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Effect of Qualifying Atherosclerotic Cardiovascular Disease Diagnosis Proximity on Cardiovascular Risk and Benefit of Empagliflozin in the EMPA-REG OUTCOME Trial 在 EMPA-REG OUTCOME 中,动脉粥样硬化性心血管疾病诊断合格与否对心血管风险和安格列酮治疗效果的影响
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.01.013
Ayodele Odutayo MD, DPhil , Bernard Zinman MD , Christoph Wanner MD , Isabella Zwiener PhD , Søren S. Lund MD , Stefan Hantel PhD , David Fitchett MD , Jacob A. Udell MD , EMPA-REG OUTCOME Trial Investigators

Background

In patients with type 2 diabetes mellitus (T2DM), a history of an ischemic event is associated with increased risk for cardiovascular (CV) disease. Whether patients with T2DM and a recent atherothrombotic diagnosis benefit from early intervention with a sodium-glucose co-transporter 2 inhibitor is unknown.

Methods

This study is a secondary analysis of the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME), which compared empagliflozin to placebo in adults with T2DM and atherosclerotic CV disease (ASCVD). Participants were categorized based on the time since their last qualifying ASCVD diagnosis (≤ 1 year vs > 1 year). Qualifying ASCVD diagnoses included ischemic or hemorrhagic stroke, myocardial infarction, coronary artery disease, and peripheral artery disease. The primary outcome was a composite of CV death, nonfatal myocardial infarction, or nonfatal stroke.

Results

A total of 6796 participants (n = 4547 empagliflozin, n = 2249 placebo) were included. Median time since the last qualifying ASCVD diagnosis was 3.8 years (quartile 1-quartile 3: 1.5-7.6), and most qualifying diagnoses occurred > 1 year before randomization (≤ 1 year, n = 1214; > 1 year, n = 5582). Empagliflozin reduced the incidence of the primary outcome irrespective of the time since the last qualifying ASCVD diagnosis (≤ 1 year: hazard ratio 0.82, 95% confidence interval: 0.57-1.16; vs > 1 year: hazard ratio 0.85, 95% confidence interval: 0.72-1.00; P for interaction = 0.84). Results were similar for the composite of CV death or hospitalization for heart failure.

Conclusions

Empagliflozin improved CV outcomes in participants with T2DM, irrespective of the time since the last qualifying ASCVD diagnosis at randomization. Prospective trials are necessary to investigate the use of sodium-glucose co-transporter 2 inhibitors at the time of an acute ASCVD event.

Trial Registration

EMPA-REG OUTCOME (Clinicaltrials.gov identifier: NCT01131676).

背景在2型糖尿病(T2DM)患者中,缺血性事件史与心血管疾病(CV)风险增加有关。本研究是对恩格列净心血管结果事件试验(Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose,EMPA-REG OUTCOME)的二次分析,该试验比较了恩格列净和安慰剂对患有T2DM和动脉粥样硬化性心血管疾病(ASCVD)的成人的治疗效果。参与者根据距上一次合格的 ASCVD 诊断时间(≤ 1 年 vs > 1 年)进行分类。合格的 ASCVD 诊断包括缺血性或出血性中风、心肌梗死、冠状动脉疾病和外周动脉疾病。主要结果是冠心病死亡、非致死性心肌梗死或非致死性卒中的复合结果。结果共纳入 6796 名参与者(n = 4547 名恩格列净患者,n = 2249 名安慰剂患者)。距上次确诊ASCVD的中位时间为3.8年(1-3分位数:1.5-7.6),大多数确诊发生在随机化前1年(≤1年,n=1214;> 1年,n=5582)。无论距上一次ASCVD诊断合格时间长短,恩格列净都能降低主要结局的发生率(≤1年:危险比0.82,95%置信区间:0.57-1.16;vs > 1年:危险比0.85,95%置信区间:0.72-1.00;交互作用P=0.84)。结论Empagliflozin能改善T2DM患者的CV预后,与随机分组时最后一次合格的ASCVD诊断时间无关。有必要开展前瞻性试验,研究在发生急性 ASCVD 事件时使用钠-葡萄糖协同转运体 2 抑制剂的情况。试验注册EMPA-REG OUTCOME(Clinicaltrials.gov 标识符:NCT01131676)。
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引用次数: 0
The Impact of an Accelerated Diagnostic Protocol Using Conventional Troponin I for Patients With Cardiac Chest Pain in the Emergency Department 使用常规肌钙蛋白 I 的加速诊断方案对急诊科心源性胸痛患者的影响
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.03.008
Jesse Hill MD, MSc , Esther H. Yang BSc, MSc , Dennis Lefebvre MD, PhD , Shandra Doran MD, PhD , Sean van Diepen MD, FRCPC , Joshua E. Raizman PhD , Albert K.Y. Tsui PhD , Brian H. Rowe MD, MSc

