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Non-Alcoholic Fatty Liver Disease as an Emerging Risk Factor for Heart Failure. 非酒精性脂肪肝是心力衰竭的一个新的危险因素。
Q1 Medicine Pub Date : 2023-08-01 Epub Date: 2023-07-04 DOI: 10.1007/s11897-023-00613-1
Riccardo M Inciardi, Alessandro Mantovani, Giovanni Targher

Purpose of the review: Non-alcoholic fatty liver disease (NAFLD) and heart failure (HF) are two chronic diseases that have become important global public health problems. This narrative review provides a comprehensive overview of the association between NAFLD and increased risk of new-onset HF, briefly discusses the putative biological mechanisms linking these two conditions, and summarizes targeted pharmacotherapies for NAFLD that might also beneficially affect cardiac complications leading to new-onset HF.

Recent findings: Recent observational cohort studies supported a significant association between NAFLD and the long-term risk of new-onset HF. Notably, this risk remained statistically significant even after adjustment for age, sex, ethnicity, adiposity measures, pre-existing type 2 diabetes and other common cardiometabolic risk factors. In addition, the risk of incident HF was further increased with more advanced liver disease, especially with higher severity of liver fibrosis. There are multiple potential pathophysiological mechanisms by which NAFLD (especially in its more advanced forms) may increase the risk of new-onset HF. Because of the strong link existing between NAFLD and HF, more careful surveillance of these patients will be needed. However, further prospective and mechanistic studies are required to better decipher the existing but complex link between NAFLD and risk of new-onset HF.

综述目的:非酒精性脂肪肝(NAFLD)和心力衰竭(HF)是两种已成为全球重要公共卫生问题的慢性疾病。这篇叙述性综述全面概述了NAFLD与新发HF风险增加之间的关系,简要讨论了将这两种情况联系起来的假定生物学机制,并总结了NAFLD的靶向药物治疗,这些药物治疗也可能有益于影响导致新发性HF的心脏并发症。最近的发现:最近的观察性队列研究支持NAFLD与新发性心衰的长期风险之间的显著关联。值得注意的是,即使在调整了年龄、性别、种族、肥胖指标后,这种风险仍然具有统计学意义,已有的2型糖尿病和其他常见的心脏代谢风险因素。此外,随着肝病的进展,发生HF的风险进一步增加,尤其是肝纤维化的严重程度越高。NAFLD(尤其是更晚期的NAFLD)可能会增加新发HF的风险,这有多种潜在的病理生理机制。由于NAFLD和HF之间存在着密切的联系,需要对这些患者进行更仔细的监测。然而,需要进一步的前瞻性和机制研究来更好地解读NAFLD与新发HF风险之间现有但复杂的联系。
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引用次数: 0
The Role of the Vasculature in Heart Failure. 血管在心力衰竭中的作用。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-09 DOI: 10.1007/s11897-023-00602-4
Mithilesh Joshi, Patrick Tran, Thomas M Barber, Waqar Ayub, Michael Kuehl, Prithwish Banerjee

The contribution of the vasculature in the development and progression of heart failure (HF) syndromes is poorly understood and often neglected. Incorporating both arterial and venous systems, the vasculature plays a significant role in the regulation of blood flow throughout the body in meeting its metabolic requirements. A deterioration or imbalance between the cardiac and vascular interaction can precipitate acute decompensated HF in both preserved and reduced ejection fraction phenotypes. This is characterised by the increasingly recognised concept of ventricular-arterial coupling: a well-balanced relationship between ventricular and vascular stiffness, which has major implications in HF. Often, the cause of decompensation is unknown, with international guidelines mainly centred on arrhythmia, infection, acute coronary syndrome and its mechanical complications as common causes of decompensation; the vascular component is often underrecognised. A better understanding of the vascular contribution in cardiovascular failure can improve risk stratification, earlier diagnosis and facilitate earlier optimal treatment. This review focuses on the role of the vasculature by integrating the concepts of ventricular-arterial coupling, arterial stiffness and venous return in a failing heart.

