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CRT-800.61 Outcomes And Incidence Of Infective Endocarditis After Trans-catheter Percutaneous Pulmonary Valve Implantation: A Single Centre Experience
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JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 10, NO. 3, SUPPL S, 2017
RESULTS From 2005 to 2012, 5,438,471 patients were hospitalized with diastolic heart failure. Of these patients, 396,812 (7.3%) had MVI and 29,490 (7.4%) of these had a diagnosis of OSA. The mortality rate of patients with MVI and OSA was 2.1% compared to 3.8% in patients with MVI but no OSA. As such, patients with MVI and OSA had 44% lower odds of dying compared to patients with MVI without OSA (95% CI ¼ 32% to 53%, p < 0.001). Total patient charges for patients with MVI and OSA were 15.9% higher than patients with MVI without OSA (95% CI ¼ 12.6% to 19.3%, charges ¼ $32,742 vs. $28,246, respectively, p < 0.001). Similarly, total hospital cost for patients with MVI and a diagnosis of OSA was about 11.4% higher than patients with MVI without OSA (95% CI ¼ 8.8% to 14.1%, cost ¼ $10,281 vs. $9,229, respectively, p < 0.001). Finally, hospital length of stay (LOS) for patients with MVI and a diagnosis of OSA was about 3.7% higher than patients with MVI without OSA (95% CI ¼ 1.6% to 5.9%, LOS ¼ 5.0 days vs. 4.8 days, respectively, p < 0 .001). CONCLUSION In this large sample of diastolic heart failure patients, we observed that in hospital mortality was significantly lower in those with mitral insufficiency and obstructive sleep apnea,though they had increased cost of care and length of stay. CRT-800.61 Outcomes And Incidence Of Infective Endocarditis After Trans-catheter Percutaneous Pulmonary Valve Implantation: A Single Centre Experience Ashish H. Shah,1 Cora Bryan,2 Kelly Rohan,2 J. Andreas Hoschtitzky,1 Arjamand Shauq,3 Heiko Schneider,1 Petra Jenkins,1 Jaspal Dua,1 Bernard Clarke,1 Vaikom Mahadevan4 1 Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; 2Manchester University, Manchester, United Kingdom; 3Alder Hey Childrens’ Hospital, Liverpool, United Kingdom; 4University of California, San Francisco, CA BACKGROUND Trans-catheter pulmonary valve implantation (TPVI) has become a less-invasive alternative to those at higher risk for surgical pulmonary valve replacement. Recent publications have raised concern with increased incidence of infective endocarditis (IE) following TPVI. METHODS We evaluated our cohort of patients treated with TPVI, and reviewed their demographics, clinical status, and investigations preand post-TPVI, with special emphasis on subsequent events of IE. RESULTS From Jan-2007 to Jun-2016, 49 patients underwent TPVI, of whom 23 (46.9%) were male and the mean age at the time of intervention was 27.410.9 years. Primary congenital diagnoses included tetralogy of Fallot (17, 31.5%), pulmonary atresia with ventricular septal defect (13, 24.1%), and aortic valve disease treated with a Ross procedure (11, 20.4%). Mean number of previous operations was 2.21. Mean age of conduit/valve was 16.38.4 years, and their mean diameter at the time of implant was 20.72.9 mm. Five patients had a history of treated IE prior to TPVI. Reason for TPVI was stenosis (10/ 49), regurgitation (16/49) or mixed disease (23/49). Pre-stenting was performed in 46 patients, whereas valve-in-valve intervention was performed in 2 patients without pre-stenting. Melody valves were deployed on 18, 20 and 22 mm balloons in 5, 26, and 13 patients respectively, whereas Edwards-Sapien 23 and 26 mm valves were used in 4 and 1 patients respectively. Thirty-two valves were post-dilated in the index procedure, whereas 4 patients required valve dilation during follow-up to improve gradient across PV. Significant symptomatic and hemodynamic improvement was observed postTPVI (peak gradient across PV: pre TPVI - 55 20 vs. post-TPVI 32 13 mmHg, P<0.0001; right ventricular systolic pressure: preTPVI - 75 20 vs. post-TPVI - 52 15 mmHg, P<0.0001). During median follow up of 42 months, 4 (8.2%) patients had confirmed IE involving Melody valve; one of whom was treated with intra-venous antibiotics alone, whereas rest 3 required prolonged antibiotics and
surgical explant. None of these patients had IE pre-TPVI. Overall reported incidence rate of IE was of 0.023/patient-year follow-up. Poor dental hygiene was noted in 2 patients, whereas one had infected veneral warts prior to IE. Prior to infection, peak gradient across PV in those with IE was no different than the ones without. CONCLUSION TPVI is a safe and effective alternative to treat dysfunctional pulmonary valve or conduit, however, IE remains a real risk. Patients and physicians should be cognizant about it.
