7 research outputs found
HighâSensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke
Background: Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high-sensitivity cardiac troponin T (hs-cTnT) are associated with recurrent vascular events and death in patients with first-ever, mild to moderate ischemic stroke.
Methods and Results: We used data from the PROSCIS-B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs-cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all-cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs-cTnT above upper reference limit, 39.2%). During a mean follow-up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all-cause death. The primary outcome occurred more often in patients with hs-cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3-3.3), with a dose-response relationship when the highest and lowest hs-cTnT quartiles were compared (15.2 versus 1.8 events per 100 person-years; adjusted hazard ratio, 4.8; 95% CI, 1.9-11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex.
Conclusions: Hs-cTnT is dose-dependently associated with an increased risk of recurrent vascular events and death within 3 years after first-ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs-cTnT for individualized risk stratification after stroke. Registration URL: ; Unique identifier: NCT01363856
State of the Art of Patient-reported Outcomes in Acromegaly or GH Deficiency: A Systematic Review and Meta-analysis
Context: Insight into the current landscape of patient-reported outcome (PRO) measures (PROM) and differences between PROs and conventional biochemical outcomes is pivotal for future implementation of PROs in research and clinical practice. Therefore, in studies among patients with acromegaly and growth hormone deficiency (GHD), we evaluated (1) used PROMs, (2) their validity, (3) quality of PRO reporting, (4) agreement between PROs and biochemical outcomes, and (5) determinants of discrepancies. Evidence Acquisition: We searched 8 electronic databases for prospective studies describing both PROs and biochemical outcomes in acromegaly and GHD patients. Quality of PRO reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. Logistic regression analysis was used to evaluate determinants. Evidence Synthesis: Ninety studies were included (acromegaly: n=53; GHD: n=37). Besides nonvalidated symptom lists (used in 37% of studies), 36 formal PROMs were used [predominantly Acromegaly Quality of Life Questionnaire in acromegaly (43%) and Quality of Life-Assessment of Growth Hormone Deficiency in Adults in GHD (43%)]. Reporting of PROs was poor, with a median of 37% to 47% of ISOQOL items being reported per study. Eighteen (34%) acromegaly studies and 12 (32%) GHD studies reported discrepancies between PROs and biochemical outcomes, most often improvement in biochemical outcomes without change in PROs. Conclusions: Prospective studies among patients with acromegaly and GHD use a multitude of PROMs, often poorly reported. Since a substantial proportion of studies report discrepancies between PROs and biochemical outcomes, PROMs are pivotal in the evaluation of disease activity. Therefore, harmonization of PROs in clinical practice and research by development of core outcome sets is an important unmet need
Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for Cushingâs disease: surgical outcome, mortality, and complications
Abstract Background First-choice treatment for Cushingâs disease is transsphenoidal adenomectomy. Since its introduction in the 1970s, many centers have now switched from microscopic to endoscopic surgery. We compared both techniques for the treatment of Cushingâs disease at the Leiden University Medical Center, a European reference center for pituitary diseases. Methods Cohort study with inclusion and follow-up of consecutive Cushingâs disease patients primarily treated by transsphenoidal surgery at the Leiden University Medical Center between 1978 and 2016. We compared remission rates (primary endpoint), mortality, and complications between microscopic (performed up to 2005) and endoscopic (performed from 2003 onwards) surgery. Subgroup analyses were performed by tumor size, surgical experience, and preoperative imaging techniques. Additionally, surgeonsâ intraoperative findings regarding presence and removal of the adenoma were related to surgical outcome. Results Of 137 included patients, 87 were treated microscopically and 50 endoscopically. Three months after microscopic surgery, 74 patients (86%) were in remission. Five-year recurrence-free survival was 89% (95% confidence interval [CI]: 82â96%), and ten-year recurrence free survival was 84% (95% CI: 75â93%). After endoscopic surgery, 39 patients (83%) were in remission. Both five-year and ten-year recurrence-free survival were 71% (95% CI: 55â87%). Hazard ratio for recurrence was 0.47 (95% CI: 0.19â1.14), and for mortality 2.79 (95% CI: 0.35â22.51), for microscopic versus endoscopic surgery. No learning curve was found for endoscopy, nor an influence of preoperative imaging technique for microscopy. In addition, we did not find a clear relation between the surgeonsâ intraoperative findings and surgical outcomes. Conclusions This study did not identify a clear advantage of microscopic or endoscopic transsphenoidal surgery for the treatment of Cushingâs disease based on clinical outcome. The transition to endoscopic surgery at our center was not accompanied by transient worsening of outcomes, which may be reassuring for those considering transitioning
HighâSensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke
Background
Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of highâsensitivity cardiac troponin T (hsâcTnT) are associated with recurrent vascular events and death in patients with firstâever, mild to moderate ischemic stroke.
Methods and Results
We used data from the PROSCISâB (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hsâcTnT levels upon study entry (Roche Elecsys, upper reference limit, 14Â ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and allâcause death). A total of 562 patients were analyzed (mean age, 67Â years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hsâcTnT above upper reference limit, 39.2%). During a mean followâup of 3Â years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of allâcause death. The primary outcome occurred more often in patients with hsâcTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3â3.3), with a doseâresponse relationship when the highest and lowest hsâcTnT quartiles were compared (15.2 versus 1.8 events per 100 personâyears; adjusted hazard ratio, 4.8; 95% CI, 1.9â11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex.
Conclusions
HsâcTnT is doseâdependently associated with an increased risk of recurrent vascular events and death within 3Â years after firstâever, mild to moderate ischemic stroke. These findings support further studies of the utility of hsâcTnT for individualized risk stratification after stroke