Clinical Cardiology最新文献_第2页

Incorporating Inflammation Biomarker-Driven Multivariate Predictive Model for Coronary Microcirculatory Dysfunction in Acute Myocardial Infarction Following Emergency Percutaneous Coronary Intervention 急诊经皮冠状动脉介入治疗后急性心肌梗死冠状动脉微循环功能障碍的炎症生物标志物多变量预测模型。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-21 DOI: 10.1002/clc.70032

Zhuoya Yao, Bin Ding, Jun Wang, Shaohuan Qian, Xilong Song, Yao Li, Siyu Ding, Hongju Wang, Miaonan Li

Background

Despite patients with successful revascularization as evidenced by angiographic findings, inadequate clinical management of coronary microcirculatory dysfunction (CMD) may result in preventable adverse outcomes. Therefore, it is imperative to use a multimodal data‑driven predictive model for the occurrence of CMD in patients with acute myocardial infarction (AMI) following emergency percutaneous coronary intervention (PCI).

Methods

A prospective case−control analysis was conducted on a cohort of 77 patients with AMI who underwent PCI. The most informative predictors were selected for the predictive model through the application of LASSO analysis and multi-factor logistic regression. The diagnosis of CMD is based on findings from cardiac magnetic resonance (CMR).

Results

Based on the findings from LASSO analysis and multi-factor logistic regression, variables including sex, neutrophil-to-lymphocyte ratio (NLR), Gensini score, and diabetes mellitus were identified as independent predictors for the development of CMD in AMI patients who underwent emergency PCI. The predictive model was evaluated using bootstrap self-sampling 500 times. The resulting predictive model demonstrated an AUC value of 0.897 (95% CI: 0.827−0.958). The calibration curves exhibited good concordance between the predictions generated by the model and the CMR analysis. Furthermore, decision curve analysis revealed that the predictive model provided valuable clinical benefit in predicting CMD.

Conclusions

The multivariate predictive model, constructed using readily available clinical variables in patients with AMI who underwent PCI, demonstrates satisfactory predictability for identifying comorbid CMD, thereby facilitating the identification of high-risk patients.

背景：尽管血管造影结果显示患者成功进行了血管再通，但如果冠状动脉微循环功能障碍（CMD）的临床处理不当，可能会导致可预防的不良后果。因此，急诊经皮冠状动脉介入治疗（PCI）后的急性心肌梗死（AMI）患者必须使用多模态数据驱动的预测模型来预测CMD的发生：对 77 名接受 PCI 的 AMI 患者进行了前瞻性病例对照分析。通过应用 LASSO 分析和多因素逻辑回归，为预测模型筛选出了最有参考价值的预测因子。CMD的诊断基于心脏磁共振（CMR）的结果：根据LASSO分析和多因素Logistic回归的结果，性别、中性粒细胞与淋巴细胞比值（NLR）、Gensini评分和糖尿病等变量被确定为急诊PCI的AMI患者发生CMD的独立预测因素。预测模型通过自引导自采样 500 次进行了评估。预测模型的 AUC 值为 0.897（95% CI：0.827-0.958）。校准曲线显示，该模型生成的预测结果与 CMR 分析结果之间具有良好的一致性。此外，决策曲线分析表明，预测模型在预测 CMD 方面提供了宝贵的临床益处：多变量预测模型是利用接受 PCI 的 AMI 患者的现成临床变量构建的，在识别合并 CMD 方面显示出令人满意的预测能力，从而有助于识别高危患者。

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引用次数: 0

The High-Sensitivity HEART Pathway Safely Reduces Hospitalizations Regardless of Sex or Race in a Multisite Prospective US Cohort 在美国多地点前瞻性队列中，无论性别或种族如何，高灵敏度 HEART 途径都能安全地降低住院率

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-17 DOI: 10.1002/clc.70027

Campbell J. Veasey, Anna C. Snavely, Zechariah L. Kearns, Nicklaus P. Ashburn, Tara Hashemian, Simon A. Mahler

Background

The high-sensitivity HEART pathway (hs-HP) risk stratifies emergency department (ED) patients with chest pain. It is unknown if its safety and effectiveness vary by sex or race.

Methods

We conducted a subgroup analysis of the hs-HP implementation study, a pre−post interrupted time series at five US EDs. The pre-implementation period (January 2019 to April 2020) utilized the traditional HEART pathway with contemporary troponin (Siemens) and the post-implementation period (November 2020 to February 2022) used the hs-HP using hs-cTnI (Beckman Coulter). Patients were risk-stratified using the hs-HP to rule-out, observation, and rule-in groups. Safety and effectiveness outcomes were 30-day all-cause mortality or myocardial infarction (MI) and 30-day hospitalization.

