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Non-Coding Ribonucleic Acids as Diagnostic and Therapeutic Targets in Cardiac Fibrosis. 作为心脏纤维化诊断和治疗靶点的非编码核糖核酸。
Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-03-15 DOI: 10.1007/s11897-024-00653-1
Samuel R Olson, W H Wilson Tang, Chia-Feng Liu

Purpose of review: Cardiac fibrosis is a crucial juncture following cardiac injury and a precursor for many clinical heart disease manifestations. Epigenetic modulators, particularly non-coding RNAs (ncRNAs), are gaining prominence as diagnostic and therapeutic tools.

Recent findings: miRNAs are short linear RNA molecules involved in post-transcriptional regulation; lncRNAs and circRNAs are RNA sequences greater than 200 nucleotides that also play roles in regulating gene expression through a variety of mechanisms including miRNA sponging, direct interaction with mRNA, providing protein scaffolding, and encoding their own products. NcRNAs have the capacity to regulate one another and form sophisticated regulatory networks. The individual roles and disease relevance of miRNAs, lncRNAs, and circRNAs to cardiac fibrosis have been increasingly well described, though the complexity of their interrelationships, regulatory dynamics, and context-specific roles needs further elucidation. This review provides an overview of select ncRNAs relevant in cardiac fibrosis as a surrogate for many cardiac disease states with a focus on crosstalk and regulatory networks, variable actions among different disease states, and the clinical implications thereof. Further, the clinical feasibility of diagnostic and therapeutic applications as well as the strategies underway to advance ncRNA theranostics is explored.

综述的目的:心脏纤维化是心脏损伤后的一个重要关头,也是许多临床心脏病表现的前兆。最近的研究发现:miRNAs 是参与转录后调控的短线性 RNA 分子;lncRNAs 和 circRNAs 是大于 200 个核苷酸的 RNA 序列,它们也通过各种机制(包括 miRNA sponging、与 mRNA 直接相互作用、提供蛋白质支架和编码自身产物)在调控基因表达方面发挥作用。NcRNA 有能力相互调控并形成复杂的调控网络。对 miRNAs、lncRNAs 和 circRNAs 在心脏纤维化中的作用和与疾病的相关性已有越来越多的描述,但其相互关系、调控动态和特定环境作用的复杂性仍需进一步阐明。本综述概述了与心肌纤维化相关的部分 ncRNA,心肌纤维化是许多心脏疾病状态的替代物,其重点是串联和调控网络、不同疾病状态下的不同作用及其临床意义。此外,还探讨了诊断和治疗应用的临床可行性以及推进 ncRNA 治疗学的现行策略。
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引用次数: 0
Relevance of Cardiovascular Exercise in Cancer and Cancer Therapy-Related Cardiac Dysfunction. 心血管锻炼对癌症和癌症治疗相关心功能障碍的意义
Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-02 DOI: 10.1007/s11897-024-00662-0
Simon Wernhart, Tienush Rassaf

Purpose of the review: Cancer therapy-related cardiac dysfunction (CTRCD) has been identified as a threat to overall and cancer-related survival. Although aerobic exercise training (AET) has been shown to improve cardiorespiratory fitness (CRF), the relationship between specific exercise regimens and cancer survival, heart failure development, and reduction of CTRCD is unclear. In this review, we discuss the impact of AET on molecular pathways and the current literature of sports in the field of cardio-oncology.

Recent findings: Cardio-oncological exercise trials have focused on variations of AET intensity by using moderate continuous and high intensity interval training, which are applicable, safe, and effective approaches to improve CRF. AET increases CRF, reduces cardiovascular morbidity and heart failure hospitalization and should thus be implemented as an adjunct to standard cancer therapy, although its long-term effect on CTRCD remains unknown. Despite modulating diverse molecular pathways, it remains unknown which exercise regimen, including variations of AET duration and frequency, is most suited to facilitate peripheral and central adaptations to exercise and improve survival in cancer patients.

