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Left Atrial Appendage Closure: A Narrative Review. 左心房附件闭合术:叙述性回顾。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-08 DOI: 10.1007/s40119-023-00337-2
Takashi Nagasaka, Mamoo Nakamura

Atrial fibrillation (AF) is the most common cardiac arrhythmia and the cause of thromboembolic events in elderly patients worldwide. AF is associated with a significantly increased risk of morbidity and mortality due to cardiac emboli, primarily from left atrial appendage (LAA) thrombus. Oral anticoagulation therapy is the standard treatment to effectively reduce the risk of thromboembolic events in patients with AF. However, anticoagulation treatment increases bleeding risk. LAA closure (LAAC) has recently been introduced as a feasible mechanical preventive intervention for thromboembolic events while minimizing the risk of bleeding. Transcatheter LAAC devices have evolved in the past decade, and several ongoing trials have demonstrated the improvements of safety and outcomes in newer generation devices. This review summarizes the current perspectives and outcomes regarding LAAC as an alternative to pharmacologic therapy.

心房颤动(AF)是世界各地老年患者最常见的心律失常和血栓栓塞事件的原因。心房颤动与主要由左心耳血栓引起的心脏栓塞导致的发病率和死亡率显著增加有关。口服抗凝治疗是有效降低房颤患者血栓栓塞事件风险的标准治疗方法。然而,抗凝治疗会增加出血风险。LAA闭合术(LAAC)最近被引入,作为一种可行的机械预防性干预措施,用于治疗血栓栓塞事件,同时将出血风险降至最低。经导管LAAC设备在过去十年中不断发展,几项正在进行的试验已经证明了新一代设备的安全性和结果的改善。这篇综述总结了目前关于LAAC作为药物治疗替代方案的观点和结果。
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引用次数: 0
Application of Hydrogels in Cardiac Regeneration. 水凝胶在心脏再生中的应用。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-18 DOI: 10.1007/s40119-023-00339-0
Xuejing Yu

Myocardial infarction (MI) is a leading cause of death globally. Due to limited cardiac regeneration, infarcted myocardial tissue is gradually replaced by cardiac fibrosis, causing cardiac dysfunction, arrhythmia, aneurysm, free wall rupture, and sudden cardiac death. Thus, the development of effective methods to promote cardiac regeneration is extremely important for MI treatment. In recent years, hydrogels have shown promise in various methods for cardiac regeneration. Hydrogels can be divided into natural and synthetic types. Different hydrogels have different features and can be cross-linked in various ways. Hydrogels are low in toxicity and highly stable. Since they have good biocompatibility, biodegradability, and transformability, moderate mechanical properties, and proper elasticity, hydrogels are promising biomaterials for promoting cardiac regeneration. They can be used not only as scaffolds for migration of stem cells, but also as ideal carriers for delivery of drugs, genetic materials, stem cells, growth factors, cytokines, and small molecules. In this review, the application of hydrogels in cardiac regeneration during or post-MI is discussed in detail. Hydrogels open a promising new area in cardiac regeneration for treating MI.

心肌梗死(MI)是全球死亡的主要原因。由于心脏再生受限,梗死心肌组织逐渐被心肌纤维化所取代,导致心功能障碍、心律失常、动脉瘤、游离壁破裂、心源性猝死。因此,发展促进心脏再生的有效方法对于心肌梗死的治疗至关重要。近年来,水凝胶在心脏再生的各种方法中显示出前景。水凝胶可分为天然型和合成型。不同的水凝胶具有不同的特性,可以以不同的方式交联。水凝胶毒性低,稳定性高。水凝胶具有良好的生物相容性、生物可降解性和可转化性,力学性能适中,弹性适宜,是促进心脏再生的重要生物材料。它们不仅可以作为干细胞迁移的支架,而且可以作为输送药物、遗传物质、干细胞、生长因子、细胞因子、小分子等的理想载体。本文就水凝胶在心肌梗死期间及心肌梗死后心脏再生中的应用作一综述。水凝胶为心肌梗死的心脏再生开辟了广阔的前景。
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引用次数: 0
Real-World Insights into Evolocumab Use in Patients with Hyperlipidemia Across Five Countries: Analysis from the ZERBINI Study. 五个国家高脂血症患者使用Evolocumab的真实世界见解:来自ZERBINI研究的分析。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-10-07 DOI: 10.1007/s40119-023-00334-5
Milan Gupta, Rajvi J Wani, Khalid Al Faraidy, Jean Bergeron, Eduardo Contreras, Angel Alberto Garcia Peña, G B John Mancini, Francisco Padilla, Abel Alberto Pavia Lopez, Kiran Philip, Johnny Wu, Erin S Mackinnon

