Hellenic Journal of Cardiology最新文献

英文中文

Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes in contemporaneous clinical practice 非st段抬高急性冠状动脉综合征的预处理抗血栓策略在同期临床实践。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2023.11.003

Hugo Costa , Miguel Espírito-Santo , Raquel Fernandes , João Bispo , João Guedes , Pedro Azevedo , Daniela Carvalho , Hugo Vinhas , Rui Baptista Gonçalves , Jorge Mimoso , Portuguese Registry of Acute Coronary Syndromes (ProACS)

Background

Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes (NSTE-ACS) during hospitalization is still a matter of contention within the cardiology community. Our aim was to analyze in-hospital and one-year follow-up outcomes of patients with NSTE-ACS pretreated with dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT).

Methods

A retrospective study was carried out with NSTE-ACS patients who planned to undergo an invasive strategy and were included in the Portuguese Registry of ACS between 2018 and 2021. A composite primary outcome (in-hospital re-infarction, stroke, heart failure, hemorrhage, death) was compared regarding antiplatelet strategy (DAPT versus SAPT). Secondary outcomes were defined as one-year all-cause mortality and one-year cardiovascular rehospitalization.

Results

A total of 1469 patients were included, with a mean age of 66 ± 12 years, and 73.9 % were male. The DAPT regime was used in 38.2 % of patients and SAPT in 61.8 % of patients. NSTE myocardial infarction was the most frequent presentation (88.5 %). Revascularization was performed within 24 h in 55.2% of patients. Time until revascularization >24 h occurred in 44.8% of patients, with 16.5% of these between [24 h–48 h], 10.6% in [48 h–72 h] and 17.6% > 72 h. The primary outcome was more frequently observed in the SAPT group (10.4 %, p = 0.033), mainly driven by more ischemic events. Time until revascularization >72 h and the SAPT regime were independent predictors of the primary outcome (OR 3.09, p = 0.005, and OR 2.03, p = 0.008, respectively).

Conclusion

NSTE-ACS patients pretreated with SAPT had worse in-hospital outcomes. This difference can probably be explained by time until revascularization delay.

背景:非st段抬高急性冠状动脉综合征(NSTE-ACS)住院期间的预处理抗血栓策略仍然是心脏病学界争论的问题。我们的目的是分析NSTE-ACS患者接受双重抗血小板治疗(DAPT)和单一抗血小板治疗(SAPT)的住院和一年随访结果。方法:回顾性研究计划接受有创策略的NSTE-ACS患者，并于2018-2021年期间纳入葡萄牙ACS登记处。综合主要结局(院内再梗死、卒中、心力衰竭、出血、死亡)比较抗血小板策略(DAPT与SAPT)。次要结局定义为1年全因死亡率和1年心血管再住院。结果:共纳入1469例患者，平均年龄66±12岁，男性占73.9%。38.2%的患者采用DAPT方案，61.8%的患者采用SAPT方案。NSTE型心肌梗死是最常见的表现(88.5%)。44.8%的患者在24h后出现血运重建术(其中63%在48h后)。依诺肝素是使用频率最高的抗凝剂(45.1%)。SAPT组的主要结局更常见(10.4%，p=0.033)，主要是由更多的缺血事件驱动。血运重建时间bbb48h和SAPT方案是主要结局的独立预测因子(OR分别为1.66,p=0.036和2.03,p=0.008)。结论:经SAPT预处理的NSTE-ACS患者住院预后较差。这种差异可能可以用血运重建的时间延迟来解释。DAPT预处理策略及肝素交叉治疗在临床应用中仍较为频繁。

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引用次数: 0

Association of objectively measured walking speed with incident cardiovascular diseases in middle-aged and older Chinese adults 客观测量步行速度与中国中老年人心血管疾病发病率的关系

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2023.10.006

Shuang Peng , Lei Yu , Yuhua Gao , Shan Dong , Yuhui Bai , Guojun Li , Changxue Liang , Zhuoyao Tian , Changsheng Lv , Fu Zhou , Yuan Wei , Ge Wang , Liangming Li , Guang Hao

Objective

To evaluate the association between objectively measured walking speed and cardiovascular disease (CVD) risk in middle-aged and elderly Chinese adults.

Methods

A total of 3969 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. Multilevel logistic and linear regression models (community-household-individual) were used to estimate the association between walking speed and the risk of CVD.

