Aspects of practical application of ‘STOPP/START’ criteria in elderly patients with atrial fibrillation and chronic kidney disease in therapeutic department of multi‑speciality hospital

2021 ◽  
pp. 57-65
Author(s):  
S. V. Batyukina ◽  
O. D. Ostroumova ◽  
A. I. Kochetkov ◽  
E. Yu. Ebzeeva ◽  
R. R. Romanovsky ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Drug Reactions ◽  
Start Criteria ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Introduction. Polypharmacy and the administration of potentially non-recommended drugs are the causes of adverse drug reactions. The absence of potentially recommended drugs leads to a decrease in the duration and quality of life, an increased risk of complications from various organs and systems.The purpose of the study. To analyze the structure of prescribed drugs in patients over 65 years of age with atrial fibrillation (AF) and chronic kidney disease (CKD) stages 3 and 4 for the presence of рolypharmacy and compliance of prescriptions with the criteria STOPP/START.Materials and methods. 125 case histories were analyzed in patients 65 years and older with AF and CKD. Patients were divided into two groups: group 1 – patients with AF and CKD 3a (n = 51; 84.3 % of women; mean age 86.1 ± 6.4 years; mean score on the CHA(2) DS(2)-VASc scale 6.2 ± 1.1 points; mean score on the HAS-BLED scale 3.00 ± 0.68 points); group 2 – patients with AF and CKD 3b and 4 stages (n = 39; 84.6 % of women; mean age 87.9 ± 4.7 years; mean score on the CHA(2) scale; DS(2)-VASc 6.1 ± 1.2 points; the average score on the HAS-BLED scale is 3.10 ± 0.71 points). All 100 % of patients in both groups had a high risk of stroke on the CHA(2) DS(2)-VASc scale (≥ 2 points for men; ≥ 3 points for women), 82.4 % of patients in group 1 and 79.5 % of patients in group 2 had a high risk of bleeding on the HAS-BLED scale (≥ 3 points). According to the prescribing sheets of medical histories, the frequency of polypharmacy was evaluated, as well as the structure of drug prescriptions according to the STOPP/START criteria.Results. The number of patients who were prescribed ≥5 drugs was 100 % in group 1 and 94.9 % in group 2. The number of patients receiving ≥10 drugs at the same time was 11.8 % and 20.5 % in group 1 and 2, respectively. In 64.7 % of patients from group 1 and in 53.8 % of patients from group 2, potentially non-recommended but prescribed drugs (STOPP) are present in the prescribing lists. At the same time, 96.1 % and 100 % of patients in groups 1 and 2, respectively, were not prescribed drugs that are recommended for elderly patients (START criteria).Conclusion. Patients with AF and CKD aged 65 years and older are often prescribed potentially non-recommended drugs that significantly reduce the quality of life and increase the risk of adverse drug reactions. These patients were also often not prescribed potentially recommended drugs that are necessary to improve the prognosis, reduce the risk of complications, and reduce the number of hospitalizations. The revealed facts dictate the need to optimize pharmacotherapy in elderly and senile patients with AF and CKD in a hospital setting.

Anxiety-depressive disorders and quality of life in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Demenko ◽  
G.A Chumakova
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Atrial Fibrillation ◽  
Correlation Analysis ◽  
Depressive Disorders ◽  
Life Assessment ◽  
Mild Depression ◽  
Group 2 ◽  
Group 1

