Heart & Lung最新文献_第3页

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。

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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。

{"title":"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","authors":"Seyedeh-Tarlan Mirzohreh , Samad Ghaffari , Mohammad Asghari-Jafarabadi , Elnaz Javanshir , Neda Roshanravan","doi":"10.1016/j.hrtlng.2025.102714","DOIUrl":"10.1016/j.hrtlng.2025.102714","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102714"},"PeriodicalIF":2.6,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901655","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

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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引用次数: 0

Cardiogenic shock complicated by acute kidney injury: Sex-specific differences and prognostic impact 心源性休克并发急性肾损伤：性别特异性差异和预后影响

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-02 DOI: 10.1016/j.hrtlng.2025.102717

Priyanka Boettger MD , Henriette Preusse-Sondermann MD , Jamschid Sedighi MD , Jannik Jobst MD , Hassan Hassan MD , Utku Bayram MD , Jakob Lorenz MD , Birgit Assmus MD , Bernhard Unsoeld MD , Matthias Janusch MD , Henning Lemm MD , Samuel Sossalla MD , Michael Buerke MD

Background

Acute kidney injury (AKI) is a frequent and prognostically relevant complication in infarct-related cardiogenic shock (CS). Although sex differences in cardiovascular outcomes are increasingly recognized, their role in AKI incidence and prognosis in CS remains unclear.

Objectives

To assess sex-specific differences in the incidence, severity, and prognostic impact of AKI in patients with infarct-related CS.

Methods

We retrospectively analyzed 369 consecutive patients with infarct-related CS enrolled in a prospective registry between 2015 and 2020. AKI was classified using KDIGO criteria. Baseline characteristics, treatment exposure, renal replacement therapy (RRT), and in-hospital mortality were compared between women and men. Multivariable logistic regression identified independent predictors of AKI and mortality.

Results

AKI occurred in 158 patients (42.8 %). Women had a higher crude incidence than men (48.4 % vs. 39.7 %, p = 0.045) and a trend toward more severe AKI (stage 3: 43.3 % vs. 30.6 %, p = 0.061). After adjustment, female sex was not an independent predictor of AKI (adjusted OR 1.36, 95 % CI 0.84–2.21; p = 0.217). Among patients with AKI, women showed higher in-hospital mortality (74.6 % vs. 55.3 %, p = 0.018), and female sex remained independently associated with mortality (adjusted OR 1.81, 95 % CI 1.01–3.28; p = 0.047). Rates of RRT did not differ by sex. Sensitivity analyses confirmed the robustness of these findings.

Conclusion

Women with infarct-related CS experienced a higher crude incidence and severity of AKI, although sex was not an independent predictor after adjustment. In contrast, female sex independently predicted mortality among patients with AKI. These results indicate sex-specific vulnerability of the cardiorenal axis and highlight the need for closer renal monitoring and tailored management strategies in women with CS.

背景：急性肾损伤（AKI）是梗死相关性心源性休克（CS）中一种常见且与预后相关的并发症。尽管越来越多的人认识到心血管结局的性别差异，但它们在CS中AKI发病率和预后中的作用仍不清楚。目的评估梗死相关性CS患者AKI发生率、严重程度和预后影响的性别差异。方法回顾性分析了2015年至2020年前瞻性登记的369例连续梗死相关CS患者。AKI采用KDIGO标准进行分类。基线特征、治疗暴露、肾脏替代治疗（RRT）和住院死亡率在女性和男性之间进行比较。多变量logistic回归确定了AKI和死亡率的独立预测因子。结果158例（42.8%）患者发生aki。女性的原始发生率高于男性（48.4%比39.7%,p = 0.045），并且有更严重AKI的趋势（3期：43.3%比30.6%,p = 0.061）。调整后，女性性别不是AKI的独立预测因子（调整后OR 1.36, 95% CI 0.84-2.21; p = 0.217）。在AKI患者中，女性显示出更高的住院死亡率（74.6%对55.3%,p = 0.018），女性仍然与死亡率独立相关（调整OR 1.81, 95% CI 1.01-3.28; p = 0.047）。RRT的比率没有性别差异。敏感性分析证实了这些发现的稳健性。结论：尽管性别不是调整后的独立预测因素，但梗死相关CS的女性AKI的粗发生率和严重程度更高。相反，女性性别独立预测AKI患者的死亡率。这些结果表明心肾轴的性别特异性易感性，并强调需要对CS女性进行更密切的肾脏监测和量身定制的管理策略。

