Angiology最新文献

The American Heart Association's Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations established estimated glomerular filtration rate (eGFR) as a component of cardiovascular risk assessment. However, the anatomical substrate underlying this risk-coronary atherosclerotic burden-remains inadequately characterized across renal function spectrum. This retrospective study included 1181 patients (mean age: 60.2 ± 8.9 years, 65.7% male) undergoing elective coronary angiography. Patients divided groups using eGFR; eGFR ≥90 (n = 596), 60 to 89 (n = 497), and 30 to 59 mL/min/1.73 m² (n = 88) were evaluated by stratification. Coronary atherosclerotic burden was determined using Gensini score. eGFR demonstrated a strong correlation with Gensini score (ρ = -0.352, P < .001). Each 10 mL/min/1.73 m² eGFR decline conferred 40% increased odds of severe coronary atherosclerosis (odds ratio [OR] = 0.960, 95% CI: 0.951-0.970, P < .001). Patients with eGFR 30 to 59 mL/min/1.73 m² exhibited 6-fold higher odds compared with preserved renal function (OR 6.073, 95% CI: 3.352-11.005, P < .001), independent of traditional risk factors. This study provides an anatomical validation for incorporating eGFR into cardiovascular risk assessment. Our angiographic evidence demonstrates that even mild renal dysfunction is accompanied by increased atherosclerotic burden. These findings bridge the gap between epidemiological risk prediction and pathophysiological reality, reinforcing the cardiovascular-kidney-metabolic health continuum and supporting aggressive risk modification strategies in patients with declining renal function, particularly among diabetic women.

Acute myocardial infarction is a major cause of mortality in individuals with obstructive airway disease. The impact of inpatient care quality following non-ST elevation myocardial infarction (NSTEMI) on long-term mortality among those with chronic obstructive pulmonary disease (COPD) and asthma remains poorly understood. We analysed 499 318 adults with NSTEMI from the Myocardial Ischaemia National Audit Project registry between 2005 and 2019, linked with Hospital Episode Statistics for airway disease diagnosis and Office for National Statistics data for mortality outcomes. Inpatient care quality was measured using the opportunity-based quality-indicator (OBQI) score. Long-term outcomes were evaluated using multivariable Cox regression and Kaplan-Meier analyses. Individuals with COPD and asthma received lower quality of care (OBQI score: no airways disease: 83.5 vs COPD: 78.1, asthma: 80.8, P < .001). Percutaneous coronary intervention was less frequent in COPD patients (22%) than in those without airway disease (30%) or with asthma (31%), P < .001. COPD was associated with higher 10-year mortality (hazard ratio [HR]: 1.58, 95% CI 1.56-1.60), whereas those with asthma had lower risk (HR: 0.97, 95% CI 0.95-0.98). COPD was associated with increased adjusted cardiovascular mortality (sub-distribution HR: 1.89, 95% CI 1.84-1.95). Individuals with COPD received lower-quality inpatient care and fewer coronary interventions, which was associated with higher long-term mortality.

This study examined the association between a blunted nocturnal heart rate decline and ventricular arrhythmias, echocardiographic findings, and clinical characteristics in patients with isolated hypertension (defined as hypertension in the absence of other systemic comorbidities). A total of 229 adults who underwent transthoracic echocardiography and 24-hour Holter monitoring were retrospectively evaluated. Patients were classified as dippers (≥10% nocturnal heart rate reduction; n = 170) or non-dippers (<10% reduction; n = 59), and were also compared according to Lown classes 0 versus 1-4. Baseline demographics, laboratory parameters, and antihypertensive treatments were similar between groups. Non-dippers demonstrated greater interventricular septal and posterior wall thickness, higher left ventricular mass and mass index, and a higher prevalence of left ventricular hypertrophy and concentric hypertrophy (P < .05 for all). They also exhibited more frequent ventricular and atrial ectopy. Patients in Lown classes 1-4 had higher systolic blood pressure, more pronounced left ventricular remodeling, and a greater arrhythmic burden. In multivariable analysis, concentric hypertrophy (Odds Ratio [OR]: 2.682; P = .034) and non-dipping nocturnal heart rate (OR: 9.254; P = .001) were independent predictors of arrhythmias. These findings suggest that non-dipping nocturnal heart rate (reflecting impaired parasympathetic activity and relative sympathetic predominance) is associated with adverse cardiac remodeling and increased arrhythmia risk in isolated hypertension.

