Abstract 250: Role of First Degree Atrioventricular Block and Long Term Mortality in U.S. Veterans With Atherothrombotic Risk Factors

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Amish Patel ◽  
Jonathan Pollock ◽  
Edward Sam Roberto ◽  
Thein Tun Aung ◽  
Ronald Markert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Common Finding ◽  
Av Block ◽  
Pr Interval ◽  
History Of ◽  
Long Term Mortality

Background: First-degree atrioventricular (AV) block [PR interval exceeding 200 milliseconds (ms)] on a 12-lead electrocardiogram is a common finding. Previous studies suggested that first-degree AVB has a benign prognosis, but more recent reports suggest that first-degree AVB may be associated with adverse outcomes. We investigated the relationship between PR interval and long term morality in U.S. Veterans with atherothrombotic risk factors. Methods: We retrospectively collected and analyzed data from a Veterans Affairs (VA) medical center for consecutive patients (October 2001 to January 2005) who presented for coronary angiography. Results: Of 1193 charts, 1082 had a PR interval reading recorded (mean = 172.5±30.5 ms; median = 168 ms [range 59-334]). Mean follow-up period was 103±52 months. Mean age was 63.2±10.8 years with 98% male. Mean body mass index was 30.0±5.9. The prevalence of selected comorbidities was: hypertension (88%), hyperlipidemia (79%), obstructive coronary artery disease (73%), diabetes mellitus (45%), smoker (39%), history of peripheral vascular disease (17%), and history of cerebrovascular accident (8%). Mean left ventricular ejection fraction was 47%±13%. Eighty-two percent were on beta-blockers (BB), and 25% were on calcium channel blockers (CCB) while intraventricular conduction delay was seen in 6%. In a comparison of patients with PR interval ≤200 ms (n=936) vs. >200 ms (n=146), long term mortality was higher with PR interval >200 ms (58.2% vs. 44.4%, p=0.002). Mortality rate was also higher with patients on BB or CCB vs. not on either (49.8% vs 39.7%, p=0.024). While PR interval was a significant univariate predictor of mortality, it was not significant when adjusted for the covariates listed above [not including BB and CCB] (odds ratio = 1.08 [95% Cl = 0.70 to 1.66], p = 0.73). Conclusion: In this study of US Veterans with atherothrombotic risk factors, the long term mortality rate was higher with first-degree AV block. PR interval has prognostic value within this specific cohort.

Intradialytic Hypotension as an Independent Risk Factor for Long-Term Mortality in Maintaining Hemodialysis Patients: A 5-Year Follow-Up Cohort Study

2018 ◽  
Vol 45 (4) ◽  
pp. 320-326 ◽  
Author(s):  
Jinbo Yu ◽  
Zhonghua Liu ◽  
Bo Shen ◽  
Jie Teng ◽  
Jianzhou Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Mortality Rate ◽  
Independent Risk Factor ◽  
Left Ventricular ◽  
Intradialytic Hypotension ◽  
Ultrafiltration Rate ◽  
Long Term Mortality

Aims: This study aimed to assess risk factors of intradialytic hypotension (IDH) and the association of prognosis and IDH among maintenance hemodialysis (MHD) patients. Methods: Among 293 patients, 117 were identified with IDH (more than 4 hypotensive events during 3 months). The association between IDH and survival was evaluated. Results: The incidence of IDH was 39.9%. Age, ultrafiltration rate, N-terminal pro-B-type natriuretic peptide (NT-proBNP), albumin, β2-microglobulin (β2MG), and aortic root inside diameter (AoRD) were independently associated with IDH. During the 5-year follow-up, 84 patients died with a mortality rate 5.2 per 100 person-year. IDH-prone patients had a higher all-cause mortality rate. IDH and left ventricular mass index were independent risk factors for death (HR 1.655, 95% CI 1.061–2.580; HR 1.008, 95% CI 1.001–1.016). Conclusion: IDH is an independent risk factor for long-term mortality in MHD patients. Patients with older age, high ultrafiltration rate, high level of serum NT-proBNP and β2MG, hypoalbuminemia, and shorter AoRD are at high risk of IDH.

