Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients. Methods: Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses. Results: Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs (p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155–2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death. Conclusions: Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.

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MO206MALE SEX IS ASSOCIATED WITH IN-HOSPITAL DEATH IN NON-DIALYSIS CKD PATIENTS WITH COVID-19

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0084 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Armando Coca ◽

Carla Burballa ◽

Francisco Javier Centellas Pérez ◽

Isabel Acosta-Ochoa ◽

María Dolores Arenas ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Organ Injury ◽

Hospital Death ◽

Cox Regression Analysis ◽

Icu Admission ◽

Matched Design ◽

Male Sex ◽

Age And Sex

Abstract Background and Aims Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) can lead to significant organ injury. CKD has been associated with increased mortality in previous epidemics, and male sex has been correlated with worse outcomes during COVID-19 in the general population. Our aim was to describe the differential effect of sex as a risk factor for in-hospital mortality among non-dialysis CKD subjects. Method Multicenter, observational cohort study including 136 adult patients with CKD and 136 age- and sex-matched controls who required admission for COVID-19 in three academic hospitals in Spain. Viral infection was confirmed by real-time RT-qPCR and/or serologic testing in all cases. Disease severity on admission was classified according to the WHO—China Joint Mission Report on COVID-19. The presence of CKD was defined as sustained eGFR <60 and >15 ml/min/1.73m2 within the 6 months prior to COVID-19 hospitalization. Demographic and clinical data were gathered from medical records. Outcomes were recorded during the following 28 days after admission. We applied Cox proportional hazards models, adjusted for age, sex, hypertension, diabetes and severe or critical disease at presentation. Results Due to the matched design, no differences were found regarding age and sex between cohorts. CKD patients suffered more frequently from hypertension and diabetes and presented higher 28-day mortality after hospital admission due to COVID-19 compared with age- and sex-matched controls (40.4 vs. 24.3%; P=0.004). In adjusted Cox regression analysis among CKD patients, only age (HR: 1.087, 95% CI: 1.047-1.128) and male sex (HR: 1.883, 95% CI: 1.045-3.391) were independent predictors of 28-day mortality. Comparatively, among patients without CKD, only age acted as an independent predictor for 28-day mortality (HR: 1.082, 95% CI: 1.033-1.133). None of the variables included in adjusted regression was able to predict ICU admission in any of the cohorts. Conclusion Male sex is associated with increased mortality, but not with ICU admission, after hospitalization due to COVID-19 among non-dialysis CKD patients. That effect was not observed among hospitalized controls without CKD.

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Predictive value of brachial artery flow-mediated dilation on coronary artery abnormality in acute stage of Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-87704-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yizhou Wen ◽

Xianmin Wang ◽

Yonghong Guo ◽

Mei Jin ◽

Jimei Xi ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Brachial Artery ◽

Characteristic Curve ◽

Coronary Aneurysm ◽

Acute Stage ◽

Flow Mediated Dilation ◽

Strong Negative Correlation ◽

Coronary Artery Abnormality ◽

Artery Flow

AbstractCoronary artery abnormalities (CAAs) are a severe complication of Kawasaki disease (KD) that may lead to cardiovascular events. Given the evidence that brachial artery flow-mediated dilation (FMD) decreases in children after the onset of KD, we hypothesized that it could be an early marker of CAA development in the acute stage and investigated its relationship with variation in the coronary artery diameter. A total of 326 sex- and age-matched children were enrolled, including 120 with KD, 109 febrile children and 97 healthy controls. In this study, FMD was significantly decreased in the KD group compared with the febrile and healthy groups. FMD was lower in the CAA group than in the no coronary artery abnormality group. The comparison of FMD showed an obvious difference among the CAA subgroups. The FMD in the coronary aneurysm (CA) group showed a strong negative correlation with the pretreatment maximum coronary artery Z-score (preZmax). While preZmax was 2.5, the receiver operating characteristic curve indicated an optimal cutoff point of 3.44% for FMD. FMD ≤ 3.44% could be considered as a signal of coronary lesions in acute stage of KD.

