scholarly journals Atrial Fibrillation as a Predictor of In-Hospital Outcome in Patients with Acute Coronary Syndrome Treated by Primary Percutaneous Coronary Intervention

2021 ◽  
pp. 70-84
Author(s):  
Mahmoud A. Saad ◽  
Ahmed F. Alarag ◽  
Randa M. Abdul Mageed ◽  
Seham F. Badr
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Creatinine Level ◽  
Multivariate Regression ◽  
Coronary Intervention ◽  
Multivariate Regression Analysis ◽  
Older Age ◽  
Primary Pci ◽  
Coronary Syndrome ◽  
Study Population

Objectives: to study the relation between atrial fibrillation (AF) and in-hospital outcome in patients with acute coronary syndrome (ACS) who were treated by primary percutaneous coronary intervention (PCI). Methods: This study was conducted on 80 patients admitted with ACS and treated with primary PCI at cardiovascular medicine department Tanta university hospitals starting from January 2020 till January 2021. The primary end points are all cause mortality and major adverse cardiovascular events (MACE) including a composite of death, nonfatal re-infarction, target vessel revascularization (TVR), new onset congestive heart failure, contrast induced nephropathy (CIN), or stroke during hospitalization. Patients was divided into 2 groups: Group 1: consisted of 40 consecutive AF-patients treated by primary PCI. Group 2: consisted of 40 consecutive sinus rhythm-patients treated by primary PCI. Results: Patients in AF group showed significantly older age, lower systolic and diastolic blood pressure, higher heart rate, higher Killip class II-IV, more inferior STEMI presentation, higher CK-MB, more RCA as infarction related artery, more moderate to sever mitral regurgitation, more patient developed congestive heart failure during hospitalization, and higher overall MACE during hospitalization. Univariate and multivariate regression analysis were performed to investigate the possible predictors of AF in the study population. In univariate regression analysis, older age, higher CKMB level, higher degree of mitral regurgitation, enlarged left atrium, and RCA as infarction related artery were correlated with AF. In the multivariate regression analysis, using model adjusted for aforementioned parameters, older age, higher CK-MB level, enlarged left atrium diameter, and RCA as infarction related artery independently predicted AF. Univariate and multivariate regression analyses were performed to investigate the possible predictors of overall in-hospital MACE in the study population. In univariate regression analysis, smoking, Killip II-IV, high creatinine level, lower ejection fraction, higher end systolic diameter, and AF were correlated with MACE. In the multivariate regression analysis, using model adjusted for aforementioned parameters, Killip II-IV, higher creatinine level, and AF independently predicted MACE. Conclusion: Patients older in age, with higher CK-MB level, enlarged left atrial diameter, and RCA as infarction related artery had higher incidence of AF during ACS. Patient with AF who presented with ACS had a higher incidence of heart failure during hospitalization. The independent predictors of MACE in our study were AF, Killip II-IV, and higher creatinine level.

Abstract 12972: Serum-induced Expression of Brain Natriuretic Peptide Contributes to its Increase in Patients With HFpEF

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ryuji Okamoto ◽  
Ryotaro Hashizume ◽  
Noboru Suzuki ◽  
Hiroshi Kiyonari ◽  
Kaoru Dohi
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Multivariate Regression ◽  
Female Gender ◽  
Multivariate Regression Analysis ◽  
Induced Expression ◽  
Reduced Ejection Fraction

