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Could SGLT2 inhibitors improve outcomes in patients with heart failure and significant valvular heart disease? Need for action. SGLT2 抑制剂能否改善心力衰竭合并严重瓣膜性心脏病患者的预后?需要采取行动。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-20 DOI: 10.1007/s10741-024-10467-x
Vasileios Kamperidis, Vasileios Anastasiou, Antonios Ziakas

Delivering valvular intervention for all eligible patients with valvular heart disease (VHD) in a timely manner remains a challenge. Therefore, a high number of patients with heart failure (HF) and VHD receive pharmacotherapy while awaiting intervention or as destination therapy if they are deemed inoperable. The sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended with a class I indication for patients with chronic HF throughout the spectrum of left ventricular ejection fraction. However, all randomized trials of SGLT2i in HF patients have consistently excluded patients with significant VHD. Considering the proven benefit of SGLT2i for stable outpatients and acutely hospitalized patients with HF, SGLT2i could potentially be used for patients with HF secondary to significant VHD. This article highlights the unmet need to produce robust clinical evidence for the pharmacological management of patients with HF and significant VHD while summarizing the potential benefit from SGLT2i in the management of these patients.

为所有符合条件的瓣膜性心脏病(VHD)患者及时实施瓣膜介入治疗仍然是一项挑战。因此,大量心力衰竭(HF)和瓣膜性心脏病患者在等待介入治疗期间接受药物治疗,或在被认为无法手术的情况下接受终点治疗。钠-葡萄糖共转运体-2抑制剂(SGLT2i)被推荐为慢性心力衰竭患者的一类适应症,适用于各种左心室射血分数的患者。然而,所有针对心房颤动患者的 SGLT2i 随机试验都一致排除了严重 VHD 患者。考虑到 SGLT2i 已被证实对病情稳定的门诊患者和急性住院的心房颤动患者有益,因此 SGLT2i 有可能用于继发于严重 VHD 的心房颤动患者。本文在总结 SGLT2i 在治疗这些患者方面的潜在益处的同时,还强调了为心房颤动和严重 VHD 患者的药物治疗提供可靠临床证据的需求尚未得到满足。
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引用次数: 0
Maternal heart failure: state-of-the-art review. 产妇心力衰竭:最新综述。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-12 DOI: 10.1007/s10741-024-10466-y
Usman S Najam, Jitae A Kim, Sophie Y Kim, Gurleen Wander, Mario Rodriguez, Hafeez Ul Hassan Virk, Mark R Johnson, W H Wilson Tang, Chayakrit Krittanawong

Pregnancy is a period of substantial changes to the body's normal physiology, and the failure to adapt to these changes can lead to life-threatening pathology, particularly involving the cardiovascular system. In comparison to pre-pregnancy physiology, pregnant women have increased blood volume and physical demands which exert increased stress on the heart. This is important to consider in women with and without previously diagnosed cardiovascular disease, as the physiologic changes during pregnancy and postpartum can lead to sudden decompensation. The management of heart failure is particularly important as it remains the most common cardiovascular complication during pregnancy and is associated with substantial maternal and fetal morbidity and mortality. This is especially true in patients with pre-existing heart failure, who should receive counseling before conception and in certain cases be advised against pregnancy. For these reasons, healthcare professionals must be well-versed in the different strategies of diagnosis, management, treatment, and monitoring. This review will outline the pathophysiology, diagnostics, management, and general approach to heart failure in pregnant patients.

