-
1
المؤلفون: Lorne J. Gula, Asher Frydman, Habib R. Khan, George J. Klein, Peter Leong-Sit, Jaimie Manlucu, Jason D. Roberts, Anthony S.L. Tang, Raymond Yee, Allan C. Skanes
المصدر: The Canadian journal of cardiology. 38(8)
مصطلحات موضوعية: Aged, 80 and over, Male, Electric Countershock, Arrhythmias, Cardiac, Stroke Volume, Middle Aged, Ventricular Function, Left, Defibrillators, Implantable, Ventricular Fibrillation, Tachycardia, Ventricular, Humans, Female, Cardiology and Cardiovascular Medicine, Aged
الوصف: Patients with hemodynamically tolerated ventricular tachycardia (VT) and minimally reduced left ventricular ejection fraction (LVEF) remain a group that presents a prognostic and therapeutic dilemma.We studied patients from our implanted cardioverter-defibrillator (ICD) database who received ICDs for hemodynamically tolerated VT and mildly reduced LVEF (36%-49%) at time of implant between May 2015 and December 2019. Time to appropriate ICD therapy was assessed. Clinical features associated with recurrent VT/ventricular fibrillation (VF) with ICD therapies were explored using binary logistic regression.Among 2037 ICDs placed between May 2015 and December 2019, 64 subjects met the inclusion criteria. The mean age of the study group was 68 ± 12 years, and 58 (90.6%) subjects were male. Average ejection fraction was 40% ± 4.4 (range 36%-49%). Twenty-two (34%) subjects received antitachycardia pacing (ATP) for VT at 229 ± 265 days after ICD placement. Fifteen (23%) subjects received appropriate ICD shocks 305 ± 321 days after implant. The rate of recurrent VT/VF among the 37 patients with ICD therapy was 195 ± 39 beats per minute (bpm). This was significantly more rapid than initial presenting VT rates before ICD placement (183 ± 27 bpm) (P = 0.048). Multivariate analysis showed no factors independently associated with recurrent VT/VF.Patients with mildly impaired LV function and hemodynamically tolerated VT receive appropriate ICD therapies over the 3 years following implant. This patient group warrants further investigation, as their recurrent VT/VF rates can be much more rapid, and 23% go on to receive appropriate ICD shocks.
-
2
المؤلفون: Luc Harvey, E. Marc Jolicoeur, Stephen B. Wilton, Wei Qi, Camille Galloway, Sarah Singh, Rebecca Fromm, Benoit Plourde, Peter Leong-Sit, Rozsa Sas, Brady Robinson, Chantale Mercure, Matthew T. Bennett, Umjeet S Jolly, Lynn Nymann, Isabelle Roy, Marina Sanchez, Nancy Hiltz, Bernice Tsang, Erick Schampaert, Marc W. Deyell, Mary Radyk, Stephanie J. Frisbee, Vincent Spagnoli, Robert MacLachlan, Ratika Parkash, Sabrina Wall, Evan Lockwood, Katherine M. Kavanagh, Jaimie Manlucu, Nicole Ell, Derek S. Chew, Frank Halperin, Elisa Ramser, C. Seifer
المصدر: JAMA Network Open
مصطلحات موضوعية: Male, medicine.medical_specialty, Canada, Time Factors, medicine.medical_treatment, Cardiology, Myocardial Infarction, Revascularization, Ventricular Function, Left, Sudden cardiac death, Cohort Studies, Ventricular Dysfunction, Left, Risk Factors, Internal medicine, medicine, Humans, Myocardial infarction, cardiovascular diseases, Cardiac imaging, Cardiac catheterization, Original Investigation, Ejection fraction, business.industry, Research, Stroke Volume, General Medicine, Middle Aged, medicine.disease, Prognosis, humanities, Online Only, Treatment Outcome, Heart failure, cardiovascular system, Female, business, circulatory and respiratory physiology, Cohort study
الوصف: Key Points Question What proportion of patients with left ventricular dysfunction identified during hospitalization for acute myocardial infarction have follow-up assessment of left ventricular ejection fraction (LVEF)? Findings In this cohort study of 501 patients, 303 patients had undergone LVEF reassessment by 6 months, with significant variability according to patient-level and site-level characteristics. Meaning These findings suggest that programs to improve the quality of post–myocardial infarction care should include measures to ensure that indicated repeat cardiac imaging is performed.
