P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nam-Jun Cho ◽  
Soon hyo Kwon ◽  
Bo Da Nam ◽  
Kyoungin Choi
Keyword(s):  
Coronary Artery ◽  
Kidney Disease ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adjusted Risk ◽  
Attenuation Index ◽  
All Cause Mortality ◽  
Long Term Mortality

Abstract Background and Aims Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown. Method This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters. Results Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09). Conclusion The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.

P1855Multiple and posterior location of moderate paravalvular leaks are associated with worse long-term outcome after successful TAVR

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Kalinczuk ◽  
Z Chmielak ◽  
K Zielinski ◽  
G S Mintz ◽  
M Dabrowski ◽  
...  
Keyword(s):  
Clinical Importance ◽  
Mortality Rates ◽  
Paravalvular Leak ◽  
Single Center ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Common Location ◽  
Long Term Mortality

Abstract Background Posterior location of a paravalvular leak (PVL) affects left ventricle fluid dynamics in a more unfavorable way than leaks of the other locations. Purpose To assess impact of the PVL location and its grade on subsequent long term mortality after successful TAVR. Methods Out of 445 consecutive patients treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 pts [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Post-procedural TTE studies done within 7 days post-TAVR were analyzed for PVL location (anterior vs posterior vs medial vs lateral) and grade (none/trace/mild vs moderate). Long-term mortality was assessed. Results Median follow-up was 29.3 (15.8–53.1) months with 1-year follow-up in all pts. The 30-day and 1-year mortality rates were 3.0% (n=13) and 13.4% (n=58) with an estimated 4-year mortality of 35.5%. Moderate PVL was reported in 28.5% (n=123) of pts, with 12.0% (n=52) having multiple locations (>1 PVL). Among moderate PVLs (n=184), most were of anterior (33.2%), 29.3% were posterior, 25.2% were lateral, and the least common location was medial (12.0%). Whereas moderate PVL alone was not associated with worse long-term outcome, the 1-year mortality rates tended to be higher for pts with PVL found at multiple or posterior locations (19.2% vs 12.6% among the rest of the subjects, p=0.20, and 18.5% vs 12.7%, p=0.28, respectively). The KM curves suggest mid-term clinical importance of multiple or posterior PVLs (Fig 1A and 1B). Figure 1 Conclusions Moderate PVL found in multiple locations or recognized in the posterior location tend to be associated with worse midterm (1–2 years) prognosis after successful TAVR.

scholarly journals Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Babak Sattartabar ◽  
Ali Ajam ◽  
Mina Pashang ◽  
Arash Jalali ◽  
Saeed Sadeghian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Family History ◽  
Positive Family History ◽  
Probability Weighting ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Inverse Probability

Abstract Background Preoperative coronary artery disease risk factors (CADRFs) distribution and pattern may also have an important role in determining major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the CADRFs distribution and trend over 10 years and also the long-term outcome of CABG in different age-sex categories. Method In this registry-based serial cross-sectional study, we enrolled 24,328 patients who underwent isolated CABG and evaluated the prevalence of CADRFs according to sex and age. We used inverse probability weighting (IPW) to compare survival and MACE between the sexes. We also used Cox regression to determine each CADRFs effect on survival and MACEs. Results In general, DLP (56.00%), HTN (53.10%), DM (38.40%), and positive family history (38.30%) were the most frequent risk factors in all patients. Prevalence of HTN, DLP, DM, obesity, and positive family history were all higher in women, all statistically significant. The median follow-up duration was 78.1 months (76.31–79.87 months). After inverse probability weighting (to balance risk factors and comorbidities), men had lower MACEs during follow-up (HR 0.72; 95% CI 0.57–0.91; P value 0.006) and there was no significant difference in survival between sexes. DM and HTN were associated with higher mortality and MACEs in both sexes. Conclusion Although DLP is still the most frequent CADRF among the CABG population, the level of LDL and TG is decreasing. Women experience higher MACE post CABG. Therefore, health care providers and legislators must pay greater attention to female population CADRFs and ways to prevent them at different levels.

scholarly journals Using CHADS2 and CHA2DS2-VASc scores for mortality prediction in patients with chronic kidney disease

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Po-Chao Hsu ◽  
Wen-Hsien Lee ◽  
Szu-Chia Chen ◽  
Yi-Chun Tsai ◽  
Ying-Chih Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Mortality Prediction ◽  
Multivariate Model ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Basic Model ◽  
All Cause Mortality

