BMC Cardiovascular Disorders[JOURNAL]
Sun
200 papers
Recruitment capacity and operational barriers to prehospital cardiac electrical biomarker acquisition: an ambulance-based pilot study.
Nicolet A, Suppan L, Stuby L
BMC Cardiovasc Disord · 2026 Jun · PMID 42350957 · Full text
BACKGROUND: In prehospital settings, myocardial infarction (MI) diagnosis relies on symptoms and electrocardiogram (ECG) analysis. The cardiac electrical biomarker (CEB) has been developed to quantify abnormal multipolar...
BACKGROUND: In prehospital settings, myocardial infarction (MI) diagnosis relies on symptoms and electrocardiogram (ECG) analysis. The cardiac electrical biomarker (CEB) has been developed to quantify abnormal multipolar electrical activity through a 12-lead ECG, reflecting ischemia-related cellular disruption. This study primarily aimed to assess recruitment capacity and operational feasibility for a future large-scale prospective prehospital study involving CEB measurements. Secondary objectives were to describe successful CEB acquisition and to identify practical barriers to data collection in the prehospital environment. METHODS: This pilot study was a secondary analysis of prospectively collected observational data from the "Ambulance Région de Bienne" service (covering 120,000 inhabitants) between March and September 2023. Adult patients managed for suspected acute coronary syndrome who underwent a prehospital 12-lead ECG with attempted CEB acquisition and were subsequently admitted to the Biel Hospital Centre were eligible. Analyses were descriptive and focused on feasibility-related endpoints. RESULTS: A total of 70 patients were identified, of whom 60 met eligibility criteria. Regarding recruitment feasibility, a mean enrolment rate of 7.7 patients per month was observed, corresponding to roughly one patient per 70 prehospital missions. Regarding operational experience with CEB acquisition, technical and practical barriers were identified, including telemetry connectivity issues, workflow constraints, and documentation limitations. Successful CEB acquisition was variable; however, the true failure rate could not be reliably determined due to incomplete systematic documentation of all attempted acquisitions. CONCLUSIONS: Recruitment of eligible patients for a future large-scale study appears potentially feasible, with an observed rate of 7.7 patients per month within this single EMS. However, while operational barriers were identified, reliable CEB acquisition could not be assessed due to incomplete capture of failed acquisition attempts. These findings primarily inform study design and implementation strategy for future investigations.
Cardioprotective effects of right stellate ganglion block combined with dexmedetomidine in rats with atrial fibrillation-like atrial tachyarrhythmia.
Xu R, Zhang J, Guo Q … +3 more , Zheng D, Zhang X, Wang L
BMC Cardiovasc Disord · 2026 Jun · PMID 42350955 · Full text
OBJECTIVE: To evaluate right stellate ganglion block (SGB) plus dexmedetomidine (Dex) in a rat model of atrial fibrillation-like (AF-like) atrial tachyarrhythmia. METHODS: Male Sprague-Dawley rats were assigned to Sham,...
OBJECTIVE: To evaluate right stellate ganglion block (SGB) plus dexmedetomidine (Dex) in a rat model of atrial fibrillation-like (AF-like) atrial tachyarrhythmia. METHODS: Male Sprague-Dawley rats were assigned to Sham, AF, AF+amiodarone, AF + SGB and AF + SGB+Dex groups. AF-like atrial tachyarrhythmia was induced by daily CaCl₂-acetylcholine injections for 7 days, and interventions were administered 1 h before modelling. ECG, echocardiography, electrophysiology, histology, ELISA, Western blot/qPCR, immunofluorescence and electron microscopy were performed. RESULTS: Compared with the AF group, SGB + Dex reduced arrhythmia duration (5.0 ± 1.5 vs. 16.3 ± 2.5 s, p < 0.001) and ventricular rate (344.3 ± 19.9 vs. 398.1 ± 19.2 bpm, p = 0.004), preserved LVEF (83.3% ± 9.2% vs. 72.2% ± 6.7%, p = 0.032), attenuated left atrial enlargement and fibrosis, partially reversed effective refractory period shortening, reduced inducibility, decreased collagen I/III, TGF-β1 and TNF-α, and altered SK2 expression in the stellate ganglion. Direct SGB versus SGB + Dex comparisons were not statistically significant across most major endpoints. CONCLUSION: Right SGB + Dex was associated with attenuation of electrical and structural remodelling in this AF-like atrial tachyarrhythmia model. These findings support a protective SGB-based strategy but remain associative. Because no Dex-only group was included, the independent contribution of Dex and the incremental benefit of adding Dex to SGB require further investigation.
Thrombectomy reduces femoral vein valve damage after acute iliofemoral vein thrombosis: a combined retrospective and prospective cohort study.
Wang Y, Yang Y, Wang S … +3 more , Zhao L, Zhang J, Chen Z
BMC Cardiovasc Disord · 2026 Jun · PMID 42343239 · Full text
BACKGROUND: Acute iliofemoral deep vein thrombosis (IFDVT) often leads to femoral vein valve incompetence and post-thrombotic syndrome (PTS). This study evaluated whether thrombus volume reduction surgery (TVRS) is assoc...
BACKGROUND: Acute iliofemoral deep vein thrombosis (IFDVT) often leads to femoral vein valve incompetence and post-thrombotic syndrome (PTS). This study evaluated whether thrombus volume reduction surgery (TVRS) is associated with better valve function preservation compared with simple anticoagulation (SA) in patients with acute IFDVT. METHODS: A combined retrospective and prospective cohort study involving 504 patients with acute IFDVT compared TVRS (n = 238) and SA (n = 266). The primary outcome was the femoral vein valve preservation rate at 12 months. Secondary outcomes included PTS incidence and quality of life. Subgroup analysis compared two pharmacomechanical thrombectomy devices: AngioJet and Acostream. Propensity score matching (1:1 nearest neighbor, caliper 0.05), inverse probability of treatment weighting, and E-value sensitivity analysis were employed to address confounding. An exploratory mediation analysis (hypothesis-generating) examined whether valve preservation potentially mediates the association between TVRS and PTS reduction. RESULTS: The TVRS group showed a significantly higher valve preservation rate (75.8% vs. 43.9%, P < 0.001) and a lower incidence of moderate-to-severe PTS (13.6% vs. 34.8%, P = 0.002) compared with the SA group. TVRS patients also achieved better quality of life scores with comparable safety profiles. In a pre-specified, exploratory subgroup analysis of patients who underwent PMT with complete ultrasound follow-up data (n = 50 per device), AngioJet appeared to be associated with a higher valve preservation rate compared with Acostream (82% vs. 70%, P = 0.04), although this comparison was underpowered, non-randomized, and should be considered strictly hypothesis-generating. CONCLUSIONS: TVRS was associated with improved femoral vein valve preservation, lower PTS incidence, and enhanced quality of life compared with SA. The AngioJet system may be associated with better valve protection than the Acostream system, but this finding is exploratory and requires validation in randomized trials. These observations support the hypothesis that early thrombectomy intervention may be beneficial for long-term venous function, but cannot establish causality.
