Long-term Prognostic Significance Research Articles

Long-term prognostic significance of stress hyperglycemia in patients with ST-elevation myocardial infarction

Abstract Funding Acknowledgements None. Background/aim Stress hyperglycemia is defined as hyperglycemia that occurs in critically ill patients without diabetes mellitus (DM). It is associated with adverse in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI). The aim of the present study is to evaluate short- and long-term prognostic impact of stress hyperglycemia in STEMI patients. Method We analysed 2505 consecutive STEMI patients treated with successful primary PCI (pPCI) without previous DM and without cardiogenic shock at admission. Successful pPCI was defined as post-procedural flow TIMI 3. Stress hyperglycemia was defined as plasma glucose level above 7.8mmol/L at any time during hospitalization. The follow-up period was 6 years. Results Stress hyperglycemia at admission was registered in 685 (27.3%) patients. Compared with patients without stress hyperglycemia, patients with stress hyperglycemia were older and presented more often with heart failure (Killip class II and III); they were more likely to have hypertension, chronic kidney disease, three vessel coronary disease (at initial angiogram) and lower predischarge left ventricular ejection fraction (EF). In-hospital, 30-day and 6-year mortality were significantly higher in patients with stress hyperglycemia vs patients without stress hyperglycemia: 7.1% vs 1.5%, 7.5% vs 1.7% and 12.5% vs 4.6% (p<0.001), respectively as shown in Figure 1. In Cox regression analysis stress hyperglycemia was an independent predictor for in-hospital, 30-days and 6-year mortality- HR 2.19 (95% 1.49-3.94), p=0.018, HR 1,58(95%CI 1.15-2.85), p=0.020 and HR 1.52 (95%CI 1.32-2.17), p=0.030, respectively. Conclusion In STEMI patients without diabetes mellitus treated with successful primary PCI stress hyperglycemia is an independent predictor for short- and long-term mortality (up to 6-years). These findings emphasize the importance of close monitoring of blood glucose level in STEMI patients regardless of diabetic status.

Magnetic resonance enterography findings 46 weeks after initiation of biological therapy predict long-term adverse outcomes in Crohn's disease.

Magnetic resonance enterography (MRE) depicts transmural changes in response to biological treatment for Crohn's disease (CD); however, the long-term prognostic significance of these findings is unknown. The primary objective of this study was to identify findings on MRE 46 weeks after initiating biological treatment that predict adverse long-term outcomes. Patients with CD underwent MRE 46 weeks after initiating biological treatment and were prospectively followed for 2 years. A logistic regression analysis was performed to assess the prognostic value of different radiologic findings for various predefined adverse outcomes. Of the 89 patients included, 46 (51.7%) had ≥1 adverse outcome during follow-up: 40 (44.9%) had clinical recurrence; 18 (20.2%) required surgery, 8 (9%) endoscopic balloon dilation, 12 (13.5%) hospitalization and 7 (7.8%) required corticosteroids. In the multivariate analysis, persistence of severe lesions (MaRIA ≥11) in any intestinal segment was associated with an increased risk of surgery [OR 11.6 (1.5-92.4)], of surgery and/or endoscopic balloon dilation [OR 6.3 (1.3-30.2)], and of clinical relapse [OR 4.6 (1.6-13.9)]. Penetrating lesions were associated with surgery [OR 3.4 (1.2-9.9)]. Creeping fat with hospitalization [OR 5.1 (1.1-25.0)] and corticosteroids requirement [OR 16.0 (1.2-210.0)]. The presence of complications (stricturing and/or penetrating lesions) was associated with having ≥1 adverse outcome [OR 3.35 (1.3-8.5)]. MRE findings at week-46 after initiating biological therapy can predict long-term adverse outcomes in CD. Therapeutic intervention may be required in patients with persistence of severe inflammatory lesions, CD-associated complications, or creeping fat.

Right Ventricular Function on Cardiovascular Magnetic Resonance Imaging and Long-Term Outcomes in Stable Heart Transplant Recipients.

