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1دورية أكاديمية
المصدر: Mathematics Faculty Publications
مصطلحات موضوعية: Cardiac troponin, Heart failure, High-sensitivity cardiac troponin, Prognosis, Mathematics
الوصف: Background: Cardiac troponin (cTn) levels offer prognostic information for patients with heart failure. Highly sensitive assays detect levels of cTn much lower than the 99th percentile of standard cTn assays. We hypothesize that cardiac troponin levels measured by a high-sensitivity assay provide better prognostic value compared with cTn levels measured by a standard assay in patients with chronic heart failure. Methods: We measured high-sensitivity cTnT (hs-cTnT) and standard cardiac troponin I (cTnI) levels, as well as amino-terminal pro B-type natriuretic peptide (NT-proBNP) in 504 sequential stable patients with a history of heart failure who underwent elective coronary angiography, without acute coronary syndrome, and with 5-year follow-up of all-cause mortality. Results: The median hs-cTnT level was 21.2 (interquartile range 12.3-40.9) ng/L and 170 subjects died over 5 years. In a head-to-head overall comparison, hs-cTnT provided increased prognostic utility compared with cTnI (area under the curve [AUC] 66.1% and AUC 69.4%, respectively, P = .03; 9.0% integrated discrimination improvement, P < .001; and 13.6% event-specific reclassification, P < .001), and was independent of NT-proBNP and renal function. Even within the subset of patients where cTn levels by both assays were above the limit of quantification, higher hs-cTnT is associated with a 2-fold increase in 5-year mortality risk after adjusting for traditional risk factors (tertile 1 vs 3: hazard ratio [95% confidence interval] 2.0 [1.3-3.2]; P = .0002). Conclusion: Cardiac troponin can be detected by the high-sensitivity assay in more patients with chronic heart failure than the standard assay, and may yield independent and better prognostic accuracy for mortality prediction than standard assay.
وصف الملف: application/pdf
العلاقة: https://engagedscholarship.csuohio.edu/scimath_facpub/219Test; https://engagedscholarship.csuohio.edu/context/scimath_facpub/article/1227/viewcontent/uc.pdfTest
الإتاحة: https://doi.org/10.1016/j.amjmed.2014.09.029Test
https://engagedscholarship.csuohio.edu/scimath_facpub/219Test
https://engagedscholarship.csuohio.edu/context/scimath_facpub/article/1227/viewcontent/uc.pdfTest -
2دورية أكاديمية
المصدر: Mathematics Faculty Publications
مصطلحات موضوعية: Chronic heart failure, functional status, prognosis, Mathematics
الوصف: BACKGROUND: Over the years, several methods have been developed to reliably quantify functional capacity in patients with heart failure. Few studies have investigated the prognostic value of these assessment tools beyond cardiorenal prognostic biomarkers in stable patients with chronic heart failure. METHODS AND RESULTS: We administered the Duke Activity Status Index (DASI) questionnaire, a self-assessment tool comprising 12 questions for estimating functional capacity, to 1,700 stable nonacute coronary syndrome patients with history of heart failure who underwent elective diagnostic coronary angiography with 5-year follow-up of all-cause mortality. In a subset of patients (n = 800), B-type natriuretic peptide (BNP) was measured. In our study cohort, the median DASI score was 26.2 (interquartile range [IQR] 15.5-42.7). Low DASI score provided independent prediction of a 3.3-fold increase in 5-year mortality risk (quartile 1 vs quartile 4: hazard ratio [HR] 3.33, 95% confidence interval [CI] 2.57-4.36; P < .0001). After adjusting for traditional risk factors, BNP, and estimated glomerular filtration rate, low DASI score still conferred a 2.6-fold increase in mortality risk (HR 2.57, 95% CI 1.64-4.15; P < .0001). CONCLUSIONS: A simple self-assessment tool of functional capacity provides independent and incremental prognostic value for mortality prediction in stable patients with chronic heart failure beyond cardiorenal biomarkers.
وصف الملف: application/pdf
العلاقة: https://engagedscholarship.csuohio.edu/scimath_facpub/227Test; https://engagedscholarship.csuohio.edu/context/scimath_facpub/article/1235/viewcontent/uc.pdfTest
الإتاحة: https://doi.org/10.1016/j.cardfail.2014.08.013Test
https://engagedscholarship.csuohio.edu/scimath_facpub/227Test
https://engagedscholarship.csuohio.edu/context/scimath_facpub/article/1235/viewcontent/uc.pdfTest -
3دورية أكاديمية
المصدر: Mathematics Faculty Publications
مصطلحات موضوعية: Mathematics
الوصف: Current guidelines recommend a coronary evaluation before valvular heart surgery (VHS). Diagnostic coronary angiography is recommended in patients with known coronary artery disease (CAD) and those with high pretest probability of CAD. In patients with low or intermediate pretest probability of CAD, the guidelines recommend coronary computed tomographic angiography. However, there are no tools available to objectively assess a patient’s risk for obstructive CAD before VHS. To address this deficit, 5,360 patients without histories of CAD who underwent diagnostic coronary angiography as part of preoperative evaluation for VHS were identified. Obstructive CAD was defined as ≥50% stenosis in ≥1 artery. Of the patients assessed, 1,035 (19.3%) were found to have obstructive CAD. Through multivariate analysis, age, gender, diabetes, renal dysfunction, hyperlipidemia, and a family history of premature CAD were found to be associated with the presence of obstructive CAD (p <0.001 for all). After adjustment, the specific dysfunctional valve was not associated with the presence of obstructive CAD. Patients were then randomly split into derivation and validation cohorts. Within the derivation cohort, using only age, gender, and the presence or absence of risk factors, a model was constructed to predict the risk for obstructive CAD (C statistic 0.766, 95% confidence interval 0.750 to 0.783). The risk prediction model performed well within the validation cohort (C statistic 0.767, 95% confidence interval 0.751 to 0.784, optimism 0.004). The bias-corrected C statistic for the model was 0.765 (95% confidence interval 0.748 to 0.782). In conclusion, this novel risk prediction tool can be used to objectively risk-stratify patients who undergo preoperative evaluation before VHS and to facilitate appropriate triage to computed tomographic angiography or diagnostic coronary angiography.
وصف الملف: application/pdf
العلاقة: https://engagedscholarship.csuohio.edu/scimath_facpub/218Test; https://engagedscholarship.csuohio.edu/context/scimath_facpub/article/1226/viewcontent/uc.pdfTest
الإتاحة: https://doi.org/10.1016/j.amjcard.2015.03.063Test
https://engagedscholarship.csuohio.edu/scimath_facpub/218Test
https://engagedscholarship.csuohio.edu/context/scimath_facpub/article/1226/viewcontent/uc.pdfTest
