Heart & Lung最新文献_第7页

Sedentary behavior and its determinants among Chinese older adults with hypertension: A cross-sectional study 中国老年高血压患者的久坐行为及其决定因素：一项横断面研究。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-17 DOI: 10.1016/j.hrtlng.2025.11.011

Yaping Deng MSN, RN , Junyan Zheng BSN, RN , Lengmeng Wang MSN, RN , Xi Cao PhD, RN (Associate Professor)

Background

Sedentary behavior is associated with poor health outcomes in elderly populations. However, the profile of sedentary behavior and its associated factors among older adults with hypertension—a subgroup particularly vulnerable to adverse health outcomes is less understood. It is crucial to identify these factors to develop effective interventions that improve health outcomes in this high-risk subgroup.

Objective

To investigate the sedentary behavior profile and its determinants in the elderly with hypertension.

Methods

This cross-sectional study included a total of 330 older adults (aged ≥ 60 years) with hypertension who were recruited from a tertiary hospital in Guangzhou from October 2022 to May 2023. Data on sedentary behavior, exercise self-efficacy, exercise social support, and community walking environment were collected in addition to sociodemographic and clinical data. Multiple linear regression analyses were performed to identify factors associated with sedentary behavior.

Results

The participants spent an average of 7.4 ± 1.86 hours/day engaged in sedentary behavior. Screen time was the most frequently reported sedentary activity, with an average of 4.3 ± 2.09 hours spent on screens per day. Multiple linear regression analysis revealed that exercise self-efficacy (B = -0.03, P < 0.001), exercise social support (B = -0.03, P = 0.001), community walking environment (B = -0.03, P = 0.045) were negatively associated with total sedentary time. Those who were male, had higher education levels, had uncontrolled blood pressure, and had more comorbidities reported more total sedentary time.

Conclusion

Sedentary behavior is highly prevalent among older adults with hypertension. Exercise self-efficacy, exercise social support, and the lack of a community walking environment were associated with sedentary time, which provides clues for developing targeted interventions to reduce sedentary time for this high-risk population.

背景：久坐行为与老年人健康状况不佳有关。然而，老年人高血压患者的久坐行为及其相关因素的概况-一个特别容易产生不良健康结果的亚组-尚不清楚。确定这些因素对于制定有效的干预措施以改善这一高危亚群的健康结果至关重要。目的：探讨老年高血压患者的久坐行为特征及其影响因素。方法：本横断面研究纳入了2022年10月至2023年5月在广州某三级医院招募的330名高血压老年人（年龄≥60岁）。除了社会人口学和临床数据外，还收集了久坐行为、运动自我效能、运动社会支持和社区步行环境的数据。进行多元线性回归分析以确定与久坐行为相关的因素。结果：参与者平均每天花7.4±1.86小时从事久坐行为。屏幕时间是最常见的久坐活动，平均每天花在屏幕上的时间为4.3±2.09小时。多元线性回归分析显示，运动自我效能感（B = -0.03, P < 0.001）、运动社会支持（B = -0.03, P = 0.001）、社区步行环境（B = -0.03, P = 0.045）与总久坐时间呈负相关。那些受教育程度较高、血压不受控制、有更多合并症的男性报告了更多的久坐时间。结论：久坐行为在老年高血压患者中非常普遍。运动自我效能感、运动社会支持和缺乏社区步行环境与久坐时间有关，这为开发有针对性的干预措施以减少这一高危人群的久坐时间提供了线索。

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引用次数: 0

Physiological assessment of left circumflex coronary artery. A bicentric validation and outcome study using μFR 左旋冠状动脉的生理评价。采用μFR进行双中心验证和结果研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-15 DOI: 10.1016/j.hrtlng.2025.11.002

Marouane Boukhris , Valentin Coussens , Adrien Jossart , Agostino Spanò , Giuseppe Colletti , Amine Mamoun Boutaleb , Pierre Chenard , Andrea Cianci , Gregor Leibundgut , Karim Benali , Antoine Da Costa , Victor Aboyans , Claudiu Ungureanu

Background

Lesions of the left circumflex artery (LCx) and its obtus marginal (OM) branches, are often challenging to assess physiologically by fractional flow reserve (FFR) due to anatomical and hemodynamic nuances. µFR is a virtual FFR analysis software based on a single angiographic view, and has been validated versus standard Quantitative Flow Reserve (QFR).

