American heart journal plus : cardiology research and practice最新文献_第6页

Subsequent pregnancies in peripartum cardiomyopathy: Patient-level differences and decision-making 围产期心肌病患者的后续妊娠：患者层面的差异和决策

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-11 DOI: 10.1016/j.ahjo.2024.100472

Olga Corazón Irizarry , Jennifer Lewey , Camille McCallister , Nathanael C. Koelper , Zoltan Arany , Lisa D. Levine

Study objective

To evaluate patient-level differences and decision making surrounding subsequent pregnancies (SSP) after peripartum cardiomyopathy (PPCM).

Design

Mixed methods approach to evaluate quantitative demographic and clinical differences between patients with and without a SSP and to qualitatively describe the decision-making regarding a SSP with a survey component.

Setting/participants

220 PPCM cases within the University of Pennsylvania Health System.

Main outcome measures

Demographic, clinical and obstetrical outcomes.

Results

73 patients (33 %) had a SSP, 37 with a live birth. Those with a SSP were more likely to self-identify as Black (70 % vs. 52 %; p = 0.04), be nulliparous in index pregnancy (68 % vs. 45 %, p = 0.02), were younger at diagnosis (24.3 vs. 30.5 years; p < 0.01), and a higher left ventricular ejection fraction (LVEF) at diagnosis (35 % vs. 27.5 %; p = 0.03) compared to patients without a SSP. There was no difference in recovery rates of LVEF (62 % vs. 50 %, p = 0.17), or need for LVAD, transplant, or death. 22 patients completed the survey (representing 44 SSPs): 41 % of SSPs (n = 18) resulted in termination, 18 % (n = 8) in a first/s trimester loss, and 41 % (n = 18) in a live-born delivery. All patients who elected termination indicated risk of recurrence/worsening heart failure to be a motivating factor.

Conclusions

Less than 20 % of patients in this single-center, multi-racial cohort had a SSP and delivery after PPCM with fear of recurrence as a large driver in this decision. Patients with a SSP were younger with a higher EF at diagnosis but ultimately had similar cardiac outcomes as patients without a SSP.

研究目的评估围产期心肌病 (PPCM) 患者层面的差异以及围绕后续妊娠 (SSP) 的决策。设计采用混合方法评估有 SSP 和无 SSP 患者之间的人口统计学和临床差异，并通过调查对 SSP 的决策进行定性描述。与无 SSP 的患者相比，有 SSP 的患者更有可能自我认同为黑人（70% 对 52%；p = 0.04），在指数妊娠中为空腹（68% 对 45%，p = 0.02），诊断时更年轻（24.3 岁对 30.5 岁；p <0.01），诊断时左心室射血分数（LVEF）更高（35% 对 27.5%；p = 0.03）。在 LVEF 恢复率（62% 对 50%，p = 0.17）、LVAD 需求、移植或死亡方面没有差异。22 名患者完成了调查（代表 44 个 SSP）：41%的 SSP（n = 18）导致终止妊娠，18%（n = 8）导致前/后三个月流产，41%（n = 18）导致活产。所有选择终止妊娠的患者均表示，复发/心衰恶化的风险是促使其终止妊娠的一个因素。结论在这个单中心、多种族的队列中，不到 20% 的患者在 PPCM 后进行了 SSP 和分娩，害怕复发是促使其做出这一决定的主要原因。有 SSP 的患者更年轻，诊断时 EF 值更高，但最终的心脏预后与没有 SSP 的患者相似。

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引用次数: 0

The role of cholesterol crystals and ocular crystal emboli in retinal pathology 胆固醇晶体和眼晶体栓塞在视网膜病理学中的作用

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-11 DOI: 10.1016/j.ahjo.2024.100475

Nicholas G. Medawar , Tim F. Dorweiler , George S. Abela , Julia V. Busik , Maria B. Grant

Cholesterol crystals (CC) can be responsible for a range of clinical syndromes in the retina from asymptomatic plaques to retinal artery occlusion with clinical trials providing evidence for the efficacy in lipid lowering therapies in preventing ocular pathology. Much of the literature has focused on CC in retinal circulation as a marker of poor systemic health and have attempted to use them to categorize risk of mortality and stroke. More recently cholesterol accumulation and CC formation have been linked to development of diabetic retinopathy with CC formation in the retina due to aberrant retinal cholesterol homeostasis and not simply systemic dyslipidemia.

