Adverse Cardiac Events In Patients Research Articles

The predictive value of the HEART and GRACE scores for major adverse cardiac events in patients with acute chest pain.

The history, electrocardiogram, age, risk factors, troponin (HEART) and global registry of acute coronary events (GRACE) scoring systems are commonly used to risk stratify patients with chest pain. This study investigated the application of these scores in predicting the short-term risk of a major adverse cardiac event (MACE) in patients with chest. A total of 509 patients were analyzed. All patients were followed up for 30days after visiting our emergency department. At 30days post-admission, the primary outcome (MACE) was recorded in 92 patients (18.1%), 88 (95.6%) of whom had experienced an acute myocardial infarction. Thirty-seven (40.2%) of the patients with a MACE underwent percutaneous coronary intervention and six patients (6.5%) died. The HEART and GRACE scores were both significantly higher in patients who developed a MACE than in those without (P < 0.05). The HEART and GRACE scores had c-statistic values of 0.811 (95% CI 0.774-0.844) and 0.648 (95% CI 0.603-0.688), respectively. The Hosmer-Lemeshow statistic revealed that the HEART and GRACE scores had values of 8.68 (P = 0.39) and 10.45 (P = 0.11), respectively. The percentages of patients with HEART scores of 0-3, 4-6, and 7-10 were 3.0%, 26.2%, and 46.3%, respectively, in those with a MACE within 30days. The findings show that while both scoring systems are useful, the HEART score is superior to the GRACE score for predicting the occurrence of MACE within 30days in patients with chest pain.

Predicting cardiac adverse events in patients receiving immune checkpoint inhibitors: A machine learning approach.

e15075 Background: Many oncology treatments have been associated with cardiovascular (CV) adverse events. Cases of CV events, including myocarditis have been reported for PD-1 and PD-L1 therapies. We created a machine learning model to predict potential CV events in PD-(L)1 patients using the CancerLinQ database. Methods: A XGBoosted decision tree model was trained to predict a patient’s risk of serious CV adverse events. The model was trained on 80% of all advanced non-small cell lung cancer (NSCLC), melanoma, and renal cell carcinoma (RCC) patients from our database including those who received PD-(L)1 therapy. Index date was defined as date of first PD-(L)1 administration or date of advanced diagnosis if no PD-(L)1 drug was given. The model contained approximately 400 potential risk factors for cardiac disease including elements of past medical history, social history, vitals, common labs, cancer history (e.g. stage, cancer type), medication history, and PD-(L)1 specific factors including PD-(L)1 expression status and PD-(L)1 therapy administered. The model was tested on two separate validation sets (patients not used in training): one using advanced NSCLC, melanoma, and RCC patients and another with PD-(L)1 patients only. Each factor’s importance to the model’s predictions was calculated using SHAP summary plots, a qualitative technique for interpreting machine learning models. Results: A total of 27,172 advanced cancer patients were included in our study. 4,966 received PD-(L)1 therapy. The model was trained on 21,758 patients and 5,414 patients were set aside for testing. The model predicted serious cardiac events within 100 days of index with an AUC-ROC of 0.75 in all patients and 0.79 in PD-(L)1 patients. The top predictors of cardiac risk in PD-(L)1 patients included a history of heart disease, weight loss, the % lymphocyte count, and median LDH. The % lymphocyte count and weight loss were noticeably more predictive in PD-(L)1 patients than in non-PD-(L)1 patients. However, in general SHAP summary plots of all and PD-(L)1 patients were nearly identical, suggesting that both cohorts’ cardiac risk is determined in a similar way. PD-(L)1 and autoimmune disease associated factors did not appear in the top 40 most predictive risk factors. Conclusions: Using traditional cardiac risk factors, our model was able to predict potential cardiac events in PD-(L)1 patients. Our model found that high lymphocyte count may be protective while weight loss and a history of cardiac disease (e.g. heart failure) could indicate a poor prognosis.

