Atrial fibrillation with or without structural abnormalities. Analysis from a nationwide database

Background

Atrial Fibrillation (AF) is often associated with underlying heart failure, valvular disease, ischemic heart disease, as well as other structural heart diseases, but can also occur as an independent entity which may be named pure AF or lone AF. Small cohort studies have suggested that lone AF patients may have a favorable prognosis in terms of mortality and ischemic stroke rates. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with lone AF and AF associated with cardiac disease.

Methods

From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information) covering hospital care and representative of the whole French population, all consecutive patients with AF diagnosis hospitalized between 2010 and 2018 were included. From this huge database, 2,793,234 patients were included: group lone FA: 665,431, group AF and cardiac disease: 2,727,803. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular [CV] death, or ischemic stroke) during follow-up were compared between groups using incidence rate ratios (RR) for the whole cohort and also for a subgroup of 539,654 propensity score matched patients for non-cardiovascular conditions (269,827 with AF alone and 269,827 with AF and CD).

Results

The majority of this population had AF associated with a cardiac disease (n=2,127,803; 76.2%). At follow-up (median [IQR] 1.1 [0.1–3.4] years), patients with AF and CD were at higher risk of all-cause mortality (yearly incidence 13.6% vs 9.0%, RR [95% CI] 1.51 [1.50–1.52], p<0.00001) and CV death (4.4% vs 1.9%, RR 2.33 [2.30–2.36], p<0.00001) than those with lone AF. In the propensity score matched population (median follow-up [IQR] 1.9 [0.3–4.4] years), patients with AF and CD also had worse outcomes than patients with lone AF (yearly incidence rates for all-cause mortality: 10.6% vs 7.4%, RR 1.43 [1.42–1.45], p<0.00001; and for CV death: 3.3% vs 2.0%, RR 1.64 [1.61–1.68], p<0.00001). However, lone AF patients were at higher risk of ischemic stroke: yearly incidence rates 2.75% in those with lone AF vs 1.69% in patients with AF and CD (RR 0.62 [0.60–0.63], p<0.00001).

Conclusion

In our large study from a nationwide database about patients hospitalized with AF, two distinct clinical entities were identified, that could explain the results highlighted: 1) the consistently higher mortality in the group associating AF and underlying heart disease (AF may bea marker for poor outcome when there is a structural heart disease; 2) Lone AF group which prognosis may be related to a higher incidence of thromboembolic events. These results could have important implications in terms of thromboembolic prevention but further studies are still needed to investigate the underlying mechanisms of embolic pathophysiology and its specific management.

Funding Acknowledgement

Type of funding source: None

High levels of lipoprotein(a) are associated with the severity of coronary disease in patients with acute myocardial infarction. Data from the RICO survey

Background

High level of Lipoprotein(a), Lp(a), is a well-recognised independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, limited data are available on the prevalence of high Lp(a) levels and on the threshold associated to coronary artery disease (CAD) burden in patients with acute myocardial infarction (MI).

Methods

We aim at assessing CAD burden in 651 consecutive patients hospitalized for an acute MI from January 2019 to September 2019 who underwent coronary angiography. Patients characteristics and angiographic features were compared for patients with Lp(a) <50 mg/dL (normal), ≥50 mg/dL (high) and >80 mg/dL (i.e >90th percentile) (very high).

Results

The prevalence of Lp(a) ≥50 mg/dL was elevated (19.0%) and 65 patients (10.0%) were in the >90th percentile. Median (IQR) age was similar across the 3 groups (normal: 68 (59–79)y; high: 74 (63–80)y; very high: 71 (57–82)y, p=0.239). When compared with patients with normal Lp(a), patients with very high levels (≥80 mg/dL) had higher prevalence of personal history of ASCVD (29 vs 16%, p=0.021) and family history of CAD (37 vs 19%, p=0.005), and were more frequently women (43 vs 29%, p=0.009). At coronary angiography, patients with very high Lp(a) levels had increased extent of CAD (Median SYNTAX score 17 (5–25) vs 10 (5–17), p=0.002) and more frequent multivessel disease (69 vs 54%, p=0.02).

Conclusion

Among real world patients hospitalized for an acute MI, Lp(a) levels >80 mg/dL are associated with an increased CAD burden and this threshold identifies a subset of patients with features of high ASCVD risk.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté; CHU Dijon Bourgogne

Post-infectious myocardial infarction: does percutaneous coronary intervention improves outcomes?