胆固醇结晶（CC）可导致视网膜出现从无症状斑块到视网膜动脉闭塞等一系列临床综合症，临床试验提供了降脂疗法在预防眼部病变方面疗效的证据。许多文献都将视网膜循环中的 CC 作为全身健康状况不良的标志，并试图将其用于死亡和中风风险的分类。最近，胆固醇积累和 CC 的形成与糖尿病视网膜病变的发展有关，视网膜中 CC 的形成是由于视网膜胆固醇平衡失调，而不仅仅是全身性血脂异常。

引用次数: 0

Traditional and non-traditional cardiovascular risk factor profiles in young patients with coronary artery disease 年轻冠心病患者的传统和非传统心血管风险因素概况

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-11 DOI: 10.1016/j.ahjo.2024.100471

Anish Adhikari , Sasha DeJesus , Nyein Swe , Georgeta Vaidean , Rachel Nahrwold , John Joshua , Monique Carrero-Tagle , Caleb Wutawanashe , Roland Hentz , Martin Lesser , Eugenia Gianos

Study objective

There is an increasing trend in myocardial infarction (MI) hospitalizations in young individuals. The prevalence of modifiable cardiovascular risk factors is high in this population. This study aims to assess the prevalence of traditional and non-traditional cardiovascular risk factors among young patients with coronary artery disease (CAD) including novel lipid and dietary biomarkers with a focus on potential gender differences.

Design

The Young Heart study is a prospective, single-center pilot cohort study. Baseline data included medical history, medications, and lifestyle factors. We also collected blood samples for lipid profile, lipoprotein (a), high-sensitivity C-reactive protein (hsCRP), and trimethylamine N-oxide (TMAO).

Participants

A total of 60 patients aged <60 years with CAD (on coronary CT or invasive angiogram) were included in the study.

Results

The median age was 51 years and predominantly male (70 %). Baseline assessment revealed a high prevalence of hypertension (76.7 %), hyperlipidemia (91.7 %), and obstructive CAD (88.3 %). 36.7 % had diabetes, 28.3 % had prediabetes, and 38.3 % had prior MI. Uncontrolled risk factors were prevalent, including increased waist circumference (54.6 %), metabolic syndrome (60.0 %), and LDL ≥70 mg/dL (47.5 %), Lp(a) ≥75 nmol/L (47.5 %). Furthermore, 41.7 % had hsCRP ≥2 mg/L, and 28.3 % had suboptimal TMAO levels. 70.0 % of patients were on guideline-directed doses of statins.

Conclusion

Young patients with CAD demonstrated a substantial burden of traditional and non-traditional cardiovascular risk factors. The study findings highlight the need for targeted interventions to improve risk factor control and optimize lifestyle behaviors. Further investigation is warranted to assess the impact of these interventions on cardiovascular outcomes.

研究目的年轻人心肌梗死（MI）住院率呈上升趋势。在这一人群中，可改变的心血管风险因素的患病率很高。本研究旨在评估冠状动脉疾病（CAD）年轻患者中传统和非传统心血管风险因素的患病率，包括新型血脂和饮食生物标志物，重点关注潜在的性别差异。基线数据包括病史、药物和生活方式因素。我们还收集了血样，用于检测血脂谱、脂蛋白（a）、高敏 C 反应蛋白（hsCRP）和三甲胺 N-氧化物（TMAO）。结果中位年龄为 51 岁，男性占绝大多数（70%）。基线评估显示，高血压（76.7%）、高脂血症（91.7%）和阻塞性 CAD（88.3%）的发病率较高。36.7%的人患有糖尿病，28.3%的人患有糖尿病前期，38.3%的人曾有过心肌梗死。未得到控制的风险因素普遍存在，包括腰围增大（54.6%）、代谢综合征（60.0%）、低密度脂蛋白≥70 毫克/分升（47.5%）、脂蛋白（a）≥75 毫摩尔/升（47.5%）。此外，41.7% 的患者 hsCRP ≥2 mg/L，28.3% 的患者 TMAO 水平不达标。70.0%的患者服用了指导剂量的他汀类药物。研究结果表明，有必要采取有针对性的干预措施，以改善风险因素控制和优化生活方式。有必要进一步调查评估这些干预措施对心血管预后的影响。

