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Preoperative Sarcopenia Assessment Using Pectoralis Muscle Mass Indicated Poor Mid-term Cardiac Surgery Prognosis. 利用胸肌质量进行术前 "肌肉疏松症 "评估表明心脏手术中期预后不佳
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6925
Yojiro Machii, Fumihiro Kitashima, Yuki Hayashi, Atsushi Harada, Keita Kamata, Naoki Eguchi, Masashi Tanaka

Background: Many studies have defined sarcopenia based on psoas muscle mass using abdominal computed tomography (CT). We hypothesized that sarcopenia can be assessed by measuring pectoralis muscle mass on chest CT and aimed to examine its relationship with the postoperative prognosis of cardiac surgery.

Methods: This retrospective study included 189 patients who underwent cardiac surgery via median sternotomy between July 2020 and June 2022. We excluded patients <70 years old, urgent/emergent cases, no chest CT within 90 days before surgery, and cases in which evaluation of the pectoralis muscle was impossible with CT. The pectoralis muscle area (PMA) was measured using a preoperative chest CT. The sarcopenia cut-off value was defined as the lowest sex-specific tertile in PMA at the level of the 4th thoracic vertebrae.

Results: Eighty patients were included. The lower tertile were classified as the sarcopenia group (SG) (n = 26) and the rest as the non-sarcopenia group (NSG) (n = 54). In the SG, 1-year survival was significantly worse than that in NSG (NSG: 92.7% vs. SG: 54.9%, p < 0.0001). In the multivariate model, sarcopenia was an independent risk factor for mid-term all-cause death (hazard ratio, 4.89; 95% confidence interval: 1.14-21.0, p = 0.033).

Conclusion: Preoperative sarcopenia defined using PMA was associated with poor mid-term survival after elective cardiac surgery via median sternotomy. The pectoralis muscle mass observed through a chest CT could be used for preoperative risk scoring in older patients undergoing cardiac surgery.

背景:许多研究根据腹部计算机断层扫描(CT)的腰肌质量来定义肌肉疏松症。我们假设可以通过胸部 CT 测量胸肌质量来评估肌肉疏松症,并旨在研究其与心脏手术术后预后的关系:这项回顾性研究纳入了2020年7月至2022年6月期间通过胸骨正中切开术接受心脏手术的189名患者。我们排除了患者:共纳入 80 例患者。较低的三分位数被分为肌肉疏松症组(SG)(n = 26),其余为非肌肉疏松症组(NSG)(n = 54)。在 SG 组中,1 年存活率明显低于 NSG 组(NSG:92.7% vs. SG:54.9%,P < 0.0001)。在多变量模型中,肌肉疏松症是中期全因死亡的独立风险因素(危险比:4.89;95% 置信区间:1.14-21.0,P = 0.033):结论:使用 PMA 确定的术前肌少症与经胸骨正中切口进行择期心脏手术后的中期存活率较低有关。通过胸部 CT 观察到的胸肌质量可用于对接受心脏手术的老年患者进行术前风险评分。
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引用次数: 0
Can Inflammation Indices Preoperatively Predict Acute Kidney Injury after Cardiac Surgery? 术前炎症指标能否预测心脏手术后的急性肾损伤?
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-26 DOI: 10.59958/hsf.6767
Serkan Yildirim

Background: Coronary artery disease is a condition characterized by atherosclerosis and inflammation in the vessel wall. In patient undergoing surgery, a systemic inflammatory-like condition occurs in the postoperative period through mediators that develop due to acute stress.

Methods: 581 patients enrolled from the hospital records from 2019 and 2022 retrospectively. Systemic immune inflammation index (SII), systemic inflammation response index (SIRI) and aggregated index of systemic inflammation (AISI) values were calculated from peripheral blood samples taken at hospital admission using the formula SII = platelet (P) × neutrophil (N) / lymphocyte (L), SIRI = N × monocyte (M) / L, AISI = (N × M × P) / L.

Results: The mean age of the 581 patients included in the study was 63.97 ± 8.77 years. 45% of the patients were women. Mean cardio-pulmonary bypass time (CPBT) was 100.31 ± 31.94 and mean cross-clamp time (CCT) was 59.79 ± 24.07. When the correlation of acute kidney injury (AKI) development was analyzed with the variables (P/L ratio, N/L ratio, SII, SIRI, AISI, CCT and CPBT), all variables we tested and age were found to be significantly correlated (p < 0.01).

