1
|
Zheng WC, Zheng MC, Ho FCS, Noaman S, Haji K, Batchelor RJ, Hanson LB, Bloom JE, Shaw JA, Yang Y, Stub D, Cox N, Kaye DM, Chan W. Clinical Features and Outcomes Among Patients With Refractory Out-of-Hospital Cardiac Arrest and an Initial Shockable Rhythm. Circ Cardiovasc Interv 2023; 16:e013007. [PMID: 37750304 DOI: 10.1161/circinterventions.123.013007] [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: 02/27/2023] [Accepted: 07/28/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Clinical features among patients with refractory out-of-hospital cardiac arrest (OHCA) and initial shockable rhythms of ventricular fibrillation/pulseless ventricular tachycardia are not well-characterized. METHODS We compared clinical characteristics and coronary angiographic findings between patients with refractory OHCA (incessant ventricular fibrillation/pulseless ventricular tachycardia after ≥3 direct-current shocks) and those without refractory OHCA. RESULTS Between 2014 and 2018, a total of 204 patients with ventricular fibrillation/pulseless ventricular tachycardia OHCA (median age 62; males 78%) were divided into groups with (36%, 74/204) and without refractory arrest (64%, 130/204). Refractory OHCA patients had longer cardiopulmonary resuscitation (23 versus 15 minutes), more frequently required ≥450 mg amiodarone (34% versus 3.8%), and had cardiogenic shock (80% versus 55%) necessitating higher adrenaline dose (4.0 versus 1.0 mg) and higher rates of mechanical ventilation (92% versus 74%; all P<0.01). Of 167 patients (82%) selected for coronary angiography, 33% (n=55) had refractory OHCA (P=0.035). Significant coronary artery disease (≥1 major vessel with >70% stenosis) was present in >70% of patients. Refractory OHCA patients frequently had acute coronary occlusion (64% versus 47%), especially left circumflex (20% versus 6.4%) and graft vessel (7.3% versus 0.9%; all P<0.05) compared with those without refractory OHCA. Refractory OHCA group had higher in-hospital mortality (45% versus 30%, P=0.036) and greater new requirement for dialysis (18% versus 6.3%, P=0.011). After adjustment, refractory OHCA was associated with over 2-fold higher odds of in-hospital mortality (odds ratio, 2.28 [95% CI, 1.06-4.89]; P=0.034). CONCLUSIONS Refractory ventricular fibrillation/pulseless ventricular tachycardia OHCA was associated with more intensive resuscitation, higher rates of acute coronary occlusion, and poorer in-hospital outcomes, underscoring the need for future studies in this extreme-risk subgroup.
Collapse
Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
| | - Maye C Zheng
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (M.C.Z.)
| | - Felicia C S Ho
- Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)
| | - Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)
| | - Kawa Haji
- Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)
| | - Riley J Batchelor
- Department of Cardiology, The Royal Melbourne Hospital, Australia (R.J.B.)
| | - Laura B Hanson
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)
| | - James A Shaw
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)
| | - Yang Yang
- Intensive Care Unit, Western Health, Melbourne, Australia (Y.Y.)
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (D.S.)
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)
- Department of Medicine, The University of Melbourne, Australia (N.C., W.C.)
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)
- Department of Medicine, The University of Melbourne, Australia (N.C., W.C.)
| |
Collapse
|
2
|
Zheng WC, Dinh D, Noaman S, Bloom JE, Batchelor RJ, Lefkovits J, Brennan AL, Reid CM, Al-Mukhtar O, Shaw JA, Stub D, Yang Y, French C, Kaye DM, Cox N, Chan W. Effect of Concomitant Cardiac Arrest on Outcomes in Patients With Acute Coronary Syndrome-Related Cardiogenic Shock. Am J Cardiol 2023; 204:104-114. [PMID: 37541146 DOI: 10.1016/j.amjcard.2023.06.123] [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: 05/02/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
Patients with acute coronary syndrome (ACS)-related cardiogenic shock (CS) with or without concomitant CA may have disparate prognoses. We compared clinical characteristics and outcomes of patients with CS secondary to ACS with and without cardiac arrest (CA). Between 2014 and 2020, 1,573 patients with ACS-related CS with or without CA who underwent percutaneous coronary intervention enrolled in a multicenter Australian registry were analyzed. Primary outcome was 30-day major adverse cardiovascular and cerebrovascular events (MACCE) (composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularization and stroke). Long-term mortality was obtained through linkage to the National Death Index. Compared with the no-CA group (n = 769, 49%), the CA group (n = 804, 51%) was younger (62 vs 69 years, p <0.001) and had fewer comorbidities. Patients with CA more frequently had ST-elevation myocardial infarction (92% vs 86%), occluded left anterior descending artery (43% vs 33%), and severe preprocedural renal impairment (49% vs 42%) (all p <0.001). CA increased risk of 30-day MACCE by 45% (odds ratio 1.45, 95% confidence interval 1.05 to 2.00, p = 0.024) after adjustment. CA group had higher 30-day MACCE (55% vs 42%, p <0.001) and mortality (52% vs 37%, p <0.001). Three-year survival was lower for CA compared with no-CA patients (43% vs 52%, p <0.001). In Cox regression, CS with CA was associated with a trend toward greater long-term mortality hazard (hazard ratio 1.19, 95% confidence interval 1.00 to 1.41, p = 0.055). In conclusion, concomitant CA among patients with ACS-related CS conferred a particularly heightened short-term risk with a diminishing legacy effect over time for mortality. CS survivors continue to exhibit high sustained long-term mortality hazard regardless of CA status.
