Cardiovascular Survival Rates Research Articles

Atrial flutter/fibrillation in adult congenital heart disease: Insights from a large Asian cohort

BackgroundThe incidence of atrial fibrillation/atrial flutter (AF/AFL) in general population is lower in Asia compared to Western countries. It is unclear whether a similar trend exists among adults with congenital heart disease (ACHD). We determine the profile, risk factors, and impact of AF/AFL in an Asian ACHD cohort. MethodsWe included all ACHD patients diagnosed in an Asia tertiary care center between 2007 and 2018, analyzing AF (sustained and paroxysmal AF) and AFL, collectively./Purpose. ResultsThe study encompassed 4391 patients (55.9% women), with 81% having simple, 16.3% moderate and 2.8% severe CHD. AF/AFL was observed in 6.7% of the patients, with 54.6% having paroxysmal AF, 27.3% sustained AF, and 18.1% AFL. Incidence of AF/AFL increased with age and was higher in patients with pulmonary hypertension (PH), severe CHD, and metabolic syndrome. We found a progressive trend in the onset age of arrhythmia: AFL at a younger age, followed by paroxysmal and sustained AF. Risk factors for AF/AFL included severe and moderate CHD, PH, previous interventions, and male sex (odds ratio 11.2 and 3.15, 2.03, 1.75, and 1.71, respectively). When stratifying by CHD severity, PH and male sex were significant risk factors in simple CHD, while only PH in severe CHD. Patients with AF/AFL had a significantly lower major adverse cardiovascular events-free survival rate. ConclusionsThis large ACHD cohort from Asia exhibited a high incidence of AF/AFL, similar to Western reports. The risk of AF/AFL was primarily associated with hemodynamic factors such as PH and CHD severity.

The advanced lung cancer inflammation index is associated with mortality in peritoneal dialysis patients

BackgroundThere is still a very high morbidity and mortality rate for patients undergoing peritoneal dialysis (PD). The advanced lung cancer inflammation index (ALI) has been demonstrated to be associated with the prognosis in multiple types of cancers. Like in cancer, systemic chronic low-grade inflammation is one of the distinguishing features of PD patients. Therefore, we aimed to investigate the relationships between the ALI and all-cause and cardiovascular disease (CVD) mortality in PD patients.MethodsPatients who started PD at Shaoxing People’s Hospital between 1 January 2013 and 31 December 2020 (n = 277) were recruited and followed up until 1 July 2023. They were divided into high-ALI group and low-ALI group according to the median of ALI. Kaplan–Meier curves and multivariate Cox regression analyses were used to assess the associations between the ALI and all-cause and CVD mortality. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to determine the predictive power of the ALI for all- cause and CVD mortality.ResultsDuring the median follow-up of 40.50 months (interquartile range, 26.42–59.77 months), a total of 55 patients died, 31 of whom died due to CVD. Kaplan–Meier curves revealed that patients in the low-ALI group had significantly lower cumulative and cardiovascular cumulative survival rates than did those in the high-ALI group (all P < 0.001). After we corrected for confounders, the risk of all-cause and CVD mortality was significantly greater in the low-ALI group than in the high-ALI group [hazard ratio (HR) 1.944, 95% confidence interval (CI) 1.068–3.540, P = 0.030, and HR 2.672, 95% CI 1.188–6.009, P = 0.017, respectively]. The predictive value of ALI (AUC = 0.708, 95% CI 0.630–0.786, P < 0.001) for all-cause mortality was superior to albumin (AUC = 0.644, 95% CI 0.556–0.726, P < 0.001), body mass index (AUC = 0.581, 95% CI 0.496–0.659, P = 0.069) and neutrophil-to-lymphocyte ratio (AUC = 0.675, 95% CI 0.596–0.754, P < 0.001).ConclusionA lower ALI is an independent risk factor for all-cause and cardiovascular mortality in PD patients. The ALI may be an effective indicator for predicting outcomes in PD patients.