Prevalence and risk factors of atrial fibrillation in type 2 diabetes mellitus: a hospital-based cross-sectional study.
Koowattanatianchai S, Rangsrisaeneepitak V, Pheugphoolphol B … +2 more , Kaladee K, Kreepala C
BMC Cardiovasc Disord · 2026 Jun · PMID 42343237 · Full text
BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with adverse cardiovascular outcomes. In type 2 diabetes mellitus (T2DM), AF further increases the risk of heart failure, str...
BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with adverse cardiovascular outcomes. In type 2 diabetes mellitus (T2DM), AF further increases the risk of heart failure, stroke, and premature death. However, epidemiological data in Asian populations remain limited. This study aimed to clarify the prevalence and identify risk factors of AF among patients with T2DM. METHODS: We conducted a hospital-based cross-sectional study using retrospectively collected medical records. AF was identified from physician documentation with electrocardiographic confirmation, including paroxysmal, persistent, and permanent types. Demographic, clinical, and laboratory variables were compared between AF and non-AF groups, and independent risk factors were assessed using multiple logistic regression. RESULTS: Among 427 T2DM patients (mean age 63.6 ± 11.6 years), AF prevalence was 10.5%. Independent predictors of AF were older age (OR 1.06, 95% CI 1.02-1.11; p = 0.001), higher BMI (OR 1.07, 95% CI 1.01-1.13; p = 0.040), and heart failure (OR 4.39, 95% CI 1.56-12.39; p = 0.005). The predictive model incorporating these factors demonstrated fair discriminative ability (AUC 0.75, 95% CI 0.68-0.83). CONCLUSIONS: AF was present in one in ten T2DM patients. Older age, elevated BMI, and heart failure were independent predictors, and together provided moderate accuracy for AF risk prediction. These findings support targeted cardiovascular risk assessment and opportunistic AF screening in high-risk patients.
Blunted heart rate response during dipyridamole stress SPECT is associated with cardiovascular outcomes in an all-comers cohort.
Izhaki A, Akuka A, Migranov A … +3 more , Geva D, Vorobeichik D, Rubinshtein R
BMC Cardiovasc Disord · 2026 Jun · PMID 42337458 · Full text
BACKGROUND: Dipyridamole stress cardiac 99mTc-SPECT (DS-SPECT) is commonly used to detect myocardial ischemia. Blunted heart rate response (BHRR) during pharmacologic stress has been associated with adverse outcomes. Thi...
BACKGROUND: Dipyridamole stress cardiac 99mTc-SPECT (DS-SPECT) is commonly used to detect myocardial ischemia. Blunted heart rate response (BHRR) during pharmacologic stress has been associated with adverse outcomes. This study evaluated the significance of BHRR in an unselected real-world DS-SPECT cohort and compared it with routine imaging findings. METHODS: In this single-center retrospective cohort study, all adult patients who underwent dipyridamole stress SPECT without adjunct exercise between 2014 and 2017 were included. Clinical data were obtained from the electronic medical record and structured pre-test interviews, and patients were followed through September 2020. RESULTS: Study population consisted of 388 patients, 227 (58.5%) had normal imaging results, and 245 (63.1%) exhibited BHRR. During a mean follow-up of four years, multivariable analysis found association of BHRR with cardiovascular death (HR 8.09, 95% CI:1.06-61.91, p < 0.05). Patients with abnormal DS-SPECT imaging and BHRR had a nearly fourfold increased risk of adverse cardiovascular events (HR 3.79, 95% CI: 1.24-11.63, p < 0.05). Moreover, individuals demonstrating both abnormal imaging results and BHRR experienced the highest rate of all-cause mortality (HR 2.93, 95% CI: 1.1-7.7, p < 0.01). Overall, BHRR significantly correlated with increased all-cause and cardiovascular mortality. CONCLUSIONS: In unselected patients referred to DS-SPECT, BHRR was associated with cardiovascular mortality. Moreover, in our population group, when combined with abnormal imaging results, BHRR significantly increases the association with DS-SPECT for cardiovascular morbidity and all-cause mortality. These findings may support future inclusion of BHRR in DS-SPECT studies.
Safety of drug-eluting stent in Chinese population with or without diabetes: a multi-center registry study.
Cao S, Ling M, Zhang X … +4 more , Wu W, Luo M, Jiang B, Yuan J
BMC Cardiovasc Disord · 2026 Jun · PMID 42337446 · Full text
BACKGROUND: The safety of drug-eluting stents (DES) in patients undergoing percutaneous coronary intervention (PCI) remains largely lacking in China. This study aimed to determine the 1-year adverse outcomes in a large r...
BACKGROUND: The safety of drug-eluting stents (DES) in patients undergoing percutaneous coronary intervention (PCI) remains largely lacking in China. This study aimed to determine the 1-year adverse outcomes in a large registry of patients undergoing PCI with DES for coronary artery disease (CAD) in China. We also examined clinical outcomes in patients with versus without diabetes. METHODS: This study employs a retrospective cohort design. Data were obtained from the Monitoring Reevaluation Platform for Key Medical Device Adverse Events-the multicenter, observational registry that includes patients undergone PCI in Beijing, Guangdong province, and Guizhou province. The primary outcome measure was the composite of major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, or any clinically indicated revascularisation procedure. Multivariable logistic regression was used to assess the association between MACE and diabetes, estimating adjusted odds ratios (ORs) and 95% confidence intervals. RESULTS: A total of 12,448 patients were included in the final analysis. There were 3,359 (26.98%) patients with DM and 9,089 (73.02%) without DM, respectively. The crude incidence rate of MACE was 0.92% (95% CI: 0.68-1.17%) over 12 months following PCI. Patients with diabetes had a slightly higher rate of MACEs than those without DM, but this difference did not reach statistical significance (1.01% vs. 0.88%; P = 0.625). After adjustment for baseline characteristics, patients with DM were not at higher risk of MACEs than those without diabetes (OR: 1.67; 95% CI: 0.44-6.34; P = 0.452). CONCLUSIONS: In this large, multicenter Chinese registry, DES use was associated with a low and acceptable 1-year MACE rate. Diabetes may not be an independent risk factor for adverse outcomes following DES implantation. However, given the high attrition rate in the observational registry and the potential for underestimation of events, further studies with stricter endpoint ascertainment are warranted, particularly among high-risk subgroups such as elderly patients and those with multiple comorbidities.
