Percutaneous treatment with Mitraclip for functional mitral regurgitation: medium-term follow up according to left ventricular function

Background: Functional mitral regurgitation (FMR) is a bad prognosis condition despite optimal medical treatment. Nowadays there is an open debate about the surgical versus percutaneous treatment. The main objective of this study is to evaluate the mid-term follow up clinical outcomes of patients with FMR treated with MitraClip((R)) system, according to their left ventricular ejection fraction (LVEF). Methods: Data was obtained from two experienced centers in transcatheter mitral valve repair (TMVR). All consecutive cases of severe FMR undergoing TMVR in both centers with the same inclusion criteria were included prospectively in this study and followed-up. Periodical follow-ups with clinical and echocardiographic evaluation were scheduled from the baseline procedure, at 3 months and then yearly. Results: From October 2015 to October 2019, a total of 119 patients with FMR at 2 centers in Spain underwent TMVR with the MitraClip((R)) procedure and were included in this study. The mean age was 73.8+/-8.9 years old and 32 patients (26.9%) were female. A 39.5% of cases [47] had a LVEF 30% (group 2). There was a similar distribution in cardiovascular risk factors, age and other diseases. All MitraClip((R)) implantations were elective and procedural success was achieved in 110 patients (92.4%) with a similar distribution between the groups. There were no differences in procedural time and the number of implanted clips. The median follow-up was 22.6 months (IQR, 11.43-34.98 months). The primary combined endpoint occurred in the 41.6% of the global cohort, 57.5% in group 1 and 30.99% in group 2 (P=0.036). LVEF was associated to the main event in the multivariate analysis (HR 2.09, 95% CI: 1.12-3.89; P=0.02). Conclusions: The MitraClip edge-to-edge technique is a safe and effective procedure for the treatment of FMR. In this study, patients with LVEF >30% treated with Mitraclip presented better clinical cardiovascular outcomes than those with a LVEF </=30%. Regardless clinical outcomes, at the end of the follow-up, there was a sustained reduction in MR grades and an important improvement in NYHA functional class

Premarital Sex in the Last Twelve Months and Its Predictors among Students of Wollega University, Ethiopia

Background: Premarital sex increases the risk of unintended pregnancy and sexually transmitted infections including HIV if unprotected and contraception is not used. Thus, the objective of this study was to assess premarital sex in the last twelve months and its predictors among regular undergraduate students of Wollega University.Methods: A cross-sectional survey using pretested, structured questionnaire was conducted on a total of 704 regular undergraduate students of Wollega University from February to March, 2014. We used multistage sampling technique to recruit study participants. Binary and multivariable logistic regressions were performed using SPSS version 20 to assess predictors of premarital sex. Statistical significance was determined through a 95% confidence level.Results: Wollega University youths who had premarital sex in the last twelve months were 28.4%; 55.5% of them did not use condom during last sex while 31.3% engaged in multiple sex. Being male [Adjusted Odds Ratio (AOR)(95% Confidence Interval(CI))=2.7(1.58-4.75)], age 20-24 years [AOR(95%CI)=2.8(1.13-7.20)], training on how to use condom [AOR(95%CI)=1.7(1.17-2.46)], being tested for HIV [AOR(95%CI)=2.3(1.48-3.53)], using social media frequently [AOR(95%CI)=1.8(1.14-2.88)], having comprehensive knowledge of HIV [AOR(95% CI)=1.5(1.01-2.10)], alcohol use [AOR (95%CI)=2.2(1.31-3.56)] were associated with increased odds of premarital sex in the last twelve months.Conclusion: Nearly one-third of regular undergraduate students of the university were engaged in premarital sex in the last twelve months. Being male, using social media frequently and alcohol use were associated with increased odds of premarital sex in the stated period. Thus, higher institutions have to deliver abstinence messages alongside information about self-protection.Keywords: Premarital sex, students, Wollega Universit

