Predictor Of Cardiovascular Mortality Research Articles

Cardiovascular mortality in patients with advanced chronic kidney disease with and without diabetes: a nationwide cohort study

BackgroundCardiovascular mortality and the impact of cardiac risk factors in advanced chronic kidney disease (CKD) remain poorly investigated. We examined the risk of cardiovascular mortality in patients with advanced CKD with and without diabetes as well as the impact of albuminuria, plasma hemoglobin, and plasma low-density lipoprotein (LDL) cholesterol levels.MethodsIn a Danish nationwide registry-based cohort study, we identified persons aged ≥ 18 years with an estimated glomerular filtration rate < 30 mL/min/1.73m2 between 2002 and 2018. Patients with advanced CKD were age- and sex-matched with four individuals from the general Danish population. Cause-specific Cox regression models were used to estimate the 1-year risk of cardiovascular mortality standardized to the distribution of risk factors in the cohort.ResultsWe included 138,583 patients with advanced CKD of whom 32,698 had diabetes. The standardized 1-year risk of cardiovascular mortality was 9.8% (95% CI 9.6–10.0) and 7.4% (95% CI 7.3–7.5) for patients with and without diabetes, respectively, versus 3.1% (95% CI 3.1–3.1) in the matched cohort. 1-year cardiovascular mortality risks were 1.1- to 2.8-fold higher for patients with diabetes compared with those without diabetes across the range of advanced CKD stages and age groups. Albuminuria and anemia were associated with increased cardiovascular mortality risk regardless of diabetes status. LDL-cholesterol was inversely associated with cardiovascular mortality risk in patients without diabetes, while there was no clear association in patients with diabetes.ConclusionsDiabetes, albuminuria, and anemia remained important risk factors of cardiovascular mortality whereas our data suggest a limitation of LDL-cholesterol as a predictor of cardiovascular mortality in advanced CKD.

Chronic Electronic Cigarette Users Exhibit Reduced Cardiorespiratory Fitness and Associated Increased Cardiovascular Disease Risk

BACKGROUND: Electronic cigarettes (e-cigs) are popular tobacco products that are currently advertised as a safer alternative to traditional cigarettes. Preliminary data, primarily from animal studies, suggests that e-cigs are associated with an increased cardiovascular disease (CVD) risk. Cardiorespiratory fitness is a marker of cardiovascular (CV) health and a predictor of CV mortality, which is diminished in traditional tobacco users. However, the effect of chronic e-cigs usage on cardiorespiratory fitness and associated CVD risk in otherwise healthy individuals without established CVD or CVD risk factor, is currently unknown. PURPOSE: The purpose of this study was to investigate the impact of chronic e-cig use on cardiorespiratory fitness and CVD risk in healthy young adults. METHODS: Ten chronic e-cig users (ECU, 4 males and 6 females; age: 24±3 yr; e-cigs usage 3±1.5 yr.) and ten demographical matched, never users (NU, 4 males and 6 females; age: 22.7±2 yr.) participated in this study. Cardiorespiratory fitness was measured by peak oxygen consumption (VO2peak) via a respiratory gas exchange analyzer during a cardiopulmonary exercise test. CVD risk was calculated using Framingham’s 30-year CVD risk score accounting for 8 risk factors (age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein, presence of diabetes mellitus, hypertension treatment, and smoking status). RESULTS: Chronic e-cig users exhibited significantly lower VO2peak (ECU vs. NU; 30.9±4.9 vs. 37.8±6.4 ml/kg/min; p=0.015) and percent predicted (ECU vs. NU; 85.9±16 vs. 105.4±14 % predicted; p=0.001) when compared to never users. Framingham’s 30-year CVD risk score was significantly higher in ECU than in NU (7.7± 4.8, vs. 2.7±0.8 %; p=0.017). Furthermore, an inverse association was identified between VO2peak and 30-year CVD risk ( r=-0.720; p= 0.030). CONCLUSIONS: For the first time, we have identified significantly reduced cardiorespiratory fitness, a marker of CV health and mortality risk, in chronic e-cig users when compared to never users. In addition, chronic e-cig users exhibit higher CVD risk scores. Results from our study imply a negative effect of chronic e-cig use on CV health in otherwise young, apparently healthy adults. Future studies are warranted to investigate the long-term effects of e-cig use on CV health. Supported in part by a Rapid Response Project NIDA/FDA (PRM). Supported in part by a Rapid Response Project NIDA/FDA (PRM). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Longer leukocyte telomere length increases cardiovascular mortality in type 2 diabetes patients.

