Heart & Lung最新文献_第2页

Risk factors and assessment system for cardiogenic death and stroke in patients with premature acute myocardial infarction 早发急性心肌梗死患者心源性死亡和卒中的危险因素及评价体系。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-06 DOI: 10.1016/j.hrtlng.2025.102716

Xinyu Hou , Jiatong Liu , Jinling Zhang, Xingyi Wang, Qi Liu, Shiyu Wang, Xinyu Yang, Yanqi Zhang, Wenjie Zhang, Shiliang Chen, Yong Sun, Jian Wu

Background

The incidence of Acute Myocardial Infarction (AMI) is rising among younger populations. Despite advancements in treatment protocols, improvements in morbidity and mortality remain limited.

Objective

To identify risk factors for cardiogenic death and stroke within one year in prematureAMI patients (≤55 years) and to develop a prognostic risk prediction model and scoring scale for comprehensive risk assessment.

Methods

Utilizing clinical study NCT03297164 and the follow-up center database, we included 3630 participants enrolled from January 2017 to August 2022 to create training and testing sets. An external set (n = 472) was then selected. Cox proportional hazards and LASSO regression were employed to identify predictive factors, and β coefficients from multivariable Cox regression were utilized to develop the scoring scale.

Results

Seven predictors were selected. The scoring scale achieved an AUC of 0.75 (0.66–0.84) in the test set and 0.77 (0.63–0.91) in the external set, outperforming the GRACE score (0.61 and 0.50, respectively). Based on event rate distributions, patients were stratified into three risk groups, with significant differences in event rates observed across subsets (log-rank test, P < 0.05). Further optimization of binning strategies, guided by the correlation between predictors and outcomes, resulted in a model with an AUC of 0.83 (0.72–0.93) in the external set. A corresponding web application was developed for supplementary risk assessment.

Conclusions

This study developed and validated a practical scoring scale and a prediction model based on optimized binning strategies for premature AMI patients, offering a comprehensive risk assessment to support clinical decision-making.

背景：急性心肌梗死（AMI）的发病率在年轻人群中呈上升趋势。尽管治疗方案取得了进步，但发病率和死亡率的改善仍然有限。目的：探讨早发ami（≤55岁）患者1年内发生心源性死亡和卒中的危险因素，建立预后风险预测模型和评分量表，进行综合风险评估。方法：利用临床研究NCT03297164和随访中心数据库，于2017年1月至2022年8月纳入3630名参与者，建立训练和测试集。然后选择一个外部集合（n = 472）。采用Cox比例风险和LASSO回归识别预测因素，采用多变量Cox回归的β系数编制评分量表。结果：选取7个预测因子。评分量表在测试集的AUC为0.75(0.66-0.84)，在外部集的AUC为0.77(0.63-0.91)，优于GRACE评分（分别为0.61和0.50）。根据事件发生率分布，将患者分为三个危险组，各组间事件发生率差异有统计学意义（log-rank检验，P < 0.05）。以预测因子与结果的相关性为指导，进一步优化分组策略，得到外部集AUC为0.83（0.72-0.93）的模型。开发了相应的web应用程序，以进行补充风险评估。结论：本研究开发并验证了一套实用的AMI早期患者评分量表和基于优化分组策略的预测模型，为临床决策提供了全面的风险评估。

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引用次数: 0

The influence of dyspnea on social frailty in elderly patients with chronic obstructive pulmonary disease: The mediating effects of social support and depression symptoms 呼吸困难对老年慢性阻塞性肺疾病患者社交脆弱性的影响：社会支持和抑郁症状的中介作用

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-06 DOI: 10.1016/j.hrtlng.2025.102703

Yan Cheng , Qingqing Liu , Xumeng Zhu , Jing Wei , Wanling Li

Background

Dyspnea in elderly COPD patients may contribute to social frailty by limiting social engagement and increasing emotional distress, therefore clarifying the underlying mechanisms is crucial for developing effective interventions.

Objectives

To investigate the prevalence of social frailty in elderly COPD patients and assess the mediating effects of social support and depressive symptoms on the relationship between dyspnea and social frailty.

