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Murad HAS, Bakarman MA. Could Plasma CXCL12 Predict Ventricular Dysfunction in Patients with Severe Myocardial Infarction? Int J Angiol 2023; 32:165-171. [PMID: 37576533 PMCID: PMC10421681 DOI: 10.1055/s-0042-1756488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Plasma level of chemokine CXCL12 can predict adverse cardiovascular outcomes in patients with coronary artery disease, but data on its relationship with severity of coronary stenosis in cases of severe myocardial infarction (MI) are scarce and conflicting. The objective of this study was to investigate link between plasma CXCL12 levels and different grades of left ventricular ejection fraction (LVEF) in statin-treated and -untreated patients with severe MI. A total of 198 consecutive patients with first-time severe MI (ST-elevated myocardial infarction [STEMI], n = 121 and non-ST-elevated myocardial infarction [NSTEMI], n = 77) were recruited from Coronary Care Unit, King Abdulaziz University Hospital. They have one to two coronary arteries blocked ≥50%, or three arteries blocked 30 to 49%. Demographic and clinical criteria were collected and plasma CXCL12 level was measured. No correlations were detected between demographic and clinical criteria and CXCL12 level. While troponin peaks and LVEF significantly differed between STEMI and NSTEMI patients, CXCL12 level showed nonsignificant changes. Plasma CXCL12 levels decreased significantly in statin-treated patients compared with those untreated. From receiver operating characteristic (ROC) analysis, high CXCL12 levels were associated with no statin therapy. For STEMI and NSTEMI patients, area under the receiver operating characteristic curve for CXCL12 test were 0.685 and 0.820, while sensitivity and specificity values were 75.9 and 54.8%, and 73.1 and 84%, respectively. Plasma CXCL12 levels showed nonsignificant changes with different ranges of LVEF and troponin peaks. In patients with severe MI, irrespective of statin therapy, plasma CXCL12 showed no correlation with different ranges of LVEF suggesting that it cannot predict left ventricular dysfunction in these cases. However, cross-sectional design of this study is a limitation.
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Affiliation(s)
- Hussam A. S. Murad
- Department of Pharmacology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marwan A. Bakarman
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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2
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Doganay B, Celebi OO. Prognostic role of the left ventricular global function index in predicting major adverse cardiovascular events in acute coronary syndrome patients. Biomark Med 2023; 17:5-16. [PMID: 36942625 DOI: 10.2217/bmm-2023-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Aim: This study aimed to evaluate the prognostic role of the left ventricular (LV) global function index (LVGFI) in predicting major adverse cardiovascular events in patients with acute coronary syndrome after long-term follow-up. Methods: This retrospective study included 718 patients with ST-elevated myocardial infarction (STEMI) and 781 patients with non-ST-elevated myocardial infarction (NSTEMI). The LVGFI was calculated on echocardiography with the following formula: (LV stroke volume/[LV cavity volume + LV myocardial volume]) × 100. Results: Mean LVGFI was higher in the NSTEMI group than in the STEMI group. Decreased LVGFI levels were independent predictors of major adverse cardiovascular events in both the STEMI and the NSTEMI group. Conclusion: Echocardiographic LVGFI may be a useful prognostic screening tool for acute coronary syndrome cohorts.
