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

Patterns and predictors of palliative care use in acute heart failure hospitalizations 急性心力衰竭住院患者使用姑息治疗的模式和预测因素

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-07 DOI: 10.1016/j.ahjo.2025.100667

Aimen Shafiq , Ali Salman , Sadia Akram , Muhammad Rizwan Farooq , Qais Bin Abdul Ghaffar , Anam Ijaz , Abdullah Imtiaz , Humna Irshad , Aroon Kumar , Muhammad Faisal Riaz , Saman Rauf , Usman Sarwar , Kaneez Fatima , Ali Hasan , Raheel Ahmed

Background

Palliative care consultation (PCC) in acute decompensated heart failure (ADHF) may enhance care quality and align treatment with patient goals. However, national trends and predictors of PCC in ADHF remain poorly defined.

Methods

We used the National Inpatient Sample (2018–2020) to identify hospitalizations for adults (≥18 years) with a primary diagnosis of ADHF using ICD-10-CM codes. PCC was defined by ICD-10-CM code Z51.5. Multivariable survey-weighted logistic regression identified predictors of PCC use, adjusting for demographics, socioeconomic status, comorbidities, and hospital factors.

Results

Among 3,655,265 hospitalizations, older age was associated with higher odds of PCC (aOR 1.05 per year; 95 % CI, 1.05–1.05). Compared to White individuals, odds of PCC were lower for Asian or Pacific Islander (aOR 0.74), Black (aOR 0.83), and Hispanic individuals (aOR 0.76). Medicare patients had lower odds than those with Medicaid (aOR 0.72). The highest income quartile was associated with greater PCC use (aOR 1.18). PCC was less common in the Northeast (aOR 0.88), South (aOR 0.93), and West (aOR 0.91) compared to the Midwest. Urban teaching hospitals had higher PCC rates than rural hospitals (aOR 1.48). Patients with greater comorbidity and higher mortality risk were more likely to receive PCC.

Conclusion

PCC use in ADHF is influenced by demographic, socioeconomic, clinical, and institutional factors. Racial, regional, and hospital-level disparities suggest a need for interventions to promote equitable access to palliative care for patients with ADHF.

背景：急性失代偿性心力衰竭（ADHF）的姑息治疗咨询（PCC）可以提高护理质量并使治疗与患者目标保持一致。然而，ADHF中PCC的国家趋势和预测因素仍然不明确。方法我们使用全国住院患者样本（2018-2020），使用ICD-10-CM代码识别初步诊断为ADHF的成人（≥18岁）的住院情况。PCC按ICD-10-CM代码Z51.5定义。多变量调查加权逻辑回归确定了PCC使用的预测因素，调整了人口统计学、社会经济地位、合并症和医院因素。结果在3,655,265例住院患者中，年龄越大，PCC的发生率越高（aOR为1.05 /年；95% CI为1.05 - 1.05）。与白人相比，亚洲或太平洋岛民（aOR 0.74）、黑人（aOR 0.83）和西班牙裔（aOR 0.76）患PCC的几率较低。医疗保险患者的风险低于医疗补助患者（aOR为0.72）。收入最高的四分位数与更大的PCC使用相关（aOR 1.18）。与中西部相比，PCC在东北部（aOR 0.88）、南部（aOR 0.93）和西部（aOR 0.91）较少见。城市教学医院PCC率高于农村医院（aOR为1.48）。合并症和死亡风险较高的患者更有可能接受PCC。结论ADHF患者pcc的使用受人口统计学、社会经济、临床和制度等因素的影响。种族、地区和医院层面的差异表明，需要采取干预措施，促进ADHF患者公平获得姑息治疗。

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引用次数: 0

APOE ε4 and ischemic heart disease in American Indian/Indigenous tribal Elders 美洲印第安人/土著部落长者的APOE ε4与缺血性心脏病

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-04 DOI: 10.1016/j.ahjo.2025.100662

Rene Labounek , Matti J. Matheson , Ashley J. Petersen , Adam Hansen , Adam D. Block , Corey Strong Jr , Annamarie Hill , Meghan Kremer , Ann J. Robertson , Valmiki Maharaj , Kamakshi Lakshminaryan , Danni Li , J. Neil Henderson , Igor Nestrasil , Christophe Lenglet , William G. Mantyh

Objective

American Indian/Indigenous (AI) populations have the highest rate of ischemic heart disease (IHD) of any racial or ethnic group in the United States. While modifiable cardiovascular risk factors represent a well-established source of elevated IHD in AI, little is known regarding genetic IHD influences, in particular APOE ε4, which has an ancestry-dependent prevalence and effect on human disease. We sought to quantify the prevalence and association between APOE ε4 and IHD in AI communities.

