Vascular Health and Risk Management最新文献

Introduction: Previous studies with visible light spectroscopy (VLS) and laser Doppler flowmetry (LDF) have shown reduced mucosal circulation of the stomach and duodenal wall in patients with median arcuate ligament syndrome (MALS) and chronic mesenteric ischemia (CMI). However, transserosal microcirculatory assessment during the operative treatment of patients with these conditions has not yet been performed. We aimed to investigate if laparoscopic decompression for MALS and aortomesenteric bypass in CMI can result in immediate measurable increase in the microcirculation in stomach and duodenum.

Patients and methods: In a single center, prospective comparative cohort study, twenty-eight patients suspected of MALS, and eleven with CMI underwent assessment of transserosal microcirculation of stomach and duodenum with Visible Light Spectroscopy (VLS) and Laser Doppler flowmetry (LDF), during surgery. Patients with computed tomography angiography (CTA) verified stenosis grade ≥50% in MALS and ≥70% in CMI were included in the study. Duplex ultrasound (DUS) was performed before and after the surgical treatment. The changes in the pre- and postoperative microcirculation were calculated with paired sample t-test.

Results: VLS showed significant increase in the transserosal relative hemoglobin concentration (rHb) after laparoscopic decompression in patients with MALS (Stomach, before: 58AU±13, after: 62AU±14, p = 0.017) and (Duodenum, before: 62AU±15, after:70AU±15, p = 0.004). Furthermore, a significantly increased blood flow was found in duodenum (Before: 276AU±89, After: 315AU±93, p = 0.015). However, the SaO2 was decreased significantly in the stomach (Before: 86AU±10, After: 82AU±14, p = 0.015), but remained unchanged in the duodenal serosa.The study did not find any increase in the microcirculation of the CMI patients after revascularization. The baseline transserosal microcirculation was indifferent between the groups.

Conclusion: Laparoscopic decompression leads to enhanced transserosal microcirculation in stomach and duodenum in the patients with MALS. The baseline transserosal microcirculation in stomach and duodenum is indifferent in the MALS and CMI.

Background: A growing number of individuals develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of the standard modifiable risk factors (hypertension, diabetes, dyslipidemia, and cigarette smoking) (SMuRF-less patients). Prevalence of SMuRF-less patients in the Middle East has not been studied. This study investigates the prevalence, clinical profiles and outcomes of SMuRF-less patients compared with those who have SMuRFs.

Methods: We analyzed data from 6 published registries and from the Jordan SMuRF-less patients study, including baseline demographic features, cardiovascular risk factors, comorbid diseases, utilization of secondary prevention pharmacotherapy and one year outcome in SMuRF-less patients, those with 1-2 SMuRFs and with 3-4 SMuRFs. Results. A total of f 5540 ASCVD patients were enrolled. Mean age was 57.5 ± 11.6 years, and 1333 (24.1%) were women. Of the whole group, 214 (3.9%) were SMuRF-less, 3014 (54.4%) had 1-2 SMuRFs and 2312 (41.7%) had 3-4 SMuRFs. Compared with the SMuRFs groups, SMuRF-less group were younger, more likely to be men, and had lower prevalence of obesity, physical inactivity, metabolic syndrome, heart failure and chronic kidney disease. SMuRF-less patients were less likely to receive secondary prevention cardiovascular medications (antiplatelet agents, statins, renin angiotensin blockers and beta blockers); all p < 0.001. One year survival in the SMuRF-less patients was significantly lower than that in the SMuRFs groups (97.7% vs.98.4% vs.98.3%, respectively, p = 0.01). Multivariate analysis showed that young age, absence of heart failure and utilization of secondary preventive medications were associated with better one year outcome.

Conclusion: In this cohort of ME patients with ASCVD, nearly four in 100 were SMuRF-less. This rate is lower than that reported by most of published studies, mainly due to the high prevalence of the 4 SMuRFs. SMuRF-less patients were younger, had less comorbid disease, received less secondary prevention pharmacotherapy and had higher rate of one year mortality than those with SMuRFs.

