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Implications of Sex Differences on the Treatment Effectiveness in Heart Failure with Reduced Ejection Fraction Related to Clinical Endpoints and Quality of Life. 性别差异对心力衰竭伴射血分数降低治疗效果的影响与临床终点和生活质量相关。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2023-12-07 DOI: 10.1007/s11897-023-00638-6
D Aydin, Y Allach, J J Brugts

Purpose of the review: This narrative review will emphasize the necessity for more female enrollment in heart failure (HF) trials and proposes future investigations regarding optimal dosages. Ultimately, a deeper understanding of the unique pathophysiology and medication responses in both men and women is crucial for effective HF management and may improve the quality of life in women.

Recent findings: An analysis of 740 cardiovascular studies reveals that women make up only 38.2% of participants on average. Regarding to trials testing the effectiveness of HF medications, women's involvement are as low as 23.1%. While current guidelines lack sex-specific treatment recommendations, emerging research suggests differential medication dosages could be beneficial. Studies indicate that women may achieve comparable outcomes with lower doses of certain medications (angiotensin-receptor blockers) compared to men, signaling potential for more tailored dosing approaches. We advocate that the next step in HF research should prioritize the importance of tailoring treatment for HF patients by taking into account the variations in drug absorption and distribution among women.

本综述的目的:这篇叙述性综述将强调在心力衰竭(HF)试验中招募更多女性的必要性,并提出关于最佳剂量的未来研究。最终,深入了解男性和女性独特的病理生理和药物反应对于有效的心衰管理至关重要,并可能改善女性的生活质量。最近的发现:对740项心血管研究的分析显示,女性平均只占参与者的38.2%。在测试心衰药物有效性的试验中,女性的参与率低至23.1%。虽然目前的指导方针缺乏针对性别的治疗建议,但新兴研究表明,不同的药物剂量可能是有益的。研究表明,与男性相比,女性可以通过较低剂量的某些药物(血管紧张素受体阻滞剂)获得类似的结果,这表明有可能采用更量身定制的剂量方法。我们主张,下一步心衰研究应考虑到女性药物吸收和分布的差异,优先考虑为心衰患者量身定制治疗的重要性。
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引用次数: 0
Antiarrhythmic Treatment in Heart Failure. 心力衰竭的抗心律失常治疗。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2024-01-15 DOI: 10.1007/s11897-023-00642-w
Hilke Könemann, Sati Güler-Eren, Christian Ellermann, Gerrit Frommeyer, Lars Eckardt

Purpose of review: Arrhythmias are common in patients with heart failure (HF) and are associated with a significant risk of mortality and morbidity. Optimal antiarrhythmic treatment is therefore essential. Here, we review current approaches to antiarrhythmic treatment in patients with HF.

Recent findings: In atrial fibrillation, rhythm control and ventricular rate control are accepted therapeutic strategies. In recent years, clinical trials have demonstrated a prognostic benefit of early rhythm control strategies and AF catheter ablation, especially in patients with HF with reduced ejection fraction. Prevention of sudden cardiac death with ICD therapy is essential, but optimal risk stratification is challenging. For ventricular tachycardias, recent data support early consideration of catheter ablation. Antiarrhythmic drug therapy is an adjunctive therapy in symptomatic patients but has no prognostic benefit and well-recognized (proarrhythmic) adverse effects. Antiarrhythmic therapy in HF requires a systematic, multimodal approach, starting with guideline-directed medical therapy for HF and integrating pharmacological, device, and interventional therapy.

审查目的:心律失常是心力衰竭(HF)患者的常见病,与重大的死亡和发病风险相关。因此,最佳的抗心律失常治疗至关重要。在此,我们回顾了目前对心力衰竭患者进行抗心律失常治疗的方法:对于心房颤动,节律控制和心室率控制是公认的治疗策略。近年来,临床试验表明,早期节律控制策略和房颤导管消融对预后有益,尤其是射血分数降低的房颤患者。使用 ICD 治疗预防心脏性猝死至关重要,但最佳的风险分层具有挑战性。对于室性心动过速,最近的数据支持尽早考虑导管消融术。抗心律失常药物治疗是无症状患者的辅助治疗方法,但对预后无益,且有公认的(促心律失常)不良反应。心房颤动患者的抗心律失常治疗需要采用系统的多模式方法,从指南指导的心房颤动药物治疗开始,整合药物、器械和介入治疗。
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引用次数: 0
Hydrogels for Cardiac Restorative Support: Relevance of Gelation Mechanisms for Prospective Clinical Use. 心脏修复性支持用水凝胶:明胶机制与前瞻性临床应用的相关性。
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-10-09 DOI: 10.1007/s11897-023-00630-0
Valentine C Vetter, Carlijn V C Bouten, Atze van der Pol

Purpose of review: Cardiac tissue regenerative strategies have gained much traction over the years, in particular those utilizing hydrogels. With our review, and with special focus on supporting post-myocardial infarcted tissue, we aim to provide insights in determining crucial design considerations of a hydrogel and the implications these could have for future clinical use.

