The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order o...The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.展开更多
目的通过Meta分析,综合分析运动后心率恢复(HRR)与心源性猝死(SCD)之间的关系。方法基于PubMed、Embase和Web of Science数据库,进行截至2024年1月2日的文献检索。队列研究关注于HRR和SCD间的风险关系,通过风险比(HR)及95%可信区间(CI)...目的通过Meta分析,综合分析运动后心率恢复(HRR)与心源性猝死(SCD)之间的关系。方法基于PubMed、Embase和Web of Science数据库,进行截至2024年1月2日的文献检索。队列研究关注于HRR和SCD间的风险关系,通过风险比(HR)及95%可信区间(CI)进行评估。统计学分析采用Stata 12.0软件。结果纳入6项研究。固定效应模型(I^(2)=41.8%,P=0.112)的汇总结果显示:与心率恢复慢相比,心率恢复快人群发生SCD风险更低(HR=0.74,95%CI:0.64~0.86,P<0.001)。大多数亚组分析中都观察到了持续结果。排除一项研究并不影响总体结果[HR(95%CI):0.66(0.55,0.79)~0.76(0.65,0.88)]。Egger检验未发现明显的发表偏倚(P=0.059)。结论心率恢复较慢会增加普通人群发生SCD的风险。因此,HRR可能是临床实践中预防SCD的一个潜在靶点。展开更多
目的总结73例脑死亡器官捐献供体评估和供心选择的临床经验。方法回顾73对脑死亡器官捐献心脏移植供受者临床资料,评估供体,选择供心,分析心脏移植受者生存情况和边缘供心使用情况。结果发现潜在供体,在判定脑死亡状态后,明确供体家属...目的总结73例脑死亡器官捐献供体评估和供心选择的临床经验。方法回顾73对脑死亡器官捐献心脏移植供受者临床资料,评估供体,选择供心,分析心脏移植受者生存情况和边缘供心使用情况。结果发现潜在供体,在判定脑死亡状态后,明确供体家属同意器官捐献后,评估供体,选择供心,使供受体最大限度匹配。73例心脏移植受者手术成功率为94.5%(69/73),围手术期死亡4例,术后随访1年死亡4例。边缘供心使用情况:供体年龄≥45岁17例,供受体体质量不匹配2例,供体中毒1例,供心冷缺血时间≥4 h 43例,大部分心脏移植受者予主动脉内球囊反搏和(或)体外膜肺氧合辅助,最终顺利出院。结论供受体最大限度匹配可使心脏移植患者获益最大;同时,适当放宽供心选择标准,增加供心数量,将为众多等待心脏移植患者带来希望。展开更多
目的:探讨床旁超声心动图评估不同脑死亡原因的潜在成人心脏移植供体的价值。方法:选取2018年2月至2020年12月在中国医学科学院阜外医院评估的670例潜在成人心脏移植供体的床旁超声心动图及临床资料。根据不同脑死亡原因将供体分为脑卒...目的:探讨床旁超声心动图评估不同脑死亡原因的潜在成人心脏移植供体的价值。方法:选取2018年2月至2020年12月在中国医学科学院阜外医院评估的670例潜在成人心脏移植供体的床旁超声心动图及临床资料。根据不同脑死亡原因将供体分为脑卒中组(包括出血性脑卒中和缺血性脑卒中,n=398)和非脑卒中组(包括脑外伤、脑肿瘤、缺血缺氧性脑病,n=272),比较两组供体超声心动图及临床特点。由中国人体器官分配系统分至我院且符合供体入选标准的供体350例,脑卒中组195例,非脑卒中组155例,我院外科行获取手术,比较两组心脏有效获取率。结果:(1)670例潜在成人心脏移植供体中,与非脑卒中组比,脑卒中组供体的年龄更大、体重指数更高、左心室舒张末期内径更大、室间隔厚度更厚、有高血压史比例更高、不符合超声心动图入选标准比例更高,差异均有统计学意义(P均<0.001)。670例潜在成人心脏移植供体中,共检出不符合超声心动图入选标准供体117例(17.5%),主要原因为左心室壁增厚有59例(50.4%)、左心室射血分数<50%有27例(23.1%)、室壁运动异常有21例(17.9%)、左心扩大有14例(12.0%)。(2)由中国人体器官分配系统分至我院且符合供体入选标准的350例供体中,心脏成功获取并移植246例(70.3%),其中脑卒中供体110例(44.7%),非脑卒中供体136例(55.3%)。与非脑卒中组比,脑卒中组的心脏获取成功率低[87.7%(136/155) vs. 56.4%(110/195),P<0.001]。外科手术未能成功获取104例(29.7%),获取不成功的主要原因为供心的冠状动脉任何一支主干发生堵塞,为91例(87.5%)。结论:应用床旁超声心动图筛查潜在移植供体的心脏,具有重要价值。脑死亡原因为脑卒中的潜在供体与非脑卒中供体的心脏结构有差异。即使初步供体评估合格,脑卒中供体的心脏获取成功率仍比非脑卒中供体低。展开更多
