Brain Natriuretic Peptide mediates the prognostic role of renal function toward 10-year cardiovascular mortality in patients with Acute Coronary Syndrome: the HHF study (2006-2016).

BACKGROUND/INTRODUCTION: Risk stratification in chronic heart failure (HF) remains a challenge. Renal function and B-natriuretic peptide (BNP) might confer predictive value towards long-term mortality in HF patients after an acute coronary syndrome (ACS). METHODS: From May 2006 to March 2009, 1,000 consecutive patients who were hospitalized with ACS diagnosis were enrolled in the study. In 2016, the 10-year follow-up (2006 -2016) was performed in 745 participants. GFR was evaluated through the MDRD formula. HF phenotype was defined according to baseline ejection fraction (EF); HF with reduced EF (i.e. <40%) (HFrEF), preserved EF (i.e. ≥50%) (HFpEF) and mid-range EF (i.e. 40 -49%) (HFmrEF). RESULTS: 10-year mortality was 21%. Deceased patients presented significantly lower GFR and higher BNP values at the baseline, compared with their alive counterparts (p <0.001 for both). By multivariable logistic regression analysis, GFR independently predicted all-cause mortality (OR = 0.98, p = 0.04). After adjusting for baseline BNP, GFR lost its predictive role while BNP was independently associated with 10-year mortality (OR = 1.39 for a 2-fold increase, p = 0.001). A significant interaction was observed between EF and BNP levels on the tested outcome (p for interaction < 0.001). In stratified analysis, BNP predicted all cause death only in HFmrEF (OR=1.43, p = 0.04) and in HFpEF (OR=1.80, p = 0.01). CONCLUSION: BNP mediates the predictive role of GFR towards long-term mortality in ACS-induced HF patients with retained systolic performance of the left ventricle (HFmrEF and HFpEF).

The "overweight paradox" in the prognosis of acute coronary syndrome for patients with heart failure-A truth for all? A 10-year follow-up study.

OBJECTIVES: In established acute coronary syndrome (ACS) with major complications (i.e. heart failure), overweight/obese patients usually have a survival advantage. To what extent this is irrespective of other characteristics remains inconclusive. The role of body mass index (BMI) in ACS prognosis (fatal/recurrent non-fatal cardiac episodes) and background potential interactions were evaluated. STUDY DESIGN: In 2006-2009, 1000 consecutive patients, hospitalized at First Cardiology Clinic of Athens with a diagnosis of ACS were enrolled in the study. All patients were classified according to heart failure phenotypes. One-month, 1-, 2- and 10-year follow-up examinations were performed (75% participation rate). MAIN OUTCOME MEASURES: Overweight was defined as 25≤BMI≤29.9kg/m2 and obesity as BMI >29.9kg/m2. RESULTS: BMI status and 10-year ACS prognosis followed a J-shape association (p=0.009). Overweight patients had significantly better ACS prognosis than their normal-weight counterparts (OR=0.45, 95% CI (0.23, 0.90)). Significant interactions were observed between sociodemographic, clinical and lifestyle parameters and BMI on 10-year ACS prognosis (all ps for interaction≤10%); the aforementioned paradoxical association was retained only in patients who: were female (OR=0.37, 95% CI (0.16, 0.82)); were aged ≤65 years (OR=0.25, 95% CI (0.09, 0.69)), HFrEF (OR=0.35, 95% CI (0.13, 0.89)); were hypercholesterolemic (OR=0.23, 95% CI (0.07, 0.81)); had no hypertension (OR=0.31, 95% CI (0.12, 0.82)) or diabetes mellitus (OR=0.29, 95% CI (0.09, 0.95)); had moderate/high adherence to a Mediterranean diet (OR=0.43, 95% CI (0.22, 0.86)); and were physically active (OR=0.37, 95% CI (0.15, 0.88)). CONCLUSIONS: Although the overweight paradox was observed in the 10-year ACS prognosis of heart failure patients, this paradoxical association was not the case for all.

Sex differences regarding the impact of physical activity on left ventricular systolic function in elderly patients with an acute coronary event.

