Poor Long-term Clinical Outcomes Research Articles

Clinical characteristics and long-term outcome of patients with bioprosthetic mitral valve- Experience from a South Asian country.

Due to rheumatic heart disease, young people are more likely to develop valvular heart disease in developing countries. In countries like Pakistan, surgeons implant more bioprosthetic mitral valves (MVs) in younger patients. However, bioprosthetic valves degenerate rapidly in younger people, leading to bioprosthetic MV dysfunction (BMVD). This study aims to evaluate the clinical characteristics and long-term outcomes of patients with bioprosthetic MV replacement (MVR) at a tertiary care hospital in a South Asian country. This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bioprosthetic MVR from the year 2006 to 2020. Clinical and surgical characteristics along with transthoracic echocardiographic findings (pre-surgery and recent most follow-up studies) were noted. Follow-up data were also collected. Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. MVR was done as an elective procedure due to the New York Heart Association (NYHA) II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 ± 2.99 years, BMVD was observed in 183 (36.5%) patients. However, re-do MV surgery was done in only 49 (9.8%) patients. Patients were divided into two groups based on normal functioning bioprosthetic MV and BMVD. Comparing the two groups, individuals with normal functioning bioprosthetic MV had a mean age of 51.6 ± 14.27 years, while those with BMVD had a mean age of 45.639 ± 14.33 years at the time of index surgery (P = 0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%), and death (n = 6, 3.28%) in the BMVD group which were statistically significant. This study is distinct because it demonstrates the outcomes of bioprosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bioprosthetic valve in younger patients, significant number of patients developed BMVD along with poor long-term clinical outcomes, even at a short follow-up period of <10 years. These findings are similar to international data and signify that mechanical MVR may be a more reasonable alternative in younger patients.

Inflammatory mesenteric fat detected by Intestinal ultrasound is correlated with poor long-term clinical outcomes in patients with Crohn's disease

BackgroundData on the correlation between inflammatory mesenteric fat (i-fat), detected by intestinal ultrasound (IUS), and the prognosis of Crohn's disease (CD) remains limited. AimsTo investigate the impact of IUS-detected i-fat on long-term clinical outcomes. MethodsWe retrospectively enrolled 171 active CD patients who initiated infliximab. Clinical remission (CR), mucosal healing (MH) and transmural healing (TH) were assessed at week-14 and 1 year. ResultsBaseline i-fat was detected in 107 patients, while 64 without i-fat. At week-14 and 1 year, patients with i-fat showed lower rates of CR (61.7% vs. 87.5%; 62.3% vs. 86.7%), MH (20.6% vs. 46.9%; 38.6% vs. 65.0%) and TH (10.3% vs. 31.3%; 21.6% vs. 51.7%), compared to those without (all p<0.01). Multivariable analysis revealed that baseline i-fat was a negative predictor for CR (OR=0.212) and MH (OR=0.425) at week-14, and CR (OR=0.340) and TH (OR=0.364) at 1 year (all p<0.05). At week-14, 56 patients with baseline i-fat recovered to without i-fat. Patients with i-fat recovery had higher rates of CR (86.8% vs. 23.1%), MH (58.5% vs. 7.7%) and TH (34.0% vs. 2.6%) at 1 year than those with i-fat at week-14 (all p<0.001). ConclusionIUS-detected i-fat correlated poor long-term clinical outcomes in CD with infliximab.

Clinical Characteristics and Long-Term Outcome of Patients with Bio-Prosthetic Mitral Valve – Experience From a South Asian Country

Objectives: The aim of this study is to evaluate clinical characteristics and long-term outcome of the patients with bio-prosthetic mitral valve replacement at a tertiary care hospital of a South Asian country.&#x0D; Methodology: The study is a retrospective observational observational study involving patients who underwent bio-prosthetic mitral valve replacement at a tertiary care hospital in Karachi, Pakistan, between 2006 and 2020, and had at least two complete echocardiograms. Patients with incomplete clinical data, no electronic reports of echocardiograms, and mechanical mitral valve replacement were excluded.&#x0D; Results: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bio-prosthetic mitral valve replacement from the year 2006 to 2020. Patients were divided into two groups based on normal functioning bio-prosthetic mitral valve and bio-prosthetic mitral valve dysfunction (BMVD). Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. Mitral valve replacement was done as an elective procedure due to NYHA II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 + 2.99 years, bio-prosthetic mitral valve dysfunction (BMVD) was observed in 183 (36.5%) patients. However, re-do mitral valve surgery was done in only 49 (9.8%) patients. Comparing the two groups, individuals with normal functioning bio-prosthetic mitral valve had a mean age of 51.6 + 14.27 years, while those with BMVD had a mean age of 45.639 + 14.33 years at the time of index surgery (p value=0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%) and death (n = 6, 3.28%) in BMVD group which were statistically significant.&#x0D; Conclusion: This study is distinct because it demonstrates the outcomes of bio-prosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bio-prosthetic valve in younger patients, a significant number of cases developed BMVD along with poor long-term clinical outcomes even at a short follow up period of less than ten years. These findings are like international data and signify that mechanical mitral valve replacement may be a more reasonable alternative in younger patients.

