Heart & Lung最新文献_第5页

Age modifies the effect of dexmedetomidine on 28-day mortality in mechanically ventilated critically ill adults: A propensity score–weighted cohort study 年龄改变右美托咪定对机械通气危重成人28天死亡率的影响：一项倾向评分加权队列研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-31 DOI: 10.1016/j.hrtlng.2025.102698

Kangjoon Kim, Daegeun Lee, Eunhye Bae, Jin-Young Huh, So-Young Park, Jae Chol Choi

Background

Dexmedetomidine (DEX) is widely used for sedation in critically ill adults, but its association with mortality remains unclear. Prior trial data suggest that this association may differ by age.

Methods

We conducted a retrospective cohort study of mechanically ventilated adults admitted to the intensive care units (ICUs) of a university-affiliated hospital in South Korea between March 2022 and September 2023. Patients were grouped by DEX use during ICU stay. To reduce confounding, inverse probability of treatment weighting was applied using a propensity score model. The primary outcome was 28-day mortality; the secondary outcome was ICU length of stay among survivors. Outcomes were analyzed using weighted logistic regression. Subgroup analyses were stratified by age (<65 vs ≥65 years), and interaction terms were tested.

Results

Among 245 patients, 124 received DEX. In patients aged <65 years, DEX use was associated with lower 28-day mortality (odds ratio [OR], 0.27; 95% CI, 0.12–0.54; p < 0.001). No significant association was observed in those aged ≥65 years (OR, 0.72; 95% CI, 0.44–1.17; p = 0.182). An interaction between age group (<65 vs ≥65 years) and DEX use was significant (OR, 2.71; 95% CI, 1.13–6.72; p = 0.028). Among survivors aged ≥65 years, DEX use was associated with longer ICU stay (+5.36 days; 95% CI, 1.04–9.68; p = 0.017).

Conclusions

In this observational cohort, DEX use was associated with lower 28-day mortality among younger critically ill adults but not among older patients. These findings require confirmation in larger multicenter studies.

右美托咪定（DEX）被广泛用于危重成人的镇静，但其与死亡率的关系尚不清楚。先前的试验数据表明，这种关联可能因年龄而异。方法对2022年3月至2023年9月在韩国某大学附属医院重症监护病房（icu）入住的机械通气成人进行回顾性队列研究。根据患者在ICU期间使用DEX进行分组。为了减少混淆，使用倾向评分模型应用处理加权的逆概率。主要终点为28天死亡率；次要结局是幸存者在ICU的住院时间。结果分析采用加权逻辑回归。亚组分析按年龄（65岁vs≥65岁）分层，并检验相互作用项。结果245例患者中，124例接受了DEX治疗。在65岁的患者中，使用DEX与较低的28天死亡率相关（优势比[OR]， 0.27; 95% CI, 0.12-0.54; p < 0.001）。≥65岁患者无显著相关性（OR, 0.72; 95% CI, 0.44-1.17; p = 0.182）。年龄组（65岁vs≥65岁）和DEX使用之间的相互作用是显著的（OR, 2.71; 95% CI, 1.13-6.72; p = 0.028）。在年龄≥65岁的幸存者中，使用DEX与ICU住院时间延长相关（+5.36天；95% CI, 1.04-9.68; p = 0.017）。结论：在这个观察性队列中，在年轻危重患者中使用DEX与较低的28天死亡率相关，但与老年患者无关。这些发现需要在更大规模的多中心研究中得到证实。

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引用次数: 0

Comparison of the effects of reflexology and classical hand massage on pain, anxiety, and vital signs in patients after coronary angiography: A randomized controlled trial 反射疗法和经典手部按摩对冠状动脉造影后患者疼痛、焦虑和生命体征的影响比较：一项随机对照试验

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-31 DOI: 10.1016/j.hrtlng.2025.102707

Necibe Dagcan Sahin PhD, RN , Burcu Nal PhD, RN , Mehmet Ali Astarcioglu MD

Background

Pain and anxiety are common issues experienced by patients after coronary angiography, often negatively impacting recovery and causing changes in vital signs.