Methods

We performed a cross-sectional, community-based study including tribal Elders (ages >54 years) at the Bois Forte Band of Chippewa in the state of Minnesota. We collected data pertaining to demographics, cardiovascular risk factors, APOE ε4 genotype, and ischemic heart disease (defined as history of myocardial infarction, coronary artery bypass graft, angiogram showing coronary artery disease, percutaneous transluminal coronary angioplasty, or thrombolytic therapy).

Findings

One-hundred-eighty-one participants were included. Their median age and interquartile range were 67 (61, 73) years, AI ancestry was 75 % (50 %, 100 %), 126 (70 %) were females, 46 (25 %) were APOE ε4 heterozygous, and 5 (2.8 %) were APOE ε4 homozygous. Each APOE ε4 allele increased the odds of IHD in AI tribal Elders 2.38-fold (95 % CI: 0.94–6.89; p = 0.06), which is comparable to a two-point rise in hemoglobin A1C.

Conclusions

APOE ε4 appears to play an important role in the risk of IHD in AI populations, given its high prevalence and strong association with IHD.

目的美洲印第安人/土著（AI）人口是美国所有种族或民族中缺血性心脏病（IHD）发病率最高的。虽然可改变的心血管危险因素代表了AI中IHD升高的一个公认的来源，但对于遗传性IHD的影响知之甚少，特别是APOE ε4，它具有依赖于祖先的患病率和对人类疾病的影响。我们试图量化APOE ε4和IHD在AI社区的患病率和相关性。方法我们在明尼苏达州Chippewa Bois Forte部落进行了一项以社区为基础的横断面研究，其中包括部落长老（54岁）。我们收集了有关人口统计学、心血管危险因素、APOE ε4基因型和缺血性心脏病（定义为心肌梗死史、冠状动脉搭桥术、血管造影显示冠状动脉疾病、经皮腔内冠状动脉成形术或溶栓治疗）的数据。研究结果共纳入181名参与者。年龄中位数和四分位数范围为67（61,73）岁，AI祖先75%(50%,100%)，女性126 (70%)，APOE ε4杂合46 (25%)，APOE ε4纯合5（2.8%）。每个APOE ε4等位基因使AI部落长者患IHD的几率增加2.38倍（95% CI: 0.94-6.89; p = 0.06），相当于血红蛋白A1C升高2个点。结论鉴于apoe ε4的高流行率和与IHD的强相关性，apoe ε4可能在AI人群IHD发病风险中起重要作用。

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引用次数: 0

Short-term outcomes of acute heart failure hospitalizations in Ethiopia: A multicenter prospective study 埃塞俄比亚急性心力衰竭住院治疗的短期结果：一项多中心前瞻性研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-03 DOI: 10.1016/j.ahjo.2025.100665

Getachew Yitayew Tarekegn , Legesse Chekleba , Tilaye Arega Moges , Fisseha Nigussie Dagnew , Samuel Berihun Dagnew , Sisay Stiotaw Anberbr , Behailu Terefe Tesfaye

Objectives

To determine the incidence and predictors of unplanned 30-day readmission and in-hospital mortality among adults hospitalized with AHF in Ethiopia.

Methods

A multicenter prospective observational study was conducted in six referral hospitals in the Amhara region between December 2023 and April 2024. Adults (≥18 years) with AHF were consecutively enrolled and followed up until discharge and 30 days post-discharge. Kaplan–Meier survival analysis and Cox regression were used to estimate outcomes and predictors.