Introduction: This study characterizes patients receiving evolocumab in clinical practice and assesses treatment effectiveness, safety and persistence outcomes across five countries.

Methods: This retrospective and prospective observational study enrolled patients initiated on evolocumab during August 2017 to July 2019 at 49 sites across Canada, Mexico, Colombia, Saudi Arabia and Kuwait. Medical records data were extracted within 6 months prior to (baseline) and every 3 months for 12 months post evolocumab initiation and reported as available.

Results: A total of 578 patients were enrolled (40.1% female, median age 60 [interquartile range (IQR) 51-68] years); 83.7% had atherosclerotic cardiovascular disease and/or familial hypercholesterolemia. Median low-density lipoprotein cholesterol (LDL-C) at baseline was 3.4 (IQR 2.7-4.2) mmol/L (131.5 [IQR 104.4-162.4] mg/dL), with 75.6% of patients receiving a statin (59.2% high intensity). Compared to baseline, the median lowest LDL-C was reduced by 70.2% and remained stable over 12 months of treatment. Guideline-recommended LDL-C thresholds < 1.8, < 1.4 and < 1.0 mmol/L (< 70, < 55 and < 40 mg/dL) were achieved by 75.3%, 63.6% and 47.4% of patients. LDL-C outcomes were consistent across high- and very high-risk patients. Background lipid-lowering therapy remained relatively stable. No serious treatment-emergent adverse events were reported, and persistence to evolocumab was 90.2% at 12 months.

Conclusion: These findings provide real-world evidence that evolocumab use is in accordance with its international guideline-recommended place in dyslipidemia therapy, as well as confirmation of its effectiveness and safety in a heterogeneous population. Evolocumab can address a healthcare gap in the management of dyslipidemia by increasing the proportion of patients achieving LDL-C goals recommended to lower cardiovascular risk.

引言:这项研究描述了在临床实践中接受埃沃洛单抗的患者,并评估了五个国家的治疗有效性、安全性和持久性结果。方法:这项回顾性和前瞻性观察性研究招募了2017年8月至2019年7月期间在加拿大、墨西哥、哥伦比亚、沙特阿拉伯和科威特的49个地点开始使用埃沃洛单抗的患者。医疗记录数据在(基线)前6个月内提取,在evolocomab启动后12个月内每3个月提取一次,并报告为可用。结果:共有578名患者入选(40.1%为女性,中位年龄60[四分位间距(IQR)51-68]岁);83.7%患有动脉粥样硬化性心血管疾病和/或家族性高胆固醇血症。基线时的中位低密度脂蛋白胆固醇(LDL-C)为3.4(IQR 2.7-4.2)mmol/L(131.5[IQR 104.4-162.4]mg/dL),75.6%的患者接受他汀类药物治疗(59.2%高强度)。与基线相比,中位最低LDL-C降低了70.2%,并在治疗的12个月内保持稳定。指南推荐的LDL-C阈值 结论:这些发现提供了现实世界的证据,证明埃沃洛单抗的使用符合其国际指南在血脂异常治疗中的推荐位置,并证实了其在异质人群中的有效性和安全性。Evolocumab可以通过增加实现LDL-C目标的患者比例来解决血脂异常管理方面的医疗差距,以降低心血管风险。
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引用次数: 0
Evaluation of Incidence and Risk Factors of Sudden Cardiac Death in Patients with Chronic Coronary Syndrome Attending Physical Training. 参加体育锻炼的慢性冠状动脉综合征患者心源性猝死的发生率和危险因素评估。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-10-06 DOI: 10.1007/s40119-023-00331-8
Gergely Galos, Eszter Szabados, Miklos Rabai, Rita Szalai, Luca Anna Ferkai, Ildiko Papp, Kalman Toth, Barbara Sandor

