CJC Open最新文献_第3页

An Optimized Assessment Pathway for Remote Patients: The Vancouver Facilitated Transcatheter Aortic Valve Implantation Program 远程患者的优化评估途径：辅助 TAVI 计划

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.07.001

Ali Husain MBBCh , Julius Jelisejevas MD , Andrew Chatfield MBCHB , Mariama Akodad MD, PhD , Sandra B. Lauck PhD , Leslie Achtem RN , Erin Tang MSN , Fady Zaky MBBS , Philipp Blanke MD , Jonathan Leipsic MD , Stephanie L. Sellers MSc, PhD , Jian Ye MD , Anson Cheung MD , Robert Moss MD , David Wood MD , Robert Boone MD , David Meier MD , Janarthanan Sathananthan MBCHB, MPH , John G. Webb MD

Background

Novel pathways are needed to accommodate the increasing demand for transcatheter aortic valve implantation (TAVI) and ensure equitable access. A single Vancouver Facilitated TAVI program (VFTP) based at St. Paul's and Vancouver General Hospitals was established to streamline the assessment of remote patients with severe aortic stenosis using virtual technologies.

Methods

Remote patients with severe aortic stenosis who expressed difficulties traveling to complete their pre-TAVI workup were included and received prospective follow-up. Clinical and echocardiographic parameters were reported per the Valve Academic Research Consortium 3.

Results

Between December 2020 and March 2023, a total of 56 remote patients were included in the VFTP. The mean patient age was 79.7 ± 9.1 years. A total of 55 patients (98%) passed the screening for candidacy; 45 patients (80%) were found suitable for transfemoral TAVI, 5 patients (9%) were directed toward surgical aortic valve replacement; 3 (5%) underwent alternative-access TAVI; and 2 patients (4%) were assigned to a watchful waiting strategy. No inpatient mortality, stroke, or major bleeding occurred in the transfemoral TAVI group, and the median hospital stay was 1 day (interquartile range, 1-2 days; range, 1-24 days). Two patients had an access-closure failure requiring surgical intervention; 1 patient had tamponade; and 4 patients had complete heart block requiring permanent pacemaker implantation. No hospital readmission had occurred at 30 days.

Conclusions

A simplified assessment pathway to assess TAVI candidacy using virtual technologies is safe and feasible. The VFTP potentially can increase access to TAVI and reduce inequity in TAVI care.

背景为满足日益增长的经导管主动脉瓣植入术（TAVI）需求并确保公平就诊，需要新的途径。温哥华协助 TAVI 计划（VFTP）设在圣保罗医院和温哥华总医院，旨在利用虚拟技术简化对偏远地区严重主动脉瓣狭窄患者的评估。方法纳入表示难以前往完成 TAVI 术前检查的偏远地区严重主动脉瓣狭窄患者，并对其进行前瞻性随访。结果2020年12月至2023年3月期间，共有56名远程患者被纳入VFTP。患者平均年龄为 79.7 ± 9.1 岁。共有 55 名患者（98%）通过了候选资格筛选；45 名患者（80%）适合经股动脉 TAVI，5 名患者（9%）接受了外科主动脉瓣置换术，3 名患者（5%）接受了替代入路 TAVI，2 名患者（4%）被指定为观察等待策略。经股动脉 TAVI 组未发生住院死亡、中风或大出血，住院时间中位数为 1 天（四分位间范围为 1-2 天；范围为 1-24 天）。有两名患者出现入路关闭不全，需要手术治疗；一名患者出现血栓形成；四名患者出现完全性心脏传导阻滞，需要植入永久起搏器。结论使用虚拟技术评估 TAVI 候选资格的简化评估路径是安全可行的。VFTP 有可能提高 TAVI 的可及性，减少 TAVI 治疗中的不公平现象。

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引用次数: 0

Peripheral Arterial Disease in Nova Scotia: Increased Prevalence, Low Public Awareness, and Poor Edinburgh Claudication Questionnaire Sensitivity 新斯科舍省的外周动脉疾病：患病率增加、公众认知度低、爱丁堡跛行问卷敏感性差

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.07.003

Emma Alicia MacLean BScN , Ethan Joel Fogarty BSc , Benjamin James Peterson MA , Shirley Xu BSc , Nicholas Blair Giacomantonio MD

Background

This study had the following 3 goals: (i) to assess the prevalence of peripheral arterial disease (PAD) in a Nova Scotian population; (ii) to evaluate the validity of the Edinburgh Claudication Questionnaire (ECQ) in a Nova Scotian context; and (iii) to evaluate Nova Scotian public knowledge about PAD.

