1,721,000 research outputs found
Pulmonary vascular response to exercise in heart failure with reduced ejection fraction and pulmonary hypertension
No full textPredictors of Chronic Dizziness in Acute Unilateral Vestibulopathy: A Longitudinal Prospective Cohort Study
No full textObjectiveChronic dizziness after acute unilateral vestibulopathy (AUVP) causes significant social and economic burdens. This study aims to identify predictors of chronic dizziness. Study DesignProspective, longitudinal cohort study. SettingENT departments from secondary and tertiary hospitals. MethodsParticipants meeting the Barany Society's diagnostic criteria for AUVP were included. Evaluations occurred within 0 to 21 days (T1), and at 4 (T2) and 10 weeks (T3) postonset. The primary outcome measure was the Dizziness Handicap Inventory (DHI) at 6 months, with a score >30 indicating chronic dizziness. Five clusters of predictors were assessed at T1-3: central vestibular compensation, visual dependence, movement exposure, psychological factors, and balance performance. Separate linear regression models for T1, T2, and T3 were constructed to explain the variability in the 6-month DHI score. Receiver operating characteristics analyses were conducted to predict chronic dizziness. ResultsFrom June 2021 to January 2024, 103 participants (55.2 +/- 16.6 years old, 49 women) were included. The regression models explained the variability in the 6-month DHI score by 33.0% at T1, 47.6% at T2, and 64.0% at T3 (P < .001), including psychological factors (T1, T2, T3), visual dependence (T2, T3), and static balance performance (T3). Cutoff values for the Vestibular Activities Avoidance Instrument (23/54), Visual Vertigo Analog Scale (33.5/100), and Hospital Anxiety and Depression Scale-Anxiety (7.5/21) at 10 weeks postonset predicted chronic dizziness. ConclusionHigher psychological burden, increased visual dependence, and poorer static balance performance were associated with chronic dizziness. Cutoff values were determined to identify individuals with AUVP at risk for chronic dizziness.The authors would like to thank the participants of the study and the Jessa Hospital (Hasselt, Belgium), and Rehabilitation Center Sint‐Lievenspoort (Ghent, Belgium) for their help in the recruitment and their guidance throughout our research project
Low hemoglobin levels are associated with lower cerebral saturations and poor outcome after cardiac arrest
No full textPurpose: Post-cardiac arrest (CA) patients have a large cerebral penumbra at risk for secondary ischemic damage in case of suboptimal brain oxygenation during ICU stay. The aims of this study were to investigate the association between hemoglobin, cerebral oxygenation (SctO(2)) and outcome in post-CA patients. Methods: Prospective observational study in 82 post-CA patients. Hemoglobin, a corresponding SctO2 measured by NIRS and SVO2 in patients with a pulmonary artery catheter (n = 62) were determined hourly during hypothermia in the first 24 h of ICU stay. Results: We found a strong linear relationship between hemoglobin and mean SctO(2) (SctO2 = 0.70 x hemoglobin + 56 (R-2 0.84, p = 10(-6))). Hemoglobin levels below 10 g/dl generally resulted in lower brain oxygenation. There was a significant association between good neurological outcome (43/82 patients in CPC 1-2 at 180 days post-CA) and admission hemoglobin above 13 g/dl (OR 2.76, 95% CI 1.09: 7.00, p = 0.03) or mean hemoglobin above 12.3 g/dl (OR 2.88, 95% CI 1.02: 8.16, p = 0.04). This association was entirely driven by results obtained in patients with a mean SVO2 below 70% (OR 6.25, 95% CI 1.33: 29.43, p = 0.01) and a mean SctO2 below 62.5% (OR 5.87, 95% CI 1.08: 32.00, p = 0.03). Conclusion: Hemoglobin levels below 10 g/dl generally resulted in lower cerebral oxygenation. Average hemoglobin levels below 12.3 g/dl were associated with worse outcome in patients with suboptimal SVO2 or SctO2. The safety of a universal restrictive transfusion threshold of 7 g/dl can be questioned in post-CA patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved
Pulmonary vascular response to exercise in heart failure with reduced ejection fraction and pulmonary hypertension
No full textGenotype-phenotype correlation study in p.Pro51Ser variant carriers in COCH causing DFNA9
