Occurrence Of Congestive Heart Failure Research Articles

Revisiting the Historic Strontium-90 Ingestion Beagle Study Conducted at the University of California Davis: Opportunity in Archival Materials.

Strontium-90 is a radionuclide found in high concentrations in nuclear reactor waste and nuclear fallout from reactor accidents and atomic bomb explosions. In the 1950s, little was known regarding the health consequences of strontium-90 internalization. To assess the health effects of strontium-90 ingestion in infancy through adolescence, the Atomic Energy Commission and Department of Energy funded large-scale beagle studies at the University of California Davis. Conducted from 1956 to 1989, the strontium-90 ingestion study followed roughly 460 beagles throughout their lifespans after they were exposed to strontium-90 in utero (through feeding of the mother) and fed strontium-90 feed at varying doses from weaning to age 540 days. The extensive medical data and formalin-fixed paraffin-embedded tissues were transferred from UC Davis to the National Radiobiology Archive in 1992 and subsequently to the Northwestern University Radiobiology Archive in 2010. Here, we summarize the design of the strontium-90 ingestion study and give an overview of its most frequent recorded findings. As shown before, radiation-associated neoplasias (osteosarcoma, myeloproliferative syndrome and select squamous cell carcinomas) were almost exclusively observed in the highest dose groups, while the incidence of neoplasias most frequent in controls decreased as dose increased. The occurrence of congestive heart failure in each dose group, not previously assessed by UC Davis researchers, showed a non-significant increase between the controls and lower dose groups that may have been significant had sample sizes been larger. Detailed secondary analyses of these data and samples may uncover health endpoints that were not evaluated by the team that conducted the study.

The association between serum testosterone level and congestive heart failure in US male adults: data from National Health and Nutrition Examination Survey (NHANES) 2011-2016.

This study aimed to investigate the relationship between serum testosterone levels and the risk of congestive heart failure (CHF) in adult males. Previous research has suggested a potential link between serum testosterone and cardiovascular health, but the findings have been inconclusive. This study was cross-sectional, and the data were obtained from the 2011-2016 cycle of the National Health and Nutrition Examination Survey (NHANES), which included a sample of 6,841 male participants. Serum testosterone levels were measured using a standardized assay, and CHF status was assessed through self-reporting. Covariates such as age, ethnicity, lifestyle factors, and health conditions were considered in the analysis. Among the participants, 242 individuals had a documented history of CHF. We observed a linear correlation between serum testosterone levels and CHF occurrence, with higher serum testosterone levels associated with a decreased risk of CHF (Q4 vs. Q1, OR = 0.29, 95% CI: 0.19-0.47, P < 0.001). After adjusting for confounding variables, multivariate analysis revealed that high serum testosterone levels remained significantly associated with a lower risk of CHF (OR: 0.47, 95% CI: 0.27-0.80, P = 0.01). Subgroup analysis indicated a significant association between high serum testosterone levels and reduced CHF risk in individuals over 50 years old. Our findings suggest that the serum testosterone level was positively associated with CHF in adult males. This study highlights the potential role of serum testosterone in cardiovascular health, particularly in older individuals. Further research is needed to elucidate the underlying mechanisms and explore the clinical implications of these findings.

Temporal associations of diabetes-related complications with health-related quality of life decrements in Chinese patients with type 2 diabetes: A prospective study among 19 322 adults-Joint Asia Diabetes Evaluation (JADE) register (2007-2018).