Collapse
Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Monash Health, Melbourne, Victoria, Australia
| | - James A Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yang Yang
- Department of Intensive Care, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Craig French
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Department of Intensive Care, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| |
Collapse
|
3
|
Ho FC, Zheng WC, Noaman S, Batchelor RJ, Wexler N, Hanson L, Bloom JE, Al-Mukhtar O, Haji K, D'Elia N, Kaye D, Shaw J, Yang Y, French C, Stub D, Cox N, Chan W. Sex differences among patients presenting to hospital with out-of-hospital cardiac arrest and shockable rhythm. Emerg Med Australas 2023; 35:297-305. [PMID: 36344254 DOI: 10.1111/1742-6723.14117] [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: 06/06/2022] [Revised: 08/29/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Sex differences in patients presenting with out-of-hospital cardiac arrest (OHCA) and shockable rhythm might be associated with disparities in clinical outcomes. METHODS We conducted a retrospective cohort study and compared characteristics and short-term outcomes between male and female adult patients who presented with OHCA and shockable rhythm at two large metropolitan health services in Melbourne, Australia between the period of 2014-2018. Logistic regression was used to assess the effect of sex on clinical outcomes. RESULTS Of 212 patients, 166 (78%) were males and 46 (22%) were females. Both males and females presented with similar rates of ST-elevation myocardial infarction (44% vs 36%, P = 0.29), although males were more likely to have a history of coronary artery disease (32% vs 13%) and a final diagnosis of a cardiac cause for their OHCA (89% vs 72%), both P = 0.01. Rates of coronary angiography (81% vs 71%, P = 0.23) and percutaneous coronary intervention (51% vs 42%, P = 0.37) were comparable among males and females. No differences in rates of in-hospital mortality (38% vs 37%, P = 0.90) and 30-day major adverse cardiac and cerebrovascular events (composite of all-cause mortality, myocardial infarction, coronary revascularization and nonfatal stroke) (39% vs 41%, P = 0.79) were observed between males and females, respectively. Female sex was not associated with worse in-hospital mortality when adjusted for other variables (odds ratio 0.66, 95% confidence interval 0.28-1.60, P = 0.36). CONCLUSION Among patients presenting with OHCA and a shockable rhythm, baseline sex and sex differences were not associated with disparities in short-term outcomes in contemporary systems of care.
Collapse
Affiliation(s)
- Felicia Cs Ho
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Samer Noaman
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Noah Wexler
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Laura Hanson
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Kawa Haji
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Nicholas D'Elia
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yang Yang
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Craig French
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Batchelor RJ, Nan Tie E, Romero L, Hopper I, Kaye DM. Meta-Analysis on Drug and Device Therapy of New York Heart Association Functional Class IV Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 188:52-60. [PMID: 36473305 DOI: 10.1016/j.amjcard.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 12/09/2022]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality, particularly in patients with New York Heart Association (NYHA) functional class IV symptoms. Decades of discovery have heralded significant advancements in the pharmacologic management of HFrEF. However, patients with NYHA IV symptoms remain an under-represented population in almost every clinical trial to date, leaving clinicians with limited evidence with which to guide drug treatment decisions in this patient group with severe heart failure. Randomized controlled trials of adult patients with NYHA IV symptoms of HFrEF randomized to current guideline-recommended medical therapy were included in this systematic review and meta-analysis. The outcomes of interest included the rate of all-cause mortality, cardiovascular mortality, and heart failure hospitalization. A total of 39 randomized controlled trials were included. A total of 6 studies examined angiotensin converting enzyme inhibitors, with meta-analyses of 2 demonstrating a reduced risk of all-cause mortality (relative risk (RR) 0.76, 95% confidence interval 0.59 to 0.97, p = 0.03). A total of 11 studies examined β blockers, with meta-analysis of 6 demonstrating a reduced risk of all-cause mortality (risk ratio 0.74, 95% confidence interval 0.60 to 0.92, p = 0.008). A study examined the mineralocorticoid antagonist spironolactone, reporting a reduced risk of all-cause mortality in the NYHA IV subgroup. A total of 6 studies examined device therapy, demonstrating the benefit of cardiac resynchronization therapy with or without an implantable cardiac defibrillator in reducing hospitalization in the NYHA IV subgroup. Although trial evidence exists for angiotensin converting enzyme inhibitors, β-blockers, and mineralocorticoid antagonist therapy in the NYHA IV population, the role of angiotensin receptor blockers is unclear. Ivabradine, angiotensin receptor neprilysin inhibitors, and sodium-glucose transport protein 2 inhibitors remain underinvestigated and have not been proved to provide any benefit above standard heart failure therapy in patients with HFrEF and NYHA IV symptoms.
