Association Between Depression and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy

Background Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of sudden death in young people and is associated with an elevated risk of mood disorders. Depression has emerged as a critical risk factor for development and progression of coronary artery disease; however, the association between depression and HCM outcomes is less clear. We sought to examine the impact of depression on clinical outcomes in patients with HCM. Methods and Results Between January 2014 and December 2017, 820 patients with HCM were recruited and followed for an average of 4.2 years. End points were defined as sudden cardiac death (SCD) events and HCM‐related heart failure events. A Chinese version of the Structured Clinical Interview followed the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and was used to diagnose depression. During the follow‐up period, SCD events occurred in 75 individuals (21.8 per 1000 person‐years), and HCM‐related heart failure events developed in 149 individuals (43.3 per 1000 person‐years). Kaplan–Meier cumulative incidence curves showed a significant association of depression disorders with SCD events (log‐rank P =0.001) and HCM‐related heart failure events (log‐rank P =0.005). A multivariate Cox regression analysis indicated that depression was an independent predictor of SCD events and HCM‐related heart failure events (41.9 versus 21.7 per 1000 person‐years; adjusted hazard ratio [HR], 1.9; 95% CI, 1.6–2.3; P <0.001; and 69.9 versus 38.6 per 1000 person‐years; HR, 1.8; 95% CI, 1.6–2.1; P <0.001, respectively). Conclusions Depression is common among patients with HCM. The diagnosis of depression is significantly and independently associated with an increased risk of SCD events and heart failure events in patients with HCM.

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Comparison of incidence rates and risk factors of heart failure between two male cohorts born 30 years apart

Heart ◽

10.1136/heartjnl-2019-316059 ◽

2020 ◽

Vol 106 (21) ◽

pp. 1672-1678

Author(s):

Constantinos Ergatoudes ◽

Per-Olof Hansson ◽

Kurt Svärdsudd ◽

Annika Rosengren ◽

Erik Östgärd Thunström ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Physical Inactivity ◽

Cox Regression ◽

Incidence Rates ◽

Cox Regression Analysis ◽

Increased Risk ◽

The Impact

ObjectiveTo compare two cohorts of middle-aged men from the general population born 30 years apart for incidence and predictors of heart failure (HF).MethodsTwo population samples of men, born in 1913 (n=855) and in 1943 (n=797), were examined at 50 years of age and followed up for 21 years (1963–1994 and 1993–2014). Cox regression analysis was used to examine the impact of different factors on the risk of developing HF.ResultsEighty men born in 1913 (9.4%) and 42 men born in 1943 (5.3%) developed HF during follow-up; adjusted HRs comparing the two cohorts (born 1943 vs 1913) were: 0.46 (95% CI 0.28 to 0.74, p=0.002). In both cohorts, higher body mass index, higher diastolic blood pressure, treatment for hypertension, onset of either atrial fibrillation (AF), ischaemic heart disease and diabetes mellitus were associated with higher risk of HF. Higher heart rate was associated with an increased risk only in men born in 1913, whereas higher systolic blood pressure (SBP), smoking, higher glucose, higher cholesterol and physical inactivity were associated with an increased risk in men born in 1943. AF contributed higher risk of incident HF, whereas SBP and physical inactivity contributed lower risk in men born in 1943 compared with men born in 1913.ConclusionsMen born in 1943 had half the risk of HF after their 50s than those born 30 years earlier. AF, obesity, ischaemic heart disease, diabetes and hypertension remain important precursors of HF.

