Heart & Lung最新文献_第5页

Navigating uncertainty and vulnerability: Cardiac nurses' perspectives on providing palliative care for patients with late-stage heart failure 导航不确定性和脆弱性：心脏护士对晚期心力衰竭患者提供姑息治疗的看法

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-06 DOI: 10.1016/j.hrtlng.2025.102686

Maiken Jørgensen RN, MSc , Britt Borregaard RN, MPQM, PhD , Tiny Jaarsma RN, MScN, PhD , Ida Elisabeth Højskov RN, MScN, PhD , Malene Kaas Larsen RN, MScN, PhD

Background

Patients with heart failure often experience debilitating symptoms, including dyspnea, fatigue, and anxiety, symptoms that influence quality of life. Cardiac nurses play an essential role in palliative care for patients with heart failure by providing comprehensive disease management, self-care support, patient education, symptom monitoring, medication management, and psychosocial support. Evidence on cardiac nurses' perspectives on palliative care remains limited.

Objective

This study examines the experiences of cardiac nurses in providing palliative care to patients with heart failure in the late palliative phase.

Methods

A qualitative approach based on a phenomenological-hermeneutical methodology was used. Four focus group interviews were conducted with 18 cardiac nurses. The analysis was based on Kirsti Malterud's theory of systematic text condensation.

Results

The cardiac nurses regarded palliative care as a complex and demanding field, which made it challenging to define their care for patients with heart failure. The analysis identified three themes: 1) Identifying the level of treatment, 2) Finding room for the palliative care, acknowledging the patients’ wishes, and 3) Organisation and support in palliative cardiac care.

Conclusion

Cardiac nurses perceive palliative care for patients with heart failure as both challenging and frequently overlooked within cardiac care settings. The nurses often struggle to integrate and appropriately frame palliative care while respecting patients’ wishes, which contributes to feelings of uncertainty and vulnerability. They highlight the critical need for systematic interdisciplinary collaboration to effectively support patients and their families throughout the palliative care process.

心衰患者通常会出现衰弱症状，包括呼吸困难、疲劳和焦虑，这些症状会影响生活质量。心脏护士通过提供全面的疾病管理、自我保健支持、患者教育、症状监测、药物管理和心理社会支持，在心力衰竭患者的姑息治疗中发挥着重要作用。关于心脏护士对姑息治疗的看法的证据仍然有限。目的探讨心内科护士对晚期心衰患者提供姑息治疗的经验。方法采用基于现象学-解释学方法论的定性方法。对18名心内科护士进行了4次焦点小组访谈。分析的基础是马尔特鲁德的系统文本凝聚理论。结果心脏科护士认为姑息治疗是一个复杂且要求高的领域，这给心衰患者的护理定义带来了挑战。分析确定了三个主题：1)确定治疗水平，2)为姑息治疗寻找空间，承认患者的意愿，以及3)组织和支持姑息性心脏护理。结论：心脏科护士认为对心衰患者进行姑息治疗既具有挑战性，又经常被忽视。护士在尊重患者意愿的同时，往往难以整合和适当地构建姑息治疗，这导致了不确定感和脆弱感。他们强调了系统的跨学科合作的迫切需要，以便在整个姑息治疗过程中有效地支持患者及其家属。

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引用次数: 0

Effects of respiratory muscle training in patients with interstitial lung diseases: Systematic review 呼吸肌肉训练对间质性肺疾病患者的影响：系统综述

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-05 DOI: 10.1016/j.hrtlng.2025.11.023

Bilge Gore PT, MSc, Aynur Demirel PhD

Background

Inspiratory muscle training (IMT) is a component of the pulmonary rehabilitation(PR) program for patients with chronic lung disease.

Objectives

This systematic review aimed to determine the effects of IMT on respiratory muscle strength, functional exercise capacity, dyspnea, quality of life (QoL), lung functions, and diffusion capacity (DLCO) in patients with Interstitial Lung Disease (ILD).

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications from inception to 2025 were searched using MeSH terms across six databases. The titles and abstracts of the studies were screened via Rayyan-AI software by two independent authors. After full-text screening, randomized controlled trials that met the inclusion criteria were included.

Results

According to mesh terms, 9020 articles were identified at baseline. After the screening, duplicate articles removed, and three randomized controlled trials were included. Finally, A total of 109 patients with ILD were included.Although only 3 studies were included in this systematic review, the evidence level for IMT on functional exercise capacity, dyspnea and inspiratory muscle strength was strong and no effect on lung functions and DLCO in patients with ILD. Additionally, there is conflicting evidence regarding the improvement in QoL, with limited evidence of the progress in expiratory muscle strength.

Conclusion

Considering the small number of articles included in this systematic review, IMT programs lasting ≥6 weeks appear beneficial and safe for improving respiratory muscle strength, dyspnea, and functional exercise capacity. However, more rigorous studies are needed to confirm these benefits.

