International journal of cardiology. Heart & vessels最新文献_第4页

Distinct structural and molecular features of the myocardial extracellular matrix remodeling in compensated and decompensated cardiac hypertrophy due to aortic stenosis 主动脉狭窄代偿性和失代偿性心肌肥厚中心肌细胞外基质重构的独特结构和分子特征

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.05.001

Victoria Polyakova , Manfred Richter , Natalia Ganceva , Hans-Jürgen Lautze , Sokichi Kamata , Jochen Pöling , Andres Beiras-Fernandez , Stefan Hein , Zoltan Szalay , Thomas Braun , Thomas Walther , Sawa Kostin

Objectives

We used immuhistochemistry and Western blot to study fibrillar and non-fibrillar collagens, collagen metabolism, matricellular proteins and regulatory factors of the ECM remodeling in left ventricular (LV) septum biopsies from 3 groups of patients with aortic valve stenosis (AS): (AS-1,n = 9): ejection fraction (EF) > 50%; AS-2,(n = 12): EF 30%–50%; AS-3,(n = 9): EF < 30%). Samples from 8 hearts with normal LV function served as controls.

Results

In comparison with controls, fibrillar collagens I and III were progressively upregulated from compensated (AS-1) toward decompensated hypertrophy (AS-3). The collagenIII/collagen I ratio decreased 2-fold in the AS-2 and AS-3 groups as compared with AS-1 and controls. Non-fibrillar collagen IV was upregulated only in AS-3 patients, whereas collagen VI progressively increased from AS-1 to AS-3 group. Collagen synthesis in AS-3 was shifted to collagen I, while the maturation/degradation level was shifted to collagen III. RECK was downregulated only in AS-3 patients. Matricellular proteins tenascin and osteopontin were increased in all AS patients. However, thrombospondin 1, 4 and CTGF were increased only in AS-3. Only AS-3 patients were characterized by increased levels of TGFβ1 and downregulation of TGFβ3, TGFβ-activated kinase1 and Smad7. In contrast, Smad3 gradually increased from AS-1 toward AS-3. Similar trend of changes was observed for TNFα-R1 and TNFα-R2, whereas TNFα was diminished only in AS-2 and AS-3.

Conclusions

Distinct changes in fibrillar collagen turnover, non-fibrillar collagens, matricellular proteins and the key regulatory profibrotic and anti-fibrotic factors of the myocardial ECM remodeling are involved in the transition from compensated to decompensated LV hypertrophy and HF in human patients with AS.

目的应用免疫组织化学和Western blot方法研究3组主动脉瓣狭窄(AS)患者左室(LV)隔活检中纤维性和非纤维性胶原、胶原代谢、基质细胞蛋白和ECM重构的调控因子:AS-1,n = 9;50%;AS-2，(n = 12): EF 30%-50%;AS-3，(n = 9): EF <30%)。8例左室功能正常的心脏作为对照。结果与对照组相比，原纤维胶原I和III从代偿性(AS-1)向失代偿性肥大(AS-3)逐渐上调。与as -1和对照组相比，as -2和as -3组的iii型胶原/ I型胶原比率降低了2倍。非纤原性胶原IV仅在AS-3患者中上调，而从AS-1组到AS-3组，胶原VI逐渐升高。AS-3中的胶原合成转移到胶原I，而成熟/降解水平转移到胶原III。RECK仅在AS-3患者中下调。所有AS患者的基质细胞蛋白tenascin和骨桥蛋白均升高。而血栓反应蛋白1、4和CTGF仅在AS-3中升高。只有AS-3患者表现为tgf - β1水平升高，tgf - β3、tgf - β活化激酶1和Smad7水平下调。而Smad3则从AS-1向AS-3逐渐增加。TNFα- r1和TNFα- r2的变化趋势相似，而TNFα仅在AS-2和AS-3中减少。结论纤原性胶原转换、非纤原性胶原、基质细胞蛋白及心肌ECM重构关键促纤维化和抗纤维化因子的显著变化参与了AS患者由代偿性左室肥大和失代偿性心衰的转变。

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引用次数: 5

Impact of blood urea nitrogen for long-term risk stratification in patients with coronary artery disease undergoing percutaneous coronary intervention 血尿素氮对经皮冠状动脉介入治疗的冠状动脉疾病患者长期危险分层的影响

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.06.002

Masayuki Kawabe , Akira Sato , Tomoya Hoshi , Shunsuke Sakai , Daigo Hiraya , Hiroaki Watabe , Yuki Kakefuda , Mayu Ishibashi , Daisuke Abe , Noriyuki Takeyasu , Kazutaka Aonuma

Background

Few studies have examined the association between blood urea nitrogen (BUN) and mortality in patients with coronary artery disease (CAD). We investigated the prognostic value of BUN concentration at hospital admission in patients with CAD.