Risk Assessment of Development of the Major Adverse Cardiac Events in Patients with Chronic Heart Failure with a Preserved and Intermediate Ejection Fraction in the Presence of a Bendopnea Symptom

Aim To evaluate the risk of major cardiovascular complications (CVC) in patients with chronic heart failure (CHF) with intermediate and preserved ejection fraction (EF) depending on the presence of bendopnea symptom.Material and methods The study included 104 patients with stage II CHF and left ventricular EF ≥40 %. Mean age of the patients was 72.8±10.6 years. A test for detection of bendopnea symptom was performed for all patients. Two groups were formed: group 1, 69 patients with the bendopnea symptom and group 2, 35 patients with a negative test. Follow-up duration was 24 months. The composite endpoint (CEP) was death and hospitalization for any CVC.Results Mean time to the bendopnea symptom was 17.3±6.61 s. At two years of follow-up, the CEP was observed in 36 (34.6 %) patients, including 30 (43.5 %) patients in group 1 and 6 (17.1 %) patients in group 2. 12 patients died, and 9 of them had the bendopnea symptom. 21 patients of group 1 were hospitalized for CVC. Risk of CEP was significantly 1.7 times higher for men (relative risk, RR 1.7 [1.1; 2.6]) than for women. The presence of bendopnea symptom increased the risk of CEP 1.4 times (ОР 1.4 [1.1;1.9]) for women and 2.3 times (RR 2.3 [1.4; 3.6]) for men.Conclusion Results of the study demonstrated an unfavorable effect of bendopnea symptom on risk of CEP during the two-year follow-up of CHF patients with preserved and intermediate EF.

Association of Isolated Coronary Microvascular Dysfunction With Mortality and Major Adverse Cardiac Events: A Systematic Review and Meta-Analysis of Aggregate Data.

BackgroundThe impact of coronary microvascular dysfunction (CMD), as diagnosed by reduced coronary flow reserve, on the outcomes of patients with symptoms of myocardial ischemia and nonobstructive coronary artery disease is poorly understood. We performed a systematic review and meta‐analysis of observational studies to determine the association of CMD with outcomes.Methods and ResultsWe searched online databases for studies where coronary flow reserve was measured invasively or noninvasively, clinical events were recorded after determination of coronary flow reserve, and the frequency of those events was reported for patients with and without CMD. The primary outcome was all‐cause mortality. The secondary outcome was major adverse cardiac events, including cardiac or cardiovascular death, nonfatal myocardial infarction, cardiac hospitalization, or coronary revascularization. Estimates of effect were calculated from crude event rates with a random‐effects model. There were 122 deaths in the 4661 patients without CMD (2.6%) and 183 deaths in the 1970 patients with CMD (9.3%). The odds ratio for mortality in patients with CMD compared with those without CMD was 3.93 (95% CI, 2.91–5.30; P<0.001). There were 167 major adverse cardiac events in the 3742 patients without CMD (4.5%) and 245 events in the 1447 patients with CMD (16.9%). The odds ratio for major adverse cardiac events in patients with CMD compared with those without CMD was 5.16 (95% CI, 2.81–9.47; P<0.001).Conclusions CMD is associated with a nearly 4‐fold increase in mortality and a 5‐fold increase in major adverse cardiac events. Future studies are needed to identify effective strategies to diagnose and treat CMD.

Preoperative blood urea nitrogen-to-left ventricular ejection fraction ratio is an independent predictor of long-term major adverse cardiac events in patients undergoing coronary artery bypass grafting surgery.

BackgroundLong-term mortality rate following coronary artery bypass grafting (CABG) procedure is still considered to be high despite advances in surgical techniques and perioperative management. Identifying high-risk patients by using cost-effective and clinically useful parameters is needed.MethodsPatients who were admitted to our cardiology clinic with the diagnosis of coronary artery disease and underwent CABG between January 2008 and August 2010 were included. Study patients were followed-up for 112.6 ± 17.8 months for major adverse cardiac events (MACE) which were defined as all-cause mortality and new-onset decompensated heart failure (HF).ResultsPatients in MACE (+) group were older (p < 0.001), had higher additive Euroscore (p < 0.001), and lower left ventricular ejection fraction (p < 0.001). Multivariate Cox regression analysis showed that additive Euroscore [odds ratio (OR) = 1.601; 95% confidence interval (CI) = 1.374–1.864; p < 0.001)] and blood urea nitrogen-to-left ventricular ejection fraction ratio (BUNEFr; OR = 1.028; 95% CI = 1.006–1.050; p = 0.011) independently predicted MACE. Receiver operating characteristic curve analysis demonstrated that BUNEFr had an area under curve of 0.794 and BUNEFr >33 had a sensitivity and specificity of 74% and 64%, respectively.ConclusionBUNEFr is a clinically useful and cost-effective parameter for the prediction of long-term mortality and new-onset decompensated HF in patients undergoing CABG.