Results

Of the 1131 patients, 275 (24.4 %) were readmitted within 30 days and 121 (10.7 %) died in the hospital. Independent predictors of readmission included hyponatremia (AHR = 10.5; 95 % CI: 3.1–36.2), thrombocytopenia (AHR = 16.7; 95 % CI: 4.8–58.3), ischemic heart disease (AHR = 6.9; 95 % CI: 1.8–27.0), Charlson Comorbidity Index ≥4 (AHR = 6.5; 95 % CI: 1.7–24.6), poor physician adherence to guideline-directed therapy (AHR = 8.2; 95 % CI: 2.3–30.1), and low patient adherence (AHR = 4.8; 95 % CI: 1.6–14.5). Prescription of ACE inhibitors, beta-blockers, and SGLT2 inhibitors at discharge significantly reduced the readmission risk (AHR range: 0.09–0.30). The predictors of in-hospital mortality included reduced ejection fraction, tachycardia, hypoxemia, left bundle branch block, pulmonary hypertension, elevated creatinine, severe hypertension, and pneumonia.

Conclusion

AHF patients in Ethiopia experience high short-term readmission and mortality. Correcting electrolyte imbalances, improving comorbidity management, strengthening physician adherence to guideline-directed therapy, and promoting patient adherence are essential for improving outcomes.

目的确定埃塞俄比亚AHF住院成人患者意外30天再入院和住院死亡率的发生率和预测因素。方法于2023年12月至2024年4月在阿姆哈拉地区6家转诊医院进行多中心前瞻性观察研究。成人（≥18岁）AHF患者连续入组并随访至出院及出院后30天。Kaplan-Meier生存分析和Cox回归用于估计结果和预测因子。结果1131例患者中，30 d内再入院275例（24.4%），死亡121例（10.7%）。再入院的独立预测因素包括低钠血症（AHR = 10.5; 95% CI: 3.1-36.2）、血小板减少症（AHR = 16.7; 95% CI: 4.8 - 58.3）、缺血性心脏病（AHR = 6.9; 95% CI: 1.8-27.0）、Charlson合病指数≥4 （AHR = 6.5; 95% CI: 1.7-24.6）、医生对指导治疗的依从性差（AHR = 8.2; 95% CI: 2.3-30.1）和患者依从性低（AHR = 4.8; 95% CI: 1.6-14.5）。出院时使用ACE抑制剂、β受体阻滞剂和SGLT2抑制剂可显著降低再入院风险（AHR范围：0.09-0.30）。院内死亡率的预测因子包括射血分数降低、心动过速、低氧血症、左束支阻滞、肺动脉高压、肌酐升高、严重高血压和肺炎。结论埃塞俄比亚ahf患者短期再入院率高，死亡率高。纠正电解质失衡，改善合并症管理，加强医生对指导治疗的依从性，并促进患者的依从性对于改善结果至关重要。

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引用次数: 0

Cognition and coronary events: A narrative overview of neurocognitive impairment in ACS patients 认知和冠状动脉事件：ACS患者神经认知障碍的叙述性概述

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-03 DOI: 10.1016/j.ahjo.2025.100666

Umaimah Batool Mirza , Faareah Mansoor , Umna Fnu , Summiya Riaz , Mehar Zaka , Ahmed Asad Raza , Abedin Samadi

Neurocognitive dysfunction is a common but often overlooked complication in patients with Acute Coronary Syndrome (ACS). This narrative review aims to provide a comprehensive synthesis of current evidence on the prevalence, mechanisms, clinical assessment, and management strategies of cognitive impairment in ACS patients. We highlight how neurocognitive deficits including memory loss, reduced attention, and executive dysfunction arise from cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. These deficits arise from mechanisms including cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. Such impairments are associated with poorer clinical outcomes, decreased treatment adherence, and increased mortality.

Routine cognitive assessment remains absent from standard ACS management, despite the availability of effective tools such as the Montreal Cognitive Assessment (MoCA), which can detect subtle cognitive deficits early in hospitalization. Integrating cognitive screening into clinical protocols enables timely interventions and better patient stratification. Management strategies should combine pharmacological treatment of cardiovascular risk factors with non-pharmacological interventions such as cognitive rehabilitation, mental health support, and lifestyle modification. Multidisciplinary collaboration between cardiology, neurology, psychology, and rehabilitation specialists is essential to address both cardiac and cognitive recovery.

