Flow rate and stroke volume index as predictors of mortality in patients undergoing transcatheter aortic valve implantation

Background

Reduced flow rate and stroke volume are a common finding in patients with severe aortic stenosis. The aim of this study was to assess their impact on mortality in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods

A total of 1080 patients with severe aortic stenosis who underwent TAVI between 2007 and 2017 were followed for a mean of 2.4±1.6 years. Patients were allocated into two groups according to flow rate (cut-off 200mL/s), 805 patients had a normal flow rate and 275 patients had reduced flow rate. Long-term survival was summarized using Kaplan-Meier curves and Cox-regression models.

Results

Patients with reduced flow rate were older (83.8±5.5 years; P<0.01) with more diabetics (36.7% P=0.02). Kaplan-Meier survival curves demonstrated inferior survival for patients with reduced flow rate (global log rank, P<0.01), Multivariable Cox-regression analysis (adjusted for age, creatinine, diabetes, hemoglobin and presence of atrial fibrillation) confirmed flow rate as an independent risk factor of all-cause mortality (HR: 0.998; 95%-CI: 0.997–0.999; P<0.01). Similar results were obtained for stroke volume index (SVI).

Conclusion

Patients with a reduced flow rate exhibit an increased mortality even after TAVI (similar to patients with reduced SVI) and should therefore be carefully evaluated in the heart-team.

PostTAVI survival according to flow rate

Funding Acknowledgement

Type of funding source: None

Microorganisms in root carious lesions in adults

PURPOSE

Root caries is emerging as a significant problem in the middle aged and elderly subjects because of the improving general health conditions, and medical and technological advances. The purpose of this investigation was to assess the prevalence of aerobic and anaerobic bacteria as well as yeasts of Candida genus in root carious lesions in middle-aged and older adults.

MATERIAL AND METHODS

Specimens of root carious lesions were collected from 78 adults for bacteriological and mycological studies. Standard procedures of culture, isolation, and identification of aerobic and anaerobic bacteria, and fungi were used in the study.

RESULTS

The analysis of results was performed independently in two age groups of adults, i.e. 52 subjects aged 35-44 years (middle age) and 26-aged 55-72 years (older age). There were 120 bacterial strains isolated from root carious lesions in middle-aged subjects, 63 (52.5%) strains belonged to 5 genera of aerobic bacteria and 57 (47.5%)--to 7 genera of anaerobic bacteria (p > 0.05). While in the second group, 85 strains were isolated, 54 (63.5%)--6 genera of aerobic bacteria and 31 (36.5%)--4 genera of anaerobic bacteria (p = 0.0004). There were no differences between the isolation rate of a various species in both examined groups, except for Streptococcus spp., S. oralis, Micrococcus spp., Neisseria spp. and Veillonella spp., which statistically significantly most frequent occurred in elderly (p < 0.05). The yeasts of Candida genus of 4 species (C. albicans, C. lusitaniae, C. pelliculosa, and C. pulcherrima) were isolated from middle-aged subjects (32.7%) with the comparable rate to older adults (30.8%; only C. albicans) (p > 0.05). Among all isolated microorganisms, Candida spp., were comprised about 10% in both examined groups (p > 0.05).

CONCLUSIONS

Aerobic Gram-positive cocci (Staphylococcus spp. and Streptococcus spp.) as well as anaerobic ones (Peptostreptococcus spp.), and Candida albicans were occurred most frequently in root carious lesions in middle-aged and older adults.

Incidence rate of Candida species in the oral cavity of middle-aged and elderly subjects

PURPOSE

The aim of this study was to determine the incidence rate of oral Candida species in middle-aged and elderly subjects.

MATERIAL AND METHODS

The study carried out in 103 adults aged 35-92 years, in which 32 (31.1%) used complet or partial acrylic dentures. Mycological tests were performed by using culture (Sabouraud agar) and API 20C AUX (bioMérieux) for identification of the species level. Material for analysis included swabs taken from the palate mucosa and mucosal part of denture surfaces in denture wearers, as well as, from tooth surface and/or dentine carious lesions. The dental caries status of each patients was evaluated using DMF index (WHO 1986 criteria).

RESULTS

Yeasts of Candida genus were isolated in 65/103 (63.1%) adults. The incidence rate of Candida spp. was higher in adults without dentures (46/71; 64.8%) compared to denture wearers (19/32; 59.4%); however, the differences were not statistically significant (p = 0.59 > p = 0.05). Candida albicans were the most frequently isolated species, and with a comparable rate (p = 0.06), both in adults with and without dentures (17/32; 53.1% and 38/71; 53.5%, respectively). In 3 individuals without dentures, two other species were found apart from C. albicans, namely C. glabrata (2x) and C. krusei (1x). In a total of 11/49 (22.5%) strains belonging to 5 non-C. albicans species were detected in adults without dentures, while in denture wearers only 2/19 (10.5%) other species were found (C. krusei and C. oralis) (p = 0.26 > p = 0.05). Strains of C. glabrata species were isolated only from the elderly. No significant differences were noted in the incidence of Candida spp. between middle-aged subjects (35-44 years) (35/52; 67.3%) and the elderly (> 55 years) (30/51; 58.8%) (p > 0.05), both in denture wearers and non-denture wearing subjects. However, the frequency of oral Candida spp. strains was increased in advanced age subgroup 71-92 years (74.2%) compared with 56-70 years (35.0%) of elderly subjects (p < 0.05), only in denture wearers (30.0% vs 5.0%) (p < 0.05). The sex and DMF index distribution of both subject groups had no significant influence on the numbers of Candida spp. detected.

CONCLUSIONS

Yeasts of the genus Candida were isolated at a comparable rate (p > 0.05) from the oral cavity of adults with and without dentures, as well as in middle-aged (35-44 years) and elderly subjects (56-92 years). However, a significant difference was observed only between elderly subgroups aged 56-70 (35%) and advanced age subgroup 71-92 years (74%).