No full textAbstract: DFNA9 is an autosomal dominant hereditary hearing disorder associated with vestibular deterioration with a late onset of symptoms. Many variants in COCH have been identified, however, the c.151C>T, p.Pro51Ser is highly prevalent in the Low Countries. The clinical characteristics of this condition were based on genetic linkage studies of some 15 years ago. However, nowadays, new clinical vestibular tools permit more detailed observation of the progression of the vestibular deterioration at different compartments and at different frequency range of the vestibular organ. Since the last several years, tremendous efforts are being displayed to develop new therapeutic options, such as vestibular implants and genetic therapy, for which a better knowledge of the natural course of DFNA9 has become essential to define the most optimal therapeutic window. A prospective multi-centric cross-sectional study, conducted in Antwerp and Hasselt, including 111 Belgian & Dutch p.Pro51Ser variant carriers, showed the following results: 1) the hearing thresholds at 8 kHz were already beyond age-referenced limits in the youngest age group (18-25 years), 2) this was followed by the decline of caloric response (35 years on average) and C-VEMPs (31 years). 3) The hearing frequencies higher than 2 kHz all started to deteriorate at about 34-38 years of age, whereas the lower frequencies started their decline ten years later. 4) The vestibulo-ocular reflexgains, which are obtained with high angular acceleration video head impulse test (vHIT), were the last to deteriorate (end of 4th & early 5th decade). Imaging of DFNA9 patients showed typical features like focal sclerosis or T2-weighted signal loss in semicircular canals (SCC) of p.Pro51Ser carriers that had reached advanced stages of oto-vestibular deterioration. These lesions seemed to correlate with lower caloric and vHIT function. These findings suggest an (auto)immune reaction as a result of accumulation of misfolded mutant cochlin in the inner ear and ampullae of the SCC, with fibrosis and late-onset calcification. Until 2018, all known COCH variants had autosomal dominant trait, however, we identified a new COCH variant with an autosomal recessive trait, causing congenital hearing loss (DFNB110). Since adult heterozygous carriers in that family all showed normal hearing and balance function, this suggests haploinsufficiency is not the cause of hearing disorder, but rather the dominant negative trait of these new variants. These new insights are useful in future research for new treatment options in DFNA9 patients
Compensatory strategies after an acute unilateral vestibulopathy: a prospective observational study
No full textPurpose In case of an acute unilateral vestibulopathy (UVP), compensatory strategies such as restoration and adaptation will lead to a decrease in intensity of the symptoms. Although measurements of compensatory strategies are available, currently, an overview taking the different strategies into account is lacking. The objectives of this study are to explore compensatory strategies and to investigate the association between compensatory strategies and patient characteristics. Methods Restoration was objectified by the vestibulo-ocular reflex (VOR) gain on the video head impulse test, and adaptation-consisting of visual, multisensory, and behavioral substitution-was objectified by the Visual Vertigo Analog Scale (VVAS), Antwerp Vestibular Compensation Index (AVeCI), and Perez and Rey score (PR score), respectively. Adequate restoration and adaptation levels were interpreted as follows: VOR gain > 0.80, VVAS 0 and PR score <= 55. Results Sixty-two UVP patients, 34 men and 28 women, were included with an average age of 52.1 +/- 17.3 years. At 10.5 +/- 1.4 weeks after onset, 41.9% of the UVP patients reached adequate restoration levels and 58.1-86.9% reached adequate adaptation levels. Furthermore, significant associations were found between (1) restoration status and UVP etiology [Odds Ratio (OR) with 95% CI: 4.167 {1.353;12.828}] and balance performance (OR: 4.400 {1.258;15.386}), (2) visual sensory substitution status and perceived handicap (OR: 8.144 {1.644;40.395}), anxiety (OR: 10.000 {1.579;63.316}) and depression (OR: 16.667 {2.726;101.896}), and (3) behavioral substitution status and balance performance (OR: 4.143 {1.341;12.798}). Conclusion UVP patients with adequate compensatory strategies presented with better balance performance, lower perceived handicap, and lower anxiety and depression scores.University of Antwerp, ID 42186, Lien Van Lae
Does Vestibulo-Ocular Reflex (VOR) Gain Correlate With Radiological Findings in the Semi-Circular Canals in Patients Carrying the p.Pro51Ser (P51S) COCH Variant Causing DFNA9? Relationship Between the Three-Dimensional Video Head Impulse Test (vHIT) and MR/CT Imaging
