Backgrounds: Increased heart rate (HR) and low systolic blood pressure (SBP) are associated with adverse clinical outcomes in patients (pts) admitted for acute decompensated heart failure (ADHF). It has been reported that simple risk index (SRI) based on easily assessed clinical characteristics (age, HR, and SBP) is useful for the prediction of short-term mortality in pts with acute myocardial infarction. However, there is no information available on the prognostic significance of pre-discharge SRI in pts admitted for ADHF relating to reduce or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 303 consecutive ADHF pts discharged with survival (HFrEF(LVEF<50%);n=163, HFpEF(LVEF≥50%);n=140), and obtained clinical characteristics, conventional hemodynamic parameters and laboratory data. SRI was calculated as (HRх[age/10] 2 )/SBP. During a follow up period of 4.2±3.3 yrs, 96 pts had all-cause death. In HFrEF group, at multivariate Cox analysis, SRI at the discharge (adjusted hazard ratio:1.055[95%CI 1.029 to 1.081], p<0.0001) was significantly associated with total mortality, independently of prior heart failure hospitalization, and serum sodium and albumin levels after adjustment for anemia and renal function. The mortality risk significantly increased by SRI tertiles (lowest tertile [<26.3]: 19%, middle tertile [26.3-36.3]: 38% and highest tertile [>36.3]: 54%, p=0.0001). In HFpEF group, SRI at the discharge (adjusted hazard ratio:1.065[95%CI 1.022 to 1.109], p=0.0026) was also significantly associated with total mortality, independently of anemia and serum sodium level after adjustment for renal function. Pts with highest and middle SRI tertile had a increased risk of total mortality than those with lowest tertile (30% vs 28% vs 13%, p=0.002, respectively). Conclusion: SRI at the discharge would provide the long-term prognostic information in ADHF pts, regardless of HFrEF or HFpEF.
Abstract Background Flow-mediated dilation (FMD) tests endothelial function, and computed tomography angiography (CTA) estimates the extent of coronary atherosclerosis and plaque vulnerability. This study aimed to examine the prognostic value of combining FMD and CTA in patients with no history of atherosclerotic disease. Methods The study retrospectively examined patients who underwent CTA and FMD within 3 months between 2012 and 2020. Patients with a history of cardio-cerebrovascular disease or significant stenoses on CTA were excluded. The study endpoint was defined as major cardiac and cerebrovascular events (MACCE): a composite of cardio-cerebrovascular death, acute coronary syndrome, fatal arrhythmia, ischaemic and haemorrhagic stroke, and late revascularisation of the coronary or carotid arteries 6 months after CTA. Finally, the patients were stratified into four groups based on the following factors: FMD <6.0%, per cent atheroma volume (PAV) ≥21.0%, and the presence of high-risk plaques (HRPs). Results During a mean follow-up of 4.7 years, MACCE occurred in 19 of 154 patients (mean age: 61.0±12.9 years, 89 males). FMD, PAV, and HRPs were independent predictors of MACCE after adjusting for age, sex, and hypertension. Compared with the patients with 0 points, hazard ratios of those with 1, 2, and 3 points were 2.76 (P=0.322), 9.89 (P=0.004), and 28.43 (P<0.001), respectively. Adding FMD, PAV, and HRPs to the baseline model, including age, sex, and hypertension, improved the C-index (0.712–0.831, P=0.023). Conclusions Although FMD and CTA findings are useful for predicting cardiovascular events, their combination synergises their prognostic abilities.
Backgrounds: Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients admitted for acute decompensated heart failure (ADHF). Clinical scenario (CS) is used in the early clinical management of ADHF. However, there is no information available on the long-term prognostic significance of AKI, relating to CS classification in ADHF patients. Methods and Results: We studied 303 ADHF patients discharged with survival. According to systolic blood pressure (SBP) at admission, these patients were classified into CS1 (SBP>140mmHg, n=162), CS2 (SBP:100-140 mmHg, n=114), and CS3(SBP 2- to 3-fold increase in Cr, stage 3: >3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.1±3.2 yrs, 81 patients had cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. At multivariate Cox analysis, SBP (p=0.0078) and AKI (p=0.0029) were significantly associated with CVR, independently of serum sodium level and renal function. In group with CS1, patients with stage 2 or 3 AKI (adjusted HR: 4.2[1.4-25.8]) had a significant increased risk of CVR, compared to patients with no AKI, while there was no significant difference in the risk between patients with stage 1 AKI and no AKI. On the other hand, in groups with CS2 or CS3, AKI stages were not significantly associated with CVR. Conclusion: Moderate to severe AKI during heart failure treatment would provide the long-term prognostic information in ADHF patients presenting CS1, but not CS2 and CS3. These results suggested that AKI which occurred in the setting without lower SBP would have the long-term prognostic value in ADHF patients.
Backgrounds: Hyponatremia is associated with not only mortality, but also excessive neurohumoral drive including sympathetic overactivation in patients (pts) with chronic heart failure (CHF). However, the prognostic significance of persistent hyponatremia (per-hypoNa) remains to be unclear in CHF pts. Cardiac metaiodobenzylguanidine (MIBG) imaging, which is useful for the estimation of cardiac sympathetic nerve activity, provides prognostic information in CHF pts. We sought to investigate whether per-hypoNa would provide the additional prognostic information to MIBG imaging in CHF pts. Methods: We studied 103 CHF outpatients with LVEF <40% in our prospective cohort study. The cardiac MIBG heart-to-mediastinum ratio (H/M) washout rate (WR) were calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. We also measured serum sodium concentration at entry and every 6month for the initial 3 years. Per-hypoNa was defined that hyponatremia (<137mEq/L) was observed for more than 6 months. Results: During a follow up period of 8.0±4.0 years, 41 pts died. At multivariate Cox analysis, per-hypoNa (p=0.01) and abnormal WR (p=0.007) were significantly independently associated with the mortality, although H/M showed the significant association with the mortality at the univariate analysis. Pts with per-hypoNa had a significantly higher risk of mortality than pts without per-hypoNa (67% vs 35%, p=0.03). Pts with both per-hypoNa and abnormal WR had a significantly greater risk of mortality than pts with either per-hypoNa or abnormal WR (80% vs 48% p=0.01, adjusted HR 2.8[1.2-6.5]). Furthermore, pts with either per-hypoNa or abnormal WR also had a significantly greater risk of mortality than pts with neither per-hypoNa nor abnormal WR (48% vs 22% p=0.009, adjusted HR 2.6 [1.2-5.4]). Conclusion: The combination of persistent hyponatremia and cardiac MIBG imaging could provide the improved prediction of mortality in CHF pts.
