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From remnant cholesterol to lipoprotein(a) - emerging risk factors for cardiovascular diseases beyond low density lipoprotein: Erratum. 从残余胆固醇到脂蛋白(a)--低密度脂蛋白之外新出现的心血管疾病风险因素:勘误。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.1097/01.hco.0001027436.73291.01
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引用次数: 0
REVIVED BCIS-2: update and key learnings. 经修订的 BCIS-2:最新情况和主要经验教训。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.1097/HCO.0000000000001158
Tesfamariam Aklilu Betemariam, Holly Morgan, Divaka Perera

Purpose of review: This review summarises the shifting paradigms in the treatment of ischemic left ventricular dysfunction, spotlighting the revascularization for ischemic ventricular dysfunction-British cardiovascular intervention society-2 (REVIVED-BCIS2) trial results and its impact on key therapeutic goals: survival, left ventricular function, arrhythmia prevention, quality of life and viability testing.

Recent findings: The REVIVED-BCIS2 trial, and its subsequent sub studies highlighted that (PCI) does not provide additional benefits to optimal medical therapy in terms of improving survival, left ventricular (LV) function, arrhythmic risk or quality of life. Additionally, viability testing did not differentiate patients who could benefit from PCI, although scar burden was found to be a significant predictor of outcome in these patients.

Summary: The outcomes of REVIVED have challenged multiple existing beliefs in the field of ischaemic left ventricular dysfunction management, emphasising the importance of investigating evidence free areas in our practice. Future work, including the STICH3 international consortium of trials, aims to answer some of the remaining unanswered questions.

综述目的:本综述总结了缺血性左心室功能障碍治疗范式的转变,重点介绍了缺血性心室功能障碍血管重建-英国心血管介入学会-2(REVIVED-BCIS2)试验结果及其对主要治疗目标的影响:生存率、左心室功能、心律失常预防、生活质量和存活率测试:REVIVED-BCIS2试验及其后续子研究强调,在改善生存率、左心室(LV)功能、心律失常风险或生活质量方面,PCI并不能提供优于最佳药物治疗的额外益处。总结:REVIVED 的研究结果对缺血性左心室功能障碍治疗领域现有的多种观点提出了挑战,强调了在实践中研究无证据领域的重要性。未来的工作,包括 STICH3 国际试验联盟,旨在回答一些余下的未解之谜。
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引用次数: 0
Device therapy for heart failure management. 治疗心力衰竭的设备疗法。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.1097/HCO.0000000000001165
Fouad Chouairi, Allison Levin, Marat Fudim

Purpose of review: Given the prevalence of heart failure (HF) and the interdisciplinary nature of device therapy, it is paramount that cardiologists not only understand the current landscape of goal-directed medical therapy, but also the ongoing efforts in device development. Thus, we aim to provide a practical overview of the broad approaches being utilized in the burgeoning field of device-based therapies for heart failure.

Recent findings: Currently, a diverse array of devices for HF treatment is being developed and tested, each targeting distinct aspects of HF pathophysiology. These innovative solutions encompass a wide spectrum, ranging from devices enabling remote monitoring of HF associated physiological parameters, to those focused on creating interatrial shunts and effecting structural modifications of the left ventricle, as well as to those designed to modulate the autonomic nervous system and diaphragm. Notably, a subset of these emerging devices is directed towards treating patients with heart failure with preserved ejection fraction, a population that has traditionally not been served by device-based therapies.

Summary: In recent decades, there has been a remarkable surge in the development and utilization of device-based treatments for managing HF. It is important for physicians to be familiar with these devices, their mechanisms of action, and their applications.

综述目的:鉴于心力衰竭(HF)的发病率和器械治疗的跨学科性质,心脏病专家不仅要了解目标导向医疗疗法的现状,还要了解器械开发的持续努力,这一点至关重要。因此,我们旨在提供一个实用的概览,介绍在基于设备的心衰治疗这一新兴领域中正在使用的广泛方法:目前,用于治疗心力衰竭的各种设备正在开发和测试中,每种设备都针对心力衰竭病理生理学的不同方面。这些创新解决方案涵盖的范围很广,从能够远程监测高频相关生理参数的设备,到专注于建立心房间分流和改变左心室结构的设备,以及旨在调节自律神经系统和膈肌的设备,不一而足。值得注意的是,这些新兴设备中有一部分是用于治疗射血分数保留型心力衰竭患者的,而这部分患者历来不在设备治疗之列。医生必须熟悉这些设备、其作用机制及其应用。
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引用次数: 0
Nuclear imaging techniques for cardiac amyloidosis. 心脏淀粉样变性的核成像技术。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-07-05 DOI: 10.1097/HCO.0000000000001167
Jean Michel Saad, Mouaz H Al-Mallah

Purpose of review: Cardiac amyloidosis is a condition marked by the misfolding of precursor proteins into insoluble amyloid fibrils, leading to restrictive cardiomyopathy and heart failure symptoms. This review discusses advancements in nuclear imaging techniques that enhance the diagnosis and guide the management of cardiac amyloidosis, addressing the critical need for early and accurate detection in clinical practice.

