Three-year All-cause Mortality Research Articles

Prognostic impact of left and right atrial strain in patients undergoing transcatheter aortic valve replacement.

Data on the prognostic value of left and right atrial strain after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are limited. Aim of this study was to evaluate outcomes of patients undergoing TAVR stratified by left and right atrial strain. Using data from a high-volume academic center, left and right atrial reservoir strain (LASr and RASr) was obtained in patients who underwent TAVR for severe AS from 2018 until 2021. Patients were stratified into groups with normal atrial function (LASr and RASr normal), uniatrial strain impairment (LASr or RASr impaired) and biatrial strain impairment (LASr and RASr impaired). Endpoints were three-year survival, symptomatic improvement as assessed by New York Heart Association functional class (NYHA class) as well as technical and device success defined by the Valve Academic Research Consortium (VARC-3) composite endpoints. The study included 1888 patients at a mean age of 81.0 ± 7.8 years (44.3% women). Mean LASr and RASr were 16.5 ± 9.4% and 21.6 ± 12.4%, respectively. Optimized cut-offs for mortality prediction were 15.5% for LASr and 15.0% for RASr. LASr and RASr were normal in 751 patients (39.8%). Impairment of either RA or LA strain was observed in 633 patients (33.5%) and 504 patients (26.7%) presented with reduced LA and RA strain. While impairment of either LASr or RASr was associated with a 1.7-fold increased risk of three-year all-cause mortality after adjustment for multiple confounders (95% CI 1.2-2.5, p=0.005), biatrial strain impairment exhibited an even higher three-year mortality risk (HR 2.5, 95% CI 1.7-3.6, p<0.001). Preprocedural assessment of atrial strain is associated with increased three-year mortality and might facilitate outcome prediction and patient selection in patients undergoing TAVR for severe AS.

Human Immunodeficiency Virus and CKD in the Tenofovir Era: A Prospective Parallel-Group Cohort Study From Tanzania

Rationale & ObjectiveLongitudinal research on chronic kidney disease (CKD) in sub-Saharan Africa is sparse, especially among people living with HIV. We evaluated the incidence of CKD among people living with HIV compared to HIV-uninfected controls in Tanzania. Study DesignProspective cohort study. Setting & Participants495 newly diagnosed people living with HIV who initiated antiretroviral therapy and 505 HIV-uninfected adults enrolled from public HIV clinics and followed from 2016 through 2021. The control group was recruited from HIV treatment partners from the same HIV clinics. ExposuresUntreated HIV (at baseline), antiretroviral therapy, socio-demographic information, health behaviors, hypertension, and diabetes. OutcomesIncident CKD, defined as follow-up eGFR <60 ml/min/1.73m2 with ≥25% reduction from baseline; annual eGFR change; incident albuminuria; three-year all-cause mortality. Analytical ApproachMultivariable Poisson and linear regression determined the association between HIV and other factors with baseline prevalent reduced eGFR and albuminuria, incident CKD and albuminuria, and annual eGFR change. Cox hazard regression assessed the association between baseline CKD and mortality. ResultsMedian age was 35 years and 67.5% were female. There were 101 incident CKD cases, 71 among people living with HIV and 30 among HIV-uninfected participants, equivalent to a CKD incidence of 57.9 per 1000 person-years (95% confidence interval (CI), 44.4-71.4) and 26.2 per 1000 person-years (95% CI, 16.8-35.5), respectively. People living with HIV had a more rapid eGFR decline (-6.65 versus -2.61 ml/min/1.73m2 per year). Female sex and older age were positively associated with incident CKD. Albuminuria incidence did not differ by HIV status. People living with HIV with albuminuria at baseline had higher mortality (hazard ratio, 2.13; 95% CI, 1.08-4.21). LimitationsAs an observational cohort study, there was no comparison group of HIV-positive participants on a non-tenofovir disoproxil fumarate-based antiretroviral therapy regimen. ConclusionsPeople living with HIV receiving tenofovir disoproxil fumarate-based antiretroviral therapy had a very high incidence of CKD and rapid eGFR decline. Conversely, albuminuria stabilized with antiretroviral therapy use. Expanding access to less nephrotoxic antiretroviral therapy, such as tenofovir alafenamide, is urgently needed throughout sub-Saharan Africa.

