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Drug treatment with empagliflozin was beneficial in people with heart failure with preserved ejection fraction: plain language summary of the EMPEROR-Preserved study. 恩帕格列嗪药物治疗射血分数保留的心力衰竭患者是有益的:皇帝保留研究的简明总结。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-09 DOI: 10.2217/fca-2023-0091
Faiez Zannad, Steven Macari

What is this summary about?: This summary describes a study of a new pill for treating chronic heart failure called empagliflozin (brand name Jardiance®). The study is called EMPEROR-Preserved and was published in the New England Journal of Medicine. Chronic heart failure is a condition where the heart does not pump blood around the body properly. Heart failure causes symptoms such as shortness of breath, tiredness and build-up of too much water in the body (fluid retention). These symptoms often need hospital treatment and increase the risk of early death.

What was the emperor-preserved study?: The EMPEROR-Preserved study looked at how empagliflozin works in people living with a type of heart failure called heart failure with preserved ejection fraction. In this type of heart failure, the lower left chamber (ventricle) of the heart is too stiff to fill with enough blood during each heartbeat.

What happened during the study?: Almost 6000 people living with preserved ejection fraction heart failure were asked to take either a pill containing empagliflozin or a placebo, an identical pill lacking empagliflozin, daily. The choice of pill for each participant was randomly assigned. The study was double-blinded, meaning that neither the participants nor their doctors knew which pill the participants were taking.

What were the results?: After an average of 26 months of treatment, empagliflozin reduced the risk of participants needing hospital treatment for complications of heart failure by about 30%. Side effects were generally similar in participants who took empagliflozin and in those who took the placebo, except for genital infections like thrush, which happened in more people who took empagliflozin (2.2%) than in those who took the placebo (0.7%).

What do the results mean?: A previous study called EMPEROR-Reduced found that empagliflozin had similar benefits in participants with heart failure with reduced ejection fraction. Therefore, the overall evidence shows that empagliflozin can help people with heart failure whether it is caused by reduced ejection fraction or preserved ejection fraction. Clinical Trial Registration: NCT03057951 (EMPEROR-Preserved study) (ClinicalTrials.gov).

此摘要是关于什么的?:本综述描述了一种治疗慢性心力衰竭的新药恩帕列嗪(品牌名为Jardiance®)的研究。这项研究被称为“帝王保存”,发表在《新英格兰医学杂志》上。慢性心力衰竭是指心脏不能正常地将血液泵送到全身的情况。心力衰竭会导致呼吸急促、疲劳和体内水分过多(液体滞留)等症状。这些症状通常需要住院治疗,并增加了早期死亡的风险。皇帝保存的书房是什么皇帝保留的研究观察了恩帕列嗪在射血分数保留的心力衰竭患者中的作用。在这种类型的心力衰竭中,心脏的左下室(心室)过于僵硬,每次心跳时都无法充满足够的血液。研究期间发生了什么?:近6000名射血分数维持性心力衰竭患者被要求每天服用含有恩帕格列嗪的药丸或安慰剂,一种不含恩帕格列嗪的相同药丸。每个参与者的药丸选择是随机分配的。这项研究是双盲的,这意味着参与者和他们的医生都不知道参与者正在服用哪种药丸。结果是什么?:经过平均26个月的治疗,恩帕列嗪将参与者因心力衰竭并发症需要住院治疗的风险降低了约30%。服用恩帕列嗪的参与者和服用安慰剂的参与者的副作用通常相似,除了鹅口疮等生殖器感染,服用恩帕列嗪的人(2.2%)比服用安慰剂的人(0.7%)多。结果意味着什么?:之前一项名为EMPEROR Reduced的研究发现,empagliflozin对射血分数降低的心力衰竭患者也有类似的益处。因此,总体证据表明,无论是射血分数降低还是射血分数保持不变,恩帕列嗪都可以帮助心力衰竭患者。临床试验注册:NCT03057951(皇帝保留研究)(ClinicalTrials.gov)。
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引用次数: 0
Optimizing interventional cardiology services. 优化介入心脏病学服务。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-02 DOI: 10.2217/fca-2023-0053
Khamis Al-Alawy, Khulood Al Sayegh, Immanuel Azaad Moonesar

Cardiovascular disease (CVD) is a common and prominent cause of morbidity and mortality interventional cardiology (IC) remains an important noninvasive intervention to improve patient outcomes and life expectancy. Aim: The study objectives were to explore how IC services could be optimized. Methods: We adopted multiple methods, including policy analysis, literature review and interviews. Results: The most prominent themes were medical devices and service integration and management. IC Consultant interviews suggest the need to balance supply and demand, implement standards of practice and establish centres of excellence. Conclusion: Optimizing IC services requires a comprehensive approach, including regulatory and financial oversight, organizational management, adoption of clinical and technological best practices, ongoing training, multidisciplinary working and service integration.

