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Pre-operative and post-operative atrial fibrillation in patients undergoing SAVR/TAVR SAVR/TAVR患者的术前和术后房颤
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.114
Vineet Tummala, Annet S. Kuruvilla, Ashutosh Yaligar, So Agha, Thomas Bilfinger, A. Shroyer
Atrial fibrillation (AF) is a common preoperative comorbidity and post-operative complication associated with cardiac surgery and is recognized as a significant predictor of adverse clinical outcomes. This review aims to highlight the current literature regarding the incidence, risk factors, and outcomes of atrial fibrillation in patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) procedures. A literature search of relevant articles was conducted via PubMed, Medline, and EMBASE. Pre-existing AF is seen in 6.3%-35.2% of SAVR patients and 15.7%-48.9% of TAVR patients and is associated with increased risk of mortality (OR = 2.2) and stroke (OR = 5.9). Postoperative AF (POAF) is more common after SAVR and in patients with hemodynamic instability. The rates for POAF range from 11.1%-84% following SAVR and range from 3.0%-55.6% following TAVR. In-hospital mortality (7.8% vs. 3.4%; P < 0.01) and stroke (4.7% vs. 2.0%; P < 0.01) are higher in the POAF group. POAF can be prevented via prophylactic antiarrhythmic medications and atrial pacing. Therapeutic anticoagulation is recommended as it reduces the risk of thrombotic complications following SAVR and TAVR procedures in the setting of POAF. Compared to those not on anticoagulant therapies, patients on anticoagulation have decreased rates of stroke (1.7% vs. 5.5%) and fewer 30-day thrombotic complications (3% vs. 40%). These preventive measures are essential as POAF is associated with more thromboembolic events, longer hospital stays, and higher overall morbidity and mortality rates.
心房颤动(AF)是与心脏手术相关的常见术前合并症和术后并发症,被认为是不良临床结果的重要预测因素。本综述旨在重点介绍目前关于手术主动脉瓣置换术(SAVR)或经导管主动脉瓣置换术(TAVR)患者房颤发生率、危险因素和预后的文献。通过PubMed、Medline和EMBASE对相关文章进行文献检索。在6.3%-35.2%的SAVR患者和15.7%-48.9%的TAVR患者中存在预先存在的房颤,并与死亡风险增加(OR = 2.2)和卒中风险增加(OR = 5.9)相关。术后房颤(POAF)在SAVR后和血流动力学不稳定患者中更为常见。SAVR后POAF发生率为11.1%-84%,TAVR后POAF发生率为3.0%-55.6%。住院死亡率(7.8% vs. 3.4%;P < 0.01)和卒中(4.7% vs. 2.0%;P < 0.01)。可通过预防性抗心律失常药物和心房起搏预防POAF。建议治疗性抗凝治疗,因为它可以降低POAF患者SAVR和TAVR手术后血栓并发症的风险。与未接受抗凝治疗的患者相比,接受抗凝治疗的患者卒中发生率降低(1.7%对5.5%),30天血栓形成并发症减少(3%对40%)。这些预防措施是必不可少的,因为POAF与更多的血栓栓塞事件、更长的住院时间以及更高的总发病率和死亡率有关。
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引用次数: 0
Stroke - the second leading cause of death 中风是第二大死因
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.117
Chung-Yin Hsu
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引用次数: 0
The changing perspective on cardiac amyloidosis in the modern era 现代对心脏淀粉样变性的看法变化
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.143
G. Sinagra, A. Porcari
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引用次数: 0
Clinico-pathophysiological considerations in coronary microvascular disorders 冠状动脉微血管病变的临床病理生理考虑
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.68
S. La, R. Tavella, S. Pasupathy, J. Beltrame
Around half of the patients undergoing an elective coronary angiogram to investigate typical stable angina symptoms are found to have non-obstructive coronary arteries (defined as < 50% stenosis). These patients are younger with a female predilection. While underlying mechanisms responsible for these presentations are heterogeneous, structural and functional abnormalities of the coronary microvasculature are highly prevalent. Thus, coronary microvascular dysfunction (CMD) is increasingly recognised as an important consideration in patients with non-obstructive coronary arteries. This review will focus on primary coronary microvascular disorders and summarise the four common clinical presentation pictures which can be considered as endotypes - Microvascular Ischaemia (formerly “Syndrome X”), Microvascular Angina, Microvascular Spasm, and Coronary Slow Flow. Furthermore, the pathophysiological mechanisms associated with CMD are also heterogenous. CMD may arise from an increased microvascular resistance, impaired microvascular dilation, and/or inducible microvascular spasm, ultimately causing myocardial ischaemia and angina. Alternatively, chest pain may arise from hypersensitivity of myocardial pain receptors rather than myocardial ischaemia. These two major abnormalities should be considered when assessing an individual clinical picture, and ultimately, the question arises whether to target the heart or the pain perception to treat the anginal symptoms.
