Performance of the EDACS-ADP incorporating high-sensitivity troponin assay:Do components of major adverse cardiac events matter?

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,respectively.CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.

Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model:A cohort study

BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.

Risk factors for adverse cardiac events in adults with fulminant myocarditis during hospitalization

BACKGROUND Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.AIM To analyze the predictors of in-hospital major adverse cardiovascular events(MACE) in patients diagnosed with fulminant myocarditis.METHODS We included a cohort of adult patients diagnosed with fulminant myocarditis who were admitted to Beijing Anzhen Hospital from January 2007 to December2017. The primary endpoint was defined as in-hospital MACE, including death,cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics,clinical history, characteristics of electrocardiograph and ultrasonic cardiogram,laboratory examination, and treatment were recorded. Multivariable logistic regression was used to examine risk factors for in-hospital MACE, and the variables were subsequently assessed by the area under the receiver operating characteristic curve(AUC).RESULTS The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis revealed that baseline QRS duration > 120 ms was the independent risk factor for in-hospital MACE(odds ratio = 4.57, 95%CI: 1.23-16.94, P = 0.023). The AUC of QRS duration > 120 ms for predicting in-hospital MACE was 0.683(95%CI: 0.532-0.833, P = 0.03).CONCLUSION Patients with fulminant myocarditis has a poor outcome. Baseline QRS duration is the independent risk factor for poor outcome in those patients.

C-reactive protein as a predictor for cardiac events in Chinese elderly patients with coronary heart disease

Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.

Contemporary nationwide trends in major adverse cardiovascular events in young cannabis users without concomitant tobacco,alcohol,cocaine use

BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent substance use remain understudied.AIM To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events(MACCE)in this cohort.METHODSWe used the National Inpatient Sample(2016-2019)to identify hospitalized young individuals(18-44 years),excluding those with concurrent substance usage(tobacco,alcohol,and cocaine).They were divided into CUD+and CUD-.Using International Classification of Diseases-10 codes,we examined the trends in MACCE hospitalizations,including all-cause mortality(ACM),acute myocardial infarction(AMI),cardiac arrest(CA),and acuteischemic stroke(AIS).RESULTSOf 27.4 million hospitalizations among young adults without concurrent substance abuse,4.2%(1.1 million)hadco-existent CUD.In CUD+group,hospitalization rates for MACCE(1.71%vs 1.35%),AMI(0.86%vs 0.54%),CA(0.27%vs 0.24%),and AIS(0.49%vs 0.35%)were higher than in CUD-group(P<0.001).However,rate of ACMhospitalizations was lower in CUD+group(0.30%vs 0.44%).From 2016 to 2019,CUD+group experienced arelative rise of 5%in MACCE and 20%in AMI hospitalizations,compared to 22%and 36%increases in CUDgroup(P<0.05).The CUD+group had a 13%relative decrease in ACM hospitalizations,compared to a 10%relative rise in CUD-group(P<0.05).However,when adjusted for confounders,MACCE odds among CUD+cohort remain comparable between 2016 and 2019.CONCLUSIONThe CUD+group had higher rates of MACCE,but the rising trends were more apparent in the CUD-group overtime.Interestingly,the CUD+group had lower ACM rates than the CUD-group.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors:A decade-apart study of two nationwide cohorts

BACKGROUND Over the years,strides in colon cancer detection and treatment have boosted survival rates;yet,post-colon cancer survival entails cardiovascular disease(CVD)risks.Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.AIM To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.METHODS We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample,studying two colon cancer survivor groups for CVD risk factors,mortality rates,and major adverse events like pulmonary embolism,arrhythmia,cardiac arrest,and stroke,adjusting for confounders via multivariable regression analysis.RESULTS Of total colon cancer survivors hospitalized in 2007(n=177542)and 2017(n=178325),the 2017 cohort often consisted of younger(76 vs 77 years),male,African-American,and Hispanic patients admitted non-electively vs the 2007 cohort.Furthermore,the 2017 cohort had higher rates of smoking,alcohol abuse,drug abuse,coagulopathy,liver disease,weight loss,and renal failure.Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities,including hypertension,hyperlipidemia,diabetes,obesity,peripheral vascular disease,congestive heart failure,and at least one traditional CVD(P<0.001)vs the 2007 cohort.On adjusted multivariable analysis,the 2017 cohort had a significantly higher risk of pulmonary embolism(PE)(OR:1.47,95%CI:1.37-1.48),arrhythmia(OR:1.41,95%CI:1.38-1.43),atrial fibrillation/flutter(OR:1.61,95%CI:1.58-1.64),cardiac arrest including ventricular tachyarrhythmia(OR:1.63,95%CI:1.46-1.82),and stroke(OR:1.28,95%CI:1.22-1.34)with comparable all-cause mortality and fewer routine discharges(48.4%vs 55.0%)(P<0.001)vs the 2007 cohort.CONCLUSION Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events(stroke 28%,PE 47%,arrhythmia 41%,and cardiac arrest 63%).It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

