npj Cardiovascular Health最新文献

{"title":"Digital health innovation and artificial intelligence in cardiovascular care: a case-based review","authors":"Jelani K. Grant, Aamir Javaid, Richard T. Carrick, Margaret Koester, Ali Asghar Kassamali, Chang H. Kim, Nino Isakadze, Katherine C. Wu, Michael J. Blaha, Seamus P. Whelton, Armin Arbab-Zadeh, Carl Orringer, Roger S. Blumenthal, Seth S. Martin, Francoise A. Marvel","doi":"10.1038/s44325-024-00020-y","DOIUrl":"10.1038/s44325-024-00020-y","url":null,"abstract":"This narrative review aims to equip clinicians with an understanding of how digital health innovations and artificial intelligence can be applied to clinical care pathways for cardiovascular prevention. We describe a case that highlights augmentative AI for the incidental detection of coronary artery calcium, a mobile application to improve patient adherence/engagement, large language models to enhance longitudinal patient communication and care, and limitations and strategies for the successful adoption of these technologies.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00020-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foundation models for cardiovascular disease detection via biosignals from digital stethoscopes","authors":"George Mathew, Daniel Barbosa, John Prince, Subramaniam Venkatraman","doi":"10.1038/s44325-024-00027-5","DOIUrl":"10.1038/s44325-024-00027-5","url":null,"abstract":"Auscultation of the heart and the electrocardiogram (ECG) are two central components of the cardiac exam. Recent innovations of the stethoscope have enabled the simultaneous acquisition of a high-quality digital acoustic signal and ECG. We present foundation models trained on phonocardiogram (PCG) and ECG data collected from digital stethoscopes during routine clinical practice. We show that these foundation models that are pre-trained on large unlabeled datasets in a self-supervised manner can be fine-tuned for a variety of cardiovascular disease detection tasks. This is the first study that builds foundation models specifically for synchronously captured PCG and ECG data. Our approach is based on the recently developed masked autoencoder framework which we extend to handle multiple signals that are synchronously captured. This paradigm makes it possible to use large capacity models leading to superior performance even though the size of datasets with medical label annotations may be limited.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00027-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142415421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Culprit lesion characteristics and prognosis in STEMI with cold onset: an OCT study","authors":"Qianhui Sun, Xing Luo, Boling Yi, Chen Zhao, Minghao Liu, Ming Zeng, Haibo Jia, Bo Yu","doi":"10.1038/s44325-024-00019-5","DOIUrl":"10.1038/s44325-024-00019-5","url":null,"abstract":"Cold temperature exposure is associated with increased cardiovascular morbidity. However, limited research has explored plaque characteristics and prognosis in ST-segment elevation myocardial infarction (STEMI) patients diagnosed in cold temperatures. In the current study, 517 STEMI patients who underwent coronary optical coherence tomography examination were included and divided according to a median of the ambient temperature(11.5 °C). Our result shows that the cold temperature group exhibited higher proportions of plaque rupture, 78.1%, compared to 68.8% in the warm temperatures group. Besides, patients in the cold temperature group showed thinner minimum fibrous cap thickness (60.0 vs. 70.0 μm, p = 0.035). Furthermore, the cold temperature group showed a higher incidence rate of major adverse cardiac events (MACE), which includes cardiac death, recurrent nonfatal myocardial infarction, stroke, or hospitalization for heart failure (15.7% vs. 9.7%, p = 0.041). Moreover, cold temperature exposure at the onset independently predicted MACE (HR1.83 [95%CI 1.06–3.14], p = 0.029).","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00019-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in understanding the roles of T cells in atrial fibrillation","authors":"Jiu Pu, Yimei Du","doi":"10.1038/s44325-024-00026-6","DOIUrl":"10.1038/s44325-024-00026-6","url":null,"abstract":"Atrial fibrillation (AF) is a common arrhythmia associated with severe outcomes like heart failure and stroke. Recent studies highlight the crucial role of T in AF. Clinical studies have observed elevated levels of CD4+CD28null T cells, Th17/Treg cells, CD8+ cells, and related markers in the peripheral blood or atrial tissue of AF patients, correlating with disease severity and cardiovascular events. These T cell subsets contribute to AF through: (1) releasing inflammatory factors like TNF-α and IL-17 which affect calcium homeostasis and electrical activity in atrial myocytes and/or promote atrial fibrosis; (2) recruiting inflammatory cells such as macrophages, causing local inflammation, oxidative stress, and atrial remodeling; (3) secreting cytotoxic proteins like perforin and granzymes, inducing apoptosis in atrial myocytes and affecting their action potentials; (4) direct contact, influencing atrial myocyte electrophysiology. Understanding these T cell-mediated mechanisms may uncover new therapeutic targets for AF.