José Antonio Parada Barcia MD, Sergio Raposeiras Roubin MD, PhD, David González Fernández MD, André González García MD, Carla Iglesias Otero MD, Inmaculada González Bermúdez MD, Andrés Íñiguez Romo MD, Emad Abu-Assi MD, PhD
Background
Rate control is the most commonly employed first-line management strategy for atrial fibrillation (AF) in patients with chronic kidney disease (CKD). Principal agents used to control heart rate (HR) include beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB). However, there is a paucity of published studies of the differences between those drugs in CKD patients.
Hypothesis
The present study aimed to investigate the differences, in terms of hospitalizations due to a poor HR control, in patients with AF under a rate-control strategy according to glomerular filtration rate (GFR).
Methods
The study cohort included 2804 AF patients under rate-control regime (BB or ND-CCB) between January 2014 and April 2020. The end point, determined by competing risk regression, was hospitalizations for AF with rapid ventricular response (RVR), slow ventricular response (SVR), and need for pacemaker.
Results
On multivariate analysis, there were no statistical differences between ND-CCB and BB for subjects with GFR > 60 mL/min/1.73 m2 (subdistribution heart rate [sHR] 0.850, 95% confidence interval [CI]: 0.61–1.19; p = .442) and GFR 30–59 mL/min/1.73 m2 (sHR 1.242, 95% CI: 0.80–1.63; p = .333), while in patients with GFR < 30 mL/min/1.73 m2, ND-CCB therapy was associated with increased hospitalizations due to poor HR control (sHR 4.53, 95% CI: 1.19–17.18; p = .026).
Conclusion
In patients with GFR ≥ 30 mL/min/1.73 m2, the choice of ND-CCB or BB had no impact on hospitalizations due to poor HR control, while in GFR < 30 mL/min/1.73 m2, a possible association was detected. The effects of these drugs on GFR < 30 mL/min/1.73 m2 would require further investigation.
{"title":"Comparison between beta-blockers and calcium channel blockers in patients with atrial fibrillation according to renal function","authors":"José Antonio Parada Barcia MD, Sergio Raposeiras Roubin MD, PhD, David González Fernández MD, André González García MD, Carla Iglesias Otero MD, Inmaculada González Bermúdez MD, Andrés Íñiguez Romo MD, Emad Abu-Assi MD, PhD","doi":"10.1002/clc.24257","DOIUrl":"https://doi.org/10.1002/clc.24257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rate control is the most commonly employed first-line management strategy for atrial fibrillation (AF) in patients with chronic kidney disease (CKD). Principal agents used to control heart rate (HR) include beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB). However, there is a paucity of published studies of the differences between those drugs in CKD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The present study aimed to investigate the differences, in terms of hospitalizations due to a poor HR control, in patients with AF under a rate-control strategy according to glomerular filtration rate (GFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study cohort included 2804 AF patients under rate-control regime (BB or ND-CCB) between January 2014 and April 2020. The end point, determined by competing risk regression, was hospitalizations for AF with rapid ventricular response (RVR), slow ventricular response (SVR), and need for pacemaker.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>On multivariate analysis, there were no statistical differences between ND-CCB and BB for subjects with GFR > 60 mL/min/1.73 m<sup>2</sup> (subdistribution heart rate [sHR] 0.850, 95% confidence interval [CI]: 0.61–1.19; <i>p</i> = .442) and GFR 30–59 mL/min/1.73 m<sup>2</sup> (sHR 1.242, 95% CI: 0.80–1.63; <i>p</i> = .333), while in patients with GFR < 30 mL/min/1.73 m<sup>2</sup>, ND-CCB therapy was associated with increased hospitalizations due to poor HR control (sHR 4.53, 95% CI: 1.19–17.18; <i>p</i> = .026).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with GFR ≥ 30 mL/min/1.73 m<sup>2</sup>, the choice of ND-CCB or BB had no impact on hospitalizations due to poor HR control, while in GFR < 30 mL/min/1.73 m<sup>2</sup>, a possible association was detected. The effects of these drugs on GFR < 30 mL/min/1.73 m<sup>2</sup> would require further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140648171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hai-Wei Deng MD, Rui Fan MD, Yuan-Sheng Zhai MD, Jie Li MD, Zhi-Bin Huang MD, PhD, Long-Yun Peng MD, PhD
Background
Cancer patients are increasingly affected by chemotherapy-related cardiac dysfunction. The reported incidence of this condition vary significantly across different studies.
Hypothesis
A better comprehensive understanding of chemotherapy-related cardiac dysfunction incidence in cancer patients is imperative. Therefore, we performed a meta-analysis to establish the overall incidence of chemotherapy-related cardiac dysfunction in cancer patients.
