Abstract Background Obesity is repeatedly emphasized as a risk factor for atrial fibrillation or flutter (AF). However, the underlying evidence may be questioned, as the obvious correlations between ...various anthropometric measures hamper identification of the characteristics that are biologically driving AF risk, and recent studies suggest that fat carries limited or no independent risk of AF. Objectives This study sought to assess mutually adjusted associations among AF risk and height, weight, body mass index, hip and waist circumference, waist-to-hip ratio, and bioelectrical impedance-derived measures of fat mass, lean body mass, and fat percentage. Methods Anthropometric measures and self-reported life-style information were collected from 1993 to 1997 in a population-based cohort including 55,273 persons age 50 to 64 years who were followed in Danish registers until June 2013. Results During a median of 17 years of follow-up, 3,868 persons developed AF. Adjusted hazard ratios per population SD difference (HRs) showed highly statistically significant, positive associations for all 9 anthropometric measures (HRs ranging from 1.08 95% confidence interval (CI): 1.05 to 1.12 for waist-to-hip ratio to 1.37 95% CI: 1.33 to 1.42 for lean body mass). Pairwise mutual adjustment of the 9 measures left the association for lean body mass virtually unchanged (lowest HR: 1.33 95% CI: 1.28 to 1.39 when adjusting for height), whereas no other association remained substantial when adjusted for lean body mass (highest HR: 1.05 95% CI: 1.01 to 1.10 for height). Conclusions Lean body mass was the predominant anthropometric risk factor for AF, whereas no association was observed for either of the obesity-related anthropometric measures after adjustment for lean body mass.
Objective Transapical chordae tendineae replacement is a promising new approach for mitral leaflet prolapse. However, animal studies have raised concerns that the tension of the transapically fixated ...artificial neochordae might be greater than the tension in the neochordae attached to papillary muscle tips, thereby reducing repair durability. Methods In eight 80-kg pigs, the primary anterior leaflet chordae were replaced by a 5-0 polytetrafluoroethylene neochord using a miniature in-line force transducer. The neochord was attached first to the anterior papillary muscle and, on a second cardiac bypass, transapically to the left ventricle apex. Occlusion of the inferior vena cava was performed to examine the effect of left ventricle pressure changes on neochord tension to adjust the crude data to 95 mm Hg. The maximum slope of the chordal tension curve was calculated to compare curve patterns. The data are presented as the mean ± standard deviation. Results The following tension was measured in the neochordae during papillary muscle and transapical fixation, respectively: peak tension (crude, 0.39 ± 0.32 vs 0.50 ± 0.25 N, P = .17; adjusted, 0.41 ± 0.30 vs 0.46 ± 0.27 N, P = .22), mid-systolic tension (crude, 0.19 ± 0.12 vs 0.19 ± 0.15 N, P = .96; adjusted, 0.28 ± 0.16 vs 0.19 ± 0.11 N, P = .12). There was a significantly lower maximum slope (dF/dtmax ) of the neochord tension curves after papillary muscle fixation compared with transapical fixation (7.4 ± 6.9 vs 10.3 ± 7.7 N/s, P = .028). Conclusions Overall, the chordal insertion site had little influence on the tension in the artificial neochordae compared with the interindividual variation. However, abnormal tension fluctuations in the transapically fixated neochordae might predispose to leaflet tears and early repair failure.
Objective To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol. Methods In a randomized, ...controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers. Results A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery ( P = .01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis. Conclusions Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.
Background Data on subsequent cancers, prognostic factors for mortality, and causes of death are limited in mycosis fungoides (MF) and parapsoriasis. Objectives To assess subsequent cancers, ...mortality, and causes of death in MF and parapsoriasis. Methods Using the Danish nationwide population-based registries, we identified 368 MF patients and 582 parapsoriasis patients and compared them with the general Danish population for subsequent cancers, mortality, and causes of death. Results Subsequent cancers were significantly increased in parapsoriasis patients (standardized incidence ratio SIR, 2.0 95% confidence interval {CI}, 1.6-2.5), and a trend was observed in MF (SIR, 1.2 95% CI, 0.9-1.5). Mortality was significantly increased in MF (SIR, 2.0 95% CI, 1.8-2.3) and parapsoriasis (SIR, 1.3 95% CI, 1.1-1.5). Excess mortality from MF was highest during the first 5 years of follow-up, and causes of increased death included both malignant and nonmalignant diseases. Limitations We have no information regarding clinical stage, treatments, and patient lifestyles. Conclusion Patients with parapsoriasis had a significantly increased risk of subsequent cancers and increased mortality. In addition, the highest excess mortality in the MF group was observed during the first 5 years of follow-up, which suggests that MF exists in both an aggressive and a more indolent form.
Abstract Objective. While depression is associated with higher risk of death due to chronic medical conditions, it is unknown if depression increases mortality following serious infections. We sought ...to determine if pre-existing unipolar depression is associated with increased mortality within 30 days after hospitalization for a serious infection. Methods We conducted a population-based cohort study of all adults hospitalized for an infection in Denmark between 2005 and 2013. Pre-existing unipolar depression was ascertained via psychiatrist diagnoses or at least two antidepressant prescription redemptions within a six month period. Our primary outcome was all-cause mortality within 30 days after infection-related hospitalization. We also studied death due to infection within 30 days after admission. Results We identified 589,688 individuals who had a total of 703,158 hospitalizations for infections. After adjusting for demographics, infectious diagnosis and time since infection, socioeconomic factors and comorbidities, pre-existing unipolar depression was associated with slightly increased risk of all-cause mortality within 30 days after infection-related hospitalization (Mortality Rate Ratio MRR: 1.07, 95% Confidence Interval 95%CI: 1.05, 1.09). The association was strongest among persons who initiated antidepressant treatment within one year before the infection (MRR: 1.30, 95%CI: 1.25, 1.35). Pre-existing unipolar depression was associated with increased risk of death due to sepsis (MRR: 1.30, 95%CI: 1.17, 1.44), pneumonia (MRR: 1.23, 95%CI: 1.16, 1.29) and urinary tract infection (MRR: 1.25, 95%CI: 1.08, 1.44) after adjusting for demographics, infectious diagnosis at admission and time since infection. Conclusions. Pre-existing unipolar depression is associated with slightly increased mortality following hospitalization for an infection.
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