Current Problems in Cardiology最新文献

英文中文

Using different anthropometric indices of obesity as predictors for type 2 diabetes mellitus in older adults 用不同的肥胖人体测量指数预测老年人的 2 型糖尿病。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-11-05 DOI: 10.1016/j.cpcardiol.2024.102924

Robinson Ramírez-Vélez , Miguel A. Pérez-Sousa , Emilio González-Jiménez , María Correa-Rodríguez , Juan Carlos Calderón-González , Albeiro Dávila-Grisales , Jacqueline Schmidt-RioValle

Background and aims

There is some evidence that anthropometric measurements can be associated with the risk of type 2 diabetes mellitus (T2DM). Nevertheless, there is no comprehensive consensus on which anthropometric index is the best for evaluating the risk and predicting T2DM, especially in older adults. For this reason, we compared the performance of six indices for detecting T2DM in a population of Colombian older adults.

Methods and results

We conducted a cross-sectional study of 3453 older adults (≥60 years old; 2023 women), analysing demographic characteristics, biochemical markers, and anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), adiposity index (VAI), conicity index (C-Index), and body roundness index (BRI). T2DM was defined as fasting plasma glucose ≥126 mg/dl (≥7.0 mmol/l). All the anthropometric indices correlated significantly with the presence of T2DM. An analysis of the receiver operating characteristic curve showed that for men the VAI (AUC = 0.71; moderate ES (0.78); OR = 4.13), BMI (AUC = 0.68; moderate ES (0.68); OR = 3.38), and WC (AUC = 0.68; moderate ES (0.68); OR = 3.38) are the best predictors for identifying T2DM. For women, however, the WC (AUC = 0.63; ES = 0.46; OR = 2.34) and C-Index (AUC = 0.63; ES = 0.46; OR = 2.34) were better indicators for predicting T2DM. Cut-off points for all the anthropometric indices were provided.

Conclusions

In summary, the VAI, BMI, and WC in men, and WC and the C-Index in women have a moderate discriminating power for detecting T2DM in Colombian older adults, evidencing that these anthropometric indices are suitable screening tools for use in the elderly.

背景和目的：有证据表明，人体测量值与罹患 2 型糖尿病（T2DM）的风险有关。然而，对于哪种人体测量指数最适合用于评估 T2DM 风险和预测 T2DM，尤其是老年人的 T2DM 风险和预测，目前还没有达成全面的共识。为此，我们比较了六种指数在哥伦比亚老年人群中检测 T2DM 的性能：我们对 3453 名老年人（≥60 岁；2023 名女性）进行了横断面研究，分析了人口特征、生化指标和人体测量指数，包括体重指数 (BMI)、腰围 (WC)、腰高比 (WHTR)、脂肪指数 (VAI)、圆锥指数 (C-Index) 和体圆指数 (BRI)。T2DM 的定义是空腹血浆葡萄糖≥126 mg/dl（≥7.0 mmol/l）。所有人体测量指数都与是否患有 T2DM 显著相关。接收器操作特征曲线分析表明，对于男性而言，VAI（AUC = 0.71；中等 ES (0.78)；OR = 4.13）、BMI（AUC = 0.68；中等 ES (0.68)；OR = 3.38）和 WC（AUC = 0.68；中等 ES (0.68)；OR = 3.38）是识别 T2DM 的最佳预测指标。然而，对于女性而言，体重指数（AUC = 0.63；ES = 0.46；OR = 2.34）和 C 指数（AUC = 0.63；ES = 0.46；OR = 2.34）是预测 T2DM 的更好指标。提供了所有人体测量指数的临界点：总之，男性的 VAI、BMI 和 WC，以及女性的 WC 和 C-Index 对检测哥伦比亚老年人的 T2DM 具有中等程度的鉴别力，证明这些人体测量指数是适用于老年人的筛查工具。

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引用次数: 0

Intra-myocardial hemorrhage and cardiac microvascular injury in ischemia/reperfusion. A systematic review of current evidences 缺血/再灌注时的心肌内出血和心脏微血管损伤。当前证据的系统回顾。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-11-05 DOI: 10.1016/j.cpcardiol.2024.102918

Konstantin V. Zavadovsky MD, PhD, DrSc , Vyacheslav V. Ryabov MD, PhD, DrSc , Evgeny V. Vyshlov MD, PhD, DrSc , Olga V. Mochula MD, PhD , Maria Sirotina MD , Artur Kan MD , Alexander V. Mukhomedzyanov MD, PhD , Ivan A. Derkachev MD , Nikita S. Voronkov MD, PhD , Andrey V. Mochula MD, PhD , Alexandra S. Maksimova MD, PhD , Leonid N. Maslov MD, PhD, DrSc

