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

Triglyceride–glucose index predicts early, short-term, and long-term mortality after transcatheter aortic valve replacement 甘油三酯-葡萄糖指数预测经导管主动脉瓣置换术后的早期、短期和长期死亡率

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-25 DOI: 10.1016/j.ahjo.2025.100684

Haitham Abu Khadija , Duha Najajra , Mohammad Masu'd , Nizar Abu Hamdeh , Omar Ayyad , Ameer Mahamid , Max Bagan , Ali Abdullah , Jebrin Alkrinawi , Alaa Zayed , Abdalaziz Darwish , Aesha L.E. Enairat , Alena Kirzhner , Tal Schiller , Mohammad Alnees

Background

Despite transforming care for severe aortic stenosis, TAVR is still followed by early and late mortality. The triglyceride–glucose (TyG) index, an insulin-resistance marker from routine triglyceride and glucose levels, may flag high-risk patients in Ashkenazi-Jewish and Mediterranean individuals. We examined whether baseline TyG predicts all-cause mortality at 30 days, 1 year, and 3 years post-TAVR.

Methods

We retrospectively studied patients with severe symptomatic aortic stenosis who underwent TAVR at a single tertiary center between 2010 and 2024. The TyG index was calculated from baseline triglyceride and glucose values. The primary endpoint was all-cause mortality at 1 year, with secondary endpoints of all-cause mortality at 30 days and 3 years. Cox proportional hazards models evaluated the association between TyG (per 1-unit increase) and mortality, adjusting for major clinical risk factors. Additionally, ROC curves were used to derive cohort-specific TyG thresholds for short-term and long-term mortality.

Results

Results: A total of 821 TAVR patients were included. All-cause mortality was 3.4 % at 30 days, 10.9 % at 1 year, and 19.7 % at 3 years. Higher baseline TyG was associated with significantly increased mortality risk at all time points. After multivariable adjustment, each 1-unit increase in TyG index conferred a higher hazard of 1-year death (adjusted HR 1.62, 95 % CI 1.21–2.16) and remained predictive of mortality at 30 days (HR 1.92, 95 % CI 1.08–3.42) and 3 years (HR 1.42, 95 % CI 1.14–1.77). ROC analysis identified distinct TyG thresholds for short-term and long-term outcomes, with an optimal cut-point of 9.012 for 30-day mortality, 9.15 for 1-year mortality, and 8.700 for 3-year mortality.

Conclusions

Baseline TyG index is an independent predictor of early, short-term, and long-term mortality after TAVR. The identification of cohort-specific TyG cut-points highlights population-specific metabolic risk calibration and supports the use of TyG as a simple and informative biomarker for refining risk stratification and follow-up intensity in TAVR recipients.

背景：尽管对严重主动脉瓣狭窄的治疗发生了转变，TAVR仍然会导致早期和晚期死亡。甘油三酯-葡萄糖（TyG）指数是一种胰岛素抵抗的标记物，它来自常规甘油三酯和葡萄糖水平，可能标志着德系犹太人和地中海个体的高危患者。我们检查了基线TyG是否预测tavr后30天、1年和3年的全因死亡率。方法回顾性研究2010年至2024年间在单一三级中心行TAVR的严重症状性主动脉瓣狭窄患者。TyG指数根据基线甘油三酯和葡萄糖值计算。主要终点是1年时的全因死亡率，次要终点是30天和3年时的全因死亡率。Cox比例风险模型评估了TyG（每增加1个单位）与死亡率之间的关系，调整了主要临床危险因素。此外，ROC曲线用于得出短期和长期死亡率的特定队列TyG阈值。结果：共纳入TAVR患者821例。30天全因死亡率为3.4%，1年为10.9%，3年为19.7%。在所有时间点，较高的基线TyG与显著增加的死亡风险相关。多变量调整后，TyG指数每增加1个单位，1年内死亡的风险就会增加（校正后的HR 1.62, 95% CI 1.21-2.16），并且仍然可以预测30天（HR 1.92, 95% CI 1.08-3.42）和3年（HR 1.42, 95% CI 1.14-1.77）的死亡率。ROC分析确定了短期和长期结果的不同TyG阈值，30天死亡率的最佳临界值为9.012,1年死亡率为9.15,3年死亡率为8.700。结论基线TyG指数是TAVR术后早期、短期和长期死亡率的独立预测因子。队列特异性TyG切割点的确定强调了人群特异性代谢风险校准，并支持将TyG作为一种简单且信息丰富的生物标志物，用于改进TAVR受者的风险分层和随访强度。

