简介:Heartfailureposesanincreasingproblemforglobalhealthcaresystems.Theepidemiologicaldatawhichhavebeenaccruedoverthelast30yearshavepredominantlybeenaccumulatedfromexperiencewithinNorthAmericaandEurope.TheEuropeanexperienceinheartfailure,althoughsimilartothatinNorthAmerica,hasrecentlydemonstrateddifferencesinhospitalizationwhichmayunderliethedifferencesbetweenhealthcaresystemconfigurations.Despitethepredictedincreaseinthenumberofpatientsaffectedbyheartfailure,overthelast30yearsaclearmanagementalgorithmhasevolvedfortheuseofpharmacotherapies,device-basedtherapies,andmechanicaltherapies,includingleftventricularassistdevicesandcardiactransplantation.Althoughthetreatmentofsuchpatientshasbeenclearlydelineatedinnationalandinternationalguidelines,theunderuseofallavailableandappropriatetherapiesremainsasignificantproblem.ThepurposeofthisreviewistoprovideaEuropeanperspectiveonmanagementofheartfailure.
简介:Itiswellestablishedthatstemcellscandifferentiateintocelltypesoftheorganinwhichthesearetransplanted.However,theprocessisveryslowduetolackofunderstandingofsignalsimportantfortheirsurvivalanddifferentiation,mostoptimalstemcellsandtheirplasticity.Limitationsandadvantagesofvariouscellsubtypeswillbedescribed.Therateofstemcellsmobilizationandtheirsurvivalintheischemicenvironmentaremajorobstaclesinengraftmentanddifferentiationofstemcellsformeaningfulrepairoftheinfarctedmyocardium.Manipulationofstemcellswithischemicpreconditioning,combinedgeneandcelltherapytogetherwithsimultaneousactivationofdiversesignalingpathwaysformassivestemcellmobilization®enerationhassignificantimpactontherepairprocessbystemcells.Theseandotherdifficultiesencounteredinefficientuseofvariousstemcellshaveresultedininventionofinducedpluripotentstemcellswhichcouldrevolutionizethestemcellbasedtherapyandtheirapplicationsforunderstandingofhumandiseaseanddrugscreeninginthenearfuture.ReprogrammingofadultcellsintoiPScellswithouttheuseofviralvectorsisamajorchallengetowardsgettingiPScellswithoutviralintegrationintocells.Tomeetthischallengewehaverepro-grammedskeletalmyoblastsintoiPScellswithhighefficiencyusingepigeneticmodifiers.TransplantationofiPScellsderivedpurecardiacprogenitorsintoinfarctedmyocardiumledtoextensiverepopulationofscarareawithfullydevelopedmyocyteswithouttumorformationandresultinginmarkedimprovementincardiacfunction.Reprogrammingwithpurechemicalmeanswillmaketherapeuticuseofthesecellsmoresafer.Targetingtheinducedpluripotentstemcellstowardscardiacprogenitorsandtheirapplicationtowardstransplantationisamajorstepforwardinenhancingthemyocardialrepaircapacitybythesecells.
简介:Amongallcongenitalheartdisease,Ebsteinanomalyisthelesionwiththewidestspectrumofpresentation.Itcanpresentasearlyastheneonatalperiodwhereimmediateinterventionisoftenneededtotheadultwithnodiscernablesymptoms.Itisalsoonewhereoveralloutcomegreatlyrelatestoageatpresentation.Generally,presentationintheneonatalperiodisassociatedwithpooroutcomeswhilepresentationbeyondtheneonatalperiodhasexcellentoutcomeswithlowoperativemortality.ItisthusapparentthatunderstandingeveryaspectoftheanatomyandphysiologyofEbsteinanomalyandhowitmanifestsclinicallyisparamounttosuccessfultreatment.ThepurposeofthisreviewistooutlinethecurrentconceptsandstrategiesinthesurgicalmanagementofEbsteinanomaly,andtodiscussthecurrentexpertconsensusonhowbesttotacklethiscongenitalheartdiseaseatdifferentagesofdiagnosis.
