Admission Heart Rate Research Articles

Baseline heart rate as a key prognostic indicator in AMI patients with cardiogenic shock undergoing successful primary PCI

Abstract Background Cardiogenic shock presents as a critical condition in patients experiencing acute myocardial infarction (AMI). Even that primary percutaneous coronary intervention (PCI) has become widespread, the mortality rate of AMI complicated with cardiogenic shock remains high. However, comprehensive prognostic stratification remains elusive. Objective Our study sought to elucidate the relationship between baseline parameters and prognostic outcomes in AMI patients with cardiogenic shock. Methods From the GETBACK-AMI multicenter retrospective registry encompassing 935 AMI patients who underwent primary PCI and attained TIMI 3 flow upon final angiography. There were 73 patients diagnosed with cardiogenic shock were ultimately analyzed. The primary endpoint of our study was all-cause mortality. Results Over a median follow-up duration of 425 days, 17 patients (23%) succumbed, of which 14 were in-hospital fatalities. Employing the Cox regression model, we identified that heart rate (HR) at the time of admission bore a potent and independent correlation with the primary endpoint (hazard ratio: 1.04 [95% CI: 1.01-1.06], p=0.002), even post-adjustment for various covariates. ROC analysis pinpointed an admission HR of 82 bpm as the threshold for the primary endpoint. Kaplan-Meier curves further highlighted a pronounced elevation in the primary endpoint occurrence rate for patients with HR > 82 bpm compared to those with HR < 82 bpm (53% vs. 13%, p=0.0002). Conclusions Within our multicenter study cohort, a heightened admission HR was demonstrably linked to increased mortality in AMI patients with cardiogenic shock who reached a final TIMI 3 flow. This readily accessible and impactful prognostic marker may guide clinicians in identifying high-risk patients, subsequently allowing for enhanced support and interventions to optimize patient outcomes.

Clinical, electrocardiographic, echocardiographic, and angiographic predictors for the final infarct size assessed by cardiac magnetic resonance in acute STEMI patients after primary percutaneous coronary intervention

BackgroundFinal infarct size (IS) after ST segment elevation myocardial infarction (STEMI) is a major predictor of mortality. Seeking early predictors for final IS can guide individualized therapeutic strategies for those recognized to be at higher risk.ResultsEighty STEMI patients successfully treated with primary percutaneous coronary intervention (pPCI) underwent baseline (within 48 h) 2D, 3D echocardiography with speckle tracking and then underwent cardiac magnetic resonance (CMR) at 3 months to assess the final IS. After recruitment, 4 patients were excluded for uncontainable claustrophobia while 76 patients completed the final analysis. The mean ± standard deviation age was 54.1 ± 10.9 years, 84% were males, 25% had diabetes, 26% were hypertensives, 71% were current smokers, 82% had dyslipidemia, and 18% had a family history of premature coronary artery disease. By 3 months, CMR was performed to accurately evaluate the final IS. In univariate regression analysis, the admission heart rate, baseline and post-pPCI ST elevation, STEMI location (anterior vs. inferior), highest peri-procedural troponin, large thrombus burden, baseline thrombolysis in myocardial infarction flow grade, the final myocardial blush grade, the 2D and 3D left ventricular ejection fraction (LVEF), and the 2D and 3D global longitudinal strain (GLS) parameters were significant predictors for the final IS. In the multivariate regression analysis, four models were constructed and recognized the residual post-PCI ST segment elevation, the highest peri-procedural troponin, the 2D-LVEF, 3D-LVEF, and 2D-GLS as significant independent predictors for final IS.ConclusionsIn STEMI patients who underwent successful pPCI, early predictors for the final IS are vital to guide therapeutic decisions. The residual post-pPCI ST elevation, the highest peri-procedural troponin, and the baseline 2D-LVEF, 3D-LVEF, and 2D-GLS can be excellent and timely tools to predict the final IS.

Risk factors and outcomes associated with systolic dysfunction following traumatic brain injury.

