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Letter to the Editor: Comparative efficacy and safety of mitral valve repair versus mitral valve replacement in rheumatic heart disease: A high-value care systematic review and meta-analysis 致编辑的信风湿性心脏病二尖瓣修复术与二尖瓣置换术的疗效和安全性比较:高价值医疗系统回顾与元分析》。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-30 DOI: 10.1016/j.cpcardiol.2024.102821
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引用次数: 0
Diagnostic and therapeutic practice for Heart Failure with preserved ejection fraction around the world: An international survey 全球射血分数保留型心力衰竭的诊断和治疗实践:一项国际调查。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-29 DOI: 10.1016/j.cpcardiol.2024.102799

Background and aims

There is a gap in knowledge about implementing diagnostic tools and therapy for heart failure with preserved ejection fraction (HFpEF) in clinical practice. This survey aimed to assess real-world practice in HFpEF diagnosis and treatment in the international medical community.

Methods

An independent academic web-based 29-question survey was designed by a group of heart failure specialists and posted by email and through scientific societies and social networks to a broad community of physicians worldwide.

Results

1.460 physicians from 95 countries answered the survey, with a mean age of 42.2±10.4 years, 39.4 % females, and 85.1 % were cardiologists. The left ventricular ejection fraction cut-off value selected for HFpEF diagnosis was 50 % for 89 % of participants. The scores for the probability of diagnosis of HFpEF were used only by 47.2 %, and H2FPEF was the most used score (31 %). Natriuretic peptides were used by 87.4 % of participants for the diagnostic workup, while the diastolic stress test was only used by 26.2 %. 54.4 % of participants chose SGLT2 inhibitors as their first drug treatment, followed by diuretics (18.6 %) and ACE inhibitors (8.4 %).

Conclusions

In an international academic survey on HFpEF management, the criteria for screening and diagnosis of HFpEF patients remain aligned with classic international guidelines with a low use of diagnostic scores. SGLT2i is the leading therapeutic drug class used for this heterogeneous patient population. These results raise the need to improve education and awareness on diagnosing and managing HFpEF patients.

背景和目的:在临床实践中,有关射血分数保留型心力衰竭(HFpEF)诊断工具和治疗方法的实施知识尚存在空白。这项调查旨在评估国际医学界在 HFpEF 诊断和治疗方面的实际做法:方法:由一组心衰专家设计了一项独立的学术性网络调查,包含 29 个问题,并通过电子邮件、科学协会和社交网络向全球广大医师群体发布:来自 95 个国家的 1460 名医生回答了调查,平均年龄为(42.2±10.4)岁,女性占 39.4%,85.1% 为心脏病专家。89%的参与者在诊断高频心衰时选择的左心室射血分数临界值为50%。只有 47.2% 的人使用了 HFpEF 诊断概率评分,H2FPEF 是使用最多的评分(31%)。87.4%的参与者在诊断过程中使用了利钠肽,而只有 26.2% 的参与者使用了舒张压试验。54.4%的参与者选择SGLT2抑制剂作为首选药物治疗,其次是利尿剂(18.6%)和ACE抑制剂(8.4%):结论:在一项关于高频血栓栓塞治疗的国际学术调查中,高频血栓栓塞患者的筛查和诊断标准与经典国际指南保持一致,诊断评分的使用率较低。SGLT2i 是用于这类异质性患者的主要治疗药物。这些结果表明,有必要加强有关诊断和管理 HFpEF 患者的教育和宣传。
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引用次数: 0
SGLT2 inhibitor therapy in patients with advanced heart failure and reduced ejection fraction 晚期心力衰竭和射血分数降低患者的 SGLT2 抑制剂疗法。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-28 DOI: 10.1016/j.cpcardiol.2024.102823

Aims

Sodium-glucose cotransporter inhibitors (SGLT2-i) improve outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF). However, evidence in patients with advanced HF is lacking. We aimed to determine the effect of SGLT2-i in advanced HFrEF compared to their effect on a non-advanced population.

