Major Adverse Clinical Outcomes Research Articles

Growth Differentiation Factor-15 and Clinical Outcomes in Japanese Patients With Ischemic Heart Disease

BackgroundDespite a reduction in the rate of thrombotic events, ischemic heart disease (IHD) remains a key medical problem associated with high major bleeding and mortality in Asian patients with IHD. Growth differentiation factor (GDF)-15, a stress-response cytokine belonging to the transforming growth factor beta superfamily, is reportedly associated with poor clinical outcomes in Western patients with IHD. However, the clinical significance of GDF-15 in Asian patients with IHD has not yet been fully elucidated. ObjectivesThe aim of the present study was to examine the impact of serum GDF-15 on clinical outcomes in Japanese patients with IHD. MethodsSerum GDF-15 levels were evaluated in 632 consecutive patients with IHD. All patients were followed up for a median period of 2.8 years. The primary endpoint was the all-cause mortality rate. Secondary endpoints were major adverse cardiovascular events (MACE), heart failure (HF)–related rehospitalization, bleeding, and thrombotic events. ResultsSerum GDF-15 levels were elevated in acute coronary syndrome, severe coronary artery disease, and the major Japanese version of the high bleeding risk criteria. Multivariate Cox proportional hazards regression analysis demonstrated that GDF-15 was an independent predictor of all-cause mortality, MACE, HF-related rehospitalizations, and bleeding events after adjusting for confounding risk factors but not for thrombotic events. Adding GDF-15 to risk factors significantly improved the net reclassification index and integrated discrimination improvement for all-cause deaths, MACE, HF-related rehospitalization, and bleeding events. ConclusionsSerum GDF-15 could be a feasible marker for major bleeding and adverse clinical outcomes in Japanese patients with IHD.

Improved Outcomes After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot

BackgroundThe impact of pulmonary valve replacement (PVR) on major adverse clinical outcomes in patients with repaired tetralogy of Fallot (rTOF) is unknown. ObjectivesThe purpose of this study was to determine whether PVR is associated with improved survival and freedom from sustained ventricular tachycardia (VT) in rTOF. MethodsA PVR propensity score was created to adjust for baseline differences between PVR and non-PVR patients enrolled in INDICATOR (International Multicenter TOF Registry). The primary outcome was time to the earliest occurrence of death or sustained VT. PVR and non-PVR patients were matched 1:1 on PVR propensity score (matched cohort) and in the full cohort, modeling was performed with propensity score as a covariate adjustment. ResultsAmong 1,143 patients with rTOF (age 27 ± 14 years, 47% PVR, follow-up 8.3 ± 5.2 years), the primary outcome occurred in 82. The adjusted HR for the primary outcome for PVR vs no-PVR (matched cohort n = 524) was 0.41 (95% CI: 0.21-0.81; multivariable model P = 0.010). Full cohort analysis revealed similar results. Subgroup analysis suggested beneficial effects in patients with advanced right ventricular (RV) dilatation (interaction P = 0.046; full cohort). In patients with RV end-systolic volume index >80 mL/m2, PVR was associated with a lower primary outcome risk (HR: 0.32; 95% CI: 0.16-0.62; P < 0.001). There was no association between PVR and the primary outcome in patients with RV end-systolic volume index ≤80 mL/m2 (HR: 0.86; 95% CI: 0.38-1.92; P = 0.70). ConclusionsCompared with rTOF patients who did not receive PVR, propensity score-matched individuals receiving PVR had lower risk of a composite endpoint of death or sustained VT.

Anesthesia outcomes in lysosomal disorders: CLN3 and GM1 gangliosidosis.

