Prognostic value of baseline versus 6-month follow infarct size in patients with reperfused STEMI

Abstract Background Acute infarct size is a predictor of clinical outcomes in acute ST segment elevation myocardial infarction (STEMI) patients, although its prognostic value has differed between studies. In acute STEMI, infarct size is often overestimated due to the presence of extensive myocardial oedema, a confounder that is no longer present at a 6-month follow-up study. It was our purpose to assess whether infarct size in the acute phase or at 6-months follow-up provided superior prognostic information in STEMI patients. Methods STEMI patients who underwent successful primary percutaneous revascularization were included and a cardiac magnetic resonance (CMR) was performed between 5–7 days after STEMI and at 6 months to study infarct size (as a % of myocardial mass). The primary endpoint was a composite of cardiovascular mortality, hospitalization for heart failure and ventricular arrhythmia. Results A total of 796 patients were included (mean age 58.3±11.5 years, 82.4% male, 52.3% anterior infarction). During a mean follow-up of 59 months, 59 patients (7.4%) presented with the primary end-point (cardiovascular death n=7, hospitalization for heart failure n=52, ventricular arrhythmia n=1). ROC curve analysis (figure 1) showed a non-significant difference between baseline and 6-month infarct size for the prediction of the primary endpoint (baseline AUC 0.685 95% CI 0.610–0.760, 6-month AUC 0.713 95% CI 0.643–0.782, p=0.60). Optimal cut-off values for baseline and 6-months follow-up infarct size for prediction of outcomes, respectively 22% and 17.5%, were used for Kaplan-Meier curve analysis (figure 2). Conclusion Infarct size estimated during the first week after STEMI and at 6-months follow-up showed similar predictive value and with similar cut-off values. Therefore, the prognostic information provided by infarct size can be obtained during initial STEMI admission and does not require a waiting period for infarct size stabilization. FUNDunding Acknowledgement Type of funding sources: None. ROC curve analysis Kaplan-Meier analysis

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Downregulation of lncRNA-PVT1 participates in the development of progressive chronic kidney disease among patients with congestive heart failure

Journal of Inflammation ◽

10.1186/s12950-021-00293-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Yingwei Chang ◽

Chunmei Liu ◽

Jing Wang ◽

Jing Feng ◽

Yulan Chen ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Congestive Heart Failure ◽

Kidney Disease ◽

Roc Curve ◽

Kidney Injury ◽

Diagnostic Value ◽

Curve Analysis ◽

Roc Curve Analysis

Abstract Background Congestive heart failure (CHF) is a major cause of the development of progressive chronic kidney disease (CKD), while the mechanism is still unknown. LncRNA PVT1 contributes to kidney injury. This study aimed to explore the role of PVT1 in the development of CKD in CHF patients. Methods Expression of PVT1 in plasma samples of CHF patients with and without CKD was determined by RT-qPCR. The diagnostic value of plasma PVT1 for CKD was evaluated by ROC curve analysis. The predictive value of PVT1 for the development of CKD in CHF patients was analyzed by a 2-year follow-up study. Changes in PVT1 expression in CKD patients during treatment were analyzed by RT-qPCR and reflected by heatmaps. Results Plasma PVT1 was downregulated in CHF and further downregulated in CHF patients complicated with progressive CKD. ROC curve analysis showed that plasma PVT1 levels could be used to distinguish CHF patients complicated with CKD from CHF patients without CKD and healthy controls. During a 2-year follow-up, patients with high CHF levels had a low incidence of progressive CKD among CHF patients. Moreover, with the treatment of progressive CKD, plasma PVT1 was upregulated. Conclusions LncRNA-PVT1 downregulation may participate in the development of progressive CKD among patients with CHF.

