Xin Zhang

Background/Objectives: Tuberculous constrictive pericarditis (TCP) is characterized by “backward failure” and systemic venous congestion, leading to secondary multi-organ dysfunction. The Model for End-Stage Liver Disease (MELD) 3.0 score assesses liver, renal, and nutritional status, yet its prognostic utility in TCP remains undefined. This study aimed to evaluate the preoperative MELD 3.0 score as a predictor of time to discharge in patients undergoing pericardiectomy for TCP. Methods: We analyzed 190 patients undergoing pericardiectomy for TCP between 2018 and 2024. The association between preoperative MELD 3.0 scores and time to discharge (ICU, postoperative, and total) was assessed using Fine–Gray competing risks regression to account for in-hospital mortality. Models were adjusted for age, albumin, and anti-tuberculosis therapy. Results: Each unit increase in MELD 3.0 was associated with higher operative mortality (OR 1.21, p = 0.013). In multivariable analysis, a high MELD 3.0 score (>median 9.6) was independently associated with a lower probability of discharge (i.e., delayed discharge) for total hospital stay (subdistribution hazard ratio [sHR] 0.606, 95% CI 0.453–0.811), postoperative stay (sHR 0.665), and ICU stay (sHR 0.658). Preoperative albumin was also a strong predictor of faster discharge. Conclusions: The preoperative MELD 3.0 score independently predicts delayed hospital discharge after pericardiectomy for TCP, even when accounting for mortality risk. It serves as a pragmatic tool for quantifying the systemic burden of congestion and stratifying perioperative risk.

Background: Papillary muscles (PMs) are important for mitral valve competence and left ventricular mechanics, but accurate evaluation is often limited by poor visualization in conventional echocardiographic views. We developed papillary muscle–targeted (PM-targeted) echocardiographic views to improve PM visualization and aimed to validate this approach and establish normative reference values in healthy adults. Methods: In protocol 1, posteromedial papillary muscle (PPM) length and maximum diameter measured using PM-targeted and standard views were compared with anatomic measurements in ten ex vivo porcine hearts. In protocol 2, measurements of the anterolateral papillary muscle (APM) and PPM were compared between PM-targeted and standard views in 100 healthy adults. In protocol 3, PM structural, spatial, and functional parameters were measured using PM-targeted views in 245 healthy adults. In protocol 4, PM measurements obtained from 2D PM-targeted views were compared with 3D echocardiographic measurements in 50 patients with ventricular functional mitral regurgitation (VFMR); PM parameters in VFMR were also compared with those in healthy adults. Results: In protocol 1, PM-targeted views showed stronger correlation with anatomic measurements for PPM length than standard views (0.966 vs. 0.752, p = 0.049), while standard views underestimated PPM length. In protocol 2, PM-targeted views enabled complete visualization of APM and PPM and yielded longer PM lengths and smaller maximum diameters than standard views. In protocol 3, males had larger PM maximum diameters and longer tip-to-annulus distances than females (all p < 0.05). With aging, interpapillary distance reduction (ΔIPMD), IPMD fractional shortening (IPMD-FS), and APM length decreased, whereas end-systolic IPMD increased (all p < 0.05). PM parameters correlated positively with body surface area (all p < 0.05). In protocol 4, PM measurements obtained from 2D PM-targeted views showed no differences from 3D echocardiographic measurements and demonstrated good correlation and agreement across assessed PM parameters against 3D echocardiographic measurement as a standard reference. Compared with healthy adults, patients with VFMR showed altered PM geometry/remodeling patterns. Conclusions: PM-targeted echocardiographic views improve visualization and measurement of papillary muscles and provide normative reference values, facilitating more accurate evaluation of PM-related abnormalities in clinical practice.

