Independent Predictor Of All-cause Mortality Research Articles

Prognostic impact of the controlling nutritional status score in Chinese patients undergoing cardiac surgery

Prognostic impact of the controlling nutritional status score in Chinese patients undergoing cardiac surgery

Does arterial stiffness predict mortality in patients with scleroderma: a long-term follow-up study.

Subclinical macrovascular impairment, which has been evaluated with various arterial stiffness (AS) parameters, has been defined in patients with systemic sclerosis (SSc). However, studies investigating the relationship between AS and clinical endpoints in SSc are lacking. This study aims to determine the prognostic value of AS parameters to predict all-cause mortality in SSc patients. AS parameters [carotid-radial pulse wave velocity (PWV) and augmentation index (AIx)] were assessed via applanation tonometry. The prognostic value of these parameters was quantified in patients with SSc (n=60) without pulmonary arterial hypertension (PAH) and obvious cardiac involvement against survival. The overall median follow-up time was 10.3 years, and a 29.4% (n=20) mortality was observed. Four significant predictors of mortality were observed: lung involvement (HR 2.608, p=0.04), the lower level of predicted carbon monoxide diffusing capacity (HR 0.978, p=0.03), lower level of estimated glomerular filtration rate (HR 0.979, p=0.04), and elevated serum C reactive protein (CRP) levels (HR 1.066, p<0.001). Among these variables, elevated CRP was found to be an independent predictor of all-cause mortality. AS parameters were not associated with all-cause mortality (HR 1.014, p=0.6 for AIx and HR 0.737, p=0.19 for PWV, respectively). Long-term data failed to demonstrate the prognostic value of AS parameters in predicting all-cause mortality in SSc patients. The exact mechanisms of cardiovascular (CV) mortality in SSc patients deemed to be atherosclerotic in origin needs to be determined in large-scale studies.

#5773 URINARY OROSOMUCOID IS ASSOCIATED WITH ALL-CAUSE MORTALITY IN THE GENERAL POPULATION

Abstract Background and Aims Urinary albumin excretion (UAE) is considered a risk factor for cardiovascular (CV) disease and all-cause mortality, but the pathophysiological mechanisms are not known, and studies are not consistent with regards to the effect of pharmacological UAE reduction on endpoints. Another protein, orosomucoid (41-43kDa), is a non-specific acute inflammatory protein and is a part of the glycolax that covers the endothelium. Under normal conditions the concentration in urine is low, but a marked increase is demonstrated under both acute and chronic inflammation and in cardiovascular disease. In patients with diabetes urinary orosomucoid excretion (UOE), was an independent predictor of all-cause and cardiovascular mortality even in normoalbuminuric patients. In this longitudinal study, our aim was to study both UAE and UOE in a middle-aged cohort from the general population. We hypothesized that UOE, but not UAE, is an independent predictor for all-cause mortality. Method The Tromsø Study is a population-based, prospective study with repeated health surveys of inhabitants of Tromsø (Northern Norway), and the first took place in 1974. From the sixth wave (Tromsø6, 2007/2008) we included all participants with urinary samples. Follow-up time was assigned from the attendance date of Tromsø6 until 31.08.2022. The associations between urinary markers and all-cause mortality were assessed by Cox regression analysis. Results The cohort included 7180 subjects (4094 women and 3086 men) with a mean (SD) age 63.5 (±9.2) years. Median urinary orosomucoid to creatinine ratio (UOCR) was 0.44 g/g, median albumin to creatinine ratio (UACR) was 0.36 mg/mmol, mean (SD) eGFR was 88.1 (±14.0) ml/min/1.73m² and 1689 died during follow-up. UOCR was independently associated with all-cause mortality (hazard ratio (HR) per g/g increase 1.02, 95% CI 1.01,1.03, p&amp;lt;0.001) adjusted for sex, age, UACR, eGFR and CV risk factors (diabetes, hypertension, smoke, cholesterol, BMI). The HR for UOCR above vs. below median adjusted for the same variables was 1.13 (95% CI 1.01, 1.27, p = 0.032). UACR above median with the same adjustments was not associated to all-cause mortality (hazard ratio 1.04, 95%CI 0.93, 1.15, p = 0.484). Conclusion In this study, we showed for the first time that UOE, but not UAE, was an independent predictor of all-cause mortality in a large cohort from the general population. Thus, UOE may be an earlier marker of vascular damage than UAE. Whether UOE is clinically useful as an early marker of CV disease should be further studied.

