Predictor Of Cardiac Complications Research Articles

Troponin I, Hyperlipidemia and Obesity as Predictor of Cardiovascular Complications: A Cross Sectional Study

High levels of Troponin I, cholesterol, triglycerides, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and Body Mass Index (BMI) are predictor of cardiac complications. Objective: To investigate the predictive efficacy of Troponin I, BMI, and lipid profiles in detecting cardiovascular problems. Methods: 300 male and female individuals were selected for current study. 100 normal individuals were in Control Group A, while 100 participants were placed in Group B all the individuals of Group B have the indications of different cardiac medical complications. BMI, systolic, diastolic blood pressure, Troponin I, cholesterol, triglycerides, LDL, HDL levels were measured respectively. Results: In present study BMI, systolic blood pressure, diastolic blood pressure, Troponin I, cholesterol, triglycerides, LDL, HDL blood serum levels of male and female in Group A and Group B were measured, the comparative analysis of above biomarkers showed a significant p-Value ≤ 0.05 change (0.02 ± 0.01, 183.01 ± 0.02, 120.01 ± 0.02, 87.01 ± 0.03, 44.01 ± 0.01), (0.02 ± 0.01, 172.01 ± 0.02, 130.01 ± 0.01, 88.01 ± 0.03, 42.01 ± 0.04), (0.39 ± 0.04, 272.01 ± 0.02, 180.01 ± 0.01, 138.01 ± 0.03, 37.01 ± 0.01) and ( 0.37 ± 0.04, 282.01 ± 0.02, 184.01 ± 0.01, 141.01 ± 0.03, 36.01 ± 0.01) were measured respectively. Conclusions: The present study found that there were notable significant p-value <0.05 differences in the blood serum levels of BMI, systolic and diastolic blood pressure, Troponin I, cholesterol, triglycerides, LDL, and HDL in both the male and female groups in Groups A and B

Cardiac function may be compromised in patients with elevated blood cobalt levels secondary to metal-on-metal hip implants.

Elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties are a suggested risk factor for developing cardiovascular complications including cardiomyopathy. Clinical studies assessing patients with MoM hips using left ventricular ejection fraction (LVEF) have found conflicting evidence of cobalt-induced cardiomyopathy. Global longitudinal strain (GLS) is an echocardiography measurement known to be more sensitive than LVEF when diagnosing early cardiomyopathies. The extent of cardiovascular injury, as measured by GLS, in patients with elevated blood cobalt levels has not previously been examined. A total of 16 patients with documented blood cobalt ion levels above 13 µg/l (13 ppb, 221 nmol/l) were identified from a regional arthroplasty database. They were matched with eight patients awaiting hip arthroplasty. All patients underwent echocardiography, including GLS, investigating potential signs of cardiomyopathy. Patients with MoM hip arthroplasties had a mean blood cobalt level of 29 µg/l (495 nmol/l) compared to 0.01 µg/l (0.2 nmol/l) in the control group. GLS readings were available for seven of the MoM cohort, and were significantly lower when compared with controls (-15.5% vs -18% (MoM vs control); p = 0.025)). Pearson correlation demonstrated that GLS significantly correlated with blood cobalt level (r = 0.8521; p < 0.001). However, there were no differences or correlations for other echocardiography measurements, including LVEF (64.3% vs 63.7% (MoM vs control); p = 0.845). This study supports the hypothesis that patients with elevated blood cobalt levels above 13 µg/l in the presence of a MoM hip implant may have impaired cardiac function compared to a control group of patients awaiting hip arthroplasty. It is the first study to use the more sensitive parameter of GLS to assess for any cardiac contractile dysfunction in patients with a MoM hip implant and a normal LVEF. Larger studies should be performed to determine the potential of GLS as a predictor of cardiac complications in patients with MoM arthroplasties.

Biomarkers for the diagnosis, treatment follow-up, and prediction of cardiac complications in Chagas disease in chronic phase: Recent advances.

