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Joint British Societies’ guideline on management of cardiac arrest in the cardiac catheter laboratory 英国心脏导管实验室心脏骤停管理指南
Pub Date : 2022-04-25 DOI: 10.1136/heartjnl-2021-320588
J. Dunning, A. Archbold, J. de Bono, Liz Butterfield, N. Curzen, C. Deakin, Ellie Gudde, Thomas R. Keeble, Alan Keys, Mike Lewis, N. O'Keeffe, J. Sarma, M. Stout, P. Swindell, S. Ray
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest. We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
超过300 000个手术在英国的心脏导管实验室中进行。自侵入性心脏病学早期以来,经皮心血管手术的种类和复杂性都大幅增加,当时主要集中在选择性冠状动脉造影和单腔(右心室)永久性起搏器植入。现代侵入性心脏病学包括初级经皮冠状动脉介入治疗、心脏再同步治疗、复杂心律失常消融和结构性心脏干预。这些手术都有心脏骤停的风险。我们制定了导管实验室中成年患者心脏骤停管理的循证指南。该指南包括九个专业和患者协会合作制定的建议,这些协会致力于促进心血管疾病患者的高质量护理。我们提出了一套方案,该方案利用了整个导管实验室团队的技能,旨在为在这种情况下心脏骤停的患者实现尽可能好的结果。我们确定了六个角色,并制定了一种治疗算法,该算法应在导管实验室的心脏骤停期间采用。我们建议所有导管实验室工作人员定期接受培训,以应对他们将不可避免地面临的这些紧急情况。
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引用次数: 2
Calcium, vitamin D and aortic valve calcification: to the bone or to the heart? 钙、维生素D和主动脉瓣钙化:对骨骼还是对心脏?
Pub Date : 2022-04-25 DOI: 10.1136/heartjnl-2021-320672
J. Bergler-Klein
CALCIUM AND VITAMIN D SUPPLEMENT: RIGHT OR WRONG? Intuitively, one might think that supplementing vitamins and minerals would be the right thing to do especially in older and comorbid people. Every year, billions of dollars are spent in this belief. However, we may all be wrong. A present study in this journal demonstrates a significantly increased cardiovascular (CV) mortality in elderly patients supplementing calcium, be it with or without vitamin D, who initially presented with mild to moderate aortic stenosis (AS) in a longitudinal analysis of a large contemporary echocardiography database cohort of 2657 patients. Patients were followed for aortic valve replacement (AVR) and/or death, as well as AS progression. About half of the study population was on supplementation, with about 40% taking calcium including vitamin D or not during more than 5.5 years. The absolute risk of CV mortality was strikingly higher with 13.7 for calcium±vitamin D supplementation and 9.6 for vitamin D only, compared with 5.8 per 1000 personyears in no supplementation. Surprisingly, also allcause mortality was significantly higher with calcium addition. In almost half of the patients with calcium administration, AVR was performed during the followup, whereas AVR was needed in only 11% of nonsupplementers. Interestingly, when stratifying by osteoporosis status, the differences in survival and AVR persisted unaltered between the groups.