Background: Accurate and early identification of impaired left ventricular (LV) function is essential to the optimal timing of intervention for primary mitral regurgitation. Myocardial work derived from noninvasive pressure‐strain loop is a novel and promising afterload‐independent approach to evaluate LV performance. We hypothesized that it may provide diagnostic and prognostic utility in these patients. This study aimed to evaluate myocardial work parameters in patients with significant primary mitral regurgitation, and explore their association with postinterventional LV ejection fraction and clinical composite events. Methods: The study prospectively enrolled 180 patients with severe primary mitral regurgitation at baseline and patients were followed up for postinterventional LV function (>12 months) and clinical events (24.0 [23.3–24.6] months). Logistic regression and Cox proportional hazards regression analyses were performed as appropriate. Results: Compared with patients exhibiting postinterventional LV ejection fraction ≥50%, individuals with LV ejection fraction P P =0.001). Preinterventional LV global longitudinal strain, GWI, GCW, and global work efficiency were independent predictors of postinterventional LV dysfunction ( P P <0.001 for all). Conclusions: Myocardial work parameters, especially GWI, GCW, and global work efficiency, are independent predictors of postinterventional LV dysfunction and are associated with the occurrence of postinterventional clinical composite events.

Background: The impaired right ventricular (RV) function may occur after heart transplantation (HT). This study aimed to develop a straightforward RV function score (RVFS) using echocardiography to predict adverse clinical events in a large cohort of subjects after HT. Methods: A total of 357 consecutive patients post HT who underwent echocardiography at our single institution were retrospectively included. RV systolic function was evaluated by echocardiography. A multivariate Cox regression analysis was performed to identify the independent predictors of RV function for adverse clinical events. Results: During a median follow‐up of 39 months from the date of the echocardiography, a composite of adverse events that included death and major adverse cardiac events occurred in 51 patients. The multivariate Cox analysis revealed that RV fractional area change, tricuspid annular plane systolic excursion, and RV free wall longitudinal strain were independent predictors of outcomes after HT. The RVFS was constructed based on these 3 parameters, assigning a value of 1 when a predictor was below its cutoff value from receiver operating characteristic curves and 0 when above. The RVFS outperformed separate RV function parameters in predicting outcomes (area under the curves: 0.84 versus 0.64–0.78, P P <0.001). Conclusions: The RVFS, a readily obtainable echo score that combines multiple RV function parameters, exhibits incremental value and significant potential as a robust predictor for adverse outcomes in clinically stable patients after HT.

Depression is prevalent among nursing students. Rumination and sleep-wake rhythms are associated to mental illness; however, no clear path has been found. This exploratory study aimed to examine the associations among circadian activity rhythms (CAR), rumination, and depressive symptoms in female nursing students; further, to test a hypothesized CAR conceptual model. A total of 148 female nursing junior students in China completed a battery of questionnaires, including Athens Insomnia Scale (AIS), Ruminative Responses Scale (RRS), and Self-rating Depression Scale (SDS). Wrist actigraphy was used to collect total sleep time, CAR, and acrophase (time of the peak of the fitted activity curve). The path analysis was explored by using SPSS and AMOS. The mean age of the students was 20.64 years (SD = 0.86). About 58.8% of the participants were either mild or moderate depressed. About 93.9% of the students reported significant insomnia symptoms (AIS scores >6). Rumination was measured by the RRS (M= 2.01, SD = 0.54), and students scored higher in brooding than that of reflective pondering (2.07 vs. 1.95). The average of TST was 394.59 minutes (SD = 51.92). The CAR ranged from 0.40 to 0.98, with a mean of 0.75 (SD = 0.11). The acrophase ranged from 12:46 to 20:14 (median 16:30), with a later acrophase indicates of a more delayed circadian phase. The final model shows satisfactory fit (χ2= 2.238, p= .327); a better CAR can indirectly reduce depressive symptoms by directly reducing brooding (B = -1.149) and improving insomnia symptoms (B = -6.6443). In order to prevent psychological problems of nursing students, ruminating and CAR should be part of health screening. The novel conceptual model provides a basis for reforming nursing education to prevent psychological problems. Chinese National Natural Science Foundation [71603279]