Heart & Lung最新文献_第9页

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 : 2026-03-01 Epub 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

Looking forward: The impact of resilience. 展望未来：弹性的影响。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-02-18 DOI: 10.1016/j.hrtlng.2026.102736

Robin Miller

引用次数: 0

Impact of aortic root abscess on outcomes in infective endocarditis and predictors of in-hospital mortality: A meta-analysis 主动脉根部脓肿对感染性心内膜炎结局和院内死亡率预测因素的影响：一项荟萃分析

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.hrtlng.2025.10.009

Ahmed Emara MD , Mohamed Emara MD , Mohamed A. Aldemerdash MD , Lina Hemmeda , Ahmed Farid Gadelmawla MD , Alhassan Saber MD , Mohamed Ellebedy , Magdi Zordok MD , Kevin M. Harris MD , Vinayak N. Bapat MD , Erik Beckmann MD , Emmanouil S. Brilakis MD PHD , Michael Megaly MD MS

Background

Aortic root abscess (ARA) is a severe and life-threatening complication of infective endocarditis (IE), often requiring urgent surgical intervention. However, data on surgical outcomes and predictors of mortality in this population are limited.

Objectives

We conducted a systematic review and meta-analysis to evaluate postoperative outcomes and identify predictors of in-hospital mortality in patients with IE complicated by ARA.

Methods

A comprehensive search of PubMed, Web of Science, Scopus, and Embase was performed through February 2025 for studies comparing surgical outcomes in patients with IE with versus without ARA. Risk ratios (RR) were used for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95 % confidence intervals (CI).

Results

Eight observational studies comprising 2266 patients (637 with ARA, 1629 without ARA) were included. ARA was significantly associated with higher in-hospital mortality (15.7 % vs. 12.8 %; RR 1.65, 95 % CI 1.28–2.13, P = 0.0001), late mortality (21.4 % vs. 20.2 %; RR 1.44, 95 % CI 1.16–1.79, P = 0.001), and IE recurrence (10.6 % vs. 4.8 %; RR 2.15, 95 % CI 1.29–3.59, P = 0.003). No significant difference in heart failure incidence was found (RR 1.02, 95 % CI 0.86–1.21, P = 0.82). Renal failure (OR 3.22, 95 % CI 1.37–7.60) and Staphylococcus aureus infection (OR 3.30, 95 % CI 1.50–7.26) were independently associated with higher in-hospital mortality.

Conclusions

ARA in patients undergoing surgery for IE is associated with worse outcomes, including higher in-hospital and late mortality and greater IE recurrence. Renal failure and S. aureus infection are significant mortality predictors.

主动脉根脓肿（ARA）是感染性心内膜炎（IE）的一种严重且危及生命的并发症，通常需要紧急手术干预。然而，这一人群的手术结果和死亡率预测因素的数据是有限的。目的：我们进行了一项系统回顾和荟萃分析，以评估IE合并ARA患者的术后结局和确定住院死亡率的预测因素。方法综合检索PubMed、Web of Science、Scopus和Embase，检索到2025年2月，比较有ARA和没有ARA的IE患者手术结果的研究。风险比（RR）用于二分类结局，平均差异（MD）用于连续结局，均为95%置信区间（CI）。结果共纳入8项观察性研究，共2266例患者（637例ARA， 1629例非ARA）。ARA与较高的住院死亡率（15.7%比12.8%;RR 1.65, 95% CI 1.28-2.13, P = 0.0001）、晚期死亡率（21.4%比20.2%;RR 1.44, 95% CI 1.16-1.79, P = 0.001）和IE复发率（10.6%比4.8%;RR 2.15, 95% CI 1.29-3.59, P = 0.003）显著相关。两组心力衰竭发生率无显著差异（RR 1.02, 95% CI 0.86 ~ 1.21, P = 0.82）。肾功能衰竭（OR 3.22, 95% CI 1.37-7.60）和金黄色葡萄球菌感染（OR 3.30, 95% CI 1.50-7.26）与较高的住院死亡率独立相关。结论IE手术患者的sara与较差的预后相关，包括较高的住院死亡率和晚期死亡率以及较高的IE复发率。肾衰竭和金黄色葡萄球菌感染是重要的死亡率预测因子。

