scholarly journals Aortic Arch Calcification Is Associated With Death From Cardiovascular Disease, Infection, and Malnutrition in Patients on Hemodialysis: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Toyohiro Hashiba ◽  
Mototsugu Tanaka ◽  
Tomoko Honda ◽  
Satoru Kishi ◽  
Yoshiyasu Ogura ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Aortic Arch ◽  
Causes Of Death ◽  
Entire Cohort ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Long Term Prognosis ◽  
Grade 3 ◽  
Aortic Arch Calcification

Abstract Background: Aortic arch calcification (AAC) is a well-known risk factor of death in patients on hemodialysis (HD); however, the causes of death in those having severe AAC have not been well studied. This study aimed to clarify the association between AAC and causes of death in HD patients and investigate their long-term prognosis.Methods: A retrospective observational study was conducted on Japanese HD patients from two clinics. AAC was classified into grade 0 to 3 using chest radiograph. The patients were followed up to 7 years, and their mortality and causes of death were recorded. The Kaplan-Meier method was used to estimate the probabilities of death from any cause and cardiovascular disease (CVD) death. The Cox proportional hazard models were employed to investigate variables relevant to all-cause mortality.Results: Among 321 patients (211 male, 64 ± 11 years old, 10 ± 8 years of dialysis duration), AAC grade 0, 1, 2, and 3 were observed in 88 (27.4%), 145 (45.2%), 54 (16.8%), and 34 (10.6%), respectively. During 5.2 ± 2.1 years, 117 (36.4%) patients died. AAC was associated with all-cause mortality (p < .001), and the death rates in AAC grade 0, 1, 2, and 3 were 19.3%, 35.2%, 46.3%, and 70.6%, respectively. In multivariate analysis, grade 3 AAC, age, ischemic heart disease and C-reactive protein were independent risk factors for all-cause mortality. The major causes of death were CVD (39.3%), infection (20.5%), and malignant tumor (15.4%) in the entire cohort. In AAC grade 3, death from infection (29.2%) and malnutrition (16.7%) increased and the combined death from these 2 reasons outweighed CVD death (33.3%).Conclusions: Although AAC was associated with all-cause and CVD mortality, the causes of death in patients on HD much differ among different AAC severities. Attention should be paid to CVD, infection, and malnutrition in patients on HD with severe AAC.

scholarly journals Deterioration of Cerebral Oxygenation by Aortic Arch Calcification Progression in Patients Undergoing Hemodialysis: A Cross-Sectional Study

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Kiyonori Ito ◽  
Susumu Ookawara ◽  
Tomohisa Okochi ◽  
Yuichiro Ueda ◽  
Masaya Kofuji ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Oxygenation ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Serum Phosphate ◽  
Phosphate Level ◽  
Serum Phosphate Level ◽  
History Of ◽  
Grade 3 ◽  
Aortic Arch Calcification

Background. Near-infrared spectroscopy revealed that the regional saturation of oxygen (rSO2) in cerebral tissue is lower in hemodialysis (HD) patients than in healthy subjects. However, no study has examined the changes in cerebral oxygenation by aortic arch calcification (AAC) progression in HD patients. Methods. A total of 104 HD patients were divided into four groups by AAC grade determined using chest radiography: 23 patients at grade 0, 24 at grade 1, 30 at grade 2, and 27 at grade 3. Differences in clinical parameters, including cerebral rSO2, among AAC grades were investigated and atherosclerotic parameters affecting cerebral rSO2 values were identified. Results. Cerebral rSO2 significantly decreased as AAC progressed (AAC grade 3 versus grade 0, p<0.01 versus grade 1, p<0.05). Multivariate logistic regression analysis was performed using parameters with p values < 0.20 in univariate analysis between cerebral rSO2 values less than the mean and atherosclerotic parameters. AAC grades 2 and 3, serum phosphate level, and history of smoking were factors associated with the cerebral rSO2 decrease. Conclusions. Cerebral rSO2 significantly decreased as AAC progressed and was independently associated with higher AAC grade, serum phosphate level, and history of smoking.