Results

A total of 1037 participants had a CVD event during the follow-up period, including 776 (19.6%) cases of cardiac disease and 353 (8.9%) cases of stroke. Participants who walked faster had a lower risk of CVD (tertile 2: OR = 0.80, 95% CI: 0.67-0.97, P = 0.022; tertile 3: OR = 0.73, 95% CI: 0.60–0.89, P = 0.002). Further analysis showed that participants who walked faster also had a lower risk of cardiac disease and stroke (cardiac disease: tertile 2: OR = 0.91, 95% CI: 0.74–1.12, P = 0.368; tertile 3: OR = 0.85, 95% CI: 0.68–1.07, P = 0.161; stroke: tertile 2: OR = 0.33, 95% CI: 0.14–0.78, P = 0.012; tertile 3: OR = 0.30, 95% CI: 0.11–0.82, P = 0.019). The results were consistent in pre-specified subgroups by sex, age, and body mass index.

Conclusion

We found that faster, objectively measured walking speed was significantly associated with a lower risk of CVD, especially stroke, in middle-aged and elderly Chinese people.

目的:评价中国中老年人客观测量步行速度与心血管疾病(CVD)风险之间的关系。本研究共纳入来自中国健康与退休纵向研究(CHARLS)的3969名参与者。采用多水平logistic和线性回归模型(社区-家庭-个人)来估计步行速度与心血管疾病风险之间的关系。在随访期间，共有1037名参与者发生心血管疾病事件，其中包括776例(19.6%)心脏病病例和353例(8.9%)中风病例。走得快的参与者患心血管疾病的风险较低(Tertile 2: OR=0.80, 95%CI:0.67-0.97, P=0.022;试验3:OR=0.73, 95%CI: 0.60-0.89, P=0.002)。进一步分析表明，走得更快的参与者患心脏病和中风的风险也更低(心脏病:Tertile 2: OR=0.91, 95%CI:0.74-1.12, P=0.368;试验3:OR=0.85, 95%CI: 0.68-1.07, P=0.161;卒中:tile 2: OR=0.33, 95%CI:0.14-0.78, P=0.012;试验3:OR=0.30, 95%CI: 0.11-0.82, P=0.019)。在预先指定的亚组中，性别、年龄和体重指数的结果是一致的。我们发现，在中国中老年人群中，更快的客观测量步行速度与更低的心血管疾病(尤其是中风)风险显著相关。

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引用次数: 0

A cardiac maze spotlight in a late-presenting patient with ALCAPA 一名晚期 ALCAPA 患者的心脏迷宫聚光灯

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.04.002

Dimitrios Karelas , Konstantinos Manousopoulos , Aristeidis Seretis , Panagiotis Varelas , Konstantinos Michailidis , Ioannis Tsiafoutis

引用次数: 0

Transoesophageal echocardiography beyond the echo-laboratory. An expert consensus paper of the working group of echocardiography of the hellenic society of cardiology 超越超声实验室的经食道超声心动图。希腊心脏病学会超声心动图工作组专家共识文件。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.06.004

Constantinos H. Papadopoulos , Nikolaos P.E. Kadoglou , Anastasios Theodosis-Georgilas , Ilias Karabinos , Savvas Loizos , Konstantinos G. Papadopoulos , Michail Chrysocheris , Vlasis Ninios , Alexandra Frogoudaki , Maria Drakopoulou , Maria Angelaki , Loukianos Rallidis , Nearchos Kassinos , Vasilios Sahpekidis , George Makavos , Kiriakos Yiangou , Stefanos Karagiannis , Nikolaos Zois , Alexandros Patrianakos , Ignatios Ikonomidis , Alexandros Stefanidis

Transoesophageal echocardiography (TOE) is a well-established and valid imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for several specific diagnoses and recently a useful guide of an increasing number of catheter-based and surgical interventions. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Society of Cardiology to state the essential steps of the TOE exam performed beyond the echo lab: a) in the operating rooms intraoperatively during either transcatheter interventions, or cardiothoracic surgery and b) in the intensive care unit for critically ill patients’ monitoring. This paper includes information and tips and tricks about the pre-procedural evaluation, the procedural echocardiographic guidance, and post-procedural evaluation of the result and potential complications.

经食道超声心动图（TOE）是一种成熟有效的成像方式，在一些特殊诊断方面比经胸超声心动图（TTE）提供更准确、更高质量的信息，最近还成为越来越多导管介入和外科介入的有用指南。本文代表了希腊心脏病学会超声心动图工作组（WG）的一项努力，旨在说明在回声室以外进行 TOE 检查的基本步骤：a）在手术室进行经导管介入或心胸手术的术中检查；b）在重症监护室对重症患者进行监测。本文包括有关术前评估、术中超声心动图指导以及术后评估结果和潜在并发症的信息和技巧。

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引用次数: 0

Energy metabolism: from physiological changes to targets in sepsis-induced cardiomyopathy 能量代谢：从生理变化到败血症诱发心肌病的目标。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.05.010

Dan Ni , Xiaofang Lin , Chuanhuan Deng , Ludong Yuan , Jing Li , Yuxuan Liu , Pengfei Liang , Bimei Jiang

