Journal of cardiology最新文献_第6页

Prognostic significance of baseline low-density lipoprotein cholesterol in patients undergoing coronary revascularization; a report from the CREDO-Kyoto registry 冠状动脉血运重建患者基线低密度脂蛋白胆固醇的预后意义；来自 CREDO-Kyoto 登记处的报告。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-06-11 DOI: 10.1016/j.jjcc.2024.05.011

Background

The impact of very low baseline levels of low-density lipoprotein cholesterol (LDL-C) on patients with coronary artery disease remains unclear.

Method

We enrolled 39,439 patients of the pooled population from the CREDO-Kyoto registries Cohorts 1, 2, and 3. The study population consisted of 33,133 patients who had undergone their first coronary revascularization. We assessed the risk for mortality and cardiovascular events according to quintiles of the baseline LDL-C levels.

Results

Patients in the very low LDL-C quintile (<85 mg/dL) had more comorbidities than those in the other quintiles. Lower LDL-C levels were strongly associated with anemia, thrombocytopenia, and end-stage renal disease. The cumulative 4-year incidence of all-cause death increased as LDL-C levels decreased (very low: 19.4 %, low: 14.5 %, intermediate: 11.1 %, high: 10.0 %, and very high: 9.2 %; p < 0.001), which was driven by both the early and late events. After adjusting for baseline characteristics, the adjusted risks of the very low and low LDL-C quintiles relative to the intermediate LDL-C quintile remained significant for all-cause death (very low: HR 1.29, 95 % CI 1.16–1.44, p < 0.001; low: HR 1.15, 95 % CI 1.03–1.29, p = 0.01). The excess adjusted risks of the lowest LDL-C quintile relative to the intermediate LDL-C quintile were significant for clinical outcomes such as cardiovascular death (HR 1.17, 95 % CI 1.01–1.35), non-cardiovascular death (HR 1.35, 95 % CI 1.15–1.60), sudden death (HR 1.44, 95 % CI 1.01–2.06), and heart failure admission (HR 1.11 95 % CI 1.01–1.22), while there was no excess risk for the lowest LDL-C quintile relative to the intermediate LDL-C quintile for myocardial infarction and stroke.

Conclusions

Lower baseline LDL-C levels were associated with more comorbidities and a significantly higher risk of death, regardless of cardiovascular or non-cardiovascular causes, in patients who underwent coronary revascularization.

背景：低密度脂蛋白胆固醇（LDL-C低密度脂蛋白胆固醇（LDL-C）基线水平很低对冠心病患者的影响仍不清楚：我们从 CREDO-Kyoto登记组 1、2 和 3 的汇总人群中招募了 39439 名患者。研究人群包括 33133 名首次接受冠状动脉血运重建的患者。我们根据基线 LDL-C 水平的五分位数评估了死亡率和心血管事件的风险：在接受冠状动脉血运重建手术的患者中，较低的基线 LDL-C 水平与较多的合并症和显著较高的死亡风险相关，无论死亡原因是心血管还是非心血管疾病。

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引用次数: 0

Unveiling the new era of heart failure management using mobile health: A pilot study of “heart sign” focusing on user experience and quality of life 利用移动医疗开启心衰管理新时代：以用户体验和生活质量为重点的 "心脏标志 "试点研究。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-06-11 DOI: 10.1016/j.jjcc.2024.06.002

引用次数: 0

Hibiscus score: Developing and validating a predictive tool for intravenous immunoglobulin treatment resistance in Malaysian children with Kawasaki disease 木槿花评分：开发并验证马来西亚川崎病儿童静脉注射免疫球蛋白治疗耐药性的预测工具。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-06-08 DOI: 10.1016/j.jjcc.2024.06.001

Background

Children with intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) are at higher risk of developing coronary artery (CA) aneurysm. Early identification of high-risk patients using a predictive tool would allow for earlier interventions to prevent cardiac complications.