Correlation of hematocrit and cardiovascular events in peritoneal dialysis patients

Objective: To investigate the correlation between hematocrit (HCT) and cardiovascular events in peritoneal dialysis (PD) patients. Methods: Patients undergoing maintenance PD in the PD center of Guizhou Provincial People's Hospital from March 19, 2012 to July 9, 2020 were included. Demographic, baseline clinical and laboratory data of the patients were collected and patients were followed up until April 8, 2022. The primary endpoint was the first occurrence of a cardiovascular event. According to the tertiles of baseline HCT, the patients were divided into group Q1 (HCT≤26.6%), group Q2 (HCT>26.6%-32.4%), and group Q3 (HCT>32.4%). Laboratory indexes and cardiovascular events were compared among the three groups. Kaplan-Meier survival curve, Cox regression analysis and sensitivity analysis were used to analyze the effect of HCT on cardiovascular outcomes. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of HCT for cardiovascular events in PD patients. Results: A total of 860 PD patients were included, including 494 males (57.4%) and 366 females (42.6%), with a mean age of (41.5±15.0) years. There were 287 cases in group Q1, 289 cases in group Q2, and 284 cases in group Q3, respectively. A total of 265 (30.8%) patients experienced first cardiovascular events during the follow-up period. The incidence of cardiovascular events in groups Q1, Q2 and Q3 was 36.2% (104/287), 34.3% (99/289), and 21.8% (62/284), respectively, with a statistically significant difference (P<0.001). The incidence of cardiovascular events decreased with the increase of HCT. Multivariate Cox proportional hazards regression model analysis showed that decreased HCT was a risk factor for cardiovascular events. Compared with group Q3, the risk of cardiovascular events in group Q1 increased by 50.7% (group Q2: HR=1.444, 95%CI: 1.029-2.028, P=0.034; group Q1: HR=1.570, 95%CI: 1.096-2.250, P=0.014). In the sensitivity analysis, using kidney transplantation as the competition event, the risk of cardiovascular events was lower in group Q3 than that in group Q1 (subdistributional HR=1.413, 95%CI: 1.006-1.990, P=0.046). Kaplan-Meier survival curve showed that compared with the other two groups, the cardiovascular events-free survival rate of patients in group Q1 was significantly lower (log-rank χ2=9.722, P=0.008). ROC analysis showed that the area under the curve (AUC) of HCT for predicting cardiovascular events in PD patients was 0.583 (95%CI: 0.542-0.623, P<0.001), with the sensitivity of 40.6% and the specificity of 75.1%. Conclusion: Low-level HCT is associated with an increased risk of the first cardiovascular event in PD patients.

Latest Trends in Hemodiafiltration.

This review provides a detailed analysis of hemodiafiltration (HDF), its progress from an emerging technique to a potential conventional treatment for chronic hemodialysis patients, and its current status. The article covers the advances, methods, and clinical benefits of HDF, specifically focusing on its impact on cardiovascular health, survival rates, and overall well-being. The review also addresses questions about the safety of HDF and provides evidence to dispel concerns related to the elimination of beneficial substances and infection risks. Additionally, the article explores the potential implications of expanded hemodialysis (HDx) as an alternative to HDF, its classification, safety profile, and an ongoing trial assessing its non-inferiority to HDF. Supported by evidence from randomized controlled trials and observational studies, the review emphasizes the superiority of HDF as a hemodialysis modality and advocates for its positioning as the gold standard in treatment. However, it acknowledges the need for extensive research to define the role of HDx in comprehensive treatment approaches in individuals undergoing dialysis. The synthesis of current knowledge underscores the importance of ongoing exploration and research to refine hemodialysis practices for optimal patient outcomes.

Relationship between Serum Irisin Level, All-Cause Mortality, and Cardiovascular Mortality in Peritoneal Dialysis Patients

Introduction: This study aimed to investigate the prospective role of serum irisin – a novel adipo-myokine – in all-cause mortality and cardiovascular (CV) mortality in patients on peritoneal dialysis (PD). Methods: A prospectively observational study was conducted with 154 PD patients. Baseline clinical data were collected from the medical records. Serum irisin concentrations were determined using enzyme-linked immunosorbent assay. Patients were divided into the high irisin group (serum irisin ≥113.5 ng/mL) and the low irisin group (serum irisin <113.5 ng/mL) based on the median value of serum irisin. A body composition monitor was used to monitor body composition. Cox regression analysis was utilized to find the independent risk factors of all-cause and CV mortality in PD patients. Results: The median serum irisin concentration was 113.5 ng/mL (interquartile range, 106.2–119.8 ng/mL). Patients in the high irisin group had significantly higher muscle mass and carbon dioxide combining power (CO2CP) than those in the low irisin group (p < 0.05). Serum irisin was positively correlated with pulse pressure, CO2CP, and muscle mass, while negatively correlated with body fat percentage (p < 0.05). During a median of follow-up for 60.0 months, there were 55 all-cause deaths and 26 CV deaths. Patients in the high irisin group demonstrated a higher CV survival rate than those in the low irisin group (p = 0.016). Multivariate Cox regression analysis showed that high irisin level (hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.135–0.858; p = 0.022), age, and diabetic mellitus were independently associated with CV mortality in PD patients. However, serum irisin level failed to demonstrate a statistically significant relationship with all-cause mortality. Conclusion: Low serum irisin levels at baseline were independently predictive of CV mortality but not all-cause mortality in PD patients. Therefore, serum irisin could be a potential target for monitoring CV outcomes in PD patients.

Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease.

Limited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH. This retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death. The 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45-13.73; P = .009). The IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered.

Exercise Effects on Left Ventricular Remodeling in Patients with Cardiometabolic Risk Factors.

Left ventricular (LV) remodeling is a dynamic process, which is characterized by changes in ventricular size, shape, and wall thickness, thus altering myocardial geometry and function, and is considered as a negative prognostic factor in patients with heart failure (HF). Hypertension, type 2 diabetes (T2D), and obesity are strongly correlated with the development and the progression of LV remodeling, LV hypertrophy, and LV systolic and/or diastolic dysfunction. Indeed, the beneficial impact of exercise training on primary and secondary prevention of cardiovascular disease (CVD) has been well-established. Recent studies have highlighted that exercise training enhances functional capacity, muscle strength and endurance, cardiac function, and cardiac-related biomarkers among patients with established coronary artery disease (CAD) or HF, thus substantially improving their cardiovascular prognosis, survival rates, and need for rehospitalization. Therefore, in this review article, we discuss the evidence of LV remodeling in patients with cardiometabolic risk factors, such as hypertension, T2D, and obesity, and also highlight the current studies evaluating the effect of exercise training on LV remodeling in these patients.

Predictive Value of the Prognostic Nutritional Index for Long-Term Mortality in Patients with Advanced Heart Failure.

Malnutrition is common in patients with advanced heart failure (HF), and both conditions have a poor prognosis. We sought to determine the predictive value of nutritional status using the prognostic nutritional index (PNI) for long-term mortality in patients with advanced HF. This is a retrospective observational study. The optimal PNI cut-off value for predicting all-cause mortality was determined to be 50.5 using receiver operating characteristic curve analysis. Patients were divided into two groups: the low PNI (≤ 50.5) and high PNI (> 50.5) group. A total of 217 patients (age 48.9 ± 9.9 years, 82.5% male) with advanced HF were included in this study. The mean follow-up duration was 28.6 ± 19.4 months. The high PNI group had higher 5-year all-cause and cardiovascular death-free survival rates compared to the low PNI group (86.7% vs. 24.6%, log-rank p < 0.001) and (89.6% vs. 36.1%, log-rank p < 0.001), respectively. In multivariable Cox regression analyses, low PNI [hazard ratio (HR): 4.70; 95% confidence interval (CI): 2.19-10.11, p < 0.001] and high sensitivity C-reactive protein (hsCRP) (HR: 1.02; 95% CI: 1.01-1.03, p = 0.04) were found to be independent predictors of long-term all-cause mortality. Low PNI (HR: 4.52; 95% CI: 1.99-10.24, p < 0.001), hsCRP (HR: 1.01; 95% CI: 1.00-1.03, p = 0.04), and New York Heart Association class IV vs. III (HR: 2.56; 95% CI: 1.36-4.82, p = 0.03) were also found to be independent predictors of long-term cardiovascular mortality. PNI was found to be an independent predictor of long-term all-cause and cardiovascular mortality in patients with advanced HF, and it can be used as an objective and simple tool for risk stratification.

#5221 PULMONARY HYPERTENSION: AN IMPORTANT RISK FACTOR IN CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS

Abstract Background and Aims It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension. Method We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH. Results The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001. Conclusion Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.

Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis.

