Risk Factor For All-cause Mortality Research Articles

Metabolic syndrome, malnutrition, and its associations with cardiovascular and all-cause mortality in hemodialysis patients: Follow-up for three years.

Metabolic disorder contributes to the increase in the mortality rate of patients on hemodialysis (HD). The aim of this study was to estimate the prevalence of metabolic syndrome (MS) and malnutrition in patients on maintenance HD and to evaluate their influence on cardiovascular and all-cause mortality during the follow-up. We carried out a prospective cross- sectional study in which we enrolled 100 patients from a single center who had been followed up for three years. Collected data included demographic characteristics, detailed medical history, clinical variables, MS variables, nutritional status, and laboratory findings. The outcomes were the occurrence of a cardiovascular event and cardiovascular or all-cause mortality during the follow-up period. The Statistical Package for the Social Sciences software was used for statistical analysis. Whereas 50% of patients had MS, 23% showed evidence of malnutrition. Patients with MS were older and had more preexisting cardiovascular diseases (CVDs). All patients were followed for 36 months. During this time, 19 patients with MS and 14 patients without MS died (38% vs. 28%; P = 0.19), most frequently of CVD. Mean survival time was 71.52 ± 42.1 months for MS group versus 92.06 ± 65 months for non-MS group, but the difference was not significant. MS was related with a higher cardiovascular mortality, while malnutrition was significantly associated with all-cause mortality. Our data showed that MS was not related to cardiovascular or all-cause mortality in HD patients and did not influence survival. The independent risk factors for all-cause mortality were older age, preexisting CVD, and malnutrition.

Predictors of erythropoietin hyporesponsiveness in chronic hemodialysis patients

Objective The aim of this work was to assess different clinical and laboratory parameters to predict erythropoietin hyporesponsiveness in chronic hemodialysis patients with anemia. Background Anemia resistant to erythropoietin-stimulating agents (ESAs) is a risk factor for all-cause mortality. Determining the etiologies of hyporesponsiveness may help to overcome the resistance. Patients and methods This cross-sectional study was carried out on 97 chronic hemodialysis patients attending Menoufia University Hospital and Manshiet Sultan hemodialysis units. Patients were classified according to the presence of anemia (hemoglobin Results The proportion of patients treated with renin-angiotensin-aldosterone system blockers (RAAS blockers) was significantly higher in group IV compared with group I (P = 0.000). Group IV patients had significantly lower dialysis adequacy (Kt/V) (P = 0.029) and significantly higher platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), and intact parathormone hormone (P = 0.002, 0.000, and 0.006, respectively). There were significant positive correlations between mean ESA hyporesponsiveness index and CRP, PLR, and intact parathormone hormone and negative correlation with Kt/V. In multivariate analysis, treatment with RAAS blockers, inflammatory markers (PLR and CRP), and secondary hyperparathyroidism were independent predictors of ESA resistance. Conclusion RAAS blockers' treatment, inflammation, and secondary hyperparathyroidism could be considered as predictors of ESA hyporesponsiveness.

Hyperuricemia is the Independent Risk Factor of All-Cause Mortality in Aged Patients with Chronic Kidney Disease

Hyperuricemia is the Independent Risk Factor of All-Cause Mortality in Aged Patients with Chronic Kidney Disease

Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States.

Background:Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States.Methods:We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors.Results:Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men (p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome.Conclusion:Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

Quantitative computed tomography measures of skeletal muscle mass in patients with idiopathic pulmonary fibrosis according to a multidisciplinary discussion diagnosis: A retrospective nationwide study in Japan.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease often accompanied by skeletal muscle wasting. We investigated whether skeletal muscle mass and muscle attenuation on computed tomography (CT) are predictors of mortality in IPF patients, using a nationwide cloud-based database and web-based multidisciplinary discussion (MDD) system. IPF patients diagnosed using MDD from April 2009 to March 2014 were included. We analyzed the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA), muscle attenuation of the ESM (ESMMA), and PM (PMMA) on single-slice axial CT. Survival probability was assessed using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox proportional hazards models were used to evaluate the relationship among the ESMCSA, PMCSA, ESMMA, PMMA, clinical parameters, and prognosis. A total of 199 IPF patients were enrolled. Seventy-four patients died during the study period and the most frequent cause was acute exacerbation (13.1%). The group with the lowest quartile of ESMCSA had significantly worse survival than other groups (P=0.009). Survival rates of the groups with the lowest quartile of PMCSA, lower ESMMA, and lower PMMA did not differ from those of other groups. According to multivariate analysis, ESMCSA<lower quartile was significantly associated with all-cause mortality (hazards ratio, 1.96; P=0.030), whereas, ESMMA<median, PMCSA<lower quartile, and PMMA<median were not. Low ESMCSA on CT images may be a strong risk factor for all-cause mortality in IPF patients based on MDD diagnosis.