Methods

Children with KD who were admitted to five selected hospitals in Malaysia between 2008 and 2018 and received 2 g/kg of IVIG within 10 days from the onset of illness were included. Predictors of IVIG resistance in KD were determined using multiple logistic regression analysis. An optimal cut-off point was set using receiver operative characteristic curve and a final multiple logistic regression analysis was performed entering these cut-off points. A new scoring system was constructed.

Results

A total of 276 patients were included. IVIG resistance occurred in 9.1 % of them. Total bilirubin [OR 7.37; 95 % CI (2.18, 24.83)], male sex [OR 0.34; 95 % CI (0.10, 1.19)], C-reactive protein (CRP) [OR 0.17; 95 % CI (0.02, 1.38)] and neutrophils [OR 0.25; 95 % CI (0.05, 1.21)] were found to be significant predictors for IVIG resistance. The findings led to the development of a new predictive tool called the Hibiscus score, which scored 1 point each for neutrophils ≥60 %, CRP ≥80 mg/L, and male sex, while total bilirubin ≥9.4 μmol/L scored 2 points. A cut-off point of ≥4 with this prediction score yielded a sensitivity of 78.9 % and specificity of 80.5 %, with area under the curve of 0.835 [95 % CI (0.752, 0.919)]. CA aneurysms occurred in 6.7 % of IVIG responders and 32 % of IVIG-resistant children (p < 0.001).

Conclusion

The findings suggest that the Hibiscus score has a higher predictive power than the existing scoring systems for IVIG resistance in children with KD in Malaysia. However, external validation is required to enable its use to guide treatment decisions.

背景：患有静脉注射免疫球蛋白（IVIG）抵抗性川崎病（KD）的儿童患冠状动脉（CA）动脉瘤的风险较高。使用预测工具及早识别高危患者，可以更早地采取干预措施，预防心脏并发症：方法：纳入2008年至2018年期间在马来西亚5家选定医院住院的KD患儿，这些患儿在发病后10天内接受了2克/千克的IVIG治疗。采用多元逻辑回归分析确定了KD患者IVIG耐药性的预测因素。利用接收者操作特征曲线设定了最佳截断点，并输入这些截断点进行了最终的多元逻辑回归分析。结果：结果：共纳入 276 例患者。结果：共纳入 276 例患者，其中 9.1%的患者出现 IVIG 耐药。研究发现，总胆红素[OR 7.37; 95% CI (2.18, 24.83)]、男性[OR 0.34; 95% CI (0.10, 1.19)]、C 反应蛋白 (CRP) [OR 0.17; 95% CI (0.02, 1.38)]和中性粒细胞[OR 0.25; 95% CI (0.05, 1.21)]是预测 IVIG 耐药的重要因素。这些发现促使人们开发了一种新的预测工具--"木槿花评分"，即中性粒细胞≥60%、CRP≥80 mg/L和男性各得1分，总胆红素≥9.4 μmol/L得2分。以≥4为分界点的预测得分的灵敏度为78.9%，特异性为80.5%，曲线下面积为0.835 [95% CI (0.752, 0.919)]。6.7%对IVIG有反应的儿童和32%对IVIG有抗药性的儿童出现了CA动脉瘤（p结论：研究结果表明，与现有的评分系统相比，木槿花评分对马来西亚 KD 患儿的 IVIG 耐受具有更高的预测能力。然而，要使用该系统指导治疗决策，还需要外部验证。

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引用次数: 0

Public awareness of palliative care for heart failure in Japan: A cross-sectional study 日本公众对心力衰竭姑息治疗的认识：横断面研究

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-06-03 DOI: 10.1016/j.jjcc.2024.05.012

Background

Palliative care (PC) benefits cancer patients and those with heart failure (HF), improving quality of life and symptom burden. Despite guidelines recommending the integration of PC into HF care, its use remains inadequate, partly due to insufficient public awareness. This study aimed to assess the public awareness of PC for HF in Japan and identify factors associated with awareness.

