Background: Understanding the manifestations of stress in family members of postoperative cardiac patients after transfer from the cardiac surgical intensive care unit (CSICU) is important so that more targeted interventions can be applied.Objectives: The aim of the study was to explore the relationships among the level of family stress after relocation of patients after cardiac surgery, family members' uncertainty regarding the illness, and caregivers' readiness, thereby providing a theoretical basis for intervention. Methods: A general information questionnaire, the Family Relocation Stress Scale, Mishel Uncertainty in Illness Scale-Family Member Form, and Caregiver Preparedness Scale form were completed by 319 family members of patients in the CSICU of a tertiary hospital in Shandong Province from June 2024 to September 2024. The profiles of individuals experiencing family relocation stress were analyzed, and the influences of individual factors were analyzed.Results: Model 3 proved to be best suited for the analysis, with entropy = 0.865 and a bootstrap likelihood ratio p < 0.001. The factors that influenced family relocation stress included educational level, caregiving experience, place of residence, caregiver preparedness, and uncertainty about the illness (p < 0.05).Conclusions: In this study, three distinct patient classifications were identified: a high relocation stress group, a medium relocation stress group, and a low relocation stress group. There was significant heterogeneity in the levels of stress experienced by the families of patients in the CSICU before transfer. These results suggest that medical staff could implement targeted interventions to reduce the relocation stress experienced by family caregivers.
Background: Early risk stratification is crucial in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Conventional indices fail to fully capture the combined effects of hemodynamic compromise and hypoxemia. The Hypoxia-Age-Shock Index (HASI) integrates age, circulatory status, and peripheral oxygen saturation (SpO2) and can be rapidly calculated at triage. In addition, the prognostic role of smoking remains controversial. We evaluated the ability of the HASI to predict in-hospital mortality and assessed the impact of smoking on short- and medium-term outcomes. Methods: This retrospective cohort study included 711 STEMI patients (455 smokers, 256 non-smokers) treated with primary PCI from 2019 to 2022. Shock Index (SI), Age Shock Index (ASI) and HASI were calculated using vital signs and SpO2. Mortality was assessed at 30 and 120 days. Logistic regression was used to identify independent predictors, and receiver operating characteristic curve analysis was used to compare predictive performance. Results: The HASI demonstrated superior discrimination for in-hospital mortality compared to the ASI and SI (area under the curve 0.747 vs. 0.700 and 0.628). At a cutoff of 0.524, the HASI showed high sensitivity (97.5%). Multivariable analysis identified HASI [odds ratio (OR) 8.14, 95% confidence interval (CI) 1.59-10.05] as an independent predictor; smoking was not significant (OR 0.81, 95% CI 0.36-1.84). Kaplan-Meier analysis showed comparable 30- and 120day survival between smokers and non-smokers. Conclusions: The HASI is a rapid, non-invasive, easily computed triage tool that outperformed conventional indices in predicting mortality in STEMI patients undergoing primary PCI in this study. Acute physiological derangements, rather than smoking, drove the outcomes. Its simplicity and speed make the HASI particularly valuable for immediate pre-laboratory risk stratification in high-volume or resource-limited emergency settings.
Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease worldwide. However, only a small percentage of cases are diagnosed clinically, suggesting under-recognition, with most clinicians exposed to small segments of the broad disease spectrum, in which effort intolerance, heart failure, arrhythmias, and sudden cardiac death can occur. Comprehensive evaluations and longitudinal assessments with echocardiography, ambulatory electrocardiography, stress testing, and, in some cases, cardiac magnetic resonance imaging, are important for diagnosis, risk stratification, distinguishing obstructive from nonobstructive forms, and guiding therapy. Symptomatic patients can be treated with various medications, including a new class of cardiac myosin inhibitors. For patients whose symptoms do not respond to medical therapy or in whom medical therapy is not desired, invasive septal reduction therapy options, when performed at expert centers, have been shown to lead to successful outcomes. The Taiwan Society of Cardiology recently appointed a task force to formulate a consensus on HCM. Based on the most up-to-date information, the consensus emphasizes a comprehensive diagnostic approach, including imaging and genetic testing, family screening and risk assessment, and provides current evidence-based important recommendations to guide clinicians in the management of patients with HCM.
