scholarly journals Left Atrioventricular Coupling Index to Predict Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Theo Pezel ◽  
Bharath Ambale Venkatesh ◽  
Yoko Kato ◽  
Henrique Doria De Vasconcellos ◽  
Susan R. Heckbert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Model Discrimination ◽  
Ethnic Study ◽  
C Statistic ◽  
Coupling Index ◽  
Score Model ◽  
Incremental Prognostic Value

Background: Although left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic value as predictors of heart failure (HF), the close physiological relationship between the LA and LV suggest that the assessment of LA/LV coupling could better reflect left atrioventricular dysfunction and be a better predictor of HF.Aim: We investigated the prognostic value of a left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), as well as change in LACI to predict incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA).Materials and Methods: In the MESA, 2,250 study participants, free of clinically recognized HF and cardiovascular disease (CVD) at baseline, had LACI assessed by CMR imaging at baseline (Exam 1, 2000–2002), and 10 years later (Exam 5, 2010–2012). Left atrioventricular coupling index was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident HF after adjustment for traditional MESA-HF risk factors. The incremental risk prediction was calculated using C-statistic, categorical net reclassification index (NRI) and integrative discrimination index (IDI).Results: Among the 2,250 participants (mean age 59.3 ± 9.3 years and 47.6% male participants), 50 incident HF events occurred over 6.8 ± 1.3 years after the second CMR exam. After adjustment, greater LACI and ΔLACI were independently associated with HF (adjusted HR 1.44, 95% CI [1.25–1.66] and adjusted HR 1.55, 95% CI [1.30–1.85], respectively; both p < 0.0001). Adjusted models for LACI showed significant improvement in model discrimination and reclassification compared to currently used HF risk score model for predicting HF incidence (C-statistic: 0.81 vs. 0.77; NRI = 0.411; IDI = 0.043). After adjustment, ΔLACI showed also significant improvement in model discrimination compared to the multivariable model with traditional MESA-HF risk factors for predicting incident HF (C-statistic: 0.82 vs. 0.77; NRI = 0.491; IDI = 0.058).Conclusions: In a multi-ethnic population, atrioventricular coupling (LACI), and coupling change (ΔLACI) are independently associated with incident HF. Both have incremental prognostic value for predicting HF events over traditional HF risk factors.

scholarly journals Left atrioventricular coupling index to predict incident heart failure: the multi-ethnic study of atherosclerosis (MESA)

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
B Ambale Venkatesh ◽  
Y Kato ◽  
H De Vasconcellos ◽  
S Heckbert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Model Discrimination ◽  
Ethnic Study ◽  
Funding Sources ◽  
C Statistic ◽  
Coupling Index ◽  
Score Model

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Although left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic value as predictors of HF, the close physiological relationship between LA and LV suggest that the assessment of LA/LV coupling could better reflect left atrioventricular dysfunction and be a better predictor of heart failure (HF). PURPOSE We investigated the prognostic value of a left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), as well as change in LACI to predict incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS In the MESA, 2,250 study participants, free of clinically recognized HF and cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (Exam 1, 2000–2002), and ten years later (Exam 5, 2010–2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident HF after adjustment on traditional HF risk factors. The incremental risk prediction was calculated using C-statistic, categorical net reclassification index (NRI) and integrative discrimination index (IDI). RESULTS Among the 2,250 participants (mean age 59.3 ± 9.3 years and 47.6% male participants), 50 incident HF events occurred over 6.8 ± 1.3 years after the second CMR exam. After adjustment, greater LACI and ΔLACI were independently associated with HF (adjusted HR 1.44, 95% CI [1.25-1.66] and adjusted HR 1.55, 95% CI [1.30-1.85], respectively; both p < 0.0001). Adjusted models for LACI showed significant improvement in model discrimination and reclassification compared to currently used HF risk score model for predicting HF incidence (C-statistic: 0.81 vs. 0.77; NRI = 0.411; IDI = 0.043). After adjustment, ΔLACI showed also significant improvement in model discrimination compared to the multivariable model with traditional HF risk factors for predicting incident HF (C-statistic: 0.82 vs. 0.77; NRI = 0.491; IDI = 0.058). CONCLUSIONS In a multi-ethnic population, atrioventricular coupling (LACI) and coupling change (ΔLACI) are independently associated with incident HF. Both have incremental prognostic value for predicting HF over traditional HF risk factors.

