MO834LOWER POST DIALYSIS POTASSIUM AND HIGHER ULTRAFILTRATION RATE ARE INDEPENDENT PREDICTORS OF ALL-CAUSE MORTALITY IN DIALYSIS PATIENTS

Abstract Background and Aims Dialysis is a life-saving procedure for the end-stage kidney disease, but mortality in this category of patients is still high. The survival of these patients is much lower compared to the general population. Factors affecting this survival has been studied for years and still continue to be an important part of current studies. While ultrafiltration rate is known to be associated with mortality in prevalent dialysis patients an important predictor of survival is the control of potassium profile. The aim of our study was to assess the hemodynamic and biochemical data, and to identify any significant association between post-dialysis potassium and all-cause mortality. Method This is a prospective study of 308 patients on maintenance dialysis, followed for seven years, ending 2019. All patients are dialysis dependent for ESKD and getting treatment in a single-center. Hypokalemia was defined as a serum potassium level < 3.5 mEq/L and high ultrafiltration rate (UFR) > 13 ml/kg/h. Other hemodynamic and metabolic data were also evaluated The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis. Results A total of 308 patients were enrolled in this study. Mean age was 52 ± 15.6 years; 62.3% of pts were male; BMI 24.7±4.2. Of these, 55 patients (17.9%) died during the follow-up period. Our data showed the presence left ventricular hypertrophy (p=0.010), peripheral artery disease (p<0.0001), diastolic disfunction (p<0.01) and ultrafiltration rate during dialysis >13ml/kg/h (p=0.002) were the most important predictors of mortality. Metabolic abnormalities, low albumin (p<0.0005), hyperphosphatemia (p=0.011), post-dialysis potassium (p=0.037) were significantly associated with higher mortality. Logistic regression analysis of the metabolic data identified post-dialysis potassium (OR 0.242, 95% CI 0.074 – 0.793, p=0.019), and logistic regression analysis of the hemodynamic data identified ultrafiltration ratio (OR 0.149, CI 0.033 – 0.673, p=0.013) as independent predictors of all-cause mortality. Conclusion Lower post dialysis potassium levels and higher ultrafiltration rate are independently associated with higher all-cause and CV mortality in prevalent hemodialysis patients. Therefore the potassium profile and the UFR of the dialysis patients needs close monitoring and optimal control. The individualization of the dialysis prescription is recommended for each patient and it has an important role in preventing the occurrence of complication with immediate and long term effects. Management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia.

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Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis

Open Heart ◽

10.1136/openhrt-2021-001720 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001720

Author(s):

Edda Bahlmann ◽

Eigir Einarsen ◽

Dana Cramariuc ◽

Helga Midtbø ◽

Costantino Mancusi ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Aortic Stenosis ◽

Logistic Regression Analysis ◽

Myocardial Dysfunction ◽

Smoothing Splines ◽

Left Ventricular ◽

Energetic Efficiency ◽

Generalised Additive Model ◽

Cox Regression Analysis

ObjectivesIn hypertension, low myocardial energetic efficiency (MEEi) has been documented as an integrated marker of metabolic and left ventricular (LV) myocardial dysfunction. We tested the predictive performance of MEEi in initially asymptomatic aortic stenosis (AS) patients free from diabetes and known cardiovascular disease.MethodsData from 1703 patients with mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study followed for 4.3 years was used. MEE was calculated from Doppler stroke volume/([heart rate/60]) and indexed to LV mass (MEEi). The threshold value for MEEi associated with increased mortality was identified in generalised additive model with smoothing splines. Covariables of MEEi were identified in logistic regression analysis. Outcome was assessed in Cox regression analysis and reported as HR and 95% CI.ResultsMEEi <0.34 mL/s per gram was associated with increased cardiovascular mortality (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) and all-cause mortality (n=155) (HR 1.74 (95% CI 1.20 to 2.52)) (both p<0.01). The association was independent of confounders of low MEEI (<0.34 mL/s per gram) identified in multivariable logistic regression analysis, including more severe AS, higher body mass index, lower LV midwall shortening and ejection fraction and presence of hypertension. Comparison of the Cox models with and without MEEi among the covariables demonstrated that MEEi significantly improved the prognostic yield (both p<0.01).ConclusionsIn patients with initially asymptomatic AS, low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during 4.3 years follow-up, independent of known prognosticators.Trial registration numberNCT00092677.

