Evaluation Of Long-term Prognosis Research Articles

Investigation of the impact of the deep learning based CT fractional flow reserve on clinical decision-making and long-term prognosis in patients with obstructive coronary heart disease

Objective: To investigate the impact of the deep-learning-based CT fractional flow reserve (CT-FFR) on clinical decision-making and long-term prognosis in patients with obstructive coronary heart disease. Methods: In this single-center retrospective cohort study, consecutive patients with obstructive coronary heart disease (with at least one stenosis≥50%) on their first coronary computed tomography angiography (CCTA) in Beijing Anzhen Hospital from February 2017 to July 2018 were included. Baseline clinical and CT characteristics were collected. Deep-learning-based CT-FFR and Leiden CCTA risk score were calculated. All patients enrolled were followed up for at least 5 years. The study endpoint was major adverse cardiovascular events (MACE), defined as the composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization. Receiver operating characteristic (ROC) curves were drawn to define the optimal cut-off point of the Leiden score in predicting the 5-year MACE, and survival analysis and Cox regression were performed to explore the related factors of MACE. Results: A total of 622 patients, aged 61 (54, 66) years, with 407 (65.4%) males were included. Diagnostic coronary angiography was performed in 78 patients after their baseline CCTA, with 34 (43.6%) patients had CT-FFR>0.80. During a follow-up time of 2 181 (2 093, 2 355) days, 155 patients (24.9%) suffered from MACE. ROC derived optimal cut-off point of Leiden score for predicting MACE was 15.48. Survival analysis found that male patients, Leiden risk score>15 and CT-FFR≤0.80 had worse prognosis. Multivariate Cox regression analysis identified CT-FFR≤0.80 as an robust and independent predictor of MACE (HR=4.98, 95%CI 3.15-7.86, P<0.001). Conclusion: Deep-learning-based CT-FFR aids in clinical decision-making and the evaluation of long-term prognosis in patients with obstructive coronary heart disease.

Оценка отдаленного прогноза после инфаркта миокарда

Оценка отдаленного прогноза после инфаркта миокарда

Evaluation of the long-term prognosis of coronary heart disease with myocardial perfusion imaging: a Meta-analysis

Objective To analyze multiple functional parameters of radionuclide MPI (SRS, SSS, SDS and LVEF) in order to evaluate the long-term prognosis in patients with coronary heart disease (CHD). Methods The published articles on MPI for long-term prognosis in patients with CHD were searched in Medline, the Excerpta Medica Database (EMbase), Cochrane and China National Knowledge Infrastructure (CNKI), Wangfang Database, Vip Database from January 2003 to January 2015 with inclusion and exclusion criteria. The meta-analysis was conducted using RevMan 5.3 software. Stata 12.0 software was used to draw the funnel plot and to determine the possibility of publication bias by Begg′s test. Results A total of 11 studies and 11 634 patients were ultimately included. The meta-analysis indicated that the SRS(hazard ratio (HR)=1.14, 95% CI: 1.11-1.18; z=8.53, P<0.01), SSS(HR=1.05, 95% CI: 1.05-1.23; z=2.34, P=0.02), SDS(HR=1.14, 95% CI: 1.01-1.10; z=3.07, P=0.002) and LVEF (HR=0.95, 95% CI: 0.93-0.97; z=4.53, P<0.01) had statistical significance for the prognosis of CHD. Conclusion MPI functional parameters are significantly valuable for the evaluation of long-term prognosis in patients with CHD. Key words: Coronary disease; Prognosis; Tomography, emission-computed, single-photon; Meta-analysis

A Predictive Study of the Dynamic Development of the P-Wave Terminal Force in Lead V1 in the Electrocardiogram in Relation to Long-Term Prognosis in Non-ST-Segment Elevation Acute Coronary Syndrome Patients during Hospitalization.

Changes in the ECG indicator PtfV1 reflect left atrial pressure and left ventricular diastolic function in NSTE-ACS patients during hospitalization. The value of PtfV1 in the evaluation of long-term prognosis in NSTE-ACS is still not clear. The purpose of this study was to investigate the relationship between the dynamic changes in P-wave terminal force in lead V1(PtfV1) in the ECG of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients during hospitalization and the long-term major adverse cardiovascular events (MACEs) of patients. A total of 595 patients who received coronary angiography and were confirmed as NSTE-ACS in the coronary heart disease database of Department of Cardiology of West China Hospital were continuously included. The PtfV1 and other clinical data at admission and discharge were collected and dynamically observed. The end events of follow-up observation were MACEs. Follow-up was performed on 595 patients for 24.71 ± 1.95 months. There were 127 PtfV1(+) and 468 PtfV1(-) at admission, and the incidences of MACEs were 14.2% and 11.1%, respectively (P = 0.731). Compared with patients with persistent PtfV1(-) ECG at admission and discharge, 53 patients with persistent PtfV1(+) ECG at admission and discharge had increased risk for MACEs (HR: 2.221, 95% CI: 1.072-4.601, P = 0.032); 94 patients with new PtfV1(+) ECG at discharge also had significantly increased risk for MACEs (HR: 2.993, 95% CI: 1.660-5.397, P = 0.000). NSTE-ACS patients with persistent PtfV1(+) ECG indicators at admission and discharge and new PtfV1(+) at discharge had significantly increased risk of MACEs.

