American heart journal plus : cardiology research and practice最新文献_第6页

The association of epicardial adipose tissue thickness and human neutrophil lipocalin with mitral annular calcification 心外膜脂肪组织厚度和人中性粒细胞脂钙素与二尖瓣环钙化的关系

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-11-12 DOI: 10.1016/j.ahjo.2025.100672

Yeheng Xue , Xinyi Wang , Xiaohong Liu , Qingxue Zhang , Zhijian Liu , Bin Leng , Xiuchang Li

Study objective

Mitral annular calcification (MAC) is significantly associated with coronary artery stenosis and valvular dysfunction. And epicardial adipose tissue (EAT) can secrete inflammatory factors and human neutrophil lipocalin (HNL) are widely used as indicators of inflammation. There is now increasing evidence of a strong link between MAC and the inflammatory response. This study aims to investigate the effects of EAT thickness and HNL in MAC.

Design

A cross-sectional approach was used in this study.

Setting

The Second Affiliated Hospital of Shandong First Medical University.

Participants

The included patients was classified into a calcification group (MAC group) and a control group based on the presence or absence of MAC on echocardiography.

Interventions

None.

Main outcome measures

The clinical data, HNL, EAT thickness of the two groups were measured, collected and analyzed. Logistic regression analysis was used to assess the independent risk factors for MAC and the receiver operating characteristic (ROC) curve was plotted to evaluate the effectiveness of EAT thickness and HNL in diagnosing MAC.

Results

Patients in the MAC group had significantly higher basal and apical EAT thickness and HNL level than those in the control group. Basal EAT thickness was independently associated with MAC (OR = 2.003, 95 % CI = 1.474–2.721, P < 0.001). The AUC for basal EAT thickness to predict MAC was 0.880.

Conclusion

Our data suggest EAT thickness and HNL were significantly associated with MAC, and basal EAT thickness near the right coronary artery was independently associated with MAC and had a high predictive value for MAC.

研究目的二尖瓣环形钙化（MAC）与冠状动脉狭窄和瓣膜功能障碍有显著相关性。心外膜脂肪组织（EAT）可分泌炎症因子，人中性粒细胞脂钙素（HNL）被广泛用作炎症指标。现在有越来越多的证据表明MAC和炎症反应之间有很强的联系。本研究的目的是探讨食管癌上皮厚度和HNL对mac的影响。本研究采用designa横断面方法。山东第一医科大学第二附属医院。根据超声心动图有无钙化，将纳入研究的患者分为钙化组（MAC组）和对照组。干预措施：主要观察指标：测量、收集两组患者的临床资料、HNL、EAT厚度，并进行分析。采用Logistic回归分析评估MAC的独立危险因素，并绘制受试者工作特征（ROC）曲线，评价EAT厚度和HNL对MAC诊断的有效性。结果MAC组患者的基底、根尖EAT厚度和HNL水平均显著高于对照组。基础EAT厚度与MAC独立相关（OR = 2.003, 95% CI = 1.474-2.721, P < 0.001）。基础EAT厚度预测MAC的AUC为0.880。结论EAT厚度和HNL与MAC有显著相关性，右冠状动脉附近基底EAT厚度与MAC独立相关，对MAC有较高的预测价值。

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引用次数: 0

Single centre experience of rotablation-assisted left main percutaneous coronary intervention 旋转辅助左主干经皮冠状动脉介入治疗的单中心经验

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-11-20 DOI: 10.1016/j.ahjo.2025.100678

Mohd Maqbool Sohil , Ishtiyaq Masood , Dixit Goyal , Haider Rashid

Background

CABG has limitations as a treatment modality in patients with Left main disease and high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Some patients are unsuitable for surgery owing to high surgical risk. Importantly, limited centers are offering CABG, particularly in our part of the world. Limited data exist on long-term outcomes in Indian patients undergoing rotablation-assisted PCI for such lesions. Our objective was to assess in-hospital and two-year clinical outcomes of patients undergoing rotablation-assisted left main PCI at our center.

Methods

This prospective observational study included 45 consecutive patients undergoing rotablation-assisted left main PCI from January 2020 to January 2023. Baseline characteristics, procedure-related factors, in-hospital, and two-year outcomes were assessed. Subgroup analysis was done to assess the predictors of adverse outcomes.

