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Machine learning in the prevention of heart failure. 预防心力衰竭的机器学习
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-07 DOI: 10.1007/s10741-024-10448-0
Arsalan Hamid, Matthew W Segar, Biykem Bozkurt, Carlos Santos-Gallego, Vijay Nambi, Javed Butler, Michael E Hall, Marat Fudim

Heart failure (HF) is a global pandemic with a growing prevalence and is a growing burden on the healthcare system. Machine learning (ML) has the potential to revolutionize medicine and can be applied in many different forms to aid in the prevention of symptomatic HF (stage C). HF prevention currently has several challenges, specifically in the detection of pre-HF (stage B). HF events are missed in contemporary models, limited therapeutic options are proven to prevent HF, and the prevention of HF with preserved ejection is particularly lacking. ML has the potential to overcome these challenges through existing and future models. ML has limitations, but the many benefits of ML outweigh these limitations and risks in most scenarios. ML can be applied in HF prevention through various strategies such as refinement of incident HF risk prediction models, capturing diagnostic signs from available tests such as electrocardiograms, chest x-rays, or echocardiograms to identify structural/functional cardiac abnormalities suggestive of pre-HF (stage B HF), and interpretation of biomarkers and epigenetic data. Altogether, ML is able to expand the screening of individuals at risk for HF (stage A HF), identify populations with pre-HF (stage B HF), predict the risk of incident stage C HF events, and offer the ability to intervene early to prevent progression to or decline in stage C HF. In this narrative review, we discuss the methods by which ML is utilized in HF prevention, the benefits and pitfalls of ML in HF risk prediction, and the future directions.

心力衰竭(HF)是一种全球流行病,发病率越来越高,对医疗保健系统造成的负担也越来越重。机器学习(ML)具有彻底改变医学的潜力,可以以多种不同的形式应用于无症状心力衰竭(C 阶段)的预防。高血压预防目前面临着一些挑战,特别是在检测高血压前期(B 阶段)方面。在现代模型中,心房颤动事件被遗漏,经证实可预防心房颤动的治疗方案有限,尤其缺乏对射血功能保留的心房颤动的预防。通过现有和未来的模型,ML 有可能克服这些挑战。ML 有其局限性,但在大多数情况下,ML 的诸多益处超过了这些局限性和风险。ML 可通过各种策略应用于高血压预防,如完善高血压发病风险预测模型,从心电图、胸部 X 光片或超声心动图等现有检查中捕捉诊断征象,以确定提示高血压前期(B 期高血压)的心脏结构/功能异常,以及解读生物标志物和表观遗传学数据。总之,ML 能够扩大对高危人群(A 期高血压)的筛查范围,识别高血压前期(B 期高血压)人群,预测 C 期高血压事件的发生风险,并提供早期干预的能力,以防止进展为 C 期高血压或病情恶化。在这篇叙述性综述中,我们将讨论在高频预防中使用 ML 的方法、ML 在高频风险预测中的益处和缺陷以及未来的发展方向。
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引用次数: 0
The role of coronary microcirculation in heart failure with preserved ejection fraction: An unceasing odyssey. 冠状动脉微循环在射血分数保留型心力衰竭中的作用:永无止境的奥德赛
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 DOI: 10.1007/s10741-024-10445-3
Kyriakos Dimitriadis, Panagiotis Theofilis, Georgios Koutsopoulos, Nikolaos Pyrpyris, Eirini Beneki, Fotis Tatakis, Panagiotis Tsioufis, Christina Chrysohoou, Christos Fragkoulis, Konstantinos Tsioufis

Heart failure with preserved ejection fraction (HFpEF) represents an entity with complex pathophysiologic pathways, among which coronary microvascular dysfunction (CMD) is believed to be an important orchestrator. Research in the field of CMD has highlighted impaired vasoreactivity, capillary rarefaction, and inflammation as potential mediators of its development. CMD can be diagnosed via several noninvasive methods including transthoracic echocardiography, cardiac magnetic resonance, and positron emission tomography. Moreover, invasive methods such as coronary flow reserve and index of microcirculatory resistance are commonly employed in the assessment of CMD. As far as the association between CMD and HFpEF is concerned, numerous studies have highlighted the coexistence of CMD in the majority of HFpEF patients. Additionally, patients affected by both conditions may be facing an adverse prognosis. Finally, there is limited evidence suggesting a beneficial effect of renin-angiotensin-aldosterone system blockers, ranolazine, and sodium-glucose cotransporter-2 inhibitors in CMD, with further evidence being awaited regarding the impact of other pharmacotherapies such as anti-inflammatory agents.

