Mortality In Cardiac Patients Research Articles

Diastolic dysfunction and survival in patients with preserved or mildly reduced left ventricular ejection fraction

Abstract Background Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (>40%) following myocardial infarction (MI). Aims This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting all-cause and cardiac mortality in patients with a first-ever MI and LVEF>40%. Methods A retrospective single centre study involving 2234 patients with a first-ever MI (STEMI or NSTEMI) with LVEF>40% was performed. Clinical, angiographic, and echocardiographic data were obtained from prospectively maintained institutional databases. Outcomes data were obtained from the state-wide registry. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined as grade 2+3 diastolic dysfunction according to current American Society of Echocardiography/ European Association of Cardiovascular Imaging guidelines. Results The mean age of patients was 61.4±12.3 years, 70.7% were males, and 12.1% had 3-vessel disease. The mean LVEF was 55.8±7.2% and 9.1% had significant DD. At a median follow up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (HR 2.01,95%CI 1.37-2.94, p<0.001) and cardiac (HR 3.97,95%CI 1.98-7.99, p<0.001) mortality. Conclusions Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively re-stratifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.

Survival and toxicity after breast-conserving surgery and external beam reirradiation for localized ipsilateral breast tumour recurrence: A population-based study

Breast-conserving surgery followed by reirradiation for a localized ipsilateral breast tumour relapse may increase the radiation dose delivered to the heart and result in a greater risk of cardiac adverse events. This study aimed to compare the incidence of cardiac mortality in patients treated for a localized ipsilateral breast tumour relapse, either with breast-conserving surgery followed by reirradiation or with total mastectomy between 2000 and 2020. All patients treated for a primary non-metastatic breast cancer with breast-conserving surgery and adjuvant radiotherapy were identified in the Surveillance, Epidemiology, and End Results (SEER) program database, and those who subsequently experienced a localized ipsilateral breast tumour relapse treated with breast-conserving surgery and reirradiation ("BCS+ReRT" group, n=239) or with total mastectomy ("TM" group, n=3127) were included. The primary objective was to compare the cardiac mortality rate between the patients who underwent breast-conserving surgery followed by reirradiation and total mastectomy. Secondary endpoints were overall survival and cancer specific survival. Cardiac mortality was significantly higher in patients treated with breast-conserving surgery followed by reirradiation (hazard ratio [HR]: 2.40, 95% confidence interval [95% CI]: 1.19-4.86, P=0.006) in univariate analysis; non-statistically significant differences were observed after adjusting for age, laterality and chemotherapy on multivariate analysis (HR: 1.96, 95% CI: 0.96-3.94, P=0.067), age being the only confounding factor. A non-statistically significant difference towards lower overall survival was observed in patients who had breast-conserving surgery followed by reirradiation compared with those who underwent total mastectomy (HR: 1.37, 95% CI: 0.98-1.90, P=0.066), and no differences were observed in terms of cancer specific survival (HR: 1.01, 95% CI: 0.56-1.82, P=0.965). In this study, the incidence of cardiac mortality was low, and breast-conserving surgery followed by reirradiation did not independently increased the risk of cardiac mortality for a localized ipsilateral breast tumour relapse.

How Right is the Right Ventricle in Predicting Cardiac Mortality in Cardiac Failure: A 6-year Prospective Cohort Study.

Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up. The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded. The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up. This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years.

Preserving flow, saving lives: Successful treatment of aortic valve failure in acute myocardial infarction without flow down-regulation using ECMO - a case report and mini review.

Direct percutaneous coronary intervention (PPCI) has significantly reduced cardiac mortality in patients with acute myocardial infarction (AMI), but the mortality rate remains high for those who develop cardiogenic shock (CS), reaching 40% to 50%. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) provides robust hemodynamic support and oxygen delivery for AMI patients with refractory CS, ensuring adequate organ perfusion and oxygen supply. However, there is currently no standardized optimal Mean Arterial Pressure (MAP) range during V-A ECMO support. Achieving the proper MAP is crucial for adequate myocardial perfusion, cardiac function recovery, successful weaning off of V-A ECMO, and improving long-term outcomes. In this case study, we successfully treated a 55-year-old man with AMI and refractory cardiogenic shock using V-A ECMO. By adjusting ECMO blood flow and employing hemodynamic strategies, including vasoactive drugs, we optimized the MAP, leading to improved cardiac function and successful weaning off of V-A ECMO. This presents a potential opportunity for MAP optimization under ECMO support in patients with acute myocardial infarction and cardiogenic shock.

