Investigation on the Prediction of Cardiovascular Events Based on Multi-Scale Time Irreversibility Analysis

Investigation of the risk factors associated with cardiovascular disease (CVD) plays an important part in the prevention and treatment of CVD. This study investigated whether alteration in the multi-scale time irreversibility of sleeping heart rate variability (HRV) was a risk factor for cardiovascular events. The D-value, based on analysis of multi-scale increments in HRV series, was used as the measurement of time irreversibility. Eighty-four subjects from an open-access database (i.e., the Sleep Heart Health Study) were included in this study. None of them had any CVD history at baseline; 42 subjects had cardiovascular events within 1 year after baseline polysomnography and were classed as the CVD group, and the other 42 subjects in the non-CVD group were age matched with those in the CVD group and had no cardiovascular events during the 15-year follow-up period. We compared D-values of sleeping HRV between the CVD and non-CVD groups and found that the D-values of the CVD group were significantly lower than those of the non-CVD group on all 10 scales, even after adjusting for gender and body mass index. Moreover, we investigated the performance of a machine learning model to classify CVD and non-CVD subjects. The model, which was fed with a feature space based on the D-values on 10 scales and trained by a random forest algorithm, achieved an accuracy of 80.8% and a positive prediction rate of 86.7%. These results suggest that the decreased time irreversibility of sleeping HRV is an independent predictor of cardiovascular events that could be used to assist the intelligent prediction of cardiovascular events.

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Hypertensive response in exercise - a tool to predict stroke risk?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.225 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

TE Graca Rodrigues ◽

N Cunha ◽

P Silverio-Antonio ◽

P Couto Pereira ◽

B Valente Silva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Exercise Test ◽

Cardiovascular Events ◽

Protective Factor ◽

Independent Predictor ◽

Stress Test ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction There is some evidence suggesting that exaggerated hypertensive response to exercise (HRE) may be associated with higher risk of future cardiovascular events, however the relationship between systolic blood pressure (SPB) during exercise test and stroke is not fully understood. Purpose To evaluate the ability to predict the risk of stroke in patients with HRE in exercise test. Methods Single-center retrospective study of consecutive patients submitted to exercise test from 2012 to 2015 with HRE to stress test. HRE was defined as a peak systolic blood pressure (PSBP) > 210 mmHg in men and > 190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure > 90 mmHg or a rise of 10 mmHg. Patient’s demographics, baseline clinical characteristics, vital signs during the stress test and the occurrence of stroke during follow-up were analysed Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%), dyslipidaemia (61%), previously known coronary disease (32%), diabetes (28%) and smoking (38%). Atrial fibrillation was present in 5.9% of patients. During a mean follow-up of 60 ± 2 months, the incidence of stroke was 2.1% (n = 8), all with ischemic origin. Considering the parameters analysed on exercise test, only PSBP demonstrated to be an independent predictor of stroke (HR 1.042, CI95% 1.002-1.084, p = 0.039,) with moderate ability to predict stroke (AUC 0.735, p = 0.0016) with a most discriminatory value of 203 mmHg (sensibility 56%, specify 67%). Regarding baseline characteristics, after age, sex and comorbidities adjustment, previously controlled hypertension was found to be an independent protective factor of stroke (OR 4.247, CI 95% 0.05-0.9, p = 0.036) and atrial fibrillation was an independent predictor of stroke occurrence (HR 8.1, CI95% 1.4-46.9, p = 0.018). Atrial fibrillation was also associated with hospitalization of cardiovascular cause and major cardiovascular events occurrence (mortality, coronary syndrome and stroke). Baseline SBP was associated with atrial fibrillation development (p = 0.008). Conclusion According to our results, PSBP during exercise test is an independent predictor of stroke occurrence and should be considered as a potencial additional tool to predict stroke occurrence, particularly in high risk patients. The identification of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs.

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Subclinical atherosclerosis: independent predictor of cardiovascular events in a 20-years follow up of patients with or without metabolic syndrome

European Heart Journal ◽

10.1093/eurheartj/eht308.p1544 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P1544-P1544

Author(s):

S. Novo ◽

A. Peritore ◽

R. L. Trovato ◽

F. P. Guarneri ◽

D. Di Lisi ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cardiovascular Events ◽

Independent Predictor ◽

Subclinical Atherosclerosis

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Abstract 4241: Left Atrial Minimum Volume Is The Most Powerful Predictor Of Adverse Cardiovascular Events.