By integrating findings from clinical and epidemiological studies, this review underscores the need for routine cognitive screening, multidisciplinary care, and innovative interventions such as telemedicine to improve patient outcomes. Recognizing cognitive health as an integral part of ACS management offers a more holistic, patient-centered approach to recovery.

神经认知功能障碍是急性冠脉综合征（ACS）患者常见但常被忽视的并发症。本文旨在对ACS患者认知功能障碍的患病率、机制、临床评估和管理策略提供全面的综合证据。我们强调包括记忆丧失、注意力下降和执行功能障碍在内的神经认知缺陷是如何由脑灌注不足、全身炎症、微血管损伤和梗死后代谢应激引起的。这些缺陷的机制包括脑灌注不足、全身炎症、微血管损伤和梗死后代谢应激。这种损伤与较差的临床结果、治疗依从性降低和死亡率增加有关。尽管蒙特利尔认知评估（MoCA）等有效工具可以在住院早期发现细微的认知缺陷，但标准的ACS管理中仍然缺少常规的认知评估。将认知筛查纳入临床方案能够及时干预并更好地对患者进行分层。管理策略应结合心血管危险因素的药物治疗和非药物干预，如认知康复、心理健康支持和生活方式改变。心脏病学、神经学、心理学和康复专家之间的多学科合作对于解决心脏和认知康复至关重要。通过整合临床和流行病学研究结果，本综述强调了常规认知筛查、多学科护理和远程医疗等创新干预措施改善患者预后的必要性。认识到认知健康是ACS管理的一个组成部分，提供了一个更全面的，以患者为中心的康复方法。

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引用次数: 0

Comparison of all-cause and cause-specific mortality after myocardial infarction – a Hungarian registry study 心肌梗死后全因死亡率和特异性死亡率的比较——匈牙利的一项登记研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-30 DOI: 10.1016/j.ahjo.2025.100663

Tamás Ferenci , András Jánosi

Study Objective

Despite advances, myocardial infarction remains a significant public health concern, with survival being a crucial outcome measure. While all-cause mortality is well-studied, less is known about causes of death following an infarction. This study aimed to analyse cause-specific mortality after myocardial infarction and to compare it with the analysis of all-cause mortality.

Design

Data from a nationwide Hungarian myocardial infarction registry from January 2020 to June 2022 were linked with official cause of death information. Cumulative incidence functions and multivariable modelling of subdistribution hazard were used for cause-specific survival analysis, accounting for competing risks. Standard all-cause survival analysis (Cox proportional hazards model) was also carried out as a comparison.

Results

Among 27,965 patients with acute myocardial infarction, 25.0 % died during follow-up (of a median of 661 days). Myocardial infarction was the primary cause of death in 38.6 % of cases, followed by other cardiovascular causes (37.5 %). Factors associated with higher cause-specific mortality for infarction included older age, male sex, ST-elevation infarction, diabetes, prior stroke, peripheral artery disease, and heart failure. Percutaneous coronary intervention and hypertension was associated with lower hazard. Results largely matched all-cause survival analysis, except for ST-elevation, where hazard was much higher in cause-specific analysis.

Conclusions

While overall and cause-specific analyses aligned in this large registry study, a notable difference was observed for ST-elevation infarction, where hazard was substantially higher in the cause-specific analysis. This highlights the potential relevance of distinguishing between causes of death for a more precise understanding of outcomes.

尽管取得了进展，但心肌梗死仍然是一个重大的公共卫生问题，生存率是一个关键的结局指标。虽然全因死亡率研究得很好，但对梗死后死亡的原因知之甚少。本研究旨在分析心肌梗死后的死因特异性死亡率，并将其与全因死亡率分析进行比较。从2020年1月至2022年6月，匈牙利全国心肌梗死登记处的设计数据与官方死亡原因信息相关联。累积关联函数和亚分布风险的多变量模型用于原因特异性生存分析，考虑竞争风险。标准全因生存分析（Cox比例风险模型）也进行了比较。结果在27,965例急性心肌梗死患者中，25.0%的患者在随访期间死亡（中位时间为661天）。心肌梗死是38.6%病例的主要死亡原因，其次是其他心血管原因（37.5%）。与梗死较高的病因特异性死亡率相关的因素包括年龄较大、男性、st段抬高性梗死、糖尿病、既往卒中、外周动脉疾病和心力衰竭。经皮冠状动脉介入治疗和高血压的风险较低。结果与全因生存分析基本一致，除了st段抬高，其风险在病因特异性分析中要高得多。结论：虽然在这项大型登记研究中，总体分析和病因特异性分析一致，但在st段抬高性梗死中观察到显著差异，在病因特异性分析中，st段抬高性梗死的危险要高得多。这突出了区分死亡原因对于更精确地了解结果的潜在相关性。

