Cardiology discovery最新文献

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A Rare and Lethal Ostial Left Main Trunk Lesion: A Case Report 一例罕见的致死性左主干外侧病变

Cardiology discovery

Pub Date : 2022-02-11 DOI: 10.1097/CD9.0000000000000043

Baotao Huang, Ran Zhang, Chen Li

Abstract Coronary artery involvement in cardiovascular syphilis is infrequent and often overlooked, especially in patients with latent syphilis. Herein, we present the case of myocardial infarction largely related to cardiovascular syphilis in a 63-year-old man. Invasive coronary angiography and contrast-enhanced computed tomography scan revealed a critical ostial narrowing of the left main trunk, an occlusive right coronary artery, and moderate-to-severe ostial stenosis of multiple major branches of the abdominal aorta. Syphilis screening and confirmatory tests were positive. Cardiovascular syphilis was considered. Percutaneous coronary intervention (PCI) was performed uneventfully, and a coronary stent was implanted in the ostium of the left main coronary artery. However, on day 3 after PCI, the patient died suddenly, likely because of stent thrombosis. In conclusion, severe coronary lesions confined to the ostia suggest rheumatologic large-vessel vasculitis or infectious aortitis.

摘要冠状动脉介入心血管梅毒是罕见的，经常被忽视，尤其是在潜伏梅毒患者中。在此，我们报告了一例63岁男性心肌梗死，主要与心血管梅毒有关。有创冠状动脉造影和增强计算机断层扫描显示，左主干严重狭窄，右冠状动脉闭塞，腹主动脉多个主要分支中度至重度狭窄。梅毒筛查和确认测试呈阳性。考虑了心血管梅毒。经皮冠状动脉介入治疗（PCI）顺利进行，并在左主冠状动脉口植入冠状动脉支架。然而，PCI术后第3天，患者突然死亡，可能是因为支架血栓形成。总之，局限于窦口的严重冠状动脉病变提示风湿性大血管血管炎或感染性动脉炎。

引用次数: 0

Ascending Aortic Aneurysm and Dissection Secondary to Bicuspid Aortic Valve with Concomitant Coarctation of Descending Aorta Successfully Repaired with Extracorporeal Membrane Oxygenation Support 体外膜肺氧合支持成功修复双尖主动脉瓣伴下行主动脉缩窄的上行主动脉瘤和夹层

Cardiology discovery

Pub Date : 2022-02-08 DOI: 10.1097/cd9.0000000000000041

Qin Jiang, J. Du, Tao Yu, Xiaobo Huang, Mingliang Zuo, Keli Huang

引用次数: 1

Case Report of Esophageal Rupture, Empyema, and Aortic Dissection Potentially Caused by Severe Vomiting 重度呕吐致食管破裂、胃胀及主动脉夹层1例报告

Cardiology discovery

Pub Date : 2022-01-27 DOI: 10.1097/cd9.0000000000000046

Jiawen Huang, Chengfeng Huang, Zhaoming Lin, Huanan Liu, Xiaoshen Zhang

引用次数: 0

Irreversible Electroporation Ablation for Atrial Fibrillation: Status and Challenges 不可逆电穿孔消融治疗心房颤动:现状与挑战

Cardiology discovery

Pub Date : 2022-01-27 DOI: 10.1097/CD9.0000000000000045

Fei Xie, Yonggang Chen, Xinhua Chen, Zhihong Zhao

Abstract Pulsed electric field (PEF) is a novel energy source by which high-voltage electric pulses are used to create irreversible electroporation. PEF is non-thermal and highly tissue-dependent in which specific targeting of the atrial myocardium is achieved and sparing of adjacent tissues is feasible, theoretically increasing the safety of the procedure, which could potentially break the trade-off between effective lesions and collateral damage and substantially improve risk-benefit ratios in atrial fibrillation (AF) ablation. Although recently published trials have shown a clear effect of AF ablation, large-scale clinical trials are lacking. Current clinical evidence has demonstrated significant efficacy in achieving durable pulmonary vein isolation without ablation-related adverse events. However, their putative benefits regarding efficacy, efficiency, and safety remain to be proven in randomized controlled trials.

