Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing
Naoya Inoue1,2, Shuji Morikawa1,2, Takashi Ogane1
1Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan.
Insights
The FIB-4 index can predict early mortality in pacemaker patients. A FIB-4 index cut-off of 3.75 indicates increased risk for all-cause mortality.
Area of Science:
- Cardiology
- Biomarkers
Background:
- The Fibrosis-4 (FIB-4) index is a known predictor of cardiovascular events and mortality in heart disease patients.
- Its utility in patients with pacemakers is not well-established.
Purpose of the Study:
- To investigate the predictive value of the FIB-4 index for mortality in patients with pacemakers.
- To determine a clinically relevant cut-off value for the FIB-4 index in this population.
Main Methods:
- Retrospective study of 201 pacemaker implantation patients.
- FIB-4 index calculated from blood tests; outcomes analyzed using survival analysis.
- Receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off value.
Main Results:
- Higher FIB-4 index tertiles were significantly associated with increased all-cause mortality, non-cardiovascular death, and major adverse cardiovascular events (MACE).
- The adjusted hazard ratio for all-cause mortality in the highest FIB-4 tertile was 4.79 (P<0.001).
- The optimal FIB-4 index cut-off for predicting all-cause mortality was 3.75 (AUC: 0.72).
Conclusions:
- The FIB-4 index is a potential predictor of early all-cause mortality in pacemaker recipients.
- A FIB-4 index value of 3.75 may identify patients at higher risk for mortality.
Background:
The fibrosis-4 (FIB-4) index has attracted attention as a predictive factor for cardiovascular events and mortality in patients with heart disease. However, its clinical value in patients with implanted pacemakers remains unclear.
Methods:
This study included patients who underwent pacemaker implantation. The FIB-4 index was calculated based on blood tests performed during the procedure. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular death, non-cardiovascular death, and major adverse cardiovascular events (MACE; composite of cardiovascular death, heart failure hospitalization, non-fatal myocardial infarction, and non-fatal stroke). The FIB-4 index was stratified into tertiles. Between-group comparisons were performed using log-rank tests and multivariate analysis using Cox proportional hazards. The predictive accuracy and cut-off value of the FIB-4 index were calculated from the receiver operating characteristic curve for all-cause mortality. Finally, based on the calculated cut-off values, the patients were divided into two groups for outcome validation and subgroup analysis.
Results:
This study included 201 participants, of whom 38 experienced death during the observation period (median: 1097 days). All-cause mortality, non-cardiovascular death, and MACE differed significantly between groups stratified by the FIB-4 index tertiles (log-rank test: P<0.001, P<0.001, and P = 0.045, respectively). Using Cox proportional hazards analysis, the unadjusted hazard ratio was 4.75 (95% confidence interval [CI]: 2.05-11.0, P<0.001) for Tertile 3 compared to Tertile 1. After adjustment for confounding factors, including sex, the presence or absence of left bundle branch block at baseline, QRS duration during pacing, and pacing rate at the last check, the hazard ratio was 4.79 (95% CI: 2.04-11.2, P<0.001). The cut-off value of the FIB-4 index was 3.75 (area under the curve: 0.72, 95% CI: 0.62-0.82).
Conclusions:
In patients with pacemakers, the FIB-4 index may be a predictor of early all-cause mortality, with a cut-off value of 3.75.
More Related Videos
10:33Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography
Published on: February 3, 2014
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