Sepsis is a systemic inflammatory response syndrome caused by a variety of dysregulated responses to host infection with life-threatening multi-organ dysfunction. Among the injuries or dysfunctions involved in the course of sepsis, cardiac injury and dysfunction often occur and are associated with the pathogenesis of hemodynamic disturbances, also defined as sepsis-induced cardiomyopathy (SIC). The process of myocardial metabolism is tightly regulated and adapts to various cardiac output demands. The heart is a metabolically flexible organ capable of utilizing all classes of energy substrates, including carbohydrates, lipids, amino acids, and ketone bodies, to produce ATP. The demand of cardiac cells for energy metabolism changes substantially in septic cardiomyopathy, with distinct etiological causes and different times. This review describes changes in cardiomyocyte energy metabolism under normal physiological conditions and some features of myocardial energy metabolism in septic cardiomyopathy and briefly outlines the role of the mitochondria as a center of energy metabolism in the septic myocardium, revealing that changes in energy metabolism can serve as a potential future therapy for infectious cardiomyopathy.

败血症是一种全身性炎症反应综合征，由宿主感染后的各种失调反应引起，并伴有危及生命的多器官功能障碍。在败血症过程中涉及的损伤或功能障碍中，心脏损伤和功能障碍经常发生，并与血流动力学紊乱的发病机制有关，也被定义为败血症诱发的心肌病（SIC）。心肌代谢过程受到严格调控，并适应各种心输出量需求。心脏是一个代谢灵活的器官，能够利用各种能量底物，包括碳水化合物、脂类、氨基酸和酮体来产生 ATP。脓毒症心肌病的病因不同，病发时间不同，心脏细胞对能量代谢的需求也会发生很大变化。这篇综述描述了正常生理条件下心肌细胞能量代谢的变化以及脓毒症心肌病心肌能量代谢的一些特点，并简要概述了线粒体作为脓毒症心肌能量代谢中心的作用，揭示了能量代谢的变化可作为未来治疗感染性心肌病的潜在方法。

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引用次数: 0

Fluoroscopy integration module guides successful ablation in atrial fibrillation with coronary-pulmonary artery fistula 透视整合模块引导冠状动脉-肺动脉瘘房颤患者成功消融。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.03.009

Reşit Yiğit Yılancıoğlu , Oğuzhan Ekrem Turan , Mahmut Mustafa Barış , Emin Evren Özcan

引用次数: 0

Shifting paradigms in hypertrophic cardiomyopathy: the role of exercise in disease management 肥厚型心肌病范式的转变：运动在疾病管理中的作用。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.07.001

Lara-Marie Yamagata , Kentaro Yamagata , Alexander Borg , Mark Abela

Hypertrophic cardiomyopathy (HCM) is traditionally associated with exercise restriction due to potential risks, yet recent evidence and guidelines suggest a more permissive stance for low-risk individuals. The aim of this comprehensive review was to examine existing research on the impact of exercise on cardiovascular outcomes, safety, and quality of life in this population and to consider implications for clinical practice. Recent studies suggest that regular exercise and physical activity in low-risk individuals with HCM are associated with positive outcomes in functional capacity, haemodynamic response, and quality of life, with consistent safety. Various studies highlight the safety of moderate-intensity exercise, showing improvements in exercise capacity without adverse cardiac remodelling or significant arrhythmias. Psychological benefits, including reductions in anxiety and depression, have been also reported following structured exercise programmes. These findings support the potential benefits of integrating individualised exercise regimens in the management of low-risk individuals with HCM, with the aim of improving their overall well-being and cardiovascular health. Adoption of the FITT (frequency, intensity, time, and type of exercise) principle, consideration of individual risk profiles, and shared decision-making are recommended. Future research is warranted to clarify the definition of ‘low risk’ for exercise participation and investigate the influence of physical activity on disease progression in HCM. Innovation in therapeutic strategies and lifestyle interventions, alongside improved patient and provider education, will help advance the care and safety of individuals with HCM engaging in exercise.

传统上，肥厚型心肌病（HCM）因其潜在风险而被限制运动，但最近的证据和指南建议对低风险人群采取更宽松的态度。本综述旨在研究运动对该人群心血管预后、安全性和生活质量的影响，并考虑对临床实践的影响。最近的研究表明，HCM 低危人群定期运动和体育锻炼可在功能能力、血流动力学反应和生活质量方面产生积极的结果，且具有持续的安全性。多项研究强调了中等强度运动的安全性，表明运动能力得到提高，但不会出现不良的心脏重塑或明显的心律失常。有报告称，有组织的运动计划还能带来心理上的益处，包括减少焦虑和抑郁。这些研究结果支持将个性化运动方案纳入 HCM 低风险患者的管理中，从而改善整体健康和心血管健康。建议采用 FITT 原则、考虑个体风险情况并共同决策。未来的研究需要明确参与运动的 "低风险 "定义，并调查体育锻炼对 HCM 疾病进展的影响。治疗策略和生活方式干预措施的创新，以及患者和医疗服务提供者教育的改进，将有助于促进 HCM 患者参与运动的护理和安全性。

