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Kataoka N, Imamura T, Koi T, Uchida K, Kinugawa K. Adverse Events Requiring Hospitalization Following Catheter Ablation for Atrial Fibrillation in Heart Failure with versus without Systolic Dysfunction. J Cardiovasc Dev Dis 2024; 11:35. [PMID: 38392249 PMCID: PMC10888582 DOI: 10.3390/jcdd11020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The safety and efficacy of atrial fibrillation (AF) ablation in individuals with heart failure (HF) with preserved ejection fraction (EF), particularly concerning the occurrence of post-procedural adverse events necessitating hospitalization, including anticoagulant-associated major bleeding, still lack conclusive determination. METHODS Data from patients with HF and AF who underwent catheter ablation for AF between 2019 and 2022 at our institution were retrospectively reviewed. All participants were divided into an EF < 50% group or an EF ≥ 50% group according to their baseline left ventricular EF. The composite incidence of the clinical events following catheter ablation was compared between the two groups: (1) all-cause death, (2) HF hospitalization, (3) stroke or systemic embolism, and (4) major bleeding. RESULTS A total of 122 patients (75 years old, 68 male) were included. Of them, 62 (50.8%) patients had an EF ≥ 50%. EF ≥ 50% was an independent predictor of the composite endpoint (adjusted odds ratio 6.07, 95% confidence interval 1.37-26.99, p = 0.018). The incidences of each adverse event were not significantly different between the two groups, except for a higher incidence of major bleeding in the EF ≥ 50% group (12.7% vs. 0%, p = 0.026). CONCLUSIONS Among patients with HF coupled with AF, the incidence of adverse events following AF ablation proved notably elevated in patients with EF ≥ 50% in contrast to their counterparts with EF < 50%. This disparity primarily stems from a heightened occurrence of major bleeding within the EF ≥ 50% cohort. The strategy to reduce adverse events, especially in patients with EF ≥ 50%, remains the next concern.
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Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Takahisa Koi
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Keisuke Uchida
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
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Kawanami S, Egami Y, Sugae H, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Matsunaga‐Lee Y, Yano M, Nishino M, Tanouchi J. Predictors of bleeding events in acute decompensated heart failure patients with antithrombotic therapy: AURORA study. ESC Heart Fail 2023; 10:1114-1121. [PMID: 36585753 PMCID: PMC10053354 DOI: 10.1002/ehf2.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/18/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023] Open
Abstract
AIMS Heart failure (HF) is reported to be one of the major risks of bleeding events. On the other hand, HF patients frequently receive anticoagulants or antiplatelet therapy to manage various co-morbidities. However, predictors of bleeding events in patients with HF have rarely been reported. This study aimed to evaluate the predictors of bleeding events and relationship between bleeding events and HF re-hospitalizations. METHODS AND RESULTS We included 1660 acute decompensated heart failure (ADHF) patients from the AURORA registry between January 2015 and December 2020. A total of 1429 patients were excluded because of history of HF admission, missing echocardiographic data at discharge, lost to follow-up, haemodialysis and no antithrombotic drugs. Finally, we evaluated 231 patients from AURORA registry. The bleeding events were defined as Type 2 to 5 bleeding according to the Bleeding Academic Research Consortium definition. We divided our patients into the bleeding group and non-bleeding group. We compared the baseline characteristics, medications, laboratory data, and echocardiographic data between the two groups. Median age was 78 (IQR 71-82) years old and male accounted for 59%. Approximately half of the patients had an antiplatelet therapy and 70% had an anticoagulant therapy. During a median follow-up of 651 (IQR 357-1139) days, 32 patients (13.8%) suffered from bleeding events. The major driver of the registered events was gastrointestinal bleeding (n = 21, 65.6%), and the other events were cerebral bleeding (n = 4, 12.5%), intraarticular bleeding (n = 2, 6.3%), urogenital bleeding (n = 2, 6.3%), haemorrhagic pericardial effusions (n = 1, 3.1%), subcutaneous hematomas (n = 1, 3.1%), and haemothorax (n = 1, 3.1%). There was a significantly lower haemoglobin level (P < 0.01), higher proportion of inferior vena cava (IVC) diameter ≥21 mm (P < 0.01), and higher furosemide equivalent doses per kilogram (P < 0.01) in the bleeding group than non-bleeding group. A multivariate analysis revealed an equivalent dose of furosemide per kilogram ≥0.66 mg/kg (hazard ratios (HR) of 2.64, 95% confidence interval (CI) 1.26-5.68, P = 0.01), haemoglobin ≤10.3 g/dL (HR of 2.43, 95% CI 1.14-5.03, P = 0.02), and IVC diameter ≥21 mm (HR of 2.79, 95% CI 1.16-6.29, P = 0.02) were independently associated with bleeding events. The Kaplan-Meier analysis showed that HF re-hospitalization rates were higher in the bleeding group than non-bleeding group (P = 0.04). CONCLUSIONS High doses of oral loop diuretics, IVC dilatation, and anaemia were predictors of bleeding events in patients hospitalized with ADHF patients. In addition, bleeding events were associated with HF re-hospitalizations.