#4713 TUMOR NECROSIS FACTOR RECEPTOR 2 POLYMORPHISM (RS1061622) AND INFLAMMATORY RESPONSE IN END-STAGE RENAL DISEASE PATIENTS UNDER DIALYSIS

Abstract Background and Aims Enhanced levels of soluble tumor necrosis factor receptor 2 (sTNFR2) are known to associate with progressive chronic kidney disease (CKD), and is pointed as a potential biomarker for early detection of CKD; moreover, it has been reported as an independent predictor of all-cause mortality in end-stage renal disease (ESRD) patients under dialysis. Despite the increase in TNFR2 and in other inflammatory markers, recognized as risk factors for mortality in dialysis patients, the hypothesis that genetic polymorphisms of those biomarkers might modulate the inflammatory response and, thereby, the patients’ survival predisposition, has been poorly studied. Concerning TNFR2 genetic variants, a single nucleotide polymorphism in TNFR2 (+ 676 T/G; rs1061622), that results in amino acid change at position 196 (Met/Arg), was associated with higher levels of sTNFR2 in inflammatory conditions. The aim of this study was to determine the allelic frequencies of TNFR2 in ESRD patients and controls, and to evaluate its relationship with the circulating levels of inflammatory biomarkers. Method We studied 277 ESRD patients on dialysis and 32 controls, matched for gender, body mass index, and, as far as possible, for age. Real time PCR TaqMan SNP genotyping assay was used to assess allelic frequencies of TNFR2 (rs1061622). We also evaluated the circulating levels of TNF-alpha, sTNFR2, ferritin, hepcidin, elastase and cell-free DNA (cfDNA). Deaths occurring along 1-year follow-up period were recorded and mortality rates were assessed. Results ESRD patients presented higher levels of all studied biomarkers, as compared to controls; their overall mortality rate was 10.5%. Allelic frequencies in ESRD patients and controls were similar for TNFR2 (rs1061622) considering the homozygous and heterozygous individuals (χ2, p = 0.518). Concerning sTNFR2 values, no significant differences were observed between patients with genotypes TT, GG or TG. The GG genotype patients, compared to TT genotype carriers, presented significantly lower ferritin (p = 0.048), hepcidin (p = 0.038), elastase (p = 0.006) and cfDNA levels (p = 0.016); and compared to TG genotype patients, showed significantly lower ferritin (p = 0.039) and a trend towards lower values of hepcidin (p = 0.097), elastase (p = 0.079) and cfDNA (p = 0.0164). TG genotype patients showed higher TNF-alpha (p = 0.049) and a trend towards lower elastase (p = 0.081) than TT genotype subjects. The GG genotype patients presented a trend towards lower mortality rate (6.3%, 7.5%, and 12.4% for GG, TG and TT, respectively). Conclusion No differences were found in the allelic frequencies between controls and ESRD patients. The GG genotype patients for TNFR2 rs1061622 polymorphism showed decreased levels of inflammation, suggesting a more favorable inflammatory response, which is usually associated to a lower mortality risk in these patients. In accordance with the scientific community, recommending studies on genetic survival predisposition in dialysis patients, the polymorphisms of TNFR2 and of other inflammatory biomarkers deserve further studies. Acknowledgements: This work was financed by CESPU, through the project SNPsCKD-GI2-CESPU-2022; FCT, through the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences—UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy—i4HB.

#6715 COGNITIVE IMPAIRMENT IS ASSOCIATED WITH INCREASED MORTALITY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Patients on dialysis are at substantially higher risk for developing cognitive impairment compared with the general population. At the same time cognitive impairment is a strong and independent risk factor for all-cause mortality. Given that the approaches used to access the prevalence of cognitive disfunction widely vary in different patient populations, their true burden in hemodialysis patients remains poorly understood. The aim of our study was to determine the association between cognitive impairment and overall survival and mortality in patients undergoing hemodialysis treatment. Method A total of 69 chronic hemodialysis patients (47 men and 22 women) were included. The median age of patients was 61 [47-69] years. The median duration of hemodialysis treatment was 32 [21-72] months. The study of cognitive status was conducted using the Montreal Cognitive Assessment (MoCA) questionnaire. The test results are between 0 and 30 points. A score of 26 points or more is considered the norm, less than 26 indicates the presence of cognitive impairment. The end point was a fatal outcome from acute pathology or progression of a chronic disease. The analysis of survival and mortality was evaluated using survival tables, the construction of Kaplan-Mayer curves with the Mantel-Cox log–rank criterion. The risks of the influence of cognitive impairment on mortality were assessed using Cox regression. Results During the 24-month follow-up period, 23 patients died. Structure of mortality over the observation period: acute coronary syndrome – 6 (26 %), COVID-19 – 6 (26 %), acute cerebrovascular accident – 2 (9%), thromboembolic complications – 3 (13%), another causes – 6 (26 %). In patients with cognitive impairment on hemodialysis, the average survival value was 16.33 months ± 1.70 months [CI 95% 12.99-19.66] and 20.48 months±1.32 months [CI 95% 17.88-23.07] in patients without cognitive impairment. According to the Mantel-Cox log-rank criterion, there was a statistically significant decrease in overall survival in patients with cognitive impairment, P = .02. The mortality rate of dialysis patients with cognitive impairment was 51%, without cognitive impairment – 19%. Relative risk of death in the group of patients with cognitive impairment using Cox regression: Hazard ratio (HR) :2.90 [95% CI 1.11-7.37, P = .03]. Conclusion Our results support the notion that cognitive impairment may be an independent predictor of all-cause mortality in hemodialysis patients. There are limitations on the sample size of patients in our study. Further larger-scale observations a large cohort of patients are required.

