scholarly journals A New Biomarker Tool for Risk Stratification in “de novo” Acute Heart Failure (OROME)

2022 ◽  
Vol 12 ◽  
Author(s):  
Rosa M. Agra-Bermejo ◽  
Carla Cacho-Antonio ◽  
Eva Gonzalez-Babarro ◽  
Adriana Rozados-Luis ◽  
Marinela Couselo-Seijas ◽  
...  

Background: Inflammation is one of the mechanisms involved in heart failure (HF) pathophysiology. Thus, the acute phase reactant protein, orosomucoid, was associated with a worse post-discharge prognosis in de novo acute HF (AHF). However, the presence of anti-inflammatory adipokine, omentin, might protect and reduce the severity of the disease. We wanted to evaluate the value of omentin and orosomucoid combination for stratifying the risk of these patients.Methods and Results: Two independent cohorts of patients admitted for de novo AHF in two centers were included in the study (n = 218). Orosomucoid and omentin circulating levels were determined by ELISA at discharge. Patients were followed-up for 317 (3–575) days. A predictive model was determined for the primary endpoint, death, and/or HF readmission. Differences in survival were evaluated using a Log-rank test. According to cut-off values of orosomucoid and omentin, patients were classified as UpDown (high orosomucoid and low omentin levels), equal (both proteins high or low), and DownUp (low orosomucoid and high omentin levels). The Kaplan Meier determined a worse prognosis for the UpDown group (Long-rank test p = 0.02). The predictive model that includes the combination of orosomucoid and omentin groups (OROME) + NT-proBNP values achieved a higher C-index = 0.84 than the predictive model with NT-proBNP (C-index = 0.80) or OROME (C-index = 0.79) or orosomucoid alone (C-index = 0.80).Conclusion: The orosomucoid and omentin determination stratifies de novo AHF patients into the high, mild, and low risk of rehospitalization and/or death for HF. Its combination with NT-proBNP improves its predictive value in this group of patients.

2021 ◽  
Author(s):  
Rosa Agra Bermejo ◽  
Carla Cacho-Antonio ◽  
Eva Gonzalez-Babarro ◽  
Adriana Rozados-Luis ◽  
Marinela Couselo-Seijas ◽  
...  

Abstract Background: Inflammation is one of the mechanisms involved on heart failure (HF) pathophysiology. Thus, the acute phase reactant protein, orosomucoid, was associated with a worse post-discharge prognosis in de novo acute HF (AHF). However, the presence of anti-inflammatory adipokine, omentin, might protect and reduce the severity of the disease. We wanted to evaluate the value of omentin and orosomucoid combination for stratifying risk of these patients.Methods and Results: Two independent cohorts of patients admitted for de novo AHF in two centers were included in the study (n=218). Orosomucoid and omentin circulating levels were determined by ELISA at discharge. Patients were follow-up for 317 (3-575) days. A predictive model was determined for primary endpoint, death and/or HF readmission. Differences in survival were evaluated using a Log-rank test. According cut-off values of orosomucoid and omentin, patients were classified on UpDown (high orosomucoid and low omentin levels), equal (both proteins high or low) and DownUp (low orosomucoid and high omentin levels). The Kaplan Meier determined worse prognosis for the UpDown group (Long-rank test p=0.02). The predictive model that includes the combination of orosomucoid and omentin groups (OROME) + NT-proBNP values achieved a higher C-index=0.84 than the predictive model with NT-proBNP (C-index=0.80) or OROME (C-index=0.79) or orosomucoid alone (C-index=0.80). Conclusions: The orosomucoid and omentin determination stratifies de novo AHF patients in high, mild and low risk of rehospitalization and/or death for HF. Its combination with NT-proBNP improves its predictive value in this group of patients.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kamisaka ◽  
K Kamiya ◽  
K Iwatsu ◽  
N Iritani ◽  
Y Iida ◽  
...  

