Heart & Lung最新文献_第10页

Wearable sensor-based gait parameters in patients with heart failure with reduced ejection fraction: associations with clinical and physical outcomes 基于可穿戴传感器的心力衰竭患者射血分数降低的步态参数：与临床和身体结果的关联

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-25 DOI: 10.1016/j.hrtlng.2025.10.018

Aylin Tanriverdi Eyolcu , Buse Ozcan Kahraman , Mehmet Birhan Yilmaz , Sema Savci

Background

Gait parameters provided by wearable inertial sensors remain significant gaps in understanding their clinical and physical implication in patients with heart failure with reduced ejection fraction (HFrEF).

Objectives

To analyse gait parameters using a wearable inertial sensor and to assess the relationships between clinical and physical outcomes in patients with HFrEF.

Methods

This cross-sectional study recruited 70 HFrEF patients and 32 apparently healthy individuals. Gait parameters were evaluated using a wearable gait analysis system during an 8-meter walk and a 6-minute walk test (6MWT). Functional class, dyspnea, and frailty were evaluated using the New York Heart Association (NYHA) classification, the Modified Medical Research Council Scale (mMRCS), and the Fried Frailty Phenotype. Pulmonary function, respiratory muscle strength and quadriceps muscle strength, functional capacity, physical activity, and dynamic balance were assessed.

Results

Age, gender, and body mass index were similar between patients with HFrEF and apparently healthy controls (p>0.05). Gait speed, cadence, and stride length obtained from both the 8-meter walk and 6MWT were significantly different between the groups (p<0.05). Gait speed and stride length obtained from both the 8-meter walk and the 6MWT were moderately to strongly correlated with NYHA functional class, mMRCS, frailty, and six-minute walk distance (6MWD) (p<0.05). Cadence obtained from both the 8-meter walk and 6MWT was moderately to strongly correlated with six-minute walk distance (p<0.05).

Conclusions

This study indicates that gait parameters are affected in patients with HFrEF. Altered gait parameters are associated with worsened clinical and physical outcomes in patients with HFrEF.

背景：可穿戴式惯性传感器提供的步态参数在了解其对心力衰竭伴射血分数降低（HFrEF）患者的临床和生理意义方面仍存在重大差距。目的利用可穿戴式惯性传感器分析HFrEF患者的步态参数，并评估其临床与身体预后之间的关系。方法采用横断面研究方法，招募70例HFrEF患者和32例表面健康个体。在8米步行和6分钟步行测试（6MWT）期间，使用可穿戴步态分析系统评估步态参数。使用纽约心脏协会（NYHA）分类、改良医学研究委员会量表（mMRCS）和Fried虚弱表型对功能分级、呼吸困难和虚弱进行评估。评估肺功能、呼吸肌力量和股四头肌力量、功能能力、体力活动和动态平衡。结果HFrEF患者的年龄、性别和体重指数与明显健康对照组相似（p < 0.05）。8米步行和6米步行的步态速度、节奏和步幅在两组间差异均有统计学意义（p < 0.05）。8米步行和6分钟步行的步态速度和步长与NYHA功能等级、mMRCS、虚弱度和6分钟步行距离（6MWD）呈中至强相关（p<0.05）。8米步行和6MWT获得的踏速与6分钟步行距离呈中至强相关（p<0.05）。结论本研究表明HFrEF患者的步态参数受到影响。步态参数的改变与HFrEF患者的临床和身体结果的恶化有关。

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引用次数: 0

Using computed tomography to assess the relationship of the left ventricle with recommended hand placement for cardiopulmonary resuscitation 使用计算机断层扫描评估左心室与心肺复苏推荐手放置的关系

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-25 DOI: 10.1016/j.hrtlng.2025.10.022

Jonathan Kei MD, MPH, Anthony J. Mannarino MD, Lauren Van Woy DO

Background

Compression of the left ventricle is essential to maximizing the forward flow of blood during cardiopulmonary resuscitation (CPR). Objective: This study uses computed tomography (CT) imaging to identify the anatomical center of the left ventricle (the target for maximal hand compression) and compares this location with the location of traditional hand placement in CPR.

Methods

Forty-eight consecutive CT studies were reviewed. For each study, the center of the left ventricle and the location of traditional hand placement were identified. A right triangle was drawn between them, measuring how inferior and lateral the left ventricle was located from the location of traditional hand placement on the sternum. In addition, the anatomical structures seen directly below traditional hand placement were identified and recorded.

