Check out the latest coverage from Transcatheter Cardiovascular Therapies Connect 2020

TCT Connect 2020

This study originally appeared on Practical Cardiology's sister site, 

Data from a study of more than 4000 patients admitted to a New York City medical center with coronavirus disease 2019 (COVID-19) suggests statin use could reduce the risk of death by 12% in 

 results of the study give credence to the idea the anti-inflammatory effect of statin therapy could reduce the severity of COVID-19.

“In this analysis involving a large cohort of hospitalized patients with COVID-19, statin use was associated with reduced in-hospital mortality in patients with diabetes,” wrote investigators. “This observation was made despite older age, higher prevalence of hypertension and atherosclerotic heart disease in diabetic statin users.”

With the anti-inflammatory effects of statin therapy described in multiple studies, a team led by Omar Saeed, MD, sought to determine whether use would impact outcomes in patients with COVID-19. With this in mind, they designed an analysis to assess data collected from within the Montefiore Medical Center in the Bronx, New York.

Using March 1, 2020 to May 2, 2020 as the study period, investigators conducted a retrospective analysis of consecutive patients admitted with COVID-19. Overall, 4252 patients were admitted during the study period. The mean age of this cohort was 65±16 years and 53% were male. Among the most prevalent comorbidities were atherosclerotic cardiovascular disease (23%), diabetes (53%), and hypertension (72%).

Among the 4252-patient cohort, 1355 received a statin. Those who received a statin were generally older and had a higher Charlson comorbidity index (5; IQR, 3-8 vs 3; IQR, 1-5; 

 <.01). Initial analysis indicated patients reviving a statin had a lower cumulative rate of in-hospital mortality compared to those not receiving a statin (23% vs 27%; 

 <.01), but investigators found the presence of diabetes modified this apparent effect.

Of the 4252 patients included in the study, 2266 were considered diabetic. Of these 2266, 983 received and 1283 did not receive a statin. When stratifying by diabetes status, patients with diabetes receiving a statin had a low cumulative in-hospital mortality than those not receiving a statin (24% vs 39%; 

 <.01), but no difference was observed among patients without diabetes (20% vs 21%; 

In a multivariable regression model, investigators determined statin use among patients with diabetes was associated with a 49% reduction for in-hospital mortality(HR, 0.51; 95% CI, 0.43-0.61). In propensity score-matched analyses using caliper matching (HR, 0.88; 95% CI, 0.83-0.94; 

 <.01) or inverse probably treatment waiting (HR, 0.88; 95% CI, 0.84-0.92; 

 <.01), statin use was associated with a 12% lower risk of death during hospitalization for statin users compared to non-users.

“In this observational analysis, statin administration to patients with diabetes was associated with a reduced risk of in-hospital mortality during COVID-19. Further study to validate our findings and investigate underlying mechanisms is needed,” wrote investigators.

Statin Use and In-Hospital Mortality in Diabetics with COVID-19,

Journal of the American Heart Association.

Articles

An analysis of data from patients presenting to a medical center in New York City details associations between statin use and mortality among diabetics hospitalized with COVID-19.

Statin Use Tied to Lower Mortality Among Diabetics Hospitalized with COVID-19

New data from a trio of New York City hospitals indicates computed tomography angiogram (CTA) scans could help identify stroke patients with coronavirus disease 2019 (COVID-19) earlier than standard nasal swab tests.

An analysis of lung scans from more than 50 

, results of the study indicate CTA scans combined with responses on COVID-19 symptom questionnaires led to an 83% accuracy rate, which could contribute to earlier detection and improve care for these patients.

“In combination with symptoms, CTA scan analysis is relatively accurate in diagnosing COVID-19, even compared to the nasal swab test. Since this analysis is much faster and at no extra cost, we hope it could be incorporated as a rapid diagnosis tool for patients with acute stroke,” said lead investigator Charles Esenwa, MD, MS, an assistant professor and a stroke neurologist at the Albert Einstein College of Medicine in the Bronx, New York City, in 

a statement from the American Heart Association

. “In addition, accurately diagnosing COVID-19 within hours, rather than the sometimes days wait-time to receive the results from nasal swab tests could help protect both patients and medical professionals.”

