Heart & Lung最新文献_第6页

Heart failure associated with chronic Chagas cardiomyopathy increases the risk of impaired lung function and reduced submaximal functional capacity 与慢性恰加斯病心肌病相关的心力衰竭会增加肺功能受损和亚最大功能能力下降的风险。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-11-05 DOI: 10.1016/j.hrtlng.2024.10.009

Patrício Braz da Silva , Clara Pinto Diniz , Mauro Felippe Felix Mediano , Fernanda de Souza Nogueira Sardinha Mendes , Alejandro Marcel Hasslocher-Moreno , Luis Felipe Fonseca Reis , Michel Silva Reis , Roberto Magalhães Saraiva , Marcelo Teixeira de Holanda , Flavia Mazzoli-Rocha , Andréa Silvestre de Sousa

Background

With the evolution of chronic Chagas cardiomyopathy (CC) and the progression towards heart failure (HF), patients may show a decline in inspiratory muscle strength, lung function, and functional capacity.

Objective

We compared respiratory function and submaximal functional capacity in patients with CC with versus without HF.

Methods

This observational, cross-sectional study was carried out with CC patients divided into CCG, a group without HF (n = 28), and HFG, a group with HF (n = 27). Spirometry (percent predicted forced vital capacity (ppFVC), forced expiratory volume in one second of FVC (ppFEV₁), forced expiratory flow between 25 % and 75 % of FVC (ppFEF_25–75 _%), and maximum voluntary ventilation (ppMVV)) and submaximal functional capacity (six-minute step test: 6MST) were evaluated. Mann-Whitney (comparison of pulmonary function and functional capacity between groups) and linear regression (association between the presence of HF and other variables) were performed.

Results

We included 55 participants, with median age of 67 years (56.25–71.75) and 54.55 % males. Dyslipidemia was the most recurrent comorbidity (49.09 %). HFG presented lower ppFVC (P = 0.000), ppFEV₁ (P = 0.011), ppFEF_25–75 _% (P = 0.017), and ppMVV (P = 0.003) than the CCG. The ppFVC (B = -18.95; P = 0.000), ppFEV₁ (B = -16.29; P = 0.021), ppFEF_25–75 _% (B = -19.57; P = 0.014), ppMVV (B = -16.59; P = 0.003), and 6MST (B = -17.13; P = 0.034) were negatively associated with the presence of HF.

Conclusion

Our data suggest that impaired lung function, compatible with a restrictive pulmonary pattern, is present among adults with CC and HF.

背景：随着慢性恰加斯病心肌病（CC）的发展和心力衰竭（HF）的进展，患者的吸气肌力、肺功能和功能能力可能会下降：我们比较了伴有和不伴有心力衰竭的慢性心肌病患者的呼吸功能和亚极限功能能力：这项观察性横断面研究将 CC 患者分为 CCG 组和 HFG 组，前者无 HF（28 人），后者有 HF（27 人）。研究人员对患者的肺活量（预测用力肺活量百分比（ppFVC）、一秒钟用力呼气量（ppFEV1）、25% 至 75% 的用力呼气流量（ppFEF25-75%）和最大自主通气量（ppMVV））和亚极限功能能力（六分钟台阶试验：6MST）进行了评估。研究人员进行了曼-惠特尼（组间肺功能和功能能力的比较）和线性回归（存在心房颤动与其他变量之间的关联）：我们共纳入 55 名参与者，中位年龄为 67 岁（56.25-71.75），男性占 54.55%。血脂异常是最常见的合并症（49.09%）。与 CCG 相比，HFG 的 ppFVC（P = 0.000）、ppFEV1（P = 0.011）、ppFEF25-75%（P = 0.017）和 ppMVV（P = 0.003）均较低。ppFVC（B = -18.95；P = 0.000）、ppFEV1（B = -16.29；P = 0.021）、ppFEF25-75%（B = -19.57；P = 0.014）、ppMVV（B = -16.59；P = 0.003）和 6MST（B = -17.13；P = 0.034）与高血压的存在呈负相关：我们的数据表明，CC 和 HF 成人患者的肺功能受损，与限制性肺功能模式相符。

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引用次数: 0

Short (30 Minutes) versus long (120 Minutes) spontaneous breathing trial among patients with difficult weaning (SL-SBT Trial) 在断奶困难的患者中进行短时（30 分钟）与长时（120 分钟）自主呼吸试验（SL-SBT 试验）

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-11-05 DOI: 10.1016/j.hrtlng.2024.10.008

Vijay Hadda , Arunachalam Meenakshisundaram , Saurabh Mittal , Karan Madan , Pawan Tiwari , Tejas Menon Suri , Maroof Ahmad Khan , Anant Mohan

Background

The optimal duration of spontaneous breath trial (SBT) for patients with difficult extubation from mechanical ventilation is unknown.