Predictive value of phase analysis of gated myocardial perfusion imaging for major adverse cardiac events in patients with coronary artery disease

Objective To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease. Methods Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE (χ2 values: 4.126, 6.021, both P 80°), abnormal entropy(>58 J·mol-1·K-1) and SSS≥12 were independent risk factors for MACE (odds ratio(OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P 26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification. Key words: Coronary artery disease; Prognosis; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tomography, X-ray computed; Technetium Tc 99m sestamibi

Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery.

BackgroundLaboratory studies demonstrate glucose‐insulin‐potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin‐glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass surgery.Methods and ResultsIn this prospective, randomized, double‐blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes before anesthesia and continuously for 12.5 hours. The primary outcome was the incidence of in‐hospital major adverse cardiac events including all‐cause death, low cardiac output syndrome, acute myocardial infarction, cardiac arrest with successful resuscitation, congestive heart failure, and arrhythmia. GIK therapy reduced the incidence of major adverse cardiac events and enhanced cardiac function recovery without increasing perioperative blood glucose compared with the control group. Mechanistically, this treatment resulted in increased glucose uptake and less lactate excretion calculated by the differences between arterial and coronary sinus, and increased phosphorylation of insulin receptor substrate‐1 and protein kinase B in the hearts of GIK‐treated patients. Systemic blood lactate was also reduced in GIK‐treated patients during cardiopulmonary bypass surgery.ConclusionsA modified GIK regimen administered perioperatively reduces the incidence of in‐hospital major adverse cardiac events in patients undergoing cardiopulmonary bypass surgery. These benefits are likely a result of enhanced systemic tissue perfusion and improved myocardial metabolism via activation of insulin signaling by GIK.Clinical Trial RegistrationURL: clinicaltrials.gov. Identifier: NCT01516138.

Cardiac Adverse Events in EGFR-Mutated Non-Small Cell Lung Cancer Treated With Osimertinib

ObjectivesThe purpose of this study was to assess osimertinib-associated cardiac adverse events (AEs) in a real-world setting, using a retrospective single-center cohort study in Japan. BackgroundCases of osimertinib-associated cardiac AEs have been reported but remain poorly understood. MethodsA total of 123 cases of advanced non–small cell lung cancer (NSCLC) with confirmed EGFR mutations who received osimertinib monotherapy from 2014 to 2019 at the Osaka International Cancer Institute (Osaka, Japan) were evaluated. Cardiac AEs were defined according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Changes in left ventricular ejection fraction (LVEF) and rates of cancer therapeutics-related cardiac dysfunction (CTRCD), defined as a ≥10 % absolute decline in LVEF from baseline to a value of <53%, were further assessed in 36 patients in whom serial measurements of LVEF were obtained before and during osimertinib treatment. ResultsSevere cardiac AEs (CTCAE grade 3 or higher) occurred in 6 patients (4.9%) after osimertinib administration. These AEs included acute myocardial infarction (n = 1), heart failure with reduced LVEF (n = 3), and valvular heart disease (n = 2). Five of the 6 patients had a history of cardiovascular risk factors or disease. Myocardial biopsies in 2 of the patients showed cardiomyocyte hypertrophy and lipofuscin deposition. In 36 patients assessed with serial LVEF, LVEF declined from 69.4 ± 4.2% to 63.4 ± 10.5% with osimertinib therapy (p < 0.001). CTRCD occurred in 4 patients with a nadir LVEF of 40.3 ± 9.1% with osimertinib. ConclusionsIn this retrospective cohort analysis, the incidence of cardiac AEs in patients treated with osimertinib was 4.9%. Additional prospective data collected from patients with NSCLC treated with osimertinib will be important in understanding the incidence, pathophysiology, and management of cardiac AEs with osimertinib.