Prognostic implications of intracranial haemorrhage on dual-energy CT immediately following endovascular treatment for acute ischemic stroke

ObjectiveTo describe the incidence, risk factors, and prognostic relevance of intracranial haemorrhage (ICH) immediately after endovascular treatment (EVT) for ischaemic stroke in the anterior circulation. MethodsEVT records from 2010 to 2019 were screened. Included patients underwent DECT within 3h post-EVT. Virtual native reconstructions were evaluated for ICH according to the Heidelberg criteria and grouped into Heidelberg classes (HCs): [HC1] haemorrhagic infarction (HI)1, HI2 and parenchymal haematoma (PH)1; [HC2] PH2; [HC3] i.a. intraventricular and subarachnoid haemorrhage. If ICH corresponding to multiple HCs was observed, we assumed that the (largest) parenchymal ICH would have the greatest prognostic impact. Hence, a single HC was attributed by the following order of severity: HC2, HC1, HC3. The primary outcome was the modified Rankin Scale (mRS) at 90 days. The effect of asymptomatic ICH (aICH) and symptomatic ICH (sICH) of (1) HC1 or HC2 and (2) HC3 on patient outcomes was evaluated with multivariable regression after multiple imputation. ResultsOut of 651 records, 498 patients were included. Eighty-one (16%) patients showed ICH on post-EVT DECT, of which 19 were classified as HC1 (21% symptomatic), 6 as HC2 (100% symptomatic), and 56 as HC3 (14% symptomatic). ICH development was mainly associated with unfavourable procedural characteristics. Both aICH and sICH of HC1 or HC2 were associated with the mRS (aICH: adjusted [a]cOR 4.92, 95%CI [1.48–16.35]; sICH: acOR 12.97, 95%CI [2.39–70.26]) and mortality (aICH: aOR 10.08, 95%CI [2.48–40.88]; sICH: aOR 9.92, 95%CI [1.48–66.31]). Likewise, sICH of HC3 was associated with the mRS and mortality (acOR 19.91, 95%CI [4.03–98.35], and aOR 13.23, 95%CI [2.27–77.18], respectively). aICH of HC3 was not significantly associated with the mRS or mortality (acOR 0.87, 95%CI [0.48–1.57], and cOR 0.84, 95%CI [0.32–2.20], respectively). ConclusionsImmediate post-EVT ICH is a frequent finding. Except for aICH of HC3, any ICH is associated with poor long-term clinical outcomes.

Long-Term Clinical Impact of Patients with Multi-Vessel Non-Obstructive Coronary Artery Disease.

Non-obstructive coronary artery disease (CAD) is a disease commonly diagnosed in patients undergoing coronary angiography. However, little is known regarding the long-term clinical impact of multi-vessel non-obstructive CAD. Therefore, the object of this study was to investigate the long-term clinical impact of multi-vessel non-obstructive CAD. A total of 2083 patients without revascularization history and obstructive CAD were enrolled between January 2010 and December 2015. They were classified into four groups according to number of vessels involved in non-obstructive CAD (25% ≤ luminal stenosis < 70%): zero, one, two, or three diseased vessels (DVs). We monitored the patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiac death, stroke, and myocardial infarction (MI). The occurrence of MACCEs increased as the number of non-obstructive DVs increased, and was especially high in patients with three DVs. After adjustment, patients with three DVs still showed significantly poorer clinical outcomes of MACCEs, stroke, and MI compared those with zero DVs. Multi-vessel non-obstructive CAD, especially in patients with non-obstructive three DVs, is strongly associated with poor long-term clinical outcomes. This finding suggests that more intensive treatment may be required in this subset of patients.