Patients with type 2 diabetes (T2D) are at high risk of developing multiple complications, affecting their health-related quality of life (HRQoL). Existing studies only considered impact of complication on HRQoL in the year of occurrence but not its residual impacts in subsequent years. We investigated temporal impacts of diabetes-related complications on HRQoL in a 12-year prospective cohort of ambulatory Chinese patients with T2D enrolled in the clinic-based Joint Asia Diabetes Evaluation (JADE) Register. HRQoL utility measures were derived from EuroQol five-dimensional three-level questionnaire (EQ-5D-3L) questionnaires completed by 19 322 patients with T2D in Hong Kong (2007-2018). Temporal EQ-5D utility decrements associated with subtypes of cardiovascular-renal events were estimated using generalized linear regression model after stepwise selection of covariates with p < .01 as cutoff. In this cohort (mean ± SD age:61.2 ± 11.5 years, 55.3% men, median [interquartile range] duration of diabetes:10.1 [3.0-15.0] years, glycated hemoglobin [HbA1C] 7.5 ± 1.5%), EQ-5D utility was 0.860 ± 0.163. The largest HRQoL decrements were observed in year of occurrence of hemorrhagic stroke (-0.230), followed by ischemic stroke (-0.165), peripheral vascular disease (-0.117), lower extremity amputation (-0.093), chronic kidney disease (CKD) G5 without renal replacement therapy (RRT) (-0.079), congestive heart failure (CHF) (-0.061), and CKD G3-G4 without RRT (-0.042). Residual impacts on HRQoL persisted for 2 years after occurrence of CHF or ischemic stroke and 1 year after hemorrhagic stroke or CKD G3-G4 without RRT. This is the first comprehensive report on temporal associations of HRQoL decrements with subtypes of diabetes-related complications in ambulatory Asian patients with T2D. These data will improve the accuracy of cost-effectiveness analysis of diabetes interventions at an individual level in an Asian setting.

Health Education tentang kewaspadaan terjadinya Congestive Heart Failure

Heart disease is still a threat in Indonesia and even in the world, one of which is congestive heart failure. congestive heart failure is a type of heart failure that requires timely medical attention. Besides that, community service is one of the duties of lecturers in carrying out the Tri dharma of higher education. The purpose of this community service is to increase public knowledge about awareness of the occurrence of congestive heart failure. The counseling method uses Flip chart and Leaflet media. As a result of the service, the community came at the appointed time, listened to the presenters seriously and during the question and answer session, many people asked questions. In the evaluation session, the community can answer according to the material provided. The conclusion of community service activities has been carried out. The community welcomes the Justitia nursing academy very well and it is hoped that the community will be aware of congestive heart failure, and this community service activity can be carried out on a scheduled basis in Enu village, Donggala district.

Comparison of a Deep Learning Algorithm vs. Humans for Vertebral Heart Scale Measurements in Cats and Dogs Shows a High Degree of Agreement Among Readers.

Heart disease is a leading cause of death among cats and dogs. Vertebral heart scale (VHS) is one tool to quantify radiographic cardiac enlargement and to predict the occurrence of congestive heart failure. The aim of this study was to evaluate the performance of artificial intelligence (AI) performing VHS measurements when compared with two board-certified specialists. Ground truth consisted of the average of constituent VHS measurements performed by board-certified specialists. Thirty canine and 30 feline thoracic lateral radiographs were evaluated by each operator, using two different methods for determination of the cardiac short axis on dogs' radiographs: the original approach published by Buchanan and the modified approach proposed by the EPIC trial authors, and only Buchanan's method for cats' radiographs. Overall, the VHS calculated by the AI, radiologist, and cardiologist had a high degree of agreement in both canine and feline patients (intraclass correlation coefficient (ICC) = 0.998). In canine patients, when comparing methods used to calculate VHS by specialists, there was also a high degree of agreement (ICC = 0.999). When evaluating specifically the results of the AI VHS vs. the two specialists' readings, the agreement was excellent for both canine (ICC = 0.998) and feline radiographs (ICC = 0.998). Performance of AI trained to locate VHS reference points agreed with manual calculation by specialists in both cats and dogs. Such a computer-aided technique might be an important asset for veterinarians in general practice to limit interobserver variability and obtain more comparable VHS reading over time.

Sleep fragmentation and incidence of congestive heart failure: the Sleep Heart Health Study.

