Therapeutic Advances in Cardiovascular Disease最新文献_第8页

Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography 用阻抗心动图分析伴有和不伴有心力衰竭的高血压患者的血流动力学差异

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-09-01 DOI: 10.1177/1753944719876517

Bruno Silva Lopes, N. Craveiro, J. Firmino-Machado, P. Ribeiro, M. Castelo-Branco

Background: Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of critically ill patients, and help in the choice of antihypertensive therapy. The objective of this study was to determine the differences between hemodynamic parameters in a study population of hypertensive patients with and without HF, using impedance cardiography. Methods: A case-control study was designed and named the TARGET study. Participants were enrolled in two study groups: control group C, hypertensive patients without HF and the HF group, hypertensive patients with HF. A descriptive analysis was carried out to characterize the sample and differences in continuous variables were tested for statistical significance by independent sample t test. Results: The study included 102 hypertensive outpatients. The control group consisted of 77 individuals (58.4% males; mean age 63.9 ± 12.5 years old) and the HF group consisted of 25 individuals (44.0% males; mean age 74.2 ± 8.7 years old). The mean Cardiac Index (CI) was 2.70 ± 1.02 L.min.m−2 (2.89 ± 1.04 versus 2.12 ± 0.70; p < 0.001), mean Stroke Index (SI) was 35.5 ± 14.7 mL.m−2 (37.7 ± 15.2 versus 28.5 ± 10.8; p = 0.006), mean Ejection Phase Contractility Index (EPCI) was 33.7 ± 12.7 1000 s−2 (35.8 ± 13.1 versus 27.2 ± 9.2; p = 0.003), mean Inotropic State Index (ISI) was 74.3 ± 28.2 100 s−2 (78.8 ± 28.9 versus 60.6 ± 20.7; p = 0.005), and mean Left Stroke Work Index (LSWI) was 51.3 ± 23.1 g.min.m−2 (55.4 ± 23.5 versus 38.9 ± 16.6; p = 0.002). Conclusions: In this study, hypertensive patients with HF had significantly lower values of blood flow parameters, contractility, and left work indices compared with hypertensive patients without HF. These differences reflected the incorrect hemodynamic pattern (mostly hypodynamic) of these patients. Impedance cardiography (ICG) seems to be an adequate method to reflect these differences.

背景：阻抗心动图是一种可靠、耐受性好、无创的方法，可用于获得血液动力学测量，并可能用于心力衰竭（HF）诊断、危重患者的血液动力学监测，并有助于选择抗高血压治疗。本研究的目的是使用阻抗心动图来确定有HF和无HF的高血压患者的研究人群中血液动力学参数之间的差异。方法：设计病例对照研究，命名为TARGET研究。参与者被分为两个研究组：对照组C，无HF的高血压患者和HF组，有HF的高血压病人。对样本进行描述性分析，并通过独立样本t检验连续变量的差异是否具有统计学意义。结果：本研究纳入102例高血压门诊患者。对照组由77人组成（58.4%为男性；平均年龄63.9岁） ± 12.5 岁），HF组由25人组成（44.0%为男性；平均年龄74.2岁 ± 8.7 岁）。平均心脏指数（CI）为2.70 ± 1.02 L.min.m−2（2.89 ± 1.04对2.12 ± 0.70；p < 0.001），平均卒中指数（SI）为35.5 ± 14.7 mL.m−2（37.7 ± 15.2对28.5 ± 10.8；p = 0.006），平均射血期收缩指数（EPCI）为33.7 ± 12.7 1000 s−2（35.8 ± 13.1对27.2 ± 9.2；p = 0.003），平均变力状态指数（ISI）为74.3 ± 28.2 100 s−2（78.8 ± 28.9对60.6 ± 20.7；p = 0.005），平均左卒中工作量指数（LSWI）为51.3 ± 23.1 g.min.m−2（55.4 ± 23.5对38.9 ± 16.6；p = 0.002）。结论：在本研究中，患有HF的高血压患者的血流参数、收缩力和左功指标值与没有HF的高血压病人相比明显较低。这些差异反映了这些病人不正确的血液动力学模式（主要是低动力）。心阻抗图（ICG）似乎是反映这些差异的一种适当方法。