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Higher BNP/NT-proBNP levels stratify prognosis in patients with coronary artery disease but without heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1335 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Hendricks ◽

I Dykun ◽

B Balcer ◽

F Al-Rashid ◽

P Luedike ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Natriuretic Peptides ◽

Cox Regression ◽

Cox Regression Analysis ◽

Increased Risk ◽

Artery Disease

Abstract Background Natriuretic peptides (BNP/NT-proBNP) are routinely used for the diagnosis of heart failure and predicts outcome in patients with both heart failure with preserved and reduced ejection fraction. In addition, natriuretic peptides are associated with incident cardiovascular disease manifestation in primary prevention cohorts. Whether the assessment of BNP/NT-proBNP is of value in patients with coronary artery disease but without heart failure has not been investigated in detail. We here evaluate the association of BNP/NT-pro BNP with mortality patients with coronary artery disease but without known chronic heart failure. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine between 2004 and 2019. For this analysis, we excluded all patients with a diagnosis of heart failure or with elevated BNP/NT-proBNP values at baseline (>100pg/nl for BNP, >400pg/nl for NTproBNP). Moreover, patients with missing follow-up information or without BNP/NT-proBNP levels at admission were excluded. As either BNP or NT-proBNP was available for singular patients, we standardized BNP and NT pro BNP levels based on percentile rank in levels from 0 to 99. Cox regression analysis was used to determine the association of BNP/NT-proBNP with morality in unadjusted and risk factor adjusted models with effect sizes depicted per one standard deviation change in BNP/NT-proBNP rank. Results Overall, 3738 patients (mean age: 62.8±12.6 years, 71% male) were included in our analysis. During a mean follow-up of 2.6±3.5 years, 172 deaths of any cause occurred. Patients without fatal events had significantly lower BNP/NT-prBNP values compared to patients who died (48.4±28.8 vs. 58.4±27.5, p<0.0001). In unadjusted cox regression analysis, BNP/NT-proBNP increase by one standard deviation was associated with a 47% increased risk of morality (HR (95% CI): 1.47 (1.25–1.72), p<0.0001). Upon adjustment for cardiovascular risk factors, the significant link between BNP/NT-proBNP levels and morality remained (HR (95% CI): 1.38 (1.14–1.66). Effect sizes were similar for patients receiving coronary revascularization therapy as part of the coronary angiography (1.32 [1.03–1.70], p=0.03) as well as for patients with purely diagnostic procedures (1.58 [1.28–1.94], p<0.0001). Conclusion In patients without heart failure undergoing coronary angiography, BNP/NT-proBNP levels stratify mortality risk independently of traditional cardiovascular risk factors. Our results support the routine assessment of natriuretic peptides also in patients without heart failure to identify patients at increased risk. Funding Acknowledgement Type of funding source: None

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P-Cresyl Sulfate Is a Valuable Predictor of Clinical Outcomes in Pre-ESRD Patients

BioMed Research International ◽

10.1155/2014/526932 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Cheng-Jui Lin ◽

Chi-Feng Pan ◽

Chih-Kuang Chuang ◽

Fang-Ju Sun ◽

Duen-Jen Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Cardiovascular Event ◽

Cox Regression ◽

Medical Center ◽

Serum Biochemistry ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Valuable Marker ◽

Valuable Predictor

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.

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Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/1526602821996725 ◽

2021 ◽

pp. 152660282199672

Author(s):

Giovanni Tinelli ◽

Marie Bonnet ◽

Adrien Hertault ◽

Simona Sica ◽

Gian Luca Di Tanna ◽

...

Keyword(s):

Operating Room ◽

Clinical Outcomes ◽

Cox Regression ◽

Statistical Significance ◽

Aortic Aneurysms ◽

Study Patient ◽

Cox Regression Analysis ◽

Significant Difference ◽

The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

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Impact of Inadequate Calorie Intake on Mortality and Hospitalization in Stable Patients with Chronic Heart Failure

Nutrients ◽

10.3390/nu13030874 ◽

2021 ◽

Vol 13 (3) ◽

pp. 874

Author(s):

Yoshikuni Obata ◽

Naoya Kakutani ◽

Shintaro Kinugawa ◽

Arata Fukushima ◽

Takashi Yokota ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Energy Requirement ◽

