Independent Predictor Of Major Adverse Cardiac Events Research Articles

Prognostic value of mid-term cardiovascular magnetic resonance follow-up in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study

BackgroundThe prognostic value of follow-up cardiovascular magnetic resonance (CMR) in dilated cardiomyopathy (DCM) patients is unclear. We aimed to investigate the prognostic value of cardiac function, structure, and tissue characteristics at mid-term CMR follow-up. MethodsThe study population was a prospectively enrolled cohort of DCM patients who underwent guideline-directed medical therapy with baseline and follow-up CMR, which included measurement of biventricular volume and ejection fraction, late gadolinium enhancement, native T1, native T2, and extracellular volume. During follow-up, major adverse cardiac events (MACE) were defined as a composite endpoint of cardiovascular death, heart transplantation, and heart-failure readmission. ResultsAmong 235 DCM patients (median CMR interval: 15.3 months; interquartile range: 12.5–19.2 months), 54 (23.0%) experienced MACE during follow-up (median: 31.2 months; interquartile range: 20.8–50.0 months). In multivariable Cox regression, follow-up CMR models showed significantly superior predictive value than baseline CMR models. Stepwise multivariate Cox regression showed that follow-up left ventricular ejection fraction (LVEF; hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.91–0.96; p < 0.001) and native T1 (HR, 1.01; 95% CI, 1.00–1.01; p = 0.030) were independent predictors of MACE. Follow-up LVEF ≥ 40% or stable LVEF < 40% with T1 ≤ 1273 ms indicated low risk (annual event rate < 4%), while stable LVEF < 40% and T1 > 1273 ms or LVEF < 40% with deterioration indicated high risk (annual event rate > 15%). ConclusionsFollow-up CMR provided better risk stratification than baseline CMR. Improvements in the LVEF and T1 mapping are associated with a lower risk of MACE.

A pilot study of S100A4, S100A8/A9, and S100A12 in dilated cardiomyopathy: novel biomarkers for diagnosis or prognosis?

Circulating biomarkers can provide important information for the diagnosis and prognosis of dilated cardiomyopathy (DCM). We explored novel biomarkers for the diagnosis and prognosis of DCM to improve clinical decision-making. A total of 238 DCM patients and 65 control were consecutively enrolled at Zhongshan Hospital between January 2017 and January 2019. In the screening set, four DCM patients and four controls underwent measurements of serum proteomic analysis. Seventy-six differentially expressed circulating proteins were screened by data-independent acquisition proteomics, and three of these proteins (S100A4, S100A8/A9, and S100A12) were validated by multiple-reaction monitoring-mass spectrometry. In the validation set, subsequently, a total of 234 DCM patients and 61 control subjects were evaluated by enzyme-linked immunosorbent assay. Circulating S100A4, S100A8/A9, and S100A12 were significantly increased in DCM patients (P<0.001). These three proteins were significant positively correlated with other parameters, such as Lg (NT-proBNP), IL-1β, TGF-β, CRP, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter, whereas they were negatively correlated with left ventricular ejection fraction, respectively (P<0.05). The receiver operator characteristic curve showed the combination of S100A4, S100A8/A9, and S100A12 [area under curve (AUC) 0.88, 95% confidence interval (CI) 0.84-0.93] was better than single S100A4 (AUC 0.74, 95% CI 0.68-0.81), S100A8/A9 (AUC 0.82, 95% CI 0.77-0.88), or S100A12 (AUC 0.80, 95% CI 0.72-0.88) in the diagnosis of DCM (P<0.01). After a median follow-up period of 33.5months, 110 patients (47.01%) experienced major adverse cardiac events (MACEs), including 46 who had cardiac deaths and 64 who had heart failure rehospitalizations. Kaplan-Meier analysis indicated that the DCM patients with ≥75th percentile level of S100A4 had a significantly higher incidence of MACEs than those with <75th percentile level of S100A4 (61.40% vs. 42.37%, P<0.05). There were no significant differences of MACE rate among DCM patients with different concentrations of S100A8/A9 and S100A12 (P>0.05). Cox proportional hazards regression analysis revealed that S100A4 [≥75th percentile vs. <75th percentile: hazard ratio (HR) 1.65; 95% CI 1.11-2.45] remained significant independent predictors for MACEs (P<0.05); however, S100A8/A9 and S100A12 were not independent factors for predicting MACE (P≥0.05). S100A4, S100A8/A9, and S100A12 may be additional diagnostic tools for human DCM recognition, and the combination of these three indicators helped to improve the accuracy of a single index to diagnose DCM. Additionally, S100A4 was identified as a significant predictor of prognosis in patients with DCM.