Outcomes after intervention for chronic venous insufficiency (CVI) is difficult to predict. This study aimed to develop machine learning (ML) models to predict 90-day clinical improvement after varicose vein surgery and identify key factors. This retrospective multicenter study included patients with CVI undergoing first-time varicose vein surgery between 2014 and 2024. CVI was classified according to the Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Clinical improvement at 90 days was defined as any decrease in CEAP stage. Three ML classifiers (Logistic Regression, Random Forest, and XGBoost) were trained to predict improvement, with nested stratified cross-validation and undersampling to address class imbalance. In total, 4015 patients were included and 87.6% showed clinical improvement at 90 days. Non-improved patients were older, had higher body mass index (BMI), and higher baseline VCSS and CEAP scores. Random Forest achieved the best overall performance, with an accuracy of 80%, recall of 75%, and F1-score of 0.49 to predict the lack of improvement, indicating effective identification of at-risk individuals. Key predictors included baseline CEAP and VCSS scores, BMI, age, and surgical variables. The overall predictive performance of ML was modest, but the models highlighted patients at risk of poor outcomes.

Intimal hyperplasia (IH) results from excessive vascular smooth muscle cell (VSMC) proliferation, migration through the internal elastic lamina, and extracellular matrix (ECM) protein deposition, orchestrated by various physical and molecular factors in the vasculature. IH is a common complication following endovascular treatments or angioplasty procedures and remains poorly managed despite decades of research. Although many molecular factors contributing to IH have been identified over recent years, earlier studies have not fully integrated these discoveries. Recent research has largely concentrated on VSMC proliferation, migration, and dedifferentiation. This review aims to comprehensively elucidate the molecular pathways involved in all stages of IH development, including endothelial injury, the coagulation cascade, inflammation, ECM deposition, and vascular remodeling, to inform future therapeutic strategies. We extensively searched PubMed for relevant animal studies reporting molecular mechanism involved in formation of IH and included 56 articles. In total, we found 69 molecules and 6 pathways involved in all stages of IH. Among the molecular pathways involved, the Mitogen-activated Protein Kinase (MAPK), Nuclear Factor kappa-light-chain-enhancer of activated B cells (NF-κB), and Transforming Growth Factor Beta (TGF-β).pathways consistently emerge in almost each step of IH development. This highlights the need for a multifaceted and comprehensive treatment to prevent IH.

The present study aimed to evaluate the predictive value of 3 nutritional scores-the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI)-for contrast-induced acute kidney injury (CI-AKI) in patients with type 2 diabetes mellitus (T2DM). A total of 2043 T2DM patients undergoing coronary angiography or intervention at Nanjing First Hospital (2021-2023) were retrospectively analyzed. Multivariable logistic regression identified independent risk factors, and receiver operating characteristic curves assessed predictive performance. CI-AKI occurred in 13.4% of patients. Female sex, elevated systolic blood pressure, increased neutrophil count, hyperglycemia, hematuria, diuretic use, and lower GNRI and PNI were independently associated with CI-AKI. Among the nutritional indices, PNI had the highest predictive value (AUC = .871), outperforming GNRI (AUC = .755) and CONUT (AUC = .547). Combining PNI or GNRI with clinical variables further improved predictive accuracy (AUC = .899 and .818, respectively). Restricted cubic spline analysis revealed nonlinear risk thresholds (PNI <38, GNRI < 92). GNRI and PNI are effective predictors of CI-AKI and may aid in early risk stratification and clinical intervention among T2DM patients, with PNI demonstrating superior performance.