Recent findings: Recent studies and guidelines emphasizes the pivotal role of nuclear imaging techniques in diagnosing cardiac amyloidosis. Cardiac scintigraphy, using bone-avid tracers like 99mTc-PYP, 99mTc-DPD, and 99mTc-HMDP, is instrumental in distinguishing between transthyretin amyloidosis and light chain amyloidosis. PET, with tracers such as 11C-Pittsburgh Compound B (11C-PiB) and 18F-Florbetapir, offers significant potential in measuring amyloid burden and monitoring disease progression, providing detailed insights into the myocardial involvement.

Summary: The advancements in nuclear imaging techniques significantly impact the management of cardiac amyloidosis. These methods allow for a more accurate diagnosis, detailed assessment of disease extent, and better differentiation between amyloidosis types, which are crucial for tailoring treatment approaches. The integration of these techniques into clinical practice is essential for improving patient outcomes and advancing research in cardiac amyloidosis.

综述的目的:心脏淀粉样变性是一种前体蛋白错误折叠成不溶性淀粉样纤维的疾病,会导致局限性心肌病和心力衰竭症状。这篇综述讨论了核成像技术的进展,这些技术可提高心脏淀粉样变性的诊断和指导管理,满足临床实践中早期准确检测的迫切需要:最近的研究和指南强调了核成像技术在诊断心脏淀粉样变性中的关键作用。使用99m锝-PYP、99m锝-DPD和99m锝-HMDP等骨惰性示踪剂的心脏闪烁成像有助于区分转甲状腺素淀粉样变性和轻链淀粉样变性。使用11C-匹兹堡化合物B(11C-PiB)和18F-氟贝他匹等示踪剂的正电子发射计算机断层显像(PET)在测量淀粉样蛋白负荷和监测疾病进展方面具有巨大潜力,可提供有关心肌受累情况的详细资料。这些方法可提供更准确的诊断、对疾病程度的详细评估以及对淀粉样变性类型的更好区分,这对定制治疗方法至关重要。将这些技术融入临床实践对于改善患者预后和推进心脏淀粉样变性研究至关重要。
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引用次数: 0
Subclinical valve leaflet thrombosis following bioprosthetic aortic valve replacement. 生物人工主动脉瓣置换术后的亚临床瓣叶血栓形成。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-06-19 DOI: 10.1097/HCO.0000000000001161
Carlos Giuliani, Antonela Zanuttini, Erwan Salaun, Nancy Côté, Marie Annick Clavel, Philippe Pibarot

Purpose of review: Subclinical leaflet thrombosis (SLT) is often an incidental finding characterized by a thin layer of thrombus involving one, two or three leaflets, with typical appearance on multi-detector computed tomography (MDCT) of hypo-attenuating defect at the aortic side of the leaflet, also called hypo-attenuating leaflet thickening (HALT). SLT may occur following both transcatheter aortic replacement (TAVR) or biological surgical aortic valve replacement (SAVR). The aim of this review is to present an overview of the current state of knowledge on the incidence, diagnosis, clinical impact, and management of SLT following TAVR or SAVR.

Recent findings: SLT occurs in 10-20% of patients following TAVR and is somewhat more frequent than following SAVR (5-15%). SLT may regress spontaneously without treatment in about 50% of the cases but may also progress to clinically significant valve thrombosis in some cases. Oral anticoagulation with vitamin K antagonist is reasonable if SLT is detected by echocardiography and/or MDCT during follow-up and is generally efficient to reverse SLT. SLT is associated with mild increase in the risk of stroke but has no impact on survival. SLT has been linked with accelerated structural valve deterioration and may thus impact valve durability and long-term outcomes.

Summary: SLT is often an incidental finding on echocardiography or MDCT that occurs in 10-20% of patients following TAVR or 5-15% following biological SAVR and is associated with a mild increase in the risk of thrombo-embolic event with no significant impact on mortality but may be associated with reduced valve durability.

