The Association between Sarcoidosis and Ischemic Heart Disease—A Healthcare Analysis of a Large Israeli Population

(1) Background: Inflammation plays a pivotal role in atherosclerosis, and the association between chronic inflammatory states and ischemic heart disease (IHD) has been shown in several rheumatic diseases. Persistent inflammation might also be a risk factor for IHD in sarcoidosis patients. (2) Methods: Demographic and clinical data of 3750 sarcoidosis patients and 18,139 age- and sex-matched controls were retrieved from the database of Clalit Health Services, Israel’s largest healthcare organization. Variables associated with IHD were assessed by a logistic regression model. To assess for variables that were related to increased risk of all-cause mortality, the Cox proportional hazards method was used, and a log-rank test was performed for survival analysis. (3) Results: Both groups were composed of 64% females with a median age of 56 years. An association between sarcoidosis and IHD was demonstrated by a multivariate analysis (adjusted odds ratio (OR) 1.5; 95% confidence interval (CI) 1.36–1.66). Long-term follow-up revealed increased mortality among sarcoidosis patients: 561 (15%) deaths compared to 1636 (9%) deaths among controls (p < 0.001). Survival analysis demonstrated that sarcoidosis patients were also at increased risk for all-cause mortality compared to controls (multivariate model, adjusted HR 1.93; 95% CI 1.76–2.13).

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Increased Remnant Cholesterol Explains Part of Residual Risk of All-Cause Mortality in 5414 Patients with Ischemic Heart Disease

Clinical Chemistry ◽

10.1373/clinchem.2015.253757 ◽

2016 ◽

Vol 62 (4) ◽

pp. 593-604 ◽

Cited By ~ 52

Author(s):

Anne-Marie K Jepsen ◽

Anne Langsted ◽

Anette Varbo ◽

Lia E Bang ◽

Pia R Kamstrup ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Hazard Ratio ◽

Residual Risk ◽

Ischemic Heart ◽

Increased Risk ◽

All Cause Mortality ◽

Remnant Cholesterol

Abstract BACKGROUND Increased concentrations of remnant cholesterol are causally associated with increased risk of ischemic heart disease. We tested the hypothesis that increased remnant cholesterol is a risk factor for all-cause mortality in patients with ischemic heart disease. METHODS We included 5414 Danish patients diagnosed with ischemic heart disease. Patients on statins were not excluded. Calculated remnant cholesterol was nonfasting total cholesterol minus LDL and HDL cholesterol. During 35836 person-years of follow-up, 1319 patients died. RESULTS We examined both calculated and directly measured remnant cholesterol; importantly, however, measured remnant cholesterol made up only 9% of calculated remnant cholesterol at nonfasting triglyceride concentrations <1 mmol/L (89 mg/dL) and only 43% at triglycerides >5 mmol/L (443 mg/dL). Multivariable-adjusted hazard ratios for all-cause mortality compared with patients with calculated remnant cholesterol concentrations in the 0 to 60th percentiles were 1.2 (95% CI, 1.1–1.4) for patients in the 61st to 80th percentiles, 1.3 (1.1–1.5) for the 81st to 90th percentiles, 1.5 (1.1–1.8) for the 91st to 95th percentiles, and 1.6 (1.2–2.0) for patients in the 96th to 100th percentiles (trend, P < 0.001). Corresponding values for measured remnant cholesterol were 1.0 (0.8–1.1), 1.2 (1.0–1.4), 1.1 (0.9–1.5), and 1.3 (1.1–1.7) (trend, P = 0.006), and for measured LDL cholesterol 1.0 (0.9–1.1), 1.0 (0.8–1.2), 1.0 (0.8–1.3), and 1.1 (0.8–1.4) (trend, P = 0.88). Cumulative survival was reduced in patients with calculated remnant cholesterol ≥1 mmol/L (39 mg/dL) vs <1 mmol/L [log-rank, P = 9 × 10−6; hazard ratio 1.3 (1.2–1.5)], but not in patients with measured LDL cholesterol ≥3 mmol/L (116 mg/dL) vs <3 mmol/L [P = 0.76; hazard ratio 1.0 (0.9–1.1)]. CONCLUSIONS Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.

