Among patients who had multivessel coronary disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of death or renal-replacement therapy was lower among those who underwent ...PCI of the culprit lesion only than among those who underwent multivessel PCI.
In a randomized trial, 706 patients with acute myocardial infarction and cardiogenic shock were assigned to either culprit-lesion-only PCI or immediate multivessel PCI. At 1 year, mortality did not ...differ significantly between the two groups.
Background
Several reports have described Takotsubo syndrome (TTS) secondary to thyrotoxicosis. A complex interaction of central and peripheral catecholamines with thyroid homeostasis has been ...suggested. In this study, we analysed sequential thyroid hormone profiles during the acute phase of TTS.
Methods
Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at predefined time points in 32 patients presenting with TTS or acute coronary syndrome (ACS, n = 16 in each group) in a 2‐year period in two German university hospitals. Data were compared to age‐ and sex‐matched controls (10 samples, each of 16 subjects), and an unsupervised machine learning (ML) algorithm identified patterns in the hormone signature. Subjects with thyroid disease and patients receiving amiodarone were excluded from follow‐up.
Results
Among patients with TTS, FT4 concentrations were significantly higher when compared to controls or ACS. Four subjects (25%) suffered from subclinical or overt thyrotoxicosis. Two additional patients developed subclinical or overt thyrotoxicosis during stay in hospital. In four subjects (25%), FT4 concentrations were increased, despite nonsuppressed TSH concentration, representing an elevated set point of thyroid homeostasis. The thyroid hormone profile was normal in only six patients (38%) presenting with TTS.
Conclusion
Abnormal thyroid function is frequent in patients with TTS. Primary hyperthyroidism and an elevated set point of thyroid homeostasis are common in TTS, suggesting a stress‐dependent endocrine response or type 2 thyroid allostasis. Thyroid function may be a worthwhile target in treating or preventing TTS.
Abstract Background Takotsubo Cardiomyopathy (TTC) is a transient disorder of ventricular wall dysfunction, mostly induced by physical or emotional stress. TTC may be associated with adverse cardiac ...events. The association of cancer and its clinical impact in TTC patients has not been described yet. Methods In 114 consecutive patients presenting with TTC between January 2003 and September 2015, we studied the frequency of cancer diagnosis, and compared the clinical course and the occurrence of a clinical endpoint of cancer and non-cancer patients during a follow up of 4.2 years. Results Of the 114 patients, 16 (14.0%) had a malignancy already diagnosed at TTC, and further 11 patients received the diagnosis during follow up. Cancer patients had higher frequency of atrial fibrillation and lower hemoglobin levels at admission than patients without cancer. While the occurrence of in-hospital events was comparable, the diagnosis of cancer at TTC event or during follow up was predictive for a higher rate of the composite endpoint. In the Kaplan-Meier analysis, malignant diseases were strongly associated not only with overall mortality but also with worsened time of event-free survival during the long-term outcome. Conclusions Prevalence of malignant diseases is high in TTC patients, and is a risk factor for worse outcome. Screening for malignancies should be recommended in all patients presenting with TTC. Further studies are needed to define the association on molecular levels.
Six shelters with 7,468 animals (2,305 cats and 5,163 dogs) were followed and diseases and shelter welfare conditions were recorded for one year. Disease records were obtained and categorised on ...three headings (surgery, internal medicine, and reproductive diseases and interventions) and subheading categories. Descriptive statistics was used to reveal disease distribution, which can attribute to surveillance data. To evaluate shelter welfare conditions, a protocol was developed and shelters were assessed. Under the surgical disease category, the most encountered disease records were open wounds (502, 59.41% and 175, 31.99%) for dogs and cats. For the internal medicine category, the most encountered were respiratory system diseases both for dogs (917, 33.26%) and cats (351, 58.21%). Under the reproductive disease category, the most common disease in dogs was orchitis (29, 60.42%). In cats, the most encountered disease was metritis (19, 79.16%). Ordinal logistic regression was used for evaluation of associations between diseases and shelter conditions. For dogs, with a one-point increase in shelter score, the odds of encountering reproductive diseases increased by 1.4%, while the odds of cumulative and internal diseases decreased 1.1 and 1.2 times (P<0.05) respectively. For cats, with an increase in shelter scores, the odds of encountering reproductive and cumulative diseases increased by 3.4% and 0.2%, respectively (P<0.05). Disease surveillance and their relation with shelter conditions may be helpful to design efficient plans in shelters.