Results

Twenty-six thousand and one hundred twenty-six patients were accrued (12 317 pre- and 13 809 post-implementation), of which 35.3% were non-White and 52.7% were female. Among 9703 patients with complete hs-HP assessments, 48.6% of White and 55.4% of non-White patients were ruled-out (p < 0.001). Additionally, 47.3% of males and 54.4% of females were ruled-out (p < 0.001). Among rule-out patients, 0.3% of White versus 0.3% of non-White patients (p = 0.98) and 0.3% of females versus males 0.3% (p = 0.90) experienced 30-day death or MI. Post-implementation, 30-day hospitalization decreased 17.2% among White patients (aOR 0.49, 95% CI: 0.45−0.52), 14.1% among non-White patients (aOR 0.53, 95% CI: 0.48−0.59), 15.6% among females (aOR 0.50, 95% CI: 0.46−0.54), and 16.6% among males (aOR 0.51, 95% CI: 0.47−0.56). The interactions for 30-day hospitalization between hs-HP implementation and race (p = 0.10) and sex (p = 0.69) were not significant.

Conclusions

The hs-HP safely decreases 30-day hospitalizations regardless of sex or race. However, it classifies more non-White patients and women to the rule-out group.

背景高灵敏度心血管病路径（hs-HP）可对急诊科（ED）胸痛患者进行风险分层。其安全性和有效性是否因性别或种族而异尚属未知。方法我们对 hs-HP 实施研究进行了亚组分析，这是一项在美国五家急诊室进行的前后间断时间序列研究。实施前（2019 年 1 月至 2020 年 4 月）采用传统 HEART 路径和当代肌钙蛋白（西门子），实施后（2020 年 11 月至 2022 年 2 月）采用 hs-HP 和 hs-cTnI（贝克曼库尔特）。使用 hs-HP 对患者进行风险分层，分为排除组、观察组和纳入组。安全性和有效性结果为 30 天全因死亡率或心肌梗死（MI）和 30 天住院率。结果共招募了 2.6126 万名患者（实施前为 12 317 人，实施后为 13 809 人），其中 35.3% 为非白人，52.7% 为女性。在完成 hs-HP 评估的 9703 名患者中，48.6% 的白人和 55.4% 的非白人患者被排除在外（p <0.001）。此外，47.3% 的男性和 54.4% 的女性被排除在外（p < 0.001）。在被排除的患者中，有 0.3% 的白人患者和 0.3% 的非白人患者（P = 0.98）以及 0.3% 的女性患者和 0.3% 的男性患者（P = 0.90）经历了 30 天死亡或心肌梗死。实施后，白人患者的 30 天住院率下降了 17.2%（aOR 0.49，95% CI：0.45-0.52），非白人患者下降了 14.1%（aOR 0.53，95% CI：0.48-0.59），女性下降了 15.6%（aOR 0.50，95% CI：0.46-0.54），男性下降了 16.6%（aOR 0.51，95% CI：0.47-0.56）。实施 hs-HP 与种族（p = 0.10）和性别（p = 0.69）之间的 30 天住院交互作用不显著。结论无论性别或种族如何，hs-HP 都能安全地降低 30 天住院率。但是，它将更多的非白人患者和女性归入排除组。

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引用次数: 0

The Role of Inflammation in Early Left Ventricular Thrombus Formation Following ST-Elevation Myocardial Infarction—A Matched Case-Control Study ST段抬高型心肌梗死后炎症在早期左心室血栓形成中的作用--一项匹配病例对照研究

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-16 DOI: 10.1002/clc.70031

Batia Litmanowicz, Moran Gvili Perelman, Michal Laufer-Perl, Yan Topilsky, Shmuel Banai, Yacov Shacham, Shafik Khoury

Background

There is limited data on the association between inflammation and the formation of early left ventricular thrombus (LVT) following ST-elevation myocardial infarction (STEMI). This study aimed to explore the predictive value of several inflammatory biomarkers for LVT formation following STEMI.

Methods and Results

Our cohort included 2534 consecutive patients admitted to the cardiac intensive care unit (CICU) with STEMI. The final analysis included 51 patients with LVT and 102 patients without LVT, matched for age, sex, anterior infarct and ejection fraction. Upon admission, patients with LVT had higher white blood cell counts (WBC) (12.8 ± 7 vs. 12.4 ± 4 ×10³/µL, p = 0.01), higher absolute neutrophil counts (10.5 ± 4 vs. 8.6 ± 4 ×10³/µL, p = 0.003), neutrophil-to-lymphocyte ratio (8.2 ± 6 vs. 4.8 ± 4, p = 0.04), and C-reactive protein (CRP) levels (35.9 ± 62 vs. 18.6 ± 40 mg/L, p = 0.04). Peak values for WBC and CRP were also higher in the LVT group (17.8 ± 8 vs. 14.6 ± 5 ×10³/µL, p = 0.003 and 95.8 ± 82 vs. 64.2 ± 76 mg/L, p = 0.02, respectively). In univariate regression analysis, WBC upon admission (OR: 1.12, 95% CI: 1.02–1.21, p = 0.02), peak WBC (OR: 1.09, 95% CI: 1.02–1.17, p = 0.009), neutrophil count upon admission (OR: 1.15, 95% CI: 1.04–1.26, p = 0.004), and peak CRP (OR: 1.01, 95% CI: 1–1.01, p = 0.03) predicted LVT formation, which was also evident in multivariate regression models.

