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
目的探究基于《国际功能、残疾和健康分类(儿童和青少年版)》(international classification of functioning,disability and health for children and youth,ICF-CY)的MACE康复体系对儿童脑性瘫痪(以下简称脑瘫)功能改善的有效性,为脑...目的探究基于《国际功能、残疾和健康分类(儿童和青少年版)》(international classification of functioning,disability and health for children and youth,ICF-CY)的MACE康复体系对儿童脑性瘫痪(以下简称脑瘫)功能改善的有效性,为脑瘫儿童康复提供更具针对性的综合方案。方法选取2022年10月至2023年12月温州医科大学附属第二医院收治的66例脑瘫儿童为研究对象,随机将其分为实验组和对照组,每组33例。实验组患儿接受基于ICF-CY的MACE康复体系综合康复干预,对照组患儿接受传统康复治疗;评估并比较两组患儿干预后的改良Ashworth量表评分、膝关节活动度、儿童功能独立性评定量表(functional independence measure for children,WeeFIM)评分、粗大运动功能评估量表(gross motor function measure,GMFM)和精细运动功能评估量表(fine motor function measure,FMFM)评分。结果干预后,两组患儿的改良Ashworth量表评分均显著低于本组干预前,膝关节活动度显著优于本组干预前,WeeFIM评分、GMFM评分和FMFM评分均显著高于本组干预前(P<0.05);实验组患儿的改良Ashworth量表评分显著低于对照组,膝关节活动度显著优于对照组,WeeFIM评分、GMFM和FMFM评分均显著高于对照组(P<0.05)。结论基于ICF-CY的MACE康复体系可有效改善脑瘫儿童的肌张力和关节活动度,增强功能独立性和运动功能。展开更多
Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. I...Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. In recent years, the incidence of acute myocarditis has gradually increased, especially in young people and athletes, which can cause serious cardiac complications and even lead to heart failure, cardiac arrest or major adverse cardiovascular events(MACEs). Methods A total of 90 patients with acute myocarditis(acute myocarditis group) and 30 healthy subjects(control group) admitted to our hospital from November 2021 to November 2023 were selected. Cardiac magnetic resonance(CMR) T1 and T2 mapping sequence scanning and cardiac function parameter measurement was performed on all subjects. The acute myocarditis group was followed up for 12 months and divided into the MACEs group and the non-MACEs group according to whether MACEs occurred. The differences in CMR parameters were analyzed, and receiver operating characteristic(ROC) curve was applied to analyze the predictive value of cardiac CMR T1 and T2 techniques for the occurrence of MACEs in patients with acute myocarditis. Results Compared with the control group, the level of left ventricular ejection fraction(LVEF) in the acute myocarditis group was significantly decreased, while left ventricular end-diastole volume(LVEDV), left ventricular endsystolic volume(LVESV), lactate dehydrogenase(LDH) and creatine kinase MB isoenzyme(CK-MB) increased significantly(P<0.05);T1 and T2 values, late gadolinium enhancement(LGE) percentage of left ventricle, left ventricular entropy and extracellular volume(ECV) in acute myocarditis group were significantly higher than those in the control group(P<0.05). Pearson correlation analysis showed that T1 and T2 values were negatively correlated with LVEF, while T1 and T2 values were positively correlated with LVESV, CK-MB, left ventricular entropy and ECV in patients with acute myocarditis(P<0.05). Among patients with acute myocarditis, the values of T1 and T2, left ventricular entropy and ECV in MACEs group were higher than those in non-MACEs group(P<0.05). Further multivariate analysis also showed that T1 and T2 values had independent predictive capacity for MACEs in patients with acute myocarditis(P<0.05). The maximum area under ROC curve was 0.894 and 0.912, and the sensitivity was 89.35% and 90.40% in patients with acute myocarditis predicted by T1 and T2 mapping. The specificity was 80.34% and 84.25%. Conclusions CMR T1 and T2 mapping techniques can effectively evaluate the cardiac function status of patients with acute myocarditis, and provide an important reference for the prognosis assessment of acute myocarditis.展开更多
