Heart & Lung最新文献_第9页

Multiparametric integration of cardiac markers in differentiating myocardial infarction with non-obstructive coronary arteries: LASSO regression 心脏标志物在鉴别心肌梗死与非阻塞性冠状动脉中的多参数整合：LASSO回归

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.005

Qing Huang , Peixuan Zhao , Yi He , Jianwei Liang , Min Xu

Background

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity requiring angiography-assisted diagnostic confirmation.

Objectives

This study proposes an innovative predictive algorithm for identifying MINOCA using non-invasive variables.

Methods

This retrospective cohort study included patients with acute myocardial infarction admitted to the Department of Cardiology at the Third Affiliated Hospital of Soochow University from June 2021 to October 2024. We systematically collected and analyzed baseline clinical data of demographics, imaging, and laboratory tests. Potential predictors were screened via Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis, followed by multivariate logistic modeling. Performance evaluation included discrimination metrics (receiver operating characteristic), calibration assessment, and decision curve analysis. A nomogram was created to visualize the multivariable prediction model, with internal validation achieved through bootstrap resampling.

Results

613 patients were included, and 46 had MINOCA (7.50 %). Using LASSO for variable selection, five predictors were retained at log(λ) = −3.90: High-sensitivity cardiac troponin I, type of myocardial infarction, gender, age, and diabetes mellitus. In the subsequent multivariable logistic regression, all five were independently associated with MINOCA(P < 0.05). Among these predictors, high-sensitivity cardiac troponin I emerged as the best biomarker for MINOCA (AUC = 0.673, 95 % CI: 0.604–0.743). Finally, a multifactorial model was built with an AUC of 0.796 (95 % CI: 0.761 - 0.831). A dynamic calculator based on the multifactorial model was also deployed and is available in open-access format.

Conclusion

The model is efficacious in facilitating the accurate diagnosis of MINOCA, assisting clinicians with early identification of MINOCA, thereby improving patients' prognostic outcomes.

背景：非阻塞性冠状动脉心肌梗死（MINOCA）是一种异质性临床实体，需要血管造影辅助诊断确认。目的提出一种利用非侵入性变量识别MINOCA的创新预测算法。方法回顾性队列研究纳入2021年6月至2024年10月苏州大学第三附属医院心内科收治的急性心肌梗死患者。我们系统地收集和分析了人口统计学、影像学和实验室检查的基线临床数据。通过最小绝对收缩和选择算子（LASSO）回归分析筛选潜在的预测因子，然后进行多变量logistic建模。性能评估包括鉴别指标（接收机工作特性）、校准评估和决策曲线分析。创建了一个nomogram来可视化多变量预测模型，并通过bootstrap重采样实现内部验证。结果共纳入613例患者，其中MINOCA 46例（7.50%）。使用LASSO进行变量选择，保留log(λ) =−3.90的五个预测因子：高敏心肌肌钙蛋白I、心肌梗死类型、性别、年龄和糖尿病。在随后的多变量logistic回归中，这五项均与MINOCA独立相关（P < 0.05）。在这些预测因子中，高灵敏度心肌肌钙蛋白I成为MINOCA的最佳生物标志物（AUC = 0.673, 95% CI: 0.604-0.743）。最后，建立了一个多因子模型，AUC为0.796 （95% CI: 0.761 - 0.831）。还部署了基于多因子模型的动态计算器，并以开放格式提供。结论该模型能有效促进MINOCA的准确诊断，帮助临床医生早期发现MINOCA，从而改善患者的预后。

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引用次数: 0

A nomogram for predicting in-stent restenosis risk after initial drug-eluting stent implantation in patients with acute coronary syndrome 预测急性冠脉综合征患者首次药物洗脱支架植入术后支架内再狭窄风险的nomogram

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.013

Guo-Biao Li , Da-Qing Zhu , Wei-Ping He , Song-Mao Ouyang

Background

In-stent restenosis (ISR) remains a common complication after drug-eluting stent (DES) implantation, limiting long-term benefits of percutaneous coronary intervention (PCI).

