scholarly journals The association of pericoronary adipose tissue attenuation with major adverse cardiac events (MACE) and atherosclerosis-relevant inflammatory mediators

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Goeller ◽  
S Achenbach ◽  
N Herrmann ◽  
D Bittner ◽  
F Ammon ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Coronary Artery ◽  
Inflammatory Mediators ◽  
Cox Regression ◽  
Independent Predictor ◽  
Coronary Calcification ◽  
Serum Levels ◽  
Cox Regression Analysis ◽  
Anti Inflammatory

Abstract Background Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) is a new imaging biomarker to detect coronary inflammation derived from routine coronary CT angiography (CTA). Purpose We aimed to investigate a potential association between RCA PCAT attenuation and i) serum levels of atherosclerosis-relevant cytokines, ii) different grades of coronary calcification iii) future coronary revascularization within the same coronary artery and iV) MACE (defined by revascularization, myocardial infarction (MI) and/or cardiac death). Methods In 293 stable individuals (59.0±9.8 years, 69% males) with intermediate likelihood for coronary artery disease (CAD) blood was drawn and subsequently analyzed for different atherosclerosis-relevant cytokines interleukin (IL)-2, IL- 4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IP-10, CRP, MCP-1, MIP-1a, Eotaxin and GM-CSF, followed by coronary calcium scoring (CCS) in non-contrast CT followed by CTA. PCAT CT attenuation (HU) was measured around the RCA (10 to 50 mm from RCA ostium) and the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) using semi-automated software. Increased RCA PCAT attenuation was defined as PCAT attenuation above the highest quartile (>−73.5 HU). A long-term follow-up over 9.6 years was performed. Results PCAT attenuation was similar in different grades of coronary calcification (CAC=0,-80.3 HU; CAC 1–99, −79.2 HU; CAC 100–400, −79.5 HU; CAC >400, −81.0 HU; p>0.05). Adipocytokine MCP-1 (r=0.23, p<0.01) and pro-inflammatory mediator IL-7 (r=0.12, p=0.04) correlated positively with RCA PCAT attenuation, whereas anti-inflammatory mediators Il-4, -10 and -13 correlated inversely (each r<−0.12, each p<0.05). In patients with increased RCA PCAT attenuation the serum levels of MCP-1 were increased (2.37 vs. 2.20, p<0.01), whereas anti-inflammatory mediators IL-4 and -13 were reduced (each p<0.05). 40 patients experienced MACE during follow-up. In multivariable Cox regression analysis, when adjusted by age, gender, baseline medications, obstructive coronary stenosis and CCS, the highest quartiles of PCAT attenuation are an independent predictor of MACE (HR 7.9, p=0.035). In patients with percutaneous coronary intervention (PCI) of the RCA during follow-up, RCA PCAT attenuation was increased at baseline CTA (−73.1 vs −80.2 HU, p=0.008). In patients with PCI of the LAD or LCX during follow-up, PCAT attenuation of LAD and LCX were not increased at baseline CTA (p>0.05). Conclusions The information captured by PCAT attenuation is independent of coronary calcification and showed a trend towards a weak association with serum levels of atherosclerosis-relevant inflammatory biomarkers. Increased RCA PCAT attenuation is an independent predictor of MACE and could guide future prevention strategies in stable patients. Funding Acknowledgement Type of funding source: None

Circulating CXCL13 could be served as a biomarker for chronic lymphocytic leukemia severity

2021 ◽  
pp. 1-7
Author(s):  
Salah Aref ◽  
Doaa Atia ◽  
Ahmed Ramez ◽  
Tarek Abou Zeid ◽  
Enas Gouda
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Cox Regression ◽  
Independent Predictor ◽  
Serum Levels ◽  
Lymphocytic Leukemia ◽  
Cox Regression Analysis ◽  
Lymphoid Malignancies ◽  
Patient’S Outcome ◽  
Time To First Treatment ◽  
Short Time

