Predictor Of Worse Clinical Outcome Research Articles

Prognostic Implication of Pulmonary Hypertension in Low-Flow Low-Gradient Aortic Stenosis After Transcatheter Aortic Valve Replacement

Prognostic implications of pulmonary hypertension (PH) in low-flow low-gradient (LG) aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) remains unexplored. We aimed to investigate the impact of baseline and changes in PH after TAVR. In this single-center retrospective study, we included patients who underwent TAVR for low-flow LG AS. Patients were categorized into 2 groups: baseline pulmonary artery systolic pressure (PASP) <46mm Hg (no-to-mild PH) and PASP ≥46mm Hg (moderate-to-severe PH). On the basis of changes in PASP after TAVR, patients were stratified into increased (ΔPASP ≥+5 mm Hg), no change (-4 to +4 mm Hg), and decreased (≤ -5 mm Hg) groups. Primary end point was a composite of all-cause mortality and heart failure rehospitalization. In total, 210 patients were included, 148 in the no-to-mild PH group and 62 in the moderate-to-severe PH group. Median follow-up was 13.2 months. The moderate-to-severe PH group was at an increased risk of composite end point (adjusted hazard ratio [HR] 3.5, 95% confidence interval [CI] 1.8 to 6.9), all-cause mortality (HR 2.4, 95% CI 1.1 to 5.6), and heart failure rehospitalization (HR 8.3, 95% CI 2.9 to 23.7). There were no differences in clinical outcomes among those with increased (32%), no change (28%), and decreased (39%) PASP after TAVR. In conclusion, moderate-to-severe PH at baseline is an independent predictor of worse clinical outcomes in patients with low-flow LG AS who undergo TAVR, and this cohort of patients do not seem to derive the benefits of postoperative reduction of PASP.

Prognostic Impact of WT1 Mutation on AML of Different Risk Groups Based on 2022 European Leukemianet (ELN) Risk Classification

Background The Wilms tumor 1 (WT1) gene, located on chromosome 11p13 exists in multiple isoforms. It has been implicated in the regulation of cell survival, proliferation and differentiation, and may function both as a tumor suppressor and an oncogene. Approximately 15% of acute myeloid leukemia (AML) patients carry WT1 mutations, and WT1 mutation have been shown to be independent predictor of worse clinical outcome in some but not all adult AML studies. Some studies suggested that NPM1-AML & AML with CEBPA double-mutation accompanied with WT1 mutation can alter their original favorable prognosis. Recently, a revised European LeukemiaNet (ELN) genetic risk classification has been published and the prognostic significance of WT1 mutation in three risk groups according to this 2022 ELIN risk classification is still unclear. Objective To investigate the prognostic significance of WT1 gene mutations in acute myeloid leukemia (AML) patients with different risk of the 2022-ELN risk classification. Methods 502 patients de novo AML diagnosed between March 2015 and July 2021 who underwent next-generation sequencing (NGS) tests and had MICM precise typing at the Peking University Institute of Hematology were enrolled in this study. The patients received chemotherapy ± hematopoietic stem cell transplantation (HSCT), and they were stratified into three groups according to the 2022 version of ELN-AML risk stratification. Results Among 502 patients, a total of 71 (14.1%) patients carried WT1 mutations, of which 57 patients had mutations at a single locus, 8 patients had mutations at double sites, 5 patients had co-mutations at 3 sites in the WT1 gene, and 1 patient had mutations at 4 sites. Comparing the incidence of AML-related mutations between the WT1 mutation group and the wild-type group, the results showed that the concomitant rate of NPM1 mutations was lower in the WT1 mutation group than in the WT1 wild-type group (14.1% vs 27.1%, p=0.028), and the concomitant rate of CEBPA-bZIP mutations was higher in the WT1 mutation group than in the WT1 wild-type group (29.6% vs 10.9%, p<0.001). The concomitant rate of CEBPA double mutation was also higher in the WT1 mutation group than in the WT1 wild-type group (29.6% vs 10.4%, p<0.001), and the concomitant rate of GATA2 mutation was higher in the WT1 mutation group than in the WT1 wild-type group (14.1% vs. 4.4%, p=0.004). In addition, the WT1 gene expression level (WT1/ABL1) was higher in the WT1 mutation group than in the WT1 wild group at diagnosis (22.0% vs 13.5%, p=0.004). All patients were further divided into 6 groups based on 2022 ELIN risk classification and whether they received HSCT. There were 158 (31.5%) patients in the low-risk chemotherapy group, 73 (14.5%) in the low-risk transplantation group, 72 (14.3%) in the intermediate-risk chemotherapy group, 58 (11.6%) in the intermediate-risk transplantation group, 78 (15.5%) in the high-risk chemotherapy group, and 63 (12.5%) in the high-risk transplantation group. Univariate and multivariate COX regression analyses were performed including WT1 mutation, FAB classification, age, sex, and karyotype stratification indicators. In 58 patients who were intermediate-risk and received HSCT, patients with WT1 mutation resulted in higher cumulative incidence of relapse(CIR) in compared with those without WT1 mutation (52.3% vs 33.5%, HR=9.28, p<0.001). In the remaining 5 groups of patients, WT1 mutation seemed have no significant effect on overall survival(OS), event-free survival (EFS), or CIR in patients (p-values were all less than 0.05). Conclusion Among intermediate-risk AML patients in the 2022 version of ELN stratification who received transplantation, the CIR after transplantation was higher in AML patients with WT1 mutation. It seemed that WT1 mutation was an independent risk factor for post-transplantation recurrence, and allogeneic HSCT cannot efficiently overcome the poor prognosis of WT1 mutation in the intermediate-risk group. Intermediate-risk AML with WT1 mutations still requires more active strategies to prevent relapse. Of course, the impact of WT1 mutation on prognosis needs to be further confirmed by expanding the sample size.