scholarly journals Change in left atrioventricular coupling index to predict incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA)

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
B Ambale Venkatesh ◽  
T Quinaglia ◽  
S Heckbert ◽  
YOKO Kato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Discrimination Performance ◽  
Left Ventricular ◽  
Ethnic Population ◽  
Ethnic Study ◽  
C Statistic ◽  
Coupling Index ◽  
Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). PURPOSE Due to the intrinsic physiological relationship between LA and LV, we sought to investigate the prognostic value of a left atrioventricular coupling index (LACI) as well as change in LACI to predict incident AF in a multi-ethnic population. METHODS In the Multi-Ethnic Study of Atherosclerosis (MESA), 1,911 study participants, free of clinically recognized AF and cardiovascular disease at baseline, had LACI assessed with CMR imaging at baseline (Exam 1, 2000–2002), and ten years later (Exam 5, 2010–2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident AF. RESULTS Among the 1,911 participants (mean age 59 ± 9 years and 47.5% male participants), 87 incident AF events occurred over 3.9 ±0.9 years following the second imaging (Exam 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (HR 1.69, 95% CI [1.46-1.96] and HR 1.71, 95% CI [1.50-1.94], respectively; both p < 0.0001). Adjusted models for LACI and ΔLACI showed significant improvement in model discrimination compared to currently used AF risk score model for predicting AF incidence (C-statistic: 0.78 vs. 0.74, and C-statistic: 0.80 vs. 0.74, respectively). The LACI and ΔLACI also showed superior discrimination performance for AF compared to the multivariable model including CHARGE-AF score, and individual LA or LV parameters. CONCLUSIONS Atrioventricular coupling (LACI) and coupling change (ΔLACI) are strong predictors for AF incidence in a multi-ethnic population. Both have incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination power compared to the CHARGE-AF score and to individual LA or LV parameters.

Abstract 13463: Left Atrioventricular Coupling Index as a Prognostic Marker: The Multi-ethnic Study of Atherosclerosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theo Pezel ◽  
Bharath Ambale Venkatesh ◽  
Henrique D De Vasconcellos ◽  
Yoko Kato ◽  
Mahsima Shabani ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Strong Predictor ◽  
Ethnic Study ◽  
End Diastolic Volume ◽  
C Statistic ◽  
Coupling Index ◽  
History Of ◽  
Independent Association ◽  
Cv Disease ◽  
Mri Study

Introduction: The left atrium (LA) and left ventricle (LV) parameters have both prognostic value for cardiovascular (CV) events. We hypothesize the left atrioventricular coupling to be a strong predictor of CV events. Hypothesis: This study aimed to investigate the prognostic value of a novel left atrioventricular coupling index (LACI) and to assess its predictive value for CV events in a population without a history of CV diseases at baseline. Methods: A total of 4,124 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a cardiac MRI study. The LACI was defined by the ratio of the LA end-diastolic volume divided by the LV end-diastolic volume by MRI. Cox proportional hazard models were built to predict the endpoints of atrial fibrillation (AF), heart failure (HF), CV death and hard CV disease (CVD) defined by myocardial infarction, resuscitated cardiac arrest, fatal and non-fatal stroke or CV death. In univariable and multivariable Cox analyses, the association between LACI and time-to-event was analysed, adjusting for 14 covariables including traditional CV risk factors and biomarkers. Results: A total of 1151 CV events were observed during a median (IQR) follow-up period of 15.9 (12.9-16.6) years. LACI was associated with AF (HR 2.14, 95%CI [1.97-2.32]), HF (HR 1.70, 95%CI [1.56-1.86]), hard CVD (HR 1.34, 95%CI [1.22-1.48]), and CV death (HR 1.53, 95%CI [1.38-1.70]; for all p<0.0001). In multivariate analysis, LACI had a significant independent association for AF (HR 1.86, 95%CI [1.69-2.04]), HF (HR 1.47, 95%CI [1.33-1.60]), hard CVD (HR 1.25, 95%CI [1.12-1.40]), and CV death (HR 1.29, 95%CI [1.15-1.50; for all p<0.001). LACI showed better discrimination than the multivariate model for AF (C-statistic: 0.84 vs 0.79), HF (0.82 vs 0.80), hard CVD (0.77 vs 0.76), and CV death (0.84 vs 0.83). Conclusions: The LACI is a predictor of incident HF, AF, hard CV disease, and CV death in MESA.