Introduction and objectives

Acute infections are frequent triggers for myocardial infarction (MI), and associated with poor prognosis. However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis remains unknown. We aimed to evaluate the prognostic impact of PCI at the acute phase of post-infectious MI in patients with significant coronary stenosis.

Methods

Observational study in 4573 consecutive MI patients of the RICO Survey in coronary units, of whom 476 patients (10%) had a concurrent diagnosis of acute infection at admission. Among them, 321 patients with a significant stenosis (>50%) at coronary angiography were analysed. After propensity score matching based on clinical and angiography data, in-hospital and one-year outcomes were compared between patients with and without PCI.

Results

Among the 321 patients (mean age 74y), most (n=195 (61%)) underwent PCI. Acute atherothrombotic event (type 1 MI) and STEMI were much more frequent in the PCI group (53 vs 19%, p<0.001, and 51% vs 32%, p=0.001, respectively). As expected, Troponin Ic peak was almost 3 times higher in the PCI group (17 [4–72] vs 6 [1–20] ng/mL, p<0.001). Coronary lesions were less severe in the PCI group (3-vessels disease: 36% vs 52%, p<0.004; SYNTAX score: 11 [6–19] vs 19 [11–28], p<0.001). At one year follow up, recurrence rate (5% for both groups, p=0.8), and cardiovascular (CV) mortality (15% vs 13%, p=0.6) were similar for both groups. After propensity score matching, in-hospital (OR = 1.45 (0.43–4.85), p=0.5) and 1-year CV mortality: OR = 1.73 (0.66–4.54), p=0.3) were similar in patients with and without PCI.

Conclusion

In this first observational work investigating treatment strategy in post-infectious MI, PCI might not improve short and long-term prognosis. These findings do not support the use of systematic invasive procedures after post-infectious MI. Interventional studies are urgently needed to confirm these findings.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Agence Régionale de Santé Bourgogne Franche Comté, CHU Dijon Bourgogne

Simultaneous cardio-cerebral embolization. A prospective study

Background

Atrial Fibrillation (AF) is a common cause of ischemic stroke but also the most common cause of Coronary Artery Embolism (CE). Many previous case of coexistence of coronary and cerebral embolism have been reported in the literature but in specific situations were clinical signs of stroke but also indisputable clinical and/or electrocardiographic (ECG) signs leaded to the realization of coronarography in emergency.

Objectives

The aim of the study was to determine the existence of simultaneous cardio-cerebral embolization associated in patients with ischemic embolic stroke on de novo AF, in the absence of clinical and/or ECG signs evocative of myocardial infarction (MI).

Methods

We prospectively included patients hospitalized in our institution for ischemic embolic stroke on de novo AF. Patients with history of ischemic disease were excluded. All patients had: 1/ troponin assay; 2/ Cardiac Magnetic Resonance (CMR) imaging with Late-Gadolinium Enhancement (LGE) in order to detect myocardial infarction; 3/ coronary exploration by cardiac CT scan or coronarography to exclude patients with significant coronary lesion.

Results

Between January and December 2019, 32 patients were included. Of them, 15 had subendocardial or transmural LGE on CMR, evocative of MI. Among these 15 MIs we classified acute MIs according to the level of troponin at the admission in stroke unit, the coronarography and T2 hypersignal on cardiac MRI. Median delay of cardiac MRI was 6 days for acute MIs.

CE was clearly identified by coronarography for 4 patients with acute simultaneous cardio-cerebral infarction (56%). The MRI abnormalities showed that lesions of all MIs were transmural, relatively small (average 1.3±0.44 segments) and in most cases in the inferior cardiac wall (47%) and these abnormalities were comparable in sequelae and acute MI. Moreover, the left appendage morphology was a “cactus” in 62.7% of simultaneous acute cardio-cerebral infarction and only 33% in patients without MI or sequelae MI. Strokes were mainly localized in the superficial territory of the middle cerebral artery, and were similar in patients with or without MI. In addition, the rate of sequelae strokes was higher in isolated stroke group than “cardiocerebral infarction” (29.5% versus 13.3%).

Conclusion

Simultaneous acute cardio-cerebral infarction is not uncommon, diagnosed in 22% of our prospective cohort of embolic stroke. Cardiac MRI may help us to diagnose a concomitant cardiac embolization and evaluate the prognosis. Unfortunately optimal therapeutic strategy of these patients is still unknown.