Leukocyte telomere length (LTL), as a biomarker of biological aging, is associated with the prevalence and complications of diabetes. This study aims to investigate the associations between LTL and all-cause and cause-specific mortality in patients with type 2 diabetes. All participants with baseline LTL records were included from the National Health and Nutrition Examination Survey 1999-2002. Death status and its causes were ascertained for National Death Index based on International Classification of Diseases, Tenth Revision code. Cox proportional hazards regression models were established to estimate the hazard ratios (HRs) of LTL associating with all-cause and cause-specific mortality. The study enrolled 804 diabetic patients with the mean follow-up of 14.9 ± 2.59 years. There were 367 (45.6%) all-cause deaths, 80 (10.0%) cardiovascular deaths, and 42 (5.2%) cancer-related deaths. Longer LTL was associated with reduced all-cause mortality, whereas this association disappeared after adjusting for other variables. Compared with the lowest tertiles of LTL, the multivariable-adjusted hazard ratio of cardiovascular mortality was 2.11 (95% confidence interval [CI] 1.31-3.39; p < .05) in the highest tertiles. In terms of cancer mortality, the highest tertile was negatively correlated with the risk of cancer mortality (HR 0.58 [95% CI 0.37, 0.91], p < .05). In conclusion, LTL was independently associated with the risk of cardiovascular mortality in patients with type 2 diabetes and was negatively correlated with the risk of cancer mortality. Telomere length may be a predictor of cardiovascular mortality in diabetes.

The effect of postoperative hepatic fibrosis factors on morbidity in mitral valve replacement surgery: A single center ten years' experience.

Previous studies have shown that hepatic fibrosis indices and rates can be used to predict cardiovascular mortality and morbidity. Our aim with this study was to investigate the effect of aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and fibrosis-4 (FIB-4) index calculated with ALT, AST, and platelet biomarkers, which are simple, fast, and relatively inexpensive and were used in previous studies to predict cardiovascular disease prognosis, on the prediction of postoperative morbidity and early mortality after mitral valve replacement (MVR) surgery. By scanning the hospital electronic health record system, 116 patients who underwent isolated MVR or MVR + tricuspid valve intervention were identified from 178 patients who underwent MVR with the standard sternotomy procedure between 2011 and 2021. The study was completed with 81 of these patients. Patients were divided into AST/ALT <2 (Group 1) and >2 (Group 2). In addition, the same patients were divided into FIB-4 index <3.25 (Group 3) and >3.25 (Group 4), and a total of four groups were formed. The mean age of Group 2 was significantly higher than Group 1 (P = 0.049). In addition, the mean age of Group 4 was significantly higher than Group 3 (P = 0.003). Postoperative complications did not differ between Groups 1 and 2 (P > 0.05). While noninvasive mechanincal ventilation (NIMV) requirements did not differ between Groups 3 and 4 (P > 0.05), MV duration and intensive care unit stay were significantly longer in Group 4 (P < 0.05). The AST/ALT ratio, which has been shown to be a predictor of cardiovascular mortality in various studies, was not useful in predicting mortality and morbidity in our study. However, a high FIB-4 index, another hepatic fibrosis index, was found to be associated with increased perioperative bleeding, duration of mechanical ventilation, and cardiac intensive care unit stay, which are important criteria in the prediction of morbidity in cardiovascular surgery.

Pre-diagnostic predictors of mortality in patients with heart failure: The multi-ethnic study of atherosclerosis.

There are multiple predictive factors for cardiovascular (CV) mortality measured at, or after heart failure (HF) diagnosis. However, the predictive role of long-term exposure to these predictors prior to HF diagnosis is unknown. We aim to identify predictive factors of CV mortality in participants with HF, using cumulative exposure to risk factors before HF development. Participants of Multi-Ethnic Study of Atherosclerosis (MESA) with incident HF were included. We used stepwise Akaike Information Criterion to select CV mortality predictors among clinical, biochemical, and imaging markers collected prior to HF. Using the AUC of B-spline-corrected curves, we estimated cumulative exposure to predictive factors from baseline to the last exam before HF. The prognostic performance for CV mortality after HF was evaluated using competing risk regression with non-CV mortality as the competing risk. Overall, 375 participants had new HF events (42.9% female, mean age: 74). Over an average follow-up of 4.7 years, there was no difference in the hazard of CV death for HF with reduced versus preserved ejection fraction (HR = 1.27, p = 0.23). The selected predictors of CV mortality in models with the least prediction error were age, cardiac arrest, myocardial infarction, and diabetes, QRS duration, HDL, cumulative exposure to total cholesterol and glucose, NT-proBNP, left ventricular mass, and statin use. The AUC of the models were 0.72 when including the latest exposure to predictive factors and 0.79 when including cumulative prior exposure to predictive factors (p = 0.20). In HF patients, besides age and diagnosed diabetes or CVD, prior lipid profile, NT-proBNP, LV mass, and QRS duration available at the diagnosis time strongly predict CV mortality. Implementing cumulative exposure to cholesterol and glucose, instead of latest measures, improves predictive accuracy for HF mortality, though not reaching statistical significance.

Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology.

Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial volumes using manual and semiautomated segmentation with contemporaneous transthoracic echocardiography (TTE) to confirm normal diastology. Thirty-five consecutive cases in sinus rhythm with no history of cardio-vascular, renal, or pulmonary disease and normal diastolic function were selected. Planimetric CTPA measurements were compared to TTE volumes measured using area length method. TTE and CTPA derived normal LAVi and RAVi were 27 + 5 and 20 + 6 mL/m2, and 30 + 8 and 29 + 9 mL/m2, respectively. Bland-Altman analysis revealed an underestimation of biatrial volumes by TTE. TTE-CT mean biases for LAV and RAV were -5.7 + 12.0 mL and -16.2 + 14.8 mL, respectively. The CT intraclass correlation coefficients (ICC 95% CI) for LA and RA volumes were 0.99 (0.96-1.00) and 0.96 (0.76-0.99), respectively. There was excellent correlation (p &lt; 0.001) between the semiautomated and manual measurements for LA (r 0.99, 95% CI 0.98-0.99) and RA (r 0.99, 95% CI 0.99-1.00). Atrial volumetric assessment on CTPA is easy and reproducible and can provide additional metric in cardiopulmonary assessment.

Cardiovascular mortality risk prediction using objectively measured physical activity phenotypes in NHANES 2003–2006

Increased physical activity (PA) has been associated with a decreased risk of cardiovascular disease (CVD) and mortality. However, most previous studies use self-reported PA instead of objectively measured PA assessed by wearable accelerometers. To the best of our knowledge, there have not been studies that quantified the univariate and multivariate ability of objectively measured PA summaries to predict the risk of CVD mortality. We investigate the ability of objectively measured PA summary variables to predict CVD mortality: as individual predictors, as part of the best multivariate model incorporating traditional predictors, and as additions to the best multivariate model using only traditional CVD predictors. Data were collected in the National Health and Nutrition Examination Survey 2003–2006 waves for US participants aged 50–85. The predictive ability was measured using Concordance, sometimes referred to as the C-statistic. Specifically, we calculated 10-fold cross-validated concordance (CVC) in survey-weighted Cox proportional hazard models. The best univariate predictor of CVD mortality was total activity count (outperformed age). In multivariate models, two of the eight predictors identified using the improvement in CVC threshold of 0.001 were PA measures (CVC = 0.844). The best model without physical activity (7 predictors) had CVC of 0.830. The addition of PA measures to the best traditional model was significantly better at predicting CVD mortality (P < 0.001). Accelerometer-derived PA measures have excellent cardiovascular mortality prediction performance. Wearable accelerometers have a potential for assessment of individuals' CVD mortality risks.

Comparison of machine learning methods for the prediction of cardiovascular mortality from environmental and socio-economic neighbourhood factors

Comparison of machine learning methods for the prediction of cardiovascular mortality from environmental and socio-economic neighbourhood factors

Elevated Cardiac Troponin I following Asymptomatic Intradialytic Hypotension: A Pilot Study with a 2-Year Follow-Up.

Background Intradialytic hypotension (IDH) has been recognized as a serious and frequent complication during hemodialysis (HD) of end-stage renal disease (ESRD) patients, but the effect of asymptomatic IDH on cardiac troponin I (cTnI) levels is not definitively elucidated. Methods 70 asymptomatic HD patients with negative predialysis cTnI were included. They were on maintenance HD thrice weekly. All patients were monitored during the HD session for hemodynamic changes and symptoms related to IDH. Patients were followed for two years, and their outcomes are noted as an acute coronary syndrome (ACS), cardiac death, no ACS, noncardiac death, and kidney transplant. Results Compared with the baseline blood pressure values, there was a drop in systolic blood pressure for all subjects, but according to the 2007 European Best Practice Guidelines on hemodynamic instability, asymptomatic IDH was defined in 27 (38.6%) patients. The results demonstrated a significant correlation (r = 0.492) (p < 0.05) between asymptomatic IDH and elevated postdialysis levels of cTnI. In 2-year follow-up of patients, ACS and cardiac death happened more in patients with elevated cTnI. Conclusion The results of our study suggest that asymptomatic IDH affects cTnI levels. Given that cTnI is a marker of myocardial damage and a predictor of cardiovascular mortality in ESRD patients, these findings recommend that considering the asymptomatic decrease in blood pressure levels during HD is very important and critical.

