Heart & Lung最新文献

{"title":"The cardiovascular effects of long-acting bronchodilators inhalers and inhaled corticosteroids purchases among asthma and COPD patients","authors":"Niv Lev-Ari ,&nbsp;Bernice Oberman ,&nbsp;Shiri Kushnir ,&nbsp;Noga Yosef ,&nbsp;Dekel Shlomi","doi":"10.1016/j.hrtlng.2024.12.010","DOIUrl":"10.1016/j.hrtlng.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Confounding reports of cardiovascular disease (CVD) with the use of Inhaled corticosteroids (ICS), long-acting beta-agonists, and muscarinic antagonists (LABA and LAMA) have been reported.</div></div><div><h3>Objective</h3><div>To explore the relationship between the purchase of ICS, LABA and LAMA inhalers and the incidence of CVDs.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with COPD and/or asthma, aged ≥ 18 years, who purchased LABA, LAMA, and ICS inhalers alone or in combination between 2017 and 2019. We calculated the odds ratios (ORs) for CVD for patients who purchased at least one inhaler during the 12 months before the diagnosis and those without any purchase from the same inhaler group. We also analyzed the risk among asthma patients and COPD patients.</div></div><div><h3>Results</h3><div>Of the 94,834-study population, 74,974 had asthma, 46,907 had COPD, and 27,047 had an asthma-COPD overlap. Average age was 57.9<u>±</u>19.7, and 44% were males. The most prominent effects of ICS were reduced risks for myocarditis (OR 0.35, 95%CI 0.14, 0.9), ischemic heart disease (IHD) (OR 0.45, 95%CI 0.41, 0.49), valvular disease (OR 0.47, 95%CI 0.39, 0.55) and hypertension (HTN) (OR 0.47, 95%CI 0.42, 0.52). LABA inhalers had a significantly lower risk for conduction disorders and arrhythmias (OR 0.71, 95%CI 0.55, 0.92), HTN (OR 0.76, 95%CI 0.63, 0.92), and cerebrovascular diseases (OR 0.83, 95%CI 0.74, 0.94). In comparison, patients with COPD had a significantly lower risk for heart failure (OR 0.62, 95%CI 0.48, 0.8). LAMA inhalers conferred a substantially lower risk of HTN (OR 0.66, 95%CI 0.57, 0.76), peripheral vascular diseases (OR 0.75, 95%CI 0.61, 0.92), IHD (OR 0.8, 95%CI 0.72, 0.89), and cerebrovascular disease (OR 0.85, 95%CI 0.78, 0.92).</div></div><div><h3>Conclusion</h3><div>ICS inhalers were associated with a significant reduction in the incidence of CVD, with lesser but significant effects observed among those using LABA and LAMA inhalers.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 250-257"},"PeriodicalIF":2.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of resource allocation among canadian cardiac surgery programs during the COVID-19 pandemic","authors":"Ryaan EL-Andari MD ,&nbsp;Jayan Nagendran MD, PhD","doi":"10.1016/j.hrtlng.2024.12.011","DOIUrl":"10.1016/j.hrtlng.2024.12.011","url":null,"abstract":"<div><h3>Background</h3><div>The coronavirus disease 2019(COVID-19) pandemic significantly impacted the lives of patients and healthcare professionals globally. With rapid spread and severe illness, a great deal of healthcare resources including personal, funding, and hospital beds were dedicated to fight the pandemic.</div></div><div><h3>Objectives</h3><div>This survey looks to characterize how resources were allocated among Canadian cardiac surgery programs, and how this impacted patient care and outcomes.</div></div><div><h3>Methods</h3><div>Canadian cardiac surgeons were identified and asked via email to complete a 24-question survey regarding the impact of resource limitations during the COVID-19 pandemic on their practice, the treatment of their patients, and their outcomes.</div></div><div><h3>Results</h3><div>Twenty-six Canadian cardiac surgeons responded to the survey. The majority of respondents experienced &gt;25 % reductions in elective case volumes(69.1 %) and noted adverse outcomes due surgery delay(92 %). Respondents felt that resource reallocation was required to provide optimal care to COVID-19 patients but also felt that the restrictions negatively impacted the outcomes of their non-COVID-19 patients(88.5 %).