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Alapati R, Wagoner SF, Lawrence A, Bon Nieves A, Desai A, Shnayder Y, Hamill C, Kakarala K, Neupane P, Gan G, Sykes KJ, Bur AM. Impact of Adjuvant Radiotherapy Setting on Quality-of-Life in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2024. [PMID: 38436503 DOI: 10.1002/lary.31382] [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: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine differences in post-treatment QoL across treatment settings in patients receiving adjuvant radiation therapy for head and neck squamous cell carcinoma (HNSCC). METHODS This was a prospective observational cohort study of patients with HNSCC initially evaluated in a head and neck surgical oncologic and reconstructive clinic at an academic medical center (AMC). Participants were enrolled prior to treatment in a prospective registry collecting demographic, social, and clinical data. Physical and social-emotional QoL (phys-QoL and soc-QoL, respectively) was measured using the University of Washington-QoL questionnaire at pre-treatment and post-treatment visits. RESULTS A cohort of 177 patients, primarily male and White with an average age of 61.2 ± 11.2 years, met inclusion criteria. Most patients presented with oral cavity tumors (n = 132, 74.6%), had non-HPV-mediated disease (n = 97, 61.8%), and were classified as Stage IVa (n = 72, 42.8%). After controlling for covariates, patients treated at community medical centers (CMCs) reported a 7.15-point lower phys-QoL compared with those treated at AMCs (95% CI: -13.96 to -0.35, p = 0.040) up to 12 months post-treatment. Additionally, patients who were treated at CMCs had a 5.77-point (-11.86-0.31, p = 0.063) lower soc-QoL score compared with those treated at an AMC, which was not statistically significant. CONCLUSION This study revealed that HNSCC patients treated with radiation at AMCs reported significantly greater phys-QoL in their first-year post-treatment compared to those treated at CMCs, but soc-QoL did not differ significantly. Further observational studies are needed to explore potential factors, including treatment planning and cancer resource engagement, behind disparities between AMCs and CMCs. LEVEL OF EVIDENCE Step 3 Laryngoscope, 2024.
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Affiliation(s)
- Rahul Alapati
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Sarah F Wagoner
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Amelia Lawrence
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Antonio Bon Nieves
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Atharva Desai
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Chelsea Hamill
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Gregory Gan
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Baylor Scott & White, Health and Wellness Center, Dallas, Texas, U.S.A
| | - Andrés M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
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Gan G, Janhavi A, Tong G, Lim JT, Dickens BL. The need for pre-emptive control strategies for mpox in Asia and Oceania. Infect Dis Model 2024; 9:214-223. [PMID: 38293686 PMCID: PMC10825486 DOI: 10.1016/j.idm.2023.12.005] [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: 08/23/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The transmission dynamics of the recent mpox outbreak highlights the lack of infrastructure available to rapidly respond to novel STI outbreaks, of which Asia and Oceania remains particularly susceptible. Here, we simulate outbreaks in this setting and propose the use of pre-emptive vaccination within the men who have sex with men (MSM) community before the arrival and establishment of the virus. Materials and methods Using data driven heterogeneous sexual contact networks, we simulated outbreaks of mpox in Singapore, Hong Kong, and Sydney. An individual based SEIR compartmental model was used to simulate epidemic trajectories and the impact of different vaccination uptakes was assessed in their ability to avert or suppress outbreaks upon the arrival of mpox within the MSM populations. Results The highly dense sexual networks of Singapore and Sydney experience rapid outbreaks, with infection peaks occurring at day 41 and 23 respectively, compared to Hong Kong which occurs at day 77. Across the simulations with no vaccination, 68.2%-89.7% of the MSM community will become infected with mpox across the different cities, over a simulation period of 1 year. By implementing vaccination strategies, the infection rate across the cities can be reduced to as low as 3.1% of the population (range: 3.1%-82.2%) depending on the implementation and uptake of the vaccine. Vaccination is also extremely effective in slowing the start of the epidemic, delaying the epidemic peak by 36-50 days in Hong Kong, or even preventing the outbreak of mpox. Discussion With extremely dense and well-connected sexual contact networks, where 65.2%-83.2% of the population are connected to a super-spreader in the different contact networks, pre-emptive or immediate vaccination upon identification of the first case is strongly recommended to help better manage the outbreak of mpox and prevent potential straining of healthcare systems.
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Affiliation(s)
- Gregory Gan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A. Janhavi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Guan Tong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Borame L. Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Tewari P, Ma P, Gan G, Janhavi A, Choo ELW, Koo JR, Dickens BL, Lim JT. Non-linear associations between meteorological factors, ambient air pollutants and major mosquito-borne diseases in Thailand. PLoS Negl Trop Dis 2023; 17:e0011763. [PMID: 38150471 PMCID: PMC10752508 DOI: 10.1371/journal.pntd.0011763] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/31/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Transmission intensity for mosquito-borne diseases are highly heterogenous and multi-factorial. Understanding risk factors associated to disease transmission allow the optimization of vector control. This study sets out to understand and compare the combined anthropogenic and environmental risk factors of four major mosquito-borne diseases, dengue, malaria, chikungunya and Japanese encephalitis in Thailand. METHODS An integrated analysis of mosquito-borne diseases, meteorological and ambient air pollutants of 76 provinces of Thailand was conducted over 2003-2021. We explored the use of generalized linear models and generalized additive models to consider both linear and non-linear associations between meteorological factors, ambient air pollutants and mosquito-borne disease incidence. Different assumptions on spatio-temporal dependence and nonlinearity were considered through province-specific and panel models, as well as different spline functions. Disease-specific model evidence was assessed to select best-fit models for epidemiological inference downstream. RESULTS Analyses indicated several findings which can be generally applied to all diseases explored: (1) higher AH above mean values was positively associated with disease case counts (2) higher total precipitation above mean values was positively associated with disease case counts (3) extremely high temperatures were negatively associated with disease case counts (4) higher SO2 and PM2.5 surface concentrations were negatively associated with disease case counts. However, the relationships between disease and RH, non-extreme temperatures and CO surface concentration were more mixed, with directions of associations changing across the different diseases considered. CONCLUSIONS This study found protective and enhancing effects of meteorological and ambient air pollutant factors on mosquito-borne diseases burdens in Thailand. Further studies should employ these factors to understand and predict risk factors associated with mosquito-borne disease transmission.