Torsades de Pointes due to Excessive Marijuana Use in a Susceptible Patient

There are several recent reports of tetrahydrocannabinol vaping-related sudden cardiac arrest, and the mechanisms are unclear. We report a unique case of a 19-year-old female who suffered documented prolonged QTc leading to Torsades de pointes and cardiac arrest in the setting of frequent marijuana wax vaping. While she demonstrated normal baseline QTc measurements years earlier, she was found to have a genetic predisposition to QTc prolongation (genetic mutation, family history of prolonged QTc), suggesting that specific patient populations are at higher risk of these adverse events. The patient was acutely managed with isoproterenol to increase the heart rate and was discharged on nadolol after placement of an implantable cardioverter-defibrillator. Marijuana wax vaping and dabbing may cause fatal Torsades de pointes in susceptible patients, and further research is required to identify these patients a priori

Torsades de Pointes due to Excessive Marijuana Use in a Susceptible Patient

There are several recent reports of tetrahydrocannabinol vaping-related sudden cardiac arrest, and the mechanisms are unclear. We report a unique case of a 19-year-old female who suffered documented prolonged QTc leading to Torsades de pointes and cardiac arrest in the setting of frequent marijuana wax vaping. While she demonstrated normal baseline QTc measurements years earlier, she was found to have a genetic predisposition to QTc prolongation (genetic mutation, family history of prolonged QTc), suggesting that specific patient populations are at higher risk of these adverse events. The patient was acutely managed with isoproterenol to increase the heart rate and was discharged on nadolol after placement of an implantable cardioverter-defibrillator. Marijuana wax vaping and dabbing may cause fatal Torsades de pointes in susceptible patients, and further research is required to identify these patients a priori.</jats:p

A Built-up Virtual Laboratory to Enhance Understanding of Concrete Structure Design Requirement

In this paper, simulation tools for educational purposes are developed to enhance understanding in undergraduate students taking courses related to concrete structural behavior. As undergraduate students learn about concrete structure, they commonly reach limits regarding their understanding of failure behavior in materials. Design codes should therefore be followed when students learn about reinforced concrete (RC) design. Students are able to follow a step-by-step design procedure for a RC beam using simple calculations. However, they usually then face some requirement, such as a design code, that requires students to make an RC beam with several pieces of rebar instead of one piece, because this provides a more desirable behavior for the RC structure. Understanding why the code is required needs more than just reading. By conducting an experiment, students can easily understand the reason for the code. However, real experiments for concrete structures are time-consuming and costly; therefore, provision of a realistic simulation tool, the ‘Virtual Concrete Structure Laboratory,’ for engineering educational purposes allows students to obtain virtual hands-on experience to learn about concrete structure. The main purpose of this paper is to show the effectiveness of this virtual lab in civil engineering education

A Built-up Virtual Laboratory to Enhance Understanding of Concrete Structure Design Requirement

In this paper, simulation tools for educational purposes are developed to enhance understanding in undergraduate students taking courses related to concrete structural behavior. As undergraduate students learn about concrete structure, they commonly reach limits regarding their understanding of failure behavior in materials. Design codes should therefore be followed when students learn about reinforced concrete (RC) design. Students are able to follow a step-by-step design procedure for a RC beam using simple calculations. However, they usually then face some requirement, such as a design code, that requires students to make an RC beam with several pieces of rebar instead of one piece, because this provides a more desirable behavior for the RC structure. Understanding why the code is required needs more than just reading. By conducting an experiment, students can easily understand the reason for the code. However, real experiments for concrete structures are time-consuming and costly; therefore, provision of a realistic simulation tool, the ‘Virtual Concrete Structure Laboratory,’ for engineering educational purposes allows students to obtain virtual hands-on experience to learn about concrete structure. The main purpose of this paper is to show the effectiveness of this virtual lab in civil engineering education

