Abstract 13332: Platelet Distribution Width is Associated With Adverse Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Yu Sato ◽  
Akiomi YOSHIHISA ◽  
Yasuhiro Ichijo ◽  
Yu Hotsuki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Natriuretic Peptide ◽  
Cardiac Death ◽  
Left Ventricular Ejection ◽  
Platelet Distribution Width ◽  
Distribution Width ◽  
Patients With Heart Failure

Backgrounds: The associations between red blood cell distribution width and prognosis in patients with heart failure (HF) have been reported. However, the prognostic impact of platelet distribution width (PDW) has been unclear in HF patients. Methods: We conducted a prospective observational study. We analyzed data on 1,746 hospitalized patients with HF who discharged alive and measured PDW at stable condition in prior to discharge. Patients were divided into tertiles based on levels of PDW: 1 st (PDW < 15.9 fL, n = 586), 2 nd (PDW 15.9-16.8 fL, n = 617), and 3 rd (PDW ≥ 16.9, n = 543) tertiles. We compared baseline patients’ characteristics and their post-discharge prognosis such as all-cause death, cardiac death, and cardiac events including cardiac death and re-hospitalization due to worsening HF. Results: Prevalence of diabetes mellitus, anemia, and chronic kidney disease was highest in the 3 rd tertile than in the 1 st and 2 nd tertiles (diabetes mellitus, 42.7% vs. 40.3% and 30.5%, P < 0.001; anemia, 52.5% vs. 48.3% and 41.2%, P < 0.001; chronic kidney disease, 57.5% vs. 49.0% and 49.3%, P = 0.005). Age was oldest and B-type natriuretic peptide levels were highest in the 3 rd tertile compared to the 1 st and 2 nd tertiles (age, 70.0, vs. 69.0 and 68.0 years old, P = 0.038; B-type natriuretic peptide, 241.0 vs. 235.2 and 171.9 pg/mL, P < 0.001). In contrast, sex and left ventricular ejection fraction did not differ among the groups. The Kaplan-Meier analysis ( Figure ) demonstrated that rates of all endpoints were the highest in the 3 rd tertile among the groups (log-rank P < 0.001, respectively). The Cox proportional hazard analysis adjusted for potential confounding factors revealed that the 3 rd tertile was independently associated with adverse prognosis (all-cause death, hazard ratio [HR] 1.312, P = 0.042; cardiac death, HR 1.422, P = 0.046; cardiac event, HR 1.283, P = 0.041). Conclusion: PDW is a novel independent predictor of adverse prognosis in patients with HF.

scholarly journals Association between platelet distribution width and prognosis in patients with heart failure

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244608
Author(s):  
Yu Sato ◽  
Akiomi Yoshihisa ◽  
Koichiro Watanabe ◽  
Yu Hotsuki ◽  
Yusuke Kimishima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Platelet Distribution Width ◽  
Distribution Width ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Background The prognostic impact of platelet distribution width (PDW), which is a specific marker of platelet activation, has been unclear in patients with heart failure (HF). Methods and results We conducted a prospective observational study enrolling 1,746 hospitalized patients with HF. Patients were divided into tertiles based on levels of PDW: 1st (PDW < 15.9 fL, n = 586), 2nd (PDW 15.9–16.8 fL, n = 617), and 3rd (PDW ≥ 16.9, n = 543) tertiles. We compared baseline patients’ characteristics and post-discharge prognosis: all-cause death; cardiac death; and cardiac events. The 3rd tertile showed the highest age and levels of B-type natriuretic peptide compared to other tertiles (1st, 2nd, and 3rd tertiles; age, 69.0, 68.0, and 70.0 years old, P = 0.038; B-type natriuretic peptide, 235.2, 171.9, and 241.0 pg/mL, P < 0.001). Left ventricular ejection fraction was equivalent among the tertiles. In the Kaplan-Meier analysis, rates of all endpoints were the highest in the 3rd tertile (log-rank P < 0.001, respectively). The Cox proportional hazard analysis revealed that the 3rd tertile was associated with adverse prognosis (all-cause death, hazard ratio [HR] 1.716, P < 0.001; cardiac death, HR 1.919, P < 0.001; cardiac event, HR 1.401, P = 0.002). Conclusions High PDW is a novel predictor of adverse prognosis in patients with HF.

