Conditional Velocities on Transcranial Doppler (TCD).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2338-2338
Author(s):  
Lena Coïc ◽  
Suzanne Verlhac ◽  
Emmanuelle Lesprit ◽  
Emmanuelle Fleurence ◽  
Francoise Bernaudin
Keyword(s):  
Risk Factors ◽  
Color Doppler ◽  
Significant Risk ◽  
Biological Data ◽  
Treatment Intensification ◽  
Significant Difference ◽  
History Of ◽  
The Mean

Abstract Abnormal TCD defined as high mean maximum velocities &gt; 200 cm/sec are highly predictive of stroke risk and justify long term transfusion program. Outcome and risk factors of conditional TCD defined as velocities 170–200 cm/sec remains to be described. Patients and methods Since 1992, 371 pediatric SCD patients (303 SS, 44 SC, 18 Sß+, 6 Sß0) were systematically explored once a year by TCD. The newborn screened cohort (n=174) had the first TCD exploration between 12 and 18 months of age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. Biological data were assessed at baseline, after the age of 1.5 years and remotely of transfusion or VOC. We report the characteristics and the outcome in patients (n=43) with an history of conditional TCD defined by mean maximum velocities ranging between 170 and 200 cm/s in the ACM, the ACA or the ICA. Results: The mean follow-up of TCD monitoring was 5,5 years (0 – 11,8 y). All patients with an history of conditional doppler were SS/Sb0 (n=43). Mean (SD) age of patients at the time of their first conditional TCD was 4.3 years (2.2) whereas in our series the mean age at abnormal TCD (&gt; 200 cm/sec) occurrence was 6.6 years (3.2). Comparison of basal parameters showed highly significant differences between patients with conditional TCD and those with normal TCD: Hb 7g4 vs 8g5 (p&lt;0.001), MCV 82.8 vs 79 (p=0.047). We also had found such differences between patients with normal and those with abnormal TCD (Hb and MCV p&lt; 0.001). Two patients were lost of follow-up. Two patients died during a trip to Africa. Conditional TCD became abnormal in 11/43 patients and justified transfusion program. Mean (SD) conversion delay was 1.8 (2.0) years (range 0.5–7y). No stroke occurred. 16 patients required a treatment intensification for other indications (frequent VOC/ACS, splenic sequestrations): 6 were transplanted and 10 received HU or TP. Significant risk factors (Pearson) of conversion to abnormal were the age at time of conditional TCD occurrence &lt; 3 y (p&lt;0.001), baseline Hb &lt; 7g/dl (p=0.02) and MCV &gt; 80 (p=0.04). MRI/MRA was performed in 31/43 patients and showed ischemic lesions in 5 of them at the mean (SD) age of 7.1 y (1.8) (range 4.5–8.9): no significant difference was observed in the occurrence of lesions between the 2 groups. Conclusions This study confirms the importance of age as predictive factor of conditional to abnormal TCD conversion with a risk of 64% when first conditional TCD occured before the age of 3 years. TCD has to be frequently controled during the 5 first years of life.

Essential Thrombocythemia: Analysis of Risk Factors for Thrombotic Events in a Series of 306 Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4937-4937
Author(s):  
Franca Radaelli ◽  
Stefania Bramanti ◽  
Mariangela Colombi ◽  
Alessandra Iurlo ◽  
Alberto Zanella
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Essential Thrombocythemia ◽  
Thrombotic Event ◽  
Previous History ◽  
Significant Difference ◽  
Platelet Number ◽  
History Of

