bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kidney Dysfunction and Deterioration of Ejection Fraction Pose Independent Risk Factors for Mortality in Implantable Cardioverter‐Defibrillator Recipients for Primary Prevention
Authors: Kreuz Jens , Horlbeck Fritz , Schrickel Jan , Linhart Markus , Fimmers Rolf , Mellert Fritz , Nickenig Georg , Schwab Jörg Otto 
Published: June 2012

AbstractBackground:A growing number of patients with advanced heart failure fulfill a primary‐prevention indication for an implantable cardioverter‐defibrillator (ICD). This study seeks to identify new predictors of overall mortality in a Sudden Cardiac Death in Heart Failure Trial (SCD‐HeFT)‐like collective to enhance risk stratification.Hypothesis:An impaired renal function and severely depressed left ventricular ejection fraction pose relevant risk factors for mortality in primary prevention ICD recipients.Methods:Ninety‐four consecutive ICD patients with New York Heart Association class II–III heart failure and depressed left ventricular function (left ventricular ejection fraction [LVEF] ≤35%) with no history of malignant ventricular arrhythmias were followed for 34 ± 20 months.Results:During this period, 30 patients died (32%). Deceased patients revealed a significantly worse renal function before ICD implantation (1.55 ± 0.7 mg/dL vs 1.1 ± 0.4 mg/dL; P = 0.007), suffered more often from coronary artery disease (53 vs 29; P = 0.006), and were older (69.5 ± 8 y vs 67 ± 12 y; P = 0.0002) than surviving patients. Furthermore, increased serum creatinine at baseline (2 mg/dL vs 1 mg/dL; odds ratio [OR]: 3.96, 95% confidence interval [CI]: 1.2–13.04, P = 0.02), presence of coronary artery disease (OR: 8.6, 95% CI: 1.1–65, P = 0.036), and low LVEF (OR per 5% baseline LVEF deterioration: 1.4, 95% CI: 1–1.8, P = 0.034) represented strong and independent predictors for overall mortality.Conclusions:Impaired renal function, the presence of coronary artery disease, and reduced LVEF before implantation represent independent predictors for mortality in a cohort of patients with advanced systolic heart failure. These conditions still bear a high mortality risk, even if ICD implantation effectively prevents sudden arrhythmic death. Indeed, in patients suffering from several of the identified “high‐risk” comorbidities, primary‐prevention ICD implantation might have a limited survival benefit. The possible adverse effects of these comorbidities should be openly discussed with the potential ICD recipient and his or her close relatives. Clin. Cardiol. 2012 doi: 10.1002/clc.22018The authors have no funding, financial relationships, or conflicts of interest to disclose.
Favorable Effects of Vasodilators on Left Ventricular Remodeling in Asymptomatic Patients With Chronic Moderate‐Severe Aortic Regurgitation and Normal Ejection Fraction: A Meta‐Analysis of Clinical Trials
Authors: Shah Rachit M. , Singh Mukesh , Bhuriya Rohit , Molnar Janos , Arora Rohit R. , Khosla Sandeep 
Published: June 2012

AbstractBackground:The role of vasodilator therapy in asymptomatic patients with chronic moderate to severe aortic regurgitation (AR) and normal left ventricular (LV) function is uncertain. We assessed the effects of vasodilator therapy (hydralazine, calcium channel blockers, and angiotensin‐converting enzyme inhibitors) in this subgroup of patient population.Hypothesis:Vasodilators have favorable effects on LV remodelling in asymptomatic patients with chronic moderate to severe aortic regurgitation and normal LV function.Methods:We performed a systematic literature search for randomized clinical trials using long‐term vasodilator therapy in asymptomatic patients with chronic severe AR and normal LV function. The magnitude of difference between the vasodilator and nonvasodilator groups was assessed by computing the mean difference (MD). Heterogeneity of the studies was analyzed by Cochran Q statistics. The MD for LV ejection fraction, LV end systolic volume index, and LV end diastolic volume index were computed by random effects model. The MD for LV end‐systolic diameter and LV end‐diastolic diameter were computed by fixed effects model. A 2‐sided alpha error <0.05 was considered to be statistically significant.Results:Seven studies with 460 patients were included. Meta‐analysis of the studies revealed a significant increase in LVEF (MD: 5.32, 95% confidence interval [CI]: 0.37 to 10.26, P = 0.035), a significant decrease in LV end diastolic volume index (MD: −16.282, 95% CI: −23.684 to −8.881, P < 0.001), and a significant decrease in LV end diastolic diameter (MD: −2.343, 95% CI: −3.397 to −1.288, P < 0.001) in the vasodilator group compared with the nonvasodilator group. However, there was no significant decrease in LV end systolic volume index (MD: −6.105, 95% CI: −12.478 to 0.267, P = 0.060) or in LV end systolic diameter (MD: 0.00, 95% CI: −0.986 to 0.986, P = 1.0) in the vasodilator group compared with the nonvasodilator group.Conclusions:In asymptomatic patients with chronic severe AR and normal LV function, vasodilators have favorable effects on LV remodeling. Clin. Cardiol. 2012 doi: 10.1002/clc.22019The authors have no funding, financial relationships, or conflicts of interest to disclose.
Impact of Acute Coronary Syndrome Classification and Procedural Technique on Clinical Outcomes in Patients With Coronary Bifurcation Lesions Treated With Drug‐Eluting Stents
Authors: Sang Song Pil , Ryeol Ryu Dong , Choi Seung‐Hyuk , Yang Jeong Hoon , Song Young Bin , Hahn Joo‐Yong , Choi Jin‐Ho , Seung Ki Bae , Park Seung‐Jung , Gwon Hyeon‐Cheol 
Published: June 2012

