Results Generated From:
Embase <1980 to 2014 Week 39>
Embase (updates since 2014-09-19)
<1>
Accession Number
24449733
Authors
Grossgasteiger M. Hien M.D. Graser B. Rauch H. Motsch J. Gondan M.
Rosendal C.
Institution
(Grossgasteiger) Cand.med, Department of Anesthesiology, University of
Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Title
Image quality influences the assessment of left ventricular function: an
intraoperative comparison of five 2-dimensional echocardiographic methods
with real-time 3-dimensional echocardiography as a reference.
Source
Journal of ultrasound in medicine : official journal of the American
Institute of Ultrasound in Medicine. 33 (2) (pp 297-306), 2014. Date of
Publication: Feb 2014.
Abstract
Transesophageal echocardiography has become a standard tool for evaluating
left ventricular function during cardiac surgery. However, the image
quality varies widely between patients and examinations. The aim of this
study was to investigate the influence of the image quality on 5 commonly
used 2-dimensional methods. Transesophageal real-time 3-dimensional
echocardiography (3DE) served as a reference. Left ventricular function
was evaluated in 63 patients with sufficient real-time 3DE image quality.
The image quality was rated using the ratio of the visualized border
divided by the total endocardial border. These ratings were used to
generate groups of poor (0%-40%), fair (41%-70%), and good (71%-100%)
image quality. The ejection fraction (EF), end-diastolic volume, and
end-systolic volume were analyzed by the Simpson method of disks (biplane
and monoplane), eyeball method, Teichholz method, and speckle-tracking
method. Furthermore, the fractional area change was determined. Each
correlation with real-time 3DE was evaluated. Correlations of the EF and
volumes, respectively, as determined by long-axis view methods increased
with improving image quality: the Simpson biplane method was found to be
the most accurate method, with good image quality for the EF (r = 0.946)
and volumes (end-diastolic volume, r = 0.962; end-systolic volume, r =
0.989). Correlations of the EF and fractional area change by short-axis
view methods decreased with improving image quality, with the Teichholz EF
found to be most accurate with poor (r = 0.928) in contrast to good (r =
0.699) image quality. With good image quality, the Simpson biplane method
is the most accurate 2-dimensional method for assessing the left
ventricular EF. Short-axis view methods, especially the Teichholz method
yield better correlations with poor image quality. The eyeball method was
unaffected by image quality.
<2>
Accession Number
2014798311
Authors
Libungan B. Hirlekar G. Albertsson P.
Institution
(Libungan, Hirlekar, Albertsson) Department of Cardiology, Sahlgrenska
University Hospital, Bla straket 3, van 1, Gothenburg SE-413 45, Sweden
Title
Coronary angioplasty in octogenarians with emergent coronary syndromes:
Study protocol for a randomized controlled trial.
Source
Trials. 15 (1) , 2014. Article Number: 349. Date of Publication: September
04, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Invasive treatment (coronary angiography and intervention if
feasible) of patients with acute coronary syndrome (ACS) has been shown to
lead to better outcomes than medical therapy alone, but the elderly have
been under-represented in many of the studies. In the elderly, medical
therapy is common in ACS. Fear of complications related to the procedure
and unclear benefit in older patients are common reasons for invasive
procedures being withheld. Our hypothesis is that invasive treatment of
elderly patients with ACS will lead to a better outcome in terms of
survival and quality of life than medical therapy alone, with acceptable
risk. Methods/Design: This multicenter, randomized controlled trial of
patients 80 years of age and over has two parallel treatment arms, a
medical group and an invasive group. In Swedish hospitals, 200 patients
with non-ST elevation myocardial infarction or unstable angina will be
randomized to medical or invasive treatment strategy. The primary outcome
measure is the combined endpoint major adverse cardiac or cerebrovascular
event (MACCE) within one year. Secondary outcome measures include quality
of life, angina, and adverse events such as bleeding. Assessments will be
conducted during hospitalization, at 1 month after allocation, and at 12
months. Discussion: This study seeks to determine the efficacy and safety
of invasive and medical treatment strategies in the elderly with ACS. The
study is currently recruiting. Trial registration: ClinicalTrials.gov
trial identifier: NCT02126202. Registered on 7 January 2014.
<3>
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Accession Number
2014591140
Authors
Borisenko O. Wylie G. Payne J. Bjessmo S. Smith J. Yonan N. Firmin R.
