scholarly journals Adjuvant Whole Breast Radiotherapy Improve Survival in Women with Heart Failure with Reduced Ejection Fraction Receiving Breast-Conserving Surgery

2021 ◽  
Vol 11 (12) ◽  
pp. 1358
Author(s):  
Jiaqiang Zhang ◽  
Shao-Yin Sum ◽  
Jeng-Guan Hsu ◽  
Ming-Feng Chiang ◽  
Tian-Shyug Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Oncologic Outcomes ◽  
Study Cohort ◽  
Breast Radiotherapy ◽  
Reduced Ejection Fraction ◽  
Whole Breast Radiotherapy

Background: to date, no data on the effect of adjuvant whole breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast invasive ductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF). Patients and Methods: we included 294 women with left-breast IDC at clinical stages IA–IIIC and HFrEF receiving breast-conserving surgery (BCS) followed by adjuvant WBRT or non-adjuvant WBRT. We categorized them into two groups based on their adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. We calculated the propensity score and applied inverse probability of treatment weighting (IPTW) to create a pseudo-study cohort. Furthermore, we performed a multivariate analysis of the propensity score–weighted population to obtain hazard ratios (HRs). Results: in the IPTW-adjusted model, adjuvant WBRT (adjusted HR [aHR]: 0.60; 95% confidence interval [CI]: 0.44–0.94) was a significant independent prognostic factor for all-cause death (p = 0.0424), and the aHR (95% CI) of LRR and DM for adjuvant WBRT was 0.33 (0.24–0.71; p = 0.0017) and 0.37 (0.22–0.63; p = 0.0004), respectively, compared with the non-adjuvant WBRT group. Conclusion: Adjuvant WBRT was associated with a decrease in all-cause death, LRR, and DM in women with left IDC and HFrEF compared with non-adjuvant WBRT.

scholarly journals Adjuvant Whole Breast Radiotherapy Improve Survival in Women with Heart Failure with Reduced Ejection Fraction Receiving Breast-Conserving Surgery

2021 ◽  
Author(s):  
Jiaqiang Zhang ◽  
Shao-Yin Sum ◽  
Jeng-Guan Hsu ◽  
Ming-Feng Chiang ◽  
Tian-Shyug Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Oncologic Outcomes ◽  
Study Cohort ◽  
Breast Radiotherapy ◽  
Reduced Ejection Fraction ◽  
Whole Breast Radiotherapy

Abstract BACKGROUND: To date, no data on the effect of adjuvant whole breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast intraductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF). PATIENTS AND METHODS: We enrolled 294 women with left-breast IDC at clinical stages IA–IIIC and HFrEF receiving breast-conserving surgery (BCS) followed by adjuvant WBRT or non-adjuvant WBRT. We categorized them into two groups based on their adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. We calculated the propensity score and applied inverse probability of treatment weighting (IPTW) to create a pseudo-study cohort. Furthermore, we performed a multivariate analysis of the propensity score–weighted population to obtain hazard ratios (HRs).RESULTS: In the IPTW-adjusted model, adjuvant WBRT (adjusted HR [aHR]: 0.58; 95% confidence interval [CI]: 0.33–1.00) was a significant independent prognostic factor for all-cause death (P = 0.0494), and the aHR (95% CI) of LRR and DM for adjuvant WBRT was 0.25 (0.10–0.62; P = 0.0028) and 0.29 (0.14–0.60; P = 0.0007), respectively, compared with the nonadjuvant WBRT group. CONCLUSION: Adjuvant WBRT was associated with a decrease in all-cause death, LRR, and DM in women with left IDC and HFrEF compared with nonadjuvant WBRT.

