scholarly journals Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy: a single-center cohort study

2018 ◽  
Vol 48 (1) ◽  
pp. 030006051880147 ◽  
Author(s):  
Li Lai ◽  
Rong Jiang ◽  
Wei Fang ◽  
Chao Yan ◽  
Yibin Tang ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dilated Cardiomyopathy ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Prognostic Impact ◽  
Bundle Branch Block ◽  
All Cause Mortality

Objective Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease resulting in symptoms of heart failure. Right bundle branch block (RBBB) is associated with increased cardiovascular risk and all-cause mortality. Therefore, the present study was performed to identify the prognostic impact of RBBB in patients with IDCM. Methods In total, 165 hospitalized patients with IDCM were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff point, and Cox regression was used to assess risk factors. Results After a median follow-up of 73.1 months (interquartile range, 36.1–88.7 months), 59 (35.8%) patients had died. All-cause mortality was significantly higher in patients with than without RBBB (log-rank χ2 = 9.400), P<0.05. Significant independent predictors of all-cause mortality in patients with IDCM were RBBB (hazard ratio, 2.898; 95% confidence interval, 1.201–6.995) and the left ventricular end-diastolic dimension (LVEDD) (hazard ratio, 1.034; 95% confidence interval, 1.004–1.066) at admission. Patients with RBBB and an LVEDD of ≥63 mm had the highest mortality (log-rank χ2 = 14.854), P<0.05. Conclusion RBBB was an independent predictor of all-cause mortality, and the combination of RBBB and LVEDD provided more clinically relevant information than RBBB alone for assessing the risk of all-cause mortality in patients with IDCM.

scholarly journals Renal dysfunction indicative of outcomes in hospitalized patients with takotsubo syndrome

2017 ◽  
Vol 7 (8) ◽  
pp. 723-731 ◽  
Author(s):  
Kaoru Ando ◽  
Hiroyasu Sukekawa ◽  
Aoi Takahata ◽  
Yusuke Kobari ◽  
Hayato Tsuchiya ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Renal Dysfunction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Rank Test ◽  
Takotsubo Syndrome ◽  
Pump Failure

Background: Left ventricular dysfunction as part of takotsubo syndrome is reversible, and the long-term prognosis appears favorable. However, life-threatening complications are not uncommon during the acute phase, and it remains unclear whether renal dysfunction is a factor in complications suffered by hospitalized patients with takotsubo syndrome. The present study was conducted to investigate the implications of renal dysfunction in this setting. Methods: Data from 61 consecutive patients (male, 21; female, 40) diagnosed with takotsubo syndrome at our hospital between years 2010 and 2016 were evaluated retrospectively. In-hospital complications by definition were all-cause deaths and severe pump failure (Killip class ≥III). Results: Overall, 30 patients (49%) developed renal dysfunction. In the 32 patients (52%) who suffered in-hospital complications (mortality, 10; severe pump failure, 22), estimated glomerular filtration rate (eGFR) was significantly lower by comparison (51.3±29.8 vs. 69.5±29.0; p=0.019). Low eGFR (<30 ml/min per 1.73m2) proved independently predictive of in-hospital complications (hazard ratio =2.84, 95% confidence interval: 1.20–6.69) in multivariate Cox hazard analysis, also showing a significant association with peak event rate of Kaplan–Meier curve (log-rank test, p=0.0073). Similarly, patients with chronic kidney disease were at significantly greater risk of in-hospital complications (hazard ratio=2.49, 95% confidence interval: 1.01–5.98), relative to non-compromised counterparts (eGFR >60 ml/min per 1.73m2). Conclusion: Renal dysfunction is a simple but useful means of predicting complications in hospitalized patients with takotsubo syndrome, especially those with chronic kidney disease.