Aortic area/height ratio, peak wall stresses, and outcomes in veterans with tricuspid versus bicuspid aortic valve–associated ascending thoracic aortic aneurysms

BackgroundIn ascending thoracic aortic aneurysm risk stratification, aortic area/height ratio is a reasonable alternative to maximum diameter. Biomechanically, aortic dissection may be initiated by wall stress exceeding wall strength. Our objective was to evaluate the association between aortic area/height and peak aneurysm wall stresses in relation to valve morphology and 3-year all-cause mortality. MethodsFinite element analysis was performed on 270 ascending thoracic aortic aneurysms (46 associated with bicuspid and 224 with tricuspid aortic valves) in veterans. Three-dimensional aneurysm geometries were reconstructed from computed tomography and models developed accounting for prestress geometries. Fiber-embedded hyperelastic material model was applied to obtain aneurysm wall stresses during systole. Correlations of aortic area/height ratio and peak wall stresses were compared across valve types. Area/height ratio was evaluated across peak wall stress thresholds obtained from proportional hazards models of 3-year all-cause mortality, with aortic repair treated as a competing risk. ResultsAortic area/height 10 cm2/m or greater coincided with 23/34 (68%) 5.0 to 5.4 cm and 20/24 (83%) 5.5 cm or greater aneurysms. Area/height correlated weakly with peak aneurysm stresses: for tricuspid valves, r = 0.22 circumferentially and r = 0.24 longitudinally; and for bicuspid valves, r = 0.42 circumferentially and r = 0.14 longitudinally. Age and peak longitudinal stress, but not area/height, were independent predictors of all-cause mortality (age: hazard ratio, 2.20 per 9-year increase, P = .013; peak longitudinal stress: hazard ratio, 1.78 per 73-kPa increase, P = .035). ConclusionsArea/height was more predictive of high circumferential stresses in bicuspid than tricuspid valve aneurysms, but similarly less predictive of high longitudinal stresses in both valve types. Peak longitudinal stress, not area/height, independently predicted all-cause mortality. Video Abstract [Display omitted]

Coronary Artery Disease as an Independent Predictor of Cardiovascular Mortality in COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) is associated with increased risk of cardiovascular mortality. However, little is known about the combined effect of coronary artery disease (CAD) and COVID-19 on mortality. We aimed to investigate the incidence of cardiovascular and all-cause mortality in COVID-19 patients with CAD. This multicenter retrospective study identified 3,336 COVID-19 patients admitted between March and December 2020. Data points were manually reviewed in the patients' electronic health records. Multivariate logistic regression was used to assess whether CAD and its subtypes were associated with mortality. This study shows that CAD was not an independent predictor of all-cause mortality (odds ratio (OR): 1.512, 95% confidence interval (CI): 0.1529 - 14.95, P = 0.723). However, there was a significant increase in cardiovascular mortality in patients with CAD compared to those without (OR: 6.89, 95% CI: 2.706 - 17.53, P < 0.001). There was no significant difference in all-cause mortality in patients with left main artery and left anterior descending artery disease (OR: 1.29, 95% CI: 0.80 - 2.08, P = 0.29). However, CAD patients with a history of interventions (e.g., coronary stenting or coronary artery bypass graft) showed increased mortality compared to those solely treated by medical management (OR: 1.93, 95% CI: 1.12 - 3.33, P = 0.017). CAD is associated with a higher incidence of cardiovascular mortality but not all-cause mortality in COVID-19 patients. Overall, this study will help clinicians identify characteristics of COVID-19 patients with increased risk of mortality in the setting of CAD.

Prognostic Value of Different Levels of Uric Acid in Patients with Coronary Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention.

Recent data suggest that uric acid (UA) might be an independent predictor of clinical outcomes following percutaneous coronary intervention (PCI). The predictive value of uric acid in patients undergoing PCI for chronic total occlusions (CTO) is unknown. We included patients with CTO who underwent PCI at our center in 2005 and 2012, with available uric acid levels before angiography. Subjects were divided into groups according to uric acid tertiles (<5.5 mg/dL, 5.6-6.9 mg/dL, and >7.0 mg/dL), and outcomes were compared among the groups. Out of the 1963 patients (mean age 65.2 ± 11 years), 34.7% (n = 682) had uric acid concentrations in the first tertile, 34.3% (n = 673) in the second tertile, and 31% (n = 608) in the third tertile. Median follow-up was 3.0 years. Uric acid levels in the first tertile were associated with significantly lower all-cause mortality, as compared to the third tertile, with an adjusted hazard ratio (HR) of 0.67 (95% confidence interval (CI): 0.49 to 0.92; p = 0.012). No significant differences regarding all-cause mortality were found between patients in the first and second tertiles (HR: 0.96 [95% CI: 0.71 to 1.3; p = 0.78]). High levels of uric acid emerged as an independent predictor of all-cause mortality in patients with chronic total occlusion treated with PCI. Hence, uric acid levels should be incorporated into the risk assessment of patients with CTO.

The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial.