背景：呼吸肌训练（IMT）是慢性肺病患者肺康复（PR）计划的一个组成部分。目的：本系统综述旨在确定IMT对间质性肺疾病（ILD）患者的呼吸肌力量、功能性运动能力、呼吸困难、生活质量（QoL）、肺功能和弥散能力（DLCO）的影响。方法本系统评价遵循系统评价和荟萃分析首选报告项目（PRISMA）指南。从成立到2025年的出版物使用MeSH术语在六个数据库中进行检索。研究的标题和摘要由两位独立作者通过Rayyan-AI软件筛选。全文筛选后，纳入符合纳入标准的随机对照试验。结果基线时共识别出9020篇文献。筛选后，删除重复的文章，并纳入三个随机对照试验。最后，共纳入109例ILD患者。虽然本系统综述只纳入了3项研究，但IMT对ILD患者的功能性运动能力、呼吸困难和吸气肌力量的影响证据水平很强，对肺功能和DLCO没有影响。此外，关于生活质量的改善存在矛盾的证据，有限的证据表明呼气肌力量的进步。考虑到本系统综述中纳入的文章数量较少，持续≥6周的IMT计划对改善呼吸肌力量、呼吸困难和功能性运动能力是有益和安全的。然而，需要更严格的研究来证实这些好处。

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引用次数: 0

Identifying the self-management strategies of people with chronic obstructive pulmonary disease in their daily lives: A qualitative survey 确定慢性阻塞性肺疾病患者在日常生活中的自我管理策略：一项定性调查

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-12-03 DOI: 10.1016/j.hrtlng.2025.11.022

Eline te Braake , Christiane Grünloh , Monique Tabak

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is an incurable chronic disease, and self-management is often used to support patients. Current research often targets clinical aspects, while actual self-management is performed by the patient at home. However, little is known about the patient experience.

Objectives

This research identifies which self-management strategies people with COPD apply and what the facilitators and barriers are to adopting these. Specific attention is given to the recruitment approach, aiming to increase response rates and the generalizability of the self-management model.

Methods

A self-management survey developed for people with rheumatic and musculoskeletal diseases (RMDs) was adapted for COPD, pilot-tested, and disseminated via traditional (e.g., via email) and enhanced (e.g., offline support) recruitment routes. Anonymized responses were deductively coded, using the self-management model for RMDs and the model of positive health.

Results

From 33 respondents, 152 self-management strategies were identified. All strategies could be categorised using the self-management model. ‘Physical activity’ was the most common category. Motivations to start a strategy are mostly derived from the ‘bodily functioning dimension’. Participants reported 122 facilitators and 41 barriers, such as ‘time’ and ‘support’. Passive approaches, in which participants themselves have to sign up, to improve response rates, were not substantial.

Conclusion

People with COPD perform diverse self-management strategies. These efforts may not always be visible in the clinical setting, as these are often initiated by one’s search journey and thus are additional to standard Healthcare Professionals´ (HCP) advice. Future research should investigate alternative approaches to reach the wider COPD population.

慢性阻塞性肺疾病（COPD）是一种无法治愈的慢性疾病，自我管理经常被用来支持患者。目前的研究往往针对临床方面，而实际的自我管理是由患者在家中进行的。然而，人们对患者的体验知之甚少。目的：本研究确定慢性阻塞性肺病患者采用的自我管理策略，以及采用这些策略的促进因素和障碍。特别关注招聘方法，旨在提高响应率和自我管理模式的普遍性。方法：针对风湿病和肌肉骨骼疾病（RMDs）患者开发的自我管理调查适用于COPD，进行了试点测试，并通过传统（例如通过电子邮件）和增强（例如离线支持）招募途径进行传播。使用rmd自我管理模型和积极健康模型对匿名回答进行演绎编码。结果：从33名受访者中，确定了152种自我管理策略。所有策略都可以使用自我管理模型进行分类。“身体活动”是最常见的类别。开始一项策略的动机大多来自“身体功能维度”。参与者报告了122个促进者和41个障碍，比如“时间”和“支持”。被动的方法，即参与者自己注册，以提高回复率，并不重要。结论：COPD患者的自我管理策略多种多样。这些努力在临床环境中可能并不总是可见的，因为这些通常是在一个人的搜索过程中开始的，因此是标准医疗保健专业人员（HCP）建议的附加内容。未来的研究应该探索其他方法来覆盖更广泛的COPD人群。

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引用次数: 0

Effects of chest wall loading in supine position on respiratory mechanics in low-compliance ARDS patients 仰卧位胸壁负荷对低顺应性ARDS患者呼吸力学的影响

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-30 DOI: 10.1016/j.hrtlng.2025.11.006

Wenwen Yan , Li Peng , Jian Zhang , Zheng Liu , Heling Zhao

Background

Acute respiratory distress syndrome (ARDS) remains a life-threatening condition in critically ill patients. Chest wall loading has been proposed as a potential intervention to improve respiratory mechanics in specific ARDS phenotypes, but evidence from large cohorts is lacking.