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The association of digoxin with mortality in ischemic heart failure: a secondary analysis of the STICH trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0882 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Pandya ◽

D.L Brown

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Medical Therapy ◽

Proportional Hazards ◽

Cardiovascular Death ◽

Cox Proportional Hazards ◽

Ischemic Heart ◽

Ischemic Heart Failure ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Digoxin, one of the first treatments for symptoms of congestive heart failure (CHF), is currently used in the management of persistent CHF symptoms as well as for ventricular rate control in atrial fibrillation. Current guidelines suggest digoxin as an adjunct to optimal medical therapy for symptomatic improvement in CHF. However, the data regarding the effect of digoxin use on mortality continue to be conflicting. Purpose The aim of this retrospective study was to evaluate the association of digoxin therapy with mortality in patients with ischemic heart failure defined by severe left ventricular (LV) dysfunction and coronary artery disease (CAD) in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Methods STICH randomized 1012 patients with CAD and LV ejection fraction<35% to coronary artery bypass graft (CABG) surgery and medical therapy vs. medical therapy alone. Factors predictive of digoxin use were identified with a binomial logistic regression model. Multivariable Cox proportional hazards modelling was performed with digoxin use modelled as a segmented time-dependent covariate. The model was adjusted for baseline clinical characteristics (including age, race, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, NYHA heart failure class, previous myocardial infarction, atrial fibrillation, creatinine level, smoking status, and STICH treatment group) and stratified based on sex. All covariates were verified to meet the proportional hazards assumption. The primary outcome was all-cause mortality. Secondary outcomes included death and hospitalization due to cardiovascular causes. Relative risks were expressed as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Results Of the 1012 patients, 351 (35% [36% of male patients and 27% of female patients]) reported digoxin use for some duration during the study period. Significant predictors of digoxin use included minority status, NYHA class, previous myocardial infarction, and baseline diagnosis of hypertension, diabetes, or atrial fibrillation. At a mean follow-up of 9.8 years, 566 patients (55.7%) experienced all-cause mortality and 387 patients (38.1%) died due to cardiovascular causes. The adjusted Cox proportional hazards model demonstrated that digoxin use was independently associated with an increased risk of all-cause mortality (aHR 1.22, 95% CI: 1.00–1.49, P=0.049). Digoxin use was also associated with increased risk of cardiovascular death (aHR 1.29, 95% CI: 1.02–1.64, P=0.032). There was no impact of digoxin on hospitalization for cardiovascular causes. Conclusion Use of digoxin in patients with ischemic heart failure was associated with an increased risk of both all-cause and cardiovascular death. Funding Acknowledgement Type of funding source: None

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Abstract 9690: Does Testosterone Therapy Increase Risk of Cardiovascular Event Among Men? A Meta-Analysis

Circulation ◽

10.1161/circ.130.suppl_2.9690 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

nader makki ◽

Wassef Karrowni ◽

Wassef Karrowni

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Cardiovascular Events ◽

Meta Analysis ◽

Ischemic Heart ◽

Sensitivity Analyses ◽

Industry Funding ◽

Testosterone Therapy ◽

Increased Risk ◽

All Cause Mortality

Background: Testosterone therapy has been increasingly promoted and prescribed over the past decade. However, there is rising concern about its safety, and randomized data adequately powered to assess its effect on cardiovascular outcomes is not available. Aim: We conducted a meta-analysis and systematic review of published randomized and observational studies to examine the overall risk of cardiovascular events associated with testosterone therapy. Methods: We searched Medline (1966-2014), Embase (1966-2014), and Cochrane central (2000-2014). Data was collected and analyzed using random and fixed effect model, as appropriate, with inverse variance weighting. Results: Of 2,800 studies identified, 34 were eligible including 76,270 patients with a mean follow up of 11.7 months. Testosterone therapy was associated with increased risk of cardiovascular events (adjusted HR=1.41, 95% CI = 1.18-1.70, p<0.05), all-cause mortality (adjusted HR=1.51, 95% CI = 1.05-2.18, p<0.05), and ischemic heart disease (adjusted HR=1.32, 95% CI = 1.11-1.57, p<0.05), but not cerebrovascular events (adjusted HR=1.22, 95% CI = 0.98-1.53, p=0.08). Using meta-regression and sensitivity analyses to account for factors such as baseline cardiovascular disease, timing of testosterone collection, and industry funding did not change the results of our main analysis. Conclusions: Our meta-analysis demonstrates that testosterone therapy may be associated with increased risk of all-cause mortality, cardiovascular events, and ischemic heart disease.