This cohort study assesses adherence with guideline-recommended left ventricular ejection fraction (LVEF) reassessment after myocardial infarction and studies the evolution of LVEF over 6 months of follow-up in the Acute Myocardial Infarction Quality Assurance (AMIQA) Canada study.
Importance Persistently depressed left ventricular ejection fraction (LVEF) after myocardial infarction (MI) is associated with adverse prognosis and directs the use of evidence-based treatments to prevent sudden cardiac death and/or progressive heart failure. Objective To assess adherence with guideline-recommended LVEF reassessment and to study the evolution of LVEF over 6 months of follow-up. Design, Setting, and Participants This was a multicenter cohort study at Canadian academic and community hospitals with on-site cardiac catheterization services. Patients with type 1 acute MI and LVEF less than or equal to 45% during the index hospitalization were enrolled between January 2018 and August 2019 and were followed-up for 6 months. Data analysis was performed from May 2020 to September 2021. Exposures Baseline clinical factors, in-hospital care and LVEF, and site-specific features. Main Outcomes and Measures The main outcomes were receipt of repeat LVEF assessment by 6 months and the presence of a persistent LVEF reduction at 2 thresholds: LVEF less than or equal to 40%, prompting consideration of additional medical therapy for heart failure, or LVEF less than or equal to 35%, prompting referral for implanted cardioverter defibrillator in addition to medical therapy. Results This study included 501 patients (mean [SD] age, 63.3 [13.0] years; 113 women [22.6%]). Overall, 370 patients (73.4%) presented with STEMI, and 454 (90.6%) had in-hospital revascularization. The median (IQR) baseline LVEF was 40% (34%-43%). Of 458 patients (91.4%) who completed the 6-month follow-up, 303 (66.2%; 95% CI, 61.7%-70.5%) had LVEF reassessment, with a range of 46.7% to 90.0% across sites (χ213 = 19.6; P = .11). Participants from community hospitals were more likely than those from academic hospitals to undergo LVEF reassessment (73.6% vs 63.2%; χ21 = 4.50; P = .03), as were those with worse LVEF at baseline. Follow-up LVEF improved by an absolute median (IQR) of 8% (3%-15%). However, 103 patients (34.1%) met the definitions of clinically relevant LVEF reduction, including 52 patients (17.2%) with LVEF less than or equal to 35% and 51 patients (16.9%) with LVEF of 35.1% to 40.0%. Conclusions and Relevance In this cohort study, approximately 1 in 3 patients with at least mild LVEF reduction after acute MI did not undergo indicated LVEF reassessment within 6 months, suggesting that programs to improve the quality of post-MI care should include measures to ensure that indicated repeat cardiac imaging is performed. In those with follow-up imaging, clinically relevant persistent LVEF reduction was identified in more than one-third of patients. -
3
المؤلفون: Leon H.R. Bouwels, Jia Wang, Carlos A. Morillo, Claus Rinne, Michel Degrâce, Philippe Gervais, David H. Birnie, François Philippon, Jaimie Manlucu, Martin E.W. Hemels, Matthew T. Bennett, Ratika Parkash, Stuart J. Connolly, Felix Ayala-Paredes, Leon Rioux, Derek V. Exner, Vidal Essebag, Satish Toal, Stanley Tung, Marco Alings, Damian P. Redfearn, Benoit Coutu, Paul Angaran, Omar Sultan, Yves Longtin, R. Aaron Low, Giuliano Becker, Paul Dorian, Eugene Crystal, Jamil Bashir, Bernard Thibault, Andrew D. Krahn, John LeMaitre
المصدر: Journal of the American College of Cardiology, 74, 23, pp. 2845-2854
Journal of the American College of Cardiology, 74, 2845-2854مصطلحات موضوعية: Male, Canada, Pacemaker, Artificial, medicine.medical_specialty, Prosthesis-Related Infections, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Renal function, 030204 cardiovascular system & hematology, Disease cluster, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Aged, Cross-Over Studies, Framingham Risk Score, business.industry, Incidence, Cardiac implanted, Arrhythmias, Cardiac, Antibiotic Prophylaxis, Implantable cardioverter-defibrillator, Crossover study, Confidence interval, Defibrillators, Implantable, Hospitalization, Cohort, Female, Cardiology and Cardiovascular Medicine, business
الوصف: Item does not contain fulltext BACKGROUND: Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. OBJECTIVES: This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. METHODS: In brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. RESULTS: Device procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (>/=7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. CONCLUSIONS: This study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911).
