Cardiac Failure Review最新文献

英文中文

Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation. 保留射血分数和房颤打破心力衰竭的循环。

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2022.03

Otilia Ţica, Waseem Khamboo, Dipak Kotecha

Heart failure with preserved ejection fraction (HFpEF) and AF are two common cardiovascular conditions that are inextricably linked to each other's development and progression, often in multimorbid patients. Current management is often directed to specific components of each disease without considering their joint impact on diagnosis, treatment and prognosis. The result for patients is suboptimal on all three levels, restricting clinicians from preventing major adverse events, including death, which occurs in 20% of patients at 2 years and in 45% at 4 years. New trial evidence and reanalysis of prior trials are providing a glimmer of hope that adverse outcomes can be reduced in those with concurrent HFpEF and AF. This will require a restructuring of care to integrate heart failure and AF teams, alongside those that manage comorbidities. Parallel commencement and non-sequential uptitration of therapeutics across different domains will be vital to ensure that all patients benefit at a personal level, based on their own needs and priorities.

心力衰竭伴保留射血分数(HFpEF)和房颤是两种常见的心血管疾病，它们之间的发展和进展有着密不可分的联系，通常发生在多病患者中。目前的管理通常针对每种疾病的特定组成部分，而没有考虑它们对诊断、治疗和预后的共同影响。患者的结果在所有三个层面上都不理想，限制了临床医生预防主要不良事件，包括死亡，2年和4年分别有20%和45%的患者发生死亡。新的试验证据和对先前试验的重新分析为减少并发HFpEF和房颤患者的不良后果提供了一线希望。这将需要重组护理，整合心力衰竭和房颤团队，以及那些管理合并症的团队。在不同领域平行启动和非顺序升级治疗对于确保所有患者根据自身需求和优先事项在个人层面受益至关重要。

引用次数: 2

Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency. 经导管主动脉瓣置换术和手术主动脉瓣置换术在左心室辅助装置不全患者中的效果。

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2022.21

Aniket S Rali, Siva S Taduru, Lena E Tran, Sagar Ranka, Kelly H Schlendorf, Colin M Barker, Ashish S Shah, JoAnn Lindenfeld, Sandip K Zalawadiya

Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are among non-medical interventions available to address post-LVAD AI. Limited data are available on outcomes with either SAVR or TAVR for the management of post-LVAD AI. Methods: The National Inpatient Sample data collected for hospital admissions between the years 2015 and 2018 for patients with pre-existing continuous-flow LVAD undergoing TAVR or SAVR for AI were queried. The primary outcome of interest was a composite of in-hospital mortality, stroke, transient ischaemic attack, MI, pacemaker implantation, need for open aortic valve surgery, vascular complications and cardiac tamponade. Results: Patients undergoing TAVR were more likely to receive their procedure during an elective admission (57.1 versus 30%, p=0.002), and a significantly higher prevalence of comorbidities, as assessed by the Elixhauser Comorbidity Index, was observed in the SAVR group (29 versus 18; p=0.0001). We observed a significantly higher prevalence of the primary composite outcome in patients undergoing SAVR (30%) compared with TAVR (14.3%; p=0.001). Upon multivariable analysis adjusting for the type of admission and Elixhauser Comorbidity Index, TAVR was associated with significantly lower odds of the composite outcome (odds ratio 0.243; 95% CI [0.06-0.97]; p=0.045). Conclusion: In this nationally representative cohort of LVAD patients with post-implant AI, it was observed that TAVR was associated with a lower risk of adverse short-term outcomes compared with SAVR.