Results

Our cohort had anatomically complex coronary artery disease with a SYNTAX score of 40.1 ± 8.2. 86.7 % (n = 39) of patients had severe angiographic calcification. Intravascular ultrasound (IVUS) was done in 75.6 % of patients (n = 34). 71.1 % (n = 32) of patients had a true bifurcation lesion. Rotablation was performed using Rotablator RA system. The target burr-artery ratio was 0.7. Burrs used were sized from 1.25 mm to 2 mm and were operated at speeds of 140,000 to 180,000 rpm. Multiple burrs were used when clinically necessary. 75.6 % (n = 34) of patients were done by the two-stent technique. Double kissing CRUSH (DK CRUSH) was the most common two-stent technique used in 71.1 % (n = 32) patients. Angiographic success was 100 %, while procedural success was 97.8 %. In-hospital mortality was 2.2 %. At two years, major adverse cardiovascular events (MACE) free survival was 93.3 %.

Conclusion

Rotablation-assisted PCI in severely calcified left main lesions is safe and effective, offering good procedural success and favourable mid-term clinical outcomes.

背景：作为左主干疾病患者的治疗方式，冠状动脉搭桥有局限性，经皮冠状动脉介入治疗与心脏手术（SYNTAX）评分之间有很高的协同作用。部分患者手术风险高，不适合手术。重要的是，有限的中心提供CABG，特别是在我们这个地区。印度患者接受旋转辅助PCI治疗此类病变的长期预后数据有限。我们的目的是评估在我们中心接受旋转辅助左主干PCI治疗的患者的住院和两年临床结果。方法本前瞻性观察性研究包括45例连续患者，于2020年1月至2023年1月接受旋转辅助左主干PCI治疗。评估基线特征、手术相关因素、住院和两年预后。进行亚组分析以评估不良结局的预测因素。结果我们的队列患者患有解剖结构复杂的冠状动脉疾病，SYNTAX评分为40.1±8.2。86.7% （n = 39）的患者有严重的血管造影钙化。75.6%（34例）患者行血管内超声检查。71.1% （n = 32）的患者出现真分叉病变。旋转采用Rotablator RA系统。目标毛囊-动脉比值为0.7。使用的毛刺尺寸为1.25 mm至2mm，转速为14万至18万rpm。临床需要时使用多个毛刺。75.6% （n = 34）的患者采用双支架技术。在71.1% （n = 32）的患者中，双吻合器（DK CRUSH）是最常见的双支架技术。血管造影成功率为100%，手术成功率为97.8%。住院死亡率为2.2%。两年后，无主要不良心血管事件（MACE）生存率为93.3%。结论旋转辅助PCI治疗左主干严重钙化病变安全有效，手术成功率高，中期临床效果良好。

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引用次数: 0

Is predictive modeling the missing link for post-STEMI recovery in rural and resource-poor regions? 预测建模是农村和资源贫乏地区stemi后恢复的缺失环节吗？

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-12-15 DOI: 10.1016/j.ahjo.2025.100697

Jose Eric M. Lacsa

引用次数: 0

Differential effects of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory markers in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized controlled trial 一项随机对照试验：术前阿托伐他汀与瑞舒伐他汀对st段抬高型心肌梗死患者经皮冠状动脉介入治疗后血流变和炎症指标的差异影响

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-12-17 DOI: 10.1016/j.ahjo.2025.100701

Ramin Khameneh Bagheri , Ali Eshraghi , Hasan Amirsoleimani , Faeze Keihanian

Background

The pleiotropic effects of statins may benefit patients with acute coronary syndromes. This study compared the impact of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory indexes in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).

Methods

In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)—were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.

Results

The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, p = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2–8.1] vs. 7.8 [4.9–10.2], p = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, p < 0.001). No significant inter-group difference was found in the 48-h PLR.

Conclusion

While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.

Registry Accessibility: http://irct.ir/trial/27377

Trial registration code: IRCT2017101236737N1.