With evaluation of lung apices using CTA scans for providing the first opportunity to screen for COVID-19 in patients 

, Esenwa and a team sought to retrospectively analyze the use of these evaluations as a COVID-19 screening measure. With this in mind, investigators pooled data from 3 Montefiore Health System hospitals in New York City, which yield a population of 110 patients with CTA scans of the head and neck for possible inclusion.

After eliminating patients who did not undergo an RT-PCR, those who did not present with acute ischemic stroke, and the application of further inclusion criteria, investigators identified a cohort of 57 patients for inclusion in their final analysis. For the purpose of analysis, CTA images were assessed by fellowship-trained radiologists blinded to the patient’s COVID-19 status using the COVID-19 reporting and data system (CO-RADS) scheme.

Of the 57 patients included in the final analysis, 30 were considered COVID-19-positive and 27 were considered COVID-19-negative. Upon initial analysis, 20 patients in the positive group and 2 patients in the negative group had findings on CTA images considered highly or very highly suspicious using CO-RADS (

When used in isolation, a CO-RADS designation of highly or very highly suspicious for COVID-19 pneumonia yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19. When used in combination with self-reported clinical symptoms, sensitivity of the lung assessments increased to 0.83.

“Early diagnosis via CT scans has helped our center protect other patients and staff through early isolation, and it has also allowed us to start early supportive care for those suspected of having stroke who are COVID-19 positive,” Esenwa added, in the aforementioned statement.

Investigators pointed out multiple limitations in their study. These included a lack of universal standard for diagnosing COVID-19, the exclusion of patients without RT-PCR, and the possibility for increased diagnostic accuracy due to location of the study centers.

Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Results from an analysis of patients presenting at 3 NYC-based centers suggests CTA scans combined with clinical questionnaire data yielded an 83% accuracy rate for diagnosing COVID-19 in stroke patients. 

CTA Scans Could Contribute to Earlier COVID-19 Diagnoses in Stroke Patients

As life expectancies have risen so have the numbers of elderly Americans. Even before the COVID-19 pandemic as many as one in four adults 65 and older were considered socially isolated.

 There is a growing body of evidence that social isolation and loneliness affect more than just the mental health of our aging population.

According to the Centers for Disease Control (CDC) social isolation is not only associated with dementia, it significantly increases a person’s risk of premature death, heart disease, and stroke.

Elderly patients with heart failure who felt loneliness were four times more likely to die, three times more likely to be hospitalized and twice as likely to visit the emergency room.

 A study published in the Journal of the American Heart Association found that identifying those at risk creates opportunities to intervene.

Just how lonely are older Americans? According to the National Social Life, Health, and Aging Project as many as one-third of older adults report that they frequently feel lonely.

 Some causes of isolation and loneliness include retiring from work, losing a partner, and or losing mobility. Leaving the workforce can cause a drastic reduction in social interaction while losing a spouse or partner compounds the grief of the loss itself with loneliness.

Christian Hakulinen, PhD, a professor of psychology and logopedics at the University of Helsinki, Finland states, “Having social support from significant others or from persons who are in a similar situation is good for your health, and socially isolated or lonely individuals might not have possibilities for this kind of support.”

There is strong evidence for the notion that close relationships promote health. Harvard University has been conducting a study looking at health and well-being for the last 80 years. This study has found that healthy social relationships at age 50 are a better predictor of physical health at age 80 than midlife cholesterol levels.

In an editorial published in the British Medical Journal, Julianne Holt-Lunstad, PhD, and Timothy Smith, MD, PhD, explore the underlying causes of increased cardiovascular disease (CVD) and mortality in isolated and lonely seniors. Evidence suggests that social isolation and loneliness are associated with negative changes in biomarkers for CVD such as hypertension, body mass index, waist circumference and inflammation

 Furthermore, being isolated may lead to decreased exercise and increased negative behaviors such as smoking and drinking alcohol.

So, what can we do as clinicians to help the lonely hearted? The first step is to identify the problem. In a study published in the Journal of the American Heart Association, a four-question survey was used successfully to identify patients at risk.

 A 1 to 5 score corresponding to an answer of “Never”, “Rarely”, “Sometimes”, “Usually”, or “Always” was given for the following questions:

“I feel that people are around me but not with me.”