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引用次数: 0

The emerging importance of assessing recovery period gas exchange variables during cardiopulmonary exercise testing 心肺运动测试期间评估恢复期气体交换变量的新重要性

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.04.001

Stavros Dimopoulos , Serafim Nanas

引用次数: 0

Impact of reduced apolipoprotein A-I levels on pulmonary arterial hypertension 载脂蛋白A-I水平降低对肺动脉高压的影响。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2023.10.004

Yuxia Huang , Ji Zhang , Qinhua Zhao , Xiaoyi Hu , Hui Zhao , Shang Wang , Lan Wang , Rong Jiang , Wenhui Wu , Jinming Liu , Ping Yuan , Sugang Gong

Objective

The significance of apolipoprotein A-I (ApoA-I) is the anti-inflammatory functional component of high-density lipoprotein, which needs to be further studied in relation to pulmonary arterial hypertension (PAH). This study aimed to identify the predictive value of ApoA-1 on the risk and prognosis of PAH, as well as the underlying anti-inflammatory mechanism.

Methods

Proteomic analysis was conducted on lung tissue from 6 PAH patients and 4 lung donors. Prediction of risk and mortality risk factors associated with PAH in 343 patients used logistic analysis and Cox regression analysis, respectively. The protective function of ApoA-I was assessed in human pulmonary arterial endothelial cells (HPAEC), while its anti-inflammatory function was evaluated in THP-1 macrophages.

Results

In the lung tissues of patients with PAH, 168 differentially expressed proteins were associated with lipid metabolism according to GO and KEGG enrichment analysis. A protein-protein interaction network identified ApoA-I as a key protein associated with PAH. Lower ApoA-I levels were independent risk factors for PAH and displayed a stronger predictive value for PAH mortality. Plasma interleukin 6 (IL-6) levels were positively correlated with risk stratification and were higher in PAH patients with lower ApoA-I levels. ApoA-I was downregulated in the lung tissues of monocrotaline (MCT) -induced rats. ApoA-I could reduce the IL-6-induced pro-proliferative and pro-migratory abilities of HPAEC and inhibit the secretion of IL-6 from macrophages, which is compromised under hypoxic conditions.

Conclusion

Our study identified the significance of ApoA-I as a biomarker for predicting the survival outcome of PAH patients, which might relate to its altered anti-inflammatory properties.

背景：载脂蛋白A-I（ApoA-I）是高密度脂蛋白的抗炎功能成分，与肺动脉高压（PAH）的关系有待进一步研究。本研究旨在确定ApoA-1对PAH风险和预后的预测价值，以及潜在的抗炎机制。方法：对6例PAH患者和4例供肺者的肺组织进行蛋白质组学分析。分别使用逻辑分析和Cox回归分析预测343名患者PAH的风险和死亡率风险因素。在人肺动脉内皮细胞（HPAEC）中评估ApoA-I的保护功能，而在THP-1巨噬细胞中评估其抗炎功能。结果：根据GO和KEGG富集分析，在PAH患者的肺组织中，168种差异表达蛋白与脂质代谢有关。蛋白质-蛋白质相互作用网络确定ApoA-I是与PAH相关的关键蛋白。ApoA-I水平较低是PAH的独立危险因素，对PAH死亡率具有较强的预测价值。血浆白细胞介素6（IL-6）水平与风险分层呈正相关，并且在ApoA-I水平较低的PAH患者中更高。ApoA-I在MCT诱导的大鼠肺组织中下调。ApoA-I可以降低IL-6诱导的HPAEC的促增殖和促迁移能力，并抑制巨噬细胞分泌IL-6，而巨噬细胞在缺氧条件下会受损。结论：我们的研究确定了ApoA-I作为预测PAH患者生存结果的生物标志物的意义，这可能与其抗炎特性的改变有关。

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引用次数: 0

Sex-based differences in complex percutaneous coronary intervention—insights from the COMPLEX registry 复杂经皮冠状动脉介入治疗中的性别差异--来自 COMPLEX 登记处的启示

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2024-11-01 DOI: 10.1016/j.hjc.2024.04.005

Sylwia Iwańczyk , Samir Ahmad Dit Al Hakim , Marta Skrzypińska , Zofia Stanisz , Patrycja Woźniak , Weronika Gościniak , Aleksander Araszkiewicz , Fatima Al Salman , Ali Hok , Marwan Mhanna , Wiktoria Chylinska , Włodzimierz Skorupski , Michał Lesiak , Marek Grygier , Maciej Lesiak

引用次数: 0

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