Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Cell-free DNA assay for malignancy classification of high-risk lung nodules 用于高危肺结节恶性程度分类的无细胞 DNA 检测。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.04.026

Siwei Wang MD, PhD , Fanchen Meng MD , Peng Chen MD , Yang Lv MSc , Min Wu PhD , Haimeng Tang PhD , Hua Bao PhD , Xue Wu PhD , Yang Shao PhD , Jie Wang PhD , Juncheng Dai PhD, MPH , Lin Xu MD, PhD , Xiaoxiao Wang PhD, MPH , Rong Yin MD, PhD

Objective

Although low-dose computed tomography has been proven effective to reduce lung cancer–specific mortality, a considerable proportion of surgically resected high-risk lung nodules were still confirmed pathologically benign. There is an unmet need of a novel method for malignancy classification in lung nodules.

Methods

We recruited 307 patients with high-risk lung nodules who underwent curative surgery, and 247 and 60 cases were pathologically confirmed malignant and benign lung lesions, respectively. Plasma samples from each patient were collected before surgery and performed low-depth (5×) whole-genome sequencing. We extracted cell-free DNA characteristics and determined radiomic features. We built models to classify the malignancy using our data and further validated models with 2 independent lung nodule cohorts.

Results

Our models using one type of profile were able to distinguish lung cancer and benign lung nodules at an area under the curve metrics of 0.69 to 0.91 in the study cohort. Integrating all the 5 base models using cell-free DNA profiles, the cell-free DNA–based ensemble model achieved an area under the curve of 0.95 (95% CI, 0.92-0.97) in the study cohort and 0.98 (95% CI, 0.96-1.00) in the validation cohort. At a specificity of 95.0%, the sensitivity reached 80.0% in the study cohort. With the same threshold, the specificity and sensitivity had similar performances in both validation cohorts. Furthermore, the performance of area under the curve reached 0.97 in both the study and validation cohorts when considering the radiomic profile.

Conclusions

The cell-free DNA profiles-based method is an efficient noninvasive tool to distinguish malignancies and high-risk but pathologically benign lung nodules.

目的虽然低剂量计算机断层扫描已被证实能有效降低肺癌特异性死亡率，但手术切除的高危肺部结节中仍有相当一部分经病理证实为良性。我们招募了 307 名接受根治性手术的高危肺部结节患者，病理证实恶性和良性肺部病变的病例分别为 247 例和 60 例。手术前采集了每位患者的血浆样本，并进行了低深度（5×）全基因组测序。我们提取了无细胞DNA特征，并确定了放射组特征。我们利用数据建立了恶性肿瘤分类模型，并用 2 个独立的肺结节队列进一步验证了模型。结果在研究队列中，我们使用一种特征的模型能够以 0.69 至 0.91 的曲线下面积指标区分肺癌和良性肺结节。整合所有 5 个使用无细胞 DNA 图谱的基础模型后，基于无细胞 DNA 的集合模型在研究队列中的曲线下面积为 0.95（95% CI，0.92-0.97），在验证队列中的曲线下面积为 0.98（95% CI，0.96-1.00）。当特异性为 95.0% 时，研究队列中的灵敏度达到 80.0%。在相同的阈值下，两个验证队列的特异性和灵敏度表现相似。结论基于无细胞 DNA 图谱的方法是一种有效的无创工具，可用于区分恶性肿瘤和高风险但病理上良性的肺结节。

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引用次数: 0

Aortic insufficiency following balloon aortic valvuloplasty does not impact long-term autograft durability after the Ross procedure 球囊主动脉瓣成形术后的主动脉瓣功能不全不会影响罗斯手术后自体移植物的长期耐久性。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.01.024

Sameer K. Singh MD, Ismail Bouhout MD, PhD, Stephanie Nguyen MD, Alice Vinogradsky BA, Anna Lampe BS, Morgan Moroi MD, Michael Salna MD, MBA, Hiroo Takayama MD, PhD, Emile Bacha MD, Andrew B. Goldstone MD, PhD

Objective

Preoperative aortic insufficiency (AI) is associated with inferior autograft durability after the Ross procedure. However, many patients with aortic stenosis (AS) undergo balloon aortic valvuloplasty (BAV) early and present with longstanding AI before Ross. We studied how BAV and subsequent valvular pathology impacts autograft durability.