综述的目的:癌症治疗相关心功能障碍(CTRCD)已被确定为对总体生存和癌症相关生存的威胁。虽然有氧运动训练(AET)已被证明能改善心肺功能(CRF),但具体的运动方案与癌症生存、心力衰竭发展和减少 CTRCD 之间的关系尚不清楚。在这篇综述中,我们将讨论 AET 对分子通路的影响,以及目前在心肺肿瘤学领域的运动文献:最近的研究结果:心因癌运动试验主要集中在通过使用中等强度的持续训练和高强度的间歇训练来改变 AET 的强度,这些都是适用、安全且有效的改善 CRF 的方法。AET 可提高 CRF,降低心血管疾病发病率和心衰住院率,因此应作为标准癌症治疗的辅助手段,但其对 CTRCD 的长期影响仍不得而知。尽管AET可调节多种分子通路,但哪种运动方案(包括AET持续时间和频率的变化)最适合促进外周和中枢对运动的适应并提高癌症患者的生存率,目前仍是未知数。
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引用次数: 0
Catheter Ablation of Ventricular Tachycardia in Ischemic Heart Disease: What Is Known and New Perspectives. 缺血性心脏病室性心动过速的导管消融:已知信息与新视角。
Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-03-27 DOI: 10.1007/s11897-024-00656-y
Pasquale Valerio Falzone, Sara Vazquez-Calvo, Ivo Roca-Luque

Purpose of the review: This review aims to evaluate current evidence regarding ventricular tachycardia ablation in patients with ischemic heart disease and explore novel approaches currently developing to improve procedural and long-term outcomes.

Recent findings: Recently published trials (PARTITA, PAUSE-SCD, and SURVIVE-VT) have demonstrated the prognostic benefit of prophylactic ventricular tachycardia ablation compared to current clinical practice. Advanced cardiac imaging provides a valuable pre-procedural evaluation of the arrhythmogenic substrate, identifying ablation targets non-invasively. Advanced cardiac mapping techniques allow to better characterize arrhythmogenic substrate during ablation procedure. Emerging technologies like pulsed field ablation and ultra-low temperature cryoablation show promise in ventricular tachycardia ablation. Advancements in mapping techniques, ablation technologies, and pre-procedural cardiac imaging offer promise for improving ventricular tachycardia ablation outcomes in ischemic heart disease.

综述的目的:本综述旨在评估缺血性心脏病患者室性心动过速消融术的现有证据,并探讨目前正在开发的改善手术和长期预后的新方法:最近发表的试验(PARTITA、PAUSE-SCD 和 SURVIVE-VT)表明,与目前的临床实践相比,预防性室速消融术对预后有益。先进的心脏成像技术为心律失常基质提供了宝贵的术前评估,可在无创情况下确定消融目标。先进的心脏绘图技术可在消融术中更好地描述致心律失常基底。脉冲场消融和超低温冷冻消融等新兴技术为室性心动过速消融带来了希望。制图技术、消融技术和术前心脏成像技术的进步有望改善缺血性心脏病的室速消融效果。
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引用次数: 0
Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure. 治疗心力衰竭的心血管植入式电子设备的经济考虑因素。
Q1 Medicine Pub Date : 2024-04-25 DOI: 10.1007/s11897-024-00664-y
Christian Elsner, Simon Bettin, Roland Tilz, Dennis Häckl
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引用次数: 0
(Non)-Exertional Variables of Cardiopulmonary Exercise Testing in Heart Failure with and Without Cardiac Amyloidosis. (有心脏淀粉样变性和无心脏淀粉样变性的心力衰竭患者心肺运动测试的(非)用力变量。
Q1 Medicine Pub Date : 2024-04-18 DOI: 10.1007/s11897-024-00661-1
Simon Wernhart, Lars Michel, Alexander Carpinteiro, P. Luedike, Tienush Rassaf
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引用次数: 0
Putting More Weight on Obesity Trials in Heart Failure. 增加心力衰竭患者肥胖试验的比重。
Q1 Medicine Pub Date : 2024-04-15 DOI: 10.1007/s11897-024-00655-z
Josephine Harrington, N. Sattar, G. M. Felker, J. Januzzi, Carolyn S P Lam, N. Pagidipati, Ambarish Pandey, H. V. Van Spall, Darren K. McGuire
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引用次数: 0
Combinational Diuretics in Heart Failure. 心力衰竭中的联合利尿剂。
Q1 Medicine Pub Date : 2024-04-09 DOI: 10.1007/s11897-024-00659-9
J. C. Trullàs, J. Casado, M. Cobo-Marcos, Francesc Formiga, J. Morales-Rull, Julio Núñez, Luís Manzano
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引用次数: 0
Impact of Frailty on Heart Failure Prognosis: Is Sex Relevant? 虚弱对心衰预后的影响:与性别有关吗?
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-16 DOI: 10.1007/s11897-024-00650-4
Lara Aguilar-Iglesias, Ana Perez-Asensio, Lidia Vilches-Miguel, Cesar Jimenez-Mendez, Pablo Diez-Villanueva, Jose-Angel Perez-Rivera