The in-hospital mortality rate in acute myocardial infarction (AMI) remains high despite the undoubted achievements in treatment of this disease achieved in the last 40 years. The dangerous complications of AMI remain cardiac microvascular injury (CMI) and intramyocardial hemorrhage (IMH). IMH is a widespread pathology that occurs in 42 – 57% of patients with ST-segment elevation myocardial infarction and percutaneous coronary intervention. IMH is associated with larger infarct size and contractile dysfunction. IMH is accompanied by inflammation. The appearance of IMH is depending on the duration of ischemia and requires reperfusion of the heart. IMH is accompanied by contractile dysfunction and adverse remodeling of the heart. The most likely cause of IMH is CMI. Pretreatment with ATL-146e, melatonin, tanshinone IIA, relaxin, empagliflozin, dapagliflozin, and astragaloside IV can mitigate I/R-induced CMI. CMI is accompanied by an increase in the myocardial and plasma proinflammatory cytokine levels and also the downregulation of tight junction proteins in cardiac vascular endothelial cells. However, there is no convincing evidence that proinflammatory cytokines trigger CMI. An increase in the proinflammatory cytokine levels and CMI could be two independent processes.

尽管在过去 40 年中，急性心肌梗死（AMI）的治疗取得了毋庸置疑的成就，但其院内死亡率仍然居高不下。急性心肌梗死的危险并发症仍然是心脏微血管损伤（CMI）和心肌内出血（IMH）。心肌内出血是一种广泛的病理现象，在 ST 段抬高型心肌梗死和经皮冠状动脉介入治疗的患者中，42% 到 57% 都会发生心肌内出血。IMH 与梗死面积增大和收缩功能障碍有关。IMH 还伴有炎症。IMH 的出现取决于缺血时间的长短，需要对心脏进行再灌注。IMH 伴有收缩功能障碍和心脏的不良重塑。导致 IMH 的最可能原因是 CMI。使用 ATL-146e、褪黑素、丹参酮 IIA、松弛素、empagliflozin、dapagliflozin 和黄芪甲苷 IV 进行预处理可减轻 I/R 诱导的 CMI。CMI 伴随着心肌和血浆中促炎细胞因子水平的升高，以及心脏血管内皮细胞中紧密连接蛋白的下调。然而，没有令人信服的证据表明促炎细胞因子会引发 CMI。促炎细胞因子水平的升高和 CMI 可能是两个独立的过程。

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引用次数: 0

Effectiveness of Emotional-Focused Coping on Heart-Focused Anxiety in Patients Prior to Cardiac Catheterization. 情绪集中应对法对心导管检查前患者心脏焦虑的影响

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.cpcardiol.2024.102917

Baneen Kamil Gatie, Hayder H Al-Hadrawi

Background: Heart-focused anxiety involves a concentration on and a fear of cardiacrelated feelings and their anticipated negative outcomes (such as a life-threatening arrhythmia or abrupt cardiac death). It results in continuing concerns about heart function, avoiding activities that are thought to cause cardiac symptoms, and frequent behavior of requesting assistance in medical settings. This study aimed to measure the effectiveness of Emotional-Focused Coping on Heart-Focused Anxiety in Patients Prior to Cardiac Catheterization.

Materials and methods: A quasi-experimental study using (pretest and posttest design with a control group). A purposive sampling technique was used to gather the study information from 120 patients prior to cardiac catheterization by using the beck anxiety inventory scale. The study is conducted in Al-Najaf Al-Ashraf Government, Al-Najaf Center for Cardiac Surgery and Trans-Catheter Therapy.

Results: A statistically significant difference is found in participant's anxiety level prior to cardiac catheterization between the first measure before applying the coping techniques and the second measure after the application of coping strategies (Mean difference =13.500, P <0.0005).

Conclusion: The emotional focused coping strategies are proving as easy interventions to apply and effective in terms of reducing the level of heart-focused anxiety prior to cardiac catheterization.

