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A Review of the Wide Range of Indications and Uses of Implantable Loop Recorders: A Review of the Literature 植入式循环记录仪的广泛适应症和用途综述:文献综述
Pub Date : 2022-04-05 DOI: 10.3390/hearts3020007
C. Kwok, Dan Darlington, Joseph Mayer, G. Panchal, Vincent Walker, D. Zachariah, T. Phan, C. Mallen, D. Barker, A. Patwala
Implantable loop recorders (ILR) are devices that are implanted subcutaneously on the chest, which enables the continuous monitoring of arrhythmias for up to three years. These devices have an important role in helping to make a diagnosis and supporting decisions about the best patient management. There are currently three companies that produce ILRs. The Reveal DX and XT device is produced by Medtronic. The Confirm device is produced by Abbott. The Biomonitor III device is produced by Biotronik. The established indications for ILR include the management of transient loss of consciousness and the diagnosis of undocumented palpitations; however, they are also used for less established applications, including atrial fibrillation (AF) monitoring and risk stratification in patients with previous myocardial infarction or inherited cardiomyopathies. There is also diverse literature exploring the use of these devices in other populations, including patients with conditions such as congenital heart disease, amyloidosis, stroke, obstructive sleep apnea, renal transplant and patients who undergo procedures such as AF ablation and coronary artery bypass graft. In this review, we describe how the use of ILR has been applied in different settings, including patients with cardiac and non-cardiac conditions as well as post-cardiac procedures. We then discuss the potential issues related to using ILR in these other indications.
植入式环路记录仪(ILR)是一种植入胸腔皮下的设备,可以连续监测心律失常长达三年。这些设备在帮助诊断和支持最佳患者管理决策方面发挥着重要作用。目前有三家公司生产ilr。Reveal DX和XT设备由美敦力公司生产。确认设备由雅培公司生产。Biomonitor III设备由Biotronik公司生产。ILR的既定适应症包括短暂意识丧失的管理和无证心悸的诊断;然而,它们也用于不太成熟的应用,包括心房颤动(AF)监测和既往心肌梗死或遗传性心肌病患者的风险分层。也有不同的文献探讨了这些装置在其他人群中的应用,包括先天性心脏病、淀粉样变性、中风、阻塞性睡眠呼吸暂停、肾移植和接受房颤消融和冠状动脉搭桥等手术的患者。在这篇综述中,我们描述了如何在不同的情况下应用ILR,包括心脏和非心脏疾病患者以及心脏后手术。然后我们讨论了在这些其他适应症中使用ILR的潜在问题。
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引用次数: 3
Outcomes of Acute Coronary Syndrome in Hospitalized Patients with Celiac Disease, a United States Nationwide Experience 腹腔疾病住院患者急性冠状动脉综合征的结果——美国全国经验
Pub Date : 2022-03-01 DOI: 10.3390/hearts3010006
K. Gupta, K. Sawalha, S. Pundlik, Mohammad Abozenah, Khadija Naseem, Mohammad Al-Akchar, Ahmad Masood Khan
Background: Cardiovascular disease remains the leading cause of death in the United States. Coronary artery disease alone accounted for approximately 13% of deaths in the US in 2016. Some studies have suggested an increased prevalence of coronary artery disease (CAD) in chronic inflammatory conditions, such as celiac disease (CD). Chronic subclinical systemic inflammation, decreased absorption of cardio-protective nutrients and drugs have all been postulated as the driving mechanisms for this increased risk of CAD. Methods: We reviewed a Nationwide Inpatient Sample from 2007 to 2017, using Acute Coronary syndrome as a principal diagnosis with CD as the secondary diagnosis, utilizing validated ICD-9-CM and ICD-10 codes. We examined the annual trends in the number of cases and hospitalization charges yearly and used survey regression to calculate adjusted odds ratios (aOR) for hospital mortality and other outcomes. Results: We identified a total of 8,036,307 ACS hospitalizations from 2007 to 2017, of which 5917 (0.07%) had a diagnosis for CD. The proportion of patients with CD in ACS hospitalizations increased from 0.015% in 2007 to 0.076% in 2017. These patients were significantly older (70.3 vs. 67.4 years, p < 0.02), more likely female (51.9% vs. 39.5%, p < 0.01), and more likely to be white (93.8% vs. 76.6%; p < 0.01) than ACS patients without CD. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, ACS hospitalizations for CD patients had a lower odds ratio for hospital mortality (aOR = 0.39; 95% CI = 0.23–0.67; p < 0.01). Additionally, length of stay in this patient population was shorter (4.53 vs. 4.84 days, p < 0.01) but the mean hospitalization charges were higher (USD 64,058 vs. USD 60,223, p < 0.01). Conclusion: We found that the number of ACS-related admissions in CD patients has risen more than five-fold between 2007 and 2017. However, the odds of in-hospital mortality in these patients is not higher than patients without CD. The results of our study demonstrate that although the systemic inflammation related to CD is associated with an increasing prevalence of ACS hospitalizations, on the contrary, the mortality rate is significantly higher in patients without celiac disease.