Abstract 12683: Combined Assessment of High-Sensitive Troponin I and N-Terminal Pro-B-Type Natriuretic Peptide Levels Improves the Prediction of Future Admission for Heart Failure in Outpatients With Chronic Kidney Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Junnichi Ishii ◽  
Hiroshi Takahashi ◽  
Midori Hasegawa ◽  
Ryuunosuke Okuyama ◽  
Hideki Kawai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Estimated Gfr ◽  
History Of ◽  
High Sensitive Troponin

Background: Heart failure (HF) is a common consequence of chronic kidney disease (CKD), and it portends high risk for mortality. We prospectively investigated the predictive value of a combination of high-sensitive troponin I (hsTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for HF admission in outpatients with CKD. Methods: Baseline hsTnI and NT-proBNP levels were measured in 451 stable outpatients with CKD (estimated GFR < 60 mL/min/1.73 m 2 ) on not dialysis (mean age, 69.7 years). Using echocardiography with tissue Doppler imaging, left ventricular ejection fraction (EF) and E/e’ ratio were estimated. Among these patients, 41% had a history of cardiovascular disease, and 48% had a history of diabetes. Results: During a mean follow-up period of 924 days, there were 70 HF admissions. Patients who admitted for HF had higher hsTnI levels (22.4 vs. 10.5 pg/mL, p < 0.0001), NT-proBNP levels (1726 vs. 310 pg/mL, p < 0.0001), and E/e’ ratio (15.3 vs. 10.3, p < 0.0001), and displayed lower values of EF (55 vs. 59%, p < 0.0001) and estimated GFR (23.7 vs. 30.6 mL/min/1.73 m 2 , p = 0.009) than those who did not. Using multivariate Cox regression analysis including 11 clinical variables, increased hsTnI (relative risk, 1.98 per 10-fold increment, p = 0.02) and NT-proBNP (3.18 per 10-fold increment, p = 0.003) levels were shown to be independent predictors of HF admission. When patients were stratified into four groups according to NT-proBNP levels > a median value of 397 pg/mL and/or hsTnI levels > a median value of 11.6 pg/mL, HF admission rates were 3.1%, 7.5%, 11.8%, and 33.1%, respectively (p < 0.0001). Furthermore, when hsTnI and NT-proBNP levels were combined, the predictive values for HF admission were increased, as shown by the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI; Table 1). Conclusions: The combined assessment of hsTnI and NT-proBNP levels can improve the prediction of HF admission in outpatients with CKD.

scholarly journals 633 Efficacy of additional medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo De Marzo ◽  
Lucia Tricarico ◽  
Giuseppe Biondi Zoccai ◽  
Michele Correale ◽  
Natale Daniele Brunetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Composite Outcome ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Abstract Aims We assessed the efficacy of add-on drugs in patients with heart failure with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD) already receiving neurohormonal inhibition (NEUi). Methods and results The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction &lt;45%, of whom &lt;30% were acutely decompensated, and with published information about the subgroup of estimated glomerular filtration rate &lt;60 ml/min/1.73 m2. Six RCTs were included in a study-level network meta-analysis evaluating the effect of NEUi, ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil (OM) on a composite outcome of cardiovascular death or hospitalization for heart failure. In a fixed-effects model, SGLT2i (HR: 0.78, 95% CrI: 0.69–0.89), ARNI (HR: 0.79, 95% CrI: 0.69–0.90), and ivabradine (HR: 0.82, 95% CrI: 0.69–0.98) decreased the risk of the composite outcome vs. NEUi, whereas OM did not (HR: 0.98, 95% CrI: 0.89–1.10). A trend for improved outcome was also found for vericiguat (HR: 0.90, 95% CrI: 0.80–1.00). In indirect comparisons, both SLGT2i (HR: 0.80, 95% CrI: 0.68–0.94) and ARNI (HR: 0.80, 95% CrI: 0.68–0.95) reduced the risk vs. OM; furthermore, there was a trend for a greater benefit of SGLT2i vs. vericiguat (HR: 0.88, 95% CrI: 0.73–1.00) and ivabradine vs. OM (HR: 0.84, 95% CrI: 0.68–1.00). Results were comparable in a random-effects model and in sensitivity analyses. SUCRA scores were 81.8%, 80.8%, 68.9%, 44.2%, 16.6%, and 7.8% for SGLT2i, ARNI, ivabradine, vericiguat, OM, and NEUi, respectively. Conclusions Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD. 633 Figure

