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Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and the triglyceride-glucose (TyG) index have become novel and convenient indicators of insulin resistance (IR) and are reported to be associated with occurrence and prognosis of myocardial infarction (MI). Mean arterial pressure (MAP) is another MI indicator that affects myocardial perfusion and oxygen delivery. However, the association between TG/HDL-C ratio and TyG index with MAP in patients with MI remains unclear. The purpose of this study was to explore the correlation between TG/HDL-C ratio and TyG index with MAP in patients with MI, which may provide valuable insights for the clinical assessment and management of MI patients. A total of 7341 patients with MI from January 2019 to December 2020 were enrolled to collect the general clinical data. Univariate and multivariate linear regression analyses were employed to examine the relationships between TG/HDL-C ratio and TyG index with MAP. Generalized additive models (GAM) and threshold effects analysis were applied to explore dose-response patterns. Gender and age interactions were tested. The average age of the 7341 patients with MI was 61.39 ± 13.13, and 62.23% were male. Both TG/HDL-C ratio and TyG index were positively associated with MAP. GAM analysis revealed that TG/HDL-C ratio showed non-linear associations with a threshold at 1.43, while TyG index demonstrated consistent linear relationships. Below the threshold, each unit increase in TG/HDL-C ratio was associated with 2.23 mmHg increase in MAP (95%CI: 0.76–3.71, P  = 0.0029); above threshold, associations were attenuated ( P  = 0.2021). TyG index showed linear association throughout its range (β = 0.30, 95%CI: 0.16–0.44, P  < 0.0001). Both markers demonstrated stronger associations in male patients ( P for interaction = 0.027). TG/HDL-C ratio and TyG index were positively associated with MAP in MI patients, showing threshold-based and linear patterns respectively. Both markers exhibited stronger associations in males. Monitoring these IR markers with consideration of threshold effects and gender differences deserves attention in clinical practice for MI management.

Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Early identification of high-risk patients is crucial for timely interventions and improved outcomes. The lactate/albumin ratio (LAR) has been suggest as a significant correlate for assessing the risk of mortality in critically ill patients. This study aimed to utilize the American eICU Collaborative Research Database to explore the association between baseline LAR and all-cause mortality within 28 days in ICU of critically ill patients diagnosed with AMI. We conducted a retrospective cohort study of 989 AMI patients from the eICU Collaborative Research Database. Patients were included based on ICD-9 code 410 and the universal definition of AMI. LAR was calculated as the ratio of baseline lactate to albumin levels within the first 24 h of ICU admission. The outcome was all-cause mortality within 28 days after ICU admission. Multivariable logistic regression models were used to evaluate the independent association between LAR and the risk of death, adjusting for potential confounders including demographics, comorbidities, vital signs, and laboratory parameters. Subgroup analyses and nonlinear modeling were performed to further explore the relationship. Of the 989 AMI patients, 171 (17.3%) died within 28 days after ICU admission. Patients who died had significantly higher LAR compared to survivors (1.66 vs. 0.96, p  < 0.001). Multivariable analysis showed that each unit increase in LAR was associated with a 2.15-fold higher risk of all-cause mortality within 28 days after ICU admission (95% CI: 1.64–2.83, p  < 0.001). Subgroup analyses confirmed the consistent association across different patient characteristics. Nonlinear modeling revealed a threshold effect, where LAR above 2.15 was no longer significantly associated with mortality. Kaplan-Meier survival analysis demonstrated lower survival probabilities for patients with higher LAR(1.0526–5.8235). The findings suggest that a higher LAR was associated with an increased risk of 28-day all-cause mortality for critically ill patients with AMI after ICU admission.

This study aimed to develop a multi-task framework for detection of five MRI predictors of CP and intelligent recognition of CP based on multi-modal MRI in infant with PVWMI. We present MMSeg-CP, a multi-task framework for joint anatomical target region segmentation, lesion of target region segmentation, and CP classification from registered T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). MMSeg-CP adopts a SegFormer-based hierarchical transformer encoder and a lightweight all-MLP decoder, followed by lesion prediction and AttentionPool2d-based classification heads for infant neuroimaging characteristics, and performance was evaluated through five-fold cross-validation against nine comparative architectures using overlap, boundary, and classification metrics. The study included 122 PVWMI infants (90 PVWMI with CP and 32 PVWMI with non-CP) and 121 infants with normal MRI. In five-fold cross-validation, the model achieved mean Dice values of 0.79 for target regions and 0.41 for lesions of target region, along with 0.95 slice-level accuracy and 0.88 subject-level accuracy. Compared with nine representative baseline models, MMSeg-CP provided the best overall balance between overlap accuracy, boundary precision, specificity, and sensitivity. MMSeg-CP enables joint detection of five MRI predictors of CP and intelligent CP recognition, supporting its potential as a clinical decision-support tool for early CP screening.