怀孕是人体正常生理发生重大变化的时期,如果不能适应这些变化,就会导致危及生命的病变,尤其是涉及心血管系统的病变。与怀孕前的生理机能相比,孕妇的血容量和体力需求都会增加,从而对心脏造成更大的压力。这一点对于既往确诊或未确诊心血管疾病的妇女来说都很重要,因为孕期和产后的生理变化可能会导致心脏突然失代偿。心力衰竭是妊娠期最常见的心血管并发症,与孕产妇和胎儿的发病率和死亡率密切相关,因此对心力衰竭的处理尤为重要。对于已有心力衰竭的患者来说尤其如此,他们应在受孕前接受咨询,并在某些情况下被建议不要怀孕。因此,医护人员必须精通诊断、管理、治疗和监测的不同策略。本综述将概述妊娠患者心力衰竭的病理生理学、诊断、管理和一般方法。
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引用次数: 0
Diagnosis and management of hypertrophic cardiomyopathy: European vs. American guidelines. 肥厚型心肌病的诊断和管理:欧洲与美国的指南。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-09 DOI: 10.1007/s10741-024-10464-0
Alberto Aimo, Giancarlo Todiere, Andrea Barison, Daniela Tomasoni, Giorgia Panichella, Ahmad Masri, Martin S Maron

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, affecting 1:200 to 1:500 individuals worldwide. Guidelines on the diagnosis and management of HCM have been recently published by the European Society of Cardiology (ESC) and American societies. The ESC guidelines cover a broad range of cardiomyopathies, including HCM, with 119 recommendations, whereas the American guidelines focus exclusively on HCM with 141 specific recommendations. Both guidelines emphasize a comprehensive diagnostic approach, including imaging and genetic testing, but differ in some specific aspects. For example, sudden cardiac death (SCD) risk assessment is a primary point of divergence. The ESC guidelines advocate for the use of a validated Risk-SCD calculator, while the American guidelines rely on specific risk markers for individualized risk evaluation. Management strategies also vary: both guidelines prioritize beta-blockers and calcium channel blockers in patients with resting or provocable left ventricular outflow tract (LVOT) obstruction. If beta-blockers (or verapamil/diltiazem) are ineffective, either disopyramide or the myosin inhibitor mavacamten may be an option with slightly different indications among the two guidelines. Septal reduction therapy is recommended in ESC guidelines for symptomatic patients with significant LVOT gradients, while American guidelines suggest earlier myectomy for certain clinical factors and emphasize shared decision-making. The ESC guidelines recommend sequential atrioventricular pacing and dual-chamber defibrillators for reducing LVOT gradients. The American guidelines focus on genetic testing for risk assessment and suggest periodic cardiac magnetic resonance imaging. This paper provides a detailed comparison of these guidelines, highlighting key differences and areas needing further research and expert debate.

肥厚型心肌病(HCM)是最常见的遗传性心脏病,全球患病率为 1:200 至 1:500。欧洲心脏病学会(ESC)和美国心脏病学会最近发布了肥厚性心肌病诊断和管理指南。欧洲心脏病学会指南涵盖了包括 HCM 在内的多种心肌病,提出了 119 项建议,而美国指南则专门针对 HCM,提出了 141 项具体建议。两份指南都强调综合诊断方法,包括影像学和基因检测,但在某些具体方面有所不同。例如,心脏性猝死(SCD)风险评估是主要的分歧点。ESC指南提倡使用经过验证的Risk-SCD计算器,而美国指南则依赖于特定的风险标志物来进行个体化风险评估。管理策略也各不相同:对于静息状态下或可证实左室流出道(LVOT)阻塞的患者,两份指南都优先考虑使用β-受体阻滞剂和钙通道阻滞剂。如果β-受体阻滞剂(或维拉帕米/地尔硫卓)无效,则可选择使用地索比拉米或肌球蛋白抑制剂马伐康坦,但两种指南的适应症略有不同。ESC指南建议对有明显左心室出口梯度的无症状患者进行室间隔减容治疗,而美国指南则建议针对某些临床因素提前进行心肌切除术,并强调共同决策。ESC指南建议使用序贯心房起搏和双腔除颤器来降低左心室出口梯度。美国指南侧重于风险评估的基因检测,并建议定期进行心脏磁共振成像。本文对这些指南进行了详细比较,强调了主要差异以及需要进一步研究和专家讨论的领域。
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引用次数: 0
Sodium-glucose co-transporter 2 inhibitors in left ventricular assist device and heart transplant recipients: a mini-review. 左心室辅助装置和心脏移植受者体内的钠-葡萄糖协同转运体 2 抑制剂:微型综述。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-08 DOI: 10.1007/s10741-024-10465-z
Emyal Alyaydin, Danaë Parianos, Julia Hermes-Laufer, Matthias P Nägele, Liesa Castro, Maria Papathanasiou, Holger Reinecke, Andreas J Flammer