Fecal lactoferrin early predicts long-term outcomes in ulcerative colitis: A post-hoc analysis of the UNIFI and PURSUIT trials.

Fecal lactoferrin (FL) is associated with disease activity and relapse in ulcerative colitis. However, whether FL could early predict long-term outcomes in ulcerative colitis is poorly understood. This post-hoc analysis included participants who received biologics and had available data of FL concentration at week 4 from the UNIFI and PURSUIT trials (n=1063). Therapeutic outcomes, including clinical remission, endoscopic improvement and remission, and histological improvement and remission, were evaluated at the end of maintenance therapy. The incidence of colectomy was observed from week 0 to maximum week 228 in the PURSUIT trial (n=667). Multivariate logistic and Cox proportional-hazard regression were conducted to evaluate the associations between FL and therapeutic outcomes and colectomy, respectively. A high FL level at week 4 was associated with poor long-term clinical, endoscopic and histologic outcomes. FL >84.5μg/mL predicted a low likelihood of clinical (OR [95% CI]: 0.43 [0.32, 0.57]; p<0.001), endoscopic (OR [95% CI]: 0.40 [0.29, 0.56]; p<0.001), and histological (OR [95% CI]: 0.27 [0.14, 0.53]; p<0.001) remission. Moreover, week-4 FL could add prognostic value to fecal calprotectin and clinical and endoscopic scores for informing long-term therapeutic outcomes. For the risk of colectomy, patients with week-4 FL <20.1 and ≥20.1µg/mL had an incidence rate of 1.10% and 6.39%, respectively. Patients with FL ≥20.1µg/mL had a 995% higher risk of colectomy (HR [95% CI], 10.95 [1.45, 82.74]). FL could be a promising prognostic biomarker for long-term therapeutic outcomes and risk of colectomy in patient of ulcerative colitis.

Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis.

We sought to investigate the relationship between circulating tissue plasminogen activator (t-PA) level and long-term outcomes in stable coronary artery disease patients with or without aortic valve sclerosis (AVSc). Serum levels of t-PA were determined in 347 consecutive stable angina patients with (n=183) or without (n=164) AVSc. Outcomes were prospectively recorded as planned clinic evaluations every 6months up to 7years. The primary endpoint was a composite of cardiovascular death and rehospitalization due to heart failure. The secondary endpoint included all-cause mortality, cardiovascular death, and rehospitalization due to heart failure. Serum t-PA was significantly higher in AVSc than in non-AVSc patients (2131.22pg/mL vs. 1495.85pg/mL, P<0.001). For patients with AVSc, those with t-PA level above the median (>1840.68pg/mL) were more likely to meet the primary and secondary endpoints (all P<0.001). After adjusting for potential confounding factors, serum t-PA level remained significantly predictive for each endpoint in the Cox proportional hazard models. The prognostic value of t-PA was good, with an AUC-ROC of 0.753 (P<0.001). The combination of t-PA with traditional risk factors improved the risk reclassification of AVSc patients, with a net reclassification index of 0.857 and an integrated discrimination improvement of 0.217 (all P<0.001). However, for patients without AVSc, both primary and secondary endpoints were similar, irrespective of t-PA levels. Elevated circulating t-PA confers an increased risk for poor long-term clinical outcomes in stable coronary artery disease patients with AVSc.

Clinical Potential of Hydrogen Sulfide in Peripheral Arterial Disease.

Peripheral artery disease (PAD) affects more than 230 million people worldwide. PAD patients suffer from reduced quality of life and are at increased risk of vascular complications and all-cause mortality. Despite its prevalence, impact on quality of life and poor long-term clinical outcomes, PAD remains underdiagnosed and undertreated compared to myocardial infarction and stroke. PAD is due to a combination of macrovascular atherosclerosis and calcification, combined with microvascular rarefaction, leading to chronic peripheral ischemia. Novel therapies are needed to address the increasing incidence of PAD and its difficult long-term pharmacological and surgical management. The cysteine-derived gasotransmitter hydrogen sulfide (H2S) has interesting vasorelaxant, cytoprotective, antioxidant and anti-inflammatory properties. In this review, we describe the current understanding of PAD pathophysiology and the remarkable benefits of H2S against atherosclerosis, inflammation, vascular calcification, and other vasculo-protective effects.