Objectives

To identify predictors of ISR after initial DES implantation and to develop and validate a nomogram for individualized ISR risk prediction.

Methods

This retrospective study included 927 patients with acute coronary syndrome (ACS) who underwent follow-up coronary angiography after first-time DES implantation at the First People’s Hospital of Fuzhou City. Patients were classified into ISR (n = 96) and non-ISR (n = 831) groups. Univariate and multivariate Cox analyses identified independent predictors, which were incorporated into a nomogram. Model performance was evaluated using concordance index (C-index), area under the curve (AUC) for 1-, 2-, and 3-year ISR, calibration curves, and decision curve analysis (DCA). Kaplan–Meier analysis compared ISR incidence between risk groups.

Results

Four independent predictors were identified—age ≥65 years, diabetes, total stent length ≥20 mm, and stent diameter <3 mm. Post-PCI smoking was borderline (p = 0.051) and was retained for clinical relevance. The nomogram showed a C-index of 0.812, with AUCs of 0.790, 0.816, and 0.834 for 1-, 2-, and 3-year ISR, respectively. Calibration curves demonstrated good agreement, and DCA confirmed clinical utility. High-risk patients had significantly higher ISR incidence than low-risk patients (P < 0.05).

Conclusion

An internally evaluated nomogram using age, diabetes, total stent length, stent diameter, and post-PCI smoking (retained for clinical relevance) estimates ISR risk after DES in ACS. External multicenter validation is required before broad use.

背景：药物洗脱支架（DES）植入术后支架内再狭窄（ISR）仍然是常见的并发症，限制了经皮冠状动脉介入治疗（PCI）的长期获益。目的确定初始DES植入后ISR的预测因素，建立并验证个体化ISR风险预测的nomogram。方法回顾性分析福州市第一人民医院927例急性冠脉综合征（ACS）患者首次植入DES后行冠脉造影随访。患者分为ISR组（n = 96）和非ISR组（n = 831）。单变量和多变量Cox分析确定了独立的预测因子，并将其纳入nomogram。采用一致性指数（C-index）、1年、2年和3年ISR的曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）来评估模型的性能。Kaplan-Meier分析比较了不同风险组间ISR的发生率。结果确定了4个独立预测因素：年龄≥65岁、糖尿病、支架总长度≥20mm和支架直径≤3mm。pci术后吸烟为临界（p = 0.051），保留其临床相关性。nomogram显示，1年、2年和3年ISR的C-index为0.812，auc分别为0.790、0.816和0.834。校准曲线显示出良好的一致性，DCA证实了临床应用。高危患者ISR发生率明显高于低危患者（P < 0.05）。结论：一项内部评估的nomogram使用年龄、糖尿病、支架总长度、支架直径和pci后吸烟（保留临床相关性）来评估ACS患者DES后的ISR风险。在广泛使用前需要进行外部多中心验证。

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引用次数: 0

Using large language models for ECG rhythm interpretation: Pitfalls, limitations, and future opportunities 使用大型语言模型进行ECG节律解释：陷阱、限制和未来机会。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.003

Nathan T. Riek , Tanmay A. Gokhale , Murat Akcakaya , Salah S. Al-Zaiti

引用次数: 0

The moderating effect of activity pacing on the relationship between physical activity and fatigue among patients with heart failure 活动起搏对心力衰竭患者体力活动与疲劳关系的调节作用

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.007

Boyi Li , Bo Zhu , Yusi Guo , Bo Fan , Xin Suo , Mei Zhou

Background

Fatigue is prevalent among patients with heart failure (HF). Activity pacing has emerged as an effective approach for managing fatigue in patients with chronic disease. However, research on the influence of activity pacing on the relationship between physical activity and fatigue in patients with HF has not been completely explore.

Objectives

This study aimed to examine the relationships among activity pacing, physical activity, and fatigue in patients with heart failure.

