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All-cause Death (all-cause + death)

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Medical Sciences	100%

Selected Abstracts

Aortic Root Dimension as an Independent Predictor for All-Cause Death in Adults <65 Years of Age (from The Chin-Shan Community Cardiovascular Cohort Study)

ECHOCARDIOGRAPHY, Issue 5 2010
Chao-Lun Lai M.D.
Background: Evidence on aortic root dimension for predicting cardiovascular morbidity and mortality is inconclusive. This cohort study sought to characterize the predictive power of aortic root dimension on cardiovascular morbidity and mortality in an ethnic Chinese population. Methods: We recruited 1,851 participants in the Chin,Shan Community Cardiovascular Cohort (CCCC) study who had received echocardiography without previous cardiovascular events. Aortic root dimension was measured by M-mode echocardiography and indexed by body surface area to obtain aortic root dimension index (AOI). The end points were all-cause death and incident cardiovascular events including coronary heart disease and stroke over a median follow-up of 11.9 years. Results: Although tertiles of AOI was associated with an increased risk of cardiovascular events and all-cause death in univariate analysis, the significance diminished after adjusting for age variable (P for trend = 0.11 for cardiovascular events; P for trend = 0.23 for all-cause death). In subgroup analysis, we found a significant association between tertiles of AOI and risk of all-cause death in the final multivariate Cox regression model in adults <65 years. The adjusted relative risk was 1.88 (95% CI, 1.04 to 3.40) in participants in the upper tertile of AOI compared with participants in the lower tertile (P for trend = 0.037). In adults ,65 years, tertile of AOI was not associated with all-cause death (P for trend = 0.14). Tertiles of AOI was not associated with cardiovascular events throughout this study. Conclusion: Our study showed a significant association between AOI and all-cause death in adults <65 years in an ethnic Chinese population. (Echocardiography 2010;27:487-495) [source]

New or Aggravated Heart Failure during Long-Term Right Ventricular Pacing after AV Junctional Catheter Ablation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2009
DRITAN POÇI M.D.
Background: Atrioventricular junctional ablation (AVJA) improves symptoms and quality of life in patients with pharmacologically resistant atrial fibrillation (AF). However, long-term right ventricular stimulation has also been reported to lead to deterioration of the left ventricular function. We retrospectively analyzed the incidence of new or aggravated heart failure (HF) during long-term right ventricular stimulation following AVJA. Methods: Two hundred thirteen patients (110F:103M), 73 ± 10 years old, were followed for a period of 6 ± 3 years after AVJA. Forty-nine patients (23%) were known to have HF before AVJA. New HF was diagnosed if at least two of the following criteria were present: NYHA class >2, an LVEF <45%, and medication for HF. Aggravated HF was defined as an increase in the functional class and/or new prescription of medication for HF. All-cause death was a secondary endpoint. Results: During follow-up, 26% of the patients with known HF showed an aggravation of HF, while 13% developed new symptoms of HF. High age and low EF were independent predictors of new or aggravated HF and of new HF, while none of the tested variables predicted aggravation of known HF. The all-cause mortality was 16%, where high age and coronary artery disease were found to be independent predictors. Conclusion: AVJA followed by right ventricular pacing was associated with aggravated HF in 23% of patients with known HF, while development of new symptoms of HF occurred much less often during follow-up (13%). The majority of patients who underwent AVJA continued to do well during long-term follow-up. [source]

Increased Mortality Associated With Low Use of Clopidogrel in Patients With Heart Failure and Acute Myocardial Infarction Not Undergoing Percutaneous Coronary Intervention

CONGESTIVE HEART FAILURE, Issue 5 2010
Scott Harris DO
We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan,Meier method and Cox regression analyses. Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78,0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83,1.16). Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.,Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300,1307. [source]

Treatment of Anemia With Darbepoetin Alfa in Heart Failure

CONGESTIVE HEART FAILURE, Issue 3 2010
William T. Abraham MD
Anemia is common in heart failure (HF) patients. A prespecified pooled analysis of 2 randomized, double-blind, placebo-controlled studies evaluated darbepoetin alfa (DA) in 475 anemic patients with HF (hemoglobin [Hb], 9.0,12.5 g/dL). DA was administered subcutaneously every 2 weeks and titrated to achieve and maintain a target Hb level of 14.0±1.0 g/dL. By week 27, mean (SD) Hb concentrations did not increase with placebo but increased with DA from 11.5 (0.7) to 13.3 (1.3) g/dL. Hazard ratios (HRs) for DA compared with placebo for all-cause death or first HF hospitalization (composite end point), all-cause death, and HF hospitalization by month 12 were 0.67 (95% confidence interval [CI], 0.44,1.03; P=.067), 0.76 (95% CI, 0.39,1.48; P=.419), and 0.66 (95% CI, 0.40,1.07; P=.093), respectively. Incidence of adverse events was similar in both groups. In post hoc analyses, improvement in the composite end point was significantly associated with the mean Hb change from baseline (adjusted HR, 0.40; P=.017) with DA treatment. There was no increased risk of all-cause mortality or first HF hospitalization with DA in patients with reduced renal function or elevated baseline B-type natriuretic peptide, a biomarker of worse HF. These results suggest that DA is well tolerated, corrects HF-associated anemia, and may have favorable effects on clinical outcomes., Congest Heart Fail. 2010;16:87,95. © 2010 Wiley Periodicals, Inc. [source]