Collapse
Affiliation(s)
- Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia
| | - Emilia Nan Tie
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, Alfred Health, Melbourne, Australia
| | - Ingrid Hopper
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia; Heart Failure Research, Baker Heart and Diabetes Institute, Melbourne, Australia.
| |
Collapse
|
5
|
Zheng WC, Noaman S, Batchelor RJ, Hanson L, Bloom JE, Al-Mukhtar O, Haji K, D'Elia N, Ho FCS, Kaye D, Shaw J, Yang Y, French C, Stub D, Cox N, Chan W. Evaluation of factors associated with selection for coronary angiography and in-hospital mortality among patients presenting with out-of-hospital cardiac arrest without ST-segment elevation. Catheter Cardiovasc Interv 2022; 100:1159-1170. [PMID: 36273421 PMCID: PMC10092555 DOI: 10.1002/ccd.30442] [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: 07/03/2022] [Accepted: 10/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical factors favouring coronary angiography (CA) selection and variables associated with in-hospital mortality among patients presenting with out-of-hospital cardiac arrest (OHCA) without ST-segment elevation (STE) remain unclear. METHODS We evaluated clinical characteristics associated with CA selection and in-hospital mortality in patients with OHCA, shockable rhythm and no STE. RESULTS Between 2014 and 2018, 118 patients with OHCA and shockable rhythm without STE (mean age 59; males 75%) were stratified by whether CA was performed. Of 86 (73%) patients undergoing CA, 30 (35%) received percutaneous coronary intervention (PCI). CA patients had shorter return of spontaneous circulation (ROSC) time (17 vs. 25 min) and were more frequently between 50 and 60 years (29% vs. 6.5%), with initial Glasgow Coma Scale (GCS) score >8 (24% vs. 6%) (all p < 0.05). In-hospital mortality was 33% (n = 39) for overall cohort (CA 27% vs. no-CA 50%, p = 0.02). Compared to late CA, early CA ( ≤ 2 h) was not associated with lower in-hospital mortality (32% vs. 34%, p = 0.82). Predictors of in-hospital mortality included longer defibrillation time (odds ratio 3.07, 95% confidence interval 1.44-6.53 per 5-min increase), lower pH (2.02, 1.33-3.09 per 0.1 decrease), hypoalbuminemia (2.02, 1.03-3.95 per 5 g/L decrease), and baseline renal dysfunction (1.33, 1.02-1.72 per 10 ml/min/1.73 m2 decrease), while PCI to lesion (0.11, 0.01-0.79) and bystander defibrillation (0.06, 0.004-0.80) were protective factors (all p < 0.05). CONCLUSIONS Among patients with OHCA and shockable rhythm without STE, younger age, shorter time to ROSC and GCS >8 were associated with CA selection, while less effective resuscitation, greater burden of comorbidities and absence of treatable coronary lesion were key adverse prognostic predictors.
Collapse
Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Laura Hanson
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Kawa Haji
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Nicholas D'Elia
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia.,Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Felicia C S Ho
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yang Yang
- Intensive Care Unit, Western Health, Melbourne, Victoria, Australia
| | - Craig French
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Intensive Care Unit, Western Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, Western Health, Melbourne, Victoria, Australia.,Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Batchelor RJ, Wheelahan A, Zheng WC, Stub D, Yang Y, Chan W. Impella versus Venoarterial Extracorporeal Membrane Oxygenation for Acute Myocardial Infarction Cardiogenic Shock: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11143955. [PMID: 35887718 PMCID: PMC9317942 DOI: 10.3390/jcm11143955] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Despite an increase in the use of mechanical circulatory support (MCS) devices for acute myocardial infarction cardiogenic shock (AMI-CS), there is currently no randomised data directly comparing the use of Impella and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO). Methods: Electronic databases of MEDLINE, EMBASE and CENTRAL were systematically searched in November 2021. Studies directly comparing the use of Impella (CP, 2.5 or 5.0) with VA-ECMO for AMI-CS were included. Studies examining other modalities of MCS, or other causes of cardiogenic shock, were excluded. The primary outcome was in-hospital mortality. Results: No randomised trials comparing VA-ECMO to Impella in patients with AMI-CS were identified. Six cohort studies (five retrospective and one prospective) were included for systematic review. All studies, including 7093 patients, were included in meta-analysis. Five studies reported in-hospital mortality, which, when pooled, was 42.4% in the Impella group versus 50.1% in the VA-ECMO group. Impella support for AMI-CS was associated with an 11% relative risk reduction in in-hospital mortality compared to VA-ECMO (risk ratio 0.89; 95% CI 0.83–0.96, I2 0%). Of the six studies, three studies also adjusted outcome measures via propensity-score matching with reported reductions in in-hospital mortality with Impella compared to VA-ECMO (risk ratio 0.72; 95% CI 0.59–0.86, I2 35%). Pooled analysis of five studies with 6- or 12-month mortality data reported a 14% risk reduction with Impella over the medium-to-long-term (risk ratio 0.86; 95% CI 0.76–0.97, I2 0%). Conclusions: There is no high-level evidence comparing VA-ECMO and Impella in AMI-CS. In available observation studies, MCS with Impella was associated with a reduced risk of in-hospital and medium-term mortality as compared to VA-ECMO.