Objective

This study aimed to compare the effects of reflexology and classical hand massage on pain, anxiety, and vital signs in patients after coronary angiography.

Methods

It was designed as a single-blind randomized controlled trial with 70 patients who underwent coronary angiography in a hospital. Patients were randomly assigned into two groups via block randomization: reflexology hand massage (n = 35) and classical hand massage (n = 35). Data were collected using the Patient Information Form, State Anxiety Inventory, Visual Analog Scale, and Vital Signs Form. Both massages were applied to both hands for 20 min after angiography. Measurements were taken before the intervention and at 30, 60, and 120 min afterward.

Results

In the reflexology group, a significantly greater reduction was found in pain (effect size=0.926) and anxiety (effect size=0.680) compared to the classical massage group (p < .05). Systolic blood pressure decreased significantly in both groups (reflexology: 0.971; classical: 0.986), while diastolic pressure dropped significantly only in the reflexology group (effect size = -1.019). A significant reduction in pulse rate was also noted only in the reflexology group (effect size=0.985). No significant change was observed in respiratory rate; however, oxygen saturation increased significantly in the reflexology group (effect size=0.998).

Conclusions

Reflexology was more effective than classical hand massage in reducing pain, anxiety, and certain vital signs after coronary angiography.

背景：疼痛和焦虑是冠状动脉造影后患者常见的问题，通常会对恢复产生负面影响，并导致生命体征的变化。目的比较反射疗法和经典手部按摩对冠状动脉造影后患者疼痛、焦虑和生命体征的影响。方法对70例在某医院行冠状动脉造影的患者进行单盲随机对照试验。采用分组随机法将患者随机分为两组：反射按摩手部按摩组（n = 35）和经典手部按摩组（n = 35）。使用患者信息表、状态焦虑量表、视觉模拟量表和生命体征表收集数据。血管造影后双手按摩20分钟。测量分别在干预前、干预后30min、60min和120min进行。结果反射疗法组患者疼痛（效应值=0.926）和焦虑（效应值=0.680）均明显低于经典按摩组（p < 0.05）。两组患者收缩压均显著下降（反射疗法组：0.971；经典疗法组：0.986），而舒张压仅在反射疗法组显著下降（效应量= -1.019）。只有反射疗法组的脉搏率显著降低（效应值=0.985）。呼吸频率无明显变化；而足底按摩组血氧饱和度明显升高（效应值=0.998）。结论反射疗法在减轻冠状动脉造影后疼痛、焦虑和某些生命体征方面比经典的手部按摩更有效。

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引用次数: 0

Association between Type D personality and psychosocial adjustment in AMI patients: Mediating role of psychological flexibility and perceived stress 急性心肌梗死患者D型人格与心理社会适应的关系：心理灵活性和感知压力的中介作用

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-31 DOI: 10.1016/j.hrtlng.2025.102705

Xin-yi Zhou MS, RN , Yan-feng Wang MS, RN , Yue-xin Huang BS, RN, Xiao-ge Liu BS, RN, Jia-hui Liu BS, RN, Zi-han Li BS, RN, Qiao-hong Yang PhD, RN

Background

Acute Myocardial Infarction (AMI) patients are experiencing an increasing incidence rate annually, coupled with substantial psychosocial adjustment challenges.

Objectives

The aim of this study was to analyze the longitudinal sequential mediating role of psychological flexibility and perceived stress between Type D personality and psychosocial adjustment in patients.

Methods

This study is a half-longitudinal panel design with a three-wave tracking survey. 212 young and middle-aged patients with first-time AMI from a Guangzhou hospital were conveniently sampled and followed at three time points: hospitalization (T1), 3 months (T2), and 6 months post-discharge (T3). Participants completed measures on Type D personality (DS-14), psychological flexibility (AAQ-II), perceived stress (PSS), and psychosocial adjustment (PAIS-SR). The data were used to construct a cross-lagged panel and a half-longitudinal sequential mediation model.