Long-term clinical impact of patients with multi-vessel involved non-obstructive coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Yuhan Corporation, Seoul, Korea. Background Although non-obstructive coronary artery disease (CAD) was a relatively common finding in patients undergoing coronary angiography (CAG), it had previously been characterized as "insignificant CAD" and underestimated in importance. However, recent studies have increasingly showed that non-obstructive CAD is also associated with poor clinical outcomes. But the long-term clinical impact of multi-vessel involved non-obstructive CAD are not yet well-known. Purpose The aim of the present study was to determine the long-term clinical impact on patients with multi-vessel involved non-obstructive CAD. Methods A total of 2,083 patients without obstructive CAD and revascularization history were enrolled between January 2010 and December 2015. They were classified into 4 groups according to the number of vessels involved non-obstructive CAD (25%≤ luminal stenosis &amp;lt; 70%): 0, 1, 2, 3 diseased vessel (DV). We followed patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs) defined as a composite of cardiac death, myocardial infarction (MI) and stroke. The secondary outcomes were each component of the primary outcome and all-cause death. Results 2,083 patients were classified into four groups according to the number of non-obstructive DVs (0 DV: 251 [60%],1 DV: 506 [24%], 2 DV: 250 [12%], 3 DV: 76 [4.0%]). The occurrence of MACCEs numerically increased as the number of non-obstructive DV increased, especially in 3 DV (MACCEs, 0 DV: 78 [6.2%], 1 DV: 33 [6.5%], 2 DV: 17 [6.8%], 3 DV: 14 [18.4%], p&amp;lt;0.001). After adjustment, patients with non-obstructive 3 DV still showed significantly poorer clinical outcomes than 0 DV in terms of MACCEs, MI and stroke. (MACCEs: hazard ratio [HR] 2.09, 95% confidence interval [CI] 1.15-3.79, p=0.016; MI: HR 15.17, 95% CI 2.37-97.25, p=0.004, Stroke: HR 2.04, 95% CI 1.01-4.16), P=0.049) Conclusions. Multi-vessel involved non-obstructive CAD, especially in 3 DV, was associated with poor long-term (5 years) clinical outcomes. Theses finding suggested that more intensive treatment may be required in this subset of patients.

Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase.

The histologic status of the immune-tolerant (IT) phase of chronic hepatitis B relative to long-term outcomes is unclear. This study aimed to discover how the serological criteria currently in use correspond to histologic criteria in determining the IT phase and indication for liver biopsy. Patients in the serological IT phase determined by positive hepatitis B e antigen, hepatitis B virus (HBV) DNA ≥106 IU/mL, and normal or minimally elevated alanine aminotransferase (ALT) ≤60 IU/L, who underwent liver biopsy at three different hospitals were included. The distribution of the histologic IT phase, defined as fibrosis of stage 1 or less and inflammation of grade 1 or less, was compared with that of the serological IT phase. The risk factors for the incidence of liver-related events, such as hepatocellular carcinoma, liver cirrhosis, liver transplantation, and death, were also analyzed. Eighty-two (31.7%) out of 259 clinically suspected IT phase patients belonged to the histologic IT phase. Age over 35, high AST, and low albumin were useful for ruling out the histologic IT phase. Risk factors predicting liver-related events were age and significant fibrosis stage. There was no significant difference in the proportion of histologic IT phase and clinical prognosis between normal ALT and mildly elevated ALT groups. However, even in patients with normal ALT, age was an important factor in predicting the presence of the histologic IT phase. A significant number of patients who belonged to the serological IT phase were not in the histologic IT phase. Patients over 35 years and those with high AST, low albumin, and low HBV DNA levels were more likely to experience poor long-term clinical outcomes. Therefore, additional histologic assessment should be considered.