Serum cystatin C predicts the risk of non-ST-elevation acute coronary syndrome

ObjectiveInflammation markers have been proposed as the predictors of adverse cardiac events in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This study aimed to investigate prognostic value of serum cystatin C (Cys-C) for NSTE-ACS patients.MethodsCys-C, neutrophil to lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hsCRP) were examined in 212 NSTE-ACS patients and 60 controls. Global registry of acute coronary events (GRACE) score and major adverse cardiac events (MACE) in NSTE-ACS patients were recorded.ResultsCys-C level in the serum was significantly higher in NSTE-ACS patients than in control, and was positively correlated with hsCRP level and NLR as well as GRACE score at admission and 6 months after discharge in NSTE-ACS patients. Serum Cys-C level was identified as a new predictor of MACE.ConclusionSerum Cys-C level may be an inflammation biomarker in patients with NSTE-ACS, and could be used as an independent predictor of MACE.

Enhancing predictive accuracy of the cardiac risk score in open abdominal aortic surgery: the role of left ventricular wall motion abnormalities.

Open abdominal aortic surgery carries many potential complications, with cardiac adverse events being the most significant concern. The Vascular Study Group Cardiac Risk Index (VSG-CRI) is a commonly used tool for predicting severe cardiac complications and guiding clinical decision-making. However, despite the potential prognostic significance of left ventricular wall motion abnormalities (LVWMAs) and reduced LV ejection fraction (LVEF) for adverse outcomes, the VSG-CRI model has not accounted for them. Hence, the main objective of this study was to analyze the added value of LV wall motion on the discriminatory power of the modified VSG-CRI in predicting major postoperative cardiac complications. A prospective study was conducted involving 271 patients who underwent elective abdominal aortic surgery between 2019 and 2021. VSG-CRI scores were calculated, and preoperative transthoracic echocardiography was conducted for all patients. Subsequently, a modified version of the VSG-CRI, accounting for reduced LVEF and LVWMAs, was developed and incorporated into the dataset. The postoperative incidence of the composite endpoint of major adverse cardiac events (MACEs), including myocardial infarction, clinically relevant arrhythmias treated with medicaments or by cardioversion, or congestive heart failure, was assessed at discharge from the index hospitalization, with adjudicators blinded to events. The predictive accuracy of both the original and modified VSG-CRI was assessed using C-Statistics. In total, 61 patients (22.5%) experienced MACEs. Among these patients, a significantly higher proportion had preoperative LVWMAs compared to those without (62.3% vs. 32.9%, p < 0.001). Multivariable regression analysis revealed the VSG-CRI [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.21-1.77; p < 0.001] and LVWMA (OR 2.76; 95% CI 1.46-5.23; p = 0.002) as independent predictors of MACEs. Additionally, the modified VSG-CRI model demonstrated superior predictability compared to the baseline VSG-CRI model, suggesting an improved predictive performance for anticipating MACEs following abdominal aortic surgery [area under the curve (AUC) 0.74; 95% CI 0.68-0.81 vs. AUC 0.70; 95% CI 0.63-0.77; respectively]. The findings of this study suggest that incorporating preoperative echocardiography can enhance the predictive accuracy of the VSG-CRI for predicting MACEs after open abdominal aortic surgery. Before its implementation in clinical settings, external validation is necessary to confirm the generalizability of this newly developed predictive model across different populations.

Very long-term prognostic value of clinical SYNTAX score in patients undergoing percutaneous coronary intervention for left main coronary artery disease

Abstract Background Recently, long-term prognostic value of SYNTAX score (SS) has been validated in patients with left main coronary artery disease (LMCA). However, the ability of clinical SYNTAX score (CSS) to predict very long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for LMCA has not been fully investigated yet. Purpose We aimed to validate the impact of CSS on very long-term outcomes in patients undergoing PCI for LMCA. Methods Between June 2006 and December 2012, 279 patients underwent unprotected LMCA PCI were analyzed. The SS for each patient was calculated by scoring all coronary lesions using SS algorithm. CSS was calculated by multiplying the SS to an ACEF score (age/left ventricular ejection fraction + 1 if serum creatinine&amp;gt;2mg/dL). Major adverse cardiac events (MACEs) were defined as death, non-fatal myocardial infarction, and revascularizations. Mean follow-up duration was 2,529±1664 days. Results The CSS (26.8±11.9 versus 39.9±26.1, p&amp;lt;0.001) as well as SS (23.2±6.9 versus 25.8±7.9, p=0.003) was significantly higher in patients with MACEs. Area under the curve for MACEs (0.672 versus 0.599, p=0.0023) and mortality (0.744 versus 0.626, p&amp;lt;0.0001) of CSS was significantly higher compared with those of SS (Figure 1). The CSS significantly improved the reclassification and the integrated discrimination of patients compared to SS. Log CSS was an independent predictor for MACEs (hazard ratio [HR] 5.37, 95% confidence interval [CI] 1.98 – 14.61; p = 0.006) and mortality (HR 11.69, 95% CI 3.30 – 41.31; p &amp;lt; 0.001). When patients were categorized into 3 groups according to tertiles of CSS (Low CSS ≤ 22, 22 &amp;lt; Mid CSS ≤ 34, High CSS &amp;gt; 34), patients in the highest CSS tertile had significantly higher rates of MACEs (log-rank p&amp;lt;0.001) and mortality (log-rank p&amp;lt;0.001) compared with those in the lower 2 tertiles (Figure 2). The highest CSS tertile was an independent predictor for MACEs (HR 2.33, 95% CI 1.42 – 3.82; p = 0.001) and mortality (HR 5.66, 95% CI 2.20 – 14.57; p &amp;lt; 0.001). Conclusions The CSS is useful to predict very long-term clinical outcome in patients underwent unprotected LMCA PCI.