Methods
We searched articles in PubMed and EMBASE from database inception to May 1, 2023. Studies that reported the incidence of chemotherapy-related cardiac dysfunction in cancer patients were included.
Results
A total of 53 studies involving 35 651 individuals were finally included in the meta-analysis. The overall pooled incidence of chemotherapy-related cardiac dysfunction in cancer patients was 63.21 per 1000 person-years (95% CI: 57.28−69.14). The chemotherapy-related cardiac dysfunction incidence increased steeply within half a year of cancer chemotherapy. Also, the trend of chemotherapy-related cardiac dysfunction incidence appeared to have plateaued after a longer duration of follow-up. In addition, chemotherapy-related cardiac dysfunction incidence rates are significantly higher among patients with age ≥50 years versus patients with age <50 years (99.96 vs. 34.48 per 1000 person-years). The incidence rate of cardiac dysfunction was higher among breast cancer patients (72.97 per 1000 person-years), leukemia patients (65.21 per 1000 person-years), and lymphoma patients (55.43 per 1000 person-years).
Conclusion
Our meta-analysis unveiled a definitive overall incidence rate of chemotherapy-related cardiac dysfunction in cancer patients. In addition, it was found that the risk of developing this condition escalates within the initial 6 months postchemotherapy, subsequently tapering off to become statistically insignificant after a duration of 6 years.
{"title":"Incidence of chemotherapy-related cardiac dysfunction in cancer patients","authors":"Hai-Wei Deng MD, Rui Fan MD, Yuan-Sheng Zhai MD, Jie Li MD, Zhi-Bin Huang MD, PhD, Long-Yun Peng MD, PhD","doi":"10.1002/clc.24269","DOIUrl":"https://doi.org/10.1002/clc.24269","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cancer patients are increasingly affected by chemotherapy-related cardiac dysfunction. The reported incidence of this condition vary significantly across different studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>A better comprehensive understanding of chemotherapy-related cardiac dysfunction incidence in cancer patients is imperative. Therefore, we performed a meta-analysis to establish the overall incidence of chemotherapy-related cardiac dysfunction in cancer patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched articles in PubMed and EMBASE from database inception to May 1, 2023. Studies that reported the incidence of chemotherapy-related cardiac dysfunction in cancer patients were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 53 studies involving 35 651 individuals were finally included in the meta-analysis. The overall pooled incidence of chemotherapy-related cardiac dysfunction in cancer patients was 63.21 per 1000 person-years (95% CI: 57.28−69.14). The chemotherapy-related cardiac dysfunction incidence increased steeply within half a year of cancer chemotherapy. Also, the trend of chemotherapy-related cardiac dysfunction incidence appeared to have plateaued after a longer duration of follow-up. In addition, chemotherapy-related cardiac dysfunction incidence rates are significantly higher among patients with age ≥50 years versus patients with age <50 years (99.96 vs. 34.48 per 1000 person-years). The incidence rate of cardiac dysfunction was higher among breast cancer patients (72.97 per 1000 person-years), leukemia patients (65.21 per 1000 person-years), and lymphoma patients (55.43 per 1000 person-years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our meta-analysis unveiled a definitive overall incidence rate of chemotherapy-related cardiac dysfunction in cancer patients. In addition, it was found that the risk of developing this condition escalates within the initial 6 months postchemotherapy, subsequently tapering off to become statistically insignificant after a duration of 6 years.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianan Li BS, Jie Zhang BS, Dan Su BS, Sanru Lin BS, Yujie Huang BS, Shujing Wu MD, Demin Xu MS
Background
Earlier studies showed a negative correlation between life's simple 7 (LS7) and high-sensitivity C-reactive protein (hs-CRP), but no association has been found between life's essential 8 (LE8), an improved version of LS7, and hs-CRP.
Hypothesis
This study investigated the association between LE8 and hs-CRP utilizing data from the National Health and Nutritional Examination Survey.
Methods
A total of 7229 adults were incorporated in our study. LE8 was scored according to American Heart Association guidelines, and LE8 was divided into health behaviors and health factors. Serum samples of the participants were used to measure hs-CRP. To investigate the association between LE8 and hs-CRP, weighted linear regression, and restricted cubic spline were utilized.