Multivariate Logistic Regression Analysis ◽

Calorie Intake ◽

Energy Deficiency ◽

Intrinsic Nature ◽

Clinical Events ◽

Kaplan Meier ◽

Increased Risk

Malnutrition is highly prevalent in patients with heart failure (HF), but the precise impact of dietary energy deficiency on HF patients’ clinical outcomes is not known. We investigated the associations between inadequate calorie intake and adverse clinical events in 145 stable outpatients with chronic HF who had a history of hospitalization due to worsening HF. To assess the patients’ dietary pattern, we used a brief self-administered diet-history questionnaire (BDHQ). Inadequate calorie intake was defined as <60% of the estimated energy requirement. In the total chronic HF cohort, the median calorie intake was 1628 kcal/day. Forty-four patients (30%) were identified as having an inadequate calorie intake. A Kaplan–Meier analysis revealed that the patients with inadequate calorie intake had significantly worse clinical outcomes including all-cause death and HF-related hospitalization during the 1-year follow-up period versus those with adequate calorie intake (20% vs. 5%, p < 0.01). A multivariate logistic regression analysis showed that inadequate calorie intake was an independent predictor of adverse clinical events after adjustment for various factors that may influence patients’ calorie intake. Among patients with chronic HF, inadequate calorie intake was associated with an increased risk of all-cause mortality and rehospitalization due to worsening HF. However, our results are preliminary and larger studies with direct measurements of dietary calorie intake and total energy expenditure are needed to clarify the intrinsic nature of this relationship.

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Fast-Track Programs in Total Hip and Knee Replacement at Swedish Hospitals—Influence on 2-Year Risk of Revision and Mortality

Journal of Clinical Medicine ◽

10.3390/jcm10081680 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1680

Author(s):

Urban Berg ◽

Annette W-Dahl ◽

Anna Nilsdotter ◽

Emma Nauclér ◽

Martin Sundberg ◽

...

Keyword(s):

Fast Track ◽

Cox Regression ◽

Cox Regression Analysis ◽

Total Hip ◽

Total Knee Replacements ◽

Risk Of Death ◽

Kaplan Meier ◽

Increased Risk ◽

Hip And Knee Arthroplasty ◽

Total Knee

Purpose: We aimed to study the influence of fast-track care programs in total hip and total knee replacements (THR and TKR) at Swedish hospitals on the risk of revision and mortality within 2 years after the operation. Methods: Data were collected from the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR), including 67,913 THR and 59,268 TKR operations from 2011 to 2015 on patients with osteoarthritis. Operations from 2011 to 2015 Revision and mortality in the fast-track group were compared with non-fast-track using Kaplan–Meier survival analysis and Cox regression analysis with adjustments. Results: The hazard ratio (HR) for revision within 2 years after THR with fast-track was 1.19 (CI: 1.03–1.39), indicating increased risk, whereas no increased risk was found in TKR (HR 0.91; CI: 0.79–1.06). The risk of death within 2 years was estimated with a HR of 0.85 (CI: 0.74–0.97) for TKR and 0.96 (CI: 0.85–1.09) for THR in fast-track hospitals compared to non-fast-track. Conclusions: Fast-track programs at Swedish hospitals were associated with an increased risk of revision in THR but not in TKR, while we found the mortality to be lower (TKR) or similar (THR) as compared to non-fast track.

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Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study

Lupus Science & Medicine ◽

10.1136/lupus-2019-000339 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000339 ◽

Cited By ~ 3

Author(s):

Fangfang Sun ◽

Yi Chen ◽

Wanlong Wu ◽

Li Guo ◽

Wenwen Xu ◽

...

Keyword(s):

