Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 9, Number 3, June 2018, pages 153-160

Efficacy of the Reactive Oxygen Metabolite Test as a Predictor of Initial Heart Failure Hospitalization in Elderly Patients With Chronic Heart Failure

Figure 2. Multivariate Cox regression analysis for heart failure hospitalization using a combination of the d-ROMs test and BNP. Group H with low BNP levels (<200 pg/mL) or group L with high BNP levels (≥200 pg/mL) exhibited significantly higher HR (HR: 2.21, 95% CI: 1.06 - 4.71, P < 0.05; HR: 2.29, 95% CI: 1.09 - 5.93, P < 0.05, respectively) than group L with low BNP levels. Furthermore, HR of group H with high BNP levels compared with group L with low BNP levels exhibited higher HR (HR, 9.18; 95% CI, 4.78 - 22.94; P < 0.001) than the other groups. Adjustment factors are age, diabetes mellitus, CAVI, and β-blocker use. *P < 0.05 vs. group L with low BNP levels; **P < 0.001 vs. group L with low BNP levels. HR: hazard ratio, CI: confidence interval, d-ROMs: derivatives of reactive oxygen metabolites; BNP: brain natriuretic peptide; HR: hazard ratio; CAVI: cardio-ankle vascular index.

Figure 3. Prediction of heart failure hospitalization at follow-up period using d-ROMs test. The d-ROMs test levels cut-off 319 U. CARR yielded the largest area under the curve of 0.701 (95% CI: 0.655 - 0.744), with a sensitivity of 86.4% and specificity of 51.8% for discriminating between non-hospitalization and hospitalization at follow-up period. CI: confidence interval; d-ROMs: derivatives of reactive oxygen metabolites.

**Table 1.** Characteristics of Patients
	Overall	Group L	Group H	P value
Continuous values are mean ± SD. D-ROMs: derivatives of reactive oxygen metabolites; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high sensitivity C reactive protein; CAVI: cardio-ankle vascular index; RAS: renin-angiotensin system.
N (Male/female)	428 (108/320)	214 (58/156)	214 (50/164)	0.375
Age (yrs)	75 ± 7	74 ± 6	76 ± 8	0.108
D-ROMs test (U. CARR)	328 ± 116	235 ± 45	421 ± 85	< 0.001
Body mass index	22.8 ± 3.5	22.9 ± 3.4	22.8 ± 3.6	0.546
Current smoker, n (%)	99 (23)	46 (21)	53 (25)	0.423
Ischemic heart disease, n (%)	70 (16)	31 (14)	39 (18)	0.396
Hypertension, n (%)	316 (74)	156 (73)	160 (75)	0.584
Systolic blood pressure (mm Hg)	144 ± 24	144 ± 21	144 ± 27	0.852
Diastolic blood pressure (mm Hg)	86 ± 11	86 ± 11	86 ± 10	0.695
Pulse rate (/min)	65 ± 13	64 ± 12	66 ± 14	0.363
Dyslipidemia, n (%)	224 (52)	102 (48)	122 (57)	0.051
Diabetes mellitus, n (%)	105 (25)	24 (11)	81 (38)	< 0.001
Hear valvular disease, n (%)	318 (74)	156 (73)	162 (76)	0.585
IVSTd (mm)	9.5 ± 1.6	9.4 ± 1.5	9.7 ± 1.7	0.059
LVDd (mm)	48 ± 4	48 ± 3	48 ± 4	0.529
LVEF (%)	67.8 ± 11.7	67.4 ± 12.1	68.3 ± 11.3	0.3
LAD (mm)	42 ± 6	42 ± 6	43 ± 6	0.421
Hemoglobin (g/dL)	12.7 ± 1.6	12.8 ± 1.6	12.7 ± 1.5	0.592
eGFR (mL/min/1.73m² )	55.2 ± 22.2	55.6 ± 22.4	54.8 ± 21.9	0.742
Log-BNP (pg/mL)	2.0 ± 0.4	1.9 ± 0.4	2.1 ± 0.3	< 0.01
hs-CRP (mg/dL)	-1.2 ± 0.5	-1.3 ± 0.5	-1.1 ± 0.5	< 0.05
CAVI	9.5 ± 1.2	9.3 ± 1.2	9.8 ± 1.2	< 0.001
Medication
RAS inhibitor, n (%)	269 (63)	134 (63)	135 (63)	0.92
β-blocker, n (%)	74 (17)	43 (20)	31 (15)	0.126
Diuretics, n (%)	87 (20)	50 (23)	37 (17)	0.12
Statin, n (%)	119 (28)	61 (29)	58 (27)	0.789

Table 1. Characteristics of Patients

Overall

Group L

Group H

P value

Continuous values are mean ± SD. D-ROMs: derivatives of reactive oxygen metabolites; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high sensitivity C reactive protein; CAVI: cardio-ankle vascular index; RAS: renin-angiotensin system.

