Abstract P014: Life’S Simple 7 And Fibroblast Growth Factor 23: The Boston Puerto Rican Health Study.

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Chinedu C Ochin ◽  
Sherman Bigornia ◽  
Mahdi O Garelnabi ◽  
Katherine L Tucker
Keyword(s):  
Puerto Rican ◽  
Fasting Glucose ◽  
Fibroblast Growth Factor 23 ◽  
Left Ventricular ◽  
Health Study ◽  
Life’S Simple 7 ◽  
Life's Simple 7 ◽  
Fgf 23 ◽  
Group 1

Introduction: FGF-23 is a phosphatouric hormone which also serves as a plasma biomarker that mediates pathologic cardiac remodeling, such as left ventricular hypertrophy or myocardial fibrosis, and is associated with increased cardiovascular mortality. However, limited evidence is available on lifestyle-related factors associated with circulating concentration of this emerging cardiovascular risk factor. Objective: Our aim was to measure the association between the American Heart Association’s Life’s Simple 7 (LS7) and circulating FGF-23 concentration among Puerto Rican adults. Methods: Data are from Boston Puerto Rican Health Study (BPRHS) participants (mean age 56.2 years, 77% female) at baseline and at approximately 8-y follow-up (n=410). LS7 was calculated at baseline and includes 4 physiological (BMI, total cholesterol, blood pressure, and fasting glucose) and 3 behavioral factors (smoking, physical activity, and diet). Each component was categorized using a constituent scoring system (ideal=2; intermediate=1; Poor=0) and these were summed to calculate the total LS7 score. Participants were categorized into 5 LS7 groups as follows: 1) score 1-4 (n=105), 2) 5 (n=76), 3) 6 (n=89), 4) 7 (n=69), and 5) 8-12 (n=71). Fasting plasma FGF-23 concentration at 8-y follow-up was measured by ELISA. Associations between baseline LS7 score and 8-y FGF-23 were assessed using ANCOVA, adjusted for age and sex (model 1), and additionally for history of cardiovascular disease and poverty-income-ratio (model 2). Results: Relative to participants in LS7 group 1 (2.98 ± 1.09 mg/dL), those in groups 5 (1.63 ± 1.12 mg/dL, p=0.0001) had significantly lower FGF-23 concentration (model 1, P-trend=0.0001). After considering additional confounders, FGF-23 concentration among LS7 group 5 (1.69 ± 1.12 mg/dL, p=0.0007) remained significantly lower than in group 1 (2.95 ± 1.09 mg/dL). The p-trend across categories was also significant at p=0.0007. In additional analyses, LS7 components for smoking (ideal vs. poor, 2.07 ± 1.10 mg/dL vs. 2.87 ± 1.10 mg/dL, p=0.01) and fasting glucose (ideal vs. poor, 2.03 ± 1.07 mg/dL vs. 2.90 ± 1.09 mg/dL, p=0.004), but no other components, were associated with FGF-23 concentration. Conclusions: Optimal LS7 status was associated with lower 8-y mean plasma FGF-23 concentration. Efforts to target LS7 components, particularly smoking and glucose control, may improve FGF-23 concentration among Puerto Rican adults.

Abstract 381: Life’s Simple 7 Cardiovascular Health Metrics versus Fuster-BEWAT Score to Predict the New 4-tiered Left Ventricular Hypertrophy Classification: Insight From a Large Asian-population