Methods

Participants were recruited from 8 sites across Nova Scotia. In 2022, they were recruited at Heartland Tour (HLT) sites—a provincial health-promotion campaign. In 2023, they were recruited in communities coinciding with HLT sites (public [PUB]). Participants completed a demographics questionnaire, ECQ, and had an ankle–brachial index (ABI) measurement. An ABI of < 0.9 was considered positive for presence of PAD.

Results

A total of 417 participants were recruited, 263 from HLT, and 154 from PUB. A total of 398 participants had ABI scores resulting in a PAD prevalence of 2.81% (249 participants) in the HLT group, and 5.37% (149 participants) in the PUB group. A total of 394 participants had both ABI and ECQ scores, with a found sensitivity of 6.67% (confidence interval 0.17%-31.95%) and specificity of 97.63% (confidence interval 95.54%-98.91%). A total of 75% of participants (311 of 417) did not have prior knowledge of PAD.

Conclusions

The PAD prevalences in both cohorts were higher than anticipated, with the PUB cohort being more than double the national average. This finding raises the following question: should specific PAD primary and/or secondary prevention strategies be targeted within the province? Our study demonstrated that a public-awareness campaign would be highly impactful, owing to a low level of awareness of PAD within both cohorts, and that the ECQ was not an effective screening tool when used on the Nova Scotian population.

背景这项研究有以下 3 个目标：(i) 评估外周动脉疾病 (PAD) 在新斯科舍省人口中的患病率；(ii) 评估爱丁堡跛行问卷 (ECQ) 在新斯科舍省环境中的有效性；(iii) 评估新斯科舍省公众对 PAD 的了解程度。2022 年，他们在心脏地带之旅 (HLT) 站点招募，这是一项省级健康推广活动。2023 年，在与 HLT 站点（公共场所 [PUB]）重合的社区招募参与者。参与者填写了人口统计学问卷、ECQ，并进行了踝肱指数（ABI）测量。结果共招募了 417 名参与者，其中 263 人来自 HLT，154 人来自 PUB。共有 398 名参与者进行了 ABI 评分，结果 HLT 组的 PAD 患病率为 2.81%（249 人），PUB 组的 PAD 患病率为 5.37%（149 人）。共有 394 名参与者同时拥有 ABI 和 ECQ 分数，灵敏度为 6.67%（置信区间为 0.17%-31.95%），特异度为 97.63%（置信区间为 95.54%-98.91%）。共有 75% 的参与者（417 人中有 311 人）事先并不了解 PAD。这一发现提出了以下问题：是否应在全省范围内采取特定的 PAD 一级和/或二级预防策略？我们的研究表明，由于两个队列中的人群对 PAD 的认识水平较低，因此公众宣传活动会产生很大的影响，而且在新斯科舍省人群中使用 ECQ 并不是一种有效的筛查工具。

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引用次数: 0

Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis 院前数字心电图传输对 STEMI 患者血管重建延迟和死亡率的影响：系统回顾与元分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.06.012

Rachel N. Moxham MRT(R), BSc, MSc , Marc-André d’Entremont MD, MPH , Hassan Mir MD, MHI, MPH, FRCPC , JD Schwalm MD, MSc , Madhu K. Natarajan MD, MSc , Sanjit S. Jolly MD, MSc

Background

Prehospital transmission of the 12-lead electrocardiogram (ECG) to the interventional cardiologist has become the standard of care in many ST-elevation myocardial infarction (STEMI) networks but has not been adopted universally. In this systematic review and meta-analysis, we assess the effect of prehospital digital ECG transmission in STEMI patients on door-to-device times, first medical contact-to-device times, and mortality.

