Heart, Lung and Circulation最新文献

英文中文

Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome 急性冠状动脉综合征中阻塞性睡眠呼吸暂停的表型特征。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-12-01 DOI: 10.1016/j.hlc.2024.07.014

Benjamin K. Tong PhD , Seren Ucak PhD , Hasthi Dissanayake PhD , Sanjay Patel FRACP, PhD , Glenn M. Stewart PhD , Kate Sutherland PhD , Brendon J. Yee MBChB, PhD , Usaid Allahwala MBBS, PhD , Ravinay Bhindi MBBS, PhD , Philip de Chazal PhD , Peter A. Cistulli MD, PhD

Background

Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.

Method

Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37–132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.

Results

OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2–6.8] vs 7.4 [6.6–8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7–1.0] vs 0.9 [0.8–1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.

Conclusions

A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.

背景：最近的中性随机临床试验为治疗阻塞性睡眠呼吸暂停（OSA）以控制心血管风险提供了临床依据。需要明确 OSA 与心血管疾病之间的联系，以提高未来临床试验的稳健性。我们旨在确定急性冠状动脉综合征（ACS）和 OSA 患者的临床相关性和代用心血管标志物的特征：方法：共对 66 名确诊为急性冠状动脉综合征（ACS）的患者进行了研究。患者在出院后（中位数[四分位间差]62[37-132]天）接受了无人值守的多导睡眠图检查。对患者进行了爱普沃斯嗜睡量表、柏林和 STOP-BANG 问卷调查。对血管结构和功能以及心血管自主神经功能进行了替代测量。脉搏波振幅下降是从通宵多导睡眠图的脉搏血氧仪信号中得出的：94%的患者被诊断为 OSA（呼吸暂停-低通气指数 [AHI] ≥5）。68%的患者被诊断为中重度 OSA（AHI≥15）。17%的患者出现白天嗜睡（埃普沃斯嗜睡量表≥10）。OSA筛查问卷不足以识别中重度OSA，接收者工作特征曲线下面积约为0.64。动脉僵化（颈动脉-股动脉脉搏波速度，6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s，p=0.002）和颈动脉内膜厚度（0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm，p=0.027）在中度至重度 OSA 患者中有所升高。在对年龄、性别和体重指数进行调整后，这些关系没有统计学意义。其他代用心血管标志物也没有发现任何关系：结论：在大多数非睡眠人群中，发现患有 ACS 的 OSA 患病率很高，这表明心血管疾病患者中 OSA 的诊断率严重不足。OSA筛查问卷的局限性凸显了作为心血管风险管理一部分的OSA筛查新模式的必要性。在对血管结构和功能的测量中观察到了一系列不一致的异常，而这些异常似乎在很大程度上是由干扰因素造成的。还需要进一步的研究来阐明 ACS 患者中是否存在 OSA 及其影响的生物标志物。

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引用次数: 0

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Eligibility and Prescription Rates in Patients Presenting With Recurrent Acute Coronary Syndromes Proprotein Convertase Subtilisin/Kexin Type 9抑制剂在复发性急性冠状动脉综合征患者中的使用资格和处方率。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-12-01 DOI: 10.1016/j.hlc.2024.07.012

William B. He MD , Dylan Jape MD , Shane Nanayakkara MBBS, PhD , James A. Shaw MBBS, PhD

Background

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel medications for reducing low-density lipoprotein cholesterol (LDL-C) levels. In 2020, the Australian Pharmaceutical Benefits Scheme (PBS) began subsidising PCSK9 inhibitors for secondary prevention of cardiovascular disease in patients with LDL-C >2.6 mmol/L despite statin and ezetimibe therapy. This criterion was expanded to LDL-C >1.8 mmol/L in 2022.