Machine learning for outcome prediction in patients with non-valvular atrial fibrillation from the GLORIA-AF registry

Clinical risk scores that predict outcomes in patients with atrial fibrillation (AF) have modest predictive value. Machine learning (ML) may achieve greater results when predicting adverse outcomes in patients with recently diagnosed AF. Several ML models were tested and compared with current clinical risk scores on a cohort of 26,183 patients (mean age 70.13 (standard deviation 10.13); 44.8% female) with non-valvular AF. Inputted into the ML models were 23 demographic variables alongside comorbidities and current treatments. For one-year stroke prediction, ML achieved an area under the curve (AUC) of 0.653 (95% confidence interval 0.576–0.730), compared to the CHADS2 and CHA2DS2-VASc scores performance of 0.587 (95% CI 0.559–0.615) and 0.535 (95% CI 0.521–0.550), respectively. Using ML for one-year major bleed prediction increased the AUC from 0.537 (95% CI 0.518–0.557) generated by the HAS-BLED score to 0.677 (95% CI 0.619–0.724). ML was able to predict one-year and three-year all-cause mortality with an AUC of 0.734 (95% CI 0.696–0.771) and 0.742 (95% CI 0.718–0.766). In this study a significant improvement in performance was observed when transitioning from clinical risk scores to machine learning-based approaches across all applications tested. Obtaining precise prediction tools is desirable for increased interventions to reduce event rates.Trial Registryhttps://www.clinicaltrials.gov; Unique identifier: NCT01468701, NCT01671007, NCT01937377.

Multilevel Disparities of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers in the United States.

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality-urbanicity measures alongside individual-level race-ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race-ethnicity (OR, 2.07; 95% CI, 1.68-2.54) and poor Yost SES (1.43; 1.24-1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race-ethnicity (2.74; 1.84-4.71) and of males with poor Yost SES (1.98; 1.79-2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race-ethnicity (2.50; 1.82-3.44) compared to males (2.23; 1.91-2.60); this was reversed for poor Yost SES (male, 1.92, 1.76-2.10; female, 1.60, 1.32-1.95). Surgery showed negative predictors of black race-ethnicity that displayed worsened effects in females (0.60, 0.44-0.79) versus males (0.75, 0.66-0.86). First-line radiation receipt uniquely featured negative predictors for males of black race-ethnicity (0.73; 0.62-0.86) with poor Yost SES (0.74; 0.68-0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race-ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population.

Temporal changes in characteristics, incidence, and mortality in patients undergoing surgical intervention for mitral stenosis

To examine temporal changes in patient characteristics, the incidence rate of surgical intervention, and the three-year mortality rate for patients undergoing surgical intervention for mitral valve stenosis (MS) from 2001 to 2021 in Denmark. Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time surgical intervention for MS (2001–2021). Temporal changes in the incidence rate of surgical intervention across calendar periods were investigated (2001–2005, 2006–2010, 2011–2015, and 2016–2021). Using Kaplan-Meier estimates, we computed temporal changes in three-year all-cause mortality across calendar periods. With multivariable Cox regression analysis, we assessed the adjusted rates of mortality. We included 256 patients (median age 60.3 years, 31.3% males). A stepwise decrease in the burden of chronic heart failure was identified (2001–2005: 54%, and 2016–2021: 20%, p-value < 0.001 for trend), while the burden of atrial fibrillation seemed stable (2001–2005: 51%, and 2016–2021: 46%, p-value = 0.27 for trend). The proportion of patients with rheumatic MS was 64% in 2001–2005 and 33% in 2016–2021, p-value < 0.001 for trend. 28 patients (10.9%) had mitral valve surgery prior to the first-time surgical intervention for MS. A stepwise decrease in the incidence rate of surgical intervention was observed: 3.3 cases per million person-years in 2001–2005 and 2.2 in 2016–2021. The incidence of patients diagnosed with first-time MS remained stable over calendar periods (2001–2005: 54.5 incidences per million person-years, and 2016–2021: 41.9, p-value = 0.46 for trend). The in-hospital mortality was 8.6% and the three-year mortality after surgical discharge was 9.0%, and we found no difference over calendar periods in either crude estimates or adjusted analysis. From nationwide data across three decades, we identified that the incidence of surgical interventiondecreased significantly within the past 20 years, while all-cause mortality remained stable. The burden of heart failure decreased, while the burden of atrial fibrillation remained stable over the study period.

Risk Factors for All-Cause Mortality in Patients Diagnosed with Advanced Heart Failure: A Scoping Review.

