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At least 343 records · Page 19Linked to original sources
PubMed1987

[Ambulatory electrocardiography in the screening of patients with palpitations].

The role of 24 hour Holter monitoring in the screening of patients complaining of palpitations is reviewed. The term "palpitations", although not always unequivocally used, implies the presence of an arrhythmia. The clinical-instrumental correlation of an intermittent symptom is made possible by continuous electrocardiographic monitoring. Answers to be expected from a 24 hour Holter monitoring in order to achieve an early characterization of the arrhythmia are related to: site of origin, incidence, circadian distribution, prognostic stratification, events aggregation, presence of other asymptomatic abnormalities (rhythm, ST-T).

Arrhythmias, Cardiac↗
PubMed1985

Long-term follow-up after recovery from acute myocardial infarction. Observations on survival, ventricular arrhythmias, and sudden death.

A long-term 12-year follow-up of 248 patients surviving acute myocardial infarction indicated a cumulative survival of 89%, 68%, 53%, and 45% for 1, 5, 10, and 12 years, respectively. When patients were assessed with five routinely obtained clinical factors, significant prognostic stratification of high- and low-risk survival groups extended throughout the follow-up period. Sudden cardiac death was found to be twice as frequent as nonsudden cardiac death, but a significant relationship between sudden death and complex ventricular ectopic beats could not be defined. The extent of complex features of ventricular ectopic beats such as pairs, multiform, repetitive, and R-on-T was inversely related to survival. During the first year after acute myocardial infarction, frequency of ventricular ectopic beats was also inversely related to survival. A long-term effect of frequency on survival, however, could not be demonstrated.

Actuarial Analysis↗
PubMed1983

Some prognostic factors in colorectal cancer with special reference to chemotherapy.

Accumulated data from 118 patients treated with chemotherapy for advanced colorectal cancers were analyzed with respect to prognostic factors. Fifty per cent of the patients had measurable disease. Patients with greater than or equal to 50% regression of tumor had significantly longer survival than those not responding. A normal bone marrow function at start of treatment was the only factor of significance for tumor regression. When survival was considered the following single factors were significant: performance status, enzyme imbalances, bone marrow function. By Cox multivariate analysis the following order of significance for risk factors was found: performance status, enzyme imbalances, renal function, bone marrow function. Emphasis is put on the clinical importance of performance status. The necessity of prognostic stratification of patients who enter chemotherapy studies is stressed.

Antineoplastic Agents↗
PubMedDate not supplied

Image analysis of neuroblastomas-discrimination of prognostic patterns.

In a series of 52 neuroblastomas with a three-year follow-up textural analysis by means of sequential transformation of the image enabled us to establish a prognostic stratification of the cases taking the value of the specific area at the tenth closure as a discriminant of the grade of differentiation. The curves obtained plotting the closing function mainly yield information on the size distribution and characteristics of the intercellular stroma, which largely corresponds to the neurofibrillar set. The correlation between the specific area at the tenth closure and the age of the children prompt us to consider two different trends in neuroblastomas, those which invariably lead to death and whose grade of differentiation bears no correlation with the outcome, and those which undergo spontaneous or treatment-induced regression, and whose maturity has a linear relationship with the age of the child at diagnosis.

Age Factors↗
PubMed1994

Different tracers and stressors in patients with coronary artery disease: how to standardize clinical questions and nuclear cardiology answers.

The recent introduction of new tracers and stressors has increased the number of combinations of techniques that can be used for the diagnostic and prognostic stratification of patients with coronary artery disease. However, these new techniques still need to be standardized for clinical use. Thallium-201 scintigraphy is at present the most common method to assess transient ischemia and viability in patients. Dynamic exercise and dipyridamole show similar incidence of major cardiac complications and their use can be considered sufficiently safe. Further experimental and multicenter clinical studies are needed for 99mTc-Sestamibi and 99mTc-Teboroxime and for new stressors such as adenosine and dobutamine.

Adenosine↗
PubMed1996

Relative role of ambulatory and residential rehabilitation.