Propensity Score ◽

Varicella Zoster Virus ◽

Cox Regression ◽

Control Period ◽

Cox Regression Analysis ◽

Varicella Zoster ◽

Propensity Score Weighting ◽

Kaplan Meier ◽

Increased Risk ◽

Risk Of Disease

ObjectiveTo explore whether varicella zoster virus (VZV) infection could increase the risk of disease flares in patients with SLE.MethodsPatients who had VZV reactivations between January 2013 and April 2018 were included from the SLE database (n=1901) of Shanghai Ren Ji Hospital, South Campus. Matched patients with SLE were selected as background controls with a 3:1 ratio. Patients with SLE with symptomatic bacterial infections of the lower urinary tract (UTI) were identified as infection controls. Baseline period and index period were defined as 3 months before and after infection event, respectively. Control period was the following 3 months after the index period. Flare was defined by SELENA SLEDAI Flare Index. Kaplan-Meier analysis, Cox regression model and propensity score weighting were applied.ResultsPatients with VZV infections (n=47), UTI controls (n=28) and matched SLE background controls (n=141) were included. 16 flares (34%) in the VZV group within the index period were observed, as opposed to only 7.1% in UTI controls and 9.9% in background controls. Kaplan-Meier curve revealed that patients with a VZV infection had a much lower flare-free survival within the index period compared with the controls (p=0.0003). Furthermore, after adjusting for relevant confounders including baseline disease activity and intensity of immunosuppressive therapy, Cox regression analysis and propensity score weighting confirmed that VZV infection within 3 months was an independent risk factor for SLE flares (HR 3.70 and HR 4.16, respectively).ConclusionsIn patients with SLE, recent VZV infection within 3 months was associated with increased risk of disease flares.

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Abstract 16202: Changes in Hemoglobin After Pulmonary Artery Catheterization: Results From the ESCAPE Trial

Circulation ◽

10.1161/circ.130.suppl_2.16202 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Abdulla Damluji ◽

Conrad Macon ◽

Mohammed Al-Damluji ◽

Arieh Fox ◽

George R Marzouka ◽

...

Keyword(s):

Pulmonary Artery ◽

Clinical Outcomes ◽

Cox Regression ◽

Evaluation Study ◽

Cardiac Transplant ◽

Pulmonary Artery Catheterization ◽

Escape Trial ◽

Cox Regression Analysis ◽

Risk Of Mortality ◽

Increased Risk

Introduction: We sought to investigate the association between hemoglobin (Hgb) changes in patients with ADHF (with and without PACs) to mortality and clinical outcomes. Methods: We examined 433 patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Change of Hgb (g/dL) was defined as at least 1 (g/dL) drop by hospital discharge. Quartiles of % change of Hgb (g/dL) were calculated. We used multivariable Cox regression analysis to evaluate the effect Hgb change on mortality and composite end points of death, cardiac re-hospitalization, or cardiac transplant. Results: Of the 433 patients, 324 (75%) had baseline and discharge Hgb available for analysis. Of those, 64 (20%) had at least 1 (g/dL) drop of Hgb by time of discharge. Patients in the Hgb drop group were older than those without Hgb changes (59 vs. 55, p = 0.011). There were no baseline differences in gender, race, and etiology of HF between groups. Compared to patients without Hgb changes, patients with Hgb drop had lower systolic BP (99 vs. 106, p = 0.017), lower sodium (136 vs. 137, p =0.025), higher BUN (37 vs. 26, p <0.001), and higher Creatinine (1.6 vs. 1.3, p <0.001), respectively. Higher Hgb drop was observed in the PACs (vs. no PACs) randomized arm of the trial (2 g/dL: PACs 10% versus 3%, p =0.010; 3 g/dL: PACs 5% versus 0%, p =0.005). After adjustments, higher in-hospital Hgb was associated with lower mortality (HR 0.79, p =0.003). In addition, patients in the Hgb drop group had increased risk of mortality (Adjusted HR 2.38, p =0.003) and composite endpoints (Adjusted HR 1.43, p =0.055). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin (Mortality: Q1: HR 0.80, p 0.601, Q2 HR 0.79, p = 0.706, Q3 HR 0.34, p =0.101, Q4 HR 2.23, p =0.357). Conclusion: In-hospital decrease in Hgb is independently associated with increased long-term mortality and adverse cardiovascular events in severe HF. The ideal Hgb levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.

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Abstract TP209: Effect of Chemotherapy on Stroke Risk in Cancer Patients

Stroke ◽

10.1161/str.51.suppl_1.tp209 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Takaya Kitano ◽

Tsutomu Sasaki ◽

Yasufumi Gon ◽

Kenichi Todo ◽

Shuhei Okazaki ◽

...

