Heart, Lung and Circulation最新文献

英文中文

Modernising Acute PE and VTE Management: Meta-Analysis of Newer Anticoagulants Versus Traditional Therapy on Recurrence and Mortality 现代化的急性肺动脉栓塞和静脉血栓栓塞治疗：新型抗凝剂与传统治疗在复发和死亡率方面的荟萃分析。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.05.092

Udvass Kumar Kotokey MBBS, DTCD, DNB , Savitri Kumari MSc

Background

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism (PE), is a leading cause of cardiovascular morbidity and mortality. While vitamin K antagonists (VKAs) and low molecular weight heparins (LMWHs) have long served as the standard of care, non-vitamin K antagonist oral anticoagulants, particularly factor Xa inhibitors, have emerged as promising alternatives due to their favourable pharmacokinetic profiles and ease of use. This meta-analysis aimed to evaluate the efficacy and safety of factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban) compared with VKAs or LMWHs in treating acute VTE and PE, including recurrence prevention and mortality outcomes.

Method

A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. Seven randomised controlled trials comprising 25,510 patients were included. Outcomes assessed included VTE recurrence, PE recurrence, and all-cause mortality. Subgroup analyses examined effects in cancer and non-cancer-associated VTE, VTE in renal impairment, VTE-related mortality, bleeding-related mortality, and major bleeding in cancer, non-cancer, and solid tumours. Statistical analyses were performed using a random-effects model.

Results

Factor Xa inhibitors were associated with a statistically significant 15% reduction in VTE recurrence (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.72–0.99; p=0.04). In cancer-associated VTE, they significantly reduced recurrence risk by 24% (HR 0.76; 95% CI 0.59–0.98). In patients without cancer, a non-significant 10% reduction was observed (HR 0.90; 95% CI 0.76–1.06). Major bleeding was significantly lower in patients without cancer (HR 0.76; 95% CI 0.58–0.99), while no significant difference was noted in cancer-associated VTE or solid tumour subgroups. Factor Xa inhibitors significantly reduced bleeding-related mortality by 49% (HR 0.51; 95% CI 0.26–0.99), but showed no difference in VTE-specific or all-cause mortality.

Conclusions

Factor Xa inhibitors are effective and safe alternatives to traditional anticoagulants for most patients with acute VTE. They significantly reduce VTE recurrence, particularly in patients with cancer and bleeding-related mortality. Major bleeding was significantly less in the non-cancer subgroup. These findings support their use as first-line therapy in appropriately selected patients, with consideration of individual bleeding risk, cancer type, renal function, and treatment setting.

背景：静脉血栓栓塞（VTE），包括深静脉血栓形成和肺栓塞（PE），是心血管疾病发病率和死亡率的主要原因。虽然维生素K拮抗剂（VKAs）和低分子量肝素（LMWHs）长期以来一直是标准的护理，但非维生素K拮抗剂口服抗凝剂，特别是Xa因子抑制剂，由于其良好的药代动力学特征和易于使用，已成为有希望的替代品。本荟萃分析旨在评估Xa因子抑制剂（阿哌沙班、利伐沙班和依多沙班）与vka或lmwh治疗急性静脉血栓栓塞和肺水肿的疗效和安全性，包括复发预防和死亡率结果。方法：根据PRISMA（首选系统评价和荟萃分析报告项目）2020指南进行系统评价和荟萃分析。纳入了7项随机对照试验，包括25510名患者。评估的结果包括静脉血栓栓塞复发、肺脏复发和全因死亡率。亚组分析检查了在癌症和非癌症相关静脉血栓栓塞、肾损害中的静脉血栓栓塞、静脉血栓栓塞相关死亡率、出血相关死亡率以及癌症、非癌症和实体肿瘤中的大出血的影响。采用随机效应模型进行统计分析。结果：Xa因子抑制剂与静脉血栓栓塞复发降低15%相关（风险比[HR] 0.85； 95%可信区间[CI] 0.72-0.99; p=0.04）。在与癌症相关的静脉血栓栓塞中，他们显著降低了24%的复发风险（HR 0.76; 95% CI 0.59-0.98）。在没有癌症的患者中，观察到10%的非显著性降低（HR 0.90; 95% CI 0.76-1.06）。无癌患者大出血发生率显著降低（HR 0.76; 95% CI 0.58-0.99），而与癌症相关的静脉血栓栓塞或实体肿瘤亚组无显著差异。Xa因子抑制剂显著降低出血相关死亡率49% (HR 0.51; 95% CI 0.26-0.99)，但在静脉血栓栓塞特异性或全因死亡率方面没有差异。结论：对于大多数急性静脉血栓栓塞患者，Xa因子抑制剂是传统抗凝药物的有效和安全的替代方案。它们能显著降低静脉血栓栓塞的复发，尤其是癌症患者和出血相关的死亡率。非癌症亚组大出血明显减少。这些发现支持在考虑个体出血风险、癌症类型、肾功能和治疗环境的情况下，适当选择患者将其作为一线治疗。