Natural history studies of pediatric rare neurometabolic diseases are important to understand disease pathophysiology and to inform clinical trial outcome measures. Some data collections require sedation given participants' age and neurocognitive impairment. To evaluate the safety of sedation for research procedures, we reviewed medical records between April 2017 and October 2019 from a natural history study for CLN3 (NCT03307304) and one for GM1 gangliosidosis (NCT00029965). Twenty-two CLN3 individuals underwent 28 anesthetic events (age median 11.0, IQR 8.4-15.3 years). Fifteen GM1 individuals had 19 anesthetic events (9.8, 7.1-14.7). All participants had the American Society of Anesthesiology classification of II (8/47) or III (39/47). Mean sedation durations were 186 (SD=54; CLN3) and 291 (SD=33; GM1) min. Individuals with GM1 (6/19, 31%) were more frequently prospectively intubated for sedation (CLN3 3/28, 11%). Minor adverse events associated with sedation occurred in 8/28 (28%, CLN3) and 6/19 (32%, GM1) individuals, frequencies within previously reported ranges. No major adverse clinical outcomes occurred in 47 anesthetic events in pediatric participants with either CLN3 or GM1 gangliosidosis undergoing research procedures. Sedation of pediatric individuals with rare neurometabolic diseases for research procedures is safe and allows for the collection of data integral to furthering their understanding and treatment.

Activated factor XI is associated with increased factor VIIa - Antithrombin complexes in stable coronary artery disease: Impact on cardiovascular outcomes.

Coronary artery disease (CAD) is associated with a prothrombotic tendency including increased factor (F) VIIa-antithrombin (FVIIa-AT) complexes, a measure of tissue factor (TF) exposure, and activated FXI (FXIa). We investigated whether increased FVIIa-AT complexes are associated with FXIa and active TF and if major adverse clinical outcomes are predicted by the complexes in CAD. In 120 CAD patients, we assessed FVIIa-AT complex concentrations and the presence of circulating FXIa and active TF. Levels of 8-iso-prostaglandin F2α (8-iso-PGF2α), interleukin-6, high-sensitivity C reactive protein, prothrombin fragment 1 + 2, and free Tissue Factor Pathway Inhibitor were determined. Myocardial infarction (MI), ischemic stroke, systemic thromboembolism (SE), and cardiovascular (CV) death were recorded separately and as a composite endpoint, during follow-up. FVIIa-AT complexes were positively associated with current smoking and multivessel CAD. Elevated FVIIa-AT complexes characterized patients with circulating FXIa and/or active TF in association with increased plasma isoprostanes but not with thrombin generation or inflammatory markers. During a median follow-up of 106 months (interquartile range 95-119), high baseline levels of FVIIa-AT complexes predicted ischemic stroke/SE (HR 4.61 [95% CI 1.48-18.42]) and a composite endpoint of MI, stroke/SE, and CV death (HR 7.47 [95% CI 2.81-19.87]). This study is the first to show that high FVIIa-AT complexes characterize advanced CAD patients with detectable FXIa and active TF, which is, in part, driven by oxidative stress. High FVIIa-AT complexes were associated with the risk of ischemic stroke/SE during long-term follow-up, highlighting the need for effective antithrombotic agents in CAD.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock.

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings' mechanisms to improve outcomes in patients with SS and underlying CHF.

Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation

To evaluate the prognostic value of preprocedural CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, previous stroke or transient ischemic attack (TIA) (doubled), vascular disease, age 65-74 years, female gender] score in predicting high SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and in-hospital mortality for non-atrial fibrillation (AF) patients presenting with non-ST elevation myocardial infarction (NSTEMI). The CHA2DS2-VASc score used to determine thromboembolic risks in AF was recently reported to predict major adverse clinical outcomes in patients with the acute coronary syndrome, irrespective of AF. A total of 906 patients with a diagnosis of NSTEMI who underwent coronary angiography were retrospectively enrolled and divided into three groups according to their SYNTAX scores (low, intermediate, and high). The CHA2DS2-VASc score of each patient was calculated. SYNTAX score had a significant positive correlation with the CHA2DS2-VASc score (r=0.320; p<0.001) in the Spearman correlation analysis. The CHA2DS2-VASc score [Odds ratio, 1.445; 95% confidence interval (CI), 1.268-1.648, p<0.001], left ventricular ejection fraction, creatinine, C-reactive protein, and high-density and low-density lipoprotein cholesterol levels were demonstrated to be independent predictors of high SYNTAX score. The CHA2DS2-VASc score [Hazard ratio (HR), 1.867; 95% CI: 1.462-2.384; p<0.001], the SYNTAX score (HR, 1.049; p=0.003), and age (HR, 1.057; p=0.002) were independently associated with higher risk of in-hospital mortality in a multiple Cox-regression model. Kaplan-Meier survival curves stratified by the CHA2DS2-VASc score (<4 vs. ≥4) also showed that higher CHA2DS2-VASc scores were associated with higher in-hospital mortality. In non-AF patients with NSTEMI, CHA2DS2-VASc and SYNTAX scores are useful for prognosis assessment and can be used to identify patients at higher risk for in-hospital mortality.