Fasting Substrate Concentrations Predict Cardiovascular Outcomes in the CANagliflozin cardioVascular Assessment Study (CANVAS).

To examine whether the circulating substrate mix may be related to the incidence of heart failure (HF) and cardiovascular (CV) mortality and how it is altered by canagliflozin treatment. We measured fasting glucose, free fatty acids (FFA), glycerol, β-hydroxybutyrate, acetoacetate, lactate, and pyruvate concentrations in 3,581 samples from the CANagliflozin cardioVascular Assessment Study (CANVAS) trial at baseline and at 1 and 2 years after randomization. Results were analyzed by univariate and multivariate Cox proportional hazards models. Patients in the lowest baseline FFA tertile were more often men with a longer duration of type 2 diabetes (T2D), higher urinary albumin excretion, lower HDL-cholesterol levels, higher history of CV disease (CVD), and higher use of statins and insulin. When all seven metabolites were used as predictors, FFA were inversely associated with incident hospitalized HF (hazard ratio [HR] 0.33 [95% CI 0.21-0.55]), while glycerol was a positive predictor (2.21 [1.45-3.35]). In a model further adjusted for 16 potential confounders, including prior HF and CVD and pharmacologic therapies, FFA remained a significant negative predictor. FFA and glycerol also predicted CV mortality (HR 0.53 [95% CI 0.35-0.81] and 1.81 [1.26-2.58], respectively) and all-cause death (0.50 [0.36-0.70] and 1.64 [1.22-2.18]). When added to these models, background insulin therapy was an independent positive predictor of risk of death. Canagliflozin treatment significantly increased plasma FFA and β-hydroxybutyrate regardless of background antihyperglycemic therapy. A constitutive metabolic setup consisting of higher lipolysis may be beneficial in delaying or preventing hospitalized HF; a further stimulation of lipolysis by canagliflozin may reinforce this influence.

Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation.

BackgroundThe HFA-PEFF score may help in predicting long-term outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis and preserved left ventricular ejection fraction (EF).MethodsWe retrieved data from 1,332 patients undergoing TAVI between 2010 and 2019 from the Prospective Segeberg TAVI Registry (ClinicalTrials.gov Identifier: NCT03192774). We calculated the HFA-PEFF score for 1,022 patients who had preserved EF (≥50%). To assess the prognostic value of the HFA-PEFF score in predicting adverse events, we dichotomised the patients according to a cut-off score of five (score <5 group: n=528 (51.6%), score ≥5 group: n=494 (48.3%)).ResultsThe HFA-PEFF score ≥5 groups were older (81.9±6.3 years vs. 80.3±6.9 years; p<0.001) and had a higher prevalence of atrial fibrillation (35.1% vs 20.8%; p<0.001) and chronic kidney disease (30.1% vs 26.1%; p<0.001). Kaplan-Meier survival analyses over 24 months showed increased cardiovascular (CV) mortality (12.5% vs. 7.7%, log-rank; p=0.028) and first heart failure-related rehospitalisation (7.7% vs. 4.0%, log-rank p=0.014) in the HFA-PEFF score ≥5 groups compared with those of lower scores. No significant difference in all-cause mortality between both groups was observed (22.0% vs. 17.9%, log-rank p=0.127). In multivariate analysis, HFA-PEFF score ≥5 failed to predict CV mortality (aHR 1.37, 95% CI: 0.90-2.08, p=0.140) and time to first heart failure-related rehospitalisation (aHR 1.49, 95% CI: 0.83-2.65, p=0.181).ConclusionThe HFA-PEFF score showed limited value in predicting long-term mortality and adverse heart failure-related events in patients with preserved EF undergoing TAVI. Clinical variables specific to this population could complement the HFA-PEFF score for better risk prediction.