Methods

This cross-sectional study investigated 330 patients with heart failure in the cardiology department (Oct 2023 - Oct 2024). Data on socio-demographics, disease status, fatigue, physical activity, and activity pacing were collected at admission for patients with chronic heart failure and post-acute phase (≥7 days hospitalization) for patients with acute heart failure. Moderated effect analyses used Hayes PROCESS macro (Model 4.1).

Results

The study included 330 participants (61.9% male, 38.5% female) with a mean age of 67.47 years (SD = 12.87, range = 18 - 94). Physical activity showed a negative correlation with fatigue (r = -0.635, p < 0.001), but positive correlation with activity pacing (r = 0.169, p < 0.01). Activity pacing also negatively correlated with fatigue (r = -0.368, p < 0.001) and moderated the relationship between physical activity and fatigue (β = -0.130, p < 0.01).

Conclusions

This study confirms the moderating effect of activity pacing on the relationship between physical activity and fatigue in patients with HF. Thus, activity pacing could potentially facilitate greater engagement in physical activity, thereby alleviating fatigue and improving disease prognosis.

背景：疲劳在心力衰竭（HF）患者中很普遍。活动起搏已成为管理慢性疾病患者疲劳的有效方法。然而，活动起搏对心衰患者体力活动与疲劳关系的影响研究尚未完全深入。目的本研究旨在探讨心力衰竭患者活动起搏、体力活动和疲劳之间的关系。方法对心内科（2023年10月- 2024年10月）330例心力衰竭患者进行横断面研究。收集慢性心力衰竭患者入院时的社会人口统计学、疾病状态、疲劳、体力活动和活动起搏数据，以及急性心力衰竭患者急性期后（住院≥7天）的数据。调节效应分析使用Hayes PROCESS宏观（模型4.1）。结果共纳入330例患者，其中男性61.9%，女性38.5%，平均年龄67.47岁（SD = 12.87，范围= 18 ~ 94）。体力活动与疲劳呈负相关（r = -0.635, p < 0.001），与活动起搏呈正相关（r = 0.169, p < 0.01）。活动起搏与疲劳呈负相关（r = -0.368, p < 0.001），调节体力活动与疲劳的关系（β = -0.130, p < 0.01）。结论活动起搏对心衰患者体力活动与疲劳的关系有调节作用。因此，活动起搏可以潜在地促进更多的身体活动，从而减轻疲劳和改善疾病预后。

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引用次数: 0

Optimal cutoff value of diaphragm thickening fraction for predicting high respiratory effort in mechanically ventilated patients 横膈膜增厚分数预测机械通气患者高呼吸力的最佳临界值

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.012

Kazuki Okura , Kasumi Satoh , Nobuhisa Hirasawa , Manabu Okuyama , Yuji Kasukawa , Naohisa Miyakoshi , Hajime Nakae

Background

Optimizing ventilatory management for lung and diaphragm protection is crucial in mechanically ventilated patients. Although monitoring inspiratory effort is useful, some ventilators lack this capability. Conversely, diaphragm thickening fraction (DTF) may serve as a surrogate index of respiratory effort. However, its optimal cutoff value remains unclear.

Objectives

This study aimed to investigate the relationship between DTF and P0.1, as a measure of respiratory effort, and to identify the optimal DTF threshold for excessive respiratory effort.

Methods

This single-center, prospective, cross-sectional study included critically ill adults receiving invasive mechanical ventilation between June 2023 and May 2024. DTF was measured using ultrasound, while P0.1 was assessed via an airway occlusion maneuver using a ventilator's built-in tool. Potentially injurious respiratory effort was defined as ΔP0.1 > 3.5 cmH₂O. Daily data were collected from the onset of spontaneous breathing. The optimal DTF cutoff was determined using receiver operating characteristic (ROC) and precision-recall (PR) curves, with the Youden index and F1 score. The prediction accuracy of DTF was evaluated using the area under the curve (AUC).

