Predictor Of Favorable Prognosis Research Articles

Three‐Pronged Induction of Tumor Calcification Synergistic Calcium Immunotherapy Enables Diagnosis and Cure of Cancer

AbstractTumor calcification is considered to have the superiority of integrating tumor diagnosis and treatment, and it also has been found to be a predictor of favorable prognosis. However, selecting suitable nanocarriers and therapeutic drugs to maximize the tumor calcification efficiency are key factors for improving calcification‐medicated theranostics. This study performs a multi‐channel calcification nanoinitiator (CalNI, i.e., BP‐Cur‐Ca@PKLAK) by loading curcumin (Cur) and depositing Ca2+ on black phosphorus (BP) and combined carrying mitochondria‐targeting cytotoxic peptide KLAK to boost a triple‐induced tumor calcification. CalNI preferentially accumulates inside tumor mitochondria and induces multilevel calcification promotion by the three combined effects of (i) the degradation of BP into PO43− provides the phosphorus source required for calcification; (ii) burst of calcium ions can directly induce cellular calcium overload; (iii) Cur can inhibit calcium efflux thus further aggravate intracellular calcium stress. Moreover, KLAK exhibited enhanced mitochondrial synergistic toxic effects. Notably, the potential function of CalNI on the regulation of macrophage polarization could completely reverse the immunosuppressive microenvironment, and activate the initiation of T cell‐mediated immune response. Therefore, this three‐pronged CalNI showed a huge promise to be an alternative to conventional oncology therapy, which presents a more satisfactory therapeutic efficiency than any kind of single induction mode.

New insights into macrophage polarization and its prognostic role in patients with colorectal cancer liver metastasis

BackgroundAs liver metastasis is the most common cause of mortality in patients with colorectal cancer, studying colorectal cancer liver metastasis (CLM) microenvironment is essential for improved understanding of tumor biology and to identify novel therapeutic targets.MethodsWe used a multiplex immunofluorescence platform to study tumor associated macrophage (TAM) polarization and adaptive T cell subtypes in tumor samples from 105 CLM patients (49 without and 56 with preoperative chemotherapy).ResultsCLM exhibited M2 macrophage polarization, and helper T cells were the prevalent adaptive T cell subtype. The density of total, M2 and TGFβ-expressing macrophages, and regulatory T cells was lower in CLM treated with preoperative chemotherapy. CLM with right-sided primary demonstrated enrichment of TGFβ-expressing macrophages, and with left-sided primary had higher densities of helper and cytotoxic T cells. In multivariate analysis, high density of M2 macrophages correlated with longer recurrence-free survival (RFS) in the entire cohort [hazard ratio (HR) 0.425, 95% CI 0.219–0.825, p = 0.011) and in patients without preoperative chemotherapy (HR 0.45, 95% CI 0.221–0.932, p = 0.032). High pSMAD3-expressing macrophages were associated with shorter RFS in CLM after preoperative chemotherapy.ConclusionsOur results highlight the significance of a multi-marker approach to define the macrophage subtypes and identify M2 macrophages as a predictor of favorable prognosis in CLM.

Favorable Impact of Serum TERT C228T for Prognosis after Surgical Resection for Liver Cancer

Introduction: Personalized medicine and molecular therapies with the diagnosis of somatic genetic alterations are expected to be developed for liver cancer. Nevertheless, it is unknown whether a mutation in the telomere reverse transcriptase promoter (TERT C228T) in serum cfDNA might be useful for making prognostic predictions after surgical resection for primary liver cancer. Methods: This cohort study retrospectively investigated 111 patients who had undergone surgical resection of liver cancer for the first time. We investigated the differences between clinicopathological features and prognosis according to classification of three tumor markers, including AFP, PIVKAII, and TERT C228T. Results: Multivariate analysis identified etiology (fatty liver disease vs. HBV odds ratio [OR] 6.853) and fibrosis stage (2–4, OR: 0.137) as determinants of TERT C228T-positive liver cancer with normal levels of AFP and PIVKAII (TERT single positive liver cancer). TERT single positive (Yes, OR: 0.301), fibrosis (FIB)-4 index (≥3.25, OR: 2.038), Child-Pugh classification (B, OR: 4.975), and number of tumors (≥2, OR: 4.098) were identified as determinants of the recurrence of liver cancer. TERT single positive (Yes, OR: 3.311), FIB-4 index (≥3.25, OR: 0.433), and number of tumors (≥2, OR: 0.262) were identified as determinants of disease-free survival. Conclusions: Our results highlight the impact of classification of prognostic tumor markers. TERT single positive is one predictor of favorable prognosis after surgical resection for liver cancer.

