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Incident stroke in individuals with peripartum cardiomyopathy 围产期心肌病患者的中风发病率。
IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-21 DOI: 10.1016/j.ahj.2024.06.006
Chinwe Ibeh MD , Erin R. Kulick PhD, MPH , Amelia K. Boehme PhD , Alexander M. Friedman MD , Eliza C. Miller MD, MS , Natalie A. Bello MD, MPH

Background

Peripartum cardiomyopathy (PPCM), a form of heart failure with reduced ejection fraction (HFrEF) that occurs during the final month of pregnancy through the first 5 months postpartum, is associated with heightened risk for maternal morbidity and mortality. Stroke is a common complication of HFrEF but there is limited data on the incidence of stroke in PPCM.

Methods

Using statewide, nonfederal administrative data from 2000 to 2015, we analyzed age-adjusted risk of stroke within 3 years after PPCM-associated pregnancies.

Results

PPCM was associated with a greater than 4-fold increased risk of pregnancy-related stroke (aHR 4.7, 95% CI: 3.0-7.5). This risk was highest at the time of PPCM diagnosis but remained elevated in the first postpartum year.

Conclusion

Our findings confirm the strong association between PPCM and stroke, with risk that persists throughout and after the peripartum period.

背景:围产期心肌病(PPCM)是一种射血分数降低的心力衰竭(HFrEF),发生在妊娠的最后一个月至产后的前 5 个月,与孕产妇发病率和死亡率的增加有关。中风是 HFrEF 常见的并发症,但有关 PPCM 中风发生率的数据却很有限:利用 2000-2015 年全州非联邦行政数据,我们分析了与 PPCM 相关的妊娠后 3 年内经年龄调整的中风风险:结果:PPCM 与妊娠相关中风的风险增加了四倍多(aHR 4.7,95% CI:3.0-7.5)。这一风险在确诊 PPCM 时最高,但在产后第一年仍然较高:我们的研究结果证实了 PPCM 与中风之间的密切联系,其风险在整个围产期及之后持续存在。
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引用次数: 0
A bridge to comfort: Palliative inotrope infusion for patients with heart failure in hospice care 通向舒适的桥梁为接受安宁疗护的心力衰竭患者进行缓和肌注
IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-15 DOI: 10.1016/j.ahj.2024.06.005
Cayla M. Pichan MD , Wil L. Santivasi MD , Robert J. Mentz MD
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引用次数: 0
Impact of the clinical frailty scale on long-term outcomes after transcatheter aortic valve implantation 临床虚弱量表对经导管主动脉瓣植入术后长期疗效的影响
IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-12 DOI: 10.1016/j.ahj.2024.05.017
Norihisa Miyawaki MD , Kenichi Ishizu MD , Shinichi Shirai MD , Katsunori Miyahara MD , Ko Yamamoto MD, PhD , Tomohiro Suenaga MD , Akira Otani MD, PhD , Kenji Nakano MD , Tadatomo Fukushima MD , Euihong Ko MD , Yasuo Tsuru MD , Miho Nakamura MD , Toru Morofuji MD , Takashi Morinaga MD , Masaomi Hayashi MD , Akihiro Isotani MD , Nobuhisa Ohno MD , Shinichi Kakumoto MD , Kenji Ando MD

Background

The semiquantitative Clinical Frailty Scale (CFS) is reportedly a useful marker for predicting short- and mid-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of CFS in patients with severe aortic stenosis undergoing TAVI.

Methods

We prospectively assessed patients undergoing TAVI in Kokura Memorial Hospital using a 9-level CFS and enrolled 1594 patients after excluding patients with CFS 8-9. The patients were divided into the low (CFS level, 1-3; N = 842), intermediate (4; N = 469), and high (5-7; N = 283) groups according to their CFS levels.