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引用次数: 9

6-minute walking test: a useful tool in the management of heart failure patients 6分钟步行测试：心力衰竭患者管理的有用工具

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-08-01 DOI: 10.1177/1753944719870084

S. Giannitsi, M. Bougiakli, A. Bechlioulis, A. Kotsia, L. Michalis, K. Naka

Reduced functional ability and exercise tolerance in patients with heart failure (HF) are associated with poor quality of life and a worse prognosis. The 6-minute walking test (6MWT) is a widely available and well-tolerated test for the assessment of the functional capacity of patients with HF. Although the cardiopulmonary exercise test (a maximal exercise test) remains the gold standard for the evaluation of exercise capacity in patients with HF, the 6MWT (submaximal exercise test) may provide reliable information about the patient’s daily activity. The current review summarizes the value of 6MWT in patients with HF and identifies its usefulness and limitations in everyday clinical practice in populations of HF. We aimed to investigate potential associations of 6MWD with other measures of functional status and determinants of 6MWD in patients with HF as well as to review its prognostic role and changes to various interventions in these patients.

心力衰竭（HF）患者的功能能力和运动耐受性降低与生活质量差和预后差有关。6分钟步行测试（6MWT）是一种广泛可用且耐受性良好的测试，用于评估HF患者的功能能力。尽管心肺运动测试（最大运动测试）仍然是评估HF患者运动能力的金标准，6MWT（次最大运动测试）可以提供关于患者日常活动的可靠信息。目前的综述总结了6MWT在HF患者中的价值，并确定了其在HF人群日常临床实践中的有用性和局限性。我们旨在研究6MWD与HF患者功能状态和6MWD决定因素的其他指标的潜在相关性，并回顾其在这些患者中的预后作用和各种干预措施的变化。

引用次数: 147

Serum visfatin level is associated with complexity of coronary artery disease in patients with stable angina pectoris 稳定型心绞痛患者血清内脂蛋白水平与冠状动脉疾病复杂性的关系

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-01-01 DOI: 10.1177/1753944719880448

H. Duman, A. G. Özyıldız, I. Bahceci, H. Duman, A. Uslu, E. Ergül

Background: Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CAD). Methods: The study population included 110 patients who underwent elective coronary angiography (CAG) due to stable angina pectoris. The severity of CAD was assessed by the ‘Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)’ score. We evaluated patients in two groups: group 1 with a SYNTAX score <22 (low) and group 2 with a SYNTAX score ⩾22 (intermediate to high). Results: Serum visfatin (8.6 ± 4.2 ng/ml versus 13.4 ± 5.2 ng/ml, p < 0.001) and serum C-reactive protein (CRP) levels [0.46 (0.25–0.77) mg/dl versus 0.71 (0.32–1.10) mg/dl, p < 0.001] were lower in group 1. A positive significant correlation was found between serum visfatin level and SYNTAX score (r = 0.559, p < 0.001). In a multivariate logistic regression analysis, visfatin [odds ratio (OR) 1.22, 95% confidence interval (CI) 1.10–1.36; p < 0.001], CRP (OR 6.22, 95% CI 1.70–22.7; p = 0.006), and diabetes mellitus (OR 3.83, 95% CI 1.10–13.2; p = 0.034) were found to be independent predictors of SYNTAX score. Conclusions: Serum visfatin level was positively correlated with CAD severity in patients with high SYNTAX score. Serum visfatin level can be a useful biomarker for predicting high SYNTAX scores in patients with angina pectoris undergoing CAG.

