Construction Of Risk Prediction Model For Cardiovascular Disease And Its Correlation With Liver Diseas

Background:Mortality risk stratification in percutaneous coronary intervention(PCI)is crucial,which may identify patients who could benefit from preventive intervention.This study aims to develop a nomogram to predict the short-term and long-term mortality risk after PCI.Methods:The study cohort included 9603 patients undergoing PCI.The primary endpoint was all-cause mortality.The least absolute shrinkage and selection operator(LASSO)Cox regression was used to select potential risk factors.These risk factors were entered into backward stepwise regression for variable selection.A nomogram was subsequently developed based on the selected variables through multivariable Cox regression.The performance of the nomogram was evaluated by the area under the curve(AUC)of the receiver operating characteristic curve,calibration plots,and decision curve analysis(DCA).Patients were stratified into low-,intermediate-and high-risk groups according to the tertile points in the nomogram,and Kaplan-Meier analysis was used to assess cumulative survival rates.Results:A total of 9603 individuals were included in this study and randomly divided into derivation(5762,60%)and validation(3841,40%)cohorts.Six variables,including age,severe renal insufficiency,left ventricular dysfunction,previous cerebrovascular disease,previous PCI,and Thrombolysis In Myocardial Infarction(TIMI)flow 0-1 before PCI,were selected to construct the nomogram.Nomogram showed good discrimination.The AUC regarding 30-day,1-year,and 2-year mortality was 0.796,0.792,and 0.757 in the training cohort and 0.766,0.754,and 0.719 in the validation cohort.The calibration curve showed good consistency between nomogram-predicted probability and actual probability.DCA showed the satisfactory clinical utility of the nomogram.Kaplan-Meier curve successfully stratified the patients in the low-,intermediate-,and high-risk groups.Conclusions:This study developed a simple-to-use nomogram predicting short-and long-term mortality risk in patients undergoing PCI and might help clinicians make risk-dependent decisions.Background:Dilated cardiomyopathy(DCM)has a poor outcome and is the most common indication of heart transplantation.Our study sought to develop a multiparametric nomogram to assess individualized all-cause mortality or heart transplantation(ACM/HTx)risk in dilated cardiomyopathy.Methods:The study cohort included 218 DCM patients.The primary endpoint was ACM/HTx.The least absolute shrinkage and selection operator(LASSO)Cox regression model was applied to variable selection.A nomogram was developed based on the selected variables through multivariable Cox regression.The performance of the nomogram was evaluated by the area under the curve(AUC)of the receiver operating characteristic curve,calibration plots,and decision curve analysis(DCA).Patients were stratified into low-and high-risk groups according to the best cutoff point in the nomogram based on log-rank statistics,and Kaplan-Meier analysis was used to assess cumulative event-free survival rates.Results:A total of 218 patients were included in the present study.They were randomly divided into training cohorts(131,60%)and validation cohorts(87,40%).The nomogram was established based on 8 variables,including mid-wall late gadolinium enhancement,systolic blood pressure,diastolic blood pressure,left ventricular ejection fraction,left ventricular end diastolic diameter,left ventricular end-diastolic volume index,free triiodothyronine,and N-terminal pro-B type natriuretic peptide.The AUC regarding 1-,3-,and 5-year ACM/HTx events were 0.859,0.831,and 0.840 in the training cohort and 0.770,0.789,and 0.819 in the validation cohort.The calibration curve and DCA showed good accuracy and clinical utility of the nomogram.Kaplan-Meier curve successfully stratified the patients in the low-and high-risk groups.Conclusions:We established and validated a multiparametric nomogram that can provide a personalized prediction of ACM/HTx for DCM patients,which may help risk stratification and decision-making in clinical practice.Background:Liver fibrosis is associated with the prognosis of cardiovascular diseases.Noninvasive liver fibrosis scores are used as a surrogate marker to evaluate the severity of liver fibrosis.We sought to examine whether the liver fibrosis scores were correlated with cardiovascular events in patients with acute coronary syndrome(ACS).Methods:We included 6386 patients with ACS treated by the percutaneous coronary intervention(PCI)in our center.We calculated six liver fibrosis scores,including aspartate aminotransferase to platelet ratio index(APRI),aspartate aminotransferase to alanine aminotransferase ratio(AST/ALT ratio),Forns score,gamma-glutamyl transpeptidase to platelet ratio(GPR),nonalcoholic fatty liver disease fibrosis score(NFS),and BARD score.