217 research outputs found
Left Ventricular Remodeling and Myocardial Work: Results From the Population-Based STAAB Cohort Study
Introduction: Left ventricular (LV) dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the implications of abnormal LV geometry on myocardial function are not well-understood. Non-invasive LV myocardial work (MyW) assessment based on echocardiography-derived pressure-strain loops offers the opportunity to study detailed myocardial function in larger cohorts. We aimed to assess the relationship of LV geometry with MyW indices in general population free from heart failure.Methods and Results: We report cross-sectional baseline data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of the general population of WĂŒrzburg, Germany, aged 30â79 years. MyW analysis was performed in 1,926 individuals who were in sinus rhythm and free from valvular disease (49.3% female, 54 ± 12 years). In multivariable regression, higher LV volume was associated with higher global wasted work (GWW) (+0.5 mmHg% per mL/m2, p < 0.001) and lower global work efficiency (GWE) (â0.02% per mL/m2, p < 0.01), while higher LV mass was associated with higher GWW (+0.45 mmHg% per g/m2, p < 0.001) and global constructive work (GCW) (+2.05 mmHg% per g/m2, p < 0.01) and lower GWE (â0.015% per g/m2, p < 0.001). This was dominated by the blood pressure level and also observed in participants with normal LV geometry and concomitant hypertension.Conclusion: Abnormal LV geometric profiles were associated with a higher amount of wasted work, which translated into reduced work efficiency. The pattern of a disproportionate increase in GWW with higher LV mass might be an early sign of hypertensive heart disease
An Update Based on the SCORE-Deutschland Risk Charts
Estimation of absolute risk of cardiovascular disease (CVD), preferably with
population-specific risk charts, has become a cornerstone of CVD primary
prevention. Regular recalibration of risk charts may be necessary due to
decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for
fatal CVD risk assessment were first calibrated for Germany with 1998 risk
factor level data and 1999 mortality statistics. We present an update of these
risk charts based on the SCORE methodology including estimates of relative
risks from SCORE, risk factor levels from the German Health Interview and
Examination Survey for Adults 2008â11 (DEGS1) and official mortality
statistics from 2012. Competing risks methods were applied and estimates were
independently validated. Updated risk charts were calculated based on
cholesterol, smoking, systolic blood pressure risk factor levels, sex and
5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower
according to the updated risk charts compared to the first calibration for
Germany. In a nationwide sample of 3062 adults aged 40â65 years free of major
CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated
charts was lower by 29% and the estimated proportion of high risk people
(10-year risk > = 5%) by 50% compared to the older risk charts. This
recalibration shows a need for regular updates of risk charts according to
changes in mortality and risk factor levels in order to sustain the
identification of people with a high CVD risk
Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery â a cohort study
Background
Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM).
Methods
This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1cââ„â6.0 %. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling.
Results
Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2 %. Patients with CHG (nâ=â165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all pââ€â0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (pâ<â0.05) were independently associated with postoperative AKI.