With scores ranging from 4 to 20 patients with higher scores could be identified as possessing greater perceived social isolation.6 Once identified a strategy should be made with the goal of reducing, not only the perception of isolation and loneliness, but also the comorbid behaviors and biomarkers associated with that isolation. A large portion of the increased CV risk in lonely adults can be attributed to the physical consequences of being alone.

When I encounter a patient with feelings of isolation, they often seem withdrawn and less interactive. When people are used to being alone, they often communicate less with clinicians. It is up to us to engage patients and offer strategies to mitigate the isolation we know can impact their health. One way we can help is by encouraging these patients to maintain existing relationships with family and friends which may involve, during the COVID-19 pandemic, assessing their ability to video call, zoom, or facetime others.

There is no doubt the pandemic increases the likelihood of loneliness and isolation especially in the elderly who are often times frightened due to their increased risk of dying from it. My suggestion is to get creative. There are many hobby groups, church activities, classes, and interactive games to be found on the internet. Just the same as prescribing the right drug for a medical condition or providing exercise and nutrition advice to a patient, we need to adapt and become educated about how to alleviate the widespread isolation and loneliness in our patients lest the owners of a lonely heart become owners of broken hearts.

Dr. Gregory Weiss reflects on the impact of isolation and loneliness on older patients during the COVID-19 pandemic.

Gregory Weiss, MD: Impact of Loneliness and Isolation on the Health of Elderly Americans

New research is describing a potential new use for coronary artery calcium (CAC) scoring in patients at risk of a 

Using data from the Dallas Heart Study, a team from the Preventive Cardiology Program at University of Texas Southwestern concluded use of CAC scanning could help clinicians identify patients that would benefit most from aspirin for primary prevention.

“Aspirin use is not a one-size-fits-all therapy,” said Amit Khera, MD, professor of internal medicine and director of the Preventive Cardiology Program at UTSW, 

. “CAC scanning can be a valuable tool to help us tailor care to help more patients avoid a first heart attack or stroke.”

With guideline changes altering the use of aspirin in prevention settings, a new emphasis has been placed on predictors and factors associated with increased bleeding when used for primary prevention. In recent years, a multitude of studies have concluded CAC scoring was useful for identifying patients at an increased atherosclerotic cardiovascular disease (ASCVD) risk. With this in mind, Khera and colleagues designed the current study to examine whether CAC scoring could help determine the net estimated effect of aspirin at different risk thresholds.

Using the 6101-patient Dallas Heart Study as a data source, investigators performed a search of patients free from ASCVD and not taking aspirin at baseline. From this search, investigators identified a cohort of 2191 patients for inclusion in the current study. This cohort had a mean age of 44 (SD, 9.1) years, 57% were women, and 47% were Black.

Of note, all patients in the Dallas Heart Study were invited to 3 sequential visits to collect health information, including various imaging studies and electron beam computed tomography for CAC scoring. Of the 2191 patients included in the study, 1063 had a CAC of 0, 967 had a score of 1-99, and 161 had a score of 100 or greater.

The primary outcomes of the study were first bleeding event and first ASCVD event associated with hospitalization or death. Bleeding events were identified through the use of ICD-9 codes and the ASCVD outcome was defined as a composite of nonfatal myocardial infarction, coronary heart disease death, and nonfatal and fatal stroke.

Over a follow-up period lasting a mean of 12.2 (1.9) years, 116 first major bleeding events and 123 ASCVD events were observed. When assessing types of bleeding events, investigators found 81 (70%) were gastrointestinal and 18 were intracerebral. Investigators pointed out 24 (21%) of the 116 events were fatal bleeds.

Upon analysis, results indicated those with a CAC score of 1-99 were at a greater risk for ASCVD (HR, 4.8; 95% CI, 2.8-8.2; 

 <.01) and bleeding events (HR, 1.6; 95% C I, 1.1-2.4; 

=.02) when compared to their counterparts with a score of 0. Results indicated those with a CAC score of 100 or greater were also at an increased risk of ASCVD (HR, 5.3; 95% CI, 3.6-7.9; 

 <.01) and bleeding events (HR, 2.6; 95% CI< 1.5-4.3; 

 <.01) when compared to those with a score of 0. However, investigators pointed out these association between bleeding events and CAC was attenuated in multivariable-adjusted models.

Using meta-analysis estimates for the effects of aspirin, irrespective of CAC, investigators found aspirin use was estimated to result in net harm for individuals at low and intermediate (less than 5%) 10-year ASCVD risk. For those considered to be at high-risk (20% or greater), aspirin use was associated with a net benefit.