Natural history of untreated HDV patients: Always a progressive disease?

A severe course has been described in early studies on chronic hepatitis D (CHD), with faster pace towards liver cirrhosis with subsequent high liver-related morbidity and mortality in the majority of patients. Earlier studies have included risk groups as people using intravenous drugs (PWID) or those with multiple co-morbidities. During the last decade, the epidemiological landscape of CHD has changed with domestic cases decreasing while increasing cases of CHD consisting of younger persons immigrating from endemic regions to low-endemic regions. Recently, further insights into the spectrum of the disease with an indolent disease course in a substantial proportion of persons with CHD have been gained. At diagnosis, ≥30%-50% had already established liver cirrhosis. Older age, liver cirrhosis, co-infection with HIV and lack of interferon (IFN) therapy are the main predictors of worse clinical outcome. The newly introduced and upcoming antivirals against CHD are highly anticipated, considering the historically low virological response rates to antiviral therapy. Further knowledge is needed to fully comprehend the natural course and the spectrum of this severe form of viral hepatitis. This is also to be able to evaluate the long-term effects of the new antivirals on disease progression.

Could serum procalcitonin play a role in an emergency setting for patients with pyogenic spondylodiscitis?

Spinal infections, represent quite rare but often severe conditions. However, due to symptoms' non-specificity and the lack of specific laboratory tests, diagnosis is often delayed with serious consequences for the patient's outcomes. The present investigation aimed at evaluating the role of procalcitonin (PCT) and other clinical features on the risk stratification and the clinical outcomes in spondylodiscitis patients treated in our Emergency Department. The present investigation represents a single-center retrospective study. Clinical records of consecutive patients admitted to our Emergency Department from 1 January 2015 to 31 March 2021 were evaluated and patients with spondylodiscitis diagnosis in this period were recruited. Our primary outcome was the degree of autonomy of patients following the acute event. Our secondary outcome was the resolution of the infection. In the study period, a total of 345 patients were evaluated. Among these, 165 met the inclusion criteria, and constituted the study cohort. Concerning the primary outcome, we observed that the most significant predictive factors for being non-autonomous were elevated serum creatinine (> 1.05 mg/dl), Blood Urea Nitrogen (BUN) > 23 mg/dl, Lactate dehydrogenase > 228 U/L, PCT > 0.11 ng/mL. Patients with higher PCT (PCT > 0.11 ng/mL) and higher BUN (BUN > 23 mg/dl) had higher odds of infection persistence (the Odd Ratio, OR, were respectively 3.78 for PCT and 3.14 for BUN). PCT assay may play a role in diagnosing spondylodiscitis in an emergency setting. A PCT value > 0.11 ng/mL should be considered as a red flag, a predictor of worse clinical outcomes and persistence of infection.

Complementarity of nutritional screening tools to GLIM criteria on malnutrition diagnosis in hospitalised patients: A secondary analysis of a longitudinal study

