Frontiers in Cardiovascular Medicine最新文献

Background: Poor nutritional status may affect outcomes after coronary revascularization, but the association between nutritional status and outcomes in patients undergoing coronary revascularization has not been fully evaluated. This study was based on the MIMIC-IV database to analyze the impact of baseline nutritional status on poor outcomes in patients with coronary revascularization.

Methods: Patients with coronary revascularization were screened from the MIMIC-IV database. A geriatric nutritional risk index (GNRI) was calculated and used to divide patients into 4 groups: no malnutrition (Q4: ≥96.79), mild malnutrition (Q3: 90.85-96.78), moderate malnutrition (Q2: 86.37-90.84), and severe malnutrition (Q1: 86.37). The primary outcome measure was 28-day mortality, and the secondary outcome measures were AKI and length of hospital stay. Cox proportional hazards model, Kaplan-Meier survival analysis, restricted cubic spline (RCS), and multiple linear regression model were used for statistical analysis, respectively, to ensure the robustness of study results.

Results: A total of 1,168 patients with coronary revascularization were included. The GNRI demonstrated a significant association with 28-day mortality in patients undergoing coronary revascularization. As a continuous variable, the GNRI exhibited a notable inverse correlation with mortality across unadjusted, partially adjusted, and fully adjusted Cox regression models [hazard ratios (HRs): 0.93, 0.94, 0.96, respectively; all P < 0.001]. When considered as a categorical variable, a low GNRI (first quartile, Q1) was significantly associated with elevated mortality risks (HRs: 2.64, 2.30, 1.82 in the unadjusted, partially adjusted, and fully adjusted models, respectively; all P < 0.05). Subgroup analysis revealed a more pronounced association in patients under 65 years of age (P for interaction = 0.014). Furthermore, reduced GNRI levels were also associated with an increased incidence of AKI and extended hospital lengths of stay.

Conclusion: GNRI is associated with prognosis in patients with coronary revascularization. Patients with lower GNRI had higher 28-day mortality, greater risk of AKI, and longer hospital stays.

Background: More than 23 million deaths and 36.5% of disability-adjusted life-years are the result of the direct effects of unhealthy behavior alone. Daily behaviors have strong implications for health outcomes and quality of life. The aim of this study is to determine the behavioral and biomedical factors associated with lifestyle modification practices among diagnosed hypertensive patients in pastoral health facilities of southern Ethiopia.

Methods: A facility-based cross-sectional study was conducted among 453 diagnosed hypertensive adult patients in pastoral health of southern Ethiopia from June 1/2023 to July 30/2023. The study population was randomly selected from among patients diagnosed with hypertension that was followed up during the study period using a systematic random sampling technique. The data were entered into Epi-Data-4.6.0.2 and exported to SATAT version 14 for analysis. A binary logistic regression model was fitted to determine independent predictors of lifestyle modification practices among hypertensive patients. An adjusted odds ratio with a 95% confidence interval was used to declare a state of significance.

Results: Out of 453 potential participants approached, 433 agreed to successfully participate in the study, for a response rate of 95.6%. Of the total participants, 56.1% (95% CI, 51.38-60.74) of the patients practiced the recommended lifestyle modifications. Alcohol consumption (AOR = 0.64, 95% CI: 0.42-0.96), ever-practiced reducing salt intake (AOR = 2.48, 95% CI: 1.57-3.93), and low-density lipoprotein cholesterol levels in the blood (>160 mg/dl) (AOR = 3.3, 95% CI: 1.72-6.34) were independently associated with lifestyle modifications in patients with hypertension.

Conclusion: This study revealed that the prevalence of lifestyle modification practices (LMP) was low among hypertensive patients. Lifestyle modification is not one-stop practical, but continuous proper awareness creation, counseling, and health education and health promotion are needed to scale up healthy behavior in patients with hypertension to create a good lifestyle.

Introduction: Based on office blood pressure (BP) values, hypertension is categorized into three stages: stage 1 (140-159/90-99 mmHg), stage 2 (160-179/100-109 mmHg), and stage 3 (≥180/≥110 mmHg). Malignant hypertension (MHT) is characterized by extreme BP elevation (systolic blood pressure above 200 mmHg and diastolic blood pressure above 130 mmHg) and acute microvascular damage affecting various organs, particularly the retinas, brain, and kidneys.

Objectives: The pathogenesis, predisposing variables, therapy, and preventive strategies for MHT were examined in this review.

Conclusions and recommendations: Malignant hypertension requires prompt and efficient treatment because it is the most severe kind of hypertension that affects target organs. At the same time, there are a number of alternatives available for treating MHT. The International Society of Hypertension 2020 and European Society of Cardiology/European Society of Hypertension 2018 recommendations suggest using labetalol and nicardipine as the first-line choice, with urapidil and nitroprusside serving as alternative medications. Elevated risk of MHT has been linked to many socio-demographic and genetic factors.