Chagas disease is caused by the Trypanosoma cruzi parasite and is transmitted by infected triatomine bugs. This infection affects approximately 8 million people in the Americas, and due to globalisation and displacement, it is becoming increasingly common to find infected patients worldwide. Diagnosis of the disease in its acute form is relatively simple, as the parasite can be detected in peripheral blood smears, and symptoms are visible. However, in its chronic condition, the parasite is almost undetectable, and indirect tests are necessary to determine the presence of antibodies in infected patients. It is important to note that a single test is not enough to confirm the disease in this phase, as a second serological test should confirm the diagnosis. If the results are contradictory, a third test should be performed to confirm or discard the disease. Unfortunately, laboratories may not have access to all necessary tests in many rural areas where the disease is more frequent. Rapid tests to diagnose this disease present problems, such as significant variations in sensitivity and specificity in different countries. Therefore, searching for new biomarkers that allow for optimal correlation is essential. In this work, we have searched scientific literature from the last 10 years for mentions of novel biomarkers for diagnosis, treatment follow-up, and prediction of cardiac complications in Chagas disease in its chronic phase.

Brain Natriuretic Peptide levels on hospital admission are a useful predictor of cardiac complications and mortality in geriatric patients with proximal femur fractures

PurposeProximal femur fractures in geriatric patients are associated with increased morbidity and mortality. This study investigates Brain Natriuretic Peptide immunoassay levels taken at the time of hospital admission in predicting cardiac complications and mortality in geriatric patients with a proximal femur fracture. MethodsA single-site prospective cohort study at a large tertiary care, level 1 trauma centre was conducted on all consecutive geriatric patients aged greater than 60 years who sustained a proximal femur fracture. Investigators collected Brain Natriuretic Peptide levels from venous blood samples on admission to the Emergency Department. The main outcome measurements were inpatient cardiovascular complications, and all-cause mortality at 30-day, 90-day, one-year, and nine-years. ResultsOver a one-year period, 112 patients were enrolled. The average age was 82.7 years, and the average follow up was 6 years and 6 months (range, 2 days to 9 years). No patients were lost to follow up. There were 44 new or exacerbations of pre-existing cardiac complications requiring management recorded in 30 (26.8%) patients. Mortality at 30 days was 9.8%, 90 days was 16.1%, and one year was 24.1%, with deceased patients having a statistically significant elevated Brain Natriuretic Peptide immunoassay on hospital admission. The Kaplan-Meier graph demonstrated a trend towards increasing Brain Natriuretic Peptide and adverse survivorship risk. The Charlson Comorbidity Index was statistically significant in predicting overall survival probability. ConclusionBrain Natriuretic Peptide immunoassay on hospital admission may be utilised to identify patients at risk of cardiac complications and mortality to guide further investigations, operative planning, the consent process, and post-operative monitoring.

The predictive value of the Kobayashi and Kawanet score systems regarding immunoglobulin resistance and cardiac complications in patients with Kawasaki disease: A pilot study

Kawasaki disease is an immunovasculitis, which, without treatment, leads to cardiac complications. Early intravenous immunoglobulin therapy moderates complications, however, 10-20% of patients are resistant to the therapy. Numerous risk score systems are used worldwide to predict this. To assess the predictive value of the Kobayashi and Kawanet score systems regarding intravenous immunoglobulin resistance and cardiac complications in our department's patient cohort. To our best knowledge, this is the first study in Hungary, which examines the predictive value of score systems in the case of Kawasaki disease. In our study, we identified the patients treated for Kawasaki disease between January 2005 and April 2020. In each case, we calculated both the Kobayashi and the Kawanet score, and we examined their specificity and sensitivity regarding the prediction of intravenous immunoglobulin resistance and cardiac complications. In the Kobayashi score system, values above 4, in the Kawanet score system, values above 2 signal risk. We identified 28 patients with Kawasaki disease. We observed moderate complications in 13, severe complications in 4 cases. 4 of our patients were resistant to intravenous immunoglobulin therapy. Regarding intravenous immunoglobulin resistance in our patient cohort, we detected low sensitivity (25%) and high specificity (91.6%) in the case of Kobayashi score, and moderate sensitivity (50%) and specificity (50%) in the case of Kawanet score. Regarding complications, we found similar results in the case of Kobayashi (sensitivity: 17%; specificity: 100%) and the Kawanet (sensitivity: 47%; specificity: 45%) score system. Similarly to the majority of non-Asian studies, we found the Kobayashi score system ineffective in predicting intravenous immunoglobulin resistance. However, due to its higher sensitivity, the predictive value of the Kawanet score system regarding intravenous immunoglobulin resistance is worth examining in a larger patient population in Hungary. Regarding the prediction of cardiac complications, both score systems were found to be ineffective. Orv Hetil. 2021; 162(47): 1885-1890.

