Cardiovascular diagnosis and therapy最新文献

Background: The relationship between improved glycemic control and mortality reduction in diabetes remains controversial. This study aimed to examine the temporal trends and association between haemoglobin A1c (HbA1c) control status and mortality risk among adults with diabetes.

Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2014. The statistical significance of linear or nonlinear trends was evaluated using logistic regression. Nonlinear temporal trends were evaluated by including quadratic terms for time in the regression models. To explore the relationships between HbA1c and mortality, the study employed the Cox proportional hazards model for multivariate analysis, along with Kaplan-Meier survival curves for univariate visualization.

Results: With 6,516 participants, the study showed a significant improvement in the control rate of HbA1c among diabetic patients, increasing from 41.61% in 1999 to 58.72% in 2014 (P<0.001). However, there was no noticeable trend in the overall all-cause mortality rate, which was 10.79% in 1999 and 12.08% in 2014 (P=0.608), or in cardiovascular mortality, which was 4.74% in 1999 and 4.24% in 2014 (P=0.371), among diabetic patients. No significant differences were found in the risks of all-cause mortality [hazard ratio (HR): 0.64; 95% confidence interval (CI): 0.36-1.13; P=0.13] or cardiovascular mortality (HR: 1.11; 95% CI: 0.41-3.02; P=0.84) between patients with HbA1c below 7.0% and those with HbA1c 7.0% or higher. Interestingly, the rate of sulfonylureas use went down from 30.25% in 1999 to 12.42% in 2014 (linear P value <0.001).

Conclusions: Despite significant improvements in HbA1c control rates among US adults with diabetes from 1999 to 2014, we observed no corresponding reduction in 5-year mortality risks. Achieving HbA1c <7.0% was not associated with lower mortality risk in this population. These findings suggest that improvements in glycemic control alone may be insufficient to reduce mortality in diabetic populations, highlighting the need for a more comprehensive approach to diabetes management.

Artificial intelligence (AI) has emerged as a widely used tool for writing, including in scientific research and publications. While its application to cardiovascular research is the focus of numerous studies, the policies related to its use for manuscript writing are rapidly evolving and not well understood. We sought to compare the policies of high-impact cardiovascular journals regarding AI for manuscript writing assistance and assess the prevalence of its use. Cardiovascular medicine journals with an SCImago Journal Rank (SJR) ≥3 and h-index ≥100 were screened for an AI policy. Journal policies were assessed for author disclosure requirements, standardization of disclosure section and language, and AI detection software used during the submission process. Each journal with an AI policy that required disclosure of its use was systematically searched to evaluate the prevalence of articles disclosing its use for writing assistance from January 2023 to August 2025. The number of publications with AI disclosure and publication characteristics was recorded. Seventeen journals met inclusion criteria and were screened for an AI policy, of which 14 journals (82%) contained such a policy. Among these, three journals (18%) had an AI policy that required disclosure, but that was not specific to AI use for manuscript writing. One journal (6%) did not require disclosure. The remaining three journals (18%) did not have any AI policy. None of the journals mandated a dedicated AI disclosure section or provided authors with standardized disclosure language. Fifteen journals (88%) used identifiable AI detection software, while only one posted this information publicly. Among the 14 journals with an AI disclosure policy, 11 AI-disclosing works were found. ChatGPT was the most common AI tool used (n=9, 82%). Journal policies regarding AI use for manuscript writing assistance vary widely, and therefore, there is a growing need for standardization. The prevalence of articles disclosing the use of AI was profoundly low across all journals evaluated, with significant variation in how AI use was disclosed. Having clear and consistent policies across journals and requiring authors to disclose their use of AI for manuscript writing is essential to uphold transparency and maintain medical research integrity.

Background: Increased aortic pulse wave velocity (aPWV), a marker of arterial stiffness, is associated with poor prognosis in patients with or at risk for heart failure with preserved ejection fraction (HFpEF). Increasingly, advanced imaging using cardiac magnetic resonance imaging (MRI) is used to evaluate cardiac dysfunction, including coronary microvascular dysfunction (CMD). To facilitate investigation linking CMD with HFpEF, we compared MRI-measured aPWV with traditional invasive or noninvasive measurements of aPWV.

