Revista Portuguesa de Cardiologia (English Edition)最新文献

英文中文

Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study 外周中性粒细胞和初始CD4 T细胞预测急性心肌梗死后心力衰竭的发展:一项生物信息学研究

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.11.002

Congyi Yu, Wenjun Zhou

Introduction

Heart failure (HF) secondary to acute myocardial infarction (AMI) is still a worldwide problem with a high mortality rate. The current study aimed to explore early and reliable predictive biomarkers of HF following AMI.

Methods

The gene expression profile GSE59867 was downloaded from GEO. Array data from peripheral blood mononuclear cells (PBMCs) was used from 46 control patients and 111 patients with AMI at four time points: (i) first day of AMI; (ii) 4-6 days after AMI; (iii) one month after AMI; and (iv) six months after AMI. Among the 111 AMI patients, nine with HF and eight without HF were studied. CIBERSORT was used to analyze the relative proportions of immune cells in PBMCs. The proportions of immune cells in different groups were compared. Differentially expressed genes (DEGs) were analyzed with R language packages.

Results

The percentages of monocytes and neutrophils increased significantly on the first day of AMI, and then decreased gradually. The percentage of regulatory T cells increased significantly 4-6 days after AMI, while the percentage of resting memory CD4 cells, CD8 T cells, and resting natural killer cells decreased significantly on the first day of AMI, and then increased gradually. Patients who developed HF had a significantly higher proportion of neutrophils in PBMCs on the first day of AMI, but had a significantly lower proportion of naive CD4 T cells. Two shared genes, interleukin-1 receptor 2 (IL1R2) and leucine-rich repeat neuronal protein 3 (LRRN3), were found to have potentially important roles in predicting the development of HF following AMI.

Conclusion

A higher proportion of neutrophils and a lower proportion of naive CD4 T cells in PBMCs on the first day of AMI may be correlated with the development of HF following AMI. IL1R2 and LRRN3 may exert functions in the development of HF following AMI.

急性心肌梗死(AMI)继发心力衰竭(HF)仍然是一个具有高死亡率的世界性问题。目前的研究旨在探索AMI后HF的早期和可靠的预测性生物标志物。方法从GEO下载基因表达谱GSE59867。采用46例对照患者和111例AMI患者在4个时间点的外周血单个核细胞(PBMCs)阵列数据:(i) AMI第一天;(ii) AMI后4-6天;(iii) AMI后一个月;(iv) AMI后6个月。在111例AMI患者中，9例合并心衰，8例不合并心衰。采用CIBERSORT分析pbmc中免疫细胞的相对比例。比较各组免疫细胞比例。用R语言包分析差异表达基因(DEGs)。结果心肌梗死第1天单核细胞和中性粒细胞百分比明显升高，随后逐渐降低。AMI后4 ~ 6 d，调节性T细胞百分比显著升高，静息记忆性CD4细胞、CD8 T细胞和静息自然杀伤细胞百分比在AMI第1天显著降低，后逐渐升高。发生HF的患者在AMI的第一天pbmc中中性粒细胞的比例显著升高，但初始CD4 T细胞的比例显著降低。两个共享基因，白细胞介素-1受体2 (IL1R2)和富含亮氨酸的重复神经元蛋白3 (LRRN3)，被发现在预测AMI后HF的发展中具有潜在的重要作用。结论急性心肌梗死第1天外周血中性粒细胞比例升高、初始CD4 T细胞比例降低可能与急性心肌梗死后HF的发生有关。IL1R2和LRRN3可能在AMI后HF的发展中发挥作用。

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引用次数: 2

Ablation of ventricular arrhythmic substrate: When the whole is more than the sum of its parts 室性心律失常底物消融:当整体大于部分之和时

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.10.023

João Primo

引用次数: 0

Impella support for cardiogenic shock and high-risk percutaneous coronary intervention: A single-center experience Impella支持心源性休克和高风险经皮冠状动脉介入治疗:单中心经验

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.11.003

Mariana Brandão, Daniel Caeiro, Gustavo Pires-Morais, João Gonçalves Almeida, Pedro Gonçalves Teixeira, Marisa Passos Silva, Marta Ponte, Adelaide Dias, Marco Oliveira, Alberto Rodrigues, Pedro Braga

Introduction and Objectives

The use of mechanical circulatory support is increasing in cases of cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The Impella® is a percutaneous ventricular assist device that unloads the left ventricle by ejecting blood to the ascending aorta. We report our center's experience with the use of the Impella® device in these two clinical settings.

