Clinical Cardiology最新文献

Background

Educational attainment and economic status are important socioeconomic characteristics and are associated with metabolic diseases and premature death risk. However, their relative importance and contributions to premature death remain unclear.

Methods

Data were collected from ten survey waves of the National Health and Nutrition Examination Survey from 1999 to 2018. Deaths before age 75 from all-cause and cause-specific mortality were ascertained from linkage to the National Death Index with follow-up through 2019. Weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for death by educational attainment and income level. Population-attributable fractions (PAFs) were calculated to quantify the proportional contributions of low income and low educational attainment to mortality.

Results

Over an average of 10.1 years of follow-up, 4310 premature deaths were confirmed from 43 637 participants. Low income and low educational attainment were associated with increased risks of all-cause and cause-specific mortality, respectively. The associations between low educational attainment and mortality risk disappeared after mutual adjusting for income and education. However, among those with high school education or above, the adjusted HRs of middle income and low income were 1.81 (95% CI, 1.48–2.21) and 2.88 (95% CI, 2.31–3.59) for all-cause mortality. The PAF showed that low educational attainment did not contribute to mortality, while 33.0% of premature deaths were attributable to low income.

Conclusions

Income had a greater impact on mortality risk than education. The disparities in mortality risk could be reduced by narrowing the income differentials.

Background

Epicardial fat thickness (EFT) is a visceral fat depot with pro-inflammatory properties, located adjacent to coronary vessels, and has been proposed as a marker of coronary artery disease (CAD). This study aimed to evaluate the association between EFT and the presence and severity of CAD in patients with type 2 diabetes mellitus.

Methods

This retrospective study was conducted at the Abbas Institute of Medical Sciences (AIMS) between January 2020 and March 2025 (Study ID: AIMS/25/007). A total of 2340 diabetic patients (mean age: 58.3 ± 9.6 years) were included. EFT was measured using transthoracic echocardiography, and CAD presence and severity were assessed via coronary angiography. Logistic regression analysis was used to evaluate associations, with results expressed as odds ratios (OR) with 95% confidence intervals (CI).

Results

Elevated EFT (≥ 5 mm) was observed in 1281 patients (54.7%). CAD was present in 1121 individuals (47.9%), with significantly higher rates in those with elevated EFT (65.7% vs. 26.3%, p < 0.001). EFT ≥ 5 mm was associated with a 5.38-fold increased odds of CAD (95% CI: 4.59–6.30, p < 0.001). Moreover, patients with elevated EFT had a significantly higher prevalence of multi-vessel CAD, indicating a correlation between EFT and disease severity.

Conclusions

In diabetic patients, elevated EFT is significantly associated with both the presence and severity of CAD. EFT measurement via echocardiography may serve as a simple, noninvasive tool for cardiovascular risk stratification and early intervention planning.

Introduction

Diabetes mellitus and hypertension are major contributors to cardiovascular and renal disease mortality, yet their combined long-term impact on mortality trends in the United States remains underexplored. This study evaluates national trends in DM and hypertension-related mortality from 2000 to 2023, analyzing disparities across sex, age groups, race/ethnicity, urbanization, and geographic regions.

Methods

We analyzed mortality data from the CDC-WONDER database, identifying deaths with DM and hypertension as listed causes among adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and temporal trends were assessed using Joinpoint regression to determine annual percentage changes.

Results

A total of 2,742,668 DM and hypertension-related deaths were recorded. The AAMR nearly doubled from 33.7 per 100,000 in 2000 to 66.2 per 100,000 in 2023. A sharp increase was observed from 2018 to 2021 (APC: 16.3 [95% CI: 11.8–19.6]), followed by a decline through 2023. Men had consistently higher mortality rates than females. Mortality rates were highest among older adults (65+ years), Non-Hispanic Black individuals, and nonmetropolitan populations. The South had the highest mortality rates, with Mississippi and the District of Columbia reporting the greatest burden.