Methods

We performed a systematic review of all English-language studies in MEDLINE, Embase, and CENTRAL (from inception to July 24, 2023), comparing the effect of prehospital digital ECG transmission to that of no ECG transmission in STEMI patients. We performed a random-effects meta-analysis.

Results

We included 17 observational studies totalling 4306 patients. Door-to-device times were reduced by 33.3 minutes in patients with prehospital digital ECG transmission (95% confidence intervals [CIs] -50.5, -16.2 minutes; P < 0.001; I² 99%). First-medical-contact-to-device time also was reduced with prehospital digital ECG transmission (mean difference, -24.7 minutes; 95% CI -37.1, -12.3 minutes; P < 0.001; I² 96%). Prehospital digital ECG transmissions was associated with a 47% reduction in mortality compared to no prehospital digital ECG transmission (117 of 1322 (8.9%) vs 181 of 1322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; P < 0.001; I² = 0%).

Conclusions

Prehospital ECG transmission in STEMI patients, coupled with a systems of care reduced door-to-device times, first-medical-contact-to-device times, and mortality. STEMI networks should consider these findings to advocate for prehospital ECG transmission within their systems of care.

Study Registration

CRD42024509271 (PROSPERO).

背景院前向介入心脏病专家传输 12 导联心电图（ECG）已成为许多 ST 段抬高型心肌梗死（STEMI）网络的护理标准，但尚未得到普遍采用。在这篇系统性综述和荟萃分析中，我们评估了 STEMI 患者院前数字心电图传输对门诊到设备时间、首次医疗接触到设备时间和死亡率的影响。方法我们对 MEDLINE、Embase 和 CENTRAL（从开始到 2023 年 7 月 24 日）中的所有英文研究进行了系统性综述，比较了 STEMI 患者院前数字心电图传输与无心电图传输的效果。我们进行了随机效应荟萃分析。结果我们纳入了 17 项观察性研究，共计 4306 名患者。在使用院前数字心电图传输的患者中，门到设备的时间缩短了 33.3 分钟（95% 置信区间 [CIs] -50.5，-16.2 分钟；P < 0.001；I2 99%）。院前数字心电图传输也缩短了首次医疗接触到设备的时间（平均差异为-24.7分钟；95% 置信区间为-37.1，-12.3分钟；P < 0.001；I2 96%）。院前数字心电图传输与无院前数字心电图传输相比，死亡率降低了 47%（1322 例中的 117 例（8.9%） vs 1322 例中的 181 例（13.7%），几率比 0.53，95% CI 0.40，0.69；P < 0.001；I2 = 0%）。STEMI 网络应考虑这些发现，在其护理系统中倡导院前心电图传输。研究注册CRD42024509271 (PROSPERO)。

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引用次数: 0

A New Era in High-Risk Tricuspid Valve Reoperation 高风险三尖瓣再手术的新时代

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.06.011

Yingjie Ke MD , Linbin Hua MD , Shanwen Pang MD , Qiuji Wang MD , Zhaolong Zhang MD , Jian Liu MD , Huanlei Huang MD, PhD

引用次数: 0

Emergent Alcohol Septal Ablation for Left Ventricular Tract Obstruction in 2 Patients 两名患者因左心室道阻塞而紧急接受酒精间隔消融术

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.06.008

Agnese Vella MD , Georgios Giannakopoulos MD , Nils Perrin MD , Martin Nicoletti , Stephane Noble MD

引用次数: 0

Prevention and Management of Cardiovascular Disease in Primary Care: A Comment on the PEER Simplified Lipid Guideline 初级医疗中的心血管疾病预防与管理：对 PEER 简化血脂指南的评论

