Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study

Abstract Background Following catheter ablation for atrial fibrillation (AF), CHADS2 and CHA2DS2-VASc have utility in predicting long-term outcomes. However, it is currently unknown if the same holds for patients undergoing surgical ablation. Purpose To determine whether CHADS2 and CHA2DS2-VASc predict long-term outcomes after surgical ablation in concomitance with other cardiac surgery. Methods In this prospective, follow-up study, we included patients who underwent biatrial ablation - or pulmonary vein isolation procedure concomitantly with other cardiac surgery between 2004 and 2018. CHADS2 and CHA2DS2-VASc scores were assessed prior to surgery and categorized in groups as 0–1, 2–4 or ≥5. Outcomes were death, AF, and AF-related death. Follow-up was ended in April 2019. Results A total of 587 patients with a mean age of 68.7±0.4 years were included. Both CHADS2 and CHA2DS2-VASc scores were predictors of survival p=0.005 and p<0.001, respectively (Figure). For CHADS2, mean survival times were 5.9±3.7 years for scores 0–1, 5.0±3.0 years for scores 2–4 and 4.3±2.6 years for scores ≥5. For CHA2DS2-VASc mean survival times were 7.3±4.0 years for scores 0–1, 5.6±2.9 years for scores 2–4 and 4.8±2.1 years for scores ≥5. The incidence of death was 20.1% for CHADS2 0–1, 24.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.186. The incidence of AF was 50.2% for CHADS2 0–1, 47.9% for CHADS2 2–4, and 76.5% for CHADS2 ≥5, p=0.073. The incidence of AF related death was 13.0% for CHADS2 0–1, 16.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.031. The incidence of death was 16.8% for CHA2DS2-VASc 0–1, 26.2% for CHA2DS2-VASc 2–4, and 45.0% for CHA2DS2-VASc ≥5, p=0.001. The incidence of AF was 49.6% for CHA2DS2-VASc 0–1, 52.5% for CHA2DS2-VASc 2–4, and 72.5% for CHA2DS2-VASc ≥5, p=0.035. The incidence of AF related death was 12.2% for CHA2DS2-VASc 0–1, 16.0% for CHA2DS2-VASc 2–4, and 42.5% for CHA2DS2-VASc ≥5, p<0.001. Conclusion Both CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after surgical ablation for AF. However, CHA2DS2-VASc was superior in predicting death, AF, and AF-related death. Survival curves Funding Acknowledgement Type of funding source: None

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P01-302 - The effects of cardiac surgery on health - related quality of life, and emotional status outcomes: a follow-up study

European Psychiatry ◽

10.1016/s0924-9338(10)70510-1 ◽

2010 ◽

Vol 25 ◽

pp. 515 ◽

Cited By ~ 2

Author(s):

H.-B. Rothenhäusler ◽

A. Stepan

Keyword(s):

Quality Of Life ◽

Cardiac Surgery ◽

Health Related Quality ◽

Emotional Status ◽

Follow Up Study ◽

Related Quality ◽

Health Related

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Perioperative management after elective cardiac surgery: the predictive value of procalcitonin for infective and noninfective complications

Future Cardiology ◽

10.2217/fca-2020-0245 ◽

2021 ◽

Author(s):

Alice Laudisio ◽

Antonio Nenna ◽

Marta Musarò ◽

Silvia Angeletti ◽

Francesco Nappi ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Predictive Value ◽

Odds Ratio ◽

Rate Ratio ◽

Perioperative Management ◽

Incidence Rate Ratio ◽

Adverse Outcomes ◽

Elective Cardiac Surgery ◽

The Third

Objective: Procalcitonin (PCT) has been associated with adverse outcomes after cardiac surgery. Nevertheless, there is no consensus on thresholds and timing of PCT measurement to predict adverse outcomes. Materials & methods: A total of 960 patients undergoing elective cardiac surgery were retrospectively evaluated. PCT levels were measured from the first to the seventh postoperative day (POD). The onset of complications was recorded. Results: Complications occurred in 421 (44%) patients. PCT on the third POD was associated with the occurrence of any kind of complications (odds ratio: 1.06; p: 0.037), and noninfectious complications (odds ratio: 1.05; p: 0.035), after adjusting. PCT above the median value at the third POD (>0.33 μg/l) predicted postoperative complications (incidence rate ratio: 1.13; p = 0.035). Conclusion: PCT seems to predict postoperative complications in cardiac surgery. The determination at the third POD yields the greatest sensitivity and specificity.