-
4
المؤلفون: Antoine Leenhardt, Shubhayan Sanatani, Susan P. Etheridge, Caitlin Brateng, Tomas Robyns, Isabelle Denjoy, Christopher Semsarian, Allan C. Skanes, Andrea Mazzanti, Jaimie Manlucu, Natalia Jura, Rahul C. Deo, Sean Connors, Andrew D. Krahn, Seshadri Balaji, Benjamin Pang, Michael J. Ackerman, Robert M. Hamilton, Julia Cadrin-Tourigny, Jason D. Roberts, Craig T. January, Arthur A.M. Wilde, Anthony Tang, Alice Maltret, Erron W. Titus, J. Martijn Bos, Silvia G. Priori, Dominic Abrams, Jeremy Wu, Martin S. Green, Frederick H. Deiter, Julie Rutberg, Jodie Ingles, Kevin Ng, Jeff S. Healey, Jan Till, Krystien V.V. Lieve, Lee L. Eckhardt, Christian van der Werf, Stephen A. Duffett, Peter S. Fischbach, Kathryn K. Collins, Kathleen R. Maginot, Kate M. Orland, Thomas M. Roston, Ferran Rosés I. Noguer, Linda M. Knight, Michael H. Gollob, Melvin M. Scheinman, Christian Steinberg
المساهمون: Graduate School, ACS - Heart failure & arrhythmias, Cardiology, CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
المصدر: Circulation
Circulation, 142(10), 932-947. Lippincott Williams and Wilkins
Circulation, American Heart Association, 2020, 142 (10), pp.932-947. ⟨10.1161/CIRCULATIONAHA.120.045723⟩
Circulation, vol 142, iss 10مصطلحات موضوعية: Male, [SDV]Life Sciences [q-bio], Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, Bioinformatics, 0302 clinical medicine, Risk Factors, Tachycardia, 2.1 Biological and endogenous factors, Inheritance Patterns, Medicine, genetics, Aetiology, Death sudden cardiac, 0303 health sciences, catecholaminergic polymorphic ventricular tachycardia, Homozygote, 3. Good health, Heart Disease, Public Health and Health Services, Female, Cardiology and Cardiovascular Medicine, arrhythmias, Heterozygote, cardiac, Clinical Sciences, Mutation, Missense, Catecholaminergic polymorphic ventricular tachycardia, Article, 03 medical and health sciences, Clinical Research, death, Physiology (medical), Genetics, Calsequestrin, Humans, 030304 developmental biology, sudden, business.industry, death, sudden, cardiac, Ventricular, Genetic variants, arrhythmias, cardiac, medicine.disease, Cardiovascular System & Hematology, Mutation, Tachycardia, Ventricular, Missense, Autosomal recessive form, business
الوصف: Background:Genetic variants in calsequestrin-2 (CASQ2) cause an autosomal recessive form of catecholaminergic polymorphic ventricular tachycardia (CPVT), although isolated reports have identified arrhythmic phenotypes among heterozygotes. Improved insight into the inheritance patterns, arrhythmic risks, and molecular mechanisms ofCASQ2-CPVT was sought through an international multicenter collaboration.Methods:Genotype-phenotype segregation inCASQ2-CPVT families was assessed, and the impact of genotype on arrhythmic risk was evaluated using Cox regression models. Putative dominantCASQ2missense variants and the established recessive CASQ2-p.R33Q variant were evaluated using oligomerization assays and their locations mapped to a recent CASQ2 filament structure.Results:A total of 112 individuals, including 36 CPVT probands (24 homozygotes/compound heterozygotes and 12 heterozygotes) and 76 family members possessing at least 1 presumed pathogenicCASQ2variant, were identified. AmongCASQ2homozygotes and compound heterozygotes, clinical penetrance was 97.1% and 26 of 34 (76.5%) individuals had experienced a potentially fatal arrhythmic event with a median age of onset of 7 years (95% CI, 6–11). Fifty-one of 66CASQ2heterozygous family members had undergone clinical evaluation, and 17 of 51 (33.3%) met diagnostic criteria for CPVT. Relative toCASQ2heterozygotes,CASQ2homozygote/compound heterozygote genotype status in probands was associated with a 3.2-fold (95% CI, 1.3–8.0;P=0.013) increased hazard of a composite of cardiac syncope, aborted cardiac arrest, and sudden cardiac death, but a 38.8-fold (95% CI, 5.6–269.1;PCASQ2missense variants evaluated exhibited filamentation defects, but only p.R33Q convincingly failed to dimerize. Structural analysis revealed that 3 of these 6 putative dominant negative missense variants localized to an electronegative pocket considered critical for back-to-back binding of dimers.Conclusions:This international multicenter study ofCASQ2-CPVT redefines its heritability and confirms that pathogenic heterozygousCASQ2variants may manifest with a CPVT phenotype, indicating a need to clinically screen these individuals. A dominant mode of inheritance appears intrinsic to certain missense variants because of their location and function within the CASQ2 filament structure.