人们对血管在心力衰竭(HF)综合征的发生和发展过程中所起的作用知之甚少,而且常常忽视这一问题。血管包括动脉和静脉系统,在调节全身血流以满足新陈代谢需求方面发挥着重要作用。心脏和血管相互作用的恶化或失衡可导致射血分数保留型和射血分数降低型急性失代偿性高血压。其特点是心室-动脉耦合的概念日益得到认可:心室和血管僵硬度之间的平衡关系对心房颤动有重大影响。失代偿的原因往往不明,国际指南主要将心律失常、感染、急性冠状动脉综合征及其机械并发症作为失代偿的常见原因;血管因素往往未得到充分认识。更好地了解血管在心血管衰竭中的作用可以改善风险分层、早期诊断并促进早期最佳治疗。本综述通过整合衰竭心脏中的心室-动脉耦合、动脉僵化和静脉回流等概念,重点探讨血管的作用。
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引用次数: 0
Role of Sodium and Sodium Restriction in Heart Failure. 钠和限钠在心力衰竭中的作用。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-25 DOI: 10.1007/s11897-023-00607-z
Pieter Martens, W H Wilson Tang

Purpose of review: Sodium plays an essential role in the regulation of extracellular volume. The current review discusses the physiologic handling of sodium in the body, underscores pathophysiologic alterations in sodium handling in heart failure and assesses the evidence and rational for sodium restriction in heart failure.

Recent findings: Recent trials such as the SODIUM-HF trial have failed to demonstrate a benefit of sodium restriction in heart failure. The current review re-evaluates physiologic elements in sodium handling and discusses how the intrinsic renal sodium avidity, which drives the renal propensity towards retaining sodium, differs amongst patients. The sodium intake in heart failure patients is often above the threshold set by guidelines. This review gives an overview of the pathophysiology of sodium retention in heart failure and the rational for sodium restriction and potential of individualizing sodium restriction recommendations based on renal sodium avidity profiles.

综述的目的:钠在细胞外容量调节中发挥着重要作用。本综述讨论了钠在体内的生理处理,强调了心衰患者钠处理的病理生理改变,并评估了心衰患者限钠的证据和合理性:最近的试验(如 SODIUM-HF 试验)未能证明限制钠摄入对心力衰竭有益。当前的综述重新评估了钠处理的生理因素,并讨论了肾脏固有的钠嗜性如何因患者而异,这种嗜性驱动肾脏保留钠的倾向。心衰患者的钠摄入量通常高于指南设定的阈值。本综述概述了心衰患者钠潴留的病理生理学、限钠的合理性以及根据肾脏钠嗜性特征提出个性化限钠建议的可能性。
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引用次数: 0
Assessment of Right Ventricular Function-a State of the Art. 右心室功能评估--最新进展
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-06-05 DOI: 10.1007/s11897-023-00600-6
Abdul Hameed, Robin Condliffe, Andrew J Swift, Samer Alabed, David G Kiely, Athanasios Charalampopoulos

Purpose of review: The right ventricle (RV) has a complex geometry and physiology which is distinct from the left. RV dysfunction and failure can be the aftermath of volume- and/or pressure-loading conditions, as well as myocardial and pericardial diseases.

Recent findings: Echocardiography, magnetic resonance imaging and right heart catheterisation can assess RV function by using several qualitative and quantitative parameters. In pulmonary hypertension (PH) in particular, RV function can be impaired and is related to survival. An accurate assessment of RV function is crucial for the early diagnosis and management of these patients. This review focuses on the different modalities and indices used for the evaluation of RV function with an emphasis on PH.

