Risultati per: Position paper della French Headache Society sul trattamento dell'emicrania

Circulation, Volume 148, Issue Suppl_1, Page A14448-A14448, November 6, 2023. Introduction:While short-term outcomes following COVID among pediatric heart transplant (HT) recipients have been described, graft outcomes including the risks of subsequent graft loss and rejection following COVID are unknown.Hypothesis:We sought to determine the overall trends of post-HT survival during the COVID pandemic and determine if there was an increased risk for subsequent graft loss and/or rejection following post-HT COVID.Methods:All pediatric recipients of first HT between 1/2003-6/2022 in the Pediatric Heart Transplant Society(PHTS) database were included. To assess if early post-HT survival changed during the COVID pandemic, 2-year HT survival was compared among those who underwent HT in 2014-2016, 2017-2019, and 2020-2022. To compare the risks of graft loss and rejection (acute cellular and/or antibody-mediated) between those with vs without post-HT COVID, a 1:2 (COVID vs non-COVID) propensity-score matched analysis using multiple pre-HT and post-HT factors (including exact matches for HT year and time post-HT) and Kaplan Meir analysis were performed. Patients with COVID within 3 months post-HT were excluded.Results:The 2-year post-HT survival was similar among patients who underwent HT across the 3 eras (Fig 1A). Among the overall 6634 patients (n = 888 [13%] with post-HT COVID), 861 patients with post-HT COVID and 1716 without post-HT COVID were included in propensity-score matching. There was no difference in the risk of subsequent graft loss (Fig 1B) or rejection (Fig 1C) among those with vs those without post-HT COVID.Conclusions:No differences were observed in early pediatric post-HT survival during the COVID pandemic compared to the immediately prior era. Post-HT COVID did not increase the risks of subsequent graft loss or rejection. Longer-term follow up is necessary to look at other potential post-HT COVID outcomes, such as coronary allograft vasculopathy.

Circulation, Volume 148, Issue Suppl_1, Page A18247-A18247, November 6, 2023. Introduction:Surgically implanted microaxial ventricular assist devices (VAD) such as Impella 5.5 are increasingly used as temporary mechanical circulatory support (tMCS) in patients at risk for and with cardiogenic shock (CS). Understanding the associations between CS severity and outcomes in patients supported with Impella 5.5 may optimize patient selection and prevent futile interventions.Hypothesis:Increasingly severe Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stages in patients supported with Impella 5.5 are associated with worse outcomes.Methods:From 2019-2022, retrospective review of perioperative characteristics, SCAI SHOCK stage and outcomes in patients supported with an Impella 5.5.Results:In total, 228 Impella 5.5s were implanted in 226 patients; 28% (63) SCAI SHOCK stage A, 4% (10) stage B, 14% (31) stage C, 46% (104) stage D and 9% (20) stage E. Stage A and B patients more often had elective Impella 5.5s for tMCS-assisted interventions (cardiac surgery, PCI, VT ablation) (30%, 69/228) while stage C-E patients primarily had Impella 5.5 placement for acute MI (AMI), chronic cardiomyopathy and postcardiotomy CS (60%, 136/228) (p

Circulation, Volume 148, Issue Suppl_1, Page A14794-A14794, November 6, 2023. Introduction:Cerebral infarction is one of the major causes of physical disability among the elderly worldwide. Weather temperature and humidity are rarely reported as predictors of cerebral infarction in our super-aging society.Hypothesis:Temperature and humidity are associate with cerebral infarction admission in super aging society.Methods:The Japanese registry of all cardiac and vascular diseases database includes patients with cardio-cerebrovascular disease who required admission and constitutes a nationwide dataset in Japan. This study included 606,807 consecutive patients with cerebrovascular disease requiring admission were admitted between 2015 and 2019. We investigated the relationship between cerebral infarction admission and temperature, or humidity.Results:Data were collected from 422,759 admitted patients with cerebral infarction. In the population with cerebrovascular disease admission, the median age was 75.0 (66.0-83.0) years and 55.8% of subjects were male. The mean temperature and humidity 1 day before cerebral infarction hospitalization were 17.2 °C and 69%, respectively. Multilevel mixed-effects linear regression models showed non-linear relationship of temperature and humidity with cerebral infarction admissions after adjusting for air pollution, hospital, and patient demographics. A negative linear association was found between mean temperature and humidity with cerebral infarction admission at mean temperature

