International heart journal最新文献

The aim of this study was to construct a residual cholesterol (RC)-based nomogram prediction model and assess its value in predicting the risk of major adverse cardiovascular events (MACE) after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Retrospective analysis of patients from Fuyang People's Hospital who underwent emergency PCI for AMI at our hospital between January 2022 and December 2023 was performed, and univariate logistic regression was used to screen the risk factors for the first occurrence of MACE in the patients, while multivariable logistic regression analysis was used to construct a prediction model. Internal validation was performed using 1,000 bootstrap resampling. The predictive effect of the nomogram model was evaluated using the receiver operating characteristic curve (ROC), Hosmer-Lemeshow deviance test, and decision curve analysis (DCA).Logistic regression analysis showed that residual cholesterol, greater than 90 minutes from symptom onset to first medical contact (SO-to-FMC > 90 minutes), number of involved coronary vessels, Killip scale II-IV, and hemoglobin concentration were factors influencing the occurrence of MACE after PCI in these AMI patients (P < 0.05). The area under the curve (ROC-AUC) of the nomogram model for predicting the risk of developing postoperative MACE was 0.780 (0.721-0.839); the result of the Hosmer-Lemeshow test of deviance, χ² = 4.758 (P = 0.783), suggests that the model shows a moderately discriminatory and calibrated decision analysis curve; DCA shows a net clinical benefit with the nomogram model.RC is a promising biomarker for identifying AMI patients at high risk of postoperative MACE, and multivariate models based on RC can be used as quick and easy tools to identify these patients.

Essential hypertension (EH) and hypertrophic non-obstructive cardiomyopathy (HNCM) are representative conditions associated with left ventricular hypertrophy (LVH). We compared the severity and distribution of LVH between these two conditions.This study included 44 patients with EH and 79 with HNCM exhibiting precordial negative T-waves (NTs) without LV heart failure. Electrocardiographic assessments included measurements of SV1 + RV5 and the maximum depth of NTs, and routine echocardiographic indices were measured.The SV1 + RV5 and maximum depth of NTs were greater in HNCM than in EH. A correlation was found between these two indices in both groups, with the correlation slope being 4.8 times steeper in the HNCM group. The difference in correlation slopes was considered to reflect the degree of myocardial ischemia. The maximum depth of NTs was predoinantly recorded in the V6 lead in EH, and the V4 and V5 leads in HNCM. Interventricular septal thickness (IVST) was greater in HNCM, whereas LV posterior wall thickness (PWT) was higher in EH. The IVST/PWT ratios were calculated as 0.91 ± 0.10 in EH and 1.20 ± 0.35 in HNCM (P< 0.0001). No significant difference was found in the LV mass index between the two groups. The areas under the receiver operating characteristic curve for the maximum depth of precordial NT and the maximum depth of precordial NT/SV1 + RV5 ratio were 0.967 and 0.952, respectively.LVH was similar between EH and HNCM; however, myocardial ischemia was more severe in HNCM than in EH. The distribution pattern of LVH differed markedly between these two conditions.

Cardiovascular-kidney-metabolic (CKM) syndrome is associated with numerous adverse health outcomes. However, the relationship between the different stages of CKM syndrome and relative muscle loss risk remains unclear. This cross-sectional study evaluated the association between CKM syndrome and relative muscle loss, including 4,322 participants from the National Health and Nutrition Examination Survey conducted in 2011-2018. The Foundation for the National Institutes of Health defined relative muscle loss as characterized by the appendicular lean mass adjusted by the body mass index. We constructed weighted multivariate logistic regression models to examine the association between different stages of CKM syndrome and relative muscle loss. Furthermore, we explored the effects of its individual components on the risk of relative muscle loss. Of 4,322 participants, 397 (9.0%) were diagnosed with relative muscle loss. Within the multivariate model, participants in CKM syndrome stages 1-4 exhibited significantly higher risks for relative muscle loss compared with those in stage 0, with odds ratios (95% confidence intervals) of 3.91 (1.96-7.81), 4.16 (2.08-8.32), 4.95 (2.37-10.34), and 7.74 (2.61-22.92), respectively. Notably, metabolic disorders were most strongly associated with relative muscle loss. Participants with clinical cardiovascular disease, chronic kidney disease, and metabolic disorders had significantly higher risks of relative muscle loss than those without these conditions. These findings remained robust across various subgroup analyses.Patients with CKM syndrome stages 1-4 exhibited a higher risk of relative muscle loss than those in stage 0. Moreover, metabolic disorders may be the most significant risk factor for relative muscle loss.

