Prognostic Significance of Visit-To-Visit Variability, Maximum and Minimum LDL Cholesterol in Diabetes Mellitus

2021 ◽  
Author(s):  
Chang-Sheng Sheng ◽  
Ya Miao ◽  
Lili Ding ◽  
Yi Cheng ◽  
Dan Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Placebo Group ◽  
Primary Outcome ◽  
Total Population ◽  
Therapy Group ◽  
Strong Predictor ◽  
Prognostic Significance ◽  
Total Mortality ◽  
Increased Risk

Abstract BACKGROUND Current guidelines for dyslipidemia management recommended that the LDL_C goal could be lower to less than 70 mg/dL. The present study was to investigate the prognostic significance of the visit-to-visit variability in LDL_C, and minimum and maximum LDL_C during follow-up in Diabetes mellitus. METHODS We studied the risk of outcomes in relation to visit-to-visit LDL_c variability in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid trial. LDL_c variability indices were coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). Multivariable Cox proportional hazards models were employed to estimate adjusted hazard ratio (HR) and 95% confidence interval (CI). RESULTS Compared with the placebo group (n=2667), Fenofibrate therapy group (n=2673) had significantly (P<0.01) lower mean of plasma triglyceride (152.5 vs. 178.6 mg/dl), total cholesterol (158.3 vs.162.9 mg/dl), but similar mean LDL_C during follow-up (88.2 vs.88.6 mg/dl, P>0.05). All three variability indices were associated with primary outcome, total mortality and cardiovascular mortality both in total population and in Fenofibrate therapy group, but only with primary outcome in the placebo group. The minimum LDL_C but not the maximum during follow-up was significantly associated with various outcomes in total population, fenofibrate therapy and placebo group. The minimum LDL_C during follow-up ≥70 mg/dl was associated with increased risk for various outcomes. CONCLUSIONS Visit-to-visit variability in LDL_C was a strong predictor of outcomes, independent of mean LDL_C. Patients with LDL_C be controlled to less than 70 mg/dl at least once during follow-up might have a benign prognosis.

Abstract 1245: The Mortality Rate from Cardiovascular Disease is more than Five Times Higher in Individuals with Diabetes Mellitus who have the Hp 2–2 Genotype as Compared to Individuals with Diabetes Mellitus who do not have the Hp 2–2 Genotype

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Uzi Milman ◽  
Shany Blum ◽  
Chen Shapira ◽  
Andrew Levy
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Treatment Strategies ◽  
Total Mortality ◽  
Fold Increase ◽  
High Risk Population ◽  
Risk Of Death ◽  
Health Care Clinics ◽  
Increased Risk

Objective: To determine if the Haptoglobin (Hp) genotype can predict the risk of death from cardiovascular disease in individuals with Diabetes Mellitus (DM) in a prospective community based longitudinal study. Background: The Hp gene is polymorphic in man with two classes of alleles denoted 1 and 2. Retrospective analysis of 5 longitudinal studies has demonstrated that the Hp genotype is a major determinant of the risk of incident CVD in DM individuals. Specifically, individuals with the Hp 2–2 genotype and DM were found to have a 2–5 fold increased risk of CVD as compared to Hp 1–1 or Hp 2–1 DM individuals. Method: 2241 individuals with DM ≥55 years of age from 47 primary health care clinics were Hp genotyped and followed prospectively for three years for incident myocardial infarction, stroke and death (all cause and cardiovascular). All aspects of the medical care of individuals in the cohort were left to the discretion of the patient’s physician. Results: The cohort consisted of 708 individuals with the Hp 2–2 genotype and 1533 individuals with the Hp 1–1 or 2–1 genotype. At baseline there were no significant differences between individuals with and without the Hp 2–2 genotype in their DM characteristics (HbA1c, duration) or in the prevalence of cardiovascular disease (25% in both groups). During the nearly 3 year period of follow up total mortality was increased in individuals with the Hp 2–2 genotype (2.5% vs 1.8%, HR 0.68, CI 0.35–1.25, p=0.2 by log rank). These differences in overall mortality were the result of a greater than 5 fold increase in CV death in Hp 2–2 individuals (1.1% vs 0.2%, HR 0.15, CI 0.038 – 0.44, p=0.001 by log rank). The incidence of non fatal MI was increased by over 50% in the Hp 2–2 group (3.9% vs. 2.5%, p=0.068). These differences were unaffected by adjustment for DM characteristics and conventional cardiovascular risk factors. Conclusions. DM individuals with the Hp 2–2 genotype are at a dramatically increased risk of death due to cardiovascular disease. Pharmacogenomic treatment strategies targeted to this high risk population may provide considerable public health and economic benefit.

