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Itelman E, Golovchiner G, Barsheshet A, Kornowski R, Erez A. Balancing innovation and professionalism: The emerging role of AI-powered chatbots in medical consultation. Heart Rhythm 2024:S1547-5271(24)02327-0. [PMID: 38588991 DOI: 10.1016/j.hrthm.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Edward Itelman
- Cardiology Division, Rabin Medical Center, Petah Tikva, Israel.
| | | | - Alon Barsheshet
- Cardiology Division, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Division, Rabin Medical Center, Petah Tikva, Israel
| | - Aharon Erez
- Cardiology Division, Rabin Medical Center, Petah Tikva, Israel
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Laufer M, Perelman M, Segal G, Sarfaty M, Itelman E. Low Alanine Aminotransferase as a Marker for Sarcopenia and Frailty, Is Associated with Decreased Survival of Bladder Cancer Patients and Survivors-A Retrospective Data Analysis of 3075 Patients. Cancers (Basel) 2023; 16:174. [PMID: 38201601 PMCID: PMC10778009 DOI: 10.3390/cancers16010174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Sarcopenia is characterized by the loss of muscle mass and function and is associated with frailty, a syndrome linked to an increased likelihood of falls, fractures, and physical disability. Both frailty and sarcopenia are recognized as markers for shortened survival in a number of medical conditions and in cancer patient populations. Low alanine aminotransferase (ALT) values, representing low muscle mass (sarcopenia), may be associated with increased frailty and subsequently shortened survival in cancer patients. In the current study, we aimed to assess the potential relationship between low ALT and shorter survival in bladder cancer patients and survivors. PATIENTS AND METHODS This was a retrospective analysis of bladder cancer patients and survivors, both in and outpatients. We defined patients with sarcopenia as those presenting with ALT < 17 IU/L. RESULTS A total of 5769 bladder cancer patients' records were identified. After the exclusion of patients with no available ALT values or ALT levels above the upper normal limit, the final study cohort included 3075 patients (mean age 73.2 ± 12 years), of whom 80% were men and 1362 (53% had ALT ≤ 17 IU/L. The mean ALT value of patients within the low ALT group was 11.44 IU/L, while the mean value in the higher ALT level group was 24.32 IU/L (p < 0.001). Patients in the lower ALT group were older (74.7 vs. 71.4 years; p < 0.001), had lower BMI (25.8 vs. 27; p < 0.001), and their hemoglobin values were lower (11.7 vs. 12.6 g/dL; p < 0.001). In a univariate analysis, low ALT levels were associated with a 45% increase in mortality (95% CI 1.31-1.60, p < 0.001). In a multivariate model controlling for age, kidney function, and hemoglobin, low ALT levels were still associated with 22% increased mortality. CONCLUSIONS Low ALT values, indicative of sarcopenia and frailty, are associated with decreased survival of bladder cancer patients and survivors and could potentially be applied for optimizing individual treatment decisions.
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Affiliation(s)
- Menachem Laufer
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel (E.I.)
| | - Maxim Perelman
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel (E.I.)
- Department of Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Gad Segal
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel (E.I.)
- Education Authority, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Michal Sarfaty
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel (E.I.)
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Edward Itelman
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel (E.I.)
- Department of Internal Medicine E, Rabin Medical Center, Beilenson Campus, Peta-Tiqva 4941492, Israel
- Cardiology Division, Rabin Medical Center, Beilenson Campus, Peta-Tiqva 4941492, Israel
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Segev A, Maor E, Goldenfeld M, Itelman E, Grossman E, Beinart R, Leshem E, Klempfner R, Klang E, Rahman N, Halabi N, Sabbag A. Atrial fibrillation in young hospitalized patients: Clinical characteristics, predictors of new onset, and outcomes. J Cardiol 2023; 82:408-413. [PMID: 37116647 DOI: 10.1016/j.jjcc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) in young adults is an uncommon and not well studied entity. METHODS Consecutive patients aged 18-45 years admitted to internal or cardiology services in a large tertiary medical center (January 1, 2009 through December 31, 2019) were included. Clinical, electrocardiographic, and echocardiographic data were compared between patients with and without AF at baseline. Predictors of new-onset AF in the young were identified using multivariate Cox regression model among patients free of baseline AF. RESULTS Final cohort included 16,432 patients with median age of 34 (IQR 26-41) years of whom 8914 (56 %) were men. Patients with AF at baseline (N = 366; 2 %) were older, more likely to be men, and had higher proportion of comorbidities and electrocardiographic conduction disorders. Male sex, increased age, obesity, heart failure, congenital heart disease (CHD) and the presence of left or right bundle branch block were all independently associated with baseline AF in a multivariate model (p < 0.001 for all). Sub-analysis of 10,691 (98 %) patients free of baseline AF identified 85 cases of new-onset AF during a median follow up of 3.5 (IQR 1.5-6.5) years. Multivariate model identified increased age, heart failure, and CHD as independent predictors of new-onset AF. Finally, the CHARGE-AF risk score outperformed the CHA2DS2-VASc score in AF prediction [AUC of ROC 0.75 (0.7-0.8) vs. 0.56 (0.48-0.65)]. CONCLUSIONS AF among hospitalized young adults is not rare. Screening for new-onset AF in young post hospitalization patients may be guided by specific clinical predictors and the CHARGE-AF risk score.
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Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Elad Maor
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Miki Goldenfeld
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Edward Itelman
- Internal Medicine Wing, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ehud Grossman
- Internal Medicine Wing, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Roy Beinart
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Eran Leshem
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Robert Klempfner
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Eyal Klang
- ARC Innovation Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Nisim Rahman
- ARC Innovation Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Nitsan Halabi
- ARC Innovation Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Avi Sabbag
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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Gatt ER, Zilber E, Perelman M, Landau N, Yakir M, Glick N, Negru L, Segal G, Itelman E. Do low levels of alanine aminotransferase, a baseline marker of sarcopenia and frailty, associate with worse clinical outcomes among hospitalized COVID-19 patients? A Retrospective Cohort Study. J Frailty Sarcopenia Falls 2023; 8:148-154. [PMID: 37663161 PMCID: PMC10472039 DOI: 10.22540/jfsf-08-148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives COVID-19 geoperdize lives. Not all the risk factors for negative outcomes are known. Sarcopenia and frailty are common, negatively affecting clinical outcomes. Studies have shown that sarcopenia and frailty are associated with worse outcomes. Our objective was to examine whether low ALT (Alanine-aminotranferase), a surrogate marker for sarcopenia, is associated with worse clinical outcomes among hospitalized COVID-19 patients. Methods We reviewed cases of COVID-19 in a tertiary hospital, during three COVID-19 waves and examined correlations between ALT and mortality using crude, univariate and multivariate analysis for age, gender, hypertension, Chronic obstructive pulmonary disease and Congestive heart failure. Results 357 patients were included in this analysis. Median age was 69, 54% were males. Median ALT was 19 IU/L. During follow-up, 73 (20%) died. Patients with low ALT were more likely to die (HR 1.82, 95% CI 1.06-3.09, P=0.028). Other predictors for mortality were low albumin, background COPD, dyslipidemia, dementia, and malignancy. The multivariate analysis showed that low ALT was still an independent predictor of poor prognosis (HR 1.7, 95% CI 1.0-2.9, P=0.049). Conclusions In our analysis of COVID-19 patients, low ALT levels were independently associated with increased risk of mortality, both as standalone and when incorporated into a multivariate analysis.
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Affiliation(s)
- Ehud Raz Gatt
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zilber
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Max Perelman
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Nitsan Landau
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Maya Yakir
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Noam Glick
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Liat Negru
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Gad Segal
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
| | - Edward Itelman
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel
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Laufer M, Perelman M, Sarfaty M, Itelman E, Segal G. Low Alanine Aminotransferase, as a Marker of Sarcopenia and Frailty, Is Associated with Shorter Survival Among Prostate Cancer Patients and Survivors. A Retrospective Cohort Analysis of 4064 Patients. EUR UROL SUPPL 2023; 55:38-44. [PMID: 37693730 PMCID: PMC10485784 DOI: 10.1016/j.euros.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/12/2023] Open
Abstract
Background Sarcopenia is characterized by loss of muscle mass and function and is associated with frailty, a syndrome with higher likelihood of falls, fractures, physical disability, and mortality. Both frailty and sarcopenia are known markers of shorter survival in various cancer patient populations. Low alanine aminotransferase (ALT), reflecting loss of muscle mass (sarcopenia), may be associated with greater frailty and shorter survival in multiple cancers. Objective To assess the potential association between low ALT and shorter survival among prostate cancer (PCa) patients and survivors. Design setting and participants This was a retrospective analysis of a historical cohort of PCa patients and survivors. Patients were defined as those still actively receiving PCa treatment, while those no longer receiving such treatment were classified as PCa survivors. Outcome measurements and statistical analysis ALT data were obtained from results for basic biochemical blood testing carried out for patients on their first hospital admission. Patients were divided into two groups: those with ALT ≥17 IU/l and those with ALT <17 IU/l. Univariate and multivariable analyses were conducted for between-group survival comparisons. Results and limitations We identified 9489 PCa records. The final study cohort with ALT data available included 4064 patients with ALT <40 IU/l. Of this cohort, 536 patients were actively receiving medical anticancer therapy for PCa. The mean age for the entire cohort was 74.6 yr (standard deviation 9.6) and the median ALT level was 19.28 IU/l; 1676 patients (41%) had low ALT (<17 IU/l). On univariate analysis, low ALT was associated with a 78% increase in mortality risk (95% confidence interval [CI] 1.62-1.97; p < 0.001). A sensitivity analysis of the 536 patients actively receiving medical anticancer treatment revealed that low ALT was associated with a 48% increase in mortality risk (95% CI 1.19-1.85; p = 0.001). In a multivariable model controlled for age, kidney disease, history of cerebrovascular event/transient ischemic attack, and baseline prostate-specific antigen, low ALT was still associated with a 35% increase in mortality risk (95% CI 1.12-1.63; p = 0.001). Limitations include the single-center, retrospective design. Conclusions Low ALT, which is indicative of sarcopenia and frailty, is associated with shorter survival among PCa patients and survivors and could potentially be used for treatment personalization. Patient summary We compared survival for prostate cancer patients and survivors according to their blood level of the protein alanine aminotransferase (ALT). Low ALT levels in the general population are associated with loss of muscle mass. We found that in our group of prostate cancer patients and survivors, the risk of death from any cause was higher for those with low ALT levels.