Objectives

We sought to assess the accuracy of μFR versus FFR and its prognostic impact in PCI within the LCx/OM territory.

Methods

A retrospective, international, bicentric study with corelab analysis was conducted, including patients who underwent either invasive physiological assessment or PCI of LCx and/or OM. Major adverse cardiac events (MACE) were defined as the composite of cardiovascular death and target vessel failure (myocardial infarction or revascularization related to the LCx/OM territory).

Results

A total of 432 patients (150 physiological assessment only and 282 PCI) were enrolled. Only 5.1 % of intermediate LCx/OM lesions were positive on FFR. Good correlation and agreement were found between μFR and FFR (R = 0.782, p < 0.001); mean difference: -0.029 ± 0.035, p = 0.301). Among patients who underwent LCx/OM PCI, only 18.8 % had positive μFR. Cardiovascular outcome was similar between patients with μFR positive and μFR negative LCx/OM lesions who underwent PCI. In patients with negative μFR, PCI did not impact MACE occurrence (HR 1.20, 95 %CI 0.41–3.23, p = 0.771).

Conclusion

µFR demonstrates good diagnostic agreement with invasive FFR for LCx/OM lesions. Most LCx/OM lesions treated with PCI were physiologically non-significant, and revascularization in this context did not improve clinical outcomes.

背景：由于解剖学和血流动力学的差异，左旋动脉（LCx）及其obtus边缘分支的病变通常难以通过分数血流储备（FFR）进行生理评估。µFR是一款基于单一血管造影视图的虚拟FFR分析软件，并已与标准定量血流储备（QFR）进行了验证。目的：我们试图评估μFR与FFR的准确性及其对LCx/OM范围内PCI预后的影响。方法采用回顾性、国际、双中心研究和相关实验室分析，纳入了行有创性生理评估或LCx和/或OM PCI的患者。主要心脏不良事件（MACE）定义为心血管死亡和靶血管衰竭（与LCx/OM区域相关的心肌梗死或血运重建术）的复合。结果共纳入432例患者，其中生理评估150例，PCI 282例。只有5.1%的中度LCx/OM病变FFR阳性。μFR与FFR具有良好的相关性和一致性（R = 0.782, p < 0.001）；平均差值：-0.029±0.035,p = 0.301)。在LCx/OM PCI患者中，仅有18.8%的患者μFR呈阳性。μFR阳性和μFR阴性LCx/OM病变行PCI后的心血管预后相似。在μFR阴性的患者中，PCI对MACE的发生无影响（HR 1.20, 95% CI 0.41 ~ 3.23, p = 0.771）。结论µFR与侵袭性FFR对LCx/OM病变的诊断具有良好的一致性。大多数PCI治疗的LCx/OM病变在生理上不显著，在这种情况下血运重建术并没有改善临床结果。

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引用次数: 0

Latent profile analysis and related factors of physical activity in older adults with chronic obstructive pulmonary disease 老年慢性阻塞性肺疾病患者体力活动的潜在特征分析及相关因素

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-14 DOI: 10.1016/j.hrtlng.2025.11.007

Xin-xin Wang , Wei-hong Zheng , Jing Zhang , Li-ling Xu , Yiliang Su , Jing Zhang , Min Xu

Background

Physical activity (PA) is an important non-pharmacological intervention that can slow the progression of Chronic Obstructive Pulmonary Disease (COPD). Unfortunately, PA levels in older adults with COPD remain low, and there is substantial heterogeneity within this population. Therefore, identifying potential subgroups is essential for developing targeted interventions.