背景:心血管疾病仍然是美国死亡的主要原因。2016年,仅冠状动脉疾病就占美国死亡人数的约13%。一些研究表明,在慢性炎症性疾病(如乳糜泻)中,冠状动脉疾病(CAD)的患病率增加。慢性亚临床全身炎症、对心脏保护性营养素和药物的吸收减少都被认为是CAD风险增加的驱动机制。方法:我们回顾了2007年至2017年的全国住院患者样本,使用经验证的ICD-9-CM和ICD-10代码,以急性冠状动脉综合征为主要诊断,CD为次要诊断。我们检查了每年病例数和住院费用的年度趋势,并使用调查回归计算了医院死亡率和其他结果的调整比值比(aOR)。结果:从2007年到2017年,我们共发现8036307例ACS住院患者,其中5917例(0.07%)被诊断为CD。CD患者在ACS住院患者中的比例从2007年的0.015%增加到2017年的0.076%。与无CD的ACS患者相比,这些患者年龄明显更大(70.3 vs.67.4岁,p<0.02),更有可能是女性(51.9%vs.39.5%,p<0.01),更可能是白人(93.8%vs.76.6%,p<0.05)。在调整了年龄、性别、种族、Charlson共病指数和医院水平特征后,CD患者的ACS住院与住院死亡率的比值比较低(aOR=0.39;95%CI=0.23-0.67;p<0.01)。此外,该患者群体的住院时间较短(4.53天vs.4.84天,p<0.01),但平均住院费用较高(64058美元vs。60223美元,p<0.01)。结论:我们发现,在2007年至2017年间,CD患者中与ACS相关的入院人数增加了五倍多。然而,这些患者的住院死亡率并不高于没有CD的患者。我们的研究结果表明,尽管与CD相关的全身炎症与ACS住院率的增加有关,但相反,没有乳糜泻的患者的死亡率明显更高。
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引用次数: 0
A Review on Atrial Fibrillation (Computer Simulation and Clinical Perspectives) 心房颤动研究进展(计算机模拟与临床展望)
Pub Date : 2022-02-14 DOI: 10.3390/hearts3010005
Muhammad Aneeq uz Zaman, D. Du
Atrial fibrillation (AF), a heart condition, has been a well-researched topic for the past few decades. This multidisciplinary field of study deals with signal processing, finite element analysis, mathematical modeling, optimization, and clinical procedure. This article is focused on a comprehensive review of journal articles published in the field of AF. Topics from the age-old fundamental concepts to specialized modern techniques involved in today’s AF research are discussed. It was found that a lot of research articles have already been published in modeling and simulation of AF. In comparison to that, the diagnosis and post-operative procedures for AF patients have not yet been totally understood or explored by the researchers. The simulation and modeling of AF have been investigated by many researchers in this field. Cellular model, tissue model, and geometric model among others have been used to simulate AF. Due to a very complex nature, the causes of AF have not been fully perceived to date, but the simulated results are validated with real-life patient data. Many algorithms have been proposed to detect the source of AF in human atria. There are many ablation strategies for AF patients, but the search for more efficient ablation strategies is still going on. AF management for patients with different stages of AF has been discussed in the literature as well but is somehow limited mostly to the patients with persistent AF. The authors hope that this study helps to find existing research gaps in the analysis and the diagnosis of AF.
