Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1399908
YuPei Zou, Jiarong Wang, Jichun Zhao, Yukui Ma, Bin Huang, Ding Yuan, Yang Liu, Maonan Han, Huatian Gan, Yi Yang
Objective: To evaluate the effect of malnutrition assessed by the Geriatric Nutritional Risk Index (GNRI) on major adverse cardiac and cerebrovascular events (MACCE) in the elderly patients after endovascular aortic aneurysm repair (EVAR).
Materials and methods: This was a retrospective cohort study of elderly patients who underwent EVAR in a tertiary hospital. Malnutrition status was assessed by the GNRI. The primary outcome was MACCE. The predictive ability of the GNRI was compared with both the Revised Cardiac Risk Index (RCRI) and the modified Frailty Index (mFI) using Receiver operating characteristic (ROC) curve.
Result: A total of 453 patients underwent EVAR November 2015 and January 2020 was retrospectively analyzed, equally divided into three (low/medium/high) groups according to GNRI values which ranked from low to high. Five (1.10%) patients were lost in follow-up after surgery, and the median length of follow-up was 28.00 (15.00-47.00) months. The high GNRI values reduced length of hospital stay following EVAR in comparison to patients in low GNRI values group (β 9.67, 95% CI 4.01-23.32, p = 0.0113; adjusted β -1.96, 95% CI -3.88, -0.05, p = 0.0454). GNRI status was associated with a significantly increased risk of long-term mortality after EVAR (Medium GNRI, unadjusted HR 0.40, 95%CI 0.23-0.70, p = 0.0014; adjusted HR 0.47, 95%CI 0.26-0.84, p = 0.0107; high GNRI, 0.27 95%CI 0.14-0.55; p = 0.0003; adjusted HR 0.32 95%CI 0.15-0.68, p = 0.0029). Both medium and high GNRI values were linked to significantly reduced risks of MACCE compared to low GNRI score patients (Medium GNRI, unadjusted HR 0.34, 95%CI 0.13-0.88, p = 0.00265; adjusted HR 0.37, 95%CI 0.14-0.96, p = 0.0408; High GNRI, 0.26 95%CI 0.09-0.78; p = 0.0168; adjusted HR 0.21 95%CI 0.06-0.73, p = 0.0029). Compared with the RCRI and mFI, the GNRI had better discrimination in predicting long-term MACCE. An area under the curve (AUC) for GNRI mFI, and RCRI is 0.707, 0.614 and 0.588, respectively. (Z statistic, GNRI vs. mFI, p = 0.0475; GNRI vs. RCRI, p = 0.0017).
Conclusion: Malnutrition assessed by the GNRI may serve as a useful predictor of long-term MACCE in elderly patients after EVAR, with preferable discrimination abilities compared with both RCRI and mFI.
{"title":"Predictive value of geriatric nutritional risk index in cardiac and cerebrovascular events after endovascular aortic aneurysm repair.","authors":"YuPei Zou, Jiarong Wang, Jichun Zhao, Yukui Ma, Bin Huang, Ding Yuan, Yang Liu, Maonan Han, Huatian Gan, Yi Yang","doi":"10.3389/fcvm.2024.1399908","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1399908","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of malnutrition assessed by the Geriatric Nutritional Risk Index (GNRI) on major adverse cardiac and cerebrovascular events (MACCE) in the elderly patients after endovascular aortic aneurysm repair (EVAR).</p><p><strong>Materials and methods: </strong>This was a retrospective cohort study of elderly patients who underwent EVAR in a tertiary hospital. Malnutrition status was assessed by the GNRI. The primary outcome was MACCE. The predictive ability of the GNRI was compared with both the Revised Cardiac Risk Index (RCRI) and the modified Frailty Index (mFI) using Receiver operating characteristic (ROC) curve.</p><p><strong>Result: </strong>A total of 453 patients underwent EVAR November 2015 and January 2020 was retrospectively analyzed, equally divided into three (low/medium/high) groups according to GNRI values which ranked from low to high. Five (1.10%) patients were lost in follow-up after surgery, and the median length of follow-up was 28.00 (15.00-47.00) months. The high GNRI values reduced length of hospital stay following EVAR in comparison to patients in low GNRI values group (β 9.67, 95% CI 4.01-23.32, <i>p</i> = 0.0113; adjusted β -1.96, 95% CI -3.88, -0.05, <i>p</i> = 0.0454). GNRI status was associated with a significantly increased risk of long-term mortality after EVAR (Medium GNRI, unadjusted HR 0.40, 95%CI 0.23-0.70, <i>p</i> = 0.0014; adjusted HR 0.47, 95%CI 0.26-0.84, <i>p</i> = 0.0107; high GNRI, 0.27 95%CI 0.14-0.55; <i>p</i> = 0.0003; adjusted HR 0.32 95%CI 0.15-0.68, <i>p</i> = 0.0029). Both medium and high GNRI values were linked to significantly reduced risks of MACCE compared to low GNRI score patients (Medium GNRI, unadjusted HR 0.34, 95%CI 0.13-0.88, <i>p</i> = 0.00265; adjusted HR 0.37, 95%CI 0.14-0.96, <i>p</i> = 0.0408; High GNRI, 0.26 95%CI 0.09-0.78; <i>p</i> = 0.0168; adjusted HR 0.21 95%CI 0.06-0.73, <i>p</i> = 0.0029). Compared with the RCRI and mFI, the GNRI had better discrimination in predicting long-term MACCE. An area under the curve (AUC) for GNRI mFI, and RCRI is 0.707, 0.614 and 0.588, respectively. (Z statistic, GNRI vs. mFI, <i>p</i> = 0.0475; GNRI vs. RCRI, <i>p</i> = 0.0017).</p><p><strong>Conclusion: </strong>Malnutrition assessed by the GNRI may serve as a useful predictor of long-term MACCE in elderly patients after EVAR, with preferable discrimination abilities compared with both RCRI and mFI.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461891","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}
Background: Previous studies have established a correlation between systemic lupus erythematosus (SLE) and cardiovascular health, but the potential causal effects of SLE on heart function and structure remain poorly understood. Cardiovascular magnetic resonance imaging (CMR), a novel non-invasive technique, provides a unique assessment of cardiovascular structure and function, making it an essential tool for evaluating the risk of heart disease. In this study, we performed a Mendelian randomization analysis to determine the causal relationship between SLE and CMR traits.