scholarly journals Prognostic significance of diabetes mellitus in patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Papazoglou ◽  
A Kartas ◽  
A Samaras ◽  
I Vouloagkas ◽  
E Vrana ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Composite Outcome ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Hba1c Levels

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF. Purpose The purpose of this study was to investigate the association of DM and levels of glycated hemoglobin (HbA1c) with outcomes in patients with AF. Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality, stroke and the composite outcome of CV death or hospitalization. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.44, 95% confidence intervals [CI]: 1.12-1.85), CV mortality (aHR = 1.44, 95% CI: 1.08-1.93), stroke (aHR = 2.62, 95% CI: 1.24-5.53) and the composite outcome of hospitalization or CV death (aHR = 1.28, 95% CI: 1.06-1.54). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values &lt;6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with a 1.5-fold increased risk for all-cause or CV mortality and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates. Follow-up outcomes by presence of DMOutcomeDMNon-DMAdjusted HR(95% CI)p-valueAll-cause death171/373 (45.8%)243/736 (33%)1.44 (1.12-1.85)&lt;0.001CV-death130/373 (34.9%)173/736 (23.5%)1.44 (1.08-1.93)&lt;0.001Major bleeding18/340 (5.3%)29/644 (4.5%)1.53 (0.71-3.28)0.291Stroke24/340 (7.1%)28/645 (4.3%)2.62 (1.24-5.53)0.013AF-related hospitalization59/340 (17.4%)115/645 (17.8%)1.20 (0.78-1.85)0.281HF-related hospitalization35/333 (10.5%)46/640 (7.2%)1.34 (0.83-2.19)0.235Hospitalization or CV-death243/373 (65.1%)399/736(54.2%)1.28 (1.06-1.54)&lt;0.001*Adjusted for: age, gender, smoking, BMI, history of hypertension, eGFR (CKD-EPI) and use of statin, ACEI-ARB, OAC and rate control medication after discharge.DM, diabetes mellitus; HR, hazard ratio; AF, atrial fibrillation; CV, cardiovascular; HF, heart failure.Abstract Figure. Visual overview of the study

scholarly journals Timing of orchidopexy and its relationship to postoperative testicular atrophy: results from the ORCHESTRA study

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
◽  
C Skerritt ◽  
C Bradshaw ◽  
N Hall ◽  
L McCarthy ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Testicular Atrophy ◽  
Wound Infections ◽  
Atrophy Rate ◽  
Younger Age ◽  
Increased Risk ◽  
Hospital Stays ◽  
Reoperation Rates ◽  
International Audit

Abstract Background In 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering the age at orchidopexy to under 1 year. There are concerns that a younger age at operation may increase postoperative testicular atrophy. The ORCHESTRA study aimed to establish the current age at orchidopexy in a multicentre, international audit and to see whether testicular atrophy was affected by age at operation. Methods The study was undertaken over a 3-month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was done using a standardized, predetermined protocol. The primary outcome was postoperative testicular atrophy. Secondary outcomes were wound infections, reoperations, and unplanned hospital stays related to anaesthetic events. Results A total of 417 patients were included, of whom only 48 (11.5 per cent) underwent orchidopexy before 1 year of age. There was no difference in anaesthetic complications in boys aged less than 1 year versus older patients: 0 of 48 (0 per cent) versus 6 of 369 (1.6 per cent) (P = 0.999). Complete follow-up was available for 331 patients (79.4 per cent). There was no difference in atrophy rate between those aged less than 1 year and older boys: 1 of 37 (3 per cent) versus 9 of 294 (3.1 per cent) (P = 0.999). Reoperation rates were 0 of 37 (0 per cent) and 7 of 294 (2.4 per cent) respectively (P = 1.000). There were more wound infections in boys under 1 year of age: 4 of 37 (11 per cent) versus 7 of 294 (2.4 per cent) (P = 0.025). Conclusion Only 11.5 per cent of boys underwent surgery before the age of 1 year. There was no increased risk of postoperative testicular atrophy with early surgery, although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy undertaken in boys aged over 1 year.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