P6251Prognostic value of ACEi/ARBS in elderly patients with heart failure with reduced ejection fraction with and without chronic kidney disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Martinez Milla ◽  
M Cortes ◽  
M Lopez-Castillo ◽  
A Devesa ◽  
A L Rivero-Monteagudo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular Ejection ◽  
Hospital Records ◽  
Patients With Heart Failure ◽  
The Mean

Abstract Introduction Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers therapy (ACEI/ARB) have shown to reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF). However, there is lack of information about the benefit of these drugs in patients with chronic kidney disease (CKD), and even less in elderly patients. Our aim is to compare the prognostic impact of ACE/ARB if CKD is present or not Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. Clinical, echocardiographic and ECG data were taken from hospital records. Follow-up was made via telephone and hospital records as well. We analyzed the relationship between treatment with ACEi/ARBs (with different doses) and occurrence of mortality or MACE (major adverse cardiovascular events: composite of death from any cause or hospitalization for heart failure). Results From the total population 410 (51%) patients that had not CKD (glomerular filtration rate (GFR) >60ml/min/1,73m2) and 390 (49%) patients had CKD (with GFR ≤60ml/min/1,73m2). We analyze the population according the presence or not of CKD. Both groups had similar characteristics except the age: 81.5±4.5 years vs. 82.6±4.1 (p<0.05) and the percentage of use of ACEi/ARB 78.8% of the total vs 66.9% of the total (p<0.05). The mean ejection fraction was 27.9±6.5% vs 28.12±6.5% (p>0.05). The mean follow up was 33±22 vs 32±23 months (p>0.05). In patients with no CKD 170 (42%) patients died and 239 (58%) patients had a MACE. In the CKD group 211 (54.1%)patients died and 257 (65.9%)patients had a major cardiovascular event. In the univariate analysis in both groups the use of ACEi/ARB reduced the mortality and the MACE. After a multivariate analysis ACEi/ARB appear to be beneficial in the CKD group (OR 0.71 [0.50–0.98]) but not in no CKD group Conclusions According to our data, treatment with ACEI/ARB in elderly patients HFrEF and CKD should be encouraged even more than in those without CKD.

Device therapy in chronic kidney disease (implantable cardioverter defibrillator, cardiac resynchronization therapy)

ESC CardioMed ◽  
2018 ◽  
pp. 999-1002
Author(s):  
Petra Nijst ◽  
Wilfried Mullens
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Death ◽  
Implantable Devices ◽  
Cardiac Resynchronization ◽  
Individual Risk ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Heart failure and chronic kidney disease (CKD) are frequent co-morbid conditions, and represent two challenging and costly diseases for individuals and societies. CKD has a prevalence up to 55% in patients with heart failure, with a significantly higher risk for arrhythmias, sudden cardiac death, hospitalization, and mortality. Cardiac implantable devices such as implantable cardioverter defibrillators and cardiac resynchronization therapy are treatments proven to have a significant benefit on clinical outcomes in selected patients with heart failure. However, due to the high risk of non-cardiac death and substantial other co-morbidities in patients with CKD, the benefit of cardiac implantable devices may be attenuated. Furthermore, device-related complications are far more frequent in patients with CKD and relate to the patient’s clinical status and co-morbidities. Renal dysfunction, particularly severe CKD (glomerular filtration rate <30 mL/min/1.73 m2) and end-stage CKD (with the necessity of dialysis or kidney transplantation), is associated with major complications including bleeding, infection, device/lead dysfunction, and vascular complications. Specific data and guidelines in this population are lacking due to the fact that CKD is a frequent exclusion criterion in most randomized clinical trials. Decisions for implantation and follow-up should be performed on an individual basis, taking into account individual risk/benefit ratios and done by a multidisciplinary team including a nephrologist and cardiologist.

Sign in / Sign up

Export Citation Format

Share Document