The truly forgotten chamber: prognostic value of right atrial dilation in patients with sinus rhythm and significant functional tricuspid regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Fortuni ◽  
M.F Dietz ◽  
E.A Prihadi ◽  
S.G Priori ◽  
J.J Bax ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Tricuspid Regurgitation ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Right Atrial ◽  
Prognostic Impact ◽  
Cox Regression Analysis ◽  
Functional Tricuspid Regurgitation ◽  
All Cause Mortality

Abstract Background Functional tricuspid regurgitation (FTR) can be caused by right ventricular (RV) and/or right atrial (RA) dilation, and it leads in turn to further RV and RA remodeling. While it is known that in these patients RV dilation is associated with worse prognosis, there are no data on the prognostic value of RA enlargement. Purpose To assess the prognostic impact of RA dilation in patients with significant (≥ moderate) FTR taking into account the presence of atrial fibrillation (AF). Methods 1382 patients (mean age: 69±13 year; 50% male) with moderate or severe FTR were included. Patients with congenital heart disease were excluded. Significant RA enlargement was identified by the value of RA area associated with excess of mortality according to spline curve analysis in the overall population (30 cm2 – Figure: Left Panel). The prognostic value of RA enlargement was investigated separately in patients with sinus rhythm (SR) and AF. The primary endpoint was all-cause mortality. Results A total of 987 (71%) patients were in SR while the remaining 395 (29%) had AF at the time of significant FTR diagnosis. Patients in SR with RA enlargement were more likely to present with RV failure symptoms and to receive diuretics compared with patients in SR with non-enlarged RA, whereas these differences were not detected in patients with AF. During a median follow-up of 53 (interquartile range, 20–89) months, 698 (51%) patients died. The survival rates of patients in SR with RA enlargement were significantly worse compared to the ones of patients in SR with normal RA size (Figure: Right Panel). In contrast, RA enlargement did not affect the prognosis of patients in AF (Log-rank χ2: 0.41; P=0.522). RA enlargement was associated with 33% increase risk of all-cause mortality in patients with SR and this association was retained on a multivariable Cox regression analysis (HR 1.27; 95% CI 1.04–1.56; P=0.022) together with older age, coronary artery disease, diabetes, severe renal impairment, reduced left ventricular or RV systolic function, and increased pulmonary artery pressures. Conclusion RA enlargement has an independent prognostic value for all-cause mortality in patients with FTR and SR, and therefore its evaluation might be useful to further improve their risk stratification. Funding Acknowledgement Type of funding source: None

A matter of proportions: a novel framework to classify functional tricuspid regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Fortuni ◽  
M.F Dietz ◽  
E.A Prihadi ◽  
G.M De Ferrari ◽  
J.J Bax ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tricuspid Regurgitation ◽  
Cox Regression ◽  
Systolic Function ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Basal Diameter ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract Background Current approaches for the assessment of tricuspid regurgitation (TR) severity do not correct for right ventricular (RV) size. Similarly to what recently proposed for the left heart, we hypothesized that TR severity can be proportional or disproportional to RV dilation. Purpose To characterize the clinical features and the prognosis of patients with disproportionate vs proportionate functional TR (FTR). Methods A total of 345 patients (mean age: 70±12 years; 40% male) with significant (≥ moderate) FTR, preserved left ventricular systolic function and who did not undergo tricuspid valvular repair during follow-up were included. Proportional and disproportional FTR were defined according to the ratio between TR severity (vena contracta [VC] width) and RV size (tricuspid annulus [TA] diameter). A prognostic relevant cut-off for VC/TA was identified with spline curve analysis. The primary end-point was all-cause mortality and the event rates were compared between patients with proportionate and disproportionate FTR. Results The cut-off for disproportionate FTR associated with an increase in all-cause mortality was identified at 0.24 (Figure 1: left panel). According to this cut-off, 172 (50%) patients showed disproportionate FTR, while the remaining had proportionate FTR. Patients with disproportionate FTR were more frequently symptomatic, had smaller RV basal diameter, higher TR severity, greater left atrial volume, higher prevalence of mitral regurgitation, and higher pulmonary artery pressures compared to those with proportionate FTR. During a median follow-up of 61 (interquartile range, 28–101) months, 135 (39%) patients died. The cumulative 5-year survival rate was significantly worse in patients with disproportionate FTR (57% vs 74%, P=0.001; Figure 1: right panel) and on multivariable Cox regression analysis disproportionate FTR was independently associated with poor outcome (HR 1.56; 95% CI 1.06–2.29; P=0.023) together with age, coronary artery disease, renal impairment, reduced RV systolic function, and increased pulmonary artery pressures. Importantly, this novel framework outperformed the TR grading system recommended by current guidelines, which in this population was not able to effectively stratify the prognosis (HR for severe FTR vs moderate FTR 1.09; 95% CI 0.72–1.64; P=0.694). Conclusions In patients with significant FTR, characterization of TR severity in relation to RV size significantly improves risk-stratification since disproportionate FTR if left untreated is associated with worse prognosis compared with proportionate FTR. Figure 1 Funding Acknowledgement Type of funding source: None

Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

2021 ◽  
Author(s):  
Sahrai Saeed ◽  
Anastasia Vamvakidou ◽  
Spyridon Zidros ◽  
George Papasozomenos ◽  
Vegard Lysne ◽  
...  
Keyword(s):  
Sex Differences ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P < 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P < 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P < 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.

scholarly journals Usefulness of NT-proBNP in the Follow-Up of Patients after Myocardial Infarction

2016 ◽  
Vol 35 (2) ◽  
pp. 158-165 ◽  
Author(s):  
Mina Radosavljevic-Radovanovic ◽  
Nebojsa Radovanovic ◽  
Zorana Vasiljevic ◽  
Jelena Marinkovic ◽  
Predrag Mitrovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Clinical Chemistry ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Cut Points ◽  
One Year

SummaryBackground:Since serial analyses of NT-proBNP in patients with acute coronary syndromes have shown that levels measured during a chronic, later phase are a better predictor of prognosis and indicator of left ventricular function than the levels measured during an acute phase, we sought to assess the association of NT-proBNP, measured 6 months after acute myocardial infarction (AMI), with traditional risk factors, characteristics of in-hospital and early postinfarction course, as well as its prognostic value and optimal cut-points in the ensuing 1-year follow-up.Methods:Fasting venous blood samples were drawn from 100 ambulatory patients and NT-proBNP concentrations in lithium-heparin plasma were determined using a one-step enzyme immunoassay based on the »sandwich« principle on a Dimension RxL clinical chemistry system (DADE Behring-Siemens). Patients were followed-up for the next 1 year, for the occurrence of new cardiac events.Results:Median (IQR) level of NT-proBNP was 521 (335–1095) pg/mL. Highest values were mostly associated with cardiac events during the first 6 months after AMI. Negative association with reperfusion therapy for index infarction confirmed its long-term beneficial effect. In the next one-year follow-up of stable patients, multivariate Cox regression analysis revealed the independent prognostic value of NT-proBNP for new-onset heart failure prediction (p=0.014), as well as for new coronary events prediction (p=0.035). Calculation of the AUCs revealed the optimal NT-proBNP cut-points of 800 pg/mL and 516 pg/mL, respectively.Conclusions:NT-proBNP values 6 months after AMI are mainly associated with the characteristics of early infarction and postinfarction course and can predict new cardiac events in the next one-year follow-up.