Methods

We performed a single-center retrospective study including all consecutive patients implanted with the Impella® between 2007 and 2019 for CS treatment or prophylactic support of HR-PCI. Data on clinical and safety endpoints were collected and analyzed.

Results

Twenty-two patients were included: 12 were treated for CS and 10 underwent an HR-PCI procedure. In the CS-treated population, the main cause of CS was acute myocardial infarction (five patients); hemolysis was the most frequent device-related complication (63.7%). In-hospital, cumulative 30-day and one-year mortality were 58.3%, 66.6% and 83.3%, respectively. In the HR-PCI group, all patients had multivessel disease (mean baseline SYNTAX I score: 44.1±13.7). In-hospital, 30-day and one-year mortality were 10.0%, 10.0% and 20.0%, respectively. There were no device- or procedure-related deaths in either group.

Conclusion

The short- and long-term results of Impella®-supported HR-PCI were comparable to those in the literature. In the CS group, in-hospital and short-term outcomes were poor, with high mortality and non-negligible complication rates.

在心源性休克(CS)和高危经皮冠状动脉介入治疗(HR-PCI)的病例中，机械循环支持的使用越来越多。Impella®是一种经皮心室辅助装置，通过向升主动脉喷射血液来卸载左心室的负荷。我们报告本中心在这两种临床环境中使用Impella®设备的经验。方法:我们进行了一项单中心回顾性研究，包括2007年至2019年期间连续植入Impella®用于CS治疗或HR-PCI预防性支持的所有患者。收集和分析临床和安全终点数据。结果本组共纳入22例患者，其中12例接受CS治疗，10例行HR-PCI手术。在接受CS治疗的人群中，CS的主要原因是急性心肌梗死(5例);溶血是最常见的器械相关并发症(63.7%)。住院、30天和1年累计死亡率分别为58.3%、66.6%和83.3%。在HR-PCI组中，所有患者都有多血管疾病(平均基线SYNTAX I评分:44.1±13.7)。住院死亡率、30天死亡率和1年死亡率分别为10.0%、10.0%和20.0%。两组均无器械或手术相关死亡。结论Impella®支持的HR-PCI的短期和长期结果与文献相当。在CS组中，住院和短期预后较差，死亡率高，并发症发生率不可忽视。

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引用次数: 0

Cardiac resynchronization system implantation guided by three-dimensional electroanatomic mapping 三维电解剖成像引导下心脏再同步系统植入

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.10.025

Pedro Silva Cunha, Hélder Santos, Mário Martins Oliveira

引用次数: 0

A new biomarker that predicts ventricular arrhythmia in patients with ischemic dilated cardiomyopathy: Galectin-3 预测缺血性扩张型心肌病患者室性心律失常的新生物标志物:半凝集素-3

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.10.019

Onur Erdogan , Ekrem Karaayvaz , Tugba Erdogan , Cafer Panc , Remzi Sarıkaya , Aytac Oncul , Ahmet Kaya Bilge

Introduction

Ventricular arrhythmias are caused by scar tissue in patients with ischemic dilated cardiomyopathy. The gold standard imaging technique for detecting scar tissue is magnetic resonance imaging (MRI). However, MRI is not feasible for use as a screening test, and also cannot be used in patients who have received an implantable cardioverter-defibrillator (ICD). In this study, we aimed to assess the association between levels of galectin-3 (Gal-3), which is known to be secreted by scar tissue, and the history of ventricular arrhythmias in patients with ischemic dilated cardiomyopathy who received an ICD.