Risk factors analysis for one-year and long-term mortality in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease

Objective: To identify the independent risk factors that predict one-year mortality and long-term mortality after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A retrospective review of medical records and long-term follow-up were performed for inpatients with the first diagnosis of AECOPD at Beijing Chaoyang Hospital between January 2013 and December 2014. The follow-up was completed on March 1, 2018. Cox regression analysis was used to determine the independent risk factors for all-cause mortality of AECOPD patients. Results: A total of 890 AECOPD patients were enrolled. The average follow-up was 41 months (range 1-62). One-year mortality was 8.4% (75/890) and long-term mortality was 37.2% (331/890). In both scenarios, the main cause of death was respiratory disorders, and the next ones were cardiovascular and tumor disorders. The risk factors independently associated with one-year mortality included body mass index (HR 0.891, 95%CI 0.838-0.947, P<0.01), length of hospitalization (HR 1.031, 95%CI 1.019-1.042, P<0.01), lymphocyte count (HR 0.295, 95%CI 0.160-0.542, P<0.01), albumin (HR 0.935, 95%CI 0.880-0.994, P=0.031), atrial fibrillation (HR 2.220, 95%CI 1.038-4.747, P=0.040), and lung cancer (HR 5.865, 95%CI 2.608-13.192, P<0.01). The risk factors independently associated with long-term mortality included age (HR 1.046, 95%CI 1.031-1.062, P<0.001), body mass index (HR 0.939, 95%CI 0.914-0.964, P<0.01), length of hospitalization (HR 1.028, 95%CI 1.019-1.038, P<0.01), albumin (HR 0.957, 95%CI 0.929-0.986, P<0.01), partial pressure of carbon dioxide (HR 1.019, 95%CI 1.009-1.028, P<0.01), heart failure (HR 1.538, 95%CI 1.180-2.005, P=0.001), lung cancer (HR 3.443, 95%CI 2.033-5.830, P<0.01). However, blood eosinophil count (≥300 cells/μl) was not independently associated with one-year mortality (HR 0.892, 95%CI 0.309-2.579, P=0.834) and long-term mortality of COPD patients (HR 1.007, 95%CI 0.682-1.486, P=0.973). Conclusion: Old age, poor nutritional status, long length of hospitalization, cardiovascular disorders, lung cancer, low lymphocyte count and hypercapnia were independent risk factors for mortality of AECOPD patients.

Race-specific alterations in DNA methylation among middle-aged African Americans and Whites with metabolic syndrome

ABSTRACTMetabolic syndrome (MetS) is a cluster of cardiometabolic risk factors for all-cause mortality, cardiovascular disease, and cancer. Identifying epigenetic alterations associated with MetS in African Americans (AAs) and Whites may provide insight into genes that influence its differential health outcomes. We examined DNA methylation (DNAm) and performed an epigenome-wide association study (EWAS) of MetS among AAs and Whites with and without MetS. We assessed age, race and poverty status associated DNAm among AAs (n = 225) and White (n = 233) adults using NCEP-ATP III guidelines. Genome-wide DNAm measurement was assessed using Illumina Infinium Methylation EPIC BeadChip. Differentially methylated positions (DMPs) and differentially methylated regions (DMRs) were identified using dmpFinder and bumphunter. EWAS was performed using CpGassoc. We found significant DMPs associated with age, poverty status and MetS in each race. GSTT1(Glutathione S-Transferase Theta 1) was one of the top-hypermethylated genes and MIPEP (Mitochondrial Intermediate Peptidase) was one of the most hypomethylated genes when comparing AAs with and without MetS. PPP1R13L (Protein Phosphatase 1 Regulatory Subunit 13 Like) was the top hypermethylated and SCD (stearoyl-CoA desaturase-1) was one of the most hypomethylated genes for Whites with and without MetS. EWAS results showed that DNAm differences might contribute to MetS risk among Whites and AAs since different genes were identified in AAs and Whites. We replicated previously identified MetS associated genes and found that Thioredoxin-interacting protein (TXN1P) was statistically significantly differentially expressed only in Whites. Our results may be useful in further studies of genes underlying differences in MetS among AAs and Whites.