Results

The center of the left ventricle was located inferiorly by 5.1 cm (95% CI 4.4 to 5.8) and laterally by 5.1 cm (95% CI 4.7 to 5.5) from the location of traditional hand placement during CPR. In addition, traditional hand placement was located directly over the following structures: left ventricular outflow tract/ascending aorta (58.3%), the aortic arch (20.8%), the right ventricular outflow tract/pulmonary trunk (12.5%), and other structures like the superior vena cava, right ventricle and septum (8.3%).

Conclusion

Current CPR hand placement recommendations may not be optimal at compressing the center of the left ventricle, which is displaced both inferior and lateral to the sternum. Current recommendations for hand placement have the potential for compressing outflow tract structures that underly the mid-sternum.

背景：在心肺复苏（CPR）过程中，压缩左心室对于使血液向前流动最大化至关重要。目的：本研究利用计算机断层扫描（CT）成像确定左心室的解剖中心（手最大压迫的目标），并将该位置与传统的手在心肺复苏术中的位置进行比较。方法回顾性分析48例连续CT研究。在每项研究中，左心室的中心和传统的手放置位置都被确定。在它们之间画一个直角三角形，测量左心室的下侧位置与传统的手放在胸骨上的位置之间的距离。此外，解剖结构直接低于传统的手放置被识别和记录。结果在心肺复苏术中，左心室中心比传统手放置位置下移5.1 cm (95% CI 4.4 ~ 5.8)，向外移5.1 cm （95% CI 4.7 ~ 5.5）。此外，传统的手放置位置直接位于以下结构上：左心室流出道/升主动脉（58.3%）、主动脉弓（20.8%）、右心室流出道/肺动脉干（12.5%）以及其他结构如上腔静脉、右心室和中隔（8.3%）。结论目前心肺复苏术的手部放置建议在压迫左心室中心时可能不是最佳的，因为左心室位于胸骨下方和外侧。目前推荐的手部放置有可能压迫胸骨中部下方的流出道结构。

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引用次数: 0

The effect of COPD stage on self-care management in COPD Patients: The mediating role of illness perception COPD分期对COPD患者自我护理管理的影响：疾病知觉的中介作用

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-25 DOI: 10.1016/j.hrtlng.2025.10.019

Yasemin Sazak , Meltem Kalaycı , Keriman Aytekin Kanadlı , Nermin Olgun

Background

Determining the stage of COPD is essential for disease prognosis and management. Self-care management is among the basic elements of non-pharmacological treatment in COPD patients and is associated with illness perception.

Objective

The current study aimed to investigate the mediating role of illness perception in the relationship between COPD stage and self-care management.

Methods

The research was conducted in the chest diseases outpatient clinic of a hospital located in the eastern Mediterranean region between July 2024 and January 2025. The cross-sectional and predictive correlational research was completed with 145 patients. The patient descriptive form, the Brief Illness Perception Questionnaire, and the Self-Care Management Processes-Guarding Scale were used to collect data. Descriptive statistics were used in the data analysis, and SPSS Process Macro Model 4 was utilized to test the mediating role.

Results

A positive and moderately significant relationship was identified between COPD stage and illness perception. A negative and moderate relationship was found between COPD stage and self-care management. Furthermore, a negative and highly significant relationship was determined between illness perception and self-care management. It was observed that COPD stage and illness perception were significant predictors of self-care management. Since the indirect effect of COPD stage on self-care management was significant, it was revealed that illness perception mediated COPD stage and self-care management.

Conclusion

It is essential to assess COPD stage and illness perception when evaluating self-care management in COPD patients and in patient care.