Background:To compare the procedural success, complication rates, and clinical outcomes of transradial and transulnar arterial interventions in patients undergoing primary percutaneous coronary interventions (PCIs) due to acute ST elevation myocardial infarction (STEMI). The effectiveness of access routes was evaluated in procedures performed using a single catheter. Materials and Methods:A total of 258 patients diagnosed with STEMI and who underwent primary PCI were included in the study. Eighteen patients were excluded for not meeting the study criteria, and the remaining 240 patients were randomized 1:1 into radial and ulnar groups. After excluding cross-overs, the remaining 231 patients underwent the procedure, including 113 via the radial route (Group R) and 118 via the ulnar route (Group U), and their data were analyzed. Procedural success, the number of arterial punctures, procedure duration, complication rates and clinical outcomes were prospectively compared. Results:No significant difference in procedural success was observed between the two groups. However, the number of arterial punctures was higher in the transulnar group (≥ 2 punctures: Group R: 24 [21.2%], Group U: 48 [40.7%]; p = 0.001), and the puncture duration was longer (Group R: 15 sec [10-20], Group U: 15 sec [10-30], p = 0.001). There were no significant differences in post-procedural hematoma formation or arterial occlusion rates between the two groups. Conclusions:Our results demonstrated that single-catheter transulnar access offers a similar procedural success rate and safety profile to transradial access. However, transulnar access was associated with a longer puncture duration and increased puncture attempts. Transulnar access may be considered a reliable alternative when transradial access is not feasible.
Background:Obesity is highly prevalent among patients with chronic coronary syndrome (CCS) and is associated with impaired functional capacity and increased cardiovascular risk. Cardiac rehabilitation (CR) is a key intervention shown to improve exercise capacity and outcomes in this population. Objective:This study aimed to compare the effectiveness of CR between obese and non-obese patients with CCS. Methods:In this retrospective study, we analyzed data from CCS patients who completed an exercise-based CR program between January 2020 and December 2024. Participants were categorized into obese (body mass index [BMI] ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) groups. Cardiopulmonary exercise testing (CPX) parameters including VO2 peak (ml/kg/min), VO2 peak (%), VO2 peak (L/min), and VO2 at anaerobic threshold (AT) (%) were assessed before and after the CR program. Results:The records of 92 obese and 124 non-obese patients were analyzed. At baseline, the obese patients had significantly lower VO2 peak values (p = 0.003). However, post-rehabilitation, both groups demonstrated significant improvements in CPX parameters, with the obese patients demonstrating greater percentage gains in VO2 peak (%) (p < 0.001) and VO2 at AT (p < 0.001). CR adherence did not differ significantly between groups. Conclusions:Despite lower baseline functional capacity, the obese patients had substantial improvements in exercise capacity post-CR, comparable to or exceeding those of non-obese individuals. These findings highlight the importance of CR in managing obesity-related cardiovascular risks and emphasize the need to promote CR participation among obese patients.
Background:Catheter ablation is a key treatment for atrial fibrillation (AF); however, recurrence often requires repeat procedures. This meta-analysis evaluates the efficacy of repeat ablation for recurrent atrial arrhythmia, focusing on ablation technique, anatomical targets, and pulmonary vein (PV) reconnection. Methods:A systematic literature search of MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials was conducted on studies assessing repeat and initial ablation outcomes until February 2025. Data on atrial arrhythmia recurrence, ablation technique, targets, and PV reconnection were extracted. A random-effects model meta-analysis was used to estimate the pooled recurrence rate after repeat ablation. Results:Fifty-three studies (8,117 patients) were included. The recurrence rate after repeat ablation was 30% (95% confidence interval [CI]: 27%-34%), with PV reconnection observed in 90% of cases following the initial ablation. The lowest recurrence rate was observed with cryoballoon ablation (CBA) followed by radiofrequency ablation (RFA) at 23% (95% CI: 15%-33%, I2 = 83%). Recurrence rates varied by strategy, with pulmonary vein isolation (PVI) alone resulting in a 25% recurrencerate (95% CI: 18%-35%, I2 = 88.5%). PV reconnection rates also varied, with the left inferior PV (LIPV) showing the lowest rateat 23% (95% CI: 22%-24%, I2 = 20.3%). Conclusions:Repeat ablation for AF was associated with the risk of recurrence, mainly due to PV reconnection. Strategies involving CBA followed by RFA and PVI-based approaches showed favorable outcomes, while lower reconnection rates in left-sided PVs, especially the LIPV, highlighting the need for optimized techniques.