Results
Among 7229 participants, the average age was 48.03 ± 16.88 years, 3689 (51.2%) were females and the median hs-CRP was 1.92 (0.81−4.49) mg/L. In adjusted weighted linear regression, a negative correlation was observed between the LE8 score and hs-CRP. Compared with the low LE8 score, the moderate LE8 score β was −0.533 (−0.646 to −0.420), and the high LE8 score β was −1.237 (−1.376 to −1.097). Health behaviors and health factors were also negatively associated with hs-CRP. In stratified analyses, the negative correlation between LE8 and hs-CRP remained consistent across subgroups.
Conclusion
There was a negative correlation between LE8 as well as its sub-indicator scores and hs-CRP. Maintaining a positive LE8 score may be conducive to lowering the level of hs-CRP.
{"title":"Association between Life's Essential 8 score and high-sensitivity C-reactive protein: A cross-sectional study from NHANES 2015−2018","authors":"Jianan Li BS, Jie Zhang BS, Dan Su BS, Sanru Lin BS, Yujie Huang BS, Shujing Wu MD, Demin Xu MS","doi":"10.1002/clc.24270","DOIUrl":"https://doi.org/10.1002/clc.24270","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Earlier studies showed a negative correlation between life's simple 7 (LS7) and high-sensitivity C-reactive protein (hs-CRP), but no association has been found between life's essential 8 (LE8), an improved version of LS7, and hs-CRP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study investigated the association between LE8 and hs-CRP utilizing data from the National Health and Nutritional Examination Survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 7229 adults were incorporated in our study. LE8 was scored according to American Heart Association guidelines, and LE8 was divided into health behaviors and health factors. Serum samples of the participants were used to measure hs-CRP. To investigate the association between LE8 and hs-CRP, weighted linear regression, and restricted cubic spline were utilized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 7229 participants, the average age was 48.03 ± 16.88 years, 3689 (51.2%) were females and the median hs-CRP was 1.92 (0.81−4.49) mg/L. In adjusted weighted linear regression, a negative correlation was observed between the LE8 score and hs-CRP. Compared with the low LE8 score, the moderate LE8 score <i>β</i> was −0.533 (−0.646 to −0.420), and the high LE8 score <i>β</i> was −1.237 (−1.376 to −1.097). Health behaviors and health factors were also negatively associated with hs-CRP. In stratified analyses, the negative correlation between LE8 and hs-CRP remained consistent across subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was a negative correlation between LE8 as well as its sub-indicator scores and hs-CRP. Maintaining a positive LE8 score may be conducive to lowering the level of hs-CRP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140559525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We analyzed the influence of the QRS duration (QRSd) to LV end-diastolic volume (LVEDV) ratio on cardiac resynchronization therapy (CRT) outcomes in heart failure patients classified as III/IV per the New York Heart Association (NYHA) and with small body size.
Hypothesis
We proposed the hypothesis that the QRSd/LV size ratio is a better index of the CRT substrate.
Methods
We enrolled 114 patients with advanced heart failure (NYHA class III/IV, and LV ejection fraction >35%) who received a CRT device, including those with left bundle branch block (LBBB) and QRSd ≥120 milliseconds (n = 60), non-LBBB and QRSd ≥150 milliseconds (n = 30) and non-LBBB and QRSd of 120−149 milliseconds (n = 24).
Results
Over a mean follow-up period of 65 ± 58 months, the incidence of the primary endpoint, a composite of all-cause death and hospitalization for heart failure, showed no significant intergroup difference (43.3% vs. 50.0% vs. 37.5%, respectively, p = .72). Similarly, among 104 patients with QRSd/LVEDV ≥ 0.67 (n = 54) and QRSd/LVEDV < 0.67 (n = 52), no significant differences were observed in the incidence of the primary endpoint (35.1% vs. 51.9%, p = .49). Nevertheless, patients with QRSd/LVEDV ≥ 0.67 showed better survival than those with QRSd/LVEDV < 0.67 (14.8% vs. 34.6%, p = .0024).
Conclusion
Advanced HF patients with a higher QRSd/LVEDV ratio showed better survival in this small-body–size population. Thus, the risk is concentrated among those with a larger QRSd, and patients with a relatively smaller left ventricular size appeared to benefit from CRT.