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Comparative Effectiveness of CABG versus PCI in Patients with Ischemic Heart Disease: insights from SWEDEHEART Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2521 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Redfors ◽

S Volz ◽

O Angeras ◽

D Ioanes ◽

J Odenstedt ◽

...

Keyword(s):

Heart Failure ◽

Sensitivity Analysis ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Ischemic Heart ◽

Funding Source ◽

Left Main

Abstract Background Several studies have compared CABG to PCI as revascularization treatment in patients with ischemic heart disease (IHD). However, it remains unclear which revascularization strategy carries survival benefits in the long-term. Methods We used data from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry for all hospital admissions at 13 cardiac care centers within Västra Götaland County in Sweden (∼20% of all SWEDEHEART data). The database contains >1000 clinical variables documenting the entire process of acute coronary hospital care. All patients hospitalized for stable angina or NSTE-ACS during the period 2000–2018 were included in the analysis. We used a propensity score-adjusted Cox proportional-hazards regression with hospitals as random-effect variables. We adjusted for patients' demographics, socio-economic status, traditional risk factors, comorbidities, the severity of coronary artery disease, left ventricular function, calendar year and medication at discharge. For sensitivity analysis, we used the instrumental variable estimator for the Cox proportional-hazards model (with treating hospital as a treatment-preference instrument) to simultaneously deal with the problems of unmeasured confounding and censoring of the outcome. The primary outcome was all-cause mortality. Results In total, 11,896 patients were included in the study. Of these, 3,129 (26.3%) were women. 20.4% had diabetes and 10.4% had a previous myocardial infarction. The mean age was 66.7±10.7, and 42.9% were >70 years old. 61.5% had three-vessel and/or left main disease. Median follow-up time was 5.7 years (range 1 day-18.2 years). Revascularization therapy after coronary angiography was PCI in 9449 (79.4%) and CABG in 2,447 (20.6%) patients. CABG patients were more likely to have diabetes, left main/multivessel disease and heart failure. The number of revascularized patients with PCI increased by 6.4% per calendar year (P<0.001). There were 2,481 (20.9%) deaths. CABG was associated with a lower risk of death compared to PCI (HR 0.81; 95% CI 0.69–0.95; P=0.011. We found no evidence for treatment heterogeneity between the revascularization strategy and age, gender, diabetes, heart failure and indication for revascularization (all P-interaction >0.05). Results from the sensitivity analysis support the conclusions from the primary model. Conclusions In hospitalized patients due to IHD, revascularization with CABG was associated with superior long-term survival compared to PCI. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Heart and Lung Foundation, ALF Västra Götaland, Swedish Scientific Council

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SO028LONG-TERM OUTCOMES IN LIVE KIDNEY DONORS: PREVALENCE OF ISCHEMIC HEART DISEASE, DIABETES, CANCER AND CEREBROVASCULAR DISEASE AFTER DONATION COMPARED TO HEALTHY CONTROLS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so028 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Anders Haugen ◽

Dag Olav Dahle ◽

Stein I Hallan ◽

Karsten Midtvedt ◽

Anna Varberg Reisater ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Cerebrovascular Disease ◽