Changes in CMR Parameters and Prediction of Cardiac Complications in Thalassemia Major: Fibrosis Tells Us More Than Iron

Introduction. Cardiovascular magnetic Resonance (CMR) has dramatically changed the clinical practice and improved the prognosis in thalassemia major (TM). This is the first study evaluating the predictive value of changes in CMR parameters (myocardial iron, function, and fibrosis) for cardiac complications in TM.Methods. We followed prospectively 709 TM patients (374 females; 29.77±8.53 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network who performed a baseline and a 1 st follow up CMR scan after 18 months. Myocardial iron overload (MIO) was measured by multislice multiecho T2* technique and atrial dimensions and biventricular function by cine images. Macroscopic myocardial fibrosis was detected by late gadolinium enhancement technique.Risk classes were defined based on the 4 patterns of MIO from worst to normal. For patients with baseline MIO (at least one segmental T2*<20 ms), improvement was defined as a transition to a better risk class, stabilization as no change in risk class, and worsening as a transition to a worse risk class. For patients without baseline MIO, the worsening was the transition to a worse risk class.The percentage change was used for continuous variables. For biventricular ejection fractions, improvement was a %change>10%, stabilization a %change between -10% and 10%, and worsening a %change<-10%. For biventricular volumes, LV mass index, and atrial areas, improvement was a % change<-10%, stabilization a % change between -10% and 10%, and worsening a % change>10%.Myocardial fibrosis was considered absent if not detected in any of the two CMRs and present if detected in at least one examination .Results. During a mean follow-up of 89.4±33.3 months, cardiac events were recorded in 50 (7.1%) patients: 24 (48%) episodes of heart failure, 24 (48%) arrhythmias (23 supraventricular and 1 hypokinetic), and 2 (4.0%) pulmonary hypertension. Mean time from the 1 st follow up CMR to the development of a cardiac complication was 75.31±35.35 months.In the univariate Cox regression analysis, cardiac iron cleareance and myocardial fibrosis were identified as univariate prognosticators (Table 1). In the multivariate analysis only myocardial fibrosis remained an independent predictor factor.Conclusion. The presence of myocardial fibrosis at the baseline CMR or developed within 18 months emerges as the strongest long-term predictor for cardiac complications in TM. Our data demonstrate the importance in using the contrast medium for CMR scans in thalassemia patients. [Display omitted] DisclosuresPepe: Bayer S.p.A.: Other: no profit support; Chiesi Farmaceutici S.p.A: Other: no profit support. Maggio: Novartis: Membership on an entity's Board of Directors or advisory committees; Celgene Corp: Membership on an entity's Board of Directors or advisory committees; Bluebird Bio: Membership on an entity's Board of Directors or advisory committees.

Функциональный статус как предиктор кардиальных осложнений после абдоминальных операций у пациентов с ожирением