脉冲电场是利用高压电脉冲产生不可逆电穿孔的一种新型能量源。PEF是非热的，高度依赖于组织，可以实现心房心肌的特异性靶向，并且可以保留邻近组织，理论上增加了手术的安全性，这可能会打破有效病变和附带损伤之间的权衡，并大大提高心房颤动(AF)消融的风险-收益比。虽然最近发表的试验已经显示了房颤消融的明确效果，但缺乏大规模的临床试验。目前的临床证据表明，在实现持久的肺静脉隔离无消融相关不良事件显著疗效。然而，它们在功效、效率和安全性方面的益处仍有待随机对照试验的证实。

引用次数: 0

Beyond Thermal Sensation 超越热感

Cardiology discovery

Pub Date : 2022-01-27 DOI: 10.1097/cd9.0000000000000047

Zhiming Zhu

引用次数: 0

Antiviral Abidol is Associated with the Reduction of In-Hospital Mortality in COVID-19 Patients. 抗病毒药物阿比多尔与降低COVID-19患者住院死亡率相关

Cardiology discovery

Pub Date : 2021-12-03 eCollection Date: 2021-03-01 DOI: 10.1097/CD9.0000000000000014

Hesong Zeng, Xingwei He, Wanjun Liu, Jing Kan, Liqun He, Jinhe Zhao, Cynthia Chen, Junjie Zhang, Shaoliang Chen

Objective: Coronavirus disease 2019 (COVID-19) is a global public health crisis. There are no specific antiviral agents for the treatment of SARS-CoV-2. Information regarding the effect of Abidol on in-hospital mortality is scarce. The present study aimed to evaluate the treatment effect of Abidol for patients with COVID-19 before and after propensity score matching (PSM).

Methods: This retrospective cohort study analyzed 1019 patients with confirmed COVID-19 in China from December 22, 2019 to March 13, 2020. Patients were divided to Abidol (200 mg, tid, 5-7 days, n = 788, 77.3%) and No-Abidol (n = 231, 22.7%) groups. The primary outcome was the mortality during hospitalization.

Results: Among 1019 COVID-19 patients, the age was (60.4 ± 14.5) years. Abidol-treated patients, compared with No-Abidol-treated patients, had a shorter duration from onset of symptoms to admission, less frequent renal dysfunction, lower white blood cell counts (lymphocytes <0.8) and erythrocyte sending rate, lower interleukin-6, higher platelet counts and plasma IgG and oxygen saturation, and less frequent myocardial injury. The mortality during hospitalization before PSM was 17.9% in Abidol group and 34.6% in No-Abidol (hazard ratio (HR) = 2.610, 95% confident interval (CI): 1.980-3.440), all seen in severe and critical patients. After PSM, the in-hospital death was 13.6% in Abidol and 28.6% in No-Abidol group (HR = 2.728, 95% CI: 1.598-4.659).

Conclusions: Abidol-treatment results in less in-hospital death for severe and critical patients with COVID-19. Further randomized study is warranted to confirm the findings from this study.

目的:2019冠状病毒病(COVID-19)是一场全球性的公共卫生危机。目前还没有治疗SARS-CoV-2的特异性抗病毒药物。关于阿比多对住院死亡率影响的信息很少。本研究旨在评价倾向评分匹配(PSM)前后阿比妥对COVID-19患者的治疗效果。方法:对2019年12月22日至2020年3月13日在中国确诊的1019例COVID-19患者进行回顾性队列研究。患者分为阿比多尔组(200mg, tid, 5 ~ 7 d, n = 788, 77.3%)和无阿比多尔组(n = 231, 22.7%)。主要结局为住院期间死亡率。结果:1019例COVID-19患者中，年龄为(60.4±14.5)岁。与未使用阿比多醇治疗的患者相比，阿比多醇治疗的患者从出现症状到入院的时间更短，肾功能不全的发生率更低，白细胞计数(淋巴细胞)更低。结论:阿比多醇治疗可降低COVID-19重型和危重症患者的院内死亡。需要进一步的随机研究来证实本研究的结果。

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引用次数: 4

Correction to: Rationale and Design of a Randomized Controlled Trial on Intensive Management of Blood PRESSure and Cholesterol in Elderly Chinese with Hypertension and Atrial FibrillatION (IMPRESSION) 更正：中国老年高血压和心房颤动患者强化血压和胆固醇管理的随机对照试验的原理和设计

Cardiology discovery

Pub Date : 2021-12-01 DOI: 10.1097/cd9.0000000000000042

引用次数: 1

Optimal Antithrombotic Therapy after Implantation of a Transcatheter Aortic Valve: Warfarin, Aspirin, or Non-Vitamin K Antagonist Oral Anticoagulants? A Systematic Review and Meta-Analysis 经导管主动脉瓣植入术后最佳抗血栓治疗:华法林、阿司匹林还是非维生素K拮抗剂口服抗凝剂?系统回顾和荟萃分析