Can patients suffering an ST elevation myocardial infarction enjoy a similar life expectancy to that of the general population?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives There has been a continuous process of improvement after (ST-segment elevation myocardial infarction) STEMI. Our aim was to know whether patients &amp;lt; and ≥ 65 years suffering a STEMI can recover a life expectancy similar to that of the general population of the same age, sex and geographical region. Methods We included all patients who suffered a STEMI from January 2014 until January 2020 and compared them to a reference population provided by the National statistics Institute from Spain. For those patients surviving the acute event as well as the first 30 days, we calculated their observed survival, expected survival and the excess of mortality calculated with the Ederer II method. If the expected survival was inside the 95% confidence interval(CI) of the observed survival there was not a significant excess of mortality. We repeated all analyses for survivors stratifying by 65 years. Results We included 1722 patients, 899 patients were &amp;lt;65 years. For patients &amp;lt; 65 years who survived a STEMI, observed survival at 3 and 5 years of follow-up was 97.68%(95%CI, 96.05%-98.64%) and 94.14%(95%CI, 90.89%-96.25%), respectively. Expected survival for 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52%(95%CI, 82.23%-88.24%) and 75.43%(95%CI, 70.26%-79.83%), respectively. Expected survival for 3 and 5 years was 86.48% and 76.56%. Conclusions For survivors of the acute event, life expectancy is similar to that of the general population of the same age, sex and geographical region. Table 1Year of Follow UpObserved Survival (95% CI)Expected SurvivalAnual Excess of Mortality (95% CI)&amp;lt;65 yearsFirst Year99.23%(98.29%-99.65%)99.43%0.19%(-0.23%-1.14%)Second Year98.76%(97.61%-99.36%)98.79%-0.16%(-0.48%-0.84%)Third Year97.68%(96.05%-98.64%)98.12%0.36%(-0.25%-1.82%)Fourth Year95.82%(93.55%-97.31%)97.39%1.37%(0.27%-3.65%)Fifth Year94.14%(90.89%-96.25%)96.61%0.73%(-0.31%-3.88%))≥65 yearsFirst Year93.69%(91.59%-95.29%)95.64%2.15%(0.45%-4.39%)Second Year90.22%(87.61%-92.31%)91.09%-1.05%(-2.46%-1.12%)third Year85.52%(82.23%-88.24%)86.48%0.21%(-1.69%-3.06%)Fourth Year81.32%(77.38%-84.65%)81.80%-0.54%(-2.69%-3.06%)Fifth Year75.43%(70.26%-79.83%)76.56%1.20%(-2.17%6.98%)Abstract Figure 1 </jats:sec

Newer glucose-lowering drugs at discharge from cardiology hospitalization department: safetyness, effectiveness and mortality reduction

Abstract Background In recent years, the paradigm of glycemic treatment has changed due to the cardiovascular impact of newer glucose-lowering drugs (GLD) (sodium-glucosa cotransporter 2 inhibitor (SGLT2i) and GLP-1 receptor agonist (GLP1a)). The cardiological patient with type 2 diabetes (2DM) is a very high cardiovascular risk patient in which the benefit of these therapies is greater. However, to date, different studies have demonstrated the efficacy and safety of newer GLD only in the outpatient setting. So its impact when they are initiated to discharge after a cardiovascular event is unknown. Objective To evaluate the efficacy and safety of the onset of these newer GLD in 2DM patients at discharge from cardiology hospitalization. And to compare mortality and readmissions among patients treated with or without newer GLD. Methods Prospective, it includes patients admitted to cardiology at a 3er level hospital between April/2018 and February/2019 with a history of 2DM or diagnosed with 2DM during hospitalization. They were followed at 6, 12 and 18 months. The evolution of anthropometric parameters, glycemic profile, renal function and blood pressure were analyzed; renal events, readmissions, mortality and combined clinical outcome (mortality or readmission) were collected during follow-up. Quantitative variables are expressed in mean/SD and categorical variables in number of patients (%). For the comparison between the parameters at discharge and thefollow-up, a T student was used for paired data. Survival analysis by K-M was performed crude and adjusted data by propensity score matching (PSM). Results Population: Diagnoses at discharge: Acute coronary syndrome 66 (64%), Heart failure 22 (21%), Arrhythmias 16 (15%). 104 diabetic patients, 39 of them (38%) were treated on discharge with newer GLD. 35 Patients with SGLT2i without GLP1a, 3 patients with SGLT2i and GLP1a and 1 patient with GLP1a without SGLT2i. The mean follow-up was 16±2 months. Regarding the subgroup of patients with newer GLD: mean age was 65±21 y, male 26 (67%). A significant decrease was observed in glycated hemoglobin (7.6 to 6.9%, p=0.04) and weight (81 to 78 kg, p&amp;lt;0.01) without significant changes in blood pressure or glomerular filtration rate (GFR). Only 1 patient presented deterioration of their GFR that forced the transient suspension of newer GLD. 10 deaths were registered in the classical GLD group (15%) and none in the newer GLD group (HR 0.81 [0.71–0.92] p=0.002, Figure 1A, HR adjusted by PSM 0.9 [0.82–0.99], p=0.04), Figure 1B. The combined clinical outcome appeared in 38 patients (58%) in the the classical GLD group and in 9 (23%) in the newer GLD group (HR 0.70 [0.58–0.85] p&amp;lt;0.001, Figure 1C, PSM adjusted HR 0.75 [0.61–0.92], p=0.001), Figure 1D. Conclusion The use of newer GLD at discharge from cardiology hospitalization reduce mortality and readmissions. Newer GLD were safe and showed significant reduction in weigth and glycated hemoglobin. Figure 1. Kaplan-Meier survival analysis crude and adjusted Funding Acknowledgement Type of funding source: None </jats:sec

