Association between the risk for cardiovascular events and antiviral treatment for herpes zoster

2020 ◽  
Author(s):  
Jinkwon Kim ◽  
Jimin Jeon ◽  
Hye Sun Lee ◽  
Kyung-Yul Lee
Keyword(s):  
Herpes Zoster ◽  
Lower Risk ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Cox Regression ◽  
Antiviral Treatment ◽  
Antiviral Agents ◽  
Cox Regression Analysis ◽  
Health Claims Data

Abstract Background Cardiovascular risk increases following herpes zoster. We investigated if the treatment with antiviral agents, steroids, and common cardiovascular medications was associated with the risk of postherpetic cardiovascular events. Methods This was a nationwide population-based, retrospective, cohort study using the National Health Insurance Service health claims data in Korea. We included patients with a first ever diagnosis of herpes zoster in 2003–2014 and no prior cardiovascular event. Primary outcome was the development of composites of myocardial infarction (ICD-10 code of “I21”) and stroke (“I60–63”) since the herpes zoster. We analyzed the exposure (intravenous or oral administration) to antiviral agents, steroids, antithrombotics, and statins within ± 7 days from the index date of herpes zoster diagnosis. Follow-up was performed until the development of primary outcome, death, or December 2015. Results Of 83,833 patients with herpes zoster, the proportion of patients who received the treatment with antiviral agents, steroids, antithrombotics, and statins were 90.5%, 48.0%, 9.0%, and 7.9%, respectively. During the 5.4 ± 3.1 years of mean follow-up period, 1,306 patients suffered the primary outcome. Multivariate Cox regression analysis demonstrated that treatment with antiviral agents (adjusted HR, 0.80; 95% CI, 0.69–0.93) and statins (adjusted HR, 0.67; 95% CI, 0.54–0.82) were significantly associated with the lower risk of primary outcome. Use of antithrombotics and steroids were not associated with the risk. Conclusions After herpes zoster, treatment with antiviral agents was significantly associated with lower risk of cardiovascular events. We need more information on the cardiovascular protective role of the herpes zoster treatments.

scholarly journals Evaluation of pulse wave velocity for predicting major advanced cardiovascular events in patients with chronic myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Meiszterics ◽  
T Simor ◽  
R J Van Der Geest ◽  
N Farkas ◽  
B Gaszner
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cardiovascular Events ◽  
Pulse Wave ◽  
Cox Regression ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used to assess PWV using direct body surface distance measurements. The comparison between the two techniques was tested. Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Event-free survival was analysed using Kaplan-Meier plots and log-rank tests. Univariable and multivariable Cox regression analysis was performed to identify outcome predictors. Results 75 patients (56 male, 19 female, average age: 56±13 years) referred for CMR were investigated, of whom 50 had coronary artery disease (CAD) including 35 patients with previous MI developing ischaemic late gadolinium enhancement (LGE) pattern. AG and CMR derived PWV values were significantly correlated (rho: 0,343, p<0,05), however absolute PWV values were significantly higher for AG (median (IQR): 10,4 (9,2–11,9) vs. 6,44 (5,64–7,5); p<0,001). Bland Altman analysis showed an acceptable agreement with a mean difference of 3,7 m/s between the two measures. In patients with CAD significantly (p<0,01) higher PWV values were measured by AG and CMR, respectively. During the median follow-up of 6 years, totally 69 MACE events occurred. Optimized PWV cut-off values for MACE prediction were calculated (CMR: 6,47 m/s; AG: 9,625 m/s) by receiver operating characteristic analysis. Kaplan-Meier analysis in both methods showed a significantly lower event-free survival in case of high PWV (p<0,01, respectively). Cox regression analysis revealed PWV for both methods as a predictor of MACE (PWV CMR hazard ratio (HR): 2,6 (confidence interval (CI) 1,3–5,1), PWV AG HR: 3,1 (CI: 1,3–7,1), p<0,005, respectively). Conclusions Our study showed good agreement between the AG and CMR methods for PWV calculation. Both techniques are feasible for MACE prediction in postinfarcted patients. However, different AG and CMR PWV cut-off values were calculated to improve risk stratification. FUNDunding Acknowledgement Type of funding sources: None. Agreement between the two methods Kaplan-Meier event curves for MACE

scholarly journals Combination of CHARGE AF score and index of 24-hour electrocardiogram to predict incident atrial fibrillation and cardiovascular events