Methods

A cross-sectional online survey was conducted from March 6–13, 2023, using a panel operated by Intage Inc. (Tokyo, Japan), which has a pool of 3.78 million potential Japanese respondents. The survey included 51,790 participants, matched for sex, age, and region of residence. Participants were asked about their awareness of PC eligibility for HF, along with demographic information, history of hospitalization for sudden illness, outpatient visits, and health status in the previous 2 years. The χ² test and Cramer's V were used to analyze associations between awareness and variables, and multivariate logistic regression was used to estimate awareness predictors.

Results

In total, 91 % of participants were unaware of PC eligibility for HF. Age group, healthcare professional occupation, and history of hospitalization for acute myocardial infarction, acute HF, acute pulmonary embolism, and ruptured aortic aneurysm had weak to moderate associations with awareness. Multivariate analysis revealed that a history of hospitalization for sudden cardiovascular illness and being a healthcare professional were positively related to awareness, while age, female sex, and being married were associated with lower odds of awareness.

Conclusion

The low public awareness of PC for HF in Japan underscores the importance of increasing awareness of the eligibility of PC for HF, as well as cancer, to integrate PC into HF practice as basic care.

背景：姑息治疗（PC）可改善癌症患者和心力衰竭（HF）患者的生活质量和症状负担。尽管指南建议将姑息治疗纳入心力衰竭护理，但姑息治疗的使用仍然不足，部分原因是公众对姑息治疗的认识不足。本研究旨在评估日本公众对心力衰竭PC治疗的认识，并确定与认识相关的因素：2023年3月6日至13日，通过Intage Inc.（日本东京）运营的面板进行了一项横断面在线调查，该面板拥有378万潜在日本受访者。调查包括 51,790 名参与者，他们的性别、年龄和居住地区均匹配。调查询问了受访者对 PC 治疗高血压资格的了解程度、人口统计学信息、突发疾病住院史、门诊就诊情况以及前两年的健康状况。采用χ2检验和Cramer's V分析认知度与变量之间的关联，并采用多变量逻辑回归估计认知度预测因素：结果：总共有 91% 的参与者不知道 PC 有资格治疗高血压。年龄组、医护人员职业以及急性心肌梗死、急性心房颤动、急性肺栓塞和主动脉瘤破裂的住院史与知晓率有微弱至中等程度的关联。多变量分析显示，突发心血管疾病住院史和医疗保健专业人员与知晓率呈正相关，而年龄、女性（OR = 0.89，95 % CI：0.84-0.95）和已婚则与知晓率较低有关：结论：日本公众对 PC 治疗高血压的知晓率较低，这凸显了提高公众对 PC 治疗高血压和癌症的知晓率的重要性，从而将 PC 纳入高血压的基本治疗中。

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引用次数: 0

Relationship between prehabilitation responsiveness and postoperative physical functional recovery in cardiovascular surgery 心血管手术术前康复反应能力与术后身体功能恢复之间的关系。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-06-03 DOI: 10.1016/j.jjcc.2024.05.008

Background

The purpose of this study was to examine the relationship between responsiveness to prehabilitation and postoperative recovery of physical function in cardiac surgery patients.

Methods

Ninety-three cardiac surgery patients (mean age: 76.4 years) were included in this retrospective cohort study. Preoperative physical function was measured using the Short Physical Performance Battery (SPPB), and a prehabilitation exercise program was implemented for the SPPB domains with low scores. Among the patients, those whose SPPB score was over 11 from the start of prehabilitation and remained over 11 on the day before surgery were defined as the high-functioning group, and those whose SPPB score improved by 2 points or more from the start of prehabilitation and exceeded 11 points were defined as the responder group. Those whose SPPB score did not exceed 11 immediately before surgery were classified as non-responders. The characteristics of each group and postoperative recovery of physical function were investigated.