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Acute heart failure: predicting early in-hospital outcomes

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.019 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Santos ◽

S Paula ◽

I Almeida ◽

H Santos ◽

H Miranda ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Acute Heart Failure ◽

Roc Curve ◽

Real Life ◽

Study Data ◽

Curve Analysis ◽

Older Age ◽

Invasive Ventilation ◽

Roc Curve Analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. Older age (p < 0.001), lower SBP (p = 0,035) and need of inotropes (p < 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage. Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p < 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p < 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84). Conclusion In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

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P2263Prognostic impact of perceived social isolation in patients with heart failure

European Heart Journal ◽

10.1093/eurheartj/ehz748.0741 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Ikeda ◽

K Iwatsu ◽

K Matsumura ◽

H Ashikawa ◽

K Takabayashi ◽

...

Keyword(s):

Heart Failure ◽

Social Isolation ◽

Roc Curve ◽

Negative Impact ◽

Roc Curve Analysis ◽

Rehospitalization Rate ◽

Kaplan Meier ◽

Patients With Heart Failure ◽

Perceived Social Isolation ◽

The Relationship

Abstract Background Perceived social isolation (SI), the subjective sense of feelings of loneliness or isolation, has a negative impact on health outcomes, particularly in older adults. Although SI may also contribute to poor prognosis in patients with HF, evidence on the relationship between SI and outcomes in patients with HF is limited. Purpose The aim of this study was to investigate the relationship between SI and hospital readmission in patients with HF. Methods This study was a single center prospective cohort study. We consecutively enrolled 203 patients (mean age 72.9±11.7) who admitted for acute HF or exacerbation of chronic HF. At hospital discharge, we assessed perceived SI by using Lubben Social Network Scale - 6 (LSNS-6). Lower scores in LSNS-6 represents greater SI. Study outcome was rehospitalization for worsening HF within 180 days after discharge. We selected the optimal cutoff point of LSNS-6 that predict a worse outcome by the receiver operating characteristic (ROC) curve analysis. We investigate the association between SI and 180-days HF rehospitalization by using Cox proportional-hazard models, controlling for potential confounding factors. Results During follow up, A total of 40events (19.7%) were observed. The optimal cut-off point of LSNS-6 score was 17 points (the area under the ROC curve: 0.62, p<0.05, sensitivity: 82.5%, specificity 42.4%). Kaplan-Meier survival curves showed that those patients with greater SI (LSNS-6≤17) presented significantly higher HF rehospitalization rate (Figure). After adjusting for several pre-existing prognostic factors, LSNS-6≤17 was independently associated with HF rehospitalization (hazard ratio2.15,95% confidence interval 1.00–4.89). Conclusion The present study shows that SI is a independent predictor of HF rehospitalization in patients with HF. Assessing SI in the clinical practice with a brief screening tool may help identify patients with heart failure at greater risk of rehospitalization.

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Abstract 12455: Evaluation of N-Terminal Pro-B-type Natriuretic Peptide as a Therapeutic Response Biomarker in Group I Pulmonary Arterial Hypertension

Circulation ◽

10.1161/circ.130.suppl_2.12455 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Aaron M Wolfson ◽

Micheal L Maitland ◽

Vasiliki Thomeas ◽

Cherylanne Glassner ◽

Mardi Gomberg-Maitland

Keyword(s):

Heart Failure ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Roc Curve ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Goal Directed Therapy ◽

