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Sex differences in potential triggers of myocardial infarction. 心肌梗塞潜在诱因的性别差异。
Pub Date : 2023-02-16 eCollection Date: 2023-03-01 DOI: 10.1093/ehjopen/oead011
Anneli Olsson, Moman A Mohammad, Rebecca Rylance, Pyotr G Platonov, David Sparv, David Erlinge

Aims: Internal and external triggers affect seasonal and circadian variations of myocardial infarction (MI). We aimed to assess sex differences in the common triggers of MI.

Methods and results: A nationwide, retrospective, cross-sectional postal survey study was conducted. Individuals who experienced a MI during holidays and weekdays were identified through the SWEDEHEART registry. Twenty-seven potential MI triggers were rated in regards to occurring more or less than usual during the last 24 h before the MI. Three areas were covered: activities, emotions, and food or alcohol consumption. A logistic regression model was used to identify sex differences for each trigger and odds ratios (ORs) were reported. Four hundred and fifty-one patients, of whom 317 were men, responded. The most commonly reported triggers were stress (35.3%), worry (26.2%), depression (21.1%), and insomnia (20.0%). Women reported emotional triggers including sadness [OR 3.52, 95% confidence interval (CI) 1.92-6.45], stress (OR 2.38, 95% CI 1.52-3.71), insomnia (OR 2.31, 95% CI 1.39-3.81), and upset (OR 2.69, 95% CI 1.47-4.95) to a greater extent than men. Outdoor activity was less reported by women (OR 0.35, 95% CI 0.14-0.87). No significant sex differences were found in other activities or food and alcohol consumption.

Conclusion: Self-experienced stress and distress were higher among women prior to MI compared with men. Understanding sex perspectives in acute triggers may help us find preventive strategies and reduce the excess numbers of MI.

目的:内部和外部诱因会影响心肌梗死(MI)的季节和昼夜变化。我们旨在评估心肌梗死常见诱因的性别差异:我们在全国范围内开展了一项回顾性横断面邮寄调查研究。通过 SWEDEHEART 登记册确定了在节假日和工作日发生心肌梗死的个人。对 27 种潜在的心肌梗塞诱因进行了评定,看其在心肌梗塞发生前 24 小时内发生的次数比平时多或少。其中包括三个方面:活动、情绪、进食或饮酒。采用逻辑回归模型确定了每种诱因的性别差异,并报告了几率比(OR)。共有 451 名患者做出了回应,其中 317 人为男性。最常报告的诱发因素是压力(35.3%)、担忧(26.2%)、抑郁(21.1%)和失眠(20.0%)。女性报告的情绪诱因包括悲伤[OR 3.52,95% 置信区间(CI)1.92-6.45]、压力(OR 2.38,95% CI 1.52-3.71)、失眠(OR 2.31,95% CI 1.39-3.81)和心烦意乱(OR 2.69,95% CI 1.47-4.95),女性报告的程度高于男性。女性较少报告户外活动(OR 0.35,95% CI 0.14-0.87)。在其他活动、饮食和饮酒方面没有发现明显的性别差异:结论:与男性相比,女性在发生心肌梗死前的自我压力和痛苦体验更高。了解急性诱发因素的性别差异有助于我们找到预防策略,减少心肌梗死的高发率。
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引用次数: 0
Clinical significance of the rivaroxaban-dronedarone interaction: insights from physiologically based pharmacokinetic modelling. 利伐沙班-决奈达隆相互作用的临床意义:基于生理学的药代动力学模型的启示。
Pub Date : 2023-01-23 eCollection Date: 2023-01-01 DOI: 10.1093/ehjopen/oead004
Burkhard Hügl, Marc Horlitz, Kerstin Fischer, Reinhold Kreutz