Recent findings: To date, two hydrogel delivery strategies are being explored, cardiac injection or patch, to treat myocardial infarction. Recent advances have demonstrated that the mechanism by which a hydrogel is gelated (i.e., physically or chemically cross-linked) not only impacts the biocompatibility, mechanical properties, and chemical structure, but also the route of delivery of the hydrogel and thus its effect on cardiac repair. With regard to cardiac regeneration, various hydrogels have been developed with the ability to function as a delivery system for therapeutic strategies (e.g., drug and stem cells treatments), as well as a scaffold to guide cardiac tissue regeneration following myocardial infarction. However, these developments remain within the experimental and pre-clinical realm and have yet to transition towards the clinical setting.

综述目的:多年来,心脏组织再生策略获得了很大的吸引力,尤其是那些利用水凝胶的策略。通过我们的综述,并特别关注支持心肌梗死后组织,我们旨在为确定水凝胶的关键设计考虑因素及其对未来临床应用的影响提供见解。最近的发现:到目前为止,正在探索两种水凝胶递送策略,心脏注射或贴片,以治疗心肌梗死。最近的进展表明,水凝胶凝胶化(即物理或化学交联)的机制不仅影响生物相容性、机械性能和化学结构,还影响水凝胶的递送途径,从而影响其对心脏修复的影响。关于心脏再生,已经开发出各种水凝胶,其能够作为治疗策略(例如,药物和干细胞治疗)的递送系统,以及引导心肌梗死后心脏组织再生的支架。然而,这些进展仍处于实验和临床前领域,尚未过渡到临床环境。
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引用次数: 0
Heart Failure and Erectile Dysfunction: a Review of the Current Evidence and Clinical Implications. 心力衰竭和勃起功能障碍:当前证据和临床意义的回顾。
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-14 DOI: 10.1007/s11897-023-00632-y
Maria Cristina Carella, Cinzia Forleo, Alessandro Stanca, Eugenio Carulli, Paolo Basile, Umberto Carbonara, Fabio Amati, Saima Mushtaq, Andrea Baggiano, Gianluca Pontone, Marco Matteo Ciccone, Andrea Igoren Guaricci

Purpose of review: Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers.

Recent findings: The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient's preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I-II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient's sexual function or relationship. This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.

综述目的:心力衰竭(HF)和勃起功能障碍(ED)是影响全球数百万男性并影响其生活质量的两种常见疾病。ED是心衰的常见并发症,也是心血管事件和死亡率的可能预测因子。ED值得临床医生和研究人员更多的关注。近期发现:HF患者ED的病理生理涉及多种因素,如内皮功能障碍、心输出量减少、神经激素激活、自主神经失衡、氧化应激、炎症和药物副作用。心衰患者ED的诊断应基于有效的问卷或客观测试,作为常规心血管风险评估的一部分。心衰患者ED的治疗管理应个性化和多学科,考虑患者的偏好、期望、合并症和潜在的药物相互作用。轻中度症状(NYHA I-II类)的HF患者ED的一线药物治疗是磷酸二酯酶5型抑制剂(PDE5Is),可改善性功能和心肺参数。使用硝酸盐或一氧化氮供体缓解心绞痛的患者禁用PDE5Is,应建议这些患者避免性活动或使用其他ED治疗方法。如果存在影响患者性功能或两性关系的重大社会心理因素,也应考虑使用非药物治疗,如心理治疗或夫妻治疗。本文旨在总结有关ED患病率的最新证据,该疾病的病理生理学,详尽分析HF患者ED发展的相关因素,深入讨论HF患者ED的诊断和治疗,为临床医生提供实用建议。
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引用次数: 0
Differentiating Cardiac Troponin Levels During Cardiac Myosin Inhibition or Cardiac Myosin Activation Treatments: Drug Effect or the Canary in the Coal Mine? 在心肌肌凝蛋白抑制或心肌肌凝蛋白激活治疗中区分心肌肌钙蛋白水平:药物效应还是煤矿中的金丝雀?
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-10-25 DOI: 10.1007/s11897-023-00620-2
Matthew M Y Lee, Ahmad Masri