Methods: We studied 118 participants (90.7% women) with or at risk for HFpEF due to suspected CMD in a cross-sectional design at Cedars-Sinai Medical Center between October 2025 and February 2022. aPWV was measured by: (I) MRI through-plane phase-contrast imaging at the ascending and distal descending aorta (MRI-aPWV) (n=78), (II) invasively via catheter pullback (cath-aPWV) (n=68), and (III) carotid-femoral applanation tonometry (cf-aPWV; SphygmoCor XCEL, Atcor Medical) (n=87). MRI-aPWV was compared to cath-aPWV and cf-aPWV using Pearson correlation and Bland-Altman plots.

Results: Mean age was 58±11.8 years, and mean aPWV were 8.48±3.21 m/s (MRI-PWV), 7.51±2.79 m/s (cath-aPWV), and 8.68±1.83 m/s (cf-aPWV). MRI-aPWV strongly correlated with cf-aPWV with r=0.74 [95% confidence interval (CI): 0.61-0.83, P<0.001] with mean difference -0.18 and standard deviation (SD) 2.14. Comparison of MRI-aPWV to cath-aPWV showed a modest correlation of 0.52 (95% CI: 0.29-0.69, P<0.001) with a mean difference of -0.74 and SD 2.78.

Conclusions: MRI measurement of aPWV shows good agreement with traditional invasive and noninvasive measurements in participants with or at risk for HFpEF. Reliable measurement of arterial stiffness combined with cardiac MRI measures of ventricular remodeling, fibrosis, scar and perfusion may offer pathophysiology insights and treatment targets for HFpEF.

Background: Epidemiological evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF); however, the magnitude of this association and its prognostic value in predicting the recurrence of AF after radiofrequency catheter ablation (RFCA) have not been fully characterized. The present study was designed to elucidate the complex interplay between NAFLD and the risk of AF recurrence after ablation.

Methods: A total of 1,182 patients with AF who underwent initial RFCA from June 2018 to December 2022 at the First Affiliated Hospital of Zhengzhou University were included in this retrospective cohort study. The Kaplan-Meier method was used to plot AF recurrence curves after ablation. Multivariable Cox models were then used to examine the associations between NAFLD and the recurrence of AF. Analyses were also conducted to assess whether the predictive effect of NAFLD was consistent across different subgroups.

Results: Over a 1-year follow-up period, 30.1% of the patients experienced recurrent AF. The multivariable Cox analysis revealed that NAFLD was an independent risk factor for the recurrence of AF after controlling for model 2 (hazard ratio =1.37, 95% confidence interval: 1.10-1.70, P=0.005). These correlations remained statistically significant across various models. Further, incorporating NAFLD in the fully adjusted basic risk model significantly increased the ability of the model to predict AF recurrence, with the C-statistic increasing from 0.672 to 0.686 (P=0.03). Additionally, diabetes mellitus (DM) (P value for interaction =0.049) and female sex (P value for interaction =0.02) had a statistically significant interactive effect with NAFLD in predicting the recurrence of AF.

Conclusions: NAFLD was found to be independently associated with the recurrence of AF after ablation. Moreover, the AF recurrence rate after RFCA was higher in the NAFLD patients who had DM or were female. The study showed that NAFLD may serve as a dependable marker for assessing AF recurrence risk in clinical practice.

Background: Insulin resistance (IR) and central obesity play a crucial role in the pathogenesis of metabolic diseases. However, the association between the triglyceride-glucose index combined with waist-to-height ratio (TyG-WHtR)-a novel proxy for both insulin resistance and central obesity-and mortality outcomes in adults with prediabetes and diabetes remains unclear. The aim of this study is to explore the association between TyG-WHtR and all-cause and cardiovascular (CVD) mortality in prediabetic and diabetic adults.