背景:主动脉功能不全(AI)恶化是左心室辅助装置(LVAD)长期持续支持的已知后遗症，对患者预后有显著影响。虽然药物治疗可以缓解症状，但不太可能阻止病情的发展。手术主动脉瓣置换术(SAVR)和经导管主动脉瓣置换术(TAVR)是解决lvad后AI的非药物干预措施。关于SAVR或TAVR治疗lvad后AI的结果数据有限。方法:查询2015年至2018年期间已存在的连续流LVAD患者接受TAVR或SAVR治疗的住院患者的全国住院样本数据。研究的主要终点是住院死亡率、卒中、短暂性缺血性发作、心肌梗死、起搏器植入、主动脉瓣开腹手术、血管并发症和心脏填塞的综合结果。结果:接受TAVR的患者更有可能在选择性入院期间接受手术(57.1比30%，p=0.002)，并且根据Elixhauser合并症指数评估，在SAVR组中观察到明显更高的合并症患病率(29比18;p = 0.0001)。我们观察到SAVR患者的主要综合结局发生率(30%)明显高于TAVR患者(14.3%;p = 0.001)。在调整入院类型和Elixhauser合并症指数的多变量分析中，TAVR与综合结局的几率显著降低相关(比值比0.243;95% ci [0.06-0.97];p = 0.045)。结论:在这个具有全国代表性的LVAD患者植入后AI队列中，观察到与SAVR相比，TAVR与较低的不良短期预后风险相关。

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引用次数: 5

Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction 老年心力衰竭伴射血分数降低的循证治疗

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.34

D. Stolfo, G. Sinagra, G. Savarese

Older patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups.

随着总人口的老龄化，老年患者在心力衰竭患者中越来越普遍。然而，在射血分数降低的HF的随机对照试验中，老年患者的代表性很大程度上不足，甚至被排除在外，这限制了试验结果在现实世界中的可推广性，并导致支持在射血得分降低的老年HF患者中使用和滴定指南导向药物治疗（GDMT）的证据较弱。这与限制指南建议应用的其他因素相结合，包括对耐受性差或不良反应的恐惧、合并症的沉重负担以及对多种疗法的需求，通常会导致老年患者对GDMT的依从性降低。尽管没有数据支持老年患者HF药物使用不足和剂量不足，但基于注册的大型研究已证实年龄是优化治疗的主要障碍之一。在这篇综述中，作者概述了GDMT在老年群体中的当代实施状况以及治疗使用率较低的原因，并讨论了一些可能有助于提高老年群体对循证建议的依从性的措施。

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引用次数: 4

Management of Type 2 Diabetes in Stage C Heart Failure with Reduced Ejection Fraction 2型糖尿病合并C期心力衰竭伴射血分数降低的治疗

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.31

Anjali Agarwalla, Jadry Gruen, Carli Peters, Lauren Sinnenberg, A. Owens, N. Reza

Type 2 diabetes is an increasingly common comorbidity of stage C heart failure with reduced ejection fraction (HFrEF). The two diseases are risk factors for each other and can bidirectionally independently worsen outcomes. The regulatory requirement of cardiovascular outcomes trials for antidiabetic agents has led to an emergence of novel therapies with robust benefits in heart failure, and clinicians must now ensure they are familiar with the management of patients with concurrent diabetes and stage C HFrEF. This review summarises the current evidence for the management of type 2 diabetes in stage C HFrEF, recapitulating data from landmark heart failure trials regarding the use of guideline-directed medical therapy for heart failure in patients with diabetes. It also provides a preview of upcoming clinical trials in these populations.

2型糖尿病是射血分数降低的C期心力衰竭的一种越来越常见的合并症。这两种疾病是彼此的风险因素，可以双向独立地恶化结果。抗糖尿病药物心血管结局试验的监管要求导致了对心力衰竭具有强大益处的新疗法的出现，临床医生现在必须确保他们熟悉并发糖尿病和C期HFrEF患者的管理。这篇综述总结了目前在C期HFrEF中治疗2型糖尿病的证据，概述了关于糖尿病患者心力衰竭使用指南指导药物治疗的里程碑式心力衰竭试验的数据。它还提供了即将在这些人群中进行的临床试验的预览。

引用次数: 0

Pulmonary Artery Catheter Monitoring in Patients with Cardiogenic Shock: Time for a Reappraisal? 心源性休克患者的肺动脉导管监测:重新评估的时机?

