1
|
Huang L, Zhao X, Liang L, Tian P, Chen Y, Zhai M, Huang Y, Zhou Q, Zhang Y, Zhang J. Renal function modifies the association between hemoconcentration and outcomes in hospitalized heart failure patients. Intern Emerg Med 2024; 19:399-411. [PMID: 38233579 DOI: 10.1007/s11739-023-03488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/13/2023] [Indexed: 01/19/2024]
Abstract
Evidence-based management of decongestion is lacking in hospitalized heart failure (HHF) patients, especially in patients with impaired renal function. Hemoconcentration is an objective measure of decongestion that portends a favorable prognosis and guides management in HHF patients with preserved renal function. We aim to investigate whether it remains a prognosticator in patients with renal impairment, and to refine the identification of subpopulations who will benefit from hemoconcentration-guided therapy. HHF patients admitted to Heart Failure Center of Fuwai Hospital were consecutively included from December 2006 to June 2018. Patient characteristics were depicted. Relationships between in-hospital hemoconcentration, worsening renal function (WRF), and one-year all-cause mortality were investigated in the total population and compared between renal function groups using survival analysis and cubic splines, with a special focus on renal function-based interactions. The association was further validated in sensitivity analyses. Clinically relevant cut-offs and subpopulations were identified by subpopulation treatment effect pattern plots (STEPP) and subgroup analysis. 3661 participants (30.4% with impaired renal function) were included. Hemoconcentration, reflected by an in-hospital increase in hemoglobin, hematocrit, or a relative reduction in estimated plasma volume from baseline to discharge, was predictive of decreased one-year mortality in the total cohort despite its correlation with higher WRF incidence. The prognostic value of hemoconcentration differed in patients with impaired and preserved renal function. Hemoconcentration was related to a favorable prognosis in patients with preserved renal function (HR, 0.69; 95% CI, 0.53-0.90; P = 0.007), especially in young male patients with New York Heart Association functional class III-IV, reduced ejection fraction, and baseline eGFR > 75 mL/min/1.73m2. Contrarily, impaired renal function patients experienced a higher incidence of WRF, and hemoconcentration was no longer related to outcome (HR, 0.90; 95% CI, 0.64-1.26; P = 0.545), with findings consistent in all clinically relevant subgroups. In HHF patients, the prognostic value of hemoconcentration differs by renal function, and the clinical utility of hemoconcentration is contingent on preserved renal function.
Collapse
Affiliation(s)
- Liyan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xuemei Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Lin Liang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Pengchao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yuyi Chen
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Mei Zhai
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Qiong Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
- Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, No.167 Beilishi Road, Beijing, 100037, China.
| |
Collapse
|
2
|
Cosentino N, Trombara F, Marenzi G. Glomerular filtration rate estimation and all-cause and cardiovascular mortality risk prediction: a progressive refinement in accuracy. Eur J Prev Cardiol 2023; 30:1652-1653. [PMID: 37335946 DOI: 10.1093/eurjpc/zwad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
| | - Filippo Trombara
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
| |
Collapse
|
3
|
Sugiura A, Zachoval C, Al-Kassou B, Shamekhi J, Vogelhuber J, Sudo M, Tanaka T, Weber M, Nickenig G, Zimmer S. Impact of New eGFR Equations on Risk Assessment In Patients Undergoing Transcatheter Aortic Valve Implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 49:42-46. [PMID: 36609100 DOI: 10.1016/j.carrev.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Recently, the Chronic Kidney Disease-Epidemiology Collaboration working group has published new formulas for race-independent estimation of glomerular filtration rate (GFR). We investigated the old and new eGFR equations in patients transcatheter aortic valve implantation (TAVI). METHODS We conducted a retrospective analysis based on the data from a prospective registry of patients who underwent TAVI from January 2008 to May 2019. The primary endpoint was 30-day mortality after TAVI, and the secondary endpoints included one- and three-year mortality. RESULTS In total, 1792 patients undergoing TAVI were included in the present analysis. The thirty-day mortality was 4.6 % (95 % CI 3.8-5.7 %), and the one- and three-year mortality were 17.5 % (95 % CI 15.7-19.4 %) and 34.4 % (95 % CI 32.0-37.0 %). After the application of the new eGFR formula, 12.0 % of patients were reclassified within the GFR category in CKD, while 13.2 % of patients were reclassified within the GFR categories of the EuroSCORE II. Hazard ratios for 30-day, one-year, and three-year mortality increased after introduction of the new creatine-based eq. (1.51, 1.52, 1.49 vs. 1.87, 1.79, 1.74, respectively). Compared to the old equation, the new eGFR <60 ml/min/1.73 m2 had a better discrimination ability for the 30-day mortality (Harell's C: 0.563 (95 % CI 0.518-0.608) vs, 0.583 (95 % CI 0.546-0.636); delta Harell's C, 0.031 ± 0.022, p < 0.001). Similar findings were consistently observed in the cystatin creatinine-based equations. CONCLUSIONS The application of the new race-independent estimators of GFR results in the reassessment of renal function in a significant proportion of TAVI patients and may influence the risk stratification of this population.
Collapse
Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Christian Zachoval
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany.
| |
Collapse
|
4
|
Pugliese NR, De Biase N, Del Punta L, Balletti A, Armenia S, Buralli S, Mengozzi A, Taddei S, Metra M, Pagnesi M, Borlaug BA, Williams B, Masi S. Deep phenotype characterization of hypertensive response to exercise: implications on functional capacity and prognosis across the heart failure spectrum. Eur J Heart Fail 2023; 25:497-509. [PMID: 36992634 DOI: 10.1002/ejhf.2827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023] Open
Abstract
AIMS Limited evidence is available regarding the role of hypertensive response to exercise (HRE) in heart failure (HF). We evaluated the systolic blood pressure (SBP) to workload slope during exercise across the HF spectrum, investigating haemodynamic and prognostic correlates of HRE. METHODS AND RESULTS We prospectively enrolled 369 patients with HF Stage C (143 had preserved [HFpEF], and 226 reduced [HFrEF] ejection fraction), 201 subjects at risk of developing HF (HF Stages A-B), and 58 healthy controls. We performed a combined cardiopulmonary exercise stress echocardiography testing. We defined HRE as the highest sex-specific SBP/workload slope tertile in each HF stage. Median SBP/workload slope was 0.53 mmHg/W (interquartile range 0.36-0.72); the slope was 39% steeper in women than men (p < 0.0001). After adjusting for age and sex, SBP/workload slope in HFrEF (0.47, 0.30-0.63) was similar to controls (0.43, 0.35-0.57) but significantly lower than Stages A-B (0.61, 0.47-0.75) and HFpEF (0.63, 0.42-0.86). Patients with HRE showed significantly lower peak oxygen consumption and peripheral oxygen extraction. After a median follow-up of 16 months, HRE was independently associated with adverse outcomes (all-cause mortality and hospitalization for cardiovascular reasons: hazard ratio 2.05, 95% confidence interval 1.81-5.18), while rest and peak SBP were not. Kaplan-Meier analysis confirmed a worse survival probability in Stages A-B (p = 0.005) and HFpEF (p < 0.001), but not HFrEF. CONCLUSION A steeper SBP/workload slope is associated with impaired functional capacity across the HF spectrum and could be a more sensitive predictor of adverse events than absolute SBP values, mainly in patients in Stages A-B and HFpEF.
Collapse
Affiliation(s)
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Buralli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, and National Institute for Health Research University College London Biomedical Research Centre, London, UK
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, and National Institute for Health Research University College London Biomedical Research Centre, London, UK
| |
Collapse
|
5
|
Joshi R, Subedi P, Yadav GK, Khadka S, Rijal T, Amgain K, Rajbhandari S. Prevalence and risk factors of chronic kidney disease among patients with type 2 diabetes mellitus at a tertiary care hospital in Nepal: a cross-sectional study. BMJ Open 2023; 13:e067238. [PMID: 36854582 PMCID: PMC9980322 DOI: 10.1136/bmjopen-2022-067238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of chronic kidney disease (CKD) among patients with type 2 diabetes mellitus (T2DM) and determine the sociodemographic and clinical risk factors associated with CKD. DESIGN AND SETTINGS Cross-sectional study among diabetic outpatients of a tertiary hospital in Nepal. PARTICIPANTS 201 patients with T2DM above 18 years of age. INTERVENTION Participants completed a questionnaire regarding their socioeconomic information and underwent pertinent physical and haematological examinations. PRIMARY AND SECONDARY OUTCOMES MEASURE The prevalence and risk factors of CKD among patients with T2DM. RESULTS The prevalence of CKD in T2DM was 86.6%. In univariable analysis, the variables like age (p=0.026), hypertension status (p=0.002), duration of diabetes (p=0.009) and haemoglobin levels (p=0.027) were significantly associated with CKD among the participants with T2DM. Kruskal-Wallis H test showed that age was significantly different between various CKD stages. Multivariate analysis demonstrated a significant relationship between CKD with age (Adjusted odds ratio (AOR) 3, 95% CI 1.1 to 8.8) and literacy status (AOR 5.8, 95% CI 1.4 to 24.6) CONCLUSION: Advancing age, concomitant hypertension, increasing duration of T2DM and presence of anaemia were found to be important risk factors of CKD. Age is the most important predictor of CKD showing increasing prevalence in the elderly population. Periodic screening tests are essential at an early age to identify kidney diseases at incipient stages, thereby preventing progression to end-stage renal disease.
Collapse
Affiliation(s)
- Rinku Joshi
- Department of Internal Medicine, Shree Birendra Hospital; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Prativa Subedi
- Department of Emergency Medicine and General Practice, Rolpa District Hospital, Rolpa, Nepal
| | - Gopal Kumar Yadav
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sitaram Khadka
- Department of Pharmacy, Shree Birendra Hospital; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Thaneshwar Rijal
- Department of Anesthesia, Shree Birendra Hospital; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Kapil Amgain
- Department of Human Anatomy and Cell Biology, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Sabin Rajbhandari
- Department of Internal Medicine, Shree Birendra Hospital; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| |
Collapse
|
6
|
Łagosz P, Biegus J, Urban S, Zymliński R. Renal Assessment in Acute Cardiorenal Syndrome. Biomolecules 2023; 13:biom13020239. [PMID: 36830608 PMCID: PMC9953721 DOI: 10.3390/biom13020239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Cardiorenal syndrome (CRS) is a complex, heterogeneous spectrum of symptoms that has kept cardiologists awake for decades. The heart failure (HF) population being burdened with multimorbidity poses diagnostic and therapeutic challenges even for experienced clinicians. Adding deteriorated renal function to the equation, which is one of the strongest predictors of adverse outcome, we measure ourselves against possibly the biggest problem in modern cardiology. With the rapid development of new renal assessment methods, we can treat CRS more effectively than ever. The presented review focuses on explaining the pathophysiology, recent advances and current practices of monitoring renal function in patients with acute CRS. Understanding the dynamic interaction between the heart and the kidney may improve patient care and support the selection of an effective and nephroprotective treatment strategy.