Abstract Essential thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by peripheral thrombocytosis and abnormal proliferation of megakariocytes in the bone marrow. Even thought thrombosis is frequently associated to ET, the risk factors of this clinical complication are still controversial. The aim of this retrospective, single institution study was to investigate clinical and laboratory characteristics associated with the occurrence of thrombotic events, with the purpose of identifying subgroups of patients who could benefit from antiaggregant and/or cytostatic treatment. 306 consecutive ET patients (109 men and 197 females, median age 58 yr) diagnosed between January 1979 and December 2002 were included in the study. At the time of analysis, 196 patients were still alive with a median follow up of 96 months. The following variables were investigated for the association with thrombotic complications: age, platelet count, previous history of thrombotic events, time from diagnosis, treatment with antiaggregant/cytostatic drugs, and cardiovascular risk factors such as arterial hypertension, obesity, hypercolesterolemia, diabetes, cigarette smoking. At the time of last follow up, 46 patients (15%) experienced at least one thrombotic event. The occurrence of thrombotic events was observed in 26/64 (40.6%) patients with previous history of thrombosis and in 20/242 (8.3%) patients with no previous history of thrombosis (p&lt;0.0001 Fisher’s exact test, odd ratio 7.6). A significant difference between the two groups of patients was also confirmed when Kaplan Meier estimates of thrombosis-free survival were compared by log-rank test (p&lt;0.0001). By logistic regression, platelet number at diagnosis did not associate with occurrence of thrombosis in the whole patient population. When patients without previous history of thrombosis were stratified according to the number of cardiovascular risk factors (none vs one vs more than one), a significant correlation with occurrence of thrombotic events was observed (Mantel-Haenszel Chi-square 5.47, p&lt;0.05). This study confirms that history of thrombosis is strongly related with risk of further thrombotic events in patients with ET, whereas platelet number at diagnosis does not seem to represent a prognostic factor. In patients with no previous history of thrombosis, the presence of other cardiovascular risk factors has to be taken into account when establishing the therapeutic approach.

Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

2000 ◽  
Vol 93 (6) ◽  
pp. 976-980 ◽  
Author(s):  
Eiichi Kobayashi ◽  
Naokatsu Saeki ◽  
Hiromichi Oishi ◽  
Shinji Hirai ◽  
Akira Yamaura
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Bleeding Episode ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

Relationship Between Insomnia, Depression, and Mortality: A 12-Year Follow-Up of Older Adults in the Community

2000 ◽  
Vol 12 (3) ◽  
pp. 295-306 ◽  
Author(s):  
Lena Mallon ◽  
Jan-Erik Broman ◽  
Jerker Hetta
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Natural History ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Mortality Data ◽  
Total Death ◽  
History Of

The purpose of the study was to investigate the natural history of insomnia and its association with depression and mortality. In 1983, 1,870 randomly selected subjects aged 45–65 years answered a questionnaire on sleep and health. Of the 1,604 survivors in 1995, 1,244 (77.6%) answered a new questionnaire with almost identical questions. Mortality data were collected for the 266 subjects that had died during the follow-up period. Chronic insomnia was reported by 36.0% of women and 25.4% of men (χ2 = 9.7; p < .01). About 75% of subjects with insomnia at baseline continued to have insomnia at follow-up. Insomnia in women predicted subsequent depression (odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.1–7.2) but was not related to mortality. In men, insomnia predicted mortality (OR = 1.7; 95% CI 1.2–2.3), but after adjustment for an array of possible risk factors, this association was no longer significant. Men with depression at baseline had an adjusted total death rate that was 1.9 times higher than in the nondepressed men (95% CI: 1.2–3.0).

Risk Factors for Growth of Unruptured Intracranial Aneurysms: Follow-up Study by Serial 0.5–T Magnetic Resonance Angiography

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1047-1053 ◽  
Author(s):  
Nobuhiko Miyazawa ◽  
Iwao Akiyama ◽  
Zentaro Yamagata
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Unruptured Aneurysms ◽  
Logistic Analysis ◽  
Aneurysm Size ◽  
History Of ◽  
Aneurysm Growth ◽  
Independent Risk Factors

Abstract OBJECTIVE: The independent risk factors for aneurysm growth were retrospectively investigated in 130 patients with unruptured aneurysms who were followed up by 0.5–T serial magnetic resonance angiography with stereoscopic images. METHODS: Age, sex, site of aneurysm, size of aneurysm, multiplicity of aneurysms, type of circle of Willis, length of follow-up period, cerebrovascular event, hypertension, diabetes, hyperlipidemia, smoking habit, and family history of subarachnoid hemorrhage were investigated using multiple logistic analysis. RESULTS: Fourteen patients (16 aneurysms) among the 130 patients (159 aneurysms) showed aneurysm growth (10.8%) during follow-up of 10 to 69 months (mean 29.3 ± 10.5 mo). Multiple logistic analysis disclosed that location on the middle cerebral artery (odds ratio [OR] 0.08, P &lt; 0.01), multiplicity of aneurysms (OR 68.5, P &lt; 0.01), aneurysm size of 5 mm or larger (OR 1.17, P = 0.05), and family history of subarachnoid hemorrhage (OR 10.9, P &lt; 0.01) were independent risk factors. CONCLUSION: Location on the middle cerebral artery, multiplicity, aneurysm size of 5 mm or larger, and family history of subarachnoid hemorrhage are independent risk factors for aneurysm growth. These results may help to determine the treatment choice for unruptured aneurysms.

