IJC Heart and Vasculature最新文献_第8页

Myocardial work assessment to improve baseline risk stratification in patients with transthyretin amyloidosis 改善甲状腺转蛋白淀粉样变患者基线风险分层的心肌工作评估

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-12-01 DOI: 10.1016/j.ijcha.2024.101551

Ana Moya , Elayne Kelen de Oliveira , Monika Beles , Dimitri Buytaert , Marc Goethals , Riet Dierckx , Jeroen Dauw , Jozef Bartunek , Ward A. Heggermont , Marc Vanderheyden

Background

Cardiac transthyretin (ATTR) amyloidosis is an often underdiagnosed and potentially fatal disorder associated with poor survival. The National Amyloidosis Centre (NAC) staging system, based on NT-proBNP level and eGFR value, discriminates patients according to survival rates. However, NAC stage II involves a heterogenous group of patients with variable prognosis. This retrospective single-center study was set up to explore the potential role of myocardial work (MW) analysis to enhance risk stratification of ATTR patients prior to therapy.

Methods and Results

37 patients diagnosed with ATTR between March 2021 and August 2023 were included. Baseline NT-proBNP and eGFR values were collected and LVEF, GLS and MW parameters were obtained from stored echocardiographic images. Patients were categorized per NAC stage (16 NAC I, 13 NAC II and 8 NAC III). Whereas the survival rate in NAC II and NAC III was significantly worse than in NAC I (p = 0.031 and p = 0.045 respectively), no significant difference was found between NAC II and III. In the ROC analysis, GCW proved to be the best survival predictor (AUC: 0.7) with optimal cut-off value 1294 mmHg%. Patients from NAC stage II were re-stratified according to GCW cut-off into HIGH RISK together with patients from NAC III or LOW RISK together with patients from NAC I. Patients in the HIGH RISK group exhibited a significantly worse prognosis with only 40 % survival at 2 years follow-up.

Conclusion

Our results demonstrate the advantages of incorporating MW analysis, particularly the use of a GCW cut-off, in the baseline risk stratification of ATTR patients.

背景：心脏转甲状腺素（ATTR）淀粉样变是一种常被误诊且潜在致命的疾病，与生存率低相关。国家淀粉样变性中心（NAC）分期系统，基于NT-proBNP水平和eGFR值，根据生存率区分患者。然而，NAC II期涉及不同预后的异质组患者。本回顾性单中心研究旨在探讨心肌功（MW）分析在治疗前加强ATTR患者风险分层中的潜在作用。方法和结果纳入2021年3月至2023年8月诊断为ATTR的37例患者。收集基线NT-proBNP和eGFR值，并从存储的超声心动图中获取LVEF、GLS和MW参数。患者按NAC分期进行分类（16例NAC I， 13例NAC II和8例NAC III）。NAC II和NAC III的生存率明显低于NAC I (p = 0.031和p = 0.045)，而NAC II和NAC III之间无显著差异。在ROC分析中，GCW被证明是最好的生存预测因子（AUC: 0.7），最佳临界值为1294 mmHg%。根据GCW分割线，将NAC II期患者重新分层，分为高风险组和NAC III期患者，或低风险组和NAC i期患者。高风险组患者预后明显较差，随访2年生存率仅为40%。结论：我们的研究结果表明，在ATTR患者的基线风险分层中，结合MW分析，特别是使用GCW截止，具有优势。

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引用次数: 0

Use of machine learning algorithms to predict outcomes among frail patients undergoing percutaneous coronary intervention: Are we there yet? 使用机器学习算法预测经皮冠状动脉介入治疗的虚弱患者的预后：我们做到了吗？

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-12-01 DOI: 10.1016/j.ijcha.2024.101538

Josip Andelo Borovac , Mihajlo Kovacic , Stefan Harb

引用次数: 0

Smartwatch ECG and artificial intelligence in detecting acute coronary syndrome compared to traditional 12-lead ECG 与传统12导联心电图相比，智能手表心电图和人工智能在检测急性冠状动脉综合征中的应用

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-12-01 DOI: 10.1016/j.ijcha.2024.101573

Jina Choi , Joonghee Kim , Carmen Spaccarotella , Giovanni Esposito , Il-Young Oh , Youngjin Cho , Ciro Indolfi

Background

Acute coronary syndromes (ACS) require prompt diagnosis through initial electrocardiograms (ECG), but ECG machines are not always accessible. Meanwhile, smartwatches offering ECG functionality have become widespread. This study evaluates the feasibility of an image-based ECG analysis artificial intelligence (AI) system with smartwatch-based multichannel, asynchronous ECG for diagnosing ACS.