Introduction: Identifying the evolving needs of patients with advanced heart failure (AdHF) and triaging those at high risk of death can facilitate timely referrals to palliative care and advance patient-centered individualized care. There are limited models specific for patients with end-stage HF. We aim to identify risk factors associated with up to three-year all-cause mortality (ACM) and describe prognostic models developed or validated in AdHF populations. Methods: Frameworks proposed by Arksey, O'Malley, and Levac were adopted for this scoping review. We searched the Medline, EMBASE, PubMed, CINAHL, Cochrane library, Web of Science and gray literature databases for articles published between January 2010 and September 2020. Primary studies that included adults aged ≥ 18 years, diagnosed with AdHF defined as New York Heart Association class III/IV, American Heart Association/American College of Cardiology Stage D, end-stage HF, and assessed for risk factors associated with up to three-year ACM using multivariate analysis were included. Studies were appraised using the Quality of Prognostic Studies tool. Data were analyzed using a narrative synthesis approach. Results: We reviewed 167 risk factors that were associated with up to three-year ACM and prognostic models specific to AdHF patients across 65 articles with low-to-moderate bias. Studies were mostly based in Western and/or European cohorts (n = 60), in the acute care setting (n = 56), and derived from clinical trials (n = 40). Risk factors were grouped into six domains. Variables related to cardiovascular and overall health were frequently assessed. Ten prognostic models developed/validated on AdHF patients displayed acceptable model performance [area under the curve (AUC) range: 0.71-0.81]. Among the ten models, the model for end-stage-liver disease (MELD-XI) and acute decompensated HF with N-terminal pro b-type natriuretic peptide (ADHF/proBNP) model attained the highest discriminatory performance against short-term ACM (AUC: 0.81). Conclusions: To enable timely referrals to palliative care interventions, further research is required to develop or validate prognostic models that consider the evolving landscape of AdHF management.

Acetate-containing bicarbonate dialysate increases all-cause mortality more than acetate-free bicarbonate dialysate containing citrate in hemodialysis patients

BackgroundNo studies have compared mortality between acetate-containing bicarbonate dialysate (ABD) and acetate-free bicarbonate dialysate containing citrate (AFD) in hemodialysis (HD) or online hemodiafiltration (OHDF). We therefore compared mortality between ABD and AFD in each modality.MethodsThis retrospective observational study included 738 patients who were receiving super high-flux (SHF) or SHF albumin-leaking HD (n = 310: ABD 235 and AFD 75) or OHDF (n = 428: ABD 321 and AFD 107) at our institution between 1 April and 1 July 2017. Three-year all-cause mortality was compared between ABD and AFD in the HD or OHDF groups using a propensity score matching model. Kaplan–Meier survival curves were compared using the log-rank test, and then Cox regression analysis with adjustments was performed for some covariates that remained significant.ResultsAfter propensity score matching, mortality on ABD was not significantly different from that on AFD in the HD group [n = 75; hazard ratio (HR) 2.271, 95% confidence interval (CI) 0.863–5.981, P = 0.087] or in the OHDF group (n = 107; HR 1.944, 95% CI 0.585–6.458, P = 0.269) without adjustments. However, with adjustments using some covariates, mortality was significantly higher on ABD than on AFD (adjusted HR 4.501, 95% CI 1.434–14.125, P = 0.010) in the HD group, but not in the OHDF group.ConclusionsThese findings suggest that ABD worsens mortality more than AFD in patients on SHF and SHF albumin-leaking HD.Trial registration: UMIN Clinical Trials Registry, UMIN000053090. Prospectively registered 13 December 2023, https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000060581.

γ-Gammaglutamyl transferase predicts all-cause mortality within three-year intervals in patients undergoing peritoneal dialysis

Objectives Peritoneal dialysis (PD) serves as a vital renal replacement therapy for patients with end-stage kidney disease (ESKD). γ-Gamma-glutamyl transferase (γ-GGT) is a recognized predictor of oxidative stress and mortality. This study aimed to assess the prognostic significance of γ-GGT in predicting all-cause and cardiovascular mortality among PD patients. Methods A retrospective study was conducted, enrolling 640 PD patients from a single center. The one-year, three-year, and five-year mortality rates for all causes and cardiovascular causes were evaluated. Kaplan–Meier survival analysis and multivariate Cox regression analysis were performed. Results Within five years of initiating PD, the observed all-cause mortality rates at one, three, and five years were 11.72%, 16.09%, and 23.44%, while cardiovascular mortality rates were 2.97%, 7.34%, and 11.09%, respectively. Lower γ-GGT levels were associated with decreased all-cause mortality during one-, three-, and five-year follow-ups, along with reduced cardiovascular mortality in the first and third years, as indicated by Kaplan–Meier analysis on median γ-GGT groupings. Multivariate Cox regression analysis showed significantly decreased hazard ratios (HRs) for one- to five-year all-cause mortality and cardiovascular mortality in the lower γ-GGT group compared to higher groups. However, when sex differences were eliminated using separate tertile groupings for males and females, only the one- and three-year all-cause mortality rates demonstrated significantly reduced hazard ratios (HRs) in the lower γ-GGT groups. Conclusion This retrospective study suggests that γ-GGT levels have prognostic significance in predicting one- and three-year all-cause mortality among PD patients when accounting for sex differences.