Long-term Clinical Outcomes of Coronary Rotational Atherectomy for Specific Indications

Objective: This study compared the long-term outcomes between rotational atherectomy (RA) for specific indications and on-label use of RA for severely calcified coronary lesions. Methods: Data for patients who underwent RA between 2015 and 2020 in a single-center registry were analyzed. The specific indication group included patients with ostial lesions, unprotected left main coronary artery stenosis, chronic total occlusions, stent ablation, angulated lesions, and cardiac dysfunction, whereas patients with none of the above-mentioned characteristics were included in the on-label group. The primary endpoint was compared between groups. Results: A total of 176 patients in the on-label group and 125 patients in the specific indication group were included. Patient clinical characteristics were comparable between groups. The incidence of complications during the procedure was higher in the specific indication group than in the on-label group (20.0% vs. 10.8%, P=0.018). No significant difference was observed in in-hospital MACCE between groups (12.5% vs 9.7%, P=0.392). During 35 (10–57) months of follow-up, MACCE occurred in 46 patients (15.3%). The incidence of MACCE was much higher in the specific indication group than the on-label group (25.6% vs 13.6%, P=0.034). Conclusions: RA for specific indications, compared with on-label use, had a higher incidence of complications during the procedure and poorer long-term clinical outcomes.

Treat calcified stenoses correctly

Due to the demographic changes with an increasing aging process of the population and the increasing incidence of comorbidities, such as diabetes mellitus, arterial hypertension, and chronic kidney disease, older patients with high-risk profiles and calcified coronary lesions are being treated more often in interventional cardiology. Despite advances in technical possibilities and materials, the treatment of severely calcified stenoses continues to be associated with an increased periprocedural risk of complications and poor long-term clinical outcomes. The purpose of this article is to discuss the various treatment approaches and summarize them in an algorithm for the treatment of severely calcified stenoses.

Ectodysplasin A is associated with the presence and severity of coronary artery disease and poor long-term clinical outcome in patients presenting with ST-elevation myocardial infarction

ABSTRACT Objectives Hepatokines are proteins secreted by hepatocytes and many hepatokines such as fetuin A/B, selenoprotein P have been shown to play a role in the pathogenesis of many metabolic dysfunctions such as diabetes, insulin resistance, hypertension, and metabolic syndrome by showing autocrine, paracrine and systemic effects. Ectodysplasin A (EDA) is a recently discovered hepatokine that plays a role in the development of ectodermal structures. In recent studies, it has been revealed that EDA may be associated with the pathogenesis of non-alcoholic liver disease, insulin resistance, Type 2 diabetes mellitus. The close relationship between these metabolic diseases and coronary artery disease (CAD), which may be associated with insulin resistance, has been well documented in previous studies. However, until now, there is no study examining the relationship of EDA with CAD and its effect on long-term outcomes. In this study, we aim to reveal this relationship on patients presenting with ST elevation myocardial infarction (STEMI). Methods EDA levels of 544 patients who applied to the study with STEMI and 544 people without coronary artery disease were included in the control group, and the patients with STEMI were followed for median of 33.7 ± 6.8 months. Results We found that EDA levels were significantly higher in patients with STEMI and that EDA levels were proportional to the severity of CAD (p < 0.001) also EDA levels may be an independent predictor of poor clinical outcome in patients with STEMI. Conclusion These results suggest that EDA is closely related to the presence and severity of CAD.