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引用次数: 0

Higher hemoglobin is associated with better survival in coronary artery disease, heart failure with reduced ejection fraction, and chronic kidney disease 较高的血红蛋白与冠状动脉疾病、心力衰竭伴射血分数降低和慢性肾病患者更好的生存率相关

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-25 DOI: 10.1016/j.ahjo.2025.100685

Cheng-Yu Hung , Wen-Lieng Lee , Wayne H.-H. Sheu , Kae-Woei Liang

Background

Anemia is a common comorbidity in patients with heart failure (HF) or chronic kidney disease (CKD) and could be associated with worse clinical outcomes. However, to date, the impact of anemia on survival in a complex triple-comorbidity of coronary artery disease (CAD), HF with reduced ejection fraction (HFrEF), and CKD remains inconclusive.

Methods

We retrospectively analyzed data for subjects with significant CAD, HFrEF (defined as left ventricular ejection fraction (EF) <40 %) and CKD (defined as estimated glomerular filtration rate (eGFR) ≦60 ml/min/1.73m²) from our cardiac catheterization laboratory between January 2010 and September 2019. Clinical and laboratory variables were recorded from traceable chart records from our hospital. All-cause and cardiovascular mortality were counted until December 2019 and served as study outcomes.

Results

A total of 128 subjects with CAD, HFrEF and CKD were analyzed. Anemia was prevalent (81/128 = 63.3 %) in this complex disease combination. The median follow-up duration was 36 months and 77 subjects (60.1 %) died. Cox survival analysis revealed that higher baseline hemoglobin (hazard ratio 0.864, 95 % CI 0.753–0.992, per 1 g/dl increase), higher eGFR, better EF, and the use of beta-blockers were associated with lower all-cause mortality.

Conclusions

A higher baseline admission hemoglobin value was associated with lower all-cause mortality in subjects with significant CAD, HFrEF, and CKD.

背景：贫血是心力衰竭（HF）或慢性肾脏疾病（CKD）患者的常见合并症，可能与较差的临床结果相关。然而，迄今为止，在复杂的冠状动脉疾病（CAD）、心衰伴射血分数降低（HFrEF）和CKD三重合并症中，贫血对生存的影响仍不确定。方法回顾性分析2010年1月至2019年9月心导管实验室中患有显著CAD， HFrEF（定义为左室射血分数(EF)≥40%）和CKD（定义为肾小球滤过率（eGFR）估计≦60 ml/min/1.73m2）的受试者的数据。临床和实验室变量记录自我院可追溯的图表记录。全因死亡率和心血管死亡率被计算到2019年12月，并作为研究结果。结果共分析了128例CAD、HFrEF和CKD患者。在这种复杂的疾病组合中，贫血是普遍存在的（81/128 = 63.3%）。中位随访时间为36个月，77名受试者（60.1%）死亡。Cox生存分析显示，较高的基线血红蛋白（风险比0.864,95% CI 0.753-0.992，每增加1 g/dl）、较高的eGFR、较好的EF和β受体阻滞剂的使用与较低的全因死亡率相关。结论在冠心病、HFrEF和CKD患者中，较高的入院血红蛋白基线值与较低的全因死亡率相关。

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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 : 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

Sex-based differences in outcomes of mitral valve surgery: A meta-analysis of propensity score-matched studies with reconstructed time-to-event data 二尖瓣手术结果的性别差异：一项基于重构事件时间数据的倾向评分匹配研究的荟萃分析

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-21 DOI: 10.1016/j.ahjo.2025.100682

Leo Consoli , Mir W. Majeed , Eren Cetinel , Pawel Lajczak , Ilias G. Koziakas , Hristo Kirov , Torsten Doenst , Tulio Caldonazo

Background

Studies indicate worse outcomes for women undergoing mitral valve surgery, but this can be biased in the context of differences in risk profiles between sexes. We aimed to assess short- and long-term outcomes of mitral valve surgery in men and women using confounder-adjusted data.

