搜索结果：Vascular medicine (London, England)

The American Heart Association (AHA) Life's Essential 8 (LE8) provides a means of scoring cardiovascular health but has yet to be correlated with vascular function in an African American cohort. In a sample of Jackson Heart Study participants (N = 2186, mean age 57 years, 65% women), LE8 scores were calculated per AHA guidelines at baseline visits (2000-2004). Noninvasive vascular assessments were performed within an ancillary study (2012-2017). Tests included carotid-femoral pulse wave velocity, carotid-brachial pulse wave velocity, carotid-radial pulse wave velocity, central pulse pressure, forward pressure wave, and characteristic impedance, as well as brachial artery baseline and hyperemic flow velocities. Linear regression models, adjusted for age, age squared, sex, and heart rate, assessed the associations of LE8 composite and component scores with vascular function. A higher LE8 score was associated with lower carotid-femoral pulse wave velocity (&#x3b2; = -0.32; 95% CI: -0.42, -0.21; p < 0.0001), characteristic impedance (&#x3b2; = -0.57; 95% CI: -0.93, -0.20; p = 0.0024), forward pressure wave amplitude (&#x3b2; = -0.21; 95% CI: -0.26, -0.16; p < 0.0001), central pulse pressure (&#x3b2; = -0.25; 95% CI: -0.32, -0.19; p < 0.0001), and brachial baseline flow velocity (&#x3b2; = -0.013; 95% CI: -0.023, -0.002; p = 0.021). Higher LE8 scores were associated with higher brachial hyperemic flow velocity (&#x3b2; = 0.095; 95% CI: 0.035, 0.15; p = 0.0018). Blood glucose and blood pressure were the components most significantly associated with vascular function. Our findings support the concept that a healthy lifestyle is predictive of better vascular function. Future longitudinal studies are warranted to investigate whether improving LE8 scores leads to improved vascular function.

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Real world data are increasingly used to evaluate revascularisation outcomes in chronic limb threatening ischaemia (CLTI). However, variation in data availability, accuracy, completeness, and granularity may influence the validity of outcome measurement. This review mapped outcomes reported in real world studies of CLTI revascularisation, examined how data infrastructure limitations affected outcome measurement and developed a framework for appraising the validity of reported outcomes. This was a scoping review of observational studies evaluating CLTI revascularisation using standalone or linked national registry, administrative, and insurance based datasets. MEDLINE and Embase were systematically searched (2015 - 2025) for eligible studies. Extracted information included data source(s), country, outcome definitions, reporting frequency, time period(s) covered, and linkage status. Outcome measurement issues were assessed in relation to data infrastructure characteristics. Fifty five studies from 10 countries reported 293 outcomes (31 unique). Reporting was dominated by mortality, major amputation, and reintervention, collectively accounting for 47% of all reported outcomes. Composite outcomes including amputation free survival, major adverse limb events, and major adverse cardiovascular events contributed a further 19%. Outcome definitions were heterogeneous, with 22 definitions of reintervention identified. Linkage with civic death registers improved mortality ascertainment. Amputation and reintervention event capture was most robust in data infrastructures supporting granular limb specific procedural analysis. Patient reported outcome measures, patency, and wound healing were infrequently reported. Linkage between registries, administrative datasets and death registers strengthened reliability of long term outcome measurement. A framework for appraising real world studies of CLTI revascularisation reflects these observations. Outcome validity in real world studies of CLTI revascularisation is influenced by the characteristics of the underlying data infrastructures, particularly coding granularity and linkage capability. Greater standardisation of outcome definitions and improved integration of data infrastructures are required to support more reliable and interpretable real world evidence in CLTI.

