Background: Comorbidities are associated with poor clinical outcome in patients with chronic heart failure, and cardiac MIBG imaging also provides prognostic information in patients with heart failure.However, there is no information available on the impact of comorbidities on the prognostic value of cardiac MIBG imaging in patients admitted for acute decompensated heart failure (ADHF).Methods: We studied 354 consecutive ADHF patients with survival discharge.Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age.Cardiac MIBG imaging were performed just before discharge and the cardiac MIBG heart-tomediastinum ratio (late HMR) were measured on the delayed image.The endpoint was cardiac event defined as a composite of cardiac death and unplanned hospitalization for worsening heart failure.Results: During a follow-up period of 2.1±1.4 years, 133 patients had cardiac event.At multivariate Cox analysis, ACCI (p=0.0003) and late HMR (p=0.0001) were significantly and independently associated with cardiac event.Patients with high ACCI (≥6: median value) had a significantly greater risk of cardiac event (47% vs 26%, p=0.0001,).In the subgroup of high ACCI≥6, patients with low late HMR (<1.55 determined by ROC analysis) had a significantly greater risk of cardiac event (68% vs 37% p<0.0001,).Furthermore, in the subgroup of low ACCI<6, patients with low late HMR (<1.48 determined by ROC analysis) also had a significantly greater risk of the cardiac event (54% vs 26%, p=0.0001, adjusted HR 3.62 [1.94-6.77]). Conclusions:The prognostic value of cardiac MIBG imaging is not affected by comorbidities and cardiac MIBG imaging provide prognostic information even in patients admitted for ADHF, irrespective of comorbidity burden.
Background: Comorbidities are associated with poor clinical outcome in heart failure patients. AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in patients with acute decompensated heart failure (ADHF). On the other hand, systemic inflammation plays a critical role in the outcomes of heart failure. Malnutrition is also associated with poor outcome in heart failure patients. It has been recently reported that advanced lung cancer inflammation index (ALI), which is calculated as body mass index х serum albumin / neutrophil to lymphocyte ratio, is an independent prognostic marker in several types of cancer. We sought to investigate the prognostic value of the combination of AHEAD score and ALI in ADHF patients. Methods and Results: We studied 263 patients admitted for ADHF and discharged with survival. At the discharge, we obtained ALI and AHEAD score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus). During a follow-up period of 5.0±4.2 yrs, 67 patients had cardiovascular death (CVD). At multivariate Cox analysis, AHEAD score and ALI were significantly independently associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and serum sodium level. The patients with both greater AHEAD score (≥median value=3) and lower ALI (≤median value=42.3) had a significantly increased risk of CVD than those with either and none of them (45% vs 24% vs 13%, p<0.0001, respectively). Conclusion: ALI would provide the additional long-term prognostic information to AHEAD score in patients with ADHF.
Abstract Background Comorbidities are associated with poor clinical outcome in patients with chronic heart failure, and acute kidney injury (AKI) also provides prognostic information in patients with heart failure. However, there is no information available on the impact of comorbidities on the prognostic value of AKI in patients admitted for acute decompensated heart failure (ADHF). Methods We prospectively studied 357 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. AKI was defined as an absolute increase in serum creatinine of 0.3mg/dl or more during hospitalization. The endpoint was all-cause death (ACD). Results During a follow-up period of 2.2±1.4 years, 97 patients had ACD. At multivariate Cox analysis, ACCI (p<0.0001) and AKI (p=0.0061) were significantly and independently associated with ACD. Patients with high ACCI (≥5: determined by ROC analysis) had a significantly greater risk of ACD (39% vs 16%). In the subgroup of high ACCI, patients with AKI had a significantly higher risk of ACD (60% vs 35%), whereas there was no significant difference in the risk of ACD between with and without AKI (15% vs 16%) in the subgroup of low ACCI. Conclusions The presence of AKI was associated with the increased risk of mortality in ADHF patients with higher comorbidity burden but not in those without them.
Background: Increased plasma volume (PV) has been shown to be associated with poor clinical outcome in patients (pts) with chronic heart failure (CHF). In addition, cardiac MIBG imaging also provides prognostic information in CHF pts. However, there is no information available on the prognostic value of combining plasma volume status (PVS) and cardiac MIBG imaging for the prediction of re-hospitalization for worsening heart failure (WHF) in pts who are admitted for acute decompensated heart failure (ADHF). Methods: We prospectively studied 271 consecutive pts who were admitted for ADHF and survived to discharge. Body weight measurement, venous blood sampling, echocardiography, and cardiac MIBG imaging were performed just before discharge. PVS was defined as follows: actual PV = (1 - hematocrit) х [a + (b х body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c х body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] х...
Background: Both the periatrial epicardial adipose tissue (EAT) and thyroid dysfunction (TD) are known to play an important role in progression of atrial fibrillation (AF). However, there is little...
Illustration of the "Stitch Artifact Technique". (A) By conducting 2-beat image acquisition without stopping the ventilation, we can create stitch artifact on the 3D image intentionally. (B) This stitch artifact on 3D image indicates the exact position and angle of 2D cut-plane image which we visualized just before showing 3D-image.
Abstract Aims Cardiohepatic interactions have been a focus of attention in heart failure (HF). The model for end‐stage liver disease excluding international normalized ratio (MELD‐XI) score has been shown to be useful for predicting poor outcomes in patients with acute decompensated HF (ADHF). Furthermore, the fibrosis‐4 (FIB‐4) index, a simple marker to assess liver fibrosis, predicts adverse prognoses in patients with HF as well. However, there is little information available on the prognostic significance of the combination of the MELD‐XI score and FIB‐4 index in patients with ADHF and its association with left ventricular ejection fraction (LVEF) subgroup. Methods and results We prospectively studied 466 consecutive patients who were admitted for ADHF [HF with reduced LVEF (LVEF < 40%): n = 164, HF with mid‐range LVEF (40% ≤ LVEF < 50%): n = 104, and HF with preserved LVEF (LVEF ≥ 50%): n = 198]. We calculated the MELD‐XI score and FIB‐4 indices at discharge. The primary endpoint was all‐cause death (ACD). During the mean follow‐up period of 2.8 years, 143 patients had ACD. In the multivariate Cox analysis, the MELD‐XI score and FIB‐4 index were independently associated with ACD. Patients were stratified into the following three groups according to the median value of MELD‐XI score (=11) and FIB‐4 index (=2.13): Group 1 had both a low MELD‐XI score and a low FIB‐4 index; Group 2 had either a high MELD‐XI score (MELD‐XI score ≥11) or a high FIB‐4 index (FIB‐4 index ≥2.13); and Group 3 had both a high MELD‐XI score and a high FIB‐4 index. Kaplan–Meier analysis revealed that Group 2 and Group 3 had a significantly greater risk of ACD than Group 1 [Group 2 vs. Group 1: adjusted hazard ratio, 2.48 (95% confidence interval: 1.75–3.53), P < 0.0001; Group 3 vs. Group 1: adjusted hazard ratio, 7.03 (95% confidence interval: 3.95–13.7), P < 0.0001]. In addition, the patients with both a higher MELD‐XI score and FIB‐4 index showed a significantly higher risk of ACD also in the patients with HF with reduced LVEF, HF with mid‐range LVEF, and HF with preserved LVEF (all P < 0.0001). Conclusions The combination of MELD‐XI score and FIB‐4 index may be useful for stratifying patients at risk for ACD in patients with ADHF, irrespective of LVEF.
