scholarly journals Phase angle by electrical bioimpedance is a predictive factor of hospitalisation, falls and mortality in patients with cirrhosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eva Román ◽  
Maria Poca ◽  
Gerard Amorós-Figueras ◽  
Javier Rosell-Ferrer ◽  
Cristina Gely ◽  
...  
Keyword(s):  
Body Composition ◽  
Phase Angle ◽  
Predictive Factor ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Predictive Marker ◽  
Adverse Outcomes ◽  
Electrical Bioimpedance ◽  
Assess Body Composition

AbstractThe phase angle is a versatile measurement to assess body composition, frailty and prognosis in patients with chronic diseases. In cirrhosis, patients often present alterations in body composition that are related to adverse outcomes. The phase angle could be useful to evaluate prognosis in these patients, but data are scarce. The aim was to analyse the prognostic value of the phase angle to predict clinically relevant events such as hospitalisation, falls, and mortality in patients with cirrhosis. Outpatients with cirrhosis were consecutively included and the phase angle was determined by electrical bioimpedance. Patients were prospectively followed to determine the incidence of hospitalisations, falls, and mortality. One hundred patients were included. Patients with phase angle ≤ 4.6° (n = 31) showed a higher probability of hospitalisation (35% vs 11%, p = 0.003), falls (41% vs 11%, p = 0.001) and mortality (26% vs 3%, p = 0.001) at 2-year follow-up than patients with PA > 4.6° (n = 69). In the multivariable analysis, the phase angle and MELD-Na were independent predictive factors of hospitalisation and mortality. Phase angle was the only predictive factor for falls. In conclusion, the phase angle showed to be a predictive marker for hospitalisation, falls, and mortality in outpatients with cirrhosis.

scholarly journals Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-Wen Lin ◽  
Mei Jiang ◽  
Xue-biao Wei ◽  
Jie-leng Huang ◽  
Zedazhong Su ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Infective Endocarditis ◽  
Adverse Events ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Large Sample Size ◽  
Cox Regression Analysis ◽  
D Dimer

Abstract Background Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). Methods 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. Results In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03–1.19, P = 0.005). In addition, the Kaplan–Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05–1.18, P < 0.001). Conclusions D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.

MO663THE UTILITY OF SMART SCALES TO MONITOR BODY COMPOSITION IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Lucia Cordero ◽  
Marta Rivero Martínez ◽  
Paula Jara Caro Espada ◽  
Elena Gutiérrez ◽  
Evangelina Mérida ◽  
...  
Keyword(s):  
Body Composition ◽  
Fat Tissue ◽  
Lean Tissue ◽  
Tissue Mass ◽  
Composition Data ◽  
The Mean ◽  
Good Concordance ◽  
Urea Distribution Volume ◽  
Assess Body Composition