背景:Visfatin是一种脂肪因子，在动脉粥样硬化的炎症过程中发挥作用。本研究旨在探讨脂肪因子是否与稳定性冠状动脉疾病(CAD)的程度相关。方法:研究人群包括110例因稳定性心绞痛而行选择性冠状动脉造影(CAG)的患者。CAD的严重程度通过“经皮冠状动脉介入治疗与心脏手术(SYNTAX)之间的协同作用”评分来评估。我们评估了两组患者:SYNTAX评分<22(低)的第1组和SYNTAX评分大于或小于22(中高)的第2组。结果:1组血清visfatin(8.6±4.2 ng/ml vs 13.4±5.2 ng/ml, p < 0.001)、c反应蛋白(CRP)水平[0.46 (0.25 ~ 0.77)mg/dl vs 0.71 (0.32 ~ 1.10) mg/dl, p < 0.001]降低。血清visfatin水平与SYNTAX评分呈正相关(r = 0.559, p < 0.001)。在多变量logistic回归分析中，visfatin[比值比(OR) 1.22, 95%可信区间(CI) 1.10-1.36;p < 0.001]， CRP (OR 6.22, 95% CI 1.70-22.7;p = 0.006)，糖尿病(OR 3.83, 95% CI 1.10-13.2;p = 0.034)是句法评分的独立预测因子。结论:SYNTAX评分高的患者血清visfatin水平与冠心病严重程度呈正相关。血清内脂素水平可作为预测心绞痛CAG患者SYNTAX评分高的有用生物标志物。

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引用次数: 10

Predicting outcomes in patients with cancer and atrial fibrillation 预测癌症和房颤患者的预后

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-01-01 DOI: 10.1177/1753944719860676

Alejandra Gutierrez, R. Patell, L. Rybicki, A. Khorana

Background: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. Methods: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). Results: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1–2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03–76). At a median of 8.2 months (range 0–61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2–6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1–1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. Conclusion: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.

背景:癌症特异性因素在癌症合并心房颤动(AF)患者缺血性卒中和死亡率中的作用尚不清楚。我们评估了先前验证的癌症门诊患者静脉血栓栓塞(VTE)风险工具[Khorana评分(KS)]在预测癌症合并房颤患者卒中和死亡率方面的效用。方法:我们对2008年至2014年克利夫兰诊所的癌症合并房颤患者进行了回顾性队列研究。结果，CHADS2、CHA2DS2-VASc和KS评分从癌症诊断之日起计算。预后因素通过Fine和Gray回归(用于中风)或Cox比例风险分析(用于死亡率)确定。结果:研究人群包括1181例患者。泌尿生殖系统(19%)、肺部(18%)和胃肠道(13%)是最常见的癌症。总体而言，67%的CHADS2大于或等于2,57%的中间KS(1-2)和7%的高KS(大于或等于3)。中位随访时间为26.5个月(范围0.03-76)。在中位8.2个月(范围0-61)时，45名患者(3.8%)发生中风，418名患者(35%)死亡。在多变量分析中，高KS (HR 4.5, 95% CI 3.2-6.3, p < 0.001)与4倍的死亡风险相关，CHADS2评分每增加1分，死亡风险增加20% (HR 1.19, 95% CI 1.1-1.2, p < 0.001)。添加KS并没有改善缺血性卒中对CHADS2的风险分层。结论:在癌症合并房颤患者中，CHADS2和CHA2DS2-VASc是缺血性卒中的预测指标，而KS不是。高KS代表了传统风险评分之外的独特的死亡率预测因子。

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引用次数: 8

Intravenous antiplatelet therapies (glycoprotein IIb/IIIa receptor inhibitors and cangrelor) in percutaneous coronary intervention: from pharmacology to indications for clinical use. 经皮冠状动脉介入治疗中的静脉注射抗血小板疗法（糖蛋白 IIb/IIIa 受体抑制剂和坎格雷罗）：从药理学到临床使用适应症。

IF 2.6 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-01-01 DOI: 10.1177/1753944719893274

