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Shen H, He Q, Li W, Zhu G, Wang X, Liu J, Zhang Y, Li S, Zhou Z. Thrombocytopenia developed in intensive care unit for congenital heart disease: incidence, risk factors, and outcomes. J Thromb Haemost 2024:S1538-7836(24)00361-1. [PMID: 38908831 DOI: 10.1016/j.jtha.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Thrombocytopenia is common for patients in the intensive care unit (ICU) and is associated with adverse outcomes. ICU thrombocytopenia in pediatric patients who underwent cardiac surgeries with cardiopulmonary bypass (CPB) is inadequately studied. OBJECTIVES We aimed to investigate the incidence, risk factors, and prognostic role of ICU thrombocytopenia after congenital cardiac surgeries with CPB. METHODS A retrospective study involving 11 761 patients was conducted. Patients were categorized into 4 groups of thrombocytopenia based on platelet counts tested during ICU: non (>150 × 109/L), mild (100-150 × 109/L), moderate (50-100 × 109/L), and severe (<50 × 109/L). Logistic and Cox regression analyses were utilized to explore the risk factors of thrombocytopenia and the association of ICU thrombocytopenia with 30-day mortality. RESULTS ICU thrombocytopenia was observed in 4007 patients (34.1%), with mild, moderate, and severe thrombocytopenia occurring in 2773 (23.6%), 987 (8.4%), and 247 (2.1%) patients, respectively. Younger age, cyanotic congenital heart disease, CPB duration, and preoperative laboratory findings (red blood cell, thrombocytopenia, red cell distribution width, hematocrit, and coagulation disorder) were identified as independent risk factors of ICU thrombocytopenia. Patients with moderate (hazard ratio [95% CI]: 11.38 [3.02-42.87]; P < .001) and severe thrombocytopenia (hazard ratio [95% CI]: 49.54 [13.11-187.14]; P < .001) had a significantly higher risk of 30-day mortality. Furthermore, with the increase in the severity of ICU thrombocytopenia, there was an incremental increase in the incidence of postoperative critical bleeding and thrombosis, perioperative blood transfusions, length of ICU stays, and duration of mechanical ventilation. CONCLUSION ICU thrombocytopenia occurred in one-third of children after congenital cardiac surgery with CPB, and it was associated with multiple adverse outcomes.
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Affiliation(s)
- Huayan Shen
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Qiyu He
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Wenke Li
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Guoyan Zhu
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xu Wang
- Pediatric Intensive Care Unit, Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jinping Liu
- Department of Cardiopulmonary Bypass, Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yang Zhang
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
| | - Zhou Zhou
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
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Wang J, Wang X, Xu X, Xie L, Yang P. The investigation of thrombocytopenia after transcatheter occlusion of patent ductus arteriosus. BMC Cardiovasc Disord 2024; 24:59. [PMID: 38238685 PMCID: PMC10795349 DOI: 10.1186/s12872-024-03718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To investigate the risk factors for thrombocytopenia after transcatheter occlusion operation of patent ductus arteriosus (PDA). METHOD Retrospective analyses were conducted using clinical data from 106 patients with PDA who underwent transcatheter closure operations at Henan Provincial Chest Hospital, Zhengzhou University, from January 2018 to June 2022. The study compared the changes in platelet counts before and after the operation, and investigated the risk factors for thrombocytopenia following PDA closure in different groups and layers. RESULTS The platelet count of patients with PDA significantly decreased after undergoing transcatheter PDA occlusion. Logistic regression analysis revealed that factors such as PDA diameter, occluder diameter, pressure difference on the two sides of the occluder, and residual shunt were associated with an increased risk of thrombocytopenia following PDA occlusion. Specifically, the size of the occluder and the pressure difference between the two sides of the occluder were found to have a negative correlation with the postoperative platelet count. Further subgroup analysis demonstrated that the incidence of total thrombocytopenia was significantly higher in the large PDA group compared to the small-medium PDA groups. CONCLUSION Our findings suggest that occluder diameter, the pressure difference between the two sides of the occluder, and the residual shunt are major risk factors correlated with the incidence of postoperative thrombocytopenia. However, a multicenter and long-term prospective study is required to further evaluate the prognosis of PDA patients with thrombocytopenia after transcatheter occlusion.
