P1633Age, creatinine, and ejection fraction (ACEF) score continues to predictive prognosis in patients with ischemic cardiomyopathy

Abstract Purpose ACEF (Age, Creatinine, and Ejection Fraction) andACEFMDRD (Modification of Diet in Renal Disease) score have been validated as effective predictors for prognosis in patients undergoing elective cardiac surgery or PCI. However, the predictive value for ICM (Ischemic Cardiomyopathy)was not clear. This study sought to investigate their predictive value in patients with ICM. Methods 862 ICM patients hospitalized in the Department of Cardiology were prospectively enrolled during November 2014 and December 2017.Inclusion criteria: previous definite diagnosis of myocardial infarction, previous PCI, CABG, or coronary angiographic findings of one or more vessel stenosis >70%; Simpson echocardiography showed LVEF <45%. Exclusion criteria: malignant tumors of any organ or once had a history of malignancies; and other serious diseases with estimated survival time less than one year.The ACEF score was calculated by the formula: age/ejection fraction + 1 (if creatinine >176 μmol/L). As for ACEFMDRD score, estimated glomerular filtration rate (eGFR) was calculated using the MDRD formula. Then using the formula: age/EF +1 point for every 10 mL/min reduction in eGFRMDRD below 60 ml/min per 1.73 m2 (up to a maximum of 6 points). Patients were divided into low, middle and high ACEF, ACEFMDRD tertiles. The median duration of follow-up was 13 months (IQR: 7–23 months). The clinical endpoints were all-cause mortality, cardiac mortality, major adverse cardiovascular and cerebrovascular events (MACCEs) and re-hospitalization for heart failure (HF). Results The mean original ACEF and ACEFMDRD score were 1.99±0.63 and 2.53±1.42. Patients in high ACEF and ACEFMDRD tertile were associated with significantly higher all-cause and cardiac mortality, MACCEs and re-hospitalization for HF. Compared with ACEFMDRD score, original ACEF exhibited similar discrimination and predictive ability on all-cause mortality (AUC: 0.739 vs. 0.724, P=0.567), cardiac mortality (AUC: 0.733 vs. 0.717, P=0.525), MACCEs (AUC: 0.635 vs. 0.624, P=0.587) and rehospitalizaiotn (AUC: 0.642 vs. 0.632, P=0.757). In multivariate Cox analysis, the original ACEF or ACEFMDRD score were related with increasing risks of all-cause mortality (HR: 2.00 vs. 1.32, 95% CI: 1.46–2.73 vs. 1.13–1.53, P<0.001), cardiac mortality (HR: 1.97 vs. 1.28, 95% CI: 1.43–2.70 vs. 1.10–1.50, P<0.001 vs. P=0.002), MACCEs and re-hospitalization for HF, respectively. ROC curves of cardiac mortality Conclusions In patients with ICM, the original ACEF and ACEFMDRD score are independent predictors of adverse outcomes during 13-month follow-up, respectively. Acknowledgement/Funding None

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Concordance and Prognostic Relevance of Angiographic and Clinical Definitions of Myocardial Infarction Type

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/10742484211005929 ◽

2021 ◽

pp. 107424842110059

Author(s):

Truong H. Hoang ◽

Pavel V. Lazarev ◽

Victor V. Maiskov ◽

Imad A. Merai ◽

Zhanna D. Kobalava

Keyword(s):

Myocardial Infarction ◽

Predictive Ability ◽

Predictive Performance ◽

Adverse Outcomes ◽

Principal Mechanism ◽

Grace Risk Score ◽

All Cause Mortality ◽

Grace Score

Background: Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis. Methods: Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed. Results: Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had “true” T1MI (atherothrombosis+ / triggers−); 174 (24.4%) were diagnosed with “true” T2MI (atherothrombosis− / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), P = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, P < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, P = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), P = 0.013 Conclusion: Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients.