Conclusion

WBC and neutrophil counts upon admission, as well as peak WBC and CRP, have additional predictive value for LVT formation following STEMI, beyond classical risk factors.

背景有关 STEMI（ST 段抬高型心肌梗死）后炎症与早期左心室血栓（LVT）形成之间关系的数据十分有限。本研究旨在探讨几种炎症生物标志物对 STEMI 后左心室血栓形成的预测价值。方法和结果我们的队列包括 2534 名连续入住心脏重症监护病房（CICU）的 STEMI 患者。最终分析结果包括 51 例 LVT 患者和 102 例无 LVT 患者，患者的年龄、性别、前梗死和射血分数均匹配。入院时，LVT 患者的白细胞计数（WBC）较高（12.8 ± 7 vs. 12.4 ± 4 ×103/µL，P = 0.01），中性粒细胞绝对计数较高（10.5 ± 4 vs. 8.6 ± 4 ×103/µL，P = 0.01）。6 ± 4 ×103/µL，p = 0.003）、中性粒细胞与淋巴细胞比率（8.2 ± 6 vs. 4.8 ± 4，p = 0.04）和 C 反应蛋白（CRP）水平（35.9 ± 62 vs. 18.6 ± 40 mg/L，p = 0.04）更高。LVT 组的白细胞和 CRP 峰值也更高（分别为 17.8 ± 8 vs. 14.6 ± 5 ×103/µL, p = 0.003 和 95.8 ± 82 vs. 64.2 ± 76 mg/L, p = 0.02）。在单变量回归分析中，入院时白细胞（OR：1.12，95% CI：1.02-1.21，P = 0.02）、白细胞峰值（OR：1.09，95% CI：1.02-1.17，P = 0.009）、入院时中性粒细胞计数（OR：1.15，95% CI：1.04-1.26，p = 0.004）和 CRP 峰值（OR：1.01，95% CI：1-1.01，p = 0.03）预测 LVT 的形成，这在多变量回归模型中也很明显。结论入院时的白细胞和中性粒细胞计数以及白细胞和 CRP 峰值对 STEMI 后 LVT 的形成具有传统风险因素之外的预测价值。

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引用次数: 0

Association Between Overweight/Obesity Metabolic Phenotypes Defined by Two Criteria of Metabolic Abnormality and Cardiovascular Diseases: A Cross-Sectional Analysis in a Chinese Population 两种代谢异常标准定义的超重/肥胖代谢表型与心血管疾病之间的关系：中国人群的横断面分析

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-14 DOI: 10.1002/clc.70020

Yue Qiu, Shujin Fan, Jing Liu, Xiaodan He, Tianxin Zhu, Li Yan, Meng Ren

Objectives

Obesity/overweight and metabolic anomalies are known to be associated with elevated cardiovascular disease (CVD) risk. However, there is a paucity of research exploring the association between different body weights, varying metabolic statuses, and the occurrence of CVD in the Chinese population. Thus, we performed this study to explore the relation between different metabolic overweight/obesity phenotypes and the prevalence of CVD.

Methods

We analyzed data from 9075 participants in the Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study. Participants were classified into four metabolic phenotypes based on their metabolic status and obesity/overweight status. Regression analysis was used to evaluate the relationship between CVD and different groups. Additionally, we conducted a subgroup analysis to further explore the relationship between CVD and different metabolic abnormalities.

Results

Compared to metabolically healthy non-overweight/obesity (MHNO) individuals, both overweight/obesity and metabolic anomalies were positively associated with CVD prevalence. Among other metabolically unhealthy and overweight/obesity phenotypes, metabolically healthy overweight/obesity (MHO) generally exhibited a comparatively lower association with CVD. In the elderly, high waist circumference was significantly associated with CVD, rather than body weight. Further analysis revealed that hypertension had the strongest association with CVD.

Conclusion

Elderly individuals should place more emphasis on managing their waist circumference rather than only on BMI. CVD prevention should focus on both body weight management and treatment of metabolic diseases, with particular emphasis on antihypertensive therapy.

众所周知，肥胖/超重和代谢异常与心血管疾病（CVD）风险升高有关。然而，有关中国人群中不同体重、不同代谢状态与心血管疾病发生之间关系的研究却很少。因此，我们开展了这项研究，探讨不同代谢超重/肥胖表型与心血管疾病发病率之间的关系。方法我们分析了中国糖尿病患者心血管疾病风险评估纵向研究（REAC）9075 名参与者的数据：纵向研究（REACTION）的 9075 名参与者的数据。根据代谢状况和肥胖/超重状况，参与者被分为四种代谢表型。采用回归分析评估心血管疾病与不同组别之间的关系。此外，我们还进行了分组分析，以进一步探讨心血管疾病与不同代谢异常之间的关系。结果与代谢健康的非超重/肥胖（MHNO）人群相比，超重/肥胖和代谢异常与心血管疾病发病率呈正相关。在其他代谢不健康和超重/肥胖表型中，代谢健康的超重/肥胖（MHO）与心血管疾病的相关性通常相对较低。在老年人中，高腰围与心血管疾病的关系比体重更为密切。进一步分析表明，高血压与心血管疾病的关系最为密切。结论老年人应更加重视控制腰围，而不仅仅是体重指数。心血管疾病的预防应同时关注体重管理和代谢性疾病的治疗，尤其要重视降压治疗。