Methods

Consecutive HFrEF outpatients who started SGLT2-i were observed for 6-months. Patients were categorized as having advanced or non-advanced HFrEF. The primary outcome was the trend of NTproBNP in the two groups. Secondary outcomes included changes in New York Heart Association (NYHA) class, glomerular filtration rate (GFR), and ejection fraction (LVEF). The association between advanced HF diagnosis and including N-terminal pro-brain natriuretic peptide (NTproBNP) reduction was tested using multivariate analysis.

Results

Overall, 105 patients (45 advanced, 60 non-advanced) were included. Mean age was 56 ± 10 years, 22 % were female, and 35 % had ischemic heart disease. Median NTproBNP at baseline for advanced and non-advanced patients was 1672pg/ml (IQR 520-3320) vs. 481 pg/ml (IQR 173-917), respectively (p < 0.001). At follow-up, only non-advanced patients reduced their NTproBNP (-32 % (95 % CI -51 to -3), p < 0.001), while advanced patients had an increase in NTproBNP. LVEF and NYHA class improved only in non-advanced patients. GFR was stable in both subgroups. At multivariate analysis a diagnosis of advanced HF was independently associated with a reduced probability of NTproBNP reduction (OR 0.041 (95 % CI 0.002-0.752), p = 0.031). Only one patient discontinued the drug due to side effects.

Conclusion

In advanced HFrEF, SGLT2-i do not impact on NTproBNP, LVEF or NYHA class but are well tolerated.

目的:钠-葡萄糖共转运抑制剂(SGLT2-i)可改善心力衰竭(HF)和射血分数降低(HFrEF)患者的预后。然而,在晚期心力衰竭患者中还缺乏相关证据。我们旨在确定 SGLT2-i 在晚期 HFrEF 中的疗效,并将其与在非晚期人群中的疗效进行比较:我们对开始服用 SGLT2-i 的连续 HFrEF 门诊患者进行了为期 6 个月的观察。患者被分为晚期和非晚期 HFrEF。主要结果是两组患者 NTproBNP 的变化趋势。次要结果包括纽约心脏协会(NYHA)分级、肾小球滤过率(GFR)和射血分数(LVEF)的变化。通过多变量分析检验了晚期 HF 诊断与 N 末端前脑钠尿肽(NTproBNP)降低之间的关系:共纳入 105 例患者(45 例晚期,60 例非晚期)。平均年龄为(56±10)岁,22%为女性,35%患有缺血性心脏病。晚期和非晚期患者基线时的 NTproBNP 中位数分别为 1672pg/ml (IQR 520-3320)和 481pg/ml (IQR 173-917)(pConclusion:对于晚期 HFrEF,SGLT2-i 对 NTproBNP、LVEF 或 NYHA 分级没有影响,但耐受性良好。
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引用次数: 0
Efficacy of Tai Chi exercise in patients with hypertension: systematic review and meta-analysis 太极拳运动对高血压患者的疗效:系统回顾和荟萃分析
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-28 DOI: 10.1016/j.cpcardiol.2024.102798

Background

An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. Pharmachological approaches have side effect, prompting exploration of Non-pharmacological approaches, like Tai Chi. Although early evidence suggests a potential favourable benefit with Tai Chi, it remains unclear whether the method can significantly reduced SBP and DBP. We aimed to assess by a systematic review and meta-analysis the effectiveness of Tai Chi in alleviating SBP and DBP on hypertension patients.

Methods

Our study adhered to the PRISMA method and was registered in PROSPERO under the code CRD42024496192. The search was carried out in the PubMed, Web of Science, Embase, and the Cochrane Library databases in December 2023. Five randomized controlled trials were included (a total of 568 patients). Risk of bias was employed to assess the quality of individual studies, and a random-effects model was utilized to examine the overall effect.

Results

The results showed that Tai Chi, when compared to routine care, had a statistically significant impact on anxiety ((MD = 5.49, 95 % CI: 3.44 to 7.54, p = 0.001), with a heterogeneity I2 = 54%. Tai Chi did not show a significant difference in terms of DBP when compared to standard care (MD =3.18, 95 % CI: 1.89 to −4.48, p = 0.31). The included trials exhibited small sample sizes, substantial heterogeneity.