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引用次数: 0

Mechanical Thrombectomy Reduces Increased High Sensitivity Troponin Levels in Intermediate-High Risk Pulmonary Embolism. 机械取栓可降低中高风险肺栓塞患者高敏感性肌钙蛋白水平升高。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-29 DOI: 10.1016/j.hlc.2025.08.023

Richard Schell, Felix Alban, Norbert Frey, Christian Erbel

Background: Pulmonary embolism is associated with significant mortality and remarkably often subject to misdiagnosis, which further adversely affects prognosis. Disease severity and corresponding prognosis are strongly dependent on the risk constellation and determine the therapy. Therefore, we sought to analyse how mechanical thrombectomy influences short term clinical, laboratory, and haemodynamic findings in patients with symptomatic pulmonary artery embolism.

Method: In this study, we retrospectively analysed clinical, laboratory, and haemodynamic parameters in 32 patients with symptomatic pulmonary embolism who underwent mechanical thrombectomy using the FlowTriever device. Only patients with pulmonary embolism confirmed by computed tomography pulmonary angiography and classified as intermediate-high or high risk according to the current European Society of Cardiology guidelines were included. The main outcome measures were periprocedural changes in troponin, lactate, pulmonary artery pressures, and vital signs.

Results: Reductions of increased heart rate, pulmonary arterial pressure, and right ventricle-to-left ventricle ratio were observed immediately after the procedure and in early clinical follow-up, as well as improvement in arterial oxygen saturation and demand. Interventional thrombectomy further resulted in a reduction of increased levels of high-sensitivity troponin and lactate. In summary, the analysis of this study shows consistent respiratory and haemodynamic improvements in line with other published data on mechanical thrombectomy with this device.

Conclusions: Mechanical thrombectomy in patients with pulmonary artery embolism at intermediate-high risk was associated with an immediate and significant decrease in both specific myocardial and systemic biomarkers, for which prognostic relevance has been repeatedly demonstrated.

背景：肺栓塞与高死亡率相关，且极易误诊，进而影响预后。疾病的严重程度和相应的预后在很大程度上取决于风险组合并决定治疗。因此，我们试图分析机械取栓对症状性肺动脉栓塞患者短期临床、实验室和血流动力学表现的影响。方法：在本研究中，我们回顾性分析了32例使用FlowTriever设备进行机械取栓的症状性肺栓塞患者的临床、实验室和血流动力学参数。仅纳入经计算机断层肺血管造影证实的肺栓塞患者，并根据当前欧洲心脏病学会指南分类为中高风险或高风险。主要观察指标为术中肌钙蛋白、乳酸、肺动脉压和生命体征的变化。结果：术后和早期临床随访均可观察到心率升高、肺动脉压、右心室与左心室比值降低，动脉血氧饱和度和需氧量改善。介入血栓切除术进一步降低了高敏感性肌钙蛋白和乳酸水平。总之，本研究的分析显示呼吸和血流动力学的改善与其他已发表的使用该装置机械取栓的数据一致。结论：中高风险肺动脉栓塞患者的机械取栓与特定心肌和全身生物标志物的立即显著降低相关，其预后相关性已被反复证明。

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引用次数: 0

Securing Long-Term Heart Health for Australians: Understanding How Funding Structures in Cardiac Rehabilitation Influence Cardiovascular Inequities. 确保澳大利亚人的长期心脏健康：了解心脏康复的资金结构如何影响心血管不公平。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-04 DOI: 10.1016/j.hlc.2025.07.016

Sarah Gauci, Lan Gao, Robyn Gallagher, Julie Redfern, Susie Cartledge, Adrienne O'Neil

引用次数: 0

The Pursuit of Truth: Revisiting Causation Versus Association in Contemporary Cardiovascular Research 追求真理：重新审视当代心血管研究中的因果关系