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Affiliation(s)
- Jipei Wang
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China.
| | - Xiaoming Wang
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
| | - Xuefei Xu
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
| | - Limin Xie
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
| | - Pengwei Yang
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
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Xie LF, Lin Y, Chen MF, Zhang GC. Complete Transthoracic Echocardiography for the Assessment and Guidance of Percutaneous Atrial Septal Defect Closure in Adults without Balloon Sizing: An Observed Study with a 10-Year Follow-Up. J Cardiovasc Dev Dis 2023; 10:321. [PMID: 37623334 PMCID: PMC10455240 DOI: 10.3390/jcdd10080321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study aims to determine if complete transthoracic echocardiography (TTE)-guided percutaneous atrial septal defect (ASD) closure without balloon sizing could be safe and efficacious in adult patients. METHODS A total of 551 patients with ASDs were enrolled in this study, of which 438 patients underwent percutaneous ASD closure. Patients who received TTE-guided percutaneous ASD closure were classified into group T, and those who underwent a procedure that was guided by transesophageal echocardiography (TEE) were classified into group E. The clinical characteristics and the outcomes of the patients were analyzed. RESULTS The characteristics were comparable at baseline, except for the body mass index (BMI) (21.6 ± 5.3 vs. 23.8 ± 7.1, p < 0.001) between group T and group E. No significant difference was observed between the two groups regarding in-hospital outcomes, except for the duration of the procedure (29.8 ± 15.3 min vs. 41.5 ± 20.4 min), the length of stay in the hospital (2.1 ± 2.3 d vs. 2.9 ± 2.6 d), and hospital costs (USD 6233.3 ± 312.4 vs. USD 6673.7 ± 446.9). There were no significant differences in the incidences of long-term complications, cardiac chamber sizes, and tricuspid regurgitation severity between the patients in the two groups during the 10-year follow-up period. CONCLUSION TTE may be as safe and efficacious as TEE for the assessment and guidance of percutaneous ASD closure without balloon sizing in adult patients with lower BMIs who are commonly found in East Asia.
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Affiliation(s)
- Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Yong Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Mei-Fang Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
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4
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Aarnink EW, Huijboom MF, Bor WL, Maarse M, Zheng KL, ten Cate H, Ten Berg JM, Boersma LV. Hemostatic biomarkers and antithrombotic strategy in percutaneous left atrial interventions: State-of-the-art review. Thromb Res 2022; 215:41-51. [DOI: 10.1016/j.thromres.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
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Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder. Pediatr Cardiol 2020; 41:716-723. [PMID: 32006083 DOI: 10.1007/s00246-020-02288-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30 mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5 years, range 15-78 years) were enrolled in the study. The median ASD size was 35 mm (range 30-42 mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42 mm (range 40-50 mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37 months (range 6-83 months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.
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Saad M, Mahmoud AN, Barakat AF, Mentias A, Elbadawi A, Elgendy IY, Abuzaid A, Elgendy AY, Jneid H. In-Hospital Outcomes After Transcatheter Aortic Valve Implantation in Patients With Versus Without Chronic Thrombocytopenia. Am J Cardiol 2019; 124:1106-1112. [PMID: 31378322 DOI: 10.1016/j.amjcard.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 11/28/2022]
Abstract
Patients with chronic thrombocytopenia (cTCP) were excluded from the pivotal transcatheter aortic valve implantation (TAVI) trials. The National Inpatient Sample was queried and propensity score matching was performed to evaluate the prevalence and impact of cTCP on in-hospital clinical outcomes after TAVI. The main outcome was in-hospital mortality in patients with versus without cTCP. Among 38,855 TAVI hospitalizations, 7,105 had a diagnosis of cTCP (18.3%). In-hospital mortality was similar in both groups (ORadjusted 0.79; 95% confidence interval [CI] 0.57 to 1.09); however, cTCP was associated with higher risk of acute kidney injury (ORadjusted 1.29; 95% CI 1.08 to 1.54), vascular complications (ORadjusted 1.99; 95% CI 1.22 to 3.25), perioperative blood product transfusion (ORadjusted 1.69; 95% CI 1.42 to 2.01), cardiac tamponade (ORadjusted 4.04; 95% CI 1.51 to 10.82), cardiogenic shock (ORadjusted 1.52; 95% CI 1.07 to 2.15), and use of extracorporeal membrane oxygenation (ORadjusted 2.32; 95% CI 1.1 to 4.9). In conclusion, cTCP is common in patients who underwent TAVI and is associated with worse postprocedure clinical outcomes, however, with similar in-hospital mortality.
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Affiliation(s)
- Marwan Saad
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, University of Washington, Seattle, Washington.