</div></div><div><h3>Conclusions</h3><div>Canadian cardiac surgery programs experienced reduced case volumes, inadequate resources to care for patients, and adverse patient outcomes as a result of limited resources. While the reallocation of personal and hospital space towards the pandemic response was certainly required and pandemic-related restrictions have largely passed, the backlog of surgical cases persists and several lessons can be learned that may help to navigate future times of limited resources. During times of limited resources, an emphasis on allocating resources by policymakers aimed at an overall reduction in morbidity may help to minimize persistent impacts of these events.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 244-249"},"PeriodicalIF":2.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of the Spanish Multidimensional Fatigue Inventory in people with heart diseases","authors":"Raúl Fabero-Garrido PT, MSc ,&nbsp;Paz Sanz-Ayan MD, PhD ,&nbsp;Tamara del Corral PT, PhD ,&nbsp;Gustavo Plaza-Manzano PT, PhD ,&nbsp;Juan Izquierdo-García PT, MSc ,&nbsp;Juan José Parra-Fuertes MD ,&nbsp;Rocío Tello-De-Meneses-Becerra MD ,&nbsp;Miriam Crespo González-Calero MD, MSc ,&nbsp;Ibai López-de-Uralde-Villanueva PT, PhD","doi":"10.1016/j.hrtlng.2024.12.009","DOIUrl":"10.1016/j.hrtlng.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Fatigue is one of the most limiting symptoms in individuals with heart disease (HD). However, valid and reliable instruments for assessing fatigue in clinical practice still need to be improved.</div></div><div><h3>Objective</h3><div>To assess the dimensional structure of the self-reported Spanish Multidimensional Fatigue Inventory (MFI) and analyze its psychometric properties in individuals with HD.</div></div><div><h3>Methods</h3><div>A longitudinal observational study included 247 participants (age 57.71 years; 23.9 % women; 89.9 % Caucasian). Test-retest reliability was assessed 10–14 days after the first evaluation. Measures evaluating fatigue, health-related quality of life (HRQoL), and functional capacity were collected to assess convergent validity. Acceptability, practicality, construct validity, floor/ceiling effects, internal consistency, and measurement error were also calculated.</div></div><div><h3>Results</h3><div>Confirmatory factor analysis supported the 4-factor structure of the MFI and the deletion of 3 items for its application in individuals with HD. The 17-item version showed no floor-ceiling effects and exhibited excellent internal consistency (Cronbach's α = 0.90) and test-retest reliability (Intraclass Correlation Coefficient (ICC) = 0.94). While all subscales demonstrated adequate internal consistency (Cronbach's α &gt; 0.70) and good to excellent test-retest reliability (ICC, 0.75 - 0.91), the reduced motivation subscale showed slightly lower internal consistency. The minimal detectable change was 9.5 points for the total score. Convergent validity was established through moderate-strong correlations with fatigue, HRQoL, and functional capacity measures (<em>r</em> = |0.320–0.729|).</div></div><div><h3>Conclusions</h3><div>The shortened version of the Spanish MFI (MFI-17) is a valid and reliable tool for quantifying fatigue in individuals with HD, supporting its clinical and research applicability.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 236-243"},"PeriodicalIF":2.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarker profiles that differentiate type-1 and type 2 myocardial infarction","authors":"Marco Mele ,&nbsp;Francesco Mautone ,&nbsp;Ilaria Ragnatela ,&nbsp;Damiano D'Alessandro ,&nbsp;Luciano Umberto Rossi ,&nbsp;Michele Granatiero ,&nbsp;Gianpaolo Palmieri ,&nbsp;Laura Giannetti ,&nbsp;Davide Diomede ,&nbsp;Antonietta Mele ,&nbsp;Antonella Liantonio ,&nbsp;Paola Imbrici ,&nbsp;Michele Correale ,&nbsp;Francesco Santoro ,&nbsp;Maria Delia Corbo ,&nbsp;Enrica Vitale ,&nbsp;Michele Magnesa ,&nbsp;Natale Daniele Brunetti","doi":"10.1016/j.hrtlng.2024.12.008","DOIUrl":"10.1016/j.hrtlng.