scholarly journals Prevalence and prognostic implications of active cytomegalovirus infection in patients with acute heart failure

2010 ◽  
Vol 119 (10) ◽  
pp. 443-452 ◽  
Author(s):  
Julio Núñez ◽  
Marifina Chilet ◽  
Juan Sanchis ◽  
Vicent Bodí ◽  
Eduardo Núñez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Cox Regression ◽  
Cmv Infection ◽  
Cox Regression Analysis ◽  
End Point ◽  
Cytomegalovirus Reactivation ◽  
Cytokines And Chemokines ◽  
Key Factor ◽  
Inflammatory State

AHF (acute heart failure) causes significant morbidity and mortality. Recent studies have postulated that the expression of inflammatory mediators, such as cytokines and chemokines, plays an important role in the development and progression of heart failure. A pro-inflammatory state has been postulated as a key factor in triggering CMV (cytomegalovirus) reactivation. Therefore we sought to determine the prevalence of active CMV infection in immunocompetent patients admitted for AHF and to quantify the association with the risk of the combined end point of death or AHF readmission. A total of 132 consecutive patients admitted for AHF were enrolled in the present study. Plasma CMV DNAaemia was assessed by qRT-PCR (quantitative real-time PCR), and cytokine measurements in plasma were performed by ELISA. Clinical data were evaluated by personnel blinded to CMV results. The independent association between active CMV infection and the end point was determined by Cox regression analysis. During a median follow-up of 120 [IQR (interquartile range), 60–240] days, 23 (17.4%) deaths, 34 (24.2%) readmissions for AHF and 45 (34.1%) deaths/readmissions for AHF were identified. Plasma CMV DNAaemia occurred in 11 (8.3%) patients, albeit at a low level (<100 copies/ml). The cumulative rate of the composite end point was higher in patients with CMV DNAaemia (81.8 compared with 29.8%; P<0.001). After adjusting for established risk factors, the occurrence of CMV DNAaemia was strongly associated with the clinical end point [hazard ratio = 4.39 (95% confidence interval, 2.02–9.52); P<0.001]. In conclusion, active CMV infection occurs, although uncommonly, in patients with AHF, and may be a marker of disease severity.

P5447Prognostic significance of carboxy-terminal telopeptide (ICTP) and Caspase-3 in patients with non-ischemic dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Kazukauskiene ◽  
V Baltruniene ◽  
D Bironaite ◽  
S Cibiras ◽  
K Rucinskas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Dilated Cardiomyopathy ◽  
Prognostic Value ◽  
Caspase 3 ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
End Point ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Carboxy Terminal

