2018 Vol. 15, No. 4
Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with?out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty (BA) of de-novo, femoropop?liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions (8 occlusions; 3 involving popliteal segment; lesion length: 86.3 ± 66.8 mm) in 44 patients (29 males; mean age 66.9 ± 9.7 years) were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection (type C to F) was lower in the atherectomy group (88.2% vs. 42.9%; P = 0.001). In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection (P = 0.013; OR = 0.12; 95% CI: 0.025?0.642). Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group (low rank P = 0.108 and 0.166), however secondary patency was significantly better (low rank P = 0.001). Conclusions Rotational atherec?tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.
Background Transcatheter aortic valve implantation (TAVI) has become the standard treatment for patients with severe symptomatic aortic stenosis (AS) considered at very high risk for surgical aortic valve replacement. The purpose of this sub-study was to evaluate long-term (> 4 years) health-related quality of life (QoL) in octogenarians who underwent TAVI. Methods A single center observational registry in twenty patients who underwent frame analysis assessment ≥ 4 years after TAVI. Health-related QoL was evaluated, using the Short Form-36 (SF-36), the EuroQoL-5D (EQ-5D) and the visual analogue score (EQ-VAS) questionnaires. Results The mean SF-36 subscale scores at follow-up were physical functioning 40.8 ± 26.3, role physical functioning 67.7 ± 34.9, vitality 54.6 ± 21.6, general health 52.1 ± 20.4, social functioning 63.8 ± 37.7, role emotional functioning 70.2 ± 36.0, mental health 73.2 ± 23.3 and bodily pain 80.9 ± 22.9. The mean EQ-VAS score > 4 years after TAVI was 64.7 ± 15.1. With respect to functional class, 80% of the patients were in NYHA class I/II at follow-up compared to 15% prior to TAVI. Conclusions This sub-study reports a significant improvement in functional class (NYHA) in a selected group of very elderly patients > 4 years after TAVI. Furthermore, all patients showed a satisfactory QoL despite their age and multiple comorbidities. In addition, our study reveals a lower QoL when compared with the general age matched Dutch population.
Background Available data regarding clinical profile and management of elderly patients with atrial fibrillation (AF) according to dependency, fragility and cognitive impairment are scarce. The objective of the study was to analyze the biodemographic data, clinical profile and antithrombotic treatment according to dependency, fragility and cognitive impairment in elderly AF patients. Methods Cross- sectional and multi-center study performed in consecutive AF patients ≥ 75 years treated with oral anticoagulants ≥ 3 months attended in Internal Medicine Departments in Spain. Results A total of 837 patients (83.0 ± 5.0 years; CHA2DS2-VASc: 5.0 ± 1.4; HAS-BLED: 2.1 ± 0.9) were included. 44.4% of patients had some degree of dependency, 43.3% were fragile, and 32.3% had cognitive impairment. Patients with any of these conditions were older, had a worse clinical profile, with more comorbidities and higher risks of thromboembolic and bleeding events. All these conditions were independently associated among them. Overall, 70.8% of patients were taking vitamin K antagonists, the remaining 29.2% direct oral anticoagulants and 9.7% oral antiplatelets. This distribution was independent of the presence of dependency or fragility, but there was a trend to a higher prescription of vitamin K antagonists in those patients with cognitive impairment (75.2% vs. 68.8%; P = 0.05). Conclusions Approximately 32%-44% of elderly anticoagulated AF patients attended have some degree of dependency, fragility and/or cognitive impairment. Patients with any of these conditions are older and have a worse clinical profile. Ap?proximately 71% of patients are taking vitamin K antagonists, regardless dependency or frailty, but with a trend to higher prescription in patients with cognitive impairment.
Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods From August 2014 to December 2015, 765 patients from 72 units (clusters) in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment (n = 295, 39%) were randomized to systematic medication review where the physician received support from peers (collegial mentoring) or were given care as usual (control condition). Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group (n = 43, 32%) compared to control (n = 11, 10%); Incidence Rate Ratio = 0.8, 95% CI = 0.7?0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values (mean 134 mmHg). Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four (P = 0.031) and nine (P = 0.041). Conclusion A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.
Background Fall injuries are common among the elderly. The aim of this study was to investigate whether blood-pressure patterns, as measured by 24-h ambulatory blood pressure monitoring (ABPM), or intensification of antihypertensive therapy following the 24-h ABPM, may be associated with fall injuries in hypertensive elderly patients. Methods In a retrospective study, community-based elderly patients (age ≥ 70 years) who were referred to 24-h ABPM were evaluated for fall injuries within one-year post-ABPM. We compared the clinical characteristics, 24-h ABPM patterns and the intensification of hypertensive therapy following 24-h ABPM, between patients with and without a fall injury. Results Overall 1032 hypertensive elderly patients were evaluated. Fifty-five (5.3%) had a fall injury episode in the year following ABPM. Patients with a fall injury were significantly older, and with higher rates of previous falls. Lower 24-h diastolic blood-pressure (67.3 ± 7.6 vs. 70.7 ± 8.8 mmHg; P vs. 68.3 ± 13.7 mmHg; P Conclusions Low diastolic blood-pressure and increased pulse-pressure in 24-h ABPM were associated with an increased risk of fall injury in elderly hypertensive patients. Intensification of antihypertensive treatment following 24-h ABPM was not associated with an increased risk of fall injury.
