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MINOCA and INOCA: Role in Heart Failure. MINOCA 和 INOCA:在心力衰竭中的作用
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-18 DOI: 10.1007/s11897-023-00605-1
Ana G Almeida

Purpose of review: Infarction (MINOCA) and ischaemia (INOCA) with non-obstructive coronary disease are recent non-conventional presentations of coronary syndromes that are increasingly recognised in the clinical arena, particularly with the availability of new cardiovascular imaging techniques. Both are related to heart failure (HF). MINOCA is not associated with benign outcomes, and HF is among the most prevalent events. Regarding INOCA, microvascular dysfunction has also been found to associate with HF, particularly with preserved ejection fraction (HFpEF).

Recent findings: Regardless of the several aetiologies underlying HF in MINOCA, it is likely related to LV dysfunction, where secondary prevention is not yet clearly established. Regarding INOCA, coronary microvascular ischaemia has been associated to endothelial dysfunction leading ultimately to diastolic dysfunction and HFpEF. MINOCA and INOCA are clearly related to HF. In both, there is a lack of studies on the identification of the risk factors for HF, diagnostic workup and, importantly, the appropriate primary and secondary prevention strategies.

审查目的:非阻塞性冠状动脉疾病的梗死(MINOCA)和缺血(INOCA)是冠状动脉综合征的最新非常规表现,在临床上得到越来越多的认可,特别是随着新的心血管成像技术的出现。两者都与心力衰竭(HF)有关。MINOCA 与良性结果无关,而心力衰竭是最常见的事件之一。关于 INOCA,微血管功能障碍也与心力衰竭有关,尤其是射血分数保留(HFpEF):最近的研究结果:无论 MINOCA 中心房颤动的病因有几种,它都可能与左心室功能障碍有关,而这种疾病的二级预防尚未明确确立。关于 INOCA,冠状动脉微血管缺血与内皮功能障碍有关,最终导致舒张功能障碍和 HFpEF。MINOCA 和 INOCA 显然与高房血症有关。在这两种情况下,都缺乏关于识别心房颤动风险因素、诊断工作的研究,更重要的是,缺乏关于适当的一级和二级预防策略的研究。
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引用次数: 0
Role of the Renal Lymphatic System in Heart Failure. 肾淋巴系统在心力衰竭中的作用。
Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11897-023-00595-0
Husam M Salah, Jan Biegus, Marat Fudim

Purpose of review: The lymphatic system plays a major but overlooked role in maintaining fluid homeostasis. Given the unique fluid homeostasis functions of the kidneys, dysregulation of the renal lymphatic system underlies the development of self-propagating congestive pathomechanisms. In this review, we outline the roles of the renal lymphatic system in heart failure (HF).

Recent findings: Studies have uncovered several pathomechanisms involving the renal lymphatic system in congestive states, such as impaired interstitial draining by the renal lymphatic system, impaired structure and valves of renal lymphatics, lymphatic-induced increase in renal reabsorption of water and sodium, and development of albuminuria with proteinuria-induced renal lymphangiogenesis. These self-propagating mechanisms result in "renal tamponade" with manifestations of cardiorenal syndrome and inappropriate renal response to diuretics. Dysregulation of the renal lymphatic system is integral to the development and progression of congestion in HF. Targeting renal lymphatics may provide a novel pathway to treat intractable congestion.

综述目的:淋巴系统在维持体液平衡中起着重要但被忽视的作用。鉴于肾脏独特的体液稳态功能,肾淋巴系统的失调是自我繁殖的充血性病理机制发展的基础。在这篇综述中,我们概述了肾淋巴系统在心力衰竭(HF)中的作用。最近发现:研究揭示了充血性肾淋巴系统的几种病理机制,如肾淋巴系统间质引流受损、肾淋巴结构和瓣膜受损、淋巴诱导的肾水钠重吸收增加、蛋白尿诱导的肾淋巴管生成的蛋白尿的发生。这些自我传播机制导致“肾填塞”,表现为心肾综合征和肾脏对利尿剂的不适当反应。肾淋巴系统的失调与心衰充血的发展和进展是不可分割的。靶向肾淋巴可能提供治疗顽固性充血的新途径。
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引用次数: 2
Sex Differences in Acute Heart Failure Management: Is There a Gap in Treatment Quality? 急性心力衰竭治疗的性别差异:治疗质量是否存在差距?
Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11897-023-00593-2
Elena Collado-Lledó, Francisco de la Cuerda, Albert Ariza-Solé

Purpose of review: Differences between men and women in demographics and clinical phenotype of heart failure have previously been described, as well as disparities in management and outcomes. This review summarizes the latest evidence concerning sex-related differences in acute heart failure and its most severe form, cardiogenic shock.