Methods

Nineteen healthy controls and 32 patients who had previously undergone VVI-ICD implantation due to ischemic dilated cardiomyopathy were enrolled in the study. Patients were divided into three groups: the first group including patients who had received no ICD therapies, the second including patients with arrhythmia requiring therapies with no arrhythmia storm, and the third including patients who had arrhythmia storm. We assessed the association between Gal-3 levels and the history of ventricular arrhythmias in these patients.

Results

Gal-3 levels were significantly higher in the patient groups than in the control group (p<0.01). Gal-3 levels of patients with arrhythmias requiring ICD therapies were significantly higher than in patients with ICD not requiring therapies (p=0.02). They were also higher in patients with a history of arrhythmia storm than in patients without shocks (p=0.05). Receiver operating curve analysis showed with 84% sensitivity and 75% specificity that Gal-3 levels over 7 ng/ml indicated ventricular arrhythmia that required therapies.

Conclusion

Gal-3 may be used to further improve risk stratification in patients with ischemic cardiomyopathy who are more prone to developing life-threatening arrhythmias.

室性心律失常是由缺血性扩张型心肌病患者的瘢痕组织引起的。检测疤痕组织的金标准成像技术是磁共振成像(MRI)。然而，MRI不能作为筛查试验，也不能用于接受植入式心律转复除颤器(ICD)的患者。在这项研究中，我们旨在评估半乳糖凝集素-3 (Gal-3)水平与接受ICD的缺血性扩张型心肌病患者室性心律失常史之间的关系。半乳糖凝集素-3是由疤痕组织分泌的。方法选取19例健康对照和32例因缺血性扩张型心肌病行VVI-ICD植入的患者作为研究对象。患者分为三组:第一组包括未接受ICD治疗的患者，第二组包括需要治疗的心律失常患者，没有心律失常风暴，第三组包括有心律失常风暴的患者。我们评估了Gal-3水平与这些患者室性心律失常史之间的关系。结果患者组血清gal -3水平明显高于对照组(p < 0.01)。需要ICD治疗的心律失常患者的Gal-3水平显著高于不需要治疗的ICD患者(p=0.02)。有心律失常风暴病史的患者比无电击的患者高(p=0.05)。受试者工作曲线分析显示，Gal-3水平超过7 ng/ml提示室性心律失常，敏感性84%，特异性75%。结论al-3可进一步改善缺血性心肌病患者的风险分层，这些患者更容易发生危及生命的心律失常。

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引用次数: 1

Current state of cardiac rehabilitation in Portugal: Results of the 2019 national survey 葡萄牙心脏康复的现状:2019年全国调查结果

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.10.024

José Paulo Fontes , Eduardo M. Vilela , Anaí Durazzo , Madalena Teixeira

Introduction

Cardiac rehabilitation (CR) programs have a central role in cardiovascular medicine, encompassing a comprehensive framework able to holistically address various facets of cardiovascular disease. However, several obstacles to their optimal application have been reported. Over the years, the Portuguese Society of Cardiology has periodically conducted a national survey on the state of CR in Portugal.

Objectives

This study reports the results of the 2019 survey on CR.

Methods

In December 2019 a voluntary questionnaire was sent to centers offering CR programs, consisting of several items concerning this intervention.

Results

In 2019, 25 centers provided structured CR programs. A total of 2182 patients underwent phase II programs, representing an increase of 13% from the previous survey. Of these, 67.2% were referred due to ischemic heart disease, and 14.5% due to heart failure. Acute coronary syndromes (ACS) comprised 49.3% of referrals, leading to an estimated 9.3% CR coverage. A total of 606 patients participated in phase III programs (a decrease of 37%). Drop-out rates ranged from 0-68%; 91% of centers presented drop-out rates <25%.

