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Comparison of MESA and PEACE Risk Score with NTproBNP Correlation: Insights from the MESA Study
S94 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 251
252
Comparison of MESA and PEACE Risk Score with NTproBNP Correlation: Insights from the MESA Study Abhinav Sood, Wilson W.H. Tang; Cleveland Clinic, Cleveland, OH
Takotsubo Cardiomyopathy Preferentially Impacts Patients by Primary Malignancy Type: Multi-Center Nationally Representative Analysis of over 6 Million Hospitalizations Phi Tran1, Dominique Monlezun2, Sovik De Sirkar2, Gloria Iliescu1, Peter Kim1, Juan Lopez-Mattei1, Nicolas Palaskas1, Jean-Bernard Durand1, Cezar Iliescu1; 1The University of Texas MD Anderson Cancer Center, Houston, TX; 2The University of Texas Health Science Center at Houston, Houston, TX
Introduction: PEACE and MESA heart failure (HF) risk scores are validated scores for predicting incident HF in an ambulatory population. We compare risk groups defined by both scores and their correlation with NTproBNP levels among participants of the MESA study. Hypothesis: Outcomes among similar risk groups of different scores is expected. MESA groups are expected to correlate better with NTproBNP. Methods: PEACE and MESA risk scores were calculated using published integer scoring systems. KM curves were constructed and compared using logrank test. NTproBNP levels among different groups were compared using KruskalWallis test. P<0.01 was considered significant. Results: Records of 5,700 patients [age 6210 years, 48% men, NTproBNP 55(24-102) pg/mL, LVEF (69+/-7%)] from MESA visit 1 were analyzed. Majority patients were low risk (PEACE 82%, MESA 84%). Outcomes in corresponding groups among both scores showed concordance despite differing median NTproBNP levels (p<0.01,figures) Conclusion: Outcome in terms of incident were comparable among corresponding risk groups irrespective of type of risk score used except for the very high MESA group.
Introduction: Cancer is a known adverse predictor of cardiovascular outcomes, yet little is known about its role in Takotsubo Cardiomyopathy (TTC). This study sought to provide the first multi-center nationally representative study of TTC according to primary malignancy. Methods: Pearson chi square bivariable analysis was conducted for malignancy overall and primary malignancy type in a case-control study using the 2016 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset. Results: Among the 6,039,969 inpatient admissions meeting study criteria, the mean age was 57.51 (20.33), 931,146 (15.43%) had malignancy, and 7,803 (0.13%) had diagnosed TTC. Those with TTC compared to those without it had significantly (all p<0.001) higher mean age (67.46 versus 57.49) and more likely to be female (80.20% versus 50.44%), Caucasian (84.24% versus 76.39%), and have Medicare (73.38% versus 65.28%), admission diagnosis of STEMI (4.24% versus 0.49%) and NSTEMI/UA (23.01% versus 2.39%), and PCI (39.04% versus 2.70%). The most common malignancies with TTC included breast (4.58%), GI (3.14%), lung (2.67%), non-solid (2.52%), and GU (2.31%). Conclusions: This study is the first known nationally representative analysis demonstrating that TTC can preferentially impact patients according to their primary malignancy type, underscoring a specific pathophysiological mechanism between tumor and cardiomyopathy biology. These findings suggest heart failure treatment of patients may be improved as cardiologists and oncologists better risk stratify patients according to their specific malignancy history presenting to the hospital with heart failure symptoms concerning for TTC.