背景：心脏焦虑是指对与心脏有关的感觉及其预期的负面结果（如危及生命的心律失常或心脏性猝死）的专注和恐惧。它导致患者持续关注心脏功能，避免从事被认为会引起心脏症状的活动，并经常在医疗环境中请求援助。本研究旨在测量情绪集中应对对心导管检查前患者心脏焦虑的有效性：准实验研究（前测和后测设计，对照组）。采用目的性抽样技术，使用贝克焦虑量表从 120 名接受心导管检查的患者中收集研究信息。研究在 Al-Najaf Al-Ashraf 政府的 Al-Najaf 心脏外科和经导管治疗中心进行：在采用应对技巧前的第一次测量和采用应对策略后的第二次测量中，发现受试者在接受心导管检查前的焦虑水平存在明显差异（平均差异 =13.500，P 结论：在采用应对策略后，受试者在接受心导管检查前的焦虑水平与采用应对技巧前的焦虑水平存在明显差异（平均差异 =13.500，P 结论）：事实证明，以情绪为重点的应对策略是一种易于应用的干预措施，而且能有效降低心导管检查前以心脏为重点的焦虑水平。

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引用次数: 0

Unveiling the link between physical parameters and safety in cardiac rehabilitation: Longitudinal observational study 揭示物理参数与心脏康复安全之间的联系：长期观察研究：物理参数与心脏不良事件。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.cpcardiol.2024.102916

Laís Manata Vanzella PhD, Felipe Ribeiro PhD, Maria Júlia Lopez Laurino PhD, Carolina Takahashi PhD, Franciele Marques Vanderlei PhD, Anne Kastelianne França da Silva PhD, Denise Brugnoli Balbi Dagostinho MSc, João Pedro Lucas Neves Silva MSc, Luiz Carlos Marques Vanderlei PhD

Objective

To identify the associations between cardiorespiratory fitness and quadriceps muscle strength and the occurrence of minor adverse events in a cardiac rehabilitation (CR) program.

Design

Prospective cohort study.

Setting

Output of a CR programme for primary or secondary prevention of cardiovascular disease (CVD).

Patients

Seventy individuals who were diagnosed with CVD and/or risk factors and 7 who were excluded due to a low adherence rate in exercise sessions (<70%), 4 due to errors in oxygen consumption recorded during the cardiopulmonary exercise test (CPET) and 11 because they decided to withdraw from the study. The data of 38 participants were analyzed.

Interventions

Not applicable.

Main outcome measures

Quadriceps muscle strength was assessed by an isokinetic dynamometer and by a manual dynamometer. Functional capacity was assessed by the CPET and by a six-minute walk test (6MWT). Participants were monitored by a physiotherapist during 24 exercise sessions to identify and register adverse events.

Results

Significant associations were detected between adverse events and quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-2.0(-2.0;0.0), p=0.047), between functional capacity assessed by the CPET (peak torque, B=-0.3(-2.4;0.0), p=0.019), between fatigue and functional capacity assessed by the CPET (VO2max, B=-1.3(-2.9;0.0), p=0.005) and between quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-10.0(-2.7;0.0); p=0.010).

Conclusions

Lower functional capacity and quadriceps muscle strength seem to be associated with a greater incidence of adverse events during exercise sessions.

目的确定心肺功能和股四头肌肌力与心脏康复（CR）项目中轻微不良事件发生率之间的关联：前瞻性队列研究：患者：70 名被诊断为心血管疾病（CVD）的患者：70名确诊患有心血管疾病和/或存在危险因素的患者，7名患者因坚持锻炼率低（低于70%）而被排除，4名患者因心肺锻炼测试（CPET）中记录的耗氧量有误而被排除，11名患者因决定退出研究而被排除。对 38 名参与者的数据进行了分析：主要结果测量：通过等速肌力计和手动肌力计评估股四头肌肌力。功能能力通过 CPET 和六分钟步行测试 (6MWT) 进行评估。理疗师在 24 次运动过程中对参与者进行监测，以识别和登记不良事件：结果：不良事件与通过等动测力计评估的股四头肌肌力（峰值扭矩，B=-2.0(-2.0;0.0)，P=0.047）、CPET评估的功能能力（峰值扭矩，B=-0.3(-2.4;0.0)，p=0.019）之间、CPET 评估的疲劳与功能能力（最大氧饱和度，B=-1.3(-2.9;0.0)，p=0.005）之间、等动测力计评估的股四头肌肌力（峰值扭矩，B=-10.0(-2.7;0.0); p=0.010）之间：结论：较低的功能能力和股四头肌肌力似乎与运动过程中较高的不良事件发生率有关。

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引用次数: 0

Heart transplantation in juvenile-onset systemic sclerosis with primary cardiac involvement: report of two cases and comprehensive literature review 原发性心脏受累的幼年型系统性硬化症的心脏移植：两例病例报告和全面的文献综述

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-31 DOI: 10.1016/j.cpcardiol.2024.102891

Daniela Bacich , Chiara Tessari , Marco Andreis , Veronica Geatti , Irene Cattapan , Nicola Pradegan , Marny Fedrigo , Giovanni Di Salvo , Giuseppe Toscano , Annalisa Angelini , Gino Gerosa

