Carbohydrate antigen 125 combined with N-terminal pro-B-type natriuretic peptide in the prediction of acute heart failure following ST-elevation myocardial infarction.

The value of serum carbohydrate antigen 125 (CA125) combined with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the evaluation of acute heart failure (AHF) after ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the efficacy of CA125 combined with NT-proBNP in predicting AHF following STEMI. A total of 233 patients with STEMI were evaluated, including 39 patients with Killip II-IV and 194 patients with Killip I. The optimal cutoff point for predicting AHF was determined by receiver operating characteristic (ROC) curve, and the independent predictors of AHF were evaluated by multiple logistic regression. According to the cutoff value, it was divided into three groups: C1 = CA125 < 13.20 and NT-proBNP < 2300 (n = 138); C2 = CA125 ≥ 13.20 or NT-proBNP ≥ 2300 (n = 59); C3 = CA125 ≥ 13.20 and NT-proBNP ≥ 2300 (n = 36). Differences between groups were compared by odds ratio (OR). The levels of CA125 and NT-proBNP in AHF group were higher than those in non-AHF group (19.90 vs 10.00, P < .001; 2980.00 vs 1029.50, P < .001, respectively). The optimal cutoff values of CA125 and NT-proBNP for predicting AHF were 13.20 and 2300, both of which were independent predictors of AHF. The incidence of AHF during hospitalization was highest in C3 (69.44%), middle in C2 (20.34%) and lowest in C1 (1.45%). After adjustment for clinical confounding variables, compared with C1: C2 (OR = 6.41, 95% CI: 1.22-33.84, P = .029), C3 (OR = 19.27, 95% CI: 3.12-118.92, P = .001). Elevated CA125 and NT-proBNP are independent predictors of AHF in STEMI patients, and their combination can improve the recognition efficiency.

How is Ambulatory Electrocardiogram Predictive of Stroke in Atrial Fibrillation Patients?

Background: Atrial fibrillation (AF) is a significant stroke risk factor. Further research is needed to clarify whether higher atrial fibrillation burden (AFB) link to the elevated risk of ischemic embolism, and how AF burden could combine with CHA2DS2-VASc score to improve the anticoagulation strategy. We aim to evaluate if the AF burden characterized using 24-hours Holter ECG monitoring is associated with the risk of ischemic stroke. Methods: This cohort study enrolled 210 Holter ECG monitoring detected atrial fibrillation patients. The burden of atrial fibrillation was defined as the percentage of time in atrial fibrillation during the monitoring period, and the AF burden and CHA2DS2-VASc score were compared between patients with and without thromboembolic outcomes. Multivariate regressions were conducted to estimate the predictors of thromboembolic outcomes. Results: Eighteen thromboembolic events occurred within a median follow-up of 11.39 months. Patients with ischemic stroke had higher CHA2DS2-VASc scores but not higher AF burden. After adjusting for age, hypertension, diabetes, anticoagulation, antithrombotic therapy, AF burden, and AF with higher CHA2DS2-VASc score was associated with increased risk for ischemic stroke (hazard ratio (HR), 15.17). CHA2DS2-VASc score > 4.5 was a predictor of significantly higher risk of future stroke (AUC 0.92). Conclusions: In Holter ECG monitoring detected AF, AF burden does not significantly impact the subsequent risk of stroke; whereas, CHA2DS2-VASc scoring is still a robust predictor of stroke risk. This may illustrate that once AF is detected from Holter ECG monitoring, underlying risk factors appear to be more predictive of subsequent stroke risk than atrial fibrillation burden.

Analysis of cognitive dysfunction and its risk factors in patients with hypertension.

ABSTRACT: To observe whether obstructive sleep apnea syndrome (OSAS) can aggravate the cognitive dysfunction of patients with hypertension (HTN), and to explore other risk factors.One hundred one hypertensive patients were selected for information collection. After the polysomnography test, they were divided into HTN-obstructive sleep apnea (OSA) and HTN groups. The Montreal cognitive assessment and the mini-mental state examination scales were used to appraise the patients' cognitive function. Logistic regressive analysis was used to determine the risk factors of cognitive dysfunction in patients with HTN.Compared with the HTN patients, HTN-OSA patients performed worse in mini-mental state examination (25.5 ±â€Š2.9 vs 23.5 ±â€Š3.2; P = .01) and Montreal cognitive assessment (28 ±â€Š1.58 vs 21.2 ±â€Š3.96; P = .003), and patients in the HTN-OSA group seemed more likely to suffer from dementia (31% vs 66%; P < .01). The apnea-hypopnea index (AHI) in the HTN group was lower than HTN-OSA group. Through multivariate logistic regression analysis, we can found that alcohol drinking, body mass index, long-term medication, diabetes, hypercholesterolemia, coronary heart disease, and OSAS were the independent risk factors of cognitive dysfunction in patients with HTN.OSAS can aggravate the cognitive dysfunction of hypertensive patients, besides, drinking, high-body mass index, long-term medication, diabetes, hypercholesterolemia, and coronary heart disease were also the risk factors of cognitive dysfunction in patients with hypertension. The cognitive dysfunction of patients with HTN can benefit from sleep apnea treatment.

