scholarly journals The Value of Fetuin-A as a Predictor to Identify Takotsubo Patients at Risk of Cardiovascular Events

2021 ◽  
Vol 8 (10) ◽  
pp. 127
Author(s):  
Albert Topf ◽  
Moritz Mirna ◽  
Nina Bacher ◽  
Vera Paar ◽  
Christoph Edlinger ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Phase ◽  
Decompensated Heart Failure ◽  
Serum Levels ◽  
Prognostic Impact ◽  
Clinical Implementation ◽  
Cardiac Events ◽  
Fetuin A ◽  
Cardiac Decompensation ◽  
Adverse Cardiac Events

Introduction: Takotsubo cardiomyopathy (TTC) remains a life-threatening disease with the risk of decompensated heart failure and arrhythmias. Valid markers for the prediction of outcome are unavailable. The novel biomarkers fetuin-A, matrix metalloproteinases-2 (MMP-2), myeloperoxidase (MPO), Syndecan-1 and CD40-L show promising results for risk stratification of cardiovascular patients. Nevertheless, clinical implementation has not been investigated in TTC patients. Methods: To investigate this issue, we evaluated clinical complications in 51 patients hospitalized for TTC and measured the serum levels of fetuin-A, MPO, MMP-2, Syndecan-1 and CD40-L within 24 h after admission. Results: Serum levels of Fetuin-A correlated inversely with the risk of cardiac decompensation and all cause complications within the acute phase of TTC. Fetuin-A levels over 190.1 µg/mL (AUC: 0.738, sensitivity 87.5%, specificity: 52.6%) indicate an acute phase of TTC without cardiac decompensation. Despite lower fetuin-A levels in patients with all cause complications, the combined endpoint remained slightly unmet (p = 0.058, AUC: 0.655). Patients with fetuin-A levels over 213.3 µg/mL are at risk of experiencing hemodynamic relevant rhythm disorders (AUC: 0.794; sensitivity: 75.0%, specificity: 79.1%). Other biomarkers failed to reveal a prognostic impact. Pro-BNP and hs troponin levels at admission did not predict adverse cardiac events. Conclusion: Fetuin-A is a promising marker in our study and could be of benefit for the prediction of short-term adverse cardiac events in TTC patients. Therefore, fetuin-A might be of value to evaluate an individual’s risk for complications within the acute phase of TTC and to individually choose the time of intensive care and hospitalization.

Diagnostic and prognostic impact of circulating microRNA-208b and microRNA-499 in patients with acute coronary syndrome

2020 ◽  
Vol 14 (2) ◽  
pp. 87-95
Author(s):  
Wei Wang ◽  
Tai Li ◽  
Lei Gao ◽  
Yang Li ◽  
Ying Sun ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiac Events ◽  
Circulating Microrna ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Primary Analysis ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events

Aim: This study aimed to investigate the correlation between the expression of circulating miR-208b and miR-499 and acute coronary syndrome (ACS) patients. Materials & methods: A total of 160 consecutive patients with ACS and 48 healthy control subjects were enrolled for primary analysis. The ACS patients (n = 160) were followed up for 6 months for further analysis regarding major adverse cardiac events. Results: Area under the curve values of miR-208b and miR-499 for predicting ACS were 0.910 and 0.851 (p < 0.001, respectively). Cox proportional hazards regression analysis revealed that miR-208b but not miR-499 was an independent predictor of major adverse cardiac events. Conclusion: Circulating miR-208b and miR-499 could be considered as diagnostic or prognostic biomarkers for patients with ACS.

scholarly journals CHOLINESTERASE GENE EXPRESSION AND SERUM LEVELS PREDICT 6 YEAR MAJOR ADVERSE CARDIAC EVENTS FOLLOWING CORONARY ANGIOGRAPHY

