scholarly journals New biochemical predictor of the ventricular tachyarrhythmias in patients with ischemic cardiomyopathy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Atabekov ◽  
R Batalov ◽  
S Sazonova ◽  
S Gusakova ◽  
S Krivolapov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Ischemic Cardiomyopathy ◽  
Roc Analysis ◽  
Ventricular Tachyarrhythmias ◽  
Icd Implantation ◽  
Galectin 3 ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The cardioverter-defibrillator (ICD) implantation is the most effective method for the sudden cardiac death (SCD) prevention. However, about 25% patients did not receive an ICD therapy during the first 5-years follow-up. At the same time ICD does not register ventricular tachyarrhythmias (VTA) events in patients with ICD implanted for the primary prevention of SCD. So, it’s necessary to find out new prognostic markers of the VTA incidence, which will help to optimize the selection of patients who really need an ICD implantation. Currently, ST-2 and galectin-3 are actively studied in patients with coronary artery disease (CAD) and chronic heart failure due to their high potential prognostic value. Moreover, their role in the development of life-threatening arrhythmias is still poorly understood. In this regard, the study of the level of biomarkers of inflammation and myocardial fibrosis is relevant. Aim. To evaluate the prognostic value of the ST-2 and galectin-3 in VTA predicting in patients with coronary artery disease and left ventricular ejection fraction less than 35 %. Material and methods. The study included 40 patients (males – 36, median age – 64,5 [57,5; 68,5] years) with CAD, II and III functional class of chronic heart failure, left ventricle ejection fraction less than 35 % and ICD implantation indications (primary prevention of the SCD). ST-2 and galectin-3 blood concentration were determined before ICD implantation. All patients were followed-up during 18 months. There were assessed arrhythmological events recorded in ICD memory and ICD-lead parameters. Results. The 1st group consisted of 10 (25,0 %) patients with VTA events terminated with ICD antitachycardia pacing or shock, the 2nd group – 30 (75,0 %) patients without VTA events. The univariate ROC-analysis showed that the high values of the ST-2 (p = 0,003) and galectin-3 (p = 0,045) were associated with frequent VTA events. Kaplan-Meier analysis showed that the ST-2 > 22,48 ng/ml (p = 0,02) and galectin-3 > 10,95 ng/ml (p = 0,009) significantly increase the risk of the VTA events. The multivariate ROC-analysis showed that only ST-2 increase (OR = 1,1053; CI 95 %: 1,0134-1,2056; р = 0,023) leaded to frequent VTA events. Conclusion. An increase of ST-2 more than 22,48 ng/ml and galectin-3 more than 10,95 ng/ml has predictive value in VTA assessing risk in patients with ischemic cardiomyopathy. In multivariate analysis, an independent predictor of VTA is the ST-2 increase more than 22,48 ng/ml.

scholarly journals Ventricular tachyarrhythmias prediction in patients with coronary artery disease and left ventricular dysfunction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Atabekov ◽  
R Batalov ◽  
S Krivolapov ◽  
M Khlynin ◽  
S Sazonova ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Standard Deviation ◽  
Frequency Domain ◽  
Ventricular Arrhythmias ◽  
Roc Analysis ◽  
Low Frequency ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The cardioverter-defibrillator (ICD) implantation is the most effective method for the sudden cardiac death (SCD) prevention. However, about 25% patients didn"t have an incidence of ICD shocks during first battery life. Most of them are mainly represented by patients who had the ICD implanted for the primary prevention of the SCD. It us known, reduced left ventricular ejection fraction (LVEF) is an independent predictor of the SCD. So, it’s necessary to find out new predictors of the SCD and ventricular arrhythmias (VTA) incidence, which will help to optimize the selection of patients who really need a ICD implantation. Purpose. To identify predicting methods of the VTA in patients with coronary artery disease and LVEF 35% or less. Materials and methods. The study included 40 patients (males – 36, mean age – 63,4 ± 7,8 years) with coronary artery disease (CAD), LVEF 35% or less and ICD implantation indications (primary prevention of the SCD). Patients before ICD implantation underwent 6-minute walk test, echocardiography, heart rate variability analysis and cardiac single-photon emission computed tomography with 123I-meta-iodobenzylguanidine (123I-MIBG). All patients after ICD implantation were followed-up during two years and divided into two groups. Results. The 1-st group consisted of 36 (90,0%) patients with VTA events. The 2-nd group consisted of 4 (10,0%) patients without VTA events. The univariate ROC-analysis showed that the low values of the average NN intervals (AUC = 0,986, p = 0,0001, t ≤ 1211 ms), standard deviation of NN intervals (AUC = 0,986, p = 0,0001, t ≤ 119 ms), standard deviation of the average NN intervals (AUC = 0,861, p = 0,0001, t ≤ 94 ms), average standard deviation of NN intervals (AUC = 0,792, p = 0,004, t ≤ 48 ms), root mean square of successive differences (AUC = 0,847, p = 0,0003, t ≤ 18 ms), very low frequency domain (AUC = 0,792, p = 0,02, t ≤ 2411 ms), low frequency domain (LFD) (AUC = 0,903, p = 0,0001, t ≤ 1046 ms), high frequency domain (AUC = 0,875, p = 0,0001, t ≤ 743 ms), total frequency domains (AUC = 0,847, p = 0,0003, t ≤ 2785 ms), heart/mediastinum ratio on early (AUC = 0,889, p = 0,0001, t ≤ 2,29) and delayed (AUC = 0,806, p = 0,001, t ≤ 1,65) scintigrams, as well as high values of the end-diastolic index (AUC = 0,944, p = 0,0001, t > 65,9 ml/m2), end-systolic index (AUC = 1,000, p = 0,0001, t > 23,6 мл/м2), 123I-MIBG accumulation defect on early (AUC = 0,958, p = 0,0001, t > 15,0%) and delayed (AUC = 0,958, p = 0,0001, t > 18,0%) scintigrams leaded to frequent occurrences of the VTA. The multivariate ROC-analysis demonstrated that the LFD (p = 0,0136) is independent predictor of the VTA. Also, increase of the VTA predictive ratio, calculated according to this predictive model, more than 0,8936 leaded to frequent occurrences of the VTA (AUC = 0,903, p = 0,0001). Conclusion. A decrease in the LFD can be a predictor of the VTA in patients with CAD. An increase in the predictive ratio more than 0,8936 is a prognostic marker of the life-threatening ventricular arrhythmias.