Conclusions

Tai Chi effectively lowers SBP levels in hypertension patients, however, did not show a statistically significant difference on DBP.

背景据估计,全球有 12.8 亿 30-79 岁的成年人患有高血压,其中大多数(三分之二)生活在中低收入国家。药物治疗方法有副作用,这促使人们探索非药物治疗方法,如太极拳。虽然早期证据表明太极拳可能带来好处,但该方法能否显著降低 SBP 和 DBP 仍不清楚。我们旨在通过系统综述和荟萃分析评估太极拳在缓解高血压患者 SBP 和 DBP 方面的有效性。方法我们的研究遵循 PRISMA 方法,并在 PROSPERO 中注册,代码为 CRD42024496192。研究于 2023 年 12 月在 PubMed、Web of Science、Embase 和 Cochrane Library 数据库中进行了检索。共纳入了 5 项随机对照试验(共 568 名患者)。结果表明,与常规护理相比,太极拳对焦虑有显著的统计学影响(MD = 5.49,95 % CI:3.44 至 7.54,p = 0.001),异质性 I2 = 54%。与标准护理相比,太极拳在DBP方面未显示出明显差异(MD = 3.18,95 % CI:1.89 至 -4.48,p = 0.31)。结论太极拳能有效降低高血压患者的 SBP 水平,但在 DBP 方面没有显示出具有统计学意义的差异。
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引用次数: 0
Racial disparities in trend, clinical characteristics and outcomes in Takotsubo syndrome Takotsubo 综合征的趋势、临床特征和结果中的种族差异。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-27 DOI: 10.1016/j.cpcardiol.2024.102826

Introduction

Takotsubo syndrome (TTS) is an acute transient nonischemic cardiomyopathy often characterized by its hallmark feature of left ventricular apical ballooning. The correlation between racial backgrounds and the prognosis of individuals with TTS remains poorly defined. Our study aimed to explore the influence of race on the trends, clinical presentations, and outcomes in patients diagnosed with TTS.

Methods

We queried the National Inpatient Sample (NIS) database from 2016 to 2020 and identified hospitalizations with TTS. We compared the clinical features and outcomes across three different races - non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic population. The primary outcome was in-hospital mortality.

Results

76,505 weighted hospitalizations for TTS were identified, of which 65,495 (85.6%) were non-Hispanic White, 5,830 (7.6%) were non-Hispanic Black, and 5,180 (6.8%) were Hispanics. After propensity-score matching, NHB patients had higher odds of acute kidney injury (OR: 1.49, 95% CI: 1.21-1.84, p < 0.001) and mechanical ventilation (OR: 1.33, 95% CI: 1.04-1.68, p = 0.02). Hispanic patients had a higher incidence of acute kidney injury requiring dialysis when compared to NHW patients (OR: 2.53, 95% CI: 1.11-5.77, p = 0.027). There was no significant difference in terms of in-hospital mortality between NHB and Hispanic patients when compared to NHW patients. Notably, Hispanic populations experienced a higher mortality rate during the COVID-19 period.

Conclusion

Our study suggested significant differences in the outcomes of TTS across different racial groups. Hispanic populations experienced a higher mortality rate with TTS during the COVID-19 era. Further research should emphasize discovering the factors contributing to the observed disparities.