Background: An increasing number of patients with congenital heart disease (CHD) engage in physical activities and may exercise at high altitudes (HA). The physiological adaptations required at HA and their implications on individuals with CHD, especially during exercise, remain underexplored. This systematic review aims to investigate cardiopulmonary exercise responses to short-term HA exposure in individuals with CHD.

Methods: A literature search was performed across PubMed, Cochrane Library, Scopus, Embase, and SPORTDiscus. The search focused on studies comparing patients with CHD to healthy controls, specifically assessing cardiorespiratory responses during cardiopulmonary exercise testing at HA (≥2,500 m) and low altitude (LA). A meta-analysis of the differences in the main cardiorespiratory adaptations during exercise from LA to HA was performed, comparing patients with CHD and controls.

Results: Of the initial 4,500 articles, four studies met the inclusion criteria, encompassing 150 participants (74 with CHD and 76 controls). Almost all the patients with CHD had lower cardiorespiratory fitness and efficiency both at LA and HA compared to the controls. Nevertheless, the patients with CHD showed a smaller decrease in peak workload [10.61 W (95% CI: 2.33-18.88)] and peak saturation [1.22% (95% CI: 0.14-2.30)] between LA and HA compared to the controls. No participants presented exercise-induced symptoms.

Conclusion: Short-term exposure to HA appears to be relatively well-tolerated by individuals with low-risk CHD, without a significantly different impact on cardiorespiratory response compared to healthy controls. Further research should confirm these outcomes and explore the long-term effects of higher altitude exposure as comprehensive recommendations for these patients are lacking.

Background: Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Various factors can exacerbate disease progression in patients with HF and negatively impact treatment outcomes. This study aims to evaluate the pooled prevalence and contributing factors associated with poor heart failure treatment outcomes in Ethiopia.

Methods: A systematic review and meta-analysis were conducted using five databases: Google Scholar, ScienceDirect, Hinari, PubMed, and Scopus. In total, 12 studies met the eligibility criteria for inclusion in this analysis. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Data extraction was performed using a Microsoft Excel spreadsheet, and statistical analysis was conducted with STATA 14. The Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument was utilized for quality assessment. Heterogeneity among the studies was evaluated using the I ² statistic and the Cochrane Q test. Publication bias was assessed using Begg's test, Egger's weighted regression, and funnel plots.

Results: The pooled prevalence of poor HF treatment outcomes was found to be 16.67% [95% confidence interval (CI): 10.67-22.67]. No significant heterogeneity was observed across the included studies (I ² = 0.0%, p = 0.962). Significant predictors of a poor treatment outcome were smoking cigarettes [adjusted odds ratio (AOR) = 10.74; 95% CI: 3.24-35.63] and medication-related problems (AOR = 3.99; 95% CI: 1.90-8.37).

Conclusion: The prevalence of poor HF treatment outcomes in Ethiopia was found to be high. Smoking cigarettes and medication-related problems are significant predictors of these adverse outcomes. Comprehensive health education and improved clinical pharmacy services are essential for addressing these issues.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437397, PROSPERO (CRD42023437397).

Background: Percutaneous mechanical thrombectomy (PMT) is increasingly used in the treatment of intermediate and high-risk acute pulmonary embolism (PE), and the treatment of high-risk PE with the aid of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has also been reported. However, there are few reports of VA-ECOM-assisted PMT in the treatment of high-risk PE. The purpose of this study is to summarize the data of 11 patients with high-risk PE treated with VA-ECMO assisted PMT, and propose feasible treatment methods for such patients.

Methods: This multicenter retrospective study included patients with acute high-risk PE who were treated with VA-ECMO-assisted PMT from January 2021 to June 2024. The analysis focused on the right/left ventricle ratio, biomarkers, and pulmonary artery pressure before and after the VA-ECMO-assisted PMT treatment.

Results: All 11 high-risk PE patients suffered cardiac arrest before treatment, computered tomograhy pulmonary angiography (CTPA) confirmed the diagnosis of PE, and all patients received VA-ECMO-assisted PMT therapy. The median age of the 11 patients was 54 years (range 18-72), the median duration of ECMO was 4.48 days (range 1.04-18.02), and the mean hospitalization time was 21 days (range 14-112). All patients received percutaneous thrombectomy, achieving a 100% technical success rate. The mortality rate was 27.3% during the 90-day follow-up. The 12-month mortality rate was 36.4%.

Conclusion: VA-ECMO-assisted PMT technology can rapidly improve pulmonary hemodynamics while maintaining stable blood flow, thereby reducing in-hospital mortality in high-risk patients with pulmonary embolism complicated by cardiac arrest.

Background: Cardiovascular disease(CVD) remains a significant global challenge. Asthma, which is characterized by airway hyperresponsiveness and reversible and limited airflow, plays an important role in cardiovascular diseases. This study aimed to investigate the association between asthma and CVD.