Early-onset Sepsis Among Preterm Neonates in China, 2015 to 2018.

The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China. All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth. Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks' gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity. There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.

Association of pulse pressure with all-cause mortality in young adults

BackgroundPulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.ObjectiveTo assess the association of pulse pressure (PP) with...

Predictive Model for Mortality Risk Including the Wound, Ischemia, Foot Infection Classification in Patients Undergoing Revascularization for Critical Limb Ischemia.

The aim of this study was to develop a predictive model for mortality risk based on preoperative risk factors, including the Wound, Ischemia, Foot Infection (WIfI) classification, in patients undergoing revascularization for critical limb ischemia. We analyzed a database of the Surgical reconstruction versus Peripheral Intervention in Patients With Critical Limb Ischemia registry, a multicenter, prospective, observational study that included 520 critical limb ischemia patients (192 surgical and 328 endovascular patients). Multivariate Cox regression analysis identified old age, impaired mobility, low body mass index, renal failure, heart failure, and high WIfI grade as independent risk factors for all-cause mortality (all P<0.05). The risk score comprising these risk factors discriminated the mortality risk well; the 2-year survival rate was >90% in the first quantile of the risk score and ≈20% in the fifth quantile. The area under the time-dependent receiver operating characteristics curve was 0.829 for thirty-day mortality and 0.811 for 2-year mortality. Adding more detailed preoperative information to the predictive model revealed that cystatin C-based estimated glomerular filtration rate, left ventricular ejection fraction, and cholinesterase levels were additional independent risk factors, but the predictive accuracy of the model was not significantly improved, according to the time-dependent receiver operating characteristics curve and net reclassification improvement. The current study developed a risk score for mortality using preoperative risk factors, including the WIfI classification, in critical limb ischemia patients undergoing revascularization.

Prognostic role of the lymphocyte-to-monocyte ratio for clinical outcomes of patients with progressive radioiodine-refractory differentiated thyroid carcinoma treated by sorafenib.

The lymphocyte-to-monocyte ratio (LMR) reflects the status of tumour-infiltrating immune cells and host immunity. The LMR has been reported as a prognostic marker in various cancers. The present study evaluated the role of the LMR as a prognostic marker in patients with progressive radioiodine-refractory (RAIR) differentiated thyroid carcinoma (DTC). Retrospective cohort study. Forty patients with progressive RAIR DTC who were treated by sorafenib with available baseline complete blood cell count data. We assessed the response rate, progression-free survival (PFS) and overall survival (OS). The patients were divided into low and high LMR groups based on their baseline LMRs (<4, n=22, 55% and ≥4, n=18, 45%, respectively). There were no significant differences in baseline characteristics between the groups. The OS curves differed significantly based on the LMR. The median OS of the low LMR group was 24.3months and that of the high LMR group was not reached until the end of observation period (P=.015). The PFS curves and median PFS also differed significantly based on the LMR values (P=.019). In multivariate analysis, low LMR was an independent risk factor for all-cause mortality in patients with progressive RAIR DTC (hazard ratio, 2.64; 95% confidence interval: 1.04-6.72, P=.041). A low LMR was associated with poor response rate, PFS and OS in patients with progressive RAIR DTC treated with sorafenib. Thus, LMR could be a simple prognostic biomarker in patients with progressive RAIR DTC.

