scholarly journals Cardio-Ankle Vascular Index Reflects Impaired Exercise Capacity and Predicts Adverse Prognosis in Patients With Heart Failure

2021 ◽  
Vol 8 ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi Yoshihisa ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Fumiya Anzai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiac Event ◽  
Event Rate ◽  
Characteristic Curve ◽  
Cardiopulmonary Exercise Testing ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiac Events ◽  
Post Discharge ◽  
Cardiac Event Rate

Aims: We aimed to assess the associations of CAVI with exercise capacity in heart failure (HF) patients. In addition, we further examined their prognosis.Methods: We collected the clinical data of 223 patients who had been hospitalized for decompensated HF and had undergone both CAVI and cardiopulmonary exercise testing.Results: For the prediction of an impaired peak oxygen uptake (VO2) of < 14 mL/kg/min, receiver-operating characteristic curve demonstrated that the cutoff value of CAVI was 8.9. In the multivariate logistic regression analysis for predicting impaired peak VO2, high CAVI was found to be an independent factor (odds ratio 2.343, P = 0.045). We divided these patients based on CAVI: the low-CAVI group (CAVI < 8.9, n = 145) and the high-CAVI group (CAVI ≥ 8.9, n = 78). Patient characteristics and post-discharge cardiac events were compared between the two groups. The high-CAVI group was older (69.0 vs. 58.0 years old, P < 0.001) and had lower body mass index (23.0 vs. 24.1 kg/m2, P = 0.013). During the post-discharge follow-up period of median 1,623 days, 58 cardiac events occurred. The Kaplan–Meier analysis demonstrated that the cardiac event rate was higher in the high-CAVI group than in the low-CAVI group (log–rank P = 0.004). The multivariate Cox proportional hazard analysis revealed that high CAVI was an independent predictor of cardiac events (hazard ratio 1.845, P = 0.035).Conclusion: High CAVI is independently associated with impaired exercise capacity and a high cardiac event rate in HF patients.

Abstract 13334: Cardio-ankle Vascular Index Reflects Impaired Exercise Capacity and Predicts Adverse Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Exercise Capacity ◽  
Cardiac Event ◽  
Multiple Logistic Regression Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Laboratory Data ◽  
Stable Condition ◽  
Cardiac Events ◽  
Patients With Heart Failure

Aims: We aimed to clarify the associations of cardio-ankle vascular index (CAVI) with exercise capacity and prognosis in patients with heart failure (HF). Methods and Results: We recruited clinical data of total of 273 patients hospitalized for treatment of decompensated HF, and underwent both CAVI and cardiopulmonary exercise testing at stable condition in prior to hospital discharge. For the prediction of impaired peak oxygen uptake (VO 2 ) of < 14 mL/kg/min, receiver-operating characteristic curve demonstrated that the cutoff value of CAVI was 8.9. According to the multiple logistic regression analysis, high CAVI was independently associated with impaired peak VO 2 (odds ratio 2.055, 95% confidence interval 1.015-3.960, P = 0.045). We divided these patients based on CAVI: the low CAVI group (CAVI < 8.9, n = 178, 65.2%) and the high CAVI group (CAVI ≥ 8.9, n = 95, 34.8%). We compared the patients’ characteristics and cardiac events such as cardiac death and re-hospitalization due to worsening HF between the two groups. The high CAVI group was older (69.0 vs. 58.0 years old, P < 0.001) and showed lower body mass index (22.9 vs. 23.8 kg/m 2 , P = 0.018). With respect to laboratory data, levels of estimated glomerular filtration rate were lower in the high CAVI group than in the low CAVI group (56.1 vs. 64.2 mL/min/1.73 m 2 , P = 0.001). During the post-discharge follow-up period of median 1,544 days, 76 cardiac events occurred. The Kaplan-Meier analysis showed that cardiac event rates was higher in the high CAVI group than in the low CAVI group ( Figure , Log-rank P = 0.021). In the multivariable Cox proportional hazard analysis, high CAVI was found to be an independent predictor of cardiac events (hazard ratio 1.765, 95% confidence interval 1.123-2.773, P = 0.014). Conclusions: High CAVI independently associated with impaired exercise capacity accompanied by a high cardiac event rate in HF patients.

