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Moderate aortic stenosis in the dysfunctional ventricle: should it be treated? 功能不全心室的中度主动脉瓣狭窄:是否应该治疗?
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1093/eurheartjsupp/suae027
Edoardo Sciatti, A. Calabrese, V. Duino, Salvatore D'isa, Luca Antonio Felice Di Odoardo, E. D’Elia, Michele Senni
Moderate aortic stenosis is associated with a worse prognosis than milder degrees. Pathophysiologically, this condition in a dysfunctional ventricle could lead to a further mechanism of haemodynamic worsening, so its treatment should lead to clinical advantages for the patient. The low risk of complications associated with percutaneous correction of aortic valve disease (transcatheter aortic valve implantation) should also be considered, which would seem to favour an interventional approach even in the aforementioned condition. However, sparse data and small population studies make this approach still controversial. Three randomized controlled trials are underway to shed definitive light on the topic.
与轻度主动脉瓣狭窄相比,中度主动脉瓣狭窄的预后较差。从病理生理学角度看,这种心室功能不全的情况可能会导致血流动力学进一步恶化,因此治疗主动脉瓣狭窄应为患者带来临床优势。此外,还应考虑到经皮矫正主动脉瓣疾病(经导管主动脉瓣植入术)的并发症风险较低,这似乎有利于采用介入治疗方法,即使是在上述情况下。然而,由于数据稀少和小规模人群研究,这种方法仍存在争议。目前有三项随机对照试验正在进行中,希望能对这一问题给出明确的答案。
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引用次数: 0
Role of glucagon-like peptide-1 agonists in obesity and heart failure with preserved ejection fraction 胰高血糖素样肽-1 激动剂在肥胖和射血分数保留型心力衰竭中的作用
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1093/eurheartjsupp/suae011
P. Temporelli
Heart failure with preserved ejection fraction (HFpEF) currently represents the majority of all heart failure cases in the community. Glucagon-like peptide-1 agonists represent a class of medications used to treat type 2 diabetes mellitus and, in some cases, obesity. This class includes semaglutide. In the available data from the Semaglutide Treatment Effect in People with Obesity (STEP) trials that were done, looking at weight loss effects of semaglutide, there was a 30–40% reduction in C-reactive protein levels, and that suggests that there is a significant anti-inflammatory effect. Recently, the STEP-HFpEF trial enrolled 529 non-diabetic patients with HFpEF and obesity who were randomly assigned to once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. A statistically significant improvement in the quality of life score and in weight loss was observed. Statistically significant improvements were also seen in the 6 min walk distance, levels of C-reactive protein, and N-terminal pro–B-type natriuretic peptide levels. Interestingly, the Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity trial has shown that semaglutide produced a consistent reduction of around 20% vs. placebo across major cardiovascular event endpoints over the ∼3-year follow-up in patients with overweight or obesity and cardiovascular disease but not diabetes.
射血分数保留型心力衰竭(HFpEF)目前占社区心力衰竭病例的大多数。胰高血糖素样肽-1 激动剂是一类用于治疗 2 型糖尿病的药物,在某些情况下也可用于治疗肥胖症。这类药物包括塞马鲁肽。根据现有的 "塞马鲁肽对肥胖症患者的治疗效果"(STEP)试验数据,在研究塞马鲁肽的减肥效果时发现,C反应蛋白水平降低了30%-40%,这表明塞马鲁肽具有显著的抗炎效果。最近,STEP-HFpEF 试验招募了 529 名患有 HFpEF 和肥胖症的非糖尿病患者,随机分配他们接受每周一次的塞马鲁肽(2.4 毫克)或安慰剂治疗,为期 52 周。结果显示,生活质量评分和体重下降均有统计学意义的改善。6分钟步行距离、C反应蛋白水平和N末端前B型利钠肽水平也有明显改善。有趣的是,"塞马鲁肽对超重或肥胖症患者心血管结果的影响 "试验表明,在对超重或肥胖症患者以及患有心血管疾病但未患糖尿病的患者进行为期3年的随访期间,塞马鲁肽与安慰剂相比,在主要心血管事件终点方面可持续减少约20%。
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引用次数: 0
Intracoronary imaging to guide percutaneous coronary intervention: from evidence to guidelines 引导经皮冠状动脉介入治疗的冠状动脉内成像:从证据到指南
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1093/eurheartjsupp/suae004
F. Biccirè, L. Gatto, Francesco Prati
Despite notable advances in devices and techniques, percutaneous coronary intervention (PCI) is still affected by a substantial number of complications and failure rates. Over the years, the use of intracoronary imaging (ICI) has dramatically improved the understanding of mechanical and technical factors related to successful and failed PCI, becoming a mainstay in complex trans-catheter interventions. However, ICI modalities are invasive, time-consuming, and costly, and a net clinical benefit needs to be shown in order to recommend their routine use in clinical practice. In the past, the lack of evidence from randomized trials has been reflected in the scepticism shown by international guidelines. The recent publication of large randomized clinical trials conducted worldwide has provided new evidence regarding the clinical usefulness of ICI guidance in PCI. The consistent reduction of adverse events achieved in these trials, also demonstrated in an updated meta-analysis, suggested that the use of ICI in PCI is compelling to achieve optimal technical results and better outcomes, especially in complex high-risk interventions. Also considering the burden of information provided by ICI on coronary artery disease, looking from the inside seems today an opportunity that modern cardiology cannot ignore anymore.