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Affiliation(s)
- Birsen Doganay
- Department of Cardiology, Ankara City Hospital, University District Bilkent Street No: 1, 06800, Ankara, Turkey
| | - Ozlem Ozcan Celebi
- Department of Cardiology, Ankara City Hospital, University District Bilkent Street No: 1, 06800, Ankara, Turkey
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3
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Residual ST-segment elevation to predict long-term clinical and CMR-derived outcomes in STEMI. Sci Rep 2022; 12:21813. [PMID: 36528716 PMCID: PMC9759567 DOI: 10.1038/s41598-022-26082-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Residual ST-segment elevation after ST-segment elevation myocardial infarction (STEMI) has traditionally been considered a predictor of left ventricular (LV) dysfunction and ventricular aneurism. However, the implications in terms of long-term prognosis and cardiac magnetic resonance (CMR)-derived structural consequences are unclear. A total of 488 reperfused STEMI patients were prospectively included. The number of Q wave leads with residual ST-segment elevation > 1 mm (Q-STE) at pre-discharge ECG was assessed. LV ejection fraction (LVEF, %) and infarct size (IS, % of LV mass) were quantified in 319 patients at 6-month CMR. Major adverse cardiac events (MACE) were defined as all-cause death and/or re-admission for acute heart failure (HF), whichever occurred first. During a mean follow-up of 6.1 years, 92 MACE (18.9%), 39 deaths and 53 HF were recorded. After adjustment for baseline characteristics, Q-STE (per lead with > 1 mm) was independently associated with a higher risk of long-term MACE (HR 1.24 [1.07-1.44] per lead, p = 0.004), reduced (< 40%) LVEF (HR 1.36 [1.02-1.82] per lead, p = 0.04) and large (> 30% of LV mass) IS (HR 1.43 [1.11-1.85] per lead, p = 0.006) at 6-month CMR. Patients with Q-STE ≥ 2 leads (n = 172, 35.2%) displayed lower MACE-free survival, more depressed LVEF, and larger IS at 6-month CMR (p < 0.001 for all comparisons). Residual ST-segment elevation after STEMI represents a universally available tool that predicts worse long-term clinical and CMR-derived structural outcomes.
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4
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Gabaldón-Pérez A, Marcos-Garcés V, Gavara J, López-Lereu MP, Monmeneu JV, Pérez N, Ríos-Navarro C, de Dios E, Merenciano-González H, Cànoves J, Racugno P, Bonanad C, Minana G, Núnez J, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Ortiz-Pérez JT, Rodríguez-Palomares JF, Bodí V. Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients. Age Ageing 2022; 51:6847804. [PMID: 36436010 DOI: 10.1093/ageing/afac248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND older patients with ST-segment elevation myocardial infarction (STEMI) represent a very high-risk population. Data on the prognostic value of cardiac magnetic resonance (CMR) in this scenario are scarce. METHODS the registry comprised 247 STEMI patients over 70 years of age treated with percutaneous intervention and included in a multicenter registry. Baseline characteristics, echocardiographic parameters and CMR-derived left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were prospectively collected. The additional prognostic power of CMR was assessed using adjusted C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI). RESULTS during a 4.8-year mean follow-up, the number of first major adverse cardiac events (MACE) was 66 (26.7%): 27 all-cause deaths and 39 re-admissions for acute heart failure. Predictors of MACE were GRACE score (HR 1.03 [1.02-1.04], P < 0.001), CMR-LVEF (HR 0.97 [0.95-0.99] per percent increase, P = 0.006) and MVO (HR 1.24 [1.09-1.4] per segment, P = 0.001). Adding CMR data significantly improved MACE prediction compared to the model with baseline and echocardiographic characteristics (C-statistic 0.759 [0.694-0.824] vs. 0.685 [0.613-0.756], NRI = 0.6, IDI = 0.08, P < 0.001). The best cut-offs for independent variables were GRACE score > 155, LVEF < 40% and MVO ≥ 2 segments. A simple score (0, 1, 2, 3) based on the number of altered factors accurately predicted the MACE per 100 person-years: 0.78, 5.53, 11.51 and 78.79, respectively (P < 0.001). CONCLUSIONS CMR data contribute valuable prognostic information in older patients submitted to undergo CMR soon after STEMI. The Older-STEMI-CMR score should be externally validated.