Institution
(Borisenko) Synergus AB, Svardvagen 19, 18233, Danderyd, Stockholm, Sweden
(Wylie) Scottish Extracorporeal Life Support Service, Royal Hospital for
Sick Children, Glasgow, United Kingdom
(Payne) Scottish National Advanced Heart Failure Service, Golden Jubilee
National Hospital, Clydebank, United Kingdom
(Bjessmo) Medical Management Centre, Department of Learning Informatics,
Management and Ethics, Karolinska Institutet, Stockholm, Sweden
(Smith) Paediatric and Neonatal ECMO Service, Freeman Hospital, Newcastle
upon Tyne, United Kingdom
(Yonan) Department of Cardiothoracic Transplant, Wythenshawe Hospital,
Manchester, United Kingdom
(Firmin) Glenfield General Hospital, Leicester, United Kingdom
Title
Thoratec centrimag for temporary treatment of refractory cardiogenic shock
or severe cardiopulmonary insufficiency: A systematic literature review
and meta-analysis of observational studies.
Source
ASAIO Journal. 60 (5) (pp 487-497), 2014. Date of Publication:
September-October 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
The aim of the study was to systematically evaluate effect of CentriMag
heart pump (Thoratec Corporation) as temporary ventricular assist device
(VAD) and part of extracorporeal membrane oxygenation (ECMO) system on
outcomes in patients with cardiac or cardiac-respiratory failure. A
systematic search was conducted in five databases for the period 2003 to
2012. Fifty-three publications with data for 999 patients, supported with
CentriMag, were included. In 72% studies, CentriMag was used as a VAD and
in 25% as part of ECMO circuit. Mean duration of VAD support was 25.0 days
in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock
group, 8.8 days in post-transplant graft failure and rejection group, and
16.0 days in post-LVAD placement right ventricular failure group. Survival
on support was 82% (95% CI 70-92) for VAD support in precardiotomy
cardiogenic shock indication, 63% (95% CI 46-78) in VAD support in
postcardiac surgery cardiogenic shock indication, 62% (95% CI 46-76) in
VAD support in post-transplant graft rejection or failure indication, and
83% (95% CI 73-92) in VAD support in post-LVAD placement right ventricular
failure indication. CentriMag is an effective technology for temporary
support of patients with cardiac and cardiorespiratory failure. Copyright
2014 by the American Society for Artificial Internal.
<4>
Accession Number
71621505
Authors
Khan I. Singer L. De Perrot M. Granton J. Keshavjee S. Chau C. Kron A.
Johnson S.
Institution
(Khan) Pulmonary Hypertension Programme, University Health Network,
University of Toronto, Toronto, Canada
(Singer) University of Toronto, Toronto, Canada
(De Perrot, Keshavjee) Division of Thoracic Surgery, University Health
Network, University of Toronto, Toronto, Canada
(Granton) Toronto General Hospital, University of Toronto, Toronto, Canada
(Chau) TorontoCanada
(Kron) Toronto Western Hospital, Mount Sinai Hospital, University of
Toronto, Toronto, Canada
(Johnson) Toronto Western Hospital, University Health Network Pulmonary
Hypertension Programme, University of Toronto, Toronto, Canada
Title
Survival after lung transplantation in systemic sclerosis. A systematic
review.
Source
Journal of Rheumatology. Conference: 69th Annual Meeting of the Canadian
Rheumatology Association, CRA 2014 Whistler, BC Canada. Conference Start:
20140224 Conference End: 20140301. Conference Publication: (var.pagings).
41 (7) (pp 1554-1555), 2014. Date of Publication: July 2014.
