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).
{"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}
Pub Date : 2025-11-29DOI: 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.
{"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 , Yahui Li , Jiapei Gao , Shenghu He , Li Zhu , 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}
Pub Date : 2025-11-28DOI: 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.
{"title":"New technology or tradition? A Bayesian meta-analysis of robotic vs. manual percutaneous coronary intervention","authors":"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","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}
Pub Date : 2025-11-27DOI: 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.
{"title":"Right ventricular strain as a predictor of surgical success in obstructive sleep apnea: Association with serum chemerin","authors":"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","doi":"10.1016/j.hrtlng.2025.11.019","DOIUrl":"10.1016/j.hrtlng.2025.11.019","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>Our aim is to investigate the effect of OSAS surgery on cardiac functions and serum chemerin levels in patients.</div></div><div><h3>Methods</h3><div>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 <em>a</em> ≥ 50 % reduction in the apnea–hypopnea index (AHI).</div></div><div><h3>Results</h3><div>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 %, <em>p</em> < 0.001; LV GLS: −21.28 ± 1.49 % to −22.74 ± 1.63 %, <em>p</em> < 0.001). Serum chemerin levels significantly decreased from 1320 (683–2530) pg/mL to 328 (66–6234) pg/mL (<em>p</em> = 0.024). AHI also decreased markedly (26.9 ± 16.4 to 16.1 ± 14.0, <em>p</em> < 0.001). In multivariate analysis, change in RV FWS independently predicted surgical success (OR 2.449, 95 % CI 1.361–4.408, <em>p</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 81-90"},"PeriodicalIF":2.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624711","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}
Pub Date : 2025-11-25DOI: 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}
Pub Date : 2025-11-23DOI: 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.
{"title":"Medication management, health outcomes, and economic burden of severe asthma stratified by asthma control levels","authors":"Ke Zhang , Xiaoning He , Jing Wu","doi":"10.1016/j.hrtlng.2025.11.013","DOIUrl":"10.1016/j.hrtlng.2025.11.013","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate the medication management, health outcomes, and economic burden of severe asthma across different control levels in China.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>A total of 2418 patients with severe asthma were identified. Inhaled corticosteroids/long-acting beta<sub>2</sub>-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, <em>p</em> = 0.000).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 66-73"},"PeriodicalIF":2.6,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598037","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}
Pub Date : 2025-11-22DOI: 10.1016/j.hrtlng.2025.11.010
Sang Hyuk Kim , Chin Kook Rhee , Won-Yeon Lee , Sang-Hoon Kim , Seong Yong Lim , Hye Yun Park , Hyoung Kyu Yoon , Kwang Ha Yoo , Kyung Hoon Min , Youlim Kim
Background
High blood eosinophil counts correlate with the risk of future exacerbations. It is uncertain whether this correlation is still valid even in stable chronic obstructive pulmonary disease (COPD) patients receiving optimal management.
Objectives
To evaluate whether increased blood eosinophil counts are associated with future exacerbation risk in stable COPD patients receiving dual bronchodilator use.
Methods
This study used data from the Korean COPD Subgroup Study (KOCOSS) cohort. Stable COPD was defined as experiencing fewer than two moderate or no severe exacerbations in the previous year. The exposure variable was blood eosinophil level, with a high level defined as ≥ 300 cells/μL. The primary and secondary outcomes were the moderate-to-severe and severe acute exacerbation of COPD (AECOPD). The risk of AECOPD was assessed using a multivariable Cox regression model.
Results
Over a median follow-up of 12 months (interquartile ranges, 6–24 months), the incidence of moderate-to-severe AECOPD was 16.5 %. In multivariable analysis, the risk of moderate-to-severe and severe AECOPD increased by 14 % and 27 % for every 100-cell/μL increase in blood eosinophil count (95 % CI: 1.00–1.30). Patients with a high eosinophil count also exhibited an increased risk of moderate-to-severe AECOPD compared to those without (adjusted hazard ratio [aHR] = 1.79, 95 % confidence interval [CI] = 1.05–3.03). Exploratory analyses showed that higher blood eosinophil counts were also associated with an increased the risk of severe AECOPD (aHR: 1.27, 95 % CI: 1.04–1.54).