Clinical trials: The study is registered with ClinicalTrials.gov, unique identifier number NCT06199869.

Regular sexual activity is comparable to moderate exercise and may be safe for patients with cardiovascular disease (CVD). According to the recommendations of the Princeton III Conference (P3), people with a low risk of adverse cardiac events can undertake sexual activity safely, while other patients must first stabilise their cardiovascular status. Exercise testing is recommended to assess the safety of sexual activity in people with questionable or uncertain cardiac risk (P3). Patients after successful and uncomplicated treatment of myocardial infarction (MI) can return to sexual activity after 3 weeks if the stress test is negative. The 4th Princeton Conference (P4) recommends the use of the 2019 regimen developed by the American College of Cardiology (ACC) and American Heart Association (AHA) to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in men with ED (ACC/AHA ASCVD 2019). Sexual health education plays an important role in the successful return to safe sexual activity, which should include post-MI patients and their relatives. The responsibility for counselling lies with cardiologists, general practitioner (GP) and nursing staff. Sexual rehabilitation should be an integral part of cardiac rehabilitation, and lifestyle modification and optimal treatment of underlying medical conditions are key to maintaining psychophysical well-being and a successful sex life.

Objective: An association between white blood cell count (WBC-C) before percutaneous coronary intervention (PCI) and prognosis has been established in patients undergoing PCI. However, the effect of WBC-C after PCI on the long-term prognosis of patients with unstable angina pectoris (UA) is unclear.

Methods: A retrospective cohort study was conducted in 1811 consecutive patients with UA. The changes of WBC and subgroup counts before and in the early postoperative stages after PCI were observed by paired Wilcoxon signed-rank test. The Kaplan-Meier method and COX proportional regression model were used to evaluate the association between the incidence of 5-year endpoint events and post-PCI leukocytosis.

Results: Leukocytosis and neutrocytosis within 24 hours after PCI were observed in majority of patients with UA, while lymphocyte count significantly decreased after PCI in those patients. There were no significant differences in 5-year all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE) between patients in the post-PCI leukocytosis and the control group. However, the 5-year incidence of major adverse cardiovascular events (MACE) was significantly increased in the post-PCI leukocytosis group (p = 0.017, Log rank test). Leukocytosis after PCI was independently associated with the occurrence of MACE (hazard ratio: 1.36; 95% confidence interval: 1.06-1.75; p = 0.015).

Conclusion: Peripheral WBC and neutrophil counts within 24 hours after PCI significantly increased in response to PCI in patients with UA, while lymphocyte count significantly decreased after PCI in those patients. The post-PCI leukocytosis offered predictive value for an increased risk of MACE for up to 5 years in patients with UA.

Background: Adequate self-care behavior is an important factor in controlling hypertension to reduce the number of complications. A patient's knowledge about hypertension can influence their self-care behavior in practice.

Purpose: The aim of this study was to identify self-care behaviors among hypertension patients based on their knowledge.

Patients and methods: This descriptive correlational study was conducted on patients with hypertension in primary care. The sample was selected using purposive sampling, with a one-month data collection period yielding 115 samples. The Hypertension Self-Care Profile instrument was used to assess self-care behavior while the Knowledge on Hypertension instrument was utilized to evaluate knowledge. The characteristics variable was analyzed using descriptive statistics, while the correlation between self-care behavior and knowledge was evaluated using spearman rank correlation.

Results: Most participants had favorable attitudes towards self-care (53%), and they had adequate knowledge about hypertension (53.9%). Patients with favorable behavior and adequate knowledge were 52.5%, while patients with unfavorable behavior and inadequate knowledge were 63.0%. This study found no significant association between self-care behavior and knowledge (p = 0.099, r = 0.155).

Conclusion: Despite most participants demonstrated favorable attitudes and adequate knowledge regarding hypertension self-care, a significant association between these variables was not identified. This suggests that knowledge alone may not be a sufficient predictor of self-care behavior in this population and further research is required to understand the complex factors influencing self-care adherence and develop effective interventions to improve patient outcomes.