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Real-world clopidogrel utilization in acute coronary syndromes: patients selection and outcomes in a single-center experience

Therapeutic Advances in Cardiovascular Disease ◽

10.1177/1753944717738911 ◽

2017 ◽

Vol 11 (12) ◽

pp. 323-331 ◽

Cited By ~ 9

Author(s):

Diego Castini ◽

Simone Persampieri ◽

Sara Cazzaniga ◽

Giulia Ferrante ◽

Marco Centola ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Adverse Events ◽

Hospital Mortality ◽

Logistic Regression Analysis ◽

Left Ventricular ◽

Hospital Death ◽

Multivariable Logistic Regression Analysis ◽

Killip Class ◽

Female Sex

Background: With this study, we sought to identify patient characteristics associated with clopidogrel prescription and its relationship with in-hospital adverse events in an unselected cohort of ACSs patients. Materials and Methods: We studied all consecutive patients admitted at our institution for ACSs from 2012 to 2014. Patients were divided into two groups based on clopidogrel or novel P2Y12 inhibitors (prasugrel or ticagrelor) prescription and the relationship between clopidogrel use and patient clinical characteristics and in-hospital adverse events was evaluated using logistic regression analysis. Results: The population median age was 68 years (57–77 year) and clopidogrel was prescribed in 230 patients (46%). Patients characteristics associated with clopidogrel prescription were older age, female sex, non-ST-elevation ACS diagnosis, the presence of diabetes mellitus and anemia, worse renal and left ventricular functions and a higher Killip class. Patients on clopidogrel demonstrated a significantly higher incidence of in-hospital mortality (4.8%) than prasugrel and ticagrelor-treated patients (0.4%), while a nonstatistically significant trend emerged considering bleeding events. However, on multivariable logistic regression analysis female sex, the presence of anemia and Killip class were the only variables independently associated with in-hospital death. Conclusion: Patients treated with clopidogrel showed a higher in-hospital mortality. However, clinical variables associated with its use identify a population at high risk for adverse events and this seems to play a major role for the higher in-hospital mortality observed in clopidogrel-treated patients.

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Circulating miR-30d Predicts Survival in Patients with Acute Heart Failure

Cellular Physiology and Biochemistry ◽

10.1159/000459899 ◽

2017 ◽

Vol 41 (3) ◽

pp. 865-874 ◽

Cited By ~ 22

Author(s):

Junjie Xiao ◽

Rongrong Gao ◽

Yihua Bei ◽

Qiulian Zhou ◽

Yanli Zhou ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Univariate Logistic Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background/Aims: Identification of novel biomarkers to identify acute heart failure (AHF) patients at high risk of mortality is an area of unmet clinical need. Recently, we reported that the baseline level of circulating miR-30d was associated with left ventricular remodeling in response to cardiac resynchronization therapy in advanced chronic heart failure patients. However, the role of circulating miR-30d as a prognostic marker of survival in patients with AHF has not been explored. Methods: Patients clinically diagnosed with AHF were enrolled and followed up for 1 year. Quantitative reverse transcription polymerase chain reactions were used to determine serum miR-30d levels. The univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the predictors for all-cause mortality in AHF patients. Kaplan–Meier survival analysis was used to analyze the role of miR-30d in prediction of survival. Results: A total of 96 AHF patients were enrolled and followed up for 1 year. Serum miR-30d was significantly lower in AHF patients who expired in the one year follow-up period compared to those who survived. Univariate logistic regression analysis yielded 18 variables that were associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 4 variables including heart rate, hemoglobin, serum sodium, and serum miR-30d level associated with mortality. ROC curve analysis showed that hemoglobin, heart rate and serum sodium displayed poor prognostic value for AHF (AUCs not higher than 0.700) compared to miR-30d level (AUC = 0.806). Kaplan–Meier survival analysis confirmed that patients with higher serum miR-30d levels had significantly lower mortality (P=0.001). Conclusion: In conclusion, this study shows evidence for the predictive value of circulating miR-30d as 1-year all-cause mortality in AHF patients. Large multicentre studies are further needed to validate our findings and accelerate the transition to clinical utilization.

