International Journal of Cardiology Cardiovascular Risk and Prevention最新文献_第4页

Efficacy and comparative performance of machine learning models for stroke risk prediction in hypertensive patients: A systematic review and meta-analysis 高血压患者卒中风险预测的机器学习模型的疗效和比较性能：系统回顾和荟萃分析

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-15 DOI: 10.1016/j.ijcrp.2025.200564

Pooya Eini , Mohammad Rezayee , Milan Kassulke , Jason Tremblay

Background

Stroke poses a significant health burden among hypertensive patients, where traditional risk models often lack precision. Machine learning (ML) has shown promise in enhancing prediction accuracy by integrating diverse data sources.

Methods

Following PRISMA guidelines, we searched 5 databases from inception to September 2025. Eligible studies reported the performance of ML models in hypertensive cohorts. Data were pooled using random-effects models, with heterogeneity assessed via I², subgroup analyses, meta-regression, and leave-one-out sensitivity. The risk of bias was evaluated using PROBAST + AI, and the evidence quality was assessed using the GRADE approach.

Results

Ten studies (n = 13,299 stroke cases) were included. Pooled sensitivity was 0.88 (95 % CI: 0.80–0.93), specificity 0.88 (95 % CI: 0.77–0.94), positive likelihood ratio 7.1 (95 % CI: 3.4–15.1), negative likelihood ratio 0.14 (95 % CI: 0.08–0.26), and AUC-ROC 0.94 (95 % CI: 0.91–0.96), indicating good discriminative ability. Heterogeneity was high for both sensitivity (I² = 79.5 %) and specificity (I² = 76.8 %), potentially due to variations in study design and populations. Subgroup analyses showed consistent performance in Chinese studies (sensitivity 0.85, specificity 0.84) and those using multimodal features (sensitivity 0.84, specificity 0.83), with higher sensitivity for ischemic/hemorrhagic-specific models (0.90). Meta-regression explained 73.9 % of variance and No publication bias was detected (Deeks' p = 0.654).

Conclusion

ML models demonstrate good performance for stroke prediction in hypertensive patients. However, heterogeneity underscores the need for standardized approaches. This evidence, rated moderate by GRADE, supports ML integration in clinical practice for improved prevention.

背景中风是高血压患者的重要健康负担，传统的风险模型往往缺乏准确性。机器学习（ML）已经显示出通过整合不同的数据源来提高预测准确性的希望。方法按照PRISMA指南检索5个数据库，检索时间为成立至2025年9月。符合条件的研究报告了ML模型在高血压队列中的表现。使用随机效应模型汇总数据，通过I2、亚组分析、meta回归和遗漏敏感性评估异质性。使用PROBAST + AI评估偏倚风险，使用GRADE方法评估证据质量。结果纳入10项研究（n = 13299例）。合并敏感性为0.88 (95% CI: 0.80 ~ 0.93)，特异性为0.88 (95% CI: 0.77 ~ 0.94)，阳性似然比为7.1 (95% CI: 3.4 ~ 15.1)，阴性似然比为0.14 (95% CI: 0.08 ~ 0.26)， AUC-ROC为0.94 (95% CI: 0.91 ~ 0.96)，表明鉴别能力较好。敏感性（I2 = 79.5%）和特异性（I2 = 76.8%）的异质性都很高，可能是由于研究设计和人群的差异。亚组分析显示，中国研究（敏感性0.85，特异性0.84）和使用多模态特征的研究（敏感性0.84，特异性0.83）表现一致，对缺血/出血特异性模型的敏感性更高（0.90）。meta回归解释了73.9%的方差，未发现发表偏倚（Deeks’p = 0.654）。结论ml模型对高血压患者脑卒中有较好的预测效果。然而，异质性强调了标准化方法的必要性。该证据被GRADE评为中等，支持ML整合到临床实践中以改善预防。

{"title":"Efficacy and comparative performance of machine learning models for stroke risk prediction in hypertensive patients: A systematic review and meta-analysis","authors":"Pooya Eini , Mohammad Rezayee , Milan Kassulke , Jason Tremblay","doi":"10.1016/j.ijcrp.2025.200564","DOIUrl":"10.1016/j.ijcrp.2025.200564","url":null,"abstract":"<div><h3>Background</h3><div>Stroke poses a significant health burden among hypertensive patients, where traditional risk models often lack precision. Machine learning (ML) has shown promise in enhancing prediction accuracy by integrating diverse data sources.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we searched 5 databases from inception to September 2025. Eligible studies reported the performance of ML models in hypertensive cohorts. Data were pooled using random-effects models, with heterogeneity assessed via I<sup>2</sup>, subgroup analyses, meta-regression, and leave-one-out sensitivity. The risk of bias was evaluated using PROBAST + AI, and the evidence quality was assessed using the GRADE approach.</div></div><div><h3>Results</h3><div>Ten studies (n = 13,299 stroke cases) were included. Pooled sensitivity was 0.88 (95 % CI: 0.80–0.93), specificity 0.88 (95 % CI: 0.77–0.94), positive likelihood ratio 7.1 (95 % CI: 3.4–15.1), negative likelihood ratio 0.14 (95 % CI: 0.08–0.26), and AUC-ROC 0.94 (95 % CI: 0.91–0.96), indicating good discriminative ability. Heterogeneity was high for both sensitivity (I<sup>2</sup> = 79.5 %) and specificity (I<sup>2</sup> = 76.8 %), potentially due to variations in study design and populations. Subgroup analyses showed consistent performance in Chinese studies (sensitivity 0.85, specificity 0.84) and those using multimodal features (sensitivity 0.84, specificity 0.83), with higher sensitivity for ischemic/hemorrhagic-specific models (0.90). Meta-regression explained 73.9 % of variance and No publication bias was detected (Deeks' p = 0.654).</div></div><div><h3>Conclusion</h3><div>ML models demonstrate good performance for stroke prediction in hypertensive patients. However, heterogeneity underscores the need for standardized approaches. This evidence, rated moderate by GRADE, supports ML integration in clinical practice for improved prevention.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200564"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes: a systematic review 缺血性和出血性脑卒中发病时间与临床结局的关系：一项系统综述

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-14 DOI: 10.1016/j.ijcrp.2025.200559

Paria Heidari , Negar Heidari , Habibolah Khazaie , Sabra Margaret Abbott , Azad Maroufi , Amir Abdolmaleki , Nader Salari , Masoud Mohammadi , Amir Sharafkhaneh

Background

Cerebrovascular accident (CVA) is a critical medical pathology caused by the interruption of cerebral blood flow and leads to neuronal injury or neurodegeneration. Generally, CVAs are classified into two primary categories of ischemic and hemorrhagic. Investigation of circadian rhythm variation at the time of CVA onset is a critical subject for patient management, clinical treatment, and further scientific research. This systematic review aimed to investigate the relationship between the timing of stroke onset and patient outcomes in both ischemic and hemorrhagic strokes.