{"title":"Association Between Overweight/Obesity Metabolic Phenotypes Defined by Two Criteria of Metabolic Abnormality and Cardiovascular Diseases: A Cross-Sectional Analysis in a Chinese Population","authors":"Yue Qiu, Shujin Fan, Jing Liu, Xiaodan He, Tianxin Zhu, Li Yan, Meng Ren","doi":"10.1002/clc.70020","DOIUrl":"https://doi.org/10.1002/clc.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Obesity/overweight and metabolic anomalies are known to be associated with elevated cardiovascular disease (CVD) risk. However, there is a paucity of research exploring the association between different body weights, varying metabolic statuses, and the occurrence of CVD in the Chinese population. Thus, we performed this study to explore the relation between different metabolic overweight/obesity phenotypes and the prevalence of CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from 9075 participants in the Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study. Participants were classified into four metabolic phenotypes based on their metabolic status and obesity/overweight status. Regression analysis was used to evaluate the relationship between CVD and different groups. Additionally, we conducted a subgroup analysis to further explore the relationship between CVD and different metabolic abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to metabolically healthy non-overweight/obesity (MHNO) individuals, both overweight/obesity and metabolic anomalies were positively associated with CVD prevalence. Among other metabolically unhealthy and overweight/obesity phenotypes, metabolically healthy overweight/obesity (MHO) generally exhibited a comparatively lower association with CVD. In the elderly, high waist circumference was significantly associated with CVD, rather than body weight. Further analysis revealed that hypertension had the strongest association with CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elderly individuals should place more emphasis on managing their waist circumference rather than only on BMI. CVD prevention should focus on both body weight management and treatment of metabolic diseases, with particular emphasis on antihypertensive therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors 接受原发性冠状动脉介入治疗的 STEMI 患者急性肾损伤后持续性肾功能障碍：发病率和预测因素

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-08 DOI: 10.1002/clc.70002

Shir Frydman, Ophir Freund, Haytham Abu katash, Daniel Rimbrot, Shmuel Banai, Yacov Shacham

Background

Acute kidney injury (AKI) is a common and serious complication of ST-elevation myocardial infarction (STEMI). AKI and chronic kidney disease (CKD) are highly heterogeneous, leaving a wide gap between them. Therefore, the term acute kidney disease (AKD) was implemented, describing prolonged renal injury between 7 and 90 days. We aimed to evaluate the prevalence and predictors of AKD among STEMI patients.

Methods

This retrospective observational study included 2940 consecutive patients admitted with STEMI between 2008 and 2022. Renal function was assessed upon admission and routinely thereafter. Renal outcomes were evaluated according to KDIGO criteria, with AKD defined as persistent renal injury of between 7 and 90 days.

Results

Two hundred and fifty-two subjects with STEMI and AKI were included; of them, 117 (46%) developed AKD. Among baseline CKD patients, higher rates of AKD were observed (60% vs. 46%). KDIGO index ≥ 2 was an independent predictor for AKD in in subjects without baseline CKD (AOR 2.63, 95% CI 1.07−6.53). In subjects with baseline CKD, older age and higher creatinine were independent predictors for AKD. Subjects with AKD had a higher 1-year mortality rate (HR 3.39, 95% CI 1.71−6.72, p < 0.01). This trend was mainly driven by the CKD subpopulation where higher mortality rates for AKD on CKD were observed (HR 5.26, 95% CI 1.83−15.1, p < 0.01).

Conclusion

AKD is common among STEMI patients with AKI. The presence of CKD and higher KDIGO stage should prompt strict monitoring for early diagnosis, treatment, and prevention of renal function deterioration.

背景：急性肾损伤（AKI急性肾损伤（AKI）是ST段抬高型心肌梗死（STEMI）常见的严重并发症。急性肾损伤和慢性肾脏病（CKD）具有高度异质性，两者之间存在很大差距。因此，急性肾脏病（AKD）一词被用来描述 7 至 90 天的长期肾损伤。我们的目的是评估 STEMI 患者中 AKD 的患病率和预测因素：这项回顾性观察研究纳入了 2008 年至 2022 年间连续收治的 2940 名 STEMI 患者。入院时即对肾功能进行评估，之后进行常规评估。根据 KDIGO 标准对肾功能结果进行评估，AKD 被定义为持续 7 至 90 天的肾损伤：共纳入 252 名 STEMI 和 AKI 患者，其中 117 人（46%）发展为 AKD。在基线 CKD 患者中，观察到较高的 AKD 发生率（60% 对 46%）。在无基线 CKD 的受试者中，KDIGO 指数≥ 2 是 AKD 的独立预测因子（AOR 2.63，95% CI 1.07-6.53）。在有基线 CKD 的受试者中，年龄越大、肌酐越高越容易患 AKD。患有 AKD 的受试者 1 年死亡率较高（HR 3.39，95% CI 1.71-6.72，P 结论：AKD 是 STEM 患者中的常见病：AKD在STEMI合并AKI患者中很常见。出现慢性肾功能衰竭和较高的 KDIGO 分期时，应进行严格监测，以便早期诊断、治疗和预防肾功能恶化。

