Cardiac Failure Review最新文献

英文中文

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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引用次数: 1

Pirfenidone for Idiopathic Pulmonary Fibrosis and Beyond 吡非尼酮治疗特发性肺纤维化及其他疾病

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.30

A. Aimo, G. Spitaleri, D. Nieri, L. Tavanti, C. Meschi, G. Panichella, J. Lupón, F. Pistelli, L. Carrozzi, A. Bayés‐Genís, M. Emdin

Pirfenidone (PFD) slows the progression of idiopathic pulmonary fibrosis (IPF) by inhibiting the exaggerated fibrotic response and possibly through additional mechanisms, such as anti-inflammatory effects. PFD has also been evaluated in other fibrosing lung diseases. Myocardial fibrosis is a common feature of several heart diseases and the progressive deposition of extracellular matrix due to a persistent injury to cardiomyocytes may trigger a vicious cycle that leads to persistent structural and functional alterations of the myocardium. No primarily antifibrotic medications are used to treat patients with heart failure. There is some evidence that PFD has antifibrotic actions in various animal models of cardiac disease and a phase II trial on patients with heart failure and preserved ejection fraction has yielded positive results. This review summarises the evidence about the possible mechanisms of IPF and modulation by PFD, the main results about IPF or non-IPF interstitial pneumonias and also data about PFD as a potential protective cardiac drug.

吡非尼酮(PFD)通过抑制过度的纤维化反应和可能通过其他机制，如抗炎作用，减缓特发性肺纤维化(IPF)的进展。PFD在其他肺纤维化疾病中也有评价。心肌纤维化是多种心脏病的共同特征，心肌细胞持续损伤导致的细胞外基质进行性沉积可能引发恶性循环，导致心肌结构和功能的持续改变。没有主要的抗纤维化药物用于治疗心力衰竭患者。有一些证据表明PFD在各种心脏病动物模型中具有抗纤维化作用，一项针对心力衰竭患者和保留射血分数的II期试验取得了积极的结果。本文综述了关于IPF的可能机制和PFD调节的证据，关于IPF或非IPF间质性肺炎的主要结果，以及PFD作为一种潜在的心脏保护药物的数据。

引用次数: 14

Cell Therapy in Heart Failure with Preserved Ejection Fraction 保留射血分数的心力衰竭细胞治疗

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.21

S. Frljak, G. Poglajen, B. Vrtovec

Heart failure with preserved ejection fraction (HFpEF) is the most common cause of hospitalisation for heart failure. However, only limited effective treatments are available. Recent evidence suggests that HFpEF may result from a systemic proinflammatory state, microvascular endothelial inflammation and microvascular rarefaction. Formation of new microvasculature in ischaemic tissues is dependent on CD34+ cells, which incorporate into the newly developing vasculature and produce pro-angiogenic cytokines. In HFpEF patients, worsening of diastolic function appears to correlate with decreased numbers of CD34+ cells. Therefore, it is plausible that increasing the myocardial numbers of CD34+ cells could theoretically lead to improved microvascular function and improved diastolic parameters in HFpEF. In accordance with this hypothesis, recent pilot clinical data suggest that CD34+ cell therapy may indeed be associated with improved diastolic function and better functional capacity in HFpEF patients and could thus represent a promising novel therapeutic modality for this patient population.

保留射血分数的心力衰竭(HFpEF)是心力衰竭住院治疗的最常见原因。然而，只有有限的有效治疗方法。最近的证据表明，HFpEF可能是由全身促炎状态、微血管内皮炎症和微血管稀疏引起的。缺血组织中新微血管的形成依赖于CD34+细胞，CD34+细胞融入新形成的微血管并产生促血管生成细胞因子。在HFpEF患者中，舒张功能的恶化似乎与CD34+细胞数量的减少有关。因此，从理论上讲，增加心肌CD34+细胞数量可能导致HFpEF微血管功能改善和舒张参数改善。根据这一假设，最近的试点临床数据表明，CD34+细胞治疗可能确实与HFpEF患者舒张功能的改善和更好的功能能力有关，因此可能代表了这一患者群体的一种有希望的新型治疗方式。