Factors Predicting outcome of patients with polytrauma in tertiary center of western Nepal

Introduction: Trauma is a public health issue associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality in a general trauma population. In this study, we assessed different clinico-biochemical parameters to investigate the associations between those parameters and their effects in outcome of a polytrauma patient. Methods: An analytical study was done in between January 2020 to December 2020 in patients with polytrauma admitted to intensive care unit Department of Surgery in Manipal Teaching Hospital to assess the effect of various socio-demographic and clinic-radiologic variables in outcome (Glasgow outcome scale) of polytrauma patients. All the categorical data were tested using chi square test or Fischer Exact test and continuous variables were tested using student’s “t” test. P value &lt;0.05 was determined significant. Those independent variables significant on univariate analysis were then subjected to binary logistic regression and the data was presented as level of significance, odds ratio and 95% confidence interval. Analysis was done using SPSS 23.0. Results: Out of 67 patients, 34 had favorable GOS and 33 had unfavorable GOS. Injury Severity Score (ISS) (P&lt;0.01), abnormal pupils (P&lt;0.01), RBS (0.04), low GCS during presentation (&lt;0.01), higher CT Marshal Grade (0.01) had strong associations with unfavorable outcome in polytraumatic patient. ISS was the only significant parameter when all the other significant variables were kept constant in binary logistic regression model (OR=1.18, 95% CI=1.08-1.28). Conclusion: Injury Severity Score, abnormal pupils during presentation, high level of blood sugar after polytrauma, low GCS during presentation, higher CT Marshal Grade are strong predictors in outcomes of polytraumatic patient.

Obesity, inflammatory and thrombotic markers, and major clinical outcomes in critically ill patients with COVID-19 in the US.

This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID-19. The primary outcome was in-hospital mortality in adults with COVID-19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI-RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable-adjusted models were used. Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m2 was associated with a greater risk of ARDS and AKI-RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers. In critically ill patients with COVID-19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI-RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID-19 by upregulating systemic inflammatory and prothrombotic pathways.

Real-life data for major adverse cardiac events in patients with ST-elevation myocardial infarction prasugrel versus ticagrelor.

We aimed to evaluate the major adverse cardiac events and other clinical outcomes in ST-segment-elevation myocardial infarction (STEMI) cases treated with prasugrel versus ticagrelor after percutaneous intervention (PCI). The study was a prospective comparative study into which 560 patients diagnosed with STEMI, being suitable for PCI, and prescribed with either prasugrel (n = 232) or ticagrelor (n = 328) as oral antiplatelet therapy were included. Patients were followed up for a mean of 10.9 ± 4.7 months and 11.9 ± 4.9 months for prasugrel and ticagrelor groups, respectively. The major adverse cardiac events developed in similar rates between prasugrel and ticagrelor groups (7.3% versus 7.9%, respectively, p = 0.793). Even if mortality rate was higher in ticagrelor group, the difference did not reach statistically significance (3.4% vs. 6.7%, p=0.092). Among all study population, stent thrombosis and minor bleeding was recorded only in 7 (1.2%) and 12 (2.1%) patients without significant difference between prasugrel and ticagrelor groups. Twenty patients (8.6%) in prasugrel group and 47 patients (14.3%) in ticagrelor group discontinued treatment (p = 0.023). In ticagrelor group, 12 patients discontinued treatment due to dyspnea, but none in prasugrel group (p = 0.001). Prasugrel and ticagrelor have similar effects on major adverse cardiac events in patients with STEMI undergoing primary PCI, but prasugrel seems more tolerated and less discontinued than ticagrelor.