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Nishimura ◽  
K Senoo ◽  
I Hibiki ◽  
T Okura ◽  
T Miki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Holter Ecg ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. AF risk prediction can facilitate the efficient deployment of diagnosis or interventions to prevent AF. Purpose We sought to assess the combination prediction value of Holter electrocardiogram (Holter ECG) and the CHARGE-AF score (Cohorts for Aging and Research in Genomic Epidemiology-AF) for the new-onset of AF in a single center study. We also investigated the association between clinical findings and the new-onset of cerebral cardiovascular events. Methods From January 2008 and May 2014, 1246 patients with aged≥20 undergoing Holter ECG for palpitations, dizziness, or syncope were recruited. Among them, 350 patients were enrolled in this study after exclusion of 1) AF history at the time of inspection or before, 2) post cardiac device implantation, 3) follow-up duration <1 year, and 4) no 12-lead ECG records within 6 months around Holter ECG. Results During the 5.9-year follow-up, 40 patients (11.4%) developed AF incidence. Multivariate cox regression analysis revealed that CHARGE-AF score (hazard ratio [HR]: 1.59, 95% confidence interval (95% CI): 1.13–2.26, P<0.01), BMI (HR: 0.91, 95% CI: 0.83–0.99, P=0.03), frequent supraventricular extrasystoles (SVEs) ≥1000 beats/day (HR: 4.87, 95% CI: 2.59–9.13, P<0.001) and first-degree AV block (HR: 3.52, 95% CI: 1.63–7.61, P<0.01) were significant independent predictors for newly AF. The area under the ROC curve (AUC) of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was greater than the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.82 vs 0.66, 95% CI: 0.56–0.75, respectively). On the ROC curve, the CHARGE-AF score of 12.9 was optimum cut-off value for newly AF. Patients with both the CHARGE-AF score≥12.9 and SVEs≥1000 developed AF at 129.0/1000 person-years, compared with those with the CHARGE-AF score<12.9 and SVEs≥1000 (48.9), the CHARGE-AF score≥12.9 and SVEs<1000 (40.0) and the CHARGE-AF score<12.9 and SVEs<1000 (7.4), respectively. In multivariate cox regression analysis, age, past history of congestive heart failure and myocardial infarction, and antihypertensive medication were significant predictors of cerebral cardiovascular events (n=43), all of which signifying the components of the CHARGE-AF score. The AUC of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was not different from the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.81 vs 0.73, 95% CI: 0.64–0.82, respectively). Conclusion CHARGE-AF score has higher predictive power of both the new incident AF and cerebral cardiovascular events. The combination of CHARGE-AF score and SVEs≥1000 beats/day in Holter ECG can demonstrate the additional effect of prediction ability for the new incident AF, but not for cerebral cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Diabetes as a Risk Factor for Cardiovascular Events in Patients Receiving Permanent Pacemaker – A Propensity Score-Matched Cohort Study

2021 ◽  
Author(s):  
Huang-Chung Chen ◽  
Wen-Hao Liu ◽  
Chien-Hao Tseng ◽  
Yung-Lung Chen ◽  
Wei-Chieh Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Study Groups ◽  
Permanent Pacemaker ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Cox Regression Analysis

Abstract Background: Type 2 diabetes was associated with higher risk for permanent pacemaker (PPM) implantation. We aimed to compare the clinical outcomes between diabetic and non-diabetic patients receiving PPM treatment. Methods: Between January 2003 and December 2017, 1742 patients receiving naïve PPM treatment comprised this retrospective cohort study and were categorized into two groups by the presence or absence of diagnosis of diabetes: diabetic group (n=632, 36.3%) and non-diabetic group (n=1110, 63.7%). The primary outcome was cardiovascular events including heart failure (HF) hospitalization and acute myocardial infarction (AMI). Propensity score matching (PSM) was applied to reduce selection bias between the study groups. Results: During a mean follow-up of 7.8 ± 4.8 years, there were 264 cardiovascular events. A total of 746 patients with a 1:1 paired ratio between diabetic and non-diabetic groups were analyzed in the propensity score-matched series. After PSM, the incidence of cardiovascular events was higher in the diabetic group compared to the non-diabetic group (18.8% vs. 12.3%, P=0.015). Moreover, the incidence of HF hospitalization was higher in the diabetic patients compared to the non-diabetic patients (15.3% vs. 10.2%, P=0.037), whereas the incidence of AMI did not differ between the diabetic and non-diabetic groups (3.5% vs. 2.1%, P=0.268). After adjustments for covariates in multiple Cox regression analysis, diabetes remained as an independent predictor for cardiovascular events [hazard ratio, 1.54; 95% confidence interval, 1.04-2.29; P=0.031].Conclusions:In this cohort study of patients with naïve PPMs implantation, diabetes increased 1.54-fold risk of cardiovascular events in PPM recipients, especially for HF hospitalization.