Conclusions
Higher blood eosinophil counts were associated with an increased risk of AECOPD in stable COPD patients, even among those receiving dual bronchodilators.
{"title":"Blood eosinophil counts and exacerbation risk in stable COPD with ≤1 moderate exacerbation on dual bronchodilator therapy","authors":"Sang Hyuk Kim , Chin Kook Rhee , Won-Yeon Lee , Sang-Hoon Kim , Seong Yong Lim , Hye Yun Park , Hyoung Kyu Yoon , Kwang Ha Yoo , Kyung Hoon Min , Youlim Kim","doi":"10.1016/j.hrtlng.2025.11.010","DOIUrl":"10.1016/j.hrtlng.2025.11.010","url":null,"abstract":"<div><h3>Background</h3><div>High blood eosinophil counts correlate with the risk of future exacerbations. It is uncertain whether this correlation is still valid even in stable chronic obstructive pulmonary disease (COPD) patients receiving optimal management.</div></div><div><h3>Objectives</h3><div>To evaluate whether increased blood eosinophil counts are associated with future exacerbation risk in stable COPD patients receiving dual bronchodilator use.</div></div><div><h3>Methods</h3><div>This study used data from the Korean COPD Subgroup Study (KOCOSS) cohort. Stable COPD was defined as experiencing fewer than two moderate or no severe exacerbations in the previous year. The exposure variable was blood eosinophil level, with a high level defined as ≥ 300 cells/μL. The primary and secondary outcomes were the moderate-to-severe and severe acute exacerbation of COPD (AECOPD). The risk of AECOPD was assessed using a multivariable Cox regression model.</div></div><div><h3>Results</h3><div>Over a median follow-up of 12 months (interquartile ranges, 6–24 months), the incidence of moderate-to-severe AECOPD was 16.5 %. In multivariable analysis, the risk of moderate-to-severe and severe AECOPD increased by 14 % and 27 % for every 100-cell/μL increase in blood eosinophil count (95 % CI: 1.00–1.30). Patients with a high eosinophil count also exhibited an increased risk of moderate-to-severe AECOPD compared to those without (adjusted hazard ratio [aHR] = 1.79, 95 % confidence interval [CI] = 1.05–3.03). Exploratory analyses showed that higher blood eosinophil counts were also associated with an increased the risk of severe AECOPD (aHR: 1.27, 95 % CI: 1.04–1.54).</div></div><div><h3>Conclusions</h3><div>Higher blood eosinophil counts were associated with an increased risk of AECOPD in stable COPD patients, even among those receiving dual bronchodilators.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 60-65"},"PeriodicalIF":2.6,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589747","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}
Pub Date : 2025-11-21DOI: 10.1016/j.hrtlng.2025.11.009
Kelley M Anderson, Sarah E Schroeder, Robert J DiDomenico, Salvatore Carbone, Carol Barsness, Quin E Denfeld, Alexandra L McPherson, Amanda Bergeron, Windy W Alonso, Christine M Hallman, Carolyn Lekavich, Linda Rohyans
Cardiac cachexia is a complex and multifactorial syndrome in patients with heart failure (HF). Cardiac cachexia is associated with poor functional status, symptoms, increased hospitalizations, and psychosocial effects. Despite its significant association with morbidity and mortality, cardiac cachexia remains under-recognized and undertreated. This scientific statement provides a comprehensive overview of the contemporary understanding of cardiac cachexia by detailing the definition, prevalence, prognostic implications, mechanisms, clinical manifestations, diagnostic strategies, treatment modalities, and recommendations for future clinical and research considerations. The development of cardiac cachexia is an indication of advanced serious illness. Diagnostic challenges persist due to the heterogeneous condition of HF, fluid imbalances that may mask or mimic weight changes, and the lack of definitive diagnostic evaluation. While no standard treatment exists, a multidisciplinary approach combining nutritional support, physical activity, and pharmacologic management is recommended. Greater clinical awareness and early identification of cardiac cachexia are essential for improving outcomes in patients with HF. Future research recommendations include prioritizing clinical trials that specifically evaluate cardiac cachexia within the context of HF to develop comprehensive treatment strategies targeting catabolic and anabolic pathways, and the associated psychosocial manifestations of the conditions.
