Higher Incidence Of Composite Endpoint Research Articles

Prognostic value of noninvasive programmed stimulation in primary prevention implantable cardioverter‐defibrillator recipients

AbstractBackgroundImplantable cardioverter‐defibrillator (ICD) offers an opportunity to study inducibility of ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing noninvasive programmed ventricular stimulation (NIPS). Whether NIPS can predict future arrhythmic events or mortality in patients with primary prevention ICD, has not yet been examined.MethodsFrom the NIPS‐ICD study (ClinicalTrials ID: NCT02373306) 41 consecutive patients (34 males, age 64 ± 11 years, 76% ischemic cardiomyopathy [ICM]) had ICD for primary prevention indication. Patients underwent NIPS using a standardized protocol of up to three premature extrastimuli at 600, 500 and 400 ms drive cycle lengths. NIPS was classified as positive if sustained VT or VF was induced. The study endpoint was occurrence of sustained VT/VF during the follow‐up.ResultsAt baseline NIPS, VT/VF was induced in 8 (20%) ICM patients. During the 5‐year follow‐up, the VT/VF occurred in 7 (17%) patients, all with ICM. The difference between NIPS‐inducible versus NIPS‐noninducible patients regarding VT/VF occurrence did not meet statistical significance (38% vs. 12%, log rank test p = .11). After a 5‐year follow‐up, the mortality rate was significantly higher in patients who had VT/VF induced at NIPS versus no VT/VF at NIPS (38% vs. 12%, p = .043). The occurrence of a composite endpoint consisting of VT/VF recurrence or death in patients with ICM was also most frequent in the NIPS‐inducible group (75% vs. 35%, p = .037).ConclusionsInducibility of VT/VF during NIPS in ICM patients with primary prevention ICD is associated with higher mortality and higher incidence of composite endpoint consisting of death or VT/VF during a long‐term observation.

Catheter ablation of atrial fibrillation in patients with left bundle branch block.

Left bundle branch block (LBBB) and atrial fibrillation (AF) are commonly coexisting conditions. The impact of LBBB on catheter ablation of AF has not been well determined. This study aims to explore the long-term outcomes of patients with AF and LBBB after catheter ablation. Forty-two patients with LBBB of 11,752 patients who underwent catheter ablation of AF from 2011 to 2020 were enrolled as LBBB group. After propensity score matching in a 1:4 ratio, 168 AF patients without LBBB were enrolled as non-LBBB group. Late recurrence and a composite endpoint of stroke, all-cause mortality, and cardiovascular hospitalization were compared between the two groups. Late recurrence rate was significantly higher in the LBBB group than that in the non-LBBB group (54.8%vs. 31.5%, p=.034). Multivariate analysis showed that LBBB was an independent risk factor for late recurrence after catheter ablation of AF (hazard ratio [HR] 2.19, 95% confidence interval [CI] 1.09-4.40, p=.031). LBBB group was also associated with a significantly higher incidence of the composite endpoint (21.4%vs. 6.5%, HR 3.98, 95% CI 1.64-9.64, p=.002). LBBB was associated with a higher risk for late recurrence and a higher incidence of composite endpoint in the patients underwent catheter ablation.

Prognostic impact of atrial cardiomyopathy: Long-term follow-up of patients with and without low-voltage areas following atrial fibrillation ablation

BackgroundAtrial cardiomyopathy is known as an underlying pathophysiological factor in the majority of patients with atrial fibrillation (AF). Left atrial low-voltage areas (LVAs) are reported to coincide with fibrosis and likely represent atrial cardiomyopathy. ObjectiveThe purpose of this study was to delineate differences in the long-term prognosis of patients stratified by the size of LVAs. MethodsThis observational study included 1488 consecutive patients undergoing initial ablation for AF. LVAs were defined as regions with a bipolar peak-to-peak voltage <0.50 mV. The total study population was divided into 3 groups stratified by LVA size: patients with no LVAs (n = 1136); those with small (<20 cm2) LVAs (n = 250) LVAs; and those with extensive (≥20 cm2) LVAs (n = 102). Composite endpoints of death, heart failure, and stroke were followed for up to 5 years. ResultsComposite endpoints developed in 105 of 1488 patients (7.1%), and AF recurrence occurred in 410 (27.6%). Composite endpoints developed more frequently in the order of patients with extensive LVAs (19.1%), small LVAs (10.8%), and no LVAs (5.1%) (P for trend <.0001). Multivariable analysis revealed that LVA presence was independently associated with higher incidence of composite endpoints, irrespective of AF recurrence (modified hazard ratio 1.73; 95% confidence interval 1.13–2.64; P = .011) ConclusionLVA presence and its extent both were associated with poor long-term composite endpoints of death, heart failure, and stroke, irrespective of AF recurrence or other confounders. Underlying atrial cardiomyopathy seems to define a poor prognosis after AF ablation.