scholarly journals Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Akiomi Yoshihisa ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
Shinji Ishibashi ◽  
Mitsuko Matsuda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Event ◽  
Doppler Ultrasonography ◽  
Event Rate ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Post Discharge ◽  
Cardiac Event Rate

AbstractWe aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n = 341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI ≥ 14.0 cm, n = 231) or low VTI (VTI < 14.0 cm, n = 103); and (B) IRVF patterns: monophasic (n = 36) or non-monophasic (n = 305). We compared post-discharge cardiac event rate between the groups, and right-heart catheterization was performed in 166 patients. Cardiac index was lower in low VTI than in high VTI (P = 0.04), and right atrial pressure was higher in monophasic than in non-monophasic (P = 0.03). In the Kaplan–Meier analysis, cardiac event rate was higher in low VTI and monophasic groups (P < 0.01, respectively). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was a predictor of cardiac events (P < 0.01). IRD imaging might be associated with cardiac output and right atrial pressure, and prognosis.

Cardiac Morbidity and Mortality after Surgery for Gastrointestinal Carcinomas

2005 ◽  
Vol 71 (10) ◽  
pp. 833-836
Author(s):  
Matthew Lin ◽  
Jason Haukoos ◽  
Amir Tahernia ◽  
Christian De Virgilio
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiac Event ◽  
Event Rate ◽  
Cardiac Risk ◽  
Clinical Risk Factors ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
Clinical Risk ◽  
Cardiac Event Rate

The number of Americans undergoing surgery for gastrointestinal (GI) cancer is increasing, as is the prevalence of cardiovascular disease. Clinical risk factors have been found to be useful in predicting cardiac events after vascular procedures. Their utility for predicting cardiac events after GI carcinoma surgery is unclear. We performed a retrospective review in order to determine whether clinical risk factors are useful in predicting cardiac events in patients undergoing GI carcinoma surgery and to ascertain the incidence of postoperative cardiac events. From 1998 to 2003, 333 patients were identified, with an average age of 56 years. One hundred one (30.3%) patients had one or more clinical risk factors. The overall cardiac event rate was 3.9 per cent. Age >70 years was the only risk factor associated with a cardiac event. There was a trend toward increased cardiac risk with increasing number of risk factors. In the absence of clinical risk factors, cardiac events after surgery for GI carcinoma are low. There is an increased cardiac risk in patients >70 years and a trend toward increased cardiac events as the number of clinical risk factors increases.

Abstract 13324: TRACP5b, a Marker of Osteoporosis, is Associated With Adverse Cardiac Events in Hospitalized Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yusuke KIMISHIMA ◽  
Akiomi YOSHIHISA ◽  
Satoshi Abe ◽  
Yasuhiro Ichijo ◽  
Koichiro Watanabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Event ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Cardiac Mortality ◽  
Cardiac Events ◽  
Post Discharge ◽  
Ventricular Ejection Fraction ◽  
Event Rates

