One-year Outcomes Of Patients Research Articles

One-year outcomes of patients with hypertrophic cardiomyopathy according to levels of inflammatory biomarkers

Abstract Background Hypertrophic cardiomyopathy (HCM) is a vastly heterogeneous sarcomere disorder unified by maximal left ventricular (LV) thickness increases. The lifetime relative risk of morbidity in HCM is four-fold higher than in the general population, primarily driven by arrhythmias and heart failure (HF). Numerous prognostic features have been identified, but our ability to identify high-risk patients of progression remains rudimentary. Small retrospective studies have shown that systemic inflammation is associated with adverse outcomes in patients with HF; others, small and single-center, have also shown associations between adverse outcomes and inflammation in HCM. Purpose We aimed to determine whether elevated levels of inflammatory biomarkers are associated with an increased risk of acute heart failure (AHF) and mortality at 1 year in a large cohort of patients with HCM across multiple centers in the United States (US). Methods In this retrospective study, using the US cohort of 60 healthcare organizations in the TriNetX database, we included more than 85,000 adult patients with HCM (ICD-10-CM codes I42.1 and I42.2) between 2004 and 2024. Patients were divided according to predetermined cut-offs of different inflammatory biomarkers (C-reactive protein [CRP], <2 mg/L vs. 2-100 mg/L; white blood cells [WBC], < vs. ≥ the median [8x10^3/µL]; neutrophils [Neu], < vs. ≥ the median [5x10^3/µL]). These cohorts were then 1:1 propensity score matched (PSM) for age, sex, and race. We used Kaplan-Meier survival curves to derive cumulative incidence curves (as 1 minus Kaplan-Meier survival estimates) for AHF (ICD-10-CM codes I50.21, I50.23, I50.31, I50.33, I50.41, I50.43) or death, and we compared them with the Log-rank (Mantel-Cox) test. We also derived Hazard Ratios (HR) with 95% Confidence Interval (CI) from Cox regression analysis to compare the outcomes within the groups at 1-year. Results After PSM, patients with HCM and CRP levels between 2-100 mg/L experienced higher rates of the composite outcome (19.6% vs. 12.2%, Log-rank p<0.001; HR 1.67, 95% CI [1.29-2.16]), as well as the separate outcomes of death (14.7% vs. 6.8%, Log-rank p<0.001; HR 2.23, 95% CI [1.68-2.98]) and AHF (10.9% vs. 7.5%, Log-rank p<0.001; HR 1.49, 95% CI [1.07-2.07]), compared to those with CRP <2 mg/L (Table 1)(Figure 1). Similarly, patients with Neu ≥5x10^3/µL reported higher incidences of the composite outcome (20.3% vs. 13.2%, Log-rank p<0.001; HR 1.62, 95% CI [1.55-1.68]) and the separates outcomes, compared to those with Neu <5x10^3/µL (Table 1) (Figure 1). Patients with WBC ≥8x10^3/µL also had increased rates of the composite outcome (19.4% vs. 14.1%, Log-rank p<0.001; HR 1.43, 95% CI [1.38-1.48]) and the separate outcomes, compared to those with WBC <8x10^3/µL (Table 1)(Figure 1). Conclusions In the first large 'real world' analysis of patients with HCM, elevated levels of inflammatory biomarkers were associated with worse outcomes of death and acute heart failure.

Characteristics and one-year outcomes of patients with advanced atrioventricular block in Saudi Arabia: A single-center retrospective cohort study.

To report and describe the characteristics and outcomes of patients with advanced atrioventricular block (AVB) in Saudi Arabia. We included consecutive patients who underwent pacemaker implantation at King Khaled University Hospital, Riyadh, Saudi Arabia, for advanced AVB, which was defined as second degree type 2 AVB, third degree AVB, and symptomatic atrial fibrillation with slow ventricular response. The variable "young patient" was defined as age of 60 or less, based on guidelines recommending cardiac sarcoidosis (CS) evaluation at this age or younger. Among 100 patients (median age: 71 males, 51%), 29 (29%) were young patients. Most patients had at least one comorbidity including hypertension, diabetes, or dyslipidemia (81%). Young patients constituted 26.6% (n=21/79) of idiopathic AVB cases and only 23.8% (n=8/21) underwent CS evaluation (8/21). A significant proportion of AVB occurs in young patients. Yet, CS is often not ruled out. Future studies should define the yield of CS evaluation in the Saudi population when international consensus documents are followed.