Sleep fragmentation (SF) has been reported to be associated with cardiovascular risk. The aim of this study was to explore the relationship between SF and congestive heart failure (CHF). A total of 4,887 participants (2,256 males and 2,631 females; mean age of 63.6 ± 11.0 years) from the Sleep Heart Health Study were included in this study. Incident CHF was defined as the first occurrence of CHF between baseline in-home polysomnography (PSG) and the end of follow-up. Objective assessments for SF, including sleep fragmentation index (SFI), arousal index (ArI), sleep efficiency (SE), and wake after sleep onset (WASO), were determined based on in-home PSG records. Multivariate Cox regression analysis was used to investigate the relationship between SF and incident CHF. During an average of 10 years of follow-up, 543 participants with CHF (11.1%) were observed. Individuals with CHF had a significantly higher SFI, total ArI, and WASO and a lower SE than controls. After multivariate Cox regression analysis, SE (odds ratio [OR], 0.967; 95% confidence interval [CI], 0.955-0.978; P < .001), WASO (OR, 1.009; 95% CI, 1.006-1.012; P < .001), SFI (OR, 1.046; 95% CI, 1.007-1.086; P = .021), and total ArI (OR, 1.018; 95% CI, 1.000-1.035; P = .044) were found to be associated with the incidence of CHF in participants without hypertension. Objectively measured SF was associated with the incidence of CHF. The role of SFI, total ArI, SE, and WASO deserves further investigation. Registry: ClinicalTrials.gov; Name: Sleep Heart Health Study (SHHS) Data Coordinating Center (SHHS); URL: https://clinicaltrials.gov/ct2/show/NCT00005275; Identifier: NCT00005275. Yan B, Wu Y, Fan X, Lu Q, Ma X, Bai L. Sleep fragmentation and incidence of congestive heart failure: the Sleep Heart Health Study. J Clin Sleep Med. 2021;17(8):1619-1625.

The impact of mild ischemic mitral regurgitation in the occurrence of congestive heart failure

Ischemic mitral regurgitation (IMR) is a common complication of myocardial infarction, leading to left ventricular (LV) dysfunction and remodeling. Its presence is associated with an increased risk for death and heart failure. The aim of this study was to evaluate the impact of a mild degree (effective regurgitant orifice area < 20 mm 2 ) of IMR on heart failure (HF). This is a retrospective, study including 210 patients who had been hospitalized in a cardiology intensive care unit for myocardial infarction from September 2018 to March 2020, 36 patients with mild IMR were compared to 40 patients without IMR (controls), measuring LV volumes, ejection-fraction, and the degree of mitral regurgitation and incidence of HF events. The main age was 59.3 ± 7.02 sex ratio: 2.86 (74.1% male, 25.9% female) 32.3% of patients had de novo heart failure of which 29.2% with mild IMR. Patients with IMR had a significantly higher incidence of HF than controls (72% vs. 34%, P = 0.001), a significant increase in LV end-diastolic and end-systolic volumes, ( P = 0.004) and lower ejection-fractions ( P = 0.0002). The culprit artery was left anterior descending artery in 54.4%. The presence of IMR, even mild in degree, has an impact on the progression of the post-infarction ventricular dysfunction and a higher rate of HF.

Insulin-like growth factor-binding protein 7 and risk of congestive heart failure hospitalization in patients with atrial fibrillation

The occurrence of congestive heart failure (CHF) hospitalization among patients with atrial fibrillation (AF) is a poor prognostic marker. The purpose of this study was to assess whether insulin-like growth factor-binding protein 7 (IGFBP-7), a marker of myocardial damage, identifies AF patients at high risk for this complication. We analyzed 2 prospective multicenter observational cohort studies that included 3691 AF patients. Levels of IGFBP-7 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from frozen plasma samples at baseline. The primary endpoint was hospitalization for CHF. Multivariable adjusted Cox regression analyses were constructed. Mean patient age was 69 ± 12 years, 1028 (28%) were female, and 879 (24%) had a history of CHF. The incidence per 1000 patient-years across increasing IGFBP-7 quartiles was 7, 10, 32, and 85. The corresponding multivariable adjusted hazard ratios (aHRs) (95% confidence interval [CI]) were 1.0, 1.05 (0.63-1.77), 2.38 (1.50-3.79), and 4.37 (2.72-7.04) (P for trend <.001). In a subgroup of 2812 patients without pre-existing CHF at baseline, the corresponding aHRs were 1.0, 0.90 (0.47-1.72), 1.69 (0.94-3.04), and 3.48 (1.94-6.24) (P for trend <.001). Patients with IGFBP-7 and NT-proBNP levels above the biomarker-specific median had a higher risk of incident CHF hospitalization (aHR 5.20; 3.35-8.09) compared to those with only 1 elevated marker (elevated IGFBP-7 aHR 2.17; 1.30-3.60); elevated NT-proBNP aHR 1.97; 1.17-3.33); or no elevated marker (reference). Higher plasma levels of IGFBP-7 were strongly and independently associated with CHF hospitalization in AF patients. The prognostic information provided by IGFBP-7 was additive to that of NT-proBNP.

Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study.

BackgroundTorasemide is a potent loop diuretic with potential to treat congestive heart failure (CHF) in dogs.ObjectiveEvaluate the efficacy and safety of torasemide compared to furosemide in dogs with first occurrence of CHF caused by degenerative mitral valve disease (DMVD).AnimalsThree hundred and nineteen dogs with new onset CHF attributable to DMVD.MethodsDouble‐blinded randomized noninferiority study of PO torasemide vs furosemide in addition to standard CHF treatment. The primary efficacy criterion was decreased pulmonary edema and cough and no worsening of dyspnea or exercise tolerance at day 14. Secondary endpoints included clinical response at day 84 and time to death, euthanasia, or premature study withdrawal for cardiac reasons.ResultsTorasemide q24h (n = 161) was noninferior to furosemide q12h (n = 158); percentage of dogs meeting primary efficacy criterion at day 14 was similar between groups (torasemide, 74.4% [95% confidence interval (CI), 66.8%‐81.0%] vs. furosemide, 73.5% [95% CI, 65.7%‐80.4%]; risk ratio [RR], 1.01; 95% CI, 0.89‐1.15; P = .87). Efficacy at day 84 showed similar results (RR, 1.05; 95% CI, 0.88‐1.25; P = .6). Dogs receiving torasemide had a longer time to endpoint and were less than half as likely to experience death, euthanasia, or premature study withdrawal (hazard ratio, 0.36; 95% CI, 0.19‐0.65; P = .001) than dogs receiving furosemide at any time during the study.Conclusion and Clinical importanceTorasemide was noninferior to furosemide as first line PO treatment for new onset CHF caused by DMVD. Torasemide significantly decreased risk of cardiac‐related death or premature study withdrawal for cardiac reasons compared to furosemide.

Effect of temperature variation on hospital admissions and outcomes in dogs with myxomatous mitral valve disease and new onset pulmonary edema.

The effect of seasonal variation on hospital admissions and outcomes in humans with cardiovascular disease and congestive heart failure (CHF) has been described. This study evaluates the effect of temperature variation on admissions and outcomes in dogs with myxomatous mitral valve disease (MMVD) and first onset CHF. Ninety-three client-owned dogs with MMVD and a first occurrence of pulmonary edema were included in this retrospective clinical cohort study. Recorded clinical and echocardiographic variables were accumulated and analyzed with dogs allocated into groups in a temperature-wise manner that considered the mean of the average (Tave) and maximum ambient temperature (Tmax) of the 14 days preceding hospital admission. A survival analysis was also performed. No difference was found in the percentage of dogs decompensating in three different temperature periods (i.e., cold, intermediate, and hot temperature) according to both Tave and Tmax. Dogs developing CHF during the intermediate temperatures according to Tmax died earlier from cardiac-related causes (median survival time 280 days, 95% CI = 147–486 days) compared to those decompensating during hot temperatures (median survival time 518 days, 95% CI = 344–819 days, P = 0.039). However, an effect of the ambient temperature on survival was not confirmed by Cox proportional hazard analysis. In conclusion, this study failed to show that ambient temperature has an effect on the first occurrence of CHF and outcomes in dogs with MMVD.

Congestive heart failure in cattle; etiology, clinical, and ultrasonographic findings in 67 cases.

Background and Aim:Congestive heart failure (CHF) is a clinical disorder that results from cardiac dysfunction with subsequent fatal outcomes in most cases. Several diseases are incriminated in occurrence of CHF. Therefore, the aims of this study were to identify CHF etiology and associated clinical findings in 67 cows and to investigate the relationship between CHF and the other body organs using ultrasonographic examination.Materials and Methods:Sixty-seven cows affected by CHF admitted to the clinic with a history of loss of appetite, decrease in milk production, constipation, and brisket edema were thoroughly investigated clinically and ultrasonographically. In addition, ten apparently healthy cows were used as a control group.Results:Clinically, cows with CHF manifested jugular engorgement and pulsation (88.1%), brisket and/or intermandibular edema (77.6%), and muffled heart sounds (76.1%). Based on the ultrasonographic examination, traumatic pericarditis (82.1%) was the most prevalent etiology of CHF. Extracardiac etiology of CHF identified were exudative pleurisy (10.4%) and mediastinal abscesses (7.5%). Hepatomegaly (88.1%) and pleural effusion (61.2%) were the most documented consequences.Conclusion:Both cardiac and extracardiac diseases could be associated with CHF in cattle. Ultrasonographic changes in liver and pleura secondary to CHF were the most common findings. Ultrasonography is a good tool for the diagnosis of cardiac and extracardiac etiologies of CHF in cattle.