尽管经皮冠状动脉介入治疗(PCI)在设备和技术方面取得了显著进步,但仍存在大量并发症和失败率。多年来,冠状动脉内成像(ICI)的使用极大地提高了人们对与 PCI 成功和失败相关的机械和技术因素的了解,成为复杂经导管介入治疗的主流。然而,ICI 方式具有侵入性、耗时且成本高昂,需要证明其临床净获益才能建议在临床实践中常规使用。过去,由于缺乏随机试验的证据,国际指南对其持怀疑态度。最近在全球范围内开展的大型随机临床试验为 PCI 中 ICI 指导的临床实用性提供了新的证据。在这些试验中,不良事件持续减少,最新的荟萃分析也证明了这一点,即在 PCI 中使用 ICI 有助于获得最佳技术效果和更好的预后,尤其是在复杂的高风险介入治疗中。此外,考虑到 ICI 为冠状动脉疾病提供了大量信息,从内部观察似乎是现代心脏病学再也不能忽视的机会。
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引用次数: 0
The role of sodium–glucose co-transporter 2 inhibitors in myocardial infarction: available evidence and future perspectives 钠-葡萄糖共转运体 2 抑制剂在心肌梗死中的作用:现有证据与未来展望
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1093/eurheartjsupp/suae008
G. Tavecchia, Elena Gualini, A. Sacco, Fabrizio Oliva
There is an unmet need for new treatment options for patients with acute myocardial infarction (AMI) as progress in patients’ outcomes has plateaued over the past 15 years. Sodium–glucose co-transporter 2 (SGLT2) inhibitors have demonstrated cardio-renal benefits in various disease states, encompassing diabetes mellitus, chronic kidney disease, and heart failure. Experimental studies further support their use in AMI, demonstrating beneficial effects in animal models by reducing infarct size and mitigating adverse cardiac remodelling. Recently, two clinical trials have been published thus paving the way for a new field to explore. This paper briefly outlines the available evidence and future perspectives regarding the use of SGLT2 inhibitors in this clinical scenario.
过去 15 年来,急性心肌梗死(AMI)患者的治疗效果一直停滞不前,因此患者对新治疗方案的需求尚未得到满足。钠-葡萄糖共转运体 2(SGLT2)抑制剂已在糖尿病、慢性肾脏病和心力衰竭等多种疾病中显示出对心肾功能的益处。实验研究进一步证实了它们在急性心肌梗死中的应用,在动物模型中,它们通过缩小梗死面积和减轻不良心脏重塑而产生了有益的效果。最近,有两项临床试验发表,从而为一个新领域的探索铺平了道路。本文简要概述了在这种临床情况下使用 SGLT2 抑制剂的现有证据和未来展望。
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引用次数: 0
Unlocking the enigma: decoding premature ventricular complexes for effective clinical assessment and risk management 揭开谜底:解码室性早搏,实现有效的临床评估和风险管理
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1093/eurheartjsupp/suae006
L. Calò, M. Tatangelo, G. Panattoni, C. Crescenzi, Marianna Squeglia, Francesca Fanisio, F. Romeo, Federica Toto, E. De Ruvo, M. Rebecchi
The identification of ventricular premature complexes during a cardiological evaluation necessitates the implementation of diagnostic processes aimed at discerning the clinical context that may predispose individuals to a high risk of sudden cardiac death. Epidemiological studies reveal that ventricular premature beats occur in approximately 75% of healthy (or seemingly healthy) individuals, as long as there is no evidence of underlying structural heart disease, such as benign idiopathic ventricular extrasystole originating from the right and left ventricular outflow tracts. In the real world, however, ventricular ectopic beats with morphologies very similar to seemingly benign occurrences are not uncommon. They are notable in subjects exhibiting rapid and complex repetitive forms during exercise testing and Holter electrocardiogram. Additionally, these subjects may display more or less extensive scarring signs on cardiac magnetic resonance and may have a family history of cardiomyopathy and/or sudden cardiac death. Therefore, the purpose of this review is to critically analyse the process of evaluating premature ventricular complexes, which is crucial for accurate risk stratification. The latter cannot overlook some inevitable elements, including morphology, origin, complexity, and the associated clinical setting (absence or presence of structural heart disease).