Abstract Background Mental disorders in patients with cardiovascular disease have a significant impact on the course, the prognosis of the underlying disease and quality of life (QOL). Objective We aimed to examine the prevalence of anxiety and depressive disorders and their impact on the quality of life in patients with atrial fibrillation (AF). Materials and methods In 52 with permanent AF and 50 with paroxysmal AF patients, we administered the depression scale Tsung, the scale of situational anxiety (SA) and personal anxiety (PA) Spielberger-Hanin; QOL was assessed the SF-36 quality of life assessment scale. Correlation analysis using Spearman's rank correlation coefficient. Results The prevalence symptoms mild depression situational or neurotic genesis was 21.1% (12 patients) in Group 1 and 12.0% (6 patients) in Group 2 (p>0.05). Subdepressive state was two percents of patients in Group 1 and Group 2. The incidence SA was 59.6% (31 patients) in Group 1 and 52.0% (26 patients) in Group 2. The incidence PA was 74.0% (37 patients) in Group 2 and 67.3% (35 patients) in Group 1. The average score the physical component of health (PCH) was 29,8±4,3 in Group 1, the mental component of health (MCH) – 49.5±7.4 points; p<0.05. In Group 2: PCH – 44.8±6.6 points, MCH – 26.6±7.5 points; p<0.05. Correlation analysis showed negative strong correlations between SA and MCH (r=−0.64, p=0.0005) and between PA and MCH (r=−0.69, p<0.0001), between SA and PCH (r=−0.71, p=0.0001), between depression and PCH (r=−0.69, p=0.023). Negative statistically significant correlation between depression and MCH (r=−0.69, p=0.54) and negative medium correlation between depression and PCH (r=−0.64, p=0.23). Conclusion These findings suggest that we did not identify patients with symptoms of a true depressive (that can cause pseudodementia and influenced to complete tests). 16.5% patients with AF had mild depression of situational or neurotic genesis. Depression may be a pathogenetic factor of AF or develop because of paroxysms AF – psychological stress. More than 50% patients in Group 1 and Group 2 had an increased anxiety score. SA is more common in patients with permanent AF, probably because older people difficult to adapt to a new situation. PA is more common in patient with paroxysmal AF, probably because disease is sudden and causes anxiety. The PCH of QOL is more impairment in patients with permanent AF, because complications (for example heart failure) impairment physical activity. However, PCH also reduced in patient with paroxysmal AF, because disease is sudden may occur during physical activity. The MCH of QOL is more impairment in patients with paroxysmal AF, because waiting attack effect on mental health and social functioning. An increased level of anxiety and depression negatively affected the mental and physical health of patients with AF. Funding Acknowledgement Type of funding source: None

scholarly journals The influence of HDBA organic complex with vitamin d and calcium on quality of life in individuals at high risk of fractures undergoing medical rehabilitation

2020 ◽  
Vol 97 (3) ◽  
pp. 153-159
Author(s):  
L.A. Marchenkova ◽  
E.V. Makarova ◽  
V.A. Vasileva
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Food Supplement ◽  
Biologically Active ◽  
Medical Rehabilitation ◽  
Life Assessment ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study is to evaluate the effect of the biologically active food supplement «Osteomed Forte» on pain intensity and quality of life in patients with high risk of fractures undergoing medical rehabilitation. Materials and methods: Included men and women 40-80 years old, with high risk of fractures. Patients who had already taken antiresorbents were identified in group №1 - they were assigned the investigated product (IP): biologically active food supplement «Osteomed Forte». Patients who had not received antiresorption therapy were divided into two equal groups by simple randomization. Group №2 was assigned to IP. There were no IPs in group №3. All the subjects were conducted: 1. Pain Assessment Score (PAS); 2. Quality of Life Assessment (QUALEFFO-41). The examination was repeated immediately after the rehabilitation course as well as after 6 and 12 months. Results: The study enrolled 120 people (group №1 n=41, group №2 n=39, group №3 n=39): 10 men, 110 women, average age 65.51±7.92 years. After a course of rehabilitation in all groups, PAS was significantly reduced (2.7, 3.0, 3.5 points, respectively, p<0.01), and the QUALEFFO-41 scores improved on all scales (p<0.05). This trend continued after 6 months. After 12 months, a significantly lower PAS was in group №1 (4.0 as compared to 6.2 and 6.4 points, p<0.05). In group №1, QUALEFFO-41 indices were significantly better than the initial ones (p<0,05) and higher than in groups №2 and 3 «Pain», «Housework», «Mobility», «General Health», «Mental Health», «General Indicator» (p<0,05). Conclusion: In patients with a high risk of fractures, the course of medical rehabilitation improved the physical and mental components of QOL and reduced the pain syndrome. In patients who took IP as a basic therapy, the achieved effect was maintained after 3, 6, 12 months. In 1 year after the rehabilitation course, the groups receiving IP and antiresorption therapy had better QOL parameters, lower PAS and better bone metabolism indices.