Background

This study strove to assess the impact of the implementation of an accelerated diagnostic protocol (ADP), using shortened serial-testing intervals and a conventional troponin I (c-TnI) test, on emergency department (ED) length of stay (LOS).

Methods

This retrospective cohort study included adults (aged ≥ 18 years) presenting to a Canadian ED with a primary complaint of cardiac chest pain between January 14, 2017 and January 15, 2019. For non-high-risk patients, the troponin delta timing decreased from 6 hours to 3 hours, and a different conventional troponin I level cut-point was implemented on January 15, 2018. The primary outcome was ED LOS. Secondary outcomes included disposition status, consultation proportions, and major adverse cardiac events within 30 days.

Results

A total of 3133 patient interactions were included. Although the overall decrease in median ED LOS was not significant (P = 0.074), a significant reduction occurred in ED LOS (-33 minutes; 95% confidence interval: -53.6 to -12.4 minutes) among patients who were discharged in the post-ADP group. Consultations were unchanged between groups (36.1% before vs 33.8% after; P = 0.17). The major adverse cardiac events outcomes were unchanged across cohorts (15.9% vs 15.3%; P = 0.62).

Conclusions

The implementation of an ADP, with a conventional troponin I test, for cardiac chest pain in a Canadian ED was not associated with a significant reduction of LOS for all patients; however, a significant reduction occurred for patients who were discharged, and the strategy appears safe.

背景本研究旨在评估加速诊断方案(ADP)的实施对急诊科(ED)住院时间(LOS)的影响,该方案采用缩短的连续检测时间间隔和常规肌钙蛋白 I(c-TnI)检测。方法这项回顾性队列研究纳入了 2017 年 1 月 14 日至 2019 年 1 月 15 日期间以心脏胸痛为主诉到加拿大一家急诊科就诊的成人(年龄≥ 18 岁)。对于非高风险患者,肌钙蛋白δ时间从6小时降至3小时,并于2018年1月15日实施了不同的常规肌钙蛋白I水平切点。主要结果是 ED LOS。次要结果包括处置状态、就诊比例和 30 天内的主要心脏不良事件。虽然 ED LOS 中位数的总体下降幅度不大(P = 0.074),但 ADP 后组出院患者的 ED LOS 显著缩短(-33 分钟;95% 置信区间:-53.6 至 -12.4 分钟)。各组之间的就诊率没有变化(就诊前为 36.1%,就诊后为 33.8%;P = 0.17)。结论在加拿大的一家急诊室对心脏性胸痛实施 ADP 和常规肌钙蛋白 I 检测并不能显著缩短所有患者的 LOS,但出院患者的 LOS 显著缩短,而且该策略似乎是安全的。
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引用次数: 0
Out-of-Hospital Cardiac Arrest From Malignant Early Repolarization Syndrome 恶性心脏早期复极综合征导致的院外心脏骤停
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.04.007
Jung-In Choi MD, MPH , Sammy Chan MD, FRCPC , Andrew Krahn MD, FCCS
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引用次数: 0
High Prevalence of Atrial Fibrillation Found in the Capital of Greenland When Using Continuous Electrocardiogram Monitoring: A Cross-Sectional Study 格陵兰首府使用连续心电图监测发现心房颤动发病率高:一项横断面研究
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.03.011
Nadja Albertsen MD, MSA , Mads Mose Jensen MD , Kunuk Lauge Koch Hansen , Michael Lynge Pedersen MD, MedScD , Stig Andersen MD, PhD , Christina Brock MSc, PhD , Sam Riahi MD, PhD