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Introduction and objectives: Chronic total coronary occlusion (CTO) is often a complex entity to deal with through a percutaneous coronary intervention, and the clinical benefits of successful recanalization still remain uncertain. Most registries feature data in limited time periods and do not reflect the impact that specific dedicated programs have on recanalization. Our study evaluates the results of a CTO program on a long-term period of time. Methods: All patients’ CTOs treated with percutaneous coronary interventions at our center from 2002 through 2017 were prospectively included in the registry. The clinical, angiographic and procedural data were collected, and clinical follow-up was conducted. Three consecutive periods of time were considered for the analysis of temporal trends. Results: A total of 424 CTOs (408 patients) were included. In 339 patients (80%) the procedure was successful. The rate of success increased over time, from 57% in 2002-2006 to 87% in 2012-2017 (P = .001). The most important independent predictor of procedural failure was lesion tortuosity. After a median follow-up of 39.7 months, the rates of major adverse cardiovascular events and cardiovascular mortality in success vs failed groups were 13.9% vs 24.7% (P = .015) and 3.6% vs 14.1% (P = .001), respectively. These were the independent predictors of cardiovascular mortality: chronic kidney disease, left anterior descending artery occlusion, and procedural failure. Conclusions: Our series shows a high rate of success in CTO recanalization, which has increased over the last few years due to greater expertise and improved program-specific technical advances. Several angiographic and procedural variables have been identified as predictors of failure. Successful procedures, especially on the left anterior descendent coronary artery, were associated with lower rates of cardiovascular mortality.

Тhe link of T(–786)C аnd G894T polymorphisms of the endothelial NO-synthase gene with endothelial vasodilatory function and long-term clinical prognosis in patients with chronic heart failure and reduced left ventricular ejection fraction

The aim – сhronic heart failure (CHF) is associated with endothelial dysfunction. The pivotal role of nitric oxide in the maintenance of endothelial function (EF) is well-known. But it is unknown whether endothelial nitric oxide synthase (eNOS) gene polymorphismis associated with both EF and clinical outcomes in systolic CHF.Materials and methods. 116 stable (NYHA II–III) ischemic CHF patients with left ventricular ejection fraction (LVEF) ≤ 45 % were examined. Flow-mediated vasodilation (FMVD) of a. brachialis was carried out by standard cuff test. Patients were followed-up for a median of twenty months to determine long-term outcomes. The frequency of T(–786)C genotypes was: TT – 40.5 % (n=47), TC – 43.1 % (n=50), CC – 16.4 % (n=19); the frequency of G894T genotypes was: GG 56.0 % (n=65), GT 33.6 % (n=39), ТТ 10.4 % (n=12). Results and discussion. FMVD in patients with TT genotype of T(–786)C polymorphisms was 7.2 [4.7; 8.3] %, in patients with TC – 6.6 [4.4; 9.1] %, where as FMVD in patients with genotype CC was 4.7 [2.8; 6.0] %, p=0.034 for TT vs. CC; p=0.046 for TC vs. CC. FMVD in patients with GG genotype of G894T polymorphisms was 7.1 [4.3; 9.4] %, in patients with GT – 6.2 [5.1; 8.1] %, in patients with genotype TT was 4.2 [2.5; 5.3] %. The difference between FMVD was significant only TT vs. CC – p=0.030. The patients with CC genotype demonstrated a significantly higher heart failure hospitalization rate (log-rank 5.304, p=0.021) and higher cardiovascular (CV) mortality rate (log-rank 4.011, p=0.045) as compared with the TT homozygote group. LVEF, FMVD, and CC genotype were the predictors of CV mortality in univariate Cox regression analysis, and only LVEF and FMVD in multivariate Cox model. Long-term outcomes were similar in patients with GG, GT and TT genotypes of G894T polymorphisms.Conclusion. In stable ischemic systolic CHF CC T(–786)C eNOS genotype is associated with worse FMVD response and worse long-term outcome versus TT T(–786)C eNOS genotype. TT G(984)T eNOS genotype is associated with worse FMVD response only, but not with long-term outcomes versus GG G(894)T eNOS genotype.

Delta Increment in Pacing QRS Duration Predicts Cardiovascular Mortality in Patients with Pre-Existing Bundle Branch Block Receiving Permanent Pacemakers.