Adjuvant Breast Radiotherapy Improve Survival in Women With Heart Failure

2021 ◽  
Author(s):  
Jiaqiang Zhang ◽  
Shao-Yin Sum ◽  
Jeng-Guan Hsu ◽  
Ming-Feng Chiang ◽  
Tian-Shyug Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Propensity Score ◽  
Oncologic Outcomes ◽  
Study Cohort ◽  
Cancer Death ◽  
Breast Radiotherapy ◽  
Reduced Ejection Fraction ◽  
Breast Cancer Death ◽  
Whole Breast Radiotherapy

Abstract BACKGROUND To date, no data on the effect of adjuvant whole breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast intraductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF). PATIENTS AND METHODS : We enrolled 294 women with left-breast IDC at clinical stages IA–IIIC and HFrEF receiving breast-conserving surgery (BCS) followed by adjuvant WBRT or non-adjuvant WBRT. We categorized them into two groups based on their adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. We calculated the propensity score and applied inverse probability of treatment weighting (IPTW) to create a pseudo-study cohort. Furthermore, we performed a multivariate analysis of the propensity score–weighted population to obtain hazard ratios (HRs). RESULTS In the IPTW-adjusted model, adjuvant WBRT (adjusted HR [aHR]: 0.60; 95% confidence interval [CI]: 0.44–0.94) was a significant independent prognostic factor for all-cause death (P = 0.0424), and the aHR (95% CI) of LRR and DM for adjuvant WBRT was 0.33 (0.24–0.71; P = 0.0017) and 0.37 (0.22–0.63; P = 0.0004), respectively, compared with the no adjuvant WBRT group. The aHR (95% CI) of breast cancer death for adjuvant WBRT was 0.54 (0.44–0.85; P = 0.0201) compared with no adjuvant WBRT group. CONCLUSION Adjuvant WBRT was associated with a decrease in all-cause death, breast cancer death, LRR, and DM in women with left IDC and HFrEF compared with no adjuvant WBRT.

Adjuvant Radiotherapy is Associated with an Increase of Survival of Old (Aged Over 80 Years) and Very Old (Aged Over 90 Years) Women with Breast Cancer Receiving Breast-Conserving Surgery

2021 ◽  
Author(s):  
Jiaqiang Zhang ◽  
Shao-Yin Sum ◽  
Chia-Lun Chang ◽  
Jeng-Guan Hsu ◽  
Ming-Feng Chiang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Older Women ◽  
Locoregional Recurrence ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Oncologic Outcomes ◽  
Breast Radiotherapy ◽  
Very Old ◽  
Breast Invasive Ductal Carcinoma ◽  
Whole Breast Radiotherapy

Abstract BACKGROUND: To date,no data on the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available forold (aged ≥80 years) and very old (≥90 years) women with breast invasive ductal carcinoma (IDC) receiving breast-conserving conservative surgery (BCS).PATIENTS AND METHODS: We enrolled old (≥80 yearsold) and very old (≥90 yearsold) women with breast IDC who had received BCS followed by adjuvant WBRT or no adjuvant WBRT. We groupedthem based on adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. To reduce the effects of potential confounders when comparing all-cause mortality between the groups, propensity score matching was performed.RESULTS:Overall, 752 older women with IDC received BCS followed by adjuvant WBRT, and 752 with IDC received BCS with no adjuvant WBRT.In multivariable Cox regression analysis, the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) of all-cause death for adjuvant WBRT compared with no adjuvant WBRT in older women with IDC receiving BCS was 0.56 (0.44-0.70). The aHRs (95% CIs) of LRR and DM foradjuvant WBRT were 0.29 (0.19-0.45) and 0.45 (0.32-0.62), respectively, compared with no adjuvant WBRT.CONCLUSION: Adjuvant WBRT was associated with decreases in all-cause death, LRR, and DM in old (aged ≥80 years) and very old (aged ≥90 years) women with IDC compared with no adjuvant WBRT.Condensed Abstract: This study is the first to examine the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM) in old (aged ≥80 years) and very old (aged ≥90 years) women with breast invasive ductal carcinoma (IDC) receiving breast-conserving surgery. After propensity score matching, adjuvant WBRT was associated with decreases in all-cause death, LRR, and DM in old and very old women with IDC compared with no use of adjuvant WBRT.