Ischemic Heart ◽

Healthy Controls ◽

Kidney Donors ◽

Increased Risk ◽

Long Term Follow Up

Abstract Background and Aims During long-term follow-up kidney donors are at increased risk of hypertension and end-stage renal disease after donation. Hypertension is a known risk factor for development of cardiovascular disease, but it is unknown whether kidney donors are at increased risk of cardiovascular disease. We evaluated a large Norwegian kidney donor cohort and assessed prevalence of ischemic heart disease after donation compared to healthy controls. Prevalence of cancer, diabetes and cerebrovascular disease was also calculated. Method Follow-up data were retrospectively retrieved from past kidney donors. Healthy non-donor controls from a general population screening study were selected. Controls were selected according to standard donation criteria, assessed in similar time periods as the living donors. Stratified logistic regression was used to estimate associations with various disease outcomes. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. A total of 1029 donors and 16084 controls were included. Results Mean observation time was eleven years after donation. Forty-four per cent of donors were male and mean age at follow-up was 56 years. Among the controls, 39 % were male and mean age at follow-up was 53 years. At the time of follow up, 3.5 % of donors vs 1.7 % of controls had been diagnosed with ischemic heart disease, 3.7 % vs 4.4 % cancer, 1.8 % vs 1.4 % cerebrovascular disease and 4.1 % vs 1.9 % diabetes. After adjusting for gender, age at follow up, smoking at baseline, BMI at baseline, systolic blood pressure at baseline and time since donation (time since participation in general population survey for controls), odds ratio for ischemic heart disease was 1.64 (CI 1.10-2.43; P=0.01) in previous kidney donors compared with healthy controls. Other outcomes did not differ significantly between donors and controls. Conclusion During long-term follow-up of kidney donors we find an increased risk of ischemic heart disease compared to healthy controls. This information may be important in the follow-up and selection process of living kidney donors.

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Incidence of Heart Failure among Diabetic Patients with Ischemic Heart Disease: A Cohort Study

10.21203/rs.2.12559/v1 ◽

2019 ◽

Author(s):

Senbeta Guteta Abdissa ◽

Wakgari Deressa ◽

Amit Shah

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Proportional Hazards ◽

Cox Regression ◽

Addis Ababa ◽

Cox Proportional Hazards ◽

Ischemic Heart ◽

Diabetic Patients

Abstract Background In population studies of heart failure (HF), diabetes was shown to be an independent risk factor but the evidence regarding Diabetes Mellitus (DM) having incremental effect in incidence of HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients. Methods A retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Results Mean age was 56.8 years and male patients accounted for 69%. Prevalence of DM was 31.4% (n=96). During the 24 months follow-up period, 196 (64.1%) had incident HF. Predictors of incident HF were female sex [COR 2.2(1.3-3.8), p=0.006], DM [COR 1.8 (1.1-3.0), p = .04], older age [t (304) = 2.5, p = 0.01, two tailed], bigger left atrial size [t (196) = 2.9, p = 0.005, two-tailed], and lower hemoglobin [t (232) = - 2.3, p = 0.02, two-tailed]. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% CI: 1.32-3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN), DM was associated with worse prognosis, the strongest association being in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66-3.98, p<0.0001] followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38-3.71, p=0.001]. Conclusion DM is the strongest predictor of incident HF in patients with IHD. It is worse when DM is combined with HTN.

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Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections

Journal of Pharmacy Practice ◽

10.1177/0897190017751208 ◽

2018 ◽

Vol 32 (4) ◽

pp. 375-381 ◽

Cited By ~ 1

Author(s):

Jesse M. Fletcher ◽

Shawn J. Kram ◽

Christina B. Sarubbi ◽

Deverick J. Anderson ◽

Bridgette L. Kram

Keyword(s):