Background

Atrial fibrillation (AF) increases the risk of conditions such as ischemic stroke, dementia, and heart failure, and early detection is crucial. In Greenland, ischemic strokes are common, and the prevalences of AF risk factors are increasing. Studies based on 30-second electrocardiograms (ECGs) and diagnosis codes so far have indicated either a low prevalence of AF or a prevalence comparable to that in other Western countries, such as Denmark. However, using short, single-point ECGs may underestimate the true prevalence, as especially paroxysmal AF can be missed. With this study, we aim to estimate the prevalence of AF using 3-5–day continuous Holter recordings among people in Nuuk, the capital of Greenland.

Methods

In this cross-sectional study, we estimated the prevalence of AF among the population aged ≥ 50 years in Greenland’s capital, Nuuk. We used an ePatch to record continuous ECGs for 3-5 days, and questionnaires to assess demographic data, comorbidities, medication, symptoms, and risk factors for AF.

Results

Of 226 participants (62% women), 21 (33% women) had either self-reported AF, AF on the recording, or both, equivalent to a prevalence of 9.3% (confidence interval [CI] 5.8-13.9). The age-stratified prevalence was 7.2% (CI 2.7-15.1) among those aged 50-59 years; 8.8% (CI 4.1-16.1) among those aged 60-69 years; and 18.2% (CI 7.0-35.5) among those aged ≥ 70 years.

Conclusions

This study provides a novel insight into AF prevalence in Nuuk, emphasizing the potential underestimation in previous studies. Continuous ECG monitoring revealed a higher prevalence, especially among the younger age groups, urging a reevaluation of diagnostic practices in this unique population.

背景心房颤动(房颤)会增加缺血性中风、痴呆症和心力衰竭等疾病的风险,因此早期发现至关重要。在格陵兰岛,缺血性中风很常见,房颤风险因素的发病率也在上升。迄今为止,基于 30 秒心电图和诊断代码的研究表明,心房颤动的发病率较低,或与丹麦等其他西方国家的发病率相当。然而,使用短时间的单点心电图可能会低估真实的患病率,因为尤其是阵发性房颤可能会被漏诊。在这项研究中,我们旨在使用 3-5 天的连续 Holter 记录来估算格陵兰首府努克的房颤患病率。方法在这项横断面研究中,我们估算了格陵兰首府努克年龄≥ 50 岁人群的房颤患病率。我们使用电子血压计连续记录了 3-5 天的心电图,并通过问卷调查评估了人口统计学数据、合并症、药物治疗、症状和心房颤动的风险因素。结果在 226 名参与者(62% 为女性)中,21 人(33% 为女性)自述有心房颤动,或在记录中发现有心房颤动,或两者皆有,患病率为 9.3%(置信区间 [CI] 5.8-13.9)。按年龄划分,50-59 岁人群的患病率为 7.2%(置信区间 [CI] 2.7-15.1);60-69 岁人群的患病率为 8.8%(置信区间 [CI] 4.1-16.1);≥ 70 岁人群的患病率为 18.2%(置信区间 [CI] 7.0-35.5)。连续心电图监测显示房颤的发病率较高,尤其是在年轻群体中,因此需要对这一特殊人群的诊断方法进行重新评估。
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引用次数: 0
Exploring Patient Viewpoints to Optimize Implementation of a Biological Therapy for Atrial Fibrillation Prevention 探索患者观点,优化心房颤动预防生物疗法的实施
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.04.003
Chloé Smith MD , Manoj M. Lalu MD, PhD , Darryl R. Davis MD

Background

Embracing patient viewpoints can enhance the translation of novel therapeutics to clinical settings. This study evaluated the acceptability of using extracellular vesicles (EVs) as a biological therapy for preventing postoperative atrial fibrillation (AF), through engagement with patients, providing insights into their attitudes and information needs.

