Heart & Lung最新文献

{"title":"Short-term effects of positive end-expiratory pressure titration strategies on lung clinical markers in COVID-19: A randomized controlled trial","authors":"Wagner Souza Leite PT. MSc ,&nbsp;Shirley Lima Campos Ph.D. ,&nbsp;Caio César Araújo Morais Ph.D. ,&nbsp;Romulo Aquino PT. MSc ,&nbsp;Emanuel Fernandes Ferreira da Silva Júnior PT. MSc ,&nbsp;Saulo Jose da Costa Feitosa MD. MSc ,&nbsp;Marianna De Fátima Araújo De Melo PT. BSc ,&nbsp;Débora Sidrônio Caetano PT. MSc ,&nbsp;Thayse Neves Santos Silva PT. MSc ,&nbsp;Marcelo Brito Passos Amato MD. PhD ,&nbsp;Daniella Cunha Brandão PT. PhD ,&nbsp;Armele Dornelas de Andrade PT. PhD","doi":"10.1016/j.hrtlng.2025.11.024","DOIUrl":"10.1016/j.hrtlng.2025.11.024","url":null,"abstract":"<div><h3>Background</h3><div>Severe acute respiratory failure from COVID-19 is associated with high mortality. Optimal positive end-expiratory pressure (PEEP) titration is essential for lung-protective ventilation; however, different strategies may elicit distinct clinical responses.</div></div><div><h3>Objective</h3><div>To compare the short-term effects of three PEEP titration strategies on lung injury score (LIS), changes in oxygenation, respiratory mechanics, and electrical impedance tomography (EIT) measures in mechanically ventilated patients with COVID-19.</div></div><div><h3>Methods</h3><div>In this randomized, parallel-group trial, 75 intubated patients were randomly assigned to EIT-guided PEEP (PEEP-EIT), driving pressure-guided PEEP (PEEP-DP), or ARDSNet-based PEEP (PEEP-ARDSNet). Primary outcome was change in lung injury score (LIS); secondary outcomes included PaO₂/FiO₂ ≥ 150 mmHg, PaO₂/FiO₂ response ≥ 20 mmHg, driving pressure reduction, compliance increase, EIT-based regional ventilation and aeration, and adverse events within a four-hour follow-up.</div></div><div><h3>Results</h3><div>Mean PEEP levels differed across groups: PEEP-EIT (13.3 cmH₂O), PEEP-DP (10.6 cmH₂O), and ARDSNet (12 cmH₂O). PEEP-EIT showed greater LIS reduction (OR_weighted 3.7, 1.58 - 8.57; <em>p</em> = 0.004) and higher odds of oxygenation response vs. PEEP-DP (OR_weighted 4.2, 2.15 – 8.27; <em>p</em> &lt; 0.01) and PEEP-ARDSNet (OR_weighted 3.6, 1.8- 7.1; <em>p</em> &lt; 0.001). Both PEEP-EIT and PEEP-DP significantly improved driving pressure (PEEP-EIT: OR_weighted 6.6, 2.6- 17.07; PEEP-DP: OR_weighted 7.02, 2.7 - 18.2) and compliance (PEEP-EIT: OR_weighted 9.5, 3.7- 24.33; PEEP-DP: OR_weighted 5.94, 2.28 - 15.5) compared to PEEP-ARDSNet (<em>p</em> &lt; 0.001 for both comparisons). No adverse events related to PEEP titration were reported.</div></div><div><h3>Conclusion</h3><div>EIT-guided PEEP titration outperformed ARDSNet and DP-guided strategies in reducing lung injury and improving compliance and oxygenation in patients with COVID-19.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 154-163"},"PeriodicalIF":2.6,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716732","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}

