ResearchPad - clinical-investigations https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Impact of leaflet thrombosis on hemodynamics and clinical outcomes after bioprosthetic aortic valve replacement: A meta‐analysis]]> https://www.researchpad.co/article/elastic_article_15256 Leaflet thrombosis (LT, also called cusp thrombosis) detected by multidetector computed tomography (MDCT) is common in bioprosthetic aortic valve replacement (bAVR). However, it remains contradictory whether MDCT‐defined LT following bAVR is associated with hemodynamic deterioration and stroke. Thus, we performed the first meta‐analysis to assess hemodynamic outcomes and updated the latest researches on the clinical outcomes of MDCT‐defined LT after bAVR.HypothesisMDCT‐defined LT might be associated with worse hemodynamic and clinical outcomes after bAVR.MethodMEDLINE, EMBASE, Cochrane Library, and http://clinicaltrial.gov were searched from inception to 15th April 2019. The fix‐effect model was utilized to calculate odds ratio (OR) and 95% confidence interval (CI). The primary outcomes were hemodynamic stability indexes, including mean pressure gradient (MPG), left ventricular ejection fraction (LVEF), paravalvular leak (PVL), and clinical heart failure. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs), which consisted of myocardial infarction, all‐cause death, stroke, and transient ischemic attack (TIA).ResultsTwelve studies with 4820 patients were included. The total prevalence of MDCT‐defined LT was 9.7%. MDCT‐defined LT was associated with a significantly increased risk of MPG (inverse variance 0.43, 95% CI: [0.30, 0.57]), MACCEs (OR 2.43, 95% CI: [1.45, 4.06]), stroke (OR 1.79, 95% CI: [1.03, 3.11]), and TIA (OR 4.09, 95% CI: [1.59, 10.54]). There were no differences for other outcomes.ConclusionsMDCT‐defined LT after bAVR is associated with increased MPG and increased risk of adverse cerebrovascular events, including TIA and stroke. While LVEF, PVL, and clinical heart failure were similar between patient with and without LT. ]]> <![CDATA[Comparing between second‐generation cryoballoon vs open‐irrigated radiofrequency ablation in elderly patients: Acute and long‐term outcomes]]> https://www.researchpad.co/article/elastic_article_15253 Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second‐generation cryoballoon (CB‐2) vs radiofrequency (RF) ablation in elderly patients (>75‐year‐old).HypothesisCB‐2 ablation may demonstrate different outcomes compared with that using RF ablation for elderly patients with AF.MethodElderly patients with symptomatic drug‐refractory AF were included in the study. Pulmonary vein isolation was performed in all patients.ResultsA total of 324 elderly patients were included (RF: 176, CB‐2:148) from September 2016 to April 2019. The CB‐2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs 135.1 ± 9.9 minutes, P < .001; 53.7 ± 8.9 vs 65.1.9 ± 9.0 minutes, P < .001), but marked fluoroscopy utilization (22.1 ± 3.3 vs 18.5 ± 3.6 minutes, P < .001). Complications occurred in 3.3% (CB‐2) and 6.2% (RF) of patients with no significant different (P = .307). The length of stay after ablation was shorter, but the costs were higher in the CB‐2 group (1.94 vs 2.53 days, P < .001 and 91 132.6 ± 3723.5 vs 81 149.4 ± 6824.1 CNY, P < .001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia was lower in the CB‐2 group (14.2 vs 23.3%, P = .047), but the long‐term success rate was similar between two groups.ConclusionsCB‐2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long‐term success are similar between the two groups. ]]> <![CDATA[Early noncardiovascular organ failure and mortality in the cardiac intensive care unit]]> https://www.researchpad.co/article/elastic_article_15251 Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population.HypothesisWe hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients.MethodsAdult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore ≥3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities.ResultsWe included 10 004 patients with a mean age of 67 ± 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5‐3.7, P < .001). After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1‐2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long‐term mortality risk.ConclusionsEarly noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues after hospital discharge, emphasizing the need to promote early recognition of organ failure in CICU patients. ]]> <![CDATA[Optimized electrocardiographic criteria for the detection of left ventricular hypertrophy in obesity patients]]> https://www.researchpad.co/article/elastic_article_15249 Despite a generally high specificity, electrocardiographic (ECG) criteria for the detection of left ventricular hypertrophy (LVH) lack sensitivity, particularly in obesity patients.ObjectivesThe aim of the study was to evaluate the accuracy of the most commonly used ECG criteria (Cornell voltage and Sokolow‐Lyon index), the recently introduced Peguero‐Lo Presti criteria and the correction of these criteria by body mass index (BMI) to detect LVH in obesity patients and to propose adjusted ECG criteria with optimal accuracy.MethodsThe accuracy of the ECG criteria for the detection of LVH was retrospectively tested in a cohort of obesity patients referred for a transthoracic echocardiogram based on clinical grounds (test cohort, n = 167). Adjusted ECG criteria with optimal sensitivity for the detection of LVH were developed. Subsequently, the value of these criteria was prospectively tested in an obese population without known cardiovascular disease (validation cohort, n = 100).ResultsEstablished ECG criteria had a poor sensitivity in obesity patients in both the test cohort and the validation cohort. The adjusted criteria showed improved sensitivity, with optimal values for males using the Cornell voltage corrected for BMI, (RaVL+SV3)*BMI ≥700 mm*kg/m2; sensitivity 47% test cohort, 40% validation cohort; for females, the Sokolow‐Lyon index corrected for BMI, (SV1 + RV5/RV6)*BMI ≥885 mm*kg/m2; sensitivity 26% test cohort, 23% validation cohort.ConclusionsEstablished ECG criteria for the detection of LVH lack sufficient sensitivity in obesity patients. We propose new criteria for the detection of LVH in obesity patients with improved sensitivity, approaching known sensitivity of the most commonly used ECG criteria in lean subjects. ]]> <![CDATA[Four‐year incidence of major adverse cardiovascular events in patients with atherosclerosis and atrial fibrillation]]> https://www.researchpad.co/article/elastic_article_15248 There is a paucity of contemporary data assessing the implications of atrial fibrillation (AF) on major adverse cardiovascular events (MACE) in patients with or at high‐risk for atherosclerotic disease managed in routine practice.HypothesisWe sought to evaluate the 4‐year incidence of MACE in patients with or at risk of atherosclerotic disease in the presence of AF.MethodsUsing US MarketScan data, we identified AF patients ≥45 years old with billing codes indicating established coronary artery disease, cerebrovascular disease, or peripheral artery disease or the presence of ≥3 risk factors for atherosclerotic disease from January 1, 2013 to December 31, 2013 with a minimum of 4‐years of available follow‐up. We calculated the 4‐year incidence of MACE (cardiovascular death or hospitalization with a primary billing code for myocardial infarction or ischemic stroke). Patients were further stratified by CHA2DS2‐VASc score and oral anticoagulation (OAC) use at baseline.ResultsWe identified 625,951 patients with 4‐years of follow‐up, of which 77,752 (12.4%) had comorbid AF. The median (25%, 75% range) CHA2DS2‐VASc score was 4 (3, 5) and 64% of patients received an OAC at baseline. The incidence of MACE increased as CHA2DS2‐VASc scores increased (P‐interaction<.0001 for all). AF patients receiving an OAC were less likely to experience MACE (8.9% vs 11.6%, P < .0001) including ischemic stroke (5.4% vs 6.7%, P < .0001).ConclusionComorbid AF carries a substantial risk of MACE in patients with or at risk of atherosclerotic disease. MACE risk increases with higher CHA2DS2‐VASc scores and is more likely in patients without OAC. ]]> <![CDATA[Learning curve for transcatheter aortic valve replacement for native aortic regurgitation: Safety and technical performance study]]> https://www.researchpad.co/article/elastic_article_15247 Transcatheter aortic valve replacement (TAVR) is a fundamentally new procedure for the treatment of native aortic regurgitation (AR). The number of cases