Methods

Fifty-six patients with ACS and 15 healthy participants were included, and their standard 12-lead and smartwatch-based 9-lead ECGs were analyzed. The ACS group was categorized into ACS with acute total occlusion (ACS-O(+), culprit stenosis ≥ 99 %, n = 44) and ACS without occlusion (ACS-O(−), culprit stenosis 70 % to < 99 %, n = 12) based on coronary angiography. A deep learning-based AI-ECG tool interpreting 2-dimensional ECG images generated probability scores for ST-elevation myocardial infarction (qSTEMI), ACS (qACS), and myocardial injury (qMI: troponin I > 0.1 ng/mL).

Results

The AI-driven qSTEMI, qACS, and qMI demonstrated correlation coefficients of 0.882, 0.874, and 0.872 between standard and smartwatch ECGs (all P < 0.001). The qACS score effectively distinguished ACS-O(±) from control, with AUROC for both ECGs (0.991 for standard and 0.987 for smartwatch, P = 0.745). The AUROC of qSTEMI in identifying ACS-O(+) from control was 0.989 and 0.982 with 12-lead and smartwatch (P = 0.617). Discriminating ACS-O(+) from ACS-O(−) or control presented a slight challenge, with an AUROC for qSTEMI of 0.855 for 12-lead and 0.880 for smartwatch ECGs (P = 0.352).

Conclusion

AI-ECG scores from standard and smartwatch-based ECGs showed high concordance with comparable diagnostic performance in differentiating ACS-O(+) and ACS-O(−). With increasing accessibility smartwatch accessibility, they may hold promise for aiding ACS diagnosis, regardless of location.

背景：急性冠状动脉综合征（ACS）需要通过初始心电图（ECG）及时诊断，但心电图机并不总是可用的。与此同时，具有ECG功能的智能手表已经普及。本研究评估了基于图像的心电分析人工智能（AI）系统与基于智能手表的多通道异步心电诊断ACS的可行性。方法对56例ACS患者和15例健康对照者的标准12导联心电图和基于智能手表的9导联心电图进行分析。ACS组分为急性全闭塞ACS （ACS- o(+)，罪魁祸首狭窄≥99%，n = 44）和无闭塞ACS (ACS- o(-)，罪魁祸首狭窄70% ~ <；99%, n = 12)基于冠状动脉造影。基于深度学习的AI-ECG工具解释二维ECG图像，生成st段抬高型心肌梗死（qSTEMI）、ACS （qACS）和心肌损伤(qMI：肌钙蛋白I >；0.1 ng / mL)。结果人工智能驱动的qSTEMI、qACS和qMI与标准心电图和智能手表心电图的相关系数分别为0.882、0.874和0.872 (P <；0.001)。qACS评分有效区分ACS-O（±）与对照组，两组心电图的AUROC（标准组0.991，智能手表组0.987,P = 0.745）。qSTEMI鉴别ACS-O（+）的AUROC分别为0.989和0.982 （P = 0.617）。区分ACS-O（+）与ACS-O（-）或对照组比较困难，12导联的qSTEMI AUROC为0.855，智能手表心电图的AUROC为0.880 （P = 0.352）。结论ai - ecg评分与基于智能手表的ecg评分在鉴别ACS-O（+）和ACS-O（-）方面具有高度一致性。随着智能手表的可访问性越来越高，它们可能有望帮助ACS诊断，无论位置如何。

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引用次数: 0

Risk of myocardial infarction and Osteoporosis: Insights from the 2015–2018 NHANES and Mendelian randomization Studies 心肌梗死和骨质疏松的风险：来自2015-2018年NHANES和孟德尔随机化研究的见解

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-12-01 DOI: 10.1016/j.ijcha.2024.101501

Guanmou Li , Bo Peng , Junqiao Fan , Dongqun Lin , Kunyang He , Rongjun Zou , Xiaoping Fan

Background

There are some common pathophysiological risk factors between myocardial infarction and osteoporosis, and the exact relationship between the two is not yet clear. Our study aims to provide evidence on the relationship between myocardial infarction and osteoporosis through the analysis of data from the National Health and Nutrition Examination Survey (NHANES) and Mendelian Randomization (MR) analysis from 2015 to 2018.

Methods

A two-sample MR study using summary statistics from genome-wide association studies (GWAS) was conducted to determine the causal relationship between myocardial infarction and osteoporosis. The Inverse Variance Weighted (IVW) method and other supplementary MR methods were used to validate the causal relationship between myocardial infarction and osteoporosis. Sensitivity analysis was performed to verify the robustness of the results. Weighted multivariable adjusted logistic regression was used on the NHANES 2015–2018 data to evaluate the relationship between HDL, LDL, and BMD factors closely related to myocardial infarction.