Results

30.66% of young and middle-aged patients with AMI exhibited Type D personality. These patients had clinically meaningfully poorer psychosocial adjustment at 6 months post-discharge (28.82±14.53) than non-Type D patients (22.76±11.73). At T1, Type D personality affected psychosocial adjustment at T3 through two serial mediation pathways: one through T2 psychological flexibility to T3 perceived stress (effect size = 0.051, accounting for 8.97% of the total effect) and another through T2 perceived stress to T3 psychological flexibility (effect size = 0.034, accounting for 5.27% of the total effect). Interventions targeting psychological flexibility and stress management may be of crucial importance for this group.

Conclusion

Among young and middle-aged AMI patients, the proportion of Type D personality is relatively high, and their psychosocial adjustment level is poorer.

背景：急性心肌梗死（AMI）患者的发病率每年都在增加，伴随着大量的心理社会适应挑战。目的分析心理弹性和应激感知在D型人格与心理社会适应之间的纵向序贯中介作用。方法本研究采用半纵向面板设计，采用三波跟踪调查。选取广州市某医院212例首次AMI的中青年患者，分别在住院（T1）、出院后3个月（T2）和出院后6个月（T3）三个时间点进行随访。参与者完成了D型人格（DS-14）、心理灵活性（AAQ-II）、感知压力（PSS）和心理社会适应（PAIS-SR）的测试。结果30.66%的中青年AMI患者表现为D型人格。这些患者出院后6个月的心理社会适应水平（28.82±14.53）明显低于非D型患者（22.76±11.73）。在T1时，D型人格通过2条连续的中介通路影响T3时的心理社会适应，即T2时心理灵活性对T3时感知压力的中介通路（效应量= 0.051，占总效应量的8.97%）和T2时感知压力对T3时心理灵活性的中介通路（效应量= 0.034，占总效应量的5.27%）。针对心理灵活性和压力管理的干预措施可能对这一群体至关重要。结论中青年AMI患者中D型人格比例较高，心理社会适应水平较差。

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引用次数: 0

Early vasoactive–inotropic score kinetics predict low cardiac output syndrome and acute kidney injury after infant cardiac surgery: a retrospective cohort study 早期血管活性-肌力评分动力学预测婴儿心脏手术后低心输出量综合征和急性肾损伤：一项回顾性队列研究。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-30 DOI: 10.1016/j.hrtlng.2025.102694

Abdullah Al-Murad , Ibtesam Hilmi

Background

Infants recovering from congenital heart surgery risk complications such as low cardiac output syndrome (LCOS) and acute kidney injury (AKI). Although clinicians use the vasoactive–inotropic score (VIS) to assess cardiovascular support, relying only on the peak value (VIS-max) may overlook meaningful changes in vasoactive requirements during early recovery.

Objective

This study evaluated whether early VIS kinetics—captured through the area under the curve (VIS-AUC₀–₁₂h) and the rate of change (VIS-slope₀–₁₂h)—offer better prediction of LCOS and AKI compared with VIS-max.

Methods

We retrospectively reviewed 320 infants under 24 months undergoing congenital heart surgery with cardiopulmonary bypass. Vasoactive doses from the first 12 postoperative hours were used to calculate VIS-max, VIS-AUC, and VIS-slope. LCOS and AKI were defined using standardized criteria. Predictive performance was evaluated with multivariable logistic regression and cross-validated AUCs.

Results

Among 320 infants, 31.6% developed LCOS and 10.3% developed AKI. Infants with LCOS showed higher VIS-max, greater VIS-AUC₀–₁₂h, and steeper VIS-slope trajectories than those without LCOS. VIS kinetics provided modest but consistent improvement in LCOS prediction over VIS-max (AUC 0.760 vs 0.746), and decision-curve analysis indicated additional net clinical benefit. In contrast, VIS metrics showed limited discrimination for AKI.

Conclusions

Monitoring VIS trends during early postoperative hours offers a broader assessment of circulatory stress than relying solely on VIS-max. Early VIS kinetics may help identify infants at higher risk of LCOS and support closer hemodynamic surveillance, while their limited value for AKI suggests a need for additional renal risk markers.

