Revista espanola de cardiologia最新文献

英文中文

Revisión sistemática y metanálisis de estudios aleatorizados y no aleatorizados sobre revascularización guiada por reserva fraccional de flujo 关于分数血流储备引导下血管再通的随机和非随机研究的系统回顾和荟萃分析

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-22 DOI: 10.1016/j.recesp.2024.02.011

Introduction and objectives

Several studies have investigated the effectiveness of fractional flow reserve (FFR) guidance in improving clinical outcomes after myocardial revascularization, yielding conflicting results. The aim of this study was to compare clinical outcomes in patients with coronary artery disease following FFR-guided or angiography-guided revascularization.

Methods

Both randomized controlled trials (RCTs) and nonrandomized intervention studies were included. Coprimary endpoints were all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE). The study is registered with PROSPERO (CRD42022344765).

Results

A total of 30 studies enrolling 393 588 patients were included. FFR-guided revascularization was associated with significantly lower rates of all-cause death (OR, 0.63; 95%CI, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no significant difference between the 2 strategies was observed for any endpoints. However, the use of FFR was associated with reduced rates of revascularizations and treated lesions. Metaregression suggested that the higher the rate of revascularized patients the lower the benefit of FFR guidance on MACE reduction compared with angiography guidance (P = .012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (P = .039).

Conclusions

FFR-guided revascularization was associated with lower rates of all-cause death, myocardial infarction and MACE compared with angiographic guidance, with RCTs and nonrandomized intervention studies yielding conflicting data. The benefits of FFR-guidance seem to be less evident in studies with high revascularization rates and with a high prevalence of patients with acute coronary syndrome.

导言和目的有几项研究调查了分数血流储备（FFR）引导在改善心肌血管再通术后临床疗效方面的有效性，但结果相互矛盾。本研究旨在比较冠状动脉疾病患者在 FFR 引导或血管造影引导下接受血管再通术后的临床疗效。方法纳入了随机对照试验（RCT）和非随机干预研究。主要终点为全因死亡、心肌梗死和主要不良心血管事件（MACE）。该研究已在 PROSPERO 注册（CRD42022344765）。FFR引导下的血管再通术与较低的全因死亡率（OR，0.63；95%CI，0.53-0.73）、心肌梗死（OR，0.70；95%CI，0.59-0.84）和MACE（OR，0.77；95%CI，0.70-0.85）相关。如果仅考虑研究性临床试验，则未观察到两种策略在任何终点上存在显著差异。然而，FFR的使用与血管再通率和治疗病变率的降低有关。元回归结果表明，与血管造影术相比，血管再通率越高的患者，FFR指导对减少MACE的益处越低（P = .012）。结论与血管造影引导相比，FFR引导下的血管再通术与较低的全因死亡、心肌梗死和MACE发生率相关，但RCT和非随机干预研究得出的数据相互矛盾。在血管重建率高、急性冠脉综合征患者发病率高的研究中，FFR引导的益处似乎不那么明显。

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引用次数: 0

Stents autoexpandibles SINUS XL para implante previo en el recambio valvular pulmonar 用于肺动脉瓣置换术前植入的 SINUS XL 自扩张支架

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-16 DOI: 10.1016/j.recesp.2024.02.021

引用次数: 0

Uso de los nuevos vasodilatadores pulmonares en pacientes con cortocircuitos sistémico-pulmonares: estrategia «tratar y reparar» 在全身-肺分流患者中使用新型肺血管扩张剂："治疗和修复 "策略

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-16 DOI: 10.1016/j.recesp.2024.04.005

引用次数: 0

La identificación subjetiva y ablación de impulsores auriculares mejora el control del ritmo en la fibrilación auricular persistente. Estudio CHAOS-AF 主观识别和消融心房冲动可改善持续性心房颤动的节律控制。CHAOS-AF 研究

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-03 DOI: 10.1016/j.recesp.2024.01.010

Introduction and objectives

The optimal approach for persistent atrial fibrillation (AF) ablation remains unknown. In patients with persistent AF, we compared an ablation strategy based on pulmonary vein isolation (PVI) plus ablation of drivers (PVI + D), with a conventional PVI-only approach performed in a 1:1 propensity score-matched cohort.