背景：确定慢性阻塞性肺病的分期对疾病的预后和治疗至关重要。自我保健管理是COPD患者非药物治疗的基本要素之一，与疾病认知有关。目的探讨疾病知觉在COPD分期与自我护理管理关系中的中介作用。方法研究于2024年7月至2025年1月在地中海东部地区某医院胸科门诊进行。145例患者完成了横断面和预测相关性研究。采用患者描述表、简短疾病感知问卷和自我护理管理过程-保护量表收集数据。数据分析采用描述性统计，采用SPSS Process Macro Model 4检验中介作用。结果慢性阻塞性肺病分期与疾病感知呈中显著正相关。COPD分期与自我护理管理呈负相关。此外，疾病感知与自我护理管理之间呈负向极显著相关。观察到COPD分期和疾病感知是自我护理管理的显著预测因子。由于COPD分期对自我保健管理的间接影响显著，我们发现疾病知觉介导COPD分期和自我保健管理。结论评价COPD患者的自我护理管理和患者护理时，评估COPD分期和疾病认知是必要的。

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引用次数: 0

Comparative effects of mind-body exercises on anxiety and depression in patients with chronic obstructive pulmonary disease: A network meta-analysis of randomized controlled trials 身心锻炼对慢性阻塞性肺疾病患者焦虑和抑郁的比较作用：随机对照试验的网络荟萃分析

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-24 DOI: 10.1016/j.hrtlng.2025.10.014

Yuanjin Tang, Junli Wang, Yuanqing Jiang

Background

Anxiety and depression are clinically common but are underestimated in chronic obstructive pulmonary disease (COPD) patients. Mind-body exercises like Qigong (e.g., Baduanjin), which combine gentle movements, breath control, and focused attention, have shown benefits for physical and psychological health, but comparative efficacy between different mind-body exercises remains unclear.

Objectives

To compare the efficacy of mind-body exercises on anxiety and depression in patients with COPD.

Methods

We searched 9 databases for randomized controlled trials of the effects of mind-body exercise on anxiety and depression in patients with chronic obstructive pulmonary disease up to January 13, 2025. A network meta-analysis was used to compare primary outcomes within a frequency theory framework, and all data analyses were performed in Stata 18.0. Each intervention was individually ranked using the surface under the cumulative ranking curve.

Results

A total of 23 studies with 2303 participants included. Compared to usual care and therapy, Mindfulness-Based Stress Reduction (MBSR) combined with Baduanjin showed the greatest benefit for anxiety (SMD = −1.93, 95 % CI −3.54 to −0.31) and for depression (SMD = −1.96, 95 % CI −3.52 to −0.41). SUCRA rankings placed MBSR combined with Baduanjin highest for anxiety at 83.5 % and for depression at 86.3 %.

Conclusion

In this study, mind-body exercise can significantly reduce anxiety and depression symptoms in patients with chronic obstructive pulmonary disease. By comparing multiple mind-body exercise methods, the results showed that the combination of MBSR and Baduanjin was the most effective modality for improving both anxiety and depression. Medical practitioners may consider combining MBSR and Baduanjin in the future to achieve the best therapeutic effect.

背景焦虑和抑郁在慢性阻塞性肺疾病（COPD）患者中很常见，但被低估了。气功（如八段锦）等身心锻炼结合了轻柔的动作、控制呼吸和集中注意力，已经显示出对身心健康的好处，但不同身心锻炼之间的比较效果尚不清楚。目的比较心身运动对慢性阻塞性肺病患者焦虑和抑郁的治疗效果。方法：我们检索了截至2025年1月13日的9个数据库，收集了身心运动对慢性阻塞性肺疾病患者焦虑和抑郁影响的随机对照试验。使用网络元分析比较频率理论框架内的主要结果，所有数据分析均在Stata 18.0中进行。利用累积排序曲线下的曲面对每个干预措施进行单独排序。结果共纳入23项研究，2303名受试者。与常规护理和治疗相比，正念减压（MBSR）联合八段金对焦虑（SMD = - 1.93, 95% CI - 3.54至- 0.31）和抑郁（SMD = - 1.96, 95% CI - 3.52至- 0.41）的疗效最大。SUCRA的排名显示，正念减压联合八段锦治疗焦虑症的比例最高，为83.5%，治疗抑郁症的比例最高，为86.3%。结论心身运动可显著减轻慢性阻塞性肺疾病患者的焦虑和抑郁症状。通过比较多种身心运动方法，结果表明正念减压和八段锦相结合是改善焦虑和抑郁的最有效方式。为了达到最佳的治疗效果，今后医生可以考虑将正念减压与八段锦联合使用。

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引用次数: 0

Impact of cannabis smoking in patients with COPD: A retrospective cross-sectional study in a safety- net hospital 大麻吸烟对慢性阻塞性肺病患者的影响：一项安全网医院的回顾性横断面研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-24 DOI: 10.1016/j.hrtlng.2025.10.011

Sujith V Cherian , Siddharth Karanth , Sandra A. Oldham , Rosa M Estrada-Y-Martin

Background

Cannabis is, after tobacco, the second most widely smoked substance in the United States. There is a dearth of studies evaluating the effects of combined cannabis and tobacco smoking in patients with known COPD secondary to tobacco smoking.