Methods

We searched PubMed, Embase, and the Cochrane Library for eligible propensity-score-matched studies. Analysis was performed for short-term (<30 days mortality and procedural complications) and long-term (>1 year mortality, reoperation, and mitral regurgitation) endpoints. A pairwise random-effects meta-analysis was done for short-term outcomes, pooling risk ratios (RR) with 95 % confidence intervals (CIs). A meta-analysis of Kaplan-Meier derived individual patient data was conducted for long-term endpoints. Cox frailty regression analysis was used to obtain hazard ratios (HR).

Results

We included 12 studies (n = 55,616). No significant differences were observed in the short-term risks of death (RR 1.02; 95 % CI: 0.91–1.15; p = 0.72), stroke (RR 1.04; 95 % CI: 0.87–1.26; p = 0.65), kidney injury (RR 0.97; 95 % CI: 0.71–1.32; p = 0.85), atrial fibrillation (RR 0.96; 95 % CI: 0.81–1.14; p = 0.61), or pacemaker implantation (RR 0.93; 95 % CI: 0.84–1.02; p = 0.1). The hazards of long-term mortality (HR 0.97; 95 % CI: 0.91–1.03; p = 0.3) and reoperation (HR 1.65; 95 % CI: 0.39–6.91; p = 0.5) were similar between sexes. However, women had a higher hazard of recurrent mitral regurgitation (HR 1.61; 95 % CI: 1.08–2.37; p = 0.018).

Conclusions

This meta-analysis found no sex-based differences in short- or long-term mortality, reoperation rates, or procedural complications following mitral valve surgery. A higher hazard of recurrent mitral regurgitation was observed in women.

研究表明，接受二尖瓣手术的女性预后较差，但这可能在性别风险差异的背景下存在偏差。我们的目的是评估二尖瓣手术在男性和女性的短期和长期的结果使用混杂因素调整的数据。方法检索PubMed、Embase和Cochrane图书馆，寻找符合条件的倾向评分匹配研究。对短期终点（30天死亡率和手术并发症）和长期终点（1年死亡率、再手术和二尖瓣返流）进行分析。对短期结果进行两两随机效应荟萃分析，合并风险比（RR）和95%置信区间（ci）。对Kaplan-Meier衍生的个体患者数据进行了长期终点的荟萃分析。采用Cox脆弱性回归分析获得风险比（HR）。结果纳入12项研究（n = 55,616）。短期死亡风险（RR 1.02; 95% CI: 0.91-1.15; p = 0.72）、卒中风险（RR 1.04; 95% CI: 0.87-1.26; p = 0.65）、肾损伤风险（RR 0.97; 95% CI: 0.71-1.32; p = 0.85）、房颤风险（RR 0.96; 95% CI: 0.81-1.14; p = 0.61）、起搏器植入风险（RR 0.93; 95% CI: 0.84-1.02; p = 0.1）均无显著差异。长期死亡率（HR 0.97; 95% CI: 0.91-1.03; p = 0.3）和再手术风险（HR 1.65; 95% CI: 0.39-6.91; p = 0.5）在性别间相似。然而，女性二尖瓣返流复发的风险较高（HR 1.61; 95% CI: 1.08-2.37; p = 0.018）。结论：本荟萃分析发现，二尖瓣手术后的短期或长期死亡率、再手术率或手术并发症没有性别差异。观察到女性二尖瓣返流复发的危险性较高。