Background Although thyroid hormone (TH) has important effects on lipid metabolism, the relationship between TH and statin responsiveness has never been investigated. We hypothesize that TH plays an important role in statin responsiveness in patients with acute myocardial infarction (AMI). Methods Consecutive 1091 hospitalized AMI patients in Fuwai hospital (Beijing, China) were enrolled into this current study. The study population was divided into three groups based on the intensity of statin treatment: low-intensity (n = 221), moderate-intensity (n = 712) and high-intensity (n = 158). Lipid levels were measured after statin therapy lasting for 10-14 days. The association between TH, lipid profile levels and achievement of low-density lipoprotein cholesterol (LDL-C) lowering goals was explored in patients with AMI on statin therapy. Results By general linear analysis, a significant linear trend between free triiodothyronine (FT3) and LDL-C level (linear coefficient r = -0.082, P = 0.001) and FT3 and total cholesterol (TC) level (r = -0.105, P = 0.031) was observed in the moderate-intensity statin group. A more apparent linear trend was detected in the high-intensity statin group (for LDL-C: r = -0.113, P = 0.005; for TC: r = -0.172, P = 0.029, respectively). However, no significant correlation was observed in the low-intensity statin group. Compared with the low-FT3 group (defined as FT3 2.95 pg/mL). The OR (95% CI) for attaining the more intensive goal (LDL-C Conclusions Our study reveals that variation in FT3 levels is related to the cholesterol-lowering responsiveness of statins in AMI patients. These findings suggest that low FT3 may be a factor responsible for lack of LDL-C goal attainment and patients’ poor responsiveness to statin treatment.
Background Heart failure is a significant problem leading to repeated hospitalizations. Telemonitoring and hemodynamic monitoring have demonstrated success in reducing hospitalization rates, but not all studies reported significant effects. The aim of this systematic review and meta-analysis is to examine the effectiveness of telemonitoring and wireless hemodynamic monitoring devices in reducing hospitalizations in heart failure. Methods & Results PubMed and Cochrane Library were searched up to 1st May 2017 for articles that investigated the effects of telemonitoring or hemodynamic monitoring on hospitalization rates in heart failure. In 31,501 patients (mean age: 68 ± 12 years; 61% male; follow-up 11 ± 8 months), telemonitoring reduced hospitalization rates with a HR of 0.73 (95% CI: 0.65-0.83; P I2 = 94%). These effects were observed in the short-term (≤ 6 months: HR = 0.77, 95% CI: 0.65-0.89; P P P I2 = 64%).This reduction was observed both in the short-term (HR = 0.55, 95% CI: 0.45-0.68; P I2 = 72%) and long-term (HR = 0.64, 95% CI: 0.57-0.72; P I2 = 55%). Conclusions Telemonitoring and hemodynamic monitoring reduce hospitalization in both short- and long-term in heart failure patients
Background Cardiac implantable electronic devices (CIEDs) greatly improve survival and life quality of patients. However, there are gender differences regarding both the utilization and benefit of these devices. In this prospective CIED registry, we aim to appraise the gender differences in CIED utilization in China. Methods Twenty centers from 14 provinces in China were included in our registry study. All patients who underwent a CIED implantation in these twenty centers between Jan 2015 and Dec 2016 were included. Results A total of 8570 patients were enrolled in the baseline cohort, including 7203 pacemaker, 664 implantable cardiac defibrillators (ICD) implants and 703 cardiac resynchronization therapy device (CRT/D). Totally, 4117 (48.0%) CIED patients were female, and more than 59% pacemaker patients were female, but women account only one third of ICD or CRT/D implantation in this registry. There were significant differences between genders at pacemaker and ICD indications. Female was more likely received a pacemaker due to sick sinus syndrome (SSS) (63.9% vs. 51.0%, P vs. 4.2%, P P vs. 41.9%, P = 0.001). In pacemaker patient, male was more likely to have structure heart disease (31.3% vs. 28.0%, P = 0.002). In ICD patient, male patients were more likely to have ischemic heart disease (48.2% vs. 29.2%, P P = 0.014). Nonischemic cardiomyopathy (70.9%) was the most common etiology in the patients who underwent the treat?ment of CRT/D, no matter male or female. Conclusions In real-world setting, female do have different epidemiology, pathophysiology and clinical presentation of many cardiac rhythm disorders when compared with male, and all these factors may affect the utilization of CIED implantation. But it also possibility that cultural and socioeconomic features may play a role in this apparent discrimination.
Objective To investigate the impact of meteorological conditions and PM2.5 on the onset of acute aortic dissection in monsoonal climate. Methods A linear regression analysis was performed in monsoonal climate epidemiological survey for a period of four years on the impact of meteorological factors (minimal temperature, mean temperature, maximal temperature, average daily surface temperature, day temperature range, relative humidity, mean wind speed, and atmospheric pressure) and PM2.5 concentration on the daily incidences of acute aortic dissections. Meteorological variables and PM2.5 concentration were retrieved on a daily basis from Beijing Regional Climate Center and the Ministry of Environmental Protection of the People’s Republic of China’s website, and the daily incidences of acute aortic dissections were retrieved from the Clinical Data Analysis and Reporting System in the Emergency and Critical Care Center of Beijing Anzhen Hospital. Results During the study period (from January 2011 to December 2014), 1164 patients were identified as having acute aortic dissections. The corresponding incidences in spring and autumn were 0.96 and 1.00, respectively, which significantly higher than that in summer and winter. The incidences of acute aortic dissection in a day could be predicted by diurnal temperature range (DTR) using the following linear multiple regression models: incidences of acute aortic dissection = 0.543 + 0.025 × DTR. Conclusion This is the first study to show an attributable effect of DTR on acute aortic events in monsoonal climate. Our study confirms that meteorological variables were important factors influencing the incidence of acute aortic dissection.