Davide Capodanno, Rocco P Milluzzo, Dominick J Angiolillo

Oral antiplatelet drugs are crucially important for patients with acute coronary syndrome or stable coronary artery disease undergoing percutaneous coronary intervention (PCI). In recent decades, several clinical trials have focused on reducing periprocedural ischemic events in patients undergoing PCI by means of more rapid platelet inhibition with the use of intravenous antiplatelet drugs. Glycoprotein IIb/IIIa receptor inhibitors (GPIs) block the final common pathway of platelet aggregation and enable potent inhibition in the peri-PCI period. In recent years, however, the use of GPIs has decreased due to bleeding concerns and the availability of more potent oral P2Y₁₂ inhibitors. Cangrelor is an intravenous P2Y₁₂ receptor antagonist. In a large-scale regulatory trial, cangrelor administration during PCI allowed for rapid, potent and rapidly reversible inhibition of platelet aggregation, with an anti-ischemic benefit and no increase in major bleeding. This article aims to provide an overview of general pharmacology, supporting evidence and current status of intravenous antiplatelet therapies (GPIs and cangrelor), with a focus on contemporary indications for their clinical use.

口服抗血小板药物对于接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征或稳定型冠状动脉疾病患者至关重要。近几十年来，一些临床试验的重点是通过使用静脉抗血小板药物更快速地抑制血小板，减少接受 PCI 患者的围手术期缺血性事件。糖蛋白 IIb/IIIa 受体抑制剂（GPIs）可阻断血小板聚集的最终共同途径，并能在 PCI 术前有效抑制血小板聚集。但近年来，由于出血问题和更强效的口服 P2Y12 抑制剂的出现，GPIs 的使用有所减少。Cangrelor 是一种静脉 P2Y12 受体拮抗剂。在一项大规模的监管试验中，PCI 期间服用坎格雷洛可快速、有效、快速可逆地抑制血小板聚集，并具有抗缺血作用，且不增加大出血。本文旨在概述静脉注射抗血小板疗法（GPIs 和坎格雷罗）的一般药理学、支持性证据和现状，重点介绍其临床应用的当代适应症。

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引用次数: 0

AHA/ACC/Multisociety Cholesterol Guidelines: highlights AHA/ACC/多协会胆固醇指南:重点

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-01-01 DOI: 10.1177/1753944719881579

I. Jialal, S. Devaraj

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Ther Adv Cardiovasc Dis

知识共享非商业性CC BY-NC:本文在知识共享署名-非商业4.0许可(http://www.creativecommons.org/licenses/by-nc/4.0/)的条款下发布，该许可允许非商业用途，复制和分发作品，无需进一步许可，前提是原始作品的署名与SAGE和开放获取页面(https://us.sagepub.com/en-us/nam/open-access-at-sage)上指定的一致。心血管疾病

引用次数: 16

Influence of model-predicted rivaroxaban exposure and patient characteristics on efficacy and safety outcomes in patients with acute coronary syndrome 模型预测的利伐沙班暴露和患者特征对急性冠脉综合征患者疗效和安全性结局的影响

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-01-01 DOI: 10.1177/1753944719863641

Liping Zhang, Xiaoyu Yan, P. Nandy, S. Willmann, K. Fox, S. Berkowitz, Amarnath Sharma, A. Hermanowski‐Vosatka, S. Schmidt, J. Weitz, D. Garmann, G. Peters