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Vascular and Cardiac Prognostic Determinants in Patients with Gynecological Cancers: A Six-Year Follow-up Study

Applied Sciences ◽

10.3390/app11136091 ◽

2021 ◽

Vol 11 (13) ◽

pp. 6091

Author(s):

Pietro Scicchitano ◽

Marco Tucci ◽

Gabriella Ricci ◽

Michele Gesualdo ◽

Santa Carbonara ◽

...

Keyword(s):

Brachial Artery ◽

Cox Regression ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Controlled Study ◽

Gynecological Cancers ◽

Roc Curve Analysis ◽

Cox Regression Analysis ◽

All Cause Mortality

Background: The aim of this study was to assess the role of cardiac and vascular parameters as all-cause mortality determinants in patients suffering from gynecological cancers. Methods: This was an observational, prospective, non-randomized, and non-controlled study. Forty-seven consecutive patients (mean age: 58 ± 13 years) were enrolled after cancer staging. All patients underwent evaluation of vascular (common carotid intima-media thickness (mean C-IMT), flow-mediated dilation of the brachial artery (FMD), and antero-posterior diameter of the infrarenal abdominal aorta (APAO)) and cardiac function and morphology before cancer-related interventions. A 6-year follow-up was carried out to assess the overall survival of the whole population. Results: Twenty patients (42%) died by the time of the 6-year follow-up. The brachial artery FMD values were higher in the survivors than the non-survivors (9.71 ± 3.53% vs. 6.13 ± 2.62%, p < 0.001), as well as the LVEF (60.8 ± 3.0% vs. 57.8 ± 4.4%, p = 0.009). There were no differences in the mean C-IMT, APAO, and other echocardiographic parameters. ROC curve analysis identified a baseline LVEF < 57% and FMD value < 5.8% as the best cut-offs. Kaplan–Meier evaluation showed that the LVEF, tricuspid annular plane systolic excursion, and FMD were the best predictors of all-cause mortality, although only the LVEF and FMD were confirmed in multivariate Cox regression analysis. Conclusions: The LVEF and brachial artery FMD are independent prognostic determinants in patients with gynecological cancers.

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Geographic Origin as a Determinant of Carotid Artery Intima-Media Thickness and Brachial Artery Flow-Mediated Dilation

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/01.atv.0000150042.43866.7f ◽

2005 ◽

Vol 25 (2) ◽

pp. 392-398 ◽

Cited By ~ 28

Author(s):

Markus Juonala ◽

Jorma S.A. Viikari ◽

Mika Kähönen ◽

Leena Taittonen ◽

Tapani Rönnemaa ◽

...

Keyword(s):

Carotid Artery ◽

Brachial Artery ◽

Geographic Origin ◽

Intima Media Thickness ◽

Flow Mediated Dilation ◽

Media Thickness ◽

Artery Flow

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The effect of oral antioxidants on brachial artery flow-mediated dilation following 5 and 10 min of ischemia

European Journal of Applied Physiology ◽

10.1007/s00421-009-1147-x ◽

2009 ◽

Vol 107 (4) ◽

pp. 445-453 ◽

Cited By ~ 27

Author(s):

Ryan A. Harris ◽

Steven K. Nishiyama ◽

D. Walter Wray ◽

Vince Tedjasaputra ◽

Damian M. Bailey ◽

...