Background:Aortic stenosis (AS) is the most common primary valvular disease, with a high prevalence (12.4%) among older patients aged ≥ 75 years. Early intervention for AS is critical, as untreated moderate and severe AS are associated with high mortality rates. Evolving patient demographics and procedural trends in surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) call for a structured framework of favorable treatment options for AS comorbidities and cardiac anatomic variants. Methods:The Taiwan Association of Thoracic and Cardiovascular Surgery held multiple meetings in 2024-2025 for local experts to examine the latest evidence and current trends and to facilitate discussion on the management of isolated severe AS in Taiwan. Results:Patient age, comorbidities, and unique cardiac structure frequently involve complex situations requiring treatment beyond SAVR or TAVI in AS management, emphasizing the need for thorough patient evaluation, accurate valvular imaging, and comprehensive patient-centered care with a multi-disciplinary heart team. Conclusions:Treatment options for individual patients must be carefully considered regarding their risk factors, anticipated life expectancy, and baseline health status. The cardiac surgeon provides valuable insights into surgical and alternative treatment methods tailored to individual patient conditions, and plays a critical role in the shared decision-making process in AS management.
Background:Transcatheter aortic valve implantation (TAVI) has emerged as preferred treatment for severe aortic stenosis in high-risk patients. Inflammatory and nutritional biomarkers have been increasingly investigated for their prognostic value. This study aimed to evaluate the utility of the procalcitonin/albumin ratio (PAR) in predicting 1-year mortality after TAVI. Methods:A retrospective cohort study was conducted on patients who underwent TAVI between June 2020 and January 2024. Pre-procedural serum procalcitonin and albumin levels were measured, and the PAR was calculated. Thirty-day and 1-year mortality and hospitalization for heart failure were defined as primary outcomes. Results:A total of 210 patients were included in the study. PAR was significantly higher in non-survivors compared to survivors (p < 0.0001). Receiver operating characteristic analysis demonstrated that the PAR had a moderate-to-good discriminatory ability for predicting 1-year mortality (area under the curve = 0.784 [95% confidence interval: 0.709-0.858]). In multivariate analysis, PAR was identified as an independent predictor of 30-day and 1-year mortality and hospitalization for heart failure. Conclusions:Our findings suggest that the PAR, as a combined marker of inflammation and nutritional status, may serve as a useful prognostic indicator in patients undergoing TAVI. The association between a higher PAR and increased mortality risk highlights the potential role of systemic inflammation and malnutrition in post-TAVI outcomes. The pre-procedural PAR appears to be a promising biomarker for predicting 1-year mortality after TAVI. Further prospective studies with larger cohorts are needed to validate these findings and explore potential clinical applications.