Recent findings: Data from the last 5 years reaffirm the previous observations, with women with acute heart failure being older, more often having preserved ejection fraction and less frequently having an ischemic cause of the acute decompensation. Despite women still receive less invasive procedures and a less optimized medical treatment, the most recent studies find similar outcomes regardless of sex. These disparities persist in the context of cardiogenic shock, where women receive less mechanical circulatory support devices even if they present with more severe forms. This review reveals a different clinical picture of women with acute heart failure and cardiogenic shock compared to men, which translates into disparities in management. More female representation in studies would be needed in order to better understand the physiopathological basis of these differences and minimize inequalities in treatment and outcomes.

回顾的目的:男性和女性在心力衰竭的人口统计学和临床表型上的差异,以及在治疗和结果上的差异已经被描述过。本文综述了关于急性心力衰竭及其最严重形式——心源性休克的性别相关差异的最新证据。最近的发现:最近5年的数据再次证实了之前的观察结果,急性心力衰竭的女性年龄越大,射血分数越保留,急性失代偿的缺血性原因越少。尽管女性仍然接受较少侵入性的手术和较少优化的医疗,但最近的研究发现,无论性别,结果都是相似的。这些差异在心源性休克的情况下仍然存在,即使女性表现出更严重的形式,她们接受的机械循环支持装置也更少。这篇综述揭示了女性急性心力衰竭和心源性休克与男性不同的临床情况,这转化为管理上的差异。研究中需要更多的女性代表,以便更好地了解这些差异的生理病理基础,并尽量减少治疗和结果方面的不平等。
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引用次数: 4
Sudden Death in Men Versus Women with Heart Failure. 男性与女性心力衰竭患者的猝死
Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11897-023-00596-z
Jorge Martínez-Solano, Manuel Martínez-Sellés

Purpose of review: Sudden cardiac death (SCD) represents the most feared complication of heart failure (HF). This review intends to provide insight on our current knowledge of sex differences in SCD mechanisms, prevention, and management in HF patients.

Recent findings: Women with HF present a better prognosis than men and have a lower incidence of SCD, irrespective of the presence of ischemic heart disease and age. The influence of sex hormones, sex differences in intracellular calcium handling, and a differential myocardial remodeling may explain such a gap between men and women. Both HF drugs and ventricular arrhythmias ablation seems also useful for the management of women at risk of SCD, but special care must be taken with the use of antiarrhythmic QT-prolonging drugs. However, implantable cardioverter defibrillator (ICD) use has not been shown to be equally effective in women than men. Sex-specific recommendations regarding SCD in HF are still lacking due to the scarcity of information and the under-representation of women in clinical trials. Further investigation is required to provide specific risk stratification models in women. Cardiac magnetic resonance imaging, genetics development, and personalized medicine will probably play an increasing role in this evaluation.

综述目的:心源性猝死(SCD)是心力衰竭(HF)最可怕的并发症。这篇综述旨在提供我们目前对心衰患者SCD机制、预防和管理的性别差异的了解。最近的研究发现:与缺血性心脏病的存在和年龄无关,HF的女性预后比男性好,SCD的发病率更低。性激素的影响、细胞内钙处理的性别差异以及不同的心肌重构可能解释了男性和女性之间的这种差距。HF药物和室性心律失常消融术似乎对有SCD风险的女性也有用,但使用抗心律失常qt延长药物时必须特别小心。然而,植入式心律转复除颤器(ICD)的使用并没有显示在女性和男性中同样有效。由于信息缺乏和临床试验中女性代表性不足,关于心衰SCD的性别特异性建议仍然缺乏。需要进一步调查以提供具体的妇女风险分层模型。心脏磁共振成像、遗传学发展和个性化医疗可能会在这一评估中发挥越来越大的作用。
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引用次数: 0
Challenges and Opportunities in Titrating Disease-Modifying Therapies in Heart Failure with Reduced Ejection Fraction and Chronic Kidney Disease. 心力衰竭伴射血分数降低和慢性肾脏疾病的疾病修饰疗法滴定的挑战和机遇。
Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11897-023-00594-1
Stefana Enachi, Maxime Schleef, Chahr-Eddine Hadjseyd, Simon Leboube, Charles Fauvel, Lucie Daniel, Antoine Jobbe-Duval, Laurent Sebbag, Sandrine Lemoine, Nathan Mewton