Methods: Genetic variants independently linked to SLE were selected from a genome-wide association study (GWAS) containing 5,201 cases and 9,066 controls as instrumental variables. A set of 82 CMR traits was obtained from a recent GWAS, serving as preclinical indicators and providing preliminary insights into the morphology and function of the four cardiac chambers and two aortic segments. Primary analysis employed a two-sample Mendelian randomization study using the inverse-variance weighted method. Heterogeneity testing, sensitivity analyses, and instrumental variable strength assessments confirmed the robustness of the findings.
Results: SLE exhibited a correlation with increased stroke volume (βLVSV = 0.007, P = 0.045), regional peak circumferential strain (βEcc_AHA_9 = 0.013, P = 0.002; βEcc_AHA_12 = 0.009, P = 0.043; βEcc_AHA_14 = 0.013, P = 0.006), and global peak circumferential strain of the LV (βEcc_global = 0.010, P = 0.022), as well as decreased regional radial strain (βErr_AHA_11 = -0.010, P = 0.017).
Conclusions: This research presents evidence of a potential causal association between traits of SLE and alterations in cardiac function, guiding cardiac examinations and disease prevention in lupus patients.
{"title":"Impact of systemic lupus erythematosus on cardiovascular morphologic and functional phenotypes: a Mendelian randomization analysis.","authors":"Zishan Lin, Wenfeng Wang, Bingjing Jiang, Jian He, Yanfang Xu","doi":"10.3389/fcvm.2024.1454645","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1454645","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have established a correlation between systemic lupus erythematosus (SLE) and cardiovascular health, but the potential causal effects of SLE on heart function and structure remain poorly understood. Cardiovascular magnetic resonance imaging (CMR), a novel non-invasive technique, provides a unique assessment of cardiovascular structure and function, making it an essential tool for evaluating the risk of heart disease. In this study, we performed a Mendelian randomization analysis to determine the causal relationship between SLE and CMR traits.</p><p><strong>Methods: </strong>Genetic variants independently linked to SLE were selected from a genome-wide association study (GWAS) containing 5,201 cases and 9,066 controls as instrumental variables. A set of 82 CMR traits was obtained from a recent GWAS, serving as preclinical indicators and providing preliminary insights into the morphology and function of the four cardiac chambers and two aortic segments. Primary analysis employed a two-sample Mendelian randomization study using the inverse-variance weighted method. Heterogeneity testing, sensitivity analyses, and instrumental variable strength assessments confirmed the robustness of the findings.</p><p><strong>Results: </strong>SLE exhibited a correlation with increased stroke volume (β<sub>LVSV</sub> = 0.007, <i>P</i> = 0.045), regional peak circumferential strain (β<sub>Ecc_AHA_9</sub> = 0.013, <i>P</i> = 0.002; β<sub>Ecc_AHA_12</sub> = 0.009, <i>P</i> = 0.043; β<sub>Ecc_AHA_14</sub> = 0.013, <i>P</i> = 0.006), and global peak circumferential strain of the LV (β<sub>Ecc_global</sub> = 0.010, <i>P</i> = 0.022), as well as decreased regional radial strain (β<sub>Err_AHA_11</sub> = -0.010, <i>P</i> = 0.017).</p><p><strong>Conclusions: </strong>This research presents evidence of a potential causal association between traits of SLE and alterations in cardiac function, guiding cardiac examinations and disease prevention in lupus patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461881","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1401609
Xue Gao, Ying Guo, Xiaoting Zhu, Chunlei Du, Beibei Ma, Yinghua Cui, Shuai Wang
Background: Cardiac rupture (CR) after acute myocardial infarction (AMI) is a fatal mechanical complication. The early identification of factors related to CR in high-risk cases may reduce mortality. The purpose of our study was to discover relevant risk factors for CR after AMI and in-hospital mortality from CR.
