Introduction This study aimed to assess if the use of kidneys from donors with a decreased eGFR had an adverse effect on patient and graft survival. Methods Data on all UK SPKT's from 2001-2021 were obtained from the NHSBT UK Transplant Registry (n=2,631). Cases with missing information were removed, leaving a final cohort of 1,819 (69.1%). eGFR was calculated using the CKD-EPI equation. Pancreas Graft (PGS), Kidney Graft (KGS) and patient survival analyses were conducted using Kaplan-Meier plots and Cox-regression models. Results 71% (n=1,292) of grafts were from donors with an eGFR>90 and 29%(n=530) were from donors with an eGFR<90. Donors with an eGFR<90 were statistically significantly more likely to be older (p<0.0001), a DBD donor (p=0.0086**) and have a higher BMI(p<0.0001). Recipients who received a graft from a donor with an eGFR<90 were well matched with those who received a graft from a donor with an eGFR>90. Univariate analysis showed a statistically significant decreased KGS(p=0.007**) when the donor had an eGFR<90. This trend was not seen when comparing patient or pancreas survival. Conclusion We accept a lower GFR could be indicative of either an AKI or a sign of early chronic kidney disease. In this current data analysis, we have been unable to successfully distinguish between the two however we have shown poorer KGS in those with a lower eGFR (<90). This had no impact on pancreas or patient survival. Further analysis is needed to explain the precise reasons for the lower eGFRs at the time of organ donation.
AimsThe aim of this three month retrospective study was to evaluate the incidental prevalence and burden of coronary artery calcification on CT Pulmonary Angiography (CTPAs) used for the assessment of patients presenting with chest pain suspicious for PE and whether this finding was reported upon by Radiologists.MethodsThe National Integrated Medical Imaging System (NIMIS) was manually searched to ascertain all CTPA examinations performed in our institution from 01/07/2014 to 30/09/2014. The Radiologist issued reports were analysed and the images of selected studies were reviewed as described below.Results261 CTPAs were performed over this three month period on 257 patients and 104 of these scans were performed on patients between the ages of 40 and 70 which were selected for this review. Of these, 53 were male and 51 were female with a mean age of 57.09 years. Only 25/104 (24%) of these scans commented on the presence of coronary artery calcification and none commented on the absence of calcification. Of the 25 (24%) positive reports, 10 (40%) commented on presence only without localising it or grading its severity, while 10 (40%) reported LAD disease and only 4 (16%) reported three vessel calcification. A total of 7 (28%) reports graded the calcification as severe. The images of the 79/104 (76%) remaining CTPAs whose reports did not comment on coronary calcification were reviewed. 8 (10.1%) were uninterpretable due to either artefact from motion/pacing leads or due to the presence of contrast in the coronary system and these were excluded from the analysis. 25/79 (31.6%) of these CTPAs had calcification of varying degrees present. 5 (20%) had left main deposits while 9 (36%) had three vessel calcification (LAD, LCx and RCA). The LAD was the most commonly involved vessel, with lesions detected in 20/25 scans. 2 patients had evidence of previous stent placement in the LAD. Calcification in the RCA was difficult to visualise well in most cases due to close proximity to contrast filling both the right atrium and ventricle. In summary only 24% of Radiologist reported CTPAs commented upon the presence of coronary artery calcification, while a further 24% of CTPAs were found to have significant calcific coronary disease with 20% of these having left main disease and 36% having three vessel disease.ConclusionsThis initial study demonstrates significant variance in reporting of incidental coronary artery calcification in non-cardiac CT in patients between 40–70 years being assessed for chest pain for suspected PE. A longer prospective study is planned to evaluate if such findings have incremental clinical benefit in identifying a cardiac aetiology for chest pain syndromes in these patients and to correlate such findings with clinical outcomes.
60.1% (P=0.105). The average GLS improved significantly from -16.2% to -18.4%. (P<0.001). For those with reduced LVEF, the improvements in the LV structure variables were more marked, with the septal and posterior walls decreasing in thicknesses from 1.2 cm to 1.0 cm (P<0.001) and 1.2 cm to 1.0 cm (P<0.001), respectively. The LV mass decreased by an average of 45.9 g from 297.5 g to 251.6 g (P<0.001). Mean LVEF increased significantly from 34.4% to 39.3% (P=0.003), and the average GLS also improved from -12.3% to -14.2% (P<0.001). Conclusion This study has demonstrated the novel findings associated with improvements in LV structure and function after metabolic surgery. There were significant decreases in LV wall thickness and LV mass, along with improvements in LVEF and LVGLS. Differential impact is observed, with greater improvements in those with reduced baseline LVEF.
IntroductionTransoesophageal echocardiography (TOE) is commonly performed in the investigation of ischaemic stroke/TIA. Previous studies have suggested a high yield of potentially significant clinical findings, but a wide variation in impact on clinical management.AimTo examine the diagnostic yield of TOE in patients referred for investigation of ischaemic stroke/TIA in a single centre and to determine the impact of these findings on clinical management.Methods108 consecutive patients undergoing TOE for investigation of ischaemic stroke/TIA between July 2014 and April 2015 were identified. TOE reports, MRI/CT brain reports and clinical discharge summaries were reviewed for each patient.Results108 patients were identified. 74 were male (68.5%). Average age was 54.9 ± 13.3 years. The majority (77.8%) were aged ≤65 years. Average age in the “young CVA/TIA” cohort was 50 ± 10.3 years (range 21–65). 88 patients (81.5%) had CT/MRI-confirmed infarcts. 6 patients (5.6%) were in atrial fibrillation at the time of TOE. 17 patients (15.7%) had recurrent events and 18 (16.7%) had bilateral infarcts. At least one potentially significant finding was detected in 86 patients (79%).Interatrial septum: Patent foramen ovale (PFO) was detected by colour flow in 48% of patients and right to left shunt demonstrated by bubble study in 84.6% of these cases. Interestingly, the prevalence of PFO did not differ between the “young stroke” cohort and the older age group (47% and 48%, respectively). Atrial septal aneurysm was detected in 12 patients (11.1%), all of whom had PFO. 3 patients who previously had device closure of PFO were investigated for symptom recurrence. Residual right to left shunt was demonstrated in one of these cases.Left ventricle: 11 patients had impaired LV systolic function (10.2%), 4 with EF ≤ 35%. Mural thrombus was identified in one patient.Left atrium (LA)/Left atrial appendage (LAA): Significant LA dilatation was identified in 23 patients (21.3%). This was more prevalent in the older age group. Spontaneous echocontrast was visualised in 3 cases (2.8%), two of whom were aged >65 years. LAA prethrombus/thrombus were detected in two older patients (1.9%).Valvular abnormalities: Valvular abnormalities were detected in 40 patients (37%). Valvular echodensities were visualised in 28 patients. The majority were degenerative, while one patient was diagnosed with infective endocarditis. 7 patients had significant mitral regurgitation (6.5%) and one patient had mechanical mitral valve thrombus.Aortic atheroma: 32 patients had Grade II or higher aortic atheroma (29.6%), which was more prevalent in the older age group. Two patients had grade V aortic atherosclerosis.Impact on clinical management: Clinical management was changed in 21 (19.4%) patients on the basis of TOE findings alone. The majority of these changes (13 patients, 12%) involved insertion of or referral for device-occlusion of PFO. No patient >65 years was referred for PFO closure. One patient was referred for LAA occlusion. Three (2.8%) were anticoagulated on t...
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