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Affiliation(s)
- Menachem Laufer
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Maxim Perelman
- Department of Internal Medicine T, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Michal Sarfaty
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Edward Itelman
- Department of Internal Medicine E, Rabin Medical Center, Beilenson Campus, Peta-Tiqva, Israel§
- Cardiology Division, Rabin Medical Center, Beilenson Campus, Peta-Tiqva, Israel§
| | - Gad Segal
- Sheba Education Authority, Chaim Sheba Medical Center, Ramat Gan, Israel§
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Uliel N, Segal G, Perri A, Turpashvili N, Kassif Lerner R, Itelman E. Low ALT, a marker of sarcopenia and frailty, is associated with shortened survival amongst myelodysplastic syndrome patients: A retrospective study. Medicine (Baltimore) 2023; 102:e33659. [PMID: 37115069 PMCID: PMC10146076 DOI: 10.1097/md.0000000000033659] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Myelodysplastic Syndrome (MDS) is a common blood dyscrasia that mainly affects the elderly population. Several prognostic scores are available utilizing blood count variables and cytogenetic abnormalities, targeting the disease rather than the patient. Sarcopenia and frailty are associated with shortened survival rates in various disease states. Low Alanine Aminotransferase (ALT) levels are a marker of lowered muscle mass and frailty status. This study aimed to examine the correlation between low ALT levels and prognosis in MDS patients. This is a retrospective cohort study. We obtained the demographic, clinical, and laboratory data of patients in a tertiary hospital. Univariate and multivariate models were used to investigate the potential relationship between low ALT level and survival. The final study included 831 patients (median age 74.3 years, Interquartile range 65.6-81.8), and 62% were males. The median ALT level was 15 international units (IU)/L and 233 patients (28%) had low ALT levels (<12 IU/L). Univariate analysis showed that low ALT levels were associated with a 25% increase in mortality (95% confidence interval [CI]: 1.05-1.50, P = .014). A multivariate model controlling for age, sex, body mass index, hemoglobin and albumin concentrations, and low ALT levels was still significantly associated with increased mortality (hazard ratio [HR] = 1.25, 95% CI: 1.01-1.56, P = .041). Low ALT levels were associated with increased mortality among patients with MDS. Impact: Using ALT as a frailty metric may allow patient-centered, personalized care in this patient population. A low ALT level reflects the pre-morbid robustness of patients and is not intended to replace disease-centered characteristics.
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Affiliation(s)
- Noa Uliel
- HARVEY Faculty of medicine, Pavia University, Ramat Gan, Israel
| | - Gad Segal
- Education Authority, Sheba Medical Center. Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Avital Perri
- Department of Neurosurgery, Sheba Medical Center. Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Natia Turpashvili
- Institute of Hematology, Sheba Medical Center. Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Reut Kassif Lerner
- Department of Pediatric intensive care, The Edmond and Lily Safra Children’s hospital, Sheba Medical Center, Tel-Hashomer, Israel. Affiliate to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Ramat Gan, Israel
| | - Edward Itelman
- Education Authority, Sheba Medical Center. Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Gan, Israel
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Itelman E, Perelman M, Bivar N, Kent D, Vaisman A, Segal G, Negru L, Dagan A. Hospitalized patients with positive antiphospholipid antibodies who have low complement levels are at increased risk for death-a retrospective cohort study. Lupus 2023; 32:668-674. [PMID: 36951167 PMCID: PMC10155279 DOI: 10.1177/09612033231164091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
PURPOSE To investigate whether low complement levels can predict worse outcomes in patients hospitalized with positive anti-phospholipid antibodies. METHODS This was a retrospective cohort study. We obtained demographics, laboratory, and prognostic data of all consecutive patients hospitalized between 2007 and 2021, for whatever reason, with at least one positively abnormal anti-phospholipid antibody, who were also tested for complement levels (C3 or C4). We then compared the rates of long-term mortality, 1-year mortality, deep vein thrombosis, and pulmonary emboli between groups of low complement and normal complement levels. Multivariate analysis was used to control for levels of clinical and laboratory confounders. RESULTS We identified 32,286 patients tested for anti-phospholipid antibodies. Of those patients, 6800 tested positive for at least one anti-phospholipid antibody and had a documented complement level. Significant higher mortality rates were found in the low complement group, with an odds ratio for mortality (OR 1.93 CI 1.63-2.27 p < .001). Deep vein thrombosis and pulmonary emboli rates were similar. Multivariate analysis confirmed that low complement was an independent predictor for mortality after controlling for age, sex, dyslipidemia, chronic heart failure (CHF), chronic kidney disease (CKD), and anemia. CONCLUSIONS Our study results indicate that low complement is associated with significantly higher mortality rates in admitted patients with elevated levels of anti-phospholipid antibodies. This finding correlates with recent literature suggesting a vital role for complement activation in anti-phospholipid syndrome.
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Affiliation(s)
- Edward Itelman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Maxim Perelman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Natali Bivar
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Daniella Kent
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Adva Vaisman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Gad Segal
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Liat Negru
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Amir Dagan
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
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Sharon A, Fishman B, Massalha E, Itelman E, Mouallem M, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Management and outcome of patients with non-ST elevation myocardial infarction and intercurrent non-coronary precipitating events. Eur Heart J Acute Cardiovasc Care 2022; 11:922-930. [PMID: 36229932 DOI: 10.1093/ehjacc/zuac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 10/11/2022] [Indexed: 12/29/2022]
Abstract
AIMS To evaluate the effect of an intercurrent non-coronary illness on the management and outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS Consecutive hospitalized patients with a primary diagnosis of NSTEMI between August 2008 and December 2019 at Sheba Medical Center. All patients' records were reviewed for the presence of a non-coronary precipitating event (NCPE): a major intercurrent acute non-coronary illness or condition, either cardiac or non-cardiac. The primary outcome was all-cause mortality. Cox regression with interaction analysis was applied. Final study population comprised 6491 patients, of whom 2621 (40%) had NCPEs. Patients with NCPEs were older (77 vs. 69 years) and more likely to have comorbidities. The most prevalent event was infection (35%, n = 922). During a median follow-up of 30 months, 2529 patients died. Patients with NCPEs were 43% more likely to die during follow-up in a multivariable model (95% CI: 1.31-1.55). Invasive strategy was associated with a 55% lower mortality among patients without NCPE and only 44% among patients with NCPE (P for interaction < 0.001). Dual antiplatelet therapy (DAPT) was associated with a 20% lower mortality in patients without NCEP and a non-significant mortality difference among patients with NCPE (P for interaction = 0.014). Sub-analysis by the specific NCPE showed the highest mortality risk among patients with infectious precipitant. The lower mortality associated with invasive strategy was not observed in this subgroup. CONCLUSION Among NSTEMI patients, the presence of an NCPE is associated with poor survival and modifies the effect of management strategies.