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Affiliation(s)
- Ana Gabaldón-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | - Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | - José Gavara
- Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, 46022, Spain
| | - María P López-Lereu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, 46004, Spain
| | - José V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, 46004, Spain
| | - Nerea Pérez
- Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain
| | - Héctor Merenciano-González
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain
| | - Paolo Racugno
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
| | - Julio Núnez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, 46022, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
| | - Filipa Valente
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, 08035, Spain
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Spain.,Cardiovascular Institute, Hospital Clínic, Barcelona, 08036, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain.,Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, 08035, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Barcelona, 08035, Spain.,Universitat Autònoma de Barcelona, Barcelona, 08193, Spain
| | - Vicente Bodí
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
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5
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Mahdavi-Roshan M, Ghorbani Z, Gholipour M, Salari A, Savar Rakhsh A, Kheirkhah J. Evaluation of cardiometabolic risk markers linked to reduced left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI). BMC Cardiovasc Disord 2022; 22:224. [PMID: 35568801 PMCID: PMC9107768 DOI: 10.1186/s12872-022-02660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background It is well established that left ventricular systolic dysfunction (LVSD), as marked by reduced left ventricular ejection fraction (LVEF), notably worsens the prognosis of ST-elevation myocardial infarction (STEMI). However, the link between cardiometabolic risk markers and LVSD seems unclear. This study aimed to investigate the differences in variables affecting reduced LVEF in STEMI patients. Methods In the current retrospective study, 200 consecutive STEMI patients were enrolled between April 2016 to January 2017. Analysis of serum parameters, anthropometric evaluation, and echocardiography was performed after admission. The participants were categorized according to LVEF levels as follows: group1 (normal: 50–70%, n = 35), group2 (mildly reduced: 40–49%, n = 48); group3 (moderately reduced: 30–39%, n = 94) and group4 (severely reduced: < 30%, n = 23). Between-group comparisons were made using the Kruskal–Wallis test. Results Overall, of 200 STEMI patients with a mean age of 62 years, 27%(n = 54) were females. The median of BMI of patients in group4 (31.07 kg/m2) was significantly higher than group3 (26.35 kg/m2), group2 (25.91 kg/m2), and group1 (24.98 kg/m2; P value < 0.0001). Group4 patients showed significantly increased fasting blood sugar (FBS) than groups 1 (212.00, vs. 139.00 mg/dl; P value = 0.040). Patients in groups 1 and 2 exerted significantly elevated triglyceride levels than those in group4 (142.00, 142.50, and 95.00 mg/dl; P value = 0.001). WBC count, neutrophil%, and neutrophil to lymphocyte ratio among those in group1 (10,200/m3, 70.00%, and 2.92, respectively) were significantly lower than group4 (12,900/m3, 83.00%, and 5.47, respectively; P value < 0.05). Conclusion These findings highlight higher BMI, FBS, and leucocyte count linked to LVSD, probably through increasing the inflammation and reducing LVEF levels. More extensive studies are needed to clarify the clinical relevance of these results.
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Affiliation(s)
- Marjan Mahdavi-Roshan
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zeinab Ghorbani
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. .,Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mahboobeh Gholipour
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Savar Rakhsh
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Jalal Kheirkhah
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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6
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Brunton-O'Sullivan MM, Holley AS, Bird GK, Kristono GA, Harding SA, Larsen PD. Examining variation and temporal dynamics of extracellular matrix biomarkers following acute myocardial infarction. Biomark Med 2022; 16:147-161. [PMID: 35107387 DOI: 10.2217/bmm-2021-0531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: This study investigated an optimal extracellular matrix (ECM) biomarker panel for measurement in acute myocardial infarction (AMI). Materials & methods: Blood samples were collected from 12 healthy volunteers, and from 23 patients during hospital admission (day 1-3) and 6 months following AMI. Protein assays measured: FGFb, MMP-2, -3, -8, -9, osteopontin, periostin, PINP, TGF-β1, TIMP-1, -4 and VEGF. Results: When compared with healthy levels, seven ECM biomarkers were significantly altered in AMI patients, and six of these biomarkers displayed stable expression during hospital admission. Clinical characteristics and baseline cardiac function were not well correlated with ECM biomarkers. Conclusion: We suggest, MMP-2, MMP-3, MMP-8, MMP-9, periostin, PINP and TIMP-1 may be useful ECM biomarkers for future studies in AMI patients.