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.10.005

Jonathan L. Ciofani BMedSc, MPH, MD , Usaid K. Allahwala MBBS, PhD, FRACP, FCSANZ , Avedis Ekmejian MBBS, MSc, PhD, FRACP, FCSANZ , Salvatore Pepe PhD, FAHA, FESC, FCSANZ , Ravinay Bhindi MBBS, PhD, FRACP, FCSANZ

引用次数: 0

Real-World Uptake of Intravascular Imaging for Percutaneous Coronary Intervention: From Exception to Everyday Practice 经皮冠状动脉介入治疗中血管内成像的实际应用：从例外到日常实践

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.10.003

Daniel G. Brieger FRACP , Adam J. Nelson PhD, FRACP , Gemma A. Figtree MBBS, DPhil , Peter J. Psaltis PhD, FRACP

引用次数: 0

Timing and Mode of Death Following ECPR: A Single Centre, Retrospective Analysis ECPR后死亡时间和方式：单中心回顾性分析

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.04.072

Humphrey G.M. Walker MRCP, FCICM , Alexander S. Richardson BMBCh, MRCP, FCICM , Arne Diehl MD, FACEM, FCICM , Aidan Burrell FCICM, PhD

Background

Currently little is known about the timing and modality in which people die following extracorporeal cardiopulmonary resuscitation (ECPR). This is important as it may define potential therapeutic targets, pathways for improvement in ECPR outcomes, and resource implications. Therefore, we undertook a study to analyse the mechanisms and timeframes of death within the first 28 days in a high-volume Australian ECPR centre.

Method

This was a single-centre, retrospective review from 1 January 2017 until 31 December 2022. All patients undergoing ECPR were analysed. Modality of death was classified into neurological (subclassified as brain death or withdrawal of life-sustaining treatment [WLST] without brain death) or non-neurological (subclassified as refractory shock or non-neurological WLST).

Results

A total of 95 patients were included. Overall, 52/95 (54.7%) had an out-of-hospital cardiac arrest. In total, 51/95 (53.7 %) had died by day 28. The most common modality of death was neurological WLST without brain death. The earliest modality of death to occur was refractory shock. Median survival times were 0 days (interquartile range [IQR] 0–2) for patients with refractory shock, 2 days (IQR 1–4) for brain death, 3 days (IQR 1–8) for non-neurological WLST and 9 days (IQR 2–14) for neurological WLST without brain death. Four (7.8%) patients underwent organ donation.

Conclusions

Mortality post ECPR remains high. Refractory shock is the earliest modality of death while neurological WLST without brain death is most common, occurring several days later. Understanding the different phenotypes of death post-ECPR is important to identify future potential therapeutic targets.

背景：目前，人们对体外心肺复苏（ECPR）后死亡的时间和方式知之甚少。这很重要，因为它可以确定潜在的治疗靶点、改善ECPR结果的途径和资源意义。因此，我们进行了一项研究，分析了澳大利亚一个大容量ECPR中心前28天内的死亡机制和时间框架。方法：这是一项从2017年1月1日至2022年12月31日的单中心回顾性研究。对所有接受ECPR的患者进行分析。死亡方式分为神经学（细分为脑死亡或无脑死亡的停止维持生命治疗[WLST]）或非神经学（细分为难治性休克或非神经学WLST）。结果：共纳入95例患者。总体而言，52/95（54.7%）发生院外心脏骤停。共有51/95例（53.7%）在第28天死亡。最常见的死亡方式是无脑死亡的神经性WLST。最早的死亡形式是难治性休克。难治性休克患者的中位生存时间为0天（四分位数范围[IQR] 0-2），脑死亡患者的中位生存时间为2天（IQR 1-4），非神经性WLST患者的中位生存时间为3天（IQR 1-8），无脑死亡的神经性WLST患者的中位生存时间为9天（IQR 2-14）。4例（7.8%）患者接受器官捐献。结论：ECPR后的死亡率仍然很高。顽固性休克是最早的死亡形式，而无脑死亡的神经性WLST最常见，发生时间晚于几天。了解ecpr后死亡的不同表型对于确定未来潜在的治疗靶点非常重要。

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引用次数: 0

The Clinical Spectrum of Bradyarrhythmias “To Pace or Not to Pace” 慢性心律失常的临床谱“起搏或不起搏”。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.04.001