BACKGROUND: Recent reports indicated the importance of chemotractants CXCL-13 in solid tumors and lymphoid malignancies. However, the prognostic value of the mentioned cytokines as biomarkers in chronic lymphocytic leukemia patient’s remains to be identified. Therefore; this study was designed in order to address the relation between CXCL-13 concentrations levels and markers of severity in CLL patients. METHODS: Our study included 150 CLL patients and 20 controls. Serum CXCL-13 was determined by ELISA for CLL patients at diagnosis as well as controls. RESULTS: The serum CXCL-13 levels were significantly higher in CLL patients as compared to controls. The high CXCL-13 concentration levels was significantly associated with high number of smudge cells; high LDH; high grade of Rai stage, short time to first treatment (TTT). Cox regression analysis was conducted for prediction of TTT, using age, gender, WBCs, smudge cells, CXCL-13, LDH, ZAP70, CD38, β2-microglobulin, Rai staging as covariates. High LDH, CXCL-13 and CD38% were significantly independent predictor for shorter TTT. CONCLUSION: High CXCL-13 serum levels at CLL diagnosis is correlated with other markers of disease activity; and could be served as biomarkers that predict CLL patient’s outcome.

scholarly journals Risk Factors for Liver Decompensation and HCC in HCV-Cirrhotic Patients after DAAs: A Multicenter Prospective Study

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3810
Author(s):  
Filomena Morisco ◽  
Alessandro Federico ◽  
Massimo Marignani ◽  
Mariarita Cannavò ◽  
Giuseppina Pontillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Independent Predictor ◽  
Liver Stiffness ◽  
Cox Regression Analysis ◽  
Liver Decompensation ◽  
Cirrhotic Patients ◽  
Multicenter Prospective Study

Background: Prospective studies on predictors of liver-related events in cirrhotic subjects achieving SVR after DAAs are lacking. Methods: We prospectively enrolled HCV cirrhotic patients in four Italian centers between November 2015 and October 2017. SVR and no-SVR cases were compared according to the presence or absence of liver-related events during a 24-month follow-up. Independent predictors of liver-related events were evaluated by Cox regression analysis. Results: A total of 706 subjects started DAAs therapy. SVR was confirmed in 687 (97.3%). A total of 61 subjects (8.9%) in the SVR group and 5 (26.3%) in the no-SVR group had liver-related events (p < 0.03). The incidence rate x 100 p/y was 1.6 for HCC, 1.7 for any liver decompensation, and 0.5 for hepatic death. Baseline liver stiffness (LSM) ≥ 20 kPa (HR 4.0; 95% CI 1.1–14.1) and genotype different from 1 (HR 7.5; 95% CI 2.1–27.3) were both independent predictors of liver decompensation. Baseline LSM > 20 KPa (HR 7.2; 95% CI 1.9–26.7) was the sole independent predictor of HCC. A decrease in liver stiffness (Delta LSM) by at least 20% at the end of follow-up was not associated with a decreased risk of liver-related events. Conclusion: Baseline LSM ≥ 20 kPa identifies HCV cirrhotic subjects at higher risk of liver-related events after SVR.

scholarly journals Resistance to Erythropoiesis-Stimulating Agents in Pre-Dialysis and Post-Dialysis Mortality in Japanese Incident Hemodialysis Patients

2019 ◽  
Vol 47 (Suppl. 2) ◽  
pp. 31-37 ◽  
Author(s):  
Toshihide Hayashi ◽  
Nobuhiko Joki ◽  
Yuri Tanaka ◽  
Masaki Iwasaki ◽  
Shun Kubo ◽  
...  
Keyword(s):  
Cox Regression ◽  
Independent Predictor ◽  
Resistance Index ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Cox Regression Analysis ◽  
Definitive Evidence ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