Abstract 14398: Predictors of Major Adverse Cardiac Events in Individuals With Left Bundle Branch Block and Cardiac Resynchronization Therapy: Analysis From the Derivate Registry

Background: Cardiac resynchronization therapy (CRT) plays an important role in managing patients with advanced heart failure (HF) with reduced ejection fraction and interventricular conduction block, as it reestablishes synchrony and cardiac function while reducing the risks of HF-related hospitalizations and mortality. Despite the well-described advantages of CRT, approximately 30% to 40% of patients fail to respond to therapy. Therefore, our study aimed to define patient characteristics associated with major adverse cardiac events (MACE) in individuals with left bundle branch block (LBBB) who received CRT. Methods: The study cohort included patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy (DERIVATE) registry who had LBBB and had previously undergone CRT. We defined MACE as a composite outcome including cardiac death, hospitalization for heart failure, or major adverse arhythmic events. Cox regression analysis was used to examine the relationship between MACE and CRT therapy. Kaplan-Meier curves were utilized to explore the association between CRT and cardiac death. Results: Out of 300 individuals, 144 (48%) experienced MACE. The cohort had a mean age of 63.9 ± 10.9, with 29% being male. The median follow-up period was 1285 days. Ischemic cardiomyopathy was identified as an independent predictor of MACE (HR = 3.54; 95% CI [2.31-5.41]; P&lt;0.01) and cardiac death (HR = 24.10; 95% CI [10.71-54.21]; P&lt;0.01) in patients with LBBB and CRT. Amiodarone therapy was associated with a 1.91-fold (95% CI [1.20-3.05]; P=0.01) increased risk of MACE. Notably, multivariate analysis did not reveal a significant association between gender, hypertension, renal function, diabetes mellitus, or NYHA class III/IV and the occurrence of MACE. Conclusion: Our findings suggest that ischemic cardiomyopathy and the use of amiodarone therapy are independent predictors of MACE in patients with LBBB who previously underwent CRT. These findings suggest that patient-level characteristics are important predictors of MACE; however, further research is needed to better understand the interplay between ejection fraction, conduction disease, and patient characteristics post-CRT therapy.

Abstract 15568: Myocardial Strain Assessment for Comprehensive Risk Prediction in Patients Following Acute Myocardial Infarction

Background: Cardiovascular magnetic resonance-feature tracking (CMR-FT) derived strain analyses provide incremental prognosticbenefit in patients following acute myocardial infarction (AMI). This study aimed to evaluate and re-validate previously reportedprognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardialinfarction (STEMI). Methods: Overall, 566 STEMI patients of the CONDITIONING-LIPSIA trial including pre-/postconditioning treatment and/orconventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronaryintervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee) and boosterpump (Ea) strain as well as left ventricular (LV)global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain analyses were carried out. Previously identified cut-offvalues were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction and newcongestive heart failure were assessed within 12 months after the index event. Results: Both atrial and ventricular strain values were significantly reduced in patients with MACE (p&lt;0.01 for all). PredeterminedLA and LV strain cut-offs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariableregression modeling (p&lt;0.001 for all) with LA Es emerging as independent predictor of MACE on multivariable regression modeling(HR 0.92, p=0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (c-index increase from 0.7 to 0.74,p=0.03). Conclusion: External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiacdeformation assessment in STEMI patients. Within the current study especially LA strain parameters enabled further riskstratification and prognostic assessment over and above clinically established risk parameters.

The Presence, Location, and Degree of Late Gadolinium Enhancement in Relation to Myocardial Dysfunction and Poor Prognosis in Patients with Systemic Lupus Erythematosus.