Relationship between the severity of functional mitral regurgitation at admission and one-year outcomes in patients hospitalized for acute heart failure with mildly reduced ejection fraction

BackgroundThe epidemiological distribution of functional mitral regurgitation (FMR) in heart failure (HF) and mildly reduced ejection fraction (HFmrEF) patients and its impact on outcomes remains unclear. We attempt to investigate the prognosis of FMR in patients with HFmrEF.MethodsThe HF center registry study is a prospective, single, observational study conducted at the Second Affiliated Hospital of Shenzhen University, where 2330 patients with acute HF (AHF) were enrolled and 890 HFmrEF patients were included in the analysis. The patients were stratified into three categories based on the severity of FMR: none/mild, moderate, and moderate-to-severe/severe groups. Subsequently, a comparison of the clinical characteristics among these groups was conducted, along with an assessment of the incidence of the primary endpoint (comprising all-cause mortality and readmission for HF) during a one-year follow-up period.ResultsThe one-year follow-up results indicated that the primary composite endpoint occurrence rates in the three groups were 23.5%, 32.9%, and 36.5%, respectively. The all-cause mortality rates in the three groups were 9.3%, 13.7%, and 16.4% respectively. Survival analysis demonstrated a statistically significant difference in the occurrence rates of the primary composite endpoint and all-cause mortality among the three groups (P < 0.05). Multifactor Cox regression revealed that moderate FMR and moderate-to-severe/severe FMR were independent risk factors for adverse clinical prognosis in HFmrEF patients, with hazard ratios and 95% confidence intervals of 1.382 (1.020–1.872, P = 0.037) and 1.546 (1.092–2.190, P = 0.014) respectively.ConclusionsModerate FMR and moderate-to-severe/severe FMR independently predict an unfavorable prognosis in patients with HFmrEF.

Oral anticoagulation with Edoxaban for stroke prevention in patients with atrial fibrillation: Analysis of 1-year follow-up data of routine clinical practice in Germany, Austria and Switzerland (DACH) from the ETNA-AF registry

Non-vitamin-K oral anticoagulants (NOACs) are safe and effective for stroke prevention in patients with atrial fibrillation (AF). Data on the safety and efficacy of Edoxaban in routine care in Germany, Austria and Switzerland (DACH) are limited. We report one-year outcomes in patients with AF treated with Edoxaban in routine care. The ETNA-AF-Europe study (Clinicaltrials.gov:NCT02 944 019) is a multicenter, prospective, observational study that enrolled 13 092 patients with AF treated with Edoxaban from 852 sites across 10 European countries (Austria, Belgium, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Switzerland, and the United Kingdom). The DACH-cohort consists of 5457 (41,7 %) patients of sites in Germany, Austria and Switzerland. Patients had a mean age of 74 years (2384 [44 %]women) and a mean CHA2DS2-VASc-score of 3.2 ± 1.4. A label-conform dosing of Edoxaban was administered to 4309 patients (78,9 %). At the one-year-follow-up a stroke or systemic embolism occurred in 42 patients (0,8 %/year), and severe bleeding was reported in 36 patients (0,7 %/year). Ten patients (0,2 %/year) suffered intracranial and 13 patients (0,3 %/year)gastrointestinal bleeding. Numbers of death from all causes and cardiovascular death occurred in 179 patients (3,4 %/year) and 85 patients (1,6 %/year), respectively. Age > 75 years, frailty and a CHA2DS2-VASc score ≥ 4 were associated with a higher all-cause mortality - and those patients were more likely to suffer a stroke or a major bleeding event. In Germany, Austria and Switzerland in patients with AF on Edoxaban therapy for stroke prevention the number of stroke and major bleeding events is low. Increasing morbidity is associated with a higher number of important clinical events.