This study aimed to evaluate the predictive value of non-specific ST-segment and/or T-wave abnormalities in electrocardiography (ECG) for all-cause and cardiovascular mortality (CVM) in peritoneal dialysis (PD) patients. All patients who started PD between November 1, 2005, and February 28, 2017, at the First Affiliated Hospital of Nanchang University were enrolled. The primary outcomes were all-cause mortality and CVM. The Kaplan-Meier method and a log-rank test were used for the survival analysis. Multivariate Cox proportional hazards models were used to investigate the risk factors for all-cause mortality and CVM. A total of 724 eligible PD patients were enrolled, including 401 (55.4%) men. In total, 153 (21.1%) patients died during a mean follow-up period of 27 (interquartile range, 13-41) months, and cardiovascular death was responsible for 84 of these deaths. The patients with non-specific ST-T abnormalities (NSSTTAs) had lower overall and cardiovascular survival rates compared to those free from any ECG abnormalities. According to the multivariate Cox proportional hazards models, (NSSTTAs) are independent risk factors for all-cause mortality and CVM, the hazard ratios are 1.81 (95% confidence interval, 1.11-2.95; p = 0.017) and 2.86 (95% confidence interval, 1.52-5.37; p = 0.001), respectively. Non-specific ST-T abnormalities can serve as risk markers of all-cause and CVM in PD patients.

Cardiac valve calcification as a predictor of cardiovascular outcomes in peritoneal dialysis patients: an inverse probability of treatment weighting analysis.

Cardiovascular events (CVE) are the leading cause of death in peritoneal dialysis (PD) patients. The predictive value of cardiac valve calcification (CVC) for CVE in dialysis patients remains controversial. In particular, such studies are limited in PD patients. We aimed to examine the predictive role of CVC for CVE and cardiovascular mortality in PD patients. A retrospective analysis was performed on patients who initiated PD in our hospital. According to the result of echocardiography, patients were divided into CVC group and non-CVC group. The differences in baseline demographic characteristics, biochemical variables, comorbidities, and clinical outcomes between the two groups were compared. Kaplan-Meier method was used to obtain survival curves. The Cox regression model was used to evaluate the influence of CVC for cardiovascular outcomes. The inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups. 458 peritoneal dialysis patients were enrolled in this study. 77 patients were in CVC group and 381 patients in non-CVC group. The average follow-up time was (32 ± 21) months. At baseline, the absolute standardized difference (ASD) of age, BMI, history of CVE, diabetes, LVEF, LVMI, albumin, calcium, phosphorus, triglycerides, hsCRP, urine volume, Kt/V, statins and vitamin D intake rate were greater than 0.1 between the two groups. All of ASD dropped to less than 0.1 after IPTW, which meant that the balance had been reached between the two groups. Multivariable logistic analysis showed that advanced age, diabetes, and hyperphosphatemia were associated with CVC. The Kaplan-Meier survival curve showed the cumulative CVE-free survival rate and cardiovascular survival rate of CVC group were significantly lower than that of non-CVC group before and after IPTW (log-rank P < 0.05). After IPTW was used to eliminate the effect of confounders, multivariate Cox regression analysis still showed CVC was an independent risk factor for CVE (HR = 2.383, 95% CI 1.331~4.264, P = 0.003) and cardiovascular mortality (HR = 2.347, 95% CI 1.211~4.548, P = 0.012) in PD patients. The prevalence of CVC is high in peritoneal dialysis patients. CVC is an independent risk factor for CVE and cardiovascular mortality in peritoneal dialysis patients.

MO852: Predialysis Blood-Pressure Control Based on Antihypertensive Guidelines Should Deteriorate Cardiovascular Prognosis in Patients on Maintenance Dialysis