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Affiliation(s)
- Shodai Kawanami
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Yasuyuki Egami
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Hiroki Sugae
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Kohei Ukita
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Akito Kawamura
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Hitoshi Nakamura
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Yutaka Matsuhiro
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Koji Yasumoto
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Masaki Tsuda
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Naotaka Okamoto
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Yasuharu Matsunaga‐Lee
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Masamichi Yano
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Masami Nishino
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
| | - Jun Tanouchi
- Division of CardiologyOsaka Rosai Hospital3‐1179 Nagasonecho, Kita‐kuSakaiOsaka591‐8025Japan
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Mascherbauer K, Donà C, Koschutnik M, Dannenberg V, Nitsche C, Duca F, Heitzinger G, Halavina K, Steinacher E, Kronberger C, Bardach C, Beitzke D, Loewe C, Waldmann E, Trauner M, Barkto P, Goliasch G, Mascherbauer J, Hengstenberg C, Kammerlander A. Hepatic T1-Time Predicts Cardiovascular Risk in All-Comers Referred for Cardiovascular Magnetic Resonance: A Post-Hoc Analysis. Circ Cardiovasc Imaging 2022; 15:e014716. [PMID: 36256728 DOI: 10.1161/circimaging.122.014716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Liver damage is frequently observed in patients with cardiovascular disease but infrequently quantified. We hypothesized that in patients with cardiovascular disease undergoing cardiac magnetic resonance, liver T1-times indicate liver damage and are associated with cardiovascular outcome. METHODS We measured hepatic T1-times, displayed on standard cardiac T1-maps, in an all-comer cardiac magnetic resonance-cohort. At the time of cardiac magnetic resonance, we assessed validated general liver fibrosis scores. Kaplan-Meier estimates and Cox-regression models were used to investigate the association between hepatic T1-times and a composite endpoint of non-fatal myocardial infarction, heart failure hospitalization, and death. RESULTS One thousand seventy-five participants (58±18 year old, 47% female) were included (972 patients, 50 controls, 53 participants with transient elastography). Hepatic T1-times were 590±89 ms in patients and 574±45 ms in controls (P=0.052). They were significantly correlated with cardiac size and function, presence of atrial fibrillation, NT-pro-BNP levels, and gamma-glutamyl-transferase levels (P<0.001 for all). During follow-up (58±31 months), a total of 280 (29%) events occurred. On Cox-regression, high hepatic T1-times yielded a significantly higher risk for events (adjusted hazard ratio, 1.66 [95% CI, 1.45-1.89] per 100 ms increase; P<0.001), even when adjusted for age, sex, left and right ventricular ejection fraction, NT-proBNP (N-terminal prohormone of brain natriuretic peptide), and myocardial T1-time. On receiver operating characteristic analysis and restricted cubic splines, we found that a hepatic T1-time exceeding 610 ms was associated with excessive risk. CONCLUSIONS Hepatic T1-times on standard cardiac magnetic resonance scans were significantly associated with cardiac size and function, comorbidities, natriuretic peptides, and independently predicted cardiovascular mortality and morbidity. A hepatic T1-time >610 ms seems to indicate excessive risk. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04220450.