Conclusion

The present survey shows an increase in the number of centers and patients undergoing phase II CR, and an increase in the estimated CR coverage after ACS. Despite this, the level of increase means that overall patient representation remained below the optimal range, while the data also showed a decrease in the number of patients in phase III programs. These findings reinforce the importance of optimization of CR entry and maintenance, in order to improve the uptake of this pivotal intervention.

心脏康复(CR)项目在心血管医学中起着核心作用，它包含了一个全面的框架，能够全面地解决心血管疾病的各个方面。然而，据报道，它们的最佳应用存在一些障碍。多年来，葡萄牙心脏病学会定期对葡萄牙的CR状况进行全国性调查。方法于2019年12月向提供CR项目的中心发送一份自愿问卷，包括与该干预有关的几个项目。结果2019年，有25个中心提供了结构化的CR项目。共有2182名患者接受了II期项目，比上一次调查增加了13%。其中，67.2%是由于缺血性心脏病，14.5%是由于心力衰竭。急性冠脉综合征(ACS)占转诊的49.3%，导致估计9.3%的CR覆盖率。共有606名患者参加了III期项目(减少了37%)。辍学率从0-68%不等;91%的中心出现了25%的辍学率。结论目前的调查显示，接受II期CR的中心和患者数量增加，ACS后估计的CR覆盖率增加。尽管如此，增加的水平意味着总体患者代表仍低于最佳范围，同时数据还显示III期项目的患者数量有所减少。这些发现加强了优化CR进入和维持的重要性，以提高这一关键干预措施的吸收。

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引用次数: 1

Acute myocardial infarction on YouTube – is it all fake news? YouTube上的急性心肌梗死——都是假新闻吗?

Revista Portuguesa de Cardiologia (English Edition)

Pub Date : 2021-11-01 DOI: 10.1016/j.repce.2021.10.001

Inês Fialho , Marco Beringuilho , Daniela Madeira , João Baltazar Ferreira , Daniel Faria , Hilaryano Ferreira , David Roque , Miguel B. Santos , Carlos Morais , Victor Gil , João B. Augusto

Introduction and objectives

The Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese.

Methods

We analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): “cardiac + arrest”; “heart + attack”; “heart + thrombosis”; “coronary + thrombosis”; “infarction – brain”, “myocardial + infarction” and “acute + myocardial + infarction”. Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non‐Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores – the higher the score, the better the quality.

Results

242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1).

Conclusions

One third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information.

互联网是健康信息的一个基本方面。然而，缺乏质量控制会助长错误信息。我们的目标是评估在YouTube (www.youtube.com)上分享的葡萄牙语急性心肌梗死视频的相关性和质量。方法:我们分析了1000个视频，对应于YouTube上前100个搜索结果，使用以下术语(葡萄牙语):“心脏+骤停”;“心脏病+发作”;“心脏+血栓”;“冠状动脉+血栓”;“梗塞-脑”、“心肌+梗塞”、“急性+心肌+梗塞”。排除不相关(n=316)、重复(n=345)、无音频(n=24)或非葡萄牙语(n=106)视频。纳入的视频根据来源、主题、目标受众和科学不准确性进行评估。信息质量采用“网络健康代码”(HONCode从0到8)和“辨别”(从0到5)评分进行评估——得分越高，质量越好。结果共纳入242个视频。大多数来自独立教师(n=95, 39.0%)，针对一般人群(n=202, 83.5%)。三分之一的视频(n=79)包含不准确信息，而科学协会和政府/卫生机构的视频没有不准确信息。平均视频质量较差或中等;只有一个视频质量好，没有任何不准确的地方。政府/卫生机构是视频质量最好的来源(HONCode 4±1,DISCERN 2±1)。结论三分之一的视频信息不相关，三分之一的相关视频信息不准确。平均视频质量很差;因此，制定策略以提高在线健康信息的质量是非常重要的。

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Revista Portuguesa de Cardiologia (English Edition)

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Revista Portuguesa de Cardiologia (English Edition)

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引用次数: 0

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