Methods

Following searching strategy designation, international databases of Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using the MeSH-based keywords. No time restrictions were applied in this regard (by December 8, 2024). All English-based observational studies reporting the risk of CVA at various daytimes were enrolled for screenings and quality control. Finally, eligible studies were selected for data extraction and categorization.

Results

According to the reports, ischemic strokes strictly occur in morning hours (06:00 to 12:00) while some studies recorded a bimodal pattern (dual peaks during morning and evening). It was also established that the strokes at night were more severe and yielded more unfavorable results. Scattered reports were found regarding the hemorrhagic strokes; some papers revealed the highest incidence in the early morning hours, while others reported the late evening or nighttime occurrence. In addition, some studies showed that nighttime hemorrhagic strokes are usually associated with greater severity and unfavorable clinical outcomes.

Conclusion

This study clarified the effect of cyclic pattern on the incidence and outcome of stroke. These trends seem greatly accounted for improvement of prevention strategies, management of treatments, and enhancement of patient outcomes.

脑血管意外（cerebrovascular accident， CVA）是由脑血流中断引起的一种重要的医学病理，可导致神经元损伤或神经变性。一般来说，cva分为缺血性和出血性两大类。研究CVA发病时的昼夜节律变化对患者管理、临床治疗和进一步的科学研究至关重要。本系统综述旨在探讨缺血性和出血性卒中患者卒中发病时间与预后之间的关系。方法采用基于mesh的关键词对Embase、PubMed、Scopus、WoS、ScienceDirect、b谷歌Scholar等国际数据库进行检索。在这方面没有时间限制（到2024年12月8日）。所有以英语为基础的观察性研究均报告了不同白天发生CVA的风险，并纳入了筛查和质量控制。最后，选择符合条件的研究进行数据提取和分类。结果缺血性脑卒中主要发生在早晨（06:00 - 12:00），也有研究记录了双峰模式（早晚双峰）。研究还发现，夜间中风更严重，产生的不良后果也更多。有关出血性中风的零星报道；一些论文揭示了清晨的发病率最高，而另一些则报道了深夜或夜间的发病率。此外，一些研究表明，夜间出血性中风通常与更严重和不利的临床结果相关。结论本研究明确了循环模式对脑卒中发病率和转归的影响。这些趋势似乎在很大程度上说明了预防策略的改进、治疗的管理和患者预后的提高。

{"title":"Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes: a systematic review","authors":"Paria Heidari , Negar Heidari , Habibolah Khazaie , Sabra Margaret Abbott , Azad Maroufi , Amir Abdolmaleki , Nader Salari , Masoud Mohammadi , Amir Sharafkhaneh","doi":"10.1016/j.ijcrp.2025.200559","DOIUrl":"10.1016/j.ijcrp.2025.200559","url":null,"abstract":"<div><h3>Background</h3><div>Cerebrovascular accident (CVA) is a critical medical pathology caused by the interruption of cerebral blood flow and leads to neuronal injury or neurodegeneration. Generally, CVAs are classified into two primary categories of ischemic and hemorrhagic. Investigation of circadian rhythm variation at the time of CVA onset is a critical subject for patient management, clinical treatment, and further scientific research. This systematic review aimed to investigate the relationship between the timing of stroke onset and patient outcomes in both ischemic and hemorrhagic strokes.</div></div><div><h3>Methods</h3><div>Following searching strategy designation, international databases of Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using the MeSH-based keywords. No time restrictions were applied in this regard (by December 8, 2024). All English-based observational studies reporting the risk of CVA at various daytimes were enrolled for screenings and quality control. Finally, eligible studies were selected for data extraction and categorization.</div></div><div><h3>Results</h3><div>According to the reports, ischemic strokes strictly occur in morning hours (06:00 to 12:00) while some studies recorded a bimodal pattern (dual peaks during morning and evening). It was also established that the strokes at night were more severe and yielded more unfavorable results. Scattered reports were found regarding the hemorrhagic strokes; some papers revealed the highest incidence in the early morning hours, while others reported the late evening or nighttime occurrence. In addition, some studies showed that nighttime hemorrhagic strokes are usually associated with greater severity and unfavorable clinical outcomes.</div></div><div><h3>Conclusion</h3><div>This study clarified the effect of cyclic pattern on the incidence and outcome of stroke. These trends seem greatly accounted for improvement of prevention strategies, management of treatments, and enhancement of patient outcomes.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200559"},"PeriodicalIF":2.1,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on “phenotype-specific associations of circulating adipokine levels with carotid atherosclerosis: a systematic review and meta-analysis” 对“循环脂肪因子水平与颈动脉粥样硬化的表型特异性关联：系统回顾和荟萃分析”的评论

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-11 DOI: 10.1016/j.ijcrp.2025.200563

Zhenxing Deng , Bin Cao

引用次数: 0

The sphingolipid metabolite sphingosine protects against hypertension by targeting metabolic-inflammatory crosstalk via the NLRP3 inflammasome 鞘脂代谢物鞘氨醇通过NLRP3炎性小体靶向代谢-炎症串扰来预防高血压

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-11 DOI: 10.1016/j.ijcrp.2025.200562

Wenjun Li , Dan Zhou , Yanmei Ji , Meirong Yang , Yunhong Yang , Mengyao Dao , Xianyu He , Xingfang Jin

Background

Hypertension is the most common chronic non-communicable disease and one of the most significant risk factors for cardiovascular and cerebrovascular diseases. Sphingosine (SPH) is a central bioactive lipid metabolite positioned at the crucial intersection of ceramide and sphingosine-1-phosphate (S1P) synthesis is increasingly implicated in cardiometabolic health. However, its precise role in the pathophysiology of hypertension and its interplay with inflammatory pathways remain largely unknown. This study aimed to research the therapeutic effects of SPH in hypertension and to explore its underlying mechanisms, focus on a key driver of sterile inflammation that the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome pathway.