Results

There were no serious adverse events during prehabilitation. Mean days of prehabilitation was 5.4 days. The responder group showed faster improvement in postoperative physical function and shorter time to ambulatory independence than the non-responder group. The non-responder group had lower preoperative skeletal muscle index, more severe preoperative New York Heart Association classification, and a history of musculoskeletal disease or stroke.

Conclusion

There were responders and non-responders to prehabilitation among cardiac surgery patients. Cardiac surgery patients who respond to prehabilitation had faster recovery of physical function. Further research is needed to determine what type of prehabilitation is more effective in postoperative recovery of physical function in cardiac surgery patients.

背景：本研究的目的是探讨心脏手术患者术前康复反应性与术后身体功能恢复之间的关系：本研究旨在探讨心脏手术患者对术前康复训练的反应能力与术后身体功能恢复之间的关系：这项回顾性队列研究共纳入 93 名心脏手术患者（平均年龄：76.4 岁）。术前使用短期体能测试（SPPB）对患者的身体功能进行了测量，并针对得分较低的 SPPB 领域实施了术前康复锻炼计划。其中，SPPB评分从康复训练开始时超过11分且在手术前一天仍超过11分的患者被定义为高功能组，SPPB评分从康复训练开始时提高2分或以上且超过11分的患者被定义为响应组。手术前SPPB评分不超过11分者为无应答组。对各组的特征和术后身体功能恢复情况进行了调查：结果：术前康复期间未发生严重不良事件。术前康复的平均天数为 5.4 天。与无应答组相比，有应答组的术后身体功能改善更快，独立行动的时间更短。无应答组的术前骨骼肌指数较低、术前纽约心脏协会分级较严重、有肌肉骨骼疾病或中风史：结论：心脏手术患者中存在对术前康复有反应者和无反应者。对康复训练有反应的心脏手术患者身体功能恢复得更快。要确定哪种类型的术前康复对心脏手术患者术后身体功能的恢复更有效，还需要进一步的研究。

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引用次数: 0

Beyond the lens: Unveiling the invisible atrioventricular node in the era of high-density mapping. 镜头之外：在高密度绘图时代揭开看不见的房室结的面纱。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-06-02 DOI: 10.1016/j.jjcc.2024.05.010

Yuji Wakamatsu, Koichi Nagashima, Ryuta Watanabe, Shu Hirata, Moyuru Hirata, Yasuo Okumura

Numerous studies have clarified the histological characteristics of the area surrounding the atrioventricular (AV) node, commonly referred to as the triangle of Koch (ToK). Although it is suggested that the conduction of electric impulses from the atria to the ventricles via the AV node involves myocytes possessing distinct conduction properties and gap junction proteins, a comprehensive understanding of this complex conduction has not been fully established. Moreover, although various pathways have been proposed for both anterograde and retrograde conduction during atrioventricular nodal reentrant tachycardia (AVNRT), the reentrant circuits of AVNRT are not fully elucidated. Therefore, the slow pathway ablation for AVNRT has been conventionally performed, targeting both its anatomical location and slow pathway potential obtained during sinus rhythm. Recently, advancements in high-density three-dimensional (3D) mapping systems have facilitated the acquisition of more detailed electrophysiological potentials within the ToK. Several studies have indicated that the activation pattern, the low-voltage area within the ToK obtained during sinus rhythm, and the fractionated potentials acquired during tachycardia may be optimal targets for slow pathway ablation. This review provides an overview of the tissue surrounding the AV node as reported to date and summarizes the current understanding of AV conduction and AVNRT circuits. Furthermore, we discuss recent findings on slow pathway ablation utilizing high-density 3D mapping systems, exploring strategies for optimal slow pathway ablation.