Background: Delayed extubation (DE) after cardiac surgery is associated with high morbidity, mortality, increased length of stay in the intensive care unit, and hospital costs. Various studies have identified factors that influence the occurrence of DE in patients after cardiac surgery, but no review has systematically synthesized the results.

Purpose: This review aimed to identify the influencing factors and the leading causes of DE in patients after cardiac surgery.

Methods: This scoping review uses the framework developed by Arksey and O'Malley (2005). Literature was searched through four databases: PubMed, Scopus, Science Direct, and CINAHL, and two search engines, Sage and Google Scholar, accessed on October 20, 2024. The articles analyzed met the inclusion criteria, such as full-text articles in English, published from 2014-2024, with case-control, cross-sectional, longitudinal, and cohort study designs and had good quality as assessed using the Joanna Briggs Institute critical appraisal checklist. Data was synthesized using thematic analysis.

Results: Eight articles with a total of 13801 participants were included in this review. The prevalence of DE after cardiac surgery ranged from 13.6% to 91.9%. The factors affecting DE were categorized into preoperative, intraoperative and postoperative. The factors most commonly reported to influence ED include preoperative factors (age ≥ 60 and EF < 50%), intraoperative factors (duration of surgery ≥7 hours, use of IABP and sedatives), and postoperative factors (BNP≥806 pg/mL). The leading causes of DE after cardiac surgery are hemodynamic instability requiring increased inotropes (33.51%), reduced level of consciousness or drowsiness (31.91%), and postoperative bleeding (20.74%).

Conclusion: The process of extubation is a crucial phase in postoperative care. By comprehending the elements that impact DE, healthcare providers can effectively allocate medical resources to enhance the success of weaning, extubation, and recovery following cardiac surgery. Consequently, further research focusing on DE is essential, particularly in patients who have undergone cardiac surgery.

Background and purpose: Body mass index (BMI), as a straightforward measure, is widely used in clinical practice, and its results are linked to HT and patient prognosis. This study aimed to ascertain if sex differences exist in the prognostic significance of BMI at the time of admission to the cardiology unit, and how this impacts the LOHS for patients suffering from hypertension.

Patients and methods: A retrospective analysis of the medical records of 486 patients admitted urgently with a diagnosis of HT to the Cardiology Department at University Hospital in Wroclaw (Poland) between January 2017 and June 2021 was conducted.

Results: Women accounted for 53% of the study group and were older than men (64.7±12.8 vs 60.5±11.8, p=0.466). The mean BMI in women was 28.49±5.39 and in men 29.14±4.88. In an unadjusted linear regression model BMI results were not independent predictors of LOHS in either sex. After adjusting the model for comorbidities and blood test results, significant independent predictors of LOHS in women were LDL (B=-0.02, p<0.001), HDL (B=-0.043, p=0.012), TC (B=0.015, p=0.007), and hsCRP (B=0.02, p=0.013), while in men they were LDL (B= -0.026, p<0.001), HDL (B= -0.058, p=0.003), and TC (B=0.022, p=0.002).

Conclusions: The result of BMI assessed at the time of a patient's admission to the cardiology department is not a significant predictor of LOHS in both men and women with hypertension.

Objective: To explore the clinical characteristics and treatment outcomes of intracerebral hemorrhage in eosinophilic granulomatosis with polyangiitis (EGPA).

Methods and patient presentation: We report an 18-year-old student of EGPA complicated with intracerebral hemorrhage. The laboratory tests showed a continuous increase in eosinophils. The CT of head and chest showed cerebral hemorrhage and pulmonary infiltration.

Interventions: The patient received an intravenous infusion of methylprednisolone 1g/(kg·d) and cyclophosphamide for 3 days, followed by oral prednisone 1 mg/(kg·d).

Outcomes: At discharge, the patient's head and chest CT showed obvious absorption of intracranial hematoma and improvement of pulmonary infiltration. We reviewed 40 previously published cases of EGPA with intracerebral hemorrhage focusing on the clinical features and treatment of intracerebral hemorrhage caused by EGPA.

