Journal of Geriatric Cardiology最新文献

Cardiovascular damage caused by cancer treatment has become an important cause of death for tumor survivors. With the recognition of cardiovascular diseases and cancer therapy-related cardiovascular toxicity (CTR-CVT) in tumor patients, noninvasive imaging technologies play pivotal roles in the risk stratification, early diagnosis, monitoring and follow-up for CTR-CVT. In recent years, the field of cardio-oncology has witnessed continual updates in diagnostic and therapeutic strategies, with several pertinent guidelines and expert consensus documents issued in China and abroad. However, there remains a conspicuous absence of systematic guidance documents on the application of imaging techniques in the clinical practice of cardio-oncology. Therefore, the Chinese Anti-Cancer Association Society of Integrative Cardio-oncology, the Ultrasound Branch of the Chinese Medical Association, and the Chinese Society of Echocardiography convened experts to formulate the "Chinese guideline for the clinical application of noninvasive imaging technology in accessing cancer therapy-related cardiovascular toxicity". Building upon the systematic evaluation of guidelines and the latest evidence-based medical research in the field of cardio-oncology domestically and abroad, and in conjunction with data derived from evidence-based medical research in China, this guideline proposes noninvasive imaging examination methods and monitoring strategies for CTR-CVT, aiming to further standardize and guide the clinical practice of multidisciplinary physicians specializing in cardio-oncology in China.

Background: There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis (AS). We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation (TAVI) and to analyze the ability of different tools for predicting clinical outcomes in this context.

Methods: This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge. The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.

Results: A total of 377 patients were included (mean age of 80.4 years). Most patients were independent or mildly dependent, with an optimal cognitive status. The proportion of frailty ranged from 17.6% to 49.8%. A total of 20 patients (5.3%) died and 110/377 patients (29.2%) died or were readmitted during follow up. Overall, most components of the geriatric assessment showed an association with clinical outcomes. Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission. The association between frailty and clinical outcomes was higher for short physical performance battery (SPPB), essential frailty toolset (EFT) and the frailty index based on comprehensive geriatric assessment (IF-VIG) and lower for Fried criteria and FRAIL scale.

Conclusions: AS patients from this series presented a good physical performance, optimal cognitive status and a reasonably low prevalence of frailty. The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT, SPPB and the IF-VIG.

Background: Acute decompensated heart failure (ADHF) is one of the leading causes of mortality, highlighting the importance of early identification of high-risk patients. The fibrosis-5 (FIB-5) index, traditionally used to evaluate hepatic fibrosis, may hold prognostic value in ADHF patients by reflecting systemic congestion, inflammation, and organ dysfunction. The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.

Methods: This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024. Patients were divided into two groups based on their left ventricular ejection fraction (LVEF ≤ 40% or LVEF > 50%). Survival was monitored for one month, and clinical, biochemical, and echocardiographic parameters were compared between survivors and death. Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.

Results: During the 1-month follow-up, 66 patients (42.6%) died. The mean FIB-5 index was significantly lower in non-survivors (-10.46 ± 6.93) compared to survivors (-8.10 ± 6.67) (P = 0.03). Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality (OR = 1.089, 95% CI: 1.022-1.160, P = 0.009). The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609 (95% CI: 0.51-0.699) with sensitivity of 59.6% and specificity of 63.4%. Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values (log-rank: 7.887, P = 0.005).

Conclusions: The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients. Its low cost, non-invasive nature, and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification. Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.

Objective: To investigate possible associations between physical function assessment scales, such as Short Physical Performance Battery (SPPB) and Berg Balance Scale (BBS), with all-cause mortality in acute decompensated heart failure (ADHF) patients.

Methods: A total of 108 ADHF patients were analyzed from October 2020 to October 2022, and followed up to May 2023. The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis, while for SPPB and BBS, univariate Cox regression analysis was followed by receiver operating characteristic curves, in which the area under the curve represented their predictive accuracy for all-cause mortality. Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores. Optimal cut-off value for BBS was then identified using restricted cubic spline plots, and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test. The clinical utility of BBS was measured using decision curve analysis.

Results: For baseline characteristics, age, female, blood urea nitrogen, as well as statins, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors, were predictive for all-cause mortality for ADHF patients. With respect to SPPB and BBS, higher scores were associated with lower all-cause mortality rates for both assessments; similar area under the curves were measured for both (0.774 for SPPB and 0.776 for BBS). Furthermore, BBS ≤ 36.5 was associated with significantly higher mortality, which was still applicable even adjusting for confounding factors; BBS was also found to have great clinical utility under decision curve analysis.

Conclusions: BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients, as well as prognosticate on all-cause mortality. Moreover, prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.

Background: The number of transcatheter aortic valve implantation (TAVI) procedures in patients with severe aortic stenosis (AS) is increasing worldwide. We aimed to assess the impact of a TAVI program on clinical profile, management and outcomes of these patients and to describe predictors of length of hospital stay (LoS) in this context.

Methods: Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge (January 2018-December 2022). A TAVI program was implemented in may 2021. Baseline clinical characteristics, management and in-hospital complications were registered. Predictors of long hospital stay (> 7 day) were assessed by binary logistic regression.

Results: We included 614 patients, with mean age 80.5 years. Most patients (438/614, 71.2%) presented conditions that precluded an early discharge. Mean hospital stay was 7.6 days. Patients admitted after the implementation of the program had a significantly lower burden of comorbidities. The rate of conduction disturbances after TAVI remained stable around 60%. However, permanent pacemaker requirement declined from 30.3% to 22.5% (P = 0.028). LoS was reduced after the implementation of the program both in patients suitable for an early discharge (from 6.5 day to 4 day, P < 0.001) and unsuitable patients (from 9.4 day to 7.7 day, P = 0.014). The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases, day of the week, emergent procedures, and conduction disturbances and other complications as independent predictors of long stay after TAVI.

Conclusions: Most patients undergoing TAVI present conditions that preclude an early hospital discharge. The implementation of a TAVI program improved selection of patients, with a lower burden of comorbidities, a lower rate of complications and a marked reduction of hospital stay.

Background: Blood glucose and serum albumin have been associated with cardiovascular disease prognosis, but the impact of admission-blood-glucose-to-albumin ratio (AAR) on adverse outcomes in critical ill coronary artery disease (CAD) patients was not investigated.

Methods: Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR. The primary outcome was 1-year mortality, and secondary endpoints were in-hospital mortality, acute kidney injury (AKI), and renal replacement therapy (RRT). A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients. Kaplan-Meier survival analysis determined differences in endpoints across subgroups.

Results: A total of 8360 patients were included. There were 726 patients (8.7%) died in the hospital and 1944 patients (23%) died at 1 year. The incidence of AKI and RRT was 63% and 4.3%, respectively. High AAR was markedly associated with in-hospital mortality (HR = 1.587, P = 0.003), 1-year mortality (HR = 1.502, P < 0.001), AKI incidence (HR = 1.579, P < 0.001), and RRT (HR = 1.640, P < 0.016) in CAD patients in the completely adjusted Cox proportional hazard model. Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles. Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.

Conclusions: The results highlight that AAR may be a potential indicator for assessing in-hospital mortality, 1-year mortality, and adverse renal prognosis in critical CAD patients.