在接受选择性冠状动脉造影以调查典型稳定型心绞痛症状的患者中,约有一半发现冠状动脉非阻塞性(定义为狭窄< 50%)。这些病人都比较年轻,而且偏爱女性。虽然导致这些表现的潜在机制是不同的,但冠状动脉微血管的结构和功能异常是非常普遍的。因此,冠状动脉微血管功能障碍(CMD)越来越被认为是非阻塞性冠状动脉患者的重要考虑因素。本文将重点介绍原发性冠状动脉微血管疾病,并总结四种常见的内型临床表现:微血管缺血(以前称为“X综合征”)、微血管心绞痛、微血管痉挛和冠状动脉慢流。此外,与CMD相关的病理生理机制也是异质性的。CMD可能由微血管阻力增加、微血管扩张受损和/或诱导微血管痉挛引起,最终导致心肌缺血和心绞痛。另外,胸痛可能是由心肌疼痛受体的超敏反应引起的,而不是心肌缺血。在评估个体临床表现时应考虑这两种主要异常,最终,问题出现了,是针对心脏还是疼痛感知来治疗心绞痛症状。
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引用次数: 0
Clinical translation of genetic testing in TTR Amyloidosis: genotype-phenotype correlations, management of asymptomatic carriers and familial screening TTR淀粉样变基因检测的临床翻译:基因型-表型相关性,无症状携带者的管理和家族筛查
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.74
Riccardo Scirpa, Domitilla Russo, G. Tini, M. Sclafani, A. Tropea, F. Cava, C. Autore, B. Musumeci
Transthyretin (TTR)-related amyloidosis (ATTR) is a heterogeneous disease with different organ involvement depending on the type of TTR infiltration [mutated (vTTR) or wild-type (wtTTR)]. Genetic testing in ATTR is required to define diagnosis and identify asymptomatic at-risk family members. Since new therapies are maximally effective in the early stages of the disease, there is a growing agreement about the need for close monitoring of genotype-positive, phenotype-negative individuals to assure a prompt treatment when minor disease signs are detected. This review summarizes the complexity of genotype-phenotype correlation and revises the current indications with respect to familiar screening and management of asymptomatic carriers.
转甲状腺素(TTR)相关淀粉样变性(ATTR)是一种异质性疾病,根据TTR浸润的类型[突变型(vTTR)或野生型(wtTTR)],可累及不同的器官。需要在ATTR中进行基因检测,以确定诊断和确定无症状的高危家庭成员。由于新疗法在疾病的早期阶段最有效,因此越来越多的人认为有必要密切监测基因型阳性和表型阴性的个体,以确保在发现轻微疾病体征时及时治疗。本文综述了基因型-表型相关性的复杂性,并对目前无症状携带者筛查和管理的适应症进行了修订。
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引用次数: 1
Taking on the elephant in the room-postoperative atrial fibrillation: a clinical program management perspective 承担房间里的大象-术后心房颤动:临床项目管理的观点
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.133
Jessica Y. Rove, Wendy S. Tzou, A. L. Shroyer, F. Grover
Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, yet there is no consistent cardiothoracic professional society-based definition of new-onset POAF, nor a broadly accepted consensus on how to prevent or treat it. Importantly, there is an ever-growing body of evidence that new-onset POAF is associated with worse patient outcomes. Given the lack of evidence-based guidelines, detection and treatment of POAF, in addition to understanding how POAF is related to these worse outcomes, represents an unaddressed quality of care concern. In the United States, the annual cardiac surgical POAF patient costs are estimated at ~$1 billion. The entire US Medicare annual budget has been reported at ~$141.2 billion for all hospital-related care; thus, the administrative challenges uniquely posed by POAF have been exposed for the first time. Mapping future tactics, this Vessel Plus special atrial fibrillation publication, swings the pendulum from impromptu observations towards action. A new strategic framework is proposed to begin the tedious but necessary task of taking on this elephant in the room. With ideal collaboration between clinical providers, health care systems, professional societies and insurers, a five-step approach is proposed to overcome these POAF patient care challenges.