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Affiliation(s)
- Morgane M Brunton-O'Sullivan
- Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Wellington Cardiovascular Research Group, University of Otago, Wellington, New Zealand
| | - Ana S Holley
- Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Wellington Cardiovascular Research Group, University of Otago, Wellington, New Zealand
| | - Georgina K Bird
- Wellington Cardiovascular Research Group, University of Otago, Wellington, New Zealand.,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Gisela A Kristono
- Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Wellington Cardiovascular Research Group, University of Otago, Wellington, New Zealand
| | - Scott A Harding
- Wellington Cardiovascular Research Group, University of Otago, Wellington, New Zealand.,Department of Cardiology, Wellington Regional Hospital, Wellington, New Zealand
| | - Peter D Larsen
- Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Wellington Cardiovascular Research Group, University of Otago, Wellington, New Zealand.,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
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7
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Clarkson SA, Heindl B, Cai A, Beasley M, Dillon C, Limdi N, Brown TM. Outcomes of Individuals With and Without Heart Failure Presenting With Acute Coronary Syndrome. Am J Cardiol 2021; 148:1-7. [PMID: 33667441 DOI: 10.1016/j.amjcard.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/24/2023]
Abstract
Major adverse cardiac event (MACE) and bleeding risks following percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) are not well defined in individuals with heart failure (HF). We followed 1,145 individuals in the Pharmacogenomic Resource to improve Medication Effectiveness Genotype Guided Antiplatelet Therapy cohort for MACE and bleeding events following PCI for ACS. We constructed Cox proportional hazards models to compare MACE and bleeding in those with versus without HF, adjusting for sociodemographics, comorbidities, and medications. We also determined predictors of MACE and bleeding events in both groups. 370 (32%) individuals did and 775 (68%) did not have HF prior to PCI. Mean age was 61.7 ± 12.2 years, 31% were female, and 24% were African American. After a median follow-up of 0.78 years, individuals with HF had higher rates of MACE compared to those without HF (48 vs. 24 events per 100 person years) which remained significant after multivariable adjustment (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.00 to 1.72). Similarly, bleeding was higher in those with versus without HF (22 vs. 11 events per 100 person years), although this was no longer statistically significant after multivariable adjustment (HR 1.29, 95% CI 0.86 to 1.93). Diabetes and peripheral vascular disease were predictors of MACE, and end-stage renal disease was a predictor of bleeding among participants with HF. MACE risk is higher in individuals with versus without HF following PCI for ACS. However, the risk of bleeding, especially among those with end-stage renal disease , must be considered when determining post-PCI anticoagulant strategies.
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8
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Malebranche D, Hasan S, Fung M, Har B, Champagne P, Schnell G, Wilton SB, Anderson TJ. Patterns of Left-Ventricular Function Assessment in Patients With Acute Coronary Syndromes. CJC Open 2021; 3:733-740. [PMID: 34169252 PMCID: PMC8209391 DOI: 10.1016/j.cjco.2020.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022] Open
Abstract
Background In patients with acute coronary syndromes (ACS), guidelines recommend the assessment of left-ventricular ejection fraction (LVEF). Many patients with ACS undergo multiple assessments of LVEF, the clinical value of which is unknown. Methods Patients with ACS undergoing cardiac catheterization between 2012 and 2016 were evaluated and assessments of LV function identified. To evaluate changes in LVEF over time, available echocardiograms were reviewed in a subsample of patients with LVEF data available (n = 3221). Patients with ACS were classified into 3 groups: group 1 (LVEF > 50%), group 2 (LVEF 35% to 50%), and group 3 (LVEF < 35%). Results Our cohort consisted of 8327 patients with ACS (76% men), presenting with a mean age of 62.4 ± 12.4 years. At index presentation, 66% of patients had an LVEF > 50%, 27% had an LVEF between 35% and 50%, and 7% had severely reduced LVEF of < 35%. More than half of the cohort (n = 4600) had follow-up assessment of LV function, performed over an average of 2.71 ± 1.31 years. In the subsample of 3221 patients, only 1.1% of those in group 1, and 5.1% of those in group 2, deteriorated to an LVEF < 35%. Conclusions Patients with ACS often undergo multiple assessments of LV function. Those with initially preserved EF rarely demonstrate a decline in EF to < 35%. A reduction in low-value cardiac tests may be an important first step in improving the quality of care for patients with ACS.