The Association between Serum Resistin Levels and Major Adverse Cardiac Events

Resistin is a member of the family of cysteine-rich secretary proteins called resistin-like molecules (RELMs). It is suggested to be involved in inflammatory conditions and atherosclerosis. We have established a significant correlation between serum resistin levels and coronary artery disease (CAD) in a study was performed between 2011 and 2012 in our institute in two hundred fourteen patients (164 CAD patients and 50 controls). Then the CAD patients were followed up to investigate the relationship between increased serum resistin levels and major adverse cardiac events (MACE) between 2012 and 2016. One hundred fifty-five of 164 patients (95%) were followed up and 9 patients lost to follow up. There were 39 MACE (25%) in four years of follow-up.?There were 16 in-hospital deaths due to cardiac causes, 8 revascularization procedures, and 15 re-hospitalization due to acute coronary syndrome (ACS) or heart failure (HF). The patients with MACE had similar serum resistin level (median: 71.37 pg/ml) compared to patients without MACE (median: 80.23 pg/ml) (p > 0.05).

The Relationship between T-Wave Alternans and Adverse Cardiac Events in Patients with Congenital Long QT Syndrome:A Systematic Review and Meta-Analysis

Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases

BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

Clinical perspective on C-reactive protein in prognostication of major adverse cardiac events in the elderly with established coronary heart disease

The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……

Early serious adverse event in immediate postoperative period in children underwent cardiac surgery

Objective Despite dramatic advances in surgical technique and perioperative care,some children still suffered serious adverse event in early postoperative period which were associated with increased morbidity and mortality.There was little information regarding the impact of adverse events on the postoperative recovery,especially the serious adverse events occurring immediately after surgery.We sought to evaluate the early postoperative serious adverse events and examine the impact of them on postoperative recovery.

不同剂量替格瑞洛治疗ST段抬高型心肌梗死患者的有效性和安全性:基于倾向性评分匹配

背景双联抗血小板治疗是接受直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者治疗的基础。阿司匹林联合替格瑞洛是STEMI患者抗血小板治疗的首选方案,与氯吡格雷相比,其能够更快、更有效地抑制血小板,并改善预后。但是尚缺乏在接受PPCI治疗的STEMI患者中应用减量替格瑞洛的研究。目的基于倾向性评分匹配(PSM)的方法,对比分析不同剂量替格瑞洛治疗STEMI患者的有效性和安全性。方法连续选取2019年6月—2021年5月在河北医科大学第二医院心血管内五科行PPCI并接受替格瑞洛治疗的STEMI患者为研究对象。根据应用替格瑞洛的维持剂量将患者分为减量组(60例:替格瑞洛60 mg/次,2次/d)和标准组(180例:替格瑞洛90 mg/次,2次/d)。采用PSM法对两组患者进行1∶1匹配,匹配变量包括性别、年龄、既往病史、入院时Killip分级和介入治疗相关参数等,最终减量组和标准组各纳入54例患者。分别于出院1、3、6个月时,对两组患者进行随访,记录和比较两组患者血小板功能相关参数和临床事件的发生情况。结果PSM后两组患者基线资料、介入治疗参数和住院期间主要不良心血管事件发生率比较,差异均无统计学意义(P>0.05)。基线时,两组患者血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)比较,差异均无统计学意义(P>0.05);减量组患者血小板聚集率(PAR)低于标准组(P<0.05)。出院时,减量组患者MPV高于标准组,PDW低于标准组(P<0.05)。出院1个月时,两组患者PLT、MPV、PDW、PAR比较,差异均无统计学意义(P>0.05)。出院3个月时,减量组患者PDW高于标准组(P<0.05)。出院6个月时,减量组患者MPV高于标准组(P<0.05)。减量组患者出院前后PLT、PAR比较,标准组患者出院前后PLT、PDW比较,差异均无统计学意义(P>0.05)。减量组、标准组患者出院时MPV高于基线,减量组患者出院时PDW低于基线,标准组患者出院时PAR低于基线(P<0.05)。减量组患者出院1、3、6个月MPV低于出院时,PDW高于出院时(P<0.05);标准组患者1、3、6个月PAR低于基线,高于出院时(P<0.05)。两组患者随访期间主要不良心血管事件、严重出血事件发生率比较,差异均无统计学意义(P>0.05)。结论在接受PPCI的STEMI患者中替格瑞洛60 mg治疗是安全有效的。

