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Update on the epidemiology, diagnosis, and management of infective endocarditis: A review 感染性心内膜炎流行病学、诊断和管理的最新进展:综述
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.tcm.2024.01.001
Huanhuan Miao, Yuhui Zhang, Yuqing Zhang, Jian Zhang
Despite advancements in the diagnosis and treatment of infective endocarditis (IE), the burden of IE has remained relatively high over the past decade. With an ageing population and an increasing proportion of healthcare-associated IE, the epidemiology of IE has undergone significant changes. Staphylococcus aureus has evolved as the most common causative microorganism, even in most low- and middle-income countries. Several imaging modalities and novel microbiological tests have emerged to facilitate the diagnosis of IE. Outpatient parenteral antibiotic treatment and oral step-down antibiotic treatment have become new trends for the management of IE. Early surgical intervention, particularly within seven days, should be considered in cases of IE with appropriate surgical indications. We comprehensively review the updated epidemiology, microbiology, diagnosis, and management of IE.
尽管感染性心内膜炎(IE)的诊断和治疗取得了进步,但在过去十年中,IE 的负担仍然相对较重。随着人口老龄化和医疗相关 IE 比例的增加,IE 的流行病学发生了重大变化。金黄色葡萄球菌已成为最常见的致病微生物,即使在大多数中低收入国家也是如此。一些影像学模式和新型微生物检测方法的出现为 IE 的诊断提供了便利。门诊肠外抗生素治疗和口服降级抗生素治疗已成为治疗 IE 的新趋势。对于有适当手术指征的 IE 病例,应考虑早期手术干预,尤其是在 7 天内。我们全面回顾了 IE 的最新流行病学、微生物学、诊断和治疗方法。
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引用次数: 0
Editorial commentary: Infective endocarditis: Five key developments 感染性心内膜炎:五项重要进展
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.tcm.2024.01.007
Mark T. Mills , Peter Calvert , Gregory Y.H. Lip
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引用次数: 0
Editorial commentary: Multimodality imaging in aortic stenosis: Measure twice, cut once 主动脉瓣狭窄的多模态成像:两次测量,一次切割。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.tcm.2024.03.004
Nikolaos Kakouros, Timothy P. Fitzgibbons
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引用次数: 0
Editorial commentary: Understanding the cardiovascular benefits of glucagon-like peptide-1 (GLP-1) receptor agonists 了解胰高血糖素样肽-1 (GLP-1) 受体激动剂对心血管的益处。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.tcm.2024.03.007
Lisa M Raven
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引用次数: 0
Personalization of primary prevention: Exploring the role of coronary artery calcium and polygenic risk score in cardiovascular diseases. 初级预防的个性化:探索冠状动脉钙和多基因风险评分在心血管疾病中的作用。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-21 DOI: 10.1016/j.tcm.2024.10.003
Mario Mekhael, Ghassan Bidaoui, Austin Falloon, Amitabh C Pandey

Personalized healthcare is becoming increasingly popular given the vast heterogeneity in disease manifestation between individuals. Many commonly encountered diseases within cardiology are multifactorial in nature and disease progression and response is often variable due to environmental and genetic factors influencing disease states. This makes accurate early identification and primary prevention difficult in certain populations, especially young patients with limited Atherosclerotic Cardiovascular Disease (ASCVD) risk factors. Newer strategies, such as coronary artery calcium (CAC) scans and polygenic risk scores (PRS), are being implemented to aid in the detection of subclinical disease and heritable risk, respectively. Data surrounding CAC scans have shown promising results in their ability to detect subclinical atherosclerosis and predict the risk of future coronary events, especially at the extremes; however, predictive variability exists among different patient populations, limiting the test's specificity. Furthermore, relying only on CAC scores and ASCVD risk scores may fail to identify a large group of patients needing primary prevention who lack subclinical disease and traditional risk factors, but harbor genetic variabilities strongly associated with certain cardiovascular diseases. PRS can overcome these limitations. These scores can be measured in individuals as early as birth to identify genetic variants placing them at elevated risk for developing cardiovascular disease, irrespective of their current cardiovascular health status. By applying PRS alongside CAC scores, previously overlooked patient populations can be identified and begin primary prevention strategies early to achieve optimal outcomes. In this review, we expand on the current knowledge surrounding CAC scores and PRS and highlight the future possibilities of these technologies for preventive cardiology.

