Mode of Death in Patients With Congestive Heart Failure:Comparison Between Possible Candidates for Heart Transplantation and Patients With Less Advanced Disease

To study whether the relative incidence of sudden death versus progressive congestive heart failure is related to the severity of congestive heart failure as assessed by determination of peak oxygen consumption, we followed 90 ambulatory patients with moderate to severe congestive heart failure for 24.1 +/- 13.1 months. All patients had a left ventricular ejection fraction of 40% or less (mean, 22.6% +/- 9.2%) and a peak oxygen consumption of 20 ml/min/kg or less (mean, 14.7 +/- 3.5 ml/min/kg). Patients with severe congestive heart failure who might be eligible for heart transplantation (group 1: n = 37; peak oxygen consumption less-than-or-equal-to 14 ml/min/kg, mean, 11.0 +/- 1.8 ml/min/kg; mean left ventricular ejection fraction, 22.3% +/- 9.3%) were compared with those considered too well for heart transplantation (group II: n = 53; peak oxygen consumption > 14 less-than-or-equal-to 20 ml/min/kg, mean, 17.1 +/- 1.6 ml/min/kg; mean left ventricular ejection fraction, 22.9% +/- 9.1%). During follow-up, 15 patients (41%) in group I died; 11 patients (21%) in group II died. In group I, seven of the 15 deaths (47%) were sudden; in group II, nine of the 11 deaths (82%) occurred suddenly. Patients who died suddenly had a significantly higher peak oxygen consumption (14.0 +/- 3.5 ml/min/kg) than those who died of progressive congestive heart failure (11.0 +/- 3.1 ml/min/kg, p <0.05). Because the relative incidence of sudden death as opposed to death from progressive congestive heart failure decreases with the severity of congestive heart failure, the benefits of implantation of an automatic cardioverter defibrillator in prospective candidates for heart transplantation should be considered and weighed against the costs

Mode of Death in Patients With Congestive Heart Failure:Comparison Between Possible Candidates for Heart Transplantation and Patients With Less Advanced Disease

To study whether the relative incidence of sudden death versus progressive congestive heart failure is related to the severity of congestive heart failure as assessed by determination of peak oxygen consumption, we followed 90 ambulatory patients with moderate to severe congestive heart failure for 24.1 +/- 13.1 months. All patients had a left ventricular ejection fraction of 40% or less (mean, 22.6% +/- 9.2%) and a peak oxygen consumption of 20 ml/min/kg or less (mean, 14.7 +/- 3.5 ml/min/kg). Patients with severe congestive heart failure who might be eligible for heart transplantation (group 1: n = 37; peak oxygen consumption less-than-or-equal-to 14 ml/min/kg, mean, 11.0 +/- 1.8 ml/min/kg; mean left ventricular ejection fraction, 22.3% +/- 9.3%) were compared with those considered too well for heart transplantation (group II: n = 53; peak oxygen consumption > 14 less-than-or-equal-to 20 ml/min/kg, mean, 17.1 +/- 1.6 ml/min/kg; mean left ventricular ejection fraction, 22.9% +/- 9.1%). During follow-up, 15 patients (41%) in group I died; 11 patients (21%) in group II died. In group I, seven of the 15 deaths (47%) were sudden; in group II, nine of the 11 deaths (82%) occurred suddenly. Patients who died suddenly had a significantly higher peak oxygen consumption (14.0 +/- 3.5 ml/min/kg) than those who died of progressive congestive heart failure (11.0 +/- 3.1 ml/min/kg, p <0.05). Because the relative incidence of sudden death as opposed to death from progressive congestive heart failure decreases with the severity of congestive heart failure, the benefits of implantation of an automatic cardioverter defibrillator in prospective candidates for heart transplantation should be considered and weighed against the costs

3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

Hybrid imaging (HI) during cardiovascular interventions enables the peri-procedural visualization of the organs and tissues by means of integrating different imaging modalities. HI can improve the procedural efficacy and safety. This review provides an overview of different systems, their possibilities and the current clinical use and benefits focused on structural and congenital heart diseases. We have performed a literature search and linked the software options to the clinical use in cardiology to gain insight into the clinical use of the systems. In this review, we focus on radiation and contrast exposure, complication rate and procedure time. We found that currently available studies are limited by small cohorts. Nevertheless, HI systems for valvular procedures result in a significant decrease of radiation and contrast exposure. The largest benefit hereof is observed when HI is used in combination with rotational angiography. Furthermore, automatically determined optimal implant angle for transcatheter aortic valve implantation decreases the complication rate significantly. Congenital heart disease interventions that require 2D/3D Transoesophageal echocardiography (TEE) such as septal defects show a significant decrease in radiation and contrast exposure and procedural time when using TEE-Mono- and bi-plane cine angiography and fluoroscopy (XRF) fusion software. MitraClip procedures using these HI systems, however, show only a trend in decrease of these effects. In conclusion, major interventional X-ray vendors offer HI software solutions which are safe and can aid the planning and image guidance of cardiovascular interventions. Even though current HI technologies have limitations, HI provides support in the increasingly complex cardiac interventional procedures to provide better patient care