scholarly journals Incremental Prognostic Value of Echocardiography of Left Ventricular Remodeling and Diastolic Function in STICH Trial

2020 ◽  
Author(s):  
Kyung-Hee Kim ◽  
Lilin She ◽  
Rafal Dabrowski ◽  
Paul A. Grayburn ◽  
Miroslaw Rajda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Risk Markers ◽  
Prognostic Information ◽  
Lv Remodeling ◽  
Incremental Prognostic Value

Abstract Aims: We sought to determine which echocardiographic markers of left ventricular (LV) remodeling and diastolic dysfunction can contribute as incremental and independent prognostic information in addition to current clinical risk markers of ischemic LV systolic dysfunction in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.Methods and Results: The cohort consisted of 1511 of 2136 patients in STICH for whom baseline transmitral Doppler (E/A ratio) could be measured by an echocardiographic core laboratory blinded to treatment and outcomes, and prognostic value of echocardiographic variables was determined by a Cox regression model. E/A ratio was the most significant predictor of mortality amongst diastolic variables with lowest mortality for E/A closest 0.8, although mortality was consistently low for E/A 0.6 to 1.0. Mortality increased for E/A <0.6 and > 1.0 up to approximately 2.3, beyond which there was no further increase in risk. Larger LV end-systolic volume index (LVESVI) and E/A <0.6 and >1.0 had incremental negative effects on mortality when added to a clinical multivariable model, where creatinine, LVESVI, age, and E/A ratio accounted for 74% of the prognostic information for predicting risk. LVESVI and E/A ratio were stronger predictors of prognosis than New York Heart Association functional class, anemia, diabetes, history of atrial fibrillation, and stroke.Conclusions: Echocardiographic markers of advanced LV remodeling and diastolic dysfunction added incremental prognostic value to current clinical risk markers. LVESVI and E/A ratio outperformed other markers and should be considered as standard in assessing risks in ischemic heart failure. E/A closest to 0.8 was the most optimal filling pattern.

Abstract 128: Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Khadijah Breathett ◽  
Larry A Allen ◽  
James Udelson ◽  
Gordon Davis ◽  
Michael Bristow
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Incremental Prognostic Value

Background: Left ventricular remodeling, as commonly measured by left ventricular ejection fraction (LVEF), is associated with clinical outcomes. Although change in LVEF over time would be anticipated to reflect response to therapy and subsequent clinical course, systematic serial measurement of LVEF is inconsistent in observational settings, and has not been systematically reported in large-scale clinical trials. Thus the incremental prognostic value of change in LVEF has not been well characterized. Methods: The Beta-Blocker Evaluation of Survival Trial (BEST, 1995-1999) collected LVEF by radionuclide ventriculography at baseline and at 3 and 12-months after randomization. Change in LVEF was defined as change from baseline to 12-month unless that value was missing, in which case the 3-month value was used. We built a series of multivariable models including 16 commonly used clinical parameters plus change in LVEF for predicting the following time to first event endpoints: all-cause mortality (ACM), cardiovascular mortality (CVM), heart failure hospitalization (HFH), and ACM or HFH. Results: Among 2,484 patients with a mean follow-up of 2-years, serial improvement in LVEF by ≥5% was the second most significant predictor (behind baseline creatinine) of outcomes (Table). LVEF change ≥5% correlated with a modest increase in C-index compared to traditional predictors (Table). Conclusions: Serial evaluation for change ≥5% LVEF predicts both survival and HFH. Further validation of the incremental prognostic value of change in LVEF for important clinical decisions, including frequency of cardiac imaging, across various heart failure populations is needed.