Composite Endpoints in Cardio-Renal Clinical Outcome Trials

Over the last several decades, major adverse clinical outcomes have been studied in the form of composite endpoints in cardiovascular and renal trials. Great utilities and challenges in the use of composite endpoints are well known and have been discussed in statistical and medical literature. For regulatory applications, unique issues relating to marketing claims necessitate additional considerations and discussions on how to define proper estimands related to the clinical questions, how to handle intercurrent events, and what statistical inferences need to be incorporated in order to result in proper interpretation of trial results. Two key issues with component-specific analyses concern handling of dependent competing risk endpoints and multiple endpoint testing. These issues may arise even in the analysis of the time to the first occurrence of composite or component endpoint, as to be discussed later in this article using the RENAAL study as an illustrative example. For developing treatments to relieve disease burden, much attention has been called to the potential value of considering all disease-related events such as all hospitalizations, rather than only one or the first event occurrence, in statistical analysis. In that case, discussion of estimands and intercurrent events will be much more challenging.

Risk of COVID-19 and major adverse clinical outcomes among people with disabilities in South Korea

BackgroundEvidence regarding the risk of coronavirus disease (COVID-19) and the major adverse clinical outcomes of COVID-19 among people with disabilities (PwDs) is scarce. ObjectiveThis study investigated the association of disability status with the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity and the risk of major adverse clinical outcomes among participants who tested positive for SARS-CoV-2. MethodsThis study included all patients (n = 8070) who tested positive for SARS-CoV-2 and individuals without COVID-19 (n = 121,050) in South Korea from January 1 to May 30, 2020. The study variables included officially registered disability status from the government, SARS-CoV-2 test positivity, and major adverse clinical outcomes of COVID-19 (admission to the intensive care unit, invasive ventilation, or death). ResultsThe study participants included 129,120 individuals (including 7261 PwDs), of whom 8070 (6.3%) tested positive for SARS-CoV-2. After adjusting for potential confounding factors, PwDs had an increased risk of SARS-CoV-2 test positivity compared with people without disabilities (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.24–1.48). Among participants who tested positive for SARS-CoV-2, PwDs were associated with an increased risk of major adverse clinical outcomes from COVID-19 compared to those without disabilities (OR: 1.43, 95% CI: 1.11–1.86). ConclusionsPwDs had an increased risk of COVID-19 and major adverse clinical outcomes of COVID-19 compared with people without disabilities. Given the higher vulnerability of PwDs to COVID-19, tailored policy and management to protect against the risk of COVID-19 are required.

The Global Limb Anatomic Staging System is associated with outcomes of infrainguinal revascularization in chronic limb threatening ischemia

ObjectiveThe Global Limb Anatomic Staging System (GLASS) has been proposed to facilitate clinical decision-making regarding revascularization for chronic limb threatening ischemia (CLTI). The purpose of the present study was to define its relationship to the treatment outcomes in CLTI. MethodsConsecutive patients who had undergone peripheral angiography for rest pain or tissue loss from January 2017 to July 2019 at a tertiary referral center with a dedicated limb preservation program were reviewed. Subjects with significant aortoiliac disease, previous infrainguinal stenting or functioning bypass grafts, or GLASS stage 0 were excluded. The GLASS score was assigned from the preintervention angiography findings, and the treating surgeon determined the primary infrapopliteal target artery pathway for the limb at risk. The demographic data, procedural details, and clinical outcomes were analyzed. ResultsThe study cohort included 167 patients and 194 limbs, of which 175 of 194 limbs (90%) had presented with tissue loss and 149 of 182 limbs (83%) with WIfI (Wound, Ischemia and foot Infection) stage 3 or 4. The GLASS stage was GLASS 1 in 14%, GLASS 2 in 18%, and GLASS 3 in 68%. GLASS 3 anatomy was present in 85% of 52 limbs treated by bypass and 55% of 108 limbs treated by endovascular intervention (EVI; P < .001). Revascularization was not performed in 34 limbs, most of which were GLASS 3 (85%). Immediate technical failure for EVI (ie, failure to establish target artery pathway) occurred exclusively in the setting of GLASS 3 anatomy (n = 13; 22%). After a median follow-up of 10 months, limb-based patency after EVI was significantly lower in GLASS 3 than in GLASS 1 or 2 limbs (42% vs 59%; P = .018). GLASS 3 was associated with reduced major adverse limb events-free survival in both the EVI group (P = .002) and the overall revascularized cohort (P = .001). GLASS 3 was also associated with significantly reduced overall survival, amputation-free survival, and reintervention-free survival. In a Cox proportional hazards model, GLASS 3 (hazard ratio, 2.35; 95% confidence interval, 1.30-4.24; P = .005) and WIfI wound grade 3 (hazard ratio, 2.64; 95% confidence interval, 1.26-5.53; P = .010) were independent predictors of reduced major adverse limb events-free survival after revascularization. ConclusionsGLASS stage 3 was strongly associated with major adverse clinical outcomes after revascularization in patients with CLTI.

Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019.

Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear. This retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. We identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event. AKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.

Below Knee Angioplasty in Diabetic Patients: Predictors of Major Adverse Clinical Outcomes

Abstract Background: Tibial vessel disease (stenoses or occlusions) has a huge variety of outcomes either technical or clinical, which has an impact on the health authorities. Aim of Study: To locate clinical outcome predictors fol-lowing Plain Old Balloon Angioplasty (POBA) in diabetic patients with below knee atherosclerotic lesions causing Chronic Limb Threatening Ischemia (CLTI). Patients and Methods: Over one year, 67 patients (CLTI 100%) underwent infragenicular angioplasty. Our main interest was Major Adverse Clinical Outcome (MACO) of thelimb operated upon at follow-up which was adressed as clinical failure, need for subsequent endovascular or surgical revas-cularization or amputation. Results: Amputation free survival was seen in 88% with CLTI. Sound healing of wounds was achieved in 76% of cases with a mean value of healing timeof 10.7 months. Significant predictors of MACO were technical failure (p-value 0.002) and occlusive lesions (p-value 0.019). Freedom of MACO was achieved in 76.1%. Conclusions: Infragenicular angioplasty is a feasible therapeutic option in diabetic population. Type ofthe lesions in addition to smoking may be predictors of adverse outcome.

Circulating Osteocrin Levels Do Not Track with Myocardial Function in Chronic Systolic Heart Failure

Background Osteocrin was originally classified as a muscular and bone secretory protein with the ability to modulate bone growth through osteoblast activity, yet it shares a similar sequence to the family of natriuretic peptides (NPs). Despite their sequence homology, it is yet unknown whether osteocrin exhibits similar properties to NPs. However, recent work has shown that osteocrin can limit C-type NPs and more definitively, that a transgenic osteocrin mouse strain exhibited improved outcomes and alleviated echocardiographic parameters, after myocardial infarction (MI). Hypothesis With previous evidence showing improved prognosis and cardiac function in osteocrin-overexpressing mice post-MI, we hypothesize that circulating osteocrin levels in chronic heart failure patients could track with echocardiographic indices and other heart failure (HF) biomarkers of interest. Method Eighty-seven symptomatic chronic HF subjects with LVEF ≤35% underwent detailed echocardiographic evaluation and measurements of plasma NPs and osteocrin by ELISA assay, with long-term follow-up for all-cause mortality, transplantation, or mechanical circulatory support. Results In our study cohort (mean age 57 years, 72% male, 44% ischemic), median plasma osteocrin level was 198.3 (IQR 131.5, 386.3) ng/L. Plasma osteocrin levels did not track with demographics, comorbidities, medications, or laboratory values including ANP and BNP. Furthermore, osteocrin did not correlate to major echocardiographic indices (Table) or long-term adverse clinical outcomes. Conclusions Although osteocrin shows similarity to NPs and has been shown to exert cardioprotective effects in mice after cardiac insult, we did not observe any relationship between circulating osteocrin levels and clinical or echocardiographic parameters in chronic HFrEF patients.