目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020...目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020年6月,青岛市胶州中心医院收治的老年HF患者。根据患者30d的存活情况,分为死亡组和存活组。采用单因素分析和多因素Logistic回归构建NIRS和死亡预测模型。采用ROC分析、校准曲线和决策曲线评估老年HF患者死亡预测列线图模型的预测能力、校准能力和临床净获益。结果:本研究共纳入797例老年HF患者,164例(20.6%)老年HF患者在30d内死亡。NIRS由预后营养指数(prognosis nutrition index,PNI)、HGB-白蛋白-淋巴细胞-血小板(hemoglobin,albumin,lymphocyte,platelet,HALP)评分、单核细胞-高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)和CRP-白蛋白比值(C-reaction protein to albumin ratio,CAR)组成。多因素Logstic回归结果表明,NIRS(OR=11.867,95%CI:7.681~18.333,P<0.001)、高血压(OR=1.935,95%CI:1.18~3.175,P<0.001)和慢性阻塞性肺疾病(OR=4.306,95%CI:2.611~7.1,P<0.001)是老年HF患者30d死亡的危险因素。此外,老年HF患者30d死亡列线图模型ACU为0.855;校准曲线显示该模型预测概率与实际概率基本吻合;决策曲线显示该模型净获益良好。结论:INRS是老年HF患者30d死亡的独立预测因素。此外,老年HF患者30d死亡列线图模型可个体化预测老年HF患者30d内的死亡风险,帮助临床医生早期识别死亡高风险个体。展开更多
背景随着人口老龄化的加剧,心力衰竭(heart failure,HF)患病率呈上升趋势,老年心力衰竭的预警、风险分层研究对改善预后具有重要意义。目的探讨血尿素氮-白蛋白比值(blood urea nitrogen to albumin ratio,BAR)对老年心力衰竭患者1年内...背景随着人口老龄化的加剧,心力衰竭(heart failure,HF)患病率呈上升趋势,老年心力衰竭的预警、风险分层研究对改善预后具有重要意义。目的探讨血尿素氮-白蛋白比值(blood urea nitrogen to albumin ratio,BAR)对老年心力衰竭患者1年内死亡的预测价值;建立包含BAR在内的列线图,并验证其临床价值。方法建模数据来自解放军总医院2016年1月—2021年10月诊断为心力衰竭的1259例老年患者,验证队列来自2021年10月—2022年10月诊断为心力衰竭的314例老年患者。以1年病死率为结局指标,采用Logistic回归分析筛选预后因素,根据预后因素构建列线图;ROC曲线、校准曲线和临床决策曲线分析(decision curve analysis,DCA)用于评估模型的区分度、一致性和临床效益;通过计算ROC曲线下面积和DCA,比较列线图与N端脑钠肽前体(N-terminal pro-B-type natriureticpeptide,NT-proBNP)及BIOSTATCHF预测模型的性能。结果训练队列和验证队列中分别有27.2%(343/1259)和25.2%(79/314)患者在1年内死亡。多因素Logistic回归结果显示,年龄、D-二聚体、NT-proBNP、BAR、血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)/血管紧张素受体阻滞剂(angiotensin receptor blockers,ARB)使用与死亡结局独立关联(P<0.05)。基于以上5个因素构建列线图,列线图展现出良好的区分度(AUC=0.838,P<0.001)、一致性(Hosmer-Lemeshowχ2=4.251,P=0.834)和临床效益。列线图模型与NT-proBNP和欧洲BIOSTAT-CHF预测模型相比预测效能均更佳(0.838 vs 0.703和0.825,P<0.05)。DCA结果提示,列线图相比NT-proBNP、BIOSTAT-CHF预测模型均增加了更多的净获益。结论BAR是老年心力衰竭患者1年内死亡的独立预测因子。包含BAR在内的列线图展现出优异的辨别力和校准能力,为预后评估提供有力支持。展开更多
文摘The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.