Vrijraj S. Rathod MBBS, BSc. PhD, Harry G. Mond MD, PhD, FCSANZ

Asystolic bradyarrhythmias, documented on ambulatory electrocardiographic monitoring, present a perplexing problem regarding clinical management. These asystolic episodes can be instigated by intrinsic and extrinsic influences. Intrinsic events are precipitated by disease in the conduction system, while extrinsic incidents are modulated by vagal tone. Vagal-mediated bradyarrhythmias represent a diverse group of arrhythmias that are poorly understood. There is a deficiency in the literature for defining vagal-mediated bradycardia and hence without a full appreciation of the multitude of characteristics that define atrioventricular block, it can be challenging to make a firm diagnosis. This review discusses the elemental characteristics of bradyarrhythmias in combination with the current guidelines to enable risk stratification for permanent cardiac pacing. Cardiac pacing has been established to alleviate symptoms and improve longevity in patients with conduction system disease, whereas vagal-mediated bradycardias are a benign phenomenon and thus it is imperative that such rhythms are correctly identified.

无收缩期慢性心律失常，记录在动态心电图监测，提出了一个令人困惑的问题，关于临床管理。这些心脏骤停可以由内在和外在的影响引起。内在事件是由传导系统中的疾病引起的，而外在事件是由迷走神经张力调节的。迷走神经介导的慢性心律失常是一种不同类型的心律失常，人们对其了解甚少。在定义迷走神经介导的心动过缓的文献中存在缺陷，因此在没有充分认识到定义房室传导阻滞的众多特征的情况下，做出明确的诊断是具有挑战性的。这篇综述讨论了慢性心律失常的基本特征，并结合目前的指导方针，使永久性心脏起搏的风险分层。心脏起搏可以缓解传导系统疾病患者的症状并延长寿命，而迷走神经介导的心动过缓是一种良性现象，因此正确识别这种节律至关重要。

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引用次数: 0

MyHeart MyLife: Empowering patients to live well with coronary heart disease 我的心脏我的生活：帮助冠心病患者更好地生活

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.10.001

引用次数: 0

Diabetes is an Increasingly Common Issue After Heart Transplantation: A Case for Integrated Diabetes Care 糖尿病是心脏移植后日益常见的问题：糖尿病综合护理的一个案例。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.04.081

Lisa M. Raven MBBS , Andrew Jabbour PhD , Peter S. Macdonald PhD , Jerry R. Greenfield PhD , Christopher A. Muir PhD

Background

Orthotopic heart transplantation (OHT) survival rates have improved with advances in immunosuppression over the last 20 years. With these improvements, there has been a greater focus on post-transplant care. Diabetes is common after transplantation and may be pre-existing (type 2 diabetes mellitus [T2DM]) or develop after transplant (post-transplant diabetes mellitus [PTDM]). The aim of this study was to compare the incidence and prevalence of diabetes in OHT recipients in two cohorts separated by 20 years.

Methods

Retrospective audit comparing the prevalence of T2DM and cumulative 2-year incidence of PTDM in 88 consecutive OHT recipients in 1996–1998 and 141 consecutive OHT recipients in 2015–2018 at the same tertiary referral teaching hospital.

Results

The prevalence of pre-transplant T2DM at the time of OHT increased three-fold between 1998 and 2018, from 6% (n=5) to 18% (n=25) respectively (p=0.009). Similarly, the incidence of PTDM increased from 16% (n=13) in 1998 to 36% (n=42) in 2018 (p=0.001). OHT recipients who developed PTDM were older in 2018 vs 1998 (mean age 52 [±11] vs 44 [±9] years; p=0.03). The mean age was not different between individuals with T2DM between the 1998 and 2018 eras. Body mass index was not different between the 1998 and 2018 eras in any of the diabetes status subgroups.

Conclusions

The incidence and prevalence of diabetes after OHT at our Australian institution has increased over 20 years. With improved OHT survival and rates of diabetes, endocrinologists should be incorporated into the care teams of heart transplant recipients. Further studies of glucose-lowering therapies in patients with diabetes after transplantation are warranted.