Efficacy and Safety of Etanercept in Elderly Patients with Rheumatoid Arthritis: A Post-Hoc Analysis of Randomized Controlled Trials.

Elderly individuals are disproportionately affected by rheumatoid arthritis (RA), but few studies have addressed the efficacy and safety of treatments in this population. Our objective was to assess the efficacy and safety of etanercept in elderly patients (aged ≥ 65years) with RA. The efficacy analysis was a post hoc analysis of data from the open-label period of three phase IV clinical trials of etanercept for RA. Least squares (LS) change from baseline (cfb) in 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and modified Total Sharp Scores (mTSS) were analyzed by age (< 65 vs. ≥ 65years) for each study. The safety analyses were of data pooled from the double-blind, placebo-controlled periods of 19 phase I-IV randomized studies of etanercept in patients with RA. The percentage occurrence of adverse events (AEs) in placebo- and etanercept-treated patients was analyzed by age (< 65 vs. ≥ 65years). There were no significant differences in LS mean cfb in DAS28 or mTSS between the two age groups. LS mean cfb in HAQ-DI scores was consistently lower in elderly than in non-elderly patients, although significant differences were not observed in all trials. Overall,AE occurrence was higher in elderly than non-elderly patients, regardless of treatment. In etanercept-treated patients, there were small yet statistically significant increases in the occurrence of congestive heart failure, serious infections, and non-melanoma skin cancers in elderly versus non-elderly patients. For most AEs, occurrence did not significantly differ between elderly and non-elderly patients. Overall, there were no substantial differences in the efficacy or safety of etanercept between elderly and non-elderly patients with RA.

Fragmented QRS and Ventricular Arrhythmias in Coroary Artery Disease Patients

Background: Fragmented QRS represents myocardial scar and will be associated with ventricular dysfunction and occurrence of congestive heart failure. In CAD, fQRS represents prior occurrence of myocardial infarction and will have a risk of subsequent occurrence of ischemic events. Objective: in our study we aimed to determine whether fragmented QRS (fQRS) is associated with increased incidence of ventricular arrhythmias in patients with coronary artery disease (CAD) or not . Patients and Methods: one hundred patients with CAD were included. Patients were divided into two groups according to presence or absence of fQRS on admission ECG. Group 1 (n=50) was defined as a fQRS (+ve) and group 2 (n=50) was defined as a fQRS (-ve). All patients were subjected to full history taking, complete physical examination, ECG, echocardiography and laboratory investigations. Results: There was higher incidence of fQRS in hypertensive patients (72%). FQRS was found to be associated with increased incidence of ventricular arrhythmias, 52% in group 1 versus 24% in group II. EF % was significantly lower in group I than in group 2 with p value 0.03. Fragmented QRS was an independent predictor of all-cause mortality with p value 0.02. Conclusion: fQRS on the resting surface electrocardiogram is a simple, fast and inexpensive modality of noninvasive investigation for evaluation of CAD patients. Patients who have known CAD present with a fQRS have an increased rate of ventricular tachyarrhythmias, death risk, and low ejection fraction.