Conclusion: We think that the calculations we tested in our study, together with the understanding of the complexity of the inflammatory system, will constitute an important step in the detection of AKI.

背景:冠状动脉疾病是一种以血管壁动脉粥样硬化和炎症为特征的疾病。在接受手术的患者中,由于急性应激导致的介质作用,术后会出现类似全身炎症的情况。根据入院时采集的外周血样本计算全身免疫炎症指数(SII)、全身炎症反应指数(SIRI)和全身炎症聚集指数(AISI)值,计算公式为:SII=血小板(P)×中性粒细胞(N)/淋巴细胞(L),SIRI=N×单核细胞(M)/L,AISI=(N×M×P)/L:参与研究的 581 名患者的平均年龄为(63.97 ± 8.77)岁。45%的患者为女性。平均心肺旁路时间(CPBT)为(100.31 ± 31.94),平均交叉钳夹时间(CCT)为(59.79 ± 24.07)。在分析急性肾损伤(AKI)发生与变量(P/L 比值、N/L 比值、SII、SIRI、AISI、CCT 和 CPBT)的相关性时,发现我们测试的所有变量与年龄都有显著相关性(P < 0.01):我们认为,我们在研究中测试的计算方法,加上对炎症系统复杂性的了解,将成为检测 AKI 的重要一步。
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引用次数: 0
Association between Left Ventricular Longitudinal Strain (GLS) and Prognosis of the Patients Undergoing Heart Valve Surgery with Preserved Left Ventricular Ejection Fraction. 左室纵向应变(GLS)与保留左室射血分数的心脏瓣膜手术患者预后的关系
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-26 DOI: 10.59958/hsf.5921
Yin-Ying Xue, Shang-Yu Chen, Ji-Lai Xiao, Xiao Shen, Huan Xu, Liang Hong, Xiao-Chun Song, Cui Zhang

Purpose: Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction. This study aimed to determine the association between GLS and postoperative intensity of inotropic support in the patients undergoing heart valve surgery with preserved left ventricular ejection fraction.

Methods: 74 patients with preserved left ventricular ejection fraction who underwent valve surgery during the period between March 2021 and June 2022 were included in this prospective observational study. Transthoracic echocardiography including strain analysis with speckle tracking was performed before surgery. Patients were stratified according to the left ventricle (LV) GLS: LV-GLS ≥-16% (Impaired GLS group) and LV-GLS <-16% (Normal GLS group). The primary endpoint was postoperative vasoactive inotropic score. A high vasoactive inotropic score (VIS) was defined as a maximum VIS of ≥15 within 24 hours postoperatively. Postoperative adverse events, baseline clinical and echocardiographic data were also recorded. We invested the ability of preoperative GLS in predicting adverse postoperative outcomes, such as prolonged mechanical ventilation and the need for pharmacologic hemodynamic support after cardiac surgery.

Results: Seventy-four patients were included and analyzed in this study, including thirty-three in impaired GLS group and forty-one in normal GLS group. In-hospital mortality was 1.27% (1/74). Patients in impaired GLS group were more likely to have prolonged mechanical ventilation (p = 0.041). Multivariable logistic regression analysis revealed that the apical four-chamber view of the left ventricle (A4C)-GLS was significantly associated with high VIS (OR 1.373, p = 0.007). A4C-GLS had a sensitivity of 62.5% and a specificity of 89.66% for predicting high VIS (area under the curve, 0.78). The relationships between GLS and other secondary outcome measures were not statistically significant. The optimal cutoff of A4C-GLS for postoperative high vasoactive inotropic score was -10.85%.

Conclusion: Preoperative LV dysfunction is an independent risk factor for postoperative high VIS. A4C-GLS may be a reliable tool in predicting high VIS after cardiac surgery. Those patients with impaired contractility were at high risk for elevated inotropic support and prolonged mechanical ventilation after cardiac surgery. These findings suggest an important role for echocardiographic GLS in perioperative assessment of cardiac function in the patients undergoing cardiac surgery.