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引用次数: 0

Meta-Analysis Comparing Oral Anticoagulant Monotherapy Versus Dual Antithrombotic Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease 比较心房颤动和稳定型冠状动脉疾病患者口服抗凝剂单一疗法与双重抗血栓疗法的 Meta 分析。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-07 DOI: 10.1002/clc.70026

Mushood Ahmed, Areeba Ahsan, Aimen Shafiq, Raheel Ahmed, Mahboob Alam, Pierre Sabouret, Jamal S. Rana, Gregg C. Fonarow

Background

Oral anticoagulants (OACs) are routinely used for the management of atrial fibrillation (AF) while antiplatelet agents are used in coronary artery disease (CAD). However, data regarding the comparative clinical outcomes of OAC monotherapy versus dual antithrombotic therapy (anticoagulant plus antiplatelet agent) in patients with AF and stable CAD are limited.

Methods

A comprehensive search of major databases including PubMed/MEDLINE, Cochrane Library, and Embase was performed from inception to September 1, 2024 to identify randomized control trials (RCTs) that compared OAC monotherapy with dual antithrombotic therapy in patients with AF and stable CAD. The risk ratios (RRs) were estimated with corresponding 95% confidence intervals (CIs) for all outcomes.

Results

A total of three RCTs reported data for 3945 patients with AF and stable CAD. The mean age of patients was 73.8 (±11.85) years and the mean follow-up was 22 months. OAC monotherapy was associated with a significantly reduced relative risk of major bleeding (RR: 0.55, 95% CI: 0.32–0.95) compared to dual therapy. The risk of all-cause death (RR: 0.85, 95% CI: 0.49–1.48), cardiovascular death (RR: 0.84, 95% CI: 0.50–1.41), any stroke event (RR: 0.74, 95% CI: 0.46–1.18), and myocardial infarction (RR: 1.57, 95% CI: 0.79–3.12) remained comparable across the two groups.

Conclusion

OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD.

背景：口服抗凝剂（OAC）是治疗心房颤动（AF）的常规药物，而抗血小板药物则用于冠状动脉疾病（CAD）。然而，有关心房颤动和稳定型冠状动脉疾病患者的口服抗心律失常药单一疗法与双重抗血栓疗法（抗凝剂加抗血小板药物）的临床疗效比较数据十分有限：方法：对主要数据库（包括 PubMed/MEDLINE、Cochrane Library 和 Embase）进行了全面检索，检索时间从开始到 2024 年 9 月 1 日，目的是确定在房颤和稳定型 CAD 患者中比较 OAC 单一疗法与双重抗血栓疗法的随机对照试验 (RCT)。对所有结果的风险比（RR）及相应的 95% 置信区间（CI）进行了估算：共有三项 RCT 报告了 3945 名房颤和稳定型 CAD 患者的数据。患者的平均年龄为 73.8 (±11.85) 岁，平均随访时间为 22 个月。与双重疗法相比，OAC 单一疗法显著降低了大出血的相对风险（RR：0.55，95% CI：0.32-0.95）。两组患者发生全因死亡（RR：0.85，95% CI：0.49-1.48）、心血管死亡（RR：0.84，95% CI：0.50-1.41）、任何卒中事件（RR：0.74，95% CI：0.46-1.18）和心肌梗死（RR：1.57，95% CI：0.79-3.12）的风险仍然相当：结论：与双联抗栓疗法相比，OAC单药疗法可显著降低房颤合并稳定型CAD患者大出血的相对风险，但缺血事件发生率和死亡率与双联抗栓疗法相似。

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引用次数: 0

Comparing Transcatheter and Surgical Mitral Valve Repair in Functional Mitral Regurgitation: Insights From a Real-World Analysis and Future Research Directions 功能性二尖瓣反流中经导管和手术二尖瓣修复的比较：真实世界分析的启示与未来研究方向。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-04 DOI: 10.1002/clc.70015