许多研究已经阐明了房室结周围区域（通常称为科赫三角区（ToK））的组织学特征。虽然有研究认为，电脉冲从心房经房室结传导至心室的过程涉及具有不同传导特性和间隙连接蛋白的心肌细胞，但对这种复杂传导的全面了解尚未完全建立。此外，虽然房室结性返流性心动过速（AVNRT）的顺行和逆行传导有多种途径，但房室结性返流性心动过速的返流回路尚未完全阐明。因此，针对房室结再发性心动过速的慢通路消融术一直以来都是针对其解剖位置和窦性心律时获得的慢通路电位进行的。最近，高密度三维（3D）绘图系统的进步促进了对 ToK 内更详细电生理电位的采集。多项研究表明，窦性心律时获得的 ToK 内的激活模式、低电压区以及心动过速时获得的分馏电位可能是慢通路消融的最佳目标。本综述概述了迄今为止所报道的房室结周围组织，并总结了目前对房室传导和房室NRT回路的理解。此外，我们还讨论了利用高密度三维绘图系统进行慢通路消融的最新发现，并探讨了最佳慢通路消融策略。

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引用次数: 0

Atrial structural remodeling and atrial fibrillation substrate: A histopathological perspective. 心房结构重塑与心房颤动基质：组织病理学视角。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-05-27 DOI: 10.1016/j.jjcc.2024.05.007

Takanori Yamaguchi

Atrial fibrillation (AF) substrate progresses with the advancement of atrial structural remodeling, resulting in AF perpetuation and recurrence. Although fibrosis is considered a hallmark of atrial structural remodeling, the histological background has not been fully elucidated because obtaining atrial specimens is difficult, especially in patients not undergoing open-heart surgery. Bipolar voltage reduction evaluated using electroanatomic mapping during AF ablation is considered a surrogate marker for the progression of structural remodeling; however, histological validation is lacking. We developed an intracardiac echocardiography-guided endomyocardial atrial biopsy technique to evaluate atrial structural remodeling in patients undergoing catheter ablation for nonvalvular AF. The histological factors associated with a decrease in bipolar voltage were interstitial fibrosis, as well as an increase in myocardial intercellular space preceding fibrosis, myofibrillar loss, and a decrease in cardiomyocyte nuclear density, which is a surrogate marker for cardiomyocyte density. Cardiomyocyte hypertrophy is closely associated with a decrease in cardiomyocyte nuclear density, suggesting that hypertrophic changes compensate for cardiomyocyte loss. Electron microscopy also revealed that increased intercellular spaces indicated the leakage of plasma components owing to increased vascular permeability. Additionally, amyloid deposition was observed in 4 % of biopsy cases. Only increased intercellular space and interstitial fibrosis were significantly higher for long-standing persistent AF than for paroxysmal AF and associated with recurrence after AF ablation, suggesting that this interstitial remodeling is the AF substrate. An increase in intercellular space that occurs early in AF formation is a therapeutic target for the AF substrate, which prevents irreversible interstitial degeneration due to collagen accumulation. This endomyocardial atrial biopsy technique will allow the collection of atrial tissue from a wide variety of patients and significantly facilitate the elucidation of the mechanisms of atrial cardiomyopathy, structural remodeling, and AF substrates.

心房颤动（房颤）基质随着心房结构重塑的进展而进展，导致房颤持续和复发。虽然纤维化被认为是心房结构重塑的标志，但组织学背景尚未完全阐明，因为很难获得心房标本，尤其是未接受开胸手术的患者。房颤消融过程中使用电解剖图评估的双极电压降低被认为是结构重塑进展的替代标志物，但缺乏组织学验证。我们开发了一种心内超声心动图引导下的心内膜心房活检技术，用于评估接受导管消融治疗的非瓣膜性房颤患者的心房结构重塑情况。与双极电压下降相关的组织学因素包括间质纤维化、纤维化前心肌细胞间隙增大、肌纤维损失以及心肌细胞核密度（心肌细胞密度的替代标记物）下降。心肌细胞肥大与心肌细胞核密度下降密切相关，这表明肥大性变化可补偿心肌细胞的损失。电子显微镜还显示，细胞间隙的增加表明血管通透性增加导致血浆成分泄漏。此外，在 4% 的活检病例中观察到淀粉样沉积。只有细胞间隙增大和间质纤维化在长期持续性房颤中明显高于阵发性房颤，并且与房颤消融后的复发有关，这表明间质重塑是房颤的基质。心房颤动形成早期出现的细胞间隙增加是心房颤动基底的治疗靶点，它能防止因胶原堆积导致的不可逆转的间质变性。这种心内膜心房活检技术可收集各种患者的心房组织，大大有助于阐明心房心肌病、结构重塑和房颤基质的机制。