Methods: The study enrolled 19,563 United States (U.S.) adults diagnosed with prediabetes or diabetes from the National Health and Nutrition Examination Survey (NHANES). Data were collected in eight continuous 2-year cycles from January 2003 to December 2018. The Kaplan-Meier curve, Cox proportional risk model, restricted cubic spline (RCS) curve, and subgroup analysis were used to evaluate the association of the TyG-WHtR index with all-cause mortality and CVD-related mortality in US adults with prediabetes and diabetes. A series of sensitivity analyses were performed to test the robustness of the findings.

Results: After a median follow-up of 7.6 years, 2,949 all-cause deaths were recorded (15.1% death rate over the follow-up period), of which 969 (32.86%) were CVD related. Multivariate adjustment models showed a gradual increase in all-cause mortality and CVD-related mortality with each increasing TyG-WHtR index quartile. Specifically, for every one unit increase in TyG-WHtR, the risk of all-cause death increased by 19% [hazard ratio (HR) =1.19, 95% confidence interval (CI): 1.1-1.28; P<0.001] and there was also an associated 11% increased risk of death from CVD, although this did not reach statistical significance (HR =1.11, 95% CI: 0.98-1.27; P=0.11). Compared with patients in the lowest quartile (Q1), those in the highest quartile (Q4) had an all-cause mortality HR of 1.39 (95% CI: 1.06-1.81) and a CVD-related mortality HR of 1.36 (95% CI: 0.91-2.03). Interaction tests revealed significant effect modification by body mass index (BMI) (all-cause mortality) and family income-to-poverty ratio (CVD-related mortality).

Conclusions: In a sample of US adults with prediabetes and diabetes, we found an association between TyG-WHtR index and both all-case and CVD-related mortality. The TyG-WHtR index could serve as an alternative biomarker for the clinical management of patients with prediabetes and diabetes.

Background: Despite successful resuscitation from cardiac arrest (CA), patients often develop a fatal post-resuscitation syndrome due to ischemia-reperfusion injury. The disruption of hemodynamic coherence, where restored macrocirculation fails to improve microcirculation, leads to persistent tissue hypoperfusion and organ failure, making early non-invasive assessment of the microvasculature crucial for detecting these post-resuscitation disturbances. This study aimed to identify markers of peripheral circulatory disturbances in the early post-resuscitation period after asphyxial CA in rats.

Methods: The study was performed on adult male Wistar rats randomized into two groups: group I-sham operated animals (Sham group), group II-asphyxial CA followed by resuscitation (CA group). Asphyxial CA was induced by cessation of ventilation. Resuscitation was performed 2 minutes after actual CA. Invasive blood pressure, skin perfusion (M) assessed by laser Doppler flowmetry and cutaneous vascular conductance (CVC) were measured at baseline, 10 and 120 min after return of a spontaneous circulation (ROSC). In addition, the variables of cutaneous post-occlusive reactive hyperemia (PORH) were calculated.

Results: At 10 minutes after ROSC, there were no differences in mean arterial pressure (MAP) values in the "CA" group compared to the "Sham" group [MAP 67.3 (61.52, 82.35) vs. 60.39 (58.54, 72.03), P=0.47, respectively]. M and CVC were decreased in the "CA" group compared to the "Sham" group [M 10.1 (7.0, 12.5) vs. 14.7 (12.1, 16.5) PU, P=0.001; CVC 0.12 (0.11, 0.21) vs. 0.21 (0.19, 0.24), P=0.005, respectively]. 120 min after ROSC, the studied groups did not differ in hemodynamic parameters and in basic microcirculatory parameters. The groups also did not differ (P>0.05) in the values of PORH variables.

Conclusions: Microcirculatory disturbances in the first minutes after ROSC are manifested by a decrease in M and CVC. These pathological alterations largely reversed 2 hours after resuscitation. The use of LDF with an occlusion test did not reveal specific changes in skin PORH variables at this time. We suggests that microcirculatory assessment might have its greatest diagnostic value in the very early phase (first minutes to hours) after ROSC, while its prognostic value might require later assessments (beyond 2 hours).

