Atrial fibrillation (AF) is the most common arrhythmia requiring medical treatment and has been associated with enhanced atrial fibrosis and heart failure (HF). Relaxin (RLX), an antifibrosis and antiinflammatory peptide hormone, may be used to evaluate atrial fibrosis and is associated with HF occurrence in AF. We aimed to clarify the clinical significance of RLX level in patients with AF.We measured circulating levels of RLX and other fibrosis-related factors in 311 patients with sinus rhythm (SR; n = 116) or AF (n = 195). All discharged AF patients were followed up for the occurrence of HF for a mean of 6 months.Circulating levels of RLX were significantly different in patients with AF as compared with SR (P < .001), and in the subgroup analysis of AF. RLX level was correlated with left atrial diameter (LAD; R = .358, P < .001). Among followed up AF patients, on Kaplan–Meier curve analysis, patients with the third RLX tertile (T3) had a significantly higher HF rate than those with the 1st tertile (T1) (P = 0.002) and the cut-off value was 294.8 ng/L (area under the ROC curve [AUC] = .723). On multivariable analysis, HF occurrence with AF was associated with increased tertile of serum RLX level (odds ratio [OR] 2.659; confidence interval [95% CI] 1.434–4.930; P = .002).RLX is associated with fibrosis-related biomarkers and significantly elevated in AF. RLX was related to the HF occurrence in patients with AF.
Background
Accurate prediction of major adverse cardiovascular events (MACE) is very important for the management of acute coronary syndrome (ACS) patients. We aim to develop and validate effective prognostic nomogram for individualized risk estimate of MACE in patients with ACS after percutaneous coronary intervention (PCI).
Methods
We conducted a prospective assessment of patients with ACS after PCI from January 2013 to July 2019 (n = 1986). Based on the training set, single-factor and multi-factor Cox proportional hazard analysis method was used to determine the results of single-factor and multi-factor Cox proportional hazard analysis. The receiver operating characteristic (ROC) and calibration curve were used to evaluate the prediction accuracy and discriminability, we have compared nomogram with the classical cardiovascular risk scores. In the validation set, X-tile analysis and Kaplan-Meier curve were used to evaluate the value of clinical application.
Results
Independent prognostic factors included lactate, age, left anterior descending branch (LAD) stenosis ≥ 50%, right coronary artery (RCA) stenosis ≥ 50%, brain natriuretic peptide (BNP), and left ventricular ejection fraction (LVEF). The area under the ROC curve (AUC) of the training group were about 0.712 to 0.762. In the validation set, the nomogram still shows good differentiation (AUC were about 0.724 to 0.818). On the calibration plot, the predicted values of the statistical chart agree well with the actual observed values. In addition, participants can be divided into two different risk groups (low and high) according to the nomogram.
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