Purpose of review: Cardiac myosin inhibitors (CMIs) and activators are emerging therapies for hypertrophic cardiomyopathy (HCM) and heart failure with reduced ejection fraction (HFrEF), respectively. However, their effects on cardiac troponin levels, a biomarker of myocardial injury, are incompletely understood.

Recent findings: In patients with HCM, CMIs cause substantial reductions in cardiac troponin levels which are reversible after stopping treatment. In patients with HFrEF, cardiac myosin activator (omecamtiv mecarbil) therapy cause modest increases in cardiac troponin levels which are reversible following treatment cessation and not associated with myocardial ischaemia or infarction. Transient changes in cardiac troponin levels might reflect alterations in cardiac contractility and mechanical stress. Such transient changes might not indicate cardiac injury and do not appear to be associated with adverse outcomes in the short to intermediate term. Longitudinal changes in troponin levels vary depending on the population and treatment. Further research is needed to elucidate mechanisms underlying changes in troponin levels.

综述目的:心肌肌球蛋白抑制剂(CMIs)和激活剂分别是治疗肥厚型心肌病(HCM)和射血分数降低的心力衰竭(HFrEF)的新兴疗法。然而,它们对心肌肌钙蛋白水平(心肌损伤的生物标志物)的影响尚不完全清楚。最近的研究结果:在HCM患者中,CMIs导致心肌肌钙蛋白水平显著降低,这在停止治疗后是可逆的。在HFrEF患者中,心肌肌球蛋白激活剂(omecamtiv-mecarbil)治疗会导致心肌肌钙蛋白水平适度升高,这在治疗停止后是可逆的,与心肌缺血或梗死无关。肌钙蛋白水平的短暂变化可能反映了心脏收缩力和机械应力的变化。这种短暂的变化可能不表明心脏损伤,并且在中短期内似乎与不良结果无关。肌钙蛋白水平的纵向变化因人群和治疗而异。需要进一步的研究来阐明肌钙蛋白水平变化的潜在机制。
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引用次数: 0
Towards Allograft Longevity: Leveraging Omics Technologies to Improve Heart Transplant Outcomes. 迈向同种异体移植寿命:利用组学技术改善心脏移植结果。
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-15 DOI: 10.1007/s11897-023-00631-z
Lauren K Truby, Dimitri Maamari, Amit Saha, Maryjane Farr, Jawan Abdulrahim, Filio Billia, Matthias Peltz, Kiran K Khush, Thomas J Wang

Purpose of review: Heart transplantation (HT) remains the optimal therapy for patients living with end-stage heart disease. Despite recent improvements in peri-transplant management, the median survival after HT has remained relatively static, and complications of HT, including infection, rejection, and allograft dysfunction, continue to impact quality of life and long-term survival.

Recent findings: Omics technologies are becoming increasingly accessible and can identify novel biomarkers for, and reveal the underlying biology of, several disease states. While some technologies, such as gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA), are routinely used in the clinical care of HT recipients, a number of emerging platforms, including pharmacogenomics, proteomics, and metabolomics, hold great potential for identifying biomarkers to aid in the diagnosis and management of post-transplant complications. Omics-based assays can improve patient and allograft longevity by facilitating a personalized and precision approach to post-HT care. The following article is a contemporary review of the current and future opportunities to leverage omics technologies, including genomics, transcriptomics, proteomics, and metabolomics in the field of HT.

