BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships bet...BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.展开更多
Unilateral pulmonary artery agenesis(UPAA)is a rare congenital cardiovascular anomaly defined by the complete absence of one pulmonary artery,most often affecting the right side.[1]Although typically identified in chi...Unilateral pulmonary artery agenesis(UPAA)is a rare congenital cardiovascular anomaly defined by the complete absence of one pulmonary artery,most often affecting the right side.[1]Although typically identified in childhood due to symptomatic presentation,certain cases may remain undiagnosed until adulthood,particularly in asymptomatic patients or those with subtle clinical signs.展开更多
Dear Editor,Central retinal artery occlusion(CRAO)is a devastating ocular event caused by obstruction of the central retinal artery,leading to a sudden and significant loss of vision.A hallmark of CRAO on funduscopic ...Dear Editor,Central retinal artery occlusion(CRAO)is a devastating ocular event caused by obstruction of the central retinal artery,leading to a sudden and significant loss of vision.A hallmark of CRAO on funduscopic examination is a characteristic“cherry-red spot”at the fovea surrounded by a pale retina[1].The anterior segment typically appears unremarkable.展开更多
BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on pati...BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.展开更多
BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary a...BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.展开更多
The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleedin...The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.展开更多
BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can pre...BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can predict all-cause mortality and major adverse CV events(MACE)in patients with coronary artery disease(CAD)and to determine the prognostic value of adiponectin in predicting all-cause mortality and MACE in patients with stable CAD.METHODS We conducted a systematic search on PubMed,Scopus,and Google Scholar to find relevant studies published through June 2023 evaluating the long-term prognostic role of adiponectin in patients with stable CAD.Using a random effects model with 95%CI,we estimated the odds ratio(OR)while assessing heterogeneity through I^(2)statistics.To ensure robustness,we performed a sensitivity analysis using the leave-one-out approach.RESULTS After screening,we included five prospective studies involving 3225 patients who were followed up for a median duration of 3.8 years.Within the study population,prevalent risk factors included hypertension,diabetes,hyperlipidemia,and smoking.The commonly prescribed medications were angiotensin-converting enzyme inhibitors,beta blockers,and statins.The combined adjusted OR for all-cause mortality was found to be 2.51(95%CI:1.36–4.62),showing heterogeneity(I^(2)=65.51%,P=0.03).On the other hand,the combined adjusted OR for MACE was determined to be 1.04(95%CI:1.02–1.06)with no significant heterogeneity observed(I^(2)=0%,P=0.68).Through a sensitivity analysis,it was discovered that none of the studies significantly impacted the overall results of the meta-analysis,thus indicating their robustness.CONCLUSION Higher levels of adiponectin were found to be associated with an increased risk of long-term mortality and MACE in patients with CAD,which highlights its potential as a cost-effective marker for risk assessment and guiding treatment strategies.Further research on the role of adiponectin could greatly influence decision-making and resource allocation in CV care.展开更多
Transradial access (TRA) has emerged as the preferred vascular access route forcoronary angiography and percutaneous coronary interventions due to itssuperior safety profile compared to transfemoral access. However, i...Transradial access (TRA) has emerged as the preferred vascular access route forcoronary angiography and percutaneous coronary interventions due to itssuperior safety profile compared to transfemoral access. However, its widespreadadoption raises concerns regarding structural alterations in the radial artery,which may impact long-term vascular health and future procedural feasibility.TRA is associated with histopathologic changes in the arterial wall, such asintimal injury and hyperplasia, medial remodeling and adventitial inflammation,collectively contributing to radial artery remodeling. Moreover, TRA can inducechanges in radial artery lumen diameter driven by an inflammatory response dueto arterial puncture and mechanical friction during the procedure. Nonetheless, amore clinically significant consequence is radial artery occlusion, which is influencedby various procedural and patient-related factors. Strategies to minimizeremodeling include meticulous pre-procedural ultrasound assessment to ensureappropriate sheath-to-artery size matching, periprocedural pharmacologicalinterventions and implementation of patent hemostasis techniques. This reviewsynthesizes current knowledge regarding the mechanisms, clinical implications,and preventive strategies related to radial artery remodeling following TRA. Further research is needed toelucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preservingradial artery patency and its suitability for future interventions.展开更多
