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Predictive value of geriatric nutritional risk index in cardiac and cerebrovascular events after endovascular aortic aneurysm repair. 老年营养风险指数对血管内主动脉瘤修补术后心脑血管事件的预测价值。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 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.

目的评估用老年营养风险指数(GNRI)评估的营养不良对血管内主动脉瘤修补术(EVAR)后老年患者主要不良心脑血管事件(MACCE)的影响:这是一项回顾性队列研究,研究对象是在一家三级医院接受EVAR手术的老年患者。营养状况由 GNRI 评估。主要结果是MACCE。使用接收者操作特征曲线(ROC)比较了 GNRI 与修订版心脏风险指数(RCRI)和改良版虚弱指数(mFI)的预测能力:回顾性分析了2015年11月至2020年1月接受EVAR手术的453例患者,根据GNRI值从低到高平均分为三组(低/中/高)。术后有五名(1.10%)患者失去随访,中位随访时间为 28.00(15.00-47.00)个月。与低 GNRI 值组患者相比,高 GNRI 值减少了 EVAR 术后住院时间(β 9.67,95% CI 4.01-23.32,p = 0.0113;调整后 β -1.96,95% CI -3.88,-0.05,p = 0.0454)。GNRI 状态与 EVAR 后长期死亡风险的显著增加有关(中等 GNRI,未调整 HR 0.40,95%CI 0.23-0.70,p = 0.0014;调整 HR 0.47,95%CI 0.26-0.84,p = 0.0107;高 GNRI,0.27 95%CI 0.14-0.55;p = 0.0003;调整 HR 0.32 95%CI 0.15-0.68,p = 0.0029)。与 GNRI 低分患者相比,GNRI 中值和高值患者的 MACCE 风险均显著降低(GNRI 中值,未调整 HR 0.34,95%CI 0.13-0.88,p = 0.00265;调整 HR 0.37,95%CI 0.14-0.96,p = 0.0408;GNRI 高值,0.26 95%CI 0.09-0.78;p = 0.0168;调整 HR 0.21 95%CI 0.06-0.73,p = 0.0029)。与 RCRI 和 mFI 相比,GNRI 在预测长期 MACCE 方面具有更好的分辨能力。GNRI mFI 和 RCRI 的曲线下面积(AUC)分别为 0.707、0.614 和 0.588。(Z统计量,GNRI vs. mFI,p = 0.0475;GNRI vs. RCRI,p = 0.0017):结论:通过 GNRI 评估的营养不良情况可作为 EVAR 术后老年患者长期 MACCE 的有效预测指标,与 RCRI 和 mFI 相比,其判别能力更佳。
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引用次数: 0
Impact of systemic lupus erythematosus on cardiovascular morphologic and functional phenotypes: a Mendelian randomization analysis. 系统性红斑狼疮对心血管形态和功能表型的影响:孟德尔随机分析。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fcvm.2024.1454645
Zishan Lin, Wenfeng Wang, Bingjing Jiang, Jian He, Yanfang Xu

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.

背景:以往的研究已证实系统性红斑狼疮(SLE)与心血管健康之间存在相关性,但人们对系统性红斑狼疮对心脏功能和结构的潜在因果关系仍然知之甚少。心血管磁共振成像(CMR)是一种新型的非侵入性技术,可对心血管结构和功能进行独特的评估,是评估心脏病风险的重要工具。在这项研究中,我们进行了孟德尔随机分析,以确定系统性红斑狼疮与 CMR 特征之间的因果关系:方法:我们从一项包含 5201 例病例和 9066 例对照的全基因组关联研究(GWAS)中选取了与系统性红斑狼疮有独立关联的基因变异作为工具变量。从最近的一项全基因组关联研究(GWAS)中获得了一组 82 个 CMR 特征,作为临床前指标,并提供了对四个心腔和两个主动脉节段的形态和功能的初步了解。主要分析采用了反方差加权法进行双样本孟德尔随机研究。异质性测试、敏感性分析和工具变量强度评估证实了研究结果的稳健性:结果:系统性红斑狼疮与卒中量增加(βLVSV = 0.007,P = 0.045)、区域峰值圆周应变(βEcc_AHA_9 = 0.013,P = 0.002;βEcc_AHA_12 = 0.009,P = 0.043;βEcc_AHA_14 = 0.013,P = 0.006)、左心室全周应变峰值(βEcc_global = 0.010,P = 0.022)以及区域径向应变减少(βErr_AHA_11 = -0.010,P = 0.017):这项研究提供了系统性红斑狼疮特征与心脏功能改变之间潜在因果关系的证据,为狼疮患者的心脏检查和疾病预防提供了指导。
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引用次数: 0
Factors related to cardiac rupture after acute myocardial infarction. 急性心肌梗塞后心脏破裂的相关因素。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 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。
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引用次数: 0
Examining the causal association between moderate alcohol consumption and cardiovascular risk factors in the Taiwan Biobank: a Mendelian randomization analysis. 研究台湾生物库中适度饮酒与心血管风险因素之间的因果关系:孟德尔随机分析。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 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.

