PETCO2 gradient: a novel prognostic parameter in cardiopulmonary exercise testing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I.D Poveda Pinedo ◽  
I Marco Clement ◽  
O Gonzalez ◽  
I Ponz ◽  
A.M Iniesta ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Proportional Hazards ◽  
Cardiopulmonary Exercise Testing ◽  
Cox Proportional Hazards ◽  
Prognostic Parameter ◽  
Cardiopulmonary Exercise ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Baseline Characteristics ◽  
The Difference

Abstract Background Previous parameters such as peak VO2, VE/VCO2 slope and OUES have been described to be prognostic in heart failure (HF). The aim of this study was to identify further prognostic factors of cardiopulmonary exercise testing (CPET) in HF patients. Methods A retrospective analysis of HF patients who underwent CPET from January to November 2019 in a single centre was performed. PETCO2 gradient was defined by the difference between final PETCO2 and baseline PETCO2. HF events were defined as decompensated HF requiring hospital admission or IV diuretics, or decompensated HF resulting in death. Results A total of 64 HF patients were assessed by CPET, HF events occurred in 8 (12.5%) patients. Baseline characteristics are shown in table 1. Patients having HF events had a negative PETCO2 gradient while patients not having events showed a positive PETCO2 gradient (−1.5 [IQR −4.8, 2.3] vs 3 [IQR 1, 5] mmHg; p=0.004). A multivariate Cox proportional-hazards regression analysis revealed that PETCO2 gradient was an independent predictor of HF events (HR 0.74, 95% CI [0.61–0.89]; p=0.002). Kaplan-Meier curves showed a significantly higher incidence of HF events in patients having negative gradients, p=0.002 (figure 1). Conclusion PETCO2 gradient was demonstrated to be a prognostic parameter of CPET in HF patients in our study. Patients having negative gradients had worse outcomes by having more HF events. Time to first event, decompensated heart Funding Acknowledgement Type of funding source: None

Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan Myers ◽  
Ross Arena ◽  
Daniel Bensimhon ◽  
Joshua Abella ◽  
Leon Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Heart Rate Recovery ◽  
Full Range ◽  
Cardiopulmonary Exercise Testing ◽  
Relative Weight ◽  
Cox Proportional Hazards ◽  
Cardiac Events ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

Serum FGF21 Is Associated with Future Cardiovascular Events in Patients with Coronary Artery Disease

Cardiology ◽  
2018 ◽  
Vol 139 (4) ◽  
pp. 212-218 ◽  
Author(s):  
Yun Shen ◽  
Xueli Zhang ◽  
Yiting Xu ◽  
Qin Xiong ◽  
Zhigang Lu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Artery Disease

Objectives: To investigate whether serum fibroblast growth factor 21 (FGF21) levels can be used to predict the future development of major adverse cardiovascular events (MACEs). Methods: This study included 253 patients who received subsequent follow-up, and complete data were collected for 234 patients. Independent predictors of MACEs were identified by using the Cox proportional-hazards regression analysis. The prognostic value of FGF21 levels for MACEs was evaluated by Kaplan-Meier survival analysis. Results: Of 229 patients finally enrolled in the analysis, 27/60 without coronary artery disease (CAD) at baseline experienced a MACE, and 132/169 patients with CAD at baseline experienced a MACE. Among patients with CAD at baseline, serum FGF21 levels were significantly higher in patients with MACEs (p < 0.05) than in patients without MACEs. Kaplan-Meier survival analysis showed patients with a higher serum FGF21 had a significantly lower event-free survival (p = 0.001) than those with a lower level. Further Cox proportional-hazards regression analysis, including the traditional risk factors for cardiovascular disease, showed that serum FGF21 was an independent predictor of MACE occurrence. Conclusions: In patients with CAD at baseline, an elevated serum FGF21 level was associated with the development of a MACE in the future.

Association of low RKIP expression with poor prognosis in non-small cell lung cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3068-3068
Author(s):  
Lingbin Meng ◽  
Rui Ji ◽  
Damian A. Laber ◽  
Xuebo Yan ◽  
Xiaochun Xu
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Tnm Stage ◽  
Erk Signaling ◽  
Small Cell Lung ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Nsclc Patients