INTRODUCTION: Regular physical activity has been associated with less severity of an acute coronary syndrome (ACS), lower in-hospital mortality rates, and an improved short term prognosis. This study evaluated the relationship between physical activity status and the development of left ventricular systolic dysfunction (LVSD) according to inflammation and sex in elderly patients who had had an ACS. METHODS: We analyzed prospectively collected data from 355 male (age 74 ± 6 years) and 137 female (76 ± 6 years) patients who were hospitalized with an ACS. LVSD was evaluated by echocardiography on the 5th day of hospitalization and physical activity status was assessed by a self-reported questionnaire. Inflammatory response was evaluated by measuring C-reactive protein levels. Logistic regression models were applied to evaluate the effect of physical activity status on the development of LVSD and inflammatory response at entry. RESULTS: Physical inactivity had a higher prevalence in women who developed LVSD than in the female patients with preserved systolic function (46% vs. 20%, p=0.02). There was a significant positive association between physical activity levels and ejection fraction in women (p=0.06), but not in men (p=0.30). Multiadjusted logistic regression showed that women who were physically active had 76% lower odds (95%CI: 1-94%) of developing LVSD compared to their sedentary counterparts. Furthermore, physical activity was inversely associated with C-reactive protein levels in both sexes (p=0.08). CONCLUSIONS: Long-term involvement in a physically active lifestyle seems to confer further cardio-protection by reducing the inflammatory response and preserving left ventricular systolic function in elderly female, but not male patients with an ACS.

Mediterranean diet mediates the adverse effect of depressive symptomatology on short-term outcome in elderly survivors from an acute coronary event.

Aims. We evaluated the interaction effect between depressive symptoms and dietary habits on 30-day development of cardiovascular disease (CVD) (death or rehospitalization) in elderly, acute coronary syndrome (ACS) survivors. Methods. During 2006-2008, we recorded 277 nonfatal, consecutive ACS admissions (75 ± 6 years, 70% males, 70% had diagnosis of myocardial infarction) with complete 30-day follow-up. Assessment of recent depressive symptoms was based on the CES-D scale. Among sociodemographic, bioclinical, lifestyle characteristics, the MedDietScore that assesses the inherent characteristics of the Mediterranean diet was applied. Results. 22% of the ACS pts developed a CVD event during the first 30 days (14.8% rehospitalization and 9.4% death). Patients in the upper tertile of the CES-D scale (i.e., >18) had higher incidence of CVD events as compared with those in the lowest tertile (21% versus 8%, P = .01). Multiple logistic regression analysis revealed that 1-unit increase in CES-D was associated with 4% higher odds (95% CI 1.008-1.076, P = .01) of CVD events; however, when MedDietScore was entered in the model, CES-D lost its significance (P = .20). Conclusion. Short-term depressive symptoms are related to a worsen 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence.

Brain natriuretic peptide mediates the effect of creatinine clearance on development of left ventricular systolic dysfunction in patients with acute coronary syndrome.

INTRODUCTION: There are only limited data about the role of renal function in the development of left ventricular systolic dysfunction in patients with an acute coronary syndrome (ACS). We sought to investigate whether renal insufficiency is an independent predictor for systolic dysfunction among patients who had an ACS. METHODS: During 2006-2007, 814 consecutive patients who presented with an ACS event were enrolled prospectively; of these, 284 men (65 ± 14 years) and 71 women (71 ± 12 years) developed left ventricular systolic dysfunction (ejection fraction <40%), 306 men (64 ± 12 years) and 78 women (67 ± 10 years) had preserved left ventricular systolic function (ejection fraction >50%), while the rest of the patients (n=75), with ejection fraction between 40-50%, were excluded from this analysis. Creatinine clearance rates were estimated by the Cockcroft-Gault formula. RESULTS: Eight percent of patients presented with severe and 30% with moderate renal dysfunction. Multiple logistic regression analysis revealed that a 10-unit increase of creatinine clearance levels decreases the odds of developing left ventricular systolic dysfunction by 8% (95%CI per 1 unit: 0.986-0.998), after controlling for potential confounders. Moreover, brain natriuretic peptide levels were inversely correlated with creatinine clearance (r=-0.378, p<0.001). When brain natriuretic peptide was entered into the model, creatinine clearance was not associated with left ventricular systolic dysfunction (OR=0.997, 95%CI 0.989-1.005). CONCLUSIONS: The role of renal insufficiency in the development of left ventricular systolic dysfunction seems to be partially explained by plasma brain natriuretic peptide levels, suggesting a potential pathophysiological mechanism. Thus, patients with impaired creatinine levels and elevated brain natriuretic peptide levels should receive more aggressive medical care, as they are prone to developing left ventricular systolic dysfunction.