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.06.006

G.B. John Mancini MD , Glen J. Pearson PharmD, FCSHP, FCCS , Arden R. Barry PharmD , Patrick Couture MD, FRCP(C), PhD , Natalie Dayan MD, MSc , Gordon A. Francis MD , Jacques Genest MD , Jean C. Gregoire MD , Robert A. Hegele MD, PhD , Lawrence A. Leiter MD , Alexander A. Leung MD, MPH , Eva Lonn MD, MSc , Priya Manjoo MD, MSc , Daniel Ngui MD , Marie-Eve Piché MD, PhD , Paul Poirier MD, PhD , John L. Sievenpiper MD, PhD , George Thanassoulis MD , Richard Ward MD

Background

In Canada, 2 guidelines provide guidance for the management of dyslipidemia. The Patients, Experience, Evidence, Research simplified lipid guidelines, intended for primary care practitioners, and the Canadian Cardiovascular Society guidelines, intended for all practitioners, are based on differing methodologies with distinct priorities and preferences. The disparate approaches may contribute to confusion among family practitioners and their co-managed patients, with the potential for compromised care, differing standards for training in the fundamentals of lipidology, and differing criteria that might be used in practice audits to evaluate quality of care.

Methods

The Patients, Experience, Evidence, Research (PEER) recommendations were considered by primary authors of the Canadian Cardiovascular Society guideline to identify areas of concordance, discordance, or agreement with qualifications.

Results

Discordance between the guidelines is greatest with respect to interpretation of the cholesterol profile, the implications of elevated triglyceride, the utility of apolipoprotein B and non-high-density lipoprotein-cholesterol measurements, the role of nonstatin medications, and the importance of assuring adherence and avoiding undertreatment through follow-up measurement of lipid profiles. The disparate importance attached to identification of patients with enhanced risk due to an elevated lipoprotein (a) level is also apparent.

Conclusions

This comparison attempts to reconcile key principles of practice, to foster both high quality of care and fully informed patient-centred decision-making.

背景在加拿大，有两份指南为血脂异常的管理提供指导。患者、经验、证据、研究 "简化血脂指南适用于初级保健从业人员，而加拿大心血管协会指南适用于所有从业人员。方法加拿大心血管协会指南的主要作者考虑了患者、经验、证据、研究（PEER）的建议，以确定一致、不一致或与资格一致的领域。结果指南之间最不一致的地方是对胆固醇谱的解释、甘油三酯升高的影响、载脂蛋白 B 和非高密度脂蛋白胆固醇测量的效用、非他汀类药物的作用以及通过血脂谱随访测量确保坚持治疗和避免治疗不足的重要性。结论本次比较试图协调实践中的主要原则，以促进高质量的护理和以患者为中心的充分知情决策。

{"title":"Prevention and Management of Cardiovascular Disease in Primary Care: A Comment on the PEER Simplified Lipid Guideline","authors":"G.B. John Mancini MD , Glen J. Pearson PharmD, FCSHP, FCCS , Arden R. Barry PharmD , Patrick Couture MD, FRCP(C), PhD , Natalie Dayan MD, MSc , Gordon A. Francis MD , Jacques Genest MD , Jean C. Gregoire MD , Robert A. Hegele MD, PhD , Lawrence A. Leiter MD , Alexander A. Leung MD, MPH , Eva Lonn MD, MSc , Priya Manjoo MD, MSc , Daniel Ngui MD , Marie-Eve Piché MD, PhD , Paul Poirier MD, PhD , John L. Sievenpiper MD, PhD , George Thanassoulis MD , Richard Ward MD","doi":"10.1016/j.cjco.2024.06.006","DOIUrl":"10.1016/j.cjco.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>In Canada, 2 guidelines provide guidance for the management of dyslipidemia. The Patients, Experience, Evidence, Research simplified lipid guidelines, intended for primary care practitioners, and the Canadian Cardiovascular Society guidelines, intended for all practitioners, are based on differing methodologies with distinct priorities and preferences. The disparate approaches may contribute to confusion among family practitioners and their co-managed patients, with the potential for compromised care, differing standards for training in the fundamentals of lipidology, and differing criteria that might be used in practice audits to evaluate quality of care.</div></div><div><h3>Methods</h3><div>The Patients, Experience, Evidence, Research (PEER) recommendations were considered by primary authors of the Canadian Cardiovascular Society guideline to identify areas of concordance, discordance, or agreement with qualifications.</div></div><div><h3>Results</h3><div>Discordance between the guidelines is greatest with respect to interpretation of the cholesterol profile, the implications of elevated triglyceride, the utility of apolipoprotein B and non-high-density lipoprotein-cholesterol measurements, the role of nonstatin medications, and the importance of assuring adherence and avoiding undertreatment through follow-up measurement of lipid profiles. The disparate importance attached to identification of patients with enhanced risk due to an elevated lipoprotein (a) level is also apparent.</div></div><div><h3>Conclusions</h3><div>This comparison attempts to reconcile key principles of practice, to foster both high quality of care and fully informed patient-centred decision-making.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 10","pages":"Pages 1189-1198"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Regional Disparities in Atrial Fibrillation Management: An IMPACT-AF Substudy 心房颤动管理中的地区差异：IMPACT 心房颤动子研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.06.010