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Electroencephalogram-Based Prognosis of Cardiac Surgery — A Long-Term Follow-Up Study

Impact of Cardiac Surgery on the Quality of Life ◽

10.1007/978-1-4613-0647-4_19 ◽

1990 ◽

pp. 145-151

Author(s):

Phiroze L. Hansotia ◽

Percy N. Karanjia ◽

Richard D. Sautter ◽

William O. Myers ◽

Jefferson F. Ray ◽

...

Keyword(s):

Cardiac Surgery ◽

Follow Up Study ◽

Long Term Follow Up

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P1633Age, creatinine, and ejection fraction (ACEF) score continues to predictive prognosis in patients with ischemic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0392 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

W Z Chen ◽

P Ran ◽

A P Cai

Keyword(s):

Ejection Fraction ◽

Predictive Value ◽

Ischemic Cardiomyopathy ◽

Malignant Tumors ◽

Predictive Ability ◽

Adverse Outcomes ◽

Cardiac Mortality ◽

Elective Cardiac Surgery ◽

All Cause Mortality

Abstract Purpose ACEF (Age, Creatinine, and Ejection Fraction) andACEFMDRD (Modification of Diet in Renal Disease) score have been validated as effective predictors for prognosis in patients undergoing elective cardiac surgery or PCI. However, the predictive value for ICM (Ischemic Cardiomyopathy)was not clear. This study sought to investigate their predictive value in patients with ICM. Methods 862 ICM patients hospitalized in the Department of Cardiology were prospectively enrolled during November 2014 and December 2017.Inclusion criteria: previous definite diagnosis of myocardial infarction, previous PCI, CABG, or coronary angiographic findings of one or more vessel stenosis >70%; Simpson echocardiography showed LVEF <45%. Exclusion criteria: malignant tumors of any organ or once had a history of malignancies; and other serious diseases with estimated survival time less than one year.The ACEF score was calculated by the formula: age/ejection fraction + 1 (if creatinine >176 μmol/L). As for ACEFMDRD score, estimated glomerular filtration rate (eGFR) was calculated using the MDRD formula. Then using the formula: age/EF +1 point for every 10 mL/min reduction in eGFRMDRD below 60 ml/min per 1.73 m2 (up to a maximum of 6 points). Patients were divided into low, middle and high ACEF, ACEFMDRD tertiles. The median duration of follow-up was 13 months (IQR: 7–23 months). The clinical endpoints were all-cause mortality, cardiac mortality, major adverse cardiovascular and cerebrovascular events (MACCEs) and re-hospitalization for heart failure (HF). Results The mean original ACEF and ACEFMDRD score were 1.99±0.63 and 2.53±1.42. Patients in high ACEF and ACEFMDRD tertile were associated with significantly higher all-cause and cardiac mortality, MACCEs and re-hospitalization for HF. Compared with ACEFMDRD score, original ACEF exhibited similar discrimination and predictive ability on all-cause mortality (AUC: 0.739 vs. 0.724, P=0.567), cardiac mortality (AUC: 0.733 vs. 0.717, P=0.525), MACCEs (AUC: 0.635 vs. 0.624, P=0.587) and rehospitalizaiotn (AUC: 0.642 vs. 0.632, P=0.757). In multivariate Cox analysis, the original ACEF or ACEFMDRD score were related with increasing risks of all-cause mortality (HR: 2.00 vs. 1.32, 95% CI: 1.46–2.73 vs. 1.13–1.53, P<0.001), cardiac mortality (HR: 1.97 vs. 1.28, 95% CI: 1.43–2.70 vs. 1.10–1.50, P<0.001 vs. P=0.002), MACCEs and re-hospitalization for HF, respectively. ROC curves of cardiac mortality Conclusions In patients with ICM, the original ACEF and ACEFMDRD score are independent predictors of adverse outcomes during 13-month follow-up, respectively. Acknowledgement/Funding None

