EMJ Cardiology最新文献_第10页

Circulating Haemoglobin Levels and the Risk of Atherosclerosis in Asian Indian Populations 亚洲印第安人血液循环血红蛋白水平与动脉粥样硬化风险

EMJ Cardiology Pub Date : 2015-10-24 DOI: 10.33590/emjcardiol/10312382

Jeetesh V. Patel, P. Flinders, A. Vyas, Imogen Glover, Avithra J. Rajan, D. Prabhakaran, D. Bhatnagar, K. Reddy, M. Mackness, J. Cruickshank, E. Hughes, P. Durrington

{"title":"Circulating Haemoglobin Levels and the Risk of Atherosclerosis in Asian Indian Populations","authors":"Jeetesh V. Patel, P. Flinders, A. Vyas, Imogen Glover, Avithra J. Rajan, D. Prabhakaran, D. Bhatnagar, K. Reddy, M. Mackness, J. Cruickshank, E. Hughes, P. Durrington","doi":"10.33590/emjcardiol/10312382","DOIUrl":"https://doi.org/10.33590/emjcardiol/10312382","url":null,"abstract":"Background: The global burden of coronary heart disease (CHD) is estimated to be the highest on the Indian subcontinent. The pathophysiology of this increased risk is complex, multifactorial, and its magnitude increases with migration from India to Britain. Haemoglobin disorders, which also frequent this ethnic group, have been linked to cardiovascular disease. We investigated the impact of migration and nutritional intake on haematological parameters amongst South Asians, with a focus on their relation to molecular indices of oxidative atherogenesis.\u0000Methods: Haematology, diet, oxidised low-density lipoprotein (LDL), and serum paraoxonase activity were measured in 230 migrant Indian Gujaratis (Britain), and 305 matched contemporaries living in rural villages (India).\u0000Results: Median levels of haemoglobin were higher amongst migrant men (14.5 µmol/l) compared to rural men (15.0 µmol/l, P=0.004) and higher in migrant women (12.7 µmol/l) compared to rural women (11.8 µmol/l, P<0.001). Irrespective of site, haemoglobin levels in South Asians were positively associated with high blood pressure, high serum cholesterol, low high density lipoprotein (HDL) cholesterol levels, and increased CHD risk scores (P<0.001). Haemoglobin concentrations were higher amongst migrants compared to rural contemporaries (P<0.001). In rural women, red cell volume was lower, and co-ordinated with lower levels of oxidised LDL compared with migrant women (P<0.001). On multivariate analysis, haemoglobin was independently associated with oxidised LDL (P=0.001) and paraoxonase activity (P=0.025).\u0000Conclusion: Levels of haemoglobin were independently associated with indices of atherogenesis in our populations of rural and migrant Indians. Iron availability may underline the pathogenesis for the oxidative modification of LDL in this group.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128752421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

International, Large-Scale, Real-World Clinical Data Confirm the Safety Profile of Rivaroxaban 国际、大规模、真实世界的临床数据证实利伐沙班的安全性

EMJ Cardiology Pub Date : 2015-10-20 DOI: 10.33590/emjcardiol/10312782

J. Camm

{"title":"International, Large-Scale, Real-World Clinical Data Confirm the Safety Profile of Rivaroxaban","authors":"J. Camm","doi":"10.33590/emjcardiol/10312782","DOIUrl":"https://doi.org/10.33590/emjcardiol/10312782","url":null,"abstract":"Rivaroxaban is a direct factor Xa inhibitor and a non-vitamin K antagonist (VKA) novel oral anticoagulant (NOAC) approved for a number of indications. It has been approved since 2011 by both the United States Food and Drug Administration and the European Medicines Agency for use in patients with non-valvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism. However, anticoagulant therapy (both VKAs and NOACs) has been associated with an increased risk of bleeding. Although the majority of bleeding events are minor from a clinical standpoint (e.g. ecchymoses), major bleeding events have also been reported. This warrants the need for robust and large-scale clinical and safety data to guide physicians in patient selection, risk stratification, and treatment choice. While NOACs have been subject to a number of randomised clinical trials, observational studies, and real-world registries, large-scale observational studies are still scarce. This article reviews the newly published data from the XANTUS and the United States Department of Defense post-marketing safety surveillance studies, two landmark real-world observational studies on rivaroxaban use and safety in NVAF patients, and puts them in perspective with regard to clinical trial data and other real-world data. Both sets of results were presented at the European Society of Cardiology Congress on 31st August, 2015. This data collection represents more than 45,000 patients from 22 countries.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125108731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Real-World Registry Study Confirms Fondaparinux Over Low-Molecular-Weight Heparin for NSTEMI 真实世界注册研究证实Fondaparinux优于低分子肝素治疗NSTEMI