Collapse
Affiliation(s)
- Riley J. Batchelor
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne 3004, Australia
| | - Andrew Wheelahan
- Department of Cardiology, Western Health, Melbourne 3004, Australia;
| | - Wayne C. Zheng
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
- Department of Cardiology, Western Health, Melbourne 3004, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Yang Yang
- Intensive Care Unit, Western Health, Melbourne 3004, Australia;
| | - William Chan
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
- Department of Cardiology, Western Health, Melbourne 3004, Australia;
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
- Correspondence: ; Tel.: +61-3-9076-3263
| |
Collapse
|
7
|
Zheng WC, Noaman S, Batchelor RJ, Hanson L, Bloom J, Kaye D, Duffy SJ, Walton A, Pellegrino V, Shaw J, Yang Y, French C, Stub D, Cox N, Chan W. Determinants of Undertaking Coronary Angiography and Adverse Prognostic Predictors Among Patients Presenting With Out-of-Hospital Cardiac Arrest and a Shockable Rhythm. Am J Cardiol 2022; 171:75-83. [PMID: 35296378 DOI: 10.1016/j.amjcard.2022.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/22/2022]
Abstract
Characteristics of patients presenting with out-of-hospital cardiac arrest (OHCA) selected for coronary angiography (CA) and factors predicting in-hospital mortality remain unclear. We assessed clinical characteristics associated with undertaking CA in patients presenting with OHCA and shockable rhythm (CA group). Predictors of in-hospital mortality were evaluated with multivariable analysis. Of 1,552 patients presenting with cardiac arrest between 2014 and 2018 to 2 health services in Victoria, Australia, 213 patients with OHCA and shockable rhythm were stratified according to CA status. The CA group had shorter cardiopulmonary resuscitation duration (17 vs 25 minutes) and time to return of spontaneous circulation (17 vs 26 minutes) but higher proportion of ST-elevation on electrocardiogram (48% vs 24%) (all p <0.01). In-hospital mortality was 38% (n = 81) for the overall cohort, 32% (n = 54) in the CA group, and 61% (n = 27) in the no-CA group. Predictors of in-hospital mortality included non-selection for CA (odds ratio 4.5, 95% confidence interval 1.5 to 14), adrenaline support (3.9, 1.3 to 12), arrest at home (2.7, 1.1 to 6.6), longer time to defibrillation (2.5, 1.5 to 4.2 per 5-minute increase), lower blood pH (2.1, 1.4 to 3.2 per 0.1 decrease), lower albumin (2.0, 1.2 to 3.3 per 5 g/L decrease), higher Acute Physiology and Chronic Health Evaluation II score (1.7, 1.0 to 3.0 per 5-point increase), and advanced age (1.4, 1.0 to 2.0 per 10-year increase) (all p ≤0.05). In conclusion, non-selection for CA, concomitant cardiogenic shock requiring inotropic support, poor initial resuscitation (arrest at home, longer time to defibrillation and lower pH), greater burden of co-morbidities (higher Acute Physiology and Chronic Health Evaluation II score and lower albumin), and advanced age were key adverse prognostic indicators among patients with OHCA and shockable rhythm.
Collapse
|
8
|
Batchelor RJ, Dinh D, Noaman S, Brennan A, Clark D, Ajani A, Freeman M, Stub D, Reid CM, Oqueli E, Yip T, Shaw J, Walton A, Duffy SJ, Chan W. Adverse 30-Day Clinical Outcomes and Long-Term Mortality Among Patients With Preprocedural Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2022; 31:638-646. [PMID: 35125322 DOI: 10.1016/j.hlc.2021.12.013] [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] [Received: 02/27/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Approximately 5-10% of patients presenting for percutaneous coronary intervention (PCI) have concurrent atrial fibrillation (AF). To what extent AF portends adverse long-term outcomes in these patients remains to be defined. METHODS We analysed data from the multicentre Melbourne Interventional Group Registry from 2014-2018. Patients were identified as being in AF or sinus rhythm (SR) at the commencement of PCI. The primary endpoint was long-term mortality, obtained via linkage with the National Death Index. RESULTS 13,286 procedures were included, with 800 (6.0%) patients in AF and 12,486 (94.0%) in SR. Compared to SR, patients with AF were older (72.9±10.9 vs 64.1±12.0 p<0.001) and more likely to have comorbidities including diabetes mellitus (31.3% vs 25.0% p<0.001), hypertension (74.4% vs 65.1% p<0.001) and moderate to severe left ventricular systolic dysfunction (36.6% vs 19.5% p<0.001). Atrial fibrillation was associated with an increased risk of in-hospital mortality (11.0% vs 2.5% p<0.001) and MACE (composite of all-cause mortality, myocardial infarction, or target vessel revascularisation) (11.9% vs 4.2% p<0.001). In-hospital major bleeding was more common in the AF group (3.1% vs 1.0% p<0.001). On Cox proportional hazards modelling, AF was an independent predictor of long-term mortality (adjusted HR 1.38 95% CI 1.11-1.72 p<0.004) at a mean follow-up of 2.3±1.5 years. CONCLUSIONS Preprocedural AF is common among patients presenting for PCI. Preprocedural AF is associated with high-rates of comorbid illnesses and portends higher risk of short- and long-term outcomes including mortality underscoring the need for careful evaluation of its risks prior to PCI.