Results

A total of 174 daily recordings from 70 patients were analyzed. Twenty-three (13 %) recordings indicated potentially injurious respiratory effort. The AUC of the ROC and PR curves were 0.938 (95 % confidence interval [CI]: 0.848 to 0.994) and 0.857 (95 % CI: 0.667 to 0.952), respectively. The optimal DTF cutoff was 35.7 %, yielding 96.0 % accuracy, 87.0 % sensitivity, and 97.4 % specificity.

Conclusion

DTF correlates with P0.1 in mechanically ventilated patients. A 35.7 % DTF cutoff accurately identifies potentially injurious respiratory effort.

背景：在机械通气患者中，优化肺和隔膜保护的通气管理至关重要。虽然监测吸气力度是有用的，但一些呼吸机缺乏这种能力。相反，隔膜增厚分数（DTF）可以作为呼吸力的替代指标。然而，其最佳截止值仍不清楚。本研究旨在探讨DTF与P0.1之间的关系，P0.1是衡量呼吸努力的一个指标，并确定过度呼吸努力的最佳DTF阈值。方法这项单中心、前瞻性、横断面研究纳入了2023年6月至2024年5月期间接受有创机械通气的危重成人患者。使用超声测量DTF，而使用呼吸机内置工具通过气道闭塞操作评估P0.1。潜在的有害呼吸力被定义为ΔP0.1 > 3.5 cmH2O。每日数据从自发呼吸开始收集。采用受试者工作特征（ROC）、精确召回率（PR）曲线，结合约登指数（Youden index）和F1评分确定最佳DTF截止点。采用曲线下面积（AUC）评价DTF的预测精度。结果共分析了70例患者的174份日常记录。23份（13%）记录显示有潜在的呼吸损伤。ROC曲线和PR曲线的AUC分别为0.938（95%可信区间[CI]: 0.848 ~ 0.994）和0.857（95%可信区间[CI]: 0.667 ~ 0.952）。最佳DTF截断值为35.7%，准确度为96.0%，灵敏度为87.0%，特异性为97.4%。结论机械通气患者dtf与P0.1相关。35.7%的DTF临界值准确地识别出潜在的有害呼吸力。

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引用次数: 0

Multi-task deep survival analysis links acute exacerbation frequency to hip fracture risk in advanced COPD. 多任务深度生存分析将急性加重频率与晚期COPD髋部骨折风险联系起来。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-23 DOI: 10.1016/j.hrtlng.2025.10.008

Pengyu Xu, Xiaoyu Wang, Zhuying Li

Background: Chronic obstructive pulmonary disease (COPD) is linked to elevated hip fracture risk, but validated prediction tools integrating disease-specific pathophysiology are lacking.

Objectives: To develop a multitask deep learning model predicting hip fracture risk and acute exacerbation frequency in COPD patients, and identify key predictors of skeletal vulnerability.

Methods: This retrospective cohort study analyzed 4995 COPD patients (245 incident hip fractures) from the China Health and Retirement Longitudinal Study (CHARLS). A multitask deep survival model combined Cox proportional hazards (fracture prediction) and regression (exacerbation frequency) tasks, integrating demographic, clinical, and biomarker data. Performance was evaluated via concordance index (C-index) and mean squared error (MSE).

Results: The model achieved a C-index of 0.725 for fracture prediction and MSE of 0.522 for exacerbation frequency, outperforming conventional methods. Key predictors included acute exacerbation frequency (fracture group: 2.5 ± 4.4 vs. non-fracture: 1.1 ± 2.2 events/year; adjusted HR = 1.28 per additional event, 95 % CI: 1.19-1.38) and baseline lung function (fracture group: 262.7 ± 96.7 mL vs. non-fracture: 277.4 ± 85.7 mL). Frequent hospitalizations (≥2/year) increased fracture risk by 47 %. Systemic inflammation (elevated CRP/IL-6) and age further contributed to skeletal vulnerability.