Method

A retrospective analysis was conducted on patients admitted to a quaternary hospital with acute coronary syndrome (ACS) between 2020–2022. PCSK9 inhibitor eligibility and prescribing patterns were compared between recurrent ACS patients (≥2 events within 5 years) and first-presentation ACS patients. Australian PBS 2020 and 2022 criteria were applied to assess eligibility.

Results

Of 817 ACS patients with LDL-C >1.8 mmol/L, 118 (14.4%) were categorised as recurrent ACS (33.9% female, mean age 67 years, LDL-C 2.9 mmol/L). When compared with first-presentation ACS patients (n=699), recurrent ACS patients had significantly higher proportions already on statin therapy (49.2% vs 6.0%, p<0.001) and ezetimibe (20.3% vs 2.4%, p<0.001). Recurrent ACS patients had significantly higher proportions of 2020 PBS-eligible patients (11.0% vs 1.3%, p<0.001) and 2022 PBS-eligible patients (20.3% vs 2.2%, p<0.001). There were no significant differences in PCSK9 inhibitor prescription rates among eligible patients (four of 13, 30.8% vs four of nine, 44.4%, p=0.51). Univariate binary logistic regression demonstrated that statin intolerance was significantly associated with PCSK9 inhibitor prescription (odds ratio 10; 95% confidence interval 1.3–79.3; p=0.029).

Conclusions

Despite significantly higher eligibility rates, PCSK9 inhibitor uptake remains low in recurrent ACS patients, demonstrating the need to raise further awareness about eligibility criteria and encourage proactive prescription to prevent recurrent cardiovascular events.

背景：Protein convertase subtilisin/kexin type 9 (PCSK9) 抑制剂是降低低密度脂蛋白胆固醇（LDL-C）水平的新型药物。2020 年，澳大利亚药品福利计划（PBS）开始补贴 PCSK9 抑制剂，用于他汀类药物和依折麦布治疗后 LDL-C 仍大于 2.6 mmol/L 的患者的心血管疾病二级预防。2022 年，这一标准扩大到 LDL-C >1.8 mmol/L：对一家四级医院 2020-2022 年间收治的急性冠状动脉综合征（ACS）患者进行了回顾性分析。比较了复发性 ACS 患者（5 年内≥2 次）和首次出现 ACS 患者使用 PCSK9 抑制剂的资格和处方模式。澳大利亚 PBS 2020 和 2022 标准用于评估资格：在 817 名 LDL-C >1.8 mmol/L 的 ACS 患者中，118 人（14.4%）被归类为复发性 ACS（33.9% 为女性，平均年龄 67 岁，LDL-C 2.9 mmol/L）。与首次就诊的 ACS 患者（n=699）相比，复发性 ACS 患者已接受他汀类药物治疗的比例明显更高（49.2% vs 6.0%，p结论：尽管符合条件的比例明显较高，但复发性 ACS 患者对 PCSK9 抑制剂的吸收率仍然很低，这表明有必要进一步提高对符合条件标准的认识，并鼓励积极处方以预防复发性心血管事件的发生。

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引用次数: 0

Cardiogenic Shock and Percutaneous Left Ventricular Assist Devices—Investigating Gender-Specific Disparities 心源性休克和经皮左心室辅助装置——调查性别差异。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-12-01 DOI: 10.1016/j.hlc.2024.11.005

Mohammad Sarraf MD , Saraschandra Vallabhajosula MD, MSc , Vinayak Nagaraja MBBS, MBiostat, FRACP

引用次数: 0

Massive Right Atrial Enlargement in an Adult 成人大规模右心房扩大。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-12-01 DOI: 10.1016/j.hlc.2024.06.1037

Alexander Marschall MD , Inés Gómez Sánchez MD , Carmen Dejuán Bitriá MD , Blanca Coto Morales MD , Freddy Delgado Calva MD , David Martí Sánchez MD, PhD

引用次数: 0

Intracoronary Versus Intravenous Low-Dose Tirofiban in Patients With ST-Elevation Myocardial Infarction: A Meta-Analysis of Randomised Controlled Trials ST段抬高型心肌梗死患者冠状动脉内治疗与静脉注射小剂量替罗非班治疗的比较：随机对照试验的 Meta 分析。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-11-01 DOI: 10.1016/j.hlc.2024.05.006

Liye Shi MD, PhD, Ling Chen MD, PhD, Wen Tian MD, PhD, Shijie Zhao MD, PhD

Background

This meta-analysis aimed to evaluate the effects of intracoronary (IC) low-dose tirofiban versus intravenous (IV) administration on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).