Patients with atrial fibrillation may require rhythm control therapy in addition to anticoagulation therapy for the prevention of stroke. Since 2012, the European Society of Cardiology and European Heart Rhythm Association guidelines have recommended non-vitamin K antagonist oral anticoagulants, including rivaroxaban, for the prevention of stroke in patients with atrial fibrillation. During the same period, these guidelines have also recommended dronedarone or amiodarone as second-line rhythm control agents in certain patients with atrial fibrillation and no contraindications. Amiodarone and dronedarone both strongly inhibit P-glycoprotein, while dronedarone is a moderate and amiodarone a weak inhibitor of cytochrome P450 3A4 (CYP3A4). Based on these data and evidence from physiologically based pharmacokinetic modelling, amiodarone and dronedarone are expected to have similar effects on rivaroxaban exposure resulting from P-glycoprotein and CYP3A4 inhibition. However, the rivaroxaban label recommends against the concomitant use of dronedarone, but not amiodarone, citing a lack of evidence on the concomitant use of rivaroxaban and dronedarone as the reason for the different recommendations. In this report, we discuss evidence from clinical studies and physiologically based pharmacokinetic modelling on the potential for increased rivaroxaban exposure resulting from drug-drug interaction between rivaroxaban and dronedarone or amiodarone. The current evidence supports the same clinical status and concomitant use of either amiodarone or dronedarone with rivaroxaban, which could be considered in future recommendations.

心房颤动患者可能需要在抗凝治疗的基础上进行心律控制治疗,以预防中风。自 2012 年起,欧洲心脏病学会和欧洲心脏节律协会指南推荐使用非维生素 K 拮抗剂口服抗凝药(包括利伐沙班)预防心房颤动患者中风。在同一时期,这些指南还推荐决奈达隆或胺碘酮作为二线节律控制药物,用于某些无禁忌症的心房颤动患者。胺碘酮和决奈达隆都对 P 糖蛋白有较强的抑制作用,而决奈达隆对细胞色素 P450 3A4 (CYP3A4) 有中度抑制作用,胺碘酮对细胞色素 P450 3A4 (CYP3A4) 有较弱的抑制作用。根据这些数据和基于生理学的药代动力学模型证据,预计胺碘酮和决奈达隆对 P-糖蛋白和 CYP3A4抑制所导致的利伐沙班暴露量具有相似的影响。然而,利伐沙班标签建议不要同时使用决奈达隆,但不建议同时使用胺碘酮,理由是缺乏利伐沙班和决奈达隆同时使用的证据。在本报告中,我们讨论了来自临床研究和基于生理学的药代动力学模型的证据,这些证据表明利伐沙班与决奈达隆或胺碘酮之间的药物相互作用可能会增加利伐沙班的暴露量。目前的证据支持在相同的临床状态下同时使用胺碘酮或决奈达隆与利伐沙班,这一点可在未来的建议中予以考虑。
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引用次数: 0
Assessment of aortic and cerebral haemodynamics and vascular brain injury with 3 and 7 T magnetic resonance imaging in patients with aortic coarctation. 利用 3 和 7 T 磁共振成像评估主动脉粥样硬化患者的主动脉和脑血流动力学以及脑血管损伤。
Pub Date : 2023-01-11 eCollection Date: 2023-01-01 DOI: 10.1093/ehjopen/oead001
Timion A Meijs, Rick J van Tuijl, Hilde van den Brink, Nick A Weaver, Jeroen C W Siero, H Bart van der Worp, Kees P J Braun, Tim Leiner, Pim A de Jong, Jaco J M Zwanenburg, Pieter A Doevendans, Michiel Voskuil, Heynric B Grotenhuis

Aims: Coarctation of the aorta (CoA) is characterized by a central arteriopathy resulting in increased arterial stiffness. The condition is associated with an increased risk of stroke. We aimed to assess the aortic and cerebral haemodynamics and the presence of vascular brain injury in patients with previous surgical CoA repair.

Methods and results: Twenty-seven patients with CoA (median age 22 years, range 12-72) and 25 age- and sex-matched controls (median age 24 years, range 12-64) underwent 3 T (heart, aorta, and brain) and 7 T (brain) magnetic resonance imaging scans. Haemodynamic parameters were measured using two-dimensional phase-contrast images of the ascending and descending aorta, internal carotid artery (ICA), basilar artery (BA), middle cerebral artery (MCA), and perforating arteries. Vascular brain injury was assessed by rating white matter hyperintensities, cortical microinfarcts, lacunes, and microbleeds. Pulse wave velocities in the aortic arch and descending aorta were increased and ascending aortic distensibility was decreased in patients with CoA vs. controls. Patients with CoA showed a higher mean flow velocity in the right ICA, left ICA, and BA and a reduced distensibility in the right ICA, BA, and left MCA. Haemodynamic parameters in the perforating arteries, total cerebral blood flow, intracranial volumes, and vascular brain injury were similar between the groups.