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ahmed Abuzaid
- Division of Cardiology, University of California at San Francisco, San Francisco, California
| | - Akram Y Elgendy
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
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7
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Abd-Elsalam S, Habba E, Elkhalawany W, Tawfeek S, Elbatea H, El-kalla F, Soliman H, Soliman S, Yousef M, Kobtan A, El Nawasany S, Awny S, Amer I, Mansour L, Rizk F. Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis. Medicine (Baltimore) 2016; 95:e3853. [PMID: 27281094 PMCID: PMC4907672 DOI: 10.1097/md.0000000000003853] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy, in a cohort of Egyptian patients with liver cirrhosis. In all, 110 patients with cirrhosis were prospectively analyzed. The presence of medium or large EVs was correlated with patients' platelet count and FIB-4. Esophageal varices were present in 87 (79.09%) patients. Among those with thrombocytopenia (platelet level below 150,000), 25.97% (20 patients) and 27.27% (21 patients) had EV grade II and EV grade III or IV, respectively. Whereas in patients in whom the platelet count was above 150,000, only 21.21% (7 patients) and 9.09% (3 patients) of patients had grade II EV and EV grade III or IV, respectively. A platelet count cut-off value of 149,000 was found to have specificity of 82% and sensitivity 39% for detection of presence of varices. A FIB-4 cut-off value of 3.175 was found to have an 83.3% sensitivity and 39.5% specificity in detecting large (grade III, IV) EVs. Platelet count is a noninvasive parameter with high accuracy for prediction of EVs. Cirrhotic patients with normal platelet counts (above 150,000), especially in financially deprived developing countries, can avoid screening endoscopy as they are at a low risk for variceal bleeding, and presence of large EVs in these patients is much less common than in those with thrombocytopenia. A 3.175 cut-off value of FIB-4 could be useful as a noninvasive predictor of large varices requiring prophylactic banding in cirrhotic patients.
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Affiliation(s)
- Sherief Abd-Elsalam
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
- ∗Correspondence: Dr Sherief Abd-Elsalam, Tanta University Faculty of Medicine, Tanta, Egypt (e-mail: )
| | - Eslam Habba
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Walaa Elkhalawany
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Salwa Tawfeek
- Internal Medicine Department, National Research Institute, Egypt
| | - Hassan Elbatea
- Tropical Medicine & Infectious Diseases Department, Kafr El-Sheikh Faculty of Medicine, Kafr El-Sheikh, Egypt
| | - Ferial El-kalla
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Hanan Soliman
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Samah Soliman
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Mohamed Yousef
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Abdelrahman Kobtan
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Sally El Nawasany
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Sheren Awny
- Internal Medicine Department, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Ibrahim Amer
- Tropical Medicine & Infectious Diseases Department, Kafr El-Sheikh Faculty of Medicine, Kafr El-Sheikh, Egypt
| | - Loai Mansour
- Tropical Medicine & Infectious Diseases department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Fatma Rizk
- Physiology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
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Pan G, Xie ZF, Zhang Y, Long SC, Xu XP, Zhang ZW. Platelet Activation Through the Efficacy of Aspirin in Congenital Heart Disease Patients Undergoing Transcatheter Closure of Atrial Septal Defects or Ventricular Septal Defects. Genet Test Mol Biomarkers 2014; 18:832-8. [PMID: 25330142 DOI: 10.1089/gtmb.2014.0206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gang Pan
- Department of Cardiovascular Medicine, Southern Medical University, Guangzhou, People's Republic of China
- Department of Cardiovascular Medicine, The First People's Hospital of Yueyang, Yueyang, People's Republic of China
| | - Zhao-Feng Xie
- Department of Cardiovascular Pediatrics, Guangdong General Hospital, Guangzhou, People's Republic of China
| | - Ying Zhang
- Department of Cardiovascular Medicine, Guangdong General Hospital, Guangzhou, People's Republic of China
| | - Sheng-Chun Long
- Department of Cardiovascular Medicine, The First People's Hospital of Yueyang, Yueyang, People's Republic of China
| | - Xi-Ping Xu
- Department of Cardiovascular Medicine, The First People's Hospital of Yueyang, Yueyang, People's Republic of China
| | - Zhi-Wei Zhang
- Department of Cardiovascular Pediatrics, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, People's Republic of China
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9