Ibrahim Manzoor, Mustafa Mansoor

<p>Functional mitral regurgitation (FMR) is characterized by normal mitral leaflet morphology but a dilated mitral annulus due to left ventricular dilatation or papillary muscle dysfunction [<span>1</span>]. The prevalence of FMR is increasing due to predicted demographic changes and it is estimated that by 2030, 4 million people will be diagnosed with FMR in the United States [<span>2</span>]. Patients with FMR are typically treated with guideline-directed medical therapy (GDMT) but when symptoms occur despite GDMT, surgery or transcatheter intervention is indicated before left ventricular function further deteriorates. Recently, transcatheter edge-to-edge mitral valve repair (TEER) has emerged as a promising treatment modality in this regard. However, there is insufficient data comparing the effectiveness of TEER to the more commonly employed surgical mitral valve repair (SMVr).</p><p>To explore this gap, Wang et al. recently presented a real-world analysis comparing the outcomes of TEER and SMVr in patients with FMR by using data from the National Inpatient Sample (NIS) database [<span>3</span>]. In 6233 and 2524 patients who underwent SMVr and TEER, respectively, the length of hospital stay was considerably shorter for TEER with a mean of 8.59 days for SMVr and 4.13 days for TEER. While the in-hospital mortality rate was similar in both groups, the study showed that SMVr was associated with increased perioperative complications such as cardiogenic shock, cardiac arrest, respiratory failure, fluid and electrolyte disorders, acute kidney injury, cerebrovascular infarction, and bleeding after the procedure. Postprocedural blood transfusion and mechanical ventilation use were also higher in the SMVr group.</p><p>This comprehensive study provides valuable data and a nuanced understanding of the comparative outcomes between transcatheter and surgical approaches to mitral valve repair. The meticulous analysis and detailed presentation of results significantly contribute to the field of cardiovascular medicine, offering a robust foundation for future research and clinical practice. For certain patients with anatomical features that make TEER challenging or not feasible, and where surgical risk remains high and prohibitive, transcatheter mitral valve replacement (TMVR) has recently emerged as an attractive option [<span>4</span>]. While a number of transcatheter replacement devices are under development and clinical investigation, their current use is largely limited to compassionate cases or clinical trials. Consequently, TEER is the first-line transcatheter treatment for both mitral and tricuspid regurgitation in many patients who are not candidates for surgery [<span>5</span>].</p><p>However, several limitations should be addressed in future research to enhance the robustness of the findings. The study's lack of laboratory or echocardiography data is a notable limitation, and subsequent studies should incorporate these assessments both pre- and pos

功能性二尖瓣反流（FMR）的特点是二尖瓣叶形态正常，但由于左心室扩张或乳头肌功能障碍导致二尖瓣环扩张[1]。据预测，由于人口结构的变化，FMR 的发病率正在上升，预计到 2030 年，美国将有 400 万人被诊断出患有 FMR [2]。FMR 患者通常接受指导性药物治疗（GDMT），但如果在接受指导性药物治疗后仍出现症状，则应在左心室功能进一步恶化前进行手术或经导管介入治疗。最近，经导管二尖瓣边缘对边缘修补术（TEER）已成为一种很有前景的治疗方式。为了填补这一空白，Wang 等人最近利用全国住院病人抽样（NIS）数据库的数据[3]，进行了一项真实世界分析，比较了 TEER 和 SMVr 对 FMR 患者的治疗效果。在分别接受 SMVr 和 TEER 的 6233 名和 2524 名患者中，TEER 的住院时间要短得多，SMVr 平均为 8.59 天，TEER 平均为 4.13 天。虽然两组患者的院内死亡率相似，但研究表明，SMVr 与围手术期并发症增加有关，如心源性休克、心脏骤停、呼吸衰竭、体液和电解质紊乱、急性肾损伤、脑血管梗塞和术后出血。这项全面的研究提供了宝贵的数据，让人们对经导管二尖瓣修复术和手术二尖瓣修复术的比较结果有了细致入微的了解。细致的分析和详尽的结果展示为心血管医学领域做出了重大贡献，为未来的研究和临床实践奠定了坚实的基础。某些患者的解剖特征使得经导管二尖瓣置换术（TEER）具有挑战性或不可行，而且手术风险仍然很高且令人望而却步，对于这些患者，经导管二尖瓣置换术（TMVR）近来已成为一种极具吸引力的选择[4]。虽然有许多经导管置换设备正在开发和临床研究中，但其目前的使用主要限于同情病例或临床试验。因此，TEER 成为许多不适合手术的二尖瓣和三尖瓣反流患者的一线经导管治疗方法[5]。该研究缺乏实验室或超声心动图数据是一个明显的局限性，后续研究应将这些评估纳入手术前和手术后。在多个中心开展具有标准化数据收集协议的随机对照试验将提供更有力的证据，有助于制定以证据为基础的二尖瓣疾病管理指南。此外，由于缺乏所使用的经导管二尖瓣修复（TMVr）设备的具体信息，以及有关资源利用和手术趋势的数据，限制了该研究的适用性。明确所使用的设备以及按地区和时间划分的资源利用率和趋势的详细信息将有助于提供更好的见解。缺乏 TMVr 的亚组数据是研究的另一个重大局限，因为 TMVr 通常风险较高，而且是出于特定的临床和解剖原因而使用的。未来的研究应包括详细的亚组分析，以更好地了解 TMVr 的结果，并针对特定患者群体进行治疗。最后，NIS 数据库缺乏纵向追踪，因此无法评估长期疗效。为解决这一问题，应使用能够进行纵向追踪的数据库来全面了解 TMVr 和 SMVr 的长期疗效和安全性。解决这些局限性将大大提高心血管医学这一关键领域未来研究的质量和适用性。Mustafa Mansoor帮助完成了手稿的定稿，并为手稿的完成提供了支持性意见。