Conclusion: Patients with CoA show an increased flow velocity and reduced distensibility in the aorta and proximal cerebral arteries, which suggests the presence of a generalized arteriopathy that extends into the cerebral arterial tree. No substantial vascular brain injury was observed in this relatively young CoA population, although the study was inadequately powered regarding this endpoint.

目的:主动脉共动脉症(CoA)的特点是中央动脉病变导致动脉僵化。该病与中风风险增加有关。我们的目的是评估主动脉和脑血流动力学以及曾接受过 CoA 手术修复的患者是否存在血管性脑损伤:27 名 CoA 患者(中位年龄 22 岁,范围 12-72)和 25 名年龄和性别匹配的对照组患者(中位年龄 24 岁,范围 12-64)接受了 3 T(心脏、主动脉和大脑)和 7 T(大脑)磁共振成像扫描。使用升主动脉和降主动脉、颈内动脉(ICA)、基底动脉(BA)、大脑中动脉(MCA)和穿孔动脉的二维相位对比图像测量血流动力学参数。脑血管损伤通过评定白质高密度、皮质微梗死、裂隙和微出血进行评估。与对照组相比,CoA 患者主动脉弓和降主动脉的脉搏波速度增加,升主动脉扩张性降低。CoA患者右侧ICA、左侧ICA和BA的平均流速较高,右侧ICA、BA和左侧MCA的扩张性降低。两组患者的穿孔动脉血流动力学参数、总脑血流量、颅内容积和脑血管损伤情况相似:结论:CoA 患者的主动脉和近端大脑动脉的血流速度增加,扩张性降低,这表明存在延伸至大脑动脉树的全身动脉病变。在这个相对年轻的 CoA 患者群体中,没有观察到严重的脑血管损伤,尽管该研究在这一终点方面的研究力量不足。
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引用次数: 0
Intramyocardial cell-based therapy with Lomecel-B during bidirectional cavopulmonary anastomosis for hypoplastic left heart syndrome: the ELPIS phase I trial. 在双向腔肺吻合术中使用 Lomecel-B 进行心肌内细胞疗法治疗左心发育不全综合征:ELPIS I 期试验。
Pub Date : 2023-01-11 eCollection Date: 2023-03-01 DOI: 10.1093/ehjopen/oead002
Sunjay Kaushal, Joshua M Hare, Jessica R Hoffman, Riley M Boyd, Kevin N Ramdas, Nicholas Pietris, Shelby Kutty, James S Tweddell, S Adil Husain, Shaji C Menon, Linda M Lambert, David A Danford, Seth J Kligerman, Narutoshi Hibino, Laxminarayana Korutla, Prashanth Vallabhajosyula, Michael J Campbell, Aisha Khan, Eric Naioti, Keyvan Yousefi, Danial Mehranfard, Lisa McClain-Moss, Anthony A Oliva, Michael E Davis

Aims: Hypoplastic left heart syndrome (HLHS) survival relies on surgical reconstruction of the right ventricle (RV) to provide systemic circulation. This substantially increases the RV load, wall stress, maladaptive remodelling, and dysfunction, which in turn increases the risk of death or transplantation.

Methods and results: We conducted a phase 1 open-label multicentre trial to assess the safety and feasibility of Lomecel-B as an adjunct to second-stage HLHS surgical palliation. Lomecel-B, an investigational cell therapy consisting of allogeneic medicinal signalling cells (MSCs), was delivered via intramyocardial injections. The primary endpoint was safety, and measures of RV function for potential efficacy were obtained. Ten patients were treated. None experienced major adverse cardiac events. All were alive and transplant-free at 1-year post-treatment, and experienced growth comparable to healthy historical data. Cardiac magnetic resonance imaging (CMR) suggested improved tricuspid regurgitant fraction (TR RF) via qualitative rater assessment, and via significant quantitative improvements from baseline at 6 and 12 months post-treatment (P < 0.05). Global longitudinal strain (GLS) and RV ejection fraction (EF) showed no declines. To understand potential mechanisms of action, circulating exosomes from intramyocardially transplanted MSCs were examined. Computational modelling identified 54 MSC-specific exosome ribonucleic acids (RNAs) corresponding to changes in TR RF, including miR-215-3p, miR-374b-3p, and RNAs related to cell metabolism and MAPK signalling.