Prognostic value of preprocedural pericoronary adipose tissue CT-Attenuation in patients with non ST-elevation acute coronary syndrome

Abstract Background Pericoronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects pericoronary inflammation. FAI has been reported to be associated with cardiac mortality in patients with suspected coronary artery disease. However, the prognostic value of FAI in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) remains elusive. Methods This retrospective single-center observational study included a total of 358 patients with NSTE-ACS who underwent preprocedural 320-slice CCTA and emergent PCI within 24 hours from admission. Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal (4cm) right coronary artery (RCA), the left anterior descending artery (LAD), and the left circumflex artery (LCx). We assessed the prognostic value of FAI for all-cause and cardiac mortality. Clinical outcomes were assessed by death and cardiac death. Results During a median follow-up period of 1715 days (1008-2538), death and cardiac death occurred in 36 (10.1%) patients and 18 (5.0%) patients, respectively. High FAI values around LAD and LCx (but not around RCA) were predictive of all-cause mortality. High FAI values around RCA, LAD, and LCx were predictive of cardiac mortality. FAI in culprit vessels and average FAI values in three vessels were predictive of all-cause and cardiac mortality. ROC analysis revealed that the best cut-off FAI value in three vessels for predicting cardiac death is -65.8 (AUC: 0.752, 0.637-0.867.) Kaplan-Meier analysis revealed that patients with average FAI values in three vessels &amp;gt;-65.8 were significantly associated with poor prognosis of cardiac mortality. (P&amp;lt;0.001). Conclusion High perivascular FAI values are an indicator of increased cardiac mortality and, therefore, could guide early targeted secondary prevention and intensive medical management in patients with NSTE-ACS after PCI.Kaplan Meier analysis for cardiac death

Abstract 14242: The Potential Impact of Inflammation on the Lipid Paradox in Patients With Acute Myocardial Infarction: A Multicenter Study

Introduction: Low-density lipoprotein cholesterol (LDL-C) is a well-recognized risk factor for cardiovascular diseases. However, several clinical studies demonstrated that LDL-C was inversely associated with mortality risk in patients with acute myocardial infarction (AMI), which is known as lipid paradox. Aims: To verify the association between LDL-C and mortality risk among AMI patients. Methods: A total of 5,358 patients with AMI from a nationwide cohort were included in our analysis. All individuals were stratified according to LDL-C quartiles (≤2.00 mmol/l, 2.00-2.54 mmol/l, 2.54-3.19 mmol/l, &gt;3.19 mmol/l) and hsCRP levels (hsCRP≤3 mg/l &amp; hsCRP&gt;3 mg/l). Primary outcome was cardiac mortality. Secondary endpoint was all-cause mortality. Results: During a median follow-up of 2.1 years, 297 deaths and 227 cardiac deaths occurred. Patients in the lowest LDL-C quartile experienced the highest incidence of cardiac and all-cause mortality. The association between mortality risk and LDL-C levels appeared to be U-shaped. Patients in the highest LDL-C quartile had increased incidences of cardiac and all-cause mortality in patients with hsCRP≤3 mg/l. However, higher incidences of both cardiac and all-cause mortality were observed in the lowest LDL-C quartile group among those with hsCRP&gt;3 mg/l. Multivariable COX regression analysis demonstrated that compared with the lowest quartile, the highest LDL-C quartile was significantly associated with a higher risk of cardiac mortality in patients with hsCRP≤3 mg/l (HR 3.04, 95%CI 1.33-6.96, p=0.008), but in patients with hsCRP&gt;3 mg/l, the other three LDL-C quartiles showed a trend for lower cardiac mortality risks, and the second LDL-C quartile met the statistical significance (HR 0.62, 95%CI 0.40-0.95, p=0.027). Conclusion: AMI patients with lower LDL-C levels had a higher risk of mortality. However, this association was only observed in those with high inflammation risk.

The Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Long-Term Survival in Patients With Severe Left Ventricular Dysfunction and Implantable Cardioverter Defibrillator.