Methods

All published randomised controlled trials (RCTs) comparing the effects of IC low-dose tirofiban (a bolus of ≤10 ug/kg) versus IV administration in patients with STEMI were identified by searching PubMed, EMBASE, Cochrane Library, and ISI Web of Science from inception to June 2023, with no language restriction. The risk ratio (RR) with 95% confidence intervals (CI) and the weighted mean difference (WMD) with 95% CI were calculated.

Results

Eleven RCTs involving 1,802 patients were included. Compared with the IV group, IC low-dose tirofiban was associated with improved major adverse cardiac events rate (RR 0.595, 95% CI 0.442–0.802; p=0.001), left ventricular ejection fraction (WMD 1.982, 95% CI 0.565–3.398; p=0.006), thrombolysis in myocardial infarction (TIMI) flow grade (RR 1.065, 95% CI 1.004–1.131; p=0.037), and TIMI myocardial perfusion grade (RR 1.194, 95% CI 1.001–1.425; p=0.049). The two groups had no significant difference in bleeding events (RR 0.952, 95% CI 0.709–1.279; p=0.745).

Conclusions

Intracoronary low-dose tirofiban administration may be a safe and effective alternative to IV administration in STEMI patients.

研究背景这项荟萃分析旨在评估冠状动脉内（IC）小剂量替罗非班与静脉（IV）给药对ST段抬高型心肌梗死（STEMI）患者临床预后的影响：方法：通过检索PubMed、EMBASE、Cochrane Library和ISI Web of Science，确定了所有已发表的随机对照试验（RCT），这些试验比较了IC低剂量替罗非班（栓剂量≤10微克/千克）与静脉给药对STEMI患者的影响，从开始到2023年6月，没有语言限制。计算了风险比（RR）及95%置信区间（CI）和加权平均差（WMD）及95%置信区间：结果：共纳入 11 项 RCT，涉及 1802 名患者。与静脉注射组相比，IC低剂量替罗非班与主要不良心脏事件发生率（RR 0.595，95% CI 0.442-0.802；P=0.001）、左室射血分数（WMD 1.982，95% CI 0.565-3.398；P=0.006）、心肌梗死溶栓（TIMI）血流分级（RR 1.065，95% CI 1.004-1.131；P=0.037）和 TIMI 心肌灌注分级（RR 1.194，95% CI 1.001-1.425；P=0.049）。两组在出血事件方面无明显差异（RR 0.952，95% CI 0.709-1.279；P=0.745）：结论：在 STEMI 患者中，冠状动脉内小剂量替罗非班给药可能是静脉给药的一种安全有效的替代方案。

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引用次数: 0

Interplay of Age and Risk Factor Control Upon Coronary Atheroma Progression 年龄和危险因素控制对冠状动脉粥样硬化进展的相互作用

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-11-01 DOI: 10.1016/j.hlc.2024.06.1031

Iryna Dykun MD , Julie Carlo MS , Steven E. Nissen MD , Samir R. Kapadia MD , Stephen J. Nicholls MBBS, PhD , Rishi Puri MBBS, PhD

Background & Aim

The extent and composition of coronary plaque, and its progression differ with patients’ age. The interplay of patient’s age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression.

Method

We performed a post hoc pooled analysis of data from 10 prospective, randomised trials involving serial coronary intravascular ultrasonography (IVUS) (n=5,823). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque.

