Cardiology and cardiovascular medicine最新文献

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Angiographic Findings in Unstable Angina and Prediction of 1-Year Risk of Recurrent Acute Coronary Syndrome or Death: A Nationwide Machine Learning Study 不稳定心绞痛的血管造影结果和预测1年复发急性冠脉综合征或死亡的风险:一项全国性的机器学习研究

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920330

T. Råmunddal, A. Rawshani, B. Redfors, P. Pétursson, O. Angerås, G. Hirlekar, D. Ioanes, J. Odenstedt, C. Dworeck, S. Völz, A. Myredal

Background: We studied whether machine learning could predict survival, risk of future acute coronary syndrome (ACS) and coronary angiographic (CAG) findings in patients with unstable angina (UA). We also studied whether high-sensitivity troponin levels within normal range can predict the presence of obstructive coronary lesions, risk of future ACS and death. Methods: We used the SWEDEHEART registry to include patients admitted to the coronary care unit due to chest pain, with normal high-sensitivity cardiac troponin T or I (hs-cTnI, hs-cTnT), who underwent CAG and did not receive a final diagnosis of acute myocardial infarction (AMI). We studied CAG findings on segmental level, developed machine learning models predicting the risk of ACS or death within 1-year, and angiographic findings. The latter model predicted CAG resulting in interventions (any) or eliciting further assessments after CAG. Models for ACS and death included 130 candidate predictors and models for angiographic findings included 110 predictors. Results: We included 9’314 patients; 1-year rate of death was 0.9% (n=78) and ACS was 2.7% (n=251). A total of 5455 (61.5%) of CAG resulted in no intervention and no further assessment afterwards, with 40% without significant stenosis. There was a strong association between hs-cTnI (within normal range) and severity of coronary atherosclerosis; e.g 32.4% in patients with hs-cTnI 26-35 ng/L had >50% stenosis in segment 6, as compared with 12.6% in those with hs-cTnI 0-5 ng/L. All segments displayed similar associations with troponin levels. Among 17 predictors for atherosclerosis, hs-cTnI was the strongest predictor of having >50% stenosis in the left anterior descending artery (LAD). Mortality increased at hs-cTnI levels above 10 ng/L for men, but not women. Age and sex adjusted hazard ratio for hs-cTnI 25-35 vs hs-TnI 0-5 was 5.73 (2.14-15.35) for 1-year mortality. No association was noted for hs-cTnT. The strongest predictors of 1-year mortality were C-reactive protein, body mass index, estimated glomerular filtration rate.

背景:我们研究了机器学习是否可以预测不稳定心绞痛(UA)患者的生存、未来急性冠脉综合征(ACS)的风险和冠状动脉造影(CAG)结果。我们还研究了正常范围内的高敏感性肌钙蛋白水平是否可以预测阻塞性冠状动脉病变的存在、未来ACS的风险和死亡。方法:我们使用SWEDEHEART登记纳入因胸痛而入住冠状动脉监护室的患者，高敏感性心肌肌钙蛋白T或I (hs-cTnI, hs-cTnT)正常，接受CAG且未接受最终诊断为急性心肌梗死(AMI)。我们研究了节段水平的CAG结果，开发了预测1年内ACS或死亡风险的机器学习模型，以及血管造影结果。后一种模型预测CAG导致干预(任何)或引发CAG后的进一步评估。ACS和死亡模型包括130个候选预测因子，血管造影结果模型包括110个预测因子。结果:我们纳入了9314例患者;1年死亡率为0.9% (n=78)， ACS为2.7% (n=251)。5455例(61.5%)CAG患者未进行干预，术后无进一步评估，40%患者无明显狭窄。hs-cTnI(在正常范围内)与冠状动脉粥样硬化的严重程度有很强的相关性;例如，在hs-cTnI 26-35 ng/L的患者中，32.4%的患者6节段狭窄达50%，而hs-cTnI 0-5 ng/L的患者中，这一比例为12.6%。所有节段均与肌钙蛋白水平有相似的关联。在17个动脉粥样硬化的预测因子中，hs-cTnI是左前降支(LAD)狭窄50%的最强预测因子。hs-cTnI水平高于10纳克/升时，男性死亡率增加，但女性没有。年龄和性别调整后的hs-cTnI 25-35与hs-TnI 0-5的1年死亡率风险比为5.73(2.14-15.35)。hs-cTnT未见关联。1年死亡率最强的预测因子是c反应蛋白、体重指数、估计的肾小球滤过率。

