Cardiovascular Mortality In Patients Research Articles

Association of Geriatric Nutritional Risk Index Scores with Outcomes in Patients Undergoing Maintenance Hemodialysis.

Aims/Background The Geriatric Nutritional Risk Index (GNRI) is an effective tool for identifying malnutrition, and helps monitor the prognosis of patients undergoing maintenance hemodialysis. However, the association between the GNRI and cardiovascular or all-cause mortality in hemodialysis patients remains unclear. Therefore, this study investigated the correlation of the GNRI with all-cause and cardiovascular mortality in patients undergoing maintenance hemodialysis. Methods This study included 402 incident hemodialysis patients. Based on the first-dialysis GNRI quartile, the patients were divided into four groups: N1 (GNRI ≤85.04), N2 (GNRI 85.05-91.04), N3 (91.05-96.49), N4 (GNRI ≥96.5) groups. The risk of all-cause and cardiovascular mortality among the different GNRI groups was compared using the Kaplan-Meier survival curve analysis through log-rank tests. Furthermore, Cox regression analysis was used to assess the association between the GNRI groups and all-cause mortality. Additionally, the predictive capability of the GNRI groups on the prognosis was evaluated by employing receiver operating characteristic (ROC) curve analysis. Results Patients in the N1 group exhibited a significantly higher risk of all-cause mortality (p < 0.001) and cardiovascular mortality (p = 0.004) compared to the other groups. ROC curve analysis revealed that GNRI, age, and serum creatinine had moderate predictive value for mortality, with GNRI indicating an area under the curve (AUC) of 0.605 for all-cause mortality and 0.565 for cardiovascular mortality. Moreover, the N2 and N3 groups had a significantly reduced risk of cardiovascular mortality compared to the N1 group. Conclusion A lower GNRI is closely associated with a higher risk of all-cause and cardiovascular mortality in hemodialysis patients.

Body roundness index as a predictor of all-cause and cardiovascular mortality in patients with diabetes and prediabetes.

There are limited population-based studies examining the correlation between body roundness index (BRI) and mortality in diabetes and prediabetes patients. Our final analysis encompassed 15,848 patients with diabetes and prediabetes sourced from the National Health and Nutrition Examination Survey(NHANES) spanning from 2003 to 2018. Cox proportional hazards model and restricted cubic splines (RCS) were utilized to assess the correlation between BRI and both all-cause mortality and cardiovascular mortality. During an average follow-up period of 92.9 months, 2655 participants (12.73 %) died, including 730 (3.44 %) from cardiovascular diseases. RCS demonstrated a U-shaped nonlinear association between BRI with all-cause mortality and cardiovascular mortality, with threshold values of 5.54 and 5.21, respectively. When BRI was below the threshold, a negative correlation was observed between BRI and all-cause mortality (HR 0.87, 95 % CI 0.81-0.93).The correlation with cardiovascular mortality is not significant. Conversely, when BRI was above the threshold, a positive correlation was observed between BRI with all-cause mortality (HR 1.10, 95 % CI 1.06-1.14) and cardiovascular mortality (HR 1.13, 95 % CI 1.07-1.20). Our research indicates that among US adults with diabetes or prediabetes, BRI exhibits a U-shaped relationship with all-cause and cardiovascular mortality, with threshold values of 5.54 and 5.21, respectively.

Associations Between Frailty and Risk of All-Cause and Cardiovascular Mortality in Patients with Prediabetes: A Population-Based Study.

Diabetes is a well-known risk factor for frailty that has been associated with adverse prognosis. However, the association of frailty with all-cause and cardiovascular disease (CVD) mortality in patients with prediabetes has not been thoroughly explored. Participants with prediabetes were derived from the 1999-2018 National Health and Nutrition Examination Survey and followed up for all-cause and CVD mortality until December 31, 2019. A frailty index calculated using a 49-item deficit accumulation model > 0.21 was used to indicate the presence of frailty. Kaplan-Meier curves and weighted Cox proportional hazards regression were used to assess the association between frailty and mortality. The weighted prevalence of frailty was 28.21% in this cohort of 7845 prediabetic participants with a mean age of 62.89 years. During a median follow-up time of 90 months, a total of 1983 all-cause (636 CVD-related) deaths occurred. Each 0.01 score increase in the frailty index was associated with a 5% and 6% increased risk of all-cause and CVD-related mortality, respectively. The hazard ratio and 95% confidence interval for all-cause and CVD mortality in the frailty group were 2.28 (1.89-2.76) and 2.84 (2.01-4.02), respectively, compared with those without frailty. Restricted cubic spline analysis showed a linear association between frailty index and all-cause or CVD mortality. Similar results were observed in the sensitivity analyses. The frailty index was positively associated with all-cause and CVD mortality in participants with prediabetes, highlighting that appropriate screening and management of frailty may help reduce mortality in patients with prediabetes.

