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Predicting Major Adverse Events in Patients Undergoing Transcatheter Left Atrial Appendage Occlusion. 预测接受经导管左房阑尾闭塞术患者的主要不良事件
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI: 10.1161/CIRCEP.123.012424
Kamil F Faridi, Emily L Ong, Sarah Zimmerman, Paul D Varosy, Daniel J Friedman, Jonathan C Hsu, Fred Kusumoto, Bobak J Mortazavi, Karl E Minges, Lucy Pereira, Dhanunjaya Lakkireddy, Christina Koutras, Beth Denton, Julie Mobayed, Jeptha P Curtis, James V Freeman

Background: The National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry (LAAO) includes the vast majority of transcatheter LAAO procedures performed in the United States. The objective of this study was to develop a model predicting adverse events among patients undergoing LAAO with Watchman FLX.

Methods: Data from 41 001 LAAO procedures with Watchman FLX from July 2020 to September 2021 were used to develop and validate a model predicting in-hospital major adverse events. Randomly selected development (70%, n=28 530) and validation (30%, n=12 471) cohorts were analyzed with 1000 bootstrapped samples, using forward stepwise logistic regression to create the final model. A simplified bedside risk score was also developed using this model.

Results: Increased age, female sex, low preprocedure hemoglobin, no prior attempt at atrial fibrillation termination, and increased fall risk most strongly predicted in-hospital major adverse events and were included in the final model along with other clinically relevant variables. The median in-hospital risk-standardized adverse event rate was 1.50% (range, 1.03%-2.84%; interquartile range, 1.42%-1.64%). The model demonstrated moderate discrimination (development C-index, 0.67 [95% CI, 0.65-0.70] and validation C-index, 0.66 [95% CI, 0.62-0.70]) with good calibration. The simplified risk score was well calibrated with risk of in-hospital major adverse events ranging from 0.26% to 3.90% for a score of 0 to 8, respectively.

Conclusions: A transcatheter LAAO risk model using National Cardiovascular Data Registry and LAAO Registry data can predict in-hospital major adverse events, demonstrated consistency across hospitals and can be used for quality improvement efforts. A simple bedside risk score was similarly predictive and may inform shared decision-making.

背景:美国国家心血管数据登记处和左心房阑尾闭塞(LAAO)登记处包括了在美国实施的绝大多数经导管 LAAO 手术。本研究的目的是建立一个模型,预测使用 Watchman FLX 进行 LAAO 患者的不良事件:2020年7月至2021年9月期间使用Watchman FLX进行的41001例LAAO手术数据被用于开发和验证院内主要不良事件预测模型。随机选取开发组群(70%,n=28 530)和验证组群(30%,n=12 471),使用前向逐步逻辑回归建立最终模型,并对1000个引导样本进行分析。利用该模型还开发了简化的床边风险评分:结果:年龄增大、性别为女性、术前血红蛋白偏低、之前未尝试过房颤终止术以及跌倒风险增加最能预测院内重大不良事件,这些因素与其他临床相关变量一起被纳入最终模型。院内风险标准化不良事件发生率的中位数为1.50%(范围为1.03%-2.84%;四分位间范围为1.42%-1.64%)。该模型显示出适度的区分度(开发 C 指数为 0.67 [95% CI,0.65-0.70],验证 C 指数为 0.66 [95% CI,0.62-0.70])和良好的校准性。简化风险评分校准良好,0至8分的院内主要不良事件风险分别为0.26%至3.90%:使用美国国家心血管数据登记处和LAAO登记处数据建立的经导管LAAO风险模型可以预测院内重大不良事件,在不同医院具有一致性,可用于质量改进工作。简单的床边风险评分也具有类似的预测能力,可为共同决策提供参考。
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引用次数: 0
Pulsed Field Ablation Index-Guided Ablation for Lesion Formation: Impact of Contact Force and Number of Applications in the Ventricular Model. 脉冲场消融指数引导的病变形成消融:心室模型中接触力和应用次数的影响
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI: 10.1161/CIRCEP.123.012717
Luigi Di Biase, Jacopo Marazzato, Assaf Govari, Andreas Altman, Christopher Beeckler, Joe Keyes, Tushar Sharma, Vito Grupposo, Fengwei Zou, Masafumi Sugawara, Atsushi Ikeda, Farshad Raissi, Rahul Bhardwaj, Jonathan C Hsu, Mark Lee, Rajesh Banker, Sanghamitra Mohanty, Andrea Natale, Qi Chen, Paras Parikh, Xiaodong Zhang, Hiroshi Nakagawa