回顾的目的:右心室(RV)具有不同于左心室的复杂几何形状和生理结构。右心室功能障碍和衰竭可能是容量和/或压力负荷条件以及心肌和心包疾病的后果:最新研究结果:超声心动图、磁共振成像和右心导管检查可通过多个定性和定量参数评估 RV 功能。特别是在肺动脉高压(PH)患者中,RV 功能可能受损,并与存活率有关。准确评估 RV 功能对这些患者的早期诊断和治疗至关重要。本综述主要介绍用于评估 RV 功能的不同模式和指标,重点是 PH。
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引用次数: 0
Myocardial Fatigue at a Glance. 心肌疲劳一瞥。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-03 DOI: 10.1007/s11897-023-00603-3
Patrick Tran, Prithwish Banerjee

Expanding on the modern lexicon of heart failure (HF), the novel mechano-energetic concept of myocardial fatigue describes a transiently energy-depleted myocardium with impaired contractility and relaxation in the face of adverse haemodynamic load. It encompasses established concepts of ventricular-arterial decoupling, deranged cardiac energetics and impaired myocardial efficiency, offering an alternative explanation for functional causes of HF.

心肌疲劳这一新颖的机械-能量概念扩展了心力衰竭(HF)的现代词汇,描述了心肌在面对不利的血流动力学负荷时收缩力和松弛力受损的短暂能量耗竭现象。它包含了心室-动脉脱钩、心脏能量失调和心肌效率受损等既有概念,为高血压的功能性病因提供了另一种解释。
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引用次数: 0
Do Women Physicians Accept and Follow Heart Failure Guidelines More Than Men? 女医生比男医生更容易接受和遵循心力衰竭指南吗?
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-04-06 DOI: 10.1007/s11897-023-00597-y
Jesús Álvarez-García, María José Cristo Ropero, Ángel Manuel Iniesta Manjavacas, Pablo Díez-Villanueva, Alberto Esteban-Fernández, Javier de Juan Bagudá, Mercedes Rivas-Lasarte, Mikel Taibo Urquía, Juan Górriz-Magaña, Marta Cobo Marcos, Josebe Goirigolzarri-Artaza, Diego Iglesias Del Valle, Ramón Bover Freire, Cristina Beltrán Herrera, Adolfo Villa, Raquel Campuzano Ruiz, Manuel Martínez-Sellés

Purpose of review: Our aim was to assess the degree of acceptance of the European Clinical Practice Guidelines (CPG) on heart failure (HF) among Spanish physicians according to sex. This was a cross-sectional study, employing Google Forms, conducted by a group of HF experts from the Region of Madrid (Spain), between November 2021 and February 2022, among specialists and residents of Cardiology, Internal Medicine, and Primary Care from Spain.

Recent findings: A total of 387 physicians-173 women (44.7%)-from 128 different centers completed the survey. Compared to men, women were significantly younger (38.2 ± 9.1 years vs. 40.6 ± 11.2 years; p = 0.024) and had fewer years of clinical practice (12.1 ± 8.1 years vs. 14.5 ± 10.7 years; p = 0.014). Briefly, women and men had a positive opinion of the guidelines and thought that implementing quadruple therapy is feasible in less than 8 weeks. Women followed more frequently than men the new paradigm of "4 pillars at lowest doses" and considered more frequently the establishment of quadruple therapy before implanting a cardiac device. Although they agreed about "low blood pressure" as the major limitation for achieving quadruple therapy in heart failure with reduced ejection fraction, there were discrepancies on the second most frequent barrier, and women were more proactive when initiating SGLT2 inhibitors. In a large survey including nearly 400 doctors from all over Spain to provide real-world opinion on 2021 ESC HF Guidelines and experience with SGLT2 inhibitors, women follow more frequently the new paradigm of "4 pillars at lowest doses", consider more frequently the establishment of quadruple therapy before implanting a cardiac device, and were more proactive when initiating SGLT2 inhibitors. Further studies confirming an association of sex with a better compliance of HF guidelines are needed.