Assessing the predictive power of nutritional indices on all-cause and cardiovascular mortality in hemodialysis patients: a longitudinal study

Background and Hypothesis The prognostic value of nutritional scoring tools in assessing the relationship between nutritional status and prognosis in hemodialysis patients is unclear. This multicenter retrospective cohort study compared the Prognostic Nutritional Index (PNI), Controlling Nutritional Status scores (CONUT), and Geriatric Nutritional Risk Index (GNRI) for predictive accuracy of all-cause and cardiovascular mortality, especially the impact of dynamic changes over time on prognosis. Methods Hemodialysis patients from four hospitals were included. Laboratory data and nutrition scores were collected at the initiation of dialysis, and at 6th, 12th, and 18th months after dialysis initiation. A joint model analyzed the relationship between dynamic nutritional scores and prognosis. Predictive values were assessed using the area under the curve (AUC). Results The study included 863 patients with a median follow-up of 37 months. During the follow-up, 23.8% of patients died, with 14% attributed to cardiovascular causes. Malnourished patients demonstrated higher risks for all-cause and cardiovascular mortality. Dynamic changes in PNI and GNRI scores were significantly associated with reduced all-cause and cardiovascular mortality risks. Precisely, longitudinal increases in PNI and GNRI scores corresponded to a 4% and 3% reduction in all-cause (PNI: HR, 0.96; 95% CI, 0.95–0.98; GNRI: HR, 0.97; 95% CI, 0.96–0.98) and cardiovascular mortality risk (PNI: HR, 0.96; 95% CI, 0.94–0.98; GNRI: HR, 0.97; 95% CI, 0.95–0.98) respectively, with longer dialysis duration. Changes in CONUT scores were not significantly associated with either all-cause or cardiovascular mortality. The AUCs of the three joint models indicated that the GNRI score (0.893) possessed higher predictive accuracy for all-cause mortality compared to PNI (0.832) and CONUT (0.852). Similar trends were observed for cardiovascular mortality. Conclusion Nutritional scores and their dynamic changes are intimately associated with mortality risk in hemodialysis patients. Compared to PNI and CONUT, the baseline GNRI and its post-dialysis variations demonstrate a superior predictive capability for all-cause and cardiovascular mortality in these patients.

Long-term Cardiovascular and All-Cause Mortality following Elective Infrarenal Repair of the Abdominal Aortic Aneurysm: A Systematic Review and Meta-analysis

Background: Patients with abdominal aortic aneurysms (AAAs) have poor survival rates after aneurysm repair compared with the general population, potentially due to increased cardiovascular risk. This systematic review and meta-analysis aimed to assess the long-term incidence of all-cause and cardiovascular mortality after elective, infrarenal AAA repair. Method: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed (PROSPERO ID: CRD42022344547). Studies published in PubMed, Web of Science, and COCHRANE databases between January 2013 and May 2023 with a mean follow-up time of ≥5 years were included. A weighted linear regression analysis was performed to determine the annual incidence of all-cause and cardiovascular mortality five years after AAA repair. A random effects model calculated the overall incidence rates per 1000 person-years (PY). Endovascular aneurysm repair (EVAR) and open surgical repair (OSR) were compared. Results: Nineteen studies with 84 212 patients (mean follow-up: 68.9 [±13.3] months) were included. Common preoperative cardiovascular comorbidities included hypertension (74.4%), dyslipidemia (43.6%), and coronary artery disease (27.6%). At five years, the mean all-cause mortality was 29.78%, and cardiovascular mortality was 11.98%, with an annual increase of 6.59% and 2.46%, respectively (R2=0.809, p&lt;0.001 and R2=0.824, p&lt;0.001). The random effects model showed an all-cause mortality rate of 62.99 events (95% CI=57.53–68.96; I2=93%) per 1000 PY and a cardiovascular mortality rate of 24.19 events per 1000 PY (95% CI=21.69–26.98; I2=66%). Patients undergoing an EVAR had a significant higher incidence of all-cause and cardiovascular mortality than patients undergoing an OSR (B-coefficient 4.10 and 2.39, both p&lt;0.001, respectively). Conclusion: The long-term all-cause and cardiovascular mortality remain high following elective, infrarenal AAA repair. These findings highlight a much needed optimization and emphasis of cardiovascular risk management, to minimize the long-term incidence of cardiovascular mortality in patients with AAA following surgical intervention. Clinical Impact This study evaluated the long-term outcomes of cardiovascular and all-cause mortality rates following elective repair of the infrarenal abdominal aortic aneurysm. The results of this systematic review and meta-analysis emphasizes the suboptimal cardiovascular risk profile observed in this patient population. Futhermore, it highlights the importance of optimization and emphasis of cardiovascular risk management, including in the long-term after surgical intervention.