Cardiac rehabilitation, derived from the concept of early mobilization after an acute cardiac event, seems destined to assume an important role in the approach to patients affected by chronic heart disease (ischaemic heart disease, valvular and congenital diseases, heart transplant, chronic heart failure, etc.). To respond to individual clinical needs, rehabilitative intervention should be organized either at an outpatient level or by combining outpatient and inpatient activities. Three different levels of intervention, of increasing complexity and specialization, are foreseen. First-level interventions are to be performed exclusively at outpatient level and directed mainly towards long-term care of stable chronic patients in order to keep them at the highest level of autosufficiency possible and to prevent acute events. Second-level interventions include the combination of outpatient and inpatient rehabilitative activity, based on an accurate prognostic stratification intended to reduce the consequences of the handicaps which the individual reports after an acute event. Third-level interventions include services provided in highly specialized centres; they should function at both inpatient and outpatient levels, and should be instituted in close collaboration with cardiosurgical departments that are particularly oriented towards transplant activity.

Ambulatory Care↗
PubMed1997

[Late ventricular potentials and acute myocardial infarction].

BACKGROUND: The presence of late ventricular potentials was evaluated in a group of patients following acute myocardial infarction hospitalised in our division. MATERIALS AND METHODS: Recordings were made between the 10th and 12th day of the pathology. The criteria for positivity were the presence of three parameters: QRSD > or = 114 msec, LAS 40 > or = 38 msec, RMS 40 < or = 20 mv. These were present in 21 patients (18 males and 3 females). Inferior acute myocardial infarction (AMI) was found to be present in 15 cases, anterior AMI in 4 cases and AMI with an unspecified localisation in 2 cases. The mean duration of qrsd was 122 msec, the mean duration of low amplitude potentials (LAS 40) were 53.5 msec, the mean amplitude of the last 40 msec (RMS 40 was 8.9 mv). CONCLUSIONS: In conclusion, the authors affirm that late potentials were present in the majority of patients with inferior AMI and the search for the latter represents an important stage in the post-AMI prognostic stratification. Delta is the positive correlation between late potentials and ventricular tachycardia in postinfarction. This non-invasive test is comparable to electrophysiological induction tests in terms of predictive capacity of arrhythmic event and/or sudden death.

Aged↗
PubMed1997

[Feasibility and safety of dobutamine/atropine echocardiography following acute myocardial infarct].

BACKGROUND: Due to the increased utilization of this test for the evaluation of chest pain and for prognostic stratification in patients with a recent myocardial infarction, the results of 235 consecutive tests have been analyzed to evaluate the incidence and clinical significance of side effects induced by dobutamine. A potential limitation to the clinical utilization of dobutamine stress echocardiography is the higher incidence of side effects comparison with to other non invasive tests for the diagnosis of coronary artery disease reported by some authors. METHODS: Dobutamine/atropine stress echocardiography was performed in 256 patients affected by acute myocardial infarction. Dobutamine was infused starting with the dose of 5 micrograms/kg/min over 3 minutes with incremental steps of 10-20-30-40 micrograms/kg/min over 3 minutes and atropine, in cases of poor chronotropic response, under 2D-echocardiographic and 12-lead electrocardiographic monitoring. RESULTS: The test was interrupted only in 4 cases for atrial fibrillation (2 patients) and symptomatic hypotension. Patients were divided according to the absence (G1) or presence (G2) of cardiac arrhythmias during the test. Patients of G2 differred from patients of G1 only in respect of the maximal dose of dobutamine infused and the incidence of a wall motion abnormality in the basal echocardiogram. CONCLUSIONS: Dobutamine/atropine echo stress test may be considered a safe test for the evaluation of the presence and severity of coronary artery disease in patients with a previous or recent myocardial infarction.

Acute Disease↗
PubMed1998

Interphase cytogenetic study of preoperative core biopsies for the prediction of early serum prostate specific antigen recurrence after radical prostatectomy of clinically localized prostate carcinoma.