Results

In the low, intermediate, and high groups, 3-year all-cause mortality rates were 17.4%, 29.4%, and 41.7% (P < .001) and composite rates of cardiovascular mortality and heart failure hospitalization were 12.1%, 19.1%, and 23.9% (P < .001), respectively. Multivariable analysis showed that higher frailty was independently associated with all-cause mortality (intermediate group: adjusted hazard ratio [HR], 1.63, 95% confidence interval [CI], 1.24-2.15, P < .001; high group: adjusted HR, 2.18, 95% CI, 1.59-2.99, P < .001) and composite of cardiovascular mortality and heart failure hospitalization (intermediate group: adjusted HR, 1.47, 95% CI, 1.04-2.08, P = .030; high group: adjusted HR, 1.66, 95% CI, 1.09-2.51, P = .018) and this result was consistent, irrespective of stratification based on age, sex, body mass index, left ventricular ejection fraction, Society of Thoracic Surgeons score, and New York Heart Association functional class without significant interaction.

Conclusions

The simple CFS tool predicts the long-term adverse outcomes post-TAVI.

背景:据报道,半定量临床虚弱量表(CFS)是预测经导管主动脉瓣植入术(TAVI)后短期和中期死亡率的有效指标。我们评估了 CFS 对接受 TAVI 的重度主动脉瓣狭窄患者的长期预后影响:我们使用 9 级 CFS 对在小仓纪念医院接受 TAVI 的患者进行了前瞻性评估,在排除了 CFS 为 8-9 级的患者后,共招募了 1594 名患者。根据患者的 CFS 水平,将其分为低(CFS 水平,1-3;N = 842)、中(4;N = 469)和高(5-7;N = 283)组:结果:在低、中和高组中,3 年全因死亡率分别为 17.4%、29.4% 和 41.7%(P 结论:简单的 CFS 工具可以预测慢性疾病的死亡率:简单的 CFS 工具可预测 TAVI 术后的长期不良后果。
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引用次数: 0
Comparative effectiveness of monitoring duration for detection of potential or suspected arrhythmias 监测持续时间对检测潜在或疑似心律失常的效果比较
IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-10 DOI: 10.1016/j.ahj.2024.04.010
James A. Reiffel MD
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引用次数: 0
Information for Readers 读者信息
IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-10 DOI: 10.1016/S0002-8703(24)00154-6
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引用次数: 0
Severe obesity among patients with left ventricular assist devices 左心室辅助装置患者中的严重肥胖症患者
IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-10 DOI: 10.1016/j.ahj.2024.05.006
Cathlyn K Medina MD , Stephanie G Barnes PhD , G Michael Felker MD, MHS , Robert J Mentz MD , Neha J Pagidipati MD , Keri A Seymour DO , Jacob N Schroder MD , Josephine Harrington MD

Background

Patients with obesity and advanced heart failure requiring left ventricular assist device (LVAD) support are more likely to experience LVAD complications and may be disproportionately Black and/or female when compared to patients without obesity. Among these patients, obesity may represent a barrier to transplant eligibility and a marker of inequity in heart transplantation and health outcomes in advanced heart failure.

Methods

To better understand this issue at our institution, we examined our active LVAD cohort and found that almost one-third of all patients had severe obesity with BMI ≥ 35 kg/m2.

Results

Patients with LVADs and severe obesity were significantly younger and more likely to self-identify as Black, and numerically more likely to be female.

Conclusion

Weight management in this group represents a vital area for improved equity in health outcomes and barriers to heart transplantation.

Trial Registration

NA.

背景肥胖和需要左心室辅助装置(LVAD)支持的晚期心力衰竭患者更有可能出现 LVAD 并发症,而且与非肥胖患者相比,黑人和/或女性患者的比例可能更高。在这些患者中,肥胖可能是移植资格的一个障碍,也是心脏移植和晚期心衰健康结果不公平的一个标志。方法为了更好地了解本机构的这一问题,我们检查了正在使用 LVAD 的队列,发现几乎三分之一的患者有严重肥胖,BMI ≥ 35 kg/m2。结果患有 LVAD 且严重肥胖的患者明显更年轻,更有可能自认为是黑人,而且在人数上更有可能是女性。结论该群体的体重管理是改善健康结果公平性和心脏移植障碍的一个重要领域。
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引用次数: 0
Temporal changes in the number of European and American guideline recommendations and underlying evidence base for the management of infective: An update of previous published data 欧洲和美国关于感染性疾病管理的指南建议数量和基本证据基础的时间变化:更新以往公布的数据
IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-10 DOI: 10.1016/j.ahj.2024.04.014
Lauge Østergaard MD, PhD, Sofie Truong MB, Jeppe Petersen MD, Eva Havers-Borgersen MD, Lars Køber MD, DMSc, Emil Loldrup Fosbøl MD, PhD

This report aimed to examine temporal changes in the number of recommendations on management of infective endocarditis in the European and American guidelines. The number of recommendations has increased since 2004 without an increment in evidence base in the European iteration. American guidelines have reduced the number of recommendations with a main evidence base of level B.