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Affiliation(s)
- Amir Sharon
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Fishman
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Massalha
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel
| | - Meir Mouallem
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel M Barbash
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bergwerk M, Lasman N, Helpman L, Rosenzweig B, Cohen D, Itelman E, Gross R, Segal G. Agreement of Authorship for Student-Faculty Collaborative Research and Publications: A Literature Review and Call for Action. Isr Med Assoc J 2022; 24:768-772. [PMID: 36436047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Moriah Bergwerk
- Infection Prevention and Control Unit, Sheba Medical Center, Tel Hashomer, Israel, Education Authority, Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Lasman
- Department of Internal Medicine I, Sheba Medical Center, Tel Hashomer, Israel, Education Authority, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Helpman
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel, Education Authority, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel, Education Authority, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dor Cohen
- Department of Internal Medicine I, Sheba Medical Center, Tel Hashomer, Israel, Education Authority, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- Department of Internal Medicine I, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel, Education Authority, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Segal
- Education Authority, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lerner RK, Lotan D, Oren D, Itelman E, Neeman Y, Dekel S, Heller E, Abu-Much A, Shilo N, Gilead R, Hubara E, Mouallem M, Haviv Y, Kogan A, Mayan H, Pessach IM. Prevalence and clinical implication of thrombocytopenia and heparin-induced thrombocytopenia in patients who are critically ill with COVID-19. Clin Med (Lond) 2022; 22:403-408. [PMID: 38589060 PMCID: PMC9595020 DOI: 10.7861/clinmed.2022-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As the COVID-19 pandemic continues to evolve, different clinical manifestations are better understood and studied. These include various haematologic disorders that have been shown to be associated with increased morbidity and mortality. We studied the prevalence of one unusual manifestation, heparin-induced thrombocytopenia (HIT) and its clinical implications in patients who are severely ill with COVID-19 in a single tertiary centre in Israel. The presence of thrombocytopenia, disseminated intravascular coagulation (DIC) and HIT, and their association with clinical course and outcomes were studied. One-hundred and seven patients with COVID-19 were included. Fifty-seven (53.2%) patients developed thrombocytopenia, which was associated with the worst outcomes (ventilation, DIC and increased mortality). Sixteen (28.0%) patients with thrombocytopenia were positive for HIT, all of which were supported by extracorporeal devices. HIT was independently associated with ventilation days, blood product transfusions, longer hospitalisation and mortality. Platelet abnormalities and HIT are common in patients who are critically ill with COVID-19 and are associated with the worst clinical outcomes. The mechanisms underlying HIT in COVID-19 are yet to be studied; HIT may contribute to the dysregulated immunologic response associated with COVID-19 critical illness and may play a significant part in the coagulopathy seen in these patients. As many patients with COVID-19 require aggressive thromboprophylaxis, further understanding of HIT and the implementation of appropriate protocols are important.
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Affiliation(s)
- Reut Kassif Lerner
- Sheba Medical Center, Ramat Gan, Israel and Tel-Aviv University, Tel-Aviv, Israel.
| | - Dor Lotan
- NewYork-Presbyterian Columbia University Irving Medical Center, New York City, USA
| | - Daniel Oren
- NewYork-Presbyterian Columbia University Irving Medical Center, New York City, USA and internal medicine resident, NewYork-Presbyterian Brooklyn Methodist Hospital, New York City, USA
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11
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Fishman B, Sharon A, Itelman E, Tsur AM, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Invasive Management in Older Adults (≥80 Years) With Non-ST Elevation Myocardial Infarction. Mayo Clin Proc 2022; 97:1247-1256. [PMID: 35787854 DOI: 10.1016/j.mayocp.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/08/2022] [Accepted: 03/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the association of invasive management (coronary angiogram) with all-cause mortality among older adult (≥80 years of age) patients presenting with non-ST elevation myocardial infarction (NSTEMI) by frailty status. PATIENTS AND METHODS This study used a retrospective cohort of consecutive older adult patients who were hospitalized with NSTEMI as their primary clinical diagnosis between August 1, 2008, and December 31, 2019. Cox regression models were applied with stratification by frailty status (low, medium, and high). Extensive sensitivity analyses were conducted including propensity score matching and inverse probability treatment weighting models. RESULTS The study population included 2317 patients with median age of 86 years (IQR, 83-90 years) of whom 1243 (53.6%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs 44%, P<.001). During the follow-up (median, 19 months, IQR, 4-41 months), 1599 (69%) patients died. In a multivariable Cox model, invasive approach was associated with adjusted hazard ratio (HR) of 0.61 (95% CI, 0.53 to 0.71) for the risk of death. The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 (95% CI, 0.58 to 0.93), 0.65 (95% CI, 0.50 to 0.85), and 0.52 (95% CI, 0.34 to 0.78), respectively (P for interaction = 0.48). Results were consistent with propensity score matching and inverse probability treatment weighting analyses (HR, 0.6; 95% CI, 0.50 to 0.71 and HR, 0.67; 95% CI, 0.55 to 0.82, respectively). Sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results. CONCLUSION Invasive approach is associated with improved survival among older adults with NSTEMI irrespective of frailty status.
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Affiliation(s)
- Boris Fishman
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Department of Medicine D and the Hypertension Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sharon
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine T, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avishai M Tsur
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Paul Fefer
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Moshe Barbash
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Department of Medicine D and the Hypertension Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Segev A, Lavee J, Kassif Y, Shemesh Y, Kogan A, Freimark D, Morgan A, Lotan D, Itelman E, Grupper A. Effect of levosimendan infusion prior to left ventricular assist device implantation on right ventricular failure. J Cardiothorac Surg 2022; 17:158. [PMID: 35710438 PMCID: PMC9205013 DOI: 10.1186/s13019-022-01915-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Investigate the safety and efficacy of preoperative levosimendan in patients undergoing left ventricular assist device (LVAD) implantation.
Methods Consecutive patients who received LVADs (HeartMate-2, 3, HVAD) in a single tertiary medical center (2012–2018). INTERMACS profile 1 patients were excluded. The primary outcome was post-LVAD right ventricular failure (RVF) and inhospital mortality rates. The secondary outcomes included other clinical, echocardiographic and hemodynamic parameters at follow-up. Results Final cohort consisted of 62 patients (40[65%] in the levosimendan group and 22[35%] in the no-levosimendan group). Post-operative RVF rate and inotrope or ventilation support time were similar in the levosimendan and no-levosimendan groups (7.5% vs. 13.6%; P = 0.43, median of 51 vs. 72 h; P = 0.41 and 24 vs. 27 h; P = 0.19, respectively). Length of hospitalization, both total and in the intensive care unit, was not statistically significant (median days of 13 vs. 16; P = 0.34, and 3 vs. 4; P = 0.44, respectively). Post-operative laboratory and echocardiographic parameters and in-hospital complication rate did not differ between the groups, despite worse baseline clinical parameters in the Levosimendan group. There was no significant difference in the in-hospital and long term mortality rate (2.5% vs. 4.5%; P > 0.999 and 10% vs. 27.3% respectively; P = 0.64). Conclusions Levosimendan infusion prior to LVAD implantation was safe and associated with comparable results without significant improved post-operative outcomes, including RVF. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01915-6.
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Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Lavee
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Yedida Shemesh
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Alexander Kogan
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Dov Freimark
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Morgan
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Dor Lotan
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Avishay Grupper
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Itelman E, Shlomai G, Leibowitz A, Weinstein S, Yakir M, Tamir I, Sagiv M, Muhsen A, Perelman M, Kant D, Zilber E, Segal G. Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study. JMIR Form Res 2022; 6:e36066. [PMID: 35679119 PMCID: PMC9227660 DOI: 10.2196/36066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/13/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Patients admitted to general wards are inherently at risk of deterioration. Thus, tools that can provide early detection of deterioration may be lifesaving. Frequent remote patient monitoring (RPM) has the potential to allow such early detection, leading to a timely intervention by health care providers. Objective This study aimed to assess the potential of a novel wearable RPM device to provide timely alerts in patients at high risk for deterioration. Methods This prospective observational study was conducted in two general wards of a large tertiary medical center. Patients determined to be at high risk to deteriorate upon admission and assigned to a telemetry bed were included. On top of the standard monitoring equipment, a wearable monitor was attached to each patient, and monitoring was conducted in parallel. The data gathered by the wearable monitors were analyzed retrospectively, with the medical staff being blinded to them in real time. Several early warning scores of the risk for deterioration were used, all calculated from frequent data collected by the wearable RPM device: these included (1) the National Early Warning Score (NEWS), (2) Airway, Breathing, Circulation, Neurology, and Other (ABCNO) score, and (3) deterioration criteria defined by the clinical team as a “wish list” score. In all three systems, the risk scores were calculated every 5 minutes using the data frequently collected by the wearable RPM device. Data generated by the early warning scores were compared with those obtained from the clinical records of actual deterioration among these patients. Results In total, 410 patients were recruited and 217 were included in the final analysis. The median age was 71 (IQR 62-78) years and 130 (59.9%) of them were male. Actual clinical deterioration occurred in 24 patients. The NEWS indicated high alert in 16 of these 24 (67%) patients, preceding actual clinical deterioration by 29 hours on average. The ABCNO score indicated high alert in 18 (75%) of these patients, preceding actual clinical deterioration by 38 hours on average. Early warning based on wish list scoring criteria was observed for all 24 patients 40 hours on average before clinical deterioration was detected by the medical staff. Importantly, early warning based on the wish list scoring criteria was also observed among all other patients who did not deteriorate. Conclusions Frequent remote patient monitoring has the potential for early detection of a high risk to deteriorate among hospitalized patients, using both grouped signal-based scores and algorithm-based prediction. In this study, we show the ability to formulate scores for early warning by using RPM. Nevertheless, early warning scores compiled on the basis of these data failed to deliver reasonable specificity. Further efforts should be directed at improving the specificity and sensitivity of such tools. Trial Registration ClinicalTrials.gov NCT04220359; https://clinicaltrials.gov/ct2/show/NCT04220359
