RESUMEN

BACKGROUND: Myocardial ischemia can impair myocardial relaxation and result in increased left ventricular (LV) diastolic pressure. Noninvasive measurements of mitral annular velocities have been used to evaluate LV diastolic pressure. We sought to determine whether mitral annular velocities, derived from novel speckle tracking echocardiography (STE), could predict mortality in patients with acute coronary syndrome (ACS). METHODS: A total of 246 patients with ACS were retrospectively studied. STE was analyzed offline with the sample volume placed on septal, lateral, inferior, and anterior mitral annulus. Peak early (E') and late (A') diastolic velocities of the mitral annulus were measured and averaged from the four regions. Peak early diastolic mitral inflow velocity (E) was obtained using pulsed-wave Doppler. RESULTS: Lower E' (P = 0.03), lower A' (P = 0.001), higher E'/A' ratio (P = 0.007), and higher E/E' ratio (P = 0.003) were independently associated with increased risk of death with adjustment for clinical and echocardiographic variables over the follow-up period of 21 months. The optimal cutoff value of E/E' ratio derived from the receiver operating characteristic analysis for predicting death was 30 (area under the curve = 0.65). E/E' ratio greater than 30 was predictive of death in univariate (HR, 2.40; CI, 1.42-4.06; P = 0.001) and multivariate (adjusted HR, 1.91; CI, 1.09-3.32; P = 0.02) models. CONCLUSION: The measurements of mitral annular velocities by STE are predictive of mortality in patients with ACS.

Asunto(s)

Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/mortalidad , Ecocardiografía/estadística & datos numéricos , Diagnóstico por Imagen de Elasticidad/estadística & datos numéricos , Válvula Mitral/diagnóstico por imagen , Modelos de Riesgos Proporcionales , District of Columbia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Factores de Riesgo , Sensibilidad y Especificidad , Análisis de Supervivencia , Tasa de Supervivencia

RESUMEN

OBJECTIVES: Nondipping pattern of circadian blood pressure (BP) is associated with increased cardiovascular morbidity and mortality; however, limited data are available among obese African-Americans. We, therefore, aimed to evaluate the pattern of circadian BP variation and to identify clinical conditions associated with nondipping in this population. METHODS: A total of 211 obese African-Americans enrolled in a weight-reduction program underwent 24-h ambulatory BP monitoring. Nondipping was defined as a nocturnal BP reduction of less than 10%. RESULTS: Systolic BP (SBP) nondipping was present in 158 participants (74.9%) and diastolic BP (DBP) nondipping was present in 93 participants (44.1%). In multivariate logistic regression analyses, diabetes was associated with SBP nondipping (adjusted OR, 2.53; CI: 1.16-5.76; P=0.02), and increasing BMI (5 kg/m) was associated with DBP nondipping (adjusted OR, 1.46; CI: 1.17-1.83; P=0.001). In linear regression analyses, BMI was positively correlated to office, 24-h, daytime, and night-time SBP (P=0.03, 0.01, 0.03, and 0.005, respectively) and office, 24-h, daytime, and night-time PP (P=0.01, P<0.001, 0.001, and P=0.003, respectively). CONCLUSION: This study demonstrated an excessively high prevalence of nondippers and independent associations between diabetes and SBP nondipping and between BMI and DBP nondipping in an obese African-American population.

Asunto(s)

Negro o Afroamericano , Presión Sanguínea , Ritmo Circadiano , Obesidad/fisiopatología , Adulto , Anciano , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

OBJECTIVE: Cardiac troponin elevation has been shown to be associated with adverse outcomes after percutaneous coronary intervention (PCI) for various subgroups of coronary artery disease. We sought to determine the prognostic significance of cardiac troponin I (cTnI) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) treated with PCI. METHODS: The study consisted of 760 consecutive patients undergoing PCI for NSTE-ACS. Levels of cTnI were obtained repeatedly every 6 h before PCI. Peak cTnI levels were used for analysis. Patients were followed for major adverse cardiac events (MACE) defined as death, myocardial infarction, and urgent target vessel revascularization for a mean follow-up of 2.9 years. RESULTS: Patients with normal cTnI levels (20 ng/ml). By multivariate analyses, patients with higher peak preprocedural cTnI levels were independently associated with increased risk of 30-day mortality [adjusted odds ratio, 1.88, 95% confidence interval (CI): 1.11-3.17, P=0.019] and composite MACE [group 1 vs. group 2 (adjusted hazard ratio 2.09, 95% CI: 1.35-3.23, P<0.001), group 1 vs. group 3 (adjusted hazard ratio 3.64, 95% CI: 2.39-5.56, P<0.001)]. CONCLUSION: Preprocedural cTnI level is a strong and independent predictor of 30-day mortality and long-term MACE after PCI in the setting of NSTE-ACS.