本报告旨在研究欧洲和美国指南中有关感染性心内膜炎管理建议数量的时间变化。自 2004 年以来,欧洲指南中的建议数量有所增加,但证据基础没有增加。美国指南减少了主要证据基础为B级的建议数量。
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引用次数: 0
REGENERATE-COBRA: A phase II randomized sham-controlled trial assessing the safety and efficacy of intracoronary administration of autologous bone marrow-derived cells in patients with refractory angina REGENERATE-COBRA:一项二期随机假对照试验,评估在难治性心绞痛患者中冠状动脉内注射自体骨髓衍生细胞的安全性和有效性。
IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-09 DOI: 10.1016/j.ahj.2024.06.001
Rohini Ramaseshan MD , Dhanuka Perera MD , Alice Reid MA , Mervyn Andiapen RN , Cono Ariti PhD , Matthew Kelham MD , Daniel A. Jones MD PhD , Anthony Mathur MD PhD

Aims

The REGENERATE-COBRA trial (NCT05711849) will assess the safety and efficacy of an intracoronary infusion of autologous bone marrow-derived mononuclear cells in refractory angina patients with no revascularization options who are symptomatic despite optimal medical and device therapy.

Methods

REGENERATE-COBRA is a single site, blinded, randomized, sham-controlled, Phase II clinical trial enrolling 110 refractory angina patients with no revascularization options who are symptomatic despite optimal medical and device therapy. Patients will be randomized to either autologous bone marrow derived-mononuclear cells or a sham procedure. Patients in the cell-treated arm will undergo a bone marrow aspiration and an intracoronary infusion of autologous bone marrow derived-mononuclear cells. Patients in the control arm will undergo a sham bone marrow aspiration and a sham intracoronary infusion. The trial's primary endpoint is an improvement in Canadian Cardiovascular Society (CCS) angina class by 2 classes between baseline and 6 months. Secondary endpoints include change in: CCS class at 12 months, myocardial ischemic burden (as measured by perfusion imaging) at 6 months, quality of life at 6 and 12 months (as measured by EQ-5D-5L, EQ-5D-VAS and Seattle Angina Questionnaire), angina frequency at 6 and 12 months, total exercise time (as measured by a modified Bruce protocol) and major adverse cardiovascular events at 6 and 12 months.

Conclusions

This is the first trial to assess the safety and efficacy of an intracoronary infusion of autologous bone marrow-derived unfractionated mononuclear cells in symptomatic refractory angina patients who have exhausted conventional therapeutic options.

目的:REGENERATE-COBRA 试验(NCT05711849)将评估冠状动脉内输注自体骨髓源性单核细胞治疗难治性心绞痛患者的安全性和有效性:REGENERATE-COBRA是一项单点、盲法、随机、假对照的II期临床试验,共招募了110名没有血管再通选择的难治性心绞痛患者,这些患者在接受了最佳的药物和器械治疗后仍无症状。患者将随机接受自体骨髓单核细胞治疗或假性治疗。细胞治疗组患者将进行骨髓抽吸,并在冠状动脉内输注自体骨髓单核细胞。对照组患者将进行假骨髓抽吸和假冠状动脉内输注。试验的主要终点是加拿大心血管协会(CCS)心绞痛分级在基线和6个月之间提高2级。次要终点包括12个月时的CCS分级、6个月时的心肌缺血负荷(通过灌注成像测量)、6个月和12个月时的生活质量(通过EQ-5D-5L、EQ-5D-VAS和西雅图心绞痛问卷测量)、6个月和12个月时的心绞痛频率、总运动时间(通过改良布鲁斯方案测量)以及6个月和12个月时的主要心血管不良事件:这是首次评估冠状动脉内输注自体骨髓来源的未分离单核细胞对用尽常规治疗方案的无症状难治性心绞痛患者的安全性和有效性的试验。
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引用次数: 0
Design and rationale of the social determinants of the risk of hypertension in women of reproductive age (SAFE HEART) study: An American Heart Association research goes red initiative 育龄妇女高血压风险的社会决定因素(SAFE HEART)研究的设计与原理:美国心脏协会 "红色研究 "计划。
IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-09 DOI: 10.1016/j.ahj.2024.05.016