回顾目的:心脏移植(HT)仍然是终末期心脏病患者的最佳治疗方法。尽管最近移植期管理有所改善,但移植后的中位生存期仍然相对稳定,而HT的并发症,包括感染、排斥反应和同种异体移植物功能障碍,继续影响生活质量和长期生存。最近的发现:组学技术正变得越来越容易获得,可以识别新的生物标志物,并揭示几种疾病状态的潜在生物学。虽然一些技术,如基因表达谱(GEP)和供体来源的无细胞DNA (dd-cfDNA),通常用于HT受体的临床护理,但许多新兴平台,包括药物基因组学、蛋白质组学和代谢组学,在识别生物标志物以帮助移植后并发症的诊断和管理方面具有很大的潜力。基于组学的分析可以通过促进个性化和精确的ht后护理方法来改善患者和同种异体移植的寿命。下面的文章回顾了当前和未来利用组学技术的机会,包括基因组学、转录组学、蛋白质组学和代谢组学在HT领域的应用。
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引用次数: 0
Cardiac CT Beyond Coronaries: Focus on Structural Heart Disease. 冠状动脉以外的心脏CT:关注结构性心脏病。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-29 DOI: 10.1007/s11897-023-00635-9
Michaela M Hell, Tilman Emrich, Philipp Lurz, Ralph Stephan von Bardeleben, Axel Schmermund

Purpose of review: Cardiac computed tomography (CT) is an established non-invasive imaging tool for the assessment of coronary artery disease. Furthermore, it plays a key role in the preinterventional work-up of patients presenting with structural heart disease.

Recent findings: CT is the gold standard for preprocedural annular assessment, device sizing, risk determination of annular injury, coronary occlusion or left ventricular outflow tract obstruction, calcification visualization and quantification of the target structure, and prediction of a co-planar fluoroscopic angulation for transcatheter interventions in patients with structural heart disease. It is further a key imaging modality in postprocedural assessment for prosthesis thrombosis, degeneration, or endocarditis. CT plays an integral part in the imaging work-up of novel transcatheter therapies for structural heart disease and postprocedural assessment for prosthesis thrombosis or endocarditis. This review provides a comprehensive overview of the key role of CT in the context of structural heart interventions.

回顾目的:心脏计算机断层扫描(CT)是一种公认的评估冠状动脉疾病的无创成像工具。此外,它在结构性心脏病患者的介入前检查中起着关键作用。最近发现:CT是术前环形评估、装置尺寸、环形损伤风险确定、冠状动脉闭塞或左心室流出道梗阻、靶结构钙化可视化和量化以及预测结构性心脏病患者经导管介入共面透视成角的金标准。它也是假体血栓形成、退变或心内膜炎术后评估的关键成像方式。CT在结构性心脏病的新型经导管治疗的影像学检查以及假体血栓形成或心内膜炎的术后评估中发挥着不可或缺的作用。本文综述了CT在心脏结构干预中的关键作用。
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引用次数: 0
Your Heart Function Has Normalized-What Next After TRED-HF? 你的心脏功能已经恢复正常——在接受了心脏病治疗后,下一步该怎么办?
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-24 DOI: 10.1007/s11897-023-00636-8
Alexandros Kasiakogias, Aaraby Ragavan, Brian P Halliday

Purpose of review: With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy.

Recent findings: There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.

综述目的:随着当代疾病改善性心力衰竭治疗的广泛实施,射血分数正常化率不断提高。TRED-HF试验证实,在对治疗有反应的扩张型心肌病患者中,心衰缓解而不是完全恢复是典型的。目前的综述概述了与这一日益增长的患者群体的管理和知识差距相关的关键点,重点是非缺血性扩张型心肌病患者。最近的研究发现:在射血分数归一化的患者中存在实质性的异质性。特定的病因可能会影响结果,尽管多发表型是常见的,如果没有全面的特征可能无法确定。单基因或多基因遗传易感性是常见的。正在进行的病理生理过程可以通过先进的心脏成像、生物标志物、多组学和机器学习技术来解开。有有限的研究调查了这些患者的特定心力衰竭治疗的退出。如果没有充血的证据,利尿剂可以安全地停药,而对于绝大多数患者来说,可能需要继续治疗,至少需要一些疾病改善治疗,以减少心肌负荷并维持缓解。了解正常射血分数患者的潜在疾病机制对于确定心肌复发标志物和指导未来的个体化治疗至关重要。正在进行的临床试验应该为个性化的治疗方法提供信息。
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引用次数: 0
The Right Heart in Congenital Heart Disease. 先天性心脏病的右心。
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-09-29 DOI: 10.1007/s11897-023-00629-7
Alexandra Arvanitaki, Gerhard Diller, George Giannakoulas

Purpose of review: To analyze the pathophysiologic importance of the right heart in different types of congenital heart disease (CHD), summarize current diagnostic modalities, and discuss treatment options.