Methods

Between November 2024 and May 2025, 245 older patients with COPD in Taiyuan City participated in this study. A self-reported questionnaire was used to evaluate dyspnea, social support, depressive symptoms, and social frailty. Structural equation modeling was employed for data analysis.

Results

Dyspnea in elder patients with COPD were directly related to social frailty. Social support and depressive symptoms jointly mediate the relationship between dyspnea and social frailty, accounting for a total indirect effect of 0.211 and a total effect of 0.580, resulting in a mediation effect of 36.42%.

Conclusions

The study reveals that social support and depressive symptoms serve as multiple mediators in the relationship between dyspnea and social frailty. Dyspnea can exacerbate social frailty in COPD patients via the effect of social support and depressive symptoms.

背景：老年COPD患者的呼吸困难可能通过限制社会参与和增加情绪困扰而导致社会脆弱，因此阐明其潜在机制对于制定有效的干预措施至关重要。目的：了解老年COPD患者社会脆弱的患病率，并评估社会支持和抑郁症状在呼吸困难与社会脆弱之间的中介作用。方法：2024年11月至2025年5月，对太原市245例老年COPD患者进行研究。采用自我报告的问卷来评估呼吸困难、社会支持、抑郁症状和社会脆弱性。采用结构方程模型对数据进行分析。结果：老年COPD患者呼吸困难与社交衰弱有直接关系。社会支持和抑郁症状共同介导呼吸困难与社交脆弱的关系，总间接效应为0.211，总效应为0.580，中介效应为36.42%。结论：社会支持和抑郁症状在呼吸困难和社交脆弱之间起多重中介作用。呼吸困难可通过社会支持和抑郁症状的影响加剧COPD患者的社会脆弱性。

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引用次数: 0

Left atrial diameter to left atrial appendage emptying velocity ratio predicts risk of recurrence of atrial fibrillation after all-zero fluoroscopy ablation 左房内径与左房附件排空速度比预测全零透视消融后房颤复发的风险。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-05 DOI: 10.1016/j.hrtlng.2025.102721

Xiaoran Cui, Yichen Li, Ruibin Li, Wenli Zhou, Jidong Zhang

Background and Objectives

This study evaluated the ability of intraprocedural intracardiac echocardiography (ICE)-measured left atrial appendage (LAA) flow characteristics to predict the long-term risk of recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation.

Methods

The study included 105 patients who underwent radiofrequency catheter ablation for AF at our institution between October 2020 and December 2021. Eighty-seven of these patients completed 12 months of follow-up. The anteroposterior left atrial diameter to LAA emptying velocity (LAD/LAAEV) ratio was calculated. The patients were stratified into a recurrence group (n=18) and a non-recurrence group (n=69) based on the 12-month outcome. Predictive performance was evaluated by Cox regression and by receiver-operating characteristic curve and Kaplan–Meier survival analyses.

Results

The LAD/LAAEV ratio (P<0.001) was significantly higher in the recurrence group than in the non-recurrence group. Multivariate Cox analysis identified the LAD/LAAEV ratio (hazard ratio 1.36, 95 % confidence interval [CI] 1.02–1.83) and New York Heart Association functional class (hazard ratio 2.75, 95 % CI 1.19–6.35) as independent predictors of recurrence by one year. Receiver-operating characteristic curve analysis confirmed that the LAD/LAAEV ratio predicted recurrence with an area under the curve of 0.806 (95 % CI 0.707–0.906); the optimal cutoff was 1.42 (sensitivity 70.4 %, specificity 87.5 %). Kaplan–Meier analysis showed that the cumulative recurrence rate was significantly higher in the group with an LAD/LAAEV ratio of ≥1.42 (P<0.001, log-rank test).

Conclusions

The ICE-measured LAD/LAAEV ratio may predict recurrence of AF post-ablation, providing a basis for intensified post-procedural management in high-risk patients.