Prognostic implications of N-terminal pro-B-type natriuretic peptide in patients with normal left ventricular ejection fraction undergoing transcatheter aortic valve implantation

BackgroundBiomarkers may significantly improve risk stratification algorithms for patients undergoing transcatheter aortic valve implantation (TAVI). While N-terminal pro-B-type natriuretic peptide (NT-proBNP) is established as a biomarker in the context of heart failure, its prognostic implications in patients with normal left ventricular ejection fraction (LVEF) undergoing TAVI are unclear. MethodsA total of 504 TAVI patients with normal LVEF were analyzed. Based on preprocedural NT-proBNP levels, patients were stratified into two groups comparing the upper quartile (“Q4”, n = 126) with the lower three quartiles (“Q1–3”, n = 378). The primary outcome of our study was survival. ResultsThe “Q4” group included more men (46.8% vs. 34.9%, p = 0.017), had higher rates of atrial fibrillation (55.6% vs. 28.3%, p < 0.001) and showed features of more advanced aortic stenosis (mean pressure gradient 49 mmHg vs. 40 mmHg, aortic valve area 0.6 cm2 vs. 0.7 cm2; p < 0.001, respectively). The “Q4” group was also characterized by more extensive cardiac remodeling including severe diastolic dysfunction (18.1% vs. 6.5%, p < 0.001) and left atrial dilation (26.8% vs. 10.8%, p < 0.001). Kaplan-Meier analysis demonstrated superior survival of the “Q1–3” group (median follow-up 22.1 months, log-rank test p < 0.001). In a multivariable analysis, preprocedural NT-proBNP emerged as a significant risk factor for all-cause mortality after TAVI (HR 1.87, CI 1.31–2.65, p < 0.001). ConclusionsNT-proBNP is associated with survival in TAVI patients with normal LVEF. In this patient group, preprocedural NT-proBNP levels do not only correlate with aortic stenosis, but reflect advanced cardiovascular dysfunction, including HFpEF, that might not be completely reversible after TAVI.

Serum gamma-glutamyltransferase, oxidized LDL and mortality in the elderly.

Serum gamma-glutamyltransferase (GGT) is a liver enzyme involved in the metabolism of glutathione (GSH), a major antioxidant in humans. GGT is a risk factor for mortality in young and middle-aged individuals but this association has been poorly investigated in the elderly. We studied the relationship between GGT and all-cause mortality and tested whether oxidized low-density lipoproteins (oxLDL) modify this association in a cohort of 1038 elderly individuals. During the observation time (median 9years), 401 individuals died. In a Cox regression model adjusting for potential confounders, GGT was an independent risk factor for all-cause mortality [HR (20U/L increase in serum GGT): 1.11, 95% CI 1.02-1.21, P = 0.02]. Furthermore, increasing levels of oxLDL amplified the risk excess for all-cause mortality associated with GGT (P for the effect modification = 0.003). In the elderly, serum GGT is an independent risk factor for all-cause mortality and circulating oxLDL amplify the magnitude of this association.

Elevated fatty liver index as a risk factor for all-cause mortality in HIV-HCV co-infected patients

Abstract Background Thanks to innovation in treatment, people living with HIV and/or HCV now live longer but are growingly facing non-communicable disease burden. HIV-HCV co-infected patients are at high risk of metabolic complications and liver-related events, which are both associated with hepatic steatosis and its progressive form, non-alcoholic steatohepatitis (NASH), a known risk factor for mortality. The fatty liver index (FLI), a non-invasive steatosis biomarker, has recently drawn attention for its clinical prognostic value, but has never been applied to HIV-HCV co-infected patients. We aimed at testing whether elevated FLI (≥60) was associated with all-cause mortality in co-infected patients. Methods Our study is based on data from ANRS CO13 HEPAVIH, a French national prospective cohort of HIV-HCV co-infected patients. Socio-behavioral and clinical data from patients clinically followed-up were used in the analysis. Using a Cox proportional hazards model for mortality from all causes (983 patients; 4,432 visits), we computed hazard ratios associated with risk factors and confounders. Results After multiple adjustment, individuals with FLI≥60 had almost double the risk of all-cause mortality (adjusted hazard ratio [95% confidence interval]: 1.91 [1.17-3.12], p = 0.009), independently of HCV cure (0.21 [0.07-0.61], p = 0.004), advanced fibrosis (1.77 [1.00-3.14], p = 0.05), history of hepatocellular carcinoma and/or liver transplantation (7.74 [3.82-15.69], p &amp;lt; 10-3), history of indirect clinical signs of cirrhosis (2.80 [1.22-6.41], p = 0.015), and HIV CDC clinical stage C (2.88 [1.74-4.79], p &amp;lt; 10-3). Conclusions An elevated fatty liver index is a risk factor for all-cause mortality in HIV-HCV co-infected patients independently of liver fibrosis and HCV cure. In the present era of nearly 100% HCV cure rates, these findings encourage the more systematic use of non-invasive steatosis biomarkers to help identify co-infected patients with higher mortality risk. Key messages A FLI≥60 is strongly associated with mortality in HIV-HCV co-infected patients. FLI could be calculated routinely to identify most at-risk patients.