The impact of dyslipidemia on prognosis of patients after endovascular abdominal aortic aneurysm repair.

Dyslipidemia is common in patients with abdominal aortic aneurysm (AAA). However, there is insufficient research on the impact of dyslipidemia on the postoperative outcomes of patients with AAA after endovascular aortic aneurysm repair (EVAR). This study aimed to determine the impact of dyslipidemia on the prognosis of patients with AAA treated with EVAR. We retrospectively reviewed patients with AAA who underwent EVAR at our hospital between 2010 and 2020. The baseline characteristics and prognoses of patients in the dyslipidemia and non-dyslipidemia groups were analyzed. A total of 641 patients were included; the prevalence of dyslipidemia in patients with AAA was 42.3% (271/641), and the mean follow-up time was 63.37 ± 26.49 months. The prevalence of diabetes (10.0% vs. 15.1%, P = 0.050), peripheral arterial disease (17.3% vs. 25.8%, P = 0.018), and chronic kidney disease (3.0% vs. 6.3%, P = 0.043) was higher in the dyslipidemia group. The three-year all-cause mortality rate after EVAR was 9.98% (64/641), and there was no difference in the incidence of all-cause mortality (10.27% vs. 9.59%, P = 0.778) between the two groups. A total of 36 (5.62%) major adverse cardiovascular and cerebrovascular events (MACCEs) were observed within 3 years and were more common in patients with dyslipidemia (2.97% vs. 9.59%, P < 0.001). The incidence of stent-related complications in all patients was 19.97% (128/641), and there was no difference in the incidence of stent-related complications between the two groups (22.16% vs. 16.97%, P = 0.105); however, the incidence of type I endoleak in the dyslipidemia group was lower than that in the non-dyslipidemia group (9.19% vs. 4.06%, P = 0.012). Cox-regression analysis showed that high level of high-density lipoprotein cholesterol (HDL-C) was the protective factor (HR, 0.203, 95% CI, 0.067-0.616, P = 0.005) for MACCES, but it was the risk factor for type I endoleak (HR, 2.317, 95% CI, 1.202-4.466, P = 0.012). Dyslipidemia did not affect the mortality of patients with AAA who underwent EVAR; however, it may increase the incidence of MACCEs. Dyslipidemia may decrease the incidence of type I endoleaks after EVAR; however, further studies are warranted. We should strengthen the postoperative management of patients with dyslipidemia, prevent the occurrence of MACCEs.

Atrial Functional Tricuspid Regurgitation in Patients Undergoing Transcatheter Aortic Valve Replacement

BackgroundKnowledge about atrial functional tricuspid regurgitation (afTR) in transcatheter aortic valve replacement (TAVR) patients is scarce. ObjectivesThe aim of the study was to analyze the association between the entity and the development of tricuspid regurgitation (TR) in patients undergoing TAVR for aortic stenosis and concomitant TR. MethodsWe analyzed patients undergoing TAVR for severe aortic stenosis from January 2013 to December 2020 and concomitant at least moderate TR at baseline. afTR was defined as enlargement of the right atrium in relation to the right ventricle. TR development after TAVR and 3-year all-cause mortality were evaluated. ResultsOut of 3,474 TAVR patients, we identified 420 patients with concomitant at least moderate TR. A total of 363 patients were included in the study, with 178 patients stratified in the afTR and 185 in the non-afTR group based on a receiver-operating characteristic curve cutoff of 1.132 of the right atrial/right ventricular area ratio. TR improvement after TAVR was observed in significantly less patients with afTR compared with non-afTR (31.1% vs 60.6%; P < 0.001). Multivariate regression analysis confirmed afTR as independent predictor for TR persistence (adjusted OR: 2.80; 95% CI: 1.66-4.76; P < 0.001). Moreover, afTR was associated with aggravation of TR after TAVR (17.0% vs 6.8%; P = 0.013). Three-year all-cause mortality was significantly higher in patients with persistence compared with patients with improvement of TR (P < 0.001). ConclusionsIn TAVR patients, afTR is an independent predictor for TR persistence. Moreover, TR persistence is associated with increased 3-year all-cause mortality.

Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction.