Background/Aims: There is lack of definitive evidence about the association between erythropoiesis-stimulating agent (ESA) responsiveness in the pre-dialysis phase and mortality. Therefore, we conducted a hospital-based, retrospective, cohort study to assess the predictive value of ESA response for prognosis in incident hemodialysis patients. Methods: A total of 108 patients without preexisting cardiovascular disease who had been started on maintenance hemodialysis were studied. ESA responsiveness just before starting dialysis was estimated using an erythropoietin resistance index (ERI). The endpoint was defined as all-cause death. Results: During a mean follow-up period of 3.1 ± 1.6 years, 18 (17%) patients died. Overall, the multivariate Cox regression analysis revealed that the log-transformed ERI remained an independent predictor of all-cause death after adjustment using a propensity score (hazard ratio 2.25, 95% CI 1.25–4.06). Conclusions: Among incident hemodialysis patients, hyporesponsiveness to ESA may be associated with mortality.

scholarly journals High-Serum Angiopoietin-Like Protein 3 Levels Associated with Cardiovascular Outcome in Patients with Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming-Chun Chen ◽  
Bang-Gee Hsu ◽  
Chung-Jen Lee ◽  
Ji-Hung Wang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Artery Disease

Background. Angiopoietin-like protein 3 (ANGPTL3) plays a pivotal role in lipid metabolism and angiogenesis, and there is growing interest regarding the association between ANGPTL3 and coronary artery disease (CAD). This study aims to investigate whether ANGPTL3 levels can be used to predict the future occurrence of major adverse cardiovascular events (MACEs) in patients with CAD. Methods. Overall, 90 patients with CAD were enrolled between January and December 2012. The study’s primary endpoint was incidence of MACEs. Patient follow-up was completed on June 30, 2017. Results. Following a median follow-up period of 54 months, 33 MACEs had occurred. Patients reporting MACEs had lower statin use (P=0.022) and higher serum C-reactive protein (P<0.001) and serum ANGPTL3 (P<0.001) levels than those without MACEs. Kaplan–Meier analysis revealed higher cumulative incidence of CV events in the high ANGPTL3 group (median ANGPTL3 level ≥ 222.37 ng/mL) than in the low ANGPTL3 group (log-rank P=0.046). Multivariable Cox regression analysis demonstrated that ANGPTL3 levels were independently associated with MACEs in patients with CAD (hazard ratio: 1.003; 95% confidence interval: 1.000–1.005; P=0.026) after adjusted for age, gender, and body mass index, classical risk factors, and potential confounders. Conclusions. Serum ANGPTL3 levels could serve as a biomarker for future occurrence of MACEs in patients with CAD.

scholarly journals Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation

Heart ◽  
2018 ◽  
Vol 105 (6) ◽  
pp. 482-488 ◽  
Author(s):  
Jan Niederdöckl ◽  
Alexander Simon ◽  
Sebastian Schnaubelt ◽  
Nikola Schuetz ◽  
Roberta Laggner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cox Regression ◽  
Troponin T ◽  
Tertiary Care ◽  
Female Gender ◽  
Serum Levels ◽  
Cardiac Biomarkers ◽  
Cox Regression Analysis

ObjectivesTo assess the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) serum levels for mid-term mortality in patients presenting with symptomatic atrial fibrillation (AF) to an emergency department.MethodsNon-interventional cohort/follow-up study, including consecutive patients presenting to a tertiary care university emergency department due to symptomatic AF between 2012 and 2016. Multivariable Cox proportional hazard regression models were used to estimate the mortality rates and hazards per 100 patient-years (pry) for NT-proBNP and hs-TnT serum levels in quintiles.Results2574 episodes of 1754 patients (age 68 (IQR 58–75) years, female gender 1199 (44%), CHA2DS2-VASc 3 (IQR 1–4)) were recorded. Following the exclusion of incomplete datasets, 1780 episodes were available for analysis. 162 patients deceased during the mid-term follow-up (median 23 (IQR 4–38) months); the mortality rate was 4.72/100 pry. Hazard for death increased with every quintile of NT-proBNP by 1.53 (HR; 95% CI 1.27 to 1.83; p<0.001) and by 1.31 (HR; 95% CI 1.10 to 1.55; p=0.002) with every quintile of hs-TnT in multivariate Cox-regression analysis. No interaction between NT-proBNP and hs-TnT levels could be observed.ConclusionElevated NT-proBNP and hs-TnT levels are independently associated with increased mid-term mortality in patients presenting to an emergency department due to symptomatic AF.Trial registration numberNCT03272620; Results.

