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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
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
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
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
The utility of urine sodium-guided diuresis during acute decompensated heart failure. 急性失代偿性心力衰竭期间尿钠指导性利尿的实用性。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI: 10.1007/s10741-024-10424-8
Hasan K Siddiqi, Zachary L Cox, Lynne W Stevenson, Kevin Damman, Jozine M Ter Maaten, Brian Bales, Jin H Han, Juan B Ivey-Miranda, JoAnn Lindenfeld, Karen F Miller, Henry Ooi, Veena S Rao, Kelly Schlendorf, Alan B Storrow, Ryan Walsh, Jesse Wrenn, Jeffrey M Testani, Sean P Collins

Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple approaches have been tried to achieve adequate decongestion rapidly while minimizing adverse effects, no single diuretic strategy has shown superiority, and there is a paucity of data and guidelines to utilize in making these decisions. Observational cohort studies have shown associations between urine sodium excretion and outcomes after hospitalization for ADHF. Urine chemistries (urine sodium ± urine creatinine) may guide diuretic titration during ADHF, and multiple randomized clinical trials have been designed to compare a strategy of urine chemistry-guided diuresis to usual care. This review will summarize current literature for diuretic monitoring and titration strategies, outline evidence gaps, and describe the recently completed and ongoing clinical trials to address these gaps in patients with ADHF with a particular focus on the utility of urine sodium-guided strategies.

对急性失代偿性心力衰竭(ADHF)住院患者进行利尿治疗以达到减充血的目的是治疗的核心目标。虽然已经尝试了多种方法来迅速实现充分的减充血,同时将不良反应降至最低,但没有任何一种利尿策略显示出其优越性,而且在做出这些决定时可利用的数据和指南也很少。观察性队列研究显示,尿钠排泄与 ADHF 住院后的预后之间存在关联。尿液化学成分(尿钠和尿肌酐)可指导 ADHF 期间的利尿剂滴定,多项随机临床试验旨在比较尿液化学成分指导的利尿策略和常规护理。本综述将总结目前有关利尿剂监测和滴定策略的文献,概述证据差距,并介绍近期完成和正在进行的临床试验,以弥补 ADHF 患者的这些差距,尤其关注尿钠指导策略的效用。
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引用次数: 0
Congestion/decongestion in heart failure: what does it mean, how do we assess it, and what are we missing?-is there utility in measuring volume? 心力衰竭的充血/心力衰竭:它意味着什么,我们如何评估它,我们遗漏了什么?
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI: 10.1007/s10741-024-10429-3
Wayne L Miller

Clinical congestion remains a major cause of hospitalization and re-hospitalizations in patients with chronic heart failure (HF). Despite the high prevalence of this issue and clinical concern in HF practice, there is limited understanding of the complex pathophysiology relating to the "congestion" of congestive HF. There is no unifying definition or clear consensus on what is meant or implied by the term "congestion." Further, the discordance in study findings relating congestion to physical signs and symptoms of HF, cardiac hemodynamics, or metrics of weight change or fluid loss with diuretic therapy has not added clarity. In this review, these factors will be discussed to add perspective to this issue and consider the factors driving "congestion." There remains a need to better understand the roles of fluid retention promoting intravascular and interstitial compartment expansions, blood volume redistribution from venous reservoirs, altered venous structure and capacity, elevated cardiac filling pressure hemodynamics, and heterogeneous intravascular volume profiles (plasma volume and red blood cell mass) with a goal to help demystify "congestion" in HF. Further, this includes highlighting the importance of recognizing that congestion is not the result of a single pathway but a complex of responses some of which produce symptoms while others do not; yet, we confine these varied responses to the single and somewhat vague term "congestion."

临床充血仍是慢性心力衰竭(HF)患者住院和再次住院的主要原因。尽管这一问题在心房颤动临床实践中非常普遍并受到关注,但人们对与充血性心房颤动 "充血 "有关的复杂病理生理学的了解却非常有限。对于 "充血 "一词的含义或含义,目前还没有统一的定义或明确的共识。此外,有关充血与心房颤动的体征和症状、心脏血流动力学或体重变化指标或利尿剂治疗后体液丢失的研究结果也不一致,这并没有使研究结果更加清晰。本综述将讨论这些因素,以增加对这一问题的认识,并考虑导致 "充血 "的因素。我们仍然需要更好地了解液体潴留在促进血管内和间质腔膨胀、静脉储库血容量再分配、静脉结构和容量改变、心脏充盈压血流动力学升高以及异质性血管内容量分布(血浆容量和红细胞质量)等方面的作用,以帮助揭开高血压 "充血 "的神秘面纱。此外,这还包括强调认识到充血不是单一途径的结果,而是一系列复杂反应的重要性,其中一些反应会产生症状,而另一些则不会;然而,我们将这些不同的反应局限于 "充血 "这个单一而略显模糊的术语。
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引用次数: 0
Pharmacological management of heart failure in adults with congenital heart disease. 先天性心脏病成人心力衰竭的药物治疗。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI: 10.1007/s10741-024-10428-4
Barbara Karnkowska, Wissam Harmouch, Peter Newman, Hamza Malik, Bisma Khwaja, Alexandra Lewis, Mohammed Faluk, Khaled Chatila