Group I ◽

Target Values ◽

Pulmonary Arterial

Purpose: Goal directed management of left heart failure with an NT-proBNP target-based approach has some evidence of providing a survival benefit. To evaluate the potential utility of serial NT-proBNP measurements for goal-directed therapy in right heart failure we retrospectively assessed NT-proBNP as a predictor for survival in Group I pulmonary arterial hypertension (PAH) patients. Methods: We identified 103 Group I PAH patients from a pulmonary hypertension registry who had baseline elevated NT-proBNP prior to either the initiation or escalation of therapy and at least two serial NT-proBNP measurements. In a two-step process, we (1) estimated baseline NT-proBNP and slope (rate of change of NT-proBNP) with a linear mixed-effects model using all patient data and then (2) compared the power of serial versus single measurements in predicting survival with measured and model-derived values of baseline NT-proBNP with a Receiver Operative Characteristic (ROC) curve analysis . Survival was determined using the Kaplan-Meier methodology. Results: ROC curve analysis revealed significantly higher AUC for model-derived NT-proBNP values compared to the measured values (AUC: for baseline 0.74 vs 0.66, p= 0.009; for slope 0.78 vs 0.66, p= 0.02). Optimal cutpoints for prediction of survival on baseline NT-proBNP were 2012 (measured) vs. 1810 (model-derived) pg/mL. The optimal cutpoint for model-derived change in NT-proBNP was -0.004 log10pg/mL/month. Sensitivity, specificity, and negative predictive values for the three predictor variables were: 64%, 67%, 80% (measured baseline NT-proBNP), 61%, 80%, 81% (model-derived baseline NT-proBNP) and 73%, 57%, 85% (model-derived slope). Conclusions: In PAH patients, serial NT-proBNP measurements better predict survival than single measurements. This retrospective finding reveals that changes in NT-proBNP are associated with overall survival in PAH patients, and set initial target values for a pilot prospective study of NT-proBNP goal-directed therapy.

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Prognostic Value of Cystatin C-Derived Estimated Glomerular Filtration Rate in Patients with Acute Heart Failure

Cardiorenal Medicine ◽

10.1159/000504084 ◽

2020 ◽

Vol 10 (4) ◽

pp. 232-242 ◽

Cited By ~ 1

Author(s):

Se Yong Jang ◽

Dong Heon Yang ◽

Hyeon Jeong Kim ◽

Bo Eun Park ◽

Yoon Jung Park ◽

...

Keyword(s):

Heart Failure ◽

Glomerular Filtration ◽

Acute Heart Failure ◽

Cystatin C ◽

Prognostic Value ◽

Survival Curve ◽

Characteristic Curve ◽

Curve Analysis ◽

Disease Epidemiology

Background: Renal function is closely related to cardiac function and an important prognostic marker in heart failure. Objective: We aimed to test the prognostic value of cystatin C (cysC)-derived estimated glomerular filtration rates (eGFR) in comparison with eGFRs from creatinine solely based equations in patients with acute heart failure (AHF). Methods: This study included 262 patients (65.8 ± 14.9 years old, 126 male) with AHF. Prognostic value of the eGFRs, from cysC-based equations chronic kidney disease epidemiology collaboration (CKD-EPI-cysC and CKD-EPI-creatinine [cr]-cysC equations) were compared with eGFRs calculated from serum creatinine levels only (Modification of Diet in Renal Disease [MDRD]-4 and CKD-EPI-cr equations). Prognosis was evaluated with the composite of all-cause mortality and hospitalization for heart failure within 1 year. Results: During the follow-up period (mean follow-up period, 264.0 ± 136.1 days), 67 (25.6%) events occurred. Estimated GFR using CKD-EPI-cysC was the best for predicting 1-year outcome using receiver operating characteristic curve analysis (area under curve 0.585, 0.607, 0.669, and 0.652 for eGFRs from MDRD-4, CKD-EPI-cr, CKD-EPI-cysC, and CKD-EPI-cr-cysC respectively). The Kaplan-Meier survival curve analysis showed that only the eGFRs classification from the equations based on cysC significantly predicted 1-year outcome in patients with AHF. Conclusions: Estimated GFRs calculated with cysC predicted the prognosis more accurately in patients with AHF than the eGFRs from creatinine only equations.

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A Novel Inflammation-Based Prognostic Score: The Fibrinogen/Albumin Ratio Predicts Prognoses of Patients after Curative Resection for Hepatocellular Carcinoma

Journal of Immunology Research ◽

10.1155/2018/4925498 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 14

Author(s):

Qiaodong Xu ◽

Yongcong Yan ◽

Songgang Gu ◽

Kai Mao ◽

Jianlong Zhang ◽

...