A total of 180 compensated heart failure patients with LVEF<35% (ischemic or nonischemic) and implantable cardioverter-defibrillator (ICD) therapy for primary prevention who applied to the cardiology outpatient clinic of Zonguldak Bülent Ecevit Üniversitesi Hospital, Zonguldak,Türkiye, between March 2018 and June 2019 were consecutively included. The patients were followed for one year after the application. In the multivariate logistic regression analysis model, only NLR (OR: 1.328; 95%CI: 1.129-1.563; p <0.01) was found independently associated with the risk of one-year cardiovascular mortality. Based on the NLR, levels were 2.69 ng/ml, and the area under the curve was found to be 0.795 (95%CI: 0.729-0.862) in the evaluation made with the receiver operating characteristic curve. High NLR ratio levels independently predicted one-year cardiac mortality in patients with LVEF<35% and ICD for secondary protection. Large-scale randomized studies are needed to fully demonstrate the relationship between NLR levels and cardiovascular mortality in patients with severe left ventricular dysfunction and ICD.

Decreased cholinesterase level combined with renal dysfunction and sympathetic denervation associated with increased cardiac mortality in systolic heart failure.

Cardiac mortality in patients with heart failure (HF) is likely to be aggravated by malnutrition, assessed by serum cholinesterase (ChE) level, as well as by kidney dysfunction or impairment of cardiac sympathetic denervation. Their prognostic interactions, however, have not been determined. A total of 991 systolic HF patients were enrolled in our HF database following clinical evaluation including evaluation of the nutrition state and assessment of standardized heart-to-mediastinum ratio (sHMR) of iodine-123-labeled meta-iodobenzylguanidine activity. Patients were followed up for an average of 43 months with the primary endpoint of fatal cardiac events (CEs). The CE patient group had a lower level of ChE, lower estimated glomerular filtration rate (eGFR) and lower late sHMR than those in the non-CE patient group. A five-parameter model with the addition of serum ChE selected in the multivariate logistic analysis (model 2) significantly increased the AUC predicting risk of cardiac events compared with a four-parameter model without serum ChE (model 1), and net reclassification analysis also suggested that the model with the addition of serum cholinesterase significantly improved cardiac event prediction. Moreover, in overall multivariate Cox hazard analysis, serum ChE, eGFR and late sHMR were identified to be significant prognostic determinants. HF patients with two or all of the prognostic variables of serum ChE < 230 U/L, eGFR < 48.8 ml/min/1.73 m2 and late sHMR < 1.90 had significantly and incrementally increased CE rates compared to those in HF patients with none or only one of the prognostic variables. Decreases in cholinesterase level and kidney function further increase cardiac mortality risk in HF patients with impairment of cardiac sympathetic innervation.

Lipoprotein (a) and myocardial infarction: impact on long-term mortality

Background and aimsLipoprotein (a) [Lp(a)] is a genetically regulated lipoprotein particle that is an independent risk factor for coronary atherosclerotic heart disease. However, the correlation between Lp(a) and left ventricular ejection fraction (LVEF) in patients with myocardial infarction (MI) has been poorly studied. The present study investigated the correlation between Lp(a) and LVEF, as well as the impact of Lp(a) on long-term mortality in patients with MI.MethodsPatients who underwent coronary angiography resulting in MI diagnosis between May 2018 and March 2020 at the First Affiliated Hospital of Anhui Medical University were included in this study. The patients were divided into groups based on the Lp(a) concentration and LVEF (reduced ejection fraction group: < 50%; normal ejection fraction group: ≥ 50%). Then, correlations between the Lp(a) level and LVEF, as well as the impact of Lp(a) on mortality, were assessed.ResultsThis study included 436 patients with MI. The Lp(a) level and LVEF were significantly and negatively correlated (r = -0.407, β = -0.349, P < 0.001). The area under the receiver operating characteristic curve (ROC) indicated that an Lp(a) concentration > 455 mg/L was the best predictive value for reduced ejection fraction (AUC: 0.7694, P < 0.0001). The clinical endpoints did not differ based on the Lp(a) concentration. However, all-cause mortality and cardiac mortality differed based on LVEF.ConclusionsThese results suggest that an elevated Lp(a) concentration predicts reduced ejection fraction and that LVEF predicts all-cause mortality and cardiac mortality in patients with MI.