The Global Leadership Initiative on Malnutrition (GLIM) proposed a two-step approach for the malnutrition diagnosis: screening to identify "at risk" patients by any validated nutritional screening tool (NST), followed by a detailed nutritional assessment for diagnosis and grading the severity of malnutrition. Since there are several validated NST, this study aimed to evaluate the complementarity of five NST to GLIM criteria for malnutrition diagnosis in a sample of hospitalized patients. A secondary analysis of a longitudinal study. Data collection occurred within 48h of hospital admission and included clinical, sociodemographic and nutritional data. We applied five tools for nutritional risk (NR) screening: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutritional Risk in Emergency-2017 (NRE-2017), Nutritional Risk Screening - 2002 (NRS-2002), and Short Nutritional Assessment Questionnaire (SNAQ). GLIM criteria were applied to malnutrition diagnosis considering all five criteria. Patients were followed up until discharge to assess hospital length of stay (LOS) and in-hospital mortality and contacted six months post-discharge to assess hospital readmission and death. We calculated the sensitivity, specificity, predictive positive and negative values (PPV and NPV), and kappa. We grouped patients according to NR and malnutrition status in four categories [i.e. NR(+)/GLIM(+)] and investigated their associations with the clinical outcomes in regression models adjusted to the Charlson Comorbidity Index. Among the 601 patients included (55.8±14.8 years, 51.4% males), 41.6% were malnourished by GLIM criteria. The frequency of NR ranged from 24.0% (NRE-2017) to 35.8% (NRS-2002). MUST had the highest sensitivity (73.6%), NPV (83.6%) and PPV (93.4%). All NST presented specificity higher than 90%, except NRS-2002. The accuracy of NST ranged from 76.3% (SNAQ) to 86.8% (MUST). NR (+)/GLIM (+) by NRE-2017, MST, and MUST increased the risk of in-hospital mortality (HR ranged from 5.34 to 10.10). NR (+)/GLIM (+) increased the odds of LOS ≥10 days (RR between 2.11 and 3.01), readmission (RR between 1.51 and 1.80), and mortality six months after discharge (RR between 3.91 and 5.12), regardless of the NST applied. MUST presented the highest metrics of accuracy in comparison to GLIM criteria and was an independent predictor of worse clinical outcomes when nutritional risk was combined to malnutrition diagnosis. So, risk screening by MUST is suggested as the first step of the GLIM approach.

58. Comparing outcomes for patients undergoing thoracolumbar fusions to either S1 or the pelvis with a prior total hip arthroplasty

58. Comparing outcomes for patients undergoing thoracolumbar fusions to either S1 or the pelvis with a prior total hip arthroplasty

Functional mitral regurgitation in advanced heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Moderate-to-severe functional mitral regurgitation (fMR) is present in about one-third of patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) and contributes to progression of the symptoms of HF and is and independent predictor of worse clinical outcomes. Objective To characterize the population of advanced HF patients with severe fMR and assess its prognostic impact. Methods Prospective evaluation of adult patients with advanced HFrEF were referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. Severe fMR was defined by an EROA ≥ 20 mm2 and/or a regurgitant volume (RVol) ≥ 30 mL either taken from TTE or TOE. A survival analysis was performed to evaluate the prognostic impact of fMR and survival curves were compared using the log-rank test. Results A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%) of which 14.4% had severe fMR, with a mean EROA of 29.2 ± 3.1 mm2 and a mean RVol of 43.6 ± 4.7 mL. Thirty patients (6.7%) met the primary endpoint. Patients with severe fMR were more likely to be female (69.2% vs 81.5%, p = 0.026) and to have atrial fibrillation (27.0% vs 14.1%, p = 0.028), had a higher NT-proBNP value (3625.8 ± 496.9 vs 1940 ± 212.4 pg/mL, p = 0.001), a lower LVEF (25.9 ± 6.8 vs 29.0 ± 6.7, p = 0.001), more dilated LV (LV end-diastolic diameter: 72.8 ± 13.3 vs 66.9 ± 9.0 P = 0.036), a lower HFSS value (8.1 ± 1.0 vs 8.6 ± 1.0). There was no difference regarding HF etiology, NYHA class or cardiopulmonary fitness (pVO2: 16.6 ± 5.6 vs 16.5 ± 6.3 ml/kg/min, p = 0.19; VE/VCO2 slope: 35.4 ± 9.9 vs 34.0 ± 9.7, p = 0.328). EROA was an independent predictor of the primary outcome (OR 1.23, 95% CI 1.08-1.54, p = 0.039) and patients with severe fMR had a lower survival free of events during the first follow-up year (log-rank p = 0.012). Conclusion Severe fMR was associated with worse clinical outcomes in advanced HF population. Abstract Figure.

Real-world clinical outcomes of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) treated with liposomal irinotecan-based regimens: Impact of prior irinotecan (IRI) exposure.