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引用次数: 0

Synergy among Genes and Genes-Environment on Coronary Artery Disease Risk and Prognosis 基因和基因-环境对冠状动脉疾病风险和预后的协同作用

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920332

M. Mendonça, M. Santos, M. Temtem, Débora Sá, F. Sousa, E. Henriques, S. Freitas, S. Borges, M. Rodrigues, G. Guerra, A. Drumond, A. C. Sousa, R. Palma Reis

引用次数: 0

The Safety of Heparin-Free Strategy in Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation 静脉体外膜氧合支持患者无肝素策略的安全性

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920339

Dong Jung Kim, J. H. Lee, J. S. Kim, C. Lim, Kay-Hyun Park, H. Chang

Background: The necessity of heparinization during venoarterial extracorporeal membrane oxygenation (VA-ECMO) is well documented. However, heparinization can increase the risk of bleeding in certain situations. The aim of this study was to investigate the safety of a heparin-free strategy in patients on VA-ECMO. Methods: Data for 90 adult patients on VA-ECMO, wherein cannulation and maintenance were performed by cardiothoracic surgeons and support was provided for >24 h (2018–2021), were retrospectively reviewed. Patients were divided into two groups: heparin-free group, without heparinization for ≥ 24 h during VA-ECMO support (n = 66), and control group (n = 24). Clinical outcomes including hemorrhagic and thromboembolic complications were compared between the two groups. Results: The reasons for VA-ECMO support included post-cardiotomy cardiogenic shock in 37 patients (41.1%), and extracorporeal cardiopulmonary resuscitation in 44 patients (48.9%). The total duration of VA-ECMO was not significantly different between the two groups (132.3±106.1 vs. 141.6±117.9 h, P=0.734). In the heparin-free group, the duration of VA-ECMO without heparinization was 79.8±60.7 h, and 26 patients (39.4%) were completely heparin-free during the support period. No significant difference was found in the frequency of oxygenator changes due to thrombosis between the two groups (8.3 vs. 10.6%, P>0.999). Pump malfunction was not observed in any group. The overall incidence of thromboembolic complications was not significantly different between the two groups. Conclusion: No additional risk of thromboembolic complications was observed with the use of a heparin-free strategy during VA-ECMO support. Appropriate discontinuation of heparinization could be a safe strategy for VA-ECMO patients with active bleeding or a high hemorrhagic risk.

背景:静脉动脉体外膜氧合(VA-ECMO)过程中肝素化的必要性已得到充分证明。然而，在某些情况下，肝素化会增加出血的风险。本研究的目的是调查无肝素策略在VA-ECMO患者中的安全性。方法:回顾性分析90例成人VA-ECMO患者的数据，这些患者由心胸外科医生进行插管和维持，并提供bbbb24 h(2018-2021)的支持。将患者分为两组:无肝素组(66例)和对照组(24例)。无肝素组在VA-ECMO支持期间不进行肝素化治疗≥24 h。比较两组的临床结果，包括出血和血栓栓塞并发症。结果:采用VA-ECMO支持的原因包括开心术后心源性休克37例(41.1%)，体外心肺复苏44例(48.9%)。VA-ECMO总持续时间两组比较差异无统计学意义(132.3±106.1∶141.6±117.9 h, P=0.734)。无肝素组未肝素化的VA-ECMO持续时间为79.8±60.7 h, 26例(39.4%)患者在支持期内完全无肝素。两组患者因血栓形成而改变氧合器的频率差异无统计学意义(8.3 vs 10.6%， P < 0.05 0.999)。各组均未见泵故障。两组血栓栓塞并发症的总发生率无显著差异。结论:在VA-ECMO支持期间，使用无肝素策略未观察到血栓栓塞并发症的额外风险。对于有活动性出血或高出血风险的VA-ECMO患者，适当停止肝素化可能是一种安全的策略。

