Showing papers by "Jawdat Abdulla published in 2008"

Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries

Abstract: Aims To explore the influence of obesity on prognosis in high-risk patients with myocardial infarction (MI) or heart failure (HF). Methods and results Individual data of 21 570 consecutively hospitalized patients from five Danish registries were pooled together. After a follow-up of 10.4 years, all-cause mortality using multivariate model and adjusted hazard ratios (HR) with 95% confidence intervals were calculated. Compared with normal weight [body mass index (BMI) 18.5–24.9 kg/m2], obesity class II (BMI ≥ 35 kg/m2) was associated with increased risk of death in patients with MI but not HF \[HR = 1.23 (1.06–1.44), P = 0.006 and HR = 1.13 (0.95–1.36), P = 0.95\] ( P -value for interaction = 0.004). Obesity class I (BMI 30–34.9 kg/m2) was not associated with increased risk of death in MI or HF [HR = 0.99 (0.92–1.08) and 1.00 (0.90–1.11), P > 0.1]. Pre-obesity (BMI 25–29.9 kg/m2) was associated with decreased death risk in MI but not HF \[HR = 0.91 (0.87–0.96), P = 0.0006 and 1.04 (0.97–1.12), P = 0.34\] ( P -value for interaction = 0.007). Underweight (BMI < 18.5 kg/m2) patients were in increased death risk regardless of MI or HF [HR = 1.54 (1.35–1.75) and 1.37 (1.18–1.59), P < 0.001]. Conclusion In patients with MI but not HF, the relationship between BMI and mortality is U-shaped with highest mortality in underweight and obese class II, but lowest in the other BMI classes.

Wall motion index, estimated glomerular filtration rate and mortality risk in patients with heart failure or myocardial infarction: a pooled analysis of 18,010 patients.

Abstract: Aims: This study was designed to assess whether the prognostic significance of estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) interact in populations with heart failure (HF) and myocardial infarction (MI). Methods: Patients were recruited from four screening registers (N=18,010) including patients admitted with HF or MI. Ten years follow-up was recorded and formal testing for interactions between eGFR and LVEF with respect to outcome was done. Results: Twelve-thousand-and-ninety patients died. A significant interaction (P=0.010) was found and each parameter became relatively more important when the value of the other was low. eGFR and LVEF were reparameterized to categorical variables and we observed that chronic kidney disease stage II was associated with a decreased (Hazard ratio (HR): 0.79 (95% Confidence Interval: 0.72–0.86)) and chronic kidney disease stages IV (HR: 1.60 (1.45–1.91) and V (HR: 1.91 (1.45–2.52) were associated with an increased mortality risk with an additive effect of left ventricular systolic dysfunction (LVSD). Conclusion: The prognostic significance of eGFR and LVEF is synergistic in patients with HF or MI and the impact of one parameter is inversely related to the level of the other. Statistical interactions are scale dependent and the relationship between chronic kidney disease stages I to V and mortality risk is J-shaped with an additive effect of LVSD.