Juvenile onset systemic sclerosis is a rare chronic multisystem connective tissue disease characterized by skin induration, microangiopathy, autoimmune disturbances and widespread fibrosis of internal organs. Primary cardiac involvement in systemic sclerosis (SSc) is associated with a variable phenotype, including heart failure and arrhythmias, which lead to poor short-term prognosis. Isolated heart transplantation is a rare approach for the treatment of advanced heart failure in patients with systemic sclerosis. We report on two juvenile SSc patients receiving cardiac transplantation due to heart failure with malignant arrhythmias. One patient presented with severe dilated cardiomyopathy with recurrent ventricular tachycardia. Following the appearance of Raynaud phenomenon, he was subsequently diagnosed a rare form of systemic sclerosis sine scleroderma, without cutaneous manifestations or other organs involved. His cardiac condition was unresponsive to antiarrhythmic therapy and immunosuppression used to treat SSc, therefore he underwent successful heart transplantation. The second patient presented diffuse scleroderma with mild pulmonary, esophageal and renal involvement. While extracardiac manifestations were effectively kept under control with immunosuppressive therapy, cardiac involvement rapidly progressed with detection of fibrosis at cardiac magnetic resonance imaging and appearance of severe ventricular arrhythmia. Herein, an extensive multidisciplinary evaluation was pivotal in defining the entity and clinical stability of extracardiac involvement, and thus the patient could profit from heart transplantation. Our experience highlights the importance of considering heart transplantation in carefully selected SSc patients with primary cardiac involvement as a lifesaving procedure.

幼年发病的系统性硬化症是一种罕见的慢性多系统结缔组织疾病，其特点是皮肤凹陷、微血管病变、自身免疫紊乱和内脏广泛纤维化。系统性硬化症（SSc）的原发性心脏受累与多变的表型有关，包括心力衰竭和心律失常，导致短期预后不良。孤立心脏移植是治疗系统性硬化症患者晚期心力衰竭的一种罕见方法。我们报告了两名青少年系统性硬化症患者因心力衰竭伴恶性心律失常而接受心脏移植的病例。其中一名患者患有严重的扩张型心肌病，并伴有反复发作的室性心动过速。在出现雷诺现象后，他被诊断为罕见的无硬皮病的系统性硬化症，没有皮肤表现或其他器官受累。他的心脏状况对治疗系统性硬化症的抗心律失常疗法和免疫抑制无效，因此他成功接受了心脏移植手术。第二例患者为弥漫性硬皮病，伴有轻度肺、食管和肾脏受累。虽然通过免疫抑制治疗有效控制了心外表现，但心脏受累情况迅速恶化，心脏磁共振成像检测到纤维化，并出现严重的室性心律失常。在这种情况下，广泛的多学科评估在确定心外膜受累的实体和临床稳定性方面发挥了关键作用，因此患者可以从心脏移植中获益。我们的经验突出表明，对于精心挑选的原发性心脏受累的 SSc 患者，考虑心脏移植是挽救生命的重要手段。

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Title Page 标题页

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-30 DOI: 10.1016/S0146-2806(24)00530-9

引用次数: 0

Guidelines for Authors 作者指南

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-30 DOI: 10.1016/S0146-2806(24)00537-1

引用次数: 0

Could “preclinical takotsubo syndrome” be the cause of spontaneous coronary artery dissection? 临床前 Takotsubo 综合征 "可能是自发性冠状动脉夹层的病因吗？

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-30 DOI: 10.1016/j.cpcardiol.2024.102912

John E. Madias MD, FACC, FAHA

It is increasingly apparent that takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are associated. While the pathophysiology of TTS and SCAD are still debated, there should not be much doubt that SCAD could trigger TTS, as the latter often emerges in the context of a great variety of physical and emotional stresses, and thus SCAD should not be excluded as a TTS precipitant. In regards to TTS precipitating SCAD, it has been proposed that the anatomic junction of vigorously contracting base of the heart and the abutting akinetic/dyskinetic mid-ventricular/apical myocardium, could form a "hinge pivoting point”, exerting a disrupting mechanical influence on the coronary vessels crossing these 2 planes, precipitating tearing of the coronary vessel wall, formation of an intramural hematoma, with resultant SCAD in susceptible individuals. This review also provides a detailed list of recommendations for exploring the plausible association of TTS and SCAD, irrespective of their temporal sequence of occurrence.