Due to limited real-world evidence on the association between time to presentation (T2P) and outcomes following acute myocardial infarction and diabetes (AMI-DM), we investigated the characteristics of patients with AMI-DM and their outcomes based on their T2P. 4,455 patients with AMI-DM from a Korean nationwide observational cohort (2011-2015) were divided into early and late presenters according to symptom-to-door time. The effects of T2P on three-year all-cause mortality were estimated using inverse probability of treatment weighting (IPTW) and survival analysis. The incidence of all-cause mortality was consistently higher in late presenters than in early presenters (11.4 vs. 17.2%; p < 0.001). In the IPTW-adjusted dataset, the incidence of all-cause mortality was numerically higher in late presenters than in early presenters (9.1 vs. 12.4%; p = 0.072). In the survival analysis, the cumulative incidence of all-cause mortality was significantly higher in late presenters than in early presenters before and after IPTW. In the subgroup with ST-elevation myocardial infarction, late presenters had a higher incidence of cardiac death than early presenters before (4.8 vs. 10.5%; p < 0.001) and after IPTW (4.2 vs. 9.7%; p = 0.034). In the initial glycated hemoglobin (HbA1c)-stratified analysis, these effects were attenuated in patients with HbA1c ≥ 9.0% before (adjusted hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 0.80-2.64) and after IPTW (adjusted HR: 0.82, 95% CI: 0.40-1.67). Late presentation was associated with higher mortality in patients with AMI-DM; therefore, multifaceted and systematic interventions are needed to decrease pre-hospital delays.

Quantitative Association between Computed-Tomography-Based L1 Skeletal Muscle Indices and Major Adverse Clinical Events Following Percutaneous Coronary Intervention

Sarcopenia is as a non-traditional risk factor for atherosclerotic cardiovascular disease. Further investigation is required to elucidate the prognostic significance of computed tomography (CT)-based sarcopenia assessment in coronary artery disease (CAD). We prospectively enrolled 475 patients, who underwent coronary stent implantation and peri-procedural CT scans within one month. Skeletal muscle index (SMI) was assessed cross-sectionally at the first lumbar vertebra (L1) level. The participants were grouped based on sex-specific L1 SMI quartiles. The primary endpoint was all-cause mortality, and the secondary composite endpoint was major adverse cardiovascular events (MACEs) over a 3-year follow-up period. Three-year all-cause mortality and MACE incidence increased significantly in patients in the lower L1 SMI quartiles compared to those of patients in the higher quartiles (p &lt; 0.001). The individual composite endpoints consistently showed a higher incidence in the lower quartiles of L1 SMI (p &lt; 0.001). In multivariable analysis, the lower L1 SMI quartiles independently predicted 3-year all-cause mortality and MACEs (lowest vs. highest quartiles, respectively: OR 4.90 (95% CI 1.54–15.5), p = 0.007; and OR 12.3 (95% CI 4.99–30.4), p &lt; 0.001). In conclusion, CT-based L1 SMI demonstrated a distinct dose-dependent relationship with future MACEs in CAD patients undergoing percutaneous coronary intervention, thereby enhancing cardiovascular risk stratification.

The prognostic value of left atrial strain in patients with low-flow, low-gradient aortic stenosis

Abstract Background Left atrial (LA) function is known to be an independent prognostic parameter in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of LA function on postinterventional outcomes in patients with severe low-flow, low-gradient aortic stenosis (LFLG AS) is unknown. Objectives We aimed to evaluate postinterventional changes and prognostic value of LA strain in patients with LFLG AS who underwent TAVR. Methods We retrospectively included 88 patients (79.66 ± 6.33, 37.5% female) with symptomatic LFLG AS who underwent TAVR at the Heart Center Bonn. LA global function and strain were comprehensively assessed by the postprocessing left atrial phasic strain analysis – LA reservoir strain, LA conduit strain, and LA contractile strain ­– using a commercially available postprocessing software at baseline and three years after the procedure. The apical four-, two-, and three-chamber views with sufficient image quality were used for strain analysis. Results Baseline LA strain was found to be impaired in all patients (reservoir: 13.17 ± 7.62 %; conduit: 6.7 ± 6.4 %; contractile: -1.7 ±1.5 %). All-cause mortality was 41 % three years after the procedure. In the overall collective, LA reservoir strain was increased at follow-up (13.17 ± 7.62 % to 15.21 ± 10.13 %, p= 0.049), whereas conduit and contractile strain remained unchanged (p &amp;gt; 0.05). According to the survival at follow-up, we divided the cohort into survivors and non-survivors. Baseline reservoir (14.55 ± 8.14 % vs 9.59 ± 5.23 %, p= 0.002) and conduit (7.66 ± 7.14 % vs 4.44 ± 4.1 %, p= 0.017) strain were significantly higher in survivors. All LA strain parameters were significantly improved in survivors at follow-up. In contrast, non-survivors showed no relevant changes in LA strain parameters. In comparison of ROC curves, reservoir strain was found to be the best predictor for postinterventional survival after TAVR (reservoir AUC: 0.677, cutoff: 10 %, p = 0.007; conduit AUC: 0.642, cutoff: 3.7 %, p = 0.037; contractile AUC: 0.672, cutoff: -1,3 %, p = 0.008). Concordantly, we found that all LA strain parameters are independent predictors for three-year all-cause mortality after TAVR in cox regression analysis (reservoir OR: 0.89, p=0.005; conduit OR: 0.90, p=0.03, contractile OR: 0.71, p=0.029) in cox regression analysis. According to multivariate analysis, reservoir strain (OR: 0.91, p=0.05) and conduit strain (OR: 0.94, p=0.04) were found to be independent predictors for postinterventional survival. According to log-rank analysis, patients with a baseline reservoir strain &amp;lt; 10 % and a baseline conduit strain &amp;lt; 4 %) showed significantly higher mortality (p = 0.048). Conclusion Using LA strain parameters might optimize risk stratification and better decision-making with sufficient patient selection in this vulnerable cohort.

Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study

BackgroundSurvival is equivalent between super high-flux hemodialysis (SHF-HD) and online hemodiafiltration (OHDF) with similar albumin leakage. According to the 2013 Japanese dialyzer performance classification, survival on HD is optimal when a type II dialyzer (β2-microglobulin clearance ≥ 70 mL/min) is used. Here, we investigated whether survival could be improved by SHF-HD using a type II-b dialyzer (sieving coefficient for albumin ≥ 0.03) with high albumin leakage compared with OHDF or SHF-HD using a type II-a dialyzer (sieving coefficient for albumin < 0.03) with low albumin leakage.MethodsThis 3-year retrospective observational propensity score-matched study included 738 patients receiving SHF-HD (n = 310) or OHDF (n = 428) with a type II dialyzer at our institution between April 1 and July 1, 2017. Three-year all-cause mortality was compared for SHF-HD with high estimated albumin leakage (EAL) versus OHDF and SHF-HD with low EAL. Kaplan–Meier survival curves were compared using the log-rank test and hazard ratios were calculated by Cox regression analysis.ResultsMortality in SHF-HD with high EAL was significantly lower than OHDF with low EAL (each n = 52 after matching; P = 0.007, log-rank test). All the dialyzers used a polyethersulfone (PES) membrane, whereas none of the hemodiafilters had a PES membrane. In SHF-HD, mortality was significantly lower when EAL was ≥ 3.0 g/session than when EAL was < 3.0 g/session (each n = 115 after matching, P = 0.004, log-rank test) and when the dialyzer used was type II-b rather than type II-a (each n = 133 after matching, P = 0.001, log-rank test).ConclusionsThese findings suggest that survival is better on SHF-HD using a type II-b dialyzer with high albumin leakage than on OHDF with low albumin leakage or SHF-HD using a type II-a dialyzers. The PES used in the type II-b dialyzer may also have a beneficial effect on survival.

The economic burden and long-term mortality in survivors of extracorporeal membrane oxygenation in South Korea.

The economic burden for extracorporeal membrane oxygenation (ECMO) survivors is a critical issue. We investigated the total healthcare costs for one year following ECMO support and its association with three-year all-cause mortality. This population-based cohort study used data from the National Health Insurance Service (NHIS) in South Korea. Adult ECMO survivors (age ≥18 years who were alive ≥365 days following ECMO support) from January 1, 2005, to December 31, 2018, were included. The total healthcare costs for one year included all the expenses for hospital and outpatient clinic visits after discharge. In total, 6,044 patients were included in the final analysis comprising 3,566 (59.0%) in the cardiac indication group, 658 (10.9%) in the respiratory indication group, and 1,820 (30.1%) in the "other" group. The median total healthcare cost was United States Dollars (USD) 46,308.0 [interquartile range (IQR): 25,727.0-86,924.8]. The median ECMO support and hospital stay durations were three (IQR: 1-7) days and 25 (IQR: 15-31) days. In the multivariable Cox regression model, a USD 1,000 increase in the total healthcare cost was associated with an increase in the three-year all-cause mortality (hazard ratio, 1.01; 95% CI: 1.00-1.01; P=0.015). After one year, ECMO survivors accrued USD 46,308 in healthcare costs in South Korea. An increase in the total healthcare cost was associated with a higher risk of three-year all-cause mortality among ECMO survivors.