580 Background: Subgroup analyses of the NAPOLI-1 study identified that among patients who were IRI naïve prior to entering the clinical trial, a survival benefit was observed between the study arm and control arm (overall survival (OS): 6.7 months vs 4.2 months). This treatment benefit was not observed among those previously exposed to IRI (OS: 4.6 months in study arm vs 4.8 months in control arm). This study sought to understand the impact of prior exposure to IRI on clinical outcomes among patients treated with liposomal irinotecan in the real-world setting. Methods: This retrospective observational study utilized the Flatiron Health EHR database. Data were analyzed for adult patients with mPDAC treated with liposomal irinotecan -based regimens between January 2016 and October 2020. Patient characteristics, OS and progression-free survival (PFS) were assessed. Prior IRI was defined as IRI given in a prior regimen in the metastatic setting. Cox proportional hazard (PH) methods were used to calculate hazard ratios (HRs). HRs were adjusted to account for demographics and relevant clinical covariates. Patients without prior exposure to IRI were used as the reference population for the Cox PH model (an HR &lt; 1 represents worse survival for unexposed patients relative to the exposed). Results: 675 patients with mPDAC treated with a liposomal irinotecan-based regimen were included. Median age at treatment initiation was 69 (IQR: 62 – 75) years and among patients with available ECOG performance status (PS), 77.4% had a PS of 0-1. 181 (27%) patients were previously exposed to IRI in the metastatic setting (Table). The unadjusted OS HR was 1.3 (95% CI: 1.1 – 1.6, p &lt; 0.001) and the unadjusted PFS HR was 1.4 (95%CI: 1.2 – 1.7, p &lt; 0.001). After adjustment for baseline characteristics the adjusted OS HR was 1.0 (95% CI: 0.8 – 1.3, p = 0.8836) and the adjusted PFS HR was 1.1 (95%: 0.8 – 1.4, p = 0.5626). Conclusions: The results of this study suggest prior exposure to IRI is not a predictor of worse clinical outcomes for patients treated with liposomal irinotecan-based treatment when accounting for key clinical characteristics in a multivariable model. The results from this real-world study can be used to support treatment sequencing decisions for patients with mPDAC following first line therapy. This is the largest real-world evidence study to date of patients with mPDAC treated with liposomal irinotecan.[Table: see text]

Risk factors associated with hospitalization and evolution in kidney transplant patients with COVID-19: A single-center retrospective cohort study

Background: The SARS -CoV -2 infection has had a major impact on kidney transplant patients. Our single -center experience aims to analyze the risk factors for affected patient hospitalization and predictors of worse clinical outcome on admission. Material and methods: A retrospective cohort study with kidney transplant patients with positive PCR for SARS -CoV -19 between March 16th 2020 and February 11th 2021 was conducted. Demographic characteristics and clinical and laboratory information on admission was collected and analyzed to assess risk factors related to patient hospitalization and disease evolution. Results: Seventy -six kidney transplant recipients diagnosed with COVID -19 were included and divided into hospitalized (n=48) and non- -hospitalized (n=28) patients. Two hospitalized patients were not taken into account for the analysis due to a lack of data, and the remaining patients were divided into mild -moderate (n=25) and severe pneumonia (n=21). Lasso and multivariate logistic regression demonstrated that age (OR 1.041, p=0.039) and hypertension (OR 4.177, p=0.040) were risk factors for hospitalization, while time after transplant (OR 0.993, p=0.029) decreases the probability of being hospitalized. Analyses also revealed that SpO2 ≤92% on admission (OR 8.954, p= 0.026) and overweight/obesity (OR 13.453, p= 0.001) were related to a worse evolution and severe pneumonia among hospitalized recipients. Seven patients died due to COVID -19 complications. Conclusion: Age and hypertension are risk factors for hospitalization among positive COVID -19 patients, while time after transplant decreases the probability of being hospitalized. Overweight/obesity and levels of SpO2 ≤92% on admission were the main risk factors that could help to predict the severity of COVID -19 disease in our series.

Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation.

BackgroundStent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation.MethodsThis study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR).ResultsOf 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED.ConclusionsSED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.