Cancer patterns and association with mortality and renal outcomes in non-dialysis dependent chronic kidney disease: a matched cohort study

BackgroundCancer in patients with chronic kidney disease (CKD) is an added burden to their overall morbidity and mortality. Cancer can be a cause or an effect of CKD. In CKD patients, a better understanding of cancer distribution and associations can aid in the proper planning of renal replacement therapy (RRT) and in the choice of chemotherapeutic agents, many of which are precluded in more advanced CKD. This study aims to investigate the distribution and the association of cancer with mortality, renal progression and RRT assignment in a non-dialysis dependent CKD cohort, few studies have investigated this in the past.MethodsThe study was carried out on 2952 patients registered in the Salford Kidney Study (SKS) between October 2002 and December 2016. A comparative analysis was performed between 339 patients with a history of cancer (previous and current) and 2613 patients without cancer at recruitment. A propensity score matched cohort of 337 patients was derived from each group and used for analysis. Cox-regression models and Kaplan-Meier estimates were used to compare the association of cancer with mortality and end-stage renal disease (ESRD) outcomes. Linear regression analysis was applied to generate the annual rate of decline in estimated glomerular filtration rate (delta eGFR).ResultsOf our cohort, 13.3% had a history of cancer at recruitment and the annual rate of de novo cancers in the non-cancer patients was 1.6%. Urogenital cancers including kidney and bladder, and prostate and testicle in males, ovary and uterus in females, were the most prevalent cancers (46%), as expected from the anatomical or physiological roles of these organs and relationship to nephrology. Over a median follow-up of 48 months, 1084 (36.7%) of patients died. All-cause mortality was higher in the previous and current cancer group (49.6% vs 35%, p < 0.001), primarily because of cancer-specific mortality. Multivariate Cox regression analysis showed a strong association of cancer with all-cause mortality (HR:1.41; 95%CI: 1.12–1.78; p = 0.004). There was no difference between the groups regarding reaching end-stage renal disease (26% in both groups) or the rate of decline in eGFR (− 0.97 for cancer vs − 0.93 mL/min/year for non-cancer, p = 0.93). RRT uptake was similar between the groups (17.2% vs 19.3%, p = 0.49).ConclusionsCancer status proved to be an added burden and an independent risk factor for all-cause mortality but not for renal progression. CKD patients with a previous or current history of cancer should be assessed on a case by case basis in planning for renal replacement therapy options, and the presence of cancer should not be a limitation for RRT provision including transplantation.

Predicting mortality with cardiac troponins: recent insights from meta-analyses.

The introduction of cardiac troponin (cTn) testing in clinical practice has been one of the most important breakthroughs that have occurred in the recent history of laboratory medicine. Although it is now uncontestable that cTn values are essential for diagnosing acute coronary syndrome (ACS), solid evidence is also emerging that assessment of either cardiac troponin I (cTnI) or T (cTnT) may provide valuable prognostic information in the general healthy population, as well as in patients with a vast array of cardiac and extra-cardiac diseases. We have hence performed a critical review of the scientific literature for identifying meta-analyses which have investigated the potential contribution of cTns in predicting the risk of death in health and disease. According to the articles identified with our research, we can conclude that increased cTn values may be considered independent risk factors for all-cause mortality in the general population, as well as in patients with ACS, in those undergoing revascularization procedures, or with stable coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF). Measurement of cTn may then be helpful for stratifying the mortality risk in non-cardiac hospitalized patients, in those with critical illness or sepsis, syncope, stroke, acute aortic dissection, pulmonary diseases, brain injury, renal failure, vascular and non-cardiac surgery. Although this evidence has notable clinical implications, the cost-effectiveness of population screening with high-sensitivity (hs) cTn immunoassays has not been proven so far.