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Mojadidi MK, Goodman-Meza D, Eshtehardi P, Pamerla M, Msaouel P, Roberts SC, Winoker JS, Jadeja NM, Zolty R. Thrombocytopenia is an independent predictor of mortality in pulmonary hypertension. Heart Lung 2014; 43:569-73. [PMID: 25169667 DOI: 10.1016/j.hrtlng.2014.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Established prognostic factors for pulmonary hypertension (PH) include brain natriuretic peptide, troponins and hemodynamic measures such as central venous pressure and cardiac output. The prognostic role of thrombocytopenia, however, has yet to be determined in patients with PH. The aim of this study was to evaluate effect of thrombocytopenia on mortality in patients with PH. METHODS 521 patients with severe PH, defined by a pulmonary artery systolic pressure >60 mm Hg on transthoracic echocardiography and a platelet count measured within one month after diagnosis were enrolled from three hospitals of Montefiore Medical Center. The cohort was divided into two groups: mild thrombocytopenia to a normal platelet count (platelet count 100,000-450,000 per uL); and moderate to severe thrombocytopenia (platelet count <100,000 per uL). Inpatient and social security death records were used to determine 1-year all-cause mortality. RESULTS Mean age was 70.3 ± 15.6 with 40% of patients being male. Overall mortality at 1 year was 30.7%, with increased mortality in PH patients with mild thrombocytopenia compared to those with moderate to severe thrombocytopenia (46.5% vs. 27.0%, p < 0.001). In multivariate analysis, moderate to severe thrombocytopenia remained an independent predictor of mortality (HR 1.798, 95% CI 1.240-2.607, p = 0.002). CONCLUSIONS Moderate to severe thrombocytopenia is an independent predictor of higher mortality in patients with severe PH. These findings may support the use of thrombocytopenia as a useful prognostic indicator in patients with severe PH.
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Affiliation(s)
- Mohammad Khalid Mojadidi
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
| | - David Goodman-Meza
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Mohan Pamerla
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Pavlos Msaouel
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Scott C Roberts
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Jared S Winoker
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Neville M Jadeja
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
| | - Ronald Zolty
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA
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10
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Dvir D, Généreux P, Barbash IM, Kodali S, Ben-Dor I, Williams M, Torguson R, Kirtane AJ, Minha S, Badr S, Pendyala LK, Loh JP, Okubagzi PG, Fields JN, Xu K, Chen F, Hahn RT, Satler LF, Smith C, Pichard AD, Leon MB, Waksman R. Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes. Eur Heart J 2014; 35:2663-71. [PMID: 24598983 DOI: 10.1093/eurheartj/ehu082] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes. METHODS AND RESULTS Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, ≥100 × 10(9)/L; moderate, 50-99 × 10(9)/L; and severe, <50 × 10(9)/L. A total of 488 patients composed of the study population (age 84.7 ± 7.5 years). At a median time of 2 days after TAVR, 176 patients (36.1%) developed significant thrombocytopenia: 149 (30.5%) moderate; 27 patients (5.5%) severe. Upon discharge, the vast majority of patients (90.2%) had no/mild thrombocytopenia. Nadir platelet count <50 × 10(9)/L was highly specific (96.3%), and a count <150 × 10(9)/L highly sensitive (91.2%), for predicting 30-day death (C-statistic 0.76). Patients with severe acquired thrombocytopenia had a significantly higher mortality rate at 1 year (66.7% for severe vs. 16.0% for no/mild vs. 20.1% for moderate; P < 0.001). In multivariate logistic regression, severe thrombocytopenia was independently associated with 1-year mortality (hazard ratio 3.44, CI: 1.02-11.6; P = 0.046). CONCLUSIONS Acquired thrombocytopenia was common after TAVR and was mostly resolved at patient discharge. The severity of thrombocytopenia after TAVR could be used as an excellent, easily obtainable, marker for worse short- and long-term outcomes after the procedure.
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Affiliation(s)
- Danny Dvir
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Philippe Généreux
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Israel M Barbash
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Susheel Kodali
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Itsik Ben-Dor
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Mathew Williams
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Rebecca Torguson
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Ajay J Kirtane
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Sa'ar Minha
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Salem Badr
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Lakshmana K Pendyala
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Joshua P Loh
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Petros G Okubagzi
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Jessica N Fields
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Ke Xu
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Fang Chen
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Rebecca T Hahn
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Lowell F Satler
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Craig Smith
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Augusto D Pichard
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
| | - Martin B Leon
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY, USA
| | - Ron Waksman
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
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