Yogurt Intake Reduces All-Cause and Cardiovascular Disease Mortality: A Meta-Analysis of Eight Prospective Cohort Studies

Objective: To assess the relationship between yogurt intake and mortality risk from prospective cohort studies. Methods: The PubMed, EMBASE, and Web of Science databases were searched for all records related to yogurt intake and mortality risk [all-cause or cardiovascular disease (CVD) or cancer mortality] before October 1, 2018. The Newcastle-Ottawa Quality Scale was used to estimate the quality of all eligible articles. The results of the highest and lowest categories of yogurt intake in each study were collected and the effect size was pooled using a random effects model. The dose-response analysis was calculated using the generalized least squares trend estimation model. Results: Eight eligible cohort studies were included in this meta-analysis. There were 235,676 participants in the 8 studies, and the number of deaths was 14,831. Compared with the lowest category, the highest category of yogurt intake was not significantly related with all cause mortality [hazard ratio (HR)=0.93; 95% confidence interval (CI): 0.85, 1.01], CVD mortality (HR=0.92; 95% CI: 0.81, 1.03) and cancer mortality (HR=0.97; 95% CI: 0.83, 1.12). These studies were homogenous, since the homogeneity test showed that I2 was 28.7%, 15.1% and 11.8%, respectively. However, yogurt intake 200 g/d was significantly associated with a lower all-cause mortality (HR=0.88; 95% CI: 0.80, 0.96) and CVD mortality (HR=0.87; 95% CI: 0.77, 0.99) in the subgroup analysis. The dose-response analysis showed that yogurt intake of 200 g/d was inversely associated with all-cause mortality (P=0.041, HR=0.95, 95% CI: 0.92, 1.00) and CVD mortality (P=0.009, HR=0.92, 95% CI: 0.86, 0.98), and all of which were linear relationship (P>0.05). Conclusions: This review provided the evidence regarding yogurt intake can reduce all-cause and CVD mortality. Although some positive findings were identified, more high-quality cohort studies and randomized controlled trials are warranted on a possible protective effect of yoghurt on health.     

心脏瓣膜钙化对维持性血液透析患者心血管预后的影响

目的探讨心脏瓣膜钙化（HVC）对维持性血液透析（MHD）患者心血管预后的影响。方法入组2009~2011年302例MHD 患者（其中99例伴HVC）,所有患者随访2年,采用生存曲线分析心血管终点事件,Cox回归分析心脏瓣膜钙化对心血管预后的 影响。结果患者初始透析的平均年龄为58.2岁,男性占53.6%。随访2年,HVC与非HVC组患者全因死亡、心血管死亡和新 发心血管事件发生率分别为30.3% vs 16.3%、22.2% vs 6.9%和48.5% vs 25.6%（P<0.05）。生存曲线分析显示两组在全因死亡率 （Log Rank P=0.006）、心血管死亡（P<0.001）和新发心血管事件（P<0.001）方面均存在统计学差异。Cox回归分析显示,校正后 HVC 仍然显著增加患者全因死亡[HR 1,88,95%CI：（1.11-3.19）]、心血管死亡[3.47（1.76-6.84）]和新发心血事件风险[1.64 （1.09-2.47）]。结论HVC是MHD患者心血管死亡及新发心血管事件的独立危险因素。     

Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators.

CONTEXT: The clinical use of ambulatory blood pressure (BP) monitoring requires further validation in prospective outcome studies. OBJECTIVE: To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension. DESIGN: Substudy to the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial, started in October 1988 with follow up to February 1999. The conventional BP at randomization was the mean of 6 readings (2 measurements in the sitting position at 3 visits 1 month apart). The baseline ambulatory BP was recorded with a noninvasive intermittent technique. SETTING: Family practices and outpatient clinics at primary and secondary referral hospitals. PARTICIPANTS: A total of 808 older (aged > or =60 years) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic. INTERVENTIONS: For the overall study, patients were randomized to nitrendipine (n = 415; 10-40 mg/d) with the possible addition of enalapril (5-20 mg/d) and/or hydrochlorothiazide (12.5-25.0 mg/d) or to matching placebos (n = 393). MAIN OUTCOME MEASURES: Total and cardiovascular mortality, all cardiovascular end points, fatal and nonfatal stroke, and fatal and nonfatal cardiac end points. RESULTS: After adjusting for sex, age, previous cardiovascular complications, smoking, and residence in western Europe, a 10-mm Hg higher conventional systolic BP at randomization was not associated with a worse prognosis, whereas in the placebo group, a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate (HR) of most outcome measures (eg, HR, 1.23 [95% confidence interval [CI], 1.00-1.50] for total mortality and 1.34 [95% CI, 1.03-1.75] for cardiovascular mortality). In the placebo group, the nighttime systolic BP (12 AM-6 AM) more accurately predicted end points than the daytime level. Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP (10% increase in night-to-day ratio; HR for all cardiovascular end points, 1.41; 95% CI, 1.03-1.94). At randomization, the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg (95% CI, 128-156 mm Hg), 145 mm Hg (95% CI, 126-164 mm Hg) or 132 mm Hg (95% CI, 120-145 mm Hg), respectively. In the active treatment group, systolic BP at randomization did not significantly predict cardiovascular risk, regardless of the technique of BP measurement. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP.     