EMJ Cardiology Pub Date : 2015-10-20 DOI: 10.33590/emjcardiol/10313943

T. Jernberg, K. Szummer

引用次数: 0

New Paradigms in Heart Failure: RAAS Inhibition and the Management of Hyperkalaemia 心力衰竭的新范式:RAAS抑制和高钾血症的管理

EMJ Cardiology Pub Date : 2015-10-20 DOI: 10.33590/emjcardiol/10310973

Lucy Smithers

引用次数: 0

Self-Expanding Coronary Stents: Rationale, Clinical Status, Future Prospects 自扩张冠状动脉支架:基本原理，临床现状，未来展望

EMJ Cardiology Pub Date : 2015-10-20 DOI: 10.33590/emjcardiol/10313835

R. Wessely, G. Amoroso

{"title":"Self-Expanding Coronary Stents: Rationale, Clinical Status, Future Prospects","authors":"R. Wessely, G. Amoroso","doi":"10.33590/emjcardiol/10313835","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313835","url":null,"abstract":"The mechanical treatment of coronary artery stenoses by placement of balloon-expandable (Bx) coronary stents has become the most widely used invasive treatment for symptomatic coronary artery disease (CAD). However, the mechanical properties of Bx stents may be limited and are frequently not well adapted to the requirements of the biological system. Consequently, there is evidence that the mechanical shortcomings of Bx stents, such as conformability to the vascular wall, stent underexpansion or oversizing, adaptability to vessel tapering, scaffolding of bifurcated lesions, inability to address vessel remodelling, and achieving optimal drug delivery, could translate into adverse clinical events. New, enhanced technology now allows the application of a number of self-expanding (Sx) coronary stents to treat CAD. Various clinical trials have proven coronary applicability and the clinical safety and efficacy of Sx stents. It is expected that this new generation of endovascular prostheses that are specifically tailored to the needs of the coronary arteries can overcome some of the limitations that are associated with Bx stents, while maintaining their valuable, traditional features. Clinical results of Sx stents may be further improved by continuous development of these devices.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127809135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Hypertension Care: It’s Time to Act 高血压护理:是时候采取行动了

EMJ Cardiology Pub Date : 2015-03-03 DOI: 10.33590/emjcardiol/10310492

Lynda M. McEvoy

{"title":"Hypertension Care: It’s Time to Act","authors":"Lynda M. McEvoy","doi":"10.33590/emjcardiol/10310492","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310492","url":null,"abstract":"The satellite symposium was held in two separate sessions – the first a traditional symposium format, and the second as an interactive panel discussion in which the faculty answered questions from the delegates. The symposium objectives included consideration of the impact of suboptimal blood pressure (BP) control on the high levels of cardiovascular (CV) events in Europe; evaluation of the importance of patient adherence in improving management of BP; consideration of the management of treatment-resistant patients; discussion of a new initiative to drive improved management of hypertension; and how angiotensin receptor blocker (ARB)-based treatments and single-pill combinations may be used to treat hypertensive patients. Professor Burnier discussed the difficulties associated with achieving good BP control in the primary care setting and highlighted the utility of single-pill fixed-dose combinations (FDCs) for improving adherence and BP normalisation. Professor Ruilope discussed the clinical work-up and management of patients with treatment-resistant hypertension, while Professors Schmieder and Weiss outlined some initiatives taking place that aim to improve BP control rates. Finally, Professor Volpe described an ARB-based treatment platform which shows how patients can be effectively treated with single-pill combination therapy.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130714788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Editor’s Pick: State of the Art of Aortic Valve Implantation: Indications, Outcomes, and Controversies 编者精选:主动脉瓣植入术的现状:适应症、结果和争议

