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  • Ovid Technologies (Wolters Kluwer Health)  (27)
  • 1
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    Online Resource
    Abstract 16375: The Association Between Pregestational Hypertension and Cardiovascular Events in Pregnant Females, a Population-based Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Pregestational hypertension is associated with poor fetal and maternal outcomes, however, the impact on maternal cardiovascular outcomes is not well defined. In this study, we aim to study the impact of pregestational hypertension on maternal cardiovascular outcomes. Methods: Pregnant women hospitalized from January 2016 to December 2017 were identified in the Nationwide Inpatient Sample. Pregnant females with pregestational hypertension were identified using AHRQ comorbidity measures. Outcomes of interest were mortality, myocardial infarction (MI), and stroke. Multivariate regression analysis adjusting for differences in baseline comorbidities was used for odds ratio (OR) and 95% confidence interval (CI). Results: Among 8,141,277 pregnant women, 224,295 (2.76%) had pregestational hypertension. Pregnant females with pregestational hypertension were significantly older (mean age of 31.52 +/- 6.03 vs. 28.65 +/- 5.84, p-value 〈 0.001), and had a higher burden of comorbidities includingpregestational diabetes mellitus (10.4% vs. 1.1%, p-value 〈 0.001), gestational diabetes (26.3% vs. 8.1%, p-value 〈 0.001), obesity (27.6% vs. 7.7%, p-value 〈 0.001), smoking (16.4% vs. 9.8%,p-value 〈 0.001), hyperlipidemia (2.1% vs. 0.2%, p-value 〈 0.001), and depression; 6.6% vs. 3.0%, p-value 〈 0.001. Females with pregestational hypertension had more cesarean section; 46.6% vs. 29.2%, p-value 〈 0.001, intra-uterine death; 1.3% vs. 0.4%, p-value 〈 0.001, and spontaneous abortion; 0.6% vs. 0.3%, p-value 〈 0.001. Pregetational hypertension had higher mortality rate (55.7 vs. 10.1 per 100,000 hospitalizations, p-value 〈 0.001), MI rate (207.3 vs. 9.3 per 100,000 hospitalizations, p-value 〈 0.001), and stroke rate (288.4 vs. 22.6 per 100,000 hospitalizations, p-value 〈 0.001). Pregestational hypertension was associated with significantly worse outcomes including in-hospital mortality (aOR 3.01, 95% CI 2.48-3.67), MI (aOR 8.27, 95% CI 7.30-9.35), and stroke (aOR 9.31, 95% CI 8.47-10.24). Conclusions: Pregestational hypertension is associated with poor maternal cardiovascular outcomes in pregnancy. Further efforts should be directed to identifying high-risk females and better approaches to management are warranted.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.16375
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Abstract P869: Racial Disparities in Pregnancy-Associated Stroke, a US Nationwide Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Introduction: Pregnancy-associated stroke (PAS) is a rare event but is associated with high morbidity and mortality. Understanding racial disparities in outcomes may help improve care in susceptible populations and shed light on areas of possible targeted improvement. Methods: Pregnant and post-partum women hospitalized from January 2002 to December 2017 were identified from the Nationwide Inpatient Sample. White and Black women were included in the current study. PAS was identified using the International Classification of Diseases (ICD) 9 and 10 revisions. In-hospital mortality was the primary outcome. Multivariate regression analysis was used for Adjusted Odds Ratio (aOR) and 95% Confidence Interval (CI) to adjust for differences in baseline and pregnancy-related comorbidities. Results: Among 38,797,752 pregnant and post-partum women, 21.9% were black. A total of 10,959 women (0.03%) suffered from PAS. Of women with PAS, 4,521 (41.3%) were Black. Black women with PAS had a higher in-hospital mortality rate compared to white women (7.8% vs. 5.0%, P 〈 0.001). A significant disparity was noted in the risk of mortality by age groups where black women of ages 18-24 with PAS had a higher aOR of mortality 2.10, 95% (confidence interval) CI (1.88-2.35) compared to white women, ages 25-29 had aOR of 2.75, 95% CI (2.46-3.07), ages 30-34 had aOR of 3.94, 95% CI (3.50-4.43), ages 35-40 had aOR of 3.73, 95% CI (3.25-4.29), and ages 40 and older had aOR of 1.27, 95% CI (1.08-1.51). A significant difference was noted when stratifying outcome by income as black women in the lowest quartile of income had an aOR of 1.91, 95% CI (1.74-2.10), while those in the highest quartile of income had OR of 2.38, 95% CI (2.02-2.80). Conclusions: Black women with PAS were associated with higher in-hospital mortality compared with the White counterparts. These differences were observed mainly among the younger age groups. Targeted interventions are needed to minimize these observed racial differences.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P869