贫血及慢性肾脏病对糖尿病人群心脑血管事件发生与死亡的影响

目的：探讨糖尿病人群中贫血与心脑血管事件发生和死亡风险的关系,并评价其关联是否受慢性肾脏病（chronic kidney disease,CKD）的影响。方法： 基于开滦研究的前瞻性队列数据,收集2010-2011年符合纳入和排除标准的8 563例糖尿病患者的体检资料。末次随访时间为2015年12月31日,终点事件包括全因死亡和发生心脑血管疾病。采用Kaplan-Meier法进行生存分析,构建Cox比例风险回归模型,评估调整混杂因素后贫血及CKD与心脑血管事件发生和全因死亡的关联强度。结果：研究对象的平均年龄为（57.3 ± 10.3）岁,其中贫血患者占5.2%。贫血患者合并CKD的比例高于非贫血患者（27.2% vs. 20.8%,P=0.001）。研究对象的中位随访时间为4.9年（四分位数间距4.6~5.2年）, 随访期间死亡559人,发生心脑血管事件434人。贫血患者的全因死亡率高于非贫血患者（3 220.3/10万人年 vs. 1 257.9/10万人年,P<0.001）,而贫血与非贫血两组的心脑血管疾病发病率差异无统计学意义（999.8/10万人年 vs. 1081.2/10万人年,P>0.05）。CKD患者的全因死亡率和心脑血管疾病的发病率都要高于非CKD患者（2 558.3/10万人年 vs. 1 044.0/10万人年,P<0.001;1 605.9/10万人年 vs. 941.6/10万人年,P<0.001）。Cox回归模型结果显示,调整混杂因素后,贫血使糖尿病患者的死亡风险增加95%（HR=1.95,95% CI：1.50~2.54）,贫血合并CKD则会显著增加死亡风险（HR=3.61,95% CI：2.48~5.26）,非贫血但合并CKD会使糖尿病患者发生心脑血管疾病的风险增加（HR=1.41,95% CI：1.13~1.74）。结论：中国糖尿病人群中,贫血会增加患者的死亡风险,CKD会增加患者心脑血管疾病发生和死亡的风险,贫血合并CKD则会使死亡风险显著增加,应重点加强对贫血合并CKD的糖尿病患者的防治。     

Self-reported adherence with medication and cardiovascular disease outcomes in the Second Australian National Blood Pressure Study (ANBP2)

OBJECTIVE: To investigate whether responses to a previously validated four-item medication adherence questionnaire were associated with adverse cardiovascular events. DESIGN: Survey conducted among a cohort of participants in the Second Australian National Blood Pressure Study. SETTING: Australian general practice. PARTICIPANTS: 4039 older people with hypertension. MAIN OUTCOME MEASURES: All major cardiovascular events or death; first specific cardiovascular event. RESULTS: Subjects who adhered to their medication regimen (compared with non-adherent subjects) were significantly less likely to experience a first cardiovascular event or a first non-fatal cardiovascular event (hazard ratio [HR] for both, 0.81; 95% CI, 0.67-0.98; P = 0.03); a fatal other cardiovascular event (HR, 0.68; 95% CI, 0.48-0.99; P = 0.04); or a first occurrence of heart failure (HR, 0.58; 95% CI, 0.37-0.90; P = 0.02). Those who answered yes to "Did you ever forget to take your medication?" were significantly more likely to experience a cardiovascular event or death (HR, 1.28; 95% CI, 1.04-1.57; P = 0.02); a first cardiovascular event or death (HR, 1.31; 95% CI, 1.07-1.60; P = 0.01); a first cardiovascular event (HR, 1.34; 95% CI, 1.09-1.65; P = 0.01); or a first non-fatal cardiovascular event (HR, 1.35; 95% CI, 1.09-1.66; P = 0.01). Those who answered yes to "Sometimes, if you felt worse when you took your medicine, did you stop taking it?" were significantly more likely to experience a first occurrence of heart failure (HR, 2.06; 95% CI, 1.16-3.64; P = 0.01). CONCLUSIONS: Subjects who adhered to their medication regimen were less likely to experience major cardiovascular events or death. The question relating to forgetting to take medication identified non-adherent subjects likely to experience a cardiovascular event or death. Clinicians could use this question to identify patients with hypertension who are likely to benefit from medication adherence strategies.     