Prognostic factor of heart failure in children with left-to-right shunt acyanotic congenital heart disease

Background Anemia is highly prevalent and affects morbidity and mortality in adults with acquired heart disease. However, its role in children with acyanotic congenital heart disease (CHD) is unclear.&#x0D; Objective To assess anemia and other potential prognostic factors of congestive failure in children with left-to-right shunt acyanotic CHD.&#x0D; Methods We conducted a case-control study in the Pediatric Cardiology Clinic, Dr. Sardjito Hospital from January to December 2017 in children with left-to-right shunt acyanotic CHD. The case and control groups consisted of subjects with and without heart failure, respectively. Anemia was defined as hemoglobin concentration &lt;11 g/dL. Measured outcome was the prevalence of congestive heart failure, as determined by the Ross criteria. Anemia, defect type, defect size, age at diagnosis, and gender were analyzed by logistic regression analysis as potential predictive factors of heart failure.&#x0D; Results Of 100 children with left-to-right shunt acyanotic CHD, 50 had heart failure (the case group) and 50 did not (the control group). The prevalence of anemia was 45%. Multivariable logistic regression revealed that defect size was the most significant factor for predicting heart failure, with adjusted OR 7.6 (95%CI 2.5 to 22.8) for moderate shunts and 21.1 (95%CI 6.8 to 65.4) for large shunts. Anemia, type of defect, age of diagnosis, and gender were not statistically significant factors for predicting outcomes.&#x0D; Conclusion Anemia is not a significant, prognostic factor for heart failure in children with left-to-right shunt acyanotic CHD. However, moderate and large shunts in children with left-to-right shunt acyanotic CHD are predictive of the occurrence of congestive heart failure.

Prognostic value of plasma MR-proADM vs NT-proBNP for heart failure in people with type 2 diabetes: the SURDIAGENE prospective study.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is the gold standard prognostic biomarker for diagnosis and occurrence of heart failure. Here, we compared its prognostic value for the occurrence of congestive heart failure with that of plasma mid-region pro-adrenomedullin (MR-proADM), a surrogate for adrenomedullin, a vasoactive peptide with vasodilator and natriuretic properties, in people with type 2 diabetes. Plasma MR-proADM concentration was measured in baseline samples of a hospital-based cohort of consecutively recruited participants with type 2 diabetes. Our primary endpoint was heart failure requiring hospitalisation. We included 1438 participants (age 65 ± 11years; 604 women and 834 men). Hospitalisation for heart failure occurred during follow-up (median 64months) in 206 participants; the incidence rate of heart failure was 2.5 (95% CI 2.2, 2.9) per 100 person-years. Plasma concentrations of MR-proADM and NT-proBNP were significantly associated with heart failure in a Cox multivariable analysis model when adjusted for age, diabetes duration, history of coronary heart disease, proteinuria and baseline eGFR (adjHR [95%CI] 1.83 [1.51, 2.21] and 2.20 [1.86, 2.61], respectively, per 1 SD log10 increment, both p < 0.001). MR-proADM contributed significant supplementary information to the prognosis of heart failure when we considered the clinical risk factors (integrated discrimination improvement [IDI, mean ± SEM] 0.021 ± 0.007, p = 0.001) (Table 3). Inclusion of NT-proBNP in the multivariable model including MR-proADM contributed significant complementary information on prediction of heart failure (IDI [mean ± SEM] 0.028 ± 0.008, p < 0.001). By contrast, MR-proADM did not contribute supplementary information on prediction of heart failure in a model including NT-proBNP (IDI [mean ± SEM] 0.003 ± 0.003, p = 0.27), with similar results for heart failure with reduced ejection fraction and preserved ejection fraction. MR-proADM is a prognostic biomarker for heart failure in people with type 2 diabetes but gives no significant complementary information on prediction of heart failure compared with NT-proBNP.

Incidence and risk factors for congestive heart failure in patients with early breast cancer who received anthracycline and/or trastuzumab: a big data analysis of the Korean Health Insurance Review and Assessment service database.

We aimed to analyze the incidence, time to occurrence, and congestive heart failure (CHF) risk factors for early breast cancer patients treated with anthracycline (AC)-based chemotherapy and/or trastuzumab (T) therapy in Korea. We included female patients > 19years old from the Health Insurance Review and Assessment Service database who had no prior CHF history and had been diagnosed with early breast cancer between January 2007 and October 2016. We included 83,544 patients in our analysis. In terms of crude incidence for CHF, AC followed by T showed the highest incidence (6.3%). However, 3.1 and 4.2% of the patients had CHF due to AC-based chemotherapy and non-AC followed by T, respectively. The median times to occurrence of CHF were different according to adjuvant treatments, approximately 2years (701.0days) in the AC-based chemotherapy group vs 1year (377.5days) AC followed by T group. T therapy was associated with earlier development of CHF irrespective of previous chemotherapy, but late risk of CHF 1.2years after T therapy rapidly decreased in both chemotherapy groups. Multivariate Cox regression analysis revealed that the adjusted hazard ratio for CHF was increased in the group of older patients (≥ 65years old) who underwent AC followed by T therapy, with Charlson comorbidity index scores of ≥ 2. Our study showed that neo-/adjuvant chemotherapy using T irrespective of previous chemotherapy (AC or non-AC) was associated with significantly increased risk of CHF compared with AC-based chemotherapy in Korean patients with early breast cancer.