背景：他汀类药物的多效性可能使急性冠脉综合征患者受益。本研究比较了手术前阿托伐他汀与瑞舒伐他汀对st段抬高型心肌梗死（STEMI）超急性背景下血液和炎症指标的影响。方法在这项预先指定的多中心三盲试验中，STEMI患者在经皮冠状动脉介入治疗（PPCI）前随机接受80 mg阿托伐他汀（n = 98）或40 mg瑞舒伐他汀（n = 102）。关键的血液学指标-中性粒细胞与淋巴细胞比率（NLR），血小板与淋巴细胞比率（PLR）和血小板分布宽度(PDW) -在ppci后基线，24和48小时进行测量。对比剂肾病（CIN）的发生率也进行了评估。结果两组CIN的发生率相似（阿托伐他汀3.0% vs瑞舒伐他汀3.5%,p = 0.99）。然而，血液学指标显示有显著差异。阿托伐他汀组48 h NLR显著低于瑞舒伐他汀组（中位数[IQR]: 5.1[3.2-8.1]比7.8 [4.9-10.2],p = 0.003）。相反，瑞舒伐他汀组在24 h时PDW显著升高（15.6±1.5 vs. 14.7±1.5,p < 0.001）。48h PLR组间差异无统计学意义。结论两种高强度他汀类药物具有相似的肾保护作用，但具有不同的调节作用。阿托伐他汀与更明显的抗炎作用（更低的NLR）相关，而瑞舒伐他汀与血小板活性增加（更高的PDW）相关。这些发现表明不同的多效性特性值得进一步研究其对临床结果的影响。注册中心访问：http://irct.ir/trial/27377Trial注册代码：IRCT2017101236737N1。

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引用次数: 0

Dementia is associated with higher mortality and worse patient-centered outcomes after complex and high-risk coronary artery stenting 在复杂和高风险的冠状动脉支架植入术后，痴呆与更高的死亡率和更差的以患者为中心的结果相关

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-12-02 DOI: 10.1016/j.ahjo.2025.100689

Khanjan B. Shah , Lingwei Xiang , Samir K. Shah , Rachel R. Adler , Joel S. Weissman

Objectives

The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI).

Background

CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored.

Methods

We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.

Results

8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, p < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14–1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03–1.43) and readmissions (OR 1.27, 95 % CI 1.07–1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48–2.22) and have lower time-at-home ratios (Mean Difference −5.48, 95 % CI −9.24 to −2.45).

Conclusions

Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.

目的本研究的目的是评估痴呆状态是否影响复杂高危指征经皮冠状动脉介入治疗（CHIP-PCI）的结果。chip - pci是一种冠状动脉支架植入术，适用于解剖结构复杂的冠状动脉疾病和严重的医学合并症患者。随着人口老龄化，更多的患者将需要CHIP-PCI，包括那些患有阿尔茨海默氏痴呆和相关痴呆（ADRD）的患者。CHIP-PCI治疗ADRD患者的疗效尚不明确。方法我们比较了2017年7月1日至2019年12月31日期间接受CHIP-PCI治疗的66岁及以上的医疗保险服务收费（FFS）受益人，有和没有ADRD。主要临床结果为1年死亡率，次要临床结果为并发症和再入院。以患者为中心的结果是在家的时间比和出院到更高的护理水平。结果8884例CHIP-PCI患者符合研究标准，766例（8.6%）患者诊断为ADRD。ADRD患者更可能是老年人（81.2 vs 77.5, p < 0.001）和体弱患者（52.1% vs 27.3%, p < 0.001）。ADRD患者的1年死亡率（OR 1.34, 95% CI 1.14-1.57）高于90天主要并发症（OR 1.22, 95% CI 1.03-1.43）和再入院（OR 1.27, 95% CI 1.07-1.50）。ADRD患者更有可能出院到更高水平的护理（OR为1.81,95% CI为1.48-2.22），并且在家的时间比更低（平均差为5.48,95% CI为9.24 - 2.45）。结论ADRD患者具有较高的1年死亡率和主要并发症。他们在家的时间比例特别低，而且有转到更高级别护理的风险。患者、家属和医生应使用这些数据来促进目标一致的护理。