Non-alcoholic fatty liver disease, the metabolic syndrome and the risk of cardiovascular disease: the plot thickens

DIABETIC MEDICINE, Issue 1 2007
G. Targher
Abstract Non-alcoholic fatty liver disease (NAFLD) affects a substantial proportion of the general population and is frequently associated with many features of the metabolic syndrome (MetS). Currently, the importance of NAFLD and its relationship with the MetS is being increasingly recognized, and this has stimulated an interest in the possible role of NAFLD in the development of atherosclerosis. Recent studies have reported the association of NAFLD with multiple classical and non-classical risk factors for cardiovascular disease (CVD). Moreover, there is a strong association between the severity of liver histopathology in NAFLD patients and greater carotid artery intima-media thickness and plaque, and lower endothelial flow-mediated vasodilation (as markers of subclinical atherosclerosis) independent of obesity and other MetS components. Finally, it has recently been demonstrated that NAFLD is associated with an increased risk of all-cause death and predicts future CVD events independently of other prognostic factors, including MetS components. Overall, therefore, the evidence from these recent studies strongly emphasizes the importance of assessing the global CVD risk in patients with NAFLD. Moreover, these novel findings suggest a more complex picture and raise the possibility that NAFLD, as a component of the MetS, might not only be a marker but also an early mediator of CVD. [source]

Recent concepts in non-alcoholic fatty liver disease

DIABETIC MEDICINE, Issue 9 2005
L. A. Adams
Abstract Non-alcoholic fatty liver disease (NAFLD) is present in up to one-third of the general population and in the majority of patients with metabolic risk factors such as obesity and diabetes. Insulin resistance is a key pathogenic factor resulting in hepatic fat accumulation. Recent evidence demonstrates NAFLD in turn exacerbates hepatic insulin resistance and often precedes glucose intolerance. Once hepatic steatosis is established, other factors, including oxidative stress, mitochondrial dysfunction, gut-derived lipopolysaccharide and adipocytokines, may promote hepatocellular damage, inflammation and progressive liver disease. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies, however, staging the disease requires a liver biopsy. NAFLD is associated with an increased risk of all-cause death, probably because of complications of insulin resistance such as vascular disease, as well as cirrhosis and hepatocellular carcinoma, which occur in a minority of patients. NAFLD is also now recognized to account for a substantial proportion of patients previously diagnosed with ,cryptogenic cirrhosis'. Diabetes, obesity and the necroinflammatory form of NAFLD known as non-alcoholic steatohepatitis, are risk factors for progressive liver disease. Current treatment relies on weight loss and exercise, although various insulin-sensitizing medications appear promising. Further research is needed to identify which patients will achieve the most benefit from therapy. [source]

Aortic Root Dimension as an Independent Predictor for All-Cause Death in Adults <65 Years of Age (from The Chin-Shan Community Cardiovascular Cohort Study)

Prognostic Significance of QTc Interval for Predicting Total, Cardiac, and Ischemic Heart Disease Mortality in Community-Based Cohort from Warsaw Pol-MONICA Population

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2000
Aleksandra Pytlak M.D.
Background: QT interval in resting electrocardiogram (ECC) is a sum of ventricular depolarization and repolarization time. Its prolongation is associated with a worse prognosis for survival due to a high incidence of severe ventricular arrhythmias. Methods: The random sample of the Warsaw Pol-MONICA population consisting of 2646 men and women, aged 35,64, screened in 1984, was followed-up until 1996. All deaths and their causes were registered based on death certificate diagnosis. QT interval was measured manually in three consecutive QRST complexes in each ECG and corrected using Bazett's formula (QT corrected: QTc). For statistical analyses the mean value of 3 QTc measurements were used. To assess the relationship between QTc and mortality, the Cox proportional hazards model with stepwise selection of variables was used. Results: Out of the screened sample, 459 persons died (309 men, 150 women), 226 due to cardiovascular diseases (CVD) (162 men, 64 women), and 81 due to ischemic heart disease (IHD) (59 men, 22 women). Both men and women who died were significantly older at baseline and had significantly longer mean QTc as compared to survivors (men: 457 ms vs 446 ms, P = 0.0001; women: 469 ms vs 459 ms, P = 0.001). Among men, after adjustment for confounding variables, mean QTc was significantly associated with total and CVD mortality, and in women, with CVD and IHD mortality. The risk of death rose with an increase in QTc duration. In men, with every increase in QTc by 20 ms, the risk of all causes of death rose by 11% (95% CI: 1.04,1.18), CVD death by 9% (95% Cl: 1.01,1.19), and IHD death by 11 % (95%: 0.97,1.28). In women, the risk of all-cause death increased by 9% (95% CI: 0.98,1.21), CVD death by 21% (95% Cl: 1.02,1.43), and IHD death by 41% (95% Cl: 1.08,1.85). Conclusion: QTc interval was significantly related to all cause, cardiovascular and ischemic heart disease. The risk of death increased with longer QTc duration. A.N.E. 2000;5(4):322,329 [source]