Cardiology discovery

Pub Date : 2021-11-23 DOI: 10.1097/CD9.0000000000000036

Wenjuan Yang, X. Fang, Yu Zhu, Fuqin Tang, Zhao Jian

Abstract Objective: Diverse antithrombotic strategies were applied to patients undergoing aortic valve replacement. However, the optimal therapeutic regimen for patients undergoing transcatheter aortic valve implantation/replacement (TAVI/TAVR) remains unclear. The purpose of this study was to compare the efficacy and safety of various antithrombotic therapies following TAVI/TAVR. Methods: Relevant clinical trials evaluating the effect of anticoagulation or antiplatelet regimens on patients after TAVI/TAVR from inception to September 2020 were identified using the PubMed, EMBASE, and the Cochrane Library databases. The inclusion criteria including (1) all patients underwent TAVI/TAVR; (2) the interventions were antithrombotic strategies that prevent the occurrence of thrombotic events in patients; (3) randomized controlled trials or prospective observational studies; and (4) investigation of at least 1 outcome with a follow-up period of ≥3 months. The exclusion criteria including (1) research content was identical or irrelevant to the purpose of the present study; (2) lack of the required outcome index or availability of fragmentary original information; and (3) the full text is not available. The major outcomes were all-cause mortality, thromboembolic complications, and bleeding events. The Cochrane Collaboration's tool and the Newcastle-Ottawa Scale were used for assessing the risk of bias in included studies. Results: Thirteen studies (3 randomized controlled trials and 10 non-randomized studies) were identified, with a total of 23,497 patients. Four studies compared direct oral anticoagulants (DOACs) with warfarin, 1 study compared aspirin with warfarin, 6 studies compared aspirin plus clopidogrel (dual antiplatelet therapy (DAPT)) with aspirin monotherapy, and 2 studies compared DAPT and aspirin monotherapy with warfarin concurrently. There were no significant differences found between the DOAC and warfarin groups regarding all-cause mortality (risk ratio (RR): 1.03; 95% confidence interval (CI): 0.65–1.64; P = 0.909; Phet = 0.105), clinical adverse events (RR: 1.59; 95% CI: 0.99–2.58; P = 0.057; Phet = 0.738), or bleeding events (RR: 0.93; 95% CI: 0.78–1.11; P = 0.437; Phet = 0.338). The rates of all-cause mortality (RR: 0.71; 95% CI: 0.54–0.93; P = 0.012; Phet = 0.845) and bleeding events (RR: 0.43; 95% CI: 0.22–0.83; P = 0.012; Phet = 0.569) were lower in the aspirin group versus the warfarin group; however, there was no difference in the rate of clinical adverse events (RR: 0.38; 95% CI: 0.14–1.07; P = 0.068; Phet = 0.593). The DAPT group had an advantage versus the aspirin group in all-cause mortality (RR: 0.89; 95% CI: 0.82–0.98; P = 0.013; Phet = 0.299); however, the incidence of bleeding events (RR: 2.06; 95% CI: 1.39–3.07; P < 0.001; Phet = 0.001) exhibited an increasing trend. Notably, there was a slight decrease in the incidence of clinical adverse events (RR: 1.09; 95% CI: 0.94–1.26; P = 0.268; Phet = 0.554). Conclusion: The pres

摘要目的：对主动脉瓣置换术患者采用不同的抗血栓策略。然而，接受经导管主动脉瓣植入/置换术（TAVI/TAVR）的患者的最佳治疗方案尚不清楚。本研究的目的是比较TAVI/TAVR后各种抗血栓疗法的疗效和安全性。方法：使用PubMed、EMBASE和Cochrane Library数据库确定了从开始到2020年9月评估TAVI/TAVR患者抗凝或抗血小板方案效果的相关临床试验。纳入标准包括（1）所有患者均接受TAVI/TAVR；（2）干预措施是预防患者血栓事件发生的抗血栓策略；（3）随机对照试验或前瞻性观察性研究；以及（4）对至少1个随访期≥3的结果进行调查月。排除标准包括（1）研究内容与本研究目的相同或无关；（2）缺乏所需的结果指数或缺乏零碎的原始信息；以及（3）全文不可用。主要结果是全因死亡率、血栓栓塞并发症和出血事件。Cochrane协作的工具和Newcastle Ottawa量表用于评估纳入研究中的偏倚风险。结果：确定了13项研究（3项随机对照试验和10项非随机研究），共23497名患者。四项研究将直接口服抗凝剂（DOAC）与华法林进行了比较，一项研究将阿司匹林与华法林相比较，六项研究将阿斯匹林加氯吡格雷（双重抗血小板治疗（DAPT））与阿司匹林单药治疗进行了比较；还有两项研究将DAPT和阿司匹林单药疗法同时与华法林·相比较。DOAC组和华法林组在全因死亡率方面没有发现显著差异（风险比（RR）：1.03；95%置信区间（CI）：0.65–1.64；P = 0.909；佩 = 0.105），临床不良事件（RR:1.59；95%CI:0.99–2.58；P = 0.057；佩 = 0.738），或出血事件（RR:0.93；95%CI:0.78–1.11；P = 0.437；佩 = 0.338）。全因死亡率（RR:0.71；95%CI:0.54–0.93；P = 0.012；佩 = 0.845）和出血事件（RR:0.43；95%CI:0.22-0.83；P = 0.012；佩 = 0.569）低于华法林组；然而，临床不良事件发生率没有差异（RR:0.38；95%CI:0.14-1.07；P = 0.068；佩 = 与阿司匹林组相比，DAPT组在全因死亡率方面具有优势（RR:0.89；95%CI:0.82–0.98；P = 0.013；佩 = 0.299）；然而，出血事件的发生率（RR:2.06；95%CI:1.39-3.07；P < 0.001；佩 = 0.001）呈现出增加的趋势。值得注意的是，临床不良事件的发生率略有下降（RR:1.09；95%CI:0.94-1.26；P = 0.268；佩 = 0.554）。结论：本荟萃分析整合了最新发表的关于TAVI/TAVR后患者抗血栓策略的结果。与华法林相比，阿司匹林具有良好的风险效益，全因死亡率和出血事件发生率较低。尽管DAPT也与全因死亡率显著降低有关，但它与出血事件的发生率较高有关。与华法林相比，DOAC没有显示出显著的益处。应该注意一些特定的局限性，例如不同类型的试验会产生异质性，TAVI/TAVR患者的有限纳入会增加选择偏差。