术后心房颤动(POAF)是心脏手术后最常见的并发症,但对于新发POAF没有一致的心胸专业学会定义,对于如何预防或治疗也没有广泛接受的共识。重要的是,越来越多的证据表明,新发POAF与患者预后较差有关。鉴于缺乏循证指南,POAF的检测和治疗,以及了解POAF与这些不良结果的关系,代表了一个未解决的护理质量问题。在美国,每年心脏手术POAF患者的费用估计约为10亿美元。据报道,整个美国医疗保险年度预算约为1412亿美元,用于所有与医院有关的护理;因此,POAF所特有的管理挑战首次暴露出来。这篇《Vessel Plus》心房纤颤特刊描绘了未来的策略,将钟摆从即兴观察转向行动。提出了一个新的战略框架,以开始这项繁琐但必要的任务,即处理这只摆在房间里的大象。通过临床提供者、医疗保健系统、专业协会和保险公司之间的理想合作,提出了克服这些POAF患者护理挑战的五步方法。
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引用次数: 0
Clinical application of cardiac scintigraphy with bone tracers: controversies and pitfalls in cardiac amyloidosis 骨示踪剂心脏闪烁显像的临床应用:心脏淀粉样变性的争议和缺陷
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.87
F. Mattana, L. Muraglia, Francesca Girardi, I. Cerio, A. Porcari, F. Dore, R. Bonfiglioli, S. Fanti
Cardiac amyloidosis (CA) is a life-threatening disease caused by extracellular deposition of amyloidogenic proteins in the heart tissue; it could be associated with a poor prognosis and remains underdiagnosed and underestimated. During the last years, bone scintigraphy has been widely used to facilitate the diagnosis of CA, avoid endomyocardial biopsy, and differentiate amyloid light-chain amyloidosis from transthyretin amyloidosis. Technetium-99m pyrophosphate (99mTc-PYP) is the most used tracer in the United States, but a standardized and shared acquisition protocol is still lacking; technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) is widely used in Europe and can count on a more grounded data than 99mTc-PYP. Both tracers suffer from some diagnostic limitations (due to their biochemical characteristics) and pitfalls that can lead to a misdiagnosis of CA. We aim to briefly describe the main differences between 99mTc-PYP and 99mTc-DPD, analyzing the data available in the literature and highlighting the most frequent causes of misdiagnosis and pitfalls. Both 99mTc-DPD and 99mTc-PYP show good accuracy for the diagnosis of CA with high specificity and sensibility. Nevertheless, to achieve this accuracy, the correct acquisition protocols must be followed for each tracer, as suggested in the latest recommendation. Proper diagnosis of CA has a crucial role in patient management; therefore, it is important for nuclear physicians to have the most specific approaches in acquiring and interpreting bone scintigraphy for transthyretin cardiac amyloidosis.