O-GlcNAc transferase promotes vascular smooth muscle calcification through modulating Wnt/β-catenin signaling.

Vascular calcification (VC), associated with high cardiovascular mortality in patients with chronic kidney disease (CKD), involves osteogenic transdifferentiation of vascular smooth muscle cells (VSMCs). O-GlcNAcylation, a dynamic post-translational modification, is closely linked to cardiovascular diseases, including VC. However, the exact role and molecular mechanism of O-GlcNAc signaling in abnormal mineral metabolism-induced VC remain unclear. In the current study, we found that the levels of O-GlcNAc transferase (OGT) and global protein O-GlcNAcylation were significantly upregulated in the artery tissues of mouse calcification models and CKD patients with VC. To further delineate the invivo role of OGT in VC, we generated Ogt smooth muscle cell-specific knockout mice and challenged them with 5/6 nephrectomy (5/6 Nx) or high-dose vitamin D3 to induce VC. Deletion of Ogt in VSMCs led to alleviated VC in response to 5/6 Nx or VD3. Moreover, elevated O-GlcNAcylation, induced by Thiamet-G, facilitated osteogenic transdifferentiation in VSMCs in response to phosphate, whereas OSMI-1, which reduces O-GlcNAcylation, exhibited an opposite phenotypic effect. Mechanistically, O-GlcNAc signaling enhanced the osteogenic conversion of VSMCs through regulation of canonical Wnt/β-catenin pathway. Indeed, β-catenin was O-GlcNAcylated by OGT and further increased its transcriptional activity in VSMCs. Furthermore, pharmacological activation of Wnt/β-catenin signaling largely reversed the diminished aortic calcification caused by Ogt ablation. Our findings demonstrate that smooth muscle O-GlcNAc signaling plays an important role in regulating hyperphosphatemia-induced VC and reveal that O-GlcNAcylation of β-catenin protein modulates its content and activity in VSMCs.

All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease.

Steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB). However, the effects of metabolic dysfunction-associated SLD (MASLD) on the long-term survival of such patients remain unknown. Accordingly, this study investigated the mortality risks in patients with CHB and concurrent SLD. Consecutive patients with CHB and concurrent SLD were retrospectively recruited at National Taiwan University Hospital. MASLD was defined by the presence of cardiometabolic risk factors (CMRF). The cumulative incidences of all-cause and cause-specific mortality were compared. A total of 8,718 patients with CHB and concurrent SLD were included from 2006 to 2021. At baseline, the MASLD group (n=6,562) was older and had a lower proportion of hepatitis B e antigen positivity and lower hepatitis B virus DNA levels compared with the non-MASLD group (n=2,156). After a median follow-up period of 9.1 years, the MASLD group exhibited a higher risk of all-cause mortality compared with the non-MASLD group (adjusted hazard ratio [aHR]: 1.79, 95% confidence interval [CI]: 1.24-2.58, p=0.002). Furthermore, cumulative CMRF dose-dependently elevated the risks of all-cause, liver-related, and cardiovascular mortality (all p<0.05). During the follow-up period, new-onset diabetes mellitus, hypertension, and significant weight gain further increased the risks of all-cause and liver-related mortality (all p<0.05). However, patients with SLD had a lower mortality risk than non-SLD patients after propensity score matching (HR: 0.62, 95% CI: 0.53 - 0.74, p<0.001). Among patients with CHB and SLD, metabolic burden dose-dependently increases the all-cause, liver-related, and cardiovascular mortality risks. Patients with SLD have a lower mortality risk than those without SLD. Identifying these metabolic dysfunctions is crucial for stratifying the level of risk in daily care. Concurrent steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB); however, the effects of the associated cardiometabolic risk factors on all-cause and cause-specific mortality remain unknown. This study demonstrated that cumulative metabolic burden dose-dependently increased the risks of all-cause, liver-related, and cardiovascular mortality in patients with CHB and SLD. Moreover, new-onset diabetes mellitus, hypertension, and weight gain during the follow-up period further exacerbated these risks. However, patients with SLD had a lower risk of mortality than those without SLD. Thus, routine screening and monitoring of metabolic dysfunctions constitute a key element of daily care for patients with CHB.

Cardiovascular Effect of Drugs Used to Treat Alzheimer's Disease.