Methods

A total of 3641 patients with CAD who underwent percutaneous coronary intervention (PCI) were included from April 2007 to June 2011. We measured BUN concentration at hospital admission and compared it with long-term clinical outcome. Patients were classified into three groups according to BUN concentration of < 20 mg/dl, 20 to 25 mg/dl, or > 25 mg/dl. Primary endpoint was all-cause death.

Results

During the follow-up period (median 15 months), 248 (6.8%) patients died. A higher BUN level was associated with multivessel disease, lower ejection fraction, lower systolic blood pressure, and higher prevalence of comorbidities. Cox regression analysis showed that patients with BUN of > 25 mg/dl had a hazard ratio (HR) for mortality of 2.73 (95% CI, 1.14 to 6.53; p = 0.023) with an estimated glomerular filtration rate (eGFR) of ≥ 45 ml/min/1.73 m² and a HR of 2.90 (95% CI, 1.75 to 4.82; p < 0.001) with an eGFR of < 45 ml/min/1.73 m². Regardless of acute coronary syndrome or stable CAD, BUN of > 25 mg/dl was independently associated with higher mortality (HR, 2.58; 95% CI, 1.43 to 4.64; p = 0.004 and HR, 2.16; 95% CI, 1.01 to 4.59; p = 0.044, respectively).

Conclusions

A BUN of > 25 mg/dl was associated with long-term mortality in CAD patients who underwent PCI independent of traditional cardiovascular risk factors and eGFR.

背景:很少有研究探讨冠状动脉疾病(CAD)患者血尿素氮(BUN)与死亡率之间的关系。我们研究了冠心病患者入院时BUN浓度的预后价值。方法收集2007年4月至2011年6月行经皮冠状动脉介入治疗(PCI)的冠心病患者3641例。我们在入院时测量BUN浓度，并将其与长期临床结果进行比较。根据血尿素氮浓度将患者分为三组;20毫克/分升，20至25毫克/分升，或>25 mg / dl。主要终点为全因死亡。结果在随访期间(中位15个月)，248例(6.8%)患者死亡。较高的BUN水平与多血管疾病、较低的射血分数、较低的收缩压和较高的合并症发生率相关。Cox回归分析显示，BUN患者;25 mg/dl的死亡率风险比(HR)为2.73 (95% CI, 1.14 ~ 6.53;p = 0.023)，估计肾小球滤过率(eGFR)≥45 ml/min/1.73 m2, HR为2.90 (95% CI, 1.75 ~ 4.82;p & lt;0.001)， eGFR为<45毫升/分钟/1.73平方米。无论急性冠状动脉综合征或稳定型冠心病，BUN >25 mg/dl与较高的死亡率独立相关(HR, 2.58;95% CI, 1.43 ~ 4.64;p = 0.004, HR为2.16;95% CI, 1.01 ~ 4.59;P = 0.044)。结论;25mg /dl与接受PCI治疗的冠心病患者的长期死亡率相关，与传统心血管危险因素和eGFR无关。

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引用次数: 8

In-hospital and 3-year clinical outcomes following ad hoc versus staged percutaneous coronary interventions in chronic total occlusion — A real world practice 慢性全闭塞患者临时与分期经皮冠状动脉介入治疗的住院和3年临床结果——一项现实世界的实践

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.06.012

Hsiu-Yu Fang , Wei-Chieh Lee , Hesham Hussein , Chih-Yuan Fang , Cheng-I Cheng , Cheng-Hsu Yang , Chien-Jen Chen , Chi-Ling Hang , Hon-Kan Yip , Yu-Sheng Lin , Chiung-Jen Wu

Background

Ad hoc percutaneous coronary intervention (PCI) which was performed immediately after diagnostic catheterization has become the most common way of coronary intervention. However, limited data is available on in-hospital and long-term outcome comparing ad hoc and staged chronic total occlusion (CTO) PCI. The aim of our study was to figure the short-term and long-term outcomes after ad hoc or staged CTO PCI.

