68 research outputs found
Epidemiology of cardiac arrhythmias in a medical-cardiologic intensive care unit: single center experience
A circadian pattern of occurrence of ventricular tachycardia and atrial fibrillation is present during periods of analgosedation
Phenotyping vs. genotyping for prediction of clopidogrel efficacy and safety: the PEGASUS-PCI study
Background: Prognostic values of genotyping and
phenotyping for assessment of clopidogrel responsiveness have
been shown in independent studies. Objectives: To compare
different assays for prediction of events during long-term
follow-up. Methods: In this prospective cohort study polymorphisms
of CYP2C19*2 and CYP2C19*17 alleles, vasodilator-
stimulated phosphoprotein phosphorylation (VASP)
assay, multiple electrode aggregometry (MEA), cone and
platelet analyser (CPA) and platelet function analyser (PFA-
100) were performed in 416 patients undergoing percutaneous
coronary intervention. The rates of events were recorded during
a 12-month follow-up. Results: Platelet aggregation by MEA
predicted stent thrombosis (2.4%) better (c-index = 0.90;
P < 0.001; sensitivity = 90%; specificity = 83%) than the
VASP assay, CPA or PFA-100 (c-index 0.05;
sensitivity < 70%; specificity < 70% for all) or even the
CYP2C19*2 polymorphism (c-index 0.05; sensitivity
= 30%; specificity = 71%). Survival analysis indicated
that patients classified as poor responders by MEA had a
substantially higher risk of developing stent thrombosis or
MACE than clopidogrel responders (12.5% vs. 0.3%,
P < 0.001, and 18.5% vs. 11.3%, P = 0.022, respectively),
whereas poor metabolizers (CYP2C19*1/*2 or *2/*2 carriers)
were not at increased risks (stent thrombosis, 2.7% vs. 2.5%,
P > 0.05; MACE, 13.5% vs. 12.1%, P = 0.556). The incidence
of major bleedings (2.6%) was numerically higher in
patients with an enhanced vs. poor response to clopidogrel
assessed by MEA (4% vs. 0%) or in ultra-metabolizers vs.
regular metabolizers (CYP2C19*17/*17 vs. CYP2C19*1/*1;
9.5% vs. 2%). The classification tree analysis demonstrated that
acute coronary syndrome at hospitalization and diabetes
mellitus were the best discriminators for clopidogrel responder
status. Conclusions: Phenotyping of platelet response to clopidogrel
was a better predictor of stent thrombosis than
genotyping
Dynamical model and nonextensive statistical mechanics of a market index on large time windows
The shape and tails of partial distribution functions (PDF) for a financial
signal, i.e. the S&P500 and the turbulent nature of the markets are linked
through a model encompassing Tsallis nonextensive statistics and leading to
evolution equations of the Langevin and Fokker-Planck type. A model originally
proposed to describe the intermittent behavior of turbulent flows describes the
behavior of normalized log-returns for such a financial market index, for small
and large time windows, both for small and large log-returns. These turbulent
market volatility (of normalized log-returns) distributions can be sufficiently
well fitted with a -distribution. The transition between the small time
scale model of nonextensive, intermittent process and the large scale Gaussian
extensive homogeneous fluctuation picture is found to be at a 200 day
time lag. The intermittency exponent () in the framework of the
Kolmogorov log-normal model is found to be related to the scaling exponent of
the PDF moments, -thereby giving weight to the model. The large value of
points to a large number of cascades in the turbulent process. The
first Kramers-Moyal coefficient in the Fokker-Planck equation is almost equal
to zero, indicating ''no restoring force''. A comparison is made between
normalized log-returns and mere price increments.Comment: 40 pages, 14 figures; accepted for publication in Phys Rev
IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe.
AIMS: There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). METHODS: Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. RESULTS: Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). CONCLUSIONS: The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women
IMPULSE: The impact of gender on the presentation and management of aortic stenosis across Europe
Aims There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). Methods Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. Results Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). Conclusions The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women
Impact of selected comorbidities on the presentation and management of aortic stenosis
Background Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. Methods Prospective registry of severe patients with AS across 23 centres in nine European countries. Results Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. Conclusions Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period
Management of patients with severe aortic stenosis in the TAVI-era: How recent recommendations are translated into clinical practice
Objective Approximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR. Methods Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR. Results Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p<0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR. Conclusions There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption
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