导言高骤变综合征(TTS)是一种急性短暂性非缺血性心肌病,通常以左心室心尖气囊扩张为特征。种族背景与 TTS 患者预后之间的相关性仍不十分明确。我们的研究旨在探讨种族对确诊为 TTS 患者的趋势、临床表现和预后的影响:我们查询了2016年至2020年的全国住院患者样本(NIS)数据库,并确定了TTS住院患者。我们比较了三种不同种族--非西班牙裔白人(NHW)、非西班牙裔黑人(NHB)和西班牙裔人群--的临床特征和预后。主要结果是院内死亡率:确定了 76,505 例 TTS 加权住院病例,其中 65,495 例(85.6%)为非西班牙裔白人,5,830 例(7.6%)为非西班牙裔黑人,5,180 例(6.8%)为西班牙裔。经过倾向分数匹配后,非西班牙裔白种人患者发生急性肾损伤的几率更高(OR:1.49,95% CI:1.21-1.84,p):我们的研究表明,不同种族群体的 TTS 结果存在显著差异。在 COVID-19 时代,西班牙裔人群的 TTS 死亡率较高。进一步的研究应强调发现导致观察到的差异的因素。
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引用次数: 0
Response to “Outcomes after septal myectomy in a cohort of patients with hypertrophic cardiomyopathy” 对 "一组肥厚型心肌病患者房间隔肌肉切除术后的疗效 "的回应
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-26 DOI: 10.1016/j.cpcardiol.2024.102822
{"title":"Response to “Outcomes after septal myectomy in a cohort of patients with hypertrophic cardiomyopathy”","authors":"","doi":"10.1016/j.cpcardiol.2024.102822","DOIUrl":"10.1016/j.cpcardiol.2024.102822","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the Editor: Rising mortality related to cardiovascular disease and prostate cancer amongst older men across the United States 致编辑的信:美国老年男性心血管疾病和前列腺癌死亡率不断上升。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-25 DOI: 10.1016/j.cpcardiol.2024.102828
{"title":"Letter to the Editor: Rising mortality related to cardiovascular disease and prostate cancer amongst older men across the United States","authors":"","doi":"10.1016/j.cpcardiol.2024.102828","DOIUrl":"10.1016/j.cpcardiol.2024.102828","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of definite vs probable/presumed cardiac sarcoidosis: a systematic review and meta-analysis 确诊与可能/推测的心脏肉样瘤病的结果:系统回顾和荟萃分析。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-25 DOI: 10.1016/j.cpcardiol.2024.102820

Background

Diagnosing cardiac sarcoidosis (CS), which can be associated with arrhythmias and heart failure, remains challenging despite multiple advances over time. The 2014 Heart Rhythm Society (HRS) consensus statement recommends an endomyocardial biopsy (EMB) to establish a definite diagnosis of CS. In the absence of a positive EMB, a diagnosis of probable or presumed CS is made on the basis of clinical and imaging criteria.

Objective

To investigate whether there is any difference in outcomes between definite vs probable/presumed CS.

Methods

PubMed/MEDLINE, Embase, and the Cochrane Library databases were searched for relevant studies published after 2014. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random effects model and presented in forest plots.

Results

6 studies involving 2,204 patients were identified. The cohort had a mean age of 56.8 years (SD: ±13.6 years). The median duration of follow-up was 40.5 months. No statistically significant difference was observed between definite and probable/presumed CS for reduced risk of the composite endpoint (RR: 1.80, 95% CI: 0.93 to 3.49), and all-cause death (RR: 1.01, 95% CI: 0.48 to 2.10).