Abstract Background Weight loss (WL) has been considered as a prognostic factor in heart failure with reduced ejection fraction (HFrEF). However, the prognosis and associated factors of WL in heart failure with preserved ejection fraction (HFpEF) have remained unclear. Purpose This study aimed to examine the prevalence, prognosis, and clinical characteristics of worse prognosis based on the identified WL after discharge in HFpEF. Methods The study was conducted as a part of a multicenter cohort study (Flagship). The cohort study enrolled ambulatory HF who hospitalized due to acute HF or exacerbation of chronic HF. Patients with severe cognitive, psychological disorders or readmitted within 6-month after discharge were excluded in the study. WL was defined as ≥5% weight loss in 6-month after discharge and HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% at discharge. Age, gender, etiology, prior HF hospitalization, New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), anemia (hemoglobin; male <13g/dL, female <12g/dL), serum albumin, Geriatric Depression Scale, hand grip strength and comorbidities were collected at discharge. Patients were stratified according to their body mass index (BMI) at discharge as non-obese (BMI <25) or obese (BMI ≥25). We analyzed the association between WL and HF rehospitalization from 6 month to 2 years after discharge using Kaplan-Meier curve analysis and Cox regression analysis adjusted for age and gender, and clinical characteristics associated to worse prognosis in WL using logistic regression analysis adjusted for potential confounders in HFpEF. Results A total of 619 patients with HFpEF were included in the analysis. The prevalence of WL was 12.9% in 482 non-obese and 15.3% in 137 obese patients. During 2 years, 72 patients were readmitted for HF (non-obese: 48, obese: 24). WL in non-obese independently associated with poor prognosis (hazard ratio: 2.2: 95% confidence interval: 1.13–4.25) after adjustment for age and sex, while WL in obese patients did not. Logistic regression analysis chose age (odds ratio 1.02 per 1 year; 1.00–1.05), anemia (2.14; 1.32–3.48), and BNP ≥200pg/mL or NT-proBNP ≥900pg/mL (1.83; 1.18–2.86) as independent associated factors for worse prognosis of WL in non-obese patients. Conclusion In HFpEF, WL in early after discharge in non-obese elderly patients may be a prognostic indicator for HF rehospitalization. HF management including WL prevention along with controlling anemia is likely to improve prognosis in this population. Kaplan Meier survival curves Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): A Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science


Author(s):  
George Syros ◽  
Mitesh Kabadi ◽  
Sarah Blanchard ◽  
Kristin Aviles ◽  
Claire Melvin ◽  
...  

Background: Approximately 5.2 million Americans have heart failure (HF). HF morbidity and mortality is high, and 27% of patients are readmitted at 1 month and 50% at six months. Objective: To determine the effect of a multidisciplinary approach on Hospital Quality Alliance (HQA) performance and 30-day HF readmission rates. Methods: A one year, prospective, observational study on the effect of a multidisciplinary approach on 30-day HF readmissions was performed and compared to the prior year’s readmission rate at a University affiliated community hospital. HF patients were identified by case and unit nurse managers, who also screened for intravenous diuretic use to determine if patients had HF but were admitted under another diagnosis. HF patients were clustered geographically where daily multidisciplinary rounds with the unit nurse and care manager, pharmacist, social worker, nutritionist, medical and nursing staff took place. The goal was to ensure compliance with the established HQA Performance Measures, initiate appropriate discharge planning, and assess functional status. Patients were educated on 2 gram sodium diet, 2 liter fluid restriction, daily weight monitoring, and smoking cessation. Follow-up appointments with their PCP or cardiologist were scheduled. Upon discharge, nursing and medical staff provided medication and home management instructions. The patient’s PCP was called by the attending physician or cardiovascular fellow as well as the Skilled Nurse Facility, Rehabilitation, and Home Care staff, when applicable. Targeted in-home support immediately following discharge from the hospital was provided. High risk patient had an in-home 2-3 day post discharge visit by VNA and a Pharmacist to access their weight, medications, and physical activity progress. Results: During the intervention year, 355 CHF patients were discharged and compared to 318 patients in the year prior. The 30 day readmissions were reduced from 79 (24.8 %) to 64 (18.03%), p = 0.04 by Wilcoxon Signed-Rank Test. The Heart Failure National Inpatient Quality Measures performance increased from 95% ± 3.8% (2010) to 99.6% ± 0.5% (2011) - p = 0.008 . Conclusions: With implementation of penalties by Medicare in 2013 for 30 day HF readmissions, strategies to reduce them are critical. A comprehensive intervention involving multiple specialties and appropriate patients’ disposition can reduce 30-day readmission rates as well as improve Heart Failure National Inpatient Quality Performance Measures. Further evaluation of this treatment approach, including an assessment of cost-effectiveness, is warranted.