Objectives

We sought to evaluate pulmonary function and chest imaging findings in patients with combined cannabis and tobacco smoking and compare them to those of only tobacco smokers in a cohort of patients previously diagnosed with COPD. Furthermore, smoking patterns were evaluated.

Methods

This was a retrospective cross-sectional study performed at a safety net hospital. Adults with known tobacco smoking-related COPD were interviewed, and information regarding smoking patterns, pulmonary function, and chest imaging was reviewed from 2015 to 2020.

Results

A total of 199 patients were interviewed. Most combined cannabis and tobacco smokers were male (62 % vs 38 %) and started smoking cannabis 4 years after initiation of tobacco smoking. Combined cannabis and tobacco smokers showed elevated Forced Vital capacity (FVC) (2.69 L vs 2.33 L; P = 0.001), Residual volumes (RV) (4.09 L vs 3.67 L; P = 0.02), and Total Lung Capacity (TLC) (7.13 L vs 6.34 L; P = 0.001). In addition, paraseptal (47 % vs 37 %; P = 0.38) and bullous emphysema (17 % vs 4 %; P = 0.02) were seen more commonly in combined tobacco and cannabis smokers.

Conclusion

Our study is the first study evaluating demographic factors and smoking patterns in concomitant cannabis and tobacco smokers in a cohort of patients with COPD (secondary to tobacco smoking) in a safety net hospital.

在美国，大麻是仅次于烟草的第二大吸食物质。目前缺乏评估大麻和烟草联合使用对已知继发于吸烟的慢性阻塞性肺病患者影响的研究。目的：我们试图评估大麻和烟草联合吸烟患者的肺功能和胸部影像学表现，并将其与先前诊断为COPD的患者队列中仅吸烟的患者进行比较。此外，还对吸烟模式进行了评估。方法回顾性横断面研究在某安全网医院进行。对已知患有吸烟相关慢性阻塞性肺病的成年人进行了访谈，并回顾了2015年至2020年期间有关吸烟模式、肺功能和胸部影像学的信息。结果共访谈199例患者。大多数大麻和烟草联合吸烟者是男性（62%对38%），并且在开始吸烟4年后开始吸食大麻。吸食大麻和烟草的人的强迫肺活量（FVC）（2.69 L vs 2.33 L, P = 0.001）、残气量（RV）（4.09 L vs 3.67 L, P = 0.02）和总肺活量（TLC）（7.13 L vs 6.34 L, P = 0.001）升高。此外，隔膜旁（47%对37%；P = 0.38）和大疱性肺气肿（17%对4%；P = 0.02）在烟草和大麻联合吸烟者中更为常见。结论：我们的研究是第一个评估安全网医院慢性阻塞性肺病（继发性吸烟）患者中伴随大麻和烟草吸烟者的人口统计学因素和吸烟模式的研究。