This review examines the cardiovascular effects of the mainstay drugs used to treat Alzheimer's disease (AD), namely cholinesterase inhibitors (ChEIs) and memantine. ChEIs represent the current first-line treatment for AD. Memantine is typically reserved for moderate to severe AD. Conventionally, ChEIs are thought to increase vagal tone, resulting in an increased risk of cardiac side effects such as bradycardia. However, emerging evidence suggests that ChEIs may offer a protective role on overall cardiovascular mortality in patients with dementia. Similarly, memantine, which is an N-methyl-D-aspartate receptor antagonist, has demonstrated cardioprotective properties in animal studies, raising the question of its clinical applications. Recently, aducanumab and lecanemab, antiamyloid-β monoclonal antibodies that aim to slow the progression of disease, have been Food and Drug Administration-approved for the treatment of AD. This review explores the current evidence regarding potential cardiovascular risks and protective effects of ChEIs and memantine in the treatment of AD, as well as the cardiovascular effects of aducanumab and lecanemab.

Association of Hypokalemia With Mortality in Patients Undergoing Hemodialysis: A Systematic Review and Meta-Analysis.

Potassium imbalance, particularly hypokalemia, is a critical risk factor for adverse outcomes in patients undergoing hemodialysis (HD). However, the association between hypokalemia and mortality is unclear. For this systematic review and meta-analysis, we assessed the association between hypokalemia and mortality in patients undergoing HD. We performed a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Scopus) to identify relevant studies published up to April 2024. Eligible studies were prospective or retrospective cohort studies reporting hazard ratios (HRs) for mortality in association with the presence of hypokalemia among patients undergoing HD. We used the assessed study Newcastle-Ottawa Scale to assess quality of the selected studies. We carried out both qualitative and quantitative assessments. For the meta-analysis, we pooled the HRs for all-cause and cardiovascular mortalities. The overall pooled HR for all-cause mortality and cardiovascular mortality were 1.34 (95% CI, 1.15, 1.55) and 1.49 (95% CI, 1.12, 1.98), respectively, indicating significant associations between hypokalemia and all-cause mortality and cardiovascular mortality in patients undergoing HD. Additionally, we conducted subgroup analyses based on study design, geographical location, type of dialysis, and serum potassium levels. Our findings provide robust evidence of a significant association between hypokalemia and mortality in patients undergoing HD. Early detection and proactive management of hypokalemia are crucial for improving outcomes and reducing mortality risk in these patients.

Association of liver fibrosis scores with all-cause and cardiovascular mortality in patients with heart failure.

The aim of this study was to examine the relationship of liver fibrosis (determined via fibrosis scores) with all-cause mortality and cardiovascular mortality in HF patients. The study examined demographic and clinical data were collected from NHANES database (1999 to 2018). A total of 1356 HF patients were enrolled in our analysis. During a median follow-up time of 70 months, 455 patients died. Compared to the survivors, the death group showed significantly elevated LFSs levels. RCS analysis revealed a linear relationship between various LFSs and all-cause and cardiovascular mortality. KM curves and Cox regression models indicated that higher FIB-4 (≥ 1.637), NFS (≥ -0.064), and AST/ALT ratio (≥ 1.172) were linked to higher risk of all-cause mortality [Cox model 2: FIB-4 adjusted hazard ratio (aHR), 1.24; 95% CI, 1.04-1.48; NFS aHR, 1.19; 95% CI, 1.01-1.38; AST/ALT ratio aHR, 1.25; 95% CI, 1.07-1.47] and cardiovascular mortality in heart failure patients (FIB-4 aHR, 1.28; 95% CI, 1.07-1.67; AST/ALT ratio aHR, 1.39; 95% CI, 1.08-1.79). ROC curves indicated that FIB-4, NFS, and the AST/ALT ratio were important predicators of all-cause mortality (AUC: 0.715, 0.707, and 0.715, respectively) and cardiovascular mortality (AUC: 0.658, 0.657, and 0.659, respectively) in heart failure patients. Random survival forests showed that FIB-4, AST/ALT ratio, and NFS emerged as important factors potentially influencing mortality of HF. Consistent associations were observed in subgroup analysis. Liver fibrosis scores (FIB-4, NFS, and AST/ALT ratio) were strongly linked to all-cause and cardiovascular mortality in heart failure patients.

Estimating cardiovascular mortality in patients with hypertension using machine learning: The role of depression classification based on lifestyle and physical activity.

