Vascular Health and Risk Management最新文献

Objective: Compared to stable abdominal aortic aneurysms (AAA), the inflammatory response in perivascular adipose tissue (PVAT) may be exacerbated prior to rupture, leading to functional and structural alterations that manifest as imaging disparities. Radiomics enables the extraction of images features, which can be integrated with machine learning(ML) to construct models for clinical decision support. This study investigated the potential of radiomic features derived from PVAT to predict AAA rupture.

Methods: A retrospective analysis was conducted using aortic Computed Tomography Angiography (CTA) images from two centers, comprising patients with either stable or ruptured AAA who had pre-rupture CTA scans. These images were allocated to a development set and an external validation set. After radiomic feature extraction, statistically significant features between the two groups were subjected to dimensionality reduction. Subsequently, ten common ML models were constructed and validated using both internal and external validation sets.

Results: The development set comprised 37 ruptured patients and 155 non-ruptured patients. The external test set included 6 ruptured patients and 30 non-ruptured patients. A total of 107 radiomic features were extracted per patient, of which 18 exhibited statistically significant differences between groups. After dimensionality reduction, 5 representative features were selected. The constructed models achieved an average accuracy of 0.76 and an average AUC of 0.81 in the internal test set, while the external test set yielded an average accuracy of 0.73 and an average AUC of 0.77.

Conclusion: Significant differences exist in PVAT characteristics between ruptured and non-ruptured AAA patients, supporting the feasibility of using radiomic features for rupture prediction with reasonable accuracy.

Background: Coronary artery disease (CAD) is a leading global health concern, with inflammation playing a pivotal role in its pathogenesis. The high-sensitivity C-reactive protein/albumin ratio (CAR) has emerged as a novel marker reflecting both systemic inflammation and physiological reserve. However, its predictive value in specific populations, particularly in the Southern Arab Peninsula, remains underexplored.

Objective: To evaluate the association of CAR in identifying CAD among Yemeni adults referred for coronary computed tomography angiography (CCTA), by assessing its association with coronary artery calcium (CAC) and CAD-RADS scores.

Methods: This cross-sectional study included 249 Yemeni patients with suspected CAD who underwent CCTA. High-sensitivity C-reactive protein and albumin levels were measured to calculate CAR. CAD severity was assessed using CAC and CAD-RADS scoring systems. Statistical analyses explored correlations and predictive performance.

Results: CAR demonstrated a significant positive correlation with CAC scores (r = 0.357, p < 0.001) and CAD-RADS levels (p < 0.001). ROC curve analysis yielded an AUC of 0.708, with an optimal CAR cut-off value of 0.0285, achieving 67.9% sensitivity and 63.6% specificity. Multivariable logistic regression confirmed CAR as an independent predictor of CAD (AOR = 11.28, p < 0.001), alongside diabetes, hypertension, dyslipidemia, and smoking.

Conclusion: CAR is a promising, cost-effective inflammatory marker for early CAD risk stratification, especially in resource-limited settings. Its strong correlation with CAC and CAD-RADS supports its clinical utility in identifying high-risk individuals who may benefit from further cardiovascular evaluation.

Background: Heart failure with preserved ejection fraction (HFpEF) is common yet diagnostically challenging in older adults presenting with acute dyspnoea to the emergency department (ED). This study evaluated the diagnostic performance of established markers used in HFpEF assessment, including echocardiographic indices, NT-proBNP, and the H₂FPEF score, in identifying newly diagnosed HFpEF in this population.

Methods: Between September 2024 and May 2025, we conducted a prospective observational study of patients aged ≥60 years presenting to the ED of a tertiary hospital in Vietnam with acute dyspnoea. HFpEF was identified using the 2021 European Society of Cardiology (ESC) guidelines, which served as the gold-standard diagnostic framework. Baseline characteristics were compared between HFpEF and non-HFpEF groups, and the diagnostic performance of candidate markers was assessed using receiver operating characteristic curve analysis.

Results: Among 280 enrolled patients, 118 (42.1%) were newly diagnosed with HFpEF. Sociodemographic, geriatric, clinical, and comorbidity characteristics were comparable between groups. Patients with HFpEF had significantly higher NT-proBNP levels (median 2205 pg/mL vs 150 pg/mL, p<0.001), left ventricular mass index (LVMI) (118.0 ± 12.1 g/m² vs 93.4 ± 15.9 g/m², p<0.001), and H₂FPEF scores (median 7 vs 4, p<0.001). NT-proBNP ≥760 pg/mL (AUC 0.979, 95% confidence interval [CI] 0.964-0.994; Youden index 0.91), LVMI ≥108 g/m² (AUC 0.889, 95% CI 0.851-0.927; Youden index 0.62), and an H₂FPEF scores ≥6 (AUC 0.861, 95% CI 0.818-0.903; Youden index 0.71) demonstrated strong discriminatory performance. Diastolic indices alone showed poor discriminatory ability (AUC <0.55).