越来越明显的是，塔克次博综合征（TTS）与自发性冠状动脉夹层（SCAD）存在关联。尽管对 TTS 和 SCAD 的病理生理学仍存在争议，但 SCAD 可能引发 TTS 的说法不容置疑，因为 TTS 通常是在各种身体和情绪压力下出现的，因此不应排除 SCAD 是 TTS 的诱因。关于 TTS 可诱发 SCAD，有人提出，剧烈收缩的心底与无运动/运动障碍的中心室/心尖心肌相邻的解剖交界处可形成一个 "铰链支点"，对穿过这两个平面的冠状动脉血管产生破坏性机械影响，诱发冠状动脉血管壁撕裂，形成壁内血肿，从而导致易感人群出现 SCAD。本综述还提供了一份详细的建议清单，用于探讨 TTS 与 SCAD 的合理关联，而不论其发生的时间顺序。

引用次数: 0

Comparison of left bundle branch area pacing between patients with pacing-induced cardiomyopathy and non-ischemic dilated cardiomyopathy 起搏诱发型心肌病和非缺血性扩张型心肌病患者左束支区起搏的比较。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-30 DOI: 10.1016/j.cpcardiol.2024.102886

Jorge Perea-Armijo MD , Guillermo Gutiérrez-Ballesteros MD , Francisco Mazuelos-Bellido MD, PhD , Rafael González-Manzanares MD, PhD , Jose María Huelva BsC , Jose López-Aguilera MD, PhD , Manuel Pan MD, PhD , José María Segura Saint-Gerons MD, PhD

Introduction

Left bundle branch area pacing (LBBAP) seems to be an alternative to coronary sinus pacing in patients with non-ischaemic dilated cardiomyopathy (NI-DCM) with left bundle branch block (LBBB) and in pacing-induced cardiomyopathy (PICM). The aim of the study was to compare the response of LBBAP in severe forms of both entities.

Material and methods

Prospective study of patients with severe forms of PICM and NI-DCM in NYHA II-IV who underwent LBBAP. Clinical, electrocardiographic, echocardiographic and electrical parameters were analysed and the medium-term prognostic impact was assessed.

Results

Eighty patients were included, 25 with PICM and 55 with NI-DCM. PICM patients were older (PICM 75 [IQR 71-83.5] y.o vs NI-DCM 72 [IQR 60-78.5] y.o;p=0.01) and with longer baseline QRS duration (PICM 180 [IQR 167-194] ms vs NI-DCM 168 [IQR 153-178] ms;p<0.01), with no differences in left ventricular ejection fraction (LVEF) or medical treatment. QRS reduction occurred in both groups, being greater in PICM (PICM CI 95% 54±20 ms, p<0.01; NI-DCM CI 95% 40±15 ms;p<0.01). A NT-ProBNP levels reduction and LVEF improvement were observed without differences between groups. At follow-up, there were no differences in admissions for HF (PICM 4.2% vs NI-DCM 11%;p=0.413), cardiac mortality (PICM 14.9% vs NI-DCM 2.9%;p=0.13) and all-cause mortality (PICM 21.7% vs NI-DCM 10.9%;p=0.08).

Conclusion

LBBAP is an effective technique with a NT-ProBNP levels reduction and LVEF improvement in both groups without differences. At follow-up, both groups had a low rate of HF readmissions and there was a non-significant trend toward higher total mortality in PICM.

导言：对于伴有左束支传导阻滞（LBBB）的非缺血性扩张型心肌病（NI-DCM）患者和起搏诱发型心肌病（PICM）患者而言，左束支区域起搏（LBBAP）似乎是冠状窦起搏的替代方案。研究的目的是比较 LBBAP 对这两种病症的严重类型的反应：对接受 LBBAP 的 NYHA II-IV 级重度 PICM 和 NI-DCM 患者进行前瞻性研究。分析了临床、心电图、超声心动图和心电参数，并评估了中期预后影响：共纳入 80 例患者，其中 25 例为 PICM 患者，55 例为 NI-DCM 患者。PICM 患者年龄较大（PICM 75 [IQR 71-83.5] y.o vs NI-DCM 72 [IQR 60-78.5] y.o; p=0.01），基线 QRS 持续时间较长（PICM 180 [IQR 167-194] ms vs NI-DCM 168 [IQR 153-178] ms; p结论：LBBAP 是一种有效的技术，两组患者的 NT-ProBNP 水平均有所下降，LVEF 均有所改善，且无差异。在随访中，两组患者的 HF 再入院率都很低，而 PICM 的总死亡率有上升趋势，但不明显。

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引用次数: 0

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IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-30 DOI: 10.1016/S0146-2806(24)00535-8

引用次数: 0

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