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>It is crucial to distinguish type-1 myocardial infarction (T1MI) from type-2 myocardial infarction (T2MI) at admission and during hospitalization to avoid unnecessary invasive exams and inappropriate admissions to the acute cardiac care unit.</div></div><div><h3>Objectives</h3><div>The purpose of the study was to define a simple profile derived from commonly used biomarkers to differentiate T1MI from T2MI.</div></div><div><h3>Methods</h3><div>We prospectively enrolled in an observational study 213 iconsecutive patients with a provisional diagnosis of non-ST-elevation acute myocardial infarction (NSTEMI) admitted to the Cardiology Department. A final diagnosis of T1MI, T2MI, and non-ischemic acute myocardial injury (NAMI) was given based on clinical and instrumental findings. We assessed high-sensitivity Troponin I (hs-cTnI), Creatine Kinase MB (CK-MB), C-reactive protein (CRP), procalcitonin (PCT), N-Terminal prohormone of brain natriuretic peptide (NTproBNP).</div></div><div><h3>Results</h3><div>A final diagnosis of T1MI was assigned to 77 patients, T2MI to 60 patients, and NAMI to 76 patients; mean age was not significantly different between groups (73 vs. 71 years), female were more prevalent in the T2MI/NAMI group (53 % vs. 34 %, <em>p</em> &lt; 0.01). Hs-cTnI peak/upper limit of normal (ULN) (559 ± 770 vs. 286 ± 429; p = 0.04), hs-cTnI peak/CRP ratio (114 ± 337 vs. 83 ± 430; <em>p</em> &lt; 0.001), hs-cTnI peak/PCT ratio (12,592 ± 21,467 vs. 4,609 ± 17,284; <em>p</em> &lt; 0.001), and hs-cTnI peak/NTproBNP ratio (0.7 ± 1.6 vs. 0.3 ± 0.6; <em>p</em> &lt; 0.01) differentiated T1MI from T2MI Hs-cTnI peak/ULN (559 ± 770 vs. 271 ± 412; <em>p</em> &lt; 0.01), hs-cTnI peak/PCT ratio (12,592 ± 21,468 vs. 3,570 ± 12,469; <em>p</em> &lt; 0.001), hs-cTnI peak/NTproBNP ratio (0.7 ± 1.6 vs. 0.3 ± 1.3; <em>p</em> &lt; 0.001) and hs-cTnI peak/CRP (114 ± 337 vs. 48 ± 288; <em>p</em> &lt; 0.001) differentiated T1MI from T2MI + NAMI. Hs-cTnI peak/PCT ratio was a predictor of T1MI, a multivariable logistic regression analysis (OR 1.03, 95 % CI 1.01–1.06, <em>p</em> &lt; 0.05) with an accuracy of 0.704 (95 % CI 0.626–0.782, <em>p</em> &lt; 0.001). No significant differences between T2MI and NAMI were detected.</div></div><div><h3>Conclusions</h3><div>Admission biomarker profile may differentiate T1MI from T2MI in patients admitted for NSTEMI.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 230-235"},"PeriodicalIF":2.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between posttraumatic stress symptoms and hope following intensive care unit discharge: Findings from a longitudinal cohort study","authors":"Klara Friberg MSc, RN, CCN ,&nbsp;Kristin Hofsø PhD, RN, CCN ,&nbsp;Tone Rustøen PhD, RN ,&nbsp;Johan Ræder PhD, MD ,&nbsp;Milada Hagen PhD ,&nbsp;Kathleen Puntillo PhD, RN, FCCM ,&nbsp;Brita Fosser Olsen PhD, RN, CCN","doi":"10.1016/j.hrtlng.2024.12.003","DOIUrl":"10.1016/j.hrtlng.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Hope is essential for mental health in general and for recovery following severe illness. However, the association<del>s</del> between posttraumatic stress symptoms (PTSS) and hope among intensive care unit (ICU) survivors has not been investigated.</div></div><div><h3>Objectives</h3><div>To assess hope at 3, 6 and 12 months after ICU admission and examine possible associations between hope and selected demographic data, clinical characteristics, and 3-month PTSS-levels among ICU patients.</div></div><div><h3>Methods</h3><div>ICU-patients from Norway self-reported on hope using Herth Hope Index. Data on demographics and clinical characteristics were collected from patient reports and medical records. PTSS were analysed 3 months after admission, using descriptive statistics and linear mixed model regression analyses.