心血管疾病(CVD)是发病率和死亡率的常见和突出原因。介入心脏病学(IC)仍然是改善患者预后和预期寿命的重要非侵入性干预措施。目的:本研究旨在探讨如何优化集成电路服务。方法:采用政策分析、文献综述和访谈等多种方法。结果:最突出的主题是医疗器械与服务的整合与管理。IC顾问的访谈表明,需要平衡供需,实施实践标准,并建立卓越中心。结论:优化IC服务需要一种全面的方法,包括监管和财务监督、组织管理、采用临床和技术最佳实践、持续培训、多学科工作和服务整合。
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引用次数: 0
Mechanisms, prevalence and management of cardiac arrhythmias in cancer patients: a comprehensive review. 癌症患者心律失常的机制、发病率和治疗:一项综合综述。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-11-06 DOI: 10.2217/fca-2023-0086
Francesco Flore, Roberto Scacciavillani, Giulia Iannaccone, Maria Lucia Narducci, Gaetano Pinnacchio, Gianluigi Bencardino, Francesco Perna, Francesco Raffaele Spera, Gianluca Comerci, Massimiliano Camilli, Antonella Lombardo, Gaetano Antonio Lanza, Filippo Crea, Gemma Pelargonio

Recently, prognosis and survival of cancer patients has improved due to progression and refinement of cancer therapies; however, cardiovascular sequelae in this population augmented and now represent the second cause of death in oncological patients. Initially, the main issue was represented by heart failure and coronary artery disease, but a growing body of evidence has now shed light on the increased arrhythmic risk of this population, atrial fibrillation being the most frequently encountered. Awareness of arrhythmic complications of cancer and its treatments may help oncologists and cardiologists to develop targeted approaches for the management of arrhythmias in this population. In this review, we provide an updated overview of the mechanisms triggering cardiac arrhythmias in cancer patients, their prevalence and management.

最近,由于癌症治疗的进展和完善,癌症患者的预后和生存率得到改善;然而,心血管后遗症在这一人群中增加,现在是肿瘤学患者死亡的第二大原因。最初,主要问题是心力衰竭和冠状动脉疾病,但现在越来越多的证据表明,这一人群的心律失常风险增加,心房颤动是最常见的。对癌症心律失常并发症及其治疗的认识可能有助于肿瘤学家和心脏病学家开发有针对性的方法来管理这一人群的心律失常。在这篇综述中,我们提供了癌症患者心律失常触发机制、发病率和管理的最新概述。
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引用次数: 0
Long-term prognosis in patients undergoing redo-isolated aortic valve replacement. 接受重新分离主动脉瓣置换术患者的长期预后。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-01 Epub Date: 2023-12-11 DOI: 10.2217/fca-2023-0050
Aleksander Dokollari, Gianluca Torregrossa, Serge Sicouri, Matteo Cameli, Giulia Elena Mandoli, Stephanie Kjelstrom, Edvin Prifti, Altin Veshti, Massimo Bonacchi, Sandro Gelsomino

Aim: To evaluate clinical outcomes after redo aortic valve replacement (AVR) with sutured valves, versus valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), versus sutureless valves. Methods: We identified 113 consecutive patients undergoing redo AVR with either ViV-TAVR, redo-sutured and redo-sutureless valves between August 2010 to March 2020. Heart-team made the decision whether patient should undergo redo-sutureless versus ViV-TAVR, versus redo-sutured AVR. Results: Preoperatively, redo-sutured (n = 57), ViV-TAVR (n = 31) and redo-sutureless (n = 25) patients were compared. Postoperatively, after propensity-adjustment analysis, the redo surgical aortic valve replacement group had a higher incidence of new postoperative atrial fibrillation (POAF; p = 0.04) compared with redo-sutureless group. Follow-up outcomes analysis did not show differences among groups. Conclusion: Patients undergoing redo-sutureless AVR experienced a higher incidence of POAF compared with patients undergoing redo-sutured.