Objective

This study compared extubation success with two different durations of SBT in patients who failed their first SBT.

Methods

This single-center randomized controlled trial included adults on mechanical ventilation who had failed their first SBT. The participants were randomized to receive pressure support ventilation (PSV) for either 30 or 120 min. Our primary outcome was the rate of successful extubation (without reintubation within 48 h). Key secondary outcomes were the length of intensive care unit (ICU) and hospital stay and in-hospital and 90-day mortality.

Results

A total of 119 patients (62.2 % male) with a mean age of 53.9 years were randomized to undergo SBT for either 30 min (n = 60) or 120 min (n = 59). Among them, 82.4 % of patients had hypercapnic respiratory failure. The rates of successful extubation were similar with SBT of 30 min and 120 min (58.3 % vs. 59.3 %, respectively; p = 0.91). There were no significant differences between the two groups in terms of the durations of ICU and hospital stay or in-hospital and 90-day mortality.

Conclusions

Extubation success and other clinically important outcomes were comparable between short (30 min) and long (120 min) SBT in difficult weaning. A 30-minute SBT may be acceptable in this setting.

背景对于难以从机械通气中拔管的患者，自发呼吸试验（SBT）的最佳持续时间尚不清楚。方法这项单中心随机对照试验纳入了首次 SBT 失败的成人机械通气患者。参与者被随机分配接受 30 或 120 分钟的压力支持通气（PSV）。我们的主要结果是成功拔管率（48 小时内未再次插管）。结果 119 名患者（62.2% 为男性），平均年龄 53.9 岁，被随机分配接受 30 分钟（n = 60）或 120 分钟（n = 59）的 SBT。其中，82.4%的患者存在高碳酸血症呼吸衰竭。30 分钟和 120 分钟 SBT 的成功拔管率相似（分别为 58.3% 和 59.3%；P = 0.91）。结论在困难断奶患者中，短（30 分钟）和长（120 分钟）SBT 的拔管成功率和其他临床重要结果相当。在这种情况下，30 分钟的 SBT 是可以接受的。

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引用次数: 0

Supplemental oxygen prescriptions after hospitalization for coronavirus disease 2019 2019 年冠状病毒病住院后的补充氧气处方

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-11-04 DOI: 10.1016/j.hrtlng.2024.10.015

Zaidan MF , Puebla Neira DA , Lau C , Nishi SP , Duarte AD , Wang J , Kuo YF , Sharma G

Background

The role of home oxygen therapy for patients recovering from Coronavirus Disease 2019 (COVID-19) pneumonia, characterized by impaired gas exchange, is not well-defined.

Objectives

To compare the characteristics, duration, odds of receiving, and continuing to receive home oxygen prescriptions between patients discharged home after COVID-19 pneumonia hospitalization and those discharged after non-COVID-19 pneumonia.

Methods

From April 2020 to March 2021, 52,951 patients with COVID-19 pneumonia (53.6 % women, 64 % White) were identified, and from January 2019 to December 2019, 26,701 patients with non-COVID pneumonia (53.9 % women, 76.7 % White) were identified, using the Optum Clinformatics Data Mart Database. New oxygen prescriptions were identified through Healthcare Common Procedure Coding Systems codes. Propensity score matching adjusted for confounders, and Cox regression analysis was conducted to compare post-discharge oxygen use.

Results

Following hospitalization, oxygen was prescribed to 52,951 patients with COVID-19 pneumonia and 26,701 patients with non-COVID pneumonia in the United States. The COVID-19 pneumonia group were four times more likely to be prescribed supplemental oxygen compared to the non-COVID-19 pneumonia group (OR 4.22; 95 % confidence interval [CI] 3.76–4.74). This trend persisted in sensitivity analyses: ICU patients (OR 4.05; 95 % CI 3.36–4.88) and those who received both ICU admission and mechanical ventilation (OR 3.84; 95 % CI 2.32–6.37). Hispanic patients had the highest likelihood of receiving a supplemental oxygen prescription after discharge (OR 6.75; 95 % CI 5.03–9.05).

Conclusions

Post-hospitalization, one in five patients with COVID-19 received prescriptions for supplemental oxygen, which was significantly higher than the proportion of patients with non-COVID-19 pneumonia.