Outcomes with rituximab plus bendamustine (R-Benda), dexamethasone, rituximab, cyclophosphamide (DRC), and bortezomib, dexamethasone, rituximab (BDR) as primary therapy in patients with Waldenstrom macroglobulinemia (WM).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 7509-7509 ◽  
Author(s):  
Jithma P. Abeykoon ◽  
Saurabh Zanwar ◽  
Stephen M. Ansell ◽  
Shaji Kumar ◽  
Carrie A. Thompson ◽  
...  
Keyword(s):  
Primary Therapy ◽  
Time To Event ◽  
Waldenström Macroglobulinemia ◽  
Entire Cohort ◽  
Waldenstrom Macroglobulinemia ◽  
Kaplan Meier ◽  
Baseline Characteristics ◽  
Frontline Therapy ◽  
Grade 3

7509 Background: Waldenstrom macroglobulinemia (WM) is a rare lymphoma for which scant comparative data exist to guide frontline therapy. Herein, we compare 3 commonly used regimens in WM: R-Benda, DRC, and BDR in frontline setting. Methods: Patients (Pts) with active WM seen at Mayo Clinic between 2000 & 2018 who received R-Benda, DRC or BDR as primary therapy were included in this retrospective study. Response rates were assessed by Consensus Criteria. All time to event analyses were performed from the frontline therapy, using Kaplan-Meier method. Results: The study included 172 pts with active WM (R-Benda, n=67, DRC, n=75, BDR, n=30).The median follow-up for the entire cohort was 3.7 years (y) (95% CI 3.7-3.0). Baseline characteristics, including IPSS, and time to frontline therapy from WM diagnosis were similar across the 3 cohorts. Clinically relevant endpoints are shown in the Table. Hematologic and non-hematologic toxicities were similar across the 3 groups. Grade 3 neuropathy requiring treatment discontinuation was encountered in 13% pts treated with BDR. 56 pts received subsequent salvage therapy [(10% in R-Benda arm, 44% in DRC arm, & 53% in BDR arm]; 29% pts in the R-Benda arm and 30% pts in DRC arm received a PI-based regimen while 69% pts in the BDR arm received alkylator-rituximab based therapy. Conclusions: Outcomes (MRR, TTNT and EFS) with frontline R-Benda are superior in comparison to frontline DRC or BDR in patients with WM. Clinically relevant endpoints are not significantly different with DRC vs. BDR. The toxicity profile across the 3 groups was comparable. [Table: see text]

scholarly journals Digitalis Therapy in Patients With Ventricular Tachyarrhythmias

2021 ◽  
Author(s):  
Tobias Schupp ◽  
Max von Zworowsky ◽  
Bican Karaca ◽  
Linda Reiser ◽  
Mohammad Abumayyaleh ◽  
...  
Keyword(s):  
Cox Regression ◽  
Composite Endpoint ◽  
Ventricular Tachyarrhythmias ◽  
Digitalis Therapy ◽  
Kaplan Meier ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Secondary Endpoints ◽  
Prognostic Outcome ◽  
Long Term Prognosis

Abstract Objective: The study sought to assess the prognostic value of treatment with digitalis on long-term prognosis in patients with ventricular tachyarrhythmias and atrial fibrillation (AF) and/or heart failure (HF).Background: Data regarding outcome of digitalis therapy following ventricular tachyarrhythmias is limited.Methods: A large retrospective registry was used including consecutive patients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with digitalis were compared to patients without. The primary prognostic outcome was all-cause mortality at three years, secondary endpoints comprised of a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, sudden cardiac death) and cardiac rehospitalization. Kaplan Meier, multivariable cox regression and time trend analyses were applied for statistics.Results: A total of 831 patients were included (20% treated with digitalis and 80% without). At three years, digitalis treatment was not associated with all-cause mortality in patients with ventricular tachyarrhythmias (24% vs. 21%, log rank p=0.736; HR=1.063; 95% CI 0.746-1.515; p=0.736). However, digitalis therapy was associated with increased risk of the composite endpoint (38% vs. 23%; log rank p=0.001; HR=1.719; 95% CI 1.279-2.311; p=0.001) and cardiac rehospitalization (31% vs. 18%; log rank p=0.001; HR=1.829; 95% CI 1.318-2.538; p=0.001) at three years, which was still evident within multivariable Cox regression analyses. Finally, digitoxin was associated with worse prognosis than digoxin.Conclusion: Digitalis therapy was not associated mortality in patients with ventricular tachyarrhythmias, but with increased risk of the composite arrhythmic endpoint and cardiac rehospitalization at three years.