Publisher
Journal of Rheumatology
Abstract
Objective: Lung transplantation is a life-saving option for systemic
sclerosis (SSc)-associated pulmonary arterial hypertension (PAH) and
interstitial lung disease (SSc-ILD) patients. Yet, there is risk of
post-transplantation mortality. The objective of this study was to
evaluate survival of SSc patients post-lung transplantation. We
secondarily evaluated SSc lung transplant recipient characteristics, and
compared post-lung transplantation survival of SSc patients to non-SSc
patients (idiopathic PAH, and ILD). Methods: A systematic review of
MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials and CINAHL
(all inception to 2012) was performed to identify studies evaluating
post-lung transplant survival in SSc compared to non-SSc patients. Two
reviewers independently abstracted study and survival data using a
standardized form. Results: 226 citations were screened to identify 7
observational studies reporting SSc patients who underwent single lung,
double lung, or heart-lung transplantation. Mean age at transplantations
ranged 46-53 years. SSc post-transplantation survival ranged 69%-91% at
30-days, 69%-85% at 6-months, 59%-93% at 1-year, 49%-80% at 2-years, and
46%-79% at 3-years. ILD post-transplant survival was 80% at 30-days,
80%-90% at 6-months, 59%-83% at 2-years, and 69% at 3-years. IPAH post
transplant survival was 79% at 30-days, 79%-90% at 6-months, and 74%-90%
at 1-year. The reporting of overlapping cohorts potentially including the
same patients precluded meta-analysis. Causes of death in SSc patients,
when reported, included graft failure (n=6), infection (n=8), cardiac
events (n=3), hemorrhagic stroke (n=1), respiratory failure (n=3),
malignancy (n=2), pulmonary hypertension (n=1), complications of
bronchiolitis obliterans syndrome (BOS) (n=1), anesthetic complication
(n=1), and scleroderma renal crisis (n=1). There were no reports of
recurrence of SSc in the lung allograft. Conclusion: SSc survival
post-lung transplantation is very good, and improving with time. The
short-term and intermediate- term survival post-lung transplantation are
similar to IPAH and ILD patients requiring lung transplantation. Future
researchers should delineate the access process for lung transplantation
and report the occurrence of acute rejection, infection, bronchiolitis
obliterans syndrome, renal dysfunction and dialysis, gastroparesis, and
need for tube feeding.
<5>
Accession Number
71621235
Authors
Wong K.K. Alder S.L. Kinnear H.A. Bethune M.D.
Institution
(Wong, Alder, Kinnear, Bethune) IWK Health Centre, Halifax, NS, Canada
Title
Implementation of a simplified pulse oximetry screening program.
Source
Paediatrics and Child Health (Canada). Conference: 91st Annual Conference
of the Canadian Paediatric Society Montreal, QC Canada. Conference Start:
20140625 Conference End: 20140628. Conference Publication: (var.pagings).
19 (6) (pp e94), 2014. Date of Publication: June-July 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: Newborn pulse oximetry screening increases detection of
critical congenital heart disease otherwise missed by antenatal ultrasound
and physical examination. The AAP endorsed a protocol checking oxygen
saturations in the right hand and one foot at >24 h of age, with abnormal
results (<95%) subject to repeat screening. Objectives: We describe our
experience in implementing a simplified protocol at a Canadian tertiary
children's hospital and a referring regional hospital. Design/Methods: We
collected information from the screening program organizers. Results:
Cardiology chose a simplified screening protocol, checking oxygen
saturations in one foot between 24 h and 36 h of age. This was supported
by a meta-analysis indicating no significant differences in sensitivity or
false positive rates compared to checking both foot and right hand
(Thangaratinam, Lancet 2012). A single abnormal saturation (<95%) requires
physician assessment. If the low saturation is confirmed and no other
cause identified, an echocardiogram would be arranged within 24 h
(utilizing telemedicine at the regional hospital). Physicians and nurses
welcomed more ways to improve detection of CHD. Screening was started in
February 2013 in the post partum unit at the tertiary hospital
(approximately 4500 neonatal admissions annually) and in July 2013 at the
regional hospital (approximately 900 annually). As of December 2013, there
have been no positive screens. All cardiac surgery in the region comes to
the tertiary hospital; we are aware of no false negative results.
Education was delivered at a staff meeting followed by individual teaching
as required, and a written protocol was distributed. As nurses were
familiar with pulse oximetry, education focused on teaching the protocol.
Reusable oximetry probes and probe wraps were used. Three dedicated
oximeter machines were adequate for the tertiary unit and one was used at
the regional site. Testing was usually done at bath time. We estimate it
takes 10 minutes to do the screen, clean the probe and document. A
selective chart review showed excellent compliance, but inconsistency in
where results were being documented. Newborns discharged from the birthing
unit and home births were not being screened. Conclusions: Our experience
shows that a pulse oximetry screening program can be readily implemented.
There are areas for improvement in documentation, and we identified groups
to target for screening. We believe the simplified protocol and shifting
the management of abnormal screens to the physician allowed for easier
implementation.
<6>
Accession Number
71621032
Authors
Baric D.
Institution
(Baric) University Hospital Dubrava, Zagreb, Croatia
Title
Remote ischemic preconditioning-from studies to clinical practice.