Congestive heart failure (CHF) is a complex clinical syndrome that significantly impacts patient outcomes, especially in critically ill patients admitted to intensive care units (ICUs). The aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), has also been reported as a risk factor of cardiovascular diseases. However, few studies investigated the correlations between the AST/ALT ratio and ICU mortality in critically ill patients with CHF. This study investigates the association between the baseline AST/ALT ratio measured within the first 24 h of ICU admission and 28-day ICU all-cause mortality in critically ill patients with CHF. This retrospective cohort study included 4869 critically ill patients with CHF from the eICU Collaborative Research Database. Patients were categorized into tertiles based on their AST/ALT ratio: Tertile 1 (0.13–0.97), Tertile 2 (0.97–1.50), and Tertile 3 (1.50–5.89). Univariate and multivariate Cox proportional hazards regression models were used to evaluate the association between the AST/ALT ratio and 28-day ICU all-cause mortality. Nonlinear threshold effects and subgroup analyses were conducted to assess the robustness of the findings. Kaplan-Meier survival curves were generated to compare survival probabilities across tertiles. Participants with higher AST/ALT ratios were older, had higher illness severity, and experienced worse clinical outcomes. In univariate analysis, the AST/ALT ratio was significantly associated with 28-day ICU mortality (HR: 1.24, 95% CI 1.13–1.37, P  < 0.0001). This association remained significant in the fully adjusted multivariate model. The highest tertile of AST/ALT ratio was associated with a significantly higher risk of mortality compared to the lowest tertile across all models (HR: 1.48, 95% CI 1.07–2.03, P  = 0.0162 in Model 4). A nonlinear relationship was observed, with a threshold identified at an AST/ALT ratio of 2.08. Below this turning point, the association remained strong (HR: 1.47, 95% CI 1.13–1.91, P  = 0.0036), while above it, the association was no longer significant. Subgroup analyses revealed no significant interactions, indicating that the association between AST/ALT ratio and mortality was consistent across various patient characteristics. Survival analysis showed that patients in the highest tertile had the poorest survival outcomes ( P  < 0.0001). An elevated AST/ALT ratio within the first 24 h of ICU admission is independently associated with increased 28-day ICU all-cause mortality in critically ill patients with CHF.

Background Homocysteine (Hcy) and the proprotein convertase subtilisin/kexin type 9 (PCSK9) significantly contribute to atherosclerosis (AS) as well as coronary lesion severity. Our previous work demonstrated that Hcy upregulates PCSK9, accelerating lipid accumulation and AS. A PCSK9 antagonist reduces plasma Hcy levels in ApoE −/− mice. These findings suggest complex roles for both Hcy and PCSK9 in AS. This study investigated the mutual mediating influence of Hcy together with PCSK9 on coronary lesion severity among individuals diagnosed with acute coronary syndrome (ACS), focusing on their interplay with inflammatory and lipid-related markers. Methods This cross-sectional study encompassed 617 individuals diagnosed with ACS. Baseline characteristics, including inflammatory and lipid-related markers, were compared between individuals with non-severe (SYNTAX score ≤ 22) and severe (SYNTAX score > 22) coronary lesions. To evaluate both the impacts of Hcy and PCSK9 on coronary lesions severity, multivariate logistic regression along with mediation analyses were utilized. The robustness of the findings was validated by conducting subgroup analyses and sensitivity tests. Results Patients with severe conditions showed higher levels of Hcy, PCSK9, and inflammatory markers compared to non-severe cases. Both Hcy and PCSK9 levels were independently linked to a heightened risk of severe coronary lesions(ORs: 1.03–1.04 and 1.01–1.02, respectively, all P  < 0.001). PCSK9 mediated 34.04% of Hcy’s effect on coronary lesion severity, whereas Hcy mediated 31.39% of PCSK9’s effect, indicating significant mutual mediation between these biomarkers. Subgroup analyses revealed consistent associations, with notable interactions based on creatinine levels for Hcy and gender, smoking status, and diagnosis for PCSK9. Sensitivity analyses confirmed the robustness of the mediation effects. Conclusions These findings emphasize the mutual mediating effects of Hcy and PCSK9 on coronary lesion severity in patients suffering from ACS. These results highlight the complex interactions between lipid metabolism and inflammation in the pathophysiology of ACS, suggesting that targeting both Hcy and PCSK9 may offer novel therapeutic strategies to mitigate severe coronary lesions among high-risk patients.