NURSE & TECH CRT-900.00 The Role of Pain Sensitivity, Pain Catastrophizing Level and Personality Traits in Prehospital Delay of Acute Myocardial Infarction Patients Xiaoli Quan,1 Daniel Yee Tak Fong,1 Angela Yee Man Leung,2 Pui Hing Chau1 1 Li Ka Shing Faculty of Medicine, Hong Kong, China; 2The Hong Kong Polytechnic University, Hong Kong, China BACKGROUND AMI patients with persisting prehospital delay have been reported worldwide. Some studies pointed higher scores of chest pain effect acute myocardial infarction (AMI) patients’ delay of hospitalize. However, the role of individual’ pain sensitivity level, pain catastrophizing score and personality traits not yet well addressed that may influenced AMI patients’ delay. OBJECTIVE The aim of this study was to identify the role of pain sensitivity, pain catastrophizing level and personality traits related to Chinese AMI patients’ prehospital delay in China. METHODS A cross-sectional study was conducted at four tertiary referral center hospitals in China by face-to-face interview using a structured questionnaire which including Pain Sensitivity Questionnaire (PSQ), Pain Catastrophizing Scale (PCS), Eysenck Personality Questionnaire (EPQ) and Short Form of McGill Pain Questionnaire. Prehospital delay refers to the time between symptoms onset and arrival at adequate equipped hospitals exceeding 90 minutes in this study. Descriptive statistics were calculated for all the variables. Logistic regression was used to identify whether pain sensitivity, pain catastrophizing level and personality traits were predictors of prehospital delay, controlling for the known socio-demographic and medical factors. RESULTS Of the 329 Chinese AMI patients interviewed, among were 184 male (55.9%) and 145 female (44.1%). 45.0% (148/329) participants have appeared in hospitals < 90 minutes after heart attack while 55.0% (181/329) participants were not. We found prehospital delay related to lower PSQ-total score (OR¼ 0.87; 95% CI¼ 0.79-0.97) and lower PSQ-minor scores (OR¼0.83; 95% CI¼0.74-0.92), but not PSQmoderate score (P¼0.087). A strong association between personality traits and AMI patients’ prehospital delay were observed, the lower scores of EPQ- P, E, N , and L subscales shown 52.0% (171/329), 91.2% (300/329), 65.3% (215/329) and 95.1% (313/329) participants have prolonged time to arrive hospitals after AMI onset, respectively. No significant relationship was found between pain catastrophizing score and prehospital delay (P¼0.496). CONCLUSION The findings of this study could provide some information towards to individual’ pain sensitivity level, pain catastrophizing score and personality traits, to investigate the potential risk factors that may impact AMI patients’ delay, in order to lessen the time for medical treatment when someone experiencing an AMI.
JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 10, NO. 3, SUPPL S, 2017
RESULTS From 2005 to 2012, 5,438,471 patients were hospitalized with diastolic heart failure. Of these patients, 396,812 (7.3%) had MVI and 29,490 (7.4%) of these had a diagnosis of OSA. The mortality rate of patients with MVI and OSA was 2.1% compared to 3.8% in patients with MVI but no OSA. As such, patients with MVI and OSA had 44% lower odds of dying compared to patients with MVI without OSA (95% CI ¼ 32% to 53%, p < 0.001). Total patient charges for patients with MVI and OSA were 15.9% higher than patients with MVI without OSA (95% CI ¼ 12.6% to 19.3%, charges ¼ $32,742 vs. $28,246, respectively, p < 0.001). Similarly, total hospital cost for patients with MVI and a diagnosis of OSA was about 11.4% higher than patients with MVI without OSA (95% CI ¼ 8.8% to 14.1%, cost ¼ $10,281 vs. $9,229, respectively, p < 0.001). Finally, hospital length of stay (LOS) for patients with MVI and a diagnosis of OSA was about 3.7% higher than patients with MVI without OSA (95% CI ¼ 1.6% to 5.9%, LOS ¼ 5.0 days vs. 4.8 days, respectively, p < 0 .001). CONCLUSION In this large sample of diastolic heart failure patients, we observed that in hospital mortality was significantly lower in those with mitral insufficiency and obstructive sleep apnea,though they had increased cost of care and length of stay. CRT-800.61 Outcomes And Incidence Of Infective Endocarditis After Trans-catheter Percutaneous Pulmonary Valve Implantation: A Single Centre Experience Ashish H. Shah,1 Cora Bryan,2 Kelly Rohan,2 J. Andreas Hoschtitzky,1 Arjamand Shauq,3 Heiko Schneider,1 Petra Jenkins,1 Jaspal Dua,1 Bernard Clarke,1 Vaikom Mahadevan4 1 Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; 2Manchester University, Manchester, United Kingdom; 3Alder Hey Childrens’ Hospital, Liverpool, United Kingdom; 4University of California, San Francisco, CA BACKGROUND Trans-catheter pulmonary valve implantation (TPVI) has become a less-invasive alternative to those at higher risk for surgical pulmonary valve replacement. Recent publications have raised concern with increased incidence of infective endocarditis (IE) following TPVI. METHODS We evaluated our cohort of patients