{"title":"Cardiac cachexia: A scientific statement from the American Association of Heart Failure Nurses (AAHFN).","authors":"Kelley M Anderson, Sarah E Schroeder, Robert J DiDomenico, Salvatore Carbone, Carol Barsness, Quin E Denfeld, Alexandra L McPherson, Amanda Bergeron, Windy W Alonso, Christine M Hallman, Carolyn Lekavich, Linda Rohyans","doi":"10.1016/j.hrtlng.2025.11.009","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2025.11.009","url":null,"abstract":"<p><p>Cardiac cachexia is a complex and multifactorial syndrome in patients with heart failure (HF). Cardiac cachexia is associated with poor functional status, symptoms, increased hospitalizations, and psychosocial effects. Despite its significant association with morbidity and mortality, cardiac cachexia remains under-recognized and undertreated. This scientific statement provides a comprehensive overview of the contemporary understanding of cardiac cachexia by detailing the definition, prevalence, prognostic implications, mechanisms, clinical manifestations, diagnostic strategies, treatment modalities, and recommendations for future clinical and research considerations. The development of cardiac cachexia is an indication of advanced serious illness. Diagnostic challenges persist due to the heterogeneous condition of HF, fluid imbalances that may mask or mimic weight changes, and the lack of definitive diagnostic evaluation. While no standard treatment exists, a multidisciplinary approach combining nutritional support, physical activity, and pharmacologic management is recommended. Greater clinical awareness and early identification of cardiac cachexia are essential for improving outcomes in patients with HF. Future research recommendations include prioritizing clinical trials that specifically evaluate cardiac cachexia within the context of HF to develop comprehensive treatment strategies targeting catabolic and anabolic pathways, and the associated psychosocial manifestations of the conditions.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582581","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}
Pub Date : 2025-11-21DOI: 10.1016/j.hrtlng.2025.11.008
Masood Azhar , Dorsa L. Majdpour , Sergio Enrique Mesa , Muni B. Rubens , Sandra Chaparro , Anshul Saxena , Venkataraghavan Ramamoorthy , Mukesh Roy , Javier Jimenez
Background
Coexisting interstitial lung disease (ILD) and pulmonary hypertension (PH) often results in poor outcomes.
Objectives
This study examines differences in US national hospitalization trends and outcomes between ILD with PH and PH alone using the National Inpatient Sample (NIS) database.
Methods
We conducted a retrospective analysis (2016–2021) of the NIS database identifying admissions of patients ≥18 years with PH-ILD and PH using ICD-10 codes. Main outcomes included in-hospital mortality rate, non-home discharge, prolonged hospital length of stay (LOS), mechanical ventilation, and vasopressor use. Logistic regression models evaluated predictors of adverse outcomes.