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引用次数: 0

Impact of atrial fibrillation on pulmonary embolism hospitalization: Nationwide analysis 心房颤动对肺栓塞住院治疗的影响：全国分析

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100465

Mubarak Hassan Yusuf , Akanimo Anita , Olayiwola Akeem Bolaji , Faridat Moyosore Abdulkarim , Chibuike Daniel Onyejesi , Maryam Yusuf , Utku Ekin , Arham Syed Hazari , Mourad Ismail

Introduction

Atrial fibrillation (AF) is the most common type of arrythmia affecting approximately 1–2 % of the adult population. Patients with an underlying history of atrial fibrillation have a greater chance of developing venous thromboembolism (VTE). Likewise, patients with VTE are at increased risk for AF. There has been conflicting evidence on the prognostic impact of AF in acute pulmonary embolism (PE) patients. The aim of this retrospective cohort study was to estimate the impact of AF on the clinical outcomes of hospitalization for PE.

Method

The 2016–2021 National Inpatient Sample database was searched for adult patients hospitalized with PE with associated history of AF as the principal discharge diagnosis. The primary outcome was inpatient mortality, while the secondary outcomes were length of stay (LOS), total hospital charge (THC), cardiogenic shock, acute respiratory failure, in-hospital cardiac arrest (IHCA). The outcomes were analyzed using multivariable logistic and linear regression analyses.

Results

A total of 1,128,269 patients were admitted for PE, 12.4 % of whom had underlying AF. The AF and non-AF cohorts had a mean age of 73.6 years and 61.6 years, respectively. PE patient with AF had significantly higher mortality compared to non-AF patients with PE (6.05 % vs 2.75 %, adjusted odds ratio of 1.67 [95 % CI 1.56–1.79; p < 0.0001]). The PE with AF cohort had increased odds of cardiac arrest, cardiogenic shock, respiratory failure requiring intubation, higher average length of stay (5.66 days vs 4.18 days, P < 0.001) and a higher total hospital cost (65,235 vs 50,118, P < 0.001).

Conclusion

AF was associated with increased inpatient mortality and worse clinical outcomes in hospitalization for acute PE.

导言心房颤动（房颤）是最常见的心律失常类型，约占成年人口的 1-2%。有心房颤动潜在病史的患者患静脉血栓栓塞症（VTE）的几率更大。同样，患有 VTE 的患者发生房颤的风险也会增加。关于急性肺栓塞（PE）患者心房颤动对预后的影响，目前还存在相互矛盾的证据。这项回顾性队列研究旨在估算房颤对 PE 住院临床预后的影响。方法在 2016-2021 年全国住院患者抽样数据库中搜索了因 PE 住院且主要出院诊断为房颤的成年患者。主要结果为住院患者死亡率，次要结果为住院时间（LOS）、住院总费用（THC）、心源性休克、急性呼吸衰竭、院内心脏骤停（IHCA）。结果共有 1,128,269 名 PE 患者入院，其中 12.4% 有潜在房颤。心房颤动和非心房颤动患者的平均年龄分别为 73.6 岁和 61.6 岁。有房颤的 PE 患者死亡率明显高于无房颤的 PE 患者（6.05% vs 2.75%，调整后的几率比为 1.67 [95 % CI 1.56-1.79; p < 0.0001]）。有房颤的 PE 患者发生心脏骤停、心源性休克、需要插管的呼吸衰竭的几率增加，平均住院时间延长（5.66 天 vs 4.18 天，P < 0.001），住院总费用增加（65,235 vs 50,118，P < 0.001）。

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引用次数: 0

Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization 对接受早期血运重建的急性心肌梗死相关心源性休克患者采用不同机械循环支持模式的趋势和结果

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100468

Shafaqat Ali , Manoj Kumar , Irisha Badu , Faryal Farooq , Thannon Alsaeed , Muhammad Sultan , Lalitsiri Atti , Sanchit Duhan , Pratik Agrawal , Vijaywant Brar , Tarek Helmy , Taher Tayeb

Background

The use of Mechanical Circulatory Support (MCS) devices in cardiogenic shock (CS) is growing. However, the recent trends in using different MCS modalities and their outcomes in acute myocardial infarction associated CS (AMI-CS) are unknown.