Abstract Background and Aims Overhydration (OH) is an independent predictor of mortality on hemodialysis (HD). The gold standard to assess OH is BCM monitor from Fresenius®, however BCM is a hospital hold device limiting its use. New smart scales have emerged as household devices reporting daily body composition data. Objective To determine if Renpho ES-CS20M® could be useful on a 52 HD patient to estimate body composition data. Method 72 body composition assessments (BCA) during mid-week HD session were performed. Each BCA included: (1) Predialysis Renpho measurement, (2) Predialysis BCM monitor measurement, (3) Postdialysis Renpho measurement. To track the fluid balance during the HD session: (1) we recorded ultrafiltration, (2) food or fluid intake was not allowed, and (3) none of the HD patients urinated during the HD session. If any intravenous fluids were needed during the HD session, we subtracted them off from UF. Results Data from 52 HD patients were studied (age 58.8 ± 16.8 years, 56.9 % males, 14.7% diabetics), with a mean pre-HD weight of 70.0 ± 13. 4 Kg, overhydration of 1.7 ± 1.5 L and urea distribution volume of 31.7 ± 5.7 L. The mean ultrafiltration during HD session was -1.8 ± 0.9 L. Renpho estimated a Pre – HD hydration of 34.25 ± 6.02 Kg vs 33.4 ± 5.7 Kg by BCM, showing a good concordance between methods (ICC 0.788 [0.67-0.86], B -0.58, p &lt;0.01). Renpho poorly estimated pre – HD lean tissue mass at 45.4 ± 6.9 Kg compared with 33.8 ± 8.0 Kg by BCM. Although Renpho was able to provide a moderate concordant estimation of fat tissue mass (33.8 ± 8.0 % with Renpho vs 34.7 ± 9.6%), the bias proportion was unacceptable. Post- HD hydration by Renpho was not able to reproduce the ultrafiltracion achieved during the HD session (pre-HD 34.25 ± 6.02 Kg vs post-HD 34.08 ± 6.00 Kg). Conclusion Renpho has a proportional bias estimating predialysis hydration compared with BCM monitor, but is not able to assess changes produced with ultrafiltration or other parameters of body composition (as lean or fat tissue mass). Although smart scales are unacurate to assess body composition on HD patients, they could be useful on the follow up of them changing the accuracy for frequency.

scholarly journals Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Brown ◽  
A Dimarco ◽  
J Bradley ◽  
G Nucifora ◽  
C Miller ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Prognostic Value ◽  
Nyha Class ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Youden Index ◽  
Private Company ◽  
Parametric Mapping ◽  
Selection For

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical. Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification. Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD  insertion  or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed. Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p &lt; 0.001), ECV (HR 1.14 (1.05-1.22), p &lt; 0.001), GLS% (HR 1.14 (1.07-1.21) p &lt; 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p &lt; 0.001), LVEF (HR 0.92 (0.9-0.95), p &lt; 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome. SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE  and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE. Conclusion Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value,  likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.

Prognostic Relevance of Monocytopenia and Lymphocyte-to-Monocyte Ratio in Primary Myelodysplastic Syndromes

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1996-1996
Author(s):  
Lyla Saeed ◽  
Mrinal M Patnaik ◽  
Kebede H. Begna ◽  
Aref Al-Kali ◽  
Mark R Litzow ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Lymphocyte Count ◽  
Research Funding ◽  
Prognostic Value ◽  
Leukocyte Count ◽  
Multivariable Analysis ◽  
Absolute Lymphocyte Count ◽  
Monocyte Count ◽  
Lymphocyte To Monocyte Ratio