Conclusion: In older adults presenting with acute dyspnoea, NT-proBNP, LVMI, and the H₂FPEF score demonstrated good discriminatory ability for newly diagnosed HFpEF. However, the diagnostic performance of NT-proBNP and LVMI should be interpreted with caution, as both are included in the ESC diagnostic framework. Diastolic indices showed limited diagnostic value, likely because diastolic abnormalities were also common among non-HFpEF patients, highlighting an important methodological constraint.

Background: Understanding the global burden of cardiovascular diseases is essential for developing effective preventive strategies and guiding policy measures worldwide. Despite significant advances in diagnosis and treatment, cardiovascular diseases remain the leading cause of morbidity and mortality across all regions. Assessing their temporal trends and regional disparities can provide valuable insights for optimizing resource allocation and improving global health outcomes.

Methods: We used data from the Global Burden of Disease 2021 (GBD 2021) to analyze the incidence, prevalence, deaths, Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and Disability-Adjusted Life Years (DALYs) of three major cardiovascular diseases-Atrial Fibrillation and Flutter (AFF), Ischemic Heart Disease (IHD), and Rheumatic Heart Disease (RHD)-globally and in the People's Republic of China, Europe, and the United States of America (USA). Comparative analyses and projections were performed through 2040.

Results: Globally, age-standardized incidence rates (ASIRs, per 100,000 population) from 1990 to 2021 slightly declined for AFF (52.51 to 52.12) and IHD (419.54 to 372.9) but increased for RHD (44.87 to 50.74). In China and the USA, AFF incidence rose (42.63 to 44.92 and 75.22 to 89.18, respectively), and IHD incidence in China increased (315.31 to 365.67). RHD incidence declined across all three regions. Notably, AFF and IHD trends increased after 2019, potentially related to COVID-19.

Conclusion: This study reveals distinct global and regional trends in the burden of AFF, IHD, and RHD from 1990 to 2021. The burden of AFF and IHD declined in most regions but showed a potential increase during the COVID-19 pandemic, while RHD continued to rise, particularly in low-SDI (Sociodemographic Index) countries. These findings provide valuable evidence to guide targeted prevention strategies and optimize resource allocation in global cardiovascular health policy.

Purpose: Prior studies on the relationship between metal exposure and blood pressure have reported inconsistent findings, potentially due to the inclusion of individuals receiving hypertension treatment. This study assessed the association between blood concentrations of selenium (Se), lead (Pb), total mercury (Hg), cadmium (Cd), and manganese (Mn) and elevated blood pressure in US adults aged 20-60 years without a prior hypertension diagnosis. We also explored the moderating effects of age, gender and body mass index (BMI), and the mediating role of non-high-density lipoprotein cholesterol (non-HDL-C).

Methods: Data from the 2013-2020 National Health and Nutrition Examination Survey were analyzed. Weighted logistic regression model were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with subgroup analyses assessing effect modification. Structural equation modelling was employed to evaluated the potential mediating effects of non-HDL-C.

Results: Among 6026 participants, 1,569 had elevated blood pressure. Adjusted analyses showed significant associations between Se and Pb and increased hypertension odds. Each 1 μg/L increase in Se corresponded to a 1% rise in odds (OR: 1.01, 95% CI: 1.00, 1.01), with those in the highest Se quintiles (Q4 and Q5) having 49% (95% CI: 1.01-2.21) and 52% (95% CI: 1.01-2.27) greater odds, respectively. A unit increase in log-transformed Pb was associated with a 36% increase in odds (95% CI: 1.09-1.71), with the highest Pb quintile showing nearly double the risk (OR: 1.94; 95% CI: 1.22-3.07). BMI significantly moderated the association with Se and Pb, albeit in different ways. Non-HDL-C mediated 36.82% of Se's and 30.80% of Pb's total effect on elevated blood pressure (p<0.05).