N (Male/female)

428 (108/320)

214 (58/156)

214 (50/164)

0.375

Age (yrs)

75 ± 7

74 ± 6

76 ± 8

0.108

D-ROMs test (U. CARR)

328 ± 116

235 ± 45

421 ± 85

< 0.001

Body mass index

22.8 ± 3.5

22.9 ± 3.4

22.8 ± 3.6

0.546

Current smoker, n (%)

99 (23)

46 (21)

53 (25)

0.423

Ischemic heart disease, n (%)

70 (16)

31 (14)

39 (18)

0.396

Hypertension, n (%)

316 (74)

156 (73)

160 (75)

0.584

Systolic blood pressure (mm Hg)

144 ± 24

144 ± 21

144 ± 27

0.852

Diastolic blood pressure (mm Hg)

86 ± 11

86 ± 10

0.695

Pulse rate (/min)

65 ± 13

64 ± 12

66 ± 14

0.363

Dyslipidemia, n (%)

224 (52)

102 (48)

122 (57)

0.051

Diabetes mellitus, n (%)

105 (25)

24 (11)

81 (38)

< 0.001

Hear valvular disease, n (%)

318 (74)

156 (73)

162 (76)

0.585

IVSTd (mm)

9.5 ± 1.6

9.4 ± 1.5

9.7 ± 1.7

0.059

LVDd (mm)

48 ± 4

48 ± 3

48 ± 4

0.529

LVEF (%)

67.8 ± 11.7

67.4 ± 12.1

68.3 ± 11.3

0.3

LAD (mm)

42 ± 6

43 ± 6

0.421

Hemoglobin (g/dL)

12.7 ± 1.6

12.8 ± 1.6

12.7 ± 1.5

0.592

eGFR (mL/min/1.73m² )

55.2 ± 22.2

55.6 ± 22.4

54.8 ± 21.9

0.742

Log-BNP (pg/mL)

2.0 ± 0.4

1.9 ± 0.4

2.1 ± 0.3

< 0.01

hs-CRP (mg/dL)

-1.2 ± 0.5

-1.3 ± 0.5

-1.1 ± 0.5

< 0.05

CAVI

9.5 ± 1.2

9.3 ± 1.2

9.8 ± 1.2

< 0.001

Medication

RAS inhibitor, n (%)

269 (63)

134 (63)

135 (63)

0.92

β-blocker, n (%)

74 (17)

43 (20)

31 (15)

0.126

Diuretics, n (%)

87 (20)

50 (23)

37 (17)

0.12

Statin, n (%)

119 (28)

61 (29)

58 (27)

0.789

**Table 2.** Clinical Parameters at Registration of Patients With and Without Heart Failure Hospitalization
	Non HF hospitalization (n = 370)	HF hospitalization (n = 58)	P value
Continuous values are mean ± SD. HF: heart failure; IVSTd: interventricular septal thickness at end- diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high sensitivity C reactive protein; CAVI: cardio-ankle vascular index; RAS: renin-angiotensin system.
Male/female	96/274	12/46	0.393
Age (yrs)	74 ± 7	79 ± 7	< 0.001
Body mass index	22.9 ± 3.4	22.7 ± 3.8	0.679
Current smoker, n (%)	78 (21)	21 (36)	< 0.05
Ischemic heart disease, n (%)	58 (16)	12 (21)	0.234
Hypertension, n (%)	271 (73)	45 (78)	0.675
Systolic blood pressure (mm Hg)	144 ± 24	141 ± 25	0.397
Diastolic blood pressure (mm Hg)	86 ± 10	85 ± 11	0.676
Pulse rate (/min)	65 ± 13	67 ± 13	0.391
Dyslipidemia, n (%)	188 (51)	36 (62)	0.111
Diabetes mellitus, n (%)	82 (22)	23 (40)	< 0.01
Hear valvular disease, n (%)	274 (74)	44 (76)	0.899
IVSTd (mm)	9.5 ± 1.6	9.7 ± 2.1	0.386
LVDd (mm)	48 ± 3	49 ± 5	0.217
LVEF (%)	67.7 ± 11.8	68.0 ± 11.5	0.359
LAD (mm)	42 ± 6	43 ± 5	0.591
Hemoglobin (g/dL)	12.7 ± 1.5	12.9 ± 1.7	0.201
eGFR (mL/min/1.73m² )	56.4 ± 22.3	47.7 ± 19.9	< 0.01
Log-BNP (pg/mL)	2.0 ± 0.4	2.2 ± 0.4	< 0.001
Log-hs-CRP (mg/dL)	-1.3 ± 0.5	-1.0 ± 0.4	< 0.01
CAVI	9.4 ± 1.2	10.1 ± 1.1	< 0.001
RAS inhibitor, n (%)	239 (65)	30 (52)	< 0.01
β-blocker, n (%)	72 (19)	2 (3)	< 0.01
Diuretics, n (%)	75 (20)	12 (21)	0.692
Statin, n (%)	104 (28)	15 (26)	0.723

Table 2. Clinical Parameters at Registration of Patients With and Without Heart Failure Hospitalization

Non HF hospitalization (n = 370)

HF hospitalization (n = 58)

P value

Continuous values are mean ± SD. HF: heart failure; IVSTd: interventricular septal thickness at end- diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-CRP: high sensitivity C reactive protein; CAVI: cardio-ankle vascular index; RAS: renin-angiotensin system.