钙和维生素D补充剂:对还是错?直觉上,人们可能会认为补充维生素和矿物质是正确的做法,尤其是对老年人和合并症患者。每年,数十亿美元都花在这个信念上。然而,我们可能都错了。本期刊上的一项研究表明,在对2657名患者的大型现代超声心动图数据库队列进行的纵向分析中,补充钙的老年患者(无论是否补充维生素D)的心血管(CV)死亡率显著增加,这些患者最初表现为轻度至中度主动脉狭窄(AS)。对患者进行主动脉瓣置换术(AVR)和/或死亡以及as进展的随访。大约一半的研究人群正在服用补充剂,大约40%的人在超过5.5年的时间里服用或不服用包括维生素D在内的钙。CV死亡率的绝对风险显著更高,补充钙±维生素D为13.7,仅补充维生素D为9.6,而不补充维生素D时为5.8/1000人年。令人惊讶的是,钙的添加也显著提高了全因死亡率。在几乎一半的钙给药患者中,在随访期间进行了AVR,而只有11%的非补充者需要AVR。有趣的是,当根据骨质疏松症状况进行分层时,两组之间的生存率和AVR差异保持不变。
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引用次数: 1
Supplemental calcium and vitamin D and long-term mortality in aortic stenosis 补充钙和维生素D与主动脉瓣狭窄的长期死亡率
Pub Date : 2022-04-25 DOI: 10.1136/heartjnl-2021-320215
Nicholas Kassis, E. Hariri, A. Karrthik, K. Ahuja, H. Layoun, Anas M. Saad, M. Gad, Manpreet Kaur, Najdat Bazarbashi, B. Griffin, Z. Popović, S. Harb, M. Desai, S. Kapadia
Objective Calcium metabolism has long been implicated in aortic stenosis (AS). Studies assessing the long-term safety of oral calcium and/or vitamin D in AS are scarce yet imperative given the rising use among an elderly population prone to deficiency. We sought to identify the associations between supplemental calcium and vitamin D with mortality and progression of AS. Methods In this retrospective longitudinal study, patients aged ≥60 years with mild-moderate native AS were selected from the Cleveland Clinic Echocardiography Database from 2008 to 2016 and followed until 2018. Groups were stratified into no supplementation, supplementation with vitamin D alone and supplementation with calcium±vitamin D. The primary outcomes were mortality (all-cause, cardiovascular (CV) and non-CV) and aortic valve replacement (AVR), and the secondary outcome was AS progression by aortic valve area and peak/mean gradients. Results Of 2657 patients (mean age 74 years, 42% women) followed over a median duration of 69 months, 1292 (49%) did not supplement, 332 (12%) took vitamin D alone and 1033 (39%) supplemented with calcium±vitamin D. Calcium±vitamin D supplementation was associated with a significantly higher risk of all-cause mortality (absolute rate (AR)=43.0/1000 person-years; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 person-years; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and AVR (AR=88.2/1000 person-years; HR=1.48, 95% CI (1.24 to 1.78); p<0.001). Any supplementation was not associated with longitudinal change in AS parameters in a linear mixed-effects model. Conclusions Supplemental calcium with or without vitamin D is associated with lower survival and greater AVR in elderly patients with mild-moderate AS.
目的长期以来,钙代谢一直与主动脉狭窄有关。评估口服钙和/或维生素D治疗AS的长期安全性的研究很少,但鉴于易缺乏的老年人群中钙和/和维生素D的使用量不断增加,这一研究势在必行。我们试图确定补充钙和维生素D与AS死亡率和进展之间的关系。方法在这项回顾性纵向研究中,从2008年至2016年克利夫兰诊所超声心动图数据库中选择年龄≥60岁的轻度至中度本土AS患者,并随访至2018年。各组被分为不补充、单独补充维生素D和补充钙±维生素D。主要结果是死亡率(全因、心血管(CV)和非心血管)和主动脉瓣置换术(AVR),次要结果是主动脉瓣面积和峰值/平均梯度的AS进展。结果2657名患者(平均年龄74岁,42%为女性)中位随访69个月,其中1292名(49%)不补充维生素D,332名(12%)单独服用维生素D,1033名(39%)补充钙±维生素D;HR=1.31,95%可信区间(1.07-1.62);p=0.009),CV死亡率(AR=13.7/1000人年;HR=2.0,95%CI(1.31-3.07);p=0.001)和AVR(AR=88/2/1000人年;HR=1.48,95%CI(1.24-1.78);p<0.001)。在线性混合效应模型中,任何补充都与AS参数的纵向变化无关。结论在轻度-中度AS的老年患者中,添加或不添加维生素D的钙与较低的生存率和较大的AVR相关。
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引用次数: 6
Management of cardiac arrest in the cardiac catheterisation laboratory: guidelines tailored to place and occasion 心脏导管实验室中心脏骤停的管理:根据地点和场合量身定制的指南
Pub Date : 2022-04-25 DOI: 10.1136/heartjnl-2021-320756
P. Kudenchuk