Source
Heart Surgery Forum. Conference: 2nd Heart Surgery Forum, HSF Meeting
Croatia Split Croatia. Conference Start: 20140514 Conference End:
20140517. Conference Publication: (var.pagings). 17 (2) (pp E107), 2014.
Date of Publication: April 2014.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Remote ischemic preconditioning (RIPC) is a preconditioning of a
non-cardiac organ or tissue that can increase myocardial tolerance to
ischemic-reperfusion injury during the subsequent prolonged ischemia.
Several studies have shown promising results of RIPC usage in cardiac
surgery, but a lot of controversies remain. Our randomized controlled
trial includes 50 patients scheduled for elective surgical aortic valve
replacement. Ischemic-reperfusion injury is assessed by measurement of
biochemical markers of myocardial injury. Hemodynamical parameters are
analyzed to evaluate influence of RIPC on postishemic heart function.
Correlation between RIPC and systemic inflammatory response is evaluated
by comparison of ischemic and inflammatory markers. Preliminary results
will be presented.
<7>
Accession Number
71617738
Authors
Schurmann K.
Institution
(Schurmann) Diagnostic and Interventional Radiology, St.-Johannes-Hospital
Dortmund, Dortmund, Germany
Title
Clinical and imaging assessment of mesenteric ischaemia.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2014 Glasgow
United Kingdom. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 37 (2 SUPPL. 1) (pp S92-S93), 2014.
Date of Publication: September 2014.
Publisher
Springer New York
Abstract
Learning Objectives 1. To define clinical presentation and assessment of
acute and chronic mesenteric ischaemia 2. To learn the different imaging
modalities available for assessment 3. To understand the efficacy of
different imaging modalities Mesenteric ischemia may be considered as an
occlusive disease of the bowel supplying and draining blood vessels. The
occlusion may occur on the arterial or venous side, it may be located in
the proximal or the distal portion of the mesenteric vasculature, and it
may be acute or chronic (1-4). The major bowel supplying vessels are the
celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric
artery. SMA is the most important feeding vessel; the superior mesenteric
and portal vein are the most important draining vessels. Acute mesenteric
ischemia (AMI) is a life-threatening disease requiring prompt diagnosis
and treatment. Symptoms of AMI are usually nonspecific, and there are no
serum parameters reliably indicating or proving AMI (1,4). Timely
diagnosis is based on clinical suspicion and early contrast-enhanced CT
imaging. As a rule of thumb, acute mesenteric ischemia is caused by: *
embolic or thrombotic occlusion of SMA in 70% patients * non-occlusive
mesenteric ischemia (NOMI) in 20% patients * mesenteric vein thrombosis
(MVT) in 10% patients (1-5) Diagnostic imaging If there is clinical
suspicion of occlusive mesenteric ischemia, the diagnostic imaging method
of choice is biphasic multislice CT (MSCT) after an intravenous
administration of contrast agent (4-8). Multiplanar reconstructions are
helpful in establishing and confirming the diagnosis. The arterial phase
is required to detect mesenteric stenosis/occlusion and the venous phase
is required to detect mesenteric vein thrombosis. In a recent
meta-analysis, the sensitivity of MSCT in patients with AMI was found to
be 93% and specificity was 96% (7). Because almost all patients suffering
from mesenteric ischemia present with abdominal pain, abdominal plain
films are frequently obtained in the early phase and also later in the
course of the disease if it is not diagnosed. The findings of plain films
are nonspecific; however, they may reveal other causes of abdominal pain,
particularly, hollow organ perforation (1). If the plain films show signs
of mesenteric ischemia, such as pneumatosis intestinalis or gas in the
portomesenteric circulation, the disease is already far advanced, gangrene
of the bowel has occurred, peritonitis is present, and mortality is
consistently high. Duplex sonography may demonstrate the proximal stenosis
or occlusion of mesenteric vessels with good diagnostic accuracy (9).
However, if findings are nonspecific, results highly depend on the
experience of the investigator, and NOMI is not assessable. Bowel
distention and bowel gas reduce the diagnostic capacity of duplex
sonography. Overall, duplex sonography alone is insufficient in reliably
diagnosing mesenteric ischemia. Reportedly, the diagnostic accuracy of
duplex sonography is improved with the use of contrast agents (10). MR and
MR angiography show vascular mesenteric pathology with high diagnostic
accuracy (6). However, availability of MR is limited, and examination
durations are much longer compared with CT. Due to the severe pressure of
time in diagnosing, MR is not considered an advisable imaging tool in
patients suspected to have AMI (4). In contrast, if chronic mesenteric
ischemia is suspected, MR may be useful (11). Clinical classification of
mesenteric ischemia Mesenteric ischemia may be classified into four
clinical stages according to the onset and severity of symptoms: *
asymptomatic * recurrent postprandial abdominal pain ("angina
abdominalis") * permanent abdominal pain, malabsorption syndrome * sudden
onset of severe abdominal pain persisting for several hours These symptoms
are nonspecific. Chronic or acute marked abdominal pain may also occur
with multiple other nonvascular abdominal diseases, such as gastric or
duodenal ulcer, several forms of bowel inflammation, bowel perforation,
acute biliary or renal colic, contained aortic rupture, and others.
