Vascular Health and Risk Management最新文献

Background: Functional compression of the internal carotid artery by hyoid bone is a rare but potentially serious condition that can lead to vascular complications, particularly when coexisting with intracranial vascular abnormalities. This case report describes a 48-year-old woman with acute cerebral ischemia due to a combination of functional right internal carotid artery compression by the hyoid bone, low carotid bifurcation, and coexisting Moyamoya syndrome.

Case report: In this article, we describe the clinical case of a 48-year-old woman who presented with sudden-onset weakness in her left arm. Imaging studies demonstrated acute ischemia in the territory supplied by the right middle cerebral artery. Further evaluation with computed tomography angiography revealed compression of the right internal carotid artery by the hyoid bone. However, additional imaging studies, including digital subtraction angiography and carotid Doppler ultrasound, did not reveal any signs of internal carotid artery stenosis. This suggested that the compression was functional, occurring only in specific positions of the head or arms. The patient was also newly diagnosed with Moyamoya syndrome, characterized by progressive stenosis of the intracranial vessels. Prompt recognition of these findings enabled timely management, including the initiation of antiplatelet therapy.

Conclusion: In cases of acute brain ischemia, it is crucial to consider both intracranial and extracranial vascular conditions. This case report underscores the significance of identifying anatomical variations in the relationship between the hyoid bone and the internal carotid artery, as it can lead to arterial compression and potentially trigger acute ischemic strokes, especially in combination with Moyamoya syndrome. Understanding these anatomical nuances is essential for early diagnosis and appropriate management.

Objective: Constructing a predictive model to evaluate the risk of coronary heart disease (CHD) for early identification of patients with CHD risk based on new metabolic indicators.

Methods: A retrospective analysis was conducted based on NHANES databases. Collect general information, cardiovascular comorbidities, new metabolic indicators (BMI, Triglycerides/Glucose, Waist Circumference-to-Height ratio, Cholesterol/HDL, Triglycerides/HDL, Cardiometabolic index, Neutrophil percentage-to-albumin ratio, etc). The least absolute shrinkage and selection operator (LASSO) regression model and multivariate logistic regression were performed to analyze the risk factors of CHD and develop a CHD risk predictive model using R software.

Results: A total of 3741 individuals were included and 160 (4.3%) individuals had CHD. According to the results of the LASSO regression model and multivariate logistic regression, 9 factors were related to CHD such as Hypertension (Yes), Cardiometabolic index (≥0.672), Mean arterial pressure (<70 mmHg), Gender (male), COPD (Yes), Age (>69), Neutrophil percentage-to-albumin ratio (≥1.465), Thyroid problem (Yes) and Stroke (Yes), which were developed a CHD risk prediction nomogram. The nomogram presented good discrimination with a C-index value of 0.869 (95% confidence interval: 0.82196-0.91604), AUC (0.868) and good calibration. Based on the maximum point of the Youden index, the individuals with a score greater than 136.5 are at high risk for CHD.

Conclusion: A risk prediction model for CHD has been developed based on new metabolic indicators in this study and boasts a relatively high accuracy in the early identification of patients with CHD risk. It may help clinicians develop strategies to prevent CHD and improve care quality.

Purpose: Sex differences in the clinical course of coronary artery disease (CAD) particularly in Acute Coronary Syndrome (ACS), have been extensively hypothesized. Although coronary bifurcations account for approximately 20% of ACS cases, data concerning potential sex disparities in the outcomes of percutaneous interventions (PCI) remain scarce. Several data suggest the double kiss (DK) Culotte may provide advantages in bifurcation PCI. Therefore, we evaluate potential sex differences in relation to the Culotte technique.

Patients and methods: This study retrospectively analyzes sex disparities following PCI interventions in ACS patients using the DK-Culotte or Culotte technique for bifurcation lesions. The primary endpoint was Target Lesion Failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR). The secondary endpoint included major adverse cardiac events MACE (myocardial infarction, cardiac death, and target lesion revascularization).