EMJ Cardiology Pub Date : 2015-02-24 DOI: 10.33590/emjcardiol/10314905

P. Salinas, L. Nombela‐Franco, P. Jiménez-Quevedo, Eulogio J. García

{"title":"Editor’s Pick: State of the Art of Aortic Valve Implantation: Indications, Outcomes, and Controversies","authors":"P. Salinas, L. Nombela‐Franco, P. Jiménez-Quevedo, Eulogio J. García","doi":"10.33590/emjcardiol/10314905","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314905","url":null,"abstract":"During the last decade, transcatheter aortic valve implantation (TAVI) has become a revolution in the treatment of high-risk severe aortic stenosis (AS). Current guidelines provide a Class I indication for TAVI in inoperable AS and Class IIa indication for TAVI as an alternative to surgical repair in high-risk patients. A large amount of retrospective, prospective, and randomised data has been published covering almost every angle of the procedure. Improved patient evaluation and selection, new devices, and technical refinements will reduce procedural complications and improve long-term outcomes. With a growing elderly population segment in the Western countries, the procedure has a bright perspective. The purpose of this review is to summarise the state of the art of TAVI procedures, including current indications, and describe procedural characteristics, as well as short and long-term outcomes. Controversial issues such as paravalvular regurgitation and stroke are discussed, as well as off-label indications. A shift towards intermediate risk AS patients, approval of some of the off-label indications, and device versus device competition are some of the future directions of the technique.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129550309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Left Ventricular Cardiomyopathy in Mitral Valve Prolapse: Fact or Fiction? 二尖瓣脱垂引起的左室心肌病:事实还是虚构?

EMJ Cardiology Pub Date : 2015-02-24 DOI: 10.33590/emjcardiol/10313096

C. Jost, M. Greutmann, H. Connolly, B. Naegeli, A. Faeh-Gunz, C. Scharf, R. Candinas, E. V. Buechel, R. Weber, C. Binggeli, O. Franzen, A. Medeiros-Domingo

{"title":"Left Ventricular Cardiomyopathy in Mitral Valve Prolapse: Fact or Fiction?","authors":"C. Jost, M. Greutmann, H. Connolly, B. Naegeli, A. Faeh-Gunz, C. Scharf, R. Candinas, E. V. Buechel, R. Weber, C. Binggeli, O. Franzen, A. Medeiros-Domingo","doi":"10.33590/emjcardiol/10313096","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313096","url":null,"abstract":"In most patients with mitral valve prolapse (MVP) without severe mitral regurgitation (MR), left ventricular (LV) function is preserved. There are, however, patients with MVP who have unexplained LV dilatation and/or decreased LV function. An association between MVP and sudden cardiac death has also been reported. LV size and function may be affected by the type of MVP, severity of regurgitation, and cause of MVP (myxomatous degeneration versus fibroelastic deficiency). There is increasing evidence suggesting an intrinsic cardiomyopathy associated with MVP. The cardiomyopathy associated with MVP can also affect the right ventricle (RV). Although the impact on ventricular dimensions and function are usually subtle, these abnormalities can affect clinical and echocardiographic estimation of the severity of MR and may thus have an impact on therapeutic decisions. Particularly in patients with the most extreme forms of MVP (Barlow disease), and in patients with Marfan syndrome or other connective tissue disorders, a cardiomyopathy affecting the LV and RV may thus occur occasionally. A better understanding of LV impairment associated with MVP is important for risk assessment and clinical decision-making.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122608976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-Effectiveness of a Novel Self-Apposing Stent in ST-Segment Elevation Myocardial Infarction (STEMI) in France 法国st段抬高型心肌梗死(STEMI)的新型自体支架的成本-效果