Joshua Hamlin BSc , Jafna Cox MD , Laura Hamilton MAHSR , Joanna Nemis-White BSc , James McKillop MD , Navjot Sandila MSc , Ratika Parkash MD, MSc, FRCPC

Background

In rural regions, atrial fibrillation (AF) management is performed predominately by local primary care professionals (PCPs). Prior work has suggested that a disparity in outcomes in AF occurs for those patients living in a rural, vs urban, location.

Methods

This post hoc analysis of the cluster randomized trial Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) compared a clinical decision support system to standard of care. Patients were classified as living in a rural (population < 10,000) or urban location. The outcomes were as follows: AF-related emergency department (ED) visits, unplanned cardiovascular (CV) hospitalizations, AF-related referrals and guideline adherence for AF treatment.

Results

A total of 1133 patients were enrolled from 2016 to 2018; 54.1% (n = 613) were classified as living in a rural location. No differences were present in age (mean, 72 ± 9.63 vs 72.5 ± 10.42 years) or Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS₂) score (mean, 2.1 ± 1.36 vs 2.16 ± 1.34). Referral rates to general internists were higher in the rural population (13.4% vs 3.9%, P < 0.001), whereas the rate of cardiology referrals was higher in the urban population (10% vs 15%, P = 0.0098). At 12 months, no difference in the composite outcome of AF-related ED visits and CV hospitalizations was seen. Fewer recurrent AF-related ED visits and CV hospitalizations occurred in the urban group (incidence rate ratio [IRR], 0.65 [95% confidence interval (0.44, 0.95), P = 0.0262). The incidence of guideline adherence was similar between the rural (IRR, 3.7 ± 1.2) and urban (IRR, 3.6 ± 1.2; P = 0.11) groups.

Conclusions

AF patients living in rural locations had higher rates of recurrent AF-related ED visits and unplanned CV hospitalizations. Further research to optimize AF-related outcomes is needed to ensure equitable delivery of care to all Canadians, irrespective of geography.

Clinical Trial Registration

NCT01927367.

背景在农村地区，心房颤动（AF）的治疗主要由当地的初级保健专业人员（PCP）负责。方法这项群集随机试验 "促进心房颤动社区治疗综合管理计划"（IMPACT-AF）的事后分析比较了临床决策支持系统和标准护理。患者被分为居住在农村（人口< 10,000）和城市两类。结果如下心房颤动相关急诊科（ED）就诊率、非计划性心血管（CV）住院率、心房颤动相关转诊率和心房颤动治疗指南遵守率。结果 2016年至2018年，共有1133名患者入选；54.1%（n = 613）的患者被归类为生活在农村地区。年龄（平均 72 ± 9.63 岁 vs 72.5 ± 10.42 岁）或充血性心力衰竭、高血压、年龄、糖尿病、卒中/短暂性脑缺血发作（CHADS2）评分（平均 2.1 ± 1.36 vs 2.16 ± 1.34）无差异。农村人口的普通内科医生转诊率更高（13.4% vs 3.9%，P < 0.001），而城市人口的心脏病学转诊率更高（10% vs 15%，P = 0.0098）。12 个月后，心房颤动相关急诊就诊和冠心病住院的综合结果无差异。城市组心房颤动相关急诊就诊和冠心病住院的复发率较低（发病率比 [IRR]，0.65 [95% 置信区间 (0.44, 0.95)，P = 0.0262）。农村组（IRR，3.7 ± 1.2）和城市组（IRR，3.6 ± 1.2；P = 0.11）遵守指南的发生率相似。需要进一步研究如何优化心房颤动相关的结果，以确保为所有加拿大人提供公平的医疗服务，而不论其地理位置如何。