{"title":"Sex-based differences in outcomes of mitral valve surgery: A meta-analysis of propensity score-matched studies with reconstructed time-to-event data","authors":"Leo Consoli , Mir W. Majeed , Eren Cetinel , Pawel Lajczak , Ilias G. Koziakas , Hristo Kirov , Torsten Doenst , Tulio Caldonazo","doi":"10.1016/j.ahjo.2025.100682","DOIUrl":"10.1016/j.ahjo.2025.100682","url":null,"abstract":"<div><h3>Background</h3><div>Studies indicate worse outcomes for women undergoing mitral valve surgery, but this can be biased in the context of differences in risk profiles between sexes. We aimed to assess short- and long-term outcomes of mitral valve surgery in men and women using confounder-adjusted data.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and the Cochrane Library for eligible propensity-score-matched studies. Analysis was performed for short-term (<30 days mortality and procedural complications) and long-term (>1 year mortality, reoperation, and mitral regurgitation) endpoints. A pairwise random-effects meta-analysis was done for short-term outcomes, pooling risk ratios (RR) with 95 % confidence intervals (CIs). A meta-analysis of Kaplan-Meier derived individual patient data was conducted for long-term endpoints. Cox frailty regression analysis was used to obtain hazard ratios (HR).</div></div><div><h3>Results</h3><div>We included 12 studies (n = 55,616). No significant differences were observed in the short-term risks of death (RR 1.02; 95 % CI: 0.91–1.15; p = 0.72), stroke (RR 1.04; 95 % CI: 0.87–1.26; p = 0.65), kidney injury (RR 0.97; 95 % CI: 0.71–1.32; p = 0.85), atrial fibrillation (RR 0.96; 95 % CI: 0.81–1.14; p = 0.61), or pacemaker implantation (RR 0.93; 95 % CI: 0.84–1.02; p = 0.1). The hazards of long-term mortality (HR 0.97; 95 % CI: 0.91–1.03; p = 0.3) and reoperation (HR 1.65; 95 % CI: 0.39–6.91; p = 0.5) were similar between sexes. However, women had a higher hazard of recurrent mitral regurgitation (HR 1.61; 95 % CI: 1.08–2.37; p = 0.018).</div></div><div><h3>Conclusions</h3><div>This meta-analysis found no sex-based differences in short- or long-term mortality, reoperation rates, or procedural complications following mitral valve surgery. A higher hazard of recurrent mitral regurgitation was observed in women.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100682"},"PeriodicalIF":1.8,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618661","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

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 : 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

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 : 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

Increasing burden of lower extremity peripheral arterial disease in Sub-Saharan Africa, 1990–2021 - results from the global burden of disease study 2021 1990-2021年撒哈拉以南非洲下肢外周动脉疾病负担增加——来自2021年全球疾病负担研究的结果

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-19 DOI: 10.1016/j.ahjo.2025.100679

Ngare Nadjingar , Vidmi Taolam Martin , Peidong Zhang

Objective

Lower extremity peripheral artery disease (PAD) is a growing public health challenge in sub-Saharan Africa (SSA), yet epidemiological data remain scarce compared to high-income regions. This study addresses this gap by analyzing trends in PAD burden across SSA from 1990 to 2021, leveraging the Global Burden of Disease (GBD) dataset to inform targeted interventions.

Methods

Using GBD 2021 data, we assessed PAD incidence, prevalence, disability-adjusted life years (DALYs), mortality, and associated risk factors across 46 SSA countries. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated, stratified by sex, age, and Socio-Demographic Index (SDI).

Results

From 1990 to 2021, SSA experienced sharp increases in PAD burden: incidence (≥132.7 %), prevalence (≥132.8 %), DALYs (≥202.9 %), and mortality (≥231.5 %), contrasting with global declines. These trends oppose global declines reported in recent studies, underscoring SSA's unique vulnerability to a diabetes-driven PAD burden. Age-standardized rates rose significantly (EAPCs: 0.12–2.24), with the highest DALY rates in Gabon (57.2/100,000) and Southern SSA. Diabetes accounted for 30.8 % of PAD-related DALYs (male-to-female ratio: 1.8:1), while aging (≥80 years) contributed to 33.9 % of deaths.