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Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

PeerJ ◽

10.7717/peerj.11650 ◽

2021 ◽

Vol 9 ◽

pp. e11650

Author(s):

Wenpeng Li ◽

Lexiang Zeng ◽

Deping Han ◽

Shanyi Zhang ◽

Bingxi Lei ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Pituitary Adenoma ◽

Logistic Regression Analysis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Close Monitoring ◽

Training Set ◽

Nonlinear Association

Objective To develop and validate a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma (PA). Methods This retrospective cohort study included 205 patients with PAs between January 2013 and April 2020 in the Sun Yat-sen Memorial Hospital, Guangzhou, China. The patients were randomly classified into either a training set (N = 143 patients) and a validation set (N = 62 patients) at a ratio of 7:3. Variables, which were identified by using the LASSO regression model were included for the construction of a nomogram, and a logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) in the training set. The area under the curve (AUC) was used to evaluate the performance of the nomogram for predicting hypokalemia. Multivariate logistic regression analysis with a restricted cubic spline analysis was conducted to identify a potential nonlinear association between the preoperative index and hypokalemia. Results The incidence of hypokalemia was 38.05%. Seven preoperative indices were identified for the construction of the nomogram: age, type of PA, weight, activated partial thromboplastin time, urea, eosinophil percentage, and plateletocrit. The AUCs of the nomogram for predicting hypokalemia were 0.856 (95% CI [0.796–0.915]) and 0.652 (95% CI [0.514–0.790]) in the training and validation sets, respectively. Restricted cubic splines demonstrated that there was no nonlinear association between hypokalemia and the selected variables. Conclusion In this study, we constructed a preoperative indices-based nomogram that can assess the risk of hypokalemia after the surgical treatment of pituitary adenomas. This nomogram may also help to identify high risk patients who require close monitoring of serum potassium.

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Preoperative QRS Duration Predicts the Responsiveness of Chronic Heart Failure Patients with Pacemaker Indications To Left Bundle Branch Area Pacing Treatment

10.21203/rs.3.rs-1094943/v1 ◽

2021 ◽

Author(s):

Tianping Chen ◽

Xu Geng ◽

Yaxing Fang ◽

Yuchun Yin ◽

Naiju Zhang

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Regression Analysis ◽

Chronic Heart Failure ◽

Logistic Regression Analysis ◽

Binary Logistic Regression ◽

Left Ventricular ◽

Binary Logistic Regression Analysis ◽

Peak Time ◽

Qrs Duration

Abstract Background This study investigated the predictive value of preoperative QRS duration (ORSd) in responsiveness of chronic heart failure (CHF) patients with pacemaker indications to the left bundle branch area pacing (LBBAP). Methods Thirty-one CHF patients with cardiac function categorized as NYHA class II or above and indications for pacemaker therapy who successfully underwent LBBAP treatment were enrolled in this study. Based on the 12-month postoperative responsiveness to treatment, patients were divided into a responsiveness group (n=18) and a no-responsiveness group (n=13). Data from all patients were collected for analysis. Multivariate binary logistic regression analysis was used to determine the independent factors associated with the responsiveness to LBBAP treatment. Results Among the 31 patients with LBBAP, 16 patients (51.6%) responded to the treatment, and 15 patients (48.4%) had no response. There were significant differences between these two groups with regard to complete left bundle branch block (CLBBB), preoperative QRSd, and preoperative left ventricular peak time (LVAT). Univariate logistic regression analysis showed that CLBBB, preoperative QRSd, and preoperative LVAT were all significantly correlated with responsiveness to LBBAP. Multivariate binary logistic regression analysis showed that ORSd was an independent predictor of responsiveness to LBBAP. The maximum area under the ROC curve for QRSd was 0.827, the maximum Youden index was 0.679, with the optimal cutoff point of QRSd ≥ 153 ms, a sensitivity of 81.3%, and a specificity of 86.7%. Conclusion Preoperative ORSd predicts the responsiveness of CHF patients with pacemaker indications to LBBAP.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1143 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