Prognostic impact of atrial fibrillation in hypertrophic cardiomyopathy: a systematic review.

Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). To conduct a systematic review of published literature to: (a) assess the incidence of AF in HCM and (b) examine the impact of AF on risk of thromboembolism, heart failure, sudden death and mortality in HCM. Search of all major databases (Pubmed, MEDLINE, Embase, Cochrane, Scopus, Web of Science) was performed to April 2020 using the search terms "atrial fibrillation" AND/OR "hypertrophic cardiomyopathy" in the title or abstract. 51 of the 1,565 citations met the inclusion criteria. Using random-effects modelling, the estimated pooled prevalence of AF amongst 21,887 HCM patients (36 studies) was 22.3% (95%, 19.9-24.8) and the pooled incidence of AF was 2.5 cases per person-years (95% CI 1.9-3.0). 15,444 patients from 28 studies were included in analysis of outcome data (mean age was 49.9years; 32.7% female; mean LVEF 69%). Over a median follow up duration of 6.9years (range 2.8-11.7years), AF, compared to sinus rhythm (SR), was associated with significantly increased risk of thromboembolism [relative risk (RR) 7.0; 95% CI 4.6-10.7; I2 = 57%], heart failure (RR 2.8; 95% CI 1.6-4.6; I2 = 82%), sudden death (RR 1.7; 95% CI 1.3-2.3; I2 = 0%), and all-cause mortality (RR 2.5; 95% CI 1.8-3.4; I2 = 69%). AF is highly prevalent in patients with HCM. The presence of AF is associated with major adverse clinical outcomes. These findings suggest that both, aggressive screening and treatment of AF, are likely to have major prognostic impact on outcomes in HCM. Incidence, prevalence and prognostic impact of AF in HCM. In this systematic review, AF incidence was 2.5 cases per-person years, prevalence was 22.3%. AF in HCM was associated with a seven-fold increased risk of thromboembolism, 2.8-fold increased risk of heart failure, 1.7-fold increased risk of sudden death and 2.5-fold increased risk of all-cause mortality.

Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease

ObjectivesTo investigate if non-alcoholic fatty liver disease (NAFLD) impacts mortality and adverse outcomes for individuals with chronic kidney disease (CKD).DesignSystematic review.Data sourcesPubMed, EMBASE and Web of Science were searched up...

Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy

BackgroundWe compared the clinical outcomes and cost-efficiency of surgical approaches (sternotomy-open, video assisted thoracoscopic surgery, and robotic assisted thoracic surgery) for thymectomy. MethodsThis is a retrospective review of 220 consecutive patients who underwent thymectomy between January 1, 2007, and January 31, 2017. Surgical approach was determined by the surgeon, but we only included cases that could be resected using any of the 3 approaches. ResultsOpen approach was used in 69 patients, whereas minimally invasive technique was used in 151 (97, video assisted thoracoscopic surgery; 54, robotic assisted thoracic surgery). Open surgery was associated with greater total hospital cost ($22,847 ± $20,061 vs $14,504 ± $10,845, P < .001). Open group also revealed longer duration of intensive care unit (1.2 ± 2.8 vs 0.2 ± 1.3 days, P < .001) and hospital stay (4.3 ± 4.0 vs 2.0 ± 2.6 days, P < .001). There were no differences in major adverse clinical outcomes. Long-term recurrence-free survival after resection of thymoma was similar between the groups. ConclusionMinimally invasive techniques were equally efficacious compared with the open approach in the resection of the thymus. Additionally, their use was associated with decreased hospital duration of stay and reduced cost. Hence the use of minimally invasive approaches should be encouraged in the resection of thymus.

P1490AGAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods to assess physical performance. Method We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationship with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia. Results The prevalence of low gait speed and handgrip strength were 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with had different determinant factors (older age, the presence of diabetes, and lower serum albumin for low gait speed, and lower body mass index, and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risk of all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and that their combination improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator for poor patient outcomes compared with handgrip strength.

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patients

BackgroundLow physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance.MethodsWe obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.ResultsThe prevalence of low gait speed and handgrip strength was 28.2 and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes.ConclusionGait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.