Cirrhotic cardiomyopathy: Predictors of major adverse cardiac events and assessment of reversibility after liver transplant
Saad A. AliHuseyin E ArmanHani ShamseddeenNathaniel ElsnerHussein ElsemesmaniSean JohnsonJoseph ZenisekAbhishek KhemkaUpasana JaroriKavish R. PatidarEric S. OrmanChandrashekhar A. KubalKyle Frick
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Objective To analyze the rule of changes in red cell parameters of patients in short term after the onset of acute myocardial infarction,and to study the relationship between red blood cell volume distribution width( RDW) and shortterm major adverse cardiovascular events( MACE). Methods A total of 100 patients with acute myocardial infarction diagnosed in this hospital were allocated in this study,blood routine examinations at 1st to 4th d,5th to 8th d and 9th to 12th d after myocardial infarction were detected for realization of changes in red blood cell parameters after infarction. They were divided into positive group( 43 cases) and negative group( 57 cases) after admission according to the occurrence of MACE or not,the difference in RDW was compared between these 2 groups. Results At 5th to 8th d after acute myocardial infarction,levels of RBC count,HB and HCT showed a trend of gradual decline,the difference was statistically significant( P 0. 05). The levels of MCV and MCH were gradually increased( P 0. 05); concentration of MCH had a gradually decreased trend( P 0. 05); RDW was increased from 1st to 4th d,and it reached peak at 5th to 8th d,and it gradually declined from 9th to 12th d( P 0. 05). The difference in RDW between MACE positive group and MACE negative group was significant( P 0. 01). Conclusion ①After acute myocardial infarction,RDW is significantly increased,it is suggested that it may closely be related to the occurrence of shortterm major adverse cardiovascular events in patients with acute myocardial infarction. ②Following the continuous progress of acute myocardial infarction,the levels of red blood cells,hemoglobin etc parameters are decreased,and other morphological parameters are also accordingly changed.
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The relationship between serum IL-38 and major adverse cardiovascular events (MACE) in patients with ST elevation myocardial infarction (STEMI) remains unclear.In the present study, 589 STEMI patients were included, the serum level of IL-38 was measured. The median follow-up time was 720 days, the STEMI patients were divided into high IL-38 (IL-38>6.49ng/mL) and low IL-38 groups (IL-38≤6.49ng/mL) to compare the probability of MACE.Plasma IL-38 levels were significantly lower in STEMI patients than in SAP patients (4.0±2.2 vs 6.9±3.2 ng/mL, P < 0.001). Ninety-three STEMI patients met the defined MACE study endpoint. The incidence of MACE was significantly lower in patients with high IL-38 group than in patients with low IL-38 group (7.8% vs 23.7%, P < 0.001). Low plasma IL-38 levels were independently associated with the occurrence of MACE (OR = 0.90, P < 0.001).We get a conclusion that low plasma levels of IL-38 are independently associated with the occurrence of MACE.