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),a composite of all-cause mortality(ACM),myocardial infarction(MI),and ischemic stroke(IS).The secondary endpoints were the components of MACCE separately and bleeding events.Results:During the follow-up,259(4.06%)MACCE occurred.According to the literature-based cutoff values,we stratified liver fibrosis scores into high,intermediate,and low scores,corresponding to high,intermediate,and low risk of liver fibrosis.After adjusting for covariables,high APRI,high AST/ALT ratio,high Forns scores,and high NFS were associated with increased risk of MACCE(Hazard ratio ranging from 1.57 to 3.73,all p<0.05)compared with those with low scores.Patients with high APRI,high NFS,and high Forns scores were associated with an increased risk of ACM(all p<0.05).Patients with high APRI,high NFS,and high BARD scores were associated with an increased risk of MI(all p<0.05).Patients with high APRI and high NFS were associated with an increased risk of IS(all p<0.05).No liver fibrosis scores were associated with an increased risk of bleeding.Conclusions:In ACS patients,increased noninvasive liver fibrosis scores were the independent risk factor for thrombotic events,including MACCE,ACM,MI,and IS.Liver fibrosis scores may help risk stratification in ACS.Background:Noninvasive liver fibrosis scores predict adverse outcomes in various cardiovascular diseases.However,the relationship between liver fibrosis scores and outcomes in dilated cardiomyopathy remains blank.This study aimed to investigate whether high liver fibrosis scores were associated with poor prognosis in patients with dilated cardiomyopathy.Methods:This study included 433 patients with dilated cardiomyopathy.Four liver fibrosis scores,including aspartate aminotransferase to platelet ratio index(APRI),aspartate aminotransferase/alanine aminotransferase ratio(AST/ALT ratio),Forns score,and gamma-glutamyltransferase platelet ratio(GPR)were examined.The primary endpoint was all-cause mortality or heart transplantation(ACM/HTx).Results:During the follow-up,140(32.3%)ACM/HTx events were recorded.According to the literature-based cutoff values,we stratified liver fibrosis scores into low,intermediate,and high scores,corresponding to low,intermediate,and high risk of liver fibrosis.In the multivariable Cox regression analysis,intermediate-to-high APRI score(HR 1.52,95%CI 1.05-2.2,p<0.026),intermediate-to-high AST/ALT ratio score(HR 1.55,95%CI 1.08-2.24,p=0.019),and intermediate or high GPR score(HR 1.59,95%CI 1.01-2.5,p=0.047;HR 1.68,95%CI 1.11-2.54,p=0.014),were associated with increased risk of ACM/HTx events.Conclusions:Increased liver fibrosis scores,including APRI,AST/ALT ratio,and GPR,predicted adverse outcomes in patients with dilated cardiomyopathy.Liver fibrosis scores may help to risk-stratification in dilated cardiomyopathy and identify patients with poor prognosis.Background:Nonalcoholic fatty liver disease(NAFLD)prevalence has increased rapidly and become a major global health problem.Tumor necrosis factor α-induced protein 8-like 2(TIPE2)plays a protective role in a cluster of liver diseases,such as autoimmune hepatitis and hepatitis B.However,the function of TIPE2 in NAFLD remains unknown.Here,we investigated the role of TIPE2 in the development of NAFLD.Methods and results:Our study found that in vitro overexpression or knockout of TIPE2 significantly ameliorated or aggravated lipid accumulation and inflammation in hepatocytes exposed to metabolic stimulation,respectively.Consistently,in vivo hepatic steatosis,insulin resistance,inflammation,and fibrosis were alleviated in hepatic Tipe2-transgenic mice but exaggerated in hepatic Tipe2-knockout mice treated by metabolic challenges.RNA sequencing revealed that TIPE2 was significantly associated with the mitogen-activated protein kinase pathway.Mechanistic experiments demonstrated that TIPE2 bound with transforming growth factor beta-activated kinase 1(TAK1),and subsequently inhibited the TAK1 phosphorylation and activation of TAK1-c-Jun N-terminal kinase(JNK)/p38 signaling.Further investigation showed that blocking the activity of TAK1 reversed the worsening of hepatic metabolic disorders and inflammation in hepatic-specific Tipe2-knockout hepatocytes and mice treated with metabolic stimulation.Conclusions:TIPE2 suppresses NAFLD advancement by blocking TAK1-JNK/p38 pathway and is a promising target molecule for NAFLD therapy.