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Affiliation(s)
- Pranav Tewari
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pei Ma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gregory Gan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - A. Janhavi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Esther Li Wen Choo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Joel Ruihan Koo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Borame Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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4
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Holcomb AJ, Farrokhian N, Tolan C, Whiteford E, Villwock M, Kakarala K, Shnayder Y, Sykes K, Lominska C, Gan G, Buchakjian MR, Harding B, Dooley L, Shinn J, Burton Wood C, Rohde S, Khaja S, Abt NB, Varvares M, Bur AM. Adjuvant radiotherapy mitigates impact of perineural invasion on oncologic outcomes in early-stage oral cavity squamous cell carcinoma. A multi-institutional analysis of 557 patients. Oral Oncol 2023; 142:106420. [PMID: 37182430 PMCID: PMC10575471 DOI: 10.1016/j.oraloncology.2023.106420] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Understand the prognostic impact of perineural invasion (PNI) in early-stage oral cavity squamous cell carcinoma (OCSCC). Assess the influence of adjuvant radiotherapy on outcomes of patients with PNI-positive early-stage OCSCC. MATERIALS AND METHODS Retrospective seven-institution cohort study including patients with pathologic T1-2 N0-1 OCSCC who underwent primary surgery with negative margins. Outcomes included disease-free survival (DFS) and locoregional control (LRC). Cox proportional hazards models were used to evaluate oncologic outcomes. Interaction terms were introduced to assess relationships between PNI and adjuvant radiotherapy. RESULTS Among 557 patients (mean (SD) age 61.0 (13.9), 47.2% female, 66.6% pathologic T1, 93.5% pathologic N0), 93 had PNI-positive tumors, among which 87.1% underwent neck dissection and 39.6% received radiotherapy. On multivariable analysis, PNI was associated with lower DFS and LRC. Adjuvant radiotherapy was not associated with improved outcomes on multivariable analysis of the entire cohort. However, among patients with PNI-positive tumors, adjuvant radiotherapy significantly decreased hazard for DFS. CONCLUSION Among patients with low-risk, early-stage OCSCC, PNI was associated with worse DFS and LRC. In patients with PNI-positive tumors, adjuvant radiotherapy lowered hazard for DFS on multivariable analysis. These data support using adjuvant radiotherapy for patients with early-stage OCSCC with PNI.
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Affiliation(s)
- Andrew J Holcomb
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, NE, United States.
| | - Nathan Farrokhian
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Claire Tolan
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, NE, United States
| | - Erin Whiteford
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, NE, United States
| | - Mark Villwock
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Kiran Kakarala
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Yelizaveta Shnayder
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Kevin Sykes
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Christopher Lominska
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Gregory Gan
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Marisa R Buchakjian
- University of Iowa Department of Otolaryngology Head & Neck Surgery, Iowa City, IA, United States
| | - Brette Harding
- University of Missouri Department of Otolaryngology Head & Neck Surgery, Columbia, MO, United States
| | - Laura Dooley
- University of Missouri Department of Otolaryngology Head & Neck Surgery, Columbia, MO, United States
| | - Justin Shinn
- Vanderbilt University Department of Otolaryngology Head & Neck Surgery, Nashville, TN, United States
| | - C Burton Wood
- Vanderbilt University Department of Otolaryngology Head & Neck Surgery, Nashville, TN, United States
| | - Sarah Rohde
- Vanderbilt University Department of Otolaryngology Head & Neck Surgery, Nashville, TN, United States
| | - Sobia Khaja
- University of Minnesota Department of Otolaryngology Head & Neck Surgery, Minneapolis, MN, United States
| | - Nicholas B Abt
- Massachusetts Eye and Ear, Harvard Medical School Department of Otolaryngology Head & Neck Surgery, Boston, MA, United States
| | - Mark Varvares
- Massachusetts Eye and Ear, Harvard Medical School Department of Otolaryngology Head & Neck Surgery, Boston, MA, United States
| | - Andrés M Bur
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
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Tao LY, Gan G, Liu J. [Interpretation of Consolidated Health Economic Evaluation Reporting Standards 2022]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:667-672. [PMID: 37147843 DOI: 10.3760/cma.j.cn112338-20221127-01002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The number of studies related to health economics evaluation is increasing. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) contains 28 items. Based on CHEERS 2013, CHEERS 2022 adds a health economic analysis plan, model sharing, and community, patient, public, and other relevant stakeholders' participation in the statement, taking into account the future development direction of health economics evaluation. It provides a useful review tool for peer reviewers, editors, and readers and supports health technology assessment agencies in establishing standard reporting standards for health economics evaluations. In this study, we briefly introduced and interpreted the CHEERS 2022 statement and analyzed an example of health economics evaluation in infectious disease epidemiology to provide a reference for researchers to report studies regarding health economics evaluation standardly.