目的:评估使用缝合瓣膜、瓣膜置入经导管主动脉瓣置换术(ViV-TAVR)和无缝合瓣膜重新进行主动脉瓣置换术(AVR)后的临床疗效。方法:我们确定了 2010 年 8 月至 2020 年 3 月期间接受 ViV-TAVR 重做主动脉瓣置换术、缝合瓣膜重做主动脉瓣置换术和无缝合瓣膜重做主动脉瓣置换术的 113 例连续患者。心脏团队决定患者是否应接受重做无缝合瓣膜与 ViV-TAVR 或重做缝合瓣膜 AVR。结果:术前,对重新缝合(57 人)、ViV-TAVR(31 人)和无缝合(25 人)患者进行了比较。术后,经过倾向调整分析,重做手术主动脉瓣置换术组与重做无缝线组相比,术后新发心房颤动(POAF;P = 0.04)的发生率更高。随访结果分析未显示出各组间的差异。结论与接受重新缝合手术的患者相比,接受重新缝合无缝线主动脉瓣置换术的患者发生 POAF 的几率更高。
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引用次数: 0
Unraveling the link: exploring the effects of environmental change on the cardiovascular system. 解开联系:探索环境变化对心血管系统的影响。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-10-13 DOI: 10.2217/fca-2023-0075
Ramsha Mahmood, Aimen Said, Sai Gautham Kanagala, Vasu Gupta, Rohit Jain

Climate change has a particularly detrimental effect on the cardiovascular system, which is highly vulnerable to harmful impacts. The accumulation of particulate matter (PM) and greenhouse gasses in the environment negatively impacts the cardiovascular system through several mechanisms. The burden of climate change-related diseases falls disproportionately on vulnerable populations, including the elderly, the poor, and those with pre-existing health conditions. A key component of addressing the complex interplay between climate change and cardiovascular diseases is acknowledging health disparities among vulnerable populations resulting from climate change, familiarizing themselves with strategies for adapting to changing conditions, educating patients about climate-related cardiovascular risks, and advocating for policies that promote cleaner environments and sustainable practices.

气候变化对心血管系统有着特别有害的影响,心血管系统极易受到有害影响。颗粒物(PM)和温室气体在环境中的积累通过多种机制对心血管系统产生负面影响。气候变化相关疾病的负担不成比例地落在弱势群体身上,包括老年人、穷人和已有健康状况的人。解决气候变化与心血管疾病之间复杂相互作用的一个关键组成部分是承认气候变化导致的弱势人群之间的健康差异,熟悉适应不断变化的条件的策略,教育患者了解气候相关的心血管风险,倡导促进清洁环境和可持续做法的政策。
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引用次数: 0
Management of patients suspected for non-ST elevation-acute coronary syndrome in the prehospital phase. 院前阶段疑似非ST段抬高型急性冠状动脉综合征患者的管理。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-11-02 DOI: 10.2217/fca-2023-0049
Rudolf T Tolsma, Enrico R de Koning, Marion J Fokkert, Nancy Wpl van der Waarden, Arnoud Wj van 't Hof, Barbra E Backus

The management of patients with suspected acute coronary syndrome, especially in prehospital settings, is challenging. This Special Report focuses on studies in emergency medical services concerning chest pain patients' triage and risk stratification. In addition, it emphasizes advancements in point-of-care cardiac troponin testing. These developments are compared with in-hospital guidelines, proposing an initial framework for a new acute care pathway. This pathway integrates a risk stratification tool with high-sensitivity cardiac troponin testing, aiming to deliver optimal care and collaboration within the acute care chain. It has the potential to contribute to a significant reduction in hospital referrals, reduce observation time and overcrowding at emergency departments and hospital admissions.

疑似急性冠状动脉综合征患者的管理,尤其是在院前环境中,具有挑战性。本专题报告关注的是急救医疗服务中有关胸痛患者分诊和风险分层的研究。此外,它强调了在护理点心肌肌钙蛋白检测方面的进步。将这些发展与住院指南进行比较,为新的急性护理途径提出了初步框架。该途径将风险分层工具与高灵敏度肌钙蛋白检测相结合,旨在在急性护理链中提供最佳护理和协作。它有可能大大减少医院转诊,减少观察时间,减少急诊室和医院的过度拥挤。
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引用次数: 0
Drug treatment with empagliflozin lowered risk for hospitalization in people with heart failure with reduced ejection fraction: plain language summary of the EMPEROR-Reduced study. empagliflozin药物治疗降低了射血分数降低的心力衰竭患者的住院风险:EMPEROR reduced研究的简明总结。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-11-09 DOI: 10.2217/fca-2023-0090
Faiez Zannad, Steven Macari

What is this summary about?: This is a summary of the article describing the EMPEROR-Reduced study of empagliflozin, which was published in the New England Journal of Medicine. Empagliflozin (brand name Jardiance®) is a new drug therapy for the treatment of chronic heart failure. Chronic heart failure is a long-term condition where the heart cannot pump enough blood around the body, leading to symptoms such as shortness of breath, fatigue and build-up of too much water in the body (fluid retention). It also increases the risk for premature death.