经皮冠脉介入治疗老年冠心病患者的预后及其影响因素

［摘要］目的: 分析老年(≥65岁)冠心病患者接受经皮冠脉介入治疗(PCI)术后影响其预后的因素。方法: 入选3 473例接受PCI术的冠心病患者,根据年龄分为老年组(≥65岁, n=2 005)和非老年组 (＜65岁, n=1 468),对患者进行随访,随访时间中位数为577 d,比较并分析两组患者预后的差异及其影响因素。结果： PCI术后老年组总死亡率(3.6%)及主要心脑血管不良事件（MACCE）发生率(12.3%)均明显高于非老年组（分别为1.5%和3.3%,P均<0.001)。相较于非老年组,老年组患者高血压、糖尿病、脑血管病及陈旧性心肌梗死患病率和完全血运重建率明显增加。冠脉病变更严重,ST段抬高型心肌梗死、3支病变、左主干病变及慢性闭塞性病变发生率高,而内生肌酐清除率则明显低于非老年组。Cox多因素回归分析显示,糖尿病(HR=1.857,95% CI：1.121~3.142,P=0.012),陈旧性心肌梗死史(HR=2.211,95% CI:1.113~4.112, P=0.015),3支血管病变(HR=1.751,95% CI:1.135~2.653, P=0.006)及老年(HR=4.585,95% CI:2.013~9.201, P<0.001)是总死亡率增加的独立危险因素;而左主干病变(HR=1.976,95%CI:1.173~2.874,P<0.001) ,内生肌酐清除率(HR=1.975,95%CI:1.101~3.215,P<0.001 )及3支血管病变(HR=1.573,95%CI:1.263~1.886,P<0.001)是MACCE发生率增加的独立危险因素。 结论： 糖尿病、3支血管病变、老年是老年冠心病患者PCI全因死亡率增加的独立危险因素,而左主干病变、内生肌酐清除率、3支血管病变是MACCE发生率增加的独立危险因素。     

基于队列数据探索精神分裂症患者自杀死亡的影响因素:一项来自中国西部170006例样本的实证研究

  目的  前瞻性探索精神分裂症患者因自杀死亡的危险因素。  方法  从某省严重精神障碍综合管理信息系统中获得2006–2018年的精神分裂症患者,使用Cox比例风险回归模型探索精神分裂症患者自杀的危险因素。  结果  研究共纳入了170006名精神分裂症患者。随访期结束后有160570人存活,9436人由于各种原因死亡,其中929人死于自杀,自杀发生率为223.61/100000人年。Cox比例风险回归模型提示:贫困（HR=1.20,95%CI:1.02～1.41）;与文盲与半文盲相比,较高的文化程度〔小学（HR=1.32,95%CI:1.09～1.60）、初中（HR=1.40,95%CI:1.14～1.73）、高中及以上（HR=1.93,95%CI:1.49～2.52）〕;自杀未遂（HR=2.70,95%CI:1.70～4.29）;服药依从性好（HR=1.91,95%CI:1.66～2.20）;存在抗精神药物治疗史（HR=1.42,95%CI:1.06～1.90）;与61～90岁年龄组相比,较小的年龄组46～60岁（HR=1.95,95%CI:1.60～2.39）、31～45岁（HR=3.61,95%CI:2.92～4.47）、15～30岁（HR=12.37,95%CI:9.69～15.78）;从事农业工作（HR=1.36,95%CI:1.13～1.65）是精神分裂症患者自杀的危险因素。  结论  较高文化程度的中青年精神分裂症患者,尤其是有过自杀未遂史的患者为自杀发生的高危人群,应针对高危人群进行重点干预以减少精神分裂症患者自杀死亡的发生。     