Introduction: Regular physical activity is recommended to patients with chronic coronary syndrome (CCS). However, vigorous physical exercise occurs as a risk factor of sudden cardiac death (SCD). The effect of short-term and irregular exercise is controversial. The aim of this research is to assess the role of regular training in the incidence of SCD and to identify risk factors among patients with CCS participating in a long-term training program.

Methods: Data of risk factors, therapy, and participation were collected retrospectively for a 10-year period, assessing the length and regularity of participation. The incidence of SCD and related mortality was registered. ANOVA, χ2 test, and multinominal logistic regression and stepwise analysis were performed.

Results: The Incidence of chronic kidney disease (CKD) was higher (p < 0.01) and taking beta-blockers (BBs) was lower (p = 0.04) in the SCD group. Irregular training, lack of BBs, smoking, and CKD increased the risk of SCD, while female sex, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ACEI/ARBs), and BBs decreased the risk of SCD.

Conclusions: Taking ACEI/ARBs and BBs proved to be a protective factor, emphasizing the use of optimal medical therapy. Assessment of cardiac risk factors and control of comorbidities also proved to be important. The occurrence of SCD was connected to irregular physical activity, probably relating to the adverse effects of ad hoc exercising.

引言:建议慢性冠状动脉综合征(CCS)患者定期进行体育活动。然而,剧烈的体育锻炼是心脏性猝死(SCD)的一个危险因素。短期和不定期锻炼的效果是有争议的。本研究的目的是评估定期训练在SCD发生率中的作用,并确定参与长期训练计划的CCS患者的风险因素。方法:回顾性收集10年的危险因素、治疗和参与的数据,评估参与的时间和规律。记录SCD的发生率和相关死亡率。方差分析、χ2检验、多元逻辑回归和逐步分析。结果:慢性肾脏病(CKD)的发病率较高(p 结论:服用ACEI/ARBs和BBs被证明是一个保护因素,强调使用最佳的药物治疗。心脏危险因素的评估和合并症的控制也被证明是重要的。SCD的发生与不规律的体育活动有关,可能与临时锻炼的不良影响有关。
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引用次数: 0
Podcast on Self-administered Intranasal Etripamil for Symptomatic Paroxysmal Supraventricular Tachycardia: The RAPID Trial. 自制鼻内注射依他阿米治疗症状性阵发性室上性心动过速播客:RAPID试验。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1007/s40119-023-00335-4
Bruce S Stambler, James E Ip