背景和目的：本研究评估术中超声心动图（ICE）测量的左心耳（LAA）血流特征预测射频导管消融后房颤（AF）复发的长期风险的能力。方法：该研究纳入了2020年10月至2021年12月期间在我院接受房颤射频导管消融治疗的105例患者。其中87名患者完成了12个月的随访。计算左房前后径与LAA排空速度之比（LAD/LAAEV）。根据12个月的预后将患者分为复发组（n=18）和非复发组（n=69）。通过Cox回归、患者工作特征曲线和Kaplan-Meier生存分析评估预测效果。结论：ice检测的LAD/LAAEV比值可预测房颤消融后复发，为加强高危患者的术后管理提供依据。

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引用次数: 0

Association of right ventricular dysfunction on electrocardiogram with outcomes and ventilatory response in patients monitored by electrical impedance tomography: A cohort study 电阻抗断层扫描监测患者心电图右室功能障碍与预后和通气反应的关系：一项队列研究。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-05 DOI: 10.1016/j.hrtlng.2025.102706

Adriano Rossi MD , Frederik J. Mooi MD , Eda Aydeniz MD , Teun Timmermans , Serge J.H. Heines , Frank van Rosmalen PhD , Jip de Kok MSc , Iwan C.C. van der Horst MD, PhD , Jan-Willem E.M. Sels MD, PhD , Dennis C.J.J. Bergmans MD, PhD , Marco Giani MD , Giuseppe Citerio MD, Prof , Bas C.T. van Bussel MD, PhD , Rob G.H. Driessen MD, PhD

Background

Mechanical ventilation is essential in critical care but can cause lung injury and hemodynamic compromise, particularly in patients with right ventricular dysfunction (RVD). Electrical impedance tomography (EIT) is increasingly used to guide ventilation, but its role in patients with RVD is not well defined.

Objectives

To evaluate how electrocardiographic (ECG) signs of RVD influence the application and effects of EIT-guided ventilation management.

Methods

This retrospective cohort study (2013–2023) included mechanically ventilated patients who underwent both ECG and EIT. Patients were grouped according to the presence of ECG signs of RVD. Demographic, clinical, and respiratory characteristics were compared. Airway pressures during EIT-guided recruitment maneuvers (RMs) and decremental positive end-expiratory pressure (PEEP) trials were analyzed using linear regression. Repeated ECG and EIT data were assessed using linear mixed-effects models.

Results

Of 285 patients, 38 (13 %) had ECG signs of RVD. They were more often male (89.5 % vs. 74.1 %, p = 0.04), older (68.2 vs. 63.5 years, p = 0.02), and had higher mortality (65.8 % vs. 48.6 %, p < 0.05). During EIT-guided RMs, they received lower maximum PEEP (–2.2 to –0.4 cmH₂O) and a narrower decremental PEEP range (–2.5 to –0.9 cmH₂O, both p < 0.01). After EIT-guided optimization, dynamic compliance was higher in patients with ECG signs of RVD (43.6 vs. 38.4 mL/cmH₂O, p = 0.04).

Conclusion

ECG signs of RVD identified a high-risk group that appeared less tolerant of, yet more responsive to, EIT-guided PEEP titration. By integrating respiratory and cardiac monitoring, EIT may facilitate safer ventilation strategies.

背景：机械通气在重症监护中是必不可少的，但可能导致肺损伤和血流动力学损害，特别是在右心室功能障碍（RVD）患者中。电阻抗断层扫描（EIT）越来越多地用于指导通气，但其在RVD患者中的作用尚未明确。目的：评价RVD的心电图征象对eit引导下通气管理的应用和效果的影响。方法：本回顾性队列研究（2013-2023）纳入了同时进行ECG和EIT检查的机械通气患者。根据有无RVD的心电图征象对患者进行分组。比较人口学、临床和呼吸特征。采用线性回归分析eit引导下气道压力恢复演习（RMs）和呼气末正压减少（PEEP）试验中的气道压力。使用线性混合效应模型评估重复ECG和EIT数据。结果：285例患者中，38例（13%）有RVD的心电图征象。男性居多（89.5%比74.1%,p = 0.04），年龄较大（68.2比63.5岁，p = 0.02），死亡率较高（65.8%比48.6%,p < 0.05）。在eit引导的RMs中，他们的最大PEEP较低（-2.2至-0.4 cmH₂O），而递减PEEP范围较窄（-2.5至-0.9 cmH₂O， p均< 0.01）。经eit引导优化后，有RVD心电图体征患者的动态依从性更高（43.6 vs 38.4 mL/cmH₂O, p = 0.04）。结论：RVD的心电图征象确定了一个高危组，他们对eit引导的PEEP滴定的耐受性较低，但对其反应更积极。通过整合呼吸和心脏监测，EIT可以促进更安全的通气策略。