背景：在过去的20年里，随着免疫抑制技术的进步，原位心脏移植（OHT）的存活率有所提高。随着这些改进，移植后的护理得到了更多的关注。糖尿病在移植后很常见，可能已经存在（2型糖尿病[T2DM]），也可能在移植后发展（移植后糖尿病[PTDM]）。本研究的目的是比较两组间隔20年的OHT接受者中糖尿病的发病率和患病率。方法：回顾性审计比较同一三级转诊教学医院1996-1998年连续接受OHT治疗的88名患者和2015-2018年连续接受OHT治疗的141名患者的T2DM患病率和2年累计PTDM发病率。结果：移植前T2DM在OHT时的患病率在1998年至2018年间增加了三倍，分别从6% （n=5）增加到18% (n=25) （p=0.009）。同样，PTDM的发病率从1998年的16% （n=13）增加到2018年的36% (n=42) （p=0.001）。2018年发生PTDM的OHT受者比1998年更老（平均年龄52[±11]岁比44[±9]岁；p=0.03）。1998年至2018年期间，T2DM患者的平均年龄没有差异。在任何糖尿病状态亚组中，1998年和2018年之间的体重指数没有差异。结论：20年来，我们澳大利亚机构OHT后糖尿病的发病率和患病率有所增加。随着OHT存活率和糖尿病发病率的提高，内分泌科医生应该被纳入心脏移植受者的护理团队。移植后糖尿病患者降糖治疗的进一步研究是有必要的。

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引用次数: 0

The Utility of Infrared Thermography and Hyperspectral Imaging in Peripheral Artery Disease: A Systematic Review 红外热成像和高光谱成像在外周动脉疾病中的应用：系统综述。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2025-11-01 DOI: 10.1016/j.hlc.2025.03.017

Olavi Yli-Harja BM , Tomppa Pakarinen DSc , Emmi Peltola MSc , Meri Hämäläinen MSc , Antti Vehkaoja DSc , Niku Oksala MD, PhD, DSc

Background

Peripheral artery disease (PAD) is a prevalent vascular disorder that reduces blood flow and tissue oxygenation. Early detection is crucial to optimise treatment outcomes and minimise ulceration or gangrene and possible subsequent amputations. This systematic review evaluated the diagnostic significance and clinical utility of infrared thermography (IRT) and hyperspectral imaging (HSI) as non-invasive, contactless techniques for PAD and chronic limb-threatening ischaemia assessment. Infrared thermography assesses blood perfusion by detecting temperature changes in limbs and HSI can be utilised to evaluate oxygen saturation, and deoxyhaemoglobin and oxyhaemoglobin concentrations in superficial tissue.

Methods

After a comprehensive PubMed literature search, a total of 15 articles were included in the final analysis: eight studies utilising IRT for circulation assessment, six studies employing HSI, and one study combining the two. A total 607 participants with PAD were included.

Results

In the IRT studies, varying levels of correlations were found between established assessment modalities and temperature changes. Significant, but mostly modest, correlations were discovered in the HSI studies—particularly with deoxyhaemoglobin, oxyhaemoglobin, and the ankle–brachial index—making the clinical significance of the results unclear, but still suggesting that HSI has potential for assessing and screening PAD. Head-to-head, HSI accurately detected immediate perfusion changes after PAD treatment, while IRT did not, suggesting that HSI-derived parameters may be more precise for perfusion assessment.

Conclusions

The results indicate that both IRT and HSI hold promise for assessing circulation, oxygenation, and perfusion in participants with vascular deficiency. Further research with larger sample sizes and standardised measurement protocols is needed to validate the clinical utility of IRT and HSI.

背景：外周动脉疾病（PAD）是一种常见的血管疾病，可减少血流量和组织氧合。早期发现对于优化治疗效果和减少溃疡或坏疽以及可能的后续截肢至关重要。本系统综述评估了红外热成像（IRT）和高光谱成像（HSI）作为非侵入性、非接触式技术在PAD和慢性肢体威胁缺血评估中的诊断意义和临床应用。红外热成像通过检测四肢的温度变化来评估血液灌注，HSI可用于评估氧饱和度，以及浅表组织中的脱氧血红蛋白和氧合血红蛋白浓度。方法：经过全面的PubMed文献检索，最终分析共纳入15篇文章：8项研究使用IRT进行循环评估，6项研究使用HSI， 1项研究将两者结合。共纳入607名PAD患者。结果：在IRT研究中，在已建立的评估模式和温度变化之间发现了不同程度的相关性。在HSI研究中发现了显著的，但大多是适度的相关性，特别是与脱氧血红蛋白、氧合血红蛋白和踝-肱指数之间的相关性，这使得结果的临床意义不明确，但仍然表明HSI具有评估和筛查PAD的潜力。头对头，HSI能准确检测PAD治疗后的即时灌注变化，而IRT不能，这表明HSI衍生的参数可能更准确地用于灌注评估。结论：结果表明，IRT和HSI都有望评估血管缺乏参与者的循环、氧合和灌注。进一步的研究需要更大的样本量和标准化的测量方案来验证IRT和HSI的临床应用。

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