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Systematic Review of the Association of the Hospital Frailty Risk Score with Mortality in Patients with Cerebrovascular and Cardiovascular Disease. 医院虚弱风险评分与脑血管和心血管疾病患者死亡率关系的系统性综述》。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X276647240217112151
Balamrit Singh Sokhal, Sowmya Prasanna Kumar Menon, Charles Willes, Nadia Corp, Andrija Matetić, Christian Mallen, Mamas Mamas

Background: There is limited systematic data on the association between the Hospital Frailty Risk Score (HFRS) and characteristics and mortality in patients with cerebrovascular and cardiovascular disease (CVD). This systematic review aimed to summarise the use of the HFRS in describing the prevalence of frailty in patients with CVD, the clinical characteristics of patients with CVD, and the association between frailty on the likelihood of mortality in patients with CVD.

Methods: A systematic literature search for observational studies using terms related to CVD, cerebrovascular disease, and the HFRS was conducted using 6 databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were appraised using the Newcastle-Ottawa Scale (NOS).

Results: Seventeen observational studies were included, all rated 'good' quality according to the NOS. One study investigated 5 different CVD cohorts (atrial fibrillation (AF), heart failure (HF), hypotension, hypertension, and chronic ischemic heart disease), 1 study investigated 2 different CVD cohorts (AF and acute myocardial infarction (AMI)), 6 studies investigated HF, 3 studies investigated AMI, 4 studies investigated stroke, 1 study investigated AF, and 1 study investigated cardiac arrest. Increasing frailty risk category was associated with increased age, female sex, and non-white racial group across all CVD. Increasing frailty risk category is also associated with increased length of hospital stay, total costs, and increased odds of 30-day all-cause mortality across all CVD.

Conclusions: The HFRS is an efficient and effective tool for stratifying frailty in patients with CVD and predicting adverse health outcomes.

背景:关于医院虚弱风险评分(HFRS)与脑血管病和心血管病(CVD)患者的特征和死亡率之间关系的系统性数据十分有限。本系统性综述旨在总结医院虚弱风险评分在描述心血管疾病患者的虚弱发生率、心血管疾病患者的临床特征以及虚弱与心血管疾病患者死亡率之间的关联方面的应用情况:根据《系统综述和荟萃分析首选报告项目》指南,我们使用 6 个数据库对观察性研究进行了系统性文献检索,并使用了与心血管疾病、脑血管疾病和 HFRS 相关的术语。研究采用纽卡斯尔-渥太华量表(NOS)进行评估:结果:共纳入 17 项观察性研究,根据 NOS,所有研究的质量都被评为 "良好"。一项研究调查了 5 个不同的心血管疾病队列(心房颤动(AF)、心力衰竭(HF)、低血压、高血压和慢性缺血性心脏病),一项研究调查了 2 个不同的心血管疾病队列(心房颤动和急性心肌梗死(AMI)),6 项研究调查了心力衰竭,3 项研究调查了急性心肌梗死,4 项研究调查了中风,1 项研究调查了心房颤动,1 项研究调查了心脏骤停。在所有心血管疾病中,虚弱风险类别的增加与年龄、女性性别和非白人种族群体的增加有关。在所有心血管疾病中,虚弱风险类别的增加还与住院时间的增加、总费用的增加以及30天全因死亡率的增加有关:HFRS是对心血管疾病患者的虚弱程度进行分层并预测不良健康后果的有效工具。
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引用次数: 0
The Interplay of Comorbidities in Chronic Heart Failure: Challenges and Solutions. 慢性心力衰竭合并症的相互作用:挑战与解决方案。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X289572240206112303
Shashipriya Agress, Jannat S Sheikh, Aida A Perez Ramos, Durlav Kashyap, Soha Razmjouei, Joy Kumar, Mankaranvir Singh, Muhammad Ali Lak, Ali Osman, Muhammad Zia Ul Haq

Background: Chronic heart failure (HF) is frequently associated with various comorbidities. These comorbid conditions, such as anemia, diabetes mellitus, renal insufficiency, and sleep apnea, can significantly impact the prognosis of patients with HF.