In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i) emerged as promising therapeutic agents in managing heart failure (HF). They demonstrated a significant impact on reducing HF hospitalizations and related mortality in patients with reduced and preserved ejection fraction. However, evidence supporting their use in patients with left ventricular assist device (LVAD) and heart transplant (HT) recipients is still limited. We identified six key studies investigating the safety and efficacy of SGLT2i in LVAD and HT recipients. In patients with LVAD, prescription of SGLT2i was predominantly associated with improved fluid management and reduced pulmonary artery pressures. However, the results regarding their effects on body weight, hemoglobin A1c, diuretic use, and right ventricular function were contradictory. In terms of safety, SGLT2i were generally well-tolerated in the LVAD population, and the reported incidence of adverse events was low. In HT recipients, SGLT2i were associated with better glycemic control and weight reduction. No relevant adverse events were reported. Despite these encouraging results, the long-term safety and efficacy of SGLT2i in these vulnerable patient populations are yet to be investigated. Future randomized controlled trials are needed to address existing gaps in evidence and help integrate SGLT2i into clinical practice for LVAD and HT recipients.

近年来,钠-葡萄糖共转运体 2 抑制剂(SGLT2i)成为治疗心力衰竭(HF)的有前途的药物。它们在减少射血分数降低和保留射血分数的患者的心衰住院率和相关死亡率方面发挥了重要作用。然而,支持在左心室辅助装置(LVAD)患者和心脏移植(HT)受者中使用这些药物的证据仍然有限。我们确定了六项主要研究,调查了 SGLT2i 在 LVAD 和心脏移植受者中的安全性和有效性。在 LVAD 患者中,处方 SGLT2i 主要与改善液体管理和降低肺动脉压力有关。然而,其对体重、血红蛋白 A1c、利尿剂使用和右心室功能的影响结果却相互矛盾。在安全性方面,LVAD 患者对 SGLT2i 的耐受性普遍良好,报告的不良事件发生率较低。在高血糖受者中,SGLT2i 能更好地控制血糖和减轻体重。没有相关不良事件的报道。尽管取得了这些令人鼓舞的结果,但 SGLT2i 在这些脆弱患者群体中的长期安全性和有效性仍有待研究。未来需要进行随机对照试验,以弥补现有证据的不足,并帮助将 SGLT2i 纳入 LVAD 和 HT 受者的临床实践中。
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引用次数: 0
The road to renal denervation for hypertension and beyond (HF): two decades of failed, succeeded, and to be determined. 高血压及其他疾病(HF)的肾脏神经支配之路:二十年的失败、成功和待定。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-07 DOI: 10.1007/s10741-024-10463-1
Haoran Jiang, Veraprapas Kittipibul, Felix Mahfoud, Michael Böhm, Paul A Sobotka, Murray Esler, Jie Wang, Marat Fudim

Activation of the sympathetic nervous system has been attributed to the development of hypertension. Two established approaches for treating hypertension are pharmacotherapy and lifestyle changes. With an improved understanding of renal nerve anatomy and physiology, renal denervation has been proposed as an alternative treatment for hypertension. Specifically, it has been shown that the interruption of sympathetic nerves connecting the kidney and the sympathetic nervous system can reduce blood pressure. Here, we present a review on how renal denervation can help hypertension patients, specifically focusing on our novel understanding of renal nerve anatomy, denervation technique, and subsequent clinical trials, and how it may be used to treat other cardiovascular diseases like heart failure.