V Ferreira ◽

L Moura Branco ◽

A Galrinho ◽

P Rio ◽

S Aguiar Rosa ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Stress Test ◽

Bypass Graft ◽

Dobutamine Stress ◽

Left Ventricular ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality

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

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Serum Irisin Predicts Mortality Risk in Acute Heart Failure Patients

Cellular Physiology and Biochemistry ◽

10.1159/000477867 ◽

2017 ◽

Vol 42 (2) ◽

pp. 615-622 ◽

Cited By ~ 12

Author(s):

Shutong Shen ◽

Rongrong Gao ◽

Yihua Bei ◽

Jin Li ◽

Haifeng Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Curve Analysis ◽

Multivariate Logistic Regression ◽

Roc Curve Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background/Aims: Irisin is a peptide hormone cleaved from a plasma membrane protein fibronectin type III domain containing protein 5 (FNDC5). Emerging studies have indicated association between serum irisin and many major chronic diseases including cardiovascular diseases. However, the role of serum irisin as a predictor for mortality risk in acute heart failure (AHF) patients is not clear. Methods: AHF patients were enrolled and serum was collected at the admission and all patients were followed up for 1 year. Enzyme-linked immunosorbent assay was used to measure serum irisin levels. To explore predictors for AHF mortality, the univariate and multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used. To determine the role of serum irisin levels in predicting survival, Kaplan-Meier survival analysis was used. Results: In this study, 161 AHF patients were enrolled and serum irisin level was found to be significantly higher in patients deceased in 1-year follow-up. The univariate logistic regression analysis identified 18 variables associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 2 variables namely blood urea nitrogen and serum irisin. ROC curve analysis indicated that blood urea nitrogen and the most commonly used biomarker, NT-pro-BNP, displayed poor prognostic value for AHF (AUCs ≤ 0.700) compared to serum irisin (AUC = 0.753). Kaplan-Meier survival analysis demonstrated that AHF patients with higher serum irisin had significantly higher mortality (P<0.001). Conclusion: Collectively, our study identified serum irisin as a predictive biomarker for 1-year all-cause mortality in AHF patients though large multicenter studies are highly needed.

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Pericardial effusion following cardiac surgery. A single-center experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317744902 ◽

2017 ◽

Vol 26 (1) ◽

pp. 5-10 ◽

Cited By ~ 1

Author(s):

Hien Sinh Nguyen ◽

Hung Doan-Thai Nguyen ◽

Thang Duc Vu

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Pericardial Effusion ◽

Logistic Regression Analysis ◽

Heart Surgery ◽

Open Heart Surgery ◽

Multivariate Logistic Regression Analysis ◽

Left Ventricular ◽

Open Heart ◽

Z Score

Background Pericardial effusion is still a common postoperative complication after open heart surgery with cardiopulmonary bypass. Pericardial effusion significantly prolongs the hospital stay and associated costs as well as affecting overall outcomes after open heart surgery in Hanoi Heart Hospital, a tertiary hospital in Vietnam with an annual volume of 1000 patients. This study aimed to investigate the clinical presentation, incidence, and risk factors of postoperative pericardial effusion, which may ensure better prevention of pericardial effusion and improvement in surgical outcomes after open heart surgery. Methods A cross-sectional study was performed on 1127 patients undergoing open heart surgery from January 2015 to December 2015. Results Thirty-six (3.19%) patients developed pericardial effusion. Of these, 16 (44.4%) had cardiac tamponade. Pericardial effusion occurred after valve procedures in 77.8% of cases. Pericardial effusion was detected after discharge in 47.2% of cases at a mean time of 18.1 ± 13.7 days. Univariate logistic regression analysis showed that age > 25 years, body surface area ≥ 1.28 m2, preoperative liver dysfunction, New York Heart Association class III/IV, left ventricular end-diastolic diameter z score ≥ 0.55, and postoperative anticoagulant use were associated with postoperative pericardial effusion. Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter z score ≥ 0.55 was an independent risk factor for postoperative pericardial effusion. Conclusions Routine postoperative echocardiography is necessary to detect postoperative pericardial effusion. Increased left ventricular end-diastolic dimension is an independent predictor of postoperative pericardial effusion.