Prognostic value of left ventricular remodelling index in idiopathic dilated cardiomyopathy

2020 ◽  
Author(s):  
Yuanwei Xu ◽  
Jiayi Lin ◽  
Yaodan Liang ◽  
Ke Wan ◽  
Weihao Li ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Dilated Cardiomyopathy ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Secondary Endpoint ◽  
Idiopathic Dilated Cardiomyopathy ◽  
All Cause Mortality ◽  
Secondary Endpoints

Abstract Aims To evaluate the prognostic value of left ventricular (LV) remodelling index (RI) in idiopathic dilated cardiomyopathy (DCM) patients. Methods and results We prospectively enrolled 412 idiopathic DCM patients and 130 age- and sex-matched healthy volunteers who underwent cardiovascular magnetic resonance imaging between September 2013 and March 2018. RI was defined as the cubic root of the LV end-diastolic volume divided by the mean LV wall thickness on basal short-axis slice. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included the primary endpoint and heart failure (HF) readmission. During the median follow-up of 28.1 months (interquartile range: 19.3–43.0 months), 62 (15.0%) and 143 (34.7%) patients reached the primary and secondary endpoints, respectively. Stepwise multivariate Cox regression showed that RI [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.11–1.30, P &lt; 0.001], late gadolinium enhancement (LGE) presence and log (N-terminal pro-B-type natriuretic peptide) were independent predictors of the primary endpoint, while RI (HR 1.15, 95% CI 1.08–1.23, P &lt; 0.001) and extracellular volume were independent predictors of the secondary endpoint. The addition of RI to LV ejection fraction (EF) and LGE presence showed significantly improved global χ2 for predicting primary and secondary endpoints (both P &lt; 0.001). Furthermore, RI derived from echocardiography also showed independent prognostic value for primary and secondary endpoints with clinical risk factors. Conclusions RI is an independent predictor of all-cause mortality, heart transplantation, and HF readmission in DCM patients and provides incremental prognostic value to LVEF and LGE presence.

scholarly journals Right bundle branch block and male sex may help predict appropriate ICD therapies in patients with non-ischemic dilated cardiomyopathy and a prophylactic implantable cardioverter defibrillator

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Amores Luque ◽  
M Jimenez-Blanco Bravo ◽  
C Parra Esteban ◽  
G.L Alonso Salinas ◽  
J Alvarez Garcia ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Right Bundle Branch Block ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Cox Regression Analysis ◽  
Device Infection ◽  
Male Sex ◽  
Baseline Characteristics

Abstract Background Previous studies have shown that prophylactic implantable cardioverter-defibrillators (ICD) in patients with symptomatic severe systolic dysfunction reduce all-cause mortality. However, their benefit in patients with severe systolic dysfunction of non-ischemic origin is not so clear, and is currently under debate. Methods/Aim We retrospectively reviewed all consecutive patients with nonischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify predictors of appropriate ICD therapies (ATP and/or shocks) in this cohort of patients. Results A total of 224 patients were included, median age 62.7 years, 73.7% men. During a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD intervention, 7 patients (3.1%) presented inappropriate shocks and 11 (4.9%) had device infection. Patients that received appropriate ICD therapies, as compared to those who did not, were more frequently men (86.9% vs 68.7%, p=0.006) and were significantly younger (median age 58.7 years, IQR 53.0–64.8 vs 63.7, IQR 57.0–69.8; p=0.02). Left ventricular end diastolic volume (LV-EDV) and left ventricular end systolic volume (LV-ESV) were both significantly higher in this subgroup of patients (median LVEDV 100 ml/m2 vs 86, p=0.0106; median LVESV 72.2 ml/m2 vs 60.9, p=0.0467). A trend towards lower LVEF was also noted, but it did not reach statistical significance (26% vs 29%, p=0.077). Regarding ECG previous to implant, patients that required ICD intervention presented more frequently complete right bundle branch block (RBBB) (14.8% vs 4.3%, p=0.007). On the other hand, left bundle branch block (LBBB) was more frequent in those patients who did not receive ICD intervention during follow-up (47.2% vs 26.2%, p=0.005). Table 1 summarizes baseline characteristics and results. In a multivariate Cox regression analysis, RBBB (HR 3.9, CI 95% 1.9–8.0, p&lt;0.001) and male sex (HR 2.38, CI 95% 1.07–5.28, p=0.034) were identified as independent predictors of appropriate ICD therapies (Figure 2). Conclusion RBBB and male sex may help identify patients with NICM at high-risk of ventricular arrhythmias requiring ICD intervention. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics and results Kaplan-Meier curves

Anaemia is a predictor of early death or cardiac transplantation in children with idiopathic dilated cardiomyopathy