Background: The effect of contact force (CF) on lesion formation is not clear during pulsed field ablation (PFA). The aim of this study was to evaluate the impact of CF, PFA, and their interplay through the PFA index (PF index) formula on the ventricular lesion size in swine.

Methods: PFA was delivered through the CF-sensing OMNYPULSE catheter. Predefined PFA applications (×3, ×6, ×9, and ×12) were delivered maintaining low (5-25 g), high (26-50 g), and very high (51-80 g) CFs. First, PFA lesions were evaluated on necropsy in 11 swine to investigate the impact of CF/PFA-and their integration in the PF index equation-on lesion size (study characterization). Then, 3 different PF index thresholds-300, 450, and 600-were tested in 6 swine to appraise the PF index accuracy to predict the ventricular lesion depth (study validation).

Results: In the study characterization data set, 111 PFA lesions were analyzed. CF was 32±17 g. The average lesion depth and width were 3.5±1.2 and 12.0±3.5 mm, respectively. More than CF and PFA dose alone, it was their combined effect to impact lesion depth through an asymptotically increasing relationship. Likewise, not only was the PF index related to lesion depth in the study validation data set (r2=0.66; P<0.001) but it also provided a prediction accuracy of the observed depth of ±2 mm in 69/73 lesions (95%).

Conclusions: CF and PFA applications play a key role in lesion formation during PFA. Further studies are required to evaluate the best PFA ablation settings to achieve transmural lesions.

背景:在脉冲场消融(PFA)过程中,接触力(CF)对病变形成的影响尚不明确。本研究旨在通过 PFA 指数(PF 指数)公式评估 CF、PFA 及其相互作用对猪心室病灶大小的影响:方法:通过CF感应OMNYPULSE导管输送PFA。在维持低(5-25 克)、高(26-50 克)和极高(51-80 克)CF 的情况下,使用预定义的 PFA 应用(×3、×6、×9 和×12)。首先,对 11 头猪的尸体解剖进行了 PFA 病变评估,以研究 CF/PFA 及其在 PF 指数方程中的整合对病变大小的影响(研究特征)。然后,在 6 头猪身上测试了 3 种不同的 PF 指数阈值--300、450 和 600,以评估 PF 指数预测心室病变深度的准确性(研究验证):在研究特征数据集中,分析了 111 个 PFA 病变。平均病变深度和宽度分别为 3.5±1.2 mm 和 12.0±3.5 mm。与单独的 CF 和 PFA 剂量相比,它们的共同作用通过渐近递增关系影响了病变深度。同样,在研究验证数据集中,PF 指数不仅与病变深度相关(r2=0.66;PConclusions:CF和PFA的应用在PFA过程中的病变形成中起着关键作用。需要进一步的研究来评估实现透壁病变的最佳 PFA 消融设置。
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引用次数: 0
The Science Behind the Standardization of Chest Protectors: Is Marketing Alone Enough to Sell Chest Protectors?... Not Anymore! 护胸标准化背后的科学依据:仅靠营销就能销售护胸产品吗?不再是了
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-03-18 DOI: 10.1161/CIRCEP.124.012844
Camila Trejo-Paredes, Rachel Lampert
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引用次数: 0
HRAS-Mutant Cardiomyocyte Model of Multifocal Atrial Tachycardia. 多灶性房性心动过速的 HRAS 突变心肌细胞模型
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-28 DOI: 10.1161/CIRCEP.123.012022
Nelson A Rodríguez, Nihir Patel, Rafael Dariolli, Simon Ng, Angelika G Aleman, Jingqi Q X Gong, Hung-Mo Lin, Matthew Rodríguez, Rebecca Josowitz, Katia Sol-Church, Karen W Gripp, Xianming Lin, Soomin C Song, Glenn I Fishman, Eric A Sobie, Bruce D Gelb