Paroxysmal supraventricular tachycardia (PSVT) is commonly seen in clinical practice and represents a significant burden to the healthcare system and to patients. First-line treatments include calcium channel blockers (CCB), although they are intravenous and require medical supervision. Etripamil is an investigational self-administered intranasal L-type CCB for unsupervised treatment of PSVT. In this podcast, we discuss the RAPID trial (NCT03464019), which was a phase 3 study that evaluated the safety and efficacy of etripamil in terminating PSVT episodes using a repeat-dosing regimen. RAPID was a multicenter, randomized trial that enrolled adults with electrocardiograph (ECG)-documented PSVT episodes lasting ≥ 20 min. Patients who tolerated test doses of etripamil were randomized 1:1 to receive either etripamil or placebo. Upon perceiving PSVT symptoms, patients began ECG monitoring and performed a vagal maneuver. If arrhythmia termination was unsuccessful, they self-administered 70 mg of etripamil or placebo, followed by an optional second dose after 10 min. The primary endpoint was time to conversion of PSVT to sinus rhythm within 30 min of the initial dose and sustained for ≥ 30 s. The safety group included all patients who self-administered the study treatment. Of 692 enrollees, 184 self-administered the study drug (99 etripamil, 85 placebo) for ECG-confirmed PSVT. Conversion of PSVT to sinus rhythm within 30 min was achieved in 64.3% of etripamil-treated subjects versus 31.2% of placebo-treated subjects. A significant threefold reduction in the median time to conversion of 17.2 min was observed in the etripamil group versus 53.5 min in the placebo group. Treatment-emergent adverse events were mild or moderate and primarily included transient nasal discomfort, nasal congestion, and rhinorrhea. If etripamil is approved by the US FDA, it can potentially address a significant unmet need for PSVT treatment outside a clinical setting, reducing the need for intravenous treatments that require medical supervision.Podcast available for this article.

阵发性室上性心动过速(PSVT)在临床实践中常见,对医疗系统和患者来说是一个重大负担。一线治疗包括钙通道阻滞剂(CCB),尽管它们是静脉注射的,需要医疗监督。依他阿米是一种用于无监督PSVT治疗的研究性自行给药的L型鼻内CCB。在本播客中,我们讨论了RAPID试验(NCT03464019),这是一项3期研究,评估了异搏定使用重复给药方案终止PSVT发作的安全性和有效性。RAPID是一项多中心随机试验,纳入了心电图(ECG)记录的持续PSVT发作的成年人 ≥ 20分钟。耐受试验剂量异搏定的患者被1:1随机分配接受异搏定或安慰剂。在发现PSVT症状后,患者开始心电图监测并进行迷走神经活动。如果心律失常终止不成功,他们自行给药70 mg异搏定或安慰剂,10分钟后任选第二次给药。主要终点是PSVT在初始剂量后30分钟内转变为窦性心律的时间,并持续 ≥ 30秒。安全组包括所有自行接受研究治疗的患者。在692名入选者中,184人自行服用研究药物(99 etripamil,85安慰剂)治疗心电图证实的PSVT。在接受异搏定治疗的受试者中,64.3%的人在30分钟内将PSVT转换为窦性心律,而接受安慰剂治疗的受受试者为31.2%。与安慰剂组的53.5分钟相比,异搏定组的中位转化时间显著缩短了三倍,为17.2分钟。治疗后出现的不良事件为轻度或中度,主要包括短暂的鼻腔不适、鼻塞和鼻漏。如果etripamil获得美国食品药品监督管理局的批准,它可能会解决临床环境之外对PSVT治疗的重大未满足需求,从而减少需要医疗监督的静脉注射治疗的需求。播客可用于本文。
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引用次数: 0
Comparative Effectiveness of Various Radiofrequency Ablation Catheters in the Ablation of Typical Atrial Flutter. 不同射频消融导管在典型心房颤动消融中的疗效比较。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-10-20 DOI: 10.1007/s40119-023-00336-3
Asher Gorantla, Mahmoud Alsaiqali, Jonathan Francois, Shruthi Sivakumar, Leonell Freytes-Santiago, Ahmad Jallad, Adam S Budzikowski

Introduction: Although ablation of typical atrial flutter (AFL) can be easily achieved with radiofrequency energy (RF), no studies compare the effectiveness of different ablation catheters. Our study aimed to compare the efficacy of various types of ablation catheters in treating typical AFL.

Methods: We analyzed patients with AFL who underwent RF ablation by a single operator at our institution. Successful ablation was evidenced by a bidirectional conduction block (trans-isthmus conduction time ≥ 130 ms or double potentials ≥ 90 ms). Logistic regression was used to compare success rate and linear regression to compare lesion time.