Cardiac Magnetic Resonance-Detected Acute Myocardial Edema as Predictor of Favourable Prognosis: A Comprehensive Review.

Acute myocardial edema (AME) is increased water content in the myocardium and represents the first and transient pathophysiological response to an acute myocardial injury. In-vivo and non-invasive evaluation is feasible with cardiac magnetic resonance (CMR), which is a powerful imaging technique capable of tissue characterization. In the clinical setting, early demonstration of AME has a recognized diagnostic value for acute coronary syndromes and acute myocarditis, although its prognostic value is not well established. This article provides a comprehensive narrative review on the clinical meaning of AME in heart diseases. In particular, the available evidence of a possible favourable prognostic value in several clinical scenarios is addressed.

Preoperative low-density lipoprotein cholesterol as a predictor of favorable prognosis in patients with clear cell renal cell carcinoma.

Studies have shown that dyslipidemia is closely tied to a variety of cancers, and the level of low-density-lipoprotein-cholesterol (LDL-C) is related to the prognosis of cancer patients. However, what remains unclear is the predictive meaning of LDL-C among patients who suffer from renal cell carcinoma, especially clear cell renal cell carcinoma (CCRCC). The aim of this study was to investigate the correlation between the preoperative levels of serum LDL-C and the prognosis of surgical patients who suffer from clear cell renal cell carcinoma. A total of 308 CCRCC patients that received radical or partial nephrectomy were retrospectively included in this study. The clinical data of each included patient were collected. Overall survival (OS) and cancer-specific survival (CSS) were calculated using Kaplan-Meier method and Cox proportional hazards regression model. Univariate analysis showed that a higher LDL-C level indicated a better OS and CSS in CCRCC patients (P=0.002 and P=0.001, respectively). The same was shown in the Multivariate analysis that a higher LDL-C level indicated a better OS and CSS in CCRCC patients (P<0.001 and P<0.001, respectively). Following propensity score matching (PSM) analysis, a higher LDL-C level still existed as an ideal indicator for both OS and CSS. The study indicated that a higher serum level of LDL-C showed clinical significance for predicting better OS and CSS in patients with CCRCC.

High endothelial venules in intracranial germinomas: Implications for lymphocytes infiltration.

Reactive lymphocytes are substantial components of germinoma, which are believed to be related to the favorable prognosis of this intracranial tumor and better response to immunotherapy. However, the mechanisms managing the recruitment of lymphocytes are poorly understood. High endothelial venules (HEVs) are specialized blood vessels that play key roles in lymphocyte trafficking in Lymph nodes. These vessels are associated with lymphocyte infiltration in chronic inflammatory diseases and various malignant tumors, but their distribution and implications in germinoma are unknown. This study aimed to investigate the distribution and implications of HEVs in intracranial germinomas. We investigated the presence and distribution of HEVs in 42 germinomas by immunohistochemical staining of peripheral node addressin (PNAd) and transmission electron microscopic examination. The correlation of the densities of HEVs with the extent of T and B lymphocyte infiltration and several clinicopathological characteristics were also analyzed to determine whether HEVs are responsible for lymphocyte recruitment and their roles in anti-tumor immunity in germinoma. PNAd-positive HEVs were detected in 31% (13/42) of germinomas, and their presence correlated with abundant infiltrating CD3+ T cells, CD20 + B cells and CD8+ cytotoxic T lymphocytes (p = 0.0410, 0.0023, and 0.0061, respectively). Higher HEVs density was also correlated with several clinicopathological parameters, which are recognized indicators for favorable prognosis in germinomas, including typical tumor location (p = 0.0093), lower tumor cell content (p = 0.0428), and younger age at diagnosis (p = 0.0121). Furthermore, bioinformatics analysis showed HEVs-associated genes mainly enriched in immune-related Gene Ontology terms, including innate immune response, inflammatory response, and B cell receptor signaling pathway. The xCell analysis revealed that germinomas with higher HEVs enrichment scores had increased levels of the immune score, microenvironment score, dendritic cells, CD8+ central memory T-cells, CD4+ memory T-cells, and B-cells. Our findings indicate that HEVs could contribute to lymphocyte recruitment in germinomas, thus may serve as a predictor of favorable prognosis and better response to immunotherapy in this intracranial tumor.

