Wellens’ Syndrome: Incidence, Characteristics, and Long-Term Clinical Outcomes

Abstract Background: Sparse study of large sample size are available on patients with Wellens’ syndrome. We sought to assess the current incidence, risk factors, clinical presentation and long-term outcomes of this population. Methods: Among a total of 3528 patients with ACS underwent angioplasty from 2017 to 2019 in our center, 2127 NSTE-ACS patients with culprit vessel of LAD were enrolled in this study. According to electrocardiographic criteria, they were divided into Wellens’ group (n = 200) and non-Wellens’ group (n =1927). The primary endpoint was cardiac death; the secondary endpoint was MACCE, a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, heart failure and stroke. Results: The incidence of Wellens’ syndrome was 5.7% (200 of 3528) in all the ACS patients. Wellens’ syndrome was more often manifested as NSTEMI (69% vs 17.5%, P＜0.001). Percent of preexisting coronary heart disease (39.6% vs 23%) and previous PCI (19.5% vs 9%) were significantly higher in the non-Wellens’ group than in Wellens’ group (all P<0.001). More importantly, the proportion of early PCI was higher in Wellens’ group (68% vs 59.3%, P=0.017). At a median follow-up of 24 months, Wellens’ syndrome was not a factor that affects the prognosis of MACCE (P=0.05) and cardiac death (P=0.188). Conclusions: In patients with NSTE-ACS, Wellens’ syndrome does not affect the prognosis. The presence of age≥65years, diabetes, NSTEMI, eGFR< 60ml/min and left main disease were associated with an incidence of cardiac death. Early recognition and aggressive intervention are critical as they may help to attenuate adverse outcomes.

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Abnormal Liver Function Tests and Long-Term Outcomes in Patients Discharged after Acute Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm10081730 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1730

Author(s):

Hiroshi Miyama ◽

Yasuyuki Shiraishi ◽

Shun Kohsaka ◽

Ayumi Goda ◽

Yosuke Nishihata ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Adverse Outcomes ◽

Long Term Outcomes ◽

Function Tests ◽

Parameter Values

Abnormal liver function tests (LFTs) are known to be associated with impaired clinical outcomes in heart failure (HF) patients. However, this implication varies with each single LFT panel. We aim to evaluate the long-term outcomes of acute HF (AHF) patients by assessing multiple LFT panels in combination. From a prospective multicenter registry in Japan, 1158 AHF patients who were successfully discharged were analyzed (mean age, 73.9 ± 13.5 years; men, 58%). LFTs (i.e., total bilirubin, aspartate aminotransferase or alanine aminotransferase, and alkaline phosphatase) at discharge were assessed; borderline and abnormal LFTs were defined as 1 and ≥2 parameter values above the normal range, respectively. The primary endpoint was composite of all-cause death or HF readmission. At the time of discharge, 28.7% and 8.6% of patients showed borderline and abnormal LFTs, respectively. There were 196 (16.9%) deaths and 298 (25.7%) HF readmissions during a median 12.4-month follow-up period. The abnormal LFTs group had a significantly higher risk of experiencing the composite outcome (adjusted hazard ratio: 1.51, 95% confidence interval: 1.08–2.12, p = 0.017), whereas the borderline LFTs group was not associated with higher risk of adverse events when referenced to the normal LFTs group. Among AHF patients, the combined elevation of ≥2 LFT panels at discharge was associated with long-term adverse outcomes.