Male/female

96/274

12/46

0.393

Age (yrs)

74 ± 7

79 ± 7

< 0.001

Body mass index

22.9 ± 3.4

22.7 ± 3.8

0.679

Current smoker, n (%)

78 (21)

21 (36)

< 0.05

Ischemic heart disease, n (%)

58 (16)

12 (21)

0.234

Hypertension, n (%)

271 (73)

45 (78)

0.675

Systolic blood pressure (mm Hg)

144 ± 24

141 ± 25

0.397

Diastolic blood pressure (mm Hg)

86 ± 10

85 ± 11

0.676

Pulse rate (/min)

65 ± 13

67 ± 13

0.391

Dyslipidemia, n (%)

188 (51)

36 (62)

0.111

Diabetes mellitus, n (%)

82 (22)

23 (40)

< 0.01

Hear valvular disease, n (%)

274 (74)

44 (76)

0.899

IVSTd (mm)

9.5 ± 1.6

9.7 ± 2.1

0.386

LVDd (mm)

48 ± 3

49 ± 5

0.217

LVEF (%)

67.7 ± 11.8

68.0 ± 11.5

0.359

LAD (mm)

42 ± 6

43 ± 5

0.591

Hemoglobin (g/dL)

12.7 ± 1.5

12.9 ± 1.7

0.201

eGFR (mL/min/1.73m² )

56.4 ± 22.3

47.7 ± 19.9

< 0.01

Log-BNP (pg/mL)

2.0 ± 0.4

2.2 ± 0.4

< 0.001

Log-hs-CRP (mg/dL)

-1.3 ± 0.5

-1.0 ± 0.4

< 0.01

CAVI

9.4 ± 1.2

10.1 ± 1.1

< 0.001

RAS inhibitor, n (%)

239 (65)

30 (52)

< 0.01

β-blocker, n (%)

72 (19)

2 (3)

< 0.01

Diuretics, n (%)

75 (20)

12 (21)

0.692

Statin, n (%)

104 (28)

15 (26)

0.723

**Table 3.** Multivariate Cox Regression Analysis for Heart Failure Hospitalization
	HR	95% CI	P value
HR: hazard ratio; CI: confidence interval; BNP: brain natriuretic peptide; CAVI: cardio-ankle vascular index; RAS: renin- angiotensin system; eGFR: estimated glomerular filtration rate; hs-CRP: high sensitivity C reactive protein.
Age (≥ 75years)	2.78	1.53 - 5.10	< 0.01
Group H	2.35	1.37 - 4.43	< 0.01
BNP (≥ 200pg/mL)	2.22	1.21 - 3.52	< 0.01
Diabetes mellitus	1.94	1.06 - 3.38	< 0.05
CAVI (≥ 10)	1.82	1.07 - 3.19	< 0.05
β-blocker	0.52	0.33 - 0.98	< 0.05
RAS inhibitor	0.44	0.27 - 1.11	0.089
eGFR (< 60mL/min/1.73m²)	1.53	0.85 - 2.77	0.159
hs-CRP (≥ 0.1mg/dL)	1.41	0.79 - 2.53	0.190
Current smoker	1.31	0.84 - 1.73	0.204

Table 3. Multivariate Cox Regression Analysis for Heart Failure Hospitalization

95% CI

P value

HR: hazard ratio; CI: confidence interval; BNP: brain natriuretic peptide; CAVI: cardio-ankle vascular index; RAS: renin- angiotensin system; eGFR: estimated glomerular filtration rate; hs-CRP: high sensitivity C reactive protein.

Age (≥ 75years)

2.78

1.53 - 5.10

< 0.01

Group H

2.35

1.37 - 4.43

< 0.01

BNP (≥ 200pg/mL)

2.22

1.21 - 3.52

< 0.01

Diabetes mellitus

1.94

1.06 - 3.38

< 0.05

CAVI (≥ 10)

1.82

1.07 - 3.19

< 0.05

β-blocker

0.52

0.33 - 0.98

< 0.05

RAS inhibitor

0.44

0.27 - 1.11

0.089

eGFR (< 60mL/min/1.73m²)

1.53

0.85 - 2.77

0.159

hs-CRP (≥ 0.1mg/dL)

1.41

0.79 - 2.53

0.190

Current smoker

1.31

0.84 - 1.73

0.204