Results: There were no significant differences between sexes regarding TLF (DK-Culotte: Females 10.3% vs Males 5.7%; p=0.401; Culotte: Females 16.2% vs Males 11.8%; p=0.481) or MACE (DK-Culotte: Females 13.8% vs Males 12.5%; p=0.771; Culotte: Females 24.3% vs Males 17.6%; p=0.370) after a 1-year follow-up for both bifurcation techniques.

Conclusion: The study found no significant differences in clinical outcomes between sexes following PCI for bifurcation lesions in the ACS cohort, regardless of whether the two-stent techniques (DK- Culotte or Culotte) were used.

Aim: The incidence of heart failure (HF) remains high throughout the world, posing a serious threat to human health, with inflammation being a pivotal factor in the entire pathophysiologic process. Systemic inflammatory response index (SIRI) and systemic immune inflammation index (SII) are novel indicators for poor prognosis of HF. This paper aimed to ascertain the connection between SIRI and mortality in critically ill HF patients and to compare the prognostic value with SII.

Methods: All data on HF patients were sourced from MIMIC-IV. Cox proportional hazards analysis, restricted cubic spline, and Kaplan-Meier survival analysis were utilized to determine the link between SIRI or SII and in-hospital mortality. Receiver operating characteristic curve, area under the curve (AUC), and Youden index were employed to compare the prognostic value of SIRI and SII. Subgroup analysis was conducted to confirm the predictive capability of SIRI on mortality. Propensity score matching was utilized to reveal the connection between SIRI and secondary outcomes.

Results: 754 patients were included and 45 patients (6.0%) died. There was a positive link between SIRI and in-hospital mortality in both unadjusted (p < 0.001) and adjusted models (p < 0.001 and p = 0.001, respectively), outperforming SII in all models (p > 0.05 in all models). SIRI had a higher AUC and Youden index than SII, indicating better prognostic power. In addition, hospital stay was shorter in the low SIRI group (p = 0.034).

Conclusion: SIRI predicts in-hospital mortality in critically ill HF patients, and the prognostic power is superior to SII.

Dyslipidemia is a condition characterized by excessive lipids in the blood plasma, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and decreased levels of high-density lipoprotein cholesterol (HDL-C), which is generated mostly due to obesity. This study aims to summarize research conducted on rats and humans regarding the potential of eight fruits in reducing dyslipidemia and their associated health benefits (eg, reduction of free radicals, hypoglycemic effects, weight reduction, lowering of blood pressure, and anti-inflammatory properties). The studied fruits include pomegranate, star fruit, Rosa roxburghii, pineapple, tree tomato, coffee, apple, and passion fruit. Various parts of these fruits, such as the root, leaves, stem, peel, and pulp, were analyzed for their effects. These fruits are edible, widely available, and cost-effective when purchased during the harvest season (Graphical abstract).

Purpose: Pemafibrate is a novel selective peroxisome proliferator-activated receptor alpha modulator (SPPARMα) that improves lipid profile, but its effects on cardiovascular events remain unproven. This study examined changes in the cardio-ankle vascular index (CAVI), a marker of arterial stiffness, in high-risk patients with type 2 diabetes mellitus (T2DM) or ischemic heart disease (IHD) treated with pemafibrate.

Patients and methods: In this single-center, prospective, observational study, 95 patients with T2DM and/or IHD, who had hypertriglyceridemia (≥150 mg/dL) and started pemafibrate (0.2 mg/day) were analyzed. CAVI was measured at baseline and after 24 weeks of treatment as an indicator of arterial stiffness, along with comprehensive assessment of lipid parameters including triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoproteins.