Collapse
Affiliation(s)
- Piotr Łagosz
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Clinical Hospital, 50-556 Wroclaw, Poland
- Correspondence:
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Clinical Hospital, 50-556 Wroclaw, Poland
| | - Szymon Urban
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Clinical Hospital, 50-556 Wroclaw, Poland
| |
Collapse
|
7
|
Ferreira JP, Pitt B, McMurray JJV, Pocock SJ, Solomon SD, Pfeffer MA, Zannad F, Rossignol P. Steroidal MRA Across the Spectrum of Renal Function: A Pooled Analysis of RCTs. JACC. HEART FAILURE 2022; 10:842-850. [PMID: 36328653 DOI: 10.1016/j.jchf.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) are underused in patients with kidney dysfunction, and their efficacy among patients with chronic kidney disease (CKD) is uncertain. OBJECTIVES The goal of this study was to analyze the efficacy and safety of steroidal MRAs across the spectrum of estimated glomerular filtration rates (eGFRs) in randomized controlled trials. The study included patients with heart failure (HF) or myocardial infarction and advanced CKD who participated in the RALES (Randomized Aldactone Evaluation Study), EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure), TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) in the Americas, and EPHESUS (Eplerenone Post-AMI Heart Failure Efficacy and Survival Study) trials. METHODS This study used individual patient data meta-analysis using Cox models stratified by trial with treatment-by-eGFR interaction terms. eGFR was recalculated by using the Chronic Kidney Disease Epidemiology Collaboration creatinine formula. RESULTS A total of 12,700 patients were included, of whom 331 (2.6%) had an eGFR ≤30 mL/min/1.73 m2 (mean eGFR: 26.8 ± 3.2 mL/min/1.73 m2). Patients with advanced CKD had higher annualized event rates for all studied outcomes: placebo event rate for the composite of cardiovascular death or HF hospitalization was ∼3-fold higher in patients with eGFR ≤30 compared with those with eGFR >90 mL/min/1.73 m2: 41.6 vs 14.6 events per 100 person-years. MRAs (vs placebo) reduced the composite of cardiovascular death or HF hospitalization, but the effect was attenuated as eGFR decreased: the corresponding HRs by eGFR categories were: HR for >90 mL/min/1.73 m2: 0.62 (95% CI: 0.49-0.78); HR for 61-90 mL/min/1.73 m2: 0.69 (95% CI: 0.61-0.77); HR for 46-60 mL/min/1.73 m2: 0.84 (95% CI: 0.74-0.95); HR for 31-45 mL/min/1.73 m2: 0.79 (95% CI: 0.68-0.91); and HR for ≤30 mL/min/1.73 m2: 0.96 (95% CI: 0.70-1.32) (treatment-by-eGFR interaction P for trend = 0.033). Investigator-reported hyperkalemia and worsening renal function were more frequent (2- to 3-fold) among MRA users, and hyperkalemia was more frequent as eGFR decreased (treatment-by-eGFR interaction P for trend = 0.002). CONCLUSIONS Steroidal MRAs reduced HF hospitalizations and mortality across a wide range of eGFR. However, declining benefit and worsening safety may limit their use in patients with lower eGFR, particularly those with levels ≤30 mL/min/1.73 m2.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Unic@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; Department of Medical Specialties and Nephrology-Hemodialysis, Princess Grace Hospital, Monaco, and Centre d'Hémodialyse Privé de Monaco, Monaco.
| |
Collapse
|
8
|
Rastogi T, Ho FK, Rossignol P, Merkling T, Butler J, Clark A, Collier T, Delles C, Jukema JW, Heymans S, Latini R, Mebazaa A, Pellicori P, Sever P, Staessen JA, Thijs L, Cleland JG, Sattar N, Zannad F, Girerd N. Comparing and contrasting risk factors for heart failure in patients with and without history of myocardial infarction: data from HOMAGE and the UK Biobank. Eur J Heart Fail 2022; 24:976-984. [PMID: 35365899 PMCID: PMC9542039 DOI: 10.1002/ejhf.2495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/28/2022] [Accepted: 03/29/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Myocardial infarction (MI) is among the commonest attributable risk factors for heart failure (HF). We compared clinical characteristics associated with the progression to HF in patients with or without a history of MI in the HOMAGE cohort and validated our results in UK Biobank. METHODS AND RESULTS During a follow-up of 5.2 (3.5-5.9) years, 177 (2.4%) patients with prior MI and 370 (1.92%) patients without prior MI experienced HF onset in the HOMAGE cohort (n = 26 478, history of MI: n = 7241). Older age, male sex and higher heart rate were significant risk factors of HF onset in patients with and without prior MI. Lower renal function was more strongly associated with HF onset in patients with prior MI. Higher body mass index (BMI), systolic blood pressure and blood glucose were significantly associated with HF onset only in patients without prior MI (all p for interactions <0.05). In the UK Biobank (n = 500 001, history of MI: n = 4555), higher BMI, glycated haemoglobin, diabetes and hypertension had a stronger association with HF onset in participants without prior MI compared to participants with MI (all p for interactions <0.05). CONCLUSION The importance of clinical risk factors associated with HF onset is dependent on whether the patient has had a prior MI. Diabetes and hypertension are associated with new-onset HF only in the absence of MI history. Patients may benefit from targeted risk management based on MI history.
Collapse
Affiliation(s)
- Tripti Rastogi
- Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Thomas Merkling
- Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Andrew Clark
- Hull York Medical School, Castle Hill Hospital, Cottingham, UK
| | | | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Stephane Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Roberto Latini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Alexandre Mebazaa
- Université de Paris; APHP, University Hospitals Saint Louis Lariboisière, Inserm 942 MASCOT, Paris, France
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing, Glasgow, UK
| | - Peter Sever
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing, Glasgow, UK.,National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, University of Glasgow, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| |
Collapse
|
9
|
Sow MA, Magne J, Toure F, Teissier MP, Aboyans V. Comparison of four equations for estimation of glomerular filtration rate in predicting cardiovascular events and subclinical vascular disease in patients with type-2 diabetes. Prim Care Diabetes 2022; 16:196-201. [PMID: 34996689 DOI: 10.1016/j.pcd.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/18/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
AIMS Chronic kidney disease (CKD), defined by a low glomerular filtration rate (GFR), is a predictor of cardiovascular disease in patients with type-2 diabetes (T2D). We aimed to compare four GFR equations in predicting future cardiovascular events in T2D and the presence of subclinical vascular disease. METHODS Four equations were used to estimate GFR in asymptomatic T2D patients consulting our centre for cardiovascular assessment. Follow-up was performed to collect cardiovascular events. Cox proportional hazard ratio (HR) was used to build and compare prediction models, and the incremental value of the addition of GFR with any of the 4 formulas was evaluated. The ability to triage patients with and without CVD events according to GFR were assessed by comparing the receiver operator characteristics (ROC) curves with the 4 models. RESULTS Among 829 asymptomatic T2D patients, the CKD prevalence was 20.2% for Modification of Diet in Renal Disease (MDRD), 17.3% for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), 20.7% for Lund-Malmö Revised (LMR) and 21.4% for Full Age Spectrum (FAS). All the estimated GFRs were well correlated from one formula to another, with stronger agreement to define CKD (GFR <60 mL/min/1.73 m2) between MDRD and CKD-EPI, and between LMR and FAS. The 5-year incidence of cardiovascular events was 8% (n = 63). After adjustment on covariables, CKD was significantly associated with cardiovascular events when defined by MDRD (HR = 2.04; 1.15-3.60) and CKD-EPI (HR = 1.90; 1.05-3.41) but missed statistical significance when using LMR (HR = 1.74; 0.97-3.14) or FAS (HR = 1.71; 0.94-3.14). Only the prediction models including MDRD and CKD-EPI provided a significant incremental information to the predictive model without GFR, but the area under the ROC curves were similar with the 4 models: 0.60 [0.54-0.68] for MDRD, 0.61 [0.49-0.65] for CKD-EPI and 0.62 [0.55-0.69] for LMR and FAS, without any significant difference among formulas. CONCLUSION In asymptomatic T2D patients, MDRD and CKD-EPI may be preferable when more specificity is desired (stronger association between GFR and CVD events), while LMR and FAS appear more sensitive by including a higher number of patients with GFR <60 mL/min/1.73 m2.
Collapse
Affiliation(s)
- Mamadou Adama Sow
- INSERM 1094 & IRD, University of Limoges, 2, Rue Marcland, 87025, Limoges, France.
| | - Julien Magne
- INSERM 1094 & IRD, University of Limoges, 2, Rue Marcland, 87025, Limoges, France; Department of Cardiology, Dupuytren 2 University Hospital, 16, Rue B. Descottes, 87042, Limoges, France
| | - Fatouma Toure
- Department of Nephrology, Dupuytren 2 University Hospital, 16, Rue B. Descottes, 87042, Limoges, France
| | - Marie-Pierre Teissier
- INSERM 1094 & IRD, University of Limoges, 2, Rue Marcland, 87025, Limoges, France; Department of Endocrinology and Diabetology, Dupuytren 2 University Hospital, 16, Rue B. Descottes, 87042, Limoges, France
| | - Victor Aboyans
- INSERM 1094 & IRD, University of Limoges, 2, Rue Marcland, 87025, Limoges, France; Department of Cardiology, Dupuytren 2 University Hospital, 16, Rue B. Descottes, 87042, Limoges, France.