scholarly journals Diagnostic Value of Angiography-Derived IMR for Coronary Microcirculation and Its Prognostic Implication After PCI

2021 ◽  
Vol 8 ◽  
Author(s):  
Neng Dai ◽  
Wenliang Che ◽  
Lu Liu ◽  
Wen Zhang ◽  
Guoqing Yin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Moderate Correlation ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
Diagnostic And Prognostic Value

Background: Angiography-derived index of microcirculatory resistance (angio-IMR) is an emerging pressure-wire-free index to assess coronary microvascular function, but its diagnostic and prognostic value remains to be elucidated.Methods and Results: The study population consisted of three independent cohorts. The internal diagnostic cohort enrolled 53 patients with available hyperemic microcirculatory resistance (HMR) calculated from myocardial blood flow and pressure. The external diagnostic cohort included 35 ischemia and no obstructive coronary artery disease (INOCA) patients and 45 controls. The prognostic cohort included 138 coronary artery disease (CAD) patients who received PCI. Angio-IMR was calculated after the estimation of angiography-derived fractional flow reserve (angio-FFR) using the equation of angio-IMR = estimated hyperemic Pa × angio-FFR × [vessel length/(K × Vdiastole)]. The primary outcome was a composite of cardiac death or readmission due to heart failure at 28 months after index procedure. Angio-IMR demonstrated a moderate correlation with HMR (R = 0.74, p < 0.001) and its diagnostic accuracy, sensitivity, specificity, and area under the curve to diagnose INOCA were 79.8, 83.1, 78.0, and 0.84, respectively, with a best cut-off of 25.1. Among prognostic cohort, patients with angio-IMR ≥25.1 showed a significantly higher risk of cardiac death or readmission due to heart failure than those with an angio-IMR <25.1 (18.6 vs. 5.4%, adjusted HR 9.66, 95% CI 2.04–45.65, p = 0.004). Angio-IMR ≥25.1 was an independent predictor for cardiac death or readmission due to heart failure (HR 11.15, 95% CI 1.76–70.42, p = 0.010).Conclusions: Angio-IMR showed a moderate correlation with HMR and high accuracy to predict microcirculatory dysfunction. Angio-IMR measured after PCI predicts the risk of cardiac death or readmission due to heart failure in patients with CAD.Clinical Trial Registration: Diagnostic and Prognostic Value of Angiography-derived IMR (CHART-MiCro), NCT04825028.

scholarly journals Galectin-3 and incident heart failure among patients with pre-existing coronary artery disease: The ADVANCE study

2015 ◽  
Vol 5 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Iribarren ◽  
Malini Chandra ◽  
Jamal S. Rana ◽  
Mark A. Hlatky ◽  
Stephen P. Fortmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Advance Study ◽  
Galectin 3 ◽  
Incident Heart Failure ◽  
Artery Disease