3068 Background: Raf1 kinase inhibitor protein (RKIP) is able to bind Raf1 to inhibit Ras-Raf-MEK-ERK signaling, a major oncogenic pathway. It has been reported that reduced RKIP expression associates with poor prognosis in many cancers, including gastric adenocarcinoma, gliomas and bladder cancer. However, there are only several studies on its role in non-small cell lung cancer (NSCLC) and the conclusion is still controversial. Hence, we performed this study to assess the prognostic significance of RKIP in our NSCLC population. Methods: Between June 2017 and June 2020, 156 NSCLC patients treated at our hospital were included for the present study. None of the patients had received chemotherapy, radiotherapy or surgery before. Their tumor tissues and surrounding normal lung tissues were collected for immunostain and western blot analysis of RKIP expression and ERK signaling. We collected information about gender, age, histological differentiation, tumor size, TNM stage, and lymph node status. Survival curves were analyzed using the Kaplan-Meier method. Cox proportional hazards model was used to determine the prognostic value of various variables in a univariate and multivariate setting. Results: Immunostain and western blot results showed a lower RKIP expression and a higher p-ERK level in cancer tissues compared with the surrounding normal tissues. A reduced RKIP expression with high level of p-ERK was also observed in TNM stages III and IV as compared with I and II. Pearson's chi-squared test confirmed low RKIP expression associated with poorer TNM stage ( p< 0.001) and N-stage ( p< 0.05). No significant correlation was observed between RKIP expression level and gender, age, histological type or tumor size. Kaplan-Meier survival analysis revealed that patients with low RKIP expression had significantly worse overall survival than patients with high RKIP expression ( p= 0.019, log-rank). This conclusion was consistent in the stage I&II patients ( p= 0.011, log-rank) but not in the stage III&IV patients ( p= 0.711, log-rank). Univariate Cox proportional hazards regression analysis indicated Tumor size, TNM stage and RKIP expression significantly affected overall survival of the NSCLC patients. Multivariate Cox proportional hazards regression analysis confirmed RKIP expression remained a significant predictor of survival after correcting for the effects of Tumor size and TNM stage (hazard ratio = 1.730, 95% confidence interval = 1.017 – 2.942, p = 0.043). Conclusions: In this study, low RKIP expression was a poor prognostic indicator in NSCLC as it significantly correlated with poorer TNM stage, N-status, and overall survival. Our findings suggest that by inhibiting Ras-Raf-MEK-ERK pathway RKIP may play an anti-tumor role in NSCLC.

The prognostic value of B7-H6 in esophageal squamous cell carcinoma

2019 ◽  
Author(s):  
Shu Yang ◽  
Huan Zhou ◽  
Jun Dong ◽  
Liyi Guo ◽  
Xicheng Wang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Lymphatic Metastasis ◽  
Proportional Hazards ◽  
Tumour Size ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Kaplan Meier

Abstract Background B7-h6, a member of the B7 family molecules, participates in the clearance of tumor cells by binding to NKp30 on NK cells. The expression of B7-H6 in esophageal squamous cell carcinoma and the clinical significance is unknown. The goal of this study was to determine the expression of B7-H6 in esophageal squamous cell carcinoma and the clinical significance of B7-H6 expression. Patients and methods We retrospectively collected clinical data from 145 patients diagnosed with esophageal squamous cell carcinoma between January 2007 and December 2008. These patients had all previously undergone surgical treatment for esophageal cancer, were clearly diagnosed, and had not received chemotherapy or radiotherapy. In addition, pathological tissue samples from the 145 patients were collected to detect the expression of B7-H6 by immunohistochemistry. The chi-square (χ2) test was used to analyse the relationships between B7-H6 and clinicopathological characteristics. The prognosis of the patients were analysed by Cox proportional hazards regression analysis and Kaplan-Meier analysis. Results B7-H6 was present in 133/145 (91.72%) of the esophageal squamous cell carcinoma samples and all localized in the cytoplasm. The expression level of B7-H6 was correlated with T stage (P=0.036) and lymphatic metastasis status (P=0.044). According to the results of the ROC curve analysis, H-score =90 was selected as the cut-off value. The 145 patients were divided into two groups, the high B7-H6 expression (H-score>90) group and the low B7-H6 expression (H-score≤90) group. Cox proportional hazards regression analysis indicated that tumour size (P=0.021), B7-H6 expression (P=0.025) and lymphatic metastasis status (P=0.049) were independent prognostic factors for esophageal squamous cell carcinoma. Kaplan-Meier analysis with the log-rank test demonstrated that the patients with high B7-H6 expression (P = 0.003), lymphatic metastasis (P <0.001) or a tumour size ≥ 3.0 cm (P = 0.001) had significantly worse survival than those with low B7-H6 expression, no lymphatic metastasis or a tumour size < 3.0 cm respectively. Conclusion B7-H6 is widely expressed in esophageal squamous cell carcinoma and high expression of B7-H6 can be used as a predictor of poor prognosis.