交感神经系统的激活是高血压发病的原因之一。治疗高血压的两种既定方法是药物疗法和改变生活方式。随着人们对肾脏神经解剖学和生理学认识的提高,肾脏神经支配被提出作为治疗高血压的另一种方法。具体来说,研究表明,中断连接肾脏和交感神经系统的交感神经可降低血压。在此,我们将综述肾脏去神经化如何帮助高血压患者,特别关注我们对肾脏神经解剖、去神经化技术和后续临床试验的新认识,以及如何将其用于治疗心衰等其他心血管疾病。
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引用次数: 0
Adrenal crisis-induced cardiogenic shock (ACCS): a comprehensive review. 肾上腺危象诱发的心源性休克(ACCS):全面回顾。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-06 DOI: 10.1007/s10741-024-10458-y
Maryam Heidarpour, Davood Shafie, Reza Eshraghi, Seyed Reza Mirjalili, Ashkan Bahrami, Mohammad Reza Movahed

Adrenal insufficiency (AI) is a disorder in which inadequate glucocorticoid and mineralocorticoid hormone production leads to a variety of symptoms, including fatigue, weight loss, and nausea. In some patients with unknown AI, adrenal crisis-induced cardiogenic shock (ACCS) can be the first presentation, resulting in a fatal situation. The ACCS may exhibit unresponsiveness to inotropes and fluid therapy; thus, glucocorticoid administration is the primary vital intervention, making early detection of AI essential. Hence, in this study, we review the case reports demonstrating acute cardiomyopathies in the context of AI. The review addresses the suggested underlying mechanisms, including the diminished protective effects of glucocorticoids against catecholamines in AI. We also highlighted some clues to aid physicians in considering AI as a differential diagnosis in critically ill patients presenting cardiogenic shock.

肾上腺功能不全(AI)是一种糖皮质激素和矿物质皮质激素分泌不足导致各种症状(包括疲劳、体重减轻和恶心)的疾病。在一些不明AI患者中,肾上腺危象诱发的心源性休克(ACCS)可能是首发症状,从而导致死亡。ACCS 可能对肌注和输液治疗无反应;因此,糖皮质激素的应用是主要的重要干预措施,这使得早期发现肾上腺危象至关重要。因此,在本研究中,我们回顾了在 AI 背景下显示急性心肌病的病例报告。该综述探讨了所建议的潜在机制,包括糖皮质激素对人工流产中儿茶酚胺的保护作用减弱。我们还强调了一些线索,以帮助医生在出现心源性休克的重症患者中将人工心肌病作为一种鉴别诊断。
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引用次数: 0
Digital health as a tool for patient activation and improving quality of care for heart failure. 将数字医疗作为激活患者和提高心力衰竭护理质量的工具。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-09-06 DOI: 10.1007/s10741-024-10433-7
Aradhana Verma, Zahra Azizi, Alexander T Sandhu

The clinical and economic impact of heart failure (HF) is immense and will continue to rise due to the increasing prevalence of the disease. Despite the availability of guideline-recommended medications that improve mortality, reduce hospitalizations, and enhance quality of life, there are major gaps in the implementation of such care. Quality improvement interventions have generally focused on clinicians. While certain interventions have had modest success in improving the use of heart failure medications, they remain insufficient in optimizing HF care. Here, we discuss how patient-facing interventions can add value and supplement clinician-centered interventions. We discuss how digital health can be leveraged to create patient activation tools that create a larger, sustainable impact. Small studies have suggested the promise of digital tools for patient engagement and self-care, but there are also important barriers to the adoption of such interventions that we describe. We share key principles and strategies around the design and implementation of digital health innovations to maximize patient participation and engagement. By uniquely activating patients in their own care, digital health can unlock the full potential of both existing and new quality improvement initiatives to drive forward high-quality and equitable heart failure care.