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引用次数: 0

Electrocardiographic Profiles by sex in a cohort of healthy Vietnamese university students 一群健康越南大学生的性别心电图特征

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-30 DOI: 10.1016/j.ahjo.2025.100660

Thang Nguyen Ngoc , Le Nguyen Thi Nhat , An Pham Van , Soan Hoang Thu , Nghia Nguyen Minh , Thang Vu Tien , Hong Le Thi Bich , Hung Tran Viet , Huyen Pham Thi Thu , Nhung Do Phuong , Linh Tran Thi Thuy , Le Dao Phuong , Cuong Duong Cao , Long Nguyen , Ngoc Nguyen Minh , Chi Do Thi Kim , Hien Nguyen Thu , Huyen Nguyen Thi Thu

Study objective

To establish sex-specific electrocardiographic (ECG) reference values in healthy Vietnamese late adolescents and characterize sex-based differences in repolarization patterns.

Design

Cross-sectional observational study.

Setting

University health screening program in Vietnam.

Participants

A total of 5127 first-year university students (58.6 % female; age 17–29 years), all asymptomatic and without known cardiovascular or metabolic disease.

Interventions

None.

Main outcome measures

Standard ECG parameters (heart rate, PR interval, QRS duration, QTc, QRST angle), J-point elevation, ST-segment amplitude, and T-wave morphology in leads V1–V6, stratified by sex.

Results

Significant sex differences were observed in all ECG parameters (p < 0.001). Females had higher heart rates (83 vs. 80 bpm), shorter PR intervals (138 vs. 140 ms), and longer QTc intervals (423 vs. 406 ms), while males showed longer QRS durations (90 vs. 80 ms) and narrower QRST angles. In precordial leads, males exhibited higher J-point and ST-segment amplitudes, especially in V2–V3, with the 98th percentile of ST60V2 reaching 0.40 mV. Anterior T-wave inversion (TWI) was more common in females, notably in V1 (71.3 % vs. 48.1 %) and V2 (2.5 % vs. 0.9 %). TWI beyond V2 was rare in both sexes.

Conclusion

This is the first large-scale study to define sex-specific ECG reference values in a Vietnamese cohort. Marked differences in repolarization patterns emphasize the importance of ethnicity- and sex-specific criteria to enhance diagnostic accuracy and avoid misinterpretation in Southeast Asian populations.

研究目的建立越南健康晚期青少年的性别特异性心电图（ECG）参考值，并描述复极模式的性别差异。设计横断面观察性研究。越南的大学健康检查项目。参与者共5127名一年级大学生（58.6%为女性，年龄17-29岁），均无已知心血管或代谢疾病。干预措施：主要结果测量标准心电图参数（心率、PR间期、QRS持续时间、QTc、QRST角度）、j点抬高、st段振幅和V1-V6导联t波形态，按性别分层。结果两组心电图参数均有显著性差异（p < 0.001）。女性心率更高（83比80 bpm）， PR间隔更短（138比140 ms）， QTc间隔更长（423比406 ms），而男性QRS持续时间更长（90比80 ms）， QRST角度更窄。在心前导联中，男性表现出更高的j点和st段振幅，特别是在V2-V3， ST60V2的第98百分位达到0.40 mV。前路t波倒置（TWI）在女性中更为常见，尤其是V1（71.3%比48.1%）和V2（2.5%比0.9%）。超过V2的TWI在两性中都很少见。结论：这是首次在越南队列中定义性别特异性心电图参考值的大规模研究。复极模式的显著差异强调了种族和性别特异性标准对提高东南亚人群诊断准确性和避免误解的重要性。