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Affiliation(s)
- L Y Tao
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - G Gan
- China National Health Development Research Center,National Health Commisson, Beijing 100033, China
| | - J Liu
- School of Public Health, Peking University, Beijing 100191, China
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6
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Yilmaz E, Ismaila N, Bauman JE, Dabney R, Gan G, Jordan R, Kaufman M, Kirtane K, McBride SM, Old MO, Rooper L, Saba NF, Sheth S, Subramaniam RM, Wise-Draper TM, Wong D, Mell LK. Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers: ASCO Guideline. J Clin Oncol 2023; 41:1132-1146. [PMID: 36521102 DOI: 10.1200/jco.22.02328] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other health care providers on immunotherapy and biomarker testing for head and neck cancers. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, radiology, pathology, and patient advocacy experts to conduct a literature search, including systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2022. Outcomes of interest included survival, overall response, and locoregional control. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 28 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address biomarker testing, first-line treatment regimens based on programmed death ligand-1 scores, immunotherapy in platinum-refractory recurrent or metastatic head and neck squamous cell carcinoma, immunotherapy in nasopharyngeal carcinoma, and radiation therapy in combination with immunotherapy for treatment of local recurrence.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | - Gregory Gan
- Kansas University Medical Center, Kansas City, KS
| | - Richard Jordan
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | - Rathan M Subramaniam
- Otago Medical School, University of Otago, Dunedin, New Zealand
- Duke University, Durham, NC
| | | | - Deborah Wong
- University of California Los Angeles, Los Angeles, CA
| | - Loren K Mell
- University of California San Diego, La Jolla, CA
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7
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Zannad N, Michy B, Brisse A, Halalchi M, Simon G, Aubert R, Parizel E, Gan G, Yassine M. Atrial flutter caused by migration of a superior vena cava stent into the right atrium. Ann Cardiol Angeiol (Paris) 2022; 71:331-334. [PMID: 36068113 DOI: 10.1016/j.ancard.2022.07.003] [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] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
We describe the case of a patient presenting with an atrial flutter mechanically induced by a stent migration from the superior vena cava to the right atrium.
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Affiliation(s)
- N Zannad
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France.
| | - B Michy
- CHR Metz-Thionville, service de pneumologie, Hôpital Bel Air 1 allée Frescaty 57100 Thionville , France
| | - A Brisse
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - M Halalchi
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - G Simon
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - R Aubert
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - E Parizel
- CHR Metz-Thionville, service radiologie, Hôpital Bel Air 1 allée Frescaty 57100 Thionville , France
| | - G Gan
- CHR Metz-Thionville, service ophtalmologie, Hôpital Mercy 1 allée du château 57530 Ars Laquenexy, France
| | - M Yassine
- CHR Metz-Thionville, service de cardiologie, Hôpital Mercy 1 allée du château 57530 Ars Laquenexy , France
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Juloori A, Gan G, Zhang J, Abazeed M, Hara J, Baschnagel A, Traynor A, Bassetti M, Patel J, Chmura S, Bestvina C. EP14.03-001 DARES: A Phase II Trial of Durvalumab and Ablative Radiation in Extensive Stage Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.968] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen H, Bhat A, Goode E, Latumahina A, Farghaian H, Omaimah N, Patel R, Tan T, Burgess D, Gan G. Performance of a Multi-Disciplinary Heart Failure Clinic Model of Care in Western Sydney: A Blacktown Hospital Pilot Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.112] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Implications of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Sclerosis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.369] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Nawaz S, Gu K, Fernandez F, Chen H, Bhat A, Gan G, Tan T. Utility of Myocardial Work in Predicting Cardiovascular Outcomes in a Diabetic Population. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.302] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Impact of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Lupus Erythematosus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.368] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Gan G, Bhat A, Gu K, Chen H, Fernandez F, Thomas L. Left Ventricular Global Longitudinal Strain Predicts Adverse Cardiovascular Outcomes in Patients With Comorbid Chronic Kidney Disease and Diabetes Mellitus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.263] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Chen H, Bhat A, Lee C, Fernandez F, Gan G, Negishi K, Tan T. Prognostic Value of Right Ventricular Free Wall Strain in Stable Non-Ischaemic Cardiomyopathy Patients With Reduced Left Ventricular Systolic Function. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.121] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gan G, Bhat A, Rao A, Gu K, Thangarajah M, Kean A, Michail D, Tanous D, Thomas L. Prevalence and Impact of Comorbid Atrial Fibrillation in Patients With Pulmonary Hypertension. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.365] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Malaty M, Chen HHL, Gan G. Left atrial reservoir strain is reduced in patients with myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.032] [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
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a management conundrum given the poorly understood pathogenic mechanisms. In recent years, novel echocardiographic measures such as deformation/strain analysis have enabled early identification of left atrial (LA) remodelling and dysfunction which take place prior to structural alterations. LA dysfunction is an important biomarker of cardiovascular disease and an independent predictor of atrial arrhythmias which may play a fundamental role in the pathogenesis of MINOCA.
Purpose
The goal of our study was to evaluate and characterise LA function by speckle tracking strain echocardiography in patients with MINOCA.
Methods
Patients admitted to our institution with acute myocardial infarction were assessed and those diagnosed with MINOCA who underwent transthoracic echocardiogram (TTE) within 48-hours of their coronary angiogram were included. Diagnosis of MINOCA was based on the 2017 ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Two-dimensional speckle tracking strain analysis of the LA and left ventricle (LV) was performed offline using vendor independent software (TomTec Arena). Clinical and echocardiographic measures were compared to healthy controls identified from our echocardiography database. We excluded patients with history of atrial fibrillation, heart failure and LV dysfunction (LVEF <50%).