Apical but not basal RV strain reflects right ventricular dysfunction in patients with dilated cardiomyopathy

BackgroundRV dysfunction is an important predictor of morbidity and mortality in cardiac patients, especially those having dilated cardiomyopathy (DCM). Deformation imaging parameters (strain and strain rate) are established as new echocardiographic measures that allow for both global and regional RV function assessment. Previous studies showed that heterogeneous segmental deformation affects global RV function differently in various disease states. Echo-Doppler parameters of RV and LV function including RV global longitudinal strain, basal & apical RV strain, LV ejection fraction and LV global longitudinal strain were evaluated in 42 DCM patients & 28 normal subjects, aiming to assess the value of apical versus basal RV strain in detection of RV dysfunction in patients with dilated cardiomyopathy.ResultsDCM patients had significantly lower values of both RV global longitudinal strain and apical RV strain compared to normal subjects (p < 0.001). Basal RV strain did not significantly differ in DCM from normal. The apical RV strain correlated significantly with RV global longitudinal strain, LV ejection fraction and LV global longitudinal strain (p < 0.001 for all). Using ROC curve, a cut-off value of apical RV strain ≤ 29.5 distinguished RV dysfunction from normal with 91.2% sensitivity & 100% specificity.ConclusionsRV apical but not basal strain reflects the status of RV function, and it represents a valuable measure to diagnose RV dysfunction in patients with DCM.

Decision Support System for Predicting Mortality in Cardiac Patients Based on Machine Learning

Researchers have proposed several automated diagnostic systems based on machine learning and data mining techniques to predict heart failure. However, researchers have not paid close attention to predicting cardiac patient mortality. We developed a clinical decision support system for predicting mortality in cardiac patients to address this problem. The dataset collected for the experimental purposes of the proposed model consisted of 55 features with a total of 368 samples. We found that the classes in the dataset were highly imbalanced. To avoid the problem of bias in the machine learning model, we used the synthetic minority oversampling technique (SMOTE). After balancing the classes in the dataset, the newly proposed system employed a χ2 statistical model to rank the features from the dataset. The highest-ranked features were fed into an optimized random forest (RF) model for classification. The hyperparameters of the RF classifier were optimized using a grid search algorithm. The performance of the newly proposed model (χ2_RF) was validated using several evaluation measures, including accuracy, sensitivity, specificity, F1 score, and a receiver operating characteristic (ROC) curve. With only 10 features from the dataset, the proposed model χ2_RF achieved the highest accuracy of 94.59%. The proposed model χ2_RF improved the performance of the standard RF model by 5.5%. Moreover, the proposed model χ2_RF was compared with other state-of-the-art machine learning models. The experimental results show that the newly proposed decision support system outperforms the other machine learning systems using the same feature selection module (χ2).

Outcomes of Preprocedural Pulmonary Hypertension on All-Cause and Cardiac Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review.

Patients with symptomatic aortic stenosis (AS) commonly have an associated finding of pulmonary hypertension (PH), and it has been previously shown to have increased morbidity and mortality following surgical aortic valve repair (SAVR) as well as transcatheter aortic valve implantation (TAVI). There are no guidelines stating the cut-off point for PH at which the patient can safely undergo TAVI with benefits outweighing the risks. This is partly due to the lack of uniformity in the PH definition used in various studies. This systematic review sought to study the effect of preprocedural pulmonary hypertension on early and late all-cause and cardiac mortality in patients undergoing TAVI.We performed a systematic review of studies comparing patients with AS undergoing TAVI having PH. The review was undertaken as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were identified from PubMed, Pubmed Central (PMC), Cochrane, and Medline on January 10, 2022, for literature published until January 10, 2022. MeSH strategy was used on PubMed to search the literature, and filters were applied to search only Observational Studies, randomized controlled trials(RCT), and meta-analysis.A total of 170 unique articles were identified and screened. Of the 33 full-text articles that were reviewed, 18 articles, including duplicates, were excluded. Fifteen articles fulfilled the selection criteria and were included in this review. The study design included two meta-analyses, one randomized control trial, one prospective cohort study, and 11 retrospective cohortstudies.The studies involved a total of approximately 30,000 patients. The observational studies in our review were of good to fair quality, the RCT had a low to moderate bias, and the meta-analysis was of moderate quality. Baseline PH and persistence of PH post-TAVI are strongly associated with all-cause and cardiac mortality. Few studies have shown that a decrease in post-TAVI PH carries mortality benefits. Therefore, efforts should be made to identify mechanisms of persistent PH post-TAVI and whether interventions to reduce PH pre-TAVI will have any clinical implications or not by conducting RCT.