2011 ◽  
Vol 22 (3) ◽  
pp. 293-300 ◽  
Author(s):  
Issam Kammache ◽  
Giovanni Parrinello ◽  
Davide Marini ◽  
Damien Bonnet ◽  
Gabriella Agnoletti
Keyword(s):  
Confidence Interval ◽  
Dilated Cardiomyopathy ◽  
Cardiac Transplantation ◽  
Cox Model ◽  
Early Death ◽  
Hazard Ratio ◽  
Idiopathic Dilated Cardiomyopathy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
First Diagnosis

AbstractIntroductionThe aim of our study was to establish the prevalence and the prognostic value of haematological abnormalities in children with cardiac failure.Patients and methodsA series of 218 consecutive children with a first diagnosis of idiopathic dilated cardiomyopathy were retrospectively examined. Haematological evaluation was performed at first diagnosis. Death or cardiac transplantation was the main outcome measure.ResultsThe median age was 0.6 years, ranging from 1 day to 15.8 years and median follow-up was 2.65 years, ranging from 0 to 17.2 years. After a median interval of 0.2 years, ranging from 0 to 8.7 years, 56 patients died and 25 were transplanted. Event-free survival at 1 and 5 years was 68% (95% confidence interval, 63–75%) and 62% (95% confidence interval, 56–69%). Blood levels of haemoglobin less than 10 grams per decilitre, urea over 8 millimoles per litre, and C-reactive protein over 10 milligrams per litre were found in 24%, 20%, and 24% of patients, respectively. The log-rank test showed that haemoglobin (p = 0.000) and C-reactive protein (p = 0.021) were predictors of death or transplantation. In the multivariate Cox model, haemoglobin (hazard ratio = 0.735; confidence interval = 0.636–0.849; p = 0.000) and urea (hazard ratio = 1.083; confidence interval = 1:002–1:171; p = 0.045) were predictive of poor outcome. Cubic spline functions showed that the positive role of haemoglobin on survival was linear for values less than 12 grams per decilitre and null for values more than 12 grams per decilitre. Adaptive index models for risk stratification and Classification and Regression Tree analysis allowed to identify the cut-off values for haemoglobin (less than 10.2 grams per decilitre) and urea (more than 8.8 millimoles per litre), as well as to derive a predictor model.ConclusionsIn children with idiopathic dilated cardiomyopathy, anaemia is the strongest independent prognostic factor of early death or transplantation.

scholarly journals Social frailty provides additive prognostic impact on one-year outcome in aged patients with congestive heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Jujo ◽  
N Kagiyama ◽  
K Kamiya ◽  
H Saito ◽  
K Saito ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Hazard Ratio ◽  
Rank Test ◽  
Funding Source ◽  
Prognostic Impact ◽  
Aged Patients ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Frailty is associated with multisystem declines in physiologic reserve and increased vulnerability to stressors, resulting in increased risks of adverse clinical outcomes in patients with heart failure (HF). Although frailty is conceptualized as an accumulation of deficits in multiple areas, most of the studies have focused mainly on physical frailty, and the social domains is one of the least investigated area. Objectives We prospectively evaluated the incidence and prognostic implication of social frailty (SF) in older patients with HF. Methods The FRAGILE-HF is a multicenter, prospective cohort study including patients hospitalized for HF and aged ≥65 years old. We defined SF by Makizako's 5 items, which are 5 questions proposed and validated to be associated with future disability. The primary endpoint of this study was a composite of death from any cause and rehospitalization due to HF. The impact of SF on all-cause mortality alone was also evaluated. Results Among 1,240 hospitalized HF patients, 5 simple questions revealed that 825 (66.5%) were in SF. During 1-year observation period after the discharge, the combined endpoint was observed in 399 (32.2%) patients, and 145 (11.7%) patients died. Kaplan-Meier analysis showed that SF patients had significantly higher rates of both the combined endpoint and all-cause mortality than those without SF (Log-rank test: p&lt;0.05 for both, Figures). Moreover, SF remained independently associated with higher event rate of the combined endpoint (hazard ratio: 1.30; 95% confidence interval: 1.02 to 1.66; p=0.038) and all-cause mortality (hazard ratio: 1.53; 95% confidence interval: 1.01 to 2.30; p=0.044), even after adjusting for other covariates. Significant incremental prognostic value was shown when information on social frailty was added to known risk factors for combined endpoint (NRI: 0.189, 95% confidence interval: 0.063–0.316, p=0.003) and all-cause mortality (NRI: 0.234, 95% confidence interval: 0.073–0.395, p=0.004). Conclusions Among older hospitalized patients with heart failure, two-thirds of the population was with SF. Evaluating SF provides additive prognostic information in elderly patients with heart failure. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Pharma Research Grants, Japan Heart Foundation Research Grant