射血分数保留型心力衰竭(HFpEF)具有复杂的病理生理途径,其中冠状动脉微血管功能障碍(CMD)被认为是一个重要的协调因素。CMD领域的研究强调,血管活性受损、毛细血管稀疏和炎症是其发展的潜在介质。CMD 可通过几种非侵入性方法诊断,包括经胸超声心动图、心脏磁共振和正电子发射断层扫描。此外,冠状动脉血流储备和微循环阻力指数等有创方法也常用于评估 CMD。就 CMD 与高频血流衰竭之间的关联而言,许多研究都强调大多数高频血流衰竭患者同时患有 CMD。此外,同时患有这两种疾病的患者可能会面临不良预后。最后,有限的证据表明,肾素-血管紧张素-醛固酮系统阻断剂、雷诺拉嗪和钠-葡萄糖共转运体-2 抑制剂对 CMD 有益,至于其他药物疗法(如抗炎药物)的影响,还有待于进一步的证据。
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引用次数: 0
Contextualizing the results of HELIOS-B in the broader landscape of clinical trials for the treatment of transthyretin cardiac amyloidosis. 在治疗转甲状腺素心脏淀粉样变性病的临床试验的大背景下理解 HELIOS-B 的结果。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1007/s10741-024-10444-4
Andrew A Girard, Brett W Sperry

This focused review will highlight the results of HELIOS-B, the first randomized outcomes trial evaluating a gene silencing treatment for transthyretin cardiac amyloidosis (ATTR-CM). In HELIOS-B, vutrisiran was tested against placebo and demonstrated a 28% reduction in the composite of all-cause mortality and recurrent cardiovascular events. Additionally, there were clinically significant benefits on the 6-min walk test, Kansas City Cardiomyopathy Questionnaire, and NYHA class. Discontinuation rates and adverse events were similar between treatment and control arms, suggesting that vutrisiran is well tolerated. In this review, these promising results are explored and compared with other treatment trials in ATTR-CM.

HELIOS-B 是首个评估转甲状腺素心脏淀粉样变性(ATTR-CM)基因沉默疗法的随机结果试验。在 HELIOS-B 试验中,vutrisiran 与安慰剂进行了对比试验,结果显示,全因死亡率和复发性心血管事件的综合死亡率降低了 28%。此外,在6分钟步行测试、堪萨斯城心肌病问卷调查和NYHA分级方面也有显著的临床疗效。治疗组和对照组的停药率和不良反应相似,表明武曲西兰的耐受性良好。本综述探讨了这些令人鼓舞的结果,并与其他 ATTR-CM 治疗试验进行了比较。
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引用次数: 0
Modulating energy metabolism to treat non-obstructive hypertrophic cardiomyopathy? Insights from IMPROVE-HCM. 调节能量代谢治疗非梗阻性肥厚型心肌病?来自 IMPROVE-HCM 的启示。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-23 DOI: 10.1007/s10741-024-10440-8
Alberto Beghini, Alberto Aimo, Andrew P Ambrosy, Daniela Tomasoni

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease worldwide and may present with or without dynamic left ventricular outflow tract obstruction (LVOTO). Significant advances have been made in the management of obstructive HCM. On the other hand, despite their significant symptomatic burden, patients with non-obstructive HCM (nHCM) (i.e., without LVOTO) still do not have evidence-based therapeutical options. The recent IMPROVE-HCM study, a phase 2 randomized, double-blinded trial, aims to place a first step in filling this gap in knowledge. The study assessed the safety (primary endpoint) and efficacy (secondary endpoint) of ninerafaxstat, a novel cardiac mitotrope drug that increases adenosine triphosphate production. We highlighted the main findings of the trial, contextualizing these results within the larger landscape of completed and ongoing trials in nHCM.