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Haoyu Wang ◽  
Yingxian Sun ◽  
Zugui Zhang ◽  
Kefei Dou ◽  
Jiang He
Keyword(s):  
Cardiovascular Health ◽  
Low Cost ◽  
Asian Population ◽  
Left Ventricular ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
End Diastolic Volume ◽  
C Statistic ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Background: AHA's Life's Simple 7 cardiovascular health score is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. This study sought to compare the effectiveness of Life's Simple 7 and FBS in predicting the newly proposed 4-tiered LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV] 0.67 ) in the general Chinese population. Methods: Participants from Northeast China Rural Cardiovascular Health study who underwent cardiac echocardiography (n=11,261) were enrolled. Patients with LVH were divided into 4 groups—eccentric nondilated (normal M/EDV and EDV), eccentric dilated (increased EDV, normal M/EDV), concentric nondilated (increased M/EDV, normal EDV), and concentric dilated (increased M/EDV and EDV)—and compared with patients with normal LVM. Results: With poor Life's Simple 7 and FBS as references, individuals with ideal Life's Simple 7 and FBS showed lower adjusted odds of having eccentric nondilated (Life's Simple 7, odds ratio [OR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.34 vs. FBS, OR: 0.28; 95% CI: 0.20 to 0.38), eccentric dilated (OR: 0.73 [0.57-0.94] vs. OR: 0.57 [0.43-0.76]), concentric nondilated (OR: 0.12 [0.04-0.38] vs. OR: 0.19 [0.07-0.52]), and concentric dilated LVH (OR: 0.12 [0.03-0.37] vs. OR: 0.26 [0.10-0.72]). Similar levels of significantly discriminating accuracy were found for Life's Simple 7 and FBS with respect to the eccentric nondilated (C-statistic: 0.737; 95% CI: 0.725 to 0.750 vs. 0.731; 95% CI: 0.718 to 0.744, respectively), eccentric dilated (0.684 [0.670-0.699] vs. 0.686 [0.671-0.701]), concentric nondilated (0.658 [0.624-0.692] vs. 0.650 [0.615-0.684]), and concentric dilated LVH (0.711 [0.678-0.744] vs. 0.698 [0.663-0.733]). Conclusions: Our findings demonstrate that the FBS appears capable of performing just as well as does the Life's Simple 7 in predicting the novel 4-group classification of LVH, making the FBS particularly suited as a reliable low-cost indicator of CV health in settings where access to laboratory analysis is limited and health care resources are constrained.

Life's simple 7 cardiovascular health metrics versus Fuster-BEWAT score to predict the new 4-tiered left ventricular hypertrophy classification: insight from a large Asian population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.Y Wang ◽  
Y.X Sun ◽  
K.F Dou ◽  
J He
Keyword(s):  
Cardiovascular Health ◽  
Asian Population ◽  
Left Ventricular ◽  
Laboratory Analysis ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Funding Source ◽  
End Diastolic Volume ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Abstract Background AHA's Life's Simple 7 cardiovascular health score is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. This study sought to compare the effectiveness of Life's Simple 7 and FBS in predicting the newly proposed 4-tiered LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV]0.67) in the general Chinese population. Methods Participants from Northeast China Rural Cardiovascular Health study who underwent cardiac echocardiography (n=11,261) were enrolled. Patients with LVH were divided into 4 groups–eccentric nondilated (normal M/EDV and EDV), eccentric dilated (increased EDV, normal M/EDV), concentric nondilated (increased M/EDV, normal EDV), and concentric dilated (increased M/EDV and EDV)–and compared with patients with normal LVM. LVH was classified as increased LV mass when indexed to height2.7 using thresholds of≥48 g/m2.7 for men and ≥39 g/m2.7 for women. Previously defined thresholds for elevated EDV indexed to BSA (≥74 ml/m2 for men and ≥68 ml/m2 for women) and M/EDV0.67 (≥9.1 g/ml0.67 for men and ≥8.1 g/ml0.67 for women) were used. Results With poor Life's Simple 7 and FBS as references, individuals with ideal Life's Simple 7 and FBS showed lower adjusted odds of having eccentric nondilated (Life's Simple 7, odds ratio [OR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.34 vs. FBS, OR: 0.28; 95% CI: 0.20 to 0.38), eccentric dilated (OR: 0.73 [0.57–0.94] vs. OR: 0.57 [0.43–0.76]), concentric nondilated (OR: 0.12 [0.04–0.38] vs. OR: 0.19 [0.07–0.52]), and concentric dilated LVH (OR: 0.12 [0.03–0.37] vs. OR: 0.26 [0.10–0.72]). For the total ICHS and FBS on a continuous scale from 0 (all 7 poor) to 7 (all 7 ideal), risk reductions of the four distinct LVH patterns were of comparable magnitude for each 1-point increment of ICHS and FBS. Similar levels of significantly discriminating accuracy were found for Life's Simple 7 and FBS with respect to the eccentric nondilated (C-statistic: 0.737; 95% CI: 0.725 to 0.750 vs. 0.731; 95% CI: 0.718 to 0.744, respectively), eccentric dilated (0.684 [0.670–0.699] vs. 0.686 [0.671–0.701]), concentric nondilated (0.658 [0.624–0.692] vs. 0.650 [0.615–0.684]), and concentric dilated LVH (0.711 [0.678–0.744] vs. 0.698 [0.663–0.733]). Conclusions Our findings demonstrate that the FBS appears capable of performing just as well as does the Life's Simple 7 in predicting the novel 4-group classification of LVH, making the FBS particularly suited as a reliable low-cost indicator of CV health in settings where access to laboratory analysis is limited and health care resources are constrained. Therefore, it may be considered the first option in settings where access to laboratory analysis is limited. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Natural Science Foundation of China

Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

2019 ◽  
Vol 10 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Chi Sum Yuen ◽  
Kwok Fai Lucius Lee ◽  
Inderjeet Bhatia ◽  
Nicholson Yam ◽  
Barnabe Antonio Rocha ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Congenital Cardiac Surgery ◽  
Group 2 ◽  
Bioprosthetic Valves ◽  
Group 1

Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.

Abstract 9947: Predictors of Left Ventricular Dysfunction After Aortic Valve Replacement in Patients With Mixed Aortic Valve Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Egbe ◽  
Joeseph Poterucha ◽  
Carole Warnes
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular Dysfunction ◽  
Aortic Valve Disease ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Group 2 ◽  
Group 1

Objectives: Predictors of left ventricular dysfunction (LVD) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) have not been studied. Objective was to determine prevalence and predictors of early and late LVD at 1 and 5 years post-AVR. Methods: Retrospective review of 247 patients (Age 63±8 years, males 81%) with moderate/severe MAVD who underwent AVR at the Mayo Clinic from 1994-2013. Only patients with follow-up data at 1 year post AVR were included (n=239). Cohort divided into 3 groups based on data collected prior to AVR, 1 and 5 years post AVR. LVD was defined as ejection fraction <50%. Results: LVD was present in 11/239 at baseline. At 1-year post AVR, 181 had normal EF (group 1) while 58/239 (24%) had early LVD (group 2). Predictors of LVD were atrial fibrillation (hazard ratio [HR] 1.83 confidence interval [CI] 1.59-1.98, p=0.001), age >70 years (HR: 3.12, CI: 2.33-4.18, p= <0.0001), CABG (HR: 2.17, CI: 2.24-5.93, p= <0.0001), and severe MAVD pre-operatively (HR: 2.87, CI: 2.33-3.17, p= 0.01), and hypertension (HR: 1.83, CI: 1.35-2.46, p= <0.0001). Prevalence of late LVD was 24% (47/197-group 3) and LVMI at 1 year post AVR was predictive of late LVD (HR 1.65, CI 1.11-3.8 per 10 g/ m 2 increment, p= 0.04)). Group 2 had less reverse LV remodeling compared to group 1 at 1 year post AVR (142±39 vs 129±42 g/ m 2 , p=0.02). Conclusions: Risk of LVD was significant even in subset of patients with moderate MAVD. Risk stratification of MAVD should be based on both clinical and echocardiographic parameters. Our data suggest earlier surgical intervention may be required in the MAVD population to prevent postoperative LVD but further studies are needed. Figure legend: FU: follow up

P4531Early and late superresponse to cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V A Kuznetsov ◽  
T N Enina ◽  
A M Soldatova ◽  
T I Petelina ◽  
N E Shirokov ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Tnf Α ◽  
Echocardiographic Parameters ◽  
Group 2 ◽  
Group 1

