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Published by MedReviews. ISSN: 1530-6550.<br /><br />REVIEWS IN CARDIOVASCULAR MEDICINE is designed to review the latest advances in the diagnosis and treatment of a wide range of cardiova scular conditions to help the busy, practicing cardiologist keep up-to-date with the rapidly evolving field of cardiology.
期刊描述简介:
Published by MedReviews. ISSN: 1530-6550. REVIEWS IN CARDIOVASCULAR MEDICINE is designed to review the latest advances in the diagnosis and treatment of a wide range of cardiova scular conditions to help the busy, practicing cardiologist keep up-to-date with the rapidly evolving field of cardiology.
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An Artificial Intelligence-Based Non-Invasive Approach for Cardiovascular Disease Risk Stratification in Obstructive Sleep Apnea Patients: A Narrative Review.
Obstructive sleep apnea (OSA) is a severe condition associated with numerous cardiovascular complications, including heart failure. The complex biological and morphological relationship between OSA and atherosclerotic cardiovascular disease (ASCVD) poses challenges in predicting adverse cardiovascular outcomes. While artificial intelligence (AI) has shown potential for predicting cardiovascular disease (CVD) and stroke risks in other conditions, there is a lack of detailed, bias-free, and compressed AI models for ASCVD and stroke risk stratification in OSA patients. This study aimed to address this gap by proposing three hypotheses: (i) a strong relationship exists between OSA and ASCVD/stroke, (ii) deep learning (DL) can stratify ASCVD/stroke risk in OSA patients using surrogate carotid imaging, and (iii) including OSA risk as a covariate with cardiovascular risk factors can improve CVD risk stratification. The study employed the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) search strategy, yielding 191 studies that link OSA with coronary, carotid, and aortic atherosclerotic vascular diseases. This research investigated the link between OSA and CVD, explored DL solutions for OSA detection, and examined the role of DL in utilizing carotid surrogate biomarkers by saving costs. Lastly, we benchmark our strategy against previous studies. (i) This study found that CVD and OSA are indirectly or directly related. (ii) DL models demonstrated significant potential in improving OSA detection and proved effective in CVD risk stratification using carotid ultrasound as a biomarker. (iii) Additionally, DL was shown to be useful for CVD risk stratification in OSA patients; (iv) There are important AI attributes such as AI-bias, AI-explainability, AI-pruning, and AI-cloud, which play an important role in CVD risk for OSA patients. DL provides a powerful tool for CVD risk stratification in OSA patients. These results can promote several recommendations for developing unique, bias-free, and explainable AI algorithms for predicting ASCVD and stroke risks in patients with OSA.
被引量：- 发表：1970
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Evaluation of Right Heart Structure and Function in Pacemaker-dependent Patients by Two-Dimensional Speckle Tracking Echocardiography: A 1-Year Prospective Cohort Study.