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Abstract 13923: Incidence and Outcomes of Infective Endocarditis After 180 Days in Transcatheter Aortic Valve Replacement and Mitraclip
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Background: Infective endocarditis (IE) after Transcatheter aortic valve replacement (TAVR) and Mitra Clip (MC) occurs less commonly but is associated with grave complications. We aim to report the incidence and outcomes of IE within 180 days of TAVR and MC. Methods: We used the Nationwide Readmissions Database (NRD) between 2014 and 2017 to select patients who underwent either TAVR or MC between January and June every year (to allow for at least 180 days of follow up in the NRD) using the appropriate International Classification of Diseases-9 th and 10 th revision (ICD) codes. We performed a chi-square test to compare baseline characteristics and rates of IE after TAVR and MC procedures. All statistical analyses were performed the using SPSS version 26. Results: We included 68,270 and 7,080 patients who underwent TAVR and MC respectively, of which 0.68% vs. 0.94% (P=.012), developed IE respectively within 180 days of procedure. During that index hospitalization, in-hospital mortality rates did not differ between the two groups (15.08% in TAVR vs. 17.91%, in MC P=.587). Other outcomes are presented in table 1. Conclusion: Our study suggests that the overall incidence of IE following TAVR and MC is relatively low but appropriate preventive measures should be taken after the procedures to reduce the morbidity and mortality. Further studies and analysis are required in modern MC and TAVR techniques to circumvent this critical complication.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13923
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 4
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    Abstract 14682: Impact of Atrial Fibrillation in Aortic Stenosis Patients: Insights From the United States Readmissions Database
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Even though atrial fibrillation (AF) is present in 〉 30% of patients with aortic stenosis (AS), it is not typically included in the decision-making algorithm for the timing or need for aortic valve replacement (AVR), either by transcatheter (TAVR) or surgical (SAVR) approaches. Large scale data on how AF affects outcomes of AS patients remain scarce. Methods: From the Nationwide Readmissions Database (NRD), we retrospectively identified AS patients aged ≥18years, with and without AF admitted between January and June in 2016 and 2017 (to allow for a six month follow up), using the International Classification of Diseases-10 th revision codes. Multivariable logistic regression was performed to examine the predictors of in-hospital mortality during index hospitalization. In-hospital complications and 6 month in-hospital mortality during any readmission after being discharged alive were compared in patients with and without AF, for patients undergoing TAVR, SAVR or no-AVR. Results: We identified 403,089 AS patients, of which 41% had AF. Patients with AF were older (median age in years: 83 vs. 79) and were more frequently females (52% vs. 48%; p 〈 0.001). Table summarizes outcomes of AS patients with and without AF. TAVR in patients with AF was associated with higher in-hospital mortality and follow-up mortality as compared to patients without AF. Although AF did not influence in-hospital mortality in SAVR population, follow-up mortality was also significantly higher after SAVR in patients with AF compared to patients without AF. For patients not undergoing AVR, in-hospital and follow-up mortality were higher in AF population compared to no AF and was higher than patients undergoing AVR (Table). Conclusions: AF is associated with worse outcomes in patients with AS irrespective of treatment (TAVR, SAVR or no-AVR). More studies are needed to understand the implications of AF in AS population and whether earlier treatment of AS in patients with AF can improve outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.14682
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 5
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    Abstract 14579: Impact of Hospital MitraClip Volume on Short-term Outcomes of Transcatheter Mitral Valve Replacement