目的:整体纵向应变(GLS)似乎能准确检测亚临床心肌功能障碍。本研究旨在确定左室射血分数保留的心脏瓣膜手术患者的 GLS 与术后肌力支持强度之间的关系。方法:74 例左室射血分数保留的患者在 2021 年 3 月至 2022 年 6 月期间接受了瓣膜手术,被纳入本前瞻性观察研究。手术前进行经胸超声心动图检查,包括斑点追踪应变分析。根据左心室 GLS 对患者进行分层:LV-GLS≥-16%(GLS受损组)和LV-GLS结果:本研究共纳入并分析了 74 例患者,其中 33 例为 GLS 受损组,41 例为 GLS 正常组。院内死亡率为 1.27%(1/74)。GLS受损组患者更有可能需要延长机械通气时间(p = 0.041)。多变量逻辑回归分析显示,左心室心尖四腔切面(A4C)-GLS 与高 VIS 显著相关(OR 1.373,p = 0.007)。A4C-GLS 预测高 VIS 的灵敏度为 62.5%,特异度为 89.66%(曲线下面积为 0.78)。GLS 与其他次要结果指标之间的关系无统计学意义。A4C-GLS预测术后高血管活性肌力评分的最佳临界值为-10.85%:结论:术前左心室功能障碍是术后高VIS的独立危险因素。A4C-GLS可能是预测心脏手术后高VIS的可靠工具。心肌收缩力受损的患者在心脏手术后接受高浓度肌力支持和延长机械通气的风险很高。这些研究结果表明,超声心动图 GLS 在心脏手术患者围术期心功能评估中发挥着重要作用。
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引用次数: 0
Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short- and Long-Term Outcomes. 美国退伍军人感染性心内膜炎的微生物学研究--致病菌与短期和长期结果之间的关联》(Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short and Long Term Outcomes)。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-26 DOI: 10.59958/hsf.6717
John Duggan, Alex Peters, Sarah Halbert, Jared Antevil, Gregory D Trachiotis

Background: Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010-2020.

Methods: We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures - Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests.

Results: Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20-3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07-3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14-5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05-2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35-13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01-1.91, p = 0.043).

Conclusions: In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.

背景:以往的研究已经阐明了致病菌与感染性心内膜炎预后之间的关系,但这种关系尚未在美国退伍军人中得到研究。本稿件旨在评估 2010-2020 年间美国退伍军人感染性心内膜炎(IE)患者的致病菌与短期和长期预后之间的关系:我们分析了退伍军人事务局(VA)外科质量改进计划和退伍军人事务局信息学与计算基础设施数据库中489名接受过手术治疗的IE患者。根据从血液或术中培养物中确定的致病菌将患者分为几组--葡萄球菌、链球菌、革兰氏阴性杆菌、肠球菌、多微生物和未知/培养阴性菌。分析中不包括其他已确定的微生物。采用 Cox 比例危险模型计算中风/短暂性脑缺血发作 (TIA)、心肌梗死 (MI) 和死亡的组别风险。模型采用反向消除法对协变量进行了调整。连续变量的比较采用方差分析或 Kruskal-Wallis H 检验,分类变量的比较采用卡方检验:平均随访时间为 4.0 ± 6.3 年。革兰氏阴性杆菌(GNRs)与更高的长期死亡风险相关(调整后危险比(aHR)2.15,95% CI:1.20-3.86,p = 0.01)。肠球菌与心肌梗死的长期风险有关(aHR 2.05,95% CI:1.07-3.94,p = 0.03)。耐甲氧西林金黄色葡萄球菌等耐药菌与心肌梗死的长期风险有关(aHR 2.51,95% CI:1.14-5.45,p = 0.02)。多菌感染与围手术期并发症风险增加有关,包括机械通气时间延长(48 小时)(aHR 1.76,95% CI:1.05-2.97,p = 0.034)、气管切开术(aHR 5.64,95% CI:2.35-13.55,p <0.001)和重症监护病房住院时间延长(5 天)(aHR 1.39,95% CI:1.01-1.91,p = 0.043):结论:在美国退伍军人中,与单微生物感染相比,多微生物感染的围手术期预后明显较差,但长期预后相似。GNR感染与长期死亡率增加有关。肠球菌和耐药菌与心肌梗死的长期风险增加有关。多微生物感染与围手术期并发症风险增加有关,包括机械通气时间延长、气管切开术和重症监护室住院时间延长。
{"title":"Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short- and Long-Term Outcomes.","authors":"John Duggan, Alex Peters, Sarah Halbert, Jared Antevil, Gregory D Trachiotis","doi":"10.59958/hsf.6717","DOIUrl":"10.59958/hsf.6717","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010-2020.</p><p><strong>Methods: </strong>We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures - Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests.</p><p><strong>Results: </strong>Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20-3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07-3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14-5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05-2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35-13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01-1.91, p = 0.043).</p><p><strong>Conclusions: </strong>In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 6","pages":"E791-E799"},"PeriodicalIF":0.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk Factors of Postoperative Infection in Newborns with Congenital Heart Disease. 先天性心脏病新生儿术后感染的风险因素。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-26 DOI: 10.59958/hsf.5827
Lifeng Zhang, Wujisi Guleng

Aims: This study aims to explore the risk factors of postoperative infection in newborns with congenital heart disease.