目的:分析急性心肌梗死(AMI)患者药物涂层球囊(DCB)治疗术后1年发生MACE事件的危险因素。方法:连续性纳入2021年1月~2023年12月于青岛市海慈医院心内科行DCB治疗的AMI患者192例。根据患者DCB治疗后1年MACE事件发生情况,将其分为非MACE组...目的:分析急性心肌梗死(AMI)患者药物涂层球囊(DCB)治疗术后1年发生MACE事件的危险因素。方法:连续性纳入2021年1月~2023年12月于青岛市海慈医院心内科行DCB治疗的AMI患者192例。根据患者DCB治疗后1年MACE事件发生情况,将其分为非MACE组(156例)和MACE组(36例)。收集患者一般资料、术中术后资料、治疗情况、1年随访情况等资料,采用Cox回归分析分析AMI患者DCB治疗后发生MACE事件的影响因素,绘制受试者工作特征(ROC)曲线,评估影响因素的预测效能。结果:多因素Cox回归分析显示,STEMI (HR = 2.187, 95%CI = 1.016~4.708, P Objective: To analyze the risk factors for Major Adverse Cardiovascular Event (MACE) in patients with Acute Myocardial Infarction (AMI) who underwent Drug-Coated Balloon (DCB) treatment within 1 year. Methods: 192 patients with AMI who underwent DCB treatment in the Cardiology Department of Qingdao Haici Hospital from January 2021 to December 2023 were continuously enrolled. According to 1-year MACE event incidence after DCB treatment, they were divided into the non-MACE group (156 cases) and the MACE group (36 cases). The patients’ general information, intraoperative and postoperative information, treatment situation, and 1-year follow-up information were collected, and Cox regression analysis was used to analyze the influencing factors of MACE events in patients with AMI after DCB treatment, and the Receiver Operating Characteristic (ROC) curve was drawn to evaluate the predictive ability of the influencing factors. Results: The multivariate Cox regression analysis showed that STEMI (HR = 2.187, 95% CI=1.016~4.708, P < 0.05) and target vessel as LCX (HR = 0.021, 95% CI = 0.006~0.070, P < 0.05) and RCA (HR = 0.028, 95% CI = 0.010~0.083, P < 0.05) were independent predictors of MACE events in patients with AMI after DCB treatment within 1 year. The ROC curve analysis showed that the predictive ability of combined STEMI and target vessel as RCA and LCX in predicting MACE events within 1 year after DCB treatment was high (AUC = 0.827,95%CI = 0.720~0.934, P < 0.05). Conclusion: Compared with non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction has a certain predictive value for the occurrence of MACE events in patients with AMI treated with DCB within 1 year;compared with target vessel for LAD, target vessels for RCA and LCX have a certain predictive value for the occurrence of MACE events in patients with AMI treated with DCB within 1 year and the combined prediction of MACE events has a higher predictive ability.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.
文摘目的探究基于《国际功能、残疾和健康分类(儿童和青少年版)》(international classification of functioning,disability and health for children and youth,ICF-CY)的MACE康复体系对儿童脑性瘫痪(以下简称脑瘫)功能改善的有效性,为脑瘫儿童康复提供更具针对性的综合方案。方法选取2022年10月至2023年12月温州医科大学附属第二医院收治的66例脑瘫儿童为研究对象,随机将其分为实验组和对照组,每组33例。实验组患儿接受基于ICF-CY的MACE康复体系综合康复干预,对照组患儿接受传统康复治疗;评估并比较两组患儿干预后的改良Ashworth量表评分、膝关节活动度、儿童功能独立性评定量表(functional independence measure for children,WeeFIM)评分、粗大运动功能评估量表(gross motor function measure,GMFM)和精细运动功能评估量表(fine motor function measure,FMFM)评分。结果干预后,两组患儿的改良Ashworth量表评分均显著低于本组干预前,膝关节活动度显著优于本组干预前,WeeFIM评分、GMFM评分和FMFM评分均显著高于本组干预前(P<0.05);实验组患儿的改良Ashworth量表评分显著低于对照组,膝关节活动度显著优于对照组,WeeFIM评分、GMFM和FMFM评分均显著高于对照组(P<0.05)。结论基于ICF-CY的MACE康复体系可有效改善脑瘫儿童的肌张力和关节活动度,增强功能独立性和运动功能。
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. In recent years, the incidence of acute myocarditis has gradually increased, especially in young people and athletes, which can cause serious cardiac complications and even lead to heart failure, cardiac arrest or major adverse cardiovascular events(MACEs). Methods A total of 90 patients with acute myocarditis(acute myocarditis group) and 30 healthy subjects(control group) admitted to our hospital from November 2021 to November 2023 were selected. Cardiac magnetic resonance(CMR) T1 and T2 mapping sequence scanning and cardiac function parameter measurement was performed on all subjects. The acute myocarditis group was followed up for 12 months and divided into the MACEs group and the non-MACEs group according to whether MACEs occurred. The differences in CMR parameters were analyzed, and receiver operating characteristic(ROC) curve was applied to analyze the predictive value of cardiac CMR T1 and T2 techniques for the