Conclusion: Intramyocardially delivered Lomecel-B appears safe in HLHS patients and may favourably affect RV performance. Circulating exosomes of transplanted MSC-specific provide novel insight into bioactivity. Conduct of a controlled phase trial is warranted and is underway.Trial registration number NCT03525418.

目的:发育不全左心综合征(HLHS)的存活有赖于通过手术重建右心室(RV)以提供全身循环。这大大增加了右心室的负荷、室壁应力、不良重塑和功能障碍,进而增加了死亡或移植的风险:我们开展了一项一期开放标签多中心试验,评估Lomecel-B作为HLHS二期手术姑息治疗的辅助药物的安全性和可行性。Lomecel-B是一种由异体医学信号细胞(间充质干细胞)组成的研究性细胞疗法,通过心肌内注射给药。主要终点是安全性,并通过测量 RV 功能来评估潜在疗效。十名患者接受了治疗。没有人出现重大心脏不良事件。治疗后一年,所有患者均存活且未接受移植手术,其生长情况与健康历史数据相当。心脏磁共振成像(CMR)显示,三尖瓣反流率(TR RF)通过定性评分评估得到改善,并在治疗后 6 个月和 12 个月与基线相比有显著的定量改善(P < 0.05)。总体纵向应变(GLS)和 RV 射血分数(EF)没有下降。为了了解潜在的作用机制,研究人员对心肌内移植间充质干细胞的循环外泌体进行了检查。计算建模确定了与 TR RF 变化相对应的 54 种间叶干细胞特异性外泌体核糖核酸(RNA),包括 miR-215-3p、miR-374b-3p 以及与细胞代谢和 MAPK 信号有关的 RNA:结论:心肌内给药 Lomecel-B 在 HLHS 患者中似乎是安全的,并可能对 RV 性能产生有利影响。移植间充质干细胞特异性循环外泌体为生物活性提供了新的视角。有必要进行阶段性对照试验,目前正在进行中。试验注册号为NCT03525418。
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引用次数: 0
Neuromodulation in patients with refractory angina pectoris: a review. 难治性心绞痛患者的神经调节:综述。
Pub Date : 2023-01-01 DOI: 10.1093/ehjopen/oeac083
Fabienne Elvira Vervaat, Antal van der Gaag, Koen Teeuwen, Hans van Suijlekom, Inge Wijnbergen

The number of patients with coronary artery disease (CAD) who have persisting angina pectoris despite optimal medical treatment known as refractory angina pectoris (RAP) is growing. Current estimates indicate that 5-10% of patients with stable CAD have RAP. In absolute numbers, there are 50 000-100 000 new cases of RAP each year in the USA and 30 000-50 000 new cases each year in Europe. The term RAP was formulated in 2002. RAP is defined as a chronic disease (more than 3 months) characterized by diffuse CAD in the presence of proven ischaemia which is not amendable to a combination of medical therapy, angioplasty, or coronary bypass surgery. There are currently few treatment options for patients with RAP. One such last-resort treatment option is spinal cord stimulation (SCS) with a Class of recommendation IIB, level of evidence B in the 2019 European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes. The aim of this review is to give an overview of neuromodulation as treatment modality for patients with RAP. A comprehensive overview is given on the history, proposed mechanism of action, safety, efficacy, and current use of SCS.

冠状动脉疾病(CAD)患者的数量持续心绞痛,尽管最佳的药物治疗称为难治性心绞痛(RAP)正在增长。目前估计,5-10%的稳定型CAD患者有RAP。在绝对数量上,美国每年有5万至10万例新发RAP病例,欧洲每年有3万至5万例新发病例。RAP一词是在2002年提出的。RAP被定义为一种慢性疾病(超过3个月),以弥漫性CAD为特征,存在已证实的缺血,不能通过药物治疗、血管成形术或冠状动脉搭桥手术联合治疗。目前,RAP患者的治疗选择很少。其中一种最后的治疗选择是脊髓刺激(SCS),在2019年欧洲心脏病学会慢性冠状动脉综合征诊断和管理指南中,其推荐等级为IIB,证据水平为B。这篇综述的目的是概述神经调节作为RAP患者的治疗方式。全面概述了SCS的历史,建议的作用机制,安全性,有效性和目前的使用。
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引用次数: 3
Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method. 晚期钆增强心血管磁共振对持续性房颤患者的预测价值:标准化方法的双中心验证。
Pub Date : 2023-01-01 DOI: 10.1093/ehjopen/oeac085
Till F Althoff, Martin Eichenlaub, David Padilla-Cueto, Heiko Lehrmann, Paz Garre, Simon Schoechlin, Elisenda Ferro, Eric Invers, Philipp Ruile, Manuel Hein, Christopher Schlett, Rosa M Figueras I Ventura, Susanna Prat-Gonzalez, Bjoern Mueller-Edenborn, Marius Bohnen, Andreu Porta-Sanchez, Jose Maria Tolosana, Eduard Guasch, Ivo Roca-Luque, Elena Arbelo, Franz-Josef Neumann, Dirk Westermann, Marta Sitges, Josep Brugada, Thomas Arentz, Lluís Mont, Amir Jadidi