Proportional Hazards ◽

Bloodstream Infections ◽

Cox Proportional Hazards ◽

Rank Test ◽

Beta Lactam ◽

Increased Risk ◽

Definitive Therapy ◽

Enterococcus Spp ◽

All Cause Mortality ◽

Vancomycin Group

Background: De-escalation to a beta-lactam improves outcomes for patients with a methicillin-susceptible Staphylococcus aureus bloodstream infection (BSI). Whether a similar strategy is appropriate for enterococcal species is less clear. Objective: To determine whether definitive antibiotic selection affects outcomes for patients with an ampicillin-susceptible enterococcal BSI. Methods: This retrospective cohort study included patients over 18 years of age receiving definitive therapy with vancomycin or a beta-lactam for one or more blood cultures positive for Enterococcus spp. isolates between 2007 and 2014. Survival differences were examined using a Kaplan-Meier curve with log-rank test. Results: One-hundred eighty-six patients received definitive therapy with either vancomycin (n = 45, 24.2%) or a beta-lactam (n = 141, 75.8%). The primary outcome, 30-day all-cause mortality, was not different between groups (6.7% vs 7.1%; P = .992). A post hoc analysis of all-cause mortality 1 year after the index BSI was significantly higher in the vancomycin group (51% vs 33%; P = .032). In a Cox proportional hazards regression model, definitive vancomycin was associated with an increased risk of all-cause mortality at 1 year (hazard ratio [HR]: 2.39; 95% confidence interval [CI]: 1.41-4.04). Conclusion: For patients with an ampicillin-susceptible enterococcal BSI, definitive therapy with vancomycin or a beta-lactam was not independently associated with a difference in 30-day all-cause mortality. Whether definitive vancomycin is associated with poor long-term outcomes warrants further exploration.

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Air Pollution Is Associated with Cognitive Deterioration of Alzheimer’s Disease

Gerontology ◽

10.1159/000515162 ◽

2021 ◽

pp. 1-9

Author(s):

Feng Cheng Lin ◽

Chih Yin Chen ◽

Chung Wei Lin ◽

Ming Tsang Wu ◽

Hsuan Yu Chen ◽

...

Keyword(s):

Risk Factors ◽

Air Pollution ◽

Social Engagement ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Rank Test ◽

Cognitive Deterioration ◽

Clinical Dementia Rating ◽

Severe Stage ◽

Increased Risk

Introduction: Dementia is one of the major causes of disability and dependency among older people worldwide. Alzheimer’s disease (AD), the most common cause of dementia among the elderly, has great impact on the health-care system of developed nations. Several risk factors are suggestive of an increased risk of AD, including APOE-ε4, male, age, diabetes mellitus, hypertension, and low social engagement. However, data on risk factors of AD progression are limited. Air pollution is revealed to be associated with increasing dementia incidence, but the relationship between air pollution and clinical AD cognitive deterioration is unclear. Methods: We conducted a case-control and city-to-city study to compare the progression of AD patients in different level of air-polluted cities. Clinical data of a total of 704 AD patients were retrospectively collected, 584 residences in Kaohsiung and 120 residences in Pingtung between 2002 and 2018. An annual interview was performed with each patient, and the Clinical Dementia Rating score (0 [normal] to 3 [severe stage]) was used to evaluate their cognitive deterioration. Air pollution data of Kaohsiung and Pingtung city for 2002–2018 were retrieved from Taiwan Environmental Protection Administration. Annual Pollutant Standards Index (PSI) and concentrations of particulate matter (PM10), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO) were obtained. Results: The PSI was higher in Kaohsiung and compared with Pingtung patients, Kaohsiung patients were exposed to higher average annual concentrations of CO, NO2, PM10, and SO2. AD patients living in Kaohsiung suffered from faster cognitive deterioration in comparison with Pingtung patients (log-rank test: p = 0.016). When using multivariate Cox proportional hazards regression analysis, higher levels of CO, NO2, PM10, and SO2 exposure were associated with increased risk of AD cognitive deterioration. Among all these air pollutants, high SO2 exposure has the greatest impact while O3 has a neutral effect on AD cognitive deterioration. Conclusions: Air pollution is an environment-related risk factor that can be controlled and is associated with cognitive deterioration of AD. This finding could contribute to the implementation of public intervention strategies of AD.