Prognostic value of carbohydrate antigen 125 combined with N-terminal pro B-type natriuretic peptide in patients with acute heart failure.

BACKGROUND: The objective was to explore the value of serum carbohydrate antigen 125 (CA125) combined with N-terminal pro B-type natriuretic peptide (NT-proBNP) in predicting the clinical prognosis of patients with acute heart failure (AHF). METHODS: We prospectively observed 213 patients with AHF. CA125 (U/ml) and NT-proBNP (pg/ml) were dichotomised based on ROC curve analysised prognostic cutpoints, and a variable with four groups was formed (CA125 and NT-proBNP): C1 = CA125 < 47.6 and NT-proBNP <3790 (n = 100); C2 = CA125 < 47.6 and NT-proBNP ≥3790 (n = 29); C3 = CA125 ≥ 47.6 and NT-proBNP < 3790 (n = 26); C4 = CA125 ≥ 47.6 and NT-proBNP ≥3790 (n = 58). Kaplan-Meier curve was drawn and multivariate COX regression analysis was performed to analyse the prognostic efficacy of CA125 combined with NT-ProBNP in patients with AHF. RESULTS: The levels of CA125 and NT-proBNP in death group were obviously higher than those in non-death group [56.20 (45.70, 78.00) vs 31.10 (19.48, 47.68), p < 0.001; 5619.00 (2924.00, 10066.00) vs 2203.00 (1460.50, 5070.25), p < 0.001]. The ROC curve showed that the best cut-off values of CA125 and NT-proBNP for predicting the prognosis of AHF were 47.6 and 3790, respectively. Multivariate COX regression analysis showed that CA125 ≥ 47.6 and NT-proBNP ≥ 3790 were independent predictors of 1-year all-cause death in patients with AHF (HR = 3.05, 95%CI: 1.50-6.20, p = 0.002) and (HR = 2.34, 95%CI: 1.19-4.61, p = 0.014). At 12 months, 55 deaths (25.8%) were identified. The cumulative rate of mortality was highest for patients in C4 (56.9%), intermediate for C2 and C3 (24.1% and 34.6%, respectively), and lowest for C1 (6.0%), and p-value for trend <0.05. After adjusting for established clinical risk factors, compared with C1: C2 (HR = 4.58, 95%CI: 1.53-13.77, p = 0.007), C3 (HR = 5.24, 95%CI: 1.85-14.82, p = 0.002), C4 (HR = 7.75, 95%CI: 3.09-19.45, p < 0.001). CONCLUSION: Elevated CA125 is an independent predictor of poor prognosis in patients with AHF, and combined with NT-proBNP can improve the efficiency of risk identification.

Effects of body mass index and gender on left atrial size in Chinese hypertensive patients.

BACKGROUND: Left atrial enlargement (LAE) is a common cardiac structural change in patients with hypertension, and obesity could further promote LAE. However, little is known about the effect of overweight on left atrial size, and if there is a gender difference of the effect. The aim of this study was to analyze the effects of different body mass index (BMI) grades (normal weight, overweight, and obesity) on left atrial size in both male and female patients with hypertension. METHODS: A total of 710 patients with hypertension were divided into 3 study groups: normal weight group (BMI < 24 g/m2, n = 302), overweight group (24 kg/m2 ≤ BMI < 28 kg2, n = 318), and obesity group (BMI ≥28 kg/m2, n = 90). The clinical data, echocardiographic indexes and left atrial size were obtained from all the subjects. Pearson correlation analysis was used to analyze the correlation between clinical variables and left atrial diameter (LAD)/left atrial diameter index (LADI), and stepwise regression evaluation was used to study the relevant factors affecting LAD/LADI among all patients, male and female patients for possible gender difference. RESULTS: The significant difference in LADI was noted in the three study groups with obesity group of 23.96 ± 2.90 mm/m, overweight group of 22.50 ± 3.02 mm/m and normal weight group of 21.08 ± 2.80 mm/m, respectively (P < . 05). After adjusting for age and gender, there was still significant difference in LADI among the three groups (P < . 05). The correlation between BMI and LADI was higher than that between systolic blood pressure (SBP) and diastolic blood pressure (DBP) (r = 0.348 vs 0.092 and -0.068, respectively, P < .05). After adjusting for other influencing factors, there was still a significant correlation between BMI and LADI (ß = 0.326, P < .001), but no correlation was found between SBP and DBP (P > .05). For each additional unit of BMI, LAD increased by 0.034 mm and LADI increased by 0.305 mm/m. Multiple linear regression analysis showed that BMI, left ventricular mass index (LVMI), age and female gender were independently correlated with LADI (P < .05). And BMI was the most significant influencing factor of LADI in male patients (ß = 0.350, P < .001), followed by LVMI (ß = 0.343, P < .001). While in female patients, LVMI was the most significant (ß = 0.353, P < .001), followed by BMI (ß = 0.302, P < .001). CONCLUSION: Overweight and obesity were significantly associated with LAE in hypertensive patients, with obesity more significant than overweight. While BMI had the greatest correlation with LAE in male, LVMI was the most important determinant of LAE in female. Therefore, in addition to weight loss, more attention should be paid to early inhibition of left ventricular remodeling in female with hypertension.