Background: This analysis aimed to evaluate the impact of rivaroxaban exposure and patient characteristics on efficacy and safety outcomes in patients with acute coronary syndrome (ACS) and to determine whether therapeutic drug monitoring might provide additional information regarding rivaroxaban dose, beyond what patient characteristics provide. Methods: A post hoc exposure–response analysis was conducted using data from the phase III ATLAS ACS 2 Thrombolysis in Myocardial Infarction (TIMI) 51 study, in which 15,526 randomized ACS patients received rivaroxaban (2.5 mg or 5 mg twice daily) or placebo for a mean of 13 months (maximum follow up: 31 months). A multivariate Cox model was used to correlate individual predicted rivaroxaban exposures and patient characteristics with time-to-event clinical outcomes. Results: For the incidence of myocardial infarction (MI), ischemic stroke, or nonhemorrhagic cardiovascular death, hazard ratios (HRs) for steady-state maximum plasma concentration (Cmax) in the 5th and 95th percentiles versus the median were statistically significant but close to 1 for both rivaroxaban doses. For TIMI major bleeding events, a statistically significant association was observed with Cmax [HR, 1.08; 95% CI, 1.06–1.11 (95th percentile versus median, 2.5 mg twice daily)], sex [HR, 0.56; 95% CI, 0.38–0.84 (female versus male)], and previous revascularization [HR, 0.62; 95% CI, 0.44–0.87 (no versus yes)]. Conclusions: The shallow slopes of the exposure–response relationships and the lack of a clear therapeutic window render it unlikely that therapeutic drug monitoring in patients with ACS would provide additional information regarding rivaroxaban dose beyond that provided by patient characteristics.

背景：本分析旨在评估利伐沙班暴露和患者特征对急性冠状动脉综合征（ACS）患者疗效和安全性结果的影响，并确定治疗药物监测是否可以提供关于利伐沙班剂量的额外信息，而不仅仅是患者特征。方法：使用III期ATLAS ACS 2心肌梗死溶栓（TIMI）51研究的数据进行临时暴露-反应分析，其中15526名随机ACS患者接受了利伐沙班（2.5 mg或5 mg，每日两次）或安慰剂，平均13 月（最长随访时间：31 月）。使用多变量Cox模型将个体预测的利伐沙班暴露量和患者特征与时间-事件临床结果相关联。结果：对于心肌梗死（MI）、缺血性中风或非出血性心血管死亡的发生率，稳态最大血浆浓度（Cmax）在第5和第95个百分位数与中位数的危险比（HR）具有统计学意义，但利伐沙班两种剂量的危险比均接近1。对于TIMI主要出血事件，观察到Cmax[HR，1.08；95%CI，1.06-1.11（第95百分位与中位数，2.5 mg，每日两次）、性别[HR，0.56；95%CI，0.38–0.84（女性与男性）]和既往血运重建[HR，0.62；95%CI，0.44–0.87（否与是）]。结论：暴露-反应关系的浅斜率和缺乏明确的治疗窗口，使得ACS患者的治疗药物监测不太可能提供患者特征之外的关于利伐沙班剂量的额外信息。

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引用次数: 6

The place of ARBs in heart failure therapy: is aldosterone suppression the key? ARBs在心力衰竭治疗中的地位：醛固酮抑制是关键吗？

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2019-01-01 DOI: 10.1177/1753944719868134

U. Markan, S. Pasupuleti, C. Pollard, Arianna Perez, Beatrix Aukszi, A. Lymperopoulos

Since the launch of the first orally available angiotensin II (AngII) type 1 receptor (AT1R) blocker (ARB) losartan (Cozaar) in the late 1990s, the class of ARBs (or ‘sartans’, short for Angiotensin-RecepTor-ANtagonistS) quickly expanded to include candesartan, eprosartan, irbesartan, valsartan, telmisartan, and olmesartan. All ARBs have high affinity for the AT1 receptor, expressed in various tissues, including smooth muscle cells, heart, kidney, and brain. Since activation of AT1R, the target of these drugs, leads, among other effects, to vascular smooth muscle cell growth, proliferation and contraction, activation of fibroblasts, cardiac hypertrophy, aldosterone secretion from the adrenal cortex, thirst-fluid intake (hypervolemia), etc., the ARBs are nowadays one of the most useful cardiovascular drug classes used in clinical practice. However, significant differences in their pharmacological and clinical properties exist that may favor use of particular agents over others within the class, and, in fact, two of these drugs, candesartan and valsartan, continuously appear to distinguish themselves from the rest of the ‘pack’ in recent clinical trials. The reason(s) for the potential superiority of these two agents within the ARB class are currently unclear but under intense investigation. The present short review gives an overview of the clinical properties of the ARBs currently approved by the United States Food and Drug Administration, with a particular focus on candesartan and valsartan and the areas where these two drugs seem to have a therapeutic edge. In the second part of our review, we outline recent data from our laboratory (mainly) on the molecular effects of the ARB drugs on aldosterone production and on circulating aldosterone levels, which may underlie (at least in part) the apparent clinical superiority of candesartan (and valsartan) over most other ARBs currently in clinical use.