Central retinal artery occlusion(CRAO)is an acute ophthalmic emergency,characterized by sudden vision loss due to retinal ischemia in areas corresponding to arterial occlusion sites.Diagnosis primarily relies on fundu...Central retinal artery occlusion(CRAO)is an acute ophthalmic emergency,characterized by sudden vision loss due to retinal ischemia in areas corresponding to arterial occlusion sites.Diagnosis primarily relies on fundus fluorescein angiography(FFA)and optical coherence tomography(OCT),which show delayed retinal artery filling time hours to days after occlusion and increased hyperreflectivity of the inner retina.展开更多
Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was sched...Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).展开更多
Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to...Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.展开更多
BACKGROUND Postmenopausal women face an increased risk of cardiovascular disease(CVD)due to estrogen withdrawal,which exacerbates traditional cardiovascular risk factors such as dyslipidemia,glucose intolerance,and hy...BACKGROUND Postmenopausal women face an increased risk of cardiovascular disease(CVD)due to estrogen withdrawal,which exacerbates traditional cardiovascular risk factors such as dyslipidemia,glucose intolerance,and hypertension.Coronary Artery Calcium Score(CACS),a well-established marker of subclinical atherosclerosis,has emerged as a key predictor of adverse cardiovascular events.Despite the recognized association between menopause and heightened CVD risk,there remains a paucity of literature exploring the specific role of menopause in influencing CACS and its implications for cardiovascular morbidity and morta lity.AIM To examine the interplay between menopause,CACS,and cardiovascular health by synthesizing existing literature.METHODS A comprehensive literature search was conducted using PubMed and Google Scholar,focusing on studies that analyzed CACS in postmenopausal women,including the influence of factors such as hormone therapy,Triglyceride-Glucose index,bone mineral density,lipid metabolism,and type-1 diabetes.Data extraction and synthesis emphasized key patterns,metabolic influences,and potential mechanisms driving coronary calcification in menopause.RESULTS Findings suggest that menopause contributes to increased CACS through multiple pathways,including altered lipid metabolism,insulin resistance,and arterial stiffness.Additionally,premature menopause is associated with higher CACS and elevated CVD risk.While hormone replacement therapy(HRT)appears to have a protective effect against coronary calcification,further research is needed to clarify its long-term benefits and risks.CONCLUSION We introduce a novel framework combining CACS with metabolic and hormonal markers,and discuss estrogendriven mechanisms and HRT considerations in postmenopausal cardiovascular risk.This review underscores the need for targeted cardiovascular risk assessment in postmenopausal women,integrating CACS with other metabolic markers to improve early detection and prevention of CVD in this high-risk population.展开更多
BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery ...BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.展开更多
BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase c...BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.展开更多
BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation.However,vertebral artery injury remains a significant challenge during such procedures.We present a case of su...BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation.However,vertebral artery injury remains a significant challenge during such procedures.We present a case of successful treatment of atlantoaxial dislocation with concurrent vertebral artery injury using interlaminar screw technology,and review the relevant literature.CASE SUMMARY A 69-year-old female patient,with no history of trauma,was diagnosed with atlantoaxial dislocation based on X-ray,computed tomography(CT),and magnetic resonance imaging.Preoperative CT angiography(CTA)revealed vertebral artery developmental anomalies,and she underwent posterior cervical surgery.Postoperative follow-up showed improvement in the patient’s clinical symptoms such as unstable walking and dizziness,as well as functional scores compared to pre-surgery.Intraoperative vertebral artery injury was successfully managed,and postoperative CTA review revealed no complications related to vascular damage.CONCLUSION Thorough preoperative evaluation,such as CTA imaging,and the surgeon’s expertise in various spinal screw placement techniques are crucial for improving the success rate of atlantoaxial dislocation surgeries.展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe ...BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe perfusion on the LGA.Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications.Unrecognized,this anatomy carries significant intraoperative injury risk during hepatobiliary/upper gastrointestinal surgery.CASE SUMMARY A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer.During dissection of the hepatogastric ligament,an unexpected vascular anatomy was encountered:The LHA originated exclusively from the LGA,with no conventional branch from the hepatic artery proper.Recognizing this variant artery was essential for left liver perfusion,the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA.The gastrectomy and reconstruction were completed without complication.Postoperative recovery was smooth,with serial liver function tests remaining normal,confirming preserved hepatic arterial supply.CONCLUSION Preoperative mapping detected a critical aberrant left hepatic artery;its preser-vation prevented liver ischemia,ensured safety.展开更多
Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient ...Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis.This correspondence advances three critical innovations in MMAE safety.First,intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography,underscoring the need for adaptive imaging protocols.Second,hybrid embolization(liquid agents for proximal occlusion+particles for distal control)balances precision and safety,reducing reflux risks compared to monotherapy.Third,a 108-day follow-up establishes a benchmark for functional recovery,challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care.Collectively,these findings advocate for procedural agility,multimodal embolic strategies,and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.展开更多
Background:Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomalous coronary artery origin disorder.Objective:We sought to summarize the clinical experience and prog...Background:Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomalous coronary artery origin disorder.Objective:We sought to summarize the clinical experience and prognostic characteristics of surgical treatment of ALCAPA.Methods:We retrospectively analyzed clinical information on patients who had ALCAPA and underwent surgery at our center from February 2016 to October 2023.Results:This comparative study of 23 ALCAPA patients(9 infants<1 year;14 children>1 year)demonstrated significant age-dependent outcomes.Infant patients exhibited markedly prolonged mechanical ventilation(183±105.6 vs.48.5±62.2 min,p=0.001)and hospitalization(30.8±8.2 vs.19.5±6.2 days,p=0.001),despite comparable operative times(p>0.05).The perioperative mortality rate was 8.7%(2/23).Early postoperative mortality showed a non-significant trend in infants(22.2%vs.0%,p=0.11).Serial follow-up revealed substantial functional improvement,with abnormal left ventricular ejection fractions decreasing from 56.5%preoperatively to 14.3%at 1-month(p<0.01),and severe mitral regurgitation declining from 34.7%to 14.3%.However,persistent left ventricular enlargement(81%at follow-up)and moderate mitral regurgitation(52.4%)were frequently observed.Conclusion:Surgical correction of ALCPA effectively restores coronary perfusion and reduces severe mitral regurgitation,though residual ventricular dilation and moderate valvular dysfunction persist in the short-term postoperative period.Nevertheless,the overall prognosis remains favorable when timely intervention is performed.展开更多
Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocar...Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocardiographic data,traditional Chinese medicine(TCM)tongue manifestations,and facial features were collected from patients who underwent coro-nary computed tomography angiography(CTA)in the Cardiac Care Unit(CCU)of Shanghai Tenth People's Hospital between May 1,2023 and May 1,2024.An adaptive weighted multi-modal data fusion(AWMDF)model based on deep learning was constructed to predict the severity of coronary artery stenosis.The model was evaluated using metrics including accura-cy,precision,recall,F1 score,and the area under the receiver operating characteristic(ROC)curve(AUC).Further performance assessment was conducted through comparisons with six ensemble machine learning methods,data ablation,model component ablation,and various decision-level fusion strategies.Results A total of 158 patients were included in the study.The AWMDF model achieved ex-cellent predictive performance(AUC=0.973,accuracy=0.937,precision=0.937,recall=0.929,and F1 score=0.933).Compared with model ablation,data ablation experiments,and various traditional machine learning models,the AWMDF model demonstrated superior per-formance.Moreover,the adaptive weighting strategy outperformed alternative approaches,including simple weighting,averaging,voting,and fixed-weight schemes.Conclusion The AWMDF model demonstrates potential clinical value in the non-invasive prediction of coronary artery disease and could serve as a tool for clinical decision support.展开更多
基金supported by the National Natural Science Foundation of China(No.82173450&No.81770237).