Systolic dysfunction has been observed following isolated moderate-severe traumatic brain injury (Ims-TBI). However, early risk factors for the development of systolic dysfunction after Ims-TBI and their impact on the prognosis of patients with Ims-TBI have not been thoroughly investigated. A prospective observational study among patients aged 16 to 65 years without cardiac comorbidities who sustained Ims-TBI (Glasgow Coma Scale [GCS] score ≤12) was conducted. Systolic dysfunction was defined as left ventricular ejection fraction <50% or apparent regional wall motion abnormality assessed by transthoracic echocardiography within 24 hours after admission. The primary endpoint was the incidence of systolic dysfunction after Ims-TBI. The secondary endpoint was survival on discharge. Clinical data and outcomes were assessed within 24 hours after admission or during hospitalization. About 23 of 123 patients (18.7%) developed systolic dysfunction after Ims-TBI. Higher admission heart rate (odds ratios [ORs]: 1.05, 95% confidence interval [CI]: 1.02-1.08; P = .002), lower admission GCS score (OR: 0.77, 95% CI: 0.61-0.96; P = .022), and higher admission serum high-sensitivity cardiac troponin T (Hs-cTnT) (OR: 1.14, 95% CI: 1.06-1.22; P < .001) were independently associated with systolic dysfunction among patients with Ims-TBI. A combination of heart rate, GCS score, and serum Hs-cTnT level on admission improved the predictive performance for systolic dysfunction (area under curve = 0.85). Duration of mechanical ventilation, intensive care unit length of stay, and in-hospital mortality of patients with systolic dysfunction was higher than that of patients with normal systolic function (P < .05). Lower GCS (OR: 0.66, 95% CI: 0.45-0.82; P = .001), lower admission oxygen saturation (OR: 0.82, 95% CI: 0.69-0.98; P = .025), and the development of systolic dysfunction (OR: 4.85, 95% CI: 1.36-17.22; P = .015) were independent risk factors for in-hospital mortality in patients with Ims-TBI. Heart rate, GCS, and serum Hs-cTnT level on admission were independent early risk factors for systolic dysfunction in patients with Ims-TBI. The combination of these 3 parameters can better predict the occurrence of systolic dysfunction.

Templer's death anxiety scale on the relationship between white coat hypertension and anxiety: A cross-sectional study.

The relationship between white coat hypertension (WCH) and anxiety remains not fully elucidated. This study aims to investigate the correlation between WCH and Templer's Death Anxiety Scale (T-DAS) questionnaire. Asymptomatic individuals with a familial history of sudden cardiac death or acute myocardial infarction within the last year, who presented at our cardiology outpatient clinic, were enrolled in this prospective, single-center, cross-sectional study. Among those with elevated blood pressure in the outpatient clinic setting, participants were categorized into normotensive and WCH groups through 24-hour ambulatory blood pressure monitoring. Demographic features, laboratory parameters, and T-DAS scores were documented. Logistic regression and sensitivity analyses were conducted to ascertain WCH occurrence. Among 324 consecutive participants, 90 were diagnosed with WCH. T-DAS scores were significantly elevated in the WCH subgroup, particularly among those seeking early medical attention following bereavement. Multivariable logistic regression highlighted gender, BMI, heart rate, T-DAS, and admission time as independent correlates of WCH. Significantly, T-DAS exhibited the third most substantial contribution to the regression analysis, following admission time and heart rate. The multivariable logistic regression analysis incorporating T-DAS exhibited high robustness, discrimination, fit, and calibration, with a Brier score of 0.106, adjusted R2 of 0.576, and C-statistic of 0.905 (95% CI: 0.871-0.940, p < 0.001). T-DAS, with a threshold of >8, demonstrated 48% sensitivity and 90% specificity in detecting WCH. Additionally, decision curve analysis verified that the model including T-DAS offers a net benefit in detecting WCH. This study unveils a potential association between WCH and death anxiety.

Association between admission heart rate and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: a retrospective cohort study

BackgroundAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure (RF) is a chronic respiratory disease that seriously endangers human health. This study aimed to specifically evaluate the relationship between admission heart rate (AHR) and in-hospital mortality in patients with combined AECOPD and RF to better inform clinical treatment.MethodsThis retrospective cohort study included 397 patients admitted to a Chinese hospital between January 2021 and March 2023. The primary outcome measure was all-cause in-hospital mortality. Multivariate logistic regression analyses were performed to calculate adjusted hazard ratios (OR) with corresponding 95% confidence intervals (CI), and curve fitting and threshold effect were performed to address nonlinear relationships.ResultsIn total, 397 patients with AECOPD/RF were screened. The mean (± SD) age of the study cohort was 72.6 ± 9.5 years, approximately 49.4% was female, and the overall in-hospital mortality rate was 5%. Multivariate logistic regression analysis and smooth curve fitting revealed a nonlinear association between AHR and in-hospital mortality in the study population, with 100 beats/min representing the inflection point. Left of the inflection point, the effect size (OR) was 0.474 (95% CI 0.016 ~ 13.683; p = 0.6635). On the right side, each 1 beat/min increase in AHR resulted in an effect size (OR) of 1.094 (95% CI 1.01 ~ 1.186; p = 0.0281).ConclusionsResults of the present study demonstrated a nonlinear relationship between AHR and in-hospital mortality in patients with AECOPD/RF. When AHR was < 100 beats/min, it was not statistically significant; however, AHR > 100 beats/min was a predictor of potential mortality, which increased by 9.4% for every 1 beat/min increase in AHR.