P5293Effect of metabolically health obesity on carotid intima-media thickness in general population: a community-based cohort study

Abstract Introduction Obesity is a common and independent risk factor for all-cause mortality. More specifically, obesity is a major component of atherosclerosis in association with metabolic disorders including metabolic syndrome (MetS), resulting in various cardiovascular diseases (CVD). Alternatively, obese subjects without MetS are prevalent, also referred to as metabolically healthy obesity (MHO). However, most preceding studies regarding MHO have been limited by small cohorts. Therefore, the effect of MHO on atherosclerosis in the general population remains unclear. Purpose In this study, we sought to clarify the effect of MHO on carotid intima-media thickness (IMT) as a marker of early stage atherosclerosis using a community-based cohort in general population. Methods We examined subjects who underwent medical check-up at our University Hospital. We defined obesity as body mass index ≥25.0 kg/m2. Abdominal obesity, defined as waist circumstance at umbilical level ≥85 cm in men and ≥90 cm in women, was obligatory for the diagnosis of MetS. In addition to abdominal obesity, any two of the following three abnormalities should be observed for the diagnosis of MetS, [1] Dyslipidemia: triglyceride ≥150 mg/dL, HDL-C &lt;40 mg/dL, or use of lipid lowering medication, [2] Hypertension: systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥85 mmHg, or use of antihypertensive medication, and [3] Hyperglycemia: fasting plasma glucose ≥110 mg/dL or use of hypoglycemic medication. MHO was defined as obese subjects without MetS, whereas we defined metabolically unhealthy obesity (MUO) as obese subjects with MetS. We defined carotid plaque as IMT ≥1.1 mm. Results Among 1,241 subjects, 857 subjects (69%) were categorized in the normal body weight group, whereas 275 subjects (22%) were categorized as MHO, and 109 subjects (9%) were categorized as MUO. Compared to non-obese subjects, prevalence of classical cardiovascular risk factors including hypertension, diabetes mellitus, and dyslipidemia increased in subjects with MHO, and further increased in those with MUO. IMT was higher in obese subjects compared to those without obesity. Similarly, the prevalence of carotid plaque formation was also higher in obese subjects. Multivariable logistic regression analysis demonstrated that age ≥60 years, male sex, hypertension, diabetes mellitus, MHO subjects (Odds ratio [OR]; 1.6, p=0.005), and MUO subjects (OR 1.7, p=0.04) were independently associated with carotid plaque formation. There was no statistical difference in the risk of carotid plaque formation between subjects with MHO and MUO. IMT and Carotid Plaque Conclusions IMT and the prevalence of carotid plaque are higher in both subjects with MHO and MUO compared to non-obese subjects in the general population. We need to take obesity regardless of the presence of MetS into consideration as high-risk subjects for subsequent CVD.

P990Assessment of clinical risk factors for all-cause mortality among hypertrophic cardiomyopathy patients with ICDs