Methods: In this study, we enrolled 1,699 AMI cases from October 2013 to May 2020. A total of 51 cases were diagnosed with CR. Clinical diagnostic information was recorded and analyzed retrospectively. We randomly matched these cases with AMI patients without CR in a 1:4 ratio. Univariate and multivariate logistic regression and stratifying analysis were used to identify risk factors for CR. Univariate and multivariate Cox regression hazard analysis and stratifying analysis were used to assess predictors of in-hospital mortality from CR.
Results: The incidence of CR after AMI was 3.0% and in-hospital mortality was approximately 57%. Multivariate logistic regression analysis identified that white blood cell count, neutrophil percentage, anterior myocardial infarction, a Killip class of >II, and albumin level were independently associated with CR (p < 0.05). Stratifying analysis showed that age, systolic blood pressure, and bicarbonate were independent risk factors for female CR (p < 0.05) but not male CR. Triglyceride and cardiac troponin I were independent risk factors for male CR (p < 0.05) but not female CR. Anterior myocardial infarction, a Killip class of >II, and neutrophil percentage were independent risk factors for male and female CR (p < 0.05). Multivariate Cox regression analysis showed that the time from symptom to CR and the site of CR were independent predictors for in-hospital mortality from CR (p < 0.05). Stratification analysis indicated that risk factors did not differ based on gender, but platelet counts were predictors for in-hospital mortality in female and male CR.
Conclusion: Low albumin, a high white blood cell count, neutrophil percentage, anterior myocardial infarction, and a Killip class of >II were independent and significant predictors for CR. However, risk factors are different in male and female CR. The time from symptom to CR, the site of CR, and platelet counts were independent predictors for in-hospital mortality from CR. These may be helpful in the early and accurate identification of high-risk patients with CR and the assessment of prognosis. In addition, gender differences should be considered.
背景:急性心肌梗死(AMI)后的心脏破裂(CR)是一种致命的机械并发症。及早发现高危病例中与 CR 相关的因素可降低死亡率。我们的研究旨在发现急性心肌梗死后 CR 的相关风险因素以及 CR 的院内死亡率:在这项研究中,我们从 2013 年 10 月到 2020 年 5 月共登记了 1,699 例 AMI 病例。共有 51 例确诊为 CR。我们记录并回顾分析了临床诊断信息。我们将这些病例与无CR的AMI患者按1:4的比例随机配对。我们采用单变量和多变量逻辑回归及分层分析来确定CR的风险因素。采用单变量和多变量 Cox 回归危险分析及分层分析来评估 CR 院内死亡率的预测因素:结果:急性心肌梗死后 CR 的发生率为 3.0%,院内死亡率约为 57%。多变量逻辑回归分析发现,白细胞计数、中性粒细胞百分比、前心肌梗死、Killip分级>II级和白蛋白水平与CR独立相关(p p p II),中性粒细胞百分比是男性和女性CR的独立风险因素(p p 结论:低白蛋白、高白细胞计数和中性粒细胞百分比是男性和女性CR的独立风险因素:低白蛋白、高白细胞计数、中性粒细胞百分比、前心肌梗死和 Killip 分级大于 II 级是 CR 的独立且显著的预测因素。不过,男性和女性 CR 的风险因素有所不同。从出现症状到发生心肌梗死的时间、发生心肌梗死的部位和血小板计数是预测心肌梗死院内死亡率的独立因素。这些因素可能有助于早期准确识别 CR 高危患者并评估预后。此外,还应考虑性别差异。
{"title":"Factors related to cardiac rupture after acute myocardial infarction.","authors":"Xue Gao, Ying Guo, Xiaoting Zhu, Chunlei Du, Beibei Ma, Yinghua Cui, Shuai Wang","doi":"10.3389/fcvm.2024.1401609","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1401609","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rupture (CR) after acute myocardial infarction (AMI) is a fatal mechanical complication. The early identification of factors related to CR in high-risk cases may reduce mortality. The purpose of our study was to discover relevant risk factors for CR after AMI and in-hospital mortality from CR.</p><p><strong>Methods: </strong>In this study, we enrolled 1,699 AMI cases from October 2013 to May 2020. A total of 51 cases were diagnosed with CR. Clinical diagnostic information was recorded and analyzed retrospectively. We randomly matched these cases with AMI patients without CR in a 1:4 ratio. Univariate and multivariate logistic regression and stratifying analysis were used to identify risk factors for CR. Univariate and multivariate Cox regression hazard analysis and stratifying analysis were used to assess predictors of in-hospital mortality from CR.</p><p><strong>Results: </strong>The incidence of CR after AMI was 3.0% and in-hospital mortality was approximately 57%. Multivariate logistic regression analysis identified that white blood cell count, neutrophil percentage, anterior myocardial infarction, a Killip class of >II, and albumin level were independently associated with CR (<i>p</i> < 0.05). Stratifying analysis showed that age, systolic blood pressure, and bicarbonate were independent risk factors for female CR (<i>p</i> < 0.05) but not male CR. Triglyceride and cardiac troponin I were independent risk factors for male CR (<i>p</i> < 0.05) but not female CR. Anterior myocardial infarction, a Killip class of >II, and neutrophil percentage were independent risk factors for male and female CR (<i>p</i> < 0.05). Multivariate Cox regression analysis showed that the time from symptom to CR and the site of CR were independent predictors for in-hospital mortality from CR (<i>p</i> < 0.05). Stratification analysis indicated that risk factors did not differ based on gender, but platelet counts were predictors for in-hospital mortality in female and male CR.</p><p><strong>Conclusion: </strong>Low albumin, a high white blood cell count, neutrophil percentage, anterior myocardial infarction, and a Killip class of >II were independent and significant predictors for CR. However, risk factors are different in male and female CR. The time from symptom to CR, the site of CR, and platelet counts were independent predictors for in-hospital mortality from CR. These may be helpful in the early and accurate identification of high-risk patients with CR and the assessment of prognosis. In addition, gender differences should be considered.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461879","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1456777