Circulation ◽

10.1161/circ.118.suppl_18.s_851-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Stefano Caselli ◽

Emanuele Canali ◽

Maria Laura Foschi ◽

Umberto Lombardi ◽

Carlos Centurion ◽

...

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Cardiovascular Events ◽

Independent Predictor ◽

Subsequent Development ◽

Left Ventricular ◽

3D Echocardiography ◽

Minimum Volume ◽

Systolic Volume

Objective: we sought to identify, among all two-dimensional (2D), Doppler and three-dimensional (3D) echocardiography variables, the best predictor of adverse cardiovascular events in a 4 years follow-up study. Methods: A population of 151 consecutive sinus rhythm outpatients (mean age 57 ± 15 years) with cardiovascular risk factors, free from previous cardiovascular events or valvular heart disease, underwent 2D, Doppler and 3D echocardiography; data were indexed by body surface area. After a mean follow up of 54 ± 3 months, the study population was divided in two subgroups according to the subsequent development of cardiovascular events (death, myocardial infarction and stroke) or not. Results: combined endpoint was reached in 28 patients (18%). These patients showed significant differences for: e/e′ ratio (p<0.001), end systolic and end diastolic left ventricular (LV) diameters (p<0.05), 2D ejection fraction (p<0.01), 3D LV end diastolic (p<0.01) and end systolic volume (p<0.01), 3D LV mass (p<0.001) and ejection fraction (p<0.01), 3D left atrial maximum (p<0.001) and minimum volumes (p<0.001). By Cox Proportional Hazard analysis we were able to identify left atrial minimum volume as the best independent predictor of cumulative events (hazard ratio: 1.286, confidence interval 1.056 to 1.565; p=0.012). Kaplan-Meier analysis allowed to highlight statistically significant differences among tertiles of 3D left atrial minimum volume in terms of combined endpoint (p=0.002; Figure ). Conclusion: left atrial minimum volume obtained by 3D echocardiography, was in our selected population, the most powerful independent predictor of adverse cardiovascular events.

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Association between P wave polarity in atrial premature complexes and cardiovascular events in a community-dwelling population

BMJ Open ◽

10.1136/bmjopen-2019-033553 ◽

2020 ◽

Vol 10 (11) ◽

pp. e033553

Author(s):

Tomoyuki Kabutoya ◽

Yasushi Imai ◽

Shizukiyo Ishikawa ◽

Kazuomi Kario

Keyword(s):

Cardiovascular Events ◽

Independent Predictor ◽

Density Lipoprotein ◽

Community Dwelling ◽

P Wave ◽

P Waves ◽

The Mean ◽

A Prospective Study ◽

Prior Stroke

ObjectiveTo examine the association between polarity of atrial premature complexes (APCs) and stroke.DesignA prospective study.Setting and participantsA total of 11 092 participants in the Jichi Medical School cohort study were included after excluding patients with atrial fibrillation. We analysed stroke events in patients with (n=136) and without (n=10 956) APCs. With regard to polarity of APCs, patients were subcategorised into having (1) negative (n=39) or non-negative (n=97) P waves in augmented vector right (aVR), and (2) positive (n=28) or non-positive (n=108) P waves in augmented vector left (aVL).Outcome measuresThe primary endpoint was stroke.ResultsPatients with APCs were significantly older than those without APCs (64.1±9.2 vs 55.1±11.6 years, p<0.001). The mean follow-up period was 11.8±2.4 years. Stroke events were observed in patients with (n=13 events) and without (n=411 events) APCs. This difference was significant (log-rank 12.9, p<0.001); however, APCs were not an independent predictor of stroke after adjusting for age, sex, height, body mass index, current drinking, diabetes, systolic blood pressure, prior myocardial infarction, prior stroke and high-density lipoprotein-cholesterol (p=0.15). The incidence of stroke in patients with APCs and non-negative P wave in aVR was significantly higher than in patients without APCs (log-rank 20.1, p<0.001), and non-negative P wave in aVR was revealed to be an independent predictor of stroke (HR 1.84, 95% CI 1.02 to 3.30). The incidence of stroke in patients with APC with non-positive P wave in aVL was also significantly higher than in patients without APC (log-rank 15.3, p<0.001), and non-positive P wave in aVL was an independent predictor of stroke (HR 1.92, 95% CI 1.05 to 3.54).ConclusionsThe presence of APCs with non-negative P wave in aVR or non-positive P wave in aVL on 12-lead ECG was associated with a higher risk of incident stroke.