Effect of antipsychotic use by patients with schizophrenia on deceleration capacity and its relation to the corrected QT interval

ObjectiveSchizophrenia patients treated with antipsychotics are at higher risk of sudden cardiac death. Decreased deceleration capacity (DC) of the heart rate is an accurate predictor of cardiac mortality. We evaluated the risk of sudden cardiac death due to antipsychotic use by assessing DC and examining the association between DC and the corrected QT interval (QTc) in schizophrenia patients. MethodsWe measured the DC and QTc of 138 schizophrenia patients. We then compared the DC of 86 age- and sex-matched healthy controls with that of 86 schizophrenia patients. We investigated the correlation of DC of approximately 138 schizophrenia patients with prescribed doses of antipsychotics using linear regression analysis. We compared the DC of schizophrenia patients with and without prolonged QT intervals. ResultsWe found DC significantly differed between schizophrenia patients on antipsychotic medication and healthy controls. Additionally, DC was negatively correlated with antipsychotic use, especially chlorpromazine, zotepine, olanzapine and clozapine, in a dose-dependent manner. There was no significant association between DC and the QTc. ConclusionAssessing DC could facilitate monitoring and identification of increased risk of cardiac mortality in patients with schizophrenia that take antipsychotics. Assessing both DC and the QTc may enhance the accuracy of predicting sudden cardiac death.

Gallstone disease and the risk of cardiac mortality in patients with acute coronary syndrome.

Gallstone disease is a common gastrointestinal disorder, which has previously been reported to be associated with the incidence of cardiovascular disease. We aimed to investigate the association between gallstone disease and long-term outcomes in patients with acute coronary syndrome (ACS). A total of consecutive 13,975 ACS patients were included in this analysis. Gallstone disease in our study included both gallstones and cholecystectomy. The primary endpoint was cardiac mortality. The secondary outcome was all-cause mortality. Relative risks were estimated using Cox proportional hazards regression. During a median follow-up period of 2.96 years, 518 (4.2%) patients without gallstone disease and 62 (3.6%) patients in those with gallstone disease suffered cardiac death. After multivariable adjustment for established risk factors, subjects with gallstone disease had decreased risks of both cardiac mortality and all-cause mortality [hazard rate ratios (HR) = 0.72, 95% CI: 0.55-0.95 and HR = 0.75, 95% CI: 0.62-0.90, respectively]. In patients with performed cholecystectomy, the associations between gallstones and risks for cardiac mortality and all-cause mortality turned out to be non-significant. HRs varied across subgroups depending on the presence of selected established risk factors. Presence of gallstone disease was associated with a significantly decreased risk of follow-up mortality in patients with ACS.

Determinants of Mortality in Adult Patients after Open Heart Surgery in Duhok City-kurdistan Region

Introduction: Despite improvements in the techniques and perioperative management in modern cardiac surgeries avoidable deaths still occur. In this regard, we aimed to determine the main causes of death following adult heart surgery and identify the most associated factors. Patients and Methods: In this case-control study, the medical records of the patients who died (n=50) or survived open heart surgery (n=80) were used at Azadi Heart Center in Duhok city in the period between January 1, 2016, and December 31, 2020. Results: The most common causes of mortality in cardiac patients were cardiogenic shock (26%) cardiac arrest (24%), renal failure (18%), septic shock (12%), CVA (6%), and cardiac events. The most associated factors were advanced age (P&lt;0.000), occupation (P=0.007), hypertension (P=0.013), hyperlipidemia (P=0.013), heart failure (P=0.020), preoperative low ejection fraction (P=0.002), preoperative elevated renal function (P=0.015), type and timing of surgery (P=0.010, 0.023) for each, type of valve used (P=0.023), type of CABG (P=0.009), prolonged duration of bypass and aortic cross-clamp time (P&lt;0.000, 0.000) for each, intraoperative event (P&lt;0.000), duration of intubation and need for re-intubation (P&lt;0.0001,0.0001) for each, need for inotropic agents (P&lt;0.000), post-operative elevated renal function and WBC (P&lt;0.000,0.000) respectively, need for re-admission (P&lt;0.000), postoperative complications(cardiac P=0.031, chest P=0.039, wound P=0.031, neurological P=0.007, renal P&lt;0.000, and arrhythmia P&lt;0.000), and prolonged both ICU and overall hospital stay (P&lt;0.000,0.000) for each. Conclusion: This study showed that several general, pre-operative, intra-operative, and post-operative factors are associated with the mortality of cardiac patients