Objectives

This study aimed to investigate the effects of acute chest wall loading on respiratory mechanics in patients with low-compliance ARDS.

Methods

A prospective study included 76 patients with severe pneumonia-induced ARDS (PaO2/FiO2 ≤150, Crs ≤35 mL/cmH2O). A 5 kg sandbag was applied to the anterior chest wall in the supine position. Respiratory mechanics (respiratory system compliance-Crs, plateau pressure-Pplat, driving pressure-DP, intrinsic and total PEEP), hemodynamic parameters (heart rate-HR, mean arterial pressure-MAP), and oxygenation index (PaO2/FiO2) were measured before and 30 min after loading. Ventilator settings remained unchanged.

Results

Chest wall loading significantly improved respiratory system compliance (median increase 4.8 mL/cmH2O, P < 0.001) and reduced both plateau pressure (median decrease 2.1 cmH2O, P < 0.001) and driving pressure (median decrease 2.3 cmH2O, P < 0.001). No significant changes occurred in HR, MAP, or PaO2/FiO2. Improvements were more pronounced in patients with lower baseline compliance (Spearman's ρ = -0.420, P < 0.001).

Conclusion

Acute chest wall loading with a 5 kg sandbag significantly improves respiratory mechanics in low-compliance ARDS patients by enhancing compliance and reducing plateau and driving pressures, without compromising hemodynamics or oxygenation. This simple intervention may serve as a useful adjunct to lung-protective ventilation in this subset of patients.

背景急性呼吸窘迫综合征（ARDS）在危重患者中仍然是危及生命的疾病。胸壁负荷被认为是一种潜在的干预措施，可以改善特定ARDS表型的呼吸力学，但缺乏大型队列的证据。目的探讨急性胸壁负荷对低顺应性ARDS患者呼吸力学的影响。方法对76例急性肺炎性ARDS （PaO2/FiO2≤150,Crs≤35 mL/cmH2O）患者进行前瞻性研究。取仰卧位，前胸壁敷5 kg沙袋。测量呼吸力学（呼吸系统顺应性- crs、平台压- pplat、驱动压- dp、内在PEEP和总PEEP）、血流动力学参数（心率- hr、平均动脉压- map）和氧合指数（PaO2/FiO2）。通风机设置保持不变。结果测试壁负荷显著改善呼吸系统顺应性（中位数增加4.8 mL/cmH2O, P < 0.001），降低平台压（中位数减少2.1 cmH2O, P < 0.001）和驱动压（中位数减少2.3 cmH2O, P < 0.001）。HR、MAP、PaO2/FiO2均无明显变化。基线依从性较低的患者改善更为明显（Spearman ρ = -0.420, P < 0.001）。结论5kg沙袋急性胸壁负荷可显著改善低顺应性ARDS患者的呼吸力学，增强顺应性，降低平台压和驱动压，而不影响血流动力学和氧合。这种简单的干预可以作为这类患者肺保护性通气的有用辅助。

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引用次数: 0

Hyperdynamic left ventricular ejection fraction as a predictor of mortality in intensive care unit patients with septic shock 高动力左心室射血分数作为重症监护病房脓毒性休克患者死亡率的预测因子

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-29 DOI: 10.1016/j.hrtlng.2025.11.015

Doaa Saeed Mohamed Hedia, Hoda Omar Mahmoud, Amr Mohamed AbdelFattah, Ehab Hamed AbdelSalam, Omar Sameh Mahmoud

Background

A hyperdynamic left ventricle (ejection fraction (EF) ≥70 %) on stress imaging is closely linked to diastolic dysfunction and may indicate heart failure with preserved EF (HFpEF) in the right clinical context.

Objectives

To investigate the underlying causes and prognostic implications of hyperdynamic left ventricular ejection fraction (HDLVEF) in critically ill patients diagnosed with sepsis.

Methods

A total of 235 patients diagnosed with septic shock and admitted to the intensive care unit were included in this study. Diagnosis of sepsis was established based on the sequential organ failure assessment (SOFA) score, which was calculated upon admission and updated every 24 h using the worst values from the prior day. Transthoracic echocardiography (TTE) was performed either by the principal investigator or a certified cardiologist accredited by the Egyptian Medical Society of Echocardiography (EMSE).

Results

Among the 235 patients, 88 (37.4 %) died within 28 days, while 147 (62.6 %) survived. Hyperdynamic EF was significantly more prevalent in the deceased group compared to survivors, with an odds ratio of 4.822 (95 % CI: 1.467–8.852), indicating a strong association with mortality. Multivariate analysis identified several independent predictors of mortality, including older age, lower mean arterial pressure, higher SOFA scores, and elevated serum lactate levels. Additionally, the mortality rate was significantly higher among male patients.