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Affiliation(s)
- Katharina Mascherbauer
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Carolina Donà
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Matthias Koschutnik
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Varius Dannenberg
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Christian Nitsche
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Franz Duca
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Gregor Heitzinger
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Kseniya Halavina
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Eva Steinacher
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Christina Kronberger
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Constanze Bardach
- Division of Cardiovascular and Interventional Radiology (C.B., D.B., C.L.), Medical University of Vienna
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology (C.B., D.B., C.L.), Medical University of Vienna
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology (C.B., D.B., C.L.), Medical University of Vienna
| | - Elisabeth Waldmann
- Division of Gastroenterology and Hepatology (E.W., M.T.), Medical University of Vienna
| | - Michael Trauner
- Division of Gastroenterology and Hepatology (E.W., M.T.), Medical University of Vienna
| | - Philipp Barkto
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Georg Goliasch
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Julia Mascherbauer
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna.,Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria (J.M.)
| | - Christian Hengstenberg
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Andreas Kammerlander
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
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Al-Maawali MS, Al-Naamani HH, Mokadem LN, Al-Maawali G, Salman B, Al-Zakwani I. Comparative Effectiveness and Safety of Rivaroxaban and Warfarin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in an Omani Tertiary Care Hospital. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2202281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
The aim of the study was to compare the effectiveness and safety of rivaroxaban and warfarin as well as to determine the appropriateness of dosing and prescribing of rivaroxaban in Omani patients with non-valvular atrial fibrillation (NVAF).
Methods:
This retrospective cohort study was conducted using the Royal Hospital data registry. The study included all adults newly diagnosed with NVAF and treated with rivaroxaban or warfarin. The outcomes measured include ischaemic stroke, gastrointestinal bleeding (GIB), non-gastrointestinal bleeding (NGIB), as well as appropriateness of dosing and prescribing of rivaroxaban.
Results:
The analysis included 96 rivaroxaban users and 183 warfarin users; 51% of the cohort included males. There were no significant differences observed in the risk of ischaemic stroke between the two groups (hazard ratio (HR), 1.1; 95% confidence interval (CI): 0.4-3.4; p=0.8). However, those on rivaroxaban exhibited a significantly higher rate of GIB compared to those on warfarin (HR, 5.9; 95% CI: 2.9-11.7; p=0.001). There were no differences observed with regards to NGIB between the two groups (HR, 0.9; 95% CI: 0.4-1.9; p=0.8). Dosing and prescribing of rivaroxaban were found to be appropriate in 89% of the patients, with only 6% being prescribed an inappropriately lower dose.
Conclusion:
The study demonstrated no significant differences in the risk of ischaemic stroke or NGIB between rivaroxaban and warfarin groups in newly diagnosed NVAF patients. However, rivaroxaban users were found to have a significantly higher risk of GIB. Rivaroxaban was appropriately prescribed to the majority of the patients, and only a small proportion of the group received an inappropriately lower dose of rivaroxaban.
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Patel SR, Vukelic S, Chinnadurai T, Madan S, Sibinga N, Kwah J, Saeed O, Goldstein DJ, Jorde UP. Gastrointestinal angiodysplasia in heart failure and during CF LVAD support. J Heart Lung Transplant 2021; 41:129-132. [PMID: 34911655 DOI: 10.1016/j.healun.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/20/2021] [Accepted: 11/10/2021] [Indexed: 01/20/2023] Open
Abstract
Angiodysplasias (AGD) are common sites of bleeding in the gastrointestinal (GI) tract after Continuous Flow Left Ventricular Assist Device (CF-LVAD) implantation. We sought to investigate whether AGDs are formed as a result of LVAD physiology or preexist as a consequence of heart failure. Thirty-six subjects with HF reduced EF (HFrEF) underwent video capsule endoscopy (VCE) to assess for the presence of AGD. Fifty-three subjects without HF who underwent VCE for a nonbleeding indication formed a control group. The prevalence of AGD was significantly higher in the HFrEF compared to the non-HF controls (50% vs 13%, p = 0.0002). This association persisted after controlling for age and comorbidities. Within the HFrEF cohort, higher Ang2, NT-proBNP and BUN were associated with the presence of AGD. AGD in the GI tract are associated with HFrEF. This is the first description of a new pathology associated with HFrEF and adds to our understanding of CF LVAD associated GI bleeding.
