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71.
72.
《JACC: Cardiovascular Interventions》2022,15(4):353-364
ObjectivesThe authors aimed to investigate the rates, predictors, and prognostic impact of technical success in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundThe Valve Academic Research Consortium-3 (VARC-3) has introduced a composite endpoint to assess the immediate technical success of TAVR.MethodsIn the prospective Bern TAVR registry, patients were stratified according to VARC-3 technical success. Technical failure differentiated between vascular and cardiac complications.ResultsIn a total of 1,624 patients undergoing TAVR between March 2012 and December 2019, 1,435 (88.4%) patients had technical success. Among 189 patients with technical failure, 140 (8.6%) had vascular and 49 (3.0%) had cardiac technical failure. Female, larger device landing zone calcium volume, and the early term of the study period were associated with an increased risk for cardiac technical failure, whereas higher body mass index and the use of the Prostar (Abbott Vascular Inc) MANTA (Teleflex) (compared with the ProGlide [Abbott Vascular Inc]) were predictors of vascular technical failure. In multivariable analysis, technical failure conferred an increased risk for cardiovascular death or stroke (HR: 2.01; 95% CI: 1.37-2.95). The adverse effect remained when stratified to cardiac (HR: 2.62; 95% CI: 1.38-4.97) or vascular technical failure (HR: 1.95; 95% CI: 1.28-2.95) and limited to the periprocedural period (0-30 days: HR: 3.42 [95% CI: 2.05-5.69]; 30-360 days: HR: 1.36 [95% CI: 0.79-2.35]; P for interaction = 0.002).ConclusionsTechnical failure according to VARC-3 was observed in 1 of 10 patients undergoing TAVR and was associated with a 2-fold increased risk of the composite outcome at 1 year after TAVR. (Swiss TAVI Registry; NCT01368250) 相似文献
73.
《Neuropsychiatrie de l'enfance et de l'adolescence》2022,70(5):270-276
ObjectivesThe present study had two objectives: 1) to examine the differences between students with different levels of academic achievement (low, average and high) in Anxiety/Depression and Test Anxiety; and 2) to test the predictive effect of academic achievement on test anxiety.MethodData were collected in two moments. In time 1, the sample was comprised of 305 students. The students were aged between 15 to 18 years, attending secondary school. The assessment protocol consisted of a Socio-demographic Data Sheet, the Youth Self-Report and the Cognitive Test Anxiety Scale.ResultsStudents with low academic achievement presented higher test anxiety than students with average and high academic achievement. Low academic achievement on time 1 predicted higher levels of test anxiety on time 2 when186 participants remained in the study.ConclusionResults suggest the importance of early psychological intervention with students with low academic achievement, and the relevance of promoting the development of skills that enable students to manage their test anxiety. 相似文献
74.
《Archives of Cardiovascular Diseases》2022,115(11):552-561
BackgroundPatients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated.MethodsAll consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores.ResultsAmong 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; P = 0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88–0.98; P = 0.010 and OR 0.61; 95% CI 0.41–0.89; P = 0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18–3.73; P = 0.011) were independent risk factors for major bleeding.ConclusionThe classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population. 相似文献
75.
Andreas W. Schoenenberger André Moser Dominic Bertschi Peter Wenaweser Stephan Windecker Thierry Carrel Andreas E. Stuck Stefan Stortecky 《JACC: Cardiovascular Interventions》2018,11(4):395-403
Objectives
This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores.Background
European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR).Methods
This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]).Results
All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction.Conclusions
This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement. 相似文献76.
Fifty-one episodes of bacteremia and a single episode of fungemia occurred during treatment with seemingly adequate doses of appropriate antibiotics. Clinical findings in these "breakthrough" bacteremias and fungemia were compared with those in 448 non-breakthrough episodes. Breakthrough was more likely to be caused by facultative or aerobic gram-negative rods (e.g., Enterobacteriaceae and Pseudomonas species) than by anaerobes. Of the underlying conditions examined, immunosuppressive doses of glucocorticosteroids, diabetes mellitus, and moderate renal failure were significantly more frequent in patients with breakthrough. A significant association was also observed between an intra-abdominal primary focus of infection (abscesses, biliary tract or bowel infections) and the occurrence of breakthrough. Mortality in breakthrough bacteremia was 61 percent compared with 40 percent in non-breakthrough episodes. The phenomenon of breakthrough bacteremia shows the potential limitations of antibiotic therapy alone. 相似文献
77.