3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

Hybrid imaging (HI) during cardiovascular interventions enables the peri-procedural visualization of the organs and tissues by means of integrating different imaging modalities. HI can improve the procedural efficacy and safety. This review provides an overview of different systems, their possibilities and the current clinical use and benefits focused on structural and congenital heart diseases. We have performed a literature search and linked the software options to the clinical use in cardiology to gain insight into the clinical use of the systems. In this review, we focus on radiation and contrast exposure, complication rate and procedure time. We found that currently available studies are limited by small cohorts. Nevertheless, HI systems for valvular procedures result in a significant decrease of radiation and contrast exposure. The largest benefit hereof is observed when HI is used in combination with rotational angiography. Furthermore, automatically determined optimal implant angle for transcatheter aortic valve implantation decreases the complication rate significantly. Congenital heart disease interventions that require 2D/3D Transoesophageal echocardiography (TEE) such as septal defects show a significant decrease in radiation and contrast exposure and procedural time when using TEE-Mono- and bi-plane cine angiography and fluoroscopy (XRF) fusion software. MitraClip procedures using these HI systems, however, show only a trend in decrease of these effects. In conclusion, major interventional X-ray vendors offer HI software solutions which are safe and can aid the planning and image guidance of cardiovascular interventions. Even though current HI technologies have limitations, HI provides support in the increasingly complex cardiac interventional procedures to provide better patient care

Assessment of variation in immunosuppressive pathway genes reveals TGFBR2 to be associated with prognosis of estrogen receptor-negative breast cancer after chemotherapy

INTRODUCTION: Tumor lymphocyte infiltration is associated with clinical response to chemotherapy in estrogen receptor (ER) negative breast cancer. To identify variants in immunosuppressive pathway genes associated with prognosis after adjuvant chemotherapy for ER-negative patients, we studied stage I-III invasive breast cancer patients of European ancestry, including 9,334 ER-positive (3,151 treated with chemotherapy) and 2,334 ER-negative patients (1,499 treated with chemotherapy). METHODS: We pooled data from sixteen studies from the Breast Cancer Association Consortium (BCAC), and employed two independent studies for replications. Overall 3,610 single nucleotide polymorphisms (SNPs) in 133 genes were genotyped as part of the Collaborative Oncological Gene-environment Study, in which phenotype and clinical data were collected and harmonized. Multivariable Cox proportional hazard regression was used to assess genetic associations with overall survival (OS) and breast cancer-specific survival (BCSS). Heterogeneity according to chemotherapy or ER status was evaluated with the log-likelihood ratio test. RESULTS: Three independent SNPs in TGFBR2 and IL12B were associated with OS (P  C) (per allele hazard ratio (HR) 1.54 (95% confidence interval (CI) 1.22 to 1.95), P = 3.08 × 10⁻⁴) was not found in ER-negative patients without chemotherapy or ER-positive patients with chemotherapy (P for interaction  A) with poorer OS (HR 1.50 (95% CI 1.21 to 1.86), P = 1.81 × 10⁻⁴), and rs2853694 (A > C) with improved OS (HR 0.73 (95% CI 0.61 to 0.87), P = 3.67 × 10⁻⁴). Similar associations were observed with BCSS. Association with TGFBR2 rs1367610 but not IL12B variants replicated using BCAC Asian samples and the independent Prospective Study of Outcomes in Sporadic versus Hereditary Breast Cancer Study and yielded a combined HR of 1.57 ((95% CI 1.28 to 1.94), P = 2.05 × 10⁻⁵) without study heterogeneity. CONCLUSIONS: TGFBR2 variants may have prognostic and predictive value in ER-negative breast cancer patients treated with adjuvant chemotherapy. Our findings provide further insights into the development of immunotherapeutic targets for ER-negative breast cancer