心脏淀粉样变性(CA)是由淀粉样蛋白在心脏组织的细胞外沉积引起的一种危及生命的疾病;它可能与预后不良有关,仍未得到充分诊断和低估。近年来,骨显像已被广泛应用于CA的诊断,避免心内膜活检,以及区分淀粉样蛋白轻链淀粉样变性和甲状腺转蛋白淀粉样变性。锝-99m焦磷酸(99mTc-PYP)是美国使用最多的示踪剂,但仍缺乏标准化和共享的获取协议;锝-99m - 3,3-二膦-1,2-丙二羧酸(99mTc-DPD)在欧洲广泛使用,其数据比99mTc-PYP更可靠。这两种示踪剂都存在一些诊断局限性(由于其生化特性)和可能导致CA误诊的陷阱。我们的目的是简要描述99mTc-PYP和99mTc-DPD之间的主要区别,分析文献中可用的数据,并强调误诊和陷阱的最常见原因。99mTc-DPD和99mTc-PYP对CA的诊断准确性好,特异性和敏感性高。然而,为了达到这种准确性,必须按照最新的建议,对每种示踪剂采用正确的获取方案。CA的正确诊断在患者管理中具有关键作用;因此,对于核内科医生来说,在获取和解释经甲状腺素型心脏淀粉样变性的骨显像时,有最具体的方法是很重要的。
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引用次数: 4
Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic dissection 慢性主动脉夹层所致胸腹主动脉瘤的开放性修复
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2021.88
Jonathan C. Hong, J. Coselli
Chronic dissection of the thoracoabdominal aorta may require surgical repair for aneurysm, malperfusion, or rupture. Endovascular repair is made difficult by a noncompliant dissection septum, visceral vessels arising from different lumens, and the common use of diseased aortic landing zones. Thus, open repair remains the gold standard in terms of favorable outcomes and durability. During thoracoabdominal aortic repair, we use a multimodal strategy to prevent spinal cord and visceral or renal artery ischemia; key modalities include cerebrospinal fluid drainage, left heart bypass with and without visceral protection, cold renal protection, and aggressive reimplantation of intercostal or lumbar arteries. Patients with chronic dissection require lifelong surveillance, as there is a significant risk for subsequent intervention on unrepaired aortic segments.
慢性胸腹主动脉剥离可能需要手术修复动脉瘤,灌注不良,或破裂。由于隔膜分离不通畅,不同腔内产生内脏血管,以及通常使用病变主动脉着陆区,使得血管内修复变得困难。因此,开放性修复在良好的疗效和耐久性方面仍然是黄金标准。在胸腹主动脉修复过程中,我们使用多模式策略来防止脊髓和内脏或肾动脉缺血;主要治疗方法包括脑脊液引流、有或没有内脏保护的左心搭桥、冷肾保护、积极重建肋间或腰椎动脉。慢性夹层患者需要终身监测,因为对未修复的主动脉段进行后续干预的风险很大。
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引用次数: 0
Serum and tissue light-chains as disease biomarkers and targets for treatment in AL amyloidosis 血清和组织轻链作为AL淀粉样变性的疾病生物标志物和治疗靶点
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2022.06
L. Camerini, A. Aimo, A. Pucci, V. Castiglione, V. Musetti, S. Masotti, L. Caponi, G. Vergaro, C. Passino, A. Clerico, M. Franzini, M. Emdin
Amyloid light-chain (AL) amyloidosis is the most common type of systemic amyloidosis and is a multi-organ disease affecting mostly the heart and kidneys. AL amyloidosis is a protein misfolding disorder characterized by the tissue deposition of monoclonal light chains (LCs) produced by neoplastic plasma cells. Measurement of circulating free LC (FLC) is an important tool for diagnosis, risk stratification, and management of AL amyloidosis and can be performed through antibody-based methods or mass spectrometry. Furthermore, correct identification of LC deposits in tissues is essential to diagnose AL amyloidosis. Together with antibody-based techniques, methods relying on mass spectroscopy are now available.
淀粉样蛋白轻链(AL)淀粉样变性是最常见的系统性淀粉样变性,是一种多器官疾病,主要影响心脏和肾脏。AL淀粉样变性是一种蛋白质错误折叠疾病,其特征是肿瘤浆细胞产生单克隆轻链(LCs)的组织沉积。循环游离LC (FLC)的测量是AL淀粉样变性诊断、风险分层和管理的重要工具,可以通过基于抗体的方法或质谱法进行。此外,正确识别组织中的LC沉积物对于诊断AL淀粉样变性至关重要。与基于抗体的技术一起,依靠质谱的方法现在是可用的。
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引用次数: 0
Challenges of mitochondrial DNA editing in mammalian cells: focus on treatment of cardiovascular disease 哺乳动物细胞线粒体DNA编辑的挑战:关注心血管疾病的治疗
Pub Date : 2022-01-01 DOI: 10.20517/2574-1209.2022.28
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引用次数: 1
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