肥厚型心肌病(HCM)是全球最常见的遗传性心脏病,可伴有或不伴有动态左心室流出道梗阻(LVOTO)。阻塞性 HCM 的治疗已取得重大进展。另一方面,非阻塞性 HCM(nHCM)(即无左心室流出道梗阻)患者尽管症状严重,但仍然没有循证治疗方案。最近的 IMPROVE-HCM 研究是一项二期随机双盲试验,旨在为填补这一知识空白迈出第一步。该研究评估了尼那非司他的安全性(主要终点)和疗效(次要终点),尼那非司他是一种新型心脏有丝分裂药物,可增加三磷酸腺苷的产生。我们重点介绍了试验的主要发现,并将这些结果与已完成和正在进行的 nHCM 试验结合起来。
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引用次数: 0
Clinical and utilization outcomes with short stay units vs hospital admission for lower risk decompensated heart failure: a systematic review and meta-analysis 短期住院与住院治疗低风险失代偿性心力衰竭的临床和使用效果:系统回顾和荟萃分析
IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1007/s10741-024-10436-4
Peter S. Pang, Sean P. Collins, Zachary L. Cox, Steven K. Roumpf, Christian C. Strachan, William Swigart, Mirian Ramirez, Benton R. Hunter

With over 1 million primary heart failure (HF) hospitalizations annually, nearly 80% of patients who present to the emergency department with decompensated HF (DHF) are hospitalized. Short stay units (SSU) present an alternative to hospitalization, yet the effectiveness of the SSU strategy of care is not well known. This study is to determine the effectiveness of a SSU strategy compared with hospitalization in lower-risk patients with DHF. Our primary outcome was a composite of 30-day mortality and re-hospitalization. Key secondary outcomes included 90-day mortality and re-hospitalization, costs, and 30-day days-alive-and-out-of-hospital (DAOOH). This is a systematic review and meta-analysis, following PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, CINAHL, SCOPUS, and Web of Science were searched from inception through February 2024. Either randomized trials or comparative observational studies were included if they compared outcomes between low-risk ED DHF patients admitted to an SSU (defined as an observation unit with expected stay ≤ 48 h) vs. admitted to the hospital. Two authors independently screened all titles and abstracts and then identified full texts for inclusion. Data extraction and risk of bias assessments were performed by two authors in parallel. The primary outcome was a composite of death or readmission within 30 days, reported as relative risk (RR), where a RR < 1 favored the SSU strategy. Secondary outcomes included 90-day mortality and re-hospitalization, costs, and 1-month days-alive-and-out-of-hospital (DAOOH). Of the 467 articles identified by our search strategy, only 3 full text articles were included. In meta-analysis for the primary outcome of 30-day death or readmission, the RR was 0.95 (95% CI = 0.56 to 1.63; I2 = 0%) for patients randomized to SSU vs hospitalization (2 studies, 241 patients). There were only 2 total deaths at 30 days in the 2 studies (total N = 258) which reported 30-day mortality, both in hospitalized patients. Only one study reported 90-day outcomes, showing no significant differences. Costs were lower in the SSU arm from one study, and 30-day DAOOH also favored SSU based on a single randomized trial. Based on very limited evidence, SSU provides similar efficacy for 30-day and 90-day mortality and readmission compared to hospitalization. An SSU strategy appears safe and may be cost effective.

每年有超过 100 万名原发性心力衰竭(HF)患者住院治疗,在急诊科就诊的失代偿性心力衰竭(DHF)患者中有近 80% 需要住院治疗。短期住院部(SSU)是住院治疗的一种替代方案,但短期住院部护理策略的有效性尚不清楚。本研究旨在确定短期住院治疗策略与住院治疗相比,对低风险 DHF 患者的疗效。我们的主要结果是 30 天死亡率和再次住院率。主要次要结果包括 90 天死亡率和再住院率、费用以及 30 天存活和出院天数(DAOOH)。这是一项系统回顾和荟萃分析,遵循 PRISMA 指南。从开始到 2024 年 2 月,对 MEDLINE、EMBASE、CENTRAL、CINAHL、SCOPUS 和 Web of Science 进行了检索。随机试验或比较观察性研究均被纳入,只要这些研究比较了入住 SSU(定义为预计住院时间不超过 48 小时的观察病房)的低风险急诊 DHF 患者与入住医院的低风险急诊 DHF 患者之间的治疗效果。两位作者独立筛选了所有标题和摘要,然后确定了纳入的全文。两位作者同时进行数据提取和偏倚风险评估。主要结果是30天内死亡或再入院的综合结果,以相对风险(RR)报告,RR < 1有利于SSU策略。次要结果包括 90 天死亡率和再入院率、费用以及 1 个月的存活和出院天数(DAOOH)。在我们的搜索策略所确定的 467 篇文章中,仅有 3 篇全文收录。在对 30 天死亡或再入院这一主要结果的荟萃分析中,随机接受 SSU 与住院治疗的患者的 RR 为 0.95(95% CI = 0.56 至 1.63;I2 = 0%)(2 项研究,241 名患者)。在报告了 30 天死亡率的 2 项研究(总人数 = 258)中,仅有 2 例患者在 30 天内死亡,且均为住院患者。只有一项研究报告了 90 天的治疗结果,结果显示两者无明显差异。一项研究显示 SSU 治疗组的成本较低,根据一项随机试验,30 天 DAOOH 也更倾向于 SSU。基于非常有限的证据,与住院治疗相比,SSU 对 30 天和 90 天死亡率和再入院治疗具有相似的疗效。SSU 策略似乎是安全的,而且可能具有成本效益。
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引用次数: 0
Contemporary clinical role of echocardiography in patients with advanced heart failure 超声心动图在晚期心力衰竭患者中的当代临床作用
IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1007/s10741-024-10434-6
Vincenzo Nuzzi, Paolo Manca, Massimiliano Mulè, Simona Leone, Luca Fazzini, Manlio G. Cipriani, Francesco F. Faletra