No full textObjective: The primary aim was to determine whether 3D video-head-impulse-test vestibulo-ocular reflex (vHIT VOR)-gains correlate with computed tomography (CT) and magnetic resonance (MR) lesions in a series of carriers of the p.(Pro51Ser)-variant (P51S) in the COCH-gene (DFNA9). Secondary aim was to compare routine imaging with second peer review radiologic lecture. Study Design: Analytical cross-sectional study. Setting: Secondary referral center. Patients: Twenty-four p.P51S carriers with MR and CT images. Eighteen carriers were selected of whom both 3D-vHIT and imaging data were available within a time interval of 24 months. Interventions: All imaging data were reassessed by two independent neuroradiologists. vHIT VOR-gains were correlated with semi-circular canal (SCC) lesions. Main Outcome Measures: Correlation between vHIT VOR-gains and SCC lesions, and additional lesions detected during scientific lecture of imaging data. Results: The average gain of the ipsilateral labyrinth was significantly lower when positive CT (0.3215; p = 0.0122) and MR results (0.3215; p = 0.0134). 92% of ears presented MR lesions on at least one SCC, whereas this was 75% on CT. The posterior SCC is the most frequently affected on MR and CT. Second lecture led to nine additional MR and 16 CT lesions. Conclusions: Significant correlation was observed between radiological lesions at any SCC and lower average gain of the three ipsilateral SCC. The substantially larger number of lesions during scientific assessment stresses the need to fully inform radiologists concerning differential diagnosis to facilitate accurate diagnosis when planning imaging. Focal sclerosis and narrowing of SCC in DFNA9 represent a possible biomarker of advanced stages of otovestibular deterioration
Genotype-phenotype Correlation Study in a Large Series of Patients Carrying the p.Pro51Ser (p.P51S) Variant in COCH (DFNA9): Part I-A Cross-sectional Study of Hearing Function in 111 Carriers
No full textIntroduction: DFNA9 is characterized by adult-onset progressive sensorineural hearing loss (SNHL) and vestibular impairment. More than 15 years ago, genotype-phenotype correlation studies estimated the initial age of hearing deterioration in the fourth to fifth decade (ranging from 32 to 43 years). However, these analyses were based on relatively limited numbers of mainly symptomatic carriers using markedly different methodologies. The starting point for the hearing deterioration is more correctly determined with larger numbers of carriers and with a more clearly defined starting point of the hearing deterioration. Aim: The aim of this study was to determine milestone ages (start and maximal hearing deterioration, potential eligibility for hearing aids and cochlear implants based on pure-tone average [PTA]) in a large series of p.Pro51Ser COCH variant carriers. The degree of individual interaural asymmetry and the degree of variability (interquartile range) with which the hearing deterioration progresses across ages were also studied, and age-related typical audiograms (ARTA) were constructed. Material and methods: One hundred eleven Belgian and Dutch p.P51S variant carriers were identified and recruited for audiological investigation. Their hearing thresholds were compared with p50th, p95th, and p97.5th percentile values of presbyacusis (ISO 7029 standards). The onset and degree of hearing deterioration were defined and assessed for each frequency and with three PTAs (PTA(0.5-4) [0.5, 1, 2, and 4 kHz]; PTA(4-8) [4 and 8 kHz]; and PTA(6-8) [6 and 8 kHz]). The milestones ages were derived from nonlinear regression model of hearing thresholds against age, for male and female carriers separately, because of different age-referenced limits. Interaural right-left asymmetry was assessed, and variability of hearing thresholds were calculated using interquartile range. ARTAs were built with both observed data and a prediction model. Results: Hearing dysfunction in p.P51S carriers begins at about 38 years of age (ranging from 28 to 43 years) on average in female and 46 years (ranging from 42 to 49 years) in male carriers (third decade: female, fifth decade: male carriers), depending on the hearing frequency and with differences in deterioration sequence between both genders. These differences, however, were mainly due to more stringent age-referenced limits for men. In contrast, predictions (ARTA) did not show any difference of phenotypic expression between genders. At about 48 to 50 years of age on average, the majority of DFNA9 patients may need conventional hearing aids (PTA >= 40 dB HL), whereas this is about 56 to 59 years for cochlear implants (PTA >= 70 dB HL). There is a high degree of individual interaural asymmetry and interindividual variability throughout all ages. Conclusion: This study demonstrates that the onset of sensorineural hearing deterioration starts in the third decade and probably even earlier. Regardless of differences in estimates, DFNA9 expresses similarly in male and female carriers, but male carriers are much more difficult to identify in early stages of the disease. Comprehensive assessment of the natural course of DFNA9 is of particular interest to predict the age of onset or critical period of most significant function deterioration in individual carriers of the pathogenic variant. This will help to design studies in the search for disease-modifying therapies.The