</div></div><div><h3>Results</h3><div>A total of 73 adult ICU survivors were included (male <em>n</em> = 45 (61.6%); median age 66 years [IQR: 51.0;74.0]). Median hope scores were 41, 40, and 42 at 3, 6 and 12 months, respectively. A clinically minor but statistically significant reduction in hope was registered at 6 months (<em>B</em> = -1.24; 95% confidence interval [CI]: -2.25, -0.23; <em>p</em> = 0.016). Lower levels of PTSS 3 months after admission (<em>B</em> = -0.13; 95% CI [-0.23, -0.03]; <em>p</em> = 0.015) and being employed before admission (<em>B</em> = 5.87; 95% CI [1.85, 9.88]; <em>p</em> = 0.004) were significantly associated with higher hope during the first year after admission. A small but statistically significant association was also found between higher hope and a more extended hospital stay (<em>B</em> = 0.08; 95% CI [0.00, 0.15]; <em>p</em> = 0.042).</div></div><div><h3>Conclusions</h3><div>Hope scores remained stable during the first year after ICU admission. Lower levels of PTSS at 3 months after admission, being employed prior to admission, and having longer hospital stay were associated with higher hope during the first year after admission. Given the small sample, more research in larger samples is needed to enhance the clinical relevance of these findings.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 223-229"},"PeriodicalIF":2.4,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methamphetamine-associated heart failure: Clinical characteristics and outcomes in a safety net population","authors":"Anjali B. Thakkar MD MBA,&nbsp;Matthew S. Durstenfeld MD MAS,&nbsp;Yifei Ma MS,&nbsp;Sithu Win MD,&nbsp;Priscilla Y. Hsue MD","doi":"10.1016/j.hrtlng.2024.11.012","DOIUrl":"10.1016/j.hrtlng.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Methamphetamine use is increasing and is associated with development of heart failure (HF). However, clinical characteristics and outcomes have not been well-described.</div></div><div><h3>Objective</h3><div>To compare outcomes among individuals with HF with and without methamphetamine use in a safety-net setting.</div></div><div><h3>Methods</h3><div>This retrospective matched cohort study included individuals with HF with history of methamphetamine use and age, gender-, and year-matched controls without history of methamphetamine use in a municipal health system from 2001 to 2019. One thousand seven hundred seventy-one individuals with methamphetamine use and HF and 3,542 age, sex, and year-of-HF-diagnosis matched controls with HF without methamphetamine use were included. The primary outcome was all-cause mortality. Secondary outcomes included time to HF hospitalization, 30-day, 90-day, and one-year HF, and all-cause readmissions.</div></div><div><h3>Results</h3><div>The median age of the cohort was 52.1 years and 22.6 % were female. Black/African American was the most common racial identity (methamphetamine: 49.1 %; no methamphetamine: 33 %). There was no significant difference in mortality between groups (40% vs 36.6 %,HR 1.00,95 % CI 0.91,1.10,<em>p</em> = 1.00). A subset had an index HF hospitalization (<em>n</em> = 1,404, 26.4 %) during the study period, including 637 (35.9 %) with history of methamphetamine use and 767 (21.7 %) without history of methamphetamine use (relative risk 1.66,95 % CI 1.52–1.81,<em>p</em> &lt; 0.0001). Among those who were ever hospitalized for HF, individuals with methamphetamine use had increased risk of HF and all-cause readmission at 30 days (RR 1.92,95 % CI 1.36–2.70,<em>p</em> &lt; 0.001), 90 days (RR 1.69,95 % CI 1.35–2.12,<em>p</em> &lt; 0.001), and one year (RR 1.61,95 % CI 1.36–1.91,<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Despite having higher all-cause and HF readmission risk, individuals with methamphetamine-associated HF did not have higher mortality risk.