Methods

Patients undergoing the Ross operation from 1993 to 2020 were identified. Those who underwent BAV before Ross were compared with patients who did not undergo BAV and underwent Ross for predominant AI (AI group) or AS (AS group). Those who underwent previous open surgical aortic valve intervention were excluded. Primary outcome of interest was autograft failure, defined as a composite of autograft reintervention or severe insufficiency.

Results

A total of 198 patients were included. Seventy-nine (39.9%) underwent BAV and subsequently underwent the Ross for predominant AI (45.6%) or AS (54.4%). Of patients who did not undergo BAV, 66 (33.3%) presented with predominant AI and 53 (26.8%) with AS. Freedom from autograft failure at 15 years was 90%, 92%, and 62% in BAV, AS, and AI groups, respectively. The AI group was at significantly increased risk of long-term autograft failure (hazard ratio, 5.6; P = .01), whereas the AS and BAV groups had similar, low risk (hazard ratio, 1.1; P = .91). Autograft durability was similar among patients who received BAV and presented with AS or AI before the Ross (P = .84).

Conclusions

BAV before the Ross procedure is common in patients with AS. These patients have excellent long-term autograft durability regardless of preoperative valvular pathology and should strongly be considered for the Ross operation.

目的：术前主动脉瓣关闭不全（AI）与罗斯手术后自体移植的耐久性较差有关。然而，许多主动脉瓣狭窄（AS）患者很早就接受了球囊主动脉瓣成形术（BAV），并在 Ross 术前就出现了长期的 AI。我们研究了 BAV 和随后的瓣膜病变对自体移植耐久性的影响：我们对 1993-2020 年间接受罗斯手术的患者进行了鉴定。方法：我们对 1993-2020 年间接受 Ross 手术的患者进行了鉴定，将 Ross 手术前接受 BAV 的患者与未接受 BAV 但因主要 AI（AI 组）或 AS（AS 组）接受 Ross 手术的患者进行了比较。之前接受过开放手术房室介入治疗的患者被排除在外。主要研究结果为自体移植失败，即自体移植再介入或严重功能不全：结果：共纳入 198 名患者。79名患者（39.9%）接受了BAV手术，随后因AI（45.6%）或AS（54.4%）为主接受了Ross手术。在未接受 BAV 手术的患者中，66 人（33.3%）为主要 AI，53 人（26.8%）为 AS。BAV组、AS组和AI组15年后自体移植失败的发生率分别为90%、92%和62%。AI组发生长期自体移植失败的风险明显增加（HR 5.6，P=0.01），而AS组和BAV组的风险相似且较低（HR 1.1，P=0.91）。Ross术前出现AS或AI的BAV患者的自体移植耐久性相似（P=0.84）：结论：Ross术前BAV在AS患者中很常见。结论：Ross手术前BAV在AS患者中很常见，无论术前瓣膜病变如何，这些患者都有很好的长期自体移植耐久性，应积极考虑进行Ross手术。

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引用次数: 0

Commentary: Circulating tumor DNA in resectable non–small cell lung cancer: Emerging canary in the coal mine 评论：可切除 NSCLC 中的 ctDNA：煤矿中新出现的金丝雀。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.03.022

Uma M. Sachdeva MD, PhD

引用次数: 0

Accurate predictor of occult mediastinal nodal metastasis in stage I lower-lobe non–small cell lung cancer 准确预测 I 期下叶非小细胞肺癌的隐匿性纵隔结节转移。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.05.003

Youwei Lin MD

引用次数: 0

Reply: Tumor distance from the mediastinum as a preoperative predictor for occult mediastinal nodal metastasis 回复：肿瘤与纵隔的距离作为隐匿性纵隔结节转移的术前预测指标。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.05.024