4078Lipoprotein(a) and clinical outcomes in patients after revascularization of peripheral arteries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N A Tmoyan ◽  
M V Ezhov ◽  
O I Afanasieva ◽  
E A Klesareva ◽  
M I Afanasieva ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Peripheral Arteries ◽  
Cox Regression Analysis ◽  
Secondary Endpoints

Abstract Background Randomized trials have proved the reduction of cardiovascular events due to LDL-cholesterol level decrease. However, despite high-intensity statin therapy, there is a residual risk, that could be associated with lipoprotein(a) [Lp(a)]. It has been shown that there is an association between elevated Lp(a) level and cardiovascular outcomes in patients with coronary heart disease. Data about the role of Lp(a) in the development of cardiovascular events after revascularization of peripheral arteries are scarce. Purpose To evaluate the relationship of Lp(a) level with cardiovascular outcomes after revascularization of carotid and lower limbs arteries. Methods The study included 258 patients with severe carotid and/or lower extremity artery disease, who underwent successful elective revascularization. The primary endpoint was the composite of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. The secondary endpoint was the composite of transitory ischaemic attack, limb amputation, hospitalization for unstable angina, or revascularization surgery. Results During 36 months follow-up 29 (11%) primary and 113 (44%) secondary endpoints were registered. It was noted greater rate of primary (21 [8%] vs. 8 [3%]; hazard ratio [HR], 3.0; 95% confidence interval [CI] 1.5–6.3; p<0.01) and secondary endpoints (72 [28%] vs. 41 (16%], HR, 2.5; 95% CI 1.7–3.7; p<0.01) in patients with elevated Lp(a) level (≥30 mg/dl) compared to patients with Lp(a) <30 mg/dl (Picture). Multivariable-adjusted Cox regression analysis revealed that Lp(a) was independently associated with incidence of cardiovascular outcomes. Conclusions Patients with peripheral artery diseases have a high risk of cardiovascular events and the level of Lp(a) ≥30 mg/dl is an independent predictor of cardiovascular events in prospective 3-year follow-up after revascularization of carotid and lower limbs arteries.

