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Assorted topics 2024-round 2 各种主题 2024-round 2.
IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.006
Carl J. Lavie
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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 Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.08.003
Clement Eiswirth Jr , Yvonne E. Gilliland
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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 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。
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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 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
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 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
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 Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.09.003
Jason V. Tso, Samuel Montalvo, Jeffrey Christle, Victor Froelicher
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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 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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引用次数: 0
Calcified coronary lesions: Imaging, prognosis, preparation and treatment state of the art review 冠状动脉钙化病变:成像、预后、准备和治疗的最新进展回顾。
IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.06.007
Calcific coronary artery stenosis is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as a key strategy to tackle the issues that accompany calcific stenosis - namely reduced device deliverability, unpredictable lesion characteristics, and difficult dilatation. Atherectomy has traditionally been the treatment modality of choice for heavily calcified coronary stenoses. Contemporary technologies have emerged to aid with planning, preparation, and treatment of calcified coronary stenosis in an attempt to improve procedural success and long-term outcomes. In this State Of The Art Review, we synthesize the body of data surrounding the diagnosis, imaging, and treatment of calcific coronary disease, with a focus on i) intravascular imaging, ii) calcific lesion preparation, iii) treatment modalities including atherectomy, and iv) updated treatment algorithms for the management of calcified coronary stenosis.
钙化性冠状动脉狭窄是一种复杂的疾病,与不良预后和不理想的经皮治疗有关。钙斑块改造已成为解决钙化狭窄问题的关键策略,即降低设备的可送达性、病变特征不可预测以及难以扩张。对于严重钙化的冠状动脉狭窄,传统上选择的治疗方式是动脉粥样硬化切除术。现代技术的出现有助于钙化冠状动脉狭窄的计划、准备和治疗,以提高手术成功率和长期疗效。在这篇最新技术综述中,我们综合了有关钙化冠状动脉疾病诊断、成像和治疗的大量数据,重点关注 i)血管内成像;ii)钙化病变准备;iii)包括动脉粥样硬化切除术在内的治疗方式;以及 iv)治疗钙化冠状动脉狭窄的最新治疗算法。
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引用次数: 0
List of recent issues 近期期刊清单
IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/S0033-0620(24)00133-6
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引用次数: 0
The role of artificial intelligence in cardiovascular magnetic resonance imaging 人工智能在心血管磁共振成像中的作用。
IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/j.pcad.2024.06.004
Cardiovascular magnetic resonance (CMR) imaging is the gold standard test for myocardial tissue characterization and chamber volumetric and functional evaluation. However, manual CMR analysis can be time-consuming and is subject to intra- and inter-observer variability. Artificial intelligence (AI) is a field that permits automated task performance through the identification of high-level and complex data relationships. In this review, we review the rapidly growing role of AI in CMR, including image acquisition, sequence prescription, artifact detection, reconstruction, segmentation, and data reporting and analysis including quantification of volumes, function, myocardial infarction (MI) and scar detection, and prediction of outcomes. We conclude with a discussion of the emerging challenges to widespread adoption and solutions that will allow for successful, broader uptake of this powerful technology.
心血管磁共振(CMR)成像是心肌组织特征描述、心腔容积和功能评估的金标准检测方法。然而,手动 CMR 分析可能非常耗时,而且受观察者内部和观察者之间差异的影响。人工智能(AI)是一个通过识别高层次复杂数据关系实现任务自动执行的领域。在这篇综述中,我们回顾了人工智能在 CMR 中迅速发展的作用,包括图像采集、序列处方、伪影检测、重建、分割以及数据报告和分析(包括容量量化、功能、心肌梗死(MI)和瘢痕检测以及预后预测)。最后,我们还讨论了广泛采用这项强大技术所面临的新挑战,以及如何成功、更广泛地采用这项技术的解决方案。
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引用次数: 0
期刊
Progress in cardiovascular diseases
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