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  • Ovid Technologies (Wolters Kluwer Health)  (52)
  • 1
    Online Resource
    Online Resource
    Development and Validation of a New Risk Prediction Score for Life-Threatening Ventricular Tachyarrhythmias in Laminopathies
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 140, No. 4 ( 2019-07-23), p. 293-302
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 140, No. 4 ( 2019-07-23), p. 293-302
    Abstract: An accurate estimation of the risk of life-threatening (LT) ventricular tachyarrhythmia (VTA) in patients with LMNA mutations is crucial to select candidates for implantable cardioverter-defibrillator implantation. Methods: We included 839 adult patients with LMNA mutations, including 660 from a French nationwide registry in the development sample, and 179 from other countries, referred to 5 tertiary centers for cardiomyopathies, in the validation sample. LTVTA was defined as (1) sudden cardiac death or (2) implantable cardioverter defibrillator–treated or hemodynamically unstable VTA. The prognostic model was derived using the Fine-Gray regression model. The net reclassification was compared with current clinical practice guidelines. The results are presented as means (SD) or medians [interquartile range]. Results: We included 444 patients, 40.6 (14.1) years of age, in the derivation sample and 145 patients, 38.2 (15.0) years, in the validation sample, of whom 86 (19.3%) and 34 (23.4%) experienced LTVTA over 3.6 [1.0–7.2] and 5.1 [2.0–9.3] years of follow-up, respectively. Predictors of LTVTA in the derivation sample were: male sex, nonmissense LMNA mutation, first degree and higher atrioventricular block, nonsustained ventricular tachycardia, and left ventricular ejection fraction (https://lmna-risk-vta.fr). In the derivation sample, C-index (95% CI) of the model was 0.776 (0.711–0.842), and the calibration slope 0.827. In the external validation sample, the C-index was 0.800 (0.642–0.959), and the calibration slope was 1.082 (95% CI, 0.643–1.522). A 5-year estimated risk threshold ≥7% predicted 96.2% of LTVTA and net reclassified 28.8% of patients with LTVTA in comparison with the guidelines-based approach. Conclusions: In comparison with the current standard of care, this risk prediction model for LTVTA in laminopathies significantly facilitated the choice of candidates for implantable cardioverter defibrillators. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03058185.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.118.039410
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Association Between Anxiety and New Organ Failure, Independently of Critical Illness Severity and Respiratory Status: A Prospective Multicentric Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Critical Care Medicine Vol. 48, No. 10 ( 2020-10), p. 1471-1479
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 10 ( 2020-10), p. 1471-1479
    Abstract: Anxiety results from the anticipation of a threat and might be associated with poor outcome in the critically ill. This study aims at showing that anxiety at admission in critically ill patients is associated with new organ failure over the first 7 days of ICU hospitalization independently of baseline organ failure at admission. Design: Prospective multicenter cohort study. Setting: Three mixed ICU from April 2014 to December 2017. Patients: Coma-, delirium-, and invasive mechanical ventilation-free patients admitted to the ICU were included. Interventions: None. Measurements and Main Results: “State anxiety” was assessed using the state component of the State-Trait Anxiety Inventory State. Severity of illness was measured using Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores. Primary endpoint was a composite of occurrence of death or new organ failure in the first 7 days after admission. Three hundred ninety-one patients were included; 159 of 391 women (40.7%); median age 63 years (49–74 yr); median Simplified Acute Physiology Score II 28 (19–37). Two hundred three out of 391 patients (51.9%) reported moderate to severe anxiety (State-Trait Anxiety Inventory State ≥ 40). One hundred two out of 391 patients (26.1%) developed a new organ failure. After adjustment to Simplified Acute Physiology Score II and Sequential Organ Failure Assessment, State-Trait Anxiety Inventory State greater than or equal to 40 was associated with the primary endpoint (odds ratio, 1.94; 95% CI, 1.18–3.18; p = 0.009) and respiratory failure. In post hoc analysis, State-Trait Anxiety Inventory State greater than or equal to 40 was associated with new organ failure independently and notably of respiratory status at admission (dyspnea-Visual Analogic Scale and Pa co 2 ≥ 45 mm Hg). Conclusions: Moderate to severe anxiety at ICU admission is associated with early occurrence of new organ failure in critically ill patients, independently of respiratory status and severity of critical illness. The causality link could be addressed in an interventional trial.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000004495
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2034247-0
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  • 3
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    Hemorrhagic Manifestations of Reversible Cerebral Vasoconstriction Syndrome : Frequency, Features, and Risk Factors