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Objective To investigate the significance of serum N-terminal pro-B-type natriuretic peptide(NTproBNP) for the future risk evaluation of major adverse cardiac events(MACE) in elderly patients with stable coronary artery disease(SCAD).Methods A total of 810 elderly patients with SCAD were classified into non-MACE group(468 cases) and MACE group [342 cases,including cardiogenic readmission group(200 cases),nonfatal acute myocardial infarction(AMI) group(61 cases) and death group(81 cases) ] according to disease prognosis.The 342 cases of MACE group were classified into the short-term MACE group(180 cases) and the long-term MACE group(162 cases).The serum NT-proBNP levels of 40 healthy controls and 810 elderly patients with SCAD,which were followed up in the third month,in the sixth month and in the twelfth month,were determined by bi-directional lateral flow immunoassay.The results were analyzed statistically.The MACE were followed up and observed for an average of 24 months.Results The serum NT-proBNP levels at initial admission in the MACE group and non-MACE group were significantly higher than those in the control group(P 0.01),the serum NT-proBNP levels at initial admission in the MACE group were significantly higher than those in the non-MACE group(P 0.01),the serum NT-proBNP levels at initial admission in the short-term MACE group were significantly higher than those in the long-term MACE group(P 0.05),and the serum NT-proBNP level at initial admission in the death group and nonfatal AMI group were significantly higher than those in the cardiogenic readmission group(P 0.05).The serum NT-proBNP levels at initial admission were negatively correlated with the interval time of the patients with readmission and AMI [r =-0.359(P = 0.000),r =-0.458(P = 0.026) ].The serum NT-proBNP level was higher,and the incidence rates of MACE were higher.The incidence rates of MACE in different serum NT-proBNP level groups were significantly different(P 0.01),except the NT-proBNP 6 000 ng/L group.Before MACE,the top value of serum NT-proBNP in the MACE group was significantly higher than that in the non-MACE group,and the top value of serum NT-proBNP in the death group was significantly higher than that in the other groups(P 0.05,P 0.01).In the third,sixth and twelfth months of follow-up period,the serum NT-proBNP levels in the MACE group were significantly higher than those at initial admission(P 0.01).The serum NT-proBNP levels in the non-MACE group were significantly lower than those at initial admission(P 0.01),and were significantly lower than those in MACE group(P 0.01).Kaplan-Meier curve showed that the survival rate with different serum NT-proBNP levels had statistical significance(P 0.01).The death group with various diseases had no statistical significance for the serum NT-proBNP levels(P 0.05).Conclusions The incidence rate of MACE and the interval time of the MACE in elderly patients with SCAD are closely correlated with the serum NT-proBNP level at initial admission and with the changes of serum NT-proBNP levels and the top value of serum NT-proBNP in the follow-up period.The serum NT-proBNP determination for the MACE risk evaluation in elderly patients with SCAD has an important prognostic significance.
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Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Background. Cardiovascular magnetic resonance (CMR) is the best tool for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of sequential LVEF assessment for major adverse cardiac event (MACE) prediction after ST-segment elevation myocardial infarction (STEMI) is uncertain. Purpose. We explored the prognostic impact of sequential assessment of CMR-derived LVEF after STEMI to predict subsequent MACE. Methods. We recruited 1036 STEMI patients in a large multicenter registry. LVEF (reduced [r]: <40%; mid-range [mr]: 40-49%; preserved [p]: ≥50%) was sequentially quantified by CMR at 1 week and after >3 months of follow-up. MACE was regarded as cardiovascular death or re-admission for acute heart failure after follow-up CMR. Results. During a 5.7-year mean follow-up, 82 MACE (8%) were registered. The MACE rate was higher only in patients with LVEF < 40% at follow-up CMR (r-LVEF 22%, mr-LVEF 7%, p-LVEF 6%; p-value < 0.001). Based on LVEF dynamics from 1-week to follow-up CMR, incidence of MACE was 5% for sustained LVEF³40% (n = 783), 13% for improved LVEF (from <40 to ³40%, n = 96), 21% for worsened LVEF (from ³40% to <40%, n = 34) and 22% for sustained LVEF <40% (n = 100), p-value < 0.001. Using a Markov approach that considered all studies performed, transitions towards improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to higher incidence of subsequent MACE. Conclusions. LVEF constitutes a pivotal CMR index for simple and dynamic post-STEMI risk stratification. Detection of reduced LVEF (<40%) by CMR at any time during follow-up identifies a small subset of patients at high risk of subsequent events.