Results

Mean overall age was 58±9 years (28% women). In a fully adjusted multivariable analysis (following adjustment of sex, body mass index, systolic blood pressure [SBP], smoking, high-density lipoprotein and low-density lipoprotein [LDL]-cholesterol, triglyceride levels, peripheral vascular disease, diabetes mellitus, trial, region, and baseline PAV), an increase in age by one standard deviation was linked with PAV progression (β-estimate 0.097; 95% confidence interval 0.048–0.15; p<0.001). In patients with good risk factor control (LDL-cholesterol <1.8 mmol/L and SBP <130 mmHg), increasing age remained associated with PAV progression (0.123; 0.014–0.23; p=0.027). Lower effect sizes for the association of age with PAV progression were observed for patients with partial control of LDL-cholesterol and SBP and were not significantly associated with PAV progression when both LDL-cholesterol and SBP were not controlled (0.099; 0.032–0.167; p=0.004 and 0.042; −0.056 to 0.14; p=0.40, respectively).

Conclusions

Patient age is directly associated with coronary atheroma progression independently of traditional cardiovascular risk factors. In the setting of poor risk factor control, the influence of age on coronary artery disease progression is attenuated.

背景和目的：冠状动脉斑块的范围和组成及其进展随患者年龄而异。目前尚未评估患者年龄与危险因素控制、动脉粥样斑块进展之间的相互影响。我们检验了风险因素控制调节年龄与冠状动脉粥样斑块进展之间关系的假设：我们对 10 项前瞻性随机试验的数据进行了事后汇总分析，这些试验涉及连续冠状动脉血管内超声成像（IVUS）（n=5,823）。动脉粥样斑块体积百分比（PAV）的计算方法是动脉粥样硬化斑块占整个血管壁的比例：平均年龄为 58±9 岁（女性占 28%）。在完全调整后的多变量分析中（在调整性别、体重指数、收缩压[SBP]、吸烟、高密度脂蛋白和低密度脂蛋白胆固醇、甘油三酯水平、外周血管疾病、糖尿病、试验、地区和基线 PAV 后），年龄增加一个标准差与 PAV 的进展有关（β-估计值 0.097；95% 置信区间 0.048-0.15；p 结论：患者年龄与冠状动脉粥样硬化斑块的进展直接相关：患者年龄与冠状动脉粥样斑块的进展直接相关，而与传统的心血管风险因素无关。在危险因素控制不佳的情况下，年龄对冠状动脉疾病进展的影响会减弱。

{"title":"Interplay of Age and Risk Factor Control Upon Coronary Atheroma Progression","authors":"Iryna Dykun MD , Julie Carlo MS , Steven E. Nissen MD , Samir R. Kapadia MD , Stephen J. Nicholls MBBS, PhD , Rishi Puri MBBS, PhD","doi":"10.1016/j.hlc.2024.06.1031","DOIUrl":"10.1016/j.hlc.2024.06.1031","url":null,"abstract":"<div><h3>Background & Aim</h3><div>The extent and composition of coronary plaque, and its progression differ with patients’ age. The interplay of patient’s age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression.</div></div><div><h3>Method</h3><div>We performed a <em>post</em> <em>hoc</em> pooled analysis of data from 10 prospective, randomised trials involving serial coronary intravascular ultrasonography (IVUS) (n=5,823). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque.</div></div><div><h3>Results</h3><div>Mean overall age was 58±9 years (28% women). In a fully adjusted multivariable analysis (following adjustment of sex, body mass index, systolic blood pressure [SBP], smoking, high-density lipoprotein and low-density lipoprotein [LDL]-cholesterol, triglyceride levels, peripheral vascular disease, diabetes mellitus, trial, region, and baseline PAV), an increase in age by one standard deviation was linked with PAV progression (β-estimate 0.097; 95% confidence interval 0.048–0.15; p<0.001). In patients with good risk factor control (LDL-cholesterol <1.8 mmol/L and SBP <130 mmHg), increasing age remained associated with PAV progression (0.123; 0.014–0.23; p=0.027). Lower effect sizes for the association of age with PAV progression were observed for patients with partial control of LDL-cholesterol and SBP and were not significantly associated with PAV progression when both LDL-cholesterol and SBP were not controlled (0.099; 0.032–0.167; p=0.004 and 0.042; −0.056 to 0.14; p=0.40, respectively).</div></div><div><h3>Conclusions</h3><div>Patient age is directly associated with coronary atheroma progression independently of traditional cardiovascular risk factors. In the setting of poor risk factor control, the influence of age on coronary artery disease progression is attenuated.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1593-1599"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Withdrawal notice to: Impact of Provision of Abdominal Aortic Calcification Results on Cardiovascular Risk Reducing Behaviours: A 12-Week RCT [Heart, Lung and Circulation, Volume 33, Supplement 4, August 2024, Page S357] 撤回通知：提供腹主动脉钙化结果对降低心血管风险行为的影响：一项为期 12 周的 RCT [《心、肺和循环》，第 33 卷，增刊 4，2024 年 8 月，第 S357 页]。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-11-01 DOI: 10.1016/j.hlc.2024.10.005