Abstract 9964: Clinical Impact of Handgrip Strength on Prognosis After Percutaneous Coronary Intervention

Introduction: Sarcopenia is defined as age-related loss of skeletal muscle mass and strength, and has been reportedly associated with cardiovascular disease. However, the impact of handgrip strength (HGS) on clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery disease has not been well investigated. Methods: This was a retrospective, single center, observational study. A total of 469 patients who underwent PCI were included. Periprocedural HGS of both hands were measured and of which better value was used for assessment. Patients were divided into 2 groups, low HGS group (men;&lt;28kg, women;&lt;18kg) and high HGS group (men;≥28kg, women;≥18kg) according to the consensus of Asian Working Group for Sarcopenia. The primary outcome was the composite endpoint of all-cause death, myocardial infarction, and heart failure readmission. Results: There were 151 patients in the low HGS group and 318 patients in the high HGS group. The age of patients in the low HGS group was significantly higher (78 [71-82] vs. 70 [61-75] years, p&lt;0.001), while the body mass index and serum albumin level were significantly lower than those in the high HGS group. During the median follow-up period of 778 days, composite endpoint occurred in 35 patients with low HGS and 29 patients with high HGS. The low HGS group had a higher incidence of composite endpoint than the high HGS group (p&lt;0.001) (Figure). The low HGS group had a higher risk of individuals of all-cause, cardiac, and non-cardiac death (p&lt;0.001, respectively). Multivariate Cox proportional hazards analysis showed that low HGS was an independent predictor for the composite endpoint (HR 1.86, 95% CI 1.04-3.33, p=0.04). Conclusions: Low HGS was independently related with long-term cardiac events after PCI.

Phenomapping in patients experiencing worsening renal function during hospitalization for acute heart failure.

AimsThe impact of worsening renal function (WRF) on the prognosis of patients with acute heart failure (AHF) remains controversial. We aimed to identify phenotypically distinct subgroups among individuals with both AHF and WRF using cluster analysis.Methods and resultsOverall, the data of 483 patients with both AHF and WRF enrolled in the West Tokyo Heart Failure Registry were analysed. Using cluster analysis, we identified three phenotypically distinct subgroups (phenogroups 1, 2, and 3). We assessed the impact of WRF on the prognosis of each phenogroup by comparing the incidence of composite endpoints, including all‐cause death and re‐hospitalization due to heart failure, with those of a propensity score‐matched, non‐WRF control group. Participants in phenogroup 1 (N = 122) were the youngest (69.3 ± 13.7 years), had relatively preserved estimated glomerular filtration rate (eGFR, 70.0 ± 27.7 mL/min/1.73 m2), and reduced left ventricular ejection fraction (LVEF) (41.8 ± 13.7%). Conversely, participants in phenogroup 3 (N = 122) were the oldest (81.7 ± 8.5 years), had the worst eGFR (33.0 ± 20.9 mL/min/1.73 m2), and had preserved LVEF (51.7 ± 14.8%). The characteristics of the participants in phenogroup 2 (N = 239) were between those of phenogroups 1 and 3. The propensity score matching analysis showed that WRF was associated with a higher incidence of composite endpoints in phenogroup 1, whereas this association was not observed in phenogroups 2 and 3.ConclusionsUsing cluster analysis, we revealed three phenotypically distinct subgroups of patients with both AHF and WRF. WRF was associated with worse clinical outcomes in the subgroup of younger patients with reduced LVEF and preserved renal function.