needed to gain proficiency with the procedure is unknown.HypothesisThis study aimed to evaluate the learning curve for TAVR for native AR.MethodsThis study retrospectively reviewed a prospective database from 134 consecutive native AR patients who underwent the J‐valve TAVR system, which performed by a single team interventional cardiologist. The cumulative sum (CUSUM) method was used to analyze the learning curve. Patients were divided into two groups in chronological order, defined by the surgeon's early (group 1: the first 52 cases) and skilled (group 2: the next 82 cases) experience. Demographic data, intraoperative characteristics, and short‐term surgical outcomes were compared between the two groups.ResultsCUSUM plots revealed decreasing procedure time and fluoroscopy time after patients 52 and 43, respectively. The patient date consistently demonstrated that high‐risk scores and major perioperative parameters were comparable between the two groups. The use of contrast dye (group 1, 94.22 ± 30.07 mL; group 2, 70.43 ± 15.02 mL, P<.05), total procedure time (group 1, 84.96 ± 17.76 minutes; group 2, 59.95 ± 12.83 minutes, P<.05), and fluoroscopy time (group 1, 11.52 ± 3.81 minutes; group 2, 6.47 ± 1.53 minutes, P<.05) were significantly reduced in group 2. The overall device success rate in group 1 was 96.2% vs 96.3% in group 2 and remained high (P = 1.0). The overall 30‐day mortality was 3.8% in group 2 (group 1, 0 to group 2, 3.8%; P = .16). The complications rate, such as pulmonary hypertension, chronic kidney disease, and coronary artery disease were higher in group 2.ConclusionsFor a surgeon without previous TAVR experience, 52 cases of performance is the minimal requirement to gain the proficiency of TAVR for native AR. The skilled surgeons have been observed with reduced procedural time, fluoroscopy times, radiation exposure dose, and contrast volume usage. However, the overall prognosis was not significantly different between the two groups. ]]> <![CDATA[Non‐ST‐elevated myocardial infarction with “N” wave on electrocardiogram and culprit vessel in left circumflex has a risk equivalent to ST‐elevated myocardial infarction]]> https://www.researchpad.co/article/elastic_article_15246 It was found that delayed activation wave often appeared in terminal QRS wave in non‐ST‐elevated myocardial infarction (NSTEMI) with culprit vessel in left circumflex artery (LCX), yet little is known about the similarities among non‐“N”‐wave non‐ST‐elevated myocardial infarction (N‐NSTEMI) and ST‐elevated myocardial infarction (STEMI).HypothesisIn AMI patients with the culprit vessel in LCX, “N” wave NSTEMI has a risk equivalent to STEMI.MethodsAll 874 patients admitted to Shenjing Hospital of China Medical University between January 1, 2013 and December 30, 2017 were included and whose coronary angiography (CAG) indicated the culprit vessel in LCX. Patients were divided into three groups: ST‐elevated myocardial infarction group (STEMI group, n = 322), “N” wave non‐ST‐elevated myocardial infarction group (N‐NSTEMI group, n = 232) and non‐“N”‐wave NSTEMI group (non N‐NSTEMI group, n = 320). The basic data and the incidence of MACE during hospitalization and 12 months were analyzed.ResultsIn STEMI and N‐NSTEMI groups, AST, CK, CK‐MB, TnI, and stenosis severity were significantly higher than non N‐NSTEMI (P < .05). The lesions in the N‐NSTEMI and STEMI groups were more often located proximal LCX before giving rise to OM1 of LCX (P < .05), however, the non N‐NSTEMI group was often located distal LCX after giving rise to OM1 and the OM1 (P < .05). The incidence rates of all MACEs, all‐cause death, ST, TVR, and rUAP were similar in N‐NSTEMI and STEMI groups, which were greater than non N‐NSTEMI (P < .05). Both N‐NSTEMI and STEMI are independent risk factors for MACE (P < .05).ConclusionThe basic data and the incidence of major adverse cardiac event were similar in N‐NSTEMI and STEMI patients, N‐NSTEMI has a risk equivalent to acute STEMI. ]]> <![CDATA[Risk stratification in patients undergoing interventional left atrial appendage occlusion—Prognostic impact of EuroSCORE II]]> https://www.researchpad.co/article/elastic_article_15245 Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient.HypothesisThe present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients.MethodsThis