P1407Efficacy of radiofrequency ablation of paroxysmal and persistent atrial fibrillation in heart failure patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Seliutskii ◽  
N Savina ◽  
A Chapurnykh
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Left Atrium ◽  
Sf 36 ◽  
Group 2 ◽  
Group 1

Abstract Background radiofrequency ablation (RFA) is considered to be one of the most preferred treatments for atrial fibrillation (AFib) in patients with heart failure (HF). Objective to study the effectiveness of AFib RFA in patients with HF, to compare the effectiveness of the procedure in patients with paroxysmal (PaAFib) and persistent (PeAFib) AFib. Materials and methods 65 patients with AF and HF with LVEF &lt; 50%, who underwent RFA were included in a prospective study. All patients underwent transthoracic echocardiography and quality of life assessment using the SF-36 questionnaire before RFA and after 12 months. AFib was recorded in 42 (65%) of patients, AFL in 23 (35%). Thirty (46%) patients had PaAfib (Group 1), and 35 (54%) PeAFib (Group 2). Results In 45 (69%) patients sinus rhythm (SR) was restored during RFA, in 15 (23%) SR was restored by electrical cardioversion. In 5 (8%) patients with PaAFib revealed SR at the time of RFA. Twelve month follow-up period revealed 49 (75%) patients who were free from AFib: 23 (77%) patients with PaAFib and 26 (74%) with PeAFib. After 12 month follow-up we revealed the improvement in LVEF (p &lt; 0.001 in both groups), decrease of anteroposterior size of left atrium (LA) (p &lt; 0.001 in both groups) and LA volume (p &lt; 0.001 in both groups), improvement in the mental (p = 0.008 in Group 1; p = 0.006 in Group 2) and physical component of health according to the SF-36 questionnaire (p = 0.036 in Group 1; p = 0.049 in Group 2). There were no significant differences between two groups of follow-up period. Conclusions AFib RFA significantly improves the course of heart failure and the quality of life of patients, leads to decrease of left atrium size and increase of LVEF. The effectiveness of RFA does not depend on the type of arrhythmia in  HF patients.

scholarly journals Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study)

Pituitary ◽  
2021 ◽  
Author(s):  
Muhammad Fahad Arshad ◽  
Oluwafunto Ogunleye ◽  
Richard Ross ◽  
Miguel Debono
Keyword(s):  
Quality Of Life ◽  
Medical Treatment ◽  
Physical Component Score ◽  
Healthy Controls ◽  
Component Score ◽  
Post Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Purpose There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. Methods QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into—Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). Results There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = − 2.5, 95% CI − 16.6 to 11.6; p = 0.72), SF36v2 [Physical component score (PCS) MD = − 4.9, 95% CI − 10.9 to 1.2; p = 0.12; mental component score MD = − 3.0, 95% CI − 10.5 to 4.4; p = 0.44], or FSS (MD = − 0.004, 95% CI − 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = − 8.3, 95% CI − 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. Conclusions Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.

scholarly journals Arthroscopic revision surgery in the arthrofibrotic knee: who benefits?

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Christian Weber ◽  
Jochen Müller-Stromberg ◽  
Nicola Weber
Keyword(s):  
Quality Of Life ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Knee Score ◽  
Sports Activity ◽  
Activity Scale ◽  
Group 2 ◽  
Group 1