Cardiac magnetic resonance strain as a predictor of clinical events in hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hypertrophic cardiomyopathy (HCM) is a relatively prevalent condition associated with cardiovascular death and heart failure. Several tools are currently available to identify which HCM patients are at risk of developing these events. Purpose We aimed to evaluate the association of new Tissue Tracking strain analysis by cardiac magnetic resonance (CMR) and the development of clinical events in patients with HCM. Methods We prospectively analyzed 136 consecutive patients with HCM diagnosis (established according to current clinical practice guidelines) from January 2006 to October 2017. Heart failure hospital admissions and death on follow-up were included in a combined clinical outcome. CMR studies were performed following our predefined CMR protocol for HCM with 1.5T magnets. Cine images were obtained with standard, retrospectively gated, steady-state free-precession (SSFP) sequences in 2, 3 and 4 chambers views and in 10–15 contiguous short-axis slices covering the ventricles from the base to the apex, with breath holding. The strain evaluation was performed by a commercially available Tissue Tracking analysis software, manually defining the endocardial border in short axis, 4, 3 and 2 chambers views and, after verifying adequate identification of the different structures, running the strain analysis (Figure 1, displaying myocardium identification by the strain analysis software). Results Mean follow-up was 49 ± 45 months. Mean age was 61 ± 15.33 years old (p 0.024) and 31% of patients were women (p 0.01). 20% had atrial fibrillation (p 0.154). Mean ejection fraction was 69 ± 9.21% (p 0.762) and mean HCM-SCD (hypertrophic cardiomyopathy sudden cardiac death) risk score was 2.20 ± 1.35 (p 0.885). Mean global radial systolic strain rate (GRSsr) was -1,33 ± 0.59 s-1 (p 0.083). During follow-up, 12 heart failure hospital admissions and 14 death from any cause were registered. GRSsr showed an area under de ROC curve of 0.63 (95% confidence interval -CI- 0.51 – 0.75) predicting clinical events. The value of 1.40 s−1 was selected as the best sensitivity/specificity cutoff point. Three variables (sex, age, and previous history of atrial fibrillation) were chosen (through the allsets method) and included as adjusting variables together with &amp;lt;1,40 s−1/≥1.40 s−1 in a multivariate Cox’s regression model (p 0.002; AIC 99.7; Harrell C index 0.82). Patients with GRSsr &amp;lt;1.40 s−1 showed more clinical evens on follow-up vs those with GRSsr ≥1.40 s−1 (adjusted HR 6.57; 95% CI 2.01 – 21.49; p 0.002; Figure 2, displaying Kaplan-Meier survival estimates). Conclusions A GRSsr &amp;lt;1.40 s−1 emerges as a novel independent predictor of worse clinical outcomes in patients with HCM and preserved ejection fraction.

Clinical Outcomes of Differentiated Thyroid Cancer With Gross Extrathyroidal Extension Into the Strap Muscles: A Case Control Study

Background: The 8th edition of the American Joint Committee on Cancer/tumor-node-metastasis (AJCC/TNM) staging system for differentiated thyroid cancer (DTC), implemented in January 2018, classifies patients >/= 55 years of age with gross extrathyroidal extension (ETE) of the primary tumor into the overlying strap muscles as prognostic stage II. However, it remains controversial as to whether or not gross ETE into the strap muscles is an independent predictor of recurrence, response to therapy, need for additional therapies, or overall survival. Using a case control study design, we evaluated the prognostic significance of gross ETE among adults. Methods: After obtaining IRB approval, we used the tumor registry at our institution to retrospectively identify 51 AJCC stage II patients with DTC aged >/= 55 years with gross ETE into only the strap muscles (51/2,225 patients). For each of the 51 cases, we identified one control who matched on all of the following important prognostic factors: age at diagnosis (± 5 years), sex, histology, size of tumor (± 1 cm), lymph node metastases, distant metastases, completeness of resection, receipt of radioactive iodine (RAI) therapy, and duration of follow-up (± 5 years). The controls (n=51) had no gross ETE. Results: In the 51 patients with gross ETE into only the strap muscles, the mean age at diagnosis was 64 years, 77% were female, 37% had lymph node metastases, and none had distant metastases. The average tumor size was 2.1 cm with the majority of patients (49/51) demonstrating papillary thyroid carcinoma (1 follicular thyroid carcinoma and 1 Hurthle cell thyroid carcinoma). Only 6% of patients (3/51) had incomplete resections and 92% (47/51) received RAI therapy. The mean duration of follow-up was 8 years.There were no statistically significant differences between the cases and controls on each of the pre-specified prognostic variables described in the methods. In addition, there were no statistically significant differences between the groups in terms of rates of recurrence: cases 18% (9/51) and controls 29% (15/51) (p=0.24), best response to initial therapy (excellent, biochemical incomplete, structural incomplete, or indeterminate response to therapy), and need for subsequent interventions including surgery, RAI, external beam radiation, or systemic therapy. Furthermore, there were no statistically significant differences between the cases and controls with respect to 10-year disease-free survival (cases 83% and controls 68%, p=0.90) and 10-year overall survival (cases 97% and controls 89%, p=0.10). Conclusions: In a case control analysis with a mean follow up of 8 years, the presence of ETE into the strap muscles was not an independent predictor of worse clinical outcomes in adults >/= 55 years old with DTC. These findings can be used to inform the future editions of the AJCC/TNM and American Thyroid Association staging systems for DTC.

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status.