Conclusion

HDLVEF holds significant prognostic value in patients with sepsis in critical care. It may serve as a valuable early echocardiographic marker of sepsis-induced cardiomyopathy or cardiovascular dysfunction, potentially aiding in risk assessment and early therapeutic decisions.

Trial registration

The trial was registered before patient enrolment at ClinicalTrials.gov (ID/ NCT06993948).

应激成像显示高动力左心室（射血分数(EF)≥70%）与舒张功能障碍密切相关，在正确的临床背景下可能提示保留EF （HFpEF）的心力衰竭。目的探讨脓毒症危重患者高动力左室射血分数（HDLVEF）的病因及预后意义。方法对235例确诊为感染性休克并入住重症监护病房的患者进行研究。脓毒症的诊断基于顺序器官衰竭评估（SOFA）评分，该评分在入院时计算，每24小时更新一次，使用前一天的最差值。经胸超声心动图（TTE）由主要研究者或经埃及超声心动图医学会（EMSE）认证的心脏病专家进行。结果235例患者中，28 d内死亡88例（37.4%），存活147例（62.6%）。与幸存者相比，高动力EF在死者组中更为普遍，优势比为4.822 (95% CI: 1.467-8.852)，表明与死亡率密切相关。多变量分析确定了几个独立的死亡率预测因素，包括年龄较大、平均动脉压较低、SOFA评分较高和血清乳酸水平升高。此外，男性患者的死亡率明显较高。结论hdlvef在脓毒症重症监护患者中具有重要的预后价值。它可以作为一个有价值的早期超声心动图标记败血症引起的心肌病或心血管功能障碍，潜在地帮助风险评估和早期治疗决策。试验注册该试验在患者入组前在ClinicalTrials.gov （ID/ NCT06993948）上注册。

{"title":"Hyperdynamic left ventricular ejection fraction as a predictor of mortality in intensive care unit patients with septic shock","authors":"Doaa Saeed Mohamed Hedia, Hoda Omar Mahmoud, Amr Mohamed AbdelFattah, Ehab Hamed AbdelSalam, Omar Sameh Mahmoud","doi":"10.1016/j.hrtlng.2025.11.015","DOIUrl":"10.1016/j.hrtlng.2025.11.015","url":null,"abstract":"<div><h3>Background</h3><div>A hyperdynamic left ventricle (ejection fraction (EF) ≥70 %) on stress imaging is closely linked to diastolic dysfunction and may indicate heart failure with preserved EF (HFpEF) in the right clinical context.</div></div><div><h3>Objectives</h3><div>To investigate the underlying causes and prognostic implications of hyperdynamic left ventricular ejection fraction (HDLVEF) in critically ill patients diagnosed with sepsis.</div></div><div><h3>Methods</h3><div>A total of 235 patients diagnosed with septic shock and admitted to the intensive care unit were included in this study. Diagnosis of sepsis was established based on the sequential organ failure assessment (SOFA) score, which was calculated upon admission and updated every 24 h using the worst values from the prior day. Transthoracic echocardiography (TTE) was performed either by the principal investigator or a certified cardiologist accredited by the Egyptian Medical Society of Echocardiography (EMSE).</div></div><div><h3>Results</h3><div>Among the 235 patients, 88 (37.4 %) died within 28 days, while 147 (62.6 %) survived. Hyperdynamic EF was significantly more prevalent in the deceased group compared to survivors, with an odds ratio of 4.822 (95 % CI: 1.467–8.852), indicating a strong association with mortality. Multivariate analysis identified several independent predictors of mortality, including older age, lower mean arterial pressure, higher SOFA scores, and elevated serum lactate levels. Additionally, the mortality rate was significantly higher among male patients.</div></div><div><h3>Conclusion</h3><div>HDLVEF holds significant prognostic value in patients with sepsis in critical care. It may serve as a valuable early echocardiographic marker of sepsis-induced cardiomyopathy or cardiovascular dysfunction, potentially aiding in risk assessment and early therapeutic decisions.</div></div><div><h3>Trial registration</h3><div>The trial was registered before patient enrolment at ClinicalTrials.gov (ID/ NCT06993948).</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 106-112"},"PeriodicalIF":2.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624680","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

Development and validation of a machine learning-based predictive model for coronary heart disease risk in middle-aged and young adults 基于机器学习的中青年冠心病风险预测模型的开发和验证

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-29 DOI: 10.1016/j.hrtlng.2025.11.016

Yifan Deng , Yahui Li , Jiapei Gao , Shenghu He , Li Zhu , Jing Zhang

Background

The incidence of coronary heart disease (CHD) continues to rise among younger populations, necessitating the development of rapid and effective risk prediction models to provide new approaches for secondary prevention of CHD. Objective: To construct a clinical prediction model for premature coronary heart disease (PCHD) in the Chinese population based on machine learning algorithms.