scholarly journals P1787 Pharmacologic stress test: still an important prognostic factor? a follow-up study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Ferreira ◽  
L Moura Branco ◽  
A Galrinho ◽  
P Rio ◽  
S Aguiar Rosa ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Stress Test ◽  
Bypass Graft ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Introduction Dobutamine stress echocardiography (DSE) is an established exam for evaluation of extent and severity of coronary artery disease. Purpose To analyse the results and complications of DSE and identify prognostic predictors in patients (P) who underwent DSE for myocardial ischemia detection. Methods 220P who underwent consecutive DSE from 2013 to 2017. P with significant valvular disease were excluded. Clinical data, echocardiographic parameters and data from follow up (FU) regarding all-cause mortality and MACEs were analysed. Mean age 64.8 ± 12.0 years(Y), 143 men (65%). Results 88P (40%) had positive, 102 had negative and 30 had inconclusive DSE; complications rate of 15%. Prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, prior MI, percutaneous coronary interventionc (PCI), coronary arterial bypass graft (CABG) and HF was 82.7%, 42.3%, 67.7%, 35.9%, 31.8%, 10.9% and 9.5%, respectively. Mean left ventricular endsystolic (LVSD) and enddiastolic dimensions were 33.7 ± 8.9 and 52.8 ± 7.1 mm. Mean resting wall motion score index (rWMSI) and peak (pWMSI) were 1.16 ± 0.28 and 1.24 ± 0.34. Mean resting GLS (rGLS) and peak GLS (pGLS) were -16.3 ± 4.3 and -16.6 ± 4.3. Mean no. of ischemic segments was 1.7 ± 2.4 and 16.8% had ischemia >3 segments. There was ischemia in left anterior descending (LAD) coronary in 53P and in circumflex and right coronary territories in 18 and 68P. 22.6% had more than one ischemic territory. 43P (49.4%) underwent intervention, 38 with PCI and 5 with CABG. During a mean FU of 38.8 ± 16.8 months, 47 MACEs were observed, including 32 deaths (14.5%). Positive DSE (p = 0.012), no. of ischemic segments (p = 0.019), ischemia in the LAD (p = 0.003), rGLS (p = 0.038) and pGLS (p = 0.038) were related to the occurrence of MACEs. In Cox regression analysis, age (p = 0.005), DM (p = 0.005), HF (p = 0.006), prior CABG (p = 0.015), LVSD (p = 0.026), rWMSI (p = 0.029), pWMSI (p = 0.013) and pGLS (p = 0.038) were associated with increased all-cause mortality. Kaplan–Meier survival analysis showed that survival was significantly worse for ischemia > 3 segments (log rank 0.005), ischemia of more than one territory (log rank 0.025) and pWMSI >1.5 (log rank < 0.0005). With multivariate Cox regression analysis, age >65Y (HR 4.22, p = 0.004), DM (HR 2.49,p = 0.038) and pWMSI > 1.5 (HR 9.73,p = 0.007) were independently associated with all-cause mortality. Conclusion In patients who underwent DSE there were some baseline and DSE-related independent predictors of long-term prognosis: age, DM and peak WMSI. Abstract P1787 Figure. Kaplan–Meier curves

scholarly journals Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001104 ◽  
Author(s):  
Sahrai Saeed ◽  
Jenna Smith ◽  
Karine Grigoryan ◽  
Stig Urheim ◽  
John B Chambers ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
The Impact

ObjectivesThe true prevalence and disease burden of moderate or severe (significant) tricuspid regurgitation (TR) in patients undergoing routine echocardiography remains unknown. Our aim was to explore the prevalence of significant TR and the impact of pulmonary hypertension (PH) on outcome in a less selected cohort of patients referred to echocardiography.MethodsFrom 12 791 echocardiograms performed between January and December 2010, a total of 209 (1.6%) patients (72±14 years, 56% men) were identified with significant TR; 123 (0.96%) with moderate and 86 (0.67%) with severe TR. Median follow-up time was 80 months (mean 70±33 months). Systolic pulmonary artery pressure was derived from peak velocity of tricuspid regurgitant jet plus the right atrial pressure and considered elevated if ≥40 mm Hg (PH).ResultsDuring follow-up there were 123 (59%) deaths with no difference in mortality between moderate and severe TR (p=0.456). The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p<0.001). PH was associated with lower event-free survival in moderate (log-rank, p<0.001), but not in severe TR (log-rank, p=0.133). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S′, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95% CI 1.41 to 3.47, p=0.001).ConclusionsModerate or severe TR was found in 1.6% of patients attending for routine echocardiograms. PH identified a high-risk subset of patients with moderate TR but not with severe TR.