Patients with systemic lupus erythematosus (SLE) typically develop myocardial fibrosis. No studies have investigated the clinical significance of the presence, location, and degree of fibrosis in SLE patients. Seventy-four SLE patients were included. Thirty-seven non-autoimmune disease patients and thirty-seven healthy individuals were included as controls. Myocardial fibrosis was evaluated at cardiac magnetic resonance via a qualitative and quantitative assessment of late gadolinium enhancement (LGE). Myocardial function was measured via speckle-tracking echocardiography. All patients were followed up for the occurrence of major adverse cardiac events (MACE). The presence, locations, and degrees of LGE disturbed regional and global myocardial function. The presence of LGE, left ventricular free-wall LGE (LVFW LGE), and severe LGE were all independent predictors of MACE in SLE patients [LGE presence HR: 3.746 (1.434-9.79), p = 0.007; LVFW LGE HR: 2.395 (1.023-5.606), p = 0.044; severe LGE HR: 3.739 (1.241-11.266), p = 0.019]. LGE combined with SLE-related organ damage identified patients at high risk of MACE (p < 0.001). In conclusion, the presence, degree, and location of LGE were associated with myocardial dysfunction. The presence, location, and degree of LGE had the potential to independently predict poor prognosis and improve risk stratification in SLE patients.

Left ventricular entropy is a novel predictor of major adverse cardiac events (MACE) in patients with coronary atherosclerosis: a multi-center study.

To investigate the incremental prognostic value of left ventricular (LV) entropy in a large multi-center population with coronary atherosclerotic heart disease (CAD). Current risk stratification of patients with CAD is imprecise and not accurate enough. A total of 314 CAD patients who underwent cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) at two medical centers in China between October 2015 and July 2022 were included in this study. Additionally, the 193 patients under 3.0-T field also underwent CMR T1 mapping. LV entropy and extracellular volume (ECV) were calculated from the LGE image of LV myocardium, and major adverse cardiac events (MACEs) were analyzed. Among 314 patients, 110 experienced MACE during a median follow-up of 13months. The risk of MACE was significantly increased in the high entropy group (log-rank p < 0.001). Entropy maintained an independent association with MACE in a multivariable model including left ventricular ejection fraction (LVEF) and LGE (HR = 1.78; p = 0.001). In addition, the primary endpoint events prognostic value was significantly improved by adding LV entropy to the baseline multivariable model (C-statistic improvement: 0.785-0.818, Delong test: p = 0.001). Similarly, among 193 3.0-T field patients, adding LV entropy to the multivariable baseline model significantly improved the prognostic value of the model for MACE (C-statistic improvement: 0.820-0.898, Delong test: p = 0.004). CMR-assessed LV entropy is a powerful independent predictor of MACE in patients with CAD, incremental to common clinical and CMR risk factors, including LVEF, LGE, Native T1, and ECV. Left ventricular entropy is a powerful independent predictor of major adverse cardiac events in patients with coronary atherosclerotic heart disease, incremental to common clinical and cardiac magnetic resonance risk factors. • Left ventricular entropy, a novel cardiac magnetic resonance parameter of myocardial heterogeneity, demonstrated a robust prognostic association with major adverse cardiac events beyond guideline-based, clinical risk markers. • Entropy can have an important role in the primary prevention of major adverse cardiac events in patients with coronary atherosclerotic heart disease. • Compared with late gadolinium enhancement, extracellular volume, and native T1, entropy could be used to more comprehensively characterize the heterogeneity of left ventricular myocardium.

Impact of Lipoprotein (a) on Long-Term Outcomes in Patients With Acute Myocardial Infarction.

Lipoprotein (a) (Lp(a)) is a complex circulating lipoprotein, and there is increasing evidence it is a risk factor for atherosclerotic cardiovascular disease (ASCVD). This study aimed to investigate the influence of Lp(a) serum levels on long-term outcomes after acute myocardial infarction (AMI).Methods and Results: Between January 2015 and January 2018, we enrolled 262 patients with AMI who underwent coronary angiography within 24 h of the onset of chest pain and had available Lp(a) data enabling subdivision into 2 groups: high Lp(a) (≥32 mg/dL: n=76) and low Lp(a) (<32 mg/dL: n=186). The primary endpoint was major adverse cardiac events (MACE), which was defined as a composite of cardiac death, nonfatal MI, and readmission for heart failure. Multivariate Cox regression analysis was performed to identify the predictors of MACE. The incidence of MACE was significantly higher in the high Lp(a) group than in the low Lp(a) group (32.8% vs. 19.6%, P=0.004). Multivariate analysis showed that Lp(a) ≥32 mg/dL was an independent predictor of MACE (hazard ratio 2.84, 95% confidence interval 1.25-6.60, P=0.013). High Lp(a) levels were associated with worse long-term outcomes after AMI, so Lp(a) may be useful for risk assessment.

