BMC Cardiovascular Disorders最新文献

Background: Improving quality of life (QOL) is a major therapeutic goal for patients with advanced heart failure undergoing left ventricular assist device (LVAD) therapy or heart transplantation. In Japan, prolonged LVAD support due to donor shortage makes long-term QOL outcomes uncertain.

Objective: To evaluate longitudinal changes in QOL before and after LVAD implantation and heart transplantation, and to examine associations with physical function.

Methods: From 2013 to 2025, 95 patients underwent LVAD implantation at our institution, of whom 23 subsequently received heart transplantation. After excluding 4 patients with incomplete data, 19 were included in the final analysis. QOL was assessed using the Short Form-36 (SF-36) at baseline, during LVAD support, and after transplantation. Physical function was evaluated by grip strength, leg strength, 6-min walk distance (6MWD), and peak oxygen uptake. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed.

Results: Baseline QOL was impaired in the physical domain but relatively preserved in the mental domain (PCS 22.9 ± 10.4; MCS 49.1 ± 15.0). During LVAD support (mean 64.1 ± 14.1 months), PCS improved significantly (40.1 ± 7.1, p = 0.008), whereas MCS remained stable (52.4 ± 6.3, p > 0.99). After transplantation (mean 33.6 ± 30.4 months), PCS further improved (46.3 ± 7.9, p = 0.006), while MCS continued to remain stable (53.3 ± 5.8, p = 0.466). Post-transplant PCS showed positive but non-significant correlations with physical function measures.

Conclusion: BTT-LVAD and subsequent heart transplantation markedly improve physical QOL in patients with advanced heart failure, while mental QOL, which is relatively preserved at baseline, remains stable throughout long-term follow-up. These findings suggest that, despite stable overall mental well-being, device- and transplant-specific psychological burdens may persist and should be addressed as part of comprehensive long-term care.

Objectives: This study was performed to evaluate the current status and to analyze the associated factors of intraoperative pain experience during radiofrequency ablation of atrial fibrillation (AF) with conscious sedation and analgesia.

Methods: This cross-sectional observational study employed convenience sampling of AF patients underwent their first radiofrequency ablation. General information questionnaire, intraoperative status sheet, Wong-Baker faces pain rating scale, hospital anxiety and depression scale, and the Connor-Davidson Resilience Scale were employed for data collection and analysis.

Results: A total of 428 patients (mean age 66.5 ± 9.6years; 59.8% male) were enrolled in this study. At ablation start, 62.9% of patients had moderate pain. When ablating specific regions, moderate pain and severe pain was encountered in 76.2% and 11.7% patients, respectively. Female patients had higher pain score than male patients at the followed 3 time-points: ablation start, ablating specific regions, and sheaths removal (z =-2.923, -4.349, -2.385, respectively, all P < 0.05). A negative correlation between the interoperative pain scales and the psychological resilience scales was confirmed at the time-point of before sedation, during ablation, ablating specific regions, and sheaths removal (r=-0.161, -0.464, -0.773, -0.352, respectively, all P < 0.05). Multivariable logistic regression analysis revealed that the strength and resilience dimensions of psychological resilience were significant protective factors against pain during radiofrequency ablation, with low levels of strength and tenacity associated with 2.32-fold and 2.17-fold increased risks of moderate pain, respectively, while optimism and clinical factors showed no significant effects.

Conclusion: Most of AF patients undergoing radiofrequency ablation with conscious sedation and analgesia experienced significant intraoperative pain experience, particularly when specific cardiac regions were ablated. Enhancing psychological resilience before the procedure may help reduce intraoperative pain scores.

Trial registration: This trial is registered on Mar 17th, 2022, in the Chinese Clinical Trial Registry (ChiCTR2200057810).

Background: Heart failure (HF) is a clinical syndrome with high global incidence and mortality, imposing a substantial economic burden. While creatinine (Cr) and body weight (BW) individually influence HF progression, the prognostic role of the creatinine-to-body weight ratio (CWR) remains unclear. This study investigates the association between CWR and mortality in HF patients, aiming to identify high-risk individuals and inform prognosis.

Methods: Patient data were extracted from the MIMIC-IV database. Participants were first stratified into CWR index quartiles to categorize the cohort. The primary endpoints were 30- and 365-day all-cause mortality, while secondary endpoints included 90- and 180-day mortality. Kaplan-Meier curves with log-rank tests were then used to compare survival across quartiles. Next, Cox proportional hazards regression (with sequential model adjustment) and restricted cubic spline (RCS) analysis assessed the association between CWR and prognosis. Sensitivity analyses were subsequently conducted to examine the robustness of the non-linear relationship, and subgroup analyses explored potential effect modifications. Finally, time-dependent receiver operating characteristic (ROC) curve analyses compared the predictive performance of CWR against traditional markers.

Results: Among 4,371 participants (median age: 75 years; 54.8% male), higher CWR index values were significantly associated with increased all-cause mortality risks at 30, 90, 180, and 365 days, as demonstrated by Kaplan-Meier survival curves (log-rank P < 0.01). Building on these results, Cox regression analysis further revealed that individuals in the highest CWR index quartile had an elevated risk of death compared to those in lower quartiles. Additionally, restricted cubic spline (RCS) analysis showed a robust biphasic nonlinear association between the CWR index and mortality, identifying 0.05 as a key threshold where the risk relationship changes. Specifically, for most patients (CWR ≤ 0.05), mortality risk increases with rising CWR values until it plateaus, whereas for those with CWR > 0.05 (n = 320), a distinct pathophysiological state may emerge, marked by a sharp increase in risk. The underlying mechanisms require further investigation.

Conclusion: CWR demonstrates a robust biphasic association with mortality, identifying 0.05 as a critical threshold separating a risk-plateau phase from extreme high-risk. Its stable prognostic value suggests CWR may integrate acute hemodynamic and chronic metabolic stress, though prospective validation is warranted.