背景以气体交换受损为特征的冠状病毒病 2019（COVID-19）肺炎患者康复后的家庭氧疗作用尚未明确。目的比较 COVID-19 肺炎住院后出院回家的患者与非 COVID-19 肺炎出院患者的特征、持续时间、接受和继续接受家庭氧疗处方的几率。方法从 2020 年 4 月到 2021 年 3 月，使用 Optum Clinformatics Data Mart 数据库识别了 52951 名 COVID-19 肺炎患者（53.6% 为女性，64% 为白人）；从 2019 年 1 月到 2019 年 12 月，识别了 26701 名非 COVID 肺炎患者（53.9% 为女性，76.7% 为白人）。通过医疗保健通用程序编码系统代码确定了新的氧气处方。结果美国有 52951 名 COVID-19 肺炎患者和 26701 名非 COVID 肺炎患者在住院后获得了氧气处方。与非 COVID-19 肺炎组相比，COVID-19 肺炎组患者被处方补充氧气的可能性高出四倍（OR 4.22; 95 % 置信区间 [CI] 3.76-4.74）。这一趋势在敏感性分析中依然存在：ICU 患者（OR 4.05；95 % 置信区间 [CI] 3.36-4.88）和既入住 ICU 又接受机械通气的患者（OR 3.84；95 % 置信区间 [CI] 2.32-6.37）。西班牙裔患者出院后收到补氧处方的可能性最大（OR 6.75；95 % CI 5.03-9.05）。结论住院后，每五名 COVID-19 患者中就有一人收到补氧处方，这一比例明显高于非 COVID-19 肺炎患者。

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引用次数: 0

Inpatient mortality and outcomes of COVID-19 among patients with non-ischemic cardiomyopathy: A propensity matched analysis. 非缺血性心肌病患者的住院死亡率和 COVID-19 的疗效：倾向匹配分析

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-11-01 Epub Date: 2024-07-15 DOI: 10.1016/j.hrtlng.2024.06.018

Mirza Faris Ali Baig, Kalyan Chaliki

Background: Patients with chronic medical conditions, particularly cardiovascular diseases, are at a greater risk of adverse outcomes due to COVID-19. The effect of COVID-19 on patients with non-ischemic cardiomyopathy (NICM) is not known well.

Objectives: To study the impact of COVID-19 infection on NICM hospital mortality and other outcomes.

Methods: This study included a cohort of patients from the 2020 and 2021 National Inpatient Sample databases. Patients hospitalized for COVID-19 with and without NICM were matched using a 1:1 propensity score-matching ratio. Outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial infarction (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges.

Results: A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %], predominantly white 1,456,203 (57.5 %); mean [SD] age 63 [5.4] years), including 64,155 (2.5 %) patients with a history of NICM. Following propensity matching, 10,258 COVID-19 patients with and without NICM were matched. Patients with NICM had higher rates of AMI (11.1 vs. 7.1 %, p < 0.001), cardiogenic shock (2 vs. 0.6 %, p < 0.001), cardiac arrest (4.4 vs. 3.2 %, p < 0.01), mechanical ventilation (13.7 vs 12 %, p < 0.01), VT (8.5 vs. 2.2 %, p < 0.001), and VF (1.0 vs 0.25 %, p < 0.001). The odds ratios for in-hospital mortality, AKI, and PE did not differ significantly.

Conclusion: A History of NICM does not affect COVID-19 mortality but increases the risk of cardiovascular complications.

背景：患有慢性疾病，尤其是心血管疾病的患者因 COVID-19 而出现不良后果的风险更大。COVID-19对非缺血性心肌病（NICM）患者的影响尚不清楚：研究 COVID-19 感染对非缺血性心肌病（NICM）住院死亡率和其他结果的影响：本研究纳入了 2020 年和 2021 年全国住院患者抽样数据库中的一组患者。因感染 COVID-19 而住院的患者与未感染 NICM 的患者按 1:1 的倾向得分匹配比例进行匹配。分析的结果包括院内死亡率、急性肾损伤（AKI）、急性心肌梗死（AMI）、心源性休克、心脏骤停、机械通气、气管插管、肺栓塞（PE）、室性心动过速（VT）、心室颤动（VF）、住院时间（LOS）和住院总费用：共有 2,532,652 名患者符合纳入标准（1,199,008 名女性[47.3%]，1,456,203 名白人（57.5%）；平均 [SD] 年龄 63 [5.4] 岁），其中包括 64,155 名（2.5%）有 NICM 病史的患者。经过倾向匹配后，10258 名 COVID-19 患者中有和没有 NICM。NICM 患者发生急性心肌梗死（11.1% 对 7.1%，P＜0.001）、心源性休克（2% 对 0.6%，P＜0.001）、心脏骤停（4.4% 对 3.2%，P＜0.01）、机械通气（13.7% 对 12%，P＜0.01）、VT（8.5% 对 2.2%，P＜0.001）和室颤（1.0% 对 0.25%，P＜0.001）的比例较高。院内死亡率、AKI 和 PE 的几率没有显著差异：结论：NICM病史不会影响COVID-19死亡率，但会增加心血管并发症的风险。