Association of anaemia with long-term mortality among patients with hypertensive crisis in the emergency department

Background Anaemia is frequent in patients with cardiovascular disease and is significantly associated with poor prognosis. However, the prognostic significance of anaemia in hypertensive crisis remains unknown. We conducted this study to determine whether anaemia is a risk factor for all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). Methods This retrospective study included patients who visited the ED between 2016 and 2019 for hypertensive crisis, which was defined as systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg. A total of 5,512 patients whose serum haemoglobin levels were checked were included in this study and were classified into three groups according to their serum haemoglobin levels at admission to the ED: moderate/severe anaemia (haemoglobin <11 g/dL), mild anaemia (haemoglobin 11 to <13 g/dL in men and 11 to <12 g/dL in women), and non-anaemia (haemoglobin ≥13 g/dL in men and ≥12 g/dL in women). Results Among 5,512 patients, 665 (12.1%) and 668 (12.1%) were classified into the moderate/severe anaemia and mild anaemia groups, respectively. The three-year all-cause mortality rates in the moderate/severe anaemia, mild anaemia, and non-anaemia groups were 46.0, 29.2, and 12.0%, respectively. After accounting for relevant covariates, patients with moderate/severe anaemia group (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.75–2.64) and mild anaemia group (HR, 1.32; 95% CI, 1.07–1.63) had a higher risk of 3-year all-cause mortality than the non-anaemia group. Conclusion Anaemia is independently associated with 3-year all-cause mortality in patients with hypertensive crisis. A comprehensive therapeutic approach through more in-depth examination and close follow up are required for patients with hypertensive crisis with anaemia. KEY MESSAGES Anaemia is independently associated with 3-year all-cause mortality in patients with hypertensive crisis. A comprehensive therapeutic approach through more in-depth examination and close follow up are required for patients with hypertensive crisis with anaemia.

Three-year outcomes following transcatheter tricuspid valve edge-to-edge repair

Abstract Background Tricuspid regurgitation (TR) has long been neglected due to limited therapeutic options. Within the past five years, transcatheter tricuspid valve edge-to-edge repair (T-TEER) has become a valuable tool in the treatment of TR besides diuretic medical therapy and valve surgery. Owing its novelty, data on long-term survival after T-TEER for relevant TR are sparse. Beyond that, there is uncertainty on the impact of TR reduction on outcomes after successful T-TEER. Purpose This study sought to investigate long-term survival outcome after T-TEER for relevant symptomatic TR. We evaluated the impact of TR reduction on outcome in patients with successful T-TEER. Methods Consecutive patients who underwent successful isolated T-TEER for relevant TR from 2016 until 2022 at a high-volume university center were included in the study. Procedural success was defined as at least one degree TR reduction. Long-term survival endpoint was three-year all-cause mortality. Survival follow-up was completed via phone calls with the patients themselves, the next of kin, local practitioners and using the German national population registry. Post-procedural TR was assessed by interventionalist and echocardiographer at the end of the T-TEER procedure. Results A total of 244 patients who underwent successful T-TEER in the study period were included in the present analysis (mean age 77.7±8.7 years; 50.8% female). Patients were highly symptomatic as represented by New York Heart Association functional class ≥ III in 95.9% of cases. TR was 4+ in 128 patients (52.2%), 3+ in 106 patients (43.4%) and 2+ in 10 patients (6.1%). The etiology of TR was predominately functional (88.5%), while 5.4% presented with degenerative TR and 6.1% with TR of mixed etiology. Median time to last contact or death was 365 days (interquartile range 166–809 days). Three-year follow-up was available in 98% of eligible patients. T-TEER was performed using a mean number of 2.0±0.6 devices (Mitra-/TriClip 53%; PASCAL 47%). Post-procedural TR was 1+ in 126 patients (51.6%), 2+ in 101 patients (41.4%) and 3+ in 17 patients (7.0%). Survival rates at one, two and three years were 76%, 68% and 56%. Among patients with procedural success (at least 1° TR reduction), a higher degree in post-procedural TR was associated with a trend towards reduced postinterventional survival (Figure 1). The absolute degree of TR reduction did not impact survival rates in patients with procedural success (Figure 2). Conclusion T-TEER effectively reduces TR severity and shows high rates of procedural success. While the extent of TR reduction did not yield prognostic value in terms of long-term survival, the degree of post-procedural TR showed a trend regarding survival outcome. These results indicate that procedural techniques and strategies should be refined to achieve TR1+ at the end of the procedure. Funding Acknowledgement Type of funding sources: None.