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Perceived Difficult Temperament, Hostile Maternal Child-Rearing Attitudes and Insulin Resistance Syndrome Precursors among Children: A 3-Year Follow-Up Study

Psychotherapy and Psychosomatics ◽

10.1159/000056229 ◽

2001 ◽

Vol 70 (2) ◽

pp. 66-77 ◽

Cited By ~ 15

Author(s):

Niklas Ravaja ◽

Saara Katainen ◽

Liisa Keltikangas-Järvinen

Keyword(s):

Insulin Resistance ◽

Insulin Resistance Syndrome ◽

Child Rearing ◽

Follow Up Study ◽

Maternal Child

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Hyperuricemia in Young Adults and Risk of Insulin Resistance, Prediabetes, and Diabetes: A 15-Year Follow-up Study

American Journal of Epidemiology ◽

10.1093/aje/kws002 ◽

2012 ◽

Vol 176 (2) ◽

pp. 108-116 ◽

Cited By ~ 116

Author(s):

E. Krishnan ◽

B. J. Pandya ◽

L. Chung ◽

A. Hariri ◽

O. Dabbous

Keyword(s):

Insulin Resistance ◽

Young Adults ◽

Follow Up Study

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Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study

Metabolism ◽

10.1016/j.metabol.2008.05.012 ◽

2008 ◽

Vol 57 (10) ◽

pp. 1422-1427 ◽

Cited By ~ 77

Author(s):

Arnljot Flaa ◽

Tonje A. Aksnes ◽

Sverre E. Kjeldsen ◽

Ivar Eide ◽

Morten Rostrup

Keyword(s):

Insulin Resistance ◽

Follow Up Study

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Increased Subcutaneous and Epicardial Adipose Tissue Production of Proinflammatory Cytokines in Cardiac Surgery Patients: Possible Role in Postoperative Insulin Resistance

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-1044 ◽

2006 ◽

Vol 91 (11) ◽

pp. 4620-4627 ◽

Cited By ~ 158

Author(s):

Jaromir Kremen ◽

Marketa Dolinkova ◽

Jana Krajickova ◽

Jan Blaha ◽

Katerina Anderlova ◽

...

Keyword(s):

Insulin Resistance ◽

Adipose Tissue ◽

Cardiac Surgery ◽

Mrna Expression ◽

Proinflammatory Cytokines ◽

Epicardial Adipose Tissue ◽

Monocyte Chemoattractant Protein 1 ◽

Elective Cardiac Surgery ◽

Tnf Α ◽

History Of

Abstract Context: Hyperglycemia and insulin resistance frequently occur in critically ill patients even without a history of diabetes. Objective: Our objective was to study the role of adipose tissue hormonal production in the development of insulin resistance in cardiac surgery patients. Participants, Interventions, and Settings: Fifteen patients with elective cardiac surgery underwent blood sampling before, at the end, and 6, 12, 24, 48, and 120 h after the end of their operation. Epicardial and sc adipose tissue sampling was done at the beginning and at the end of surgery in the Department of Cardiac Surgery. Main Outcome Measures: We measured serum concentrations and sc and epicardial adipose tissue mRNA expression of IL-6, monocyte chemoattractant protein-1 (MCP-1), TNF-α, leptin, resistin, and adiponectin and sc and epicardial adipose tissue mRNA expression of CD14, CD45, and CD68. Results: The rate of insulin infusion required to maintain euglycemia increased up to 7-fold 12 h after the operation, suggesting the development of insulin resistance. Serum IL-6 levels increased 43-fold 12 h after surgery. MCP-1 peaked 6-fold at the end of surgery. Smaller peaks of TNF-α and leptin appeared 6 and 12 h after surgery, respectively. Resistin levels peaked 4-fold 24 h after surgery, but adiponectin levels were not significantly affected. TNF-α and CD45 mRNA expression increased markedly during the operation in sc adipose tissue. IL-6, resistin, and MCP-1 mRNA expression increased in both sc and epicardial adipose tissue. Leptin, adiponectin, CD14, and CD68 mRNA expression did not change significantly. Conclusions: Both sc and epicardial adipose tissue is a source of proinflammatory cytokines in cardiac surgery patients and may contribute to the development of postoperative insulin resistance.

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