Multicenter Prospective Cohort on Aortic Valve Stenosis in Japanese Patients With End Stage Kidney Disease in Tokai Region (ASKIT)

Abstract Background:The prevalence of aortic valve stenosis (AS) in patients on maintenance dialysis is high and the prognosis is poor. Because only few large cohort studies have analyzed patients with AS on dialysis, the factors that cause AS in such patients remain unclear.Methods:This multicenter, prospective cohort study included 2,786 patients on dialysis who underwent transthoracic echocardiography between July 1, 2017 and June 30, 2018. Patients with a maximum aortic jet velocity (Vmax) ≥2.0 m/s, pressure gradient (PG) between the left ventricle and ascending aorta (mean PG) ≥20 mmHg, or aortic valve area (AVA) ≤1.0 cm2 were categorized into the AS group. Of these, patients with Vmax ≥3.0 m/s, mean PG ≥20 mmHg, or AVA ≤1.0 cm2 were categorized into the severe AS group. The AS and severe AS groups were then compared with the non-AS group to identify the risk factors for AS using multivariate logistic analysis. We also compared the risk factors for AS with and without aortic valve calcification, which is the stage prior to age-related AS.Results:Of the 2,786 patients analyzed, 555 (20.0%) and 139 (6.9%) were categorized into the AS and severe AS groups, respectively. Multivariate logistic analysis revealed that aging, long-term dialysis, and elevated serum phosphorus levels were associated with AS in the AS and severe AS groups (p <0.05). Additional investigation using stratified multivariate analysis revealed that groups with serum phosphorus levels of 5.0–5.9 mg/dL and >6.0 mg/dL had a higher risk of AS than those with serum phosphorus levels of <4.0 mg/dL (odds ratio: 2.24; p = 0.01 and odds ratio: 2.66, p = 0.005, respectively). Aortic valve calcification was associated with aging, long-term dialysis, diabetes mellitus, administration of vitamin D receptor activators, elevated serum calcium levels, and anemia (p <0.05 for all).Conclusions:Dialysis patients had a high prevalence of AS, and AS was associated with aging, long dialysis duration, and elevated serum phosphorus levels.Trial registration: UMIN000026756, Registered on March 29, 2017.

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Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00248-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daiki Sakai ◽

Wataru Matsumiya ◽

Sentaro Kusuhara ◽

Makoto Nakamura

Keyword(s):

Candida Albicans ◽

Medical Records ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Patient Characteristics ◽

Antifungal Drugs ◽

Factors Associated ◽

Logistic Analysis ◽

Multivariate Logistic Analysis ◽

Systemic Antifungal Therapy

Abstract Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

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Abstract 17124: Aortic Valve Calcification as a Predictor of Post-TAVR Pacemaker Dependence

Circulation ◽

10.1161/circ.138.suppl_1.17124 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Esseim Sharma ◽

Antony F Chu ◽

Brian D McCauley

Keyword(s):

Aortic Valve ◽

Rhode Island ◽

Aortic Valve Calcification ◽

Valve Calcification ◽

Tissue Edema ◽

Number Of Patients ◽

Increased Risk ◽

Rv Pacing ◽

Enhanced Computed Tomography

Introduction: Atrioventricular block requiring permanent pacemaker (PPM) implantation is a common complication of TAVR. Our group has previously reported that a significant number of patients receiving PPM immediately post-TAVR do not require right ventricular (RV) pacing at 30 days. The mechanism of AV block during TAVR is not fully understood, but is thought to partly be due to the mechanical stress of TAVR deployment and resultant tissue edema, resulting in possible injury to the nearby compact AV node. Aortic valve calcification (AVC) may worsen this condition and has been associated with an increased risk for post-TAVR PPM implantation. We performed a retrospective analysis to determine if AVC is predictive for long-term RV pacing in post-TAVR pacemaker patients at 30 days. Methods: Prospectively collected data of 262 consecutive patients who underwent TAVR with placement of a balloon-expandable valve at Rhode Island Hospital from March 2012 to October 2016 were analyzed. AVC data were derived from contrast-enhanced computed tomography and characterized by leaflet sector and region. Results: A total of 25 patients (11.1%) required post-TAVR PPM implantation. Seventeen patients did not require RV pacing at 30 days. Nine of these 17 patients had no RV pacing requirement within 10 days. Non-coronary leaflet (NCL) calcium volume was significantly higher in patients who were pacemaker dependent at 30 days ( p =0.01) and a calcium volume of >200mm 3 in the NCL was significantly associated with pacemaker dependence at 30 days (OR 51.9, 2.3-1170.2, p = 0.01). Pre-existing RBBB (OR 105.4, 4.52-2458.5, p=0.0002), bifascicular block (OR 12.50, 1.60-97.65, p=0.02), intra-procedural complete heart block (OR 12.83, 1.26-130.52, p =0.03), and QRS duration >120ms (OR 70.43, 3.23-1535.22, p=0.0002) were also significantly associated with pacemaker dependence at 30 days. Conclusions: Quantification of AVC by non-coronary leaflet calcium volume was found to be a novel predictor for RV pacing dependence at 30 days. The association of NCL calcification and pacemaker dependence may be related to the proximity of the conduction bundle to the non-coronary leaflet. Further studies are necessary to improve risk prediction for long-term RV pacing requirements following TAVR.