Sex differences at diagnosis and in one-year outcomes in patients with early atrial fibrillation

Abstract Background Little is known about differences in clinical phenotype between men and women with atrial fibrillation (AF). Our aim was to explore phenotypical sex differences at diagnosis and at one-year follow-up, in patients with early AF. Methods We used data from 5,469 participants of the DUTCH-AF registry; a nationwide prospective registry of patients with early AF or atrial flutter (diagnosis ≤ 6 months before inclusion) in the Netherlands, aged ≥ 18 years. We describe sex differences in clinical phenotype at diagnosis and at one-year follow-up, including the following outcomes: i) ischemic and bleeding events, ii) all-cause mortality, iii) AF-related hospital admissions, including ablation and cardioversion, and iv) AF progression patterns. Results At inclusion, women were older than men (median 73 vs. 69 years, p&amp;lt;0.001), had more often paroxysmal AF (66% vs. 55%, p&amp;lt;0.001), and less often persistent AF (27% vs. 37%, p&amp;lt;0.001). They also had hypertension more often (59% vs. 53%, p&amp;lt;0.001), and less often vascular disease (12% vs. 21%, p&amp;lt;0.001, and reported more often symptoms at inclusion and in the month before follow-up; 56% vs. 46%, p&amp;lt;0.001, and 31% vs. 23%, p&amp;lt;0.001, respectively. Women underwent cardioversion and ablation procedures less often than men (14% vs. 21% p&amp;lt;0.001 and 3% vs. 5%, p&amp;lt;0.001, respectively). Moreover, for the combined rhythm control intervention cardioversion and ablation, women also underwent this rhythm control outcome less often than men (unadjusted odds ratio was 0.63 95% CI (0.55-0.73)), regardless of age, and the type of AF (i.e., paroxysmal or persistent AF) at inclusion (adjusted odds ratio 0.77 95% CI (0.62-0.92)). No differences were observed for ischemic and bleeding events, all-cause mortality, or AF progression patterns, but the number of these events was small. Conclusion Men and women with early AF differ in age, comorbidities, symptoms, and management. These findings are building blocks for individualized sex-specific AF care and research.

The Intersection of Atrial Fibrillation and Coronary Artery Disease in Middle Eastern Patients. Analysis from the Jordan Atrial Fibrillation Study.

There is a scarcity of clinical studies which evaluate the association of atrial fibrillation (AF) and coronary artery disease (CAD) in the Middle East. The aim of this study was to evaluate the impact of CAD on baseline clinical profiles and one-year outcomes in a Middle Eastern cohort with AF. Consecutive AF patients evaluated in 29 hospitals and cardiology clinics were enrolled in the Jordan AF Study (May 2019-December 2020). Clinical and echocardiographic features, use of medications and one-year outcomes in patients with AF/CAD were compared to AF/no CAD patients. Of 2020 AF patients enrolled, 216 (10.7%) had CAD. Patients with AF/CAD were more likely to be men and had significantly higher prevalence of hypertension, diabetes, dyslipidemia, heart failure and chronic kidney disease compared to the AF/no CAD patients. They also had lower mean left ventricular ejection fraction and larger left atrial size. Mean CHA2DS2 VASc and HAS-BLED scores were higher in AF/CAD patients than those with AF/no CAD (4.3 ± 1.7 vs. 3.6 ± 1.8, p < 0.0001) and (2.0 ± 1.1 vs. 1.6 ± 1.1, p < 0.0001), respectively. Oral anticoagulant agents were used in similar rates in the two groups (83.8% vs. 82.9%, p = 0.81), but more patients with AF/CAD were prescribed additional antiplatelet agents compared to patients with AF/no CAD (73.7% vs. 41.5%, p < 0.0001). At one year, AF/CAD patients, compared to AF/no CAD patients had significantly higher hospitalization rate (39.4% vs. 29.2%, p = 0.003), more acute coronary syndrome and coronary revascularization (6.9% vs. 2.4%, p = 0.004), and higher all-cause mortality (18.5% vs. 10.9%, p = 0.002). In this cohort of Middle Eastern patients with AF, one in 10 patients had CAD. The coexistence of AF and CAD was associated with a worse baseline clinical profile and one-year outcomes. Clinical study registration: the study is registered on clinicaltrials.gov (unique identifier number NCT03917992).