{"title":"Dementia is associated with higher mortality and worse patient-centered outcomes after complex and high-risk coronary artery stenting","authors":"Khanjan B. Shah , Lingwei Xiang , Samir K. Shah , Rachel R. Adler , Joel S. Weissman","doi":"10.1016/j.ahjo.2025.100689","DOIUrl":"10.1016/j.ahjo.2025.100689","url":null,"abstract":"<div><h3>Objectives</h3><div>The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI).</div></div><div><h3>Background</h3><div>CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored.</div></div><div><h3>Methods</h3><div>We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.</div></div><div><h3>Results</h3><div>8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, <em>p</em> < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14–1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03–1.43) and readmissions (OR 1.27, 95 % CI 1.07–1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48–2.22) and have lower time-at-home ratios (Mean Difference −5.48, 95 % CI −9.24 to −2.45).</div></div><div><h3>Conclusions</h3><div>Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100689"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sudden cardiac death in stable coronary artery disease: A literature review 稳定性冠状动脉疾病的心源性猝死：文献综述

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-11-20 DOI: 10.1016/j.ahjo.2025.100674

Randa Tabbah , Walid Saliba , Bernard Abi-Saleh

Sudden cardiac death (SCD) remains a leading cause of mortality in patients with stable coronary artery disease (CAD), despite advances in diagnosis, risk stratification, and therapy. This review synthesises current evidence on epidemiology, pathophysiology, clinical predictors, and preventive strategies for SCD in chronic coronary syndromes. Historical perspectives, including early autopsy observations, highlight the longstanding recognition of SCD as a complication of CAD. Contemporary data reveal that SCD often represents the first clinical manifestation of coronary heart disease, with a substantial proportion of cases occurring in individuals classified as low risk. Mechanistically, SCD is frequently triggered by acute ischemia or arrhythmogenic substrates in the context of structural and electrical remodeling. Key predictors include left ventricular dysfunction, ventricular arrhythmias, and specific electrocardiographic markers, though their predictive value in stable CAD remains limited. Preventive strategies range from optimal medical therapy and lifestyle interventions to device-based approaches, such as implantable cardioverter-defibrillators, in selected high-risk subgroups. Despite these measures, risk stratification tools lack sufficient sensitivity and specificity to guide widespread prophylactic interventions. Future research should focus on refining predictive models by integrating clinical, imaging, and biomarker data to enable more targeted prevention of SCD in stable CAD populations.

心源性猝死（SCD）仍然是稳定性冠状动脉疾病（CAD）患者死亡的主要原因，尽管在诊断、风险分层和治疗方面取得了进展。本文综述了慢性冠脉综合征SCD的流行病学、病理生理学、临床预测因素和预防策略方面的最新证据。历史观点，包括早期尸检观察，强调了长期以来对SCD作为CAD并发症的认识。当代数据显示，SCD通常是冠心病的第一个临床表现，其中相当大比例的病例发生在低风险人群中。从机制上讲，SCD经常由急性缺血或结构和电重构背景下的致心律失常底物触发。关键的预测因素包括左心室功能障碍、室性心律失常和特定的心电图标志物，尽管它们在稳定型CAD中的预测价值仍然有限。预防策略包括从最佳药物治疗和生活方式干预到基于设备的方法，如在选定的高风险亚群中植入心律转复除颤器。尽管采取了这些措施，但风险分层工具缺乏足够的敏感性和特异性来指导广泛的预防性干预措施。未来的研究应侧重于通过整合临床、影像学和生物标志物数据来完善预测模型，以便在稳定的CAD人群中更有针对性地预防SCD。

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引用次数: 0

Oxidized low-density lipoprotein cholesterol and plaque vulnerability 氧化低密度脂蛋白胆固醇与斑块易损性

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-12-05 DOI: 10.1016/j.ahjo.2025.100691

Jun Goto , Daisuke Kinoshita , Yoichiro Otaki , Seisei Ra , Hiroe Ono , Takafumi Mito , Taku Shikama , Shingo Tachibana , Shigehiko Kato , Tetsu Watanabe , Ik-Kyung Jang , Masafumi Watanabe

Background

The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. The study aimed to investigate the association between LDL-C oxidation and plaque morphology assessed using optical coherence tomography (OCT).

Methods

A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL-C (MDA-LDL), a representative form of oxidized LDL-C, was measured. Levels of LDL-C oxidation were assessed using the ratio of MDA-LDL to LDL-C ratio. Plaque morphology was assessed by OCT at the target lesions.