Background: Sudden cardiac death (SCD) is associated with severe electrocardiogram (ECG) abnormalities. Current prediction relies heavily on static ECG parameters, limiting accuracy. This study aimed to explore dynamic ECG parameters, particularly the S-wave area and its circadian variations, as novel markers for SCD risk prediction.

Methods: All participants were divided into three different SCD risk groups based on their disease status at the time of enrollment. Dynamic single-lead ECG data was collected continuously for 24 hours and segmented into 1,440 one-minute intervals with time information tags from 0:00 to 24:00. Forty-two ECG parameters, including the S-wave area, were analyzed. Randomly selected 70% of the samples from Sun Yat-sen Memorial Hospital to construct training set and remaining samples to construct independent test set. Student's t-test was used to compare the expression differences of ECG parameters in different SCD risks patients at different time points within a day. Repeatedly attempted to establish multivariate logistics regression models combining different time points and ECG parameters and performed five-fold cross validation sequentially. Selected time point-ECG parameter combined model with the highest AUC to conduct further univariate logistic regression and calculate odds ratio (OR) of each time point-ECG parameter combination.

Results: From September 2017 to December 2020, 289 participants were enrolled: 43 at high risk of SCD (SCDHR), 138 with heart failure (HF), and 108 healthy controls (HC). Significant circadian variations in ECG parameters were observed. In the SCDHR group, key parameters significantly increased during 16:00-22:00, while the HF group showed distinct changes from 21:00-06:00. Logistic regression achieved robust performance in distinguishing groups: SCDHR vs. HC (AUC =0.887 training; AUC =0.747, accuracy =0.755, precision =0.800 test), SCDHR vs. HF (AUC =0.857 training; AUC =0.714, accuracy =0.681, precision =0.280 test) and HF vs. HC (AUC =0.965 training; AUC =0.842, accuracy =0.704, precision =0.867 test). Decision curve analysis and calibration curve showed good clinical performance of three logistics models for each comparison pair.

Conclusions: Dynamic ECG parameters, especially time-dependent variations in the S-wave area, were strongly associated with the SCD risk. They may develop into promising markers enhancing predictive accuracy for SCD stratification after further large-scale and prospective validation.

Background: Medial arterial calcification (MAC) increases vascular stiffness and reduces arterial compliance, often leading to serious systemic vascular diseases. However, research progress in this field has been limited by the lack of effective animal models. To address this gap and facilitate MAC research, this study established a novel experimental animal model of MAC in wild-type C57BL/6J mice and developed corresponding pathological grading standards.

Methods: To establish an optimal MAC modeling protocol, we systematically compared key parameters, including wire diameter, modeling duration, and combination with a vitamin D₃ (VD₃) diet. The resulting model was then subjected to interventional treatments with various calcification inhibitors. For pathological assessment, a four-tier histopathological grading system was established to categorize calcification severity based on its extent and distribution. Tissue sections were analyzed by hematoxylin and eosin and Von Kossa staining. The expression of inflammatory factors and bone-related proteins was analyzed by immunohistochemistry (IHC), while macrophage markers (CD68, CD86) were further characterized by immunofluorescence (IF).

Results: The most effective method was identified as endothelial injury of the common carotid artery (CCA) using a 0.45 mm rough guide wire combined with a VD₃ diet for 3 months, achieving a 100% MAC incidence. Compared with those in the sham group, the CCAs of the mice in the experimental group were infiltrated with activated macrophages and inflammatory factors such as interleukin-1beta (IL-1β) and interleukin-6 (IL-6). Calcifcation inhibitors etidronate and SNF472 significantly prevented MAC occurrence, showing inhibition rates of 45.45% (P=0.006) and 50% (P=0.002), respectively, conpared to the VD₃ group (Fisher's exact test).

Conclusions: This study not only establishes a MAC animal model by inducing injury to the CCA combined with a VD₃ diet but also introduces a corresponding pathological scoring system. Together, this model, coupled with this associated grading method, provides a valuable toolset for future basic medical research, drug screening, and investigations into the genetic mechanisms of MAC.