When assessing bleeding risk, results suggested a CAC score of 100 or greater in patients considered to be at low bleeding risk indicated net benefit from aspirin use, but only in those at borderline or higher (5% or greater) 10-year ASCVD risk. Among individuals at higher bleeding risk, aspirin use was associated with net harm regardless of CAC and ASCVD risk.

, Miguel Cainzos-Achirica, MD, MPH, PhD, and Philip Greenland, MD, applaud investigators of the current study for adding to a growing body of evidence suggesting CAC scores could help guide aspirin use for primary prevention, but cautions that more conclusive studies are needed before overinterpreting data.

“Until further studies become available, the overall consistent observations from the DHS and the MESA have important clinical implications…Although it has been proposed that clinical risk scores could aid in the identification of optimal candidates for aspirin therapy, CAC scores seem to be a better tool to inform risk management discussions involving aspirin, leading to a safer allocation in candidates who are appropriate and motivated—particularly in middle-aged populations,” wrote the pair.

Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease

An analysis of the Dallas Heart Study from UTSW details how use of CAC scoring can help determine what patients would stand to benefit from aspirin use for primary prevention. 

CAC Scoring Helps Determine Net Benefit or Harm of Aspirin in Primary Prevention

Results of a study carried out by physicians at Columbia University Irving Medical Center detail the effects of a multidisciplinary approach, consisting of a cardio-obstetrics team, when caring for pregnant women with cardiovascular disease.

A review of data from more than 300 pregnant women, results of the study give further credence to the notion that implementation of such a practice would lead to improvements in care and outcomes for pregnant women with 

"While cardiologists have been managing the care of pregnant women for decades, the notion of a dedicated cardio-obstetrics team is a recent development aimed at reducing maternal death rates due to cardiovascular disease," said lead investigator Jennifer Haythe, MD, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, 

. "This study shows that programs like ours may help provide improved cardiovascular care to an otherwise underserved population, though more research is needed to evaluate the impact of these programs."

With a recent emphasis on encouraging the use of cardio-obstetric teams for expecting mothers, Haythe and a team of colleagues sought to describe the clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions from a cohort of pregnant women with cardiovascular disease being treated with su h an approach. To do so, they designed their study as an analysis of women treated by the cardio-obstetrics team at Columbia University Irving Medical Center between January 1, 2010-December 31, 2019.

From electronic medical record data, investigators obtained information related to demographics, comorbidities, underlying cardiovascular disease, medications, outcomes, and cardiovascular readmissions of patients treated by the team during the aforementioned time period. Based on this information, all patients considered eligible for inclusion were assigned a Cardiac Disease in Pregnancy (CARPREG) II score.

In total, 306 pregnant women with cardiovascular disease were identified over the study period. The median age at delivery was 30 (IQR, 25-35) years, 52.9% were Hispanic or Latino, and 74.2% were insured through Medicaid. The median CARPREG II score was 3, with 42.5% of patients receiving a score of 4 or greater. Among the entire study cohort, the most common forms of cardiovascular disease were arrhythmias (28.8%), congenital heart disease (23.5%), cardiomyopathy (23.5%), and valvular heart disease (16.3%).

When assessing maternal outcomes, investigators found 11.4% of patients developed gestational diabetes, 9.5% had gestational hypertension, and preeclampsia was present in 12.1% of patients. Investigators also pointed out 3.6% of patients required treatment with insulin and 1.6% required medication for treatment of gestational hypertension.

Results indicated patients treated by the cardio-obstetrics team had 30-day readmission rate of 2% and a readmission rate of 4.6% for the period 30-90 days after delivery. Investigators noted a single maternal death occurred within a year of delivery in a woman with Eisenmenger syndrome.

In the aforementioned statement, Haythe points out the low rate of readmissions underlines the real-world impact of collaborative care with a cardio-obstetrics team.

"Despite the high cardiovascular risk in our study population, we found low rates of maternal and fetal complications and a low rate of hospital readmissions after delivery compared to previously published national rates," Haythe added.

Cardiovascular Care for Pregnant Women With Cardiovascular Disease

Journal of the American College of Cardiology.