{"title":"Interaction of left ventricular size with the outcome of cardiac resynchronization therapy in Japanese patients","authors":"Ryo Ito MD, PhD, Yusuke Kondo MD, PhD, FESC, Masahiro Nakano MD, PhD, Takatsugu Kajiyama MD, PhD, Miyo Nakano MD, PhD, Mari Kitagawa MD, PhD, Masafumi Sugawara MD, Toshinori Chiba MD, Yoshio Kobayashi MD, PhD","doi":"10.1002/clc.24267","DOIUrl":"https://doi.org/10.1002/clc.24267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We analyzed the influence of the QRS duration (QRSd) to LV end-diastolic volume (LVEDV) ratio on cardiac resynchronization therapy (CRT) outcomes in heart failure patients classified as III/IV per the New York Heart Association (NYHA) and with small body size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We proposed the hypothesis that the QRSd/LV size ratio is a better index of the CRT substrate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 114 patients with advanced heart failure (NYHA class III/IV, and LV ejection fraction >35%) who received a CRT device, including those with left bundle branch block (LBBB) and QRSd ≥120 milliseconds (<i>n</i> = 60), non-LBBB and QRSd ≥150 milliseconds (<i>n</i> = 30) and non-LBBB and QRSd of 120−149 milliseconds (<i>n</i> = 24).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a mean follow-up period of 65 ± 58 months, the incidence of the primary endpoint, a composite of all-cause death and hospitalization for heart failure, showed no significant intergroup difference (43.3% vs. 50.0% vs. 37.5%, respectively, <i>p</i> = .72). Similarly, among 104 patients with QRSd/LVEDV ≥ 0.67 (<i>n</i> = 54) and QRSd/LVEDV < 0.67 (<i>n</i> = 52), no significant differences were observed in the incidence of the primary endpoint (35.1% vs. 51.9%, <i>p</i> = .49). Nevertheless, patients with QRSd/LVEDV ≥ 0.67 showed better survival than those with QRSd/LVEDV < 0.67 (14.8% vs. 34.6%, <i>p</i> = .0024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Advanced HF patients with a higher QRSd/LVEDV ratio showed better survival in this small-body–size population. Thus, the risk is concentrated among those with a larger QRSd, and patients with a relatively smaller left ventricular size appeared to benefit from CRT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140553075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiong Huang MS, Yuansheng Fan MS, Jialin Wang BS, Zhiyang Xu MS, Linfeng Yang BS, Junhong Wang MD, PhD, Yiyang Zhan MD, PhD, Xiangqing Kong MD, PhD, Ningtian Zhou MD, PhD
Background
Electrocardiography (ECG) and 24 hours Holter monitoring (24 h-Holter) provided valuable information for premature ventricular and supraventricular contractions (PVC and PSVC). Currently, artificial intelligence (AI) based 2 hours single-lead Holter (2 h-Holter) monitoring may provide an improved strategy for PSVC/PVC diagnosis.
Hypothesis
AI combined with single-lead Holter monitoring improves PSVC/PVC detection.
Methods
In total, 170 patients were enrolled between August 2022 and 2023. All patients wore both devices simultaneously; then, we compared diagnostic efficiency, including the sensitivity/specificity/positive predictive-value (PPV) and negative predictive-value (NPV) in detecting PSVC/PVC by 24 h-Holter and 2 h-Holter.
Results
The PPV and NPV in patients underwent 2 h-Holter were 76.00%/87.50% and 96.35%/98.55, respectively, and the sensitivity and specificity were 79.17%/91.30%, and 95.65%/97.84% in PSVC/PVC detection compared with 24 h-Holter. The areas under the ROC curves (AUCs) for PSVC and PVC were 0.885 and 0.741, respectively (p < .0001).
Conclusions
The potential advantages of the 2 h-Holter were shortened wearing period, improved convenience, and excellent consistency of diagnosis.
{"title":"The diagnostic efficiency of artificial intelligence based 2 hours Holter monitoring in premature ventricular and supraventricular contractions detection","authors":"Qiong Huang MS, Yuansheng Fan MS, Jialin Wang BS, Zhiyang Xu MS, Linfeng Yang BS, Junhong Wang MD, PhD, Yiyang Zhan MD, PhD, Xiangqing Kong MD, PhD, Ningtian Zhou MD, PhD","doi":"10.1002/clc.24266","DOIUrl":"https://doi.org/10.1002/clc.24266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electrocardiography (ECG) and 24 hours Holter monitoring (24 h-Holter) provided valuable information for premature ventricular and supraventricular contractions (PVC and PSVC). Currently, artificial intelligence (AI) based 2 hours single-lead Holter (2 h-Holter) monitoring may provide an improved strategy for PSVC/PVC diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>AI combined with single-lead Holter monitoring improves PSVC/PVC detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 170 patients were enrolled between August 2022 and 2023. All patients wore both devices simultaneously; then, we compared diagnostic efficiency, including the sensitivity/specificity/positive predictive-value (PPV) and negative predictive-value (NPV) in detecting PSVC/PVC by 24 h-Holter and 2 h-Holter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PPV and NPV in patients underwent 2 h-Holter were 76.00%/87.50% and 96.35%/98.55, respectively, and the sensitivity and specificity were 79.17%/91.30%, and 95.65%/97.84% in PSVC/PVC detection compared with 24 h-Holter. The areas under the ROC curves (AUCs) for PSVC and PVC were 0.885 and 0.741, respectively (<i>p</i> < .0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The potential advantages of the 2 h-Holter were shortened wearing period, improved convenience, and excellent consistency of diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xue Liang, Xinyu Li, Guosheng Li, Bing Wang, Yudan Liu, Dongli Sun, Li Liu, Ran Zhang, Shukun Ji, Wanying Yan, Ruize Yu, Zhengnan Gao, Xuhan Liu
Background
Recently, patients with type 2 diabetes mellitus (T2DM) have experienced a higher incidence and severer degree of vascular calcification (VC), which leads to an increase in the incidence and mortality of vascular complications in patients with T2DM.