由于个体之间的疾病表现存在巨大的异质性,个性化医疗正变得越来越流行。由于环境和遗传因素对疾病状态的影响,心脏病学中常见的许多疾病都具有多因素性质,疾病的进展和反应也往往各不相同。这使得某些人群,尤其是动脉粥样硬化性心血管疾病(ASCVD)危险因素有限的年轻患者,很难进行准确的早期识别和一级预防。冠状动脉钙化(CAC)扫描和多基因风险评分(PRS)等新策略正在实施中,以分别帮助检测亚临床疾病和遗传风险。有关 CAC 扫描的数据显示,其在检测亚临床动脉粥样硬化和预测未来冠心病事件风险(尤其是在极端情况下)的能力方面取得了可喜的成果;但是,不同患者群体之间存在预测差异,从而限制了该测试的特异性。此外,仅依靠 CAC 评分和 ASCVD 风险评分可能无法识别一大批需要进行一级预防的患者,这些患者缺乏亚临床疾病和传统风险因素,但却存在与某些心血管疾病密切相关的基因变异。PRS 可以克服这些局限性。这些分数可以在个体出生时就进行测量,以确定哪些基因变异会使其罹患心血管疾病的风险升高,而不论其目前的心血管健康状况如何。通过将 PRS 与 CAC 评分一起应用,可以确定以前被忽视的患者人群,并尽早开始一级预防策略,以达到最佳效果。在这篇综述中,我们扩展了目前有关 CAC 评分和 PRS 的知识,并强调了这些技术在预防性心脏病学方面的未来可能性。
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引用次数: 0
Guidelines for treating heart failure. 心力衰竭治疗指南。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-21 DOI: 10.1016/j.tcm.2024.10.002
Michelle M Kittleson

Optimal guideline-directed medical therapy for heart failure with reduced ejection fraction comprises the angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan), an evidence-based beta-blocker (bisoprolol, carvedilol, or sustained-release metoprolol), a mineralocorticoid antagonist (spironolactone or eplerenone), and a sodium-glucose cotransporter-2 inhibitor (dapagliflozin or empagliflozin). Optimal guideline-directed medical therapy for heart failure with preserved ejection fraction comprises a sodium-glucose cotransporter-2 inhibitor with emerging evidence to support the use of a mineralocorticoid antagonist and glucagon-like peptide-1 receptor agonists. This review will summarize the evidence behind the guideline recommendations, the impact of newer trials on management of patients with HF, and strategies for implementation into clinical practice.

射血分数减低型心力衰竭的最佳指南指导疗法包括血管紧张素受体-奈普利酶抑制剂(sacubitril/valsartan)、循证β-受体阻滞剂(比索洛尔、卡维地洛或缓释美托洛尔)、促矿物质皮质激素拮抗剂(螺内酯或依普利酮)和钠-葡萄糖共转运体-2抑制剂(dapagliflozin或empagliflozin)。针对射血分数保留型心力衰竭的最佳指南指导疗法包括钠-葡萄糖共转运体-2抑制剂,以及支持使用矿物皮质激素拮抗剂和胰高血糖素样肽-1受体激动剂的新证据。本综述将总结指南建议背后的证据、较新试验对心房颤动患者管理的影响以及在临床实践中的实施策略。
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引用次数: 0
Selected highlights in the updated treatment of hypertension 高血压最新治疗精选亮点。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.tcm.2023.11.001

Hypertension remains the leading international risk factor for cardiovascular disease and premature death but, despite effective treatments, hypertension remains significantly underdiagnosed and undertreated. In the present review paper, we provide a selected update on recent developments of interest in the management of hypertension. We focus on summarizing four topics that we believe are worth highlighting to a clinical audience: (1) the evidence and strong motivation for new lower systolic BP treatment targets; (2) new studies reporting on the efficacy of renal denervation in the management of hypertension; (3) interesting new data to inform the great salt debate; and (4), perhaps most importantly, pioneering new work highlighting the huge potential of multi-disciplinary care in the management of hypertension.