文摘BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.
文摘Unilateral pulmonary artery agenesis(UPAA)is a rare congenital cardiovascular anomaly defined by the complete absence of one pulmonary artery,most often affecting the right side.[1]Although typically identified in childhood due to symptomatic presentation,certain cases may remain undiagnosed until adulthood,particularly in asymptomatic patients or those with subtle clinical signs.
文摘Dear Editor,Central retinal artery occlusion(CRAO)is a devastating ocular event caused by obstruction of the central retinal artery,leading to a sudden and significant loss of vision.A hallmark of CRAO on funduscopic examination is a characteristic“cherry-red spot”at the fovea surrounded by a pale retina[1].The anterior segment typically appears unremarkable.
文摘BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.
文摘BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.
文摘The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.
文摘BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can predict all-cause mortality and major adverse CV events(MACE)in patients with coronary artery disease(CAD)and to determine the prognostic value of adiponectin in predicting all-cause mortality and MACE in patients with stable CAD.METHODS We conducted a systematic search on PubMed,Scopus,and Google Scholar to find relevant studies published through June 2023 evaluating the long-term prognostic role of adiponectin in patients with stable CAD.Using a random effects model with 95%CI,we estimated the odds ratio(OR)while assessing heterogeneity through I^(2)statistics.To ensure robustness,we performed a sensitivity analysis using the leave-one-out approach.RESULTS After screening,we included five prospective studies involving 3225 patients who were followed up for a median duration of 3.8 years.Within the study population,prevalent risk factors included hypertension,diabetes,hyperlipidemia,and smoking.The commonly prescribed medications were angiotensin-converting enzyme inhibitors,beta blockers,and statins.The combined adjusted OR for all-cause mortality was found to be 2.51(95%CI:1.36–4.62),showing heterogeneity(I^(2)=65.51%,P=0.03).On the other hand,the combined adjusted OR for MACE was determined to be 1.04(95%CI:1.02–1.06)with no significant heterogeneity observed(I^(2)=0%,P=0.68).Through a sensitivity analysis,it was discovered that none of the studies significantly impacted the overall results of the meta-analysis,thus indicating their robustness.CONCLUSION Higher levels of adiponectin were found to be associated with an increased risk of long-term mortality and MACE in patients with CAD,which highlights its potential as a cost-effective marker for risk assessment and guiding treatment strategies.Further research on the role of adiponectin could greatly influence decision-making and resource allocation in CV care.
文摘Transradial access (TRA) has emerged as the preferred vascular access route forcoronary angiography and percutaneous coronary interventions due to itssuperior safety profile compared to transfemoral access. However, its widespreadadoption raises concerns regarding structural alterations in the radial artery,which may impact long-term vascular health and future procedural feasibility.TRA is associated with histopathologic changes in the arterial wall, such asintimal injury and hyperplasia, medial remodeling and adventitial inflammation,collectively contributing to radial artery remodeling. Moreover, TRA can inducechanges in radial artery lumen diameter driven by an inflammatory response dueto arterial puncture and mechanical friction during the procedure. Nonetheless, amore clinically significant consequence is radial artery occlusion, which is influencedby various procedural and patient-related factors. Strategies to minimizeremodeling include meticulous pre-procedural ultrasound assessment to ensureappropriate sheath-to-artery size matching, periprocedural pharmacologicalinterventions and implementation of patent hemostasis techniques. This reviewsynthesizes current knowledge regarding the mechanisms, clinical implications,and preventive strategies related to radial artery remodeling following TRA. Further research is needed toelucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preservingradial artery patency and its suitability for future interventions.
基金Supported by National Natural Science Foundation of China(No.82070991).