وصف الملف: application/pdf
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4f65dd090adfafecad5435b8af35536a
https://europepmc.org/articles/PMC7484339/ -
5
المؤلفون: Bishoy Deif, Michael Mikhail, William F. McIntyre, John L. Sapp, Jeff S. Healey, Jaimie Manlucu, Anthony Tang, Fahad Almehmadi, Brennan Ballantyne, Jason D. Roberts, Peter Leong-Sit, Raymond Yee
المصدر: Cardiovascular Research. 114:1435-1444
مصطلحات موضوعية: Male, medicine.medical_specialty, genetic structures, Physiology, medicine.medical_treatment, Clinical Decision-Making, Electric Countershock, Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, Risk Assessment, Ventricular Function, Left, Cardiac Resynchronization Therapy, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Physiology (medical), Internal medicine, Humans, Medicine, Cardiac Resynchronization Therapy Devices, cardiovascular diseases, 030212 general & internal medicine, Ventricular remodeling, Prospective cohort study, Aged, Heart Failure, Ventricular Remodeling, business.industry, Arrhythmias, Cardiac, Retrospective cohort study, Middle Aged, medicine.disease, Confidence interval, Defibrillators, Implantable, Treatment Outcome, Meta-analysis, Relative risk, Heart failure, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
الوصف: Aims Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and heart failure (HF) hospitalization but its effects on the rate of ventricular arrhythmias (VAs) appears to be neutral. We hypothesize that CRT with LV epicardial stimulation is inherently pro-arrhythmic and increases VA rates in the absence of reverse ventricular remodelling while conferring an anti-arrhythmic effect in mechanical responders. Methods and results In this systematic review and meta-analysis, we considered retrospective cohort, prospective cohort, and randomized controlled trials comparing VA rates between cardiac resynchronization therapy-defibrillator (CRT-D) non-responders, CRT-D responders and those with implantable cardioverter-defibrillator (ICD) only. Studies were eligible if they defined CRT-D responders using a discrete left ventricular volumetric value as assessed by any imaging modality. Studies were identified through searching electronic databases from their inception to July 2017. We identified 2579 citations, of which 23 full-text articles were eligible for final analysis. Our results demonstrated that CRT-D responders were less likely to experience VA than CRT-D non-responders, relative risk (RR) 0.49 [95% confidence interval (CI) 0.41-0.58, P
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e9cea3a27cd67c65726eb6411789661a
https://doi.org/10.1093/cvr/cvy182 -
6
المؤلفون: George A. Wells, Jodi Koehler, Raymond Yee, Lorne J. Gula, Jaimie Manlucu, Anthony Tang, Eduardo N. Warman, Vinod Sharma
المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
مصطلحات موضوعية: Male, Prognostic factor, medicine.medical_specialty, medicine.medical_treatment, Population, Electric Countershock, 02 engineering and technology, 030204 cardiovascular system & hematology, implantable cardioverter‐defibrillator, Risk Assessment, Cardiac Resynchronization Therapy, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Risk Factors, Internal medicine, Atrial Fibrillation, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, In patient, Cardiac Resynchronization Therapy Devices, education, Cardiac device, prognostic factor, Original Research, Aged, Heart Failure, education.field_of_study, model, business.industry, 020208 electrical & electronic engineering, Stroke Volume, device diagnostics, Middle Aged, Implantable cardioverter-defibrillator, medicine.disease, Prognosis, mortality, 3. Good health, Defibrillators, Implantable, Heart failure, Cardiology, Female, Mortality/Survival, Cardiology and Cardiovascular Medicine, business, Value (mathematics)
