Older adults face a high risk of in-hospital mortality following acute coronary syndrome (ACS). The C-reactive protein-albumin-lymphocyte (CALLY) index reflects systemic inflammation, immunity, and nutritional status. We investigated its predictive value for in-hospital mortality in elderly ACS patients. A total of 699 older patients diagnosed with ACS were retrospectively analyzed. The cohort was divided into survivors (n = 562) and non-survivors (n = 137). Admission values of serum C-reactive protein, albumin, and lymphocyte counts were utilized to compute the CALLY index. The non-survivor cohort exhibited a remarkably lower CALLY index compared with those who survived (0.22 [0.08-0.78] vs 3.09 [0.73-10.3], P < .001). A CALLY index threshold of ≤0.716 identified in-hospital mortality with 75.4% sensitivity and 74.5% specificity (Area under the curve [AUC] = 0.816, 95% CI: 0.776-0.856, P < .001), showing higher sensitivity and specificity than the Global Registry of Acute Coronary Events (GRACE) score. Multivariable regression revealed that CALLY index <0.716 (odds ratio [OR] = 4.41, 95% CI: 2.27-8.54, P < .001) independently predicted adverse outcomes. The CALLY index may serve as a valuable and independent prognostic marker in elderly patients with ACS.
Atherosclerosis (AS) is a chronic inflammatory vascular disease in which exosomes play important roles in intercellular communication. Exosomes derived from macrophages, endothelial cells, vascular smooth muscle cells, immune cells, and mesenchymal stem cells participate in several stages of AS progression by transferring bioactive molecules, including microRNAs (miRNAs) and proteins. Macrophage-derived exosomes promote endothelial dysfunction and inflammation, whereas endothelial cell-derived exosomes regulate vascular smooth muscle cell phenotypic switching. Vascular smooth muscle cell-derived exosomes contribute to plaque calcification, while mesenchymal stem cell-derived exosomes appear to exert anti-atherosclerotic effects by suppressing inflammation and promoting M2 macrophage polarization. Exosomal cargos also exhibit potential diagnostic value, with specific expression patterns correlating with disease severity. Furthermore, engineered exosomes have emerged as promising targeted drug delivery systems for AS therapy. This review summarizes the roles of exosomes derived from various cellular sources in the pathogenesis, diagnosis, and treatment of AS, and highlights their potential as biomarkers and therapeutic targets.
Thyroid hormones may accelerate heart rate and enhance cardiac contractility, improving both systolic and diastolic functions of heart, while reducing systemic vascular resistance at rest. Thyroid dysfunction may be associated with an increased risk of cardiovascular disease (CVD). However, current findings are not entirely consistent, and variations in thyroid hormone sensitivity may serve as a key factor underlying the inconsistent associations between thyroid function and CVD. Hence, the present narrative review synthesizes the association between thyroid hormone sensitivity and common CVDs, such as hypertension, coronary heart disease (CHD), and stroke. The possible molecular mechanisms of thyroid hormone sensitivity-mediated cardiovascular pathology are also summarized. We found that most studies failed to establish a significant relationship between peripheral, central thyroid hormone sensitivity and hypertension. Further, current studies generally suggest a positive correlation between reduced peripheral thyroid hormone sensitivity and an increased risk of stroke. Similarly, most studies indicate that reduced thyroid hormone sensitivity is associated with an elevated risk of adverse clinical outcomes after CHD.
This retrospective study evaluated a diagnostic framework integrating systemic inflammatory indices with contrast enhanced ultrasound for stratifying carotid plaque vulnerability. We included 322 patients with a mean age of 68.4 years who underwent imaging to grade intraplaque neovascularization as an established reference. The Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and pan-immune-inflammation value were analyzed alongside diagnostic performance using receiver operating characteristic curves and reclassification metrics. Results showed that higher levels of these indices were significantly associated with increased neovascularization severity. The combined model yielded an AUC of 0.822, which was comparable to that of SII alone (AUC = 0.821; DeLong P = .789). The pan-immune-inflammation value showed a high sensitivity of 88.6% for initial screening while the Systemic Inflammation Response Index demonstrated 78.3% specificity for confirming plaque instability. Adding SII to the baseline model improved reclassification and discrimination after bootstrap correction, with a continuous NRI of 0.949 (95% CI: 0.752-1.153) and an IDI of 0.266 (95% CI: 0.213-0.311). Integrating these accessible inflammatory indices with ultrasound may provide a cost-effective and noninvasive approach to vascular risk stratification, with potential value for the personalized management of patients with carotid atherosclerosis.