Background:Complex patent foramen ovale (PFO) anatomical features can increase procedural difficulty during transcatheter closure, often leading to prolonged fluoroscopy time. Aim:This study aimed to evaluate the relationship between PFO anatomy, assessed via transesophageal echocardiography (TEE), and prolonged fluoroscopy time during transcatheter closure. Methods:This retrospective study analyzed 83 patients (median age: 45 years, 58% male) undergoing PFO closure for cryptogenic stroke. TEE measurements included key anatomical parameters related to PFO morphology and shunting dynamics. Patients were categorized into prolonged (≥ 80th percentile) and standard (< 80th percentile) fluoroscopy-time groups. Logistic regression, Pearson correlation analysis, and receiver operating characteristic (ROC) curve analyses were used to identify predictors of prolonged fluoroscopy time. Results:The prolonged fluoroscopy-time group had a significantly longer tunnel length (17.5 mm [interquartile range (IQR): 14.25-20.75] vs. 12.0 mm [IQR: 8.00-14.00], p < 0.01) and smaller aortic rim (3.0 mm [IQR: 2.0-3.75] vs. 6.0 mm [IQR: 5.0-8.0], p < 0.01). Fluoroscopy time correlated positively with tunnel length (r = 0.72, p < 0.001) and negatively with aortic rim length (r = -0.65, p < 0.001). Logistic regression identified tunnel length (odds ratio [OR] = 1.459; 95% confidence interval [CI]: 1.190-1.789) and aortic rim length (OR = 0.537; 95% CI: 0.378-0.764) as independent predictors. ROC curve analysis revealed a cut-off of 12.5 mm (area under the curve [AUC] = 0.770) for tunnel length and 5.5 mm (AUC = 0.798) for aortic rim in predicting prolonged fluoroscopy time. Conclusions:The findings of this study suggest that complex PFO anatomical features significantly impact fluoroscopy time, underscoring the need for detailed pre-procedural TEE assessments to optimize procedural planning and outcomes.
Background:Lipoprotein (a) [Lp(a)] is a major carrier of pro-atherogenic oxidized phospholipids. It is widely recognized as an independent risk factor for cardiovascular diseases. Oxidative stress caused by oxidized phospholipids is a crucial trigger of chronic vascular inflammation, leading to atherosclerosis. Although various parameters provide information about oxidative stress, the relationship between oxidative stress and Lp(a) levels has not been thoroughly investigated. This study aimed to analyze this relationship and evaluate the diagnostic accuracy of these parameters in identifying high-risk patients. Methods:Healthy subjects were grouped according to Lp(a) levels: those with Lp(a) ≥ 30 mg/dl were classified as high risk, and those with Lp(a) < 30 mg/dl as low risk. Monocyte to high-density lipoprotein ratio (MHR) and lymphocyte to monocyte ratio (LMR) were calculated and compared between groups. Results:MHR (23.61 ± 6.73 vs. 13.17 ± 4.56; p < 0.0001), LMR (5.17 ± 1.53 vs. 3.99 ± 1.11; p < 0.0001), lymphocyte count (3.15 ± 0.73 vs. 2.48 ± 0.62; p < 0.0001), and monocyte count (0.73 ± 0.23 vs. 0.58 ± 0.15; p < 0.0001) were significantly higher in the high-risk group. There were moderate positive correlations between Lp(a) level and monocyte count (r = 0.467; p < 0.0001), MHR (r = 0.598; p < 0.0001), and LMR (r = 0.464; p < 0.0001). A cut-off value of 14.73 for MHR was associated with 83.55% sensitivity and 83.03% specificity [area under the curve (AUC): 0.859; 95% confidence interval (CI): 0.802-0.925], and a cut-off value of 4.31 for LMR was associated with 81.68% sensitivity and 81.16% specificity (AUC: 0.853; 95% CI: 0.808-0.910) in predicting the high-risk group. Conclusions:Oxidative stress-inflammation parameters were higher in the high-risk group and positively correlated with Lp(a) levels. Furthermore, MHR and LMR could be used to detect high-risk patients.