{"title":"Impact of cannabis smoking in patients with COPD: A retrospective cross-sectional study in a safety- net hospital","authors":"Sujith V Cherian , Siddharth Karanth , Sandra A. Oldham , Rosa M Estrada-Y-Martin","doi":"10.1016/j.hrtlng.2025.10.011","DOIUrl":"10.1016/j.hrtlng.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Cannabis is, after tobacco, the second most widely smoked substance in the United States. There is a dearth of studies evaluating the effects of combined cannabis and tobacco smoking in patients with known COPD secondary to tobacco smoking.</div></div><div><h3>Objectives</h3><div>We sought to evaluate pulmonary function and chest imaging findings in patients with combined cannabis and tobacco smoking and compare them to those of only tobacco smokers in a cohort of patients previously diagnosed with COPD. Furthermore, smoking patterns were evaluated<strong>.</strong></div></div><div><h3>Methods</h3><div>This was a retrospective cross-sectional study performed at a safety net hospital. Adults with known tobacco smoking-related COPD were interviewed, and information regarding smoking patterns, pulmonary function, and chest imaging was reviewed from 2015 to 2020.</div></div><div><h3>Results</h3><div>A total of 199 patients were interviewed. Most combined cannabis and tobacco smokers were male (62 % vs 38 %) and started smoking cannabis 4 years after initiation of tobacco smoking. Combined cannabis and tobacco smokers showed elevated Forced Vital capacity (FVC) (2.69 L vs 2.33 L; <em>P</em> = 0.001), Residual volumes (RV) (4.09 L vs 3.67 L; <em>P</em> = 0.02), and Total Lung Capacity (TLC) (7.13 L vs 6.34 L; <em>P</em> = 0.001). In addition, paraseptal (47 % vs 37 %; <em>P</em> = 0.38) and bullous emphysema (17 % vs 4 %; <em>P</em> = 0.02) were seen more commonly in combined tobacco and cannabis smokers.</div></div><div><h3>Conclusion</h3><div>Our study is the first study evaluating demographic factors and smoking patterns in concomitant cannabis and tobacco smokers in a cohort of patients with COPD (secondary to tobacco smoking) in a safety net hospital.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 263-269"},"PeriodicalIF":2.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363376","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

Acute left ventricular ejection fraction changes in Sepsis: Clinical predictors, management, and hospital outcomes 脓毒症的急性左心室射血分数变化：临床预测因素、管理和医院结果

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.017

Mohamad Ghazal , Shayhaan Shaikh , Zachary Daniel , Omar Daghstani , John Musumeci , Abhinay Gajjala , Scott H. Beegle , Mikhail Torosoff

Background

Sepsis causes systemic vasodilation and sympathetic activation, potentially increasing left ventricular ejection fraction (LVEF), while acidosis and cellular dysfunction may decrease it. The effects of sepsis on LVEF and its predictors remain underexplored.

Methods

In this IRB-approved retrospective cohort study, we analyzed consecutive ICU patients with sepsis who had transthoracic echocardiograms before and during sepsis. Patients were categorized into four groups based on baseline LVEF (normal vs. reduced <50 %) and LVEF change during sepsis (unchanged/increased vs. decreased). Patients with STEMI or significant valvular disease were excluded.

Objectives

The aim of this study is to investigate acute LVEF changes in sepsis and assess their predictors and associated outcomes.

Results

Of 216 included patients (39.4 % female, mean age 65±14.5 years), 64.5 % with low baseline LVEF and 74.4 % with normal baseline LVEF had unchanged or increased LVEF during sepsis. LVEF decreased in 35.4 % and 25.6 % of these groups, respectively (p = 0.180). LVEF decline was associated with a history of coronary artery disease (p = 0.003), atrial fibrillation (p = 0.015), and right ventricular dysfunction (p < 0.001). This group also had higher BNP (p < 0.001), lower blood pressures (p = 0.013), and increased vasopressor needs (p < 0.001). However, LVEF decline was not associated with differences in-hospital mortality (p = 0.862) or length of stay (p = 0.472).

Conclusion

Acute changes in LVEF during sepsis appear to be influenced by the severity of sepsis and underlying cardiac comorbidities. BNP may serve as a marker for acute LVEF changes. Importantly, acute changes in LVEF do not appear to influence outcomes such as mortality or hospital length of stay.

脓毒症引起全身血管舒张和交感神经激活，潜在地增加左心室射血分数（LVEF），而酸中毒和细胞功能障碍可能降低它。脓毒症对LVEF的影响及其预测因素仍未得到充分探讨。方法在这项经irb批准的回顾性队列研究中，我们分析了脓毒症前和脓毒症期间连续进行经胸超声心动图检查的ICU脓毒症患者。根据基线LVEF（正常vs降低50%）和脓毒症期间LVEF变化（不变/增加vs降低）将患者分为四组。排除STEMI或有明显瓣膜疾病的患者。目的本研究旨在探讨脓毒症患者LVEF的急性变化，并评估其预测因素和相关结果。结果216例患者（女性39.4%，平均年龄65±14.5岁），64.5%基线LVEF低，74.4%基线LVEF正常，败血症期间LVEF不变或升高。LVEF分别降低35.4%和25.6% （p = 0.180）。LVEF下降与冠状动脉疾病（p = 0.003）、心房颤动（p = 0.015）和右室功能障碍（p < 0.001）相关。该组还具有较高的BNP (p < 0.001)，较低的血压（p = 0.013）和增加的血管加压药物需求（p < 0.001）。然而，LVEF的下降与住院死亡率（p = 0.862）或住院时间（p = 0.472）的差异无关。结论脓毒症期间LVEF的急性变化似乎受脓毒症严重程度和潜在的心脏合并症的影响。BNP可作为急性LVEF变化的标志物。重要的是，LVEF的急性变化似乎不会影响死亡率或住院时间等结果。