引用次数: 3

Aortic Pulsatility Index: A New Haemodynamic Measure with Prognostic Value in Advanced Heart Failure 主动脉搏动指数：一种对晚期心力衰竭具有预后价值的新血液动力学指标

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2022.09

T. Deis, K. Rossing, F. Gustafsson

Aim: To test if the newly described haemodynamic variable, aortic pulsatility index (API), predicts long-term prognosis in advanced heart failure (HF). Methods: A single-centre study on 453 HF patients (median age: 51 years; left ventricular ejection fraction [LVEF]: 19% ± 9%) referred for right heart catheterisation. API was calculated as pulse pressure/pulmonary capillary wedge pressure. Results: Log(API) correlated significantly with central venous pressure (CVP; p<0.001) and cardiac index (p<0.001) in univariable regression analysis. CVP remained associated with log(API) in a multivariable analysis including cardiac index, heart rate, log(NT-proBNP [N-terminal proB-type natriuretic peptide]), LVEF, New York Heart Association (NYHA) class III or IV and sex (p=0.01). In univariable Cox models, log(API) was a significant predictor of freedom from the combined endpoint of death, left ventricular assist device implantation, total artificial heart implantation or heart transplantation (HR 0.33; (95% CI [0.22–0.49]); p<0.001) and all-cause mortality (HR 0.56 (95% CI [0.35–0.90]); p=0.015). After adjusting for age, sex, NYHA class III or IV and estimated glomerular filtration rate in multivariable Cox models, log(API) remained a significant predictor for the combined endpoint (HR 0.33; 95% CI [0.20–0.56]; p<0.001) and all-cause mortality (HR 0.49; 95% CI [0.26–0.96]; p=0.034). Conclusion: API was strongly associated with right-sided filling pressure and independently predicted freedom from the combined endpoint and all-cause mortality.

目的：检测新描述的血液动力学变量主动脉搏动指数（API）是否能预测晚期心力衰竭（HF）的长期预后。方法：对453名HF患者（中位年龄：51岁；左心室射血分数[LVEF]：19%±9%）进行单中心研究。API计算为脉冲压力/肺毛细血管楔压。结果：在单变量回归分析中，Log（API）与中心静脉压（CVP）和心脏指数（p＜0.001）显著相关。在包括心脏指数、心率、log（NT-proBNP[N-末端B型钠尿肽原]）、LVEF、纽约心脏协会（NYHA）III级或IV级和性别在内的多变量分析中，CVP仍与log（API）相关（p=0.01），全人工心脏植入或心脏移植（HR 0.33；（95%CI[0.22–0.49]）；p＜0.001）和全因死亡率（HR 0.56（95%CI[0.35-0.90]）；p=0.015）。在校正了年龄、性别、NYHA III或IV级以及多变量Cox模型中估计的肾小球滤过率后，log（API）仍然是联合终点（HR 0.33；95%CI[0.20–0.56]；p<0.001）和全因死亡率（HR 0.49；95%CI[0.26–0.96]；p=0.034）的重要预测指标。

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引用次数: 3

Out with the Old and In with the New: Primary Care Management of Heart Failure with Preserved Ejection Fraction 推陈出新：保留射血分数的心力衰竭的初级保健管理

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2021.27

S. Stewart, Amy R Stewart, Laura H. Waite, J. Beilby

Primary care plays an integral role in the management of complex, chronic disease states such as heart failure. However, there is a disconnect between the characteristics of those recruited into clinical trials and those managed in the real world, which means the contribution and consideration of primary care in current guidelines is suboptimal. In this article, the authors explore key issues in the diagnosis and management of heart failure that need to be addressed from a primary care perspective. This article focuses on the issue of heart failure with preserved ejection fraction and the integration of new clinical epidemiology and trial evidence into clinical practice. In response, the authors advocate for dedicated guidelines for the primary care management of heart failure, the development of strategies to facilitate communications between health professionals in acute and community care and a renewed focus on researching optimal models of heart failure care in the community.