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Affiliation(s)
- Daniel Malebranche
- Arthur J.E. Child Fellow, Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Sarah Hasan
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinda Fung
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bryan Har
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Champagne
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory Schnell
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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9
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Marcos-Garces V, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Perez N, Cànoves J, Gonzalez J, Minana G, Nunez J, de la Espriella R, Santas E, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Rodríguez-Palomares JF, Ortiz-Pérez JT, Bodi V. Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction. Circ Cardiovasc Imaging 2020; 13:e011491. [PMID: 33297764 DOI: 10.1161/circimaging.120.011491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment-elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment-elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment-elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discrimination improvement index. Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 readmissions for acute heart failure). In the entire group, CMR-LVEF (but not echocardiography-LVEF) independently predicted MACE occurrence. The MACE rate significantly increased only in patients with CMR-LVEF<40% (≥50%: 7%, 40%-49%: 9%, <40%: 27%, P<0.001). Most patients displayed echocardiography-LVEF≥50% (629, 56%), and they had a low MACE rate (57/629, 9%). In patients with echocardiography-LVEF<50% (n=490, 44%), the MACE rate was also low in those with CMR-LVEF≥40% (24/278, 9%) but significantly increased in patients with CMR-LVEF<40% (55/212, 26%; P<0.001). Compared with echocardiography-LVEF, CMR-LVEF significantly improved MACE prediction in the group of patients with echocardiography-LVEF<50% (C statistic, 0.80 versus 0.72; net reclassification improvement index, 0.73; integrated discrimination improvement index, 0.10) but not in those with echocardiography-LVEF≥50% (C statistic 0.66 versus 0.66; net reclassification improvement index, 0.17; integrated discrimination improvement index, 0.01). Conclusions A straightforward strategy based on a selective use of CMR for risk prediction in ST-segment-elevation myocardial infarction patients with echocardiography-LVEF<50% can provide insights into patient care. The cost-effectiveness of this approach, as well as the direct implications in clinical management, should be further explored.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Jose Gavara
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Maria P Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (M.P.L.-L., J.V.M.)
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (M.P.L.-L., J.V.M.)
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Elena de Dios
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Nerea Perez
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.)
| | - Jessika Gonzalez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.)
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Enrique Santas
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Spain (D.M.)
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
| | - Filipa Valente
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain (F.V., J.F.R.-P.)
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (D.L., J.T.O.-P.)
| | | | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (D.L., J.T.O.-P.).,Cardiovascular Institute, Hospital Clínic, Barcelona, Spain (J.T.O.-P.)
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
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10
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Kahyaoglu M, Gecmen C, Candan O, Gucun M, Karaduman A, Guner A, Cakmak EO, Bayam E, Yilmaz Y, Celik M, Izgi IA. Presence of ear lobe crease may predict intermediate and high-risk patients with acute non-ST elevation acute coronary syndrome. J Cardiovasc Thorac Res 2020; 12:172-178. [PMID: 33123322 PMCID: PMC7581836 DOI: 10.34172/jcvtr.2020.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Ear lobe crease (ELC) was first described in 1973 as a physical examination finding indicating significant coronary artery disease (CAD). Several studies have been carried out in relation to this finding, and it has been shown that it is a marker of intima-media thickness, carotid artery disease, and CAD. We aimed to investigate the relationship between earlobe crease, which is a simple physical examination finding, and GRACE score as a risk estimation index in acute coronary syndromes without ST-segment elevation (NSTE-ACS) patients. Methods: 360 patients (mean age 62.2 years, 70% male) were included in our study. Patients were divided into two groups of GRACE scores ≤ 109 and >109, 167 patients were enrolled in group 1, and193 cases in group 2.
Results: The group 2 patients were older, had higher systolic blood pressure (SBP) levels, a higher rate of hypertension, higher glucose levels, lower creatinine clearance levels, higher initial and peak troponin levels, lower hemoglobin levels, lower left ventricular ejection fraction (LVEF) and higher Gensini scores than the patients in group 1. The higher GRACE score group had markedly increased frequencies of ELC compared to the lower GRACE score group (80.8% vs. 24.5%, respectively, P < 0.001).
Conclusion: The presence of ELC may predict moderate to high risk group of patients with NSTEACS.