文摘Central retinal artery occlusion(CRAO)is an acute ophthalmic emergency,characterized by sudden vision loss due to retinal ischemia in areas corresponding to arterial occlusion sites.Diagnosis primarily relies on fundus fluorescein angiography(FFA)and optical coherence tomography(OCT),which show delayed retinal artery filling time hours to days after occlusion and increased hyperreflectivity of the inner retina.
文摘Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).
基金National Key Research and Development Program of China(2022YFC2503500 and 2022YFC2503504)。
文摘Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.
文摘BACKGROUND Postmenopausal women face an increased risk of cardiovascular disease(CVD)due to estrogen withdrawal,which exacerbates traditional cardiovascular risk factors such as dyslipidemia,glucose intolerance,and hypertension.Coronary Artery Calcium Score(CACS),a well-established marker of subclinical atherosclerosis,has emerged as a key predictor of adverse cardiovascular events.Despite the recognized association between menopause and heightened CVD risk,there remains a paucity of literature exploring the specific role of menopause in influencing CACS and its implications for cardiovascular morbidity and morta lity.AIM To examine the interplay between menopause,CACS,and cardiovascular health by synthesizing existing literature.METHODS A comprehensive literature search was conducted using PubMed and Google Scholar,focusing on studies that analyzed CACS in postmenopausal women,including the influence of factors such as hormone therapy,Triglyceride-Glucose index,bone mineral density,lipid metabolism,and type-1 diabetes.Data extraction and synthesis emphasized key patterns,metabolic influences,and potential mechanisms driving coronary calcification in menopause.RESULTS Findings suggest that menopause contributes to increased CACS through multiple pathways,including altered lipid metabolism,insulin resistance,and arterial stiffness.Additionally,premature menopause is associated with higher CACS and elevated CVD risk.While hormone replacement therapy(HRT)appears to have a protective effect against coronary calcification,further research is needed to clarify its long-term benefits and risks.CONCLUSION We introduce a novel framework combining CACS with metabolic and hormonal markers,and discuss estrogendriven mechanisms and HRT considerations in postmenopausal cardiovascular risk.This review underscores the need for targeted cardiovascular risk assessment in postmenopausal women,integrating CACS with other metabolic markers to improve early detection and prevention of CVD in this high-risk population.
基金supported by the National Nature Science Foundation of China(No.82370336&No.82330014)the Key Research and Development Plan of Heilongjiang Province(2022ZX06C23&JD2023SJ44)the Research Project of the First Affiliated Hospital of Harbin Medical University(No.2021M19).
文摘BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.
文摘BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.
基金Supported by Applied Basic Research Programs of Science and Technology Commission Foundation of Yunnan Province of China,No.202401AY070001-158.
文摘BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation.However,vertebral artery injury remains a significant challenge during such procedures.We present a case of successful treatment of atlantoaxial dislocation with concurrent vertebral artery injury using interlaminar screw technology,and review the relevant literature.CASE SUMMARY A 69-year-old female patient,with no history of trauma,was diagnosed with atlantoaxial dislocation based on X-ray,computed tomography(CT),and magnetic resonance imaging.Preoperative CT angiography(CTA)revealed vertebral artery developmental anomalies,and she underwent posterior cervical surgery.Postoperative follow-up showed improvement in the patient’s clinical symptoms such as unstable walking and dizziness,as well as functional scores compared to pre-surgery.Intraoperative vertebral artery injury was successfully managed,and postoperative CTA review revealed no complications related to vascular damage.CONCLUSION Thorough preoperative evaluation,such as CTA imaging,and the surgeon’s expertise in various spinal screw placement techniques are crucial for improving the success rate of atlantoaxial dislocation surgeries.
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
基金Supported by Lanzhou Science and Technology Project,No.2024-9-139.