Results
The cohort consisted of 82 patients; 41 patients with MINOCA were compared to 41 age and sex matched controls (61% male, mean age 51±12.8 years). At baseline, patients with MINOCA had a higher prevalence of modifiable vascular risk factors including smoking, hypertension and diabetes (p<0.001 for all). Of the echocardiographic parameters, no differences in left ventricular (LV) parameters including LV global longitudinal strain (p=0.463), indexed LV mass (p=0.084) and the E/e' (p=0.391) was appreciated. Though there was no difference in LA volumes or volumetric parameters of LA function (LAEF; p=0.328), patients with MINOCA had a lower LA reservoir strain (29.7±8.5% vs 33.2±6.5%; p=0.04; 95% CI 0.32–5.33).
Conclusion
Patients with MINOCA demonstrated lower LASr despite normal LV and LA volumes. This suggests that LA dysfunction may play a role in the pathogenesis of MINOCA. Further studies are required to evaluate the significance of our findings.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Malaty
- Blacktown Hospital, Department of Cardiology, Blacktown, Australia
| | - H H L Chen
- Blacktown Hospital, Department of Cardiology, Blacktown, Australia
| | - G Gan
- Blacktown Hospital, Department of Cardiology, Blacktown, Australia
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Chmura S, Winter KA, Robinson C, Pisansky TM, Borges V, Al-Hallaq H, Matuszak M, Park SS, Yi S, Hasan Y, Bazan J, Wong P, Yoon HA, Horton J, Gan G, Milano MT, Sigurdson ER, Moughan J, Salama JK, White J. Evaluation of Safety of Stereotactic Body Radiotherapy for the Treatment of Patients With Multiple Metastases: Findings From the NRG-BR001 Phase 1 Trial. JAMA Oncol 2021; 7:845-852. [PMID: 33885704 PMCID: PMC8063134 DOI: 10.1001/jamaoncol.2021.0687] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Stereotactic body radiotherapy (SBRT) for oligometastases is hypothesized to improve survival and is increasingly used. Little evidence supports its safe use to treat patients with multiple metastases. OBJECTIVE To establish safety of SBRT dose schedules in patients with 3 to 4 metastases or 2 metastases in close proximity to each other. DESIGN, SETTING, AND PARTICIPANTS This phase 1 trial opened on August 4, 2014, and closed to accrual on March 20, 2018. Metastases to 7 anatomic locations were included: bone/osseous (BO), spinal/paraspinal (SP), peripheral lung (PL), central lung (CL), abdominal-pelvic (AP), mediastinal/cervical lymph node (MC), and liver (L). Six patients could be enrolled per anatomic site. The setting was a consortium of North American academic and community practice cancer centers participating in NRG Oncology trials. Patients with breast, prostate, or non-small cell lung cancer with 3 to 4 metastases or 2 metastases in close proximity (≤5 cm) amenable to SBRT were eligible for this phase 1 study. Statistical analyses were performed from December 31, 2017, to September 19, 2019. INTERVENTIONS The starting dose was 50 Gy in 5 fractions (CL, MC), 45 Gy in 3 fractions (PL, AP, L), and 30 Gy in 3 fractions (BO, SP). MAIN OUTCOMES AND MEASURES The primary end point was dose-limiting toxicity (DLT) defined by the Common Terminology Criteria for Adverse Events, version 4.0, as specific adverse events (AEs) of grades 3 to 5 (definite or probable per the protocol DLT definition) related to SBRT within 180 days of treatment. Dose levels were considered safe if DLTs were observed in no more than 1 of 6 patients per location; otherwise, the dose at that location would be de-escalated. RESULTS A total of 42 patients enrolled, 39 were eligible, and 35 (mean [SD] age, 63.1 [14.2] years; 20 men [57.1%]; 30 White patients [85.7%]) were evaluable for DLT. Twelve patients (34.3%) had breast cancer, 10 (28.6%) had non-small cell lung cancer, and 13 (37.1%) had prostate cancer; there was a median of 3 metastases treated per patient. Median survival was not reached. No protocol-defined DLTs were observed. When examining all AEs, 8 instances of grade 3 AEs, most likely related to protocol therapy, occurred approximately 125 to 556 days from SBRT initiation in 7 patients. CONCLUSIONS AND RELEVANCE This phase 1 trial demonstrated the safety of SBRT for patients with 3 to 4 metastases or 2 metastases in close proximity. There were no treatment-related deaths. Late grade 3 AEs demonstrate the need for extended follow-up in long-surviving patients with oligometastatic disease. Treatment with SBRT for multiple metastases has been expanded into multiple ongoing randomized phase 2/3 National Cancer Institute-sponsored trials (NRG-BR002, NRG-LU002). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02206334.