AbstractBackground:We examined the impact of non–ST‐segment elevation acute coronary syndrome (NSTE‐ACS) on clinical outcomes in patients with bifurcation lesions treated with drug‐eluting stents.Hypothesis:We hypothesized that NSTE‐ACS would be attributable to the increased risk of major adverse cardiac events (MACE) in bifurcation percutaneous coronary intervention.Methods:We enrolled 1668 patients, using data from a multicenter real‐world bifurcation registry. The primary objective was to compare the 2‐year cumulative risk of MACE in patients with NSTE‐ACS to those with stable angina. Major adverse cardiac events were defined as the composite endpoint of cardiac death, myocardial infarction (MI), and target‐lesion revascularization.Results:Non–ST‐segment elevation acute coronary syndrome was seen in 969 (58.1%) patients and stable angina in 699. Major adverse cardiac events occurred in 7.3% of NSTE‐ACS patients and in 5.2% with stable angina (P = 0.042). However, cardiac death, MI, and target‐lesion revascularization were similar between the 2 groups. We stratified patients with NSTE‐ACS into those with non–ST‐segment elevation MI and those with unstable angina. Cumulative risks of 2‐year MACEs were 7.0% in non–ST‐segment elevation MI patients and 7.5% in unstable angina patients (P = 0.87). In the NSTE‐ACS cohort, the baseline lesion length in the side branch (adjusted hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01‐1.07, P = 0.022), paclitaxel‐eluting stents in the main vessel (adjusted HR: 2.02, 95% CI: 1.21‐3.40, P = 0.008), and final kissing ballooning (adjusted HR: 1.88, 95% CI: 1.10‐3.21, P = 0.021) were independent predictors of MACE.Conclusions:Compared with stable angina patients, the NSTE‐ACS patients who underwent bifurcation percutaneous coronary intervention had an increased risk of MACE during the 2‐year follow‐up. Clin. Cardiol. 2012 doi: 10.1002/clc.22020Drs Pil Sang Song and Dong Ryeol Ryu contributed equally to this work. Coronary Bifurcation Stenting (COBIS) Registry in South Korea, US Department of Health and Human Services, US National Institutes of Health, ClinicalTrials.gov no. NCT00851526.This work was supported by the Korean Society of Interventional Cardiology, Seoul, South Korea. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Identification of High‐Risk Chronic Heart Failure Patients in Clinical Practice: Role of Changes in Left Ventricular Function
Authors: Cicoira Mariantonietta , Rossi Andrea , Chiampan Andrea , Frigo Giulia , Bergamini Corinna , Rigolli Marzia , Zanolla Luisa , Vassanelli Corrado 
Published: June 2012