Arthrofibrotic stiffness of the knee joint has been recognized as a highly debilitating complication after complex knee reconstruction. The clinical impact of arthroscopic revision surgery was evaluated for patients with knee arthrofibrosis following total knee arthroplasty (TKA) and after joint preserving procedures. Hypothesis: Arthroscopic revision surgery is associated with functional benefits in both groups. We retrospectively reviewed a consecutive series of adult patients (#CHR: greaterlike#18 years) at a single institution who underwent arthroscopic revision for knee stiffness. Minimum follow-up: 24 months. The analysis included demographic, surgical and histological data. The following outcome parameters were evaluated: pain (Visual Analog Scale, VAS); objective score systems (Oxford Knee Score) and patient activity (Tegner Activity Scale (TAS), Univ. of California Activity Scale (UCLA)). Furthermore, range of motion (ROM) was compared pre-, intra- and postoperatively. Finally, we compared body mass index (BMI) and quality of life (EQ-5D) changes. We identified a total of 57 patients who underwent arthroscopic adhesiolysis for knee arthrofibrosis: 45 after TKA (Group 1) and 12 patients with ligament reconstruction (Group 2). The patient cohort included thirty (43.5%) males and thirty-six (56.5%) females. Mean age was 69 (SD 10.6) years in the TKA group and 41 (SD 12.7) years in group 2 (p=0.01). Mean length of stay (LOS) was 4.6 days in Group 1 and 2.8 days in Group 2. Pain levels (VAS) were reduced significantly in both groups (p=0.004); from 7.5 to 4.8 in Group 1 and from 7.8 to 2.9 (Group 2). In terms of sports activity, 26 patients (37.7%) reported an improved sports activity (UCLA score). The TAS improved from 2.58 to 4.08 in Group 2. The Oxford Knee Score improved from 23.5 to 27.2 in Group 1 and from 16.5 to 36.3 in Group 2. No reduction in BMI was observed. However, quality of life (EQ-5D) improved from 47.6 to 51.9 Group 1; and from 52.9 to 71.7 in Group 2. Arthroscopic revision of the stiff knee may offer clinical benefits in terms of significant pain reduction, an improved level of activity and quality of life in stiffness following both TKA and joint preserving surgical reconstruction.

scholarly journals Single sitting multimodality management of hemorrhoid

2021 ◽  
Vol 8 (11) ◽  
pp. 3302
Author(s):  
Mahendra P. Singh
Keyword(s):  
Variable Number ◽  
Concomitant Treatment ◽  
Stage Management ◽  
Group 4 ◽  
Number Of Patients ◽  
Clinical Complexity ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: It is usual to face clinical complexity in piles patients. They usually present with variable number of pile masses and in different grades of progression. This led to the idea of offering concomitant single stage management in our hemorrhoid patients matching to our criteria. We conducted hospital based descriptive study among the patients coming to my clinical practice falling in grade-1-3.Methods: All the patients falling in grade-1-3 and matching to our criteria were included. The study was conducted   from January 2012 to December 2020. Place of study was basically at two centres: Karamdeep medical centre, Kanpur and Mayo health care, Mohali. Total number of patients were 581. Patients having grade-4 piles and with local co-morbidities were excluded from the study. Modalities of treatment used were sclerotherapy, band ligation and hemorrhoidectomy.Results: Patients managed were divided into four groups – group 1 included patients with piles in grade-1; group-2 included patients having piles in grade-1 and 2; group-3 included patients having piles in grade-1 and 3; and group-4 included patients having piles in grade-1, 2 and 3. Total 952 pile masses were treated in 581 patients. Sclerotherapy was required in 732 (77%) masses, banding in 99 (10.3%) masses and surgery in 122 (12.7%) masses.Conclusions: Concomitant treatment policy proved to be comprehensive way to tackle pile patients of grade-1-3. Mixed and matched method using surgical and non-surgical modalities in a single sitting proved to be beneficial. 86.4% cases were cured this way. Cost of the treatment was economical with lesser complications including local mutilation and better quality of life.

Comparison of polymethoxyethylacrylate-coated circuits with leukocyte filtration and reduced heparinization protocol on heparin-bonded circuits in different risk cohorts

Perfusion ◽  
2006 ◽  
Vol 21 (6) ◽  
pp. 329-342 ◽  
Author(s):  
Serdar Gunaydin ◽  
Kevin McCusker ◽  
Venkataramana Vijay ◽  
Selim Isbir ◽  
Tamer Sari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Control Cell ◽  
Postoperative Bleeding ◽  
Cell Counts ◽  
Heparin Administration ◽  
Control Serum ◽  
Group 2 ◽  
Filter Mesh ◽  
Group 1