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 11 ( 2010-11), p. 2505-2511
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 11 ( 2010-11), p. 2505-2511
    Abstract: Background and Purpose— Reversible cerebral vasoconstriction syndrome (RCVS), characterized by severe headaches and reversible constriction of cerebral arteries, may be associated with ischemic and hemorrhagic strokes. The aim of this study was to describe the frequency, patterns, and risk factors of intracranial hemorrhages in RCVS. Methods— We analyzed prospective data on 89 consecutive patients with RCVS, of which 8 were postpartum and 46 used vasoactive substances. Standard bivariate and multivariate statistical tests were applied to compare patients with and without hemorrhage. Results— Thirty patients (34%), of which 5 were postpartum and 12 used vasoactive substances, developed at least 1 type of intracranial hemorrhage, including cortical subarachnoid (n=27), intracerebral (n=11), and subdural hemorrhage (n=2). Patients with hemorrhage had an older age (46.6 versus 41.6 years, P =0.049) and were more frequently females (90% versus 51%, P =0.0017) or were migrainers (43% versus 19%, P =0.022) than those without hemorrhage. Multivariate testing identified 2 independent risk factors of hemorrhage in RCVS: female gender (OR, 4.05; 95% CI, 1.46 to 11.2) and migraine (OR, 2.34; 95% CI, 1.06 to 5.18). Patients with hemorrhage had a greater risk of persistent focal deficits (30% versus 2%, P =0.0002), cerebral infarction (13% versus 2%, P =0.039), posterior reversible encephalopathy syndrome (17% versus 3%, P =0.041) at the acute stage, and of inability to resume normal activities at 6 months (27% versus 0%, P 〈 0.0001). Conclusion— In RCVS, women and migrainers seem to be at higher risk of intracranial hemorrhage. Overall, intracranial hemorrhages are frequent in RCVS and are associated with a more severe clinical spectrum.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.109.572313
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 1467823-8
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  • 4
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    MRI of Clot in Cerebral Venous Thrombosis : High Diagnostic Value of Susceptibility-Weighted Images
    Ovid Technologies (Wolters Kluwer Health) ; 2006
    In:  Stroke Vol. 37, No. 4 ( 2006-04), p. 991-995
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 4 ( 2006-04), p. 991-995
    Abstract: Background and Purpose— In cerebral venous thrombosis (CVT), the sensitivity of conventional MRI sequences to detect clot in the sinuses or veins is incomplete and largely depends on the time elapsed since thrombus formation. Little is known concerning the corresponding diagnostic value of fluid-attenuated inversion recovery (FLAIR), echo-planar T2* susceptibility-weighted imaging (T2*SW) or diffusion-weighted images (DWI). Methods— We performed a retrospective analysis of 114 MRI examinations from 39 patients with CVT using a structured assessment. The time course of sensitivity in the detection of clot (n=166 clots) was analyzed for different MR sequences using a multilevel logistic model. The sensitivity of different MR sequences for diagnosis of cortical venous thrombosis was tested separately (n=38 clots). Results— The sensitivity of T2*SW and T1-weighted spin echo image (T1SE) sequences to detect clot in the sinuses or veins was estimated at 90% and 71% between day 1 and day 3, which was much higher than that of T2SE, FLAIR or DWI during the first week of clinical onset. The sensitivity of T2*SW was stable in the first week. After this period, the sensitivity of T2*SW decreased less than that of T1SE. Thrombosed cortical veins, even in the absence of visible occlusion on magnetic resonance venography, were detected more frequently with T2*SW (97%) and T1SE (78%) than with FLAIR or DWI ( 〈 40%). Conclusions— T2*SW imaging appears to be of additional diagnostic value in CVT. The T2*SW sequence may be particularly useful during the acute phase of CVT when the sensitivity of the other sequences is incomplete and for the diagnosis of isolated cortical venous thrombosis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000206282.85610.ae
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2006
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Potential of Stratified Medicine for High Blood Pressure Management : A Modeling Study Using NHANES Survey Data
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Hypertension Vol. 74, No. 6 ( 2019-12), p. 1420-1427
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 74, No. 6 ( 2019-12), p. 1420-1427