Abstract Background Non-ischemic dilated cardiomyopathy (niDCM) is a common debilitating disease leading to heart failure and poor prognosis. Therefore, a reliable diagnosis of niDCM and search of prognostic biomarkers is a task of paramount importance preventing final destruction of myocardium and improving the outcomes of the disease. The aim of the study was to evaluate the prognostic value of carboxy-terminal telopeptide (ICTP), a marker of myocardial collagen I degradation, and Caspase-3, a marker of apoptosis, in serum and endomyocardium biopsies (EMBs) of patients with niDCM. Methods 34 consecutive patients (male 25 (78%); 43.83±12.17 years) with niDCM (average of left ventricle (LV) end-diastolic diameter 6.94±0.78 cm, LV ejection fraction 24.97±6.93%, mean pulmonary capillary wedge pressure 32.9±8.7 mmHg) were enrolled in the study. The levels of ICTP and Caspase-3 in patients' serum and EMBs were measured by ELISA. After a follow-up period of 5 years, 18 patients (53%) have reached the primary composite end-point of heart failure: 6 patients (17.6%) died, 6 patients (17.6%) had heart transplantation and 6 patients (17.6%) underwent left ventricle assist device implantation. Results Univariate Cox proportional hazard model and ROC curve analysis identified levels of ICTP and Caspase-3 in serum as predictors of composite end-point (Table 1). However, the levels of ICTP and Caspase-3 in EMBs had no prognostic value. The cut-off values of serum biomarkers for prediction of the outcome were 13.43 pg/mg protein (sensitivity 67%; specificity 81%) for ICTP and 10.21 pg/mg protein (sensitivity 53%; specificity 87%) for Caspase-3. Univariate Cox regression analysis revealed that patients with higher levels of ICTP and Caspase-3 than cut-off values in serum had higher risk of reaching the composite end-point compared to the patients with lower cut-off values (HR 4.4 (95% CI: 1.6–12.1) and 3.15 (95% CI: 1.2–8.29), respectively). Kaplan-Meier survival analysis demonstrated that patients with serum Caspase-3 and ICTP levels above cut-off values had significantly worse outcome (p=0.01 and p=0.002, respectively). Table 1 Biomarkers (pg/mg protein) Mean ± SD HR (95% CI) p-value AUC (95% CI) ICTP in serum 15.26±10.59 1.052 (1.013–1.093) 0.009 0.71 (0.53–0.89) ICTP in EMB 132±295 0.999 (0.998–1.001) 0.56 0.45 (0.28–0.61) Caspase-3 in serum 7.78±9.86 1.047 (1.002–1.093) 0.04 0.69 (0.51–0.87) Caspase-3 in EMB 283±282 1 (0.998–1.002) 0.92 0.50 (0.28–0.72) Conclusion The findings show that increased serum levels of Caspase-3 and ICTP are significantly associated with poor outcome in patients with niDCM. Acknowledgement/Funding the Research Council of Lithuania (Grants nos. MIP-086/2012 and MIP-011/2014), the European Union, EU-FP7, SARCOSI Project (no. 291834)

scholarly journals Prognostic significance of carbohydrate antigen 125 in acute heart failure: a prospective comparative study with N-terminal pro-B-type natriuretic peptide

2021 ◽  
Author(s):  
Ji Zhang ◽  
Wenhua Li ◽  
Gaojun Cai ◽  
Jianqiang Xiao ◽  
Jie Hui ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Events ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Primary Endpoint ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Carbohydrate Antigen ◽  
Cox Regression Analysis ◽  
Carbohydrate Antigen 125

Abstract Background In acute heart failure (AHF), elevated carbohydrate antigen 125 (CA125) and N-terminal pro-B-type natriuretic peptide (NTproBNP) have shown to correlate with adverse events. We sought to quantify their prognostic usefulness in predicting the 6-month combined endpoint of death/heart failure readmission. Methods The study includes 352 patients admitted for AHF. The primary endpoint was 6-month combined endpoint of death/AHF rehospitalization. CA125 and NTproBNP were dichotomized according to the best cut-offs to predict 6-month primary endpoint. By multivariate Cox regression analysis, the independent association of CA125 and NTproBNP with the primary endpoint was assessed, and their incremental prognostic utility evaluated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index. Results A total of 47 (13.4%) deaths and 113 (32.1%) AHF rehospitalizations were identified at 6-month follow-up. The subjects with CA125 ≥ 39.7 U/ml and NTproBNP ≥ 3900 pg/ml had significantly higher cumulative event rates (56.1% vs. 33.3% and 53.3% vs. 33.8%, both P < 0.001). Elevated CA125 (HR 1.93; 95%CI [1.32–2.83]; P = 0.001) was associated with higher HR than NTproBNP ≥ 3900 pg/ml (HR 1.71; 95%CI [1.19–2.48]; P = 0.004) after adjusting for established risk factors. Elevated CA125 still independently predicted adverse events when both CA125 and NTproBNP were entered together in the same multivariate model. Furthermore, risk reclassification analyses demonstrated significant improvements in NRI of 22.3% (P = 0.014) and IDI of 2.7% (P = 0.012) when adding CA125 to the base model + NTproBNP. Conclusions Elevated CA125 and NTproBNP predicted adverse outcomes in AHF patients. CA125 added prognostic value to NTproBNP, and thus, their combination conferred greater predictive capacity.

scholarly journals 570 Prevalence and prognosis of cardiac cachexia in acute heart failure patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gaetano Ruocco ◽  
Guido Pastorini ◽  
Marzia Testa ◽  
Arianna Rossi ◽  
Mauro Feola
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Cox Regression ◽  
De Novo ◽  
Fat Free Mass ◽  
Prognostic Impact ◽  
Term Outcome ◽  
Cardiac Cachexia ◽  
Long Term Outcome ◽  
Cox Regression Analysis