Background Congestive heart failure (CHF) among critically ill patients is a significant cardiovascular disorder that is linked to elevated mortality rates. The lactate/albumin ratio (LAR) is a readily available clinical metric that may provide valuable information regarding the metabolic and nutritional conditions. However, its association with mortality in patients with CHF remains unexplored. This study aimed to investigate the association between LAR and 28‐day intensive care unit (ICU) mortality among critically ill patients with CHF. Methods Using the eICU Collaborative Research Database (eICU‐CRD), this study was retrospective and observational. The study included those admitted to the ICU with a preliminary CHF diagnosis. The nonlinear relationship between LAR and 28‐day mortality was assessed using multivariate Cox regression and generalized additive models (GAMs), with confounders adjusted, and the crucial LAR value was identified through threshold effect analysis. Results Among 2117 patients diagnosed with CHF, 291 (13.7%) died within 28 days of ICU admission. A nonlinear relationship was observed between the LAR and mortality. For LAR values under 1.65, each unit increment was associated with a 2.41‐fold increase in the likelihood of mortality (p < 0.001). Nonetheless, this link was not significant for LARs ≥ 1.65 (HR = 1.14, p = 0.111). Subgroup analyses validated the robustness of this nonlinear relationship, except for a significant interaction with the respiratory rate. Mediation analysis revealed that white blood cell (WBC) counts partially mediated the link between LAR and mortality, suggesting potential connections between metabolic disturbances, inflammatory pathways, and adverse outcomes in this population. Conclusions LAR was nonlinearly related to 28‐day ICU mortality, identifying a particular turning point in critically ill patients with CHF. These findings suggest that the LAR, a readily available clinical metric, may help identify high‐risk patients with CHF and inform clinical management strategies.

Objectives We aim to investigate whether cerebral small vessel disease (cSVD) imaging markers correlate with deep medullary vein (DMV) damage in small vessel occlusion acute ischemic stroke (SVO-AIS) patients. Methods The DMV was divided into six segments according to the regional anatomy. The total DMV score (0–18) was calculated based on segmental continuity and visibility. The damage of DMV was grouped according to the quartiles of the total DMV score. Neuroimaging biomarkers of cSVD including white matter hyperintensity (WMH), cerebral microbleed (CMB), perivascular space (PVS), and lacune were identified. The cSVD score were further analyzed. Results We included 229 SVO-AIS patients, the mean age was 63.7 ± 23.1 years, the median NIHSS score was 3 (IQR, 2–6). In the severe DMV burden group (the 4th quartile), the NIHSS score grade (6 (3–9)) was significantly higher than other groups ( p  < 0.01). The grade scores for basal ganglia PVS (BG-PVS) were positively correlated with the degree of DMV ( R  = 0.67, p  < 0.01), rather than centrum semivole PVS (CS-PVS) ( R  = 0.17, p  = 0.1). In multivariate analysis, high CMB burden (adjusted odds ratio [aOR], 25.38; 95% confidence interval [CI], 1.87–345.23) was associated with severe DMV scores. In addition, BG-PVS was related to severe DMV burden in a dose-dependent manner: when BG-PVS score was 3 and 4, the aORs of severe DMV burden were 18.5 and 12.19, respectively. Conclusion The DMV impairment was associated with the severity of cSVD, which suggests that DMV burden may be used for risk stratification in SVO-AIS patients. Clinical relevance statement The DMV damage score, based on the association between small vessel disease and the deep medullary veins impairment, is a potential new imaging biomarker for the prognosis of small vessel occlusion acute ischemic stroke, with clinical management implications. Key Points • The damage to the deep medullary vein may be one mechanism of cerebral small vessel disease. • Severe burden of the basal ganglia perivascular space and cerebral microbleed is closely associated with significant impairment to the deep medullary vein. • The deep medullary vein damage score may reflect a risk of added vascular damage in small vessel occlusion acute ischemic stroke patients.