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Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphate binder among hemodialysis patients: a historical cohort study

BMC Nephrology ◽

10.1186/s12882-019-1582-9 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Kamyar Kalantar-Zadeh ◽

Linda H. Ficociello ◽

Vidhya Parameswaran ◽

Nicolaos V. Athienites ◽

Claudy Mullon ◽

...

Keyword(s):

Serum Albumin ◽

Dietary Intake ◽

Phosphate Binder ◽

Clinical Care ◽

Elevated Serum ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Pill Burden ◽

Historical Cohort ◽

Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein. Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients (N = 79) switched to SO were also examined. Results SO therapy was associated with a mean reduction of 45.7 and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively (P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group. Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

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Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation

Cardiosomatics ◽

10.26442/22217185.2020.2.200098 ◽

2020 ◽

Vol 11 (2) ◽

pp. 28-34

Author(s):

Vladlen V. Bazylev ◽

Dmitrii S. Tungusov ◽

Ruslan M. Babukov ◽

Fedor L. Bartosh ◽

Artur I. Mikulyаk ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Odds Ratio ◽

Low Flow ◽

Normal Flow ◽

Long Term Follow Up ◽

Group 2 ◽

Long Term Mortality

Relevance.It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currently no comparative studies of patients with NFHG and LFLG after the Ozaki procedure. The better hemodynamic properties of autopericardial cusps compared with biological prostheses can more favorably influence the results in patients with LFLG in the short and long-term follow-up periods. Aim.1. Compare the hospit and long-term results of patients of the LFLG group with the results of patients of the NFHG group after the Ozaki procedure. 2. Identify predictors of hospital and long-term mortality in patients with LFLG. Materials and methods.All patients have been divided into two groups. Group 1: 137 patients with NFHG and signs of classic aortic stenosis: AVA1 cm2, Gmean40, SV index 35 ml/m2and normal left ventricle (LV) ejection fraction. Group 2. 71 patients with LFLG and underestimation of the average gradient indices (Gmean40) despite a decrease in the aortic valve aperture AVA1 cm2amid a decrease in the index of stroke volume 35 ml/m2and LV systolic function. Results.Hospital mortality after surgical correction of AV stenosis was significantly higher in patients of group 2: 3 (4.2%) patients and 1 (0.7%) patients, respectively (p=0.002). Survival at the maximum follow-up period for patients with LFLG was significantly lower than in the group of patients with NFHG 88.6 (95% confidence interval CI 4449.6) and 97.8 (95% CI 48.951), respectively (p=0.009). According to the results of the Cox regression analysis, the independent predictors of mortality in the long-term follow-up of patients with LFLG are the SV odds ratio 0.8 (95% CI 0.91.1);p=0.008 and the global longitudinal LV deformation (GLS) odds ratio 0.56 (95% CI 0.471.1);p=0.01. Conclusions.1. After the Ozaki procedure, patients with the LFLG group have higher risks of adverse events, both at the hospital stage and in the long-term follow-up, compared to patients with NFHG. 2. The duration of ischemia and LV mass are predictors of hospital mortality in the LFLG group of patients. 3. Predictors of long-term mortality in patients with LFLG are LV stroke volume index and global longitudinal LV deformation.

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Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphorus binder among hemodialysis patients: a historical cohort study

10.21203/rs.2.13440/v1 ◽

2019 ◽

Author(s):

Kamyar Kalantar-Zadeh ◽

Linda H Ficociello ◽

Vidhya Parameswaran ◽

Nicolaos V. Athienites ◽

Claudy Mullon ◽

...