Ivabradine alone and in combination with metoprolol reduces the incidence of major adverse cardiac events in patients with heart failure: A prospective study

Background: Altered hemodynamics of heart failure patients is associated with an increased heart rate (HR). The effect of β-blockers on prognosis has been linked to their HR lowering effect. Ivabradine is an If current inhibitor and it decreases the heart rate. Aims and Objectives: The aim of this study was to compare the efficacy of ivabradine, a combination of ivabradine and metoprolol, with that of metoprolol alone in patients with heart failure. Materials and Methods: This prospective observational study was done in patients with New York Heart Association (NYHA) Class III/IV heart failure over 18 months. Patients were categorized into Group A: Ivabradine (5 mg BD), Group B: Metoprolol (12.5 mg BD), and Group C: Combination of both (5 mg BD and 12.5 mg BD). At the end of 6 months follow-up, the outcomes of therapy were assessed based on the occurrence of major adverse cardiac events (MACE) such as acute coronary syndrome, rehospitalization, or death. Effectiveness was also measured in terms of a decrease in HR, improvement in left ventricular ejection fraction (LVEF), and NYHA functional class. Results: One hundred and fifty-two patients were included in this study in three groups – 51 patients in Group A, 50 patients in Group B, and 51 patients in Group C. At the end of follow-up period, it was found that the highest number of MACE occurred in Group B followed by A and C. Group C showed significant improvement with therapy in terms of decrease in HR, increase in LVEF, and improvement in NYHA class. Conclusion: Administration of ivabradine alone or a combination of ivabradine and metoprolol is more effective than metoprolol in reducing the incidence of MACE in heart failure.

Platelet indices and blood cell ratios in acute coronary syndrome and their predictive values

Background Platelets have a chief role in the pathogenesis of acute coronary syndrome (ACS), where plaque rupture is followed by platelet activation and thrombus formation, leading to coronary artery occlusion. When platelets are activated, they become bigger in size, which can be measured by both mean platelet volume (MPV) and platelet distribution width (PDW). Aim The aim of this study was to evaluate the predictive value of blood count parameters, including platelet indices such as MPV, mean platelet component, plateletcrit, PDW, and mean platelet mass and blood cell ratios such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell to mean platelet volume (WMR) in ACS. Patients and methods This work was carried out at the Clinical Pathology and Cardiology Departments at Assiut University Hospital during the period between January 2017 and December 2017. It included two groups of participants: 250 patients with ACS (patient group) and 100 apparently healthy age-matched and sex-matched individuals (control group). Results Mean age of the patient group was 57.41 ± 12.15 years, with range between 31 and 90 years old. Of 250 patients with ACS, 187 (74.8%) patients were males. The patient group had significantly higher MPV, PDW, WMR, and neutrophil-to-lymphocyte ratio in comparison with the control group, but the control group had higher mean platelet component and platelet-to-lymphocyte ratio (P Conclusion Low hemoglobin and increased RDW, MPV, and WMR were predictors for the development of major adverse cardiac event in patients diagnosed with ACS.

An Innovative Scoring System for Predicting Major Adverse Cardiac Events in Patients With Chest Pain Based on Machine Learning

Chest pain is a common complaint in the emergency department, but this may prevent a diagnosis of major adverse cardiac events, a composite of all-cause mortality associated with cardiovascular-related illnesses. To determine potential predictors of major adverse cardiac events in Taiwan, a pilot study was performed, involving the data from 268 patients with major adverse cardiac events, which was by an artificial neural network method. Nine biomarkers were selected for identifying non-ST-elevation myocardial infarction from common chest pain patients. By using a machine learning-based feature selection technique, five biomarkers were chosen from a set of 37 candidate variables. A full and a reduced risk stratification model were built. The full model was based on the characteristics of both invasive (i.e., creatinine and troponin I) and non-invasive (i.e., age, coronary artery disease risk factors, and corrected QT interval) variables, and the reduced model was based only on non-invasive variable characteristics. The full model showed a sensitivity of 0.948 and a specificity of 0.546 when the cutoff was set at 2 points, with a missed major adverse cardiac events rate of 1.32%, a positive predictive value of 0.228, and a negative predictive value of 0.987. High performance was also obtained with the five major biomarkers in the predictor built by the machine learning algorithm. The full model had the highest performance, but the reduced model can be applied as a quick and reasonably performing diagnostic tool.