Methods

An Angiotensin II (Ang II)-induced hypertensive mouse model and an in vitro model using human umbilical vein endothelial cells (HUVECs) were established. The effects of SPH administration on Ang II-induced hypertension, end-organ damage, and the activation status of the NLRP3 inflammasome were systematically evaluated.

Results

In vivo, Ang II infusion triggered significant hypertension, cardiac hypertrophy, and aortic fibrosis, which was accompanied by activation of the NLRP3 inflammasome in cardiovascular tissues. Therapeutic administration of SPH, in a manner comparable to the specific NLRP3 antagonist MCC950, markedly lowered blood pressure and attenuated these pathological changes. In vitro, SPH treatment effectively suppressed Ang II-induced NLRP3 inflammasome activation.

and released of pro-inflammatory cytokines in HUVECs. Furthermore, SPH exhibited direct protective effects on the endothelium by promoting HUVEC proliferation and against Ang II-induced injury. Mechanistically, SPH suppressed the expression and activation of key inflammasome components, including NLRP3, cleaved Caspase-1, and mature IL-1β and IL-18.

Conclusions

This study reveals a novel protective role for Sphingosine in hypertension, acting via the suppression of the NLRP3 inflammasome pathway to decrease inflammation and oxidative stress. These findings explore a new mechanistic link between sphingolipid metabolism and blood pressure regulation and highlight SPH as a potential therapeutic agent for targeting the critical series of metabolic dysregulation and inflammation in hypertensive cardiovascular disease.

背景高血压是最常见的慢性非传染性疾病，也是心脑血管疾病最重要的危险因素之一。鞘氨醇（SPH）是一种中枢生物活性脂质代谢物，位于神经酰胺和鞘氨醇-1-磷酸（S1P）合成的关键交叉点，与心脏代谢健康的关系日益密切。然而，其在高血压病理生理中的确切作用及其与炎症途径的相互作用在很大程度上仍然未知。本研究旨在研究SPH在高血压中的治疗作用并探讨其潜在机制，重点研究nod样受体家族pyrin domain containing 3 （NLRP3）炎性小体通路这一无菌炎症的关键驱动因素。方法建立血管紧张素II （angii）诱导的高血压小鼠模型和人脐静脉内皮细胞（HUVECs）体外模型。系统评估SPH给药对Ang ii诱导的高血压、终末器官损伤和NLRP3炎性体激活状态的影响。结果体内注射Angⅱ可引起明显的高血压、心肌肥厚、主动脉纤维化，并伴有心血管组织NLRP3炎性体的激活。与NLRP3特异性拮抗剂MCC950类似，SPH治疗可显著降低血压并减轻这些病理变化。在体外，SPH治疗可有效抑制Ang ii诱导的NLRP3炎性体活化。并释放促炎细胞因子。此外，SPH通过促进HUVEC增殖和抗angii诱导的内皮细胞损伤，对内皮细胞具有直接保护作用。在机制上，SPH抑制了炎性小体关键成分的表达和激活，包括NLRP3、cleaved Caspase-1、成熟的IL-1β和IL-18。结论鞘氨醇可能通过抑制NLRP3炎症小体通路，降低炎症和氧化应激，对高血压有新的保护作用。这些发现揭示了鞘脂代谢与血压调节之间的新机制联系，并突出了SPH作为针对高血压心血管疾病代谢失调和炎症的关键系列的潜在治疗药物。

{"title":"The sphingolipid metabolite sphingosine protects against hypertension by targeting metabolic-inflammatory crosstalk via the NLRP3 inflammasome","authors":"Wenjun Li , Dan Zhou , Yanmei Ji , Meirong Yang , Yunhong Yang , Mengyao Dao , Xianyu He , Xingfang Jin","doi":"10.1016/j.ijcrp.2025.200562","DOIUrl":"10.1016/j.ijcrp.2025.200562","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension is the most common chronic non-communicable disease and one of the most significant risk factors for cardiovascular and cerebrovascular diseases. Sphingosine (SPH) is a central bioactive lipid metabolite positioned at the crucial intersection of ceramide and sphingosine-1-phosphate (S1P) synthesis is increasingly implicated in cardiometabolic health. However, its precise role in the pathophysiology of hypertension and its interplay with inflammatory pathways remain largely unknown. This study aimed to research the therapeutic effects of SPH in hypertension and to explore its underlying mechanisms, focus on a key driver of sterile inflammation that the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome pathway.</div></div><div><h3>Methods</h3><div>An Angiotensin II (Ang II)-induced hypertensive mouse model and an in vitro model using human umbilical vein endothelial cells (HUVECs) were established. The effects of SPH administration on Ang II-induced hypertension, end-organ damage, and the activation status of the NLRP3 inflammasome were systematically evaluated.</div></div><div><h3>Results</h3><div>In vivo, Ang II infusion triggered significant hypertension, cardiac hypertrophy, and aortic fibrosis, which was accompanied by activation of the NLRP3 inflammasome in cardiovascular tissues. Therapeutic administration of SPH, in a manner comparable to the specific NLRP3 antagonist MCC950, markedly lowered blood pressure and attenuated these pathological changes. In vitro, SPH treatment effectively suppressed Ang II-induced NLRP3 inflammasome activation.</div><div>and released of pro-inflammatory cytokines in HUVECs. Furthermore, SPH exhibited direct protective effects on the endothelium by promoting HUVEC proliferation and against Ang II-induced injury. Mechanistically, SPH suppressed the expression and activation of key inflammasome components, including NLRP3, cleaved Caspase-1, and mature IL-1β and IL-18.</div></div><div><h3>Conclusions</h3><div>This study reveals a novel protective role for Sphingosine in hypertension, acting via the suppression of the NLRP3 inflammasome pathway to decrease inflammation and oxidative stress. These findings explore a new mechanistic link between sphingolipid metabolism and blood pressure regulation and highlight SPH as a potential therapeutic agent for targeting the critical series of metabolic dysregulation and inflammation in hypertensive cardiovascular disease.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200562"},"PeriodicalIF":2.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment of prescriber adherence to guideline-directed medical therapy for heart failure at Jimma Medical Center, Ethiopia 埃塞俄比亚吉马医疗中心对心衰药物治疗遵医嘱的评估

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-05 DOI: 10.1016/j.ijcrp.2025.200555

Getachew Yitayew Tarekegn , Legese Chelkeba , Mariam Dubale Deko , Fisseha Nigussie Dagnew , Samuel Berihun Dagnew , Tilaye Arega Moges , Sisay Sitotaw Anberbr , Taklo Simeneh Yazie , Addisu Assfaw Ayen , Behailu Terefe Tesfaye

Background

Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical therapy (GDMT) to reduce morbidity and mortality. However, adherence to GDMT is often suboptimal in resource-limited settings, such as the Jimma Medical Center, Ethiopia.