Genetic prognostic factors for neoadjuvant chemoradiotherapy for colorectal cancer

Introduction. There has been a recent trend toward a gradual increase in the incidence of rectal cancer and a decrease in the average age of patients. These changes interpret the need to personalize treatment in each case.Objective – to evaluate the association of polymorphic variants of some genes with the results of neoadjuvant chemoradiotherapy of rectal cancer.Materials and methods. We analyzed polymorphic variants of MTHFR, XPD, XRCC1, XRCC1, P53, VEGF, EGFR, TNF, CHEK2 and MMP1 genes in 76 patients with rectal cancer who underwent preoperative chemoradiation therapy followed by surgical treatment. Genotyping was performed by DNA isolation from venous blood leukocytes of the subjects followed by polymerase chain reaction with electrophoretic detection of the result.Results. Statistical analysis of the association of polymorphic variants of the studied genes with the treatment pathomorphosis revealed significance in relation to the MMP1-1607 gene (1G &gt;2G) (p = 0.033). There was also an association of co-carrying polymorphic variants of TNF (G / A) + MMP1 (2G / 2G) genes with grade III–IV therapeutic pathomorphosis (p = 0.007).Conclusion. Carriage of recessive allele of MMP1 gene can be a predictor of favorable prognosis of preoperative chemoradiotherapy in patients with rectal cancer.

WISP1 and Mir-29c-3p are Novel Prognostic Biomarkers and Therapeutic Targets for Bladder Cancer

Aberrant expression of WISP1 is associated with carcinogenesis; however, the expression and prognostic values of WISP1 in bladder cancer remain elusive. Therefore, the present study aimed to investigate the WISP1 expression in bladder cancer and explore the possible mechanisms and clinical value of WISP1 in bladder carcinogenesis. The in silico analysis based on oncomine and Kaplan-Meier Plotter databases revealed that WISP1 was up-regulated in bladder cancer and associated with poor survival in patients with bladder cancer. Besides, WISP1 expression was identified to be up-regulated both in bladder cancer tissues and cell lines by qRT-PCR and Western blot assays. Using TargetScan database, we identified 13 miRNAs that putatively regulate the expression of WISP1. Of these miRNAs, only miR-29c-3p was found to be significantly negatively correlated with WISP1 in bladder cancer tissues. The correlation of in situ expressions of WISP1 and miR-29c-3p by immunohistochemistry (IHC) and clinical characteristics revealed that WISP1 was significantly associated with tumor size and hsa-miR-23b- 3p expression, and miR-29c-3p was associated with tumor size, M stage, and WISP1 expression. Multivariate Cox regression analysis indicated that TNM stage and WISP1 expression were predictors of unfavorable prognosis, while hsa-miR-29c-3p was a predictor of favorable prognosis in patients with bladder cancer. Collectively, the findings indicated that WISP1 and miR-29c-3p might serve as novel prognostic biomarkers and potential therapeutic targets for bladder cancer.

MRD Level in NPM1 Mutated and RUNX1-RUNX1T1 Positive AML Predicts RFS and Defines Indications for ASCT

NPM1 mutation and leukemia-specific fusion transcript RUNX1-RUNX1T1 are the predictors of favorable prognosis (DFS and OS). Nevertheless, a substantial proportion of this patients show disease relapses. It is necessary to identify negative prognostic factors for pts with NPM1mut and RUNX1-RUNX1T1 and evaluate if ASCT could overcome them.