Conclusion

This meta-analysis demonstrated the equivalence of clinical course and prognosis between definite and probable/presumed CS. This highlights the importance of a multi-disciplinary approach to CS care and emphasizes that histological confirmation should not be a prerequisite to diagnose or manage this condition.
背景:心脏肉样瘤病(CS)可伴有心律失常和心力衰竭,尽管随着时间的推移取得了多项进展,但诊断CS仍具有挑战性。2014 年心律学会(HRS)共识声明建议通过心内膜活检(EMB)明确诊断 CS。如果心内膜活检未呈阳性,则根据临床和影像学标准诊断为可能或推测的 CS:调查确诊 CS 与可能/推测 CS 的结果是否存在差异:方法:检索 PubMed/MEDLINE、Embase 和 Cochrane Library 数据库中 2014 年之后发表的相关研究。采用随机效应模型计算风险比(RR)及95%置信区间(CI),并以森林图的形式展示:结果:共发现 6 项研究,涉及 2,103 名患者。研究队列的平均年龄为 56.8 岁(标准差:±13.6 岁)。随访时间的中位数为 40.5 个月。在降低复合终点风险(RR:1.06,95% CI:0.66 至 1.72)、全因死亡风险(RR:1.03,95% CI:0.73 至 1.46)、心脏性猝死(RR:1.59,95% CI:0.99 至 2.56)、心律失常(RR:0.80,95% CI:0.60 至 1.07)和 HF 相关住院(RR:0.91,95% CI:0.59 至 1.38):这项荟萃分析表明,确诊 CS 和可能/推测 CS 的临床病程和预后相当。这凸显了多学科方法对 CS 护理的重要性,并强调组织学确诊不应成为诊断或处理这种疾病的先决条件。
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引用次数: 0
Response to “Rising mortality related to cardiovascular disease and prostate cancer amongst older men across the United States” 回应 "美国老年男性心血管疾病和前列腺癌死亡率上升"。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-25 DOI: 10.1016/j.cpcardiol.2024.102824
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引用次数: 0
Aspirin use in patients with elevated lipoprotein(a): Impact on cardiovascular events and bleeding 脂蛋白(a)升高患者使用阿司匹林:对心血管事件和出血的影响。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-25 DOI: 10.1016/j.cpcardiol.2024.102827

The role of aspirin in cardiovascular primary prevention remains controversial. There are physiological reasons to explore its potential benefits in patients with high levels of lipoprotein(a) [Lp(a)], mainly due to its antifibrinolytic properties and interactions with platelets. The primary objective of this systematic review was to evaluate the cardiovascular benefits and bleeding risks associated with aspirin use in patients who have elevated Lp(a) levels but no history of cardiovascular disease. This systematic review was conducted following PRISMA guidelines. We performed a literature search to identify studies assessing the cardiovascular benefits and bleeding risks of aspirin use in patients with elevated Lp(a) levels (or a related genetic variant) who have no history of cardiovascular disease. Five studies (49,871 individuals) were considered for this systematic review. Three studies assessed the impact of aspirin use in relation to genetic variants associated with elevated Lp(a) levels (SNP rs379822), while the remaining two studies directly measured plasma levels of Lp(a). The endpoints evaluated varied among the studies. Overall, the findings consistently show that carriers of the apolipoprotein(a) variant or patients with Lp(a) levels > 50 mg/dL experience a reduction in cardiovascular risk with aspirin use. No significant bleeding issues were observed, although such events were reported in only two studies. This systematic review suggests that aspirin use in patients with elevated Lp(a) levels and no prior cardiovascular history may reduce cardiovascular risk. The available data on bleeding risk is insufficient.

阿司匹林在心血管一级预防中的作用仍存在争议。探讨阿司匹林对脂蛋白(a)[Lp(a)]水平高的患者的潜在益处有其生理原因,主要是由于阿司匹林的抗纤维蛋白溶解特性以及与血小板的相互作用。本系统综述的主要目的是评估脂蛋白(a)水平升高但无心血管疾病史的患者服用阿司匹林对心血管的益处和出血风险。本系统综述遵循 PRISMA 指南进行。我们进行了文献检索,以确定评估无心血管疾病史的脂蛋白(a)水平升高(或相关基因变异)患者服用阿司匹林对心血管的益处和出血风险的研究。本系统综述考虑了五项研究(49,871 人)。其中三项研究评估了阿司匹林的使用对与脂蛋白(a)水平升高相关的基因变异(SNP rs379822)的影响,其余两项研究则直接测量了血浆中的脂蛋白(a)水平。各项研究评估的终点各不相同。总体而言,研究结果一致表明,载脂蛋白(a)变异体携带者或脂蛋白(a)水平大于 50 毫克/分升的患者服用阿司匹林可降低心血管风险。尽管只有两项研究报告了出血事件,但未观察到明显的出血问题。本系统综述表明,脂蛋白(a)水平升高且无心血管病史的患者服用阿司匹林可降低心血管风险。有关出血风险的现有数据尚不充分。
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引用次数: 0
期刊
Current Problems in Cardiology
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