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引用次数: 0

Metadichol Treatment of Fibroblasts and Embryonic Stem Cells Regulates Key Cardiac Progenitors 成纤维细胞和胚胎干细胞的二元醇处理调节关键的心脏祖细胞

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920340

Palayakotai R. Raghavan

引用次数: 0

Prevalence and Associated Predictors of Hypertension in Adult Patients with Thyroid Nodules at the Royal Commission Hospital, Kingdom of Saudi Arabia. 沙特阿拉伯王国皇家委员会医院成年甲状腺结节患者高血压患病率及相关预测因素

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.9220303

Ahmed M Khair, Mona A Sid Ahmed, Faisal H Alharbi, Soha Hassan, Nusaiba M Elbadwi, Sami Naji Almutairi, Imad R Musa

Background: Hypertension and thyroid nodules (TNs) are common medical problems that are increasing in prevalence globally. Hence, we conducted this study to assess the prevalence and associated predictors of hypertension in adult patients with TNs at the Royal Commission Hospital, Kingdom of Saudi Arabia (KSA).

Methods: A retrospective study was conducted between 1 January 2015 and 31 December 2021. Patients with documented TNs based on the Thyroid Imaging Reporting and Data System (TI-RADS) were recruited to assess the prevalence and associated risk factors for hypertension.

Result: Three hundred ninety-one patients with TNs were recruited for this study. The median (interquartile range, IQR) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. The median (IQR) body mass index (BMI) was 30.26 (7.71) kg/m². There was a high prevalence of hypertension (22.5%) in adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed hypertension in patients with TNs and age, sex, diabetes mellitus (DM), bronchial asthma, triiodothyronine (FT3), total cholesterol and high-density lipoprotein (HDL). In the multivariate analysis, age (OR = 1.076 [95% CI 1.048 - 1.105]), sex (OR = 2.28 [95% CI 1.132 - 4.591]), DM (OR = 0.316 [95% CI 0.175 - 0.573]) and total cholesterol levels (OR = 0.820 [95% CI 0.694 - 0.969]) were significantly associated with hypertension.

Conclusion: There is a high prevalence of hypertension in patients with TNs. Age, female sex, DM and elevated total cholesterol are significant predictors of hypertension in adult patients with TNs.

背景:高血压和甲状腺结节(TNs)是常见的医学问题，在全球范围内的患病率正在上升。因此，我们在沙特阿拉伯王国(KSA)皇家委员会医院进行了这项研究，以评估成年TNs患者的高血压患病率和相关预测因素。方法:2015年1月1日至2021年12月31日进行回顾性研究。根据甲状腺影像学报告和数据系统(TI-RADS)，研究人员招募了有TNs记录的患者，以评估高血压的患病率和相关危险因素。结果:391例TNs患者被纳入本研究。年龄中位数(四分位间距，IQR)为46.00岁(20.0岁)，女性332例(84.9%)。中位(IQR)体重指数(BMI)为30.26 (7.71)kg/m2。成年TNs患者高血压患病率较高(22.5%)。在单因素分析中，TNs患者的高血压诊断与年龄、性别、糖尿病(DM)、支气管哮喘、三碘甲状腺原氨酸(FT3)、总胆固醇和高密度脂蛋白(HDL)有显著相关。在多因素分析中，年龄(OR = 1.076 [95% CI 1.048 - 1.105])、性别(OR = 2.28 [95% CI 1.132 - 4.591])、糖尿病(OR = 0.316 [95% CI 0.175 - 0.573])和总胆固醇水平(OR = 0.820 [95% CI 0.694 - 0.969])与高血压有显著相关性。结论:TNs患者高血压患病率较高。年龄、女性、糖尿病和总胆固醇升高是成年TNs患者高血压的重要预测因素。

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引用次数: 0

Role of Sodium-Glucose Cotransporter Inhibitors in the Management of Heart Failure: A Position Statement 钠-葡萄糖共转运蛋白抑制剂在心力衰竭治疗中的作用:立场声明