Effect of HPV Status on Survival of Oropharynx Cancer with Distant Metastasis

2020 ◽  
Vol 163 (2) ◽  
pp. 372-374 ◽  
Author(s):  
Adam W. Kaplon ◽  
Thomas J. Galloway ◽  
Mihir K. Bhayani ◽  
Jeffrey C. Liu
Keyword(s):  
Distant Metastasis ◽  
Survival Data ◽  
Regression Models ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
National Cancer Database ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Hpv Status ◽  
Oropharynx Squamous Cell Carcinoma

Human papillomavirus (HPV)–positive oropharynx squamous cell carcinoma (OPSCC) is known to have improved survival over HPV-negative disease. However, it is largely unknown whether HPV status similarly affects survival in patients presenting with distant metastatic disease. We queried the National Cancer Database for OPSCC with distant metastasis. Kaplan-Meier curves and Cox proportional hazards regression models controlling for relevant demographics were used to evaluate overall survival. In total, 768 OPSCC cases were available for analysis with HPV and survival data: 50% of cases were HPV negative and 50% were HPV positive. The 1- and 2-year survival for HPV-negative disease was 49% and 27%, respectively, as compared with 67% and 42% in the HPV-positive cohort. HPV positivity was associated with improved median survival in treated and untreated patients. Age, comorbidities, and HPV status were predictive of improved survival on multivariate analysis. HPV-positive OPSCC has improved survival in the setting of distant metastatic presentation as compared with HPV-negative disease and shows greater responsiveness to treatment.

Impact of periodic breathing on measurement of oxygen uptake and respiratory exchange ratio during cardiopulmonary exercise testing

2002 ◽  
Vol 103 (6) ◽  
pp. 543-552 ◽  
Author(s):  
Darrel P. FRANCIS ◽  
L. Ceri DAVIES ◽  
Keith WILLSON ◽  
Roland WENSEL ◽  
Piotr PONIKOWSKI ◽  
...  
Keyword(s):  
Oxygen Uptake ◽  
Exercise Testing ◽  
Respiratory Exchange Ratio ◽  
Cardiopulmonary Exercise Testing ◽  
Periodic Breathing ◽  
Moving Window ◽  
Carbon Dioxide Output ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
The Difference

Metabolic exercise testing is valuable in patients with chronic heart failure (CHF), but periodic breathing may confound the measurements. We aimed to examine the effects of periodic breathing on the measurement of oxygen uptake (VO2) and respiratory exchange ratio (RER). First, we measured the effects of different averaging procedures on peak VO2 and RER values in 122 patients with CHF undergoing cardiopulmonary exercise testing. Secondly, we studied the effects of periodic breathing on VO2 and RER in healthy volunteers performing computer-guided periodic breathing. Thirdly, we used a Fourier analysis to study the effects of periodic breathing on gas exchange measurements. The first part of the study showed that 1min moving window gave a mean peak VO2 of 13.8mlμmin-1μkg-1 for the CHF patients. A 15s window gave significantly higher values. The difference averaged 1.0mlμmin-1μkg-1 (P<0.0001), but varied widely: 41% of subjects showed a difference greater than 1.0mlμmin-1μkg-1. RER values were also higher by an average of 0.09 (P<0.0001); in 20% of subjects the difference was greater than 0.10. In the second part of the study, we found artefactual elevations of peak VO2 (without averaging) of 2.9mlμmin-1μkg-1 (P<0.01) and of peak RER of 0.13 (P<0.001), which were still significant when 30s averaging was applied [Δ(peak VO2) = 1.8mlμmin-1μkg-1, P<0.01; ΔRER = 0.08, P<0.001]. The third, theoretical, part of the study showed that values of carbon dioxide output and VO2 oscillate with different phases and amplitudes, resulting in oscillations in their ratio, RER. Averaging over 15s or 30s can be expected to give only 10% or 36% attenuation respectively. Thus periodic breathing causes variable artefactual elevations of measured peak VO2 and RER, which can be attenuated by using longer averaging periods. Clinical reports and research publications describing peak VO2 in CHF should be accompanied by details of the averaging technique used.

scholarly journals Clinicopathological Significance of MicroRNA-20b Expression in Hepatocellular Carcinoma and Regulation of HIF-1αand VEGF Effect on Cell Biological Behaviour