BACKGROUND: Current clinical and pathologic methods are imprecise in predicting the extent of prostate carcinoma progression. This study was conducted to evaluate the role of interphase cytogenetics (ICG) with chromosome enumeration probes relative to the role of conventional pathologic characteristics in the preoperative prediction of postoperative tumor classification and recurrence of elevated serum concentrations of prostate specific antigen (PSA). METHODS: The authors performed ICG with enumeration probes for chromosomes 7, 17, and X on 6-microm sections of core biopsies from 75 patients with clinically localized adenocarcinoma of the prostate. Results were compared with pathologic findings (tumor classification, volume, and status of surgical margins) of the corresponding radical prostatectomy specimens and data on serum PSA measurements taken for 72 patients during a follow-up period of up to 42 months (mean, 19.8 months). In addition to ICG, biopsies were reviewed for primary, secondary, highest, and combined Gleason grades, number and bilaterality of positive biopsies, amount of carcinoma (percentage and core length of infiltration), amount of high grade carcinoma, and perineural invasion. RESULTS: Chromosome categories were unevenly distributed among pathologic tumor classification groups (P = 0.0008) and between groups with positive and negative surgical margins (P = 0.0116). Tumors with aneusomic chromosome numbers had larger volumes than those with eusomy and tetrasomy (P = 0.0022). Kaplan-Meier analysis demonstrated that PSA recurrences (> or = 0.4 ng/mL) were more frequent and observed earlier in patients with detected chromosomal aneusomies than in those with eusomic and tetrasomic chromosome numbers (P < 0.0001). Cox regression analysis indicated that ICG was the most valuable independent factor in predicting PSA recurrences. CONCLUSIONS: The detection of numeric chromosomal aberrations in preoperative core biopsies is an adverse prognostic sign. Grading based on the quantification of genetic changes might prove useful in the prognostic stratification of patients with clinically localized prostate carcinoma.

Adenocarcinoma↗
PubMed1998

[Pulmonary hypertension in patients with left ventricular dysfunction studied with contrast-enhanced Doppler echocardiography: relations with diastolic parameters and prognostic implications].

In patients with left ventricular dysfunction, the prognostic value of both pulmonary hypertension and mitral flow patterns has been recognized. However, the effect of the association of different degrees of pulmonary hypertension on prognosis and the corresponding left ventricular diastolic dysfunction is not clear. Accordingly, we considered the impact on survival of a categorization based on the relationship between pulmonary artery pressure and left ventricular diastolic dysfunction, as assessed by mitral and pulmonary venous flow analyses. Transthoracic Doppler echocardiography was carried out in 92 patients with ejection fraction < 45%, pulmonary artery systolic pressure > 25 mmHg and sinus rhythm. Tricuspid regurgitant velocity and Doppler parameters derived from transmitral and pulmonary venous flows were evaluated. In the case of inadequate baseline tracings, weak or poor Doppler signals were enhanced by intravenous injection of a galactose-based contrast agent (Levovist 8 ml suspension at a concentration of 400 mg/ml). To select those whose pulmonary hypertension was either proportional or unproportional to left side filling pressures, patients were divided as follows: Group 1 (n = 69) with low discrepancies and Group 2 (n = 23) with marked discrepancies between Doppler estimates of pulmonary artery systolic pressure and left side filling abnormalities. The patients of each group were also classified according to their mitral flow pattern: abnormal relaxation, pseudonormal and restrictive. Mean pulmonary artery systolic pressure was 49 +/- 16 mmHg in the total population, 43 +/- 11 mmHg in Group 1 and 68 +/- 14 mmHg in Group 2 (p < 0.0001). Several mitral and pulmonary venous flow variables significantly correlated with pulmonary artery systolic pressure in the total population and in the study groups. The best correlations were observed in Group 1 as regards the ratio of reverse-to-forward atrial wave duration (r = 0.83), E wave deceleration rate (r = 0.81), E wave deceleration time (r = -0.81) and the systolic fraction of pulmonary venous flow peak velocities (r = -0.75). In Group 1, the lower heart failure-free survival rate at 10 months was observed in patients with restrictive pattern (68%) as opposed to those with pseudonormal (94%) and abnormal relaxation patterns (97%). The overall heart failure-free survival rate in Group 2 was 86%. In conclusion, the classification according to the relationship between pulmonary hypertension and the alterations of left chamber filling may contribute to the prognostic stratification of patients with left ventricular dysfunction. The patients with pulmonary hypertension proportional to the increase in left chamber filling pressures and restrictive pattern exhibited the worst prognosis.

Aged↗
PubMed2002

Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction.