Takahiro Mimae MD, PhD, Morihito Okada MD, PhD

引用次数: 0

Adult Articles in AATS Journals AATS 期刊上的成人文章

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/S0022-5223(24)00858-4

引用次数: 0

Discussion to: Heterogeneous treatment effects of coronary artery bypass grafting in ischemic cardiomyopathy: A machine-learning causal forest analysis 讨论:缺血性心肌病冠状动脉旁路移植术的异质性治疗效果:机器学习因果森林分析。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2023.11.013

引用次数: 0

Identifying and mitigating risk of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy 识别和降低缺血性和非缺血性心肌病患者开胸手术后心源性休克的风险。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.02.025

Michael J. Javorski MD, MS , Karolis Bauza BMBCh, DPhil , Fei Xiang MD , Edward Soltesz MD, MPH , Lin Chen BA , Faisal G. Bakaeen MD , Lars Svensson MD, PhD , Lucy Thuita MS , Eugene H. Blackstone MD , Michael Z. Tong MD, MBA

Objectives

To identify preoperative predictors of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy and evaluate trajectory of postoperative ventricular function.

Methods

From January 2017 to January 2020, 238 patients with ejection fraction <30% (206/238) or 30% to 34% with at least moderately severe mitral regurgitation (32/238) underwent conventional cardiac surgery at Cleveland Clinic, 125 with ischemic and 113 with nonischemic cardiomyopathy. Preoperative ejection fraction was 25 ± 4.5%. The primary outcome was postcardiotomy cardiogenic shock, defined as need for microaxial temporary left ventricular assist device, extracorporeal membrane oxygenation, or vasoactive-inotropic score >25. RandomForestSRC was used to identify its predictors.

Results

Postcardiotomy cardiogenic shock occurred in 27% (65/238). Pulmonary artery pulsatility index <3.5 and pulmonary capillary wedge pressure >19 mm Hg were the most important factors predictive of postcardiotomy cardiogenic shock in ischemic cardiomyopathy. Cardiac index <2.2 L·min⁻¹ m⁻² and pulmonary capillary wedge pressure >21 mm Hg were the most important predictive factors in nonischemic cardiomyopathy. Operative mortality was 1.7%. Ejection fraction at 12 months after surgery increased to 39% (confidence interval, 35-40%) in the ischemic group and 37% (confidence interval, 35-38%) in the nonischemic cardiomyopathy group.

Conclusions

Predictors of postcardiotomy cardiogenic shock were different in ischemic and nonischemic cardiomyopathy. Right heart dysfunction, indicated by low pulmonary artery pulsatility index, was the most important predictor in ischemic cardiomyopathy, whereas greater degree of cardiac decompensation was the most important in nonischemic cardiomyopathy. Therefore, preoperative right heart catheterization will help identify patients with low ejection fraction who are at greater risk of postcardiotomy cardiogenic shock.

目的确定缺血性和非缺血性心肌病患者开胸手术后心源性休克的术前预测因素，并评估术后心室功能的变化轨迹：方法：2017年1月至2020年1月，238例射血分数为25.0%的患者接受了心肌切除术。采用RandomForestSRC确定其预测因素：结果：27%的患者（65/238）发生了开胸手术后心源性休克。肺动脉搏动指数 19 mmHg 是预测缺血性心肌病患者心肌梗死术后心源性休克的最重要因素。心脏指数-1∙m-2和肺毛细血管楔压>21 mmHg是非缺血性心肌病最重要的预测因素。手术死亡率为1.7%。缺血性心肌病组术后12个月的射血分数增至39%（CI：35-40），非缺血性心肌病组增至37%（CI：35-38）：缺血性心肌病和非缺血性心肌病的心肌梗死术后心源性休克的预测因素不同。肺动脉搏动指数低所显示的右心功能不全是缺血性心肌病最重要的预测因素，而心脏失代偿程度越大则是非缺血性心肌病最重要的预测因素。因此，术前右心导管检查将有助于识别射血分数较低、发生开胸术后心源性休克风险较高的患者。