Methods

A retrospective cohort study was conducted young and middle-aged patients undergoing coronary angiography at Northern Jiangsu People's Hospital (November 2018-May 2023).Feature selection was performed using Lasso regressionwith 10-fold cross-validation, followed by multivariate logistic regression. Seven supervised learning algorithms were evaluated: Logistic Regression (LR), LightGBM (LGBM), Random Forest (RF), Decision Trees (DT), Support Vector Machines (SVM), eXtreme Gradient Boosting (XGBoost), k-Nearest Neighbors (KNN), and Naïve Bayes (NB).

Results

This study enrolled a total of 1276 participants, comprising ‌881 in the PCHD group‌ and ‌395 in the non-PCHD group. LASSO regression analysis‌ identified ‌nine potential predictors. All sevne machine learning models demonstrated good predictive performance. After excluding overfitted models, the LR model (AUC: 0.82; Sensitivity: 0.654; Specificity: 0.805; Recall: 0.654; F1: 0.749) and SVM model had higher AUC values than XGBoost (AUC: 0.794; Sensitivity: 0.858; Specificity: 0.504; Recall: 0.858; F1: 0.82) in the validation set. Therefore, we used Nomogram and SHAP summary plot to visualize and interpret the LR model and SVM model, respectively.

Conclusion

The LR-based nomogram and SVM-SHAP model provide clinically actionable tools for PCHD risk stratification. These models facilitate early identification of high-risk individuals for targeted preventive interventions.

背景冠心病（CHD）在年轻人群中的发病率持续上升，需要开发快速有效的风险预测模型，为冠心病的二级预防提供新的途径。目的：构建基于机器学习算法的中国人群早发性冠心病（PCHD）临床预测模型。方法对2018年11月- 2023年5月苏北人民医院行冠状动脉造影的中青年患者进行回顾性队列研究。特征选择使用Lasso回归进行10倍交叉验证，然后进行多变量逻辑回归。评估了七种监督学习算法：逻辑回归（LR）、LightGBM （LGBM）、随机森林（RF）、决策树（DT）、支持向量机（SVM）、极端梯度增强（XGBoost）、k-近邻（KNN）和Naïve贝叶斯（NB）。结果本研究共纳入1276名参与者，其中PCHD组881名，非PCHD组395名。LASSO回归分析确定了9个潜在的预测因素。所有七个机器学习模型都显示出良好的预测性能。排除过拟合模型后，验证集中LR模型（AUC: 0.82，灵敏度：0.654，特异性：0.805，召回率：0.654,F1: 0.749）和SVM模型的AUC值均高于XGBoost模型（AUC: 0.794，灵敏度：0.858，特异性：0.504，召回率：0.858,F1: 0.82）。因此，我们分别使用Nomogram和SHAP summary plot对LR模型和SVM模型进行可视化和解释。结论基于lr的nomogram和SVM-SHAP模型为PCHD风险分层提供了临床可行的工具。这些模型有助于早期识别高风险个体，以便进行有针对性的预防干预。

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引用次数: 0

New technology or tradition? A Bayesian meta-analysis of robotic vs. manual percutaneous coronary intervention 新技术还是传统？机器人与人工经皮冠状动脉介入治疗的贝叶斯荟萃分析

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-28 DOI: 10.1016/j.hrtlng.2025.11.017

Paweł Łajczak , Ayesha Ayesha , Ogechukwu Obi , Leo Noanh Consoli , Oguz Kagan Sahin , Sherif Eltawansy , Faizan Ahmed , Ilias Georgios Koziakas , Luis Rene Puglla-Sanchez , Anna Łajczak , Stanisław Buczkowski , Kamil Jóźwik , Przemysław Nowakowski , Michele Schincariol

Background

Conventional percutaneous coronary intervention (CV-PCI) remains a standard treatment approach for coronary artery disease (CAD); however, robotic PCI (RB-PCI) is gaining attention due to possible radiation reduction.

Objectives

This meta-analysis aims to compare periprocedural outcomes of RB-PCI with those of CV-PCI using a Bayesian framework.

Methods

A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Cochrane Library, to identify studies comparing RB-PCI and CV-PCI. A Bayesian non-informative random-effects model was applied to synthesize the data, providing posterior estimates with credible intervals (Crl).

Results

A total of ten studies and one report encompassing 3587 cases (RB-PCI and CV-PCI) were included. No significant differences were observed between RB-PCI and CV-PCI in terms of procedure time (MD 5.99; 95 % Crl -3.44 to 15.40), fluoroscopy time (MD -0.03; 95 % Crl -2.22 to 2.05), contrast volume (MD -5.87; 95 % CrI -17.85 to 6.55), or dose area product (MD -786.96; 95 % Crl -2374.70 to 773.10). Additionally, there was no significant difference in complications.

Conclusion

This Bayesian meta-analysis indicates that RB-PCI offers procedural efficiency and clinical outcomes comparable to those of CV-PCI, with no significant differences in key procedural parameters. The outcomes of this synthesis may question the cost-effectiveness of this technology in the management of CAD, as the benefits of RB-PCI are limited to radiation reduction. Lack of high-quality randomized trials leads to lower certainty of current evidence.