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 214-222"},"PeriodicalIF":2.4,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Latent profile analysis of dyspnea-related kinesiophobia in older adults with chronic obstructive pulmonary disease” [Heart & lung: The Journal of Critical Care 69 (2024) 241247/PMID: 39522284]","authors":"Li-Chen Peng ,&nbsp;Min Xu ,&nbsp;Ying Wang ,&nbsp;Run-Ling Guo ,&nbsp;Liang Wang ,&nbsp;Xin-Xin Wang ,&nbsp;Li-Ling Xu","doi":"10.1016/j.hrtlng.2024.11.016","DOIUrl":"10.1016/j.hrtlng.2024.11.016","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Page 213"},"PeriodicalIF":2.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PTX 3 (pentraxin3) is associated with lung function among people with stable-stage smoking-related chronic obstructive pulmonary disease","authors":"Xincheng Liu ,&nbsp;Rui Li ,&nbsp;Maoxu Xia ,&nbsp;Yuanyuan Gao ,&nbsp;Jiuqi Wang ,&nbsp;Li Pan ,&nbsp;Zhengjin Xie ,&nbsp;Mingming Shen ,&nbsp;Guangcui Feng","doi":"10.1016/j.hrtlng.2024.11.010","DOIUrl":"10.1016/j.hrtlng.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory illness. Pentraxin-3 (PTX3) is abnormally elevated in the plasma of patients with acute exacerbation of COPD. However, the role and significance of PTX3 in the clinical diagnosis of COPD remain unclear.</div></div><div><h3>Objectives</h3><div>This study was to explore the functional role of plasma PTX3 in COPD and its relationship with lung function metrics and influence on the severity of the disease.</div></div><div><h3>Methods</h3><div>We prospectively recruited 170 patients with stable-stage COPD admitted to our hospital between June 2020 and May 2023 and healthy study participants as study participants. Based on their smoking history, all participants were classified into those with a history of smoking and those without a smoking history.</div></div><div><h3>Results</h3><div>Stable-stage smoking-related COPD patients exhibited lower values for FEV1(% predicted) and reduced FEV1/FVC ratios, with increased values for smoking index, red cell distribution width, fibrinogen, d-dimer, white blood cell counts, neutrophil to lymphocyte ratio (NLR), Medical Research Council (mMRC) scores, COPD assessment test (CAT) score, and plasma PTX3 level. There was a positive correlation of PTX3 levels with mMRC and CAT scores and a negative correlation with FEV1 % predicted and FEV1/FVC. Increased smoking index and plasma PTX3 and NLR were independent risk factors for exacerbation in stable smoking-related COPD patients. The area under the curve (AUC) for plasma PTX3 in predicting severe COPD was 0.831.</div></div><div><h3>Conclusions</h3><div>A plasma PTX3 level &gt; 246.2 ng/mL could be a valuable indicator for predicting exacerbations in patients with stable-stage smoking-associated COPD exacerbation.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 197-203"},"PeriodicalIF":2.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of a prediction model for extubation failure risk in ICU patients using bedside ultrasound technology","authors":"Jun Liu MSc ,&nbsp;Qianhui Yao MSc ,&nbsp;Pengfei Du MSc ,&nbsp;Dong Han MSc ,&nbsp;Donghui Jiang MD, PhD ,&nbsp;Hongyan Qiao MD ,&nbsp;Ming Huang MD, PhD","doi":"10.1016/j.hrtlng.2024.12.007","DOIUrl":"10.1016/j.hrtlng.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical ventilation (MV) is crucial for managing critically ill patients; however, extubation failure, associated with adverse outcomes, continues to pose a significant challenge.</div></div><div><h3>Objective</h3><div>The purpose of this prospective observational study was to develop and validate a predictive numerical model utilizing bedside ultrasound to forecast extubation outcomes in ICU patients.