Left bundle branch area pacing (LBBAP) has evolved into a practical and secure pacing procedure. However, previous studies of LBBAP focused on left heart function and synchronization and lacked assessment of right heart structure and function and interventricular synchrony. The objective of this study was to examine the impacts of LBBAP, right ventricular (RV) septal pacing (RVSP), and RV apical pacing (RVAP) on right heart structure, function and interventricular synchrony. Between January and July 2021, A total of 90 patients exhibited a normal left ventricular (LV) ejection fraction and received dual chamber pacemaker implantation for bradycardia at Beijing Anzhen Hospital. The patients were assigned to three groups based on the pacing site: LBBAP, RVSP, or RVAP. RV function was evaluated using right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), right ventricular myocardial performance index (RVMPI), global longitudinal strain of the right ventricle (GLSRV), and right ventricular free wall longitudinal strain (RVFWLS). Tricuspid regurgitation (TR) was assessed using vena contracta magnitude (VCM) and the ratio of TR jet area to right atrial area (RAA). Interventricular mechanical synchrony was evaluated using interventricular mechanical delay (IVMD) and left ventricular to right ventricular time-to-peak standard deviation (LV-RV TPSD). Baseline echocardiographic parameters and characteristics were comparable among the three groups. No significant differences were observed in the LBBAP group from baseline to follow-up for QRS duration (p = 0.783), TAPSE (p = 0.122), RVFAC (p = 0.679), RVMPI (p = 0.93), GLSRV (p = 0.511), RVFWLS (p = 0.939), VCM (p = 0.467), and TR jet area/RAA (p = 0.667). In contrast, a significant decline was observed in the RVAP group (all p < 0.05). RVSP resulted in a similar percentage reduction in TAPSE, GLSRV, and RVFWLS (all p > 0.05). However, there were significant differences in RVFAC (p = 0.009), RVMPI (p = 0.037), TRVCM (p = 0.046), and TR jet area/RAA (p = 0.033) in the RVSP group. Moreover, compared to baseline, a 1-year follow-up showed that LBBAP significantly reduced IVMD (from 17.3 ± 26.5 ms to 8.6 ± 7.1 ms, p < 0.05) and LV-RV TPSD [from 16.41 (8.81-42.5) to 12.28 (5.64-23.7), p < 0.05], while RVSP and RVAP worsened IVMD and LV-RV TPSD (all p < 0.05). Compared with RVSP or RVAP, LBBAP can maintain RV function and improve electrical and interventricular synchrony, with limited TR deterioration after a 1-year follow-up. No. ChiCTR2100048503, https://www.chictr.org.cn/showproj.html?proj=129290.
被引量：- 发表：1970
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Early and Mid-Term Outcomes of Coronary Protection during Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis.
Coronary obstruction (CO) is a fatal complication in transcatheter aortic valve replacement (TAVR). However, data on the outcomes and details of coronary protection (CP) use in TAVR are limited. We retrospectively analyzed the patients who had undergone CP during TAVR at our tertiary cardiac center from March 2017 to January 2024. CP was achieved by an undeployed coronary balloon or stent positioned within the coronary artery, which releases the stent at CO occurrence. Patients' computed tomography (CT) evaluation reports and perioperative and follow-up outcomes were reviewed. A total of 33 out of 493 patients (6.7%) underwent CP during TAVR due to the high risk of CO based on preoperative CT analysis. The mean sinus dimensions measured 30.1 ± 3.6 mm, 29.2 ± 3.4 mm, and 30.4 ± 3.7 mm for the left, right, and non-coronary sinus, respectively. The average left main height was 11.7 mm, and the right coronary height was 14 mm. Self-expanding valves were used in 93.9% of the patients. Coronary balloons were used for CP in 30 patients, whereas undeployed coronary stents were used in three cases. A total of 36 coronary arteries were protected, including 28 left coronary arteries alone, two right coronary arteries alone, and three dual coronary arteries. Eight patients (24.2%) developed CO and underwent stent release. The in-hospital and 30-day all-cause mortality rates were 9.1% and 0%, respectively. The median follow-up time was 10 months, and only one patient died 2 months after discharge due to stroke during the follow-up. Pre-emptive coronary balloons or stents for CP allow for revascularization in the shortest possible time in the event of CO. Early and mid-term outcomes of CP during TAVR in patients with a high risk of CO show that CP is safe and feasible.
被引量：- 发表：1970
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Predictors and Prognostic Factors of Heart Failure with Improved Ejection Fraction.