scholarly journals Right atrial volume is a major determinant of tricuspid annulus area in functional tricuspid regurgitation: a three-dimensional echocardiographic study

2020 ◽  
Author(s):  
Denisa Muraru ◽  
Karima Addetia ◽  
Andrada C Guta ◽  
Roberto C Ochoa-Jimenez ◽  
Davide Genovese ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Major Determinant ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Tricuspid Annulus ◽  
Maximal Volume ◽  
Ventricular Ejection Fraction ◽  
Functional Tricuspid Regurgitation

Abstract Aims The aim of this study is to explore the relationships of tricuspid annulus area (TAA) with right atrial maximal volume (RAVmax) and right ventricular end-diastolic volume (RVEDV) in healthy subjects and patients with functional tricuspid regurgitation (FTR) of different aetiologies and severities. Methods and results We enrolled 280 patients (median age 66 years, 59% women) with FTR due to left heart disease (LHD), pulmonary hypertension (PH), corrected tetralogy of Fallot (TOF), chronic atrial fibrillation (AF), and 210 healthy volunteers (45 years, 53% women). We measured TAA at mid-systole and end-diastole, tenting volume of tricuspid leaflets, RAVmax, and RVEDV by 3D echocardiography. Irrespective of TA measurement timing, TAA correlated more closely with RAVmax than with RVEDV in both controls and FTR patients. On multivariable analysis, RAVmax was the most important determinant of TAA, accounting for 41% (normals) and 56% (FTR) of TAA variance. In FTR patients, age, RVEDV, and left ventricular ejection fraction were also independently correlated with TAA. RAVmax (AUC = 0.81) and TAA (AUC = 0.78) had a greater ability than RVEDV (AUC = 0.72) to predict severe FTR (P &lt; 0.05). Among FTR patients, those with AF had the largest RAVmax and smallest RVEDV. RAVmax and TA were significantly dilated in all FTR groups, except in TOF. PH and TOF had largest RVEDV, yet tenting volume was increased only in PH and LHD. Conclusion RA volume is a major determinant of TAA, and RA enlargement is an important mechanism of TA dilation in FTR irrespective of cardiac rhythm and RV loading conditions.

scholarly journals Prevalence and prognostic value of various types of right ventricular dysfunction in mechanically ventilated septic patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongmin Zhang ◽  
Wei Huang ◽  
Qing Zhang ◽  
Xiukai Chen ◽  
Xiaoting Wang ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Venous Pressure ◽  
Left Ventricular ◽  
Prognostic Information ◽  
Mechanically Ventilated ◽  
Cox Regression Analysis ◽  
Mechanical Ventilation Duration

Abstract Introduction Right ventricle (RV) dilation in combination with elevated central venous pressure (CVP), which is a state of RV congestion, is seen as a sign of RV failure (RVF). On the other hand, RV systolic function is usually assessed by tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). This study aimed to investigate the prevalence and prognostic value of RVF and RV systolic dysfunction (RVSD) in septic patients. Methods Mechanically ventilated sepsis and septic shock patients were included. We collected haemodynamic and echocardiographic parameters as well as prognostic information including mechanical ventilation duration, length of ICU stay and 30-day mortality. RVF was defined as a right and left ventricular end-diastolic area ratio ≥ 0.6 in combination with CVP ≥ 8 mmHg. RVSD was defined as TAPSE < 16 mm or FAC < 35%. Results A total of 215 patients were enrolled in this study, and the patients were divided into 4 groups: patients with normal RV function (normal, n = 101), patients with RVF but without RVSD (RVF only, n = 38), patients with RVSD but without RVF (RVSD only, n = 44), and patients with combined RVF–RVSD (RVF/RVSD, n = 32). The RVF/RVSD group and RVSD only group had a lower cardiac index than the RVF only group and normal groups (p < 0.05). At 30 days after ICU admission, 50.0% of patients had died in the RVF/RVSD group, which was much higher than the mortality in the RVF only group (13.2%) and normal group (13.9%) (p < 0.05). In a Cox regression analysis, the presence of RVF/RVSD was independently associated with 30-day mortality (HR 3.004, 95% CI:1.370–6.587, p = 0.006). In contrast, neither the presence of RVF only nor the presence of RVSD only was associated with 30-day mortality (HR 0.951, 95% CI:0.305–2.960, p = 0.931; HR 1.912, 95% CI:0.853–4.287, p = 0.116, respectively). Conclusion The presence of combined RVF–RVSD was associated with 30-day mortality in mechanically ventilated septic patients. Additional studies are needed to confirm and expand this finding.