الوصف: Background Heart failure remains a leading cause of morbidity and mortality. Clinical prediction models provide suboptimal estimates of mortality in this population. We sought to determine the incremental value of implantable device diagnostics over clinical prediction models for mortality. Methods and Results RAFT (Resynchronization/Defibrillation for Ambulatory Heart Failure Trial) patients with implanted devices capable of device diagnostic monitoring were included, and demographic and clinical parameters were used to compute Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) heart failure risk scores. Patients were classified according to MAGGIC score into low (0–16), intermediate (17–24), or high (>24) risk groups. Mortality was evaluated from 6 months postimplant in accordance with the RAFT protocol. In a subset of 1036 patients, multivariable analysis revealed that intermediate and high MAGGIC scores, fluid index, atrial fibrillation, and low activity flags were independent predictors of mortality. A device‐integrated diagnostic parameter that included a fluid index flag and either a positive atrial fibrillation flag or a positive activity flag was able to significantly differentiate higher from lower risk for mortality in the intermediate MAGGIC cohort. The effect was more pronounced in the high‐risk MAGGIC cohort, in which device‐integrated diagnostic–positive patients had a shorter time to death than those who were device‐integrated diagnostic negative. Conclusions Device diagnostics using a combination of fluid index trends, atrial fibrillation burden, and patient activity provide significant incremental prognostic value over clinical heart failure prediction scores in higher‐risk patients. This suggests that combining clinical and device diagnostic parameters may lead to models with better predictive power. Whether this risk is modifiable with early medical intervention would warrant further studies. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00251251.
-
7
المؤلفون: Dominique, de Waard, Jaimie, Manlucu, Anne M, Gillis, John, Sapp, Jordan, Bernick, Steve, Doucette, Anthony, Tang, George, Wells, Ratika, Parkash
المصدر: JACC. Clinical electrophysiology. 5(9)
مصطلحات موضوعية: Cardiac Resynchronization Therapy, Heart Failure, Hospitalization, Male, Treatment Outcome, Humans, Arrhythmias, Cardiac, Female, Middle Aged, Aged, Defibrillators, Implantable
الوصف: This study sought to evaluate the effect of cardiac resynchronization therapy with defibrillator (CRT-D) as compared with implantable cardioverter-defibrillator (ICD) on mortality, heart failure (HF) hospitalization, and ventricular arrhythmia in women versus men.CRT-D has demonstrated reduced mortality and HF hospitalizations with greater benefit observed in women compared with men. However, whether CRT-D prevented ventricular arrhythmias in women compared with men was unclear.The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1,798 patients to an ICD or CRT-D. In this post hoc analysis, women and men were compared by randomized group. By using a multivariable model, the outcomes of death and HF hospitalization and incidence of ventricular arrhythmia were compared between men and women.There were 1,490 (83%) men (732, ICD; 758, CRT-D) and 308 (17%) women (172, ICD; 136, CRT-D) included in the analysis. Women with CRT-D had a significantly reduced incidence of death and HF hospitalization compared with men with CRT-D (hazard ratio: 0.52; 95% confidence interval: 0.33 to 0.81; p 0.001) on multivariable analysis. Women with a primary prevention indication and CRT-D had the lowest rate of ventricular arrhythmia compared with men (hazard ratio: 0.59; 95% confidence interval: 0.39 to 0.91; p = 0.016).Women have improved rates of death and HF hospitalization with CRT-D and were less likely to experience ventricular arrhythmia when compared with men, after adjusting for differences in baseline characteristics over a prolonged follow-up. Whether these improved outcomes reflect inherent sex differences in the underlying myocardial substrate resulting in an enhanced response to CRT-D requires further research.