The clinical implication of pre-existing intraventricular conduction disturbance (IVCD) in permanent pacemaker (PPM) recipients is unknown. To explore the clinical outcomes in patients with pre-existing IVCD after implantation of PPMs. A total of 1424 patients who received PPMs were categorized into three groups by pre-procedural electrocardiography: patients without IVCD (n = 1045), patients with right bundle branch block (RBBB) (n = 309), and patients with left bundle branch block (LBBB) (n = 70). The primary outcome was cardiovascular (CV) mortality. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off values of variable in predicting CV mortality. During follow-up, there was no significant difference in CV mortality between patients with and without IVCD. In multivariate analysis, independent predictors of CV mortality were age [hazard ratio (HR): 1.03; 95% confidence interval (95% CI): 1.00-1.05; p = 0.026], history of heart failure [HR: 1.98; 95% CI: 1.19-3.29; p = 0.009], chronic kidney disease [HR: 1.75; 95% CI: 1.11-2.74; p = 0.015] and increment in pacing QRS duration [HR: 1.01; 95% CI: 1.00-1.04; p = 0.038]. Delta increments in pacing QRS duration ≥ 43 msec [HR: 2.91; 95% CI: 1.23-6.83; p = 0.014] in patients with pre-existing RBBB, and ≥ 33 msec [HR: 11.44; 95% CI: 2.03-64.30; p = 0.006] in patients with pre-existing LBBB were independent determinants of CV mortality. There was no difference in CV mortality between patients with or without IVCD. However, wider pacing QRS duration increased the risk of CV mortality in PPM recipients, and delta increment in pacing QRS duration increased the risk of CV mortality in patients with pre-existing IVCD.

Prognostic significance of incidental suspected transthyretin amyloidosis on routine bone scintigraphy

BackgroundTransthyretin amyloidosis (ATTR) is an occasional incidental finding on bone scintigraphy. We studied its prognostic impact in elderly patients. MethodsThe study population consisted of 2000 patients aged over 70 years who underwent bone scintigraphies with clinical indications in three nuclear medicine departments (Kymenlaakso, Jorvi and Meilahti hospitals) in Finland. All studies were performed using 99mTechnetium labeled hydroxymethylene diphosphonate (HMDP). ATTR was suspected in patients with ≥grade 2 Perugini grade uptake (grade 0-3). Heart-to-contralateral ratio (H/CL) of ≥ 1.30 was considered positive for ATTR. The overall and cardiovascular mortality were obtained from the Finnish National Statistical Service. ResultsThere were a total of 1014 deaths (51%) and 177 cardiovascular deaths (9%) during median follow-up of 4 ± 2 years. ATTR was suspected in 69 patients (3.6%) of which 54 (2.7%) had grade 2 and 15 (.8%) had grade 3 uptake and in 47 patients (2.4%) by H/CL ratio. In multivariate analyses age, bone metastasis, H/CL ratio and grade 3 uptake were independent predictors of overall and cardiovascular mortality. Grade 2 uptake was a predictor of cardiovascular mortality. ConclusionsA suspected ATTR as an incidental finding on bone scintigraphy predicts elevated overall and cardiovascular mortality in elderly patients.

1097-P: Value of Blood Pressure Measurement Earlier vs. Later in Life to Predict Cardiovascular Mortality

We here aimed at comparing the value of systolic blood pressure (BP) earlier versus later in life to predict cardiovascular mortality. In a cardiovascular observation study (OS) we prospectively recorded fatal cardiovascular events over up to years in 1282 patients of whom 570 had the Metabolic Syndrome (MetS) at baseline. These patients had participated in a health survey (HS) 15 years prior to the OS baseline. BP was measured both at the HS and at the baseline of the OS. We found that the increase in cardiovascular mortality matched the increase of BP in the HS in a linear way but this is not the case for BP assessed at the OS (figure) . A cox regression analysis revealed that each millimeter of mercury (mm Hg) increased the risk for cardiovascular death by 2% (HR = 1.02 [1.01-1.03], p&amp;lt;0.001) . Applying a stratification for the presence of MetS, we found that in both groups BP was a significant predictor of cardiovascular mortality (HRMetS = 1.02 [1.01-1.02], p&amp;lt;0.0 and HRnoMetS = 1.02 [1.01-1.03], p&amp;lt;0.001) . In contrast, BP as measured at the baseline of the OS was not significantly associated with cardiovascular death during follow-up neither in the total population nor in any subgroup (HR = 1.00 [0.99-1.01], p=0.652; HRMetS = 1.00 [0.99-1.01], p=0.468 and HRnoMetS = 1.00 [0.99-1.01], p=4.66) . We thus conclude that BP assessed earlier in life is a better predictor of cardiovascular mortality than BP assessed later in life. Disclosure A.Leiherer: None. B.Larcher: None. W.Brozek: None. G.Nagel: None. E.Zitt: None. H.Concin: None. H.Drexel: None. H.Ulmer: None. A.Muendlein: None. C.H.Saely: None. P.Fraunberger: None. A.Mader: None. L.Sprenger: None. M.Maechler: None. A.Vonbank: None.