Methods

This retrospective analysis included 512 consecutive patients that underwent 561 CTO PCI procedures between January 2002 and December 2009. Patient basic demographics, lesion characteristics, interventional procedure, devices used and in-hospital outcomes were compared between ad hoc and staged CTO PCI groups. 3-Year clinical outcomes that included all-cause mortality, cardiac mortality, myocardial infarction (MI), the need for coronary artery bypass graft surgery (CABG), major adverse cardiac events (MACE) and target vessel revascularization (TVR) were compared. Time-to-event analyses were performed using Kaplan–Meier statistics.

Results

Four hundred fifty-one patients (80.4%) were enrolled in ad hoc CTO PCI group. Final successful revascularization was higher in ad hoc CTO PCI group compared with staged CTO PCI group (82.9 vs. 77.3%, p = 0.17) without statistical significance. There was no significant difference between ad hoc CTO PCI and staged CTO PCI groups in in-hospital outcomes such as all-cause mortality, cardiac death, myocardial infarction, urgent bypass surgery, urgent PCI or complications. Patients with ad hoc CTO PCI had lower rate of all-cause mortality (6.2% vs. 6.5%, p = 0.89), the need for CABG (1.9% vs. 2.1%, p = 0.89) but higher rate of cardiac mortality (1.7% vs. 0.0%, p = 0.21), MI (1.0% vs. 0.0%, p = 0.34), MACE (24.1% vs. 17.5%, p = 0.19) and TVR (17.8% vs. 10.0%, p = 0.069) without statistical significance in 3-year clinical outcomes.

Conclusion

3-Year clinical outcomes compared with ad hoc CTO PCI and staged CTO PCI had insignificant differences between: all-cause mortality, cardiac mortality, MI, the need for CABG, MACE and TVR.

背景经皮冠状动脉介入治疗(PCI)在诊断性置管后立即进行，已成为最常见的冠状动脉介入治疗方式。然而，比较临时和分期慢性全闭塞PCI (CTO)的住院和长期结果的数据有限。我们研究的目的是计算临时或分期CTO PCI后的短期和长期结果。方法回顾性分析2002年1月至2009年12月期间512例连续接受561例CTO PCI手术的患者。比较临时和分期CTO PCI组患者的基本人口统计学特征、病变特征、介入程序、使用的器械和住院结果。比较3年的临床结果，包括全因死亡率、心脏死亡率、心肌梗死(MI)、冠状动脉搭桥手术(CABG)的必要性、主要心脏不良事件(MACE)和靶血管重建术(TVR)。使用Kaplan-Meier统计进行时间-事件分析。结果入组451例(80.4%)。临时CTO PCI组最终血运重建率高于分期CTO PCI组(82.9% vs 77.3%， p = 0.17)，但无统计学意义。在全因死亡率、心源性死亡、心肌梗死、紧急搭桥手术、紧急PCI或并发症等院内结局方面，临时CTO PCI组与分期CTO PCI组之间无显著差异。临时性CTO PCI患者的全因死亡率(6.2% vs. 6.5%， p = 0.89)、CABG必要性(1.9% vs. 2.1%， p = 0.89)较低，但心脏死亡率(1.7% vs. 0.0%， p = 0.21)、心肌梗死(1.0% vs. 0.0%， p = 0.34)、MACE (24.1% vs. 17.5%， p = 0.19)和TVR (17.8% vs. 10.0%， p = 0.069)较高，3年临床结果无统计学意义。结论与临时CTO PCI和分期CTO PCI相比，3年临床结果:全因死亡率、心脏死亡率、心肌梗死、冠脉搭桥必要性、MACE和TVR差异均无统计学意义。

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引用次数: 5

Systemic perfusion at peak incremental exercise in left ventricular assist device recipients: Partitioning pump and native left ventricle relative contribution 左心室辅助装置接受者在峰值增量运动时的全身灌注:分配泵和原生左心室的相对贡献

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.07.004

Alessandro Mezzani , Massimo Pistono , Ugo Corrà , Andrea Giordano , Marco Gnemmi , Alessandro Imparato , Paolo Centofanti , Mauro Rinaldi , Silvia Colombo , Elena Canal , Pantaleo Giannuzzi

Background

In continuous-flow left ventricular assist device (LVAD) recipients, little is known about the relative pump- and left ventricle-generated blood flow (PBF and LVBF, respectively) contribution to peak systemic perfusion during incremental exercise and about how PBF/LVBF interplay and exercise capacity may be affected by pump speed increase.