Obesity paradox among elderly patients with coronary artery disease undergoing non-cardiac surgery

Background High body mass index （BMI） is a risk factor for chronic cardiac disease. However, mounting evidence supports that high BMI is associated with less risk of cardiac morbidity and mortality compared with normal BMI, also known as the obesity paradox. There- fore, we sought to determine the existence of the obesity paradox in regard to perioperative 30-day cardiac events among elderly Chinese patients with known coronary artery disease undergoing non-cardiac surgery. Methods A post-hoc analysis of a prospective, multi-institutional cohort study was performed. Patients aged 〉 60 years with a history of coronary artery disease and undergoing non-cardiac surgery were grouped according to BMI： underweight （〈 18.5 kg/m2）, normal weight （18.5-24.9 kg/m2）, overweight （25-29.9 kg/m2） and obese （≥ 30 kg/m2）. Demographic information, perioperative clinical variables and incidence of 30-day postoperative cardiac adverse event were retrieved from a research database. Results We identified 1202 eligible patients （BMI： 24.3 ± 3.8 kg/m2）. Across BMI groups, a U-shaped distribution pattern of incidence of 30-day postoperative major cardiac events was observed, with the lowest risk in the overweight group. When using the normal-weight group as a reference, no difference was found in either the obesity or overweight groups in terms of a major cardiac adverse event （MACE）. However, risk of a 30-day postoperative MACE was significantly higher in the underweight group （odds ratio [OR] 2.916, 95% confidence interval [CI]： 1.072-7.931, P = 0.036）. Conclusion Although not statistically significant, the U-shaped relation between BMI and cardiac complications indicates the obesity paradox possibly exists.

Clinical Signifi cance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma

Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.

PCI术后卧床便秘病人并发心脏不良事件列线图预测模型的构建

目的:分析经皮冠状动脉介入(PCI)术后卧床便秘病人并发心脏不良事件的危险因素,并建立预测列线图模型。方法:选取2020年11月—2021年10月我院收治的248例PCI围术期卧床便秘病人作为研究对象,根据病人住院治疗期间是否发生心脏不良事件分为心脏不良事件组和非心脏不良事件组。收集两组临床资料并进行单因素和二元Logistic回归分析,得出独立预测因素,基于此构建列线图风险模型,并对该模型进行预测效能评价。结果:病人心脏不良事件发生率为17.3%。单因素和二元Logistic回归分析结果表明,病人年龄≥68岁[OR=9.970,95%CI(2.599,38.251)]、平卧位排便[OR=3.308,95%CI(1.074,10.188)]、D-二聚体≥402.99 ng/mL[OR=29.901,95%CI(8.800,101.601)]和左心室射血分数≤47.46%[OR=23.540,95%CI(7.118,77.853)]是PCI术后卧床便秘病人并发心脏不良事件的独立危险因素(P<0.05)。基于以上影响因素建立列线图风险模型,验证结果显示模型一致性指数(C-index)为0.955,校正曲线显示该列线图模型具有良好的区分度及一致性。结论:PCI术后卧床便秘病人年龄、排便体位、D-二聚体水平及左室射血分数与心脏不良事件发生存在密切关系,基于此建立的列线图模型有助于临床护理人员早期识别高危病人。