2016 ◽  
Vol 67 (13) ◽  
pp. 159
Author(s):  
Yaron Arbel ◽  
Shani Shenhar-Tsarfaty ◽  
Ilan Freidson ◽  
Ariel Finkelstein ◽  
Shlomo Berliner ◽  
...  
Keyword(s):  
Gene Expression ◽  
Coronary Angiography ◽  
Serum Levels ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Abstract P186: Extent of Myocardium at Risk in Women, but Not in Men, is Associated With Major Adverse Cardiac Events Following Coronary Artery Bypass Grafting

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Karen J Buth ◽  
Maria E Currie ◽  
Alexandra M Yip ◽  
Gregory M Hirsch
Keyword(s):  
At Risk ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Cardiac Events ◽  
Men And Women ◽  
Adverse Cardiac Events ◽  
Angiographic Data ◽  
Myocardium At Risk ◽  
Cabg Patients ◽  
The Impact

Objective: Many studies have reported higher rates of adverse outcomes in women than men following CABG surgery. To date, the mechanism has not been elucidated. We studied a large group of CABG patients for whom detailed angiographic data were available and investigated the impact of myocardium at risk (MAR) on major adverse cardiac events (MACE) in men and women post-CABG. Methods: For patients undergoing isolated primary CABG, a Duke Index score was calculated from angiographic data. Duke Index is a validated score that quantifies MAR using distribution and severity of coronary artery disease. Categories of MAR were defined as Low, Moderate and High based on number of diseased vessels as well as location of disease, with proximal lesions conferring a higher weight than distal stenoses. The post-CABG outcome was in-hospital MACE (1 or more of mortality, low cardiac output, stroke, MI, sepsis, deep sternal wound infection, ventilation >48 hrs or return to ICU). Logistic regression was used to examine the impact of MAR as a predictor of MACE in women and in men, after adjusting for clinical comorbidities. Results: Of 3744 CABG patients, 70% (2614) had complete angiographic data and were included in the analysis; 23% (607 of 2614) were women. Compared with men, women undergoing CABG had similar Duke Index scores but were older and more likely to have diabetes, hypertension, vascular disease, disabling angina, and require urgent surgery. Completeness of revascularization did not differ between men and women. Prevalence of MACE was higher in women than in men: 19.9% (121 of 607) versus 13.0% (262 of 2007), p=0.0001. In a logistic regression model fully adjusted for comorbidities, there was a significant interaction between female sex and increased MAR as predictors of MACE. In separate logistic regression models for each sex, increasing MAR was an independent predictor of MACE for women (High MAR: OR 3.2, 95% CI 1.4-7.6, Moderate MAR: OR 2.5, 95% CI 1.0-6.2), but not for men (High MAR: OR 1.0, 95% CI 0.6-1.7, Moderate MAR: OR 1.1, 95% CI 0.6-1.8). Conclusions: Myocardium at risk impacts post-CABG outcome differently for women than for men. This novel finding suggests that CABG surgery may not provide the same potential for recovery of ischemic myocardium for women compared with men.

Impact of 2016 ASE/EACVI recommendations on evaluation of left ventricular diastolic function and clinical outcomes in patients with diabetes and hypertension without prior adverse cardiac events

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Foo ◽  
K.H Lam ◽  
M Igo ◽  
M.A Bujang ◽  
M.Y Ku ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Cardiovascular Outcomes ◽  
Funding Source ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Patients With Diabetes