Results: Out of 222 patients, only six did not meet the success criteria (2.7%). The catheters used were non-irrigated, large-tip, internally irrigated (Chili II Boston Scientific), and externally irrigated (non-force-sensing) catheters (Cool Path, Abbott). An externally irrigated force-sensing catheter (TactiCath, Abbott) was used with > 10 gm of force and (LPLD) setting (30 W- 45 °C- 60 s), and high-power short-duration (HPSD) setting (50 W- 43 °C - 12 s). No complications were encountered. The catheter type had no statistically significant association with ablation success. With the use of externally irrigated catheter with contract force-sensing and HPSD settings, statistically significantly shortening of lesion time was achieved 758.3 s, [CI - 1128.29, - 388.35 s] followed by LPLD by 419.0 s [CI - 808.49, - 29.47 s].

Conclusions: The typical atrial flutter radiofrequency ablation procedure had a high success rate, which was not influenced by the type of ablation catheter. Contact force ablation catheter and HPSD are associated with shorter total lesion time.

引言:尽管使用射频能量(RF)可以很容易地实现典型房扑(AFL)的消融,但没有研究比较不同消融导管的有效性。我们的研究旨在比较不同类型的消融导管治疗典型AFL的疗效。方法:我们分析了在我们机构由单一操作员进行射频消融的AFL患者。双向传导阻滞(经峡部传导时间 ≥ 130毫秒或双电位 ≥ 90ms)。Logistic回归用于比较成功率,线性回归用于比较病变时间。结果:在222名患者中,只有6名不符合成功标准(2.7%)。使用的导管为非灌注、大尖端、内部灌注(Chili II Boston Scientific)和外部灌注(非力敏)导管(Cool Path,Abbott)。使用外部冲洗的力感应导管(TactiCath,Abbott) > 10 gm的力和(LPLD)设置(30 W-45°C-60 s),以及高功率短持续时间(HPSD)设置(50 W-43°C-12 s)。未发现并发症。导管类型与消融成功率无统计学显著相关性。使用具有收缩力传感和HPSD设置的外部灌注导管,在统计学上显著缩短了病变时间758.3 s,[CI-1128.29,-388.35 s],随后LPLD缩短了419.0 s[CI-808.49,-29.47 s],其不受消融导管类型的影响。接触力消融导管和HPSD与较短的总损伤时间相关。
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引用次数: 0
Contemporary Use of Coronary Physiology in Cardiology. 冠状动脉生理学在心脏病学中的当代应用。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-09-05 DOI: 10.1007/s40119-023-00329-2
Ayman Elbadawi, Ramy Sedhom, Mohamed Ghoweba, Abdelazeem Mohamed Etewa, Waleed Kayani, Faisal Rahman

Coronary angiography has a limited ability to predict the functional significance of intermediate coronary lesions. Hence, physiological assessment of coronary lesions, via fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), has been introduced to determine their functional significance. An accumulating body of evidence has consolidated the role of physiology-guided revascularization, particularly among patients with stable ischemic heart disease. The use of FFR or iFR to guide decision-making in patients with stable ischemic heart disease and intermediate coronary lesions received a class I recommendation from major societal guidelines. Nevertheless, the role of coronary physiology testing is less clear among certain patients' groups, including patients with serial coronary lesions, acute coronary syndromes, aortic stenosis, heart failure, as well as post-percutaneous coronary interventions. In this review, we aimed to discuss the utility and clinical evidence of coronary physiology (mainly FFR and iFR), with emphasis on those specific patient groups.