高血压仍然是心血管疾病和过早死亡的主要国际危险因素,但是,尽管有有效的治疗,高血压仍然严重未得到诊断和治疗。在这篇综述文章中,我们提供了最近在高血压治疗方面的最新进展。我们重点总结了我们认为值得向临床观众强调的四个主题:(1)新的低收缩压治疗目标的证据和强烈动机;(2)肾去神经治疗高血压疗效的新研究报道;(3)有趣的新数据为盐的大争论提供了信息;(4),也许最重要的是,开创性的新工作突出了高血压管理中多学科护理的巨大潜力。
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引用次数: 0
Editorial commentary: Commentary for gender and race-related disparities in the management of ventricular arrhythmias 室性心律失常治疗中性别和种族差异的评论。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.tcm.2023.11.004
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引用次数: 0
Mechanical valve thrombosis: Current management and differences between guidelines 机械瓣膜血栓:目前的管理和指南之间的差异。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.tcm.2023.07.004

All foreign bodies inserted in the circulatory system are thrombogenic and require temporary or lifelong antithrombotic therapies to prevent thrombosis. The adequate level of anticoagulation during the first few months determines the long-term durability, particularly for mechanical prostheses, and also for biological valves. Suboptimal anticoagulation is the most frequent source of mechanical valve thrombosis (MVT).

The patient's clinical presentation decides how mechanical prosthetic valve obstruction is managed. If the mechanical valve thrombosis is obstructive and the patient is in a critical condition with hemodynamic instability, an immediate surgical intervention should be performed. The thrombolytic treatment is an option for left mechanical valve thrombosis in patients who have high surgical risk and no contraindications and also for right heart valve thrombosis.

In non-obstructive thrombosis on the mechanical valve, patients can be asymptomatic, requiring optimization of the anticoagulant treatment. Both obstructive and non-obstructive thrombus formed on the mechanical prosthesis can result in embolic events. If the thrombus persists following anticoagulant treatment, the recommended options include thrombolytic treatment or redo surgery. Pannus can also cause obstruction of the prosthesis for which surgical treatment is the only option.

While these clinical scenarios may initially appear to have straightforward solutions in terms of surgery, thrombolysis, or effective anticoagulation, real-world clinical experience often proves more complex. For instance, a patient with some usual comorbidities and non-obstructive mechanical valve thrombosis, experiencing symptoms solely by repeated systemic embolizations, might undergo all three therapeutic options due to the unpredictable nature of MVT. Therefore, treatment indications can intersect both on the time axis and depending on the patient's clinical status and the expertise of the center where he is hospitalized. Moreover, the European and American guidelines show subtle but important differences. The aim of this review was to compare these differences, comment on recent studies and evidence gaps, propose a more pragmatic algorithm combining all current recommendations, and highlight important research directions for this disease that has dominated the cardiovascular landscape for more than five decades, but for which there have been no significant recent changes in management.

所有插入循环系统的异物都有血栓形成的可能,需要暂时或终生使用抗血栓疗法来防止血栓形成。最初几个月的适当抗凝水平决定了瓣膜的长期耐久性,尤其是机械人工瓣膜和生物瓣膜。抗凝效果不佳是机械瓣膜血栓形成(MVT)最常见的原因。患者的临床表现决定了如何处理机械人工瓣膜阻塞。如果机械瓣膜血栓是阻塞性的,且患者病情危重、血流动力学不稳定,则应立即进行手术治疗。对于手术风险高且无禁忌症的左侧机械瓣血栓形成患者,以及右心瓣血栓形成患者,可选择溶栓治疗。对于机械瓣膜上的非梗阻性血栓,患者可能没有症状,需要优化抗凝治疗。机械假体上形成的阻塞性和非阻塞性血栓都可能导致栓塞事件。如果抗凝治疗后血栓仍然存在,建议选择溶栓治疗或重新手术。浆液性血栓也可能导致假体阻塞,而手术治疗是唯一的选择。虽然这些临床情况最初似乎可以直接通过手术、溶栓或有效抗凝来解决,但实际临床经验往往证明更为复杂。例如,如果患者有一些常见的合并症和非梗阻性机械瓣膜血栓形成,仅因反复全身性栓塞而出现症状,由于中风瓣膜血栓形成的不可预测性,患者可能会接受所有三种治疗方案。因此,治疗指征在时间轴上会有交叉,并取决于患者的临床状态和住院中心的专业水平。此外,欧洲和美国的指南也存在微妙但重要的差异。本综述旨在比较这些差异,对近期的研究和证据差距进行评论,提出一种更实用的算法,将目前所有的建议结合起来,并强调这种疾病的重要研究方向。
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引用次数: 0
Editorial commentary: The evolution of prosthetic heart valves and related preventative antithrombotic therapy: Different paths with divergent progression 人工心脏瓣膜的发展和相关的预防性抗血栓治疗:不同的途径和不同的进展。
IF 7.3 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.tcm.2023.09.003
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引用次数: 0
期刊
Trends in Cardiovascular Medicine
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