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.32

M. Bertaina, A. Galluzzo, N. Morici, A. Sacco, F. Oliva, S. Valente, F. D’Ascenzo, S. Frea, P. Sbarra, E. Petitti, Silvia Maria Brach Prever, G. Boccuzzi, Paola Zanini, M. Attisani, F. Rametta, G. D. de Ferrari, P. Noussan, M. Iannaccone

Cardiogenic shock represents one of the most dramatic scenarios to deal with in intensive cardiology care and is burdened by substantial short-term mortality. An integrated approach, including timely diagnosis and phenotyping, along with a well-established shock team and management protocol, may improve survival. The use of the Swan-Ganz catheter could play a pivotal role in various phases of cardiogenic shock management, encompassing diagnosis and haemodynamic characterisation to treatment selection, titration and weaning. Moreover, it is essential in the evaluation of patients who might be candidates for long-term heart-replacement strategies. This review provides a historical background on the use of the Swan-Ganz catheter in the intensive care unit and an analysis of the available evidence in terms of potential prognostic implications in this setting.

心源性休克是心脏病重症监护中最引人注目的情况之一，短期死亡率高。综合方法，包括及时诊断和表型，以及完善的休克团队和管理方案，可以提高生存率。Swan-Ganz导管的使用可以在心源性休克管理的各个阶段发挥关键作用，包括诊断和血液动力学特征、治疗选择、滴定和断奶。此外，它在评估可能成为长期心脏替代策略候选者的患者时至关重要。这篇综述提供了Swan-Ganz导管在重症监护室使用的历史背景，并分析了在这种情况下潜在预后影响的现有证据。

引用次数: 9

The Effect of Iron Deficiency on Cardiac Function and Structure in Heart Failure with Reduced Ejection Fraction 缺铁对心力衰竭伴射血分数降低心功能及结构的影响

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.26

Pieter Martens

Over the past decade, the detrimental impact of iron deficiency in heart failure with reduced ejection fraction has become abundantly clear, showing a negative impact on functional status, quality of life, cardiac function and structure, exercise capacity and an increased risk of hospitalisation due to heart failure. Mechanistic studies have shown the impact of iron deficiency in altering mitochondrial function and negatively affecting the already altered cardiac energetics in heart failure with reduced ejection fraction. Such failing energetics form the basis of the alterations to cellular myocyte shortening, culminating in reduced systolic function and cardiac performance. The IRON-CRT trials show that ferric carboxymaltose is capable of improving cardiac structure and cardiac performance. This article discusses the effect of iron deficiency on cardiac function and structure and how it can be alleviated.

在过去的十年中，缺铁对心力衰竭和射血分数降低的不利影响已经变得非常清楚，显示出对功能状态、生活质量、心功能和结构、运动能力的负面影响，以及因心力衰竭而住院的风险增加。机制研究表明，在心力衰竭伴射血分数降低时，缺铁会改变线粒体功能，并对已经改变的心脏能量学产生负面影响。这种能量的衰竭形成了细胞肌细胞缩短改变的基础，最终导致收缩功能和心脏功能的降低。铁- crt试验表明，羧麦芽糖铁能够改善心脏结构和心脏功能。本文讨论了铁缺乏对心脏功能和结构的影响以及如何减轻这种影响。

引用次数: 6

Telecommunication for Advance Care Planning in Heart Failure 电讯技术在心力衰竭的预先照护计划上的应用

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.23

Rekha V Thammana, S. Goodlin

Heart failure is a chronic illness that carries a significant burden for patients, caregivers and health systems alike. The integration of palliative care and telehealth is a growing area of interest in heart failure management to help alleviate these burdens. This review focuses on the incorporation of advance care planning for complex decision-making in heart failure in the setting of increasing virtual care and telehealth. The review will also consider the role of virtual education for advance care planning and serious illness communication. Telecommunication for clinical care and clinical education are both described as non-inferior to in-person methods. Nevertheless, more research is needed to discern best practices and the optimal integration of methods.

心力衰竭是一种慢性疾病，给患者、护理人员和卫生系统带来了巨大负担。姑息治疗和远程医疗的结合是心力衰竭管理中一个越来越受关注的领域，以帮助减轻这些负担。这篇综述的重点是在增加虚拟护理和远程医疗的背景下，将心力衰竭复杂决策的预先护理计划纳入其中。审查还将考虑虚拟教育在提前护理规划和重症沟通中的作用。用于临床护理和临床教育的电信都被描述为不亚于面对面的方法。然而，还需要更多的研究来辨别最佳实践和方法的最佳集成。

引用次数: 1

Extracorporeal Membrane Oxygenation as a Treatment for Branch Pulmonary Artery Rupture Following Right Heart Catheterisation 体外膜肺氧合治疗右心导管术后肺动脉分支破裂