Introduction: Brain natriuretic peptide (BNP) levels are relatively higher in patients with heart failure with preserved ejection fraction (HFpEF) than heart failure with reduced ejection fraction (HFrEF); however, the mechanism remains unclear. BNP is induced by undetermined stretch-activated receptors including mechanically gated channels, which can be activated by a mechanical stimulus alone, and mechanically modulated channels, which require nonmechanical stimuli such as agonists. Thus it is possible that serum-induced expression of BNP may contribute to the increase of BNP in patients. Purpose: Our purpose is to examine whether serum-induced BNP expression (iBNP) partly contributes to the increase in BNP in patients with HFpEF. Methods: We generated the BNP reporter mice by knocking luciferase cDNA in the initiation site of NPPB . Neonatal cardiomyocytes were isolated and cultured from 2-day-old neonates. These cardiomyocytes were stimulated for 24 hours with 20% serum from patients with HFpEF or HFrEF (n=114 and 82, respectively) and the luciferase activity was examined as iBNP and the ratio of iBNP to BNP was measured. The patients’ characteristics and clinical parameters were compared and multivariate regression analysis was performed using SPSS version 25. Results: The mean ages were 71 yrs in HFpEF and 67 yrs in HFrEF. The female gender was higher in HFpEF (46% vs 32%). The prevalence of atrial fibrillation and hypertension and the use of calcium channel blocker (CCB) were higher in HFpEF than in HFrEF (31 vs 17%, 66 vs 43%, 28 vs 18%). The prevalence of coronary artery disease, chronic kidney disease and diabetes mellitus were lower in HFpEF than HFrEF (21 vs 42%, 44 vs 74%, 25 vs 44%). The ratio of iBNP to BNP was significantly higher in HFpEF than in HFrEF (26.9 vs 16.1, P<0.001). Multivariate regression analysis showed the existence of HFpEF was an independent predictor for the ratio of iBNP to BNP after adjusting all other measurements (β=0.154, P=0.032). Age, hemoglobin, the use of CCB and the deceleration time were also independent predictors (β=0.167, P=0.025; β=0.203, P=0.006; β=0.138, P=0.049; β=0.143, P=0.049, respectively). Conclusions: These results indicate the elevation of BNP in patients with HFpEF is partly due to the iBNP from heart.

scholarly journals The association between Chiari malformation Type I, spinal syrinx, and scoliosis

2015 ◽  
Vol 15 (6) ◽  
pp. 607-611 ◽  
Author(s):  
Jennifer Strahle ◽  
Brandon W. Smith ◽  
Melaine Martinez ◽  
J. Rajiv Bapuraj ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Chiari Malformation ◽  
Multivariate Regression ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
Older Age ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Female Sex ◽  
The Relationship

OBJECT Chiari malformation Type I (CM-I) is often found in patients with scoliosis. Most previous reports of CM-I and scoliosis have focused on patients with CM-I and a spinal syrinx. The relationship between CM-I and scoliosis in the absence of a syrinx has never been defined clearly. The authors sought to determine if there is an independent association between CM-I and scoliosis when controlling for syrinx status. METHODS The medical records of 14,118 consecutive patients aged ≤ 18 years who underwent brain or cervical spine MRI at a single institution in an 11-year span were reviewed to identify patients with CM-I, scoliosis, and/or syrinx. The relationship between CM-I and scoliosis was analyzed by using multivariate regression analysis and controlling for age, sex, CM-I status, and syrinx status. RESULTS In this cohort, 509 patients had CM-I, 1740 patients had scoliosis, and 243 patients had a spinal syrinx. The presence of CM-I, the presence of syrinx, older age, and female sex were each significantly associated with scoliosis in the univariate analysis. In the multivariate regression analysis, older age (OR 1.02 [95% CI 1.01–1.03]; p < 0.0001), female sex (OR 1.71 [95% CI 1.54–1.90]; p < 0.0001), and syrinx (OR 9.08 [95% CI 6.82–12.10]; p < 0.0001) were each independently associated with scoliosis. CM-I was not independently associated with scoliosis when controlling for these other variables (OR 0.99 [95% CI 0.79–1.29]; p = 0.9). CONCLUSIONS A syrinx was independently associated with scoliosis in a large pediatric population undergoing MRI. CM-I was not independently associated with scoliosis when controlling for age, sex, and syrinx status. Because CM-I is not independently associated with scoliosis, scoliosis should not necessarily be considered a symptom of low cerebellar tonsil position in patients without a syrinx.

scholarly journals Surgical Outcomes in Brainstem Arteriovenous Malformations: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Anadjeet Singh Khahera ◽  
Oludotun Ogunsola ◽  
Justin Sim ◽  
Alison Clarke ◽  
E Sander Connolly
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Functional Outcome ◽  
Multivariate Regression ◽  
Arteriovenous Malformations ◽  
Meta Analysis ◽  
Multivariate Regression Analysis ◽  
Older Age ◽  
Treatment Modalities ◽  
Time Treatment