Abstract 10593: Resting Energy Expenditure is an Important Factor to Predict Cardiac Mortality in Chronic Heart Failure

Introduction: Parameters derived from cardiopulmonary exercise testing (CPET) with respiratory gas analyzer are important prognostic factors in patients with chronic heart failure (CHF). However, all patients with CHF cannot undergo CPET for reasons such as frailty and comorbidity. On the other hands, resting energy expenditure (REE) derived from respiratory gas analyzer can be easily measured in most patients with CHF, but clinical significance of this parameter had not been fully elucidated in patients with CHF. Aims: We aimed to determine the clinical importance including the prognostic impact of REE in patients with CHF. Methods: A total of 1185 consecutive CHF patients who underwent CPET were enrolled. REE was calculated by Weir's formula (3.941resting oxygen consumption (VO 2 )+1.106resting carbon dioxide production (VCO 2 )). The study population was divided into two groups according to median REE and we compered the clinical characteristics between two groups. Also, we examined the value of REE to predict cardiac mortality in CHF patients. Results: In all subjects, 966 were males, median age was 63 years. Median resting VO 2 was 236 ml/min, median resting VCO 2 was 222 ml/min and median REE was 1178 kcal/day. Patients with low REE (&lt;1178 kcal/day) were older and had higher prevalence of female and anemia, lower body mass index (BMI), more impaired renal function, lower parameters of nutrition such as serum total protein and albumin, higher levels of plasma type-B natriuretic peptide, lower resting VO 2 , lower resting VCO 2 and lower peak VO 2 than those with high REE (&gt;1178 kcal/day). But left ventricular ejection fraction was similar between two groups. Patients with low REE had significantly higher rates of cardiac death, all cause death and composite cardiac event (cardiac death and re-hospitalization due to worsening heart failure). Furthermore, REE was the independent predictor of cardiac death, all-cause death and composite cardiac events in the Cox proportional hazard analysis after adjusted cofounding variables including peak VO 2 . Conclusions: REE as well as peak VO 2 is important predictor of cardiac mortality in patients with CHF.

Abstract 11777: The Prognostic Impact of Living Alone on Long-Term Cardiac Mortality in Patients With Chronic Coronary Syndrome After Percutaneous Coronary Intervention

Background: It has been reported that social frailty is associated with increased mortality in elderly patients with heart failure. However, the prognostic impact of social frailty on mortality in ischemic heart disease is unclear. Here we examined the relationship between living alone, which is one of the criteria for social frailty, and long-term mortality in patients with chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI). Methods and Results: Consecutive 830 patients with CCS who underwent PCI were enrolled. Patients were divided into two groups according to whether they lived alone or not at the time of discharge. We compared clinical characteristics between two groups and followed cardiac mortality. Patients living alone were younger (66.3 vs. 69.9 years, P = 0.002). The prevalence of comorbidities such as hypertension, diabetes, dyslipidemia, chronic kidney disease, anemia, atrial fibrillation, heart failure, stroke and peripheral artery disease were comparable between two groups. In addition, the rates of medications such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, statins and anti-thrombotic agents did not differ between two groups. In the Kaplan-Meier analysis (mean follow-up period of 1703.9 days), cardiac mortality was significantly higher in the group of patients who were living alone than those who were not (P = 0.008). In the multivariable Cox proportional hazard analyses after adjusting for confounding factors, living alone was an independent predictor of cardiac mortality (hazard ratio 2.44, 95% confidence interval 1.25 - 4.74, P = 0.009). Subgroup analysis which was performed adjusting for interactions between living alone and clinically important variables revealed no interactions. Conclusion: Among CCS patients who underwent PCI, living alone was associated with long-term cardiac mortality regardless of other comorbidities and medications.

Increased Soluble Epoxide Hydrolase Activity Positively Correlates with Mortality in Heart Failure Patients with Preserved Ejection Fraction: Evidence from Metabolomics.

The online version contains supplementary material available at 10.1007/s43657-022-00069-8.