Objectives

To assess prescriber adherence to guideline-based medical therapy in heart failure at Jimma Medical Center, Ethiopia.

Methods

A convergent mixed-methods study was conducted from December 2023 to April 2024, enrolling 215 adult HFrEF patients. Prescriber adherence was measured using the Guideline Adherence Index (GAI) and QUALIFY scores. Semi-structured interviews with physicians explored the qualitative factors that affect adherence. Multinomial logistic regression identified the factors associated with adherence.

Results

Only 13.5 % of patients were discharged on all four recommended GDMT classes (ACEI/ARB, beta-blockers, MRAs, and SGLT2 inhibitors). Moderate and poor prescriber adherence occurred in 70.1 % and 16.3 % of the cases, respectively. Patient adherence was higher (74.9 % by MARS-5), yet 94 % were physically inactive, and 54.4 % regularly consumed salt. Insurance coverage (AOR: 4.81; p = 0.001), salt restriction (AOR: 6.62; p = 0.003), and shorter hospital stays (AOR: 0.90; p = 0.005) were linked to better adherence, whereas higher ejection fraction (AOR: 1.07; p = 0.005) and more comorbidities (AOR: 2.36; p = 0.037) predicted poorer adherence. The qualitative findings highlighted medication stock-outs, financial barriers, and clinical complexities as key challenges, with institutional support and multidisciplinary care as facilitators.

Conclusions

Prescriber and patient adherence to GDMT for HFrEF at Jimma Medical Center was suboptimal. Interventions targeting prescriber training, expansion of insurance coverage, patient education, and multidisciplinary care are needed to improve outcomes.

背景：心力衰竭伴射血分数降低（HFrEF）需要有指导的药物治疗（GDMT）来降低发病率和死亡率。然而，在资源有限的环境中，如埃塞俄比亚的Jimma医疗中心，坚持GDMT往往不是最佳的。目的评估埃塞俄比亚Jimma医疗中心心衰患者对基于指南的药物治疗的依从性。方法于2023年12月至2024年4月进行一项融合混合方法研究，纳入215例成人HFrEF患者。使用指南依从性指数（GAI）和合格评分来衡量处方依从性。与医生的半结构化访谈探讨了影响依从性的定性因素。多项逻辑回归确定了与依从性相关的因素。结果只有13.5%的患者在所有四种推荐的GDMT类别（ACEI/ARB， β受体阻滞剂，MRAs和SGLT2抑制剂）下出院。中度和不良处方依从性分别占70.1%和16.3%。患者的依从性更高（MARS-5为74.9%），但94%的人不运动，54.4%的人经常食用盐。保险覆盖率（AOR: 4.81; p = 0.001）、限盐（AOR: 6.62; p = 0.003）和较短住院时间（AOR: 0.90; p = 0.005）与较好的依从性相关，而较高的射血分数（AOR: 1.07; p = 0.005）和较多的合共病（AOR: 2.36; p = 0.037）预示较差的依从性。定性调查结果强调，药品缺货、财务障碍和临床复杂性是主要挑战，而机构支持和多学科护理是促进因素。结论吉马医疗中心治疗HFrEF的处方医师和患者对GDMT的依从性不理想。需要针对处方培训、扩大保险覆盖范围、患者教育和多学科护理的干预措施来改善结果。

{"title":"Assessment of prescriber adherence to guideline-directed medical therapy for heart failure at Jimma Medical Center, Ethiopia","authors":"Getachew Yitayew Tarekegn , Legese Chelkeba , Mariam Dubale Deko , Fisseha Nigussie Dagnew , Samuel Berihun Dagnew , Tilaye Arega Moges , Sisay Sitotaw Anberbr , Taklo Simeneh Yazie , Addisu Assfaw Ayen , Behailu Terefe Tesfaye","doi":"10.1016/j.ijcrp.2025.200555","DOIUrl":"10.1016/j.ijcrp.2025.200555","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical therapy (GDMT) to reduce morbidity and mortality. However, adherence to GDMT is often suboptimal in resource-limited settings, such as the Jimma Medical Center, Ethiopia.</div></div><div><h3>Objectives</h3><div>To assess prescriber adherence to guideline-based medical therapy in heart failure at Jimma Medical Center, Ethiopia.</div></div><div><h3>Methods</h3><div>A convergent mixed-methods study was conducted from December 2023 to April 2024, enrolling 215 adult HFrEF patients. Prescriber adherence was measured using the Guideline Adherence Index (GAI) and QUALIFY scores. Semi-structured interviews with physicians explored the qualitative factors that affect adherence. Multinomial logistic regression identified the factors associated with adherence.</div></div><div><h3>Results</h3><div>Only 13.5 % of patients were discharged on all four recommended GDMT classes (ACEI/ARB, beta-blockers, MRAs, and SGLT2 inhibitors). Moderate and poor prescriber adherence occurred in 70.1 % and 16.3 % of the cases, respectively. Patient adherence was higher (74.9 % by MARS-5), yet 94 % were physically inactive, and 54.4 % regularly consumed salt. Insurance coverage (AOR: 4.81; p = 0.001), salt restriction (AOR: 6.62; p = 0.003), and shorter hospital stays (AOR: 0.90; p = 0.005) were linked to better adherence, whereas higher ejection fraction (AOR: 1.07; p = 0.005) and more comorbidities (AOR: 2.36; p = 0.037) predicted poorer adherence. The qualitative findings highlighted medication stock-outs, financial barriers, and clinical complexities as key challenges, with institutional support and multidisciplinary care as facilitators.</div></div><div><h3>Conclusions</h3><div>Prescriber and patient adherence to GDMT for HFrEF at Jimma Medical Center was suboptimal. Interventions targeting prescriber training, expansion of insurance coverage, patient education, and multidisciplinary care are needed to improve outcomes.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200555"},"PeriodicalIF":2.1,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A study of extended lipid profile in patients with acute coronary syndrome: Focus on Lipoprotein(a) and PCSK9 急性冠状动脉综合征患者扩展脂质谱的研究：关注脂蛋白(A)和PCSK9