Takotsubo Syndrome (TTS) is an acute reversible left ventricular dysfunction. Recently published studies have highlighted a similar mortality rate as acute coronary syndrome (ACS). We compared the ...impact of gender differences on the outcome of TTS patients as compared to ACS patient.
We included a collective of 138 patients TTS between 2003 and 2016 at our institution. Patients were divided according to their gender into two groups (Males n=21, 15% and females, n=117, 85%). They were compared with a cohort of 300 patients with a diagnosis of ACS.
On the acute phase, in male patients with TTS, a treatment with inotropic was more often required (33.3 vs. 11.5%, P<0.01), were more susceptible to cardiogenic shock (28.6 vs. 12.5%, P<0.04). Concerning the long-term prognosis after the acute event, male patients had higher all-cause mortality over long-term follow-up. A Kaplan-Meier analysis indicated that the mortality of male patients with TTS was significantly higher compared to male patients with ACS (log-rank <0.01), while there was no significant difference between female patients with TTS and ACS (log-rank =0.60, P=0.45). In a multivariate cox regression analysis, male gender (HR 2.7, 95% CI: 1.1-6.5, P=0.02) GFR <60 ml/min (HR 2.8, 95% CI: 1.2-6.0, P=0.01) and history of cancer (HR 3.6, 95% CI 1.4-9.3, P<0.01) were independent predictors of 5-year mortality.
Considerable evidence suggests that TTS compared to ACS implicates more significant clinical short-term events on male patients and it may be associated with poorer long-term prognosis.
Abstract Aortic dissection is an uncommon but a highly lethal condition. Dissection of the ascending aorta is associated with a mortality rate of 1–2% per hour within the first 24 h and should be ...managed by an open surgery. An uncomplicated, acute, type B dissection, which should be treated medically, is less frequently lethal, with survival rates of 84% within 1 year. Unfortunately, long-term outcome of medical therapy alone is suboptimal, with a reported 30–50% mortality rate at 5 years and a delayed expansion of the false lumen in 20–50% of patients at 4 years. In this setting, endovascular treatment should be considered when the aortic diameter exceeds 55–60 mm, in case of uncontrolled pain, blood pressure and rapid growth of the dissecting aneurysm (>1 cm per year). About 30–42% of acute, type B aortic dissections are complicated, as evidenced by haemodynamic instability or peripheral vascular ischaemia with a mortality rate of 50–85% if not treated properly. In this scenario, stent-graft repair is an attractive alternative to surgical repair for correcting ischaemic complications. The long-term therapy of patients with aortic dissection includes aggressive medical therapy, follow-up visits and serial imaging.
In this study, usability of weathered phosphogypsum (PG) from residue areas as set retarder in Portland cement was investigated. The effects on the setting and mechanical properties of PG added in ...ratios 1, 3, 5, 7, 10, and 12.5 wt.% to Portland cements were studied and compared with a Portland cement containing natural gypsum (NG). It was found that PG can be used in place of NG for Portland cement according to Turkish standards. The highest 28-day compressive strength was found in the sample with 3 wt.% PG.
Takotsubo cardiomyopathy (TC) is an important differential diagnosis of coronary artery disease (CAD), mimicking acute coronary syndrome in clinical symptoms, biomarker profiles and ST-elevation in ...ECG. Absence of occlusive coronary disease is an essential criterion distinguishing both diseases. The aim of the study was to explore the influence of co-existing incidental CAD on poorer clinical outcomes and all-cause mortality in TC.
Our mono-centric study cohort constituted 114 consecutive patients diagnosed with TC between 2003 and 2015. The primary endpoint was the all-cause mortality. Additionally, we compared the incidence of thromboembolic events, life-threatening arrhythmias, cardiogenic shock and in-hospital death. There was no significant difference in gender distribution or mean age in both groups. Patients diagnosed with a co-existing CAD (n = 22), had a more pronounced cardiovascular risk profile. The all-cause mortality among patients with co-existing CAD after a 2-year follow-up was higher than those diagnosed with lone TC (22.7 vs. 5.4 %, P = 0.07). In a multivariate cox regression analysis CAD (HR 3.5, 95 %CI 1.0-11.6; P = 0.04), LVEF ≤ 35% (HR 3.8, 95% CI 0.0-0.6, P = 0.01) and cardiogenic shock (HR 3.8, 95% CI 1.2-11.3; P = 0.01) were independent predictors of the primary endpoint.
Our study reveals that co-existing CAD impairs the outcome in patients with TC. The diagnostic work-up for TC should therefore not necessarily hinge on ruling out CAD.
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