Peter Gloviczki,1 Yun Han,2 Vladica Velickovic,3,4 Grace Gahlon,2 Cornelia Santoso,3 Shelby L Corman,2 David G Armstrong,5 Jan Kottner,6 Kenneth J Rothman7 1Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA; 2Precision AQ, Bethesda, MD, USA; 3Evidence Generation Department, HARTMANN GROUP, Heidenheim, Germany; 4Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall in Tirol, Austria; 5Keck School of Medicine of University of Southern California, Los Angeles, CA, USA; 6Institute for Clinical Nursing Science, Charité-Universitätsmedizin, Berlin, Germany; 7Department of Epidemiology, Boston University School of Public Health, Boston, MA, USACorrespondence: Vladica Velickovic, Email vladica.velickovic@hartmann.infoObjective: To evaluate the relationship between wound exudate severity and time to healing among venous leg ulcers (VLUs).Design: A retrospective cohort study was conducted using Net Health WoundExpert electronic health record data from United States outpatient wound care centers 2002– 2020. The status of VLUs was followed from the initial wound clinic visit until healing or censoring.Methods: Exudate severity (none, mild, moderate, or heavy) was modeled as a time-varying exposure, and the outcome was time to complete healing. Weighted Royston–Parmar flexible parametric survival models were used to fit marginal structural models. Stabilized inverse probability of treatment and censoring weights were applied to address time varying confounding and informative censoring. The weight models included demographic characteristics, clinical factors, and wound specific variables. Effect measures included average hazard ratios, healing probabilities, and restricted mean survival time (RMST).Results: The cohort included 8,184 patients (mean age 67.8 years; 48.1% male) contributing 18,435 VLUs. Increasing exudate severity was associated with progressively lower rates of healing, with adjusted hazard ratio for mild (HR 0.24; 95% CI 0.20– 0.29), moderate (HR 0.20; 95% CI 0.16– 0.25), and heavy exudate (HR 0.15; 95% CI 0.10– 0.22), compared with ulcers without exudate. Interval-specific average hazard ratios showed similar patterns. At 12 weeks, higher exudate levels were associated with substantially lower healing probabilities (46.1%, 29.4%, and 18.4% for mild, moderate, and heavy exudate vs 92.7% with no exudate) and longer time unhealed (62.8, 70.4, and 75.3 days vs 31.4 days).Conclusion: Higher wound exudate severity was associated with markedly delayed healing among VLUs in routine outpatient care. Because “no exudate” is not a typical clinical state for an active VLU, these estimates are best interpreted as relative prognostic contrasts along the exudate gradient rather than as expected trajectories for a hypothetical exudate-free VLU. Routine exudate assessment may provide useful prognostic information regarding healing trajectories among patients with VLUs.Plain Language Summary: This study shows that clinically assessed wound exudate severity is associated with healing as a time-dependent prognostic factor of VLU in routine outpatient care. In a large longitudinal electronic health record cohort, higher exudate burden was associated with lower hazards of healing, reduced cumulative healing probabilities, and longer time to healing. Using marginal structural models and flexible parametric survival analysis, this study provides population-level estimates of relative and absolute healing outcomes. These findings extend existing evidence by quantifying the magnitude and persistence of delayed healing associated with exudate severity, supporting its relevance for prognostic assessment and monitoring in VLU management.Keywords: varicose ulcer, wound exudates, wound healing, electronic health records, survival analysis
Cang Trung Huynh,1,2 Trung Minh Tran,1,2 Kien Trung Nguyen,3 Ha Hong Nguyen31Department of Cardiology, Kien Giang General Hospital, Rach Gia, An Giang Province, Vietnam; 2Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam; 3Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, VietnamCorrespondence: Ha Hong Nguyen, Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, 179 Nguyen Van Cu Street, Tan An Ward, Can Tho, Vietnam, Email nhha82@ctump.edu.vnBackground: Reduced renal function is linked to coronary calcification, which can limit stent expansion, and to contrast-associated acute kidney injury (CI-AKI). We examined renal function, optical coherence tomography (OCT)-defined calcification and OCT measures of stent optimization in a Vietnamese provincial hospital.Methods: This prospective, single-center, cross-sectional