Methods

Twenty-two LVAD recipients underwent ramp cardiopulmonary exercise tests at fixed and increasing pump speed (+ 1.5% of baseline speed/10 W workload increase), echocardiography and NT-proBNP dosage. Peak systemic perfusion was peak VO₂/estimated peak arterio-venous O₂ difference, and LVBF was systemic perfusion minus PBF provided by LVAD controller. A change of peak percentage of predicted VO_2max (Δpeak%VO₂) ≥ 3 in increasing- vs. fixed-speed test was considered significant.

Results

Tricuspid annular plane systolic excursion (TAPSE) and NT-proBNP were significantly lower and higher, respectively, in Δpeak%VO₂ < 3 than ≥ 3. A LVBF contribution to systemic perfusion significantly larger than that of PBF was observed in Δpeak%VO₂ ≥ 3 vs. < 3 in fixed-speed test, which was further amplified in increasing-speed test (2.4 ± 1.7 l/min vs. 2.0 ± 1.5 l/min and 0.8 ± 2.2 l/min vs. 1.3 ± 2.3 l/min, respectively, p for trend < 0.0005). Among several clinical-instrumental parameters, logistic regression selected only TAPSE > 13 mm as a predictor of Δpeak%VO₂ ≥ 3.

Conclusions

A significant LVBF contribution to peak systemic perfusion and pump speed increase-induced peak VO₂ improvement was detectable only in patients with a more preserved right ventricular systolic function and stable hemodynamic picture. These findings should be taken into consideration when designing LVAD controllers aiming to increase pump speed according to increasing exercise demands.

在连续血流左心室辅助装置(LVAD)接受者中，关于在增量运动期间泵和左心室产生的相对血流量(分别为PBF和LVBF)对全身灌注峰值的贡献以及PBF/LVBF如何相互作用和运动能力可能受到泵速增加的影响知之甚少。方法22例LVAD受者分别在固定和增加泵速(+ 1.5%基线速度/10 W工作量增加)、超声心动图和NT-proBNP剂量下进行斜坡式心肺运动试验。全身灌注峰值为峰值VO2/估计峰值动静脉O2差值，LVBF为全身灌注减去LVAD控制器提供的PBF。在变速与定速试验中，预测VO2max的峰值百分比(Δpeak%VO2)≥3的变化被认为是显著的。结果:Δpeak%VO2和lt时，心肌环面收缩偏移(TAPSE)和NT-proBNP分别显著降低和升高;3比≥3。在Δpeak%VO2≥3 vs. <时，LVBF对全身灌注的贡献明显大于PBF;3在定速试验中，在提速试验中进一步放大(分别为2.4±1.7 l/min vs. 2.0±1.5 l/min和0.8±2.2 l/min vs. 1.3±2.3 l/min, p为趋势和lt;0.0005)。在几个临床仪器参数中，逻辑回归只选择了TAPSE >13mm作为Δpeak%VO2≥3的预测因子。结论LVBF对全身灌注峰值和泵速增加引起的峰值VO2改善的显著贡献仅在右室收缩功能保存较好且血流动力学图像稳定的患者中可见。在设计LVAD控制器时应考虑到这些发现，目的是根据不断增加的运动需求来提高泵速。