循序渐进的运动康复护理对慢性心衰患者运动耐力、生活质量及不良心脏事件的影响

目的探究循序渐进的运动康复护理对慢性心衰患者运动耐力、生活质量及不良心脏事件的影响。方法选取2022年6月-2023年6月我院收治的106例慢性心衰患者进行研究。以随机数字表法均分为2组。对照组(53例):基础护理。观察组(53例):循序渐进的运动康复护理。比较6 MWD、生活质量、不良心脏事件、满意度。结果干预前,两组6 MWD相比差异不显著(t=0.267,P=0.790),干预3个月后,两组6 MWD均显著提升(t=11.710,P=0.000,t=8.469,P=0.000),且观察组(403.18±62.11)m高于对照组(375.51±68.43)分,差异显著(t=2.180,P=0.032)。干预前,两组生活质量评分相比差异不显著(t=1.690,P=0.094),干预3个月后,两组生活质量评分均显著提升(t=14.053,P=0.000,t=8.409,P=0.000),且观察组(47.11±3.16)分高于对照组(42.34±3.28)分,差异显著(t=7.625,P=0.000)。与对照组16.98%的心衰加重、心源性再入院、急性心肌梗死、心律失常等不良心脏事件总发生率相比,观察组(3.77%)显著降低,差异显著(χ^(2)=4.970,P=0.026)。观察组满意度(90.57%)优于对照组(75.47%),差异显著(χ^(2)=4.283,P=0.039)。结论循序渐进的运动康复护理在提升慢性心衰患者运动耐力方面有积极意义。该护理能够提高患者生活质量及满意度,降低不良心脏事件的发生率。

艾司洛尔不良反应/事件报告分析

目的分析艾司洛尔不良反应/事件发生特点,为临床安全用药提供参考。方法检索Web of Science、PubMed、Springer Link、中国知网、万方数据、维普网从建库至2023年10月31日中艾司洛尔致不良反应/事件个案报道,进行统计和分析,并基于美国食品药品监督管理局(FDA)不良事件报告系统(FAERS)数据(2004年第1季度至2023年第4季度)进行挖掘验证其一致性。结果文献检索共纳入14篇个案报道,14例患者发生艾司洛尔不良反应/事件;男性10例,女性4例;年龄15~94岁,平均年龄59.79岁;发生时间最短为立即发生,最长9 d;不良反应主要有癫痫发作、谵妄、低钠血症、心脏骤停、严重室性心律失常、多巴酚丁胺应激超声心动图假阳性冠状动脉痉挛等。美国FAERS数据库中艾司洛尔不良事件报告208例,发生不良事件559例次,累及系统--器官分类(SOC)21个;不良事件信号强度排序为:交界异位性心动过速、心搏出量降低、无脉性电活动、外渗、热射病、心室机能障碍、室颤、输液部位渗出、心源性休克、冠状动脉痉挛等,与文献收集的病例报告一致性较高。结论艾司洛尔临床应用广泛,发生的不良反应/事件多为轻微且短暂,但有严重的且说明书未记载的不良反应/事件。建议临床使用时仍需谨慎,对不良反应/事件早期判断、及时停药、尽早给予相关对症处理。

麻醉精准干预在高危心血管病患者非心脏手术围手术期的应用效果

目的探讨麻醉精准干预在高危心血管病患者非心脏手术围手术期的应用效果。方法选取2022年1月至12月四川省广元市第一人民医院收治的190例高危心血管病患者作为研究对象,按照随机数字表法分为观察组(95例)与对照组(95例),对照组采用普通经验管理,观察组采用麻醉精准干预措施,比较两组患者的血清学指标和心脏不良事件发生率。结果术后观察组肌钙蛋白(cTn)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、高敏肌钙蛋白T(hs-TnT)、脑钠肽(BNP)、氨基末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)均低于对照组,差异有统计学意义(P<0.05)。观察组心脏不良事件总发生率低于对照组,差异有统计学意义(P<0.05)。结论麻醉精准干预应用于高危心血管患者非心脏手术围手术期能进一步减轻对心脏损伤,且降低不良事件发生率,值得临床应用。