Background: Germline HRAS gain-of-function pathogenic variants cause Costello syndrome (CS). During early childhood, 50% of patients develop multifocal atrial tachycardia, a treatment-resistant tachyarrhythmia of unknown pathogenesis. This study investigated how overactive HRAS activity triggers arrhythmogenesis in atrial-like cardiomyocytes (ACMs) derived from human-induced pluripotent stem cells bearing CS-associated HRAS variants.

Methods: HRAS Gly12 mutations were introduced into a human-induced pluripotent stem cells-ACM reporter line. Human-induced pluripotent stem cells were generated from patients with CS exhibiting tachyarrhythmia. Calcium transients and action potentials were assessed in induced pluripotent stem cell-derived ACMs. Automated patch clamping assessed funny currents. HCN inhibitors targeted pacemaker-like activity in mutant ACMs. Transcriptomic data were analyzed via differential gene expression and gene ontology. Immunoblotting evaluated protein expression associated with calcium handling and pacemaker-nodal expression.

Results: ACMs harboring HRAS variants displayed higher beating rates compared with healthy controls. The hyperpolarization activated cyclic nucleotide gated potassium channel inhibitor ivabradine and the Nav1.5 blocker flecainide significantly decreased beating rates in mutant ACMs, whereas voltage-gated calcium channel 1.2 blocker verapamil attenuated their irregularity. Electrophysiological assessment revealed an increased number of pacemaker-like cells with elevated funny current densities among mutant ACMs. Mutant ACMs demonstrated elevated gene expression (ie, ISL1, TBX3, TBX18) related to intracellular calcium homeostasis, heart rate, RAS signaling, and induction of pacemaker-nodal-like transcriptional programming. Immunoblotting confirmed increased protein levels for genes of interest and suppressed MAPK (mitogen-activated protein kinase) activity in mutant ACMs.

Conclusions: CS-associated gain-of-function HRASG12 mutations in induced pluripotent stem cells-derived ACMs trigger transcriptional changes associated with enhanced automaticity and arrhythmic activity consistent with multifocal atrial tachycardia. This is the first human-induced pluripotent stem cell model establishing the mechanistic basis for multifocal atrial tachycardia in CS.

背景:基因型 HRAS 功能增益致病变异可导致科斯特罗综合征(Costello Syndrome,CS)。在儿童早期,50%的患者会出现多灶性房性心动过速,这是一种抗药性快速性心律失常,发病机制不明。本研究探讨了过度活跃的HRAS活性如何触发由携带CS相关HRAS变异体的人类诱导多能干细胞衍生的心房样心肌细胞(ACMs)的心律失常发生。人诱导多能干细胞由表现出快速性心律失常的 CS 患者产生。对诱导多能干细胞衍生的ACM中的钙离子瞬态和动作电位进行了评估。自动贴片钳夹评估了滑稽电流。HCN抑制剂针对突变ACM的起搏器样活动。通过差异基因表达和基因本体分析转录组数据。免疫印迹法评估了与钙处理和起搏器节点表达相关的蛋白质表达:结果:与健康对照组相比,携带 HRAS 变体的 ACMs 表现出更高的跳动率。超极化激活环核苷酸门控钾通道抑制剂伊伐布雷定和Nav1.5阻滞剂非加尼显著降低了突变型ACMs的搏动率,而电压门控钙通道1.2阻滞剂维拉帕米减轻了其不规则性。电生理评估显示,在突变体 ACMs 中,起搏器样细胞数量增加,滑稽电流密度升高。突变型 ACMs 的基因表达(即 ISL1、TBX3 和 TBX18)升高,这些基因表达与细胞内钙平衡、心率、RAS 信号转导和诱导起搏器节点样转录程序有关。免疫印迹证实,突变 ACMs 中相关基因的蛋白水平升高,MAPK(丝裂原活化蛋白激酶)活性受到抑制:结论:在诱导多能干细胞衍生的ACMs中,CS相关的功能增益HRASG12突变引发了与多灶性房性心动过速的自动性增强和心律失常活动相关的转录变化。这是首个建立CS多灶性心房性心动过速机理基础的人类诱导多能干细胞模型。
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引用次数: 0
Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study. 法洛氏四联症修复患者心脏再同步化疗法的长期疗效:一项多中心研究。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-02-12 DOI: 10.1161/CIRCEP.123.012363
Nawin L Ramdat Misier, Jeremy P Moore, Hoang H Nguyen, Michael S Lloyd, Anne M Dubin, Douglas Y Mah, Richard J Czosek, Paul Khairy, Philip M Chang, Jens C Nielsen, Alper Aydin, Thomas A Pilcher, Edward T O'Leary, Kalyanam Shivkumar, Natasja M S de Groot

