8 research outputs found
Reversible Pulmonary Hypertension and Isolated Right-sided Heart Failure Associated with Hyperthyroidism
Hyperthyroidism may present with signs and symptoms related to dysfunction of a variety of organs. Cardiovascular pathology in hyperthyroidism is common. A few case reports describe isolated right heart failure, tricuspid regurgitation, and pulmonary hypertension as the prominent cardiovascular manifestations of hyperthyroidism. Although most textbooks do not mention hyperthyroidism as a cause of pulmonary hypertension and isolated right heart failure, the literature suggests that some hyperthyroid patients may develop reversible pulmonary hypertension and isolated right heart failure. We report a case of hyperthyroidism presenting with signs and symptoms of isolated right heart failure, tricuspid regurgitation, and pulmonary hypertension, which resolved with treatment of hyperthyroidism
Frailty factors and outcomes in vascular surgery patients: a systematic review and meta-analysis
Objective To describe and critique tools used to assess frailty in vascular surgery patients, and
investigate its associations with patient factors and outcomes. Background Increasing evidence shows negative impacts of frailty on outcomes in surgical
patients, but little investigation of its associations with patient factors has been
undertaken.
Methods Systematic review and meta-analysis of studies reporting frailty in vascular surgery
patients (PROSPERO registration: CRD42018116253) searching Medline, Embase,
CINAHL, PsycINFO and Scopus. Quality of studies was assessed using Newcastle Ottawa scores (NOS) and quality of evidence using GRADE criteria. Associations of
frailty with patient factors were investigated by difference in means (MD) or
expressed as risk ratios (RR), and associations with outcomes expressed as odds
ratios (OR) or hazard ratios (HR). Data were pooled using random effects models.
Results Fifty-three studies were included in the review and only 8 (15%) were both good
quality (NOS ≥7) and used a well-validated frailty measure. Eighteen studies (62,976
patients) provided data for the meta-analysis. Frailty was associated with increased
age (MD 4.05 years; 95% confidence interval [CI] 3.35, 4.75), female sex (RR 1.32;
95%CI 1.14, 1.54), and lower body-mass index (MD -1.81; 95%CI -2.94, -0.68).
Frailty was associated with 30-day mortality (adjusted [A]OR 2.77; 95%CI 2.01-3.81),
post-operative complications (AOR 2.16; 95%CI 1.55, 3.02) and long-term mortality
(HR 1.85; 95%CI 1.31, 2.62). Sarcopenia was not associated with any outcomes. Conclusion Frailty, but not sarcopenia, is associated with worse outcomes in vascular surgery
patients. Well-validated frailty assessment tools should be preferred clinically, and in
future research.</div
Leg Ischaemia Management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre
Introduction
Severe limb ischaemia (SLI) is the end-stage of peripheral arterial occlusive disease where
the viability of the limb is threatened. Around 25% of patients with SLI will ultimately
require a major lower limb amputation which has a substantial adverse impact on quality of
life. A newly established rapid-access vascular limb salvage clinic and modern
revascularisation techniques may reduce amputation rate. The aim of this study is to
investigate the 12-month amputation rate in a contemporary cohort of patients and
compare this to a historical cohort. Secondary aims are to investigate the use of frailty and
cognitive assessments, and cardiac MRI in risk-stratifying patients with SLI undergoing
intervention and establish a biobank for future biomarker analyses.
Methods & analysis
This single-centre prospective cohort study will recruit patients aged 18-110 years
presenting with SLI. Those undergoing intervention will be eligible to undergo additional
venepuncture (for biomarker analysis) and/or cardiac MRI. Those aged ≥65 years and
undergoing intervention will also be eligible to undergo additional frailty and cognitive
assessments. Follow-up will be at 12 and 24 months and subsequently via data-linkage with
NHS digital to 10 years post-recruitment. Those undergoing cardiac MRI and/or frailty
assessments will receive additional follow-up during the first 12 months to investigate for
peri-operative myocardial infarction and frailty related outcomes, respectively. A sample
size of 420 patients will be required to detect a 10% reduction in amputation rate in
comparison to a similar sized historical cohort, with 90% power and 5% type-I error rate.
Statistical analysis of this comparison will be by adjusted and unadjusted logistic regression
analyses.
Ethics & dissemination
Ethical approval for this study has been granted by the UK National Research Ethics Service
(19/LO/0132). Results will be disseminated to participants, via scientific meetings, peerreviewed medical journals and social media.
Study registration
ClinicalTrials.gov [NCT04027244