Background

Cardiovascular health literacy (CVHL) and social determinants of health (SDoH) play interconnected and critical roles in shaping cardiovascular health (CVH) outcomes. However, awareness of CVH risk has declined markedly, from 65% of women being aware that cardiovascular disease (CVD) is the leading cause of death for women in 2009 to just 44% being aware in 2019. The American Heart Association Research Goes Red (RGR) initiative seeks to develop an open-source, longitudinal, dynamic registry that will help women to be aware of and participate in research studies, and to learn about CVD prevention. We proposed to leverage this platform, particularly among Black and Hispanic women of reproductive age, to address CVHL gaps and advance health equity.

Methods

The primary objective of the study is to evaluate the cross-sectional association of CVHL, SDoH using a polysocial score, and CVH in women of reproductive age at increased risk of developing hypertension (HTN). To achieve this we will use a cross-sectional study design, that engages women already enrolled in the RGR registry (registry-enrolled). To enhance the racial and ethnic/social economic diversity of the cohort, we will additionally enroll 300 women from the Baltimore and Washington D.C. community into the Social Determinants of the Risk of Hypertension in Women of Reproductive Age (SAFE HEART) Study. Community-enrolled and registry-enrolled women will undergo baseline social phenotyping including detailed SDoH questionnaire, CVH metrics assessment, and CVHL assessment. The secondary objective is to assess whether a 4-month active health education intervention will result in a change in CVHL in the 300 community-enrolled women.

Discussion

The SAFE HEART study examines the association between CVHL, SDoH, and CVH, with a focus on racial and ethnic minority groups and socioeconomically disadvantaged women of reproductive age, and the ability to improve these parameters by an educational intervention. These findings will inform the future development of community-engaged strategies that address CVHL and SDoH among women of reproductive age.

背景:心血管健康知识(CVHL)和健康的社会决定因素(SDoH)在塑造心血管健康(CVH)结果方面发挥着相互关联的关键作用。然而,人们对心血管健康风险的认识却明显下降,从 2009 年 65% 的女性意识到心血管疾病(CVD)是导致女性死亡的主要原因,到 2019 年仅有 44% 的女性意识到这一点。美国心脏协会 "红色研究"(RGR)计划旨在开发一个开源、纵向、动态的登记册,帮助女性了解和参与研究,并学习心血管疾病的预防知识。我们建议利用这一平台,特别是在黑人和西班牙裔育龄妇女中,解决心血管疾病和慢性心血管疾病的差距,促进健康公平:本研究的主要目的是评估心血管健康素养(CVHL)、使用多元社会评分的 SDoH 以及高血压(HTN)发病风险增加的育龄妇女的心血管健康素养之间的横向联系。为此,我们将采用横断面研究设计,让已加入 RGR 注册表(注册表已注册)的妇女参与其中。为了增强队列的种族和民族/社会经济多样性,我们还将从巴尔的摩和华盛顿特区社区招募 300 名妇女参加 "育龄妇女高血压风险的社会决定因素(SAFE HEART)研究"。社区注册和注册妇女将接受基线社会表型分析,包括详细的 SDoH 问卷、CVH 指标评估和 CVHL 评估。次要目标是评估为期 4 个月的积极健康教育干预是否会导致 300 名社区登记妇女的 CVHL 发生变化:讨论:SAFE HEART 研究探讨了 CVHL、SDoH 和 CVH 之间的关联,重点关注少数民族群体和社会经济条件较差的育龄妇女,以及通过教育干预改善这些参数的能力。这些发现将为今后制定社区参与战略,解决育龄妇女的 CVHL 和 SDoH 问题提供参考。
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引用次数: 0
Information for Readers 读者信息
IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-08 DOI: 10.1016/S0002-8703(24)00134-0
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引用次数: 0
期刊
American heart journal
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