QRS时限变化对心脏再同步化治疗后全因死亡及心源性猝死的预测价值

目的: 探索QRS时限（QRS duration, QRSd）的变化（ΔQRSd）对心脏再同步化治疗（cardiac resynchronization therapy,CRT）后全因死亡及心源性猝死的预测价值。方法:纳入2011年3月至2020年12月南京医科大学附属无锡人民医院行CRT的患者并收集其临床资料和12导联体表心电图数据。测量术前和术后QRSd。Cox回归分析筛选全因死亡和心源性猝死的预测因子。以X tile软件分析ΔQRSd（QRSd术后-QRSd术前）对全因死亡和心源性猝死预测的截断值,以Kaplan Meier生存分析判断ΔQRSd与全因死亡和心源性猝死的关系。结果: 共纳入66例患者,中位随访时间72个月,15例死亡,16例发生心源性猝死事件。多因素Cox回归分析提示ΔQRSd是全因死亡的预测因子（HR=1.019,95% CI：1.004～1.035,P=0.014）;ΔQRSd（HR=1.016,95% CI：1.002～1.031,P=0.024）和完全性左束支传导阻滞（HR=0.211,95% CI：0.065～0.682,P=0.009）均是心源性猝死的预测因子。ΔQRSd对全因死亡和心源性猝死预测的截断值均为0 ms。ΔQRSd>0 ms组的术前左室舒张末内径显著高于ΔQRSd≤0 ms组（P<0.001）,其术前QRSd显著低于ΔQRSd≤0 ms组（P=0.001）。Kaplan Meier生存分析提示ΔQRSd>0 ms是CRT后全因死亡、心源性猝死、5年生存率及5年心源性猝死率的预测因子（P值分别为<0.001、<0.001、0.01和<0.001）。结论:术后QRSd增宽是CRT患者全因死亡和心源性猝死的独立预测因子。     

药物洗脱支架与金属裸支架置入术后对糖尿病患者远期死亡、心肌梗死和支架血栓发生情况的影响

目的本研究通过比较糖尿病患者置入金属裸支架(bare metal stents,BMS)vs药物洗脱支架(drug eluting stents,DES)后发生死亡、心肌梗死(myocardial infarction,MI)、再次血运重建和支架血栓的情况,以评价糖尿病患者置入DES后的远期安全性和有效性。方法本研究于2003年7月～2005年12月连续入选了834例因冠心病合并糖尿病在首都医科大学附属北京安贞医院心内科行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者,按置入支架类型将患者分为DES组(n=583)和BMS组(n=251)。主要终点事件为24个月时全因病死率;次要终点事件为24个月时非致死性MI、再次血运重建以及主要不良心血管事件(major adverse cardiac events,MACE)的发生率。结果本研究结果经多因素回归分析显示,DES组明显降低了24个月时死亡[3.2%vs 5.1%,危险比(hazard ratio,HR)0.34,95%可信区间(confidential interval,CI)0.12～0.94,P=0.038]和心性死亡的风险(2.2%vs 4.4%,HR=0.29,95%CI:0.13～0.87,P=0.027),非致死性MI和心性死亡与非致死性MI复合终点发生风险比较差异无统计学意义;明确和可能的支架血栓的发生风险比较差异也没有统计学意义(1.9%vs 2.0%,HR=0.96,95%CI:0.51～2.17,P=0.351)。DES明显降低了再次血运重建的风险(10.5%vs 20.7%,HR=0.24,95%CI:0.11～0.78,P<0.001)和靶血管再次血运重建的风险(8.9%vs 17.1%,HR=0.33,95%CI:0.16～0.87,P<0.001);与BMS组比较DES组的MACE的风险也明显降低,差异有统计学意义(15.8%vs 27.9%,HR=0.19,95%CI:0.09～0.85,P<0.001);其主要与DES组患者的死亡和靶血管再次血运重建的风险降低有关。结论与BMS相比,DES可显著降低糖尿病患者的24个月时死亡、再次血运重建和MACE的风险,而未增加非致死性MI和支架血栓的风险。置入DES后死亡风险的降低原因,主要与DES降低再狭窄后的死亡和MI风险,获得更高的完全血运重建率以及未增加支架血栓的风险相关。     

营养风险指数在肝脓肿患者预后评估中的价值

目的:探讨营养风险指数(nutritional risk index, NRI)与肝脓肿(PLA)患者预后不良结局之间的关系,并评估NRI的预后预测价值。方法:选取2016年6月至2021年12月期间就诊的PLA患者90例,根据NRI临界值83.5分,分为NRI<83.5组(n=44例)和NRI≥83.5组(n=46例),比较两组患者间的人口统计学资料、临床资料以及临床治疗效果,并利用Logistic回归分析模型和受试者操作特征(ROC)曲线对预后评估价值进行分析。结果:与NRI≥83.5组PLA患者相比,NRI<83.5组患者的转移性感染(25.00%vs 6.52%)、急性肝衰竭(9.09%vs 0.00%)、急性呼吸衰竭(13.64%vs 2.17%)、上消化道出血(13.64%vs 2.17%)、肺部感染(20.45%vs 6.52%)、预后不良(45.45%vs 19.57%)和病死率(13.64%vs 2.17%)的风险明显更高(P<0.05)。多元Logistic回归分析显示,年龄(HR=2.519,95%CI=1.106-5.739)、BMI(HR=0...     