Conclusions

The divergent rise of PAD in SSA, which contrasts with global trends, demands region-specific solutions: (1) integrating PAD screening into diabetes programs, (2) aging-focused care, and (3) improved local data to address disparities in Gabon (highest DALYs) and conflict zones.

目的下肢外周动脉疾病（PAD）是撒哈拉以南非洲（SSA）日益严重的公共卫生挑战，但与高收入地区相比，流行病学数据仍然匮乏。本研究通过分析1990年至2021年SSA地区PAD负担的趋势，利用全球疾病负担（GBD）数据集为有针对性的干预措施提供信息，解决了这一差距。方法使用GBD 2021数据，我们评估了46个SSA国家的PAD发病率、患病率、残疾调整生命年（DALYs）、死亡率和相关危险因素。计算年龄标准化率（ASRs）和估计年百分比变化（EAPCs），并按性别、年龄和社会人口指数（SDI）分层。从1990年到2021年，SSA经历了PAD负担的急剧增加：发病率（≥132.7%），患病率（≥132.8%），DALYs（≥202.9%）和死亡率（≥231.5%），与全球下降相比。这些趋势与最近研究报告的全球下降趋势相反，强调了SSA对糖尿病驱动的PAD负担的独特脆弱性。年龄标准化率显著上升（EAPCs: 0.12-2.24），其中加蓬（57.2/100,000）和南部SSA的DALY率最高。糖尿病占pad相关DALYs的30.8%（男女比例：1.8:1），而衰老（≥80岁）占死亡的33.9%。结论：与全球趋势相反，南撒哈拉地区PAD发病率的上升存在差异，因此需要针对不同地区的解决方案：(1)将PAD筛查纳入糖尿病规划；(2)以老年人为重点的护理；(3)改善当地数据，以解决加蓬（DALYs最高）和冲突地区的差异。

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引用次数: 0

Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data 1999-2022年全国二度或三度房室传导阻滞死亡趋势和差异：对CDC WONDER数据的24年回顾性分析

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-19 DOI: 10.1016/j.ahjo.2025.100680

Humza Saeed , Samia Aziz Sulaiman , Abdullah , Priya Goyal , Kamya Thakkar , Wania Sultan , Jawad Zafar Mayo , Muhammad Khubaib Arshad , Ajeet Singh , Mohamed Daoud , Hritvik Jain

Background

AV block prevalence increases with age: first-degree affects 6 % of adults over 60 with low mortality, second-degree is more serious, and third-degree, though rare (0.02 % in the U.S.), has a 37 % five-year survival rate if untreated. Analyzing mortality trends in second- or third-degree AV blocks in the U.S. is vital for treatment and identifying at-risk populations.

Methodology

We analyzed death certificates from the CDC WONDER database (1999–2022) for second- and third-degree AV Block (ICD-10 codes I44.1 and I44.2) in individuals aged 25 and older. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity and geographics.

Results

Between 1999 and 2022, 54,420 deaths were reported in patients with second- or third-degree AV block. The AAMR increased from 12.8 to 14.9, with a significant rise from 2013 to 2022 (APC: 7.26; 95 % CI: 6.13 to 9.96; p < 0.001). Older adults had higher AAMRs (45.0) compared to middle-aged (2.1) and young adults (0.3). Men had higher AAMRs than women (11.3 vs. 8.6). Ethnoracial disparities showed the highest AAMRs in NH American Indian individuals (13.3), followed by NH Black (10.5), NH White (9.8), Hispanic (7.3), and NH Asian individuals (5.9). Non-metropolitan areas had higher AAMRs than metropolitan areas (11.7 vs. 9.2).

Conclusions

Mortality from second- and third-degree AV block has increased since 1999, particularly in the last decade, with higher rates in men, older adults, NH American Indian or Alaska Native individuals, and non-metropolitan areas, highlighting the need for further research to address these disparities.