Hypothesis
To construct and validate prediction models for the risk of VC in patients with T2DM.
Methods
Twenty-three baseline demographic and clinical characteristics were extracted from the electronic medical record system. Ten clinical features were screened with least absolute shrinkage and selection operator method and were used to develop prediction models based on eight machine learning (ML) algorithms (k-nearest neighbor [k-NN], light gradient boosting machine, logistic regression [LR], multilayer perception [(MLP], Naive Bayes [NB], random forest [RF], support vector machine [SVM], XGBoost [XGB]). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and precision.
Results
A total of 1407 and 352 patients were retrospectively collected in the training and test sets, respectively. Among the eight models, the AUC value in the NB model was higher than the other models (NB: 0.753, LGB: 0.719, LR: 0.749, MLP: 0.715, RF: 0.722, SVM: 0.689, XGB:0.707, p < .05 for all). The k-NN model achieved the highest sensitivity of 0.75 (95% confidence interval [CI]: 0.633–0.857), the MLP model achieved the highest accuracy of 0.81 (95% CI: 0.767–0.852) and specificity of 0.875 (95% CI: 0.836–0.912).
Conclusions
This study developed a predictive model of VC based on ML and clinical features in type 2 diabetic patients. The NB model is a tool with potential to facilitate clinicians in identifying VC in high-risk patients.
{"title":"A machine learning approach to predicting vascular calcification risk of type 2 diabetes: A retrospective study","authors":"Xue Liang, Xinyu Li, Guosheng Li, Bing Wang, Yudan Liu, Dongli Sun, Li Liu, Ran Zhang, Shukun Ji, Wanying Yan, Ruize Yu, Zhengnan Gao, Xuhan Liu","doi":"10.1002/clc.24264","DOIUrl":"10.1002/clc.24264","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recently, patients with type 2 diabetes mellitus (T2DM) have experienced a higher incidence and severer degree of vascular calcification (VC), which leads to an increase in the incidence and mortality of vascular complications in patients with T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>To construct and validate prediction models for the risk of VC in patients with T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-three baseline demographic and clinical characteristics were extracted from the electronic medical record system. Ten clinical features were screened with least absolute shrinkage and selection operator method and were used to develop prediction models based on eight machine learning (ML) algorithms (<i>k</i>-nearest neighbor [<i>k</i>-NN], light gradient boosting machine, logistic regression [LR], multilayer perception [(MLP], Naive Bayes [NB], random forest [RF], support vector machine [SVM], XGBoost [XGB]). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and precision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1407 and 352 patients were retrospectively collected in the training and test sets, respectively. Among the eight models, the AUC value in the NB model was higher than the other models (NB: 0.753, LGB: 0.719, LR: 0.749, MLP: 0.715, RF: 0.722, SVM: 0.689, XGB:0.707, <i>p</i> < .05 for all). The <i>k</i>-NN model achieved the highest sensitivity of 0.75 (95% confidence interval [CI]: 0.633–0.857), the MLP model achieved the highest accuracy of 0.81 (95% CI: 0.767–0.852) and specificity of 0.875 (95% CI: 0.836–0.912).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study developed a predictive model of VC based on ML and clinical features in type 2 diabetic patients. The NB model is a tool with potential to facilitate clinicians in identifying VC in high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ying Liu MM, Wen Li MM, Shuoyan An MD, Zhengqin Zhai MD, Xinju Liu RN, Mengxue Hei MBBS, Gailing Chen MD, PhD
Background
In recent years, the mortality of patients with AMI has not declined significantly. The relationship between blood pressure variability (BPV) and acute myocardial infarction (AMI) is unclear. We explored the relationship between 24-h BPV and mortality in patients with AMI.