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P908Prognostic value of energy loss index in patients with low gradient severe aortic stenosis and preserved ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz747.0504 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Altes ◽

A Ringle Griguer ◽

Y Bohbot ◽

O Bouchot ◽

F Delelis ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Energy Loss ◽

Volume Index ◽

Preserved Ejection Fraction ◽

Cardiac Mortality ◽

All Cause Mortality ◽

Loss Index

Abstract Background Assessment of pressure recovery adjusted indexed aortic valve area (AVAi) – energy loss index (ELI) – has been shown of prognostic interest for patients with asymptomatic and/or mild aortic stenosis (AS), but limited data are available in the setting of low gradient aortic stenosis (LG-AS). Purpose We hypothesized that among these patients with LG-AS, reclassification of AS severity as moderate by ELI may help to identify a subgroup of patients with moderate AS. Methods 379 patients with low gradient severe AS (defined by AVAi ≤0.6 cm2/m2 and mean aortic pressure gradient (MPG) <40 mmHg) and preserved left ventricular ejection fraction (LVEF ≥50%) were prospectively included. Reclassification as moderate AS by ELI was defined as AVAi ≤0.6 cm2 /m2 but an ELI >0.6 cm2/m2. Clinical and echocardiographic features of patients reclassified by ELI were studied. Clinical outcomes were all-cause and cardiac mortality. Results 148 patients (39%) were reclassified as moderate AS by ELI. By multivariable logistic regression analysis, patients being reclassified as moderate AS by ELI were associated with increased stroke volume index (SVi), absence of documented coronary artery disease and decreased body surface area, left indexed ventricular mass (all p<0.05). During a median follow-up of 34 months (30–38 months), 119 patients died, 52 of them from cardiac causes. Three-year survival free from all-cause or cardiac death were 76±4%, 96±2% for patients with moderate AS by ELI and 71±3%, 84±3% for patients with severe AS by ELI (p=0.178 and p=0.013, respectively). After adjustment for variables of prognostic interest including aortic valve replacement as a time-dependent covariable, there was a significant reduction of risk of cardiac mortality in patients with moderate AS by ELI (adjusted HR 0.44 [95% CI, 0.23–0.85]; p=0.014) but not for all-cause mortality (adjusted HR 0.85 [95% CI, 0.58–1.25]; p=0.403) Conclusion In patients with low gradient “severe” AS and preserved ejection fraction, calculation of ELI permits to reclassify almost 40% of patients as having moderate AS. Patients reclassified as moderate AS by ELI had a reduction of risk of cardiac mortality during follow-up but not for all-cause mortality. Calculation of ELI may be useful for decision making in AS patients with discordant grading and preserved ejection fraction. Acknowledgement/Funding Local funding

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Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0983 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Huang ◽

C Liu

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Funding Source ◽

Preserved Ejection Fraction ◽

Risk Of Mortality ◽

All Cause Mortality ◽

History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽

10.1159/000513440 ◽

2021 ◽

pp. 1-8

Author(s):

Clemens F. Hinke ◽

Rudolf A. Jörres ◽

Peter Alter ◽

Robert Bals ◽

Florian Bornitz ◽

...

Keyword(s):

Pulmonary Disease ◽

Predictive Value ◽

Hemoglobin Concentration ◽

Blood Gas Analysis ◽

Study Data ◽

Gas Analysis ◽

Chronic Obstructive ◽

Acute Exacerbations ◽

All Cause Mortality

Background: Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). Objectives: We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). Methods: In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO2, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. Results: During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (p < 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV1 % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (p = 0.006) was superior to that of Hb or SpO2 and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; p = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; p = 0.001) as covariates. Conclusion: The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

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Twin peaks diversity with sacubitril/valsartan treatment responses in cardiomyopathic heart failure patients of non-ischemic compared to ischemic etiologies

European Heart Journal ◽

10.1093/ehjci/ehaa946.1056 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H.Y Chang ◽

W.R Chiou ◽

P.L Lin ◽

C.Y Hsu ◽

C.T Liao ◽

...