Asunto(s)

Síndrome Coronario Agudo/terapia , Angioplastia Coronaria con Balón , Troponina I/sangre , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/mortalidad , Adulto , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/mortalidad , Biomarcadores/sangre , Femenino , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Oportunidad Relativa , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba

RESUMEN

BACKGROUND: Prior studies have reported conflicting findings regarding racial disparities in long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Our aim was to compare major adverse cardiac events (MACE) following PCI in black versus non-black patients in a Public Health Service (PHS) setting. METHODS: A cohort of 1,438 consecutive patients undergoing intended PCI at a large public teaching hospital between April 2002 and September 2006 were followed for the development of MACE, defined as a composite of death, myocardial infarction (MI) and urgent target vessel revascularization. RESULTS: The study population consisted of 47.4% blacks, 21.3% whites, 15.2% Hispanics and 16.1% Asians. Overall, 17.4% of patients developed MACE over the mean followup period of 2.9 years. The rate of MACE was significantly higher in blacks compared with non-blacks (21.7% vs. 13.6%, log-rank p < 0.001). After adjusting for age, gender, cardiovascular risk factors, socioeconomic status (SES) and potential confounding factors, black race remained a strong and independent predictor of MACE (adjusted HR, 1.52; CI, 1.18-1.96; p = 0.001). Blacks had higher rates of death (12.3% vs. 5.2%, log-rank p < 0.001) and MI (8.7% vs. 4.4%, log rank p = 0.002). There were no racial differences in in-hospital mortality and 3-month and 6-month MACE. CONCLUSIONS: In this PHS population, blacks were found to have worse long-term cardiovascular outcomes and mortality following PCI, irrespective of differences in baseline cardiovascular risk factors, SES and health-care access.

Asunto(s)

Angioplastia Coronaria con Balón/mortalidad , Asiático/estadística & datos numéricos , Población Negra/estadística & datos numéricos , Puente de Arteria Coronaria/mortalidad , Disparidades en Atención de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Infarto del Miocardio/etnología , Complicaciones Posoperatorias/mortalidad , Stents , Población Blanca/estadística & datos numéricos , Adulto , Anciano , Causas de Muerte , Chicago , Estudios Transversales , Femenino , Estado de Salud , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/cirugía , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos

RESUMEN

The goal of this study was to evaluate the relation between serum levels of carbohydrate antigen 125 (CA125) and prognosis in African American (AA) patients with heart failure (HF). Little is known about the usefulness of CA125 in the AA population, which has different pathophysiology and higher prevalence of HF. The authors enrolled 172 consecutive AA patients (mean age, 55.8 years; 61.1% men) admitted with a clinical diagnosis of acute decompensated HF. CA125 was measured within 48+/-12 hours of presentation. Patients were grouped according to CA125 levels into quartiles. The median CA125 level was 16 U/mL. Serum levels of CA125 were elevated (>35 U/mL) in 58 patients (33.7%). Fifty-two patients (30.8%) died over a median follow-up period of 40 months. The CA125 threshold derived from the receiver operating characteristic curves for the prediction of mortality was 35 U/mL. In a multivariate analysis, CA125 levels >35 U/mL were found to be predictive of 40-month all-cause mortality (adjusted hazard ratio, 2.53; confidence interval, 1.40-4.59; P=.002). However, CA125 levels were not associated with 18-month HF rehospitalization. CA125 value is a strong and independent predictor of long-term mortality in AA patients admitted with a diagnosis of acute decompensated HF. Identifying a higher-risk cohort might allow for a more targeted treatment approach.

Asunto(s)

Negro o Afroamericano , Antígeno Ca-125/sangre , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/mortalidad , Enfermedad Aguda , Biomarcadores/sangre , Comorbilidad , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etnología , Humanos , Mediciones Luminiscentes , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Pronóstico , Curva ROC , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Análisis de Supervivencia

RESUMEN

BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) increases systemic inflammation, which is implicated in development and maintenance of atrial fibrillation (AF); therefore, we hypothesized that the prevalence of AF would be increased among nondialysis patients with CKD. This study also reports independent predictors of the presence of AF in this population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective, cross-sectional analysis of 1010 consecutive nondialysis patients with CKD from two community-based hospitals was conducted. Estimated GFRs (eGFRs) were calculated using the Modification of Diet in Renal Disease (MDRD) equation. Multivariate logistic regression was used to determine independent predictors. RESULTS: Of 1010 nondialysis patients with CKD, 214 (21.2%) had AF. Patients with AF were older than patients without AF (76 +/- 11 versus 63 +/- 15 yr). The prevalence of AF among white patients (42.7%) was higher than among black patients (12.7%) or other races (5.7%). In multivariate analyses, age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure were identified as independent predictors of the presence of AF. Although serum high-sensitivity C-reactive protein levels were elevated in our population (5.2 +/- 7.4 mg/L), levels did not correlate with the presence of AF or with eGFR. Finally, eGFR did not correlate with the presence of AF in our population. CONCLUSIONS: The prevalence of AF was increased in our population, and independent predictors were age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure.