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引用次数: 0

Outcomes of mitral TEER in non-responders to cardiac resynchronization therapy: A systematic review and meta-analysis 心脏再同步化疗法无应答者二尖瓣 TEER 的疗效：系统回顾与元分析。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-05-16 DOI: 10.1016/j.jjcc.2024.05.005

Background

Secondary mitral regurgitation (MR) worsens in 10–15 % of heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). Transcatheter edge-to-edge repair (TEER) with Mitra-Clip (Abbot Vascular, Santa Clara, CA, USA) therapy is associated with improved survival and decreased rates of hospitalization for HF in selected patients with secondary MR. Data on TEER outcomes in CRT-non-responders are limited. The purpose of this meta-analysis was to evaluate outcomes of mitral TEER with Mitra-Clip in CRT-non-responders.

Methods

Cochrane, Scopus, MEDLINE, and EMBASE were searched for studies discussing outcomes of Mitra-Clip in CRT non-responders. Two reviewers were independently involved in screening studies and extracting relevant data. Individual study incidence rate estimates underwent logit transformation to calculate the weighted summary proportion under the random effect model.

Results

A total of eight reports met the inclusion criteria (439 patients). Mitra-Clip improved MR grade to ≤2+ in 83.8 % and 86.8 % of CRT non-responders at six months and one year, respectively. Symptomatic improvement (New York Heart Association class ≤II) was also found in 71 % and 78.1 % of CRT non-responders at six months and one year, respectively. The pooled overall incidence estimates of mortality at 30 days, 6 months, 1 year, and 2 years were 3.6 %, 9.2 %, 17.8 %, and 25.9 %, respectively.

Conclusion

TEER with Mitra-Clip in patients with significant secondary MR who do not respond to CRT was associated with MR improvement, alleviation of symptoms, and mortality rates similar to those in the COAPT trial.

背景：在接受心脏再同步化治疗（CRT）的心力衰竭（HF）患者中，10%-15%的患者会出现继发性二尖瓣反流（MR）。使用 Mitra-Clip （Abbot Vascular，Santa Clara，CA，USA）治疗经导管边缘到边缘修补术（TEER）可提高继发性二尖瓣反流患者的生存率，降低因心衰住院的比例。有关 TEER 在 CRT 无应答患者中疗效的数据很有限。本荟萃分析的目的是评估二尖瓣 TEER 与 Mitra-Clip 在 CRT 无应答患者中的疗效：方法：在 Cochrane、Scopus、MEDLINE 和 EMBASE 中检索讨论 CRT 无应答者 Mitra-Clip 治疗效果的研究。两名审稿人独立参与筛选研究并提取相关数据。在随机效应模型下，对单项研究的发病率估计值进行对数转换，以计算加权汇总比例：共有8篇报告符合纳入标准（439名患者）。六个月和一年后，83.8%和86.8%的CRT无反应者的MR分级分别被Mitra-Clip改善至≤2+。六个月和一年后，分别有 71% 和 78.1% 的 CRT 无应答患者的症状得到改善（纽约心脏协会分级≤II）。30天、6个月、1年和2年的总死亡率估计值分别为3.6%、9.2%、17.8%和25.9%：对于对 CRT 无反应的严重继发性 MR 患者，使用 Mitra-Clip 的 TEER 与 MR 改善、症状缓解和死亡率相关，与 COAPT 试验的结果相似。

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引用次数: 0

Clinically significant incidental noncardiac findings on preprocedural computed tomography in patients with aortic stenosis undergoing aortic-valve replacement 接受主动脉瓣置换术的主动脉瓣狭窄患者在术前计算机断层扫描中出现的具有临床意义的非心脏意外发现。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-05-15 DOI: 10.1016/j.jjcc.2024.05.006

Background

There is a scarcity of data on the prevalence of abnormal findings on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with aortic stenosis (AS).

