Progress in cardiovascular diseases最新文献

英文中文

Stemming the chronic disease pandemic through a generational shift in public health policy and practice 通过公共卫生政策和实践的世代转变遏制慢性病的流行。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.004

Ross Arena , Annamaria Arena

引用次数: 0

Predictors of short-term and long-term effects of mavacamten in obstructive hypertrophic cardiomyopathy 阻塞性肥厚型心肌病患者服用马伐康坦短期和长期疗效的预测因素。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.05.008

引用次数: 0

COVID-19 susceptibility causally related to stroke risk: Using SARS-CoV-2 infection as a natural test of disease predisposition? COVID-19 易感性与中风风险存在因果关系：将 SARS-CoV-2 感染作为疾病易感性的自然测试？

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.002

Ming Zheng , Carl J. Lavie

The COVID-19 pandemic, caused by SARS-CoV-2, has sparked recurring outbreaks and remains endemic, posing ongoing health risks. In addition to its immediate effects, COVID-19 has been linked to cardiovascular complications, including stroke. However, it remains unclear whether COVID-19 causally increases future stroke risk. This study used Mendelian randomization (MR) analysis to explore the causal link between COVID-19 susceptibility and stroke risk. By analyzing genome-wide association study (GWAS) data, genetically determined susceptibility to COVID-19 was identified and linked to various stroke subtypes, including cardioembolic, small-vessel, and large-artery ischemic stroke. Results indicated a significant association between COVID-19 susceptibility and increased stroke risk, particularly for large-artery ischemic stroke. These findings suggest that SARS-CoV-2 infection could serve as a natural indicator of disease predisposition, revealing inherent cardiovascular vulnerabilities. This revolutionizes the way we view pathogen infections—not only as harmful threats, but also as opportunities to assess individual health risks. By analyzing how people respond to infections, we can gain valuable insights into their predisposition to other diseases later in life, offering an analytical framework for early diagnosis and prevention. This perspective—using pathogen infections as natural tests of disease predisposition—offers a transformative way to view human diseases as a continuum. Instead of merely treating infections as isolated diseases, we can exploit natural infections to assess broader population health, thus paving the way for precision medicine and personalized healthcare interventions.

由 SARS-CoV-2 引起的 COVID-19 大流行引发了反复的疫情爆发，目前仍在流行，对健康构成持续的威胁。除了直接影响外，COVID-19 还与包括中风在内的心血管并发症有关。然而，COVID-19 是否会增加未来的中风风险，目前仍不清楚。本研究利用孟德尔随机化（MR）分析来探讨 COVID-19 易感性与中风风险之间的因果联系。通过分析全基因组关联研究（GWAS）数据，确定了由基因决定的 COVID-19 易感性，并将其与各种中风亚型（包括心肌栓塞性中风、小血管性中风和大动脉缺血性中风）联系起来。结果表明，COVID-19 易感性与中风风险增加之间存在明显关联，尤其是大动脉缺血性中风。这些发现表明，SARS-CoV-2 感染可作为疾病易感性的自然指标，揭示心血管的内在脆弱性。这彻底改变了我们看待病原体感染的方式--不仅将其视为有害威胁，还将其视为评估个人健康风险的机会。通过分析人们对感染的反应，我们可以获得有关他们日后易患其他疾病的宝贵见解，为早期诊断和预防提供分析框架。这种视角--将病原体感染作为疾病易感性的自然测试--为将人类疾病视为一个连续体提供了一种变革性的方法。我们可以利用自然感染来评估更广泛的人群健康状况，而不是仅仅将感染作为孤立的疾病来治疗，从而为精准医疗和个性化医疗干预铺平道路。

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引用次数: 0

Assorted topics 2024-round 2 各种主题 2024-round 2.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.006

Carl J. Lavie

引用次数: 0

Reflections on community experience with Mavacamten 对 Mavacamten 社区经验的思考。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.08.003