Aims: With recurrence rates up to 50% after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF), predictive tools to improve patient selection are needed. Patient selection based on left atrial late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been proposed previously (UTAH-classification). However, this approach has not been widely established, in part owed to the lack of standardization of the LGE quantification method. We have recently established a standardized LGE-CMR method enabling reproducible LGE-quantification. Here, the ability of this method to predict outcome after PVI was evaluated.

Methods and results: This dual-centre study (n = 219) consists of a prospective derivation cohort (n = 37, all persistent AF) and an external validation cohort (n = 182; 66 persistent, 116 paroxysmal AF). All patients received an LGE-CMR prior to first-time PVI-only ablation. LGE was quantified based on the signal-intensity-ratio relative to the blood pool, applying a uniform LGE-defining threshold of >1.2.  In patients with persistent AF in the derivation cohort, left atrial LGE-extent above a cut-off value of 12% was found to best predict relevant low-voltage substrate (≥2 cm two with <0.5 mV during sinus rhythm) and arrhythmia-free survival 12 months post-PVI. When applied to the external validation cohort, this cut-off value was also predictive of arrhythmia-free survival for both, the total cohort and the subgroup with persistent AF (LGE < 12%: 80% and 76%; LGE > 12%: 55% and 44%; P = 0.007 and P = 0.029, respectively).

Conclusion: This dual-centre study established and validated a standardized, reproducible LGE-CMR method discriminating PVI responders from non-responders, which may improve choice of therapeutic approach or ablation strategy for patients with persistent AF.

目的:持续性心房颤动(AF)患者肺静脉隔离(PVI)后复发率高达50%,需要预测工具来改善患者选择。基于左心房晚期钆增强(LGE)心血管磁共振(CMR)的患者选择先前已被提出(犹他分类)。然而,这种方法尚未得到广泛建立,部分原因是LGE量化方法缺乏标准化。我们最近建立了一种标准化的LGE-CMR方法,可以重复进行lge定量。在这里,我们评估了这种方法预测PVI后预后的能力。方法和结果:这项双中心研究(n = 219)包括一个前瞻性衍生队列(n = 37,均为持续性房颤)和一个外部验证队列(n = 182;66例持续性房颤,116例阵发性房颤)。所有患者在首次仅行pvi消融前均接受了LGE-CMR检查。根据相对于血池的信号强度比对LGE进行量化,采用统一的LGE定义阈值>1.2。在衍生队列中的持续性房颤患者中,左心房lge -程度高于12%的临界值被发现可以最好地预测相关的低压底物(≥2 cm 2,分别为12%:55%和44%;P = 0.007和P = 0.029)。结论:这项双中心研究建立并验证了一种标准化的、可重复的LGE-CMR方法,可以区分PVI反应者和无反应者,这可能会改善持续性房颤患者治疗方法或消融策略的选择。
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引用次数: 3
Epicardial fat accumulation and left heart remodelling in patients with chronic coronary syndrome. 慢性冠状动脉综合征患者心外膜脂肪堆积与左心重构。
Pub Date : 2023-01-01 DOI: 10.1093/ehjopen/oeac082
Hikari Seki, Koki Nakanishi, Masao Daimon, Kazutoshi Hirose, Yasuhiro Mukai, Yuriko Yoshida, Tomoko Nakao, Hiroyuki Morita, Marco R Di Tullio, Shunichi Homma, Issei Komuro

Aims: Patients with chronic coronary syndrome (CCS) suffer from subsequent cardiovascular events, even after complete revascularization; thus, elucidation of the underlying pathophysiological mechanisms is required. Epicardial adipose tissue (EAT) is increasingly recognized as a metabolically active organ with a key role in the pathogenesis of metabolic-related cardiac diseases. The present study investigated the association between EAT burden and left heart remodelling in patients with CCS.