{"title":"Systemic perfusion at peak incremental exercise in left ventricular assist device recipients: Partitioning pump and native left ventricle relative contribution","authors":"Alessandro Mezzani , Massimo Pistono , Ugo Corrà , Andrea Giordano , Marco Gnemmi , Alessandro Imparato , Paolo Centofanti , Mauro Rinaldi , Silvia Colombo , Elena Canal , Pantaleo Giannuzzi","doi":"10.1016/j.ijchv.2014.07.004","DOIUrl":"10.1016/j.ijchv.2014.07.004","url":null,"abstract":"<div><h3>Background</h3><p>In continuous-flow left ventricular assist device (LVAD) recipients, little is known about the relative pump- and left ventricle-generated blood flow (PBF and LVBF, respectively) contribution to peak systemic perfusion during incremental exercise and about how PBF/LVBF interplay and exercise capacity may be affected by pump speed increase.</p></div><div><h3>Methods</h3><p>Twenty-two LVAD recipients underwent ramp cardiopulmonary exercise tests at fixed and increasing pump speed (+ 1.5% of baseline speed/10 W workload increase), echocardiography and NT-proBNP dosage. Peak systemic perfusion was peak VO<sub>2</sub>/estimated peak arterio-venous O<sub>2</sub> difference, and LVBF was systemic perfusion minus PBF provided by LVAD controller. A change of peak percentage of predicted VO<sub>2max</sub> (Δpeak%VO<sub>2</sub>) ≥ 3 in increasing- vs. fixed-speed test was considered significant.</p></div><div><h3>Results</h3><p>Tricuspid annular plane systolic excursion (TAPSE) and NT-proBNP were significantly lower and higher, respectively, in Δpeak%VO<sub>2</sub> < 3 than ≥ 3. A LVBF contribution to systemic perfusion significantly larger than that of PBF was observed in Δpeak%VO<sub>2</sub> ≥ 3 vs. < 3 in fixed-speed test, which was further amplified in increasing-speed test (2.4 ± 1.7 l/min vs. 2.0 ± 1.5 l/min and 0.8 ± 2.2 l/min vs. 1.3 ± 2.3 l/min, respectively, p for trend < 0.0005). Among several clinical-instrumental parameters, logistic regression selected only TAPSE > 13 mm as a predictor of Δpeak%VO<sub>2</sub> ≥ 3.</p></div><div><h3>Conclusions</h3><p>A significant LVBF contribution to peak systemic perfusion and pump speed increase-induced peak VO<sub>2</sub> improvement was detectable only in patients with a more preserved right ventricular systolic function and stable hemodynamic picture. These findings should be taken into consideration when designing LVAD controllers aiming to increase pump speed according to increasing exercise demands.</p></div>","PeriodicalId":90542,"journal":{"name":"International journal of cardiology. Heart & vessels","volume":"4 ","pages":"Pages 40-45"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchv.2014.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54358245","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: 18

Automated template matching correlates with earliest activation during mapping of idiopathic premature ventricular contractions 自动模板匹配与特发性室性早搏制图中最早激活相关

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.08.006

Jakob Lüker , Arian Sultan , Helge Servatius , Imke Berner, Boris Alexander Hoffmann, Stephan Willems, Daniel Steven

Background

Ablation of premature ventricular contractions (PVC) can be challenging due to infrequent spontaneous ectopy and the limitations subjective pacemapping (PM). Activation mapping (AM) provides an objective parameter, but relies on spontaneous ectopic activity.

Objectives

The objective of the study was to evaluate the correlation of automated template matching (TM) with activation timing and to investigate potential implications towards ablation success.

Methods

Forty patients undergoing catheter ablation of idiopathic outflow tract VT or PVC in 47 procedures were included. PVC/VT origin was determined by PM and AM. A percentage value for PM was calculated using TM software and correlated with corresponding activation timing. Overall, 126 TM and corresponding AM values were analyzed. All patients were followed (313 ± 158 days after ablation) including a 24-hour Holter ECG.

Results

A correlation between TM and activation timing (r = 0.66, P < 0.0001) could be shown. Success rate at followup was 77%. No statistically significant coherence of TM percentage and relapse was observed.

Conclusions

Template matching correlates with activation timing in the process of mapping idiopathic focal PVC/VT. TM helps to objectify the process of PM and may therefore be helpful to guide successful ablation in the absence of spontaneous ectopy.

背景:由于自发性室性早搏(PVC)少见和主观起搏(PM)的局限性，室性早搏(PVC)的消融具有挑战性。激活映射(AM)提供了一个客观参数，但依赖于自发异位活性。目的本研究的目的是评估自动模板匹配(TM)与激活时间的相关性，并探讨对消融成功的潜在影响。方法对47例特发性流出道VT或PVC行导管消融的患者40例进行回顾性分析。PVC/VT来源由PM和AM确定。使用TM软件计算PM的百分比值，并与相应的激活时间相关联。总共分析了126个TM和相应的AM值。随访所有患者(消融后313±158天)，包括24小时动态心电图。结果TM与激活时间相关(r = 0.66, P <0.0001)。随访成功率为77%。TM百分比与复发率的相关性无统计学意义。结论stemplate匹配在特发性局灶性PVC/VT定位过程中与激活时间相关。TM有助于使PM过程客观化，因此可能有助于指导在没有自发性异位的情况下成功消融。

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引用次数: 4

Trends in percutaneous coronary intervention and angiography in Ireland, 2004–2011: Implications for Ireland and Europe 2004-2011年爱尔兰经皮冠状动脉介入治疗和血管造影的趋势:对爱尔兰和欧洲的影响

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.08.001

S. Jennings , K. Bennett , E. Shelley , P. Kearney , K. Daly , W. Fennell

Background/objectives

To study temporal trends in crude and age standardised rates of cardiac catheterisation and percutaneous coronary intervention (PCI) in Ireland, 2004–2011.