Late cardiac adverse events in patients with cancer treated with immune checkpoint inhibitors

BackgroundImmune checkpoint inhibitor (ICI)-associated early cardiac adverse events (CAEs), mostly acute and fulminant myocarditis, have been well characterized and mainly occur during the first 90 days after ICI therapy initiation....

Research progress on WeChat platform in continuous care for patients with coronary heart disease

This paper reviews the application of WeChat in continuous care for patients with coronary heart disease (CHD) , namely the WeChat group-based intervention, the WeChat public platform-based intervention, the combination of WeChat group and WeChat public platform, and the combination of WeChat group and other information technologies. In addition, this paper analyzes the effect of WeChat intervention, that is, its impact on disease knowledge, self-management behavior, quality of life and the occurrence of adverse cardiac events in patients with CHD, in order to provide a reference for enriching continuous care for patients with CHD, so that continuous care can be effectively combined with WeChat information technology. Key words: Review; Continuous care; Coronary heart disease; WeChat

Preoperative Right Ventricular Echocardiographic Parameters Predict Perioperative Cardiovascular Complications in Patients Undergoing Non-Cardiac Surgery

Transthoracic echocardiography is frequently ordered before non-cardiac surgery (NCS), but the impact of preoperative echocardiography on perioperative outcomes in patients undergoing NCS is unknown. The present study aimed to evaluate the predictive value of preoperative right ventricular echocardiograhic parameters for the occurrence of perioperative cardiovascular complications (PCC) in patients undergoing NCS. We reviewed the data of 660 patients aged ≥18 years and over (mean age 66.3±15 yr) who underwent preoperative comprehensive echocardiography before elective NCS between January 2015 and February 2019. Only patients who had undergone echocardiography before NCS were included. Echocardiographic measurements of right ventricular function, including tricuspid annular plane systolic excursion (TAPSE), Tei index, right ventricular fractional area change, and pulmonary artery systolic pressure, were retrospectively evaluated. The primary outcome of the study was major PCC defined as cardiac death, non-fatal cardiac arrest, severe arrhythmias requiring treatment, acute heart failure, acute coronary syndrome, pulmonary thrombo-embolism, and cardio-embolic stroke. Eighty (80) patients (12.1%) experienced PCC. Patients with PCC were older, and had a higher prevalence of coronary artery disease, heart failure, and diabetes mellitus. Patients with PCC had lower TAPSE (16.9±4.4 vs 20.8±4.2 mm; p<0.001) than patients without PCC. Multivariate logistic regression analysis showed that older age (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.25-4.65; p<0.01), presence of diabetes (OR, 1.78; 95% CI, 0.95-3.46; p=0.03), and TAPSE <17.6mm (OR, 3.12; 95% CI, 1.12-5.46; p=0.03) were significant variables associated with PCC. This is the first study to demonstrate that preoperative reduced right ventricular systolic function, as measured by TAPSE, is associated with increased rates of perioperative adverse cardiac events in patients undergoing NCS.

Variability Rate of Serum Potassium Levels Predicts In-hospital Major Adverse Cardiac Events in Patients with ST Elevation Myocardial Infarction (STEMI)

