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ABSTRACT: OBJECTIVE: To describe the natural history of combined stenotic and regurgitant aortic valve disease. BACKGROUND: Data on outcome and prognostic factors in combined aortic valve disease are scarce. METHODS: 71 consecutive asymptomatic patients (21 female, age 52±17 yrs) with at least moderate aortic stenosis in combination with at least moderate aortic regurgitation and preserved left ventricular function (EF ≥ 55%) were prospectively followed. RESULTS: During a median potential follow-up of 8.9 years, 50 patients developed an indication for aortic valve replacement and no cardiac deaths were observed. Overall event-rates were high with an event-free survival for the entire patient-population of 82±5%, 62±6%, 49±6%, 33±6% and 19±5% at 1, 2, 3, 4 and 6 years, respectively. There was one operative and no postoperative death. Peak aortic-jet velocity (AV-Vel) independently predicted event-free survival. Patients with an AV-Vel between 3 and 3.9 m/s had an event-free survival of 94±4%, 88±6%, 65±9% and 51±9% after 1, 2, 4 and 6 years, respectively, compared with 92±4%, 67±7%, 38±8% and 12±6% for patients with an AV-Vel between 4 and 4.9 m/s and 67±8%, 39±10%, 17±9% and 0% for patients with an AV-Vel ≥ 5 m/s (p<0.0001). CONCLUSION: Asymptomatic patients with combined aortic valve disease can be safely followed until surgical criteria defined for aortic stenosis, aortic regurgitation or the aorta are reached. However, high event rates can be expected even in younger patients and those with only moderate disease. AV-Vel which reflects both stenosis and regurgitant severity provides an objective and easily assessable predictive parameter.
Journal of the American College of Cardiology 03/2013; · 14.16 Impact Factor
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ABSTRACT: Randomized controlled trials have resulted in improved outcomes in pulmonary arterial hypertension; however, they are biased by stringent inclusion criteria, pre-specified patient sub-sets, and study durations. In addition, common practice is to start oral therapies ahead of the more potent and titratable prostanoid therapies, despite advanced disease states at diagnosis. The objectives of our prospective registry were to evaluate long-term effects on functional class, 6-minute walking distance, hemodynamics, and survival, and also long-term tolerability of first-line sub-cutaneous treprostinil, a prostacyclin analog, in patients with severe pulmonary hypertension.
Data were collected from patients with functional class III/IV pre-capillary pulmonary hypertension (Dana Point groups 1 and 4; mean right arterial pressure ≥ 10 mmHg, and/or cardiac index ≤ 2.2 liters/min/m(2)). Treprostinil dose adjustments were driven by clinical symptoms and side effects.
The study included 111 patients (1999 to 2010). Of these, 13 (12%) stopped treatment prematurely because of drug side effects, 11 (9.9%) underwent double lung transplantation, and 49 (44.1%) died of any cause (41 on treatment, 8 after early drug discontinuation). Overall survival rates at 1, 5, and 9 years were 84%, 53%, and 33%. In patients who were able to tolerate treatment > 6 months, survival rates were 57% at 9 years.
First-line treatment of severe pre-capillary pulmonary hypertension with sub-cutaneous treprostinil is safe and efficacious over many years. If up-titration beyond 6 months is tolerated, effective doses are reached and outcomes are good.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 04/2012; 31(7):735-43. · 3.54 Impact Factor
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Michael Wittinger,
Petr Vanhara,
Ahmed El-Gazzar,
Bettina Savarese-Brenner,
Dietmar Pils,
Mariam Anees,
Thomas W Grunt,
Maria Sibilia,
Martin Holcmann,
Reinhard Horvat, Michael Schemper,
Robert Zeillinger,
Christian Schöfer,
Helmut Dolznig,
Peter Horak,
Michael Krainer
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ABSTRACT: Although prognostic and predictive factors in ovarian cancer have been extensively studied for decades, only few have been identified and introduced to clinical practice. Here, we evaluate hVps37A (HCRP1) as a possible novel predictive marker for ovarian cancer. hVps37A was originally described as a member of the membrane-trafficking ESCRT-I complex mediating the internalization and degradation of ubiquitinated membrane receptors.