Conclusion: In US adults without diagnosed hypertension, higher blood Se and Pb concentrations were associated with elevated blood pressure, with BMI modifying and non-HDL-C potentially and partially mediating these associations. These findings highlight the need for targeted public health strategies to limit environmental metal exposure and suggest that monitoring non-HDL-C levels in conjunction with individual metabolic profiles may support early cardiovascular risk assessment and timely intervention.

Aim: Coronary artery disease is a major cause of mortality in patients with chronic kidney disease (CKD); however, the actual burden of asymptomatic coronary artery stenosis in patients with advanced-stage CKD remains unclear. We investigated the prevalence and associated factors of significant coronary artery stenosis (≥ 50%) in asymptomatic patients with moderate-to-severe (stage G3-5) CKD. Furthermore, we evaluated the usefulness of carotid maximum intima-media thickness (IMT) in predicting significant coronary artery stenosis in these patients.

Methods: We enrolled 128 patients (men: 68.0%; mean age: 70.3±11.2 years; mean estimated glomerular filtration rate: 37.6±12.9 mL/min/1.73 m²) in a prospective, cross-sectional study. The presence and severity of coronary artery stenosis was evaluated by coronary magnetic resonance angiography. Carotid maximum-IMT was also evaluated by carotid ultrasonography. Factors which were associated with the presence of significant coronary artery stenosis were explored by multivariable logistic regression analysis. The diagnostic accuracy of carotid maximum-IMT for detecting significant coronary artery stenosis was explored by receiver operating characteristic (ROC) curve analysis.

Results: Seventy-six patients (60%) had significant coronary artery stenosis. Univariable analyses showed that age, body mass index, high-density lipoprotein cholesterol, glycated hemoglobin, C-reactive protein, and carotid maximum-IMT were associated with the presence of significant coronary artery stenosis. However, multivariable logistic regression analysis revealed that only carotid maximum-IMT (odds ratio: 4.86; P < 0.001) was associated with the presence of significant coronary artery stenosis. The ROC curve of carotid maximum-IMT was significant (P < 0.001), with an area under the curve of 0.788 (cut-off value, 1.5 mm; sensitivity, 0.84; specificity, 0.58).

Conclusion: The prevalence of significant coronary artery stenosis was high (60%) in patients with moderate-to-severe CKD. Carotid maximum-IMT was the primary factor associated with the presence of significant coronary artery stenosis and might be a surrogate marker for significant coronary artery stenosis in these patients.

Background: CVD remains the leading global cause of mortality, especially in individuals with T2D and Pre-DM, where insulin resistance increases cardiometabolic risk and early myocardial injury often goes unrecognized. This study aimed to evaluate baseline serum concentrations of H-FABP and Hs-cTnI, biomarkers linked to myocardial injury, in newly diagnosed T2D, Pre-DM, and normoglycemic individuals, to assess their predictive value for CVEs and the association between H-FABP and HOMA-IR.

Methods: In a prospective cohort study of 72 medication-free participants (25 T2D, 22 Pre-DM, 25 normoglycemic) without clinical myocardial symptoms, baseline anthropometric and biochemical measurements were obtained, including H-FABP, Hs-cTnI, HbA1c, fasting glucose, fasting insulin, and HOMA-IR was calculated. Participants were followed one year to evaluate the occurrence of CVE.

Results: Strong correlations between baseline H-FABP and Hs-cTnI across all glycemic groups (all p<0.01) with no significant intergroup differences. In abnormal weight T2D participants, baseline fasting insulin correlated moderately with baseline H-FABP (ρ=0.50, p=0.029) and strongly with baseline HOMA-IR (ρ=0.74, p<0.001). CVEs occurred in 33.3% of participants and were associated with elevated baseline H-FABP and Hs-cTnI (p<0.001 and p=0.001), alongside strong biomarker inter-correlation (ρ=0.64 overall; ρ=0.84 in CVEs). Both biomarkers independently predicted CVEs; H-FABP had higher sensitivity and NPV, while Hs-cTnI showed greater specificity and PPV. Glycemic status was not statistically associated with CVE occurrence, although higher HOMA-IR and insulin were observed in the CVE group (p=0.073 and p=0.054).

Conclusion: These findings support H-FABP as a cardiac biomarker for myocardial injury across normoglycemic, Pre-DM, and T2D groups. The link between H-FABP and insulin resistance in individuals with greater burden of metabolic disturbance highlights its role as a cardiometabolic indicator. Both biomarkers predicted CVEs in asymptomatic individuals, with H-FABP potentially useful for early risk exclusion and Hs-cTnI for confirming high-risk status.