Methods

Drivers were subjectively identified using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid), without dedicated software, as fractionated continuous or quasicontinuous electrograms on 1 to 2 adjacent bipoles, which were ablated first; and as sites with spatiotemporal dispersion (the entire cycle length comprised within the mapping catheter) plus noncontinuous fractionation, which were only targeted in patients without fractionated continuous electrograms, or without AF conversion after ablation of fractionated continuous electrograms. Ablation included PVI plus focal or linear ablation targeting drivers.

Results

A total of 50 patients were included in each group (61 ± 10 years, 25% women). Fractionated continuous electrograms were found and ablated in 21 patients from the PVI + D group (42%), leading to AF conversion in 7 patients. In the remaining 43 patients, 143 sites with spatiotemporal dispersion plus noncontinuous fractionation were targeted. Globally, AF conversion was achieved in 21 patients (42%). The PVI + D group showed lower atrial arrhythmia recurrences at 1 year of follow-up (30.6% vs 48%; P = .048) and at the last follow-up (46% vs 72%; P = .013), and less progression to permanent AF (10% vs 40%; P = .001).

Conclusions

Subjective identification and ablation of drivers, added to PVI, increased 1-year freedom from atrial arrhythmia and decreased long-term recurrences and progression to permanent AF.

导言和目的持续性心房颤动（房颤）消融的最佳方法仍然未知。在持续性房颤患者中，我们比较了基于肺静脉隔离（PVI）和驱动因素消融（PVI + D）的消融策略，以及在 1:1 倾向评分匹配队列中仅采用传统 PVI 的方法。方法使用传统的高密度绘图导管（IntellaMap ORION、PentaRay NAV 或 Advisor HD Grid），在不使用专用软件的情况下，根据 1 到 2 个相邻双极上的连续或类连续电图分段主观地识别驱动因素，并首先对其进行消融；以及具有时空弥散（整个周期长度包含在映射导管内）和非连续分馏的部位，仅针对无分馏连续电图或分馏连续电图消融后无房颤转换的患者。消融包括 PVI 加局灶或线性消融靶向驱动器。结果每组共纳入 50 名患者（61 ± 10 岁，25% 为女性）。PVI + D 组中有 21 名患者（42%）发现了分段连续电图并进行了消融，其中 7 名患者转为房颤。在其余 43 名患者中，143 个时空弥散加非连续分馏的部位成为目标。总体而言，21 名患者（42%）实现了房颤转复。PVI + D 组在随访 1 年（30.6% vs 48%；P = .048）和最后一次随访（46% vs 72%；P = .013）时的房性心律失常复发率较低，发展为永久性房颤的比例较低（10% vs 40%；P = .001）。

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引用次数: 0

Pregnancy in women with dilated cardiomyopathy genetic variants. 患有扩张型心肌病基因变异的妇女的怀孕问题。

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-01 DOI: 10.1016/j.rec.2024.04.002

M. A. Restrepo-Córdoba, P. Chmielewski, G. Truszkowska, M. L. Peña-Peña, M. Kubanek, Alice Krebsová, Luis R Lopes, Álvaro García-Ropero, M. Merlo, A. Paldino, Stacey Peters, R. Jurcut, R. Barriales-Villa, E. Zorio, M. Hazebroek, Jens Mogensen, P. García-Pavía

引用次数: 0

Description and prevalence of ventricular mitral annular disjunction: variation of normality or pathological variant? 心室二尖瓣环脱节的描述和发生率：常态变异还是病理变异？

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-01 DOI: 10.1016/j.rec.2024.04.003

Agata Krawczyk-Ożóg, M. Hołda, J. Batko, Kacper Jaśkiewicz, Artur Dziewierz, Barbara Zdzierak, Wojciech Zasada, Krzysztof Gil, J. Hołda

引用次数: 0

Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock. 急性心肌梗死和心源性休克患者的血管内成像引导经皮冠状动脉介入治疗。