Results

An observational study conducted in NHANES included a total of 2516 participants. Weighted multivariable adjusted logistic regression analysis showed that HDL was positively correlated with BMD, with OR and 95 % CI of 0.051 and 0.013–0.088, respectively. LDL was negatively correlated with BMD. The MR analysis also indicated a causal relationship between myocardial infarction and osteoporosis (IVW (OR = 1.16, 95 % CI = 1.02–1.32, P = 0.03)). Sensitivity analysis further confirmed the robustness and reliability of these study results (all P > 0.05).

Conclusion

There is a causal relationship between myocardial infarction and osteoporosis.

背景心肌梗死与骨质疏松之间存在一些共同的病理生理危险因素，两者之间的确切关系尚不清楚。我们的研究旨在通过分析2015 - 2018年国家健康与营养调查（NHANES）和孟德尔随机化（MR）分析的数据，为心肌梗死与骨质疏松症之间的关系提供证据。方法采用全基因组关联研究（GWAS）的汇总统计数据进行两样本MR研究，以确定心肌梗死与骨质疏松症之间的因果关系。采用逆方差加权（IVW）方法及其他辅助MR方法验证心肌梗死与骨质疏松之间的因果关系。进行敏感性分析以验证结果的稳健性。采用加权多变量调整logistic回归分析NHANES 2015-2018数据，评价与心肌梗死密切相关的HDL、LDL和BMD因素之间的关系。结果在NHANES中进行的一项观察性研究共纳入2516名参与者。加权多变量校正logistic回归分析显示HDL与BMD呈正相关，OR为0.051,95% CI为0.013 ~ 0.088。LDL与BMD呈负相关。MR分析还显示心肌梗死与骨质疏松之间存在因果关系（IVW (OR = 1.16, 95% CI = 1.02-1.32, P = 0.03)）。敏感性分析进一步证实了这些研究结果的稳健性和可靠性(所有P >；0.05)。结论心肌梗死与骨质疏松有一定的因果关系。

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引用次数: 0

Risk of atrial fibrillation in patients with inflammatory bowel disease: A systematic review and meta-analysis 炎症性肠病患者心房颤动的风险：一项系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-12-01 DOI: 10.1016/j.ijcha.2024.101531

Yangyang Ke , Wengen Zhu , Wulamiding Kaisaier , Yili Chen

Background

Several studies have reported the association between inflammatory bowel disease (IBD) and the risk of atrial fibrillation (AF). This systematic review and meta-analysis aimed to determine the prevalence and incidence of AF in the IBD population.

Methods

We conducted a systematic search of the PubMed and Embase databases for relevant studies published up to February 2024. We used the random-effects model to pool the prevalence and incidence rates of AF among IBD patients. The subgroup analyses were performed according to the IBD type.

Results

A total of twenty-five studies were included. The pooled prevalence of AF among IBD patients was 6.23 % (95 % confidence interval [CI]: 4.99 %−7.47 %). The incidence rate of AF among IBD patients was 3.53 % (95 % CI: 0.57 %−6.48 %). The risk of developing AF in IBD patients was 1.45 times higher than that in the general population (risk ratio [RR]: 1.45, 95 % CI: 1.21–1.73). When comparing specific IBD types to the general population, the RR was 1.35 (95 % CI: 1.11–1.64) for CD and 1.17 (95 % CI: 1.11–1.23) for UC.

Conclusions

Our findings suggest that IBD patients exhibit an increased risk of developing AF compared to the general population. CD patients have a higher AF incidence compared to UC patients.

一些研究报道了炎症性肠病（IBD）与心房颤动（AF）风险之间的关联。本系统综述和荟萃分析旨在确定心房颤动在IBD人群中的患病率和发病率。方法系统检索PubMed和Embase数据库中截至2024年2月发表的相关研究。我们使用随机效应模型汇总IBD患者房颤的患病率和发病率。根据IBD类型进行亚组分析。结果共纳入25项研究。IBD患者AF的总患病率为6.23%（95%可信区间[CI]: 4.99% ~ 7.47%）。IBD患者房颤发生率为3.53% （95% CI: 0.57% ~ 6.48%）。IBD患者发生房颤的风险是普通人群的1.45倍（风险比[RR]: 1.45, 95% CI: 1.21-1.73）。当将特定IBD类型与一般人群进行比较时，CD的RR为1.35 (95% CI: 1.11-1.64)， UC的RR为1.17 （95% CI: 1.11-1.23）。结论：研究结果表明，IBD患者发生房颤的风险高于普通人群。与UC患者相比，CD患者有更高的AF发生率。