Abstract Background Superresponders to cardiac resynchronization therapy (CRT) demonstrate significant reverse remodeling, improvement in cardiac function, decrease in inflammatory mediators and markers of cardiac fibrosis. It is not clear if superresponse (SR) can be early or late and if the time of SR to CRT is associated with different degree of biochemical improvement. Aim To assess structural and functional heart parameters, sympathetic activity, levels of biomarkers of myocardial fibrosis, inflammatory and neurohormonal mediators in patients with various time of SR to CRT. Methods The study enrolled 82 superresponders to CRT (decrease in left ventricular end-systolic volume (LVESV) >30%) (mean age 60.4±9.3 years; 80.5% men, 19.5% women; 54.9% with ischemic etiology of heart failure). Patients were divided into two groups: group 1 (n=19) – SR was achieved within 24 months (14.0 [8.0; 21.0] months); group 2 (n=63) - SR was achieved after 24 months (59 [43.0; 84.0] months). Echocardiographic parameters, plasma levels of epinephrine, norepinephrine, NT-proBNP, interleukin (IL) 1β, IL-6, IL-10, tumor necrosis factor alpha (TNF-α), metalloproteinase (MMP) 9, tissue inhibitors of metalloproteinase (TIMP) 1 and 4 were evaluated. Results At baseline there were no differences in demographic, clinical and echocardiographic characteristics between the groups. Levels of epinephrine (1.1 [0.1; 2.2] ng/ml vs 2.1 [0.7; 3.4] ng/ml; p=0.049) and IL-10 (1.8 [1.5; 3.5] pg/ml vs 3.9 [2.7; 5.1] pg/ml; p=0.019) were significantly higher in group 2. Both groups demonstrated significant improvement in echocardiographic parameters. On follow-up left ventricular (LV) end-systolic dimension (p=0.041), LV end-diastolic dimension (p=0.049), LVESV (p=0.014), LV end-diastolic volume (p=0.045) were lower in group 2. In group 1 IL-6 (p=0.047), TNF-α (p=0.047) decreased significantly and there was a tendency for IL-1β (p=0.064) and norepinephrine (p=0.069) levels to increase. In group 2 levels of IL-1β (p<0.001), IL-6 (p=0.030), IL-10 (p=0.003), TNF-α (p<0.001), TIMP-1 (p=0.010) and epinephrine (p=0.024) decreased significantly while MMP-9/TIMP-1 (p=0.023) increased as compared to baseline levels. Additionally there was a tendency for NT-proBNP level to decrease in group 2 (p=0.069). Follow-up level of norepinephrine (7.8 [2.9; 17.2] ng/ml vs 1.1 [0.2; 8.7] ng/ml; p=0.011 was lower and MMP-9/TIMP-4 level was higher (0.058 [0.044; 0.091] vs 0.092 [0.064; 0.111]; p=0.013) in group 2. Diverse trends were observed in IL-10 (0.4 [−0.6; 1.2] pg/ml in group 1 vs −2.3 [−3.4; −0.5] pg/ml in group 2; p=0.007) and norepinephrine (4.0 [−5.2; 14.3] ng/ml in the group 1 vs −1.2 [−11.6; 4.0] ng/ml in the group 2; p=0.015) between the groups. Conclusion CRT modulates sympathetic, neurohumoral, immune and fibrotic activity. Late SR to CRT is associated with decrease of sympathetic and inflammatory activity and more pronounced LV reverse remodeling.

scholarly journals Fibroblast growth factor-23 is associated with imaging markers of diabetic cardiomyopathy and anti-diabetic therapeutics

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Martin H. Sørensen ◽  
Annemie S. Bojer ◽  
Niklas R. Jørgensen ◽  
David A. Broadbent ◽  
Sven Plein ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Growth Factor ◽  
Fibroblast Growth Factor ◽  
Kidney Function ◽  
Fibroblast Growth Factor 23 ◽  
Left Ventricular ◽  
Fibroblast Growth ◽  
Cardiovascular Morbidity And Mortality ◽  
Fgf 23