Introduction: Tarterate-resistant acid phosphatase type 5b (TRACP5b) is derived from osteoclast, and has been used as a maker of osteoporosis. Although heart failure (HF) is associated with catabolic bone remodeling, serum TRACP5b levels have not been rigorously examined in patients with HF. Methods and Results: We conducted a prospective observational study of 688 decompensated HF patients, and patients were divided into tertiles based on serum TRACP5b levels: 1 st (TRACP5b <316 mU/dL, n = 229), 2 nd (316 ≤ TRACP5b <490 mU/dL, n = 229), and 3 rd (490 mU/dL ≤ TRACP5b, n = 230) tertiles. We compared baseline patients’ characteristics and their post-discharge prognosis including cardiac mortality and cardiac events such as cardiac death and worsening HF. Age was significantly higher, and prevalence of female and anemia was significantly higher in the 3 rd tertile than in the 1 st and 2 nd tertiles (age, 71.9 vs. 64.2 and 67.3 years, P<0.001; female, 50.4% vs. 35.4% and 43.2%, P=0.005; anemia, 54.8% vs. 41.9% and 46.7%, P=0.021). In contrast, left ventricular ejection fraction, prevalence of hypertension, diabetes, chronic kidney disease and atrial fibrillation did not differ among the tertiles. In the Kaplan-Meier analysis ( Figure , mean follow up of 426 days), cardiac mortality and cardiac event rates progressively increased from the 1 st to the 3 rd tertiles (cardiac mortality, 3.1%, 5.2% and 8.7%, log-rank P =0.024; cardiac event rates, 10.9%, 14.0% and 20.4%, log-rank P=0.010). In the multivariable Cox proportional hazard analysis, the 3 rd tertile was found to be an independent predictor of cardiac mortality and cardiac events (cardiac mortality, hazard ratio 1.381, P=0.035; cardiac events, hazard ratio 1.664, P=0.044). Conclusion: High serum levels of TRACP5b, a marker of osteoporosis, is associated with adverse prognosis in HF patients.

Abstract 13330: Intrarenal Doppler Ultrasonography Reflects Hemodynamics and Predicts Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Event ◽  
Doppler Ultrasonography ◽  
Event Rate ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Cardiac Event Rate ◽  
Patients With Heart Failure

Introduction: We aimed to clarify clinical implications of intrarenal hemodynamics (congestion and hypoperfusion) assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in patients with heart failure (HF). Methods and Results: We performed IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n=341). These patients were categorized based on 1) VTI: high VTI (VTI ≥ 14.0 cm, n=231) or low VTI (VTI < 14.0 cm, n=103); and 2) IRVF: monophasic (n=36) or non-monophasic (n=305) pattern. We performed right-heart catheterization, and examined post-discharge cardiac event rate such as cardiac death and rehospitalization due to worsening HF. Regarding renal perfusion, cardiac index was positively correlated with VTI (R=0.270, P=0.040). Concerning renal congestion, levels of right atrial pressure were higher in monophasic pattern than in non-monophasic pattern (9.0 vs. 7.2 mmHg, P=0.029). Importantly, HF patients with low VTI and a monophasic IRVF pattern (subset 4) had the highest cardiac event rate ( Figure ). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was found to be a strong predictor of cardiac events (HR 8.357, 95% CI 3.365-20.752). Conclusion: Intrarenal hypoperfusion and congestion assessed by IRD imaging reflected cardiac output and right atrial pressure, and was useful to risk-stratify HF patients.

scholarly journals High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katsuhiko Ohori ◽  
Toshiyuki Yano ◽  
Satoshi Katano ◽  
Hidemichi Kouzu ◽  
Suguru Honma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Fat ◽  
Fat Mass ◽  
Cardiac Event ◽  
Muscle Wasting ◽  
Obesity Paradox ◽  
Percent Body Fat ◽  
Body Fat Mass ◽  
Cardiac Events ◽  
Kaplan Meier

Abstract Background Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. Methods We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. Results The median age of the patients was 76 years (interquartile range [IQR], 67–82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33–63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22–0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function. Conclusions High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients.

Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan Myers ◽  
Ross Arena ◽  
Daniel Bensimhon ◽  
Joshua Abella ◽  
Leon Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Heart Rate Recovery ◽  
Full Range ◽  
Cardiopulmonary Exercise Testing ◽  
Relative Weight ◽  
Cox Proportional Hazards ◽  
Cardiac Events ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

Abstract 17499: Addition of Myocardial Parameters to the Diagnosis of Stage B Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tom Marwick ◽  
Wojciech Kosmala ◽  
Christine Jellis
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Exercise Capacity ◽  
Beta Blockers ◽  
Cardiopulmonary Exercise Testing ◽  
Structural Heart Disease ◽  
Filling Pressure ◽  
Ischemic Heart