We analyzed an ovarian cancer tissue microarray for HCRP1, EGFR, and HER2 expression. We used a tetracycline inducible ovarian cancer cell culture model to show the effects of hVps37A knockdown in vitro and in vivo. In addition, we studied the effects of epidermal growth factor receptor (EGFR) inhibitors cetuximab and lapatinib on ovarian cancer cells under conditions of hVps37A knockdown.
We find that hVps37A is significantly downregulated in ovarian cancer and modifies the prognostic value of EGFR and HER2 expression. In addition, hVps37A downregulation in ovarian cancer cells leads to cytoplasmic pEGFR retention and hyperactivation of downstream pathways and is associated with enhanced xenograft growth in nude mice and invasion of the collagen matrix. Furthermore, due to subsequent sustained Akt- and MAPK-pathway activation, hVps37A-deficient cells become irresponsive to inhibition by the therapeutic antibody cetuximab.
We propose that hVps37A status could become a novel prognostic and therapeutic marker for EGFR or HER2 driven tumors.
Clinical Cancer Research 12/2011; 17(24):7816-27. · 7.74 Impact Factor
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ABSTRACT: We extend the Tarone and Ware scheme of weighted log-rank tests to cover the associated weighted Mantel-Haenszel estimators of relative risk. Weighting functions previously employed are critically reviewed. The notion of an average hazard ratio is defined and its connection to the effect size measure P(Y > X) is emphasized. The connection makes estimation of P(Y > X) possible also under censoring. Two members of the extended Tarone-Ware scheme accomplish the estimation of intuitively interpretable average hazard ratios, also under censoring and time-varying relative risk which is achieved by an inverse probability of censoring weighting. The empirical properties of the members of the extended Tarone-Ware scheme are demonstrated by a Monte Carlo study. The differential role of the weighting functions considered is illustrated by a comparative analysis of four real data sets.
Statistical Methods in Medical Research 12/2011; · 2.44 Impact Factor
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ABSTRACT: This prospective study was intended to evaluate the overall deviation in a clinical treatment setting to provide for quantification of the potential impairment of treatment safety and reliability with computer-assisted, template-guided transgingival implantation.
The patient population enrolled (male/female=10/8) presented with partially dentate and edentulous maxillae and mandibles. Overall, 86 implants were placed by two experienced dental surgeons strictly following the NobelGuide™ protocol for template-guided implantation. All patients had a postoperative computed tomography (CT) with identical settings to the preoperative examination. Using the triple scan technique, pre- and postoperative CT data were merged in the Procera planning software, a newly developed procedure - initially presented in 2007 allowing measurement of the deviations at implant shoulder and apex.
The deviations measured were an average of 0.43 mm (bucco-lingual), 0.46 mm (mesio-distal) and 0.53 mm (depth) at the level of the implant shoulder and slightly higher at the implant apex with an average of 0.7 mm (bucco-lingual), 0.63 mm (mesio-distal) and 0.52 mm (depth). The maximum deviation of 2.02 mm was encountered in the corono-apical direction. Significantly lower deviations were seen for implants in the anterior region vs. the posterior tooth region (P<0.01, 0.31 vs. 0.5 mm), and deviations were also significantly lower in the mandible than in the maxilla (P=0.04, 0.36 vs. 0.45 mm) in the mesio-distal direction. Moreover, a significant correlation between deviation and mucosal thickness was seen and a learning effect was found over the time period of performance of the surgical procedures.
Template-guided implantation will ensure reliable transfer of preoperative computer-assisted planning into surgical practice. With regard to the required verification of treatment reliability of an implantation system with flapless access, all maximum deviations measured in this clinical study were within the safety margins recommended by the planning software.
Clinical Oral Implants Research 01/2011; 22(10):1157-63. · 2.51 Impact Factor
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ABSTRACT: Univariate Cox regression (COX) is often used to select genes possibly linked to survival. With non-proportional hazards (NPH), COX could lead to under- or over-estimation of effects. The effect size measure c=P(T(1)<T(0)), i.e. the probability that a person randomly chosen from group G(1) dies earlier than a person from G(0), is independent of the proportional hazards (PH) assumption. Here we consider its generalization to continuous data c' and investigate the suitability of c' for gene selection.
Under PH, c' is most efficiently estimated by COX. Under NPH, c' can be obtained by weighted Cox regression (WHE) or a novel method, concordance regression (CON). The least biased and most stable estimates were obtained by CON. We propose to use c' as summary measure of effect size to rank genes irrespective of different types of NPH and censoring patterns.