An analysis of data from women treated at Columbia University Irving Medical Center details outcomes in pregnant women with cardiovascular disease treated by a cardio-obstetrics care team. 

Cardio-Obstetrics Approach Could Improve Outcomes in Pregnant Women with Cardiovascular Disease

A new study suggests an approach combining standard heart failure therapies with the Heartmate II Left Ventricular Assist Device (LVAD) could reverse structural heart damage in patients with 

Named RESTAGE-HF, results from the multicenter trial indicate implementing the approach could contribute to improved survival and explantation rates, which investigators point out could reduce the rate of heart transplantation and long-term device use.

"For decades, heart transplantation and LVADs have been the therapeutic cornerstones of advanced heart failure," said study investigator Stavros Drakos, MD, PhD, a cardiologist and director of Cardiovascular Research for the University of Utah Health Division of Cardiology, 

. "But this alternative approach is different. It appears to be a bridge to heart recovery without requiring transplantation or long-term use of an artificial heart pump."

In hopes of identifying a treatment that allows for greater rates of LVAD unloading and hemodynamic support in patients with advanced HF, the Abbott Medical-supported study sought to determine whether an approach combing optimized therapy with use of the Heartmate II LVAD could improve rates of LVAD and induce reverse remodeling of structural damage.Designed as a prospective, non-randomized trial, RESTAGE-HF enrolled a population of 40 patients and was conducted at the University of Utah, University of Louisville, University of Pennsylvania, the Albert Einstein College of Medicine/Montefiore Medical Center, the Cleveland Clinic, and the University of Nebraska Medical Center.

For inclusion in the study, patients needed to be between 18-59 years of age, have an LVAD indication as a bridge to transplant (BTT) or destination therapy (DT), have an ejection fraction less than 25%, and have a duration of HF of 5 years or less. All patients included in the study agreed to not undergo heart transplantation for a minimum of 4.5 months after LVAD.

For the primary end point, investigators chose to assess the proportion of patients who met explant criteria after treatment and testing protocol within 18 months with subsequent freedom from death, mechanical circulatory support, and heart transplantation at 1-year post-LVAD removal. For secondary end points, investigators chose to assess the proportion of patients meeting explant criteria and subsequently explanted, the durability of remission from HF at 1-3 years, the time course of reverse remodeling, changes in left ventricular ejection fraction (LVEF), and predictors of recovery.

The therapy regimen prescribed to patients included lisinopril 20 mg PO bid, carvedilol 50 mg PO bid, spironolactone 25 mg PO daily, digoxin 125 mcg PO daily and Losartan 150 mg PO daily. Additionally, LVAD speed was optimized after implantation according to echocardiography to maximize left ventricular unloading.

Prior to implantation of the HeartMate II LVAD, the mean age of patients was 35.1±10.8 years, 67.5% were men, mean duration of HF was 20.8±20.6 months, and 95% required inotropic and 20% required temporary mechanical support. Additionally, the group had a mean LVEF of 14.5±5.3%, mean end-diastolic diameter (LVEDD) of 7.33±0.89 cm, mean end-systolic diameter (LVESD) of 6.74±0.88 cm, PA saturations of 46.7±9.2%, and mean pulmonary capillary wedge pressure (PCWP) was 26.2±7.6 mmHg. Of the 40 patient cohort, 4 patients did not undergo protocol due to medical complications unrelated to the study procedures.

Upon analysis, 16 patients achieved the primary end point (

 <.0001) and 50% of patients receiving the protocol were explanted within 18 months (pre-explant LVEF 57±8%; LVEDD, 4.81±0.58 cm; LVESD 3.53±0.51cm; PCWP, 8.1±3.1 mmHg; PA saturation, 63.6±6.8% at 6000 rpm). In total, 19 patients in the trial were explanted. Results of the study indicated post-explantation survival free from LVAD or transplantation was 90% at 1-year and 77% at 2 and 3 years.

"This multi-center study builds on and validates more than a decade of research conducted by Utah physician-scientists in this exciting field of heart recovery," added Drakos, in the aforementioned statement. "We are invested in figuring how to help a failing heart recover its function with just a little help from us."

A Prospective Multicentre Study of Myocardial Recovery Using Left Ventricular Assist Devices (REmission from Stage D Heart Failure: RESTAGE-HF): Medium Term and Primary Endpoint Results

Results of a prospective, non-randomized trial indicate an approach using the HeartMate II LVAD combined with optimized medical therapy could increase the rate of device explantation and help facilitate cardiac remodeling.

