Vascular Health and Risk Management最新文献

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.

Introduction: Acute lower limb ischemia (ALI) is a life and limb threatening event often affecting patients with type 2 diabetes mellitus (T2DM). Little is known about how T2DM affects the risk of adverse events in patients revascularized for ALI. This study aimed to investigate if there were differences in major outcomes between ALI patients with and without T2DM.

Methods: Between 2010 and 2014, 615 patients underwent revascularization for ALI, according to the Swedish Vascular Registry (SWEDVASC). Using the National Diabetes Registry (NDR), 245 (39.8%) of the patients were identified as having T2DM. Uni- and multivariable Cox or logistic regression analyses were performed to evaluate risk differences for major amputation, mortality, major adverse cardiovascular events (MACE), and fasciotomy between patients with and without T2DM.

Results: The rates of major amputation and mortality at one year were 32.7% and 21.6% in the T2DM group, compared to 21.9% and 31.9% in the non-DM group, respectively, resulting in a hazard ratio (HR) of 1.52 (95% confidence interval [CI] 1.12-2.07) for major amputation and HR of 0.64 (95% CI 0.46-0.88) for mortality. At one year, the HR for major amputation was 1.45 (95% CI 0.99-2.11), HR for mortality 0.92 (95% CI 0.61-1.39), HR for combined major amputation/mortality 1.27 (95% CI 0.94-1.72), and HR for MACE 1.24 (95% CI 0.92-1.67) for those with T2DM compared to those without in the multivariable Cox-regression analyses. The multivariable logistic regression analysis showed significantly lower odds of fasciotomy, OR 0.1 (95% CI 0.01-0.51) in the T2DM-group.

Conclusion: T2DM was not significantly associated with higher hazard of major amputation, mortality, combined major amputation/mortality, or MACE after revascularization for ALI, compared to patients without T2DM. Patients with T2DM had significantly lower odds of fasciotomy.

Background: The clinical performance of drug-coated balloons (DCBs) for the treatment of femoro-popliteal lesions may depend on the specific device used. There is limited evidence on the clinical safety and efficacy of the paclitaxel-coated device Stellarex^® for the treatment of long (>180 mm) femoro-popliteal lesions.

Methods: This is a single arm, prospective, open label, observational study including symptomatic patients with long femoro-popliteal lesions undergoing endovascular revascularization with Stellarex^® DCB. The primary endpoints were the safety and efficacy of the DCB over time. Secondary endpoints were represented by functional outcomes.

Results: Ninety-five patients (median age 72, lesion length 250 mm) were included. At 6 months after the procedure, 61% of patients were asymptomatic as defined by the Rutherford classification, decreasing over time (57% at 12 months, 56% at 24 months, 44% at 36 months). Walking Impairment Questionnaire showed a remarkable improvement at 6 months, with a decreasing trend over time. When single components were analysed, better performances were observed for distance and climbing scores throughout the study period, while speed returned to baseline levels after 24 months. EQ5D Questionnaire showed a statistically significant improvement throughout the study period (with a decreasing trend over time, as seen for Rutherford classification and Walking Impairment Questionnaire). During the 36-months follow-up, 9% of patients died, with previous limb amputation being an independent predictor of mortality (HR = 7.4, p = 0.013). One-year primary patency was 76.5%, with no significant difference compared to the reference rate of 80% (p = 0.810). Primary patency defined as PSVR ≤2.4 (peak systolic velocity ratio) was maintained over time (median survival time free from PSVR >2.4 was not assessable as it exceeded the 36 months of follow-up).

Conclusion: In our sample, Stellarex showed to be safe and effective and it was associated with an event rate comparable to other devices reported in literature.

Objective: To analyze the relationship between resistant hypertension (RH) and hypertension, diabetes mellitus, chronic kidney disease, sodium, calcium, magnesium, phosphorus.