Abstract 20072: Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain and Late Gadolinium Enhancement in Patients with Dilated Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Misato Chimura ◽  
Tetsuari Onishi ◽  
Hiroya Kawai ◽  
Shinishiro Yamada ◽  
Yoshinori Yasaka
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Incremental Prognostic Value

Introduction: Reduced left ventricular (LV) global longitudinal strain (GLS) by two-dimensional speckle-tracking (2DST) echocardiography and late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) have been reported to be associated with unfavorable outcome in patient with heart failure (HF). We investigated to assess these 2 markers as prognostic parameters over conventional HF markers in patients with dilated cardiomyopathy (DCM). METHODS: We studied consecutive 179 DCM patients (Age 61±15 years, 121 males, LV ejection fraction (LVEF) 33±9%, NYHA class I: n= 0; II: n=71; III: n=107; IV: n=1) who underwent CMR and echocardiography with conventional assessment including LV end-diastolic and end-systolic volume (LVEDV, LVESV), LVEF and mitral regurgitation grade (MR), and with 2DST analysis of GLS. Brain natriuretic peptide (BNP) was measured. Outcome was assessed according to death and hospitalization with heart failure in the follow-up period for 3.8±2.5 years. RESULTS: There were 7 cardiac deaths and 40 HF hospitalizations in the follow-up period. Univariate Cox proportional hazard regression analysis showed NYHA class, systolic blood pressure, diastolic blood pressure, BNP, LVEDV, LVESV, LVEF, MR, GLS and positive LGE were significantly associated with outcome. Multivariate Cox proportional hazards regression analysis revealed GLS and positive LGE (p<0.05 for both) were independent predictors of outcome. Dividing all 179 patients into 4 groups with the median of GLS (-8.3%) and the presence or absence of LGE, Kaplan-Meier analysis showed worse GLS predicted adverse events in patients with and without LGE (p<0.05 for both). GLS and LGE provide additional benefit over conventional parameters (Age, NYHA class, LVEF and BNP). CONCLUSIONS: Risk stratification with LGE and GLS is useful to predict long-term outcome in DCM patients. These 2 markers provide incremental prognostic value to conventional HF markers.

Incremental prognostic value of a complex left ventricular remodeling classification in asymptomatic for heart failure hypertensive patients

2017 ◽  
Vol 11 (7) ◽  
pp. 412-419 ◽  
Author(s):  
Iacopo Fabiani ◽  
Nicola Riccardo Pugliese ◽  
Salvatore La Carrubba ◽  
Lorenzo Conte ◽  
Francesco Antonini-Canterin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Incremental Prognostic Value

scholarly journals Ceruloplasmin, NT-proBNP, and Clinical Data as Risk Factors of Death or Heart Transplantation in a 1-Year Follow-Up of Heart Failure Patients

2020 ◽  
Vol 9 (1) ◽  
pp. 137
Author(s):  
Ewa Romuk ◽  
Wojciech Jacheć ◽  
Ewa Zbrojkiewicz ◽  
Alina Mroczek ◽  
Jacek Niedziela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Heart Transplantation ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis

We investigated whether the additional determination of ceruloplasmin (Cp) levels could improve the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF) patients in a 1-year follow-up. Cp and NT-proBNP levels and clinical and laboratory parameters were assessed simultaneously at baseline in 741 HF patients considered as possible heart transplant recipients. The primary endpoint (EP) was a composite of all-cause death (non-transplant patients) or heart transplantation during one year of follow-up. Using a cut-off value of 35.9 mg/dL for Cp and 3155 pg/mL for NT-proBNP (top interquartile range), a univariate Cox regression analysis showed that Cp (hazard ratio (HR) = 2.086; 95% confidence interval (95% CI, 1.462–2.975)), NT-proBNP (HR = 3.221; 95% CI (2.277–4.556)), and the top quartile of both Cp and NT-proBNP (HR = 4.253; 95% CI (2.795–6.471)) were all risk factors of the primary EP. The prognostic value of these biomarkers was demonstrated in a multivariate Cox regression model using the top Cp and NT-proBNP concentration quartiles combined (HR = 2.120; 95% CI (1.233–3.646)). Lower left ventricular ejection fraction, VO2max, lack of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, and nonimplantation of an implantable cardioverter-defibrillator were also independent risk factors of a poor outcome. The combined evaluation of Cp and NT-proBNP had advantages over separate NT-proBNP and Cp assessment in selecting a group with a high 1-year risk. Thus multi-biomarker assessment can improve risk stratification in HF patients.

scholarly journals Short Physical Performance Battery versus 6-minute Walking Test in Hospitalized Elderly Patients with Heart Failure

2021 ◽  
Author(s):  
Takeshi Kitai ◽  
Takayuki Shimogai ◽  
W H Wilson Tang ◽  
Kentaro Iwata ◽  
Andrew Xanthopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Elderly Patients ◽  
Physical Performance ◽  
Prognostic Value ◽  
Walking Test ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients ◽  
Incremental Prognostic Value ◽  
Conventional Risk Factors

Abstract Aims Functional decline due to skeletal muscle abnormalities leads to poor outcomes in patients with acute heart failure (AHF). The 6-minute walking test (6MWT) reliably evaluates functional capacity, but its technical difficulty for the elderly often limits its benefits. Although the Short Physical Performance Battery (SPPB) is a comprehensive measure of physical performance, its role in AHF remains unclear. This study aimed to examine the prognostic significance of SPPB compared to the 6MWT in elderly patients hospitalized for AHF. Methods and Results We retrospectively analyzed 1,192 elderly patients with AHF whose SPPB and 6MWT were measured during the hospitalization. The primary outcome measure was defined as a composite of all-cause death and heart failure readmission until 1 year after discharge. Patients with lower SPPB scores (0 − 6, n = 373) had significantly poorer outcomes than those with higher SPPB scores (7 − 12, n = 819) even after multivariable adjustment (adjusted hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.01 − 1.61, p = 0.049), similar to those with shorter 6MWT (&lt;median) than those with longer 6MWT (adjusted HR:1.61, 95% CI:1.27 − 2.04, p &lt; 0.001). Although both SPPB and 6MWT (net reclassification index [NRI]: 0.139, p = 0.036 and NRI: 0.350, p &lt; 0.001, respectively) exhibited incremental prognostic value over conventional risk factors of HF, the additive prognostic effect of 6MWT was superior to that of SPPB (NRI: 0.300, p &lt; 0.001). Conclusions Reduced functional capacity assessed by either the SPPB or 6MWT was associated with worse outcomes in hospitalized elderly patients with AHF. The incremental prognostic value over the conventional risk factors was higher in 6MWT than in SPPB. Trial Registration UMIN000023929

Independent and incremental prognostic value of Doppler-derived left ventricular total isovolumic time in patients with systolic heart failure

2011 ◽  
Vol 148 (3) ◽  
pp. 271-275 ◽  
Author(s):  
Gani Bajraktari ◽  
Frank Lloyd Dini ◽  
Paolo Fontanive ◽  
Shpend Elezi ◽  
Venera Berisha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Incremental Prognostic Value
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