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引用次数: 0

Evaluating machine learning accuracy in detecting significant coronary stenosis using CCTA-derived fractional flow reserve: Meta-analysis and systematic review 利用ccta衍生的分数血流储备评估机器学习检测显著冠状动脉狭窄的准确性：荟萃分析和系统回顾

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-12-01 DOI: 10.1016/j.ijcha.2024.101528

Danny van Noort , Liang Guo , Shuang Leng , Luming Shi , Ru-San Tan , Lynette Teo , Min Sen Yew , Lohendran Baskaran , Ping Chai , Felix Keng , Mark Chan , Terrance Chua , Swee Yaw Tan , Liang Zhong

Background

The use of machine learning (ML) based coronary computed tomography angiography (CCTA) derived fractional flow reserve (ML-FFR_CT), shortens the time of diagnosis of ischemia considerably and eliminates unnecessary invasive procedures, when compared to invasive coronary angiography with invasive FFR (iFFR). This systematic review aims to summarize the current evidence on the diagnostic accuracy of (ML-FFR_CT) compared with iFFR for diagnosis of patient- and vessel-level coronary ischemia.

Methods

To identify suitable studies, comprehensive literature search was performed in PubMed, the Cochrane Library, Embase, up to August 2023. The index test was ML derived FFR and studies with diagnostic test accuracy data of ML-FFR_CT at a threshold of 0.8 were included for the review and meta-analysis. Quality of evidence was assessed using QUADAS-2 checklist.

Results

After full text review of 230 identified studies, 17 were included for analysis, which encompassed 3255 participants (age 62.0 ± 3.7). 8 studies reported patient-level data; and 12, vessel-level data. With iFFR as the reference standard, the pooled patient-level sensitivity, specificity, and area-under-curve (AUC) of ML-FFR_CT were 0.86 [95 % CI: 0.79, 0.91], 0.87 [95 % CI: 0.76, 0.94], and 0.92 [95 % CI: 0.89–0.94], respectively; and pooled vessel-level sensitivity, specificity, and AUC, 0.80 [95 % CI: 0.74–0.84], 0.84 [95 % CI: 0.77–0.89), and 0.88 [95 % CI: 0.85–0.91], respectively.

Conclusions

This systemic review demonstrated the favourable diagnostic performance of ML-FFR_CT against standard iFFR, although heterogeneity exists, providing support for the use of ML-FFR_CT as a triage tool for non-invasive screening of coronary ischemia in the clinical setting.

与有创性冠状动脉造影有创性FFR （iFFR）相比，基于机器学习（ML）的冠状动脉计算机断层造影（CCTA）衍生分数血流储备（ML- ffrct）的使用大大缩短了缺血的诊断时间，并消除了不必要的侵入性手术。本系统综述旨在总结（ML-FFRCT）与iFFR在诊断患者和血管水平冠状动脉缺血方面的诊断准确性的现有证据。方法为确定合适的研究，检索截至2023年8月PubMed、Cochrane Library、Embase的综合文献。指标检验为ML衍生FFR，并纳入阈值为0.8的ML- ffrct诊断试验准确性数据的研究进行回顾和荟萃分析。采用QUADAS-2检查表评估证据质量。在对230项确定的研究进行全文综述后，17项纳入分析，其中包括3255名参与者（年龄62.0±3.7）。8项研究报告了患者水平的数据；12、船舶级数据。以iFFR为参考标准，ML-FFRCT的患者水平敏感性、特异性和曲线下面积（AUC）分别为0.86 [95% CI: 0.79, 0.91]、0.87 [95% CI: 0.76, 0.94]和0.92 [95% CI: 0.89-0.94]；合并血管水平敏感性、特异性和AUC分别为0.80 [95% CI: 0.74-0.84]、0.84 [95% CI: 0.77-0.89]和0.88 [95% CI: 0.85-0.91]。尽管存在异质性，但该系统评价表明ML-FFRCT的诊断性能优于标准iFFR，为ML-FFRCT作为临床无创筛查冠状动脉缺血的分诊工具提供了支持。