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-01 DOI: 10.1016/j.rec.2024.03.009

H. Joh, Seung Hun Lee, Jinhwan Jo, Hyun Kuk Kim, W. Lim, Hack‐Lyoung Kim, Jae-Bin Seo, Woo-Young Chung, Sang-Hyun Kim, J. Zo, Myung-A Kim, Min Chul Kim, Ju Han Kim, Young Joon Hong, Y. Ahn, Myung Ho Jeong, S. Hur, Doo-Il Kim, Kiyuk Chang, Hun Sik Park, Jang-Whan Bae, J. Jeong, Yonghwan Park, Kyeong Ho Yun, Chang-Hwan Yoon, Yisik Kim, Jin-Yong Hwang, H. Kim, David Hong, Woo-Duk Kwon, K. Choi, T. Park, Jeong Hoon Yang, Young Bin Song, J. Hahn, Seung‐Hyuk Choi, H. Gwon, Joo Myung Lee

引用次数: 0

Adherence to Life's Essential 8 is associated with delayed biological aging: a population-based cross-sectional study. 坚持 "人生必修 8 "与生物衰老延迟有关：一项基于人群的横断面研究。

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-01 DOI: 10.1016/j.rec.2024.04.004

Hongyu Chen, H. Tang, Xuan Zhang, Jingtao Huang, Nan Luo, Qingqian Guo, Xin Wang

引用次数: 0

Obesidad en España: un libro abierto que debemos leer 西班牙的肥胖症：一本值得一读的开放之书

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-03-28 DOI: 10.1016/j.recesp.2024.03.010

引用次数: 0

Cirugía cardiovascular y cardiología, situación actual en España de las dos especialidades hermanas: el estudio CARDIOXCARDIO 心血管外科和心脏病学，这两个姊妹专业在西班牙的现状：CARDIOXCARDIO 研究。

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-03-26 DOI: 10.1016/j.recesp.2024.03.012

In recent years, there has been a notable shift in cardiovascular clinical practice within cardiology and surgery. The CARDIOXCARDIO study aimed to identify professionals’ opinions on working practices and relations between specialties. A survey was simultaneously sent to the 4442 members of the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the Spanish Society of Cardiology (SEC), yielding 385 valid responses. More than half (59%) of respondents were men, mostly specialists (7.3% residents), and 74.8% worked in the field of cardiology, predominantly in public centers (88.3%). Using a Likert scale ranging from 1 to 5 (worst to best), respondents rated relations between surgery and cardiology with an average of 3.57 ± 0.9 points. Cardiologists rated surgeons with a mean score of 3.83 ± 0.8, while surgeons gave cardiologists a mean score of 3,92 ± 0.72. In addition, respondents provided numerous suggestions for improvement, which are discussed in detail, highlighting certain discrepancies in criteria between specialties. Implementing strategies based on the suggestions of professionals, together with a proactive approach to continuous improvement, could substantially enhance the quality of cardiovascular care in Spain.

近年来，心血管内科和外科的临床实践发生了显著变化。CARDIOXCARDIO 研究旨在了解专业人员对工作实践和专科之间关系的看法。我们同时向西班牙心血管和血管内外科学会（SECCE）和西班牙心脏病学会（SEC）的 4442 名会员发出了调查问卷，共收到 385 份有效回复。超过半数（59%）的受访者为男性，大部分为专科医生（7.3% 为住院医师），74.8% 的受访者在心脏病学领域工作，主要在公立中心工作（88.3%）。受访者使用 1 到 5 分（从最差到最好）的李克特量表对外科和心脏病学之间的关系进行评分，平均分为 3.57 ± 0.9 分。心脏病专家给外科医生的平均评分为 3.83 ± 0.8 分，而外科医生给心脏病专家的平均评分为 3,92 ± 0.72 分。此外，受访者还提出了许多改进建议，我们将对这些建议进行详细讨论，并强调各专科在标准上的某些差异。根据专业人士的建议实施相应的策略，同时积极主动地进行持续改进，可以大大提高西班牙心血管病治疗的质量。

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