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Long-term Outcomes of Patients with Anti–Leucine-Rich Glioma-Inactivated 1 Encephalitis

10.21203/rs.3.rs-76702/v1 ◽

2020 ◽

Author(s):

Shan Qiao ◽

Huai-kuan Wu ◽

Ling-ling Liu ◽

Ke-jun Zang ◽

Xuewu liu

Keyword(s):

Clinical Symptoms ◽

Early Recognition ◽

Chinese Patients ◽

Long Term Outcomes ◽

Ancillary Test ◽

Behavioral Abnormalities ◽

Long Term Follow Up ◽

And Behavior

Abstract Background: This report aims to provide a detailed description of the clinical manifestation, immunotherapy, and long-term outcomes of 117 Chinese patients with anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. Methods: We retrospectively selected 117 patients diagnosed with anti-LGI1 encephalitis from the databases of multiple clinical centers from September 2014 to December 2019. The clinical features, ancillary test results, and details of long-term outcomes were analyzed.Results: Among the 117 anti-LGI1 encephalitis patients, 81 (69%) were male and 36 (31%) were female; the median onset age was 51 years (range: 30-77 years). The median time from symptom onset until diagnosis was 8.7 weeks (range: 2-49 weeks). The main features evaluated in our cohort were seizures, cognitive impairment, and mental and behavioral abnormalities. One hundred and nine patients were treated with immunotherapy, After 3-5 days of treatment, the clinical symptoms were somewhat alleviated in all the patients, and their memory, mental ability, and behavior improved. The median follow-up time was 33 months (range: 6-59 months). A total of 19 (16%) patients experienced a relapse; the median duration from onset to the first relapse was 5 (0.3-27) months. There were no mortalities during the follow-up period.Conclusions: The outcome of patients with anti-LGI1 encephalitis is mostly favorable, although some patients continue to suffer from cognitive dysfunction. Early recognition is of great significance for the treatment of anti-LGI1 encephalitis. Prompt adequate immunotherapy has positive implications for the improvement of clinical symptoms of anti-LGI1 encephalitis. Long-term follow-up is important for the assessment of LGI1 antibody-mediated encephalitis.

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LO58: Long-term outcomes among emergency department syncope patients: a systematic review

CJEM ◽

10.1017/cem.2018.120 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S27-S27

Author(s):

C. Leafloor ◽

P. Jiho Hong ◽

L. Sikora ◽

J. Elliot ◽

M. Mukarram ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Phase 1 ◽

Adverse Outcomes ◽

Cochrane Central Register ◽

Phase 2 ◽

Long Term Outcomes ◽

One Year

Introduction: Approximately 50% of patients discharged from the Emergency Department (ED) after syncope have no cause found. Long-term outcomes among syncope patients are not well studied, to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for long-term (one year) outcomes among ED patients with syncope. We aim to use the results of this review to guide us in prospective analysis of one year outcomes with our large database of syncope patients. Methods: We searched Cochrane Central Register of Controlled Trials, Medline and Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from the inception to June, 2017. We included studies that reported long-term outcomes among adult ED patients (16 years or older) with syncope. We excluded studies on pediatric patients, and studies that included syncope mimickers: pre-syncope, seizure, intoxication, loss of consciousness after head trauma. We also excluded case reports, letters to the editor and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. We selected articles based on title and abstract review during phase-1 and conducted full article review during phase-2. Meta-analysis was performed by pooling the outcomes using random effects model (RevMan v.5.3; Cochrane Collaboration). Results: Initial literature search generated 2094 articles after duplicate removal. 50 articles remained after phase-1 (=0.85) and 16 articles were included in the systematic review after phase-2 (=0.86). The 16 included studies enrolled a total of 44,755 patients. Pooled analysis at 1-year follow-up showed the following outcomes: 7% mortality; 14% recurrence of syncope requiring hospitalization; one study reported that 0.6% of patients had a pacemaker inserted; and two studies reported 0.8 11.5% of patients suffered new arrhythmias. Conclusion: An important proportion of ED patients with syncope suffer outcomes at 1-year. Appropriate follow-up is needed to prevent long-term adverse outcomes. Further prospective research to identify patients at risk for long-term important cardiac outcomes and death is needed.