尿路上皮癌伴鳞状分化对TURBT术后pT1期患者预后的影响

目的: 探讨尿路上皮癌伴鳞状分化对初次经尿道膀胱肿瘤电切术（TURBT）术后pT1期患者预后的影响。方法: 回顾性分析初次经TURBT手术、术后病理诊断为T1期的尿路上皮癌的533例膀胱肿瘤患者的临床病理资料。根据患者的术后病理诊断将患者分为2组:A组为尿路上皮癌（单纯型）441例,B组为尿路上皮癌伴鳞状分化90例,应用SPSS 20.0统计软件,运用Kaplan-Meier法分析两种临床病理特点对无复发生存期（RFS）和无进展生存期（PFS）的影响, 并用Log-rank检验比较生存曲线;运用COX回归模型单因素和多因素分析膀胱尿路上皮癌伴鳞状分化与初次TURBT术后pT1期患者预后之间的关系,评估影响其RFS和PFS的因素。结果: A组单纯尿路上皮癌441例（83.05%）,B组尿路上皮癌伴鳞状分化90例（16.95%）。B组与A组比较更易具有高级别肿瘤（P＜0.001）,同时B组较A组有较高的复发率（P=0.018）、较短的无复发生存期（P＜0.001）以及较高的进展率（P=0.001）、较短的无进展生存期（P＜0.001）。B组与A组比较,年龄（P=0.185）、性别（P=0.135）、吸烟（P=0.728）、肿瘤大小（P=0.436）、肿瘤数目（P=0.112）和膀胱灌注（P=0.054）等差异均无统计学意义。COX多因素生存分析显示:吸烟（HR 1.34, 95% CI 1.00–1.79, P=0.048）、鳞状分化的伴发情况（HR 1.43, 95% CI 1.02–2.00, P=0.040）以及病理分级（HR 1.51, 95% CI 1.13–2.01, P=0.005）等因素显著增加TURBTpT1期患者的复发风险;同时,吸烟（HR 1.80, 95% CI 1.17–2.76, P=0.008）、鳞状分化的伴发情况（HR 2.07, 95% CI 1.32–3.24, P=0.001）以及病理分级（HR 1.90, 95% CI 1.24–2.92, P=0.003）等因素增加TURBTpT1期患者的进展风险。结论: 尿路上皮癌伴鳞状分化是TURBT术后pT1期患者的预后独立影响因素,复发率及进展率较高,需密切随访。     

Does a diagnosis of the metabolic syndrome provide additional prediction of cardiovascular disease and total mortality in the elderly? The Dubbo Study

OBJECTIVE: To assess whether a diagnosis of the metabolic syndrome (MetS) improves the prediction of cardiovascular disease or total mortality beyond that already provided by conventional risk factors. DESIGN AND SETTING: A longitudinal cohort study conducted in Dubbo, New South Wales. PARTICIPANTS: 2805 men and women aged 60 years and older living in the community, first assessed in 1988-1989 and followed for 16 years. MAIN OUTCOME MEASURES: Coronary heart disease (CHD) events, ischaemic stroke events, and total mortality. RESULTS: MetS was present in 31% of men and 34% of women. Crude CHD, ischaemic stroke, and total mortality rates were higher in the presence of MetS in men and women. In proportional hazards models that included conventional risk factors, but excluded variables used to define the presence of MetS, MetS was a significant predictor of CHD, stroke and total mortality. In men, the respective hazard ratios were 1.64 (95% CI, 1.37-1.96), 1.31 (95% CI, 0.97-1.77), and 1.53 (95% CI, 1.30-1.79). In women, the respective hazard ratios were 1.70 (95% CI, 1.43-2.02), 1.37 (95% CI, 1.04-1.82), and 1.35 (95% CI, 1.15-1.59). The use of MetS variables on an ordinal scale produced broadly similar conclusions. CONCLUSIONS: A diagnosis of MetS provides additional prediction of CHD events, stroke events, and total mortality beyond that provided by other conventional risk factors.     