Keyword(s):

Heart Failure ◽

Primary Endpoint ◽

Ischemic Cardiomyopathy ◽

Ventricular Remodeling ◽

Left Ventricular Ejection ◽

Funding Source ◽

Heart Failure Patients ◽

Twin Peaks ◽

All Cause Mortality

Abstract Background Ischemic cardiomyopathy (ICM) has been associated with increased mortality when compared with non-ischemic cardiomyopathy (NICM) from several heart failure (HF) cohorts. Instead, PARADIGM study demonstrated similar event rates of cardiovascular (CV) death, all-cause mortality and HF readmissions between ICM and NICM patients. Although the beneficiary effect of sacubitril/valsartan (SAC/VAL) compared to enalapril on these endpoints was consistent across etiologic categories, PARADIGM study did not analyze the effect of ventricular remodeling of SAC/VAL on patients with different HF etiologies, which may significantly affect treatment outcomes. Purpose We aim to compare alterations of left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes in patients with different HF etiologies. Methods Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients (TAROT-HF) study is a multicenter study which enrolled 1552 patients with LVEF <40%, whom had been on SAC/VAL treatment from 9 hospitals between 2017 and 2018. After excluding patients without having follow-up echocardiographic studies, patients were grouped by HF etiologies and by LVEF changes following treatment for 8-month period. LVEF improvement ≥15% was defined as “significant improvement”, 5–15% as “marginal improvement”, and <5% or worse as “lack of improvement”. The primary endpoint was a composite of CV death or a first hospitalization for HF. Mean follow-up period was 726 days. Results A total of 1230 patients were analyzed. Patients with ICM were significantly older, more male, and prone to have associated hypertension and diabetes. On the other hand, patients with NICM had lower LVEF and higher likelihood of atrial fibrillation. LVEF increase was significantly greater in patients with NICM compared to those with ICM (11.2±12.4% vs. 6.9±9.8, p<0.001). The effect of ventricular remodeling of SAC/VAL on patients with NICM showed twin peaks diversity (Significant improvement 37.1%, lack of improvement 42.3%), whereas in patients with ICM the proportions of significant, marginal and lack of improvement groups were 19.4%, 28.2% and 52.4%, respectively. The primary endpoint showed twin peaks diversity also in patients with NICM in line with LVEF changes: adjusted HR for patients with NICM and significant improvement was 0.41 (95% CI 0.29–0.57, p<0.001), for patients with NICM and lack of improvement was 1.54 (95% CI 1.22–1.94, p<0.001). Analyses for CV death, all-cause mortality, and HF readmission demonstrated consistent results. Conclusion Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients may indicate favorable outcome. NICM patients without response to SAC/VAL treatment should serve as an indicator for poor clinical outcome and warranted meticulous HF management. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Cheng Hsin General Hospital

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Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

Scientific Reports ◽

10.1038/s41598-020-79729-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pankaj Garg ◽

Hosamadin Assadi ◽

Rachel Jones ◽

Wei Bin Chan ◽

Peter Metherall ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

T1 Mapping ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Native T1 ◽

Lv Mass ◽

All Cause Mortality ◽

Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

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Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain)

BMJ Open ◽

10.1136/bmjopen-2017-018719 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018719 ◽

Cited By ~ 17

Author(s):

Nuria Farré ◽

Josep Lupon ◽

Eulàlia Roig ◽

Jose Gonzalez-Costello ◽

Joan Vila ◽

...

Keyword(s):

Ejection Fraction ◽

Prospective Observational Study ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

End Point ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Baseline Characteristics

ObjectivesThe aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%–49%) and the effect of 1-year change in LVEF in this group.SettingMulticentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units.ParticipantsFourteen per cent (n=504) of the 3580 patients included had HFmrEF.InterventionsBaseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes.ResultsMedian follow-up was 3.66 (1.69–6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%–49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively).ConclusionsPatients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

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Predictors of adverse prognosis in patients with infective endocarditis in a surgical referral center

European Heart Journal ◽

10.1093/ehjci/ehaa946.1880 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Scheggi ◽

I Olivotto ◽

N Ceschia ◽

I Merilli ◽

V Andrei ◽

...