Methods: From January 2019 to January 2023, 78 neonates with congenital heart disease who were diagnosed and treated in our hospital with postoperative infection as well as an age- and sex-matched non-infected group (n = 78) were enrolled. After collecting the data and clinical information of 156 children, we compared the differences in the days of catheter indwelling, days of mechanical ventilation, times of blood transfusion, days of intensive care unit (ICU) stay, and survival status between postoperative infection and non-infection groups. Multivariate logistic regression was used to analyze the risk factors of postoperative infection in newborns with congenital heart disease.

Results: Age (11 ± 4 vs. 10 ± 5 days) and sex (56.4% vs. 52.6%) were comparable between the infection and non-infection groups. Children in the infection group had lower birth weight, higher proportion of cesarean section, lower oxygen saturation levels, and higher risk adjustment in congenital heart surgery (RACHS-1) scores than those in the non-infection group. In terms of postoperative indicators, neonates in the infection group had longer catheter indwelling time, mechanical ventilation time, ICU hospitalization days, and more blood transfusion times than those in the non-infection group. Multivariate logistic regression analysis showed that oxygen saturation <85% (OR: 6.5; 95% CI: 3.7-15.4), catheter indwelling days >14 days (OR: 3.2; 95% CI: 2.1-10.7), and ICU stay >10 days (OR: 7.1; 95% CI: 3.6-18.5) were independent risk factors for postoperative infection in newborns with congenital heart disease.

Conclusion: Low oxygen saturation, prolonged catheterization days, and prolonged ICU stay were independent risk factors for postoperative infection in neonates with congenital heart disease undergoing cardiac surgery.

目的:本研究旨在探讨先天性心脏病新生儿术后感染的风险因素:自2019年1月至2023年1月,选取我院诊治的78例先天性心脏病新生儿术后感染患儿以及年龄、性别匹配的非感染组患儿(n=78)作为研究对象。在收集了 156 名患儿的数据和临床信息后,我们比较了术后感染组和非感染组在导管留置天数、机械通气天数、输血次数、重症监护室(ICU)住院天数和生存状况方面的差异。采用多变量逻辑回归分析先天性心脏病新生儿术后感染的风险因素:结果:感染组和非感染组新生儿的年龄(11 ± 4 天对 10 ± 5 天)和性别(56.4% 对 52.6%)相当。与非感染组相比,感染组患儿出生体重较轻,剖宫产比例较高,血氧饱和度较低,先天性心脏病手术风险调整(RACHS-1)评分较高。在术后指标方面,感染组新生儿的导管留置时间、机械通气时间、重症监护室住院天数和输血次数均长于非感染组。多变量逻辑回归分析显示,氧饱和度14天(OR:3.2;95% CI:2.1-10.7)和ICU住院天数大于10天(OR:7.1;95% CI:3.6-18.5)是先天性心脏病新生儿术后感染的独立风险因素:结论:在接受心脏手术的先天性心脏病新生儿中,低血氧饱和度、延长导管插入天数和延长重症监护室住院时间是导致术后感染的独立风险因素。
{"title":"Risk Factors of Postoperative Infection in Newborns with Congenital Heart Disease.","authors":"Lifeng Zhang, Wujisi Guleng","doi":"10.59958/hsf.5827","DOIUrl":"10.59958/hsf.5827","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to explore the risk factors of postoperative infection in newborns with congenital heart disease.</p><p><strong>Methods: </strong>From January 2019 to January 2023, 78 neonates with congenital heart disease who were diagnosed and treated in our hospital with postoperative infection as well as an age- and sex-matched non-infected group (n = 78) were enrolled. After collecting the data and clinical information of 156 children, we compared the differences in the days of catheter indwelling, days of mechanical ventilation, times of blood transfusion, days of intensive care unit (ICU) stay, and survival status between postoperative infection and non-infection groups. Multivariate logistic regression was used to analyze the risk factors of postoperative infection in newborns with congenital heart disease.</p><p><strong>Results: </strong>Age (11 ± 4 vs. 10 ± 5 days) and sex (56.4% vs. 52.6%) were comparable between the infection and non-infection groups. Children in the infection group had lower birth weight, higher proportion of cesarean section, lower oxygen saturation levels, and higher risk adjustment in congenital heart surgery (RACHS-1) scores than those in the non-infection group. In terms of postoperative indicators, neonates in the infection group had longer catheter indwelling time, mechanical ventilation time, ICU hospitalization days, and more blood transfusion times than those in the non-infection group. Multivariate logistic regression analysis showed that oxygen saturation <85% (OR: 6.5; 95% CI: 3.7-15.4), catheter indwelling days >14 days (OR: 3.2; 95% CI: 2.1-10.7), and ICU stay >10 days (OR: 7.1; 95% CI: 3.6-18.5) were independent risk factors for postoperative infection in newborns with congenital heart disease.</p><p><strong>Conclusion: </strong>Low oxygen saturation, prolonged catheterization days, and prolonged ICU stay were independent risk factors for postoperative infection in neonates with congenital heart disease undergoing cardiac surgery.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 6","pages":"E800-E807"},"PeriodicalIF":0.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Retrospective Clinical Study on Cardiovascular Complications from Colorectal Cancer. 大肠癌心血管并发症回顾性临床研究
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-26 DOI: 10.59958/hsf.6733
Ting Yin, Jianqi Yang, Xiaojing Liu, Jiaqi Huang, Erxun Dai