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引用次数: 0

Assessing ICU mortality among non-COVID-19 patients during the COVID-19 pandemic 评估COVID-19大流行期间非COVID-19患者的ICU死亡率。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-03 DOI: 10.1016/j.hrtlng.2025.102709

Caroline Paley PharmD , Ryan M Rivosecchi PharmD , Ian Barbash MD, MS , Aimee Boeltz DNP, RN , Allison Burdick PharmD , Chenell Donadee MD, MBA , Lara Groetzinger PharmD , Christopher M Horvat MD, MHA , Kangho Suh PharmD, PhD

Background

The COVID-19 pandemic challenged healthcare infrastructure and delivery, particularly during peak periods. How these disruptions affected care and outcomes for non-COVID patients in intensive care units (ICUs) remains unclear.

Objectives

To evaluate whether COVID-19 burden at the institutional and ICU level impacted ICU mortality among mechanically ventilated (MV) non-COVID patients across a health system.

Methods

Clinical data for ICU patients admitted within the University of Pittsburgh Medical Center system from March 2020 through December 2022 were included. High and low periods of COVID-19 were defined based on the average COVID-19 positivity rate across UPMC hospitals with high periods defined as months when the average positivity rate ≥10 %. A mixed-effects logistic regression evaluated the association between COVID-19 periods and ICU mortality with random intercepts for hospital and patient. Secondary models evaluated variation by ICU subtype and institution type. Models adjusted for demographic, clinical, and ICU characteristics.

Results

Among 19,727 MV non-COVID ICU admissions, 10,798 occurred during high COVID-19 periods and 8929 during low periods. Baseline characteristics were similar with the largest age group being 60–69 years (28.1 % low vs 28.6 % high). Patients were predominantly White males admitted to quaternary hospitals. Admission during high COVID-19 periods was associated with higher ICU mortality (OR=1.19, 95 % CI: 1.08,1.31) particularly in MICUs (OR=1.18, 95 % CI: 1.14,1.22) and quaternary hospitals (OR=1.19, 95 % CI: 1.09,1.29).

Conclusion

High COVID-19 periods were associated with increased odds of ICU mortality among MV non-COVID-19 patients. These findings underscore the need for system-wide surge planning and incorporation of case-mix and workload measures in future evaluations.

背景：COVID-19大流行对医疗基础设施和服务提出了挑战，尤其是在高峰时期。目前尚不清楚这些中断如何影响重症监护病房（icu）非covid - 19患者的护理和结果。目的：评估机构和ICU层面的COVID-19负担是否影响整个卫生系统机械通气（MV）非covid患者的ICU死亡率。方法：纳入2020年3月至2022年12月匹兹堡大学医学中心系统ICU患者的临床数据。根据UPMC医院的平均COVID-19阳性率定义COVID-19的高、低期，高期定义为平均阳性率≥10%的月份。混合效应logistic回归评估COVID-19期间与ICU死亡率之间的关系，随机截取医院和患者。二级模型评估了ICU亚型和机构类型的差异。根据人口统计学、临床和ICU特征调整模型。结果：19,727例MV非covid ICU入院患者中，10,798例发生在COVID-19高发病期，8929例发生在低发病期。基线特征相似，最大年龄组为60-69岁（28.1%低对28.6%高）。第四医院的病人主要是白人男性。在COVID-19高发期入院与较高的ICU死亡率相关（OR=1.19, 95% CI: 1.08,1.31），特别是在重症监护病房（OR=1.18, 95% CI: 1.14,1.22）和第四医院（OR=1.19, 95% CI: 1.09,1.29）。结论：MV非COVID-19患者的高COVID-19期与ICU死亡率增加相关。这些调查结果强调需要在今后的评价中进行全系统的激增规划和纳入病例组合和工作量措施。