Objectives: The relative benefits of strategic leukofiltration on polymer-coated and low-dose heparin protocol on heparin-coated circuits were studied across EuroSCORE patient risk strata for three different cohorts. Methods: In a prospective, randomized study, 270 patients undergoing coronary artery bypass grafting were allocated into three groups (n = 90): Group 1 -polymethoxyethylacrylate-coated circuits+leukocyte filters; Group 2 -polypeptide-based heparin-bonded circuits with reduced heparinization; and Group 3 -Control: uncoated circuits. Each group was further divided into three subgroups (n = 30), with respect to low- (EuroSCORE 0-2), medium- (3-5), and high- (6+) risk patients. Blood samples were collected at T1: following induction of anesthesia; T2: following heparin administration; T3: 15 min after CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal; and T6: ICU. Results: In high-risk cohorts, leukocyte counts demonstrated significant differences at T4 and T5 in Group 1, and at T4 in Group 2. Platelet counts were preserved significantly better at T4 and T5 in both groups (p <0.05 versus control). Serum IL-2 and C3a levels were significantly lower at T3, T4 and T5 in Group 1, and T4 and T5 in Group 2 (p <0.05). Postoperative bleeding, respiratory support time and incidence of atrial fibrillation were lower in the study groups versus control. Cell counts on filter mesh and heparin-coated fibers/circuits were significantly higher in the high-risk cohorts versus uncoated fibers. Phagocytic capacity increased on filter mesh, especially in high-risk specimens. SEM evaluation demonstrated better preserved coated circuits. Conclusion: Leukofiltration and coating reduced platelet adhesion, protein adsorption, atrial fibrillation and reduced heparinization acted via modulation of systemic inflammatory response in high-risk groups.

TREATMENT OF A COMBINATION OF DIABETIC POLYNEUROPATHY WITH TYPE 2 DIABETES AND GOUT

2021 ◽  
Vol 7 (3) ◽  
pp. 24-27
Author(s):  
S. Tokareva ◽  
R. Kupeev ◽  
Aleksandr Hadarcev ◽  
Sof'ya Belyaeva
Keyword(s):  
Quality Of Life ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Diabetic Polyneuropathy ◽  
Sf 36 ◽  
Effect Of Therapy ◽  
Male Patients ◽  
Group 2 ◽  
Group 1

The purpose of the work. To show the expediency of using a complex DPN therapy with thio-gammoy-600 in combination with TPP, B12-ankerman and febuxostat. Materials and research methods. The study involved 28 male patients suffering from DM2 aged 56-77 years, with an av-erage age of 64.6±0.7 years. The initial values of average fasting blood glucose were 7.8 ± 1.52 mmol/l, glycosylated hemoglobin 7.4 ± 0.13%. Two groups were identified: group 1 (main) – 14 people and group 2 (control) - 16 people. In group 2, basic DPN therapy was used (thiogamma 600 mg/day for 4 months). For the first 14 days, the drug was administered intravenously, and then administered orally. In group 1, in addition to basic DPN therapy, B12-ankerman and febuxostat (adenuric) – 80 mg/day were received. TPP was carried out on a portable device TPP-03 for 15 minutes daily. This treatment regimen was used for 4 months. The assessment of the quality of life (QL) was carried out using the MOS SF-36 questionnaire. Results and their discussion. Four months after the start of therapy, more pronounced changes were observed in patients of the first group. The total score of the NSS scale in this group increased by 28.9%, and in group 2 - by 18.8%. The positive effect of therapy with adenuric and TES on the course of DPN shows that the use of this treatment will naturally lead to an improve-ment in the quality of life of patients, the dynamics of which was studied according to the results of the SF-36 questionnaire.

MO799IS COMBINATION OF MAINTENANCE HEMODIALYSIS WITH HEMOPERFUSION AN EFFECTIVE METHOD IN MANAGEMENT OF RENAL OSTEODYSTROPHY AND INFLAMMATION IN HEMODIALYSIS PATIENTS?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Amela Beciragic ◽  
Alma Mutevelic-Turkovic ◽  
Amela Dervisevic ◽  
Badema Äœengiä† Roljiä† ◽  
Fahrudin Masnic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Renal Osteodystrophy ◽  
Uremic Toxins ◽  
Large Molecule ◽  
Maintenance Hemodialysis ◽  
Group 2 ◽  
Group 1