背景：先天性心脏手术后恢复的婴儿有低心输出量综合征（LCOS）和急性肾损伤（AKI）等并发症的风险。尽管临床医生使用血管活性-肌力评分（VIS）来评估心血管支持，但仅依靠峰值（VIS-max）可能会忽略早期恢复期间血管活性需求的有意义的变化。目的：本研究评估早期VIS动力学-通过曲线下面积（VIS- auc 0 -₁₂h）和变化率（VIS-斜率0 -₁₂h）捕获-是否比VIS-max更好地预测LCOS和AKI。方法：对320例24个月以下接受先天性心脏手术合并体外循环的婴儿进行回顾性分析。术后前12小时的血管活性剂量用于计算VIS-max、VIS-AUC和VIS-slope。LCOS和AKI采用标准化标准定义。采用多变量逻辑回归和交叉验证auc对预测性能进行评估。结果：320例患儿中，LCOS发生率为31.6%，AKI发生率为10.3%。与无LCOS的婴儿相比，LCOS婴儿的VIS-max、VIS-AUC 0 -₁₂h更大，vis斜率轨迹更陡。VIS动力学相对于VIS-max （AUC 0.760 vs 0.746）提供了适度但一致的LCOS预测改善，决策曲线分析显示了额外的净临床获益。相比之下，VIS指标显示AKI的歧视有限。结论：术后早期监测VIS趋势比单纯依赖VIS-max提供了更广泛的循环应激评估。早期VIS动力学可能有助于识别LCOS风险较高的婴儿，并支持更密切的血流动力学监测，但其对AKI的有限价值表明需要额外的肾脏风险标志物。

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引用次数: 0

Development of a long-term survival prediction model for patients undergoing invasive coronary angiography using ensemble-based machine learning in time-to-event analysis 在时间-事件分析中使用基于集合的机器学习，为接受侵入性冠状动脉造影的患者开发长期生存预测模型。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-30 DOI: 10.1016/j.hrtlng.2025.102697

Hong-Jae Choi , Hyeryn Park , Dongjoon Lee , Changhee Lee , Hack-Lyoung Kim

Background

Prognosis prediction for high-risk patients undergoing invasive coronary angiography (ICA) is crucial for clinical decision-making. Despite machine learning (ML) advancements, time-to-event survival prediction remains limited.

Objectives

This study developed an ensemble ML model based on survival analysis to predict long-term outcomes in ICA patients.

Methods

A total of 9517 ICA patients (2008–2020) were retrospectively analyzed. The primary outcome was all-cause mortality, with follow-up until December 31, 2021. Using 8 ML algorithms, we developed a model comprising 80 variables. Model performance was assessed using time-dependent C-index and Brier score, with variable importance analyzed using permutation-based and partial dependent plots.

Results

Survival Quilts model achieved the highest time-dependent C-index (0.920 at 30 days, 0.897 at 365 days), outperforming other ML algorithms. Time-dependent Brier scores generally increased, which remained stable. ICA-related characteristics had the greatest impact on mortality, while laboratory results, comorbidities, and patient characteristics gained influence over time. By day 365, patient characteristics and laboratory results became more prominent predictors. Among the domains, key variables included catheterization status, C-reactive protein, smoking, and chronic kidney disease.

Conclusion

Survival analysis-based ensemble ML models, such as Survival Quilts, improve survival prediction by capturing time-varying influences of key predictors, offering a foundation for more precise cardiovascular care.

背景：高危患者行有创冠状动脉造影（ICA）的预后预测对临床决策至关重要。尽管机器学习（ML）取得了进步，但时间到事件的生存预测仍然有限。目的：本研究建立了一个基于生存分析的集成ML模型来预测ICA患者的长期预后。方法：对2008-2020年9517例ICA患者进行回顾性分析。主要结局为全因死亡率，随访至2021年12月31日。使用8ml算法，我们开发了一个包含80个变量的模型。使用时间依赖的c指数和Brier评分评估模型性能，使用基于排列和部分依赖的图分析变量重要性。结果：Survival Quilts模型获得了最高的时间依赖c指数（30天0.920,365天0.897），优于其他ML算法。随时间变化的Brier评分普遍增加，并保持稳定。ica相关特征对死亡率的影响最大，而实验室结果、合并症和患者特征的影响随着时间的推移而增加。到第365天，患者特征和实验室结果成为更重要的预测因素。在这些域中，关键变量包括导管状态、c反应蛋白、吸烟和慢性肾脏疾病。结论：基于生存分析的集成ML模型，如Survival Quilts，通过捕获关键预测因子的时变影响，提高了生存预测，为更精确的心血管护理奠定了基础。