Transcatheter aortic valve implantation for the treatment of degenerated mitroflow bioprosthesis

Abstract Introduction The leading cause of valvular heart replacement therapy is symptomatic aortic stenosis (AS). The Mitroflow (MF) bovine pericardial prosthesis is prone to early structural valve deterioration (SVD) and has been used in over 100,000 patients for the treatment of symptomatic AS. The standard of care for degenerated bioprosthesis is surgical aortic valve replacement. However, valve-in-valve transcatheter aortic valve replacement (VIV-TAVI) is an interesting therapeutic modality currently being evaluated to avoid redo surgery. Purpose The purpose of this study was to evaluate the clinical outcomes of patients with SVD MF bioprosthesis treated with VIV-TAVI. Methods Data was collected from all the patients undergoing TAVI in a single center from March 2012 to July 2019. All the cases remitted for VIV-TAVI were prospectively included and followed. All events were classified according to the VARC-2 definitions. The primary endpoints were a combination of clinical events at the end of the follow-up which included all-cause mortality, cardiovascular mortality, hospitalizations due to heart failure and stroke/transient ischemic attack. Secondary endpoints were absence of SVD and valve hemodynamics at the end of the follow-up. Results Between march 2012 and July 2019, 65 patients were derived for VIV-TAVI. The mean age was 80,4±5.93 years. 50,8% were male. The average STS score was 6.39±5,62 and Euroscore II 8.86±5.17. All the patients were diagnosed with SVD with a mixed mechanism (stenosis/regurgitation) being the most frequent form of disfunction (38,5%) followed by regurgitation (33,9%) and stenosis (27,7%). Procedural success was achieved in 98,5% of the cases, there were 2 deaths of cardiovascular origin, 1 stroke, and 2 hospitalizations due to heart failure. The mean gradient, peak gradient and valve area at discharge were 13,3mmHg, 27,2mmHg and 1,14cm2, respectively. After 28,8 months (17,4–60,9) of follow-up the combined endpoint occurred in 21 patients (32,3%). There was a total of 13 deaths (20%) and only 4 (7.3%) from cardiovascular causes. 2 patients were reported of having a stroke/TIA and there were 5 readmissions from heart failure (2 of them within the first 30 days). The mean gradient, peak gradient and valve area remained steady when comparing post-TAVI vs follow-up, 20.3mmHg vs 18.8mmHg (p=0.2), 39.6mmHg vs 35.2mmHg (p=0.01) and 1.3cm2 vs 1.3cm2 (p=0.7), respectively. The same tendency was observed in aortic regurgitation. There were no significant changes in the LVEF over time. There were only 2 patients (3.1%) presenting with valve deterioration during follow-up. Conclusions VIV-TAVI for SVD MF bioprosthesis is a safe procedure and a valid alternative to surgery in this group patients, with a high rate of success and low intraprocedural complications. At 28 months of follow-up, 68% of patients were free of late clinical events and valve hemodynamics maintain over time. Figure 1 Funding Acknowledgement Type of funding source: None </jats:sec