简介:Hypertensionisaleadingriskfactorforcardiovasculardisease,theleadingcauseofdeathandmorbidityinoursocietyandonaglobalscale.Majorcomponentsofcardiovasculardiseaseincludestroke,coronaryarterydisease,heartfailure,andchronickidneydisease,inallofwhichhypertensionplaysamajorrole.Theriskofthesecomplicationsincreasesdirectlyandlinearlywithsystolicbloodpressurestartingat115mmHg.Althoughusuallyasymptomatic,hypertensionisreadilydetectableonphysicalexaminationandisamenabletobothlifestylemodificationandpharmacologictreatmentinmostpatients.However,largeproportionsofthehypertensivepopulationremainundetectedandundertreated.Numerousguidelineshavebeenissuedduringthepastfewdecadestopromotedetectionandoptimaltherapy.Despitetheincreaseinriskwithsystolicbloodpressuregreaterthan115mmHg,thegenerallyacceptedthresholdfordiagnosisandtreatmenthasbeensystolicbloodpressuregreaterthan139mmHganddiastolicbloodpressuregreaterthan80mmHgbecauseuntilrecentlytreatmenttolowerlevelshasbeenassociatedwithanunfavorablerelationbetweenclinicalbenefitandharm.Inthepastseveralyears,newguidelines,advisories,commentaries,andclinicaltrialshaveprovidedevidenceforapotentialchangeincurrentrecommendationsforthemanagementofhypertension.Inthisregard,thelong-awaitedeighthreportoftheJointNationalCommitteeonthePrevention,Detection,Evaluation,andTreatmentofHighBloodPressurerecommendedpatientsolderthan60yearsbetreatedtoasystolicbloodpressureoflessthan150mmHg,whichhasgeneratedconsiderablecontroversyandcaution.ThestrikingfindingsoftheSystolicBloodPressureInterventionTrial(SPRINT)havereceivedconsiderableattentionbecauseofthedemonstrationthatintensivetherapytoatargetsystolicbloodpressurebelow120mmHgdecreasescardiovascularmortalityandmorbiditymorethanlessintensivetreatmenttoatargetsystolicbloodpressurebelow140mmHg
简介:Thispaperreviewscurrentrecommendationsontheappropriateevaluationandmanagementofcardiacarrhythmiasinthepregnantpatient.Mostarrhythmiasduringpregnancyarebenignandrequirenointervention.Whenrequired,thedecisiontotreatshouldbebasedonsymptomseverityandtheassociatedrisktomotherandfetusposedbypotentiallyrecurringarrhythmiaepisodesthroughoutthepregnancy.Anytreatmentstrategyinthispatientpopulationhasinherentrisktobothmotherandunbornchild.Beforetheinitiationofanyintervention,documentationofaclinicalarrhythmiaandcorrelationwithclinicalsymptomsshouldbeobtained.Thereisnoroleforempirictherapy.
简介:Iatrogenicaortocoronarydissection(IACD)isararebutpotentiallylife-threateningcomplicationduringcoronarycatheterizations.Althoughtheincidencewasrelativelylow,thedissectionoftenleadstoprocedurefailurewithincreasedriskofmyocardialinfarctionanddeath.IACDismainlycausedbydisruptionofintimaattheostiaofleftorrightcoronaryarteryduringinterventionalprocedures,andappearsasluminalfillingdefectsorpersistenceofcontrast(“extraluminalcap”)orintimaltearoutsidethecoronarylumen.Dissectioncoulddisseminateantegradelyandleadtosubtotalortotalocclusionofthecoronarylumen.Similarly,itcouldextendretrogradelyintothesinusofValsalvaandcusp,oreventheascendingaorta,aorticarch,ordescendingaorta,leadingtohemodynamiccollapse.EarlyidentificationandpromptmanagementiscrucialtotheprognosisofpatientswithIACD.Immediatebail-outstentingshouldbeperformedasrapidlyaspossibleinmostcasesofseveredissection,evenwhensignificantpropagationhasalreadyoccurred.Surgeryshouldonlybeconsideredwhenstentingfailedtosealthedissectionandthepatientshadhemodynamiccompromise.
简介:Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.