Methods

Patients participated in prerecorded presentations, virtual focus groups, and surveys to assess their perspectives on EV therapy and determine the factors influencing their acceptance of the intervention.

Results

Participants with postoperative AF experienced prolonged intensive care unit and hospital stays, compared to those of patients with normal heart rhythm. Prior to the presentation, a number of participants were unfamiliar with postoperative AF and biological therapies. However, postpresentation and post–focus group activities resulted in enhanced understanding of the research, with high levels of comprehension reported by all participants. The level of acceptance of EV therapy tended to increase, with a majority expressing willingness to participate in clinical trials and accept the therapy. The focus groups identified and addressed common questions regarding the potential risks and side effects of EVs, their source, dosing, utility for patients with preexisting AF, and the risk of human immunodeficiency virus (HIV) contraction or allergic reactions.

Conclusions

The study highlights the importance of providing education, involving the patient's circle of care, and addressing patient concerns, to promote acceptance of therapies such as EV therapy for postoperative AF.

Clinical Trial Registration

NCT05032495.

背景了解患者的观点可以促进新型疗法向临床转化。本研究通过让患者参与评估使用细胞外囊泡(EVs)作为生物疗法预防术后房颤(AF)的可接受性,从而深入了解他们的态度和信息需求。结果与心律正常的患者相比,术后房颤患者在重症监护室和医院的住院时间更长。在演讲之前,许多与会者对术后房颤和生物疗法并不熟悉。然而,演讲后和焦点小组活动后,与会者对研究有了更深入的了解,所有与会者都表示理解程度很高。参与者对 EV 疗法的接受程度趋于提高,大多数人表示愿意参加临床试验并接受该疗法。焦点小组确定并解决了有关 EV 潜在风险和副作用、其来源、剂量、对已有房颤的患者的效用以及感染人类免疫缺陷病毒 (HIV) 或过敏反应的风险等常见问题。
{"title":"Exploring Patient Viewpoints to Optimize Implementation of a Biological Therapy for Atrial Fibrillation Prevention","authors":"Chloé Smith MD ,&nbsp;Manoj M. Lalu MD, PhD ,&nbsp;Darryl R. Davis MD","doi":"10.1016/j.cjco.2024.04.003","DOIUrl":"10.1016/j.cjco.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Embracing patient viewpoints can enhance the translation of novel therapeutics to clinical settings. This study evaluated the acceptability of using extracellular vesicles (EVs) as a biological therapy for preventing postoperative atrial fibrillation (AF), through engagement with patients, providing insights into their attitudes and information needs.</p></div><div><h3>Methods</h3><p>Patients participated in prerecorded presentations, virtual focus groups, and surveys to assess their perspectives on EV therapy and determine the factors influencing their acceptance of the intervention.</p></div><div><h3>Results</h3><p>Participants with postoperative AF experienced prolonged intensive care unit and hospital stays, compared to those of patients with normal heart rhythm. Prior to the presentation, a number of participants were unfamiliar with postoperative AF and biological therapies. However, postpresentation and post–focus group activities resulted in enhanced understanding of the research, with high levels of comprehension reported by all participants. The level of acceptance of EV therapy tended to increase, with a majority expressing willingness to participate in clinical trials and accept the therapy. The focus groups identified and addressed common questions regarding the potential risks and side effects of EVs, their source, dosing, utility for patients with preexisting AF, and the risk of human immunodeficiency virus (HIV) contraction or allergic reactions.</p></div><div><h3>Conclusions</h3><p>The study highlights the importance of providing education, involving the patient's circle of care, and addressing patient concerns, to promote acceptance of therapies such as EV therapy for postoperative AF.</p></div><div><h3>Clinical Trial Registration</h3><p><span>NCT05032495</span><svg><path></path></svg>.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 7","pages":"Pages 893-900"},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24001720/pdfft?md5=0011c792af7514aaa0ff933653ee7f38&pid=1-s2.0-S2589790X24001720-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769249","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
Distinguishing Primary Prevention From Secondary Prevention Implantable Cardioverter Defibrillators Using Administrative Health and Cardiac Device Registry Data 利用行政健康和心脏设备登记数据区分一级和二级预防植入式心律转复除颤器
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1016/j.cjco.2024.02.003
Isaac Robinson , Daniel Daly-Grafstein MSc , Mayesha Khan MA , Andrew D. Krahn MD , Nathaniel M. Hawkins MD , Jeffrey R. Brubacher MD , John A. Staples MD, MPH