Serum glucose level at hospital admission correlates with left ventricular systolic dysfunction in nondiabetic, acute coronary patients: the Hellenic Heart Failure Study.

The purpose of this work was to evaluate the relation between serum glucose levels at hospital admission and left ventricular systolic function in nondiabetic patients with an acute coronary syndrome (ACS). Of the 1000 ACS patients who were consecutively enrolled during 2007-2008, 583 (63 +/- 13 years, 20% females) nondiabetic patients were studied in this work. Of these, 254 presented left ventricular systolic dysfunction (ejection fraction <40%). Biochemical measurements and detailed medical information were recorded in all participants. Patients having glucose levels at hospital admission in the highest tertile (>155 mg/dl) had lower left ventricular ejection fraction (40% vs 45%, P = 0.003), were older (66 +/- 11 vs 61 +/- 13, P = 0.004) and less physically active (49% vs 63%, P = 0.02), had higher troponin (14.7 +/- 39.7 vs 5.6 +/- 13.5, P = 0.03), higher brain natriuretic peptide (510.39 +/- 932.33 vs 213.4 +/- 301.14, P = 0.008), higher C-RP (42.26 +/- 55.26 vs 26.46 +/- 38.18, P = 0.04), lower creatinine clearance levels (68 +/- 33 vs.81 +/- 31, P = 0.009), higher white blood cell count (13 416 +/- 16 420 vs 9310 +/- 3020, P = 0.001), and lower body mass index (26.8 +/- 4 vs 27.2 +/- 4.4, P = 0.07), compared to those in the lowest tertile (<114 mg/dl). The multiadjusted logistic regression analysis revealed that a 10 mg/dl difference in glucose levels was independently associated with 8% (95% confidence interval 2%-14%) higher likelihood of left ventricular systolic dysfunction. Low glucose concentrations at hospital admission in nondiabetic post-ACS patients is a predictor for the appearance of left ventricular dysfunction, and could be a target marker for risk stratification.

The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event.

BACKGROUND: The effect of the cardioprotective Mediterranean diet on the development of cardiac abnormalities and prognosis of cardiac patients has rarely been investigated. OBJECTIVE: We sought to evaluate the relation between the Mediterranean diet, the development of left ventricular systolic dysfunction (LVSD) at hospitalization, and the 2-y prognosis of patients who have had an acute coronary syndrome (ACS). DESIGN: During 2006-2009, 1000 consecutive patients with ACS were enrolled; of these patients, 459 had LVSD (ejection fraction <40%) at hospitalization [367 men with a mean (+/-SD) age of 64 +/- 14 y, and 92 women aged 71 +/- 12 y], whereas 541 had preserved left ventricular systolic function (421 men aged 62 +/- 12 y, and 120 women aged 67 +/- 12 y). Adherence to the Mediterranean diet was assessed by the validated Mediterranean Diet Score (MedDietScore; theoretical range: 0-55). RESULTS: The MedDietScore was associated with less likelihood of developing LVSD at hospitalization [odds ratio (OR) per 1/55 unit: 0.93; 95% CI: 0.88, 0.99; P = 0.04], less likelihood of remodeling (ie, ejection fraction <50% at 3 mo follow-up; OR: 0.90; 95% CI: 0.78, 1.03: P = 0.06), and less likelihood of recurrent cardiovascular disease events during the 2 y of follow-up (OR: 0.88; 95% CI: 0.80, 0.98; P = 0.04), after adjustment for various confounders. CONCLUSIONS: Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an ACS.

Exclusive olive oil consumption is associated with lower likelihood of developing left ventricular systolic dysfunction in acute coronary syndrome patients: the hellenic heart failure study.