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引用次数: 0

Impact of vasopressin initiation at norepinephrine dose thresholds in septic shock patients with high SOFA scores: A retrospective observational cohort study 去甲肾上腺素剂量阈值对SOFA评分高的脓毒性休克患者抗利尿激素启动的影响：一项回顾性观察队列研究。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-30 DOI: 10.1016/j.hrtlng.2025.102696

Jennifer Cortes , Kayla Cann , Gabriel Patarroyo - Aponte , Brandy McKelvy , Sophie Samuel

Background

Norepinephrine is the first-line vasopressor in septic shock, with vasopressin commonly added as a second-line agent. However, the optimal norepinephrine dose threshold for initiating vasopressin remains uncertain.

Objectives

To evaluate whether initiating vasopressin at lower norepinephrine doses (<20 µg/min) is associated with improved clinical outcomes compared with initiation at higher doses (≥20 µg/min) in adults with septic shock.

Methods

This retrospective observational cohort study included adult patients with septic shock who received norepinephrine followed by vasopressin at a tertiary academic center between 2017 and 2022. Patients were stratified by norepinephrine dose at vasopressin initiation: <20 µg/min (Low-dose) versus ≥20 µg/min (High-dose). The primary outcome was in-hospital mortality. Inverse probability of treatment weighting and Cox proportional hazards modeling were used for adjustment.

Results

Of 570 included patients, 343 received vasopressin at Low-dose norepinephrine and 227 at High-dose. Crude mortality was higher in the High-Dose group (64.3% vs 54.2%), with a relative risk of 0.84 (95% CI, 0.74–0.97; p = 0.017). After adjustment, vasopressin initiation at higher norepinephrine doses remained independently associated with increased mortality (HR 1.54; 95% CI, 1.23–1.93; p = 0.0002). Kaplan–Meier and Aalen–Johansen competing-risk analyses also demonstrated lower survival and higher cumulative incidence of in-hospital death in the High-dose group.

Conclusions

Initiating vasopressin at higher norepinephrine dose thresholds was associated with increased mortality, suggesting potential benefit from earlier vasopressin use. Residual confounding due to greater illness severity cannot be excluded.

背景：去甲肾上腺素是脓毒性休克的一线抗利尿激素，抗利尿激素通常作为二线药物。然而，启动抗利尿激素的最佳去甲肾上腺素剂量阈值仍然不确定。目的：评估在较低的去甲肾上腺素剂量下是否启动抗利尿激素(方法：这项回顾性观察队列研究纳入了2017年至2022年在三级学术中心接受去甲肾上腺素和抗利尿激素治疗的感染性休克成年患者。结果：在570例纳入的患者中，343例接受低剂量去甲肾上腺素治疗，227例接受高剂量去甲肾上腺素治疗。高剂量组粗死亡率更高（64.3% vs 54.2%），相对危险度为0.84 （95% CI, 0.74-0.97; p = 0.017）。调整后，高去甲肾上腺素剂量的抗利尿激素起始与死亡率增加独立相关（HR 1.54; 95% CI, 1.23-1.93; p = 0.0002）。Kaplan-Meier和aallen - johansen竞争风险分析也表明，高剂量组的生存率较低，住院死亡的累积发生率较高。结论：在更高的去甲肾上腺素剂量阈值下启动抗利尿激素与死亡率增加相关，提示早期使用抗利尿激素可能有益。不能排除由于更严重的疾病引起的残留混杂。

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引用次数: 0

Mechanical ventilation patterns and outcomes in patients with right ventricular (RV) dysfunction: A cohort study 右心室功能障碍患者的机械通气模式和预后：一项队列研究。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-28 DOI: 10.1016/j.hrtlng.2025.102700

Elizabeth Joyce , Vincent D. Marshall , Aaron Lopacinski , Steven King , Gagan Gupta , Sarah K. Adie , Anna K. Barker , Matthew C. Konerman , Scott W. Ketcham

Background

Lung-protective ventilation (LPV), defined as tidal volume (TV) <8ml/kg ideal body weight and plateau pressure (Pplat) <30cmH2O, improves mortality in many populations. Although little data exists for IMV management of patients with RV failure, the American College of Cardiology (ACC) Critical Care Working Group recommends LPV and low (<3–5cmH2O) starting positive end-expiratory pressure (PEEP) in right ventricular (RV) failure.