WHE and CON are available as R packages.
georg.heinze@meduniwien.ac.at
Supplementary Data are available at Bioinformatics online.
Bioinformatics 03/2010; 26(6):784-90. · 5.47 Impact Factor
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ABSTRACT: We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.
We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67 + or - 16 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). During a median follow-up of 41 months (interquartile range, 26 to 63 months), 96 events occurred (indication for aortic valve replacement, 90; cardiac deaths, 6). Event-free survival was 64%, 36%, 25%, 12%, and 3% at 1, 2, 3, 4, and 6 years, respectively. AV-Vel but not aortic valve area was shown to independently affect event-free survival. Patients with an AV-Vel > or = 5.5 m/s had an event-free survival of 44%, 25%, 11%, and 4% at 1, 2, 3, and 4 years, respectively, compared with 76%, 43%, 33%, and 17% for patients with an AV-Vel between 5.0 and 5.5 m/s (P<0.0001). Six cardiac deaths occurred in previously asymptomatic patients (sudden death, 1; congestive heart failure, 4; myocardial infarction, 1). Patients with an initial AV-Vel > or = 5.5 m/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class >II) than those with an AV-Vel between 5.0 and 5.5 m/s (27%; P=0.03).
Despite being asymptomatic, patients with very severe aortic stenosis have a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early elective valve replacement surgery should therefore be considered in these patients.
Circulation 12/2009; 121(1):151-6. · 14.74 Impact Factor
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ABSTRACT: Often the effect of at least one of the prognostic factors in a Cox regression model changes over time, which violates the proportional hazards assumption of this model. As a consequence, the average hazard ratio for such a prognostic factor is under- or overestimated. While there are several methods to appropriately cope with non-proportional hazards, in particular by including parameters for time-dependent effects, weighted estimation in Cox regression is a parsimonious alternative without additional parameters. The methodology, which extends the weighted k-sample logrank tests of the Tarone-Ware scheme to models with multiple, binary and continuous covariates, has been introduced in the nineties of the last century and is further developed and re-evaluated in this contribution. The notion of an average hazard ratio is defined and its connection to the effect size measure P(X<Y) is emphasized. The suggested approach accomplishes estimation of intuitively interpretable average hazard ratios and provides tools for inference. A Monte Carlo study confirms the satisfactory performance. Advantages of the approach are exemplified by comparing standard and weighted analyses of an international lung cancer study. SAS and R programs facilitate application.
Statistics in Medicine 06/2009; 28(19):2473-89. · 1.88 Impact Factor
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ABSTRACT: Despite the complex health burden for women with breast hypertrophy, medical directors of health insurance companies are not convinced that this procedure is of medical benefit for patients. Therefore, coverage of cost by the health insurance companies is no longer guaranteed. The purpose of this study is to evaluate the influence of breast weight on the physical and psychological morbidity of women and to prove the medical necessity of reduction mammaplasty.
We performed a cohort study of 50 women with various breast sizes, a mean age of 28 years (range 20-40 years), and a body mass index (BMI) <25. Breast weight was measured, the spine was investigated by magnetic resonance imaging (MRI), and a spine score of clinical symptoms was assessed. The Beck Depression Inventory (BDI) was used to evaluate psychological impairment. Pathological findings have been correlated with breast weight, and the risk of developing a morphological or psychological disorder independence of the breast weight was calculated.
The incidence of degenerative spine disorders and the extent of depressive symptoms are correlated with increasing breast weight.
The data show that high breast weight has a negative influence on the physical and psychological morbidity of women. This objective evidence in support of the medical necessity of reduction mammaplasty should guide managed care organizations' methods for determining coverage for reduction mammaplasty.
Journal of Women s Health 10/2007; 16(7):1062-9. · 1.57 Impact Factor
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ABSTRACT: Cox's proportional hazards model can be extended to accommodate time-dependent effects of prognostic factors. We briefly review these extensions along with their varying degrees of freedom. Spending more degrees of freedom with conventional procedures (a priori defined interactions with simple functions of time, restricted natural splines, piecewise estimation for partitions of the time axis) allows the fitting of almost any shape of time dependence but at an increased risk of over-fit. This results in increased width of confidence intervals of time-dependent hazard ratios and in reduced power to confirm any time-dependent effect or even any effect of a prognostic factor. By means of comparative empirical studies the consequences of over-fitting time-dependent effects have been explored. We conclude that fractional polynomials, and similarly penalized likelihood approaches, today are the methods of choice, avoiding over-fit by parsimonious use of degrees of freedom but also permitting flexible modelling if time dependence of a usually a priori unknown shape is present in a data set. The paradigm of a parsimonious analysis of time-dependent effects is exemplified by means of a gastric cancer study.