Collapse
Affiliation(s)
- Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Diem Dinh
- Monash University, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | | | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Andrew Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | - Christopher M Reid
- Monash University, Melbourne, Vic, Australia; Curtin University, Perth, WA, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Vic, Australia
| | - Thomas Yip
- Deakin University, Geelong, Vic, Australia; Department of Cardiology, Barwon Health, Geelong, Vic, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
| |
Collapse
|
9
|
Batchelor RJ, Wong N, Liu DH, Chua C, William J, Tee SL, Sata Y, Bergin P, Hare J, Leet A, Taylor AJ, Patel HC, Burrell A, McGiffin D, Kaye DM. Vasoplegia Following Orthotopic Heart Transplantation: Prevalence, Predictors and Clinical Outcomes. J Card Fail 2021; 28:617-626. [PMID: 34974975 DOI: 10.1016/j.cardfail.2021.11.020] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients undergoing heart transplant are at high risk for postoperative vasoplegia. Despite its frequency and association with poor clinical outcomes, there remains no consensus definition for vasoplegia, and the predisposing risk factors for vasoplegia remain unclear. Accordingly, the aim of this study was to evaluate the prevalence, predictors, and clinical outcomes associated with vasoplegia in a contemporary cohort of patients undergoing heart transplantation. METHODS This was a retrospective cohort study of patients undergoing heart transplantation from January 2015 to December 2019. A binary definition of vasoplegia of a cardiac index of 2.5 L/min/m2 or greater and requirement for norepinephrine (≥5 µg/min), epinephrine (≥4 µg/min), or vasopressin (≥1 unit/h) to maintain a mean arterial blood pressure of 65 mm Hg, for 6 consecutive hours during the first 48 hours postoperatively, was used in determining prevalence. Given the relatively low threshold for the binary definition of vasoplegia, patients were divided into tertiles based on their cumulative vasopressor requirement in the 48 hours following transplant. Outcomes included all-cause mortality, intubation time, intensive care unit length of stay, and length of total hospitalization. RESULTS After exclusion of patients with primary cardiogenic shock, major bleeding, or overt sepsis, data were collected on 95 eligible patients. By binary definition, vasoplegia incidence was 66.3%. We separately stratified by actual vasopressor requirement tertile (high, intermediate, low). Stratified by tertile, patients with vasoplegia were older (52.7 ± 10.2 vs 46.8 ± 12.7 vs 44.4 ± 11.3 years, P = .02), with higher rates of chronic kidney disease (18.8% vs 32.3% vs 3.1%, P = .01) and were more likely to have been transplanted from left ventricular assist device support (n = 42) (62.5% vs 32.3% vs 37.5%, P = .03). Cardiopulmonary bypass time was prolonged in those that developed vasoplegia (155 min [interquartile range 135-193] vs 131 min [interquartile range 117-152] vs 116 min [interquartile range 102-155], P = .003). Intubation time and length of intensive care unit and hospital stay were significantly increased in those that developed vasoplegia; however, this difference did not translate to a significant increase in all-cause mortality at 30 days or 1 year. CONCLUSIONS Vasoplegia occurs at a high rate after heart transplantation. Older age, chronic kidney disease, mechanical circulatory support, and prolonged bypass time are all associated with vasoplegia; however, this study did not demonstrate an associated increase in all-cause mortality LAY SUMMARY: Patients undergoing heart transplantation are at high risk of vasoplegia, a condition defined by low blood pressure despite normal heart function. We found that vasoplegia was common after heart transplant, occurring in 60%-70% of patients after heart transplant after excluding those with other causes for low blood pressure. Factors implicated included age, poor kidney function, prolonged cardiopulmonary bypass time and preoperative left ventricular assist device support. We found no increased risk of death in patients with vasoplegia despite longer lengths of stay in intensive care and in hospital.