Possibility of Using &lt;sup&gt;99m&lt;/sup&gt;Tc-HMPAO in Estimating Long-Term Prognosis of Cerebral Complications of Coronary Artery Bypass Graft

The aim of this work was to investigate the possibility of using brain SPECT with 99mTc-HMPAO to estimate long-term prognosis of the development of neurocognitive deficits in patients after coronary artery bypass graft (CABG). The study included 22 patients with coronary artery disease who underwent a standard estimate of neurological status, 99mTc-HMPAO brain SPECT and neuropsychological testing before CABG, 14 days and 6 months after surgical intervention. The results showed that 99mTc-HMPAO is useful radiopharmaceutical for evaluation of long-term prognosis of the development of neurocognitive deficits in patients after CABG. Thus, in 96% of patients after CABG one could observe the early cognitive deficit, which persisted in 55% of cases after 6 months. At that, a correlation between the deterioration of long-term memory after 6 months and a decrease in perfusion in the temporal lobes was detected in the early postoperative period.

Clinical Evaluation of Long-term Prognosis and the Concurrent Diseases in 22 Dogs Suspected Suture-reactive Granuloma Following Ovariohysterectomy

卵巣子宮摘出術後の縫合糸反応性肉芽腫が疑われた犬22症例について、その疫学、治療、および長期予後を臨床的に解析した。22症例中15例（68％）がミニチュア・ダックスフントであった。診断時の年齢は、中央値3.5（1.1～9.3）歳齢、卵巣子宮全摘出術から診断されるまでの期間は、中央値2（0.3～4.3）年であった。最も多く認められた（13/22）症状は、嘔吐または下痢を伴うあるいは伴わない、元気消失、食欲不振、体重減少、発熱といった非特異的なものであった。検査した17頭中14頭（82％）で、血漿C反応性蛋白（CRP）の上昇を認めた。腹腔内の肉芽腫をすべて摘出した20例では、20症例中16例で、肉眼的または病理組織学的に縫合糸が確認された。周術期に腎不全で斃死した1例を除く19症例中8例（42％）が、経過良好であった。一方、11例は、肉芽腫性胃腸炎、脂肪織炎、無菌性肉芽腫などの新たな疾患の発症や、腹腔内肉芽腫の再発が認められ、11例中10例がミニチュア・ダックスフントであった。以上のことから、避妊手術後の腹腔内肉芽腫はミニチュア・ダックスフントに好発し、腹腔内の肉芽腫を外科的に切除しても、病理組織学的に肉芽腫性炎症を特徴とする新たな疾患を発症する可能性があるものと推察された。

Predictive potential of testing for bone marrow involvement in Ewing tumor patients by RT-PCR: a preliminary evaluation.

EWS/ets-oncogene fusion transcripts can be detected in at least 98% of Ewing tumors [(ET) Ewing sarcoma and peripheral primitive neuroectodermal tumor] by reverse transcriptase-polymerase chain reaction (RT-PCR), thus confirming the histopathologic diagnosis. To detect minimal amounts of tumor cells in the bone marrow (BM), we used an RT-PCR assay with a high sensitivity, revealing one tumor cell in a background of 10(6) normal cells. We examined BM samples from 35 newly diagnosed ET patients (23 with localized and 12 with metastatic disease). At diagnosis, tumor cells in the BM were detected in 7/23 patients with localized disease (30%). Fifty percent of patients with isolated lung metastasis were RT-PCR positive (3/6), whereas 6/6 patients with bone metastases showed positive signals (100%). All patients with initial PCR positivity in the BM became negative during treatment. After a median follow-up of 30 months, relapses were observed in both groups of patients with localized disease (3/7 RT-PCR positive and 2/16 RT-PCR negative). The only recurrence in the group with isolated lung metastases occurred as progressive lung disease in 1 of the 2 RT-PCR-negative patients, whereas among the 6 patients with bone metastases 2 remain in complete remission. So far, RT-PCR screening for BM involvement did not allow prediction of early relapse in ET. To assess better the significance of this test in the evaluation of long-term prognosis and in monitoring the effectiveness of systemic therapy, long observation periods are warranted before it becomes a tool for treatment stratification.

成人もやもや病患者の長期予後と血行再建術の有効性についての検討 : 脳血流検査結果からの考察

成人もやもや病患者の長期予後と血行再建術の有効性についての検討 : 脳血流検査結果からの考察