treated with TPVI, and reviewed their demographics, clinical status, and investigations preand post-TPVI, with special emphasis on subsequent events of IE. RESULTS From Jan-2007 to Jun-2016, 49 patients underwent TPVI, of whom 23 (46.9%) were male and the mean age at the time of intervention was 27.410.9 years. Primary congenital diagnoses included tetralogy of Fallot (17, 31.5%), pulmonary atresia with ventricular septal defect (13, 24.1%), and aortic valve disease treated with a Ross procedure (11, 20.4%). Mean number of previous operations was 2.21. Mean age of conduit/valve was 16.38.4 years, and their mean diameter at the time of implant was 20.72.9 mm. Five patients had a history of treated IE prior to TPVI. Reason for TPVI was stenosis (10/ 49), regurgitation (16/49) or mixed disease (23/49). Pre-stenting was performed in 46 patients, whereas valve-in-valve intervention was performed in 2 patients without pre-stenting. Melody valves were deployed on 18, 20 and 22 mm balloons in 5, 26, and 13 patients respectively, whereas Edwards-Sapien 23 and 26 mm valves were used in 4 and 1 patients respectively. Thirty-two valves were post-dilated in the index procedure, whereas 4 patients required valve dilation during follow-up to improve gradient across PV. Significant symptomatic and hemodynamic improvement was observed postTPVI (peak gradient across PV: pre TPVI - 55 20 vs. post-TPVI 32 13 mmHg, P<0.0001; right ventricular systolic pressure: preTPVI - 75 20 vs. post-TPVI - 52 15 mmHg, P<0.0001). During median follow up of 42 months, 4 (8.2%) patients had confirmed IE involving Melody valve; one of whom was treated with intra-venous antibiotics alone, whereas rest 3 required prolonged antibiotics and
surgical explant. None of these patients had IE pre-TPVI. Overall reported incidence rate of IE was of 0.023/patient-year follow-up. Poor dental hygiene was noted in 2 patients, whereas one had infected veneral warts prior to IE. Prior to infection, peak gradient across PV in those with IE was no different than the ones without. CONCLUSION TPVI is a safe and effective alternative to treat dysfunctional pulmonary valve or conduit, however, IE remains a real risk. Patients and physicians should be cognizant about it.
NURSE & TECH CRT-900.00 The Role of Pain Sensitivity, Pain Catastrophizing Level and Personality Traits in Prehospital Delay of Acute Myocardial Infarction Patients Xiaoli Quan,1 Daniel Yee Tak Fong,1 Angela Yee Man Leung,2 Pui Hing Chau1 1 Li Ka Shing Faculty of Medicine, Hong Kong, China; 2The Hong Kong Polytechnic University, Hong Kong, China BACKGROUND AMI patients with persisting prehospital delay have been reported worldwide. Some studies pointed higher scores of chest pain effect acute myocardial infarction (AMI) patients’ delay of hospitalize. However, the role of individual’ pain sensitivity level, pain catastrophizing score and personality traits not yet well addressed that may influenced AMI patients’ delay. OBJECTIVE The aim of this study was to identify the role of pain sensitivity, pain catastrophizing level and personality traits related to Chinese AMI patients’ prehospital delay in China. METHODS A cross-sectional study was conducted at four tertiary referral center hospitals in China by face-to-face interview using a structured questionnaire which including Pain Sensitivity Questionnaire (PSQ), Pain Catastrophizing Scale (PCS), Eysenck Personality Questionnaire (EPQ) and Short Form of McGill Pain Questionnaire. Prehospital delay refers to the time between symptoms onset and arrival at adequate equipped hospitals exceeding 90 minutes in this study. Descriptive statistics were calculated for all the variables. Logistic regression was used to identify whether pain sensitivity, pain catastrophizing level and personality traits were predictors of prehospital delay, controlling for the known socio-demographic and medical factors. RESULTS Of the 329 Chinese AMI patients interviewed, among were 184 male (55.9%) and 145 female (44.1%). 45.0% (148/329) participants have appeared in hospitals < 90 minutes after heart attack while 55.0% (181/329) participants were not. We found prehospital delay related to lower PSQ-total score (OR¼ 0.87; 95% CI¼ 0.79-0.97) and lower PSQ-minor scores (OR¼0.83; 95% CI¼0.74-0.92), but not PSQmoderate score (P¼0.087). A strong association between personality traits and AMI patients’ prehospital delay were observed, the lower scores of EPQ- P, E, N , and L subscales shown 52.0% (171/329), 91.2% (300/329), 65.3% (215/329) and 95.1% (313/329) participants have prolonged time to arrive hospitals after AMI onset, respectively. No significant relationship was found between pain catastrophizing score and prehospital delay (P¼0.496). CONCLUSION The findings of this study could provide some information towards to individual’ pain sensitivity level, pain catastrophizing score and personality traits, to investigate the potential risk factors that may impact AMI patients’ delay, in order to lessen the time for medical treatment when someone experiencing an AMI.