{"title":"Assessing ICU mortality among non-COVID-19 patients during the COVID-19 pandemic","authors":"Caroline Paley PharmD , Ryan M Rivosecchi PharmD , Ian Barbash MD, MS , Aimee Boeltz DNP, RN , Allison Burdick PharmD , Chenell Donadee MD, MBA , Lara Groetzinger PharmD , Christopher M Horvat MD, MHA , Kangho Suh PharmD, PhD","doi":"10.1016/j.hrtlng.2025.102709","DOIUrl":"10.1016/j.hrtlng.2025.102709","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic challenged healthcare infrastructure and delivery, particularly during peak periods. How these disruptions affected care and outcomes for non-COVID patients in intensive care units (ICUs) remains unclear.</div></div><div><h3>Objectives</h3><div>To evaluate whether COVID-19 burden at the institutional and ICU level impacted ICU mortality among mechanically ventilated (MV) non-COVID patients across a health system.</div></div><div><h3>Methods</h3><div>Clinical data for ICU patients admitted within the University of Pittsburgh Medical Center system from March 2020 through December 2022 were included. High and low periods of COVID-19 were defined based on the average COVID-19 positivity rate across UPMC hospitals with high periods defined as months when the average positivity rate ≥10 %. A mixed-effects logistic regression evaluated the association between COVID-19 periods and ICU mortality with random intercepts for hospital and patient. Secondary models evaluated variation by ICU subtype and institution type. Models adjusted for demographic, clinical, and ICU characteristics.</div></div><div><h3>Results</h3><div>Among 19,727 MV non-COVID ICU admissions, 10,798 occurred during high COVID-19 periods and 8929 during low periods. Baseline characteristics were similar with the largest age group being 60–69 years (28.1 % low vs 28.6 % high). Patients were predominantly White males admitted to quaternary hospitals. Admission during high COVID-19 periods was associated with higher ICU mortality (OR=1.19, 95 % CI: 1.08,1.31) particularly in MICUs (OR=1.18, 95 % CI: 1.14,1.22) and quaternary hospitals (OR=1.19, 95 % CI: 1.09,1.29).</div></div><div><h3>Conclusion</h3><div>High COVID-19 periods were associated with increased odds of ICU mortality among MV non-COVID-19 patients. These findings underscore the need for system-wide surge planning and incorporation of case-mix and workload measures in future evaluations.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102709"},"PeriodicalIF":2.6,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901660","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 predictive model based on the systemic immune-inflammation index combined with other hematologic indices: A dynamic web-based nomogram for early detection of massive acute pulmonary embolism 基于全身免疫炎症指数结合其他血液学指标的预测模型：早期发现大面积急性肺栓塞的动态网络图。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-03 DOI: 10.1016/j.hrtlng.2025.102714

Seyedeh-Tarlan Mirzohreh , Samad Ghaffari , Mohammad Asghari-Jafarabadi , Elnaz Javanshir , Neda Roshanravan

Background

Massive acute pulmonary embolism (MACPE) is a life-threatening condition where early risk stratification is essential. The systemic immune-inflammation index (SII) is a promising biomarker, but its role in predicting MACPE has not been fully defined.

Objectives

To develop and validate an SII-based predictive model, augmented by other hematologic indices, for early MACPE detection, and to present it as a dynamic web-based nomogram.

Methods

We retrospectively analyzed 444 patients with confirmed acute pulmonary embolism from the Persian Pulmonary Embolism Registry. Hematologic indices, including SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-platelet count ratio (MPV/PLT), hemoglobin-to-red cell distribution width ratio (Hb/RDW), and others, were evaluated using correlation analysis, logistic regression, and receiver operating characteristic (ROC) curves. SII served as the base predictor, with additional variables added sequentially if they significantly improved the area under the curve (AUC). Continuous and binary multivariable models were developed and calibrated.

Results

SII, RDW, and MPV/PLT were the strongest independent predictors. The best continuous model (SII, RDW, MPV/PLT, and diabetes mellitus) achieved an AUC of 0.829 with good calibration. The corresponding binary model, using optimal cut-offs (SII ≥ 1.152, RDW ≥ 14.55 %, MPV/PLT ≥ 0.545), achieved an AUC of 0.806 with acceptable calibration.

Conclusions

We developed an SII-based predictive model enhanced by RDW, MPV/PLT, and diabetes mellitus, presented as a web-based nomogram for real-time MACPE risk estimation. Prospective multicenter validation is warranted.