study consecutively included 128 patients who received an interventional LAA occlusion with Amplatzer device (St Jude Medical, St Paul, Minnesota). The preinterventional risk assessment was performed with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. The primary endpoint was all‐cause mortality. Secondary endpoints were thromboembolic events and severe bleeding.ResultsDuring a follow‐up of 781 ± 498 days the primary endpoint (all‐cause mortality) was reached in 35 patients (27%). The only independent predictor of mid‐term mortality was a logistic EuroSCORE II > 2% (Hazard risk [HR] 4.55, confidence interval [CI] 1.599‐12.966, P = .005). In our study, 33 patients (26%) suffered from end‐stage renal disease which was not associated with increased mortality (P = .371), increased thromboembolic events (P = .475), or severe bleeding (P = .613).ConclusionsIn patients undergoing interventional LAA occlusion, preprocedural assessment of logistic EuroSCORE II provide independent prognostic information. This parameter might help to improve risk stratification in these highly selected patients. In contrast, terminal renal failure was not associated with a significantly worse outcome. ]]> <![CDATA[Acute Physiology and Chronic Health Evaluation II Score as a Predictor of Hospital Mortality in Patients of Coronavirus Disease 2019]]> https://www.researchpad.co/article/elastic_article_7073 Coronavirus disease 2019 has emerged as a major global health threat with a great number of deaths in China. We aimed to assess the association between Acute Physiology and Chronic Health Evaluation II score and hospital mortality in patients with coronavirus disease 2019, and to compare the predictive ability of Acute Physiology and Chronic Health Evaluation II score, with Sequential Organ Failure Assessment score and Confusion, Urea, Respiratory rate, Blood pressure, Age 65 (CURB65) score.Design:Retrospective observational cohort.Setting:Tongji Hospital in Wuhan, China.Subjects:Confirmed patients with coronavirus disease 2019 hospitalized in the ICU of Tongji hospital from January 10, 2020, to February 10, 2020.Interventions:None.Measurements and Main Results:Of 178 potentially eligible patients with symptoms of coronavirus disease 2019, 23 patients (12.92%) were diagnosed as suspected cases, and one patient (0.56%) suffered from cardiac arrest immediately after admission. Ultimately, 154 patients were enrolled in the analysis and 52 patients (33.77%) died. Mean Acute Physiology and Chronic Health Evaluation II score (23.23 ± 6.05) was much higher in deaths compared with the mean Acute Physiology and Chronic Health Evaluation II score of 10.87 ± 4.40 in survivors (p < 0.001). Acute Physiology and Chronic Health Evaluation II score was independently associated with hospital mortality (adjusted hazard ratio, 1.07; 95% CI, 1.01–1.13). In predicting hospital mortality, Acute Physiology and Chronic Health Evaluation II score demonstrated better discriminative ability (area under the curve, 0.966; 95% CI, 0.942–0.990) than Sequential Organ Failure Assessment score (area under the curve, 0.867; 95% CI, 0.808–0.926) and CURB65 score (area under the curve, 0.844; 95% CI, 0.784–0.905). Based on the cut-off value of 17, Acute Physiology and Chronic Health Evaluation II score could predict the death of patients with coronavirus disease 2019 with a sensitivity of 96.15% and a specificity of 86.27%. Kaplan-Meier analysis showed that the survivor probability of patients with coronavirus disease 2019 with Acute Physiology and Chronic Health Evaluation II score less than 17 was notably higher than that of patients with Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 (p < 0.001).Conclusions:Acute Physiology and Chronic Health Evaluation II score was an effective clinical tool to predict hospital mortality in patients with coronavirus disease 2019 compared with Sequential Organ Failure Assessment score and CURB65 score. Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 serves as an early warning indicator of death and may provide guidance to make further clinical decisions. ]]> <![CDATA[Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction]]> https://www.researchpad.co/article/Ne079a449-f212-440e-9534-7d3d96359913