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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 : 2026-01-01 Epub 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

Wearable sensor-based gait parameters in patients with heart failure with reduced ejection fraction: associations with clinical and physical outcomes 基于可穿戴传感器的心力衰竭患者射血分数降低的步态参数：与临床和身体结果的关联

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-01 Epub Date: 2025-10-25 DOI: 10.1016/j.hrtlng.2025.10.018

Aylin Tanriverdi Eyolcu , Buse Ozcan Kahraman , Mehmet Birhan Yilmaz , Sema Savci

Background

Gait parameters provided by wearable inertial sensors remain significant gaps in understanding their clinical and physical implication in patients with heart failure with reduced ejection fraction (HFrEF).

Objectives

To analyse gait parameters using a wearable inertial sensor and to assess the relationships between clinical and physical outcomes in patients with HFrEF.

Methods

This cross-sectional study recruited 70 HFrEF patients and 32 apparently healthy individuals. Gait parameters were evaluated using a wearable gait analysis system during an 8-meter walk and a 6-minute walk test (6MWT). Functional class, dyspnea, and frailty were evaluated using the New York Heart Association (NYHA) classification, the Modified Medical Research Council Scale (mMRCS), and the Fried Frailty Phenotype. Pulmonary function, respiratory muscle strength and quadriceps muscle strength, functional capacity, physical activity, and dynamic balance were assessed.

Results

Age, gender, and body mass index were similar between patients with HFrEF and apparently healthy controls (p>0.05). Gait speed, cadence, and stride length obtained from both the 8-meter walk and 6MWT were significantly different between the groups (p<0.05). Gait speed and stride length obtained from both the 8-meter walk and the 6MWT were moderately to strongly correlated with NYHA functional class, mMRCS, frailty, and six-minute walk distance (6MWD) (p<0.05). Cadence obtained from both the 8-meter walk and 6MWT was moderately to strongly correlated with six-minute walk distance (p<0.05).

Conclusions

This study indicates that gait parameters are affected in patients with HFrEF. Altered gait parameters are associated with worsened clinical and physical outcomes in patients with HFrEF.

背景：可穿戴式惯性传感器提供的步态参数在了解其对心力衰竭伴射血分数降低（HFrEF）患者的临床和生理意义方面仍存在重大差距。目的利用可穿戴式惯性传感器分析HFrEF患者的步态参数，并评估其临床与身体预后之间的关系。方法采用横断面研究方法，招募70例HFrEF患者和32例表面健康个体。在8米步行和6分钟步行测试（6MWT）期间，使用可穿戴步态分析系统评估步态参数。使用纽约心脏协会（NYHA）分类、改良医学研究委员会量表（mMRCS）和Fried虚弱表型对功能分级、呼吸困难和虚弱进行评估。评估肺功能、呼吸肌力量和股四头肌力量、功能能力、体力活动和动态平衡。结果HFrEF患者的年龄、性别和体重指数与明显健康对照组相似（p < 0.05）。8米步行和6米步行的步态速度、节奏和步幅在两组间差异均有统计学意义（p < 0.05）。8米步行和6分钟步行的步态速度和步长与NYHA功能等级、mMRCS、虚弱度和6分钟步行距离（6MWD）呈中至强相关（p<0.05）。8米步行和6MWT获得的踏速与6分钟步行距离呈中至强相关（p<0.05）。结论本研究表明HFrEF患者的步态参数受到影响。步态参数的改变与HFrEF患者的临床和身体结果的恶化有关。