The impact of triglyceride-glucose index on short-term prognosis in patients with acute myocarditis.
Jiang M, Ke J, Xiong J … +3 more , Lu L, Liu W, Ruan H
BMC Cardiovasc Disord · 2026 Jun · PMID 42337398 · Full text
OBJECTIVES: This study aimed to investigate the association between the triglyceride-glucose index (TyG) and Short-Term Prognosis in patients with acute myocarditis, addressing the knowledge gap on the TyG index in this...
OBJECTIVES: This study aimed to investigate the association between the triglyceride-glucose index (TyG) and Short-Term Prognosis in patients with acute myocarditis, addressing the knowledge gap on the TyG index in this patient cohort. METHODS: In this cohort study, clinical data were retrospectively gathered from adults with acute myocarditis across three hospital districts-Zhongfa District, Guanggu District, and Qiaokou District of Tongji Hospital. The primary outcome measured was In-hospital Mortality. Non-linear relationships were assessed through restricted cubic spline (RCS) regression and U-test analyses. The impact of the TyG index on prognosis was evaluated using generalized linear models with a logit link function. Subgroup analyses were conducted across different age, gender, smoking, drinking, and comorbidity categories. RESULTS: A total of 1,373 patients were included in the study. Various cardiac morphological and functional indices, such as pericardial effusion, ventricular wall motion abnormalities, atrial enlargement, mitral stenosis/insufficiency, tricuspid stenosis/insufficiency, left ventricular systolic dysfunction, and pleural effusion, exhibited significant changes with increasing TyG index levels (all P < 0.05). The TyG index emerged as an independent risk factor for In-hospital Mortality among acute myocarditis patients (adjusted odds ratio (OR) 2.266 (95% CI: 1.681-3.055), P < 0.001), and RCS regression demonstrated a non-linear relationship with In-hospital Mortality (P for non-linearity < 0.001). Elevated or reduced TyG levels were associated with increased In-hospital Mortality (U-test P < 0.05). Subgroup analyses found no interaction effect in the correlation between the TyG index and In-hospital Mortality. CONCLUSIONS: Extremes in TyG levels, whether high or low, are linked to elevated In-hospital Mortality in patients with acute myocarditis.
Association between lactate to albumin ratio and 28-day all-cause mortality in patients with extracorporeal membrane oxygenation: a retrospective multi-cohort study.
Zhao J, Xu C, Peng Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42337394 · Full text
BACKGROUND: The relationship between lactate-to-albumin ratio (LAR) and mortality in patients with cardiogenic etiology undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. Against this...
BACKGROUND: The relationship between lactate-to-albumin ratio (LAR) and mortality in patients with cardiogenic etiology undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. Against this backdrop, the present study is designed to explore the correlation between LAR and 28-day mortality among patients supported by VA-ECMO. METHODS: This study was a multicenter retrospective study that included patients undergone VA-ECMO from Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and the First People's Hospital of Kunshan in China. The primary outcome was 28-day in-hospital mortality. Kaplan-Meier survival analysis, multivariable Cox regression, and restricted cubic splines (RCS) were used to assess the association between LAR and mortality. Model performance was assessed using receiver operating characteristic (ROC) curve analysis. Subgroup analyses were used to test interactions. RESULTS: In total, 154 patients (78 patients in Chinese database and 76 patients in MIMIC database) participated in this study. LAR were associated with 28-days mortality significantly as a continuous variable (HR: 1.16, 95% CI: 1.05 ~ 1.28, P < 0.01) or categorical variable (HR 5.67, 95% CI: 1.58 ~ 17.23, P < 0.01) in Chinese database. The same result was also observed in the MIMIC group. RCS analysis model illustrated the linear relationship between higher LAR and 28-day mortality in patients with VA-ECMO. ROC analysis suggest that LAR holds less predictive value, when combined with APACHII or APSIII scores the improvement is also small. CONCLUSIONS: LAR is associated with 28-day mortality in patients with cardiogenic etiology undergone VA-ECMO which offers valuable prognostic marker.
Cardiometabolic multimorbidity and atrial fibrillation: insights from traditional statistical and artificial intelligence approaches.
Jia R, Cui X, Jia S … +7 more , Xu M, Wang X, Huang N, Sun X, Wang L, Li J, Cui K
BMC Cardiovasc Disord · 2026 Jun · PMID 42332627 · Full text
BACKGROUND: Cardiometabolic multimorbidity (CMM) is increasingly prevalent among patients with atrial fibrillation (AF), yet its independent impact on post-ablation outcomes, the underlying mechanistic pathways, and the...