{"title":"Evaluating machine learning accuracy in detecting significant coronary stenosis using CCTA-derived fractional flow reserve: Meta-analysis and systematic review","authors":"Danny van Noort , Liang Guo , Shuang Leng , Luming Shi , Ru-San Tan , Lynette Teo , Min Sen Yew , Lohendran Baskaran , Ping Chai , Felix Keng , Mark Chan , Terrance Chua , Swee Yaw Tan , Liang Zhong","doi":"10.1016/j.ijcha.2024.101528","DOIUrl":"10.1016/j.ijcha.2024.101528","url":null,"abstract":"<div><h3>Background</h3><div>The use of machine learning (ML) based coronary computed tomography angiography (CCTA) derived fractional flow reserve (ML-FFR<sub>CT</sub>), shortens the time of diagnosis of ischemia considerably and eliminates unnecessary invasive procedures, when compared to invasive coronary angiography with invasive FFR (iFFR). This systematic review aims to summarize the current evidence on the diagnostic accuracy of (ML-FFR<sub>CT</sub>) compared with iFFR for diagnosis of patient- and vessel-level coronary ischemia.</div></div><div><h3>Methods</h3><div>To identify suitable studies, comprehensive literature search was performed in PubMed, the Cochrane Library, Embase, up to August 2023. The index test was ML derived FFR and studies with diagnostic test accuracy data of ML-FFR<sub>CT</sub> at a threshold of 0.8 were included for the review and <em>meta</em>-analysis. Quality of evidence was assessed using QUADAS-2 checklist.</div></div><div><h3>Results</h3><div>After full text review of 230 identified studies, 17 were included for analysis, which encompassed 3255 participants (age 62.0 ± 3.7). 8 studies reported patient-level data; and 12, vessel-level data. With iFFR as the reference standard, the pooled patient-level sensitivity, specificity, and area-under-curve (AUC) of ML-FFR<sub>CT</sub> were 0.86 [95 % CI: 0.79, 0.91], 0.87 [95 % CI: 0.76, 0.94], and 0.92 [95 % CI: 0.89–0.94], respectively; and pooled vessel-level sensitivity, specificity, and AUC, 0.80 [95 % CI: 0.74–0.84], 0.84 [95 % CI: 0.77–0.89), and 0.88 [95 % CI: 0.85–0.91], respectively.</div></div><div><h3>Conclusions</h3><div>This systemic review demonstrated the favourable diagnostic performance of ML-FFR<sub>CT</sub> against standard iFFR, although heterogeneity exists, providing support for the use of ML-FFR<sub>CT</sub> as a triage tool for non-invasive screening of coronary ischemia in the clinical setting.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101528"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of the prognostic value of lateral MAPSE in patients with suspected coronary artery disease 评估侧位MAPSE对疑似冠状动脉疾病患者的预后价值

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-30 DOI: 10.1016/j.ijcha.2024.101567

Chengxi Yan , Ying Chang , FangWu , Minglei Yang , Shuangfeng Dai , Jiannan Zhang , Yuelang Zhang

Objectives

To evaluate the prognostic value of lateral mitral annular plane systolic excursion (MAPSE) in the prediction of major adverse cardiology events (MACE) in patients with suspected coronary artery disease (CAD).

Methods

233 consecutive patients were enrolled with suspected CAD from October 2012 to September 2013 and performed contrast-enhanced cardiac magnetic resonance (CMR) and two-dimensional echocardiogram studies no later than 72 h after admission. CMR imaging protocol included 4-chamber cine(cine-CMR), cardiovascular magnetic resonance angiography (CMRA) and late gadolinium enhancement (LGE). The primary endpoint is the time of first occurrence of a MACE The independent association between lateral MAPSE and MACE was evaluated by Kaplan-Meier analysis and multivariable Cox regression analysis. C statistic and net reclassification improvement (NRI) were used to evaluate the prognostic value of lateral MAPSE in MACE.

Results

Forty-five MACE occurred during an average follow-up of 9.2 years. Patients with lateral MAPSE＜9.885 mm experienced a significantly higher incidence of MACE than patients with lateral MAPSE ≥ 9.885 mm (P＜0.001). After adjustment for established univariate predictors (age, diabetes, hypertension, hypercholesterolemia, transmural myocardial infarction), lateral MAPSE remained a significant independent predictor of MACE (HR = 1.373; P = 0.020). The incorporation of lateral MAPSE into the risk model resulted in significant improvement in C statistic (increasing from 0.668 to 0.844; P = 0.005). NRI improvement was 0.33 (P＜0.001).

Conclusions

lateral MAPSE derived from cine-CMR is an independent predictor of MACE, and improve risk reclassification beyond traditional clinical and CMR risk factors in patients with suspected coronary disease.