Circulation, Volume 148, Issue Suppl_1, Page A17750-A17750, November 6, 2023. Purpose:Pediatric ventricular assist devices (VAD) improve waitlist mortality. We aimed to compare outcomes after heart transplant (HT) based on pre-HT support in patients (pt)

Circulation, Volume 148, Issue Suppl_1, Page A12628-A12628, November 6, 2023. Introduction:Cerebrovascular disease is known as one of the leading causes of death and disability in the elderly worldwide. Although weather was reported as predictor with cardiovascular disease, it was few evidence with cerebrovascular disease in Japan.Hypothesis:The weather is correlate with cerebrovascular disease hospitalizations.Methods:The Japanese registry of all cardiac and vascular diseases database includes patients with cardio-cerebrovascular disease who required hospitalization and constitutes a nationwide dataset in Japan. This study included 4,998,541 consecutive patients with cardio-cerebrovascular disease requiring hospitalization were admitted between 2015 and 2019. We investigated the relationship between cerebrovascular disease hospitalization and temperature, or humidity.Results:Data were collected from 606,807consecutive patients with cerebrovascular disease admitted. In this study population, the median age was 75.0 (66.0-83.0) years and 55.8% of subjects were male. The mean weather temperature and humidity 1 day before cerebrovascular disease hospitalization were 17.2 °C and 69%, respectively. Multilevel mixed-effects linear regression models showed the association of temperature and humidity with cerebrovascular disease hospitalizations after adjusting for air pollution, hospital, and patient demographics. Lower mean temperatures and humidity

Circulation, Volume 148, Issue Suppl_1, Page A12849-A12849, November 6, 2023. Introduction:Cancer treatment-related cardiovascular toxicity (CTR-CVT) is a growing concern in patients undergoing anticancer therapy. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) risk assessment tools have been proposed for the baseline cardiovascular (CV) risk stratification of patients with cancer. This study examined the incidence of adverse CV events associated with cancer treatment in clinical practice, also using the HFA-ICOS risk assessment tool.Methods:This single-center, prospective, observational study was conducted at Kurume University Hospital between October 2016 and August 2021 in patients aged ≥20 years with hematologic malignancies or breast cancer who were receiving anticancer agents. CV assessments were performed at enrollment and every 6 months until February 2022, with additional assessments for suspected CV adverse events. The primary endpoint was adverse CV event as defined by Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade ≥2, and the secondary endpoints were all-cause and CV death.Results:Of the enrolled 486 patients, adverse CV events occurred in 24.5% of patients with leukemia, 15.8% of patients with malignant lymphoma, 38.1% of patients with multiple myeloma, and 18.0% of patients with breast cancer, respectively. Kaplan-Meier curves of the primary endpoint and heart failure (HF)/ left ventricular (LV) dysfunction stratified by HFA-ICOS risk assessment group have shown the significant worse events in high/very high-risk group, in which the hazard ratios in the high/very high-risk group compared to the low-risk group were 2.34 (95% CI 1.48-3.71, p

Circulation, Volume 148, Issue Suppl_1, Page A13662-A13662, November 6, 2023. Background:Left atrial appendage (LAA) of Asians is generally larger and more complicated than that of non-Asians. Whereas the four classifications from previous reports are widely used in the world, different physicians have different point of views in the real-world practice.Purpose:To identify the relationship between morphological features of LAA and cardioembolic stroke in Japanese patients.Methods:All left atrial appendage closure (LAAC) cases in our institution performed between February 2020 and April 2023 were retrospectively analyzed. The three-dimensional printing of LAA was generated from cardiovascular computed tomography imaging data. The shapes of the LAA were classified into 3 morphological types: (1) The LAA with bi lobe was defined as “Scissors” type; (2) The one with complicated peripheral branches was “Paper” type; (3) The simple one was “Rock” type. We examined the relationship between the risk of cardioembolic stroke and the morphological features of the LAA.Results:The cohort consisted of 93 consecutive patients (age, 75±1 years; male gender, 72%; the size of WATCHMAN device, 29±0 mm). There were 41 (44%) patients who had a history of cardioembolic stroke (27% vs. 41% vs. 58%; Rock vs. Scissors vs. Paper types, p-value = 0.0466). In the multivariate analysis, the Paper type is the potential risk factor of cardioembolic stroke (p-value < 0.01) (Table1.2).Conclusions:The morphological features of LAA by three-dimensional printing was significantly related to cardioembolic stroke in this population. Physicians should pay attention to anticoagulant therapy management and proactively consider LAAC in LAA with complicated peripheral branches.