P2514Pupillary area predicts all-cause mortality in patients with cardiovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Nozaki ◽  
K Kamiya ◽  
N Hamazaki ◽  
R Matsuzawa ◽  
T Ichikawa ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Cox Regression ◽  
Independent Predictor ◽  
Area Measurement ◽  
Rank Tests ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Background Autonomic dysfunction is among the most important pathophysiological factors involved in the high mortality rate associated with cardiovascular disease (CVD). Autonomic function is generally evaluated by heart rate variability, which is obtained by Holter electrocardiography. However, the measurement of heart rate variability requires continuous electrocardiographic monitoring for 24 h, which is time consuming and not always feasible. The pupillary area is controlled by the autonomic nervous system; however, limited data are available regarding the utility of the pupillary area for predicting prognosis in patients with CVD. Purpose We aimed to investigate whether pupillary area can be used as a novel prognostic marker in patients with CVD. Methods We retrospectively reviewed 1342 consecutive Japanese patients hospitalized for CVD. The study was performed in accordance with the tenets of the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of our University Hospital. The pupillary area measurement was performed on both eyes at least 7 days after hospitalization for CVD using a portable videopupillography system (Iriscorder Dual C10641; Hamamatsu Photonics, Hamamatsu, Japan) consisting of a goggle-shaped measurement portion with a charge-coupled device camera and a control portion with a video monitor and microcomputer with software for data analysis. After securing the goggles on the patient's face and fully covering the patient's eyes, a 5-minute period was allowed for dark adaptation. All patients were tested once between 09:00 and 12:00 h. The primary outcome of this study was all-cause mortality, and the endpoint time was calculated as the number of days from the date of pupillary area measurement up to three years. We performed the Kaplan–Meier and log-rank tests and multivariable Cox regression analysis to evaluate the prognostic predictive capability of the pupillary area. Results The study population had a mean age of 65±13 years, and 69.4% of the patients were male. The median of the pupillary area was 18.5 mm2 (interquartile range: 13.3–23.4 mm2). Over a median follow-up period of 1.9 years (interquartile range: 1.0–3.0 years), a total of 114 deaths occurred in the patient population. The Kaplan–Meier and log-rank tests revealed that all-cause mortality was significantly higher in the small pupillary area group than in the large pupillary area group (P<0.0001, Figure). Furthermore, Cox regression analysis indicated that the pupillary area was an independent predictor of mortality (Hazard ratio: 0.96; 95% confidence interval: 0.93–0.98; P=0.006) even after adjusting for several preexisting prognostic factors. Kaplan-Meire Curve Conclusion The pupillary area can be an independent predictor of prognosis in patients with CVD, and our observations suggest that the assessment of the pupillary area can be useful as a new noninvasive prognostic predictor in patients with CVD.

scholarly journals Growth Differentiation Factor 15 May Predict Mortality of Peripheral and Coronary Artery Diseases and Correlate with Their Risk Factors

2017 ◽  
Vol 2017 ◽  
pp. 1-13 ◽  
Author(s):  
Lung-An Hsu ◽  
Semon Wu ◽  
Jyh-Ming Jimmy Juang ◽  
Fu-Tien Chiang ◽  
Ming-Sheng Teng ◽  
...  
Keyword(s):  
Systemic Disease ◽  
Lipocalin 2 ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
High Level ◽  
Circulating Levels ◽  
And Oxidative Stress

Plasma GDF15 concentrations were measured in 612 Taiwanese individuals without overt systemic disease. Clinical parameters, GDF15 genetic variants, and 22 biomarker levels were analyzed. We further enrolled 86 patients with PAD and 481 patients with CAD, who received endovascular intervention and coronary angiography, respectively, to examine the role of GDF15 level in predicting all-cause mortality. Significant associations were found between GDF15 genotypes/haplotypes and GDF15 levels. The circulating GDF15 level was positively associated with age, smoking, hypertension, and diabetes mellitus as well as circulating levels of lipocalin 2 and various biomarkers of inflammation and oxidative stress. Kaplan-Meier survival analysis showed that baseline GDF15 levels of above 3096 pg/mL and 1123 pg/mL were strong predictors of death for patients with PAD and CAD, respectively (P=0.011 and P<0.001). GDF15 more accurately reclassified 17.3% and 29.2% of patients with PAD and CAD, respectively (P=0.0046 and P=0.0197), compared to C-reactive protein. Both genetic and nongenetic factors, including cardiometabolic and inflammatory markers and adipokines, were significantly associated with GDF15 level. A high level of GDF15 was significantly associated with an increase of all-cause mortality in patients with high-risk PAD and in patients with angiographically documented CAD.

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