In heart transplant recipients, right ventricular (RV) dysfunction may occur for a variety of reasons. Whether RV dysfunction in the stable phase after heart transplantation is associated with long-term adverse outcomes is unknown. We aimed to determine the long-term prognostic significance of RV dysfunction identified on cardiovascular magnetic resonance imaging (CMR) at least 1 year after heart transplantation. In consecutive heart transplant recipients who underwent CMR for surveillance, we assessed 2 CMR measures of RV function: RV ejection fraction and RV global longitudinal strain (RVGLS). We investigated associations between RV dysfunction and a composite end point of death or major adverse cardiac events, including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. A total of 257 heart transplant recipients (median age, 59 years; 75% men) who had CMR at a median of 4.3 years after heart transplantation were included. Over a median follow-up of 4.4 years after the CMR, 108 recipients experienced death or major adverse cardiac events. In a multivariable Cox regression analysis adjusted for age, time since transplantation, indication for transplantation, cardiac allograft vasculopathy, history of rejection, and CMR covariates, RV ejection fraction was not associated with the composite end point, but RVGLS was independently associated with the composite end point with a hazard ratio of 1.08 per 1% worsening in RVGLS ([95% CI, 1.00-1.17]; P=0.046). RVGLS provided incremental prognostic value over other variables in multivariable analyses. The association was replicated in subgroups of recipients with normal RV ejection fraction and recipients with late gadolinium enhancement imaging. A similar association was seen with a composite end point of cardiovascular death or major adverse cardiac events. CMR feature tracking-derived RVGLS assessed at least 1 year after heart transplantation was independently associated with the long-term risk of death or major adverse cardiac events. Future studies should investigate its role in guiding clinical decision-making in heart transplant recipients.

Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome.

Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment. NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding. Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41-5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80-1.93]; P = 0.328) and mortality (HR: 1.49 [95% CI: 0.86-2.59]; P = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55-5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53-1.59]; P = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55-5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65-1.39]; P = 0.794). Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS. NCT01933581.

Long-Term Prognostic Value of Infarct Transmurality Determined by Contrast-Enhanced Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction.

The long-term prognostic significance of maximal infarct transmurality evaluated by contrast-enhanced cardiac magnetic resonance (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients has yet to be determined. This study aimed to see if maximal infarct transmurality has any additional long-term prognostic value over other CE-CMR predictors in STEMI patients, such as microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). The study included 112 consecutive patients who underwent CE-CMR after STEMI to assess established parameters of myocardial injury as well as the maximal infarct transmurality. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE), which included all-cause death, non-fatal reinfarction, and new heart failure hospitalization. The MACE occurred in 10 patients over a median follow-up of 7.9 years (IQR, 5.8 to 9.2 years) (2 deaths, 3 nonfatal MI, and 5 heart failure hospitalization). Patients with MACE had significantly higher rates of transmural extent of infarction, infarct size >5.4 percent, MVO, and IMH compared to patients without MACE. In stepwise multivariable Cox regression analysis, the transmural extent of infarction defined as 75 percent or more of infarct transmurality was an independent predictor of the MACE after correction for MVO and IMH (hazard ratio 8.7, 95% confidence intervals [CIs] 1.1-71; p=0.043). In revascularized STEMI patients, post-infarction CE-CMR-based maximal infarct transmurality is an independent long-term prognosticator. Adding maximal infarct transmurality to CE-CMR parameters like MVO and IMH could thus identify patients at high risk of long-term adverse outcomes in STEMI.

Prognostic value of serum bicarbonate in patients hospitalized for acute heart failure