Abstract BACKGROUND AND AIMS Guidelines of KDOQI for dialysis patients on blood-pressure (BP) targets proposed blow 140/90 mmHg at predialysis and &amp;lt; 130/80 mmHg at postdialysis. On the other hand, in dialysis patients, many reports have shown an association between predialysis hypotension and poor prognosis. Moreover, it has been reported that low systolic blood-pressure (SBP) is associated with poor prognosis in non-dialysis patients with heart failure. Therefore, predialysis BP controlled according to KDOQI guideline should worsen survival rate in dialysis patients, especially with any cardiac disease. This time, we investigated the difference on cardiovascular survival-rate between the group complied with KDOQI guidelines and the group complied with them for diastolic blood-pressure alone, by using Yoshikawa clinic dialysis-database (YCD). METHOD A total of 455 dialysis patients (264 males and 176 females) registered in YCD enrolled in this study from April 2006 on. From these patients, we extracted two groups, group G, strictly lowering on systolic and diastolic blood-pressure and group D, lowering on diastolic blood-pressure (DBP) alone, in accordance with antihypertensive guidelines. According to calculated propensity score on group G, patients were extracted by 1: 1 matching from each group. Their survival analysis was estimated by Kaplan–Meier method, and a log-rank test was used to examine the differences between the cardiovascular survival curves. The prognostic factors for cardiovascular mortality were extracted from background factors, including blood-pressure level, using Cox regression model. RESULTS In 455 patients, mean predialysis SBP and DBP were 143.3 mmHg and 73.1 mmHg, respectively. 141 patients were extracted as group G and 219 were as group D. According to calculated propensity-score, 116 pairs (group Gp and Dp) were extracted from group G and D. There was no significant difference in matching covariates except predialysis blood-pressure between the two groups. During mean-observational period of 5.8 years, 111 patients died, among that 59 were cardiovascular death (CVD). The survival curve on cardiovascular mortality in the group Gp showed significantly poor prognosis. In multivariate analysis of Cox proportional hazard model, SBP &amp;lt; 140 mmHg was extracted as a prognostic factor for CVD, and the hazard ratio was 1.892. On the other hand, in group Dp, non-cardiovascular prognosis was poor, especially in those &amp;lt; 70 years old. CONCLUSION Blood-pressure control in maintenance dialysis-patients based on current antihypertensive guidelines (KDOQI) should worsen their cardiovascular prognosis. Therefore, it is necessary to set SBP control for each case. This study is a cohort study with a single institution, and a prospective study with multiple institutions will be needed in the future.

Temporal Trends in Diagnosis, Treatments, and Outcomes in Patients With Bicuspid Aortic Valve.

Background: The population is aging and advances in multimodal imaging and transcatheter valve intervention have been prominent in the past two decades. This study investigated temporal trends in demographic characteristics, use of multimodal imaging, treatments, and outcomes in patients with bicuspid aortic valve (BAV).Methods and Results: A total of 1,497 patients (male 71.7%, 57 ± 14 years old) first diagnosed with BAV between January 2003 and December 2020, in a single tertiary center were divided into three groups according to year of diagnosis: group 1 (2003–2008, n = 269), group 2 (2009–2014, n = 594), and group 3 (2015–2020, n = 634). The patients' demographic characteristics, comorbidities, BAV morphology, BAV function, BAV-related disease, use of multimodal diagnostic imaging, treatment modality for BAV, and clinical outcomes were compared among the three groups. The ages at diagnosis and at the time of surgery/intervention increased considerably from group 1 to 3. The patients' comorbidity index also increased progressively. The proportion of non-dysfunctional BAV and significant AS increased, while that of significant AR decreased. The frequency of infective endocarditis as an initial presentation significantly decreased over time. Additionally, the use of multimodal imaging increased markedly in the most recent group. The results also indicated increasing trends in the use of bioprosthetic valves and transcatheter aortic valve replacement. Overall and cardiovascular survival rates improved from group 1 to 3 (log rank p < 0.001).Conclusions: For the past two decades, remarkable temporal changes have occurred in patient characteristics, use of multimodal diagnostic imaging, choice of treatment modality, and clinical outcomes in patients with BAV.

The potential effect of cardiac function on pulmonary hypertension, other risk factors, and its impact on survival in dialysis patients.

Pulmonary hypertension (PH) is a recently recognized as a complication of chronic kidney disease and end-stage renal disease. The pathogenesis of pulmonary hypertension in this group of patients is not fully understood, probably due to the interaction of multiple aspects of the altered cardiovascular physiology and also hormonal and metabolic disorders. The present study aimed to determine the prevalence of PH, correlation with cardiac function and other risk factors and its impact of survival in chronic hemodialysis and peritoneal dialysis patients. We studied 125 stable hemodialysis and peritoneal patients (females 40%, mean age 52.42 ± 11.88years) on renal replacement therapy (RRT) for more than 3months with a follow up 2years. Demographic information, clinical characteristics, blood test, and thoroughly echocardiographic evaluation at the optimal dry weight were collected. After conventional echocardiographic examination, tissue Doppler echocardiographic (TDE) examination was performed to evaluate global and regional myocardial systolic as well as diastolic function, and pulmonary hypertension. PH was defined as systolic pulmonary artery pressure (sPAP) ≥ 35mmHg. To rule out secondary PH, patients with pulmonary disease, collagen vascular disease, and volume overload at the time of echocardiography were excluded. Variables were compared between two groups-subjects with PH and non-PH. Logistic regression analysis was used to evaluate the risk factor for PH and its impact on survival. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. Mean PH was 33.46 ± 5.38mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP) and E/E' average, lower left ventricular ejection fraction (EF), peak systolic velocity at the lateral mitral annulus (MASa) and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found predictor of PH. The cardiovascular mortality rate was 15.5%. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001]. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E' and PP, AUC = 0.76; 0.75; 0.72 respectively while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. Our study shows that PH is frequent in dialysis patients. It is influenced by inflammation, CKD-MBD biomarkers associated with diastolic and also systolic left and right ventricle dysfunction. Pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy are interrelated and all contribute to cardiovascular morbidity and mortality among dialysis patients. Easy to implement, cardiac imaging at the bedside and in outpatient clinics offers a positive perspective in early diagnosis of cardiac abnormalities and immediate approach to this condition, so is highly recommended in the dialysis population.