Abstract Aims Cachexia is characterized by a pathological shift of metabolism towards a catabolic state. The prevalence of cardiac cachexia in heart failure (HF) patients is around 10% and it recognizes a negative prognostic impact. In this study we would like to evaluate prevalence and prognosis of cardiac cachexia in acute heart failure (AHF) patients. Methods and results This is an observational retrospective study enrolling patients with diagnosis of acute heart failure (AHF) de novo or not, admitted to our department from January 2015 to September 2018 within 12 h from emergency department admission. Patients underwent to clinical examination, laboratory analysis and echocardiography. Cardiac cachexia was defined as unintentional weight loss, with or without skeletal muscle wasting, of at least 5% of baseline weight during the previous year. For the diagnosis, three of the following factors are also required: anorexia, fatigue, reduced muscle strength, reduced fat-free mass index, and abnormalities in blood biomarkers (haemoglobin ≤12 g/dl, serum albumin &lt;3.2 g/dl, elevated IL-6, or increased C-reactive protein).1 Patients were followed for 1 year after hospital discharge for the composite outcome of HF re-hospitalization and cardiovascular death through 1 year. A total of 415 AHF patients were included in this analysis. 111 patients met the criteria for the diagnosis of cardiac cachexia. Median age was 78(70–83) years. Patients with cardiac cachexia showed higher age [79 (73–84) vs. 77 (68–82) years; P = 0.005], length of hospital stay [12 (8–15) vs. 9 (6–13) days; P = 0.004], and RDW [14.9 (13.9–16.3) vs. 15.3 (14.3–16.9); P = 0.02] with respect to patients without cachexia. Moreover, patients with cachexia demonstrated reduced eGFR [53 (38–68) vs. 48 (31–60) ml/min/m2; P = 0.03] and TAPSE [18 (15–20) vs. 15 (14–19) mm; P = 0.002] compared to patients without cachexia. No differences were found among groups in terms of NTproBNP. In-hospital mortality was higher in patients with cachexia compared to other patients (6.3% vs. 1.3%; P = 0.005). Univariate Cox regression analysis confirmed the poor prognosis of patients with cachexia at one month [HR: 2.53 (1.24–5.19); P = 0.01], six months [HR: 2.47 (1.61–3.77); P &lt; 0.001] and 1 year [HR: 2.04 (1.40–2.98); P &lt; 0.001]. Conclusions Patients with cardiac cachexia were characterized by renal dysfunction and right ventricle dysfunction. These alterations should act as worsening factors in terms of abdominal venous congestion and subsequent malabsorption. Finally, in our population, cardiac cachexia was related to poor short term and long term outcome as confirmed by recent studies.

scholarly journals Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Benedetta De Berardinis ◽  
Laura Magrini ◽  
Giorgio Zampini ◽  
Benedetta Zancla ◽  
Gerardo Salerno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Cox Regression ◽  
Survival Curve ◽  
Early Assessment ◽  
Cox Regression Analysis ◽  
Survival Difference ◽  
Galectin 3 ◽  
Short And Long Term

Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED).Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement.Results. GAL3 level was significantly higher in patients >71 years old, and witheGFR<30 cc/min. The area under the curve (AUC) ofGAL3+BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P<0.005).Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.

scholarly journals Prognostic Significance of Carbohydrate Antigen 125 in Acute Heart Failure: A Prospective Comparative Study With N-terminal Pro-B-type Natriuretic Peptide

2021 ◽  
Author(s):  
Ji Zhang ◽  
Wenhua Li ◽  
Gaojun Cai ◽  
Jianqiang Xiao ◽  
Jie Hui ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Events ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Primary Endpoint ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Carbohydrate Antigen ◽  
Cox Regression Analysis ◽  
Carbohydrate Antigen 125