Особенности хирургического лечения больных раком молочной железы, получающих предоперационную лекарственную терапию

Preoperative systemic therapy of breast cancer is one of the most promising and rapidly developing areas of modern oncology. Effective preoperative systemic treatment modifies the subsequent surgical step, contributes to the elimination of subclinical micrometastases and carcinoma sensitivity assessment for this type of therapy. However, the main goal is to achieve complete morphological regression, as a predictor of favorable prognosis of the disease. The proportion of patients who achieved a complete tumor response to preoperative effective systemic therapy is steadily growing, which creates certain difficulties at all steps of surgical treatment due to loss of macroscopic tumor area. Placement of image-detectable marker into the primary tumor and assessment of the status of regional lymph nodes before the start of systemic therapy, preoperative demarcate the residual tumor, planning volume of removed tissue, evaluation of resection margins and clipping the tumor bed for adjuvant radiation therapy with boost is a continuous chain of modern multidisciplinary approach in the treatment of breast cancer, the need to implement in clinical practice becomes apparent.

Abstract 10103: Improvement in Survival With Favorable Neurological Outcome in Elderly Japanese Patients With Out-of-Hospital Cardiac Arrest: A Nationwide Observational Cohort Study

Introduction: Although older age is associated with worse prognosis after cardiac arrest, little is known about the improvement in survival of very elderly patients with out-of hospital cardiac arrest (OHCA). Hypothesis: We aimed to evaluate the survival trends and predictors of favorable prognosis in this population. Method: We analyzed the records of 607,147 OHCA events obtained from a prospectively collected nationwide Utstein-style Japanese database from 2008 to 2012. The end-point was 1-month survival with favorable neurological outcome (Cerebral Performance Category Scale, category 1 or 2; CPC 1-2). Results: In total, 334,730 OHCA patients aged ≥75 years were eligible for analyses. The overall 1-month CPC 1-2 rate was 0.88% (2,933/334,730). OHCA aged 75-84 years had better 1-month CPC 1-2 rate than those ≥85years (1.18% [2,067/174,781] vs 0.54% [866/159,949], p &lt;0.0001). The 1-month CPC 1-2 rate improved in OHCA aged ≥75 years (0.73% [433/59,595] in 2008 to 0.96% [708/73,487] in 2012, p for trend &lt;0.001), even in only OHCA aged ≥85 years (0.42% [115/27,163] in 2008 to 0.65% [241/36,860] in 2012, p for trend &lt;0.0001). Multivariate logistic regression analysis indicated that bystander-witnessed arrest (adjusted odds ratio [aOR] 5.7, 95% confidential interval [CI] 5.2–6.3, p &lt;0.0001) and initial shockable rhythm (aOR 10.6, 95% CI 9.8–11.5, p &lt;0.0001) were significantly associated with 1-month CPC 1-2 rates of OHCA aged ≥75 years. OHCA with bystander witness and initial shockable rhythm had a higher 1-month CPC 1-2 rate than the others (11.14% [1,061/9,520] vs 0.58% [1,872/325,210], p &lt;0.0001, aOR 19.1, 95% CI 17.6–20.7, p &lt;0.0001). The 1-month CPC 1-2 rate of OHCA with initial unshockable rhythm also improved 0.42% (239/56,927) in 2008 to 0.60% (420/70,583) in 2012 (p for trend &lt;0.001); however, in OHCA without bystander witness, the 1-month CPC 1-2 rate did not improve between 2008 (0.19% [71/36,736]) and 2012 (0.28% [125/45,224]) (p for trend = 0.080). Conclusion: Data drawn from a large subset of elderly patients in Japanese registry suggest that rate of 1-month CPC 1-2 from OHCA have significantly improved during the study period; however, the OHCA outcome differed by bystander-witness and first documented rhythm.

Post-ablative thyroglobulin level as a predictor of favourable prognosis in patients with differentiated thyroid cancer

Post-ablative thyroglobulin level as a predictor of favourable prognosis in patients with differentiated thyroid cancer

Abstract 9333: Prognostic Value of Stress Echocardiography In Patients Achieving a High Exercise Workload (=10 Metabolic Equivalents) and Submaximal Heart Rate Response