253 Differential Prevalence and Predictors of Preclinical Diastolic Dysfunction in a Hispanic Population with Type 2 Diabetes Mellitus Based on 2009 versus 2016 ASE Diastolic Function Guidelines Siu-Hin Wan1, Andrew S. Pumerantz2, Fanglong Dong3, Cesar Ochoa2, Horng H. Chen1; 1Mayo Clinic, Rochester, MN; 2Western Diabetes Institute, Pomona, CA; 3 Western University of Health Sciences, Pomona, CA Introduction: The prevalence and predictors of undetected pre-clinical diastolic dysfunction (PDD), Stage B heart failure, in the Hispanic population with type 2 diabetes (T2D) is not well defined. In 2016, the American Society of Echocardiography (ASE) recommended a revised diastolic dysfunction categorization guideline. Objectives: To identify prevalence and predictors of PDD in Hispanic adults with T2D, and compare differences in clinical and echocardiographic characteristics utilizing 2009 versus 2016 ASE diastolic function guidelines. Methods: A cross-sectional study of Hispanic adults with T2D from 2013 to 2016 was performed. Subjects without signs or symptoms of heart failure (HF) underwent 2D/Doppler echocardiography and grouped into two sub-cohorts: 1) normal diastolic function, and 2) PDD, defined by 2009 or 2016 ASE criteria. Univariable and multivariable logistic analysis were performed to identify characteristics associated with PDD. Results: Among 307 subjects, by 2009 criteria, 63% and 37% had normal diastolic function and PDD, respectively. By 2016 criteria, 85%, 7%, and 8% had normal diastolic function, PDD, and indeterminate diastolic function, respectively. Those with PDD were older (mean age 59.1§12.7 vs 52.2§12.2 years, p<0.01), with higher proportion female (69.0 vs 53.9%, p<0.01), and higher systolic blood pressure (136.5§18.6 vs 131.7§19.9, p=0.04). Among those with normal diastolic function by 2016 criteria, 29% had DD by 2009 criteria, and they were more likely to have higher E/e’ and left atrial volume
Table. Comparison of Clinical and Echocardiographic Characteristics Between Patients with PDD Based on 2009 and 2016 Criteria
Mean Age (years) Female History of Hypertension Systolic Blood Pressure (mmHg) Serum Creatinine (mg/dL) E/e’ Medial E/A LA Volume Index (mL/m2)
No DD by 2016 criteria but DD by 2009 criteria (n=76)
No DD by 2009 and 2016 criteria (n=184)
P-value
57.5§12.3 56/76 (73.7%) 57/76 (75.0%) 135.5§18.3 0.8§0.3 16.0§4.9 0.98§0.27 24.4§8.6
52.5§12.1 100/184 (53.4%) 135/184 (73.4%) 131.3§20.0 0.9§0.8 13.6§5.2 1.02§0.28 21.9§8.4
0.03 0.04 0.79 0.12 0.40 <0.01 0.25 0.03
252
Comparison of MESA and PEACE Risk Score with NTproBNP Correlation: Insights from the MESA Study Abhinav Sood, Wilson W.H. Tang; Cleveland Clinic, Cleveland, OH
Takotsubo Cardiomyopathy Preferentially Impacts Patients by Primary Malignancy Type: Multi-Center Nationally Representative Analysis of over 6 Million Hospitalizations Phi Tran1, Dominique Monlezun2, Sovik De Sirkar2, Gloria Iliescu1, Peter Kim1, Juan Lopez-Mattei1, Nicolas Palaskas1, Jean-Bernard Durand1, Cezar Iliescu1; 1The University of Texas MD Anderson Cancer Center, Houston, TX; 2The University of Texas Health Science Center at Houston, Houston, TX
Introduction: PEACE and MESA heart failure (HF) risk scores are validated scores for predicting incident HF in an ambulatory population. We compare risk groups defined by both scores and their correlation with NTproBNP levels among participants of the MESA study. Hypothesis: Outcomes among similar risk groups of different scores is expected. MESA groups are expected to correlate better with NTproBNP. Methods: PEACE and MESA risk scores were calculated using published integer scoring systems. KM curves were constructed and compared using logrank test. NTproBNP levels among different groups were compared using KruskalWallis test. P<0.01 was considered significant. Results: Records of 5,700 patients [age 6210 years, 48% men, NTproBNP 55(24-102) pg/mL, LVEF (69+/-7%)] from MESA visit 1 were analyzed. Majority patients were low risk (PEACE 82%, MESA 84%). Outcomes in corresponding groups among both scores showed concordance despite differing median NTproBNP levels (p<0.01,figures) Conclusion: Outcome in terms of incident were comparable among corresponding risk groups irrespective of type of risk score used except for the very high MESA group.