Objectives

The purpose of this study is to identify latent profiles of PA, and explore the associated factors to inform personalized interventions for this population.

Methods

This multicenter cross-sectional study was conducted from November 2024 to March 2025 at a tertiary hospital and four community health service centers in the Changning District of Shanghai. The revised International Physical Activity Questionnaire—Long (IPAQ—L) was utilized to assess PA and sedentary behavior. Latent profile analysis (LPA) was employed to classify the subgroups, followed by multinomial logistic regression to explore influencing factors.

Results

A total of 423 older adults with COPD (male N = 383; aged 60–89) were included in this study. LPA identified three distinct PA profiles, named the “moderate activity-moderate sedentary-low barrier (C1) group”, the “low activity-high sedentary-high barrier (C2) group”, and the “high activity-low sedentary-moderate barrier (C3) group”. The factors were significantly associated with PA, including Body Mass Index (BMI), disease duration, number of hospitalizations, GOLD stage, COPD Assessment Test (CAT) score, exercise self-efficacy, and exercise social support (p < 0.05).

Conclusion

LPA identified three subgroups of PA in older adults with COPD. The results of this research will facilitate targeted interventions for each of the identified subgroups with distinct characteristics, thereby enhancing the management of COPD and reducing healthcare burdens.

背景：体力活动（PA）是一种重要的非药物干预措施，可以减缓慢性阻塞性肺疾病（COPD）的进展。不幸的是，老年COPD患者的PA水平仍然很低，并且在这一人群中存在很大的异质性。因此，确定潜在的亚群体对于制定有针对性的干预措施至关重要。目的：本研究的目的是确定PA的潜在特征，并探讨相关因素，为该人群提供个性化干预措施。方法：本研究于2024年11月至2025年3月在上海市长宁区1所三级医院和4所社区卫生服务中心进行。采用修订后的国际体育活动问卷（IPAQ-L）来评估PA和久坐行为。采用潜剖面分析（LPA）对亚组进行分类，并采用多项logistic回归分析影响因素。结果：本研究共纳入423例老年COPD患者（男性383例，年龄60-89岁）。LPA鉴定出三种不同的PA类型，分别命名为“中度活动-中度静坐-低屏障（C1）组”、“低活动-高静坐-高屏障（C2）组”和“高活动-低静坐-中等屏障（C3）组”。体重指数（BMI）、病程、住院次数、GOLD分期、COPD评估测试（CAT）评分、运动自我效能感、运动社会支持与PA有显著相关（p < 0.05）。结论：LPA确定了老年COPD患者PA的三个亚组。这项研究的结果将有助于针对具有不同特征的每个确定的亚组进行有针对性的干预，从而加强对COPD的管理并减轻医疗负担。

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引用次数: 0

Association of borderline pulmonary artery wedge pressure with major cardiovascular events in patients with pulmonary hypertension and chronic kidney disease 肺动脉边缘楔压与肺动脉高压和慢性肾病患者主要心血管事件的关系

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-14 DOI: 10.1016/j.hrtlng.2025.11.003

Jose Manuel Martinez Manzano MD , Esteban Kosak Lopez MD , Andrew Geller DO , Phuuwadith Wattanachayakul MD , John Malin DO , Raul Leguizamon MD , Tara A John MD , Michael Vera Ricaurte MD , Simone A. Jarrett MD , Kevin Bryan Lo MD, MSc , Christian Witzke MD

Background

Pulmonary hypertension (PH) is common among chronic kidney disease (CKD) patients. Early detection of postcapillary PH may help identify CKD patients at risk of adverse cardiovascular outcomes.

Objectives

To assess the clinical outcomes among patients with borderline pulmonary artery wedge pressure (PAWP) (12-15 mmHg).