scholarly journals Abdominal aortic calcification is superior to other arteries calcification in predicting the mortality in peritoneal dialysis patients – a 8 years cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Qingyu Niu ◽  
Huiping Zhao ◽  
Bei Wu ◽  
Shihming Tsai ◽  
Jian Wu ◽  
...  
Keyword(s):  
Radial Artery ◽  
Femoral Artery ◽  
Iliac Artery ◽  
Cox Regression ◽  
Independent Predictor ◽  
Abdominal Aortic Calcification ◽  
Cox Regression Analysis ◽  
Abdominal Aortic ◽  
All Cause Mortality

Abstract Background In recent years, there has been a growing concern that abdominal aortic calcification (AAC) has a predictive effect on the prognosis of patients with end-stage renal disease (ESRD). However, whether other vascular calcification (VC) can predict the occurrence of adverse events in patients, and whether it is necessary to assess the calcification of other blood vessels remains controversial. This study aimed to assess VC in different sites using X-ray films, and to investigate the predictive effects of VC at different sites on all-cause mortality and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients. Methods The data of Radiographs (lateral abdominal plain film, frontal pelvic radiograph and both hands radiograph) were collected to evaluate the calcification of abdominal aorta, iliac artery, femoral artery, radial artery, and finger arteries. Patients’ demographic data, clinical characteristics, laboratory data were recorded. The total follow-up period was 8 years, and the time and cause of death were recorded. Survival curves were estimated using Kaplan-Meier analysis. COX regression analysis was used to examine independent predictors of all-cause mortality and CV mortality. Results One hundred fifty PD patients were included, a total of 79 patients (52.7%) died at the end of follow-up. After adjusting variables in the multivariate COX regression analysis, AAC was an independent predictor of all-cause mortality in PD patients (HR = 2.089, 95% CI: 1.089–4.042, P = 0.029), and was also an independent predictor of CV mortality (HR = 4.660, 95% CI: 1.852–11.725, P = 0.001). We also found that femoral artery calcification had a predictive effect on all-cause and CV mortality. But the calcification in iliac artery, radial artery, and finger arteries were not independent predictors of patients’ all-cause and CV mortality in PD patients. Conclusion AAC was more common in PD patients and was an independent predictor of all-cause mortality and CV mortality. The femoral artery calcification also can predict the mortality, but the calcification of iliac artery, radial artery, and finger arteries cannot predict the mortality of PD patients.

Incremental prognostic value of pericoronary adipose tissue attenuation on top of comprehensive CCTA assessment

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.A Van Diemen ◽  
M.J Bom ◽  
R.S Driessen ◽  
H Everaars ◽  
S.P Schumacher ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Regression Analysis ◽  
Prognostic Value ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Ratio Test ◽  
Plaque Volume ◽  
Cox Regression Analysis ◽  
Incremental Prognostic Value