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Impact of type 2 diabetes mellitus and blood glucose admission levels in patients with myocardial infarction with non obstructive coronary artery disease (MINOCA)

European Heart Journal ◽

10.1093/ehjci/ehaa946.1808 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Paolisso ◽

F Donati ◽

L Bergamaschi ◽

S Toniolo ◽

E.C D'Angelo ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Events ◽

Independent Predictor ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Type 2 Dm ◽

All Cause Mortality ◽

Age And Sex

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinically entity and represents 5% to 10% of all patients with myocardial infarction (MI). Besides type 2 diabetes mellitus (DM), which is a common comorbidity in patients hospitalized for an acute coronary syndrome, high glucose levels (HGL) at admission are frequently observed in this context. The risk of major adverse cardiovascular events following acute coronary syndrome is increased in people with DM and HGL. However, evidence regarding diabetes and high glucose level among MINOCA patients is lacking. Purpose To examine the incidence of major adverse cardiovascular events (MACEs) in diabetic and non-diabetic MINOCA patients as well as according to HGL at presentation. Methods Among 1995 patients with acute MI admitted to our coronary care unit from 2016 to 2018, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. HGL at admission was defined as serum glucose level above 180 mg/dl. All-cause mortality and a composite end-point of all-cause mortality and myocardial re-infarction were compared. The median follow-up time was 19.6±12.9 months. Results Diabetic MINOCA patients were older (mean age 75.5±9.6 vs 66.5±14.7; p=0.002) and with higher prevalence of hypertension (p=0.016). Conversely, there were no significant differences in gender, BMI, dyslipidemia and atrial fibrillation. Similarly, no significant differences were observed regarding clinical and ECG presentation, echocardiographic features and laboratory tests. The rates of death (30.8% vs 8.3%; p=0.013) and MACEs (22.2% vs 6.8%; p=0.025) were significantly higher in MINOCA-DM patients; conversely, no significant differences were observed for re-MI (p=0.58). At multivariate regression model adjusted for age and sex, type 2 DM was not an independent predictor of all cause deaths (p=0.36) and MACE (p=0.24). Patients with admission HGL had similar baseline characteristics, cardiovascular risk factors, clinical presentations, echocardiographic features and troponin values as compared to patients with no-HGL. HGL at admission was associated with higher incidence of all-cause-death (p<0.001) and MACE (p=0.003) during follow-up compared to patients with no HGL; conversely, no significant differences were observed in the incidence of re-MI (p=0.7). Multivariate analysis adjusted for age and sex demonstrated that HGL was an independent predictor of death (HR 6.25; CI 1.64–23.85; p=0.007) and MACEs (HR 6.17; CI 1.79–21.23, p=0.004). Conclusion In MINOCA patients, HGL was an independent risk factor for both MACEs and death while type 2 DM was not correlated with these hard endpoints. As a consequence, HGL could have a still unexplored pathophysiological role in MINOCA. Properly powered randomized trials are warranted. Funding Acknowledgement Type of funding source: None

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Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study

PLoS ONE ◽

10.1371/journal.pone.0251260 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251260

Author(s):

Janice Hegewald ◽

Karla Romero Starke ◽

Susan Garthus-Niegel ◽

Andreas Schulz ◽

Matthias Nübling ◽

...