Abstract

Background

Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern.

Hypothesis

CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function.

Methods

Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF‐CA), 150 congestive HF who were undergoing medical therapy (AFHF‐Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF‐CA).

Results

After 30 ± 6 months of follow up, 45.8% of patients in the AFHF‐CA and 61.3% of patients in the AF‐CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF‐Med (P < .01). Hospitalization for HF was significantly lower in AFHF‐CA than in AFHF‐Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF‐CA group, which was lower than 18% in the AFHF‐Med group (P < .01). Significant improvements in heart function were shown in the AFHF‐CA group compared to the AFHF‐Med group, including LVEF (P < .01), LV end‐diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF‐CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia‐related diseases.

Conclusion

CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.

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<![CDATA[Safety and efficacy of the ThermoCool SmartTouch SurroundFlow catheter for atrial fibrillation ablation: A meta‐analysis]]> https://www.researchpad.co/article/Nd85914db-ea57-4250-abf1-5559234149c1

Abstract

Background

The ThermoCool Smarttouch Surroundflow catheter (STSFc) is an advanced catheter, which integrating contact force sensing and surroundflow technology. However, comparative data between STSFc and contact force sensing catheter (Thermocool SmartTouch catheter [STc]) are limited.

Hypothesis

We thought that STSFc might bring more clinical benefits. The aim of this meta‐analysis was to compare the safety and efficiency between the STSFc and the STc for treatment of atrial fibrillation (AF).

Methods

The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies comparing STSFc and STc.

Results

Four trials involving 727 patients were included in the study. Pool‐analyses demonstrated that, as compared STc ablation, STSFc ablation was more beneficial in terms of procedural times (standard mean difference [SMD]: −0.22; 95% confidence interval [CI], −0.37 to −0.07, P = .005) and irrigation fluid volume (SMD: −1.94; 95% CI, −2.65 to −1.22, P < .0001). There was no significant difference between STSFc and STc (risk ratio [RR]: 1.02; 95% CI: 0.86 to 1.21, P = .79) for free from AF. Evidence of complications were low and similar for both groups (RR: 0.83; 95% CI: 0.19‐3.55, P = .80). Additionally, patients administered STSFc ablation tended to have shorter fluoroscopic times (SMD: −0.20; 95% CI, −0.63‐0.23, P = .21).

Conclusions

STSFc ablation was associated with reducing procedural times and irrigation fluid volume. Further, STSFc ablation tended to shorten fluoroscopic times. Therefore, STSFc ablation would be a better choice for AF patients especially in patients with heart failure.

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<![CDATA[Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome]]> https://www.researchpad.co/article/N25680dc5-3984-4aed-83f1-4c7c4818f2d1

Abstract

Background

Epicardial placement of the left ventricular (LV) lead via a video‐assisted thoracoscopic (VAT) approach is an alternative to the standard transvenous technique.

Hypothesis

Long‐term safety and efficacy of VAT and transvenous LV lead implantation are comparable. To test it, we reviewed our experience and we compared the outcomes of patients who underwent implantation with the two techniques.

Methods

The VAT procedure is performed under general anesthesia, with oro‐tracheal intubation and right‐sided ventilation, and requires two 5 mm and one 15 mm thoracoscopic ports. After pericardiotomy at the spot of the epicardial target area, pacing measurements are taken and a spiral screw electrode is anchored at the final pacing site. The electrode is then tunneled to the pectoral pocket and connected to the device.

Results

105 patients were referred to our center for epicardial LV lead implantation. After pre‐operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery. The remaining 100 underwent the procedure. LV lead implantation was successful in all patients (median pacing threshold 0.8 ± 0.5 V, no phrenic nerve stimulation) and cardiac resynchronization therapy was established in all but one patient. The median procedure time was 75 min. During a median follow‐up of 24 months, there were no differences in terms of death, cardiovascular hospitalizations or device‐related complications vs the group of 100 patients who had undergone transvenous implantation. Patients of both groups displayed similar improvements in terms of ventricular reverse remodeling and functional status.

Conclusions

Our VAT approach proved safe and effective, and is a viable alternative in the case of failed transvenous LV implantation.

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<![CDATA[Retrospective cohort analysis of heart rate variability in patients with high altitude pulmonary hypertension in Tibet ]]> https://www.researchpad.co/article/Ne0d3dd3d-dbd8-4ba6-978f-cb672eb95c15

Abstract

Background

Studies from both humans and animals experiments have offered abundant evidence supporting that mountain sickness is associated with changes in autonomic nervous function (ANF), which can be measured by heart rate variability (HRV).

Hypothesis

We aimed to assess changes of ANF in chronic mountain disease by measuring HRV in patients with high altitude pulmonary hypertension (HAPH).