心房颤动(AF)是一种心脏疾病,在过去的几十年里一直是一个研究得很好的话题。这个多学科领域的研究涉及信号处理、有限元分析、数学建模、优化和临床程序。本文对AF领域发表的期刊文章进行了全面的综述。从古老的基本概念到当今AF研究中涉及的专业现代技术,都进行了讨论。我们发现,在AF的建模和仿真方面已经发表了大量的研究文章。相比之下,研究者对AF患者的诊断和术后流程还没有完全了解和探索。AF的仿真和建模已经被许多研究者进行了研究。细胞模型、组织模型和几何模型等已被用于模拟AF。由于AF的性质非常复杂,迄今为止尚未完全了解AF的原因,但模拟结果得到了真实患者数据的验证。已经提出了许多算法来检测心房房颤的来源。房颤患者有许多消融策略,但寻找更有效的消融策略仍在进行中。不同阶段房颤患者的房颤管理也有文献讨论,但大多局限于持续性房颤患者。作者希望本研究有助于发现房颤分析和诊断方面的现有研究空白。
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引用次数: 0
Acknowledgment to Reviewers of Hearts in 2021 向2021年的红心评审者致谢
Pub Date : 2022-01-29 DOI: 10.3390/hearts3010004
Rigorous peer-reviews are the basis of high-quality academic publishing [...]
严格的同行评议是高质量学术出版的基础[…]
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引用次数: 0
Why Does the NOTION Trial Show Poorer Than Expected Outcomes in the Surgical Arm? 为什么concept试验在手术组的结果不如预期?
Pub Date : 2022-01-26 DOI: 10.3390/hearts3010003
S. Urso, R. Sádaba, Eliú Nogales, F. Portela
The NOTION trial compares transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients. Looking carefully at the outcomes of this trial, there is no doubt that the transcatheter aortic valve implantation results were outstanding. The same thing cannot be said for the results of the surgery. We tried to understand the reason for that.
concept试验比较了经导管主动脉瓣植入术与手术主动脉瓣置换术在低危患者中的应用。仔细观察本试验的结果,毫无疑问,经导管主动脉瓣植入术的效果是显著的。手术的结果就不一样了。我们试图理解其中的原因。
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引用次数: 2
An Alternative to Transvenous Lead Extraction in Selected Patients with CIED Infections—A Retrospective Outcome Study 一项回顾性结果研究:经静脉铅提取在特定CIED感染患者中的替代方法
Pub Date : 2022-01-20 DOI: 10.3390/hearts3010002
Jennifer J. Llewellyn, G. Meda, D. Garner, D. Wright, A. Rao
Cardiac implantable electronic device (CIED) implants are rising in an older, more co-morbid population. The prevalence of CIED infection ranges from 1–4%. Whilst complete extraction of all transvenous hardware is recommended for infected, eroded, or pre-eroding CIEDs, this approach is not without risk and may be unacceptable to some patients. Long-term data on a more conservative strategy is lacking. We report on our experience of conservative management with pocket revision as a primary strategy in carefully selected patients. Method: A retrospective review of all CIED revision procedures was undertaken at a large tertiary center, over a 7-year period, with a mean follow-up timeframe of 39 months. Results: A total of 86 patients underwent 96 revision procedures; 7 patients required further revisions and 13 went on to undergo CIED extraction by the end of the follow-up period. The overall rate of mortality at 12 months was 8.1%, increasing to 24.4% at the end of the follow-up period. Conclusion: Our data provide important outcome information on an alternative strategy to lead extraction in carefully selected patients where the risk of extraction is perceived to be unacceptable. The absence of systemic infection appears to predict better outcomes than previously reported, and over two-thirds of patients remained complication-free at 12 months.