authors would like to thank the Dutch-Belgian DFNA9patient association “De negende van” for their support in recruiting patients. S.J., V.V.R., and J.M. selected and identified all family pedigrees and enrolled participants to the study each at both centers (Hasselt and Antwerp, Belgium). J.M., B.B., K.D., and C.N. administered clinical audiometric investigations. All vestibular data at the Hasselt center were administered by S.J., whereas these were done by J.M. at the Antwerp center. S.J. and J.M. reviewed data from all sites. All descriptive and inferential statistics were conducted by S.J. and corrected as well as supervised by E.F. Molecular analysis was conducted by G.V.C. The manuscript and Supplemental Digital Content, http://links.lww.com/EANDH/A821, were written by S.J. All revisions were carried out by S.J. and E.F. All authors discussed the results and implications and commented on the manuscript at all stages. The project was supervised by V.V.R. and O.V.V. Registration ClinicalTrials.fgov: NCT03716908 There are no conflicts of interest to declar
Interaural and sex differences in the natural evolution of hearing levels in pre-symptomatic and symptomatic carriers of the p.Pro51Ser variant in the COCH gene
No full textHearing impairment constitutes a significant health problem in developed countries. If hearing loss is slowly progressive, the first signs may not be noticed in time, or remain untreated until the moment the auditory dysfunction becomes more apparent. The present study will focus on DFNA9, an autosomal dominant disorder caused by pathogenic variants in the COCH gene. Although several cross-sectional studies on this topic have been conducted, a crucial need for longitudinal research has been reported by many authors. Longitudinal trajectories of individual hearing thresholds were established as function of age and superimposed lowess curves were generated for 101 female and male carriers of the p.Pro51Ser variant. The average number of times patients have been tested was 2.49 years with a minimum of 1 year and a maximum of 4 years. In addition, interaural and sex differences were studied, as they could modify the natural evolution of the hearing function. The current study demonstrates that, both in female carriers and male carriers, the first signs of hearing decline, i.e. hearing thresholds of 20 dB HL, become apparent as early as the 3rd decade in the highest frequencies. In addition, a rapid progression of SNHL occurs between 40 and 50 years of age. Differences between male and female carriers in the progression of hearing loss are most obvious between the age of 50 and 65 years. Furthermore, interaural discrepancies also manifest from the age of 50 years onwards. High-quality prospective data on the long-term natural evolution of hearing levels offer the opportunity to identify different disease stages in each cochlea and different types of evolution. This will provide more insights in the window of opportunity for future therapeutic intervention trials
Driving ability in patients with dizziness: a systematic review
No full textPurpose The aim of this systematic review was to identify and evaluate studies dealing with driving performance of dizzy patients or patients with a vestibular disorder. Methods A systematic review was performed according to the preferred reporting items for systematic reviews and meta-analysis guidelines. (1) PubMed, Embase, and Cochrane library. (2) Study selection: articles about driving ability and reported driving difficulties in patients with dizziness, or a diagnosed vestibular disorder, were included. (3) Data extraction was performed by two independent authors using predefined data fields: patient's characteristics, diagnostic criteria, sample size, and type of evaluation of driving ability and outcome of the study. Results Eight out of 705 articles matched the inclusion criteria but varied widely regarding the study population, study design, and outcome measures. The majority of studies reported a negative impact of dizziness and/or vestibular disorders on self-reported driving ability and car accidents. Yet several studies could not identify any impairment of driving ability. Conclusions Driving ability was negatively affected by dizziness or a vestibular disorder in the majority of included studies with low risk of bias. This systematic review revealed a significant heterogeneity in studies reporting driving performance and contradictory results. We were, therefore, unable to identify a causal relationship between dizziness and driving ability. There is a need for prospective studies in populations with different vestibular disorders using subjective and objective outcome measures that have been validated to evaluate driving performance.The authors did not receive support from any organization for the submitted work
- …