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引用次数: 0

Comorbidity patterns of respiratory symptoms and diseases and their impact on all-cause and respiratory mortality: Prospective cohort study 呼吸道症状和疾病的共病模式及其对全因死亡率和呼吸道死亡率的影响：前瞻性队列研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-02 DOI: 10.1016/j.hrtlng.2025.102713

Fei Yu , Kunyi Wang , Shiqiang Wang

Background

Respiratory symptoms and diseases often co-occur and may increase mortality risk.

Objective

This study aims to identify patterns of respiratory multimorbidity and assess their links with mortality.

Methods

We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2011, linked to mortality records through 2019. Participants aged ≥40 years were classified using latent class analysis based on respiratory symptoms, diseases, and spirometry patterns. Cox models were used to estimate the relationship between respiratory clusters and all-cause and respiratory mortality.

Results

Five clusters were identified. Compared with the minimal-symptom group (Cluster 4), the severe obstructive cluster (Cluster 5) had the highest risk of all-cause mortality (HR=1.355, 95% CI: 1.040–1.767) and respiratory mortality (HR=12.956, 95% CI: 4.870–34.465). The chronic cough-phlegm cluster (Cluster 1) also showed elevated risks for all-cause (HR=1.297, 95% CI: 1.001–1.680) and respiratory mortality (HR=4.605, 95% CI: 1.468–14.441). The restrictive lung cluster (Cluster 3) was associated with higher all-cause mortality (HR=1.295, 95% CI: 1.055–1.589), especially among participants with cardiovascular disease (HR=2.013, 95% CI: 1.346–3.010). No significant associations were found for the asthma-wheezing cluster (Cluster 2) after full adjustment.

Conclusion

Individuals with severe airflow obstruction or chronic cough and phlegm have the highest risk of death. Restrictive lung patterns also predict higher mortality, particularly when combined with cardiovascular disease. Early identification and integrated care are crucial for respiratory multimorbidity.

背景：呼吸道症状和疾病经常同时发生，并可能增加死亡风险。目的本研究旨在确定呼吸系统多病的模式，并评估其与死亡率的关系。方法：我们使用2007-2011年国家健康与营养检查调查（NHANES）的数据进行了一项前瞻性队列研究，该数据与截至2019年的死亡率记录相关。年龄≥40岁的参与者根据呼吸道症状、疾病和肺活量测定模式进行潜在分类分析。Cox模型用于估计呼吸聚集与全因死亡率和呼吸死亡率之间的关系。结果共鉴定出5个聚类。与最小症状组（聚类4）相比，严重阻塞性聚类（聚类5）的全因死亡率（HR=1.355, 95% CI: 1.040 ~ 1.767）和呼吸系统死亡率（HR=12.956, 95% CI: 4.870 ~ 34.465）风险最高。慢性咳嗽-痰聚类（聚类1）的全因死亡率（HR=1.297, 95% CI: 1.001-1.680）和呼吸系统死亡率（HR=4.605, 95% CI: 1.468-14.441）均升高。限制性肺聚类（聚类3）与较高的全因死亡率相关（HR=1.295, 95% CI: 1.055-1.589），特别是患有心血管疾病的参与者（HR=2.013, 95% CI: 1.346-3.010）。完全调整后，哮喘-喘息集群（集群2）未发现显著关联。结论严重气流阻塞或慢性咳嗽、痰多者死亡风险最高。限制性肺模式也预示着更高的死亡率，特别是当合并心血管疾病时。早期识别和综合护理对呼吸道多重疾病至关重要。

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引用次数: 0