Echocardiography represents an essential tool for imagers and clinical cardiologists in the management of patients with heart failure. Advanced heart failure (AdHF) is a more severe and, typically, later stage of HF that exposes patients to a high risk of adverse outcomes, with a 1-year mortality rate of around 50%. Currently, several therapies are available to improve the outcomes of these patients, reduce their mortality rate, and, possibly, delay the need for advanced therapies such as heart transplant and long-term mechanical circulatory support. When accurately performed and interpreted, echocardiography provides crucial information to properly tailor medical and device therapy of patients with AdHF and to identify those at even higher risk. In this review, we present the state of the art of echocardiography applications in the clinical management of patients with AdHF. We will discuss the role of echocardiography chronologically, beginning with the prediction of AdHF, proceeding through diagnosis, and detailing how echocardiography informs clinical decision-making, before concluding with indications for advanced therapies.

Graphical Abstract

The role of echocardiography in the management of patients with advanced heart failure. Echocardiography is a useful method for predicting the occurrence of AdHF during follow-up of patients with HF (top line). The diagnosis of AdHF requires an echocardiographic criterion for AdHF (middle line). In patients with AdHF, echocardiography is useful to identify patients who will benefit most from medical therapy adjustment, device therapy, and LVAD implantation. HF, heart failure; LA, left atrium; RV, right ventricle; LVEF, left ventricular ejection fraction. HF, heart failure; LA, left atrium; LVEF, left ventricular ejection fraction; RV, right ventricle

超声心动图是图像学家和临床心脏病专家治疗心力衰竭患者的重要工具。晚期心力衰竭(AdHF)是一种更为严重的心力衰竭,通常是心力衰竭的晚期阶段,患者面临不良后果的风险很高,1 年死亡率约为 50%。目前,有几种疗法可以改善这些患者的预后,降低其死亡率,并有可能推迟对心脏移植和长期机械循环支持等高级疗法的需求。如果超声心动图检查和解读准确,就能为 AdHF 患者提供至关重要的信息,从而正确调整医疗和器械疗法,并识别风险更高的患者。在这篇综述中,我们将介绍超声心动图在 AdHF 患者临床管理中的应用现状。我们将按时间顺序讨论超声心动图的作用,从 AdHF 的预测开始,到诊断,并详细介绍超声心动图如何为临床决策提供信息,最后介绍晚期疗法的适应症。超声心动图是随访心力衰竭患者期间预测 AdHF 发生的有效方法(上图)。AdHF 的诊断需要有 AdHF 的超声心动图标准(中线)。对于 AdHF 患者,超声心动图有助于确定哪些患者将从药物治疗调整、设备治疗和 LVAD 植入中获益最多。HF,心力衰竭;LA,左心房;RV,右心室;LVEF,左心室射血分数。HF(心力衰竭);LA(左心房);LVEF(左心室射血分数);RV(右心室
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引用次数: 0
Lifestyle interventions in cardiometabolic HFpEF: dietary and exercise modalities 心血管代谢性高血压(HFpEF)的生活方式干预:饮食和运动方式
IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-16 DOI: 10.1007/s10741-024-10439-1
Antonio Vacca, Rongling Wang, Natasha Nambiar, Federico Capone, Catherine Farrelly, Ahmed Mostafa, Leonardo A. Sechi, Gabriele G. Schiattarella