Purpose of review: Chronic kidney disease (CKD) is highly prevalent in patients with heart failure and reduced ejection fraction (HFrEF), representing a major factor of adverse outcomes. In clinical practice, it is one of the main reasons for not initiating, not titrating, and even withdrawing efficient heart failure drug therapies in patients.

Recent findings: Despite limited data, studies show that HFrEF therapies maintain their benefits on cardiovascular outcomes in patients with CKD. Most HF drugs cause acute renal haemodynamic changes, but with stabilisation or even improvement after the acute phase, thus with no long-term worsening of the renal function. In this expert opinion-based paper, we challenge the pathophysiology misunderstandings that impede HF disease-modifying therapy implementation in this setting and propose a strategy for HF drug titration in patients with moderate, severe, and end-stage chronic kidney disease.

综述目的:慢性肾脏疾病(CKD)在心力衰竭和射血分数降低(HFrEF)患者中非常普遍,是不良结局的主要因素。在临床实践中,这是患者不启动、不滴定甚至撤销有效心力衰竭药物治疗的主要原因之一。最新发现:尽管数据有限,但研究表明,HFrEF治疗对CKD患者的心血管预后仍有益处。大多数心衰药物引起急性肾血流动力学改变,但在急性期后稳定甚至改善,因此没有肾功能的长期恶化。在这篇基于专家意见的论文中,我们挑战了在这种情况下阻碍HF疾病改善治疗实施的病理生理学误解,并提出了中度、重度和终末期慢性肾脏疾病患者的HF药物滴定策略。
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引用次数: 0
Heart Failure and Multimorbidity in Asia. 亚洲的心力衰竭和多病。
Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1007/s11897-023-00585-2
Nathalie Ang, Chanchal Chandramouli, Kelvin Yiu, Claire Lawson, Jasper Tromp

Purpose of the review: Multimorbidity, the presence of two or more comorbidities, is common in patients with heart failure (HF) and worsens clinical outcomes. In Asia, multimorbidity has become the norm rather than the exception. Therefore, we evaluated the burden and unique patterns of comorbidities in Asian patients with HF.

Recent findings: Asian patients with HF are almost a decade younger than Western Europe and North American patients. However, over two in three patients have multimorbidity. Comorbidities usually cluster due to the close and complex links between chronic medical conditions. Elucidating these links may guide public health policies to address risk factors. In Asia, barriers in treating comorbidities at the patient, healthcare system and national level hamper preventative efforts. Asian patients with HF are younger yet have a higher burden of comorbidities than Western patients. A better understanding of the unique co-occurrence of medical conditions in Asia can improve the prevention and treatment of HF.

综述目的:多病,即存在两种或两种以上的合并症,在心力衰竭(HF)患者中很常见,并会恶化临床结果。在亚洲,多病已成为常态,而非例外。因此,我们评估了亚洲心衰患者的负担和独特的合并症模式。最近发现:亚洲HF患者比西欧和北美患者年轻近10岁。然而,超过三分之二的患者患有多重疾病。由于慢性病之间密切而复杂的联系,合并症通常聚集在一起。阐明这些联系可以指导公共卫生政策解决风险因素。在亚洲,患者、卫生保健系统和国家层面在治疗合并症方面的障碍阻碍了预防工作。亚洲的心衰患者较年轻,但合并症的负担却高于西方患者。更好地了解亚洲独特的合并症可以改善心衰的预防和治疗。
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引用次数: 2
What Is the Clinical Utility of Cardiac Troponins in Heart Failure? Are They Modifiable Beyond Their Prognostic Value? 心脏肌钙蛋白在心力衰竭中的临床作用是什么?它们是否可以超越其预测价值进行修改?
Q1 Medicine Pub Date : 2023-02-01 Epub Date: 2023-01-31 DOI: 10.1007/s11897-023-00588-z
David Agdashian, Lori B Daniels