目的评价二尖瓣侧环面收缩偏移（MAPSE）在预测疑似冠心病（CAD）患者主要不良心脏病事件（MACE）中的预后价值。方法于2012年10月至2013年9月，连续233例疑似CAD患者入组，在入院后不迟于72 h行心脏磁共振造影和二维超声心动图检查。CMR成像方案包括四室电影（cine-CMR）、心血管磁共振血管造影（CMRA）和晚期钆增强（LGE）。主要终点为首次发生MACE的时间，通过Kaplan-Meier分析和多变量Cox回归分析评估侧位MAPSE与MACE之间的独立关联。采用C统计量和净重分类改善（NRI）评价侧位MAPSE在MACE中的预后价值。结果平均随访9.2年，发生MACE 45例。侧位MAPSE<9.885 mm的患者MACE发生率显著高于侧位MAPSE≥9.885 mm的患者（P<0.001）。在调整了已建立的单因素预测因子（年龄、糖尿病、高血压、高胆固醇血症、跨壁心肌梗死）后，侧位MAPSE仍然是MACE的重要独立预测因子(HR = 1.373；P = 0.020)。将横向MAPSE纳入风险模型后，C统计量显著改善(从0.668增加到0.844；p = 0.005)。NRI改善为0.33 （P<0.001）。结论cine-CMR衍生的侧侧MAPSE是MACE的独立预测因子，可改善疑似冠心病患者的风险再分类，超越传统的临床和CMR危险因素。

{"title":"Evaluation of the prognostic value of lateral MAPSE in patients with suspected coronary artery disease","authors":"Chengxi Yan , Ying Chang , FangWu , Minglei Yang , Shuangfeng Dai , Jiannan Zhang , Yuelang Zhang","doi":"10.1016/j.ijcha.2024.101567","DOIUrl":"10.1016/j.ijcha.2024.101567","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the prognostic value of lateral mitral annular plane systolic excursion (MAPSE) in the prediction of major adverse cardiology events (MACE) in patients with suspected coronary artery disease (CAD).</div></div><div><h3>Methods</h3><div>233 consecutive patients were enrolled with suspected CAD from October 2012 to September 2013 and performed contrast-enhanced cardiac magnetic resonance (CMR) and two-dimensional echocardiogram studies no later than 72 h after admission. CMR imaging protocol included 4-chamber cine(cine-CMR), cardiovascular magnetic resonance angiography (CMRA) and late gadolinium enhancement (LGE). The primary endpoint is the time of first occurrence of a MACE The independent association between lateral MAPSE and MACE was evaluated by Kaplan-Meier analysis and multivariable Cox regression analysis. C statistic and net reclassification improvement (NRI) were used to evaluate the prognostic value of lateral MAPSE in MACE.</div></div><div><h3>Results</h3><div>Forty-five MACE occurred during an average follow-up of 9.2 years. Patients with lateral MAPSE＜9.885 mm experienced a significantly higher incidence of MACE than patients with lateral MAPSE ≥ 9.885 mm (<em>P</em>＜0.001). After adjustment for established univariate predictors (age, diabetes, hypertension, hypercholesterolemia, transmural myocardial infarction), lateral MAPSE remained a significant independent predictor of MACE (HR = 1.373; <em>P</em> = 0.020). The incorporation of lateral MAPSE into the risk model resulted in significant improvement in C statistic (increasing from 0.668 to 0.844; <em>P</em> = 0.005). NRI improvement was 0.33 (<em>P</em>＜0.001).</div></div><div><h3>Conclusions</h3><div>lateral MAPSE derived from cine-CMR is an independent predictor of MACE, and improve risk reclassification beyond traditional clinical and CMR risk factors in patients with suspected coronary disease.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101567"},"PeriodicalIF":2.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical characteristics and risk factors for in-hospital mortality of COVID-19 patients in Hubei Province: A multicenter retrospective study 湖北省新型冠状病毒肺炎患者住院死亡临床特征及危险因素的多中心回顾性研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-30 DOI: 10.1016/j.ijcha.2024.101574

Wu He , Gen Li , Ke Xu , Bo Yu , Yang Sun , Kaineng Zhong , Da Zhou , Yongcui Yan , Junfang Wu , Dao Wen Wang

Background

Coronavirus disease (COVID-19) remains one of the most significant factors threatening public health security worldwide. The COVID-19 pandemic has been ongoing for more than 3 years; however, there are few studies on the clinical characteristics and mortality risk factors in patients with COVID-19 based on comprehensive data from multiple centers.

Methods

A total of 53,030 patients with confirmed COVID-19 from 138 hospitals in Hubei Province were included in this study. We compared the clinical characteristics between survivors and non-survivors and analyzed the risk factors for in-hospital mortality.