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-04 DOI: 10.1016/j.ijcrp.2025.200558

Pradeep Kumar , Sudesh Prajapathi , Abhishek Singh , Akshyaya Pradhan , Ayush Shukla , Monika Bhandari , Akhil Sharma , Pravesh Vishwakarma , Gaurav Chaudhary , Sharad Chandra , Rishi Sethi , Sudhanshu Dwivedi , Raman Puri

Background

Lipoprotein(a) [Lp(a)] and PCSK9 are emerging lipid biomarkers implicated in atherogenesis and residual cardiovascular risk, but their relationship with coronary disease complexity in acute coronary syndrome (ACS) is unclear. This study evaluates their serum levels in first-episode ACS patients versus controls and explores their relationship with SYNTAX score–defined coronary severity.

Methods

This single-centre observational study enrolled 160 patients presenting with their first episode of ACS (aged 18–75) and 40 age-matched healthy controls. All participants were free from lipid-lowering therapy and major comorbidities. Fasting serum samples were collected to measure the standard lipid profile, Lp(a), and PCSK9 levels. The severity of coronary artery disease was quantified using the SYNTAX score after coronary angiography.

Results

The ACS cohort (mean age 55.7 years; 73.1 % male) most frequently presented with STEMI (53.7 %). Traditional risk factors included smoking/tobacco use (48.8 %), diabetes (40.0 %), and hypertension (38.1 %). Median SYNTAX score was 19.4. Compared with controls, ACS patients had significantly lower HDL-C and higher LDL/HDL and cholesterol/HDL ratios. Lp(a) (38.9 vs. 15.9 mg/dL, p < 0.001) and PCSK9 (272.3 vs. 169.6 ng/mL, p < 0.001) were markedly elevated in ACS patients. Neither Lp(a) nor PCSK9 correlated with SYNTAX score. LDL-C showed a modest positive correlation with Lp(a) (r = 0.163, p = 0.040). Higher SYNTAX scores were associated with more extensive multivessel disease.

Conclusion

Patients with ACS exhibited significantly higher Lp(a) and PCSK9 levels compared with healthy controls, but these biomarkers did not reflect angiographic disease complexity. Their role may lie more in underlying cardiovascular risk assessment than in predicting anatomical severity.

脂蛋白(a) [Lp(a)]和PCSK9是新兴的脂质生物标志物，与动脉粥样硬化和残留心血管风险有关，但它们与急性冠状动脉综合征（ACS）中冠状动脉疾病复杂性的关系尚不清楚。本研究评估了首发ACS患者与对照组的血清水平，并探讨了它们与SYNTAX评分定义的冠状动脉严重程度的关系。方法本单中心观察性研究纳入了160例首次出现ACS发作的患者（18-75岁）和40例年龄匹配的健康对照。所有参与者均无降脂治疗和主要合并症。采集空腹血清样本，测量标准血脂、Lp(a)和PCSK9水平。冠状动脉造影后使用SYNTAX评分量化冠状动脉疾病的严重程度。结果ACS队列（平均年龄55.7岁，73.1%为男性）最常表现为STEMI（53.7%）。传统的危险因素包括吸烟/烟草使用（48.8%）、糖尿病（40.0%）和高血压（38.1%）。SYNTAX得分中位数为19.4。与对照组相比，ACS患者的HDL- c显著降低，LDL/HDL和胆固醇/HDL比值显著升高。Lp(a) （38.9 vs. 15.9 mg/dL, p < 0.001）和PCSK9 （272.3 vs. 169.6 ng/mL, p < 0.001）在ACS患者中显著升高。Lp(a)和PCSK9与SYNTAX评分均无相关性。LDL-C与Lp(a)呈正相关（r = 0.163, p = 0.040）。较高的SYNTAX评分与更广泛的多血管疾病相关。结论ACS患者Lp(a)和PCSK9水平明显高于健康对照组，但这些生物标志物不能反映血管造影疾病的复杂性。它们的作用可能更多地在于潜在的心血管风险评估，而不是预测解剖严重程度。

{"title":"A study of extended lipid profile in patients with acute coronary syndrome: Focus on Lipoprotein(a) and PCSK9","authors":"Pradeep Kumar , Sudesh Prajapathi , Abhishek Singh , Akshyaya Pradhan , Ayush Shukla , Monika Bhandari , Akhil Sharma , Pravesh Vishwakarma , Gaurav Chaudhary , Sharad Chandra , Rishi Sethi , Sudhanshu Dwivedi , Raman Puri","doi":"10.1016/j.ijcrp.2025.200558","DOIUrl":"10.1016/j.ijcrp.2025.200558","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] and PCSK9 are emerging lipid biomarkers implicated in atherogenesis and residual cardiovascular risk, but their relationship with coronary disease complexity in acute coronary syndrome (ACS) is unclear. This study evaluates their serum levels in first-episode ACS patients versus controls and explores their relationship with SYNTAX score–defined coronary severity.</div></div><div><h3>Methods</h3><div>This single-centre observational study enrolled 160 patients presenting with their first episode of ACS (aged 18–75) and 40 age-matched healthy controls. All participants were free from lipid-lowering therapy and major comorbidities. Fasting serum samples were collected to measure the standard lipid profile, Lp(a), and PCSK9 levels. The severity of coronary artery disease was quantified using the SYNTAX score after coronary angiography.</div></div><div><h3>Results</h3><div>The ACS cohort (mean age 55.7 years; 73.1 % male) most frequently presented with STEMI (53.7 %). Traditional risk factors included smoking/tobacco use (48.8 %), diabetes (40.0 %), and hypertension (38.1 %). Median SYNTAX score was 19.4. Compared with controls, ACS patients had significantly lower HDL-C and higher LDL/HDL and cholesterol/HDL ratios. Lp(a) (38.9 vs. 15.9 mg/dL, p < 0.001) and PCSK9 (272.3 vs. 169.6 ng/mL, p < 0.001) were markedly elevated in ACS patients. Neither Lp(a) nor PCSK9 correlated with SYNTAX score. LDL-C showed a modest positive correlation with Lp(a) (r = 0.163, p = 0.040). Higher SYNTAX scores were associated with more extensive multivessel disease.</div></div><div><h3>Conclusion</h3><div>Patients with ACS exhibited significantly higher Lp(a) and PCSK9 levels compared with healthy controls, but these biomarkers did not reflect angiographic disease complexity. Their role may lie more in underlying cardiovascular risk assessment than in predicting anatomical severity.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200558"},"PeriodicalIF":2.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Observational, Multicenter study on long-term Effectiveness and tolerability of aliROcumab (OMERO): an Italian real-life experience aliROcumab （OMERO）的长期有效性和耐受性的观察性多中心研究：意大利的现实生活经验