Keyword(s):

Roc Curve ◽

Prognostic Value ◽

Curative Resection ◽

Operating Characteristic ◽

Curve Analysis ◽

Prognostic Scores ◽

Roc Curve Analysis ◽

Optimal Cutoff ◽

Albumin Ratio ◽

Cutoff Value

Background. Inflammation is an important hallmark of cancer. Fibrinogen and albumin are both vital factors in systemic inflammation. This study investigated the prognostic value of the fibrinogen/albumin ratio in HCC patients who underwent curative resection. Methods. HCC patients (n=151) who underwent curative resection were evaluated retrospectively. The optimal cutoff value for the fibrinogen/albumin ratio was selected by receiver operating characteristic (ROC) curve analysis. Correlations between preoperative fibrinogen/albumin ratios and clinicopathologic characteristics were analyzed by χ2 test. The area under the receiver operating characteristic curve (AUC) was calculated to compare the prognostic value of the fibrinogen/albumin ratio with other prognostic scores (neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and albumin-bilirubin (ALBI) score). The overall survival (OS) and time to recurrence (TTR) were assessed by the log-rank test and the Cox proportional hazard regression model. Results. An optimal cutoff value of the preoperative fibrinogen/albumin ratio (0.062) was determined for 151 patients who underwent curative resection for HCC via a ROC curve analysis. Fibrinogen/albumin ratio > 0.062 was significantly associated with microvascular invasion, an advanced BCLC stage, and ALBI grade. Multivariate analyses revealed that fibrinogen/albumin ratio was an independent predictor for OS (P=0.003) and TTR (P=0.035). The prognostic ability of fibrinogen/albumin ratio was comparable to other prognostic scores (NLR, PLR, and ALBI score) by AUC analysis. Patients with a fibrinogen/albumin ratio > 0.062 had lower 1-, 3-, and 5-year OS rates (66.0%, 41.8%, and 28.2% versus 81.9%, 69.3%, and 56.1%, resp., P<0.001) and higher 1-, 3-, and 5-year recurrence rates (60.9%, 79.2%, and 90.5% versus 49.5%, 69.1%, and 77.1%, resp., P=0.008) compared with patients with fibrinogen/albumin ratio ≤ 0.062. Conclusion. The preoperative fibrinogen/albumin ratio is an effective prognostic factor for HCC patients who underwent curative resection. An elevated fibrinogen/albumin ratio significantly correlates with poorer survival and a higher risk of recurrence in HCC patients.

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A Novel Ferroptosis-Related Long Non-coding RNA Prognostic Risk Model for Gastric Cancer

10.21203/rs.3.rs-718468/v1 ◽

2021 ◽

Author(s):

Shenglan Huang ◽

Dan Li ◽

Lingling Zhuang ◽

Liying Sun ◽

Jianbing Wu

Keyword(s):

Gastric Cancer ◽

Risk Score ◽

Roc Curve ◽

Cox Regression ◽

Risk Group ◽

Clinical Stage ◽

Curve Analysis ◽

Clinicopathological Features ◽

Roc Curve Analysis ◽

Kaplan Meier

Abstract Background：Gastric cancer (GC) is one of the most common malignant tumors with a poor prognosis. Ferroptosis is a novel and distinct type of non-apoptotic cell death that is closely associated with metabolism, redox biology, and tumor prognosis. Recently, ferroptosis-related long non-coding RNAs (lncRNAs) have received increasing attention in predicting cancer prognosis. Thus, we aimed to construct an ferroptosis-related lncRNAs signature for predicting the prognosis of patients with gastric cancer.Methods：We built an ferroptosis-related lncRNA risk signature by using Cox regression based on TCGA database. Kaplan-Meier survival analysis was conducted to compare the overall survival (OS) in different risk groups. Cox regression was performed to explore whether the signature could be used as an independent factor. A nomogram was built involving the risk score and clinicopathological features. Furthermore, we explored the biological functions and immune states in two groups.Results：Eight ferroptosis-related lncRNAs were obtained for constructing the prognosis model in gastric cancer. Kaplan–Meier curve analysis revealed that patients in the high-risk group had worse survival than those in the low-risk group. The survival outcome was also appropriate for subgroup analysis, including age, sex, grade, and clinical stage. Multivariate Cox regression analysis and receiver operating characteristic (ROC) curve analysis demonstrated that the risk score was an independent prognostic factor and superior to traditional clinicopathological features in predicting GC prognosis. Next, we established a nomogram according to clinical parameters (age, sex, grade, and clinical stage) and risk score. All the verified results, including ROC curve analysis, calibration curve, and decision curve analysis, demonstrated that the nomogram could accurately predict the survival of patients with gastric cancer. Gene set enrichment analysis revealed that these lncRNAs were mainly involved in cell adhesion, cancer pathways, and immune function regulation.Conclusion: We established a novel ferroptosis-related prognostic risk signature including eight lncRNAs and constructed a nomogram to predict the prognosis of gastric cancer patients, which may improve prognostic predictive accuracy and guide individualized treatment for patients with GC.