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Affiliation(s)
| | - Cetin Gecmen
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ozkan Candan
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Murat Gucun
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ahmet Karaduman
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ahmet Guner
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | | | - Emrah Bayam
- Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Celik
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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11
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Li YM, Li ZL, Chen F, Liu Q, Peng Y, Chen M. A LASSO-derived risk model for long-term mortality in Chinese patients with acute coronary syndrome. J Transl Med 2020; 18:157. [PMID: 32252780 PMCID: PMC7137217 DOI: 10.1186/s12967-020-02319-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background The formal risk assessment is essential in the management of acute coronary syndrome (ACS). In this study, we develop a risk model for the prediction of 3-year mortality for Chinese ACS patients with machine learning algorithms. Methods A total of 2174 consecutive patients who underwent angiography with ACS were enrolled. The missing data among baseline characteristics were imputed using the MissForest algorithm based on random forest method. In model development, a least absolute shrinkage and selection operator (LASSO) derived Cox regression with internal tenfold cross-validation was used to identify the predictors for 3-year mortality. The clinical performance was assessed with decision curve analysis. Results The average follow-up period was 27.82 ± 13.73 months; during the 3 years of follow up, 193 patients died (mortality rate 8.88%). The Kaplan–Meier estimate of 3-year mortality was 0.91 (95% confidence interval (CI): 0.890.92). After feature selection, 6 predictors were identified: Age,” “Creatinine,” “Hemoglobin,” “Platelets,” “aspartate transaminase (AST)” and “left ventricular ejection fraction (LVEF)”. At tenfold internal validation, our risk model performed well in both discrimination (area under curve (AUC) of receiver operating characteristic (ROC) analysis was 0.768) and calibration (calibration slope was approximately 0.711). As a comparison, the AUC and calibration slope were 0.701 and 0.203 in Global Registry of Acute Coronary Events (GRACE) risk score, respectively. Additionally, the highest net benefit of our model within the entire range of threshold probability for clinical intervention by decision curve analysis demonstrated the superiority of it in daily practice. Conclusion Our study developed a prediction model for 3-year morality in Chinese ACS patients. The methods of missing data imputation and model derivation base on machine learning algorithms improved the ability of prediction. . Trial registration ChiCTR, ChiCTR-OOC-17010433. Registered 17 February 2017–Retrospectively registered
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Affiliation(s)
- Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Zhuo-Lun Li
- Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, USA
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Qi Liu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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12
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Tosun V, Korucuk N, Güntekin Ü. Akut anterior ST segment miyokard infarktüsü sonrası GRACE risk skorunun sol ventrikül ejeksiyon fraksiyonundaki prediktif değeri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.459500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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13
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Pack QR, Priya A, Lagu T, Pekow PS, Schilling JP, Hiser WL, Lindenauer PK. Association Between Inpatient Echocardiography Use and Outcomes in Adult Patients With Acute Myocardial Infarction. JAMA Intern Med 2019; 179:1176-1185. [PMID: 31206134 PMCID: PMC6580445 DOI: 10.1001/jamainternmed.2019.1051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Guidelines recommend that patients with acute myocardial infarction (AMI) undergo echocardiography for assessment of cardiac structure and ejection fraction, but little is known about the association between echocardiography as used in routine clinical management of AMI and patient outcomes. OBJECTIVE To examine the association between risk-standardized hospital rates of transthoracic echocardiography and outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of data from 397 US hospitals that contributed to the Premier Healthcare Informatics inpatient database from January 1, 2014, to December 31, 2014, used International Classification of Diseases, Ninth Revision (ICD-9) codes to identify 98 999 hospital admissions for patients with AMI. Data were analyzed between October 2017 and January 2019. EXPOSURES Rates of transthoracic echocardiography. MAIN OUTCOMES AND MEASURES Inpatient mortality, length of stay, total inpatient costs, and 3-month readmission rate. RESULTS Among the 397 hospitals with more than 25 admissions for AMI in 2014, a total of 98 999 hospital admissions for AMI were identified for analysis (38.2% women; mean [SD] age, 66.5 [13.6] years), of which 69 652 (70.4%) had at least 1 transthoracic echocardiogram performed. The median (IQR) hospital risk-standardized rate of echocardiography was 72.5% (62.6%-79.1%). In models that adjusted for hospital and patient characteristics, no difference was found in inpatient mortality (odds ratio [OR], 1.02; 95% CI, 0.88-1.19) or 3-month readmission (OR, 1.01; 95% CI, 0.93-1.10) between the highest and lowest quartiles of echocardiography use (median risk-standardized echocardiography use rates of 83% vs 54%, respectively). However, hospitals with the highest rates of echocardiography had modestly longer mean lengths of stay (0.23 days; 95% CI, 0.04-0.41; P = .01) and higher mean costs ($3164; 95% CI, $1843-$4485; P < .001) per admission compared with hospitals in the lowest quartile of use. Multiple sensitivity analyses yielded similar results. CONCLUSIONS AND RELEVANCE In patients with AMI, hospitals in the quartile with the highest rates of echocardiography showed greater hospital costs and length of stay but few differences in clinical outcomes compared with hospitals in the quartile with the lowest rates of echocardiography. These findings suggest that more selective use of echocardiography might be used without adversely affecting clinical outcomes, particularly in hospitals with high rates of echocardiography use.