The aging population has led to an increase in nonagenarians undergoing percutaneous coronary intervention (PCI). Nonagenarian patients are at risk for geriatric complications, including delirium, which can worsen clinical outcomes. However, research on delirium and its clinical implications in nonagenarians with acute coronary syndrome (ACS) following PCI is limited.This retrospective observational cohort study analyzed data from 307 nonagenarians with ACS who underwent PCI. Delirium was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Prevalence and prognostic impact of delirium during hospitalization were investigated.Delirium occurred in 85 patients (27.7%) during hospitalization. Patients with delirium had longer hospital stays and lower discharge rates to home or the same location as prior to hospitalization compared to patients without delirium. However, in-hospital mortality rates were comparable between the groups. Over a median follow-up of 480 days, no significant differences were found in all-cause mortality between the two groups.Delirium was common among nonagenarians with ACS following PCI. While delirium was associated with length of hospital stays and discharge destination, it was not linked to survival rates. Prevention, early detection, and effective management of delirium are important for optimizing care in super-aged patients following PCI.

Clinical outcomes in patients with chronic heart failure (HF) remain suboptimal, even in the contemporary era of guideline-directed medical therapy. HF nursing clinics may offer additional benefits by enhancing self-management and improving quality of life in this population.We retrospectively analyzed prospectively collected clinical data regarding a monthly HF nursing clinic conducted between April 2023 and March 2025. The clinic was operated by certified HF nurses and certified HF educators, who consistently followed patients with chronic HF following discharge from an index HF hospitalization. All participants underwent a multidisciplinary conference prior to index discharge.A total of 47 patients (median age: 75 years; 31 [66%] men) were included, with 27 patients (57%) classified as having preserved ejection fraction. Over a median follow-up of 217 (93, 321) days, the median number of clinic visits was 5, and the median counseling duration was 25 (20, 30) minutes per visit. The most frequent counseling topics included psychological support, promotion of self-monitoring and self-management, and dietary guidance. Plasma B-type natriuretic peptide and serum albumin levels improved over the follow-up period, while the estimated glomerular filtration rate remained unchanged. The one-year freedom from HF hospitalization rate was 54%.We report our preliminary two-year experience with a HF nursing clinic led by certified HF nurses and HF educators at a rural Japanese university hospital. These findings are exploratory and may help inform future development of nurse-led multidisciplinary care models. Further studies are needed to validate this approach and better understand its potential clinical implications.

The clinical relevance and standardized methodology of heart failure (HF) nursing clinics remain inadequately defined. Since 2019, our institution has operated an HF nursing clinic designed to provide comprehensive, multidisciplinary care to patients with complex needs. We present the case of a 72-year-old man hospitalized for decompensated HF due to dilated cardiomyopathy, triggered by excessive salt and fluid intake. He was ultimately discharged after one year of intensive multidisciplinary management, which included temporary support with a percutaneous left ventricular assist device (Impella 5.0), cardiac resynchronization therapy, and trans-catheter edge-to-edge mitral valve repair. Following discharge, he was followed monthly at the HF nursing clinic, where certified HF nurses and HF educators delivered structured counseling focused on psychological support, self-monitoring, dietary modification, and lifestyle adjustment. Remarkably, he has remained free from HF-related hospitalizations for five years, despite being categorized as stage D. While further investigation is warranted to develop standardized protocols, HF nursing clinics may represent a valuable strategy for supporting high-risk patients with impaired self-care capacity, attenuating HF progression, and improving quality of life.