Effects of renin-angiotensin system inhibitor type and dosage on survival after transcatheter aortic valve implantation.

The objective of the study was to determine the effect of renin-angiotensin system inhibitors (RASI) on the survival of subgroups of patients with aortic stenosis after transcatheter aortic valve implantation (TAVI) and to assess the impact of types and dosages of RASI on outcomes. This single-centre, retrospective analysis included 2862 patients (n=2227 with RASI and n=635 without RASI) after successful TAVI. Propensity score matching established comparable patient populations (n=625 per group). Survival was analysed by Kaplan-Meier curves and Cox regression and was corrected for baseline, procedural, and medical parameters. Self-reported adherence to RASI therapy 3 months after hospital discharge was 94%. Three-year all-cause mortality rates were 12.3% and 20.2% for patients with or without RASI, respectively (log-rank<0.001).In the matched study populations, mortality rates were 14.2%vs. 20.0% (log-rank<0.03).RASI was particularly beneficial in patients with ejection fraction<40%[adjusted hazard ratio (HR) and 95% confidence interval 0.50 (0.29-0.87)], EuroScore II≥4% [HR 0.47 (0.35-0.65)], or low-flow, low-gradient aortic stenosis [HR 0.53 (0.31-0.93)] who were also on beta-blockers and statins. An association between discharge dosage and survival was observed, with HR 0.75 (0.58-0.96) and 0.57 (0.44-0.72) for patients on<50%and≥50% target dose, respectively. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) reduced mortality rates similarly (13.9%vs. 9.8%, log-rank 0.103). The beneficial association between RASI after TAVI and improved survival during follow-up is particularly evident in high-risk patients and may be dose dependent. No superiority was noted in the effectiveness of ACEI or ARB.

Soluble α-Klotho as a potential predictor of all-cause mortality in Chinese maintenance hemodialysis patients

IntroductionThis study aimed to clarify the potential association of serum soluble α-klotho levels with all-cause mortality in Chinese patients on maintenance hemodialysis (MHD).Material and methodsThe present study is a single -center prospective cohort study. It comprised 134 MHD patients which were divided into two groups according to the median level of serum α -klotho: 68 patients representing the low soluble α-klotho group (&lt; 1.15 ng/ml and equivalent to 1.15 ng/ml) and 66 patients representing the high soluble α -klotho group (&gt;1.15 ng/ml). These patients were followed up for 36 months. The three-year all-cause mortality rate, overall survival (OS) and cardio-cerebrovascular mortality were observed. The potential risk factors of all-cause mortality in MHD patients were investigated by Cox regression models.ResultsThe 3-year all-cause mortality rates in low soluble α-klotho group were significantly higher than those in high soluble α-klotho group (33.82% vs. 16.67%, P=0.039). The difference of the 3-year cardio-cerebrovascular mortality rates between the two groups was non-significant (26.47% vs. 15.15%, P=0.107). The Kaplan-Meier analysis showed that the differences in the rates of OS and cardio-cerebrovascular death free survival between the two groups were significantly different (all P&lt;0.05). The Cox regression analyses revealed that low soluble α-klotho level was an independent predictor of all-cause mortality in MHD patients after adjusting for potential confounding factors.ConclusionsLow serum soluble α-klotho levels was associated with increased risk of all-cause mortality in Chinese MHD patients.

Gender Differences in All-Cause Mortality after Acute Myocardial Infarction: Evidence for a Gender-Age Interaction.

Gender difference studies in mortality after acute myocardial infarction (AMI) have shown inconsistent results. A total of 13,104 patients from the KAMIR-NIH between November 2011 and December 2015 were classified into young (n = 3837 [29.3%]) and elderly (n = 9267 [70.7%]) patients. For the study, women <65 and men <55 years of age were considered “young”. In the adjusted model of the entire cohort, there was no significant difference in three-year all-cause mortality between women and men (17.8% vs. 10.3%; adjusted hazard ratio [HR], 0.953; 95% confidence interval [CI], 0.799–1.137). However, when the entire cohort was subdivided into two age groups, young women showed an 84.3% higher mortality rate than young men (adjusted HR, 1.843; 95% CI, 1.098–3.095). Contrariwise, elderly women patients had a 20.4% lower hazard of mortality compared with elderly men (adjusted HR, 0.796; 95% CI, 0.682–0.929). The interaction of gender with age was significant, even after multiple adjustments (adjusted p for interaction = 0.003). The purpose of this study was to assess whether gender differences depend on the patients’ age. Based on our analysis, higher mortality of young women remains even in the contemporary era of AMI. A better understanding of the mechanisms underlying these differences is warranted.