{"title":"Wearable sensor-based gait parameters in patients with heart failure with reduced ejection fraction: associations with clinical and physical outcomes","authors":"Aylin Tanriverdi Eyolcu , Buse Ozcan Kahraman , Mehmet Birhan Yilmaz , Sema Savci","doi":"10.1016/j.hrtlng.2025.10.018","DOIUrl":"10.1016/j.hrtlng.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Gait parameters provided by wearable inertial sensors remain significant gaps in understanding their clinical and physical implication in patients with heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Objectives</h3><div>To analyse gait parameters using a wearable inertial sensor and to assess the relationships between clinical and physical outcomes in patients with HFrEF.</div></div><div><h3>Methods</h3><div>This cross-sectional study recruited 70 HFrEF patients and 32 apparently healthy individuals. Gait parameters were evaluated using a wearable gait analysis system during an 8-meter walk and a 6-minute walk test (6MWT). Functional class, dyspnea, and frailty were evaluated using the New York Heart Association (NYHA) classification, the Modified Medical Research Council Scale (mMRCS), and the Fried Frailty Phenotype. Pulmonary function, respiratory muscle strength and quadriceps muscle strength, functional capacity, physical activity, and dynamic balance were assessed.</div></div><div><h3>Results</h3><div>Age, gender, and body mass index were similar between patients with HFrEF and apparently healthy controls (p>0.05). Gait speed, cadence, and stride length obtained from both the 8-meter walk and 6MWT were significantly different between the groups (p<0.05). Gait speed and stride length obtained from both the 8-meter walk and the 6MWT were moderately to strongly correlated with NYHA functional class, mMRCS, frailty, and six-minute walk distance (6MWD) (p<0.05). Cadence obtained from both the 8-meter walk and 6MWT was moderately to strongly correlated with six-minute walk distance (p<0.05).</div></div><div><h3>Conclusions</h3><div>This study indicates that gait parameters are affected in patients with HFrEF. Altered gait parameters are associated with worsened clinical and physical outcomes in patients with HFrEF.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 277-284"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The role of cardiac positron emission tomography in prediction of atrial fibrillation rhythm: A systematic review and meta-analysis 心脏正电子发射断层扫描在预测心房颤动节律中的作用：系统回顾和荟萃分析

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-01 Epub Date: 2025-09-26 DOI: 10.1016/j.hrtlng.2025.09.007

Shayan Shojaei MD, MPH, MBA , Asma Mousavi MD, MPH, MBA , Diar Zooravar MD , Hanieh Radkhah MD , Pedram Soltani MD

Background

Atrial fibrillation (AF), the most common cardiac arrhythmia, is driven by inflammation-induced fibrosis and remodeling. Positron emission tomography (PET) offers a promising alternative by visualizing metabolic and inflammatory activity in cardiac tissue. Objectives: Evaluate PET's role in predicting AF to improve risk stratification and patient outcomes.

Methods

Systematic review of PubMed, Scopus, Web of Science, EMBASE was conducted using PRISMA guidelines. Our meta-analysis was registered in PROSPERO (CRD42024602021). Studies comparing quantitative PET scan parameters in AF versus non-AF patients were included. Random-effects models were performed using standardized mean differences (SMD) with 95 % Confidence intervals (CIs). Sensitivity analyses and publication bias with Egger's test and meta-regression analyses were performed.

Results

Ten studies with 1145 participants (661 with AF, 484 controls) were included. Patients with AF demonstrated significantly higher maximum SUV in the left atrium (LA) (SMD: 0.62, 95 % CI 0.41–0.83), left atrial appendage (LAA) (SMD: 0.78, 95 % CI 0.41–1.15), right atrium (RA) (SMD: 1.00, 95 % CI 0.72–1.27), and right atrial appendage (RAA) (SMD: 0.89, 95 % CI 0.63–1.14), but no significant differences in mean SUV or left ventricle (LV) metrics. Target-to-background ratios (TBR) were also significantly elevated in the LA, LAA, RA, and RAA in AF patients (p < 0.01).

Conclusion

Inflammation and AF suggest a bidirectional relationship as supported by cardiac FDG-PET imaging. Early detection using PET scans can enhance AF management by preventing irreversible cardiac damage.