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Affiliation(s)
- Steve Chmura
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Thomas M Pisansky
- Department of Medicine-Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Hania Al-Hallaq
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Sean S Park
- Department of Medicine-Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sun Yi
- Department of Radiation Oncology, University of Arizona Medical Center - University Campus, Tucson
| | - Yasmin Hasan
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Jose Bazan
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Philip Wong
- Centre Hospitalier de L'Universite de Montréal, Hotel Dieu de Montréal, Montréal, Quebec, Canada
| | - Harold A Yoon
- Heartland Cancer Research National Cancer Institute Community Oncology Research Program, Decatur, Illinois
| | - Janet Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Gregory Gan
- New Mexico Minority Underserved National Cancer Institute Community Oncology Research Program, Albuquerque
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | | | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Julia White
- Ohio State University Comprehensive Cancer Center, Columbus
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Sot M, Gan G, François J, Chaussard D, Da Costa M, Luc MS, Goetz C, Dinot V, Lhuillier L, Perone JM. Risk factors for keratoconus progression after treatment by accelerated cross-linking (A-CXL): A prospective 24-month study. J Fr Ophtalmol 2021; 44:863-872. [PMID: 34059330 DOI: 10.1016/j.jfo.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2020] [Revised: 08/15/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Identification of potential predictive factors for keratoconus progression after treatment by accelerated Cross-linking (A-CXL) SECONDARY OBJECTIVES: Evaluation of clinical and topographic outcomes for two years following accelerated cross-linking treatment for progressive keratoconus including: best spectacle corrected visual acuity (BSCVA), thinnest pachymetry, maximum keratometry (Kmax), cylinder. STUDY Prospective, interventional, monocentric study. SITE: Metz-Thionville Regional Medical Center, Lorraine University, Mercy Hospital, Metz, France. PATIENTS AND METHODS We included 82 eyes of 60 patients between March 2014 and June 2016 who underwent accelerated corneal cross-linking (A-CXL) with epithelial debridement for progressive keratoconus, with a minimum follow-up of 2 years. A complete clinical evaluation and corneal topography were performed before cross-linking, and subsequently at 6, 12 and 24 months post-procedure. The following parameters were monitored during follow-up: best spectacle corrected visual acuity (BSCVA), minimal pachymetry, maximum keratometry (Kmax), mean anterior and posterior curvatures, maximum posterior curvature, presence of optical aberrations, subdivided into spherical aberration, coma, astigmatism, higher order optical aberrations and residual optical aberrations. After a 2-year follow-up, two groups, defined as "responders" and "non-responders" to treatment, were separated for analysis, and their initial characteristics were compared. RESULTS Data for 82 eyes of 60 patients with progressive keratoconus with a mean age of 24±7 years were studied. Fourteen eyes (17.1%) showed signs of progression after treatment by A-CXL (non-responders), and 68 eyes (82.9%) showed stabilization of the disease (responders). Characteristics of non-responding eyes after A-CXL included a younger mean age (20±5 vs. 25±7 years) (P=0.04) and a lower initial mean BCVA for non-responders of 0.44±0.16 logMAR vs. 0.29±0.19 logMAR (P=0.03). Non-responders also had a higher mean maximal posterior curvature (AKB) of -10.84±1.72D vs. -9.46± 1.12D (P=0.03). They also showed more higher order optical aberrations (3.84±1.72D vs. 2.4±1.02D; P=0.01), including coma (3.85±1.81D vs. 2.1±1.01D; P=0.03) and more residual aberrations than responders (1.05±0.44D vs. 0.45±0.6D; P=0.005). No significant differences were found between responders and non-responders for the other parameters in our study. CONCLUSION Eyes with progressive keratoconus who did not respond to A-CXL treatment were the most aggressive cases in the youngest patients, with highest maximum corneal curvatures and most pronounced optical aberrations. These patients should be informed in advance of the high risk of non-response to A-CXL treatment, and of the potential need for additional treatment in the future.
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Affiliation(s)
- M Sot
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - G Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - J François
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - D Chaussard
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - M Da Costa
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - M S Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - C Goetz
- Clinical Research Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - V Dinot
- Clinical Research Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - L Lhuillier
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - J M Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
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Bhat A, Chen H, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan G, Dobbins T, MacIntyre C, Tan T. Diagnostic and Prognostic Value of Novel Echocardiographic Biomarkers in Identification of Cardioembolism and Prediction of Outcomes in Patients with Stroke of Undetermined Source. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.006] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khanna S, Newman J, Gupta A, Wen I, Bhat A, Chen H, Gan G, Tan T. Left Ventricular Global Longitudinal Strain is a Predictor of Adverse Cardiovascular Outcomes in Patients With Rheumatoid Arthritis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.226] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Malaty M, Chandrakumar D, Li C, Aladdin A, Jethwani U, Gan G, Tan T. Prevalence of Cardiotoxicity in Cancer Patients Treated With Single and Combination Immune Checkpoint Inhibitor Therapy—A Single Centre Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.319] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Stefani L, Gan G, Trivedi S, Ferkh A, Altman M, Thomas L. LA Strain Mechanics are Altered in Hypertensive Patients vs Healthy Individuals. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.221] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Malaty M, Chandrakumar D, Li C, Aladdin A, Jethwani U, Gan G, Tan T. Factors Impacting on the Early Versus Late Major Adverse Cardiovascular Events Amongst Oncology Patients Receiving Non-Anthracycline Chemotherapy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.284] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Wen I, Khanna S, Thakur A, Chen H, Bhat A, Gan G, Tan T. Patients With Neuro-Immunological Disorders With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.235] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Khanna S, Amarasekera A, Li C, Bhat A, Chen H, Gan G, Tan T. Characterisation of Myocardial Structure and Function by Cardiac Magnetic Resonance Imaging in Adult Patients With Acute-Phase Myocarditis: A Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.196] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Abstract
Background
Hypertension (HTN) and diabetes mellitus (DM) are prevalent cardiovascular disease states which have been shown to be associated with adverse cardiac remodelling and subclinical myocardial dysfunction. Myocardial work (MW) indices are novel non-invasive measures of left ventricular (LV) function. We aimed to characterise key differences in MW indices in patients with these conditions.
Methods
Outpatients with HTN and DM undergoing transthoracic echocardiography (TTE; 2016–2019) at our institution were assessed and compared to healthy controls. Only patients without cardiac disease with normal diastolic parameters on TTE were recruited. Patients with impaired LV function, cardiac ischaemia or arrhythmia, structural and valvular heart disease or poor-quality images were excluded. Recruited patients were stratified into 3 groups (Group1: Healthy Controls; Group 2: HTN; Group 3: HTN-DM). MW assessment was performed using GE E-95 EchoPac v2.2 system.