审查目的:亚临床瓣叶血栓形成(SLT)通常是一种偶然发现,其特征是一层薄薄的血栓累及一个、两个或三个瓣叶,在多载体计算机断层扫描(MDCT)上的典型表现是瓣叶主动脉侧的低增强缺损,也称为低增强瓣叶增厚(HALT)。经导管主动脉瓣置换术(TAVR)或生物手术主动脉瓣置换术(SAVR)后都可能出现 SLT。本综述旨在概述经导管主动脉瓣置换术(TAVR)或生物手术主动脉瓣置换术(SAVR)后SLT的发生率、诊断、临床影响和处理的知识现状:TAVR术后10-20%的患者会出现SLT,其发生率略高于SAVR术后(5-15%)。在大约 50% 的病例中,SLT 可在不治疗的情况下自行消退,但在某些病例中,SLT 也可能发展为具有临床意义的瓣膜血栓。如果在随访期间通过超声心动图和/或MDCT发现SLT,使用维生素K拮抗剂口服抗凝治疗是合理的,而且通常能有效逆转SLT。SLT 与中风风险轻度增加有关,但对存活率没有影响。SLT与瓣膜结构加速退化有关,因此可能影响瓣膜耐久性和长期预后。小结:SLT通常是超声心动图或MDCT的偶然发现,TAVR术后10-20%的患者或生物SAVR术后5-15%的患者会出现SLT,与血栓栓塞事件风险轻度增加有关,对死亡率无显著影响,但可能与瓣膜耐久性降低有关。
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引用次数: 0
Vascular regenerative cell content in South Asians: the key learnings. 南亚人的血管再生细胞内容:重要启示。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-06-07 DOI: 10.1097/HCO.0000000000001159
Aishwarya Krishnaraj, Fallon Dennis, Hwee Teoh, Subodh Verma, David A Hess

Purpose of review: We aim to provide a comprehensive examination of the literature linking elevated rates of cardiovascular disease (CVD) in individuals of South Asian ethnicity with the severity of circulating vascular regenerative cell exhaustion.

Recent findings: Recent findings have demonstrated reduced bioavailability of pro-vascular progenitor cell subsets in individuals with T2D and obesity. Depletion of vascular regenerative cells in the bone marrow - coupled with decreased mobilization into circulation - can negatively impact the capacity for vascular repair and exacerbate CVD risk. Several recent studies have established that although South Asian individuals possess similar inflammatory cell burden compared with other ethnicities, they exhibit marked decreases in vessel regenerative hematopoietic progenitor cells and monocyte subsets. Validation of these findings and investigation the functional capacity of vascular regenerative cell subsets to mediate vessel repair is highly warranted.

Summary: Vascular regenerative cells play a key role coordinating angiogenic and arteriogenic vessel remodelling. Recent studies have demonstrated that South Asian individuals with T2D show severe depletion in circulating vascular regenerative cell subsets. Because the reversal of vascular regenerative cell exhaustion by current glucose-lowering pharmaceutical agents has recently been documented, early intervention to bolster vascular regenerative cell content may prevent CVD co-morbidities in South Asian individuals with cardiometabolic disease.

综述的目的:我们旨在对南亚种族心血管疾病(CVD)发病率升高与循环血管再生细胞衰竭严重程度有关的文献进行全面研究:最近的研究结果表明,在患有糖尿病和肥胖症的人群中,促血管祖细胞亚群的生物利用率降低。骨髓中血管再生细胞的耗竭--加上进入血液循环的减少--会对血管修复能力产生负面影响,并加剧心血管疾病风险。最近的几项研究证实,虽然南亚人的炎症细胞负担与其他种族相似,但他们的血管再生造血祖细胞和单核细胞亚群明显减少。总结:血管再生细胞在协调血管生成和动脉生成的血管重塑过程中发挥着关键作用。最近的研究表明,南亚 T2D 患者的循环血管再生细胞亚群严重缺乏。由于目前的降糖药物可以逆转血管再生细胞的衰竭,因此,对患有心脏代谢疾病的南亚人进行早期干预以提高血管再生细胞的含量,可以预防心血管疾病的并发症。
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引用次数: 0
Left main revascularization guidelines: navigating the data. 左主干血管重建指南:数据导航。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-06-20 DOI: 10.1097/HCO.0000000000001160
Aurelien Vallée, Kenza Rahmouni, Menaka Ponnambalam, Hugo Issa, Marc Ruel

Purpose of review: This article explores recent developments in left main revascularization, with a focus on appraising the latest American and European guidelines.