Effects of blood pressure goals on cardiovascular outcomes in hypertensive patients.

IntroductionThe aim of the study was to evaluate the effects of blood pressure (BP) goals on cardiovascular outcomes in hypertensive patients.Material and methodsPrimary hypertensive patients were retrospectively enrolled from outpatient clinics. The demographics, comorbidities, laboratory parameters and glomerular filtration rate (GFR) were collected. All participants were followed for 1 year. Cardiovascular outcomes included composite of all-cause mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke/transient ischemic attack. Adverse event was defined as falling down and GFR decrease at follow-up.ResultsA total of 1226 patients were included. Based on therapeutic BP goals, participants were divided into low (< 130/80 mm Hg) and high (< 140/90 mm Hg) therapeutic goal groups and an uncontrolled hypertension (≥ 140/90 mm Hg) group. Compared to the low therapeutic goal group, patients in the uncontrolled group were older and more likely to be smokers, have longer duration of hypertension, diabetes mellitus, lower GFR and higher prevalent ischemic stroke (p < 0.05). Patients in the uncontrolled hypertension group had higher incidence of composite endpoints than low and high therapeutic goal groups. Two cases of falling down were observed in the low therapeutic goal group and no significant changes in GFR were observed. With adjustment for confounding factors, the uncontrolled hypertension group had higher risk of composite endpoints compared to low and high therapeutic goal groups, and these benefits were more prominent in the low versus high therapeutic goal group.ConclusionsIn hypertension patients, when compared to uncontrolled hypertension patients, low therapeutic BP goal is associated with better cardiovascular outcomes than high therapeutic BP goal.

N-terminal brain natriuretic peptide predicted cardiovascular events stronger than high-sensitivity C-reactive protein in hypertension: a LIFE substudy

N-terminal pro-brain natriuretic peptide (Nt-proBNP) and high-sensitivity C-reactive protein (hsCRP) are cardiovascular risk markers in various populations, but are not well examined in hypertension. Therefore, we wanted to investigate whether high Nt-proBNP or hsCRP predicted the composite endpoint of cardiovascular death, non-fatal stroke or non-fatal myocardial infarction independently of traditional cardiovascular risk factors and the urine albumin: creatinine ratio (UACR), which is a well established cardiovascular risk factor in hypertension. In 945 hypertensive patients from the LIFE study with electrocardiographic left ventricular (LV) hypertrophy, we measured traditional cardiovascular risk factors including electrocardiography, morning UACR, hsCRP by immunoturbidimetry assay and Nt-proBNP by immunoassay after 2 weeks of placebo treatment. During 55 months' follow-up 80 patients suffered a composite endpoint. HsCRP as well as Nt-proBNP above the median values of 3.0 mg/l and 170 pg/ml, respectively, was associated with a higher incidence of composite endpoint (13.1 versus 3.8%, P < 0.01, and 11.5 versus 5.4%, P < 0.01). In Cox regression analyses, standardized log(hsCRP)/SD predicted a composite endpoint [hazard ratio (HR) 1.3 per SD = 0.47 log(mg/l), P < 0.05] after adjustment for traditional cardiovascular risk factors, but not after further adjustment for UACR. Standardized log(Nt-proBNP)/SD predicted a composite endpoint after adjustment for traditional cardiovascular risk factors [HR 1.9 per SD = 0.49 log(pg/ml), P < 0.05] as well as after further adjustment for UACR [HR 1.5 per SD = 0.49 log(pg/ml), P < 0.01]. Log(Nt-proBNP) added significantly to the Cox regression models using traditional cardiovascular risk factors with and without UACR (both P < 0.001). Nt-proBNP predicted a composite endpoint after adjustment for traditional risk factors, UACR and a history of diabetes or cardiovascular disease and added significantly to the prediction of composite endpoint, whereas hsCRP did not.