-
8
المؤلفون: Umjeet Jolly, Imane El Hajjaji, Jaimie Manlucu, Claus Rinne
المصدر: Pacing and clinical electrophysiology : PACE. 42(6)
مصطلحات موضوعية: Aged, 80 and over, Male, business.industry, General Medicine, Defibrillators, Implantable, Diagnosis, Differential, Equipment Failure Analysis, Electrocardiography, Heart Conduction System, Tachycardia, Ventricular, Medicine, Humans, Telemetry, Cardiology and Cardiovascular Medicine, business, Classics, Algorithms
-
9
المؤلفون: Mikael Hanninen, Susan Conacher, Peter Leong-Sit, Lorne J. Gula, Allan C. Skanes, Andrew D. Krahn, Raymond Yee, Jaimie Manlucu, Zachary Laksman, George J. Klein
المصدر: Journal of Genetic Counseling. 24:558-564
مصطلحات موضوعية: Adult, Male, Proband, medicine.medical_specialty, Adolescent, Genotype, Genetic counseling, Long QT syndrome, DNA Mutational Analysis, Genetic Counseling, Cascade screening, Internal medicine, London, Humans, Medicine, Genetic Testing, Index case, Genetics (clinical), Genetic testing, Genetics, medicine.diagnostic_test, business.industry, Middle Aged, Patient Acceptance of Health Care, medicine.disease, Human genetics, Long QT Syndrome, Phenotype, Female, business
الوصف: The acceptance and yield of family screening in genotype-negative long QT syndrome (LQTS) remains incompletely characterized. In this study of family screening for phenotype-definite Long QT Syndrome (LQTS, Schwartz score ≥3.5), probands at a regional Inherited Cardiac Arrhythmia clinic were reviewed. All LQTS patients were offered education by a qualified genetic counselor, along with materials for family screening including electronic and paper correspondence to provide to family members. Thirty-eight qualifying probands were identified and 20 of these had family members who participated in cascade screening. The acceptance of screening was found to be lower among families without a known pathogenic mutation (33 vs. 77 %, p = 0.02). A total of 52 relatives were screened; fewer relatives were screened per index case when the proband was genotype-negative (1.7 vs. 3.1, p = 0.02). The clinical yield of screening appeared to be similar irrespective of gene testing results (38 vs. 33 %, p = 0.69). Additional efforts to promote family screening among gene-negative long QT families may be warranted.
-
10
المؤلفون: Damian P. Redfearn, Raymond Yee, Jodi Koehler, Shantanu Sarkar, John L. Sapp, George A. Wells, Vinod Sharma, Jaimie Manlucu, Lorne J. Gula, Allan C. Skanes, Anthony Tang
المصدر: Heart Rhythm. 11:1626-1631
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Exacerbation, medicine.medical_treatment, Glucosinolates, Diagnostic Techniques, Cardiovascular, Cardiac resynchronization therapy, Heart Rate, Recurrence, Physiology (medical), Internal medicine, Diagnosis, Heart rate, Humans, Medicine, Heart rate variability, Aged, Heart Failure, Framingham Risk Score, business.industry, ICD, Reproducibility of Results, Hospital admission, medicine.disease, Confidence interval, Defibrillators, Implantable, Algorithm, Hospitalization, Heart failure, Ambulatory, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Algorithms, Follow-Up Studies
الوصف: Background The integrated diagnostics (ID) algorithm is an implantable device-based tool that collates data pertaining to heart rhythm, heart rate, intrathoracic fluid status, and activity, producing a risk score that correlates with 30-day risk of heart failure (HF) hospitalization. Objective We sought to validate the ID algorithm using the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. Methods Diagnostic measures of the algorithm include OptiVol fluid index, nighttime heart rate, minutes of patient activity, heart rate variability, and combined measure of cardiac rhythm and biventricular pacing. Monthly evaluations of ID parameters were assessed for the development of HF symptoms and hospitalization for HF. Results A total of 1224 patients were included: 741 (61%) with cardiac resynchronization therapy with defibrillator devices and 483 (39%) with implanted cardioverter-defibrillator only. The mean age was 66 ± 9 years, and 1013 (83%) were men. A total of 37,861 months of follow-up data were available, with 258 HF hospitalizations (event rate 0.68% per month). There were 33 HF hospitalizations during low-risk months (0.21% per month), 123 during medium-risk months (0.66% per month), and 102 during high-risk months (2.61% per month). Compared with low-risk months, and 95% confidence intervals) of HF hospitalizations during medium-risk months was 2.9 (2.0–4.4) and during high-risk months was 10.7 (6.9–16.6). Multivariable analysis demonstrated that each ID variable had independent association with HF hospitalization. Conclusion The risk of HF as determined by the ID algorithm correlated with HF hospitalization and several HF signs and symptoms among patients in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. This may present a useful adjunct to detect early signs of HF and adjust therapy to reduce morbidity and costs involved with hospital admission.
إعادة تعيين المنقحات
عرض المنقحات (%%عد%%)
Full Text via ClinicalKey 
Find this article in full text from Springer Verlag.