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Clinical significance of lactate clearance in patients with cardiogenic shock: results from the RESCUE registry

Journal of Intensive Care ◽

10.1186/s40560-021-00571-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ik Hyun Park ◽

Jeong Hoon Yang ◽

Woo Jin Jang ◽

Woo Jung Chun ◽

Ju Hyeon Oh ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Clinical Significance ◽

Logistic Regression Analysis ◽

Lactate Clearance ◽

Serum Lactate ◽

Left Ventricular

Abstract Background Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients. Methods We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance [HLC] group vs. low lactate clearance [LLC] group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level. Results In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval [CI] 0.985–0.993, p < 0.001), and the cut-off value for the LC of the study population was 64%. The HLC group (initial 24 h LC ≥ 64%, n = 333) had a significantly lower incidence of in-hospital death than the LLC group (n = 295) (25.5% in the HLC group vs. 42.7% in the LLC group, p < 0.001). During 12 months of follow-up, the cumulative incidence of all-cause death was significantly lower in the HLC group than in the LLC group (33.0% vs. 48.8%; hazard ratio 0.55; 95% CI 0.42–0.70; p < 0.001). In subgroup analysis, 24 h LC predicted in-hospital mortality better in patients with initial serum lactate > 5 mmol/L than in those with serum lactate ≤ 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate ≤ 5 mmol/L = 0.660, p = 0.011). Conclusions Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC ≥ 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L. Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016—retrospectively and prospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02985008

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Left ventricular blood flow energetics after acute ST-segment elevation myocardial infarction associate with left ventricular remodeling

European Heart Journal ◽

10.1093/eurheartj/ehab724.0249 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Demirkiran ◽

P Garg ◽

R J Geest ◽

H J Berkhof ◽

R Nijveldt ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Flow ◽

Logistic Regression ◽

Regression Analysis ◽

Infarct Size ◽

Logistic Regression Analysis ◽

Left Ventricular ◽

St Segment Elevation ◽

St Segment ◽

Lv Remodeling

Abstract Background Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics. It remains unknown how four-dimensional (4D) acute changes in LV blood flow kinetic energy (KE) affect LV remodeling. We hypothesized that LV blood flow energetics are independently associated with adverse LV-remodeling. Methods In total, 69 revascularised ST-segment elevation MI patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart 4D flow acquisitions. CMR analysis included: LV volumes, function, infarct size (indexed to body surface area), microvascular obstruction (MVO), two-dimensional, retrospective valve tracking derived mitral inflow metrics, and 4D blood flow KE components (Fig. 1). Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume: 10% (mild), 15% (moderate), and 20% (severe). Results Twenty-four patients (35%) developed mild, 17 patients (25%) moderate, 11 patients (16%) severe LV remodeling. Demographics and clinical history were comparable between patients with/without LV remodeling. In univariable logistic regression analysis, A-wave KE was associated with mild, moderate, and severe LV remodeling (p=0.03, p=0.02, p=0.02, respectively), whereas infarct size was associated with only mild LV remodeling (p=0.02). In multivariable logistic regression analysis, whilst the infarct size and A-wave KE were identified as independent markers for mild LV remodeling (p=0.03, p=0.09, respectively), A-wave KE was the only independent marker regarding moderate and severe LV remodeling (both, p<0.01). In ROC analysis for A-wave KE to be associated with the presence of adverse LV remodeling, the area under the curve was 0.67 for mild (p=0.02), 0.70 for moderate (p=0.01), 0.71 for severe (p=0.03) LV remodeling. Conclusion In patients with STEMI, LV hemodynamics assessment by LV blood flow KE demonstrated an incremental value to predict adverse LV-remodeling. A-wave KE early after acute MI had an independent effect on adverse LV remodeling. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported by the British Heart Foundation [FS/10/62/28409 to S.P.] and Dutch Technology Foundation (STW), project number 11626 (JW, ME).

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