文摘BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe perfusion on the LGA.Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications.Unrecognized,this anatomy carries significant intraoperative injury risk during hepatobiliary/upper gastrointestinal surgery.CASE SUMMARY A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer.During dissection of the hepatogastric ligament,an unexpected vascular anatomy was encountered:The LHA originated exclusively from the LGA,with no conventional branch from the hepatic artery proper.Recognizing this variant artery was essential for left liver perfusion,the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA.The gastrectomy and reconstruction were completed without complication.Postoperative recovery was smooth,with serial liver function tests remaining normal,confirming preserved hepatic arterial supply.CONCLUSION Preoperative mapping detected a critical aberrant left hepatic artery;its preser-vation prevented liver ischemia,ensured safety.
文摘Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis.This correspondence advances three critical innovations in MMAE safety.First,intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography,underscoring the need for adaptive imaging protocols.Second,hybrid embolization(liquid agents for proximal occlusion+particles for distal control)balances precision and safety,reducing reflux risks compared to monotherapy.Third,a 108-day follow-up establishes a benchmark for functional recovery,challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care.Collectively,these findings advocate for procedural agility,multimodal embolic strategies,and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.
文摘Background:Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomalous coronary artery origin disorder.Objective:We sought to summarize the clinical experience and prognostic characteristics of surgical treatment of ALCAPA.Methods:We retrospectively analyzed clinical information on patients who had ALCAPA and underwent surgery at our center from February 2016 to October 2023.Results:This comparative study of 23 ALCAPA patients(9 infants<1 year;14 children>1 year)demonstrated significant age-dependent outcomes.Infant patients exhibited markedly prolonged mechanical ventilation(183±105.6 vs.48.5±62.2 min,p=0.001)and hospitalization(30.8±8.2 vs.19.5±6.2 days,p=0.001),despite comparable operative times(p>0.05).The perioperative mortality rate was 8.7%(2/23).Early postoperative mortality showed a non-significant trend in infants(22.2%vs.0%,p=0.11).Serial follow-up revealed substantial functional improvement,with abnormal left ventricular ejection fractions decreasing from 56.5%preoperatively to 14.3%at 1-month(p<0.01),and severe mitral regurgitation declining from 34.7%to 14.3%.However,persistent left ventricular enlargement(81%at follow-up)and moderate mitral regurgitation(52.4%)were frequently observed.Conclusion:Surgical correction of ALCPA effectively restores coronary perfusion and reduces severe mitral regurgitation,though residual ventricular dilation and moderate valvular dysfunction persist in the short-term postoperative period.Nevertheless,the overall prognosis remains favorable when timely intervention is performed.
基金Construction Program of the Key Discipline of State Administration of Traditional Chinese Medicine of China(ZYYZDXK-2023069)Research Project of Shanghai Municipal Health Commission (2024QN018)Shanghai University of Traditional Chinese Medicine Science and Technology Development Program (23KFL005)。
文摘Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocardiographic data,traditional Chinese medicine(TCM)tongue manifestations,and facial features were collected from patients who underwent coro-nary computed tomography angiography(CTA)in the Cardiac Care Unit(CCU)of Shanghai Tenth People's Hospital between May 1,2023 and May 1,2024.An adaptive weighted multi-modal data fusion(AWMDF)model based on deep learning was constructed to predict the severity of coronary artery stenosis.The model was evaluated using metrics including accura-cy,precision,recall,F1 score,and the area under the receiver operating characteristic(ROC)curve(AUC).Further performance assessment was conducted through comparisons with six ensemble machine learning methods,data ablation,model component ablation,and various decision-level fusion strategies.Results A total of 158 patients were included in the study.The AWMDF model achieved ex-cellent predictive performance(AUC=0.973,accuracy=0.937,precision=0.937,recall=0.929,and F1 score=0.933).Compared with model ablation,data ablation experiments,and various traditional machine learning models,the AWMDF model demonstrated superior per-formance.Moreover,the adaptive weighting strategy outperformed alternative approaches,including simple weighting,averaging,voting,and fixed-weight schemes.Conclusion The AWMDF model demonstrates potential clinical value in the non-invasive prediction of coronary artery disease and could serve as a tool for clinical decision support.
