Strong independent association between third-degree AV-block and diabetes mellitus using a large database.

BACKGROUND: Recent data suggests an association between DM and third-degree AV- Block. The goal of this study was to evaluate the independent association between diabetes and third-degree AV-Block using a very large database. METHOD: We used ICD-9 Codes for DM and third-degree AV-block from the Nationwide Inpatient Sample (NIS) database. We randomly selected the 1992 and 2002 databases which are 10 years apart as two independent samples. We used uni- and multi-variate analysis to evaluate this association. RESULTS: 1992 database contained a total of 6,195,744 patients. Diabetes occurred in (0.5 %) of patients with third-degree AV-block vs. (0.2 %) of the control (OR: 2.15, CI 2.06-2.25, p < 0.0001). 2002 database contained a total of 7,853,982 patients. Diabetes occurred in (0.4 %) of patients with third-degree AV-block vs. (0.2 %) of the control (OR: 1.86, CI: 1.80-1.93, p < 0.0001). Using Multivariate analysis adjusting for age, congestive heart failure, and coronary artery disease, DM remained independently associated with third-degree AV block in both databases. (for 1999: OR: 2.54, CI 2.51-2.57, p < 0.0001 and for 2002 OR: 1.56, CI 1.55-1.57, p < 0.0001). CONCLUSION: DM is independently associated with third-degree AV-block with persistent association over a period of 10 years. The cause of this association warrants further investigation.

Left ventricular hypertrophy is independently associated with all-cause mortality.

BACKGROUND: Left Ventricular Hypertrophy (LVH) is associated with adverse outcomes. The goal of this study was to evaluate any association between LVH and all-cause mortality using a large echocardiographic database. METHODS: We retrospectively evaluated 2,352 echocardiograms between the ages 16-99 years that were performed from 1983 to 1998 for clinical reasons in Southern California. Mortality data were extracted from the national mortality database at the end of the year 2007. Using uni- and multi-variant analysis, we evaluated any association between total mortality and echocardiographic presence of LVH defined as any wall thickness >11 mm. RESULTS: LVH was significantly associated with all-cause mortality [207/583 (35.5%) of patients died with LVH vs. 416/1769 (23.5%) of patients with normal wall thickness, P<0.001, HR 1.79, CI: 1.46-2.19]. Using multivariate analysis adjusting for age, gender, abnormal left ventricular systolic function, and significant valvular abnormalities, LVH remained independently associated with all-cause mortality (OR 1.39, CI 1.10-1.74, P=0.005). CONCLUSION: Using a large echocardiographic database, we found that LVH is independently associated with all-cause mortality. Our finding confirms the negative effect of LVH on the long-term outcome.

Mitral annulus calcification is independently associated with all-cause mortality.

BACKGROUND: Mitral annulus calcification (MAC) is an important echocardiographic finding that is significantly associated with valvular abnormalities. However, the effect of documented MAC on all-cause mortality is not known. Using a large database, associations between MAC and long-term all-cause mortality were evaluated. METHODS: A retrospective analysis of 3169 echocardiograms, which were performed for clinical reasons in southern California between 1983 and 1998 in patients between 16 and 99 years of age, was performed. Mortality data were extracted from the national mortality database at the end of 2007. Using uni- and multivariate analysis, associations between total mortality and the echocardiographic presence of MAC documented in the final report by the interpreting cardiologist were evaluated. RESULTS: MAC was significantly associated with all-cause mortality (174 of 334 [52.1%] patients with MAC died versus 709 of 2835 [25.0%] patients without MAC; OR 3.26 [95% CI 2.58 to 4.10]; P<0.001). Using multivariate analysis adjusting for age, left ventricular hypertrophy, sex, abnormal left ventricular systolic function and significant valvular abnormalities, MAC remained independently associated with all-cause mortality (OR 2.50 [95% CI 1.81 to 3.45]; P<0.001). CONCLUSION: Using a large echocardiographic database, MAC was found to be independently associated with all-cause mortality. This finding confirms the importance of an abnormal mitral annulus as an important prognostic marker.