Abstract INTRODUCTION Due to their propensity to hemorrhage and the surrounding eloquent tissue, brainstem arteriovenous malformations (BS-AVMs) carry significantly higher risk of morbidity and mortality compared to their supratentorial counterparts. In this study, we examined the literature for outcomes following microsurgery and performed an analysis to determine preoperative characteristics that can best predict outcome. METHODS We performed a Pubmed and Web of Science search using the terms “brainstem,” “AVM,” “arteriovenous malformation,” and “outcome.” We collected data on demographics, presentation, AVM characteristics, treatment modalities, angiographic obliteration, and functional outcome. We then ran a multivariate regression analysis to determine factors correlated to outcome. RESULTS We found 114 papers, of which 15 were included in our systematic review and 6 in our meta-analysis. There were 187 BS-AVM patients (59.7% male, mean age 37.8 yr, 70% hemorrhagic presentation) who underwent microsurgical resection. In total, 87% were <3 cm in size with 90% Spetzler-Martin III or less. The AVMs were located in the pons 44.5%, midbrain 38.7%, and medulla 16.8% of the time. Treatment methods included microsurgery alone 65.5%, radiation alone 10.3%, embolization alone 3.4%, microsurgery plus radiation 2.2%, microsurgery plus embolization 12%, radiation plus embolization 2.2%, and >3 modalities in 5.2% of cases. Postoperatively, 78% of AVMs were completely obliterated and 73% of patients were improved or unchanged in their functional outcome. Mean follow-up was 39.1 mo. Multivariate regression analysis showed hemorrhage (P < .001) to be significantly correlated with improved or unchanged functional outcome with medullary location (P = .067) and older age (P = .1) trending toward significance. CONCLUSION BS-AVMs occur in 20 to 50 yr old male patients and predominantly present with hemorrhage. They are most commonly located in the upper brainstem. Obliteration rates are favorable with nearly 3 quarters of patients improving or remaining unchanged in function. Factors associated with favorable functional outcome include hemorrhage, and to lesser degrees, medullary location and older age.

scholarly journals 1574. Multivariate Regression Analysis to Determine Independent Predictors of Treatment Outcomes in the RESTORE-IMI 2 Trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S785-S786
Author(s):  
Robert Tipping ◽  
Jiejun Du ◽  
Maria C Losada ◽  
Michelle L Brown ◽  
Katherine Young ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Response ◽  
Treatment Outcomes ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Apache Ii Score ◽  
Double Blind ◽  
Mitt Population ◽  
Study Results ◽  
All Cause Mortality

Abstract Background In the RESTORE-IMI 2 trial, imipenem/cilastatin/relebactam (IMI/REL) was non-inferior to PIP/TAZ for treating hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) in the primary endpoint of Day 28 all-cause mortality (D28 ACM) and the key secondary endpoint of clinical response (CR) at early follow-up (EFU; 7-14 d after end of therapy). We performed a multivariate regression analysis to determine independent predictors of treatment outcomes in this trial. Methods Randomized, controlled, double-blind, phase 3, non-inferiority trial comparing IMI/REL 500 mg/250 mg vs PIP/TAZ 4 g/500 mg, every 6 h for 7-14 d, in adult patients (pts) with HABP/VABP. Stepwise-selection logistic regression modeling was used to determine independent predictors of D28 ACM and favorable CR at EFU, in the MITT population (randomized pts with ≥1 dose of study drug, except pts with only gram-positive cocci at baseline). Baseline variables (n=19) were pre-selected as candidates for inclusion (Table 1), based on clinical relevance. Variables were added to the model if significant (p &lt; 0.05) and removed if their significance was reduced (p &gt; 0.1) by addition of other variables. Results Baseline variables that met criteria for significant independent predictors of D28 ACM and CR at EFU in the final selected regression model are in Fig 1 and Fig 2, respectively. As expected, APACHE II score, renal impairment, elderly age, and mechanical ventilation were significant predictors for both outcomes. Bacteremia and P. aeruginosa as a causative pathogen were predictors of unfavorable CR, but not of D28 ACM. Geographic region and the hospital service unit a patient was admitted to were found to be significant predictors, likely explained by their collinearity with other variables. Treatment allocation (IMI/REL vs PIP/TAZ) was not a significant predictor for ACM or CR; this was not unexpected, since the trial showed non-inferiority of the two HABP/VABP therapies. No interactions between the significant predictors and treatment arm were observed. Conclusion This analysis validated known predictors for mortality and clinical outcomes in pts with HABP/VABP and supports the main study results by showing no interactions between predictors and treatment arm. Table 1. Candidate baseline variables pre-selected for inclusion Figure 1. Independent predictors of greater Day 28 all-cause mortality (MITT population; N=531) Figure 2. Independent predictors of favorable clinical response at EFU (MITT population; N=531) Disclosures Robert Tipping, MS, Merck & Co., Inc. (Employee, Shareholder) Jiejun Du, PhD, Merck & Co., Inc. (Employee, Shareholder) Maria C. Losada, BA, Merck & Co., Inc. (Employee, Shareholder) Michelle L. Brown, BS, Merck & Co., Inc. (Employee, Shareholder) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Joan R. Butterton, MD, Merck & Co., Inc. (Employee, Shareholder) Amanda Paschke, MD MSCE, Merck & Co., Inc. (Employee, Shareholder) Luke F. Chen, MBBS MPH MBA FRACP FSHEA FIDSA, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder)