Objective: This review aims to synthesize current evidence on the prevalence, impact, and management of comorbidities in patients with chronic HF.

Methods: A comprehensive review was conducted, with a rigorous selection process. Out of an initial pool of 59,030 articles identified across various research modalities, 134 articles were chosen for inclusion. The selection spanned various research methods, from randomized controlled trials to observational studies.

Results: Comorbidities are highly prevalent in patients with HF and contribute to increased hospitalization rates and mortality. Despite advances in therapies for HF with reduced ejection fraction, options for treating HF with preserved ejection fraction remain sparse. Existing treatment protocols often lack standardization, reflecting a limited understanding of the intricate relationships between HF and associated comorbidities.

Conclusion: There is a pressing need for a multidisciplinary, tailored approach to manage HF and its intricate comorbidities. This review underscores the importance of ongoing research efforts to devise targeted treatment strategies for HF patients with various comorbid conditions.

背景:慢性心力衰竭(HF慢性心力衰竭(HF)常伴有各种合并症。这些合并症,如贫血、糖尿病、肾功能不全和睡眠呼吸暂停等,会严重影响心力衰竭患者的预后:本综述旨在总结慢性高血压患者合并症的患病率、影响和管理方面的现有证据:方法:我们通过严格的筛选过程进行了全面综述。在最初确定的 59,030 篇不同研究方式的文章中,有 134 篇被选中纳入。研究方法多种多样,既有随机对照试验,也有观察性研究:合并症在心房颤动患者中非常普遍,导致住院率和死亡率上升。尽管射血分数降低型心房颤动的治疗方法取得了进展,但治疗射血分数保留型心房颤动的方法仍然很少。现有的治疗方案往往缺乏标准化,反映出人们对心房颤动与相关合并症之间错综复杂的关系了解有限:目前迫切需要一种多学科的、量身定制的方法来管理心房颤动及其错综复杂的合并症。本综述强调了当前研究工作的重要性,即为合并各种疾病的心房颤动患者制定有针对性的治疗策略。
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引用次数: 0
Cardiovascular Manifestations in Inflammatory Bowel Disease. 炎症性肠病的心血管表现。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-24 DOI: 10.2174/011573403X256094231031074753
Anish Meda, Fremita Fredrick, Urvashi Rathod, Priyanshi Shah, Rohit Jain

Inflammatory bowel disease is a group of long-term systemic inflammatory disorders affecting the gastrointestinal tract, including Crohn's disease and ulcerative colitis, which may be associated with an increased risk of developing extraintestinal manifestations, including cardiovascular disease, thereby decreasing the quality of life. Pathophysiological changes associated with inflammatory bowel disease include alterations of the microbiome, endotoxemia, and changes to glucose and lipid metabolism. Inflammatory bowel disease patients have higher carotid intima-media thickness, lower flow-mediated dilatation, and increased carotid-femoral pulse wave velocity, which are markers of elevated cardiovascular risk. In addition, inflammatory bowel disease patients are at an increased risk for developing venous and arterial thrombotic events due to a hypercoagulable state caused by thrombocytosis and coagulation system activation. To reduce the risk of developing cardiovascular disease, lifestyle modifications, such as smoking cessation, dietary changes, and increased physical activity alongside management with appropriate medication, should be considered. This research paper examines how inflammatory bowel disease can influence the risk of cardiovascular complications and the involvement of drug therapy. Methods: PubMed was searched using keywords, such as inflammatory bowel disease, Crohn's disease, ulcerative colitis, cardiovascular disease, pericarditis, thromboembolism, and many more. Relevant literature up to March 2023 has been examined and summarized, which consisted of data from various clinical trials, meta-analyses, retrospective/prospective cohort studies, and current guidelines.

