Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie?

Aims: We investigated the relationship between clinically assessed left ventricular ejection fraction (LVEF) and survival in a large, heterogeneous clinical cohort. Methods and results: Physician-reported LVEF on 403 977 echocardiograms from 203 135 patients were linked to all-cause mortality using electronic health records (1998–2018) from US regional healthcare system. Cox proportional hazards regression was used for analyses while adjusting for many patient characteristics including age, sex, and relevant comorbidities. A dataset including 45 531 echocardiograms and 35 976 patients from New Zealand was used to provide independent validation of analyses. During follow-up of the US cohort, 46 258 (23%) patients who had undergone 108 578 (27%) echocardiograms died. Overall, adjusted hazard ratios (HR) for mortality showed a u-shaped relationship for LVEF with a nadir of risk at an LVEF of 60–65%, a HR of 1.71 [95% confidence interval (CI) 1.64–1.77] when ≥70% and a HR of 1.73 (95% CI 1.66–1.80) at LVEF of 35–40%. Similar relationships with a nadir at 60–65% were observed in the validation dataset as well as for each age group and both sexes. The results were similar after further adjustments for conditions associated with an elevated LVEF, including mitral regurgitation, increased wall thickness, and anaemia and when restricted to patients reported to have heart failure at the time of the echocardiogram. Conclusion: Deviation of LVEF from 60% to 65% is associated with poorer survival regardless of age, sex, or other relevant comorbidities such as heart failure. These results may herald the recognition of a new phenotype characterized by supra-normal LVEF

In-vivo corneal biomechanical analysis of unilateral keratoconus

•AIM: To evaluate and compare corneal biomechanical findings measured by ocular response analyzer, topographic and pachymetric findings in patients with unilateral keratoconus patients and healthy controls. •METHODS: This is an observational, case -control study. Patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with sex and age matched with controls healthy subjects. All subjects were evaluated with rotating scheimpflug imaging system. The receiver -operating -characteristic curves were analyzed to evaluate the sensitivity and specificity of the parameters. • RESULTS: Twenty-seven patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with 40 eyes of 40 normal subjects. Corneal hysteresis (CH) was 8.0 ±1.7 mm Hg in keratoconus group, 8.3 ±1.6 mm Hg in forme fruste keratoconus group, and 9.8 ±1.6 mm Hg in control groups (P 0.54 between keratoconus and forme fruste keratoconus groups, P<0.01 between control group and other groups). Corneal resistance factor (CRF) was 7.1 ±2.2 mm Hg in keratoconus group, 7.8 ±1.2 mm Hg in forme fruste keratoconus group and 9.9±1.5 mm Hg in control group (P <0.001 between control group and other groups). Using receiver-operating-characteristic analysis, the area under curve values of the parameters to distinguish forme fruste keratoconus from control subjects were: CH (0.768), CRF (0.866). Best cut-off points were 9.3 mm Hg and 8.8 mm Hg for CH and CRF respectively. • CONCLUSION: Ocular response analyzer parameters (CH and CRF) are found to be significantly lower in forme fruste keratoconus patients compared to normal control subjects. © 2015, International Journal of Ophthalmology (c/o Editorial Office). All Rights Reserved

RELATIONSHIP BETWEEN FATIGUE AND SLEEP QUALITY OF CANCER PATIENTS AND CAREGIVERS

This study aims to identify the relationship between fatigue and sleep quality of cancer patients and caregivers. Patient and caregiver fact sheet, Pittsburgh sleep quality index (PSQI), Piper fatigue scale (PFS), Visual analog scale (VAS) for fatigue and sleep quality were used for data collection. Average and percentage calculations and Pearson correlation analysis were used for data analysis and multiple regression analysis was used for evaluation of affecting factors. The statistical significance level was accepted as 0.05. The patients participating 26.3% had difficulties especially in dealing with symptoms such as nausea, vomiting, mucositis, pain, weight loss, lack of appetite and shortness of breath. As a result of multiple regression analysis, a weak and moderate relationship was found between VAS for Fatigue scores and VAS for sleep quality, PSQI and PFS scores. It was deteimined that sleep quality of patients and caregivers decreased as their level of fatigue increased