Introduction: Stage B heart failure (BHF, asymptomatic structural heart disease) is diagnosed in the presence of myocardial scar or impaired LVEF. However, the insensitivity of LVEF may lead to under-recognition of BHF in non-ischemic heart disease. This may be important, as BHF may precede the onset of HF symptoms, and necessitates the initiation of treatment. We sought the implications of using additional LV assessment to identify BHF in pts at risk of HF (stage A HF, AHF). Methods: We studied 510 asymptomatic pts (age 58±12yrs) with AHF (diabetes, hypertension or obesity), but no history of ischemic heart disease and a normal stress echo. All pts underwent echocardiography (including assessment of strain and diastolic dysfunction) and cardiopulmonary exercise testing. Results: BHF was defined as the presence of at least one of; reduced LV longitudinal strain (<18%), increased LV filling pressure (E/e’>13) or moderate-to-severe LV hypertrophy (LV mass index ≥109 g/m 2 in women and 132 g/m 2 in men) in 243 patients (47%). Reduced exercise capacity (peakVO 2 and METS) was identified in BHF compared with other AHF (Table). Using this definition, BHF was associated with lower peak VO 2 (β=-0.20, p<0.00001) and METS (β=-0.21, p<0.0001), independent of higher BMI, insulin resistance, older patient age, male sex and treatment with beta-blockers. Conclusions: LV hypertrophy, elevated LV filling pressure elevation and abnormal myocardial deformation independently contribute to lower exercise capacity in pts at risk of HF. Given the association of exercise capacity with outcome, these factors should be considered grounds for the diagnosis of BHF.

Abstract 3281: The Prognostic Characteristics of Cardiopulmonary Exercise Testing in Caucasian and African-American Patients with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ross Arena ◽  
Jonathan Myers ◽  
Mary Ann Peberdy ◽  
Daniel Bensimhon ◽  
Paul Chase ◽  
...  
Keyword(s):  
African American ◽  
Exercise Testing ◽  
Event Rate ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Assist Device ◽  
Heart Transplants ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Introduction: Peak oxygen consumption (VO 2 ) and the minute ventilation (VE)/carbon dioxide production (VCO 2 ) slope are prognostically important in the heart failure (HF) population. Hypothesis: We assessed the hypothesis that the prognostic characteristics of peak VO 2 and the VE/VCO 2 slope would be comparable between Caucasian and African-American subjects with HF. Methods: Four hundred and ninety one HF patients (339 Caucasian/152 African-American) underwent cardiopulmonary exercise testing and were tracked for major cardiac events for three years. Results: The following comparisons are reported as Caucasian vs. African-American subgroups, respectively. Age (56.7 ±14.4 vs. 47.1 ±13.4 years, p<0.001) and ejection fraction (30.6 ±12.9 vs. 25.2 ±11.7%, p<0.001) were significantly lower in the African-American subgroup. Peak VO 2 (15.7 ± 5.6 vs. 14.8 ± 5.7 mlO 2 ·kg −1 ·min −1 , p<0.11) and the VE/VCO 2 slope (35.4 ±9.8 vs. 36.8 ±9.7, p=0.15) were not significantly different. There were 44 (annual event rate: 8.3%) major cardiac events (25 deaths/14 heart transplants/5 left ventricular assist device implantations) in the Caucasian subgroup and 25 (annual event rate: 10.1%) major cardiac events (18 deaths/5 heart transplants/2 left ventricular assist device implantations) in the African-American subgroup. Receiver operating characteristic (ROC) curve analysis and hazard ratios for exercise test variables are listed in Table 1 . Peak VO 2 and the VE/VCO 2 slope were prognostically significant in both subgroups. Conclusions: Despite differences in baseline characteristics between Caucasian and African-American subjects, the optimal prognostic threshold values of established exercise testing variables were similar. The VE/VCO 2 slope was the superior prognostic marker in both subgroups. While, peak VO 2 was prognostically significant in Caucasian and African-American subjects, its value was diminished in the latter subgroup.

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