Background: High exercise capacity (≥10 metabolic equivalents, METS) is a predictor of favorable prognosis. Submaximal studies (&lt;85% maximum predicted heart rate, MPHR) may lead to non-diagnostic results and indeterminate outcomes. The purpose of this study was to examine the prognostic value of stress echocardiography (SEcho) in patients achieving high exercise capacity and submaximal heart rate response. Methods: We evaluated 81 patients (50 ± 13 years; 62% male) achieving nine minutes (≥10 METS) and &lt;85% MPHR with treadmill SEcho. Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on 5-point scale of wall motion. Abnormal SEcho was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Followup (3.4 ± 1.5 years) for non-fatal myocardial infarction and cardiac death (n = 2) were obtained. Results: By univariate analysis, the number of new ischemic wall motion abnormalities (hazard ratio = 2.5, confidence interval 1.2 - 5.3, p = 0.02) was the most significant predictor of cardiac events. Cumulative survival in patients achieving nine minutes (≥10 METS) and &lt;85% MPHR was significantly worse in patients with abnormal (ischemic) vs. normal (nonischemic) SEcho (1.1%/year vs. 0.2%/year, p = 0.02)[Graph]. Conclusions: The ability to achieve nine minutes (≥10 METS), despite &lt;85% MPHR by treadmill SEcho was associated with a benign prognosis (~1.0%/year). In the setting of high achieved exercise capacity and &lt;85% MPHR, SEcho results (presence or absence of ischemia) were further able to sub-stratify this low risk group.

Prognostic Value of Treadmill Stress Echocardiography at Extremes of Exercise Performance: Submaximal &lt;85% Maximum Predicted Heart Rate versus High Exercise Capacity ≥10 Metabolic Equivalents

Submaximal stress testing or achieving <85% maximum predicted heart rate (MPHR) may lead to nondiagnostic results and indeterminate outcomes. High exercise capacity (≥ 10 metabolic equivalents, METS) is a predictor of favorable prognosis. The purpose of this study was to evaluate the prognostic value of submaximal or high exercise capacity stress echocardiography. We evaluated 1781 patients (55 ± 13 years; 59% male) undergoing treadmill stress echocardiography divided into 811 patients with submaximal (<85% MPHR) and 970 patients with high exercise capacity (≥ 10 METS). Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on 5-point scale of wall motion. Abnormal stress echocardiography was defined as stress-induced ischemia (wall-motion score of ≥ 1 grade). Follow-up (3.3 ± 1.5 years) for nonfatal myocardial infarction (MI) (n = 40) and cardiac death (n = 52) were obtained. By univariate analysis, echocardiographic variables of ejection fraction, peak wall-motion score index (WMSI) and number of new ischemic wall-motion abnormalities were significant predictors of cardiac events. Cumulative survival was significantly worse in patients with abnormal (ischemic) versus normal (nonischemic) stress echocardiography in submaximal (4.4%/year vs. 1.3%/year, P < 0.0001) and high exercise capacity (1.5%/year vs. 0.2%/year, P < 0.0001) studies. Multivariate Cox proportional hazards analysis identified number of new ischemic wall-motion abnormalities as the strongest predictor of cardiac events (P < 0.05) in both groups. Despite normal stress echocardiography, the inability to achieve 85% MPHR conferred a higher, intermediate cardiac event rate of 2.9%/year. The ability to achieve 9 minutes (≥ 10 metabolic equivalents, METS) conferred an overall low cardiac event rate of 0.4%/year. However, the absence or presence of ischemia by stress echocardiography was able to further risk stratify patients with either submaximal or high exercise capacity studies.

Abstract 9509: Prognostic Value of Treadmill Stress Echocardiography at Extremes of Exercise Workload: Submaximal, &lt;85% Maximum Predicted Heart Rate and High Exercise Capacity, ≥10 Metabolic Equivalents