Keyword(s):

Cancer Patients ◽

Propensity Scores ◽

Stroke Risk ◽

Cox Regression ◽

Treatment Plan ◽

University Hospital ◽

Chemotherapy Group ◽

Kaplan Meier ◽

Increased Risk ◽

The Impact

Introduction: Chemotherapy may be a cause of cancer-associated stroke, but whether it increases stroke risk remains uncertain. We aimed to clarify the impact of chemotherapy on stroke risk in cancer patients. Methods: We investigated 27,932 patients enrolled in a hospital-based cancer registry at Osaka University Hospital between 2007 and 2015. The registry collects clinical data, including cancer status (site and stage), on all patients treated for cancer. Of them, 19,006 patients with complete data were included. A validated algorithm was used to identify stroke events within 2 years of cancer diagnosis. Patients were divided based on whether their initial treatment plan included chemotherapy. The association between chemotherapy and stroke was analyzed using the Kaplan-Meier method and stratified Cox regression. Results: Of the 19,006 patients, 5,887 (31%) patients were in the chemotherapy group. Non-targeted chemotherapy was used in 5,371 patients. Stroke occurred in 44 patients (0.75%) in the chemotherapy group and 51 patients (0.39%) in the no-chemotherapy group. Kaplan-Meier curve analysis showed that patients in the chemotherapy group had a higher stroke risk than patients in the no-chemotherapy group (HR 1.84; 95% CI 1.23-2.75; Figure [A]). However, this difference was insignificant after adjustment for cancer status using inverse probability of treatment weighting with propensity scores (HR 1.20; 95% CI 0.76-1.91; Figure [B]). Similarly, in the stratified Cox regression model, chemotherapy was not associated with stroke after adjustment for cancer status (HR 1.26; 95% CI 0.78-2.03). These findings were consistent with analysis wherein the effect of chemotherapy was treated as a time-dependent covariate (HR 1.02; 95% CI 0.55-1.88). Conclusions: In this population, the elevated stroke risk in cancer patients who received chemotherapy was presumably due to advanced cancer stage; chemotherapy was not associated with the increased risk of stroke.

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P0211GLOMERULAR HYPERFILTRATION AND CANCER: A NATIONWIDE POPULATION-BASED STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0211 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yaerim Kim ◽

Jeongsoo Yoon ◽

Jin Hyuk Paek ◽

Woo Yeong Park ◽

Kyubok Jin ◽

...

Keyword(s):

National Health ◽

Malignant Disease ◽

Cox Regression ◽

Asian Population ◽

Population Based ◽

Glomerular Hyperfiltration ◽

Outcome Variable ◽

Cox Regression Analysis ◽

Increased Risk ◽

The Impact

Abstract Background and Aims Glomerular hyperfiltration is associated with all-cause mortality. Herein, we evaluated the association between glomerular hyperfiltration and the development of malignant disease, the most common cause of death, in an Asian population. Method We retrospectively reviewed the National Health Insurance Service database of Korea for people who received national health screenings from 2012 to 2013. Glomerular hyperfiltration was defined as the 95th percentile and greater after adjusting for age and sex. We performed a multivariate Cox regression analysis using glomerular hyperfiltration at the first health screening as the exposure variable and cancer development as the outcome variable to evaluate the impact of glomerular hyperfiltration on the development of malignant disease. Results A total of 1,953,123 examinations who followed-up for 4.9 years were included in this study. Among the 8 different site-specific malignant disease categories, digestive organs and female genital organs showed a significant associations between glomerular hyperfiltration and malignancy. The population with glomerular hyperfiltration showed an increased risk for stomach cancer (adjusted hazard ratio [aHR], 1.27), colorectal cancer (aHR, 1.23), and liver or intrahepatic malignancy (aHR, 1.40). In addition, the risk for uterine and ovarian cancer was significantly increased in the population with glomerular hyperfiltration (aHR, 1.36). Conclusion Glomerular hyperfiltration was associated with an increased risk for the development of malignant diseases in specific organs, such as the stomach, colorectum, uterus, and ovary. Glomerular hyperfiltration needs to be considered a significant sign of the need to evaluate the possibility of hidden adverse health conditions, including malignancies.

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