Congenital heart disease (CHD) is the most common global congenital defect affecting over 2.4 million individuals in the United States. Ongoing medical and surgical advancements have improved the survival of children with CHD leading to a shift where, as of 2010, adults constitute two-thirds of the CHD patient population. The increasing number and aging of adult congenital heart disease (ACHD) patients present a clinical challenge due to heightened complexity, morbidity, and mortality. Studies indicate that 1 in 13 ACHD patients will develop heart failure (HF) in their lifetime. ACHD-HF patients experience more frequent emergency department visits, higher hospitalization rates, longer hospital stays, and higher mortality compared to non-ACHD patients with heart failure (non-ACHD-HF). Despite HF being the leading cause of death in ACHD patients, there is a notable gap in evidence regarding treatment. While guideline-directed medical therapy (GDMT) has been extensively studied in non-ACHD-HF, research specific to ACHD-HF individuals is limited. This article aims to comprehensively review available literature addressing the pharmacological treatment of ACHD-HF.

先天性心脏病(CHD)是全球最常见的先天性缺陷,在美国影响着 240 多万人。医疗和外科手术的不断进步提高了儿童先天性心脏病患者的存活率,截至 2010 年,成人先天性心脏病患者已占总人数的三分之二。成人先天性心脏病(ACHD)患者的数量和年龄都在不断增加,由于其复杂性、发病率和死亡率都有所提高,这给临床治疗带来了挑战。研究表明,每 13 名 ACHD 患者中就有一人会在一生中患上心力衰竭(HF)。与非 ACHD 心衰患者(非 ACHD-HF)相比,ACHD-HF 患者的急诊就诊频率更高,住院率更高,住院时间更长,死亡率更高。尽管心力衰竭是导致 ACHD 患者死亡的主要原因,但在治疗方面却存在明显的证据差距。虽然指南指导的医疗疗法(GDMT)已在非 ACHD-HF 患者中得到广泛研究,但针对 ACHD-HF 患者的研究却很有限。本文旨在全面回顾有关 ACHD-HF 药物治疗的现有文献。
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引用次数: 0
Peripartum cardiomyopathy: a comprehensive and contemporary review. 围产期心肌病:全面的当代综述。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI: 10.1007/s10741-024-10435-5
Farai Russell Sigauke, Hopewell Ntsinjana, Nqoba Tsabedze

Cardiovascular disease is a major non-communicable disease globally, with increasing prevalence, posing a significant public health challenge. It is the leading non-obstetric cause of perinatal morbidity and mortality, with a substantial number of cardiac fatalities occurring in individuals without any known pre-existing cardiovascular disease. Peripartum cardiomyopathy is a type of de novo heart failure that occurs in pregnant women in the late stages of pregnancy or following delivery. Despite extensive research, diagnosing and managing peripartum cardiomyopathy remains challenging, resulting in significant morbidity and mortality. Recent advancements and novel approaches have been made to better understand and manage peripartum cardiomyopathy, including molecular and non-molecular biomarkers, genetic predisposition and risk prediction, targeted therapies, multidisciplinary care, and improved patient education. This narrative review provides a comprehensive overview and new perspectives on peripartum cardiomyopathy, covering its epidemiology, updated pathophysiological mechanisms, diagnosis, management, and future research directions for healthcare professionals, researchers, and clinicians.

心血管疾病是全球主要的非传染性疾病,发病率不断上升,对公共卫生构成重大挑战。它是围产期发病率和死亡率的主要非产科原因,其中相当多的心脏死亡病例发生在没有任何已知先心病的人身上。围产期心肌病是一种新发心力衰竭,发生在妊娠晚期或产后的孕妇身上。尽管进行了广泛的研究,但诊断和治疗围产期心肌病仍然具有挑战性,会导致严重的发病率和死亡率。为了更好地了解和管理围产期心肌病,最近取得了一些进展和新方法,包括分子和非分子生物标志物、遗传易感性和风险预测、靶向治疗、多学科护理和改进的患者教育。这篇叙述性综述全面概述了围产期心肌病并提供了新的视角,涵盖了其流行病学、最新的病理生理机制、诊断、管理以及未来的研究方向,供医疗保健专业人员、研究人员和临床医生参考。
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引用次数: 0
A fine addition: Finerenone in the evolving landscape of heart failure with preserved ejection fraction. 锦上添花:非格列酮:射血分数保留型心力衰竭不断变化的前景。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-30 DOI: 10.1007/s10741-024-10462-2
Rami Halaseh, Andrew J Sauer, Orly Vardeny, Mario Enrico Canonico, Josephine Harrington, Jana Svetlichnaya, Andrew P Ambrosy
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引用次数: 0
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Heart Failure Reviews
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