Clement Eiswirth Jr , Yvonne E. Gilliland

引用次数: 0

The premise, promise, and perils of artificial intelligence in critical care cardiology 人工智能在重症监护心脏病学中的前提、前景和危险。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.06.006

Artificial intelligence (AI) is an emerging technology with numerous healthcare applications. AI could prove particularly useful in the cardiac intensive care unit (CICU) where its capacity to analyze large datasets in real-time would assist clinicians in making more informed decisions. This systematic review aimed to explore current research on AI as it pertains to the CICU. A PRISMA search strategy was carried out to identify the pertinent literature on topics including vascular access, heart failure care, circulatory support, cardiogenic shock, ultrasound, and mechanical ventilation. Thirty-eight studies were included. Although AI is still in its early stages of development, this review illustrates its potential to yield numerous benefits in the CICU.

人工智能（AI）是一种新兴技术，在医疗保健领域有着广泛的应用。人工智能在心脏重症监护病房（CICU）中尤其有用，它能够实时分析大型数据集，帮助临床医生做出更明智的决定。本系统性综述旨在探讨当前与 CICU 相关的人工智能研究。我们采用了 PRISMA 搜索策略来确定相关文献，主题包括血管通路、心衰护理、循环支持、心源性休克、超声和机械通气。共纳入 38 项研究。虽然人工智能仍处于早期发展阶段，但这篇综述说明了它在 CICU 中产生诸多益处的潜力。

引用次数: 0

Real-world experience with mavacamten in obstructive hypertrophic cardiomyopathy: Observations from a tertiary care center 阻塞性肥厚型心肌病患者使用马伐康坦的真实体验：一家三级医疗中心的观察结果。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.02.001

Background

In symptomatic obstructive hypertrophic cardiomyopathy (oHCM) patients, mavacamten is commercially approved to help improve left ventricular (LV) outflow tract (LVOT) gradients, symptoms, and reduce eligibility for septal reduction therapy (SRT) under the risk evaluation and mitigation strategy (REMS) program. We sought to prospectively report the initial real-world clinical experience with the use of commercially available mavacamten in a multi-hospital tertiary healthcare system.

Methods

We studied the first 150 consecutive oHCM patients (mean age 65 years, 53% women, 83% on betablockers and 61% in New York Heart Association [NYHA] class III) who were initiated on 5 mg of mavacamten with dose titrations using symptom assessment and echocardiographic measurements of LVOT gradient and LV ejection fraction (LVEF) measurements. We measured changes in NYHA class, LVEF, LVOT gradients (resting and Valsalva) at baseline, 4, 8 and 12 weeks.

Results

At 261 ± 143 days (range of 31–571 days), 69 (46%) patients had ≥1 NYHA class, and 27 (18%) additional patients had ≥2 NYHA class improvement. The mean Valsalva LVOT gradient decreased from 72 ± 43 mmHg at baseline to 29 ± 31 mmHg at 4 weeks, 29 ± 28 mmHg at 8 weeks and 30 ± 29 mmHg at 12 weeks (p < 0.001). At baseline, 100% patients had Valsalva LVOT gradients ≥30 mmHg, which reduced to 29% at 4 weeks, 28% at 8 weeks and 30% at 12 weeks. In 40 patients who reported no symptomatic improvement, the mean Valsalva LVOT gradient decreased from 73 ± 39 mmHg at baseline to 34 ± 27 mmHg at 4 weeks, 35 ± 28 mmHg at 8 weeks and 30 ± 24 mmHg at 12 weeks (P < 0.001). The mean LVEF at baseline was 66 ± 6% and changed to 64 ± 5% at 4 weeks, 63 ± 5% at 8 weeks and 62 ± 7% at 12 weeks (p < 0.0001). No patient underwent SRT, developed LVEF ≤30% or developed heart failure requiring admission. Three (2%) patients needed temporary interruption of mavacamten due to LVEF<50%.