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Objective To investigate the factors of major adverse cardiac events and symptomatic nursing methods with acute myocardial infarction after thrombolysis.Methods 60 patients with acute myocardial infarction and underwent successful thrombolytic therapy,Recorded the clinical data on detail and the major adverse cardiac events(MACE) during hospitalization and follow-up period of 60 days.Results The MACE rate was 8.3% in the hospital,and was 33.3% in followed up for 60 days.COX regression analysis showed that gender,left ventricular ejection fraction,history of diabetes were independent predictor of acute myocardial infarction with MACE.Conclusions The main factors of MACE after thrombolysis were gender,left ventricular ejection fraction,history of diabetes in the cute myocardial infarction after thrombolysis patient,the nurses should be familiar with the formation of MACE,and implement various nursing measures and carry out health guidance.
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Background Magnetic resonance imaging (MRI) is the most accurate imaging technique for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of LVEF assessment at any time after ST‐segment elevation myocardial infarction (STEMI) for subsequent major adverse cardiac event (MACE) prediction is uncertain. Purpose To explore the prognostic impact of MRI‐derived LVEF at any time post‐STEMI to predict subsequent MACE (cardiovascular death or re‐admission for acute heart failure). Study Type Prospective. Population One thousand thirteen STEMI patients were included in a multicenter registry. Field Strength/Sequence 1.5‐T . Balanced steady‐state free precession (cine imaging) and segmented inversion recovery steady‐state free precession (late gadolinium enhancement) sequences. Assessment Post‐infarction MRI‐derived LVEF (reduced [r]: <40%; mid‐range [mr]: 40%–49%; preserved [p]: ≥50%) was sequentially quantified at 1 week and after >3 months of follow‐up. Statistical Tests Multi‐state Markov model to determine the prognostic value of each LVEF state (r‐, mr‐ or p‐) at any time point assessed to predict subsequent MACE. A P ‐value <0.05 was considered to be statistically significant. Results During a 6.2‐year median follow‐up, 105 MACE (10%) were registered. Transitions toward improved LVEF predominated and only r‐LVEF (at any time assessed) was significantly related to a higher incidence of subsequent MACE. The observed transitions from r‐LVEF, mr‐LVEF, and p‐LVEF states to MACE were: 15.3%, 6%, and 6.7%, respectively. Regarding the adjusted transition intensity ratios, patients in r‐LVEF state were 4.52‐fold more likely than those in mr‐LVEF state and 5.01‐fold more likely than those in p‐LVEF state to move to MACE state. Nevertheless, no significant differences were found in transitions from mr‐LVEF and p‐LVEF states to MACE state ( P ‐value = 0.6). Data Conclusion LVEF is an important MRI index for simple and dynamic post‐STEMI risk stratification. Detection of r‐LVEF by MRI at any time during follow‐up identifies a subset of patients at high risk of subsequent events. Level of Evidence 2 Technical Efficacy Stage 2
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Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). Major adverse cardiovascular events prediction may improve outcomes. The aim was to evaluate the ten-year predictors of MACE in patients without angina.Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected and followed up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard models to predict MACE morbidity and MACE mortality.There were 525 patients; 401 (76.0%) were Indian, 167 (31.8%) had diabetes at baseline. At 10-year follow up 157/525 (29.9%) experienced MACE morbidity, of whom, 82/525 (15.6%) had MACE mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow up. For MACE morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Predictors for MACE morbidity were age (hazard ratio [HR] = 1.025), diabetes (HR = 1.436), Duke Risk category (HR = 1.562) and Ischaemic burden category (HR = 1.531). For MACE mortality, mean and longest observation times were 107.9 and 204 months, respectively. Predictors for MACE mortality were age (HR = 1.044), Duke Risk category (HR = 1.983), echocardiography risk category (HR = 2.537) and Ischaemic burden category (HR = 1.780).Among patients without typical angina, early ischaemia on noninvasive tests indicated microvascular disease and hyperglycaemia, predicting long-term MACE morbidity and MACE mortality.Contribution: Diabetes was a predictor for MACE morbidity but not for MACE mortality; patients lost to follow-up were possibly diabetic patients with MACE mortality at district hospitals. Early screening for ischaemia and hyperglycaemia control may improve outcomes.
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