Background: A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot.

Methods: Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation.

Results: A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%-44%] at baseline to 42% [32%-50%] at early follow-up (P<0.001) and remained improved from baseline thereafter (P≤0.002). The QRS duration decreased from 180 [160-205] ms at baseline to 152 [133-182] ms at early follow-up (P<0.001) and remained decreased at intermediate and late follow-up (P≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point (P≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline (P≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%.

Conclusions: In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.

背景:越来越多的法洛氏四联症患者除了右心室功能障碍外,还出现左心室收缩功能障碍和心力衰竭。虽然心脏再同步化疗法(CRT)是一种成熟的治疗方案,但该疗法在这一人群中的效果仍未得到很好的界定。本研究旨在调查法洛氏四联症患者接受 CRT 治疗的早期和晚期疗效、存活率和安全性:方法:分析的数据来自儿科和先天性电生理学会与国际成人先天性心脏病学会联合发起的一项观察性、回顾性、多中心队列研究。12个中心提供了基线和纵向数据,包括生命状态、左心室射血分数(LVEF)、QRS持续时间和NYHA分级。结果分析了CRT植入后早期(3个月)、中期(1年)和晚期(≥2年)的随访结果:共有 44 名法洛氏四联症患者(40.3±19.2 岁)接受了 CRT 治疗。29名患者(65.9%)在CRT升级前进行过右室起搏。左室射血分数从基线时的 32% [24%-44%] 提高到早期随访时的 42% [32%-50%](PP≤0.002)。QRS持续时间从基线时的180 [160-205] ms降至早期随访时的152 [133-182] ms(PP≤0.001)。使用升级版 CRT 的患者在每个时间点的左室射血分数和 QRS 持续时间都有持续改善(P≤0.004)。与基线相比,植入 CRT 后患者在每个时间点的纽约心脏协会分级都有明显改善(P≤0.002)。CRT植入后3年、5年和8年的无移植生存率分别为85%、79%和73%:结论:在接受 CRT 治疗的法洛氏四联症患者中,QRS 时程、左心室射血分数、纽约心脏协会临床状态和合理的长期生存率都得到了持续改善。这项多中心研究的结果支持在这一特殊人群中考虑使用 CRT。
{"title":"Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study.","authors":"Nawin L Ramdat Misier, Jeremy P Moore, Hoang H Nguyen, Michael S Lloyd, Anne M Dubin, Douglas Y Mah, Richard J Czosek, Paul Khairy, Philip M Chang, Jens C Nielsen, Alper Aydin, Thomas A Pilcher, Edward T O'Leary, Kalyanam Shivkumar, Natasja M S de Groot","doi":"10.1161/CIRCEP.123.012363","DOIUrl":"10.1161/CIRCEP.123.012363","url":null,"abstract":"<p><strong>Background: </strong>A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot.</p><p><strong>Methods: </strong>Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation.</p><p><strong>Results: </strong>A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%-44%] at baseline to 42% [32%-50%] at early follow-up (<i>P</i><0.001) and remained improved from baseline thereafter (<i>P</i>≤0.002). The QRS duration decreased from 180 [160-205] ms at baseline to 152 [133-182] ms at early follow-up (<i>P</i><0.001) and remained decreased at intermediate and late follow-up (<i>P</i>≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point (<i>P</i>≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline (<i>P</i>≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%.</p><p><strong>Conclusions: </strong>In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012363"},"PeriodicalIF":8.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139721854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study. 甜饮料、遗传易感性和心房颤动的发生:前瞻性队列研究
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-03-05 DOI: 10.1161/CIRCEP.123.012145
Ying Sun, Bowei Yu, Yuefeng Yu, Bin Wang, Xiao Tan, Yingli Lu, Yu Wang, Kun Zhang, Ningjian Wang