Conclusion: This study establishes the first multitask deep learning framework for COPD-related fracture risk, demonstrating superior performance through multidimensional feature synthesis. The model enables personalized prevention by highlighting exacerbation burden, lung function decline, and inflammation as critical risk factors.

背景：慢性阻塞性肺疾病（COPD）与髋部骨折风险升高有关，但缺乏整合疾病特异性病理生理学的有效预测工具。目的：建立一个多任务深度学习模型，预测COPD患者髋部骨折风险和急性加重频率，并确定骨骼易损性的关键预测因素。方法：本回顾性队列研究分析了来自中国健康与退休纵向研究（CHARLS）的4995例COPD患者（245例髋部骨折）。多任务深度生存模型结合了Cox比例风险（骨折预测）和回归（恶化频率）任务，整合了人口统计学、临床和生物标志物数据。通过一致性指数（C-index）和均方误差（MSE）来评估性能。结果：该模型预测骨折的c指数为0.725，预测加重频率的MSE为0.522，优于常规方法。关键预测因素包括急性加重频率（骨折组：2.5±4.4 vs.非骨折组：1.1±2.2事件/年；调整HR = 1.28 /个额外事件，95% CI: 1.19-1.38）和基线肺功能（骨折组：262.7±96.7 mL vs.非骨折组：277.4±85.7 mL）。频繁住院（≥2次/年）使骨折风险增加47%。全身性炎症（CRP/IL-6升高）和年龄进一步加剧了骨骼的脆弱性。结论：本研究建立了首个copd相关骨折风险的多任务深度学习框架，通过多维特征综合展现了优越的性能。该模型通过强调加重负担、肺功能下降和炎症作为关键危险因素，实现个性化预防。

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引用次数: 0

The association between electrical risk score and non-dipper hypertensive pattern with newly diagnosed hypertensive patients 新诊断高血压患者电危险评分与非北侧高血压类型的关系。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-21 DOI: 10.1016/j.hrtlng.2025.10.004

Samet Sevinc , Yusuf Demir

Background

The electrical risk score (ERS) is composed of six simple electrocardiography (ECG) parameters: heart rate, presence of left ventricular hypertrophy, QRS transition zone, corrected QT interval, T-peak-to-T-end interval and frontal QRS-T angle. ERS has been shown to improve risk assessment for various diseases.

Objective

This study aimed to investigate the relationship between ERS and circadian blood pressure variability.

Methods

This study recruited 144 hypertensive individuals who underwent 24 h ambulatory blood pressure monitoring (ABPM). Based on the findings of 24 h ABPM, the study population was categorized into the following two groups: patients with dipper hypertension (HT) and those with non-dipper HT. ERS was measured using 12-lead ECG.

Results

The ERS in individuals with non-dipper HT was substantially greater than in patients with dipper HT (2.75±1.07 vs. 2.31±1.03 respectively, p = 0.018). ERS (OR:1.507, 95 % CI:1.060– 2.142; p = 0.022) was independently associated with non-dipper HT according to multivariate analysis. An optimal ERS cut-off value of >2 predicted a non-dipper hypertensive pattern with 59.1 % sensitivity and 56.9 % specificity ([AUC]: 0.604 [95 % CI: 0.519–0.684, p = 0.0263]).

Conclusion

This study showed that increased ERS was associated with non-dipper pattern in newly diagnosed patients with HT.