Purpose of review: To review the role of cardiac troponin (cTn) for prognosis in acute and chronic heart failure, and for predicting heart failure; and to explore the association between troponin and response to heart failure therapies, with an eye toward a possible role for troponin in a personalized approach to heart failure management, beyond prognosis.

Recent findings: A number of therapies, including the neprilysin inhibitor sacubitril/valsartan and sodium-glucose cotransporter-2 inhibitors, have recently been shown to improve outcomes in heart failure patients. Most studies suggest that these agents improve outcomes regardless of baseline cTn concentration, but have greater absolute benefit among patients with highest cTn and baseline risk. Troponin is prognostic across the heart failure spectrum, but whether it can significantly help with heart failure prevention and with tailoring and guiding heart failure treatments and interventions remains unknown.

综述目的:综述肌钙蛋白(cTn)在急性和慢性心力衰竭预后和预测心力衰竭中的作用;探讨肌钙蛋白与心力衰竭治疗反应之间的关系,着眼于肌钙蛋白在个性化心力衰竭管理方法中的可能作用,超越预后。最近的发现:包括奈普赖氨酸抑制剂沙库比曲/缬沙坦和钠-葡萄糖协同转运蛋白-2抑制剂在内的多种疗法最近被证明可以改善心力衰竭患者的预后。大多数研究表明,无论基线cTn浓度如何,这些药物都能改善疗效,但在cTn和基线风险最高的患者中具有更大的绝对益处。肌钙蛋白是心力衰竭的预后指标,但它是否能显著帮助预防心力衰竭,以及定制和指导心力衰竭治疗和干预措施,目前尚不清楚。
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引用次数: 1
Role of Arterial Hypertension and Hypertension-Mediated Organ Damage in Cardiotoxicity of Anticancer Therapies. 动脉高血压和高血压介导的器官损伤在抗癌治疗的心脏毒性中的作用。
Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1007/s11897-023-00590-5
Giacomo Tini, Giuliano Tocci, Allegra Battistoni, Matteo Sarocchi, Camilla Pietrantoni, Domitilla Russo, Beatrice Musumeci, Carmine Savoia, Massimo Volpe, Paolo Spallarossa

Purpose of the review: Arterial hypertension (AH) is the most common cardiovascular (CV) risk factor in the community and in oncologic patients. It also represents the most important CV condition predisposing to anticancer treatment-related cardiotoxicity. This risk is heightened in the presence of cardiac AH-mediated organ damage (HMOD). Influence of AH and HMOD on the development of cardiotoxicity will be reviewed, with a focus on specific scenarios and implications for management of oncologic patients.

Recent findings: Not adequately controlled AH before or during anticancer treatments and/or development of AH during or after completion of such therapies have detrimental effects on the clinical course of oncologic patients, particularly if HMOD is present. As overlooking CV health can jeopardize the success of anticancer treatments, the goal for clinicians caring for the oncologic patient should include the treatment of AH and HMOD.

综述的目的:动脉高血压(AH)是社区和肿瘤患者中最常见的心血管(CV)危险因素。它也代表了最重要的心血管疾病易患抗癌治疗相关的心脏毒性。在存在心脏ah介导的器官损伤(HMOD)时,这种风险增加。将回顾AH和HMOD对心脏毒性发展的影响,重点关注肿瘤患者的具体情况和管理意义。最近的研究发现:在抗癌治疗之前或期间没有充分控制AH和/或在治疗期间或完成后AH的发展对肿瘤患者的临床病程有不利影响,特别是如果存在HMOD。由于忽视心血管健康可能危及抗癌治疗的成功,临床医生照顾肿瘤患者的目标应该包括AH和HMOD的治疗。
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引用次数: 0
Cardiotoxicity of Anti-Cancer Radiation Therapy: a Focus on Heart Failure. 抗癌放射治疗的心脏毒性:对心力衰竭的关注。
Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1007/s11897-023-00587-0
Alex Ritter, Cooper Quartermaine, Jovan Pierre-Charles, Suryakumar Balasubramanian, Pejman Raeisi-Giglou, Daniel Addison, Eric Miller