艾滋病毒阻断的患病率随着年龄的增长而增加：60岁以上的成年人中，一级阻断发生率为6%，死亡率较低，二级阻断更为严重，三级阻断虽然罕见（在美国为0.02%），但如果不治疗，其5年生存率为37%。分析美国二度或三度房室阻滞的死亡率趋势对于治疗和识别高危人群至关重要。方法：我们分析了来自CDC WONDER数据库（1999-2022）的25岁及以上个体的二度和三度房颤阻滞（ICD-10代码I44.1和I44.2）的死亡证明。年龄调整死亡率（AAMRs）和年变化百分比（APC）按年份、性别、年龄、种族/民族和地理位置计算。结果1999年至2022年间，有54,420例二度或三度房室传导阻滞患者死亡。AAMR从12.8上升到14.9，从2013年到2022年显著上升（APC: 7.26; 95% CI: 6.13至9.96;p < 0.001）。老年人的AAMRs（45.0）高于中年人（2.1）和年轻人（0.3）。男性的aamr高于女性（11.3比8.6）。种族差异显示，NH美洲印第安人的aamr最高（13.3），其次是NH黑人（10.5），NH白人（9.8），西班牙裔（7.3）和NH亚洲人（5.9）。非都市地区的aamr高于都市地区（11.7比9.2）。结论：自1999年以来，二度和三度房室传导阻滞的死亡率有所增加，特别是在过去十年中，男性、老年人、NH美洲印第安人或阿拉斯加原住民以及非大都市地区的发生率较高，强调需要进一步研究来解决这些差异。

{"title":"Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data","authors":"Humza Saeed , Samia Aziz Sulaiman , Abdullah , Priya Goyal , Kamya Thakkar , Wania Sultan , Jawad Zafar Mayo , Muhammad Khubaib Arshad , Ajeet Singh , Mohamed Daoud , Hritvik Jain","doi":"10.1016/j.ahjo.2025.100680","DOIUrl":"10.1016/j.ahjo.2025.100680","url":null,"abstract":"<div><h3>Background</h3><div>AV block prevalence increases with age: first-degree affects 6 % of adults over 60 with low mortality, second-degree is more serious, and third-degree, though rare (0.02 % in the U.S.), has a 37 % five-year survival rate if untreated. Analyzing mortality trends in second- or third-degree AV blocks in the U.S. is vital for treatment and identifying at-risk populations.</div></div><div><h3>Methodology</h3><div>We analyzed death certificates from the CDC WONDER database (1999–2022) for second- and third-degree AV Block (ICD-10 codes I44.1 and I44.2) in individuals aged 25 and older. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity and geographics.</div></div><div><h3>Results</h3><div>Between 1999 and 2022, 54,420 deaths were reported in patients with second- or third-degree AV block. The AAMR increased from 12.8 to 14.9, with a significant rise from 2013 to 2022 (APC: 7.26; 95 % CI: 6.13 to 9.96; <em>p</em> < 0.001). Older adults had higher AAMRs (45.0) compared to middle-aged (2.1) and young adults (0.3). Men had higher AAMRs than women (11.3 vs. 8.6). Ethnoracial disparities showed the highest AAMRs in NH American Indian individuals (13.3), followed by NH Black (10.5), NH White (9.8), Hispanic (7.3), and NH Asian individuals (5.9). Non-metropolitan areas had higher AAMRs than metropolitan areas (11.7 vs. 9.2).</div></div><div><h3>Conclusions</h3><div>Mortality from second- and third-degree AV block has increased since 1999, particularly in the last decade, with higher rates in men, older adults, NH American Indian or Alaska Native individuals, and non-metropolitan areas, highlighting the need for further research to address these disparities.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100680"},"PeriodicalIF":1.8,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555244","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

Exploring the interaction between klotho and TyG index in cardiovascular risk stratification: A metabolic-inflammatory network analysis with mediation and machine learning insights 探索心血管风险分层中klotho和TyG指数之间的相互作用：具有中介和机器学习见解的代谢-炎症网络分析

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-19 DOI: 10.1016/j.ahjo.2025.100681

Jieqing Min , Yunjuan Yang

Background

This study explores the relationship of metabolic-inflammatory network and cardiovascular disease (CVD), offering new insights into the roles of Klotho and the Triglyceride-Glucose (TyG) index in CVD pathogenesis.