Abstract P6-08-09: Incidence and risk factors for congestive heart failure in early breast cancer received anthracycline and/or trastuzumab; big-data analysis of Korean health insurance review and assessment service database

Abstract Background: Anthracycline (AC) and/or trastuzumab (T) are the most commonly used for neo-/adjuvant therapy for early breast cancer. However, use of those regimens are limited owing to congestive heart failure (CHF). Although reported incidence from pivotal trials is very low and acceptable, no big data-based population study has not been conducted in Koreans yet. The aim of this study was to analyze the incidence, time to occurrence, and risk factors for CHF in patients with early breast cancer, who were treated with AC and/or T therapy, in Korea. Methods: We used the Health Insurance Review and Assessment Service database and included women with no prior history of CHF who were aged &amp;gt;19 years and diagnosed as having early breast cancer between 2007 and 2016. Only patients who had received breast cancer surgery and AC and/or T therapy were included. Patients with metastatic cancer codes were excluded. Result: In total, 86,086 patients were included for this analysis. The incidence and median time to occurrence of CHF according to chemotherapy type were, 3.27% and 683.5 days in the AC only group, 6.39% and 374 days in the AC followed by T group, and 4.43% and 286 days in the T with or without non-AC group, respectively. The multivariate Cox regression analysis revealed that the adjusted hazard ratio (HR) for CHF was increased with older age; in those aged ≥65 years versus &amp;lt;50 years (HR, 2.79; 95% confidence interval [CI], 2.50–3.12). The HR in the AC followed by T group was significantly higher than that in the AC only group (HR, 2.21; 95% CI, 2.05-2.37). The T with or without non-AC group also showed a significantly higher HR than the AC only group (HR, 1.67; 95% CI, 1.37-2.04). CCI scores of ≥2 were significant predictors of CHF; score 2 versus 0 (HR, 1.30; 95% CI, 1.18-1.45), and score ≥3 versus 0 (HR, 1.87; 95% CI, 1.69-2.06). In addition, preexisting medical conditions were significant predictors for CHF: hypertension (HR, 1.58; 95% CI, 1.45-1.72), diabetes (HR, 1.17; 95% CI, 1.07-1.28), and ischemic heart disease (HR, 1.60; 95% CI, 1.45-1.76). Conclusion: This is the first big data-based population study in Korea on the development of CHF after treatment with AC and/or T. The overall incidence of CHF was 3% to 6%, with a median time to occurrence of 1 to 2 years. Adjusted HR increased with older age, AC followed by T therapy, CCI scores ≥2, and preexisting conditions. Table 1. Incidence and median time to occurrence of congestive heart failure according to chemotherapy typeChemotherapy typeTotalCHF event (%)Median time to occurenceAC only66,6992,182 (3.27%)683.5AC followed by T17,0621,090 (6.39%)374T ± non-AC2,325103 (4.43%)286 Table 2. Cox proportional hazards model for congestive heart failure, adjusted for age, chemotherapy type, and Charlson comorbidity index scoreVariableP-valueHR95% CIAge (ref &amp;lt;50 years) 50-64 years&amp;lt;0.00011.541.43-1.66≥65 years&amp;lt;0.00012.792.50-3.12Chemotherapy type (ref AC only) AC folloewed by T&amp;lt;0.00012.212.05-2.37T ± non-AC&amp;lt;0.00011.671.37-2.04Charlson comorbidity index score (ref 0) 10.12061.080.98-1.192&amp;lt;0.00011.301.18-1.45≥3&amp;lt;0.00011.871.69-2.06 Citation Format: Choi JY, Cho EY, Lee JW, Kim JW, Choi YJ, You JY, Bae SY, Jung SP, Cho KR, Park KH. Incidence and risk factors for congestive heart failure in early breast cancer received anthracycline and/or trastuzumab; big-data analysis of Korean health insurance review and assessment service database [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-09.