| |
Collapse
|
10
|
Ferreira JP, Rossignol P, Bakris G, Mehta C, White WB, Zannad F. Blood and Urine Biomarkers Predicting Worsening Kidney Function in Patients with Type 2 Diabetes Post-Acute Coronary Syndrome: An Analysis from the EXAMINE Trial. Am J Nephrol 2021; 52:969-976. [PMID: 34872085 DOI: 10.1159/000519436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/01/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Worsening kidney function (WKF) is frequent among patients with type 2 diabetes (T2D) and a recent acute coronary syndrome (ACS) and is associated with a poor prognosis. An accurate prediction of WKF is clinically important. AIMS Using data from the Cardiovascular Outcomes Study of Alogliptin in Patients with Type 2 Diabetes and Acute Coronary Syndrome trial including patients with T2D and a recent ACS, and a large biomarker panel incorporating proteins measured both in blood and urine, we aim to determine those with best performance for WKF prediction. METHODS WKF was defined as a ≥40% estimated glomerular filtration rate (eGFR) drop from baseline, eGFR <15 mL/min, or dialysis. Mixed-effects and time-updated Cox models were used. RESULTS 5,131 patients were included from whom 222 (4.3%) developed at least one WKF episode over a median follow-up of 18 months. Patients who developed WKF were more frequently women, had longer diabetes duration, a more frequent heart failure history, higher anemia prevalence, and impaired kidney function. In multivariable models including all variables (clinical and biomarkers) independently associated with WKF with a p value ≤0.0001, blood kidney injury molecule 1 (KIM-1) was (by far) the variable with strongest WKF association, followed by anemia. KIM-1 alone provided good discrimination for WKF prediction (area under the curve = 0.73). Patients in the high KIM-1-derived risk tertile had a 6.7-fold higher risk of any WKF than patients classified as low risk. In time-updated Cox models, the occurrence of WKF was independently associated with a higher risk of death: adjusted hazard ratio = 4.93 (3.06-7.96), p value <0.0001. CONCLUSION Blood KIM-1 was the biomarker with the strongest association with WKF. The occurrence of WKF was independently associated with a higher risk of subsequent cardiovascular events and mortality.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Institut Lorrain Du Coeur et des Vaisseaux Louis Mathieu, Vandoeuvre lès Nancy, France
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patrick Rossignol
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Institut Lorrain Du Coeur et des Vaisseaux Louis Mathieu, Vandoeuvre lès Nancy, France
| | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago, Chicago, Illinois, USA
| | - Cyrus Mehta
- Cytel Corporation, Cambridge, Massachusetts, USA
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Faiez Zannad
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Institut Lorrain Du Coeur et des Vaisseaux Louis Mathieu, Vandoeuvre lès Nancy, France
| |
Collapse
|
11
|
The Prognostic Impact of Estimated Creatinine Clearance by Bioelectrical Impedance Analysis in Heart Failure: Comparison of Different eGFR Formulas. Biomedicines 2021; 9:biomedicines9101307. [PMID: 34680423 PMCID: PMC8533548 DOI: 10.3390/biomedicines9101307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/11/2023] Open
Abstract
The estimation of glomerular filtration rate (eGFR) provides prognostic information in patients with heart failure (HF). Bioelectrical impedance analysis may calculate eGFR (Donadio formula). The aim of this study was to evaluate the impact of the Donadio formula in predicting all-cause mortality in patients with HF as compared to Cockroft-Gault, MDRD-4 (Modification of Diet in renal Disease Study), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. Four-hundred thirty-six subjects with HF (52% men; mean age 75 ± 11 years; 42% acute HF) were enrolled. Ninety-two patients (21%) died during the follow-up (median 463 days, IQR 287-669). The area under the receiver operator characteristic curve for eGFR, as estimated by Cockroft-Gault formula (AUC = 0.75), was significantly higher than those derived from Donadio (AUC = 0.72), MDRD-4 (AUC = 0.68), and CKD-EPI (AUC = 0.71) formulas. At multivariate analysis, all eGFR formulas were independent predictors of death; 1 mL/min/1.73 m2 increase in eGFR-as measured by Cockroft-Gault, Donadio, MDRD-4, and CKD-EPI formulas-provided a 2.6%, 1.5%, 1.2%, and 1.6% increase, respectively, in mortality rate. Conclusions. eGFR, as calculated with the Donadio formula, was an independent predictor of mortality in patients with HF as well as the measurements derived from MDRD4 and CKD-EPI formulas, but less accurate than Cockroft-Gault.
Collapse
|
12
|
Ndrepepa G, Holdenrieder S, Neumann FJ, Lahu S, Cassese S, Joner M, Xhepa E, Kufner S, Wiebe J, Laugwitz KL, Gewalt S, Schunkert H, Kastrati A. Prognostic value of glomerular function estimated by Cockcroft-Gault creatinine clearance, MDRD-4, CKD-EPI and European Kidney Function Consortium equations in patients with acute coronary syndromes. Clin Chim Acta 2021; 523:106-113. [PMID: 34529983 DOI: 10.1016/j.cca.2021.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND It remains unknown which equation used to assess the glomerular function is better for risk stratification in patients with acute coronary syndrome (ACS). METHODS This study included 3985 patients with ACS. Glomerular function was assessed using 4 equations: the Cockcroft-Gault creatinine clearance (C-GCrCl), Modification of Diet in Renal Disease-4 (MDRD-4), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations. The primary outcome was one-year all-cause mortality. RESULTS For each 30 ml/min decrement, the adjusted hazard ratio [HR] with 95% confidence interval [CI] for one-year mortality was 1.67 [1.27-2.25] for C-GCrCl, 1.45 [1.16-1.81] for MDRD-4, 1.76 [1.35-2.30] for CKD-EPI and 1.94 [1.44-2.63] for EKFC equation. Area under the receiver operating characteristic curve (AUC) for one-year mortality was 0.748 [0.709-0.788] for C-GCrCl, 0.670 [0.621-0.718] for estimated glomerular filtration rate (eGFR) calculated by MDRD-4 equation, 0.725 [0.684-0.765] for eGFR calculated by CKD-EPI equation and 0.741 [0.703-0.779] for eGFR calculated by EKFC equation (P = 0.342 for C-GCrCl, vs. EKFC equation and P ≤ 0.009 for all other AUC comparisons). CONCLUSIONS In patients with ACS, C-GCrCl and EKFC equations showed a similar discriminatory power regarding prediction of one-year mortality. Both equations were better than MDRD-4 and CKD-EPI equations for risk discrimination for mortality. CLINICAL TRIAL REGISTRATION NCT01944800.
Collapse
Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
| | - Stefan Holdenrieder
- Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | - Shqipdona Lahu
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany; Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Munich, Germany
| | - Senta Gewalt
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| |
Collapse
|
13
|
Ferreira JP, Lamiral Z, Bakris G, Mehta C, White WB, Zannad F. Red cell distribution width in patients with diabetes and myocardial infarction: An analysis from the EXAMINE trial. Diabetes Obes Metab 2021; 23:1580-1587. [PMID: 33687751 DOI: 10.1111/dom.14371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022]
Abstract
AIM To determine the clinical correlates of increased red blood cell distribution width (RDW), its potential mechanistic association with multiple circulating biomarkers, and its prognostic value in patients with type 2 diabetes (T2D) who had a recent acute coronary syndrome. METHODS We used time-updated Cox models applied to patients enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial. RESULTS A total of 5380 patients were included, the median age was 61 years and 32% were women. Patients with higher RDW were older, more frequently women, with a longer diabetes duration and increased co-morbidities. An RDW of more than 16.1% (both baseline and time-updated) was independently associated with the study primary composite outcome of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death (time-updated adjusted HR = 1.36, 95% CI = 1.16-1.61, p < .001), all-cause death (time-updated adjusted HR = 2.01, 95% CI = 1.60-2.53, p < .001), as well as mortality from non-cardiovascular causes (time-updated adjusted HR = 2.67, 95% CI = 1.72-4.15, p < .001). RDW had a weak-to-moderate correlation with haemoglobin and circulating markers that reflected inflammation, apoptosis, fibrosis and congestion. Alogliptin did not alter RDW values. CONCLUSIONS RDW is a marker of disease severity associated with a multitude of poor outcomes, including both cardiovascular and non-cardiovascular death. RDW correlated modestly with inflammatory, pro-apoptotic, pro-fibrotic and congestion markers, and its levels were not affected by alogliptin during the course of the trial.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Zohra Lamiral
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| |
Collapse
|
14
|
Al-Shamsi S, Govender RD, King J. Predictive Value of Creatinine-based Equations of Kidney Function in the Long-term Prognosis in United Arab Emirates Patients. Oman Med J 2021; 36:e217. [PMID: 33520290 PMCID: PMC7818017 DOI: 10.5001/omj.2021.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022] Open
Abstract
Objectives Chronic kidney disease (CKD) is an independent predictor of mortality. Several creatinine-based equations are used to assess the estimated glomerular filtration rate or creatinine clearance and mortality prediction in various ethnic populations. Similarly, renal insufficiency is associated with poor prognosis of UAE nationals with cardiovascular disease (CVD) risk factors. However, the equation that best assesses prognosis among these patients is unknown. This study aimed to compare the prognostic abilities of different creatinine-based kidney function equations for predicting all-cause mortality in UAE nationals with vascular comorbidities. Methods This retrospective observational study analyzed 1186 patients (54.0% men) with CVD risk factors. Multivariable Cox regression analysis was used to evaluate the associations of categorical renal function stages with all-cause mortality. Measures of performance in each equation assessed with respect to all-cause mortality were evaluated and compared to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation by calculating the C-index, net reclassification index (NRI), and integrated discrimination index. Results Over a median follow-up of 8.9 years, the cumulative incidence of all-cause mortality was 9.4% (n = 112). After multivariable adjustment, the discriminative ability for all-cause mortality was significantly higher in the body surface area-adjusted Cockcroft-Gault (BSA-CG) formula than in the CKD-EPI equation (C-indices: 0.869 vs. 0.861, respectively, p = 0.037). NRI was significantly positive and favored the BSA-CG formula (0.54; 95% confidence interval: 0.35–0.64) compared to the CKD-EPI equation. Conclusions Our findings suggest that the BSA-CG equation may have the potential to slightly improve mortality prediction compared to the CKD-EPI equation in UAE nationals with vascular risk. Further large multicenter studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- Saif Al-Shamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Romona D Govender
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Jeffrey King
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| |
Collapse
|
15
|
Guideline-directed medical therapy in real-world heart failure patients with low blood pressure and renal dysfunction. Clin Res Cardiol 2021; 110:1051-1062. [DOI: 10.1007/s00392-020-01790-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 01/14/2023]
|
16
|
Del Bo' C, Bernardi S, Cherubini A, Porrini M, Gargari G, Hidalgo-Liberona N, González-Domínguez R, Zamora-Ros R, Peron G, Marino M, Gigliotti L, Winterbone MS, Kirkup B, Kroon PA, Andres-Lacueva C, Guglielmetti S, Riso P. A polyphenol-rich dietary pattern improves intestinal permeability, evaluated as serum zonulin levels, in older subjects: The MaPLE randomised controlled trial. Clin Nutr 2020; 40:3006-3018. [PMID: 33388204 DOI: 10.1016/j.clnu.2020.12.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 12/02/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIM Increased intestinal permeability (IP) can occur in older people and contribute to the activation of the immune system and inflammation. Dietary interventions may represent a potential strategy to reduce IP. In this regard, specific food bioactives such as polyphenols have been proposed as potential IP modulator due to their ability to affect several critical targets and pathways that control IP. The trial aimed to test the hypothesis that a polyphenol-rich dietary pattern can decrease serum zonulin levels, an IP surrogate marker involved in tight junction modulation, and can beneficially alter the intestinal microbiota, and IP-associated biochemical and clinical markers in older subjects. METHODS A randomised, controlled, cross-over intervention trial was performed. Sixty-six subjects (aged ≥ 60 y) with increased IP based on serum zonulin levels, were randomly allocated to one of the two arms of the intervention consisting of a control diet (C-diet) vs. a polyphenol-rich diet (PR-diet). Each intervention was 8-week long and separated by an 8-week wash out period. At the beginning and at the end of each intervention period, serum samples were collected for the quantification of zonulin and other biological markers. Faecal samples were also collected to investigate the intestinal microbial ecosystem. In addition, anthropometrical/physical/biochemical parameters and food intake were evaluated. RESULTS Fifty-one subjects successfully completed the intervention and a high compliance to the dietary protocols was demonstrated. Overall, polyphenol intake significantly increased from a mean of 812 mg/day in the C diet to 1391 mg/day in the PR-diet. Two-way analysis of variance showed a significant effect of treatment (p = 0.008) and treatment × time interaction (p = 0.025) on serum zonulin levels, which decreased after the 8-week PR-diet. In addition, a treatment × time interaction was observed showing a reduction of diastolic blood pressure (p = 0.028) following the PR-diet, which was strongest in those not using antihypertensive drugs. A decrease in both diastolic (p = 0.043) and systolic blood pressure (p = 0.042) was observed in women. Interestingly, a significant increase in fibre-fermenting and butyrate-producing bacteria such as the family Ruminococcaceae and members of the genus Faecalibacterium was observed following the PR intervention. The efficacy of this dietary intervention was greater in subjects with higher serum zonulin at baseline, who showed more pronounced alterations in the markers under study. Furthermore, zonulin reduction was also stronger among subjects with higher body mass index and with insulin resistance at baseline, thus demonstrating the close interplay between IP and metabolic features. CONCLUSIONS These data show, for the first time, that a PR-diet can reduce serum zonulin levels, an indirect marker of IP. In addition, PR-diet reduced blood pressure and increased fibre-fermenting and butyrate-producing bacteria. These findings may represent an initial breakthrough for further intervention studies evaluating possible dietary treatments for the management of IP, inflammation and gut function in different target populations. THIS STUDY WAS REGISTERED AT WWW.ISRCTN. ORG AS ISRCTN10214981.