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Tong-min Xue ◽  
Li-de Tao ◽  
Miao Zhang ◽  
Jie Zhang ◽  
Xia Liu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Proportional Hazards ◽  
Clinicopathological Characteristics ◽  
Cox Proportional Hazards ◽  
Biological Behaviour ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Clinicopathological Significance ◽  
Tumor Types

miRNA-20b has been shown to be aberrantly expressed in several tumor types. However, the clinical significance of miRNA-20b in the prognosis of patients with hepatocellular carcinoma (HCC) is poorly understood, and the exact role of miRNA-20b in HCC remains unclear. The aim of the present study was to investigate the association of the expression of miR-20b with clinicopathological characteristics and overall survival of HCC patients analyzed by Kaplan-Meier analysis and Cox proportional hazards regression models. Meanwhile, the HIF-1αand VEGF targets of miR-20b have been confirmed. We found not only miR-20b regulation of HIF-1αand VEGF in normal but also regulation of miR-20b in hypoxia. This mechanism would help the tumor cells adapt to the different environments thus promoting the tumor invasion and development. The whole study suggests that miR-20b, HIF-1α, and VEGF serve as a potential therapeutic agent for hepatocellular carcinoma.

scholarly journals Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015101 ◽  
Author(s):  
Hsien-Feng Lin ◽  
Kuan-Fu Liao ◽  
Ching-Mei Chang ◽  
Cheng-Li Lin ◽  
Shih-Wei Lai
Keyword(s):  
Cohort Study ◽  
Incidence Rate ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Confounding Variables ◽  
Taiwan National Health Insurance

ObjectiveThis study aimed to investigate the association between splenectomy and empyema in Taiwan.MethodsA population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.ResultsThe overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.ConclusionThe incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

The Timing of Subsequent Treatment for Teeth Restored with Large Amalgams and Crowns: Factors Related to the Need for Subsequent Treatment

2004 ◽  
Vol 83 (11) ◽  
pp. 854-858 ◽  
Author(s):  
J.L. Kolker ◽  
P.C. Damiano ◽  
M.P. Jones ◽  
D.V. Dawson ◽  
D.J. Caplan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Subsequent Treatment ◽  
Cox Proportional Hazards ◽  
Regression Modeling ◽  
Survival Curves ◽  
Rank Tests ◽  
Factors Associated ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Kaplan Meier

Crowns and large amalgams protect structurally compromised teeth to various degrees in different situations. The aim of this investigation was to evaluate the survival of teeth with these two types of restorations and the factors associated with better outcomes. Retrospective administrative and chart data were used. Survival was defined and modeled as: (1) receipt of no treatment and (2) receipt of no catastrophic treatment over five- and 10-year periods. Analyses included: Kaplan-Meier survival curves, Log-Rank tests, and Cox proportional hazards regression modeling. Crowns survived longer with no treatment and with no catastrophic treatment; however, mandibular large amalgams were least likely to have survived with no treatment, and maxillary large amalgams were least likely to have survived with no catastrophic treatment. Having no adjacent teeth also decreased survival. Crowns survived longer than large amalgams, but factors such as arch type and the presence of adjacent teeth contributed to the survival of large amalgams.

Association of irritable bowel syndrome in patients with atrial fibrillation: a nationwide population-based investigation

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 847-852
Author(s):  
Wei-Syun Hu ◽  
Cheng-Li Lin
Keyword(s):  
Atrial Fibrillation ◽  
Irritable Bowel Syndrome ◽  
Proportional Hazards ◽  
Female Gender ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Regression Methods ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Irritable Bowel

Objective: We seek to characterize the association between atrial fibrillation and irritable bowel syndrome. Methods: We identify 11,642 cases (atrial fibrillation) and 46,487 sex-, age-, and index year–matched controls (non-atrial fibrillation) from Longitudinal Health Insurance Database. Kaplan–Meier, Cox proportional hazards regression methods and competing risk analysis methods were used to assess the association of atrial fibrillation with outcome of irritable bowel syndrome. Results: After adjustment for gender, age, comorbidities and medications, patients with atrial fibrillation had a significant higher risk (adjusted hazard ratio = 1.12, p < 0.01) to develop irritable bowel syndrome than patients without atrial fibrillation. Compared to participants without atrial fibrillation, those with atrial fibrillation had 1.13-fold (p < 0.05) and 1.11-fold (p < 0.05) risk of irritable bowel syndrome in female and male subgroup, respectively. Among subjects aged ≥65 years, those with AF had 1.11-fold risk of irritable bowel syndrome than non-AF cohort (P < 0.01). Among participants with any one of the comorbidities, those with atrial fibrillation had 1.10-fold risk of irritable bowel syndrome than non-atrial fibrillation cohort (p < 0.05). Conclusion: We report that the presence of atrial fibrillation is associated with greater incidence of irritable bowel syndrome and the association is stronger among female gender, age 65 years or above, and with comorbidities.

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