Background: An association between sweetened beverages and several cardiometabolic diseases has been reported, but their association with atrial fibrillation (AF) is unclear. We aimed to investigate the associations between consumption of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) and risk of consumption with AF risk and further evaluate whether genetic susceptibility modifies these associations.

Methods: A total of 201 856 participants who were free of baseline AF, had genetic data available, and completed a 24-hour diet questionnaire were included. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: During a median follow-up of 9.9 years, 9362 incident AF cases were documented. Compared with nonconsumers, individuals who consumed >2 L/wk of SSB or ASB had an increased risk of AF (HR, 1.10 [95% CI, 1.01-1.20] and HR, 1.20 [95% CI, 1.10-1.31]) in the multivariable-adjusted model. A negative association was observed between the consumption of ≤1 L/wk of PJ and the risk of AF (HR, 0.92 [95% CI, 0.87-0.97]). The highest HRs (95% CIs) of AF were observed for participants at high genetic risk who consumed >2 L/wk of ASB (HR, 3.51 [95% CI, 2.94-4.19]), and the lowest HR were observed for those at low genetic risk who consumed ≤1 L/wk of PJ (HR, 0.77 [95% CI, 0.65-0.92]). No significant interactions were observed between the consumption of SSB, ASB, or PJ and genetic predisposition to AF.

Conclusions: Consumption of SSB and ASB at >2 L/wk was associated with an increased risk for AF. PJ consumption ≤1 L/wk was associated with a modestly lower risk for AF. The association between sweetened beverages and AF risk persisted after adjustment for genetic susceptibility to AF. This study does not demonstrate that consumption of SSB and ASB alters AF risk but rather that the consumption of SSB and ASB may predict AF risk beyond traditional risk factors.

背景:甜饮料与多种心脏代谢疾病之间的关系已有报道,但它们与心房颤动(房颤)之间的关系尚不清楚。我们旨在研究含糖饮料(SSB)、人工甜饮料(ASB)和纯果汁(PJ)的消费与心房颤动风险之间的关联,并进一步评估遗传易感性是否会改变这些关联:方法:共纳入了 201 856 名基线无房颤、有遗传数据并填写了 24 小时饮食问卷的参与者。采用 Cox 比例危险模型估算危险比(HRs)和 95% CIs:结果:在中位 9.9 年的随访期间,共记录了 9362 例房颤病例。在多变量调整模型中,与不消费的人相比,每周消费 2 升以上 SSB 或 ASB 的人患房颤的风险增加(HR,1.10 [95% CI,1.01-1.20] 和 HR,1.20 [95% CI,1.10-1.31])。食用≤1 升/周的 PJ 与房颤风险之间呈负相关(HR,0.92 [95% CI,0.87-0.97])。遗传风险高且每周摄入大于 2 升 ASB 的参与者房颤的 HR 值(95% CI)最高(HR,3.51 [95% CI,2.94-4.19]),遗传风险低且每周摄入≤1 升 PJ 的参与者房颤的 HR 值最低(HR,0.77 [95% CI,0.65-0.92])。在食用 SSB、ASB 或 PJ 与房颤遗传易感性之间未观察到明显的相互作用:结论:摄入 SSB 和 ASB>2升/周与房颤风险增加有关。PJ 消费量≤1 升/周与房颤风险略低有关。在对房颤遗传易感性进行调整后,甜饮料与房颤风险之间的关联仍然存在。这项研究并没有证明饮用固体饮料和含糖饮料会改变心房颤动的风险,而是证明饮用固体饮料和含糖饮料可能会超越传统的风险因素而预测心房颤动的风险。
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引用次数: 0
Is Seeing Believing? Adding Another Tool to Assess PFA Durability. 眼见为实?为评估 PFA 耐久性添加另一种工具。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1161/CIRCEP.124.012773
Nishaki Kiran Mehta, David E Haines
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引用次数: 0
The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use. 水泡评分:用于预测心脏植入式电子设备感染的新型外部验证工具及其对抗菌包膜使用的成本效益影响。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-01-22 DOI: 10.1161/CIRCEP.123.012446
Edd Maclean, Karishma Mahtani, Shohreh Honarbakhsh, Charles Butcher, Nikhil Ahluwalia, Adam S C Dennis, Antonio Creta, Malcolm Finlay, Mark Elliott, Vishal Mehta, Nadeev Wijesuriya, Omar Shaikh, Yom Zaw, Chizute Ogbedeh, Vasu Gautam, Pier D Lambiase, Richard J Schilling, Mark J Earley, Philip Moore, Amal Muthumala, Simon C E Sporton, Ross J Hunter, Christopher A Rinaldi, Jonathan Behar, Claire Martin, Christopher Monkhouse, Anthony Chow