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.25

V. Agrawal, K. Costopoulos, Mohammed Chowdhary, K. Balsara, K. Schlendorf, J. Lindenfeld, J. Menachem

引用次数: 0

Cardiac Magnetic Resonance in the Evaluation of COVID-19 心脏磁共振评价新冠肺炎

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.20

D. Clark, Sachin K Aggarwal, Neil J Phillips, J. Soslow, J. M. Dendy, Sean G. Hughes

Cardiovascular involvement following COVID-19 is heterogeneous, prevalent and is often missed by echocardiography and serum biomarkers (such as troponin I and brain natriuretic peptide). Cardiac magnetic resonance (CMR) is the gold standard non-invasive imaging modality to phenotype unique populations after COVID-19, such as competitive athletes with a heightened risk of sudden cardiac death, patients with multisystem inflammatory syndrome, and people suspected of having COVID-19 vaccine-induced myocarditis. This review summarises the key attributes of CMR, reviews the literature that has emerged for using CMR for people who may have COVID-19-related complications after COVID-19, and offers expert opinion regarding future avenues of investigation and the importance of reporting findings.

新冠肺炎后的心血管受累是异质性的、普遍的，超声心动图和血清生物标志物（如肌钙蛋白I和脑钠尿肽）经常会错过。心脏磁共振（CMR）是新冠肺炎后表型独特人群的金标准非侵入性成像方式，如心脏猝死风险增加的竞技运动员、多系统炎症综合征患者和怀疑患有新冠肺炎疫苗诱导心肌炎的人。本综述总结了CMR的关键属性，回顾了已出现的将CMR用于新冠肺炎后可能出现COVID-19-19相关并发症的人的文献，并就未来的调查途径和报告结果的重要性提供了专家意见。

引用次数: 4

Medical Treatment of Heart Failure with Reduced Ejection Fraction in the Elderly 老年人射血分数降低的心力衰竭的药物治疗

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.14

Ivan Milinković, M. Polovina, A. Coats, G. Rosano, P. Seferovic

The aging population, higher burden of predisposing conditions and comorbidities along with improvements in therapy all contribute to the growing prevalence of heart failure (HF). Although the majority of trials have not demonstrated age-dependent heterogeneity in the efficacy or safety of medical treatment for HF, the latest trials demonstrate that older participants are less likely to receive established drug therapies for HF with reduced ejection fraction. There remains reluctance in real-world clinical practice to prescribe and up-titrate these medications in older people, possibly because of (mis)understanding about lower tolerance and greater propensity for developing adverse drug reactions. This is compounded by difficulties in the management of multiple medications, patient preferences and other non-medical considerations. Future research should provide a more granular analysis on how to approach medical and device therapies in elderly patients, with consideration of biological differences, difficulties in care delivery and issues relevant to patients’ values and perspectives. A variety of approaches are needed, with the central principle being to ‘add years to life – and life to years’. These include broader representation of elderly HF patients in clinical trials, improved education of healthcare professionals, wider provision of specialised centres for multidisciplinary HF management and stronger implementation of HF medical treatment in vulnerable patient groups.

人口老龄化、易感疾病负担加重和合并症以及治疗方法的改进都导致心力衰竭(HF)的患病率不断上升。尽管大多数试验没有证明心衰药物治疗的有效性或安全性存在年龄依赖性异质性，但最新的试验表明，老年参与者接受现有的降低射血分数的心衰药物治疗的可能性较小。在现实世界的临床实践中，仍然不愿意在老年人中开处方和增加这些药物的剂量，可能是因为(错误地)理解了较低的耐受性和更大的发生药物不良反应的倾向。在管理多种药物、患者偏好和其他非医疗考虑方面的困难使情况更加复杂。未来的研究应更细致地分析如何对老年患者进行医疗和器械治疗，同时考虑到生物学差异、护理提供的困难以及与患者的价值观和观点相关的问题。我们需要多种方法，其核心原则是“让生命延长，让生命延长”。这些措施包括在临床试验中更广泛地代表老年心衰患者，改善医疗保健专业人员的教育，更广泛地提供多学科心衰管理的专门中心，以及在弱势患者群体中更有力地实施心衰医疗。

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