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Cardiovascular disease (CVD) mortality is rising in Sierra Leone, but the health-system drivers of this trend are not well characterised. We mapped health-system barriers and facilitators for CVD care in Sierra Leone using a systems lens tied to universal health coverage (UHC). We conducted a scoping review following PRISMA-ScR guidelines. We searched MEDLINE, Embase, Scopus, Global Health, and African Journals Online (1 Jan 2000 - 10 May 2025), Of 498 unique records, we included 40 sources reporting CVD-relevant data. Findings were mapped to WHO health-system building blocks, and synthesised narratively. Our findings show a health system shaped by path dependence: investments in infectious disease programmes have strengthened vertical delivery platforms with limited integration of non-communicable disease services. Facility readiness averaged 41% for HIV services versus 16.8% for cardiovascular care. An urban risk paradox was identified: urbanisation increased the odds of hypertension (OR 1.46) and diabetes (OR 1.84), while primary care infrastructure remained more oriented toward rural maternal health. Service delivery was undermined by diagnostic gaps; limited access to neuroimaging for stroke was associated with a threefold increase in mortality. High out-of-pocket costs narrowed effective coverage toward wealthier groups, and recurrent medicine stockouts reinforced distrust and disengagement from formal care. Scalable enablers included task-sharing, digital tools, pooled procurement, and community engagement. Strengthening task-shared primary care, ring-fenced CVD budgets, pooling drug procurement, and improving digital infrastructure could accelerate UHC-effective coverage in Sierra Leone. Evidence on cost-effectiveness and socio-cultural determinants remains limited and should guide implementation research. Heart diseases are a major cause of death in Sierra Leone. However,&#xa0;the health system is still mainly designed to respond to infectious diseases including malaria and HIV, rather than long-term conditions&#xa0;like heart disease. In this review, we analysed 40 studies to understand why people often struggle to get proper heart disease care. We found that health facilities were much better prepared to deliver HIV services (41% readiness) than heart disease services (17% readiness). High blood pressure and other heart disease risks are increasing, especially with urbanisation. However, services for heart disease are not always available where people need them most. Many people still face long travel distances, limited services at nearby clinics, and poor availability of medicines, equipment, and trained staff. Unlike HIV care, heart disease&#xa0;care often requires out-of-pocket payments, which delays treatment until emergencies such as stroke happen. Solutions include adapting HIV infrastructure for heart disease&#xa0;care and lowering costs.

Pulmonary arterial hypertension therapies have not been systematically studied in early disease stages, despite potential benefit. Is riociguat safe, well tolerated, and potentially effective in early pulmonary vascular disease? This was a prospective, multicenter, double-blind phase 2a trial. Adults with early pulmonary vascular disease, defined as mean pulmonary arterial pressure &#x2265; 25 mm Hg with pulmonary vascular resistance (PVR) &#x2265; 2 to < 3 Wood units (WU), or mean pulmonary arterial pressure 21 to < 25 mm Hg with PVR &#x2265; 2 WU, were randomized to receive 1:1 riociguat or placebo for 24 weeks. The primary end point was change in PVR from baseline to week 24. Secondary end points, evaluated hierarchically, comprised changes in cardiac index, total pulmonary resistance, diffusing capacity of the lung for carbon monoxide, 6-minute walking distance, World Health Organization functional class, and quality of life. Complementary parameters were analyzed in an exploratory manner, and safety was monitored throughout. Of 261 prescreened patients, 35 eligible patients were randomized to treatment (97% female; mean age, 65.5 &#xb1; 6.9 years; 77.1% connective tissue disease-associated pulmonary arterial hypertension); 32 completed the trial. Reasons for ineligibility were documented. Riociguat significantly improved the primary end point of change in PVR (riociguat -0.73 &#xb1; 0.67 WU vs placebo -0.02 &#xb1; 0.67 WU; P = .043; 27% placebo-adjusted reduction). No significant differences were observed in secondary end points. Of the exploratory end points, only cardiac output showed a trend toward improvement under riociguat (0.35 &#xb1; 0.86 L/min vs placebo -0.19 &#xb1; 0.75 L/min; P = .084). Only mild to moderate adverse events were observed, and serious events were not considered treatment related. Despite the limited number of participants, treatment with riociguat was safe and significantly improved the primary end point PVR over 24 weeks. ClinicalTrials.gov; No.: NCT05339087; URL: www. gov).