Epicardial fat thickness as arterial hypertension predictor in normotensive patients with abdominal obesity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kuznetsova ◽  
M Druzhilov
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Blood Glucose ◽  
Waist Circumference ◽  
Arterial Hypertension ◽  
Multivariate Regression ◽  
Fasting Blood Glucose ◽  
Multivariate Regression Analysis ◽  
Epicardial Fat Thickness ◽  
Fat Thickness

Abstract Objective Arterial hypertension (HTN) is one of the most common diseases associated with obesity. Visceral obesity (VO) with dysfunctional visceral adipose tissue plays the main role in obesity induced HTN. Direct criteria of VO including echocardiographic epicardial fat thickness (EFT) may become an additional predictor of HTN. Purpose The aim was to assess the role of echocardiographic EFT (EEFT) as a predictor of HTN in normotensive patients with abdominal obesity (AO). Methods 526 normotensive men (according to ambulatory blood pressure monitoring (ABPM) without therapy) with AO (waist circumference (WC) &gt;94 cm) and SCORE &lt;5%, without cardiovascular diseases and diabetes mellitus were examined (age 45.1±5.0 years). The lipid and glucose profiles, creatinine, uric acid and C-reactive protein blood levels, albuminuria evaluation, echocardiography, carotid ultrasound, bifunctional ABPM were performed. The values of EEFT ≥75 percentile for persons 35–45 years and 46–55 years were 4.8 mm and 5.8 mm respectively. These values used as epicardial VO criteria. Patients with subclinical carotid atherosclerosis due to the lipid-lowering therapy administration (n=98) were excluded from the follow-up. Re-examination with ABPM was conducted on average through 46.3±5.1 months. Data were summarized as mean ± standard error, statistical analysis conducted with paired two-tailed t-tests, Pearson χ2 criterion and multivariate regression analysis. Results Data of 406 persons were available for analysis. HTN as average daily blood pressure ≥130/80 mm Hg was detected in 157 (38.7%) patients. These patients were characterized by initially higher values of age (45.9±4.6 years vs 44.3±4.9 years, p&lt;0.001), waist circumference (106.9±7.3 cm vs 104.2±7.3 cm, p&lt;0.001), body mass index (BMI) (32.0±3.3 kg/m2 vs 30.9±3.2 kg/m2, p&lt;0.001), average daily systolic and diastolic blood pressure (120.7/74.5±4.6/3.4 mm Hg vs 118.2/73.2±5.5/3.9 mm Hg, p&lt;0.001), EEFT (5.2±0.7 mm vs 4.4±1.0 mm, p&lt;0.001). The epicardial VO was initially detected in 95 (23.3%) patients. In patients with HTN the initial prevalence of epicardial VO was greater (58.0% vs 23.3%, p&lt;0.001). As predictors for the multivariate regression analysis the clinical and laboratory examinations data and EEFT were evaluated. According to the results a mathematical model for estimating the probability HTN was obtained: 0.696*fasting blood glucose + 0.198*systolic BP + 2.844*EFT – 40.166 (constant). Among these predictors EEFT was characterized by the highest standardized regression coefficient (0.302, p&lt;0.001) (0.295, p&lt;0.01 for fasting blood glucose, 0.035, p&lt;0.001 for systolic BP). The Hosmer-Lemeshow test value was 0.863, the total percentage of correct classifications was 86%, the area under the ROC-curve was 0.913. Conclusions EEFT (4.8 mm for persons 35–45 years and 5.8 mm for persons 46–55 years) may be an additional predictor of HTN in normotensive patients with AO. Funding Acknowledgement Type of funding source: None

Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Murai ◽  
T Sugiura ◽  
Y Dohi ◽  
H Takase ◽  
T Mizoguchi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
General Population ◽  
Arterial Stiffness ◽  
Pulmonary Function ◽  
Multivariate Regression ◽  
Troponin I ◽  
Augmentation Index ◽  
Smoking Status ◽  
Multivariate Regression Analysis ◽  
The Other

Abstract Background Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population. Purpose We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population. Methods Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC). Results A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI. Conclusions The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals. Funding Acknowledgement Type of funding source: None

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