Abstract Background Acute heart failure (AHF) requiring hospitalization is associated with significant morbidity and mortality. Acid-base disorders are very common in patients with AHF due to pulmonary oedema and low tissue perfusion. However, its long-term prognostic significance remains to be clarified. We aimed to determine the relationships between serum bicarbonate (HCO3) levels, which reflect acid–base homeostasis, with long-term outcomes. Methods This cohort study included all patients admitted for AHF from June 2021 to August 2022 in a single center. We excluded patients who did not have available gasometric values at admission. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) of 300 pg/mL at least. Clinical and demographic characteristics of all patients were collected during hospitalization. Normal range of HCO33 were defined as 22 to 26 mmol/L. The primary objective was a composite outcome of cardiovascular death and AHF readmission. Results Total of 153 patients were enrolled. Median age was 75,4 ± 10,8 years and 66 (43%) patients were female. 62 (38%) patients had diabetes and 67(41%) had chronic kidney disease. The median [IQR] of NT-ProBNP at admission was 4525 (IQR 25-75: 2010-7148), 58 (38%) patients had left ventricular ejection fraction (LVEF) ≤ 40%, 90 (56%) patients had atrial fibrillation and 49 (32%) patients had coronary artery disease. Regarding acid-base disorders, 38 (24,8%) patients had high serum HCO3 level, and 53 (34,6%) patients had low serum HCO3 level. During a median follow-up period of 10 months, there were 24 deaths (15%), and 60 patients were readmitted for heart failure. High serum HCO3 level (≥26 mmol/L) was significantly associated with higher incidence of the composite outcome (24/38, 63,2% vs 48/115, 41,7%; OR 2.39, 95% CI: 1.12-5.09, p = 0,017) compared with normal and low HCO3 level. In contrast, low serum HCO3 level had lower incidence of the composite outcome (19/53, 36% vs 53/100, 53%; OR 0.5, 95% CI: 0,25-0,98, p = 0,032) compared with normal and high serum HCO3 level. Moreover, we did not find differences between groups stratified by acidaemia (OR 0.82, 95% CI: 0,32-2,08, p = 0,43), alkalaemia (OR 2,8, 95% CI: 0,69-11,26, p = 0,12) and hyperlactatemia (OR 0,72, 95% CI: 0,34-1,52, p = 0,45). Conclusions High serum HCO3 level, but not low serum HCO3 level, on admission was associated with composite outcome cardiovascular death or AHF readmission in patients with acute heart failure. HCO3 level seems to be a useful tool to identify acid-base disorders for stratifying the risk of adverse outcomes in patients with acute heart failure.

Long-term prognostic significance modified body mass index in patients with decompensated acute heart failure: Insight from the OPAR study

Abstract Background/Introduction Malnutrition is a well-known poor prognostic factor in patients with acute decompensated heart failure (ADHF). Although conventional body mass index (cBMI) and serum albumin level are commonly used as indicators of malnutrition, these values are affected by fluid balance. The recently proposed modified BMI (mBMI, serum albumin [g/l] × cBMI [kg/m2] ) may be a better prognostic marker, but its usefulness in patients with ADHF remains unclear. Purpose This study aimed to investigate the prognostic significance of mBMI in patients hospitalized for ADHF. Methods The OPAR study is a single-center registry enrolling 605 consecutive patients who were admitted for ADHF with survival discharge between October 2011 and October 2017. The present study population was consisted of 573 patients admitted for ADHF who had a value of cBMI and serum albumin at discharge. The eligible patients divided into the following four groups according to the mBMI quartiles: lowest quartile (Q1, mBMI <600, n = 144), second quartile (Q2, 600≤ mBMI <715, n = 144), third quartile (Q3, 715≤ mBMI <842, n = 142), and highest quartile (Q4, mBMI ≥842, n = 143). The primary outcome measure was all-cause death, and the second outcome measures were cardiac death, non-cardiac death, and heart failure rehospitalizations. Cumulative incidences of death and heart failure rehospitalizations were estimated by the Kaplan-Meier and Gray’s method, respectively. Cox proportional hazards regression models were used to identify patients at risk of all-cause death to calculate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The predictive power of mBMI for all-cause mortality was assessed using receiver operator characteristic curve analysis. Results During a median follow-up period of 4.68 years (interquartile range, 2.16–6.72 years), the cumulative 5-year incidences of all-cause death substantially increased in the lower mBMI quartiles (Q1: 60.7% [95% CI, 52.5%–68.9%], Q2: 53.9% [95% CI, 45.7%–62.5%], Q3: 38.8% [31.1%–47.7%], and Q4: 21.3%[15.3%–29.2%], log-rank P <0.001). After adjustment for the potential confounders, the excess risk of Q1 relative to Q4 for all-cause death tended to be higher (adjusted HR, 1.44 [95% CI, 0.94–2.20], P = 0.09). The predictive power of mBMI was modest with a C-statistic of 0.65 (95%CI, 0.61–0.70). The cumulative 5-year incidence of cardiac death and non-cardiac death also increased in the lower mBMI quartiles (Q1: 29.1% and 44.5%, Q2: 18.9% and 43.1%, Q3: 21.3% and 22.3%, and Q4: 7.2% and 15.2%, respectively, log-rank P <0.001 for both). The cumulative 5-year incidences of heart failure rehospitalizations did not significantly differ across the mBMI quartiles (P = 0.35). Conclusions The mBMI at discharge is a simple and potentially helpful marker for the prediction of long-term mortality in patients hospitalized for ADHF.Primary outcomeSecondary outcome