背景：电风险评分（ERS）由6个简单的心电图（ECG）参数组成：心率、左室肥厚的存在、QRS过渡区、校正QT间期、t峰-t端间期和QRS- t正面角。ERS已被证明可以改善各种疾病的风险评估。目的：探讨ERS与昼夜血压变异性的关系。方法：对144例高血压患者进行24小时动态血压监测（ABPM）。根据24 h ABPM的结果，将研究人群分为两组：斗型高血压（HT）患者和非斗型高血压患者。采用12导联心电图测量ERS。结果：非杓型HT患者的ERS明显高于杓型HT患者（2.75±1.07 vs. 2.31±1.03,p = 0.018）。多因素分析显示，ERS （OR:1.507, 95% CI:1.060 ~ 2.142; p = 0.022）与非髋部HT独立相关。最佳ERS临界值>2预测非北侧高血压的敏感性为59.1%，特异性为56.9% （[AUC]: 0.604 [95% CI: 0.519-0.684, p = 0.0263]）。结论：本研究表明，新诊断的HT患者ERS增加与非倾斗模式相关。

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引用次数: 0

Maximal respiratory exchange ratio during treadmill cardiopulmonary exercise testing in adults based on age, sex, and body mass index 基于年龄、性别和体重指数的成人跑步机心肺运动试验中最大呼吸交换率

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-17 DOI: 10.1016/j.hrtlng.2025.10.002

Victor Zuniga Dourado PT, Ph.D , Agatha Caveda Matheus PE, MSc. , Alan Carlos Brisola Barbosa PT, MSc. , Maria do Socorro Morais Pereira Simões PT, Ph.D , Vinícius Tonon Lauria PE, Ph.D. , Marcello Romiti MD, Ph.D. , Rodolfo Leite Arantes MD, Ph.D.

Background

Chronotropic and biomechanical limitations, and elevated O2/workload ratio during cardiopulmonary exercise testing (CPET), often constrain the ability to reach a maximal rate of gas exchange (RER) > 1.00 in obese subjects. We hypothesize that RER during CPET differs significantly by body mass index (BMI), necessitating BMI- Age- and Sex-specific values to assess maximal effort.

Objectives

To establish RER reference values in adults undergoing treadmill CPET based on age, sex, and BMI.

Methods

We analyzed 1612 treadmill ramp CPETs in adults (893 women) with obesity (n=772; mean age 42±13 years, weight 104±20 kg, and BMI 37±5 kg/m²) and without (n=840; mean age 39±14 years, weight 69±12 kg, and BMI 24±2 kg/m²). We excluded CPETs with operational problems and with spirometric and/or ECG abnormalities. We generated sex-, age- (<33, 34–46, >46 years), and BMI-specific (<30, ≥30 kg/m²) RER values. We fit a multiple regression to explore determinants of RER. We also derived an obesity-specific estimation of maximum heart rate (HRmax).

Results

Participants were 442 normal-weight (BMI<25 kg/m²), 398 overweighted (BMI=25–29.99 kg/m²), 295 class-1 obese (BMI=30–34.99 kg/m²), 247 class-2 obese (BMI=35–39.99 kg/m²), and 230 class-3 obese (BMI≥40 kg/m²). We set p<0.05 as the significance threshold for all statistical tests. Age, sex, and BMI significantly determined RER (R² = 0.195). We found sub-1.0 RER, notably in obese and older females. The HR_bpm equation was 195.2-(0.796 x age_years).

Conclusion

Fixed values of RER may inadequately reflect maximal effort, particularly in obese, older, and unfit individuals. These findings have direct implications for accurately assessing cardiorespiratory fitness in individuals with obesity.