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Transcatheter mitral valve replacement (TMVR) is an alternative to surgical mitral valve replacement for patients at prohibitive or high surgical risk. Both transseptal TMVR and MitraClip procedures require transseptal puncture and subsequent manipulation of a catheter within the left atrium and ventricle. Hypothesis: Higher MitraClip experience leads to better procedural outcomes of transseptal TMVR. Methods: We retrospectively identified patients who underwent transseptal-TMVR using the Nationwide Readmissions Database 2016-2017. We defined hospital volume as the annual number of MitraClip cases in each hospital and categorized hospitals into high- (≥26 cases/year) and low- ( 〈 26 cases/year) volume groups by the median value. We compared the in-hospital and 30-day outcomes between the two groups. Results: A total of 1,023 TMVR patients (median 74 years; female 56.1%) were divided into the high- (n=487) and low- (n=536) volume groups. The high-volume group had a higher prevalence of prior valve implantation (30.8% vs. 24.8%; p=0.036), prior coronary artery bypass grafting (28.7% vs. 22.7%; p=0.031), and heart failure (86.7% vs. 79.5%; p=0.003) than the low-volume group. There was no significant difference in the rates of in-hospital death (9.0% vs. 9.5%; p=0.830), stroke (2.1% vs. 3.2%; p=0.330), and pacemaker implantation (2.5% vs. 4.5%; p=0.091), while surgical bailout was less frequent in the high-volume group (2.5% vs. 6.5%; p=0.002). Multivariable logistic regression analyses showed that high volume was significantly associated with a lower risk of surgical bailout, prolonged hospital stay, cardiovascular-cause readmission, but not with other outcomes including in-hospital death (Figure). Conclusions: Centers with greater MitraClip experience had a lower risk of surgical bailout, prolonged hospital stay, and early readmission after transseptal-TMVR, although mortality was high irrespective of MitraClip experience.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.14579
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Abstract 12850: Isolated and Assisted Transcatheter Coil Embolization of Coronary Artery Lesions: The Cleveland Clinic Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Transcatheter coil embolization (TCE) has been introduced as a modality in treating several coronary artery lesions including coronary artery fistula (CAF), patent left internal mammary artery (LIMA) side branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) is limited. Hypothesis: TCE is underutilized in various coronary lesions despite its efficacy. Methods: This is a retrospective, descriptive study of all adult patients who underwent TCE at the Cleveland Clinic between August 2007 and August 2019. A total of 41 patients, including 25 CAF, 7 patent LIMA side branches, 5 CAP, 2 CAA, and 2 CAPA from a total of 121,196 cases, were studied. Results: Successful angiographic closure was performed in 37 out of 41 (90%) cases (100% ,100% ,100%, 88%, 80%, of patent LIMA side branch ,CAA, CAPA, CAF, CAP, respectively). Ampatzer vascular plug was used as an adjunctive device in 10% of the total cohort. No adverse events were directly associated with TCE among the LIMA, CAA, and CAPA lesions, and only one patient with CAF required re-intervention at three months due to coil migration. One patient with a large CAP of the mid-left anterior descending artery died while hospitalized due to cardiogenic shock despite successful embolization. Conclusions: Transcatheter Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with successful angiographic results in 90% of treated cases. Additional study on the utilization of vascular plug devices in cases such as LIMA side branch or CAF would be beneficial to better understand the treatment options.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.12850
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 7
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    Stress induced cardiomyopathy complicated by cardiogenic shock: A non-survivor case
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  The Egyptian Journal of Critical Care Medicine Vol. 6, No. 3 ( 2018-12), p. 131-132
    Details
    In: The Egyptian Journal of Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 3 ( 2018-12), p. 131-132
    Type of Medium: Online Resource
    ISSN: 2090-7303
    URL: Article
    DOI: 10.1016/j.ejccm.2018.12.018
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2814835-6
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  • 8
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    Secondary Prophylaxis of Gastric Variceal Bleeding: A Systematic Review and Network Meta‐Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Liver Transplantation Vol. 28, No. 6 ( 2022-06), p. 945-958
    Details
    In: Liver Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 6 ( 2022-06), p. 945-958
    Type of Medium: Online Resource
    ISSN: 1527-6465 , 1527-6473
    URL: Article
    DOI: 10.1002/lt.26383
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2002186-0