Impact of Nonobstructive Left Main Coronary Artery Atherosclerosis on Long-Term Mortality

BackgroundAlthough the presence of severe stenosis in the left main coronary artery (LMCA) is a well-established predictor of mortality, whether this extends to nonobstructive atherosclerosis in the LMCA is unknown. ObjectivesThe aim of this study was to evaluate the association between LMCA disease by intravascular ultrasound (IVUS) and long-term mortality. MethodsBetween 2005 and 2013, 3,239 patients with LMCA IVUS imaging without LMCA revascularization (either before angiography or scheduled based on index angiography or IVUS) were included. The primary and secondary endpoints were all-cause and cardiac mortality at a minimum of 5 years obtained from the National Death Index. ResultsThe IVUS-measured LMCA minimum lumen area (MLA) and plaque burden were 13.1 ± 5.0 mm2 and 41.7% ± 15.6%, respectively. The median follow-up was 8.2 years. The Kaplan-Meier estimated 12-year all-cause and cardiac death rates were 37.5% and 17.0%, respectively. Greater plaque burden (unadjusted HR per 10%: 1.17; 95% CI: 1.12-1.22; P < 0.0001) and smaller IVUS MLA (unadjusted HR per 1 mm2: 0.98; 95% CI: 0.96-0.99; P = 0.0008) were associated with all-cause death. After adjusting for clinical, angiographic, and IVUS factors, plaque burden (adjusted HR per 10%: 1.12; 95% CI: 1.04-1.21; P = 0.003) but not MLA (adjusted HR per 1 mm2: 1.02; 95% CI: 0.99-1.04; P = 0.18) was associated with long-term all-cause death. These findings were also consistent for long-term cardiac mortality. ConclusionsIn the present large-scale study with a 12-year follow-up, increasing LMCA plaque burden was associated with long-term all-cause and cardiac mortality in patients not undergoing LMCA revascularization, even when the lumen area was preserved.

Impact of atrial fibrillation in clinical outcomes of low gradient aortic stenosis

Abstract Introduction Aortic stenosis (AS) is the most common significant valvular heart disease in developed countries. A significant portion of the AS populations have low-gradient AS (LGAS), defined as aortic valve area ≤1.0 cm2 and a trans-aortic mean systolic gradient and peak velocity &amp;lt;40 mmHg and &amp;lt;4 m/s, respectively. LGAS has been shown previously to have worse mortality compared to high-gradient AS (HGAS). Atrial fibrillation (AF) is associated with LGAS and AF has been associated with worse outcomes compared to sinus rhythm (SR) in HGAS. The prognostic impact of AF in LGAS is not well described in previous literature. Hypothesis AF will be associated with worse clinical outcomes compared to SR in patients with LGAS. Methods 3400 patients diagnosed with LGAS from 2010–2020 were retrospectively identified and analyzed. Their electrical rhythm was analyzed at the time of their echocardiographic diagnosis of LGAS and patients were split into 3 separate groups: SR (n=2036), SR with history of AF (n=519), and AF (n=845). After adjustment for age, sex, and Charlson Comorbidity Index (CCI), primary endpoints of overall mortality and cardiac mortality were assessed for patients. Results Compared to those with SR, patients with AF and history of AF had significantly higher overall mortality (HR 1.52, p&amp;lt;0.0001 and HR 1.22, p=0.004, respectively) and cardiac mortality (HR 2.05, p&amp;lt;0.0001 and HR 1.37, p=0.03, respectfully) (Figure 1). On further sub group analysis, AF seemed to be most importantly associated with mortality and cardiac mortality in patients with preserved ejection fraction (EF &amp;gt;50%, normal flow LGAS) compared to those patients with reduced EF (classical low-flow LGAS), where there was no statistically significant difference in outcomes between AF and SR (Figure 2). Conclusions Atrial fibrillation, compared to sinus rhythm, is associated with worse overall mortality and cardiac mortality in patients with LGAS and preserved EF. Specifically, this association was strongest in patients with preserved EF &amp;gt;50%. Given these findings, the presence of AF should be factored into clinical decision making regarding LGAS management given the higher risk of age, sex, and CCI adjusted overall and cardiac mortality. Further research needs to be done to see if earlier aortic valve intervention in these patients would improve mortality compared to their SR counterparts. Funding Acknowledgement Type of funding sources: None.