Electrocardiographic Findings in Genotype-Positive and Non-sarcomeric Children with Definite Hypertrophic Cardiomyopathy and Subclinical Variant Carriers.

In children with hypertrophic cardiomyopathy (HCM), the genotype-phenotype association of abnormal electrocardiographic (ECG) features in the backdrop of gene positivity has not been well described. This study aimed to describe the abnormal ECG findings in children with HCM harboring who have genetic variants and determine the association with major adverse cardiac events (MACE). We retrospectively analyzed 81 variants-positive, phenotype-positive (V+P+), 66 variant-positive, phenotype-negative (V+P-), and 85 non-sarcomeric subjects. We analyzed ECG findings and clinical outcomes in the three groups of subjects. Repolarization abnormalities (ST and T wave changes) and pathologic Q waves were the most common abnormalities in variant and non-sarcomeric subjects. The V+P+ group showed higher occurrence of ST segment changes and T wave abnormalities compared to V+P- group. Independent predictors of MACE included ST segment changes (OR 3.54, CI 1.20-10.47, p = 0.022). T wave changes alone did not predict outcome (OR 2.13, CI 0.75-6.07, p = 0.157), but combined repolarization abnormalities (ST+T changes) were strong predictors of MACE (OR 5.84, CI 1.43-23.7, p = 0.014) than ST segment changes alone. Maximal wall z score by echocardiography was a predictor of MACE (OR 1.21, CI 1.07-1.37, p = 0.002). Despite the presence of significant myocardial hypertrophy (z score > 4.7), voltage criteria for LVH were much less predictive. In the non-sarcomeric group, RVH was significantly associated with MACE (OR 3.85, CI 1.08-13.73, p = 0.038). These abnormal ECG findings described on the platform of known genetic status and known myocardial hypertrophy may add incremental value to the diagnosis and surveillance of disease progression in children with HCM. Select ECG findings, particularly repolarization abnormalities, may serve as predictors of MACE in children.

Predictors of major adverse cardiac events during 7-days period in acute coronary syndrome patients who had percutaneous coronary intervention in Cipto Mangunkusumo National Hospital, Jakarta

Link of Video Abstract: https://youtu.be/YDWnVBBGC0Q Background: Major adverse cardiac events (MACE) increase the morbidity and mortality of patients with acute coronary syndrome (ACS). Data are lacking on MACE occurrence in patients with ACS after percutaneous coronary intervention (PCI). This study aims to find out the predictors of MACE during 7 days in ACS patients who had PCI. Methods: The study design was unmatched case-control. The study included 461 patients with ACS who were hospitalized in the intensive cardiology care unit in Cipto Mangunkusumo Hospital from January 1st, 2015 until November 30th, 2017. Age, female sex, diabetes mellitus, hypertension, heart failure, kidney function disorder, cardiogenic shock, ejection fraction ≤ 40%, left main (LM) coronary artery stenosis, arrhythmia, 3-vessel coronary artery stenosis, and left anterior descending (LAD) artery stenosis were included in the analysis as predictors of MACE. Results: Cardiogenic shock (OR = 10.65, p = 0.001), LAD stenosis (OR = 15.23, p = 0.02), ejection fraction ≤ 40% (OR = 10.8, p = 0.00), 3-vessels or more coronary artery stenosis (OR 3.47, p = 0.01), heart failure (OR = 3.1, p = 0.02), and renal function disorder (OR 4.76, p = 0.00) were proven as predictors of MACE during 7-days period in ACS patients who had PCI. Female sex, cardiogenic shock, LAD stenosis, and ejection fraction ≤ 40% were independent predictors of MACE in ACS patients who had PCI, with OR values of 6.33 (95%CI 1.32- 30.50), OR 17.56 (1.85-167.06), OR 26.61 (1.38-513.81), and OR 7.6 (1.86-31.09), respectively. Conclusion: Cardiogenic shock, LAD stenosis, ejection fraction ≤ 40%, ≥ 3 vessels stenosis, heart failure, and renal function disorder were predictors of MACE during 7 days in ACS patients who had PCI.