occurrence of MACEs in patients with acute myocarditis. Results Compared with the control group, the level of left ventricular ejection fraction(LVEF) in the acute myocarditis group was significantly decreased, while left ventricular end-diastole volume(LVEDV), left ventricular endsystolic volume(LVESV), lactate dehydrogenase(LDH) and creatine kinase MB isoenzyme(CK-MB) increased significantly(P<0.05);T1 and T2 values, late gadolinium enhancement(LGE) percentage of left ventricle, left ventricular entropy and extracellular volume(ECV) in acute myocarditis group were significantly higher than those in the control group(P<0.05). Pearson correlation analysis showed that T1 and T2 values were negatively correlated with LVEF, while T1 and T2 values were positively correlated with LVESV, CK-MB, left ventricular entropy and ECV in patients with acute myocarditis(P<0.05). Among patients with acute myocarditis, the values of T1 and T2, left ventricular entropy and ECV in MACEs group were higher than those in non-MACEs group(P<0.05). Further multivariate analysis also showed that T1 and T2 values had independent predictive capacity for MACEs in patients with acute myocarditis(P<0.05). The maximum area under ROC curve was 0.894 and 0.912, and the sensitivity was 89.35% and 90.40% in patients with acute myocarditis predicted by T1 and T2 mapping. The specificity was 80.34% and 84.25%. Conclusions CMR T1 and T2 mapping techniques can effectively evaluate the cardiac function status of patients with acute myocarditis, and provide an important reference for the prognosis assessment of acute myocarditis.
文摘目的:分析急性心肌梗死(AMI)患者药物涂层球囊(DCB)治疗术后1年发生MACE事件的危险因素。方法:连续性纳入2021年1月~2023年12月于青岛市海慈医院心内科行DCB治疗的AMI患者192例。根据患者DCB治疗后1年MACE事件发生情况,将其分为非MACE组(156例)和MACE组(36例)。收集患者一般资料、术中术后资料、治疗情况、1年随访情况等资料,采用Cox回归分析分析AMI患者DCB治疗后发生MACE事件的影响因素,绘制受试者工作特征(ROC)曲线,评估影响因素的预测效能。结果:多因素Cox回归分析显示,STEMI (HR = 2.187, 95%CI = 1.016~4.708, P Objective: To analyze the risk factors for Major Adverse Cardiovascular Event (MACE) in patients with Acute Myocardial Infarction (AMI) who underwent Drug-Coated Balloon (DCB) treatment within 1 year. Methods: 192 patients with AMI who underwent DCB treatment in the Cardiology Department of Qingdao Haici Hospital from January 2021 to December 2023 were continuously enrolled. According to 1-year MACE event incidence after DCB treatment, they were divided into the non-MACE group (156 cases) and the MACE group (36 cases). The patients’ general information, intraoperative and postoperative information, treatment situation, and 1-year follow-up information were collected, and Cox regression analysis was used to analyze the influencing factors of MACE events in patients with AMI after DCB treatment, and the Receiver Operating Characteristic (ROC) curve was drawn to evaluate the predictive ability of the influencing factors. Results: The multivariate Cox regression analysis showed that STEMI (HR = 2.187, 95% CI=1.016~4.708, P < 0.05) and target vessel as LCX (HR = 0.021, 95% CI = 0.006~0.070, P < 0.05) and RCA (HR = 0.028, 95% CI = 0.010~0.083, P < 0.05) were independent predictors of MACE events in patients with AMI after DCB treatment within 1 year. The ROC curve analysis showed that the predictive ability of combined STEMI and target vessel as RCA and LCX in predicting MACE events within 1 year after DCB treatment was high (AUC = 0.827,95%CI = 0.720~0.934, P < 0.05). Conclusion: Compared with non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction has a certain predictive value for the occurrence of MACE events in patients with AMI treated with DCB within 1 year;compared with target vessel for LAD, target vessels for RCA and LCX have a certain predictive value for the occurrence of MACE events in patients with AMI treated with DCB within 1 year and the combined prediction of MACE events has a higher predictive ability.