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Affiliation(s)
- Edward Itelman
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Gadi Shlomai
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Avshalom Leibowitz
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Shiri Weinstein
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Maya Yakir
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Idan Tamir
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Michal Sagiv
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Aia Muhsen
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Maxim Perelman
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Daniella Kant
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Eyal Zilber
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Gad Segal
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
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14
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Itelman E, Perelman M, Kent D, Bibar N, Segal G, Negru L, Dagan A. POS0784 LOW COMPLEMENT LEVELS ARE ASSOCIATED WITH HIGHER MORTALITY IN HOSPITALIZED PATIENTS WITH POSITIVE ANTIPHOSPHOLIPID ANTIBODIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAntiphospholipid Syndrome is an autoimmune disease characterized by increased risk for vascular thrombosis (arterial and/or venous) thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies. The mechanisms by which aPLs induce thrombosis are unclear; several have been suggested, among them complement activation.(1-2) The complement system is a system of enzymes and regulatory proteins of the innate immune system that play a crucial role in the inflammatory response to various pathogenic stimuli. The complement and coagulation pathways are interconnected, and expanding evidence indicates that complement may be activated in patients with antiphospholipid syndrome (3-5).ObjectivesOur study was intended to better characterize the complicated relations between antiphospholipid antibodies and complement activation among hospitalized patients with antiphospholipid syndrome and its impact on short- and long-term prognosisMethodsA retrospective cohort studies. Clinical and prognostic data of hospitalized patients with antiphospholipid syndrome and a measurement of complement levels (C3 or C4) were obtained. Rates of long-term mortality, one-year mortality, deep vein thrombosis (DVT), and pulmonary emboli (PE) were compared between patients with low complement levels and patients with normal complement levels. Low complement was defined as C3 < 90 mg/dl or C4 < 10 mg/dl. A multivariate analysis was performed to control for Anticardiolipin levels, β₂ macroglobulin levels and RVVT ratio.ResultsComplete data was available for 6,599 patients, of which 712 (11%) had low complement levels. The median age of the cohort was 47.7, and most of the patients were females (56%). Patients with low complement levels had significantly higher mortality rates 30% vs. 18%, p < 0.001 for long-term mortality (Figure 1) and 15% vs. 5%, p < 0.001 for 1 year mortality when compared to patients with normal complement levels. DVT and PE rates were similar (4% vs 3.8%, P = 0.78 and 4% vs 2.4%, P = 0.13 respectively). Results of the multivariate analysis (Table 1) were consistent and showed that patients with low complement levels had 111% higher mortality rates (CI 1.52-2.90, P < 0.001).Table 1.Multivariate Analysis for long term mortalityMultivariate AnalysisOR (CI)pLow Complement2.11 [1.52, 2.90]<0.001Anticardiolipin IGG1.00 [1.00, 1.01]0.243Anticardiolipin IGM0.99 [0.98, 1.00]0.084β₂ IGM1.01 [1.00, 1.01]0.017β₂ IGG1.00 [0.99, 1.00]0.663RVVT Ratio0.99 [0.63, 1.52]0.954Figure 1.Cumulative 10-Year survivalConclusionIn hospitalized patients with high aPLs, low complement levels are associated with significantly higher mortality rates. This finding is in correlation with recent literature, suggesting an important role for complement activation in APS.References[1]Chaturvedi S, Brodsky RA, McCrae KR. Complement in the pathophysiology of the antiphospholipid syndrome. Front Immunol. 2019 Mar 14;10:449.[2]Bu C, Gao L, Xie W, Zhang J, He Y, Cai G, et al. beta2-glycoprotein i is a cofactor for tissue plasminogen activator-mediated plasminogen activation. Arthritis Rheum. 2009 Feb;60(2):559–568.[3]Tedesco F, Borghi MO, Gerosa M, Chighizola CB, Macor P, Lonati PA, et al. Pathogenic role of complement in antiphospholipid syndrome and therapeutic implications. Front Immunol. 2018 Jun 19;9:1388.[4]Oku K, Nakamura H, Kono M, Ohmura K, Kato M, Bohgaki T, et al. Complement and thrombosis in the antiphospholipid syndrome. Autoimmun Rev. 2016 Oct;15(10):1001–1004.[5]Salmon JE, Girardi G, Holers VM. Complement activation as a mediator of antiphospholipid antibody induced pregnancy loss and thrombosis. Ann Rheum Dis. 2002 Nov;61 Suppl 2:ii46–50.Disclosure of InterestsNone declared
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15
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Wasserstrum Y, Larrañaga-Moreira JM, Martinez-Veira C, Itelman E, Lotan D, Sabbag A, Kuperstein R, Peled Y, Freimark D, Barriales-Villa R, Arad M. Hypokinetic hypertrophic cardiomyopathy: clinical phenotype, genetics, and prognosis. ESC Heart Fail 2022; 9:2301-2312. [PMID: 35488723 PMCID: PMC9288812 DOI: 10.1002/ehf2.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/12/2022] Open
Abstract
Aims To describe the phenotype, genetics, and events associated with the development of hypertrophic cardiomyopathy (HCM) with reduced ventricular function (HCMr). Heart failure in HCM is usually associated with preserved ejection fraction, yet some HCM patients develop impaired systolic function that is associated with worse outcomes. Methods and results Our registry included 1328 HCM patients from two centres in Spain and Israel. Patients with normal baseline ventricular function were matched, and a competing‐risk analysis was performed to find factors associated with HCMr development. Patient records were reviewed to recognize clinically significant events that occurred closely before the development of HCMr. Genetic data were collected in patients with HCMr. A composite of all‐cause mortality or ventricular assist device (VAD)/heart transplantation was assessed according to ventricular function. Median age was 56, and 34% were female patients. HCMr at evaluation was seen in 37 (2.8%) patients, and 46 (3.5%) developed HCMr during median follow up of 9 years. HCMr was associated with younger age of diagnosis, poor functional class, and ventricular arrhythmia. Atrial fibrillation, pacemaker implantation, and baseline left ventricular ejection fraction (LVEF) of ≤55% were significant predictors of future HCMr development, while LV obstruction predicted a lower risk. Genetic testing performed in 53 HCMr patients, identifying one or more pathogenic variant in 38 (72%): most commonly in myosin binding protein C (n = 20). Six of these patients had an additional pathogenic variant in one of the sarcomere genes. Patients with baseline HCMr had a higher risk (hazard ratio 6.4, 4.1–10.1) for the composite outcome and for the individual components. Patients who developed HCMr in the course of the study had similar mortality but a higher rate of VAD/heart transplantation compared with HCM with normal LVEF. Conclusions Hypertrophic cardiomyopathy with reduced ejection fraction is associated with heart failure and poor outcome. Arrhythmia, cardiac surgery, and device implantation were commonly documented prior to HCMr development, suggesting they may be either a trigger or the result of adverse remodelling. Future studies should focus on prediction and prevention of HCMr.
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Affiliation(s)
- Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - José M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Cristina Martinez-Veira
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Edward Itelman
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Dor Lotan
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Avi Sabbag
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Yael Peled
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Dov Freimark
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
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Haskel O, Itelman E, Zilber E, Barkai G, Segal G. Remote Auscultation of Heart and Lungs as an Acceptable Alternative to Legacy Measures in Quarantined COVID-19 Patients-Prospective Evaluation of 250 Examinations. Sensors (Basel) 2022; 22:3165. [PMID: 35590854 PMCID: PMC9103963 DOI: 10.3390/s22093165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic accelerated the assimilation of telemedicine platforms into medical practice. Nevertheless, research-based evidence in this field is still accumulating. This was a prospective, cross-sectional comparative assessment of a remote physical examination device used mainly for heart and lung digital auscultation. We analyzed usage patterns, user (physician) subjective appreciation and compared it to legacy measures. Eighteen physicians (median age 36 years (IQR 32-45): two interns, seven residents and nine senior physicians; eleven internists, five geriatricians and two pediatricians) executed over 250 remote physical examinations. Their median work duration with quarantined patients was 60 days (IQR 45-60). The median number of patients examined by a single physician was 17 (IQR 10-34). Regarding overall estimation, all participants tended to prefer the remote examination in the setting of quarantined patients (median 6, IQR 3.75-8), while no statistically significant difference was demonstrated compared to the indifference value (p = 0.122). Internists preferred tele-medical examination over non-internists, with significant differences between groups regarding heart auscultation, (median 7, (IQR 3-7) vs. median 2, (IQR 1-5, respectively)), p = 0.044. In the setting of quarantined patients, from the physicians' perspective, a digital platform for remote auscultation of heart and lungs was considered as an acceptable alternative to legacy measures.
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Affiliation(s)
- Or Haskel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
| | - Edward Itelman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Internal Medicine “I”, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Eyal Zilber
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Internal Medicine “I”, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Galia Barkai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Beyond, Virtual Hospital, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Gad Segal
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Internal Medicine “I”, Sheba Medical Center, Ramat-Gan 52621, Israel
- Beyond, Virtual Hospital, Sheba Medical Center, Ramat-Gan 52621, Israel
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Sharon A, Fishman B, Itelman E, Mouallem M, Barbash I, Fefer P, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. MANAGEMENT AND OUTCOME OF PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION AND INTERCURRENT NONCORONARY PRECIPITATING EVENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Itelman E, Segev A, Ahmead L, Leibowitz E, Agbaria M, Avaky C, Negro L, Shenhav-Saltzman G, Wasserstrum Y, Segal G. Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients. QJM 2022; 114:843-847. [PMID: 32642782 DOI: 10.1093/qjmed/hcaa219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/13/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sarcopenia and frailty influence clinical patients' outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes. AIM We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality. DESIGN This was a retrospective cohort analysis. METHODS We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients' data were retrieved from their electronic medical records. RESULTS The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT < 10 IU/l in the whole cohort (14.3% vs. 10.4%, P < 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P < 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P < 0.001 and 4.3% vs. 3.2%, P < 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels < 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13-1.29, P < 0.001). CONCLUSIONS Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.