冠状动脉造影在预测中度冠状动脉病变的功能意义方面能力有限。因此,通过分数血流储备(FFR)或瞬时无波比(iFR)对冠状动脉病变进行生理评估,以确定其功能意义。越来越多的证据证实了生理引导的血运重建术的作用,特别是在稳定性缺血性心脏病患者中。在稳定性缺血性心脏病和中度冠状动脉病变患者中,使用FFR或iFR来指导决策获得了主要社会指南的I级推荐。然而,冠状动脉生理测试在某些患者群体中的作用尚不清楚,包括一系列冠状动脉病变、急性冠状动脉综合征、主动脉狭窄、心力衰竭以及经皮冠状动脉介入治疗后的患者。在这篇综述中,我们的目的是讨论冠状动脉生理学(主要是FFR和iFR)的应用和临床证据,重点是那些特定的患者群体。
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引用次数: 0
Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom. 英国预防二次脑卒中的抗血小板治疗模式和结果。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 Epub Date: 2023-10-04 DOI: 10.1007/s40119-023-00332-7
Xuejun Liu, Jenny Jiang, Danshi Li, Jay Horrow, Hiroshi Tamada, Anja Kahl, Vignesh Hariharan, Ankur Avinav, Xiaoyan Li

Introduction: Stroke is a leading cause of death and disability worldwide. Antiplatelet therapies are recommended to reduce the risk of recurrent stroke in patients with ischemic stroke/transient ischemic attack (IS/TIA). This study evaluated outpatient antiplatelet treatment patterns and outcomes for secondary stroke prevention (SSP) among UK adults without atrial fibrillation who were hospitalized for IS/TIA.

Methods: This retrospective observational study utilized data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics data (01/01/2011-30/06/2019). Treatment patterns included type and duration of treatments. Treatment outcomes included IS, myocardial infarction, major bleeding, and cardiovascular-related and all-cause mortality. Descriptive statistics were reported.

Results: Of 9270 patients, 13.9% (1292) might not receive antithrombotic therapy within 90 days of hospital discharge. Of 7978 patients who received antiplatelet therapies, most used clopidogrel (74.8%) or aspirin (16.7%) single antiplatelet therapy and clopidogrel + aspirin dual antiplatelet therapy (DAPT, 5.9%). At 1-year post-hospitalization, 36.9, 43.3, and 35.1% of those receiving these treatments discontinued them, respectively, and of the patients initiating DAPT, 62.3% switched to single antiplatelet therapy. At 1-year post-discharge, the incidence rate (per 100 person-years) of IS, myocardial infarction, major bleeding, cardiovascular-related mortality, and all-cause mortality among the treated were 6.5, 0.7, 4.1, 5.0, and 7.3, respectively, and among the untreated were 14.9, 0.7, 8.6, 28.1, and 39.8, respectively.

Conclusions: In the United Kingdom, 13.9% of patients hospitalized for stroke might not have any antiplatelet treatment to prevent secondary stroke; among the treated, clopidogrel, aspirin, and DAPT were commonly used. These study findings suggest that improved anti-thrombotic therapies for long-term SSP treatment are needed, which may lead to higher treatment and persistence rates and, therefore, improved outcomes in this population.

