Predictive Value of Lung Ultrasound Combined With ACEF Score for the Prognosis of Acute Myocardial Infarction

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Okasha Tahir, Ali Bin Nasir, Sonam Lohana, Taha Naveed, Muhammad Abdullah
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引用次数: 0

Abstract

We read the recent study by Lun et al. [1] on the “Predictive value of lung ultrasound (LUS) combined with the ACEF score for the prognosis of acute myocardial infarction (AMI)” with great interest. The authors provide a novel approach to risk stratification, yet several methodological and clinical concerns warrant discussion.

The study's exclusion of patients older than 80, those with significant pulmonary disease, and those without LUS within 48 h of admission substantially limits its external validity. Elder patients and those with chronic lung conditions constitute a substantial proportion of AMI cases, and their exclusion raises concerns about the findings' real-world applicability [2, 3]. The single-center design with a relatively small sample size (n = 204) further restricts generalizability. By addressing this limitation, future research could improve the external validity of LUS as a prognostic tool for a broader patient population.

While the study suggests that combining LUS with the ACEF score improves predictive performance, it does not adequately account for key confounders. For instance, diuretic use was significantly associated with adverse outcomes (OR 4.79, p < 0.01), yet its impact on B-line counts and overall prognostication was not thoroughly explored. Without rigorous adjustment, the study may overestimate the independent predictive value of LUS [3]. A more rigorous multivariate analysis or propensity score matching would strengthen the study's conclusions and ensure that LUS retains its predictive value independent of other clinical interventions.

The median follow-up period of 12 months is insufficient to capture long-term cardiovascular outcomes, particularly for AMI patients at risk of late heart failure events. Additionally, the reliance on telephone follow-ups introduces potential reporting bias, as clinical outcomes were not objectively verified through imaging or biomarker assessments [4]. Extending the follow-up period and incorporating objective clinical data would enhance the reliability of LUS and ACEF score-based prognostication.

Despite these limitations, the study introduces an important concept by integrating LUS into AMI risk stratification. Future studies with more extensive, multicenter cohorts, improved statistical adjustments, and extended follow-up are necessary to confirm the robustness of this approach. We commend the authors for their valuable contribution to the evolving landscape.

The authors declare no conflicts of interest.

肺部超声结合 ACEF 评分对急性心肌梗死预后的预测价值
我们饶有兴趣地阅读了Lun等人[1]近期关于“肺超声(LUS)联合ACEF评分对急性心肌梗死(AMI)预后的预测价值”的研究。作者提供了一种新的风险分层方法,但一些方法学和临床问题值得讨论。该研究排除了80岁以上的患者、有明显肺部疾病的患者以及入院48小时内没有LUS的患者,这大大限制了其外部有效性。老年患者和慢性肺部疾病患者占AMI病例的很大比例,他们的排除引起了对研究结果在现实世界中的适用性的担忧[2,3]。单中心设计和相对较小的样本量(n = 204)进一步限制了通用性。通过解决这一局限性,未来的研究可以提高LUS作为更广泛患者群体预后工具的外部有效性。虽然该研究表明,将LUS与ACEF评分相结合可以提高预测性能,但它并没有充分考虑关键的混杂因素。例如,利尿剂的使用与不良结局显著相关(OR 4.79, p < 0.01),但其对b线计数和总体预后的影响尚未得到充分探讨。如果没有严格的调整,研究可能会高估LUS[3]的独立预测值。更严格的多变量分析或倾向评分匹配将加强研究结论,并确保LUS保持其独立于其他临床干预的预测价值。中位随访期为12个月,不足以捕获长期心血管预后,特别是对于有晚期心力衰竭事件风险的AMI患者。此外,对电话随访的依赖引入了潜在的报告偏倚,因为临床结果没有通过成像或生物标志物评估客观验证[10]。延长随访时间和纳入客观临床数据将提高LUS和ACEF评分预测的可靠性。尽管存在这些局限性,该研究通过将LUS整合到AMI风险分层中引入了一个重要的概念。未来有必要进行更广泛的多中心队列研究,改进统计调整,并延长随访时间,以确认该方法的稳健性。我们赞扬作者对不断变化的景观所作的宝贵贡献。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Cardiology
Clinical Cardiology 医学-心血管系统
CiteScore
5.10
自引率
3.70%
发文量
189
审稿时长
4-8 weeks
期刊介绍: Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.
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