传统经皮冠状动脉介入治疗（CV-PCI）仍然是冠状动脉疾病（CAD）的标准治疗方法；然而，机器人PCI （RB-PCI）由于可能减少辐射而受到关注。目的：本荟萃分析旨在使用贝叶斯框架比较RB-PCI与CV-PCI的围手术期预后。方法在PubMed、Scopus、Cochrane Library等多个数据库中进行综合文献检索，找出RB-PCI与CV-PCI的比较研究。采用贝叶斯非信息随机效应模型综合数据，提供具有可信区间（Crl）的后验估计。结果共纳入10项研究和1份报告，共3587例（RB-PCI和CV-PCI）。RB-PCI和CV-PCI在手术时间（MD 5.99; 95% Crl -3.44至15.40）、透视时间（MD -0.03; 95% Crl -2.22至2.05）、造影剂体积（MD -5.87; 95% CrI -17.85至6.55）或剂量面积积（MD -786.96; 95% Crl -2374.70至773.10）方面均无显著差异。此外，两组并发症发生率无显著差异。结论本贝叶斯荟萃分析表明，RB-PCI的手术效率和临床结果与CV-PCI相当，关键手术参数无显著差异。这种综合的结果可能会质疑该技术在CAD管理中的成本效益，因为RB-PCI的益处仅限于减少辐射。缺乏高质量的随机试验导致当前证据的确定性较低。

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引用次数: 0

Right ventricular strain as a predictor of surgical success in obstructive sleep apnea: Association with serum chemerin 右心室应变作为阻塞性睡眠呼吸暂停手术成功的预测因素：与血清趋化素的关系

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-27 DOI: 10.1016/j.hrtlng.2025.11.019

Alperen Taş M.D , Tolga Çimen M.D , Abdullah Musa Altaş , İlker Akyıldız , Hamza Sunman , Kamuran Kalkan M.D , Çağatay Tunca M.D , Ayşenur Özkaya İbiş M.D , Mehmet Taha Özkan M.D , İbrahim Hikmet Fırat M.D

Background

Obstructive sleep apnea syndrome (OSAS) is a disease characterized by recurrent obstruction of the upper airways during sleep, posing an independent risk for cardiovascular diseases. Serum chemerin is an adipokine associated with both OSAS and cardiovascular diseases.

Objectives

Our aim is to investigate the effect of OSAS surgery on cardiac functions and serum chemerin levels in patients.

Methods

This prospective study included 43 surgical OSAS patients. Echocardiographic parameters and serum chemerin levels were assessed before and 6 months after surgery. Right and left ventricular strain were measured by speckle-tracking echocardiography (STE). Surgical response was defined as a ≥ 50 % reduction in the apnea–hypopnea index (AHI).

Results

Six months after surgery, RV FWS and LV GLS values became significantly more negative, indicating improved myocardial function (RV FWS: −20.98 ± 2.26 % to −23.71 ± 2.53 %, p < 0.001; LV GLS: −21.28 ± 1.49 % to −22.74 ± 1.63 %, p < 0.001). Serum chemerin levels significantly decreased from 1320 (683–2530) pg/mL to 328 (66–6234) pg/mL (p = 0.024). AHI also decreased markedly (26.9 ± 16.4 to 16.1 ± 14.0, p < 0.001). In multivariate analysis, change in RV FWS independently predicted surgical success (OR 2.449, 95 % CI 1.361–4.408, p = 0.003).

Conclusion

Our study revealed a decrease in serum chemerin levels and improvement in LV and RV functions in patients undergoing surgery for OSAS. The change in the RV FWS parameter in OSAS patients indicates the response to surgical treatment.

背景：阻塞性睡眠呼吸暂停综合征（OSAS）是一种以睡眠期间上呼吸道反复阻塞为特征的疾病，具有心血管疾病的独立风险。血清趋化素是一种与OSAS和心血管疾病相关的脂肪因子。目的探讨OSAS手术对患者心功能及血清趋化素水平的影响。方法本前瞻性研究纳入43例外科OSAS患者。术前和术后6个月分别评估超声心动图参数和血清趋化素水平。采用斑点跟踪超声心动图（STE）测量左、右心室应变。手术疗效定义为呼吸暂停低通气指数（AHI）降低≥50%。结果术后6个月，右心室FWS和左心室GLS值明显变负，心肌功能改善（右心室FWS:−20.98±2.26% ~−23.71±2.53%,p < 0.001；左心室GLS:−21.28±1.49% ~−22.74±1.63%,p < 0.001）。血清趋化素水平从1320 (683-2530)pg/mL显著降低至328 (66-6234)pg/mL （p = 0.024）。AHI也明显降低（26.9±16.4 ~ 16.1±14.0,p < 0.001）。在多变量分析中，RV FWS的变化独立预测手术成功（OR 2.449, 95% CI 1.361-4.408, p = 0.003）。结论：OSAS手术患者血清趋化素水平下降，左室和右室功能改善。OSAS患者RV FWS参数的变化表明对手术治疗的反应。