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引用次数: 0

COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases. COVID-19:世纪大流行及其对心血管疾病的影响

Cardiology discovery

Pub Date : 2021-11-22 eCollection Date: 2021-12-01 DOI: 10.1097/CD9.0000000000000038

Yuanyuan Zhang, Mingjie Wang, Xian Zhang, Tianxiao Liu, Peter Libby, Guo-Ping Shi

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely ranks among the deadliest diseases in human history. As with other coronaviruses, SARS-CoV-2 infection damages not only the lungs but also the heart and many other organs that express angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2. COVID-19 has upended lives worldwide. Dietary behaviors have been altered such that they favor metabolic and cardiovascular complications, while patients have avoided hospital visits because of limited resources and the fear of infection, thereby increasing out-hospital mortality due to delayed diagnosis and treatment. Clinical observations show that sex, age, and race all influence the risk for SARS-CoV-2 infection, as do hypertension, obesity, and pre-existing cardiovascular conditions. Many hospitalized COVID-19 patients suffer cardiac injury, acute coronary syndromes, or cardiac arrhythmia. SARS-CoV-2 infection may lead to cardiomyocyte apoptosis and necrosis, endothelial cell damage and dysfunction, oxidative stress and reactive oxygen species production, vasoconstriction, fibrotic and thrombotic protein expression, vascular permeability and microvascular dysfunction, heart inflammatory cell accumulation and activation, and a cytokine storm. Current data indicate that COVID-19 patients with cardiovascular diseases should not discontinue many existing cardiovascular therapies such as ACE inhibitors, angiotensin receptor blockers, steroids, aspirin, statins, and PCSK9 inhibitors. This review aims to furnish a framework relating to COVID-19 and cardiovascular pathophysiology.

由严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)感染引起的COVID-19可能是人类历史上最致命的疾病之一。与其他冠状病毒一样，SARS-CoV-2感染不仅会损害肺部，还会损害心脏和许多其他表达血管紧张素转换酶2 (ACE2)的器官，ACE2是SARS-CoV-2的受体。COVID-19颠覆了全世界的生活。饮食习惯发生了改变，有利于代谢和心血管并发症的发生，而由于资源有限和担心感染，患者避免去医院就诊，从而增加了因诊断和治疗延误而导致的院外死亡率。临床观察表明，性别、年龄和种族都会影响感染SARS-CoV-2的风险，高血压、肥胖和既往心血管疾病也是如此。许多住院的COVID-19患者出现心脏损伤、急性冠状动脉综合征或心律失常。SARS-CoV-2感染可导致心肌细胞凋亡和坏死、内皮细胞损伤和功能障碍、氧化应激和活性氧产生、血管收缩、纤维化和血栓形成蛋白表达、血管通透性和微血管功能障碍、心脏炎症细胞积聚和激活以及细胞因子风暴。目前的数据表明，患有心血管疾病的COVID-19患者不应停止许多现有的心血管治疗，如ACE抑制剂、血管紧张素受体阻滞剂、类固醇、阿司匹林、他汀类药物和PCSK9抑制剂。本文旨在为COVID-19与心血管病理生理提供一个框架。

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引用次数: 6

The Liver and Heart 肝脏和心脏

Cardiology discovery

Pub Date : 2021-11-15 DOI: 10.1097/cd9.0000000000000037

Wenjun Yan, L. Tao, Xinliang Ma

引用次数: 0

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