文摘目的通过Meta分析,综合分析运动后心率恢复(HRR)与心源性猝死(SCD)之间的关系。方法基于PubMed、Embase和Web of Science数据库,进行截至2024年1月2日的文献检索。队列研究关注于HRR和SCD间的风险关系,通过风险比(HR)及95%可信区间(CI)进行评估。统计学分析采用Stata 12.0软件。结果纳入6项研究。固定效应模型(I^(2)=41.8%,P=0.112)的汇总结果显示:与心率恢复慢相比,心率恢复快人群发生SCD风险更低(HR=0.74,95%CI:0.64~0.86,P<0.001)。大多数亚组分析中都观察到了持续结果。排除一项研究并不影响总体结果[HR(95%CI):0.66(0.55,0.79)~0.76(0.65,0.88)]。Egger检验未发现明显的发表偏倚(P=0.059)。结论心率恢复较慢会增加普通人群发生SCD的风险。因此,HRR可能是临床实践中预防SCD的一个潜在靶点。
文摘目的总结73例脑死亡器官捐献供体评估和供心选择的临床经验。方法回顾73对脑死亡器官捐献心脏移植供受者临床资料,评估供体,选择供心,分析心脏移植受者生存情况和边缘供心使用情况。结果发现潜在供体,在判定脑死亡状态后,明确供体家属同意器官捐献后,评估供体,选择供心,使供受体最大限度匹配。73例心脏移植受者手术成功率为94.5%(69/73),围手术期死亡4例,术后随访1年死亡4例。边缘供心使用情况:供体年龄≥45岁17例,供受体体质量不匹配2例,供体中毒1例,供心冷缺血时间≥4 h 43例,大部分心脏移植受者予主动脉内球囊反搏和(或)体外膜肺氧合辅助,最终顺利出院。结论供受体最大限度匹配可使心脏移植患者获益最大;同时,适当放宽供心选择标准,增加供心数量,将为众多等待心脏移植患者带来希望。
文摘目的:探讨床旁超声心动图评估不同脑死亡原因的潜在成人心脏移植供体的价值。方法:选取2018年2月至2020年12月在中国医学科学院阜外医院评估的670例潜在成人心脏移植供体的床旁超声心动图及临床资料。根据不同脑死亡原因将供体分为脑卒中组(包括出血性脑卒中和缺血性脑卒中,n=398)和非脑卒中组(包括脑外伤、脑肿瘤、缺血缺氧性脑病,n=272),比较两组供体超声心动图及临床特点。由中国人体器官分配系统分至我院且符合供体入选标准的供体350例,脑卒中组195例,非脑卒中组155例,我院外科行获取手术,比较两组心脏有效获取率。结果:(1)670例潜在成人心脏移植供体中,与非脑卒中组比,脑卒中组供体的年龄更大、体重指数更高、左心室舒张末期内径更大、室间隔厚度更厚、有高血压史比例更高、不符合超声心动图入选标准比例更高,差异均有统计学意义(P均<0.001)。670例潜在成人心脏移植供体中,共检出不符合超声心动图入选标准供体117例(17.5%),主要原因为左心室壁增厚有59例(50.4%)、左心室射血分数<50%有27例(23.1%)、室壁运动异常有21例(17.9%)、左心扩大有14例(12.0%)。(2)由中国人体器官分配系统分至我院且符合供体入选标准的350例供体中,心脏成功获取并移植246例(70.3%),其中脑卒中供体110例(44.7%),非脑卒中供体136例(55.3%)。与非脑卒中组比,脑卒中组的心脏获取成功率低[87.7%(136/155) vs. 56.4%(110/195),P<0.001]。外科手术未能成功获取104例(29.7%),获取不成功的主要原因为供心的冠状动脉任何一支主干发生堵塞,为91例(87.5%)。结论:应用床旁超声心动图筛查潜在移植供体的心脏,具有重要价值。脑死亡原因为脑卒中的潜在供体与非脑卒中供体的心脏结构有差异。即使初步供体评估合格,脑卒中供体的心脏获取成功率仍比非脑卒中供体低。
文摘目的:心力衰竭(heart failure,HF)是住院患者死亡的重要原因。本研究旨在探究营养炎症风险评分(nutrition-inflammation risk score,NIRS)及其列线图模型对老年心力衰竭患者30d死亡率的预测价值。方法:本研究回顾性分析2018年1月至2020年6月,青岛市胶州中心医院收治的老年HF患者。根据患者30d的存活情况,分为死亡组和存活组。采用单因素分析和多因素Logistic回归构建NIRS和死亡预测模型。采用ROC分析、校准曲线和决策曲线评估老年HF患者死亡预测列线图模型的预测能力、校准能力和临床净获益。结果:本研究共纳入797例老年HF患者,164例(20.6%)老年HF患者在30d内死亡。NIRS由预后营养指数(prognosis nutrition index,PNI)、HGB-白蛋白-淋巴细胞-血小板(hemoglobin,albumin,lymphocyte,platelet,HALP)评分、单核细胞-高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)和CRP-白蛋白比值(C-reaction protein to albumin ratio,CAR)组成。多因素Logstic回归结果表明,NIRS(OR=11.867,95%CI:7.681~18.333,P<0.001)、高血压(OR=1.935,95%CI:1.18~3.175,P<0.001)和慢性阻塞性肺疾病(OR=4.306,95%CI:2.611~7.1,P<0.001)是老年HF患者30d死亡的危险因素。此外,老年HF患者30d死亡列线图模型ACU为0.855;校准曲线显示该模型预测概率与实际概率基本吻合;决策曲线显示该模型净获益良好。结论:INRS是老年HF患者30d死亡的独立预测因素。此外,老年HF患者30d死亡列线图模型可个体化预测老年HF患者30d内的死亡风险,帮助临床医生早期识别死亡高风险个体。
