Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city i...Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.展开更多
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 pha... 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).……展开更多
Background Chronic heart failure(CHF)is the end-stage manifestation and main cause of death of cardiovascular system diseases.Ventricular arrhythmia is a common complication,which can increase myocardial oxygen consum...Background Chronic heart failure(CHF)is the end-stage manifestation and main cause of death of cardiovascular system diseases.Ventricular arrhythmia is a common complication,which can increase myocardial oxygen consumption,aggravate the disease,and even cause sudden death due to malignant arrhythmia.As a quantitative method to evaluate cardiac autonomic nervous function,heart rate variability is non-invasive and reproducible,and can quantify the risk associated with various cardiac and non-cardiac diseases.The purpose of this study was to analyze the correlation between heart rate variability and the incidence of cardiovascular adverse events in patients with heart failure.Methods 80 patients with heart failure who were treated in our hospital from May 2020 to May 2022 were selected as the study objects.After 3 months of follow-up,patients were divided into occurrence group(n=44)and nonoccurrence group(n=36)according to the occurrence of adverse cardiovascular events(angina pectoris,myocardial infarction,arrhythmia).The index of heart rate variability and the indicators of cardiac function in patients with heart failure was analyzed by one-way analysis of variance(ANOVA).The Key indicators of heart rate variability include standard deviation of normal RR interval(SDNN),mean standard deviation of consecutive 5-minute heartbeat interval(SDANN),square root of mean square of difference between adjacent heartbeat intervals(RMSSD),and percentage of RR intervals differing more than 50 ms from the preceding one(PNN50).The indicators of cardiac function include the New York Heart Association(NYHA)functional classification,left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP)and cardiac troponin I(c Tn I).Multivariate logistic regression was used to analyze the incidence of cardiovascular adverse events in patients with heart failure.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of heart rate variability in patient outcomes.The correlation between heart rate variability and the incidence of cardiovascular adverse events was analyzed by Kendall's tau-b analysis.Results There were significant differences in SDNN,SDANN,RMSSD,PNN50,cardiac function grade,LVEF and BNP level between the two groups(P<0.05).Through logistic regression analysis,SDNN,SDANN,RMSSD and PNN50 were independent predictors for the incidence of cardiovascular adverse events(P<0.05).The areas under curve for SDNN,SDANN,RMSSD,and PNN50 predicting of the incidence of cardiovascular adverse events were 0.732,0.732,0.758,and 0.819 respectively,and the sensitivity was 77.27%,81.81%,75.00%and 65.91%,respectively.The specificity was 61.11%,61.11%,80.56%,83.33%(P<0.05),respectively.Through Kendall's tau-b analysis,the index of heart rate variability was negatively correlated with the incidence of adverse cardiovascular events in patients with prognosis(P<0.05).Conclusions Heart rate variability has predictive value for the incidence of adverse cardiovascular events in patients with heart failure.The lower the heart rate variability,the higher incidence of cardiovascular adverse events.[S Chin J Cardiol 2024;25(3):135-141]展开更多
文摘Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.
文摘 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).……
文摘Background Chronic heart failure(CHF)is the end-stage manifestation and main cause of death of cardiovascular system diseases.Ventricular arrhythmia is a common complication,which can increase myocardial oxygen consumption,aggravate the disease,and even cause sudden death due to malignant arrhythmia.As a quantitative method to evaluate cardiac autonomic nervous function,heart rate variability is non-invasive and reproducible,and can quantify the risk associated with various cardiac and non-cardiac diseases.The purpose of this study was to analyze the correlation between heart rate variability and the incidence of cardiovascular adverse events in patients with heart failure.Methods 80 patients with heart failure who were treated in our hospital from May 2020 to May 2022 were selected as the study objects.After 3 months of follow-up,patients were divided into occurrence group(n=44)and nonoccurrence group(n=36)according to the occurrence of adverse cardiovascular events(angina pectoris,myocardial infarction,arrhythmia).The index of heart rate variability and the indicators of cardiac function in patients with heart failure was analyzed by one-way analysis of variance(ANOVA).The Key indicators of heart rate variability include standard deviation of normal RR interval(SDNN),mean standard deviation of consecutive 5-minute heartbeat interval(SDANN),square root of mean square of difference between adjacent heartbeat intervals(RMSSD),and percentage of RR intervals differing more than 50 ms from the preceding one(PNN50).The indicators of cardiac function include the New York Heart Association(NYHA)functional classification,left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP)and cardiac troponin I(c Tn I).Multivariate logistic regression was used to analyze the incidence of cardiovascular adverse events in patients with heart failure.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of heart rate variability in patient outcomes.The correlation between heart rate variability and the incidence of cardiovascular adverse events was analyzed by Kendall's tau-b analysis.Results There were significant differences in SDNN,SDANN,RMSSD,PNN50,cardiac function grade,LVEF and BNP level between the two groups(P<0.05).Through logistic regression analysis,SDNN,SDANN,RMSSD and PNN50 were independent predictors for the incidence of cardiovascular adverse events(P<0.05).The areas under curve for SDNN,SDANN,RMSSD,and PNN50 predicting of the incidence of cardiovascular adverse events were 0.732,0.732,0.758,and 0.819 respectively,and the sensitivity was 77.27%,81.81%,75.00%and 65.91%,respectively.The specificity was 61.11%,61.11%,80.56%,83.33%(P<0.05),respectively.Through Kendall's tau-b analysis,the index of heart rate variability was negatively correlated with the incidence of adverse cardiovascular events in patients with prognosis(P<0.05).Conclusions Heart rate variability has predictive value for the incidence of adverse cardiovascular events in patients with heart failure.The lower the heart rate variability,the higher incidence of cardiovascular adverse events.[S Chin J Cardiol 2024;25(3):135-141]