MO754: Impact of Calcium-to-Magnesium Ratio on Carotid Intima-Media Thickness—Cardiovascular Risk Assessment in Haemodialysis

Abstract BACKGROUND AND AIMS Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease patients. The interaction between calcium and magnesium has been associated with several pathophysiological processes that occur in the vessel wall, such as endothelial dysfunction and vascular calcification. The aim of this study was to assess the relationship between calcium-to-magnesium (Ca: Mg) ratio and carotid intima-media thickness (CIMT), a widely used risk marker for CVD in the assessment of subclinical atherosclerosis. This study also aimed to establish the role of the Ca: Mg ratio as a predictor of cardiovascular mortality in haemodialysis (HD). METHOD Prevalent HD patients were enrolled in the longitudinal prospective study in a single tertiary centre. According to CIMT measured through B-mode ultrasound, the patients were divided into two groups: ≥0.9 mm (G1) and &amp;lt;0.9 mm (G2). Data from both groups were compared by Student's t-test. Partial correlation was used to assess the relationship between the variables under analysis and the CIMT, when controlled by dialysis time. The prevalence ratio of predictors of carotid thickening was calculated using a Poisson model with robust variance. Multivariable Cox regression analysis was performed to determine the predictive factors of cardiovascular death. RESULTS A total of 120 patients on HD were included with mean age 66.5 ± 13.97 years, 66.7% male. Magnesium (P &amp;lt; 0.001), Ca: Mg ratio (P &amp;lt; 0.001) and Adragão score (P &amp;lt;0.001) were statistically different between the two groups (Table 1). The partial correlation showed a strong positive association between CIMT and Ca: Mg ratio (r = 0.873; P &amp;lt;0.001) and a moderate association between CIMT and Adragão score (r = 0.614, P &amp;lt; 0.001), whereas there was a moderate negative correlation between CIMT and magnesium (r = –0.671, P &amp;lt;0.001). The Poisson model showed high prevalence of carotid thickening for higher values ​​of Ca: Mg ratio [aPR = 1.055, 95% confidence interval (95% Cl) 1.007–2.176] and Adragão score (aPR = 1.106, 95% Cl 1.006–1.351), and for lower magnesium values ​​(aPR = 0.462, 95% CI 0.248–0.861). Using the multivariate Cox model, age (HR = 1.045, 95% CI 1.012–1.084), Adragão score (HR = 1.078, 95% CI 1.006–1.234) and Ca: Mg ratio (HR = 1.154, 95% CI 1.098–2.236) were predictors of cardiovascular mortality. CONCLUSION In our population, the Ca: Mg ratio was a predictor of carotid thickening, so its monitoring can be useful to identify patients at higher cardiovascular risk. The Ca: Mg ratio was further validated as a predictor of cardiovascular mortality in HD patients. More studies are needed to better understand the relationship between this ratio and cardiovascular events.

MO057: Serum Irisin and Prediction of Cardiovascular Events in Elderly Patients with CKD Stage 3–5

Abstract BACKGROUND AND AIMS Irisin is a circulating myokine released by skeletal muscle after exercise. Its production decreases in chronic kidney disease (CKD) as a potential consequence of sarcopenia and physical inactivity. Irisin produces beneficial effects in glucose and lipid homeostasis: it promotes glucose tolerance and lipid metabolism and improves insulin resistance, stimulates browning of white adipose tissue and upregulates thermogenesis. Irisin may also produce a protective effect on the cardiovascular system as it promoted the proliferation of cardiomyocytes and suppressed myocardial fibrosis and hypertrophy. Low serum irisin was proposed as a predictor of cardiovascular mortality. We studied the relationship of serum irisin with cardiovascular risk in a sample of patients at different stages of CKD not undergoing dialysis and characterized for their artery calcification and mineral metabolism variables. METHOD Seventy-nine consecutive patients with stage 3–5 CKD were recruited from the patients of the nephrology outpatient clinic of our institute in Milan from 2010 to 2014. Serum irisin levels were measured at baseline in all recruited patients and in 20 healthy controls. Incident cardiovascular events were recorded during a 3-year follow-up. They included myocardial infarction, angina pectoris, coronary revascularization, congestive heart failure, stroke, TIA and cardiovascular death. RESULTS Serum irisin was significantly higher in controls than that in patients with CKD and in patients with CKD stage 3 than that in patients at stage 4 and 5 taken together. Taking controls and patients with CKD together eGFR was positively correlated with serum irisin. Patients with CKD were grouped according to tertiles of serum irisin. Patients in the lowest tertile had lower serum 1,25(OH)2D levels than patients in the middle and the highest tertile. Patients in the highest tertile had lower Kauppila aortic calcification score than patients in the middle and the lowest tertiles. Twenty patients suffered from cardiovascular events during a 3-year follow-up. Cox regression analysis confirmed the association of serum irisin with incident cardiovascular events during the follow-up, as patients in the highest tertile of serum irisin showed a lower cardiovascular risk than patients in the middle or the lowest tertile. Kaplan–Meier survival analysis showed that patients in the highest serum irisin tertile developed less cardiovascular events during the follow-up than patients in the other tertiles taken together (P = 0.049). CONCLUSION The present study suggests that irisin is a marker of cardiovascular risk in patients with CKD. It might contribute to the cardiovascular protection that physical exercise and active lifestyle produce in patients with CKD.