</div></div><div><h3>Methods</h3><div>We enrolled 300 patients undergoing MV, from whom clinical variables, biomarkers, and ultrasound parameters were collected. Patients were randomly assigned to two groups at a 6:4 ratio: the derivation cohort (<em>n</em> = 180) and the validation cohort (<em>n</em> = 120). A nomogram prediction model was developed using significant predictors identified through multivariate analysis and its performance was assessed and validated by evaluating its discrimination, calibration, and clinical utility.</div></div><div><h3>Results</h3><div>A total of 300 patients (mean age 72 years; 57.3 % male) were included, with an extubation failure rate of 26.7 %. The model, including diaphragm thickening fraction (OR: 0.890, <em>P</em> = 0.009), modified lung ultrasound score (OR: 1.371, <em>P</em> &lt; 0.001), peak relaxation velocity (OR: 1.515, <em>P</em> = 0.015), and APACHE II (OR: 1.181, <em>P</em> = 0.006), demonstrated substantial discriminative capability, as indicated by an area under the receiver operating characteristic curve (AUC) of 0.886 (95 % CI: 0.830–0.942) for the derivation cohort and 0.846 (95 % CI: 0.827–0.945) for the validation cohort. Hosmer-Lemeshow tests yielded <em>P</em>-values of 0.224 and 0.212 for the derivation and validation cohorts.</div></div><div><h3>Conclusions</h3><div>We have established a risk prediction model for extubation failure in mechanically ventilated ICU patients. This risk model base on bedside ultrasound parameters provides valuable insights for identifying high-risk patients and preventing extubation failure.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 204-212"},"PeriodicalIF":2.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visceral fat as the main tomographic risk factor for COVID-19 mortality","authors":"Luis Ricardo Hinojosa-Gutiérrez ,&nbsp;Adriana Lizbeth González-Sánchez ,&nbsp;Jair Antonio Rios-Muñoz ,&nbsp;Rodolfo Aguilar-Guerrero ,&nbsp;Hilda Elizabeth Macías-Cervantes","doi":"10.1016/j.hrtlng.2024.12.005","DOIUrl":"10.1016/j.hrtlng.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a risk factor for COVID-19 mortality; a BMI &gt;35 increases the risk of death up to 12-fold; two previous studies have examined the association between visceral fat quantified by tomography and the risk of severe COVID-19, but not its association with mortality.</div></div><div><h3>Objective</h3><div>Examine whether tomographic findings differentiated data from patients who died of COVID-19 pneumonia from those who survived in a cohort of patients at a tertiary hospital.</div></div><div><h3>Methods</h3><div>This was a case-control study (1:1) in which we recruited data from patients at a tertiary care hospital in Mexico. Cases (<em>N</em> = 213) were data from patients with COVID-19 pneumonia discharged due to death, and controls (<em>N</em> = 216) were data from patients discharged due to improvement. All had chest computed tomography (CT) scans in the Picture Archiving and Communication System (PACS) platform. Multivariate analysis was used to identify tomographic variables associated with mortality, and odds ratios were calculated. As tomographic variables, we refer to the total severity score, the total percentage of pulmonary involvement, the pattern of involvement, the location of the lesions, and subcutaneous and visceral fat.</div></div><div><h3>Results</h3><div>A total of 429 sets of data from Mexican patients were analyzed<strong>,</strong> with an overall age of 57 years (18–93). Sixty-three percent were male, and arterial hypertension was the most common comorbidity in 48.3 %. An odds ratio (OR) of 8.79 (95 % CI 1.44–53.73) was found for visceral fat and mortality; the rest of the tomographic variables did not show a statistically significant association.</div></div><div><h3>Conclusion</h3><div>Visceral fat was the most significant tomographic risk factor for mortality in patients with COVID-19 pneumonia.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 191-196"},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}