Recent findings: Recent pooled data analysis from four major randomized controlled trials (RCTs) for left main coronary artery stenosis indicate an advantage for CABG over PCI in regard to freedom from major adverse cardiovascular events, despite no significant difference in mortality observed at 5 years. Additional data support the use of CABG for patients with left ventricular dysfunction, complex left main lesions, diffuse coronary disease, and diabetes.

Summary: The data underpinning the guidelines on each revascularization modality (PCI versus CABG) must consider factors such as lesion complexity, diabetes, and left ventricular dysfunction. Additionally, the findings of the four major RCTs upon which the guidelines are based must be ascertained in light of the latest advancements in these revascularization techniques.

综述目的:本文探讨了左主干血运重建的最新进展,重点评估了最新的美国和欧洲指南:最近的研究结果:针对左主干冠状动脉狭窄的四项主要随机对照试验(RCTs)的汇总数据分析显示,在避免主要不良心血管事件方面,CABG 比 PCI 更有优势,尽管在 5 年的死亡率方面没有观察到显著差异。其他数据支持对左心室功能障碍、左主干病变复杂、弥漫性冠状动脉疾病和糖尿病患者使用 CABG。摘要:每种血管重建方式(PCI 与 CABG)指南的基础数据必须考虑病变复杂性、糖尿病和左心室功能障碍等因素。此外,还必须根据这些血管重建技术的最新进展来确定指南所依据的四项主要 RCT 研究结果。
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引用次数: 0
Improving diversity in cardiac surgery clinical trials with ROMA:Women as an exemplar. 以 ROMA:Women 为典范,提高心脏外科临床试验的多样性。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-06-25 DOI: 10.1097/HCO.0000000000001162
Ruth Masterson Creber, Sarah Eslami, Mario Gaudino

Purpose of review: To describe methods to improve representation of women in cardiac surgery clinical trials.

Recent findings: Cardiovascular disease risk among women is high. Historically, women have been excluded from cardiac surgery trials, in part due to restrictive inclusion criteria. Surgical outcomes, specifically after coronary artery bypass grafting, are consistently worse among female patients, and these outcomes have not improved over the last decade. Addressing treatment effects and clinical benefit among women requires accurate representation in cardiovascular surgery trials. ROMA:Women, is the first cardiac surgery trial to focus solely on women, with the goal of addressing underrepresentation. Through utilizing specific strategies, ROMA:Women is a promising first step in advancing health equity.

Summary: Strategies to ensure effective recruitment and representation among women in cardiac surgery clinical trials, such as tailored eligibility criteria and comprehensive strategies to improve communication and increase trust, are two of many potential approaches to address the structural barriers to female representation in cardiac surgery clinical trials. To date, ROMA:Women is an example of a trial that has shown extraordinary preliminary success enrolling women. Designing trials exclusively for women is one strategy to improve the diversity of clinical trial participation.

综述的目的:描述提高女性在心脏外科临床试验中代表性的方法:最新发现:女性患心血管疾病的风险很高。从历史上看,女性一直被排除在心脏外科试验之外,部分原因是纳入标准的限制。特别是冠状动脉旁路移植术后,女性患者的手术效果一直较差,而且在过去十年中,这些效果并没有得到改善。要解决女性患者的治疗效果和临床获益问题,就需要在心血管外科试验中准确地体现女性的代表性。ROMA:Women是首个专门针对女性的心脏手术试验,目的是解决代表性不足的问题。摘要:确保心脏外科临床试验有效招募女性和女性代表的策略,如量身定制的资格标准和改善沟通、增加信任的综合策略,是解决心脏外科临床试验中女性代表结构性障碍的众多潜在方法中的两种。迄今为止,ROMA:Women 就是一个初步成功招募女性参与试验的例子。专门为女性设计试验是提高临床试验参与多样性的一种策略。
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引用次数: 0
Cardiac magnetic resonance findings in cardiac amyloidosis. 心脏淀粉样变性的心脏磁共振发现。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI: 10.1097/HCO.0000000000001166
Aneesh Dhore-Patil, Vivek Modi, El-Moatasem Gabr, Akila Bersali, Amr Darwish, Dipan Shah

Purpose of review: The purpose of this review is to highlight the increasing importance of cardiac magnetic resonance (CMR) imaging in diagnosing and managing cardiac amyloidosis, especially given the recent advancements in treatment options.

Recent findings: This review emphasizes the crucial role of late gadolinium enhancement (LGE) with phase-sensitive inversion recovery (PSIR) techniques in both diagnosing and predicting patient outcomes in cardiac amyloidosis. The review also explores promising new techniques for diagnosing early-stage disease, such as native T1 mapping and ECV quantification. Additionally, it delves into experimental techniques like diffusion tensor imaging, MR elastography, and spectroscopy.