Age and diabetes mellitus associated with worse outcomes after percutaneous coronary intervention in a multi-ethnic Asian dialysis patient population

INTRODUCTIONThere is limited literature on clinical outcomes following percutaneous coronary intervention (PCI) in Asian dialysis patients. We evaluated the angiographic characteristics and clinical outcomes of dialysis patients treated with PCI in an Asian society.METHODSA retrospective analysis was performed of 274 dialysis patients who underwent PCI in a tertiary care institution from January 2007 to December 2012. Data on clinical and angiographic characteristics was collected. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, acute myocardial infarction (AMI) and stroke at two years.RESULTS274 patients (65.0% male, median age 62.0 years) with 336 lesions (81.8% Type B2) were treated. 431 stents (35.0% drug-eluting stents) with a mean diameter of 2.96 mm and mean length of 21.30 mm were implanted. The MACE rate was 55.8% (n = 153) at two years, from death (36.5%) and AMI (35.0%). In multivariable analysis, age and diabetes mellitus were significant predictors of both mortality (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05–1.12, p < 0.001; OR 2.65, 95% CI 1.46–4.82, p = 0.001, respectively) and MACE (OR 1.06, 95% CI 1.03–1.08, p < 0.001; OR 1.84, 95% CI 1.07–3.15, p = 0.027, respectively). Left ventricular ejection fraction (LVEF) (OR 0.97, 95% CI 0.95–0.99, p = 0.006) was a significant predictor of mortality but not MACE.CONCLUSIONAsian dialysis patients who underwent PCI had a two-year MACE rate of 55.8% due to death and AMI. Age, LVEF and diabetes mellitus were significant predictors of mortality at two years.     

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up

Background:Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023–1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958–0.983), fatigue (HR: 1.127, 95% CI: 1.009–1.258), ascites (HR: 1.190, 95% CI: 1.057–1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140–1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291–1.769), heart rate (HR: 1.003, 95% CI: 1.001–1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993–0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008–1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220–1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223–1.690), serum sodium (HR: 0.980, 95% CI: 0.972–0.988), serum albumin (HR: 0.981, 95% CI: 0.971–0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073–1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183–1.614), diabetes (HR: 1.118, 95% CI: 1.010–1.237), stroke (HR: 1.252, 95% CI: 1.121–1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626–0.814), β-blockers (HR: 0.673, 95% CI: 0.588–0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604–0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646–0.965), spironolactone (HR: 0.814, 95% CI: 0.663–0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531–0.733), nitrates (HR: 0.715, 95% CI: 0.631–0.811), and digoxin (HR: 0.579, 95% CI: 0.465–0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.     

Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic

CONTEXT: Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic dysfunction and CHF in the community remain undefined. OBJECTIVES: To determine the prevalence of CHF and preclinical diastolic dysfunction and systolic dysfunction in the community and determine if diastolic dysfunction is predictive of all-cause mortality. DESIGN, SETTING, PARTICIPANTS: Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. MAIN OUTCOME MEASURES: Doppler echocardiographic assessment of systolic and diastolic function. Presence of CHF diagnosis by review of medical records with designation as validated CHF if Framingham criteria are satisfied. Subjects without a CHF diagnosis but with diastolic or systolic dysfunction were considered as having either preclinical diastolic or preclinical systolic dysfunction. RESULTS: The prevalence of validated CHF was 2.2% (95% confidence interval [CI], 1.6%-2.8%) with 44% having an EF higher than 50%. Overall, 20.8% (95% CI, 19.0%-22.7%) of the population had mild diastolic dysfunction, 6.6% (95% CI, 5.5%-7.8%) had moderate diastolic dysfunction, and 0.7% (95% CI, 0.3%-1.1%) had severe diastolic dysfunction with 5.6% (95% CI, 4.5%-6.7%) of the population having moderate or severe diastolic dysfunction with normal EF. The prevalence of any systolic dysfunction (EF < or =50%) was 6.0% (95% CI, 5.0%-7.1%) with moderate or severe systolic dysfunction (EF < or =40%) being present in 2.0% (95% CI, 1.4%-2.5%). CHF was much more common among those with systolic or diastolic dysfunction than in those with normal ventricular function. However, even among those with moderate or severe diastolic or systolic dysfunction, less than half had recognized CHF. In multivariate analysis, controlling for age, sex, and EF, mild diastolic dysfunction (hazard ratio, 8.31 [95% CI, 3.00-23.1], P<.001) and moderate or severe diastolic dysfunction (hazard ratio, 10.17 [95% CI, 3.28-31.0], P<.001) were predictive of all-cause mortality. CONCLUSIONS: In the community, systolic dysfunction is frequently present in individuals without recognized CHF. Furthermore, diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognized CHF, and associated with marked increases in all-cause mortality.     