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-04 DOI: 10.1016/j.ijcrp.2025.200549

Alberico L. Catapano , Aldo Pietro Maggioni , Francesco Rossi , Eleonora Consolo , Lucia Notarianni , Giancarlo Agnelli , the OMERO study group

Background

The OMERO study (Observational Multicenter study on Effectiveness and tolerability of aliROcumab in real-world) aimed to evaluate the long-term effectiveness, safety and adherence of alirocumab in a cohort of Italian patients with elevated cholesterol at high- or very-high cardiovascular risk.

Methods

Italian patients with elevated cholesterol received alirocumab for at least six months before the inclusion visit and were monitored for up to five years. The achievement of the recommended LDL-Cholesterol (LDL-C) goal (70 mg/dL in high-risk patients; 100 mg/dL in very-high-risk patients) after one year, regardless of modifications of concurrent lipid-lowering therapy or treatment adherence, was the primary endpoint of the study. The evaluation of the lipid profile, the concomitant use of lipid-lowering therapies, the treatment adherence and the occurrence of adverse events were also investigated.

Results

517 (68.6 %) of the 754 FAS patients met the primary endpoint 12 months after beginning their treatment with alirocumab. Median (mean ± SD) LDL-C reductions at the final visit (median or mean follow-up period) were −60.7 % (−57.4 % ± 19.3 %) compared to baseline. The primary endpoint was achieved by 341(70.7%) of the 482 patients with an LDL-C measurement 3 years after initiating alirocumab. Adherence to the alirocumab regimen was approximately 100 % during the observation period. Eighteen (2.3 %) of the 797 patients included in the safety population experienced at least one adverse drug reaction.

Conclusion

The effectiveness of alirocumab in reducing LDL-C and its favorable safety and tolerability profile have been consistently confirmed in a real-world setting among Italian patients treated for up to 3 years.

背景：OMERO研究（aliROcumab在现实世界中的有效性和耐受性的多中心观察性研究）旨在评估aliROcumab在一组具有高或极高心血管风险的胆固醇升高患者中的长期有效性、安全性和依从性。方法意大利胆固醇升高患者在纳入前接受alirocumab治疗至少6个月，并监测长达5年。一年后达到推荐的ldl -胆固醇（LDL-C）目标（高危患者为70 mg/dL；高危患者为100 mg/dL），无论是否修改同时进行的降脂治疗或坚持治疗，都是该研究的主要终点。血脂评估，同时使用降脂疗法，治疗依从性和不良事件的发生也进行了调查。结果754例FAS患者中有517例（68.6%）在开始使用alirocumab治疗12个月后达到了主要终点。与基线相比，最终访视时（中位或平均随访期）LDL-C中位数（平均±SD）降低为- 60.7%（- 57.4%±19.3%）。482例患者中有341例（70.7%）在开始alirocumab治疗3年后进行了LDL-C检测，达到了主要终点。在观察期间，阿里单抗方案的依从性约为100%。纳入安全人群的797例患者中有18例（2.3%）经历了至少一次药物不良反应。alirocumab在降低LDL-C方面的有效性及其良好的安全性和耐受性已经在现实世界的意大利患者中治疗了长达3年的时间。

{"title":"Observational, Multicenter study on long-term Effectiveness and tolerability of aliROcumab (OMERO): an Italian real-life experience","authors":"Alberico L. Catapano , Aldo Pietro Maggioni , Francesco Rossi , Eleonora Consolo , Lucia Notarianni , Giancarlo Agnelli , the OMERO study group","doi":"10.1016/j.ijcrp.2025.200549","DOIUrl":"10.1016/j.ijcrp.2025.200549","url":null,"abstract":"<div><h3>Background</h3><div>The OMERO study (Observational Multicenter study on Effectiveness and tolerability of aliROcumab in real-world) aimed to evaluate the long-term effectiveness, safety and adherence of alirocumab in a cohort of Italian patients with elevated cholesterol at high- or very-high cardiovascular risk.</div></div><div><h3>Methods</h3><div>Italian patients with elevated cholesterol received alirocumab for at least six months before the inclusion visit and were monitored for up to five years. The achievement of the recommended LDL-Cholesterol (LDL-C) goal (70 mg/dL in high-risk patients; 100 mg/dL in very-high-risk patients) after one year, regardless of modifications of concurrent lipid-lowering therapy or treatment adherence, was the primary endpoint of the study. The evaluation of the lipid profile, the concomitant use of lipid-lowering therapies, the treatment adherence and the occurrence of adverse events were also investigated.</div></div><div><h3>Results</h3><div>517 (68.6 %) of the 754 FAS patients met the primary endpoint 12 months after beginning their treatment with alirocumab. Median (mean ± SD) LDL-C reductions at the final visit (median or mean follow-up period) were −60.7 % (−57.4 % ± 19.3 %) compared to baseline. The primary endpoint was achieved by 341(70.7%) of the 482 patients with an LDL-C measurement 3 years after initiating alirocumab. Adherence to the alirocumab regimen was approximately 100 % during the observation period. Eighteen (2.3 %) of the 797 patients included in the safety population experienced at least one adverse drug reaction.</div></div><div><h3>Conclusion</h3><div>The effectiveness of alirocumab in reducing LDL-C and its favorable safety and tolerability profile have been consistently confirmed in a real-world setting among Italian patients treated for up to 3 years.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200549"},"PeriodicalIF":2.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between body roundness index trajectories and the risk of cardiometabolic multimorbidity in Chinese middle-aged and older adults: Evidence from the China health and retirement longitudinal study 中国中老年人身体圆度指数轨迹与心血管代谢多病风险之间的关系：来自中国健康与退休纵向研究的证据

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-03 DOI: 10.1016/j.ijcrp.2025.200556

Laixi Zhang , Mi Yan , Chunyu Hu, Yuanling Tao, Zhen Cheng, Yalan Zhang, Jiayang Shi, Bing Zou, Li Sun, Zongtao Chen

Background

Cardiometabolic multimorbidity (CMM) is a growing global public health concern, particularly among aging populations. Body Roundness Index (BRI), a novel anthropometric measure reflecting visceral adiposity, may outperform BMI in predicting cardiometabolic risk. This study aimed to investigate the association between longitudinal BRI trajectories and the risk of CMM in a longitudinal cohort.