Abstract Background The biomarker fibroblast growth factor-23 (FGF-23) has been associated with increased cardiovascular morbidity and mortality in both patients with and without type 2 diabetes. The aim of this study was to evaluate the relationship between FGF-23 and cardiac structure, function and perfusion in patients with type 2 diabetes and normal or mildly impaired kidney function. Furthermore, to investigate the association between FGF-23, anti-diabetes therapy and the classic complications and risk factors associated with type 2 diabetes. Methods In this cross-sectional study, 246 patients with type 2 diabetes underwent echocardiography and advanced cardiac magnetic resonance imaging to assess left ventricular (LV) structure and function. In addition, myocardial blood flow (MBF) during rest and pharmacological stress (adenosine 140 µg/kg/min) were evaluated in 183 of the patients. Patients with eGFR < 60 ml/min/1.73 m2 were excluded. Results Median (Q1–Q3) FGF-23 was 74 (58–91) ng/L. Patients with FGF-23 above the median had lower MBF during stress (2.3 ± 0.9 vs. 2.7 ± 0.9 ml/min/g, P = 0.001) and lower overall myocardial perfusion reserve (MPR) (2.7 ± 0.8 vs. 3.3 ± 1.1, P < 0.001). LV mass (143 ± 40 vs. 138 ± 36 g, P = 0.04) and E/e* (8.5 ± 3.2 vs. 7.6 ± 2.7, P = 0.04) were higher in patients with FGF-23 above the median. In a linear model adjusted for age, sex, eGFR and hypertension, increasing FGF-23 was associated with decreased MPR (P < 0.01, R2 = 0.11) and increased E/e* (P < 0.01, R2 = 0.07). FGF-23 was lower in patients receiving glucagon like peptide-1 (GLP-1) analogues (71 (57–86) vs. 80 (60–98) ng/L, P = 0.01) than in those who did not receive GLP-1 analogues. Conclusions In patients with type 2 diabetes and normal or mildly impaired kidney function, increased levels of FGF-23 are associated with impaired cardiac diastolic function and decreased MPR, caused by a decrease in maximal MBF during stress. Use of GLP-1 analogues is associated with decreased levels of FGF-23. Clinical trial registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT02684331. Date of registration: February 18, 2016

scholarly journals Fibroblast Growth factor 23 and α-Klotho protein are associated with adverse clinical outcomes in non dialysis chronic kidney disease stage 1-5 patients

2019 ◽  
Author(s):  
Eleni Manou ◽  
Elias Thodis ◽  
George Arsos ◽  
Ploumis Pasadakis ◽  
Stylianos Panagoutsos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Growth Factor ◽  
Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Serum Phosphate ◽  
Fibroblast Growth ◽  
Fgf 23 ◽  
Stage 1

Abstract Background: Fibroblast Growth Factor 23 (FGF-23) and α-Klotho contribute to the patho-genesis of chronic kidney disease - mineral and bone disorders (CKD-MBD). The aim of our study was to evaluate the association of FGF-23 and α-Klotho levels with CKD-MBD parameters, as well as with renal prognosis and mortality, in CKD patients stage 1-5, not in renal replacement therapy (RRT). Methods: 128 patients were included. At enrollment GFR was measured (mGFR) and plasma levels of carboxyl terminal FGF-23 (cFGF-23) and soluble α-Klotho (sKlotho) were determined by ELISA. Abdominal aorta calcification (AAC) score was assessed in lateral abdominal X ray. The composite end point (event) was initiation of RRT or death. Follow-up was five years (median 36, range 2-60 months). Results: mGFR significantly correlated with cFGF-23 and sKlotho negatively and posi-tievely respectively (p<0.0001 for both). Multiple regression analysis showed an inde-pendent correlation of cFGF-23 with mGFR, 25-OH vitamin D, presence of diabetes melli-tus and AAC score, of sKlotho with mGFR and phosphate and of AAC score with sKlotho and cFGF-23. Multivariate regression tree analysis, led to the formation of three regression groups (A, B, C) based on two “cut off” values: mGFR levels of 60.85 ml/min/1.73m2 and serum phosphate levels of 3.7 mg/dl. These groups significantly correlated with the five CKD stages and additionally cFGF-23 and sKlotho plasma levels (p<0.0001 for both). During follow-up, 40 out of the 128 patients, (31.2%) either initiated RRT or died (31 and 9 respectively). Kaplan Meier survival analysis showed that groups of patients with cFGF-23 levels less than median and those with sKlotho more than median value showing a more favorable course, regarding outcome (p=0.0003 for cFGF-23, p=0.004 for s-Klotho). In Cox regression analysis the association of cFGF-23 (p=0.04), sKlotho (p=0.008) and AAC score (p=0.01) with the presence of “event” remained significant after adjustment for traditional and CKD- related covariates. Conclusions: In CKD patients stage 1-5, cFGF-23 and sKlotho levels are associated with adverse clinical outcomes. mGFR and serum phosphate, in association with sKlotho lev-els, may provide a “new classification” of CKD patients, which appears to be predictive of outcome.