Short and medium chain acylcarnitines as markers of outcome in diabetic and non-diabetic subjects with acute coronary syndromes

BackgroundCarnitine metabolism produces numerous molecular species of short-, medium-, and long-chain acylcarnitines, which play important roles in energy homeostasis and fatty acid transport in the myocardium. Given that disturbances in the carnitine metabolism are linked to cardiometabolic disease, we studied the relationship of circulating acylcarnitines with outcomes in patients with acute coronary syndromes (ACS) and evaluated differences in circulating levels of these metabolites between diabetic and non-diabetic patients. MethodsHarnessing a prospective multicentre cohort study (SPUM-ACS; NCT01000701), we measured plasma levels of acylcarnitines, carnitine, and carnitine metabolites to assess their relationship with adjudicated major adverse cardiac events (MACE), defined as composite of myocardial infarction, stroke, clinically indicated revascularization, or death of any cause. The SPUM-ACS study enrolled patients presenting with ACS to Swiss University Hospitals between 2009 and 2012. Acetylcarnitine, octanoylcarnitine, proprionylcarnitine, butyrylcarnitine, pentanoylcarnitine, hexanoylcarnitine, carnitine, γ-butyrobetaine, and trimethylamine N-oxide were measured in plasma using stable isotope dilution high-performance liquid chromatography with online electrospray ionization tandem mass spectrometry. ResultsA total of 1683 patients with ACS were included in the study. All measured metabolites except γ-butyrobetaine and carnitine were higher in diabetic subject (n = 294) than in non-diabetic subjects (n = 1389). On univariate analysis, all metabolites, apart from octenoylcarnitine, were significantly associated with MACE at 1 year. After multivariable adjustment for established risk factors, acetylcarnitine remained an independent predictor of MACE at 1-year (quartile 4 vs. quartile 1, adjusted hazard ratio 2.06; 95% confidence interval 1.12–3.80, P = 0.020). ConclusionCirculating levels of acetylcarnitine independently predict residual cardiovascular risk in patients with ACS.

Impact of myocardial deformation on risk prediction in patients following acute myocardial infarction.

Strain analyses derived from cardiovascular magnetic resonance-feature tracking (CMR-FT) provide incremental prognostic benefit in patients sufferring from acute myocardial infarction (AMI). This study aims to evaluate and revalidate previously reported prognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardial infarction (STEMI). Overall, 566 STEMI patients enrolled in the CONDITIONING-LIPSIA trial including pre- and/or postconditioning treatment in addition to conventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronary intervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee), and boosterpump (Ea) strain analyses, as well as left ventricular (LV) global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) analyses were carried out. Previously identified cutoff values were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction, and new congestive heart failure were assessed within 12 months after the occurrence of the index event. Both atrial and ventricular strain values were significantly reduced in patients with MACE (p < 0.01 for all). Predetermined LA and LV strain cutoffs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariable regression modeling (p < 0.001 for all), with LA Es emerging as an independent predictor of MACE on multivariable regression modeling (HR 0.92, p = 0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (a c-index increase from 0.7 to 0.74, p = 0.03). External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiac deformation assessment in STEMI patients. In the present study, LA strain parameters especially enabled further risk stratification and prognostic assessment over and above clinically established risk parameters. ClinicalTrials.gov, identifier NCT02158468.

Prognostic value of myocardial flow reserve derived by quantitative SPECT for patients with intermediate coronary stenoses

BackgroundFunctional assessment of myocardial ischemia is critical for patients with intermediate coronary stenosis. As the diagnosis performance of absolute quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) by single-photon emission tomography (SPECT) has been proven, its prognostic value in patients with intermediate coronary stenosis remains to be evaluated. MethodsPatients with one or more target lesions of ≥ 50% to ≤ 80% diameter stenoses on invasive coronary angiography were prospectively included in this study. All patients were scheduled for clinically indicated SPECT myocardial perfusion imaging (MPI) within 3 months and agreed to provide informed consent to participate in quantitative SPECT acquisitions to obtain MBF and MFR values. The primary endpoint was defined as a composite of the major adverse cardiac events (MACE): Cardiac death, myocardial infarction, late revascularization and heart failure or unstable angina-related rehospitalization. ResultsOne hundred and nineteen patients (mean age 57 ± 8 years, 62.2% men) were included in the analysis. The average lumen stenosis of patients was 67.0 ± 10.4%. Over a median follow-up duration of 1408 days (interquartile range 1297-1666 days), 18 patients (15.1%) had MACE. Patients with impaired MFR (MFR < 2) had a significantly higher incidence of events than those with preserved MFR (MFR ≥ 2) in Kaplan-Meier survival analysis (Log-rank = 8.105, P = 0.004), while no significant difference was found between patients with normal relative perfusion and those with relative perfusion abnormalities (log-rank = 0.098, P > 0.05). In a multivariate Cox hazards analysis, the SPECT-derived MFR remained an independent predictor of MACE (HR 0.352, 95% CI 0.145-0.854, P = 0.021). ConclusionsIn a cohort of patients with angiographic intermediate coronary lesions, SPECT-derived MFR was an independent predictor of prognosis.