EMJ Cardiology Pub Date : 2015-02-24 DOI: 10.33590/emjcardiol/10311664

L. Annemans, J. Silvain, G. Montalescot

{"title":"Cost-Effectiveness of a Novel Self-Apposing Stent in ST-Segment Elevation Myocardial Infarction (STEMI) in France","authors":"L. Annemans, J. Silvain, G. Montalescot","doi":"10.33590/emjcardiol/10311664","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311664","url":null,"abstract":"The objective was to calculate the cost-effectiveness profile of STENTYS compared to conventional bare and drug-eluting stents (DES). Stents are widely used in the treatment of patients with ST-segment elevation myocardial infarction (STEMI). However, several reports point to the prevailing risk of coronary events such as recurrent myocardial infarction, some of which are related to in-stent thrombosis, possibly explained by poorly apposed stents. 1-year results of the self-apposing stent, STENTYS, are promising regarding the incidence of fatal and non-fatal cardiovascular (CV) events. A model was developed to simulate costs and quality-adjusted life years (QALYs) over 1-5 years. In the first 12 months, a decision tree framework was used to define different CV outcomes for STEMI patients receiving a stent. After 12 months, outcomes were categorised in a Markov stage of the model as myocardial infarction (MI), other CV events, revascularisation, and death. Cost of comparative treatments and follow-up in relation to CV events were calculated from the French health insurance perspective. The results indicated, in the base case, over a time horizon of 5 years, that STENTYS bare metal stent (BMS) is dominant (less costly and more QALYs) against conventional DES. The STENTYS DES is dominant compared with conventional DES and very cost-effective versus BMS. The results were robust for different variations in the input variables. This first analysis of the cost-effectiveness of STENTYS showed that it is dominant or very costeffective as compared to conventional stents. Further comparative research and longer follow-up data are needed to expand on these results.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127719924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Functional Mitral Regurgitation: If the Myocardium Is Guilty Do We Also Need to ‘Rehabilitate’ the Valve? 功能性二尖瓣反流:如果心肌是有罪的，我们还需要“修复”瓣膜吗?

EMJ Cardiology Pub Date : 2015-02-24 DOI: 10.33590/emjcardiol/10310014

M. Pepe, V. Paradies, F. Resta, A. Cafaro, F. Bartolomucci, Filippo Masi, D. Quagliara, S. Favale

{"title":"Functional Mitral Regurgitation: If the Myocardium Is Guilty Do We Also Need to ‘Rehabilitate’ the Valve?","authors":"M. Pepe, V. Paradies, F. Resta, A. Cafaro, F. Bartolomucci, Filippo Masi, D. Quagliara, S. Favale","doi":"10.33590/emjcardiol/10310014","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310014","url":null,"abstract":"Mitral regurgitation (MR) is the most frequent valvulopathy in the general population with an incidence that grows with age and is associated with a poor prognosis. Regardless of its primary cause, which can be both ischaemic and non-ischaemic cardiomyopathy, it finally activates a self-feeding process. Due to the complexity of mitral valve (MV) apparatus and its interaction with the myocardium, even the diagnosis could represent a challenge for physicians. Higher technological instruments such as 3D echocardiography and cardiac magnetic resonance could play an important role in the evaluation of MV. In this paper we reviewed the most salient aspects of functional MR pathophysiology as well as the current diagnostic methods. The management of functional mitral regurgitation (FMR) is even more challenging and controversial; the optimal approach, timing, and effectiveness of interventions are still debated. Treatment of FMR begins with optimal medical therapy for left ventricular dysfunction, including cardiac resynchronisation when indicated. While functional improvement after surgery is well established, the benefits in terms of survival are still questionable. Moreover, in patients with high perioperative risk there is a growing interest in emerging percutaneous techniques. Among a variety of medical, surgical, and percutaneous opportunities, authors support an accurate case-by-case evaluation to find a tailored and stepwise treatment according to anatomical features and patient comorbidities.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128472589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0