炎症性肠病是一组影响胃肠道的长期全身性炎症性疾病,包括克罗恩病和溃疡性结肠炎,这可能与发生肠外表现(包括心血管疾病)的风险增加有关,从而降低生活质量。与炎症性肠病相关的病理生理变化包括微生物组的改变、内毒素血症以及糖脂代谢的改变。炎症性肠病患者颈动脉内膜-中膜厚度增高,血流介导的扩张降低,颈动脉-股动脉脉波速度增高,这些都是心血管风险升高的标志。此外,由于血小板增多和凝血系统激活引起的高凝状态,炎症性肠病患者发生静脉和动脉血栓事件的风险增加。为降低患心血管疾病的风险,应考虑改变生活方式,如戒烟、改变饮食、增加体力活动,同时适当用药。本研究报告探讨了炎症性肠病如何影响心血管并发症的风险和药物治疗的参与。方法:通过关键词PubMed检索,如炎症性肠病、克罗恩病、溃疡性结肠炎、心血管疾病、心包炎、血栓栓塞等。对截至2023年3月的相关文献进行了检查和总结,包括来自各种临床试验、荟萃分析、回顾性/前瞻性队列研究和现行指南的数据。
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引用次数: 0
Acknowledgements to Reviewers 审稿人致谢
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 DOI: 10.2174/1573403x1906231002102918
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引用次数: 0
Prevention of Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention. 经皮冠状动脉介入治疗患者造影剂肾病的预防。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-24 DOI: 10.2174/011573403X260319231016075216
Raymond Pranata, Dendi Puji Wahyudi

Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury has varying definitions, but in general, increased serum creatinine level by ≥ 0.3 mg/dL (26.5 µmol/L) or 1.5x of baseline value or urine output <0.5 mL/kg/h within 1-7 days after contrast media (CM) administration can be considered as CIN. CIN is one of the most common complications and is associated with increased mortality in patients undergoing percutaneous coronary intervention (PCI). Thus, risk stratification for CIN should be made and preventive strategies should be employed in which the intensity of the approach must be tailored to patient's risk profile. In all patients, adequate hydration is required, nephrotoxic medications should be discontinued, and pre-procedural high-intensity statin is recommended. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, IV hydration should be started 12 hours pre-procedure up until 12-24 hours after the procedure. Remote ischemic preconditioning may be performed pre-procedurally. Radial first approach for vascular access is recommended. During the procedure, low or iso-osmolar CM should be used and its volume should be limited to eGFR x 3.7. In patients at high risk for CIN, additional contrast-sparing strategies may be applied, such as using a contrast reduction system, 5 Fr catheter with no sideholes, CM dilution, limiting test injection, confirming placement using guidewire, use of stent enhancing imaging technology, using metallic/software roadmap to guide PCI, use of IVUS or dextran-based OCT, and coronary aspiration. A more advanced hydration technique based on central venous pressure, left ventricular end-diastolic pressure, or using furosemide-matched hydration, might be considered.

造影剂诱导性肾病(CIN)或造影剂诱导的急性肾损伤有不同的定义,但通常情况下,血清肌酐水平增加≥0.3 mg/dL(26.5µmol/L)或基线值或尿量的1.5倍
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引用次数: 0
When Pulmonary Arterial Hypertension may be Associated with Portal Hypertension: A Case Report of Two Different Hepatic Disorders in One Patient with Pulmonary Hypertension. 肺动脉高压何时可能与门静脉高压相关:一例肺动脉高压患者两种不同肝脏疾病的病例报告。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-20 DOI: 10.2174/011573403X267162231011154808
Ganna Radchenko, Yuriy Sirenko

Background: pulmonary arterial hypertension (PAH) is a rare complication of hepatic diseases with portal hypertension that, however, has a significant influence on prognosis. We present a mini-review of how to diagnose and treat it based on a clinical case.

Case presentation: in early childhood, a patient had portal hypertension associated with cavernous transformation of the portal vein. It was successfully treated by reno-splenic surgery. At the age of 20 years, this patient experienced increased dyspnea at minimal physical activity after the hepatic biopsy due to a hepatocellular adenoma. The examination in the specialized unit showed PAH, which was evaluated as associated with portal hypertension (PAH-PoH). The specific two-drug combination therapy was started with prominent improvement in patient's state. Successful surgical tumor treatment was provided some months later. The practical and clinical approaches to the diagnosis and treatment of PAH-PoH are discussed. It was emphasized that not all patients with portal hypertension have pulmonary hypertension, which needs to be treated. A lot of evidence gaps exist in management of these patients.