AbstractBackground:Left ventricular (LV) dysfunction and remodeling are key pathophysiological features underlying disease progression in chronic heart failure (CHF).Hypothesis:To describe the course of LV dysfunction and identify predictors and prognostic impact of changes in LV volumes and function in stable CHF patients under optimal therapy.Methods:There were 318 consecutive CHF outpatients who underwent a repeated echocardiographic evaluation at baseline and at 1 year and subsequently followed‐up for at least 12 months. The end point of the study was all‐cause mortality.Results:Mean LV ejection fraction (LVEF) was 33 ± 7% at baseline and 36 ± 9% at follow‐up. Twenty‐four percent of patients had an improvement of LVEF >5 absolute points (group 1); 58% remained stable (group 2), 17% worsened at >5 absolute points (group 3). Age, New York Heart Association class, diuretic dose, renal function, and baseline LVEF were independent predictors of LVEF improvement at 1 year. At the Cox analysis, patients in group 3 had a 4‐fold higher risk of death when compared with group 1 (hazard ratio: 3.99, 95% confidence interval: 1.6‐9.9, P = 0.002), independently of age, etiology, and symptoms severity.Conclusions:In stable CHF outpatients, LV function improves in 24% of cases; a modest decrease in LV systolic function is associated with a significantly higher risk of all‐cause mortality, independent of other markers of disease severity. Clin. Cardiol. 2012 doi: 10.1002/clc.22024The authors have no funding, financial relationships, or conflicts of interest to disclose.
Leukoencephalopathy after whole‐brain radiation therapy plus radiosurgery versus radiosurgery alone for metastatic lung cancer
Authors: Monaco Edward A. , Faraji Amir H. , Berkowitz Oren , Parry Phillip V. , Hadelsberg Uri , Kano Hideyuki , Niranjan Ajay , Kondziolka Douglas , Lunsford L. Dade 
Published: June 2012

AbstractBACKGROUND:As systemic therapies improve and patients live longer, concerns mount about the toxicity of whole‐brain radiation therapy (WBRT) for treatment of brain metastases. Development of delayed white matter abnormalities indicative of leukoencephalopathy have been correlated with cognitive dysfunction. This study assesses the risk of imaging‐defined leukoencephalopathy in patients whose management included WBRT in addition to stereotactic radiosurgery (SRS). This risk is compared to patients who only underwent SRS.METHODS:We retrospectively compared 37 patients with non–small cell lung cancer who underwent WBRT plus SRS to 31 patients who underwent only SRS. All patients survived at least 1 year after treatment. We graded the development of delayed white matter changes on magnetic resonance imaging using a scale to evaluate T2/FLAIR (fluid attenuated image recovery) images: grade 1 = little or no white matter hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity.RESULTS:Patients treated with WBRT and SRS had a significantly greater incidence of delayed white matter leukoencephalopathy compared to patients who underwent SRS alone (P < .001). On final imaging, 36 of 37 patients (97.3%) treated by WBRT developed leukoencephalopathy (25% with grade 2; 70.8% with grade 3). Only 1 patient treated with SRS alone developed leukoencephalopathy.CONCLUSIONS:Risk of leukoencephalopathy in patients treated with SRS alone for brain metastases was significantly lower than that for patients treated with WBRT plus SRS. A prospective study is necessary to correlate these findings with neurocognition and quality of life. These data supplement existing reports regarding the differential effects of WBRT and SRS on normal brain structure and function. Cancer 2013. © 2012 American Cancer Society.
Widening socioeconomic disparities in cervical cancer mortality among women in 26 states, 1993‐2007
Authors: Simard Edgar P. , Fedewa Stacey , Ma Jiemen , Siegel Rebecca , Jemal Ahmedin 
Published: June 2012

AbstractBACKGROUND:Despite substantial declines in cervical cancer mortality because of widespread screening, socioeconomic status (SES) disparities persist. The authors examined trends in cervical cancer mortality rates and the risk of late‐stage diagnoses by SES.METHODS:Using data from the National Vital Statistics System, trends in age‐standardized mortality rates among women ages 25 to 64 years (1993‐2007) by education level (≤12 years, 13‐15 years, and ≥16 years) and race/ethnicity for non‐Hispanic white (NHW) women and non‐Hispanic black (NHB) women in 26 states were assessed using log‐linear regression. Rate ratios (RRs) and 95% confidence intervals (CIs) were used to assess disparities between those with ≤12 years versus ≥16 years of education during 1993 to 1995 and 2005 to 2007. Avertable deaths were calculated by applying mortality rates from the most educated women to others in 48 states. Trends in the risk of late‐stage diagnosis by race/ethnicity and insurance status were evaluated in the National Cancer Data Base.RESULTS:Declines in mortality were steepest for those with the highest education levels (3.2% per year among NHW women and 6.8% per year among NHB women). Consequently, the education disparity widened between the periods 1993 to 1995 and 2005 to 2007 from 3.1 (95% CI, 2.4‐3.9) to 4.4 (95% CI, 3.5‐5.6) for NHW women and from 3.8 (95% CI, 2.0‐7.0) to 5.6 (95% CI, 3.1‐10.0) for NHB women. The risk of late‐stage diagnosis increased for uninsured versus privately insured women over time. During 2007, 74% of cervical cancer deaths in the United States may have been averted by eliminating SES disparities.CONCLUSIONS:SES disparities in cervical cancer mortality and the risk of late‐stage diagnosis increased over time. Most deaths in 2007 may have been averted by eliminating SES disparities. Cancer 2012. © 2012 American Cancer Society.
Acute promyelocytic leukemia: A population‐based study on incidence and survival in the United States, 1975‐2008
Authors: Chen Yiming , Kantarjian Hagop , Wang Haijun , Cortes Jorge , Ravandi Farhad 
Published: June 2012