Conclusions

In a real-world study in symptomatic oHCM patients at a multi-hospital tertiary care referral center, we demonstrate the efficacy and safety, along with the logistic feasibility of prescribing mavacamten under the REMS program.

背景：对于有症状的梗阻性肥厚型心肌病（oHCM）患者，mavacamten已获得商业批准，有助于改善左心室流出道（LVOT）梯度和症状，并根据风险评估和缓解策略（REMS）计划降低室间隔减容疗法（SRT）的适用性。我们试图前瞻性地报告在一个多医院三级医疗系统中使用市售马伐康坦的初始实际临床经验：我们研究了首批连续使用 5 毫克马伐康坦的 150 名 oHCM 患者（平均年龄 65 岁，53% 为女性，83% 正在使用贝特类受体阻滞剂，61% 属于纽约心脏协会 [NYHA] III 级），他们通过症状评估、左心室出口梯度超声心动图测量和左心室射血分数 (LVEF) 测量进行剂量滴定。我们测量了基线、4周、8周和12周时NYHA分级、LVEF、左心室出口梯度（静息和Valsalva）的变化：在 261 ± 143 天（31-571 天不等）时，69 例（46%）患者的 NYHA 分级≥1 级，另有 27 例（18%）患者的 NYHA 分级提高≥2 级。平均 Valsalva LVOT 梯度从基线时的 72 ± 43 mmHg 降至 4 周时的 29 ± 31 mmHg、8 周时的 29 ± 28 mmHg 和 12 周时的 30 ± 29 mmHg（p 结论：患者的平均 Valsalva LVOT 梯度从基线时的 72 ± 43 mmHg 降至 4 周时的 29 ± 31 mmHg、8 周时的 29 ± 28 mmHg 和 12 周时的 30 ± 29 mmHg：在一项针对多医院三级医疗转诊中心有症状的 oHCM 患者的实际研究中，我们证明了在 REMS 计划下处方马伐康坦的有效性、安全性和后勤可行性。

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引用次数: 0

Anthracyclines, Diastolic Dysfunction and the road to Heart Failure in Cancer survivors: An untold story 蒽环类药物、舒张功能障碍和癌症幸存者的心力衰竭之路：一个不为人知的故事。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.07.002

Massimiliano Camilli , Péter Ferdinandy , Emanuela Salvatorelli , Pierantonio Menna , Giorgio Minotti

Many cardiovascular diseases are characterized by diastolic dysfunction, which associates with worse clinical outcomes like overall mortality and hospitalization for heart failure (HF). Diastolic dysfunction has also been suspected to represent an early manifestation of cardiotoxicity induced by cancer drugs, with most of the information deriving from patients treated with anthracyclines; however, the prognostic implications of diastolic dysfunction in the anthracycline-treated patient have remained poorly explored or neglected. Here the molecular, pathophysiologic and diagnostic aspects of anthracycline-related diastolic dysfunction are reviewed in the light of HF incidence and phenotype in cancer survivors. We describe that the trajectories of diastolic dysfunction toward HF are influenced by a constellation of patient- or treatment- related factors, such as comorbidities and exposure to other cardiotoxic drugs or treatments, but also by prospective novel opportunities to treat diastolic dysfunction. The importance of a research-oriented multidimensional approach to patient surveillance or treatment is discussed within the framework of what appears to be a distinct pathophysiologic entity that develops early during anthracycline treatment and gradually worsens over the years.