Abstract Background Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes, compared to those without diabetes. The complexity of previous 2009 ASE/EACVI algorithms makes diastolic function (DF) assessment challenging. Hence, prognostic value of LVDD estimates in clinical setting is not well-established. Objective To evaluate the impact of 2016 recommendations in estimates of LVDD and predicting cardiovascular outcomes in patients with diabetes and hypertension. Materials and methods A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients were clinically NYHA Class I, had no prior adverse cardiac events, and had preserved left ventricular (LV) ejection fraction on echocardiography at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LVDD. Both 2009 and 2016 algorithms were applied in DF assessment. All patients follow-up at 1 year to assess clinical outcomes. Results There were 65 (58.6%) female patients. Mean age was 59.86 (7.45); mean duration of diabetes was 10.5 (5.41). 55 (50.5%) patients had LV hypertrophy on echocardiography. Prevalence of LVDD (14.4% vs 55.0%) and elevated LV filling pressure (9.0% vs 26.1%) were lower with 2016 compared with 2009 recommendations. Prevalence of indeterminate DF was 18.0% and 12.6% according to 2016 and 2009 recommendations respectively. Concordance between 2016 and 2009 recommendations was fair (k=0.29, p&lt;0.001), with a reclassification rate of 45.9%. None out of 45 patients who were diagnosed with indeterminate and normal DF according to 2016 and LVDD with 2009 algorithms developed MACE at 1 year. Out of 12 patients diagnosed with LVDD based on both 2016 and 2009 recommendations, 4 patients developed MACE at 1 year. 2016 recommendations showed better accuracy (sensitivity=80.0%; specificity=88.68%) than 2009 recommendations (sensitivity=80.0%; specificity= 45.28%) in predicting MACE at 1 year. Conclusions The application of 2016 recommendations results in lower prevalence of LVDD. The 2016 criteria detect more advanced cases and predict 1 year cardiovascular outcomes better. Further studies are warranted to investigate the prognostic impact of this criteria. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH), Ministry of Health Malaysia

P4589The prognostic impact of the Medina classification in bifurcation lesion percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Perl ◽  
G Witberg ◽  
H Vaknin-Assa ◽  
R Kornowski ◽  
A Assali
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Prognostic Significance ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Target Vessel Revascularization ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions ◽  
Poor Outcomes

Abstract Background/Introduction The Medina classification is the most widespread method to describe bifurcation lesions. However, little is known regarding the prognostic impact of the classification. Purpose To assess the prognostic significance of the Medina classification following percutaneous coronary intervention (PCI). Methods The study included 738 consecutive patients from a prospective bifurcation registry. There were 609 patients (82.5%) with “true bifurcation” (TB) lesions (Medina class 1.0.1, 1.1.1, 0.1.1) and 129 (17.5%) in all other categories (“non-true bifurcation” = NTB). We compared rates of death and major adverse cardiac events (MACE: cardiac death, myocardial infarction, or target vessel revascularization) at 12 months and 3 years. Results Patients with TB had lower rates of previous bypass surgery (9.4% vs. 12.2%, p=0.03) and hyperlipidemia (75.2% vs. 79.0%, p=0.04). TB lesions were more likely to be calcified (33.8% vs. 28.2%, p=0.03) and ulcerated (8.9% vs. 3.4%, p<0.01). At 12 months, mortality was numerically higher for TB PCI (4.1% vs. 2.0%m p=0.052) and MACE rates were higher (13.2% vs. 5.2%, p<0.001). At 3 years, both all cause death (10.1% vs. 4.9%, p=0.002), as well as rates of MACE (27.2% vs. 11.6%, p<0.001) were higher for TB PCI (Figure 1). After performing regression analysis, TB remained an independent predictor for poor outcomes (OR- 3.93 at 12 months, CI 1.45–10.66, p=0.007, OR-3.26 at 3 years, CI 1.47–7.25, p=0.004 for MACE). Conclusions TB lesions, according to the Medina classification, portend worse prognosis for patients undergoing bifurcation PCI. This may guide prognostication and decision making in treatment.