Methods

Data from 5402 adults (mean age: 58.04 ± 10.83 years; 50.96 % female) from the NHANES in 2007–2016 database were analyzed. We proposed a prediction model for CVD risk incorporating Klotho protein, TyG index, and their interaction. The predictive value of these factors was evaluated using machine learning techniques, including random forest analysis and CHAID decision tree modeling.

Results

The study found no association between serum alpha-Klotho levels and CVD risk. However, the TyG index was demonstrated to be a significant predictor of CVD risk, particularly when lifestyle and socio-economic factors were not accounted for. TyG values were associated with an increased risk of metabolic syndrome and CVD (Model 1 OR: 1.234; Model 2 OR: 1.268). There was a significant interaction between Klotho-TyG was observed (coefficient − 2.608 × 10⁶). In addition, the random forest model achieved an accuracy of 66.63 % with high specificity and precision, and in the CHAID model an error of 27 %.

Conclusions

This study underscores the TyG index as a key biomarker for CVD risk, with the Klotho-TyG interaction improving risk stratification, and supporting early screening, treatment, and personalized interventions for more effective CVD management.

本研究旨在探讨代谢-炎症网络与心血管疾病（CVD）的关系，为Klotho和甘油三酯-葡萄糖（TyG）指数在CVD发病机制中的作用提供新的见解。方法分析2007-2016年NHANES数据库中5402例成人（平均年龄58.04±10.83岁，女性50.96%）的数据。我们提出了一个结合Klotho蛋白、TyG指数及其相互作用的CVD风险预测模型。使用机器学习技术评估这些因素的预测价值，包括随机森林分析和CHAID决策树建模。结果研究发现血清α - klotho水平与心血管疾病风险之间无关联。然而，TyG指数被证明是心血管疾病风险的重要预测指标，特别是在生活方式和社会经济因素不考虑的情况下。TyG值与代谢综合征和CVD风险增加相关（模型1 OR: 1.234；模型2 OR: 1.268）。Klotho-TyG之间存在显著的交互作用（系数为−2.608 × 106）。随机森林模型的准确率为66.63%，具有较高的特异性和精密度，CHAID模型的误差为27%。结论：本研究强调TyG指数是CVD风险的关键生物标志物，Klotho-TyG相互作用可改善风险分层，支持早期筛查、治疗和个性化干预，从而更有效地管理CVD。

{"title":"Exploring the interaction between klotho and TyG index in cardiovascular risk stratification: A metabolic-inflammatory network analysis with mediation and machine learning insights","authors":"Jieqing Min , Yunjuan Yang","doi":"10.1016/j.ahjo.2025.100681","DOIUrl":"10.1016/j.ahjo.2025.100681","url":null,"abstract":"<div><h3>Background</h3><div>This study explores the relationship of metabolic-inflammatory network and cardiovascular disease (CVD), offering new insights into the roles of Klotho and the Triglyceride-Glucose (TyG) index in CVD pathogenesis.</div></div><div><h3>Methods</h3><div>Data from 5402 adults (mean age: 58.04 ± 10.83 years; 50.96 % female) from the NHANES in 2007–2016 database were analyzed. We proposed a prediction model for CVD risk incorporating Klotho protein, TyG index, and their interaction. The predictive value of these factors was evaluated using machine learning techniques, including random forest analysis and CHAID decision tree modeling.</div></div><div><h3>Results</h3><div>The study found no association between serum alpha-Klotho levels and CVD risk. However, the TyG index was demonstrated to be a significant predictor of CVD risk, particularly when lifestyle and socio-economic factors were not accounted for. TyG values were associated with an increased risk of metabolic syndrome and CVD (Model 1 <em>OR</em>: 1.234; Model 2 <em>OR</em>: 1.268). There was a significant interaction between Klotho-TyG was observed (coefficient − 2.608 × 10<sup>6</sup>). In addition, the random forest model achieved an accuracy of 66.63 % with high specificity and precision, and in the CHAID model an error of 27 %.</div></div><div><h3>Conclusions</h3><div>This study underscores the TyG index as a key biomarker for CVD risk, with the Klotho-TyG interaction improving risk stratification, and supporting early screening, treatment, and personalized interventions for more effective CVD management.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100681"},"PeriodicalIF":1.8,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555288","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