自20世纪90年代末推出首个口服血管紧张素II（AngII）1型受体（AT1R）阻滞剂（ARB）氯沙坦（Cozaar）以来，ARB（或“沙坦”，血管紧张素受体拮抗剂的缩写）的类别迅速扩展到包括坎地沙坦、依普罗沙坦、厄贝沙坦、缬沙坦、替米沙坦和奥美沙坦。所有ARB对AT1受体具有高亲和力，AT1受体在各种组织中表达，包括平滑肌细胞、心脏、肾脏和大脑。由于AT1R（这些药物的靶点）的激活导致血管平滑肌细胞生长、增殖和收缩、成纤维细胞的激活、心脏肥大、肾上腺皮质分泌醛固酮、口渴液摄入（高容量）等，ARBs是目前临床实践中最有用的心血管药物类别之一。然而，它们的药理学和临床特性存在显著差异，这可能有利于使用特定药物，而不是同类药物中的其他药物。事实上，在最近的临床试验中，其中两种药物，坎地沙坦和缬沙坦，似乎不断地将自己与其他药物区分开来。这两种制剂在ARB类中潜在优势的原因目前尚不清楚，但正在进行深入调查。本简短综述概述了美国食品和药物管理局目前批准的ARBs的临床特性，特别关注坎地沙坦和缬沙坦，以及这两种药物似乎具有治疗优势的领域。在我们综述的第二部分，我们概述了我们实验室（主要）关于ARB药物对醛固酮产生和循环醛固酮水平的分子影响的最新数据，这可能是（至少部分）坎地沙坦（和缬沙坦）比目前临床使用的大多数其他ARB明显临床优势的基础。

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引用次数: 17

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection. 升主动脉、血弓和弓修复对Stanford A型急性主动脉夹层患者早期和长期预后的影响

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2018-12-01 Epub Date: 2018-10-08 DOI: 10.1177/1753944718801568

Julia Merkle, Anton Sabashnikov, Antje-Christin Deppe, Mohamed Zeriouh, Johanna Maier, Carolyn Weber, Kaveh Eghbalzadeh, Georg Schlachtenberger, Olga Shostak, Ilija Djordjevic, Elmar Kuhn, Parwis B Rahmanian, Navid Madershahian, Christian Rustenbach, Oliver Liakopoulos, Yeong-Hoon Choi, Ferdinand Kuhn-Régnier, Thorsten Wahlers

Background:: Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD.

Methods:: From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9 years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed.

Results:: There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke ( p = 0.034), need for reopening due to bleeding ( p = 0.031) and in-hospital mortality ( p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival ( p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke ( p = 0.023), reopening for bleeding ( p = 0.010) and in-hospital mortality ( p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke ( p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified.

Conclusions:: With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.