Collapse
Affiliation(s)
- Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nathan Wong
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | | | - Clara Chua
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Jeremy William
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Su Ling Tee
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Yusuke Sata
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Peter Bergin
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - James Hare
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Angeline Leet
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Andrew J Taylor
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hitesh C Patel
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Heart Failure Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Aidan Burrell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Heart Failure Research, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - David McGiffin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Heart Failure Research, Baker Heart and Diabetes Institute, Melbourne, Australia.
| |
Collapse
|
10
|
Batchelor RJ, Dinh D, Brennan A, Wong N, Lefkovits J, Reid C, Duffy SJ, Chan W, Cox N, Liew D, Stub D. Relation of Timing of Percutaneous Coronary Intervention on Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction. Am J Cardiol 2020; 136:15-23. [PMID: 32946855 DOI: 10.1016/j.amjcard.2020.09.011] [Citation(s) in RCA: 2] [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: 07/10/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
International guidelines suggest revascularization within 24 hours in non-ST segment elevation myocardial infarction (NSTEMI). Within a large population cohort study, we aimed to explore clinical practice regarding timing targets for percutaneous coronary intervention (PCI) in NSTEMI. The Victorian Cardiac Outcomes Registry was established in 2013 as a state-wide clinical quality registry, pooling data from public and private PCI capable centers. Data were collected on 11,852 PCIs performed for NSTEMI from 2014 to 2018. Patients were divided into 3 groups by time of symptom onset to PCI (<24 hours; 24 to 72 hours; >72 hours). We performed multivariable logistic regression analysis conditional on several baseline covariates in investigating the impact of timing of PCI in NSTEMI on clinical outcomes. Patients who underwent PCI within 24 hours represented 18.4% (n = 2,178); 24 to 72 hours 45.8% (n = 5,434); >72 hours 35.8% (n = 4,240). Patients waiting longer for PCI were older (62.6 ± 12.2 vs 64.8 ± 12.6 vs 67.0 ± 12.7, p <0.001), more likely to be female (23.1% vs 24.2% vs 26.4%, p = 0.007), and have diabetes (18.6% vs 21.1% vs 27.1%, p <0.001). Multivariate logistic regression found that as compared with PCI <24 hours, PCI 24 to 72 hours and PCI >72 hours of symptom onset were associated with a decreased risk of 30-day mortality (odds ratio 0.55; 95% confidence interval 0.35 to 0.86, p = 0.008 and odds ratio 0.64; 95% confidence interval 0.35 to 1.01, p = 0.053, respectively). There was no significant difference in 30-day mortality between groups following exclusion of patients presenting with cardiogenic shock or out of hospital cardiac arrest requiring intubation. In conclusion, many registry patients undergo PCI outside the 24-hour window following NSTEMI. This delay is at odds with current guideline recommendations but does not appear to be associated with an increased mortality risk.
Collapse
Affiliation(s)
- Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Diem Dinh
- Monash University, Melbourne, Australia
| | | | - Nathan Wong
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Jeffrey Lefkovits
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Christopher Reid
- Monash University, Melbourne, Australia; Curtin University, Perth, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia
| | - Nicholas Cox
- Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia
| | | | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia.
| |
Collapse
|
11
|
Batchelor RJ, Clark SM. Silver hair in a 3-year-old. Clin Exp Dermatol 2009; 34:281-3. [PMID: 19187319 DOI: 10.1111/j.1365-2230.2007.02535.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R J Batchelor
- Dermatology Department, Leeds General Infirmary, Leeds, UK.
| | | |
Collapse
|
12
|
Batchelor RJ, Rose RF, Yung A, Rathmell B, Turner D, Goulden V. Audit of erythema in patients with psoriasis undergoing phototherapy with narrowband (TL-01) ultraviolet B: impact of the introduction of a comprehensive erythema-reporting protocol. Br J Dermatol 2007; 156:1045-6. [PMID: 17313490 DOI: 10.1111/j.1365-2133.2007.07775.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
13
|
|
14
|
|
15
|
Abstract
Photopatch testing is indicated in the investigation of patients with eczematous eruptions, affecting mainly light-exposed sites and in those who give a history of worsening of their condition with sun exposure. 3 different protocols are described by the British Photodermatology Group (Br J Dermatol 1997:136:371-376), 1 of which includes irradiation of allergens 1 day after application and 2 using irradiation of allergens 2 days after application. There is no evidence for superiority of any of these protocols. We reviewed the records of all patients who underwent photopatch testing in Leeds over a 50-month period, who had had the allergens applied in triplicate with 1 set irradiated after 1 day occlusion and another after 2 days. The control was occluded for 2 days. Readings were performed at 2 days and 4 days. 15 of 74 patients photopatch tested during this period had 49 positive results between them. 43 of these were felt to be of current relevance to their clinical problem. 34 of the positive results were indicative of photoallergy. Additional photoallergic reactions were detected following 2 days occlusion and irradiation compared with 1 day occlusion (16 versus 5). In conclusion, our case series suggests that 2 days occlusion before irradiation of allergens is more sensitive at detecting photoallergy.
