Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

To date, inconsistent results evaluating the effect of parameters on mechanical thrombectomy (MT) outcomes in stroke-patients have been published. This study aimed to identify the key parameters for functional status after MT in stroke-patients in short and long-term follow-up. Method: The study analysis focused on the relevance of selected clinical and non-clinical parameters to the functional status of the patients after MT. Results: 417 stroke-patients (mean age 67.8 ± 13.2 years) were qualified. Atrial fibrillation, and leukocytosis were significant for the neurological status on the first day of stroke (p = 0.036, and p = 0.0004, respectively). The parameters with the strongest effect on the functional status on day 10 were: age (p = 0.009), NIHSS (p = 0.002), hyperglycemia (p = 0.009), the result in TICI (p = 0.046), and first pass effect (p = 0.043). The parameters with the strongest effect on the functional status on day 365 were: age and NIHSS on the first day of stroke (p = 0.0002 and 0.002, respectively). Leukocytosis and the neurological status at baseline were key parameters associated with ICB after MT (p = 0.007 and p = 0.003, respectively). Conclusions: Age and neurological status in the ultra-acute phase of stroke are crucial for the functional status in short and long-term observations of patients treated with mechanical thrombectomy. Atrial fibrillation, hyperglycemia, and inflammatory state are relevant to the short-term post-stroke functional status. First pass effect and the degree of post-interventional reperfusion are important technical parameters to the short-term functional status. Neurological status and white blood count during the acute phase are associated with a high rate of post-procedural intracranial bleeding

The usefulness of telemedicine devices in patients with severe heart failure with an implanted cardiac resynchronization therapy system during two years of observation

Background: Heart failure (HF) remains a disease with a poor prognosis. Telemonitoring is a medical service aimed at remote monitoring of patients.Aim: The study aimed to identify the clinical relevance of non-invasive telemonitoring devices in HF patients.Methods: Sixty patients aged 66.1 (11) years, with left ventricular ejection fraction (LVEF) 26.3 (6.8)% underwent cardiac resynchronization therapy (CRT) implantation. They were randomly allocated to the control (standard medical care) or study (standard medical care + telemonitoring device) groups. During the follow-up (24 months), the patients in the study group provided body mass and blood pressure, along with electrocardiogram on a daily basis. The data were transferred to the monitoring center and consulted with a cardiologist. Transthoracic echocardiography and a 6-minute walk test were performed before and 24 months after CRT implantation.Results: During the two-year observation, the composite endpoint (death or HF hospitalization) occurred in 21 patients, more often in the control group (46.8% vs. 21.4%; P = 0.026). In univariate analysis: the use of telemetry (hazard ratio [HR], 0.2; 95% confidence interval [CI], 0.07–0.7; P = 0.004), the presence of coronary heart disease (HR, 41.4; 95% CI, 3.1–567.7; P = 0.005), hypertension (HR, 0.24; 95% CI, 0.07–0.90; P = 0.035), and patient’s body mass (HR, 0.36; 95% CI, 0.14–0.92; P = 0.03) were related to the occurrence of the composite endpoint.Conclusions: The use of a telemonitoring device in CRT recipients improved the prognosis in 2-year observation and contributed to the reduction of HF hospitalization