The presence of an electrocardiographic (ECG) strain pattern-among other ECG features-has been shown to be predictive of adverse cardiovascular outcomes in asymptomatic patients with aortic stenosis. However, data evaluating its impact on symptomatic patients undergoing TAVI are scarce. Therefore, we tried to investigate the prognostic impact of baseline ECG strain pattern on clinical outcomes after TAVI. A sub-group of patients of the randomized DIRECT (Pre-dilatation in Transcatheter Aortic Valve Implantation Trial) trial with severe aortic stenosis who underwent TAVI with a self-expanding valve in one single center were consecutively enrolled. Patients were categorized into two groups according to the presence of ECG strain. Left ventricular strain was defined as the presence of ≥1 mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on the baseline 12-lead ECG. Patients were excluded if they had paced rhythm or left bundle branch block at baseline. Multivariate Cox proportional hazard regression models were generated to assess the impact on outcomes. The primary clinical endpoint was all-cause mortality at 1 year after TAVI. Of the 119 patients screened, 5 patients were excluded due to left bundle branch block. Among the 114 included patients (mean age: 80.8 ± 7), 37 patients (32.5%) had strain pattern on pre-TAVI ECG, while 77 patients (67.5%) did not exhibit an ECG strain pattern. No differences in baseline characteristics were found between the two groups. At 1 year, seven patients reached the primary clinical endpoint, with patients in the strain group demonstrating significantly higher mortality in Kaplan-Meier plots compared to patients without left ventricular strain (five vs. two, log-rank p = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square p = 0.164). In the multivariate analysis, left ventricular strain was found to be an independent predictor of all-cause mortality after TAVI [Exp(B): 12.2, 95% Confidence Intervals (CI): 1.4-101.9]. Left ventricular ECG strain is an independent predictor of all-cause mortality after TAVI. Thus, baseline ECG characteristics may aid in risk-stratifying patients scheduled for TAVI.

Efficacy of alcohol septal ablation in mildly symptomatic or severely symptomatic patients with hypertrophic obstructive cardiomyopathy

Objective: To compare the prognosis of mildly or severely symptomatic patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent alcohol septal ablation (ASA). Methods: This retrospective study cohort consisted of patients with OHCM who received ASA treatment in Beijing Anzhen Hospital, Capital Medical University from March 2001 to August 2021. These patients were divided into mildly and severely symptomatic groups according to the severity of clinical symptoms. Long-term follow-up was conducted, and the following data were collected: duration of follow-up, postoperatire treatment, New York Heart Association (NYHA) classification, arrhythmia events and pacemaker implantation, echocardiographic parameters, and cause of death. Overall survival and survival free from OHCM-related death were observed, and the improvement of clinical symptoms and resting left ventricular outflow tract gradient (LVOTG) and the incidence of new-onset atrial fibrillation were evaluated. The Kaplan-Meier method and log-rank test were used to determine and compare the cumulative survival rates of the different groups. Cox regression analysis models were used to determine predictors of clinical events. Results: A total of 189 OHCM patients were included in this study, including 68 in the mildly symptomatic group and 121 in the severely symptomatic group. The median follow-up of the study was 6.0 (2.7, 10.6) years. There was no statistical difference in overall survival between the mildly symptomatic group (5-year and 10-year overall survival were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year overall survival were 94.2% and 83.9%, respectively, P=0.405); there was also no statistical difference in survival free from OHCM-related death between the mildly symptomatic group (5-year and 10-year survival free from HCM-related death were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year survival free from HCM-related death were 95.2% and 92.6%, respectively, P=0.846). In the mildly symptomatic group, NYHA classification was improved after ASA (P<0.001), among which 37 patients (54.4%) were in NYHA class Ⅰ, and the resting left ventricular outflow tract gradient (LVOTG) decreased from 67.6 (42.7, 90.1) mmHg (1 mmHg=0.133 kPa) to 24.4 (11.7, 35.6) mmHg (P<0.001). In severely symptomatic group, NYHA classification was also improved post ASA (P<0.001), among which 96 patients (79.3%) improved by at least one NYHA classification, and the resting LVOTG decreased from 69.6 (38.4, 96.1) mmHg to 19.0 (10.6, 39.8) mmHg (P<0.001). The incidence of new-onset atrial fibrillation was similar between the mildly and severely symptomatic groups (10.2% vs. 13.3%, P=0.565). Cox multivariate regression analysis showed that age was an independent predictor of all-cause mortality in OHCM patients post ASA (HR=1.068, 95%CI 1.002-1.139, P=0.042). Conclusions: Among patients with OHCM treated with ASA, overall survival and survival free from HCM-related death were similar between mildly symptomatic group and severely symptomatic group. ASA therapy can effectively relieve resting LVOTG and improve clinical symptoms in mildly or severely symptomatic patients with OHCM. Age was an independent predictor of all-cause mortality in OHCM patients post ASA.