Background

Administrative health data and cardiac device registries can be used to empirically evaluate outcomes and costs after implantable cardioverter defibrillator (ICD) implantation. These datasets often have incomplete information on the indication for implantation (primary vs secondary prevention of sudden cardiac death).

Methods

We used 16 years of population-based cardiac device registry and administrative health data from British Columbia, Canada, to derive and internally validate statistical models that predict the likely indication for ICD implantation. We used chart review data as the reference standard for ICD indication in the Cardiac Device Registry database (CDR; 2004-2012 [Cardiac Services BC]) and nonmissing indication as the reference standard in the Heart Information System registry database (HEARTis; 2013-2019 [Cardiac Services BC]). We created 3 logistic regression prediction models in each database: one using only registry data, one using only administrative data, and one using both registry and administrative data. We assessed the predictive performance of each model using standard metrics after optimism correction with 200 bootstrap resamples.

Results

Models that used registry data alone demonstrated excellent predictive performance (sensitivity ≥ 89%; specificity ≥ 87%). Models that used only administrative data performed well (sensitivity ≥ 84%; specificity ≥ 70%). Models that used both registry and administrative data showed modest gains over those that used registry data alone (sensitivity ≥ 90%; specificity ≥ 89%).

Conclusions

Administrative health data and cardiac device registry data can distinguish secondary prevention ICDs from primary prevention ICDs with acceptable sensitivity and specificity. Imputation of missing ICD indication might make these data resources more useful for research and health system monitoring.

背景行政健康数据和心脏设备登记可用于对植入式心律转复除颤器(ICD)植入后的疗效和成本进行经验性评估。我们利用加拿大不列颠哥伦比亚省 16 年的基于人口的心脏设备登记和行政健康数据,推导并在内部验证了预测 ICD 植入可能适应症的统计模型。我们使用病历审查数据作为心脏设备登记数据库(CDR;2004-2012 年 [Cardiac Services BC])中 ICD 适应症的参考标准,并使用心脏信息系统登记数据库(HEARTis;2013-2019 年 [Cardiac Services BC])中的非遗漏适应症作为参考标准。我们在每个数据库中创建了 3 个逻辑回归预测模型:一个仅使用登记数据,一个仅使用管理数据,一个同时使用登记数据和管理数据。结果仅使用登记处数据的模型表现出卓越的预测性能(灵敏度≥ 89%;特异性≥ 87%)。仅使用行政数据的模型表现良好(灵敏度≥ 84%;特异度≥ 70%)。结论行政健康数据和心脏设备登记数据能以可接受的灵敏度和特异性区分二级预防 ICD 和一级预防 ICD。对缺失的 ICD 适应症进行估算可能会使这些数据资源在研究和卫生系统监测方面更加有用。
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引用次数: 0
Prescription Trends of Thiazide Diuretics in a Canadian Primary Care Population From 2015 to 2021 2015-2021 年加拿大初级保健人群中噻嗪类利尿剂的处方趋势
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.03.001
Catherine Ji MD, MSc , Jemisha Apajee MPhil , Ellen Stephenson PhD , Karen Tu MD, Msc