S. Radavelli Bagatini ∗ , C. Bondonno , J. Dalla Via , M. Sim , A. Gebre , L. Blekkenhorst , E. Connolly , N. Bondonno , J. Schousboe , R. Woodman , K. Zhu , S. Mullin , P. Szulc , B. Jackson , J. Dimmock , M. Schlaich , K. Cox , D. Kiel , W. Lim , M. Stanley , J. Lewis

引用次数: 0

Indocyanine Green (ICG): A Versatile Tool in Enhancing Precision in Minimally Invasive Thoracic Surgery 吲哚菁绿 (ICG)：提高胸腔镜微创手术精确度的多功能工具。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-11-01 DOI: 10.1016/j.hlc.2024.04.310

Oscar Zhang MD , Gavin Wright PhD , Yin-Kai Chao PhD , Christopher Cao PhD

Intraoperative fluorescence imaging using indocyanine green (ICG) is an innovative and safe tool in minimally invasive thoracic surgery. It provides real-time imaging capabilities that can enhance surgical precision. We describe several clinical uses of ICG including intersegmental plane identification, thoracic duct injury localisation, anomalous systemic artery identification in pulmonary sequestration, phrenic nerve identification, and sentinel lymph node mapping. Successful visualisation of ICG was achieved to identify intra-thoracic anatomical structures and boundaries, allowing for safe and precise dissection.

使用吲哚菁绿（ICG）进行术中荧光成像是微创胸外科手术中一种创新而安全的工具。它提供的实时成像功能可以提高手术的精确度。我们介绍了 ICG 的几种临床应用，包括节间平面识别、胸导管损伤定位、肺动脉栓塞的异常系统动脉识别、膈神经识别和前哨淋巴结绘图。ICG 成功实现了可视化，可识别胸腔内解剖结构和边界，从而进行安全、精确的解剖。

引用次数: 0

Giant Recurrent Left Ventricular Pseudo-Aneurysm 巨大复发性左心室假性动脉瘤

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-11-01 DOI: 10.1016/j.hlc.2024.05.013

Alice Haouzi MD , Arpan Karki MD , Rohan Prasad MD , Michael Zhen-Yu Tong MD , Bo Xu MBBS

引用次数: 0

Heart Failure Admissions in Women With a History of Gender-Based Violence 有性别暴力史的女性因心力衰竭而入院。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-11-01 DOI: 10.1016/j.hlc.2024.05.012

Alicia Chan FRACP, PhD, FCSANZ , Suzanne M. Cosh MPsych(Clin), PhD , Phillip J. Tully MPsych(Clin), PhD

引用次数: 0

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