Author(s):  
Wesam Mulla ◽  
Robert Klempfner ◽  
Sharon Natanzon ◽  
Israel Mazin ◽  
Leonid Maizels ◽  
...  

2020 ◽  
Vol 14 (18) ◽  
pp. 1733-1745
Author(s):  
Tian-Jun Zhao ◽  
Qian-Kun Yang ◽  
Chun-Yu Tan ◽  
Li-Dan Bi ◽  
Jie Li ◽  
...  

Aim: To evaluate the clinical value of plasma D-dimer/fibrinogen ratio (DFR) in patients hospitalized for heart failure (HF). Methods: Clinical data of 235 patients were retrospectively analyzed. Kaplan–Meier method and Cox regression analysis were used to identify significant prognosticators. Results: The Kaplan–Meier analysis showed that a higher DFR level was significantly associated with an increase in the end point outcomes, including HF readmission, thrombotic events and death (log-rank test: p < 0.001). The multivariate Cox regression analysis showed that the high tertile of DFR was significantly associated with the study end points (HR: 2.18; 95% CI: 1.31–3.62; p = 0.003), compared with the low tertile. Conclusion: DFR is a reliable prognostic indicator for patients hospitalized for HF.


2021 ◽  
Vol 11 ◽  
Author(s):  
Jiaojiao Deng ◽  
Shuchen Sun ◽  
Jiawei Chen ◽  
Daijun Wang ◽  
Haixia Cheng ◽  
...  

BackgroundAdjuvant radiotherapy (RT) is one of the most commonly used treatments for de novo high-grade meningiomas (HGMs) after surgery, but genetic determinants of clinical benefit are poorly characterized.ObjectiveWe describe efforts to integrate clinical genomics to discover predictive biomarkers that would inform adjuvant treatment decisions in de novo HGMs.MethodsWe undertook a retrospective analysis of 37 patients with de novo HGMs following RT. Clinical hybrid capture-based sequencing assay covering 184 genes was performed in all cases. Associations between tumor clinical/genomic characteristics and RT response were assessed. Overall survival (OS) and progression-free survival (PFS) curves were plotted using the Kaplan–Meier method.ResultsAmong the 172 HGMs from a single institution, 42 cases (37 WHO grade 2 meningiomas and five WHO grade 3 meningiomas) were identified as de novo HGMs following RT. Only TERT mutations [62.5% C228T; 25% C250T; 12.5% copy number amplification (CN amp.)] were significantly associated with tumor progression after postoperative RT (adjusted p = 0.003). Potential different somatic interactions between TERT and other tested genes were not identified. Furthermore, TERT alterations (TERT-alt) were the predictor of tumor progression (Fisher’s exact tests, p = 0.003) and were associated with decreased PFS (log-rank test, p = 0.0114) in de novo HGMs after RT.ConclusionOur findings suggest that TERT-alt is associated with tumor progression and poor outcome of newly diagnosed HGM patients after postoperative RT.


BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mar Achalandabaso Boira ◽  
Marcello Di Martino ◽  
Carlos Gordillo ◽  
Magdalena Adrados ◽  
Elena Martín-Pérez