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引用次数: 0

The effect of milrinone on short- and mid-term outcomes in patients with sepsis-related myocardial injury: A propensity score matched retrospective study 米力农对败血症相关心肌损伤患者中短期预后的影响：倾向评分匹配的回顾性研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-25 DOI: 10.1016/j.hrtlng.2025.11.014

Zhennan Yuan , Tianyu She , Zeheng Wu , Qiuyun Li

Background

Sepsis-induced myocardial injury is a significant contributor to adverse outcomes in critically ill patients. The impact of milrinone on the prognosis of patients with sepsis-related myocardial injury remains limited.

Objectives

This study aimed to evaluate whether milrinone treatment improves short- and mid-term prognoses in patients with sepsis-related myocardial injury.

Methods

A retrospective study was conducted using the MIMIC-IV version 3.1 database, involving 94,458 ICU admissions. Among these, 41,295 were diagnosed with sepsis according to Sepsis-3 criteria, leading to the identification of 22,376 patients with sepsis-related myocardial injury. We established 565 matched pairs of milrinone and non-milrinone users through 1:1 propensity score matching based on demographics, organ function status, and laboratory indicators. Kaplan-Meier survival curves were utilized to visualize survival distributions, and log-rank tests were performed to compare group survival. The primary outcomes were the 90-day and 365-day survival rates.

Results

Before matching, the 90-day survival rates were 67.5% for the milrinone group versus 72.1% for the non-milrinone group (p = 0.078). The 365-day survival rates were 62.0% vs. 58.4% (p = 0.092). After matching, the 90-day survival rates were 71.3% vs. 72.2% (p = 0.801), while the 365-day rates were 66.7% vs. 59.7% (p = 0.013). Notably, milrinone benefited patients aged ≥65 and those with specific risk factors, with low-dose milrinone showing higher survival rates (70.0% vs 62.4%, p = 0.043).

Conclusions

Milrinone treatment may improve long-term survival rates in patients with sepsis-related myocardial injury. Future research should focus on refining treatment protocols and tailoring therapeutic approaches based on individual patient characteristics.

背景败血症引起的心肌损伤是危重患者不良结局的重要因素。米力农对脓毒症相关心肌损伤患者预后的影响仍然有限。目的本研究旨在评估米力农治疗是否能改善败血症相关心肌损伤患者的短期和中期预后。方法采用MIMIC-IV 3.1版数据库进行回顾性研究，纳入94458例ICU住院患者。其中41295例根据脓毒症-3标准诊断为脓毒症，共鉴定出22376例脓毒症相关心肌损伤。我们根据人口统计学、器官功能状态和实验室指标，通过1:1的倾向评分匹配，建立了565对米力农和非米力农使用者的匹配对。Kaplan-Meier生存曲线显示生存分布，log-rank检验比较各组生存。主要结局为90天和365天生存率。结果配对前，米力酮组90天生存率为67.5%，非米力酮组为72.1% （p = 0.078）。365天生存率分别为62.0%和58.4% （p = 0.092）。配对后，90天生存率为71.3%比72.2% (p = 0.801)， 365天生存率为66.7%比59.7% （p = 0.013）。值得注意的是，米力农对年龄≥65岁和有特定危险因素的患者有好处，低剂量米力农的生存率更高（70.0% vs 62.4%, p = 0.043）。结论米利酮治疗可提高脓毒症相关性心肌损伤患者的长期生存率。未来的研究应侧重于改进治疗方案，并根据个体患者的特点定制治疗方法。

{"title":"The effect of milrinone on short- and mid-term outcomes in patients with sepsis-related myocardial injury: A propensity score matched retrospective study","authors":"Zhennan Yuan , Tianyu She , Zeheng Wu , Qiuyun Li","doi":"10.1016/j.hrtlng.2025.11.014","DOIUrl":"10.1016/j.hrtlng.2025.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-induced myocardial injury is a significant contributor to adverse outcomes in critically ill patients. The impact of milrinone on the prognosis of patients with sepsis-related myocardial injury remains limited.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate whether milrinone treatment improves short- and mid-term prognoses in patients with sepsis-related myocardial injury.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted using the MIMIC-IV version 3.1 database, involving 94,458 ICU admissions. Among these, 41,295 were diagnosed with sepsis according to Sepsis-3 criteria, leading to the identification of 22,376 patients with sepsis-related myocardial injury. We established 565 matched pairs of milrinone and non-milrinone users through 1:1 propensity score matching based on demographics, organ function status, and laboratory indicators. Kaplan-Meier survival curves were utilized to visualize survival distributions, and log-rank tests were performed to compare group survival. The primary outcomes were the 90-day and 365-day survival rates.</div></div><div><h3>Results</h3><div>Before matching, the 90-day survival rates were 67.5% for the milrinone group versus 72.1% for the non-milrinone group (<em>p</em> = 0.078). The 365-day survival rates were 62.0% vs. 58.4% (<em>p</em> = 0.092). After matching, the 90-day survival rates were 71.3% vs. 72.2% (<em>p</em> = 0.801), while the 365-day rates were 66.7% vs. 59.7% (<em>p</em> = 0.013). Notably, milrinone benefited patients aged ≥65 and those with specific risk factors, with low-dose milrinone showing higher survival rates (70.0% vs 62.4%, <em>p</em> = 0.043).</div></div><div><h3>Conclusions</h3><div>Milrinone treatment may improve long-term survival rates in patients with sepsis-related myocardial injury. Future research should focus on refining treatment protocols and tailoring therapeutic approaches based on individual patient characteristics.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 74-80"},"PeriodicalIF":2.6,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624787","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