Results: No significant change in CAVI was observed after 24 weeks of treatment (median [interquartile range (IQR)]; baseline vs 24 weeks: CAVI 9.4 [8.8-10.6] vs 9.6 [8.9-10.8], p=0.715). However, pemafibrate significantly reduced triglycerides (233 mg/dL [171-329] to 143 mg/dL [111-187], p<0.001), apolipoprotein C-II (8.1 mg/dL [6.1-10.2] to 6.3 mg/dL [5.3-8.3], p<0.001), apolipoprotein C-III (15.3 mg/dL [12.2-18.3] to 11.6 mg/dL [9.3-14.2], p<0.001) and liver enzymes; and increased HDL-C (45 mg/dL [39-52] to 50 mg/dL [40-60], p<0.001), LDL-C (92 mg/dL [70-111] to 103 mg/dL [79-128], p<0.001), apolipoprotein A-I and apolipoprotein A-II (both p<0.05). Calculated small dense low-density lipoprotein cholesterol also decreased significantly (40 mg/dL [31-49] to 36 mg/dL [28-45], p=0.002).

Conclusion: While pemafibrate improves lipid profile and liver enzymes, its short-term impact on vascular stiffness, as measured by CAVI, appears limited. Extended follow-up studies are needed to clarify its cardiovascular benefits in high-risk patients.

Background: Despite a growing evidence from the animal models of the cardioprotective function of the apelinergic system in the setting of myocardial infarction, little is known on the role of apelinergic system in the development of post- infarction adverse left ventricle remodeling in humans.

Methods: The study group consisted of 49 patients with first-time ST-segment elevation myocardial infarction of anterior wall treated invasively. Echocardiography was performed on index hospitalization and on one-year check-up, with categorizing the study population into group with adverse LV remodeling defined as an increase of LV end diastolic volume by >20% (n = 12) and the group without adverse remodeling (n = 29). ELA, AP-17, AP-13 and APJ receptor levels were measured on one-year follow-up.

Results: Patients with adverse LV remodeling presented significantly higher plasma level of apelin-13 (85.63 [75.43-96.13] vs 65.43 [57.35-69.35], p = 0.001) and apelin-17 (69.36 [42.61-77.04] vs 30.04 [25.97-41.95], p = 0.004). In a univariable logistic regression analysis, higher LVEDV and LVEDV1, higher LVESV and LVESVi, lower LVEF, higher WMSI score, higher SYNTAX score, higher levels of hs-CRP during index hospitalization and higher levels of AP-13 and AP-17 on the one-year check-up were associated with adverse LV remodeling. In multivariable logistic regression analysis, only AP-17 level was independently associated with adverse LV remodeling (p = 0.050).

Conclusion: Apelinergic system may be involved in the development of post- infarction adverse left ventricle remodeling.

Objective: Hypertension significantly impacts cardiovascular health, leading to arterial stiffness and myocardial dysfunction. Pulse wave velocity (PWV) is a recognized measure of arterial stiffness, while cardiac magnetic resonance imaging (MRI) is the gold standard for assessing myocardial structure and function. The aim of the present study is to investigate the relationship between arterial stiffness, ambulatory blood pressure monitoring (ABPM), and cardiac MRI findings in untreated hypertensive individuals.

Methods: This cross-sectional study included 22 untreated hypertensive participants referred to the Hypertension ABPM Center of Excellence at Aristotle University of Thessaloniki. Participants underwent carotid-femoral PWV measurement and 24-hour ABPM. Cardiac function and structure were evaluated through cardiac MRI. Statistical analyses included Mann-Whitney and Kruskal-Wallis tests, with logistic regression for associations between c-f PWV and cardiac abnormalities. A significance threshold of p<0.05 was applied.

Results: The study population had increased office and 24-hour ABPM values. Cardiac MRI revealed systolic LV dysfunction in 31.8% and diastolic LV dysfunction in 63.6% of participants. Myocardial fibrosis was present in 50% of the participants. Elevated PWV was significantly associated with LV systolic dysfunction (p=0.003), LV diastolic dysfunction (p=0.002), myocardial stiffness (p<0.001), and myocardial fibrosis (p = 0.004). Additionally, aortic valve velocity was significantly associated with increased arterial stiffness (p=0.006). Post-hoc analysis of fibrosis showed significant differences (p=0.007 for minimal vs no fibrosis; p=0.011 for severe vs no fibrosis).