RESTAGE-HF: HeartMate II Combined w/ Optimized Therapy Could Facilitate Cardiac Remodeling 

Results from an analysis of data from a pair of European registries details a wide array of cardiovascular and overall health benefits from metabolic surgery in severely obese patients with a history of myocardial infarction (MI).

Conducted by a team from Sweden, the study’s results indicate Roux-en-Y gastric bypass and sleeve gastrectomy procedures were associated with a low risk of serious complications and a lower risk of mortality, new MI, and other major adverse cardiovascular events (MACE) in a population of patients considered severely obese with a history of MI.

"We found that individuals operated on for their obesity were at a much lower risk of suffering another myocardial infarction, of death and of developing heart failure," said lead investigator Erik Näslund, MD, PhD, professor at the Department of Clinical Sciences at Danderyd Hospital of the Karolinska Institute, 

 "These data suggest that severely obese people who suffer a myocardial infarction should be offered metabolic surgery for their obesity as a secondary prevention."

With the prevalence of obesity increasing throughout the world, determining the most effective course of treatment for obese patients is paramount. In an effort to evaluate whether metabolic surgery was an effective strategy for secondary prevention among obese patients, Naslund and colleagues designed the current study as an analysis of data from the SWEDEHEART and SOReg registries.

By combining data from the registries, investigators identified 509 patients with a BMI greater than 35 for inclusion in their analysis. These patients were then matched in a 1:1 ratio to controls with a history of MI but not undergoing metabolic surgery based on the sex, age, year of MI, and BMI of each patient. Investigators noted both groups were well-matched but pointed out patients in the surgery group had a lower proportion of reduced ejection fraction after MI (7% vs 12%), previous heart failure (10% vs 19%), atrial fibrillation (6% vs 10%), and chronic obstructive pulmonary disease (4% vs 7%).

The primary outcome of interest was MACE, which was defined as first occurrence of death or readmission with MI or stroke. Investigators chose individual components of the primary outcome, admission with not previously known atrial fibrillation, and admission because of previously unknown heart failure as secondary outcomes of the study.

During an 8-year follow-up period, which lasted a median of 4.6 (2.7–7.1) years, investigators found the probably of MACE was lower among patients who underwent metabolic surgery (18.7%; 95% CI, 15.9-21.5% vs 36.2%; 33.2-39.3% [aHR, 0.44; 95% CI, 0.32-0.61]).Patients undergoing surgery also had a lower risk of death (aHR, 0.45; 95% CI, 0.29-0.70), MI (aHR, 0.24; 95% CI, 0.14-0.41), and new onset heart failure. However, investigators pointed out there were no significant differences regarding stroke (aHR, 0.91; 95% CI, 0.38-2.20) and new onset atrial fibrillation (aHR, 0.56; 95% CI, 0.31-1.01).

Investigators also noted additional health changes at 2 years after metabolic surgery which could have contributed to reductions in primary and secondary outcome measures. Among these were a 67% remission in sleep apnea, 22% remission in hypertension, and a 29% remission in cholesterol and triglyceride levels in the surgery group. Additionally, results suggested more than half of the patients with type 2 diabetes experienced clinical remission after surgery.

Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity

Results of an analysis of data from the SWEDEHEART and SOReg registries describe reductions in MACE and other health markers associated with metabolic surgery in severely obese patients with a history of myocardial infarction. 

Metabolic Surgery Post-Heart Attack Could Prolong Life, Reduce Future Events for Obese Patients

New data from a study presented at ASN Kidney Week 2020 provides clinicians suggests a pair of biomarkers used to identify patients at increased risk of myocardial injury could help predict which chronic kidney disease (CKD) patients were most likely to develop 

The most common form of arrhythmia, results of the study indicate high sensitivity troponin T (hsTnT) and N-terminal brain natriuretic peptide (NT-proBNP) could help improve prediction of atrial fibrillation in patients with CKD, especially when paired in machine learning algorithms.