背景:孟德尔随机化方法使用遗传变异作为工具变量来研究风险因素与相关健康结果之间的因果关系。我们的目的是利用酒精脱氢酶 1B (ADH1B) rs1229984 和醛脱氢酶 2 (ALDH2) rs671 这两个遗传变异作为工具变量,研究饮酒与心血管风险因素之间的关系:我们的分析使用了台湾生物数据库(一项正在进行的前瞻性人群队列研究)中收集的数据,其中包括 129,032 人(46,547 名男性和 82,485 名女性)的 ADH1B rs1229984 和 ALDH2 rs671 基因型及饮酒状况的完整数据。我们对饮酒与体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖、糖化血红蛋白(HbA1c)、甘油三酯、高密度脂蛋白胆固醇(HDLc)和低密度脂蛋白胆固醇(LDLc)之间的关系进行了工具变量回归分析:结果:在 rs1229984 工具分析中,饮酒仅与男性较高的 SBP 水平和女性较低的 DBP 水平相关。结果:在 rs1229984 工具分析中,饮酒与男性较高水平的 BMI、SBP、DBP、空腹血糖、甘油三酯、HDLc 和较低水平的 LDLc 相关;饮酒与女性较高水平的 HDLc 和较低水平的 SBP、HbA1c 和甘油三酯相关:结论:通过孟德尔随机分析法,我们对男性的一些研究结果与之前的系统综述结果一致,表明饮酒可能与较高水平的体重指数(BMI)、SBP、DBP、空腹血糖、甘油三酯、高密度脂蛋白胆固醇(HDLc)和较低水平的低密度脂蛋白胆固醇(LDLc)存在因果关系。尽管饮酒对少数心血管风险因素有益,但对许多其他因素却有害。在解释此类研究结果时,还应仔细研究孟德尔随机方法的假设前提。
{"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}
引用次数: 0
Machine learning derived model for the prediction of bleeding in dual antiplatelet therapy patients. 用于预测双重抗血小板疗法患者出血情况的机器学习衍生模型。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 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.

研究目的本研究旨在开发一种用于评估双重抗血小板疗法(DAPT)患者出血风险的预测模型:共纳入 18,408 名 DAPT 患者。温州医科大学附属东阳医院收集了患者的人口统计学、临床特征、基础疾病、既往史和实验室检查数据。按照 7:3 的比例将患者随机分为两组,其中最多的一组用于模型开发,其余的一组用于内部验证。采用LASSO回归、多元逻辑回归以及随机森林(RF)、k-近邻归因(KNN)、决策树(DT)、极梯度提升(XGBoost)、轻梯度提升机(LGBM)和支持向量机(SVM)等六种机器学习模型开发预测模型。使用曲线下面积(AUC)、校准曲线、决策曲线分析(DCA)、临床影响曲线(CIC)和净减少曲线(NRC)对模型预测性能进行评估:结果:XGBoost 模型的 AUC 值最高。结果:XGBoost 模型的 AUC 最高:HGB、PLT、既往出血、脑梗塞、性别、手术史和高血压。根据七个变量建立了一个提名图。在开发队列中,该模型的 AUC 为 0.861(95% CI 0.847-0.875),在验证队列中为 0.877(95% CI 0.856-0.898),表明该模型具有良好的差异化性能。校准曲线分析结果显示,该提名图模型的校准曲线接近理想曲线。临床决策曲线也显示该提名图模型具有良好的临床净效益:本研究成功开发了一种用于估计 DAPT 患者出血风险的预测模型。结论:本研究成功开发了一种用于估计 DAPT 患者出血风险的预测模型,该模型具有优化治疗计划、改善患者预后和提高资源利用率的潜力。
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引用次数: 0
Editorial: Contemporary percutaneous interventions for coronary chronic total occlusions. 社论:当代冠状动脉慢性全闭塞的经皮介入治疗。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.3389/fcvm.2024.1495936
Iosif Xenogiannis, Antonis N Pavlidis, Grigorios V Karamasis
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引用次数: 0
Plasma proteomics and carotid intima-media thickness in the UK biobank cohort. 英国生物库队列中的血浆蛋白质组学和颈动脉内膜中层厚度。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.3389/fcvm.2024.1478600
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

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 (R 2).