Conclusion: all patients, even with past history of portal hypertension, should be monitored closely and screened for PAH earlier, for better results of treatment.

背景:肺动脉高压(PAH)是门脉高压肝病的一种罕见并发症,但对预后有重要影响。我们根据一个临床病例对如何诊断和治疗它进行了一个简短的综述。病例介绍:在儿童早期,一名患者患有与门静脉海绵状变性相关的门静脉高压症。肾脾手术成功治疗。该患者在20岁时,由于肝细胞腺瘤,在肝活检后,在最小的体力活动下呼吸困难加剧。在专科病房的检查显示PAH,被评估为与门静脉高压(PAH-PoH)有关。在患者状态显著改善的情况下,开始了特定的两种药物的联合治疗。几个月后,肿瘤手术治疗成功。讨论了诊断和治疗PAH-PoH的实用和临床方法。强调并非所有门静脉高压患者都有肺动脉高压,需要治疗。在对这些患者的管理中存在许多证据空白。结论:所有患者,即使有门静脉高压病史,也应密切监测并尽早筛查PAH,以获得更好的治疗效果。
{"title":"When Pulmonary Arterial Hypertension may be Associated with Portal Hypertension: A Case Report of Two Different Hepatic Disorders in One Patient with Pulmonary Hypertension.","authors":"Ganna Radchenko, Yuriy Sirenko","doi":"10.2174/011573403X267162231011154808","DOIUrl":"10.2174/011573403X267162231011154808","url":null,"abstract":"<p><strong>Background: </strong>pulmonary arterial hypertension (PAH) is a rare complication of hepatic diseases with portal hypertension that, however, has a significant influence on prognosis. We present a mini-review of how to diagnose and treat it based on a clinical case.</p><p><strong>Case presentation: </strong>in early childhood, a patient had portal hypertension associated with cavernous transformation of the portal vein. It was successfully treated by reno-splenic surgery. At the age of 20 years, this patient experienced increased dyspnea at minimal physical activity after the hepatic biopsy due to a hepatocellular adenoma. The examination in the specialized unit showed PAH, which was evaluated as associated with portal hypertension (PAH-PoH). The specific two-drug combination therapy was started with prominent improvement in patient's state. Successful surgical tumor treatment was provided some months later. The practical and clinical approaches to the diagnosis and treatment of PAH-PoH are discussed. It was emphasized that not all patients with portal hypertension have pulmonary hypertension, which needs to be treated. A lot of evidence gaps exist in management of these patients.</p><p><strong>Conclusion: </strong>all patients, even with past history of portal hypertension, should be monitored closely and screened for PAH earlier, for better results of treatment.</p>","PeriodicalId":10832,"journal":{"name":"Current Cardiology Reviews","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11071676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fetal Aortic And Umbilical Doppler Flow Velocity Waveforms In Pregnancy: The Concept of Aortoumbilical Column 妊娠期胎儿主动脉和脐多普勒血流速度波形:主动脉-脐柱的概念
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-10 DOI: 10.2174/011573403x255256230919061018
De Almeida Ana Beatriz, Morais Ana Rita, Ferreira Miguel, Gaio Ana Rita, Guedes-Martins Luís
Abstract: Low impedance within the uteroplacental circulation is crucial for fetal development. Flow velocity waveforms (FVW) have been established for the aortic and umbilical arteries in low-risk pregnancies during the second half of pregnancy, but data regarding early gestation is limited. Both vascular territories exhibit higher impedance patterns in pregnancies complicated by fetal growth restriction (FGR), hypertensive disorders, fetal anemia, and chromosomal abnormalities. Early identification of these complications is critical in obstetric practice, to reduce perinatal morbidity and mortality through prevention and close antenatal surveillance. Available data suggest that aortic and umbilical impedances follow the same variation pattern as pregnancy progresses. This observation implies that both vessels may be considered as a single artery, referred to as the “aortoumbilical column”. Our hypothesis posits that changes in the hemodynamic