Collapse
Affiliation(s)
- Cristian Del Bo'
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Stefano Bernardi
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, 60127 Ancona, Italy
| | - Marisa Porrini
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Giorgio Gargari
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Nicole Hidalgo-Liberona
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERfes), Instituto de Salud Carlos III, 08028 Barcelona, Spain
| | - Raúl González-Domínguez
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERfes), Instituto de Salud Carlos III, 08028 Barcelona, Spain
| | - Raul Zamora-Ros
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain; Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Spain
| | - Gregorio Peron
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERfes), Instituto de Salud Carlos III, 08028 Barcelona, Spain
| | - Mirko Marino
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Letizia Gigliotti
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Mark S Winterbone
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, United Kingdom
| | - Benjamin Kirkup
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, United Kingdom
| | - Paul A Kroon
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, United Kingdom
| | - Cristina Andres-Lacueva
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERfes), Instituto de Salud Carlos III, 08028 Barcelona, Spain
| | - Simone Guglielmetti
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy
| | - Patrizia Riso
- Università, degli Studi di Milano, Department of Food, Environmental and Nutritional Sciences (DeFENS), 20133 Milan, Italy.
| |
Collapse
|
17
|
Hébert M, Amr G, Cossette M, Cartier R. Reassessment of kidney function equations in predicting long-term survival in cardiac surgery. J Card Surg 2020; 35:2550-2558. [PMID: 32840928 DOI: 10.1111/jocs.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Chronic kidney disease (CKD) is a risk factor for long-term survival in cardiac surgery. The Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) study, CKD Epidemiology Collaboration (CKD-EPI), revised Lund-Malmö (LM), and full age spectrum equations are used to estimate glomerular filtration rates (eGFR), but each have advantages and disadvantages. Our objective was to determine which equation better predicts long-term survival. METHODS Data on 1492 consecutive patients who underwent isolated off-pump coronary artery bypass surgery between September 1996 and December 2008 were prospectively collected. Preoperative and postoperative eGFR were calculated using the five equations and compared using Cox regression analyses and time-dependent receiver operating characteristic (ROC) curves at 10 years. RESULTS In a Cox regression model after correction for significant predictors of long-term mortality, adjusted hazard ratios (HR) for one standard deviation increase in preoperative eGFR were 0.661 (P < .0001), 0.844 (P = .0166), 0.787 (P = .0002), 0.746 (P < .0001), and 0.717 (P < .0001) for the CG, MDRD, CKD-EPI, LM, and FAS equations, respectively. The areas under the time-dependent ROC curve at 10 years also showed that the CG formula has a better predictive value. Postoperative eGFR at discharge were also significant predictors of long-term mortality (HR = 0.603, P < .0001; HR = 0.725, P < .0001; HR = 0.688, P < .0001; HR = 0.673, P < .0001; HR = 0.632, P < .0001 for the CG, MDRD, CKD-EPI, LM, and FAS equations, respectively). CONCLUSIONS The CG formula was shown to better predict survival in cardiac surgery, though the FAS equation has a comparable prognostic value. Additionally, postoperative eGFR at discharge also predicted long-term survival.
Collapse
Affiliation(s)
- Mélanie Hébert
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| | - Gilles Amr
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| | - Mariève Cossette
- Division of Biostatistics, Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Canada
| | - Raymond Cartier
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| |
Collapse
|
18
|
Ferreira JP, Sharma A, Mehta C, Bakris G, Rossignol P, White WB, Zannad F. Multi-proteomic approach to predict specific cardiovascular events in patients with diabetes and myocardial infarction: findings from the EXAMINE trial. Clin Res Cardiol 2020; 110:1006-1019. [DOI: 10.1007/s00392-020-01729-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
|
19
|
Chen W, Chen P, Ni Z, Liu Y, Guo W, Jiang L, Wei X, Chen J, Tan N, He P, Guo Y. Prognostic of different glomerular filtration rate formulas in patients receiving percutaneous coronary intervention: insights from a multicenter observational cohort. BMC Cardiovasc Disord 2020; 20:341. [PMID: 32682399 PMCID: PMC7368721 DOI: 10.1186/s12872-020-01621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background The relationships of renal dysfunction (RD) and chronic kidney disease (CKD) with prognosis have been well established among non-ST elevation acute coronary syndrome (NSTE-ACS) patients who receive percutaneous coronary intervention (PCI), but the efficacy of different estimated glomerular filtration rate (eGFR) formulas for predicting the prognosis is unknown. Methods The cohort originated from a retrospective data, which consecutively enrolled 8197 patients. The eGFR was calculated by the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), CKD Epidemiology Collaboration-creatinine, CKD Epidemiology Collaboration-Cys-C, CKD Epidemiology Collaboration-Cys-C-creatinine and a modified abbreviated MDRD (c-aGFR) equations in Chinese CKD patients. Patients were excluded if the eGFR could not be obtained by one of the formulas. Patients were categorized as having normal renal function, mild RD, moderate RD, severe RD, or kidney failure to compare prognosis. The primary outcome was the in-hospital net adverse clinical events (NACE). The secondary outcomes were NACE and all-cause death during follow-up. Results In total, 2159 NSTE-ACS patients (age: 64.23 ± 10.25 years; males: 73.7%) were enrolled. 39 (1.8%) patients with in-hospital NACE were observed. During the 3.23 ± 1.55-year follow-up, 1.7% death and 4.2% NACE were observed in 1 year. The percentage of severe RD patients ranged from 15.4 to 39.2% according to different calculation formulas. A high prevalence of in-hospital NACE was observed in the severe RD groups (ranging from 8 to 14.3% for different formulas). Multiple regression analysis showed that a high eGFR is a protect factor against NACE and all-cause death regardless of the formula use. Receiver operating characteristic curves showed similar predictive performance of the c-aGFR when compared to other formulas (in-hospital NACE: AUC = 0.612, follow-up NACE: AUC = 0.622, and follow-up death: AUC = 0.711). Conclusions Severe RD results in a high prevalence of in-hospital NACE in NSTE-ACS patients after PCI regardless of the formulas use. Different formulas have a similar ability to predict in-hospital and long-term prognosis in NSTE-ACS patients. The c-aGFR formula is the simplest and a more convenient formula for use in practice.
Collapse
Affiliation(s)
- Wei Chen
- Clinical College of Fujian Provincial Hospital, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fujian Cardiovascular Institute, Fuzhou, 350001, China
| | - Pengyuan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second Hospital of Nanhai District Foshan City, Foshan, 528000, China
| | - Zhonghan Ni
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Wei Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Xuebiao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second Hospital of Nanhai District Foshan City, Foshan, 528000, China. .,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.
| | - Yansong Guo
- Clinical College of Fujian Provincial Hospital, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fujian Cardiovascular Institute, Fuzhou, 350001, China.
| |
Collapse
|
20
|
Armstrong MK, Schultz MG, Picone DS, Black JA, Dwyer N, Roberts-Thomson P, Sharman JE. Associations of Reservoir-Excess Pressure Parameters Derived From Central and Peripheral Arteries With Kidney Function. Am J Hypertens 2020; 33:325-330. [PMID: 32006010 DOI: 10.1093/ajh/hpaa013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Central artery reservoir-excess pressure parameters are clinically important but impractical to record directly. However, diastolic waveform morphology is consistent across central and peripheral arteries. Therefore, peripheral artery reservoir-excess pressure parameters related to diastolic waveform morphology may be representative of central parameters and share clinically important associations with end-organ damage. This has never been determined and was the aim of this study. METHODS Intra-arterial blood pressure (BP) waveforms were measured sequentially at the aorta, brachial, and radial arteries among 220 individuals (aged 61 ± 10 years, 68% male). Customized software was used to derive reservoir-excess pressure parameters at each arterial site (reservoir and excess pressure, systolic and diastolic rate constants) and clinical relevance was determined by association with estimated glomerular filtration rate (eGFR). RESULTS Between the aorta and brachial artery, the mean difference in the diastolic rate constant and reservoir pressure integral was -0.162 S-1 (P = 0.08) and -0.772 mm Hg s (P = 0.23), respectively. The diastolic rate constant had the strongest and most consistent associations with eGFR across aortic and brachial sites (β = -0.20, P = 0.02; β = -0.20, P = 0.03, respectively; adjusted for traditional cardiovascular risk factors). Aortic, but not brachial peak reservoir pressure was associated with eGFR in adjusted models (aortic β = -0.48, P = 0.02). CONCLUSIONS The diastolic rate constant is the most consistent reservoir-excess pressure parameter, in both its absolute values and associations with kidney dysfunction, when derived from the aorta and brachial artery. Thus, the diastolic rate constant could be utilized in the clinical setting to improve BP risk stratification.
Collapse
Affiliation(s)
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - J Andrew Black
- Department of Cardiology, Royal Hobart Hospital, Australia
| | - Nathan Dwyer
- Department of Cardiology, Royal Hobart Hospital, Australia
| | | | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Australia
| |
Collapse
|
21
|
Jang SM, Bahjri K, Tran H. Safety and Efficacy of Direct Oral Anticoagulants for Atrial Fibrillation in Patients with Renal Impairment. PHARMACY 2020; 8:pharmacy8010030. [PMID: 32143504 PMCID: PMC7151721 DOI: 10.3390/pharmacy8010030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/14/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are gaining popularity for patients with nonvalvular atrial fibrillation (AF) for stroke prevention. Less bleeding risk with comparable stroke prevention compared to warfarin was shown. DOACs have predictable anticoagulant effects, infrequent monitoring requirements and less drug-food interactions compared to warfarin. However, safety and efficacy data of DOACs in patients with chronic kidney disease (CKD) are limited. This is a retrospective study to evaluate thromboembolic and bleeding events in patients with AF (with/without CKD) in October 2010 and July 2017. A total of 495 patients were included and only 150 patients had CKD. Our study found that patients with renal impairment on a DOAC do not have a higher incidence of bleeding events. It showed significant increase in thromboembolic events in CKD patients with dabigatran compared to CKD patients with apixaban with odds ratio of 6.58 (95%CI 1.35-32.02, p = 0.02).