Pei-Shan Chien, Tzu-Jung Wong, An-Shun Tai, Yau-Huo Shr, Tsung Yu
Background: The Mendelian randomization approach uses genetic variants as instrumental variables to study the causal association between the risk factors and health outcomes of interest. We aimed to examine the relation between alcohol consumption and cardiovascular risk factors using two genetic variants as instrumental variables: alcohol dehydrogenase 1B (ADH1B) rs1229984 and aldehyde dehydrogenase 2 (ALDH2) rs671.
Methods: Using data collected in the Taiwan Biobank-an ongoing, prospective, population-based cohort study-our analysis included 129,032 individuals (46,547 men and 82,485 women) with complete data on ADH1B rs1229984 and ALDH2 rs671 genotypes and alcohol drinking status. We conducted instrumental variables regression analysis to examine the relationship between alcohol drinking and body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated hemoglobin (HbA1c), triglycerides, high-density lipoprotein cholesterol (HDLc), and low-density lipoprotein cholesterol (LDLc).
Results: In the rs1229984-instrumented analysis, alcohol drinking was only associated with higher levels of SBP in men and lower levels of DBP in women. In the rs671-instrumented analysis, alcohol drinking was associated with higher levels of BMI, SBP, DBP, fasting glucose, triglycerides, HDLc and lower levels of LDLc in men; alcohol drinking was associated with higher levels of HDLc and lower levels of SBP, HbA1c, and triglycerides in women.
Conclusion: Using Mendelian randomization analysis, some of our study results among men echoed findings from the previous systematic review, suggesting that alcohol drinking may be causally associated with higher levels of BMI, SBP, DBP, fasting glucose, triglycerides, HDLc, and lower levels of LDLc. Although alcohol drinking is beneficial to a few cardiovascular risk factors, it is detrimental to many others. The assumptions that underlie the Mendelian randomization approach should also be carefully examined when interpreting findings from such studies.
{"title":"Examining the causal association between moderate alcohol consumption and cardiovascular risk factors in the Taiwan Biobank: a Mendelian randomization analysis.","authors":"Pei-Shan Chien, Tzu-Jung Wong, An-Shun Tai, Yau-Huo Shr, Tsung Yu","doi":"10.3389/fcvm.2024.1456777","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1456777","url":null,"abstract":"<p><strong>Background: </strong>The Mendelian randomization approach uses genetic variants as instrumental variables to study the causal association between the risk factors and health outcomes of interest. We aimed to examine the relation between alcohol consumption and cardiovascular risk factors using two genetic variants as instrumental variables: alcohol dehydrogenase 1B (<i>ADH1B</i>) rs1229984 and aldehyde dehydrogenase 2 (<i>ALDH2</i>) rs671.</p><p><strong>Methods: </strong>Using data collected in the Taiwan Biobank-an ongoing, prospective, population-based cohort study-our analysis included 129,032 individuals (46,547 men and 82,485 women) with complete data on <i>ADH1B</i> rs1229984 and <i>ALDH2</i> rs671 genotypes and alcohol drinking status. We conducted instrumental variables regression analysis to examine the relationship between alcohol drinking and body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated hemoglobin (HbA1c), triglycerides, high-density lipoprotein cholesterol (HDLc), and low-density lipoprotein cholesterol (LDLc).</p><p><strong>Results: </strong>In the rs1229984-instrumented analysis, alcohol drinking was only associated with higher levels of SBP in men and lower levels of DBP in women. In the rs671-instrumented analysis, alcohol drinking was associated with higher levels of BMI, SBP, DBP, fasting glucose, triglycerides, HDLc and lower levels of LDLc in men; alcohol drinking was associated with higher levels of HDLc and lower levels of SBP, HbA1c, and triglycerides in women.</p><p><strong>Conclusion: </strong>Using Mendelian randomization analysis, some of our study results among men echoed findings from the previous systematic review, suggesting that alcohol drinking may be causally associated with higher levels of BMI, SBP, DBP, fasting glucose, triglycerides, HDLc, and lower levels of LDLc. Although alcohol drinking is beneficial to a few cardiovascular risk factors, it is detrimental to many others. The assumptions that underlie the Mendelian randomization approach should also be carefully examined when interpreting findings from such studies.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461878","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1402672
Yang Qian, Lei Wanlin, Wang Maofeng
Objective: This study aimed to develop a predictive model for assessing bleeding risk in dual antiplatelet therapy (DAPT) patients.