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引用次数: 0

Noninvasive Cardiac Testing and Cardiovascular Outcomes for Low-Risk Chest Pain in the Emergency Department: A Systematic Review and Meta-Analysis 急诊科低风险胸痛的无创心脏检测和心血管预后：系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.06.009

Chen Yang Kevin Zhang MD , Aaron Dou MD (C) , Bhadra U. Pandya MD (C) , Sushmitha Srinivasan HBSc , Chloe Campbell BSc , Janet Tang BSc (Hons) , William Shi MD , Saswata Deb MD, PhD , Maneesh Sud MD, PhD , Candace D. McNaughton MD, PhD, MPH , Dennis T. Ko MD, MSc

Background

With the widespread adoption of high-sensitivity troponin testing, recent guidelines no longer recommend urgent noninvasive cardiac testing for suspected cardiac disease in low-risk emergency department (ED) patients. We conducted a meta-analysis to determine whether urgent noninvasive testing, compared to no testing, is associated with improved cardiovascular outcomes in low-risk patients.

Methods

We searched databases for studies of adults evaluated in the ED for low-risk acute chest pain based on clinical criteria, diagnostic testing, or risk scores. Outcomes were all-cause death or myocardial infarction (MI), and revascularization alone, at 90 days and 1 year.

Results

A total of 1.5 million patients were included from 17 observational and 2 randomized studies. The overall rate of death or MI was 0.3% at 90 days, and 0.4% at 1 year. The odds of death or MI were not significantly different at 90 days (9 studies with 144,447 participants; odds ratio [OR] = 0.92 [0.48-1.76]) or 1 year (13 studies with 146,563 participants; OR = 0.92 [0.63-1.35]) between the tested and nontested groups. The odds of revascularization were significantly higher in tested groups at 90 days (12 studies with 513,862 participants; OR = 2.21 [1.17-4.17]) and 1 year (16 studies with 1,441,693 participants; OR = 2.61 [1.95-3.48]).

Conclusions

Noninvasive testing for low-risk chest pain in the ED was not associated with lower odds of death or MI, but it was associated with more than twice the odds of revascularization. This finding supports current guidelines recommending against universal noninvasive testing for ED patients with low-risk chest pain.

背景随着高敏肌钙蛋白检测的广泛采用，最近的指南不再建议对急诊科（ED）低风险患者的疑似心脏病进行紧急无创心脏检测。我们进行了一项荟萃分析，以确定与不进行检测相比，紧急无创检测是否与低风险患者心血管预后的改善有关。方法我们在数据库中搜索了根据临床标准、诊断性检测或风险评分对急诊科低风险急性胸痛成人进行评估的研究。结果共纳入了 17 项观察性研究和 2 项随机研究中的 150 万名患者。90天内死亡或心肌梗死的总发生率为0.3%，1年后为0.4%。在 90 天（9 项研究，144447 名参与者；几率比 [OR] = 0.92 [0.48-1.76]）或 1 年（13 项研究，146563 名参与者；OR = 0.92 [0.63-1.35]）时，接受测试组和未接受测试组的死亡或心肌梗死几率没有显著差异。在 90 天（12 项研究，513,862 名参与者；OR = 2.21 [1.17-4.17]）和 1 年（16 项研究，1,441,693 名参与者；OR = 2.61 [1.95-3.48]）时，检测组的血管再通几率明显更高。这一发现支持当前指南的建议，即不要对急诊室低风险胸痛患者进行普遍的无创检查。