Purpose of review: As the percentage of patients achieving long-term survival following treatment of their cancer grows, it is increasingly important to understand the long-term toxicities of cancer-directed treatment. In this review, we highlight the recent findings regarding radiation-induced cardiotoxicity across multiple disease sites, with a particular focus on heart failure.

Recent findings: Despite its relative lack of study historically, radiation-induced heart failure has now recently been implicated in several studies of breast cancer, lung cancer, esophageal cancer, and lymphoma as a non-trivial potential consequence of thoracic radiotherapy. Data regarding specific cardiac dosimetric endpoints relevant to cardiotoxicity continue to accumulate. Radiation-induced heart failure is a rare but significant toxicity of thoracic radiotherapy, that is likely underreported. Important areas for future focus include understanding the interplay between thoracic radiotherapy and concurrent cardiotoxic systemic therapy as well as development of potential mitigation strategies and novel therapeutics.

综述目的:随着癌症治疗后实现长期生存的患者比例的增加,了解癌症定向治疗的长期毒性变得越来越重要。在这篇综述中,我们强调了最近关于辐射引起的心脏毒性在多个疾病部位的发现,特别关注心力衰竭。最近发现:尽管历史上相对缺乏研究,但辐射诱发的心力衰竭最近在乳腺癌、肺癌、食管癌和淋巴瘤的几项研究中被认为是胸部放疗的一个重要潜在后果。与心脏毒性相关的特定心脏剂量终点的数据继续积累。辐射引起的心力衰竭是一种罕见但显著的胸部放疗毒性,这可能被低估了。未来重点关注的重要领域包括了解胸部放射治疗与并发心脏毒性全身治疗之间的相互作用,以及开发潜在的缓解策略和新疗法。
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引用次数: 0
Remote Monitoring of Cardiac Implantable Electronic Devices: What is the Evidence? 心脏植入式电子设备的远程监测:证据是什么?
Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1007/s11897-023-00586-1
Adrian Reinhardt, Rodolfo Ventura

Purpose of review: This review offers an overview of the evidence in diagnostic and therapeutic applications of remote monitoring implantable devices.

Recent findings: Remote monitoring of cardiac implantable devices has become more and more popular in recent years as healthcare is moving towards a more patient centralized system. For heart failure patients with an ICD or pacemaker, there is controversial evidence regarding improvements in the clinical outcome, e.g., reduction of hospitalization rates or overall mortality. New developments as hemodynamic remote monitoring via measurement of the pulmonary artery pressure are promising technical achievements showing encouraging results. In cardiac remote monitoring of syncope and arrhythmias, implantable loop recorder plays an important role in diagnostic algorithms. Although there is controversial evidence according to remote monitoring of implantable devices, its use is rapidly expanding, giving healthcare providers the opportunity to react promptly to worsening of their patients. Adequate evaluation of the data created by remote monitoring systems remains an unsolved challenge of contemporary healthcare services.

综述目的:本文综述了远程监测植入式设备在诊断和治疗中的应用。最近的发现:近年来,随着医疗保健朝着更加病人集中的系统发展,心脏植入装置的远程监测变得越来越流行。对于装有ICD或起搏器的心力衰竭患者,关于临床结果的改善,例如,住院率或总死亡率的降低,存在有争议的证据。通过测量肺动脉压进行血流动力学远程监测的新发展是有希望的技术成果,显示出令人鼓舞的结果。在晕厥和心律失常的心脏远程监测中,植入式环路记录仪在诊断算法中起着重要作用。尽管关于植入式装置的远程监测存在争议,但其使用正在迅速扩大,使医疗保健提供者有机会对患者病情恶化作出迅速反应。对远程监测系统产生的数据进行充分评估仍然是当代医疗保健服务的一个未解决的挑战。
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引用次数: 0
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Current Heart Failure Reports
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