{"title":"Inpatient mortality and outcomes of COVID-19 among patients with non-ischemic cardiomyopathy: A propensity matched analysis.","authors":"Mirza Faris Ali Baig, Kalyan Chaliki","doi":"10.1016/j.hrtlng.2024.06.018","DOIUrl":"10.1016/j.hrtlng.2024.06.018","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic medical conditions, particularly cardiovascular diseases, are at a greater risk of adverse outcomes due to COVID-19. The effect of COVID-19 on patients with non-ischemic cardiomyopathy (NICM) is not known well.</p><p><strong>Objectives: </strong>To study the impact of COVID-19 infection on NICM hospital mortality and other outcomes.</p><p><strong>Methods: </strong>This study included a cohort of patients from the 2020 and 2021 National Inpatient Sample databases. Patients hospitalized for COVID-19 with and without NICM were matched using a 1:1 propensity score-matching ratio. Outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial infarction (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges.</p><p><strong>Results: </strong>A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %], predominantly white 1,456,203 (57.5 %); mean [SD] age 63 [5.4] years), including 64,155 (2.5 %) patients with a history of NICM. Following propensity matching, 10,258 COVID-19 patients with and without NICM were matched. Patients with NICM had higher rates of AMI (11.1 vs. 7.1 %, p < 0.001), cardiogenic shock (2 vs. 0.6 %, p < 0.001), cardiac arrest (4.4 vs. 3.2 %, p < 0.01), mechanical ventilation (13.7 vs 12 %, p < 0.01), VT (8.5 vs. 2.2 %, p < 0.001), and VF (1.0 vs 0.25 %, p < 0.001). The odds ratios for in-hospital mortality, AKI, and PE did not differ significantly.</p><p><strong>Conclusion: </strong>A History of NICM does not affect COVID-19 mortality but increases the risk of cardiovascular complications.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"160-165"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617687","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

Accelerated biological age mediates the associations between sleep patterns and chronic respiratory diseases: Findings from the UK Biobank Cohort 生物年龄的加速介导了睡眠模式与慢性呼吸系统疾病之间的关联：英国生物库队列研究结果。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-11-01 DOI: 10.1016/j.hrtlng.2024.10.012

Dongze Chen , Zekang Su , Yali Zhang , Yi Bai , Guiping Hu , Yi Zhou , Zhisheng Liang

Background

Unhealthy sleep patterns and accelerated biological age are frequently associated with multiple chronic respiratory diseases (CRDs), including COPD, asthma, and interstitial lung disease (ILD). However, few studies have explored the role of biological age in the relationship between sleep patterns and CRDs.

Objectives

To explore the association between sleep patterns and CRD, and the extent to which biological age mediates the relationship between sleep patterns and CRD.

Methods

This was a prospective cohort study based on UK Biobank. The sleep score was derived from five self-reported sleep traits: sleep duration, daytime sleepiness, chronotype, snoring, and insomnia. The score ranged from 0 (least healthy) to 5 (healthiest). Biological age was represented by PhenoAgeAccel.

Results

Among 303,588 participants, 11,105 (3.7 %), 9,380 (3.1 %), and 1,667 (0.5 %) were diagnosed with asthma, COPD, and ILD, respectively. Each 1-point increase in the sleep score was associated with a 0.156-year reduction in PhenoAgeAccel, and 14.3 %, 12.4 %, and 6.7 % reduction in asthma, COPD, and ILD, respectively. For each 1-year increase in PhenoAgeAccel, the risk of asthma, COPD, and ILD increased by 2.8 %, 4.3 %, and 5.7 %, respectively. PhenoAgeAccel mediated the associations between the sleep score and asthma, COPD, and ILD, with a mediated proportion (95 % CI) of 2.81 % (2.35 % to 3.27 %), 4.94 % (4.23 % to 5.66 %), and 12.48 % (10.43 % to 14.53 %), respectively.

Conclusion

A better sleep score was significantly associated with younger biological age and decreased risk of CRDs, with biological age playing a mediating role in the association between sleep score and CRDs.

