Clinical impact of estimated plasma volume status and its additive effect with the GRACE risk score on in-hospital and long-term mortality for acute myocardial infarction

Prognostic relevance of pre-procedural plasma volume status estimation in patients undergoing transcatheter aortic valve implantation: A meta-analysis

BACKGROUND

To systematically evaluate the prognostic utility of estimated plasma volume status (ePVS) on the outcomes of patients undergoing transcatheter aortic valve implantation (TAVI).

METHODS

The exposure variable of interest was the ePVS, enumerating the percentage change of the actual plasma volume from the ideal plasma volume, and being calculated on the basis of weight and hematocrit using sex-specific constants. A random-effects meta-analysis was performed after a systematic literature search in PubMed, Scopus and Web Of Science.

RESULTS

The systematic literature search yielded 5 eligible observational cohort studies encompassing a total of 7,121 patients undergoing TAVI. The meta-analysis suggested that "high ePVS" status was independently associated with increased risk for 1-year all-cause mortality (pooled adjusted hazard ratio: 1.63, 95 % confidence intervals: 1.36-1.95) compared to "low ePVS". Also, the pooled unadjusted odds for 1-year mortality, 30-day mortality, peri-procedural stroke, major bleeding, and acute kidney injury were significantly increased in the "high ePVS" group of patients. Conversely, the unadjusted risk of pacemaker implantation and major vascular complications did not differ significantly between the 2 groups.

CONCLUSIONS

Plasma volume expansion appears to be linked with a worse peri-procedural and long-term prognostic course in TAVI. Its use in clinical practice could refine risk stratification and candidate selection practices.

Prognostic value of estimated plasma volume status at discharge in acute myocardial infarction

AIMS

Congestive heart failure (HF) is a common complication in patients with acute myocardial infarction (AMI). The estimated plasma volume status [ePVS = (100 - haematocrit)/haemoglobin] is used as the blood plasma volume index to determine the presence of congestion in patients with HF. However, the clinical impact of ePVS at discharge in patients with AMI remains unclear. This study aimed to investigate whether ePVS at discharge could determine the long-term prognosis in patients with AMI.

METHODS AND RESULTS

We retrospectively identified patients with AMI with ePVS measured at discharge between January 2012 and December 2020. The primary endpoint was post-discharge all-cause death. The patients were divided into two groups according to an ePVS cut-off value of 5.5%, which is commonly used in HF. In total, 1012 patients with AMI were included. The median age was 70 years (range, 61-78 years), and 76.4% of the patients were male. The ePVS > 5.5% (high-ePVS) group included 365 patients (36.1%), and the all-cause mortality rate in the total cohort was 17.7%. The log-rank test revealed that the high-ePVS group had a significantly higher rate of all-cause death than the ePVS ≤ 5.5% (low-ePVS) group (P < 0.001). Multivariate Cox proportional hazards model analysis revealed that high ePVS was associated with post-discharge all-cause death, independent of other risk factors (hazard ratio = 1.879; 95% confidence interval = 1.343-2.629, P < 0.001).

CONCLUSIONS

High ePVS at discharge was independently associated with high post-discharge all-cause mortality in patients with AMI. Our study suggests that ePVS at discharge in patients with AMI could serve as a novel prognostic marker.

Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment

Background and purpose

The impact of calculated plasma volume status (PVS) on the prognosis of acute ischemic stroke treated with endovascular treatment (EVT) remains undetermined. This study aimed to investigate the association between PVS and 90 days functional outcomes after EVT.

Methods

We enrolled patients treated with EVT in the anterior circulation from a prospective registry. The endpoint was a modified Rankin scale score of ≥3 points at 90 days after EVT. We used multivariable logistic regression models to investigate the association between PVS and poor outcomes. We used the restricted cubic spline to present the linearity between PVS and poor outcomes.

Results

Among the 187 enrolled patients (median age, 65 years; 35.8% women), a total of 81 patients (43.3%) experienced poor outcomes at 90 days. In multivariable analyses, PVS was associated with poor outcomes despite increasing confounding factors (odds ratio, 3.157; 95% confidence interval, 1.942-5.534; P < 0.001). The restricted cubic spline revealed a positive correlation between PVS and the risk of poor outcomes after EVT (P for nonlinearity = 0.021).

Conclusion

Our study found that an elevated PVS value was associated with poor outcomes after EVT. Further prospective cohorts were warranted to evaluate the utility of PVS in AIS treated with EVT.

