•We identified six phenotype subgroups•Löfgren's syndrome comprised 3 clusters (C1, C2, and C3)•C4 cluster comprised patients with pulmonary sarcoidosis•C5 cluster comprised patients with abdominal ...and pulmonary sarcoidosis•C6 cluster comprised patients with stage I plus extrapulmonary sarcoidosis
Sarcoidosis is a heterogeneous disease with high variability in natural history and clinical spectrum. The study aimed to reveal different clinical phenotypes of patients with similar characteristics and prognosis.
Cluster analysis including 26 phenotypic variables was performed in a large cohort of 694 sarcoidosis patients, collected and followed-up from 1976 to 2018 at Bellvitge University Hospital, Barcelona, Spain.
Six homogeneous groups were identified after cluster analysis: C1 (n=47; 6.8%), C2 (n=85; 12.2%), C3 (n=153; 22%), C4 (n=29; 4.2%), C5 (n=168; 24.2%), and C6 (n=212; 30.5%). Presence of bilateral hilar lymphadenopathy (BHL) ranged from 65.5% (C4) to 97.9% (C1). Patients with Löfgren syndrome (LS) were distributed across 3 phenotypes (C1, C2, and C3). In contrast, phenotypes with pulmonary (PS) and/or extrapulmonary sarcoidosis (EPS) were represented by groups C4 (PS 100% with no EPS), C5 (PS 88.7% plus EPS), and C6 (EPS). EPS was concentrated in groups C5 (skin lesions, peripheral and abdominal lymph nodes, and hepatosplenic involvement) and C6 (skin lesions, peripheral lymph nodes, and neurological and ocular involvement). Unlike patients from LS groups, most patients with PS and/or EPS were treated with immunosuppressive therapy, and evolved to chronicity in higher proportion. Finally, the cluster model worked moderately well as a predictive model of chronicity (AUC=0.705).
Cluster analysis identified 6 different clinical patterns with similar phenotypic variables and predicted chronicity in our large cohort of patients with sarcoidosis. Classification of sarcoidosis into phenotypes with prognostic value may help physicians to improve the efficacy of clinical decisions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Spontaneous haemothorax (SH) is a rare subcategory of haemothorax that involves the accumulation of blood within the pleural space in the absence of trauma. SH especially occurs in middle-aged or ...elderly patients, but data are usually limited to case reports and case series. Coagulopathy, aneurysm or aortic dissection, Rendu-Osler-Weber syndrome and malignancy have to be considered among the causes of SH.
We describe a case of primary angiosarcoma of the spleen presenting as relapsing haemothorax.
An 81-year-old woman was referred to our hospital because of a 2-month history of relapsing haemothorax after the performance of urgent splenectomy due to active bleeding from large spleen cysts. No evidence of neoplasm was seen after pathological examination of the spleen. On admission, left haemothorax and 2 new cystic masses in the thoracic wall were documented, both in close relation to the scars of previous surgery and chest tubes. After excision of 1 mass, histological examination revealed angiosarcoma, and a final diagnosis of primary angiosarcoma of the spleen with postsurgical metastatic dissemination to the thorax and pleura was made.
Primary angiosarcoma should be included in the differential diagnosis of haemorrhagic spleen cysts. Clinical diagnosis and management usually requires splenectomy, but it should be carefully planned in order to avoid local metastatic dissemination or haematogenous spread of the tumour.
The differential diagnosis of spleen cysts must include malignant conditions.Despite its absolute rarity, angiosarcoma is considered the most common primary non-haematolymphoid splenic malignancy and has a poor prognosis.Splenectomy is usually required for a prompt diagnosis of primary angiosarcoma of the spleen, but it needs to be performed with extreme caution to avoid metastatic dissemination.
Aim
To examine whether the presence of a prior diagnosis of diabetes mellitus (DM) influences mortality risk in elderly patients experiencing a first episode of heart failure (HF) hospitalization.
...Methods
A total of 677 consecutive patients aged ≥75 years admitted for a first episode of acute decompensated heart failure were evaluated according to the presence or not of DM, and in‐hospital and 1‐year mortality rates were evaluated.