Predictive value of coronary stenosis degree combined with CT-FFR and resting-state CTP for major adverse cardiac events in obstructive coronary artery disease.

CT-based flow reserve fraction (CT-FFR) and CT perfusion (CTP), as a complement to coronary computed tomographic angiography (CCTA) have been revealed to be associated with the prognosis of patients with obstructive coronary artery disease (CAD). However, the prognostic value of coronary stenosis combined with CT-FFR and resting-state CTP based on CCTA for major adverse cardiac events (MACE) is not known and requires further investigation. Fifty-two patients with obstructive CAD (50%-90% stenosis) examined by CCTA were retrospectively collected and followed-up for the occurrence of MACE. Logistic regression was performed to analyze the effects of the degree of coronary stenosis, resting-state CTP, and CT-FFR in predicting the risk of MACE. MACE prediction models were developed, and the area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive validity of different models for MACE. Ethics approval was provided by the First Affiliated Hospital of Hebei North University (Zhangjiakou, China; No. K2020237). Logistic regression analysis showed that coronary artery stenosis ≥ 70%, CT-FFR ≤ 0.80, and perfusion index (PI) were independent predictors for MACE in patients with obstructive CAD (P < .05). The model based on coronary stenosis combined with PI and CT-FFR (AUC = 0.944) was better than those based on the degree of coronary stenosis combined with PI (AUC = 0.874), coronary stenosis degree combined with CT-FFR (AUC = 0.895), and any single index (P < .05). The combined model established by coronary stenosis, CT-FFR, and resting-state CTP based on a "1-stop" CCTA examination for predicting MACE among patients with obstructive CAD has good diagnostic efficacy and shows incremental discriminatory power.

Predictive value of CHA2 DS2 -VASc score for in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction undergoing primary PCI.

This study aimed to explore the predictive value of CHA2 DS2 -VASc score for in-hospital major adverse cardiac events (MACEs) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary artery intervention. A total of 746 STEMI patients were divided into four groups according to CHA2 DS2 -VASc score (1, 2-3, 4-5, >5). The predictive ability of the CHA2 DS2 -VASc score for in-hospital MACE was made. Subgroup analysis was made between gender differences. In a multivariate logistic regression analysis model including creatinine, total cholesterol, and left ventricular ejection fraction, CHA2 DS2 -VASc score was an independent predictor of MACE as a continuous variable (adjusted odds ratio: 1.43, 95% confidence interval [CI]: 1.27-1.62, p < .001). As a category variable, using the lowest CHA2 DS2 -VASc score of 1 as a reference, CHA2 DS2 -VASc score 2-3, 4-5, >5 groups for predicting MACE was 4.62 (95% CI: 1.94-11.00, p = .001), 7.74 (95% CI: 3.18-18.89, p < .001), and 11.71 (95% CI: 4.14-33.15, p < .001). The CHA2 DS2 -VASc score was also an independent risk factor for MACE in the male group, either as a continuous variable or category variable. However, CHA2 DS2 -VASc score was not a predictor of MACE in the female group. The area under the curve value of the CHA2 DS2 -VASc score for predicting MACE was 0.661 in total patients (74.1% sensitivity and 50.4% specificity [p < .001]), 0.714 in the male group (69.4% sensitivity and 63.1% specificity [p < .001]), but there was no statistical significance in the female group. CHA2 DS2 -VASc score could be considered as a potential predictor of in-hospital MACE with STEMI, especially in males.

Prognostic role of feature tracking strain in stress cardiac magnetic eesonance (the PROGRESS study)

Abstract Funding Acknowledgements Type of funding sources: None. Objectives This study aims to assess the role of feature-tracking (FT) strain in the long-term risk stratification of a large population of patients with known or suspected coronary artery disease (CAD) undergoing stress cardiac magnetic resonance (S-CMR) with dipyridamole. Background Recently, FT strain has been applied to S-CMR to improve risk stratification of patients with known or suspected CAD. However, no data are available on the prognostication role of FT strain in patients undergoing a S-CMR with dipyridamole. Methods 729 consecutive patients (age: 63±10 y, male 84%) with stable symptoms suggesting possible cardiac ischemia underwent dipyridamole S-CMR and followed up for 5.8±1.2 years. CMR-FT analysis was performed in each patient to obtain 2D global peak systolic rest and stress longitudinal (GLS), circumferential (GCS), and radial strain (GRS). Major adverse cardiac events (MACE) were defined as non-fatal myocardial infarction and cardiac death. Results MACE occurred in 70 (9.6%) patients. At multivariate analysis, the presence of late gadolinium enhancement (LGE) (HR 2.737 [95% CI 1.534–4.884]), p &amp;lt;0.001, and stress GCS (HR 1.064 [95% CI 1.011–1.119]), p = 0.0164 were independently associated with MACE. By Kaplan-Meier analysis, patients with stress GCS &amp;gt;-15% had significantly reduced event-free survival compared with those with stress GCS ≤-15 (log-rank p = 0.007). The best predictive model of MACE included left ventricular ejection fraction (LVEF) + positive S-CMR for inducible ischemia (positive S-CMR) + LGE. A model based on LVEF + stress GCS (contrast free) showed higher performance in predicting MACE compared to LVEF alone and a similar performance compared to LVEF + positive S-CMR (p =0.05). Conclusions In patients with known or suspected CAD undergoing S-CMR with dipyridamole, stress GCS and LGE presence are independent predictors of MACE. Adding strain analysis of stress GCS can help define patients' risk after S-CMR on top of LVEF without needing contrast agents.