    Abstract: The 2017 American College of Cardiology/American Heart Association hypertension guidelines lowered the thresholds for defining and treating hypertension. However, the SPRINT trial showed substantial heterogeneity in benefits and harms of intensive antihypertensive treatment depending on patients’ characteristics. We aimed at illustrating the potential gains of personalizing intensive antihypertensive treatment. Using the US National Health and Nutrition Examination Survey 2011 to 2014 (n=2067), and prediction models derived from the SPRINT trial, we computed expected benefits and harms of intensive antihypertensive treatment for individuals aged 50 or more. We compared 2 interventions: (1) intensive antihypertensive treatment for all individuals meeting the 2017 American College of Cardiology/American Heart Association thresholds and (2) a stratified medicine strategy excluding from intensive treatment individuals with predicted unfavorable benefit-risk. Outcome measures were model-predicted 5-year risk of cardiovascular events or death (myocardial infarction, acute coronary, stroke, acute decompensated heart failure, and cardiovascular-related death), and severe adverse events (hypotension, syncope, electrolyte abnormalities, bradycardia, and acute kidney injury). Per 2017 American College of Cardiology/American Heart Association guidelines, 40.1 million (39.2%) US individuals aged 50 or more should initiate or intensify antihypertensive treatment, thereby preventing cardiovascular events for 795 000 individuals and inducing severe adverse events for 848 000 over 5 years. A stratified treatment strategy could decrease the number of individuals treated by 21.2 million (52.9%) and reduce the number of individuals with severe adverse events by 38.3%, with 11.7% fewer individuals with cardiovascular events prevented. Personalizing antihypertensive treatment according to predicted benefits and harms could spare treatment for more than half individuals while reducing harms 3× more than benefits.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.119.13749
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2094210-2
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  • 6
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    Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Society of Nephrology Vol. 33, No. 3 ( 2022-03), p. 628-637
    Details
    In: Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 3 ( 2022-03), p. 628-637
    Abstract: Findings of the international prospective multicenter PEXIVAS trial challenge the role of PLEX in AAV. We conducted a retrospective study of 425 patients: 188 with AAV and renal failure treated with PLEX and 237 not treated. A score to identify patients who would benefit from PLEX was developed. With kidney biopsy data, scores more than seven achieved sensitivity and specificity of 83.1% and 96.0%, respectively, for recommending PLEX. The average effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. Patients in the PLEX-recommended group had microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score. These findings, which require independent validation, could provide guidance in selecting patients with AAV who will benefit from PLEX. Background Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. Methods We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). Results No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had 〉 5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (−15.9%; 95% CI, −29.4 to −2.5) compared with the PLEX not recommended group (−4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. Conclusions PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
    Type of Medium: Online Resource
    ISSN: 1046-6673 , 1533-3450
    URL: Article
    DOI: 10.1681/ASN.2021060771
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2029124-3
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  • 7
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    Editorial: Sparse-data Bias—What the Savvy Reader Needs to Know
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Clinical Orthopaedics & Related Research Vol. 476, No. 4 ( 2018-04), p. 657-659
    Details
    In: Clinical Orthopaedics & Related Research, Ovid Technologies (Wolters Kluwer Health), Vol. 476, No. 4 ( 2018-04), p. 657-659
    Type of Medium: Online Resource
    ISSN: 0009-921X
    URL: Article
    DOI: 10.1007/s11999.0000000000000228
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2018318-5
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  • 8
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    Initial Liver Involvement in Acute GVHD is Predictive for Nonrelapse Mortality
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Transplantation Vol. 88, No. 9 ( 2009-11-15), p. 1131-1136
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 9 ( 2009-11-15), p. 1131-1136
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/TP.0b013e3181bc2583
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2035395-9
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  • 9
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    Clinical Severity Scores in Gastrointestinal Graft-Versus-Host Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Transplantation Vol. 97, No. 9 ( 2014-05-15), p. 965-971
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 9 ( 2014-05-15), p. 965-971
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/01.TP.0000438209.50089.60
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2035395-9
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  • 10
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    Plasma cortisol levels in Guillain-Barré syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Critical Care Medicine Vol. 37, No. 8 ( 2009-08), p. 2436-2440
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 8 ( 2009-08), p. 2436-2440
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0b013e3181a0fdfc
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2034247-0
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