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引用次数: 0

Ten-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with three-vessel disease and heart failure 冠状动脉旁路移植术与经皮冠状动脉介入治疗三支血管疾病合并心力衰竭患者的10年预后

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-30 DOI: 10.1016/j.ahjo.2025.100659

Jimmy Kang , Ryaan El-Andari , Nicholas Fialka , Yongzhe Hong , Michael S. McMurtry , Jeevan Nagendran , Jayan Nagendran

Objective

The optimal revascularization strategy for patients with three-vessel coronary artery disease (3VD) and heart failure (HF) remains uncertain due to the absence of randomized trials directly comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). With few observational studies providing long-term follow-up, clinical equipoise persists. We therefore evaluated 10-year outcomes between CABG and PCI in patients with HF and 3VD.

Methods

This retrospective population-based cohort study included adults with 3VD and HF undergoing isolated CABG or PCI in Edmonton, Alberta, Canada (2009–2018). Patients with STEMI, prior CABG, or concomitant procedures were excluded. The primary endpoint was all-cause mortality. Secondary endpoints included readmission for myocardial infarction (MI), stroke, repeat revascularization, and all-cause rehospitalization. Multivariable Cox regression was used to adjust for baseline characteristics.

Results

Of 1774 screened patients, 632 met inclusion criteria (CABG: n = 97; PCI: n = 535). At 10 years, all-cause mortality was significantly lower in the CABG group (62.4 %) compared to PCI (71.8 %) (adjusted hazard ratio [aHR] 0.65, 95 % CI 0.47–0.92; p = 0.014). CABG was also associated with markedly lower rates of MI readmission (3.2 % vs. 23.7 %; aHR 0.11, 95 % CI 0.03–0.38; p < 0.001) and repeat revascularization (6.4 % vs. 21.6 %; aHR 0.22, 95 % CI 0.09–0.53; p = 0.001). Rates of stroke (p = 0.757) and all-cause rehospitalization (p = 0.157) were not significantly different.

Conclusions

In patients with 3VD and HF, CABG is associated with significantly improved long-term survival, reduced MI readmissions, and fewer repeat revascularizations compared to PCI. These findings reinforce the need for a multidisciplinary Heart Team review to ensure the optimal intervention strategy.

目的由于缺乏直接比较冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的随机试验，三支冠状动脉疾病（3VD）合并心力衰竭（HF）患者的最佳血运重建策略仍不确定。由于很少有观察性研究提供长期随访，临床平衡仍然存在。因此，我们评估了心衰和3VD患者CABG和PCI的10年预后。方法这项基于人群的回顾性队列研究纳入了2009-2018年在加拿大艾伯塔省埃德蒙顿接受孤立CABG或PCI治疗的3VD和HF成人患者。排除STEMI患者、既往冠脉搭桥或伴随手术。主要终点是全因死亡率。次要终点包括心肌梗死（MI）、卒中、重复血运重建术和全因再住院。采用多变量Cox回归对基线特征进行调整。结果在1774例筛查患者中，632例符合纳入标准（CABG: n = 97; PCI: n = 535）。10年时，CABG组的全因死亡率（62.4%）明显低于PCI组（71.8%）（校正风险比[aHR] 0.65, 95% CI 0.47-0.92; p = 0.014）。CABG还与心肌梗死再入院率（3.2%比23.7%;aHR 0.11, 95% CI 0.03-0.38; p < 0.001）和重复血运重成率（6.4%比21.6%;aHR 0.22, 95% CI 0.09-0.53; p = 0.001）显著降低相关。卒中发生率（p = 0.757）和全因再住院率（p = 0.157）无显著差异。结论在3VD和HF患者中，与PCI相比，CABG显著提高了长期生存率，减少了心肌梗死再入院率，减少了重复血运重建。这些发现加强了多学科心脏小组审查的必要性，以确保最佳的干预策略。

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引用次数: 0

Addressing maternal cardiovascular risk: The impact of lactation, adverse pregnancy outcomes, and racial disparities 解决产妇心血管风险：哺乳的影响，不良妊娠结局，和种族差异