Abstract Background Various parameters have been considered for predicting survival in pancreatic ductal adenocarcinoma. Information about western population is missing. The aim of this study is to assess the association between Glucose transporter type 1 (GLUT-1) expression and prognosis for patients with PDAC submitted for surgical resection in a European cohort. Methods Retrospective analysis of PDAC specimens after pancreatoduodenectomy assessing GLUT-1 expression according to intensity (weak vs strong) and extension (low if < 80% cells were stained, high if > 80%) was performed. Statistical analysis was performed using the exact Fisher test, Student t test or the Mann-Whitney U test. Survival was analysed using the Kaplan-Meier method and compared with the Log-rank test. The differences were considered significant at a two-sided p value of < 0.05. All statistical analyses were performed using SPSS® 23.0 for Windows (SPSS Inc., Chicago, IL, USA). Results Our study consisted of 39 patients of which 58.9% presented with weak and 41.1% with strong intensity. The median extension was 90%: 28.2% cases presented with a low extension and 71.8% with a high extension. No significant differences related to intensity were found. The high-extension group showed a higher percentage of T3 PDAC (92.9% vs 63.6%, p = 0.042) and LNR20 (35.7% vs 0%, p = 0.037) as well as shorter disease-free survival (17.58 vs 54.46 months; p = 0.048). Conclusions Our findings suggest that GLUT-1 could be related to higher aggressivity in PDAC and could be used as a prognostic marker, identifying patients with a worse response to current therapies who could benefit from more aggressive treatments.


Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ashish Shukla ◽  
S Wamique Yusuf ◽  
Iyad Daher ◽  
Daniel Lenihan ◽  
Jb Durand

Beta blockers (BB) and ACE inhibitors (ACE) are recommended for management of left ventricular (LV)dysfunction including patients with chemotherapy-induced cardiomyopathy (CCM). There is a scarcity of data for the long term requirement of these medications in cancer patients, and the effect of their withdrawal after improvement of LV function is unknown. We report a cohort study involving patients with CCM on BB and ACE who underwent withdrawal of these medications and their outcome. Methods: In a cohort of patients with CCM stabilized on BB (commonly carvedilol) and ACE, sixteen patients were identified that had therapy withdrawn and then presented with acute heart failure. Patients resumed BB and ACE therapy and outcomes of LV function and survival were evaluated. The change in LVEF by ECHO was compared using paired t-test, with a matched control population with t-test and survivability compared and calculated using Kaplan-Meier estimates and log rank test. Results: A total of 48 patients, case (n=16) and matched control (n=32), on maximal tolerated doses of ACE+BB, mean EF of 49.62% Upon withdrawal mean EF decreased to 30.62% (p<0.0001). Nine patients died within six months of discontinuation of therapy, three of sudden cardiac death. Reinstitution of carvedilol+ACE improved LVEF to a mean of 45% (p<0.0001). Discussion: This study demonstrates acute deterioration in cardiac function and survival upon withdrawal of BB and ACE in patients with CCM, and a mortality of 56.25% for case patients and 28.12% for control patients. These data indicate that BB and ACE are pivotal in cancer patients with CCM and necessitates their indefinite use.


Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 486-486 ◽  
Author(s):  
Martin Weisser ◽  
Susanne Schnittger ◽  
Wolfgang Kern ◽  
Wolfgang Hiddemann ◽  
Torsten Haferllach ◽  
...  