Abstract Background Coronary computed tomography angiography (CCTA) derived parameters linked to severity and extent of atherosclerosis are associated with prognosis in patients with coronary artery disease (CAD). Furthermore, coronary inflammation, by determining pericoronary adipose tissue CT-attenuation (PCATa), can be assessed on CCTA as well and has been proposed as promising prognostic marker. Objective To assess the prognostic value of PCATa on top of traditional CCTA derived atherosclerotic parameters. Methods A total of 543 patients who underwent CCTA because of suspected CAD and in whom follow-up was obtained were included. CCTA assessment comprised; coronary artery calcium score (CACS), presence of obstructive CAD (≥50% stenosis) and high-risk plaques (HRP), total plaque volume (TPV), non-calcified plaque volume (NCPV), and PCATa. The endpoint was a composite of death and non-fatal myocardial infarction (MI). Optimal prognostic thresholds were determined for quantitative CCTA variables. Univariable Cox regression analyses were performed to determine clinical characteristics and CCTA variables associated with the endpoint, a subsequent multivariable Cox regression analysis that included variables associated with the endpoint was used to determine independent predictors of the endpoint. An additional Cox regression analysis was performed to test the incremental prognostic value of CCTA variables over clinical characteristics, significance of each sequentially added variable was tested using the likelihood ratio test. Results During a median follow-up time of 6.6 [interquartile range: 4.7–7.8] years, a total of 42 (20 MI/22 death) (8%) patients suffered an endpoint. CACS &gt;83.2, obstructive CAD, HRP, TPV &gt;269mm3, and NCPV &gt;83mm3 were all associated with occurrence of the endpoint with unadujsted hazard ratio's (HR) of; 5.37, 5.70, 3.31, 7.76, and 6.77, respectively (p&lt;0.001 for all). PCATa of the RCA above −74.4 Hounsfield units (HU) had a detrimental effect on prognosis (unadjusted HR: 1.99, p=0.037), while PCATa of the LAD nor Cx was associated with outcome (Log-rank p-value 0.255 and 0.218, respectively). PCATa of the RCA remained an independent predictor of death and MI when incorporated in a multivariable analysis inlcuding all CCTA variables and clincal chacteristics associated with the endpoint (adjusted HR: 2.11, p=0.024). Furthermore, adding PCATa of the RCA to a model that included clinical characteristics and all CCTA parameters led to an improvement of the prognostic value of the model (change in Chi-square = 4.45, p=0.035) (figure). Conclusion Coronary inflammation of the RCA determined by PCATa provides incremental prognostic value on top of traditional CCTA parameters linked to extent and severity of CAD. Figure 1. Cox regression analysis demonstrating the incremental prognostic value of sequentially added CCTA variables over clinical characteristics tested for significance using the likelihood ratio test. Funding Acknowledgement Type of funding source: None

scholarly journals Complement Factor 3 Could Be an Independent Risk Factor for Mortality in Patients with HBV Related Acute-on-Chronic Liver Failure

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Geng-lin Zhang ◽  
Ting Zhang ◽  
Yi-nong Ye ◽  
Jing Liu ◽  
Xiao-hong Zhang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Liver Failure ◽  
Cox Regression ◽  
Independent Predictor ◽  
Serum Levels ◽  
Chronic Liver ◽  
Complement Factor ◽  
Chronic Liver Failure ◽  
Complement Components ◽  
Cox Regression Analysis

The complement is thought to be involved in the pathogenesis of multiple liver disorders. However, its role in patients with HBV related acute-on-chronic liver failure (HBV-ACLF) remains unclear. Serum levels of the third and fourth complement components (C3, C4) and complement function (CH50) were examined in this prospective, observational study. Associations between their expression and disease activity were analyzed. Survival was analyzed by Kaplan-Meier curves. Predictors of clinical outcome were determined by Cox regression analysis. C3, C4, and CH50 levels were significantly lower in HBV-ACLF patients compared to controls. C3, C4, and CH50 levels were negatively correlated with Tbil levels but positively associated with PTA levels. C3 levels were negatively associated with MELD-Na. C3 levels were significantly lower in HBV-ACLF patients who died compared to patients who survived. In a median hospital stay of 39 days, mortality occurred in 41 patients with a progressive increase based on C3 grade (P=0.008). The actuarial probability of developing mortality was significantly higher in patients with low C3 grade compared to those with high C3 grade (P<0.001). Multivariate Cox regression analysis showed that C3 levels were an independent predictor of mortality. Complement played a pathogenic role in HBV-ACLF patients and C3 was an independent predictor of mortality.

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