Collapse
Affiliation(s)
- Soo Min Jang
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy; Loma Linda, CA 92350, USA;
| | - Khaled Bahjri
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy; Loma Linda, CA 92350, USA;
| | - Huyentran Tran
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy; Loma Linda, CA 92350, USA;
- Correspondence:
| |
Collapse
|
22
|
Mullens W, Damman K, Testani JM, Martens P, Mueller C, Lassus J, Tang WW, Skouri H, Verbrugge FH, Orso F, Hill L, Ural D, Lainscak M, Rossignol P, Metra M, Mebazaa A, Seferovic P, Ruschitzka F, Coats A. Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:584-603. [DOI: 10.1002/ejhf.1697] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Kevin Damman
- University Medical Center Groningen University of Groningen Groningen The Netherlands
| | | | | | | | - Johan Lassus
- Cardiology, Heart and Lung Center Helsinki University and Helsinki University Hospital Helsinki Finland
| | | | - Hadi Skouri
- American University of Beirut Medical Center Beirut Lebanon
| | | | | | - Loreena Hill
- School of Nursing and Midwifery Queen's University Belfast UK
| | | | | | - Patrick Rossignol
- Université de Lorraine INSERM, Centre d'Investigations Clinique – 1433 and INSERM U1116; CHRU Nancy; F‐CRIN INI‐CRCT Nancy France
| | | | | | | | | | | |
Collapse
|
23
|
Ferreira JP, Ouwerkerk W, Tromp J, Ng L, Dickstein K, Anker S, Filippatos G, Cleland JG, Metra M, van Veldhuisen DJ, Voors AA, Zannad F. Cardiovascular and non-cardiovascular death distinction: the utility of troponin beyond N-terminal pro-B-type natriuretic peptide. Findings from the BIOSTAT-CHF study. Eur J Heart Fail 2019; 22:81-89. [PMID: 31793144 DOI: 10.1002/ejhf.1654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure (HF) patients are at high-risk of cardiovascular (CV) events, including CV death. Nonetheless, a substantial proportion of these patients die from non-CV causes. Identifying patients at higher risk for each individual event may help selecting patients for clinical trials and tailoring cardiovascular therapies. The aims of the present study are to: (i) characterize patients according to CV vs. non-CV death; (ii) develop models for the prediction of the respective events; (iii) assess the models' performance to differentiate CV from non-CV death. METHODS AND RESULTS This study included 2309 patients with HF from the BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) study. Competing-risk models were used to assess the best combination of variables associated with each cause-specific death. Results were validated in an independent cohort of 1738 HF patients. The best model to predict CV death included low blood pressure, estimated glomerular filtration rate ≤ 60 mL/min, peripheral oedema, previous HF hospitalization, ischaemic HF, chronic obstructive pulmonary disease, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin (c-index = 0.73). The non-CV death model incorporated age > 75 years, anaemia and elevated NT-proBNP (c-index = 0.71). Both CV and non-CV death rose by quintiles of the risk scores; yet these models allowed the identification of patients in whom absolute CV death rates clearly outweigh non-CV death ones. These findings were externally replicated, but performed worse in a less severely diseased population. CONCLUSIONS Risk models for predicting CV and non-CV death allowed the identification of patients at higher absolute risk of dying from CV causes (vs. non-CV ones). Troponin helped in predicting CV death only, whereas NT-proBNP helped in the prediction of both CV and non-CV death. These findings can be useful both for tailoring therapies and for patient selection in HF trials in order to attain CV event enrichment.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Hospital Drive, Singapore.,Department of Dermatology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Jasper Tromp
- National Heart Centre Singapore, Hospital Drive, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Leong Ng
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | | | - Stefan Anker
- Department of Cardiology (CVK), and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| |
Collapse
|
24
|
De Filippo O, D’Ascenzo F, Raposeiras-Roubin S, Abu-Assi E, Peyracchia M, Bocchino PP, Kinnaird T, Ariza-Solé A, Liebetrau C, Manzano-Fernández S, Boccuzzi G, Henriques JPS, Templin C, Wilton SB, Omedè P, Velicki L, Xanthopoulou I, Correia L, Cerrato E, Rognoni A, Fabrizio U, Nuñez-Gil I, Iannaccone M, Montabone A, Taha S, Fujii T, Durante A, Song X, Gili S, Magnani G, Varbella F, Kawaji T, Blanco PF, Garay A, Quadri G, Alexopoulos D, Caneiro Queija B, Huczek Z, Cobas Paz R, González Juanatey JR, Cespón Fernández M, Nie SP, Muñoz Pousa I, Kawashiri MA, Gallo D, Morbiducci U, Conrotto F, Montefusco A, Dominguez-Rodriguez A, López-Cuenca A, Cequier A, Iñiguez-Romo A, Usmiani T, Rinaldi M, De Ferrari GM. P2Y12 inhibitors in acute coronary syndrome patients with renal dysfunction: an analysis from the RENAMI and BleeMACS projects. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:31-42. [DOI: 10.1093/ehjcvp/pvz048] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction.
Methods and results
All consecutive patients from RENAMI (REgistry of New Antiplatelets in patients with Myocardial Infarction) and BLEEMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60 mL/min/1.73 m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MBs), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint. A total of 19 255 patients were enrolled. Mean age was 63 ± 12; 14 892 (77.3%) were males. A total of 2490 (12.9%) patients had chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2. Mean follow-up was 13 ± 5 months. Mortality was significantly higher in CKD patients (9.4% vs. 2.6%, P < 0.0001), as well as the incidence of reinfarction (5.8% vs. 2.9%, P < 0.0001) and MB (5.7% vs. 3%, P < 0.0001). At Cox multivariable analysis, potent P2Y12 inhibitors significantly reduced the mortality rate [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.54–0.96; P = 0.006] and the risk of reinfarction (HR 0.53, 95% CI 0.30–0.95; P = 0.033) in CKD patients as compared to clopidogrel. The reduction of risk of reinfarction was confirmed in patients with preserved renal function. Potent P2Y12 inhibitors did not increase the risk of MB in CKD patients (HR 1.00, 95% CI 0.59–1.68; P = 0.985).
Conclusion
In ACS patients with CKD, prasugrel and ticagrelor are associated with lower risk of death and recurrent MI without increasing the risk of MB.
Collapse
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Sergio Raposeiras-Roubin
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Albert Ariza-Solé
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8 61231, Bad Nauheim, Germany
| | - Sergio Manzano-Fernández
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Giacomo Boccuzzi
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Jose Paulo Simao Henriques
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, GE64 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Lazar Velicki
- Medical Faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, and Institute of Cardiovascular Diseases Vojvodina, Put doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Ioanna Xanthopoulou
- Department of Cardiology, Patras University Hospital, Rion, 265 04 Patras, Greece
| | - Luis Correia
- Department of Cardiology, Hospital São Rafael - Avenida São Rafael, 2152 - São Marcos, 41253-196 Salvador, Bahia, Brazil
| | - Enrico Cerrato
- Interventional Cardiology Unit, Orbassano, and San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano Rivoli, Turin, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Corso Mazzini 18, Novara, Italy
| | - Ugo Fabrizio
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Iván Nuñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Mario Iannaccone
- Cardiology Department, “SS. Annunziata” Hospital, Via Ospedali, 9, Savigliano, Cuneo, Italy
| | - Andrea Montabone
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Libraries Street, Assiut, Egypt
| | - Toshiharu Fujii
- Division of Cardiovascular Medicine, Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Japan
| | - Alessandro Durante
- U.O. Cardiologia, Ospedale Valduce, Via Dante Alighieri, 11, 22100 Como, Italy
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Giulia Magnani
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Ferdinando Varbella
- Interventional Cardiology Unit, Orbassano, and San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano Rivoli, Turin, Italy
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, Japan
| | - Pedro Flores Blanco
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Alberto Garay
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Via Rivalta, 29, Rivoli, Torino, Italy
| | | | - Berenice Caneiro Queija
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, 1 a Banacha St, Warsaw, Poland
| | - Rafael Cobas Paz
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - José Ramón González Juanatey
- Servicio de Hemodinámica, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana s/n 15706, Santiago de Compostela, A Coruña, Spain
| | - María Cespón Fernández
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Shao-Ping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Isabel Muñoz Pousa
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Masa-Aki Kawashiri
- Department of Cardiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, 920-86 Kanazawa, Japan
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Torino, Italy
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Torino, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Alberto Dominguez-Rodriguez
- Department of Cardiology, Hospital Universitario de Canarias, Carretera Cuesta Taco, 0, 38320 Cuesta ( La, Santa Cruz de Tenerife), Spain
| | - Angel López-Cuenca
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Angel Cequier
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrés Iñiguez-Romo
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Tullio Usmiani
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| |
Collapse
|
25
|
Coiro S, Girerd N, Sharma A, Rossignol P, Tritto I, Pitt B, Pfeffer MA, McMurray JJV, Ambrosio G, Dickstein K, Moss A, Zannad F. Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non-sudden cardiac death in myocardial infarction survivors with heart failure. Eur J Heart Fail 2019; 21:1248-1258. [PMID: 31476097 DOI: 10.1002/ejhf.1541] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS An implantable cardioverter-defibrillator (ICD) is recommended for reducing the risk of sudden cardiac death (SCD) in myocardial infarction (MI) patients with a left ventricular ejection fraction (LVEF) ≤ 30%, as well as patients with a LVEF ≤ 35% and heart failure symptoms. Diabetes and/or impaired kidney function may confer additional SCD risk. We assessed the association between these two risk factors with SCD and non-SCD among MI survivors taking account of age and LVEF. METHODS AND RESULTS A total of 17 773 patients from the High-Risk MI Database were evaluated. Overall, diabetes and estimated glomerular filtration rate < 60 mL/min/1.73 m2 , individually and together, conferred a higher risk of SCD [adjusted competing risk: hazard ratio (HR) 1.23, 1.23, and 1.32, respectively; all P < 0.03] and non-SCD (HR 1.34, 1.52, and 2.13, respectively; all P < 0.0001). Annual SCD rates in patients with LVEF > 35% and with diabetes, impaired kidney function, or both (2.0%, 2.5% and 2.7%, respectively) were comparable to rates observed in patients with LVEF 30-35% but no such risk factors (1.7%). However, these patients had also similarly higher non-SCD rates, such that the ratio of SCD to non-SCD was not increased. Importantly, this ratio was mostly dependent on age, with higher overall ratios in youngest subgroups (0.89 in patients < 55 years vs. 0.38 in patients ≥ 75 years), regardless of risk factors. CONCLUSION Although MI survivors with LVEF > 35% with diabetes, impaired kidney function, or both are at increased risk of SCD, the risk of non-SCD risk is even higher, suggesting an extension of the current indication for an ICD to them is unlikely to be worthwhile. MI survivors with low LVEF and aged < 55 years are likely to have the greatest potential benefit from ICD implantation.