Abstract Background and Aims Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications. Method A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two groups: Group 1 (27 patients) received combined treatment of HD with hemoperfusion (HP) in this regimen: HD 2 times a week with HD+HP once a week two times in a row, then after two weeks, and afterwards once a month as a maintenance treatment. Group 2 (27 patients) was only undergoing maintenance HD 3 times a week. The clinical and laboratory properties of both groups were followed up for 18 months, whereas the primary outcomes included normal clinical data, high sensitive C-reactive protein (hsCRP), immunoreactive parathyroid hormone (iPTH), phosphorus (P04), calcium (Ca), albumin, iron (Fe), total iron binding capacity (TIBC), hemoglobin, Epo doses and types of hypertensive drugs. Results At the end of the 18-month observation, the serum concentration of albumin, P04, hsCRP, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower with Group 1 than with Group 2 (p&lt;0.05). Whereas, higher levels of iPTH were noticed in group 1, but when the laboratory and clinical data are analysed of the group 1 alone a statistically significant lower values after the observational period are noticed especially in the serum values of iPTH (p&lt;0.05), P04 (p&lt;0.001), CRP (p&lt;0.011), SBP and DBP (p&lt;0.05). Conclusion HD+HP was superior to HD in regularly eliminating middle and large molecule uremic toxins accumulated in the body which is mostly shown through reducing the values of iPTH and hsCRP. These findings suggest a potential role for HD+HP in the treatment of inflammation and renal osteodystrophy as well, because lowering these values of iPTH leads to a normalization of other minerals which is expected and therefore leads to a stabilization of this long-term uremic complications, which can improve the overall general condition of the MHD patient.

P175 Prognostic value of 99mTc-ECD brain perfusion SPECT in patients with atrial fibrillation and dementia

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
H Hashimoto ◽  
R Nakanishi ◽  
S Mizumura ◽  
Y Hashimoto ◽  
Y Okamura ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Prognostic Value ◽  
Cox Model ◽  
Brain Perfusion ◽  
Z Score ◽  
Brain Perfusion Spect ◽  
Perfusion Spect

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, and those afflicted have reduced quality of life, functional status, and cardiac performance. The patients with AF have a high risk of coronary heart disease and cardiovascular disease. Although the prevalence of AF is increasing, cognitive disorders are also on the rise in tandem with the aging of the population. The patients with dementia have also experienced lower the quality of life and have increased mortality. Technetium 99m ECD brain perfusion single photon emission computed tomography (99mTc-ECD brain perfusion SPECT) is a useful modality for diagnosing dementia and identifying high risk patients with mild cognitive impairment. However, there are few reports about the relationship between the value of Z score calculated by 99mTc-ECD brain perfusion SPECT and prognosis of patients with AF and dementia. Purpose The aim of this study was to evaluate the prognostic values of brain perfusion using 99mTc-ECD SPECT in patients with AF and dementia. Methods Among 405 consecutive patients who were diagnosed as AF in cardiac outpatients and subsequently diagnosed as dementia using Mini-Mental State Examination by neurologists or psychiatrists, we identified 170 patients (81 ± 10 years) who underwent 99mTc-ECD brain perfusion SPECT for the current study. Of those, 73, 73, and 24 were diagnosed as Alzheimer’s dementia (AD), vascular dementia (VD), and non-specified dementia respectively. Multivariate Cox model was used to assess if higher Z score by 99mTc-ECD brain perfusion SPECT and clinical parameters were associated with major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, hospitalization for heart failure, and stroke. Sub-analyses of multivariate Cox models by AD or VD were also assessed. The cut-off values of Z score were determined using area under the curve by a receiver operating characteristic analysis based on MACE occurrences. Results During a mean follow-up of 1258 ± 1044 days, 62 MACE occurred. There was not significant difference of MACE between AD and VD (33%, vs. 44%, p = 0.153). By multivariable Cox model, the higher Z score of temporal-occipital-pariental lobe was associated with increased MACE compared to the lower group (HR 2.521, 95% CI 1.465–4.337, p &lt; 0.001). In a sub-analysis of patients with AD, Z score was the most significant prognostic factor for MACE (HR 3.969, 95% CI 1.374–11.468, p = 0.011). The similar trend was observed in those with VD (HR 2.247, 95% CI 1.028–4.913, p = 0.043). Conclusion: This study demonstrated that the Z score of temporal-occipital-pariental lobe by 99mTc-ECD brain perfusion SPECT could be a potential prognostic value among patients with AF and dementia, regardless of type of dementia.

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