Methods

This was a single-center retrospective cohort study of patients with CKD stages 3b, 4, and 5 who underwent right heart catheterization between 2018 and 2023. We excluded patients receiving dialysis. We stratified the data into 4 groups: group 1 (non-PH) and groups 2-4 (PAWP groups); group 2 (low PAWP [<12 mmHg]), group 3 (borderline PAWP [12-15 mmHg]), and group 4 (high PAWP [>15 mmHg]). We performed a multivariable analysis to determine if borderline PAWP was independently associated with 1-year major cardiovascular events (MACE).

Results

Of 406 CKD patients, 15 % (n = 59) had non-PH, 14 % (n = 55) had low PAWP, 14 % (n = 55) had borderline PAWP, and 58 % (n = 237) had elevated PAWP. The incidence of 1-year MACE in the non-PH group was 17 %, low PAWP group (31 %), borderline PAWP group (40 %), and high PAWP group (30 %). Among the borderline PAWP group, MACE were primarily driven by non-fatal heart failure exacerbations. Compared to the non-PH group, the borderline PAWP group had a greater risk of developing 1-year MACE (adjusted hazard ratio = 2.38, [95 % confidence interval 1.02-5.55], p = 0.044).

Conclusions

Borderline PAWP (12-15mmHg) is independently associated with MACE in PH-CKD patients. Early detection of postcapillary PH in CKD patients should prompt optimization of CV risk factors to potentially improve clinical outcomes.

背景：肺动脉高压（PH）在慢性肾脏疾病（CKD）患者中很常见。早期检测毛细血管后PH值可能有助于识别有心血管不良后果风险的CKD患者。目的：评价临界肺动脉楔压（PAWP）（12-15 mmHg）患者的临床结局。方法：这是一项单中心回顾性队列研究，研究对象是2018年至2023年间接受右心导管插入术的CKD 3b、4和5期患者。我们排除了接受透析的患者。我们将数据分为4组：1组（非ph组）和2-4组（PAWP组）；2组（低paap [15 mmHg]）。我们进行了多变量分析，以确定临界PAWP是否与1年主要心血管事件（MACE）独立相关。结果：406例CKD患者中，15% （n = 59）为非ph， 14% （n = 55）为低PAWP， 14% （n = 55）为临界PAWP， 58% （n = 237）为高PAWP。非ph组1年MACE发生率为17%，低paap组（31%），临界paap组（40%），高paap组（30%）。在临界paap组中，MACE主要由非致死性心力衰竭加重引起。与非ph组相比，临界paap组发生1年MACE的风险更高（校正风险比= 2.38，[95%可信区间1.02-5.55],p = 0.044）。结论：PH-CKD患者临界paap （12-15mmHg）与MACE独立相关。早期发现CKD患者的毛细血管后PH值应提示优化心血管危险因素，以潜在地改善临床结果。

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引用次数: 0

Board of Directors 董事会

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-14 DOI: 10.1016/S0147-9563(25)00249-3

引用次数: 0

Time from waking to first cigarette, genetic susceptibility, and the risk of COPD: A Prospective cohort study from UK Biobank 从醒来到吸第一支烟的时间、遗传易感性和COPD风险：来自UK Biobank的一项前瞻性队列研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-12 DOI: 10.1016/j.hrtlng.2025.11.005

Liu Qiqi , Liu Haoxiang , Wu Chuansha , Sun Xiaojie , Xiong Longzhu , Kong Chunxue , Ma Jixuan , Zhou Ting

Background

Smoking is a well-established risk factor for COPD, but the impact of time from waking to first cigarette (TWFC) remains underexplored, particularly regarding its interactions.

Objectives

We aim to investigate the TWFC-COPD association among current smokers and evaluate its interactions with genetic susceptibility, smoking pack-years and difficulty not smoking for one day (DNSD).

Methods

Using data from 302,412 UK Biobank participants, a COPD genetic risk score (GRS) was developed from 22 independent established SNPs associated with COPD and related phenotypes. Cox proportional hazards models was used to estimate adjusted hazard ratios (aHRs, 95% CIs), and assesse additive and multiplicative interactions.