Objectives

Describe IMV patterns in cardiac ICU patients with RV dysfunction and compare to ACC Critical Care Working Group recommendations. Secondary was to evaluate LPV impact on two-year survival.

Methods

This is a single-center, retrospective study. We included patients intubated >24 h in the cardiac ICU between 2017–2022 with RV dysfunction prior to intubation, identified by echocardiography. Patients were excluded if they did not have at least one fraction of inspired oxygen ≥50 %. We collected median PEEP in initial 24 h and twice daily measurements (6am/6pm) for IMV duration or 28 days.

Results

There were 192 patients, with 4010 TVs and 2628 Pplats. When both TV and Pplat were available (2594), 2014/2594 (77.6 %) qualified as LPV. LPV was associated with decreased two-year mortality (HR 0.2, p < 0.001). Less than half (59/139, 42.4 %) had starting PEEP of ≤5cmH2O, which was not associated with two-year survival.

Conclusions

As compared to ACC Critical Care Working group guidelines, most patients with RV dysfunction at our institution were ventilated using LPV but not low starting PEEP. LPV was associated with increased two-year survival and low starting PEEP was not associated in a positive or negative way.

背景：肺保护性通气（LPV），定义为潮气量（TV）目的：描述心脏ICU右室功能障碍患者的IMV模式，并与ACC重症监护工作组的建议进行比较。其次是评估LPV对两年生存率的影响。方法：这是一项单中心回顾性研究。我们纳入了2017-2022年期间在心脏ICU插管bbbb24小时的患者，插管前RV功能障碍，经超声心动图识别。如果患者吸入氧至少有一个分数不≥50%，则排除。在IMV持续时间或28天内，我们在最初24小时和每天两次（上午6点/下午6点）测量中位PEEP。结果：192例患者，TVs 4010例，plats 2628例。当TV和Pplat同时可用时（2594），2014/2594（77.6%）符合LPV。LPV与两年死亡率降低相关（HR 0.2, p < 0.001）。不到一半（59/139,42.4%）患者的起始PEEP≤5cmH2O，与两年生存率无关。结论：与ACC重症监护工作组指南相比，我院大多数RV功能障碍患者使用LPV通气，而不是低起始PEEP。LPV与两年生存率增加相关，而低起始PEEP无正相关或负相关。

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引用次数: 0

Diaphragmatic ultrasound in guiding weaning from invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease 膈超声指导慢性阻塞性肺疾病急性加重期有创机械通气患者脱机

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-26 DOI: 10.1016/j.hrtlng.2025.102692

Shunnan Sun , Liuhua Pan , Xiaofang Wang , Jing Zhao

Background

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) often necessitates invasive mechanical ventilation (IMV), and timely weaning is critical to improving patient outcomes. However, reliable predictors of weaning success in this population remain unclear.

Objectives

To assess the predictive value of diaphragmatic function indicators for successful weaning from IMV in AECOPD patients.

Methods

This single-center, prospective observational study enrolled 120 AECOPD patients admitted to the intensive care unit (ICU) who received IMV. Based on weaning outcomes, patients were categorized into successful weaning (n = 84) and failed weaning (n = 36) groups. Clinical data, including baseline characteristics, diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), rapid shallow breathing index (RSBI), and arterial blood gas parameters, were collected. Independent predictors of successful weaning were identified using logistic regression analysis. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of these parameters. Correlation between DTF and RSBI was also analyzed.