Актуальность. Связь между предоперационным функциональным состоянием и послеоперационными осложнениями очень хорошо описана в абдоминальной хирургии у пациентов пожилого возраста и в хирургии шейного отдела позвоночника. Однако для пациентов с ожирением таких данных нет. Цель: оценить инцидентность кардиальных осложнений после плановых абдоминальных операций у пациентов с ожирением и определить, является ли уровень предоперационного функционального состояния предиктором их развития. Материалы и методы. В ретроспективно-проспективном исследовании был проведен анализ госпитальных послеоперационных кардиальных осложнений у 770 пациентов с индексом массы тела &gt; 30 кг/м2, перенесших операции на органах брюшной полости и передней брюшной стенке в период с 2007 по 2018 год. Инцидентность кардиальных осложнений сравнивали с прогнозируемыми по индексу Lee (Revised Cardiac Risk Index — RCRI) и калькулятору American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) величинами, определяли их связь с исходным уровнем функционального состояния пациентов (независимый, частично зависимый, полностью зависимый, метаболический эквивалент (MET) &lt; 4, MET &gt; 4) и видом хирургического вмешательства (лапароскопия, лапаротомия, поверхностная хирургия). Статистическая обработка результатов проведена с помощью t-теста Стьюдента, U-теста Манна — Уитни, критерия χ2, точного критерия Фишера, регрессионного анализа. Результаты. Прогнозируемый риск кардиальных осложнений по RCRI составил 0,9 % [0,9; 6,6], а по калькулятору ACS-NSQIP — 0,4 % [0; 3,2] (p &lt; 0,05). Инцидентность инфаркта миокарда и остановки сердца была нулевой и отличалась от прогнозируемой (p &lt; 0,01), нефатальные кардиальные осложнения наблюдались у 2,8–3,6 % пациентов. Более 96 % пациентов проспективной части исследования (n = 490) были функционально независимыми, имели хорошую функциональную способность и инцидентность кардиальных осложнений на уровне 2 %. У частично зависимых пациентов этот показатель повышался до 23,5 % (соотношение шансов (СШ) 14,76; 95% доверительный интервал (ДИ) 4,09–53,32), а у пациентов с MET &lt; 4 — до 36,4 % (СШ 17,45; 95% ДИ 4,73–64,33). Выводы. У пациентов с ожирением после плановых операций на органах брюшной полости и передней брюшной стенке процент больших кардиальных осложнений достоверно меньше прогнозируемого по RCRI и калькулятору ACS-NSQIP. Частично зависимое функциональное состояние пациентов и MET &lt; 4 являются факторами повышенного риска послеоперационных нефатальных кардиальных осложнений.

Changes in CMR parameters and prediction of cardiac complications in thalassemia major: fibrosis tells us more than iron

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The MIOT project received “no-profit support” from industrial sponsorships (Chiesi Farmaceutici S.p.A. and ApoPharma Inc.). Background Cardiovascular magnetic Resonance (CMR) has dramatically changed the clinical practice and improved the prognosis in thalassemia major (TM). Aim This is the first study evaluating the predictive value of changes in CMR parameters (myocardial iron, function, and fibrosis) for cardiac complications in TM. Methods We followed prospectively 709 TM patients (374 females; 29.77 ± 8.53 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network who performed a baseline and a 1st follow up CMR scan after 18 months. Myocardial iron overload (MIO) was measured by multislice multiecho T2* technique and atrial dimensions and biventricular function by cine images. Macroscopic myocardial fibrosis was detected by late gadolinium enhancement technique. Risk classes were defined based on the 4 patterns of MIO from worst to normal. For patients with baseline MIO (at least one segmental T2*&amp;lt;20 ms), improvement was defined as a transition to a better risk class, stabilization as no change in risk class, and worsening as a transition to a worse risk class. For patients without baseline MIO, the worsening was the transition to a worse risk class. The percentage change was used for continuous variables. For biventricular ejection fractions, improvement was a %change &amp;gt; 10%, stabilization a %change between -10% and 10%, and worsening a %change&amp;lt;-10%. For biventricular volumes, LV mass index, and atrial areas, improvement was a % change&amp;lt;-10%, stabilization a % change between -10% and 10%, and worsening a % change &amp;gt; 10%. Myocardial fibrosis was considered absent if not detected in any of the two CMRs and present if detected in at least one examination. Results During a mean follow-up of 89.4 ± 33.3 months, cardiac events were recorded in 50 (7.1%) patients: 24 (48%) episodes of heart failure, 24 (48%) arrhythmias (23 supraventricular and 1 hypokinetic), and 2 (4.0%) pulmonary hypertension. Mean time from the 1st follow up CMR to the development of a cardiac complication was 75.31 ± 35.35 months. In the univariate Cox regression analysis, cardiac iron cleareance and myocardial fibrosis were identified as univariate prognosticators (Table 1). In the multivariate analysis only myocardial fibrosis remained an independent predictor factor. Conclusion The presence of myocardial fibrosis at the baseline CMR or developed within 18 months emerges as the strongest long-term predictor for cardiac complications in TM. Our data demonstrate the importance in using the contrast medium for CMR scans in thalassemia patients.

Prediction of perioperative cardiac complications in patients with proximal femoral fracture

Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients. Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture. Material and methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index. Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively. Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications.