Objective: To investigate the incidence and risk factors of cardiovascular complications amongst patients with colorectal cancer (CRC).

Methods: A retrospective cohort study was conducted on 2085 patients diagnosed with CRC in two tertiary hospitals in China between 2015 and 2020. The patients' medical records were reviewed to identify cardiovascular complications, including myocardial infarction, heart failure, stroke, hypertension, coronary heart disease, heart failure, and arrhythmia. The incidence rate of cardiovascular complications was calculated, and Cox proportional hazards regression analysis was used to identify risk factors.

Results: Of the 2085 CRC patients, 329 (15.8%) experienced cardiovascular complications during the follow-up period, with an incidence rate of 17.4 cases per 1000 person-years. The risk was significantly higher in patients who were older than 60 years (adjusted hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.22-3.41), had a higher level of low-density lipoprotein cholesterol (LDL-C) (adjusted HR 2.32, 95% CI 1.31-4.10), had higher levels of serum C-reactive protein (CRP) (adjusted HR 1.57, 95% CI 1.21-2.04), or who underwent chemotherapy or radiotherapy. CRC patients with cardiovascular complications had significantly higher levels of oxidative stress markers, including malondialdehyde (MDA) (5.8 ± 1.2 μmol/L vs. 3.4 ± 0.9 μmol/L, p < 0.001), lower levels of superoxide dismutase (SOD) (85.2 ± 15.6 U/mg protein vs. 112.5 ± 21.3 U/mg protein, p < 0.001), and lower levels of glutathione peroxidase (GPx) (15.6 ± 3.2 U/mg protein vs. 20.4 ± 4.1 U/mg protein, p < 0.001) compared to those without complications. A progressive increase was observed in the proportion of CRC patients with cardiovascular complications over time, rising from 10% in the first year to 38% by the tenth year of follow-up.

Conclusion: Cardiovascular complications pose a high risk in CRC patients, particularly amongst older patients and those with higher levels of LDL-C or CRP. Regular monitoring of cardiovascular function should be considered in the management of patients with CRC.

