January 2024
·
2,136 Reads
·
12 Citations
The Lancet Child & Adolescent Health
This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.
January 2024
·
2,136 Reads
·
12 Citations
The Lancet Child & Adolescent Health
December 2023
·
1,388 Reads
·
2 Citations
Cardiology Research
Mitral annular disjunction is a cardiac structural abnormality characterized by the distinct separation between the top of the left ventricular myocardium and the mitral annulus supporting the posterior mitral leaflet occurring during systole. It has recently gained wide attention due to the increasing recognition of the link between mitral annular disjunction and arrhythmogenic mitral valve prolapse, particularly, with the increased risks of ventricular arrhythmias resulting in sudden cardiac death. This review has summarized the recent progress in the diagnostic modalities, clinical implications of mitral annular disjunction, and its specific surgical considerations.
December 2022
·
296 Reads
·
1 Citation
September 2022
·
319 Reads
·
46 Citations
BMC Medicine
Background Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.
May 2022
·
44 Reads
·
5 Citations
Aims The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process. Methods and results Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60–25.9], (Sb) (aHR 1.21, 95% CI: 1.08–1.35), and (Su) (aHR 1.27, 95% CI: 1.14–1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45–2.06) and (Sy) (aHR 1.29, 95% CI: 1.00–1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55–0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16–1.56). Conclusion Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.
May 2022
·
128 Reads
·
2 Citations
April 2022
·
34 Reads
·
2 Citations
Cardiology Research
Background: Existing data regarding isolated tricuspid valve replacement for primary tricuspid valve disease such as infective endocarditis (IE) are limited. The aim of this study was to review our experience of isolated tricuspid valve replacement for IE. Methods: A retrospective review was performed to evaluate the perioperative and long-term outcomes of patients undergoing isolated tricuspid valve replacement for IE at our tertiary referral center between January 2000 and December 2014. Surgical outcomes were reviewed to include survival and postoperative complications. Results: Seven patients underwent isolated tricuspid valve replacement for IE during the study period. Mean age was 41 ± 14 years with six (86%) males. Six patients (86%) were intravenous drug users. Five patients (71%) presented with septic emboli to the lungs. Five patients (71%) had active endocarditis at the time of surgery. The indications for surgery were heart failure in three patients (43%), persistent sepsis in three patients (43%) and both in one patient (14%). Methicillin-sensitive Staphylococcus aureus was the most common infective organism, isolated in five patients (71%). There were no in-hospital mortalities or permanent pacemaker implantations. Follow-up was completed in 86% of the cases. The median follow-up period was 13 months (range 2 to 129 months). Three patients (43%) died during the follow-up period, at 7 months, 8 months and 13 months, respectively. All deaths were associated with prosthetic valve IE and recurrent intravenous drug use. Conclusions: This study supplements the paucity of data pertaining to tricuspid valve replacement for IE in the local population. Survival outcomes can be improved with prompt surgical intervention, optimal medical optimization, and a holistic, psychosocial approach targeting intravenous drug abuse.
March 2022
·
86 Reads
January 2022
·
261 Reads
·
2 Citations
December 2021
·
9 Reads
·
1 Citation
Pathology International
... An intention-to-treat analysis of data from the RECOV-ERY trial, a multicenter RCT in the UK, in which 214 patients with MIS-C were randomized to initial treatment with supportive care, IVIg alone (2 g/kg), or methylprednisolone (10 mg/kg/day for 3 days), demonstrated shorter length-of-stay with corticosteroids compared to supportive care, and no benefit of IVIg on this outcome [92], demonstrating the benefit of corticosteroid monotherapy as initial treatment for MIS-C. Neither corticosteroids nor IVIg reduced the need for critical care, vasopressors, advanced respiratory support, development of CALs, and development of LV systolic dysfunction. ...