Abstract 114: Relationship Between Duration of QRS Complex and Long Term Mortality in U.S. Veterans With Atherothrombotic Risk Factors

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Amish Patel ◽  
Jonathan Pollock ◽  
Edward Sam Roberto ◽  
Thein Tun Aung ◽  
Ronald Markert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Qrs Duration ◽  
Long Term Mortality

Background: The 12-lead electrocardiogram (ECG) remains a cost-effective diagnostic tool in risk stratification for cardiovascular disease. Little is known of the prognostic value of QRS duration but recent reports suggest that a prolonged QRS duration may be associated with adverse outcomes. We investigated the relationship between QRS duration and long term mortality in Veterans with atherothrombotic risk factors. Methods: We retrospectively collected data from a Veterans Affairs (VA) medical center for consecutive patients (October 2001 to January 2005) to determine the long term mortality rates associated with different intervals of QRS duration in patients who presented for coronary angiography. Results: Of the 1193 charts reviewed, 1186 had a QRS duration reading recorded. For these 1186 patients the mean follow-up period was 103±52 months. Mean age was 63.2±10.8 years with 98% male. Mean body mass index was 30.0±5.9. The prevalence of comorbidities was: hypertension (88%), hyperlipidemia (79%), obstructive coronary artery disease (73%), left ventricular hypertrophy (50.4%), diabetes mellitus (45%), peripheral vascular disease (17%), and cerebrovascular accident (8%). Mean left ventricular ejection fraction (LVEF) was 47±13%, and mean PR interval was 172.5±30.5 milliseconds (ms). Most patients were on beta-blocker (82%). Among patients with bundle branch blocks (BBB), left BBB was present in 4.6% and right BBB was present in 6.9%. Mean QRS duration was 102.2±23.6 ms. As the QRS duration increased by intervals of 10-milliseconds, the mortality rate (%) increased [QRS ≤100 (40.7%), 101 to 110 (51.3%), 111 to 120 (66.3%), >120 (71.2%), p<0.001]. Among patients with QRS duration >120, mortality was higher in those >150 vs. 121 to 150 (79.7% vs 65.7, p=0.045). While QRS duration was a significant univariate predictor of morality, QRS duration is not significant when adjusted for 10 covariates listed above (odds ratio = 1.00 [95% Cl = 0.98 to 1.01], p = 0.72). Conclusion: Long term mortality was higher as QRS duration increased. QRS duration had utility in predicting mortality within this cohort of US Veterans with atherothrombotic risk factors.

scholarly journals Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

2021 ◽  
Author(s):  
Ibrahim El‐Battrawy ◽  
Victoria L. Cammann ◽  
Ken Kato ◽  
Konrad A. Szawan ◽  
Davide Di Vece ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
The United States ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Takotsubo Syndrome ◽  
Clinical Correlates ◽  
History Of ◽  
Long Term Mortality

Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher ( P <0.001), and there were fewer women ( P =0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower ( P =0.001), and cardiogenic shock was more often observed ( P <0.001) in the AF group. Both in‐hospital ( P <0.001) and long‐term mortality ( P <0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P <0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01947621.

Sex differences in pharmacotherapy and long-term outcomes in patients with ischaemic heart disease and left ventricular dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Dagan ◽  
D Dinh ◽  
J Stehli ◽  
C Tan ◽  
A Brennan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Medical Therapy ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Kaplan Meier ◽  
Long Term Mortality

Abstract Background Left ventricular dysfunction and ischaemic heart disease are common amongst women, however, women tend to present later and are less likely to receive guideline-directed medical therapy compared to their male counterparts. Purpose To investigate if a sex discrepancy exists for optimal medical therapy (OMT) and long-term mortality in a cohort of patients with known ischaemic heart disease (IHD) and left ventricular dysfunction. Methods We analysed prospectively collected data from a multicentre registry database collected between 2005–2018 on pharmacotherapy 30-days post percutaneous coronary intervention (PCI) in 13,015 patients with left ventricular ejection fraction (LVEF) &lt;50%. OMT at 30-days was defined as beta-blocker (BB), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) ± mineralocorticoid receptor antagonist (MRA). Long-term mortality was determined by linkage with the National Death Index, with median follow up of 4.7 (IQR 2.0–8.6) years. Results Mean age was 65±12 years; women represented 20.2% (2,634) of the cohort. Women were on average 5 years older, had higher average BMI, higher rates of hypertension, diabetes, renal dysfunction, prior stroke and rheumatoid arthritis. Men were more likely to have sleep apnoea, be current/ex-smokers and to have had prior myocardial infarction, PCI and bypass surgery. Overall, 72.3% (9,411) of patients were on OMT, which was similar between sexes (72.7% in women vs. 72.2% in men, p=0.58). Rates of BB therapy were similar between sexes (85.2% vs. 84.5%, p=0.38), while women were less likely to be on an ACEi/ARB (80.4% vs. 82.4%, p=0.02) and more likely to be on a MRA (12.1% vs. 10.0%, p=0.003). Amongst those with LVEF ≤35% (n=1,652), BB (88.7% vs. 87.3%, p=0.46), ACEi/ARB (83.3% vs. 82.1%, p=0.59) and MRA use (32.5% vs. 33.3%, p=0.78) was comparable. Aspirin use was similar between sexes (95.3% vs. 95.9%, p=0.12), while women were less likely to be on statin therapy (93.5% vs. 95.3%, p&lt;0.001) and a second antiplatelet agent (94.4% vs. 95.6%, p=0.007). On unadjusted analysis women had significantly higher long-term mortality of 25.4% compared to 19.0% for men (p&lt;0.001). Kaplan-Meier analysis out to 14 years demonstrated that men on OMT have the best long-term survival overall and women on sub-OMT have significantly poorer outcomes compared to men on sub-OMT. However, after adjusting for OMT and other comorbidities there was no difference in long-term mortality between sexes (HR 0.99, 95% CI 0.87–1.14, p=0.94). Conclusion From this large multicentre registry, we found similar rates of guideline-directed pharmacotherapy for left ventricular dysfunction between sexes, however women were less likely to be on appropriate IHD secondary prevention. The increased unadjusted long-term mortality amongst women is likely due to differing baseline risk, given that adjusted mortality was similar between sexes. Kaplan-Meier Survival Analysis Funding Acknowledgement Type of funding source: None