AbstractBACKGROUND:With the introduction of all‐trans retinoic acid and arsenic trioxide, the management of acute promyelocytic leukemia (APL) has changed dramatically. We performed a population‐based study of APL in the United States to determine its incidence and relative survival (RS) during a 34‐year period.METHODS:We identified 1397 patients diagnosed with APL between 1975 and 2008 in the Surveillance, Epidemiology, and End Results database. Patients were categorized into 4 age groups and 3 calendar periods. As a comparison, we also reviewed the outcome of APL patients treated at our institution during approximately the same time interval.RESULTS:The incidences of APL increased with time period and patient age. Short‐ and long‐term RS improved with each calendar period, with the greatest improvement occurring between 1991 and 1999; 5‐year RS rates were 0.18 for patients diagnosed in 1975‐1990, 0.52 in 1991‐1999, and 0.64 in 2000‐2008. Age was an important predictor of survival. For example, the 5‐year RS rate in patients diagnosed in 2000‐2008 was 0.38 for patients aged ≥60 years and 0.73 and 0.75 for patients aged <20 years and 20‐39 years, respectively. Similar treads of improvements in the survival were observed in APL patients treated at our institution.CONCLUSIONS:The incidence of APL has increased, especially in the last decade. Clinical outcome improved remarkably in patients with APL diagnosed from 1991 to 1999, mainly because of the increased use of all‐trans retinoic acid. Cancer 2012;. © 2012 American Cancer Society.
Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity‐modulated radiotherapy with concurrent chemotherapy
Authors: Romesser Paul B. , Romanyshyn Jonathan C. , Schupak Karen D. , Setton Jeremy , Riaz Nadeem , Wolden Suzanne L. , Gelblum Daphna Y. , Sherman Eric J. , Kraus Dennis , Lee Nancy Y. 
Published: June 2012

AbstractBACKGROUND:The clinical benefit of routine placement of prophylactic percutaneous endoscopic gastrostomy (pPEG) tubes was assessed in patients with oropharyngeal cancer (OPC) who are undergoing intensity‐modulated radiotherapy (IMRT) with concurrent chemotherapy.METHODS:From 1998 through 2009, 400 consecutive patients with OPC who underwent chemoradiation were included. Of these, 325 had a pPEG and 75 did not (nPEG). Weight and albumin change from baseline to mid‐IMRT, end of IMRT, 1 month post‐IMRT, and 3 months post‐IMRT were evaluated. The treating physicians prospectively recorded acute and late toxicities.RESULTS:Significantly lower absolute weight loss at end of IMRT (6.80 kg vs 8.38 kg, P = .007), 1 month post‐IMRT (9.06 kg vs 11.33 kg, P = .006), and 3 months post‐IMRT (11.10 kg vs 13.09 kg, P = .044) was noted in the pPEG versus nPEG groups. This benefit in reduction of percent weight loss was consistently significant only among patients with BMI < 25. Significant differences were noted in hospital admission rate (15.1% vs 26.7%, P = .026) and volume of nonchemotherapy hydration (8.9 liters vs 17.2 liters, P = .004). There were no differences in percent albumin change, acute dysphagia, acute mucositis, acute xerostomia, chronic dysphagia, radiation treatment duration, and overall survival. Multivariate analysis noted age >55 years (P < .001), female sex (P < .001), and T3/4 category disease (P < .001) were significantly associated with prolonged PEG use.CONCLUSIONS:Although pPEG reduced absolute and percent weight loss and need for hospitalizations in our cohort of patients with OPC undergoing chemoradiation, no differences were noted in radiation treatment duration, toxicity, and overall survival. Prolonged PEG use correlated with age >55 years, female sex, and T3/T4 tumors. Cancer 2012. © 2012 American Cancer Society.
Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy
Authors: Small Alexander C. , Tsao Che‐Kai , Moshier Erin L. , Gartrell Benjamin A. , Wisnivesky Juan P. , Godbold James H. , Smith Cardinale B. , Sonpavde Guru , Oh William K. , Galsky Matthew D. 
Published: June 2012