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引用次数: 0

Nonvitamin K Anticoagulants: Risk of Bleeding When Interacting With Other Medications: A Cohort Study From Medicare 非维生素 K 抗凝剂：与其他药物相互作用时的出血风险：来自医疗保险的队列研究。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-03 DOI: 10.1002/clc.70023

Ainhoa Gomez-Lumbreras, Madeline Brendle, Krystal Moorman-Bishir, Malinda Tan, Daniel C. Malone

Introduction

Patients on nonvitamin K antagonist (NVKA) are usually taking other drugs. Potential interaction may increase the gastrointestinal (GI) bleeding risk associated with NVKA.

Methods

Observational cohort study using Medicare data from 2017 to 2020. Participants receiving a NVKA were included. A concomitant overlapping period while on NVKA was assessed for nonsteroidal anti-inflammatory drugs (NSAIDS), selective serotonin reuptake inhibitors (SSRI), antiplatelets, glucocorticoids, aspirin and proton pump inhibitors (PPI). A logistic regression predicting either any bleeding or GI bleeding was conducted estimating the odds ratio (OR) and 95% confidence interval (CI).

Results

A total of 102 531 people on NVKA with mean age 77 years (SD = 9.8) and 55% females (N = 56 671) were included. Previous history of GI bleeding occurred in 2 908 (2.8%) participants, concomitant exposure to PPI occurred in 38 713 (38%), SSRI in 16 487 (16%), clopidogrel in 15 795 (15.4%), NSAIDs in 13 715 (13.4%) and glucocorticoids in 13 715 (13.4%). Risk for any bleeding was shown for clopidogrel (OR: 1.37, 95% CI: 1.30, 1.44), prasugrel/ticagrelor (OR: 1.36, 95% CI: 1.18, 1.58), glucocorticoids (OR: 1.26, 95% CI: 1.19, 1.34), and SSRIs (OR: 1.13, 95% CI: 1.07, 1.19). GI bleeding risk was shown for clopidogrel (OR: 1.44, 95% CI: 1.34, 1.55), prasugrel/ticagrelor (OR: 1.47, 95% CI: 1.20, 1.79), SSRIs (OR: 1.09, 95% CI: 1.01, 1.17) and glucocorticoids (OR: 1.33, 95% CI: 1.23, 1.44). PPI use was correlated with both NSAID (r = 0.07, p ≤ 0.0001) and SSRI use (r = 0.09, p ≤ 0.0001).

Conclusion

NVKA concomitantly taken with antiplatelets, glucocorticoids, and SSRIs showed an increased risk for any bleeding and GI bleeding.

简介服用非维生素K拮抗剂（NVKA）的患者通常还在服用其他药物。潜在的相互作用可能会增加与 NVKA 相关的胃肠道（GI）出血风险：使用 2017 年至 2020 年的医疗保险数据进行观察性队列研究。纳入接受 NVKA 的参与者。在服用 NVKA 期间，评估了非甾体抗炎药（NSAIDS）、选择性血清素再摄取抑制剂（SSRI）、抗血小板药物、糖皮质激素、阿司匹林和质子泵抑制剂（PPI）的同时重叠期。对任何出血或消化道出血的预测进行了逻辑回归，估算出了几率比（OR）和 95% 的置信区间（CI）：共纳入 102 531 名服用 NVKA 的患者，平均年龄 77 岁（SD = 9.8），55% 为女性（N = 56 671）。2 908人（2.8%）曾有消化道出血史，38 713人（38%）同时服用过PPI，16 487人（16%）服用过SSRI，15 795人（15.4%）服用过氯吡格雷，13 715人（13.4%）服用过非甾体抗炎药，13 715人（13.4%）服用过糖皮质激素。氯吡格雷（OR：1.37，95% CI：1.30，1.44）、普拉格雷/替卡格雷（OR：1.36，95% CI：1.18，1.58）、糖皮质激素（OR：1.26，95% CI：1.19，1.34）和 SSRIs（OR：1.13，95% CI：1.07，1.19）均有任何出血风险。氯吡格雷（OR：1.44，95% CI：1.34，1.55）、普拉格雷/替卡格雷（OR：1.47，95% CI：1.20，1.79）、SSRIs（OR：1.09，95% CI：1.01，1.17）和糖皮质激素（OR：1.33，95% CI：1.23，1.44）均有消化道出血风险。PPI的使用与非甾体抗炎药（r = 0.07，p ≤ 0.0001）和SSRI的使用（r = 0.09，p ≤ 0.0001）相关：结论：在服用 NVKA 的同时服用抗血小板药物、糖皮质激素和 SSRIs 会增加任何出血和消化道出血的风险。