Methods: A total of 18,408 DAPT patients were included. Data on patients' demographics, clinical features, underlying diseases, past history, and laboratory examinations were collected from Affiliated Dongyang Hospital of Wenzhou Medical University. The patients were randomly divided into two groups in a proportion of 7:3, with the most used for model development and the remaining for internal validation. LASSO regression, multivariate logistic regression, and six machine learning models, including random forest (RF), k-nearest neighbor imputing (KNN), decision tree (DT), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and Support Vector Machine (SVM), were used to develop prediction models. Model prediction performance was evaluated using area under the curve (AUC), calibration curves, decision curve analysis (DCA), clinical impact curve (CIC), and net reduction curve (NRC).
Results: The XGBoost model demonstrated the highest AUC. The model features were comprised of seven clinical variables, including: HGB, PLT, previous bleeding, cerebral infarction, sex, Surgical history, and hypertension. A nomogram was developed based on seven variables. The AUC of the model was 0.861 (95% CI 0.847-0.875) in the development cohort and 0.877 (95% CI 0.856-0.898) in the validation cohort, indicating that the model had good differential performance. The results of calibration curve analysis showed that the calibration curve of this nomogram model was close to the ideal curve. The clinical decision curve also showed good clinical net benefit of the nomogram model.
Conclusions: This study successfully developed a predictive model for estimating bleeding risk in DAPT patients. It has the potential to optimize treatment planning, improve patient outcomes, and enhance resource utilization.
{"title":"Machine learning derived model for the prediction of bleeding in dual antiplatelet therapy patients.","authors":"Yang Qian, Lei Wanlin, Wang Maofeng","doi":"10.3389/fcvm.2024.1402672","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1402672","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a predictive model for assessing bleeding risk in dual antiplatelet therapy (DAPT) patients.</p><p><strong>Methods: </strong>A total of 18,408 DAPT patients were included. Data on patients' demographics, clinical features, underlying diseases, past history, and laboratory examinations were collected from Affiliated Dongyang Hospital of Wenzhou Medical University. The patients were randomly divided into two groups in a proportion of 7:3, with the most used for model development and the remaining for internal validation. LASSO regression, multivariate logistic regression, and six machine learning models, including random forest (RF), k-nearest neighbor imputing (KNN), decision tree (DT), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and Support Vector Machine (SVM), were used to develop prediction models. Model prediction performance was evaluated using area under the curve (AUC), calibration curves, decision curve analysis (DCA), clinical impact curve (CIC), and net reduction curve (NRC).</p><p><strong>Results: </strong>The XGBoost model demonstrated the highest AUC. The model features were comprised of seven clinical variables, including: HGB, PLT, previous bleeding, cerebral infarction, sex, Surgical history, and hypertension. A nomogram was developed based on seven variables. The AUC of the model was 0.861 (95% CI 0.847-0.875) in the development cohort and 0.877 (95% CI 0.856-0.898) in the validation cohort, indicating that the model had good differential performance. The results of calibration curve analysis showed that the calibration curve of this nomogram model was close to the ideal curve. The clinical decision curve also showed good clinical net benefit of the nomogram model.</p><p><strong>Conclusions: </strong>This study successfully developed a predictive model for estimating bleeding risk in DAPT patients. It has the potential to optimize treatment planning, improve patient outcomes, and enhance resource utilization.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461883","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1495936
Iosif Xenogiannis, Antonis N Pavlidis, Grigorios V Karamasis
{"title":"Editorial: Contemporary percutaneous interventions for coronary chronic total occlusions.","authors":"Iosif Xenogiannis, Antonis N Pavlidis, Grigorios V Karamasis","doi":"10.3389/fcvm.2024.1495936","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1495936","url":null,"abstract":"","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461875","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}
Background and aims: Ultrasound derived carotid intima-media thickness (cIMT) is valuable for cardiovascular risk stratification. We assessed the relative importance of traditional atherosclerosis risk factors and plasma proteins in predicting cIMT measured nearly a decade later.