Development and validation a nomogram for predicting new-onset postoperative atrial fibrillation following pulmonary resection

BackgroundThe new-onset postoperative atrial fibrillation (NOPAF) following pulmonary resection is a common clinical concern. The aim of this study was to construct a nomogram to intuitively predict the risk of NOPAF and offered protective treatments.MethodsPatients who underwent pulmonary resection between January 2018 and December 2020 were consecutively enrolled. Forward stepwise multivariable logistic regression analyses were used to screen independent predictors, and a derived nomogram model was built. The model performance was evaluated in terms of calibration, discrimination and clinical utility and validated with bootstrap resampling.ResultsA total of 3583 patients who met the research criteria were recruited for this study. The incidence of NOPAF was 1.507% (54/3583). A nomogram, composed of five independent predictors, namely age, admission heart rate, extent of resection, laterality, percent maximum ventilation volume per minute (%MVV), was constructed. The concordance index (C-index) was 0.811. The nomogram showed substantial discriminative ability, with an area under the receiver operating characteristic curve of 0.811 (95% CI 0.758-0.864). Moreover, the model shows prominent calibration performance and higher net clinical benefits.ConclusionWe developed a novel nomogram that can predict the risk of NOPAF following pulmonary resection, which may assist clinicians predict the individual probability of NOPAF and perform available prophylaxis. By using bootstrap resampling for validation, the optimal discrimination and calibration were demonstrated, indicating that the nomogram may have clinical practicality.

Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure.

This study investigated whether an activated R-mode in patients carrying a cardiac implantable electronic device (CIED) is associated with worse prognosis during and after an episode of acutely decompensated heart failure (AHF). Six hundred and twenty-three patients participating in an ongoing prospective cohort study that phenotypes and follows patients admitted for AHF were studied. We compared CIED carriers with activated R-mode stimulation (CIED-R) to CIED carriers not in R-mode (CIED-0) and patients without CIEDs (no-CIED). The independent impact of R-mode activation on 12-month all-cause death was examined using uni- and multivariable Cox proportional hazards regression taking into account potential confounders, and hazard ratios (HR) with their 95% confidence intervals (CI) were reported. Mean heart rate on admission was lower in CIED-R (n = 37, 16% women) vs. CIED-0 (n = 64, 23% women) or no-CIED (n = 511, 43% women): 70 bpm vs. 80 bpm or 82 bpm; both p<0.001. In-hospital mortality was similar across groups, but age- and sex-adjusted all-cause 12-month mortality risk was differentially affected by R-mode activation; CIED-R vs. CIED-0: HR 2.44, 95%CI 1.25-4.74; CIED-R vs. no-CIED: HR 2.61, 95%CI 1.59-4.29. These effects persisted after multivariable adjustment for potential confounders. Within CIED-R, mortality risk was similar in patients with pacemakers vs. ICDs and in subgroups with left ventricular ejection fraction (LVEF) <50% vs. ≥50%. In patients admitted with AHF, R-mode stimulation was associated with a significantly increased 12-month mortality risk. Our findings shed new light on "admission heart rate" as a potentially treatable target in AHF. Our data are compatible with the concept that chronotropic incompetence contributes to an adverse outcome in these patients and may not be adequately treated through accelerometer-based R-mode stimulation.