scholarly journals Prognostic value of fast semi-automated left atrial long-axis strain analysis in hypertrophic cardiomyopathy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Fuyao Yang ◽  
Lili Wang ◽  
Jie Wang ◽  
Lutong Pu ◽  
Yuanwei Xu ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Adverse Events ◽  
Left Atrial ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Volume Index ◽  
Cox Regression Analysis ◽  
Long Axis Strain

Abstract Background The prognostic value of left atrial (LA) size and function in hypertrophic cardiomyopathy (HCM) is well recognized, but LA function is difficult to routinely analyze. Fast LA long-axis strain (LA-LAS) analysis is a novel technique to assess LA function on cine cardiovascular magnetic resonance (CMR). We aimed to assess the association between fast LA-LAS and adverse clinical outcomes in patients with HCM. Methods 359 HCM patients and 100 healthy controls underwent routine CMR imaging. Fast LA-LAS was analyzed by automatically tracking the length between the midpoint of posterior LA wall and the left atrioventricular junction based on standard 2- and 4-chamber balanced steady-state free precession cine-CMR. Three strain parameters including reservoir strain (εs), conduit strain (εe), and active strain (εa) were assessed. The endpoint was set as composite adverse events including cardiovascular death, resuscitated cardiac arrest, sudden cardiac death aborted by appropriate implantable cardioverter-defibrillator discharge, and hospital admission related to heart failure. Results During an average follow-up of 40.9 months, 59 patients (19.7%) reached endpoints. LA strains were correlated with LA diameter, LA volume index (LAVI) and LA empty fraction (LAEF) (all p < 0.05). In the stepwise multivariate Cox regression analysis, εs and εe (hazard ratio, 0.94 and 0.89; p = 0.019 and 0.006, respectively) emerged as independent predictors of the composite adverse events. Fast LA εs and LA εe are stronger prognostic factors than LA size, LAVI and the presence of left ventricular late gadolinium enhancement. Conclusions Fast LA reservoir and conduit strains are independently associated with adverse outcomes in HCM.

Survival prognostic value of obesity in localized triple negative breast cancer in Peruvian women.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12100-e12100
Author(s):  
Gabriel Antonio De la Cruz Ku ◽  
Daniel Enriquez ◽  
Zaida Morante ◽  
Eduardo Eyzaguirre ◽  
Renato Luque ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Prognostic Value ◽  
Cox Regression ◽  
Family Background ◽  
Neoadjuvant Treatment ◽  
Conservative Surgery ◽  
Prognostic Impact ◽  
Obese Women ◽  
Nodal Involvement ◽  
Cox Regression Analysis