One-year Outcomes Of Patients With HFrEF Followed At A Multidisciplinary Heart Failure Clinic In The Middle East: HFimpEF Vs. Persistent HFrEF

One-year Outcomes Of Patients With HFrEF Followed At A Multidisciplinary Heart Failure Clinic In The Middle East: HFimpEF Vs. Persistent HFrEF

The relationship between hyperpolypharmacy and one-year outcomes in patients with critical limb ischemia undergoing below-knee endovascular therapy.

Critical limb ischemia (CLI) patients take too many medications because they are elderly and frail patients with multiple comorbidities. Polypharmacy is associated with frailty, although its prognostic significance in CLI patients is unknown. In this study, we aimed to determine the prevalence of hyperpolypharmacy among adults with CLI and its effect on 1-year amputation and mortality. A total of 200 patients with CLI who underwent endovascular therapy (EVT) for below-knee (CTC) lesions were included in this study. Hyperpolypharmacy was defined as using ≥10 drugs. Patients were divided into two groups according to the presence of hyperpolypharmacy. We detected hyperpolypharmacy in 66 patients. The incidence of 1-year amputation [24 (36.4) versus 12 (9), p<.001] and mortality [28 (42.4) versus 12 (9), p<.001] were higher in patients with hyperpolypharmacy. Univariate and multivariate cox regression analyses were used to determine the independent predictors of amputation and mortality. In the receiver operating characteristic curve analysis, the cut-off value was defined as 10 or more drug use was able to detect the presence of 1-year mortality with 67.5% sensitivity and 79.4% specificity. The Kaplan-Meier method showed a significant difference (rank p <.001 between log groups), and hyperpolypharmacy was associated with 1-year amputation and mortality. Hyperpolypharmacy was significantly associated with 1-year mortality and major amputation in CLI patients. Hyperpolypharmacy can be a valuable aid in patient risk assessment in the CLI.

Abstract 17996: One-Year Outcomes of Patients With ST-Segment Elevation Myocardial Infarction According to Eosinophil Blood Count

Background: ST-segment elevation myocardial infarction (STEMI) elicits an intense inflammatory response but the relation between eosinophil blood count and outcomes in this setting is not clear. Hypothesis: A difference in eosinophil blood count in patients with STEMI is associated with a different incidence of death or hospitalization for heart failure (HF). Methods: In this retrospective study using the US cohort of 49 healthcare organizations in the TriNetX database, we included 41,945 patients with STEMI (identified by ICD-10-CM code) between January 1, 2012, and June 2, 2022. Patients were divided into two groups according to the median of eosinophil blood count measured 2-3 days after the acute event in our previous study (0.2x103/μL). The Kaplan-Meier method was used to compare the risks of the composite outcome of death or HF hospitalization within the two cohorts. Results: We included 15,725 and 26,220 patients with median eosinophil blood count equal/above and below 0.2x103/μL, respectively. At 1-year follow-up, the risk of death or HF hospitalization was lower in patients with eosinophil blood count above/equal to the median, 0.2x103/μL (13.6% vs 18.9%; Hazard Ratio 0.68, 95% CI [0.64-0.71]; p&lt;0.001). The incidence of the composite outcome at 1 year was 15.3% and 21.5% for patients with median eosinophil blood count equal/above and below 0.2x103/μL, respectively (p&lt;0.001 for the log-rank test). Figure 1. Secondary analysis suggested that this result was driven mainly by lower mortality in the cohort with higher eosinophil count (10.1% vs 14.9%; HR 0.63, 95% CI [0.59-0.67]; p&lt;0.001). Conclusions: In our large 'real world' analysis, a higher eosinophil blood count within the normal range during the acute phase post-STEMI is associated with a better outcome of death or hospitalization for heart failure.