Abstract 12391: Correlation of Admission Heart Rate With MACE Among ST-segment Elevation Myocardial Infarction Patients (killip1) Undergoing Primary Percutaneous Coronary Intervention

Introduction: Different admission heart rate (AHR) levels are frequently observed in ST-segment elevation myocardial infarction (STEMI) patients. However, it is not clear whether AHR is related to the occurrence of major adverse cardiovascular effects (MACE) after pPCI. Hypothesis: We aim to explore the possible correlation between AHR and MACE after STEMI patients receive the primary percutaneous coronary intervention (pPCI). Methods: The Chinese STEMI pPCI Registry was registered with ClinicalTrials.gov (NCT04996901). We analyzed 5586 patients with STEMI who underwent pPCI in a multi-center study in China, and patients were grouped according to the AHR greater or less than 70 bpm. Patients’ in-hospital MACE referred to new-onset heart failure and death. The association between AHR and in-hospital MACE was assessed in Logistic regression analysis. Results: 4004 patients were enrolled ultimately, including 1105 patients with AHR&lt; 70 bpm and 2899 patients with AHR≥ 70 bpm. After multivariate adjustment for age, gender, DBP, HR, smoking, hypertension, et al., the OR of MACE in patients with AHR ≥ 70 bpm was 1.573-1.581 times that of the other group in calibration Model I to IV. Subgroup analysis showed that it was also observed in the young (&lt;60 years old) or the old (≥60 years old), male or female, Left anterior descending (LAD), and Right circumflex artery (RCA) patients (all P &lt;0.05). We still found that AHR was a risk factor for in-hospital MACE after excluding those patients with a history of MACE, RCA occlusion and AHR less than 50 bpm or greater than 90 bpm in sensitivity analysis. ROC curve of AHR in predicting the occurrence of MACE after pPCI was 0.699. The cubic spline also confirmed that the risk of MACE decreased significantly with the reduction of AHR. Conclusions: In STEMI patients undergoing pPCI, elevated AHR (≥70 bpm) identifies those at increased risk of in-hospital MACE. AHR less than 70 bpm may be a protective factor to avoid the occurrence of MACE.

Association between admission heart rate and major adverse cardiovascular events in acute myocardial infarction participants with different left ventricular ejection fraction

BackgroundThis study intended to investigate the independent effect of admission heart rate (HR) on the risk of major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with different left ventricular ejection fraction (LVEF) levels. MethodsThe study was a secondary analysis of the Acute Coronary Syndrome Quality Improvement in Kerela Trial. The relationship between admission HR and 30-day adverse outcomes in AMI patients with different LVEF levels was detected using a Logistic regression model. Interaction tests were used to compare the effects of different subgroups on HR and MACEs. ResultsOur study enrolled 18,819 patients. In both partially and fully adjusted models (Model1 and Model2), the risk of MACEs was highest in patients with HR ≥ 120 (OR: 1.62, 95%CI: (1.16, 2.26), P = 0.004, Model1; OR: 1.46, 95%CI: (1.00, 2.12), P = 0.047, Model2). There was a significant interaction between LVEF and HR (P for interaction = 0.003). Meanwhile, the trend test for this association showed that HR was positively and significantly associated with the MACEs in LVEF≥40% group (OR (95%CI): 1.27 (1.12, 1.45), P < 0.001). However, in LVEF<40% group, the trend test was not statistically significant (OR (95%CI): 1.09 (0.93, 1.29), P = 0.269). ConclusionThis study found that elevated admission HR was associated with a significantly higher risk for MACEs in patients admitted with AMI. Elevated admission HR was significantly associated with the risk of MACEs in AMI patients without low LVEF but not those with low LVEF (<40%). LVEF levels should be considered when evaluating the association between admission HR and the prognosis of AMI patients in the future.

The Correlation between QRS Dispersion and Coronary Artery Disease Severity in Patients with Non ST Elevation Myocardial Infraction

Non ST elevation myocardial infarction (NSTEMI) has been the subject of numerous studies. Risk stratification is a fundamental element for the management of NSTEMI; therefore, several scores have been established in this direction, particularly prognostic markers derived from the ECG.&#x0D; Aims: The aim of our study is to correlate the dispersion of the QRS with the severity of coronary lesions assessed by the GENSINI score in patients admitted for NSTEMI at the University Hospital of Marrakech.&#x0D; Methods: A retrospective study was conducted in the cardiology department of Mohammed VI university hospital of Marrakech from January 01, 2022 to March 31, 2022. Data was derived from the hospitalization register, including 30 patients (16 women and 14 men). Age ranged from 56 to 74 years with an average of 64.6 ± 9.3. Data was analyzed by SPSS, the level of significance set at p &lt;0.05.&#x0D; Results: We found, in our study, a highly significant positive correlation between QRS dispersion (considered important if &gt;20 ms) and admission heart rate (p=0.003) as well as the level of ultrasensitive troponins (p=0.003). There is also a very significant correlation between QRS dispersion and corrected QT interval (p=0.005), Moreover, we concluded that in patients admitted for NSTEMI, the greater the dispersion of the QRS, the higher the score of GENSINI (p&lt;0.0001).&#x0D; Conclusion: The dispersion of the QRS is a simple marker on the ECG that can have a predictive value in different clinical contexts, particularly in acute ischemic heart disease. Further studies are needed, however, to validate its usefulness in routine practice.