背景：大面积急性肺栓塞（MACPE）是一种危及生命的疾病，早期风险分层是必不可少的。全身免疫炎症指数（SII）是一种很有前景的生物标志物，但其在预测MACPE中的作用尚未完全确定。目的：开发和验证基于sii的预测模型，并辅以其他血液学指标，用于早期MACPE检测，并将其呈现为动态的基于网络的nomogram。方法：我们回顾性分析了444例来自波斯肺栓塞登记的确诊急性肺栓塞患者。血液学指标包括SII、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、平均血小板体积与血小板计数比（MPV/PLT）、血红蛋白与红细胞分布宽度比（Hb/RDW）等，采用相关分析、logistic回归和受试者工作特征（ROC）曲线进行评估。SII作为基本预测因子，如果其他变量显著改善曲线下面积（AUC），则依次添加其他变量。建立并校准了连续和二元多变量模型。结果：SII、RDW和MPV/PLT是最强的独立预测因子。最佳连续模型（SII， RDW， MPV/PLT和糖尿病）的AUC为0.829，校准良好。采用最佳截止值（SII≥1.152,RDW≥14.55%,MPV/PLT≥0.545），相应的二元模型在可接受的校准下获得了0.806的AUC。结论：我们建立了一个基于sii的预测模型，由RDW、MPV/PLT和糖尿病增强，作为实时MACPE风险估计的基于网络的nomogram。前瞻性多中心验证是必要的。

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引用次数: 0

Associations of modifiable lifestyle behaviors with cardiovascular–kidney–metabolic syndrome across risk categories: Findings from a U.S. national survey 可改变的生活方式行为与心血管-肾脏-代谢综合征的关联：来自美国全国调查的结果

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-02 DOI: 10.1016/j.hrtlng.2025.102712

Xin Chen , Xinyu Tao , Zhonghua Sun , Hanning Xiong , Yameng Xu , Ying Xu , Zhengxia Liu , Chen Qu , Biao Xu

Background

Poor cardiovascular–kidney–metabolic (CKM) health is highly prevalent and strongly associated with premature mortality. Although healthy lifestyle behaviors are linked to cardiovascular, renal, and metabolic outcomes, evidence on their associations with CKM syndrome risk categories, particularly by sex, remains limited.

Objectives

To examine the associations of five modifiable lifestyle behaviors with CKM syndrome risk categories in a nationally representative U.S. sample and to explore potential sex-specific patterns.

Methods

We conducted a cross-sectional analysis of 9447 adults from the 2007–2018 National Health and Nutrition Examination Survey. CKM stages (0–4) were grouped into low-, moderate-, and high-risk categories. Physical activity, diet quality, smoking status, sleep duration, and alcohol intake were assessed using standardized questionnaires. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for moderate- and high-risk CKM; a 0–5 lifestyle score assessed dose–response; sex-stratified and sensitivity analyses were performed.

Results

Physical inactivity, current smoking, short or long sleep, and nondrinking (vs light drinking) were associated with higher odds of moderate- or high-risk CKM. Poor diet quality was associated with moderate- but not high-risk CKM. Higher lifestyle scores showed an inverse dose–response pattern, and several associations varied by sex.

Conclusion

In this nationally representative cross-sectional study, modifiable lifestyle behaviors were strongly associated with CKM syndrome risk categories, with important sex-specific patterns. These findings support incorporating lifestyle information into CKM risk stratification and motivate future longitudinal and interventional studies.

背景：不良的心血管-肾脏代谢（CKM）健康是非常普遍的，并且与过早死亡密切相关。尽管健康的生活方式行为与心血管、肾脏和代谢结果有关，但其与CKM综合征风险类别（特别是性别）的关联证据仍然有限。目的在具有全国代表性的美国样本中，研究五种可改变的生活方式行为与CKM综合征风险类别的关系，并探讨潜在的性别特异性模式。方法对2007-2018年全国健康与营养调查的9447名成年人进行横断面分析。CKM分期（0-4）分为低、中、高风险三类。采用标准化问卷对体育活动、饮食质量、吸烟状况、睡眠时间和酒精摄入量进行评估。加权逻辑回归估计中等和高风险CKM的优势比（ORs）和95%置信区间（ci）；0-5生活方式评分评估剂量反应；进行性别分层和敏感性分析。结果：缺乏运动、吸烟、睡眠时间短或长、不饮酒（与轻度饮酒相比）与中度或高风险CKM的发生几率较高相关。不良的饮食质量与中度但非高风险CKM相关。较高的生活方式得分显示出相反的剂量反应模式，并且一些关联因性别而异。结论：在这项具有全国代表性的横断面研究中，可改变的生活方式行为与CKM综合征风险类别密切相关，并具有重要的性别特异性模式。这些发现支持将生活方式信息纳入CKM风险分层，并激励未来的纵向和干预性研究。