Flow Chart

Funding Acknowledgement

Type of funding source: None

[Prognostic value of HbA1c and plasma glucose on one-year mortality in non-diabetic patients after myocardial infarction]

BACKGROUND

The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear.

PURPOSE

In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in non-diabetic patients after AMI.

METHODS

From the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey database, we included all consecutive non-diabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF<40% and GRACE risk score. Cut-off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA1c 5.9% and PG 131mg/dL) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817).

RESULTS

Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m² and higher troponin Ic pic (all P<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (P<0.001); high HbA1c and high PG together were associated with higher rate of MACE (P<0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause [OR (95%CI): 1.64 (1.31-2.05)] mortality and cardiovascular mortality [OR (95%CI): 1.75 (1.33-2.31)], beyond GRACE score [OR (95%CI): 1.03 (1.03-1.04)], as well as elevated HbA1c [OR (95%CI): 1.43 (1.15-1.78) and OR (95%CI): 1.83 (1.39-2.41) respectively].

CONCLUSIONS

Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our non-diabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population.

Influence of cardiac hemodynamic variables on retinal vessel density measurement on optical coherence tomography angiography in patients with myocardial infarction

INTRODUCTION

Quantitative measurements of retinal microvasculature by optical coherence tomography angiography (OCT-A) have been used to assess cardiovascular risk profile. However, to date, there are no studies focusing on OCT-A imaging in the setting of the altered hemodynamic status found in high-risk cardiovascular patients.

METHODS

To determine the potential association between retinal vascular density on OCT-A and a comprehensive battery of hemodynamic variables in patients with myocardial infarction (MI) using data from the acute phase and at 3 months follow-up after cardiac rehabilitation. This prospective longitudinal study included patients who presented with MI in the cardiology intensive care unit at Dijon University Hospital. Main outcomes and measurements were retinal vessel density on OCT-A, hemodynamic status based on left ventricular ejection fraction (LVEF), and indexed cardiac output during the acute phase of myocardial infarction and at 3 months follow-up.

RESULTS

Overall, 30 patients were included in this pilot study. The median (IQR) age was 64 years (55-71) with 87% men. At admission, the mean (SD) LVEF was 53% (11), and the mean indexed cardiac output was 2.70 (0.83) L/min/m². On OCT-A, the mean inner retinal vascular density was 19.09 (2.80) mm^-1. No significant association was found between retinal vascular density and hemodynamic variables.

CONCLUSION

We found no significant association between retinal vascular density on OCT-A and hemodynamic variables in the acute phase of a myocardial infarction or after 3 months of cardiac rehabilitation. Therefore, OCT-A findings do not seem to be influenced by the hemodynamic changes associated with myocardial infarction.

Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric Surgery

BACKGROUND

Factors contributing to adolescents' non-completion of bariatric surgery, defined as self-withdrawal during the preoperative phase of care, independent of program or insurance denial, are largely unknown. Recent adolescent and adult bariatric surgery literature indicate that psychological factors and treatment withdrawal play a role; however, for adolescents, additional age-salient (family/caregiver) variables might also influence progression to surgery.

OBJECTIVES

The present study examined demographic, psychological, and family/caregiver variables as predictors of whether adolescents completed surgery ("completers") or withdrew from treatment ("non-completers").

SETTING

Adolescents were from a bariatric surgery program within a pediatric tertiary care hospital.

METHODS

A retrospective chart review was conducted of consecutive patients who completed bariatric surgery psychological intake evaluations from September 2009 to April 2013. Data involving completer (n = 61) versus non-completer (n = 65) status were analyzed using two-tailed independent t tests, Chi-squared tests, and logistic regressions.

RESULTS

Forty-three percent of adolescents completed surgery, similar to adult bariatric samples. Significantly more males were non-completers (p < .05), and there was a trend towards non-completion for older adolescents (p = 0.06). No other demographic, psychological, or caregiver/family variables were significant predictors of non-completion.

CONCLUSIONS

These findings indicate that demographic variables, rather than psychological or family factors, were associated with the progression to or withdrawal from surgery. Further assessment is needed to determine specific reasons for completing or withdrawing from treatment, particularly for males and older adolescents, to improve clinical care and reduce attrition.

P6389Infection and type 2 myocardial infarction: a large observational study from emergency department

Background

Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin.

Methods

Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes).

Results

Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract (n=111), urinary tract (n=27), skin (n=15), digestive tract (n=9) or other or indefinite site (n=23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, p=0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality.

Conclusions

Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.