Methods

Among consecutive 593 patients with severe AS who were planned to undergo AVR, we evaluated the prevalence of clinically significant incidental noncardiac findings on preprocedural CT. Clinically significant incidental noncardiac findings were defined as newly detected abnormalities that required therapy, consultation for expert, further investigation, or clinical follow-up.

Results

The mean age was 82.0 years and 39.5 % of the patients were men. Of those, 78.4 % of the patients were treated with transcatheter aortic valve implantation (TAVI) and 21.6 % of the patients were treated with surgical AVR (SAVR). There were 271 clinically significant incidental noncardiac findings in 227 patients (38.3 %) including 2.5 % of malignancy. The prevalence of clinically significant incidental noncardiac findings were higher in the TAVI group than in the SAVR group (40.2 % versus 31.3 %). The prevalence of clinically significant incidental noncardiac findings were lower in patients under 60 years of age (10.0 %) than in patients over 60 years of age (60–69 years: 40.0 %, 70–79 years: 34.3 %, 80–89 years: 39.7 %, and ≥90 years: 42.1 %).

Conclusions

Clinically significant incidental noncardiac findings were newly identified on preprocedural CT in approximately 40 % of patients with severe AS undergoing AVR including 2.5 % of malignancy.

背景：主动脉瓣狭窄（AS）患者在主动脉瓣置换术（AVR）前进行术前计算机断层扫描（CT）发现异常情况的数据很少：在计划接受主动脉瓣置换术的连续 593 例重度 AS 患者中，我们评估了手术前 CT 中临床意义重大的意外非心源性发现的发生率。具有临床意义的附带非心脏检查结果被定义为需要治疗、专家会诊、进一步检查或临床随访的新发现异常：平均年龄为 82.0 岁，39.5% 的患者为男性。其中，78.4%的患者接受了经导管主动脉瓣植入术（TAVI）治疗，21.6%的患者接受了外科主动脉瓣置换术（SAVR）治疗。在 227 名患者（38.3%）中，有 271 项具有临床意义的非心脏意外发现，其中包括 2.5% 的恶性肿瘤。TAVI 组的临床重大附带非心脏检查结果发生率高于 SAVR 组（40.2% 对 31.3%）。60 岁以下患者的临床重大非心脏意外发现率（10.0%）低于 60 岁以上患者（60-69 岁：40.0%；70-79 岁：31.3%）：60-69 岁：40.0%；70-79 岁：34.3%；80-89 岁：40.0%：34.3%，80-89 岁：39.7%，≥60 岁：34.3%：结论结论在接受房室重建术的重度 AS 患者中，约 40% 的患者在术前 CT 上新发现了具有临床意义的非心脏意外发现，其中包括 2.5% 的恶性肿瘤。

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引用次数: 0

The significance of non-sustained ventricular tachycardia on life-threatening ventricular arrhythmia events in patients with non-ischemic cardiomyopathy in the contemporary era: A systematic review and meta-analysis 非持续性室性心动过速对当代非缺血性心肌病患者危及生命的室性心律失常事件的意义：系统回顾和元分析。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2024-05-14 DOI: 10.1016/j.jjcc.2024.05.004

Background

Risk stratification for patients with non-ischemic cardiomyopathy (NICM) remains challenging as previous studies predicting life-threatening ventricular arrhythmia (LTVA) events were conducted before the establishment of the current standard treatment. We investigated the prognostic value of non-sustained ventricular tachycardia (NSVT) in NICM patients among recent studies.