January 2024
The Lancet Child & Adolescent Health
... The fact that only 9% of unknown-cause patients in our study showed replacement fibrosis is probably due to a compound of these and maybe still unknown pathophysiological mechanisms that result in arrhythmias even before being measurable. Then, if the currently more prevalent idea of a sequence consisting of a hypermobile mitral valve apparatus causing persistent myocardial stretch, which itself leads to myocardial fibrosis, proves right or at least partially truthful, future considerations regarding treatment could involve interventional or surgical remedying of the primarily underlying hypermobility before the development of clinically relevant fibrosis [35]. ...
December 2023
Cardiology Research
... 10 Various studies have shown that appropriate characterisations of AF patients according to the 4S-AF scheme followed by corresponding managements were associated with improved clinical outcomes (Fig. 2). [19][20][21][22] Patients with all 4S-AF domains treated were associated with a 29% lower risk of mortality in EORP-AF registry, and a 62% lower risk of composite outcome of ischaemic stroke/systemic embolic events (SEEs), heart failure, acute coronary syndrome, significant coronary artery disease requiring coronary intervention and mortality in APHRS registry. 19,20 For Sb domain, the AF burden should ideally be assessed via ...
Reference:
Atrial fibrillation: stroke prevention
May 2022
... We included patients with AF from two large, prospective observational registries from Europe and Asia. Details on the studies' design, baseline characteristics and primary results have been previously published [11,12]. Briefly, both registries enrolled consecutive adult patients (> 18 years old) with an ECG-documented episode of AF in the 12 months before inclusion. ...
July 2019
... Polypharmacy has been linked to detrimental effects on the prognosis of patients with AF, including all-cause mortality, thromboembolism and major bleeding [4,5]. Indeed, concomitant pharmacological treatment contributes to increased complexity of management of patients with AF [6]. ...
September 2022
BMC Medicine
... Current guidelines suggest that switching warfarin to a NOAC and maintaining an adequate TTR cannot be sustained [2][3][4][5]. Therefore, the quality of anticoagulation control (AC) prediction model with TTR is needed, and the SAMe-TT 2 R 2 scoring system (Sex, female; Age, < 60 yr; Medical history, more than two comorbidities; Treatment, interacting drug, e.g., Amiodarone; Tobacco use (doubled); and Race (doubled) is available for this purpose [6][7][8][9][10][11][12][13][14][15][16][17]. The patients with SAMe-TT 2 R 2 score more than 1 point are less likely to achieve a good TTR and alternative strategies may be required [8]. ...
April 2015
... The APHRS AF registry also examined the clinical utility and prognostic implications of the 4S-AF scheme [7]. As expected, increasing adverse features by the 4S-AF scheme is associated with worse outcomes, consistent with prior analyses from Europe [8,9] and China [10]. Nonetheless, if the 4S-AF domains are appropriately treated, for example, for stroke risk, anticoagulation therapy reduces the composite clinical outcome, as does appropriate rate or rhythm control and risk factor management [7]. ...
May 2022
... The study enrolled consecutive AF inpatients and outpatients in 250 cardiology practices, across 27 countries. Details on study design, baseline characteristics, outcomes adjudication and follow-up are reported elsewhere [18,19]. ...
July 2019
... The studied patients had paroxysmal or persistent AF with high CHA 2 DS 2 -VASc scores and multiple cardiovascular and non-cardiovascular comorbidities. They were considered high-risk phenotypes of AF according to the cluster analysis of the clinical characteristics of patients with AF. 32,33 Vigneshwar et al. 34 analysed 789 patients on VA-ECMO and reported that pre-ECMO sinus rhythm was associated with a survival benefit. Wang et al. 35 conducted a small retrospective study of 87 patients on PC-ECMO and reported that the frequency of AF was 13% and 38% (P < 0.001) in survivors and non-survivors, respectively; however, it was not included in the logistic regression model. ...
December 2021
... They used the ESC-EHRA EORP-AF General Long-Term Registry. 17 They reported that compared with beta-blockers, digoxin therapy was associated with increased all-cause mortality. However, in multivariable analysis, there were no differences in any of the outcomes between both groups after accounting for potential confounders. ...
May 2018