Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.

Introduction There is a dearth of comprehensive studies on the association between serum electrolyte and adverse short-term prognosis of Chinese patients with acute decompensated heart failure (ADHF). Patients and methods A total of 5166 patients with ADHF were divided into four serum electrolyte-related study populations (potassium ( n = 5145), sodium ( n = 5135), chloride ( n = 4966), serum total calcium (STC) ( n = 4143)) under corresponding exclusions. Different logistic regression models were utilized to gauge the association between these electrolytes or the number of electrolyte abnormalities and the risk of a composite of all-cause mortality or 30-day heart failure (HF) readmission. Results In multivariable adjusted analysis, patients with potassium below 3.5 mmol/L (odds ratios (ORs) 1.45; 95% confidence interval (CI):1.07–1.95), 4.01–4.50 mmol/L (OR: 1.29, CI: 1.02–1.62), 4.51–5.00 mmol/L (OR: 1.43, CI: 1.08–1.90) and above 5.00 mmol/L (OR: 1.74, CI: 1.21–2.51) had an increased risk of outcome when compared with potassium at 3.50–4.00 mmol/L. Sodium levels were inversely related to the risk of a composite outcome (<130 mmol/L: OR: 2.73 (95% CI, 1.81–4.12); 130–134 mmol/L: OR, 1.97 (CI, 1.45–2.68); 135–140 mmol/L: OR, 1.45 (CI, 1.17–1.81); p for trend < 0.001) in comparison with sodium at 141–145 mmol/L. Chloride < 95 mmol/L corresponded to a higher risk of a composite outcome with an OR of 1.65 (95% CI, 1.16–2.37) in contrast to chloride levels at 101–105 mmol/L. In addition, the adjusted ORs (95% CI) for a composite outcome comparing the STC < 2.00 and 2.00–2.24 vs. 2.25–2.58 mmol/L were 0.98 (0.69–1.43) and 1.13 (0.89–1.44), respectively. Besides that, the number of electrolyte abnormalities was positively related to the risk of a composite outcome ( N = 1, OR 1.40, 95% CI: 1.13–1.73; N = 2, OR 2.51, 95% CI: 1.85–3.42; N = 3, OR 2.47, 95% CI: 1.45–4.19; p for trend < 0.001) in comparison with N = 0. Conclusions A deviation of potassium levels from 3.50 to 4.00 mmol/L, lower sodium levels and hypochloremia were associated with poorer short-term prognosis of ADHF. Furthermore, the number of electrolyte abnormalities positively correlated with adverse short-term prognosis of patients with ADHF. Key Messages ADHF patients with baseline serum potassium at first half part of normal range (3.50–4.00 mmol/L) may herald the lowest risk of recent cardiovascular events. Serum sodium and chloride levels exhibit discrepancies in terms of risk of short-term adverse events of ADHF patients. The number of electrolyte abnormalities is a significant predic...

Objectives We hypothesised that primary percutaneous coronary intervention (PCI) and contemporary medical treatment will result in a lower incidence of malignant ventricular arrhythmias (VA) and shorten the time frame of their occurrence. Thus, an electrocardiographic monitoring period of 24 hours should be sufficient to detect more than 95% of all malignant VA. Methods We continuously monitored all patients with ST-segment elevation myocardial infarction (STEMI) for 48 hours. Results Of the 255 patients who underwent PCI for STEMI, 12 (4.7%) developed malignant VA. Sixty percent of malignant VA occurred during the first 24 hours; and 92%, during the first 48 hours. In univariate analysis, heart rate greater than 100 beats per minute, Thrombolysis in Myocardial Infarction flow grade less than 3, elevated creatinine, elevated C-reactive protein, higher white blood cell count, use of diuretics, and lower hematocrit were associated with an increased risk of VA. Symptom-onset-to-balloon time of 4 hours or more in patients with postprocedural Thrombolysis in Myocardial Infarction 3 flow, treatment with β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins were associated with a reduced risk of VA. After multivariate adjustment, independent predictors of sustained VA included total white blood cell count of 12 × 1012/L or more, hematocrit of 39% or less, and lack of β-blocker medication. Conclusions In this study, we could demonstrate that primary PCI results in a lower incidence of VA compared with data from the literature but did not shorten the time frame of VA occurrence. Thus, an electrocardiographic monitoring period for VA of 48 hours should be performed in patients with STEMI.

Objectives The aim of this study was to determine if patients presenting with symptoms of acute coronary syndrome and foud to have mild (25% to 50%) diameter reduction with computed tomographic angiography (CCTA) are likely to benefit from further diagnostic testing. Methods A registry study of 215 subjects with symptoms concerning for possible acute coronary syndrome with low-risk features found to have mild maximal diameter stenosis on CCTA was performed at our hospital. The potential contribution of additional testing was determined by measuring the major adverse cardiac events (MACE) from presentation through 30 days. The MACE included myocardial infarction, coronary revascularisation, unstable angina, and cardiovascular death. Results The MACE occurred in 1 (0.5%) of 215 subjects (95% confidence interval, 0%-2.6%) and was identified by an elevation of serial cardiac markers during the index hospitalisation. No patients experienced cardiovascular death or required revascularisation. Conclusions In patients with emergent low-risk chest pain and 25% to 50% diameter coronary stenosis by CCTA, the rate of near-term MACE is very low. Serial cardiac markers may be beneficial in this subgroup. Routine provocative testing is unlikely to be beneficial during the index visit.

Background: Few prognostic risk scores (PRSs) have been widely applied in acute decompensated heart failure (ADHF). We therefore externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods: A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohort (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was used to select the predictors and create the new PRS. Calibration of the new PRS was assessed by Hosmer-Lemeshow goodness-of-fit test.Results: The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53-0.57), 0.54 (95% CI 0.53-0.56), and 0.56 (95% CI 0.54-0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC 0.67 (95% CI 0.64-0.70) and a good calibration (Hosmer-Lemeshow χ2=3.366, P=0.186). The results in validation cohort verified these findings. Conclusions: The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We firstly found the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF. Our findings might help to recognize high-risk ADHF patients.