The 2021 ESC guidelines on cardiovascular (CV) disease prevention recommend the SMART-REACH lifetime risk model to guide treatment decisions in patients with established atherosclerotic CV disease. The aim was to develop the SMART-REACH2 model for estimating lifetime risk of recurrent CV events and treatment benefits in patients with established atherosclerotic CV disease, with systematic recalibration to the four European and other global risk regions. SMART-REACH2 was derived in 8708 individuals aged 40-90 years with coronary, cerebrovascular, peripheral artery disease and/or abdominal aortic aneurysm from the UCC-SMART cohort. Sex-stratified, cause-specific Cox models for recurrent CV events and non-CV death were fitted using age as timescale and routinely available predictors. Recurrent CV events were defined as a composite of myocardial infarction, stroke, or CV death. Recalibration was based on representative cohorts per risk region. External validation was performed in 2 085 780 patients from 54 countries; model performance was assessed by calibration plots and Harrell's C-statistic. In the derivation cohort, 2057 recurrent CV events occurred over a median follow-up of 8.5 years (25th-75th: 4.3-13.0). In external validation, 307 706 events occurred. The pooled C-statistic was 0.68 (95% confidence interval 0.66-0.69) and ranged from 0.66 (0.64-0.69) for European low-risk region up to 0.72 (0.66-0.78) for Latin America, with adequate calibration across risk regions. Performance was consistent across sexes and CV disease subtypes. Using SMART-REACH2, estimated potential gains in CV disease-free life expectancy for a 50-year-old example patient receiving intensified preventive treatment (15 mmHg systolic blood pressure and 1.0 mmol/L low-density lipoprotein cholesterol reduction) ranged from 2 years in the low-risk region to 4.4 years in the very-high-risk region. The updated SMART-REACH2 model accounts for geographical and sex-specific variations and allows estimation of short-term and lifetime risk of recurrent CV events and treatment benefits, facilitating shared decision-making as recommended by guidelines.

Pulmonary embolism response teams (PERTs) are multidisciplinary care teams that perform rapid assessment and recommendations for patients with pulmonary embolism (PE). Challenges in creating and maintaining a PERT include physician buy-in and availability at all hours. One potential solution is to share PE interventions across specialty services. Patients with acute PE who received a PERT consultation and subsequent mechanical thrombectomy (MT) were included in this single-center, retrospective study. Patients from January 2021 to June 2024 were divided into two cohorts: one that received MT from interventional radiology (IR) and another that received MT from vascular surgery (VS). Outcomes included 30-day mortality, bleeding, 6-minute follow-up walk distance, time to intervention, total procedure time, and complication rates. A total of 76 patients were included in this analysis. IR and VS performed 61.8% (n = 47) and 38.2% (n = 29) of MTs, respectively. Of patients treated with MT, 46.1% (n = 35) had high-risk status and 53.9% (n = 41) had intermediate-high-risk status. In patients who received MT from IR, there was a 6.4% (three of 47) 30-day mortality rate compared to 6.9% (two of 29) from VS (p = 0.938). The occurrence of complications after MTs performed by IR and VS were 4.3% (two of 47) and 6.9% (two of 29), respectively (p = 0.792). Major procedure-related adverse events were 4.3% (two of 47) for IR and 6.9% (two of 29) for VS (p = 0.792). Outcomes of PE thrombectomy did not differ by whether the proceduralist was IR or VS. Intervention-sharing among different provider groups within PERTs could alleviate provider burden and make response team implementation more feasible.