Background: Submaximal stress testing, &lt;85% maximum predicted heart rate (MPHR) may be non diagnostic and high exercise capacity (≥10 metabolic equivalents, METS) is a predictor of favorable prognosis. The purpose of this study was to evaluate the prognostic value of submaximal and high exercise capacity stress echocardiography (EXSE). Methods: We evaluated 1781 patients (55 ± 13 years; 59% male) undergoing EXSE divided into 811 with submaximal (&lt;85% MPHR) and 970 with high exercise capacity (≥10 METS). Resting left ventricular ejection fraction and wall motion was assessed. The left ventricle was divided into 16 segments and scored on a 5-point scale of wall motion. Abnormal EXSE was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Follow-up (3.3 ± 1.5 years) for non-fatal myocardial infarction (n = 40) and cardiac death (n = 52) were obtained. Results: By univariate analysis, exercise work load (p&lt;0.0001), ejection fraction (p&lt;0.0001) and number of new ischemic wall motion abnormalities (p&lt;0.0001) were significant predictors of cardiac events. Cumulative survival was significantly worse in patients with abnormal vs. normal EXSE in submaximal (4.5%/year vs. 1.4%/year, p&lt;0.0001) and high exercise capacity groups (1.1%/year vs. 0.2%/year, p=0.001) (Graph). Multivariate logistic regression analysis identified number of new ischemic wall motion abnormalities as the best predictor of cardiac events (p&lt;0.05) in both groups. Conclusions: Despite normal EXSE, inability to achieve 85% MPHR conferred a higher, intermediate event rate of 3.0%/year. The ability to achieve nine minutes (≥10 METS) on EXSE conferred a benign prognosis (1.0%/year) regardless of EXSE results. In either group (submaximal or high exercise capacity), EXSE results (absence or presence ischemia) were useful in further, effectively risk stratifying patients.

Quantitative Prediction of the Hemodynamic Impact of Left Ventricular (LV) Assist Device (LVAD)

available for 132 patients (58.1%). Patients were followed for a median of 774 days (IQ; 447.5, 1080). LVRR was defined as a decrease in indexed left ventricular systolic dimension of at least 15% and a 25% improvement in left ventricular ejection fraction (LVEF) at outpatient check-up compared with measurements at discharge. LVRR accomplishment within 400 days was defined as early-LVRR. The remaining LVRR patients were classified as late-LVRR. The patients had a mean age of 63.86615.12 years; 80.3% were male, and 72.0% had a non-ischemic etiology. LVRR was observed in 51 patients (38.6%). Overall, there were 53 events of death or heart failure hospitalization. Events in the LVRR and non-LVRR groups was 12 (23.5%) and 53 (50.6%), respectively (logrank test, p!0.001). LVRR was a predictor of favorable prognosis (HR, 2.85; p 5 0.007) and early-LVRR was associated with better prognosis compared with the late-LVRR group (log-rank test, p 5 0.004). Prognosis was improved in patients who achieved LVRR. Early response to treatment was a major advantage in terms of long-term prognosis.

Role of emmprin in endometrial cancer

BackgroundExtracellular matrix metalloproteinase inducer (Emmprin/CD147) is a transmembrane glycoprotein that belongs to the immunoglobulin superfamily. Enriched on the surface of many tumor cells, emmprin promotes tumor growth, invasion, metastasis and angiogenesis. We evaluated the clinical importance of emmprin and investigated its role in endometrial cancer.MethodsEmmprin expression was examined in uterine normal endometrium, endometrial hyperplasia and cancer specimens by immunohistochemistry. In addition, the biological functions and inhibitory effects of an emmprin knockdown were investigated in HEC-50B and KLE endometrial cancer cell lines.ResultsThe levels of emmprin expression were significantly increased in the endometrial cancer specimens compared with the normal endometrium and endometrial hyperplasia specimens (p < 0.05). The disease-free survival (DFS) and overall survival (OS) rates of patients with high emmprin expression were significantly higher than those of patients with low emmprin expression (DFS: p < 0.001; OS: p < 0.001). Emmprin knockdown by the siRNA led to cell proliferation, migration and invasion through TGF-β, EGF, NF-κB, VEGF, MMP-2, and MMP-9 expression, which in turn resulted in increased levels of E-cadherin and reduced levels of Vimentin and Snail in endometrial cancer.ConclusionsThe present findings suggest that low emmprin expression might be a predictor of favorable prognosis in endometrial cancer patients, and that emmprin may represent a potential therapeutic target for endometrial cancer.

Abstract 9888: Is There Additional Prognostic Value of Stress Echocardiography in Patients Achieving a High Exercise Capacity (≥10 Metabolic Equivalents)?