A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF): Clinical trial design and methods 评估Anumana临床决策支持工具对心衰指导管理（ACT-HF）影响的实用试验：临床试验设计和方法

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-15 DOI: 10.1016/j.ahjo.2025.100675

Francisco Lopez-Jimenez , Heather M. Alger , Sarah P. Hackett , Vinay Gundurao , Ketan Mehta , Prerak Jain , Praveen Kumar-M , Chinmay Padhye , Arjun Puranik , Kitzner Vassor , Sunil Kumar Ravi , Barbara Barry , Ranee Chatterjee , Chen Chow , Rowena Dolor , Stephen J. Greene , Grace Lin , David Rushlow , Mark Stampehl , Xuan Zhu , Samir Awasthi

Background

Heart failure with reduced ejection fraction (HFrEF) is progressive and pervasive. Guidelines provide evidence-based recommendations to manage HFrEF, yet adherence to Guideline Directed Medical Therapy (GDMT) is low. An opportunity exists to improve adherence by delivering actionable data, reducing clinician information overload, and enhancing patient care. A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF) will evaluate a clinical decision support software (CDSS) that integrates in electronic health records (EHR), automates chart review, and identifies care gaps.

Methods

Anumana's Guideline Navigator is an innovative, multi-module AI-enabled CDSS with automated chart review to rapidly analyze EHR data, detect care gaps, and provide alerts for eligible patients not receiving optimal GDMT. ACT-HF, a multi-center cluster pragmatic trial, will recruit and randomize clinician participants (≤250) from 2 health systems to receive intervention software or provide usual care. The trial will evaluate outpatient care for adults with documented HFrEF and not on optimal GDMT (>2148). Outcomes will be evaluated at 90 days. Clinician participants may discuss results with patients, but patients will not have access to the CDSS.

Results

Primary outcome is change in GDMT medications; exploratory endpoints include clinical outcomes, resource utilization, and usability. Subgroup analyses include health system, clinician, and patient-level characteristics associated with outcomes.

Conclusion

Building on efforts to improve GDMT adherence, ACT-HF will test Anumana's Guideline Navigator in a multicenter study to evaluate outcomes and further refine the CDSS EHR integration EHR for improved clinical utility, workflow integration, and patient outcomes.

背景：心力衰竭伴射血分数降低（HFrEF）是进行性和普遍性的。指南为管理HFrEF提供了基于证据的建议，但对指南指导药物治疗（GDMT）的依从性很低。通过提供可操作的数据、减少临床医生信息过载和加强患者护理，有机会提高依从性。一项评估Anumana临床决策支持工具对心衰指导管理（ACT-HF）影响的实用试验将评估一种临床决策支持软件（CDSS），该软件集成了电子健康记录（EHR）、自动图表审查和识别护理差距。sanumana的指南导航器是一种创新的、多模块人工智能支持的CDSS，具有自动图表审查功能，可快速分析电子病历数据，检测护理差距，并为未接受最佳GDMT的符合条件的患者提供警报。ACT-HF是一项多中心集群实用试验，将从两个卫生系统招募和随机分配临床医生参与者（≤250人），接受干预软件或提供常规护理。该试验将评估记录在案的HFrEF成人的门诊护理，而不是最佳GDMT （>2148）。将在90天内评估结果。临床医生可以与患者讨论结果，但患者不能使用CDSS。结果主要转归指标为GDMT用药变化；探索性终点包括临床结果、资源利用率和可用性。亚组分析包括与结果相关的卫生系统、临床医生和患者水平特征。在努力提高GDMT依从性的基础上，ACT-HF将在一项多中心研究中测试Anumana的guide Navigator，以评估结果，并进一步完善CDSS EHR整合，以改善临床效用、工作流程整合和患者预后。

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引用次数: 0