目的:调查结直肠癌(CRC)患者心血管并发症的发生率和风险因素:调查结直肠癌(CRC)患者心血管并发症的发生率和风险因素:方法:对2015年至2020年间在中国两家三甲医院确诊的2085名CRC患者进行回顾性队列研究。研究人员查阅了患者的病历,以确定心血管并发症,包括心肌梗死、心力衰竭、中风、高血压、冠心病、心力衰竭和心律失常。计算了心血管并发症的发病率,并采用 Cox 比例危险回归分析来确定风险因素:结果:在 2085 名 CRC 患者中,有 329 人(15.8%)在随访期间出现心血管并发症,发病率为 17.4 例/1000 人-年。年龄超过60岁(调整后危险比[HR]2.04,95%置信区间[CI]1.22-3.41)、低密度脂蛋白胆固醇(LDL-C)水平较高(调整后危险比2.32,95%置信区间1.31-4.10)、血清C反应蛋白(CRP)水平较高(调整后危险比1.57,95%置信区间1.21-2.04)或接受过化疗或放疗的患者的风险明显更高。有心血管并发症的 CRC 患者的氧化应激标记物水平明显较高,包括丙二醛(MDA)(5.8 ± 1.2 μmol/L vs. 3.4 ± 0.9 μmol/L,P < 0.001)、超氧化物歧化酶(SOD)水平较低(85.与无并发症者相比,超氧化物歧化酶(SOD)水平较低(85.2 ± 15.6 U/mg 蛋白质 vs 112.5 ± 21.3 U/mg 蛋白质,p < 0.001),谷胱甘肽过氧化物酶(GPx)水平较低(15.6 ± 3.2 U/mg 蛋白质 vs 20.4 ± 4.1 U/mg 蛋白质,p < 0.001)。随着时间的推移,观察到患有心血管并发症的 CRC 患者比例逐渐增加,从第一年的 10% 增加到随访第十年的 38%:结论:心血管并发症是 CRC 患者的高危因素,尤其是老年患者和低密度脂蛋白胆固醇(LDL-C)或 CRP 水平较高的患者。在对 CRC 患者进行管理时,应考虑定期监测心血管功能。
{"title":"A Retrospective Clinical Study on Cardiovascular Complications from Colorectal Cancer.","authors":"Ting Yin, Jianqi Yang, Xiaojing Liu, Jiaqi Huang, Erxun Dai","doi":"10.59958/hsf.6733","DOIUrl":"10.59958/hsf.6733","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence and risk factors of cardiovascular complications amongst patients with colorectal cancer (CRC).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 2085 patients diagnosed with CRC in two tertiary hospitals in China between 2015 and 2020. The patients' medical records were reviewed to identify cardiovascular complications, including myocardial infarction, heart failure, stroke, hypertension, coronary heart disease, heart failure, and arrhythmia. The incidence rate of cardiovascular complications was calculated, and Cox proportional hazards regression analysis was used to identify risk factors.</p><p><strong>Results: </strong>Of the 2085 CRC patients, 329 (15.8%) experienced cardiovascular complications during the follow-up period, with an incidence rate of 17.4 cases per 1000 person-years. The risk was significantly higher in patients who were older than 60 years (adjusted hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.22-3.41), had a higher level of low-density lipoprotein cholesterol (LDL-C) (adjusted HR 2.32, 95% CI 1.31-4.10), had higher levels of serum C-reactive protein (CRP) (adjusted HR 1.57, 95% CI 1.21-2.04), or who underwent chemotherapy or radiotherapy. CRC patients with cardiovascular complications had significantly higher levels of oxidative stress markers, including malondialdehyde (MDA) (5.8 ± 1.2 μmol/L vs. 3.4 ± 0.9 μmol/L, p < 0.001), lower levels of superoxide dismutase (SOD) (85.2 ± 15.6 U/mg protein vs. 112.5 ± 21.3 U/mg protein, p < 0.001), and lower levels of glutathione peroxidase (GPx) (15.6 ± 3.2 U/mg protein vs. 20.4 ± 4.1 U/mg protein, p < 0.001) compared to those without complications. A progressive increase was observed in the proportion of CRC patients with cardiovascular complications over time, rising from 10% in the first year to 38% by the tenth year of follow-up.</p><p><strong>Conclusion: </strong>Cardiovascular complications pose a high risk in CRC patients, particularly amongst older patients and those with higher levels of LDL-C or CRP. Regular monitoring of cardiovascular function should be considered in the management of patients with CRC.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 6","pages":"E780-E790"},"PeriodicalIF":0.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Postoperative Platelet to Creatinine Ratio as A Prognostic Index of In-Hospital Mortality in Patients with Acute Type A Aortic Dissection. 作为急性 A 型主动脉夹层患者院内死亡率预后指标的术后血小板与肌酐比值。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-18 DOI: 10.59958/hsf.6935
Yaman Wang, Shengfeng Qiu, Ying Chen, Xiangjun Cheng, Jun Zhou

Background: The purpose of the investigation was to assess the value of post-operation platelet to creatinine ratio (PCR) in predicting in-hospital mortality among patients with acute type A aortic dissection (TAAAD).