Abstract Background We have previously shown an independent adverse prognostic effect of lymphopenia (absolute lymphocyte count <1.2 x 10(9)/L) for survival in MDS (Jacobs et al. Am J Hematol 2010;85:160) whereas others have suggested a similar value from lymphocyte-to-monocyte ratio (LMR); patients with LMR ≥5 experienced shorter survival with median 67 vs. 126 months (Mushtaq et al. JCO May 20 Supp. 2016:7062). Whether or not "monocytopenia" also carries a prognostic value in MDS is currently unknown and was the main objective for the current study, which also addresses the prognostic value of LMR. Methods We retrospectively recruited 889 consecutive patients with primary MDS who were untreated at the time of referral to our institution and in whom absolute monocyte count (AMC) and absolute lymphocyte count (ALC) at time of referral were documented. The diagnosis of MDS and leukemic transformation (LT) was made according to WHO criteria (Blood. 2009;114:937). Complete follow-up information was updated in January 2015. For the purposes of the current study, monocytopenia was defined as AMC below the lower limit of the institutional normal range, which was 0.3 to 0.9 x 10(9)/L. Comparisons of survival and other clinical parameters were performed between i) patients with and without monocytopenia and ii) patients with and without LMR ≥5. Conventional methods were used for statistical analysis. Results Patient characteristics: Median (range) values for the 889 study patients (69% males) included: age 72 (18-98), hemoglobin 9.6 g/dL (5.4-15.7), leukocyte count 3.4 x 10(9)/L (0.4-35), platelet count 106 x 10(9)/L (2-1804), circulating blasts 0% (0-18), bone marrow blasts 3% (0-19) and absolute lymphocyte count (ALC) 1.2 x 10(9)/L (.02-8.9). Transfusion need was documented in 33% of patients and abnormal cytogenetics in 49%. Risk stratification by the revised international prognostic scoring system (IPSS-R) was very high in 11%, high in 16%, intermediate in 21%, low in 36% and very low in 16%. The median (range) AMC for the entire study population of 889 patients was 0.22 x 10(9)/L (0.0-1.8).The number of patients with subnormal AMC was 539 (61%). After a median follow-up of 27 months, 712 (80%) deaths and 116 (13%) leukemic transformations were documented. Comparison of patients stratified by absolute monocyte count and LMR Compared to patients with AMC >0.3 x 10(9)/L, MDS patients with monocytopenia displayed younger age (p<0.0001), lower hemoglobin (p=0.005), higher red blood cell transfusion need (p=0.03), lower leukocyte count (p<0.0001), lower platelet count (p<0.0001), lower absolute neutrophil count (p<0.0001), higher circulating (p=0.03) and bone marrow (p<0.0001) blasts, higher incidence of abnormal karyotype (p=0.03), and higher risk distribution in terms of both IPSS-R (p<0.0001) and cytogenetic risk stratification by IPSS-R (p=0.03). In univariate analysis, lower AMC was associated with inferior survival (p=0.002); significance was even more apparent when comparing patients with and without monocytopenia (p=0.0003; HR 1.3, 95% CI 1.1-1.5). Similarly, there was significant association between LMR and survival (p<0.0001) with patients with LMR ≥5 experiencing inferior survival (p=0.03; HR 1.2; 95% CI 1.02-1.4). In multivariable analysis, the adverse effect of monocytopenia was shown to be independent of age (p<0.0001), gender (p=0.0001), anemia (Hemoglobin <10 g/dL; p=0.002), thrombocytopenia (platelets <100 x 10(9)/L; p=0.01), neutropenia (absolute neutrophil count <0.8 x 10 (9)/L; p=0.005), subnormal ALC (p=0.0008), circulating blast percentage (p=0.002), cytogenetic risk stratification by IPSS-R (p=0.006) and LMR (p=0.02) or LMR ≥5 (p=0.002); however, significance was lost when risk stratification by IPSS-R was added to the multivariable analysis (p=0.7). In regards to LMR, it retained its significance (p=0.009) during multivariable analysis that included monocytopenia or subnormal ALC, as covariates; however, significance was lost in the context of IPSS-R (p=0.24 for LMR and 0.8 for LMR ≥5) Conclusions Monocytopenia in MDS clusters with adverse disease features and both monocytopenia and higher LMR were associated with poor survival. Despite the display of prognostic independence from each other and other risk factors considered individually, the survival impact of neither monocytopenia nor LMR was found to be independent of IPSS-R. Disclosures Al-Kali: Novartis: Research Funding; Celgene: Research Funding.

African American race to predict for earlier failure of active surveillance: Results from the Duke Prostate Center.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4670-4670
Author(s):  
Mitchell Bassett ◽  
Michael Abern ◽  
Lionel Lloyds Banez ◽  
Michael Ferrandino ◽  
Cary N. Robertson ◽  
...  
Keyword(s):  
African American ◽  
Active Surveillance ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Patient Choice ◽  
Gleason Grade ◽  
Volume Number ◽  
Initial Biopsy