Method: We examined 6,136 UK Biobank participants with 1,461 proteins profiled using the proximity extension assay applied to their baseline blood draw who subsequently underwent a cIMT measurement. We implemented linear regression, stepwise Akaike Information Criterion-based, and the least absolute shrinkage and selection operator (LASSO) models to identify potential proteomic as well as non-proteomic predictors. We evaluated our model performance using the proportion variance explained (R2).
Result: The mean time from baseline assessment to cIMT measurement was 9.2 years. Age, blood pressure, and anthropometric related variables were the strongest predictors of cIMT with fat-free mass index of the truncal region being the strongest predictor among adiposity measurements. A LASSO model incorporating variables including age, assessment center, genetic risk factors, smoking, blood pressure, trunk fat-free mass index, apolipoprotein B, and Townsend deprivation index combined with 97 proteins achieved the highest R2 (0.308, 95% C.I. 0.274, 0.341). In contrast, models built with proteins alone or non-proteomic variables alone explained a notably lower R2 (0.261, 0.228-0.294 and 0.260, 0.226-0.293, respectively). Chromogranin b (CHGB), Cystatin-M/E (CST6), leptin (LEP), and prolargin (PRELP) were the proteins consistently selected across all models.
Conclusion: Plasma proteins add to the clinical and genetic risk factors in predicting a cIMT measurement. Our findings implicate blood pressure and extracellular matrix-related proteins in cIMT pathophysiology.
{"title":"Plasma proteomics and carotid intima-media thickness in the UK biobank cohort.","authors":"Ming-Li Chen, Pik Fang Kho, Rodrigo Guarischi-Sousa, Jiayan Zhou, Daniel J Panyard, Zahra Azizi, Trisha Gupte, Kathleen Watson, Fahim Abbasi, Themistocles L Assimes","doi":"10.3389/fcvm.2024.1478600","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1478600","url":null,"abstract":"<p><strong>Background and aims: </strong>Ultrasound derived carotid intima-media thickness (cIMT) is valuable for cardiovascular risk stratification. We assessed the relative importance of traditional atherosclerosis risk factors and plasma proteins in predicting cIMT measured nearly a decade later.</p><p><strong>Method: </strong>We examined 6,136 UK Biobank participants with 1,461 proteins profiled using the proximity extension assay applied to their baseline blood draw who subsequently underwent a cIMT measurement. We implemented linear regression, stepwise Akaike Information Criterion-based, and the least absolute shrinkage and selection operator (LASSO) models to identify potential proteomic as well as non-proteomic predictors. We evaluated our model performance using the proportion variance explained (<i>R</i> <sup>2</sup>).</p><p><strong>Result: </strong>The mean time from baseline assessment to cIMT measurement was 9.2 years. Age, blood pressure, and anthropometric related variables were the strongest predictors of cIMT with fat-free mass index of the truncal region being the strongest predictor among adiposity measurements. A LASSO model incorporating variables including age, assessment center, genetic risk factors, smoking, blood pressure, trunk fat-free mass index, apolipoprotein B, and Townsend deprivation index combined with 97 proteins achieved the highest <i>R</i> <sup>2</sup> (0.308, 95% C.I. 0.274, 0.341). In contrast, models built with proteins alone or non-proteomic variables alone explained a notably lower <i>R</i> <sup>2</sup> (0.261, 0.228-0.294 and 0.260, 0.226-0.293, respectively). Chromogranin b (CHGB), Cystatin-M/E (CST6), leptin (LEP), and prolargin (PRELP) were the proteins consistently selected across all models.</p><p><strong>Conclusion: </strong>Plasma proteins add to the clinical and genetic risk factors in predicting a cIMT measurement. Our findings implicate blood pressure and extracellular matrix-related proteins in cIMT pathophysiology.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461889","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1477337
Ping Ping, Beimeng Yu, Renjie Xu, Pingping Zhao, Shuqi He
With the development of neonatal medicine, more and more extremely preterm infants have been treated. How to deal with hypotension is a big challenge for neonatologist in the process of diagnosis and treatment. The lack of uniformity in the definition of hypotension, challenges in measuring blood pressure accurately, and insufficient consistency between digital hypotension and hypoperfusion are the primary causes. How to check for hypotension and monitor blood pressure is thoroughly explained in the article. To give neonatologists a resource for the clinical management of hypotension in extremely preterm.
{"title":"Monitoring and evaluation of hypotension in the extremely preterm.","authors":"Ping Ping, Beimeng Yu, Renjie Xu, Pingping Zhao, Shuqi He","doi":"10.3389/fcvm.2024.1477337","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1477337","url":null,"abstract":"<p><p>With the development of neonatal medicine, more and more extremely preterm infants have been treated. How to deal with hypotension is a big challenge for neonatologist in the process of diagnosis and treatment. The lack of uniformity in the definition of hypotension, challenges in measuring blood pressure accurately, and insufficient consistency between digital hypotension and hypoperfusion are the primary causes. How to check for hypotension and monitor blood pressure is thoroughly explained in the article. To give neonatologists a resource for the clinical management of hypotension in extremely preterm.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461886","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1442857
Yiya Kong, Ruihuan Shen, Tao Xu, Jihong Zhou, Chenxi Xia, Tong Zou, Fang Wang
Background: There is limited knowledge regarding the association between heart rate (HR) during different exercise phases and coronary artery disease (CAD). This study aimed to evaluate the relationship between four exercise-related HR metrics detected by cardiopulmonary exercise testing (CPET) and CAD. These metrics include HR at the anaerobic threshold (HRAT), HR at respiratory compensatory point (HRRCP), maximal HR (HRmax), and HR 60 s post-exercise (HRRec60s).