Results

Over a median follow-up of 12.42 years, 13,131 incident COPD cases were identified. Compared with never smokers, current smokers exhibited a significant inverse gradient association between shorter TWFC and increased COPD risk (P trend<0.001), with aHRs (95% CIs) increasing from 4.18 (3.66–4.78) for TWFC >120 min to 8.76 (8.01–9.58) for TWFC <5 min. Compared to current smokers with TWFC >120 min and low genetic risk, those with the shortest TWFC (<5 min) and high genetic risk had the highest COPD risk (aHR=2.85, 95% CI: 2.34–3.46), with a tendency toward additive interaction (RERI=0.26, 95% CI: -0.06–0.58; AP=8%, 95% CI: -0.03–0.19). Similarly, TWFC <5 min combined with higher pack-years (aHR=3.08, 95% CI: 2.66–3.57) or greater DNSD (aHR=5.14, 95% CI: 4.22–6.25) elevated the risk, with significant additive interactions.

Conclusions

Shorter TWFC is strongly associated with increased COPD risk among current smokers, amplified by high genetic susceptibility to COPD, higher smoking pack-years, and greater DNSD.

背景：吸烟是COPD的一个公认的危险因素，但从醒来到第一支烟的时间（TWFC）的影响仍未得到充分研究，特别是其相互作用。目的：研究当前吸烟者中twfc与copd的相关性，并评估其与遗传易感性、吸烟包年和一天不吸烟困难（DNSD）的相互作用。方法：使用来自英国生物银行302412名参与者的数据，从22个与COPD和相关表型相关的独立已建立的snp中开发出COPD遗传风险评分（GRS）。Cox比例风险模型用于估计调整后的风险比（aHRs, 95% ci），并评估加性和乘性相互作用。结果：在中位随访12.42年期间，发现13131例COPD病例。与从不吸烟者相比，当前吸烟者在TWFC较短与COPD风险增加之间表现出显著的负相关梯度（P趋势为120分钟至8.76(8.01-9.58)），对于TWFC较短且遗传风险较低的吸烟者，TWFC较短与当前吸烟者COPD风险增加密切相关，并被COPD的高遗传易感性、较高的吸烟包年和更大的DNSD放大。

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引用次数: 0

Association of albumin with coronary plaque characteristics in patients with acute coronary syndrome: An optical coherence tomography study 白蛋白与急性冠脉综合征患者冠脉斑块特征的关系：一项光学相干断层扫描研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-08 DOI: 10.1016/j.hrtlng.2025.11.004

Yan Zhang , Ximei Liu , Kexin Song , Shuli Bi , Mingyang Li , Zhuhua Yao

Background

Serum albumin levels have been shown to be significantly associated with the incidence and prognosis of various cardiovascular conditions. Previous studies have indicated a close correlation between the characteristics of coronary artery plaques and the prognosis of patients with acute coronary syndrome (ACS). Objective: This study aimed to evaluate the relationship between serum albumin levels and coronary artery plaque characteristics in ACS patients.

Methods

This cross-sectional study examined patients with ACS who underwent percutaneous coronary intervention (PCI) and optical coherence tomography (OCT) evaluations. Serum albumin levels were analyzed alongside OCT imaging to assess coronary artery plaque features. Multivariable regression analysis, subgroup analysis and generalized additive models (GAM) and smooth curve fitting were conducted to analyze the potential relationship. Mediation analysis was conducted to explore the mediating effects of inflammation-related indicators on the associations of albumin with plaque calcification.

Results

In this study, we observed a significant negative correlation between albumin levels and the incidence of plaque calcification in ACS patients [OR=0.63, 95 % CI (0.53, 0.76)], while no significant differences were found in other plaque characteristics. Subgroup and interaction analyses confirmed the robustness of the findings. GAM and smooth curve fitting demonstrated a predominantly linear relationship between albumin and coronary artery plaque calcification. Lymphocytes and systemic immunity-inflammation index mediated 5.6 % and 8.8 %, respectively, of the association between albumin and calcification.