Methods: A total of 475 patients with hypertension admitted to Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2021 to December 2023 were divided into hypertension group (HT group) and resistant hypertension group (RH group). We compared the differences between these two groups, and analyzed the influencing factors of RH, as well as the correlation between RH and the course of hypertension, diabetes mellitus, chronic kidney disease, and levels of sodium, calcium, magnesium and phosphorus.

Results: Compared with HT group, RH group had a significantly higher blood pressure (P < 0.05), longer duration of hypertension, diabetes mellitus, and chronic kidney disease (P < 0.01) and a higher proportion of combined chronic kidney disease (P = 0.006). The duration of hypertension, serum sodium ion concentration (≥142.00 mmol/L), calcium ion concentration (2.19 to < 2.30 mmol/L), and 24h urinary phosphorus ion level were independent influencing factors of RH (P < 0.05).

Conclusion: For hypertension patients with diabetes mellitus or chronic kidney disease, the risk of RH is significantly higher. The risk of RH may be lower in patients with blood sodium <142.00 mmol/L, blood calcium >2.29 mmol/L, 24h urine sodium and magnesium ions of 116.52 and 2.69 mmol, respectively, and higher 24h urine phosphorus ions.

Purpose: To evaluate the performance and outcomes of the 6-minute magnetic resonance imaging (MRI) protocol in diagnosing stroke within Indonesian healthcare setting compared to computed tomography (CT).

Patients and methods: This retrospective single-center study was conducted at the Universitas Indonesia Hospital in Depok, Indonesia from September 2021 to September 2023. Patients who were diagnosed with acute stroke underwent a clinical evaluation and a 6-minute MRI protocol. The primary objective was to assess the efficiency of the 6-minute MRI protocol in promptly and accurately evaluating acute stroke patients, including determining average MRI time, thrombolysis eligibility, and post-thrombolysis outcomes compared to CT imaging. Exclusions comprised those requiring resuscitation, lack of stroke code activation, or having incomplete documentation.

Results: This study involved 182 stroke patients, 136 of which underwent MRI and 46 had CT scans. Thrombolysis eligibility was similar between the groups (48.9% for MRI vs 47.8% for CT-Scan), but a higher proportion of eligible MRI patients received thrombolysis (70.1% vs 54.5%, p = 0.037). MRI also achieved shorter door-to-imaging times, especially from February to June 2022. Among those treated for ischemic stroke via MRI, 70.3% showed improvement compared to 55% for CT (p=0.016). Door-to-MRI times varied across periods, averaging 88.2 minutes before national healthcare insurance collaboration, 29.1 minutes during transition, and 47.8 minutes afterward.

Conclusion: This study emphasizes the crucial role of the 6-minute MRI protocol for accurately diagnosing stroke types, severity, and determining thrombolysis eligibility. Positive outcomes in thrombolysis patients using this protocol highlight its effectiveness. However, prolonged time-to-MRI indicates the need for further improvement. Optimizing time management and workflow efficiency are critical for improving treatment efficacy and safety.

Purpose: To explore the association between angiopoietin-like protein 2 (Angptl2) and cyclophilin A (CyPA) with acute myocardial infarction (AMI) and the occurrence of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).

Patients and methods: A single-center retrospective research was conducted. Clinical data from 146 AMI patients who underwent PCI at our hospital were analyzed and designated as the AMI group. Additionally, 56 healthy individuals who underwent medical check-ups during the same period were enrolled as the Control group. Serum levels of Angptl2 and CyPA were compared between the AMI and control groups. Furthermore, based on the presence or absence of in-stent restenosis (ISR) during the follow-up period, the AMI patients were further divided into ISR and NISR groups. Logistic regression analysis was utilized to ascertain the risk factors influencing ISR after PCI in AMI patients. The diagnostic value of serum Angptl2 and CyPA for ISR after PCI was assessed using the receiver operating characteristic (ROC) curve.

Results: Compared with the Control group, the AMI group exhibited significantly elevated levels of Angptl2 and CyPA (P<0.05). Logistic regression analysis identified serum Angptl2 and CyPA are risk factors for occurrence of ISR after PCI in AMI patients. Additionally, the ROC curve analysis demonstrated that the combined use of serum Angptl2 and CyPA achieved an area under the curve (AUC) of 0.895 for predicting ISR in AMI patients after PCI.