在心脏评估过程中发现室性早搏复律时,有必要实施诊断程序,以辨别可能导致心脏性猝死高风险的临床背景。流行病学研究表明,只要没有潜在结构性心脏病的证据,如源于左右心室流出道的良性特发性室性期外收缩,约 75% 的健康人(或看似健康的人)都会出现室性早搏。然而,在现实生活中,形态与看似良性的心室异位搏动非常相似的情况并不少见。在运动测试和 Holter 心电图中表现出快速和复杂的重复形式的受试者中,异位搏动尤为明显。此外,这些受试者可能在心脏磁共振上显示或多或少的广泛瘢痕征象,并可能有心肌病和/或心脏性猝死的家族史。因此,本综述旨在批判性地分析室性早搏复律的评估过程,这对准确的风险分层至关重要。后者不能忽略一些不可避免的因素,包括形态、起源、复杂性和相关的临床环境(是否存在结构性心脏病)。
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引用次数: 0
I prefer the MitraClip in these cases: the 5-year COAPT data 在这些情况下,我更倾向于使用 MitraClip:5 年 COAPT 数据
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1093/eurheartjsupp/suae003
Antonio L. Bartorelli, L. Grancini, G. Monizzi, Emanuele Gallinoro, A. Mastrangelo, Vincenzo Mallia, Franco Fabbiocchi, D. Andreini
The COAPT 5-year data demonstrate that compared with medical treatment transcatheter edge-to-edge repair (TEER) with the MitraClip in symptomatic patients with Grade 3+/Grade 4+ secondary mitral regurgitation (SMR) reduced by nearly half the annualized hospitalization risk (33 vs. 57%), by almost 30% the death rate (57 vs. 67%) and achieved significant and durable SMR reduction in 95% of patients. Control patients who crossed over to TEER at 2 years had better prognosis, but nearly half of them died before reaching crossover eligibility. Death or hospitalization for heart failure (HHF) occurred in 73.6% of TEER patients and 91.5% of controls within 5 years, pointing to a need for further study to address left ventricle (LV) dysfunction, the underlying cause of patient’s disease. MTRA-FR targeted SMR using the same device and did not improve the composite endpoint of all-cause mortality or HHF at 12 months. Possible reasons for the discrepancy include enrolment of patients with more severe MR and less-advanced LV disease (dilation/dysfunction), less-procedural complications, and higher success in reducing MR in COAPT compared with MITRA-FR. Thus, the ideal patient for MitraClip treatment would be one with severe MR, but with no too severe LV dilation/dysfunction, which is what differentiates COAPT patients from those in MITRA-FR.