Mesenteric vein thrombosis is not well captured with this classification,
because symptoms due to MVT are mostly even more nonspecific. Stage 1 of
arterial mesenteric ischemia is usually found accidentally with an
abdominal CT or CTA. Treatment is normally not necessary. Chronic
mesenteric ischemia (CMI) Symptoms of stages 2 and 3 are found in patients
suffering from chronic mesenteric ischemia. Abdominal pain mostly begins
at 20-30 min after a meal and persists for 1-3 h (1). Pain frequently
increases over time and may become permanent. Because of fear of eating,
patients complain of marked waste loss. The main cause of CMI is
arteriosclerosis of the major splanchnic arteries. It depends on the
degree of collateralization whether or not the patient develops symptoms
(12). There are variable collaterals between the splanchnic arteries and
variable collaterals of splanchnic arteries to extrasplanchnic vessels,
such as hypogastric and lumbar arteries. In case of poor
collateralization, occlusion of a single mesenteric artery may be
sufficient to render the patient symptomatic, whereas good
collateralization may preserve the patient asymptomatic even if all three
major splanchnic arteries are occluded. As a rule of thumb, it is said
that 2/3 or 3/3 splanchnic arteries have to be occluded before symptoms
occur (1,12). The term "chronic" implies that elective treatment is
possible; however, the chronic state may turn to acute at any time.
Therefore, there is still a dire necessity for treatment. Acute mesenteric
ischemia (AMI) Stage 4 symptoms may indicate life-threatening abdominal
disease requiring urgent diagnosis and treatment. If other differential
diagnoses as mentioned above can be excluded and symptoms persist for
several hours, AMI has to be suspected. Occlusion of the proximal
splanchnic arteries AMI caused by an obstruction of the proximal segments
of the splanchnic arteries occurs mostly due to SMA occlusion that is of
embolic nature in most cases; thrombosis favored by underlying
arteriosclerotic stenosis is observed in 20%-30% cases (13). A typical
patient with AMI is older than 70 years. Among all patients presenting
with an acute abdomen, only 1% have AMI; however, in patients older than
70 years, the rate increases to 10% (14). Important risk factors are
atrial fibrillation, major heart disease (coronary artery disease,
congestive heart failure, and myocardial infarction), peripheral arterial
occlusive disease, and arterial hypertension. Time to treat critical
ischemia of the small bowel is approximately 6 h. Because diagnosis and
treatment are frequently delayed, the lethality of AMI is still between
50%-90% and has not improved during the last decades (1,4). Based on
pathophysiology, the clinical course of acute arterial mesenteric
occlusion is divided into three stages: * initial stage (first 6 h):
characterized by severe griping pains in the bowel, nausea, vomiting,
diarrhea, and vertigo * intermediate stage (7-12 h): relief of symptoms,
tolerable permanent abdominal pain, so-called "deceptive peace," resulting
from necrosis of intramural pain receptors * final stage (>12 h): increase
in symptoms, paralytic ileus, penetrating peritonitis, shock, and death
Nonocclusive mesenteric ischemia (NOMI) NOMI is a special form of acute
mesenteric ischemia that refers to all forms of non-central mesenteric
occlusions (3,4,15). NOMI mainly occurs perioperatively in patients
following a major cardiac or aortic surgery. Different from this group of
patients, NOMI is also observed in patients requiring long-term
hemodialysis (16,17). Etiology is not fully understood. It is assumed that
NOMI is caused by sympathetic dysregulation with spasm of the distal
segments of the mesenteric circulation (1,3). NOMI is observed in 0.5%-1%
of all patients undergoing a heart surgery (18). Mortality being
approximately 50% is at least as high as or even higher than in acute SMA
occlusion (3,4), because symptoms are nonspecific, and they are frequently
diagnosed too late. The typical NOMI patient is older than 50 years and
treated in the intensive care unit. Different from the other forms of
mesenteric ischemia, not CTA but selective arterial DSA of the splanchnic
arteries is the method of choice for diagnosis. Despite advances in
technology, CTA is not yet able to depict the subtle changes in the
