Combined Outcome Of Death Research Articles

Tricuspid annular plane systolic excursion in pulmonary hypertension-Moving beyond the sector plane.

Tricuspid annular plane systolic excursion (TAPSE) is usually measured with M-mode using sector line, however, this may not align with the anatomical shortening of the right ventricular(RV). In this study, we compared the different methods to measure TAPSE using three different reference lines (sector line, anatomical line, and apico-annular line). We included 148 patients diagnosed with pulmonary arterial hypertension (PAH) who underwent TTE and right heart catheterization within 2 weeks of each other. TAPSE was measured by M-mode (sector, anatomical), 2D (sector, anatomical), or as tricuspid apico-annular displacement (TAAD). Agreement between measures was assessed using coefficient of variation (COV), Spearman's correlation, and Bland-Altman analysis. Receiver-operating characteristics and Kaplan-Meier analysis were used to explore associations with the combined outcome of death or lung transplantation at 5 years. There was a good concordance between anatomical and sector M-mode with a COV of 15.5 ± 1.6% and a bias of -0.6 ± 3.2 mm. In contrast, anatomical M-mode TAPSE and TAAD differed significantly with the mean difference of 3.3 ± 3.8 mm (COV 30.5 ± 6.1%; p < 0.0001). Among the different 2D methods, anatomical 2D agreed well with anatomical M-mode TAPSE (COV of 11.8 ± 2.0%; r = 0.89; p < 0.0001). Among the five methods, TADD had the strongest association with the combined endpoint of death or transplantation at 5 years (C-statistic 0.64, 95% confidence interval [CI] 0.57-0.71). We concluded that different measures of TAPSE are not interchangeable.

#2470 Isolated diastolic hypertension in hemodialysis patients

Abstract Background and Aims Isolated diastolic hypertension (IDH) is relatively rare in the general population (prevalence about 6.5%, Front Cardiovasc Med. 2021;8:810105) and of uncertain etiologic implications. The prevalence of this alteration in the hemodialysis (HD) population and the etiologic implications of IDH have not been studied. Method We investigated the prevalence and the risk for all-cause death and cardiovascular events of isolated diastolic hypertension in a population of 534 HD patients enrolled in 7 centres in 3 European countries (the EURECA-m working group). BP was measured by a golden standard method in this population (48 h ABPM) using well-validated instruments (AAMI/ESH/ISO). Along with recommendations by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes at night. According to a consensus document by the EURECAm working group (Nephrol Dial Transplant. 2019;34:1542-1548), isolated diastolic hypertension was defined as 48 h diastolic BP &amp;gt; 80 mmHg with a systolic BP &amp;lt;130. Results Among 534 HD patients, thirty-one (5.8%) had isolated diastolic HTN, which is very close to the prevalence estimated in the general population (6.5%). During a mean follow-up of 2.6 years, 138 patients died, 188 had at least one CV event, and 249 experienced the combined event. In univariate analyses, diastolic hypertension was associated with death (HR 0.21; 95% CI: 0.05-0.86, P = 0.03) and the combined outcome of death and CV events (HR 0.42, 95% CI: 0.20-0.88, P = 0.02). However, these associations were no longer significant after adjustment for age and sex (all P &amp;gt; 0.45). Additional sensitivity analyses substantially confirmed these findings. No effect modification by age or gender was observed in these associations. Conclusion In a large cohort of HD patients studied by state-of-the-art 48-hour BP monitoring, the prevalence of isolated diastolic hypertension in HD patients (5.8%) is close to that registered in the general population (6.5%). This alteration predicts the risk for clinical outcomes in unadjusted analyses but not after adjustment for age and sex. Isolated diastolic hypertension is as rare as it is in the general population and unlikely to contribute to the high risk of adverse clinical outcomes in the dialysis population.

Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy.