简介:Ventriculartachycardia(VT)inthepresenceofstructuralheartdiseaseisassociatedwithsuddencardiacdeathandwarrantspromptattention.Implantablecardioverterdefibrillators(ICDs)whilehighlyeffectiveinterminatingsustainedventriculararrhythmiasandreducingmortality,havenoeffectonthearrhythmiasubstrateandrecurrentshocksforVTterminationoccurinapproximately20%ofpatients.Shocksworsenqualityoflifeandareassociatedwithprogressionofheartfailureandincreasedmortality.Antiarrhythmicdrugs,mainlyintheformofbeta-blockersoramiodarone,aremoderatelyeffectiveinreducingICDtherapiesbutdrugintoleranceandserioustoxicitiesofamiodaronenecessitatedrugcessationinaquarterofpatients.CatheterablationhasemergedasaneffectivetreatmentforcontroloffrequentVTepisodesandcanbelifesavingincasesofincessantVTorVTstorm.Asexperienceincreases,itisbeingusedincreasinglyearlier,ratherthanalastresorttherapy.Efficacyvarieswiththenatureoftheunderlyingheartdisease.Intramuralarrhythmiasubstrateandfailuretocreatepermanentablationlesionsremainchallengesandrepeatproceduresarenecessaryinathirdtoahalfofpatients.ForidiopathicVTsorPVCsthataresymptomaticorworsenLVfunction,catheterablationisoftenaneffectivetherapy.
简介:Accordingtothemostrecentepidemiologicaldata,theprevalenceofhypertensionrangedfromabout25%inChineselivingeitherinthemainlandorinTaiwanandKoreans,toapproximately40%inMongolians.Thecontrolrateofhypertensionwasabout35%inKoreansandJapanese,24%inMongolians,andlessthan10%inChinese.Fourplacebo-controlledtrialsinChinaunequivocallyprovedthatantihypertensivetherapymaypreventstrokeandothercardiovascularcomplicationsinhypertensionorpatientswithahistoryofstrokeortransientischemicattack.Fouractively-controlledtrialsinJapandidnotshowsignificantdifferencebetweenvariousclassesorcombinationsofantihypertensivedrugs.TwotrialsthatcomparedintensivewithlessintensivebloodpressurecontrolinelderlyJapanesehypertensivepatientsdidnotshowfurtherbenefitofcontrollingsystolicbloodpressuretoalevelbelow140mmHgincomparisonwithbloodpressurecontroltoalevelof140mmHgorabove.Thesetrialsthatcomparedvariousclassesofantihypertensivedrugsorintensivewithlessintensivebloodpressurecontroloftenhadsmallsamplesizeandhenceinadequatepowertodetectmodestormoderatebenefit.ThereisstillaneedforhighqualityoutcometrialdatainEastAsians.
简介:Sinceitsoriginaldescription,theFontanoperationhasbeenwidelyusedforthepalliationofchildrenwithsingleventriclephysiologyandhasresultedinanincreasingnumberofthesepatientssurvivingtoadulthood.TheFontanoperationisauniqueapproachtocreateacirculationinserieswithouttwodistinctpumpingchambers.AlthoughtheFontanoperationincreasedthesurvivalratesofpatientswithsingleventriclephysiology,itcarriesaninevitableriskoflong-termmorbiditiesthatimpactstheoutcomesandqualityoflifeinthesepatients.Inthisreview,wediscussthechallengesresultingfromtheuniquepathophysiologyofFontancirculationandproposemanagementstrategies.
简介:Congenitalheartdisease(CHD)-associatedpulmonaryarterialhypertension(PAH)includesaheterogeneouspatientpopulationthatcanbecharacterizedbytheunderlyingcardiacmalformation.CHD-associatedPAHhasanestimatedprevalenceof5–10%inadultpatients,withanincreasingnumberofpatientssurvivingtoadulthoodbecauseofadvancesinthesurgicalmanagementandthedevelopmentofpulmonaryarterialhypertension(PAH)-targetedpharmacotherapy.Althoughlimiteddataexist,targetedPAHpharmacotherapyhasproventobebeneficialinpatientswithCHD-associatedPAH,withobservedimprovementinfunctionalclass,increaseinexercisecapacity,andimprovementinqualityoflifeandcardiopulmonaryhemodynamics.Additionally,therehasbeenincreasinginterestinthe“treat-to-close”strategy.PAH-targetedpharmacotherapymaybeusedtooptimizecardiopulmonaryhemodynamicssoastoimprovepatients’operabilityinrepairingthecardiacdefect.Althoughtherehavebeensignificantadvancesinthemanagementofthisdiseasestateinthepast2decades,mortalityremainshigh,andongoingclinicaltrialsareneededtobetterunderstandthetreat-to-closestrategy.