One-year outcomes in patients undergoing very high-power short-duration temperature-controlled ablation for atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background The very high-power short-duration (vHPSD) temperature-controlled ablation (vHPSD) improves the efficiency of pulmonary vein isolation (PVI) procedures. Aims We evaluated the procedural and 12-months outcomes in atrial fibrillation (AF) patients undergoing PVI by means of vHPSD ablation. In patients with AF or atrial tachy-arrythmia (AT) recurrence undergoing a redo procedure the durability of the PVI was investigated. Methods Consecutive paroxysmal/persistent AF patients undergoing PVI with the vHPSD ablation strategy (90 W, for 4 s) were enrolled. The rate of PVI, first pass isolation, acute reconnection, and procedural complications were evaluated. Follow-up examinations and EKG were scheduled at 1,6, and 12 months. In case of AF/AT recurrence, patients underwent a redo procedure. Results Overall, 163 AF patients (29 persistent and 134 paroxysmal) were enrolled. The PVI was reached in 100% of patients (88% at first pass). The rate of acute reconnection was 2%. The radiofrequency, fluoroscopy and procedural times were respectively 5,5±1 min, 9±1 min and 75±20 min. No death, tamponade nor steam pops occurred, however 5 patients had vascular complications. The 12-months freedom from AF/AT recurrence was 84% in paroxysmal patients and 71% in persistent. Overall, 9 patients underwent a redo procedure, and in 4 all veins were still isolated, whereas in 5 pulmonary vein reconnections were found. The PVI durability was 83%. No overt complications were observed in the follow-up. Conclusions The vHPSD ablation represents an effective and safe ablation strategy to achieve PVI. The 12-months follow-up showed high freedom from AF/AT recurrence and a good safety profile.

Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses: Differences Between Patients < 75 and ≥ 75 Years of Age?

The benefit of ICU in older patients is often debated. There is little knowledge on subjective impressions of excessive care in ICU clinicians combined with objective patient data in real-life cases. Is there a difference in treatment limitation decisions and one-year outcomes in patients above and below 75 years, with and without concordant perceptions of excessive care by two or more ICU clinicians? Reanalysis of the prospective observational DISPROPRICUS study, performed in 56 ICUs. Clinicians (nurses, physicians) completed a daily questionnaire about the appropriateness of care for each of their patients during a 28 day period in 2014. We compared the cumulative incidence of patients with concordant perceptions of excessive care, treatment limitation decisions and the proportion of patients attaining the combined endpoint (death, poor quality of life or not being at home) at one year across age groups via Cox-regression with propensity score weighing and Fisher-exact tests. Of 1641 patients, 405 (25%) were ≥75 years. The cumulative incidence of concordant perceptions of excessive care was higher in older patients (13.6% versus 8.5%, p<0.001).In patients with concordant perceptions of excessive care, we found no difference between age groups in risk of death (one-year mortality 83% in both groups, p=1, HR after weighing 1.11, 95%CI 0.74-1.65); treatment limitation decisions (33% versus 31%, HR after weighing 1.11, 95%CI 0.69-2.17) and reaching the combined endpoint at one year (90% versus 93%, p=0.546).In patients without concordant perceptions of excessive care, we found a difference in risk of death (one-year mortality 41% versus 30%, p<0.001, HR after weighting 1.38, 95%CI 1.11-1.73) and treatment limitation decisions (11% versus 5%, p<0.001; HR 2.11, 95%CI 1.37-3.27), though treatment limitation decisions were mostly documented prior to ICU admission. The risk of reaching the combined endpoint was higher in the older (61.6% versus 52.8%, p<0.001). Although the incidence of perceptions of excessive care is slightly higher in older patients, there is no difference in treatment limitation decisions and one-year outcomes between older and younger patients once patients are identified by concordant perceptions of excessive care. Additionally, in patients without concordant perceptions the outcomes are worse in the older, pleading against ageism in ICU clinicians.