Methods: The 705 participants included 383 with CAD and 322 without CAD in Beijing Hospital, who underwent CPET between January 2021 and December 2022. The Logistic regression analysis was applied to estimate the odds ratio and the 95% confidence interval. Additionally, the multivariable Logistic regression analyses with restricted cubic splines were conducted to characterize the dose-response association and explore whether the relationship was linear or nonlinear.
Results: Our primary finding indicates that for each one-beat increase in HRAT, there is a 2.8% reduction in the adjusted risk of CAD in the general population. Similarly, a one-beat increase in HRRCP corresponds to a 2.6% reduction in the adjusted risk of CAD. Subgroup analyses revealed significant interactions between HRAT and factors such as sex, hypertension, and lung cancer, as well as between HRRCP and sex and hypertension, in relation to CAD. The dose-response analysis further confirmed that higher HRAT and HRRCP are associated with a reduced risk of CAD.
Conclusion: These results are suggestive of a good association between HRAT, HRRCP, and CAD. The lower HRAT, and HRRCP are signs of poor HR response to exercise in CAD. HRAT and HRRCP are potentially good indicators of poor HR response to exercise without considering maximal effort.
{"title":"The association of coronary artery disease with heart rate at anaerobic threshold and respiratory compensatory point.","authors":"Yiya Kong, Ruihuan Shen, Tao Xu, Jihong Zhou, Chenxi Xia, Tong Zou, Fang Wang","doi":"10.3389/fcvm.2024.1442857","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1442857","url":null,"abstract":"<p><strong>Background: </strong>There is limited knowledge regarding the association between heart rate (HR) during different exercise phases and coronary artery disease (CAD). This study aimed to evaluate the relationship between four exercise-related HR metrics detected by cardiopulmonary exercise testing (CPET) and CAD. These metrics include HR at the anaerobic threshold (HR<sub>AT</sub>), HR at respiratory compensatory point (HR<sub>RCP</sub>), maximal HR (HR<sub>max</sub>), and HR 60 s post-exercise (HR<sub>Rec60s</sub>).</p><p><strong>Methods: </strong>The 705 participants included 383 with CAD and 322 without CAD in Beijing Hospital, who underwent CPET between January 2021 and December 2022. The Logistic regression analysis was applied to estimate the odds ratio and the 95% confidence interval. Additionally, the multivariable Logistic regression analyses with restricted cubic splines were conducted to characterize the dose-response association and explore whether the relationship was linear or nonlinear.</p><p><strong>Results: </strong>Our primary finding indicates that for each one-beat increase in HR<sub>AT</sub>, there is a 2.8% reduction in the adjusted risk of CAD in the general population. Similarly, a one-beat increase in HR<sub>RCP</sub> corresponds to a 2.6% reduction in the adjusted risk of CAD. Subgroup analyses revealed significant interactions between HR<sub>AT</sub> and factors such as sex, hypertension, and lung cancer, as well as between HR<sub>RCP</sub> and sex and hypertension, in relation to CAD. The dose-response analysis further confirmed that higher HR<sub>AT</sub> and HR<sub>RCP</sub> are associated with a reduced risk of CAD.</p><p><strong>Conclusion: </strong>These results are suggestive of a good association between HR<sub>AT</sub>, HR<sub>RCP</sub>, and CAD. The lower HR<sub>AT</sub>, and HR<sub>RCP</sub> are signs of poor HR response to exercise in CAD. HR<sub>AT</sub> and HR<sub>RCP</sub> are potentially good indicators of poor HR response to exercise without considering maximal effort.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461895","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}
Pub Date : 2024-10-01eCollection Date: 2024-01-01DOI: 10.3389/fcvm.2024.1364744
Junyi Gao, Yi Cheng
Background: Previous studies proposed the predictive value of baseline serum uric acid (SUA) in the prognosis of coronary artery bypass grafting (CABG) patients. The association of perioperative SUA variation with in-hospital adverse outcomes in CABG patients is unknown.
Methods: A total of 2,453 patients were included in the study and were divided into four groups (G1-G4) according to perioperative SUA variation (ΔSUA) (G1, ΔSUA ≤ -90 μmol/L; G2, -90 μmol/L < ΔSUA < 0; G3, 0 ≤ ΔSUA < 30 μmol/L; G4, 30 μmol/L ≤ ΔSUA.) The basic characteristics and incidence of adverse outcomes were compared between the groups in the overall population and the subgroups. Multivariate logistic regression was performed to explore the association between perioperative SUA increases and adverse outcomes, and receiver operating characteristic analysis was used to obtain the cutoff value of SUA increases.