简介:Despitethedevelopmentofnoninvasivetoolsasechocardiography,right-sidedheartcatheterizationremainsanintegralpartofthecardiovascularevaluation.Inthelastdecade,betterunderstandingofthehemodynamicprocessbeforeheartfailuredecompensationledtoimprovementofoutpatientstrategiestopreventit.Advancesinimplantablewirelesstechnologynowallowfrequentanddirectmeasurementofintracardiacfillingpressures,whichcanbemonitoredbyhealthcareproviderstohelptailortherapytoreducefillingpressuresandhospitalreadmissionrates.
简介:INTRODUCTIONWiththedevelopmentofeconomyandimprovementoflifequality,theincidencesofhypertension,hyper-cholesterolemia,diabetes,obesityandsmokinghavebeenincreasedinChina,whichhasledtoasignificantincreaseinthemorbidityandmortalityofcoronaryarterydisease(CAD)~1.SinceitwasintroducedintoChinain1984,coronaryintervention(PCI)hasdevelopedrapidlyandhasbecomethemajortreatmentofCADbecauseofitsuniquecharacteristicsofminimalinvasiveand
简介:The2016revisionofthe“ChineseGuidelinesonPreventionandTreatmentofDyslipidemiainAdults”istheoutcomeofthejointeffortsofthemembersofanexpertpanelformorethan1year,andisbasedonthe2007guidelines.Thereisnodoubtthatthereleaseofthe2007guidelinesgreatlyfacilitatedthemanagementofdyslipidemiaandthepreventionandtreatmentofatheroscleroticcardiovasculardiseases(ASCVDs)inChina.However,anupdateoftheguidelinesforthemanagementofdyslipidemiainChineseadultsisurgentlyneededsincehugechangeshaveoccurredintheconceptsofdyslipidemiaresearchandcontrolduringthelastdecade.
简介:Amlodipine/valsartan(Aml/Val)single-pillcombination(SPC)therapyhasbeenwidelyusedandstudiedinclinicalpracticeinrecentyears.ThisarticlereviewstheChineseandEnglishliteratureontheclinicaluseofAml/ValSPCtherapyinChinesehypertensivepatients.Accordingtofivestudiesconcerningtheefficacyandsafetyofthistreatment,Aml/ValSPCtherapywasmoreefficaciousthanmonotherapywithvalsartan,amlodipine,orthenifedipinegastrointestinaltherapeuticsystem.Thistreatmentshowedgreaterbloodpressure-loweringeffects,ahigherbloodpressurecontrolrate,andahigherresponserate.Aml/ValSPCtreatmentwaswelltolerated,withadverseeventratessimilartothoseofmonotherapywithvalsartanoramlodipineandsignificantlyrareradverseeventscomparedwiththenifedipinegastrointestinaltherapeuticsystem.Aml/ValSPCisahighlyefficaciousandwell-toleratedantihypertensivetreatmentinChinesehypertensivepatients.
简介:Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.