Heart failure with preserved ejection fraction (HFpEF) is rapidly growing as the most common form of heart failure. Among HFpEF phenotypes, the cardiometabolic/obese HFpEF — HFpEF driven by cardiometabolic alterations — emerges as one of the most prevalent forms of this syndrome and the one on which recent therapeutic success have been made. Indeed, pharmacological approaches with sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have proved to be effective due to metabolic protective effects. Similarly, lifestyle changes, including diet and exercise are crucial in HFpEF management. Increasing evidence supports the important role of diet and physical activity in the pathogenesis, prognosis, and potential reversal of HFpEF. Metabolic derangements and systemic inflammation are key features of HFpEF and represent the main targets of lifestyle interventions. However, the underlying mechanisms of the beneficial effects of these interventions in HFpEF are incompletely understood. Hence, there is an unmet need of tailored lifestyle intervention modalities for patients with HFpEF. Here we present the current available evidence on lifestyle interventions in HFpEF management and therapeutics, discussing their modalities and potential mechanisms.

射血分数保留型心力衰竭(HFpEF)正迅速发展成为最常见的心力衰竭形式。在射血分数保留型心力衰竭表型中,心脏代谢/肥胖型射血分数保留型心力衰竭(HFpEF)--由心脏代谢改变引起的射血分数保留型心力衰竭--是该综合征最常见的形式之一,也是最近治疗取得成功的一种。事实上,使用钠-葡萄糖共转运体 2 型抑制剂(SGLT2i)和胰高血糖素样肽-1 受体激动剂(GLP-1RA)的药物治疗方法因其代谢保护作用而被证明是有效的。同样,生活方式的改变,包括饮食和运动,在高频血栓栓塞治疗中也至关重要。越来越多的证据表明,饮食和体育锻炼在 HFpEF 的发病机制、预后和潜在逆转中发挥着重要作用。代谢紊乱和全身炎症是 HFpEF 的主要特征,也是生活方式干预的主要目标。然而,这些干预措施对 HFpEF 产生有益影响的内在机制尚未完全明了。因此,为 HFpEF 患者量身定制生活方式干预方法的需求尚未得到满足。在此,我们将介绍目前生活方式干预在高频心衰管理和治疗中的可用证据,并讨论其模式和潜在机制。
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引用次数: 0
Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis 射血分数保留型心力衰竭和心房颤动:导管消融与标准药物疗法的比较--系统回顾和荟萃分析
IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-15 DOI: 10.1007/s10741-024-10437-3
Mehrdad Mahalleh, Hamidreza Soleimani, Mohammadreza Pazoki, Saba Maleki, Parham Dastjerdi, Pouya Ebrahimi, Sahar Zafarmandi, Sima Shamshiri Khamene, Izat Mohammad Khawajah, Shehroze Tabassum, Rahul Bhardwaj, Jishanth Mattumpuram, Andrew Kaplan, Marmar Vaseghi, Parisa Seilani, Ali Bozorgi, Kaveh Hosseini, Stylianos Tzeis

Background

The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).

Methods

PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.

Results

Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group.

Conclusion

CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population.

背景 最新指南主张,在治疗射血分数降低型心力衰竭(HFrEF)患者的心房颤动(AF)时,采用导管消融术(CA)而非标准药物疗法(SMT)。然而,在射血分数保留型心力衰竭(HFpEF)患者中,CA 与 SMT 的疗效相比还存在很大的知识差距。方法系统检索了截至 2024 年 2 月的 PubMed、Scopus 和 Embase。由于随机研究的数量有限,因此还纳入了倾向评分匹配的观察性研究,对射血分数保留的心力衰竭患者的 CA 与 SMT 进行了比较。主要结果是全因死亡率和心房颤动住院率的复合终点。结果共纳入了 8 项研究,其中包括 17717 名 SMT 患者和 2537 名 CA 患者。CA与全因死亡率和心房颤动住院综合终点风险明显降低相关(HR 0.61;95% CI,0.43-0.85)。CA 组的 HF 住院风险(HR 0.44;95% CI,0.23-0.83)、心血管死亡率(HR 0.43;95% CI,0.22-0.84)和房颤复发风险(HR 0.53;95% CI,0.39-0.73)也较低。
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引用次数: 0
Beyond weight loss: the potential of glucagon-like peptide-1 receptor agonists for treating heart failure with preserved ejection fraction 减肥之外:胰高血糖素样肽-1 受体激动剂治疗射血分数保留型心力衰竭的潜力
IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1007/s10741-024-10438-2
Tian-Yu Wang, Qiang Yang, Xin-Yi Cheng, Jun-Can Ding, Peng-Fei Hu