Non-revascularized chronic total occlusion is associated with worse outcomes in post-MI drug-refractory electrical storm patients treated by catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Outcomes in post-myocardial infarction (MI) patients which are referred for catheter ablation (CA) for drug-refractory electrical storm (ES) are influenced both by patient characteristics and procedural results. Previous data has shown higher risk for the first incident ES episode in the presence of non-revascularized chronic total occlusions (nCTOs). However, the prognostic effect of nCTOs in post-ES ablation patients is relatively unknown. Purpose We evaluated the impact of the presence of nCTO on all-cause mortality and sustained VT recurrence rate after CA for ES in post-MI patients. Methods In this single centre retrospective longitudinal study, we included consecutive post-MI patients referred for CA for drug-refractory ES. The median follow-up interval was 34.36 (7.25-63.65) months. CA outcome was defined by the absence or presence of residual sustained monomorphic VT at end-procedural programmed ventricular stimulation (PVS). Coronary angiography was performed prior to ablation in all patients. Results Sixty-four patients were included (85.9% (n = 55) males, age 62.64 ± 11.13 years). The mean left ventricular ejection fraction (LVEF) was 31.41 ± 10.99. There were 18.8% (n = 12) patients with nCTOs. Residual sustained monomorphic VT inducibility was documented in 28.1% (n = 18) cases. There were 29.7% (n = 19) deaths and sustained VT recurrences, respectively, during the monitored interval. Nine out of twelve (75%) nCTO patients died during follow-up. The presence of a nCTO induced a borderline significant higher risk of sustained VT recurrence during follow-up (HR 2.527, CI.95% 0.992 – 6.435, p = 0.052) in univariable Cox regression. In addition to age and residual sustained monomorphic VT at PVS, a multivariable Cox regression model identified the presence of nCTO as an independent predictor for all-cause mortality (HR 3.194, CI 95% 1.212-8.420, p = 0.019) (Figure 1). Conclusion(s) The presence of a nCTO in post-MI patients may be associated with higher all-cause mortality and sustained VT recurrences after ablation for drug-refractory electrical storm.

The prevalence and importance of frailty in cardiac resynchronization therapy patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Nemzeti Kardiovaszkuláris Laboratórium RRF-2.3.1-21-2022-00003. Background Frailty, characterized by loss of homeostatic reserves and increased vulnerability to physiological decompensation, results from an aggregation of insults across multiple organ systems. Frailty can be quantified by counting the number of ‘health deficits’ across a range of domains. Aims We assessed the frequency of, and outcomes related to frailty in patients with heart failure and reduced ejection fraction who previously underwent cardiac resynchronization therapy (CRT) implantation. Methods We used a cumulative deficits approach to construct a 30-item frailty index (FI) and applied it to identify frail patients enrolled in our CRT registry. The 30 items were derived from medical history, other patient characteristics and laboratory results, covering a range of body systems. In keeping with previous studies, patients with FI ≤0.210 were classified as non-frail and those with higher scores were divided into two categories using score increments of 0.100. Our primary endpoint was all-cause mortality. Results Among 1004 included patients, 75 (7%) were considered Non-frail, while 271 (27%) and 658 (66%) participants were categorized as Frail in groups 1- and 2. Patients in Frail group 2 were older, had a less favorable renal function, and generally had more comorbidities (i.e. atrial fibrillation, hypertension, ischemic cardiovascular disease) than patients categorized in the Non-frail or Frail group 1. During the median follow-up time of 4.4 (2.3-6.9) years, 17 (22%) patients in the Non-frail group, 103 (38%) in Frail group 1, and 479 (73%) in the Frail group 2 reached the primary endpoint. Non-frail patient group showed the most beneficial survival with a 70% (HR 0.31; 95% CI: 0.23-0.41; p&amp;lt;0.001) lower all-cause mortality risk compared to Frail group 2. Adjusting for relevant covariates, NYHA class, creatinine, and TAPSE were identified as independent predictors for all-cause mortality. Conclusion Based on our results, CRT candidates are exceedingly vulnerable with a high prevalence of frailty. The calculated frailty index was associated with the primary outcome of death from any cause. FI proved to be prevalent in individual risk stratification and can predict the outcome.