Insulin-like growth factor-1 (IGF-1) as predictor of cardiovascular mortality in heart failure patients: data from the T.O.S.CA. registry

IntroductionData from the “Trattamento Ormonale nello Scompenso CArdiaco” (T.O.S.CA) registry showed that heart failure (HF) represents a complex clinical syndrome with different hormonal alterations. Renal failure represents a frequent complication in HF. We evaluated the relationship between renal function and insuline-like growth factor-1 (IGF-1) deficiency and its impact on cardiovascular mortality (CVM) in patients enrolled in the T.O.S.CA. registry.MethodsAt the enrolment, all subjects underwent chemistry examinations, including circulating hormones and cardiovascular functional tests. COX regression analysis was used to evaluate factors related to CVM during the follow-up period in all populations, in high-risk patients and in the young-adult population. Also, we evaluate the effects of renal function on the CVM.Results337 patients (41 deceased) were analyzed. CVM was related to severe renal dysfunction (HR stages IV–V = 4.86), high-risk conditions (HR 2.25), serum IGF-1 (HR 0.42), and HF etiology (HR 5.85 and HR 1.63 for valvular and ischemic etiology, respectively). In high-risk patients, CVM was related to IGF-1 levels, severe renal dysfunction and valvular etiology, whereas in young patients CMV was related to the high-risk pattern and serum IGF-1 levels.ConclusionsOur study showed the clinical and prognostic utility of the IGF-1 assay in patients with HF.

Value of FT3/FT4 Ratio in Prognosis of Patients With Heart Failure: A Propensity-Matched Study.

AimsAbnormal thyroid hormone secretions can alter the manifestation and prognosis of cardiovascular disease. To assess the effect of the free triiodothyronine (FT3)/free thyroxine (FT4) ratio on the prognosis of patients with heart failure (HF), we performed a propensity-matched study on patients with well-balanced baseline characteristics.MethodsOverall, 8,887 patients with HF were divided into two groups according to the FT3/FT4 ratio. Propensity scores were calculated from each patient. A cohort comprising 2,164 pairs with high or low ratios and with 34 well-balanced baseline characteristics was then assembled. The endpoints were Cardiovascular (CV) mortality and all-cause mortality. The correlation between FT3/FT4 ratio and prognosis was assessed using matched Cox regression analyses. The mean follow-up was 3.3 years.ResultsIn the full pre-match cohort, 3,710 (41.7%) patients died, with 2,581 (29.0%) cases of CV mortality. In the matched-pair cohort, all-cause mortality occurred in 923 (1,238/10,000 person-years of follow-up) patients with a high ratio and 1,036 (1,484/10,000 person-years) patients with a low ratio, resulting in a matched HR of 0.841 (95% CI: 0.769–0.919; P < 0.001). For CV mortality, the result was 638 (856/10,000 person-years) and 714 (1,023/10,000 person-years) patients, respectively, resulting in a matched HR of 0.844 (95% CI: 0.759–0.940; P < 0.001). Subgroup analysis revealed that a low FT3/FT4 ratio had a greater predictive value for all-cause and CV mortality in elderly or male patients and in patients with coronary artery disease (CAD), hypertension, diabetes mellitus, HFmrEF, or HFpEF.ConclusionsA low FT3/FT4 ratio is valuable for predicting CV mortality and all-cause mortality in patients with HF.