One-year outcomes in patients undergoing very high-power short-duration ablation for atrial fibrillation

BackgroundThe very high-power short-duration (vHPSD) temperature-controlled ablation (vHPSD) improves the efficiency of pulmonary vein isolation (PVI) procedures.We evaluated the procedural and 12-months outcomes in atrial fibrillation (AF) patients undergoing PVI by means of vHPSD ablation. In patients with AF or atrial tachyarrythmia (AT) recurrence undergoing a redo procedure the durability of the PVI was investigated.MethodsConsecutive paroxysmal/persistent AF patients undergoing PVI with the vHPSD ablation strategy (90 W, for 4 s) were enrolled. The rate of PVI, first-pass isolation, acute reconnection, and procedural complications were evaluated. Follow-up examinations and EKG were scheduled at 3,6, and 12 months. In case of AF/AT recurrence, patients underwent a redo procedure.ResultsOverall, 163 AF patients (29 persistent and 134 paroxysmal) were enrolled. The PVI was reached in 100% of patients (88% at the first pass). The rate of acute reconnection was 2%. The radiofrequency, fluoroscopy and procedural times were respectively 5.5 ± 1 min, 9 ± 1 min and 75 ± 20 min. No death, tamponade nor steam pops occurred; however, 5 patients had vascular complications. The 12-months freedom from AF/AT recurrence was 86% in both paroxysmal and persistent patients. Overall, 9 patients underwent a redo procedure, and in 4 all veins were still isolated, whereas in 5 pulmonary vein reconnections were found. The PVI durability was 78%. No overt clinical complications were observed in the follow-up.ConclusionsThe vHPSD ablation represents an effective and safe ablation strategy to achieve PVI. The 12-months follow-up showed high freedom from AF/AT recurrence and a good safety profile.

The Effects of the Obesity Paradox and In-Hospital and One-Year Outcomes in Patients With ST Elevation Myocardial Infarction (STEMI): Results From a STEMI Registry.

Obesity is strongly associated with increased cardiovascular diseases (CVD) and cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. However, numerous studies have suggested the existence of an "obesity paradox" in which overweight and mildly obese patients often exhibit a better outcome than their leaner counterparts. Therefore, this study aimed to characterize the association between BMI and in-hospital and one-year outcomes. This hospital-based research was conducted as a part of the Kermanshah STEMI Registry. Following the application of inclusion criteria, a total of 2,397 STEMI patients were evaluated. The data were collected using a standardized case report developed by the European Observational Registry Program (EORP). Body mass index (BMI) (kg/m2) was classified into underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), class I/mild obese (30-34.9), and class II/extreme obese (≥35) categories. The independent predictors of the in-hospital and one-year outcomes were assessed using multivariable logistic regression models. Out of the 2397 patients, 43 (1.79%) were underweight, 934 (38.97%) were normal, 1038 (43.30%) were overweight, 322 (13.43%) were class I obese, and 60 (2.50%) were class II obese. The results of the crude analysis showed that class I obesity was protective against CV death (OR 0.50; 95% CI 0.30-0.84), MACE3 (MI, stroke, and death) (OR 0.47; 95% CI 0.29-0.76), and MACE5 (MACE3 plus unstable angina and heart failure) (OR 0.59; 95% CI 0.44-0.79). Multivariate adjustment eliminated the protective effect of class I obesity against death and MACE events. Therefore, it is possible that this protective effect does not exist and instead reflects the impact of confounding variables such as age.

ГОДИЧНЫЕ ИСХОДЫ У БОЛЬНЫХ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА С ПРОГРЕССИРУЮЩИМ АТЕРОСКЛЕРОЗОМ

Вackground. Progressive atherosclerosis syndrome, in contrast to spontaneous one, is accompanied by a more severe course and frequent complications. Therefore, it is crucial to define the risk stratification criteria and treatment of such patients. Purpose of the study to study one-year outcomes in patients with coronary heart disease with progressive atherosclerosis. Patient Characterization and Research Methods. The study included 202 patients with confirmed diagnosis of CHD: 147 men and 55 women. The mean age of the patients was (53,3 ± 7,16) years. The main group (100 patients) included those who had two (or more) additional cardiovascular events from the following in the two years before the study: MI or unstable angina pectoris, emergency artery stenting, stroke, peripheral artery thrombosis, critical ischemia or lower limb amputation, and the comparison group included 102 patients with CHD without such events. After 12 months from the time of inclusion, end points were evaluated. Statistical Analysis Methods. Microsoft Office Excel 2019 program was used. Results. The work revealed that patients with progressive atherosclerosis have worse long-term (one-year) prognosis in comparison with its spontaneous course; a significant influence on unfavorable outcomes is exerted by: Angina of any EF without surgical treatment - OR 4.125 (1.213; 14.027), multivessel coronary artery disease - OR 3.929, CI (1.156-13.350), C-reactive protein level 5 mg/L or higher - OR 18.667, CI (4.684-74.393).