Abstract 13417: Impact of Sex on the Prognostic Value of Galectin-3 in Patients With Suspected or Known Coronary Artery Disease: The ANOX Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiromichi Wada ◽  
Kazuhiko Kotani ◽  
masahiro suzuki ◽  
Morihiro Matsuda ◽  
Yoichi Ajiro ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Prognostic Information ◽  
Standard Deviation Increase ◽  
Entire Cohort ◽  
Galectin 3 ◽  
Artery Disease ◽  
Using Data ◽  
The Impact

Background: High circulating levels of galectin-3 are associated with all-cause mortality, cardiovascular (CV) mortality, and/or major adverse CV events (MACE) in patients with CV diseases such as heart failure and coronary artery disease (CAD). However, the impact of sex on the prognostic value of galectin-3 in patients with suspected or known CAD remains unclear. Methods: Using data from a multicenter, prospective cohort of 2418 patients with suspected or known CAD, we assessed the impact of sex on the association between galectin-3 levels and the risks of all-cause death, CV death, and MACE defined as a composite of CV death, nonfetal myocardial infarction, and nonfetal stroke. Galectin-3 was measured in 1624 men and 794 women enrolled in the ANOX Study. Patients were followed up over 3 years. Results: The mean ages (standard deviations) were 69.8 (10.6) years in men and 72.2 (9.9) years in women ( P <0.001). Men exhibited significantly lower levels of galectin-3 compared to women (median [interquartile range], 9.0 [6.9-11.9] versus 9.6 [7.3-12.4] ng/mL, respectively; P =0.004). In the entire patient cohort, the galectin-3 level was significantly associated with all-cause death (hazard ratio per 1 standard deviation increase [HR], 1.28; 95% confidence interval [CI], 1.16-1.42), CV death (HR, 1.24; 95% CI, 1.04-1.46), and MACE (HR, 1.24; 95% CI, 1.09-1.41) after adjusting for potential clinical confounders. These associations were still significant in women (HR for all-cause death, 1.59; 95% CI, 1.26-1.98; HR for CV death, 1.53; 95% CI, 1.06-2.21; HR for MACE, 1.61; 95% CI, 1.21-2.09), whereas in men, galectin-3 was significantly associated with all-cause death (HR, 1.23; 95% CI, 1.08-1.39), but not with CV death (HR, 1.14; 95% CI, 0.93-1.40) or MACE (HR, 1.15; 95% CI, 0.99-1.35). Furthermore, galectin-3 provided incremental prognostic information for all-cause death, but not for CV death or MACE, to the model with potential clinical confounders and the established CV biomarkers in the entire cohort and in women, but not in men. Conclusions: We identified a significantly stronger prognostic value of galectin-3 in women than in men among patients with suspected or known CAD.

scholarly journals Prognostic Value of T1 Mapping and Feature Tracking by Cardiac Magnetic Resonance in Patients With Signs and Symptoms Suspecting Heart Failure and No Clinical Evidence of Coronary Artery Disease

2022 ◽  
Author(s):  
Ayako Seno ◽  
Panagiotis Antiochos ◽  
Helena Lichtenfeld ◽  
Eva Rickers ◽  
Iqra Qamar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Clinical Evidence ◽  
Signs And Symptoms ◽  
Artery Disease ◽  
Incremental Prognostic Value

Background The ability of left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) by cardiac magnetic resonance for risk stratification in suspected heart failure is limited. We aimed to evaluate the incremental prognostic value of cardiac magnetic resonance‐assessed extracellular volume fraction (ECV) and global longitudinal strain (GLS) in patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease. Methods and Results A total of 474 consecutive patients (57±21 years of age, 56% men) with heart failure‐related symptoms and absence of coronary artery disease underwent cardiac magnetic resonance. After median follow‐up of 18 months, 59 (12%) experienced the outcome of all‐cause death or heart failure hospitalization (DeathCHF). In univariate analysis, cardiac magnetic resonance‐assessed LVEF, LGE, GLS, and ECV were all significantly associated with DeathCHF. Adjusted for a multivariable baseline model including age, sex, LVEF and LGE, ECV, and GLS separately maintained a significant association with DeathCHF (ECV, hazard ratio [HR], 1.44 per 1 SD increase; 95% CI 1.13–1.84; P =0.003, and GLS, HR, 1.78 per 1 SD increase; 95% CI, 1.06–2.96; P =0.028 respectively). Adding both GLS and ECV to the baseline model significantly improved model discrimination (C statistic from 0.749 to 0.782, P =0.017) and risk reclassification (integrated discrimination improvement 0.046 [0.015–0.076], P =0.003; continuous net reclassification improvement 0.378 [0.065–0.752], P <0.001) for DeathCHF, beyond LVEF and LGE. Conclusions In patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease, joint assessment of GLS and ECV provides incremental prognostic value for DeathCHF, independent of LVEF and LGE.

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