{"title":"Exercise motivation mediates the relationship between basic psychological needs and exercise adherence in older adults with coronary heart disease","authors":"Zhiyue Li ,&nbsp;Xinxin Li ,&nbsp;Xincan Zhou ,&nbsp;Xinying Song ,&nbsp;Jianke Lei ,&nbsp;Weihong Zhang","doi":"10.1016/j.hrtlng.2025.11.018","DOIUrl":"10.1016/j.hrtlng.2025.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Community-dwelling older adults with coronary heart disease (CHD) exhibit low adherence to exercise regimens. Exercise aids in secondary prevention, yet adherence remains low.</div></div><div><h3>Objectives</h3><div>Guided by self-determination theory (SDT), this study aimed to investigate the current status of exercise adherence and its associated factors among older adult patients with coronary heart disease who reside in the community and to explore the interconnections among exercise motivation, basic psychological needs for exercise, and exercise adherence.</div></div><div><h3>Methods</h3><div>A cross-sectional study of 207 community-dwelling older adults with CHD was conducted from communities in Zhengzhou City between February and May 2023. Data were collected using validated instruments, including the General Information Questionnaire, Exercise Adherence Questionnaire, Psychological Needs Satisfaction in Exercise Scale (PNSE), Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2), and Control Attitudes Scale-Revised (CAS-R).</div></div><div><h3>Results</h3><div>Exercise adherence was moderate (<em>M</em> = 24.02, <em>SD</em> = 5.74). Key predictors included monthly income (≥3000 CNY), exercise frequency, basic psychological needs, autonomous motivation, and perceived control (<em>p</em> &lt; 0.05). Basic psychological needs directly predicted exercise adherence (<em>β</em> = 0.257, <em>p</em> &lt; 0.001) and indirectly via exercise motivation (indirect effect = 0.323, 95% CI [0.240, 0.416]), accounting for 55.7% of the total effect.</div></div><div><h3>Conclusion</h3><div>Basic psychological needs for exercise had a predictive direct impact on the exercise adherence of community-dwelling older adults with coronary heart disease. It is possible to improve exercise adherence by intervening in patients’ exercise motivation and basic psychological needs for exercise.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 147-153"},"PeriodicalIF":2.6,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716740","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}

{"title":"Prediction of weaning in mechanically ventilated sepsis patients using interpretable machine learning methods","authors":"Wei Song ,&nbsp;Guolong Cai ,&nbsp;Caibao Hu","doi":"10.1016/j.hrtlng.2025.11.021","DOIUrl":"10.1016/j.hrtlng.2025.11.021","url":null,"abstract":"<div><h3>Background</h3><div>Weaning from mechanical ventilation remains a critical challenge in intensive care units. Machine learning has shown potential in supporting clinical decisions during this process.</div></div><div><h3>Objective</h3><div>Sepsis frequently leads to ALI/ARDS, requiring mechanical ventilation. However, with evolving definitions of weaning, many existing predictive models have become outdated. This study aimed to develop a predictive model based on the standardized WIND framework to accurately predict successful weaning in septic patients under current clinical practices.</div></div><div><h3>Methods</h3><div>Data from the MIMIC-IV database were analyzed. Univariate analysis identified risk factors for extubation outcomes, and feature selection was performed using LASSO regression with 10-fold cross-validation and recursive feature elimination (RFE). Predictive models, including XGB, RF, and GBM, were evaluated based on AUC and F1 score. SHAP values were used to assess feature importance.</div></div><div><h3>Results</h3><div>A total of 3774 patients were included. Univariate analysis showed that the failed weaning group had longer ICU stays, higher ventilator settings, and elevated levels of blood urea nitrogen, blood glucose, creatinine, SOFA scores, lactate, and platelet count (<em>P</em> &lt; 0.05). Feature selection reduced 46 variables to 12 key predictors. The XGB model performed best, with AUC values of 0.849, 0.838, and 0.825 for the training, internal, and external cohorts, respectively. SHAP analysis identified mean airway pressure, ICU length of stay, and lactate as the most influential predictors.</div></div><div><h3>Conclusion</h3><div>We developed an interpretable, accurate XGB-based model to predict weaning outcomes in septic patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 139-146"},"PeriodicalIF":2.6,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693550","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}

{"title":"Navigating uncertainty and vulnerability: Cardiac nurses' perspectives on providing palliative care for patients with late-stage heart failure","authors":"Maiken Jørgensen RN, MSc ,&nbsp;Britt Borregaard RN, MPQM, PhD ,&nbsp;Tiny Jaarsma RN, MScN, PhD ,&nbsp;Ida Elisabeth Højskov RN, MScN, PhD ,&nbsp;Malene Kaas Larsen RN, MScN, PhD","doi":"10.1016/j.hrtlng.2025.102686","DOIUrl":"10.1016/j.hrtlng.2025.102686","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>This study examines the experiences of cardiac nurses in providing palliative care to patients with heart failure in the late palliative phase.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102686"},"PeriodicalIF":2.6,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685776","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}