Abstract 12796: N-Terminal Pro-B-Type Natriuretic Peptide Levels for Determining Long Term Prognosis in Patients With Non-ST-Elevation Myocardial Infarction (NSTEMI); a Systematic Review and Meta-Analysis

Introduction: The utilization of the biomarker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) holds diagnostic value for identifying heart failure and acute coronary syndromes. However, its long-term prognostic significance in patients with non-ST-elevation Myocardial Infarction (NSTEMI), a subtype of acute coronary syndromes, remains inadequately explored. Hypothesis: This meta-analysis aims to investigate the correlation between NT-proBNP levels and the subsequent occurrence of adverse clinical outcomes in individuals with NSTEMI. Methods: A systematic search was conducted on PubMed, Google Scholar, Science Direct, Cochrane, and Embase, encompassing articles published until June 2023. The highest recorded NT-proBNP value was utilized for analysis, considering a follow-up duration of at least 30 days. Odds ratios (OR) were synthesized using the random-effects DerSimonian-Laird model, with statistical significance set at a p-value <0.05. Results: The study involved 8 articles, comprising a total of 7,921 patients, of whom 7,161 were diagnosed with NSTEMI. The analysis examined the relationship between NT-proBNP levels and clinical outcomes in NSTEMI patients over an average follow-up period of 19.85 months. Elevated NT-proBNP levels exhibited a significant association with increased odds of Major Adverse Cardiac Events (MACE) [OR 2.56, 95% CI: 1.58-3.53, I2=94.06%, p<0.001], all-cause mortality [OR 2.54, 95% CI: 0.53-4.55, I2=76.96%, p=0.01], and myocardial infarction (MI) [OR 1.10, 95% CI: 0.56-1.63, I2=0.00%, p<0.001]. Conclusions: The elevated NT-proBNP levels in patients with NSTEMI are significantly associated with long-term adverse cardiovascular outcomes. Consequently, NT-proBNP can serve as a valuable tool for assessing the risk of unfavorable cardiac events. However, further extensive investigations are warranted to validate these results on a larger scale.

Long-term prognostic significance of history of cancer and atrial fibrillation in coronary artery disease

BackgroundLimited data exist on the prognostic significance of a history of cancer and atrial fibrillation (AF) in patients with coronary artery disease (CAD). This study aimed to evaluate the associations among a history of cancer, AF, and long-term prognosis in patients with CAD. MethodsWe studied 3,233 patients with CAD (69 ± 11 years; women, 23%) in a multicenter hospital-based cohort study, the CHART-2 and related a history of cancer and AF to cardiovascular outcomes with a median follow-up of 10.8 years. ResultsOf the 3,233 patients enrolled, 10.7% and 11.2% had a history of cancer and AF, respectively, while 2.8% had both. Patients with AF and a history of cancer were characterized by older age, male sex, and higher BNP levels. Anticoagulant use with warfarin or direct oral anticoagulants increased from 43% at baseline to 56% at 10 years in patients with CAD with AF and no history of cancer and increased from 49% to 83% in those with both. Patients with CAD with both comorbidities had a higher risk of a composite outcome including stroke, thrombosis, and major bleeding (Hazard Ratio [HRadjusted], 2.26; 1.50–3.40, P < 0.001). Furthermore, patients with both comorbidities had a higher risk of all-cause death (1.55; 95% confidence interval [CI] 1.12–2.12, P = 0.007) including cancer death (2.62; 1.51–4.54, P = 0.001), and new-onset heart failure (HF) requiring hospitalization (2.47; 1.54–3.96, P < 0.001). ConclusionsThese results demonstrate that CAD patients with a history of cancer and AF have an increased risk of composite outcomes, including stroke, systemic thrombosis, major bleeding, all-cause death, cancer-related death, and new-onset HF.