Medication management, health outcomes, and economic burden of severe asthma stratified by asthma control levels 按哮喘控制水平分层的重症哮喘的药物管理、健康结局和经济负担。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-23 DOI: 10.1016/j.hrtlng.2025.11.013

Ke Zhang , Xiaoning He , Jing Wu

Background

Severe asthma—a critical subset of asthma—is known for escalating the risk of asthma-related symptoms. However, current research on the management and burden of severe asthma in developing countries remains limited, especially in China, constraining evidence-based policymaking.

Objectives

This study aims to evaluate the medication management, health outcomes, and economic burden of severe asthma across different control levels in China.

Methods

We analyzed routinely collected data on nearly 1.7 million subjects from Tianjin, China. Severe asthma was identified based on specific medication use patterns. Patients were stratified as uncontrolled, suboptimally controlled or controlled according to the inpatient admission, short-term systemic corticosteroid use and short-acting inhaled beta₂-agonist use. Over a one-year follow-up period, the medication management, health outcomes, and economic burden were assessed.

Results

A total of 2418 patients with severe asthma were identified. Inhaled corticosteroids/long-acting beta₂-agonist (ICS/LABA) was the most commonly used controller medication (93.51 %), while patients with poorer control spent more on additional controller medications and Chinese herbal medicines. Oral corticosteroids (OCS) were less used (10.75 %), but the mean daily dosage of OCS among OCS users was as high as 15.68 mg—1.6 times the recommended dosage in Chinese guidelines. Only 17.78 % of patients with severe asthma demonstrated good adherence (defined as proportion of days covered ≥ 0.8) to asthma control treatment. Patients with uncontrolled asthma showed a significantly high proportion of exacerbations (51.42 %) and incurred higher asthma-related medical cost than suboptimally controlled and controlled patients (CNY 8506.83 vs. 3559.35 vs. 2105.70, p = 0.000).

Conclusion

Patients with severe asthma exhibit poor treatment adherence, low OCS usage rates but excessively high doses among users, pursuit of alternative therapies, and a high economic burden in Tianjin, China. These findings underscore the urgent need to improve severe asthma management, particularly for those with uncontrolled asthma.

研究背景：严重哮喘是哮喘的一个重要亚型，已知可使哮喘相关症状的风险升高。然而，目前关于发展中国家严重哮喘的管理和负担的研究仍然有限，特别是在中国，这限制了基于证据的政策制定。目的：本研究旨在评估中国不同控制水平下重症哮喘的药物管理、健康结局和经济负担。方法：我们分析了来自中国天津的近170万受试者的常规收集数据。根据特定的药物使用模式确定严重哮喘。根据住院情况、短期全身性皮质类固醇使用情况和短效吸入β 2激动剂使用情况，将患者分为未控制、次优控制或控制。在一年的随访期间，评估药物管理、健康结果和经济负担。结果：共发现重度哮喘患者2418例。吸入皮质类固醇/长效β -受体激动剂（ICS/LABA）是最常用的控制药物（93.51%），而控制较差的患者更多地使用额外的控制药物和中草药。口服皮质类固醇（OCS）的使用较少（10.75%），但OCS使用者的平均日剂量高达中国指南推荐剂量的15.68 mg-1.6倍。只有17.78%的严重哮喘患者表现出良好的哮喘控制治疗依从性（定义为覆盖天数比例≥0.8）。未控制哮喘患者发作比例（51.42%）显著高于控制次优和控制次优患者，哮喘相关医疗费用（8506.83元人民币vs. 3559.35元人民币vs. 2105.70元人民币，p = 0.000）。结论：中国天津市重症哮喘患者治疗依从性差，OCS使用率低，但用药剂量过高，追求替代治疗，经济负担高。这些发现强调了改善严重哮喘管理的迫切需要，特别是对那些未控制的哮喘患者。

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引用次数: 0