Methods

8412 participants were ultimately selected from in the China Health and Retirement Longitudinal Study database. BRI measurements were repeatedly obtained from these participants between 2011 and 2016. Group-based trajectory modeling (GBTM) was applied to identify BRI trajectories from 2011 to 2016, with CMM between 2017 and 2020 designated as the primary outcome. We executed a Cox proportional hazards regression model to assess the association between BRI trajectories and the incidence of CMM. In the sensitivity analysis, we stratified cumulative BRI into quartiles to assess whether the association with CMM remained consistent.

Results

Based on the GBTM, participants were categorized into three distinct BRI trajectory groups. These groups, labeled Low-stable, Moderate-stable, and High-stable, comprised 48.23 %, 42.21 %, and 9.56 % of the study population, respectively. Compared to the Low-stable group, Moderate-stable (HR = 1.99, 95 % CI: 1.69–2.35) and High-stable (HR = 2.88, 95 % CI: 2.28–3.63) groups had significantly increased risks of CMM. Subgroup analyses revealed a significant interaction between BMI level and BRI trajectory on CMM outcomes. Sensitivity results supported these findings.

Conclusion

Persistently high BRI trajectories significantly increase CMM risk. BRI is a simple, noninvasive marker with public health utility for early identification and prevention of cardiometabolic diseases, especially in resource-limited settings.

背景心脏代谢多病（CMM）是一个日益增长的全球公共卫生问题，特别是在老龄化人群中。身体圆度指数（BRI）是一种反映内脏脂肪的新型人体测量指标，在预测心脏代谢风险方面可能优于BMI。本研究旨在调查纵向队列中纵向BRI轨迹与CMM风险之间的关系。方法从中国健康与退休纵向研究数据库中最终选择8412名参与者。在2011年至2016年期间，从这些参与者那里反复获得BRI测量值。采用基于群体的轨迹模型（GBTM）识别2011 - 2016年的“一带一路”发展轨迹，并将2017 - 2020年的CMM模型指定为主要结果。我们使用Cox比例风险回归模型来评估BRI轨迹与CMM发病率之间的关系。在敏感性分析中，我们将累积BRI分层为四分位数，以评估与CMM的关联是否保持一致。基于GBTM，参与者被分为三个不同的“一带一路”轨迹组。这些被标记为低稳定、中稳定和高稳定的组分别占研究人群的48.23%、42.21%和9.56%。与低稳定组相比，中稳定组（HR = 1.99, 95% CI: 1.69-2.35）和高稳定组（HR = 2.88, 95% CI: 2.28-3.63） CMM的风险显著增加。亚组分析显示BMI水平和BRI轨迹对CMM结果有显著的相互作用。敏感性结果支持这些发现。结论持续高的BRI轨迹显著增加CMM风险。BRI是一种简单、无创的标志物，具有早期识别和预防心脏代谢疾病的公共卫生效用，特别是在资源有限的环境中。

{"title":"Association between body roundness index trajectories and the risk of cardiometabolic multimorbidity in Chinese middle-aged and older adults: Evidence from the China health and retirement longitudinal study","authors":"Laixi Zhang , Mi Yan , Chunyu Hu, Yuanling Tao, Zhen Cheng, Yalan Zhang, Jiayang Shi, Bing Zou, Li Sun, Zongtao Chen","doi":"10.1016/j.ijcrp.2025.200556","DOIUrl":"10.1016/j.ijcrp.2025.200556","url":null,"abstract":"<div><h3>Background</h3><div>Cardiometabolic multimorbidity (CMM) is a growing global public health concern, particularly among aging populations. Body Roundness Index (BRI), a novel anthropometric measure reflecting visceral adiposity, may outperform BMI in predicting cardiometabolic risk. This study aimed to investigate the association between longitudinal BRI trajectories and the risk of CMM in a longitudinal cohort.</div></div><div><h3>Methods</h3><div>8412 participants were ultimately selected from in the China Health and Retirement Longitudinal Study database. BRI measurements were repeatedly obtained from these participants between 2011 and 2016. Group-based trajectory modeling (GBTM) was applied to identify BRI trajectories from 2011 to 2016, with CMM between 2017 and 2020 designated as the primary outcome. We executed a Cox proportional hazards regression model to assess the association between BRI trajectories and the incidence of CMM. In the sensitivity analysis, we stratified cumulative BRI into quartiles to assess whether the association with CMM remained consistent.</div></div><div><h3>Results</h3><div>Based on the GBTM, participants were categorized into three distinct BRI trajectory groups. These groups, labeled Low-stable, Moderate-stable, and High-stable, comprised 48.23 %, 42.21 %, and 9.56 % of the study population, respectively. Compared to the Low-stable group, Moderate-stable (HR = 1.99, 95 % CI: 1.69–2.35) and High-stable (HR = 2.88, 95 % CI: 2.28–3.63) groups had significantly increased risks of CMM. Subgroup analyses revealed a significant interaction between BMI level and BRI trajectory on CMM outcomes. Sensitivity results supported these findings.</div></div><div><h3>Conclusion</h3><div>Persistently high BRI trajectories significantly increase CMM risk. BRI is a simple, noninvasive marker with public health utility for early identification and prevention of cardiometabolic diseases, especially in resource-limited settings.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200556"},"PeriodicalIF":2.1,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deep learning model for identifying significant tricuspid regurgitation using standard 12-lead electrocardiogram 使用标准12导联心电图识别显著三尖瓣返流的深度学习模型

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-02 DOI: 10.1016/j.ijcrp.2025.200557

Chun-Chin Chang , Ming-Tsung Hsieh , Yin-Hao Lee , Chih-Hsueh Tseng , Wei-Ming Huang , Ruey-Hsing Chou , Chin-Sheng Lin , Po-Hsun Huang

Introduction

Transthoracic echocardiography (TTE) is the current standard for detecting tricuspid regurgitation (TR); however, it incurs additional costs and is dependent on the operator's skill. In contrast, the 12-lead electrocardiogram (ECG) is widely available during initial evaluations. This study aimed to develop deep learning (DL) models using 12-lead ECG signals and clinical features to detect significant TR.