Methods

The national readmission database (2016–2020) was used to identify AMI-CS requiring MCS. Cohorts were stratified as ECMO compared to Impella. Propensity score matching (PSM) was used to remove confounding factors. Pearson's x2 test was applied to matched cohorts to compare outcomes. We used multivariate regression and reported predictive margins for adjusted trend analysis.

Results

Among 20,950 AMI-CS hospitalizations requiring MCS, 19,628 (93.7 %) received Impella vs 1322 (6.3 %) were placed only on ECMO. ECMO group was younger (median age: 61 vs. 68 years, p < 0.001) and had a lower comorbidity burden. On propensity-matched cohorts (N 742), the ECMO cohort had higher adverse events, including mortality (51.6 % vs. 41.5 %), sudden cardiac arrest (SCA) (40.9 % vs. 31.8 %), acute stroke (9.2 % vs. 4.6 %) and major bleeding (16 % vs 12.2 %) [p < 0.05]. However, comparing ECPELLA (ECMO + Impella) to Impella alone, mortality (46.2 % vs. 39.4 %) and SCA (44 % vs. 36.4 %) rates were similar, though major bleeding was higher (18.2 % vs. 9.8 %). From 2016 to 2020, mortality trends for AMI-CS in the U.S. showed no significant change (p-trend: 0.071).

Conclusion

Despite advances in MCS modalities, the overall mortality rate for AMI-CS remains unchanged. ECMO use without LV unloading showed higher mortality and adverse events compared to Impella. Prospective studies are needed to verify these findings.

背景机械循环支持（MCS）设备在心源性休克（CS）中的使用日益增多。然而，在急性心肌梗死相关性心源性休克（AMI-CS）中使用不同 MCS 模式及其结果的最新趋势尚不清楚。方法使用国家再入院数据库（2016-2020 年）来识别需要 MCS 的 AMI-CS。队列按 ECMO 与 Impella 进行分层。采用倾向评分匹配法（PSM）去除混杂因素。对匹配队列进行皮尔逊 x2 检验，以比较结果。结果在 20,950 例需要 MCS 的 AMI-CS 住院患者中，19,628 例（93.7%）接受了 Impella 治疗，1322 例（6.3%）仅接受了 ECMO 治疗。ECMO 组患者更年轻（中位年龄：61 岁 vs. 68 岁，p < 0.001），合并症负担更轻。在倾向匹配队列（742 人）中，ECMO 队列的不良事件较多，包括死亡率（51.6% 对 41.5%）、心脏骤停（SCA）（40.9% 对 31.8%）、急性中风（9.2% 对 4.6%）和大出血（16% 对 12.2%）[p <0.05]。然而，将 ECPELLA（ECMO + Impella）与单独使用 Impella 相比，死亡率（46.2% 对 39.4%）和 SCA（44% 对 36.4%）相似，但大出血率更高（18.2% 对 9.8%）。从 2016 年到 2020 年，美国 AMI-CS 的死亡率趋势没有显著变化（P-趋势：0.071）。与 Impella 相比，使用 ECMO 而不进行 LV 负载显示出更高的死亡率和不良事件。需要进行前瞻性研究来验证这些发现。