scholarly journals Real-World Clinical Outcomes Associated with Canagliflozin in Patients with Type 2 Diabetes Mellitus in Spain: The Real-Wecan Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2275
Author(s):  
Juan J. Gorgojo-Martínez ◽  
Manuel A. Gargallo-Fernández ◽  
Alba Galdón Sanz-Pastor ◽  
Teresa Antón-Bravo ◽  
Miguel Brito-Sanfiel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Real World ◽  
Primary Outcome ◽  
Baseline Hba1c ◽  
Real World Setting ◽  
Antihyperglycemic Therapy ◽  
The Mean ◽  
Hba1c Levels

The aims of this multicentric retrospective study were to assess in a real-world setting the effectiveness and safety of canagliflozin 100 mg/d (CANA100) as an add-on to the background antihyperglycemic therapy, and to evaluate the intensification of prior sodium–glucose co-transporter type 2 inhibitor (SGLT-2i) therapy by switching to canagliflozin 300 mg/d (CANA300) in patients with T2DM. One cohort of SGLT2i-naïve patients with T2DM who were initiated on CANA100 and a second cohort of patients with prior background SGLT-2i therapy who switched to CANA300 were included in the study. The primary outcome of the study was the mean change in HbA1c over the follow-up time. In total, 583 patients were included—279 in the cohort of CANA100 (HbA1c 8.05%, weight 94.9 kg) and 304 in the cohort of CANA300 (HbA1c 7.51%, weight 92.0 kg). Median follow-up periods in both cohorts were 9.1 and 15.4 months respectively. CANA100 was associated to significant reductions in HbA1c (−0.90%) and weight (−4.1 kg) at the end of the follow-up. In those patients with baseline HbA1c > 8% (mean 9.25%), CANA100 lowered HbA1c levels by 1.51%. In the second cohort, patients switching to CANA300 experienced a significant decrease in HbA1c (−0.35%) and weight (−2.1 kg). In those patients with baseline HbA1c > 8% (mean 8.94%), CANA300 lowered HbA1c levels by 1.12%. There were significant improvements in blood pressure in both cohorts. No unexpected adverse events were reported. In summary, CANA100 (as an add-on therapy) and CANA300 (switching from prior SGLT-2i therapy) significantly improved several cardiometabolic parameters in patients with T2DM.

Multiple biomarkers covering distinct pathways for predicting outcomes after ischemic stroke

Neurology ◽  
2018 ◽  
Vol 92 (4) ◽  
pp. e295-e304 ◽  
Author(s):  
Chongke Zhong ◽  
Zhengbao Zhu ◽  
Aili Wang ◽  
Tan Xu ◽  
Xiaoqing Bu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Complement C3 ◽  
Vascular Events ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
Multiple Biomarkers ◽  
Novel Biomarkers ◽  
Integrated Discrimination Improvement

ObjectiveTo study the prognostic significance of multiple novel biomarkers in combination after ischemic stroke.MethodsWe derived data from the China Antihypertensive Trial in Acute Ischemic Stroke, and 12 informative biomarkers were measured. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.ResultsIn 3,405 participants, 866 participants (25.4%) experienced major disability or died within 3 months. In multivariable analyses, elevated high-sensitive C-reactive protein, complement C3, matrix metalloproteinase-9, hepatocyte growth factor, and antiphosphatidylserine antibodies were individually associated with the primary outcome. Participants with a larger number of elevated biomarkers had increased risk of all study outcomes. The adjusted odds ratios (95% confidence intervals) of participants with 5 elevated biomarkers were 3.88 (2.05–7.36) for the primary outcome, 2.81 (1.49–5.33) for major disability, 5.67 (1.09–29.52) for death, and 4.00 (1.22–13.14) for vascular events, compared to those with no elevated biomarkers. Simultaneously adding these 5 biomarkers to the basic model with traditional risk factors led to substantial reclassification for the combined outcome (net reclassification improvement 28.5%, p < 0.001; integrated discrimination improvement 2.2%, p < 0.001) and vascular events (net reclassification improvement 37.0%, p = 0.001; integrated discrimination improvement 0.8%, p = 0.001).ConclusionWe observed a clear gradient relationship between the numbers of elevated novel biomarkers and risk of major disability, mortality, and vascular events. Incorporation of a combination of multiple biomarkers observed substantially improved the risk stratification for adverse outcomes in ischemic stroke patients.