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引用次数: 0

Multiparametric integration of cardiac markers in differentiating myocardial infarction with non-obstructive coronary arteries: LASSO regression 心脏标志物在鉴别心肌梗死与非阻塞性冠状动脉中的多参数整合：LASSO回归

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.005

Qing Huang , Peixuan Zhao , Yi He , Jianwei Liang , Min Xu

Background

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity requiring angiography-assisted diagnostic confirmation.

Objectives

This study proposes an innovative predictive algorithm for identifying MINOCA using non-invasive variables.

Methods

This retrospective cohort study included patients with acute myocardial infarction admitted to the Department of Cardiology at the Third Affiliated Hospital of Soochow University from June 2021 to October 2024. We systematically collected and analyzed baseline clinical data of demographics, imaging, and laboratory tests. Potential predictors were screened via Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis, followed by multivariate logistic modeling. Performance evaluation included discrimination metrics (receiver operating characteristic), calibration assessment, and decision curve analysis. A nomogram was created to visualize the multivariable prediction model, with internal validation achieved through bootstrap resampling.

Results

613 patients were included, and 46 had MINOCA (7.50 %). Using LASSO for variable selection, five predictors were retained at log(λ) = −3.90: High-sensitivity cardiac troponin I, type of myocardial infarction, gender, age, and diabetes mellitus. In the subsequent multivariable logistic regression, all five were independently associated with MINOCA(P < 0.05). Among these predictors, high-sensitivity cardiac troponin I emerged as the best biomarker for MINOCA (AUC = 0.673, 95 % CI: 0.604–0.743). Finally, a multifactorial model was built with an AUC of 0.796 (95 % CI: 0.761 - 0.831). A dynamic calculator based on the multifactorial model was also deployed and is available in open-access format.

Conclusion

The model is efficacious in facilitating the accurate diagnosis of MINOCA, assisting clinicians with early identification of MINOCA, thereby improving patients' prognostic outcomes.

背景：非阻塞性冠状动脉心肌梗死（MINOCA）是一种异质性临床实体，需要血管造影辅助诊断确认。目的提出一种利用非侵入性变量识别MINOCA的创新预测算法。方法回顾性队列研究纳入2021年6月至2024年10月苏州大学第三附属医院心内科收治的急性心肌梗死患者。我们系统地收集和分析了人口统计学、影像学和实验室检查的基线临床数据。通过最小绝对收缩和选择算子（LASSO）回归分析筛选潜在的预测因子，然后进行多变量logistic建模。性能评估包括鉴别指标（接收机工作特性）、校准评估和决策曲线分析。创建了一个nomogram来可视化多变量预测模型，并通过bootstrap重采样实现内部验证。结果共纳入613例患者，其中MINOCA 46例（7.50%）。使用LASSO进行变量选择，保留log(λ) =−3.90的五个预测因子：高敏心肌肌钙蛋白I、心肌梗死类型、性别、年龄和糖尿病。在随后的多变量logistic回归中，这五项均与MINOCA独立相关（P < 0.05）。在这些预测因子中，高灵敏度心肌肌钙蛋白I成为MINOCA的最佳生物标志物（AUC = 0.673, 95% CI: 0.604-0.743）。最后，建立了一个多因子模型，AUC为0.796 （95% CI: 0.761 - 0.831）。还部署了基于多因子模型的动态计算器，并以开放格式提供。结论该模型能有效促进MINOCA的准确诊断，帮助临床医生早期发现MINOCA，从而改善患者的预后。

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引用次数: 0

A nomogram for predicting in-stent restenosis risk after initial drug-eluting stent implantation in patients with acute coronary syndrome 预测急性冠脉综合征患者首次药物洗脱支架植入术后支架内再狭窄风险的nomogram

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.013

Guo-Biao Li , Da-Qing Zhu , Wei-Ping He , Song-Mao Ouyang

Background

In-stent restenosis (ISR) remains a common complication after drug-eluting stent (DES) implantation, limiting long-term benefits of percutaneous coronary intervention (PCI).