PATTERN OF LIVER DISEASE ADMISSIONS AT A TERTIARY GOVERNMENT HOSPITAL IN SANA’A, YEMEN

Back ground and objectives: Liver disease causes major public health problems international, especially in poor countries, and it is associated with poor long-term clinical outcomes and results in the deaths of millions worldwide annually. The aim of this study is to ascertain the virtual frequencies of liver disease and to assess etiological factors among patients admitted to Al-Thawra tertiary Hospital in Sana'a City, Yemen.&#x0D; Methods: This was a descriptive retrospective analysis study of gastrointestinal patients admitted from January 1, 2021 to December 31, 2021 to the medical wards of Al-Thawra Hospital. This is a tertiary hospital located in the Yemeni capital, Sana'a City. Data were extracted from patient case folders for the period of under review. Data validated with Microsoft Excel version 13 and exported to SPSS version 23.0 for windows; for statistical analysis. Data were evaluated for demographic and other clinical characteristics as definite variables.&#x0D; Results: Of the 516 gastroenterology patients admitted to the gastroenterology service in medical wards during a one-year period, liver disease accounted for 30% of all gastroenterology in the same period. There were 155 patients diagnosed with liver disease. There were 86 (55.5%) males and 69 (44.5%) females, with a male to female ratio of 1.2:1. The mean overall age of patients and the age range were 46.14±16.5 and 8-85 years, respectively. The peak incidence of age occurred during the fifth and sixth decades of life at 38.1%. The most common liver disease was; autoimmune hepatitis 43 (27.7%), followed by nonalcoholic fatty liver disease 35 (22.6%), viral hepatitis 32 (20.6%) and schistosomiasis 10 (6.5%).&#x0D; Conclusion: Current findings show that autoimmune hepatitis was the most common cause among gastrointestinal diseases in Sana'a city, Yemen; the male to female ratio was roughly the same. In light of this, health education and public awareness about hepatitis virus screening tests and schistosomiasis screening and treatment is the primary preventive strategy to be considered.&#x0D; &#x0D; Peer Review History: &#x0D; Received: 4 July 2022; Revised: 12 August; Accepted: 7 September, Available online: 15 September 2022&#x0D; Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, gehankandeel9@yahoo.com &#x0D; UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. &#x0D; Received file: Reviewer's Comments:&#x0D; Average Peer review marks at initial stage: 6.0/10&#x0D; Average Peer review marks at publication stage: 7.5/10&#x0D; Reviewers:&#x0D; Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com&#x0D; Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg&#x0D; Dr. Rima Benatoui,Laboratory of Applied Neuroendocrinology, Department of Biology, Faculty of Science, Badji Mokhtar University Annaba, Algeria. benattouiryma@gmail.com&#x0D; Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com&#x0D; Similar Articles: &#x0D; PREVALENCE OF HEPATITIS G VIRUS AMONG PATIENTS WITH CHRONIC LIVER DISEASE AND HEALTHY INDIVIDUALS, SANA'A CITY-YEMEN

The long-term prognostic value of E/e’ in patients with ST segment elevation myocardial infarction

ObjectivesThis study aimed to evaluate the long-term prognostic value of E/e’ ratio in patients with ST-segment elevation myocardial infarction (STEMI). MethodsWe retrospectively assessed 314 patients who underwent primary coronary interventions between January 2010 and December 2015. The included patients were classified into two groups according to the E/e’ ratios: E/e’<15 (n = 245) and E/e’≥15 (n = 69). We investigated the incidence of major adverse cardiac events (MACEs) from the event to the final follow-up period of at least three years. ResultsA total of 55 cases of MACEs occurred during the follow-up. The E/e’≥15 group showed a significantly higher rate of MACEs than the E/e’<15 group (34.8% vs. 12.7%, p < 0.001). Among the MACE, the percentage of cardiac deaths (17.4% vs. 0.4%, p < 0.001) was higher in the E/e’≥15 group than in the E/e’<15 group. In the multivariable model, E/e’≥15 was demonstrated as the strongest prognostic factor for MACEs (hazard ratio [HR], 2.597; 95% confidence interval [CI], 1.294–5.211; p = 0.007) and cardiac death (HR, 27.537; 95% CI, 3.287–230.689; p = 0.002), while left ventricular ejection fraction (LVEF) was not. Neither the discrepancy of systolic nor diastolic function between initial and follow-up echocardiography affected the overall prevalence of MACEs. A disparity was observed between the two groups, with a significant increase in the rate of MACEs in the E/e’≥15 group (log-rank test, p < 0.001). ConclusionThe baseline E/e’≥15 in patients with STEMI after successful reperfusion is the strongest predictor of poor long-term clinical outcomes among those analyzed.

Early Biomarker Signatures in Surgical Sepsis

IntroductionSepsis has complex, time-sensitive pathophysiology and important phenotypic subgroups. The objective of this study was to use machine learning analyses of blood and urine biomarker profiles to elucidate the pathophysiologic signatures of subgroups of surgical sepsis patients. MethodsThis prospective cohort study included 243 surgical sepsis patients admitted to a quaternary care center between January 2015 and June 2017. We applied hierarchical clustering to clinical variables and 42 blood and urine biomarkers to identify phenotypic subgroups in a development cohort. Clinical characteristics and short-term and long-term outcomes were compared between clusters. A naïve Bayes classifier predicted cluster labels in a validation cohort. ResultsThe development cohort contained one cluster characterized by early organ dysfunction (cluster I, n = 18) and one cluster characterized by recovery (cluster II, n = 139). Cluster I was associated with higher Acute Physiologic Assessment and Chronic Health Evaluation II (30 versus 16, P < 0.001) and SOFA scores (13 versus 5, P < 0.001), greater prevalence of chronic cardiovascular and renal disease (P < 0.001) and septic shock (78% versus 17%, P < 0.001). Cluster I had higher mortality within 14 d of sepsis onset (11% versus 1.5%, P = 0.001) and within 1 y (44% versus 20%, P = 0.032), and higher incidence of chronic critical illness (61% versus 30%, P = 0.001). The Bayes classifier achieved 95% accuracy and identified two clusters that were similar to development cohort clusters. ConclusionsMachine learning analyses of clinical and biomarker variables identified an early organ dysfunction sepsis phenotype characterized by inflammation, renal dysfunction, endotheliopathy, and immunosuppression, as well as poor short-term and long-term clinical outcomes.