Hypothesis
The mortality of patients with AMI is related to BPV. We hope to provide therapeutic ideas for reducing the risk of death in patients with AMI.
Methods
This is a retrospective cohort study. We extracted and analyzed data from the MIMIC-IV 2.0, which was established in 1999 under the auspices of the National Institutes of Health (America). The average real variability (ARV) was calculated for the first 24-h blood pressure measurement after patients with AMI were admitted to the intensive care unit (ICU). Patients were divided into four groups according to ARV quartiles. The outcomes were 30-day, 1-year, and 3-year all-cause mortalities. Data were analyzed using Cox regression, Kaplan–Meier curves, and restricted cubic spline (RCS) curves.
Results
We enrolled 1291 patients with AMI, including 475 female. The patients were divided into four groups according to the qualities of diastolic blood pressure (DBP)-ARV. There were significant differences in the 30-day, 1-year and 3-year mortality among the four groups (p = .02, p < .001, p < .001, respectively). After adjustment for confounding factors, systolic blood pressure (SBP)-ARV could not predict AMI patient mortality (p > .05), while the highest DBP-ARV was associated strongly with increased 30-day mortality (HR: 2.291, 95% CI 1.260-4.168), 1-year mortality (HR: 1.933, 95% CI 1.316-2.840) and 3-year mortality (HR: 1.743, 95% CI 1.235-2.461). Kaplan–Meier curves demonstrated that, regardless of SBP or DBP, the long-term survival probabilities of patients in the highest ARV group were significantly lower than that of those in other groups. RCS curves showed that the death risk of patients with AMI first decreased and then increased with the increase in ARV when DBP-ARV < 8.04. The 30-day death risk first increased and then decreased, and the 1-year and 3-year death risks increased and then stabilized with ARV increase when DBP-ARV > 8.04.
Conclusion
This study showed that patients with AMI ma
背景：近年来，急性心肌梗死患者的死亡率并未明显下降。血压变异性（BPV）与急性心肌梗死（AMI）之间的关系尚不清楚。我们探讨了 24 小时血压变异与急性心肌梗死患者死亡率之间的关系：假设：急性心肌梗死患者的死亡率与血压波动有关。我们希望为降低 AMI 患者的死亡风险提供治疗思路：这是一项回顾性队列研究。我们从 MIMIC-IV 2.0 中提取并分析了数据，MIMIC-IV 2.0 于 1999 年在美国国立卫生研究院（National Institutes of Health）的支持下建立。我们计算了急性心肌梗死患者入住重症监护室（ICU）后首次 24 小时血压测量的平均实际变异率（ARV）。根据 ARV 四分位数将患者分为四组。结果为 30 天、1 年和 3 年全因死亡率。数据采用 Cox 回归、Kaplan-Meier 曲线和限制性立方样条曲线（RCS）进行分析：我们共收治了 1291 名 AMI 患者，其中包括 475 名女性。根据舒张压（DBP）-ARV 的质量将患者分为四组。四组患者的 30 天、1 年和 3 年死亡率存在明显差异（P = .02，P .05），而最高 DBP-ARV 与 30 天死亡率（HR：2.291，95% CI 1.260-4.168）、1 年死亡率（HR：1.933，95% CI 1.316-2.840）和 3 年死亡率（HR：1.743，95% CI 1.235-2.461）的增加密切相关。Kaplan-Meier 曲线显示，无论 SBP 或 DBP 如何，抗逆转录病毒药物剂量最高组患者的长期生存概率均显著低于其他组别。RCS曲线显示，当DBP-ARV为8.04时，随着ARV的增加，AMI患者的死亡风险先下降后上升：本研究表明，如果急性心肌梗死患者在入住重症监护室的前 24 小时内 DBP-ARV 升高或降低，其短期和长期死亡风险都会增加。
{"title":"Relationship between 24 h blood pressure variability and mortality in acute myocardial infarction patients","authors":"Ying Liu MM, Wen Li MM, Shuoyan An MD, Zhengqin Zhai MD, Xinju Liu RN, Mengxue Hei MBBS, Gailing Chen MD, PhD","doi":"10.1002/clc.24261","DOIUrl":"10.1002/clc.24261","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In recent years, the mortality of patients with AMI has not declined significantly. The relationship between blood pressure variability (BPV) and acute myocardial infarction (AMI) is unclear. We explored the relationship between 24-h BPV and mortality in patients with AMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The mortality of patients with AMI is related to BPV. We hope to provide therapeutic ideas for reducing the risk of death in patients with AMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study. We extracted and analyzed data from the MIMIC-IV 2.0, which was established in 1999 under the auspices of the National Institutes of Health (America). The average real variability (ARV) was