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Affiliation(s)
- E Itelman
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - A Segev
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - L Ahmead
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - E Leibowitz
- Department of Internal Medicine "A", Yoseftal Hospital, Yotam road, POB 600. Eilat 88104, Israel
| | - M Agbaria
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - C Avaky
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - L Negro
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - G Shenhav-Saltzman
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - Y Wasserstrum
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - G Segal
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
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Barkai G, Amir H, Dulberg O, Itelman E, Gez G, Carmon T, Merhav L, Zigler S, Atamne A, Pinhasov O, Zimlichman E, Segal G. “Staying at Home”: A pivotal trial of telemedicine-based internal medicine hospitalization at a nursing home. Digit Health 2022; 8:20552076221125958. [PMID: 36133002 PMCID: PMC9483959 DOI: 10.1177/20552076221125958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background In-hospital stay of acutely ill elderlies could be reduced by increasing the
availability of community-based hospitalizations. The feasibility of
remotely managing these patients by specialized internists, without leaving
their nursing homes should be sought. In the current pivotal study, we aimed
to evaluate the aforementioned model. Methods This was a prospective, open-label study at a tertiary medical center and a
nursing home. The study aimed at comparing clinical outcomes of patients
hospitalized in each location. Results Over a period of 5.5 months, we recruited 18 patients designated for
hospitalization, meeting our inclusion criteria to either in-hospital stay
or staying in their nursing home and treated by means of telemedicine from
our tertiary medical center. The mean age was 85.3 years. Out of 114
hospitalization days, 44 days (48%) were at the nursing home. No significant
difference was noted in terms of age, gender, and length of stay between the
patients who were hospitalized in either location. In almost all cases,
diagnosis changed during hospitalization. Three patients died during the
study, all included in the in-hospital group. No safety breaching events
happened in the nursing home-hospitalization group. Conclusions Remote, telemedicine-based hospitalization of nursing home-dwelling elderlies
is safe and feasible, potentially reducing the length of in-hospital stay by
almost 50%. Larger studies in this realm are warranted.
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Affiliation(s)
- G Barkai
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
| | - H Amir
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
| | - O. Dulberg
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - E Itelman
- Sackler faculty of medicine, Tel Aviv university, Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - G Gez
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - T Carmon
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - L Merhav
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - S Zigler
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - A Atamne
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - O Pinhasov
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - E Zimlichman
- Sackler faculty of medicine, Tel Aviv university, Management Wing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - G Segal
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv university, Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan, Israel
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Itelman E, Segel MJ, Kuperstein R, Feinberg M, Segev A, Segal G, Maor E, Grossman E. Pulmonary Hypertension Is Associated With Systemic Arterial Hypertension Among Patients With Normal Left Ventricular Diastolic Function. J Am Heart Assoc 2021; 10:e023603. [PMID: 34873923 PMCID: PMC9075261 DOI: 10.1161/jaha.121.023603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The association of pulmonary and systemic arterial hypertension is believed to be mediated through hypertensive left heart disease. The purpose of the current study was to investigate whether pulmonary hypertension (PHT) is associated with systemic arterial hypertension among patients with apparently normal left ventricular diastolic function. Methods and Results Consecutive patients who had echocardiographic evaluation between 2007 and 2019 were enrolled. Patients with disease states that are known to be associated with PHT, including diastolic dysfunction, were excluded from the analysis. Estimated right ventricular systolic pressure was extracted for all patients from the echocardiographic reports. PHT was defined as estimated right ventricular systolic pressure >40 mm Hg. Multivariate logistic regression models were applied. Final study population included 25 916 patients with a median age of 59 (interquartile range, 44–69) years, of whom 12 501 (48%) were men and 13 265 (51%) had systemic arterial hypertension. Compared with normotensive patients, hypertensive patients were 3.2 times more likely to have PHT (95% CI, 2.91–3.53; P<0.001). A multivariate model adjusted for clinical and echocardiographic parameters that are known to be associated with PHT demonstrated that hypertensive patients are almost 3 times more likely to have PHT (95% CI, 2.45–3.15; P<0.001). The association was significant in multiple subgroups but was more significant among women compared with men (odds ratio, 3.1 versus 2.4; P for interaction <0.001). Conclusions PHT is associated with systemic arterial hypertension irrespective of left heart disease. The association is more pronounced among women.
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Affiliation(s)
- Edward Itelman
- Internal Medicine Ward "T" Chaim Sheba Medical Center Ramat Gan Israel.,Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel
| | - Michael J Segel
- Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel.,Department of Pulmonology Chaim Sheba Medical Center Ramat Gan Israel
| | - Rafael Kuperstein
- Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel.,Leviev Heart Center Chaim Sheba Medical Center Ramat Gan Israel
| | - Micha Feinberg
- Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel.,Leviev Heart Center Chaim Sheba Medical Center Ramat Gan Israel
| | - Amit Segev
- Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel.,Leviev Heart Center Chaim Sheba Medical Center Ramat Gan Israel
| | - Gad Segal
- Internal Medicine Ward "T" Chaim Sheba Medical Center Ramat Gan Israel.,Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel
| | - Elad Maor
- Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel.,Leviev Heart Center Chaim Sheba Medical Center Ramat Gan Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine Tel-Aviv University Tel Aviv Israel.,Internal Medicine Wing Chaim Sheba Medical Center Ramat Gan Israel
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21
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Itelman E, Vatury O, Kuperstein R, Ben-Zekry S, Fefer P, Barbash I, Klempfner R, Segev A, Feinberg M, Guetta V, Maor E. The Association of Moderate Aortic Stenosis with Poor Survival is Modified by Age and Left Ventricular Function. J Am Soc Echocardiogr 2021; 35:378-386.e3. [PMID: 34915134 DOI: 10.1016/j.echo.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Data on the independent association of moderate aortic stenosis (AS) with excess mortality, even when it does not progress to severe AS, is limited. OBJECTIVE To evaluate the association of moderate AS with poor survival and to identify clinically important modifiers of that association. METHODS Consecutive patients who underwent echocardiographic evaluation between 2007 and 2019. All-cause mortality and cancer data were available for all patients from national registries. Cox regression survival models were applied with censoring of patients who developed metastatic cancer, developed > moderate AS, or underwent aortic valve intervention during follow-up. RESULTS The study population included 92,622 patients. There were 2,202 (2%) patients with moderate AS, with a median age of 79 (IQR 70-85), of whom 1,254(57%) were men. During follow-up of 5 (IQR 3-8) years, 19,712 (21%) patients died. The cumulative probability of death at 5 years was higher for moderate AS patients (46% vs. 18% respectively, p Log-rank < .001). Propensity score matching analysis (N=2,896) that included clinical, laboratory, and echocardiographic predictors of poor survival demonstrated that compared with ≤ mild AS, patients with moderate AS were 17% more likely to die (95% CI 1.04-1.30, p = 0.007). Moreover, the model showed that the moderate AS associated risk was ejection fraction (EF) and age-dependent with a more pronounced association among non-octogenarian patients and patients with reduced EF (p for interaction .001 and .016 respectively). CONCLUSION Moderate AS is independently associated with excess mortality, even when it does not progress to severe AS. The associated risk is more pronounced among patients with reduced EF and patients younger than 80 years.
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Affiliation(s)
- Edward Itelman
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Vatury
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Kuperstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Ben-Zekry
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Feinberg
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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22
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Segev A, Itelman E, Beigel R, Segal G, Chernomordik F, Matetzky S, Grupper A. Low ALT levels are associated with poor outcomes in acute coronary syndrome patients in the intensive cardiac care unit. J Cardiol 2021; 79:385-390. [PMID: 34696927 DOI: 10.1016/j.jjcc.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/25/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Frailty is an underrecognized and important entity that bears worse prognosis. Although low serum alanine aminotransferase (ALT) can serve as a novel marker of frailty, its use was never assessed in acute coronary syndrome (ACS) patients. METHODS A retrospective analysis of hospitalized ACS patients in the intensive cardiac care unit (ICCU)between 1/5/2011 and 1/12/2020 at a single tertiary medical center. RESULTS The study included 3956 patients after excluding patients with ALT >40 IU/L, cirrhosis, and missing data, followed for a medianduration of 47 months (IQR 20-77).Patients were stratified into two groups based on their first ALT measurement within the index hospitalization: low-normal ALT group (ALT ≤10 IU/L) vs. high-normal ALT group (ALT >10 IU/L). Patients with ALT≤10 IU/L were older (mean age 71 years vs. 65 years, p<0.001), presented more frequently with non-ST elevation myocardial infarction (66.4% vs. 53.2%, p< 0.001), had higher rates of comorbiditiesat baseline, and had a lower Norton score upon admission. Hospitalization length was longer in the low-normal ALT group (p< 0.001). Although the in-hospital mortality rate was similar between the groups (0.9% vs. 0.7%, p = 0.99), long-termmortality was significantly higher in the low-normal ALT group (22.7% vs. 7.9%, p< 0.001). In a multivariate regression model ALT ≤10 IU/l was associated with increased mortality (HR 2.1, 95% CI 1.46-3). CONCLUSIONS Lower serum ALT is associated with worse outcomes in ACS patients admitted to the ICCU.