This study aims to harness machine learning techniques, particularly the Random Survival Forest (RSF) model, to assess the impact of depression on cardiovascular disease (CVD) mortality among hypertensive patients. A key objective is to elucidate the interplay between mental health, lifestyle, and physical activity while comparing the effectiveness of the RSF model against the traditional Cox proportional hazards model in predicting CVD mortality. Data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2014 were used for comprehensive depression screening. The Patient Health Questionnaire-9 (PHQ-9) was employed to categorize depression severity levels among participants. The final cohort included 9271 participants, selected after excluding those with incomplete data. Participants were followed up for a median of 7.1years, and cardiovascular mortality was assessed up to December 31, 2019. We employed the RSF model to predict cardiovascular mortality with high effectiveness and precision. And to ensure comparability, we developed the traditional Cox proportional hazards model using the same set of predictors. RSF model outperformed the Cox proportional hazards model in predicting cardiovascular mortality among hypertensive patients with varying depression levels. The RSF model's integrated area under the curve (iAUC) scores were 0.842, 0.893, and 0.760 for none, mild, and severe depression, respectively, surpassing the Cox model's scores of 0.826, 0.805, and 0.746. The RSF model provides a more accurate prediction of CVD mortality among hypertensive patients with varying degrees of depression, offering a valuable tool for personalized patient care. Its ability to stratify patients into risk categories can assist healthcare professionals in making informed decisions, underscoring the potential of machine learning in public health and clinical settings. This model demonstrates particular utility in settings where detailed, patient-specific risk assessments are critical for managing long-term health outcomes. Future research should focus on external validation and integration of more diverse variables to enhance predictive power.

Transfusion Requirements for Severe Anemia in Acute Cardiovascular Patients-A Single Center Retrospective Study in Constanta County Cardiology Department.

Background: Anemia is common in hospitalized cardiac patients and affects prognosis and cardiovascular mortality in patients with acute decompensated heart failure. Aim: to investigate the impact of anemia severity, blood transfusion practices, and the evolution and outcome in patients with acute cardiovascular events. Methods: We performed a retrospective analysis of the patients hospitalized in the Cardiology Department of Constanta County Hospital who required blood derivatives transfusions, between 1 January 2021 and 31 December 2021. Results: Out of the total 270 patients, 170 received a single unit of resuspended erythrocyte concentrate within the same month, while 100 required multiple transfusions, receiving between 2 and 5 units during a single hospitalization, to correct anemia. Before transfusions, the mean hemoglobin (Hb) level was 7.60 g/dL, with values ranging from 6.50 g/dL to 9.10 g/dL. Men show a higher prevalence (64%) than women (36%), likely due to gender differences in susceptibility to heart conditions. Patients with associated acute or chronic renal failure consistently experience higher in-hospital mortality in all left ventricular ejection fraction (LVEF) subgroups. Conclusions: Anemia in heart failure patients is linked to worsening symptoms, decreased kidney function, and higher hospitalization and mortality rates. The findings aim to inform and optimize clinical decision making, particularly regarding transfusion strategies and risk management in this high-risk population.

The systemic immune-inflammation index and systemic inflammation response index are useful for predicting mortality in patients with diabetic nephropathy

BackgroundThis study investigated the correlation between the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) and all-cause, cardiovascular, and kidney disease mortality in patients with diabetic nephropathy (DN). It aimed to provide a new predictive assessment tool for the clinic and a scientific basis for managing inflammation in DN.MethodsThe data utilized in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) database, spanning 1999 to 2018. A total of 2641 patients diagnosed with DN were included in the analysis. The association between SII and SIRI levels and mortality in patients with DN was investigated using multivariate Cox proportional risk regression models. These relationships were further validated by Kaplan-Meier survival curves and restricted cubic spline (RCS) modeling, and subgroup analyses were performed to explore the heterogeneity among different characteristic subgroups.ResultsThe multivariate Cox regression analysis indicated that SII and SIRI levels were independently associated with all-cause mortality and cardiovascular mortality in patients with DN. SIRI levels were found to be an independently associated factor with kidney disease mortality in patients with DN. Patients in the highest quartile of SII and SIRI exhibited a 1.49-fold and 1.62-fold increased risk of all-cause mortality, respectively, compared to patients in the lowest quartile. The risk of cardiovascular mortality was 1.31 and 1.73 times higher than that in patients in the lowest quartile, respectively. The risk of kidney disease mortality in patients in the highest quartile of SIRI was 2.74 times higher than that in patients in the lowest quartile. Kaplan-Meier survival curve and RCS analyses further confirmed the positive association between SII and SIRI and mortality and a significant nonlinear relationship between SII and all-cause mortality. The SII and SIRI indices offer incremental value in model predictive power for mortality in patients with DN. Subgroup analyses demonstrated that the correlation between SII and SIRI and mortality risk was stable but heterogeneous across different subgroups.ConclusionSII and SIRI can be utilized as biomarkers for forecasting the likelihood of all-cause and cardiovascular mortality in patients with DN.