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A comparison of long-term clinical outcomes between PCI and medical therapy in patients with chronic total occlusion in non-Infarct-related arteries after AMI PCI

European Heart Journal ◽

10.1093/eurheartj/ehab724.1444 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Q Qin ◽

J Ma ◽

J Ge

Keyword(s):

Myocardial Infarction ◽

Medical Therapy ◽

Lower Incidence ◽

Cardiac Death ◽

Chronic Total Occlusion ◽

Long Term Outcomes ◽

Total Occlusion ◽

Kaplan Meier

Abstract Background Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) is one of the risk factors for mortality after acute myocardial infarction (AMI). However, there are limited data comparing the long-term outcomes of patients underwent successful percutaneous coronary intervention (s-PCI) with patients having medical therapy (MT) in CTO lesion after AMI PCI. Methods We retrospectively enrolled 330 patients (n=166 in s-PCI group and n=164 in MT group) with CTO in a non-IRA from a total of 4372 patients who underwent PCI after AMI from July 2011 to July 2019 in our center (Figure 1). Propensity matching (119 matched pairs) was used to adjust for baseline differences. Major adverse cardiovascular and cerebrovascular events (MACCEs) on follow-up were defined as the composite of cardiac death, all cause death, myocardial infarction (MI), stroke and any revascularization. Kaplan-Meier analysis were used to evaluate the long-term outcomes between s-PCI and MT group. Results The patients in MT group were older, more likely to be diagnosed as STEMI, had lower eGFR and higher peak troponin T level during AMI compared with s-PCI group. Furthermore, in MT group, the involvement of LAD as IRA (50.6% vs 38.6%, p=0.028) and LCX as CTO vessel (45.1% vs 27.1%, p=0.001) was more frequent than in s-PCI group, and thus the involvement of LAD as CTO vessel was less frequent (28.9% vs 39.8%, p<0.001). During a median follow-up period of 946 days, patients in s-PCI group had significantly lower incidences of cardiac death (3.0% vs 10.4%, p=0.017) and all cause death (5.4% vs 14.0%, p=0.030) when compared with patients in MT group. Moreover, after PSM, patients in s-PCI group still showed lower incidence of cardiac death (2.5% vs 9.2%, p=0.04). The incidence of MI, stroke, revascularization and MACCE showed no significant difference between the two groups both before and after PSM. In multivariate analysis, age (HR 1.06, 95% CI 1.02–1.10, p=0.003) and LVEF<50% (HR 4.71, 95% CI 1.72–12.90, p=0.003) showed significant correlation with long term cardiac death, however, successful CTO PCI showed borderline significance (HR 0.42, 95% CI 0.15–1.16, p=0.095). In subgroup analysis, Kaplan–Meier curve showed s-PCI group had a lower incidence of cardiac death compared with MT in patients with LVEF<50% both before (p=0.011) and after PSM (p=0.045). However, no difference was observed between two groups in patients with LVEF≥50%. Conclusions In our center, s-PCI of CTO in non-IRA after AMI PCI showed better long-term cardiac survival as compared with MT. Moreover, patients with low LVEF may be benefit from CTO PCI in non-IRA. FUNDunding Acknowledgement Type of funding sources: None. Flow chart of the study Kaplan-Meier analysis between two groups

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Abstract 351: Nonlinear Dynamics in Long-Term Left Ventricular Remodeling in Chagas Heart Disease and Adverse Outcomes: SEARCH-Rio Substudy

Circulation Research ◽

10.1161/res.111.suppl_1.a351 ◽

2012 ◽

Vol 111 (suppl_1) ◽

Author(s):

Paulo R Benchimol-Barbosa ◽

Bharat K Kantharia ◽

Claudio G Carvalhaes

Keyword(s):