One-Year Outcomes in Patients Who Survived COVID-19-Related Acute Respiratory Distress Syndrome (ARDS): Pulmonary Function Tests PFTs, Oxygen Requirement, and Quality of Life QoL

One-Year Outcomes in Patients Who Survived COVID-19-Related Acute Respiratory Distress Syndrome (ARDS): Pulmonary Function Tests PFTs, Oxygen Requirement, and Quality of Life QoL

One-year outcomes in patients who underwent coronary intravascular shockwave lithotripsy for highly-calcified coronary lesions

Intravascular lithotripsy (IVL) is associated with excellent angiographic and short-term results in patients with calcified lesions requiring percutaneous coronary intervention. We conducted a 1-year follow up of a retrospective cohort of 47 patients (61 lesions) who underwent IVL. The primary outcome was target vessel revascularization (TVR) at 1-year from index procedure. Four percent of patients required TVR within 1 year; 96% who underwent IVL remained free from repeat intervention on the same vessel. One patient suffered a myocardial infarction; the culprit vessel had not been previously treated with IVL. IVL is an effective and durable modality for treatment of highly calcified coronary lesions in high-risk patients.

224 One-Year Outcomes in Patients with Colorectal Malignancy and Low Functional Capacity on CPET

Abstract Aim Many patients with colorectal carcinoma (CRC) undergo Cardio-Pulmonary Exercise Test (CPET) to risk-stratify their suitability for surgery. This study aims to evaluate the 1-year outcomes of patients with colorectal malignancy and low functional capacity on CPET. The secondary aim is to evaluate the correlation between P-/CR-POSSUM scores and one-year outcomes. Method All patients with stage I-IIICRC who underwent CPET between January 2013-August 2020 with Anaerobic Threshold (AT)&amp;lt;10ml/min/kg follow-up for one year were included. Major complications were classified using Clavien-Dindo classification of Grade III or higher. Results We included 77patients(64%males) with median age of 77(range 53–90). Thirty-one patients received best supportive care;46 underwent elective resection with median AT of 7.9(5.3–9.5)ml/min/kg and 8.7(6.4–9.9)ml/min/kg respectively(p=0.001).Of those treated surgically,9(20%)had major complications. There was no 30-day mortality. Median postoperative length of stay (LOS) was 8(3–42) days. Median overall survival(OS) among patients with surgery versus best supportive management was longer–42(8–106)months vs.25(2–59)months(p&amp;lt;0.0001).1-year survival rate was higher-57%vs.19%(p=0.002)in patients who had surgery compared to those with non-surgical management. Presence of major complications correlates with AT(p=0.003), LOS(p=0.007), OS(p&amp;lt;0.0001) and death(p=0.002). P-/CR-POSSUM scores(n=11) showed no significant correlation with major complications or LOS. One-year survival demonstrated no correlation between P-/CR-POSSUM with OS. Conclusions Surgical treatment of CRC showed survival benefit and should be considered for patients with low functional capacity. Due to our small sample size, P-/CR-POSSUM were not correlated with major complications, LOS and OS.