Abstract Background: In acute heart failure (AHF), elevated carbohydrate antigen 125 (CA125) and N-terminal pro-B-type natriuretic peptide (NTproBNP) have shown to correlate with adverse events. We sought to quantify their prognostic usefulness in predicting the 6-month combined endpoint of death/heart failure readmission.Methods: The study includes 352 patients admitted for AHF. The primary endpoint was 6-month combined endpoint of death/AHF rehospitalization. CA125 and NTproBNP were dichotomized according to the best cut-offs to predict 6-month primary endpoint. By multivariate Cox regression analysis, the independent association of CA125 and NTproBNP with the primary endpoint was assessed, and their incremental prognostic utility evaluated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index. Results: A total of 47 (13.4%) deaths and 113 (32.1%) AHF rehospitalizations were identified at 6-month follow-up. The subjects with CA125≥39.7 U/ml and NTproBNP≥3900 pg/ml had significantly higher cumulative event rates (56.1% vs. 33.3% and 53.3% vs. 33.8%, both P<0.001). Elevated CA125 (HR 1.93; 95%CI [1.32-2.83]; P=0.001) was associated with higher HR than NTproBNP≥3900 pg/ml (HR 1.71; 95%CI [1.19-2.48]; P=0.004) after adjusting for established risk factors. Elevated CA125 still independently predicted adverse events when both CA125 and NTproBNP were entered together in the same multivariate model. Furthermore, risk reclassification analyses demonstrated significant improvements in NRI of 22.3% (P=0.014) and IDI of 2.7% (P=0.012) when adding CA125 to the base model + NTproBNP.Conclusions: Elevated CA125 and NTproBNP predicted adverse outcomes in AHF patients. CA125 added prognostic value to NTproBNP, and thus, their combination conferred greater predictive capacity.

Tricuspid regurgitation pressure gradient identifies prognostically relevant worsening renal function in acute heart failure

2020 ◽  
Author(s):  
Kazuto Hayasaka ◽  
Yuya Matsue ◽  
Takeshi Kitai ◽  
Takahiro Okumura ◽  
Keisuke Kida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Pressure Gradient ◽  
Acute Heart Failure ◽  
Tricuspid Regurgitation ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Body Weight Reduction ◽  
Worsening Renal Function ◽  
Patients With Heart Failure

Abstract Aims Not all worsening renal function (WRF) during heart failure treatment is associated with a poor prognosis. However, a metric capable providing a prognosis of relevant WRF has not been developed. Our aim was to evaluate if a change in tricuspid regurgitation pressure gradient (TRPG) could discriminate prognostically relevant and not relevant WRF in patients with acute heart failure (AHF). Methods and results We examined 809 consecutive hospitalized patients with heart failure (78 ± 12 years, 54% male). WRF was defined as an increase in creatinine &gt;0.3 mg and ≥25% from admission to discharge. TRPG was measured at admission and before discharge using echocardiography. The primary outcome was all-cause death within 1-year after discharge. Patients were classified as follows for analysis: no WRF and no TRPG increase (n = 523); no WRF and TRPG increase (no WRF with iTRPG, n = 170); WRF and no TRPG increase (WRF without iTRPG, n = 90); and WRF and TRPG increase (WRF with iTRPG, n = 26). A change in TRPG weakly but significantly correlated to a change in haemoglobin and haematocrit, a percent decrease in brain natriuretic peptide, and body weight reduction during the index period of hospitalization. All-cause mortality within 1 year was higher in patients with WRF and iTRPG, compared to the other three groups (P = 0.026). On Cox regression analysis, only WRF with iTRPG was associated with higher mortality (hazard ratio 4.24, P = 0.001), even after adjustment for other confounders. Conclusion An increase in TRPG may provide a marker to identify prognostically relevant WRF in patients with AHF.