综述目的:我们的目的是根据性别评估西班牙医生对欧洲心力衰竭(HF)临床实践指南(CPG)的接受程度。这是一项横断面研究,由一组来自马德里地区(西班牙)的心力衰竭专家在 2021 年 11 月至 2022 年 2 月期间使用谷歌表格进行,研究对象为西班牙心脏病学、内科学和初级保健的专家和住院医师:共有来自 128 个不同中心的 387 名医生--173 名女性(44.7%)--完成了调查。与男性相比,女性明显更年轻(38.2 ± 9.1 岁 vs 40.6 ± 11.2 岁;p = 0.024),临床执业年限更短(12.1 ± 8.1 年 vs 14.5 ± 10.7 年;p = 0.014)。简而言之,女性和男性都对指南持肯定态度,并认为在不到 8 周的时间内实施四联疗法是可行的。女性比男性更倾向于遵循 "最低剂量四支柱 "的新范例,更倾向于在植入心脏设备前建立四联疗法。虽然她们一致认为 "低血压 "是射血分数降低型心力衰竭患者实现四联疗法的主要限制因素,但在第二大障碍上存在差异,女性在开始使用 SGLT2 抑制剂时更加积极主动。在一项大型调查中,来自西班牙各地的近 400 名医生就 2021 ESC HF 指南和使用 SGLT2 抑制剂的经验提供了真实世界的意见,其中女性更常遵循 "最低剂量的四大支柱 "的新范例,更常考虑在植入心脏设备前建立四联疗法,并且在使用 SGLT2 抑制剂时更积极主动。还需要进一步研究证实性别与更好地遵守高血压指南之间的关系。
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引用次数: 0
Tricuspid Regurgitation: Right Ventricular Volume Versus Pressure Load. 三尖瓣反流:右心室容量与压力负荷。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-04-26 DOI: 10.1007/s11897-023-00599-w
Robert Naeije, Khodr Tello, Michele D'Alto

Purpose of the review: Tricuspid regurgitation is associated with increased mortality in proportion to right ventricular adaptation to increased volume loading and pulmonary artery pressure. We here review recent progress in the understanding of right ventricular adaptation to pre- and after-loading conditions for improved recommendations of tricuspid valve repair.

Recent findings: Trans-catheter tricuspid valve repair has made the correction of tricuspid regurgitation more easily available, triggering a need of tighter indications. Several studies have shown the feasibility and relevance to the indications of tricuspid valve repair of imaging of right ventricular ejection fraction measured by magnetic resonance imaging or 3D-echocardiography, and the 2D-echocardiography of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio combined with invasively determined mean pulmonary artery pressure and pulmonary vascular resistance. Improved definitions of right ventricular failure and pulmonary hypertension may be considered in future recommendations on the treatment of tricuspid regurgitation.

综述的目的:三尖瓣反流与死亡率的增加有关,这与右心室对增加的容量负荷和肺动脉压力的适应性成正比。在此,我们回顾了在了解右心室对负荷前和负荷后条件的适应性方面的最新进展,以改进三尖瓣修复的建议:最近的研究结果:经导管三尖瓣修复术使三尖瓣反流的矫治变得更加容易,从而引发了对更严格适应症的需求。多项研究表明,通过磁共振成像或三维超声心动图测量右心室射血分数,以及通过二维超声心动图测量三尖瓣环平面收缩期偏移与收缩期肺动脉压的比值,并结合有创测定的平均肺动脉压和肺血管阻力,对三尖瓣修复术的适应症具有可行性和相关性。在未来的三尖瓣反流治疗建议中,可考虑改进右心室衰竭和肺动脉高压的定义。
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引用次数: 0
Sex differences in Cardiorenal Syndrome: Insights from CARDIOREN Registry. 心肾综合征的性别差异:CARDIOREN 登记的启示。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-24 DOI: 10.1007/s11897-023-00598-x
Marta Cobo Marcos, Rafael de la Espriella, Jara Gayán Ordás, Isabel Zegrí, Antonia Pomares, Pau Llácer, Aleix Fort, Adriana Rodríguez Chavarri, Ana Méndez, Zorba Blázquez, Pedro Caravaca Pérez, Jorge Rubio Gracia, Alejandro Recio-Mayoral, Jose Manuel García Pinilla, Maria Jose Soler, Ramón Garrido González, Jose Luis Górriz, Miguel González Rico, Almudena Castro, Julio Núñez

Purpose of the work: Although sex-specific differences in heart failure (HF) or kidney disease (KD) have been analyzed separately, the predominant cardiorenal phenotype by sex has not been described. This study aims to explore the sex-related differences in cardiorenal syndrome (CRS) in a contemporary cohort of outpatients with HF.