Results
A total of 240 patients (35.4%) had a diagnosis of DM. Overall, 42 patients (6.2%) died during admission; and 205 patients (30.3%) died after 1 year; however, no differences were observed in mortality rates between both groups. Cox univariate analysis did not identify prior DM diagnosis as a risk factor for 1‐year mortality (HR 0.767, P < 0.082). Multivariate analysis identified older age (HR 1.101, P < 0.0001), lower preadmission Barthel Index (HR 0.987, P = 0.002), higher heart rate (HR 1.013, P = 0.02), higher admission serum potassium (HR 1.471, P = 0.016) and non‐prescription of angiotensin‐converting enzyme inhibitors or angiotensin II receptor antagonists (HR 1.597, P = 0.018) as independent risk factors for 1‐year mortality.
Conclusions
More than one‐third of elderly patients experiencing a first admission because of acute heart failure decompensation had a prior diagnosis of DM. However, DM did not seem to be associated to a significant 1‐year mortality risk. Geriatr Gerontol Int 2018; 18: 554–560.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Aim
To assess whether 1‐year mortality in older patients experiencing a first admission for acute heart failure was related to sex, and to explore differential characteristics according to sex.
...Methods
We reviewed the medical records of 1132 patients aged >70 years of age admitted within a 3‐year period because of a first episode of acute heart failure. We analyzed sex differences. Mortality was assessed using multivariate Cox analysis.
Results
There were 648 (57.2%) women (mean age 82.1 years) and 484 men (mean age 80.1 years). There were some differences in risk factors: women more often had hypertension, and less frequently had coronary heart disease and comorbidities (women more often had dementia, and men more often had chronic obstructive pulmonary disease, chronic kidney disease and stroke). Women were treated more frequently with spironolactone. The 1‐year all‐cause mortality rate was 30.2% (30.7% women and 29.5% men). Multivariate Cox analysis identified an association between reduced heart failure (hazard ratio HR 0.35, 95% confidence interval 95% CI 0.21–0.59), hemoglobin <10 g/dL (HR 1.99, 95% CI 1.16–3.40), systolic blood pressure (HR 0.98, 95% CI 0.97–0.99), previous diagnosis of dementia (HR 2.07, 95% CI 1.12–3.85), number of chronic therapies (HR 1.12, 95% CI 1.05–1.19) and 1‐year mortality in women. In men, an association with mortality was found for low systolic blood pressure (HR 0.97, 95% CI 0.97–0.98) and higher potassium values (HR 1.42, 95% CI 1.01–2.00).
Conclusions
Among older patients hospitalized for the first acute heart failure episode, there is a slightly higher predominance of women. There are sex differences in risk factors and comorbidities. Although the mortality rate is similar, the factors associated with it according to sex are different. Geriatr Gerontol Int 2019; 19: 184–188.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Chronic kidney disease is related to poor outcomes in patients with heart failure (HF). Few studies have assessed whether renal function influences one-year mortality risk in patients admitted for ...the first time for acute HF.
We reviewed the medical records of all patients aged >50 years admitted within a two-year period for a first episode of decompensated HF. The sample was divided according to the patients’ estimated glomerular filtration rate (eGFR) on admission into three groups (eGFR >60, 30-60 and <30 ml/min/1.73 m2). Index admission and one-year all-cause mortality rates were compared between groups using Cox regression analysis.
A total of 985 patients were included in the study, mean age 78.4±9 years, and with mean admission eGFR of 60.5±26 ml/min/1.73 m2. Of these, 516 (52.3%) patients had eGFR <60 ml/min/1.73 m2. One-year all-cause mortality was 25.4%, with a significant association between worse eGFR category and mortality (p<0.0001). Cox regression analysis assessing eGFR as a categorical variable confirmed this association (HR 1.378; p=0.030), together with older age (HR 1.066; p<0.001), previous diagnosis of hypertension (HR 0.527; p<0.001), and both lower systolic blood pressure (HR 0.993; p=0.009) and higher serum potassium on admission (HR 1.471; p <0.001).
Renal impairment is common in HF patients, even at the time of first admission. In this group of HF patients the presence of renal impairment was associated with higher mid-term (one-year) mortality risk.
A doença renal crónica (CKD) está relacionada com um pior prognóstico em doentes com insuficiência cardíaca (HF). Poucos estudos avaliaram se a função renal influencia o risco de mortalidade a um ano, em doentes admitidos pela primeira vez por insuficiência cardíaca aguda.