430Non-invasive estimation of right atrial pressure by IVC measurement differently predicts long-term prognoses in acute heart failure patients with reduced and preserved LVEF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Saito ◽  
K Jujo ◽  
T Abe ◽  
M Kametani ◽  
K Arai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Mortality Rate ◽  
Acute Heart Failure ◽  
Cox Regression ◽  
Left Ventricular ◽  
Right Atrial ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
Kaplan Meier

Abstract Introduction Inferior vena cava (IVC) measurement by bed-side echocardiography is a non-invasive, reproducible and feasible estimation of right atrial pressure (RAP). However, the effect of left ventricular systolic functions on the clinical efficacy of estimation of RAP using IVC parameters in hospitalized patients with acute heart failure (AHF) has not been fully discussed. Purpose We aimed to investigate the prognostic impact of RAP evaluation by IVC measurement in AHF patients, focusing on left ventricular ejection fraction (LVEF). Methods This observational study initially included 1,350 consecutive patients who were urgently hospitalized due to AHF. After the exclusion of patients receiving hemodialysis, those died in hospital, and those without full information of echocardiography during the index hospitalization, 507 patients with reduced (<40%; HFrEF) and 482 patients with preserved (≥40%; HFpEF) LVEF who discharged alive were respectively analyzed. In accordance with ESC guidelines, HFrEF and HFpEF patients were respectively divided into three groups depending on maximum IVC diameter and collapse; Normal-RAP group (IVC diameter ≤2.1cm and collapse >50%), High-RAP group (IVC diameter >2.1cm and collapse <50%), and Intermediate-RAP group (others). The endpoints of this study were cardiovascular (CV) death after the discharge, and hospitalization due to heart failure recurrence (HHF). Results During the observation period, 70 HFrEF patients (13.8%) and 51 HFpEF patients (10.5%) died by CV cause, and 223 HFrEF patients (43.9%) and 158 HFpEF patients (32.8%) were rehospitalized due to HF. In HFrEF patients, Kaplan-Meier analysis showed a low CV mortality rate only in the Normal-RAP group (Log-rank trend: P=0.001, Figure), but no significant difference in HHF rate among RAP groups (p=0.35, Figure). In multivariate Cox regression analysis, RAP classification was an independent predictor of CV mortality in HFrEF patients (adjusted hazard ratio (AHR) 1.90 [95% confidence interval (CI) 1.12–3.21)), even after the adjustment of diverse covariants. On the other hand, in HFpEF patients, Kaplan-Meier analysis showed the high mortality rate and HHF rate only in the High-RAP group (Log-rank trend: both p<0.001, Figure). Multivariate Cox regression analysis revealed that RAP classification independently predicted both prognoses (CV mortality: AHR 2.23 [95% CI 1.10–4.52]; HHF: AHR 1.34 [95% CI 1.03–1.74]) in HFpEF patients. Figure 1 Conclusion Non-invasive and easy classification of AHF patients by maximum IVC size and collapse may predict CV mortality after the discharge in HFrEF and HFpEF; while, it failed in HHF of HFrEF patients.

Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Mustafa Umut Somuncu ◽  
Belma Kalayci ◽  
Ahmet Avci ◽  
Tunahan Akgun ◽  
Huseyin Karakurt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Lower Systolic Blood Pressure ◽  
Cox Regression Analysis ◽  
Killip Class ◽  
Target Vessel Revascularization

AbstractBackgroundThe increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients.Materials and methodsIn this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure.ResultsDuring a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124–4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality.ConclusionsHigh sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Guerrero ◽  
L Alcoberro ◽  
J Vime ◽  
E Calero ◽  
E Hidalgo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Cox Regression ◽  
Oldest Old ◽  
Primary Diagnosis ◽  
Care Group ◽  
Old Patients ◽  
End Point ◽  
Period 2 ◽  
Intervention Modality

Abstract Background Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored. Methods We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (&lt;80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization. Results The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011). Conclusions Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients. Event-free survival cumulative curves. Funding Acknowledgement Type of funding source: None

scholarly journals Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Zhang ◽  
X Xie ◽  
C He ◽  
X Lin ◽  
M Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Remodeling ◽  
Cox Regression ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Cox Regression Analysis ◽  
Long Term Mortality

Abstract Background Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI). Purpose To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI. Methods We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a &gt;15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) &lt;50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis. Results The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P&lt;0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P&lt;0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002). Conclusions LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality. FUNDunding Acknowledgement Type of funding sources: None. Association Between LLVR and outcomes Kaplan-Meier Estimates of the Mortality

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