Introduction: Cancer is a known adverse predictor of cardiovascular outcomes, yet little is known about its role in Takotsubo Cardiomyopathy (TTC). This study sought to provide the first multi-center nationally representative study of TTC according to primary malignancy. Methods: Pearson chi square bivariable analysis was conducted for malignancy overall and primary malignancy type in a case-control study using the 2016 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset. Results: Among the 6,039,969 inpatient admissions meeting study criteria, the mean age was 57.51 (20.33), 931,146 (15.43%) had malignancy, and 7,803 (0.13%) had diagnosed TTC. Those with TTC compared to those without it had significantly (all p<0.001) higher mean age (67.46 versus 57.49) and more likely to be female (80.20% versus 50.44%), Caucasian (84.24% versus 76.39%), and have Medicare (73.38% versus 65.28%), admission diagnosis of STEMI (4.24% versus 0.49%) and NSTEMI/UA (23.01% versus 2.39%), and PCI (39.04% versus 2.70%). The most common malignancies with TTC included breast (4.58%), GI (3.14%), lung (2.67%), non-solid (2.52%), and GU (2.31%). Conclusions: This study is the first known nationally representative analysis demonstrating that TTC can preferentially impact patients according to their primary malignancy type, underscoring a specific pathophysiological mechanism between tumor and cardiomyopathy biology. These findings suggest heart failure treatment of patients may be improved as cardiologists and oncologists better risk stratify patients according to their specific malignancy history presenting to the hospital with heart failure symptoms concerning for TTC.
253 Differential Prevalence and Predictors of Preclinical Diastolic Dysfunction in a Hispanic Population with Type 2 Diabetes Mellitus Based on 2009 versus 2016 ASE Diastolic Function Guidelines Siu-Hin Wan1, Andrew S. Pumerantz2, Fanglong Dong3, Cesar Ochoa2, Horng H. Chen1; 1Mayo Clinic, Rochester, MN; 2Western Diabetes Institute, Pomona, CA; 3 Western University of Health Sciences, Pomona, CA Introduction: The prevalence and predictors of undetected pre-clinical diastolic dysfunction (PDD), Stage B heart failure, in the Hispanic population with type 2 diabetes (T2D) is not well defined. In 2016, the American Society of Echocardiography (ASE) recommended a revised diastolic dysfunction categorization guideline. Objectives: To identify prevalence and predictors of PDD in Hispanic adults with T2D, and compare differences in clinical and echocardiographic characteristics utilizing 2009 versus 2016 ASE diastolic function guidelines. Methods: A cross-sectional study of Hispanic adults with T2D from 2013 to 2016 was performed. Subjects without signs or symptoms of heart failure (HF) underwent 2D/Doppler echocardiography and grouped into two sub-cohorts: 1) normal diastolic function, and 2) PDD, defined by 2009 or 2016 ASE criteria. Univariable and multivariable logistic analysis were performed to identify characteristics associated with PDD. Results: Among 307 subjects, by 2009 criteria, 63% and 37% had normal diastolic function and PDD, respectively. By 2016 criteria, 85%, 7%, and 8% had normal diastolic function, PDD, and indeterminate diastolic function, respectively. Those with PDD were older (mean age 59.1§12.7 vs 52.2§12.2 years, p<0.01), with higher proportion female (69.0 vs 53.9%, p<0.01), and higher systolic blood pressure (136.5§18.6 vs 131.7§19.9, p=0.04). Among those with normal diastolic function by 2016 criteria, 29% had DD by 2009 criteria, and they were more likely to have higher E/e’ and left atrial volume
Table. Comparison of Clinical and Echocardiographic Characteristics Between Patients with PDD Based on 2009 and 2016 Criteria
Mean Age (years) Female History of Hypertension Systolic Blood Pressure (mmHg) Serum Creatinine (mg/dL) E/e’ Medial E/A LA Volume Index (mL/m2)
No DD by 2016 criteria but DD by 2009 criteria (n=76)
No DD by 2009 and 2016 criteria (n=184)
P-value
57.5§12.3 56/76 (73.7%) 57/76 (75.0%) 135.5§18.3 0.8§0.3 16.0§4.9 0.98§0.27 24.4§8.6
52.5§12.1 100/184 (53.4%) 135/184 (73.4%) 131.3§20.0 0.9§0.8 13.6§5.2 1.02§0.28 21.9§8.4
0.03 0.04 0.79 0.12 0.40 <0.01 0.25 0.03