Results: The patients had a mean age of 60.9 years and the majority were males (76.7%). In the group with the most significant increase in SUA (G4), incidences of in-hospital all-cause death and fatal arrhythmia were higher than in other groups in the overall population and the subgroups. Multivariate logistic regression showed that an increase in the SUA level of ≥30 µmol/L was significantly associated with in-hospital all-cause death and fatal arrhythmia, independent of the baseline SUA level and renal function. This association was significant in most subgroups for in-hospital fatal arrhythmia and in the ≥60 years, myocardial infarction, and female subgroups for in-hospital all-cause death. The cutoff values of SUA increases in the overall population were 54.5 µmol/L for in-hospital all-cause death and 42.6 µmol/L for in-hospital fatal arrhythmia.
Conclusions: The perioperative SUA increase significantly correlated with a higher incidence of in-hospital all-cause death and fatal arrhythmia in CABG patients, independent of the baseline SUA level and renal function. Perioperative SUA variation may provide complementary information in the identification of patients potentially at risk.
背景:先前的研究提出了基线血清尿酸(SUA)对冠状动脉旁路移植术(CABG)患者预后的预测价值。围手术期 SUA 变化与 CABG 患者院内不良预后的关系尚不清楚:研究共纳入 2,453 例患者,并根据围手术期 SUA 变化(ΔSUA)将其分为四组(G1-G4)(G1,ΔSUA ≤ -90 μmol/L;G2,-90 μmol/L 结果:患者平均年龄为 60 岁,围手术期 SUA 变化与 CABG 患者院内不良预后的关系尚不清楚:患者的平均年龄为 60.9 岁,大多数为男性(76.7%)。在 SUA 升高最明显的组别(G4)中,院内全因死亡和致命性心律失常的发生率高于总体和亚组中的其他组别。多变量逻辑回归显示,SUA水平升高≥30 µmol/L与院内全因死亡和致命性心律失常显著相关,与基线SUA水平和肾功能无关。在大多数亚组中,这种关联与院内致命性心律失常显著相关;在≥60 岁、心肌梗死和女性亚组中,这种关联与院内全因死亡显著相关。总体人群的 SUA 升高临界值为:院内全因死亡为 54.5 µmol/L,院内致命性心律失常为 42.6 µmol/L:结论:围手术期 SUA 升高与 CABG 患者较高的院内全因死亡和致命性心律失常发生率显著相关,与基线 SUA 水平和肾功能无关。围术期 SUA 变化可为识别潜在风险患者提供补充信息。
{"title":"The association of perioperative serum uric acid variation with in-hospital adverse outcomes in coronary artery bypass grafting patients.","authors":"Junyi Gao, Yi Cheng","doi":"10.3389/fcvm.2024.1364744","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1364744","url":null,"abstract":"<p><strong>Background: </strong>Previous studies proposed the predictive value of baseline serum uric acid (SUA) in the prognosis of coronary artery bypass grafting (CABG) patients. The association of perioperative SUA variation with in-hospital adverse outcomes in CABG patients is unknown.</p><p><strong>Methods: </strong>A total of 2,453 patients were included in the study and were divided into four groups (G1-G4) according to perioperative SUA variation (ΔSUA) (G1, ΔSUA ≤ -90 μmol/L; G2, -90 μmol/L < ΔSUA < 0; G3, 0 ≤ ΔSUA < 30 μmol/L; G4, 30 μmol/L ≤ ΔSUA.) The basic characteristics and incidence of adverse outcomes were compared between the groups in the overall population and the subgroups. Multivariate logistic regression was performed to explore the association between perioperative SUA increases and adverse outcomes, and receiver operating characteristic analysis was used to obtain the cutoff value of SUA increases.</p><p><strong>Results: </strong>The patients had a mean age of 60.9 years and the majority were males (76.7%). In the group with the most significant increase in SUA (G4), incidences of in-hospital all-cause death and fatal arrhythmia were higher than in other groups in the overall population and the subgroups. Multivariate logistic regression showed that an increase in the SUA level of ≥30 µmol/L was significantly associated with in-hospital all-cause death and fatal arrhythmia, independent of the baseline SUA level and renal function. This association was significant in most subgroups for in-hospital fatal arrhythmia and in the ≥60 years, myocardial infarction, and female subgroups for in-hospital all-cause death. The cutoff values of SUA increases in the overall population were 54.5 µmol/L for in-hospital all-cause death and 42.6 µmol/L for in-hospital fatal arrhythmia.</p><p><strong>Conclusions: </strong>The perioperative SUA increase significantly correlated with a higher incidence of in-hospital all-cause death and fatal arrhythmia in CABG patients, independent of the baseline SUA level and renal function. Perioperative SUA variation may provide complementary information in the identification of patients potentially at risk.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461896","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}