Conclusions
Our results suggest that CHG defined on a single measurement of HbA1cââ„â6.0 % was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes
identifying demand for support by recording stroke patientsâ and carersâ needs in different phases after stroke
Background Previous studies examining social work interventions in stroke
often lack information on content, methods and timing over different phases of
care including acute hospital, rehabilitation and out-patient care. This
limits our ability to evaluate the impact of social work in multidisciplinary
stroke care. We aimed to quantify social-work-related support in stroke
patients and their carers in terms of timing and content, depending on the
different phases of stroke care. Methods We prospectively collected and
evaluated data derived from a specialized âStroke-Service-Pointâ (SSP); a
âdrop inâ center and non-medical stroke assistance service, staffed by social
workers and available to all stroke patients, their carers and members of the
public in the metropolitan region of Berlin, Germany. Results Enquiries from
257 consenting participants consulting the SSP between March 2010 and April
2012 related to out-patient and in-patient services, therapeutic services,
medical questions, medical rehabilitation, self-help groups and questions
around obtaining benefits. Frequency of enquiries for different topics
depended on whether patients were located in an in-patient or out-patient
setting. The majority of contacts involved information provision. While the
proportion of male and female patients with stroke was similar, about two
thirds of the carers contacting the SSP were female. Conclusion The social-
work-related services provided by a specialized center in a German
metropolitan area were diverse in terms of topic and timing depending on the
phase of stroke care. Targeting the timing of interventions might be important
to increase the impact of social work on patientâs outcome
Stenosis Length and Degree Interact With the Risk of Cerebrovascular Events Related to Internal Carotid Artery Stenosis
Background and Purpose: Internal carotid artery stenosis (ICAS)â„70% is a leading cause of ischemic cerebrovascular events (ICVEs). However, a considerable percentage of stroke survivors with symptomatic ICAS (sICAS) have <70% stenosis with a vulnerable plaque. Whether the length of ICAS is associated with high risk of ICVEs is poorly investigated. Our main aim was to investigate the relation between the length of ICAS and the development of ICVEs.Methods: In a retrospective cross-sectional study, we identified 95 arteries with sICAS and another 64 with asymptomatic internal carotid artery stenosis (aICAS) among 121 patients with ICVEs. The degree and length of ICAS as well as plaque echolucency were assessed on ultrasound scans.Results: A statistically significant inverse correlation between the ultrasound-measured length and degree of ICAS was detected for sICASâ„70% (Spearman correlation coefficient Ï = â0.57, p < 0.001, n = 51) but neither for sICAS<70% (Ï = 0.15, p = 0.45, n = 27) nor for aICAS (Ï = 0.07, p = 0.64, n = 54). The median (IQR) length for sICAS<70% and â„70% was 17 (15â20) and 15 (12â19) mm (p = 0.06), respectively, while that for sICAS<90% and sICAS 90% was 18 (15â21) and 13 (10â16) mm, respectively (p < 0.001). Among patients with ICAS <70%, a cut-off length of â„16 mm was found for sICAS rather than aICAS with a sensitivity and specificity of 74.1% and 51.1%, respectively. Irrespective of the stenotic degree, plaques of the sICAS compared to aICAS were significantly more often echolucent (43.2 vs. 24.6%, p = 0.02).Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICASâ„70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICASâ„70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results
Methods of implementation of evidence-based stroke care in Europe : European implementation score collaboration
BACKGROUND AND PURPOSE:
Differences in stroke care and outcomes reported in Europe may reflect different degrees of implementation of evidence-based interventions. We evaluated strategies for implementing research evidence into stroke care in 10 European countries.
METHODS:
A questionnaire was developed and administered through face-to-face interviews with key informants. Implementation strategies were investigated considering 3 levels (macro, meso, and micro, eg, policy, organization, patients/professionals) identified by the framing analysis, and different settings (primary, hospital, and specialist) of stroke care. Similarities and differences among countries were evaluated using the categorical principal components analysis.
RESULTS:
Implementation methods reported by â„7 countries included nonmandatory policies, public financial incentives, continuing professional education, distribution of educational material, educational meetings and campaigns, guidelines, opinion leaders', and stroke patients associations' activities. Audits were present in 6 countries at national level; national and regional regulations in 4 countries. Private financial incentives, reminders, and educational outreach visits were reported only in 2 countries. At national level, the first principal component of categorical principal components analysis separated England, France, Scotland, and Sweden, all with positive object scores, from the other countries. Belgium and Lithuania obtained the lowest scores. At regional level, England, France, Germany, Italy, and Sweden had positive scores in the first principal component, whereas Belgium, Lithuania, Poland, and Scotland showed negative scores. Spain was in an intermediate position.
CONCLUSIONS:
We developed a novel method to assess different domains of implementation in stroke care. Clear variations were observed among European countries. The new tool may be used elsewhere for future contributions
- âŠ