scholarly journals POS0772 PREVALENCE AND RISK FACTORS FOR HERPES ZOSTER REACTIVATION IN 1542 PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 640.1-640
Author(s):  
C. C. Mok ◽  
L. Y. Ho ◽  
S. M. Tse ◽  
K. L. Chan ◽  
C. H. To
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Regression Analysis ◽  
Herpes Zoster ◽  
Rheumatic Diseases ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Objectives:To study the prevalence and risk factors of herpes zoster (HZ) infection in patients with rheumatic diseases.Methods:Medical records of patients with rheumatic diseases who attended our out-patient rheumatology clinics between 2019 March and 2019 August were retrospectively reviewed. Patients who were using biological or targeted DMARDs were excluded. Episodes of HZ infection since disease diagnosis were identified and the prevalence over time was calculated. Laboratory parameters (total white cell count, neutrophil-to-lymphocyte ratio, serum albumin, globulin & creatinine), history of diabetes mellitus and the highest doses of immunosuppressive medications within 6 months of the first episode of HZ infection were compared with those within 6 months of last follow-up in patients who did not have HZ infection. Cox regression analysis was performed to identify factors associated with the first HZ infection in all patients.Results:1542 patients were studied (88% women, age 46.4±15.0 years). The underlying diseases were systemic lupus erythematosus (SLE) (38%), rheumatoid arthritis (26%) and other rheumatic diseases (36%). After a total follow-up of 11,515 patient-years since diagnosis (7.5±7.0 years), 122 (7.9%) patients developed 146 episodes of HZ infection, giving an overall prevalence of 1.27/100-patient years. The prevalence rates of HZ in SLE, RA and non-SLE/RA patients were 1.70, 0.64 and 0.76 per 100 patient-years, respectively. Patients who experienced HZ reactivation were younger (41.6±14.7 vs 46.8±15.0 years; p<0.001), more likely to have SLE (74% vs 35%; p<0.001) and diabetes mellitus (17% vs 7.3%; p=0.01), and had a significantly lower albumin (38.6±5.6 vs 41.3±3.5; p<0.001) and higher neutrophil-to-lymphocyte ratio (4.9±6.2 vs 2.8±2.6; p<0.001). More patients with HZ reactivation were treated with prednisolone (54% vs 22%; p<0.001), azathioprine (20% vs 8%; p<0.001), mycophenolate mofetil [MMF] (21% vs 12%; p=0.006), cyclophosphamide [CYC] (4.9% vs 0.1%; p<0.001) and hydroxychloroquine (48% vs 34%; p=0.002) in the preceding 6 months compared with those who did not have HZ infection. Among those using immunosuppressive drugs, the doses of MMF (1.42±0.64 vs 1.02±0.31g; p=0.005) and prednisolone (15.6±15.9 vs 5.5±4.5mg; p<0.001) were significantly higher in those with HZ infection. The cumulative risk of having HZ reactivation in SLE patients at 24 and 48 months since diagnosis was 5.9% and 8.6%, respectively, which was significantly higher than that in non-SLE patients (1.9% and 2.5%, respectively; p<0.001 by log rank test). Cox regression analysis revealed that having a diagnosis of SLE (HR 1.97 [1.17-3.31]), albumin level (HR 0.93 [0.90-0.97] per g/L; p=0.001), serum creatinine (HR 0.995 [0.990-1.00] per umol/L), higher neutrophil/lymphocyte ratio (HR 1.08 [1.05-1.11]) and the use of CYC (HR 6.69 [2.56-17.5]) and prednisolone (HR 1.61 [1.02-2.45]) in the preceding 6 months were independently associated with the development of HZ infection.Conclusion:Reactivation of HZ is fairly common in patients with rheumatic diseases. Underlying SLE, prednisolone/cyclophosphamide therapy and the neutrophil/lymphocyte ratio, but not age, sex or other laboratory parameters, are the major risk factors for HZ reactivation.Disclosure of Interests:None declared

scholarly journals Relationship between lncRNA-Ang362 and prognosis of patients with coronary heart disease after percutaneous coronary intervention

2020 ◽  
Vol 40 (7) ◽  
Author(s):  
Hui Wang ◽  
Huichao Gong ◽  
Yingwu Liu ◽  
Limin Feng
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Quantitative Polymerase Chain Reaction ◽  
Coronary Intervention ◽  
Cox Regression Analysis ◽  
Percutaneous Coronary

Abstract The severity and complexity evaluation of coronary artery disease in patients with coronary heart disease (CHD) require objective and accurate prognosis indexes. We assessed the relationship between lncRNA-Ang362 and prognosis of CHD patients after percutaneous coronary intervention (PCI). Clinical follow-up data of CHD patients were prospectively collected. LncRNA-Ang362 levels were detected by real-time quantitative polymerase chain reaction. Survival rate was calculated by the Kaplan–Meier method, and risk ratios and 95% confidence intervals were computed using univariate and multivariate COX proportional hazard models. Finally, 434 patients were included in the follow-up cohort. The median follow-up time was 24.8 months (6.7–40). The incidence of adverse cardiovascular events was 13.6%. The high expression group significantly tended to be smoker and higher body mass index, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, creatinine, and uric acid levels compared with the low expression group. According to the SYNTAX grade, the high-risk and medium-risk groups had significantly higher lncRNA expression levels than the low-risk group. The univariate COX regression analysis indicated that high lncRAN-Ang362 expression significantly increased the risk of adverse cardiovascular events in CHD patients after PCI (hazard risk (HR) = 3.19, 95% confidence interval (CI): 1.29–7.92). Multivariate analysis found high lncRNA-Ang362 expression was independently related to worse prognosis in CHD patients after PCI (HR = 2.83, 95%CI: 1.34–6.02). Plasma lncRNA-Ang362 may be a prognosis factor in CHD patients after PCI. The patients with higher lncRNA-Ang362 expression usually have poor prognosis.

scholarly journals Bone Strength and Arterial Stiffness Impact on Cardiovascular Mortality in a General Population