Objectives

To identify predictors of ISR after initial DES implantation and to develop and validate a nomogram for individualized ISR risk prediction.

Methods

This retrospective study included 927 patients with acute coronary syndrome (ACS) who underwent follow-up coronary angiography after first-time DES implantation at the First People’s Hospital of Fuzhou City. Patients were classified into ISR (n = 96) and non-ISR (n = 831) groups. Univariate and multivariate Cox analyses identified independent predictors, which were incorporated into a nomogram. Model performance was evaluated using concordance index (C-index), area under the curve (AUC) for 1-, 2-, and 3-year ISR, calibration curves, and decision curve analysis (DCA). Kaplan–Meier analysis compared ISR incidence between risk groups.

Results

Four independent predictors were identified—age ≥65 years, diabetes, total stent length ≥20 mm, and stent diameter <3 mm. Post-PCI smoking was borderline (p = 0.051) and was retained for clinical relevance. The nomogram showed a C-index of 0.812, with AUCs of 0.790, 0.816, and 0.834 for 1-, 2-, and 3-year ISR, respectively. Calibration curves demonstrated good agreement, and DCA confirmed clinical utility. High-risk patients had significantly higher ISR incidence than low-risk patients (P < 0.05).

Conclusion

An internally evaluated nomogram using age, diabetes, total stent length, stent diameter, and post-PCI smoking (retained for clinical relevance) estimates ISR risk after DES in ACS. External multicenter validation is required before broad use.

背景：药物洗脱支架（DES）植入术后支架内再狭窄（ISR）仍然是常见的并发症，限制了经皮冠状动脉介入治疗（PCI）的长期获益。目的确定初始DES植入后ISR的预测因素，建立并验证个体化ISR风险预测的nomogram。方法回顾性分析福州市第一人民医院927例急性冠脉综合征（ACS）患者首次植入DES后行冠脉造影随访。患者分为ISR组（n = 96）和非ISR组（n = 831）。单变量和多变量Cox分析确定了独立的预测因子，并将其纳入nomogram。采用一致性指数（C-index）、1年、2年和3年ISR的曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）来评估模型的性能。Kaplan-Meier分析比较了不同风险组间ISR的发生率。结果确定了4个独立预测因素：年龄≥65岁、糖尿病、支架总长度≥20mm和支架直径≤3mm。pci术后吸烟为临界（p = 0.051），保留其临床相关性。nomogram显示，1年、2年和3年ISR的C-index为0.812，auc分别为0.790、0.816和0.834。校准曲线显示出良好的一致性，DCA证实了临床应用。高危患者ISR发生率明显高于低危患者（P < 0.05）。结论：一项内部评估的nomogram使用年龄、糖尿病、支架总长度、支架直径和pci后吸烟（保留临床相关性）来评估ACS患者DES后的ISR风险。在广泛使用前需要进行外部多中心验证。

{"title":"A nomogram for predicting in-stent restenosis risk after initial drug-eluting stent implantation in patients with acute coronary syndrome","authors":"Guo-Biao Li , Da-Qing Zhu , Wei-Ping He , Song-Mao Ouyang","doi":"10.1016/j.hrtlng.2025.10.013","DOIUrl":"10.1016/j.hrtlng.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>In-stent restenosis (ISR) remains a common complication after drug-eluting stent (DES) implantation, limiting long-term benefits of percutaneous coronary intervention (PCI).</div></div><div><h3>Objectives</h3><div>To identify predictors of ISR after initial DES implantation and to develop and validate a nomogram for individualized ISR risk prediction.</div></div><div><h3>Methods</h3><div>This retrospective study included 927 patients with acute coronary syndrome (ACS) who underwent follow-up coronary angiography after first-time DES implantation at the First People’s Hospital of Fuzhou City. Patients were classified into ISR (<em>n</em> = 96) and non-ISR (<em>n</em> = 831) groups. Univariate and multivariate Cox analyses identified independent predictors, which were incorporated into a nomogram. Model performance was evaluated using concordance index (C-index), area under the curve (AUC) for 1-, 2-, and 3-year ISR, calibration curves, and decision curve analysis (DCA). Kaplan–Meier analysis compared ISR incidence between risk groups.</div></div><div><h3>Results</h3><div>Four independent predictors were identified—age ≥65 years, diabetes, total stent length ≥20 mm, and stent diameter <3 mm. Post-PCI smoking was borderline (<em>p</em> = 0.051) and was retained for clinical relevance. The nomogram showed a C-index of 0.812, with AUCs of 0.790, 0.816, and 0.834 for 1-, 2-, and 3-year ISR, respectively. Calibration curves demonstrated good agreement, and DCA confirmed clinical utility. High-risk patients had significantly higher ISR incidence than low-risk patients (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>An internally evaluated nomogram using age, diabetes, total stent length, stent diameter, and post-PCI smoking (retained for clinical relevance) estimates ISR risk after DES in ACS. External multicenter validation is required before broad use.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 231-238"},"PeriodicalIF":2.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363379","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