心力衰竭(HF)对临床和经济的影响是巨大的,而且由于该病的发病率越来越高,其影响还将继续上升。尽管有指南推荐的药物可改善死亡率、减少住院次数并提高生活质量,但在实施此类护理方面仍存在很大差距。提高质量的干预措施一般以临床医生为重点。虽然某些干预措施在改善心衰药物使用方面略有成效,但仍不足以优化心衰护理。在此,我们将讨论面向患者的干预措施如何增加价值,并对以临床医生为中心的干预措施进行补充。我们还讨论了如何利用数字健康技术来创建患者激活工具,从而产生更大的、可持续的影响。一些小型研究表明,数字工具在促进患者参与和自我护理方面大有可为,但在采用此类干预措施方面也存在我们所描述的重要障碍。我们分享了数字医疗创新设计和实施的关键原则和策略,以最大限度地提高患者的参与度。通过独特的方式让患者参与到自己的护理中,数字医疗可以释放现有和新的质量改进措施的全部潜力,从而推动高质量和公平的心衰护理。
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引用次数: 0
Artificial intelligence and myocarditis-a systematic review of current applications. 人工智能与心肌炎--当前应用的系统回顾。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-14 DOI: 10.1007/s10741-024-10431-9
Paweł Marek Łajczak, Kamil Jóźwik

Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. This study, guided by PRISMA guidelines, explores the expanding role of artificial intelligence (AI) in myocarditis, aiming to consolidate current knowledge and guide future research. Following PRISMA guidelines, a systematic review was conducted across PubMed, Cochrane Reviews, Scopus, Embase, and Web of Science databases. MeSH terms including artificial intelligence, deep learning, machine learning, myocarditis, and inflammatory cardiomyopathy were used. Inclusion criteria involved original articles utilizing AI for myocarditis, while exclusion criteria eliminated reviews, editorials, and non-AI-focused studies. The search yielded 616 articles, with 42 meeting inclusion criteria after screening. The identified articles, spanning diagnostic, survival prediction, and molecular analysis aspects, were analyzed in each subsection. Diagnostic studies showcased the versatility of AI algorithms, achieving high accuracies in myocarditis detection. Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. Molecular analyses demonstrated AI's potential in deciphering complex immune interactions. This systematic review provides a comprehensive overview of AI applications in myocarditis, highlighting transformative potential in diagnostics, survival prediction, and molecular understanding. Collaborative efforts are crucial for overcoming limitations and realizing AI's full potential in improving myocarditis care.

心肌炎以心肌发炎为特征,给临床带来了巨大挑战。本研究以 PRISMA 指南为指导,探讨了人工智能(AI)在心肌炎中不断扩大的作用,旨在巩固现有知识并指导未来研究。根据 PRISMA 指南,我们在 PubMed、Cochrane Reviews、Scopus、Embase 和 Web of Science 数据库中进行了系统性综述。使用的 MeSH 术语包括人工智能、深度学习、机器学习、心肌炎和炎症性心肌病。纳入标准包括利用人工智能治疗心肌炎的原创文章,而排除标准则排除了综述、社论和非人工智能研究。搜索共获得 616 篇文章,经筛选后有 42 篇符合纳入标准。我们在每个小节中对已确定的文章进行了分析,这些文章涉及诊断、生存预测和分子分析等方面。诊断研究展示了人工智能算法的多功能性,在心肌炎检测方面达到了很高的准确率。生存预测模型表现出强大的判别能力,尤其是在急诊环境和儿科人群中。分子分析表明了人工智能在破译复杂的免疫相互作用方面的潜力。这篇系统综述全面概述了人工智能在心肌炎中的应用,强调了人工智能在诊断、生存预测和分子理解方面的变革潜力。要克服局限性并充分发挥人工智能在改善心肌炎治疗方面的潜力,合作努力至关重要。
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引用次数: 0
Embracing an era of targeted combination therapy for heart failure with preserved ejection fraction. 迎接射血分数保留型心力衰竭靶向综合疗法时代的到来。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-27 DOI: 10.1007/s10741-024-10432-8
Satoshi Shoji, Stephen J Greene, Robert J Mentz