背景：不健康的睡眠模式和加速的生理年龄往往与多种慢性呼吸系统疾病（CRD）有关，包括慢性阻塞性肺疾病、哮喘和间质性肺疾病（ILD）。然而，很少有研究探讨生理年龄在睡眠模式与慢性呼吸系统疾病之间关系中的作用：探讨睡眠模式与 CRD 之间的关系，以及生理年龄在多大程度上介导睡眠模式与 CRD 之间的关系：这是一项基于英国生物库的前瞻性队列研究。睡眠评分由五项自我报告的睡眠特征得出：睡眠时间、白天嗜睡、慢性型、打鼾和失眠。得分范围从 0（最不健康）到 5（最健康）。生物年龄由 PhenoAgeAccel 表示：在 303,588 名参与者中，分别有 11,105 人（3.7%）、9,380 人（3.1%）和 1,667 人（0.5%）被诊断患有哮喘、慢性阻塞性肺病和 ILD。睡眠评分每增加 1 分，PhenoAgeAccel 就会减少 0.156 年，哮喘、慢性阻塞性肺病和 ILD 就会分别减少 14.3%、12.4% 和 6.7%。PhenoAgeAccel 每增加 1 年，哮喘、慢性阻塞性肺病和 ILD 的风险分别增加 2.8%、4.3% 和 5.7%。PhenoAgeAccel介导了睡眠评分与哮喘、慢性阻塞性肺病和ILD之间的关联，介导比例（95 % CI）分别为2.81 %（2.35 %至3.27 %）、4.94 %（4.23 %至5.66 %）和12.48 %（10.43 %至14.53 %）：睡眠评分越高，生理年龄越小，罹患 CRD 的风险就越低，而生理年龄在睡眠评分与 CRD 的关系中起着中介作用。

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引用次数: 0

Inflammatory and cardiac biomarkers in pulmonary arterial hypertension: The prognostic role of IL-34 肺动脉高压的炎症和心脏生物标志物：IL-34 的预后作用

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-11-01 DOI: 10.1016/j.hrtlng.2024.10.010

Hasan Ata Bolayır , Mehdi Karasu MD , Mehmet Ali Gelen MD , Yusuf Akın MD , Erkan Çeçen MD , Uğur Küçük MD , Aykut Bulu MD

Background

Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary artery pressure with significant morbidity and mortality. Inflammatory processes are crucial in PAH pathogenesis, with inflammatory cells and mediators present early in disease progression. IL-34 involvement in inflammatory pathways suggests that IL-34 could be an important player in the progression of PAH, influencing both pulmonary pressures and vascular changes.

Objective

The purpose of this study was to investigate the correlation between IL-34 levels and pulmonary arterial hypertension (PAH), aiming to enhance the understanding of the molecular mechanisms underlying PAH and explore IL-34′s potential as a biomarker.

Methods

Consecutive PAH patients diagnosed via right-heart catheterization at Malatya Turgut Ozal Eğitim ve Araştırma Hastanesi (Dec 2022 - Apr 2024) were enrolled. Patients were classified into low-risk and high-risk groups based on comprehensive risk assessments that included clinical parameters, hemodynamic measurements and biomarkers, in-line with ESC/ERS guidelines. Serum IL-34, hs-CRP, and NT-proBNP levels were measured and compared with those of healthy controls. Echocardiographic assessments and statistical analyses, including ROC analysis, were conducted to evaluate biomarker significance and predictive capabilities.

Results

The mean age of low-risk and high-risk PAH patients was 42 ± 7.2 years and 45 ± 5.5 years, respectively. The mean age of the control group was 40 ± 6.4 years. Males comprised 54.29 % of the low-risk group, 56 % of the high-risk group, and 53.3 % of the control group. IL-34 and hs-CRP levels were significantly elevated in PAH patients compared to controls. IL-34 correlated positively with systolic pulmonary artery pressure, RA area, and NT-proBNP levels. Multivariate analysis revealed that IL-34 and hs-CRP were independent predictors of PAH. IL-34 levels>29.8 pg/mL predicted PAH with 78 % sensitivity and 69 % specificity, while levels >44.4 pg/mL predicted high-risk PAH with 84 % sensitivity and 77 % specificity.

Conclusion

Elevated IL-34 and hs-CRP levels are associated with PAH severity and right ventricular dysfunction, suggesting IL-34′s potential as a diagnostic and prognostic biomarker. Further research is needed to validate these findings and explore IL-34-targeted therapies in pH management.