Findings: An analysis of the Cardiorenal Spanish registry (CARDIOREN) was performed. CARDIOREN Registry is a prospective multicenter observational registry including 1107 chronic ambulatory HF patients (37% females) from 13 Spanish HF clinics. Estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m2 was present in 59.1% of the overall HF population, being this prevalence higher in the female population (63.2% vs. 56.6%, p = 0.032, median age: 81 years old, IQR:74-86). Among those with kidney dysfunction, women displayed higher odds of showing HF with preserved ejection fraction (HFpEF) (odds ratio [OR] = 4.07; confidence interval [CI] 95%: 2.65-6.25, p < 0.001), prior valvular heart disease (OR = 1.76; CI 95%:1.13-2.75, p = 0.014), anemia (OR: 2.02; CI 95%:1.30-3.14, p = 0.002), more advanced kidney disease (OR for CKD stage 3: 1.81; CI 95%:1.04-3.13, p = 0.034; OR for CKD stage 4: 2.49, CI 95%:1.31-4.70, p = 0.004) and clinical features of congestion (OR:1.51; CI 95%: 1.02-2.25, p = 0.039). On the contrary, males with cardiorenal disease showed higher odds of presenting HF with reduced ejection fraction (HFrEF) (OR:3.13; CI 95%: 1.90-5.16, p < 0.005), ischemic cardiomyopathy (OR:2.17; CI 95%: 1.31-3.61, p = 0.003), hypertension (OR = 2.11; CI 95%:1.18-3.78, p = 0.009), atrial fibrillation (OR:1.71; CI 95%: 1.06-2.75, p = 0.025), and hyperkalemia (OR:2.43, CI 95%: 1.31-4.50, p = 0.005). In this contemporary registry of chronic ambulatory HF patients, we observed sex-related differences in patients with combined heart and kidney disease. The emerging cardiorenal phenotype characterized by advanced CKD, congestion, and HFpEF was predominantly observed in women, whereas HFrEF, ischemic etiology, hypertension, hyperkalemia, and atrial fibrillation were more frequently observed in men.

工作目的虽然已对心力衰竭(HF)或肾脏疾病(KD)的性别差异进行了单独分析,但尚未描述不同性别的主要心肾表型。本研究旨在探讨当代心力衰竭门诊患者队列中与性别相关的心肾综合征(CRS)差异:对西班牙心肾登记处(CARDIOREN)进行了分析。CARDIOREN 登记是一项前瞻性多中心观察登记,包括来自西班牙 13 家高血压诊所的 1107 名慢性门诊高血压患者(37% 为女性)。估计肾小球滤过率(eGFR)为 2 的患者占所有高血压患者的 59.1%,女性患者的比例更高(63.2% 对 56.6%,p = 0.032,中位年龄:81 岁,IQR:74-86)。在肾功能不全患者中,女性出现射血分数保留型心房颤动(HFpEF)的几率更高(几率比 [OR] = 4.07;置信区间 [CI] 95%:2.65-6.25, p
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引用次数: 0
PCSK9 Inhibition in Patients After Heart Transplantation: a Retrospective Review and Literature Analysis. 心脏移植术后患者的 PCSK9 抑制:回顾性综述和文献分析。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-08 DOI: 10.1007/s11897-023-00604-2
Jeffrey J Chapa, Jonathan C McCollum, Janina Quintero Bisono, Rishika S Prakash, Maya E Guglin, Roopa A Rao

Purpose of review: Following cardiac transplantation, patients have an increased risk of developing cardiac allograft vasculopathy and atherosclerotic cardiovascular disease. Therefore, aggressive lipid management is indicated. Some patients do not achieve optimal lipid profiles with statin monotherapy, however, or discontinue statins due to intolerance. In this review, we investigated the use of PCSK9 inhibitors as an alternative treatment for hyperlipidemia following cardiac transplantation.