心脏植入式电子装置(CIED)植入物在年龄较大、合并症较多的人群中呈上升趋势。CIED的感染率在1-4%之间。虽然对于感染、侵蚀或预侵蚀的cied,建议完全取出所有经静脉硬体,但这种方法并非没有风险,有些患者可能无法接受。缺乏更为保守策略的长期数据。我们报告我们的经验,保守管理与口袋翻修作为主要策略,精心挑选的患者。方法:回顾性分析在一家大型三级中心进行的所有CIED修订程序,为期7年,平均随访时间为39个月。结果:86例患者共进行了96次翻修手术;随访结束时,7例患者需要进一步修复,13例患者继续接受CIED拔除。12个月时的总死亡率为8.1%,在随访期结束时上升至24.4%。结论:我们的数据提供了重要的结果信息,在精心选择的患者中,拔牙的风险被认为是不可接受的。没有全身性感染似乎预示着比以前报道的更好的结果,超过三分之二的患者在12个月时仍然无并发症。
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引用次数: 0
The Application of Computer Techniques to ECG Interpretation 计算机技术在心电解释中的应用
Pub Date : 2022-01-11 DOI: 10.3390/hearts3010001
P. Macfarlane
It is over 120 years since Einthoven introduced the electrocardiogram [...]
Einthoven推出心电图已经120多年了〔…〕
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引用次数: 0
Bundle Branch Re-Entrant Ventricular Tachycardia after Minimal Invasive Cardiac Surgery 微创心脏手术后束支再入性室性心动过速
Pub Date : 2021-12-15 DOI: 10.3390/hearts2040044
Vincent Vandoren, T. Phlips, P. Timmermans
Background: Bundle branch re-entrant ventricular tachycardia (BBRVT) is a monomorphic ventricular arrhythmia with wide QRS complexes caused by re-entrant tachycardia between both bundle branches. BBRVT can occur in a variety of cardiac pathologies with His–Purkinje system (HPS) conduction abnormalities such as dilated cardiomyopathy, coronary artery disease, hypertrophic cardiomyopathy, valvular heart disease and even after aortic valve surgery. Case report: A 62-year-old male patient with an ischemic cardiomyopathy and implantable cardioverter defibrillator (ICD) underwent minimal invasive aortic valve replacement (Yil-AVR) and coronary artery bypass graft (CABG). He was remitted a week later because of relapsing sustained ventricular tachycardia (VT). Electrocardiogram showed a wide QRS tachycardia, which was remarkably similar to the patient’s sinus rhythm. Analysis of ICD revealed the presence of BBRVT. Catheter ablation of the right bundle branch (RBB) was performed. He is currently in clinical follow-up and no reoccurrence of VT has been recorded so far. Conclusion: Patients with known cardiomyopathy can develop BBRVT early after cardiac surgery. To our knowledge, this is the first time that BBRVT occurred after Yil-AVR.
背景:束支再入性室性心动过速(BBRVT)是由束支再入性心动过速引起的单形态室性心律失常,伴有宽QRS复合物。BBRVT可发生于多种伴有His-Purkinje系统(HPS)传导异常的心脏疾病,如扩张性心肌病、冠状动脉疾病、肥厚性心肌病、瓣膜性心脏病,甚至主动脉瓣手术后。病例报告:62岁男性缺血性心肌病患者,植入式心律转复除颤器(ICD)行微创主动脉瓣置换术(il- avr)和冠状动脉搭桥(CABG)。一周后因复发性持续性室性心动过速(VT)而出院。心电图显示宽QRS心动过速,这与患者的窦性心律非常相似。ICD分析显示BBRVT的存在。行右束支(RBB)导管消融。目前在临床随访中,未见再次发生室速。结论:已知心肌病患者可在心脏手术后早期发生BBRVT。据我们所知,这是首次在il- avr后发生BBRVT。
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引用次数: 0
Cost-Effectiveness and Safety of Same-Day Discharge after Elective Percutaneous Coronary Intervention 选择性经皮冠状动脉介入治疗后当天出院的成本效益和安全性
Pub Date : 2021-12-08 DOI: 10.3390/hearts2040043
Abhisheik Prashar, K. Mitchell, A. Hopkins, M. Sader, A. Prasan
Objectives: We sought to investigate the rates of same-day discharge (SDD) post elective percutaneous coronary intervention (PCI) at our institution and review its safety by examining clinical outcomes. We also performed an economic analysis evaluating our hospital’s cost data for SDD following PCI. Methods: Patients undergoing elective PCI at St George Hospital, Australia, from January 2017 to December 2019 were evaluated. Primary outcomes included 7-day major adverse cardiovascular endpoints (MACEs) and readmission to hospital within 30 days. Results: Among 502 patients who underwent elective PCI, 421 patients (83.8%) were managed with SDD. There was one case of acute stent thrombosis and one case of coronary wire-induced perforation requiring a pericardial drain that occurred following elective PCI with SDD (0.54%). Unplanned cardiac re-hospitalisation at 30 days following elective PCI was 5.2%. SDD after elective PCI was associated with a healthcare cost saving of AUD 4817 per case. Conclusion: SDD following elective PCI was demonstrated to be a safe and effective strategy that was also associated with significant cost savings. SDD following elective PCI warrants more widespread use as it lowers healthcare costs, has equivalent patient outcomes and improves patient satisfaction.