Abstract The fusion transcript CBFB-MYH11 is the molecular correlate of inv(16)/t(16;16) and strictly associated with FAB subtype M4eo. This subgroup is associated with a favorable prognosis in AML. However, approximately 30% of the patients relapse. Our intention was to examine prognostic factors for the outcome within this subgroup. Therefore 153 CBFB-MYH11 positive AML patients were analyzed. The median age was 52 years (range 18–83), 80 patients were female, 73 were male. In 22 cases AML was therapy-related, in 131 cases a de novo AML was diagnosed. Inv(16) was detected in 138 and t(16;16) in 12 cases. In 3 cases neither inv(16) nor t(16;16) were detectable despite PCR and FISH positivity for CBFB-MYH11 suggesting cryptic rearrangements. The most frequent additional cytogenetic abnormalities were +8 (n=19), +9 (n=3), +21 (n=7), +22 (n=23). Cox regression analysis revealed that advanced age (OS: p=0.026; EFS: p=0.029) and increased CBFB-MYH11/ABL ratio at diagnosis (OS: 0.016, EFS: p=0.064) were associated with a worse prognosis. Using log rank test additional factors influencing survival were detected. These included: t(16;16) vs inv(16) (OS: n=8, censored 4, median 362 days vs n=118, censored 92, median not reached, p=0.018; EFS: n=8, censored 4, median 232 days vs n=118, censored 70, median 918 days, p=0.048) and trisomy 21 vs no additional aberrations (OS: n=6, censored 3, median 435 days vs n=74, censored 59, median not reached, p=0.024; EFS: n=6, censored 2, median 293 d vs n=74, censored 44, median 764 days, p=0.0047). Therapy related AML was associated with worse EFS than de novo AML (n=16, censored 6, median 371 days vs n=112, censored 70, median 1179 days, p=0.0167) and there was a trend towards worse OS (p=0.157 n=16, censored 10, median 764 days vs n=112, censored 88, median not reached). A multivariate analysis including t(16;16), age, CBFB-MYH11/ABL ratio, therapy related AML and +21 as covariates revealed t(16;16) and age as independent factor for OS (p=0.014 and p=0.015, respectively) and age, t(16;16), and +21 as independent factors for EFS (p=0.047, p=0.013, and p=0.016, respectively). There was no evidence that the additional aberrations +22 or +8 had an influence on survival. Taken together our data suggest that t(16;16) as compared to inv(16), trisomy 21 and age are associated with worse prognosis in patients with CBFB-MYH11 positive AML.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4567-4567
Author(s):  
Alessia Pepe ◽  
Antonella Meloni ◽  
Giovanni Carlo Del Vecchio ◽  
Maria Antonietta Romeo ◽  
Maria Rita Gamberini ◽  
...  

Abstract Background: In 2004 seven Italian centers reported survival data for patients with thalassemia major (TM) and showed that heart disease due to iron overload was the most common cause of death (Borgna et al Haematologica 2004). In the same years the accurate and noninvasive assessment of cardiac siderosis was made possible in Italy by the introduction of the T2* cardiovascular magnetic resonance (CMR). Purpose: We aimed to evaluate if the deployment of T2* CMR had an impact on the mortality rate. Methods: Four centers contributed to the present study, updating the data of the enrolled patients until August 31, 2010. For the patients who died, the date of the death represented the end of the study. 577 patients (264 females and 313 males) were included. Results: One-hundred and fifty-nine (27.6%) patients died, 124 of whom (77.9%) died before the year 2000. The Table shows the comparison between dead patients and survivors. Dead patients were significantly younger and they were more frequently males. Dead patients started chelation therapy significantly later. HIV, arrhythmias and heart failure were significantly more frequent in dead patients. According to the Cox model, the following variables were identified as significant univariate prognosticators for the death: male sex (HR=1.87, 95%CI=1.34-2.60, P<0.0001), HIV (HR=2.55, 95%CI=1.25-5.20, P=0.010) and heart failure (HR=8.86, 95%CI=6.37-12.31, P<0.0001). MRI was not performed in 406 patients (70.4%) and no patient had been scanned before his/her death. Among the survivors, MRI was not performed in the 59% of the cases (P<0.0001). The absence of an MRI scan was a significant univariate prognosticator for death (HR=43.25, 95%CI=11.32-165.33, P<0.0001). The study was restricted to the patients dead after 2004 (19/159=12%) or followed until August 2010 (N=357). In this subgroup of 376 patients, MRI was not performed in the 52.4% of the survivors and in all dead patients (P<0.0001). The absence of a MRI exam was reconfirmed as a strong predictive factor for death (HR=49.37, 95%CI=1.08-2263.24, P=0.046). The Kaplan-Meier curve is showed in Figure 1. The log-rank test revealed a significant difference in the curves (P<0.0001). Conclusions: Our data suggests that the use of T2* CMR, that enables individually tailored chelation regimes reducing the likelihood of developing decompensated cardiac failure, allowed the reduction of cardiac mortality in chronically transfused TM patients. Table 1. Table 1. Figure 1. Figure 1. Disclosures Pepe: Novartis: Speakers Bureau; Chiesi: Speakers Bureau; ApoPharma Inc: Speakers Bureau.


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