Background

Hypertension Canada 2017 guidelines favoured the use of thiazide (TZ)-like diuretics, such as CLTD (chlorthalidone) and indapamide (IND) over hydrochlorothiazide (HCTZ). Health Canada warned in 2019 that HCTZ may be associated with increased risk of skin cancer. Our study looked at the changes in TZ prescriptions from 2015 to 2021 in Ontario, Canada.

Methods

A retrospective cohort study was conducted of adults with hypertension, using electronic medical record data from the University of Toronto Practice-Based Research Network database covering mostly the Greater Toronto area. Outcomes included the proportion of patients who received a prescription of HCTZ, CLTD, or IND each month. Interrupted time-series analysis was used to evaluate the change in outcomes after publication of the 2017 guidelines and 2019 safety warning. Prescription trends were stratified by prescribing physicians’ sex and year of medical school graduation.

Results

A total of 100,428 patients with hypertension were included in the cohort, with 31,700 patients who received at least one TZ prescription from 343 family physicians. We found a declining trend in HCTZ prescriptions over time, accompanied by an increase in IND and CLTD prescriptions, with statistically significant but transient changes in prescription rates after publication of the 2017 guidelines and the 2019 safety warning for all 3 medications. Female physician and early-career physician prescription rates changed faster than that of their counterparts immediately after the Health Canada safety warning was issued.

Conclusions

TZ diuretic prescription patterns have changed in recent years, but Hypertension Canada’s 2017 guidelines and the 2019 Health Canada safety warning did not have a sustained significant impact on the change in prescription rates of HCTZ, IND, and CLTD.

背景加拿大2017年高血压指南倾向于使用噻嗪类(TZ)利尿剂,如CLTD(氯沙利酮)和吲哒帕胺(IND),而不是氢氯噻嗪(HCTZ)。加拿大卫生部在2019年警告说,HCTZ可能与皮肤癌风险增加有关。我们的研究调查了加拿大安大略省从2015年到2021年TZ处方的变化情况。研究方法利用多伦多大学基于实践的研究网络数据库(主要覆盖大多伦多地区)中的电子病历数据,对成人高血压患者进行了一项回顾性队列研究。研究结果包括每月获得 HCTZ、CLTD 或 IND 处方的患者比例。采用间断时间序列分析来评估 2017 年指南和 2019 年安全警告发布后的结果变化。根据处方医生的性别和医学院毕业年份对处方趋势进行了分层。结果共有 100,428 名高血压患者被纳入队列,其中 31,700 名患者从 343 名家庭医生处获得了至少一张 TZ 处方。我们发现,随着时间的推移,HCTZ处方量呈下降趋势,同时IND和CLTD处方量有所增加,在2017年指南发布和2019年所有3种药物的安全警告发布后,处方率发生了统计学意义上的显著变化,但这种变化是短暂的。在加拿大卫生部安全警告发布后,女性医生和早期职业医生的处方率变化比她们的同行更快。结论近年来,TZ 利尿剂处方模式发生了变化,但加拿大高血压协会 2017 年指南和 2019 年加拿大卫生部安全警告并未对 HCTZ、IND 和 CLTD 处方率的变化产生持续的重大影响。
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引用次数: 0
Lymphopenia in the Adult Population With Fontan Physiology: A Potential New Marker for Disease Assessment 成人 Fontan 群体中的淋巴细胞减少症:疾病评估的潜在新标记物
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.01.012
Anna L. Scandinaro MD , Michael D. McCann MD, MBA , Anisa Chaudhry MD , Allen Kunselman MA , Elisa A. Bradley MD , William R. Davidson Jr. MD

Background

Patients with complex congenital heart disease and Fontan palliation frequently develop extracardiac disease, including hematologic abnormalities, such as lymphopenia. However, the clinical implications of this finding are poorly understood and are therefore the topic of this investigation.