Increased risk of congestive heart failure in patients with acetaminophen poisoning: A nationwide cohort study.

Acetaminophen poisoning increases cytochrome P450 2E1 expression and reactive oxygen species production, which may lead to maladaptive myocardial remodeling and congestive heart failure (CHF). We conducted a nationwide cohort study to investigate the incidence and risk of CHF in patients with acetaminophen poisoning. We identified a cohort of adult patients with newly diagnosed acetaminophen poisoning in the inpatient claims of the Taiwan National Health Insurance Research Database for the 1998-2011 period. A comparison cohort was frequency matched at a 4:1 ratio for sex, age and index year. All patients were followed up until the occurrence of CHF, withdrawal from the National Health Insurance program, or December 31, 2011. Cox proportional hazards models were employed to calculate the risk of CHF in the acetaminophen poisoning cohort compared with the comparison cohort, and the hazard ratios with 95% confidence intervals are presented. A total of 3546 and 14 184 patients with and without acetaminophen poisoning were followed up for a total of 25 856 and 102 119 person-years, respectively. The overall incidence of CHF was higher in the acetaminophen poisoning cohort than in the comparison cohort (8.12 vs. 5.19 per 10 000 person-years). After adjustment for covariates, the acetaminophen poisoning cohort exhibited a 1.59-fold higher risk of CHF (adjusted hazard ratio = 1.59; 95% confidence interval = 1.43-1.75) than did the comparison cohort. Patients with acetaminophen poisoning exhibited a significantly higher risk of CHF compared with the comparison cohort. Clinicians should follow up heart function in patients with acetaminophen poisoning.

Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease

Introduction: Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.Methods: Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke.Results: In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64–6.90; p = 0.001) and ACS or stroke (HR 1.95; 95%CI 1.29–2.96; p = 0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71–0.85) to 0.81 (0.74–0.88) and improved classification (NRI 0.36; 95%CI 0.13–0.60; p = 0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001–0.030; p = 0.031).Conclusions: High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated.Key messagesLeptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors.High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors.The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.

PP.29.11] METABOLIC SYNDROME AS THE PREDICTOR OF NEW CARDIOVASCULAR EVENTS IN PATIENTS WITH MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Objective: The presence of Metabolic syndrome (MetS) promotes the development of atherosclerotic cardiovascular disease as well as the appearance of its complications and is a sole indicator of the elevated risk for new cardiovascular events. The aim of this study is to determine the prevalence and the impact of MetS on the appearance of new unwanted cardiovascular events in patients with STEMI treated with primary percutaneous coronary intervention. Design and method: The study group consisted of 507 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI) in Clinical Centre of Serbia. During the 36 month-follow up, a telephone visit was conducted in all patients after 1, 3, 6, 12, 24 and 36 months. All the patient who reported new cardiovascular events were called up for events evaluation. For patients who died during the follow up, hospital records and necrophy data were reviewed. AHA/NHLBI (American Heart Association and national Heart, Lung and Blood Institute) criteria were used for diagnosing the patients. Results: The prevalence of MetS in our study was 42.80% (217 patients). During the three-year follow-up, a significant increase of unwanted cardiovascular events (p = 0.0063) was detected in the group of patients with MetS. The presence of MetS in our patients was associated with relative risk for new myocardial infarctions 3.77 (95% CI (1.45–9.80);p = 0.001) and with relative risk for the occurrence of congestive heart failure 1.43 (95% CI (1.07–2.64);p = 0.027). Among the risk factors for MetS, hyperglycemia solely had to be independently associated with cardiovascular death (OR 3.39 95%CI (1.70–6.77) (p = 0.001)), whereas it did not have a significant influence on the appearance of new myocardial infarctions and congestive heart failure. Elevated blood pressure turned out to be a moderate risk for the appearance of new unwanted cardiovascular events while elevated triglyceride level, low HDL cholesterol and obesity did not significantly influenced the appearance of new cardiovascular events and did not present a significant risk. Conclusions: MetS is significantly associated with new myocardial infarction and the occurrence of heart failure, among patients with STEMI regardless of the fully conducted secondary prevention in these patients.