Prognostic impact of multiple fragmented QRS on cardiac events in idiopathic dilated cardiomyopathy

EP Europace ◽  
2020 ◽  
Author(s):  
Kyohei Marume ◽  
Teruo Noguchi ◽  
Tsukasa Kamakura ◽  
Emi Tateishi ◽  
Yoshiaki Morita ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cox Regression ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Fragmented Qrs ◽  
Kaplan Meier

Abstract Aims  To evaluate the prognostic impact of fragmented QRS (fQRS) on idiopathic dilated cardiomyopathy (DCM). Methods and results  We conducted a prospective observational study of 290 consecutive patients with DCM (left ventricular ejection fraction ≤ 40%) and narrow QRS who underwent cardiac magnetic resonance. We defined fQRS as the presence of various RSR′ patterns in ≥2 contiguous leads representing the anterior (V1–V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Multiple fQRS was defined as the presence of fQRS in ≥2 myocardial segments. Patients were divided into three groups: no fQRS, single fQRS, or multiple fQRS. The primary endpoint was a composite of hard cardiac events consisting of heart failure death, sudden cardiac death (SCD), or aborted SCD. The secondary endpoints were all-cause death and arrhythmic event. During a median follow-up of 3.8 years (interquartile range, 1.8–6.2), 31 (11%) patients experienced hard cardiac events. Kaplan–Meier analysis showed that the rates of hard cardiac events and all-cause death were similar in the single-fQRS and no-fQRS groups and higher in the multiple-fQRS group (P = 0.004 and P = 0.017, respectively). Multivariable Cox regression identified that multiple fQRS is a significant predictor of hard cardiac events (hazard ratio, 2.23; 95% confidence interval, 1.07–4.62; P = 0.032). The multiple-fQRS group had the highest prevalence of a diffuse late gadolinium enhancement pattern (no fQRS, 21%; single fQRS, 22%; multiple fQRS, 39%; P &lt; 0.001). Conclusion  Multiple fQRS, but not single fQRS, is associated with future hard cardiac events in patients with DCM.

scholarly journals Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mineaki Kitamura ◽  
Kosei Yamaguchi ◽  
Yuki Ota ◽  
Satoko Notomi ◽  
Maya Komine ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Clinical Relevance ◽  
Patient Characteristics ◽  
Hazard Ratio ◽  
Essential Medicines ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
Prescribed Medicines

AbstractAlthough polypharmacy is common among patients on hemodialysis (HD), its association with prognosis remains unclear. This study aimed to elucidate the association between the number of prescribed medicines and all-cause mortality in patients on HD, accounting for essential medicines (i.e., antihypertensives, antidiabetic medicines, and statins) and non-essential medicines. We evaluated 339 patients who underwent maintenance HD at Nagasaki Renal Center between July 2011 and June 2012 and followed up until June 2021. After adjusting for patient characteristics, the number of regularly prescribed medicines (10.0 ± 4.0) was not correlated with prognosis (hazard ratio [HR]: 1.01, 95% confidence interval [CI] 0.97–1.05, p = 0.60). However, the number of non-essential medicines (7.9 ± 3.6) was correlated with prognosis (HR: 1.06, 95% CI 1.01–1.10, p = 0.009). Adjusting for patient characteristics, patients who were prescribed more than 10 non-essential medicines were found to have a significantly higher probability of mortality than those prescribed less than five non-essential medicines, with a relative risk of 2.01 (p = 0.004). In conclusion, polypharmacy of non-essential medicines increases the risk of all-cause mortality in patients on HD. As such, prescribing essential medicines should be prioritized, and the clinical relevance of each medicine should be reviewed by physicians and pharmacists.

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