Valor pronóstico de las frecuencias cardiacas bajas en pacientes ingresados con infarto agudo de miocardio

Introduction and objectivesThe risk prediction scores adopted in acute coronary syndromes (ACS) use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, previous studies reported a nonlinear relationship between HR and events, suggesting that low HR may have an unrecognized prognostic role. We aimed to assess the prognostic impact of low HR in ACS, defined as admission HR <50 bpm. MethodsThis study analyzed data from the AMIS Plus registry, a cohort of hospitalized patients with ACS between 1999 and 2021. The primary endpoint was in-hospital all-cause mortality, while a composite of all-cause mortality, major cardiac/cerebrovascular events was set as the secondary endpoint. A multilevel statistical method was used to assess the prognostic role of low HR in ACS. ResultsThe study included 51 001 patients. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. A nonlinear relationship between HR and in-hospital mortality was observed on restricted cubic spline analysis. An HR of 50 to 75 bpm showed lower mortality than HR <50 bpm (OR, 0.67; 95%CI, 0.47-0.99) only after primary multivariable analysis, which was not confirmed after multiple sensitivity analyses. After propensity score matching, progressive fading of the prognostic role of HR <50 bpm was evident. ConclusionsLow admission HR in ACS is associated with a higher crude rate of adverse events. Nonetheless, after correction for baseline differences, the prognostic role of low HR was not confirmed. Therefore, low HR probably represents a marker of underlying morbidity. These results may be clinically relevant in improving the accuracy of risk scores in ACS.

Admission Heart Rate and Mortality in Critically Ill Patients with Acute Aortic Dissection.

The association between admission heart rate (HR) and the mortality of critically ill patients with acute aortic dissection (AAD) remains unclear.The data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Cox regression models and Kaplan-Meier (KM) survival curve were used to explore the association between admission HR and 90-day, 1-year, and 3-year mortality in patients with AAD. Sensitivity analyses were conducted to assess potential bias.A total of 374 eligible AAD patients were included and divided in 4 groups according to admission HR (HR ≤ 70, 71-80, 81-90, and > 90 beats per minute (bpm) ). The patients with AAD in the group with HR > 90 bpm had higher 90-day, 1-year, and 3-year mortality than those in the groups with HR ≤ 70, 71-80, and 81-90 bpm. After adjusting for age, sex, BMI, systolic blood pressure, diastolic blood pressure, SOFA score, SAPSII score, Stanford type, hypertension, coronary artery disease, liver disease, atrial fibrillation, valvular disease, intensive care unit mechanical ventilation, aortic surgery, and thoracic endovascular aortic repair, patients with admission HR > 90 bpm had a higher risk of 90-day, 1-year, and 3-year mortality [adjusted hazard ratio, 95% confidence interval, 5.14 (2.22-11.91) P < 0.001; 4.31 (2.10-8.84) P < 0.001; 3.01 (1.66-5.46) P < 0.001] than those with HR 81-90 bpm. The 90-day, 1-year, and 3-year mortality were similar among the groups with HR ≤ 70, 71-80, and 81-90 bpm.Admission HR > 90 bpm was independently associated with all-cause mortality in critically ill AAD patients, either type A or B aortic dissection.

The course of complicated injury of the cervical spine with the development of neurogenic shock