Using large language models for ECG rhythm interpretation: Pitfalls, limitations, and future opportunities 使用大型语言模型进行ECG节律解释：陷阱、限制和未来机会。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.003

Nathan T. Riek , Tanmay A. Gokhale , Murat Akcakaya , Salah S. Al-Zaiti

引用次数: 0

The moderating effect of activity pacing on the relationship between physical activity and fatigue among patients with heart failure 活动起搏对心力衰竭患者体力活动与疲劳关系的调节作用

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.007

Boyi Li , Bo Zhu , Yusi Guo , Bo Fan , Xin Suo , Mei Zhou

Background

Fatigue is prevalent among patients with heart failure (HF). Activity pacing has emerged as an effective approach for managing fatigue in patients with chronic disease. However, research on the influence of activity pacing on the relationship between physical activity and fatigue in patients with HF has not been completely explore.

Objectives

This study aimed to examine the relationships among activity pacing, physical activity, and fatigue in patients with heart failure.

Methods

This cross-sectional study investigated 330 patients with heart failure in the cardiology department (Oct 2023 - Oct 2024). Data on socio-demographics, disease status, fatigue, physical activity, and activity pacing were collected at admission for patients with chronic heart failure and post-acute phase (≥7 days hospitalization) for patients with acute heart failure. Moderated effect analyses used Hayes PROCESS macro (Model 4.1).

Results

The study included 330 participants (61.9% male, 38.5% female) with a mean age of 67.47 years (SD = 12.87, range = 18 - 94). Physical activity showed a negative correlation with fatigue (r = -0.635, p < 0.001), but positive correlation with activity pacing (r = 0.169, p < 0.01). Activity pacing also negatively correlated with fatigue (r = -0.368, p < 0.001) and moderated the relationship between physical activity and fatigue (β = -0.130, p < 0.01).

Conclusions

This study confirms the moderating effect of activity pacing on the relationship between physical activity and fatigue in patients with HF. Thus, activity pacing could potentially facilitate greater engagement in physical activity, thereby alleviating fatigue and improving disease prognosis.

背景：疲劳在心力衰竭（HF）患者中很普遍。活动起搏已成为管理慢性疾病患者疲劳的有效方法。然而，活动起搏对心衰患者体力活动与疲劳关系的影响研究尚未完全深入。目的本研究旨在探讨心力衰竭患者活动起搏、体力活动和疲劳之间的关系。方法对心内科（2023年10月- 2024年10月）330例心力衰竭患者进行横断面研究。收集慢性心力衰竭患者入院时的社会人口统计学、疾病状态、疲劳、体力活动和活动起搏数据，以及急性心力衰竭患者急性期后（住院≥7天）的数据。调节效应分析使用Hayes PROCESS宏观（模型4.1）。结果共纳入330例患者，其中男性61.9%，女性38.5%，平均年龄67.47岁（SD = 12.87，范围= 18 ~ 94）。体力活动与疲劳呈负相关（r = -0.635, p < 0.001），与活动起搏呈正相关（r = 0.169, p < 0.01）。活动起搏与疲劳呈负相关（r = -0.368, p < 0.001），调节体力活动与疲劳的关系（β = -0.130, p < 0.01）。结论活动起搏对心衰患者体力活动与疲劳的关系有调节作用。因此，活动起搏可以潜在地促进更多的身体活动，从而减轻疲劳和改善疾病预后。

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