Keyword(s):

Brachial Artery ◽

Flow Mediated Dilation ◽

Artery Flow

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Reduced endothelial progenitor cells and brachial artery flow-mediated dilation as evidence of endothelial dysfunction in ocular hypertension and primary open-angle glaucoma

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2009.01573.x ◽

2010 ◽

Vol 88 (1) ◽

pp. 135-141 ◽

Cited By ~ 37

Author(s):

Gian Paolo Fadini ◽

Claudio Pagano ◽

Ilenia Baesso ◽

Olympia Kotsafti ◽

Daniele Doro ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Progenitor Cells ◽

Ocular Hypertension ◽

Endothelial Progenitor Cells ◽

Brachial Artery ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Flow Mediated Dilation ◽

Open Angle ◽

Artery Flow

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Low hematocrit levels: a risk factor for long-term outcomes in patients requiring prolonged mechanical ventilation after cardiovascular surgery. A retrospective study

Journal of Investigative Medicine ◽

10.1136/jim-2019-001122 ◽

2019 ◽

Vol 68 (2) ◽

pp. 392-396 ◽

Cited By ~ 1

Author(s):

Akito Tsukinaga ◽

Shunsuke Takaki ◽

Takahiro Mihara ◽

Kenta Okamura ◽

Susumu Isoda ◽

...

Keyword(s):

Mechanical Ventilation ◽

Risk Factor ◽

Cardiovascular Surgery ◽

Cox Regression ◽

Prolonged Mechanical Ventilation ◽

Cox Regression Analysis ◽

Icu Admission ◽

Risk Patients ◽

Long Term Mortality

While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study aimed to evaluate the effects of perioperative hematocrit levels on mortality in patients requiring prolonged mechanical ventilation (PMV) after a cardiovascular surgery. This single-center retrospective cohort study was conducted on 172 patients who underwent cardiovascular surgery with cardiopulmonary bypass or off-pump coronary artery bypass grafting and required PMV for ≥72 hours in the intensive care unit (ICU) from 2008 to 2012 at the Yokohama City University Medical Center in Yokohama, Japan. Patients were classified according to hematocrit levels on ICU admission: high (≥30%) and low (<30%) groups. Of 172 patients, 86 were included to each of the low-hematocrit and high-hematocrit groups, with median hematocrit levels (first to third quartiles) of 27.4% (25.4%–28.7%) and 33.0% (31.3%–35.5%), respectively. The difference in survival rates was significant between the two groups using the log-rank test (HR 0.55, 95% CI 0.32 to 0.95, p=0.033). Cox regression analysis revealed that ≥30% increase in hematocrit levels on ICU admission was significantly associated with decreased long-term mortality (HR 0.40, 95% CI 0.20 to 0.80, p=0.0095). Lower hematocrit levels on ICU admission was a risk factor for increased long-term mortality, and higher hematocrit levels might outweigh the risk of transfusion in patients requiring PMV after a cardiovascular surgery.

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H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137434 ◽

2020 ◽

pp. postgradmedj-2019-137434

Author(s):

Yifei Tao ◽

Wenjing Wang ◽

Jing Zhu ◽

Tao You ◽

Yi Li ◽

...

Keyword(s):

Heart Failure ◽

Regression Analysis ◽

Ejection Fraction ◽

Cox Regression ◽

Area Under The Curve ◽

Support Vector ◽

Preserved Ejection Fraction ◽

Cox Regression Analysis ◽

Non Invasive ◽

Patients With Heart Failure

BackgroundHeart failure with preserved ejection fraction (HFpEF) has received widespread attention in recent years. There is currently a lack of valuable predictors for the prognosis of this disease. Here, we aimed to identify a non-invasive scoring system that can effectively predict 1-year rehospitalisation for patients with HFpEF.MethodsWe included 151 consecutive patients with HFpEF in a prospective cohort study and investigated the association between H2FPEF score and 1-year readmission for heart failure using multivariate Cox regression analysis.ResultsOur findings indicated that obesity, age >70 years, treatment with ≥2 antihypertensives, echocardiographic E/e’ ratio >9 and pulmonary artery pressure >35 mm Hg were independent predictors of 1-year readmission. Three models (support vector machine, decision tree in R and Cox regression analysis) proved that H2FPEF score could effectively predict 1-year readmission for patients with HFpEF (area under the curve, 0.910, 0.899 and 0.771, respectively; p<0.001).ConclusionOur study demonstrates that the H2FPEF score has excellent predictive value for 1-year rehospitalisation of patients with HFpEF.

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