To determine the safety and effectiveness of sodium bicarbonate administration in the management of metabolic acidemia and short-term outcomes in neonates with hypoxic-ischemic encephalopathy (HIE). Retrospective cohort study of neonates born at ≥35 weeks of gestation and receiving therapeutic hypothermia. Demographics, pH, lactate, base deficit, treatment, MRI findings, seizure incidence, death prior to discharge were collected. There was higher mortality (p = 0.010) and injury on MRI (p = 0.008)-primarily deep gray matter (p < 0.001) and cortical injury (p = 0.003)-in the bicarbonate groupcompared to controls in univariate analysis. The combined outcome of death or abnormal MRI was not significantly associated (OR 1.97, 95% CI 0.80-4.87, p = 0.141) with bicarbonate administration when adjusting for sex, 5-minute Apgar, and initial base deficit. This study demonstrated association between bicarbonate use after HIE and negative short-term outcomes. Future prospective trials could overcome the treatment bias limitation demonstrated in this retrospective study.

Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center.

Chagas cardiomyopathy (ChCC) is one of the causes of the implantation of pacemakers (PM) in many patients and has been associated with an adverse prognosis. To compare the prognosis of the chagasic and non-chagasic populations undergoing PM and cardiac resynchronizer implantation. Observational, retrospective study, which analyzed a cohort of patients who underwent implantation of these devices, in a tertiary center, from October 2007 to December 2017, comparing the chagasic group with non-chagasic patients. The non-parametric Kaplan-Meier method was used to calculate patient survival. The significance level adopted in the statistical analysis was 5%. The primary outcome was mortality from any cause, while the secondary outcomes were the occurrence of hospitalization and the combination of hospitalization and death. A total of 911 patients were included, of which 23.4% had ChCC. In a Cox analysis adjusted for sex and age, Chagas disease (ChD) was not associated with an increased risk of death (HR: 1.14, CI:95%, 0.86-1.51, p=0.365), hospitalization (HR: 0.79, CI:95%, 0.61-1.04, p=0.09) or combined outcome of death and hospitalization (HR: 0.90, CI:95%, 0.72-1 .12, p=0.49). ChD was not associated with an increased risk of death, hospitalization, or combined outcome of death and hospitalization, even after adjustment for sex and age. These results contrast with those of previous studies and suggest changes in the quality of care of patients with cardiomyopathy.

The Association between Blood Pressure and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) has emerged as a common and effective treatment for patients with severe aortic stenosis. Changes in systemic blood pressure after TAVI have been described, yet their prognostic value is not established. Thus, we aimed to examine the association of the periprocedural changes in systolic blood pressure (SBP) and in pulse pressure on clinical outcomes after the procedure. A retrospective study of consecutive patients who underwent TAVI procedure in our medical center. We assessed the effect of the periprocedural changes in blood pressure measurements on mortality, acute myocardial infarction, stroke and hospitalizations at 1 year and on the combined outcome of death, myocardial infarction, and stroke 1 year following the procedure. Our cohort included 455 patients (44% males). Of them, 343 patients (75.4%) had raised SBP immediately after the procedure. Patients with raised SBP had a significantly higher rate of the 1-year composite outcome, compared to patients who did not have a raise in SBP following the procedure (43 [13%] vs. 6 [5.4%], respectively, p = 0.033). After adjustment for age and sex, the postprocedural increase in SBP was significantly associated with the composite outcome, with a hazard ratio of 2.42, 95% CI: 1.03-5.7. An immediate increase in SBP after TAVI is associated with worse 1-year clinical cardiovascular outcomes.

Surgery in patients with infective endocarditis and prognostic importance of patient frailty