Outcomes of radiofrequency catheter ablation for persistent and long-standing persistent atrial fibrillation

ObjectiveTo assess one-year outcomes in patients with persistent and long-standing persistent atrial fibrillation (AF) treated by catheter ablation. MethodsA retrospective observational study was conducted of consecutive patients referred for catheter ablation of persistent or long-standing persistent AF between May 2016 and October 2018. Patients underwent two different ablation strategies: pulmonary vein isolation (PVI) plus complex fractionated atrial electrograms (CFAE) (from May 2016 to June 2017) or a tailored approach (from July 2017 to October 2018). The overall recurrence rate at one year was analyzed. The secondary endpoint was arrhythmia recurrence according to the type of AF (persistent vs. long-standing persistent AF) and according to the ablation strategy employed. ResultsDuring the study period, 67 patients were included (40% with long-standing persistent AF). During a mean follow-up of 16±6 months, 27% of the patients had arrhythmia recurrence. Patients with long-standing persistent AF had a higher recurrence rate than those with persistent AF (44.4% vs. 15%, p=0.006), while patients who underwent a tailored approach presented better outcomes than those undergoing PVI plus CFAE ablation (17.5% vs. 40.7%, p=0.024). Ablation strategy (HR 6.457 [1.399-29.811], p=0.017), time in continuous AF (HR 1.191 [1.043-1.259], p=0.010) and left atrial volume index (HR 1.160 [1.054-1.276], p=0.002) were independent predictors of arrhythmia recurrence. ConclusionCatheter ablation is an effective treatment for patients with persistent and long-standing persistent AF. Patients with persistent AF and those undergoing a tailored approach presented lower arrhythmia recurrence.

Clinical profile and one-year outcomes of patients with mural infective endocarditis: – A tertiary care centre study based on data from a seven-year registry

BackgroundInfective endocarditis patients present very rarely with vegetations on the mural endocardium. Only very few studies are available comparing Mural infective endocarditis with commoner valvular or device related infective endocarditis. AimTo analyse the clinical features, microbiological profile and clinical course of mural endocarditis in comparison to valvular endocarditis. MethodsThis was a retrospective analysis of data from a registry of infective endocarditis. Patients enrolled between April 2012 and April 2019 were included. Patients who were reported to have vegetations on the mural endocardial surface were taken as a group and compared with rest of the patients. Clinical profile, laboratory parameters including culture and outcomes were compared between the two groups. ResultsOut of 278 patients in the study, 15 (5.38%) had vegetations on the mural endocardium. Of them, only 4 patients had structural heart diseases. All the patients with mural endocarditis were NYHA class II or below at presentation. Ventricles were the commonest sites of vegetations. Inflammatory markers like ESR and CRP were low in mural endocarditis compared to rest. Culture positivity was high in mural endocarditis and Staphylococcus Aureus was the commonest organism. Mural endocarditis patients had similar in hospital mortality to rest of the patients. Cardiac complications were not reported in mural endocarditis, but they had similar incidence of embolic complications including neurological events. ConclusionMural endocarditis is a rare clinical entity with similar morbidity and mortality to that of endocarditis with valvular vegetation.

Return to work after acute myocardial infarction with cardiogenic shock: a Danish nationwide cohort study.

Physical and mental well-being after critical illness may be objectified by the ability to work. We examined return to work among patients with myocardial infarction (MI) by cardiogenic shock (CS) status. Danish nationwide registries were used to identify patients with first-time MI by CS status between 2005 and 2015, aged 18-63 years, working before hospitalization and discharged alive. Multiple logistic regression models were used to compare groups. We identified 19 799 patients with MI of whom 653 had CS (3%). The median age was similar for patients with and without CS (53 years, interquartile range 47-58). One-year outcomes in patients with and without CS were as follows: 52% vs. 83% returned to work, 41% vs. 16% did not and 6% vs. 1% died. The adjusted odds ratio (OR) of returning to work was 0.53 [95% confidence limit (CI): 0.42-0.66]. In patients with CS, males and patients surviving OHCA were more likely to return to work (OR: 1.83, 95% CI: 1.15-2.92 and 1.55, 95% CI: 1.00-2.40, respectively), whereas prolonged hospitalization (OR: 0.38, 95% CI: 0.22-0.65) and anoxic brain damage (OR: 0.36, 95% CI: 0.18-0.72) were associated with lower likelihood of returning to work. In patients with MI discharged alive, approximately 80% of those without CS returned to work at 1-year follow-up in contrast to 50% of those with CS. Among patients with CS, male sex and OHCA survivors were markers positively related to return to work, whereas prolonged hospitalization and anoxic brain damage were negatively related markers.