Keyword(s):

Serum Albumin ◽

Dietary Intake ◽

Phosphate Binder ◽

Clinical Care ◽

Elevated Serum ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Pill Burden ◽

Historical Cohort ◽

Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein.Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients ( N = 79) switched to SO were also examined.Results SO therapy was associated with a mean reduction of 45.7% and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively ( P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group.Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

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Association between Near Work Time and Depression among Workers in South Korea

Korean Journal of Family Medicine ◽

10.4082/kjfm.20.0217 ◽

2021 ◽

Vol 42 (5) ◽

pp. 390-394

Author(s):

Na Rae Jeong ◽

Seung Hun Lee ◽

Yun Jin Kim ◽

Jeong Gyu Lee ◽

Yu Hyeon Yi ◽

...

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Reference Group ◽

Nutrition Examination Survey ◽

Work Time ◽

Logistic Analysis ◽

Health And Nutrition ◽

Patient Health ◽

Near Work ◽

Multivariate Logistic Analysis

Background: The aim of this study was to evaluate the association between near work time and depression. Methods: Data of 1,551 workers aged 19–49 years from the sixth Korea National Health and Nutrition Examination Survey were examined. The Patient Health Questionaire-9 scores were used to screen for depression. Participants who scored a total of 10 or above, which is suggestive of the presence of depression, were classified as the depression group; the rest were classified as normal. The correlation between daily near work time and depression was analyzed using multivariate logistic analysis after adjusting for other sociodemographic and health behavior-related variables. Results: Multivariate logistic analysis found that workers with 3 or more hours of near work were more likely to report depression compared to the reference group who had 2 or fewer hours per day of near work (adjusted odds ratio, 2.471; 95% confidence interval, 1.062–5.747). Conclusion: Longer near work time was associated with depression among South Korea’s workers. Therefore, it is necessary to reduce near work time to prevent depression.

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Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphorus binder among hemodialysis patients: a historical cohort study

10.21203/rs.2.13440/v2 ◽

2019 ◽

Author(s):

Kamyar Kalantar-Zadeh ◽

Linda H Ficociello ◽

Vidhya Parameswaran ◽

Nicolaos V. Athienites ◽

Claudy Mullon ◽

...

Keyword(s):

Serum Albumin ◽

Dietary Intake ◽

Phosphate Binder ◽

Clinical Care ◽

Elevated Serum ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Pill Burden ◽

Historical Cohort ◽

Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein.Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients ( N = 79) switched to SO were also examined.Results SO therapy was associated with a mean reduction of 45.7% and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively ( P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group.Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

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P1353Echocardiographic predictor of sick sinus syndrome following catheter ablation of persistent atrial fibrillation

EP Europace ◽

10.1093/europace/euaa162.107 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Yoshie ◽

A Okada ◽

S Seki ◽

H Tabata ◽

W Shoin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Odds Ratio ◽

Sick Sinus Syndrome ◽

Independent Predictor ◽

Persistent Atrial Fibrillation ◽

Logistic Analysis ◽

Baseline Characteristics ◽

And Gender ◽

Multivariate Logistic Analysis

Abstract Funding Acknowledgements Abbott Medical Japan, Medtronic Japan, Boston Scientific Japan, Biotronic Japan, Japan Life Line Background / Introduction Although sick sinus syndrome(SSS) can be associated with atrial fibrillation(AF), predictive factors of SSS following catheter ablation(CA) of persistent atrial fibrillation(perAF) are not well known. Purpose We investigated echocardiographic parameters to predict occurrence of SSS after restoration of sinus rhythm by CA for perAF patients. Methods Ninety-eight consecutive perAF patients from June 2014 to May 2018 treated with CA were retrospectively reviewed. Twelve patients(12%, SSS group) developed SSS after successful CA and 86 patients(88%, non-SSS group) did not. Baseline characteristics, blood exam, and echocardiographic findings(RA area size, LA area size, EF, etc) before AF CA were analyzed using Student’s t test, Mann-Whitney test, Chi-square test and Univariate analysis. Multivariate logistic analysis was then performed using those parameters. The atrial area size was calculated from 4 chamber view at the atrial end- systole. Results The multivariate analysis for predictive factors of SSS is shown in the table. Right atrium(RA) area could predict SSS(17.3 ± 4.8cm2 vs. 14.7 ± 3.6cm2, odds ratio 1.468; 95% confidence interval 1.088 to 1.981, p = 0.012). Gender (female) was also an independent predictor(4/12 (33%) vs. 8/86 (9%), odds ratio 39.832; 95% confidence interval 2.589 to 612.938, p = 0.008). The other echocardiographical findings(LA area size, EF, etc), baseline characteristics and blood exam results were not related to SSS after successful CA of perAF patients. Conclusions The large RA area size and gender (female) could predict SSS in perAF patients after restoration of sinus rhythm by successful CA. We may need to inform possible SSS after CA to female patients with a large RA before CA. Multivariate Logistic analysis Total(N = 98) SSS group (N = 12) Non SSS group (N = 86) Odds ratio 95% CI P-value Age 64(58-69) 68(60-72) 63(57-69) 1.032 0.929-1.145 0.560 Gender/Female 12(12%) 4(33%) 8(9%) 39.832 2.589-612.938 0.008 CKD 27(28%) 6(50%) 21(24%) 1.264 0.179-8.945 0.814 BNP 91(53-180) 206(167-304) 82(48-169) 1.003 0.993-1.012 0.609 RDW 45.1 ± 3.9 46.4 ± 4.8 44.9 ± 3.8 1.242 0.971-1.588 0.085 RA area 15.1 ± 3.8 17.3 ± 4.8 14.7 ± 3.6 1.468 1.088-1.981 0.012 LA area 24.2(17.0-24.9) 24.4(17.7-26.3) 24.1(16.8-24.4) 0.967 0.803-1.165 0.726 Right atrium area and gender were the independent predictor of SSS in persistent atrial fibrillation patients after restoration of sinus rhythm