Clinical impact of echocardiography-defined pulmonary hypertension on the clinical outcome in patients with multiple myeloma.

Pulmonary hypertension (PH) is a complication of multiple myeloma (MM); however, the clinical outcomes and prognosis are relatively not well known. We aimed to investigate the risk factors of transthoracic echocardiography-defined PH and its impact on the clinical outcome in patients with MM.A retrospective study was performed using data from the Chonnam National University Hwasun Hospital database for patients who underwent transthoracic echocardiography (TTE) within 1 month of the MM diagnosis between January 2007 and December 2017. PH was defined as an estimated right ventricular systolic pressure (RVSP) > 40 mmHg. A total of 390 patients were included. TTE-defined PH was observed in 107 patients (27%). During the follow-up period (median, 688 days), all-cause death was noted for 134 patients (34.4%). In the Kaplan-Meier survival analysis, the cumulative overall survival and cardiovascular death-free survival rates were significantly lower in the PH group than in the non-PH group (P < .001). In the propensity score-matched population, RVSP > 40 mmHg on TTE and history of congestive heart failure (CHF) were identified as the significant independent predictors of all-cause and cardiovascular death.This study reports that the prevalence of TTE-defined PH is higher in patients with MM than in the general population. Moreover, TTE-defined PH and a history of CHF are the independent prognostic factors for all-cause and cardiovascular death in patients with MM. These results highlight the risk of associated cardiovascular disease in patients with MM and emphasize the importance of management strategies that prevent the deterioration of cardiac function.

SUN-225 Significant association between posterior mitral annular calcification and the mortality in maintenance hemodialysis patients

It is widely recognized that maintenance dialysis patients have many cardiovascular complications causing morbidity and mortality. The mortality rate due to cardiovascular disease (CVD) in maintenance dialysis patients is 10-30 times higher than that in the general population, making it a leading cause of death. Thus, risk stratification for CVD mortality is clinically important for improving survival in such individuals. Vascular calcification (VC) is common in maintenance hemodialysis patients and results in increased cardiovascular disease and both overall and cardiovascular mortality. Cardiac valve calcification, also frequently seen in hemodialysis patients, has been regarded as a marker of atherosclerosis, and its existence could not only affect therapeutic outcomes after coronary intervention, but is also predict factor of CVD morbidity. Furthermore, in maintenance hemodialysis patient cardiac valvular calcification is also correlated with mortality. However, no detailed investigation has been done on which part of the heart valve calcification is associated with mortality. The purpose of this study was to investigate the prevalence of calcification according to the location of heart valve leaflets and mitral annulus, and to clarify the association between them and the mortality in maintenance hemodialysis patients. This was a retrospective cohort study of a clinical database containing the medical records of 130 patients on maintenance HD who received hemodialysis during the period between February 2016 and January 2017 in a single center. Totally, 120 patients were involved in this study. Of whom, 72 (65.0%) patients were male, the mean age was 71.1 ± 11.1 years, and the median hemodialysis duration was 129.2 ± 96.4 months. Cardiac valve calcification was seen in 50 (41.7%) patients: 29 (24.2%) had aortic valve calcification and 41 (34.2%) had mitral annulus calcification (MAC) (Anterior MAC, 8 [6.6%], and posterior MAC, 41 [34.2%]) (Figure 1). A total of 22 (18.3%) patients died, including 11 (9.2%) as a result of cardiovascular death. Patients without pMAC had a higher all-cause survival rate compared with those with pMAC (88.6% versus 68.3%, log-rank P Figure2A). Patients without pMAC had a higher cardiovascular survival rate compared with those with pMAC (94.6% versus 79.4%, log-rank P=0.01, Figure2B). Multivariate cox proportional hazards analysis revealed that posterior MAC was independently positively correlated with all-cause death and cardiovascular death (HR for all-cause death, 5.924; P<0.01, HR for all-cause death and cardiovascular death, 17.746; P=0.01). The presence of posterior MAC, which is cheap and easy to detect with echocardiography, can predict all causes of death and cardiovascular death. This findings may further help risk stratification of maintenance hemodialysis patients in any dialysis center, including small dialysis center with limited medical resources, such as developing countries.