What was the emperor-reduced study?: The EMPEROR-Reduced study looked at the effects of empagliflozin, a medication taken once daily, in people with reduced ejection fraction. This is a type of heart failure where insufficient blood is pushed out of the heart muscle as it contracts. The study was conducted because more evidence is needed on the effects of empagliflozin and similar drugs in people with heart failure, including those with reduced ejection fraction. The main aim of the EMPEROR-Reduced study was to see if empagliflozin reduces the risk of being taken to hospital for complications of heart failure or dying from heart disease.

What happened during the study?: Over 3700 people with heart failure and reduced ejection fraction were randomly given either empagliflozin or placebo (an identical pill lacking medication) daily for about 16 months. This was a double-blind study, which means that neither the participants nor the researchers knew which treatment participants were receiving.

What were the results?: After an average of 16 months of continuous treatment, fewer patients taking empagliflozin (13.2%) needed to be hospitalized for complications of heart failure than those taking placebo (18.3%). Also, fewer patients taking empagliflozin (1.6%) developed serious kidney problems than those taking placebo (3.1%). Side effects were generally similar in participants who received empagliflozin and those who received placebo, except for genital tract infections, which affected more participants who received empagliflozin (1.7%) than placebo (0.6%).

What do the results mean?: This study suggests that people with chronic heart failure with reduced ejection fraction may benefit from treatment with empagliflozin, mainly by needing to go to hospital less often because of complications of heart failure. Clinical Trial Registration: NCT03057977 (EMPEROR-Reduced study) (ClinicalTrials.gov).

此摘要是关于什么的?:这是发表在《新英格兰医学杂志》上的一篇文章的摘要,该文章描述了恩帕列嗪的帝王还原研究。恩帕列嗪(品牌名Jardiance®)是一种治疗慢性心力衰竭的新药。慢性心力衰竭是一种长期疾病,心脏无法向全身泵送足够的血液,导致呼吸急促、疲劳和体内积水(液体滞留)等症状。它还增加了过早死亡的风险。皇帝减少学习的内容是什么EMPEROR Reduced研究观察了每天服用一次的恩帕列嗪对射血分数降低的人的影响。这是一种心力衰竭,当心肌收缩时,血液不足会被挤出心肌。之所以进行这项研究,是因为需要更多的证据来证明恩帕列嗪和类似药物对心力衰竭患者(包括射血分数降低的患者)的影响。EMPEROR Reduced研究的主要目的是观察恩帕列嗪是否能降低因心力衰竭并发症或死于心脏病而被送往医院的风险。研究期间发生了什么?:3700多名心力衰竭和射血分数降低的患者被随机每天服用恩帕列嗪或安慰剂(一种缺乏药物的相同药丸),持续约16个月。这是一项双盲研究,这意味着参与者和研究人员都不知道参与者正在接受哪种治疗。结果是什么?:经过平均16个月的连续治疗,服用恩帕列嗪的患者(13.2%)因心力衰竭并发症需要住院治疗的人数少于服用安慰剂的患者(18.3%),与服用安慰剂的患者(3.1%)相比,服用恩帕列嗪的患者(1.6%)出现严重肾脏问题的人数较少。服用恩帕列嗪的参与者和服用安慰剂的参与者的副作用通常相似,但生殖道感染除外,这影响了服用恩帕格列嗪的参与者(1.7%)多于安慰剂的参与者(0.6%)。结果意味着什么?:这项研究表明,射血分数降低的慢性心力衰竭患者可能会从恩帕列嗪的治疗中受益,主要是因为心力衰竭并发症而需要较少去医院。临床试验注册:NCT03057977(EMPEROR减少研究)(ClinicalTrials.gov)。
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引用次数: 0
Incidence and prevalence rates of coronary artery disease in women with and without rheumatoid arthritis in Kentucky Women's Health Registry. 肯塔基州妇女健康登记处患有和不患有类风湿性关节炎的妇女冠状动脉疾病的发病率和患病率。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-11-01 DOI: 10.2217/fca-2022-0075
Hassan Mousa, David Mannino

Aim: To investigate the incidence and prevalence rates of coronary artery disease (CAD) in women with and without rheumatoid arthritis (RA). Methods: Data was collected from the Kentucky Women's Health Registry (2007, 2008, 2009 and 2010) with 3982, 6730, 6898 and 7944, respectively. Results: Women with RA and reported CAD were over 45 years. 10% of women with RA reported CAD, while 4% of women without RA reported CAD. The incidence of CAD in women with RA were 10, 5.2 and 3.4% while the incidence of CAD in women without RA were 2.2, 2.2 and 1.4% in 2007-2010, 2008-2010 and 2009-2010, respectively. Conclusion: The incidence and prevalence of CAD was greater in women with RA compared with women without RA.