Methods

MEDLINE, Embase were searched from January 2000 to October 2023. The risk of NSVT on LTVA and mortality was assessed using a random-effects model for patients with NICM. A meta-regression analysis was employed to identify sources of heterogeneity. The systematic review and meta-analysis were carried out according to the PRISMA guidelines.

Results

A total of 18 studies were identified, including 5238 pooled participants. Meta-analysis demonstrated that the presence of NSVT was considered a significant prognostic indicator for LTVA events [hazard ratio (HR): 2.90; 95 % CI; 2.31–3.64] with low heterogeneity (I²: 19 %) and for mortality (HR; 2.28; 95%CI; 1.26–4.13) with high heterogeneity (I²: 69 %). The prognostic value of NSVT for LTVA was not affected by either ejection fraction or medications at baseline.

Conclusion

NSVT remained an important predictor of LTVA events even in patients receiving healthcare in contemporary eras. Detection of NSVT helps us to identify the high-risk patients with NICM.

背景：对非缺血性心肌病（NICM）患者进行风险分层仍具有挑战性，因为以往预测危及生命的室性心律失常（LTVA）事件的研究都是在目前的标准治疗方法确立之前进行的。我们调查了近期研究中 NICM 患者非持续性室性心动过速（NSVT）的预后价值：方法：检索 2000 年 1 月至 2023 年 10 月的 MEDLINE 和 Embase。采用随机效应模型评估了NICM患者NSVT对LTVA和死亡率的风险。荟萃回归分析用于确定异质性的来源。系统综述和荟萃分析均按照PRISMA指南进行：结果：共确定了 18 项研究，包括 5238 名共同参与者。荟萃分析表明，NSVT的存在被认为是LTVA事件[危险比（HR）：2.90；95%CI；2.31-3.64]和死亡率（HR；2.28；95%CI；1.26-4.13）的重要预后指标，但异质性较低（I2：19%），异质性较高（I2：69%）。LTVA的NSVT预后价值不受射血分数或基线用药的影响：结论：即使是在当代接受医疗保健的患者中，NSVT 仍是预测 LTVA 事件的重要指标。NSVT的检测有助于我们识别NICM高危患者。

{"title":"The significance of non-sustained ventricular tachycardia on life-threatening ventricular arrhythmia events in patients with non-ischemic cardiomyopathy in the contemporary era: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.jjcc.2024.05.004","DOIUrl":"10.1016/j.jjcc.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>Risk stratification<span><span> for patients with non-ischemic cardiomyopathy (NICM) remains challenging as previous studies predicting life-threatening ventricular arrhythmia (LTVA) events were conducted before the establishment of the current standard treatment. We investigated the prognostic value of non-sustained </span>ventricular tachycardia (NSVT) in NICM patients among recent studies.</span></p></div><div><h3>Methods</h3><p>MEDLINE, Embase were searched from January 2000 to October 2023. The risk of NSVT on LTVA and mortality was assessed using a random-effects model for patients with NICM. A meta-regression analysis was employed to identify sources of heterogeneity. The systematic review and meta-analysis were carried out according to the PRISMA guidelines.</p></div><div><h3>Results</h3><p>A total of 18 studies were identified, including 5238 pooled participants. Meta-analysis demonstrated that the presence of NSVT was considered a significant prognostic indicator for LTVA events [hazard ratio (HR): 2.90; 95 % CI; 2.31–3.64] with low heterogeneity (I<sup>2</sup>: 19 %) and for mortality (HR; 2.28; 95%CI; 1.26–4.13) with high heterogeneity (I<sup>2</sup><span>: 69 %). The prognostic value of NSVT for LTVA was not affected by either ejection fraction or medications at baseline.</span></p></div><div><h3>Conclusion</h3><p>NSVT remained an important predictor of LTVA events even in patients receiving healthcare in contemporary eras. Detection of NSVT helps us to identify the high-risk patients with NICM.</p></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 3","pages":"Pages 177-179"},"PeriodicalIF":2.5,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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