初级保健在管理复杂的慢性疾病状态(如心力衰竭)中起着不可或缺的作用。然而，在临床试验中招募的患者和在现实世界中管理的患者的特征之间存在脱节，这意味着当前指南中对初级保健的贡献和考虑是不理想的。在这篇文章中，作者探讨了需要从初级保健角度解决的心力衰竭诊断和管理的关键问题。本文重点讨论了保留射血分数的心力衰竭问题，以及将新的临床流行病学和试验证据整合到临床实践中。作为回应，作者主张为心力衰竭的初级保健管理制定专门的指南，制定策略以促进急性和社区护理卫生专业人员之间的沟通，并重新关注研究社区心力衰竭护理的最佳模式。

引用次数: 3

Multimodality Imaging in Valvular Structural Interventions. 多模态成像在瓣膜结构干预中的应用。

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2022-01-01 DOI: 10.15420/cfr.2022.10

Karine Grigoryan, Camelia Demetrescu, Ioannis Kasouridis, Olukayode Abiola, Pier Giorgio Masci, Didem Oguz, Giulia Benedetti, Mak SzeMun, Purvi Parwani, Rebecca Preston, Amedeo Chiribiri, Jane Hancock, Tiffany Patterson, Simon Redwood, Bernard Prendergast, Julia Grapsa

Structural valvular interventions have skyrocketed in the past decade with new devices becoming available and indications for patients who would previously have been deemed inoperable. Furthermore, while echocardiography is the main imaging tool and the first line for patient screening, cardiac magnetic resonance and CT are now essential tools in pre-planning and post-procedural follow-up. This review aims to address imaging modalities and their scope in aortic, mitral and tricuspid structural valvular interventions, including multimodality imaging. Pulmonary valve procedures, which are mostly carried out in patients with congenital problems, are discussed. This article presents a guide on individualised imaging approcahes on each of the available interventional procedures.

在过去的十年里，随着新设备的出现，结构瓣膜介入治疗迅速发展，并且适应了以前被认为不能手术的患者。此外，超声心动图是主要的成像工具和患者筛查的第一线，心脏磁共振和CT现在是术前计划和术后随访的重要工具。本文综述了主动脉瓣、二尖瓣和三尖瓣结构介入的成像方式及其范围，包括多模态成像。肺动脉瓣手术，这主要是在患者进行先天性问题，讨论。这篇文章提出了个体化成像方法对每个可用的介入程序的指导。

引用次数: 1

Adjunctive Techniques for Repair of Ischaemic Mitral Regurgitation. 辅助技术修复缺血性二尖瓣返流。

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiac Failure Review

Pub Date : 2021-12-06 eCollection Date: 2021-03-01 DOI: 10.15420/cfr.2021.06

Sigrid L Johannesen, Colin M Barker, Melissa M Levack

Ischaemic mitral regurgitation is a complex process with debate in the literature as to the optimal treatment pathway. Multiple therapies are available to alleviate mitral regurgitation including medical management, transcatheter edge-to-edge repair, mitral valve repair and mitral valve replacement. Medical management with goal-directed therapy should be utilised in patients with heart failure and mild-to-moderate regurgitation. Transcatheter approaches are typically used in patients with prohibitive operative risk, although their use is expanding, especially in those with functional mitral regurgitation who are not responding to goal-directed medical therapy. It is generally accepted that patients with mild-to-moderate disease can avoid valve intervention if successful revascularisation is performed. A higher consideration should be given to valve replacement over repair in patients with severe mitral regurgitation in the setting of myocardial ischaemia. Operative course must be personalised to each patient, and continues to develop with improving technologies and ongoing research into optimal treatment.

缺血性二尖瓣反流是一个复杂的过程，在文献中关于最佳治疗途径的争论。缓解二尖瓣返流有多种治疗方法，包括医学治疗、经导管边缘到边缘修复、二尖瓣修复和二尖瓣置换术。目标导向治疗的医疗管理应用于心衰和轻度至中度反流患者。经导管入路通常用于有手术风险的患者，尽管其使用范围正在扩大，特别是那些有二尖瓣功能反流的患者，他们对目标导向的药物治疗没有反应。人们普遍认为，轻中度疾病的患者如果成功地进行了血运重建，可以避免瓣膜干预。在心肌缺血情况下，严重二尖瓣返流患者应优先考虑瓣膜置换术而非修复术。手术过程必须为每位患者量身定制，并随着技术的改进和对最佳治疗方法的持续研究而不断发展。

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