Abstract 2198: Rhythmic Risk in Idiopathic Dilated Cardiomyopathy Depending on the Evolution of Left Ventricular Ejection Fraction in Patients with Implantable Cardioverter Defibrillators

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Claude Kouakam ◽  
Guillaume Theodore ◽  
Christelle Marquie ◽  
Didier Klug ◽  
Laurence Guedon-Moreau ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Drug Therapy ◽  
Early Period ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Late Period ◽  
Reverse Remodelling ◽  
Group 2 ◽  
Group 1

Background : Patients with idiopathic dilated cardiomyopathy (DCM) receiving an ICD often improve their left ventricular dysfunction in the year following implantation due to reverse remodelling and/or optimization of concomitant drug therapy. We examined whether this improvement impacts the benefit of ICD in terms of appropriate therapy. Methods : The study comprised 93 consecutive DCM patients with LVEF <35% and an indication for ICD (primary prevention = 37, secondary prevention = 56). Follow-up duration was 12 to 42 (median 25) months. LVEF was reassessed 5 to 13 (median 7) months after implantation and compared with baseline value at implantation. Concomitant drug therapy with ACE inhibitors and beta blockers was optimized during the same period, according to recent guidelines. All arrhythmic events were assessed by ICD memory interrogation during follow-up. Major (MaAE) and minor (MiAE) arrhythmic events were defined as appropriate shock or ATP for sustained ventricular tachyarrhythmias >200 bpm or <200 bpm respectively. Early events (before LVEF evaluation) were separated from late events (after LVEF evaluation). Results : Overall the mean LVEF increased by 7.2 % from 24.6±7% at baseline to 31.8±12% at revaluation. Two patterns were observed: 23 patients had a >14% LVEF increase (group 1) whereas 70 others had an increase <14% in LVEF (group 2). In group 1, 3 MaAE and 1 MiAE occurred in the early period but no event in the late period. In contrast, MaAE were observed in 15 and MiAE in 31 patients from group 2 during the late period. On multivariate analysis, changes in LVEF was an independent predictor of MaAE (OR=0.85; 95% CI 0.77 to 0.95; p=0.005) and MiAE (OR=0.91; 95% CI 0.84 to 0.99; p=0.02) during the late period. On multivariate analysis LVEF improvement was negatively correlated to diuretic use and QRS duration at baseline and to the absence of moderate or severe mitral regurgitation. Conclusions : In DCM, rhythmic risk is dynamic and inversely related to the improvement in LVEF. Reverse remodelling under optimal therapy is associated with a late favourable outcome, but 17% of these patients however benefit from ICD therapy in the early period.