Prediction of Cardiac Complications in SCD

Introduction: Cardiac magnetic resonance (CMR) is the non-invasive gold standard for the quantification of biventricular functional parameters and for myocardial tissue characterization. The aim of this study was to prospectively assess the predictive value of CMR parameters for cardiovascular complications in sickle cell disease (SCD) patients. Methods: We considered 102 white SCD patients (34.38±12.67 years, 53 females) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. Myocardial iron overload (MIO) was measured by the multislice multiecho T2* technique. Atrial dimensions and biventricular function parameters were quantified by cine images. Results: At baseline CMR only two patients had MIO (global heart T2*&lt;20 ms). During a mean follow-up was of 63.29±24.41 months, 10 cardiac events (9.8%) were registered: 3 pulmonary hypertension, 1 pulmonary embolism, 1 peripheral vascular disease, 1 transient ischemic attack, 2 supraventricular arrhythmias, 1 heart failure, and 1 death after acute chest syndrome. CMR predictors of cardiovascular events at univariate analysis were left ventricular ejection fraction and right ventricular mass index (see Table). Both variables remained independent predictors at multivariate analysis (see Table). Conclusions: Reduced left ventricular ejection fraction and increased right ventricular mass index showed a significant prognostic value in patients with SCD. Our data seem to suggest that also CMR could be added as screening tool for identifying SCD patients at high risk for pulmonary and systemic vasculopathy and death. Table Disclosures Pepe: Chiesi Farmaceutici S.p.A., ApoPharma Inc., and Bayer: Other: No profit support.

Delta-neutrophil index: a potential predictor of coronary artery involvement in Kawasaki disease by retrospective analysis.

DNI is the immature granulocyte fraction provided by a blood cell analyzer, which is determined by subtracting the fraction of mature polymorphonuclear leukocytes from the sum of myeloperoxidase-reactive cells. We aimed to evaluate the role of Delta-neutrophil index (DNI) in cardiac prognosis prediction in children with Kawasaki disease (KD). Medical records of 193 patients were retrospectively reviewed. The values of DNI, white blood cells, erythrocyte sedimentation rate, the percent of polymorphonuclear leucocytes, C-reactive protein, aspartate transaminase, alanine aminotransferase, total bilirubin data of children with KD were analyzed. Also, sex and age of children were compared. The value of DNI was higher in children with cardiac complications [median 0.8 (0-0.26) vs 5.3 (3.55-8.95); P < 0.001]. The ROC curves showed that DNI was a better predictor of cardiac complications than other parameters. The best cutoff value for DNI to predict cardiac complications was 5.55% with sensitivity of 80% and specificity of 82% (AUC 0.883, 95% confidence interval [CI] 0.807-0.959, P < 0.05). DNI could serve as a facile and useful marker to predict cardiac complications in children with KD, as it is included in a routine complete blood count.

PB2391 MYOCARDIAL CONTRACTILE FRACTION BY MAGNETIC RESONANCE AND RISK OF CARDIAC COMPLICATIONS IN THALASSEMIA MAJOR

Background:The analysis of cine cardiovascular magnetic resonance (CMR) images allows the quantification of the myocardial contraction fraction (MCF), a volumetric analog of myocardial deforming, that is calculated by dividing left ventricular (LV) stroke volume by LV myocardial volume.Aims:We verified the association of this new marker with myocardial iron overload and cardiac events (heart failure, arrhythmias and pulmonary hypertension) in thalassemia major (TM) patients.Methods:We considered 1492 TM patients (771 females, 31.06 ± 8.95 yrs) enrolled in the MIOT network. Myocardial iron overload (MIO) was quantified by the multislice multiecho T2∗ technique and biventricular morphological and functional parameters by cine sequences.Results:MCF values were significantly lower in males (0.94 ± 0.22 vs 1.01 ± 0.22; P &lt; 0.0001) and decreased with increasing age (R = −0.129 P &lt; 0.0001).Patients with MIO (global heart T2∗ &lt; 20 ms; N = 400) showed significant lower MCF values than patients without MIO (0.91 ± 0.20 vs 1.00 ± 0.22; P &lt; 0.0001).The patient population was randomly divided in two groups of equal size (N = 746).In the first group 99 patients had at least one cardiac complication and at receiver‐operating characteristic (ROC) curve analysis a MCF ≤ 0.87 was the best predictor of cardiac complications (area under the curve 0.659, 95% CI 0.64 to 0.69; sensitivity 60%, specificity 67%).In order to validate the result, the obtained value was tested in the remaining 746 patients (group 2). One hundred and thirty‐five patients had a cardiac complication and patients with a MCF ≤ 0.87 were more likely to have cardiac complications (odds ratio – OR = 2.73, 95%CI = 1.86‐4.01; P &lt; 0.0001), also adjusting for cardiac iron (see Figure).Summary/Conclusion:Contractile function is reduced in patients with MIO. A MCF ≤0.87 can help to identify patients with a significant higher risk of adverse cardiovascular events, independently by the presence of MIO.image