{"title":"Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization","authors":"Shafaqat Ali , Manoj Kumar , Irisha Badu , Faryal Farooq , Thannon Alsaeed , Muhammad Sultan , Lalitsiri Atti , Sanchit Duhan , Pratik Agrawal , Vijaywant Brar , Tarek Helmy , Taher Tayeb","doi":"10.1016/j.ahjo.2024.100468","DOIUrl":"10.1016/j.ahjo.2024.100468","url":null,"abstract":"<div><h3>Background</h3><div>The use of Mechanical Circulatory Support (MCS) devices in cardiogenic shock (CS) is growing. However, the recent trends in using different MCS modalities and their outcomes in acute myocardial infarction associated CS (AMI-CS) are unknown.</div></div><div><h3>Methods</h3><div>The national readmission database (2016–2020) was used to identify AMI-CS requiring MCS. Cohorts were stratified as ECMO compared to Impella. Propensity score matching (PSM) was used to remove confounding factors. Pearson's x2 test was applied to matched cohorts to compare outcomes. We used multivariate regression and reported predictive margins for adjusted trend analysis.</div></div><div><h3>Results</h3><div>Among 20,950 AMI-CS hospitalizations requiring MCS, 19,628 (93.7 %) received Impella vs 1322 (6.3 %) were placed only on ECMO. ECMO group was younger (median age: 61 vs. 68 years, <em>p</em> < 0.001) and had a lower comorbidity burden. On propensity-matched cohorts (N 742), the ECMO cohort had higher adverse events, including mortality (51.6 % vs. 41.5 %), sudden cardiac arrest (SCA) (40.9 % vs. 31.8 %), acute stroke (9.2 % vs. 4.6 %) and major bleeding (16 % vs 12.2 %) [<em>p</em> < 0.05]. However, comparing ECPELLA (ECMO + Impella) to Impella alone, mortality (46.2 % vs. 39.4 %) and SCA (44 % vs. 36.4 %) rates were similar, though major bleeding was higher (18.2 % vs. 9.8 %). From 2016 to 2020, mortality trends for AMI-CS in the U.S. showed no significant change (p-trend: 0.071).</div></div><div><h3>Conclusion</h3><div>Despite advances in MCS modalities, the overall mortality rate for AMI-CS remains unchanged. ECMO use without LV unloading showed higher mortality and adverse events compared to Impella. Prospective studies are needed to verify these findings.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100468"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Racial/ethnic disparities, artificial intelligence, and cutting-edge research: Proceedings from the 2023 Florida cardio-oncology symposium 种族/族裔差异、人工智能和前沿研究：2023 年佛罗里达心脏病肿瘤学研讨会论文集

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100469

Katelyn A. Bruno , Michael G. Fradley , Sherry-Ann Brown , Avirup Guha , Lakeshia Cousin , Yi Guo , Walter G. O'Dell , Ashely J. Smuder , Shuang Yang , Dejana Braithwaite , Carl J. Pepine , Yan Gong

引用次数: 0

Overlap of frailty and malnutrition as prognosticators in older patients with heart failure 老年心力衰竭患者的预后指标--虚弱与营养不良的重叠

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100467

Takuro Abe , Kentaro Jujo , Yudai Fujimoto , Daichi Maeda , Yuki Ogasahara , Kazuya Saito , Hiroshi Saito , Kentaro Iwata , Masaaki Konishi , Takeshi Kitai , Takatoshi Kasai , Hiroshi Wada , Shin-ichi Momomura , Nobuyuki Kagiyama , Kentaro Kamiya , Emi Maekawa , Yuya Matsue

Background

Physical frailty and malnutrition coexist in older patients with heart failure (HF) and form a vicious cycle exacerbating each other and can cause poor clinical outcomes. We aimed to clarify the association of prevalence of physical frailty and malnutrition and clinical outcomes in hospitalized patients with HF.

Methods

A total of 862 hospitalized patients aged ≥65 years with HF decompensation were included in this FRAGILE-HF post-hoc sub-analysis. Patients were categorized into Neither, Either, or Both groups based on the prevalence of physical frailty and malnutrition. The primary outcome was all-cause mortality within 1 year after discharge. Prognoses among the groups were compared in the entire cohort and in subgroups with preserved ejection fraction (pEF) and reduced/mildly reduced left ventricular ejection fractions (rEF/mrEF).

Results

The Neither, Either, and Both groups comprised 32 %, 40 %, and 28 % respectively. During a 1-year follow-up period, 101 (12 %) patients died. Kaplan–Meier analysis showed significant differences in the primary outcomes among the groups (P < 0.001). The Both group had a higher risk of mortality (HR: 2.47, 95 % CI: 1.38–4.42) than the Neither group, while the Either group showed insignificant risk increase (HR: 1.58, 95 % CI: 0.86–2.90). Similar trends were observed in the pEF and rEF/mrEF subgroups (P = 0.60).