Methods and results: We studied 267 CCS patients (210 men; 71 ± 9 years) with complete revascularization and normal left ventricular (LV) ejection fraction who underwent follow-up echocardiography. All patients underwent the measurement of EAT thickness and speckle-tracking analysis to evaluate LV global longitudinal strain (LVGLS) and left atrial (LA) phasic strain. The mean EAT thickness was 5.0 ± 1.8 mm. Age, sex, body mass index, and diabetes mellitus were independently associated with EAT thickness (all P < 0.05). Multivariable linear regression analysis demonstrated that EAT thickness was significantly associated with LV mass index, early diastolic mitral annular velocity, and LA conduit strain independent of age, sex, and cardiovascular risk factors (all P < 0.05). On the other hand, there was no relationship between EAT thickness and LV systolic parameters including LV ejection fraction and LVGLS.

Conclusion: CCS patients with increased EAT thickness had unfavourable left heart remodelling. The assessment of EAT thickness by echocardiography may have clinical utility as a simple surrogate to aid in risk stratification for impaired left heart function in CCS patients.

目的:慢性冠状动脉综合征(CCS)患者即使在完全血运重建术后也会出现后续心血管事件;因此,阐明潜在的病理生理机制是必要的。心外膜脂肪组织(EAT)越来越被认为是一个代谢活跃的器官,在代谢相关心脏病的发病机制中起着关键作用。本研究探讨了CCS患者的EAT负担与左心重构之间的关系。方法和结果:我们研究了267例CCS患者(210名男性;71±9岁),血运重建完全,左室射血分数正常,接受随访超声心动图检查。所有患者均行EAT厚度测量和斑点跟踪分析,评估左室整体纵向应变(LVGLS)和左房相应变(LA)。平均EAT厚度为5.0±1.8 mm。年龄、性别、体重指数、糖尿病与EAT厚度独立相关(均P < 0.05)。多变量线性回归分析显示,EAT厚度与左室质量指数、舒张早期二尖瓣环速度、左室导管应变相关,与年龄、性别、心血管危险因素无关(均P < 0.05)。另一方面,EAT厚度与左室射血分数、左室gls等左室收缩参数无相关性。结论:心肌梗死患者左心重构不利。通过超声心动图评估EAT厚度作为一种简单的替代方法可能具有临床应用价值,有助于对CCS患者左心功能受损进行风险分层。
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引用次数: 0
Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry. 主动脉内球囊反搏对Takotsubo综合征合并心源性休克患者全因死亡率的影响:来自德国-意大利-西班牙(GEIST)登记的结果
Pub Date : 2023-01-01 DOI: 10.1093/ehjopen/oead003
Francesco Santoro, Iván J Núñez Gil, Thomas Stiermaier, Ibrahim El-Battrawy, Christian Moeller, Federico Guerra, Giuseppina Novo, Luca Arcari, Beatrice Musumeci, Luca Cacciotti, Enrica Mariano, Francesco Romeo, Michele Cannone, Pasquale Caldarola, Irene Giannini, Adriana Mallardi, Alessandra Leopizzi, Enrica Vitale, Roberta Montisci, Luigi Meloni, Pasquale Raimondo, Matteo Di Biase, Manuel Almendro-Delia, Alessandro Sionis, Aitor Uribarri, Ibrahim Akin, Holger Thiele, Ingo Eitel, Natale Daniele Brunetti

Aims: Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting.

Methods and results: In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (P < 0.01 in all cases). Forty-three patients with CS (20% of 212) received IABP within 8 h (interquartile range 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors, and admission left ventricular ejection fraction were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs. 17%, P = 0.98), length of hospitalization (18.9 vs. 16.7 days, P = 0.51), and need of invasive ventilation (35% vs. 41%, P = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (log-rank P = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs. 35%, P = 0.72).

Conclusions: In a large multi-centre observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS.