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00026-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac rehabilitation and secondary prevention of CVD: time to think about cardiovascular health rather than rehabilitation","authors":"Julie Redfern, Robyn Gallagher, Andrew Maiorana, Dion Candelaria, Matthew Hollings, Sarah Gauci, Adrienne O’Neil, Georgia K. Chaseling, Ling Zhang, Emma E. Thomas, Gabriela L. M. Ghisi, Irene Gibson, Karice Hyun, Alexis Beatty, Tom Briffa, Rod S. Taylor, Ross Arena, Catriona Jennings, David Wood, Sherry L. Grace","doi":"10.1038/s44325-024-00017-7","DOIUrl":"10.1038/s44325-024-00017-7","url":null,"abstract":"During the past century, there have been major developments in the medical and surgical treatment of cardiovascular disease (CVD). These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascular risk management. The physical and emotional effects of living with CVD are ongoing with broad challenges ranging from the individual to system level. However, post-discharge care of people with coronary disease continues to follow a 50-year-old cardiac rehabilitation model which focuses on the sub-acute phase and is of a finite in duration. The aim of this paper is to consider the concept of supporting survivors to live well with CVD rather than ‘rehabilitating’ them and propose factors for consideration in reframing secondary prevention towards optimizing cardiovascular health. We discuss deeply-held potential considerations and challenges associated with the concept of supporting survivors achieve optimal cardiovascular health and live well with CVD rather than ‘rehabilitating’ them. We propose the concept of 5 x P’s for reframing traditional cardiac rehabilitation towards the concept of cardiovascular health for survivors beyond ‘rehabilitation’. These include the need for personalization, processes, patient-centered care, parlance, and partnership. Taken together, consideration of challenges at the systems and population level will ultimately improve engagement with secondary prevention as well as outcomes for all people who need it.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00017-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circadian rhythms in cardiovascular (dys)function: approaches for future therapeutics","authors":"Margaux Lecacheur, Daniëlle J. M. Ammerlaan, Pieterjan Dierickx","doi":"10.1038/s44325-024-00024-8","DOIUrl":"10.1038/s44325-024-00024-8","url":null,"abstract":"The circadian clock is an evolutionarily conserved time-keeper that regulates physiological processes across 24 h. In the cardiovascular system, several parameters, such as blood pressure, heart rate, and metabolism, exhibit time-of-day variations. These features are in part driven by the circadian clock. Chronic perturbation of diurnal rhythmicity due to shift work or irregular social schedules has been associated with an increased risk of hypertension, arrhythmias, and myocardial infarction. This review discusses the impact of circadian rhythms on human cardiovascular health and the effect of clock disruption on the occurrence of adverse cardiac events. Additionally, we discuss how the main risk factors of cardiovascular diseases, such as obesity, sleep disorders, and aging, affect circadian rhythms. Finally, we elaborate on chronotherapy as well as on targeting the clock and highlight novel approaches to translate our scientific understanding of the circadian clock into clinical practice.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00024-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy outcomes among patients with complex congenital heart disease","authors":"Jiaqi Gu, He Zhao, Jun Zhang","doi":"10.1038/s44325-024-00022-w","DOIUrl":"10.1038/s44325-024-00022-w","url":null,"abstract":"Patients with complex congenital heart disease (CCHD) may pose a serious threat to the mother-infant safety. This study intends to explore the influencing factors for adverse pregnancy outcomes in the CCHD population. Totally 108 CCHD patients who terminated pregnancy from January 2013 to January 2023 were recruited. We collected clinical data during the pregnancy from electronic medical records. Among them, 45 patients had adverse pregnancy outcomes (41.7%) and no patient died. 5 patients with no newborn. The incidence rate of adverse pregnancy outcomes was significantly higher in patients with brain natriuretic peptide (BNP) > 100 pg/mL (OR: 2.736; 95%CI: 1.001–7.481, p = 0.049) and hypoxemia (OR: 15.46; 95%CI: 1.689–141.512, p = 0.015) and without undergoing cardiac surgical correction (OR: 3.226; 95%CI: 1.121–9.259, p = 0.03). It was confirmed by propensity score matching that no cardiac surgical correction was an independent risk factor. Maternal patients without undergoing cardiac surgical correction had poorer NYHA cardiac function (p = 0.000) and were more prone to heart failure (p = 0.027), hypoxemia (p = 0.042), pulmonary arterial hypertension (p = 0.038) and postpartum hemorrhage (p = 0.016). Moreover, these patients had prolonged Surgical Intensive Care Unit (SICU) stay (p = 0.000) and significantly higher risk of premature delivery (p = 0.005), low birth weight (p = 0.018), infection and asphyxia (p = 0.043). Corrective cardiac surgery in patients with CCHD before pregnancy significantly reduces the incidence of adverse pregnancy outcomes.