Methods: This cross-sectional study included demographic, laboratory, and questionnaire data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. CVD included stroke, congestive heart failure, coronary heart disease, and angina. Multiple logistic regression models were used to detect the association between asthma and the prevalence of CVD, adjusting for age, gender, race, education level, body mass index, ratio of family income to poverty, smoking exposure, drinking exposure, diabetes history, hypertension history, chronic obstructive pulmonary disease (COPD) history, and chronic kidney disease (CKD) history. A subgroup analysis was performed to investigate the association between asthma and CVD in different populations.

Results: In total, 16,807 participants were included in this study, including 2,446 who reported having asthma. Compared with participants without asthma, the prevalence of stroke in those with asthma was increased by 1.607 times; the prevalence of congestive heart failure was increased by 1.911 times. Asthma significantly increased the prevalence of stroke among participants aged 18-44 years old, with a BMI 18.50-29.99 kg/m², with low education levels, and with a PIR < 1.00. Asthma also increased the prevalence of angina in females, non-Hispanic Blacks, participants aged 45-59 years old, with a BMI ≥ 30.00 kg/m², and with a PIR < 1.00. The prevalence of congestive heart failure was positively associated with asthma in non-Hispanic Whites or Blacks, participants aged ≥45 years old, with a BMI 25.00-29.99 kg/m², with a PIR < 1.00, and with a low or middle education level.

Conclusion: Asthma significantly increases the prevalence of stroke, congestive heart failure. Patients with asthma should be monitored for CVD, including stroke and congestive heart failure.

Objective: To investigate the association between cardiovascular health (CVH) and obstructive sleep apnea (OSA) within the U.S. population.

Methods: This study enrolled 12,540 participants aged 20 years and older from the 2007-2008 and 2015-2018 cycles of the National Health and Nutrition Examination Surveys (NHANES). Weighted univariate and multivariate logistic regression were utilized to examine the relationship between CVH and OSA symptoms. Life's Essential 8 (LE 8) metrics was employed to evaluate the CVH status of participants. Identification of OSA symptoms was determined based on a sleep questionnaire. They include (1) how often you snore; (2) how often you snort/stop breathing; or (3) how often you feel overly sleepy during day. Individuals who answered that they snore 3 or more per week; snort/stop breathing 3 or more per week and feel overly sleepy during day 16-30 times per month were classified as having OSA symptoms.

Results: Significant inverse associations were observed between LE8 scores and symptoms of OSA after adjusting for covariates. The 95% CI was 0.750 (0.630,0.893) for the moderate CVH group and 0.573 (0.454,0.723) for the high CVH group. Subgroup analyses, stratified by age and gender, highlighted a significant interaction between LE8 scores and OSA symptoms with age (P < 0.0001). Participants under 60 years old in the high CVH group exhibited a reduced likelihood OSA symptoms (OR: 0.470; 95% CI: 0.345,0.641). Restricted cubic splines (RCS) in a multivariate regression analysis showed a non-linear relationship between LE8 score and OSA. Our finding demonstrates a substantial decrease in OSA symptom prevalence with increased LE 8 scores.

Conclusion: The results demonstrate a strong inverse correlation between LE8 scores and OSA symptoms. Participants with higher LE8 scores showed a reduced likelihood of experiencing OSA symptoms.

Objective: The aim of this study was to explore the predictive value of the Systemic Inflammatory Response Index (SIRI) for the prognosis of older postmenopausal women with coronary artery disease (CAD).

Patients and methods: This retrospective cohort study included 617 postmenopausal female patients aged 50 years or older with a CAD diagnosis confirmed by coronary angiography seen at the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2020. Patients were divided into three groups based on SIRI tertiles. Primary endpoints were all-cause mortality (ACM) and cardiac mortality (CM), and secondary endpoints were major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs).

Results: The frequencies of all adverse outcomes were greater in the high level (third tertile) SIRI group than in the low level (first tertile) SIRI group. Multivariable regression analysis showed that compared to the low level SIRI group, the high level SIRI group had a 1.581-fold greater risk of ACM [hazard ratio (HR) = 2.581, 95% confidence interval (CI): 1.045-6.373, p = 0.040) and a 1.798-fold greater risk of CM (HR = 2.798, 95% CI: 0.972-8.060, p = 0.057). In addition, the risks of MACEs and MACCEs were 62.3% (HR = 1.623, 95% CI: 1.123-2.346, p = 0.01) and 55.8% (HR = 1.558, 95% CI: 1.100-2.207, p = 0.012) greater in the high level SIRI group compared with the low level SIRI group. Kaplan-Meier survival analyses confirmed that the high SIRI level was associated with increased risks of ACM (p = 0.001), CM (p = 0.005), MACEs (p = 0.003), and MACCEs (p = 0.005).

Conclusion: This retrospective study demonstrates that the novel derived inflammatory index SIRI can effectively predict the risk of multiple adverse outcomes in postmenopausal women with CAD.