Keyword(s):

Cardiovascular Disease ◽

Arterial Stiffness ◽

Cardiovascular Events ◽

Cardiovascular Health ◽

Health Study ◽

Incident Hypertension ◽

Gutenberg Health Study ◽

Hazard Ratios ◽

Artery Disease

Introduction Work-life conflicts (WLC) may impact health, but few studies prospectively consider the impact of WLC on objective outcomes such as cardiovascular disease. Using data from the Gutenberg Health Study (GHS), we examined if WLC at baseline was associated with an increased five-year incidence of cardiovascular events (myocardial infarct, stroke, atrial fibrillation, peripheral artery disease, coronary artery disease, chronic heart failure, sudden cardiac death). We also considered if WLC was associated with incident hypertension and arterial stiffness and if the effects of WLC on cardiovascular health differ for men and women. Methods A working subsample of the 15,010 GHS cohort participants completed the Copenhagen Psychosocial Questionnaire, which included five "work-privacy conflict" questions at baseline and at the five-year follow-up. Relative risks for incident hypertension due to increased WLC at baseline (WLC scores exceeding 60 out of 100) were estimated with Poisson regression in the subgroup of participants without hypertension at baseline (n = 2426). Categories of WLC at baseline and follow-up were also used to examine the risk of hypertension due to chronic/recurrent WLC. In this subgroup, we also examined the association between WLC as a continuous score ranging from 0 to 100 with change to arterial stiffness after five years using linear regression. Hazard ratios were estimated for incident cardiovascular events in a larger subsample of participants without prevalent cardiovascular disease at baseline (n = 3698) using Cox regression. We used various multivariable regression models to adjust for sex, age, socioeconomic status, occupational, household, and cardiovascular risk factors. Results We found no association between WLC and incident hypertension or increased arterial stiffness. The fully-adjusted relative risk for WLC >60 at baseline and hypertension was 0.93 (95% 0.74–1.17). The risk of hypertension due to chronic/recurrent WLC >60 was increased but not statistically significant (RR = 1.13, 95% CI 0.83–1.54). Overall, hazard ratios for incident cardiovascular events were also not increased. However, stratifying the results by sex resulted in a hazard ratio of 1.47 (95% CI 0.54–3.98) for incident cardiovascular disease among women in the fully adjusted model. Conclusions Although our results were not statistically significant, they indicate that WLC is negatively impacting the cardiovascular health of women. While these results need to be confirmed with additional research and a longer follow-up, interventions to prevent WLC will promote health and could be especially beneficial for women.

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Abstract 2535: The Adverse Long-Term Impact of Renal Impairment on Patients undergoing Percutaneous Coronary Intervention in the DES Era

Circulation ◽

10.1161/circ.118.suppl_18.s_740-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Clare Appleby ◽

Joan Ivanov ◽

Karen Mackie ◽

Shahar Lavi ◽

Doug Ing ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Renal Impairment ◽

Cardiovascular Events ◽

Independent Predictor ◽

Coronary Intervention ◽

Late Mortality ◽

Percutaneous Coronary ◽

Long Term Impact

Renal impairment (RI) is known to be associated with poor in-hospital outcomes following percutaneous coronary intervention (PCI) but its effect on outcomes beyond one year, particularly in the drug eluting stent (DES) era has not been reported. We undertook an observational study to determine the long-term impact of renal impairment on patients undergoing PCI at a large, tertiary cardiac referral centre. Baseline creatinine was available for 11,969 of the 15,012 consecutive patients undergoing PCI at our institution between April 2000 and Sept 2007. Patients were stratified into those with or without at least moderate RI, defined as a creatinine clearance <60ml/min (CKD class ≤ 3). In-hospital mortality and morbidity were calculated for each cohort. Follow up data was obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed and Cox multiple regression analysis was used to identify independent predictors of late mortality and MACE (major adverse cardiovascular events), and to examine the association between DES use and late outcomes in the presence or absence of RI. Of the 11,953 patients with available long-term follow-up, 3070 had RI (25.7%). In hospital mortality and MACE were significantly increased in those patients (3.34% vs 0.44%, p<0.001, and 5.73% vs 2.2%, p<0.001, respectively). At 7 year follow-up, survival and MACE-free survival were both reduced (64.5 ± 1.4% vs 89.4 ± 0.5%, p<0.001, and 44.0 ± 1.4% vs 63.4 ± 0.8%, p<0.001). RI was identified as an independent predictor of both late mortality and cardiovascular events (HR 2.2, p<0.0001 and HR 1.4, p<0.0001) but DES use was associated with a significant risk reduction for these events (HR 0.7, p<0.0001). In patients with RI, DES use, rather than bare metal stents, was associated with a reduction in mortality (HR 0.83, CI 0.66 –1.0, p=0.1) and reduced subsequent CABG (HR 0.46, CI 0.22– 0.97, p=0.041) but had no effect on repeat PCI (p=0.63). In a large registry of “all-comers” for PCI, RI was an independent predictor of adverse late outcomes at 7 year follow-up. DES use however was associated with improved long-term outcomes in this high risk cohort.