Abstract 18615: Subclinical Thyroid Dysfunction, Rather than Low-T3 Syndrome, is an Independent Predictor of Adverse Cardiac Events in Patients with Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tomohiro Hayashi ◽  
Takuya Hasegawa ◽  
Hideaki Kanzaki ◽  
Akira Funada ◽  
Makoto Amaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Thyroid Dysfunction ◽  
Independent Predictor ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Low T3 Syndrome ◽  
Low T3 ◽  
Adverse Cardiac Events

Background: Altered thyroid hormone metabolism characterized by low triiodothyronine (T3) levels is a common finding in patients with severe systemic diseases, called low T3 syndrome (LT3-S). Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid-stimulation hormone (TSH) and normal thyroxine (T4) levels, causes left ventricular dysfunction. However, the prevalence and prognostic impact of LT3-S and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF) have not been investigated. Methods: We examined consecutive 287 patients with ADHF who received thyroid function tests and no thyroid medications at admission (age 69±15 years, 166 male). Thyroid dysfunction was defined as follows: LT3-S as free T3< 4.0 pmol/L; euthyroidism as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism (Sc-hypo) as TSH of 4.5 to 19.9 mIU/L; subclinical hyperthyroidism (Sc-hyper) as TSH< 0.45mIU/L with normal free T4 levels for the last two. We sought to investigate the impact of the indices of thyroid function and the thyroid disorders above to predict cardiac death and re-hospitalization for heart failure after discharge. Results: At admission for ADHF, 155 patients (54%) showed LT3-S, and 62 (22%) Sc-hypo, and 5 (2%) Sc-hyper, and 196 (68%) euthyroidism. Cox proportional hazards model analysis revealed that TSH and fT4, not fT3, were independent predictors of adverse cardiac events among variables including age, sex, estimated glomerular filtration rate, left ventricular ejection fraction and B-type natriuretic peptide. Indeed, Sc-hypo was an independent predictor (HR 2.21, 95% CI 1.41-3.43, p< 0.001), whereas LT3-S and SC-hyper was not (p = 0.49 and 0.24, respectively). Conclusion: Although LT3-S was observed in about half of ADHF patients, the presence of LT3-S did not indicate poor prognosis after discharge. Meanwhile, Sc-hypo at admission was an independent predictor of adverse cardiac events in ADHF patients.

scholarly journals Value of Copeptin Measurement as A Novel Biomarker for Prognosis in Acute Heart Failure

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Mahmoud M Hassanein ◽  
Mohammed A Sadaka ◽  
Ahmed Mokhtar ◽  
Nermeen Eldabbah ◽  
Eman Mubarak
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Cutoff Value ◽  
Copeptin Level ◽  
Adverse Cardiac Events

Abstract Background Copeptin, C-terminal segment of pro-arginine vasopressin, is expected to be a strong novel biomarker for prognosis in acute heart failure (AHF). Aim Evaluate the prognostic role of copeptin in AHF either de novo or on top of chronic heart failure and its correlation with adverse cardiac events. Methods The study included 45 patients with acute decompensated heart failure (ADHF) to assess the relationship of serum copeptin level on admission and 72 hours after admission with adverse cardiac events (death, re-hospitalization and arrhythmias) in patients hospitalized with ADHF between May 2019 and November 2019 with median follow up period 6 months. Results In this study, 15 patients died, re-admission for heart failure occurred in 22 patients and arrhythmias were documented in 14 patients with atrial fibrillation (n = 9) and ventricular arrhythmias (n = 5). Mortality rate was higher among the elderly, smokers and patients with higher heart rate, lower left ventricular ejection fraction, more frequent arrhythmias, impaired kidney function and higher copeptin level. Furthermore, copeptin level at day 1 with cutoff value of &gt; 2.54 pmol/l predicted mortality with sensitivity of 86.67% and specificity of 53.33% while at day 3 copeptin level with cutoff value &gt; 2.74 pmol/l predicted mortality with sensitivity of 93.33% and specificity of 83.33%. Finally, change in copeptin level between day 1 and day 3 was associated with increased mortality. (p&lt;0.001) Conclusion Serum copeptin is suggested to be a strong biomarker to predict adverse clinical outcomes in patients with acute decompensated heart failure.

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