Abstract Chronic kidney disease (CKD) is a public health issue and is associated with high morbidity and mortality. How to identify the high-risk CKD patients is very important to improve the long-term outcome. CHADS2 and CHA2DS2-VASc scores are clinically useful scores to evaluate the risk of stroke in patients with atrial fibrillation. However, there was no literature discussing about the usefulness of CHADS2 and CHA2DS2-VASc scores for cardiovascular (CV) and all-cause mortality prediction in CKD patients. This longitudinal study enrolled 437 patients with CKD. CHADS2 and CHA2DS2-VASc scores were calculated for each patient. CV and all-cause mortality data were collected for long-term outcome prediction. The median follow-up to mortality was 91 (25th–75th percentile: 59–101) months. There were 66 CV mortality and 165 all-cause mortality. In addition to age and heart rate, CHADS2 and CHA2DS2-VASc scores (both P value < 0.001) were significant predictors of CV and all-cause mortality in the multivariate analysis. Besides, in direct comparison of multivariate model, basic model + CHA2DS2-VASc score had a better additive predictive value for all-cause mortality than basic model + CHADS2 score (P = 0.031). In conclusion, our study showed both of CHADS2 and CHA2DS2-VASc scores were significant predictors for long-term CV and all-cause mortality in CKD patients and CHA2DS2-VASc score had a better predictive value than CHADS2 score for all-cause mortality in direct comparison of multivariate model. Therefore, using CHADS2 and CHA2DS2-VASc scores to screen CKD patients may be helpful in identifying the high-risk group with increased mortality.

scholarly journals Sex-specific differences and long-term outcome of patients with coronary artery disease and chronic kidney disease: the Coronary Artery Disease and Renal Failure (CAD-REF) Registry

2021 ◽  
Author(s):  
Christiane Engelbertz ◽  
Hans O. Pinnschmidt ◽  
Eva Freisinger ◽  
Holger Reinecke ◽  
Boris Schmitz ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Cox Regression ◽  
Peripheral Artery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Artery Disease ◽  
Long Term Mortality

Abstract Background Cardiovascular morbidity and mortality are closely linked to chronic kidney disease (CKD). Sex-specific long-term outcome data of patients with coronary artery disease (CAD) and CKD are scarce. Methods In the prospective observational multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry, 773 (23.1%) women and 2,579 (76.9%) men with angiographically documented CAD and different stages of CKD were consecutively enrolled and followed for up to 8 years. Long-term outcome was evaluated using survival analysis and multivariable Cox-regression models. Results At enrollment, women were significantly older than men, and suffered from more comorbidities like CKD, hypertension, diabetes mellitus, and multivessel coronary disease. Regarding long-term mortality, no sex-specific differences were observed (Kaplan–Meier survival estimates: 69% in women vs. 69% in men, plog-rank = 0.7). Survival rates decreased from 89% for patients without CKD at enrollment to 72% for patients with CKD stages 1–2 at enrollment and 49% for patients with CKD stages 3–5 at enrollment (plog-rank < 0.001). Cox-regression analysis revealed that sex or multivessel coronary disease were no independent predictors of long-term mortality, while age, CKD stages 3–5, albumin/creatinine ratio, diabetes, valvular heart disease, peripheral artery disease, and left-ventricular ejection fraction were predictors of long-term mortality. Conclusions Sex differences in CAD patients mainly exist in the cardiovascular risk profile and the extent of CAD. Long-term mortality was not depended on sex or multivessel disease. More attention should be given to treatment of comorbidities such as CKD and peripheral artery disease being independent predictors of death. Clinical Trail Registration ClinicalTrials.gov Identifier: NCT00679419 Graphic abstract

scholarly journals Long term prognostic value of myocardin expression levels in non-ischemic dilated cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Marketou ◽  
J Kontaraki ◽  
A Patrianakos ◽  
E Kanoupakis ◽  
A Plevritaki ◽  
...  
Keyword(s):  
Gene Expression ◽  
Blood Cells ◽  
Prognostic Value ◽  
Peripheral Blood Cells ◽  
Term Outcome ◽  
Long Term Outcome ◽  
All Cause Mortality ◽  
Non Ischemic Dilated Cardiomyopathy

Abstract Background We The mortality of patients with non-ischemic dilated cardiomyopathy (NIDCM) remains substantial. We evaluated gene expression levels of myocardin, an early cardiac gene, in the peripheral blood cells of NIDCM patients as a prognostic biomarker in their long-term outcome and mortality from congestive HF (CHF). Methods We retrospectively analyzed 101 consecutives optimally treated NIDCM patients of Cretan origin who were enrolled from the HF clinic of our hospital from November 2005 to December 2008. Our patient data were either taken from their medical files or recorded during visits to the HF unit or hospitalizations. Follow-up was carried out by telephone interview and by accessing information from general practitioners and cardiologists in private practice. Results The median follow up period was 8 years (mean follow-up 7±3.4 years). The overall mortality during follow-up was 61.4%, while mortality due to congestive heart failure (CHF) was 49.5%. Higher CHF and all-cause mortality were observed in patients with myocardin levels &gt;14.26 (p&lt;0.001 for both CHF and all-cause mortality). A multivariate Cox regression analysis showed that myocardin level of expression had independent significant prognostic value for the risk of death from CHF (HR: 14.5, 95% confidence interval (CI): 5.3–39). in those patients. Conclusions Peripheral blood cells gene expression of myocardin, an early myocardial marker, may serve as prognostic biomarkers of the long-term outcome of patients with NIDCM. Our findings open new prospects in the risk stratification of these patients. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Abstract 1565: Characterization and Outcome of Patients with Severe Symptomatic Aortic Stenosis Referred for Percutaneous Aortic Valve Replacement