Collapse
Affiliation(s)
- Stefano Coiro
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.,INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Nicolas Girerd
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,University of Alberta, Edmonton, Alberta, Canada.,Stanford University, Palo Alto, CA, USA
| | - Patrick Rossignol
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Isabella Tritto
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | | | - Marc A Pfeffer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Kenneth Dickstein
- Division of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Arthur Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Faiez Zannad
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| |
Collapse
|
26
|
Comparison of five glomerular filtration rate estimating equations as predictors of acute kidney injury after cardiovascular surgery. Sci Rep 2019; 9:11072. [PMID: 31363147 PMCID: PMC6667489 DOI: 10.1038/s41598-019-47559-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/18/2019] [Indexed: 01/09/2023] Open
Abstract
We aimed to compare the ability of preoperative estimated glomerular filtration rate (eGFR), calculated using five different equations, to predict adverse renal outcomes after cardiovascular surgery. Cohorts of 4,125 adult patients undergoing elective cardiovascular surgery were evaluated. Preoperative eGFR was calculated using the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Chronic Kidney Disease Epidemiology Collaboration, and Mayo quadratic (Mayo) equations. The primary outcome was postoperative acute kidney injury (AKI), defined by Kidney Disease: Improving Global Outcomes Definition and Staging criteria based on changes in serum creatinine concentrations within 7 days. The MDRD II and Cockcroft-Gault equations yielded the highest (88.1 ± 26.7 ml/min/1.73 m2) and lowest (79.6 ± 25.5 ml/min/1.73 m2) mean eGFR values, respectively. Multivariable analysis showed that a preoperative decrease in renal function according to all five equations was independently associated with an increased risk of postoperative AKI. The area under the receiver operating characteristics curve for predicting postoperative AKI was highest for the Mayo equation (0.713). Net improvements in reclassification and integrated discrimination were higher for the Mayo equation than for the other equations. The Mayo equation was the most accurate in predicting postoperative AKI in patients undergoing cardiovascular surgery.
Collapse
|
27
|
Ferreira JP, Duarte K, McMurray JJV, Pitt B, van Veldhuisen DJ, Vincent J, Ahmad T, Tromp J, Rossignol P, Zannad F. Data-Driven Approach to Identify Subgroups of Heart Failure With Reduced Ejection Fraction Patients With Different Prognoses and Aldosterone Antagonist Response Patterns. Circ Heart Fail 2019; 11:e004926. [PMID: 29997240 DOI: 10.1161/circheartfailure.118.004926] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction have a poor prognosis. The identification of subgroups with different outcomes and treatment response patterns may help to tailor strategies to each individual patient. We present an exploratory study of patients enrolled in the EMPHASIS-HF trial (Eplerenone in Patients With Systolic Heart Failure and Mild Symptoms) using latent class analysis with validation using the EPHESUS trial (Eplerenone, a Selective Aldosterone Blocker, in Patients With Left Ventricular Dysfunction After Myocardial Infarction) to identify subgroups of patients with different prognosis and response to eplerenone therapy. METHODS AND RESULTS Latent class analysis identifies mutually exclusive groups of individuals maximizing within-group similarities and between-group differences. In the EMPHASIS-HF trial, 2279 heart failure with reduced ejection fraction patients were randomized to eplerenone or placebo and were characterized according to 18 clinical features. Subgroup definitions were applied to 6472 patients enrolled in the EPHESUS trial to validate observations. Event-free survival and effect of eplerenone on the composite of cardiovascular death and heart failure hospitalization were determined for each subgroup. Four subgroups were identified with significant differences in event-free survival (P=0.002). The subgroup C had the worst event-free survival in both studies and was characterized by older age, lower body mass index, worse renal function, higher baseline potassium levels, high prevalence of anemia, diabetes mellitus, previous revascularization and higher rates of eplerenone discontinuation, and hyperkalemia during follow-up. Two subgroups (B and C) showed a poorer response to eplerenone in both studies and these groups shared common features such as lower body mass index and high prevalence of anemia. Clinical profiles, prognosis, and treatment response patterns of the 4 subgroups applied in EPHESUS trial presented similarities to those observed in EMPHASIS. CONCLUSIONS Using a data-driven approach, we identified heart failure with reduced ejection fraction subgroups with significantly different prognoses and potentially different responses to eplerenone. However, these data should be regarded as hypothesis-generating and prospective validation is warranted, to assess the potential clinical implications of these subgroups. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00232180.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, France (J.P.F., K.D., P.R., F.Z.).,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Portugal (J.P.F.)
| | - Kevin Duarte
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, France (J.P.F., K.D., P.R., F.Z.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Scotland, United Kingdom (J.J.V.M)
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (D.J.v.V., J.T.)
| | | | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (T.A.)
| | - Jasper Tromp
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (D.J.v.V., J.T.)
| | - Patrick Rossignol
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, France (J.P.F., K.D., P.R., F.Z.)
| | - Faiez Zannad
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, France (J.P.F., K.D., P.R., F.Z.).
| |
Collapse
|
28
|
Elkhadragy N, Ifeachor AP, Diiulio JB, Arthur KJ, Weiner M, Militello LG, Glassman PA, Zillich AJ, Russ AL. Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis. BMJ Open 2019; 9:e027439. [PMID: 31129589 PMCID: PMC6537985 DOI: 10.1136/bmjopen-2018-027439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Many studies identify factors that contribute to renal prescribing errors, but few examine how healthcare professionals (HCPs) detect and recover from an error or potential patient safety concern. Knowledge of this information could inform advanced error detection systems and decision support tools that help prevent prescribing errors. OBJECTIVE To examine the cognitive strategies that HCPs used to recognise and manage medication-related problems for patients with renal insufficiency. DESIGN HCPs submitted documentation about medication-related incidents. We then conducted cognitive task analysis interviews. Qualitative data were analysed inductively. SETTING Inpatient and outpatient facilities at a major US Veterans Affairs Medical Centre. PARTICIPANTS Physicians, nurses and pharmacists who took action to prevent or resolve a renal-drug problem in patients with renal insufficiency. OUTCOMES Emergent themes from interviews, as related to recognition of renal-drug problems and decision-making processes. RESULTS We interviewed 20 HCPs. Results yielded a descriptive model of the decision-making process, comprised of three main stages: detect, gather information and act. These stages often followed a cyclical path due largely to the gradual decline of patients' renal function. Most HCPs relied on being vigilant to detect patients' renal-drug problems rather than relying on systems to detect unanticipated cues. At each stage, HCPs relied on different cognitive cues depending on medication type: for renally eliminated medications, HCPs focused on gathering renal dosing guidelines, while for nephrotoxic medications, HCPs investigated the need for particular medication therapy, and if warranted, safer alternatives. CONCLUSIONS Our model is useful for trainees so they can gain familiarity with managing renal-drug problems. Based on findings, improvements are warranted for three aspects of healthcare systems: (1) supporting the cyclical nature of renal-drug problem management via longitudinal tracking mechanisms, (2) providing tools to alleviate HCPs' heavy reliance on vigilance and (3) supporting HCPs' different decision-making needs for renally eliminated versus nephrotoxic medications.
Collapse
Affiliation(s)
- Nervana Elkhadragy
- Centre for Health Information and Communication, Health Service Research and Development, Department of Veterans Affairs, Roudebush VA Medical Centre, Indianapolis, Indiana, USA
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Amanda P Ifeachor
- US Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | | | - Karen J Arthur
- US Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michael Weiner
- Centre for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Centre; Regenstrief Institute, Inc;, Indiana University, Indianapolis, Indiana, USA
| | | | - Peter A Glassman
- Internal Medicine, Department of Veterans Affairs, Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alan J Zillich
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Alissa L Russ
- Centre for Health Information and Communication, Health Service Research and Development, Department of Veterans Affairs, Roudebush VA Medical Centre, Indianapolis, Indiana, USA
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
29
|
Jiang Y, Song T, Liu J, Wang Z, Wang X, Huang Z, Fan Y, Lin T. Single kidney transplantation from donors with acute kidney injury: A single-center experience. Pediatr Transplant 2019; 23:e13326. [PMID: 30770619 DOI: 10.1111/petr.13326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/30/2018] [Accepted: 10/30/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Despite a severe shortage of organ supply, patients are reluctant to accept organs from deceased donors with AKI, let alone from pediatric AKI donors. METHODS We assessed 70 patients who received kidneys from donors with AKI (10 with pediatric and 60 with adult donors) and 176 contemporaneous patients who received kidneys from non-AKI donors (41 with pediatric and 135 with adult donors) between March 2012 and February 2017 for retrospectively evaluating the clinical outcomes. RESULTS AKI was defined and staging by the RIFLE criteria and pediatric-modified RIFLE criteria. Median age was 11.00 years IQR (4.50-14.00 years), and median weight was 25.00 kg (IQR, 17.00-45.00 kg) for all pediatric donors. Median follow-up was 8 months (range, 1-49 months). Adult AKI group had the highest incidence of DGF (35.0% vs 10%, 9.8%, and 19.3%, P = 0.011). There was a significant increase in DGF in higher AKI stages (Risk: 20.7%, Injury: 46.7%, Failure: 50.0%; P = 0.014) among patients with adult donors. No significant differences were noted in 1-year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) and 3-year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) patient survival, and 1-year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) and 3-year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) graft survival. CONCLUSION Transplants procured from donors with AKI, particularly pediatric ones, could achieve excellent intermediate-term clinical outcomes and thus potentially expand the donor pool.
Collapse
Affiliation(s)
- Yamei Jiang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jinpeng Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiling Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xianding Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongli Huang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Fan
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
30
|
Dos Reis D, Fraticelli L, Bassand A, Manzo-Silberman S, Peschanski N, Charpentier S, Elbaz M, Savary D, Bonnefoy-Cudraz E, Laribi S, Henry P, Guerraoui A, Tazarourte K, Chouihed T, El Khoury C. Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey. BMJ Open 2019; 9:e022776. [PMID: 30782685 PMCID: PMC6340446 DOI: 10.1136/bmjopen-2018-022776] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Cardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction. DESIGN Prospective, multicentre. SETTING Twenty-six academic, community and regional hospitals in France. PARTICIPANTS 507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min): n=172). RESULTS Differences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had ≥2 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534 ng/L and 5120 vs 2513 ng/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days). CONCLUSIONS Renal impairment in AHF should not limit the use of loop diuretics and/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.