AbstractBACKGROUND:A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described.METHODS:The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log‐binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer.RESULTS:Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6%; 95% confidence interval, 20.5%‐20.7%) received no anticancer therapy. Patients with NSCLC accounted for 55% of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5% and 24.0%, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1%. Across all cancer types, older age (PR range, 1.37‐1.49; all P < .001), black race (PR range, 1.05‐1.32; all P < .001), lack of medical insurance (PR range, 1.47‐2.46; all P < .001), and lower income (except for cancer of the uterus; PR range, 0.91‐0.98 for every $10,000‐increase in income [all P < .001]) were associated with a lack of treatment.CONCLUSIONS:Approximately 20% of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care. Cancer 2012. © 2012 American Cancer Society.
Ten‐year survival after autologous stem cell transplantation for immunoglobulin light chain amyloidosis
Authors: Cordes Stefan , Dispenzieri Angela , Lacy Martha Q. , Hayman Suzanne R. , Buadi Francis K. , Dingli David , Kumar Shaji K. , Hogan William J. , Gertz Morie A. 
Published: June 2012

AbstractBACKGROUND:The current study was conducted to determine characteristics distinguishing the 10‐year survivor group in patients with systemic immunoglobulin light chain (AL) amyloidosis who underwent autologous stem cell transplantation (SCT).METHODS:The study group included all 74 patients with AL amyloidosis who underwent high‐dose melphalan treatment supported by autologous SCT since the beginning of the Mayo Clinic's SCT program until prior to August 2001.RESULTS:A total of 32 patients (43%) patients survived for > 10 years. Statistically significant baseline differences in the 10‐year survivor group included: 1) the number of organs involved; 2) septal thickness; 3) total cholesterol; and 4) urine total protein. The number of organs involved was the only predictor found on multivariable analysis. Depth of the response to therapy, as measured by the lowest posttransplantation serum free light chain level, was found to be the most significant indicator of durability of response.CONCLUSIONS:Autologous SCT can offer durable benefit for patients with AL amyloidosis. The number of organs involved offers the greatest pretreatment prognostic value, whereas the lowest posttransplantation serum free light chain level offers the best posttreatment prognostic value. Cancer 2012. © 2012 American Cancer Society.
Loss of efficacy and cost‐effectiveness when screening colonoscopy is performed by nongastroenterologists
Authors: Hassan Cesare , Rex Douglas K. , Zullo Angelo , Cooper Gregory S. 
Published: June 2012

AbstractBACKGROUND:Specialty of the endoscopist has been related to the postcolonoscopy interval risk of colorectal cancer (CRC). However, the impact of such a difference on the long‐term CRC prevention rate by screening colonoscopy is largely unknown.METHODS:A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the specialty of the endoscopist in 100,000 individuals aged 50 years until death. The postcolonoscopy interval CRC risk (0.02%) and the relative risk (1.4) of interval CRC between gastroenterologist (GI) endoscopists and non‐GI endoscopists were extracted from the literature. Both efficacy and costs were projected over a steady‐state US population. Eventual increase in endoscopic capacity when assuming all procedures to be performed by GI endoscopists was simulated.RESULTS:According to the simulation model, screening colonoscopy performed by non‐GI endoscopists resulted in a 11% relative reduction in the long‐term CRC incidence prevention rate compared with the same procedure performed by GI endoscopists. When projected on the US population, the reduced non‐GI efficacy resulted in an additional 3043 CRC cases and the loss of $200 million per year. When increasing the relative risk from 1.4 to 2.0, the difference in the prevention rate between GI endoscopists and non‐GI endoscopists increased to 19%. It increased further to 38% when also assuming a 3‐fold increase in the risk of interval CRC. An additional 165 screening colonoscopies per endoscopist per year would be required to shift all non‐GI procedures to GI endoscopists.CONCLUSIONS:When screening colonoscopy is performed by non‐GI endoscopists, a substantial reduction in the long‐term CRC prevention rate may be expected. Such difference appeared to be greater when a suboptimal efficacy of colonoscopy in preventing CRC was assumed. A 10‐year saving of $2 billion may be expected when shifting all screening colonoscopies from non‐GI endoscopists to GI endoscopists. Cancer 2012. © 2012 American Cancer Society.