Sequential organ failure assessment score on admission predicts long-term mortality in acute heart failure patients.

AIMS: The sequential organ failure assessment (SOFA) score has been a widely used predictor of outcomes in the intensive care unit, whereas short-term and long-term survivals of heart failure (HF) patients are predicted by the American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) risk score. The purpose of present study was to examine whether the SOFA score on admission is more useful for predicting long-term mortality in acute HF patients than the GWTG-HF risk score. METHODS AND RESULTS: A total of 269 patients (mean age, 78.5 ± 10.9 years; all-cause mortality, 53.9%) seen in a single facility from January 2007 to December 2016 were enrolled retrospectively. They were followed up for a mean of 32.1 ± 22.3 months. All-cause death was associated with higher SOFA and GWTG-HF risk scores. However, no significant difference was observed in the area under the curve value between the scores. Kaplan-Meier survival analysis indicated that higher SOFA scores (P < 0.001) and GWTG-HF risk scores (P < 0.001) were related to increased probabilities of all-cause death. On multivariate Cox proportional hazard model analysis, the SOFA score (P < 0.001) and GWTG-HF (P < 0.001) score were independent predictors of all-cause death. Incorporating the SOFA score into the GWTG-HF risk score yielded a significant net reclassification improvement and integrated discrimination improvement. On decision curve analysis, the net benefit of the SOFA score model when compared with the reference model was greater across the range of threshold probabilities. CONCLUSIONS: In acute HF patients, long-term all-cause mortality can be predicted by the SOFA score. Discriminative performance metrics, such as net reclassification improvement, integrated discrimination improvement, and decision curve analysis, for predicting mortality were improved when the SOFA score was incorporated.

Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Mild Diabetes Mellitus Following Treatment With Pioglitazone: Reports of a Randomised Trial From The Japan Working Group for the Assessment Whether Pioglitazone Protects DM Patients Against Re-Infarction (PPAR Study).

BACKGROUND: Secondary prevention in patients with myocardial infarction (MI) is critically important to prevent ischaemic heart failure and reduce social burden. Pioglitazone improves vascular dysfunction and prevents coronary atherosclerosis, mainly via anti-inflammatory and antiatherogenic effects by enhancing adiponectin production in addition to antihyperglycemic effects, thus suggesting that pioglitazone attenuates cardiovascular events in patients with mild (HbA1c levels < 6·5%) diabetes mellitus (DM). Therefore, we evaluated the effects of pioglitazone on cardiovascular events in patients with both previous MI and mild DM. METHODS: In this multicentre, prospective, randomised, open, blinded-endpoint trial, we randomly assigned 630 patients with mild DM with a history of MI to undergo either DM therapy with (pioglitazone group) or without (control group) pioglitazone. DM was diagnosed using the 75-g oral glucose tolerance test, and mild DM was defined if HbA1c level was < 6·5%. The primary endpoint was the composite of cardiovascular death and hospitalisation caused by acute MI, unstable angina, coronary revascularisation (including percutaneous coronary intervention and cardiac bypass surgery), and stroke. FINDINGS: HbA1C levels were 5·9 and 5·8% (p = 0·71) at baseline and 6·0 and 5·8% (p < 0·01) at 2 years for the control and pioglitazone groups, respectively.The primary endpoint was observed in 14·2% and 14·1% patients in the control and pioglitazone groups during two years (95% confidential interval (CI):0.662-1·526, p = 0·98), respectively; the incidence of MI and cerebral infarction was 0·3% and 2·2% (95%CI: 0·786-32·415, p = 0·09) and 1·0% and 0·3% (95%CI: 0·051-3·662, p = 0·44), respectively. Post-hoc analyses of the 7-year observation period showed that these trends were comparable (21·9% and 19·2% in the control and pioglitazone groups, 95%CI: 0.618-1·237, p = 0·45). INTERPRETATION: Pioglitazone could not reduce the occurrence of cardiovascular events in patients with mild DM and previous MI.

Comparative assessment of 18F-fluorodeoxyglucose PET and 99mTc-tetrofosmin SPECT for the prediction of functional recovery in patients with reperfused acute myocardial infarction.

PURPOSE: Although preserved glucose metabolism is considered to be a marker of myocardial viability in the chronic stage, it has not been fully elucidated whether this is also true with regard to reperfused acute myocardial infarction (AMI). The aim of this study was to compare the diagnostic performance of(99m)Tc-tetrofosmin SPECT and(18)F-fluorodeoxyglucose (FDG) PET for the prediction of functional recovery in reperfused AMI. METHODS: The study population comprised 28 patients. Both tetrofosmin SPECT and FDG PET were performed in all 28 patients at ca. 2 weeks and in 23 at 6 months. The tetrofosmin and FDG findings in infarct-related segments were compared with the regional wall motion score assessed by left ventriculography over 6 months to determine the predictive value for functional recovery. RESULTS: Of 120 infarct-related segments, 83 had preserved flow (tetrofosmin uptake >/=50%) and 81 had preserved glucose metabolism (FDG uptake >/=40%). The sensitivity and specificity of tetrofosmin SPECT for the prediction of functional recovery tended to be superior to those of FDG PET (90.0% and 72.5% vs 85.0% and 67.5%, respectively). Thirteen segments with preserved flow and decreased glucose metabolism demonstrated marked recovery of contractile function from 2.5+/-1.0 to 1.4+/-1.4 (p<0.01), with restoration of glucose metabolism at 6 months. In contrast, 11 segments with decreased flow and preserved glucose metabolism demonstrated incomplete functional improvement from 3.0+/-0.8 to 2.2+/-1.2. CONCLUSION: In the subacute phase, preserved myocardial blood flow is more reliable than glucose metabolism in predicting functional recovery in reperfused myocardium.