目的:我们试图调查我们机构选择性经皮冠状动脉介入治疗(PCI)后的当天出院率,并通过检查临床结果来审查其安全性。我们还进行了经济分析,评估了我们医院PCI后SDD的成本数据。方法:对2017年1月至2019年12月在澳大利亚圣乔治医院接受选择性PCI的患者进行评估。主要转归包括7天主要心血管不良终点(MACE)和30天内再次入院。结果:在502名接受选择性PCI的患者中,421名患者(83.8%)接受了SDD治疗。在选择性经皮冠状动脉介入治疗(SDD)后,发生了1例急性支架血栓形成和1例需要心包引流的冠状动脉导线诱导穿孔(0.54%)。选择性经皮介入治疗后30天的非计划心脏再住院率为5.2%。选择性经皮内介入治疗后的SDD可为每例患者节省4817澳元的医疗费用。结论:选择性PCI后的SDD被证明是一种安全有效的策略,也可以显著节省成本。选择性PCI后的SDD保证了更广泛的使用,因为它降低了医疗成本,具有同等的患者结果,并提高了患者满意度。
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引用次数: 0
PAF Physiology in Target Organ Systems—A Deep Dive to Understand the PAF Mystery in Pathogenesis of Disease 靶器官系统中的PAF生理学——解读PAF在疾病发病机制中的奥秘
Pub Date : 2021-11-29 DOI: 10.3390/hearts2040042
N. Shah, Karan Kumar, Nikeith Shah
The purpose of this literature review is to gain an overview of the role of platelet-activating factor (PAF) within each of the body systems and how it contributes to normal and pathophysiological states. The review showed that there are multiple functions of PAF that are common to several body systems; however, there is little evidence to explain why PAF has this affect across multiple systems. Interestingly, there seems to be conflicting research as to whether PAF is an overall protective or pathogenic pathway. Within this research, it was found that there are different pathways depending on the specific body system, as well as between body systems. However, one universal function reported in the literature is of PAF as a pro-inflammatory molecule. Overall, this review identified five major functions of PAF: vasoconstriction, increased inflammation, vascular remodeling, increased edema, and endothelial permeability.
本文献综述的目的是获得血小板活化因子(PAF)在每个身体系统中的作用的概述,以及它如何促进正常和病理生理状态。综述表明,PAF具有多种人体系统共有的功能;然而,几乎没有证据可以解释为什么PAF在多个系统中都有这种影响。有趣的是,关于PAF是一种全面的保护性途径还是致病性途径,似乎存在相互矛盾的研究。在这项研究中,研究人员发现,根据特定的身体系统,以及身体系统之间,存在不同的途径。然而,文献中报道的一个普遍功能是PAF作为促炎分子。总的来说,这篇综述确定了PAF的五种主要功能:血管收缩、炎症增加、血管重塑、水肿增加和内皮通透性。
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引用次数: 2
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Hearts (Basel, Switzerland)
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