心房纤颤（AF）是最常见的心律失常，由炎症诱导的纤维化和重构驱动。正电子发射断层扫描（PET）提供了一种很有前途的替代方法，通过可视化心脏组织中的代谢和炎症活动。目的：评估PET在预测房颤中的作用，以改善风险分层和患者预后。方法采用PRISMA指南对PubMed、Scopus、Web of Science、EMBASE进行系统评价。我们的荟萃分析已在PROSPERO注册（CRD42024602021）。包括比较房颤与非房颤患者定量PET扫描参数的研究。随机效应模型采用95%置信区间（ci）的标准化平均差（SMD）。采用Egger检验和meta回归分析进行敏感性分析和发表偏倚分析。结果共纳入10项研究，共1145名受试者（AF患者661名，对照组484名）。房颤患者在左心房（LA）（SMD: 0.62, 95% CI 0.41-0.83）、左心房附件（LAA）（SMD: 0.78, 95% CI 0.41-1.15）、右心房（RA）（SMD: 1.00, 95% CI 0.72-1.27）和右心房附件（RAA）（SMD: 0.89, 95% CI 0.63-1.14）的最大SUV显著升高，但在平均SUV或左心室（LV）指标上无显著差异。AF患者的LA、LAA、RA和RAA的靶本比（TBR）也显著升高（p < 0.01）。结论心脏FDG-PET显示炎症与房颤呈双向关系。PET扫描的早期检测可以通过预防不可逆的心脏损伤来加强房颤的管理。

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引用次数: 0

Impact of rhBNP and ivabradine on outcomes, cardiac markers, and microcirculation in ischemic heart failure rhBNP和伊伐布雷定对缺血性心力衰竭结局、心脏指标和微循环的影响。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-01 Epub Date: 2025-10-06 DOI: 10.1016/j.hrtlng.2025.09.020

Liqin Zhang, Zhenhua Jiang, Hailiang Ma, Liang Dong, Shifen Feng, Jin Xu, Jie Chen

Background

Ischemic cardiomyopathy (ICM) with heart failure (HF) is characterized by myocardial hypoxia, microcirculation dysfunction, and neuroendocrine activation. While ivabradine and recombinant human brain natriuretic peptide (rhBNP) are individually used for HF, their combined efficacy remains underexplored.

Objective

To evaluate the effects of rhBNP combined with ivabradine on cardiac function, myocardial microcirculation, endocrine hormones, and biomarkers (CysC, Gal-3, miR-19a) in ICM-HF patients.

Methods

In this prospective study, 126 ICM-HF patients were randomized 1:1 to either ivabradine alone (control) or rhBNP + ivabradine (intervention). Both groups received conventional therapy. Cardiac function (LVEF, LVESD, LVEDD), microcirculation parameters (ischemic burden, ST-segment shift), serum hormones (ALD, NE, Ang II), and biomarkers were assessed at baseline and after 1 month.

Results

The intervention group showed higher total efficacy (93.65%¦vs. 76.19%, P<0.05), improved LVEF (51.76%¦vs. 46.68%), and reduced ventricular volumes (LVESD: 34.75 vs. 40.47 mm; P<0.05). Myocardial microcirculation parameters (ischemic burden, time, frequency) and neuroendocrine levels (ALD: 38.31 vs. 65.02 ng/L; NE: 102.39 vs. 180.23 ng/L; P<0.05) were significantly lower. Serum CysC, Gal-3, and miR-19a levels also decreased more prominently (P<0.05). Adverse reactions were comparable (11.11%¦vs. 7.94%, P>0.05).

Conclusion

rhBNP combined with ivabradine synergistically improves cardiac function, myocardial microcirculation, and neuroendocrine regulation in ICM-HF patients, with superior efficacy and safety.