study included consecutive patients undergoing OCT-guided percutaneous coronary intervention (December 2023 to January 2026). eGFR was calculated with the CKD-EPI 2021 equation and CI-AKI defined by KDIGO creatinine criteria. Lesion-level associations were estimated by logistic or linear regression with patient-clustered robust standard errors, before and after adjustment for age, sex, diabetes, hypertension, smoking and acute coronary syndrome.Results: The cohort comprised 300 patients, 309 procedures and 356 lesions. Mean eGFR was 79.7 ± 20.7 mL/min/1.73 m2 and 60 procedures (19.4%) had eGFR < 60. Calcification was present in 235 lesions (66.0%). Each 10 mL/min/1.73 m2 lower eGFR was associated with calcification in unadjusted analysis (OR 1.19; 95% CI 1.03– 1.38), but not after adjustment including age (OR 1.04; 0.88– 1.22), whereas age remained associated (OR 1.46 per 10 years; 1.09– 1.95). Mean minimum stent area was 5.75 ± 2.26 mm2 and was not correlated with eGFR (ρ=0.05; P=0.36); stent expansion ≥ 80% (87.4%) and procedural success (88.7%) were not associated with eGFR in crude or adjusted models. CI-AKI occurred in 8 of 206 procedures with paired creatinine (3.9%). Subgroups with eGFR < 45 (22 lesions) and < 30 (7 lesions) were small, and these analyses were exploratory.Conclusion: In this single-center cross-sectional study, the crude association between lower eGFR and OCT-defined calcification was largely explained by age. Under OCT guidance, renal function was not associated with stent optimization, and CI-AKI was infrequent. Prospective studies with larger advanced-CKD populations and a comparator arm are needed to establish whether OCT guidance offsets renal-related procedural disadvantage.Keywords: chronic kidney disease, estimated glomerular filtration rate, coronary calcification, optical coherence tomography, minimum stent area, contrast-associated acute kidney injury
Pham Truong Son,1 Le Van Dung,2 Pham Nguyen Son,2 Nguyen Thi Kieu Ly,1 Dinh Cong Pho11Department of Cardiology, Heart Institute, 108 Military Central Hospital, Hanoi, Vietnam; 2Department of Cardiology, Duc Giang General Hospital, Hanoi, VietnamCorrespondence: Dinh Cong Pho, Department of Cardiology, Heart Institute, 108 Military Central Hospital, No. 1 Tran Hung Dao, Hanoi, Vietnam, Email dinhcongphohvqy@gmail.comBackground: The cardio-ankle vascular index (CAVI) reflects arterial stiffness and is associated with the severity of coronary artery disease (CAD). Short-term change in CAVI in patients with angiographically documented CAD is poorly described. We explored whether baseline CAVI was associated with its 12-month change.Methods: This exploratory secondary analysis used data from a previously published single-center study, extended with 12-month follow-up. Clinically stable patients with at least 50% coronary stenosis on invasive angiography and paired CAVI measurements were included. Change in the mean of right and left CAVI (ΔCAVI-mean) was the 12-month value minus the baseline value; positive values indicate greater stiffness, and ΔCAVI-mean ≥ +0.5 defined worsening. Non-worsening was analyzed by logistic regression; post hoc analyses estimated the change expected from regression to the mean.Results: Of 157 patients, 33 (21.0%) worsened. CAVI-mean was 9.20 ± 0.80 at baseline and 9.15 ± 0.76 at 12 months (r = 0.43). Baseline CAVI-mean ≥ 9.0 was associated with non-worsening (odds ratio adjusted for age and sex 8.10, 95% CI 3.35– 19.58). ΔCAVI-mean differed by − 0.81 (95% CI − 1.08 to − 0.54) between patients with baseline CAVI-mean ≥ 9.0 and those below 9.0; regression to the mean alone predicted a difference of − 0.74. ΔCAVI-mean was not related to the average of the two measurements (Oldham’s method: r = − 0.05; p = 0.54).Conclusion: In this selected single-center CAD cohort, baseline CAVI-mean ≥ 9.0 was associated with lower odds of CAVI worsening over 12 months. The association was of the size expected from regression to the mean and should not be interpreted as a biological effect. The worsening threshold is not clinically validated and no clinical outcomes were assessed. Studies of change in CAVI need repeated measurements, continuous modeling, and validation in larger cohorts with clinical outcomes.Keywords: cardio-ankle vascular index, arterial stiffness, coronary artery disease, longitudinal change, regression to the mean