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引用次数: 0

Safety and Usefulness of Intracoronary Acetylcholine 200 μg Into the Left Coronary Artery as Vasoreactivity Testing: Comparisons With Intracoronary Acetylcholine Maximum 100 μg 冠状动脉内乙酰胆碱 200 μg 进入左冠状动脉作为血管活性测试的安全性和实用性：与冠状动脉内乙酰胆碱最大值 100 μg 的比较。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-02 DOI: 10.1002/clc.70001

Shozo Sueda, Yutaka Hayashi, Hiroki Ono, Tomoki Sakaue, Shuntaro Ikeda

Objectives

We retrospectively analyzed the usefulness and safety of intracoronary acetylcholine (ACh) 200 μg into the left coronary artery (LCA) as vasoreactivity testing compared with intracoronary ACh 100 μg.

Methods

We recruited 1433 patients who had angina-like chest pain and intracoronary ACh testing in the LCA, including 1234 patients with a maximum ACh 100 μg and 199 patients with a maximum ACh 200 μg. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis, usual chest pain, and ischemic electrocardiogram (ECG) changes.

Results

The incidence of coronary constriction ≥ 90%, usual chest pain, and ischemic ECG changes with a maximum ACh of 100 μg was markedly higher than that with a maximum ACh of 200 μg. The frequency of unusual chest pain in patients with a maximum ACh of 200 μg was higher than that in those with a maximum ACh of 100 μg (13% vs. 3%, p < 0.001). In patients with rest angina, positive spasm of maximum ACh 100 μg was significantly higher than that of maximum ACh 200 μg, whereas there was no difference regarding positive spasm in patients with atypical chest pain between the two ACh doses. Major complications (1.38% vs. 1.51%, p = 0.8565) and the occurrence of paroxysmal atrial fibrillation (1.81% vs. 2.63%, p = 0.6307) during ACh testing in the LCA were not different between the two maximum ACH doses.

Conclusions

Intracoronary ACh 200 μg into the LCA is clinically useful and safe for vasoreactivity testing when intracoronary ACh 100 μg dose not provoke spasms.

目的：我们回顾性分析了左冠状动脉（LCA）冠状动脉内乙酰胆碱（ACh）200 μg与冠状动脉内ACh 100 μg作为血管活性测试的有用性和安全性：我们招募了 1433 名有心绞痛样胸痛并在 LCA 进行冠脉内 ACh 测试的患者，其中 1234 名患者的 ACh 最大值为 100 μg，199 名患者的 ACh 最大值为 200 μg。ACh 以 20/50/100/200 μg 的递增剂量注入 LCA。狭窄≥90%、常见胸痛和缺血性心电图（ECG）改变即为阳性痉挛：最大 ACh 值为 100 μg 时，冠状动脉收缩≥90%、常见胸痛和缺血性心电图变化的发生率明显高于最大 ACh 值为 200 μg 时。最大 ACh 值为 200 μg 的患者出现异常胸痛的频率高于最大 ACh 值为 100 μg 的患者（13% 对 3%，P，结论）：当冠状动脉内 ACh 100 μg 剂量不会引起痉挛时，冠状动脉内 ACh 200 μg 进入 LCA 对血管活性测试具有临床实用性和安全性。

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引用次数: 0

Pulsed-Field Ablation in Management of Ventricular Tachycardia: A Systematic Review of Case Reports and Clinical Outcomes 脉冲场消融治疗室性心动过速：病例报告和临床结果的系统回顾。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-01 DOI: 10.1002/clc.70018

Amir Askarinejad, Erfan Kohansal, Amirreza Sabahizadeh, Hamed Hesami, Sara Adimi, Majid Haghjoo

Background

Pulsed-field ablation (PFA) is a cutting-edge technique that employs non-thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo-ablation for treating ventricular tachycardia.

Methods

PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed-field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis.

Results

We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long-term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases.

Conclusion

The absence of complications, high effectiveness, and long-term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed.

背景：脉冲场消融术（PFA）是一种尖端技术，它利用非热能量通过诱导细胞膜的不可逆电穿孔而导致细胞死亡。本系统综述评估了射频场消融作为射频和冷冻消融治疗室性心动过速的潜在替代方法的有效性：使用与室速和脉冲场消融相关的关键词对 PubMed、Embase、Scopus 和 Web of Science 进行了系统检索。最终分析纳入了评估这种室性心动过速治疗方法的合格研究：我们在系统回顾中纳入了六项研究（五项病例报告和一项系列病例）。其中八项（88.8%）手术成功，长期疗效达 100%。这些病例均未出现手术并发症或室性心动过速（VT）复发：结论：PFA 无并发症、疗效高、长期成功率高，是治疗 VT 的良好选择。然而，PFA 治疗 VT 的安全性和有效性研究还很少。因此，迫切需要对这一课题进行更大规模的研究。

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