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Petar Avramovski ◽  
Maja Avramovska ◽  
Aleksandar Sikole
Keyword(s):  
Regression Analysis ◽  
General Population ◽  
Arterial Stiffness ◽  
Bone Strength ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Mineral Density ◽  
Cox Regression Analysis

Osteoporosis and increased arterial stiffness independently have been found to be associated with higher cardiovascular events rates in the general population (GP). We examined 558 patients from GP by dual-energy X-ray absorptiometry (DXA) and pulse wave velocity (PWV) measurements at baseline, with 36-month follow-up period. DXA assessed bone mineral density of femoral neck (BMD FN) and lumbar spine (BMD LS). Carotid-femoral PWV was assessed by pulsed-Doppler. The aim of our study is to find correlation between bone strength and arterial stiffness and their impact on cardiovascular mortality in GP. The mean ± SD of BMD FN, BMD LS, and PWV was0.852±0.1432 g/cm2,0.934±0.1546 g/cm2, and9.209±1.9815 m/s. In multiple regression analysis we found BMD FN (βst=-6.0094,p<0.0001), hypertension (βst = 1.7340,p<0.0091), and diabetes (βst=0.4595,p<0.0046). With Cox-regression analysis, after 17 cardiovascular events, the significant covariates retained by the backward model were BMD FN (b=-2.4129,p=0.015) and PWV (b=0.2606,p=0.0318). The cut-off values were PWV = 9.4 m/s, BMD FN = 0.783 g/cm2, and BMD LS = 0.992 g/cm2. The results for BMD FN and PWV hazard ratio risk were 1.116 and 1.297, respectively. BMD FN as a measure of bone strength and PWV as a measure of arterial stiffness are strong independent predictors of cardiovascular mortality in GP.

scholarly journals Dipeptidyl peptidase-4 inhibition to prevent progression of calcific aortic stenosis

Heart ◽  
2020 ◽  
Vol 106 (23) ◽  
pp. 1824-1831 ◽  
Author(s):  
Sahmin Lee ◽  
Seung-Ah Lee ◽  
Bongkun Choi ◽  
Ye-Jee Kim ◽  
Soo Jin Oh ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Lower Risk ◽  
Cardiac Tissue ◽  
Cox Regression ◽  
Dipeptidyl Peptidase ◽  
Distribution Profile ◽  
Cox Regression Analysis ◽  
Dipeptidyl Peptidase 4

ObjectiveTo evaluate whether the use of dipeptidyl peptidase-4 (DPP-4) inhibitors and their cardiac tissue distribution profile and anticalcification abilities are associated with risk of aortic stenosis (AS) progression.MethodsOut of the five different classes of DPP-4 inhibitors, two had relatively favourable heart to plasma concentration ratios and anticalcification ability in murine and in vitro experiments and were thus categorised as ‘favourable’. We reviewed the medical records of 212 patients (72±8 years, 111 men) with diabetes and mild-to-moderate AS who underwent echocardiographic follow-up and classified them into those who received favourable DPP-4 inhibitors (n=28, 13%), unfavourable DPP-4 inhibitors (n=69, 33%) and those who did not receive DPP-4 inhibitors (n=115, 54%).ResultsMaximal transaortic velocity (Vmax) increased from 2.9±0.3 to 3.5±0.7 m/s during follow-up (median, 3.7 years), and the changes were not different between DPP-4 users as a whole and non-users (p=0.143). However, the favourable group showed significantly lower Vmax increase than the unfavourable or non-user group (p=0.018). Severe AS progression was less frequent in the favourable group (7.1%) than in the unfavourable (29.0%; p=0.03) or the non-user (29.6%; p=0.01) group. In Cox regression analysis after adjusting for age, baseline renal function and AS severity, the favourable group showed a significantly lower risk of severe AS progression (HR 0.116, 95% CI 0.024 to 0.551, p=0.007).ConclusionsDPP-4 inhibitors with favourable pharmacokinetic and pharmacodynamic properties were associated with lower risk of AS progression. These results should be considered in the preparation of randomised clinical trials on the repositioning of DPP-4 inhibitors.