Since first compiled in 45 BCE as the Hippocratic Corpus, medical practice guidelines have served to summarise scientific knowledge and inform clinical management. In 1992, the International Liaison Committee on Resuscitation (ILCOR—the acronym being a deliberate play on words by adding ‘ill’ to the Latin ‘cor’ for heart) was formed by the major world resuscitation councils to carry forward this challenge in emergency cardiovascular care. Comprised of recognised international experts in resuscitation, ILCOR has since been charged with conducting evidence reviews of resuscitation science. The quality of this evidence is rigorously evaluated in terms of its certainty, consistency, indirectness, risk of bias and confounding influences using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology when formulating recommendations, and represents the current standard for timely and now continuously updated resuscitationrelated treatment guidance. The published guidance from ILCOR is then taken by the individual resuscitation councils (such as the American Heart Association, the European Resuscitation Council and others) and adapted to their localities, creating formal regional guidelines. ‘The Joint British Societies’ guideline on management of cardiac arrest in the cardiac catheter laboratory’ presents an additional adaptation of existing resuscitation guidelines. In this instance, the guidelines are applied to a specific place for such events—the cardiac catheterisation laboratory, and are tailored to a specific occasion—a witnessed cardiac arrest in a closely monitored patient. The need to adapt guidelines to this setting is understandable. Both the acuity of patients needing cardiac procedures and the complexity of the interventions themselves can provoke spontaneous or iatrogenic events resulting in haemodynamic destabilisation and cardiac arrest in the laboratory. The circumstances surrounding a cardiac arrest in a catheterisation laboratory also create a unique occasion for intervention. That is, unlike outofhospital cardiac arrest or arrest in other hospital locations, a patient in the laboratory is typically already being monitored and procedurally prepped. In addition, the event is usually witnessed by skilled providers from its outset; reasons for the arrest’s occurrence are likely already apparent or suspected, and invasive tools readily available for its management. Taken together, adapting resuscitation to this environment is sensible and the participating British Societies, which spanned a wide spectrum of specialties, are to be commended for this endeavour. In recognising this exemplary effort, it is also important to appreciate both the value and limitation of these guidelines. What the British Societies’ guidelines do well is provide a paradigm for resuscitation that takes advantage of the immediate
自公元前45年作为希波克拉底语料库首次编纂以来,医疗实践指南一直用于总结科学知识并为临床管理提供信息。1992年,主要的世界复苏委员会成立了国际复苏联络委员会(ilcor -首字母缩略词是故意在拉丁语“cor”中添加“ill”来表示心脏),以在紧急心血管护理中推进这一挑战。由公认的国际复苏专家组成,ILCOR一直负责进行复苏科学的证据审查。本证据的质量在制定建议时采用建议、评估、发展和评估分级(GRADE)方法,从确定性、一致性、间接性、偏倚风险和混杂影响等方面进行了严格评估,并代表了及时且不断更新的复苏相关治疗指导的当前标准。然后,各个复苏委员会(如美国心脏协会、欧洲复苏委员会等)采用ILCOR公布的指导方针,并根据当地情况进行调整,形成正式的区域指导方针。《英国联合学会心导管实验室心脏骤停管理指南》提出了对现有复苏指南的额外调整。在这种情况下,该指南适用于此类事件的特定场所-心导管实验室,并针对特定场合进行定制-在密切监测的患者中目睹心脏骤停。调整指导方针以适应这种情况的需要是可以理解的。在实验室中,需要心脏手术的患者的敏锐度和干预本身的复杂性都可能引发自发或医源性事件,导致血流动力学不稳定和心脏骤停。导管实验室中心脏骤停的环境也为干预创造了一个独特的场合。也就是说,与院外心脏骤停或其他医院地点的骤停不同,实验室里的病人通常已经被监测和程序准备好了。此外,事件通常从一开始就由熟练的提供者见证;发生逮捕的原因很可能已经很明显或被怀疑,并且可以随时使用侵入性工具进行管理。综上所述,使复苏适应这种环境是明智的,参与其中的英国学会跨越了广泛的专业领域,这一努力值得赞扬。在认识到这一模范努力的同时,认识到这些准则的价值和局限性也很重要。英国学会的指导方针做得很好,它提供了一个利用即时复苏的范例
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引用次数: 1
Cardiac surgery and congenital heart disease: reflections on a modern revolution 心脏外科手术和先天性心脏病:对现代革命的反思
Pub Date : 2022-04-21 DOI: 10.1136/heartjnl-2021-320148
J. Lim, Martin J. Elliott, J. Wallwork, B. Keogh
The success of cardiac surgery has transformed the prospects of children with congenital heart disease with over 90% now surviving to adulthood. The early pioneering surgeons took on significant risk, whilst current surgical practice emphasises safety and consistency. In this article we review important British contributions to the field and consider challenges for the future, specifically how to better manage and reduce the adverse sequelae of congenital cardiac surgery by continuing to innovate safely.