Linh Tran Pham,1 Si Dung Chu,2 Minh Thi Tran31Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam; 2Health Management Training Institute, Hanoi University of Public Health (HUPH), Hanoi, Vietnam; 3Department of Internal Medicine, Vietnam University of Traditional Medicine, Hanoi, VietnamCorrespondence: Si Dung Chu, Health Management Training Institute, Hanoi University of Public Health (HUPH), Hanoi, Vietnam, Tel + 84 906 086168, Email cds@huph.edu.vn; sichu.bvbachmai@gmail.comObjective: To evaluate rehospitalization rates and identify modifiable risk factors in chronic heart failure (CHF) patients enrolled in an optimal management and treatment program.Methods: A prospective cross-sectional study with longitudinal follow-up was conducted on 163 patients diagnosed with CHF patients (Framingham criteria) at an international hospital model in Vietnam from January 2022 to November 2023. Clinical, behavioral, and comorbid factors were analyzed over 6 months.Results: The program demonstrated high efficacy with a low 6-month rehospitalization rate of 9.82%. Statistical analysis revealed significant correlations between rehospitalization and male gender (p< 0.01), alcohol consumption (p< 0.05), smoking (p< 0.05), elevated heart rate (p< 0.001), and NYHA functional class (p< 0.05). Key comorbidities including coronary heart disease (p< 0.01), sinus tachycardia (p < 0.001), atrial fibrillation (p< 0.01), and sleep disorders were also significantly associated with readmission (p< 0.05).Conclusion: Optimizing CHF outcomes requires a comprehensive intervention strategy targeting both modifiable lifestyle factors and underlying clinical comorbidities like sleep disorders.Keywords: risk profile, lifestyle intervention, underlying disease, rehospitalization rate, chronic heart failure
Wenhui Huang,1,2 Fang Liu,1,2 Yangfan Hu,1,2 Guoyan Xu,1– 4 Liangdi Xie,1– 5 Tingjun Wang1– 41Department of General Practice, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 2Department of General Practice, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 3Fujian Hypertension Research Institute, Fuzhou, Fujian, People’s Republic of China; 4General Practitioner Branch of Fujian Medical Doctor Association, Fuzhou, Fujian, People’s Republic of China; 5Branch of National Clinical Research Center for Aging and Medicine, Fujian Province; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, Fujian, People’s Republic of ChinaCorrespondence: Tingjun Wang, Department of General Practice, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Huashan Road 999, Changle District, Fuzhou, 350212, People’s Republic of China, Email 1870311076@qq.comBackground: The aim of this study was to investigate the association between endothelial activation and stress index (EASIX), a composite marker of endothelial dysfunction, and microalbuminuria.Methods: This cross-sectional study included adult patients from Departments of General Practice and Geriatrics at the First Affiliated Hospital of Fujian Medical University between January 2017 and December 2023. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) of 30– 300 mg/g. EASIX was calculated as lactate dehydrogenase (U/L) × serum creatinine (mg/dL) / platelet count (109/L). The association of EASIX with microalbuminuria was evaluated using logistic regression models, restricted cubic splines (RCS), and subgroup analyses.Results: Among 3,126 patients, 403 (12.9%) had microalbuminuria and exhibited significantly higher EASIX levels compared with those with normal UACR [median (P 25~P 75): 0.63 (0.47– 0.90) vs 0.62 (0.48– 0.82) mg/g, P = 0.019]. Multivariate linear regression identified EASIX as an independent factor for lnUACR (β = 0.100, 95% CI: 0.115~0.233, P< 0.001). Logistic regression further showed that EASIX was independently associated with microalbuminuria (OR = 1.420, 95% CI:1.167~1.728, P < 0.001). In the fully adjusted model, EASIX quartiles remained independently associated with microalbuminuria (OR = 1.395, 95% CI: 1.147~1.698, P < 0.001). RCS analysis revealed a U-shaped non-linear association (P for non-linear = 0.007), with an inflection point at EASIX = 0.625, above which the risk of microalbuminuria increased significantly. This association remained consistent across subgroups stratified by age, sex, body mass index (BMI), and hypertension or diabetes status in patients with EASIX > 0.625, with no significant interactions.Conclusion: This study provides evidence that EASIX, a composite marker derived from routine blood tests, is independently associated with microalbuminuria. A threshold of 0.625 for the EASIX may warrant further investigation in longitudinal studies.Keywords: endothelial activation and stress index, microalbuminuria, endothelial dysfunction, hypertension, diabetes