Methods

Patients with Fontan physiology in our centre (1999-2018) were evaluated for the presence and impact of lymphopenia. The cohort was divided into a group with lymphopenia (L) (2 consecutive absolute lymphocyte counts ≤ 1∗103 K/ μL) and a group who had never had lymphopenia (NL). Clinical characteristics and hospital admissions (762 patient-years) were evaluated.

Results

In 62 adult patients with Fontan physiology (aged 34 ± 9 years; 32 women [52%]), the patients who developed lymphopenia earliest did so 8 years after Fontan completion, with up to 60% of patients developing lymphopenia by 30 years. Lymphopenia was found to be associated with portal hypertension (varices, ascites, splenomegaly, and thrombocytopenia [VAST] score)—NL: 0 (0-2) vs L: 2 (0-4), P < 0.0001). A total of 76 heart failure and 81 arrhythmia-associated admissions occurred per 1000 patient-years. At 40 years post-Fontan, the probability of a heart failure admission was higher in the L group (L: 51 [86%] vs NL: 8 [14%], P < 0.01).

Conclusions

Adult patients with Fontan physiology and lymphopenia demonstrated portal hypertension and lymphatic dysfunction more commonly, perhaps suggesting that this may be a marker of Fontan congestion and early Fontan failure. Further investigation into the relationship between lymphopenia, clinical outcomes, and Fontan function is needed.

背景复杂先天性心脏病和Fontan姑息治疗患者经常会出现心外疾病,包括血液学异常,如淋巴细胞减少症。方法对本中心的丰坦生理学患者(1999-2018 年)进行了淋巴细胞减少症存在及其影响的评估。研究对象分为淋巴细胞减少症(L)组(连续两次淋巴细胞绝对计数≤1∗103 K/μL)和从未出现淋巴细胞减少症(NL)组。结果 在 62 名患有丰坦生理学的成年患者(年龄为 34 ± 9 岁;32 名女性 [52%])中,最早出现淋巴细胞减少症的患者是在丰坦手术完成后 8 年出现的,多达 60% 的患者在 30 年前出现淋巴细胞减少症。淋巴细胞减少症与门静脉高压有关(静脉曲张、腹水、脾肿大和血小板减少[VAST]评分)--NL:0 (0-2) vs L:2 (0-4),P < 0.0001)。每 1000 患者年中,共有 76 例心力衰竭和 81 例心律失常相关入院。结论成人丰坦生理学和淋巴细胞减少症患者更常表现为门脉高压和淋巴功能障碍,这可能是丰坦充血和早期丰坦衰竭的标志。需要进一步研究淋巴细胞减少症、临床结果和Fontan功能之间的关系。
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引用次数: 0
Progression of Left Ventricular Aneurysm to Pseudoaneurysm on Serial Imaging 连续成像显示左心室动脉瘤向假性动脉瘤发展
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.04.002
Yoshito Kadoya MD, PhD , Alexander Dick MD , Hassan Mir MD , Luc Beauchesne MD , D. Ian Paterson MD
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引用次数: 0
Multimodal Assessment of Immunosuppressive Therapy in a Patient With Chronic Active Myocarditis 3 Months Following COVID-19 Infection COVID-19 感染 3 个月后对慢性活动性心肌炎患者免疫抑制疗法的多模式评估
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cjco.2024.03.010
Yuta Kobayashi MD, PhD , Takeshi Hamaya MD , Toshiyuki Nagai MD, PhD , Yuki Mori MD , Takuma Sato MD, PhD , Satonori Tsuneta MD, PhD , Kento Wakabayashi MD , Kohsuke Kudo MD, PhD , Yoshihiro Matsuno MD, PhD , Toshihisa Anzai MD, PhD
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引用次数: 0
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