Methods: A retrospective study was carried out from January 2017 to December 2019. The best cutoff value of post-operation PCR was assessed by receiver operating characteristic (ROC) curve. Patients were divided into survivors and nonsurvivors. Univariate and multivariate logistic analyses were carried out to identify independent risk factors influencing in-hospital mortality.

Results: A total of 171 patients were included in this investigation, with an in-hospital mortality rate of 18.1%. The optimal cut-off value of post-operation PCR was 0.7242 (area under the ROC curve (AUC): 0.798, 95% confidence interval (CI) 0.730-0.856, p < 0.001), and the sensitivity and specificity were 74.2% and 74.3%. The levels of post-operation PCR were lower in nonsurvivors than in survivors (0.56 ± 0.33 vs. 1.50 ± 1.36, p < 0.001). Multivariate logistic regression analysis displayed that post-operation PCR was positively related to in-hospital survivors when confounding factors were adjusted (HR = 8.850, 95% CI = 2.611-30.303, p < 0.001).

Conclusions: Post-operative PCR is a readily accessible and cost-effective biomarker that is independently associated with in-hospital mortality in TAAAD patients. Furthermore, it exhibits superior performance in predicting patient outcomes following surgery.

背景:该研究旨在评估手术后血小板与肌酐比值(PCR)在预测急性A型主动脉夹层(TAAAD)患者院内死亡率方面的价值:2017年1月至2019年12月进行了一项回顾性研究。通过接收器操作特征曲线(ROC)评估手术后 PCR 的最佳临界值。患者分为存活者和非存活者。进行单变量和多变量逻辑分析,以确定影响院内死亡率的独立风险因素:本次调查共纳入了 171 名患者,院内死亡率为 18.1%。手术后 PCR 的最佳临界值为 0.7242(ROC 曲线下面积(AUC):0.798,95% 置信度):灵敏度和特异度分别为 74.2% 和 74.3%。非幸存者的术后 PCR 水平低于幸存者(0.56 ± 0.33 vs. 1.50 ± 1.36,p < 0.001)。多变量逻辑回归分析显示,调整混杂因素后,手术后 PCR 与院内幸存者呈正相关(HR = 8.850,95% CI = 2.611-30.303,p < 0.001):结论:术后 PCR 是一种容易获得且经济有效的生物标记物,与 TAAAD 患者的院内死亡率有独立关联。此外,它在预测术后患者预后方面也表现出卓越的性能。
{"title":"The Postoperative Platelet to Creatinine Ratio as A Prognostic Index of In-Hospital Mortality in Patients with Acute Type A Aortic Dissection.","authors":"Yaman Wang, Shengfeng Qiu, Ying Chen, Xiangjun Cheng, Jun Zhou","doi":"10.59958/hsf.6935","DOIUrl":"10.59958/hsf.6935","url":null,"abstract":"<p><strong>Background: </strong>The purpose of the investigation was to assess the value of post-operation platelet to creatinine ratio (PCR) in predicting in-hospital mortality among patients with acute type A aortic dissection (TAAAD).</p><p><strong>Methods: </strong>A retrospective study was carried out from January 2017 to December 2019. The best cutoff value of post-operation PCR was assessed by receiver operating characteristic (ROC) curve. Patients were divided into survivors and nonsurvivors. Univariate and multivariate logistic analyses were carried out to identify independent risk factors influencing in-hospital mortality.</p><p><strong>Results: </strong>A total of 171 patients were included in this investigation, with an in-hospital mortality rate of 18.1%. The optimal cut-off value of post-operation PCR was 0.7242 (area under the ROC curve (AUC): 0.798, 95% confidence interval (CI) 0.730-0.856, p < 0.001), and the sensitivity and specificity were 74.2% and 74.3%. The levels of post-operation PCR were lower in nonsurvivors than in survivors (0.56 ± 0.33 vs. 1.50 ± 1.36, p < 0.001). Multivariate logistic regression analysis displayed that post-operation PCR was positively related to in-hospital survivors when confounding factors were adjusted (HR = 8.850, 95% CI = 2.611-30.303, p < 0.001).</p><p><strong>Conclusions: </strong>Post-operative PCR is a readily accessible and cost-effective biomarker that is independently associated with in-hospital mortality in TAAAD patients. Furthermore, it exhibits superior performance in predicting patient outcomes following surgery.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 6","pages":"E735-E739"},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interventional Bridging Therapy for Radical Cardiac Surgery in a Patient Seemed to be Inoperable Due to Very Poor Left Ventricular Function: A Case Report 介入桥接治疗根治性心脏手术患者因左心室功能极差而无法手术:1例报告