背景：变时性和生物力学的限制，以及心肺运动试验（CPET）中O2/负荷比升高，常常限制肥胖受试者达到最大气体交换率（RER）的能力。我们假设CPET期间的RER因体重指数（BMI）而有显著差异，因此需要BMI-年龄和性别特异性值来评估最大努力。目的：建立基于年龄、性别和BMI的成人跑步机CPET的RER参考值。方法：我们分析了1612名成人（893名女性）的跑步机坡道cpet，其中肥胖（n=772，平均年龄42±13岁，体重104±20 kg， BMI 37±5 kg/m²）和非肥胖（n=840，平均年龄39±14岁，体重69±12 kg， BMI 24±2 kg/m²）。我们排除了有操作问题、肺活量测定和/或心电图异常的cpet。我们生成了性别、年龄（46岁）和bmi特异性(2)的RER值。我们拟合了多元回归来探索RER的决定因素。我们还推导出了针对肥胖的最大心率（HRmax）估计。结果：体重正常（BMI2） 442人，超重（BMI=25-29.99 kg/m2） 398人，1级肥胖（BMI=30-34.99 kg/m2） 295人，2级肥胖（BMI=35-39.99 kg/m2） 247人，3级肥胖（BMI≥40 kg/m2） 230人。我们设p2 = 0.195)。我们发现RER低于1.0，特别是在肥胖和老年女性中。HRbpm方程为195.2-（0.796 x年龄年）。结论：固定的RER值可能不能充分反映最大的努力，特别是在肥胖、老年和不健康的个体中。这些发现对准确评估肥胖个体的心肺健康具有直接意义。

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引用次数: 0

Repurposing sodium glucose cotransporter-2 (SGLT-2) inhibitors in sarcoidosis: A potential strategy for reducing mortality 重新利用葡萄糖共转运蛋白2 （SGLT-2）抑制剂治疗结节病：降低死亡率的潜在策略

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-11 DOI: 10.1016/j.hrtlng.2025.10.001

A B M Nasibul Alam MD , Natasha Gill MD , Isabella Han , Reina Nagasaka , Wenting Hu , Laeeq Shamsuddin MD

Introduction

The renin-angiotensin-aldosterone system (RAAS) plays a key role in sarcoidosis pathogenesis. A recent study suggests that ACE inhibitors may worsen outcomes in sarcoidosis, whereas ARBs may be more beneficial. SGLT2 inhibitors modulate RAAS activity and have anti-inflammatory properties, making them a potential therapeutic option in this population.

Objectives

To evaluate whether the addition of SGLT2 inhibitors to ARB therapy improves long-term survival outcomes in patients with sarcoidosis.

Methods

This retrospective cohort study analyzed adults diagnosed with sarcoidosis from the TrinetX database between 2015 and 2025. Patients receiving ARBs with or without SGLT2 inhibitors were compared following propensity score matching for demographics, comorbidities, and concurrent immunosuppressive therapies.

Results

Patients receiving both ARBs and SGLT2 inhibitors had lower all-cause mortality over five years compared to those on ARBs alone. No significant differences were observed in secondary outcomes such as sepsis, respiratory failure, cardiovascular events, or renal complications.

Conclusion

In patients with sarcoidosis treated with ARBs, the addition of SGLT2 inhibitors was associated with improved long-term survival. These findings support further investigation into the role of SGLT2 inhibitors as adjunctive therapy in sarcoidosis.

肾素-血管紧张素-醛固酮系统（RAAS）在结节病发病中起关键作用。最近的一项研究表明，ACE抑制剂可能使结节病的预后恶化，而arb可能更有益。SGLT2抑制剂调节RAAS活性并具有抗炎特性，使其成为该人群的潜在治疗选择。目的：评估在ARB治疗中加入SGLT2抑制剂是否能改善结节病患者的长期生存结果。方法：本回顾性队列研究分析了2015年至2025年间TrinetX数据库中诊断为结节病的成年人。根据人口统计学、合并症和并发免疫抑制治疗的倾向评分匹配，对接受arb的患者进行比较。结果：与单独接受arb的患者相比，同时接受arb和SGLT2抑制剂的患者在5年内的全因死亡率较低。在脓毒症、呼吸衰竭、心血管事件或肾脏并发症等次要结局方面没有观察到显著差异。结论：在接受arb治疗的结节病患者中，添加SGLT2抑制剂与改善长期生存相关。这些发现支持进一步研究SGLT2抑制剂作为结节病辅助治疗的作用。

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引用次数: 0

Transcatheter versus surgical treatment in aortic stenosis with coronary artery disease: A meta-analysis of time-to-event data on 162,305 patients 经导管与手术治疗合并冠状动脉疾病的主动脉狭窄：162305例患者事件发生时间数据的荟萃分析