简介:中风是世界范围内死亡和致残的主要原因。建议采用抗血小板治疗来降低缺血性脑卒中/短暂性脑缺血发作(IS/TIA)患者复发性脑卒中的风险。本研究评估了因IS/TIA住院的无心房颤动的英国成年人的门诊抗血小板治疗模式和二次脑卒中预防(SSP)的结果。治疗模式包括治疗类型和持续时间。治疗结果包括IS、心肌梗死、大出血、心血管相关和全因死亡率。报告了描述性统计。结果:9270名患者中,13.9%(1292)可能在出院后90天内未接受抗血栓治疗。在7978名接受抗血小板治疗的患者中,大多数患者使用氯吡格雷(74.8%)或阿司匹林(16.7%)单次抗血小板治疗和氯吡格雷 + 阿司匹林双联抗血小板治疗(DAPT,5.9%)。在住院后1年,接受这些治疗的患者中,分别有36.9%、43.3%和35.1%停止了这些治疗,在开始DAPT的患者中有62.3%转为单联抗血小板治疗。出院后1年,接受治疗者的IS、心肌梗死、大出血、心血管相关死亡率和全因死亡率(每100人年)分别为6.5、0.7、4.1、5.0和7.3,未接受治疗者分别为14.9、0.7、8.6、28.1和39.8。结论:在英国,13.9%的中风住院患者可能没有进行任何抗血小板治疗来预防继发性中风;在接受治疗的患者中,常用氯吡格雷、阿司匹林和DAPT。这些研究结果表明,需要改进长期SSP治疗的抗血栓疗法,这可能会导致更高的治疗率和持续率,从而改善该人群的预后。
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引用次数: 0
Atrial Arrhythmias in Adults with Fontan Palliation. Fontan姑息治疗的成人心房心律失常。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-09-01 DOI: 10.1007/s40119-023-00326-5
Matthew Laubham, Ben Blais, Anna N Kamp

Single ventricle physiology is a rare form of congenital heart disease and was, historically, a uniformly lethal condition. However, the atriopulmonary Fontan operation, and its successive iterations, the lateral tunnel and extracardiac conduit Fontan, became the fundamental approach to treating single ventricle heart disease. Over time, dysrhythmias are some of the most common complications with Fontan physiology, compounding morbidity and mortality. Atrial arrhythmias are prevalent in the Fontan population and occur in about 15-60% of patients with Fontan palliation, increasingly with age. Diagnosing atrial arrhythmias in patients with Fontan palliation may be challenging because of low voltage amplitudes arising from myopathic atrial tissue making it difficult to clearly assess atrial depolarization on surface electrocardiograms (ECG), vague symptoms not suggestive of tachyarrhythmia, or atrial arrhythmia with ventricular rates below 100 beats per minute. Intra-atrial reentrant tachycardia (IART) is the most common type of supraventricular tachycardia in adults with Fontan palliation. Acute management of atrial arrhythmias in patients with Fontan palliation involves prompt assessment of a patient's hemodynamic stability, anticoagulation and thrombosis risk, systemic ventricular function, and risk of sedation or anesthesia if needed. Long-term management of atrial arrhythmias is often multifactorial and may include long-term anti-arrhythmic therapy, permanent pacing, and ablation. The best approach for the management of atrial arrhythmias in adults with Fontan palliation is patient-specific and involves collaboration between congenital electrophysiologists, adult congenital cardiologists, and the patient.

单心室生理是一种罕见的先天性心脏病,历史上,是一种统一的致命疾病。然而,心房肺Fontan手术及其后续迭代,外侧隧道和心外导管Fontan,成为治疗单心室心脏病的基本方法。随着时间的推移,心律失常是一些最常见的并发症与Fontan生理,复合发病率和死亡率。房性心律失常在Fontan人群中很普遍,在Fontan姑息治疗患者中约有15-60%发生房性心律失常,随着年龄的增长而增加。Fontan姑息治疗患者的房性心律失常的诊断可能具有挑战性,因为肌病性心房组织产生的低电压幅值使得很难在表面心电图(ECG)上清楚地评估心房去极化,模糊的症状不提示速性心律失常,或心室率低于每分钟100次的房性心律失常。房内可重入性心动过速(IART)是房上性心动过速最常见的类型。Fontan姑息治疗患者心房心律失常的急性管理包括及时评估患者的血流动力学稳定性、抗凝和血栓形成风险、全身心室功能以及必要时镇静或麻醉的风险。房性心律失常的长期治疗通常是多因素的,可能包括长期抗心律失常治疗、永久性起搏和消融。采用Fontan姑息治疗成人心房心律失常的最佳方法是针对患者的,需要先天性电生理学家、成人先天性心脏病专家和患者之间的合作。
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引用次数: 0
Utility of Follow-Up Echocardiograms in Uncomplicated Surgical Secundum Atrial Septal Defect Closures: Preliminary Analysis. 随访超声心动图在简易手术房间隔缺损闭合中的应用:初步分析。
IF 3.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-09-01 DOI: 10.1007/s40119-023-00327-4
Ritika Gupta, May Ling Mah, Jessica Bowman, Clifford L Cua

Introduction: Though less common in the current era, surgical closure of secundum atrial septal defects (ASD2) is still performed in certain clinical situations. Guidelines currently recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who have undergone a surgical ASD2 closure. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated ASD2 closure.