calculated for the first 24-h blood pressure measurement after patients with AMI were admitted to the intensive care unit (ICU). Patients were divided into four groups according to ARV quartiles. The outcomes were 30-day, 1-year, and 3-year all-cause mortalities. Data were analyzed using Cox regression, Kaplan–Meier curves, and restricted cubic spline (RCS) curves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 1291 patients with AMI, including 475 female. The patients were divided into four groups according to the qualities of diastolic blood pressure (DBP)-ARV. There were significant differences in the 30-day, 1-year and 3-year mortality among the four groups (<i>p</i> = .02, <i>p</i> < .001, <i>p</i> < .001, respectively). After adjustment for confounding factors, systolic blood pressure (SBP)-ARV could not predict AMI patient mortality (<i>p</i> > .05), while the highest DBP-ARV was associated strongly with increased 30-day mortality (HR: 2.291, 95% CI 1.260-4.168), 1-year mortality (HR: 1.933, 95% CI 1.316-2.840) and 3-year mortality (HR: 1.743, 95% CI 1.235-2.461). Kaplan–Meier curves demonstrated that, regardless of SBP or DBP, the long-term survival probabilities of patients in the highest ARV group were significantly lower than that of those in other groups. RCS curves showed that the death risk of patients with AMI first decreased and then increased with the increase in ARV when DBP-ARV < 8.04. The 30-day death risk first increased and then decreased, and the 1-year and 3-year death risks increased and then stabilized with ARV increase when DBP-ARV > 8.04.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study showed that patients with AMI ma","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amir Hossein Behnoush MD, MPH, Saba Maleki MD, Alireza Arzhangzadeh MD, Amirmohammad Khalaji MD, Parmida Sadat Pezeshki MD, Zahra Vaziri MD, Zahra Esmaeili MD, Pouya Ebrahimi MD, Haleh Ashraf MD, Farzad Masoudkabir MD, MPH, Ali Vasheghani-Farahani MD, Kaveh Hosseini MD, MPH, Mehdi Mehrani MD, Adrian V. Hernandez MD, PhD, FACC, FESC
Background
Unlike diabetes, the effect of prediabetes on outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) is not much investigated. We investigated the association between fasting glycemic status and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS undergoing PCI and had mid to long-term follow-up after coronary stenting.
Methods
Registry-based retrospective cohort study included ACS patients who underwent PCI at the Tehran Heart Center from 2015 to 2021 with a median follow-up of 378 days. Patients were allocated into normoglycemic, prediabetic, and diabetic groups. The primary and secondary outcomes were MACCE and its components, respectively. Unadjusted and adjusted Cox models were used to evaluate the association between glycemic status and outcomes.
Results
Among 13 682 patients, 3151 (23%) were prediabetic, and 5834 (42.6%) were diabetic. MACCE risk was significantly higher for diabetic versus normoglycemic (adjusted hazard ratio [aHR]: 1.22, 95% confidence interval [CI]: 1.06–1.41), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 0.95, 95% CI: 0.78–1.10). All-cause mortality risk was significantly higher in diabetic versus normoglycemic (aHR: 1.42, 95% CI: 1.08–1.86), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 1.15, 95% CI: 0.84–1.59). Among other components of MACCE, only coronary artery bypass grafting was significantly higher in diabetic patients, and not prediabetic, compared with normoglycemic.
Conclusions
Prediabetic ACS patients undergoing PCI, unlike diabetics, are not at increased risk of MACCE and all-cause mortality. While prediabetic patients could be regarded as having the same risk as nondiabetics, careful consideration to provide more intensive pre- and post-PCI care in diabetic patients is mandatory.