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引用次数: 0

Building a resilient heart failure nursing workforce: A leadership imperative. 建立一支有弹性的心力衰竭护理队伍：领导势在必行。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-02 DOI: 10.1016/j.hrtlng.2025.102691

Linda Ordway

引用次数: 0

Emergency-use spacers: a considerable option for asthmatic patients 紧急使用垫片：哮喘患者的一个相当大的选择

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-02 DOI: 10.1016/j.hrtlng.2025.102719

Omar Ahmed Sayed , Nabila Ibrahim Laz , Mohamed EA Abdelrahim , Haitham Saeed

Background

Pressurized metered dose inhalers (pMDIs) spacers improve delivery by reducing hand-breath coordination requirements.

Objectives

This study aimed to assess the efficacy of emergency-use and conventional spacers.

Method

a multi-arm, parallel-group, randomized trial in which 108 asthmatics were randomized to 9 groups (pMDI alone and various spacers); each received 400 µg salbutamol. Emitted dose on the ex vivo filter was quantified using high-performance liquid chromatography. Pulmonary absorption was assessed via urinary salbutamol at 0.5 h post-dose (USAL0.5) and spirometry changes was assessed via forced expiratory volume in 1 second (FEV₁) and its percent of predicted (∆FEV₁ and ∆FEV₁% predicted), and forced vital capacity (∆FVC).

Results

While the pMDI alone group yielded the highest ex vivo deposition (325.4 µg, P ˂0.001), it showed the lowest USAL0.5 (4.13 µg, P ˂0.001–0.032) and ∆FEV₁ (0.12 L, P ˂0.001). Among all tested devices, the Aerochamber, Able, and Tips-Haler spacers demonstrated superior performance (ex vivo filter: 207.1, 181.1, 167.5 µg, P ˂0.001–0.02; USAL0.5: 11.61, 11.15, 10.73 µg, P ˂0.001–0.09), ∆FEV₁: 0.32, 0.29, 0.31 L, respectively, P ˂0.001–0.06), with no significant difference between the three spacers, except the Aerochamber showed a significantly higher ex vivo result (P ˂0.001–0.02). DispozABLE and Lite-Air showed moderate efficacy, whereas the Atomizer, showed the lowest pulmonary function performance with varied significance across devices.

Conclusion

This study emphasizes the significance of spacer design. It supports the use of validated emergency-use spacers in low-resource or emergency settings where conventional devices are not available.

The trial was registered at ClinicalTrials.gov, identifier: NCT06816342.

背景：加压计量吸入器（pmdi）间隔器通过减少手呼吸协调要求来改善输送。目的评价急诊使用的与常规垫片的疗效。方法采用多臂、平行组、随机试验，将108例哮喘患者随机分为9组（pMDI单独用药和不同间隔剂）；每人服用400µg沙丁胺醇。用高效液相色谱法测定离体滤器上的放射剂量。在给药后0.5 h通过尿沙丁胺醇评估肺吸收（USAL0.5），通过1秒用力呼气量（FEV₁）及其预测百分比（∆FEV₁和∆FEV₁预测百分比）和用力肺活量（∆FVC）评估肺活量变化。结果pMDI组体外沉积最高（325.4µg， P小于0.001），USAL0.5最低（4.13µg， P小于0.001 ~ 0.032），∆FEV 1最低（0.12 L， P小于0.001）。在所有测试装置中，Aerochamber、Able和Tips-Haler隔震器表现出优越的性能（离体滤波器：207.1、181.1、167.5µg， P小于0.001-0.02;USAL0.5: 11.61、11.15、10.73µg， P小于0.001-0.09），∆FEV 1: 0.32、0.29、0.31 L， P小于0.001-0.06)，三种隔震器之间没有显著差异，但Aerochamber隔震器的离体效果显著高于其他隔震器（P小于0.001-0.02）。一次性和Lite-Air表现出中等疗效，而雾化器表现出最低的肺功能表现，在不同的设备上具有不同的意义。结论本研究强调了垫片设计的重要性。它支持在资源不足或没有常规装置的紧急情况下使用经过验证的紧急使用垫片。该试验已在ClinicalTrials.gov注册，识别码：NCT06816342。