背景：肺动脉高压（PAH）的特点是肺动脉压力增高，发病率和死亡率都很高。炎症过程在 PAH 的发病机制中至关重要，炎症细胞和介质出现在疾病进展的早期。IL-34 参与炎症通路表明，IL-34 可能是 PAH 进展过程中的一个重要角色，同时影响肺压和血管变化：本研究的目的是调查 IL-34 水平与肺动脉高压（PAH）之间的相关性，旨在加深对 PAH 潜在分子机制的理解，并探索 IL-34 作为生物标记物的潜力：马拉蒂亚-图尔古特-奥扎尔医院（Malatya Turgut Ozal Eğitim ve Araştırma Hastanesi）通过右心导管检查确诊的连续 PAH 患者（2022 年 12 月至 2024 年 4 月）。根据ESC/ERS指南，根据包括临床参数、血液动力学测量和生物标志物在内的综合风险评估，将患者分为低风险组和高风险组。测量血清IL-34、hs-CRP和NT-proBNP水平，并与健康对照组进行比较。进行了超声心动图评估和统计分析，包括 ROC 分析，以评估生物标志物的意义和预测能力：结果：低风险和高风险 PAH 患者的平均年龄分别为（42 ± 7.2）岁和（45 ± 5.5）岁。对照组的平均年龄为 40 ± 6.4 岁。男性在低危组中占 54.29%，在高危组中占 56%，在对照组中占 53.3%。与对照组相比，PAH 患者的 IL-34 和 hs-CRP 水平明显升高。IL-34 与肺动脉收缩压、RA 面积和 NT-proBNP 水平呈正相关。多变量分析显示，IL-34 和 hs-CRP 是 PAH 的独立预测因子。IL-34水平>29.8 pg/mL可预测PAH，灵敏度为78%，特异度为69%；IL-34水平>44.4 pg/mL可预测高风险PAH，灵敏度为84%，特异度为77%：IL-34和hs-CRP水平升高与PAH严重程度和右心室功能障碍有关，这表明IL-34具有作为诊断和预后生物标志物的潜力。还需要进一步的研究来验证这些发现，并探索以IL-34为靶点的pH管理疗法。

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引用次数: 0

Time to death after compassionate extubation in medical and neuroscience intensive care units 在内科和神经科学重症监护病房实施体恤性拔管后的死亡时间

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-10-31 DOI: 10.1016/j.hrtlng.2024.10.005

Elaine Chen MD , Nicholas Kosinski BA , Ramandeep Kaur PhD

Background

Medical ICU (MICU) and neuroscience ICU (NSICU) populations undergoing compassionate extubation (CE) may have different characteristics that affect post-procedure outcomes.

Objectives

To contrast clinical characteristics and evaluate time to death (TTD) following CE in MICU and NSICU populations.

Methods

Single-center retrospective cohort study of patients who completed CE in a MICU or NSICU in 2021. Data were obtained by manual chart abstraction. A Mann-Whitney U test was used to compare characteristics between the clinical units.

Results

Fifty patients were included in the study, 27 were in the MICU and 23 in the NSICU. Median age was 68 years. Patients in the MICU had a longer LOS before CE than those in the NSICU (10.0 vs. 3.0 days, p=0.001). Patients in the MICU experienced a shorter median TTD after CE than those in the NSICU (25 vs. 195 mins, p=0.004). MICU patients had a higher pre-hospital burden of illness (median CCI 6 vs 3, p=0.003), and a higher degree of organ failure at CE (median SOFA 12 vs 6, p<0.001), with more severe hypoxemia (PaO2/FiO2 ratio of 149 vs 360, p<0.001). Most MICU patients died of infection or cancer, compared with NSICU patients who had intracranial hemorrhage or ischemic stroke.

Conclusion

Patients in the NSICU underwent CE after shorter time in the ICU and survived longer afterwards than MICU patients. Patients in the MICU have a higher pre-hospital severity of illness and a higher level of organ failure at the time of CE compared with NSICU patients.