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2025-10-09 DOI: 10.1016/j.hrtlng.2025.09.018

Ahmed Emara MD , Mohamed Emara MD , Ahmed Farid Gadelmawla MD , Mohamed R. Murad MD , Heba Aboeldahab PharmD , Mohamed S. Elgendy MBBCh , Mohamed Sabri Hassanin MD , Mohamed A. Aldemerdash MD , Ali M. Othman MD , Mohamed Khaled MBBCh , Abdalhakim Shubietah MD , Abdalrahman Assaassa MD , Vinayak N. Bapat MDMS

Background

Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD), present in about 50 % of patients undergoing valve intervention. Surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) has been the traditional standard, providing revascularization and durability, whereas transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) offers a less invasive option. PCI + TAVR may lower perioperative risk, but SAVR + CABG may confer superior survival, with conflicting evidence.

Objectives

This meta-analysis of time-to-event data aimed to compare PCI + TAVR with CABG + SAVR in patients with concomitant AS and CAD.

Methods

We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases up to March 2025. Individual patient data (IPD) were reconstructed from published Kaplan–Meier curves to estimate hazard ratios (HRs) for all-cause mortality. Dichotomous outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CI).

Results

Fifteen studies including 162,305 patients were analyzed. PCI + TAVR was associated with higher all-cause mortality at 48 months (HR 1.29, 95 % CI 1.23–1.35, p < 0.001), but lower in-hospital acute kidney injury (RR 0.37, 95 % CI 0.21–0.66, p = 0.0007), short-term (≤30 days) major adverse cardiovascular events (RR 0.67, 95 % CI 0.50–0.91, p = 0.0093), and new-onset atrial fibrillation (RR 0.23, 95 % CI 0.17–0.32, p < 0.0001). Conversely, long-term (>30 days) myocardial infarction risk was higher (RR 1.61, 95 % CI 1.08–2.39, p = 0.01).

Conclusions

PCI+TAVR was associated with higher mortality or adverse event rates compared to CABG+SAVR, but lower perioperative complications. High-quality randomized trials are warranted to confirm these findings.

背景：严重主动脉瓣狭窄（AS）常与冠状动脉疾病（CAD）共存，约50%的患者接受瓣膜介入治疗。外科主动脉瓣置换术（SAVR）与冠状动脉旁路移植术（CABG）一直是传统的标准，提供血运重建和持久性，而经导管主动脉瓣置换术（TAVR）与经皮冠状动脉介入治疗（PCI）提供了一种侵入性较小的选择。PCI + TAVR可能降低围手术期风险，但SAVR + CABG可能具有更高的生存率，但证据相互矛盾。目的：本荟萃分析旨在比较合并AS和CAD患者PCI + TAVR与CABG + SAVR。方法：系统检索PubMed、Web of Science、Scopus和Cochrane数据库，检索时间截止到2025年3月。根据已发表的Kaplan-Meier曲线重建个体患者数据（IPD），以估计全因死亡率的风险比（hr）。采用95%置信区间（CI）的风险比（RR）分析二分类结果。结果：15项研究共纳入162305例患者。PCI + TAVR与48个月时较高的全因死亡率（HR 1.29, 95% CI 1.23-1.35, p < 0.001）相关，但与院内急性肾损伤（RR 0.37, 95% CI 0.21-0.66, p = 0.0007）、短期（≤30天）主要不良心血管事件（RR 0.67, 95% CI 0.50-0.91, p = 0.0093）和新发房颤（RR 0.23, 95% CI 0.17-0.32, p < 0.0001）相关。相反，长期（bbb30天）心肌梗死风险较高（RR 1.61, 95% CI 1.08-2.39, p = 0.01）。结论：与CABG+SAVR相比，PCI+TAVR的死亡率或不良事件发生率更高，但围手术期并发症更低。有必要进行高质量的随机试验来证实这些发现。

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