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Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphorus binder among hemodialysis patients: a historical cohort study

10.21203/rs.2.13440/v3 ◽

2019 ◽

Author(s):

Kamyar Kalantar-Zadeh ◽

Linda H Ficociello ◽

Vidhya Parameswaran ◽

Nicolaos V. Athienites ◽

Claudy Mullon ◽

...

Keyword(s):

Serum Albumin ◽

Dietary Intake ◽

Phosphate Binder ◽

Clinical Care ◽

Elevated Serum ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Pill Burden ◽

Historical Cohort ◽

Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein.Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients ( N = 79) switched to SO were also examined.Results SO therapy was associated with a mean reduction of 45.7% and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively ( P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group.Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

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Higher levels of serum phosphorus are associated with coronary calcification post heart transplantation

European Heart Journal ◽

10.1093/eurheartj/ehab724.2271 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Ozcan ◽

T Toya ◽

M T Corban ◽

A Ahmad ◽

V Nardi ◽

...

Keyword(s):

Coronary Artery ◽

Heart Transplantation ◽

Coronary Calcification ◽

Serum Phosphorus ◽

Normal Range ◽

Funding Sources ◽

Recipient Age ◽

Group Serum ◽

Phosphorus Levels

Abstract Background A higher serum phosphorus level, although within the normal range has been linked to coronary artery and aortic calcification in the non-transplant population. Coronary calcification is mostly associated with donor-derived lesions, and is uncommon within the first years after heart transplantation. Purpose We aimed to investigate the association of phosphorus levels with plaque calcification after heart transplantation. Methods A total of 156 patients who underwent virtual histology intravascular ultrasound (VH-IVUS) studies for cardiac allograft vasculopathy (CAV) surveillance and had fasting serum phosphorus levels <4.5 mg/dL, were included in the analyses. IVUS analyses were performed in the proximal left anterior descending artery, and plaque composition of dense calcium (DC) was evaluated using VH-IVUS, and presented as percent DC of total plaque volume. The patients were separated into 3 groups according to tertiles of serum phosphorus levels. Results Mean recipient and donor ages were 54±13 and 31±14 years, respectively. Mean serum phosphorus in recipients was 3.5±0.6 mg/dL, with median time after transplantation at the IVUS studies of 6 (3,10) years. There were no significant differences in %DC between phosphorus tertiles in patients who underwent IVUS within 6 years after transplantation (p=0.11, Fig. 1A). However, beyond 6 years after transplantation, we observed an incremental association between phosphorus levels and the extent of calcification (p=0.02, Fig. 1B). In this group, serum phosphorus levels significantly correlated with %DC (standardized β=0.29, P=0.008), and this correlation remained significant after adjustment for donor age, recipient age, and eGFR (standardized β=0.26, P=0.001). Conclusion Higher serum phosphorus levels were associated with a level-dependent increase in calcified coronary artery plaque in patients starting 6 years post heart transplant. Long-term exposure to higher serum phosphorus, even within the normal range, might promote plaque calcification after heart transplantation. FUNDunding Acknowledgement Type of funding sources: None.

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