P4570Prognostic interest of HbA1c and plasma glucose assessment on one-year mortality in non-diabetic patients after acute myocardial infarction

Background

The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in nondiabetic patients remains unclear.

Purpose

In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in nondiabetic patients after AMI.

Methods

From the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey database, we included all consecutive nondiabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF<40% and GRACE risk score. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA1c 5.9% and PG 7.3mmol/L) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817).

Results

Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m2 and higher troponin Ic pic (all p<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (p<0.001); High HbA1C and high PG together were associated with higher rate of MACE (p<0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause (OR (95% CI): 1.64 (1.31–2.05)) mortality and cardiovascular mortality (OR (95% CI): 1.75 (1.33–2.31)), beyond GRACE score (OR (95% CI): 1.03 (1.03–1.04)), as well as elevated HbA1c (OR (95% CI): 1.43 (1.15–1.78) and OR (95% CI): 1.83 (1.39–2.41) respectively).

Conclusions

Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our nondiabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, France

P852Frequency and prognosis of type 2 myocardial infarction vs non ischemic myocardial injury: large observational study from an emergency department

Background

Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and non-ischemic myocardial injury (NIMI), corresponding to troponin elevation without overt ischemia, are emerging concepts which are suspected to be common in patients hospitalized. However, their respective frequencies, risk profiles and short term prognosis in current routine clinical practice of emergency unit remains to be investigated.

Methods

Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital emergency unit (n=82 543), patients with elevated troponin Ic (≥0.10μg/L) (n=4568) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes), or as NIMI without such signs. Patients with missing biological data on admission (n=112) or T1MI diagnosis (n=2467) were excluded.

Results

Among the 1989 patients included, 539 (27%) were classified as T2MI and 1450 (73%) as NIMI. When compared with patients with NIMI, T2MI had higher troponin levels (0.27 (0.14–0.71) vs 0.22 (0.13–0.54) μg/L, p=0.008, respectively). NIMI and T2MI had similar risk factors (age (84 (74–90) vs 84 (75–91) y, p=0.3), male sex (43 vs 48%, p=0.07), hypertension (67 vs 71%, p=0.133), diabetes (25 vs 25%, p=0.9), prior CAD (24 vs 26%, p=0.342), systemic inflammatory response syndrome (SIRS, 47 vs 49%, p=0.3), and systolic blood pressure (SBP) (130 (111–153) vs 132 (112–153) mmHg, p=0.545). Biological data on admission were also similar (hyperglycemia (glucose ≥11 mmol/L), 14 vs 13%, p=0.37, creatinine (96 (72–148) vs 94 (72–141) μmole/L, p=0.598), anemia (Hemoglobin rate ≤10g/dL, 13 vs 14%, p=0.5), C-reactive protein elevation (CRP ≥3 mg/L, 88 vs 89%, p=0.7)). Moreover, in-hospital mortality was high and similar for both groups (15 vs 18%, p=0.2). In multivariate analysis, age, troponin rate, SIRS, anemia, SBP, hyperglycemia, creatinine and CRP elevation were independent factors associated with hospital mortality, but not T2MI (vs NIMI) (OR: 0.88 (0.66–1.17)). Older age and hyperglycemia were specific covariates associated with increased risk of mortality in T2MI, but not in NIMI.

Conclusions

This large real-life study of non-T1MI inpatients with elevated troponins from emergency department shows that myocardial injury without necrosis and T2MI share the same risk factors, characterized by a high rate of infections and anemia and a high risk of hospital mortality.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, France

2214Prevalence and severity of coronary disease in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the RICO survey

Aim

Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described. From a large database of a regional registry of acute MI, we aimed to address prevalence of FH and severity of CAD.

Methods

Consecutive patients hospitalized with MI in a multicentre database from 2001–2017 were considered. An algorithm, adapted from Dutch Lipid Clinic Network criteria, was built upon 4 variables (LDL-cholesterol (LDL-C) and lipid lowering agents, premature and family history of CAD) to identify FH probabilities.

Results

Among the 11624 patients included in the survey, 249 (2.1%) had probable/definite FH (score ≥6), and 2405 (20.7%) had possible FH (score 3–5). When compared with patients without FH (score 0–2), FH patients (score ≥6) were 20y younger (51 (46–57) vs 71 (61–80) y, p<0.001), with a lower rate of hypertension (47 vs 59%, p<0.001), diabetes (17 vs 25%, p<0.001) and prior stroke (4 vs 8%, p=0.016), but a higher prevalence of smokers (56 vs 23%, p<0.001), personal (20 vs 15%, p=0.02) or familial history of CAD (78 vs 18%, p<0.001). Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex and diabetes, FH patients were characterized by increased extent of CAD (syntax score 11 (4–19) vs 7 (1–13), p<0.001) and multivessel disease (55 vs 40%, p<0.001).