Results
A total of 6789 PH-ILD, and 11,863 PH admissions were analyzed. PH-ILD hospitalizations remained stable (3.2/100,000), while PH hospitalizations increased slightly (5.2 to 5.4/100,000). The adverse outcomes such as mortality rate (3.2 % versus 2.9 %, P < 0.001), disposition other than home (51.6 % versus 50.9 %, P < 0.001), prolonged hospital LOS (19.5 % versus 17.1 %, P < 0.001), mechanical ventilation (73 % versus 57.1 %, P < 0.001), and vasopressor use (57.4 % versus 41.8 %, P < 0.001) were significantly higher among those with PH-ILD, compared to PH. Logistics regression showed that PH-ILD admissions had significantly higher odds for mortality rate (aOR, 1.92, 95 % CI: 1.72–2.15, P < 0.001), disposition other than home (aOR, 1.71, 95 % CI: 1.41–1.98, P < 0.001), prolonged hospital LOS (aOR, 1.51, 95 % CI: 1.29–1.62, P < 0.001), mechanical ventilation (aOR, 2.01, 95 % CI: 1.79–2.38, P < 0.001), and vasopressor use (aOR, 1.87, 95 % CI: 1.66–2.09, P < 0.001).
Conclusion
In-hospital adverse outcomes were higher in hospitalizations with concomitant PH-ILD. This highlights the need to risk stratify patients with concomitant ILD and PH during any hospitalization.
{"title":"Hospital outcomes of interstitial lung disease with pulmonary hypertension patients versus pulmonary hypertension alone: results from the national inpatient sample (2016–2021)","authors":"Masood Azhar , Dorsa L. Majdpour , Sergio Enrique Mesa , Muni B. Rubens , Sandra Chaparro , Anshul Saxena , Venkataraghavan Ramamoorthy , Mukesh Roy , Javier Jimenez","doi":"10.1016/j.hrtlng.2025.11.008","DOIUrl":"10.1016/j.hrtlng.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Coexisting interstitial lung disease (ILD) and pulmonary hypertension (PH) often results in poor outcomes.</div></div><div><h3>Objectives</h3><div>This study examines differences in US national hospitalization trends and outcomes between ILD with PH and PH alone using the National Inpatient Sample (NIS) database.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis (2016–2021) of the NIS database identifying admissions of patients ≥18 years with PH-ILD and PH using ICD-10 codes. Main outcomes included in-hospital mortality rate, non-home discharge, prolonged hospital length of stay (LOS), mechanical ventilation, and vasopressor use. Logistic regression models evaluated predictors of adverse outcomes.</div></div><div><h3>Results</h3><div>A total of 6789 PH-ILD, and 11,863 PH admissions were analyzed. PH-ILD hospitalizations remained stable (3.2/100,000), while PH hospitalizations increased slightly (5.2 to 5.4/100,000). The adverse outcomes such as mortality rate (3.2 % versus 2.9 %, <em>P</em> < 0.001), disposition other than home (51.6 % versus 50.9 %, <em>P</em> < 0.001), prolonged hospital LOS (19.5 % versus 17.1 %, <em>P</em> < 0.001), mechanical ventilation (73 % versus 57.1 %, <em>P</em> < 0.001), and vasopressor use (57.4 % versus 41.8 %, <em>P</em> < 0.001) were significantly higher among those with PH-ILD, compared to PH. Logistics regression showed that PH-ILD admissions had significantly higher odds for mortality rate (aOR, 1.92, 95 % CI: 1.72–2.15, <em>P</em> < 0.001), disposition other than home (aOR, 1.71, 95 % CI: 1.41–1.98, <em>P</em> < 0.001), prolonged hospital LOS (aOR, 1.51, 95 % CI: 1.29–1.62, <em>P</em> < 0.001), mechanical ventilation (aOR, 2.01, 95 % CI: 1.79–2.38, <em>P</em> < 0.001), and vasopressor use (aOR, 1.87, 95 % CI: 1.66–2.09, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>In-hospital adverse outcomes were higher in hospitalizations with concomitant PH-ILD. This highlights the need to risk stratify patients with concomitant ILD and PH during any hospitalization.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 55-59"},"PeriodicalIF":2.6,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579884","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}
Pub Date : 2025-11-17DOI: 10.1016/j.hrtlng.2025.11.012
Lynn F. Reinke , Rachael Alexander , Eli Iacob , Mike Hollingshaus , Paula Meek , Caroline Stephens
Background
Heart failure (HF) and chronic obstructive pulmonary disease (COPD), are highly prevalent, thus reducing burdensome end-of-life (EOL) care is critical. Families play a key role at EOL, yet most studies focus on the primary caregiver role. Little is known about the effect of the family network on EOL utilization.