The Index of Microcirculatory Resistance after Primary Percutaneous Coronary Intervention Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction.

The index of microcirculatory resistance (IMR) is a simple method that can measure microvascular function after primary percutaneous coronary intervention (PCI) in patients with ST-segment Elevation Myocardial Infarction (STEMI). This study is to find out whether IMR predicts clinical long-term outcomes in STEMI patients. A total of 316 patients with STEMI who underwent primary PCI from 2005 to 2015 were enrolled. The IMR was measured using pressure sensor/thermistor-tipped guidewire after primary PCI. The primary endpoint was the rate of death or hospitalization for heart failure (HF) over a mean follow-up period of 65 months. The mean corrected IMR was 29.4 ± 20.0. Patients with an IMR > 29 had a higher rate of the primary endpoint compared to patients with an IMR ≤ 29 (10.3% vs. 2.1%, p = 0.001). During the follow-up period, 13 patients (4.1%) died and 6 patients (1.9%) were hospitalized for HF. An IMR > 29 was associated with an increased risk of death or hospitalization for HF (OR 5.378, p = 0.004). On multivariable analysis, IMR > 29 (OR 3.962, p = 0.022) remained an independent predictor of death or hospitalization for HF with age (OR 1.048, p = 0.049) and symptom-to-balloon time (OR 1.002, p = 0.049). High IMR was an independent predictor for poor long-term clinical outcomes in STEMI patients after primary PCI.

Coronary slow-flow phenomenon in takotsubo syndrome: the prevalence, clinical determinants and long-term prognostic impact

Abstract Background Previous studies demonstrated that patients with takotsubo syndrome (TTS) may present with coronary slow-flow (CSF) at coronary angiography performed in the acute phase [1]. However, the exact clinical relevance and its long-term prognostic impact have not been established yet. In the only recently published study Montone et al. proved that TTS patients with CSF were characterized by a worse clinical presentation with higher rate of intrahospital complications and poor long-term clinical outcome [2]. Purpose We sought to investigate the prevalence of CSF in TTS patients, its determinants and long-term prognostic impact. Methods Among 7771 myocardial infarction patients hospitalized in our center in 2012–2019 years, we identified 82 (1.1%) TTS patients with performed coronary angiography (Figure 1A). The coronary flow was assessed quantitatively with TIMI Frame Count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). The clinical and angiographic characterstics of 67 TTS patients complying with MINOCA definition were compared with representative 50 non-TTS MINOCA (Figure 1A). Results CSF (TIMI 2) was identified in 33 (40.2%) TTS patients. CSF-TTS patients were characterized with higher TFC and worse TMPG in each analyzed coronary vessel (Figure 1B). CSF was observed in LAD artery in each patient, in 78.8% in LCx and in 33.3% in RCA, respectively. In CSF-TTS lower values of LVEF on admission (33.5 (25–40) vs 40 (35–45)%, P=0.019) as well as more frequent midventricular TTS (27.3 vs 8.2%, P=0.020), nearly normal coronary arteries (&amp;lt;30% stenosis) (75.8 vs 49.0%, P=0.015) and coexistence of both physical and emotional triggers (9.1 vs 0%, P=0.032) were noted. Moreover, CSF was observed significantly more frequent than in non-TTS MINOCA (44.8 vs 10.0%, P&amp;lt;0.001) with different distribution in particular vessels (P&amp;lt;0.001). In median 55 months of long-term observation higher all-cause mortality was stated in CSF-TTS (30.3 vs 10.2%, P=0.024) (Figure 1C) without difference between TTS and non-TTS MINOCA (P=0.42) (Figure 1D). By Cox proportional hazards model the CSF was identified as an independent predictor of long-term mortality (P&amp;lt;0.001). Conclusions As has been shown high proportion of TTS patients were characterized with remarkably marked myocardial perfusion abnormalities, especially in the left coronary vessels, which were associated with unfavorable long-term prognosis. Our study is the first presenting the direct angiographic, clinical and prognostic comparison of TTS MINOCA and non-TTS MINOCA patients. Funding Acknowledgement Type of funding sources: None. Figure 1