periphery of the splanchnic arteries found with NOMI. Moreover, it does
not allow CT for the evaluation of splanchnic blood flow, which is simply
possible with DSA. Beside the criterion time to portal vein filling, the
other two main DSA criteria for the diagnosis of NOMI are vessel
morphology and a reflux of contrast medium into the aorta. Based on these
three criteria, Minko et al developed a scoring system that well
correlated with perioperative mortality (15). Finally, DSA offers the
opportunity to combine diagnosis and therapy by infusing vasodilators via
the catheter in SMA. Mesenteric vein thrombosis (MVT) Different from
arterial mesenteric ischemia, MVT is observed more frequently in younger
patients (<50 years) (2,4). Symptoms and prognosis of the patients vary
considerably depending on the location, extension, and speed of thrombus
formation (2,8,19). Patients with a combination of proximal and distal
mesenteric vein thrombosis are more likely to develop mesenteric
infarction than those with isolated thrombosis of the proximal mesenteric
veins (19). Patients with slowly progressing chronic MVT may be
asymptomatic due to the formation of venous collaterals protecting from
mesenteric necrosis (2). Most patients present with non-specific symptoms,
mainly diffuse abdominal pain that may last for days or even weeks until
the diagnosis is conducted.
<8>
Accession Number
71616870
Authors
Philip M. Martin H. Robin T. Richard L. Jonathan C. Angela W.
Institution
(Philip, Martin, Robin, Richard, Jonathan, Angela) University of Sydney,
Australia
Title
Chronic kidney disease and risk of stroke: a systematic review and
meta-analysis.
Source
Nephrology. Conference: 14th Asian Pacific Congress of Nephrology Tokyo
Japan. Conference Start: 20140514 Conference End: 20140517. Conference
Publication: (var.pagings). 19 (pp 63), 2014. Date of Publication: May
2014.
Publisher
Blackwell Publishing
Abstract
Introduction: Reduced glomerular filtration rate (GFR) and proteinuria are
associated with increased stroke risk but the consistency and strength of
this relationship is unknown. We estimated the independent and combined
effects of GFR and proteinuria on stroke risk. Methods: Systematic review
and meta-analysis of observational studies and randomised trials using
Meta-analysis Of Observational Studies in Epidemiology and Preferred
Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We
searched MEDLINE and Embase for studies which prospectively measured GFR,
proteinuria or both, and quantified subsequent risk of stroke. Reviewers
abstracted risk (RR) of stroke, synthesized data using a random-effects
model and explored heterogeneity with meta-regression. We assessed study
quality using the Newcastle-Ottawa scale or Cochrane risk of bias tool.
Results: We included 71 studies (1,693,306 participants): 53 cohort
studies (1,537,097 participants) and 18 trials (156,209 participants).
Risk of stroke increased by 39% in people with eGFR <90 ml/min/1.73 m2
(RR1.39, 95%CI1.31 to 1.48) and increased with declining GFR (figure 1).
We estimated stroke risk increased by 7% for every 10% decline in GFR
(RR1.07, 95%CI 1.04 to 1.10). Larger studies (>20,000 participants)
reported smaller risk (RR0.67, 95%CI 0.52 to 0.87) and studies where
participants were undergoing cardiac surgery reported larger risk of
stroke (RR1.42, 95%CI1.15 to 1.60). Considering proteinuria, risk of
stroke increased by 69% when any proteinuria was detectable (RR1.69,
95%CI1.55 to1.84) and rose further as proteinuria increased (figure 1). We
estimated that stroke risk increased by 6% for every 10-fold increase in
the quantity of proteinuria (RR1.06, 95%CI1.02 to 1.11). Studies which
recruited mainly Asian participants reported an almost two-fold risk of
stroke compared to studies recruiting mainly white participants (RR1.93,
95%CI1.19 to 3.13). When GFR and proteinuria were both present, their
combined effects were additive. All of our observations were consistent
across different subtypes of stroke. Conclusions: Risk of stroke increases
with declining GFR and increasing quantities of proteinuria with variation
in the effect of proteinuria by ethnicity. Assessing risk of stroke
requires measurement of both GFR and proteinuria and recognition of
subgroups of people at particular risk. (Figure presented) .
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