Procedural outcome and risk prediction in young patients undergoing transvenous lead extraction. A GALLERY subgroup analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background The prevalence of young patients with cardiac implantable electronic devices (CIED) is continuously rising. Along with this development there is a concomitant increase in the incidence of CIED-related complications, such as device-related infections and lead failure. Transvenous lead extraction (TLE) has evolved into an indispensable therapeutic option for such cases. Aim The aim of this study was to analyze patient characteristics and procedural outcomes of young patients undergoing TLE and to identify independent risk factors for adverse events. Methods We performed a subgroup analysis of all patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) who were 45 years or younger at the time of enrollment. Predictor variables for all-cause mortality, procedural complications and procedural failure were assessed via multivariate analyses. Results We identified 160 patients (6.3% of the GALLERY) aged 45 years or younger with a mean age of 35.3±7.6 years and 42.5% (n=68) female patients. Mean body mass index was 25.6±5.4 kg/m2 and the proportion of patient with highly reduced ejection fraction (LVEF &amp;lt;30%) was 11.3%. Comorbidities, such as arterial hypertension (AHT), diabetes mellitus (DM) and chronic kidney disease (CKD) were present in 23.8%, 6.3% and 5.0% of patients, respectively. Leading extraction indication was lead dysfunction in 51.3% of cases, followed by local infections in 20.6% and systemic infections in 16.9%. The most common device to be extracted were implantable cardioverter-defibrillators (ICD) with 52.5%. Mean number of leads per patient was 2.2±1.0. Median age of the oldest indwelling lead was 91.5 [54.75-137.5] months. Median procedural time was 88 [65-151.75] minutes. Overall complication rate was 3.8% with 1.9% minor and 1.9% major complications. Complete procedural success was achieved in 90.6% of cases. Clinical procedural success rate was 98.1%. Procedure-related mortality was 0.0%. All-cause in-hospital mortality was 2.5%, which was mainly due to septic shock. Multivariate analysis revealed CKD as independent predictor for all-cause mortality (OR: 51.48; 95% CI: 1.98-1340.0; p=0.018). Lead age ≥10 years (OR: 14.58, 95% CI: 1.36-156.2; p=0.027) was identified as sole independent risk factor for procedural complication. Conclusion Transvenous lead extraction in young patients is safe and effective with a procedure-related mortality rate of 0.0%. All-cause mortality was mainly driven by patients succumbing to CIED-related sepsis, despite successful extraction. Chronic kidney disease and lead age ≥10 years are relevant risk factors in young patients undergoing TLE.

Growth Differentiation Factor-15 and Clinical Outcomes in Japanese Patients With Ischemic Heart Disease

BackgroundDespite a reduction in the rate of thrombotic events, ischemic heart disease (IHD) remains a key medical problem associated with high major bleeding and mortality in Asian patients with IHD. Growth differentiation factor (GDF)-15, a stress-response cytokine belonging to the transforming growth factor beta superfamily, is reportedly associated with poor clinical outcomes in Western patients with IHD. However, the clinical significance of GDF-15 in Asian patients with IHD has not yet been fully elucidated. ObjectivesThe aim of the present study was to examine the impact of serum GDF-15 on clinical outcomes in Japanese patients with IHD. MethodsSerum GDF-15 levels were evaluated in 632 consecutive patients with IHD. All patients were followed up for a median period of 2.8 years. The primary endpoint was the all-cause mortality rate. Secondary endpoints were major adverse cardiovascular events (MACE), heart failure (HF)–related rehospitalization, bleeding, and thrombotic events. ResultsSerum GDF-15 levels were elevated in acute coronary syndrome, severe coronary artery disease, and the major Japanese version of the high bleeding risk criteria. Multivariate Cox proportional hazards regression analysis demonstrated that GDF-15 was an independent predictor of all-cause mortality, MACE, HF-related rehospitalizations, and bleeding events after adjusting for confounding risk factors but not for thrombotic events. Adding GDF-15 to risk factors significantly improved the net reclassification index and integrated discrimination improvement for all-cause deaths, MACE, HF-related rehospitalization, and bleeding events. ConclusionsSerum GDF-15 could be a feasible marker for major bleeding and adverse clinical outcomes in Japanese patients with IHD.

Cardiac Magnetic Resonance in myocarditis: besides the diagnosis?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with acute myocarditis (AM) can be at increased risk of adverse cardiac events after the index episode. Beyond its undoubted role in diagnosis, Cardiac Magnetic Resonance (CMR) can also provide additional prognostic information and contribute to the patients risk stratification. Methods Retrospective study with patients admitted with the clinical suspicion of myocarditis in our center from February/2018 to September/2021, in whom CMR was performed. A total of 48 patients were included and divided into two groups based on the number of segments with late gadolinium enhancement (LGE). The threshold (&amp;gt; or &amp;lt; than 5 segments) was determined according to ROC curve analysis. The primary outcome was a composite of all-cause mortality, heart failure and myocarditis recurrence. Results We included 48 patients (95,8% males; mean age 37,0±16,1 years old), 93,8% presenting with chest pain and 63,2% presenting with st-segment elevation on electrocardiogram. During hospitalization, 3 patients needed ionotropic support, 7 had supraventricular tachycardia, 9 non-sustained ventricular tachycardia, 1 sustained ventricular tachycardia, 1 needed extracorporeal membrane oxygenation and 9 had heart failure. CMR (performed 6 days (median) after admission) showed LGE in 45 patients (93,8%) and mean left ventricular ejection fraction (LVEF) of 55,5±8,7%. Both groups had similar age (35,0±13,7 vs 38,5±17,6 years, p=0,45), cardiovascular risk factors, st-segment elevation at admission (61,9% vs 63,0%, p=0,38), pro-BNP levels at admission [286 (IQR 144-699) mg/dl vs 522 (IQR 222-1253) mg/dl, p = 0,20] and peak C-reactive protein [5,7 (IQR 4-12) vs 5,2 (IQR 2,6-12,5),p=0,77]. Patients with LGE in ≥5 segments (56,3%) had lower LVEF (53,2±9,6 vs 58,2±6,6, p=0,02), had more non-sustained ventricular tachycardia episodes (29,6% vs 4,8%, p=0,03), incidence of heart failure during hospitalization (25,9% VS 9,6%, p=0,19) and higher peak troponin levels [1,54 (IQR0,64-2,45) vs 0,594 (IQR 0,374-1,07), p=0,002]. During a median follow-up of 21,5 (IQR 8–35,2) months, 11 patients (22,9%) experienced the primary outcome (6 for heart failure, 4 for AM recurrence, 1 death). The incidence of the primary endpoint increased by 1,20 (95% CI 1,08-1,60) for each segment involved. Patients with ≥ 5 segments had a higher incidence of this outcome (25,7 vs 5,1 per 100 patient/year, log rank p=0,02). After adjusting for possible cofounders, LGE≥ 5 segments on CMR was an independent predictor of all-cause mortality, heart failure and myocarditis recurrence (HR 7,22, 95% CI 1,33-39,16). Conclusion In this study, LGE involving 5 or more segments by LGE was correlated with adverse cardiovascular events among patients with suspected myocarditis. These data suggest that cardiac resonance imaging might add value to currently existing diagnostic tools for risks assessment in AM.