Results

Patients were divided into three groups according to the tertiles of LDL-C oxidation levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of LDL-C oxidation in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, p for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, p for trend = 0.009). In contrast, no association was found in patients without DM (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, p for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, p for trend = 0.748). Those associations remained significant even after adjusting for confounders in patients with DM but not in those without.

Conclusions

The levels of LDL-C oxidation were associated with plaque vulnerability, especially in patients with DM.

低密度脂蛋白胆固醇（LDL-C）的氧化在斑块炎症和随后的高风险斑块形成中起着关键作用。然而，糖尿病（DM）患者LDL-C氧化与斑块形态之间的关系尚未有系统的研究。该研究旨在通过光学相干断层扫描（OCT）评估LDL-C氧化与斑块形态之间的关系。方法对138例慢性冠脉综合征患者行OCT检查的临床资料进行分析。测定氧化LDL-C的代表形式丙二醛修饰LDL-C （MDA-LDL）。用MDA-LDL与LDL-C比值评估LDL-C氧化水平。在靶病变处用OCT评估斑块形态。结果根据LDL-C氧化水平分位数将患者分为三组。DM患者LDL-C氧化水平越高，脂质指数和巨噬细胞等级越高（低、中、高；脂质指数：714、1226、2217，p趋势= 0.040；巨噬细胞等级：2、7、13，p趋势= 0.009）。相比之下，非糖尿病患者无相关性（低、中、高；脂质指数：1109、1181、1436，p为趋势= 0.633；巨噬细胞分级：8、5、8，p为趋势= 0.748）。即使在糖尿病患者中调整混杂因素后，这些相关性仍然显著，而在非糖尿病患者中则没有。结论LDL-C氧化水平与斑块易感性相关，尤其是在糖尿病患者中。

{"title":"Oxidized low-density lipoprotein cholesterol and plaque vulnerability","authors":"Jun Goto , Daisuke Kinoshita , Yoichiro Otaki , Seisei Ra , Hiroe Ono , Takafumi Mito , Taku Shikama , Shingo Tachibana , Shigehiko Kato , Tetsu Watanabe , Ik-Kyung Jang , Masafumi Watanabe","doi":"10.1016/j.ahjo.2025.100691","DOIUrl":"10.1016/j.ahjo.2025.100691","url":null,"abstract":"<div><h3>Background</h3><div>The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. The study aimed to investigate the association between LDL-C oxidation and plaque morphology assessed using optical coherence tomography (OCT).</div></div><div><h3>Methods</h3><div>A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL-C (MDA-LDL), a representative form of oxidized LDL-C, was measured. Levels of LDL-C oxidation were assessed using the ratio of MDA-LDL to LDL-C ratio. Plaque morphology was assessed by OCT at the target lesions.</div></div><div><h3>Results</h3><div>Patients were divided into three groups according to the tertiles of LDL-C oxidation levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of LDL-C oxidation in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, <em>p</em> for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, <em>p</em> for trend = 0.009). In contrast, no association was found in patients without DM (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, <em>p</em> for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, <em>p</em> for trend = 0.748). Those associations remained significant even after adjusting for confounders in patients with DM but not in those without.</div></div><div><h3>Conclusions</h3><div>The levels of LDL-C oxidation were associated with plaque vulnerability, especially in patients with DM.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100691"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

BUN-albumin ratio as a prognostic marker in decompensated heart failure with reduced ejection fraction bun -白蛋白比值作为失代偿性心力衰竭伴射血分数降低的预后指标

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-11-24 DOI: 10.1016/j.ahjo.2025.100683

Bahy Abofrekha , Mahmoud Shadi , Jennifer Jdaidani , Alaukika Agarwal , Elie Bou Sanayeh , Ahmad Zayed , Hadi Itani , Lee Un Jung , Suzanne El-Sayegh , Geurys R. Rojas-Marte

Background

Decompensated heart failure with reduced ejection fraction (D-HFrEF) is a prevalent cause of hospitalization and mortality. Early risk stratification is crucial for targeted interventions. The blood urea nitrogen to serum albumin ratio (BAR) has shown prognostic value in critical illness, but its role in D-HFrEF is understudied.