Methods: Chart review was performed on patients who had a surgical ASD2 closure between April 1, 1996, and August 30, 2021. Patients were excluded if they had other congenital heart disease, had a diagnosis of a residual ASD2, atrial/ventricular arrhythmias, pulmonary hypertension, heart failure, or did not have a follow-up TTE > 6 months after the procedure. The most recent TTEs and clinic notes were evaluated.

Results: A total of 30 patients met the criteria. The median age at ASD2 surgery was 4.0 years (IQ; 1.9-10.5). ASD2 was closed via patch repair in 16 patients and primarily closed in 14 patients. The most recent TTE was performed a median of 9.5 years (IQ; 4.0, 14.7) after ASD2 closure. Two patients had mild right atrial and ventricular dilation, one patient had mild right atrial dilation, and one patient had mild right ventricular dilation. All other patients had qualitatively normal right-sided chamber sizes. All patients had normal biventricular function (left ventricular fractional shortening (median 36% (IQ; 33, 42)), no evidence of residual atrial shunts, and no evidence of pulmonary hypertension. No patient was on any cardiac medications at last clinic visit. Four patients were discharged from cardiology clinic and 10 patients were lost to follow-up. There were no deaths. Twenty-four patients had 46 repeat echocardiograms > 1 year after ASD2 with no change in clinical management.

Conclusion: In patients who underwent an uncomplicated ASD2 closure, there were no significant abnormalities noted on follow-up TTEs. The need for repeat lifetime TTEs and their frequency, in this uncomplicated population, should be reassessed if larger studies with longer follow-up confirm these initial findings.

导语:虽然在当今时代不太常见,但在某些临床情况下仍会进行二次房间隔缺损(ASD2)的手术闭合。指南目前推荐对ASD2手术闭合的患者进行终身随访,经胸超声心动图(TTE)。本研究的目的是确定随访TTE在接受无并发症ASD2闭合的患者中的效用。方法:对1996年4月1日至2021年8月30日期间接受ASD2手术闭合的患者进行图表回顾。如果患者患有其他先天性心脏病,诊断为残留ASD2,心房/室性心律失常,肺动脉高压,心力衰竭,或术后没有随访TTE > 6个月,则排除患者。对最近的病例和临床记录进行了评估。结果:30例患者符合标准。ASD2手术的中位年龄为4.0岁(IQ;1.9 - -10.5)。16例患者通过补片修复关闭ASD2, 14例患者主要关闭ASD2。最近一次TTE的中位数为9.5年(IQ;4.0, 14.7)后ASD2关闭。2例患者有轻度右心房和心室扩张,1例患者有轻度右心房扩张,1例患者有轻度右心室扩张。所有其他患者的右心室大小定性正常。所有患者双心室功能正常(左心室分数缩短(中位数36%);33,42)),没有残留心房分流的证据,也没有肺动脉高压的证据。在最后一次就诊时,没有患者服用任何心脏药物。4例出院,10例失访。没有人员死亡。24例ASD2术后1年内复查超声心动图46次,临床处理无变化。结论:在接受无并发症ASD2闭合的患者中,随访tte未发现明显异常。如果更大规模、随访时间更长的研究证实了这些初步发现,那么在这一简单人群中重复终生tte的必要性及其频率应重新评估。
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引用次数: 0
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Cardiology and Therapy
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