背景：缺血性心肌病（ICM）合并心力衰竭（HF）以心肌缺氧、微循环功能障碍和神经内分泌激活为特征。虽然伊伐布雷定和重组人脑利钠肽（rhBNP）单独用于治疗心衰，但它们的联合疗效仍未得到充分研究。目的：评价rhBNP联合伊伐布雷定对ICM-HF患者心功能、心肌微循环、内分泌激素及生物标志物（CysC、Gal-3、miR-19a）的影响。方法：在这项前瞻性研究中，126例ICM-HF患者以1:1的比例随机分为单独伊伐布雷定组（对照组）和rhBNP +伊伐布雷定组（干预组）。两组均接受常规治疗。在基线和1个月后评估心功能（LVEF、LVESD、LVEDD）、微循环参数（缺血负荷、st段移位）、血清激素（ALD、NE、Ang II）和生物标志物。结果：干预组总有效率高于对照组（93.65%）。76.19%, P0.05)。结论：rhBNP联合伊伐布雷定可协同改善ICM-HF患者心功能、心肌微循环及神经内分泌调节，具有较好的疗效和安全性。

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引用次数: 0

Clinical and hemodynamic effect of intravenous calcium administration in cardiac surgery: A systematic review 心脏手术中静脉给钙的临床和血流动力学影响：系统综述

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.hrtlng.2025.10.016

Alessandro Belletti , Vladimir Boboshko , Enrica Piazza , Martina Carmela Crusi , Luisa Zaraca , Krisztina Tóth , Özgün Ömer Asiller , Giovanni Landoni , Fabrizio Monaco , Alberto Zangrillo , Vladimir Lomivorotov , ICARUS Study Group Collaborators

Background

Intravenous calcium is frequently administered in cardiac surgery patients to improve hemodynamics.

Objectives

To assess safety and efficacy of intravenous calcium administration in this population.

Methods

We conducted a systematic review (with meta-analysis of hemodynamic data) and searched PubMed and Scopus up to March 15th, 2025. All studies investigating intravenous calcium administration in patients undergoing cardiac surgery were considered. Animal studies and studies investigating oral calcium administration were excluded. We abstracted data on study design, sample size, setting, calcium formulation, dose and timing of administration. Primary outcome was all-cause mortality. Secondary outcomes included rate of myocardial ischemia, postoperative release of cardiac necrosis biomarkers, adverse events, and hemodynamic data. Only data from randomized controlled trials (RCTs) were included in the quantitative analysis.

Results

Twenty-two studies were selected (nine RCTs, eight pediatric studies, ten including a control group), with a total sample size of 1278 patients (809 receiving calcium). The most common formulation was calcium chloride. Most studies followed up patients for <60 min. Only one non-RCT study with a control group reported mortality data (4/66 [6.1 %] calcium group vs 8/69 [11.6 %] control group). Intravenous calcium transiently increases mean arterial pressure (MAP) and reduces heart rate, with effects fading within 10-20 min. Calcium administration may blunt hemodynamic response to catecholamines

Conclusions

There is no data on the effects of intravenous calcium on major clinical outcomes in patients undergoing cardiac surgery. Calcium may transiently improve MAP and reduce heart rate. Large RCTs are needed to assess the effects of calcium on clinically relevant endpoints. Review Registration: International Prospective Register of Systematic Reviews (PROSPERO), n. CRD420250282624

背景：在心脏手术患者中，静脉补钙经常用于改善血流动力学。目的评价静脉给钙在该人群中的安全性和有效性。方法进行系统评价（对血流动力学数据进行荟萃分析），检索截至2025年3月15日的PubMed和Scopus。所有关于心脏手术患者静脉给钙的研究都被考虑在内。排除了动物研究和口服钙给药的研究。我们提取了有关研究设计、样本量、环境、钙制剂、剂量和给药时间的数据。主要结局为全因死亡率。次要结局包括心肌缺血率、术后心肌坏死生物标志物的释放、不良事件和血流动力学数据。定量分析只纳入随机对照试验（rct）的数据。结果共选择22项研究（9项rct， 8项儿科研究，10项包括对照组），总样本量为1278例（其中809例接受钙治疗）。最常见的配方是氯化钙。大多数研究对患者随访60分钟。只有一项对照组的非rct研究报告了死亡率数据（4/66[6.1%]钙组vs 8/69[11.6%]对照组）。静脉注射钙会短暂地增加平均动脉压（MAP）并降低心率，效果在10-20分钟内消退。结论静脉补钙对心脏手术患者主要临床结局的影响尚无相关数据。钙可以短暂地改善MAP和降低心率。需要大型随机对照试验来评估钙对临床相关终点的影响。综述注册：国际前瞻性系统综述注册（PROSPERO），编号CRD420250282624