Purpose of review: Heart failure (HF) is one of the most frequent causes of hospital admission in elderly patients, especially in women, who present a high prevalence of geriatric syndromes like frailty. Studies have suggested that frailty and its impact may also differ between males and females. Understanding how frailty may differently affect HF patients depending on sex is therefore imperative for providing personalized care. The aim of this review is to summarize the role of sex in the prognostic impact of frailty in HF patients.

Recent findings: Numerous studies have identified frailty as a significant predictor of all-cause mortality and hospital readmissions. A recent study of elderly HF out-patients demonstrated that while women had a higher prevalence of frailty, it was an independent predictor of mortality and readmission only in men. Moreover, another study revealed that physical frailty was associated with time to first clinical event among men but not among women. These results raise the question about why frailty affects differently HF prognosis in men and women. Women with HF present a higher prevalence of frailty, especially when it is considered as physical decline. Nevertheless, frailty affects differently HF prognosis in men and women. Women with HF present lower mortality than men and frailty is related with prognosis only in men. The different severity of HF between men and women and other hormonal, psychosocial, and clinical factors might be involved in this fact.

审查目的:心力衰竭(HF)是导致老年患者入院的最常见原因之一,尤其是女性患者,她们患有老年综合征(如虚弱)的比例很高。研究表明,虚弱及其影响在男性和女性之间也可能存在差异。因此,了解虚弱如何因性别不同而对高血压患者产生不同影响,对于提供个性化护理至关重要。本综述旨在总结性别对高血压患者虚弱预后影响的作用:大量研究发现,虚弱是全因死亡率和再入院率的重要预测因素。最近一项针对老年心房颤动门诊患者的研究表明,虽然女性的体弱发生率较高,但只有男性的体弱才是死亡率和再入院率的独立预测因素。此外,另一项研究显示,身体虚弱与男性首次发生临床事件的时间有关,但与女性无关。这些结果提出了一个问题:为什么虚弱会对男性和女性的心房颤动预后产生不同的影响?女性心房颤动患者体弱的发生率更高,尤其是当体弱被视为身体机能下降时。然而,虚弱对男性和女性心房颤动预后的影响是不同的。女性心房颤动患者的死亡率低于男性,只有男性的预后与体弱有关。男女之间心房颤动的严重程度不同,以及其他荷尔蒙、社会心理和临床因素都可能与这一事实有关。
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引用次数: 0
Heart Failure: a Punch from the Gut. 心力衰竭:来自内脏的一拳。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-01 DOI: 10.1007/s11897-024-00648-y
Ajay Mahenthiran, Jennifer Wilcox, W H Wilson Tang

Purpose of review: This article seeks to elucidate the mechanisms underlying the bidirectional relationship between the gut and the heart, focusing on the pathophysiology of heart failure. We have previously demonstrated that Heart failure (HF) has significant effects on splanchnic vasculature and leads to key alterations in the gut microbiome, portending greater comorbidity with HF.