Results
Three hundred patients (57.3±17.4y, 51% female) were recruited. HTN and HTN-DM patients were associated with higher resting systolic blood pressure (SBP), indexed LV mass (LVMI), e' and E/e' compared to controls but no differences were noted in these parameters between HTN and HTN-DM. Global myocardial work index (GWI) was higher in HTN patients compared to Controls but not different compared to HTN-DM. Of interest, HTN-DM patients had higher global myocardial wasted work (GWW) and lower global myocardial work efficiency (GWE) compared to HTN patients and Controls.
Conclusions
MW indices may be a sensitive tool for the detection of subclinical changes in cardiac function in cardiometabolic disease states.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | | | | | - M Kodsi
- Blacktown Hospital, Sydney, Australia
| | - G Gan
- Blacktown Hospital, Sydney, Australia
| | - T.C Tan
- Blacktown Hospital, Sydney, Australia
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Bhat A, Gan G, Chen H, Gu K, Denniss M, Burgess D, MacIntyre R, Tan T. Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0494] [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
The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population.
Purpose
The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD.
Methods
Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to <6 months.
Results
2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p<0.01), with lower eGFR (p<0.01) and higher rates of renal replacement therapy (p<0.01). They also had a greater burden of coronary disease (p<0.01), heart failure (p<0.01), stroke (p<0.01), obstructive sleep apnoea (p<0.01), chronic obstructive pulmonary disease (p<0.01), anaemia (p<0.01) and obesity (p<0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p<0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p<0.01).
Conclusions
Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD.
Figure 1. Kaplan Meier Curve
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Bhat
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - G Gan
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - H.H.L Chen
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - K Gu
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - M Denniss
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - D.C Burgess
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - R MacIntyre
- University of New South Wales, Sydney, Australia
| | - T.C Tan
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
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28
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Yilmaz E, Lee D, Cowan A, Gan G, Ozbun M, Guo Y. Abstract 6474: FAT1 and CASP8 co-mutations are associated with poor prognosis in HPV negative head and neck squamous cell carcinoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-6474] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: FAT1 alterations with somatic mutations or deletions are observed in head and neck squamous cell carcinomas (HNSCC). These alterations lead to loss of function of FAT1. FAT1 loss of function was known to be associated with aberrant Wnt activation, cell migration and invasion. In this study, we present analysis and outcomes of co-mutations seen in FAT1-mutation positive HNSCC.
METHODS: TCGA data were analyzed for mutation, gene expression data and overall survival. We examined mutation data in 415 HPV negative samples and 72 HPV positive samples. The Fisher's Exact test was used to determine if differences in mutation frequency existed between the different cohorts. Mantel-Cox method was used for overall survival (OS) comparison between the cohorts.
RESULTS: FAT1 somatic mutation was the third most commonly mutated gene in HPV-negative HNSCC while it was not common in HPV-positive HNSCC. FAT1 mutation was seen in 25.8% of HPV negative HNSCC (107/415), while 4.2% (3/72) HPV positive HNSCC had FAT1 mutation. We then analyzed the frequency of co-mutations in FAT1-mutated HPV-negative HNSCC. CDKN2A, NOTCH1, CASP8, FBXW7, ZFHX4, HRAS, DCC, ATR mutations were more common in FAT1-mutated cancers. CASP8 mutation was seen in 24.30% (26 out of 107 samples) of FAT1-mutations positive HPV negative HNSCC, while it was less common in FAT1-mutation negative HNSCC (9.08% 28/308) (P=0.002). The patients with FAT1 and CASP8 co-mutation were associated with shorter overall survival when compared with patients with FAT1-mutation (19.8 months vs 52.3 months P=0.02). FAT1 only or CASP8 only mutation without co-mutation did not affect survival. To determine the mutation impact of the FAT1 and CASP8 mutations in HNSCC, differentially expressed genes between mutated and non-mutated genes were analyzed in HNSCC. CASP8 mutation was the top gene among the genes with somatic mutation in HNSCC and associated with gene expression changes in more than 6000 genes. FAT1 was ranked 11th resulting in differential gene expression in more than 1000 genes.
DISCUSSION: FAT1 somatic mutations are commonly seen in HPV negative HNSCC. We have demonstrated for the first time that CASP8 and FAT1 co-mutations are associated with poor prognosis with decreased overall survival in HPV negative HNSCC. Both CASP8 and FAT1 mutations are among the top genes with mutation impact on differential gene expression in HNSCC suggesting significance of these mutations in HNSCC.
Citation Format: Emrullah Yilmaz, David Lee, Andrew Cowan, Gregory Gan, Michelle Ozbun, Yan Guo. FAT1 and CASP8 co-mutations are associated with poor prognosis in HPV negative head and neck squamous cell carcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6474.
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Affiliation(s)
- Emrullah Yilmaz
- 1University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - David Lee
- 1University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Andrew Cowan
- 1University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Gregory Gan
- 2University of Kansas Medical Center, Kansas City, KS
| | - Michelle Ozbun
- 1University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Yan Guo
- 1University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
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29
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Braunstein ML, Oancea I, Barry BK, Darlington S, Steel J, Hansen DP, Battock J, Cheung D, Gan G, Hooper B, Lundin R, Nicol D, O'Brien J, Whittington S, Wilkinson C, Wong TT. The development and electronic delivery of case-based learning using a fast healthcare interoperability resource system. JAMIA Open 2020; 2:440-446. [PMID: 32025640 PMCID: PMC6994000 DOI: 10.1093/jamiaopen/ooz055] [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: 05/25/2019] [Revised: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022] Open
Abstract
HL7 International’s Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.