简介:In2014theAmericanCollegeofCardiology/AmericanHeartAssociationissuedfournewguidelinesforcardiovasculardiseasepreventionthatfocusedoncardiovascularriskassessment,lifestylemanagement,obesitymanagement,andbloodcholesterolmanagement.Thedevelopmentofanatheroscleroticcardiovasculardiseaseriskcalculatorformedthebasisoftheriskassessmentguideline,andthelifestylemanagementguidelinefocusedonrecommendinganevidence-baseddietarypattern.Thebloodcholesterolmanagementguidelinespecificallyidentifiedfourgroupsofpatientsshowntobenefitfrommoderate-intensityorhigh-intensitystatintherapyfrompreviousclinicaltrialsandabandonedtheuseofspecificlow-densitylipoprotein(LDL)cholesterol(LDL-C)goallevelsonthebasisofthelackofclinicaltrialevidence.Therecommendationsfortreatmentwithmoderate-intensityorhigh-intensitystatintherapyarebasedonrigorousevidencefromrandomizedclinicaltrials.Guidancehassincebeenprovidedfortheuseofnonstatintherapies,includingcholesterolabsorptioninhibitorandproproteinconvertasesubtilisin/kexintype9monoclonalantibodytherapywhenadequatereductionofLDL-Clevelsisnotachievedwithmaximallytoleratedstatintherapy.TherecentdevelopmentandapplicationofthesetherapieshaveresultedinremarkablereductionsinLDL-Clevelsthatarewelltolerated,andpreliminaryoutcomedataarepromisinginshowingsubstantialatheroscleroticcardiovasculardiseaseeventreductionsbeyondstatintherapy.
简介:BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.
简介:BackgroundAnomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery(ALCAPA)isararecongenitalanomaly.Itdemonstratedthecombinedeffectsoftheabsenceofanormalcoronaryflowwithacoronarystealandtheprofoundischemiathatcanproduceleftventriculardysfunctionandmitralregurgitation.Wehereintroducethepostoperativemanagementofpatientswithrepairofanomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery,withanemphasisonitsoutcome.MethodsRecordsof31patientswithanomalousoriginoftheleftcoronaryarteryfromthepulmonaryarteryreceivingsurgeryfrom1998to2010werereviewedretrospectively,10ofwhichweretreatedwiththemitralvalvesurgicallyatthesametime.Theageofpatientswas4monthsto16years(median,1year)andweightofthosewas5to53kilograms(median,7.8kilograms),allofwhichwerediagnosedofanomalousoriginoftheleftcoronaryarteryfromthepulmonarybyechocardiographyandcardiaccatheterization.Aftersurgery,electrocardiogram,echocardiography,arterialbloodpressure,transcutaneousoxygensaturationandcentralvenouspressureweremonitored.Commonpostoperativecomplicationsinourgroupwereanalysed.Andpreoperativeandpostoperativedataincludingareaofmitralregurgitation,leftventricularsystolicdiameterandleftventriculardistolicdiameterwereobtained.Cardiopulmonarybypasstimeandmechanicalventilationtimeofpostoperativepatientswithnopneumoniawerecomparedwiththosewithpneumonia.Binarylogisticregressionwasappliedfortheanalysisoftheriskfactorsofpostoperativepneumonia.ResultsOf31patients,30survivedaftersurgerywithearlymortalityof3.23%.Onepatientdiedofseverelowcardiacoutputsyndrome.Mechanicalventilationtimewas4hoursto168hourshours(mean,39.68±50.52hours;median,18hours).ICUstaywas16hoursto425hours(mean,111.65±127.03hours;median,44hours).Inourgroup,commonpostoperativecomplicationsweremyocardialischemia(n=12,36.4%),infection(n=
简介:BackgroundValvularheartdisease(VHD)isdefinedasastructuralorfunctionalabnormalityincardiacvalvewhichencompassesanumberofcommoncardiovascularconditions.ThisstudywasaimedtoanalyzetheepidemiologicalchangesofVHDinasinglecardiovascularcenterofSouthernChina.MethodsAtotalof13,138VHDpatientsofGuangdonggeneralhospitalfromJanuary2011toDecember2013werescreenedbytransthoracicechocardiography(TTE)ortransesophagealechocardiography(TEE)andenrolledforthisstudy.Themorbidity,etiologicalspectrumandmanagementofthesepatientswereanalyzed.Continuousvariableswereexpressedasmean±standarddeviation.Categoricalvariableswereexpressedasratioorpercentage.ResultsPatientsinthisstudyweredividedintodifferentgroupsandwereanalyzedthroughoutchangesinmorbidity,etiologicalspectrumandmanagement.ConclusionsTheprevalenceofVHDremainshighinSouthernChinaandRHDisstilltheleadingetiologyofVHD.Butmorbidityrateisreducedandsurgeryisstillthemaintreatmentoption.