BACKGROUND: Cardiometabolic multimorbidity (CMM) is increasingly prevalent among patients with atrial fibrillation (AF), yet its independent impact on post-ablation outcomes, the underlying mechanistic pathways, and the optimal approach to risk prediction in this population remain incompletely defined. METHODS: We analyzed three independent cohorts of patients undergoing AF catheter ablation: a derivation cohort (n = 3,308), an external validation cohort, and a prospective testing cohort. CMM was defined as the coexistence of two or more cardiometabolic conditions. Cox proportional hazards models and propensity score-matched analyses assessed the association between CMM and AF recurrence, all-cause death, and cardiovascular death. Mediation analysis quantified the contributions of structural, metabolic, and inflammatory pathways. Ten machine learning algorithms were developed and validated for predicting AF recurrence, and model performance was compared against eight established clinical risk scores. Time-dependent ROC analysis was used to evaluate discrimination across multiple follow-up horizons. RESULTS: Among 3,308 patients in the derivation cohort, 686 (20.7%) had CMM. CMM was independently associated with an increased risk of AF recurrence (adjusted HR 1.17, 95% CI 1.03-1.33), all-cause death (HR 1.83, 95% CI 1.11-3.00), and cardiovascular death (HR 2.22, 95% CI 1.24-3.98), with a graded dose-response relationship across the number of CMM components (p for trend < 0.001). These associations persisted in propensity score-matched analyses (HR 1.32, 95% CI 1.16-1.50) and were replicated in external and prospective cohorts. Mediation analysis identified left atrial diameter (46.5% of total effect), insulin resistance (METS-IR, 25.6%), left atrial appendage emptying velocity (24.9%), and the uric acid-to-HDL ratio (UHR, 24.1%) as key mediators of recurrence risk. For pre-ablation prediction, the LightGBM model achieved the best discriminative performance (ROC-AUC 0.766, 95% CI 0.687-0.844; PR-AUC 0.755), outperforming all conventional risk scores. Time-dependent AUC values at 1, 2, and 3 years were 0.776, 0.760, and 0.730, respectively. A post-blanking model incorporating early recurrence (TabPFN) achieved an ROC-AUC of 0.873. Both models were validated in external and prospective cohorts. CONCLUSIONS: CMM is an independent predictor of poor outcomes after AF ablation, driven by structural, metabolic, and inflammatory remodeling that is partially mediated through left atrial enlargement. A machine learning-based prediction provides more accurate risk stratification than traditional clinical scores, supporting personalized management in this high-risk population.
Joint association of high-sensitivity C-reactive protein and cumulative atherogenic index of plasma with cardiovascular disease risk in CKM syndrome stages 0-3: a prospective cohort study.
Zhu Y, Zhai C, Wang J
BMC Cardiovasc Disord · 2026 Jun · PMID 42332601 · Full text
BACKGROUND: Although high-sensitivity C-reactive protein (hs-CRP) and cumulative atherogenic index of plasma (CumAIP) are recognized risk markers for cardiovascular disease (CVD), their association with CVD incidence-and...
BACKGROUND: Although high-sensitivity C-reactive protein (hs-CRP) and cumulative atherogenic index of plasma (CumAIP) are recognized risk markers for cardiovascular disease (CVD), their association with CVD incidence-and specifically their combined effect-in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome is far less understood. METHODS: This study analyzed 3,028 participants at CKM stages 0-3 from the China Health and Retirement Longitudinal Study. Kaplan‑Meier survival curves and Cox proportional hazards models were used to investigate the associations of CumAIP and hs-CRP levels with the risk of CVD in this population, as well as to evaluate their combined effect on CVD incidence. RESULTS: During the 5-year follow-up period (2015-2020), 495 participants developed CVD. Both hs-CRP and CumAIP were associated with CVD risk. After progressively adjusting for all covariates, compared with the low-hs-CRP group, the high-hs-CRP group exhibited a 36.6% increased risk of CVD (HR = 1.366, 95%CI: 1.133 ~ 1.648); compared with the low-CumAIP group, the high-CumAIP group showed a 40.8% increased risk (HR = 1.408, 95%CI: 1.158 ~ 1.711). The combination of high hs-CRP and high CumAIP was associated with a higher risk of developing CVD. Compared to individuals with both low hs-CRP and low CumAIP, those with high levels of both biomarkers had a 1.834-fold higher risk (95%CI: 1.408-2.389). Subgroup analysis indicated that the combined association of hs-CRP and CumAIP was more pronounced in males. CONCLUSION: This study suggests that elevated hs-CRP and CumAIP are jointly associated with CVD incidence, and their combination exhibits a joint effect among middle-aged and older adults with stage 0-3 CKM syndrome.
Efficacy stratification of digital health modalities in home-based cardiac rehabilitation for heart failure: a systematic review and meta-analysis.
Zheng Z, Gao Y, Tan X … +4 more , Peng X, Feng H, Li H, Lu J
BMC Cardiovasc Disord · 2026 Jun · PMID 42332587 · Full text
BACKGROUND: Digital health (DH) enables home-based cardiac rehabilitation (HBCR) for heart failure, but no prior systematic review has compared wearable-guided vs. interaction-guided DH modalities' efficacy on cardioresp...
BACKGROUND: Digital health (DH) enables home-based cardiac rehabilitation (HBCR) for heart failure, but no prior systematic review has compared wearable-guided vs. interaction-guided DH modalities' efficacy on cardiorespiratory fitness, exercise capacity, and quality of life. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and CNKI until April 2025 for RCTs. Two investigators independently extracted data, assessed the risk of bias using the Cochrane Risk of Bias Tool 2.0, and graded evidence (GRADE). RESULTS: Analysis of 20 RCTs (n = 4,652) showed DH-HBCR significantly improved 6-minute walk test (6MWT: MD = 21.92 m, 95% CI 12.27-31.58), peak oxygen uptake (VO₂peak: MD = 0.96 mL/kg/min, 95% CI 0.56-1.35), and quality of life (MLHFQ: MD = -7.21, 95% CI -11.40--3.02) versus control. Wearable-guided interventions provided superior gains in 6MWT (MD = 51.98 m, 95% CI 34.21-69.76; I² = 0%) and MLHFQ (MD = -11.14, 95% CI -14.55--7.72; I² = 0%), while interaction-guided interventions significantly improved VO₂peak (MD = 1.00 mL/kg/min, 95% CI 0.49-1.51; I² = 15.2%) more effectively. CONCLUSIONS: DH-mediated HBCR was associated with improved exercise capacity, cardiorespiratory fitness, and quality of life in patients with HF. Preliminary evidence suggests differential efficacy profiles between wearable-guided and interaction-guided modalities. Given the limitations of the included evidence, these findings should be considered hypothesis-generating. Future research should develop phenotype-stratified protocols and conduct head-to-head RCTs to validate these observations.
Prognostic value of postoperative albumin-bilirubin score in patients with acute type A aortic dissection after surgery: a propensity-score matched analysis.