Recent findings: Nine published articles were identified that included 110 patients treated with alirocumab or evolocumab after cardiac transplantation. PCSK9 inhibitors were tolerated by all patients, and each study demonstrated an effective reduction of low-density lipoprotein ranging from 40 to 87% decrease from baseline. In our study, the 110 patients from literature review were added to a cohort of 7 similar patients from our institution for combined analysis. This report supports that PCSK9 inhibitors should be considered following cardiac transplantation when conventional medial therapy is not tolerated or ineffective.

审查目的:心脏移植后,患者发生心脏异体移植血管病变和动脉粥样硬化性心血管疾病的风险增加。因此,应积极进行血脂管理。然而,有些患者在使用他汀类药物单药治疗后血脂状况并不理想,或因不耐受而停用他汀类药物。在这篇综述中,我们研究了使用 PCSK9 抑制剂作为心脏移植后高脂血症的替代治疗方法:我们发现了九篇已发表的文章,共纳入了 110 名接受心脏移植手术后使用阿利珠单抗或依维莫司单抗治疗的患者。所有患者都能耐受 PCSK9 抑制剂,而且每项研究都显示低密度脂蛋白从基线下降了 40% 到 87% 不等。在我们的研究中,我们将文献综述中的 110 例患者与本机构的 7 例类似患者进行了合并分析。本报告支持在心脏移植术后,当常规药物治疗不能耐受或无效时,应考虑使用 PCSK9 抑制剂。
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引用次数: 0
Management of Acute Right Ventricular Failure. 急性右心室衰竭的处理。
Q1 Medicine Pub Date : 2023-06-01 Epub Date: 2023-05-08 DOI: 10.1007/s11897-023-00601-5
Ayu Asakage, Josefine Bækgaard, Alexandre Mebazaa, Benjamin Deniau

Purpose of review: Acute right ventricular failure (RVF) is a frequent condition associated with high morbidity and mortality. This review aims to provide a current overview of the pathophysiology, presentation, and comprehensive management of acute RVF.

Recent findings: Acute RVF is a common disease with a pathophysiology that is not completely understood. There is renewed interest in the right ventricle (RV). Some advances have been principally made in chronic right ventricular failure (e.g., pulmonary hypertension). Due to a lack of precise definition and diagnostic tools, acute RVF is poorly studied. Few advances have been made in this field. Acute RVF is a complex, frequent, and life-threatening condition with several etiologies. Transthoracic echocardiography (TTE) is the key diagnostic tool in search of the etiology. Management includes transfer to an expert center and admission to the intensive care unit (ICU) in most severe cases, etiological treatment, and general measures for RVF.

审查目的:急性右心室功能衰竭(RVF)是一种与高发病率和高死亡率相关的常见病。本综述旨在概述急性右心室功能衰竭的病理生理学、表现和综合管理:急性右心房颤动是一种常见疾病,其病理生理学尚不完全清楚。人们对右心室(RV)重新产生了兴趣。主要在慢性右心室功能衰竭(如肺动脉高压)方面取得了一些进展。由于缺乏准确的定义和诊断工具,对急性右心室功能衰竭的研究很少。在这一领域也鲜有进展。急性 RVF 是一种复杂、多发且危及生命的疾病,有多种病因。经胸超声心动图(TTE)是寻找病因的关键诊断工具。处理方法包括转到专家中心,最严重的病例可入住重症监护室(ICU)、病因治疗和 RVF 的一般措施。
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引用次数: 0
期刊
Current Heart Failure Reports
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