“The application of such a model could be used to identify patients with CKD who may benefit from enhanced cardiovascular care and also to identify selection of patients for clinical trials of AF therapies,” said lead author Leila Zelnick, PhD, assistant professor in the Division of Nephrology at the University of Washington, 

With previous studies demonstrating the prognostic value of hsTnT and NT-proBNP for predicting AF in community-based populations, Zelnick and a team from institutions across the US sought to examine the value of these biomarkers for predicting AF using machine learning methods. With this in mind, investigators identified the Chronic Renal Insufficiency Cohort (CRIC) as the data source for their analysis.

Beginning in 2001, CRIC contains data related to nearly 4000 CKD in the US. For the purpose of the analysis, investigators only included those without prior AF–yield a population of 2690 participants. Investigators noted participants were also excluded if they did not have complete cardiac biomarker, demographics, medical history, lifestyle information, medication history, physical characteristics, and laboratory data available for analysis.

Investigators performed their analyses using Cox regression, LASSO, ridge regression, elastic net, boosting methods, and a previously-validated prediction model to predict incident AF. Of note, the clinical prediction model used in the analysis was validated in the CHARGE-AF study.

The mean age of the 2690-patient population was 57 (SD, 11) years, 55% were men, 38% were black, and the group had a mean eGFR of 45 (SD, 15) mL/min/1.73m2. During a follow-up period lasting a mean of 7.3 (SD, 2.8) years, 251 participants experienced an incident AF event.

In their analyses, the CHARGE-AF predication equations using original and re-estimated coefficients both had a cross-validated C-index of 0.69. In a LASSO model analysis using only clinical data, results indicated the model achieved a C-index of 0.69. When adding NT-proBNP, hsTnT, or both biomarkers, the LASSO model achieved a C-index of 0.75, 0.73, and 0.76, respectively (

Prediction of Atrial Fibrillation Using Clinical and Cardiac Biomarker Data: The CRIC Study,”

 was presented at the American Society of Nephrology Kidney Week 2020.

Using data from the CRIC study, a team of investigators has designed a machine learning model they suggest could predict AF incidence in patients with chronic kidney disease. 

Machine Learning Model Predicts Incident Afib in CKD Patients

This article was originally published on Practical Cardiology’s sister site, 

An analysis of data from an ongoing study in Switzerland is shedding light on the impact bariatric surgery can have on life expectancy compared to standard obesity care.

While neither group of patients achieved the life expectancy of the general population, results of the study suggest patients undergoing bariatric surgery lived a median of 3 years longer than their counterparts in the study’s control group.

“Our study shows that bariatric surgery prolongs (life expectancy) by three years. But even after surgery, patients still have a shorter life expectancy than the general population. That's why it's very important for bariatric patients to be offered adequate postoperative monitoring and follow-up," noted Lena Carlsson Ekander, MD, PhD, Professor of Clinical Metabolic Research at Sahlgrenska Academy,

To learn more about the effects of treatment course on mortality in obese patients, Carlsson Ekander and a group of colleagues designed an analysis of the ongoing Swedish Obese Subjects (SOS) study. The SOS study, which recruited participants from September 1, 1987 through January 31, 2001, provided investigators with information related to 4047 obese patients and 1135 patients from the general population, which were used as a reference cohort.

Of the 4047, 2007 underwent surgery and 2040 were used as a control group. When the investigators performed their analysis on December 31, 2018, the median duration of follow-up was 24 (IQR, 22-27) years for patients in the surgery group, 22 (IQR, 21-27) years for patients in the control group, and 20 (IQR, 19-21) for patients in the reference group.

Of note, patients in the surgery group underwent banding (18%), vertical banded gastroplasty (69%), or gastric bypass (13%) procedures while those in the control group received conventional obesity treatment.

Upon analysis, investigators found 22.8% (n=457) of patients in the surgery group and 26.4% (n=539) of the control group died (HR, 0.77; 95% CI, 0.68-0.87; 

 <.001).Based on the results, investigators calculated the median life expectancy in the surgery group was 2.4 (95% CI, 1.3-3.5; 

 <.001) years longer than in the control group, with an adjusted difference of 3.0 years (95% CI, 1.8-4.2; 

However, investigators pointed out patients in the control group had a median life expectancy 5.5 (95% CI, 3.4-7.6; 

 < .001) than patients included in the reference cohort from the general population.