ABSTRACTObjective: The critical role of potassium (K+) in cardiovascular (CV) disease and, maintaining a normokalemic state are increasingly being recognized to preclude adverse cardiac events. The main objective of our study was to evaluate whether there is an association between the variability of serum potassium levels, even within the normal range, and in-hospital major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction (STEMI).Materials and Method: A total of 419 patients who were admitted to our tertiary heart center with a diagnosis of STEMI from May 2013 to May 2015 were included in this retrospective study. The patients who have any serum K+levels beyond the normal range on admission and during the in-hospital follow-up interval were excluded. The patients who had at least five consecutive serum K+measurements during the in-hospital stay were included in the study. Results: In multivariable logistic regression analysis, the variability of serum K+levels (OR: 7.84, 95%CI: 1.18-51.81, p=0.03) was found to be independently associated with MACE in the study population. The optimal cut-off value of the variability of serum K+levels was ≥ 0.57 with a sensitivity of 46.2% and a specificity of 84.9% (area under curve (AUC) 0.66, p=0.001).Conclusion: Our findings provide evidence that variability of serum K+levels even within the normal range may be an independent predictor of MACE in STEMI patients. Therefore, close follow up of the patients with a high variability of serum K+levels has utmost importance in order to minimize the risk of MACE. Keywords: Potassium; ST-elevation myocardial infarction; Major adverse cardiovascular events ÖZETAmaç: Potasyumun (K+) kardiyovasküler hastalıklardaki kritik rolü ve olumsuz kardiyak olayları önlemede normokalemik durumu devam ettirmenin önemi her geçen gün daha iyi anlaşılmaktadır. Çalışmamızda, normal sınırlar içerisinde olmasına rağmen, serum potasyum düzeylerindeki değişkenlik oranı ile ST yükselmeli miyokard enfarktüsü (STyME) hastalarında izlenen hastane içi majör kardiyak olaylar (MACE) arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: 2013 – 2015 yılları arasında tersiyer merkezimize STyME tanısı ile başvuran toplam 419 hasta retrospektif olarak dizayn edilen çalışmamıza dahil edildi. Hastaneye başvuru anında veya hastane içi takipleri sırasında normal değerlerin dışında K+düzeyi saptanan hastalar çalışmaya alınmaz iken, hastane yatışı boyunca en az 5 (beş) ardışık K+değeri mevcut olan hastalar çalışmaya dahil edildi.Bulgular: Çok değişkenli regresyon analizinde, çalışma populasyonundaki serum K+ düzeylerinin değişkenlik oranı (OR: 7.84, 95%CI: 1.18-51.81, p=0.03) hastane içi olumsuz kardiyak olayların (MACE) bağımsız öngördürücüsü olarak saptandı. Serum K+ düzeylerinin değişkenlik oranı ≥ 0.57 (optimal kestirim değeri) olması halinde, hastane içi olumsuz olayları % 46.2 duyarlılık ve % 84.9 özgüllükle öngörmekteydi. (area under curve (AUC) 0.66, p=0.001).Sonuç: Çalışmamızın sonuçları, normal sınırlar içinde olsa dahi değişkenlik gösteren K+ düzeylerinin STyME hastalarında hastane içi olumsuz olayların bağımsız bir öngördürücüsü olabileceğini göstermiştir. Bu nedenle, artmış oranda K+ düzeyi değişkenliği gösteren hastaların daha yakından takibi olumsuz kardiyak olayları en aza indirmek açısından büyük önem arz etmektedir. Anahtar kelimeler: Potasyum; ST-yükselmeli miyokard enfarktüsü; Majör olumsuz kardiyak olaylar

Preoperative blood urea nitrogen-to-left ventricular ejection fraction ratio is an independent predictor of long-term major adverse cardiac events in patients undergoing coronary artery bypass grafting surgery

BackgroundLong-term mortality rate following coronary artery bypass grafting (CABG) procedure is still considered to be high despite advances in surgical techniques and perioperative management. Identifying high-risk patients by using cost-effective and clinically useful parameters is needed. MethodsPatients who were admitted to our cardiology clinic with the diagnosis of coronary artery disease and underwent CABG between January 2008 and August 2010 were included. Study patients were followed-up for 112.6 ± 17.8 months for major adverse cardiac events (MACE) which were defined as all-cause mortality and new-onset decompensated heart failure (HF). ResultsPatients in MACE (+) group were older (p < 0.001), had higher additive Euroscore (p < 0.001), and lower left ventricular ejection fraction (p < 0.001). Multivariate Cox regression analysis showed that additive Euroscore [odds ratio (OR) = 1.601; 95% confidence interval (CI) = 1.374–1.864; p < 0.001)] and blood urea nitrogen-to-left ventricular ejection fraction ratio (BUNEFr; OR = 1.028; 95% CI = 1.006–1.050; p = 0.011) independently predicted MACE. Receiver operating characteristic curve analysis demonstrated that BUNEFr had an area under curve of 0.794 and BUNEFr >33 had a sensitivity and specificity of 74% and 64%, respectively. ConclusionBUNEFr is a clinically useful and cost-effective parameter for the prediction of long-term mortality and new-onset decompensated HF in patients undergoing CABG.