scholarly journals Association of Body Weight Variability with Adverse Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3381
Author(s):  
Sang Heon Suh ◽  
Tae Ryom Oh ◽  
Hong Sang Choi ◽  
Chang Seong Kim ◽  
Eun Hui Bae ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Body Weight ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Body Weight Gain ◽  
Absolute Difference ◽  
Composite Outcome ◽  
Increased Risk ◽  
All Cause Mortality

To investigate the association of body weight variability (BWV) with adverse cardiovascular (CV) outcomes in patient with pre-dialysis chronic kidney disease (CKD), a total of 1867 participants with pre-dialysis CKD from Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) were analyzed. BWV was defined as the average absolute difference between successive values. The primary outcome was a composite of non-fatal CV events and all-cause mortality. Secondary outcomes were fatal and non-fatal CV events and all-cause mortality. High BWV was associated with increased risk of the composite outcome (adjusted hazard ratio (HR) 1.745, 95% confidence interval (CI) 1.065 to 2.847) as well as fatal and non-fatal CV events (adjusted HR 1.845, 95% CI 1.136 to 2.996) and all-cause mortality (adjusted HR 1.861, 95% CI 1.101 to 3.145). High BWV was associated with increased risk of fatal and non-fatal CV events, even in subjects without significant body weight gain or loss during follow-up periods (adjusted HR 2.755, 95% CI 1.114 to 6.813). In conclusion, high BWV is associated with adverse CV outcomes in patients with pre-dialysis CKD.

Abstract P060: Plasma Osteocalcin And Incident Diabetes Mellitus: The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Jeffrey R Misialek ◽  
Elizabeth R Stremke ◽  
Elizabeth Selvin ◽  
Sanaz Sedaghat ◽  
James S Pankow ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cox Regression ◽  
Self Report ◽  
Incident Diabetes ◽  
Blood Levels ◽  
Total Plasma ◽  
Phone Calls ◽  
Increased Risk ◽  
Primary Model

Introduction: Diabetes is a major risk factor for cardiovascular disease. Osteocalcin is a vitamin K-dependent, bone-derived hormone that functions as an endocrine regulator of energy metabolism, male fertility, and cognition. Early studies of endocrine effects of osteocalcin have shown that genomic deletion of osteocalcin in mice resulted in a diabetic phenotype (i.e. glucose intolerance, and insulin resistance). However, results from clinical studies have shown mixed associations between blood levels of osteocalcin and risk of incident type 2 diabetes mellitus. Hypothesis: Lower values of plasma osteocalcin would be associated with an increased risk of diabetes. Methods: A total of 11,557 ARIC participants without diabetes at baseline were followed from ARIC visit 3 (1993-1995) through 2018. Diabetes cases were identified through self-report on annual and semi-annual follow-up phone calls. Plasma osteocalcin data was measured using an aptamer-based proteomic profiling platform (SomaLogic). We used Cox regression to evaluate the association of quintiles of plasma osteocalcin and incident diabetes. The primary model adjusted for age, sex, and race-center. Results: Participants were age 60 ± 5.6 years at visit 3, 56% identified as female, 21% identified as Black. There were 3,031 incident diabetes cases over a median follow-up of 17.9 years. Mean ± SD was 10.053 ± 0.775. When comparing the highest quintile of plasma osteocalcin (values 10.42 to 14.66) to the lowest quintile (values 9.03 to 9.52), there was no association with incident diabetes (HRs [95% CIs]: 0.92 [0.81, 1.02]). There was also no significant trend across the quintiles (p = 0.19). Results were similar when adjusting for additional potential confounders, and when limiting the follow-up time to 10 years. Conclusions: These data do not support the hypothesis that total plasma osteocalcin, as measured by Somalogic proteomic panel, is a biomarker associated with diabetes risk. It is possible that total plasma or serum osteocalcin and/or other isoforms of osteocalcin protein (i.e. gamma carboxylated or uncarboxylated osteocalcin) measured via other validated methodologies may be linked to diabetes.