Results

Compared with the failed group, patients in the successful weaning group demonstrated significantly higher DE and DTF, and lower RSBI values (all P < 0.05). Logistic regression revealed that DE, DTF, and RSBI were independent predictors of successful weaning. ROC analysis showed that the combined model of DE, DTF, and RSBI yielded an area under the curve (AUC) of 0.961, with 88.89% sensitivity and 92.86% specificity. Additionally, the failed group experienced longer mechanical ventilation duration, prolonged ICU stay, and higher complication rates.

Conclusion

DTF, DE, and RSBI are reliable predictors of successful IMV weaning in AECOPD patients. Early assessment of diaphragmatic function may enhance clinical decision-making in ventilator liberation.

慢性阻塞性肺疾病（AECOPD）急性加重往往需要有创机械通气（IMV），及时脱机对改善患者预后至关重要。然而，这一人群断奶成功的可靠预测因素仍不清楚。目的探讨膈功能指标对AECOPD患者成功脱机的预测价值。方法本研究为单中心前瞻性观察性研究，纳入120例重症监护病房（ICU）接受IMV治疗的AECOPD患者。根据断奶结果，将患者分为断奶成功组（n = 84）和断奶失败组（n = 36）。收集临床数据，包括基线特征、膈增厚分数（DTF）、膈偏移（DE）、快速浅呼吸指数（RSBI）和动脉血气参数。使用逻辑回归分析确定成功断奶的独立预测因素。采用受试者工作特征（ROC）曲线评价这些参数的预测效果。分析了DTF与RSBI的相关性。结果与失败组比较，成功断奶组患者DE、DTF显著升高，RSBI值显著降低（P < 0.05）。Logistic回归显示DE、DTF和RSBI是断奶成功的独立预测因子。ROC分析显示，DE、DTF和RSBI联合模型的曲线下面积（AUC）为0.961，敏感性为88.89%，特异性为92.86%。此外，失败组机械通气时间更长，ICU住院时间更长，并发症发生率更高。结论dtf、DE和RSBI是预测AECOPD患者IMV成功脱机的可靠指标。早期评估膈肌功能可提高呼吸机解除的临床决策。

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引用次数: 0

Patient-reported substance use in heart failure 心力衰竭患者报告的药物使用情况

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-26 DOI: 10.1016/j.hrtlng.2025.102695

Kenneth E. Freedland , Brian C. Steinmeyer , Judith A. Skala , Robert M. Carney , Michael W. Rich

Background

Substance use comorbidities complicate the care of patients with heart failure (HF). Most of the previous research on this problem has been based on analyses of epidemiological datasets or electronic health records. The aim of this study was to conduct in-depth clinical interviews to document the prevalence of patient-reported substance use comorbidities and polysubstance use in patients with HF.

Methods

Patients with HF were enrolled in the study within 30 days after hospital discharge and interviewed within two weeks after enrollment. The NetSCID-5 interview was administered to evaluate substance use disorders and other psychiatric comorbidities. The Social Determinants of Health Patient Interview Form was administered to document patient-reported social determinants of health. Questionnaires were administered to measure perceived stress and health-related quality of life.

Results

The sample included 362 patients with HF. The participants were 61.3 ± 12.0 years of age at enrollment; 155 (42.8 %) were female and 208 (57.5 %) were racial minorities. Alcohol (26 %), stimulant (10 %), and cannabis (6 %) use disorders were prevalent, and approximately 9 % of the patients had a history of polysubstance use. These disorders were associated with cigarette smoking, chronic obstructive pulmonary disease, high levels of exposure to adverse social determinants of health, and poor health-related quality of life.

Conclusions

Substance use disorders are common comorbidities in patients with heart failure. Research on the prevention and treatment of these comorbidities is needed.