{"title":"Prediabetes and major adverse cardiac events after acute coronary syndrome: An overestimated concept","authors":"Amir Hossein Behnoush MD, MPH, Saba Maleki MD, Alireza Arzhangzadeh MD, Amirmohammad Khalaji MD, Parmida Sadat Pezeshki MD, Zahra Vaziri MD, Zahra Esmaeili MD, Pouya Ebrahimi MD, Haleh Ashraf MD, Farzad Masoudkabir MD, MPH, Ali Vasheghani-Farahani MD, Kaveh Hosseini MD, MPH, Mehdi Mehrani MD, Adrian V. Hernandez MD, PhD, FACC, FESC","doi":"10.1002/clc.24262","DOIUrl":"https://doi.org/10.1002/clc.24262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Unlike diabetes, the effect of prediabetes on outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) is not much investigated. We investigated the association between fasting glycemic status and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS undergoing PCI and had mid to long-term follow-up after coronary stenting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Registry-based retrospective cohort study included ACS patients who underwent PCI at the Tehran Heart Center from 2015 to 2021 with a median follow-up of 378 days. Patients were allocated into normoglycemic, prediabetic, and diabetic groups. The primary and secondary outcomes were MACCE and its components, respectively. Unadjusted and adjusted Cox models were used to evaluate the association between glycemic status and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 13 682 patients, 3151 (23%) were prediabetic, and 5834 (42.6%) were diabetic. MACCE risk was significantly higher for diabetic versus normoglycemic (adjusted hazard ratio [aHR]: 1.22, 95% confidence interval [CI]: 1.06–1.41), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 0.95, 95% CI: 0.78–1.10). All-cause mortality risk was significantly higher in diabetic versus normoglycemic (aHR: 1.42, 95% CI: 1.08–1.86), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 1.15, 95% CI: 0.84–1.59). Among other components of MACCE, only coronary artery bypass grafting was significantly higher in diabetic patients, and not prediabetic, compared with normoglycemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prediabetic ACS patients undergoing PCI, unlike diabetics, are not at increased risk of MACCE and all-cause mortality. While prediabetic patients could be regarded as having the same risk as nondiabetics, careful consideration to provide more intensive pre- and post-PCI care in diabetic patients is mandatory.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140333294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liping Dong MD, Ming Tian MD, Hua Li MD, Junwu Dong MD, Xiaohong Song MD
Background
The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown.
Hypothesis
We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD.
Methods
A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan–Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis.
Results
The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates.
Conclusions
The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.
背景：接受维持性血液透析（MHD）的患者在透析间期的家庭血压变异性（BPV）与预后之间的关系在很大程度上是未知的：我们提出的假设是，透析间期家庭血压变化对接受维持性血液透析（MHD）患者的心脏和全因死亡率有影响：本前瞻性队列研究纳入了 2019 年 12 月至 2020 年 8 月期间在武汉市第四医院血液透析室接受 MHD 治疗的 158 例患者。根据收缩压（SBPV）将患者分为三等分，主要终点为心脏死亡和全因死亡。Kaplan-Meier 分析用于评估长期生存与治疗间期家庭 SBPV 之间的关系。此外，还使用 Cox 比例危险回归模型来确定导致不良预后的风险因素：结果：患者心脏死亡和全因死亡的风险随 SBPV 的分层而逐渐增加（3.5% vs. 14.8% vs. 19.2%，p=0.021；11.5% vs. 27.8% vs. 44.2%，p=0.021）：研究结果表明，治疗间期家庭 SBPV 升高与 MHD 患者死亡风险升高呈正相关。
{"title":"Interdialytic home systolic blood pressure variability increases all-cause mortality in hemodialysis patients","authors":"Liping Dong MD, Ming Tian MD, Hua Li MD, Junwu Dong MD, Xiaohong Song MD","doi":"10.1002/clc.24259","DOIUrl":"10.1002/clc.24259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan–Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, <i>p</i> for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, <i>p</i> for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (<i>p</i> = .026) and 3.24 (<i>p</i> = .021), respectively, after adjustment for a series of covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140317901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rafael Y. Brzezinski PhD, Shmuel Banai MD, Malka Katz Shalhav DMD, Moshe Stark PhD, Ilana Goldiner PhD, Ori Rogowski MD, PhD, Itzhak Shapira MD, David Zeltser MD, Noa Sasson MPH, Shlomo Berliner MD, PhD, Yacov Shacham MD
Introduction
The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).
Methods
We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8–4.3].
Results
Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, p < 0.01). However, among patients with “normal” CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, p < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], p < 0.01 for patients with high troponin and high CRP levels).
Conclusions
Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with “normal” CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti-inflammatory therapies.
{"title":"The CRP troponin test (CTT) stratifies mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI)","authors":"Rafael Y. Brzezinski PhD, Shmuel Banai MD, Malka Katz Shalhav DMD, Moshe Stark PhD, Ilana Goldiner PhD, Ori Rogowski MD, PhD, Itzhak Shapira MD, David Zeltser MD, Noa Sasson MPH, Shlomo Berliner MD, PhD, Yacov Shacham MD","doi":"10.1002/clc.24256","DOIUrl":"10.1002/clc.24256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8–4.3].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, <i>p</i> < 0.01). However, among patients with “normal” CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, <i>p</i> < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], <i>p</i> < 0.01 for patients with high troponin and high CRP levels).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with “normal” CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti-inflammatory therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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