Nonlinear Dynamics ◽

Heart Disease ◽

Cardiac Death ◽

Left Ventricular ◽

Adverse Outcomes ◽

Lv Mass ◽

Lv Remodeling ◽

Chagas Heart Disease

Introduction: Left ventricular (LV) remodeling in Chagas heart disease (CHD) depends on the severity of the initial insult and may have clinical implication. SEARCH-Rio study investigated nonlinear dynamics in long-term LV remodeling in CHD. Methods: Fifty stable outpatients with CHD were enrolled and followed at scheduled visits. Cardiac death (sudden, arrhythmic or heart failure) was ascertained by review of medical records. LV dimension was assessed by echocardiogram, and mass estimated by Devereux. Subjects were distributed in four equally spaced groups according to initial mass. Intra-group standard deviation (SD) was calculated throughout follow-up. A plot of LV mass (corrected to initial value) vs recurrences during follow-up assessed non-linear relationship. Lyapunov exponent (LE) assessed LV mass dynamics during follow-up. Results: Median follow-up was 95 months; 10 subjects died. LV mass groups were [mean; Figure 1]: I-110g, II-140g, III-170g, IV-200g. No inter-group SD differences at baseline were observed (p=NS; table inset). At end of follow-up, intra-group SD increased roughly proportional to initial mean LV mass (Figure 1; p=0.01). A logistic parabolic-shaped equation was fit to corrected LV mass data in the plot (r²=0.98) and alpha coefficient was 3.9 (p<0.01; Figure 2). In groups, median LE was: I: 0.22; II: 0.17; III: 0.22; IV: 0.15. Median LE was 0.7 for survivors and -0.45 for nonsurvivors. LE cutoff at 0.26 yielded 100% sensitivity and 88% specificity for cardiac death (AUC=0.89; p<0.01). Conclusion: In CHD, LV remodeling exhibits complex nonlinear dynamics. LV remodeling dynamics has prognostic implication in this population.

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Late Outcomes of Carotid Artery Stenting for Radiation Therapy-Induced Carotid Stenosis

Journal of Endovascular Therapy ◽

10.1177/15266028211068757 ◽

2022 ◽

pp. 152660282110687

Author(s):

Bahaa Nasr ◽

Valentin Crespy ◽

Edouard Penasse ◽

Marine Gaudry ◽

Eugenio Rosset ◽

...

Keyword(s):

Radiation Therapy ◽

Mortality Rate ◽

Carotid Artery ◽

Carotid Stenosis ◽

Target Lesion ◽

Long Term Outcomes ◽

Stent Restenosis ◽

In Stent Restenosis

Purpose: Carotid artery stenting (CAS) appears as a promising alternative treatment to carotid endarterectomy for radiation therapy (RT)-induced carotid stenosis. However, this is based on a poor level of evidence studies (small sample size, primarily single institution reports, few long-term data). The purpose of this study was to report the long-term outcomes of a multicentric series of CAS for RT-induced stenosis. Methods: All CAS for RT-induced stenosis performed in 11 French academic institutions from 2005 to 2017 were collected in this retrospective study. Patient demographics, clinical risk factors, elapsed time from RT, clinical presentation and imaging parameters of carotid stenosis were preoperatively gathered. Long-term outcomes were determined by clinical follow-up and duplex ultrasound. The primary endpoint was the occurrence of cerebrovascular events during follow-up. Secondary endpoints included perioperative morbidity and mortality rate, long-term mortality rate, primary patency, and target lesion revascularization. Results: One hundred and twenty-one CAS procedures were performed in 112 patients. The mean interval between irradiation and CAS was 15 ± 12 years. In 31.4% of cases, the lesion was symptomatic. Mean follow-up was 42.5 ± 32.6 months (range 1–141 months). The mortality rate at 5 years was 23%. The neurologic event-free survival and the in-stent restenosis rates at 5 years were 87.8% and 38.9%, respectively. Diabetes mellitus (p=0.02) and single postoperative antiplatelet therapy (p=0.001) were found to be significant predictors of in-stent restenosis. Freedom from target lesion revascularization was 91.9% at 5 years. Conclusion: This study showed that CAS is an effective option for RT-induced stenosis in patients not favorable to carotid endarterectomy. The CAS was associated with a low rate of neurological events and reinterventions at long-term follow-up.