Further analysis indicated the most common causes of death were deaths from cardiovascular disease and cancers. Specifically, cardiovascular disease was responsible for 167 deaths in the surgery group and 221 deaths in the control group (HR, 0.70; 95% CI, 0.57-0.85) while cancers were responsible for 135 deaths in the surgery group and 165 deaths in the control group (HR, 0.77; 95% CI, 0.61-0.96).

“For the first time, we've got a measure of how much bariatric surgery prolongs life expectancy for the average patient. But it's important to point out that it's a matter of averages. Not all patients are the same, so you can't draw the conclusion that everyone who gets the operation done lives three years longer,” added Carlsson Ekander.

Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study,

An analysis of a Swedish obesity study with more than 20 years of follow-up data is detailing differences in life expectancy among patients who undergo bariatric surgery versus those opting for usual care.

Weight Loss Surgery Linked to 3-Year Increase in Life Expectancy

New research from McGill University suggests a diagnosis of polycystic ovary syndrome (PCOS) could serve as an independent risk factor for gestational hypertension and other pregnancy-associated metabolic complications.

A common condition among women of childbearing age, results of the analysis indicate PCOS was associated with increased odds of developing gestational diabetes, gestational hypertension, and preeclampsia after adjustment for confounding factors.

“We discovered that PCOS is a risk factor for morbidity in pregnancy,” explained lead investigator Michael Dahan, MD, an assistant professor in the Department of Obstetrics and Gynecology at McGill University, 

. “We are now able to precisely determine the relative risk in pregnancy related to the disease process itself by controlling for underlying conditions, which previous studies were unable to do.”

With PCOS impacting 1 in 10 women of childbearing age, Dahan and a team of colleagues sought to narrow the knowledge gap surrounding its associations with increased prevalence of maternal pregnancy complications through an analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. Using the database, which is the largest inpatient sample database in the US and contains information related to more than 7 million hospital admission per year, investigators identified a cohort of more than 9 million patients for inclusion in their analysis.

Using a time period ranging from 2004-2014, investigators identified 14,882 deliveries to women with PCOS and 9,081,906 deliveries identified during the study period were categorized as non-PCOS births. Of note, final analysis performed by investigators adjusted for age, race, income level, insurance type, obesity, IVF use, previous cesarean section, chronic hypertension, pregestational diabetes, thyroid disease, multiple gestations, smoking, and recreational drug use.

When comparing the study arms, rates of obesity (22.3% vs 3.5%; 

 <.001), chronic hypertension (8.4% vs. 1.8%; 

 <.001), pregestational diabetes (4.1% vs 0.9%; 

 <.001), and previous treatment for thyroid disease (12.6% vs 2.4%; 

 <.001) were all greater among women with PCOS. Additionally, data from HCUP-NIS indicated women with PCOS were more likely to have undergone IVF treatment (2.4% vs 0.1%; 

 <.001), have multi-gestation pregnancies (5.9% vs. 1.5%; 

 <.001)—investigators also pointed out more multiple gestations in the PCOS group were the result of IVF treatment than the non-PCOS groups (12.3% vs 2.3%; 

In adjusted analyses, investigators found women with PCOS were more likely to develop gestational diabetes (aOR, 2.19; 95% CI, 2.02-2.37), pregnancy associated hypertension (aOR, 1.38; 95% CI, 1.27-1.50; 

 < 0.001), gestational hypertension (aOR, 1.47; 95% CI, 1.31-1.64), preeclampsia (aOR, 1.29; 95% CI, 1.14-1.45) and superimposed PEC (aOR, 1.29; 95% CI, 1.04-1.59) than women in the non-PCOS cohort.

When assessing women pregnant with multiple fetuses, PCOS was associated with a statistically significant increased risk of developing gestational diabetes mellitus (aOR, 2.33; 95% CI, 1.92-2.83; 

 <.001). Investigators pointed out there was also a trend toward an increased risk for developing pregnancy-related hypertension (aOR, 1.92; 95% CI, 0.99-1.42; 

“PCOS is the most common hormonal condition among reproductive age women,” added Dahan, in the aforementioned statement. “It is important to consider the risk of other co-existing conditions frequently encountered in women with PCOS, as these risks are additive and place them at a significantly increased risk of adverse pregnancy outcomes.”

Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies

An analysis of data from more than 9 million women details the increased odds of developing gestational diabetes, gestational hypertension, and other complications associated with having polycystic ovary syndrome.