Objectives

This study aimed to evaluate the association of BAR calculated within 24 h of admission with length of hospital stay (LOS), in-hospital mortality, and 30-day readmissions in patients hospitalized with D-HFrEF and identify an optimal cut-off value for each outcome.

Methods and results

This was a multicenter retrospective cohort analysis of 2286 patients hospitalized in 2022 with D-HFrEF. The population's median age was 72.00 years, with 59.8 % being male. In the fully adjusted model, each one-unit increase in baseline BAR was associated with a 2.85 % increase in the length of hospital stay in days (IRR: 1.027, 95 % CI: 1.021–1.033, p < 0.001) and significantly higher odds of in-hospital mortality (OR: 1.107, 95 % CI: 1.076–1.139, p < 0.001) and prolonged LOS (≥30 days) (OR: 1.065, 95 % CI: 1.034–1.097, p < 0.001). BAR was not significantly associated with 30-day readmission (p = 0.06). Receiver operating characteristic analysis identified optimal BAR cut-off points of 6.82 for mortality.

Conclusions

Our data show that an elevated BAR on admission is associated with increased in-hospital mortality and LOS > 30 days in patients hospitalized for D-HFrEF. This readily available marker can aid in identifying patients at higher risk for adverse events. Prospective studies are needed to validate our findings.

背景：失代偿性心力衰竭伴射血分数降低（D-HFrEF）是住院和死亡的常见原因。早期风险分层对于有针对性的干预至关重要。血尿素氮与血清白蛋白比（BAR）在危重疾病中具有预测价值，但其在D-HFrEF中的作用尚未得到充分研究。本研究旨在评估入院24小时内计算的BAR与D-HFrEF住院患者住院时间（LOS）、住院死亡率和30天再入院的关系，并确定每个结果的最佳临界值。方法和结果：对2022年住院的2286例D-HFrEF患者进行多中心回顾性队列分析。人口年龄中位数为72.00岁，男性占59.8%。在完全调整的模型中，基线BAR每增加一个单位，住院天数增加2.85% (IRR: 1.027, 95% CI: 1.021-1.033, p < 0.001)，住院死亡率（OR: 1.107, 95% CI: 1.076-1.139, p < 0.001）和LOS延长（≥30天）（OR: 1.065, 95% CI: 1.034-1.097, p < 0.001）的几率显著增加。BAR与30天再入院无显著相关性（p = 0.06）。受试者工作特征分析确定死亡率的最佳BAR分界点为6.82。研究数据显示，入院时BAR升高与D-HFrEF患者住院30天的住院死亡率和LOS增加有关。这种现成的标志物可以帮助识别不良事件风险较高的患者。需要前瞻性研究来验证我们的发现。

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引用次数: 0

Impact of pre-procedural requirements on time to aortic valve replacement: Transcatheter AVR vs surgical AVR 术前要求对主动脉瓣置换术时间的影响：经导管AVR vs手术AVR

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-12-10 DOI: 10.1016/j.ahjo.2025.100698

Curtiss Stinis , Sean Tunis , Sandra Lauck , Aakriti Gupta , Shannon Murphy , Soumya Chikermane , Seth Clancy , Mark Russo

Background/objective

This study aims to understand the extent that cardiac specialist visits and imaging requirements contribute to the difference in time to Aortic valve replacement (AVR) stratified by approach transcatheter AVR (TAVR) and surgical AVR (SAVR).

Methods

Optum Market Clarity Data was used to identify patients with clinically significant AS (CSAS) who received an AVR between 2016 and 2023 and whose AVR occurred within two years of their CSAS diagnosis. Patient characteristics were measured at baseline; pre-procedural factors, including the number of cardiac specialist visits and imaging events, were measured from CSAS diagnosis to AVR (TAVR vs SAVR). Stepwise generalized linear models were used to assess whether the number of cardiac specialist visits and imaging events contribute to the differences in time to TAVR and SAVR, after adjusting for baseline characteristics.