Background: Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology.

Methods: A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation.

Results: In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9-6.1]; P<0.0001), C-reactive protein >50 mg/L (hazard ratio, 3.0 [95% CI, 1.4-6.4]; P=0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6-17.9]; P<0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6-4.1]; P=0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71; P=0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69; P=0.001), and in all patients (n=12 198, event rate: 1%, area under the curve, 0.8 versus 0.75, P=0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores ≥6 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%; P=0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, £18 446).

Conclusions: The BLISTER score (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.

背景:抗菌包膜可降低心脏植入式电子设备(CIED)感染的发生率,但其成本限制了其在英国的常规使用。风险评分有助于确定哪些患者最受益于这项技术。方法:通过对与 CIED 感染相关的因素进行多变量分析,得出一个新的风险评分(BLISTER)。在标准和高风险外部验证队列中,对照现有的 PADIT 评分对诊断效用进行了评估,成本效用模型检查了 TYRXTM 抗菌包膜 (AE) 分配的不同 BLISTER 和 PADIT 评分阈值。结果:在衍生队列(人数=7383)中,59 人在手术后 12 个月内发生了 CIED 感染(事件发生率:0.8%)。除 PADIT 评分构成因素外,铅抽取(HR 3.3 (1.9-6.1),p50mg/l(HR 3.0 (1.4-6.4),p=0.005),两年内再次干预(HR 10.1 (5.6-17.9),p结论:BLISTER评分(https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection)是预测CIED感染的有效指标,有助于对高风险患者进行具有成本效益的AE分配。
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引用次数: 0
Utilizing Human-Induced Pluripotent Stem Cells to Study Cardiac Electroporation Pulsed-Field Ablation. 利用人类诱导多能干细胞研究心脏电穿孔脉冲场消融。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-02-12 DOI: 10.1161/CIRCEP.123.012278
Leonid Maizels, Eyal Heller, Michal Landesberg, Shany Glatstein, Irit Huber, Gil Arbel, Amira Gepstein, Doron Aronson, Shirley Sharabi, Roy Beinart, Amit Segev, Elad Maor, Lior Gepstein

Background: Electroporation is a promising nonthermal ablation method for cardiac arrhythmia treatment. Although initial clinical studies found electroporation pulsed-field ablation (PFA) both safe and efficacious, there are significant knowledge gaps concerning the mechanistic nature and electrophysiological consequences of cardiomyocyte electroporation, contributed by the paucity of suitable human in vitro models. Here, we aimed to establish and characterize a functional in vitro model based on human-induced pluripotent stem cells (hiPSCs)-derived cardiac tissue, and to study the fundamentals of cardiac PFA.