Hu JW, Shi T
BMC Cardiovasc Disord · 2026 Jun · PMID 42332550 · Full text
BACKGROUND: Postoperative hepatic dysfunction is a frequent and severe complication in patients with acute type A aortic dissection (ATAAD) following emergency surgical repair, and it is strongly associated with adverse...
BACKGROUND: Postoperative hepatic dysfunction is a frequent and severe complication in patients with acute type A aortic dissection (ATAAD) following emergency surgical repair, and it is strongly associated with adverse clinical outcomes and poor prognosis. The albumin-bilirubin (ALBI) score is an objective and well-validated indicator for evaluating hepatic function and reserve. Accumulating evidence has demonstrated its favorable prognostic value across a variety of clinical conditions, including cardiovascular diseases. Accordingly, this study was performed to comprehensively investigate the prognostic significance of the ALBI score in patients with ATAAD undergoing emergency surgical repair. METHOD: A total of 306 patients with ATAAD who underwent emergent repair surgery were enrolled in this single-center retrospective study. The primary outcomes of interest included delayed extubation, reintubation, neurological dysfunction, requirement for continuous renal replacement therapy (CRRT), and 30-day mortality. Propensity score matching (PSM) was performed to balance baseline characteristics between low and high postoperative ALBI (postALBI) score groups, followed by comparison of adverse outcome incidences. Multivariate logistic regression analysis was used to identify independent risk factors for poor prognosis. RESULTS: After PSM, 191 matched pairs were obtained. The high postALBI group (≥-2.12) exhibited significantly higher rates of delayed extubation (40.34% vs. 18.48%, P < 0.001), CRRT requirement (31.93% vs. 10.92%, P < 0.01), and 30-day mortality (16.81% vs. 6.72%, P = 0.017) compared to the low postALBI group (<-2.12). Although the reintubation rate was higher in the high postALBI group (18.52% vs. 9.24%), the difference approached but did not reach statistical significance (P = 0.064). Multivariate analysis revealed that high postALBI was consistently identified as a common risk factor for all adverse outcomes, including delayed extubation (OR: 2.670; 95%CI: 1.080-6.601, P = 0.033), reintubation (OR: 3.071; 95%CI: 1.076-8.769, P = 0.036), neurological dysfunction (OR: 4.174; 95%CI: 1.354-12.868, P = 0.013), CRRT requirement (OR: 4.25; 95%CI: 1.544-11.699, P = 0.005), and 30-day mortality (OR: 3.215; 95%CI: 1.132-9.127, P = 0.028). The postALBI score exhibited superior discriminatory ability over individual liver function parameters (postoperative albumin and total bilirubin) for predicting multiple adverse clinical outcomes: its AUC and 95% CI were 0.668 (0.547-0.788, P = 0.006) for 30-day mortality, 0.737 (0.645-0.829, P < 0.001) for CRRT requirement, 0.730 (0.582-0.879, P = 0.002) for neurological dysfunction, 0.706 (0.588-0.824, P = 0.001) for reintubation, and 0.637 (0.548-0.725, P = 0.003) for delayed extubation. CONCLUSIONS: The postALBI score demonstrates independent prognostic potential for postoperative adverse events in patients with ATAAD undergoing emergent surgical repair. Owing to its simplicity and wide accessibility, this score may serve as a supportive tool for postoperative risk stratification and clinical decision-making in this high-risk population.
Association of noninvasive liver fibrosis scores with severity and outcomes among individuals with cardiovascular-kidney-metabolic syndrome: evidence from the NHANES 2005-2018.
Gao Y, Chen H, Li J … +2 more , Chen M, Zhang H
BMC Cardiovasc Disord · 2026 Jun · PMID 42324457 · Full text
BACKGROUND: This study aimed to investigate the associations of multiple noninvasive liver fibrosis scores with cardiovascular-kidney-metabolic (CKM) syndrome severity and clinical outcomes. METHODS: This retrospective c...
BACKGROUND: This study aimed to investigate the associations of multiple noninvasive liver fibrosis scores with cardiovascular-kidney-metabolic (CKM) syndrome severity and clinical outcomes. METHODS: This retrospective cohort study included 8,592 participants from the National Health and Nutrition Examination Survey 2005-2018. Six noninvasive liver fibrosis scores, including LiverRisk, metabolic dysfunction-associated fibrosis 5 (MAF-5), nonalcoholic fatty liver disease fibrosis score (NFS), Fibrosis-4 (FIB-4), steatosis-associated fibrosis estimator (SAFE), and aspartate aminotransferase-to-platelet ratio index (APRI), were evaluated. Logistic regression was used to assess associations with advanced CKM syndrome. Cox proportional hazards models and Fine-Gray competing-risk models were applied to evaluate associations with all-cause mortality and cardiovascular disease (CVD) mortality, respectively. Restricted cubic spline, subgroup, sensitivity, and incremental prediction analyses were also performed. RESULTS: The participants had a mean age of 50.82 ± 0.22 years, 51.85% were female, and 12.30% had advanced CKM syndrome. During a median follow-up of 7.42 years, 599 all-cause deaths and 166 CVD deaths occurred. Higher LiverRisk, MAF-5, NFS, FIB-4, and SAFE scores were significantly associated with advanced CKM syndrome, whereas APRI was not. All six fibrosis scores were significantly associated with increased all-cause mortality. For CVD mortality, higher LiverRisk, NFS, FIB-4, and SAFE were significantly associated with increased risk, with corresponding sHRs of 3.84, 3.54, 2.25, and 3.63, respectively (all P < 0.05), whereas MAF-5 and APRI were not significantly associated with CVD mortality. These findings were supported by dose-response analyses and remained materially unchanged in sensitivity analyses. CONCLUSION: Higher LiverRisk, MAF-5, NFS, FIB-4, and SAFE scores were associated with advanced CKM syndrome, whereas all six scores were associated with all-cause mortality. LiverRisk, NFS, FIB-4, and SAFE showed more consistent associations with CVD mortality.
Prognostic value of the aggregate index of systemic inflammation in predicting in-hospital adverse outcomes among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous intervention.
Kahraman E, Parsova KE, Durak F … +4 more , Gumusdag A, Iskender H, Cakir B, Velibey Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42324455 · Full text
OBJECTIVES: Inflammation plays a pivotal role in the initiation and progression of atherosclerosis and acute coronary syndromes. The Aggregate Index of Systemic Inflammation (AISI), a novel biomarker derived from neutrop...