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引用次数: 0

High haller index and outcomes in pectus excavatum repair: What to believe in this matter? 高哈勒指数与乳突修补术的结果：如何看待这一问题？

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.05.001

Frank Vincenzo de Paoli MD, PhD , Ara S. Media MD , Peter Juhl-Olsen MD, PhD , Niels Katballe MD, PhD , Henrik Vad MD , René Horsleben Petersen MD, PhD , Anette Højsgaard MD , Thomas Decker Christensen MD, PhD

引用次数: 0

Effects of diet-induced metabolic syndrome on cardiac function and angiogenesis in response to the sodium-glucose cotransporter-2 inhibitor canagliflozin 饮食引起的代谢综合征对钠-葡萄糖转运体-2抑制剂卡那格列净的心功能和血管生成的影响

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.06.004

Dwight D. Harris MD, Mark Broadwin MD, Sharif A. Sabe MD, Chris Stone MD, Meghamsh Kanuparthy MD, Ju-Woo Nho, Krishna Bellam, Debolina Banerjee MD, M. Ruhul Abid MD, PhD, Frank W. Sellke MD

Introduction

Sodium-glucose cotransporter-2 inhibitors are antidiabetic medications that have been shown to decrease cardiovascular events and heart failure-related mortality in clinical studies. We attempt to examine the complex interplay between metabolic syndrome and the sodium-glucose cotransporter-2 inhibitor canagliflozin (CAN) in a clinically relevant model of chronic myocardial ischemia.

Methods

Twenty-one Yorkshire swine were fed a high-fat diet starting at 6 weeks of age to induce metabolic syndrome. At 11 weeks, all underwent placement of an ameroid constrictor around the left circumflex coronary artery to induce chronic myocardial ischemia. After 2 weeks, swine received either control (CON) (n = 11) or CAN 300 mg by mouth daily (n = 10) for 5 weeks, whereupon all underwent terminal harvest.

Results

There was a significant increase in cardiac output and heart rate with a decrease in pulse pressure in the CAN group compared with CON (all P values < .05). The CAN group had a significant increase in capillary density (P = .02). There was no change in myocardial perfusion or arteriolar density. CAN induced a significant increase in markers of angiogenesis, including Phospho-endothelial nitric oxide synthase, Endothelial nitric oxide synthase, vascular endothelial growth factor receptor-1, heat shock protein 70, and extracellular signal-regulated kinases (all P values < .05), plausibly resulting in capillary angiogenesis.

Conclusions

CAN treatment leads to a significant increase in capillary density and augmented cardiac function in a swine model of chronic myocardial ischemia in the setting of metabolic syndrome. This work further elucidates the mechanism of sodium-glucose cotransporter-2 inhibitors in patients with cardiac disease; however, more studies are needed to determine if this increase in capillary density plays a role in the improvements seen in clinical studies.

简介：钠-葡萄糖共转运体-2（SGLT-2）抑制剂是一种抗糖尿病药物，在临床研究中已被证明可减少心血管事件和心衰相关死亡率。我们试图在与临床相关的慢性心肌缺血（CMI）模型中研究代谢综合征（MS）与 SGLT-2 抑制剂卡格列净（CAN）之间复杂的相互作用：21头约克夏猪从6周龄开始喂食高脂肪饮食以诱发MS。11 周时，所有约克夏猪都在左侧冠状动脉周围放置了一个气囊收缩器，以诱导慢性心肌缺血。两周后，猪只接受对照组（CON，n=11）或 CAN 300 毫克每日 PO（n=10）治疗 5 周，然后所有猪只接受末期收割：结果：与对照组相比，CAN 组的心输出量和心率明显增加，脉压下降（均为 p）：在多发性硬化症的猪 CMI 模型中，CAN 治疗可显著增加毛细血管密度并增强心脏功能。这项研究进一步阐明了 SGLT-2 抑制剂在心脏病患者中的作用机制；不过，还需要更多的研究来确定毛细血管密度的增加是否在临床研究中起到了改善作用。

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