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 R 2 (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 R 2 (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.

背景和目的:超声波得出的颈动脉内膜中层厚度(cIMT)对心血管风险分层很有价值。我们评估了传统动脉粥样硬化风险因素和血浆蛋白在预测近十年后测量的 cIMT 中的相对重要性:我们对 6,136 名英国生物库参与者进行了研究,他们的基线抽血中使用了接近延伸测定法,对 1,461 种蛋白质进行了分析,随后对他们进行了 cIMT 测量。我们采用线性回归、基于阿凯克信息准则的逐步回归以及最小绝对收缩和选择算子(LASSO)模型来识别潜在的蛋白质组和非蛋白质组预测因子。我们使用解释方差比例(R 2)来评估模型的性能:从基线评估到 cIMT 测量的平均时间为 9.2 年。年龄、血压和人体测量相关变量是 cIMT 的最强预测因素,而躯干区域的去脂质量指数是脂肪测量中最强的预测因素。将年龄、评估中心、遗传风险因素、吸烟、血压、躯干无脂质量指数、载脂蛋白 B 和汤森剥夺指数等变量与 97 种蛋白质结合的 LASSO 模型获得了最高的 R 2(0.308,95% C.I.0.274,0.341)。相比之下,单独使用蛋白质或单独使用非蛋白质组变量建立的模型解释的 R 2 明显较低(分别为 0.261,0.228-0.294 和 0.260,0.226-0.293)。Chromogranin b (CHGB)、胱抑素-M/E (CST6)、瘦素 (LEP) 和前列素 (PRELP) 是所有模型一致选择的蛋白质:结论:血浆蛋白是预测 cIMT 测量值的临床和遗传风险因素的补充。我们的研究结果表明,血压和细胞外基质相关蛋白与 cIMT 病理生理学有关。
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引用次数: 0
Monitoring and evaluation of hypotension in the extremely preterm. 监测和评估极早产儿低血压。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 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.

随着新生儿医学的发展,越来越多的极早产儿得到了治疗。如何应对低血压是新生儿科医生在诊断和治疗过程中面临的一大挑战。低血压的定义不统一、血压测量不准确、数字低血压与低灌注之间的一致性不够是主要原因。文章详细介绍了如何检查低血压和监测血压。为新生儿科医生临床处理极早产儿低血压提供资源。
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引用次数: 0
The association of coronary artery disease with heart rate at anaerobic threshold and respiratory compensatory point. 冠状动脉疾病与无氧阈值心率和呼吸代偿点的关系。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 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.

背景:人们对不同运动阶段的心率(HR)与冠状动脉疾病(CAD)之间的关系了解有限。本研究旨在评估心肺运动测试(CPET)检测到的四种运动相关心率指标与冠心病之间的关系。这些指标包括无氧阈值心率(HRAT)、呼吸代偿点心率(HRRCP)、最大心率(HRmax)和运动后 60 秒心率(HRRec60s):705名参与者包括北京医院的383名CAD患者和322名无CAD患者,他们在2021年1月至2022年12月期间接受了CPET。采用 Logistic 回归分析估算几率比例和 95% 的置信区间。此外,我们还利用受限立方样条进行了多变量 Logistic 回归分析,以确定剂量-反应关系的特征,并探讨这种关系是线性的还是非线性的:我们的主要研究结果表明,HRAT 每增加一搏,普通人群患 CAD 的调整风险就会降低 2.8%。同样,HRRCP 每增加一搏,调整后的 CAD 风险就会降低 2.6%。亚组分析显示,HRAT 与性别、高血压和肺癌等因素之间,以及 HRRCP 与性别和高血压之间,都存在与 CAD 相关的显著交互作用。剂量反应分析进一步证实,HRAT和HRRCP越高,患CAD的风险越低:这些结果表明,HRAT、HRRCP 和 CAD 之间存在良好的关联。较低的 HRAT 和 HRRCP 是 CAD 患者对运动的心率反应较差的表现。在不考虑最大努力的情况下,HRAT 和 HRRCP 是运动时心率反应差的潜在良好指标。
{"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}
引用次数: 0
The association of perioperative serum uric acid variation with in-hospital adverse outcomes in coronary artery bypass grafting patients. 冠状动脉搭桥术患者围手术期血清尿酸变化与院内不良预后的关系。
IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 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。
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引用次数: 0
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Frontiers in Cardiovascular Medicine
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