e12100 Background: Obesity has been associated with development of TNBC, but its prognostic value on outcomes is still controversial. The aim of this study was to describe clinicopathological characteristics and compare Disease Free Survival (DFS) and Overall Survival (OS) according to obesity status. Methods: We performed a retrospective study on 1415 patients diagnosed with TNBC, admitted during the 2000-2014 period at the Instituto Nacional de Enfermedades Neoplasicas. We divided TNBC patients in two groups based on WHO classification: Non-obese (BMI: 18.5-29.9) and Obese women (BMI≥30). The survival differences were assessed with log-rank test and prognostic factors were then investigated by Cox regression analysis. Results: The median age was 49.5years (19-89years). Of all registered patients, 389 (27.5%) had obesity and 45% were premenopausal, however obese women were predominantly postmenopausal (55%, p < 0.001). Breast-ovarian cancer family background was present in 16.9%. T3-T4 tumors were 46.1% while 58.8% had nodal involvement. Neoadjuvant treatment was administered to more than a third patients (37.2%), and 430 out of 1415 had conservative surgery. With a median of follow-up of 5.1 years, there were 274 (18.9%) local and 402 (27.8%) distant recurrences registered without differences between groups. In obese women, 5-year DFS was 63%, while non-obese was 65% (HR: 1.10, 95%CI: 0.96-1.4, p = 0.35). 5-year OS, was 65 and 64% in obese and non-obese, respectively (HR: 0.93, 95%CI: 0.8-1.1, p = 0.43). Nevertheless, no significant impact was reached on outcomes at uni or multivariate analysis. In multivariate cox regression analysis, neoadjuvant chemotherapy was related to a better prognosis in DFS and OS; in addition, conservative surgery was a protector factor of OS. On the other hand, T4 and nodal involvement were statistically significant to worse DFS and OS; besides premenopausal status and family background affected the DFS and OS, respectively. Conclusions: In this population of TNBC patients, we did not find negative prognostic impact of obesity in terms of DFS and OS. Others potential factors are needed to be explored in futures studies.

scholarly journals PATH-02. A COMBINATION OF MGMT METHYLATION AND NFKBIA COPY NUMBER ALTERATION REFINES PROGNOSTICATION OF IDH-WT GLIOBLASTOMAS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi143-vi143
Author(s):  
Toru Umehara ◽  
Hideyuki Arita ◽  
Ema Yoshioka ◽  
Tomoko Shofuda ◽  
Manabu Kinoshita ◽  
...  
Keyword(s):  
Copy Number ◽  
Prognostic Value ◽  
Cox Regression ◽  
Methylation Status ◽  
The Cancer Genome Atlas ◽  
Prognostic Impact ◽  
Mgmt Methylation ◽  
Wild Type ◽  
Cox Regression Analysis ◽  
Japanese Cohort

Abstract INTRODUCTION Recent studies have reported that NFKBIA deletion (dNFKBIA) was potentially associated with worse prognosis in glioblastoma (GBM) patients. However, no consensus has been reached to its universal prognostic value. Here, we investigated the survival impact of dNFKBIA using two primary IDH wild-type GBM cohorts: an original Japanese cohort and a dataset from The Cancer Genome Atlas (TCGA). Additionally, prognostic impact of a combination of NFKBIA copy number and MGMT methylation status was evaluated. METHOD The Japanese cohort was collected from cases registered in Kansai Molecular Diagnosis Network for CNS tumors (KNBTG). The survival impact of dNFKBIA and/or unmethylated MGMT (uMGMT) were analyzed for 212 KNBTG cases and 265 TCGA cases. The hazard ratio (HR) and p-value were computed using Cox regression analysis. RESULTS dNFKBIA was less frequently observed in KNBTG (47 cases, 22.2%) than in TCGA (84 cases, 31.7%). dNFKBIA was associated with unfavorable prognosis in KNBTG (HR 1.52, p = 0.031), while this was not validated in TCGA (HR 1.14, p=0.406). uMGMT was a common adverse prognostic factor in KNBGT (HR 1.72, p = 0.001) and TCGA (HR 1.50, p = 0.008) cohort. When stratified by NFKBIA status, uMGMT was also associated with shorter survival in NFKBIA deleted cases both in KNBTG (HR 1.87, p = 0.002) and TCGA (HR 1.59, p = 0.014). On the other hand, MGMT status was not significantly associated with prognosis in NFKBIA intact cases in either KNBTG (HR 1.45, p = 0.279) or TCGA (HR 1.55, p = 0.131). DISCUSSION Although the prognostic value of dNFKBIA in IDH wild-type GBM patients was not validated in TCGA cohort, our results indicated that the prognostication based on MGMT methylation was potentially interacted by NFKBIA status.

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