APACHE Ⅳ评分系统在内科重症监护室不同患者群体使用的比较

 【目的】 评估并比较APACHE Ⅳ评分系统在内科重症监护室对于不同群体患者预后的预测效力。【方法】 回顾性资料收集2005年3月至2010年12月入住我院内科ICU患者的病历资料450例。计算入院24 h内的APACHE Ⅳ评分及预测死亡率,通过标准化死亡比值(SMR)来评估其对总体患者及不同群体患者死亡率的预测准确性。【结果】 本研究共纳入450例患者,死亡率为34.9%。APACHE Ⅳ评分为(61 ± 26)分,预测死亡率为28.03%。APACHE Ⅳ预测的死亡率显著低于实际死亡率(SMR分别为1.24,95% CI 1.13 ~ 1.39)。对不同疾病、不同死亡风险、不同年龄的患者,APACHE Ⅳ评分系统预测死亡率的准确性均不一致。对呼吸系统患者的死亡率存在低估(SMR = 1.44,95%CI 1.34 ~ 1.52),尤其是对重症肺炎患者。APACHE Ⅳ低估了低风险及中间组患者的死亡率(SMR = 1.57,95%CI 1.45 ~ 1.72;SMR = 1.40,95%CI 1.34 ~ 1.46),而在高风险组预测死亡率准确性高(SMR = 1.02,95% CI 0.97 ~ 1.08)。对年龄 < 70岁的患者,APACHE Ⅳ也明显低估死亡率(SMR = 1.33,95% CI 1.18 ~ 1.52),但对于>70岁的患者预测准确(SMR = 1.10,95%CI 0.96 ~ 1.33)。【结论】 在内科ICU对APACHE Ⅳ进行验证,其对总体患者的死亡率存在低估,主要是对呼吸系统疾病、低风险组及年龄 < 70岁等患者的死亡风险呈现低估。     

Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG

CONTEXT: Both attenuated heart rate recovery following exercise and the Duke treadmill exercise score have been demonstrated to be independent predictors of mortality, but their prognostic value relative to each other has not been studied. OBJECTIVE: To assess the associations among abnormal heart rate recovery, treadmill exercise score, and death in patients referred specifically for exercise electrocardiography. DESIGN AND SETTING: Prospective cohort study conducted in an academic medical center between September 1990 and December 1997, with a median follow-up of 5.2 years. PATIENTS: A total of 9454 consecutive patients (mean [SD] age, 53 [11] years; 78% male) who underwent symptom-limited exercise electrocardiographic testing. Exclusion criteria included age younger than 30 years, history of heart failure or valvular disease, pacemaker implantation, and uninterpretable electrocardiograms. MAIN OUTCOME MEASURES: All-cause mortality, as predicted by abnormal heart rate recovery, defined as failure of heart rate to decrease by more than 12/min during the first minute after peak exercise, and by treadmill exercise score, defined as (exercise time) - (5 x maximum ST-segment deviation) - (4 x treadmill angina index). RESULTS: Three hundred twelve deaths occurred in the cohort. Abnormal heart rate recovery and intermediate- or high-risk treadmill exercise score were present in 20% (n = 1852) and 21% (n = 1996) of patients, respectively. In univariate analyses, death was predicted by both abnormal heart rate recovery (8% vs 2% in patients with normal heart rate recovery; hazard ratio [HR], 4.16; 95% confidence interval [CI], 3.33-5.19; chi(2) = 158; P<.001) and intermediate- or high-risk treadmill exercise score (8% vs 2% in patients with low-risk scores; HR, 4.28; 95% CI, 3.43-5.35; chi(2) = 164; P<.001). After adjusting for age, sex, standard cardiovascular risk factors, medication use, and other potential confounders, abnormal heart rate recovery remained predictive of death (among the 8549 patients not taking beta-blockers, adjusted HR, 2.13; 95% CI, 1.63-2.78; P<.001), as did intermediate- or high-risk treadmill exercise score (adjusted HR, 1. 49; 95% CI, 1.15-1.92; P =.002). There was no interaction between these 2 predictors. CONCLUSIONS: In this cohort of patients referred specifically for exercise electrocardiography, both abnormal heart rate recovery and treadmill exercise score were independent predictors of mortality. Heart rate recovery appears to provide additional prognostic information to the established treadmill exercise score and should be considered for routine incorporation into exercise test interpretation. JAMA. 2000;284:1392-1398.     