Collapse
|
16
|
Affiliation(s)
- R J Batchelor
- Leeds Centre for Dermatology, Dermatology Department, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
| | | |
Collapse
|
17
|
|
18
|
Batchelor RJ, Lyon CC, Highet AS. Successful treatment of pain in two patients with cutaneous leiomyomata with the oral alpha-1 adrenoceptor antagonist, doxazosin. Br J Dermatol 2004; 150:775-6. [PMID: 15099382 DOI: 10.1111/j.0007-0963.2004.05880.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
19
|
Abstract
51V NMR and IR spectroscopic studies of the complexes formed between vanadate and the alpha-hydroxylic acid ligands, (S)-2-hydroxypropanoic acid (L-(+)-lactic acid), 2-hydroxy-2-methylpropanoic acid, and 2-ethyl-2-hydroxybutanoic acid were carried out for aqueous 1 M ionic strength (NaCl) solutions. Three major products in V to L stoichiometries of 1:1, 2:2, and 3:2 were identified from vanadate and ligand concentration studies, while a pH variation study allowed charge states to be determined. At pH 7.06, the formation constants for the predominant reactions were (26 +/- 1) M (-1), (V + L <= => VL); (6.8 +/- 0.4) x 10(3) M(-1), (2VL <= => V(2)L(2)); and (3.5 +/- 0.3) x 10(3) M(-1), (V(2)L(2) + V <= => V(3)L(2)). Dissolution studies of various crystalline products were carried out for aqueous, nonaqueous, and mixed solvent systems. These studies combined with information available from X-ray structural studies provided a basis for the assignment of solution state structures. Pentacoordinate vanadium in a trigonal-bipyramidal geometry was proposed for the both the 1:1 and 2:2 complexes when in aqueous solution. Observed changes in (51)V chemical shift patterns were consistent with a cis fusion in octahedral coordination for the central vanadium of the 3:2 complex, while the remaining vanadiums retained a pentacoordinate geometry.
Collapse
Affiliation(s)
- S Hati
- Department of Chemistry, Simon Fraser University, Burnaby B.C., V5A 1S6, Canada
| | | | | | | |
Collapse
|
20
|
Leznoff DB, Xue BY, Batchelor RJ, Einstein FW, Patrick BO. Gold-gold interactions as crystal engineering design elements in heterobimetallic coordination polymers. Inorg Chem 2001; 40:6026-34. [PMID: 11681921 DOI: 10.1021/ic010756e] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A series of coordination polymers containing Cu(II) and [Au(CN)(2)](-) units has been prepared. Most of their structures incorporate attractive gold-gold interactions, thus illustrating that such "aurophilic" interactions can be powerful tools for increasing structural dimensionality in supramolecular systems. [Cu(tren)Au(CN)(2)][Au(CN)(2)] (1, tren = tris(2-ethylamino)amine) forms a cation/anion pair, which is weakly linked by hydrogen bonds but not by aurophilic interactions. [Cu(en)(2)Au(CN)(2)][Au(CN)(2)] (2-Au, en = ethylenediamine) is a 2-D system composed of a chain of [Au(CN)(2)](-) anions and another chain of [(en)(2)Cu-NCAuCN](+) cations; short Au-Au bonds of 3.1405(2) A connect the anions. This bond is shorter than that observed in the analogous silver(I) structure, 2-Ag. The average M-C bond lengths of 1.984(8) A in 2-Au are significantly shorter than those found in 2-Ag, suggesting that Au(I) is smaller than Ag(I). Cu(dien)[Au(CN)(2)](2) (3, dien = diethylenetriamine) forms a 1-D chain of tetranuclear [Au(CN)(2)](-) units that are bound to [Cu(dien)] centers. Aurophilic interactions of ca. 3.35 A hold the tetramer together. Cu(tmeda)[Au(CN)(2)](2) (4, tmeda = N,N,N',N'-tetramethylethylenediamine) forms a 3-D network by virtue of aurophilic interactions of 3.3450(10) and 3.5378(8) A. Altering the Cu:Au stoichiometry yields Cu(tmeda)[Au(CN)(2)](1.5)(ClO(4))(0.5) (5), which has an unusual 2-D rhombohedral layer structure (space group R32). Complex 5 is composed of three mutually interpenetrating Cu[Au(CN)(2)](1.5) networks which are interconnected by aurophilic interactions of 3.4018(7) and 3.5949(8) A. Weak antiferromagnetic coupling is observed in 2 and 5.
Collapse
Affiliation(s)
- D B Leznoff
- Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada.
| | | | | | | | | |
Collapse
|
21
|
Abstract
The conformational preferences about the C-N bond in N-(4-methoxyphenyl)-2,3,4,6-tetra-O-acetyl-alpha (1) and beta-D-glucopyranosylamine (2), in the solid state and in solution, have been investigated. The crystal structure of the axially substituted alpha anomer (1) indicates a conformational preference about the C-1-N bond in which nN-->sigma*C-O exo-anomeric interactions may be expressed, although this conformational preference is not displayed in solution. The solution conformation relieves steric interactions that result from expression of the exo-anomeric effect in the solid-state conformation. The conformational preference in the equatorially substituted beta anomer (2) both in solution and in the solid state is similar and permits expression of nN-->sigma*C-O exo-anomeric interactions. The structural data for 1 and 2 indicate significant differences in O-5-C-1-N-1 bond angles but insignificant differences in each of the O-5-C-1 or C-1-N-1 bond lengths. The J(C-1-H-1 coupling constants in 1 and 2 indicate a greater coupling constant for the alpha anomer that is consistent with a dominant nO-->sigma*C-H orbital interaction in the beta anomer that weakens the C-1-H-1 bond.