Objective(s)
To examine whether family availability and relationship type are associated with hospitalizations and ED rates in the last six months of life among decedents with HF, COPD, or both.
Methods
Using a Utah population dataset, we conducted a retrospective cohort analysis of 60,142 adults aged ≥55 who died, categorized into three diagnostic groups: HF only(n = 51,222), HF+COPD(n = 8069), and COPD only(n = 851). “Family availability” is defined as having ≥1 first-degree relative residing in Utah at death (n = 210,213). Negative binomial regression models, adjusted for sociodemographic and clinical covariates, estimated associations between diagnosis, family type, and hospitalization and ED rates.
Results
Nearly 80 % of decedents had ≥1 hospitalization and 38.9 % had ≥1 ED visit. In adjusted models, diagnosis did not significantly affect utilization. Spouse-only decedents had the highest ED visits (41.8 %; IRR 1.07[1.02–1.12]) and spousal presence was associated with hospitalizations (82.4 %; IRR 1.05[1.02–1.07] and 80.3 %; IRR 1.04[1.02–1.06]) respectively compared to those without family.
Conclusions
Spousal presence was associated with higher ED visits and hospitalization rates among HF and/or COPD decedents. Because linkage indicates geographic presence rather than confirmed caregiving, these findings should be interpreted cautiously. Further research should focus on equipping family members with palliative care skills to optimize EOL care.
{"title":"End-of-life care utilization of older adults with heart failure and/or COPD: the role of family availability","authors":"Lynn F. Reinke , Rachael Alexander , Eli Iacob , Mike Hollingshaus , Paula Meek , Caroline Stephens","doi":"10.1016/j.hrtlng.2025.11.012","DOIUrl":"10.1016/j.hrtlng.2025.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) and chronic obstructive pulmonary disease (COPD), are highly prevalent, thus reducing burdensome end-of-life (EOL) care is critical. Families play a key role at EOL, yet most studies focus on the primary caregiver role. Little is known about the effect of the family network on EOL utilization.</div></div><div><h3>Objective(s)</h3><div>To examine whether family availability and relationship type are associated with hospitalizations and ED rates in the last six months of life among decedents with HF, COPD, or both.</div></div><div><h3>Methods</h3><div>Using a Utah population dataset, we conducted a retrospective cohort analysis of 60,142 adults aged ≥55 who died, categorized into three diagnostic groups: HF only(<em>n</em> = 51,222), HF+COPD(<em>n</em> = 8069), and COPD only(<em>n</em> = 851). “Family availability” is defined as having ≥1 first-degree relative residing in Utah at death (<em>n</em> = 210,213). Negative binomial regression models, adjusted for sociodemographic and clinical covariates, estimated associations between diagnosis, family type, and hospitalization and ED rates.</div></div><div><h3>Results</h3><div>Nearly 80 % of decedents had ≥1 hospitalization and 38.9 % had ≥1 ED visit. In adjusted models, diagnosis did not significantly affect utilization. Spouse-only decedents had the highest ED visits (41.8 %; IRR 1.07[1.02–1.12]) and spousal presence was associated with hospitalizations (82.4 %; IRR 1.05[1.02–1.07] and 80.3 %; IRR 1.04[1.02–1.06]) respectively compared to those without family.</div></div><div><h3>Conclusions</h3><div>Spousal presence was associated with higher ED visits and hospitalization rates among HF and/or COPD decedents. Because linkage indicates geographic presence rather than confirmed caregiving, these findings should be interpreted cautiously. Further research should focus on equipping family members with palliative care skills to optimize EOL care.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"76 ","pages":"Pages 47-54"},"PeriodicalIF":2.6,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551836","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}
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