背景医疗重症监护室（MICU）和神经科学重症监护室（NSICU）接受体恤性拔管（CE）的人群可能具有不同的特征，从而影响术后结果。方法对 2021 年在 MICU 或 NSICU 完成 CE 的患者进行单中心回顾性队列研究。数据通过人工抽取病历获得。结果研究共纳入 50 名患者，其中 27 名在 MICU，23 名在 NSICU。中位年龄为 68 岁。MICU患者的CE前住院时间比NSICU患者长（10.0天对3.0天，P=0.001）。MICU患者在CE后的中位TTD比NSICU患者短（25分钟对195分钟，P=0.004）。MICU 患者的院前疾病负担较重（中位数 CCI 为 6 vs 3，p=0.003），CE 时器官衰竭程度较高（中位数 SOFA 为 12 vs 6，p<0.001），低氧血症更为严重（PaO2/FiO2 比率为 149 vs 360，p<0.001）。与颅内出血或缺血性中风的 NSICU 患者相比，大多数 MICU 患者死于感染或癌症。与 NSICU 患者相比，MICU 患者入院前的病情严重程度更高，CE 时的器官衰竭程度更高。

{"title":"Time to death after compassionate extubation in medical and neuroscience intensive care units","authors":"Elaine Chen MD , Nicholas Kosinski BA , Ramandeep Kaur PhD","doi":"10.1016/j.hrtlng.2024.10.005","DOIUrl":"10.1016/j.hrtlng.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Medical ICU (MICU) and neuroscience ICU (NSICU) populations undergoing compassionate extubation (CE) may have different characteristics that affect post-procedure outcomes.</div></div><div><h3>Objectives</h3><div>To contrast clinical characteristics and evaluate time to death (TTD) following CE in MICU and NSICU populations.</div></div><div><h3>Methods</h3><div>Single-center retrospective cohort study of patients who completed CE in a MICU or NSICU in 2021. Data were obtained by manual chart abstraction. A Mann-Whitney U test was used to compare characteristics between the clinical units.</div></div><div><h3>Results</h3><div>Fifty patients were included in the study, 27 were in the MICU and 23 in the NSICU. Median age was 68 years. Patients in the MICU had a longer LOS before CE than those in the NSICU (10.0 vs. 3.0 days, p=0.001). Patients in the MICU experienced a shorter median TTD after CE than those in the NSICU (25 vs. 195 mins, p=0.004). MICU patients had a higher pre-hospital burden of illness (median CCI 6 vs 3, p=0.003), and a higher degree of organ failure at CE (median SOFA 12 vs 6, p<0.001), with more severe hypoxemia (PaO2/FiO2 ratio of 149 vs 360, p<0.001). Most MICU patients died of infection or cancer, compared with NSICU patients who had intracranial hemorrhage or ischemic stroke.</div></div><div><h3>Conclusion</h3><div>Patients in the NSICU underwent CE after shorter time in the ICU and survived longer afterwards than MICU patients. Patients in the MICU have a higher pre-hospital severity of illness and a higher level of organ failure at the time of CE compared with NSICU patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 185-191"},"PeriodicalIF":2.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561378","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

Lived experiences of persons with heart transplantation: A systematic literature review and meta-synthesis 心脏移植患者的生活经历：系统性文献综述和元综合

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-10-30 DOI: 10.1016/j.hrtlng.2024.10.013

Safae Nour El Hadi RN, MSc , Renzo Zanotti RN, PhD , Matteo Danielis RN, PhD

Background

Heart transplantation (HT) recipients often report improved quality of life and increased overall happiness, viewing the transplantation as a rebirth and a second chance at life. However, interpretations of normality vary among individuals. Understanding patients' and caregivers’ experiences in depth is crucial to adjust clinical care paths and avoid complications.

Objective

To examine the experiences of patients and caregivers after cardiac transplantation.

Methods

A systematic search of the literature was performed from January 1, 2013, to September 30, 2023, using the MEDLINE (PubMed), CINHAL (EBSCO), SCOPUS, Web of Science, and Embase (OVID) databases. Full-text, primary qualitative articles written in English, which reported patients’ experiences of daily life after HT, were included.

Results

The search yielded 5,114 articles; 13 articles that fully met the inclusion criteria were selected for extraction and synthesis. The inductive approach led to the identification of 28 codes, which were then grouped into seven categories and three themes: 1) Undergoing an emotionally charged journey, 2) Balancing personal health and social dynamics, and 3) Fostering existential reflection.

Conclusions

This review underscores the importance of further research and the development of a standardized assessment framework for post-HT patients, emphasizing the need to consider not just clinical factors but also psychological and personal aspects to improve outcomes and quality of life. Additionally, the review identified a lack of comprehensive information about the experiences of caregivers, highlighting the need for further studies to better understand and support their roles in the post-transplant journey.