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Affiliation(s)
- Snehal R Patel
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Sasha Vukelic
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Thiru Chinnadurai
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Shivank Madan
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicholas Sibinga
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Joann Kwah
- Division of Gastroenterology, Department of Medicine, New York University, New York, New York
| | - Omar Saeed
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Goldstein
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Morita S, Malik AH, Kuno T, Ando T, Kaul R, Yandrapalli S, Briasoulis A. Analysis of outcome of 6-month readmissions after percutaneous left atrial appendage occlusion. Heart 2021; 108:606-612. [PMID: 34400473 DOI: 10.1136/heartjnl-2021-319345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Percutaneous left atrial appendage occlusion (LAAO) is an alternative strategy for prevention of thromboembolic events in patients with atrial fibrillation and unsuitable for long-term oral anticoagulation. The study aimed to evaluate the causes and timing of readmissions within 6 months following percutaneous LAAO in a real-world setting. METHODS We conducted a retrospective cohort study of percutaneous LAAO performed in the USA between January and June of 2016-2018 using the Nationwide Readmissions Database. RESULTS Overall, 12 446 patients who underwent LAAO were included in the analyses and 3477 patients (28%) were readmitted within 6 months following the interventions. Readmitted patients were more often women (p=0.001). The index hospitalisation was characterised by longer duration of hospital stay (p<0.001) and complicated with acute kidney injury (p<0.001) among readmitted patients compared with those without readmissions. Readmissions within 6 months following the index intervention were mainly due to heart failure (13%) and gastrointestinal bleeding (12%). Characteristics associated with readmissions due to heart failure included previously known heart failure (HR 2.39; 95% CI 1.70 to 3.37), valvular heart disease (HR 1.39; 95% CI 1.05 to 1.84) and chronic kidney disease (HR 1.42; 95% CI 1.03 to 1.94). Readmissions due to gastrointestinal bleeding were associated with diabetes mellitus (HR 1.78; 95% CI 1.25 to 2.53), chronic kidney disease (HR 1.86; 95% CI 1.23 to 2.81) and previous anaemia (HR 2.41; 95% CI 1.54 to 3.77). CONCLUSIONS After percutaneous LAAO, over a quarter of the patients in the USA required rehospitalisation within 6 months, mainly due to heart failure and gastrointestinal bleeding.
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Affiliation(s)
- Sae Morita
- Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Toshiki Kuno
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Tomo Ando
- Internal Medicine, Kawasaki Saiwai Hospital, Kawasaki, Japan.,Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Risheek Kaul
- Department of Cardiology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center Health Network, Valhalla, New York, USA
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Zhu W, Wu Y, Zhou Y, Liang W, Xue R, Wu Z, Dong Y, Liu C. CHA2DS2-VASc and ATRIA Scores and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction. Cardiovasc Drugs Ther 2020; 34:763-72. [PMID: 32583288 DOI: 10.1007/s10557-020-07011-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Heart failure (HF) patients have high risks of thromboembolic events regardless of the category of left ventricular ejection fraction. We sought to assess whether the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, and female sex) and ATRIA (anticoagulation and risk factors in atrial fibrillation) scores could predict clinical outcomes in HF patients with preserved ejection fraction (HFpEF). METHODS We performed a retrospective analysis in a multicenter, America-based population of 1766 HFpEF patients who were stratified according to their baseline CHA2DS2-VASc or ATRIA scores. The CHA2DS2-VASc and ATRIA scores were analyzed as a continuous or categorical variable. The outcomes were stroke, all-cause death, cardiovascular death, any hospitalization, and HF hospitalization. RESULTS When score was considered as a continuous variable, each point increase in CHA2DS2-VASc was associated with increased risks of stroke (hazard ratio (HR) 1.22, 95% confidence interval (CI) = 1.06-1.41, C-index = 0.62), HF hospitalization (HR 1.08, 95% CI = 1.01-1.17, C-index = 0.59), and any hospitalization (HR 1.06, 95% CI = 1.01-1.11, C-index = 0.57) whereas each point increase in ATRIA was associated with increased risks of stroke (HR 1.11, 95% CI = 1.01-1.21, C-index = 0.62), all-cause death (HR 1.09, 95% CI = 1.05-1.14, C-index = 0.61), cardiovascular death (HR 1.08, 95% CI = 1.02-1.14, C-index = 0.59), HF hospitalization (HR 1.07, 95% CI = 1.03-1.12, C-index = 0.58), and any hospitalization (HR 1.04, 95% CI = 1.01-1.06, C-index = 0.57). When score was regarded as a categorical variable, compared with controls, CHA2DS2-VASc ≥ 4 was associated with increased risks of stroke and hospitalization whereas ATRIA ≥ 8 was associated with increased risks of stroke, death, and hospitalization. CONCLUSIONS The CHA2DS2-VASc and ATRIA scores are associated with risks of adverse outcomes in HFpEF patients. However, the predictive abilities of CHA2DS2-VASc and ATRIA are modest, and their clinical utility in HFpEF remains to be determined. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov . Identifier: NCT00094302.