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Affiliation(s)
- Quinn R Pack
- Division of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield.,Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield.,Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Aruna Priya
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield
| | - Tara Lagu
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield.,Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Penelope S Pekow
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield.,School of Public Health and Health Sciences, University of Massachusetts, Amherst
| | - Joshua P Schilling
- Division of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - William L Hiser
- Division of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield.,Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
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14
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Karabağ Y, Çınar T, Çağdaş M, Rencüzoğulları İ, Tanık VO. In-hospital and long-term prognoses of patients with a mid-range ejection fraction after an ST-segment myocardial infarction. Acta Cardiol 2019; 74:351-358. [PMID: 30136621 DOI: 10.1080/00015385.2018.1501140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: The recent reclassification of heart failure (HF) patients in the 2016 European Society of Cardiology HF guidelines according to the left ventricular ejection fraction (LVEF) has created a 'grey area' consisting of midrange ejection fraction (mrEF) HF patients with LVEFs of 40-49%. Additionally, there is limited data regarding the in-hospital and long-term prognoses of patients with an mrEF after an ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the baseline characteristics, in-hospital and long-term mortalities, clinical events in mrEF, preserved ejection fraction (pEF), and reduced ejection fraction (rEF) patients during their hospital stays in a cohort of consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI). Methods: One thousand two hundred sixty patients were enrolled in the study. The incidences of all the clinical events were recorded during the hospital stays and the mean follow-up duration was 34.4 ± 15.4 months. Results: The incidence of HF signs and symptoms was statistically significant in the mrEF patients when compared to the pEF patients during their hospital stays (3vs. 0.8%, p = 0.05). The overall survival rate in the mrEF patients was between those of the rEF and pEF patients. However, the rate of rehospitalisation due to HF was significantly higher in the mrEF patients when compared to the pEF patients [p (log-rank) < 0.001]. Conclusion: Although the mrEF patients with primary PCI-treated STEMIs exhibited similar baseline clinical characteristics, their in-hospital, long term mortality rates and rate of rehospitalisation due to HF were different from those of the rEF and mrEF patients.
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Affiliation(s)
- Yavuz Karabağ
- Department of Cardiology, Kafkas University, Kars, Turkey
| | - Tufan Çınar
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Metin Çağdaş
- Department of Cardiology, Kafkas University, Kars, Turkey
| | | | - Veysel Ozan Tanık
- Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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15
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Syyli N, Hautamäki M, Antila K, Mahdiani S, Eskola M, Lehtimäki T, Nikus K, Lyytikäinen LP, Oksala N, Hernesniemi J. Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study. Open Heart 2019; 6:e001007. [PMID: 31328004 PMCID: PMC6609116 DOI: 10.1136/openhrt-2019-001007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/25/2019] [Accepted: 05/30/2019] [Indexed: 01/21/2023] Open
Abstract
Background Reduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting. Methods A retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015–2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong’s method for paired samples and by index of discrimination improvement (IDI). Results In univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031). Conclusions Adding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.
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Affiliation(s)
- Nina Syyli
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markus Hautamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kari Antila
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Shadi Mahdiani
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Markku Eskola
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
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16
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Arylesterase activity of Paraoxonase 1 - prognostic factor for one-year survival in patients with acute myocardial infarction. REV ROMANA MED LAB 2018. [DOI: 10.2478/rrlm-2018-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Introduction: Reduced serum levels of paraoxonase 1 (PON1) activities are associated with diseases involving increased oxidative stress, such as acute coronary syndrome. We aimed to determine whether serum PON1 activities are a prognostic factor for one-year survival following ST-elevation myocardial infarction (STEMI).