目的:Takotsubo综合征(TTS)是一种急性可逆左心室功能障碍,可并发心源性休克(CS)。然而,关于TTS合并CS的最佳护理的数据很少。本研究的目的是评估主动脉内球囊泵送(IABP)对这种情况下死亡率的短期和长期影响。方法和结果:在一个多中心的TTS国际注册中,来自德国、意大利和西班牙的38个中心的2248例连续患者入组。在2248例患者中,212例(9.4%)发生CS。CS患者有较高的糖尿病患病率(27%比19%)、男性患病率(25%比10%)和右室受累(10%比5%)(所有病例P < 0.01)。43例CS患者(212例中的20%)在入院后8小时(四分位数范围4-18)内接受IABP治疗。在有和没有IABP的患者中,年龄、性别、心血管危险因素和入院时左心室射血分数没有差异。两组患者在30天死亡率(16%对17%,P = 0.98)、住院时间(18.9对16.7天,P = 0.51)和有创通气需求(35%对41%,P = 0.60)方面无显著差异,即使在倾向评分调整后,30天生存率也无显著差异(log-rank P = 0.73)。在42个月的随访中,CS和TTS患者的总死亡率为35%,接受IABP和未接受IABP的患者之间无显著差异(37% vs 35%, P = 0.72)。结论:在一项大型多中心观察性登记中,在TTS和CS患者的短期和长期随访中,IABP的使用与较低的死亡率无关。
{"title":"Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry.","authors":"Francesco Santoro,&nbsp;Iván J Núñez Gil,&nbsp;Thomas Stiermaier,&nbsp;Ibrahim El-Battrawy,&nbsp;Christian Moeller,&nbsp;Federico Guerra,&nbsp;Giuseppina Novo,&nbsp;Luca Arcari,&nbsp;Beatrice Musumeci,&nbsp;Luca Cacciotti,&nbsp;Enrica Mariano,&nbsp;Francesco Romeo,&nbsp;Michele Cannone,&nbsp;Pasquale Caldarola,&nbsp;Irene Giannini,&nbsp;Adriana Mallardi,&nbsp;Alessandra Leopizzi,&nbsp;Enrica Vitale,&nbsp;Roberta Montisci,&nbsp;Luigi Meloni,&nbsp;Pasquale Raimondo,&nbsp;Matteo Di Biase,&nbsp;Manuel Almendro-Delia,&nbsp;Alessandro Sionis,&nbsp;Aitor Uribarri,&nbsp;Ibrahim Akin,&nbsp;Holger Thiele,&nbsp;Ingo Eitel,&nbsp;Natale Daniele Brunetti","doi":"10.1093/ehjopen/oead003","DOIUrl":"https://doi.org/10.1093/ehjopen/oead003","url":null,"abstract":"<p><strong>Aims: </strong>Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting.</p><p><strong>Methods and results: </strong>In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (<i>P</i> < 0.01 in all cases). Forty-three patients with CS (20% of 212) received IABP within 8 h (interquartile range 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors, and admission left ventricular ejection fraction were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs. 17%, <i>P</i> = 0.98), length of hospitalization (18.9 vs. 16.7 days, <i>P</i> = 0.51), and need of invasive ventilation (35% vs. 41%, <i>P</i> = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (log-rank <i>P</i> = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs. 35%, <i>P</i> = 0.72).</p><p><strong>Conclusions: </strong>In a large multi-centre observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS.</p>","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/90/oead003.PMC9921723.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9303259","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: 4
Highlights from 2022 in EHJ Open. 2022 年 EHJ 公开赛的亮点。
Pub Date : 2022-12-30 eCollection Date: 2022-11-01 DOI: 10.1093/ehjopen/oeac084
Magnus Bäck, Maciej Banach, Frieder Braunschweig, Salvatore De Rosa, Alessia Gimelli, Thomas Kahan, Daniel F J Ketelhuth, Patrizio Lancellotti, Susanna C Larsson, Linda Mellbin, Edit Nagy, Gianluigi Savarese, Karolina Szummer, Denis Wahl
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引用次数: 0
Endothelial progenitor cell mobilization based on exercise volume in patients with cardiovascular disease and healthy individuals: a systematic review and meta-analysis. 基于心血管疾病患者和健康人运动量的内皮祖细胞动员:系统回顾和荟萃分析。
Pub Date : 2022-12-21 eCollection Date: 2022-11-01 DOI: 10.1093/ehjopen/oeac078
Georgios Mitsiou, Savvas P Tokmakidis, Petros C Dinas, Ilias Smilios, Serafeim Nanas