4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-06 DOI: 10.59958/hsf.5779
JeongA Lee, Masahiro Tsutsui, Nobuhiro Mochizuki, Yuki Setogawa, Fumitaka Suzuki, Masahiko Narita, Aina Hirofuji, Shingo Kunioka, Tomonori Shirasaka, Natsuya Ishikawa, Sayaka Yuzawa, Hiroyuki Kamiya
Cases that are inoperable owing to poor preoperative conditions are sometimes encountered. However, there are some cases that are led to radical treatment by performing bridge therapy. Here, we presented a case of a patient with complex cardiac disease in an inoperable state who underwent bridging therapy that led to successful surgical treatment. A 73-year-old male who received hemodialysis treatment and had severe aortic valve stenosis and coronary artery disease planned surgical treatment. However, he was deemed inoperable owing to his low cardiac function and hemodynamic instability. Therefore, to escape from a fatal condition, we first performed balloon aortic valvuloplasty and percutaneous coronary intervention as palliative procedures. Subsequently, his cardiac function and hemodynamic stability remarkably improved; therefore, after 1 month, we performed a successful radical surgical treatment. Even in inoperable patients, bridging therapy leading to radical treatment is possible.
由于术前条件不佳而不能手术的病例有时也会遇到。然而,也有一些病例通过桥接治疗导致根治性治疗。在这里,我们提出了一个病例的复杂心脏疾病的病人在不能手术的状态下,谁接受桥接治疗,导致成功的手术治疗。73岁男性,接受血液透析治疗,有严重主动脉瓣狭窄和冠状动脉疾病,计划手术治疗。然而,由于他的心功能低下和血流动力学不稳定,他被认为不能手术。因此,为了避免致命的情况,我们首先进行了球囊主动脉瓣成形术和经皮冠状动脉介入治疗作为姑息性手术。随后心功能和血流动力学稳定性明显改善;因此,1个月后,我们成功地进行了根治性手术治疗。即使对于不能手术的病人,桥接疗法也可以导致根治性治疗。
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引用次数: 0
Central Catheter-Induced Cardiac Tamponade in Neonates: Two Case Reports 新生儿中心导管诱发心包填塞2例报告
4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-06 DOI: 10.59958/hsf.5825
Hyungtae Kim, Kwang Ho Choi
Intraoperative central venous catheter (CVC) insertion has become a routine procedure for pediatric cardiac surgery patients at our center. The case in which large amounts of pericardial effusion resulting in cardiac tamponade other than direct puncture of the catheter is a rare, but often causes fatal complications. Two of our patients suffered cardiac collapse after surgery owing to cardiac tamponade. Both the patients were successfully treated with pericardiocentesis, and the pericardial fluid had a high glucose level. Subsequently, the patients were discharged without any sequelae. During a serial radiographic follow-up, we found a pre-event alteration in the CVC angulation. These two cases highlight the fact that clinicians should pay attention to serial follow-up of chest radiography for monitoring any changes in the catheter status, such as its position or angulation, to prevent unexpected complications. The only way to prevent fatal complications due to CVC is timely recognition of any alteration in CVC based on radiological examinations. In instances of CVC changes, the issues should be addressed as quickly as possible.
术中中心静脉置管(CVC)已成为我中心小儿心脏手术患者的常规操作。大量心包积液导致心包填塞而不直接穿刺导管的情况很少见,但往往会引起致命的并发症。其中2例患者术后因心包填塞导致心脏衰竭。两例患者均经心包穿刺治疗成功,心包液血糖水平较高。随后,患者出院,无任何后遗症。在一系列的x线随访中,我们发现CVC成角的事前改变。这两个病例强调临床医生应注意连续随访胸片,以监测导管状态的任何变化,如其位置或成角,以防止意外并发症。预防CVC致死性并发症的唯一方法是根据影像学检查及时识别CVC的任何改变。在CVC变化的情况下,应该尽快解决这些问题。
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引用次数: 0
Everything You Need to Know about Venting during Cardiac Surgery (And It's More than You Thought!). 关于心脏手术期间的通气,你需要知道的一切(这比你想象的要多!)。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-30 DOI: 10.59958/hsf.6725
Curt Tribble

No abstract present.

没有摘要。
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引用次数: 0
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Heart Surgery Forum
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