Conclusions

Physical frailty and malnutrition coexist in approximately one-quarter of hospitalized older patients with HF and are associated with an increased risk of mortality. Assessing both conditions is crucial for risk stratification and interventions to mitigate their interplay.

背景老年心力衰竭（HF）患者的体质虚弱和营养不良同时存在，并形成恶性循环，相互加重，可导致不良的临床预后。我们的目的是明确心力衰竭住院患者身体虚弱和营养不良的患病率与临床预后之间的关系。方法共有 862 名年龄≥65 岁的心力衰竭失代偿期住院患者被纳入 FRAGILE-HF 事后子分析。根据体质虚弱和营养不良的发生率，将患者分为 "两者皆无 "组、"两者皆有 "组和 "两者皆有 "组。主要结果是出院后一年内的全因死亡率。比较了整个组群以及射血分数保留组（pEF）和左心室射血分数降低/轻度降低组（rEF/mrEF）中各组的预后情况。在为期一年的随访期间，101 名（12%）患者死亡。Kaplan-Meier 分析显示，两组患者的主要预后存在显著差异（P < 0.001）。两组患者的死亡风险（HR：2.47，95% CI：1.38-4.42）高于两组患者，而两组患者的死亡风险增加不明显（HR：1.58，95% CI：0.86-2.90）。在 pEF 和 rEF/mrEF 亚组中也观察到了类似的趋势（P = 0.60）。评估这两种情况对于进行风险分层和干预以减轻其相互作用至关重要。

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引用次数: 0

The environmental effects of non-invasive cardiac imaging 无创心脏成像的环境效应

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100463

Kelsey Gardiner , Kate Hanneman , Rebecca Kozor

The healthcare sector is a major contributor to the universal climate footprint, of this a significant proportion is attributable to medical imaging and further to dedicated cardiac imaging. The increasing availability and utility of cardiac imaging techniques for prognosis, diagnosis and management raises concerns for the impact of these investigations on the environment.

Our objective was to review the published literature assessing the environmental impact of non-invasive imaging modalities within cardiology, subsequently helping guide physicians toward a more sustainable approach to cardiac imaging and improved awareness of the environmental impact of healthcare within this field.

We conducted a systematic review of studies measuring the environmental impact of non-invasive cardiac imaging. A total of 8 studies were included in the final analysis.

Cardiac imaging has a significant environmental impact, which varies by modality: lowest for echocardiography and highest for MRI. As a whole this field represents a significant contributor to climate-related threats to human health, which we should strive toward harm minimisation. This may be mitigated through the conscious utilisation of energy consumption and contrast media, as well as healthcare worker education and quality improvement to guide imaging choice based on environmental impact alongside conventional determinants such as patient characteristics, clinical guidelines and cost (visual abstract).

医疗保健行业是造成全球气候足迹的一个主要因素，其中很大一部分要归因于医学影像，而专用的心脏成像技术则更进一步。心脏成像技术在预后、诊断和管理方面的可用性和实用性越来越高，这引起了人们对这些检查对环境影响的关注。我们的目标是回顾已发表的文献，评估心脏病学中无创成像模式对环境的影响，从而帮助指导医生采用更具可持续性的方法进行心脏成像，并提高对这一领域中医疗保健对环境影响的认识。我们对测量无创心脏成像对环境影响的研究进行了系统性回顾，共有 8 项研究被纳入最终分析。总体而言，该领域对气候相关的人类健康威胁贡献巨大，我们应努力将其危害降至最低。可以通过有意识地利用能源消耗和造影剂，以及医护人员的教育和质量改进来减轻这种影响，从而根据环境影响以及患者特征、临床指南和成本等传统决定因素来指导成像选择（视觉摘要）。

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引用次数: 0

An in-depth evaluation of the efficacy and safety of various treatment modalities for chronic thromboembolic pulmonary hypertension: A systematic review and network meta-analysis 深入评估慢性血栓栓塞性肺动脉高压各种治疗方法的有效性和安全性：系统综述和网络荟萃分析

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100466

Noha Rami Ismail , Hamdy A. Makhlouf , Atef Hassan , Ahmed Elshahat , Mohamed Abdelfatah Abdellatif , Abdelmoemen Esam Rezk , Abdelrahman Mady , Rashad G. Mohamed , Hanady Mohammad Elfeky , Ahmed Abdelaziz

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) is a major risk for pulmonary hypertension with poor prognosis. Limited data is available on the optimal treatment of choice. We aimed to comprehensively assess the efficacy and safety of CTEPH targeted therapies and update the evidence.