Poor Renal and Cardiovascular Outcomes in Patients with Biopsy-Proven Diabetic Nephropathy

Background: Despite the high mortality of cardiovascular disease (CVD) in diabetic patients with renal injury, few studies have compared cardiovascular characteristics and outcomes between patients with diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). Methods: A total of 326 type 2 diabetes mellitus patients with renal biopsy were assigned to DN and NDRD groups. Echocardiography and Doppler ultrasound were performed to evaluate left ventricular hypertrophy (LVH) and peripheral atherosclerosis disease (PAD). Renal and cardiovascular survival rates were compared between the DN and NDRD groups by Kaplan-Meier analysis. Risk factors for renal and cardiovascular events in DN patients were identified by a Cox proportional hazards model. Results: In total, 179 patients entered the DN group (54.9%) and 147 made up the NDRD group (45.1%). The presence of diabetic retinopathy, family history of diabetes, and dependence on insulin therapy were associated with the presence of DN. DN patients had more CVD with more severe LVH and PAD. Poorer renal (log-rank χ² = 26.534, p < 0.001) and cardiovascular (log-rank χ² = 16.257, p < 0.001) prognoses were seen in the DN group. DR (HR 1.539, 95% CI 1.332–1.842), eGFR (HR 0.943, 95% CI 0.919–0.961), and 24-h proteinuria (HR 1.211, 95% CI 1.132–1.387) were identified as risk factors for renal endpoints. Age (HR 1.672, 95% CI 1.487–1.821), HbA1C (HR 1.398, 95% CI 1.197–1.876), and 24-h proteinuria (HR 1.453, 95% CI 1.289–1.672) were associated with cardiovascular endpoints. Conclusion: Patients with DN had more severe CVD along with poorer renal and cardiovascular prognoses than those with NDRD.

P1582Prognostic value of C-reactive protein/albumin ratio for cardiovascular morbidity and mortality in end-stage renal disease patients with incident haemodialysis therapy

Abstract Background Hypoalbuminemia, a manifestation of protein-energy wasting or malnutrition, is commonly observed in patients with end-stage renal disease (ESRD), and is associated with chronic inflammation and increasing cardiovascular (CV) risk. Recently, C-reactive protein (CRP)/albumin ratio at discharge is reportedly a well-predictor of mortality in severe sepsis or cancer patients. We investigated prognostic value of the CRP/albumin ratio at just starting haemodialysis (HD) therapy for CV morbidity and mortality in patients with ESRD. Methods A total of 1,548 ESRD patients were enrolled and were divided into quartiles according to CRP/albumin levels at initiation of HD; quartile 1 (Q1): &lt;0.22, Q2: 0.23–0.54, Q3: 0.55–1.83 and Q4: &gt;1.84. They were followed up for 10-year after starting HD therapy. Primary endpoint was CV events defined as hospitalization due to CV events such as cardiac disease, stroke and peripheral artery disease and CV death. We also evaluated the incremental value with C-index when CRP alone, albumin alone and the CRP/albumin ratio were added into a model with established risk factors. Results During follow-up period (median: 59 months), 512 cases experienced CV events (33.1%) including 165 cases of CV deaths (10.7%). Kaplan-Meier analysis shows that CV event-free survival rates for 10 years were 63.5%, 53.8%, 47.5% and 31.9% in Q1, Q2, Q3 and Q4, and that CV survival rates were 90.4%, 83.9%, 77.2% and 64.6% in Q1, Q2, Q3 and Q4, respectively (p&lt;0.0001 in both). After adjustment for all baseline variables, elevated CRP/albumin ratio was identified as an independent predictor for CV events [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.11–2.07, p=0.0093 for Q2 vs. Q1, HR 1.79, 95% CI 1.33–2.42, p&lt;0.0001 for Q3 vs. Q1and HR 2.27, 95% CI 1.70–3.07, p&lt;0.0001 for Q4 vs. Q1, respectively]. As to CV mortality, similar results were obtained (HR 1.80, 95% CI 0.98–3.44, p=0.056 for Q2 vs. Q1, HR 2.56, 95% CI 1.45–4.71, p=0.0009 for Q3 vs. Q1 and HR 2.66, 95% CI 1.53–4.86, p=0.0004 for Q4 vs. Q1, respectively). Furthermore, adding the CRP/albumin ratio to a baseline model with established risk factors improved the C-index greater than that of CRP alone or albumin alone, respectively (0.715 from 0.692, p=0.0095 and from 0.683, p=0.0019) Conclusion The CRP/albumin ratio, which easily available from daily practice, could strongly stratify the risk of future CV morbidity and mortality in ESRD patients who need HD therapy.