Preoperative and Postoperative N-terminal Pro B-type Natriuretic Peptide Levels Predict Cardiac Morbidity and Mortality in Patients Undergoing Colorectal Cancer Resection

Introduction: Cardiac complications are a major cause of perioperative morbidity and mortality in patients undergoing colorectal cancer surgery. A quick and reliable system for predicting postoperative cardiac morbidity is needed to predict cardiac events in order to improve outcome in surgery. The aim of this study was to investigate the role of the biochemical marker NT-proBNP in the prediction of postoperative all-cause mortality, cardiac-related mortality and cardiovascular events in patients undergoing colorectal cancer resections. Methods: 100 consecutive patients undergoing colorectal cancer surgery were prospectively recruited. Blood samples were taken preoperatively, 24h, 48h and 5-7 postoperative days to measure NT-proBNP levels. The predictive power of NT-proBNP levels was assessed using Receiver Operating Characteristics (ROC) curves. Results: Cardiac-related morbidity and mortality was 9%. Of eleven deaths, 5 were cardiac-related. Preoperative NT-proBNP was a good predictor of death with ROC area under curve (AUC) of 0.83 (95% C.I. 0.673, 0.993) a strong predictor of cardiac death with AUC of 0.914 (95% C.I. 0.823, 1.000) and a good predictor of cardiac complications with AUC of 0.875 (95% C.I. 0.757, 0.993). NT-proBNP levels 24 hours and 48 hours postoperatively were also strongly predictive of postoperative cardiac morbidity and mortality. Conclusion: Pre- and postoperative NT-proBNP have a role in predicting postoperative death and cardiac complications. This may have significant implications in the planning of postoperative care for high-risk patients.

Маркеры системного воспаления как предикторы кардиологических осложнений у пациентов с коморбидным течением хронической обструктивной болезни легких и ишемической болезни сердца

Маркеры системного воспаления как предикторы кардиологических осложнений у пациентов с коморбидным течением хронической обструктивной болезни легких и ишемической болезни сердца

Cardiovascular complications in head & neck microvascular flap reconstruction: A retrospective risk stratification and outcomes assessment

BackgroundTo determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction. MethodsA series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes. ResultsTwenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia. Multivariate analyses showed that RCRI (p < 0.001) and amount of blood transfused (p = 0.02) were independent predictors of CC. ConclusionsCardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.

P6224Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

P6224Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

Abstract 67: Blood Biomarkers for Prediction of Cardiac Complications in the Stroke Unit

Introduction: Cardiac complications such as acute coronary syndrome (ACS) or acute congestive heart failure (ACHF) account for 2-6%of mortality after stroke. Early detection of the patients at the highest risk to suffer from cardiac complications could be of interest to indicate a closer monitoring or therapeutic measures. We aimed to test whether a panel of blood biomarkers could predict the development of cardiac complications during stroke unit admission. Methods: The StrokeChip was a prospective, observational study, conducted at six Hospitals in Catalonia. Patients with suspected stroke were enrolled at Emergency Departments. Blood samples were obtained within the first six hours after symptom onset to measure a 21-biomarker panel. In-hospital development of cardiac complications (ACS and ACHF) was recorded. The association between the measured biomarkers and the development of complications was assessed by logistic regression analysis. Results: From August-2012 to December-2013, 941 out of 1308 patients enrolled were ischemic strokes. Cardiac complications were developed by 25 patients, including 19 ACHF and six cases of ACS. Due to the small number of ACS, just ACHF were further analyzed. Patients with ACHF had higher baseline levels of D-dimer, endostatin, VAP-1, NT-proBNP, FasL and vWF, and lower levels of IGFBP-3. After logistic regression analysis, NT-proBNP [OR=3.56(1.17-10.84)], FasL [OR=4.94(1.60-15.26)], VAP-1 [OR=6.56(2.21-19.46)] and IGFBP-3 [OR=0.21(0.07-0.67)] were independently associated with ACHF after adjustment by clinical predictors such as stroke severity, previous disability or history of coronary disease. Addition of the biomarker panel over clinical predictors resulted in improved accuracy (AUC from 0.808 to 0.925, p=0.05). Conclusions: Baseline measurement of blood biomarkers in acute stroke could be useful to predict the development of cardiac complications during stroke unit admission.