COAPT 5年期数据显示,与药物治疗相比,使用MitraClip进行经导管边缘到边缘修补术(TEER)治疗3+/4+级继发性二尖瓣反流(SMR)的无症状患者,年住院风险降低了近一半(33%对57%),死亡率降低了近30%(57%对67%),95%的患者的SMR显著而持久地降低。对照组患者在2年后接受TEER治疗,预后较好,但其中近一半患者在达到交叉治疗资格前死亡。73.6%的TEER患者和91.5%的对照组患者在5年内死亡或因心力衰竭(HHF)住院,这表明需要进一步研究解决患者疾病的根本原因--左心室(LV)功能障碍。MTRA-FR 使用相同的设备以 SMR 为目标,但在 12 个月内并未改善全因死亡率或 HHF 的复合终点。造成这种差异的可能原因包括:入组患者的 MR 更严重、左心室疾病(扩张/功能障碍)更轻微、手术并发症更少,以及 COAPT 减少 MR 的成功率高于 MITRA-FR。因此,接受 MitraClip 治疗的理想患者应该是有严重 MR 但左心室扩张/功能障碍不太严重的患者,这也是 COAPT 患者与 MITRA-FR 患者的区别所在。
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引用次数: 0
Correction to: Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries 更正:服务不足国家的心动过缓负担和获得心动过缓治疗的障碍
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2024-01-19 DOI: 10.1093/eurheartjsupp/suae001
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引用次数: 1
Differential utilization of Impella devices, extracorporeal membrane oxygenation, and combined therapies as escalation and de-escalation strategies. 有区别地使用 Impella 设备、体外膜肺氧合和综合疗法作为升级和降级策略。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad131
Alexander M Bernhardt, Evgenij Potapov, Christophe Vandenbriele, Carsten Skurk, Letizia F Bertoldi, Federico Pappalardo

Cardiogenic shock (CS) is a life-threatening condition characterized by a state of inadequate systemic tissue perfusion caused by cardiac dysfunction. When to implement, change, or remove the use of a temporary mechanical circulatory support (tMCS) in patients with CS is dependent on the aetiology and severity. Here, patient scenarios underlying the need to escalate, de-escalate, wean, or bridge from tMCS devices are taken into consideration by interdisciplinary heart failure and CS teams. This includes a comprehensive review of and focus on the rationale for specific device escalation and de-escalation strategies, device selection, and general management.

心源性休克(CS)是一种危及生命的疾病,其特点是心功能障碍导致全身组织灌注不足。何时对 CS 患者实施、改变或取消使用临时机械循环支持(tMCS)取决于病因和严重程度。在此,跨学科心衰和 CS 团队将考虑患者的具体情况,以确定是否需要升级、降级、断药或桥接临时机械循环支持装置。这包括全面回顾和关注特定装置升级和降级策略的原理、装置选择和一般管理。
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引用次数: 0
Editorial. 社论
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad126
Norman Mangner, Jacob Møller, Holger Thiele, Federico Pappalardo
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引用次数: 0
From medical therapy to mechanical support: strategies for device selection and implantation techniques. 从药物治疗到机械支持:设备选择和植入技术策略。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad128
Letizia F Bertoldi, Andrea Montisci, Dirk Westermann, Mario Iannaccone, Vasileios Panoulas, Nikos Werner, Norman Mangner

Cardiogenic shock (CS) is a complex clinical syndrome with a high risk of mortality. The recent, rapid development of temporary mechanical circulatory support (tMCS) has altered CS treatment. While catecholamines remain the cornerstone of CS therapy, tMCS usage has increased. According to shock severity, different treatment strategies including catecholamines alone, catecholamines and tMCS, or multiple tMCS might be used. State-of-the-art implantation techniques are necessary to avoid complications linked to the invasive nature of tMCS. In particular, bleeding and access-site complications might counteract the potential haemodynamic benefit of a percutaneous ventricular assist device. In this review, we describe the role of catecholamines in CS treatment and present the different tMCS devices with an explanation on how to use them according to CS aetiology and severity. Finally, an overview of the best practice for device implantation is provided.

心源性休克(CS)是一种复杂的临床综合征,死亡率很高。最近,临时机械循环支持(tMCS)的快速发展改变了心源性休克的治疗。虽然儿茶酚胺仍是 CS 治疗的基石,但 tMCS 的使用率却在增加。根据休克的严重程度,可能会采用不同的治疗策略,包括单独使用儿茶酚胺、儿茶酚胺和临时机械循环支持或多种临时机械循环支持。为避免与 tMCS 的侵入性有关的并发症,有必要采用最先进的植入技术。特别是,出血和入路部位并发症可能会抵消经皮心室辅助装置对血流动力学的潜在益处。在这篇综述中,我们描述了儿茶酚胺在 CS 治疗中的作用,介绍了不同的 tMCS 装置,并根据 CS 的病因和严重程度解释了如何使用这些装置。最后,我们还概述了设备植入的最佳实践。
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引用次数: 0
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European Heart Journal Supplements
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