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.
Background: The association between hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR) and the risk of cerebrovascular events has attracted much attention. Although previous studies have reported that the incidence of HALT after TAVR in patients with bicuspid aortic valve (BAV) is comparable to that in patients with tricuspid aortic valve (TAV), the specific contributing factors remain incompletely understood. This study aimed to investigate the incidence, predictors, and prognosis of HALT in a TAVR cohort of young patients with 50-50% bicuspid-TAV anatomy.
Methods: We retrospectively analyzed consecutive patients with severe symptomatic aortic stenosis who underwent the TAVR procedure between May 2012 and January 2021 in West China Hospital, Sichuan University. Multislice computed tomography (MSCT) was employed to evaluate the early HALT post-TAVR at discharge. Echocardiograms were conducted at baseline, upon discharge, 30 days after the procedure, and at 1-year follow-up. Patients were grouped according to the presence of HALT at discharge. The baseline data, procedural details, and clinical outcomes of the patients were compared, and then multivariate regression analysis was performed.
Results: We ultimately enrolled 605 patients undergoing TAVR for severe symptomatic aortic stenosis, of whom 79 (13.1%) developed HALT during hospitalization. The incidence of HALT was significantly higher in patients with BAV than in those with TAV (15.9% vs. 10.2%; P=0.04). In the multivariate analysis, BAV was identified as an independent predictor of HALT [odds ratio (OR) =2.148; 95% confidence interval (CI): 1.283-3.596; P=0.004]. The other independent predictors included coronary artery disease (OR =1.810; 95% CI: 1.091-2.768; P=0.02), higher body mass index (OR =0.912; 95% CI: 0.846-0.982; P=0.02), postdilation (OR =0.552; 95% CI: 0.327-0.934; P=0.03), bioprosthetic valve size >23 mm (OR =1.965; 95% CI: 1.013-3.813; P=0.05), and the presence of a greater-than-mild paravalvular leak (OR =0.28; 95% CI: 0.13-0.62; P=0.001). In terms of clinical outcomes, there were no significant differences in stroke or death between the HALT group or the non-HALT group at 30 days or 1 year.
Conclusions: BAV was associated with higher risk of early HALT after TAVR, whereas the presence of HALT was not associated with stroke or death at 1 year. The underlying mechanisms and long-term prognosis of HALT after TAVR in patients with BAV remain to be further investigated.
Background: Aortic regurgitation (AR) is a common valvular disease, but data comparing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) for pure native AR are limited. The aim of this study is to provide more robust evidence for employing TAVR in patients with pure native AR.
Methods: This retrospective cohort study included 208 elderly patients (≥65 years) with pure native AR who underwent elective aortic valve replacement (SAVR or TAVR, all patients underwent TAVR procedure using the J-Valve™ system) between January 2018 and June 2023 at Beijing Anzhen Hospital, China. Safety and hemodynamic outcomes were assessed up to 3.1 years [interquartile range (IQR), 1.9-4.8 years], with propensity score weighting used to adjust for confounders.
Results: The median ages were 74.0 in the TAVR group and 68.0 in the SAVR group. SAVR patients were younger and had fewer comorbidities. The all-cause mortality in the TAVR group during the in-hospital period was significantly higher than the SAVR group after adjustment (15.8% vs. 6.6%; P=0.003), while there was no statistical difference in cardiac mortality between the two groups (4.3% vs. 3.3%; P=0.58). The TAVR group saw more adverse results in terms of the requirement for a permanent pacemaker (11.5% vs. 0.0%; P<0.001) and vascular complications (8.7% vs. 0.0%; P<0.001) during the in-hospital period after adjustment. No significant statistical difference all-cause stroke, acute myocardial infarction, and aortic valve redo both during the in-hospital period and follow-up. Before discharge, TAVR patients had significantly larger effective orifice area (EOA) [median 2.1 (IQR, 2.0-2.2) vs. 1.6 (IQR, 1.5-1.8) cm2; P<0.001] and EOA index [median 1.2 (IQR, 1.1-1.3) vs. 0.9 (IQR, 0.8-1.0) cm2/m2; P<0.001] compared to SAVR patients. The maximum aortic valve velocity [median 180.6 (IQR, 151.0-208.0) vs. 236.1 (IQR, 212.0-253.0) cm/s; P<0.001] and pressure gradient [median 13.9 (IQR, 9.0-17.0) vs. 23.2 (IQR, 19.0-27.0) mmHg; P<0.001] were also lower in the TAVR group before discharge. These hemodynamic advantages persisted during follow-up.