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引用次数: 0

Exploring intensive care unit nurses’ decision-making in alarm management: A qualitative study 探讨重症监护室护士在报警管理中的决策：一项质的研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2026-01-01 Epub Date: 2025-09-21 DOI: 10.1016/j.hrtlng.2025.09.013

Nikola Haskell , Davina Banner , Shelley Raffin Bouchal , Kathryn King-Shier

Background

Alarm fatigue occurs when there is frequent exposure to an increased amount of false or nonactionable alarms. Alarm fatigue can lead to alarm desensitization and reduced clinical response by nurses, posing a significant risk to patient safety. Alarm fatigue is an important and growing safety concern that needs to be explored and addressed.

Objectives

The purpose of this qualitative study was to better understand how Intensive Care Unit (ICU) nurses make decisions about and respond to alarms, specifically how they recognize different alarms, and how they triage and manage them within the ICU setting.

Methods

Twelve nurses from three ICUs participated in-depth semi-structured interviews. Using Interpretive Description methodology, the decision-making regarding alarm response was explored. Thematic analysis was used to identify key themes.

Results

The ICU nurses’ decision-making consisted of three steps: their awareness, including how they heard the alarms; how different alarms were triaged; and how they responded and prioritized different alarms. Factors that affected nurses’ awareness included competing tasks and priorities, the busy nature of the unit, inadequate staffing, increased unit noise, and an increased amount of false/nonactionable alarms. Next, nurses triaged their alarm response based on their experience, character/nature, situational fatigue and burnout. Lastly, nurses incorporated multiple factors when considering how quickly to respond to an alarm. Urgent responses occurred with high priority electrocardiogram alarms, alarms on more acute patients, bed alarms and intravenous (IV) pumps infusing life sustaining medication.

Conclusion

A positive safety culture, standardized alarm-related education, and mentorship should be evaluated to implement an effective alarm response and management and reduce alarm fatigue.

当频繁接触到越来越多的虚假或不可操作的警报时，就会出现警报疲劳。警报疲劳可导致警报脱敏，减少护士的临床反应，对患者安全构成重大风险。警报疲劳是一个重要的和日益增长的安全问题，需要探索和解决。目的本定性研究的目的是更好地了解重症监护室（ICU）护士如何对警报做出决定和反应，特别是他们如何识别不同的警报，以及他们如何在ICU环境中对其进行分类和管理。方法对来自3个icu的12名护士进行深度半结构化访谈。运用解释性描述方法，对报警响应决策进行了探讨。专题分析用于确定关键主题。结果ICU护士的决策包括三个步骤：意识，包括如何听到警报；不同的警报是如何分类的；以及他们如何回应和优先处理不同的警报。影响护士意识的因素包括相互竞争的任务和优先事项，单位繁忙的性质，人员配备不足，单位噪音增加，以及虚假/不可操作警报数量增加。接下来，护士根据他们的经验、性格/性质、情境疲劳和倦怠对他们的警报反应进行分类。最后，护士在考虑对警报的反应速度时考虑了多种因素。紧急响应发生在高优先级的心电图警报、更急症患者的警报、床上警报和静脉（IV）泵注入维持生命的药物。结论积极的安全文化、规范的报警教育和指导是实施有效的报警响应和管理，减少报警疲劳的有效途径。

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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 : 2026-01-01 Epub 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