Abstract Background/Introduction Patients with infective endocarditis have (IE) a poor one-year prognosis with a high risk of death or rehospitalizations within the first year after discharge. Surgery remains a cornerstone in the treatment of infective endocarditis but might be futile in frail patients with limited life expectancy; however, knowledge on surgical outcomes across frailty remains sparse. Purpose To characterize patients with IE according to frailty and how frailty modifies prognosis among those who undergo surgery. Methods We identified all first-time admissions for IE who underwent surgery during admission in Denmark (2010-2020). All patients were categorized according to frailty (low or intermediate/high frailty) using the validated Hospital Frailty Risk Score based on the ICD-10 diagnosis codes. Hospitalization was defined as the cumulative admission length reported by frailty. In survival analysis, patients were followed from IE discharge until death, 14 days of hospitalization, December 31 (2021), or one year after IE discharge, whichever came first. The 1-Kaplan-Meier estimator was used to estimate the unadjusted probabilities of hospitalization or death by frailty. Furthermore, multivariate Cox proportional hazards model regression was used to assess the association of frailty with the combined outcome of death or rehospitalization of ≥14 days. We adjusted for the following risk factors not included in the Hospital Frailty Risk Score: age, sex, microbiological etiology, hypertension, diabetes, chronic kidney disease, and dialysis. Results We identified 6,290 patients with first-time IE, of whom 1,282 (20.4%) underwent surgery. Among the patients who underwent surgery, 967 (75.4%) were categorized as having low frailty and 315 (24.6%) as intermediate/high frailty. Intermediate/high frail patients were older (67 vs. 64 years) and had a lower proportion of males (71.7% vs. 79.9%). Intermediate/high frail patients who underwent surgery were more often hospitalized for ≥14 days (19.1% vs. 12.3%) or died during the first year from IE discharge (11.7% vs. 6.2%) than low frail patients. Intermediate/high-frail patients were associated with an increased one-year probability of both the combined outcome of rehospitalization ≥ 14 days or death (31.5% [25.6%-37.0%] vs. 19.3% [16.7%-21.9%], Figure 1A) and death (11.7% [7.7%-15.5%] vs. 6.1% [4.5%-7.7%], Figure 1B) compared with low frail patients. In the adjusted analysis, intermediate/high frail patients were associated with an increased rate of rehospitalization ≥14 days or death (HR 1.39 [1.04-1.85]) as compared with low frail patients. Conclusion Intermediate/high frail patients were older and were associated with an increased rate of rehospitalizations ≥14 days or death. Frailty is a key patient feature in patient assessment and surgical treatment and more studies are needed to assess effectiveness of surgery by frailty to avoid futile surgeries.Figure 1:Rehospitalization or death

Nasal high flow therapy for primary respiratory support in preterm infants.

Nasal high flow therapy for primary respiratory support in preterm infants.

PO-05-058 PROGNOSTIC EVALUATION OF PATIENTS WITH ICD IN A LATIN AMERICAN TERTIARY CENTER.

Despite advances in ICD, SCD remains a public health problem. Chagas disease, still prevalent in Brazil, is associated with higher VT and VF events and SCD when compared to other cardiopathies. Data are conflicting in correlating mortality reduction in chagasic patients and the ICD implantation. We aimed to evaluate the ICD receivers mortality after structuring arrhythmia service in a Latin American tertiary center. Evaluate if the mortality and VT/VF events decrease when patients who received ICD at different periods of time (2007-2010, 2011-2014, 2015-2018) are compared in a tertiary center; compare the prognosis of chagasic to non-chagasic patients in different periods. Retrospective observational study of patients with ICD implanted in the Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) between October 2007 and December 2018. The primary outcome was mortality, evaluated in the total sample and in each period. The secondary outcomes were the VT/VF events and the combined outcome of death and/or VT/VF, evaluated in the total sample and in each period. A total of 885 patients were included, 31% chagasic. Out of these, 254 (28%) died, 127 (14%) had VT/VF and 329 (37%) died and/or had VT/VF. The Kaplan-Meier curves showed that period 3 vs. 1 was the only variable associated with better death-free survival, p=0.007. For the VT/VF and the combined outcome free survival curves, Chagas disease was the only variable associated with higher rate of events; p<0.001 and p=0.009, respectively. In the cox's analysis adjusted for age, sex and Chagas, period 2 vs. 1 was protective for death (HR 0.715, 95%CI 0.539-0.948) and combined outcome (HR 0.713, 95%CI 0.537-0.945); period 3 vs. 1 was protective for death (HR 0.516, 95%CI 0.351-0.759) and combined outcome (HR 0.530, 95%CI 0.361-0.780). After adjusting for age and gender, Chagas was associated with VT/VF in periods 1 (HR 2.531, 95%CI 1.469-4.360) and 2 (HR 3.247, 95%CI 1.735-6.076). There was a gradual reduction in mortality and combined outcome for ICD receivers at periods 2011-2014 and 2015-2018 compared to the initial period 2007-2010. Chagas was associated with a higher VT/VF events in ICD receivers only in the first two periods. The improvement of results was concomitant with the incorporation of new modalities and technologies to treat patients with ICD. The better organization of care may be associated with reduction of overall mortality and arrhythmic events in this population.