Abstract PR046

Background & Objectives: Currently, the most commonly used model to predict cardiac risk before non-cardiac or vascular surgery is the Revised Cardiac Risk Index (RCRI), but some studies have pointed out that the Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) is a better predictor of cardiac complications. The objective of this study was to assess which index indicates intraoperative hemodynamics instability (IHI) and a higher incidence of following comorbidities (FC). Materials & Methods: The medical records of 101 patients, underwent carotid endarterectomy under cervical plexus block during a 3 month period at our institution, were retrospectively reviewed. RCRI and VSG-CRI were used to classify patients into 3 groups: low (I), medium (II) and high risk group (III). IHI was defined as an increase/decrease in systolic and diastolic blood pressure or heart rate for ≥20% from basal value, for 2 minutes. The incidence of FC such as insulin-dependent diabetes mellitus (IDDM), chronic heart failure (CHF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), old age and smoking, were compared among groups. Results: According to RCRI, group I consisted of 26 patients (25.74%), group II of 68 (67.33%) and group III of 7 (6.93%). On the other hand, according to VSG-CRI, group I consisted of 52 patients (51.49%), group II of 35 (36.63%) and group III of 12 (11.88%). No statistically significant differences in blood pressure alterations (systolic and diastolic) and heart rate were noted among groups classified by the RCRI and VSG-CRI. The incidence of IDDM, CHF and CAD were significantly higher in III group compared to the other two groups classified by RCRI (p=0.004, p=0.005, p=0.0001, respectively). In line with VSG-CRI, age and the incidence of CHF and CAD were significantly higher in group III compared to the other two groups (p<0,0001, p<0.0001). The incidence of COPD and smoking were statistically higher in the medium group compared to the other two groups, in accordance to VSG-CRI as well (p=0,008, p=0.03). Conclusion: VSG-CRI showed greater representation of the incidences of FC in high (3 FC) and medium risk group (2 FC), compared to RCRI which showed the presence of the only 3 FC in high risk group. Follow-up is necessary to confirm better predictive value of VSG-CRI.

Abstract 18427: Low Left Ventricular Ejection Fraction and β-blocker Use Before Admission is Associated With In-hospital Cardiac Complications in Patients With Takotsubo Cardiomyopathy

Introduction: The prognosis of patients with takotsubo cardiomyopathy (TC) is thought to be relatively favorable. However, serious cardiac complications during hospitalization occur in some patients. There is little information about risk factors associated with in-hospital cardiac complications in patients with TC. Hypothesis: We assessed the hypothesis that severe left ventricular (LV) dysfunction is associated with in-hospital cardiac complications in patients with TC. Methods: A total of 154 consecutive patients with TC based on Mayo criteria were enrolled. Coronary angiography and left ventriculography were performed in all patients and absence of obstructive coronary disease explaining the left ventricular contraction abnormality was confirmed. In-hospital cardiac complications were defined as cardiogenic shock, pulmonary edema, sustained ventricular tachycardia or ventricular fibrillation, complete atrioventricular block, thromboembolism, cardiac rupture, and cardiac death. Multivariate logistic regression analysis was performed to predict in-hospital cardiac complications. Results: In-hospital cardiac complications were observed in 61 patients (40%). There were 25 patients with cardiogenic shock (16%) and 44 patients with pulmonary edema (29%). Sustained ventricular tachycardia or ventricular fibrillation, complete atrioventricular block, and thromboembolism were noted in 10 (7%), 4 (3%) and 4 patients (3%), respectively. Four cardiac deaths (3%) were observed. Of these, one patient died of cardiac rupture. Multivariate logistic regression analysis identified systolic blood pressure (odds ratio=0.97, 95% CI=0.95-0.98, p &lt;0.01), LV ejection fraction (odds ratio=0.95, 95% CI=0.91-0.98, p &lt;0.01), and β-blocker use before admission (odds ratio=8.72, 95%CI=1.00-194.2, p =0.049) as independent predictors of cardiac complications during hospitalization. Conclusion: Low systolic blood pressure and low LV ejection fraction are independent predictors of in-hospital cardiac complications in patients with TC. Furthermore, β-blocker use before admission is associated with worse outcomes during hospitalization.