Methods

We searched PubMed, Scopus, and the Cochrane library up to December 2023 to include randomized controlled trials comparing different therapies in patients with CTEPH. Primary outcomes were 6-minute walk distance (6 MWD), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). While secondary outcomes were the mean right atrial pressure (mRAP), Borg dyspnea score, cardiac output (CO), cardiac index, adverse events, and all-cause mortality.

Results

Fourteen RCTs comprising 1047 patients were included in this network meta-analysis. Regarding 6 MWD, PADN (MD=113.59, 95% CI: 53.80; 173.39), BPA (MD=48.84, 95% CI: 27.99; 69.69), riociguat (MD=42.59, 95% CI: 22.01; 63.18), treprostinil (MD=41.60, 95% CI: 17.07; 66.13), and macitentan (MD=34.00, 95% CI: 3.50; 64.50) were favored compared to placebo. In terms of PVR, BPA (MD=-392.19, 95% CI: -571.77; -212.62), treprostinil (MD=-287.20, 95% CI: -475.63; -98.77), PADN (MD=-280.61, 95% CI: -506.69; -54.52), bosentan (MD=-176.00, 95% CI: -340.91; -11.09), and riociguat (MD=-171.61, 95% CI: -298.40; -44.81) displayed statistically significant results.

Conclusion

Current therapeutic modalities are effective in terms of improving exercise capacity, pulmonary hemodynamics, and reducing adverse events and all-cause mortality. Overall, BPA and PADN were superior to all other targeted medications in the studied outcomes.

背景慢性血栓栓塞性肺动脉高压（CTEPH）是预后不良的肺动脉高压的主要危险因素。关于最佳治疗选择的数据有限。我们旨在全面评估 CTEPH 靶向疗法的疗效和安全性，并更新证据。方法我们检索了 PubMed、Scopus 和 Cochrane 图书馆（截至 2023 年 12 月），以纳入比较 CTEPH 患者不同疗法的随机对照试验。主要结果为6分钟步行距离（6 MWD）、肺血管阻力（PVR）和平均肺动脉压（mPAP）。次要结果包括平均右心房压（mRAP）、Borg 呼吸困难评分、心输出量（CO）、心脏指数、不良事件和全因死亡率。就 6 MWD 而言，与安慰剂相比，PADN（MD=113.59，95% CI：53.80；173.39）、BPA（MD=48.84，95% CI：27.99；69.69）、riociguat（MD=42.59，95% CI：22.01；63.18）、treprostinil（MD=41.60，95% CI：17.07；66.13）和 macitentan（MD=34.00，95% CI：3.50；64.50）更受青睐。在 PVR 方面，BPA（MD=-392.19，95% CI：-571.77；-212.62）、曲普瑞斯替尼（MD=-287.20，95% CI：-475.63；-98.77）、PADN（MD=-280.61，95% CI：-506.69；-54.52）、波生坦（MD=-176.00，95% CI：-340.91；-11.09）和利奥吉曲特（MD=-171.61，95% CI：-298.40；-44.81）显示出具有统计学意义的结果。结论目前的治疗模式在改善运动能力、肺血流动力学、减少不良事件和全因死亡率方面是有效的。总体而言，在研究结果方面，BPA 和 PADN 优于所有其他靶向药物。

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引用次数: 0

OCEANIC-AF and the inferior efficacy of asundexian compared to apixaban in patients at high risk with atrial fibrillation: Have we come to the end of the road for factor XIa inhibitors? OCEANIC-AF和阿松德西安对心房颤动高危患者的疗效不如阿哌沙班：我们是否已经走到了 XIa 因子抑制剂的尽头？

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-09-21 DOI: 10.1016/j.ahjo.2024.100464

Keith C. Ferdinand, Asaad Nakhle

引用次数: 0