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Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Edward Itelman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Roy Beigel
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Gad Segal
- Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Fernando Chernomordik
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Shlomi Matetzky
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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23
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Sharon A, Fishman B, Itelman E, Fefer P, Barbash I, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. The effect of early invasive strategy on mortality outcome in patients with chronic kidney disease presenting with non-ST segment elevation myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current guidelines recommend an early invasive strategy for patients with non-ST segment elevation myocardial infarction (NSTEMI).
Purpose
To evaluate whether early invasive strategy is associated with better outcome among patients with chronic kidney disease (CKD).
Methods
Retrospective cohort analysis of consecutive patients with NSTEMI between 2008 and 2021. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation. Invasively treated patients were dichotomized into early (<24 hours) and non-early groups. Mortality data was available for all patients from a national registry. Multivariate Cox regression models with interaction analysis were applied.
Results
Final study population comprised 7,107 NSTEMI patients, of whom 3,172 (45%) had eGFR <60 ml/min/1.73m2. 1,988 (28%) and 973 (14%) patients had eGFR under 45 and 30 ml/min/1.73m2, respectively. 3,529 (50%) patients were treated invasively, among them 1837 (52%) underwent early invasive strategy. Patients in the early invasive group were younger (64 vs. 68 years, p<0.001) and were less likely to have comorbidities including kidney disease. During a median follow-up of 3 years (IQR 1.2–5.2), 2,552 (36%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death was 50%, 15%, and 6% among patients in the conservative, non-early, and early invasive groups respectively (p Log-rank <0.001). Subgroup analysis of invasively managed patients showed that early invasive strategy was associated with a significant 32% reduced risk of death in a multivariate model (95% CI 0.56–0.82, p<0.001), but this associated benefit was modified by eGFR (p for interaction 0.045). The modification effect of CKD on the association of early invasive strategy with outcome was most pronounced among invasively treated patients with eGFR <45 ml/min/1.73m2, with no survival benefit for early invasive approach in these patients (HR 0.8, 95% CI 0.57–1.14, p=0.221 vs. HR 0.6 95% CI 0.45–0.72, p<0.001; p for interaction=0.046).
Conclusion
Among invasively treated NSTEMI patients, the benefit of early invasive strategy is modified by CKD, and limited to those with eGFR ≥45 ml/min/1.73m2.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sharon
- Sheba Medical Center, Tel Aviv, Israel
| | - B Fishman
- Sheba Medical Center, Tel Aviv, Israel
| | - E Itelman
- Sheba Medical Center, Tel Aviv, Israel
| | - P Fefer
- Sheba Medical Center, Tel Aviv, Israel
| | - I Barbash
- Sheba Medical Center, Tel Aviv, Israel
| | - A Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | - V Guetta
- Sheba Medical Center, Tel Aviv, Israel
| | - E Grossman
- Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Maor
- Sheba Medical Center, Tel Aviv, Israel
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Fishman B, Sharon A, Itelman E, Tsur AM, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Invasive management in elderly patients with non-ST elevation myocardial infarction is beneficial regardless of frailty status. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Elderly patients are underrepresented in clinical trials evaluating the management of non-ST elevation myocardial infarction (NSTEMI) patients. Moreover, frailty status is often not reported in these trials.
Purpose
To evaluate the association of invasive management with outcome among elderly (≥80) patients presenting with NSTEMI by frailty status.
Methods
Retrospective cohort of consecutive elderly patients who were hospitalized with NSTEMI as a primary clinical diagnosis between 2008 to 2019. Primary outcome was all-cause mortality. Frailty status was estimated as a continuous variable as well as categorized to low, medium, and high. Cox regression models were applied with stratification by frailty status. Additional sensitivity analyses were conducted including propensity score matching (PSM) and inverse probability treatment weighting (IPTW) models.
Results
Study population included 2,317 patients with median age of 86 years (IQR 83–90) of whom 1,243 (54%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs. 44%, p<.001). During the follow up (median of 19 months, [IQR 4–41]), 1,599 (69%) patients died. Kaplan Meier survival curves (Figure 1) show that the cumulative probability of death at 19 months was 50% among patients who were managed conservatively compared with 21% among invasively managed patients (p Log rank <.001). In the multivariable Cox model, invasive approach was associated with a significant 39% decrease in the risk of death (95% CI 0.53–0.71). The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 [0.58–0.93], 0.65 [0.50–0.85] and 0.52 [0.34–0.78], respectively; p for interaction NS). Results were consistent with PSM and IPTW analyses (HR of 0.6 [0.50–0.71] and 0.67 [0.55–0.82], respectively). Additional sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results.
Conclusions
Invasive approach is associated with improved survival among elderly patients with NSTEMI irrespective of frailty status. Our results support and extend recent ESC recommendations for the management of elderly patients with NSTEMI
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- B Fishman
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - A Sharon
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - E Itelman
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - A M Tsur
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - P Fefer
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - I M Barbash
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - A Segev
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - S Matetzky
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - V Guetta
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - E Grossman
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - E Maor
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
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25
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Itelman E, Segal M, Kuperstein R, Feinberg M, Segev A, Segal G, Maor E, Grossman E. Pulmonary hypertension is associated with systemic arterial hypertension among patients with normal diastolic function. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The association of pulmonary and systemic arterial hypertension is believed to be mediated through hypertensive left heart disease. The purpose of the current study was to investigate whether pulmonary arterial hypertension (PAH) is associated with systemic arterial hypertension among patients with apparently normal left heart diastolic function.
Methods
Consecutive patients who had echocardiographic evaluation between 2007 and 2019. Patients with disease states that are known to be associated with PAH including diastolic dysfunction were excluded from the analysis. Estimated right ventricular systolic pressure (RVSP) was extracted for all patients from the echocardiographic reports. PAH was defined as estimated RVSP >40 mmHg. Multivariate logistic regression models were applied.
Results
Final study population included 25,916 patients with a median age of 59 (IQR 44–69), of whom 12,501 (48%) were male and 13,265 (51%) had systemic arterial hypertension. Compared with normotensive patients, hypertensive patients were 3.2 times more likely to have PAH (95% CI; 2.91–3.53, p<0.001). A multivariate model adjusted for clinical and echocardiographic parameters that are known to be associated with PAH demonstrated that hypertensive patients are almost 3 times more likely to have PAH (95% CI 2.45–3.15, p<0.001). The association was significant in multiple subgroups but was more significant among women compared with men (OR 3.1 vs. 2.4, p for interaction <0.001).
Conclusions
PAH is associated with systemic arterial hypertension irrespective of left heart disease. The association is more pronounced among women.
Funding Acknowledgement
Type of funding sources: None. Estimated RVSP >40 by Systolic BP
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Affiliation(s)
- E Itelman
- Sheba Medical Center, Tel Hashomer, Israel
| | - M Segal
- Sheba Medical Center, Tel Hashomer, Israel
| | | | - M Feinberg
- Sheba Medical Center, Tel Hashomer, Israel
| | - A Segev
- Sheba Medical Center, Tel Hashomer, Israel
| | - G Segal
- Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Sheba Medical Center, Tel Hashomer, Israel
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Itelman E, Maor E, Kuperstein R, Freimark D, Matetzky S, Mazin I. Peripheral artery disease is associated with adverse outcome among hospitalized patients with decompensated heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Patients with heart failure (HF) and peripheral artery disease (PAD) share common high co-morbidities and outcomes. Management of HF patients has changed dramatically in the last decade. Our purpose in this analysis was to describe the prognostic significance of PAD in a large contemporary cohort of HF patients.
Methods
Analysis included consecutive patients who were hospitalized with decompensated HF between 2008–2020 at our Center. All patients' records were reviewed for the presence of PAD. Patients with cancer or chronic obstructive pulmonary disease were excluded from the analysis. Study outcomes were all-cause mortality and HF hospitalizations. Cox regression and propensity score matching models were applied.
Results
Final study population included 8,216 patients of whom 548 (7%) had PAD. Patients with PAD had higher rates of co-morbidities. Median follow-up was 3 (IQR 1–7) years. PAD was associated with a significant 35% increased risk of re-admission and mortality in univariate analysis (p<.001 for both). Propensity score matching analysis has demonstrated that PAD patients had similar mortality rates, but higher re-hospitalization rates during follow up. Finally, sensitivity analysis of the matching model (n=474), after excluding patients with RV dysfunction or severe pulmonary hypertension, successfully showed that HF patients with PAD were 50% more likely to be re-admitted and 30% more likely to die during follow-up (p=0.02 and 0.006 respectively; Figure 1)
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- E Itelman
- Sheba Medical Center, Tel Hashomer, Israel
| | - E.M Maor
- Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - I.M Mazin
- Sheba Medical Center, Tel Hashomer, Israel
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27
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Vaturi O, Itelman E, Kuperstein R, Fefer P, Barbash I, Klempfner R, Segev A, Feinberg M, Guetta V, Maor E. Right ventricular function and systolic pressure effect on survival of patients with tricuspid regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Severe tricuspid regurgitation (TR) is associated with poor outcome. The current analysis investigated the long term outcome of TR patients.