目的:了解女性类风湿性关节炎(RA)患者和非类风湿性关节病患者冠状动脉疾病(CAD)的发生率和患病率。方法:数据来自肯塔基州妇女健康登记处(2007年、2008年、2009年和2010年),分别为3982、6730、6898和7944。结果:患有RA并报告CAD的女性年龄超过45岁。10%患有RA的女性报告CAD,而4%没有RA的女性则报告CAD。2007-2010年、2008-2010年和2009-2010年,患有RA的女性CAD发病率分别为10%、5.2%和3.4%,而无RA的女性的CAD发病率则分别为2.2%、2.2%和1.4%。结论:RA患者CAD的发生率和患病率高于非RA患者。
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引用次数: 0
Obstructive hypertrophic cardiomyopathy: a review of new therapies. 梗阻性肥厚型心肌病:新疗法综述。
IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-10-01 Epub Date: 2023-11-07 DOI: 10.2217/fca-2023-0056
Nandini Mehra, Adel Hajj Ali, Milind Y Desai

Hypertrophic cardiomyopathy (HCM) is a phenotypically heterogeneous disease with a genetic basis and variable penetrance. The hallmarks of HCM include dynamic left ventricular outflow tract obstruction, typically caused by asymmetric septal hypertrophy. However, abnormal papillary muscle placement, abnormal mitral valve and subvalvular apparatus and apical hypertrophic forms have also been described. Typical medical treatment has been stagnant for decades, although there have been significant advances in surgical treatment of patients with obstructive HCM. Herein, we describe a new class of drugs targeting the specific pathophysiology of HCM.

肥厚型心肌病(HCM)是一种表型异质性疾病,具有遗传基础和变异外显率。HCM的特征包括动态左心室流出道梗阻,通常由不对称间隔肥大引起。然而,乳头肌位置异常、二尖瓣和瓣下器异常以及心尖肥大也有描述。尽管阻塞性HCM患者的外科治疗取得了重大进展,但典型的医疗治疗几十年来一直停滞不前。在此,我们描述了一类针对HCM特定病理生理学的新药物。
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引用次数: 0
Anthracycline chemotherapy, vascular dysfunction and cognitive impairment: burgeoning topics and future directions. 蒽环类化疗、血管功能障碍和认知障碍:新兴话题和未来方向。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-09-01 Epub Date: 2022-11-10 DOI: 10.2217/fca-2022-0086
Grace S Maurer, Zachary S Clayton

Anthracyclines, chemotherapeutic agents used to treat common forms of cancer, increase cardiovascular (CV) complications, thereby necessitating research regarding interventions to improve the health of cancer survivors. Vascular dysfunction, which is induced by anthracycline chemotherapy, is an established antecedent to overt CV diseases. Potential treatment options for ameliorating vascular dysfunction have largely been understudied. Furthermore, patients treated with anthracyclines have impaired cognitive function and vascular dysfunction is an independent risk factor for the development of mild cognitive impairment. Here, we will focus on: anthracycline chemotherapy associated CV diseases risk; how targeting mechanisms underlying vascular dysfunction may be a means to improve both CV and cognitive health; and research gaps and potential future directions for the field of cardio-oncology.

蒽环类是一种用于治疗常见形式癌症的化学治疗剂,会增加心血管(CV)并发症,因此有必要对改善癌症幸存者健康的干预措施进行研究。蒽环类药物化疗引起的血管功能障碍是显性心血管疾病的既定先兆。改善血管功能障碍的潜在治疗方案在很大程度上研究不足。此外,蒽环类药物治疗的患者认知功能受损,血管功能障碍是发展为轻度认知障碍的独立风险因素。在这里,我们将重点关注:蒽环类药物化疗相关心血管疾病的风险;血管功能障碍的靶向机制如何成为改善心血管和认知健康的手段;以及心脏肿瘤学领域的研究空白和潜在的未来方向。
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引用次数: 0
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Future cardiology
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