The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the manitoba follow-up study

1995 ◽  
Vol 98 (5) ◽  
pp. 476-484 ◽  
Author(s):  
Andrew D. Krahn ◽  
Jure Manfreda ◽  
Robert B. Tate ◽  
Francis A.L. Mathewson ◽  
T. Edward Cuddy
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Natural History ◽  
Follow Up Study ◽  
Incidence Risk ◽  
History Of

Abstract 16649: Natural History of Ascending Aortic Aneurysms With Bicuspid and Tricuspid Aortic Valves

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Serena Tharakan ◽  
Christopher Bellaire ◽  
Jordan Roy ◽  
Miguel Bravo ◽  
John Puskas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Adverse Event Rate ◽  
Minimal Risk ◽  
Aortic Valves ◽  
High Risk Factors ◽  
Aortic Pathology ◽  
History Of

Introduction: Patients with bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) with ascending aortic aneurysms (AAA) are at risk for aortic complications. Meticulous follow-up and assessment of risk factors can mitigate the adverse aortic events. Hypothesis: We hypothesized that BAV and TAV with AAA can be managed conservatively with acceptable survival, low aortic complication rate, and timely surgery. Methods: From 2016 to 2018, 188 patients were seen for an isolated AAA. 147 patients had two or more CT scans (631-patient-years) which allowed measurement of aortic growth. We used a 1:1 greedy matching algorithm in R to identify similar cohorts of BAV and TAV patients matched by age, sex, hypertension, family history of aortic disease, coronary artery disease, and hyperlipidemia. Univariate and multivariate analysis of the unmatched cohorts were performed. Echocardiogram data was evaluated for each patient. Results: Initial mean AAA diameter was 4.3±0.58 cm (Table 1). The mean time between scans was 4.2 ± 3.3 years. 20 patients had an ascending aortic aneurysm ≥ 5cm with mean diameter 5.2 ± 0.23 cm (range 5.0-6.0 cm). Five patients had an aortic event (1 BAV and 4 TAV). Three of these aortic events lead to patient deaths (1 BAV and 2 TAV), in addition to one death (TAV) unrelated to aortic pathology. From time of enrollment, survival at 10 years was 90 ± 32%. Our model suggests that given the absence of known high risk factors, BAV patients do not have an accelerated ascending or root growth rate in comparison to their TAV counterparts. BAV patients do have higher rates of aortic stenosis (p <.05), a factor that influenced the need for aortic repair. Conclusion: In conclusion, regardless of aortic valve type, the associated AAA has a similar natural history and low adverse event rate. In the absence of risk factors, conservative management of AAA can be accomplished with minimal risk to the patient.

Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms

2013 ◽  
Vol 119 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Aichi Chien ◽  
Feng Liang ◽  
James Sayre ◽  
Noriko Salamon ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Unruptured Aneurysms ◽  
Multiple Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Aneurysm Growth ◽  
Small Aneurysms

Object This study was performed to investigate the risk factors related to the growth of small, asymptomatic, unruptured aneurysms in patients with no history of subarachnoid hemorrhage (SAH). Methods Between January 2005 and December 2010, a total of 508 patients in whom unruptured intracranial aneurysms were diagnosed at the University of California, Los Angeles medical center did not receive treatment to prevent rupture. Of these, 235 patients with no history of SAH who had asymptomatic, small, unruptured aneurysms (< 7 mm) were monitored with 3D CT angiography images. Follow-up images of the lesions were used to measure aneurysm size changes. Patient medical history, family history of SAH, aneurysm size, and location were studied to find the risk factors associated with small aneurysm growth. Results A total of 319 small aneurysms were included, with follow-up durations of 29.2 ± 20.6 months. Forty-two aneurysms increased in size during the follow-up; 5 aneurysms grew to become ≥ 7 mm within 38.2 ± 18.3 months. A trend of higher growth rates was found in single aneurysms than in multiple aneurysms (p = 0.07). A history of stroke was the only factor associated with single aneurysm growth (p = 0.03). The number of aneurysms (p = 0.011), number of aneurysms located within the posterior circulation (p = 0.030), and patient history of transient ischemic attack (p = 0.044) were related to multiple aneurysm growth. Conclusions Multiple small aneurysms are more likely to grow, and multiple aneurysms located in the posterior circulation may require additional attention. Although single aneurysms have a lower risk of growth, a trend of higher growth rates in single aneurysms was found.

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