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引用次数: 0

Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score 左心房阑尾闭塞术后器械相关血栓的预测因素 - TED-F2 评分

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.05.015

Background

Left atrial appendage (LAA) occlusion (LAAO) is performed to prevent LAA thrombus in patients with atrial fibrillation (AF). The risk of device-related thrombus (DRT) on the atrial side of the LAAO device is approximately 4%. Identifying patients at high risk of DRT would enable closer surveillance and more-aggressive anticoagulation to prevent post-LAAO DRT-related stroke.

Methods

From the LAAO registry at The University of Kansas Medical Center, we identified patients who developed DRT. We chose 3 unmatched controls per DRT case from LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram reports and/or images, transthoracic echocardiogram reports, and chart review. Implant depth was measured from the limbus of the left atrial ridge to the centre of the atrial aspect of the LAAO device, on a 45° transesophageal echocardiogram view.

Results

We identified 26 patients with DRT (aged 77.7 ± 9.7 years; 34.6% female) and selected 78 unmatched controls without DRT. Univariate predictors of DRT, comprising a novel TED-F₂ score, included history of venous Thromboembolism (23.1% vs 5.1%, P = 0.01), an LAA Emptying velocity ≤ 20 cm/s (45.8% vs 18.9%, P = 0.01), an implant Depth > 2 cm (34.6% vs 12.8%, P = 0.02), and presence of AF rhythm at time of device implantation (50.0 % vs 11.5%, P = 0.0001). A TED-F₂ score of ≥ 3 was very strongly associated with DRT—odds ratio 12.5 (95% confidence interval, 3.8-41.1, P < 0.0001).

Conclusions

We propose a novel risk score to predict development of DRT after LAAO, comprising history of venous Thromboembolism, LAA Emptying velocity ≤ 20 cm/s, implant Depth > 2 cm (1 point each), and an AF rhythm at implantation (2 points). A TED-F₂ risk score of ≥ 3 identified patients who are at greatly elevated risk of developing DRT.

背景对心房颤动（房颤）患者实施左心房阑尾（LAA）闭塞术（LAAO）是为了防止 LAA 血栓形成。LAAO 装置心房侧发生装置相关血栓 (DRT) 的风险约为 4%。方法我们从堪萨斯大学医学中心的 LAAO 登记册中确定了发生 DRT 的患者。我们从无 DRT 的 LAAO 受者中为每个 DRT 病例选择了 3 个不匹配的对照。预测变量来自经食道超声心动图报告和/或图像、经胸超声心动图报告以及病历审查。植入深度是在 45° 经食道超声心动图视图上从左心房嵴边缘到 LAAO 装置心房侧中心测量的。DRT的单变量预测因素包括新的TED-F2评分，包括静脉血栓栓塞史（23.1% vs 5.1%，P = 0.01）、LAA排空速度≤20 cm/s（45.8% vs 18.9%，P = 0.01）、植入深度大于2 cm（34.6% vs 12.8%，P = 0.02）和植入装置时存在房颤节律（50.0% vs 11.5%，P = 0.0001）。结论我们提出了一种新的风险评分方法来预测 LAAO 后 DRT 的发生，包括静脉血栓栓塞史、LAA 排空速度≤ 20 cm/s、植入深度≥2 cm（各 1 分）和植入时存在房颤节律（2 分）。TED-F2 风险评分≥ 3 分的患者罹患 DRT 的风险极高。

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引用次数: 0

Takotsubo Cardiomyopathy After Oxaliplatin Chemotherapy Exposure: A Case Report 奥沙利铂化疗后的塔克苏波心肌病：病例报告

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-10-01 DOI: 10.1016/j.cjco.2024.07.005

Shafaz Veettil MD , Omar Khan MD , Daniel P. Durocher MD

引用次数: 0