Collapse
Affiliation(s)
| | | | - Adrien Bassand
- SAMU-SMUR-SAU Nancy, Hôpital Central, Nancy, Lorraine, France
| | | | | | - Sandrine Charpentier
- Emergency Department, Rangueil University Hospital, Toulouse, France
- INSERM, U1027, Toulouse, France
- Medical Department, Université Toulouse III – Paul Sabatier, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil Hospital, Toulouse, France
| | - Dominique Savary
- Emergency Department and Intensive Care Unit, Metz-Tessy, France
| | | | - Said Laribi
- Emergency Medicine Department, University Hospital of Tours, Tours, France
- INSERM UMR-S 942, Université Paris-Diderot, Paris, France
| | - Patrick Henry
- Lariboisière Hospital, Department of Cardiology, Université Paris-Diderot, Paris, France
| | | | - Karim Tazarourte
- Emergency Department, Edouard Herriot Hospital, Rhône-Alpes, France
| | - Tahar Chouihed
- SAMU-SMUR-SAU Nancy, Hôpital Central, Nancy, Lorraine, France
- Centre d’Investigation Clinique Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre-lès-Nancy, France
- INSERM U1116, Université de Lorraine, Nancy, France
| | - Carlos El Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France
- University Lyon, Claude Bernard Lyon 1 University, HESPER EA, Lyon, France
| |
Collapse
|
31
|
Ferreira JP, Metra M, Anker SD, Dickstein K, Lang CC, Ng L, Samani NJ, Cleland JG, van Veldhuisen DJ, Voors AA, Zannad F. Clinical correlates and outcome associated with changes in 6-minute walking distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail 2019; 21:218-226. [PMID: 30600578 DOI: 10.1002/ejhf.1380] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The 6-minute walk test (6MWT) is a simple and inexpensive way of measuring exercise capacity in patients with heart failure (HF) that predicts morbidity and mortality. However, there are few reports from large multicentre cohorts assessing the predictive value of baseline and changing walk distance. METHODS AND RESULTS In BIOSTAT-CHF, a 6MWT was performed at baseline (n = 1714) and 9 months (n = 1520). Cox proportional hazards models were used to assess the associations between 6MWT distance and the composite of HF hospitalization and/or death. Median follow-up was 21 months. The median (pct25-75 ) of the 6MWT distance at baseline was 300 m (200-388 m). Independent predictors of a shorter 6MWT distance included older age, female sex, higher heart rate, New York Heart Association class III/IV, orthopnoea, ischaemic heart disease, a previous stroke, current malignancy, and higher N-terminal pro-B-type natriuretic peptide (all P < 0.05). Patients in the lowest baseline 6MWT tertile (≤ 240 m) were less likely to receive guideline-recommended doses of disease-modifying therapies (P < 0.05). Compared to patients in the highest baseline 6MWT tertile (> 360 m), those in the lowest and middle tertiles had a worse prognosis [adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.38-2.18]. Patients with a decrease in the distance walked had a worse prognosis (adjusted HR for each 50 m decrease 1.09, 95% CI 1.06-1.12). 6MWT distance was not modified by treatment up-titration nor the 6MWT improved the BIOSTAT-CHF prognostic models. CONCLUSIONS The 6-minute walk test distance at baseline and a decline in walking distance were both associated with worse prognosis but did not improve the prognostic models. 6MWT distance was not modified by treatment up-titration and its use for assessing the benefits of pharmacologic treatment up-titration may be limited.
Collapse
Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.,Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Göttingen, Germany
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - John G Cleland
- National Heart and Lung Institute, Imperial College London, London, UK; and Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Dirk J van Veldhuisen
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| |
Collapse
|
32
|
Saliba F, Fischer L, de Simone P, Bernhardt P, Bader G, Fung J. Association Between Renal Dysfunction and Major Adverse Cardiac Events After Liver Transplantation: Evidence from an International Randomized Trial of Everolimus-Based Immunosuppression. Ann Transplant 2018; 23:751-757. [PMID: 30361470 PMCID: PMC6248043 DOI: 10.12659/aot.911030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Prospective evidence is lacking regarding the association between renal dysfunction and cardiovascular events after liver transplantation. Material/Methods Data were analyzed post hoc regarding renal function and major adverse cardiac events in a two-year prospective trial of de novo liver transplant recipients randomized at 30 days post-transplant to (i) everolimus [EVR]/reduced tacrolimus [EVR/rTAC] (ii) EVR with tacrolimus discontinued [TAC Elimination] or (iii) standard tacrolimus [TAC Control]. Results By month 24 post-transplant, 32/716 patients had experienced a first major cardiac event (4.5%): 4.1% (10/245), 2.2% (5/229) and 7.0% (17/242) of patients in the EVR/rTAC, TAC Elimination and TAC Control groups, respectively (p=0.043). The cumulative eGFR area under the curve (AUC) from randomization to month 24 was 119 706, 123 082, and 105 946 mL in the EVR/rTAC, TAC Elimination, and TAC Control groups, respectively, corresponding to a mean eGFR AUC of 82.4, 83.0, and 71.9 mL/min/1.73 m2. Cox regression modeling showed that mean eGFR AUC was inversely associated with time to first major cardiac event: the hazard ratio per mL/min/1.73 m2 was −0.0000015 [95% CI −0.00000078; −0.0000024] (p<0.001). Conclusions These findings confirm retrospective evidence that the risk of major cardiac events increases with deteriorating renal function after liver transplantation and demonstrate the need for careful cardiovascular risk management in patients with renal impairment. Immunosuppression based on everolimus with tacrolimus withdrawal, or to a lesser extent tacrolimus reduction, improves both renal function and the risk of major cardiac events compared to standard tacrolimus therapy in liver transplant recipients.
Collapse
Affiliation(s)
- Faouzi Saliba
- Hepato-Biliary Center, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Eppendorf, Hamburg, Germany
| | - Paolo de Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa, Pisa, Italy
| | | | | | - John Fung
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
33
|
Ferreira JP, Metra M, Mordi I, Gregson J, ter Maaten JM, Tromp J, Anker SD, Dickstein K, Hillege HL, Ng LL, van Veldhuisen DJ, Lang CC, Voors AA, Zannad F. Heart failure in the outpatient versus inpatient setting: findings from the BIOSTAT-CHF study. Eur J Heart Fail 2018; 21:112-120. [DOI: 10.1002/ejhf.1323] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/14/2018] [Accepted: 08/29/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433; Université de Lorraine; CHRU de Nancy and F-CRIN INI-CRCT, Nancy France
- Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine; University of Porto; Porto Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | - Ify Mordi
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School; University of Dundee; Dundee UK
| | - John Gregson
- Department of Biostatistics; London School of Hygiene & Tropical Medicine; London UK
| | - Jozine M. ter Maaten
- Department of Cardiology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Jasper Tromp
- Department of Cardiology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin; Germany
- Department of Cardiology and Pneumology; University Medicine Göttingen (UMG); Göttingen Germany
| | - Kenneth Dickstein
- Department of Internal Medicine; University of Bergen; Bergen Norway
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
| | - Hans L. Hillege
- Department of Cardiology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Leong L. Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK, and NIHR Leicester Biomedical Research Centre; Glenfield Hospital; Leicester UK
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Chim C. Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School; University of Dundee; Dundee UK
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433; Université de Lorraine; CHRU de Nancy and F-CRIN INI-CRCT, Nancy France
| |
Collapse
|
34
|
Patti G, Ricottini E, Nenna A, Cavallari I, Antonucci E, Calabrò P, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Bisignani A, Marcucci R. Impact of Chronic Renal Failure on Ischemic and Bleeding Events at 1 Year in Patients With Acute Coronary Syndrome (from the Multicenter START ANTIPLATELET Registry). Am J Cardiol 2018; 122:936-943. [PMID: 30057232 DOI: 10.1016/j.amjcard.2018.05.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
Chronic renal failure (CRF) impairs prognosis in patients with acute coronary syndromes (ACS); the differential impact of CRF on ischemic and bleeding events in the setting of ACS is unclear. We explored the predictive role of CRF, identified by different equations for the glomerular filtration rate estimation, on the occurrence of the composite end point, including both ischemic cardiovascular and major bleeding (major adverse cardiovascular and bleeding events [MACBE]) at 1 year, and its components. We accessed each patients data from 718 participants in the prospective, multicenter, and START ANTIPLATELET registry, performed on patients with ACS. The ability to predict the risk of MACBE was modest and similar for Cockcroft-Gault, MDRD, and CKD-EPI equations (area under the curves: 0.55, 95% confidence interval [CI] 0.47 to 0.63; 0.53, 95% CI 0.45 to 0.61; 0.54, 95% CI 0.46 to 0.62; respectively, overall p = 0.63). The incidence of MACBE in patients with CRF was 12.6 versus 7.4 per 100 patients/year in those with preserved renal function (adjusted odds ratio [OR] 1.80, 1.02 to 3.20, p = 0.045); the absolute excess in events rate due to CRF was higher for ischemic events (3.5%) than for major bleeding (2.6%). The increased occurrence of MACBE was even greater in patients with CRF and concomitant anemia (OR 2.16) and in patients with severe CRF (OR 2.78). In conclusion, our study indicates that, in patients with ACS, CRF impairs the clinical outcome at 1 year, especially when severe and when is concomitant with anemia. CRF is associated with greater absolute increase of ischemic events than major bleeding.
Collapse
Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Elisabetta Ricottini
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Paolo Calabrò
- Division of Cardiology, Monaldi Hospital and "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, School of Medicine, "Federico II" University, Naples, Italy
| | - Paolo Gresele
- Department of Medicine, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Vittorio Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, La Sapienza University of Rome, Rome, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic Diseases, University of Florence, Florence, Italy
| |
Collapse
|
35
|
Bataille Y, Costerousse O, Bertrand OF, Moranne O, Pottel H, Delanaye P. One-year mortality of patients with ST-Elevation myocardial infarction: Prognostic impact of creatinine-based equations to estimate glomerular filtration rate. PLoS One 2018; 13:e0199773. [PMID: 29979700 PMCID: PMC6034802 DOI: 10.1371/journal.pone.0199773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Renal dysfunction is associated with worse outcomes after primary percutaneous coronary intervention (PCI). However, whether glomerular filtration rate (GFR) estimated with various equations can equally predict outcomes after ST-Elevation Myocardial Infarction (STEMI) is still debated. METHODS We compared the clinical impact of 3 different creatinine-based equations (Cockcroft and Gault (CG), CKD-epidemiology (CKD-EPI) and Full Age Spectrum (FAS)) to predict 1-year mortality in STEMI patients. RESULTS Among 1755 consecutive STEMI patients who had undergone primary PCI included between 2006 and 2011, median estimated GFR was 79 (61;96) with the CG, 81 (65;95) with CKD-EPI and 75 (60;91) mL/min/1.73 m2 with FAS equation. Reduced GFR values were independently associated with 1-year mortality risk with the 3 equations. Receiver operating curves (ROC) of CG and FAS equations were significantly superior to the CKD-EPI equation, p = 0.03 and p = 0.01, respectively. Better prediction with FAS and CG equations was confirmed by net reclassification index. CONCLUSIONS Our results suggest that in STEMI patients who have undergone primary PCI, 1-year mortality is better predicted by CG or FAS equations compared to CKD-EPI.