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Abstract 13918: Prognostic Value of Plasma Ngal in the 12-month All-cause Mortality of Acute Heart Failure or Acute Decompensated Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.13918 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Hao T Phan

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Prognostic Value ◽

Acute Decompensated Heart Failure ◽

Kidney Injury ◽

Decompensated Heart Failure ◽

Plasma Ngal ◽

Kaplan Meier ◽

All Cause Mortality

Introduction: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Renal dysfunction is common in patients with AHF or ADHF and is associated with significant early and late morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in AHF or ADHF patients, its significance remains poorly understood. This study was aimed to evaluate the 12 month prognostic value of plasma NGAL in AHF or ADHF patients Hypothesis: plasma NGAL has value in prognosis of 12-month all-cause mortality of Acute Heart Failure or Acute Decompensated Heart Failure Methods: This was a prospective cohort study Results: there were 46 all-cause mortality cases (rate 33.1%) 12 months follow up after discharge. There were 11 cases (rate 7.9%) lost to follow-up; mean age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off of NGAL for 12-month all-cause mortality prognosis was > 383.74 ng/ml, AUC 0.632 (95% CI 0.53-0.74, p = 0.011), sensitivity 58.7 %, specificity 68.29 %, positive predictive value 50.9%, negative predictive value 74.7%. Kaplan-Meier analysis revealed that the high plasma NGAL (≥ 400 ng/ml) group exhibited a worse prognosis than the low plasma NGAL (< 400 ng/ml) group in 12-month all-cause death (Hazard Ratio 2.56; 95%CI 1.35-4.84, P=0.0039. Independent predictors of 12-month all-cause-mortality were identified using multivarable Cox proportional-hazards regression models with backward-stepwise selection method consisted of two variables: level of NGAL, mechanical ventialtion at admission. Conclusions: Plasma NGAL and mechanical ventilation at admission were independent predictors of 12-month all-cause mortality in patients with AHF or ADHF. The survival probability 12-month follow-up of high level NGAL (≥ 400 ng/ml) groups were lower than that of low level NGAL (<400 ng/ml,), difference was statistically significant χ2 = 8.31; p = 0.0047 by Kaplan-Meier curves.

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Abstract 12872: Machine Learning on Dual-isotope Myocardial Semiconductor SPECT Can Predict Cardiac Prognosis in Patients With Congestive Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.12872 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Masato Shimizu ◽

shummo cho ◽

Yoshiki Misu ◽

Mari Ohmori ◽

Ryo Tateishi ◽

...