Association of atrial myopathy in mitral valve disease on safety outcomes in left atrial appendage closure

BackgroundPatients undergoing left atrial appendage (LAA) occlusion (LAAO) are multi-morbid, including mitral valve disease (MVD) which is associated with anatomic changes of the left atrium (LA). This study aims to identify how atrial myopathy in MVD influences outcomes in LAAO.MethodsAtrial myopathy in MVD was defined as LA diameter > 45 mm (♀) and > 48 mm (♂) and existing MVD or history of surgical/interventional treatment. Patients were compared with controls from the prospective, multicentre LAArge registry of LAAO.ResultsA total of 528 patients (52 MVD, 476 no-MVD) were included. The MVD group was significantly more likely to be older (78.2 years vs 75.9 years, p = 0.036) and female (59.6% vs 37.8%, p = 0.002). Altered LA anatomy was observed in MVD with significantly larger LA diameter (53 mm vs. 48 mm, p < 0.001) and LAA Ostia [at 135° 23.0 mm (20.5, 26.0) vs 20.0 mm (18.0, 23.0), p = 0.002]. Implant success was high with 96.2% and 97.9%, respectively, without differences in severe complications (7.7% vs 4.6%, p = 0.31). One-year mortality (17.8% vs 11.5%, p = 0.19) and a combined outcome of death, stroke, and systemic embolism (20.3% vs 12.4%, p = 0.13) were not different. Independent predictors of the combined outcome were peripheral artery disease (HR 2.41, 95% CI 1.46–3.98, p < 0.001) and chronic kidney disease (HR 3.46, 95% CI 2.02–5.93, p < 0.001) but not MVD and atrial myopathy.ConclusionPatients with MVD present with altered LA anatomy with increased LA and LAA diameter. However, procedural success and safety in LAAO are not compromised. One-year mortality is numerically higher in patients with MVD but driven by comorbidities.Graphical abstract

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

AimTo examine the incidence of intrapartum-related neonatal encephalopathy, and neonatal mortality and neurodevelopmental outcomes associated with it in low-income and middle-income countries.MethodsReports were included when neonatal encephalopathy diagnosed clinically within...

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities.

Hypoplastic left heart syndrome and single ventricle variants with aortic hypoplasia are commonly classified as severe forms of CHD. We hypothesised patients with these severe defects and reported genetic abnormalities have increased morbidity and mortality during the interstage period. This was a retrospective review of the National Pediatric Cardiology Quality Improvement Collaborative Phase I registry. Three patient groups were identified: major syndromes, other genetic abnormalities, and no reported genetic abnormality. Tukey post hoc test was applied for pairwise group comparisons of length of stay, death, and combined outcome of death, not a candidate for stage 2 palliation, and heart transplant. Participating centres received a survey to establish genetic testing and reporting practices. Of the 2182 patients, 110 (5%) had major genetic syndromes, 126 (6%) had other genetic abnormalities, and 1946 (89%) had no genetic abnormality. Those with major genetic syndromes weighed less at birth and stage 1 palliation. Patients with no reported genetic abnormalities reached full oral feeds sooner and discharged earlier. The combined outcome of death, not a candidate for stage 2 palliation, and heart transplant was more common in those with major syndromes. Survey response was low (n = 23, 38%) with only 14 (61%) routinely performing and reporting genetic testing. Patients with genetic abnormalities experienced greater morbidity and mortality during the interstage period than those with no reported genetic abnormalities. Genetic testing and reporting practices vary significantly between participating centres.

Low Vitamin D Levels at Birth and Early Respiratory Outcome in Infants With Gestational Age Less Than 29 Weeks.