Background: High exercise capacity is a predictor of favorable prognosis in patients with known or suspected coronary artery disease. The purpose of this study was to examine the prognostic value of stress echocardiography (SEcho) in patients achieving high exercise workload. Methods: We evaluated 970 patients (51 ± 11 years; 62% male) achieving nine minutes (≥10 metabolic equivalents) on a Bruce protocol by treadmill SEcho. Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on 5-point scale of wall motion. Abnormal SEcho was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Followup (3.4 ± 1.5 years) for non-fatal myocardial infarction (n = 11) and cardiac death (n = 3) were obtained. Results: By univariate analysis, both peak wall motion score index (p=0.002) and number of new ischemic wall motion abnormalities (p&lt;0.0001) were significant predictors of cardiac events. Cumulative survival in patients achieving nine minutes (≥10 metabolic equivalents) was signficantly worse in patients with abnormal (ischemic) vs. normal (nonischemic) SEcho (1.1%/year vs. 0.2%/year, p=0.001)(Graph). Multivariate logistic regression analysis identified number of new ischemic wall motion abnormalities as the strongest predictor of cardiac events (RR 1.27, 95% CI 1.0-1.6, p=0.01). Conclusions: The ability to achieve nine minutes (≥10 metabolic equivalents) by treadmill stress echocardiography confers a benign prognosis (~1.0%/year). In the setting of high achieved exercise capacity, stress echocardiography (absence or presence of ischemia) is further able to effectively risk stratify a low risk group.

Beneficial Effects of Statin Therapy in Acute Myocardial Infarction Patients with Presenting Atrial Fibrillation

Methods: 559 AMI patients who were enrolled in Korea AMI registry (KAMIR) and presented with AF on EKG at arrival in the emergency room were divided into two groups; statin group (n=364) or control group (n=195). We evaluated the effects of statin therapy on MACE including all-cause death, re-infarction, coronary artery bypass grafting, heart failure requiring re-hospitalization, and target lesion revascularization during inhospital period and one-year clinical follow-up. Results: The baseline clinical characteristics were similar between the two groups including hemodynamic parameters, killip class, risk factor of atherosclerosis, EKG and echocardiographic, and coronary angiographic findings. The baseline level of LDL cholesterol was higher in statin treatment group than control group (107.9 mg/dl vs. 96.8 mg/dl, p=0.003). The rate of in-hospital death was significantly lower in statin treatment group (5.5% vs. 23.8%, p<0.001). The incidence rate of MACE during one-year clinical follow-up was significantly lower in statin treatment group (11.8% vs. 27.7%, p<0.001). Multivariate Cox regression analysis revealed that statin therapy (P=0.015, hazard ratio: 0.51; 95% confidence interval: 0.31–0.85) was a significant predictor of favorable prognosis. Conclusion: Statin therapy was beneficial for long-term outcome of AMI patients with AF.

Outcome of Lupus nephritis-A 5-year Analysis

Objective: To investigate the long-term outcome of class IV lupus nephritis (LN) and to analyze its prognostic factors. Materials and Methods: We performed a retrospective chart review study of 157 patients with LN between January 1986 and June 2004 in Chang Gung Memorial Hospital at Kaohsiung. All of these LN patients fulfilled the systemic lupus erythematosus classification criteria of the American College of Rheumatology and had histopathological findings of LN. Only those pathology-proved subjects with class IV by 2003 ISN/RPS classification were recruited. We reviewed the charts and collected the demographic data, serological parameters, and treatment courses of subjects recruited. The end point of renal outcome were doubling of serum creatinine (I) and end stage renal disease (ESRD)/death (II) within 60 months after renal biopsy Results: A total of 75 subjects were recruited, including 13 male and 62 female. Mean age was 25.9±9.7 year. Five years after renal biopsy, 16 subjects (21.3%) developed outcome I and 15 subjects (20.0%) developed outcome II. Those who did not develop outcome I had higher mean (14.5±2.1) activity index (AI) than that (13.1±2.5) of those did (HR=0.55, CI=0.35-0.87, p=0.01). For those who did not develop outcome II, the mean AI was also higher than those who did (14.4±2.2 vs.13.5±2.3, HR=0.67, CI=0.44-1.00, p=0.05). Conclusions: The 5-year renal survival of current series, in terms of ESRD/death, was 80% and this was not as favorable as those reported in the other investigations. High activity index at biopsy is a predictor of favorable prognosis of long-term renal outcomes in case that aggressive treatment had been given.