BACKGROUND: Mean left atrioventricular plane displacement is strongly related to prognosis in patients with heart failure. We aimed to examine its value for prognostication and risk stratification in patients hospitalised for acute myocardial infarction. METHODS AND RESULTS: Left atrioventricular plane displacement was assessed by echocardiography in 271 consecutive patients with acute myocardial infarction. Mean prospective follow-up was 628 days. Atrioventricular plane displacement was readily assessed in all patients and was significantly lower in patients who died (n=41, 15.1%) compared to the survivors: 8.2(5.6) v. 10.0(5.5) mm, P<0.0001. Overall mortality was 31.3% in the lowest quartile with regard to atrioventricular plane displacement (<8.00 mm) and 10.1% in the combined upper three quartiles. Thus, the hazard ratio for an atrioventricular plane displacement <8.0 mm compared to 8 mm or more was 3.1, P=0.0001. The combined mortality/heart failure hospitalisation incidence was 43.8% in the lowest and 14.6% in the combined upper three quartiles: Risk ratio 3.0, P<0.0001. In multivariate analysis, including age and history of atrial fibrillation, left atrioventricular plane displacement was an independent prognostic marker. CONCLUSION: In post-myocardial infarction patients, echocardiographic assessment of atrioventricular plane displacement showed a strong, independent prognostic value. Determination of left atrioventricular plane displacement can be readily performed in virtually all patients, and may in clinical practice facilitate identification of high-risk patients.

Aged↗
PubMed1985

Prognostic significance of stratification systems in multiple myeloma. I. Risk categories (good and poor risk).

A group of 193 patients with multiple myeloma (MM) consisting of cases treated only symptomatically or by nonsystematic therapy with Cyclophosphamide or Melphalan (1959-76), and of patients given systematic polychemotherapy with intensive supportive treatment (1976-84) were subjected to prognostic analysis of the importance of MM stratification into two categories, poor and good risk. The evaluation included only hitherto untreated patients with MM of the IgG, IgA, and Bence-Jones' types. All the three evaluated stratification systems (ALGB, NCI-SECSG and CALGB) were found in the present study to show a good, equally significant relation to the prognosis of the disease. The survival median of poor risk patients in terms of the used classification system for the 1959-76 subgroup was 5-6 months, for the 1976-84 subgroup 20-22 months. In the good risk category it was 24-27 months in the 1959-76 subgroup and 47-50 months in the 1976-84 subgroup. Permanent validity of the initial prognosis and in the poor risk category safe coverage of patients with a high risk of early death was proved. Good agreement of the studied stratification systems with the clinical staging system of Durie and Salmon [14] (most of the Stage III patients consisted of poor risk patients) was recorded, which, however, was not the case with the staging system of Merlini, Waldenström and Jayakar [27]. The CALGB system is considered the most suited to the needs of clinical practice.

Adult↗
PubMed1985

Prognostic significance of stratification systems in multiple myeloma. II. Clinical staging systems.

A group of 193 multiple myeloma (MM) patients consisting of cases treated only symptomatically (1959-63) or by nonsystematic monotherapy with Cyclophosphamide or Melphalan (1963-76) and of a subgroup given systematic polychemotherapy and intensive supportive treatment (1976-84) were evaluated for the practical applicability and prognostic relevance of three staging systems. The clinical staging system of Durie and Salmon and the quantitative system of Salmon and Wampler have proved in both subgroups of various periods and with different therapeutic approaches to be well applicable in the clinic allowing the patients to be divided into three prognostically different groups according to the size of the tumor mass. Merlini, Waldenström and Jayakar's staging system has likewise shown relationship to prognosis though the patients could be divided only into two prognostically different groups. It is evident that a deeper knowledge of MM requires nowadays a more comprehensive, complex and prognostically more relevant classification system.

Adult↗
PubMed2026

Lactylation-related immune-metabolic dysregulation defines prognostic and therapeutic stratification in lung adenocarcinoma.