Clinical features and prognosis of patients hospitalized with heart failure and low T3 syndrome

Objective: To investigate the association between triiodothyronine (T3) and inflammatory factors, and its potential effect on long-term outcomes in hospitalized patients with heart failure (HF). Methods: A total of 2 475 patients with HF admitted in Heart Failure Care Unit were consecutively enrolled in this retrospective cohort study from December 2006 to June 2018. Patients were divided into low T3 syndrome group (n=610, 24.6%) and normal thyroid function group (n=1 865, 75.4%). The median follow-up time was 2.9 (1.0, 5.0) years. A total of 1 048 all-cause deaths were recorded at the final follow-up. The effects of free T3 (FT3) and high-sensitivity C-reactive protein (hsCRP) on the risk of all-cause death were evaluated by Cox regression analysis and Kaplan-Meier analysis. Results: The age of the total population was 19-95 (57±16) years, 1 823 cases (73.7%) were male. Compared to those with normal thyroid function, albumin [(36.5±5.4) vs. (40.7±4.7) g/L], hemoglobin [(129.4±25.1) vs. (140.6±20.6) g/L], total cholesterol [3.6 (3.0, 4.4) vs. 4.2 (3.5, 4.9) mmol/L] (all P<0.001) were lower, Whereas age [(60.5±16.0) vs. (55.2±15.4) years], creatinine [105.0 (83.6, 137.0) vs. 87.8 (75.6, 106.3) mmol/L], log N-terminal B-type natriuretic peptide [(8.2±1.3) vs. (7.2±1.4) ng/L] were higher in LT3S patients (all P<0.001). In Kaplan-Meier survival analysis, patients with lower FT3 and higher hsCRP had significantly lower cumulative survival (P<0.001), lower FT3 combined with higher hsCRP subgroup had the highest risk of all-cause death (Ptrend<0.001). In multivariate Cox regression analysis, LT3S was an independent predictor of all-cause mortality (HR=1.40, 95%CI 1.16-1.69, P<0.001). Conclusion: LT3S is an independent predictor of poor prognosis in patients with heart failure. FT3 combined with hsCRP improve the predictive value of all-cause death in hospitalized patients with heart failure.

CONUT score is associated with short-term prognosis in patients with severe acute pancreatitis: a propensity score matching cohort study.

The Controlling Nutritional Status (CONUT) score was designed to assess the immune-nutritional status in patients. This study aimed to investigate the role of the CONUT score in the short-term prognosis of severe acute pancreatitis. This was a retrospective cohort study. 488 patients with severe acute pancreatitis at the Department of Critical Care Medicine of the West China Hospital of Sichuan University (Chengdu, China) were enrolled in the study. Baseline data were collected from the West China Hospital of Sichuan University database. The primary outcome during follow-up was all-cause mortality. The secondary outcomes were 28 day mortality, renal insufficiency, length of stay (LOS) in the ICU, and length of stay (LOS) in the hospital. Patients were divided into two groups based on a median CONUT score of 7, and baseline differences between the two groups were eliminated by propensity matching. Univariate Cox regression analyses were performed to estimate the association between CONUT score and outcomes. The Kaplan-Meier method was used to estimate the survival rate of patients. CONUT score was an independent predictor of all-cause mortality (hazard ratio [HR]:2.093; 95%CI: 1.342-3.263; p < 0.001) and 28 day mortality (hazard ratio [HR]:1.813; 95%CI: 1.135-2.896; p < 0.013). CONUT score was not statistically significant in predicting the incidence of renal insufficiency. The high CONUT group had significantly higher all-cause mortality (p < 0.001), and 28 day mortality (p < 0.011) than the low CONUT group. The CONUT score is an independent predictor of short-term prognosis in patients with severe acute pancreatitis, and timely nutritional support is required to reduce mortality in patients with severe acute pancreatitis.

