BACKGROUND Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions.However,the role of serum albumin in mortality among elderly patients with chronic aortic regurgi...BACKGROUND Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions.However,the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation(AR)has not been thoroughly investigated.This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population.METHODS Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study,with baseline serum albumin measured at enrollment.Mortality outcomes were monitored for two years post-enrollment,employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality.RESULTS During the 2-year follow-up period,we observed 63 all-cause deaths.The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve,indicating a mortality threshold at 35 g/L.For serum albumin levels below 35 g/L,each 1 g/L decrease was associated with a 25%higher risk of all-cause mortality(HR=1.25,95%CI:1.07–1.45).In contrast,no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L.Moreover,when serum albumin is classified as hypoproteinemia(serum albumin<35 g/L),the higher risks of all-cause death were observed in hypoproteinemic patients(HR=2.93,95%CI:1.50–5.74).More importantly,the association between serum albumin and death was significantly stronger in overweight/obese patients(≥24 kg/m^(2)vs.<24 kg/m^(2),Pinteraction=0.006).CONCLUSIONS In elderly patients with AR,serum albumin levels showed an approximating L-shaped relationship with all-cause death,with thresholds of 35 g/L.Body mass index was significant effect modifiers of the association.These results suggest that serum albumin,as an inexpensive and readily available biochemical marker,may further improve the stratified risk of mortality in older AR patients.展开更多
Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&...Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0%)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:cardiomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outperforming both EuroSCORE II and ACCI(P<0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95%CI:0.665−0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95%CI):1.263(1.245-1.282),P<0.001)or categorized using thresholds determined by the Yoden index(VHDACI≥9 vs.<9,adjusted HR(95%CI):6.216(5.378-7.184),P<0.001),were independently associated with mortality.The prognostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral regurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology.Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.展开更多
OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study function...OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study functioned as the development cohort,while the China Valvular Heart Disease(China-VHD)Study was employed for external validation.We included patients aged 60 years and above receiving medical treatment for moderate or severe MR(2274 patients in the development cohort and 1929 patients in the validation cohort).Candidate predictors were chosen using Cox’s proportional hazards model and stepwise selection with Akaike’s information criterion.RESULTS Eight predictors were identified:age≥75 years,body mass index<20 kg/m^(2),NYHA class Ⅲ/Ⅳ,secondary MR,anemia,estimated glomerular filtration rate<60 mL/min per 1.73 m^(2),albumin<35 g/L,and left ventricular ejection fraction<60%.The model displayed satisfactory performance in predicting one-year mortality in both the development cohort(C-statistic=0.73,95%CI:0.69-0.77,Brier score=0.06)and the validation cohort(C-statistic=0.73,95%CI:0.68-0.78,Brier score=0.06).The Elder-MR score ranges from 0 to 15 points.At a one-year follow-up,each point increase in the Elder-MR score represents a 1.27-fold risk of death(HR=1.27,95%CI:1.21-1.34,P<0.001)in the development cohort and a 1.24-fold risk of death(HR=1.24,95%CI:1.17-1.30,P<0.001)in the validation cohort.Compared to EuroSCORE II,the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort(C-statistic=0.71 vs.0.70,net reclassification improvement=0.320,P<0.01;integrated discrimination improvement=0.029,P<0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.展开更多
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2017-12M-3-002)the Central High Level Hospital Clinical Research Operating Expenses,China(Zero Balance 2022-GSP-GG-15)the Natural Science Foundation Project of the Inner Mongolia Autonomous Region of China(2022LHQN08003).
文摘BACKGROUND Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions.However,the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation(AR)has not been thoroughly investigated.This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population.METHODS Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study,with baseline serum albumin measured at enrollment.Mortality outcomes were monitored for two years post-enrollment,employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality.RESULTS During the 2-year follow-up period,we observed 63 all-cause deaths.The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve,indicating a mortality threshold at 35 g/L.For serum albumin levels below 35 g/L,each 1 g/L decrease was associated with a 25%higher risk of all-cause mortality(HR=1.25,95%CI:1.07–1.45).In contrast,no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L.Moreover,when serum albumin is classified as hypoproteinemia(serum albumin<35 g/L),the higher risks of all-cause death were observed in hypoproteinemic patients(HR=2.93,95%CI:1.50–5.74).More importantly,the association between serum albumin and death was significantly stronger in overweight/obese patients(≥24 kg/m^(2)vs.<24 kg/m^(2),Pinteraction=0.006).CONCLUSIONS In elderly patients with AR,serum albumin levels showed an approximating L-shaped relationship with all-cause death,with thresholds of 35 g/L.Body mass index was significant effect modifiers of the association.These results suggest that serum albumin,as an inexpensive and readily available biochemical marker,may further improve the stratified risk of mortality in older AR patients.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2017-12M-3-002)the National Key R&D Program of China(No.2020YFC2008100).
文摘Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0%)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:cardiomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outperforming both EuroSCORE II and ACCI(P<0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95%CI:0.665−0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95%CI):1.263(1.245-1.282),P<0.001)or categorized using thresholds determined by the Yoden index(VHDACI≥9 vs.<9,adjusted HR(95%CI):6.216(5.378-7.184),P<0.001),were independently associated with mortality.The prognostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral regurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology.Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.
基金supported by the National Key R&D Program of China(No.2020YFC2008100).
文摘OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study functioned as the development cohort,while the China Valvular Heart Disease(China-VHD)Study was employed for external validation.We included patients aged 60 years and above receiving medical treatment for moderate or severe MR(2274 patients in the development cohort and 1929 patients in the validation cohort).Candidate predictors were chosen using Cox’s proportional hazards model and stepwise selection with Akaike’s information criterion.RESULTS Eight predictors were identified:age≥75 years,body mass index<20 kg/m^(2),NYHA class Ⅲ/Ⅳ,secondary MR,anemia,estimated glomerular filtration rate<60 mL/min per 1.73 m^(2),albumin<35 g/L,and left ventricular ejection fraction<60%.The model displayed satisfactory performance in predicting one-year mortality in both the development cohort(C-statistic=0.73,95%CI:0.69-0.77,Brier score=0.06)and the validation cohort(C-statistic=0.73,95%CI:0.68-0.78,Brier score=0.06).The Elder-MR score ranges from 0 to 15 points.At a one-year follow-up,each point increase in the Elder-MR score represents a 1.27-fold risk of death(HR=1.27,95%CI:1.21-1.34,P<0.001)in the development cohort and a 1.24-fold risk of death(HR=1.24,95%CI:1.17-1.30,P<0.001)in the validation cohort.Compared to EuroSCORE II,the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort(C-statistic=0.71 vs.0.70,net reclassification improvement=0.320,P<0.01;integrated discrimination improvement=0.029,P<0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.