Atrial fibrillation in patients with dilated cardiomyopathy: prevalence, risk factors and prognostic significance

Aim. To study the epidemiological profile and long-term prognostic significance of atrial fibrillation (AF) as a risk factor for adverse clinical outcomes in patients with dilated cardiomyopathy (DCM).Material and methods. The study included 270 patients with DCM (206/76,3% men, age 47 [37; 56] years, left ventricular (LV) ejection fraction 29 [21; 35]%). The observation period was 6 years (Me 76 [57; 119] months). To assess the effect of AF on DCM prognosis, Kaplan-Meier curves and Cox regression of clinical outcomes, including cardiovascular death, heart transplantation, and ventricular assist device implantation, were analyzed.Results. Of 270 patients with DCM, paroxysmal AF was detected in 10 (3,7%) patients (initial, 5/1,85%; during the first follow-up year, 5/1,85%). After 5 years, another 65 (24,1%) individuals had AF (paroxysmal, persistent or permanent). Ventricular tachyarrhythmias were registered in 163 (60,4%) patients. Compared with patients maintaining sinus rhythm, patients with AF were older (51,4±10 vs 43,6±13 years, p=0,001) and had lower exercise tolerance (6-minute walk test: 379±45 vs 445±43 meters; p=0,0002) and a higher heart failure functional class (NYHA class III-IV: 38/50,7% vs 52/26,7%; χ2=13,6; p=0 ,0003). In patients with AF, initially more pronounced manifestations of right ventricular contractile dysfunction (TAPSE: 13,1±3,4 vs 15,5±4,6 mm; p=0,0001) and LV diastolic dysfunction (E/A: 2,9±1,5 vs 2,1±1,3; p=0,006; E/e' 15,6±6,9 vs 11,8±7,2; p=0,019), more dilated left atrium (left atrial volume index: 63,3±19 vs 50±18,7 ml/m2; p=0,006). During the 6-year median follow-up, AF was observed in 75 patients (0,46 new cases/100 patients/year). As a result of Cox regression analysis, AF as a time-dependent factor was identified as an independent predictor of cardiovascular death (hazard ratio 3,99; 95% confidence interval, 1,67-8,59; p=0,0001).Conclusion. AF, as one of the most common sustained atrial tachyarrhythmias in the population, demonstrated a lower prevalence (27,8%) in the DCM cohort compared to ventricular tachyarrhythmias (60,4%), but a high prognostic significance of the negative impact on the risk of fatal outcomes. The development of AF in patients with DCM is associated with a 4-fold increase in cardiovascular death risk over a 6-year period.

Long-term prognostic significance of gasping in out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: a post hoc analysis of a multi-center prospective cohort study

BackgroundGasping during resuscitation has been reported as a favorable factor for out-of-hospital cardiac arrest. We examined whether gasping during resuscitation is independently associated with favorable neurological outcomes in patients with refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) undergoing extracorporeal cardiopulmonary resuscitation ECPR.MethodsData from a 2014 study on advanced cardiac life support for ventricular fibrillation with extracorporeal circulation in Japan (SAVE-J), which examined the efficacy of ECPR for refractory VF/pVT, were analyzed. The primary endpoint was survival with a 6-month favorable neurological outcome in patients who underwent ECPR with or without gasping during resuscitation. Multivariate logistic regression analysis was performed to evaluate the association between gasping and outcomes.ResultsOf the 454 patients included in the SAVE-J study, data from 212 patients were analyzed in this study after excluding those with missing information and those who did not undergo ECPR. Gasping has been observed in 47 patients during resuscitation; 11 (23.4%) had a favorable neurological outcome at 6 months. Multivariate logistic regression analysis showed that gasping during resuscitation was independently associated with a favorable neurological outcome (odds ratio [OR], 10.58 [95% confidence interval (CI) 3.22–34.74]). The adjusted OR for gasping during emergency medical service transport and on arrival at the hospital was 27.44 (95% CI 5.65–133.41).ConclusionsGasping during resuscitation is a favorable factor in patients with refractory VF/pVT. Patients with refractory VF/pVT with continuously preserved gasping during EMS transportation to the hospital are expected to have more favorable outcomes.

Predictors and Long-Term Prognostic Significance of Acute Renal Function Change in Patients Who Underwent Surgical Aortic Valve Replacement.