Methods
Historical retrospective cohort of all cardiovascular patients evaluated at a tertiary heart center between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. TR severity was extracted for all patients from the echocardiographic reports. Primary outcome was all cause mortality and was available for all patients from the national population register.
Results
Final cohort included 97,561 subjects, of whom 42,187 (43%) were outpatients. Mean age was 66±17 and 55,976 (57%) were men. Mild, moderate and severe TR was documented in 27,389 (28%), 2,871 (3%) and 1,812 (2%) patients, respectively. During a median follow up of 50 months [IQR 22–83] 18,476 (19%) patients died. Kaplan-Meier survival analysis demonstrated increased risk of death with increasing degree of TR (FIGURE; p Log rank <0.001). Multivariate cox regression with adjustment to age, gender, BMI and echocardiographic predictors of adverse outcome showed that compared with no or mild TR, patients with moderate or severe TR were 10% and 45% more likely to die (95% CI: 1.02–1.18, p=0.009 and 1.34–1.57 p<0.001 respectively). Interaction analysis with adjustment to known predictors of poor survival demonstrated that the association of severe TR with survival was dependent on right ventricle (RV) dysfunction and estimated RV systolic pressure (RVSP) with a more pronounced effect on patients with severe RV dysfunction (HR of 1.38 [1.07–1.80] vs. 1.09 [1.00–1.19], p for interaction = 0.01) and a more pronounced effect on patients with estimated RVSP <40 mmHg (HR of 1.60 [1.21–2.11] vs. 1.14 [1.03–1.25], p for interaction <0.001). Finally, a propensity score matching of patients with severe TR (N=1,154) and matched controls with no or mild TR successfully demonstrated that patients with severe TR were 27% more likely to die during follow up (95% CI: 1.14–1.42, p<0.001).
Conclusions
Severe TR is independently associated with poor survival. The association is modified by RV dysfunction and estimated RVSP. This report supports the need for studies to evaluate TR interventions on patients' clinical outcomes.
Kaplan Meier Survival Curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Vaturi
- Sheba Medical Center, Tel Aviv, Israel
| | - E Itelman
- Sheba Medical Center, Tel Aviv, Israel
| | | | - P Fefer
- Sheba Medical Center, Tel Aviv, Israel
| | | | | | - A Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | - V Guetta
- Sheba Medical Center, Tel Aviv, Israel
| | - E Maor
- Sheba Medical Center, Tel Aviv, Israel
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Abstract
Abstract
Background
Pericarditis in pregnancy is uncommon. Treatment options, including NSAIDs and long term gluco-corticosteroids (CS) have extensive side-effects, while data on the use of Colchicine in pregnant women who suffer from pericarditis is limited.
Objective
To evaluate the management and outcome of active pericarditis during pregnancy in both acute (AP) and recurrent pericarditis (RP) patients.
Methods and results
Twelve pregnant women (14 pregnancies) with active pericarditis were followed prospectively in our cardiology-pregnancy clinic; 6 with AP and 8 with RP. Etiology: 11 idiopathic, 2 post-pericardiotomy syndrome and 1 Q fever. Maternal age on presentation was 27±4y vs. 33±3y in RP vs AP respectively. Average gestational age upon diagnosis was lower in RP than in AP (18 weeks, range 6–30 vs 26 weeks, range 5–35). In the RP group, 7/8 women (87%) were treated with CS compared with 2/6 women (33%) in the AP group; 3 women in RP group (37%) failed to respond to subsequent treatment with azathioprine and 1 patient was treated successfully with Anakinra. Colchicine was prescribed in 13/14 (93%) of pregnancies, average colchicine exposure during pregnancy was 25±15 weeks. Recurrence during pregnancy: 6/8 (75%) of RP; 2/6 (33%) of the AP, all of them on CS. All pregnancies culminated in a live birth with a mean gestational age on delivery of 37±1.4 weeks. Average birthweight was 3267±507 grams. There were no fetal anomalies or developmental delays after a mean follow-up of 2.7 years. All newborns and maternal outcomes were normal. On long term follow-up after delivery RP patients treated with colchicine developed less recurrences.
Conclusion
Active pericarditis is associated with a high recurrence rate during pregnancy despite treatment with CS. Colchicine use in pregnant women with active pericarditis appears to be safe.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Lotan
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - Y Wasserstrum
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - E Itelman
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - M Nir-Simchen
- Sheba Medical Center, Gynaecology and Obstetrics, Ramat Gan, Israel
| | - M Arad
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - R Kuperstein
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
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29
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Wasserstrum Y, Lotan D, Oren D, Sanalla S, Itelman E, Dekel S, Beigel R, Shlomo N, Matetzky S. Serum lactate levels are an independent marker for complications in acute pulmonary embolism: from the PERT registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Serum lactate is a marker for the presence and severity of imbalances between tissue oxygen supply and demand. There are only scare data regarding the significance of arterial lactate in PE patients.
Purpose
We sought to explore the significance of venous serum lactate as a short- and long-term predictor of adverse outcomes.
Methods
We prospectively enrolled 570 patients with topographically-confirmed pulmonary embolism, hospitalized in our center during 2016–2019. Patient's data was collected using an electronic medical record and follow-up interviews via telephone. The combined end point of hemodynamic instability, shock, mechanical ventilation, or need for CPR was prospectively documented during hospitalization as well as 1-year mortality.
Results
The analysis included 461 consecutive patients with available clinical data including venous lactate. The median age was 69 years, and 262 (58%) were female. Median serum lactate levels were 21 mg/dL (IQR 16–31). The composite endpoint was documented in 92 patients (20%), and lactate levels above 21 mg/dl had a higher incidence of the composite end point (26% vs, 14%, p=0.002). Similar findings were seen when adding either the need for escalating therapy (44% vs. 24%, p<0.001), in-hospital mortality (31% vs. 16%, p=0.001) or 30-day mortality (27% vs. 21%, p<0.001) to the previous composite. One-year mortality was significantly higher in the higher lactate group (17% vs 5%, p<0.001), and a lactate level above 21 mg/dL was independently associated with 1-year mortality in a Cox-regression model adjusted for age, gender and a history of heart failure or malignancy, HR 2.5 (95% CI 1.7–3.9).
In subgroup analyses, lactate levels were associated with 1-year mortality regardless of age or gender. Similar predictive trends for 1-year mortality were seen in patients stratified by diabetes status, a current malignancy, PE risk and right-ventricle abnormalities (see figure).
Conclusions
Venous serum lactate levels are associated with a myriad of in-hospital adverse outcomes, as well as long-term mortality. In a 1-year follow-up, a higher lactate level was predictive of mortality across various subgroups, with higher hazard ratios seen specifically in lower-risk patients. Further studies are needed in order to evaluate the possible prognostic role of the change in serum lactate during PE management.
Elevated lactate and 1-year mortality
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - D Lotan
- Sheba Medical Center, Ramat Gan, Israel
| | - D Oren
- Sheba Medical Center, Ramat Gan, Israel
| | - S Sanalla
- Sheba Medical Center, Ramat Gan, Israel
| | - E Itelman
- Sheba Medical Center, Ramat Gan, Israel
| | - S Dekel
- Sheba Medical Center, Ramat Gan, Israel
| | - R Beigel
- Sheba Medical Center, Ramat Gan, Israel
| | - N Shlomo
- Sheba Medical Center, Ramat Gan, Israel
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30
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Itelman E, Vatury O, Ben-Zekry S, Kuperstein R, Fefer P, Barbash I, Klempfner R, Segev A, Feinberg M, Guetta V, Maor E. Survival of patients with moderate aortic stenosis: propensity score matching analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction and purpose
Data on the survival of patients with moderate aortic stenosis (AS) is conflicting. The purpose of the current analysis was to assess survival of moderate AS patients.
Methods
SHARE is an historical retrospective cohort of all cardiovascular patients evaluated in an Israeli tertiary hospital between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. Aortic stenosis severity was extracted for all patients from the echocardiographic reports. All-cause mortality and was available for all patients. Subjects with severe AS or aortic valve replacement were excluded from the analysis.
Results
Cohort included 97,561 subjects of whom 42,187 (43.2%) were outpatients. Final cohort included 93,889 patients with a mean age of 66±17 (58% men). There were 2,949 (3%) with moderate AS. During a median follow up of 52 [IQR 22–89] months 17,173 (18%) patients died. Kaplan-Meier survival analysis demonstrated worse cumulative probability of death of 51%±2% vs. 20%±0% at 5 years for patients with moderate AS vs. mild or no AS, respectively (p Log rank <0.001). Sub-analysis of 32,745 patients for whom clinical laboratory and medication data was available yielded consistent results in a comprehensive multivariate model such that patients with moderate AS (N=1,381) were 26% more likely to die (95% CI: 1.17–1.37, p<0.0001). Finally, a propensity score matching of patients with moderate AS and controls with no or mild AS (N=1,381) successfully demonstrated that patients with moderate AS were 40% more likely to die during follow up (95% CI 1.25–1.57, p<0.001; FIGURE). Four-years mortality rates were 2 fold higher for patients with moderate AS compared with controls (OR = 1.96, 95% CI 1.6–2.4, p<0.001). Interaction analysis demonstrated that the association of moderate AS with survival was not dependent on left ventricular ejection fraction.