Background:Blood pressure (BP), recanalization status, and collateral circulation are important factors for cerebral autoregulation after stroke. We aimed to investigate the association of various BP variability (BPV) parameters with clinical outcomes after mechanical thrombectomy (MT) according to recanalization and collateral status.Methods:We included 502 consecutive patients who underwent MT due to anterior circulation large vessel occlusion stroke at three comprehensive stroke centers. BPV parameters were standard deviation (SD), maximum/minimum BP, coefficient of variation (CV) and successive variation (SV). The clinical outcomes included 90-day functional outcome assessed by modified Rankin Scale score and symptomatic intracranial hemorrhage (sICH).Results:Among the included patients, 219 (43.6%) achieved good functional outcomes and 59 (11.8%) developed sICH. After adjusting for confounders, higher systolic BP (SBP) variability [CV (odds ratio (OR), 1.089, p = 0.035), SV (OR, 1.082, p = 0.004). and SD (OR, 1.074, p = 0.027)] was associated with a lower likelihood of a favorable outcome. In addition, higher SBP [CV (OR, 1.156, p = 0.001) and SD (OR, 1.118, p = 0.001)] were significantly associated with increased odds of sICH. Moreover, the relationship between BPV and the outcomes depended on recanalization status. However, regardless of collateral status, a higher BPV after MT was associated with worse outcomes.Conclusions:Higher SBP SD and CV during the first 24 h after MT was a powerful predictor of worse clinical outcomes, regardless of the collateral status. However, the effects of BPV on outcomes were more substantial among patients with successful reperfusion.

Ventricular stroke work indices to predict mortality after successful percutaneous edge-to-edge-repair for severe mitral valve regurgitation

Abstract Background Several studies identified predictors of worse clinical outcome despite successful transcatheter mitral valve repair (TMVR). The capability of invasively measured left and right ventricular stroke work indices (LVSWi, RVSWi) to predict mortality after successful TMVR is unclear. Purpose To assess the impact of LVSWi and RVSWi on mortality in patients with chronic heart failure (CHF) and severe mitral regurgitation (MR) undergoing TMVR. Methods Consecutive patients (pts.) with CHF (LV ejection fraction ≤50% from any cause) and severe MR who underwent successful TMVR (MR≤2+ at discharge) were included and followed prospectively. Primary endpoint was defined as all-cause mortality during a median follow-up period of 16±9 months. LVSWi was calculated as: Stroke volume index × (mean arterial pressure − postcapillary wedge pressure) × 0.0136 = g/m–1/m2. RVSWi was calculated as: Stroke volume index × (mean pulmonary artery pressure − right atrial pressure) × 0.0136 = g/m–1/m2. Receiver operator characteristic (ROC) analysis was used to determine discriminative capacity of LVSWi and RVSWi. Kaplan-Meier estimate was used for survival analysis. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for all-cause mortality. Results 140 patients (median age 74±9.9 years, 67.9% male) at high operative risk (LogEuro-SCORE 34.6±14.1%) were enrolled. Mean LVSWi and RVSWi were 22.3±10.7 g/m–1/m2 and 8.9±4.1 g/m–1/m2, respectively. 46 pts. died (33.1%). Pts. who died presented higher LogEuro-SCORE (27.8±16.6% vs. 20.1±13.7%; p=0.001), higher levels of NT-proBNP (12121±10602 ng/l vs. 6745±10820 ng/l; p=0.001), higher levels of creatinine (1.8±0.8 mg/dl vs. 1.4±0.8 mg/dl; p&amp;lt;0.001), lower LVSWi (18.9±8.1 g/m–1/m2 vs. 24.0±11.4 g/m–1/m2; p=0.01) and RVSWi (7.8±3.2 g/m–1/m2 vs. 9.4±4.4 g/m–1/m2; p=0.037), respectively. ROC curve analysis revealed that optimal sensitivity and specificity were achieved using a threshold of 24.8 g/m–1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60–0.81]; p=0.001) and 8.3 g/m–1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56–0.78]; p=0.006), respectively. At long-term follow-up, a significantly lower survival rate was observed in pts. with LVSWi ≤24.8 g/m–1/m2 (20.0% vs. 39.4%; log-rank p=0.038) and in pts. with RVSWi ≤8.3 g/m–1/m2 (22.1% vs. 43.7%; log-rank p=0.026), respectively. In Cox regression analysis a LVSWi of ≤24.8 g/m–1/m2 and a RVSWi of ≤8.3 g/m–1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p=0.04; HR 2.52; 95% CI 1.04 to 6.1; p=0.041). Conclusions LVSWi and RVSWi are associated with mortality among pts. with CHF undergoing successful TMVR for severe MR. A LVSWi cut-off value of &amp;gt;24g/m–1/m2 and a RVSWi cut-off value of &amp;lt;8g/m–1/m2 seem to predict mortality independent of other clinical and echocardiographic factors. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Links der Weser, Bremen, Germany

Systematic Review of Preinjury Mental Health Problems as a Vulnerability Factor for Worse Outcome After Sport-Related Concussion.