Recent findings: A growing field of research is focused on the effects of a "leaky gut" in the development of disease across organ systems. The leaky gut hypothesis centers on intestinal epithelial barrier dysfunction causing increased permeability of the gut and subsequent alterations to gut composition by endotoxins and microbial metabolites. Changes in the quantities of metabolites including short-chain fatty acids, trimethylamine N-oxide and other amino acid metabolites, and various bile acid species have been shown to result in gut dysbiosis and worsening HF. The gut plays a highly significant role in HF prognosis and requires greater attention for future therapeutic interventions. Treatments targeting gut composition could have very beneficial effects on HF prognosis.

综述的目的:本文旨在阐明肠道与心脏之间双向关系的内在机制,重点关注心力衰竭的病理生理学。我们之前已经证明,心力衰竭(HF)对脾脏血管有显著影响,并导致肠道微生物组发生关键性改变,预示着心力衰竭的合并症会更多:越来越多的研究集中于 "肠道渗漏 "对各器官系统疾病发展的影响。肠道渗漏假说的核心是肠道上皮屏障功能障碍导致肠道通透性增加,随后内毒素和微生物代谢产物改变了肠道成分。包括短链脂肪酸、三甲胺 N-氧化物和其他氨基酸代谢物以及各种胆汁酸种类在内的代谢物数量的变化已被证明会导致肠道菌群失调和高血脂症的恶化。肠道在心房颤动预后中起着非常重要的作用,需要在未来的治疗干预中给予更多关注。针对肠道成分的治疗可能会对高血压预后产生非常有益的影响。
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引用次数: 0
Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions. 优化心衰患者指导性医疗处方的数字化解决方案:当前应用与未来方向》。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-16 DOI: 10.1007/s11897-024-00649-x
Jelle P Man, Joanna Klopotowska, Folkert W Asselbergs, M Louis Handoko, Steven A J Chamuleau, Mark J Schuuring

Purposeof review: Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF.

Recent findings: We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.

综述目的:在心力衰竭(HF)患者中,指南指导下的医疗疗法(GDMT)使用不足的情况很常见。数字解决方案有可能帮助医疗专业人员在不断增长的心衰患者中优化 GDMT 处方。我们旨在回顾目前有关数字解决方案对优化高血压患者 GDMT 处方有效性的文献:我们报告了已发表的 GDMT 优化数字解决方案的疗效、研究特点和适用人群。我们讨论了以下数字解决方案:远程会诊、远程监控、心脏植入式电子设备、嵌入电子健康记录的临床决策支持以及多方面干预。数字解决方案的效果在专门研究、回顾性研究或大型研究中有所报道,这些研究的另一个重点也对 GDMT 的使用进行了评论。总体而言,我们看到更多关于数字化解决方案的研究报告称,GDMT 的使用率显著提高。但是,在研究设计、所用结果和研究人群方面存在很大的异质性,这阻碍了对不同数字化解决方案的比较。本文讨论了障碍、促进因素、研究设计和未来方向。目前仍然需要设计良好的评估研究,以确定用于优化高血压患者 GDMT 的数字化解决方案的安全性和有效性。根据本综述,应鼓励在远程医疗研究中测量和控制生命体征,应积极提醒专业人员注意不理想的 GDMT,研究人员应考虑采用多方面的数字解决方案来优化效果,并使用适合数字解决方案独特的社会技术方面的研究设计。预计未来的研究方向将包括人工智能解决方案,以处理更大的数据集,减轻医疗专业人员的工作量。
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引用次数: 0
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Current Heart Failure Reports
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