Asunto(s)

Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Enfermedades Renales/complicaciones , Enfermedades Renales/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etnología , Fibrilación Atrial/fisiopatología , Presión Sanguínea , Enfermedad Crónica , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Hospitales Comunitarios/estadística & datos numéricos , Humanos , Illinois/epidemiología , Enfermedades Renales/diagnóstico , Enfermedades Renales/etnología , Enfermedades Renales/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Ultrasonografía , Población Blanca/estadística & datos numéricos

RESUMEN

The association of noncompliance with evidence-based medical therapies after myocardial infarction (MI) on long-term outcomes is not well recognized in minority and uninsured populations. Consecutive MI patients at a large urban hospital were followed for compliance with evidence-based medications (aspirin, clopidogrel, statins, beta blockers, and angiotensin converting enzyme inhibitors [ACEIs]/angiotensin receptor blockers [ARBs]). Noncompliance was defined as proportion of days covered < or =80%. The outcome was combined mortality and MI. Kaplan-Meier analyses were used to explore the impact of noncompliance > or =4 medications. Of the 509 patients (86% minorities, 77% uninsured, and 54% diabetics), 132 (25.9%) presented with ST segment elevation with myocardial infarction (STEMI) and 377 (74.1%) with a non-ST segment elevation with myocardial infarction (NSTEMI), revascularization was performed in 297 (58.4%) patients, 72 (14.2%) patients died, 22 (4.3%) patients had an MI, and 91 (17.9%) patients had either event at a median follow-up of 2 (0.5-2.9) years. Noncompliance > or = 4 medications was significantly associated with adverse survival compared with compliant patients (29.7% vs 78.9%). After adjusting for traditional risk factors, The Global Registry of Acute Coronary Events risk score for predicting death during 6 months post-discharge, revascularization, left ventricular (LV) function, coronary artery disease (CAD) severity, and punctual clinic visits, noncompliance with > or = 4 evidence-based medications was an independent factor associated with death or MI (hazard ratio [HR], 2.83; 95% confidence interval [CI]=1.60-5.01) in this minority and uninsured population.

Asunto(s)

Fármacos Cardiovasculares/uso terapéutico , Pacientes no Asegurados/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Infarto del Miocardio/tratamiento farmacológico , Cooperación del Paciente , Medicina Basada en la Evidencia , Humanos , Infarto del Miocardio/mortalidad , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de Tiempo

RESUMEN

BACKGROUND: High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher rates of short-term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear. HYPOTHESIS: Measurement of cTnI very early after admission to the emergency room can be used as a prognosticator for long-term outcomes after CABG. METHODS: We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow-up of 290.42 person-years. Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to determine whether early cTnI measurement can independently predict the adverse outcomes in the study subjects. RESULTS: In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise in early cTnI is associated with a 3% (95% confidence interval [CI]: 2%- 5%, p < 0.001) faster progression to long-term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times faster to adverse outcomes (95% CI: 1.05-6.36, p = 0.039). This effect remained after adjustment for other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and electrocardiographic ischemia. CONCLUSION: Early cTnI measurement after admission can predict adverse outcomes after CABG. This association extends to long-term adverse events after CABG.

Asunto(s)

Síndrome Coronario Agudo/cirugía , Puente de Arteria Coronaria/efectos adversos , Troponina I/sangre , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/mortalidad , Anciano , Biomarcadores/sangre , Puente de Arteria Coronaria/mortalidad , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba

RESUMEN

BACKGROUND: The prognostic value of the 6-minute walk test (6MWT) has been described in patients with heart failure (HF); however, limited data are available in an African-American (AA) population. We prospectively evaluated the usefulness of the 6MWT in predicting mortality and HF rehospitalization in AA patients with acute decompensated HF. METHODS AND RESULTS: Two hundred AA patients (63.1% men, mean age 55.7 +/- 12.9 years) with acute decompensated HF were prospectively studied. Patients were followed to assess 40-month all-cause mortality and 18-month HF rehospitalization. The median distance walked on the 6MWT was 213 m. Of the 198 patients with available mortality data, 59 patients (29.8%) died. Of the 191 patients with available rehospitalization data, 114 (59.7%) were rehospitalized for worsening HF. For patients who walked 200 m (P = .001). For patients who walked 200 m (P = .027). Multivariate Cox regression analysis showed that 6MWT distance

Asunto(s)

Negro o Afroamericano/estadística & datos numéricos , Prueba de Esfuerzo , Tolerancia al Ejercicio , Insuficiencia Cardíaca/mortalidad , Pacientes Internos , Readmisión del Paciente/estadística & datos numéricos , Caminata , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Prospectivos , Perfil de Impacto de Enfermedad , Factores de Tiempo , Insuficiencia del Tratamiento , Estados Unidos/epidemiología