Conclusion: Elevated serum levels of Angptl2 and CyPA in AMI patients who developed ISR after PCI suggest that these biomarkers may serve as potential risk indicators for predicting ISR following PCI.

Introduction: Manny evidence indicates that numerous immune cells are linked to the onset and progression of VTE, though the causal relationship remains unclear. To determine the association between immune cells and VTE, we performed a bidirectional two-sample Mendelian randomization (MR) study.

Methods: A comprehensive MR analysis was conducted to ascertain the causal relationship between immune cell signatures and VTE. Leveraging publicly available genetic data, we examined the causal associations between 731 immune cell signatures and the risk of VTE. The analysis encompassed four types of immune signatures, namely median fluorescence intensities, relative cell counts, absolute cell counts, and morphological parameters. We employed the two-sample MR analysis, used the inverse variance-weighted (IVW) approach as the primary analytical method. Rigorous sensitivity analyses were employed to validate the robustness, heterogeneity, and presence of horizontal pleiotropy in the results. Furthermore, the reverse MR analysis was implemented to confirm the existence of reverse causal relationships.

Results: Eighteen immune cell signatures were found to have nominally significant associations with VTE according to the IVW method. The level of CD14 expression on CD14+ CD16+ monocytes (OR 0.95) and ten other phenotypes were identified as protective factors against VTE. Conversely, the percentage of HLA DR+ T cells among lymphocytes (OR 1.03) and six other phenotypes were identified as risk factors associated with an increased likelihood of VTE. The expression level of CX3CR1 on CD14- CD16+ monocytes showed a potential bidirectional causal relationship.

Conclusion: Our study identified 18 types of immune cell signatures that could impact VTE development, offering novel insights for future mechanistic and clinical studies in this field. Further studies to prospectively validate our findings are needed.

Purpose: It is crucial to differentiate critically ill patients exhibiting thrombocytopenia and hemolytic anemia alongside organ damage to enable rapid identification of thrombotic thrombocytopenic purpura (TTP) and TTP-like syndrome, which allows for targeted emergency interventions such as plasma exchange.

Patients and methods: This study retrospectively analyzed clinical data from patients with TTP and TTP-like syndrome to further elucidate the potential differences between these conditions. We also established a new predictive model to facilitate early identification and differentiation between TTP and TTP-like syndrome. A new predictive model for diagnosing TTP was developed using five key indicators: reticulocyte percentage, platelet count, schistocyte percentage, LDH/ULN, and indirect bilirubin. The performance of this new model was compared with the traditional PLASMIC score by evaluating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: Thirty-five patients were diagnosed with TTP and 42 were diagnosed with TTP-like syndrome. TTP is most commonly associated with autoimmune diseases (n=13, 37.14%), while TTP-like syndrome frequently arises from infections (n=23, 54.76%). The ADAMTS13 activity was significantly lower in the TTP group than in the TTP-like syndrome group (Mean 8.30% vs 46.12%). TTP-like syndrome patients had significantly higher levels of inflammatory markers. The new predictive model was developed for TTP with a predictive ability of 96.9%. Overall, 16 patients (20.77%) died, including 3 (8.57%) in the TTP group and 13 (30.95%) in the TTP-like syndrome group. Kaplan-Meier survival analysis showed significant differences in survival between TTP and TTP-like syndrome patients, with a 180-day overall survival (OS) rate of 90.6% vs 60.9% (p=0.009); and plasma exchange improved 180-day OS rate in the TTP group compared to the TTP-like syndrome group (90.6% vs 65.6%) (p=0.054).

Conclusion: This study demonstrates that TTP and TTP-like syndrome are two distinct types of diseases. The new predictive model has shown good efficacy in distinguishing TTP and TTP-like syndrome. Plasma exchange significantly improves survival in TTP patients; however, its effect on TTP-like syndrome is minimal.