Conclusion

A negative association was observed between serum albumin and coronary artery plaque calcification in ACS patients. Larger prospective studies are warranted to validate these findings.

背景：血清白蛋白水平已被证明与各种心血管疾病的发病率和预后显著相关。既往研究表明，冠状动脉斑块的特征与急性冠脉综合征（ACS）患者的预后密切相关。目的：探讨ACS患者血清白蛋白水平与冠状动脉斑块特征的关系。方法本横断面研究调查了经皮冠状动脉介入治疗（PCI）和光学相干断层扫描（OCT）评估的ACS患者。分析血清白蛋白水平和OCT成像以评估冠状动脉斑块特征。采用多变量回归分析、亚组分析、广义加性模型（GAM）和光滑曲线拟合等方法分析两者之间的潜在关系。进行中介分析，探讨炎症相关指标对白蛋白与斑块钙化关联的中介作用。结果在本研究中，我们观察到白蛋白水平与ACS患者斑块钙化发生率呈显著负相关[OR=0.63, 95% CI(0.53, 0.76)]，而其他斑块特征无显著差异。亚组分析和相互作用分析证实了研究结果的稳健性。GAM和光滑曲线拟合显示白蛋白与冠状动脉斑块钙化之间主要呈线性关系。淋巴细胞和全身免疫炎症指数分别介导了白蛋白和钙化之间5.6%和8.8%的关联。结论ACS患者血清白蛋白与冠脉斑块钙化呈负相关。需要更大规模的前瞻性研究来验证这些发现。

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引用次数: 0

Prevalence and risk factors of recurrent respiratory infections in a low-and middle-income country: A cross-sectional study on immunodeficiency indicators 低收入和中等收入国家复发性呼吸道感染的患病率和危险因素：免疫缺陷指标的横断面研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-07 DOI: 10.1016/j.hrtlng.2025.11.001

Muhammad Muneeb Hassan , Muhammad Ameeq , Alpha Kargbo

Background

Recurrent respiratory infections (RRIs) pose a significant global health burden, particularly in immune-compromised individuals. Identifying the key risk factors is crucial for effective prevention and management.

Objective

This study aimed to assess the prevalence of recurrent respiratory infections (RRIs) and identify associated risk factors, including demographic, lifestyle, and clinical factors, with a focus on immunodeficiency indicators in a low- and middle-income country (LMIC) setting.

Methods

This cross-sectional study was conducted at the District Headquarters (DHQ) Hospital, Muzaffargarh, Pakistan. A total of 608 participants were selected using systematic random sampling. Data on demographics, lifestyle behaviors, clinical history, and immunodeficiency indicators were collected using a structured questionnaire. Multinomial logistic regression was used to analyze the risk factors associated with RRIs.

Results

RRIs were significantly associated with older age, male gender, and urban residence. Smoking (odds ratio [OR] = 2.554, p = 0.05), poor diet (OR = 0.895, p = 0.03), lack of physical activity (OR = 0.904, p = 0.01), and insufficient sleep (OR = 0.555, p = 0.06) increased the risk of infection. Chronic diseases (odds ratio [OR] = 1.379, p = 0.04), frequent antibiotic use (OR = 0.563, p = 0.02), and nutritional deficiencies (OR = 2.528, p = 0.04) were significant contributors.

Conclusion

RRIs are influenced by modifiable lifestyle and other clinical factors. Addressing smoking, diet, and chronic disease management can help to reduce its prevalence. Public health efforts should focus on preventive strategies, particularly in resource-limited settings.