The concept of quadruple therapy as a "one-size-fit-all" approach is effective among all eligible patients with heart failure with reduced ejection fraction, with consistent and significant clinical benefits including reduced mortality across various subgroups. However, with exception of sodium-glucose cotransporter 2 inhibitors, the consistency of benefit with therapies does not extend to patients with heart failure with preserved ejection fraction. The clinical benefits of other promising medical therapies, such as angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, have been demonstrated only in certain phenotypes of the highly heterogenous heart failure with preserved ejection fraction population. This variability can confuse frontline practicing cardiologists, potentially leading to the under-implementation of these medications. Therefore, we propose a simple approach: "targeted" combination therapy. This strategy aims to optimize evidence-based medications in heart failure with preserved ejection fraction by tailoring treatments to specific subgroups within the heart failure with preserved ejection fraction population where significant benefits are most evident.

四联疗法作为一种 "放之四海而皆准 "的方法,对所有符合条件的射血分数降低型心力衰竭患者都有效,在不同的亚组中具有一致且显著的临床疗效,包括降低死亡率。然而,除了钠-葡萄糖共转运体 2 抑制剂外,其他疗法的持续获益并没有扩展到射血分数保留的心衰患者。血管紧张素受体-奈普利酶抑制剂、矿物质皮质激素受体拮抗剂和胰高血糖素样肽-1受体激动剂等其他有前景的药物疗法,仅在射血分数保留的高度异质性心力衰竭人群的某些表型中显示出临床疗效。这种差异性会使一线心脏病医生感到困惑,可能导致这些药物的使用不足。因此,我们提出了一种简单的方法:"靶向 "联合疗法。这一策略的目的是针对射血分数保留型心力衰竭患者中获益最明显的特定亚组,量身定制治疗方案,从而优化射血分数保留型心力衰竭患者的循证药物治疗。
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引用次数: 0
Treating heart failure by targeting the vagus nerve. 通过迷走神经治疗心力衰竭。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-09 DOI: 10.1007/s10741-024-10430-w
Francesco Gentile, Giulia Orlando, Sabrina Montuoro, Yu Fu Ferrari Chen, Vaughan Macefield, Claudio Passino, Alberto Giannoni, Michele Emdin

Increased sympathetic and reduced parasympathetic nerve activity is associated with disease progression and poor outcomes in patients with chronic heart failure. The demonstration that markers of autonomic imbalance and vagal dysfunction, such as reduced heart rate variability and baroreflex sensitivity, hold prognostic value in patients with chronic heart failure despite modern therapies encourages the research for neuromodulation strategies targeting the vagus nerve. However, the approaches tested so far have yielded inconclusive results. This review aims to summarize the current knowledge about the role of the parasympathetic nervous system in chronic heart failure, describing the pathophysiological background, the methods of assessment, and the rationale, limits, and future perspectives of parasympathetic stimulation either by drugs or bioelectronic devices.

交感神经活动增加和副交感神经活动减少与慢性心力衰竭患者的疾病进展和不良预后有关。尽管采用了现代疗法,但自律神经失衡和迷走神经功能障碍的标志物(如心率变异性和气压反射敏感性降低)在慢性心力衰竭患者中仍具有预后价值,这一事实鼓励了针对迷走神经的神经调节策略的研究。然而,迄今为止所测试的方法都没有得出结论。本综述旨在总结目前关于副交感神经系统在慢性心力衰竭中的作用的知识,描述病理生理学背景、评估方法以及通过药物或生物电子设备刺激副交感神经的原理、局限性和未来前景。
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引用次数: 0
期刊
Heart Failure Reviews
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