Temporal Trends in the Clinical and Pathological Characteristics of Victims of Sudden Cardiac Death in the Absence of Previously Identified Heart Disease

Junttila, M. Juhani; Hookana, Eeva; Kaikkonen, Kari; Kortelainen, Marja-Leena; Myerburg, Robert J.; Huikuri, Heikki V.

doi:10.1161/circep.115.003723

Cited by 48 publications

(32 citation statements)

References 28 publications

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“…ST2 acts as a decoy receptor for IL-33, thus blocking its protective effects. It has been reported that mice treated with soluble ST2 developed signi cantly larger atherosclerotic plaques in the aortic sinus of the ApoE(-/-) mice compared with the control mice [23].These results suggested that ST2 may be proposed as a marker of plaque burden and predictors of future cardiovascular event [24].Although the above data suggest that ST2 has a role in the prognosis of patients presenting with an acute coronary syndrome, whether ST2 contributes to cardiovascular risk prediction in a large scale CAD patients during a long-term follow up remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

M¹,

H²,

Duan³

et al. 2020

Preprint

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PurposeST2 has been proved the prognostic value in acute coronary syndrome (ACS), its prognostic value to predict cardiac events in established coronary artery disease (CAD) patients is unknown. The study ought to investigate the prognostic value of ST2 in patients with established coronary artery disease.MethodsA total of 3650 consecutive patients were included in the study. The primary end point was major adverse cardiovascular events (MACEs). The secondary end point was all-cause death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.ResultsDuring a median follow up of 6.4 years, there were 775 patients had the occurrence of MACEs and 275 patients died. Kaplan–Meier survival estimates indicated that the patients with higher level of ST2 (ST2 > 19 ng/ml) had a significantly increased risk of MACEs (log-rank p<0.001)and all-cause death(log-rank p<0.001). After adjustment for potential confounders, multiple COX regression models showed that higher level of ST2 was an independent predictor in developing MACEs(HR 1.31; 95% CI: 1.13–1.52; p<0.001) and all-cause death(HR 1.78; 95% CI: 1.38–2.30; p<0.001). We saw a significant increase of AUC in ROC curve after addition of GDF-15 to a clinical model 0.586 vs 0.619 For MACEs (p<0.001).For long-term all-cause death the increase of AUC 0.766 vs 0.642 (95% CI 0.787–0.846(p<0.001).ConclusionHigher level of ST2 is significantly associated with long-term all-cause death, MACEs and provides incremental prognostic value beyond traditional risks factors.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

M¹,

H²,

Duan³

et al. 2020

Preprint

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“…However, the rate of SCD in the nonischemic cardiomyopathy population remains unacceptably high. Up to 35% of deaths in these patients are sudden, with an annual SCD incidence of 2% to 3%, often occurring in previously asymptomatic patients 21,22 . Because patients with NICM are typically younger and have less comorbid illness compared with patients with ischemic cardiomyopathy, they may be expected to derive substantial benefit from ICD therapy via avoidance of SCD 1 .…”

Section: Discussionmentioning

confidence: 99%

Positron emission tomography absolute stress myocardial blood flow for risk stratification in nonischemic cardiomyopathy

Middour

Rosenthal

Abi‐Samra

et al. 2020

Cardiovasc electrophysiol

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Introduction: Sudden cardiac death is a substantial cause of mortality in patients with cardiomyopathy, but evidence supporting implantable cardioverter-defibrillator (ICD) implantation is less robust in nonischemic cardiomyopathy (NICM) than in ischemic cardiomyopathy. Improved risk stratification is needed. We assessed whether absolute quantification of stress myocardial blood flow (sMBF) measured by positron emission tomography (PET) predicts ventricular arrhythmias (VA) and/or death in patients with NICM.Methods: In this pilot study, we prospectively followed patients with NICM (left ventricular ejection fraction ≤ 35%) and an ICD who underwent cardiac PET stress imaging with sMBF quantification. NICM was defined as the absence of angiographic obstructive coronary stenosis, significant relative perfusion defects on imaging, coronary revascularization, or acute coronary syndrome. Endpoints were appropriate device therapy for VA and all-cause mortality. Subgroup analysis was performed in patients who had no prior history of VA (ie, the primary prevention population). Results:We followed 37 patients (60 ± 14 years, 46% male) for 41 ± 23 months. The median sMBF was 1.56 mL/g/min (interquartile range: 1.00-1.82). Lower sMBF predicted VA, both in the whole population (hazard ratio [HR] for each 0.1 mL/g/min increase: 0.84, P = .015) and in the primary prevention subset (n = 27; HR for each 0.1 mL/g/min increase: 0.81, P = .049). Patients with sMBF below the median had significantly more VA than those above the median, both in the whole population (P = .004) and in the primary prevention subset (P = .046). Estimated 3-year VA rates in the whole population were 67% among low-flow patients vs 13% among high-flow patients, and 39% vs 8%, respectively, among primary-prevention patients. sMBF did not predict all-cause mortality.Abbreviations: ACEi/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker; BMI, body mass index; BNP, brain natriuretic peptide; BP, blood pressure; BUN, blood urea

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Section: The Underlying Mechanismsmentioning

confidence: 99%

Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

Duan

Cai

et al. 2020

Preprint

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Background: Suppression of tumorigenesis-2 is implicated in the myocardial overload and it was long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but the data on prognostic value of suppression of tumorigenesis-2 on patients with coronary artery disease remains limited. The study ought to investigate the prognostic value of suppression of tumorigenesis-2 in patients with established coronary artery disease.Methods: In this prospective cohort study, a total of 3641 consecutive patients were included. The primary end point was major adverse cardiovascular events. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). The secondary end point was all-cause death. The association between suppression of tumorigenesis-2 and outcomes was investigated using multivariable COX regression.Results: During a median follow up of 6.4 years, there were 775 patients had the occurrence of major adverse cardiovascular events and 275 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). Multiple COX regression models showed that higher level of suppression of tumorigenesis-2 was an independent predictor in developing major adverse cardiovascular events (HR=1.36, 95% CI 1.17-1.56, p＜0.001) and all-cause death (HR=2.01, 95%CI 1.56-2.59, p＜0.001). The addition of suppression of tumorigenesis-2 to established risk factors significantly improved risk prediction of the composite outcome of major adverse cardiovascular events and all-cause death (c-statistic, net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusions: Higher level of suppression of tumorigenesis-2 is significantly associated with long-term all-cause death and major adverse cardiovascular events. Suppression of tumorigenesis-2 may provide incremental prognostic value beyond traditional risk factors.

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Temporal Trends in the Clinical and Pathological Characteristics of Victims of Sudden Cardiac Death in the Absence of Previously Identified Heart Disease

Abstract: Because the primary prevention strategies, public awareness of early symptoms of CAD, and secondary prophylaxis has changed during the past 2 decades, we studied the temporal trends in the pathogenesis of unexpected SCD during

Cited by 48 publications

References 28 publications

Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

Positron emission tomography absolute stress myocardial blood flow for risk stratification in nonischemic cardiomyopathy

Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

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