There are few reports on short-term changes in renal function after surgical aortic valve replacement, and data are scarce regarding its impact on long-term outcomes. This is a retrospective study of patients who underwent isolated aortic valve replacement between 2009 and 2020 in four medical centers. Patients with end-stage renal disease were excluded. Renal function was assessed based on short-term changes. Multivariable regression models were used to identify predictors of improvement/deterioration. Cox proportional hazard models were used to assess survival trends. The study included 2402 patients, with a mean age of 69.3 years and a mean eGFR of 82.3 mL/min/1.73 m2. Short-term improvement rates were highest in stage 4 (24.4%) and stage 3 (16.8%) patients. Deterioration rates were highest in stage 1 (38.1%) and stage 2 (34.8%) patients. Deterioration in the chronic kidney disease stage was associated with a higher ten-year mortality (p < 0.001, HR 1.46); an improved stage trended toward improved survival (p = 0.14, HR 0.722). Patients with stage 3 and 4 kidney disease tended to remain stable or improve in the short term after aortic valve replacement while patients at stages 1 and 2 were at increased risk of deteriorating.

The role of fibrosis, inflammation, and congestion biomarkers for outcome prediction in candidates to cardiac resynchronization therapy: is "response" the right answer?

Cardiac resynchronization therapy (CRT) is an established treatment in selected patients suffering from heart failure with reduced ejection fraction (HFrEF). It has been proposed that myocardial fibrosis and inflammation could influence CRT "response" and outcome. Our study investigated the long-term prognostic significance of cardiac biomarkers in HFrEF patients with an indication for CRT. Consecutive patients referred for CRT implantation were retrospectively evaluated. The soluble suppression of tumorigenicity 2 (sST2), galectin-3 (Gal-3), N-terminal portion of the B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured at baseline and after 1 year of follow-up. Multivariate analyses were performed to evaluate their correlation with the primary composite outcome of cardiovascular mortality and heart failure hospitalizations at a mean follow-up of 9 ± 2 years. Among the 86 patients enrolled, 44% experienced the primary outcome. In this group, the mean baseline values of NT-proBNP, Gal-3, and sST2 were significantly higher compared with the patients without cardiovascular events. At the multivariate analyses, baseline Gal-3 [cut-off: 16.6 ng/ml, AUC: 0.91, p < 0.001, HR 8.33 (1.88-33.33), p = 0.005] and sST2 [cut-off: 35.6 ng/ml AUC: 0.91, p < 0.001, HR 333 (250-1,000), p = 0.003] significantly correlated with the composite outcome in the prediction models with high likelihood. Among the parameters evaluated at 1-year follow-up, sST2, eGFR, and the variation from baseline to 1-year of Gal-3 levels showed a strong association with the primary outcome [HR 1.15 (1.08-1.22), p < 0.001; HR: 0.84 (0.74-0.91), p = 0.04; HR: 1.26 (1.10-1.43), p ≤ 0.001, respectively]. Conversely, the echocardiographic definition of CRT response did not correlate with any outcome. In HFrEF patients with CRT, sST2, Gal-3, and renal function were associated with the combined endpoint of cardiovascular death and HF hospitalizations at long-term follow-up, while the echocardiographic CRT response did not seem to influence the outcome of the patients.

Short and Long-Term Prognostic Significance of Galectin-3 in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

This study evaluated the short and long-term prognostic value of galectin-3 in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Patients (n = 143) were admitted with STEMI and followed up for 2years. The study population was divided into high and low galectin-3 groups based on the admission median value of serum galectin-3. Primary clinical outcomes consisted of cardiovascular (CV) mortality, non-fatal reinfarction, stroke, and target vessel revascularization (TVR). CV events were recorded in hospital and at 1 and 2years. The primary clinical outcomes (in-hospital, 1year and 2year) were significantly higher in the high galectin-3 group. (P = .008, P = .004, P = .002, respectively). High galectin-3 levels were also associated with heart failure development and re-hospitalization at both 1year (P = .029, P = .009, respectively) and 2years (P = .019, P = .036, respectively). According to Cox multivariate analysis, left ventricular ejection fraction (LVEF) was an independent predictor of 2-year cardiovascular mortality (P = .009), whereas galectin-3 was not (P = .291). Although high galectin-3 levels were not independent predictors of long-term CV mortality in patients with acute STEMI who underwent primary PCI, it was associated with short-term and long-term development of adverse CV events, heart failure, and re-hospitalization.

Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance

Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. Retrospective analysis of a large single-center database of 3654 TLEs. Repeat TLE was a rare occurrence (193, i.e., 5,28% among 3654 TLEs). Subsequent re-extractions occurred in 12.21% of the patients. Lead failure was the most common cause of re-extraction (51.16%). Cox regression analysis showed that patients who were older at first implantation [HR = 0.987; p = 0.003], had infection-related TLE [HR = 0.392; p < 0.001] and complete procedural success [HR = 0.544; p = 0.034] were less likely to undergo repeat TLE. Functional leads left in place for continuous use [HR = 1.405; p = 0.012] or superfluous leads left in place (abandoned) [HR = 2.370; p = 0.011] were associated with an increased risk of undergoing a repeat procedure. Overall mortality in patients with repeat TLE and subsequent re-extraction in the entire FU period was similar to that in patients without a history of re-extraction [HR = 0.949; p = 0.480]. Repeat TLE was a rare occurrence (5.28%) among TLEs. Left of both active and nonactive leads during TLE increased the risk of re-extraction. Re-extraction has no effect on the long-term mortality.

The prognostic significance of the circumferential resection margin in esophageal squamous cell carcinoma patients without neoadjuvant treatment

BackgroundCircumferential resection margin (CRM) is very important in esophageal cancer, but its diagnostic criteria has not been unified. The College of American Pathologists (CAP) and the Royal College of Pathologists (RCP) provide two different criteria. The aim of this study is to evaluate the long-term prognostic significance of CRM status with different CRM criteria in esophageal squamous cell carcinoma (ESCC).MethodsInfluence of CRM status according to the CAP and RCP criteria on long-term survival of 838 patients with resected pT3 tumors and without neoadjuvant therapy was analyzed. Patients stratified into three groups on the basis of tumor distance from the CRM (CRM > 1 mm, 0-1 mm, and 0 mm) were also analysed.ResultsPositive CRM was found in 59 (7%) patients according to the CAP criteria and 317 (37.8%) patients according to the RCP criteria. Univariate and multivariate survival analysis showed that CRM status, according to three different criteria, was independent prognostic factor. However, subgroup analysis showed that the prognostic value of CRM status was limited to certain metastatic lymph node load. In pN0 subgroup, patients with CRM > 1 mm had better prognosis than patients with CRM 0-1 mm. Patients with CRM 0 mm had worse outcome than patients with CRM > 0 mm in pN1-2 subgroup. But CRM status had no prognosis value in pN3 subgroup.ConclusionsThe CRM status is an important prognostic factor in ESCC patients, but this effect was limited to patients without or with less lymph node metastasis (pN0-2). In clinical practice, we recommend the 1 mm-three-tier criteria as it provides more prognostic value than the traditional two-tier criteria.

Abstract 14755: Left Ventricular Three-Dimensional Speckle Tracking Echocardiography Predicts Adverse Clinical Outcomes in Heart Transplant Patients

Background: The prognostic value of 3D-GLS in HT recipients has not been evaluated. This study explored the long-term prognostic significance of 3D-GLS in HT recipients. Methods: The study comprised 296 consecutive patients who underwent HT between January 2015 and December 2019 at Union Hospital in Wuhan, China. All subjects underwent comprehensive transthoracic two-dimensional (2D) and 3D echocardiographic examinations. Patients were followed until January 1st, 2022. Major adverse cardiac events (MACE) were defined as a composite of heart failure hospitalization, re-transplantation and death. Results: After a median follow-up of 3.3 years, 53 HT patients experienced MACE. Patients with MACE displayed significantly impaired 2D-GLS and 3D-GLS compared with those without MACE. Kaplan-Meier analysis showed that the risk of MACE increased significantly with worsening tertiles of 2DGLS and 3DGLS (both log-rank p &lt; 0.001). Area under the curve for 3D-GLS was larger than that in 2D-GLS for MACE prediction. On multivariate Cox proportional hazards regression, 2D-GLS and 3D-GLS were independently associated with the MACE after adjustment for diabetes, history of rejection, hemoglobin, brain natriuretic peptide (BNP), and LV ejection fraction. In addition, 3D-GLS provided incremental prognostic value over 2D-GLS. Continuous net reclassification improvement analysis showed an improvement of + 23.3% was noted in the accuracy of classification between 3D-GLS and 2D-GLS. Conclusion: In heart transplant recipients, 3D-GLS is an independently predictor of MACE. These findings support the potential of 3D-GLS to identify higher risk HT patients.