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920326

P. Mohanan, V. Chopra, R. Yadav, J. Dalal, Mrinal Kanti Das, S. Ray, H. P, P. Kerkar

引用次数: 0

Modified Shock Index to Predict In-Hospital Outcome among Patients Presenting with ST-Segment Elevation Myocardial Infarction 改良休克指数预测st段抬高型心肌梗死患者的住院预后

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920333

M. Asifudduza, N. Ahmed, Md. Owashak Faysal, Rahatul Quadir, Sharmin Ali, Md Rakibul Hasan, Nurul Islam, S. Sultana

Background: Prompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach. Objective: To evaluate the Modified Shock Index (MSI), as a predictor of in-hospital outcome among patients with STEMI. Methods: This cross sectional observational study was carried out in the Department of Cardiology, National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka from January 2020 to December 2020. A total of 100 patients were selected with acute STEMI admitted in the department of Cardiology, NHFH&RI, within the study period, who fulfilled the inclusion and exclusion criteria. Results: The mean age 55.6±10.2 years in Group I and 56.1±12.0 years in Group II. Male patients were predominant in both the groups. Regarding MSI 40(40.0%) patients had high admission MSI (≥0.91) and 60(60.0%) patients had normal admission MSI (<0.91). Regarding risk factors, hypertension, diabetes mellitus, smoking, dyslipidemia and family H/O CAD were not statistically significant (p>0.05) between the two groups. There was a significant (p<0.05) difference observed for NT-pro-BNP which was higher in group I than group II (77.5% vs 40.0%), but other investigations were not statistically significant (p>0.05) between the two groups. LVEF was found lower in Group I than group II (38.0±4.7 percent vs 42.6±5.2 percent), which was statistically significant (p<0.05) between the two groups. Regarding ECG findings 72.5% of patients were found with anterior MI in group I and 33.3% in group II, which was statistically significant (p<0.05) between the two groups. During the period of hospitalization patients in group I developed heart failure more than group II patients (67.5% vs 26.7%, p value=0.001). Development of cardiogenic shock was also significant in group I patients compared to group II patients (57.5% vs

背景:及时识别st段抬高型心肌梗死(STEMI)的高危患者对于采取更积极的治疗方法至关重要。目的:评价改良休克指数(MSI)作为STEMI患者住院预后的预测指标。方法:本横断面观察研究于2020年1月至2020年12月在达卡米尔普尔国立心脏基金会医院和研究所心内科进行。选择研究期间在国家卫生与社会科学研究院心内科住院的急性STEMI患者100例，符合纳入和排除标准。结果:ⅰ组患者平均年龄55.6±10.2岁，ⅱ组患者平均年龄56.1±12.0岁。两组患者均以男性为主。MSI方面，两组患者入院时MSI高(≥0.91)者40例(40.0%)，入院时MSI正常者60例(60.0%)(0.05)。两组比较差异有统计学意义(p0.05)。I组LVEF低于II组(38.0±4.7% vs 42.6±5.2%)，两组比较差异有统计学意义(p<0.05)。心电图表现方面，ⅰ组有72.5%的患者出现前路心肌梗死，ⅱ组为33.3%，两组比较差异有统计学意义(p<0.05)。在住院期间，I组患者发生心力衰竭的比例高于II组(67.5% vs 26.7%， p值=0.001)。与II组患者相比，I组患者发生心源性休克的比例也很显著(57.5% vs

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引用次数: 0

Effectiveness of Dobutamine to Facilitate Induction of Supraventricular Tachycardia Compared to Isoproterenol 与异丙肾上腺素相比，多巴酚丁胺促进诱发室上性心动过速的有效性

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920344

Joseph Donnelly, Ali Seyar Rahyab, Haisam Ismail, Laurence Epstein, Bruce Goldner