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00022-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular health (“Life’s Essential 8”), risk of depression and anxiety: a prospective cohort study","authors":"Shuzhen Liu, Xiangju Hu, Meijie Jiang, Ninghao Huang, Hailun Liang, Ruimao Zheng, Shuyan Wang, Jian Qin, Zhiyong Zhang, Tao Huang, Xu Gao","doi":"10.1038/s44325-024-00023-9","DOIUrl":"10.1038/s44325-024-00023-9","url":null,"abstract":"There is a growing interest in the linkage of cardiovascular health (CVH) with depression/anxiety but the evidence of “Life’s Essential 8” CVH score is scarce. We evaluated the associations of CVH score with risk of incident depression/anxiety among ~0.4 million participants. During follow-up, 17,554 incident events with symptoms of either disorder were recorded. Per 100-point decrease in CVH score was associated with an increased risk of incident either disorder (Hazard ratio [HR] = 1.133, 95% confidence interval [CI]:1.114–1.153), depression (HR = 1.205, 95% CI:1.180–1.231), and anxiety (HR = 1.042, 95% CI:1.017–1.069). Per 100-point decrease in health assessments or health behaviors was associated with an increased risk of incident either disorder (HRhealth assessments = 1.085, 95% CI: 1.058–1.113, HRhealth behaviors = 1.217, 95% CI: 1.186–1.250). Poor CVH is a risk factor for the incident late-life depression/anxiety symptoms of middle-aged and older adults, and healthy behaviors could be targeted for the risk assessment and intervention of depression/anxiety.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00023-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure management to prevent recurrent stroke: current evidence and perspectives","authors":"Gisele Sampaio Silva, João Brainer Clares de Andrade, Eduardo Bello Martins, Karla Santo, M. Julia Machline-Carrion","doi":"10.1038/s44325-024-00021-x","DOIUrl":"10.1038/s44325-024-00021-x","url":null,"abstract":"Hypertension is the leading risk factor for stroke, causing about 60% of cases. Effective blood pressure control is vital for preventing recurrent ischemic strokes, with studies showing mixed results. Intensive control reduces cardiovascular events, as seen in the SPRINT, PROGRESS and STEP studies, while trials like RESPECT show no difference. Technological advances like AI and wearables enhance management, but challenges remain in achieving equitable control, especially for minorities.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00021-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global implementation and evaluation of atrial fibrillation screening in the past two decades – a narrative review","authors":"Kam Cheong Wong, Tu N. Nguyen, Clara K. Chow","doi":"10.1038/s44325-024-00014-w","DOIUrl":"10.1038/s44325-024-00014-w","url":null,"abstract":"Advances in screening technology have been made in tandem with the aging population and increasing atrial fibrillation (AF) prevalence. While several randomized controlled trials demonstrate the efficacy of AF screening, less evidence has been synthesized addressing the implementation and evaluation of AF screening programs. We systematically searched the PubMed database from 1st January 2000 to 18th January 2024. The search terms included “atrial fibrillation” and “screening” and their synonyms. Articles that described screening implementation, including screening methods, were included. Editorial, commentary, engineering, and basic science articles were excluded. 1767 abstracts were screened, of which 138 full articles were reviewed, and 87 studies were included: 90% from high-income, 8% from upper-middle-income and 2% from lower-middle-income countries/ regions. The screening initiatives included general practice (n = 31), remote self-screening (n = 30), pharmacy (n = 11), community centers and villages (n = 10), hospital (n = 4), and nursing home (n = 1). Most studies used handheld ECG devices (n = 72, 83%), some used wearable devices (n = 13, 15%), and two (2%) used implantable cardiac devices. Comparator groups were described in 17% (15/87) studies: all 6 remote self-screening trials showed superior AF detection rates compared to usual care (these studies applied intermittent screening using handheld ECG devices over 2 weeks to 12 months or wearing ECG patches for continuous monitoring over 2–4 weeks), but 9 trials using systematic and opportunistic screening in primary care settings showed mixed results. Among 72 studies without comparator groups, 18 reported new AF detection rates below 1%, 48 reported 1–10%, 5 reported above 10%, and one reported an AF incidence rate of 2.25% patient-years (95% CI 2.03–2.48). Only 22% (19/87) of studies reported on the implementation evaluation (12 by surveys and 7 by interviews), surveying participant acceptability, usability, and satisfaction, and some studies in general practice and pharmacy interviewing participants and qualitatively evaluating the enablers and barriers to implementation. These studies reported barriers of lack of resources and referral pathways and enablers of having a designated staff member to lead implementation at point-of-care settings. AF screening implementation studies were mainly conducted in high-income countries/ regions. Detection rates were highest in older and higher risk groups, and if longer continuous ECG monitoring was used. Few studies reported details of the implementation of AF screening programs concerning cost, scalability, or comparative effectiveness of remote technology-driven screening approaches versus lower-tech approaches such as pulse palpation. Despite AF screening recommendations existing for some time, we seem to lack the data to effectively scale these initiatives.","PeriodicalId":501706,"journal":{"name":"npj Cardiovascular Health","volume":" ","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s44325-024-00014-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}