Material and methods: We prospectively followed for one-year 75 patients diagnosed and treated for STEMI. Clinical, laboratory and imagistic data were gathered after coronary angiography. PON1 activities (paraoxonase, arylesterase, and lactonase) were assayed spectophotometrically on samples of heparinized plasma taken from the patients in a timeframe of maximum 20 minutes after coronary angiography.
Results: Increased mortality was linked to age (patients over 68 years), permanent atrial fibrillation or left ventricular ejection fraction (LVEF) <40% (associated with global hypokinesia, apical or septal akinesia), trivascular disease atherosclerosis, reduced PON1 activities (paraoxonase <18.4 IU/mL, arylesterase <12.6 IU/mL, lactonase <27.6 IU/mL), and glomerular filtration rate levels <54 mL/min/1.73m2. Multivariate survival analysis showed the independent prognostic role of age (HR 3.92; 95%CI 1.08-14.16; p=0.03), LVEF (HR 9.93; 95%CI 2.20-44.86; p=0.003) and arylesterase (HR 4.25; 95%CI 0.94-19.18; p=0.05) for one-year mortality.
Conclusion: Reduced arylesterase activity of PON1 is an independent predictor of one-year survival after acute myocardial infarction.
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17
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Khaled S, Matahen R. Cardiovascular risk factors profile in patients with acute coronary syndrome with particular reference to left ventricular ejection fraction. Indian Heart J 2017; 70:45-49. [PMID: 29455787 PMCID: PMC5902818 DOI: 10.1016/j.ihj.2017.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/01/2017] [Accepted: 05/27/2017] [Indexed: 12/17/2022] Open
Abstract
Background Acute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS. Objectives To identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS. Results The total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF < 40% (64.5%), Group II: 106 patients with LVEF equal or > 40% (35.5%). The patients of group I were significant elderly compared to those of group II (60.9 ± 11.2 vs 56.9 ± 10.6; p = 0.002), had significant history of DM and CKD (66.3% and 31.1% VS 49.1% and 19.8%; p = 0.004 and 0.036 respectively), presented mainly with STEMI- ACS (51.3% VS 28.3% respectively; p < 0.001) with +v cardiac biomarker (troponin) (90.2% VS 66.0%; p < 0.001). Moreover, patients of group I had more significant ischemic MR compared to the patients of group II (24.9% VS 3.8% respectively; p < 0.001) with higher rate of LV thrombus discovered by echocardiography (25.4% VS 1.9%; p < 0.001). Extensive significant CAD disease was observed to be higher among patients of group I (69.4% VS 57.5%; p = 0.039) and those patients treated mainly with PCI revascularization therapy (68.9% VS 52.8%; p = 0.002) compared to patients of group II who mainly treated medically (34.9% VS 17.6 %; p < 0.001). Multiple logistic regression analysis demonstrated that DM (odd ratio (OR): 2.64, 95% confidence interval (CI): 1.45-4.79, P = 0.01), presence of significant ischemic MR (OR: 13.7, 95% CI:2.84-66.1, p = 0.001)and presence of significantly diseased coronary vessels (odd ratio (OR): 5.06, 95% confidence interval (CI): 1.14-22.6, P = 0.033,) all were independent predictors for significant LV dysfunction (LVEF < 40%) which predict poor outcome in ACS patients. Conclusion We concluded that DM, presence of significant ischemic MR, and increased number, severity of diseased coronaries all were independent predictors of LV dysfunction (LVEF < 40%) which is known to predict poor outcome. Identification of those risk predictors upon patient evaluation could be helpful to identify high risk-patients, in need of particular care, aggressive therapy and close follow-up to improve their poor outcome.
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Affiliation(s)
- Sheeren Khaled
- King Abdullah Medical City, Muzdallfa Road, Makkah, 21955, Saudi Arabia; Banha University, Egypt.
| | - Rajaa Matahen
- King Abdullah Medical City, Muzdallfa Road, Makkah, 21955, Saudi Arabia.
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