A prior retrospective single-center study involving patients with chronic limb-threatening ischemia (CLTI) demonstrated that sciatic nerve atrophy (SNA) is associated with impaired wound healing (IWH) and reduced amputation-free survival (AFS). We conducted a prospective single-center pilot study to validate the prognostic implications of SNA in predicting wound healing and AFS. Patients diagnosed with CLTI and associated tissue loss were recruited for participation in this prospective, noninterventional study. The cross-sectional area (CSA) of the sciatic nerve at the mid-to-lower femoral quarter was quantified utilizing computed tomography imaging. SNA was identified based on the predefined CSA threshold. Patient outcomes were evaluated through outpatient clinic visits and telephone follow-ups. Outcomes assessed included wound healing rate, adverse wound outcomes (AWO), and AFS. In the cohort of 52 limbs with CLTI from 52 patients, 19 individuals were categorized into the SNA group. The 6-month wound healing rate was significantly lower in the SNA group (15.8%) compared to the normal group (87.9%) (p < 0.001). The sensitivity and specificity of SNA for predicting AWO at 6 months were 80.0% and 90.6%, respectively. Patients in the SNA group had significantly lower AFS at 1 year (68.4% vs 93.9%, p = 0.011). Multivariable analysis further established that SNA was an independent prognostic factor for both AWO (hazard ratio [HR]: 0.113; 95% CI: 0.034-0.381; p < 0.001) and AFS (HR: 6.135; 95% CI: 1.236-30.303; p = 0.026) following endovascular therapy (EVT). SNA was identified as a predictor for AWO and AFS in patients with CLTI after EVT. Future research should involve rigorous basic and large-scale clinical studies to elucidate the association between SNA and prognosis in patients with peripheral artery disease (PAD)/CLTI and explore the underlying pathophysiological mechanisms.

Patients with cancer usually report limitations of their functional capacity, which may range from subclinical impairment of cardiopulmonary exercise reserve to poor quality of life with physical, cognitive, or psychosocial consequences. Exercise training is a potent multi-targeted approach to control pre-existing and new risk factors. Preliminary evidence shows that it is associated with a lower risk of cancer therapy-related cardiotoxicity and increased self-reported well-being in patients with cancer. Current evidence demonstrates that supervised exercise therapy, including high-intensity interval training, is safe and well-tolerated and reduces risk in subjects with cancer in the pre-, active-, and post-treatment settings. The present consensus document will discuss the role of exercise training in cardio-oncology, focusing on patients with cardiovascular diseases induced by cancer treatment and on those who received cardiotoxic therapies.

Hemodynamic failure, defined as insufficient postprocedural improvement in limb perfusion, occurs frequently after endovascular therapy (EVT). However, the predictors of hemodynamic failure and its clinical course have not been adequately investigated. This study aimed to investigate the predictors and clinical course of chronic limb-threatening ischemia (CLTI) with hemodynamic failure after EVT. This retrospective, multicenter analysis of the SAPLING database included 924 patients with CLTI and tissue loss who underwent EVT between April 2010 and March 2023, with skin perfusion pressure (SPP) measured pre- and postprocedure. Hemodynamic failure was defined as postprocedural SPP < 40 mmHg. Kaplan-Meier analysis evaluated cumulative wound healing, reintervention, and wound recurrence. Logistic regression and Cox proportional hazards models identified predictors of hemodynamic failure and wound healing. Hemodynamic failure occurred in 52.2% (482/924) of cases. Multivariable analysis identified lower preprocedural SPP and the absence of wound blush as independent predictors. Stratified analysis revealed the highest hemodynamic failure rate in patients with preprocedural SPP < 20 mmHg and absent wound blush (66.5%). Patients with hemodynamic failure showed significantly lower wound healing rates and higher rates of reintervention and wound recurrence (all p < 0.05). Factors independently associated with delayed wound healing included age &#x2a7e; 75 years, nonambulatory status, hemodialysis, hemodynamic failure, Wound, Ischemia, and foot Infection (WIfI) stage 4, and the absence of wound blush. Hemodynamic failure after EVT was common and strongly associated with delayed wound healing, reintervention, and wound recurrence. Preprocedural SPP and wound blush assessment may be useful for identifying patients at high risk for hemodynamic failure.