OBJECTIVES: Inflammation plays a pivotal role in the initiation and progression of atherosclerosis and acute coronary syndromes. The Aggregate Index of Systemic Inflammation (AISI), a novel biomarker derived from neutrophil, monocyte, platelet, and lymphocyte counts, reflects the systemic inflammatory response. Although AISI has demonstrated prognostic value in various cardiovascular settings, its utility in its association with in-hospital adverse outcomes among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) remains unclear. This study aimed to evaluate whether AISI reflects systemic inflammatory burden and its association with in-hospital adverse outcomes in STEMI patients undergoing primary PCI. MATERIALS AND METHODS: This retrospective, single-center study included 2,678 consecutive STEMI patients who underwent primary PCI. AISI was calculated as (neutrophil × monocyte × platelet) / lymphocyte, and patients were stratified into high and low AISI groups according to the median value. The primary outcomes were in-hospital mortality and major adverse cardiac and cerebrovascular events (MACCE). Secondary endpoints included arrhythmic complications, acute stent thrombosis, and ischemic stroke. RESULTS: Patients with high AISI were older, had higher rates of diabetes and hypertension, elevated glucose and creatinine, and lower left ventricular ejection fraction. High AISI was associated with mortality and MACCE in univariate analyses, whereas continuous AISI showed only a statistically significant but clinically modest association after multivariable adjustment when expressed per 100-unit increase. These findings indicate that AISI has limited standalone prognostic value and should be interpreted as an adjunctive inflammatory marker. Elevated AISI showed an independent association with ischemic stroke (adjusted OR = 4.77, 95% CI 1.02-22.30, p = 0.047); however, this finding should be interpreted cautiously given the low number of events and wide confidence intervals. ROC analysis showed moderate discriminative performance for in-hospital mortality (AUC = 0.64), MACCE (AUC = 0.60), and ischemic stroke (AUC = 0.70). CONCLUSION: AISI is a simple, cost-effective inflammatory marker that may aid in risk stratification for in-hospital adverse and cerebrovascular outcomes in STEMI patients undergoing primary PCI.
Adipokine-mediated metabolic responses across BMI in acute myocardial infarction.
Sunita S, Syamsunarno MRAA, Akbar MR … +5 more , Nugrahani AD, Sylviana N, Nugraha GI, Ghozali M, Achmad TH
BMC Cardiovasc Disord · 2026 Jun · PMID 42323542 · Full text
BACKGROUND: Adipose tissue secretes adipokines, bioactive proteins that regulate inflammation and cardiometabolic processes. During acute myocardial infarction (AMI), adipokine profiles may vary according to body mass in...
BACKGROUND: Adipose tissue secretes adipokines, bioactive proteins that regulate inflammation and cardiometabolic processes. During acute myocardial infarction (AMI), adipokine profiles may vary according to body mass index (BMI), yet this association remains underexplored. AIMS: To compare circulating adiponectin, fibroblast growth factor 21 (FGF21), growth differentiation factor 15 (GDF15), and interleukin-6 (IL-6) between non-obese and obese patients with AMI. METHODS: In this cross-sectional study, 105 patients with AMI were stratified as non-obese (BMI < 25 kg/m², n = 62) or obese (BMI ≥ 25 kg/m², n = 43). Serum adiponectin, GDF15, and IL-6 were measured by Luminex, and FGF21 was measured by ELISA. Clinical variables and lipid indices were compared between BMI groups, and correlation analyses were performed. RESULTS: Although myocardial injury levels were comparable between the two groups, non-obese patients had significantly higher serum levels of adiponectin, FGF21, GDF15, and IL-6 than obese patients (all p < 0.05). In all patients, adiponectin was negatively correlated with total cholesterol, LDL-c, and triglycerides, and positively correlated with HDL-c; however, these associations were not consistently observed within BMI subgroups after stratification and FDR correction. GDF15 and IL-6 also showed inverse correlations with selected lipid parameters in all patients. CONCLUSION: Non-obese AMI patients exhibited higher levels of adiponectin, FGF21, GDF15, and IL-6 compared to obese AMI patients. These adipokine profiles were associated with lipid parameters, notably showing inverse correlations between adiponectin and GDF15 with total cholesterol and LDL-c. These findings highlight the association between adiposity and early metabolic responses in AMI across BMI categories.
Validation of aortic valve calcification quantification on contrast-enhanced computed tomography against ex vivo gravimetric analysis: comparison of fixed Hounsfield unit thresholds and deep learning segmentation.
Jiang D, Zhang W, Liu L … +13 more , Li G, Shang X, Dong N, Yang Y, Yang J, Zhang H, Zhou Q, Jian C, Zhao Y, Ni B, Shao Y, Liu J, Wu Z
BMC Cardiovasc Disord · 2026 Jun · PMID 42323538 · Full text
BACKGROUND: Accurate quantification of aortic valve calcification (AVC) on contrast-enhanced computed tomography angiography (CTA) is pivotal for planning surgical and transcatheter aortic valve replacement. The optimal...