Heart failure with reduced ejection fraction (HFrEF) patients who have improved ejection fraction have a better prognosis than those with persistently reduced ejection fraction. This study aimed to analyze the predictors for progression of patients with HFrEF to heart failure with improved ejection fraction (HFimpEF), as well as their characteristics and analyze predictors for prognosis. A retrospective analysis was conducted on 1251 patients with HFrEF at baseline, who also had a second echocardiogram ≥ 3 months. After left ventricular ejection fraction (LVEF) reassessment, patients were separated into the HFimpEF group (n = 408) and the persistent HFrEF group (n = 611). The primary endpoint was a composite of cardiovascular death or heart failure hospitalization. Multivariate logistic regression showed that without history of alcohol consumption (OR: 0.47, 95% CI: 0.28-0.78), non-New York Heart Association (NYHA) class III-IV (OR: 0.28, 95% CI: 0.15-0.52), without dilated cardiomyopathy (OR: 0.47, 95% CI: 0.26-0.84), concomitant hypertension (OR: 1.53, 95% CI: 1.02-2.29), β -blockers use (OR: 2.29, 95% CI: 1.54-3.43), and lower uric acid (OR: 0.999, 95% CI: 0.997-1.000) could predict LVEF improvement. Kaplan-Meier curves demonstrated that HFimpEF patients had a significantly lower incidence of adverse events than HFrEF patients (log Rank p < 0.001). Multivariate Cox regression found that older age (HR: 1.04, 95% CI: 1.02-1.06), NYHA class III-IV (HR: 2.25, 95% CI: 1.28-3.95), concomitant valvular heart disease (HR: 1.98, 95% CI: 1.01-3.85), and higher creatinine (HR: 1.003, 95% CI: 1.001-1.004) were independent risk factors for the primary endpoint in HFimpEF patients. HFrEF patients without a history of alcohol consumption, non-NYHA class III-IV, without dilated cardiomyopathy, concomitant hypertension, β -blockers use, and lower uric acid were more likely to have LVEF improvement. Although the prognosis of HFimpEF patients was better than that of HFrEF patients, older age, NYHA class III-IV, concomitant valvular heart disease, and higher creatinine were still risk factors for cardiovascular events in HFimpEF patients.
被引量：- 发表：1970
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Prognostic Value of the Advanced Lung Cancer Inflammation Index Ratio in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Cohort Study.
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) carries a high mortality risk. Inflammation and nutrition are involved in the pathogenesis and prognosis of both AMI and CS. The advanced lung cancer inflammation index ratio (ALI) combines the inflammatory and nutritional status. Our present study aimed to explore the prognostic value of ALI in patients with CS following AMI. In total, 217 consecutive patients with AMI complicated by CS were divided into two groups based on the ALI admissions cut-off: ≤ 12.69 and > 12.69. The primary endpoint of this study was 30-day all-cause mortality. The secondary endpoints were gastrointestinal hemorrhage and major adverse cardiovascular events (MACEs), including 30-day all-cause mortality, atrioventricular block, ventricular tachycardia/ventricular fibrillation, and nonfatal stroke. The association of ALI with the study endpoints was analyzed by Cox regression analysis. During the 30-day follow-up period after admission, 104 (47.9%) patients died and 150 (69.1%) suffered MACEs. The Kaplan-Meier analysis revealed significantly higher cumulative mortality and lower MACE rates in the low-ALI group compared to the high-ALI group (both log-rank p < 0.001). The 30-day mortality rate was significantly higher in patients with ALI ≤ 12.69 compared to ALI > 12.69 (72.1% vs. 22.6%; p < 0.001). Furthermore, the incidence of MACEs was higher in patients with ALI ≤ 12.69 (85.6% vs. 51.9%; p < 0.001). The receiver operating curve showed that ALI had a modest predictive value (area under the curve [AUC]: 0.789, 95% confidence interval [CI]: 0.729, 0.850). After multivariable adjustment, ALI ≤ 12.69 was an independent predictor for both 30-day all-cause mortality (hazard ratio [HR]: 3.327; 95% CI: 2.053, 5.389; p < 0.001) and 30-day MACEs (HR: 2.250; 95% CI 1.553, 3.260; p < 0.001). Furthermore, the addition of ALI to a base model containing clinical and laboratory data statistically improved the predictive value. Assessing ALI levels upon admission can provide important information for the short-term prognostic assessment of patients with AMI complicated by CS. A lower ALI may serve as an independent predictor of increased 30-day all-cause mortality and MACEs.
被引量：1 发表：1970