Keyword(s):

Machine Learning ◽

Heart Failure ◽

Congestive Heart Failure ◽

Random Forest ◽

Roc Curve ◽

Cardiac Death ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Dual Isotope ◽

Machine Learning Model

Introduction: Dual-isotope (201TlCl and 123I-β-methyl-P-iodophenyl-pentadecanoic acid (BMIPP) ) single photon emission computed tomography (SPECT) is utilized to estimate not only in patients with ischemic heart disease but with congestive heart failure (CHF). We tried to construct predictive model for cardiac prognosis on the SPECT for cardiac death by machine learning. Hypothesis: Machine learning is a powerful tool to predict cardiac prognosis in patients with CHF Methods: Consecutive 310 patients who admitted with CHF (77.1±3.1 years, 164 males) were enrolled. After initial treatment, they underwent electrocardiography gated SPECT and observed in median 507 days [IQR: 165, 1032]. Multivariate Cox regression analysis for cardiac death was performed, and predictive model was constructed by ROC curve analysis and machine learning (Random Forest and Deep Learning). The accuracies (= [True positive + True negative] / Total) of the prediction models were compared with ROC curve model. Results: Thirty-six patients fell into cardiac death. Cox analysis showed Age, left ventricular ejection fraction (LVEF), summed rest score (SRS) of BMIPP, and mismatch score were significant predictors (Hazard ratio: 1.068, 0.970, 1.032, 1.092, P value: <0.001, 0.014, 0.002, <0.001, respectively). ROC curve analysis of them revealed the accuracy of the cut-off value was 0.479-0.773. Conversely, machine learning model demonstrated higher accuracy for cardiac death (Random Forest: 0.895, Deep Learning: 0.935). The top 4 feature importance of the random forest were LVEF (0.299), SRS BMIPP (0.263), Age (0.262), and mismatch score (0.160). Conclusions: Machine learning model on SPECT had powerful predictive value for predicting cardiac death in patients with CHF.

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Safety and prognostic value of vasodilator stress CMR in patients with heart failure and reduced ejection fraction

European Heart Journal ◽

10.1093/ehjci/ehaa946.0252 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Pezel ◽

F Sanguineti ◽

M Kinnel ◽

V Landon ◽

P Garot ◽

...

Keyword(s):

Heart Failure ◽

Prognostic Value ◽

Cardiovascular Death ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Inducible Ischemia ◽

Kaplan Meier ◽

Stress Cmr ◽

Perfusion Cmr

Abstract Background Recent data suggest that patients with HFrEF (heart failure with reduced left ventricular ejection fraction (LVEF) <40%) referred for stress cardiovascular magnetic resonance (CMR) may have a less optimal haemodynamic response to intravenous vasodilator. The prognostic value of stress CMR has been poorly investigated in this population. Purpose To assess the safety and the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF. Material Between 2008 and 2018, we prospectively included consecutive patients with HFrEF referred for vasodilator stress perfusion CMR with dipyridamole. HFrEF was defined by a previous history of HF and known LVEF <40%. All patients with LVEF ≥40% measured by CMR were excluded. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined by cardiovascular death or nonfatal myocardial infarction (MI). The secondary endpoint was a composite outcome of cardiovascular death or rehospitalization for acute HF defined by the use of intravenous diuretics. The safety of the stress perfusion CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Results Of 1084 patients with HFrEF (65±11 years, median LVEF 34.6±4.9%), 1049 (97%) completed the CMR protocol and among those 952 (91%) completed the follow-up (median 5.6±2.4 years). Reasons for failure to complete CMR included declining participation (n=11), renal failure (n=9), intolerance to stress agent (n=8), claustrophobia (n=4) and poor gating (n=3). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Among patients who underwent CMR, 600 (57%) were diagnosed with MI defined by LGE. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.8%) than those with ischemia and without LGE (9.4%), or those with both ischemia and LGE (12.0%; p<0.001 for all). Using Kaplan-Meier analysis, the presence of inducible ischemia and LGE were significantly associated with the occurrence of MACE (hazard ratio [HR], 2.46 [95% CI, 1.69–3.59]; p<0.001) (Figure). In multivariable stepwise Cox regression including clinical characteristics and CMR, the inducible ischemia was an independent predictor of a higher incidence of MACE at follow-up (adjusted HR, 2.26 [95% CI, 1.52–3.35]; p<0.001). However, there was no significant difference between patients with or without ischemia for the secondary outcome (p=0.28). Conclusions Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None

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