Chronic Total Occlusions in Non-Infarct-Related Coronary Arteries and Long-Term Cardiovascular Mortality in Patients Receiving Percutaneous Coronary Intervention in Acute Coronary Syndromes.

Background and aim: Patients with non-infarct-related artery chronic total occlusion (non-IRA CTO) found during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACSs) are not rare and have worse clinical outcomes. We aimed to analyze their long-term clinical outcomes in regard to clinical characteristics, revascularization strategies, and adherence to medical therapy. Patients and methods: The dual-center ACS registry of patients treated from Jan 2017 to May 2023 was used to identify 1950 patients with timely PCI in ACS who survived to discharge with documented adequate demographic, clinical, and angiographic characteristics, treatment strategies, and medical therapy adherence during a median follow-up time of 49 months. Results: There were 171 (9%) patients with non-IRA CTO. In comparison to patients without non-IRA CTO, they were older, with more diabetes mellitus (DM), higher Syntax scores (median 27.5 vs. 11.5), and lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 50% vs. 55%). There was also a lower proportion of patients with high adherence to medical therapy (32% vs. 46%). Patients with non-IRA CTO had significantly higher cardiovascular mortality during follow-up (18% vs. 8%, RR 1.87, 95% CI 1.27-2.75). After adjusting for relevant clinical and treatment characteristics in a multivariate Cox regression analysis, only lower LVEF, worse renal function, the presence of DM, and lower adherence to medical therapy were independently associated with higher cardiovascular mortality during follow-up, with low adherence to medical therapy as the strongest predictor (RR 3.18, 95% CI 1.76-5.75). Time to cardiovascular death was significantly lower in patients who did not receive non-IRA CTO revascularization, although CTO revascularization did not show independent association with survival in the multivariate analysis. Conclusions: Patients with non-IRA CTO found during ACS treatment have more unfavorable clinical characteristics, worse adherence to medical therapy, and higher cardiovascular mortality. They need a more scrutinized approach during follow-up to increase adherence to optimal medical therapy and to receive revascularization of the non-IRA CTO whenever it is clinically indicated and reasonably achievable without excess risks.

Triglyceride-glucose index and risk of all-cause and cardiovascular mortality in patients with cardiovascular disease: Analysis from 1999 to 2018 NHANES data.

This research seeks to examine the correlation between the triglyceride-glucose index and the hazard of all-cause and cardiovascular death in individuals with cardiovascular disease (CVD). By evaluating the index, we can better anticipate and assess the risk and prognosis of CVD patients, and provide precise and individualized guidance for clinical treatment and management. Demographic and clinical data of 2185 CVD patients from 10 cycles of the National Health and Nutrition Examination Survey database from 1999 to 2018 were extracted for analysis. Employed the 3-level quantile method to group data, and a multivariate Cox proportional hazard model along with subgroup analysis to study the correlation between index and both mortalities. Additionally, restricted cubic spline examination was employed to assess the correlation, aiming to enhance the comprehension of their interrelation. Over the course of an average post-observation duration of 89.5 months involving 2185 CVD individuals, 607 patients suffered from all-cause mortality and 313 patients suffered from CVD-related mortality. An inverted U-shaped correlation was identified through restricted cubic spline analysis. During the multivariate COX regression analysis, it was found that individuals in the T2 and T3 had a dramatically lower hazard of both mortalities as opposed to those in the T1. The results were overall consistent across subgroup analyses according to age, gender, race, body mass index, diabetes, and hypertension, the interaction between these characteristics and the index was not remarkable (P > .05). Studies conducted on CVD individuals in the US have revealed a U-shaped correlation between triglyceride-glucose index and hazard of both all-cause and CVD-related death. However, further investigations are required to examine the particular function of index in forecasting the prognosis of CVD individuals. This will be helpful in accurately evaluating the risk and prognosis of CVD patients, and ultimately in developing more precise and personalized treatment and management strategies.

J-shaped association of serum uric acid with all-cause and cardiovascular mortality in patients with diabetic kidney disease.

The association of serum uric acid (SUA) with mortality remains unclear in patients with diabetic kidney disease (DKD). Thus, this prospective cohort study aimed to explore the association of SUA with all-cause and cardiovascular disease (CVD) mortality among patients with DKD in a large, nationally representative sample. This cohort study included data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 and the National Death Index mortality data until 31 December 2019. The restricted cubic spline and the Cox proportional hazards regression were conducted to describe the association of SUA with all-cause and CVD mortality and evaluate potential nonlinear associations. The analysis included 3470 patients with DKD from NHANES 1999-2018. During the follow-up time of 24,633 person-years, we recorded 1489 all-cause deaths, including 542 CVD deaths. We identified a J-shaped association of SUA with all-cause and CVD mortality. The corresponding inflection points were observed at 5.1 and 5.7mg/dL. When SUA were higher than inflection points, each 1mg/dL increase in SUA was linked to a 13% and 22% higher risk of all-cause (HR: 1.13; 95% CI: 1.07-1.20;P < 0.001) and CVD (HR: 1.22; 95% CI: 1.06-1.41;P = 0.006) mortality, respectively. This study indicated the J-shaped association of SUA with all-cause and CVD mortality in patients with DKD. The corresponding inflection points were 5.1 mg/dL for all causes and 5.7mg/dL for CVD, respectively. More clinical randomized trials are needed to confirm the optimal uric acid-lowering target.