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-30 DOI: 10.1016/j.ahjo.2025.100646

Monica Rodriguez , Michele L. McCarroll , Caroline Marrs , Kamala P. Tamirisa

Pregnancy functions as a cardiopulmonary stress test, revealing underlying cardiovascular disease (CVD) or heightening future CVD risk following adverse pregnancy outcomes (APOs). Studies consistently demonstrate strong associations between APOs, higher mortality rates, and increased risk of cardiometabolic diseases in women from racial and ethnic underrepresented groups (UREG). Social determinants of health, particularly in UREGs, contribute to increasing allostatic load, potentially driving poorer pregnancy outcomes. Breastfeeding has a protective effect on allostatic load and is linked to improved maternal cardiometabolic health. In the United States, UREGs have lower rates of breastfeeding initiation, retention, and duration—potentially influenced by both cultural factors and systemic biases within healthcare. Interventions must extend beyond healthcare settings to engage key stakeholders, including community leaders and families, to create sustainable change and reduce disparities. As maternal CVD prevalence rises among UREG populations, a collaborative, multidisciplinary approach to improving breastfeeding rates is essential to improving maternal and infant health outcomes.

妊娠可作为心肺压力测试，揭示潜在心血管疾病（CVD）或增加不良妊娠结局（apo）后未来心血管疾病的风险。研究一致表明，在种族和民族代表性不足群体（UREG）的妇女中，apo、较高的死亡率和心脏代谢疾病风险增加之间存在强烈关联。健康的社会决定因素，特别是在ureg中，有助于增加适应负荷，可能导致较差的妊娠结局。母乳喂养对适应负荷有保护作用，并与改善母亲的心脏代谢健康有关。在美国，ureg的母乳喂养开始、保持和持续时间的比例较低，这可能受到文化因素和医疗保健系统偏见的影响。干预措施必须延伸到医疗保健环境之外，让包括社区领导人和家庭在内的关键利益攸关方参与进来，以创造可持续的变革并减少差距。随着孕产妇心血管疾病患病率在泌尿系人群中上升，采用多学科合作方法提高母乳喂养率对于改善孕产妇和婴儿健康结果至关重要。

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引用次数: 0

Clinical utility of the exercise optically pumped magnetocardiographic stress test in young adults: an exploratory study 运动光泵心脏磁图应激试验在年轻人中的临床应用：一项探索性研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-30 DOI: 10.1016/j.ahjo.2025.100661

Lanxin Feng , Xin Zhao , Shuwen Yang , Linqi Liu , Zhao Ma , Huan Zhang , Jianping Xiang , Ming Ding , Chenchen Tu , Xiantao Song , Hongjia Zhang

Background

To assess the clinical feasibility and safety of exercise magnetocardiographic stress test based on optically pumped magnetometers (OPMs).

Methods

Subjects without previous cardiovascular disease were enrolled in this study. All subjects underwent exercise electrocardiographic stress test (EST) and both rest and stress OPM-based magnetocardiography (MCG).

Results

A total of 26 healthy subjects finally enrolled in this study. None of the subjects reported chest pain, dyspnea or any other discomfort during the test. The mean interval between the completion of EST and the initiation of OPM-based MCG signal acquisition was 60.3 ± 8.4 s. One subject observed obvious deflection of magnetic field (Unstable-MCG group) during stress OPM-based MCG, whereas 25 subjects did not (Stable-MCG group). In Stable-MCG group, the rest and stress magnetocardiographic parameters were phenotypically similar (P > 0.05).

Conclusion

We demonstrated an innovative diagnostic technology with broad potential application value for diagnosing myocardial ischemia and assessed its clinical feasibility and safety. This is a critical step toward making the examination widely used in clinical practice.