Abstract 154: Diabetic Retinopathy and Risk of Stroke: A Secondary Analysis of Accord

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ka-ho Wong ◽  
Cecilia Peterson ◽  
Rock Theodore ◽  
Kinga aitken ◽  
Michael Dela Cruz ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Primary Outcome ◽  
Cox Model ◽  
Secondary Analysis ◽  
Cox Models ◽  
Interaction Terms ◽  
Increased Risk ◽  
Microvascular Pathology ◽  
Fundus Photographs

Background: Diabetic retinopathy is a common microvascular complication of diabetes. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with shared and, possibly, synergistic pathology. Methods: This is a secondary analysis of the subgroup of patients who enrolled in the ACCORD Eye study of ACCORD. The primary outcome is stroke during follow-up. The primary predictor was presence of diabetic retinopathy on the Early Treatment Diabetic Retinopathy Study Severity Scale as assessed from seven-field stereoscopic fundus photographs at study baseline. We fit adjusted Cox models to the primary outcome to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms. Results: We included 2,828 patients with a mean (SD) age of 62.1 years and 61.8% were male. The primary outcome of stroke was met by 117 patients during a mean (SD) of 5.4 (1.8) years of follow-up. Diabetic retinopathy was present in 874/2,828 (30.9%) of patients at baseline, and was more common in patients with stroke versus without stroke (41.0 vs 30.5%, p=0.016). In the Cox model, adjusted for baseline patient age, gender, race, total cholesterol, Hgb A1c, smoking, and randomization arm, we found that diabetic retinopathy remained associated with incident stroke (HR 1.60, 95% CI 1.10-2.32, p=0.015) (Figure 1). This association was not affected by randomization to the ACCORD glucose intervention (p=0.305), lipid intervention (p=0.546), or blood pressure intervention (p=0.422). Conclusion: Diabetic retinopathy is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to diabetic retinopathy has larger cardiovascular implications.

Abstract 16314: Late Survival After Atrial Switch in Transposition of the Great Arteries: Results From a Multi-institutional Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexandra van Dissel ◽  
Alexander Opotowsky ◽  
Jamil Aboulhosn ◽  
Martijn Kauling ◽  
Salil Ginde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplant ◽  
Cumulative Incidence ◽  
Primary Outcome ◽  
Pacemaker Implantation ◽  
Circulatory Support ◽  
Atrial Switch ◽  
Increased Risk ◽  
Late Survival

Background: Although several factors have been cited for risk stratification in patients with simple transposition of the great arteries (dTGA), no single predictor emerges consistently. We aimed to assess survival and determine factors associated with survival in a large cohort of dTGA adults with atrial switch. Methods and Results: We included 1,169 dTGA adults (median age 28.1 years, 38.7% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 9.2 [IQR 5.5-14.2] years, 67 (5.7%) patients died, six (0.5%) patients underwent MCS and 21 (1.8%) had a heart transplant. Cumulative incidence of composite endpoint at 15 years was 12.8% [95% CI 9.8 - 15.7], see Figure). Median age at time of primary outcome was 39.5 [IQR 33.9 - 45.1] years. Leading causes of death were worsening of heart failure (34%), non-cardiac (21%) and sudden unexplained death (12%). In multivariable Cox analyses for baseline variables, age, VSD, ventricular arrhythmia and heart failure admission were each associated with increased risk of the outcome, whereas prior pacemaker (26% of patients) was not. New pacemaker implantation was performed in 107 (9.1%), ICD in 109 (9.3%), and cardiac surgery in 35 (3%) patients. Patients who died were more likely to develop arrhythmias, be admitted for heart failure or require surgery during follow-up. Conclusion: In this large contemporary cohort of dTGA adults after atrial switch, late survival was excellent and seemed to be determined by arrhythmia and heart failure-related complications. Few patients underwent advanced heart failure therapies. Figure. Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 15 years from first visit at an adult congenital heart disease clinic since 2002. Shading represents upper and lower 95% confidence limits.

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