Results

Of the 14,225 patients in the cohort, 42 % received a TAVR. Compared to the SAVR cohort, the TAVR cohort was, on average, more male, older, sicker, and had more Medicare enrollees. TAVR patients had approximately two times more cardiac specialist visits (3.73 vs 6.37) and imaging events (1.18 vs 2.07) than SAVR patients. Time to TAVR is 65 days longer (RR = 1.77, 1.67–1.87) than SAVR, after adjustment for patient characteristics. This difference reduces to 11 days (RR = 1.12, 1.07–1.17) after accounting cardiac specialist encounters and imaging events.

Discussion

Pre-procedural encounters significantly contribute to the longer time to AVR for TAVR patients. Findings suggest a need for streamlining the pre-procedural process for TAVR to enhance timely care delivery for CSAS patients.

背景/目的本研究旨在了解心脏专科就诊和影像学要求对经导管AVR （TAVR）和外科AVR （SAVR）分层主动脉瓣置换术（AVR）时间差异的影响程度。方法使用soptum市场清晰度数据识别在2016年至2023年期间接受AVR且在CSAS诊断后两年内发生AVR的临床显著性AS （CSAS）患者。在基线时测量患者特征；从CSAS诊断到AVR (TAVR vs SAVR)，测量术前因素，包括心脏专科就诊次数和影像学事件。在调整基线特征后，采用逐步广义线性模型来评估心脏专科就诊次数和影像学事件是否导致TAVR和SAVR的时间差异。结果在14225例患者中，42%的患者接受了TAVR。与SAVR队列相比，TAVR队列平均更多的是男性，年龄更大，病情更重，并且有更多的医疗保险参保者。TAVR患者的心脏专科就诊次数（3.73 vs 6.37）和影像学事件（1.18 vs 2.07）大约是SAVR患者的两倍。调整患者特征后，到达TAVR的时间比到达SAVR的时间长65天（RR = 1.77, 1.67-1.87）。考虑到心脏病专家就诊和影像学事件后，这一差异减少到11天（RR = 1.12, 1.07-1.17）。术前接触显著增加了TAVR患者到AVR的时间。研究结果表明，需要简化TAVR的术前流程，以提高对CSAS患者的及时护理。

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引用次数: 0

Cardiac troponin T elevation predicts mortality in hospitalized COVID-19 patients 心脏肌钙蛋白T升高预测住院COVID-19患者的死亡率

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 Epub Date: 2025-12-02 DOI: 10.1016/j.ahjo.2025.100690

Katelyn A. Bruno , R. Scott Wright , Joshua Culberson , Mikolaj A. Wieczorek , David O. Hodge , Patrick W. Johnson , Yomary A. Jimenez , Emily R. Whelan , Jose M. Malavet , Kathryn F. Larson , Jonathon W. Senefeld , Chad C. Wiggins , Stephen A. Klassen , Jacob Ricci , Taimur Sher , Rickey E. Carter , Michael J. Joyner , DeLisa Fairweather , Allan S. Jaffe

Objective

To evaluate if cardiac troponin values predict poor outcomes in COVID-19 patients across the range of patients of different sex and age.

Methods

We examined high-sensitivity cardiac troponin T (hs-cTnT) levels in 1050 severely ill hospitalized COVID-19 patients who had hs-cTnT data available and participated in the Expanded Access Program for convalescent plasma study during the first wave (April–August 2020) of the COVID-19 pandemic.

Results

We observed a continuous relationship between hs-cTnT levels and mortality in hospitalized males and females with COVID-19. This finding was present regardless of sex or age.

Conclusion

These data indicate the prognostic ability of hs-cTnT to predict mortality in hospitalized COVID-19 patients across all relevant patient groups.

Clinical Trials registration number: NCT04338360

目的探讨心肌肌钙蛋白值对不同性别和年龄的COVID-19患者预后不良的预测作用。方法我们检测了1050名有hs-cTnT数据的重症住院COVID-19患者的高敏心肌肌钙蛋白T （hs-cTnT）水平，这些患者参加了第一波（2020年4月- 8月）COVID-19大流行期间恢复期血浆研究扩大准入计划。结果我们观察到住院的男性和女性COVID-19患者的hs-cTnT水平与死亡率之间存在连续关系。这一发现与性别和年龄无关。结论这些数据表明hs-cTnT在所有相关患者组中预测住院COVID-19患者死亡率的预后能力。临床试验注册号：NCT04338360

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引用次数: 0