Deep learning-based quantification of epicardial adipose tissue volume in cardiac magnetic resonace predicts major adverse cardiovascular events in patients with known or suspected CAD

Abstract Funding Acknowledgements Type of funding sources: None. Background Increased epicardial adipose tissue (EAT) volume quantified with cardiac magnetic resonance (CMR) has been associated with the development of major adverse cardiac events (MACE). We sought to investigate the additional prognostic role EAT volume in patients with known or suspected coronary artery disease (CAD) undergoing CMR imaging. Methods 702 consecutive patients (age: 63±10 y, male 84%) with known or suspected CAD underwent clinically indicated CMR. Using a new DL algorithm, EAT volume was quantified on short-axis stack steady state free precession (SSFP) images. Firstly, a training set of 300 patients with manually traced EAT (ground truth) was randomly split (patient-wise) into development (n=240, 80%) and held-out testing (n=60, 20%) cohorts. Secondly, we applied our segmentation network on a validation set of 402 patients with unlabeled data for automated EAT segmentations. Finally, we applied the algorith to the entire population (702 patients) to quantify EAT. EAT volume, normalized for the body mass index (EAT index), was compared to standard clinical and imaging variables for the prediction of MACE defined as non-fatal myocardial infarction and cardiac deaths. Results 52 patients (7.4%) developed MACE during a follow-up of 5.8±1.2 years. Left ventricular ejection fraction (LVEF) &amp;lt; 50% (HR 2.271 [95% CI 1.117–4.616]), p = 0.023, late gadolinium enhancement (LGE) presence (HR 2.456 [95% CI 1.077–5.602]), p = 0.033 and EAT index ≥ 1,8 (HR 6.187 [95% CI 1.879–20.372]), p = 0.003 were independent predictors of MACE. Adding EAT index in a model including LVEF and LGE provided a significant improvement in predicting the endpoint with a Harrell C statistic of 0.75. Conclusions In patients with known or suspected CAD undergoing CMR, fully automated EAT volume quantification provides additional prognostic information on top of standard clinical and imaging parameters.

Prognostic implications of non-infarct-related territory unrecognized myocardial infarction in patients with non-ST-segment-elevation acute coronary syndrome

BackgroundPrognostic value of non-infarct-related territory (non-IR) unrecognized myocardial infarction (UMI) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) remains to be elucidated. We sought to evaluate the prognostic impact of non-IR UMI in patients with first NSTE-ACS presentation. MethodsThis retrospective single-center analysis was conducted in patients with NSTE-ACS without prior history of coronary artery disease, who underwent uncomplicated urgent percutaneous coronary intervention (PCI) within 48 h of admission between August 2014 and January 2018. All patients underwent postprocedural cardiac magnetic resonance imaging (CMR) within 30 days after PCI. Non-IR UMI was defined as the presence of non-IR delayed gadolinium enhancement with an ischemic distribution pattern. We investigated the association of non-IR UMI, other CMR findings and baseline clinical characteristics with major adverse cardiac events (MACE), defined as death, non-fatal myocardial infarction, stroke, late revascularization, and hospitalization for congestive heart failure. ResultsA total of 168 NSTE-ACS patients were included [124 men (73.8 %); 66 ± 11 years]. Non-IR UMI was detected in 28 patients (16.7 %). During a median follow-up of 32 (15–58) months, MACE occurred in 10 (35.7 %) patients with non-IR UMI, and 20 (14.3 %) patients without (p = 0.013). Cox's proportional hazards analysis showed that the presence of non-IR UMI was an independent predictor of MACE (hazard ratio [HR], 2.37, 95 % confidence interval [CI], 1.09–5.18, p = 0.030). In patients with NSTE-ACS undergoing urgent PCI, the prevalence of non-IR UMI was 16.7 %. ConclusionsNon-IR UMI provided prognostic information independent of conventional risk factors and the extent of myocardial injury caused by NSTE-ACS.