Collapse
Affiliation(s)
- R J Batchelor
- Department of Chemistry and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | | | | | | | | |
Collapse
|
22
|
Affiliation(s)
- K S Tanaka
- Department of Chemistry, Simon Fraser University 8888 University Drive, Burnaby British Columbia V5A 1S6, Canada
| | | | | | | | | |
Collapse
|
23
|
Batchelor RJ, Einstein FW, Gay ID, Gu JH, Mehta S, Pinto BM, Zhou XM. Synthesis, characterization, and redox behavior of new selenium coronands and of copper(I) and copper(II) complexes of selenium coronands. Inorg Chem 2000; 39:2558-71. [PMID: 11197010 DOI: 10.1021/ic991345p] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R J Batchelor
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | | | | | | | | | | | | |
Collapse
|
24
|
George A, Dazzi F, Lynch J, Sidhu S, Marelli F, Batchelor RJ, Lombardi G, Lechler RI. Biased TCR gene usage in alloreactive T cells specific for a structurally dissimilar MHC alloantigen. Int Immunol 1994; 6:1785-90. [PMID: 7865471 DOI: 10.1093/intimm/6.11.1785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Two models of allorecognition of MHC molecules have been proposed. One emphasizes specificity for MHC molecule-bound peptides and the other for exposed MHC polymorphisms. We predicted that the latter model would predominate in responder:stimulator combinations whose MHC molecules differed extensively in their TCR-contacting surfaces and that this would be reflected in biased TCR usage. Two panels of anti-DR11 T cell clones were generated, one from a DR17 and the other from a DR15 responder. The TCR-contacting surfaces of DR17 and DR11 have multiple differences, and those of DR15 and DR11 are very similar. TCR analysis by polymerase chain reaction amplification and mAb staining revealed that five out of nine DR17 anti-DR11 clones used the V beta 13 and two the V beta 6, family. In contrast seven different V beta families were used by the eight DR15 anti-DR11 clones. A similar bias in TCR V beta usage was observed in the polyclonal DR17 and DR11 T cell lines from which the clones were derived, and in a second DR17 anti-DR11 line from a different individual. These results support the concept that specificity for the foreign MHC structure itself may play an important role in the alloresponse between responders and stimulators with structurally dissimilar MHC molecules.
Collapse
Affiliation(s)
- A George
- Department of Immunology, Royal Postgraduate Medical School, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Dodi AI, Brett S, Nordeng T, Sidhu S, Batchelor RJ, Lombardi G, Bakke O, Lechler RI. The invariant chain inhibits presentation of endogenous antigens by a human fibroblast cell line. Eur J Immunol 1994; 24:1632-9. [PMID: 8026524 DOI: 10.1002/eji.1830240727] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The human fibroblast cell line, M1, expressing the products of transfected DRA and DRB1*0101 genes (M1-DR1) was unable to present intact influenza antigens to a series of DR1-restricted human T cell lines and clones, but was fully able to present synthetic peptides for T cell recognition. In contrast, M1-DR1 cells infected with live influenza virus were recognized by two polyclonal hemagglutinin- or whole virus-specific T cell lines and one of four T cell clones. This difference could not be accounted for simply by the ability of infectious virus to overcome a defect in antigen uptake by the M1-DR1 cells, in that direct studies of endocytosis showed that the M1 cells were more efficient than human B cells in the internalization of exogenous protein. These data suggested that the M1 cells were unable to present exogenous antigens but were capable of loading major histocompatibility complex (MHC) class II molecules with peptides derived from endogenous antigens. To investigate this further, the M1-DR1 cells were super-transfected with a cDNA encoding the p33 and p35 forms of the human invariant chain (Ii). Expression of the Ii chain was detected by intracytoplasmic staining of transfectants, and by metabolic labeling. Equimolar amounts of the p33 and p35 forms were detected, and the high level of p35 Ii was reflected by extensive retention of Ii protein in the endoplasmic reticulum. Addition of the Ii chain led to no recovery of presentation of intact antigens with DR1, but inhibited the presentation of live virus. These data indicate that MHC class II molecules in the M1-DR1 cells can be loaded with peptides derived from endogenous proteins, possibly in the biosynthetic pathway, and that the Ii chain has a role in limiting this route of class II antigen presentation.
Collapse
Affiliation(s)
- A I Dodi
- Department of Immunology, Royal Postgraduate Medical School, London, GB
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Fong R, Dahn JR, Batchelor RJ, Einstein FW, Jones CH. New Li2-xCuxFeS2 (0 <= x <= 1) and CuxFeS2 (~0.25 <= x <= 1) phases. Phys Rev B Condens Matter 1989; 39:4424-4429. [PMID: 9948786 DOI: 10.1103/physrevb.39.4424] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
|
27
|
|
28
|
Lehner T, Lamb JR, Welsh KL, Batchelor RJ. Association between HLA-DR antigens and helper cell activity in the control of dental caries. Nature 1981; 292:770-2. [PMID: 6973697 DOI: 10.1038/292770a0] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|