Soluble urokinase-type plasminogen activator receptor represents exercise tolerance and predicts adverse cardiac events in patients with heart failure.

Soluble urokinase-type plasminogen activator receptor (suPAR) is a membrane-binding protein that is released into the blood stream by immune activation. Recent reports suggest that circulating suPAR levels are associated with adverse cardiovascular outcomes. Exercise tolerance is an independent predictor of prognosis in patients with heart failure (HF); however, the relationship between serum suPAR level and exercise tolerance is unclear. We prospectively enrolled 94 patients who were hospitalized for worsening of HF. All patients underwent a symptom-limited cardiopulmonary exercise test to evaluate exercise tolerance. The median value of serum suPAR was 4848pg/ml. During follow up, 44 patients (47%) were admitted for all-cause mortality and re-hospitalization for HF. Median serum suPAR was significantly higher in the patients with cardiac events than in the patients with non-event group. Patients were divided into two groups according to circulating suPAR levels. Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly higher in the high suPAR group (log-rank p = 0.023). Multivariate analysis revealed that suPAR was independently correlated with the parameters of exercise tolerance such as anaerobic threshold (p = 0.007) and peak oxygen uptake (p = 0.005). suPAR levels predicted adverse cardiac events and independently correlated with the parameters of exercise tolerance. suPAR could be a useful surrogate biomarker of exercise tolerance in patients with HF.

HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department.

Aims:Coronary computed tomography angiography is increasingly employed in the emergency department for suspected acute coronary syndrome patients. The HEART score has been proposed for initial risk stratification in these patients. The aim of this study was to investigate the diagnostic value and efficiency of the HEART score before coronary computed tomography angiography.Methods and results:We included patients suspected of acute coronary syndrome who underwent coronary computed tomography angiography in the emergency department. Based on the HEART score, patients were stratified as low-risk (HEART≤3), intermediate-risk (HEART4–6) and high-risk (HEART≥7). We assessed coronary computed tomography angiography for the presence of significant coronary artery disease (>50% stenosis). The primary outcome, the level of major adverse cardiac events, was a composite endpoint of all-cause mortality, acute coronary syndrome or coronary revascularisation within 30 days. The study population consisted of 340 patients (mean age: 55.6±10.1 years, 44.7% women), major adverse cardiac events occurred in 45 (13.2%) patients. The incidence of major adverse cardiac events in patients stratified as low-risk (35.0%), intermediate-risk (56.8%) and high-risk (8.2%) was 3.4%, 12.4% and 60.7%, respectively. All four low-risk patients with major adverse cardiac events had a HEART score of three. An algorithm where coronary computed tomography angiography is reserved for patients with HEART 3–6 resulted in a sensitivity of 97.8%, specificity of 84.1%, negative predictive value of 99.6% and positive predictive value of 48.4%, while reducing the need for coronary computed tomography angiography by 22% (n=75).Conclusion:The predictive value of coronary computed tomography angiography for 30-day major adverse cardiac events in suspected acute coronary syndrome patients is good, and reserving coronary computed tomography angiography for HEART score 3–6 patients reduces the number of needed coronary computed tomography angiograms without affecting diagnostic accuracy.

Importance of lead aVR on predicting adverse cardiac events in patients with noncompaction cardiomyopathy.