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samir R Kapadia ◽  
Lars Svensson ◽  
Sachin Goel ◽  
Lee Wallace ◽  
Leonardo Rodriguez ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Medical Management ◽  
Term Outcome ◽  
Long Term Outcome ◽  
All Cause Mortality

Introduction: Although severe symptomatic aortic stenosis (AS) is associated with poor long-term outcome without aortic valve replacement (AVR), many patients are considered high risk for AVR surgery. These patients are typically not referred to cardiac surgery and therefore remain ill defined. Many of these patients are now referred for possible percutaneous AVR (percAVR). We report the clinical and echocardiographic characteristics of these patients with their outcome. Methods: All patients screened for percAVR between 2/06 to 3/07 were studied. Clinical and echocardiographic characteristics of patients undergoing surgical AVR (sAVR), percAVR, balloon aortic valvuloplasty (BAV) and medical management were compared. Clinical follow-up was performed for all cause mortality. Patients that were bridged to sAVR or percAVR after BAV were included in the respective groups. Results: We screened 92 pts for consideration of percAVR at our institution in 1 year. Of these, 19 pts underwent surgical AVR, 18 patients percAVR and 36 patients had medical management without BAV. BAV was performed in 30 patients of which 8 pts underwent percAVR and 3 had sAVR. Most common reasons for medical management included death while being screened (n=10, 28%), patient not interested in the study (n=10, 28%) and questionable severity of symptoms or AS (n=9, 25%). BAV was used in patients that could not wait for percAVR to become available with an intention to bridge. This could not be accomplished in 9 (45%) pts due to death while waiting for percAVR, 4 (20%) pts doing well after BAV not wanting percAVR, and the remaining 6 (30%) pts with exclusion from the current percAVR protocol (e.g. age, bleeding, infection, etc). Conclusion: Symptomatic patients with severe AS have high mortality if AVR is not feasible in a timely manner. About one fifth of the patients referred for percAVR could undergo sAVR with good outcome. Patients managed medically or with BAV alone have unfavorable outcomes. Characteristics and Outcome of Screened Patients

Review of a 13-Year Single-Center Experience with Minimally Invasive Direct Coronary Artery Bypass as the Primary Surgical Treatment of Coronary Artery Disease

2012 ◽  
Vol 15 (2) ◽  
pp. 61 ◽  
Author(s):  
David M. Holzhey ◽  
Jan P. Cornely ◽  
Ardawan J. Rastan ◽  
Piroze Davierwala ◽  
Friedrich W. Mohr
Keyword(s):  
Coronary Artery ◽  
Survival Rate ◽  
Minimally Invasive ◽  
Artery Bypass ◽  
Postoperative Mortality ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome

<p><b>Background and Aim of the Study:</b> In this study, we review our experience with 1768 minimally invasive direct coronary artery bypass (MIDCAB) operations. The focus is on long-term outcome with more than 10 years of follow-up.</p><p><b>Methods:</b> All patients undergoing standard MIDCAB between 1996 and 2009 were included. For all 1768 patients, pre-, intra-, and postoperative data could be completed. Long-term follow-up information about health status, major adverse cardiac and cerebrovascular events (MACCE), and freedom from angina was collected annually via questionnaire or personal contact. Five-year follow-up is available for 1313 patients, and 10-year-follow-up is available for 748 patients. A multivariate Cox regression analysis was performed to determine risk factors for long-term outcome.</p><p><b>Results:</b> Mean age was 63.4 � 10.8 years, mean ejection fraction was 60.0% � 14.2%, and perioperative mortality risk calculated by logistic EuroSCORE was 3.8 � 6.2%. In 31 patients (1.75%) intraoperative conversion to sternotomy was necessary. Early postoperative mortality was 0.8% (15 patients); 0.4% (7 patients) had a perioperative stroke. Seven hundred twelve patients received routine postoperative angiogram, showing 95.5% early graft patency. Short-term target vessel reintervention was needed in 59 patients (3.3%) (11 percutaneous transluminal coronary angioplasty (PTCA)/stent, 48 re-operation). Kaplan-Meyer analysis revealed a 5-year survival rate of 88.3% (95% confidence interval [CI], 86.6% to 89.9%) and a 10-year-survival rate of 76.6% (95% CI, 73.5% to 78.7%). The freedom from MACCE and angina after 5 and 10 years was 85.3% (95% CI, 83.5% to 87.1%) and 70.9% (95% CI, 68.1% to 73.7%), respectively.</p><p><b>Conclusions:</b> MIDCAB is a safe operation with low postoperative mortality and morbidity. With excellent short-term and long-term results, it is a very good alternative compared to both percutaneous coronary intervention (PCI) and conventional surgery.</p>

scholarly journals A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting

2021 ◽  
Vol 10 (14) ◽  
pp. 3032
Author(s):  
Tomasz Kamil Urbanowicz ◽  
Michał Michalak ◽  
Aleksandra Gąsecka ◽  
Anna Olasińska-Wiśniewska ◽  
Bartłomiej Perek ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Risk Score ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass ◽  
Long Term Mortality

Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7–10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment.

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