Statistics in Medicine 07/2007; 26(13):2686-98. · 1.88 Impact Factor
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ABSTRACT: High-density lipoprotein (HDL) protects against arterial atherothrombosis, but it is unknown whether it protects against recurrent venous thromboembolism.
We studied 772 patients after a first spontaneous venous thromboembolism (average follow-up 48 months) and recorded the end point of symptomatic recurrent venous thromboembolism, which developed in 100 of the 772 patients. The relationship between plasma lipoprotein parameters and recurrence was evaluated. Plasma apolipoproteins AI and B were measured by immunoassays for all subjects. Compared with those without recurrence, patients with recurrence had lower mean (+/-SD) levels of apolipoprotein AI (1.12+/-0.22 versus 1.23+/-0.27 mg/mL, P<0.001) but similar apolipoprotein B levels. The relative risk of recurrence was 0.87 (95% CI, 0.80 to 0.94) for each increase of 0.1 mg/mL in plasma apolipoprotein AI. Compared with patients with apolipoprotein AI levels in the lowest tertile (<1.07 mg/mL), the relative risk of recurrence was 0.46 (95% CI, 0.27 to 0.77) for the highest-tertile patients (apolipoprotein AI >1.30 mg/mL) and 0.78 (95% CI, 0.50 to 1.22) for midtertile patients (apolipoprotein AI of 1.07 to 1.30 mg/mL). Using nuclear magnetic resonance, we determined the levels of 10 major lipoprotein subclasses and HDL cholesterol for 71 patients with recurrence and 142 matched patients without recurrence. We found a strong trend for association between recurrence and low levels of HDL particles and HDL cholesterol.
Patients with high levels of apolipoprotein AI and HDL have a decreased risk of recurrent venous thromboembolism.
Circulation 04/2007; 115(12):1609-14. · 14.74 Impact Factor
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ABSTRACT: It is widely accepted that gene expression classifiers need to be externally validated by showing that they predict the outcome well enough on other patients than those from whose data the classifier was derived. Unfortunately, the gain in predictive accuracy by the classifier as compared to established clinical prognostic factors often is not quantified. Our objective is to illustrate the application of appropriate statistical measures for this purpose. In order to compare the predictive accuracies of a model based on the clinical factors only and of a model based on the clinical factors plus the gene classifier, we compute the decrease in predictive inaccuracy and the proportion of explained variation. These measures have been obtained for three studies of published gene classifiers: for survival of lymphoma patients, for survival of breast cancer patients and for the diagnosis of lymph node metastases in head and neck cancer. For the three studies our results indicate varying and possibly small added explained variation and predictive accuracy due to gene classifiers. Therefore, the gain of future gene classifiers should routinely be demonstrated by appropriate statistical measures, such as the ones we recommend.
European Journal of Cancer 04/2007; 43(4):745-51. · 5.54 Impact Factor
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ABSTRACT: The management of asymptomatic severe mitral regurgitation remains controversial. The aim of this study was to evaluate the outcome of a watchful waiting strategy in which patients are referred to surgery when symptoms occur or when asymptomatic patients develop left ventricular (LV) enlargement, LV dysfunction, pulmonary hypertension, or recurrent atrial fibrillation.
A total of 132 consecutive asymptomatic patients (age 55+/-15 years, 49 female) with severe degenerative mitral regurgitation (flail leaflet or valve prolapse) were prospectively followed up for 62+/-26 months. Patients underwent serial clinical and echocardiographic examinations and were referred for surgery when the criteria mentioned above were fulfilled. Overall survival was not statistically different from expected survival either in the total group or in the subgroup of patients with flail leaflet. Eight deaths were observed. Thirty-eight patients developed criteria for surgery (symptoms, 24; LV criteria, 9; pulmonary hypertension or atrial fibrillation, 5). Survival free of any indication for surgery was 92+/-2% at 2 years, 78+/-4% at 4 years, 65+/-5% at 6 years, and 55+/-6% at 8 years. Patients with flail leaflet tended to develop criteria for surgery slightly but not significantly earlier. There was no operative mortality. Postoperative outcome was good with regard to survival, symptomatic status, and postoperative LV function.