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Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis

Blood Purification ◽

10.1159/000512962 ◽

2021 ◽

pp. 1-11

Author(s):

Dongying Fu ◽

Jiani Shen ◽

Wei Li ◽

Yating Wang ◽

Zhong Zhong ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Proportional Hazards ◽

Elevated Serum ◽

Ultra Performance Liquid Chromatography ◽

Cox Proportional Hazards ◽

Serum Samples ◽

Entire Cohort ◽

Increased Risk ◽

All Cause Mortality ◽

Male Patients

Background: Elevated levels of serum trimethylamine N-oxide (TMAO) have been previously linked to adverse cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the clinical significance of serum TMAO levels in patients treated with peritoneal dialysis (PD) is unclear. Methods: A total of 1,032 PD patients with stored serum samples at baseline were enrolled in this prospective study. Serum concentrations of TMAO were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. Cox proportional hazards and competing-risk regression models were performed to examine the association of TMAO levels with all-cause and CV mortality. Results: The median level of serum TMAO in our study population was 34.5 (interquartile range (IQR), 19.8–61.0) μM. During a median follow-up of 63.7 months (IQR, 43.9–87.2), 245 (24%) patients died, with 129 (53%) deaths resulting from CV disease. In the entire cohort, we observed an association between elevated serum TMAO levels and all-cause mortality (adjusted subdistributional hazard ratio [SHR], 1.22; 95% confidence interval [95% CI], 1.01–1.48; p = 0.039) but not CV mortality. Further analysis revealed such association differed by sex; the elevation of serum TMAO levels was independently associated with increased risk of both all-cause (SHR, 1.37; 95% CI, 1.07–1.76; p = 0.013) and CV mortality (SHR, 1.41; 95% CI, 1.02–1.94; p = 0.038) in men but not in women. Conclusions: Higher serum TMAO levels were independently associated with all-cause and CV mortality in male patients treated with PD.

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Hemodialysis patients with better coronary flow reserve and nutrition status have surprising prognosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1269 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Imaoka ◽

N Umemoto ◽

S Oshima

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Coronary Flow Reserve ◽

Coronary Flow ◽

Ischemic Heart ◽

Nutrition Status ◽

Flow Reserve ◽

All Cause Mortality ◽

Conventional Risk Factors

Abstract Background In clinical setting, ischemic heart disease is a challenging problem in hemodialysis (HD) population. Coronary flow reserve (CFR) measured by 13 ammonia positron emitting tomography (13NH3PET) is an established and reliable modality for detecting coronary artery disease. Furthermore, some prior studies show CFR is an important and independent predictor for cardiovascular event and mortality. On the other hand, HD patients with malnutrition status have poor prognosis. We have reported about the relationship between cardiovascular events and geriatric nutrition risk index (GNRI). Now, we wonder the predictability of combination of CFR and GNRI. Methods and result We collected 438 consecutive HD patients who received 13NH3PET in our hospital suspected for ischemic heart disease. 29 patients were excluded due to undergoing coronary revascularization within 60 days, 103 patients were excluded due to incomplete database. In total, 306 HD patients were classified into 4 group according the median value of CFR (1.99) and GNRI (97.73); Low CFR Low GNRI group (n=77), High CFR and Low GNRI group (n=76), Low CFR High GNRI group (n=78) and High CFR High GNRI group (n=75). We collected their follow up data up to 1544 days (median 833 days) about all-cause mortality and cardiovascular (CV) mortality. Surprisingly, there is no mortality event in High CFR High GNRI group. We analyzed about all-cause mortality, CV mortality. Kaplan-Meyer analysis shows there are statistically intergroup differences in each (all-cause mortality; log rank p<0.01, CV mortality; log rank p=0.02). Furthermore, we calculated area under the curve (AUC) analysis, net reclassification improvement (NRI) and integrated discrimination improvement (IDI)m adding GNRI and CFR on conventional risk factors. There are intergroup differences for all-cause mortality in AUC [conventional risk factors, +GNRI, +GNRI+CFR; 0.70, 0.72 (p=0.29), 0.79 (p<0.01)], NRI [+GNRI; 0.32 (p=0.04), +GNRI+CFR 0.82 (p<0.01)] and IDI [+GNRI; 0.01 (p=0.05), +GNRI+CFR 0.09 (p<0.01)]. Conclusion HD patients with low CFR and malnutrition status has statistically significant poorer prognosis comparing HD patients with high CFR and without malnutrition status. Adding combination of GNRI and CFR on conventional risk factors improves the predictability of HD population's prognosis. Funding Acknowledgement Type of funding source: None

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