4670 Background: As concerns mount regarding overtreatment and over-diagnosis of prostate cancer (CaP), active surveillance (AS) is increasingly utilized in low risk patients. While African-American (AA) race is associated with adverse outcomes after prostatectomy, its effect on patients managed with AS is not known. Methods: A retrospective review identified 222 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. All men had CaP diagnosed on biopsy performed at our center, and elected AS over treatment. Failure was defined as progression to treatment. In men who failed AS, the reasons for failure, follow-up PSA and biopsy characteristics were analyzed. The primary outcome - time from diagnosis to failure of AS for a reason other than patient choice - was analyzed with univariable and multivariable Cox proportional hazards models. Results: In our AS cohort, 73% are Caucasian and 23% AA. Median follow-up is 25.4 months. Age, household income, BMI, PSA, clinical stage, family history, prostate volume, number of cores with cancer, and Gleason grade on initial biopsy did not differ by race. The number of biopsies and PSA tests performed on AS did not differ by race. A higher proportion of AA men tended to fail from biopsy progression (72.7% vs. 63.8%) while a lower proportion failed by choice (9.1% vs. 14.9%) compared to Caucasians (p = 0.114). AA men had a significantly shorter time to failure (HR 1.74, p = 0.045) compared to Caucasians. There was a trend toward increased Gleason grade 8 or higher cancer on follow-up biopsy in AA compared to Caucasian men (10% vs. 2.5%, p = 0.08). AA race remained a predictor (HR 1.76, p = 0.058) of failure on multivariable analysis, as did initial PSA (HR 1.90, p = 0.031) and number of cores with cancer on initial biopsy (HR 1.29, p = 0.013). Conclusions: AA race was associated with higher risk for failure of AS. There was a trend toward AA men failing due to biopsy progression and with higher grade cancer. Additional follow-up is necessary to determine how this affects the long term outcomes of these men.

scholarly journals Change in GFR over time in the Oxford Renal Cohort Study

2021 ◽  
pp. BJGP.2021.0477
Author(s):  
Jennifer A Hirst ◽  
Maarten Taal ◽  
Simon D Fraser ◽  
Jose Ordóñez-Mena ◽  
Chris O'Callaghan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Function ◽  
Smoking Status ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Adverse Health Outcomes ◽  
Ckd Stage ◽  
Gfr Decline ◽  
Egfr Decline

Background: Decline in kidney function can result in adverse health outcomes. The OxREN study has detailed baseline assessments from 884 participants ≥60 years. Aim: To determine the proportion of participants with decline in estimated glomerular filtration rate (eGFR), identify determinants of decline and determine proportions with chronic kidney disease (CKD) remission. Design and setting: Observational cohort study in UK primary care. Methods: Data were used from baseline and annual follow-up assessments to monitor change in kidney function. Rapid eGFR decline was defined as eGFR decrease >5 ml/min/1.73m2/year, improvement as eGFR increase >5ml/min/1.73m2/year and remission in those with CKD at baseline and eGFR>60 ml/min/1.73m2 during follow-up. Cox proportional hazard models were used to identify factors associated with eGFR decline. Results: In 686 participants with a median follow-up of 2.1 years, 164 (24%) evidenced rapid GFR decline, 185 (27%) experienced eGFR improvement and 82 of 394 (21%) meeting CKD stage 1-4 at baseline experienced remission. In the multivariable analysis, smoking status, higher systolic blood pressure and being known to have CKD at cohort entry were associated with rapid GFR decline. Those with CKD stage 3 at baseline were less likely to exhibit GFR decline compared with normal kidney function. Conclusions: This study established that 24% of people evidenced rapid GFR decline whereas 21% evidenced remission of CKD. People at risk of rapid GFR decline may benefit from closer monitoring and appropriate treatment to minimise risks of adverse outcomes, though only a small proportion meet the NICE criteria for referral to secondary care.

scholarly journals Phase Angle as an Objective and Predictive Factor of Radiotherapy-induced Changes in Body Composition of Male Patients With Head and Neck Cancer