Keyword(s):

Renal Failure ◽

Infective Endocarditis ◽

Adverse Events ◽

Ejection Fraction ◽

Relapse Rate ◽

Left Ventricular Ejection ◽

All Cause Mortality ◽

Fatal Adverse Events

Abstract Background Despite optimal medical and surgical treatment, mortality in infective endocarditis (IE) remains high. Aim of this study was to identify predictors of long term mortality for any cause, adverse event rate, relapse rate and valvular dysfunction at follow-up, in a high-volume surgical center. Methods We retrospectively analyzed 358 consecutive patients (127 women) admitted to our department with definite diagnosis of IE not device-related. IE occurred on native valves in 224 patients (63%); the infection involved the aortic valve in 192 (54%), mitral valve in 139 (39%) and tricuspid valve in 26 (7%). Overall 285 (80%) patients underwent surgery and 73 (20%) were treated conservatively, 38 due to absence of surgical indication and 35 due to refusal or prohibitive surgical risk. Long-term follow-up was obtained by structured telephone interviews. Primary endpoints were all-cause mortality, freedom from recurrent endocarditis, postoperative incidence of major adverse events (hospitalization for any cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), worsening of left ventricular ejection fraction (LVEF) and valvular dysfunction. Results Mean age was 65 years (SD 15.2). Mean vegetation length was 8.9 mm (SD 7.6). Endocarditis was left-sided in 332 (93%). Average follow-up was 6 months. At univariable analysis, mortality was associated with female gender (p=0.031), age (p<0.001), higher EuroSCORE 2 (p<0.001), chronic renal failure (p<0.001), diabetes (p=0.002), brain embolism on presentation (p=0.05), double valve infection (p=0.008), low ejection fraction (p<0.001), paravalvular extension (p=0.031), prosthetic infection (p=0.018), exclusion from surgery if indicated (p<0.001), high procalcitonin levels (p=0.035); factors associated with a significantly lower mortality were streptococcal infection (p=0.04; OR 0.34) and early surgery (p=0.009, OR 0.55). At multivariable analysis independent predictors of all-cause mortality were lower EF, EuroSCORE2, procalcitonin levels and diabetes. Non-fatal adverse events were associated with renal failure (p 0.035, OR 2.8). Relapse rate was associated with S aureus infection (p=0.005, OR 3.8), right-sided endocarditis (p<0.001, OR 6.7) and drug abuse (p<0.001, OR 9.4). Conclusions The present study shows that low EF, EuroSCORE2, procalcitonin levels and diabetes are independent predictors of death in patients with IE. Non-fatal adverse events are more frequent in patients with renal failure. Relapse rate is higher in drug abusers. These informations may help personalize follow-up strategies after acute admission for IE. Funding Acknowledgement Type of funding source: None

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Perioperative management after elective cardiac surgery: the predictive value of procalcitonin for infective and noninfective complications

Future Cardiology ◽

10.2217/fca-2020-0245 ◽

2021 ◽

Author(s):

Alice Laudisio ◽

Antonio Nenna ◽

Marta Musarò ◽

Silvia Angeletti ◽

Francesco Nappi ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Predictive Value ◽

Odds Ratio ◽

Rate Ratio ◽

Perioperative Management ◽

Incidence Rate Ratio ◽

Adverse Outcomes ◽

Elective Cardiac Surgery ◽

The Third

Objective: Procalcitonin (PCT) has been associated with adverse outcomes after cardiac surgery. Nevertheless, there is no consensus on thresholds and timing of PCT measurement to predict adverse outcomes. Materials & methods: A total of 960 patients undergoing elective cardiac surgery were retrospectively evaluated. PCT levels were measured from the first to the seventh postoperative day (POD). The onset of complications was recorded. Results: Complications occurred in 421 (44%) patients. PCT on the third POD was associated with the occurrence of any kind of complications (odds ratio: 1.06; p: 0.037), and noninfectious complications (odds ratio: 1.05; p: 0.035), after adjusting. PCT above the median value at the third POD (>0.33 μg/l) predicted postoperative complications (incidence rate ratio: 1.13; p = 0.035). Conclusion: PCT seems to predict postoperative complications in cardiac surgery. The determination at the third POD yields the greatest sensitivity and specificity.