High serum uric acid level is a mortality risk factor in peritoneal dialysis patients: a retrospective cohort study

BackgroundThe results remain controversial with regards to the impact of serum uric acid on clinical outcomes from peritoneal dialysis population. The aim of our study was to investigate the influence of serum uric acid levels on mortality in peritoneal dialysis patients.MethodsData on 9405 peritoneal dialysis patients from the Zhejiang Renal Data system were retrospectively analyzed. All demographic and laboratory data were recorded at baseline. The study cohort was divided into quintiles according to baseline uric acid level (mg/dL): Q1 (< 6.06), Q2 (6.06–6.67), Q3 (6.68–7.27) (reference), Q4 (7.28–8.03), and Q5 (≥8.04). Hazards ratio (HR) of all-cause and cardiovascular mortality was calculated.ResultsMean serum uric acid was 7.07 ± 1.25 mg/dL. During a median follow-up of 29.4 (range, 3.0 to 115.4) months, 1226 (13.0%) patients died, of which 515 (5.5%) died of cardiovascular events. The Kaplan-Meier survival curves showed that patients in the middle uric acid quintile (Q3: 6.68–7.27) exhibited the highest patient and cardiovascular survival rates (log-rank test P < 0.05). Multivariate Cox regression analysis showed that, using Q3 as the reference, in the fully adjusted model, a higher uric acid level (Q4: 7.28–8.03, and Q5: ≥8.04) was significantly associated with higher all-cause mortality (Model 3; Q4: HR, 1.335, 95% CI, 1.073 to 1.662, P = 0.009; Q5: HR, 1.482, 95% CI, 1.187 to 1.849, P = 0.001), but not with cardiovascular mortality. The adverse effect of higher uric acid level (≥7.28 mg/dL) on all-cause mortality was more prominent in groups such as male, hypoalbuminemia, normal weight, non-diabetes mellitus at baseline rather than in their counterparts respectively.ConclusionsA higher uric acid level was an independent risk factor for all-cause mortality in peritoneal dialysis patients.

Impact of serum fibroblast growth factor(FGF)23 and carotid intima-media thickness on long-term outcome in maintenance hemodialysis patients

Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness(CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients. Methods A total of 88 MHD patients were enrolled, with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months). CIMT and atherosclerotic plaques were measured by B-mode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the -80℃ refrigerator for measuring serum FGF23 levels. Results The 88 patients were aged(64.2±11.5)years, with 52 males and 36 females, and the mean CIMT was(1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8%)subjects.Carotid artery atherosclerotic plaques(CASP)were found in 58(65.9%)patients aged 60 years and over.Compared with non-elderly patients, elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow-up period, 34 patients died and 23(67.6%)patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003). And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P=0.043). Multivariate COX regression analysis showed that FGF23(HR=1.056, 95%CI: 1.007-1.108, P=0.026)and CIMT(HR=1.165, 95%CI: 1.032-1.315, P=0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium(HR=0.022, 95%CI: 0.001-0.489, P=0.016), hemoglobin(HR=0.966, 95%CI: 0.937-0.997, P=0.033), FGF23(HR=1.071, 95%CI: 1.017-1.128, P=0.010)and CIMT(HR=1.202, 95%CI: 1.049-1.377, P=0.008)were independent predictors for cardiovascular mortality in elderly MHD patients. Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher, in which the factors affecting prognosis are more complex. Key words: Maintenance hemodialysis; Tunia media; Fibroblast growth fator 23; Prognosis