Aims Our purpose is to assess the role of cerebral small vessel disease (SVD) in prediction models in patients with different subtypes of acute ischemic stroke (AIS). Methods We enrolled 398 small‐vessel occlusion (SVO) and 175 large artery atherosclerosis (LAA) AIS patients. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days. MRI was performed to assess white matter hyperintensity (WMH), perivascular space (PVS), lacune, and cerebral microbleed (CMB). Logistic regression (LR) and machine learning (ML) were used to develop predictive models to assess the influences of SVD on the prognosis. Results In the feature evaluation of SVO‐AIS for different outcomes, the modified total SVD score (Gain: 0.38, 0.28) has the maximum weight, and periventricular WMH (Gain: 0.07, 0.09) was more important than deep WMH (Gain: 0.01, 0.01) in prognosis. In SVO‐AIS, SVD performed better than regular clinical data, which is the opposite of LAA‐AIS. Among all models, eXtreme gradient boosting (XGBoost) method with optimal index (OI) has the best performance to predict excellent outcome in SVO‐AIS. [0.91 (0.84–0.97)]. Conclusions Our results revealed that different SVD markers had distinct prognostic weights in AIS patients, and SVD burden alone may accurately predict the SVO‐AIS patients' prognosis. Characteristics of cerebral small vessel disease (CSVD) in acute ischemic stroke (AIS) patients can affect outcomes at 90 days. Meanwhile, different imaging markers of CSVD have different weights of impact on large artery atherosclerosis and small vessel occlusion subtype AIS.

The interaction effect between collateral circulation and ischemic core size on stroke outcomes has been highlighted in acute ischemic stroke (AIS). However, biomarkers that assess the magnitude of this interaction are still lacking. We aimed to present a new imaging marker, the collateral-core ratio (CCR), to quantify the interaction effect between these factors and evaluate its ability to predict functional outcomes using machine learning (ML) in AIS. Patients with AIS caused by anterior circulation large vessel occlusion (LVO) were recruited from a prospective multicenter study. CCR was calculated as collateral perfusion volume/ischemic core volume. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days. An ML model was built and tested with a tenfold cross-validation using nine clinical and four imaging variables with mRS score 3–6 as unfavorable outcomes. Among 129 patients, CCR was identified as the most important variable. The prediction model incorporating clinical factors, ischemic core volume, collateral perfusion volume, and CCR showed better discriminatory power in predicting unfavorable outcomes than the model without CCR (mean C index 0.853 ± 0.108 versus 0.793 ± 0.133, P  = 0.70; mean net reclassification index 52.7% ± 32.7%, P  < 0.05). When patients were divided into two groups based on their CCR value with a threshold of 0.73, unfavorable outcomes were significantly more prevalent in patients with CCR ≤ 0.73 than in those with CCR > 0.73. CCR is a robust predictor of functional outcomes, as identified by ML, in patients with acute LVO. The prediction model that incorporated CCR improved the model’s ability to identify unfavorable outcomes. ClinicalTrials.gov Identifier: NCT02580097.

NOABSTRACTThe Alberta Stroke Program CT Score (ASPECTS) is a widely used rating system for assessing infarct extent and location. We aimed to investigate the prognostic value of ASPECTS subregions’ involvement in the long-term functional outcomes of acute ischemic stroke (AIS).Consecutive patients with AIS and anterior circulation large-vessel stenosis and occlusion between January 2019 and December 2020 were included. The ASPECTS score and subregion involvement for each patient was assessed using posttreatment magnetic resonance diffusion-weighted imaging. Univariate and multivariable regression analyses were conducted to identify subregions related to 3-month poor functional outcome (modified Rankin Scale scores, 3–6) in the reperfusion and medical therapy cohorts, respectively. In addition, prognostic efficiency between the region-based ASPECTS and ASPECTS score methods were compared using receiver operating characteristic curves and DeLong’s test.A total of 365 patients (median age, 64 years; 70% men) were included, of whom 169 had poor outcomes. In the reperfusion therapy cohort, multivariable regression analyses revealed that the involvement of the left M4 cortical region in left-hemisphere stroke (adjusted odds ratio [aOR] 5.39, 95% confidence interval [CI] 1.53–19.02) and the involvement of the right M3 cortical region in right-hemisphere stroke (aOR 4.21, 95% CI 1.05–16.78) were independently associated with poor functional outcomes. In the medical therapy cohort, left-hemisphere stroke with left M5 cortical region (aOR 2.87, 95% CI 1.08–7.59) and caudate nucleus (aOR 3.14, 95% CI 1.00–9.85) involved and right-hemisphere stroke with right M3 cortical region (aOR 4.15, 95% CI 1.29–8.18) and internal capsule (aOR 3.94, 95% CI 1.22–12.78) affected were related to the increased risks of poststroke disability. In addition, region-based ASPECTS significantly improved the prognostic efficiency compared with the conventional ASPECTS score method.The involvement of specific ASPECTS subregions depending on the affected hemisphere was associated with worse functional outcomes 3 months after stroke, and the critical subregion distribution varied by clinical management. Therefore, region-based ASPECTS could provide additional value in guiding individual decision making and neurological recovery in patients with AIS.