Aortic Valve Sclerosis and Albuminuria Predict Cardiovascular Events Independently in Hypertension: A Losartan Intervention for Endpoint-reduction in Hypertension (LIFE) Substudy

Aortic valve (AV) sclerosis and urine albumin/creatinine ratio (UACR) are both markers of atherosclerosis. We aimed to investigate whether they predicted cardiovascular (CV) events independently in patients with hypertension and electrocardiographic left ventricular (LV) hypertrophy. After 2 weeks of placebo treatment, clinical, laboratory, and echocardiographic variables were assessed in 960 hypertensive patients from the LIFE Echo substudy who had electrocardiographic LV hypertrophy. Morning urine albumin and creatinine were measured calculating UACR. The presence of AV sclerosis was defined as valve thickening or calcification. Fifteen patients with mild AV stenosis were excluded. The patients were followed for 60 +/- 4 months and the composite endpoint (CEP) of CV death, nonfatal stroke, or nonfatal myocardial infarction was recorded. A value of UACR above the median value of 1.406 was associated with higher incidence of CEP and CV death in patients with AV sclerosis (CEP: 18.8% v 9.0% P < 0.05, CV death: 7.1% v 0.7% P < 0.01) and in patients without AV sclerosis (CEP: 14.0% v 4.9% P < 0.001, CV death: 5.1% v 1.1% P < 0.01). In Cox regression analysis, AV sclerosis predicted CEP (hazard ratio [HR] = 1.52, P < .05), but not CV death (HR = 1.30 [0.62 to 2.70], NS) independently of logUACR (HR = 1.70 and HR = 3.25, both P < .001). After adjusting for the Framingham Risk Score, CV disease, diabetes, smoking, and treatment allocation, AV sclerosis predicted CEP (HR = 1.5, P < .05) but not CV death (HR = 1.4, NS) independently of logUACR (HR = 1.2, P = .09 and HR = 1.94, P < .05). In hypertensive patients with electrocardiographic LV hypertrophy, AV sclerosis predicted CEP but not CV death independently of UACR after adjusting for CV risk factors and treatment allocation, indicating that AV sclerosis and UACR might be markers of different aspects of the atherosclerotic process.

Is albuminuria a cardiovascular risk factor independent of left ventricular hypertrophy in hypertension? A LIFE study

Background: Albuminuria and left ventricular (LV) hypertrophy are strong cardiovascular risk factors perceived to be Interrelated. In the LIFE study we investigated the predictive value of albuminuria for the composite endpoint (CEP) of cardiovascular death, nonfatal stroke or non-fatal myocardial infarction controlling for, respectively, echocardiographic LV mass, end-diastolic LV posterior wall thickness (PWTd) and relative wall thickness (RWT). Methods: After two weeks of placebo treatment, clinical, laboratory, and echocardiographic varrables were assessed in 960 hypertensive patients from the LIFE Echo substudy, aged 55-80 (mean 66+7) years, with electrocardiographic LV hyperlrophy. Morning urine albumin and creatinine were measured, and urine albumincreatinine ratlo (UACR) was calculated. Macroand microalbuminuria were defined as UACR235 and 3.5<UACRc35, respectively. Results: Macroand microalbuminuria were found I” 23 (2.7%) and 146 (17.2%) patients respectively, and were both associated with higher incidence of CEP (22%, 15.1% vs. 9.9%‘). PWTD above the median value of about 10.1 mm added significantly to the risk of CEP in patients with albuminuria (19.8% vs. 7.3%*), but not in patients without albuminuria (10.8 vs. 9.4%). In Cox regression analyses controlling for LV mass index, log UACR remaned significantly predictive of the CEP (odds ratio [OR] = 1,5) as was history of peripheral vascular disease (1.9’), diabetes (2.1”). cerebral vascular disease (2.3”): smoking (1.8’): and low hioh densitv lipoprotein _. . cholesterol (0.5’). Log UACR significantly predicted the CEP I” alternative models adiustina for RWT or PWTd (ORs=lS and 1.4). independent of the same clinical covariates. go.05, ** P<O.Ol. Conclusions: Albuminuria strongly predicts cardiovascular morbidity and mortality I” hypertensive patients with electrocardiographic LV hypertrophy Independent of LV mass and geometry. Thus, despite the known relation of albuminuria with LVH. the predictive value of albuminma for cardiovascular events is independent of that of LV hyperlrophy.