Conclusions

DM and hypertension-related mortality has significantly increased over the past two decades, with notable demographic and geographic disparities. Public health interventions should prioritize high-risk populations to mitigate mortality trends and improve health equity.

Background

Heart failure (HF) is a prevalent cause of hospital readmissions. Our study aims to determine the correlation between the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-month readmission in our Southeast Asian population.

Methods

We evaluated KCCQ-12 in a cohort of 180 patients at first post-discharge visit after a recent hospitalization for HF with reduced ejection fraction (HFrEF). Logistic regression was used to determine the predictive significance of the KCCQ scores for 6-month HF readmission. The selection of predictive parameters was performed using Stepwise Akaike Information Criterion (StepAIC).

Results

Out of 180 patients, 52 (29%) were readmitted for HF within 6 months. The mean KCCQ score was higher in the non-readmitted group (78.5) compared to the readmitted group (69.7, p = 0.0129). Multivariate analysis indicated a significant association between higher KCCQ scores (better health status) and lower HF readmission rates (adjusted OR = 0.929, p = 0.0255). The initial predictive model, using patient demographic data, had an AUC score of 0.64. Integrating KCCQ scores with demographics, length of stay (LOS), medical history and discharge medication variables raised the AUC score to 0.82.

Conclusion

KCCQ scores recorded at first post-discharge encounter were found to have a significant relationship with 6-month readmissions in our cohort, suggesting that KCCQ scores can serve as an effective clinical indicator of 6 month readmissions.

Background

Sudden cardiac death (SCD) remains a major cause of death despite progress in prevention and intervention of cardiac diseases. The most common cause of nonischemic SCD in young individuals in Northern Finland is primary myocardial fibrosis (PMF).

Methods

Fingesture study consists of 5869 prospectively collected subjects with SCD from Northern Finland collected from 1998 to 2017. Nonischemic etiology was the cause of SCD in 1477 (25%) subjects out of which primary myocardial fibrosis was the cause of SCD in 184 (12%) subjects (65% men, median age 55 ± 16 years). We examined the ante mortem ECG and medical history of the subjects to discover preceding symptoms and ECG changes.

Results

Prior health care contact in electronic health record system (EHR) was found for 89 (48%) subjects and ECG was available for 52 (28%) subjects. Both medical history and ECG were available for 20 subjects (11%). We observed that transient loss of consciousness (TLOC) was the most common symptom recorded and was reported by 33 (37%) subjects. ECG was abnormal in 38 (73%) subjects. Fragmented QRS (fQRS) complex was found in 26 (50%) subjects. Vast majority, 87% of subjects had either TLOC or abnormal ECG. Only seven subjects with ECG or EHR history available had normal ECG and did not have TLOC.

Conclusions

Many SCD victims with primary myocardial fibrosis had abnormal ECG or history of TLOC. The results suggest that the combination should generate careful cardiovascular examination to detect underlying myocardial disease and possibly prevent SCD.

Background

High-intensity statins are recommended for patients with chronic coronary artery disease, with reports suggesting improved clinical outcomes. However, recent findings in coronary artery bypass graft (CABG) patients question whether a treat-to-target low density lipoprotein (LDL) approach is non-inferior to high-intensity statin therapy.

Methods

This single-center observational study analyzed all CABG only (n = 1854) procedures performed between 2013 and 2015. Patients were divided into three groups based on statin prescription: high-intensity statin therapy (atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg), low/moderate-intensity statin therapy, and a no-statin group. The primary outcome measured was major adverse cardiovascular events (MACE), a composite of post-CABG acute coronary syndrome, cerebrovascular accident and cardiovascular mortality.