BACKGROUND: Lactylation links lactate metabolism with inflammatory signaling and immune regulation in tumors. However, its cellular distribution and translational value in lung adenocarcinoma (LUAD) remain unclear. METHODS: Single-cell RNA-sequencing datasets GSE189357 and GSE171145 were integrated to characterize lactylation-related activity, intercellular communication, and malignant epithelial cell states in LUAD. Single-cell-derived lactylation-related differentially expressed genes were mapped to TCGA-LUAD and multiple GEO cohorts. Univariate Cox regression and machine learning algorithms were used to construct a lactylation-related prognostic signature (LRPS). The associations of LRPS with prognosis, immunotherapy response, drug sensitivity, genomic alterations, immune infiltration, and inflammation- and metabolism-related pathways were evaluated. KRT7 was further validated using virtual knockout analysis, spatial transcriptomics, and in vitro and in vivo experiments. RESULTS: lactylation-related transcriptional activity showed heterogeneous distribution across LUAD cell populations and was associated with altered cell-cell communication. In malignant epithelial cells, LRTS-high and LRTS-low states exhibited distinct metabolic, inflammatory, and tumor-related pathway activities. LRPS showed stable prognostic performance in TCGA-LUAD and multiple GEO cohorts and remained an independent prognostic factor. Low LRPS was associated with greater potential benefit from immunotherapy, whereas different LRPS groups displayed distinct drug sensitivity, genomic alteration, and immune microenvironment patterns. KRT7 was highly expressed in LUAD and associated with poor prognosis. KRT7 knockdown suppressed LUAD cell proliferation, migration, invasion, colony formation, and tumor growth in vivo. CONCLUSIONS: This study identifies lactylation-related immune-metabolic dysregulation as a clinically relevant feature of LUAD and develops a single-cell-guided LRPS for prognosis and therapeutic stratification. KRT7 emerged as an LRPS-related functional candidate with experimentally supported roles in malignant LUAD phenotypes.

Immunotherapy↗
PubMedDate not supplied

[Dynamic echocardiography in coronary risk stratification].

The prognostic value of some coronary risk factors related to Stress/Echocardiography was analyzed. The most important prognostic factors during an abnormal study are: presence and time of beginning, severity and extension of the myocardial ischemic changes.

Coronary Disease↗
PubMed1996

Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification.

BACKGROUND: We evaluated the incremental prognostic value, the role in risk stratification, and the impact on patient management of myocardial perfusion single-photon emission computed tomography (SPECT) in a population of patients without prior myocardial infarction, catheterization, or revascularization. METHODS AND RESULTS: We examined 2200 consecutive patients who at the time of their dual-isotope SPECT had not undergone catheterization, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty and had no known history of previous myocardial infarction. Follow-up was performed at a mean of 566 +/- 142 days (97% complete) for hard events (cardiac death and myocardial infarction) and for referral to cardiac catheterization or revascularization within 60 days after nuclear testing. Examination of clinical, exercise, and nuclear models by use of pre-exercise tolerance test (ETT), post-ETT, and nuclear information using a stepwise Cox proportional hazards model and receiver-operating characteristic curve analysis revealed that nuclear testing added incremental prognostic value after inclusion of the most predictive clinical and exercise variables (global chi2 = 12 for clinical variables; 31 for clinical + exercise variables; 169 for nuclear variables; gain in chi2, P < .0001 for all; receiver-operating characteristic areas: 0.66 +/- 0.04 for clinical, 0.73 +/- 0.04 for clinical + exercise variables, 0.87 +/- 0.03 for nuclear variables, P = .03 for gain in area with exercise variables; P < .001 for increase with nuclear variables). Multiple logistic regression analysis revealed that scan information contributed 95% of the information regarding referral to catheterization with further additional information provided by presenting symptoms and exercise-induced ischemia. Referral rates to early catheterization and revascularization paralleled the hard event rates in all scan categories - very low referral rates in patients with normal scans and significant increases in referral rates as a function of worsening scan results. Even after stratification by clinical and exercise variables such as the Duke treadmill score, pre- and post-ETT likelihood of coronary artery disease, presenting symptoms, sex, and age, the nuclear scan results further risk-stratified the patient subgroups, thus demonstrating clinical incremental value. CONCLUSIONS: In a patient population with no evidence of previous coronary artery disease at overall low risk (1.8% hard event rate), myocardial perfusion SPECT adds incremental prognostic information and risk-stratifies patients even after clinical and exercise information is known. It appears that referring physicians use this test in an appropriate manner in selecting patients to be referred to catheterization or revascularization.

Cardiac Catheterization↗