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Interleukin-18: an independent predictor of cardiovascular events in patients with acute coronary syndrome after 6 months of follow-up

Coronary Artery Disease ◽

10.1097/mca.0b013e32832e5c73 ◽

2009 ◽

Vol 20 (5) ◽

pp. 327-331 ◽

Cited By ~ 19

Author(s):

Mariana Vargas Furtado ◽

Ana Paula Webber Rossini ◽

Raquel Barth Campani ◽

Carolina Meotti ◽

Majorie Segatto ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiovascular Events ◽

Independent Predictor ◽

Interleukin 18 ◽

Coronary Syndrome

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The relation of CUN-BAE index and BMI with body fat, cardiovascular events and diabetes during a 6-year follow-up: the Hordaland Health Study

Clinical Epidemiology ◽

10.2147/clep.s145130 ◽

2017 ◽

Vol Volume 9 ◽

pp. 555-566 ◽

Cited By ~ 9

Author(s):

Kathrine J. Vinknes ◽

Eha Nurk ◽

Grethe Tell ◽

Gerhard Sulo ◽

Helga Refsum ◽

...

Keyword(s):

Body Fat ◽

Cardiovascular Events ◽

Health Study

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P939 Global longitudinal myocardial strain: an independent predictor of cardiovascular events in patients with hematopoietic stem cell transplantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.572 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Martin Garcia ◽

V Vallejo Garcia ◽

L Lopez Corral ◽

A C Martin-Garcia ◽

J C Castro Garay ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Cardiovascular Events ◽

Independent Predictor ◽

Hematopoietic Stem ◽

Allogeneic Hsct ◽

Fourth Quartile

Abstract BACKGROUND Hematopoietic stem cell transplantation (HSCT) increases the likelihood of potentially serious cardiovascular complications. The scientific evidence on prognostic predictors is limited and cardiac monitoring of these patients is not systematized. Our aim was to analyze cardiovascular prognosis and identify echocardiographic factors predicting cardiovascular events in the context of HSCT. METHODS An observational, retrospective study was designed, including 243 patients (mean age 54 ± 16yo, 60%males, 13% hypertension, 5% diabetes) undergoing a HSCT (60% Allogeneic/40% Autologous) with previous echocardiography, from December 2016 to the present. Clinical data, echocardiographic findings, mortality and cardiovascular events (CVE) were collected and analyzed. RESULTS After a median follow-up of 18 [12] months, 22 patients (9%) suffered CVE (54% arrhythmias, 40% heart failure, and 9% ischemic heart disease). Patients with Allogeneic-HSCT (13% vs. 3%; p: 0.007), left ventricular dilatation (40% vs. 8.5%, p = 0.02) or hypertrophy (33% vs. 8%, p: 0.01), dilated left atrium (33% vs. 9%, p:0.03), or pericardial effusion (33% vs. 9%, p: 0.04) in the echocardiographic study performed prior to HSCT suffered significantly more CVE at follow-up. Patients with CVE had significantly higher global longitudinal strain (GLS) (-19 ± 3% vs. -21 ± 3%, p= 0.001). Patients were divided into quartiles based on GLS, those belonging to the fourth quartile (>-19.4%) suffered more frequently CVE (log Rank: 9.6; 18% vs. 6%, p = 0.002) with a significantly lower time to event (27 ± 1.8 vs. 32 ± 0.6 months) (Figure). In multivariate analysis (Cox regression), Allogeneic-HSCT (HR: 5.6; p = 0.02) and the fourth quartile of GLS (HR: 4.3; p = 0.004) were maintained as independent predictors of cardiovascular event. CONCLUSION GLS before HSCT is an independent predictor of cardiovascular events at follow-up. This parameter could allow the identification of high-risk patients who could benefit from intensive protocolized cardiac follow-up. Abstract P939 Figure. Survival analysis (Kaplan Meier)

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