BACKGROUND: Accurate quantification of aortic valve calcification (AVC) on contrast-enhanced computed tomography angiography (CTA) is pivotal for planning surgical and transcatheter aortic valve replacement. The optimal Hounsfield unit (HU) threshold for calcification detection on contrast-enhanced images remains unresolved, and every prior validation study has relied on non-contrast Agatston scoring-itself an imaging estimate-as the reference standard. This study validated two widely used fixed HU thresholds (450 HU and 850 HU) and a self-configuring nnU-Net deep learning model against ex vivo gravimetric calcium weight as an absolute physical ground truth. METHODS: Four hundred patients were included in a retrospective cohort study with a pre-specified temporal validation split: 300 with CT-confirmed AVC and 100 with normal aortic valves. Fifty chronologically later AVC patients who underwent elective open surgical aortic valve replacement (SAVR) within seven days of clinically indicated pre-operative contrast-enhanced CTA formed the locked surgical validation cohort; their excised native leaflets underwent standardised high-temperature ashing (550 °C, 12 h) and analytical weighing (precision 0.1 mg) to obtain gravimetric calcium mass. The remaining 350 cases served exclusively for nnU-Net development (280 training / 70 internal validation). CT-derived calcium mass-equivalent estimates were quantified on the validation cohort and compared with gravimetric weight using Pearson and Spearman correlation and Bland-Altman analysis. RESULTS: The nnU-Net achieved the strongest observed correlation with gravimetric weight (Pearson r = 0.967; bias + 6.2 mg; RMSE 13.7 mg), significantly outperforming the 450 HU threshold for correlation (r = 0.864; bias + 36.2 mg; RMSE 42.1 mg; Steiger p < 0.001) and showing a non-significant trend toward stronger correlation than 850 HU (r = 0.929; bias + 17.5 mg; RMSE 23.9 mg; Steiger p = 0.085). Compared with 850 HU, nnU-Net provided lower bias and RMSE, although the difference in Pearson r did not reach statistical significance. The 450 HU method exhibited significant proportional bias (p = 0.024), whereas neither 850 HU nor nnU-Net did. The nnU-Net achieved a mean Dice coefficient of 0.873 and intersection-over-union of 0.812. CONCLUSIONS: Against physically weighed calcium, nnU-Net deep learning segmentation provided the most favourable overall performance profile on contrast-enhanced CTA, with the lowest bias and RMSE and the strongest observed correlation. The improvement in Pearson correlation over 850 HU represented a non-significant trend, whereas the error and agreement metrics favoured nnU-Net. Among fixed thresholds, 850 HU substantially outperformed 450 HU, offering direct physical-rather than surrogate imaging-evidence to support 850 HU as the preferred fixed threshold in standard contrast-enhanced protocols.
Impact of a comprehensive healthy lifestyle and genetic risk on arrhythmia: insights from the UK biobank study.
Yang Q, Lu X, Lu Y … +3 more , Jiang X, Wang T, Guo C
BMC Cardiovasc Disord · 2026 Jun · PMID 42321644 · Full text
BACKGROUND: Arrhythmias such as atrial fibrillation and bradyarrhythmia impose a substantial public health burden. Although genetic predisposition contributes to arrhythmia risk, the extent to which modifiable lifestyle...
BACKGROUND: Arrhythmias such as atrial fibrillation and bradyarrhythmia impose a substantial public health burden. Although genetic predisposition contributes to arrhythmia risk, the extent to which modifiable lifestyle factors may mitigate this risk remains unclear. This study aimed to evaluate the association between a comprehensive healthy lifestyle and incident arrhythmias, and to assess whether these associations differ across levels of genetic susceptibility. METHODS: A prospective cohort analysis was conducted using 341,736 UK Biobank participants after excluding individuals with baseline arrhythmias and incomplete lifestyle information. A healthy lifestyle score (HLS) incorporating smoking status, alcohol consumption, diet quality, and physical activity was constructed. Incident arrhythmias were identified through ICD-10 and procedure codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall arrhythmia, atrial fibrillation, and bradyarrhythmia, adjusting for demographic and clinical covariates. Genetic susceptibility was quantified using a polygenic risk score (PRS) for atrial fibrillation, and joint lifestyle-genetic risk categories were used to evaluate their combined associations with AF risk. RESULTS: Over a mean follow-up of 10.9 years, 37,990 participants developed an incident arrhythmia, comprising 34,491 atrial fibrillation/flutter (AF) events and 9,399 bradyarrhythmia events; the composite count is a deduplicated union, so the two subtype counts overlap by 5,900 dual-subtype cases (Supplementary Table S4). Higher HLS values were associated with lower risks of overall arrhythmia and AF, whereas the association with bradyarrhythmia appeared weaker and non-monotonic. Compared with participants in the unfavorable lifestyle category, those in the favorable category had lower risks of AF (HR, 0.89; 95% CI, 0.87-0.91), overall arrhythmia (HR, 0.91; 95% CI, 0.89-0.94), and bradyarrhythmia (HR, 0.92; 95% CI, 0.87-0.97). The intermediate lifestyle category was also associated with lower risks of AF (HR, 0.92; 95% CI, 0.90-0.94), overall arrhythmia (HR, 0.93; 95% CI, 0.90-0.95), and bradyarrhythmia (HR, 0.94; 95% CI, 0.90-0.99). In joint-category analyses using participants with high genetic risk and an unfavorable lifestyle as the common reference group, the lowest AF risk was observed among individuals with both low genetic susceptibility and a favorable lifestyle. A competing-risks sensitivity analysis with non-arrhythmia death treated as a competing event preserved the direction and approximate magnitude of the lifestyle association for AF and overall arrhythmia (Supplementary Table S10): 10-year cumulative incidence in the favorable versus unfavorable categories was 5.85% versus 6.61% for AF and 6.44% versus 7.14% for overall arrhythmia. For bradyarrhythmia, 10-year cumulative incidence was numerically similar across lifestyle strata (1.64-1.72%), consistent with a residual contribution of differential survival to the observed bradyarrhythmia pattern (Supplementary Figure S1). A sensitivity analysis substituting the diet subscore with an AHA Life's Essential 8-aligned cardiovascular-specific subscore produced directionally consistent estimates across all endpoints (Supplementary Table S8). CONCLUSIONS: In this large population-based cohort, adherence to a healthier lifestyle was associated with modestly lower risks of overall arrhythmia and atrial fibrillation. The association with bradyarrhythmia was weaker and appeared non-monotonic. These observational findings require confirmation in randomized lifestyle-intervention studies before causal inference.
The modified balloon-anchored technique for iliac branch device deployment via ipsilateral femoral access.
Xu C, Xu GX, Gu XF … +2 more , Chen L, Jin YQ
BMC Cardiovasc Disord · 2026 Jun · PMID 42321638 · Full text
BACKGROUND: For iliac branch device (IBD) procedures, contralateral femoral access is generally regarded as the standard route, whereas upper-extremity access is usually reserved for selected anatomically challenging cas...