The Clinical Significance Of Diastolic Dysfunction On The Outcome After Allogeneic Hematopoietic Stem Cell Transplantation

Introduction Cardiac diastolic dysfunction plays a crucial role in the development of heart failure. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e') reflects left ventricular end-diastolic pressure and is used in the diagnosis of diastolic heart failure. Although cardiac complication is one of the most serious problems in hematopoietic stem cell transplantation (HSCT), the impact of diastolic dysfunction on clinical outcomes after allogeneic HSCT is unclear. Thus, we investigated the effects of diastolic dysfunction on HSCT using E/e'. Patients and Methods We retrospectively reviewed the records of 102 evaluable patients who underwent their first allogeneic HSCT at our hospital between November 2010 and July 2012, and investigated whether elevated E/e' would affect the clinical outcomes such as incidence of cardiac complications, overall survival (OS) and non-relapse mortality (NRM). Patients were classified into high- E/e' group if E/e' was ≥9 and classified into low- E/e' group if E/e' was &lt;9. In multivariable analysis, the hazard ratio of E/e' was adjusted for variables with a P -value ≤ 0.2 in a univariable analysis, with stepwise deletions. Results This study analyzed 58 males and 44 females with a median age of 47 years (range: 15-71). Forty one patients were classified into the high- E/e' group and 61 classified into the low- E/e' group. High- E/e' patients were older than low- E/e' patients (median: 57 years in E/e'-high vs. 41 years in E/e'-low, P=0.027). Reduced intensity regimen was more frequent in the high- E/e' group (39% vs. 16%, P=0.019) and there were also more men in the high- E/e' group compared with patients in the low- E/e' group (68% vs. 49%, P=0.07). Twelve patients developed cardiac complications during the first 100 days after HSCT (Day100) and its cumulative incidence was11.9%. Of them, 6 patients developed heart failure, 5 developed arrhythmia, and 1 developed both myocardial ischemia and heart failure. The cumulative incidence of cardiac complications at Day 100 was significantly higher in the high- E/e' group (22.4%) than that in the low- E/e' group (22.4% vs. 5%, P=0.0087, Figure 1a). Non-relapse death occurred in 17 patients within 1 year after HSCT. Nine patients died of infection, 3 died of hemorrhage, 2 died of graft-versus-host disease, 1 died of heart failure, 1 died of thrombotic microangiopathy, and 1 died of veno-occlusive disease/sinusoidal obstruction disease. NRM was higher in the high- E/e' group than in the low- E/e' group (28.8% vs. 10.5% at 1year, P=0.0165, Figure 1b). A multivariate analysis revealed that high- E/e' and high disease status were significant risk factors for high NRM (other co-variates were HLA compatibility and HCT-CI). Conversely, the relapse rate did not significantly differ in both groups (23% in the high- E/e' vs. 17% in the low- E/e' at 1 year, P=0.44). The OS was significantly poorer in the high- E/e' group than in the low- E/e' group (55.2% vs. 75.6% at 1 year, P=0.0085, Figure 1c). On multivariate analysis, E/e', disease status, and donor source were defined as independent prognostic factors for OS (other co-variates were HLA compatibility, preparative regimens, disease status, and QTc). Conclusions Diastolic dysfunction is associated with iron overload, anemia, diabetes, kidney disease, heart failure, cardiomyopathy, aging, and hypertension. Thus, pre-transplat E/e' value might reflect the potential risk of these diseases in transplant candidates and be associated with poor outcomes. Our results suggest that pre-transplant E/e' value would be an early predictor of cardiac complications and survival after HSCT. Disclosures: No relevant conflicts of interest to declare.