Clinical Efficacy of Ulinastatin Combined with Meglumine Adenosine Cyclophosphate in the Treatment of Acute Myocardial Infarction

Ulinastatin, a common adjuvant drug in the clinical treatment of acute circulatory failure, has a good effect on various inflammatory diseases. In this study, we aim to explore the clinical efficacy of ulinastatin combined with meglumine adenosine cyclophosphate in patients with acute myocardial infarction (AMI) and its effect on cardiac function and endothelial function of patients. 100 AMI patients treated in our hospital (February 2020-October 2020) were randomly chosen and divided into group J and group Q, with 50 cases in each group. Group Q was treated with meglumine adenosine cyclophosphate only, while group J was treated with ulinastatin combined with meglumine adenosine cyclophosphate to compare the treatment efficiency, cardiac structure indexes, cardiac systolic function, blood lipid levels, vascular endothelial function, QLI (quality of life) scores, BI indexes, and FMA (motor function) scores between the two groups. The treatment efficiency, QLI score, BI index, and FMA score in group J were notably higher compared with group Q (P < 0.05). The cardiac structure indexes, cardiac systolic function, blood lipid level, and vascular endothelial function in group J were notably better compared with group Q (P < 0.05). Ulinastatin combined with meglumine adenosine cyclophosphate can obviously enhance the therapeutic effect of AMI patients and improve the endothelial function and cardiac function of patients, which is very promising in this medical area.

Combination of TyG Index and GRACE Risk Score as Long-Term Prognostic Marker in Patients with ACS Complicated with T2DM Undergoing PCI

OBJECTIVE

We aimed to investigate the prognostic value of the triglyceride-glucose (TyG) index combined the with Global Registry of Acute Coronary Events (GRACE) score in adult acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) who underwent percutaneous coronary intervention (PCI).

METHODS

The study enrolled total 899 ACS patients with T2DM who underwent PCI. TyG index and the GRACE risk score were calculated and assessed by median. The correlation was analyzed by Spearman's rank correlation coefficient. The cumulative major adverse cardiovascular event (MACE) curve was generated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the receiver operating characteristic curve (ROC), net reclassification index (NRI) and Integrated Discrimination Improvement (IDI) were applied to analyze the performance of each single factor index and combined multivariate index in predicting MACE.

RESULTS

In the ACS patients with T2DM after PCI, there were significant differences in the TyG index and GRACE risk score between the MACE group and the MACE-free group (P < 0.001). Kaplan-Meier analysis showed that the TyG index combined with the GRACE risk score was positively correlated with the occurrence of MACEs (log rank P < 0.001). Multivariate Cox regression analyses showed that the TyG index, the GRACE risk score, and the TyG index combined with the GRACE risk score were independent predictors of long-term MACEs (adjusted HR: 1.805; 95% CI: 1.479-2.203, P < 0.001; adjusted HR: 1.012; 95% CI: 1.009-1.016, P < 0.001; and adjusted HR: 2.337; 95% CI: 1.805-3.025, P < 0.001, respectively). Correlation analysis indicated that the TyG index was positively correlated with the GRACE risk score (R = 0.140, P < 0.001). The analysis of AUC, NRI and IDI revealed that the combined multivariate index performed better prognostic role than each single factor index in predicting the occurrence of MACE.

CONCLUSION

Both the GRACE risk score and the TyG index could be significant and independent predictors of clinical outcomes in ACS patients with T2DM after PCI. A combination of them could be enhanced predictions of clinical outcomes in these patients.

Estimated plasma volume status is a modest predictor of true plasma volume excess in compensated chronic heart failure patients

Plasma volume and especially plasma volume excess is a relevant predictor for the clinical outcome of heart failure patients. In recent years, estimated plasma volume based on anthropometric characteristics and blood parameters has been used whilst direct measurement of plasma volume has not entered clinical routine. It is unclear whether the estimation of plasma volume can predict a true plasma volume excess. Plasma volume was measured in 47 heart failure patients (CHF, 10 female) using an abbreviated carbon monoxide rebreathing method. Plasma volume and plasma volume status were also estimated based on two prediction formulas (Hakim, Kaplan). The predictive properties of the estimated plasma volume status to detect true plasma volume excess > 10% were analysed based on logistic regression and receiver operator characteristics. The area under the curve (AUC) to detect plasma volume excess based on calculation of plasma volume by the Hakim formula is 0.65 (with a positive predictive value (PPV) of 0.62 at a threshold of - 16.5%) whilst the AUC for the Kaplan formula is 0.72 (PPV = 0.67 at a threshold of - 6.3%). Only the estimated plasma volume status based on prediction of plasma volume by the Kaplan formula formally appears as an acceptable predictor of true plasma volume excess, whereas calculation based on the Hakim formula does not sufficiently predict a true plasma volume excess. The low positive predictive values for both methods suggest that plasma volume status estimation based on these formulas is not suitable for clinical decision making.