药物使用合并症使心力衰竭（HF）患者的护理复杂化。以前对这一问题的大多数研究都是基于对流行病学数据集或电子健康记录的分析。本研究的目的是进行深入的临床访谈，以记录心衰患者报告的物质使用合并症和多物质使用的患病率。方法HF患者出院后30天内入组，入组后2周内随访。NetSCID-5访谈用于评估物质使用障碍和其他精神合并症。健康的社会决定因素患者访谈表用于记录患者报告的健康的社会决定因素。通过问卷调查来测量感知压力和健康相关的生活质量。结果共纳入362例心衰患者。受试者入组时年龄为61.3±12.0岁；女性155人（42.8%），少数民族208人（57.5%）。酒精（26%）、兴奋剂（10%）和大麻（6%）使用障碍普遍存在，约9%的患者有多种物质使用史。这些疾病与吸烟、慢性阻塞性肺病、高度暴露于不利于健康的社会决定因素以及与健康相关的生活质量差有关。结论物质使用障碍是心力衰竭患者常见的合并症。需要对这些合并症的预防和治疗进行研究。

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引用次数: 0

Non-rheumatic calcific aortic valve disease as a global driver of heart failure: Burden and three-decade trends 非风湿性钙化主动脉瓣疾病是心力衰竭的全球驱动因素：负担和三十年趋势

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-24 DOI: 10.1016/j.hrtlng.2025.102690

Lin Zhu , Yanqing Gong , Zijie An , Liumei Mo , Jian Rong , Zhenhao Liu

Background

Global aging and lifestyle shifts raise cardiovascular disease burden, but the specific contribution of non-rheumatic calcific aortic valve disease (nrCAVD) to heart failure (HF) in older adults is incompletely defined.

Objectives

To quantify global trends, drivers, inequalities, and future projections of HF attributable to nrCAVD among persons aged ≥60 and to assess causality.

Methods

Using GBD 2021 estimates (1990–2021) for prevalence, Years Lived with Disability(YLDs), and age-standardized rates across 204 countries, we applied decomposition analysis, Social Inequality Index (SII), and Bayesian age-period-cohort forecasting to 2040. Two-sample Mendelian randomization (FinnGen GWAS) evaluated causality.

Results

In 2021 an estimated 1.38 million persons aged ≥60 had HF due to nrCAVD with 123,907 YLDs—cases rose 123 % since 1990 though age-standardized prevalence fell ∼16.7 %. Male burden was ∼1.5 × female. High-SDI regions had the highest rates but burdens are rising in middle/low-SDI areas. Decomposition attributed increases to population growth (+100.9 %) and aging (+20.0 %), partially offset by epidemiological improvement (−20.9 %). Cross-country inequality declined. Forecasts project ∼79 % increases in cases and YLDs by 2040. Mendelian randomization supported a causal effect of nrCAVD on HF.

Conclusions

These findings demonstrate that heart failure due to non-rheumatic calcific aortic valve disease represents a growing global health burden in aging populations, particularly in lower-SDI settings. Targeted preventive measures, early screening, and equitable access to effective interventions are urgently needed to mitigate this trend.

背景：全球老龄化和生活方式的改变增加了心血管疾病负担，但非风湿性钙化主动脉瓣疾病（nrCAVD）对老年人心力衰竭（HF）的具体影响尚未完全确定。目的：量化60岁以上人群中nrCAVD导致HF的全球趋势、驱动因素、不平等和未来预测，并评估因果关系。方法：使用GBD 2021（1990-2021）估计的204个国家的患病率、残疾生活年数（YLDs）和年龄标准化率，我们应用分解分析、社会不平等指数（SII）和贝叶斯年龄-时期-队列预测到2040年。双样本孟德尔随机化（FinnGen GWAS）评估因果关系。结果：2021年，估计有138万≥60岁的人因nrCAVD而发生HF，其中123,907例ylds病例自1990年以来增加了123%，尽管年龄标准化患病率下降了~ 16.7%。男性负担是女性的1.5倍。高sdi地区的比率最高，但中/低sdi地区的负担正在上升。分解归因于人口增长（+ 100.9%）和老龄化（+ 20.0%），部分被流行病学改善（- 20.9%）所抵消。国家间的不平等有所下降。预测显示，到2040年，病例数和死亡总人数将增加79%。孟德尔随机化支持nrCAVD对HF的因果效应。结论：这些研究结果表明，非风湿性钙化主动脉瓣疾病引起的心力衰竭代表了老龄化人群日益增长的全球健康负担，特别是在低sdi环境中。为缓解这一趋势，迫切需要采取有针对性的预防措施、早期筛查和公平获得有效干预措施。

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引用次数: 0