Conclusion

In this large real world population of acute MI, a high prevalence of FH was found. FH patients were characterized by their young age associated with the severity of CAD burden and limited use of preventive lipid lowering therapy.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, Agence Régionale de Santé Bourgogne Franche Comté, France

P4573In patients with acute myocardial infarction, PCSK9 levels do not predict severity and recurrence of cardiovascular events

Background

In patients with coronary artery disease (CAD), it remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future cardiovascular events.

Methods

Among the patients admitted for an acute myocardial infarction (MI) from September 2015 to December 2016 in an intensive care unit from a university hospital, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy. We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography, and the risk of in-hospital events and at one-year follow-up.

Results

In a total of 648 patients (mean age: 66 years, 67% male), the median PCSK9 was 263 ng/ml, higher for females compared with males (270 vs 256 ng/ml, p=0.009). Serum PCSK9 was associated with LDL cholesterol (r=0.083, p=0.036), total cholesterol (r=0.136, p=0.001) and triglycerides (r=0.137, p=0.001). A positive association was also observed in the subgroup of patients with CRP >10 mg/L (p<0.001), but not with NT-proBNP, troponin and creatine kinase. PCSK9 levels were similar whatever the SYNTAX score or the number of significant coronary lesions. Moreover, PCSK9 levels were not predictive of in-hospital events (death, recurrent MI and stroke) and events (cardiovascular death, cardiovascular events, recurrent MI) at one-year follow-up.

Conclusion

In this large cohort of patients hospitalized for acute MI and not previously receiving statin therapy, PCSK9 levels was not associated with the severity or the recurrence of cardiovascular events. The clinical utility of measuring PCSK9 levels remains to be demonstrated for this category of patients.

P4550Growth differentiation factor 15 as an integrative biomarker of heart failure in patients with acute myocardial infarction

Background

Growth differentiation factor 15 (GDF15), a stress-responsive cytokine member of the transforming growth factor-β family, is an emerging biomarker in cardiovascular (CV) diseases. GDF15 is weakly expressed in normal condition but increased in pathological situations such as inflammation, oxidative stress, and left ventricular remodeling. Recent data suggest GDF15 as a marker in heart failure (HF).

Purpose

We aimed to identify the determinants of GDF15 circulating levels in patients admitted for an acute myocardial infarction (AMI).

Methods

In our prospective study, all consecutive patients admitted from June 2016 to February 2018 for type 1 AMI in the Coronary Care unit from our University Hospital were included. Chronic HF patients were excluded. In-hospital severe HF was defined as killip class>2. Blood samples were taken on admission and serum levels of GDF15 were measured using a commercially available ELISA kit.

Results

Among the 284 AMI patients, median age was at 67 (57–78) y, 27% were women, 23% had diabetes and 59% were hypertensive. GDF15 levels (median = 1,144 (775–1,891) ng/L were strongly correlated with age (r=0.493, p<0.001), and elevated with most CV risk factors (i.e. hypertension, diabetes), prior CAD, chronic kidney disease (p<0.001 for all) and in patients with CRP >3 mg/L (p<0.001). When compared with patients who didn't develop severe HF (274/284), patients experiencing HF (10/284), GDF15 was more than twice higher (figure). By Receiving Operating Curve analysis, GDF15 was associated with HF (AUC (95% CI) = 0.716 (0.52–0.91), p=0.021). Moreover, GDF15 levels were negatively correlated with Left Ventricular Ejection Fraction (LVEF) (r=−0.193, p=0.001). Multivariate logistic regression analysis showed that GDF15 >5,000 ng/L [OR: 8.43; 95% CI (1.57–45.32)] is as independent estimate of HF, beyond age and other confounding (i.e. admission systolic blood pressure, LVEF and Log N-terminal pro-Brain Natriuretic Peptide).

GDF15 levels according to HF development

Conclusions

These preliminary results suggest that GDF15 could be an integrative biomarker of severe HF in patient with AMI. Further studies are needed to elucidate the underlying mechanisms linking the cytokine with the development of HF.