Background:It is difficult to predict who will experience prolonged health problems after sustaining a sport-related concussion.Purpose:To synthesize the literature and conduct a gap analysis on the association between preinjury mental health problems and clinical outcome from sport-related concussion.Study Design:Systematic review; Level of evidence, 4.Methods:Data sources were PubMed, PsycINFO, MEDLINE (and MEDLINE in Process), CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. Studies published before February 2019 that addressed preinjury mental health problems as a possible predictor of worse clinical outcome or clinical recovery from concussion were eligible for inclusion.Results:Of 4013 studies screened, 358 full texts were reviewed, and 12 studies involving 3761 participants (n = 471 [12.5%] with preexisting mental health problems) were ultimately included. The participants with a preinjury history of mental health problems were at greater risk for having persistent symptoms or worse outcome in 9 of 12 studies. The studies had major methodological differences, and most studies were not focused on mental health as a primary predictor or prognostic factor. Rather, they included it as a secondary or tertiary predictor. The sample sizes with preinjury mental health problems in most studies were small or very small (ie, <25). The age of onset, type, course, severity, and duration of mental health problems were not defined. The extent to which mental health problems were present before the season, during baseline testing, was not reported.Conclusion:Preinjury mental health problems appear to confer risk for worse clinical outcome after sport-related concussion. Future research is needed to (1) examine this risk factor in large representative populations of middle school students, high school students, and collegiate athletes; (2) quantify the risk for each mental health condition; (3) understand the mechanisms underlying this increased risk; and (4) develop more refined treatment and rehabilitation approaches for these student-athletes.

Using a Likelihood Heuristic to Summarize Conflicting Literature on Predictors of Clinical Outcome Following Sport-Related Concussion.

To introduce a new methodology for summarizing the results from systematic reviews-a likelihood heuristic-to the field of sport-related concussion. We applied the likelihood heuristic to the results of a systematic review published by Iverson et al (2017), containing 101 studies, on the predictors of worse clinical outcome following sport-related concussion. We re-examined 5 individual prognostic factors that are of clinical interest and for which there is conflicting literature (female sex = 44 studies, prior concussion history = 41 studies, loss of consciousness = 31 studies, post-traumatic amnesia = 25 studies, and retrograde amnesia = 10 studies). For each prognostic factor, likelihood ratios were generated using the (1) number of significant and nonsignificant studies, (2) study power, (3) alpha level, and (4) prior probability that the alternative hypothesis was true. Assuming each study had 80% power and an alpha level of 5%, observing the reported number of conflicting studies for female sex, prior concussion history, and retrograde amnesia is substantially more likely if each prognostic factor is associated with worse clinical outcome following sport-related concussion. For loss of consciousness, the observed number of conflicting studies is more likely if loss of consciousness is not associated with worse clinical outcome following sport-related concussion. A secondary analysis incorporating potentially more realistic study parameters of statistical power (45%) and alpha level (25%) generates weaker likelihood evidence that the observed numbers of studies for each prognostic factor are associated with worse clinical outcome following sport-related concussion than they are not. Using a likelihood heuristic with 80% power and 5% alpha level, there is very strong likelihood evidence that female sex, prior concussion history, and retrograde amnesia are associated with worse clinical outcome following sport-related concussion. The strength of likelihood evidence that prognostic factors are associated with worse clinical outcome reduces when statistical power is lower and alpha level is inflated.

Impact of donor age and kinship on clinical outcomes after T-cell–replete haploidentical transplantation with PT-Cy

AbstractDonor selection contributes to improve clinical outcomes of T-cell–replete haploidentical stem cell transplantation (haplo-SCT) with posttransplant cyclophosphamide (PT-Cy). The impact of donor age and other non-HLA donor characteristics remains a matter of debate. We performed a multicenter retrospective analysis on 990 haplo-SCTs with PT-Cy. By multivariable analysis, after adjusting for donor/recipient kinship, increasing donor age and peripheral blood stem cell graft were associated with a higher risk of grade 2 to 4 acute graft-versus-host-disease (aGVHD), whereas 2-year cumulative incidence of moderate-to-severe chronic GVHD was higher for transplants from female donors into male recipients and after myeloablative conditioning. Increasing donor age was associated with a trend for higher nonrelapse mortality (NRM) (hazard ratio [HR], 1.05;P= .057) but with a significant reduced risk of disease relapse (HR, 0.92;P= .001) and improved progression-free survival (PFS) (HR, 0.97;P= .036). Increasing recipient age was a predictor of worse overall survival (OS). Risk of relapse was higher (HR, 1.39;P< .001) in patients aged ≤40 years receiving a transplant from a parent as compared with a sibling. Moreover, OS and PFS were lower when the donor was the mother rather than the father. Pretransplant active disease status was an invariably independent predictor of worse clinical outcomes, while recipient positive cytomegalovirus serostatus and hematopoietic cell transplant comorbidity index >3 were associated with worse OS and PFS. Our results suggest that younger donors may reduce the incidence of aGVHD and NRM, though at higher risk of relapse. A parent donor, particularly the mother, is not recommended in recipients ≤40 years.