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FC 100ASSOCIATION OF SINGLE AND SERIAL MEASURES OF SERUM PHOSPHORUS WITH ADVERSE OUTCOMES IN PATIENTS ON PERITONEAL DIALYSIS: RESULTS FROM THE INTERNATIONAL PDOPPS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab141.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Marcelo Lopes ◽

Angelo Karaboyas ◽

David W Johnson ◽

Talerngsak Kanjanabuch ◽

Martin Wilkie ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Adverse Outcomes ◽

Serum Phosphorus ◽

Target Range ◽

Recent Measurement ◽

Baseline Serum ◽

All Cause Mortality ◽

Serial Measurements ◽

Phosphorus Levels

Abstract Background and Aims While it has been established that high serum phosphorus is associated with mortality in hemodialysis (HD) patients, there is limited evidence in the peritoneal dialysis (PD) setting. We evaluated the association of serum phosphorus with mortality and major adverse cardiovascular events (MACE) in patients on PD, and investigated various parameterizations using single and serial measurements of serum phosphorus. Method We utilized data from 7 countries in phase 1 (2014-2017) of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Australia, Canada, Japan, New Zealand, Thailand, the UK, and the US. We investigated the association of serum phosphorus and 3 outcomes: all-cause mortality, cardiovascular (CV) mortality, and MACE (CV mortality + non-fatal angina, myocardial infarction, stroke, and heart failure). We parameterized serum phosphorus using 4 different methods: (1) single measurement of baseline serum phosphorus [most recent measurement during 6-month run-in period]; (2) mean serum phosphorus over a 6-month run-in period; (3) number of months (over the past 6 months) with serum phosphorus above the target range (>4.5 mg/dL); (4) mean area-under-the-curve (AUC), calculated as the average amount of time spent with serum phosphorus >4.5 mg/dL multiplied by the extent to which this threshold was exceeded over 6 months. Cox regression was used to estimate the association between each of these 4 exposures with the time-to-event outcomes, in models thoroughly adjusted for possible confounders. Follow-up began after the 6-month run-in period and continued until the outcome occurred, 7 days after leaving the facility due to transfer or change in kidney replacement therapy modality, loss to follow-up, or end of study phase (whichever event occurred first). Results Our sample consisted of 5904 patients who were on PD. Those with higher serum phosphorus levels were younger and had lower hemoglobin levels. Compared to patients with serum phosphorus ≥3.5 to <4.5 mg/dL, we found an all-cause mortality hazard ratio (HR) of 1.62 (95% CI: 1.19, 2.20) for patients with serum phosphorus ≥ 7 mg/dL. Strong associations were also observed using serial phosphorus measures [Table]. For example, compared to the reference group of AUC=0, the HR (95% CI) of death was 1.49 (1.10, 2.00) for AUC >1 to 2; and 1.67 (1.15, 2.41) for AUC >2. Akaike Information Criteria (AIC) results showed that, among the 4 exposures, AUC was the strongest predictor of all-cause mortality, and the single phosphorus measure was the weakest predictor. Associations between serum phosphorus and adverse outcomes were generally stronger for CV death and MACE than for all-cause mortality [Table]. Conclusion As seen in HD patients, this analysis demonstrates that serum phosphorus is a strong predictor of adverse outcomes in patients on PD. When considering serial measurements of serum phosphorus, rates of adverse events began to rise at phosphorus levels >4.5 mg/dL. As recommended by KDIGO guidelines, serial measurements that consider a history of serum phosphorus excursions >4.5 mg/dL should be considered when assessing risks of adverse outcomes.

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