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various phenotypes, and obesity is one of the most common and clinically relevant phenotypes of HFpEF. Obesity contributes to HFpEF through multiple mechanisms, including sodium retention, neurohormonal dysregulation, altered energy substrate metabolism, expansion of visceral adipose tissue, and low-grade systemic inflammation. Glucagon-like peptide-1 (GLP-1) is a hormone in the incretin family. It is produced by specialized cells called neuroendocrine L cells located in the distal ileum and colon. GLP-1 reduces blood glucose levels by promoting glucose-dependent insulin secretion from pancreatic β cells, suppressing glucagon release from pancreatic α cells, and blocking hepatic gluconeogenesis. Recent evidence suggests that GLP-1 receptor agonists (GLP-1 RAs) can significantly improve physical activity limitations and exercise capacity in obese patients with HFpEF. The possible cardioprotective mechanisms of GLP-1 RAs include reducing epicardial fat tissue thickness, preventing activation of the renin–angiotensin–aldosterone system, improving myocardial energy metabolism, reducing systemic inflammation and cardiac oxidative stress, and delaying the progression of atherosclerosis. This review examines the impact of obesity on the underlying mechanisms of HFpEF, summarizes the trial data on cardiovascular outcomes of GLP-1 RAs in patients with type 2 diabetes mellitus, and highlights the potential cardioprotective mechanisms of GLP-1 RAs to give a pathophysiological and clinical rationale for using GLP-1 RAs in obese HFpEF patients.

射血分数保留型心力衰竭(HFpEF)是一种具有多种表型的异质性综合征,而肥胖是 HFpEF 最常见且与临床相关的表型之一。肥胖通过多种机制导致心衰,包括钠潴留、神经激素失调、能量底物代谢改变、内脏脂肪组织扩张和低度全身炎症。胰高血糖素样肽-1(GLP-1)是增量素家族中的一种激素。它由位于回肠远端和结肠中的称为神经内分泌 L 细胞的特化细胞产生。GLP-1 通过促进胰腺β细胞分泌葡萄糖依赖性胰岛素、抑制胰腺α细胞释放胰高血糖素以及阻断肝脏葡萄糖生成来降低血糖水平。最近的证据表明,GLP-1 受体激动剂(GLP-1 RAs)可显著改善肥胖型高频心衰患者的体力活动限制和运动能力。GLP-1 RAs 可能的心脏保护机制包括减少心外膜脂肪组织厚度、防止肾素-血管紧张素-醛固酮系统活化、改善心肌能量代谢、减少全身炎症和心脏氧化应激以及延缓动脉粥样硬化的进展。本综述探讨了肥胖对 HFpEF 潜在机制的影响,总结了 GLP-1 RAs 对 2 型糖尿病患者心血管预后的试验数据,并强调了 GLP-1 RAs 的潜在心脏保护机制,从而为肥胖 HFpEF 患者使用 GLP-1 RAs 提供了病理生理学和临床依据。
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引用次数: 0
New insights gained from cellular landscape changes in myocarditis and inflammatory cardiomyopathy. 从心肌炎和炎症性心肌病的细胞景观变化中获得新见解。
IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-06-19 DOI: 10.1007/s10741-024-10406-w
Weiteng Wang, Hao Jia, Xiumeng Hua, Jiangping Song

Advances in the etiological classification of myocarditis and inflammatory cardiomyopathy (ICM) have reached a consensus. However, the mechanism of myocarditis/ICM remains unclear, which affects the development of treatment and the improvement of outcome. Cellular transcription and metabolic reprogramming, and the interactions between cardiomyocytes and non-cardiomyocytes, such as the immune cells, contribute to the process of myocarditis/ICM. Recent efforts have been made by multi-omics techniques, particularly in single-cell RNA sequencing, to gain a better understanding of the cellular landscape alteration occurring in disease during the progression. This article aims to provide a comprehensive overview of the latest studies in myocarditis/ICM, particularly as revealed by single-cell sequencing.

心肌炎和炎症性心肌病(ICM)的病因分类取得了进展,并已达成共识。然而,心肌炎/炎症性心肌病的发病机制仍不清楚,这影响了治疗的发展和疗效的改善。细胞转录和代谢重编程,以及心肌细胞与非心肌细胞(如免疫细胞)之间的相互作用,都是心肌炎/心肌病发生的原因。近年来,多组学技术,尤其是单细胞 RNA 测序技术的应用,使人们对疾病进展过程中发生的细胞景观变化有了更深入的了解。本文旨在全面概述有关心肌炎/心肌梗死的最新研究,尤其是单细胞测序所揭示的内容。
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引用次数: 0
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Heart Failure Reviews
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