{"title":"Effects of respiratory muscle training in patients with interstitial lung diseases: Systematic review","authors":"Bilge Gore PT, MSc,&nbsp;Aynur Demirel PhD","doi":"10.1016/j.hrtlng.2025.11.023","DOIUrl":"10.1016/j.hrtlng.2025.11.023","url":null,"abstract":"<div><h3>Background</h3><div>Inspiratory muscle training <strong>(</strong>IMT) is a component of the pulmonary rehabilitation(PR) program for patients with chronic lung disease.</div></div><div><h3>Objectives</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 132-138"},"PeriodicalIF":2.6,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693551","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}

{"title":"Identifying the self-management strategies of people with chronic obstructive pulmonary disease in their daily lives: A qualitative survey","authors":"Eline te Braake ,&nbsp;Christiane Grünloh ,&nbsp;Monique Tabak","doi":"10.1016/j.hrtlng.2025.11.022","DOIUrl":"10.1016/j.hrtlng.2025.11.022","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 124-131"},"PeriodicalIF":2.6,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679675","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}

{"title":"Effects of chest wall loading in supine position on respiratory mechanics in low-compliance ARDS patients","authors":"Wenwen Yan ,&nbsp;Li Peng ,&nbsp;Jian Zhang ,&nbsp;Zheng Liu ,&nbsp;Heling Zhao","doi":"10.1016/j.hrtlng.2025.11.006","DOIUrl":"10.1016/j.hrtlng.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the effects of acute chest wall loading on respiratory mechanics in patients with low-compliance ARDS.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Chest wall loading significantly improved respiratory system compliance (median increase 4.8 mL/cmH2O, <em>P</em> &lt; 0.001) and reduced both plateau pressure (median decrease 2.1 cmH2O, <em>P</em> &lt; 0.001) and driving pressure (median decrease 2.3 cmH2O, <em>P</em> &lt; 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, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"98"},"PeriodicalIF":2.6,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624710","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}

{"title":"Hyperdynamic left ventricular ejection fraction as a predictor of mortality in intensive care unit patients with septic shock","authors":"Doaa Saeed Mohamed Hedia,&nbsp;Hoda Omar Mahmoud,&nbsp;Amr Mohamed AbdelFattah,&nbsp;Ehab Hamed AbdelSalam,&nbsp;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}

{"title":"Development and validation of a machine learning-based predictive model for coronary heart disease risk in middle-aged and young adults","authors":"Yifan Deng ,&nbsp;Yahui Li ,&nbsp;Jiapei Gao ,&nbsp;Shenghu He ,&nbsp;Li Zhu ,&nbsp;Jing Zhang","doi":"10.1016/j.hrtlng.2025.11.016","DOIUrl":"10.1016/j.hrtlng.2025.11.016","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 113-123"},"PeriodicalIF":2.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624679","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}

{"title":"New technology or tradition? A Bayesian meta-analysis of robotic vs. manual percutaneous coronary intervention","authors":"Paweł Łajczak ,&nbsp;Ayesha Ayesha ,&nbsp;Ogechukwu Obi ,&nbsp;Leo Noanh Consoli ,&nbsp;Oguz Kagan Sahin ,&nbsp;Sherif Eltawansy ,&nbsp;Faizan Ahmed ,&nbsp;Ilias Georgios Koziakas ,&nbsp;Luis Rene Puglla-Sanchez ,&nbsp;Anna Łajczak ,&nbsp;Stanisław Buczkowski ,&nbsp;Kamil Jóźwik ,&nbsp;Przemysław Nowakowski ,&nbsp;Michele Schincariol","doi":"10.1016/j.hrtlng.2025.11.017","DOIUrl":"10.1016/j.hrtlng.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>This meta-analysis aims to compare periprocedural outcomes of RB-PCI with those of CV-PCI using a Bayesian framework.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 91-97"},"PeriodicalIF":2.6,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624788","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}