Abstract Introduction According to the literature, the annual mortality rate of hypertrophic cardiomyopathy (HCM) patients is estimated to 1–2%. Sudden cardiac death (SCD), heart failure and thromboembolism are the main causes of death among this population. Patients at high risk for SCD, identified using HCM risk score, are qualified for ICD implantation. Unfortunately for clinicians, there is no validated model or statistical tool for assessment of the risk of mortality within the HCM patients with ICDs. Purpose The aim of this study was to determine the main risk factors of all- cause mortality in HCM patients with ICDs. Methods The long-term follow-up of group of 104 consecutive patients with HCM, who had the ICD implanted between 1996 and 2006 in tertiary reference clinical unit was performed. Twenty patients who died during observation were the subject of the current analysis. ICD was implanted for primary (n=16) and secondary (n=4) prevention of SCD within this subpopulation. Analysis were performed for mentioned below potential risk factors: age at the time of implantation, syncopes, family history of SCD, atrial fibrillation/supraventricular tachycardia, decreased left ventricular ejection fraction (LVEF), non-sustained ventricular tachycardia (nsVT), maximum left ventricular wall thickness, abnormal exercise blood pressure response, left ventricular outflow tract obstruction. Results The average time of survival since ICD implantation was 8,5±4,6 years. Decreased LVEF (Wald chi2 4,57; p=0,033), secondary prevention (Wald chi2 8,57; p=0,003), family history of SCD (Wald chi2 4,93; p=0,026) and episodes of nsVT (Wald chi2 3,49; p=0,062) are the clinical risk factors that significantly affect the time of survival. The probability of death, expressed as Hazard Ratio, was 27-fold higher in secondary prevention group (HR=27,18), almost 10-fold higher in patients with positive family history of SCD (HR=9,74) and 3,7-fold higher when nsVT was detected. The cause of death was established in 16/20 patients. In 15 cases, these were deaths from cardiovascular causes: end-stage heart failure (8), complications of heart transplantation or circulatory support (4), SCD (1) and other cardiovascular (2). Conclusion Secondary prevention, positive family history of SCD, nsVT and decreased LVEF seem to be the most significant risk factors associated with all- cause mortality in HCM patients with ICDs. Despite the ICD implantation, subpopulation studied had poor prognosis with high incidence of progression to end-stage heart failure. Further studies to create validated model for assessment of death risk in long-term observation of patients with HCM after ICD implantation are required.

Visual impairment and mortality in patients with type 2 diabetes

ObjectiveTo evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes.Research design and methodsThis is a 19-year follow-up of a cohort of 1241...

P6240The impact of stress myocardial blood flow as a very strong predictor for all-cause mortality, cardiovascular mortality and adverse cardiac and cerebrovascular event in hemodialysis population

Abstract Background In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic device for IHD. Although coronary flow reserve is the most important index in IHD diagnosis, there are limited data about stress myocardial blood flow (MBF). We investigated the prognosis predictability of stress MBF in all-cause mortality, cardiovascular (CV) mortality and adverse cardiac and cerebrovascular event (MACCE). Methods and results A total 438 of HD patients who undergone 13NH3PET for suspected IHD were enrolled. 29 cases were excluded due to revascularization therapy in 60 days. In total we collected 409 eligible cases. All patients were undergone13NH3PET at Nagoya Radiological Diagnosis Foundation. Patients were divided into two group according to the median value of stress MBF levels; low stress MBF group (&lt;2.12) and high stress MBF group (≥2.12). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their all-cause mortality, CV mortality and MACCE. Kaplan-Meyer analysis shows that intergroup difference in all-cause mortality (log rank p=0.001, hazard ratio [HR] 0.411, 95% confident interval [CI] 0.261–0.632), CV mortality (log rank p=0.002, HR 0.324, 95% CI 0.157–0.625) and MACCE (log rank p&lt;0.001, HR 0.465, 95% CI 0.324–0.657). Multiple cox analysis that include established risk factors shows CFR is an independent risk factor for all-cause mortality (HR 0.261, 95% CI 0.154–0.442), CV mortality (HR 0.172, 95% CI 0.079–0.374) and MACCE (HR 0.329, 95% CI 0.213–0.503). As a result of the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors, each indicator shows adding stress MBF on established risk factors improve the predictability in all-cause mortality, CV mortality and MACCE (all-cause mortality; NRI 0.642, p&lt;0.001, IDI 0.091, p&lt;0.001, CV mortality NRI 0.809, p&lt;0.001, IDI 0.116, p&lt;0.001, MACCE; NRI 0.646, p&lt;0.001, IDI 0.072, p&lt;0.001). Conclusion Considering prognosis of HD population, stress MBF is an important and independent predictor for all-cause mortality, CV mortality and MACCE. As a result of our investigation, stress MBF is one of most strong predictors in HD population.