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Study protocol: The Dutch 20|30 Postmeningitis study: a cross-sectional follow-up of two historical childhood bacterial meningitis cohorts on long-term outcomes

BMC Pediatrics ◽

10.1186/s12887-019-1900-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

O. El Tahir ◽

R. C. J. de Jonge ◽

S. Ouburg ◽

S. A. Morré ◽

A. M. van Furth

Keyword(s):

Quality Of Life ◽

Bacterial Meningitis ◽

Prediction Models ◽

Adverse Outcomes ◽

Long Term Effects ◽

Long Term Outcomes ◽

Cross Sectional

Abstract Background Bacterial meningitis (BM) is a serious, life-threatening infectious disease of the central nervous system that often occurs in young children. The most common severe to moderate sequelae following BM are sensorineural hearing loss, neuromotor disabilities and mental retardation, while subtle sequelae include academic and behavioral disabilities. It is largely unknown whether these more subtle sequelae persist into adolescence and adulthood. Therefore, this study will investigate the very long-term effects of childhood BM in later life. Better understanding of long-term effects and early identification of adverse outcomes after BM are essential for more timely interventions. Additionally, certain single nucleotide polymorphisms (SNPs) are associated with disease severity and might predict adverse sequelae. These include SNPs in genes encoding for pathogen recognition and immune response upon infection. Accordingly, a secondary objective of this study is to investigate the role of genetic variation in BM and use any insights to predict short- and long-term outcomes. Methods In the Dutch 20|30 Postmeningitis study, adolescents and young adults (n = 947) from two historical cohorts with a prior episode of BM during childhood will be enrolled into a cross-sectional follow-up investigation using mainly questionnaires that examine executive and behavioral functioning, health-related quality of life, subjective hearing, mood and sleeping disorders, academic performance, and economic self-sufficiency. The results will be compared to normative data by one-sample t-tests. Multivariable regression analysis will be used to assess for any associations with causative pathogens and severity of BM. Participants that complete the questionnaires will be approached to provide a swab for buccal DNA and subsequent sequencing analyses. Logistic regression models will be used to predict sequelae. Discussion The unique follow-up duration of this cohort will enable us to gain insights into the possible very long-term adverse effects of childhood BM and how these might impact on quality of life. The investigation of host genetic factors will contribute to the development of prediction models which will serve as prognostic tools to identify children who are at high risk of adverse outcome after BM. Trial Registration Dutch Trial Register NTR-6891. Retrospectively registered 28 December 2017.

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Long-Term Outcomes of Acute Osteoarticular Infections in Children

Frontiers in Pediatrics ◽

10.3389/fped.2020.587740 ◽

2020 ◽

Vol 8 ◽

Author(s):

Nora Manz ◽

Andreas H. Krieg ◽

Michael Buettcher ◽

Nicole Ritz ◽

Ulrich Heininger

Keyword(s):