背景:急性主动脉夹层(AAD)是一种危及生命的紧急情况，与主要发病率和死亡率相关。本研究的目的是比较三种不同手术入路治疗Stanford A - AAD患者的结果。方法:2006年1月至2015年3月，连续240例确诊为Stanford a AAD的患者在本中心接受了选择性、孤立性手术主动脉修复。根据手术修复程度将患者分为孤立升主动脉置换术组、血弓置换术组和全弓置换术组。患者随访时间长达9年。单因素分析后，采用多项逻辑回归进行亚组分析。分析基线特征和终点以及长期生存。结果:三组患者在人口统计学、术前基线及临床特征方面均无统计学差异。住院卒中发生率(p = 0.034)、因出血而重开手术的需要(p = 0.031)和住院死亡率(p = 0.017)随着手术入路的扩大而显著增加。三组患者的长期生存率比较，差异无统计学意义(p = 0.166)。应用多项logistic回归对亚组分析发现，与升主动脉手术组相比，足弓手术组卒中(p = 0.023)、因出血重新开业(p = 0.010)和住院死亡率(p = 0.009)的几率显著较高，而全足弓手术组卒中的几率显著高于足弓手术组(p = 0.029)。结论:Stanford A AAD围手术期并发症的发生率随手术入路的扩大而明显增加。亚组分析和长期随访显示，与全弓置换术相比，接受孤立升弓或血弓手术的患者脑血管事件发生率较低。

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引用次数: 13

Remote post-conditioning and allopurinol reduce ischemia-reperfusion injury in an infra-renal ischemia model. 远程后处理和别嘌呤醇可减少肾下缺血模型的缺血-再灌注损伤。

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Therapeutic Advances in Cardiovascular Disease

Pub Date : 2018-12-01 Epub Date: 2018-10-08 DOI: 10.1177/1753944718803309

Rafael Inácio Brandão, Ricardo Zanetti Gomes, Luana Lopes, Filipe Silva Linhares, José Carlos Rebuglio Vellosa, Katia Sabrina Paludo

Background:: The aim of this study was to evaluate the effects of the antioxidant allopurinol and ischemic post-conditioning on the deleterious effects of ischemia followed by reperfusion (I/R) in a standardized model of ischemia involving infra-renal aortic occlusion in rats.

Methods:: The animals were randomly divided into five groups: (A) animals not subjected to ischemia; (B) animals subjected to 2 h of ischemia and reperfusion only once; (C) animals given an allopurinol dose by gavage, then subjected to 2 h of ischemia and reperfusion only once; (D) animals subjected to 2 h of ischemia and post-conditioning and (E) animals that received allopurinol, then subjected to 2 h of ischemia and post-conditioning. The blood samples and small intestine segments were harvested for analysis after 3 days.

Results:: The protective effects of the use of allopurinol and ischemic post-conditioning were observed by measuring aspartate aminotransferase, alanine aminotransferase and lactate levels. The benefits of post-conditioning were evident from the total antioxidant capacity and creatinine levels, but these could not ascertain any positive effects of allopurinol. The histological analysis of mesentery revealed that both methods were effective in minimizing the harmful effects of the ischemia and reperfusion process.

Conclusion:: Individual protocols significantly reduced I/R systemic injuries, but no additional protection was observed when the two strategies were combined.

背景:本研究的目的是评价抗氧化剂别嘌呤醇和缺血后处理对肾下主动脉阻塞大鼠缺血再灌注(I/R)的影响。方法:将大鼠随机分为5组:(A)未缺血组;(B)仅缺血再灌注2 h的动物;(C)动物灌胃给予别嘌呤醇剂量，然后只进行一次缺血再灌注2 h;(D)缺血后适应2h的动物和(E)给予别嘌呤醇，再缺血后适应2h的动物。3天后采集血样和小肠段进行分析。结果:通过测定天冬氨酸转氨酶、丙氨酸转氨酶和乳酸水平，观察别嘌呤醇对缺血后适应的保护作用。从总抗氧化能力和肌酐水平来看，后处理的好处是显而易见的，但这些不能确定别嘌呤醇的任何积极作用。肠系膜的组织学分析表明，这两种方法都能有效地减少缺血再灌注过程的有害影响。结论:单个方案显著减少I/R系统损伤，但当两种策略联合使用时，没有观察到额外的保护。

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引用次数: 6