Association of Body Mass Index With Clinical Outcomes in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril/Valsartan

2021 ◽  
pp. 107424842110244
Author(s):  
Kazuhiko Kido ◽  
Christopher Bianco ◽  
Marco Caccamo ◽  
Wei Fang ◽  
George Sokos
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Normal Weight ◽  
Reduced Ejection Fraction ◽  
Propensity Score Weighting ◽  
Patients With Heart Failure

Background: Only limited data are available that address the association between body mass index (BMI) and clinical outcomes in patients with heart failure with reduced ejection fraction who are receiving sacubitril/valsartan. Methods: We performed a retrospective multi-center cohort study in which we compared 3 body mass index groups (normal, overweight and obese groups) in patients with heart failure with reduced ejection fraction receiving sacubitril/valsartan. The follow-up period was at least 1 year. Propensity score weighting was performed. The primary outcomes were hospitalization for heart failure and all-cause mortality. Results: Of the 721 patients in the original cohort, propensity score weighting generated a cohort of 540 patients in 3 groups: normal weight (n = 78), overweight (n = 181), and obese (n = 281). All baseline characteristics were well-balanced between 3 groups after propensity score weighting. Among our results, we found no significant differences in hospitalization for heart failure (normal weight versus overweight: average hazard ratio [AHR] 1.29, 95% confidence interval [CI] = 0.76-2.20, P = 0.35; normal weight versus obese: AHR 1.04, 95% CI = 0.63-1.70, P = 0.88; overweight versus obese groups: AHR 0.81, 95% CI = 0.54-1.20, P = 0.29) or all-cause mortality (normal weight versus overweight: AHR 0.99, 95% CI = 0.59-1.67, P = 0.97; normal weight versus obese: AHR 0.87, 95% CI = 0.53-1.42, P = 0.57; overweight versus obese: AHR 0.87, 95% CI = 0.58-1.32, P = 0.52). Conclusion: We identified no significant associations between BMI and clinical outcomes in patients diagnosed with heart failure with a reduced ejection fraction who were treated with sacubitril/valsartan. A large-scale study should be performed to verify these results.

scholarly journals Diabetes in Patients With Heart Failure With Reduced Ejection Fraction During Hospitalization: A Retrospective Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiling Zhou ◽  
Miye Wang ◽  
Si Wang ◽  
Nan Li ◽  
Shengzhao Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Reduced Ejection Fraction ◽  
Icu Admission ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Subgroup Effects

BackgroundDiabetes is prevalent worldwide including hospitalized patients with heart failure with reduced ejection fraction (HFrEF). This retrospective study investigated the association of diabetes with in-hospital adverse events in patients with HFrEF.MethodsWe analyzed data from electronic medical records of patients hospitalized with HFrEF in West China Hospital of Sichuan University from January 1, 2011, to September 30, 2018. Propensity score matching balances the baseline characteristics between patients with and without diabetes. Logistic and Poisson regressions investigated the association of diabetes with risks of intubation, cardiogenic shock, acute kidney injury (AKI), intensive care unit (ICU) admission and death during hospitalization, and length of ICU and hospital stay in the matched cases.ResultsAmong 6,022 eligible patients (including 1,998 with diabetes), 1,930 patient pairs with and without diabetes were included by propensity score matching. Patients with diabetes had a significantly increased risk of intubation (odds ratio [OR], 2.69; 95% confidence interval [CI], 2.25–3.22; P<0.001), cardiogenic shock (OR, 2.01; 95% CI, 1.72–2.35; P<0.001), AKI at any stage (OR, 1.67; 95% CI, 1.44–1.94; P<0.001), ICU admission (OR, 1.89; 95% CI, 1.65–2.15; P<0.001), and death (OR, 4.25; 95% CI, 3.06–6.02; P<0.001) during hospitalization. Patients with diabetes had longer ICU (median difference, 1.47 days; 95% CI, 0.96–2.08; P<0.001) and hospital stay (2.20 days; 95% CI, 1.43–2.86; P<0.001) than those without diabetes. There were potential subgroup effects by age and by hypertension, and CKD status on the association of diabetes with risk of AKI at any stage; and subgroup effects by sex and CKD status on the association of diabetes with risk of intubation. The increase in length of hospital stay was larger in patients without hypertension than those with hypertension.ConclusionsAmong patients with HFrEF, those with diabetes have a worse prognosis, including a higher risk of in-hospital intubation, cardiogenic shock, AKI, ICU admission and death during hospitalization, and longer ICU and hospital stay.

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