Background: The aim of this study was to assess the long-term outcomes of patients treated with intra-aortic balloon pump (IABP) alone and in combination with extracorporeal membrane oxygenation (ECMO), focusing on the real-world effectiveness and patient survival. Objective: To evaluate the effectiveness and survival outcomes of patients undergoing IABP support alone versus those receiving combined IABP and ECMO support in a tertiary care setting. Methods: We conducted a retrospective cohort analysis of 544 patients, of whom 362 received IABP support and 182 received combined IABP and ECMO support. The study was set in a tertiary care environment. Using Cox proportional hazard regression models, we examined biochemical, echocardiographic data, comorbidities, and medication histories to identify factors associated with mortality. Results: From January 2001 to June 2018 (median follow-up: 30 months), 544 patients received IABP with or without ECMO. Among the IABP-only group, non-survivors were older and had worse renal function, lower cholesterol, and more frequent cardiopulmonary resuscitation, pulseless electrical activity (PEA), ventricular tachycardia/ventricular fibrillation, and sepsis. Age and PEA independently predicted all-cause mortality (hazard ratio [HR]: 1.020 and 1.653, respectively), while age, peak creatine kinase, shock, and PEA were associated with cardiovascular (CV) death. In the IABP + ECMO group, mortality was similarly associated with older age, renal dysfunction, coronary artery disease, and PEA. After adjustment, age remained an independent predictor of all-cause (HR: 1.012) and CV mortality (HR: 1.014). Compared to IABP alone, the combination group had more critical illness features and higher adjusted risks of all-cause (HR: 1.827) and CV death (HR: 1.953). Conclusions: This study underscores the need for precise patient selection for advanced mechanical circulatory support, focusing on age and comorbidities. Our findings advocate for targeted management strategies to enhance the therapeutic potential of mechanical support in cardiogenic shock and improve survival rates among critically ill cardiac patients.
Background:Although computed tomography pulmonary angiography (CTPA) is the diagnostic gold standard for confirming pulmonary embolism (PE), it has limitations such as the risks associated with contrast media and logistical delays. Electrocardiography (ECG) is a widely accessible and safe alternative; however, it also has a low diagnostic sensitivity. Objectives:This meta-analysis aimed to evaluate the diagnostic performance of artificial intelligence (AI)-based deep learning models using ECG data for PE detection and identify their strengths, limitations, and future directions. Methods:PubMed, Embase, and the Cochrane Library were comprehensively searched to identify studies evaluating AI models using ECG for PE detection. Studies were included if CTPA was used as the reference standard. Results:Five studies involving 467,017 patients were analyzed. The pooled sensitivity and specificity of the AI-based ECG models for PE detection were 70% (95% confidence interval [CI]: 68-72%) and 67% (95% CI: 66-67%), respectively. The pooled diagnostic odds ratio was 3.68 (95% CI: 3.31-4.09), and the summary receiver operating characteristic analysis yielded an area under the summary receiver operating characteristic curve of 0.754, indicating moderate diagnostic accuracy. Significant heterogeneity was observed across the studies (I2 > 90%). Compared with ECG-only approaches, multimodal models integrating ECG with clinical data demonstrated superior diagnostic performance. Conclusions:Current AI-based deep learning models for ECG analysis have moderate accuracy in detecting acute PE, with promising potential for clinical screening. However, the significant heterogeneity and limited external validation highlight the need for standardized methodologies and larger multicenter studies.
Background: Patients undergoing percutaneous coronary intervention (PCI) have a higher risk of recurrence. While lipid and glucose control can improve the prognosis, concerns remain about side effects such as myopathy, liver dysfunction, and potential new-onset diabetes mellitus. This study aimed to evaluate the real-world safety and efficacy of dual lipid-lowering therapy with pitavastatin 4 mg/day (P4) and ezetimibe 10 mg/day (E10), hereafter referred to as P4/E10 in post-PCI patients in Taiwan. Methods: The retrospective cohort study enrolled patients who underwent PCI between 2008 and 2021 at two institutes in Taiwan and received P4/E10 combination therapy for longer than a year. The primary endpoint was the overall adverse event rate associated with P4/E10. Efficacy evaluations included changes from baseline in lipid profile and glycemic markers. Results: A total of 120 patients were enrolled. No adverse events were recorded during the study period. After 12 months of therapy, the average low-density lipoprotein cholesterol level decreased by 32.54% from baseline, and there were decreases in glycated hemoglobin and triglyceride glucose index (-0.40% and -0.23, respectively) in diabetic patients. Conclusions: In this real-world study of Taiwanese patients, P4/E10 combination therapy was safe and effective in both lipid and glycemic index control. Nevertheless, further large-scale studies are warranted to validate our findings.