BACKGROUND: For iliac branch device (IBD) procedures, contralateral femoral access is generally regarded as the standard route, whereas upper-extremity access is usually reserved for selected anatomically challenging cases. However, both approaches may be difficult or undesirable in patients with a short common iliac artery (CIA), an unfavourable aortic bifurcation, prior endograft reconstruction, or access-related concerns. This study aimed to describe a modified balloon-anchored technique for IBD deployment via ipsilateral femoral access and to evaluate its technical feasibility and early outcomes. METHODS: This retrospective, two-centre study included consecutive patients who underwent IBD deployment via ipsilateral femoral access between May 2023 and February 2024. Eligibility was limited to patients in whom contralateral femoral access was considered unsuitable because of predefined hostile anatomical or procedural features, including CIA length < 50 mm, an unfavourable aortic bifurcation or iliac tortuosity that limited coaxial sheath advancement, prior EVAR or aorto-iliac stent-graft configuration, or relevant access limitations. Computed tomography angiography (CTA) from the aortic arch to the femoral arteries was reviewed, and the modified balloon-anchored technique was applied according to a standardised algorithm. Technical success was defined as successful IBD deployment with preserved IIA branch patency and no type I or III endoleak on final angiography and CTA within 30 days. RESULTS: Twenty-three patients (91.3% male; median age, 75 years) were included. Indications were aorto-iliac aneurysm with reduced CIA working length (n = 13, 56.5%) and type Ib endoleak after previous aortic stent-graft placement (n = 10, 43.5%). Technical success was achieved in all cases (100%). Over a median follow-up of 16 months (interquartile range [IQR], 14-18 months), the 1-year patency rates for the IBD main body and bridging stent were 100% and 95.7%, respectively. No aortic- or IBD-related re-interventions were required. Two complications occurred (8.7%): one asymptomatic bridging-stent occlusion and one conservatively managed type II endoleak. No major adverse events or clinically evident pelvic ischaemic complications were observed. CONCLUSION: The ipsilateral balloon-anchored technique appears feasible for IBD deployment and was associated with encouraging early outcomes in selected patients unsuitable for conventional access strategies.
Deep learning-based myocardial infarction detection using echocardiography.
Bulbule S, Soma S
BMC Cardiovasc Disord · 2026 Jun · PMID 42321627 · Full text
Myocardial infarction (MI) is a life-threatening condition caused by reduced oxygen supply to the heart muscle due to blockage of the coronary arteries. Delayed or missed diagnosis increases the risk of mortality and hea...
Myocardial infarction (MI) is a life-threatening condition caused by reduced oxygen supply to the heart muscle due to blockage of the coronary arteries. Delayed or missed diagnosis increases the risk of mortality and heart failure, making early detection critical. Echocardiography is a non-invasive imaging technique that uses real-time ultrasound to examine the heart's structure and function, including the evaluation of coronary artery disease and detection of regional wall motion abnormalities linked to MI. However, current approaches encounter limitations such as susceptibility to noise, restricted motion analysis capabilities, and significant computational demands. Hence, this work proposes EfficientNet_SpinalNet (Efficient_SpinalNet) for MI detection using echocardiography video. The proposed model utilizes the Hamad Medical Corporation Heart Hospital & Qatar University (HMC-QC) dataset and the Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) dataset. The process begins by retrieving a video sample from the dataset, which is then decomposed into individual image frames. A hybrid filtering approach, integrating both median and Gaussian techniques, is first applied to the frames to suppress noise and enhance image quality. Following this preprocessing step, the Left Ventricle (LV) wall is fully extracted using the Fuzzy Local Information C-Means Clustering (FLICM) method, which further enables precise identification of the endocardial border. Following segmentation, displacement metrics and area variation curves are computed and passed into the feature extraction module. The extracted features, along with the displacement and area data, are then utilized for MI detection using the Efficient_SpinalNet architecture, which synergistically merges EfficientNet-B3-attn-2 with SpinalNet for enhanced diagnostic accuracy. Moreover, the experimental result reveals that the Efficient_SpinalNet functioned efficiently, attaining accuracy, sensitivity, and specificity values of 91.19%, 92.01%, and 92.435%. These results indicate that Efficient_SpinalNet is a reliable and efficient approach for real-time MI detection, offering potential improvements in clinical decision-making and patient outcomes.
Association between prognostic nutritional index and mortality in critically ill patients with atrial fibrillation: a retrospective cohort study.
Kong X, Hu Z, Huang X … +4 more , Chen J, Chen L, Huang L, Tan S
BMC Cardiovasc Disord · 2026 Jun · PMID 42321625 · Full text
BACKGROUND: The prognostic nutritional index (PNI), a composite marker derived from serum albumin and total lymphocyte count, has been associated with adverse outcomes in several cardiovascular and critical care settings...
BACKGROUND: The prognostic nutritional index (PNI), a composite marker derived from serum albumin and total lymphocyte count, has been associated with adverse outcomes in several cardiovascular and critical care settings. However, its prognostic value in critically ill patients with atrial fibrillation (AF) remains unclear. This study aimed to evaluate the association between PNI and mortality in this high-risk population. METHODS: This retrospective cohort study included critically ill patients with AF from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.1). The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, 90- and 365-day mortality. Multivariable Cox proportional hazards and logistic regression models were used to assess the associations between PNI and outcomes. Kaplan-Meier survival analyses and restricted cubic spline (RCS) analyses were performed to further characterize these associations. The association between PNI and in-hospital mortality was further examined in an independent cohort from the eICU Collaborative Research Database (eICU-CRD). RESULTS: A total of 3,007 critically ill patients with AF were included in the MIMIC-IV cohort, and 2,741 patients were included in the independent eICU-CRD cohort. In the primary model (Model 2), each 10-unit increase in PNI was associated with a lower risk of 30-day mortality (HR, 0.63; 95% CI, 0.57-0.70; P < 0.001), 90-day mortality (HR, 0.64; 95% CI, 0.58-0.70; P < 0.001), and 365-day mortality (HR, 0.68; 95% CI, 0.63-0.74; P < 0.001) in the MIMIC-IV cohort. Higher PNI was also associated with lower in-hospital mortality in the MIMIC-IV cohort (OR, 0.58; 95% CI, 0.50-0.66; P < 0.001). In the independent eICU-CRD cohort, higher PNI remained significantly associated with lower in-hospital mortality (OR, 0.66; 95% CI, 0.57-0.76; P < 0.001). Kaplan-Meier analyses showed progressively better survival across increasing PNI quartiles, whereas RCS analyses demonstrated a nonlinear inverse relationship between PNI and mortality. CONCLUSIONS: Lower PNI was independently associated with increased short- and long-term mortality in critically ill patients with AF. As a readily available laboratory-based index, PNI may provide simple adjunctive prognostic information in this high-risk population.
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