BackgroundNoncompaction cardiomyopathy (NCCM) is a relatively rare cardiac abnormality with high rates of mortality and morbidity. T‐wave amplitudes during ventricular repolarization in lead aVR (TaVR) have been reported to be associated with the prognosis of various cardiovascular diseases. This study sought to investigate the prevalence and prognostic role of positive TaVR in patients with NCCM.MethodsWe evaluated consecutive 161 patients with NCCM (65.8% men, mean age 42.5 ± 15.2 years old). Presentation electrocardiogram was assessed regarding classical parameters as well as T‐wave amplitudes in lead aVR. The primary endpoint was defined as composite lethal arrhythmic events, including sudden cardiac death, ventricular fibrillation, or sustained ventricular tachycardia or appropriate implantable cardioverter–defibrillator shock. Heart failure requiring hospitalization, cardiovascular death, and all‐cause mortality were also investigated as secondary endpoints.ResultsPatients with positive TaVR showed higher rates for arrhythmic events, hospitalization for heart failure, and death compared with patients without it. In multivariate Cox model, after adjusting for other known clinical and electrocardiographic risk factors, the positive TaVR was found to be a strong independent predictor of primary endpoint (HR: 4.8, 95% CI: 1.2–19.3; p = .025) and all‐cause death (HR: 3.5, 95% CI: 1.0–12.1; p = .045).ConclusionOur findings revealed that positive TaVR is significantly and independently associated with adverse outcomes in NCCM patients. This unique ECG criterion in the often ignored lead provides incremental information beyond what is available with other traditional risk factors.

P3553Right ventricular echocardiographic composite parameters in predicting major adverse cardiac events in patients with heart failure with reduced ejection fraction

Abstract Background Echocardiography assessment of right ventricle still play an indispensable role in diagnosis, decision-making for further therapy and risk assessment of patients with heart failure with reduced ejection fraction (HFrEF). Aims Our objective was to compare the predictive value of five composite echo parameters of right ventricle (RV) in decompensated patients with HFrEF. Methods and results A total of 191 NYHA III-IV patients admitted for decompensation of advanced HFrEF (EF=25.53±6,87%) were prospectively enrolled. During the follow-up period mean period of 340±84 days, 111 (58.1%) patients met the primary composite endpoint (MACE) of cardiac death, rehospitalization due to repeated decompensation, malignant rhythm disorders, heart attack or stroke. The average time of MACE occurrence was 110.5±98.7 days. Among group of patients with MACE, during the follow-up, there were 34 (30.6%) cardiac related deaths. Re-hospitalization due to cardiovascular causes had 77 patients (69.4%). The study was performed at our hospital between June 2016 and January 2018. Patients were assessed for the following combined echo parameters: (i) relationship of right and left ventricle basal diameter (RVb/LVb x0,1); (ii) relationship of tricuspid annular plane systolic excursion and right ventricle systolic pressure (TAPSE/RVSP mm/mmHg); (iii) relationship of tricuspid annular systolic velocity and right ventricle systolic pressure (TAs'x100/ RVSP cm/s/mmHg); (iv) product of tricuspid annular systolic velocity and pulmonic valve acceleration time (TAs'x PVAcT (cm/s2 x 1000)); (v) product of systolic and diastolic velocity of tricuspid annulus (TAs xTAe). The last three parameters were result of this study and were not mentioned in earlier researches. In this study, univariat analysis of combined RV echo parameters, TAPSE/RVSP, TAs'x100 /RVSP as well as TAs'xPVAcT have been shown to be highly significant predictors of MACE, p=0.001. The TAs'xTAe' product has been also distinguished as a significant predictor of MACE, p=0.04, as well as the ratio RVb/LVb x 0.1, p=0.007. Multivariate analysis of these five combined RV echo parameters shows that significant independent predictor of MACE turned out to be TAs'x100/RVSP (p&lt;0.001, HR = 0.668 (0.531–0.840)). Obtained by reconstruction of the ROC curve (Area = 0.70 (95% CI 0.59–0.75); p&lt;0.001, we have got cut off value of TAs'x100/RVSP = 1.92 (cm/s/mmHg). Kaplan-Meier curves were constructed by comparing the time to the occurrence of MACE. Patients with TAs'x100/RVSP ≤1.92 (cm/s/mmHg) have a significantly worse prognosis (Log Rank p&lt;0.001). Conclusion New variable TAs'x100/RVSP, derived from this research, proved to be the most powerful combined RV echo parameter, independent predictor of one year MACE, with a better predictive value compared to the already described combined parameters in the literature.