Short-Term Prognostic Efficacy of mGPS and LCS in Patients With Acute Heart Failure.

Aim: Systemic inflammation plays an important role in the occurrence and development of acute heart failure. The modified Glasgow Prognostic Score (mGPS) and "lymphocyte C-reactive protein score" (LCS) are used to assess the inflammation levels in cancer patients. The purpose of this study was to assess the prognostic value of these two inflammation-related scoring systems in patients with acute heart failure. Methods: Two hundred and fifty patients with acute heart failure were enrolled in this study. The mGPS and LCS scores were recorded after admission. All patients were divided into 2 groups: the death group and the survival group according to the 3-month follow-up results. The predictive values of mGPS and LCS were assessed using receiver-operating characteristic (ROC) analyses. Univariate and multivariate logistic analyses were used to evaluate the relationships between variables and endpoint. Results: The levels of mGPS and LCS in the death group were significantly higher than those in the survival group (P < 0.05). The areas under the ROC curve of the mGPS and LCS for predicting death were 0.695 (95%CI: 0.567~0.823) and 0.736 (95%CI: 0.616~0.856), respectively. Multivariate analysis demonstrated that both LCS, LVEF and serum direct bilirubin were independent predictors of all-cause death, excluding mGPS. Conclusions: Compared with mGPS, LCS is independently associated with short-term outcomes in patients with acute heart failure. LCS was a clinically promising and feasible prognostic scoring system for patients with acute heart failure.

Measurement of myocardial extracellular volume using cardiac dual-energy computed tomography in patients with ischaemic cardiomyopathy: a comparison of different methods.

To clarify the consistency and efficiency of four methods for myocardial extracellular volume (ECV) measurement (manual method using dual-energy iodine [manual ECViodine], manual method using subtraction [manual ECVsub], automatic ECViodine, automatic ECVsub) in patients with ischaemic cardiomyopathy. Fifty patients with ischaemic cardiomyopathy who underwent coronary computed tomography angiography (CCTA) following dual-energy computed tomography (CT) with late iodine enhancement (LIE-DECT) were included. LIE with ischaemic patterns representing scarring could be detected using iodine maps in all patients. The global and remote ECVs of non-scarred myocardium were measured using four methods (manual ECViodine, automatic ECViodine, manual ECVsub, and automatic ECVsub). The consistency and time cost of the four methods were analysed. There were no significant differences in the mean global ECVs or remote ECVs among the four methods (p > 0.05). ECViodine resulted in a lower Bland-Altman limit of agreement than that of ECVsub for both global and remote measurements. Intraclass correlation coefficients of the automatic and manual ECViodine measurements demonstrated better concordance (0.804 and 0.859, respectively) than those of automatic and manual ECVsub (0.607 and 0.669, respectively) for both global and remote measurements. The measurement time for automatic ECV was less than that for manual ECV for both global and remote ECV measurements (all p < 0.001). ECV measurement using dual-energy iodine yielded good concordance, and the automatic method has the advantages of being simple and convenient, which can become a useful tool for quantification of myocardial fibrosis.

Measurement of myocardial extracellular volume fraction in patients with heart failure with preserved ejection fraction using dual-energy computed tomography.

OBJECTIVES: To measure the myocardial extracellular volume (ECV) in patients with heart failure with preserved ejection fraction (HFpEF) using dual-energy computed tomography with late iodine enhancement (LIE-DECT) and to evaluate the relationship between ECV and risk of HFpEF and cardiac structure and function. METHODS: A total of 112 consecutive patients with HFpEF and 80 consecutive subjects without heart disease (control group) who underwent LIE-DECT were included. All patients were divided into ischaemic and non-ischaemic groups according to the LIE patterns detected using iodine maps. The ischaemic scar burden was calculated in the ischaemic HFpEF group. Iodine maps and haematocrit were used to measure ECV in the non-ischaemic HFpEF group and remote ECV of the non-scarred myocardium in the ischaemic HFpEF group, respectively. Cardiac structural and functional variables were collected. RESULTS: ECV in patients with non-ischaemic HFpEF (n = 77) and remote ECV in patients with ischaemic HFpEF (n = 35) were significantly higher than those in control subjects (p < 0.001). Multivariate logistic regression analysis revealed that after adjusting for age, sex, body mass index, smoking, and drinking, a higher ECV/remote ECV was still associated with non-ischaemic HFpEF and ischaemic HFpEF (p < 0.001). A positive correlation was established between ECV and cardiac structural and functional variables (p < 0.05) in all participants. Subgroup analysis showed that ECV/remote ECV and ischaemic scar burden positively correlated with heart failure classification in the HFpEF subgroup (p < 0.05). CONCLUSION: ECV/remote ECV elevation was significantly associated with non-ischaemic and ischaemic HFpEF. Remote ECV and LIE may have synergistic effects in the risk assessment of ischaemic HFpEF. KEY POINTS: • ECV/remote ECV elevation is associated not only with non-ischaemic HFpEF but also with ischaemic HFpEF. • ECV/remote ECV and ischaemic scar burden are correlated with cardiac structure and function.

Myocardial extracellular volume fraction quantitation using cardiac dual-energy CT with late iodine enhancement in patients with heart failure without coronary artery disease: A single-center prospective study.

PURPOSE: To evaluate the relationship between myocardial extracellular volume (ECV) fraction measured using dual-energy computed tomography with late iodine enhancement (LIE-DECT) and risk of heart failure (HF) in patients without coronary artery disease (CAD), and to evaluate the relationship between ECV and left ventricular structure and function. MATERIALS AND METHODS: Sixty consecutive HF patients without CAD and 60 consecutive participants without heart disease who underwent coronary CT angiography (CCTA) following LIE-DECT were included. ECV of the left ventricle was calculated from the iodine maps and hematocrit levels using the American Heart Association (AHA) 16-segment model. Cardiac structural and functional parameters were collected including left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left atrial volume (LAV), interventricular septal thickness (IVST), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). RESULTS: ECV in HF patients without CAD (31.3 ±â€¯4.0 %) was significantly higher than that in healthy subjects (27.1 ±â€¯3.7 %) (P < 0.001). Multivariate linear analysis revealed that ECV was associated with age (ß = 0.098, P = 0.010) and hypertension (ß = 2.093, P = 0.011) in all participants. Binary logistic regression analysis showed that after adjusting for age, sex, body mass index (BMI), smoking, and drinking, ECV was a risk factor affecting the occurrence of HF in those without CAD (OR = 1.356, 95 %CI：1.178-1.561, P < 0.001). A positive correlation was found between ECV and NT-pro-BNP, LVEDV, LVESV, and LAV (r = 0.629, 0.329, 0.346, and 0.338, respectively; all P < 0.001) in all participants. CONCLUSIONS: ECV could be measured using LIE-DECT iodine maps. ECV elevation was a risk factor for HF without CAD and correlated with cardiac structure and function.