Results

Among the 53,030 patients with COVID-19, 49,320 (93.0 %) were discharged, and 3,710 (7.0 %) died during hospitalization. Cardiovascular disease was the most common comorbidity, followed by endocrine and digestive diseases. Male sex, >65-year-old, and high diastolic blood pressure, a series of abnormal laboratory test indicators and hyponatremia, hypokalemia, acute respiratory distress syndrome, shock, solid tumor, hematological tumor, and insulin use were independent risk factors for in-hospital mortality of patients with COVID-19. In addition, male sex, older age, and higher disease severity were associated with increased mortality in patients with COVID-19.

Conclusion

Patients with early COVID-19 in Hubei Province had high mortality and a high proportion of severe cases and initial comorbidities. Cardiovascular disease was the most common comorbidity in patients with COVID-19. Male sex, older age, comorbidities, and abnormal laboratory data have been identified as independent risk factors for in-hospital mortality in patients with COVID-19. Therefore, there should be an increased focus on patients with COVID-19 with these risk factors.

背景冠状病毒病（COVID-19）仍然是威胁全球公共卫生安全的最重要因素之一。COVID-19大流行已经持续了3年多；但基于多中心综合数据对新冠肺炎患者临床特征及死亡危险因素的研究较少。方法收集湖北省138家医院新冠肺炎确诊患者53030例。我们比较了幸存者和非幸存者的临床特征，并分析了院内死亡的危险因素。结果53030例新冠肺炎患者出院49320例（93.0%），住院期间死亡3710例（7.0%）。心血管疾病是最常见的合并症，其次是内分泌和消化系统疾病。男性、65岁、舒张压高、一系列实验室检查指标异常以及低钠血症、低钾血症、急性呼吸窘迫综合征、休克、实体瘤、血液学肿瘤、胰岛素使用是COVID-19患者院内死亡的独立危险因素。此外，男性、年龄较大和疾病严重程度较高与COVID-19患者死亡率增加有关。结论湖北省早期新冠肺炎患者病死率高，重症和首发合并症比例高。心血管疾病是COVID-19患者最常见的合并症。男性、年龄较大、合并症和实验室数据异常已被确定为COVID-19患者住院死亡的独立危险因素。因此，应更加关注具有这些风险因素的COVID-19患者。

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引用次数: 0

Incidence, timing and variation in unplanned readmissions within 30-days following isolated coronary artery bypass grafting 孤立冠状动脉旁路移植术后30天内意外再入院的发生率、时间和变化

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-29 DOI: 10.1016/j.ijcha.2024.101552

Aayush Patel , Sunnya Khawaja , Trang Dang , Isuru Ranasinghe

Background

Coronary Artery Bypass Grafting (CABG) is the most common cardiac surgery, yet little is known about unplanned readmissions after CABG despite increasing clinical and policy focus on reducing readmissions. We assessed the incidence, timing, and reasons for unplanned readmission within 30 days of CABG and evaluated for variation in readmission rates across hospitals in Australia and New Zealand (ANZ).

Method

We identified isolated CABG procedures from 2013 to 2017 across all public and most private hospitals in ANZ. The primary outcome was unplanned (acute) readmissions within 30-days of discharge. Hospital specific risk standardised readmission rates (RSRRs) and 95% CI were estimated using a hierarchical generalized linear model accounting for differences in patient characteristics.

Results

52,104 patients (mean age 66.1 ± 9.9 years, 17.6 % female, 30.7 % acute) were included. The 30-day unplanned readmission rate was 12.7 % (n = 6,613) and was higher following urgent surgery (16.2 %, n = 2,595). Readmission rates peaked on days 2–4 with a median time to readmission of 9 (IQR: 4–17) days. Procedural complications and chest pain were the most common diagnoses on readmission. Risk adjustment model demonstrated satisfactory performance (C-statistic = 0.62). The median RSRR was 12.8 % (range: 6.1–20.3 %) across 37 hospitals. Only one hospital had its RSRR estimate lower than average and no hospitals had higher than average RSRR.

Conclusion

One-in-8 patients undergoing CABG experienced an unplanned readmission within 30-day, rising to one-in-6 following urgent CABG. There was little statistically significant institutional variation in RSRR. Nevertheless, many readmissions are likely related to care quality and potentially preventable, highlighting scope for clinical and policy interventions to reduce readmissions.