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Functional outcomes in patients with acute ischemic stroke due to large-vessel occlusion who undergo thrombectomy remain suboptimal, and the benefits of intra-arterial alteplase after thrombectomy remain uncertain. To investigate whether treatment with intra-arterial alteplase after successful endovascular reperfusion improves functional outcomes among patients with acute, anterior-circulation, large-vessel occlusion stroke. This multicenter, randomized clinical trial recruited patients with anterior-circulation, large-vessel occlusion stroke within 24 hours of symptom onset who achieved successful reperfusion (expanded Thrombolysis in Cerebral Infarction scale score of &#x2265;2b50) after thrombectomy. Guideline-based intravenous thrombolysis was allowed. Patients were randomized between August 1, 2023, and October 16, 2024, and the trial was conducted at 28 hospitals in China. Final follow-up occurred on January 7, 2025. Intra-arterial alteplase treatment (n&#x2009;=&#x2009;164) with 0.225 mg/kg (maximum dose of 20 mg) vs standard treatment (n&#x2009;=&#x2009;160). The primary outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days (score range, 0 [no symptoms] to 6 [death]; a score of 0 or 1 indicates an excellent outcome). The safety outcomes included symptomatic intracranial hemorrhage within 36 hours of randomization, all-cause mortality within 90 days, and any intracranial hemorrhage within 36 hours. Of the 324 patients randomized (median age, 68 years [IQR, 58-75 years]; 99 were female [30.6%]), 1 patient in each group was lost to follow-up. The proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days was 44.8% (73/163) in the intra-arterial alteplase group vs 30.2% (48/159) in the standard treatment group (adjusted risk ratio [RR], 1.45 [95% CI, 1.08-1.96]; P&#x2009;=&#x2009;.01). The proportion of patients with symptomatic intracranial hemorrhage within 36 hours was 4.3% (7/164) in the intra-arterial alteplase group vs 5.0% (8/160) in the standard treatment group (adjusted RR, 0.85 [95% CI, 0.43-1.69]; P&#x2009;=&#x2009;.67). The proportion of patients with all-cause mortality within 90 days was 17.1% (28/164) in the intra-arterial alteplase group vs 11.3% (18/160) in the standard treatment group (adjusted hazard ratio, 1.60 [95% CI, 0.88-2.89]; P&#x2009;=&#x2009;.12). The proportion of patients with any intracranial hemorrhage within 36 hours was 32.9% (54/164) in the intra-arterial alteplase group vs 26.9% (43/160) in the standard treatment group (adjusted RR, 1.22 [95% CI, 0.92-1.63]; P&#x2009;=&#x2009;.17). Among patients with acute, anterior-circulation, large-vessel occlusion stroke who achieved successful endovascular reperfusion by mechanical thrombectomy, intra-arterial alteplase resulted in a higher likelihood of excellent outcomes at 90 days. The incidence of all-cause mortality and any intracranial hemorrhage was higher in patients who received intra-arterial alteplase, although these differences were not statistically significant. ClinicalTrials.gov Identifier: NCT05856851.

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Eisenmenger syndrome (ES) is an advanced form of pulmonary arterial hypertension associated with congenital heart disease, marked by pulmonary vascular disease and right-to-left or bidirectional shunting. Although vascular remodeling is central, lung involvement is still underrecognized. This review describes pulmonary and related aspects that accompany ES and their contribution to symptoms, prognosis, and management. A restrictive pattern is common on function testing, whereas obstructive defects and bronchial hyperresponsiveness may occur even without typical risk factors. Diffusion impairment related to vascular disease is frequent and linked to reduced exercise capacity and worse survival. Exercise intolerance reflects the combined effects of pulmonary vascular disease, shunt-related hypoxemia, and ventilation-perfusion mismatch, which increase ventilatory demand, promote early anaerobic metabolism, and reduce peak oxygen uptake. Cardiopulmonary exercise testing and the 6-minute walk test provide prognostic information, with peak oxygen consumption emerging as the strongest predictor. An additional complication is marked pulmonary artery dilatation, predisposing to in situ thrombosis and compressive syndromes. Hemoptysis, often bronchial in origin, requires a structured emergency pathway. Lower respiratory tract infections are relatively common and may increase morbidity and mortality. Long-term oxygen therapy provides limited benefit because hypoxemia is mainly shunt-driven; supervised rehabilitation is safe and can improve functional capacity. In advanced disease refractory to treatment, bilateral lung or heart-lung transplantation remains the only definitive option, despite suboptimal outcomes. ES is a multisystem disorder in which pulmonary abnormalities meaningfully influence symptoms and prognosis; systematic lung assessment can refine risk stratification and support individualized supportive care by integrated cardiology-pulmonology teams.