Medical Care ◽

Adverse Outcomes ◽

Initial Presentation ◽

Joint Involvement ◽

Long Term Outcomes ◽

Osteoarticular Infections ◽

Number Of Patients ◽

Long Term Follow Up

Background: Acute hematogenous osteomyelitis (OM) and septic arthritis require immediate diagnosis and treatment by an interdisciplinary team of pediatric infectious disease specialists and pediatric orthopedic surgeons. Adverse outcomes such as growth disturbance, bone deformity, and chronic infections have been described in older studies. However, there is only little known about long-term follow-up of patients of the last two decades. Therefore, we aimed to evaluate subjective and objective long-term outcomes of these children with osteoarticular infections treated in the millennial years.Methods: Cross-sectional study performed in two pediatric centers including patients admitted for OM and/or SA between 2005 and 2014 and follow-up consultations in 2019. Patients with symptoms of ≤2 weeks duration at initial presentation were contacted. Subjective outcomes were assessed by standardized interview, objective outcomes by clinical examination. Medical charts were used to extract data from the initial presentations. Statistical analysis was performed by non-parametric tests and Fisher's exact test.Results: Of 147 eligible patients 77 (52%) agreed to participate, of which 68 (88%) had an interview and physical examination and 9 (12%) an interview only. Thirty-three (39%) had OM, 26 (34%) SA, and 21 (27%) combined OM/SA. Median (IQR) age at follow-up was 13.3 (10.5–18.0) years with a median (IQR) follow-up of 7.1 (6.1–8.6) years. Persistent complaints including pain, functional differences and scar paresthesia, reported by 21 (28%) patients, were generally mild and only 3 (5%) required ongoing medical care. Objective sequelae including pain, limited range of motion, unilateral axis deformity or asymmetric gait were found in 8 (12%) participants. Older age, female sex, joint involvement, surgical intervention, persistent fever, and C-reactive protein elevation were associated with adverse clinical outcome.Conclusions: Adverse outcomes were observed in a considerable number of patients, most of which were minor, and only few required ongoing medical care. Long-term follow up is advisable for patients with risk factors identified during the initial presentation.This study was registered on ClinicalTrials.gov (NCT03827980).

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Laryngeal cancer

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738017721939 ◽

2017 ◽

Vol 10 (10) ◽

pp. 585-593 ◽

Cited By ~ 1

Author(s):

Hammaad Khan ◽

Karan Jolly

Keyword(s):

Head And Neck Cancer ◽

Early Diagnosis ◽

Head And Neck ◽

Laryngeal Cancer ◽

Neck Cancer ◽

Early Recognition ◽

Long Term Outcomes ◽

The Uk

Laryngeal cancer is the most common form of head and neck cancer in the UK. The majority of cases are in people aged 60 years and over. Early diagnosis improves long-term outcomes and requires early recognition of significant symptoms and prompt referral. This article aims to provide an overview of the presenting features, investigation, management and follow-up of laryngeal cancer.

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Long-term outcome of first 300 implanted Absorb bioresorbable vascular scaffolds in an all-comers Middle East population

Journal of International Medical Research ◽

10.1177/0300060518798994 ◽

2018 ◽

Vol 47 (1) ◽

pp. 173-187 ◽

Cited By ~ 1

Author(s):

Arif Al Nooryani ◽

Wael N. Elabbassi ◽

Bassam AlBaba ◽

Jalal A. Kerfes ◽

Loai M. Abudaqa ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Death ◽

Target Lesion ◽

Target Vessel ◽

Term Outcome ◽

Long Term Outcome ◽

Absorb Bvs

Objectives To evaluate long-term clinical outcomes of the Absorb bioresorbable vascular scaffold (BVS) system (Abbott Vascular) in an all-comers Middle East population. Methods This prospective registry study included an initial set of patients with coronary lesions treated using Absorb BVS. Patients were followed for target vessel failure (TVF) including cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization. Results A total of 217 patients (age, 55 ± 11 years; male, 169) with 300 treated lesions were included (median follow-up, 36 months [range, 26–41 months]; complete follow-up, 201 patients). Diabetes mellitus and acute coronary syndrome were present in 50% and 57% of patients, respectively. TVF rate was 32/201 (15.9%), including cardiac death in 10 (5%), target vessel MI in 13 (6.5%), and target lesion revascularization in 22 patients (10.9%). Definite or probable device thrombosis occurred in 11/201 patients (5.5%). TVF was associated with heart failure, worse ejection fraction, multi-vessel BVS, multi BVS in lesion, and total BVS length >50 mm. Conclusions Long-term outcome following Absorb BVS implantation in a population with high prevalence of high-risk and complex patients is acceptable, but heart failure, worse ejection fraction, and multi-vessel or long BVS implantation were associated with worse outcomes.

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