In Vivo ◽  
2019 ◽  
Vol 33 (5) ◽  
pp. 1645-1651 ◽  
Author(s):  
TERESA MAŁECKA-MASSALSKA ◽  
TOMASZ POWRÓZEK ◽  
MONIKA PRENDECKA ◽  
RADOSŁAW MLAK ◽  
GRZEGORZ SOBIESZEK ◽  
...  
Keyword(s):  
Body Composition ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Phase Angle ◽  
Neck Cancer ◽  
Predictive Factor ◽  
Male Patients ◽  
Induced Changes

Circulating biomarkers and outcomes in a single-arm phase II trial of first-line sunitinib alternating with everolimus for advanced renal cell carcinoma (aRCC): EVERSUN ANZUP trial 0901.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 428-428
Author(s):  
Sonia Yip ◽  
Nick Pavlakis ◽  
Rozelle Harvie ◽  
Andrew Martin ◽  
Lidija Jovanovic ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Prognostic Score ◽  
Multivariable Analysis ◽  
Tumour Response ◽  
Univariable Analysis ◽  
Protein Biomarkers ◽  
Baseline Serum ◽  
Hazard Ratios ◽  
Grade 3

428 Background: We sought biomarkers at baseline associated with clinically important outcomes in this trial of alternating sunitinib and everolimus. Methods: Baseline blood was tested for circulating tumor cells (CTCs) using CellSearch CTC system (Veridex). Baseline serum was tested for protein biomarkers: bFGF, CAIX; e-selectin; HIF1; IL8; NGAL; PDGF; PLGF; vCAM; VEGF-A, C and D; VEGFR1-3; by multiplex immunoassays (Bio-Plex system BioRad) or ELISA (R&D Systems DuoSets). Biomarker levels were dichotomised according to median or limit of detectability. Outcomes were progression free, overall survival (PFS, OS), objective tumour response (OTR) and toxicity (cycle 1 grade 3-5 AEs). Regression models were used for hazard ratios (HR), odds ratios (OR), p-values (p) in univariable analysis, adjusted for established prognostic factors in multivariable analysis. Results: Patient (n=55) characteristics were mean age 61 yrs: male 71%; MSKCC good risk 16%, intermediate risk 84%. There were 47 progression events and 30 deaths after a median follow-up of 20 mos. CTCs were detected in 5/31 (16%). Univariable analysis showed associations between OTR and low levels of bFGF (6 v 0, p 0.009); shorter OS and high levels of both NGAL (HR 2.5, p 0.02) and IL8 (HR 2.3, p 0.04); toxicity with detectable levels of CAIX (OR 4.7, p 0.03); none was associated with PFS. Adjusting for MSKCC prognostic score, age, gender and presence of liver or bone metastases: shorter PFS was associated with high bFGF (HR 2.0, p 0.03), low vCAM1 (HR 0.50, p 0.04), undetectable HIF1 (HR 0.33, p 0.01), shorter OS was associated with high NGAL (HR 2.5, p 0.03) and undetectable HIF1 (HR 0.35, p 0.04). Toxicity was associated with detectable CAIX (OR 5.8, p 0.04). None were statistically significant after adjusting for multi-comparisons. Conclusions: This exploratory study did not find strong statistical evidence for the prognostic value of these circulating baseline biomarkers. Prognostic value of changes from baseline during therapy remains an important area of study. EVERSUN is an ANZUP Cancer Trials Group Ltd trial coordinated by NHMRC Clinical Trials Centre (ACTRN12609000643279).

Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

2020 ◽  
Author(s):  
Alexander R van Rosendael ◽  
A Maxim Bax ◽  
Inge J van den Hoogen ◽  
Jeff M Smit ◽  
Subhi J Al’Aref ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Hazard Analysis ◽  
Multivariable Analysis ◽  
Clinical Predictors ◽  
Coronary Ct ◽  
Major Cardiovascular Events ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
Incremental Prognostic Value

Abstract Aims  The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. Methods and results  From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1–6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29–1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02–1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. Conclusion  In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

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