The association between hyperfibrinogenemia and clinicopathological factors, and the survival analysis of gastric cancer.

e16547 Background: It is reported that hyperfibrinogenemia is commonly seen in gastric cancer. This study aim to discuss the association between fibrinogen level and preoperative clinicopathological factors and to evaluate the value as a predictor of prognosis. Methods: Retrospectively reviewed the medical records and follow-up data of patients with gastric cancer who underwent curative resection from January 2011 to December 2014 at Surgery Department of the Fourth Hospital of Hebei Medical University. Fibrinogen was measured a week before the surgery. Results: A total of 248 cases were enrolled. The means±SD of fibrinogen was 3.28±1.06g/L. Fibrinogen level was higher in older adults(≥60y), advanced tumor, poorly differentiated, deep invasion, lymph node metastasis, large tumor size and in those with high CEA, platelet count, albumin, NLR and PLR,( P&lt; 0.05). All the people were divided by the TNM staging system and found that the plasma fibrinogen was higher in stageⅡand Ⅲ (stageⅠvs. stageⅡ: 2.84±0.72g/L vs. 3.36±1.18g/L, P= 0.009;stageⅠvs. stage Ⅲ: 2.84±0.72g/L vs. 3.43±1.07g/L, P&lt; 0.001), however, there was no difference between stageⅡand Ⅲ( P= 0.662)(our study did not enrolled stage IV patients).When patients were classified into 4 groups according to the T classification, the plasma fibrinogen level gradually increased with increasing depth of cancer invasion (one way ANOVA; P= 0.002). Yet, when the patients who have lymph nodes metastasis classified according to the N classification, the differences among them did not have statistically significance ( P= 0.333). Multivariate analysis revealed that hyperfibrinogenemia had an independent association with advanced cancer (odds ratio,2.686(1.012-7.125); P= 0.047), lymph node metastasis (odds ratio,2.012 (1.012-3.125); P= 0.035) and tumor size(odds ratio,1.949 (1.099-3.454); P= 0.022). Our study aslo suggested that the patients with hyperfibrinogenemia before surgery showed a significantly lower survival rate (Log-Rank test; P&lt; 0.001), hyperfibrinogenemia was a independent predictor on the overall survival, which could predict worse clinical outcome. Conclusions: Hyperfibrinogenemia may be considered a useful biomarker to predict advanced tumor, lymph node metastasis and large tumor size and can be a good predictor of worse clinical outcome.

Endothelial Dysfunction in Primary Aldosteronism.

Primary aldosteronism (PA) is characterized by excess production of aldosterone from the adrenal glands and is the most common and treatable cause of secondary hypertension. Aldosterone is a mineralocorticoid hormone that participates in the regulation of electrolyte balance, blood pressure, and tissue remodeling. The excess of aldosterone caused by PA results in an increase in cardiovascular and cerebrovascular complications, including coronary artery disease, myocardial infarction, stroke, transient ischemic attack, and even arrhythmia and heart failure. Endothelial dysfunction is a well-established fundamental cause of cardiovascular diseases and also a predictor of worse clinical outcomes. Accumulating evidence indicates that aldosterone plays an important role in the initiation and progression of endothelial dysfunction. Several mechanisms have been shown to contribute to aldosterone-induced endothelial dysfunction, including aldosterone-mediated vascular tone dysfunction, aldosterone- and endothelium-mediated vascular inflammation, aldosterone-related atherosclerosis, and vascular remodeling. These mechanisms are activated by aldosterone through genomic and nongenomic pathways in mineralocorticoid receptor-dependent and independent manners. In addition, other cells have also been shown to participate in these mechanisms. The complex interactions among endothelium, inflammatory cells, vascular smooth muscle cells and fibroblasts are crucial for aldosterone-mediated endothelial dysregulation. In this review, we discuss the association between aldosterone and endothelial function and the complex mechanisms from a molecular aspect. Furthermore, we also review current clinical research of endothelial dysfunction in patients with PA.

TCT-304 1-Year Clinical Outcomes in Patients Implanted With Biodegradable Polymer Coated Ultrathin Strut Sirolimus-Eluting Coronary Stent System for the Treatment of Very Long (≥40-mm) Lesions

Very long lesions are considered technically difficult and a predictor of worse clinical outcome after percutaneous coronary interventions. The purpose of this retrospective study was to evaluate safety and performance of an ultrathin (65-μm) strut biodegradable polymer–coated BioMime sirolimus-