Recent findings: The right ventricle (RV) plays a key role in disease progression and prognosis, either as the subpulmonary or as the systemic ventricle. Volume and/or pressure overload as well as intrinsic myocardial disease are the main factors for RV remodeling. Echocardiography and cardiac magnetic resonance imaging are important noninvasive modalities for assessing anatomy, size, and function of the right heart. Timely repair of related lesions is essential for preventing RV dysfunction. Few inconclusive data exist on conventional pharmacotherapy in CHD-related RV dysfunction. Cardiac resynchronization therapy and ventricular assist devices are an option in patients with advanced systemic RV failure. Right heart disease is highly related with adverse clinical outcomes in CHD. Research should focus on early identification of patients at risk and development of medical and interventional treatments that improve RV function.

综述目的:分析右心在不同类型先天性心脏病(CHD)中的病理生理重要性,总结当前的诊断模式,并讨论治疗方案。最近的研究结果:右心室(RV)在疾病进展和预后中起着关键作用,无论是作为肺下心室还是作为系统心室。容积和/或压力超负荷以及内在心肌疾病是RV重塑的主要因素。超声心动图和心脏磁共振成像是评估右心解剖、大小和功能的重要非侵入性方法。及时修复相关病变对于预防RV功能障碍至关重要。关于CHD相关RV功能障碍的常规药物治疗,几乎没有不确定的数据。心脏再同步治疗和心室辅助装置是晚期系统性RV衰竭患者的一种选择。右心疾病与冠心病的不良临床结果高度相关。研究应侧重于早期识别有风险的患者,并开发改善RV功能的医疗和介入治疗方法。
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引用次数: 0
Coordinated Metabolic Responses Facilitate Cardiac Growth in Pregnancy and Exercise. 协调的代谢反应促进怀孕和运动中的心脏生长。
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-08-15 DOI: 10.1007/s11897-023-00622-0
Emily B Schulman-Geltzer, Helen E Collins, Bradford G Hill, Kyle L Fulghum

Purpose of review: Pregnancy and exercise are systemic stressors that promote physiological growth of the heart in response to repetitive volume overload and maintenance of cardiac output. This type of remodeling is distinct from pathological hypertrophy and involves different metabolic mechanisms that facilitate growth; however, it remains unclear how metabolic changes in the heart facilitate growth and if these processes are similar in both pregnancy- and exercise-induced cardiac growth.

Recent findings: The ability of the heart to metabolize a myriad of substrates balances cardiac demands for energy provision and anabolism. During pregnancy, coordination of hormonal status with cardiac reductions in glucose oxidation appears important for physiological growth. During exercise, a reduction in cardiac glucose oxidation also appears important for physiological growth, which could facilitate shuttling of glucose-derived carbons into biosynthetic pathways for growth. Understanding the metabolic underpinnings of physiological cardiac growth could provide insight to optimize cardiovascular health and prevent deleterious remodeling, such as that which occurs from postpartum cardiomyopathy and heart failure. This short review highlights the metabolic mechanisms known to facilitate pregnancy-induced and exercise-induced cardiac growth, both of which require changes in cardiac glucose metabolism for the promotion of growth. In addition, we mention important similarities and differences of physiological cardiac growth in these models as well as discuss current limitations in our understanding of metabolic changes that facilitate growth.

综述目的:妊娠和运动是系统性压力源,可促进心脏的生理生长,以应对重复的容量过载和心输出量的维持。这种类型的重塑不同于病理性肥大,并涉及促进生长的不同代谢机制;然而,目前尚不清楚心脏的代谢变化是如何促进生长的,以及这些过程在妊娠和运动诱导的心脏生长中是否相似。最近的发现:心脏代谢大量底物的能力平衡了心脏对能量供应和合成代谢的需求。在怀孕期间,激素状态与心脏葡萄糖氧化减少的协调对生理生长似乎很重要。在运动过程中,心脏葡萄糖氧化的减少对生理生长也很重要,这可能有助于葡萄糖衍生的碳穿梭到生长的生物合成途径中。了解生理性心脏生长的代谢基础可以为优化心血管健康和防止有害的重塑(如产后心肌病和心力衰竭)提供见解。这篇简短的综述强调了已知的促进妊娠和运动诱导的心脏生长的代谢机制,这两种机制都需要改变心脏葡萄糖代谢来促进生长。此外,我们在这些模型中提到了心脏生理生长的重要相似性和差异性,并讨论了目前我们对促进生长的代谢变化的理解存在的局限性。
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引用次数: 0
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Current Heart Failure Reports
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