Background: Isoproterenol has been utilized for the induction of supraventricular and ventricular arrhythmias during electrophysiological (EP) testing. However, with the increasing number of catheter ablations performed and the significant increase in the price of isoproterenol in 2015, the cost implications led us to explore alternatives, although the price of isoproterenol has decreased since 2015. Dobutamine is a synthetic compound which was developed from isoproterenol with a similar ability to enhance conduction and shorten refractoriness of the AV node, thus making it an ideal choice given its lower cost. The effectiveness of dobutamine to facilitate induction of arrhythmias has not been extensively studied. Objective: To evaluate the ability of dobutamine to reproduce the properties of isoproterenol to help facilitate induction of arrhythmias. This study also evaluated the safety of dobutamine. Methods: From January 2014 to January 2017, 174 non-consecutive patients, with a diagnosis of confirmed or suspected supraventricular tachycardia (SVT) were enrolled. Dobutamine was used to induce SVT if patients were non-inducible at baseline using programmed electrical stimulation (PES). Post procedure, dobutamine was

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引用次数: 0

Oncostatin M, Serpins, and Oxidative Stress in Extracellular Matrix Remodeling and Arteriovenous Fistula Maturation. 细胞外基质重塑和动静脉瘘成熟中的抑癌素M、蛇形蛋白和氧化应激。

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920318

Nathaniel DeMarco, Vikrant Rai, Daniel R Wilson, Devendra K Agrawal

End-stage renal disease is a crippling diagnosis that generally requires dialysis to prolong life. To facilitate filtration of patient's blood in dialysis, surgical formation of an arteriovenous fistula (AVF) is commonly performed. Maturation of the AVF is required to allow for successful dialysis. However, AVFs commonly fail to mature, leading to the fistula closure, the necessity for another fistula site, and markedly increased morbidity and mortality. The current literature concerning molecular mechanisms associated with AVF maturation failure supports the role of inflammatory mediators involving immune cells and inflammatory cytokines. However, the role of oncostatin M (OSM), an inflammatory cytokine, and its downstream targets are not well investigated. Through inflammation, oxidative stress, and hypoxic conditions, the vascular tissue surrounding the AVF undergoes fibrosis, stenosis, and wall thickening, leading to complete occlusion and nonfunctional. In this report, first we critically review the existing literature on the role of OSM in the most common causes of early AVF failure - vascular inflammation, thrombosis, and stenosis. We next consider the potential of using OSM as a therapeutic target, and finally discuss therapeutic agents targeting inflammatory mediators involved in OSM signaling to potentiate successful maturation of the AVF.

终末期肾病是一种严重的诊断，通常需要透析来延长生命。为了便于透析时患者血液的过滤，手术形成动静脉瘘(AVF)是常用的方法。AVF成熟是透析成功的必要条件。然而，avf通常不能成熟，导致瘘管关闭，需要另一个瘘管位置，并显著增加发病率和死亡率。目前关于AVF成熟失败相关分子机制的文献支持炎症介质的作用，包括免疫细胞和炎症细胞因子。然而，抑癌素M(一种炎症细胞因子)及其下游靶点的作用尚未得到很好的研究。通过炎症、氧化应激和缺氧条件，AVF周围的血管组织发生纤维化、狭窄和壁增厚，导致完全闭塞和功能丧失。在本报告中，我们首先回顾了OSM在早期AVF衰竭最常见的原因(血管炎症、血栓形成和狭窄)中的作用。接下来，我们考虑使用OSM作为治疗靶点的潜力，最后讨论靶向参与OSM信号的炎症介质的治疗剂，以增强AVF的成功成熟。

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引用次数: 0

Assessment of Right Ventricular Systolic Dysfunction Using 2D STE to Predict Short Term Outcome in Patients with Heart Failure with Reduced Ejection Fraction 用2D STE评估右心室收缩功能障碍预测心力衰竭伴射血分数降低患者的短期预后

Cardiology and cardiovascular medicine

Pub Date : 2023-01-01 DOI: 10.26502/fccm.92920336

Md Rakibul Hasan, T. Haque, Nurul Islam, M. Asifudduza, Md. Owashak Faysal, Rahatul Quadir, Sharmin Ali, Hosne Ara Sonia

Dysfunction Using 2D STE to Predict

用2D STE预测功能障碍

引用次数: 0

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