Methods

Two data sources were used: a) a survey of publicly and privately funded hospitals with cardiac catheter laboratories to obtain the annual number of procedures performed and b) anonymised data from the Hospital In-Patient Enquiry (HIPE) for angiography and PCI in acute publicly funded hospitals; age standardised rates were calculated to study trends over time.

Results

From 2004 to 2011 the crude rate of angiography and PCI increased by 47.8% and 35.9% respectively, with rates of 6689 and 1825 per million population in 2011. Following age standardisation, however, PCI activity showed a non-significant decrease over time. The PCI to angiography ratio decreased from 30% to 27% and PCI was performed predominantly for stable coronary heart disease (54%) in 2011.

Conclusion

Angiography and PCI rates have increased in Ireland but PCI crude and age adjusted rates show divergent trends. While Ireland differs from USA and UK, with a higher proportion of PCI being performed for stable CHD in recent years, little systematic surveillance of cardiological interventions within Europe is available to benchmark improvements in Ireland.

背景/目的研究2004-2011年爱尔兰心脏导管插入术和经皮冠状动脉介入治疗(PCI)的粗标准化率和年龄标准化率的时间趋势。方法采用两种数据来源:a)对拥有心导管实验室的公立和私立医院进行调查，以获得每年进行的手术数量;b)来自公立医院急性血管造影和PCI的医院住院查询(HIPE)的匿名数据;计算年龄标准化比率是为了研究一段时间内的趋势。结果2004 - 2011年血管造影和PCI粗检率分别上升47.8%和35.9%，2011年分别为6689例和1825例/百万人口。然而，在年龄标准化之后，PCI活动随时间的推移显示出不显著的下降。2011年，PCI与血管造影的比例从30%降至27%，PCI主要用于稳定型冠心病(54%)。结论爱尔兰的血管造影和PCI率有所上升，但PCI粗率和经年龄调整后的PCI率呈差异趋势。虽然爱尔兰与美国和英国不同，近年来，稳定型冠心病的PCI治疗比例较高，但在欧洲，很少有系统的心脏病干预监测可以用于爱尔兰的基准改善。

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引用次数: 20

Elevated urinary albumin excretion complements the Framingham Risk Score for the prediction of cardiovascular risk — response to treatment in the PREVEND IT trial 升高的尿白蛋白排泄补充了Framingham风险评分，用于预测预防IT试验中心血管风险对治疗的反应

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.04.004

Frank P. Brouwers , Folkert W. Asselbergs , Hans L. Hillege , Ron T. Gansevoort , Rudolf A. de Boer , Wiek H. van Gilst

Background

The PREVEND IT trial reported on a high cardiovascular (CV) event rate in subjects with a baseline urinary albumin excretion (UAE) rate of ≥ 50 mg/24 h. Here, we report on the observed 10-year CV outcome of this population and compare this with the predicted Framingham Risk Score (FRS). In addition, we evaluated the effect of four years of fosinopril treatment on this relation.

Methods and results

From the PREVEND IT cohort, 833 subjects without history of CV disease, randomized to fosinopril (N = 412) or placebo (N = 421), were studied. The primary endpoint included CV mortality and adjudicated hospitalization for CV disease during a 10-year follow-up period. Mean age was 51 ± 12 years and 65% were males, while prevalence of diabetes (2.6%) and use of CV drugs (3.5%) was low. Subjects were categorized to high UAE (≥ 50 mg/24 h) or low UAE (< 50 mg/24 h). After 10 years of follow-up, the event rate in the high UAE group was almost twice as high as predicted by the FRS (29.5% vs. 17.2%). Treatment for four years with fosinopril reduced the event rate to comparable levels of that predicted by FRS. The addition of UAE ≥ 50 mg/24 h to the FRS improved the Integrated Discrimination Improvement (P = 0.033) and increased the area under the curve by 0.54% (P = 0.024).

