Brain Natriuretic Peptide mediates the prognostic role of renal function toward 10-year cardiovascular mortality in patients with Acute Coronary Syndrome: the HHF study (2006-2016).

BACKGROUND/INTRODUCTION: Risk stratification in chronic heart failure (HF) remains a challenge. Renal function and B-natriuretic peptide (BNP) might confer predictive value towards long-term mortality in HF patients after an acute coronary syndrome (ACS). METHODS: From May 2006 to March 2009, 1,000 consecutive patients who were hospitalized with ACS diagnosis were enrolled in the study. In 2016, the 10-year follow-up (2006 -2016) was performed in 745 participants. GFR was evaluated through the MDRD formula. HF phenotype was defined according to baseline ejection fraction (EF); HF with reduced EF (i.e. <40%) (HFrEF), preserved EF (i.e. ≥50%) (HFpEF) and mid-range EF (i.e. 40 -49%) (HFmrEF). RESULTS: 10-year mortality was 21%. Deceased patients presented significantly lower GFR and higher BNP values at the baseline, compared with their alive counterparts (p <0.001 for both). By multivariable logistic regression analysis, GFR independently predicted all-cause mortality (OR = 0.98, p = 0.04). After adjusting for baseline BNP, GFR lost its predictive role while BNP was independently associated with 10-year mortality (OR = 1.39 for a 2-fold increase, p = 0.001). A significant interaction was observed between EF and BNP levels on the tested outcome (p for interaction < 0.001). In stratified analysis, BNP predicted all cause death only in HFmrEF (OR=1.43, p = 0.04) and in HFpEF (OR=1.80, p = 0.01). CONCLUSION: BNP mediates the predictive role of GFR towards long-term mortality in ACS-induced HF patients with retained systolic performance of the left ventricle (HFmrEF and HFpEF).

The "overweight paradox" in the prognosis of acute coronary syndrome for patients with heart failure-A truth for all? A 10-year follow-up study.

OBJECTIVES: In established acute coronary syndrome (ACS) with major complications (i.e. heart failure), overweight/obese patients usually have a survival advantage. To what extent this is irrespective of other characteristics remains inconclusive. The role of body mass index (BMI) in ACS prognosis (fatal/recurrent non-fatal cardiac episodes) and background potential interactions were evaluated. STUDY DESIGN: In 2006-2009, 1000 consecutive patients, hospitalized at First Cardiology Clinic of Athens with a diagnosis of ACS were enrolled in the study. All patients were classified according to heart failure phenotypes. One-month, 1-, 2- and 10-year follow-up examinations were performed (75% participation rate). MAIN OUTCOME MEASURES: Overweight was defined as 25≤BMI≤29.9kg/m2 and obesity as BMI >29.9kg/m2. RESULTS: BMI status and 10-year ACS prognosis followed a J-shape association (p=0.009). Overweight patients had significantly better ACS prognosis than their normal-weight counterparts (OR=0.45, 95% CI (0.23, 0.90)). Significant interactions were observed between sociodemographic, clinical and lifestyle parameters and BMI on 10-year ACS prognosis (all ps for interaction≤10%); the aforementioned paradoxical association was retained only in patients who: were female (OR=0.37, 95% CI (0.16, 0.82)); were aged ≤65 years (OR=0.25, 95% CI (0.09, 0.69)), HFrEF (OR=0.35, 95% CI (0.13, 0.89)); were hypercholesterolemic (OR=0.23, 95% CI (0.07, 0.81)); had no hypertension (OR=0.31, 95% CI (0.12, 0.82)) or diabetes mellitus (OR=0.29, 95% CI (0.09, 0.95)); had moderate/high adherence to a Mediterranean diet (OR=0.43, 95% CI (0.22, 0.86)); and were physically active (OR=0.37, 95% CI (0.15, 0.88)). CONCLUSIONS: Although the overweight paradox was observed in the 10-year ACS prognosis of heart failure patients, this paradoxical association was not the case for all.