Summary: This review underscores CMR as a powerful tool for diagnosing cardiac amyloidosis, assessing risk factors, and monitoring treatment response. While LGE imaging remains the current best practice for diagnosis, emerging techniques such as T1 mapping and ECV quantification offer promise for improved detection, particularly in early stages of the disease. This has significant implications for patient management as newer therapeutic options become available for cardiac amyloidosis.

综述的目的:本综述旨在强调心脏磁共振成像(CMR)在诊断和管理心脏淀粉样变性方面日益重要的作用,尤其是考虑到最近治疗方案的进步:本综述强调了后期钆增强(LGE)与相位敏感反转恢复(PSIR)技术在诊断和预测心脏淀粉样变性患者预后方面的关键作用。该综述还探讨了用于诊断早期疾病的前景广阔的新技术,如原生 T1 映射和 ECV 定量。摘要:本综述强调了 CMR 是诊断心脏淀粉样变性、评估危险因素和监测治疗反应的有力工具。虽然 LGE 成像仍是目前诊断的最佳方法,但 T1 映射和 ECV 定量等新兴技术有望改善检测,尤其是在疾病的早期阶段。随着心脏淀粉样变性的治疗方法不断推陈出新,这对患者管理具有重要意义。
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引用次数: 0
Expanding revascularization trials to women and underserved minorities and shifting to patient-centered outcomes: RECHARGE trials program. 将血管重建试验扩大到妇女和服务不足的少数民族,并转向以患者为中心的结果:RECHARGE 试验计划。
IF 2.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-20 DOI: 10.1097/hco.0000000000001177
Bjorn Redfors,John A Spertus,Clyde Yancy,Ruth Masterson-Creber,Gregg W Stone,Mario F L Gaudino
PURPOSE OF REVIEWWe review the limited available evidence informing coronary revascularization decisions in women and minorities, and introduce the RECHARGE trial program, which consists of two separate but integrated parallel multicenter, randomized trials comparing coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI), one exclusively enrolling women (RECHARGE:Women) and one exclusively enrolling Black or Hispanic patients (RECHARGE:Minorities).RECENT FINDINGSThe extensive evidence base supporting coronary revascularization suffers from under-representation of women, minorities and minoritized populations, and the use of heterogeneous primary composite outcomes whose components have varying strengths of association with prognosis and quality-of-life (QOL). In RECHARGE, participants will be followed for up to 10 years, with QOL assessments at baseline, 30 days, 3 months, every 6 months for 3 years, and annually thereafter. The primary endpoint is the hierarchical composite of time to all-cause mortality, time-averaged change from baseline in the physical component of the SF-12v2 physical summary score, and time-averaged change from baseline in the mental component of the SF12v2 summary score, evaluated using a win ratio. Independently adjudicated major adverse cardiovascular and noncardiovascular events and disease-specific QoL will be secondary endpoints.SUMMARYThe RECHARGE trials are the first revascularization trials to enroll exclusively women and minority patients and to use patient-centered outcomes as their primary outcome.
研究目的我们回顾了为女性和少数民族冠状动脉血运重建决策提供信息的有限可用证据,并介绍了 RECHARGE 试验计划,该计划包括两项独立但整合的平行多中心随机试验,比较冠状动脉旁路移植术 (CABG) 和经皮冠状动脉介入治疗 (PCI),其中一项专门招募女性患者(RECHARGE:Women),另一项专门招募黑人或西班牙裔患者(RECHARGE:Minorities)。最新发现:支持冠状动脉血运重建的大量证据表明,女性、少数民族和少数群体的代表性不足,而且使用的主要复合结果也不尽相同,其组成部分与预后和生活质量(QOL)的关联性也各不相同。RECHARGE 将对参与者进行长达 10 年的随访,在基线、30 天、3 个月、3 年内每 6 个月及之后每年进行一次 QOL 评估。主要终点是全因死亡时间、SF-12v2 身体总分中身体部分与基线相比的时间平均变化、SF-12v2 总分中精神部分与基线相比的时间平均变化的分层复合结果,采用胜率进行评估。独立判定的主要心血管和非心血管不良事件以及疾病特异性 QoL 将作为次要终点。摘要RECHARGE 试验是首个专门招募女性和少数民族患者并以患者为中心的结果作为主要结果的血管再通试验。
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引用次数: 0
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Current Opinion in Cardiology
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