《JACC: Cardiovascular Interventions》2021,14(24):2670-2681
ObjectivesThe aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups.BackgroundPPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations.MethodsTP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year.ResultsAmong 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19).ConclusionsIn this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group. (Transpacific TAVR Registry [TP-TAVR]; NCT03826264) 相似文献
78.
Pier Pasquale Leone Damiano Regazzoli Matteo Pagnesi Jorge Sanz-Sanchez Mauro Chiarito Francesco Cannata Nicolas M. Van Mieghem Marco Barbanti Corrado Tamburino Rui Teles Marianna Adamo Mizuki Miura Francesco Maisano Won-Keun Kim Francesco Bedogni Giulio Stefanini Antonio Mangieri Francesco Giannini Azeem Latib 《JACC: Cardiovascular Interventions》2021,14(11):1218-1228
ObjectivesThe aim of this study was to define predictors of prosthesis-patient mismatch (PPM) and its impact on mortality after transcatheter aortic valve replacement (TAVR) with self-expandable valves (SEVs) in patients with small annuli.BackgroundTAVR seems to reduce the risk for PPM compared with surgical aortic valve replacement, especially in patients with small aortic annuli. Nevertheless, predictors and impact of PPM in this population have not been clarified yet.MethodsPredictors of PPM and all-cause mortality were investigated using multivariable logistic regression analysis from the cohort of the TAVI-SMALL (International Multicenter Registry to Evaluate the Performance of Self-Expandable Valves in Small Aortic Annuli) registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2 on computed tomography) treated with transcatheter SEVs: 445 patients with (n = 129) and without (n = 316) PPM were enrolled.ResultsIntra-annular valves conferred increased risk for PPM (odds ratio [OR]: 2.36; 95% confidence interval [CI]: 1.16 to 4.81), while post-dilation (OR: 0.46; 95% CI: 0.25–0.84) and valve oversizing (OR: 0.53; 95% CI: 0.28–1.00) seemed to protect against PPM occurrence. At a median follow-up of 354 days, patients with severe PPM, but not those with moderate PPM, had a higher all-cause mortality rate compared with those without PPM (log-rank p = 0.008). Multivariable Cox regression confirmed severe PPM as an independent predictor of all-cause mortality (hazard ratio: 4.27; 95% CI: 1.34 to 13.6).ConclusionsAmong patients with aortic stenosis and small aortic annuli undergoing transcatheter SEV implantation, use of intra-annular valves yielded higher risk for PPM; conversely, post-dilation and valve oversizing protected against PPM occurrence. Severe PPM was independently associated with all-cause mortality. 相似文献
79.
Masatoshi Katagiri Hiroyuki Ito Yasuo Murayama Megumi Hamada Syunji Nakajima Nobuya Takayanagi Ai Uemiya Mitsunori Myogan Akio Nakai Masatsugu Tsujii 《Brain & development》2021,43(5):605-615
BackgroundDifficulties in fine and gross motor skills are often overlooked as developmental problems, although approximately 6–13% of all school-age children have poor motor coordination. Understanding motor coordination is important from the perspective of school adaptation. This longitudinal cohort study aimed to determine whether fine and gross motor skills in preschool children predict later academic achievement and psychosocial maladaptation.Methods & ProceduresParticipants were 2,501 children from nursery and elementary schools (5–13 years old). The motor skills of preschool children were assessed by their nursery teacher immediately before entering elementary school. The Strengths and Difficulties Questionnaire and a standardized Japanese test were administered annually throughout elementary school.ResultsEarly motor difficulties in preschool children had significant effects on their academic achievement and psychosocial maladaptation up until the sixth grade. Gross motor difficulties in preschool were associated with the later peer problems and worsened emotional symptoms.ConclusionsMotor skills in preschool children are useful as a predictor of later psychosocial maladaptation and academic achievement. 相似文献
80.
目的 调查希望、乐观与大学生学业成就的关系,以及自尊水平对此关系的调节作用.方法 对330名大学生进行了问卷调查,并利用层次回归的方法对数据进行分析.结果 希望的动力维度和大学生的学业成就相关显著(R =0.32,P<0.01);且在控制了相关的人口学变量之后,希望对学业成就的主效应仍然非常显著(R2 =0.073,P<0.01);自尊水平在希望预测大学生学业成就时的调节效应显著.结论 希望能显著的正向预测大学生的学业成就,乐观和学业成就相关不显著,这也说明了希望和乐观是两个独立的概念;自尊水平在希望预测大学生学业成就时起着调节的作用,希望对大学生学业成就的影响主要表现在中等自尊水平和低自尊水平的个体上. 相似文献