Revimos os registos médicos de todos os doentes > 50 anos, admitidos num período de dois anos por um primeiro episódio de descompensação de HF. Dividimos a amostra de acordo com a taxa de filtração glomerular estimada dos doentes (eGFR) após a admissão em três grupos (eGFR >60, 30-60 e <30 ml/min/1,73 m2). Comparamos a admissão inicial e as taxas de mortalidade por todas as causas num ano, com análises de regressão de Cox.
Foram incluídos 985 doentes no estudo, a média foi de 78,4 ± 9 anos e a eGFR média na admissão foi de 60,5 ± 26. Do total, 516 (52,3%) doentes apresentaram eGFR < 60. A um ano, a taxa de mortalidade por todas as causas foi de 25,4%, com uma associação significativa entre a pior categoria eGFR e a taxa de mortalidade (p < 0,0001). A análise de regressão de Cox que avaliou a eGFR como variável categórica confirmou essa associação (HR 1,378; p = 0,030) juntamente com idade avançada (HR 1,066; p < 0,001), diagnóstico prévio de hipertensão (HR 0,527; p < 0,001) e pressão arterial sistólica inferior (HR 0,993; p = 0,009) e maiores valores de potássio sérico após a admissão (HR 1,471; p < 0,001).
A insuficiência renal é comum em doentes com insuficiência cardíaca, mesmo no momento da primeira admissão. Nesse grupo de doentes com insuficiência cardíaca a presença de insuficiência renal está associada a um maior risco de mortalidade em médio prazo (um ano).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
(1) Background: Catheter-directed therapies (CDT) may be considered for selected patients with pulmonary embolism (PE); (2) Methods: Retrospective observational study including all consecutive ...patients with acute PE undergoing CDT (mechanical or pharmacomechanical) from January 2010 through December 2020. The aim was to evaluate in-hospital and long-term mortality and its predictive factors; (3) Results: We included 63 patients, 43 (68.3%) with high-risk PE. All patients underwent mechanical CDT and, additionally, 27 (43%) underwent catheter-directed thrombolysis. Twelve (19%) patients received failed systemic thrombolysis (ST) prior to CDT, and an inferior vena cava (IVC) filter was inserted in 28 (44.5%) patients. In-hospital PE-related and all-cause mortality rates were 31.7%; 95% CI 20.6–44.7% and 42.9%; 95% CI 30.5–56%, respectively. In multivariate analysis, age > 70 years and previous ST were strongly associated with PE-related and all-cause mortality, while IVC filter insertion during the CDT was associated with lower mortality rates. After a median follow-up of 40 (12–60) months, 11 more patients died (mortality rate of 60.3%; 95% CI 47.2–72.4%). Long-term survival was significantly higher in patients who received an IVC filter; (4) Conclusions: Age > 70 years and failure of previous ST were associated with mortality in acute PE patients treated with CDT. In-hospital and long-term mortality were lower in patients who received IVC filter insertion.
Aims
The role of non‐invasive telemedicine (TM) combining telemonitoring and teleintervention by videoconference (VC) in patients recently admitted due to heart failure (HF) (‘vulnerable phase’ HF ...patients) is not well established. The aim of the Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS) trial is to assess the impact on clinical outcomes of implementing a TM service based on mobile health (mHealth), which includes remote daily monitoring of biometric data and symptom reporting (telemonitoring) combined with VC structured, nurse‐based follow‐up (teleintervention). The results will be compared with those of the comprehensive HF usual care (UC) strategy based on face‐to‐face on‐site visits at the vulnerable post‐discharge phase.
Methods and results
We designed a 24 week nationwide, multicentre, randomized, controlled, open‐label, blinded endpoint adjudication trial to assess the effect on cardiovascular (CV) mortality and non‐fatal HF events of a TM‐based comprehensive management programme, based on mHealth, for patients with chronic HF. Approximately 508 patients with a recent hospital admission due to HF decompensation will be randomized (1:1) to either structured follow‐up based on face‐to‐face appointments (UC group) or the delivery of health care using TM. The primary outcome will be a composite of death from CV causes or non‐fatal HF events (first and recurrent) at the end of a 6 month follow‐up period. Key secondary endpoints will include components of the primary event analysis, recurrent event analysis, and patient‐reported outcomes.
Conclusions
The HERMeS trial will assess the efficacy of a TM‐based follow‐up strategy for real‐world ‘vulnerable phase’ HF patients combining telemonitoring and teleintervention.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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