pattern of this column could identify high-risk pregnancies, particularly those complicated by preeclampsia, FGR, intrauterine fetal demise, fetal aneuploidies, and fetal anemia. Understanding vascular embryogenesis and the FVWs of the aortic and umbilical arteries enables comprehension of impedance changes throughout normal pregnancies. The continuous variation in impedance along a single vessel supports our concept of the aortoumbilical column. Deviations from the regular pattern could assist in identifying compromised fetuses during early pregnancy. Further research on normal aortoumbilical column FVW and the development of reference charts is necessary to consider this arterial column as a screening tool in clinical practice.
子宫胎盘循环低阻抗对胎儿发育至关重要。流速波形(FVW)已经建立在低风险妊娠的主动脉和脐动脉在妊娠后半段,但有关妊娠早期的数据有限。在妊娠合并胎儿生长受限(FGR)、高血压疾病、胎儿贫血和染色体异常时,这两个血管区域表现出更高的阻抗模式。早期发现这些并发症在产科实践中至关重要,通过预防和密切的产前监测来降低围产期发病率和死亡率。现有数据表明,随着妊娠的进展,主动脉和脐带阻抗遵循相同的变化模式。这一观察结果表明,这两条血管可以被认为是一条动脉,称为“主动脉-脐柱”。我们的假设是,血液动力学模式的改变可以识别高危妊娠,特别是那些伴有先兆子痫、FGR、宫内胎儿死亡、胎儿非整倍体和胎儿贫血的妊娠。了解血管胚胎发生和主动脉和脐带动脉的FVWs有助于理解正常妊娠期间的阻抗变化。沿着单个血管的阻抗的连续变化支持了我们的主动脉柱的概念。偏离常规模式有助于在妊娠早期识别受损胎儿。为了将正常动脉柱FVW作为临床筛查工具,有必要进一步研究正常动脉柱FVW并制定参考图表。
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引用次数: 0
Cardiac Amyloidosis: A Contemporary Review of Medical and Surgical Therapy 心脏淀粉样变性:内科和外科治疗的当代回顾
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-04 DOI: 10.2174/011573403x240302230925043500
Drew Brownell, Aiswarya J Pillai, Nandini Nair
Abstract: Amyloidosis is a systemic disease initiated by deposition of misfolded proteins in the extracellular space, due to which multiple organs may be affected concomitantly. Cardiac amyloidosis, however, remains a major cause of morbidity and mortality in this population due to infiltrative /restrictive cardiomyopathy. This review attempts to focus on contemporary medical and surgical therapies for the different types of cardiac amyloidosis. Amyloidosis affecting the heart are predominantly of the transthyretin type (acquired in the older or genetic in the younger patients), and the monoclonal immunoglobulin light chain (AL) type which is solely acquired. A rare form of secondary amyloidosis AA type can also affect the heart due to excessive production and accumulation of the acute-phase protein called Serum Amyloid A” (SAA) in the setting of chronic inflammation, cancers or autoinflammatory disease. More commonly AA amyloidosis is seen in the liver and kidney. Other rare types are Apo A1 and Isolated Atrial Amyloidosis (AANF). Medical therapies have made important strides in the clinical management of the two common types of cardiac amyloidosis. Surgical therapies such as mechanical circulatory support and cardiac transplantation should be considered in appropriate patients. Future research using AI driven algorithms for early diagnosis and treatment as well as development of newer genetic engineering technologies will drive improvements in diagnosis, treatment and patient outcomes.
摘要:淀粉样变性是一种由细胞外空间错误折叠蛋白沉积引起的全身性疾病,可能同时影响多个器官。然而,由于浸润性/限制性心肌病,心脏淀粉样变仍然是这一人群发病率和死亡率的主要原因。本文综述了不同类型的心脏淀粉样变性的当代医学和外科治疗方法。影响心脏的淀粉样变性主要为转甲状腺素型(老年人获得性或年轻患者遗传性)和单克隆免疫球蛋白轻链(AL)型(完全获得性)。一种罕见的AA型继发性淀粉样变性也会影响心脏,因为在慢性炎症、癌症或自身炎症性疾病的背景下,急性期蛋白质血清淀粉样蛋白A (SAA)的过量产生和积累。AA淀粉样变更常见于肝脏和肾脏。其他罕见的类型是Apo A1和孤立性心房淀粉样变性(AANF)。医学治疗在两种常见类型的心脏淀粉样变的临床管理方面取得了重要进展。手术治疗,如机械循环支持和心脏移植应考虑在适当的患者。未来利用人工智能驱动算法进行早期诊断和治疗的研究,以及新基因工程技术的发展,将推动诊断、治疗和患者预后的改善。
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引用次数: 0
Valve Repair in Aortic Insufficiency: A State-of-the-art Review. 主动脉瓣关闭不全的瓣膜修复:最新进展。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X18666220427120235
Leandros Sassis, Pelagia Kefala-Karli, Irene Cucchi, Ilias Kouremenos, Michalis Demosthenous, Konstantinos Diplaris

Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild, moderate or severe according to the volume of regurgitating blood. Intervention is required in severe AI when the patient is symptomatic or when the left ventricular function is impaired. Aortic valve replacement has been considered the gold standard for decades for these patients, but several repair techniques have recently emerged that offer exceptional stability and long-term outcomes. The appropriate method of repair is selected based on the mechanism of AI and each patient's anatomic variations. This review aims to describe different pathologies of AI based on its anatomy, along with the different surgical techniques of aortic repair and their reported results.

主动脉瓣功能不全(AI)描述了舒张期血液通过主动脉瓣泄漏到左心室的病理学,根据回流血液的量分为轻度、中度或重度。当患者出现症状或左心室功能受损时,需要对严重AI进行干预。几十年来,主动脉瓣置换术一直被认为是这些患者的金标准,但最近出现了几种修复技术,它们具有非凡的稳定性和长期效果。根据人工智能的机制和每个患者的解剖变化选择合适的修复方法。这篇综述旨在根据人工智能的解剖结构描述其不同的病理学,以及主动脉修复的不同手术技术及其报告的结果。
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引用次数: 0
Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India. 印度慢性冠状动脉综合征和心力衰竭患者射血分数降低的以艾伐拉定为基础的心率管理治疗专家共识。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X19666230320105623
J C Mohan, I Sathyamurthy, Monotosh Panja, Rajeev Agarwala, C K Ponde, A Sreenivas Kumar, Bijay Kumar Mahala, Vivek Kolapkar, R V Lokesh Kumar, Kamlesh Patel

Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides β-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed β-blocker dosing or having contraindication/intolerance to β-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/β-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and β-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.

心率是健康和疾病的重要指标,调节心率有助于改善心血管结果。除了β受体阻滞剂外,艾伐拉定是一种公认的心率调节药物,可以降低心率,而不会对血液动力学产生任何影响。这份共识文件是在印度各地心脏病专家的专家意见的帮助下制定的,这些专家意见涉及常规临床实践中的有效心率管理,并考虑到现有的科学数据和指南建议,选择合适的以艾伐拉定为基础的疗法。根据会议期间的讨论,在射血分数降低的慢性冠状动脉综合征和心力衰竭患者中,心率增加被认为是不良心血管后果的重要预测因素,这使得心率调节在这些亚群中很重要。艾伐拉定适用于治疗慢性冠状动脉综合征和心力衰竭,射血分数降低的患者,尽管有指南指导的β-阻滞剂给药或对β-阻滞剂有禁忌症/不耐受性,但仍无法达到心率目标。对于每天两次已稳定服用艾韦拉定的患者,可以考虑延长每天一次的艾韦拉啶释放量。Ivabradine/β-阻滞剂固定剂量组合也可考虑减少药丸负担。已经开发了两种共识算法,以进一步指导基于艾伐拉定的疗法的适当使用。Ivabradine和β-阻滞剂可以在大多数慢性冠状动脉综合征和心力衰竭患者中提供更显著的临床改善,射血分数降低,固定剂量的组合提供了改善依从性的机会。
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引用次数: 0
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