Conclusion
Moderate AS is associated with worse survival. Our findings underscore the importance of careful clinical observation as well as the need for further studies.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Itelman
- Sheba Medical Center, Tel Hashomer, Israel
| | - O Vatury
- Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - P Fefer
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Barbash
- Sheba Medical Center, Tel Hashomer, Israel
| | | | - A Segev
- Sheba Medical Center, Tel Hashomer, Israel
| | - M Feinberg
- Sheba Medical Center, Tel Hashomer, Israel
| | - V Guetta
- Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Sheba Medical Center, Tel Hashomer, Israel
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Wasserstrum Y, Itelman E, Barriales-Villa R, Fernandez-Fernandez X, Adler Y, Lotan D, Klempfner R, Shlomo N, Sabbag A, Freimark D, Monserrat L, Arad M. Effect of hypokintic transformation on the clinical phenotype and functional capacity in hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Advanced hypertrophic cardiomyopathy (HCM) may be complicated by a dilated hypokinetic transformation. Reduced left ventricular ejection fraction (HFrEF) has been described in terms of specific risks of morbidity and mortality, and specifically in terms of increased risk for fatal arrhythmias. Nevertheless, recent publications have casted doubt regarding the role of arrhythmia in non-ischemic HFrEF and questioned the role of primary prevention strategies in these cases.
Methods
We've reviewed clinical characteristics of 883 patients age ≥40, diagnosed with HCM who were evaluated in the cardiomyopathy clinic in two tertiary medical centers in Israel and Spain.
Results
Forty-five patients (5%) suffered from hypokinetic transformation. They were younger at diagnosis (median 32 [IQR 24–55] vs. 49 [35–60], p<0.001), had a lower body-mass index (28.4 [±4.7] vs. 26.0 [±3.9], p<0.001), and suffered more from strokes (19% vs 6%, p<0.001). They had lower had a lower NYHA class (p=0.001) and lower exercise capacity (7.3 [4.5–10.8] vs. 9.6 [6.7–12.0] METS, p<0.001). Patients with hypokinetic HCM had higher rates of pacemaker and implanted defibrillator (ICD) implantations (41% vs 11%, p<0.001) and (43% vs 13%, p<0.001) respectively. These patients had a higher incidence of sustained ventricular tachyarrhythmias (14% vs 2%, p<0.001). Among patients who had an ICD, patients suffering from hypokinetic transformation had received more appropriate ICD therapy (27% vs 12%, p<0.001). These patients received more heart transplantations (13% vs 1%, p<0.001), and had a trend for higher incidence rate of Sudden cardiac death (6% vs 2% p=0.06) and a higher 5-year mortality rates (21% vs. 5%, p<0.001).
Conclusions
HCM patients suffering from hypokinetic transformation have lower functional and exercise capacities, are more likely to suffer from ventricular tachyarrhythmias and experience appropriate ICD therapy, and undergo heart transplantation. They also have a significantly lower 5-year survival.
Five-year survival
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - E Itelman
- Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Y Adler
- Sheba Medical Center, Ramat Gan, Israel
| | - D Lotan
- Sheba Medical Center, Ramat Gan, Israel
| | | | - N Shlomo
- Sheba Medical Center, Ramat Gan, Israel
| | - A Sabbag
- Sheba Medical Center, Ramat Gan, Israel
| | | | - L Monserrat
- University Hospital Complex A Coruña, A Coruña, Spain
| | - M Arad
- Sheba Medical Center, Ramat Gan, Israel
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32
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Segev A, Itelman E, Avaky C, Negru L, Shenhav-Saltzman G, Grupper A, Wasserstrum Y, Segal G. Low ALT Levels Associated with Poor Outcomes in 8700 Hospitalized Heart Failure Patients. J Clin Med 2020; 9:E3185. [PMID: 33008125 PMCID: PMC7600048 DOI: 10.3390/jcm9103185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia and frailty are causes for morbidity and mortality amongst heart failure (HF) patients. Low alanine transaminase (ALT) is a marker for these syndromes and, therefore, could serve as a biomarker for the prognostication of HF patients. We performed a retrospective analysis of all consecutive hospitalized HF patients in our institute in order to find out whether low ALT values would be a biomarker for poor outcomes. Our cohort included 11,102 patients, 35.6% categorized as heart failure with reduced ejection fraction. We excluded patients with ALT > 40 IU/L and cirrhosis. 8700 patients were followed for a median duration of 22 months and included in a univariate analysis. Patients with ALT < 10 IU/L were older (mean age 78.6 vs. 81.8, p < 0.001), had past stroke (24.6% vs. 19.6%, p < 0.001), dementia (7.7% vs. 4.6%, p < 0.001), and malignancy (13.4% vs. 10.2%, p = 0.003). Hospitalization length was longer in the low-ALT group (4 vs. 3 days, p < 0.001), and the rate of acute kidney injury during hospitalization was higher (19.1% vs. 15.6%; p = 0.006). The in-hospital mortality rate was higher in the low-ALT group (6.5% vs. 3.9%; p < 0.001). Long-term mortality was also higher (73.3% vs. 61.5%; p < 0.001). In a multivariate regression analysis, ALT < 10 IU/L had a 1.22 hazard ratio for mortality throughout the follow-up period (CI = 1.09-1.36; p < 0.001). Low ALT plasma level, a biomarker for sarcopenia and frailty, can assist clinicians in prognostic stratification of heart failure patients.
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Affiliation(s)
- Amitai Segev
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Edward Itelman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Chen Avaky
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Liat Negru
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gilat Shenhav-Saltzman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel;
| | - Yishay Wasserstrum
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gad Segal
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
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Itelman E, Wasserstrum Y, Segev A, Avaky C, Negru L, Cohen D, Turpashvili N, Anani S, Zilber E, Lasman N, Athamna A, Segal O, Halevy T, Sabiner Y, Donin Y, Abraham L, Berdugo E, Zarka A, Greidinger D, Agbaria M, Kitany N, Katorza E, Shenhav-Saltzman G, Segal G. Clinical Characterization of 162 COVID-19 patients in Israel: Preliminary Report from a Large Tertiary Center. Isr Med Assoc J 2020; 22:271-274. [PMID: 32378815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND In February 2020, the World Health Organisation designated the name COVID-19 for a clinical condition caused by a virus identified as a cause for a cluster of pneumonia cases in Wuhan, China. The virus subsequently spread worldwide, causing havoc to medical systems and paralyzing global economies. The first COVID-19 patient in Israel was diagnosed on 27 February 2020. OBJECTIVES To present our findings and experiences as the first and largest center for COVID-19 patients in Israel. METHODS The current analysis included all COVID-19 patients treated in Sheba Medical Center from February 2020 to April 2020. Clinical, laboratory, and epidemiological data gathered during their hospitalization are presented. RESULTS Our 162 patient cohort included mostly adult (mean age of 52 ± 20 years) males (65%). Patients classified as severe COVID-19 were significantly older and had higher prevalence of arterial hypertension and diabetes. They also had significantly higher white blood cell counts, absolute neutrophil counts, and lactate dehydrogenase. Low folic acid blood levels were more common amongst severe patients (18.2 vs. 12.9 vs. 9.8, P = 0.014). The rate of immune compromised patients (12%) in our cohort was also higher than in the general population. The rate of deterioration from moderate to severe disease was high: 9% necessitated non-invasive oxygenation and 15% were intubated and mechanically ventilated. The mortality rate was 3.1. CONCLUSIONS COVID-19 patients present a challenge for healthcare professionals and the whole medical system. We hope our findings will assist other providers and institutions in their care for these patients.
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Affiliation(s)
- Edward Itelman
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishay Wasserstrum
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Segev
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Avaky
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Negru
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dor Cohen
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natia Turpashvili
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sapir Anani
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zilber
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Lasman
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahlam Athamna
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Segal
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Halevy
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Sabiner
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Donin
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Abraham
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elisheva Berdugo
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Zarka
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dahlia Greidinger
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhamad Agbaria
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noor Kitany
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Management Wing, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilat Shenhav-Saltzman
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Segal
- Department of Internal Medicine: Corona Care Unit, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, University of Nicosia, Nicosia, Cyprus
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wasserstrum Y, Lotan D, Itelman E, Barbarova I, Kogan M, Klempfner R, Dagan A, Segal G. Corrected QT interval anomalies are associated with worse prognosis among patients suffering from sepsis. Intern Med J 2016; 46:1204-1211. [DOI: 10.1111/imj.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Y. Wasserstrum
- Sackler School of Medicine, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - D. Lotan
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - E. Itelman
- Sackler School of Medicine, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - I. Barbarova
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - M. Kogan
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - R. Klempfner
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - A. Dagan
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - G. Segal
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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