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Affiliation(s)
- Mark L Braunstein
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, USA.,The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Iulia Oancea
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Benjamin K Barry
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sharon Darlington
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jim Steel
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - David P Hansen
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - James Battock
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Daniel Cheung
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Gregory Gan
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Ben Hooper
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Reilly Lundin
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Duncan Nicol
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Joshua O'Brien
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Scott Whittington
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Chris Wilkinson
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Tse Tse Wong
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Thangarajah M, Gan G, MacIntyre R, Tan T. 180 The Impact of Influenza, Pneumococcal and Herpes Zoster Vaccinations on Hospital Presentations for Acute Heart Failure Exacerbations in a Cohort of Patients With Chronic Heart Failure. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.187] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Khanna S, Tan J, Chen H, Bhat A, Gan G, Tan T. 372 Left Ventricular Sphericity Index is a Predictor of Cardiovascular Events in Patients With Anterior Transmural Myocardial Infarction but not in Takotsubo Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.379] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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32
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Gan G, Kadappu K, Bhat A, Fernandez F, Gu K, Cai L, Eshoo S, Thomas L. P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1072] [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
Funding Acknowledgements
Nil
Background and objectives
Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients.
Methods
Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE.
Results
243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p < 0.01), history of diabetes mellitus (p < 0.01), indexed LV mass(LVMI) (p < 0.01), LV global longitudinal strain(GLS) (p < 0.01), indexed LA volume(LAVI) (p < 0.01), E/e’ ratio (p < 0.01) and LA strain (LAs) (p < 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p < 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point.
Conclusions
LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD.
Abstract P1709 Figure. Kaplan Meier curve of LAs
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Affiliation(s)
- G Gan
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Kadappu
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - A Bhat
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - F Fernandez
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Gu
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Cai
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - S Eshoo
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Thomas
- Westmead Hospital, Department of Cardiology, Sydney, Australia
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Chen H, Bhat A, Chandrakumar D, Fernandez F, Fernandez A, Stephens M, Kodsi M, Gan G, Tan T. 361 Key Differences in Myocardial Work Indices in Cardiometabolic Disease States. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.368] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen H, Oh F, Cheng T, Bhat A, Fernandez F, Gan G, Tan T. 415 The Immediate Impact of Electrical Cardioversion on Right Ventricular Systolic Function in Patients With Non-Valvular Atrial Fibrillation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.422] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bhat A, Makarious D, Mahajan V, Husen Y, Tan E, Burdusel C, Gan G, Lee L, Chow C, Tan T. 720 Characterisation of Recent Trends in Cardiovascular Risk Factors in Young Patients With Ischaemic Stroke. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.727] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gan G, Bhat A, Chen H, Gu K, Fernandez F, Kadappu K, Byth K, Eshoo S, Thomas L. 367 Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: A Powerful Determinant of Exercise Capacity in Chronic Kidney Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.374] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chandrakumar D, Bhat A, Chen H, Gan G, Fernandez A, Cheng T, Fernandez F, Tan T. 357 Indices of Myocardial Work Correlates With Maximum Metabolic Equivalents and is Predictive of Exercise Capacity. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.364] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan J, Tan S, Mok C, Shehab S, Chen H, Bhat A, Gan G, Tan T, Khanna S. 500 Impact of Left Ventricular Hypertrophy Phenotypes on Electrocardiographic Detection of Left Ventricular Hypertrophy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.507] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chandrakumar D, Jethwani U, Bhat A, Chen H, Gan G, Tan T. 425 Uptake of Cardiac Screening by Echocardiography in Patients with Solid Organ Malignancies Undergoing Chemotherapy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.432] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chen H, Khanna S, Kayes T, Bhat A, Gan G, Ahlenstiel G, Tan T. 300 Characterisation of Atrial and Ventricular Myocardial Deformation Indices with Increasing Body Mass Index. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.307] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Khanna S, Newman J, Bhat A, Chen H, Fernandez F, Gan G, Tan T. 385 Patients with Systemic Lupus Erythematosus With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.392] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chen H, Chandrakumar D, Fernandez F, Bhat A, Gan G, Tan T. 293 Assessment of the Accuracy of Right Ventricular Fractional Area Change Using an Automated Feature Tracking Algorithm in a Clinical Laboratory. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.300] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gan G, Kadappu K, Bhat A, Fernandez F, Chen H, Eshoo S, Thomas L. 1679 E/e predicts exercise capacity and adverse cardiovascular outcomes in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1043] [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
Funding Acknowledgements
Nil
OnBehalf
NA
Background
Patients with chronic kidney disease(CKD) have reduced physical fitness that contributes to the disproportionately elevated risk of cardiovascular disease in this population. Our aim was to assess the association between E/e’ and exercise capacity in CKD patients and the prognostic role of E/e’.
Methods
Patients with Stage 3/4 CKD, without previous cardiac disease were prospectively recruited. Recruited patients underwent transthoracic echocardiogram and exercise stress echocardiogram with assessment of exercise E/e’. Patients were compared, one to one, to age, gender and risk factor matched controls and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular events (MACE). Exercise capacity was assessed as metabolic equivalents (METs) with reduced exercise capacity defined as METS of ≤7. Raised exercise E/e’ was defined as exercise E/average e’ of >13.