scholarly journals Impact of diabetes mellitus on mortality in patients with acute heart failure: a prospective cohort study

2020 ◽  
Author(s):  
Min Gyu Kong ◽  
Se Yong Jang ◽  
Jieun Jang ◽  
Hyun-Jai Cho ◽  
Sangjun Lee ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Glycemic Control ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inadequate Glycemic Control ◽  
Long Term Mortality

Abstract Background Although more than one third of the patients with acute heart failure (AHF) have diabetes mellitus (DM), it is unclear whether DM exerts adverse impact on clinical outcomes. This study aimed to compare the outcomes in patients hospitalized for AHF in accordance with DM and left ventricular ejection fraction (LVEF). Methods The Korean Acute Heart Failure registry prospectively enrolled and completed follow-up of 5,625 patients from March 2011 to February 2019. Primary endpoints were in-hospital and overall all-cause mortality. We evaluated the impact of DM on these mortalities according to HF subtypes and glycemic control. Results DM was significantly associated with increased long-term mortality (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.02-1.22) even after adjusting for potential confounders. In subgroup analysis according to LVEF, DM was associated with higher long-term mortality in only HF with reduced ejection fraction (HFrEF) (adjusted HR, 1.14; 95% CI, 1.02-1.27). Inadequate glycemic control defined by HbA1c ≥ 7.0% within 1 year after discharge was significantly associated with higher long-term mortality compared to adequate glycemic control (HbA1c <7.0%) (44.0% vs. 36.8%; Log-rank p =0.016). Conclusions This large registry data showed that DM and inadequate glycemic control were significantly associated with increased long-term mortality in AHF, especially HFrEF. Tight glucose control is required to mitigate long-term mortality.

Predictors of mortality and heart transplantation in patients with Chagas’ cardiomyopathy and ventricular tachycardia treated with implantable cardioverter-defibrillators

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1070-1078 ◽  
Author(s):  
Wagner L Gali ◽  
Alvaro V Sarabanda ◽  
José M Baggio ◽  
Eduardo F Silva ◽  
Gustavo G Gomes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Secondary Prevention ◽  
Heart Transplantation ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

Aims Data on long-term follow-up of patients with Chagas’ heart disease (ChHD) receiving a secondary prevention implantable cardioverter-defibrillator (ICD) are limited and its benefit is controversial. The aim of this study was to evaluate the long-term outcomes of ChHD patients who received a secondary prevention ICD. Methods and results We assessed the outcomes of consecutive ChHD patients referred to our Institution from 2006 to 2014 for a secondary prevention ICD [89 patients; 58 men; mean age 56 ± 11 years; left ventricular ejection fraction (LVEF), 42 ± 12%]. The primary outcome included a composite of death from any cause or heart transplantation. After a mean follow-up of 59 ± 27 months, the primary outcome occurred in 23 patients (5.3% per year). Multivariate analysis showed that LVEF < 35% [hazard ratio (HR) 4.64; P < 0.01] and age ≥ 65 years (HR 3.19; P < 0.01) were independent predictors of the primary outcome. Using these two risk factors, a risk score was developed, and lower- (no risk factors), intermediate- (one risk factor), and higher-risk (two risk factors) groups were recognized with an annual rate of primary outcome of 1.4%, 7.4%, and 20.4%, respectively. A high burden of appropriate ICD therapies (16% per year) and electrical storms were documented, however, ICD interventions did not impact on the primary outcome. Conclusion Among ChHD patients receiving a secondary prevention ICD, older age (≥65 years) and left ventricular dysfunction (LVEF < 35%) portend a poor outcome and were associated with increased risk of death or heart transplantation. Most patients received appropriate ICD therapies, however, ICD interventions did not impact on the primary outcome.