背景：复发性呼吸道感染（RRIs）造成了重大的全球健康负担，特别是在免疫功能低下的人群中。确定关键风险因素对于有效预防和管理至关重要。本研究旨在评估复发性呼吸道感染（RRIs）的患病率，并确定相关的危险因素，包括人口统计学、生活方式和临床因素，重点关注中低收入国家（LMIC）的免疫缺陷指标。方法横断面研究在巴基斯坦Muzaffargarh地区总部（DHQ）医院进行。采用系统随机抽样的方法，选取608名参与者。采用结构化问卷收集人口统计数据、生活方式行为、临床病史和免疫缺陷指标。采用多项logistic回归分析与风险风险相关的危险因素。结果rris与年龄、男性、城市居住显著相关。吸烟（优势比[OR] = 2.554, p = 0.05）、饮食不良（OR = 0.895, p = 0.03）、缺乏体育锻炼（OR = 0.904, p = 0.01）、睡眠不足（OR = 0.555, p = 0.06）增加了感染风险。慢性疾病（优势比[OR] = 1.379, p = 0.04）、频繁使用抗生素（OR = 0.563, p = 0.02）和营养缺乏（OR = 2.528, p = 0.04）是显著的影响因素。结论rris受生活方式改变及其他临床因素的影响。解决吸烟、饮食和慢性病管理问题有助于降低其患病率。公共卫生工作应侧重于预防战略，特别是在资源有限的情况下。

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引用次数: 0

Sex differences in in-hospital outcomes following catheter-based pulmonary embolism thrombectomy: Insights from a National Cohort 基于导管的肺栓塞取栓术后住院结果的性别差异：来自国家队列的见解

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-05 DOI: 10.1016/j.hrtlng.2025.09.021

Montaser Elkholy MDMSc , Mohammad Akkawi MD , George G. Kidess , Zijin Lin , Ahmed K. Abdelrahman MD , Yousef Alsmairat MD , Yasemin Bahar MD , Zain UL Abideen Asad MDMS , M Chadi Alraies MDMPH

Background

Pulmonary embolism (PE) remains a significant cause of cardiovascular morbidity and mortality. Catheter-based PE thrombectomy has emerged as an important therapeutic option for high-risk PE patients. Still, sex-based disparities in the outcomes of this procedure are not well understood.

Objective

To evaluate sex-based differences in in-hospital outcomes among patients undergoing catheter-based PE thrombectomy.

Methods

A retrospective cohort analysis was conducted using National Inpatient Sample database. Adult patients who underwent catheter-based PE thrombectomy from January 1, 2018, to December 31, 2021, were included. Primary outcomes included in-hospital mortality, while secondary outcomes included complications such as acute kidney injury (AKI), bleeding, need for blood transfusion, and respiratory and vascular complications. Multivariate logistic regression was used to adjust for potential confounders.

Results

A total of 25,300 patients were included (11,680 females and 13,620 males). Females were older and had higher rates of obesity and anemia. In-hospital mortality was higher in females, but after multivariate adjustment, sex was not a significant independent predictor of mortality. Females had significantly higher odds of peri-procedural bleeding, while males had higher rates of AKI.

Conclusion

This study found significant sex-based differences in the in-hospital outcomes of PE thrombectomy. Female patients had higher rates of peri-procedural bleeding and lower rates of AKI, but no sex differences were observed in mortality after adjusting for confounders. Further studies are needed to explore the underlying mechanisms of these disparities and improve patients care.

背景：肺栓塞（PE）仍然是心血管疾病发病率和死亡率的重要原因。导管为基础的PE取栓已成为高风险PE患者的重要治疗选择。尽管如此，这种手术结果的性别差异还没有得到很好的理解。目的：评价基于导管的PE血栓切除术患者住院结局的性别差异。方法：采用全国住院患者样本数据库进行回顾性队列分析。纳入2018年1月1日至2021年12月31日接受导管PE取栓的成年患者。主要结局包括住院死亡率，次要结局包括急性肾损伤（AKI）、出血、需要输血以及呼吸和血管并发症等并发症。采用多元逻辑回归对潜在混杂因素进行校正。结果：共纳入25,300例患者（女性11,680例，男性13,620例）。女性年龄更大，肥胖和贫血的比例更高。女性住院死亡率较高，但在多变量调整后，性别不是死亡率的显著独立预测因子。女性术中出血的几率明显更高，而男性AKI的发生率更高。结论：本研究发现PE血栓切除术的住院结果存在显著的性别差异。女性患者术中出血发生率较高，AKI发生率较低，但在调整混杂因素后，在死亡率方面没有观察到性别差异。需要进一步的研究来探索这些差异的潜在机制，并改善患者的护理。