Conclusions

The 10-year CV risk of subjects with an elevated UAE (≥ 50 mg/24 h) is substantially underestimated by the FRS. Treatment with fosinopril successfully reduced this increased event rate to FRS-predicted CV risk.

PREVEND IT试验报告了基线尿白蛋白排泄(UAE)率≥50 mg/24小时的受试者的高心血管(CV)事件发生率。在这里，我们报告了该人群观察到的10年CV结局，并将其与预测的Framingham风险评分(FRS)进行了比较。此外，我们评估了福辛普利治疗4年对这一关系的影响。方法和结果在PREVEND队列中，研究了833名无CV病史的受试者，随机分为福辛普利组(N = 412)和安慰剂组(N = 421)。主要终点包括10年随访期间的CV死亡率和因CV疾病而确定的住院治疗。平均年龄为51±12岁，男性占65%，糖尿病患病率(2.6%)和CV药物使用率(3.5%)较低。受试者被分为高UAE(≥50 mg/24 h)和低UAE (<经过10年的随访，高UAE组的事件发生率几乎是FRS预测的两倍(29.5%对17.2%)。4年的福sinopril治疗将事件发生率降低到FRS预测的相当水平，在FRS中添加≥50 mg/24 h的UAE提高了综合判别改善(P = 0.033)，曲线下面积增加了0.54% (P = 0.024)。结论:UAE升高(≥50 mg/24 h)受试者的10年CV风险被FRS大大低估，福辛普利治疗成功地将升高的事件发生率降低到FRS预测的CV风险。

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引用次数: 0

Fractional flow reserve-guided endovascular therapy for common iliac artery stenosis; a comparison with the exercise ankle brachial index: A case report 血流储备分数引导血管内治疗髂总动脉狭窄；与运动踝臂指数的比较：一例报告

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.05.003

Tsuyoshi Ito , Hiroshi Fujita, Tomomitsu Tani, Nobuyuki Ohte

引用次数: 2

Clinical outcomes and risk factors of coronary artery aneurysms after successful percutaneous coronary intervention and drug-eluting stent implantation for chronic total occlusions 慢性全闭塞经皮冠状动脉介入治疗及药物洗脱支架置入术成功后冠状动脉瘤的临床结局及危险因素

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.06.004

Xin Zhong , Hua Li , Chenguang Li , Nobel Zong , David Liem , X'avia Chan , Shuning Zhang , Youen Zhang , Xinggang Wang , Xing Wu , Wenbin Zhang , Kang Yao , Xuebo Liu , Lei Ge , Kai Hu , Juying Qian , Mario Deng , Junbo Ge

Objective

The study aimed to analyze the risk factors and long-term outcomes associated with coronary artery aneurysms (CAAs) after successful percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation in patients with CTOs.

Background

There are sporadic data available on post-procedure CAAs after transcatheter revascularization for CTOs.

Methods and results

A total of 141 patients with 149 CTOs who underwent successful CTO-PCI and DES implantation with angiographic follow-up from 2004 to 2010 were included. Patients were divided into CAA group and non-CAA group according to the presence of CAAs in the follow-up angiography. The independent predictors and major adverse cardiac events (MACEs) including cardiac death, myocardial infarction (MI) and target-vessel revascularization (TVR) were compared between two groups. The incidence of CAAs was 11.4% (17/149) after index procedure. Multivariate analysis showed that age (OR: 0.925, CI 0.873–0.980, P = 0.008), ostial occlusion (OR: 6.715, CI 1.473–30.610, P = 0.014), the parallel wire technique (OR: 6.167, CI 1.709–22.259, P = 0.005) and DES length (OR: 1.030, CI 1.002–1.058, P = 0.036) were the independent predictors of CAAs after successful CTO-PCI and DES implantation. MACEs were similar between two groups (adjusted hazard ratio 0.670; 95% CI 0.160–2.808; P = 0.584) during the 5-year follow-up.

Conclusions

The independent predictors of CAAs after successful CTO-PCI and DES implantation are age, ostial occlusion, the parallel wire technique and DES length. CAAs after index procedure are not frequently associated with adverse clinical events under dual antiplatelet therapy. Further large clinical studies are warranted to explore the clinical implications of patients with this distinct new entity.