背景：评价基于光泵磁强计（OPMs）的运动心电图应力测试的临床可行性和安全性。方法既往无心血管疾病的受试者加入本研究。所有受试者都进行了运动心电图压力测试（EST）和基于休息和压力opm的心脏磁图（MCG）。结果26名健康受试者最终入组。在测试过程中，没有受试者报告胸痛、呼吸困难或任何其他不适。EST完成与基于opm的MCG信号采集开始的平均间隔时间为60.3±8.4 s。1名受试者（不稳定MCG组）在应力OPM-based MCG过程中观察到明显的磁场偏转，25名受试者（稳定MCG组）在应力OPM-based MCG过程中观察到明显的磁场偏转。在稳定- mcg组，休息和应激时的心磁图参数表型相似（P > 0.05）。结论展示了一种具有广泛潜在应用价值的心肌缺血诊断技术，并对其临床可行性和安全性进行了评价。这是使该检查广泛应用于临床实践的关键一步。

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引用次数: 0

Global trends and inequalities in hypertensive and ischemic heart disease attributable to high body mass index: A systematic analysis from 1990 to 2021 with projections to 2035 高体重指数导致的高血压和缺血性心脏病的全球趋势和不平等：1990年至2021年的系统分析和2035年的预测

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-29 DOI: 10.1016/j.ahjo.2025.100656

Xinyu Liu , Xu Zhang , Cheng Li

Background

Hypertensive heart disease (HHD) and ischemic heart disease (IHD) are major global burdens. High body mass index (BMI) is a key modifiable risk factor, but the global burden, trends, and inequalities of HHD and IHD attributable to high BMI remain poorly defined.

Methods

We analyzed Global Burden of Disease data from 1990 to 2021 across 204 countries, estimating age-standardized mortality rates (ASMRs), disability-adjusted life-year rates (ASDRs), and annual average percentage changes (AAPCs). Additional analyses included age- and sex-specific distributions, socio-demographic index (SDI) patterns, frontier and decomposition analyses, inequality metrics, and projections to 2035 using Bayesian age–period–cohort and ARIMA models.

Results

From 1990 to 2021, global ASMR and ASDR for HHD attributable to high BMI slightly increased (AAPC: 0.014 and 0.099), whereas those for IHD declined (AAPC: −0.067 and −0.751). The highest HHD burden occurred in Southern Sub-Saharan Africa, and the greatest IHD burden in Eastern Europe. Elderly females had higher HHD mortality and DALYs, while middle-aged males bore greater IHD burden. HHD inversely correlated with SDI (r = −0.5524, P < 0.001), whereas IHD showed a unimodal relationship. Decomposition highlighted aging and population growth as major contributors. Inequalities worsened for HHD but improved for IHD. Forecasts suggest continued rises in HHD and declines in IHD by 2035.

Conclusions

HHD and IHD attributable to high BMI show divergent global trends and inequality patterns, underscoring the urgent need for targeted weight management and cardiovascular risk reduction, particularly in low- and middle-SDI regions.

背景：高血压心脏病（HHD）和缺血性心脏病（IHD）是全球主要的疾病负担。高身体质量指数（BMI）是一个关键的可改变的危险因素，但高BMI导致的HHD和IHD的全球负担、趋势和不平等仍然不明确。方法分析了204个国家1990年至2021年的全球疾病负担数据，估计了年龄标准化死亡率（ASMRs）、残疾调整生命年率（ASDRs）和年平均百分比变化（AAPCs）。其他分析包括年龄和性别特定分布、社会人口指数（SDI）模式、前沿和分解分析、不平等指标，以及使用贝叶斯年龄-时期-队列和ARIMA模型对2035年的预测。结果从1990年到2021年，高BMI导致的HHD的全球ASMR和ASDR略有增加（AAPC: 0.014和0.099），而IHD的全球ASMR和ASDR则有所下降（AAPC: - 0.067和- 0.751）。最重的HHD负担发生在南撒哈拉非洲，最重的IHD负担发生在东欧。老年女性的HHD死亡率和DALYs较高，而中年男性的IHD负担较大。HHD与SDI呈负相关（r = - 0.5524, P < 0.001），而IHD呈单峰关系。分解显示，老龄化和人口增长是主要因素。HHD患者的不平等加剧，IHD患者的不平等有所改善。预测显示，到2035年，HHD将继续上升，IHD将下降。结论高BMI导致的shhd和IHD在全球范围内呈现出不同的趋势和不平等模式，强调了有针对性的体重管理和降低心血管风险的迫切需要，特别是在中低sdi地区。

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引用次数: 0