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Hotsuki Y, Sato Y, Yoshihisa A, Watanabe K, Kimishima Y, Kiko T, Yokokawa T, Misaka T, Sato T, Kaneshiro T, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Takeishi Y. Glasgow-Blatchford Score Predicts Post-Discharge Gastrointestinal Bleeding in Hospitalized Patients with Heart Failure. J Clin Med 2020; 9:E4083. [PMID: 33348860 DOI: 10.3390/jcm9124083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The Glasgow-Blatchford Score (GBS) is one of the most widely used scoring systems for predicting clinical outcomes for gastrointestinal bleeding (GIB). However, the clinical significance of the GBS in predicting GIB in patients with heart failure (HF) remains unclear. Methods and Results: We conducted a prospective observational study in which we collected the clinical data of a total of 2236 patients (1130 men, median 70 years old) who were admitted to Fukushima Medical University Hospital for acute decompensated HF. During the post-discharge follow-up period of a median of 1235 days, seventy-eight (3.5%) patients experienced GIB. The GBS was calculated based on blood urea nitrogen, hemoglobin, systolic blood pressure, heart rate, and history of hepatic disease. The survival classification and regression tree analysis revealed that the accurate cut-off point of the GBS in predicting post-discharge GIB was six points. The patients were divided into two groups: the high GBS group (GBS > 6, n = 702, 31.4%) and the low GBS group (GBS ≤ 6, n = 1534, 68.6%). The Kaplan–Meier analysis showed that GIB rates were higher in the high GBS group than in the low GBS group. Multivariate Cox proportional hazards analysis adjusted for age, malignant tumor, and albumin indicated that a high GBS was an independent predictor of GIB (hazards ratio 2.258, 95% confidence interval 1.326–3.845, p = 0.003). Conclusions: A high GBS is an independent predictor and useful risk stratification score of post-discharge GIB in patients with HF.
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Chen F, Zhou Y, Wan Q, Yu P, Ma J, Hu J. Effect of non-vitamin K antagonist oral anticoagulants versus warfarin in heart failure patients with atrial fibrillation. Heart Fail Rev. [DOI: 10.1007/s10741-020-09946-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ishikawa H, Izumiya Y, Shibata A, Ichikawa Y, Yamaguchi T, Yamaguchi Y, Kitada R, Iwata S, Ehara S, Tomita S, Hanatani A, Yoshiyama M. Soluble urokinase-type plasminogen activator receptor represents exercise tolerance and predicts adverse cardiac events in patients with heart failure. Heart Vessels 2019; 35:681-688. [PMID: 31741050 DOI: 10.1007/s00380-019-01538-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Soluble urokinase-type plasminogen activator receptor (suPAR) is a membrane-binding protein that is released into the blood stream by immune activation. Recent reports suggest that circulating suPAR levels are associated with adverse cardiovascular outcomes. Exercise tolerance is an independent predictor of prognosis in patients with heart failure (HF); however, the relationship between serum suPAR level and exercise tolerance is unclear. We prospectively enrolled 94 patients who were hospitalized for worsening of HF. All patients underwent a symptom-limited cardiopulmonary exercise test to evaluate exercise tolerance. The median value of serum suPAR was 4848 pg/ml. During follow up, 44 patients (47%) were admitted for all-cause mortality and re-hospitalization for HF. Median serum suPAR was significantly higher in the patients with cardiac events than in the patients with non-event group. Patients were divided into two groups according to circulating suPAR levels. Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly higher in the high suPAR group (log-rank p = 0.023). Multivariate analysis revealed that suPAR was independently correlated with the parameters of exercise tolerance such as anaerobic threshold (p = 0.007) and peak oxygen uptake (p = 0.005). suPAR levels predicted adverse cardiac events and independently correlated with the parameters of exercise tolerance. suPAR could be a useful surrogate biomarker of exercise tolerance in patients with HF.
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Affiliation(s)
- Hirotoshi Ishikawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Atsushi Shibata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Yoshitaka Ichikawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Takehiro Yamaguchi
- Department of Pharmacology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yumi Yamaguchi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Ryoko Kitada
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Shoichi Ehara
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Shuhei Tomita
- Department of Pharmacology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihisa Hanatani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
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