Methods

From November 2018 to March 2019, 120 patients in the cardiac care unit of the People's Hospital of Tibet Autonomous Region were selected as the observation group, and 50 patients without organic heart disease served as the control group. Pulmonary artery systolic pressure was evaluated by echocardiography in patients with HAPH, divided into three groups: mild (30‐49 mm Hg), moderate (50‐69 mm Hg) and severity (≥70 mm Hg) groups. A 24‐hour dynamic electrocardiogram (DCG) was obtained for each patient. HRV (SDNN, SDANN, RMSSD, PNN50, and HRVTI for time domain; TP, VLF, LF, HF, and LF/HF for frequency domain) indexes were measured and compared.

Results

Compared with the control group, time domain parameters including SDNN, SDANN, RMSSD, PNN50, and HRVTI were reduced, as well as frequency domain indexes such as TP, VLF, LF, and HF. LF/HF was highest in mild HAPH group and lowest in the moderate HAPH group, and the difference between the two groups was statistically significant.

Conclusions

The HRV of patients with chronic HAPH in high altitude areas in Tibet is significantly reduced relative to healthy controls, and significantly negatively correlated with the severity of pulmonary artery hypertension.

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<![CDATA[Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators]]> https://www.researchpad.co/article/N626ad18b-ed0b-4bd0-b464-d2b9fe1e6575

Abstract

Objective

To identify predictors of left ventricular ejection fraction (LVEF) improvement in patients with newly detected cardiomyopathy using wearable cardioverter defibrillators (WCDs).

Background

WCDs are useful in preventing sudden cardiac death in patients with reduced LVEF <35% while awaiting implantable cardioverter defibrillator (ICD) placement. In many patients, LVEF improves and an ICD is not indicated.

Methods

Patients who received WCDs from November 2013 to November 2015 were identified and followed over a period of 2 years. Clinical variables were examined. The primary outcome was improvement in LVEF ≥35%. Predictors of outcome were determined using a multivariate logistic regression model.

Results

A total of 179 patients were followed. Median age was 65 (interquartile range [IQR]: 56, 73) years, 69.3% were men. Median baseline LVEF was 20% (IQR: 15, 30). LVEF improved ≥35% in 47.5% patients, with patients being younger (62 vs 68.5 years, P = .006), having lower blood urea nitrogen (BUN) (19 vs 24 mg/dL, P = .002), fewer left bundle branch block (LBBB 9.5% vs 25.8%, P = .004), shorter QRS duration (98 vs 112 ms, P < .001), and higher use of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (92.9% vs 74.4%, P = .001) compared to those without LVEF improvement. Absence of LBBB (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.11‐0.70), lower BUN (OR 0.13, 95% CI 0.02‐0.76), and ACEI/ARB use (OR 3.53, 95% CI 1.28‐9.69) were identified as independent predictors. Ventricular tachycardia/ventricular fibrillation was observed in three patients, all of whom received successful WCD shocks.

Conclusion

Absence of LBBB, lower BUN, and ACEI/ARB use predicts LVEF improvement. WCDs help treat arrhythmic events.

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<![CDATA[Efficacy and safety of dronedarone in patients with a prior ablation for atrial fibrillation/flutter: Insights from the ATHENA study]]> https://www.researchpad.co/article/Nffb3f416-7591-44e7-b8b4-5f616b0f6d63

Abstract

Background

The role of antiarrhythmic drugs for atrial fibrillation/atrial flutter (AF/AFL) after catheter ablation is not well established.

Hypothesis

We hypothesized that changing the myocardial substrate by ablation may alter the responsiveness to dronedarone.

Methods

We assessed the efficacy and safety of dronedarone in the treatment of paroxysmal/persistent atrial fibrillation/atrial flutter (AF/AFL) post‐ablation, based on a post hoc analysis of the ATHENA study. A total of 196 patients (dronedarone 90, placebo 106) had an ablation for AF/AFL before study entry. In these patients, the effect of treatment on the first hospitalization because of cardiovascular (CV) events/all‐cause death was assessed, as was AF/AFL recurrence in individuals with sinus rhythm at baseline. The safety of dronedarone vs placebo was also determined.