Preoperative D-dimer and outcomes in obstructive hypertrophic cardiomyopathy after myectomy

BackgroundThe prognostic significance of D-dimer in patients with hypertrophic cardiomyopathy undergoing septal myectomy has not been well established. MethodsWe retrospectively analyzed D-dimer levels in 728 patients who underwent septal myectomy at our hospital between 2009 and 2018. Baseline D-dimer levels were categorized into tertiles (<0.21, 0.21–0.3, ≥0.3 mg/L) The primary and secondary endpoints were all-cause mortality and cardiovascular mortality, respectively. Cox regression and competing risk models were used to evaluate risk factors for all-cause and cardiovascular mortality, respectively. ResultsHigher D-dimer levels were associated with older age, female sex, more severe mitral regurgitation, and elevated N-terminal pro B-type natriuretic peptide levels (P < 0.05). Over a median follow-up of 4.2 years, 31 (4.3 %) patients reached the primary endpoint; 23 deaths were attributed to cardiovascular causes. The optimal cutoff D-dimer level for predicting 5-year mortality was 0.29 mg/L. After adjusting for covariates, D-dimer levels of >0.29 mg/L were significantly associated with an increased risk of all-cause mortality (hazard ratio [HR], 3.12; 95 % confidence interval [CI], 1.42–6.86; p = 0.005) and cardiovascular mortality (HR, 3.29; 95 % CI, 1.12–9.62; p = 0.030). Body mass index and left atrial diameter were also independent predictors of both all-cause mortality (HR, 1.12; p = 0.026, and HR, 1.08; p = 0.006, respectively) and cardiovascular mortality (HR, 1.12; p = 0.043, and HR, 1.11; p = 0.004, respectively). The inclusion of D-dimer levels of >0.29 mg/L improved the net reclassification index for all-cause mortality (p = 0.016). ConclusionD-dimer is a robust predictor of mid-to-long-term all-cause and cardiovascular mortality in patients undergoing septal myectomy.

Association of serum uric acid with all-cause and cardiovascular mortality in cardiovascular disease patients

The relationship between serum uric acid (SUA) and mortality in patients with cardiovascular disease (CVD) remains controversial. We aimed to explore the relationship between SUA and all-cause mortality (ACM) and cardiovascular mortality (CVM) in adult patients with CVD. This cohort study included 3977 patients with CVD from the National Health and Nutrition Examination Survey (2005–2018). Death outcomes were determined by linking National Death Index (NDI) records through December 31, 2019. We explored the association of SUA with mortality using weighted Cox proportional hazards regression models, subgroup analysis, Kaplan-Meier survival curves, weighted restricted cubic spline (RCS) models, and weighted threshold effect analysis among patients with CVD. During a median follow-up of 68 months (interquartile range, 34–110 months), 1,360 (34.2%) of the 3,977 patients with cardiovascular disease died, of which 536 (13.5%) died of cardiovascular deaths and 824 (20.7%) died of non-cardiovascular deaths. In a multivariable-adjusted model (Model 3), the risk of ACM (HR 1.38, 95% CI 1.16–1.64) and the risk of CVM (HR 1.39, 95% CI 1.04–1.86) for participants in the SUA Q4 group were significantly higher. In patients with CVD, RCS regression analysis revealed a nonlinear association (p < 0.001 for all nonlinearities) between SUA, ACM, and CVM in the overall population and in men. Subgroup analysis showed a nonlinear association between ACM and CVM with SUA in patients with CVD combined with chronic kidney disease (CKD), with thresholds of 5.49 and 5.64, respectively. Time-dependent ROC curves indicated areas under the curve of 0.61, 0.60, 0.58, and 0.55 for 1-, 3-, 5-, and 10-year survival for ACM and 0.69, 0.61, 0.59, and 0.56 for CVM, respectively. We demonstrate that SUA is an independent prognostic factor for the risk of ACM and CVM in patients with CVD, supporting a U-shaped association between SUA and mortality, with thresholds of 5.49 and 5.64, respectively. In patients with CVD combined with CKD, the association of the ACM and the CVM with SUA remains nonlinear.