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引用次数: 0

Positive end-expiratory pressure optimization with esophageal pressure during prone position in severe acute respiratory distress syndrome: a physiologic study. 严重急性呼吸窘迫综合征俯卧位时呼气末正压优化与食管压：一项生理学研究。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-11-01 Epub Date: 2025-08-09 DOI: 10.1016/j.hrtlng.2025.07.020

Laure Crognier, Arthur Villain-Amirat, Jean-Marie Conil, Baptiste Compagnon, Emilie Chambon, Adam Tuijnman, Michaël Poëtte, Juliette Joseph, Stéphanie Ruiz, Vincent Minville, Fanny Vardon

Background: Protective ventilation [tidal volume at 6 ml/kg of predicted body weight, plateau pressure ≤ 30 cm H₂O, optimal positive end expiratory pressure (PEEP)] and prone position (PP) improved survival in acute respiratory distress syndrome (ARDS), PEEP improves alveolar recruitment but may generate overdistension, requiring specific monitoring. Esophageal pressure is used to estimate pleural pressure and to calculate the transpulmonary pressures. There are few data on PEEP variations and optimization during PP.

Objectives: To describe PEEP evolution through transpulmonary pressure monitoring during PP in severe ARDS patients.

Methods: Prospective observational study in severe ARDS needing prone positioning. An esophageal pressure catheter was placed in every patient to monitor transpulmonary pressure. The targets were an end-expiratory transpulmonary pressure (PLEE) between 0 and 2 cmH₂O and an end-inspiratory transpulmonary pressure (PLEI) < 25 cmH₂O. We described the evolution of ventilator parameters during PP.

Results: We included 35 patients with severe ARDS requiring prone positioning. Optimized PEEP decreased significantly during PP in the first eight hours then stabilized. We found significant interindividual variations. The transpulmonary pressures objectives were reached. PLEE measured before PEEP modification decreased significantly at H + 8.

Conclusion: Our study shows that optimized PEEP during PP varies mainly within the first 8 h. Monitoring transpulmonary pressures through an esophageal catheter throughout a PP session allows for PEEP optimization and ensures maximum recruitment and minimal overdistension.

Trial registration: RC 31/21/0514 - no 2021-A02752-39.

背景：保护性通气[6 ml/kg预测体重的潮气量，平台压≤30 cm H2O，最佳呼气末正压（PEEP）]和俯卧位（PP）可改善急性呼吸窘迫综合征（ARDS）的生存率，PEEP可改善肺泡恢复，但可能产生过度扩张，需要特异性监测。食道压力用于估计胸膜压力和计算经肺压力。目的：通过监测重症ARDS患者PP过程中经肺压力的变化来描述PEEP的演变。方法：对需要俯卧位的重症ARDS患者进行前瞻性观察研究。每个病人都放置了食管压力导管来监测肺压。目标是呼气末转肺压（PLEE）在0 ~ 2 cmH2O之间，吸气末转肺压(PLEI) < 25 cmH2O。结果：我们纳入了35例需要俯卧位的严重ARDS患者。优化后的PEEP在PP的前8小时显著下降，之后趋于稳定。我们发现了显著的个体间差异。经肺压达标。在H + 8时，PEEP修饰前测得的PLEE显著下降。结论：我们的研究表明，在PP过程中，优化的PEEP主要在前8小时内变化。在PP过程中，通过食管导管监测经肺压力可以优化PEEP，并确保最大限度的恢复和最小的过度膨胀。试验注册：RC 31/21/0514 - no 2021-A02752-39。

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