Methods: hiPSC-derived cardiomyocytes were seeded as circular cell sheets and subjected to different PFA protocols. Detailed optical mapping, cellular, and molecular characterizations were performed to study PFA mechanisms and electrophysiological outcomes.

Results: PFA generated electrically silenced lesions within the hiPSC-derived cardiac circular cell sheets, resulting in areas of conduction block. Both reversible and irreversible electroporation components were identified. Significant electroporation reversibility was documented within 5 to 15-minutes post-PFA. Irreversibly electroporated regions persisted at 24-hours post-PFA. Per single pulse, high-frequency PFA was less efficacious than standard (monophasic) PFA, whereas increasing pulse-number augmented lesion size and diminished reversible electroporation. PFA augmentation could also be achieved by increasing extracellular Ca2+ levels. Flow-cytometry experiments revealed that regulated cell death played an important role following PFA. Assessing for PFA antiarrhythmic properties, sustainable lines of conduction block could be generated using PFA, which could either terminate or isolate arrhythmic activity in the hiPSC-derived cardiac circular cell sheets.

Conclusions: Cardiac electroporation may be studied using hiPSC-derived cardiac tissue, providing novel insights into PFA temporal and electrophysiological characteristics, facilitating electroporation protocol optimization, screening for potential PFA-sensitizers, and investigating the mechanistic nature of PFA antiarrhythmic properties.

背景:电穿孔是治疗心律失常的一种前景广阔的非热消融方法。尽管最初的临床研究发现电穿孔脉冲场消融术(PFA)既安全又有效,但有关心肌细胞电穿孔的机理性质和电生理后果的知识仍有很大差距,而合适的人类体外模型却很少。在此,我们旨在建立一个基于人类诱导多能干细胞(hiPSCs)衍生心脏组织的功能性体外模型,并对其进行表征,同时研究心脏PFA的基本原理。方法:将 hiPSC 衍生的心肌细胞播种成圆形细胞片,并对其进行不同的 PFA 处理,然后进行详细的光学绘图、细胞和分子表征,以研究 PFA 机制和电生理结果:结果:PFA 在 hiPSC 衍生的心脏圆形细胞片中产生了电沉默病变,导致传导阻滞区域。可逆和不可逆电穿孔成分均已确定。电穿孔后 5 至 15 分钟内记录到明显的电穿孔可逆性。不可逆电穿孔区域在 PFA 术后 24 小时仍然存在。与标准(单相)PFA 相比,单脉冲高频 PFA 的疗效较差,而脉冲数的增加会增大病变面积并减弱可逆电穿孔。增加细胞外 Ca2+ 水平也能增强 PFA。流式细胞术实验表明,PFA 作用下的细胞死亡调节起着重要作用。在评估 PFA 抗心律失常特性时,可使用 PFA 生成可持续的电阻滞线,从而终止或隔离 hiPSC 衍生的心脏圆形细胞片中的心律失常活动:结论:可利用 hiPSC 衍生的心脏组织研究心脏电穿孔,同时提供有关 PFA 时间和电生理特性的新见解,促进电穿孔方案优化、筛选潜在的 PFA 增敏剂以及研究 PFA 抗心律失常特性的机理本质。
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引用次数: 0
Artificial Sweeteners: A New Dietary Environmental Risk Factor for Atrial Fibrillation? 人工甜味剂:心房颤动的新饮食环境风险因素?
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-03-05 DOI: 10.1161/CIRCEP.124.012761
Robert A Koeth, Jonathan D Smith, Mina K Chung
{"title":"Artificial Sweeteners: A New Dietary Environmental Risk Factor for Atrial Fibrillation?","authors":"Robert A Koeth, Jonathan D Smith, Mina K Chung","doi":"10.1161/CIRCEP.124.012761","DOIUrl":"10.1161/CIRCEP.124.012761","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012761"},"PeriodicalIF":8.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10958529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
期刊
Circulation. Arrhythmia and electrophysiology
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