急性心肌梗死患者血清ANGPTL8、KLF2表达与冠脉病变程度及主要心脏不良事件发生的关系

目的探讨急性心肌梗死(AMI)患者血清血管生成素样蛋白8(ANGPTL8)、Kruppel样因子2(KLF2)表达与冠脉病变程度及主要心脏不良事件(MACE)发生的关系。方法选取106例AMI患者为研究对象,根据冠脉病变程度将患者分为轻度组(52例)和重度组(54例),根据MACE发生情况将患者分为MACE组(18例)和非MACE组(88例)。收集患者一般资料,酶联免疫吸附试验(ELISA)法检测血清ANGPTL8、KLF2水平,Spearman相关分析AMI患者血清ANGPTL8、KLF2水平与Gensini评分的相关性,多因素Logistic回归分析AMI患者冠脉病变程度的影响因素;绘制受试者工作特征(ROC)曲线分析血清ANGPTL8、KLF2水平预测AMI患者发生MACE的价值。结果重度组AMI患者高血压史、高血脂史患者比例,收缩压、舒张压、三酰甘油(TG)、N-末端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平,Gensini评分以及血清ANGPTL8水平高于轻度组(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平以及血清KLF2水平低于轻度组(P<0.05);且轻度组和重度组AMI患者病变支数比较,差异有统计学意义(P<0.05)。AMI患者血清ANGPTL8水平与Gensini评分呈正相关(r=0.638,P<0.05),血清KLF2水平与Gensini评分呈负相关(r=-0.612,P<0.05)。高血压史、高血脂史、cTnI、ANGPTL8是AMI患者冠脉病变进展为重度的危险因素(P<0.05),而HDL-C、KLF2是保护因素(P<0.05)。MACE组血清ANGPTL8水平高于非MACE组(P<0.05),而血清KLF2水平低于非MACE组(P<0.05)。血清ANGPTL8、KLF2水平及二者联合预测AMI患者发生MACE的曲线下面积分别为0.740(95%CI:0.646~0.820)、0.799(95%CI:0.710~0.870)、0.806(95%CI:0.717~0.876)。结论血清ANGPTL8、KLF2表达均与AMI患者冠脉病变程度密切相关,且对MACE发生具有一定预测价值。

血清LTBP-2、COMP水平与ST段抬高型心肌梗死患者病情、预后的关系

目的分析ST段抬高型心肌梗死(STEMI)患者血清潜在转化生长因子结合蛋白2(LTBP-2)和软骨寡聚基质蛋白(COMP)的表达水平,探讨其与患者的病情及预后的关系。方法以2019年1月至2020年12月郑州大学第五附属医院收治的135例STEMI患者为STEMI组,另外选取135名健康体检人员为对照组,STEMI患者根据出院1年随访中是否出现主要不良心脏事件(MACE)分为MACE组和非MACE组;ELISA法检测血清中LTBP-2和COMP的表达水平;采用Pearson法分析STEMI组患者LTBP-2与COMP表达的相关性;采用多因素logistic回归分析影响STEMI患者术后出现MACE的危险因素。结果与对照组相比,STEMI组患者的LTBP-2、COMP表达水平以及饮酒史、吸烟史的人数升高(P<0.05);Gensini积分≤38分的STEMI患者血清LTBP-2、COMP水平明显低于Gensini积分>38分的患者(P<0.05);Pearson法分析显示,STEMI患者血清中LTBP-2和COMP表达呈正相关(r=0.660,P<0.05);STEMI患者术后出现MACE的例数为30/135(22.22%),MACE组患者中发病时间>6 h,Gensini积分>38分、Killip分级Ⅲ~Ⅳ级比例、支架植入个数、血清LTBP-2与COMP表达水平明显高于非MACE组(P<0.05);多因素logistic回归分析表明,发病时间>6 h、Gensini积分>38分、Killip分级Ⅲ~Ⅳ级、支架植入个数≥3、LTBP-2≥39.36 ng/mL和COMP≥35.73 ng/mL是影响STEMI患者术后出现MACE的危险因素(P<0.05)。结论STEMI患者血清中LTBP-2、COMP的表达水平升高,二者与STEMI患者的病情严重程度及预后密切相关。