Results

In patients with prior ablation, dronedarone reduced the risk of AF/AFL recurrence (hazard ratio [HR]: 0.65 [95% confidence interval [CI]: 0.42, 1.00]; P < .05) as well as the median time to first AF/AFL recurrence (561 vs 180 days) compared with placebo. The HR for first CV hospitalization/all‐cause death with dronedarone vs placebo was 0.98 (95% CI: 0.62, 1.53; P = .91). Rates of treatment‐emergent adverse events were 83.1% vs 75.5% and rates of serious TEAEs were 27.0% vs 18.9% in the dronedarone and placebo groups, respectively. One death occurred with dronedarone (not treatment‐emergent) and five occurred with placebo.

Conclusion

In patients with prior ablation for AF/AFL, dronedarone reduced the risk of AF/AFL recurrence compared with placebo, but not the risk of first CV hospitalization/all‐cause death. Safety outcomes were consistent with those of the overall ATHENA study.

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<![CDATA[Imaging and histopathologic correlates of plasma cell-free DNA concentration and circulating tumor DNA in adult patients with newly diagnosed glioblastoma]]> https://www.researchpad.co/article/Nd44f3b00-52fd-4641-a1b7-c1f41aff6c94

Abstract

Background

Plasma cell-free DNA (cfDNA) concentration is lower in glioblastoma (GBM) compared to other solid tumors, which can lead to low circulating tumor DNA (ctDNA) detection. In this study, we investigated the relationship between multimodality magnetic resonance imaging (MRI) and histopathologic features with plasma cfDNA concentration and ctDNA detection in patients with treatment-naive GBM.

Methods

We analyzed plasma cfDNA concentration, MRI scans, and tumor histopathology from 42 adult patients with newly diagnosed GBM. Linear regression analysis was used to examine the relationship of plasma cfDNA concentration before surgery to imaging and histopathologic characteristics. In a subset of patients, imaging and histopathologic metrics were also compared between patients with and without a detected tumor somatic mutation.

Results

Tumor volume with elevated (>1.5 times contralateral white matter) rate transfer constant (Kep, a surrogate of blood–brain barrier [BBB] permeability) was independently associated with plasma cfDNA concentration (P = .001). Histopathologic characteristics independently associated with plasma cfDNA concentration included CD68+ macrophage density (P = .01) and size of tumor vessels (P = .01). Patients with higher (grade ≥3) perivascular CD68+ macrophage density had lower volume transfer constant (Ktrans, P = .01) compared to those with lower perivascular CD68+ macrophage density. Detection of at least 1 somatic mutation in plasma cfDNA was associated with significantly lower perivascular CD68+ macrophages (P = .01).

Conclusions

Metrics of BBB disruption and quantity and distribution of tumor-associated macrophages are associated with plasma cfDNA concentration and ctDNA detection in GBM patients. These findings represent an important step in understanding the factors that determine plasma cfDNA concentration and ctDNA detection.

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<![CDATA[Cell Cycle Biomarkers and Soluble Urokinase-Type Plasminogen Activator Receptor for the Prediction of Sepsis-Induced Acute Kidney Injury Requiring Renal Replacement Therapy: A Prospective, Exploratory Study]]> https://www.researchpad.co/article/N182c43ee-80b0-4ff8-ab4d-92f66f8ce3f4

Supplemental Digital Content is available in the text.

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<![CDATA[Early Prediction of Sepsis From Clinical Data: The PhysioNet/Computing in Cardiology Challenge 2019]]> https://www.researchpad.co/article/Nd8982d5a-42fc-4481-a99e-67732945cdad

Supplemental Digital Content is available in the text.

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<![CDATA[Hyperlactatemia After Intracranial Tumor Surgery Does Not Affect 6-Month Survival: A Retrospective Case Series]]> https://www.researchpad.co/article/Ndc6255ee-39d4-4334-984c-0cf4624a2d8c

Supplemental Digital Content is available in the text.

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<![CDATA[Conditional Survival With Increasing Duration of ICU Admission: An Observational Study of Three Intensive Care Databases]]> https://www.researchpad.co/article/Ne0cda67f-867c-43b9-8959-59b6d431846f

Supplemental Digital Content is available in the text.

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