Impact of Heat Wave in 2005 on Mortality in Guangzhou,China

ObjectiveTo assess the impact of the heat wave in 2005 on mortality among the residents in Guangzhou and to identify susceptible subpopulations in Guangzhou, China.MethodsThe data of daily number of deaths and meteorological measures from 2003 to 2006 in Guangzhou were used in this study. Heat wave was defined as ≥7 consecutive days with daily maximum temperature above 35.0 °C and daily mean temperature above the 97th percentile during the study period. The excess deaths and rate ratio (RR) of mortality in the case period compared with the reference period in the same summer were calculated.ResultsDuring the study period, only one heat wave in 2005 was identified and the total number of excess deaths was 145 with an average of 12 deaths per day. The effect of the heat wave on non-accidental mortality (RR=1.23, 95% CI: 1.11-1.37) was found with statistically significant difference. Also, greater effects were observed for cardiovascular mortality (RR=1.34, 95% CI: 1.13-1.59) and respiratory mortality (RR=1.31, 95% CI: 1.02-1.69). Females, the elderly and people with lower socioeconomic status were at significantly higher risk of heat wave-associated mortality.ConclusionThe 2005 heat wave had a substantial impact on mortality among the residents in Guangzhou, particularly among some susceptible subpopulations. The findings from the present study may provide scientific evidences to develop relevant public health policies and prevention measures aimed at reduction of preventable mortality from heat waves.     

急性心力衰竭患者住院期间发生心血管不良事件风险预测模型的构建与验证

目的 分析急性心力衰竭（AHF）患者住院期间心血管不良事件发生的主要影响因素,构建心血管不良事件风险预测模型并进行验证。方法 回顾性选取2021年2月—2022年2月宁夏医科大学总医院心脑血管病医院收治的515例AHF患者,根据患者住院期间是否发生心血管不良事件将其分为发生组与未发生组。采用R 4.2.1统计软件对两组各项指标进行单因素Logistic分析并进行Lasso回归初步筛选,再经多因素一般Logistic回归分析确定预测变量,构建AHF患者住院期间心血管不良事件预测模型,并通过绘制列线图、受试者工作特征（ROC）曲线及校准曲线对模型的性能进行评价,最后采用Bootstrap法对模型进行内部验证。结果 515例AHF患者中有62例发生心血管不良事件。心血管不良事件发生组与未发生组的冠心病、扩心病、脑卒中、睡眠差、呼吸频率、合并心房颤动（以下简称房颤）比较,差异均有统计学意义（P <0.05）;先后经单因素Logistic分析及Lasso回归初步筛选变量后,最终通过多因素一般Logistic回归分析确定AHF患者住院期间发生心血管不良事件的主要影响因素为脑卒中［O^R=7.99（95% CI：3.29,19.59）］、白细胞计数［O^R=1.25（95% CI：1.00,1.52）］、血尿素氮［O^R=1.13（95% CI：1.04,1.23）］、D-二聚体［O^R=1.13（95% CI：1.03,1.24）］、左心室短轴缩短率［O^R=0.89（95% CI：0.81,0.96）］、合并房颤［O^R=2.40（95% CI：1.07,5.31）］。基于以上6个影响因素构建风险预测列线图模型,结果显示,模型的ROC曲线下面积（AUC）为0.82（95% CI：0.76,0.88）,校准曲线贴近理想曲线。经Bootstrap法内部验证所得AUC值为0.81（95% CI：0.75,0.87）。结论 AHF患者住院期间发生心血管不良事件的主要影响因素是脑卒中、白细胞计数、血尿素氮、D-二聚体、左心室短轴缩短率、合并房颤,以此构建的心血管不良事件风险预测模型具有良好的效能。     

高剂量氯吡格雷对急性冠脉综合征患者行介入术后临床疗效和安全性的评价

目的 对比高剂量与标准剂量氯吡格雷在急性冠脉综合征患者介入术后治疗中的临床效果和安全性。 方法 纳入2013年2月-2015年12月期间收治的急性冠脉综合征的患者270例,按治疗时氯吡格雷用量情况分为2组,其中双倍剂量组120例,标准剂量组150例。双倍剂量组给予氯吡格雷150 mg每日口服,标准剂量组给予75 mg每日口服。比较2组支架内血栓事件、全因死亡以及出血事件的发生情况。 结果 2组比较总事件发生率差异无统计学意义(P>0.05),其中支架内血栓事件发生率与死亡率差异均无统计学意义(P>0.05);而双倍剂量组总出血事件显著高于标准剂量组(P<0.001),且其中的小出血事件(P=0.008)及轻微出血事件均分别高于标准剂量组(P<0.001)。Cox回归分析,调整年龄、性别、血糖、血脂、血压、心率、疾病史等因素后,双倍剂量组较标准剂量组并未降低总事件风险(HR=1.32,95%CI: 0.83~1.89,P=0.654);但增加了出血事件风险(HR=2.52,95%CI: 1.13~3.03)。 结论 在急性冠脉综合征患者介入术后治疗中,高剂量氯吡格雷较标准剂量氯吡格雷并未降低支架内血栓事件及全因死亡率,但却显著增加了出血事件风险。