Effects of Statin Intensity on Long-term Outcomes After Coronary Artery Bypass Grafting

BackgroundThe current study sought to investigate the association between statin intensity and long-term clinical outcomes according to initial clinical presentation after coronary artery bypass grafting (CABG). MethodsThe 6531 patients who underwent CABG included in this study were classified into 4 groups according to statin intensity: 731 in the no or low statin group (atorvastatin <10 mg), 2310 in the lower-moderate group (atorvastatin 10-mg equivalent), 2404 in the higher-moderate group (atorvastatin 20-mg equivalent), and 1086 in the high-intensity group (atorvastatin ≥ 40-mg equivalent). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 5 years. Multivariate Cox and inverse probability weighting methods were performed to adjust for baseline differences. ResultsAt least moderate-intensity statin use was associated with significantly lower risk of 5-year MACCE compared with no or low-intensity statin use (hazard ratio [HR], 0.694; 95% confidence interval [CI], 0.493-0.977; P = .036). Among patients who were taking at least a moderate-intensity statin, both higher-moderate intensity (HR, 0.622; 95% CI, 0.479-0.807; P < .001) and high-intensity statin (HR, 0.613; 95% CI, 0.421-0.894; P = .011) groups showed significantly lower risks of MACCE than the lower-moderate intensity statin group at 5 years after CABG. There was no significant difference in the risk of MACCE between higher-moderate intensity and high-intensity statin groups (HR, 0.987; 95% CI, 0.661-1.475; P = .950). Multivariable Cox and inverse probability weighting methods yielded similar results. In a subgroup analysis compared with the use of a lower-moderate intensity statin, the use of a higher-moderate or high-intensity statin (equivalent dose with atorvastatin ≥20 mg) was associated with a significantly lower risk of MACCE among CABG patients who presented with acute coronary syndrome but not in those who presented with stable ischemic heart disease (interaction P = .001). ConclusionsThe use of a lower-moderate intensity statin (atorvastatin 10-mg equivalent) was associated with relatively poorer long-term clinical outcomes than the use of higher-moderate or high-intensity statin, especially in acute coronary syndrome patients after CABG.

Right ventricular branch compromise after percutaneous coronary intervention and baseline chronic kidney disease: A high-risk combination associated with long-term prognoses in acute inferior myocardial infarction

Background: Right ventricular branch compromise (RVBC) following percutaneous coronary intervention (PCI) in patients with acute inferior myocardial infarction (AIMI) is associated with short-term adverse clinical outcomes. Chronic kidney disease (CKD) is also known to be a major risk factor after PCI in AIMI. However, little is known about the impact of RVBC and CKD on long-term prognosis. Methods: From January 2009 to January 2019, we retrospectively enrolled 90 consecutive patients with ST-elevation AIMI who had a culprit lesion in the proximal-to-mid right coronary arteries and underwent PCI in our institution. After the measurement of the Thrombolysis in Myocardial Infarction frame counts in RV branches using post-PCI angiography, we divided them into two groups (RVBC, n = 49; non-RVBC, n = 41), and investigated their long-term prognosis for 43±31 months. The primary endpoint was the incidence of major adverse cardiac events (MACEs), including all-cause death, nonfatal MI, congestive heart failure requiring hospitalization, and life-threatening arrhythmia.Results: Both groups showed similar clinical characteristics; however, the baseline right ventricular function after PCI was significantly worse in RVBC than in non- RVBC. Twenty-four MACEs occurred during the follow-up (RVBC vs. non-RVBC: 37% vs. 14%, p = 0.002). In the multivariate analysis, both RVBC and baseline CKD were powerful predictors of MACEs (RVBC: hazard ratio [HR] 2.85, CKD: HR 2.29). Baseline CKD showed higher hazard ratios of MACEs in RVBC (CKD: HR 7.19 vs. non-CKD: HR 0.24).Conclusions: The prognoses of RVBC after primary PCI in patients with AIMI were poor. Baseline CKD and RVBC were associated with poor long-term clinical outcomes.