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引用次数: 0

Artificial intelligence applications for enhancing patient self-care education following sternotomy: Development and initial evaluation 人工智能应用于加强胸骨切开术后患者自我护理教育：发展与初步评估

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-02 DOI: 10.1016/j.hrtlng.2025.102704

Shu-Fen Wung PhD, MS, RN, ACNP-BC, FAAN , James A. Noboa DNP, MS, RN, MS Ed., AGACNP-BC , Zoe Wung CCMA, CPT , Courtney Bartlett DNP, RN, AGACNP-BC

Background

Research indicates that over 12% of patients undergoing coronary artery bypass grafting and more than 14% of patients undergoing surgical aortic valve replacement experience rehospitalization within 30 days of discharge. Many of these re-admissions are potentially preventable. Comprehensive discharge education is essential, and AI applications can deliver tailored recommendations that encourage adherence to recovery self-care.

Objective

The purpose of this project was to design an artificial intelligence (AI) application capable of addressing common patient questions about self-care after hospital discharge following a sternotomy. The intended outcome is to provide patients with pertinent information to mitigate the risk of postoperative complications that could lead to readmission.

Methods

A Beta version of a novel AI application was developed to enhance the understanding of discharge instructions for patients undergoing sternotomy. Seventy-five potential patient inquiries were developed and entered into the AI application. For each inquiry, the application generated responses based on 50 scholarly articles. Although intended for future patient use, this initial beta version was not deployed to real patients; rather, it was developed and evaluated by the research team, who reviewed each AI response and assigned it as “thumbs up,” “thumbs down,” or “neither.”

Results

The AI application successfully answered all 75 questions. Of these, 65 responses (86.7%) received “thumbs-up” ratings, indicating that they were comprehensive, while 10 responses (13.3%) were marked as “neither” due to convoluted or incomplete information.

Conclusion

Tailored patient education is critical for reducing postoperative complications after discharge. An AI application can serve as an effective tool for personalized education. Initial evaluations should be conducted by a cardiac surgery team to assess accuracy and relevance, followed by testing on actual patients undergoing sternotomy to assess usability before wider implementation.

研究表明，超过12%的冠状动脉旁路移植术患者和超过14%的主动脉瓣置换术患者在出院后30天内再次住院。其中许多重新入院是可以预防的。全面的出院教育至关重要，人工智能应用程序可以提供量身定制的建议，鼓励坚持康复自我护理。目的设计一款人工智能（AI）应用程序，能够解决胸骨切开术患者出院后自我护理的常见问题。预期的结果是为患者提供相关信息，以减轻可能导致再入院的术后并发症的风险。方法开发一种新型人工智能应用程序的Beta版本，以提高对胸骨切开术患者出院指示的理解。开发了75个潜在的患者询问并将其输入人工智能应用程序。对于每个查询，应用程序根据50篇学术文章生成响应。虽然这个最初的测试版是为未来的患者使用的，但并没有部署到真正的患者身上；相反，它是由研究团队开发和评估的，他们审查每个人工智能的反应，并将其分配为“赞”、“不赞”或“都不赞”。结果人工智能应用程序成功回答了全部75个问题。其中，65个回答（86.7%）被评为“赞”，表明它们是全面的，而10个回答（13.3%）被标记为“都不是”，因为信息复杂或不完整。结论有针对性的患者教育是减少术后并发症的关键。人工智能应用程序可以作为个性化教育的有效工具。初步评估应由心脏外科团队进行，以评估准确性和相关性，然后在进行胸骨切开术的实际患者中进行测试，以评估可用性，然后再进行更广泛的实施。

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