Conclusion: For the cases of EGPA complicated with intracerebral hemorrhage, we should timely differentiate diagnosis and recognition. Early diagnosis with aggressive immunosuppressive therapy can help improve the prognosis of patients EGPA with intracerebral hemorrhage. When a patient is affected by EGPA, it is essential to remain vigilant for signs of Central Nervous System involvement. The treatment with glucocorticoids and cyclophosphamide is effective in managing EGPA.

Purpose: Hemoglobin (Hb) levels and red cell distribution width (RDW) are standard and widely used parameters that predict clinical outcomes in patients with chronic heart failure (CHF). The Hb to RDW ratio (HRR) provides an incremental clinical prediction, as it reflects the various clinical characteristics of patients. No published data exists in the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) databases on HRR and its association with in-hospital mortality among patients with CHF. The aim of this study was to evaluate the relationship between the HRR and in-hospital mortality in two large real-world cohorts of patients with chronic CHF.

Patients and methods: Data from the MIMIC-IV and eICU-CRD databases were used to explore the association between HRR and in-hospital mortality. Multivariate logistic regression, stratified analysis with interaction, and restricted cubic splines were used to investigate the association between HRR and in-hospital mortality.

Results:  A total of 30,411 patients with CHF were enrolled based on the MIMIC-IV and multicenter eICU-CRD databases (15,983 and 14,428, respectively), including 16,295 men and 14,116 women with a median age of 73 years. The mean HRR was 0.69 ± 0.20. The overall in-hospital mortality rate was 12.63%. Increasing quantiles of HRR were associated with reduced in-hospital mortality rates. After adjusting for significant predictors, multivariate logistic regression analysis demonstrated that a low HRR was a significant predictor of in-hospital mortality, with a graded reduction in risk as HRR increased. Sensitivity analysis using restricted cubic splines demonstrated a continuous increase in in-hospital mortality risk with decreasing HRR (P = 0.262 for the non-linear model).

Conclusion: A linear relationship was observed between baseline HRR levels and in-hospital mortality. Lower HRR levels were associated with higher in-hospital mortality in patients with CHF. HRR could be a reliable clinical metric for assessing in-hospital mortality risk.

Purpose: Studies consistently show abnormally high levels of lactate acid in cardiovascular disease patients, suggested that targeting lactate production may serve as potential strategies for the treatment in the future. However, observational results may be subject to residual confounding and bias.

Methods: This study used the dataset from GWAS database to examine confounding in epidemiologic associations between lactate and cardiovascular diseases. A genome-wide genetic association study using Mendelian randomization (MR) was performed from December 02, 2023 to January 15, 2024 to reduce confounding and enhance causal inference. Primary analysis was conducted using inverse-variance-weighted MR. All studies included patients predominantly of European ancestry.

Results: The association between lactate and cardiovascular diseases, including 60801 cases from coronary heart disease, 7018 cases from myocardial infarction, 14334 cases from coronary atherosclerosis, 60620 cases from atrial fibrillation, 54358 cases from hypertension, 71 cases from hypertrophic cardiomyopathy, 47309 cases from heart failure, 7055 cases from stroke, 7193 cases from cardioembolic ischemic stroke, 4373 cases from ischemic stroke caused by large vascular atherosclerosis, 2118 cases from pulmonary embolism, 1230 cases from peripheral artery disease, and 4620 cases from venous thromboembolism. Genetically predicted coronary atherosclerosis was associated with a higher risk of lactate level (OR = 1.950; 95% CI (0.087, 1.249); P = 0.024); this association was also evident for peripheral artery disease (OR = 1.003; 95% CI (0.000, 0.005); P = 0.021). No genetically predicted associations were noted for the other cardiovascular diseases.

Conclusion: The findings of this study provide genetic evidence supporting a higher risk of lactate level only in coronary atherosclerosis and peripheral artery disease. However, no genetic association between lactate level and the other cardiovascular diseases.