Abstract P001: Life′s Simple 7 in Middle-age and Prognosis After Myocardial Infarction in Later Life

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Yejin Mok ◽  
Yingying Sang ◽  
Shoshana H Ballew ◽  
Casey M Rebholz ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Middle Age ◽  
Later Life ◽  
Adverse Outcomes ◽  
Dietary Quality ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Background: The AHA recommends focusing on seven traditional risk factors (Life’s Simple 7) for cardiovascular health promotion, primarily based on their impact on the risk of incident cardiovascular disease. However, the contribution of Life’s simple 7 in mid-life to prognosis after myocardial infarction (MI) in later life is unknown. Methods: In 13,500 participants from the Atherosclerosis Risk in Communities (ARIC) study (age 45-64 years) at Visit 1 (1987-1989), a 14-point score of Life’s simple 7 was constructed according to the status of each of seven factors (smoking, body mass index, physical activity, dietary quality, total cholesterol, blood pressure, and fasting glucose). We quantified the association between this score and adverse outcomes after validated incident hospitalized MI occurring during ARIC follow-up, using Cox proportional hazards models adjusting for age at MI, gender, race, and year of MI occurrence. Results: 1,341 participants had a definite or probable hospitalized MI after the ARIC baseline visit (median elapsed time between baseline and MI occurrence, 24.4 years [IQR 17.5-25.4]). Of these, 807 (60%) had cardiovascular outcomes of interest after MI during a median follow-up of 3.0 years. Higher Life’s Simple 7 score (better cardiovascular health) in middle-age was associated with lower risk of adverse outcomes after MI in later life (Table). For example, individuals with Life’s Simple 7 score ≥10 had 50-80% lower risk of cardiovascular mortality, recurrent MI, and heart failure compared to those with score ≤3. The associations were largely consistent across years of MI occurrence and when we restricted the follow-up after MI to 1-3 years. Conclusion: A better AHA Life’s Simple 7 in middle-age was associated not only with lower incidence but also with a lower risk of adverse outcomes after MI in later life. Our findings suggest a secondary prevention benefit of striving for ideal CV health status in mid-life, further supporting AHA promotion of Life’s Simple 7.

Abstract 14245: Fibroblast Growth Factor 23 and Long-term Cardiac Function: The Multi- Ethnic Study of Atherosclerosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ravi B Patel ◽  
Hongyan Ning ◽  
Ian H de Boer ◽  
Bryan Kestenbaum ◽  
Joao Ac Lima ◽  
...  
Keyword(s):  
Growth Factor ◽  
Fibroblast Growth Factor ◽  
Circumferential Strain ◽  
Fibroblast Growth Factor 23 ◽  
Later Life ◽  
Left Ventricular ◽  
Fibroblast Growth ◽  
Global Circumferential Strain ◽  
Ethnic Study

Background: While fibroblast growth factor 23 (FGF23) is associated with incident heart failure (HF) and atrial fibrillation (AF), the mechanisms driving these associations are unclear. FGF23 elevation leads to cardiomyocyte calcium handling abnormalities, suggesting that FGF23 may directly reduce myocardial function. Methods: In the Multi-Ethnic Study of Atherosclerosis, a cohort free of cardiovascular disease at recruitment, we evaluated the associations of serum FGF23 (2000-2002) with measures of left ventricular (LV) and left atrial (LA) mechanical function on cardiac magnetic resonance (CMR) at 10-year follow up (2010-2012). Results: Of 2,276 participants with baseline FGF23 and CMR at 10-year follow up, participants with higher FGF23 levels were more likely white race, taking anti-hypertensive medications, and had lower baseline glomerular filtration rate (GFR). After covariate adjustment, baseline FGF23 levels were independently associated with worse LV global circumferential strain, worse LV mid-wall circumferential strain, and lower LA total emptying fraction in later life ( Table ). The association of FGF23 and LV global circumferential strain was consistent across the spectrum of GFR ( Figure ). While higher FGF23 was associated with higher LV mass (β coefficient per SD higher: 1.14, 95% CI: 0.16, 2.12, P= 0.02), it was not associated with the presence of macroscopic myocardial scar (OR per SD higher: 1.12, 95% CI: 0.86-1.45, P= 0.42). Conclusions: Baseline FGF23 is independently associated with lower LV and LA systolic function in later life. These findings provide mechanistic insight driving the associations of FGF23 with development of both HF and AF.

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