Abstract 12969: Rapid Nonsustained Ventricular Tachycardia Detected by Continuous Device Monitoring for Risk Stratification in Hypertrophic Cardiomyopathy: Redefining a Traditional Risk Marker

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Karthik Viswanathan ◽  
Adrian M Suszko ◽  
Nicholas M Jackson ◽  
Douglas Cameron ◽  
Danna A Spears ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Odds Ratio ◽  
Ventricular Arrhythmias ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Icd Therapy ◽  
Device Monitoring

Introduction: Nonsustained VT (NSVT) detected by Holter (Holter +NSVT) is a major risk factor (RF) for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We hypothesized that using a higher heart rate cut-off and prolonged monitoring for detecting NSVT would improve its accuracy in predicting sustained ventricular arrhythmias (VA). Methods: We prospectively enrolled 56 patients (mean 44±14 yrs) with HCM, who had a preexisting prophylactic ICD. We assessed the prevalence of rapid NSVT (+RNSVT, ≥4 beats at 167-200 bpm) detected by their ICD within the first 12 months of implant. The primary outcome was appropriate ICD therapy after implant. Results: The prevalence of RF at ICD implant was 50% for syncope, 57% for Holter +NSVT, 45% for +family history SCD, and 25% for septum ≥ 30mm. The prevalence of 0, 1, 2 and ≥3 RF was 2, 32, 54 and 13%, respectively. +RNSVT occurred in 19 patients (34%) of whom 4 were Holter -NSVT. When compared to -RNSVT, those with +RNSVT had less syncope (21 vs 65%, p=0.004) but more Holter +NSVT (79 vs 46%, p=0.02). Over a median follow-up of 59 (25, 123) months after ICD implant, 8 patients had ≥1 appropriate ICD therapy from VA. According to the number of RF, the proportion of patients with VA was 0=0%, 1=6%, 2=13%, ≥3=43% (p=0.11). +RNSVT was associated with higher VA compared to Holter +NSVT (Figure 1A). +RNSVT predicted VA by Cox regression analysis, both univariate [odds ratio 10, 95% CI 1-84, p=0.03] and adjusted for differences in RF [adjusted odds ratio 11, 95% CI 1-114, p=0.046]. ROC analysis for +RNSVT (area under curve 0.78, p=0.02) showed the optimal cut-point to be RNSVT ≥2 episodes (Figure 1B) for discriminating patients with and without VA (Sensitivity 71%, Specificity 83%, PPV 38%, NPV 95%). Conclusions: RNSVT detected from continuous device monitoring is an independent predictor of VA in HCM patients and a better risk stratifier than Holter +NSVT. The role of implantable loop monitoring to detect RNSVT and evaluate VA risk in HCM warrants study

scholarly journals Carotid Vascular Strain Predicts Cardiovascular Events in Patients with Hypertension

2021 ◽  
Author(s):  
Wei-Chuan Tsai ◽  
Wen-Huang Lee ◽  
Huey-Ru Tsai ◽  
Mu-Shiang Huang
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Speckle Tracking ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events

Background: We aim to investigate prognostic effects of carotid strain (CS) and strain rate (CSR) in hypertension. Methods: We prospectively recruited 120 patients being treated for hypertension (65.8 ± 11.8 years, 58% male) in this observational study. Peak circumferential CS and peak CSR after ejection were identified using two-dimensional speckle tracking ultrasound. Major cardiovascular events were any admission for stroke, acute coronary syndrome, and heart failure. Results: After a mean follow-up period of 63.6 ± 14.5 months, 14 (12%) patients had cardiovascular events. Age (75.3 ± 9.2 vs. 64.6 ± 11.6 years; p = 0.001), systolic blood pressure (131.8 ± 15.5 vs. 143.1 ± 16.6 mmHg; p = 0.021), diastolic blood pressure (74.6 ±11.4 vs. 82.1 ± 12.2 mmHg; p = 0.039), use of diuretics (71 vs. 92 %; p = 0.014), carotid CS (2.17 ± 1.02 vs. 3.28 ± 1.14 %; p = 0.001), and CSR (0.28 ± 0.17 vs. 0.51 ± 0.18 1/s; p <0.001) were significantly different between the patients who did and did not reach the end-points. Multivariate Cox regression analysis controlling for age, systolic blood pressure, diastolic blood pressure, and use of diuretics showed that CS (HR 0.425, 95%CI 0.223-0.811, p = 0.009) and CSR (HR 0.001, 95%CI 0.000-0.072, p = 0.001) were independent predictors for cardiovascular events. Conclusion: In conclusions, decreased CS and CSR were associated with cardiovascular events in hypertension.

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