心脏手术的成功改变了患有先天性心脏病的儿童的前景,现在90%以上的儿童存活到成年。早期的外科先驱承担了巨大的风险,而目前的外科实践强调安全性和一致性。在本文中,我们回顾了英国对该领域的重要贡献,并考虑了未来的挑战,特别是如何通过持续安全创新来更好地管理和减少先天性心脏手术的不良后遗症。
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引用次数: 0
Introduction to the British Cardiovascular Society centenary special issue 英国心血管学会百年特刊简介
Pub Date : 2022-04-21 DOI: 10.1136/heartjnl-2021-320274
S. Ray, I. Simpson
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引用次数: 0
American College of Cardiology and British Cardiovascular Society at 100—learning, sharing and growing together: a letter from America 美国心脏病学会和英国心血管学会在100年共同学习,分享和成长:一封来自美国的信
Pub Date : 2022-04-21 DOI: 10.1136/heartjnl-2021-320141
D. Itchhaporia
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引用次数: 0
Let there be light! The meteoric rise of cardiac imaging 要有光!心脏成像技术的迅速崛起
Pub Date : 2022-04-21 DOI: 10.1136/heartjnl-2021-320147
A. Reid, M. Dweck
Imaging plays a central role in modern cardiovascular practice. It is a field characterised by exciting technological advances that have shaped our understanding of pathology and led to major improvements in patient diagnosis and care. The UK has played a key international role in the development of this subspecialty and is the current home to many of the leading global centres in multimodality cardiovascular imaging. In this short review, we will outline some of the key contributions of the British Cardiovascular Society and its members to this rapidly evolving field and look at how this relationship may continue to shape future cardiovascular practice.
成像在现代心血管实践中起着核心作用。这是一个以令人兴奋的技术进步为特征的领域,这些技术进步塑造了我们对病理学的理解,并导致了患者诊断和护理的重大改进。英国在这一亚专业的发展中发挥了关键的国际作用,目前是许多全球领先的多模式心血管成像中心的所在地。在这篇简短的综述中,我们将概述英国心血管学会及其成员对这一快速发展的领域的一些关键贡献,并探讨这种关系如何继续塑造未来的心血管实践。
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引用次数: 0
History and evolution of pacing and devices 起搏和装置的历史和演变
Pub Date : 2022-04-21 DOI: 10.1136/heartjnl-2021-320149
P. Haydock, A. Camm
Cardiac implanted electronic devices are commonplace in the modern practice of cardiology. This article reviews the history of the development of these technologies, with particular reference to the role played by UK physicians and members of the British Cardiovascular Society. Key breakthroughs in the treatment of heart block, ventricular arrhythmia and heart failure are presented in their historical and contemporary context so that the reader might look back on the incredible progress and achievements of the last 100 years and also look forward to what may be achieved in the coming decades.
心脏植入的电子设备在现代心脏病学实践中很常见。本文回顾了这些技术的发展历史,特别是英国医生和英国心血管学会成员所发挥的作用。在治疗心脏传导阻滞、室性心律失常和心力衰竭方面的关键突破是在其历史和当代背景下提出的,以便读者回顾过去100年令人难以置信的进步和成就,并展望未来几十年可能取得的成就。
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引用次数: 3
British Cardiovascular Society: from club to community 英国心血管学会:从俱乐部到社区
Pub Date : 2022-04-21 DOI: 10.1136/heartjnl-2021-320140
N. Boon
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引用次数: 0
期刊
British Heart Journal
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