Results

No-Statin group had significantly higher incidence of MACE compared to statin group (14.2% vs 8.9%; odds ratio (OR) 1.60, 95% confidence interval (CI) 1.055–2.427, p = 0.029). Low/moderate-intensity therapy (n = 1301) was associated with a numerically higher overall rate of MACE compared to high-intensity therapy (n = 397) but was not statistically significant (9.6% vs 6.6%; OR 1.45, CI 0.961–2.172, p = 0.073). Beyond 2 years post-CABG, low/moderate intensity statin use was associated with a significant higher incidence of MACE (9.1% vs 5.3%; OR 1.72, 95% CI 0.993–2.978, p = 0.047) compared to high intensity statins.

Patients who received high-intensity statin therapy had the lowest LDL levels (82.21 ± 41.85 mg/dL), compared to those on low/moderate-intensity statins (90.84 ± 45.89 mg/dL) and no-statin group (104.83 ± 38.93 mg/dL, p < 0.001).

Conclusion

High-intensity statin therapy following CABG is associated with improved long-term clinical outcomes compared to low- or moderate-intensity statin regimens.

Aims

High plasma fibrinogen and systemic inflammation response index (F-SIRI) has been proposed as a novel prognostic factor in resectable gastric cancer. However, available data on the prognostic value of F-SIRI in chronic heart failure (CHF) patients is limited. We aimed to conduct a retrospective cohort study exploring the correlation between F-SIRI and prognosis in CHF individuals.

Methods

We consecutively enrolled 1589 hospitalized patients (aged 66 ± 8 years, 32.9% women) with CHF from January 1, 2019 to August 31, 2022 in this single-center retrospective study. SIRI was calculated with the formula (monocyte count*neutrophil count/lymphocyte count). The primary endpoints encompassed all-cause death, the major adverse cardiac and cerebral events (MACCEs) and cardiovascular death. The association between F-SIRI and the risk of developing adverse outcomes were explored using four multivariate-adjusted Cox proportional hazard models.

Results

During a median follow-up of 687 days, 207 all-cause deaths, 462 MACCEs and 136 cardiovascular deaths were recorded. After adjusting for potential confounding factors, only risk of all-cause death remained significantly associated with higher levels of F-SIRI. The hazard ratios (HRs) for the highest F-SIRI group (F-SIRI = 2) versus the lowest F-SIRI group (F-SIRI = 0) were 2.37 (95% confidence interval [CI], 1.46−3.83; p < 0.001) for all-cause death. The addition of F-SIRI could increase the prognostic ability for all-cause death on the basis of traditional risk factors.

Conclusions

F-SIRI is a significant predictor of all-cause death but has limited predictive value for MACCEs and cardiovascular death in CHF patients.

Introduction

The prognosis of acute heart failure (AHF) remains poor. Studies focusing on the time-sensitivity of early AHF management have reported controversial results. Thus, our aim is to review current studies focusing on AHF patients using emergency medical services (EMS), their early management, and patient outcomes.

Methods

We searched the recent literature in PubMed and Scopus for studies comparing AHF patients arriving at the hospital by EMS to those self-presenting (non-EMS) at ED (emergency department) from database inception until November 2022.

Results

The literature search found five studies fulfilling our inclusion criteria. The percentage of AHF patients using EMS varied in these studies: 11.5% (100/873) in Finnish FINN-AKVA II, 22.1% (236/1068) in Canadian ASCEND-HF, 35.5% (5129/14454) in a Pakistan Heart Failure-registry study, 52.8% (3224/6106) in Spanish SEMICA, and 61.8% (309/500) in the European EURODEM study. The pre-hospital management differed across the reviewed studies. The use of NIV was rare, ranging from zero to four percent. Vasodilators and diuretics were more commonly used. Although, the differences in the use were obvious (range from 7.1% to 22.0%, and 0.0% to 29.0% accordingly). Three of the studies reported significantly higher 30-day mortality among EMS patients compared to non-EMS patients: ranging from 5.6% versus 3.5%, p < 0.001% to 15.0% versus 6.9%, p < 0.001.

Conclusion

The use of EMS, as well as pre-hospital management, varies between the international cohorts and registries. The pre-hospital AHF management is generally limited. Moreover, EMS patients tend to have worse outcomes compared to non-EMS patients.