许多心血管疾病都以舒张功能障碍为特征，舒张功能障碍与总体死亡率和心力衰竭（HF）住院治疗等较差的临床结果有关。舒张功能障碍也被怀疑是癌症药物诱发心脏毒性的早期表现，其中大部分信息来自接受蒽环类药物治疗的患者；然而，舒张功能障碍对接受蒽环类药物治疗的患者预后的影响仍未得到充分探讨或被忽视。在此，我们根据癌症幸存者的高频发生率和表型，对蒽环类药物相关舒张功能障碍的分子、病理生理学和诊断方面进行了综述。我们描述了舒张功能障碍向心房颤动发展的轨迹受到一系列患者或治疗相关因素的影响，如合并症和接触其他心脏毒性药物或治疗，同时也受到治疗舒张功能障碍的前瞻性新机会的影响。以研究为导向的多维方法对患者进行监测或治疗的重要性将在蒽环类药物治疗期间早期出现并在数年后逐渐恶化的独特病理生理实体的框架内进行讨论。

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引用次数: 0

Can the outlier percentiles from norms increase the sensitivity of the ECG criteria for screening athletes? 超出标准值的百分位数能否提高心电图标准筛选运动员的灵敏度？

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.003

Jason V. Tso, Samuel Montalvo, Jeffrey Christle, Victor Froelicher

引用次数: 0

Landscape of stroke comorbidities: A disease-wide association study 中风并发症情况。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.005

Ming Zheng , Carl J. Lavie

Stroke is a leading cause of death and disability worldwide, with diverse comorbidities that influence its clinical outcomes. However, a comprehensive understanding of the short- and long-term patterns of stroke-related comorbidities remains limited. To address this gap, we conducted a disease-wide association study (DWAS) to systematically explore the landscape of stroke comorbidities in a population-based cohort. Using data from the FinnGen cohort, which included 337,194 participants and 27,496 ischemic stroke cases, we analyzed 1,757 medical events as potential stroke comorbidities. We employed Cox proportional hazards regression, adjusting for sex and age, to identify significant associations between stroke and these medical events. Comorbidities were classified into pre- and post-stroke categories, and their temporal patterns were analyzed over a 1- to 15-year follow-up period. Our findings revealed that stroke comorbidities span multiple disease taxonomies, with significant enrichment in the circulatory, digestive, and musculoskeletal systems. Notably, the study identified distinct pre-stroke and post-stroke comorbidities that persist or evolve over time, supporting the concept of a disease continuum. These temporal patterns suggest that stroke risk and outcomes are shaped by sequential comorbidities rather than simultaneous occurrences. This study provides the most comprehensive profile of stroke comorbidities to date, highlighting the interconnected nature of diseases. By mapping the progression of comorbidities across time and disease categories, DWAS offers valuable insights for early intervention and long-term treatment. Our findings emphasize the importance of viewing stroke as part of a broader disease continuum, offering new opportunities for prevention, diagnosis, and treatment strategies tailored to individual risk profiles.

脑卒中是导致全球死亡和残疾的主要原因，其多种并发症影响着临床预后。然而，对卒中相关合并症的短期和长期模式的全面了解仍然有限。为了填补这一空白，我们开展了一项全疾病关联研究（DWAS），以系统地探索人群队列中中风合并症的分布情况。芬兰基因队列包括 337,194 名参与者和 27,496 例缺血性中风病例，我们利用该队列的数据分析了作为潜在中风合并症的 1,757 个医疗事件。我们采用 Cox 比例危险度回归，并对性别和年龄进行了调整，以确定中风与这些医疗事件之间的显著关联。合并症分为卒中前和卒中后两类，并对其在 1-15 年随访期内的时间模式进行了分析。我们的研究结果表明，中风合并症涉及多种疾病分类，其中循环系统、消化系统和肌肉骨骼系统的合并症明显增多。值得注意的是，该研究发现了卒中前和卒中后不同的合并症，这些合并症随着时间的推移而持续或演变，支持了疾病连续体的概念。这些时间模式表明，中风风险和预后是由相继发生的合并症而不是同时发生的合并症决定的。这项研究提供了迄今为止最全面的中风合并症概况，突出了疾病的相互关联性。通过描绘合并症在不同时间和不同疾病类别中的进展，DWAS 为早期干预和长期治疗提供了宝贵的见解。我们的研究结果强调了将中风视为更广泛的疾病连续体的一部分的重要性，为针对个体风险特征的预防、诊断和治疗策略提供了新的机会。

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