The neutrophil–lymphocyte ratio is associated with all-cause and cardiovascular mortality in cardiovascular patients

This study investigates the relationship of neutrophil–lymphocyte ratio (NLR) with the risk of all-cause and cardiovascular mortality in patients with cardiovascular disease. The data for this analysis came from 2239 participants with cardiovascular disease of the National Health and Nutrition Examination Survey conducted between 1999–2018. The optimal cutoff point for NLR was determined using maximally selected rank statistics. Survival analysis was performed using Cox regression models to assess the impact of NLR on the risk of all-cause mortality and cardiovascular mortality. Restricted cubic spline was used to visualize the association of NLR with mortality risk. Subgroup analysis was performed to examine the relationship between NLR and mortality within subgroups based on age, sex, diabetes and hypertension. During a median follow-up period of 6.7 (IQR, 3.3–10.9) years, 992 all-cause deaths occurred, including 381 cardiovascular deaths. Our study revealed that NLR is a risk factor for all-cause mortality (HR: 1.15 95%Cl: 1.11 ~ 1.19) and cardiovascular mortality (HR: 1.14 95%Cl: 1.08 ~ 1.2) among patients with cardiovascular disease. The restricted cubic spline regression analysis showed a non-linear association between NLR and all-cause mortality (p < 0.05 for nonlinearity) in cardiovascular patients. This association remained robust in subgroup analyses stratified by age, sex, diabetes, and hypertension. Conclusion NLR stands as a significant risk factor for both all-cause and cardiovascular mortality among patients with cardiovascular disease.

Left ventricular late diastolic strain rate predicts cardiovascular mortality in patients with heart failure with reduced ejection fraction

Abstract Background Left ventricular (LV) strain rate measures provide detailed information regarding LV contraction and filling pressures. These include global systolic strain rate (GSRs), early and late diastolic strain rates (GSRe and GSRa), and ratio of transmitral early filling velocity to GSRe (E/GSRe). Purpose To investigate the prognostic value of strain rate measures with regard to cardiovascular mortality in patients with heart failure with reduced ejection fraction (HFrEF). Methods The study population was retrospectively included from a HF clinic and consisted of patients with LV ejection fraction (LVEF) ≤45%. Echocardiography was obtained within 1 year of referral. The study endpoint was cardiovascular mortality, which was analysed using univariable and adjusted Cox proportional hazards models. Incremental prognostic information was assessed using Harrell’s C-index and continuous net reclassification improvement (NRI). Cubic spline analysis was used to dichotomise variables at a hazard ratio (HR) of 1 for better interpretability. Results The final study population consisted of 1160 patients with HFrEF (mean age 68±11.8 years, 72.7% male, LV ejection fraction (LVEF) 28.6±9.9%). During follow-up (median 10.1 years, IQR: 4.7-13.0), 333 (28.7%) met the outcome. Subjects who met the outcome generally had higher age and prevalence of male sex, a higher burden of comorbidities, and more severely impaired conventional echocardiographic parameters. All four strain rate measures were significantly associated with cardiovascular mortality (GSRs: HR 16.88 95% CI [8.42, 33.84] per 1 s-1 increase, GSRe: HR 0.29 [0.18, 0.47] per 1 s-1 increase, E/GSRe ratio: HR 1.31 [1.22, 1.41] per 1 unit increase, GSRa: HR 0.15 95% CI [0.23, 0.65] per 1 s-1 increase, p&amp;lt;0.0001 for all). However, only GSRa remained an independent predictor in multivariable Cox regression after adjustment for clinical risk factors including sex, age, mean arterial pressure, heart rate, body mass index, cigarette pack years, diabetes mellitus, total cholesterol, ischemic heart disease, and echocardiographic factors including LVEF, global longitudinal strain, tricuspid annular plane systolic excursion, LV mass index, LV internal diameter index, E/e’ ratio and left atrial volume index (HR 0.39 [0.23,0.65], p=0.0003). Furthermore, GSRa provided incremental prognostic information to a model containing all aforementioned parameters (Harrell’s C-index 0.789 vs. 0.792 and continuous NRI 0.158). GSRa was dichotomised at 0.5 s-1, and a Kaplan-Meier curve stratified according to this was plotted (log rank p&amp;lt;0.0001)(Figure 2). Conclusion GSRa is an independent predictor of cardiovascular mortality in patients with HFrEF after multivariable adjustment. GSRa provides incremental prognostic value over conventional echocardiographic measures in risk stratification of HFrEF patients. Our results suggest an increased risk of cardiovascular mortality associated with a GSRa below 0.5 s-1.Figure 1:Spline of HR according to GSRaFigure 2:Kaplan-Meier curve