背景冠状动脉旁路移植术（CABG）是最常见的心脏手术，尽管临床和政策越来越关注减少再入院，但对冠状动脉旁路移植术后意外再入院的情况知之甚少。我们评估了CABG术后30天内意外再入院的发生率、时间和原因，并评估了澳大利亚和新西兰各医院再入院率的差异。方法：我们从2013年至2017年在澳新银行所有公立和大多数私立医院中确定了孤立的CABG手术。主要结局是出院30天内意外（急性）再入院。使用考虑患者特征差异的分层广义线性模型估计医院特定风险标准化再入院率（RSRRs）和95% CI。结果共纳入52104例患者，平均年龄66.1±9.9岁，女性17.6%，急性期30.7%。30天意外再入院率为12.7% (n = 6,613)，紧急手术后更高（16.2%,n = 2,595）。再入院率在第2-4天达到峰值，再入院的中位时间为9 （IQR: 4-17）天。手术并发症和胸痛是再入院最常见的诊断。风险调整模型的效果令人满意（C-statistic = 0.62）。37家医院的中位RSRR为12.8%（范围：6.1 - 20.3%）。只有一家医院的RSRR估计低于平均水平，没有一家医院的RSRR高于平均水平。结论1 / 8的CABG患者在30天内出现了意外再入院，紧急CABG后这一比例上升到1 / 6。RSRR的制度差异几乎没有统计学意义。然而，许多再入院可能与护理质量和潜在的可预防性有关，强调了临床和政策干预减少再入院的范围。

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引用次数: 0

Sex differences in the prevalence and survival of pulmonary hypertension in obstructive hypertrophic cardiomyopathy following septal myectomy 房间隔切除术后阻塞性肥厚型心肌病肺动脉高压发病率和存活率的性别差异

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-26 DOI: 10.1016/j.ijcha.2024.101569

Changrong Nie , Yifeng Zhu , Minghu Xiao , Changsheng Zhu , Yanhai Meng , Zhengyang Lu , Qiulan Yang , Shuiyun Wang

Background

Pulmonary hypertension (PH) and female have been linked to a worse survival in patients with obstructive hypertrophic cardiomyopathy (oHCM). However, female patients with PH exhibited a better prognosis than males. Herein, we investigated sex differences in the prevalence and survival of pH in oHCM following septal myectomy.

Methods

We consecutively enrolled 1491 patients diagnosed with oHCM. PH was defined as a pulmonary artery systolic pressure (PASP) > 36 mm Hg.

Results

Females were older, more likely to experience chest pain and NYHA class III/IV symptoms, and had a higher prevalence of PH (37.6 % vs. 19.9 %, p < 0.001) than males. Multivariable analysis showed that female was an independent risk for PH (OR 2.3, 95 % CI: 1.70–3.11, p < 0.001) though the PASP was comparable between males and females (44.93 ± 10.87 vs. 44.74 ± 9.72 mm Hg, p = 0.856). Over a median follow-up of 36 months [IQR 23.5–52.5 months), 28 deaths and 189 composite endpoints were observed. Kaplan-Meier analysis showed a higher cumulative incidence of death (p = 0.015) and composite endpoints (p < 0.001) in patients with PH, and Cox regression analysis revealed that PH (HR 1.78, 95 % CI: 1.30–2.45, p < 0.001) and female (HR 1.39, 95 % CI: 1.02–1.90, p = 0.038) were independently associated with composite endpoints. However, no significant survival differences were found between males and females within the PH subgroup.

Conclusions

Female was independently associated with higher prevalence but not severity of PH. Although PH and female were independently associated with worse survival, no survival difference was found between males and females in the PH subgroup.

背景肺动脉高压（PH）和女性与阻塞性肥厚型心肌病（oHCM）患者的生存率降低有关。然而，女性高血压患者的预后优于男性。在此，我们研究了室间隔肌肉切除术后 oHCM 患者 PH 患病率和存活率的性别差异。结果与男性相比，女性年龄更大，更有可能出现胸痛和 NYHA III/IV 级症状，PH 患病率更高（37.6% 对 19.9%，P< 0.001）。多变量分析显示，女性是 PH 的独立风险因素（OR 2.3，95 % CI：1.70-3.11，p < 0.001），尽管男性和女性的 PASP 值相当（44.93 ± 10.87 vs. 44.74 ± 9.72 mm Hg，p = 0.856）。在中位随访 36 个月[IQR 23.5-52.5 个月]期间，共观察到 28 例死亡和 189 个综合终点。Kaplan-Meier 分析显示，PH 患者的死亡累积发生率（p = 0.015）和复合终点（p < 0.001）较高，Cox 回归分析显示 PH（HR 1.78，95 % CI：1.30-2.45，p < 0.001）和女性（HR 1.39，95 % CI：1.02-1.90，p = 0.038）与复合终点独立相关。然而，在 PH 亚组中，男性和女性之间没有发现明显的生存差异。虽然 PH 和女性与较差的存活率独立相关，但在 PH 亚组中，男性和女性之间没有发现存活率差异。

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