Results
156 CKD patients (62.8 ± 10.6 yrs, male 62%) were compared to 156 matched controls. CKD patients had higher rates of anemia (p < 0.01), larger left ventricular indexed mass (p < 0.01), larger LAVI (p < 0.01) and higher resting (p < 0.01) and exercise E/e’ (p < 0.01). Overall, CKD patients achieved lower METs (p < 0.01) with exercise and a greater proportion of CKD patients had METs ≤7 (p < 0.01). Receiver operating curves (Figure1) showed exercise E/e’ (AUC 0.89, CI 0.84-0.95, p < 0.01) to be the strongest predictor of reduced exercise capacity in CKD patients. Exercise E/e’ of >13 was also associated with higher rates of cardiovascular death and MACE amongst CKD patients.
Conclusion
Exercise E/e’ is a strong predictor of exercise capacity amongst CKD patients, who commonly have reduced exercise capacity presumably consequent to diastolic dysfunction. Raised exercise E/e’ in CKD patients is predictor of cardiovascular death and MACE.
Abstract 1679 Figure.
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Affiliation(s)
- G Gan
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Kadappu
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - A Bhat
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - F Fernandez
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - H Chen
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - S Eshoo
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Thomas
- Westmead Hospital, Department of Cardiology, Sydney, Australia
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Chen H, Stephens M, Fernandez F, Bhat A, Gan G, Pathan F, Tan T. 371 Left Ventricular Geometry Impacts on Left Ventricular Function and Myocardial Energetics. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.378] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stephens M, Chen H, Bhat A, Gan G, Tan T. 401 Relationship of Myocardial Work Indices to Quantitative Measures of Mitral Regurgitation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.408] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fernandez F, Nawaz S, Bhat A, Chen H, Fernandez A, Gan G, Hung J, Handschumacher M, Nunes M, Tan T. 364 Left Atrial Cross Sectional Area as a Measure of Left Atrial Remodelling in Patients With Hypertension and Diabetes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.371] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Makarious D, Bhat A, Khanna S, Chen H, Drescher A, Stephens M, Fernandez F, Gan G, Tan T. 312 Correlation between Atrial Fibrillation Burden and Changes in Indices of Left Atrial Size and Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.319] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gan G, Kadappu K, Bhat A, Fernandez F, Chen H, Eshoo S, Thomas L. P246 Exercise E/e refines diagnosis of diastolic impairment in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.108] [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
Background
Diastolic dysfunction is common in chronic kidney disease (CKD) patients and is associated with reduced exercise capacity. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) correlates with invasively measured left ventricular pressures, both at rest and during exercise. The aim of our study was to evaluate the relationship of resting and exercise E/e’ to exercise capacity in patients with stage 3 and 4 CKD.
Methods
CKD patients were prospectively recruited. All patients were required to be in sinus rhythm, without previous cardiac disease and with normal LVEF. The E/e’ ratio was assessed at rest and patients were stratified into 3 groups based on conventional clinical classifications (normal: ≤8, indeterminate: 8-14, raised: >14). Patients then underwent a symptom limited exercise stress echocardiogram whereby patients with resting E/e’ <14 additionally had post exercise E/e’ measured. Exercise capacity was assessed as metabolic equivalents (METs). A raised exercise E/e’ was defined as exercise E/e’ of ≥13. Lastly, we grouped patients based on abnormalities of baseline and exercise E/e’ (resting E/e’<14 & exercise E/e’<13, resting E/e’<14 & exercise E/e ≥13, resting E/e’ ≥14) and the relationship to METs achieved was evaluated.
Results
The cohort consisted of 156 CKD patients (62.8 ± 10.6 yrs, male 62%). 85% had hypertension and 39% had diabetes mellitus. 52/156 (34%) CKD patients had resting E/e’ of ≥14. Of the 104/156 (66%) CKD patients with normal/indeterminate resting E/e’, 66/104(63%) had normal exercise E/e’ <13 whilst 38/104(37%) had exercise E/e’ ≥13. Patients with resting E/e" & raised exercise E/e’ ≥13 achieved significantly lower METs compared to CKD patients with resting E/e’ <14 & exercise E/e’ <13 (5.0 ± 2.2 vs 8.8 ± 2.5, p< 0.01). Of note, METs achieved in this group were comparable to that achieved by CKD patients with raised resting E/e’ ≥ 14 (5.0 ± 2.2 METs vs 5.3 ± 2.6 METs, p = 0.55).
Conclusion
In CKD patients with normal/indeterminate resting E/e’, there is utility in performing exercise E/e’, which was increased in 37% of patients. Raised exercise E/e’ is associated with poorer exercise capacity and is a potential tool to refine diastolic abnormalities in patients with CKD.
Group Total (n,%) METs Achieved Exercise Duration (minutes) Resting E/e’ ≤ 14 & Exercise E/e’ ≤ 13 66/156 (42%) 8.8 ± 2.5 8.4 ± 3.1 Resting E/e’ ≤ 14 & Exercise E/e’ ≥ 13 38/156 (24%) 5.0 ± 2.2 6.0 ± 3.1 Resting E/e’ ≥ 14 52/156 (34%) 5.3 ± 2.6 5.6 ± 2.2
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Affiliation(s)
- G Gan
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Kadappu
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - A Bhat
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - F Fernandez
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - H Chen
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - S Eshoo
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Thomas
- Westmead Hospital, Department of Cardiology, Sydney, Australia
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Rao A, Hales S, Bhat A, Chen H, MacIntyre R, Tan T, Gan G. 470 COVID-19 Experience in New South Wales (NSW) - A Case Series. Heart Lung Circ 2020. [PMCID: PMC7648880 DOI: 10.1016/j.hlc.2020.09.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Rao A, Hales S, Roach K, Bhat A, Chen H, Tanous D, Gan G. 654 Coronary Arteriovenous Fistulae in Setting of Giant Coronary Artery in a Patient with Sarcoidosis-Lymphoma Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.661] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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