NT-proBNP Is a Predictor of Mortality in Adults with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease.

About 5-10% of adults with congenital heart disease (ACHD) will develop pulmonary arterial hypertension (PAH), which is associated with significant mortality. Studies on risk factors for poor outcome in a contemporary cohort of these patients with PAH associated with CHD (PAH-CHD) are rare. In this retrospective, single-center study, adult patients with the diagnosis PAH-CHD who had at least one contact as an outpatient or inpatient at the German Heart Centre Munich during the period January 2010-September 2019 were included. Patients with PAH without a CHD were excluded. The primary endpoint was all-cause mortality. Altogether, 158 patients (mean age 39.9 ± 15.4 years, female 64.6%) were included in the study. A pre-tricuspid shunt was present in 17.7%, other shunts in 51.3%, PAH associated with complex CHD in 22.8%, and segmental PAH in 8.2%. An NT-proBNP measurement at baseline was available in 95 patients (60.1%). During a median follow-up of 5.37 years [IQR 1.76-8.63], the primary endpoint occurred in 10 patients (6.7%). On univariate analysis, CRP (log) (HR 3.35, 95% CI (1.07-10.48), p = 0.037), NT-proBNP (log) (HR: 7.10, 95% CI: 1.57-32.23, p = 0.011), and uric acid (HR: 1.37, 95% CI: 1.05-1.79, p = 0.020) were predictors of the primary endpoint. On multivariate analysis, only NT-proBNP (log) (HR: 6.91, 95% CI: 1.36-35.02, p = 0.0196) remained as an independent predictor. NT-proBNP is an independent predictor of all-cause mortality in a contemporary cohort of PAH-CHD patients. The role of CRP and uric acid should be further assessed in future studies.

The prognostic value of monocyte-to-lymphocyte ratio in peritoneal dialysis patients

BackgroundThe monocyte-to-lymphocyte ratio (MLR) is considered as a new inflammation marker. This study was aimed to investigate the prognostic value of MLR for all-cause mortality and new-onset cardiovascular disease (CVD) events in peritoneal dialysis (PD) patients.MethodsThis study enrolled patients receiving PD treatment for ≥ 3 months. Baseline characteristics were obtained within 1 week before PD catheterization. The receiver operating characteristic curve analysis was conducted to determine the optimal cut-off value of MLR. The Kaplan–Meier curve estimated the cumulative survival rate and new CVD free survival rate. Univariate and multivariate Cox regression models were preformed to investigate the association between MLR and clinical outcomes.ResultsA total of 369 PD patients participated in this study. During a median follow-up period of 32.83 months, 65 patients (24.2%) died, and 141 patients (52.4%) occurred new-onset CVD events. The Kaplan–Meier curve revealed that survival rate in high MLR group (MLR > 0.2168) was significantly lower than in low MLR group (P = 0.008). Patients in high MLR group were more likely to experience CVD events (P = 0.002). Even after adjustment of traditional risk factors, including age, diabetes mellitus, CVD history, smoking, hyperlipidemia, high MLR remained an independent predictor of all-cause mortality [hazard ration (HR) = 2.518, 95% confidence intervals (CI) = 1.020–6.214, P = 0.045] and new-onset CVD events (HR = 1.815, 95% CI = 1.157–2.849, P = 0.010).ConclusionsThis study suggested that high MLR was significantly and independently associated with all-cause mortality and CVD events in PD patients. The MLR is an inexpensive and straightforward indicator to reflect systemic inflammation status and help clinicians improve PD management.

Mortality was predicted by depression and functional dependence in a cohort of elderly adults of Italian descent from southern Brazil

The older population has an increasing burden of non-communicable disease, which can potentially be associated with physical and mental disabilities and shorten life spam. To investigate whether depression, loss of functionality for activities of daily living, and lower social support are associated with all-cause mortality in the older population of Italian descent. This population-based cohort study was conducted in Veranópolis, a country city from southern Brazil, among individuals aged 60 years or older. Interviews were performed in a systematic random sampling regarding demographic, socioeconomic, and psychosocial variables, in addition to depression (Geriatric Depression Scale), activities of daily living (Barthel Index), and social support (Medical Outcomes Study scale). In the follow-up, participants were reinterviewed or, in case of death, the next of kin, and hospital records were revised. Hierarchical analysis was used to determine characteristics independently associated with all-cause mortality, using Poisson regression with robust variance, expressed as relative risk with 95% confidence intervals (RR; 95%CI). A total of 997 participants were enrolled and 882 participants completed the study, after 7.24 ± 2.41 years; with 581 remaining alive. The mean age was 73.12 ± 8.03 years, 4% were nonagenarians or centennials, and 62% were women. Symptoms of depression (RR: 1.04; 1.01–1.06) and functional dependence for ADL (RR: 1.00; 0.99–1.00) were associated with all-cause mortality, even after controlling for confounding factors. Lower social support was not associated with mortality (RR: 1.00; 0.99–1.01). Depression and functional dependence are independent predictors of all-cause mortality in the older population from Italian descent.