Methods

Between 2017 and 2019, a total of 5432 patients who underwent both 12-lead ECG and TTE were eligible for this study. Significant TR was identified in 570 of these patients. The DL model architecture was based on a combination of one-dimensional convolutional neural network, efficient channel attention block, and Multihead Attention modules. The model was trained on data from 3910 patients, tested on 435 patients, and validated using both internal and external cohorts.

Results

The diagnostic performance of the DL model using ECG signals, age, and sex to predict significant TR was as follows: an accuracy of 0.762, sensitivity of 0.809, specificity of 0.756, and an area under the curve (AUC) of 0.857. After incorporating additional factors such as RR interval, QRS duration, corrected QT interval, atrial fibrillation, and hypertension into the DL model, the diagnostic performance remained substantial, with an accuracy of 0.762, sensitivity of 0.836, specificity of 0.752, and an AUC of 0.866. External validation of the DL model showed satisfactory results.

Conclusions

Implementing the DL model for ECG interpretation could facilitate the diagnosis of significant TR. However, the clinical utility of this DL model requires further validation and exploration.

经胸超声心动图（TTE）是目前检测三尖瓣反流（TR）的标准；然而，它会产生额外的成本，并且取决于操作人员的技能。相比之下，12导联心电图（ECG）在初始评估中广泛使用。本研究旨在利用12导联ECG信号和临床特征开发深度学习（DL）模型，以检测显著的tr。方法2017年至2019年，共有5432例12导联ECG和TTE患者入选本研究。在这些患者中，570例发现了明显的TR。深度学习模型的结构是基于一维卷积神经网络、高效通道注意力块和多头注意力模块的组合。该模型使用来自3910名患者的数据进行训练，对435名患者进行测试，并使用内部和外部队列进行验证。结果基于心电信号、年龄和性别的DL模型预测显著TR的准确率为0.762，灵敏度为0.809，特异性为0.756，曲线下面积（AUC）为0.857。在DL模型中加入RR间期、QRS持续时间、校正QT间期、房颤、高血压等附加因素后，诊断效果仍然很好，准确率为0.762，敏感性为0.836，特异性为0.752，AUC为0.866。DL模型的外部验证结果令人满意。结论应用DL模型进行心电判读有助于诊断显著性TR，但该模型的临床应用有待进一步验证和探索。

{"title":"Deep learning model for identifying significant tricuspid regurgitation using standard 12-lead electrocardiogram","authors":"Chun-Chin Chang , Ming-Tsung Hsieh , Yin-Hao Lee , Chih-Hsueh Tseng , Wei-Ming Huang , Ruey-Hsing Chou , Chin-Sheng Lin , Po-Hsun Huang","doi":"10.1016/j.ijcrp.2025.200557","DOIUrl":"10.1016/j.ijcrp.2025.200557","url":null,"abstract":"<div><h3>Introduction</h3><div>Transthoracic echocardiography (TTE) is the current standard for detecting tricuspid regurgitation (TR); however, it incurs additional costs and is dependent on the operator's skill. In contrast, the 12-lead electrocardiogram (ECG) is widely available during initial evaluations. This study aimed to develop deep learning (DL) models using 12-lead ECG signals and clinical features to detect significant TR.</div></div><div><h3>Methods</h3><div>Between 2017 and 2019, a total of 5432 patients who underwent both 12-lead ECG and TTE were eligible for this study. Significant TR was identified in 570 of these patients. The DL model architecture was based on a combination of one-dimensional convolutional neural network, efficient channel attention block, and Multihead Attention modules. The model was trained on data from 3910 patients, tested on 435 patients, and validated using both internal and external cohorts.</div></div><div><h3>Results</h3><div>The diagnostic performance of the DL model using ECG signals, age, and sex to predict significant TR was as follows: an accuracy of 0.762, sensitivity of 0.809, specificity of 0.756, and an area under the curve (AUC) of 0.857. After incorporating additional factors such as RR interval, QRS duration, corrected QT interval, atrial fibrillation, and hypertension into the DL model, the diagnostic performance remained substantial, with an accuracy of 0.762, sensitivity of 0.836, specificity of 0.752, and an AUC of 0.866. External validation of the DL model showed satisfactory results.</div></div><div><h3>Conclusions</h3><div>Implementing the DL model for ECG interpretation could facilitate the diagnosis of significant TR. However, the clinical utility of this DL model requires further validation and exploration.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200557"},"PeriodicalIF":2.1,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of vitamin D insufficiency on cardiac function in patients with systemic sclerosis 维生素D不足对系统性硬化症患者心功能的影响

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-01 DOI: 10.1016/j.ijcrp.2025.200546

Susan Darroudi , Leila Bigdelu

This is a commentary on a recent research paper about the link between vitamin D deficiency and cardiovascular compromise in systemic sclerosis (SSc) patients. The study is a sound report and contributes significantly to knowledge about the cardiovascular impact of vitamin D deficiency. Strengths are adherence to ethical and diagnostic guidelines throughout, thorough cardiopulmonary characterization, and complete data acquisition. However, the absence of dietary and adiposity data (for example, energy intake), the possibility of a selection bias, as well as assumptions on parametrization for categorical variables could all introduce some limitations to our findings.Nevertheless, despite these limitations, the study indeed adds significant value to our knowledge on how vitamin D status interplays with cardiac remodeling amongst individuals with SSc and highlights the need for more mechanistic/intervention work.

这是对最近一篇关于系统性硬化症（SSc）患者维生素D缺乏与心血管损害之间联系的研究论文的评论。这项研究是一份可靠的报告，对了解维生素D缺乏对心血管的影响有重要贡献。优点是始终坚持道德和诊断指南，彻底的心肺特征和完整的数据采集。然而，缺乏饮食和肥胖数据（例如，能量摄入），选择偏差的可能性，以及对分类变量参数化的假设，都可能给我们的研究结果带来一些局限性。然而，尽管存在这些局限性，该研究确实为我们了解维生素D状态如何与SSc个体的心脏重塑相互作用增加了重要价值，并强调了更多机制/干预工作的必要性。

引用次数: 0