Conclusions: TAVR patients with pure native AR were older, had more comorbidities, and had higher Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores than SAVR patients. Cardiac mortality was similar between groups during hospitalization and follow-up. TAVR is a safe and effective treatment for elderly patients with pure native AR, providing superior hemodynamic performance and the potential for improved long-term outcomes.
Background: In Africa alone, 500,000 live newborns are born each year with congenital heart disease (CHD). Sub-Saharan Africa contributes a larger portion of these numbers. The prevalence of delayed diagnosis in Ethiopia is unknown. The aim of this study was to determine the magnitude of delayed diagnosis of CHD and associated factors at Tikur Anbessa Specialized Hospital (TASH).
Methods: This study was conducted in TASH at the Department of Pediatrics and Child Health from June 1 to October 30, 2023. TASH is the tertiary and largest hospital in the country, located in the capital city, Ethiopia. An appropriate diagnosis of CHD is usually made after referral to the hospital. A cross-sectional study design was employed. The data were collected via the KoboToolbox and exported to SPSS version 29 for analysis. Descriptive statistics were used to examine participants' sociodemographic, socioeconomic and clinical characteristics. Binary and multivariate logistic regression analyses were used to assess associations between variables.
Results: Out of 228 study participants, 121 (53.1%) had a delayed diagnosis of CHD. The majority of patients (n=39, 83%) with cyanotic heart diseases were diagnosed late. The proportion of delayed diagnoses among patients with acyanotic CHDs was 45.4% (n=82). The median age at diagnosis for patients with acyanotic CHD was 6 months [interquartile range (IQR), 1.5-24 months], whereas the median age at diagnosis for patients with cyanotic CHD was 9 months (IQR, 1.5-29 months). The probability of a delayed diagnosis of CHD was 2.34 [95% confidence interval (CI): 1.05-5.25], 4.47 (95% CI: 1.29-17.59), 2.79 (95% CI: 1.49-5.19) and 6.84 (95% CI: 2.86-16.34) times greater respectively for lack of optimal antenatal care (ANC) visits, no obstetric ultrasound, traditional birth attendant and cyanotic CHDs.
Conclusions: The magnitude of delayed CHD diagnosis was unacceptably high (53.1%). The factors associated with delayed diagnosis were ANC visits, obstetric ultrasound, type of birth attendant and type of CHD.
Background: Thoracic aortic fenestration is one of the methods employed for aortic arch reconstruction. To address the technical complexities of conventional fenestrated thoracic endovascular aortic repair (f-TEVAR) for aortic diseases involving the arch, we developed a streamlined approach using a novel physician-modified Relay nonbare stent graft (Terumo Aortic), eliminating the need for time-consuming marker suturing or guidewire-assisted fenestration alignment. This study evaluated the clinical application of this minimalist modification protocol.
Methods: This retrospective cohort study analyzed 33 patients undergoing minimalist f-TEVAR with Relay nonbare stent-grafts between January 2023 and December 2023 in Beijing Anzhen Hospital, with precise preoperative electrocardiography-gated, computed tomography angiography-guided fenestration planning being applied. The stent graft's proprietary self-alignment mechanism enabled marker-free orientation via its precurved design and 12/6 o'clock markers. Intraoperative modifications included partial deployment, low-temperature fenestration punching, and simplified resheathing with dual-layer delivery. The primary endpoints were technical success, stent-graft modification time, fluoroscopy time, procedure time, endoleak rate, procedure-related complications, length of stay, and 30-day and late mortality.
Results: The cohort (mean age 63.2±10.6 years; 75.8% male) comprised patients with variety of aortic diseases, including penetrating ulcers (42.4%), type-B dissections (27.3%), non-A non-B dissections (18.2%), and aneurysms (12.1%). The modified protocol proved to be efficient : the graft modification time was 6.8±1.8 minutes, the fluoroscopy exposure was 8.2±3.9 minutes, and the total procedure time was 57.9±13.1 minutes. All procedures achieved technical success (100%), with no instances of endoleak, retrograde dissection, or neurological complications. All patients survived after a mean follow-up of 12.6±3.7 months. Supra-arch branches were all patent by the end of follow-up.
Conclusions: Our experience demonstrates that the Relay nonbare stent-graft self-aligning design enables safe and efficient fenestration while maintaining excellent sealing properties and branch vessel patency. This stent-graft selection strategy provides a reliable foundation for simplified arch repair, potentially expanding the accessibility of complex endovascular aortic interventions.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：