Conclusion: The study confirms a significant correlation between increased arterial stiffness, systolic ABPM-derived systolic blood pressure, and cardiac MRI dysfunction in untreated hypertensive individuals. These findings highlight the importance of arterial stiffness evaluation as a diagnostic tool for early detection of myocardial dysfunction, allowing for timely intervention and targeted treatment strategies to mitigate heart damage.

Purpose: This study aimed to investigate the current practices of VTE prophylaxis in patients undergoing abdominal-pelvic surgery (PAS) and to identify the factors that influence surgeons' practice of VTE prophylaxis.

Patients and methods: This two-phase explanatory sequential mixed-method study used chart audits followed by semi-structured interviews based on the theoretical domain framework (TDF). During Phase I, quantitative data from 240 medical records of patients with PAS in April 2023 were audited to measure adherence rates to the standard thromboprophylaxis guidelines. In Phase II, in-depth interviews with 16 surgeons were conducted and analyzed using thematic content analysis based on the TDF framework to understand the determinants of thromboprophylaxis in patients with PAS.

Results: Audits of 240 medical records of patients showed the rate of appropriate prophylactic methods was low (11.7%). For patients on anticoagulant prophylaxis, adherence rates regarding drug selection and dosage were high (100% and 89.3%, respectively), whereas adherence rates regarding time of initiation and length of prophylaxis were low (50% and 28.6%, respectively). A qualitative analysis identified 12 theoretical domains relevant to thromboprophylaxis practices among surgeons. The most encountered barriers included concerns about bleeding risk, resource issues, low beliefs about preventive benefits for certain patients with PAS, inadequate knowledge and training, and a lack of protocol and policy. The most encountered enablers included positive beliefs in prophylaxis benefits, mandatory policy and computerized supportive tools, thromboprophylaxis set as patient safety goals, leadership and multidisciplinary working, and training.

Conclusion: Significant quality gaps were present in VTE prevention practice for abdominal-pelvic surgical patients, and multiple coexisting factors prevented the full adoption of practice standards. The implementation of an anticoagulation stewardship program is essential for addressing practical issues.

Objective: There is a significant difference in prognosis among patients with hypertrophic cardiomyopathy (HCM) across different age groups and gender groups. This study aims to explore the risk of sudden cardiac death (SCD) in various age groups and genders.

Methods: A cohort of 2781 patients with HCM, initially evaluated between 1996 and 2023, were followed for a median of 4.54 years. The patients were divided into three age groups: youth group (aged ≤ 40 years), middle-aged group (aged between 40 and 60 years), and elderly group (aged ≥60 years). The outcome event was (SCD). Kaplan-Meier survival curves and Cox regression analysis were employed to compare outcomes across different age groups for both genders. Additionally, restricted cubic splines (RCS) were utilized to evaluate the potential relationship between age and prognosis within different gender categories.

Results: A total of 128 patients (4.6%) experienced SCD. In the whole population, significant age differences were observed in the Kaplan-Meier survival curves for SCD (log-rank P<0.0001). Significant age differences in SCD were also noted in both genders (log-rank P<0.0001). In multivariate Cox regression analysis, age was an independent predictor of SCD in the whole population [HR: 0.983; 95% CI: 0.972-0.994; P=0.003] and female patients [HR: 0.963; 95% CI: 0.947-0.98; P<0.001]. However, it was not significant in male patients [HR: 0.995; 95% CI: 0.98-1.01; P=0.538].

Conclusion: In patients with HCM, age was an independent predictor of SCD both the whole population and female patients. Compared to young patients, the risk of SCD is reduced by 71.4% in middle-aged patients and by 43.5% in elderly patients across the whole population. Among male patients, the risk of SCD decreases by 68.5% in middle-aged patients and by 10.7% in elderly patients. In female patients, the risk of SCD is reduced by 77.8% in middle-aged patients and by 75.3% in elderly patients.