BackgroundVitamin D (VitD) is involved in lung development but its influence on respiratory distress syndrome of extremely preterm (EPT) infants have been little investigated. In this study, we examined the influence of low vitamin D status at birth on early respiratory outcomes of this vulnerable infant population.MethodsCord blood 25(OH)D levels ≤ 75 nmol/L were considered as Low vitamin D levels. Stepwise logistic regression and classification regression-tree analyses were used and the primary outcome was the combined outcome of death or mechanical ventilation need by the end of the first week (death or MV DoL7) as a marker od RDS severity.ResultsThe mean (SD) GA and birth weight were 26 (1.4) weeks and 801 (212) gr, respectively; 81/109 (74%) infants had low 25(OH)D levels. Infants with low VitD levels had 25% higher initial FiO2 levels (p < 0.05) and were more likely to be mechanically ventilated on DoL7 (36 vs. 7%, p < 0.05). Adjusted for gestational age, they had 10-fold higher odds of death or MV DoL7 (p < 0.01). By regression tree analysis, the rate of death or MV DoL7 increased from 18 to 71% in infants with GA < 26 weeks and with cord blood 25(OH)D levels higher and lower than 74 nmol/L, respectively (p < 0.05).ConclusionLow vitamin D levels at birth are associated with early adverse respiratory outcomes in infants with GA less 29 weeks. Further largest studies are needed to confirm this association.

Prognosis and Clinical Results after Coronary Artery Bypass Operation in Young Patients Aged

Coronary artery bypass grafting (CABG) is the recommended type of revascularization procedure in patients with left main or three-vessel disease and is considered an alternative when percutaneous coronary intervention is not feasible. We evaluated registry data to obtain long-term outcome data.All patients ≤45 years in whom CABG was performed between 2009 and 2019 were selected from the Heart and Diabetes Center NRW, Germany. Cox regression analysis was applied to estimate the incidence risk of events after surgery.A total of 209 patients (81.8% male) were included. Mean (standard deviation) follow-up duration was 5.8 (3.1) years. The combined outcome of death, stroke, myocardial infarction, or repeated revascularization occurred in 31 patients (14.8%). Estimated mean time to event was 8.5 (standard error: 0.22) years. By the end of the follow-up period, 8 patients (3.8%) had died, among whom 2 (1.0%) died within 1 month after surgery, 1 (0.5%) within 1 year, 1 (0.5%) within 2 years, and 4 (1.9%) after 2 years.Risk factors independently associated with postsurgery events were angina pectoris CCS (Canadian Cardiovascular Society) class IV (adjusted hazard ratio [HR]: 4.954; 95% confidence interval [CI]: 1.322-18.563; p = 0.018) and STS (Society of Thoracic Surgeons) score (adjusted HR: 1.152 per scoring point; 95% CI: 1.040-1.276; p = 0.007).After performing CABG in patients ≤45 years, event-free long-term outcomes were observed in the majority of patients. Presence of angina pectoris CCS class IV and higher STS scores were independently associated with adverse postsurgery events.

Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants.

Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants.

Right atrial volume index to left atrial volume index ratio is associated with adverse clinical outcomes in cardiogenic shock.

Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Our objective was to test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume index (LAVI) ratio is associated with adverse clinical outcomes in CS. Patients in this cohort were admitted to the intensive care unit with evidence of congestion (pulmonary capillary wedge pressure > 15) and cardiogenic shock (cardiac index < 2.2, systolic blood pressure < 90mmHg, and clinical evidence supporting CS) and had an echocardiogram at the time of admission. RAVI was measured using Simpson's method in the apical four-chamber view, while LAVI was measured using the biplane disc summation method in the four and two-chamber views by two independent observers. Cox proportional hazards regression analysis was used to assess the association of RAVI-LAVI with the combined outcome of death or left ventricular assist device (LVAD). Among 113 patients (mean age 59 ± 14.9years, 29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of 12months, 43 patients died, and 65 patients had the combined outcomes of death or LVAD. Patients with RAVI/LAVI ratio above the median had a greater incidence of death or LVAD (Log-rank p ≤ 0.001), and increasing RAVI/LAVI was significantly associated with the outcomes of death or LVAD (HR 1.71 95% CI 1.11-2.64, chi square 5.91, p = 0.010) even after adjustment for patient characteristics, echocardiographic and hemodynamic variables. RAVI/LAVI is an easily assessed novel echocardiographic parameter strongly associated with the survival and or the need for mechanical circulatory support in patients with CS.

Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates.

Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. · Plastic bag placement during placental transfusion is effective in stabilization of preterms.. · Plastic bag placement after placental transfusion is effective in stabilization of preterms.. · Plastic bag placement during placental transfusion and risk of death or necrotizing enterocolitis needs additional study..

Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

BackgroundNon-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death.MethodsComparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE).ResultsA total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041).ConclusionAtrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.Graphic abstract

Impact of atrial fibrillation pattern on left atrial appendage closure: insights from the prospective LAARGE registry

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Stiftung für Herzinfarkforschung Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death compared with paroxysmal AF (PAF). This study investigates the procedural safety and long-term outcomes of left atrial appendage closure (LAAC) in patients with different forms of AF. Methods Comparison of procedural details and long-term outcomes in patients (pts) with PAF against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC in Germany (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. NPAF consisted of 31.6% patients with persistent AF and 68.4% with longstanding persistent AF or permanent AF. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The PAF group had significantly less history of heart failure (19.0% vs 33.0%, p &amp;lt; 0.001) while the current median LVEF was similar (60% vs 60%, p = 0.26). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), but no difference in the HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was observed. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77) in both groups. In the three-month echo follow-up, device-related thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak &amp;gt;5 mm (0.0% vs 7.1%, p= 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95%-CI: 1.02-2.72). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE of patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality and combined outcome of death, stroke and systemic embolism.

Fetal cardiac dimensions in congenital diaphragmatic hernia: relationship with gestational age and postnatal outcomes.

To serially assess fetal cardiac dimensions in congenital diaphragmatic hernia (CDH) and their relation to disease severity. Retrospective analysis of CDH cases and matched controls. Mitral (MVd) and tricuspid (TVd) valve diameters, left (LV) and right (RV) ventricular length and area, Z-scores, were serially assessed at 24-26, 30-32, and 35-37 weeks gestational age (GA). In CDH cases MVd, MVd Z-score, and LV area were significantly reduced at 24-26 and 35-37 weeks GA. TVd, TVd Z-score, and RV area were significantly reduced at 24-26 weeks. RV area Z-score increased with advancing GA. MVd and MVd Z-score were significantly lower at 24-26 weeks GA in CDH who had a combined outcome of death and/or ECMO. LV hypoplasia in CDH is characterized by reduced MVd from 24 weeks GA. MVd, and the ratio of mitral and tricuspid valve diameters at later gestations, may be potential predictors of disease severity.

Preventing Brain Injury in the Preterm Infant-Current Controversies and Potential Therapies.

Preterm birth is associated with a high risk of morbidity and mortality including brain damage and cerebral palsy. The development of brain injury in the preterm infant may be influenced by many factors including perinatal asphyxia, infection/inflammation, chronic hypoxia and exposure to treatments such as mechanical ventilation and corticosteroids. There are currently very limited treatment options available. In clinical trials, magnesium sulfate has been associated with a small, significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood but no effect on the combined outcome of death or disability, and longer-term follow up to date has not shown improved neurological outcomes in school-age children. Recombinant erythropoietin has shown neuroprotective potential in preclinical studies but two large randomized trials, in extremely preterm infants, of treatment started within 24 or 48 h of birth showed no effect on the risk of severe neurodevelopmental impairment or death at 2 years of age. Preclinical studies have highlighted a number of promising neuroprotective treatments, such as therapeutic hypothermia, melatonin, human amnion epithelial cells, umbilical cord blood and vitamin D supplementation, which may be useful at reducing brain damage in preterm infants. Moreover, refinements of clinical care of preterm infants have the potential to influence later neurological outcomes, including the administration of antenatal and postnatal corticosteroids and more accurate identification and targeted treatment of seizures.