Collapse
Affiliation(s)
- Yoann Bataille
- Quebec Heart-Lung Institute, Quebec, Canada
- Department of Cardiology, Centre Hospitalier Régional la Citadelle, Liège, Belgium
| | | | | | - Olivier Moranne
- Department of Nephrology-Dialysis-Apheresis, CHU de Nîmes, Medical School, University Montpellier-Nimes, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, Kulak, University of Leuven, Kortrijk, Belgium
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (CHU ULg), Liège, Belgium
| |
Collapse
|
36
|
Rivera-Caravaca JM, Ruiz-Nodar JM, Tello-Montoliu A, Esteve-Pastor MA, Quintana-Giner M, Véliz-Martínez A, Orenes-Piñero E, Romero-Aniorte AI, Vicente-Ibarra N, Pernias-Escrig V, Carrillo-Alemán L, Candela-Sánchez E, Hortelano I, Villamía B, Sandín-Rollán M, Nuñez-Martínez L, Valdés M, Marín F. Disparities in the Estimation of Glomerular Filtration Rate According to Cockcroft-Gault, Modification of Diet in Renal Disease-4, and Chronic Kidney Disease Epidemiology Collaboration Equations and Relation With Outcomes in Patients With Acute Coronary Syndrome. J Am Heart Assoc 2018; 7:JAHA.118.008725. [PMID: 29680822 PMCID: PMC6015275 DOI: 10.1161/jaha.118.008725] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A simple method to assess renal function is the estimated glomerular filtration rate, and it shows prognostic implications. However, it remains unknown which equation should be used in patients with acute coronary syndrome. We compared the ability and correlation of the Cockcroft-Gault, Modification of Diet in Renal Disease-4 (MDRD-4), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and their predictive performance for major adverse cardiovascular events, all-cause mortality, and major bleeding in a cohort of patients with acute coronary syndrome. METHODS AND RESULTS Multicenter prospective registry involving 1699 consecutive patients with acute coronary syndrome from 3 tertiary institutions. At entry, renal function was assessed using the Cockcroft-Gault, MDRD-4, and CKD-EPI-creatinine equations. During 12 months of follow-up, we recorded all major adverse cardiovascular events (composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke), bleeding events (Bleeding Academic Research Consortium classification), and all-cause mortality. Receiver operating characteristic curve comparisons demonstrated that Cockcroft-Gault equation had higher predictive ability compared with MDRD-4 equation for major adverse cardiovascular events (0.651 versus 0.616; P=0.023), major bleeding (0.600 versus 0.551; P=0.005), and all-cause mortality (0.754 versus 0.717; P=0.033), as well as higher predictive ability compared with CKD-EPI equation for major bleeding (0.600 versus 0.564; P=0.018). Integrated discrimination improvement and net reclassification improvement analyses showed superior discrimination and reclassification of Cockcroft-Gault equation. Decision curve analyses graphically demonstrated higher net benefit and clinical usefulness of the Cockcroft-Gault equation in comparison with MDRD-4 and CKD-EPI equations. CONCLUSIONS In patients with acute coronary syndrome, the Cockcroft-Gault equation presented superior predictive ability for major adverse cardiovascular events, major bleeding, and all-cause mortality compared with MDRD-4 equation, and superior predictive ability for major bleeding compared with CKD-EPI equation. The Cockcroft-Gault equation also showed higher net benefit and clinical usefulness.
Collapse
Affiliation(s)
- José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Juan Miguel Ruiz-Nodar
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Antonio Tello-Montoliu
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Miriam Quintana-Giner
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Andrea Véliz-Martínez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Ana Isabel Romero-Aniorte
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Nuria Vicente-Ibarra
- Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Luna Carrillo-Alemán
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Elena Candela-Sánchez
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Ignacio Hortelano
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Beatriz Villamía
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Miriam Sandín-Rollán
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Laura Nuñez-Martínez
- Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | - Mariano Valdés
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| |
Collapse
|
37
|
Chen F, Li JQ, Ou YWX, Xia TL, Huang FY, Chai H, Huang BT, Li Q, Pu XB, Li GY, Peng Y, Chen M, Huang DJ. The impact of renal function on the prognostic value of N-terminal pro-B-type natriuretic peptide in patients with coronary artery disease. Cardiol J 2018; 26:696-703. [PMID: 29611168 DOI: 10.5603/cj.a2018.0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/08/2018] [Accepted: 03/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The impact of renal function on the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) remains unclear in coronary artery disease (CAD). This study sought to investigate the value of using NT-proBNP level to predict prognoses of CAD patients with different estimated glomerular filtration rates (eGFRs). METHODS A retrospective analysis was conducted from a single registered database. 2087 consecutive patients with CAD confirmed by coronary angiography were enrolled. The primary endpoint was allcause mortality. RESULTS The mean follow-up time was 26.4 ± 11.9 months and death events occurred in 197 cases. The NT-proBNP levels increased with the deterioration of renal function, as well as the optimal cutoff values based on eGFR stratification to predict endpoint outcome (179.4 pg/mL, 1443.0 pg/mL, 3478.0 pg/mL, for eGFR ≥ 90, 60-90 and < 60 mL/min/1.73 m2, respectively). Compared with the routine cut-off value or overall optimal one, stratified optimal ones had superior predictive ability for endpoint in each eGFR group (all with the highest Youden's J statistics). And the prognostic value became weaker as eGFR level decreased (eGFR ≥ 90 vs. 60-90 vs. < 60 mL/min/1.73 m2, odds ratio [OR] 7.7; 95% confidence interval [CI] 1.7-33.9 vs. OR 4.8; 95% CI 2.7-8.5 vs. OR 3.0; 95% CI 1.5-6.2). CONCLUSIONS This study demonstrated that NT-proBNP exhibits different predictive values for prognosis for CAD patients with different levels of renal function. Among the assessed values, the NT-proBNP cut-off value determined using renal function improve the accuracy of the prognosis prediction of CAD. Moreover, lower eGFR is associated with a higher NT-proBNP cut-off value for prognostic prediction.
Collapse
Affiliation(s)
- Fei Chen
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China.
| | - Jia-Qi Li
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Yuan-Wei-Xiang Ou
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Tian-Li Xia
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Fang-Yang Huang
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Hua Chai
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Bao-Tao Huang
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Qiao Li
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Xiao-Bo Pu
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Guo-Yong Li
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Yong Peng
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Mao Chen
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - De-Jia Huang
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| |
Collapse
|
38
|
Ferreira JP, Duarte K, Pfeffer MA, McMurray JJV, Pitt B, Dickstein K, Zannad F, Rossignol P. Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative. Eur J Heart Fail 2018; 20:323-331. [PMID: 29314455 DOI: 10.1002/ejhf.1131] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Observational data have described the association of blood pressure (BP) with mortality as 'J-shaped', meaning that mortality rates increase below a certain BP threshold. We aimed to analyse the associations between BP and prognosis in a population of acute myocardial infarction (MI) patients with heart failure (HF) and/or systolic dysfunction. METHODS AND RESULTS The datasets included in this pooling initiative are derived from four trials: CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT. A total of 28 771 patients were included in this analysis. Arithmetic means of all office BP values measured throughout follow-up were used. The primary outcome was cardiovascular death. The mean age was 65 ± 11.5 years and 30% were female. Patients in the lower systolic BP (SBP) quintiles had higher rates of cardiovascular death (reference: SBP 121-128 mmHg) [adjusted hazard ratio (HR) 2.49, 95% confidence interval (CI) 2.26-2.74 for SBP ≤112 mmHg, and HR 1.29, 95% CI 1.16-1.43 for SBP 113-120 mmHg]. The findings for HF hospitalization and MI were similar. However, stroke rates were higher in patients within the highest SBP quintile (reference: SBP 121-128 mmHg) (HR 1.38, 95% CI 1.11-1.72). Patients who died had a much shorter follow-up (0.7 vs. 2.1 years), less BP measurements (4.6 vs. 9.8) and lower mean BP (-8 mmHg in the last SBP measurement compared with patients who remained alive during the follow-up), suggesting that the associations of low BP and increased cardiovascular death represent a reverse causality phenomenon. CONCLUSION Systolic BP values <125 mmHg were associated with increased cardiovascular death, but these findings likely represent a reverse causality phenomenon.
Collapse
Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kevin Duarte
- Université de Lorraine, Institut Elie Cartan de Lorraine, UMR 7502, Vandoeuvre-lès-Nancy, France.,CNRS, Institut Elie Cartan de Lorraine, UMR 7502, Vandoeuvre-lès-Nancy, France.,Team BIGS, INRIA, Villers-lès-Nancy, France
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Kenneth Dickstein
- Department of Cardiology, University of Bergan, Stavanger University Hospital, Stavanger, Norway
| | - Faiez Zannad
- INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | | |
Collapse
|
39
|
Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure. Am J Cardiol 2017; 120:973-979. [PMID: 28739034 DOI: 10.1016/j.amjcard.2017.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/19/2017] [Accepted: 06/07/2017] [Indexed: 11/23/2022]
Abstract
If the heart is represented by a hydraulic pump, cardiac power represents the hydraulic function of the heart. Cardiac pump function is frequently determined through left ventricular ejection fraction using imaging. This study aims to validate resting cardiac power output (CPO) as a predictive biomarker in patients with advanced heart failure (HF). One hundred and seventy-two patients with HF severe enough to warrant cardiac transplantation were retrospectively reviewed at a single tertiary care institution between September 2010 and July 2013. Patients were initially evaluated with simultaneous right-sided and left-sided cardiac catheter-based hemodynamic measurements, followed by longitudinal follow-up (median of 52 months) for adverse events (cardiac mortality, cardiac transplantation, or ventricular assist device placement). Median resting CPO was 0.54 W (long rank chi-square = 33.6; p < 0.0001). Decreased resting CPO (<0.54 W) predicted increased risk for adverse outcomes. Fifty cardiac deaths, 10 cardiac transplants, and 12 ventricular assist device placements were documented. The prognostic relevance of resting CPO remained significant after adjustment for age, gender, left ventricular ejection fraction, mean arterial pressure, pulmonary vascular resistance, right atrial pressure, and estimated glomerular filtration rate (HR, 3.53; 95% confidence interval, 1.66 to 6.77; p = 0.0007). In conclusion, lower resting CPO supplies independent prediction of adverse outcomes. Thus, it could be effectively used for risk stratification in patients with advanced HF.
Collapse
|
40
|
Wilkinson TJ, Gould DW, Watson EL, Smith AC. Commentary: Renal Function Estimation and Cockcroft-Gault Formulas for Predicting Cardiovascular Mortality in Population-Based, Cardiovascular Risk, Heart Failure and Post-Myocardial Infarction Cohorts: The Heart 'OMics' in AGEing (HOMAGE) and the High-Risk Myocardial Infarction Database Initiatives. Front Med (Lausanne) 2017; 4:77. [PMID: 28660190 PMCID: PMC5467000 DOI: 10.3389/fmed.2017.00077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/26/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Exercise Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Douglas W Gould
- Leicester Kidney Exercise Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Emma L Watson
- Leicester Kidney Exercise Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Alice C Smith
- Leicester Kidney Exercise Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.,John Walls Renal Unit, University Hospitals of Leicester Trust, Leicester, United Kingdom
| |
Collapse
|