Endothelial progenitor cells (EPCs) play a vital role in protecting endothelial dysfunction and cardiovascular disease (CVD). Physical exercise stimulates the mobilization of EPCs, and along with vascular endothelial growth factor (VEGF), promotes EPC differentiation, and contributes to vasculogenesis. The present meta-analysis examines the exercise-induced EPC mobilization and has an impact on VEGF in patients with CVD and healthy individuals. Database research was conducted (PubMed, EMBASE, Cochrane Library of Controlled Trials) by using an appropriate algorithm to indicate the exercise-induced EPC mobilization studies. Eligibility criteria included EPC measurements following exercise in patients with CVD and healthy individuals. A continuous random effect model meta-analysis (PROSPERO-CRD42019128122) was used to calculate mean differences in EPCs (between baseline and post-exercise values or between an experimental and control group). A total of 1460 participants (36 studies) were identified. Data are presented as standard mean difference (Std.MD) and 95% confidence interval (95% CI). Aerobic training stimulates the mobilization of EPCs and increases VEGF in patients with CVD (EPCs: Std.MD: 1.23, 95% CI: 0.70-1.76; VEGF: Std.MD: 0.76, 95% CI:0.16-1.35) and healthy individuals (EPCs: Std.MD: 1.11, 95% CI:0.53-1.69; VEGF: Std.MD: 0.75, 95% CI: 0.01-1.48). Acute aerobic exercise (Std.MD: 1.40, 95% CI: 1.00-1.80) and resistance exercise (Std.MD: 0.46, 95%CI: 0.10-0.82) enhance EPC numbers in healthy individuals. Combined aerobic and resistance training increases EPC mobilization (Std.MD:1.84, 95% CI: 1.03-2.64) in patients with CVD. Adequate exercise volume (>60%VO2max >30 min; P = 0.00001) yields desirable results. Our meta-analysis supports the findings of the literature. Exercise volume is required to obtain clinically significant results. Continuous exercise training of high-to-moderate intensity with adequate duration as well as combined training with aerobic and resistance exercise stimulates EPC mobilization and increases VEGF in patients with CVD and healthy individuals.

内皮祖细胞(EPC)在保护内皮功能障碍和心血管疾病(CVD)方面发挥着重要作用。体育锻炼能刺激 EPCs 的动员,并与血管内皮生长因子(VEGF)一起促进 EPC 的分化,有助于血管生成。本荟萃分析研究了心血管疾病患者和健康人运动诱导的 EPC 动员及其对血管内皮生长因子的影响。我们使用适当的算法进行了数据库研究(PubMed、EMBASE、Cochrane 对照试验图书馆),以确定运动诱导 EPC 动员的研究。资格标准包括心血管疾病患者和健康人运动后的 EPC 测量结果。采用连续随机效应模型荟萃分析(PROSPERO-CRD42019128122)计算 EPC 的平均差异(基线值与运动后值之间或实验组与对照组之间的差异)。共确定了 1460 名参与者(36 项研究)。数据以标准平均差 (Std.MD) 和 95% 置信区间 (95% CI) 表示。在心血管疾病患者(EPCs:Std.MD:1.23,95% CI:0.70-1.76;VEGF:Std.MD:0.76,95% CI:0.16-1.35)和健康人(EPCs:Std.MD:1.11,95% CI:0.53-1.69;VEGF:Std.MD:0.75,95% CI:0.01-1.48)中,有氧训练可刺激 EPCs 的动员并增加 VEGF。急性有氧运动(Std.MD:1.40,95% CI:1.00-1.80)和阻力运动(Std.MD:0.46,95% CI:0.10-0.82)可增加健康人的 EPC 数量。在心血管疾病患者中,有氧运动和阻力训练相结合可提高 EPC 的动员能力(Std.MD:1.84,95% CI:1.03-2.64)。充足的运动量(>60%VO2max >30 分钟;P = 0.00001)会产生理想的效果。我们的荟萃分析支持文献的研究结果。要获得有临床意义的结果,运动量是必需的。在心血管疾病患者和健康人中,持续进行高到中等强度、持续时间足够长的运动训练,以及有氧运动和阻力运动的联合训练,可刺激 EPC 的动员并增加血管内皮生长因子。
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引用次数: 0
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European Heart Journal Open
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