Asymptomatic cardiotoxicity in long-term breast cancer survivors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24084-e24084
Author(s):  
Mohammed Alaeddine Saidi ◽  
Soumeyya Ghomari
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Survivors ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Breast Cancer Survivors ◽  
Left Ventricular ◽  
Left Ventricular Ejection

e24084 Background: Multimodal approach in the adjuvant treatment of early breast cancer has led to a significant number of survivors. However, the combination of these treatments may increase the risk of long-term cardiotoxicity, particularly in the presence of cardiovascular risk factors (CVRF). Methods: We examined cardiac function in patients who had previously been treated for early breast cancer. Echocardiograms were performed at least 2 years after therapy. We measured left ventricular ejection fraction (LVEF) and reported pre-treatment LVEF and all CVRF. The initial Framingham Risk Score (FRS) has been calculated. Asymptomatic cardiotoxicity was defined by decrease of 5% or more in the LVEF value without clinical symptoms of CHF. Doxorubicin, Trastuzumab, Radiotherapy, older age, and CVRF (hypertension (HTN), diabetes, dyslipidemia, obesity, Waist circumference) were evaluated as potential risk factors for the development of cardiotoxicity. All statistical analysis was performed using SPSS version 25.0. Results: A total of 143 breast cancer survivors with a median age of 46 ± 10 years (range: 26-72) underwent Echocardiogram imaging after a median follow-up of 9,22 years (range: 2 - 22). 48 women were postmenopausal at diagnostic. 32,2% were obese. HTN was present in 15%, diabetes in 12%, and dyslipidemia in 12% of patients. ARA-II was the most used treatment of HTN (55%). 11,9% of patients were under statin therapy. FRS was low in 69%, moderate in 22% and high in 9% of patients. 4 patients had received endocrine therapy alone, none of whom developed cardiotoxicity. There was only one case of symptomatic cardiotoxicity. In the remaining 138 women who received multimodal treatment (Anthracyclines:100%, Docetaxel:62,9%, Endocrine therapy:72%, Trastuzumab:7%, Radiotherapy:83,2%), a statistical but non-clinically significant decrease was observed in LVEF (67.7 ± 3.6 to 65.4 ± 5.1, p < 0.001). 39 women (28,3%) developed asymptomatic cardiotoxicity. In multivariate analysis, factors that contributed to decreased LVEF were HTN (p = 0,006), diabetes (p = 0,008) and dyslipidemia (p = 0,03). Conclusions: The use of adjuvant therapy in breast cancer may increase long term cardiotoxicity particularly in survivors with CVRF. Long-term cardiac follow-up is essential in order to initiate cardioprotective therapy at the right time.

INFLUENCE OF RISK FACTORS FOR CARDIOVASCULAR DISEASES, HISTORY OF CARDIOVASCULAR DISEASES, AND STRUCTURAL AND FUNCTIONAL STATE OF THE HEART ON 3-YEAR SURVIVAL IN PERSONS 95 YEARS AND OLDER

2021 ◽  
pp. 727-733
Author(s):  
К.А. Ерусланова ◽  
А.В. Лузина ◽  
Ю.С. Онучина ◽  
В.С. Остапенко ◽  
Н.В. Шарашкина ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
History Of ◽  
The Right

В последние годы появляется все больше работ, посвященных снижению воздействия классических факторов риска, негативно сказывающихся на выживаемости с возрастом. Целью исследования была оценка влияния сердечно-сосудистых заболеваний, их факторов риска и структурно-функциональных характеристик сердца на трехлетнюю выживаемость лиц 95 лет и старше. В исследовании участвовали 69 пациентов 95 лет и старше (98±1,9 года), из них 61 (88,4 %) женщина и 8 (11,6 %) мужчин. Через 3 года были получены данные о статусе жизни участников: 25 (36,2 %) были живы и 44 (63,8 %) умерли. По результатам проведенного однофакторного регрессионного анализа было определено, что факторы риска и анамнез сердечно-сосудистых заболеваний не ассоциированы с трехлетней выживаемостью. Однако в трехлетнем периоде риск смерти увеличивался в 3 раза при снижении ДАД <75 мм рт. ст., в 7,8 раза - при снижении ФВ ЛЖ <62 % и в 4,9 раза - при увеличении конечного диастолического размера правого желудочка >2,9 см. In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4 %) were women. After 36 months, data were obtained on the participants’ status of life: 25 (36,2 %) were alive, and 44 (63,8 %) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62 %, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.

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