BACKGROUND/AIMS: The aim of the present work was to evaluate the association between exclusive olive oil consumption and the development of left ventricular systolic dysfunction (LVSD) in patients with a previous acute coronary syndrome (ACS). METHODS: From 2006 to 2007, 651 consecutive ACS patients were enrolled. In 288 males (64 +/- 13 years) and 75 females (71 +/- 11 years), LVSD (ejection fraction <40%) developed after the cardiac event, and 221 males (62 +/- 11 years) and 69 females (66 +/- 11 years) were without LVSD (ejection fraction >50%). Detailed information regarding their clinical characteristics, anthropometric data, physical activity, smoking and dietary habits (including lipids use) were recorded. RESULTS: 70% of the LVSD patients and 76% of the non-LVSD patients reported exclusive olive oil consumption. Multi-adjusted analysis revealed that exclusive olive oil consumption in post-ACS patients with a first cardiac episode was associated with a 65% (95% confidence interval 0.14-0.87) lower likelihood of developing LVSD after adjusting for various confounders. No significant association was observed among participants with a previous history of ACS. CONCLUSIONS: Exclusive, long-term olive oil consumption seems to offer significant protection against the development of LVSD in post-ACS patients.

Comparative value of simple inflammatory markers in the prediction of left ventricular systolic dysfunction in postacute coronary syndrome patients.

OBJECTIVES: We sought to assess the comparative value of inflammatory markers on the occurrence of left ventricular systolic dysfunction (LVSD) after an acute coronary syndrome (ACS). METHODS: During 2006-2008, 760 patients with an ACS were enrolled. C-reactive protein (CRP) and white blood cell (WBC) count were measured during the first 12 hours of hospital admission. RESULTS: CRP levels and WBC count were significantly higher in those who developed LVSD compared to those who did not. The analysis revealed that a 10 mg/dL increase of CRP levels and a 1000/microL increase in WBC are associated with a 6% and a 7% increase in the likelihood of developing LVSD, respectively. Furthermore, WBC count at entry and CRP have almost the same predictive value for development of LVSD after an ACS (R(2) = 0.109 versus R(2) = 0.093). CONCLUSIONS: Serum CRP levels and WBC count at entry are almost equally powerful independent predictors of LVSD, after an ACS.

Moderate coffee consumption lowers the likelihood of developing left ventricular systolic dysfunction in post-acute coronary syndrome normotensive patients.

The aim of the present work was to evaluate the association between coffee consumption and the development of left ventricular systolic dysfunction (LVSD) in patients who had had an acute coronary syndrome. During 2006-2007, 144 male (65 +/- 14 years) and 50 female (71 +/- 12 years) post-acute coronary syndrome patients who developed LVSD (ejection fraction <40%) after the cardiac event and 129 male (64 +/- 12 years) and 51 female (67 +/- 10 years) post-acute coronary syndrome patients without LVSD (ejection fraction >50%) were included in the study. Participants were consequently selected. Detailed information regarding their medical records, sociodemographic and anthropometric data, and various psychological and lifestyle characteristics (physical activity, smoking habits, etc.) were recorded. In particular, nutritional habits, including coffee consumption, were evaluated using a semiquantitative food-frequency questionnaire. Multi-adjusted analysis revealed that in normotensive patients coffee consumption of 1-2 cups/day was associated with 88% (95% confidence interval, 0.02-0.84) lower likelihood of developing LVSD and consumption of >3 cups/day with 90% (95% confidence interval, 0.01-0.88) lower likelihood for LVSD, compared with no history of consumption of coffee and after adjusting for various confounders. In contrast, in hypertensive patients coffee consumption of >3 cups/day was associated with 4.5-fold higher likelihood for developing LVSD (95% confidence interval, 0.89-22.58) as compared with no history of coffee consumption. Coffee consumption has opposite effects on the likelihood of developing LVSD in post-acute coronary syndrome patients depending on their blood pressure levels.

Long-term fish consumption is associated with lower risk of 30-day cardiovascular disease events in survivors from an acute coronary syndrome.

This study aimed to assess the relationship between long-term fish consumption and short-term prognosis of patients who had an acute coronary syndrome. The multi-adjusted data analysis from a total of 214 men and 79 women patients showed that intake of fish, n-3 and n-6 fatty acids above 7 portions, 8.8 g and 13.2 g per week correspondingly, is associated with 83%, 83% and 79% reduction on the likelihood of recurrent events in a 30-day period after hospitalisation hospitalization (OR=0.17, 95%CI 0.04-0.80, OR=0.17, 95%CI 0.04-0.81, OR=0.21, 95%CI 0.05-0.97). Conclusively, an inverse relationship between long-term fish and fish oils consumption and short-term prognosis of patients who had had an ACS was observed, irrespective of various potential confounders.