Objective. To establish the effect of neurogenic shock (NS) on the course of acute complicated injury of the cervical spine.Material and Methods. The retrospective study included 96 patients with acute complicated injury of the cervical spine. The criteria for the presence of NS were determined as mean blood pressure (BP) &lt; 70 mm Hg, and heart rate (HR) &lt; 60 per minute. Two groups were distinguished: Group 1 included 13 patients with NS, and Group 2 – 83 patients without NS. The main characteristics of patients and the course of spinal cord injury were analyzed from the moment of admission to the 30th day of follow-up.Results. There were no statistically significant differences between the groups in terms of gender, age, level of spinal injury, severity of spinal cord injury and comorbidity. Admission BP and HR in patients with NS were below the reference values and had statistically significant differences in comparison with similar indicators in patients of Group 2. On the first day of treatment in the intensive care unit (ICU), hemodynamic support was required for all patients of Group 1, and for 69 patients of Group 2 (83.1 %). The duration of hemodynamic support in Group 1 was 11 days [6; 15], and in Group 2 – 7 days [4; 14]; p = 0.231. Blood lactate and pH levels were consistent with reference values at all stages, with no intergroup differences. Differences in the severity of organ dysfunctions (SOFA scale) were registered only on the seventh day of treatment in the ICU (p = 0.010); there were no significant differences in the severity of the patients’ condition (APACHE II scale). The presence of NS was accompanied by a statistically significant increase in the complication rate. The duration of treatment in the ICU was 28 days [22; 57] in Group 1, 23.5 days [11; 37] in Group 2 (p = 0.055), and that in the hospital – 58 days [44; 70] in Group 1 versus 41.5 [24; 59.5] in Group 2 (p &lt; 0.025). Positive dynamics in the neurological status was noted at discharge in 15.0 % of Group 1 patients and in 19.3 % of Group 2 patients.Conclusion. The prevalence of NS in isolated injury of the cervical spine was 13.5 %. The development of NS significantly increases the complication rate and duration of hospital stay, but does not exclude the possibility of regression of existing neurological disorders.

Prediction Model of New Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome.

Atrial fibrillation (AF) is one of the most common complications of acute coronary syndrome (ACS) patients. Possible risk factors related to new-onset AF (NOAF) in ACS patients have been reported in some studies, and several prediction models have been established. However, the predictive power of these models was modest and lacked independent validation. The aim of this study is to define risk factors of NOAF in patients with ACS during hospitalization and to develop a prediction model and nomogram for individual risk prediction. Retrospective cohort studies were conducted. A total of 1535 eligible ACS patients from one hospital were recruited for model development. External validation was performed using an external cohort of 1635 ACS patients from another hospital. The prediction model was created using multivariable logistic regression and validated in an external cohort. The discrimination, calibration, and clinical utility of the model were evaluated, and a nomogram was constructed. A subgroup analysis was performed for unstable angina (UA) patients. During hospitalization, the incidence of NOAF was 8.21% and 6.12% in the training and validation cohorts, respectively. Age, admission heart rate, left atrial diameter, right atrial diameter, heart failure, brain natriuretic peptide (BNP) level, less statin use, and no percutaneous coronary intervention (PCI) were independent predictors of NOAF. The AUC was 0.891 (95% CI: 0.863-0.920) and 0.839 (95% CI: 0.796-0.883) for the training and validation cohort, respectively, and the model passed the calibration test (P > 0.05). The clinical utility evaluation shows that the model has a clinical net benefit within a certain range of the threshold probability. A model with strong predictive power was constructed for predicting the risk of NOAF in patients with ACS during hospitalization. It might help with the identification of ACS patients at risk and early intervention of NOAF during hospitalization.

Admission D-dimer to lymphocyte counts ratio as a novel biomarker for predicting the in-hospital mortality in patients with acute aortic dissection

BackgroundInflammatory factors are well-established indicators for vascular disease, but the D-dimer to lymphocyte count ratio (DLR) is not measured in routine clinical care. Screening of DLR in individuals may identify individuals at in-hopital mortality of acute aortic dissection (AD).MethodsA retrospective analysis of clinical data from 2013 to 2020 was conducted to identify which factors were related to in-hospital mortality risk of AD. Baseline clinical features, cardiovascular risk factors, and laboratory parameters were obtained from the hospital database. The end point was in-hospital mortality. Forward conditional logistic regression was performed to identify independent risk factors for AA in-hospital death. The cutoff value of the DLR should be ideally calculated by receiver operating characteristic (ROC) analysis.ResultsThe in-hospital mortality rate was 15% (48 of 320 patients). Patients with in-hospital mortality had a higher admission mean DLR level than the alive group (1740 vs. 1010, P < .05). The cutoff point of DLR was 907. The in-hospital mortality rate in the high-level DLR group was significantly higher than that in the low-level DLR group (P < .05). Univariate analysis showed that 8 of 38 factors were associated with in-hospital mortality (P < .05), including admission WBC, neutrophils, lymphocytes, neutrophils/lymphocytes (NLR), prothrombin time (PT), heart rate (HR), D-dimer, and DLR. In multivariate analysis, DLR (odds ratio [OR] 2.127, 95% CI 1.034–4.373, P = 0.040), HR (odds ratio [OR] 1.016, 95% CI 1.002–1.030, P = 0.029) and PT (odds ratio [OR] 1.231, 95% CI 1.018–1.189, P = 0.032) were determined to be independent predictors of in-hospital mortality (P < .05).ConclusionCompared with the common clinical parameters PT and HR, serum DLR level on admission is an uncommon but independent parameter that can be used to assess in-hospital mortality in patients with acute AD.