Purpose: Coronary artery bypass grafting (CABG) is widely recognized as the gold standard treatment for patients with complex coronary artery disease (CAD). The identification of reliable hematologic predictors for major adverse cardiovascular events (MACE) after CABG remains limited. In recent years, the platelet-to-hemoglobin ratio (PHR) has emerged as a promising prognostic marker in various cardiovascular conditions and malignancies. This study investigated the prognostic value of the PHR for predicting in-hospital and short-term adverse outcomes after CABG.

Patients and methods: This retrospective cohort study included 1672 Chinese patients who underwent isolated CABG surgery between 2015 and 2021. PHR was calculated as platelet count (×10⁹/L) divided by hemoglobin (g/L). The primary endpoint was 3-point MACE (3P-MACE), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke during hospitalization. A predictive nomogram was developed and validated using bootstrap resampling.

Results: In our study, individuals with elevated PHR levels were more likely to experience 3P-MACE and stroke. After propensity matching, the incidence of 3P-MACE was 5.7% in the high PHR group (PHR≥1.890) and 1.5% in the low PHR group (P = 0.010). Multivariate analysis identified preoperative PHR (odds ratio: 1.800 [95% CI 1.073-3.021], P=0.026) as an independent predictor for 3P-MACE post-CABG. A predictive nomogram for 3P-MACE following CABG was successfully developed. The predictive performance of PHR was comparable to NLR and PLR, with an area under the ROC curve (AUC) of 0.595 (95% CI 0.486-0.691). Combining PHR with nomogram parameters improved AUC to 0.762 (95% CI 0.687-0.837).

Conclusion: Elevated PHR (≥1.890) was independently associated with postoperative 3P-MACE, reflecting the integrated effects of thrombosis and anemia risk. Although PHR demonstrated modest discrimination as a single variable, its integration into a multivariable nomogram improved predictive accuracy. These findings are hypothesis-generating and future multicenter, prospective validation studies are warranted.

Acetaldehyde, a metabolite of alcohol, accumulates in the body through excessive alcohol consumption. This accumulation triggers a range of vascular endothelial cell damage, including changes of signaling pathways, and ultimately results in organ and tissue damage. In this review, we highlight the role of acetaldehyde in vascular endothelial cell damage, including DNA damage, oxidative stress, and changes in signaling pathways. Particularly concerning the role of the NEIL3 pathway in DNA repair, the NEIL3 pathway is prioritized over the Fanconi anemia pathway, which may result in genomic rearrangements and the cleavage of the crosslink. Insulin, and estrogen receptors α damage induced by acetaldehyde. Notably, we describe the mechanisms by which long-term acetaldehyde exposure causes DNA damage, oxidative stress, imbalance in Ca²⁺ homeostasis, inflammatory response, and signaling pathway changes. We provide novel insights into the intervention of acetaldehyde exposure-mediated vascular endothelial cell disorders.

Background: COVID-19 has been associated with a hypercoagulable state, leading to various thrombotic complications, including aortic thrombosis, a rare but severe manifestation requiring surgical intervention. Additionally, vaccine-induced immune thrombotic thrombocytopenia (VITT), linked to adenoviral vector vaccines, presents unique surgical challenges due to a heightened risk of thrombosis and bleeding. This review focuses on the surgical management of COVID-19-associated aortic thrombosis and VITT-related large-vessel occlusions.

Results: Surgical intervention in COVID-19-associated aortic thrombosis depends on thrombus burden, patient stability, and associated comorbidities. Open thrombectomy, aortic bypass, and hybrid endovascular techniques have been employed, with perioperative anticoagulation being critical to prevent recurrence. High thrombus burden cases often require open repair, while endovascular approaches are preferred in high-risk patients. Mortality rates remain elevated (up to 30%), with post-surgical complications including recurrent thrombosis and limb loss. In VITT cases, surgical revascularization is complicated by thrombocytopenia and a prothrombotic state, necessitating non-heparin anticoagulation and close hematologic monitoring. Delayed diagnosis and inappropriate anticoagulation significantly worsen outcomes.

Conclusion: The surgical management of aortic thrombosis in COVID-19 and VITT patients requires a multidisciplinary approach, incorporating vascular surgery, hematology, and intensive care. Early intervention with individualized surgical and anticoagulation strategies is crucial in optimizing outcomes. Further research is needed to refine surgical decision-making, improve postoperative anticoagulation protocols, and enhance patient survival in these complex thrombotic conditions.