背景心脏移植（HT）受者通常表示生活质量得到改善，整体幸福感增加，将移植视为重生和第二次生命的机会。然而，每个人对正常生活的理解各不相同。深入了解患者和护理人员的经历对于调整临床护理路径和避免并发症至关重要。方法从 2013 年 1 月 1 日至 2023 年 9 月 30 日，使用 MEDLINE (PubMed)、CINHAL (EBSCO)、SCOPUS、Web of Science 和 Embase (OVID) 数据库对文献进行了系统检索。结果共检索到 5,114 篇文章，其中 13 篇完全符合纳入标准，被选中进行提取和综合。通过归纳法确定了 28 个代码，然后将其归纳为七个类别和三个主题：1）经历一段充满情感的旅程；2）平衡个人健康和社会动态；3）促进存在主义反思。结论本综述强调了进一步研究和开发针对 HT 术后患者的标准化评估框架的重要性，强调不仅要考虑临床因素，还要考虑心理和个人方面，以改善预后和生活质量。此外，综述还发现缺乏有关护理人员经历的全面信息，这突出表明有必要开展进一步研究，以更好地了解和支持护理人员在移植后历程中的作用。

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引用次数: 0

Impact of day of admission on patients admitted with complete heart block: Analyzing the weekend effect 入院日期对完全性心脏传导阻滞患者的影响：分析周末效应

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-10-30 DOI: 10.1016/j.hrtlng.2024.10.007

Nahush Roop Bansal , Abdulmajeed Alharbi , Shahnaz Rehman , Ragheb Assaly

Background

Complete heart block (CHB) is a conduction disorder that can be fatal if not treated promptly. Admission on a week or weekend day may influence the outcomes of cardiac emergencies, such as CHB.

Objectives

The purpose of this study was to determine the effects of weekday vs. weekend admissions in terms of CHB outcomes.

Methods

A retrospective cohort study was conducted using the National Inpatient Sample database to study the outcomes of adult patients admitted with complete heart block. Outcomes were compared between the patients admitted on weekends (midnight Friday to midnight Sunday) and weekdays.

Results

Thirty-four thousand three hundred ninety-five patients were included, of which 7350 (21.37 %) were admitted on weekends. Mean age for included patients was 75.69 years, with 43.23 % females. Compared to those admitted on weekdays, participants admitted on weekends had similar mortality (aOR 0.73; 95 % CI 0.46–1.16), longer length of stay (mean increase 0.74 days; P < 0.01) and higher hospital charges (mean increase $10,540.82; P < 0.01). Weekend admissions were associated with higher rates of cardiac arrest (adjusted OR 1.40; 95 % CI 1.07–1.84; P = 0.02) and higher rates of cardiogenic shock (adjusted OR 1.40; 95 % CI 1.07–1.83; P = 0.01) and similar rates of permanent pacemaker implantation (adjusted OR 0.88; 95 % CI 0.77–1.01; P = 0.06), but had longer delay to permanent pacemaker (mean increase 0.46 days; P < 0.01).

Conclusion

Hospital and administrative-level strategies are needed to address the differences between the weekend and weekday CHB admissions.

背景：完全性心脏传导阻滞（CHB完全性心脏传导阻滞（CHB）是一种传导障碍，如不及时治疗可能致命。在工作日或周末入院可能会影响心脏急症（如 CHB）的治疗效果：本研究旨在确定工作日与周末入院对 CHB 预后的影响：方法：利用全国住院病人抽样数据库进行了一项回顾性队列研究，以了解因完全性心脏传导阻滞而入院的成年病人的治疗效果。比较了周末（周五午夜至周日午夜）和工作日入院患者的治疗效果：共纳入 34395 名患者，其中 7350 人（21.37%）在周末入院。患者平均年龄为 75.69 岁，女性占 43.23%。与平日入院的患者相比，周末入院的患者死亡率相似（aOR 0.73；95 % CI 0.46-1.16），住院时间更长（平均增加 0.74 天；P < 0.01），住院费用更高（平均增加 10540.82 美元；P < 0.01）。周末入院与较高的心脏骤停发生率（调整后 OR 1.40；95 % CI 1.07-1.84；P = 0.02）和较高的心源性休克发生率（调整后 OR 1.40；95 % CI 1.07-1.83；P = 0.01），永久性心脏起搏器植入率相似（调整后 OR 0.88；95 % CI 0.77-1.01；P = 0.06），但植入永久性心脏起搏器的延迟时间更长（平均增加 0.46 天；P < 0.01）：结论：需要在医院和管理层面制定策略，以解决周末和平日慢性阻塞性肺病入院率之间的差异。

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引用次数: 0

Co-morbidities and Disparities in Heart Failure Care, How Are We Doing? 心力衰竭护理中的共病和差异，我们做得如何？

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-10-29 DOI: 10.1016/j.hrtlng.2024.10.002

Linda Ordway MS, NP

引用次数: 0