Prognostic value of low heart rates in patients admitted with acute myocardial infarction

Introduction and objectivesThe risk prediction scores adopted in acute coronary syndromes (ACS) use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, previous studies reported a nonlinear relationship between HR and events, suggesting that low HR may have an unrecognized prognostic role. We aimed to assess the prognostic impact of low HR in ACS, defined as admission HR <50 bpm. MethodsThis study analyzed data from the AMIS Plus registry, a cohort of hospitalized patients with ACS between 1999 and 2021. The primary endpoint was in-hospital all-cause mortality, while a composite of all-cause mortality, major cardiac/cerebrovascular events was set as the secondary endpoint. A multilevel statistical method was used to assess the prognostic role of low HR in ACS. ResultsThe study included 51 001 patients. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. A nonlinear relationship between HR and in-hospital mortality was observed on restricted cubic spline analysis. An HR of 50 to 75 bpm showed lower mortality than HR <50 bpm (OR, 0.67; 95%CI, 0.47-0.99) only after primary multivariable analysis, which was not confirmed after multiple sensitivity analyses. After propensity score matching, progressive fading of the prognostic role of HR <50 bpm was evident. ConclusionsLow admission HR in ACS is associated with a higher crude rate of adverse events. Nonetheless, after correction for baseline differences, the prognostic role of low HR was not confirmed. Therefore, low HR probably represents a marker of underlying morbidity. These results may be clinically relevant in improving the accuracy of risk scores in ACS.

Association of heart rate at admission and angiographic and clinical results of ST elevation myocardial infarction patients undergoing primary angioplasty on the left circumflex artery

Goal: Heart rate is a factor that predicts cardiovascular diseases such as heart failure, high blood pressure, stroke and coronary artery diseases. This study examined the association between admission heart rate of STEMI[1] patients undergoing PCI[2] on the LCX[3] artery and their clinical and angiographic results. Materials and procedure: This retrospective cross-sectional study was carried out on 155 patients with acute inferior or posterior STEMI who underwent angioplasty on the LCX at the Shahid Madani Hospital of Tabriz, Iran, from 2018 to 2021. To gather data, all the files of the STEMI patients undergoing PPCI[4] on the LCX artery were identified at the Medical Records Department of the hospital, and registered in the questionnaire. Patients’ heart rate at admission was obtained from the ECGs recorded in the files. The patients were divided into three groups of under 70 beats (low), 70-100 beats (normal), and over 100 beats (high) per minute. Findings: The studied group consisted of 155 patients, including 31 ones (20%) with low heart rates, 107 ones (69%) with normal heart rates and 17 ones (11%) with high heart rates.

Heart rate and mortality in myocardial infarction: incremental or bimodal correlation?

Abstract Introduction Risk prediction scores adopted in acute coronary syndromes use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, a non-linear, bimodal relationship, with higher event rates at low or high HR, has been described, potentially hampering risk prediction accuracy. Purpose Our aim was to assess the prognostic impact of bradycardia, defined as admission HR &amp;lt;50 bpm, in myocardial infarction (MI) among patients enrolled in a large nationwide registry. Methods Data of patients enrolled between 1999 and 2021 stratified by admission HR were retrospectively analysed. The primary endpoint was in-hospital mortality. The secondary endpoint was a composite of death, cerebrovascular event, and reinfarction. Associations between HR and outcomes were assessed at univariate and multivariable logistic regression analyses, then verified after sequential propensity-score matchings among HR groups. Results 51001 patients (median age 66 years, IQR 56–76) were included. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. Association of HR &amp;lt;50 bpm with mortality was recognised only at primary multivariable logistic regression analysis (OR 1.49; 95% CI 1.01–2.13 p=0.038) but not at multiple sensitivity analyses after exclusion of patients on negative chronotropic therapy. Three sequential propensity-score matching were performed among patients with HR &amp;lt;50 bpm at admission and those with HR 50–75 bpm, HR 76–100 bpm and HR &amp;gt;100 bpm at admission, identifying 1159, 1159 and 1158 matched pairs, respectively. After propensity-score matching, rates of primary and secondary endpoints equalled among groups with HR &amp;lt;100 bpm. Conclusions Bradycardia (HR &amp;lt;50 bpm) at admission in patients with MI identified a group with higher crude rate of adverse events. Nonetheless, the signal supporting an independent association between bradycardia at admission and short-term mortality is weak and was not confirmed after correction for relevant baseline differences by propensity score matching. These findings support the hypothesis that lower HR might not be causative for the worse outcomes, but rather serves as a marker of underlying morbidity. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The AMIS Plus registry is funded by unrestricted grants from the Swiss Heart Foundation and from Abbot AG, Amgen AG, AstraZeneca AG, Bayer (Schweiz) AG, Biotronik AG, Boston Scientific AG, B. Braun Medical AG, Daiichi-Sankyo/Lilly AG, Cordis Cardinal Health GmbH, Medtronic AG, Novartis Pharma Schweiz AG, Sanofi-Aventis (Schweiz) AG, SIS Medical AG, Terumo AG, Vascular Medical GmbH, all in Switzerland, and the Swiss Working Group for Interventional Cardiology. The sponsors did not play any role in the design, data collection, analysis, or interpretation of data.