Long-term prognostic significance of sarcopenia in acute ischemic stroke.

Because sarcopenia is widely distributed in patients with acute ischemic stroke (AIS) and has not attracted enough attention, this study aims to explore the relationship between sarcopenia defined by temporal muscle thickness (TMT) and physical function and prognosis of patients with AIS. A total of 265 hospitalized nonsurgical AIS patients from 2015 to 2018, with an age range of 28 ~ 92, were analyzed retrospectively. The median value of TMT was used as the risk classification index of sarcopenia. The main results were the relationship between sarcopenia and Essen Stroke Risk Score, National Institutes of Health Stroke Scale, modified Rankin Score, water swallow test, venous thromboembolism assessment of medical inpatients, activities of daily living assessed by Barthel Index, and the relationship between TMT and final survival outcome. The mean TMT of men in the study cohort was higher than that of women. The measured values of TMT among different researchers had good consistency (intraclass correlation coefficient, 0.980; P < .001). After adjusting for confounding variables, logistic regression showed that sarcopenia was associated with Essen Stroke Risk Score (odds ratio, 1.89; P < .05) and Barthel Index (odds ratio, 1.67; P < .05). Kaplan-Meier analysis showed that the survival time of low TMT group was significantly lower than that of high TMT group (36 vs 49 months; P < .001). Multivariate Cox regression showed that there was causal correlation between sarcopenia and patient death (hazard ratio, 3.54; 95% confidence interval, 1.46–8.58; P < .01). As a potential comprehensive index, thickness of temporal muscle can be included in baseline evaluation to show the physical status, stroke recurrence, and survival prognosis of AIS patients.

Long-term prognostic significance of HER2-low and HER2-zero in node-negative breast cancer

BackgroundRecently, novel antibody––drug conjugates (ADCs) showed clinical activity in a subset of advanced human epidermal growth factor receptor 2 (HER2)-negative patients. We investigated the prognostic significance of HER2-low and HER2-zero tumours. Patients and methodsThe retrospective cohort study included 410 consecutive node-negative breast cancer patients without adjuvant systemic therapy treated between 1985 and 2000 (median follow-up: 16.73 [IQR 8.58–23.45] years). 351 (85.6%) were HER-2 negative and subdivided into HER2-zero (immunohistochemistry [IHC] score 0) and HER2-low (IHC score 1+ or 2+/in situ hybridisation [ISH]-negative). HER2 gene expression was available in 170 (48.4%) patients. Differences in HER2 status for immunohistochemistry, gene expression and clinico-pathologic parameters were assessed using Fisher's exact test, Pearson's correlation and Mann–Whitney test. Prognosis was investigated using the Kaplan–Meier method and Cox regression analyses. ResultsOf the 351 HER2-negative patients, 198 (56.4%) had HER2-low tumours and 153 (43.6%) were HER2-zero. Significant differences between HER2-zero and HER2-low tumours were found in histologic grading (P = 0.001), Ki-67 (P = 0.013) and HER2 gene expression (P = 0.002). HER2-low patients had significantly longer disease-free survival (DFS) (15-year rate: 67.5% [95% CI 61.0–74.7] vs. 47.3% [95% CI 39.9–56.1], P < 0.001) and overall survival (OS) (15-year rate: 75.4% [95% CI 69.4–81.9] vs. 66.8% [95% CI 59.5–74.9], P = 0.009). The OS difference was observed in hormone receptor (HR)-positive (P = 0.039) but not HR-negative (P = 0.086) tumours. The results of multivariable analyses confirmed the independent prognostic significance of HER2 status (DFS: HR, 0.546; 95% CI, 0.402–0.743; P < 0.001; OS: HR, 0.653; 95% CI, 0.458–0.932; P = 0.019). ConclusionHER2-low patients had a better survival than HER2-zero patients.

Long-term Prognostic Significance of Pentraxin-3 in Patients with Non-ST Elevation Myocardial Infarction and Coronary Stenting

Long-term Prognostic Significance of Pentraxin-3 in Patients with Non-ST Elevation Myocardial Infarction and Coronary Stenting