Asymptomatic patients with severe degenerative mitral regurgitation can be safely followed up until either symptoms occur or currently recommended cutoff values for LV size, LV function, or pulmonary hypertension are reached. This management strategy is associated with good perioperative and postoperative outcome but requires careful follow-up.
Circulation 06/2006; 113(18):2238-44. · 14.74 Impact Factor
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Statistics in Medicine 03/2006; 25(4):719. · 1.88 Impact Factor
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ABSTRACT: The preservation of the sensitivity of the nipple-areola complex after reduction mammaplasty is an important goal. The authors performed this prospective study to accurately assess whether sensitivity changes are influenced by the weight of resection or the surgical technique. Eighty patients who underwent bilateral breast reduction (Lassus, 10 patients; Lejour, 13 patients; McKissock, 18 patients; Wuringer, 20 patients; and Georgiade, 19 patients) were tested for sensitivity changes of the nipple and cardinal points of the areola with Semmes-Weinstein monofilaments before surgery, at 3 weeks, and at 3, 6, and 12 months after surgery. Patient characteristics (age, body mass index, and preoperative sensitivity) were statistically similar in all groups. The mean resection weight was significantly smaller in the Lassus (540 g) and the Lejour groups (390 g) than in the Georgiade group (935 g). The sensitivity of the nipple and the inferior and lateral part of the areola was significantly lower after a superior pedicle technique (Lassus and Lejour) than after any other technique at 3 weeks and at 3, 6, and 12 months postoperatively. Insensate nipples and areolas were found only after breast reductions with the Lassus and the Lejour techniques (47.8 percent). Nipple sensitivity after breast reduction by the other techniques was unchanged (Wuringer, McKissock, and Georgiade) or sometimes even improved (Georgiade) as early as 3 weeks postoperatively. Changes in nipple and areola sensitivity after reduction mammaplasty depend on the surgical technique rather than the weight of resection. Superior glandular pedicle techniques that require tissue resections at the base of the breast are associated with a higher risk of injury to the nerve branches innervating the nipple-areola complex.
Plastic and reconstructive surgery 04/2005; 115(3):743-51; discussion 752-4. · 2.74 Impact Factor
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Diana Bonderman,
Johannes Jakowitsch,
Christopher Adlbrecht, Michael Schemper,
Paul A Kyrle,
Verena Schönauer,
Markus Exner,
Walter Klepetko,
Meinhard P Kneussl,
Gerald Maurer,
Irene Lang
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ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by organized thromboemboli that obstruct the pulmonary vascular bed. Although CTEPH is a serious complication of acute symptomatic pulmonary embolism in 4% of cases, signs, symptoms and classical risk factors for venous thromboembolism are lacking. The aim of the present study was to identify medical conditions conferring an increased risk of CTEPH. We performed a case-control-study comparing 109 consecutive CTEPH patients to 187 patients with acute pulmonary embolism that was confirmed by a high probability lung scan. Splenectomy (odds ratio=13, 95% CI 2.7-127), ventriculo-atrial (VA-) shunt for the treatment of hydrocephalus (odds ratio=13, 95% CI 2.5-129) and chronic inflammatory disorders, such as osteomyelitis and inflammatory bowel disease (IBD, odds ratio=67, 95% CI 7.9-8832) were associated with an increased risk of CTEPH.
Thrombosis and Haemostasis 04/2005; 93(3):512-6. · 5.04 Impact Factor
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ABSTRACT: Recently, statins and angiotensin-converting enzyme inhibitors (ACEIs) have been shown to slow aortic valve calcium accumulation. Although several studies also suggest that statins may reduce the hemodynamic progression of aortic stenosis (AS), no data are available for ACEIs or the combination of both.