Circulation, Volume 148, Issue Suppl_1, Page A159-A159, November 6, 2023. Background:While short-term prognosis of cardiac arrest (CA) patients has been extensively studied, less is known regarding the mid- and long-term outcome of survivors.Aims:The aim of the DESAC study was to describe mid- and long-term survival and neurological status of CA survivors, and to assess the influence of pre- and intra-hospital therapeutic strategies on these outcomes.Methods:Between Jul 2015 and Oct 2018, patients over 18 years who were discharged alive from intensive care units in Paris and suburbs (France) after a non-traumatic CA were included and interviewed every 6 months during at least 24 months and up to 48 months in this multicentric study. Factors associated with Cerebral Performance Category (CPC) scale at 24 months were assessed with logistic regression, with CPC 1 or 2 level considered as a favorable neurological outcome. Trajectories of CPC were derived by mixed linear model in survivors with at least 3 evaluations.Results:Out of 593 survivors, 525 had a 24 months follow-up (mean age 57.6 +/-15.3, 79% men). CA occurred in public location in 251/525, with an initial shockable rhythm in 392/525. Prognostic factors independently associated with a favorable neurological outcome at 24 months were initial shockable rhythm (OR= 3.53 (1.65; 7.58)) and previous practice of sport (OR= 3.12 (1.20 ; 8.11)), whereas older age (OR per 10 years= 0.52 (0.40; 0.68)) and previous ischemic cardiomyopathy (OR= 0.34 (0.15 ; 0.77)) were poor prognostic factors. Therapeutic hypothermia or coronary procedures were not related to prognosis. Five trajectories of CPC could be derived among the 514 patients. Overall, 64% remained in CPC1, 13% in CPC2, 11% improved from CPC2 to CPC 12% died either early or lately (Figure 1).Conclusions:In this multicentric and prospective study, practice of sport and shockable rhythm were strongly associated with a favorable neurological recovery at 24 months. Furthermore, two thirds of the survivors remained in CPC 1 over time.

Circulation, Volume 148, Issue Suppl_1, Page A13714-A13714, November 6, 2023. Introduction:Individuals of low socioeconomic position are at greatest risk for incident heart failure (HF). Few data exist, however, regarding factors associated with mortality among individuals with prevalent HF and low socioeconomic position.Methods:The Southern Community Cohort Study (SCCS) is a prospective observational study of 84,797 individuals of predominantly low socioeconomic position enrolled between 2002 to 2009 from 12 states in the southeastern US. Using Cox regression models, we examined demographic, social determinants, and clinical factors associated with 5-year all-cause mortality in a subset of 4,309 black or white adults with prevalent HF receiving Centers for Medicare and Medicaid Services at enrollment. Death was ascertained through linkage with the National Death Index and cohort follow-up.Results:Individuals with prevalent HF at SCCS enrollment were predominantly middle age (mean ~59 years), female (64%), black (70%), low income (75%

Circulation, Volume 148, Issue Suppl_1, Page A220-A220, November 6, 2023. Background:Ventricular fibrillation (VF) or ventricular tachycardia (VT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) positions, impacts patient outcomes in VF/VT OHCA.Aim:Evaluate the association between initial defibrillator pad placement (AP vs. AL) and OHCA outcomes for patients presenting with VF/VT.Methods:This was a prospective observational study of non-traumatic OHCA patients with initial VF/VT on EMS rhythm analysis treated by a single EMS agency in the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry) from July 1st, 2019 through October 15th, 2022. Our primary outcome was return of spontaneous circulation (ROSC) at any time and secondary outcomes were ROSC at emergency department (ED) arrival, survival to admission, survival to discharge, and functional survival (cerebral perfusion category score of ≤2). We performed t-tests, chi-squared tests, and multivariable logistic regressions adjusting for age, sex, witness status, bystander interventions, arrest location, 911 call to EMS arrival time, and year of arrest.Results:A total of 243 OHCA patients met inclusion criteria and 232 (95.5%) had initial pad positioning documented (133 AP and 99 AL). Patients with AP placement had higher rates of ROSC at any time (72.2% vs. 47.5%, p

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.