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  • 9
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    Abstract 11507: Radiation Reduction in Catheterization Laboratory: Single Center Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Radiation reduction measures were incorporated in the Cleveland Clinic Catheterization laboratories to mitigate the hazards from radiation exposure to patients and personnel during diagnostic and interventional coronary procedures. We report our experience with these improved systems over a 10-year period. Methods: Fluoroscopes were modified in 2013 by reducing the default fluoroscopic pulse rate from 10 to 7.5 pules/s, added default low-dose acquisitions, revised field-of-view dose factors, and instructed operators to use larger fields-of-view with appropriate collimation. A retrospective data analysis of all patients undergoing diagnostic catheterization from 2009 to 2012 (pre-initiative group), and 2013 to 2019 (post-initiative group) was done using Siemens CARE analytics software. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (K a,r ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups after propensity matching them based on age, sex, BSA, and total fluoroscopic time. Results: The total fluoroscopic time for the pre-initiative group (N=18,181) was 8.02 seconds while that for the post-initiative group (N=25,868) was 8.05 seconds. After matching 18,181 patients in both the groups (mean age, 64 years; 62% males), a significant reduction (54.4%) in the mean K a,r was observed in the post- in comparison to the pre-initiative group (420.94 mGy vs. 921.21 mGy; p 〈 2.2e -16 ). Further analysis revealed a reduction in the mean acquisition- (59.3%; 217.33 mGy vs. 533.50 mGy; p 〈 2.2e -16 ) and fluoroscopy-mode (47.5%; 203.61 mGy vs. 387.71 mGy; p 〈 2.2e -16 ) air kerma in the post-initiative group. A sub-analysis of patients matched on the basis of their exact fluoroscopy and acquisition times also revealed a significant reduction in K a,r , acquisition- and fluoroscopy-mode air kerma in the post-initiative group relative to the pre-initiative group (43.95%, 44.04%, 43.78% respectively). Conclusions: Optimization of imaging systems can significantly reduce patient radiation exposures which directly affect the radiation exposure of the Cath lab personnel. Similar algorithms can be applied in other labs to achieve a reduction in radiation exposure.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.11507
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Abstract 10945: Risk Stratification and Prediction of Acute Myocardial Infarction Events Patients of Connective Tissue Disorders
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Connective tissue disorders (CTD) play an important role in the pathogenesis of atherosclerotic heart disease with a dynamic interplay between inflammatory and traditional cardiovascular risk factors. Hypothesis: We aim to develop, validate, and compare population-level machine learning models to predict the first acute myocardial infarction (AMI) event in CTD. Methods: We extracted patient data from the Healthcare Cost and Utilization Project (HCUP) and identified 62 demographic and clinical variables. We identified those with systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed connective tissue disorder, Sjogren’s syndrome, polymyositis, and dermatomyositis. We excluded those with prior history of myocardial infarction, known coronary artery disease, or missing key variables. We split the records randomly into training (70%) and testing (30%) datasets. Keras sequential model with Adadelta optimizer was used to compile the deep neural network model and scikit-learn classifiers were used for machine learning models. We estimated model performance based on the area under the receiver-operator characteristics curve (AUC). Results: 961,405 records were identified, and out of these, 14,961 (1.6%) had the first AMI event. The neural network model performed best in predicting AMI with an AUC:0.96 [A]. Classifier models had varying degrees of success range from 0.71 to 0.86 with Gradient Boosting Classifier, AUC:0.86 [B] , being the best performing classifier, followed by Decision Tree, AUC:0.85, Logistic regression, AUC:0.84, Random Forest, AUC:0.84, Naive Bayes, AUC:0.75, Stochastic Gradient Descend, AUC: 0.71. Conclusions: A neural network model was able to predict the first AMI in people with CTD accurately. Developing and implementing machine learning models can help clinicians predict individual patient risk with a high degree of success.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.10945
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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