目的分析CTOs患者经皮冠状动脉介入治疗(PCI)及药物洗脱支架(DES)置入术成功后发生冠状动脉瘤(CAAs)的危险因素及远期预后。背景:关于CTOs经导管血运重建术后CAAs的资料并不多见。方法与结果回顾性分析2004 ~ 2010年行CTO-PCI及DES植入成功的149例CTOs患者141例。根据随访血管造影中CAAs的存在情况将患者分为CAA组和非CAA组。比较两组的独立预测指标和主要不良心脏事件(mace)，包括心源性死亡、心肌梗死(MI)和靶血管重建术(TVR)。术后CAAs发生率为11.4%(17/149)。多因素分析显示，年龄(OR: 0.925, CI 0.873-0.980, P = 0.008)、口闭塞(OR: 6.715, CI 1.473-30.610, P = 0.014)、平行线技术(OR: 6.167, CI 1.709-22.259, P = 0.005)和DES长度(OR: 1.030, CI 1.002-1.058, P = 0.036)是CTO-PCI和DES植入成功后CAAs的独立预测因素。两组间mace相似(校正风险比0.670;95% ci 0.160-2.808;P = 0.584)。结论CTO-PCI和DES植入成功后CAAs的独立预测因素是年龄、口闭塞、平行丝技术和DES长度。在双重抗血小板治疗下，指数手术后的CAAs通常与不良临床事件无关。进一步的大型临床研究是有必要的，以探索这种独特的新实体患者的临床意义。

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引用次数: 7

Sonothrombolysis in acute stroke and myocardial infarction: A systematic review 急性脑卒中和心肌梗死的超声溶栓:系统综述

International journal of cardiology. Heart & vessels

Pub Date : 2014-09-01 DOI: 10.1016/j.ijchv.2014.08.003

Sebastiaan T. Roos , Lynda J.M. Juffermans , Jeroen Slikkerveer , Evan C. Unger , Thomas R. Porter , Otto Kamp

Introduction

Current treatment of patients with an acute occlusion of a cranial or a coronary artery, in for example ST segment elevation myocardial infarction (STEMI), consists of either thrombolysis or percutaneous intervention. Various thrombolytic agents (tissue plasminogen activators) are used for reperfusion therapy in patients with STEMI. However, their use may be associated with an increased risk of bleeding which is inherent to their action mechanism. Therefore, new methods of coronary clot resolution are being studied in an attempt to potentiate the efficacy and reduce the side effects of thrombolytics. A new method is ultrasound mediated thrombus dissolution, or sonothrombolysis. The current literature exploring sonothrombolysis is diverse in size and quality. In this systematic review of the current literature, we describe cardiovascular applications of sonothrombolysis in patients. A comparison to the neurovascular application in ischemic stroke is made, as more research has been performed on patients suffering from stroke.

Methods

A systematic search was performed following the PRISMA guidelines using EMBASE and MEDLINE databases regarding sonothrombolysis in human ischemic stroke and acute myocardial infarction patients.

Results

12 original case–control or randomized controlled trials using a combination of ultrasound and microbubbles were found. 6 trials studied ischemic stroke, and 6 trials studied acute myocardial infarction.

Conclusion

This systematic review provides up to date information on the subject of sonothrombolysis.

目前治疗急性颅脑或冠状动脉闭塞的患者，例如ST段抬高型心肌梗死(STEMI)，包括溶栓或经皮介入治疗。各种溶栓剂(组织纤溶酶原激活剂)用于STEMI患者的再灌注治疗。然而，它们的使用可能与出血风险增加有关，这是它们的作用机制所固有的。因此，人们正在研究冠状动脉血栓溶解的新方法，以增强溶栓药物的疗效并减少其副作用。一种新的方法是超声介导的血栓溶解或超声溶栓。目前关于超声溶栓的文献在大小和质量上都是不同的。在这篇系统的文献综述中，我们描述了超声溶栓在心血管患者中的应用。由于对脑卒中患者的研究较多，与神经血管在缺血性脑卒中中的应用进行了比较。方法采用EMBASE和MEDLINE数据库，按照PRISMA指南对人缺血性卒中和急性心肌梗死患者的超声溶栓进行系统检索。结果共发现超声与微泡联合应用的原始病例对照或随机对照试验12例。6项试验研究缺血性卒中，6项试验研究急性心肌梗死。结论:本系统综述提供了有关超声溶栓的最新信息。

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引用次数: 17