A prediction model for acute kidney injury in adult patients with hemophagocytic lymphohistiocytosis

Background and aimsHemophagocytic lymphohistiocytosis is a clinical syndrome resulting from abnormally active immune cells and a cytokine storm, with the accompanying phagocytosis of blood cells. Patients with hemophagocytic lymphohistiocytosis often suffer acute kidney injury during hospitalization, which usually signifies poor prognosis. We would like to establish a prediction model for the occurrence of acute kidney injury in adult patients with hemophagocytic lymphohistiocytosis for risk stratification.MethodWe extracted the electronic medical records of patients diagnosed with hemophagocytic lymphohistiocytosis during hospitalization from January 2009 to July 2019. The observation indicator is the occurrence of acute kidney injury within 28 days of hospitalization. LASSO regression was used to screen variables and modeling was performed by COX regression.ResultsIn the present study, 136 (22.7%) patients suffered from acute kidney injury within 28 days of hospitalization. The prediction model consisted of 11 variables, including vasopressor, mechanical ventilation, disseminated intravascular coagulation, admission heart rate, hemoglobin, baseline cystatin C, phosphorus, total bilirubin, lactic dehydrogenase, prothrombin time, and procalcitonin. The risk of acute kidney injury can be assessed by the sum of the scores of each parameter on the nomogram. For the development and validation groups, the area under the receiver operating characteristic curve was 0.760 and 0.820, and the C-index was 0.743 and 0.810, respectively.ConclusionWe performed a risk prediction model for the development of acute kidney injury in patients with hemophagocytic lymphohistiocytosis, which may help physicians to evaluate the risk of acute kidney injury and prevent its occurrence.

Very Early Discharge After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Mortality Outcomes at Six Months

BackgroundCurrent guidelines recommend that low risk patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing uncomplicated primary percutaneous coronary intervention (PPCI) can be discharged home in 48–72 h. We report the safety of early discharge in STEMI patients undergoing uncomplicated PPCI after 24-h stay in-hospital. MethodsWe performed a retrospective analysis of prospectively collected data of consecutive patients presenting with STEMI between January 2014 and December 2020. One- and 6-month mortality rates were compared between patients who underwent next day (early discharge group) and two days in-hospital stay (standard discharge group). ResultsOf 6119 STEMI patients, 4033 were included in the analysis, of whom 1674 (42 %) underwent early discharge. Patients in the early discharge group were younger, more likely to be male, and had a lower peak troponin. Both groups had similar ischemia- and door-to-balloon time, but anterior STEMI were less frequent in the early discharge group. The 1- and 6-month mortality rate for the whole cohort was 0.6 % and 1.3 %, respectively. After adjustment, there were no significant differences in the 1-month [HR 0.54; 95 % CI (0.20 to 1.47), P = 0.23] and 6-month mortality [HR 0.73; 95 % CI (0.38 to 1.41), P = 0.35] between early and standard discharge groups. Age, admission heart rate and chronic obstructive lung disease were identified as independent predictors of 6-month mortality in patients who underwent early discharge strategy. ConclusionOur data confirms safety of next day discharge of patients presenting with STEMI after successful PPCI and uncomplicated post-procedural course.