A total of 211 consecutive patients (aged 70+/-10 years, 104 females) with native AS, defined by a peak velocity >2.5 m/s (valve area 0.84+/-0.23 cm(2), mean gradient 42+/-19 mm Hg), with normal left ventricular function and no other significant valvular lesion who were examined between 2000 and 2002 and who had 2 echocardiograms separated by at least 6 months were included. Of these, 102 patients were treated with ACEIs, 50 patients received statins, and 32 patients received both. Hemodynamic progression of AS was assessed and related to medical treatment. Annualized increase in peak aortic jet velocity for the entire study group was 0.32+/-0.44 m x s(-1) x y(-1). Progression was significantly lower in patients treated with statins (0.10+/-0.41 m x s(-1) x y(-1)) than in those who were not (0.39+/-0.42 m x s(-1) x y(-1); P<0.0001). This effect was observed both in mild-to-moderate and severe AS. ACEI use, however, did not significantly affect hemodynamic progression (P=0.29). Furthermore, ACEIs had no additional effect on AS progression when given in combination with statins (0.11+/-0.42 versus 0.08+/-0.43 m x s(-1) x y(-1) for combination versus statin only; P=0.81). Cholesterol levels did not correlate with hemodynamic progression either in the group receiving statins or in the group that did not.
ACEIs do not appear to slow AS progression. However, statins significantly reduce the hemodynamic progression of both mild-to-moderate and severe AS, an effect that may not be related to cholesterol lowering.
Circulation 10/2004; 110(10):1291-5. · 14.74 Impact Factor
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ABSTRACT: To compare two methods of measuring intraocular pressure (IOP) and to evaluate whether repeated measurements taken with the Ocuton S applanation self-tonometer can improve reliability.
Ocuton S and Goldmann applanation tonometry (GAT), and corneal thickness measurements taken with the Orbscan topography system, were successfully performed in 64 of 68 glaucoma patients.
The median IOPs were 15.5 mmHg using GAT, and 16 mmHg using the first self-taken Ocuton S measurement (n = 64). The differences between the median of the GAT measurements and the first Ocuton S measurement, and the medians of the three and six separate Ocuton S measurements were within 3 mmHg in 52%, 59% and 67% of cases, respectively. The mean corneal thickness of all evaluated eyes was 545.3 microm. There was no effect of corneal thickness on the accuracy of either of the two devices (p > 0.05).
Repeated measurements can improve the reliability of the Ocuton S. However, even with repeated measurements only every second patient succeeds in obtaining reliable measurements.
Acta Ophthalmologica Scandinavica 09/2004; 82(4):405-9. · 1.85 Impact Factor
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ABSTRACT: To define the natural history and predictors of outcome in mild and moderate aortic stenosis (AS).
One hundred and seventy-six consecutive asymptomatic patients (73 women, age 58+/-19 years) with mild to moderate AS (jet velocity 2.5 to 3.9m/s) were followed for 48+/-19 months. Haemodynamic progression and clinical outcome was analysed. Event-free survival with end-points defined as death (n=34) or aortic valve surgery (n=33), was 95+/-2%, 75+/-3% and 60+/-5% at 1, 3 and 5 years, respectively. Both, cardiac and non-cardiac mortality were significantly increased, resulting in a 1.8 times higher mortality than expected (P<0.005). By multivariate analysis, moderate to severe aortic valve calcification, coronary artery disease (CAD) and peak jet velocity were independent predictors of outcome. Event-free survival for patients with moderate or severe valve calcification was 92+/-4%, 61+/-7% and 42+/-7% at 1, 3 and 5 years versus 100%, 90+/-4% and 82+/-5% for patients with no or mild calcification. Patients with calcified aortic valves, CAD or with an event had a significantly faster haemodynamic progression. Of 129 patients with a follow-up echocardiographic exam, 59 (46%) developed severe stenosis during follow-up.
Outcome of mild and moderate AS is worse than commonly assumed. Rapid progression and excess mortality have to be considered. Significant valve calcification, CAD and rapid progression of aortic jet velocity indicate poor outcome. Patients with these characteristics may require closer follow-up than generally assumed.
European Heart Journal 02/2004; 25(3):199-205. · 10.48 Impact Factor
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ABSTRACT: Parametric models are only occasionally used in the analysis of clinical studies of survival although they may offer advantages over Cox's model. In this paper, we report experiences that we have made fitting parametric models to data sets from different clinical trials mainly performed at the Vienna University Medical School. We emphasize the role of residuals for discriminating among candidate models and judging their goodness of fit. The effect of misspecification of the baseline distribution on parameter estimates and testing has been explored. The results from parametric analyses have always been contrasted with those from Cox's model.
Statistics in Medicine 01/2004; 22(23):3597-610. · 1.88 Impact Factor
