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Thromboprophylaxis in atrial fibrillation: device therapy and surgical techniques 房颤的血栓预防:器械治疗和手术技术
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0516
T. Lewalter, C. Jilek, P. Sick
{"title":"Thromboprophylaxis in atrial fibrillation: device therapy and surgical techniques","authors":"T. Lewalter, C. Jilek, P. Sick","doi":"10.1093/med/9780198784906.003.0516","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0516","url":null,"abstract":"The concept of left atrial appendage (LAA) occlusion is to mainly prevent stroke by excluding the most relevant source of embolism from the blood circulation. The LAA can be occluded by a number of interventional or surgical approaches. Following a successful LAA occlusion implant procedure or surgical LAA exclusion, oral anticoagulation is typically terminated, followed by antiplatelet therapy, which is routinely used in the post-implant phase for 3–6 months. The need for chronic antiplatelet therapy is still unclear. Most patients are maintained on a single antiplatelet medication, but patients with a particularly high bleeding risk receive no chronic drug therapy. Currently, the main indication for LAA occluder implantation or LAA exclusion is stroke prevention in patients at high stroke risk, with contraindications for long-term oral anticoagulation due to a bleeding history or an otherwise elevated risk for major bleeding.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"24 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120922613","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
Non-reentrant junctional tachycardias 不可重入性结性心动过速
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0492
D. Katritsis
{"title":"Non-reentrant junctional tachycardias","authors":"D. Katritsis","doi":"10.1093/med/9780198784906.003.0492","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0492","url":null,"abstract":"The diagnosis and management of non-reentrant junctional tachycardias are discussed in this chapter.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121217460","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
Estimating prognosis: biomarkers 预估预后:生物标志物
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0412
M. Richards
{"title":"Estimating prognosis: biomarkers","authors":"M. Richards","doi":"10.1093/MED/9780198784906.003.0412","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0412","url":null,"abstract":"Risk stratification informs the management of heart failure (HF). A range of clinical variables are associated with outcome in HF and have been incorporated into risk calculators which perform adequately at a population level, especially for those with more severe or recently decompensated HF. Their performance in predicting individual patient outcomes among the ambulant community-based populations with chronic HF is less assured. Risk score performance is enhanced by incorporation of selected circulating biomarkers. The cardiac natriuretic peptides, particularly B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), are independently predictive of mortality in both acute and chronic HF. Risk at a given level of BNP is similar regardless of left ventricular ejection fraction. The prognostic performance of NT-proBNP and BNP enriches therapeutic trials for clinical events. Trials of marker-guided therapy in HF consistently indicate that lowering plasma NT-proBNP (preferably to <1000 pg/mL) is associated with improved outcomes. The cardiac natriuretic peptides may be combined with other markers including mid-regional pro-adrenomedullin, ST2, growth/differentiation factor 15, and cardiac troponin to refine risk stratification. There is a need for an improved, independently validated, risk score calculator derived from a large well-annotated HF population incorporating both key clinical predictors and one or more circulating biomarkers.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127126813","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
Genetics of cardiomyopathies: dilated cardiomyopathy 心肌病的遗传学:扩张型心肌病
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0155
Daniel Oehler, H. Katus, B. Meder
{"title":"Genetics of cardiomyopathies: dilated cardiomyopathy","authors":"Daniel Oehler, H. Katus, B. Meder","doi":"10.1093/MED/9780198784906.003.0155","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0155","url":null,"abstract":"Dilated cardiomyopathy is a complex disorder with genetic factors being responsible for up to 35% of all cases. With the knowledge about the different disease genes and methods for comprehensive genotyping, genetic testing of patients with dilated cardiomyopathy is already of high clinical utility. In recent studies, the detection rate for causal variants approaches 30–50% of investigated probands, which allows clinicians to consolidate diagnosis, perform cascade genetic testing, and identify patients with substantial risk for sudden cardiac death. Pivotal for dilated cardiomyopathy research of the next decade will be the careful and unified phenotyping in international consortia, accompanied by comprehensive genotyping using established next-generation sequencing methods. To reliably link the phenotypic expression with the individuality of the genotypes of each proband, new strategies such as multi-omics studies, functional in vitro testing, induced pluripotent stem cell systems, and computer simulations are required.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125034160","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
Epidemiology and pathophysiology of hypertension 高血压的流行病学和病理生理学
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0563_UPDATE_001
S. Taddei, R. Bruno, S. Masi, A. Solini
{"title":"Epidemiology and pathophysiology of hypertension","authors":"S. Taddei, R. Bruno, S. Masi, A. Solini","doi":"10.1093/MED/9780198784906.003.0563_UPDATE_001","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0563_UPDATE_001","url":null,"abstract":"Hypertension remains the leading cause of morbidity and mortality worldwide and significantly impacts the risk of all major cardiovascular events, including stroke, sudden cardiac death, coronary heart disease, heart failure, abdominal aortic aneurysm, and peripheral vascular disease. Important advances in our understanding of its pathophysiology contributed to clarifying the complex origins of the disease, involving dysregulation of multiple homeostatic systems influencing not only blood pressure but also the progression of end-organ damage related to hypertension. Growing evidence suggests that the pathophysiology of hypertension results from complex interactions between environmental and genetic factors, resulting in different risks and age of onset of the disease within the general population. This chapter reviews the recent statistics of hypertension with a specific emphasis on its prevalence and temporal trends in Europe. Also, it provides a comprehensive overview of the mechanisms involved in the aetiopathogenesis of hypertension, highlighting their relative importance in different forms of hypertension.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125173096","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: 8
Heart failure 心脏衰竭
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0182
P. De Meester, W. Budts, M. Gewillig
{"title":"Heart failure","authors":"P. De Meester, W. Budts, M. Gewillig","doi":"10.1093/med/9780198784906.003.0182","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0182","url":null,"abstract":"Heart failure is a common presentation of neonates and children with congenital heart disease and is the most important long-term complication in adults. It may be due to residual lesions and/or the complex circulation which are present even after repair. The mechanisms of heart failure are often different from normally built hearts and this will influence optimal treatment approaches. Several interventions (surgical, transcatheter, or pharmacological) can improve patient outcome and assist devices and heart transplantation are options in severe refractory cases.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123245350","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
Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy 肥厚性心肌病心源性猝死的危险分层
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0547
P. Attanasio, W. Haverkamp
{"title":"Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy","authors":"P. Attanasio, W. Haverkamp","doi":"10.1093/MED/9780198784906.003.0547","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0547","url":null,"abstract":"Identification of patients with hypertrophic cardiomyopathy (HCM) who are at high risk of sudden cardiac death (SCD) is essential, as life-threatening arrhythmic events can be effectively treated with implantable cardioverter defibrillator therapy. Various models for risk stratification of patients with HCM have been proposed. The latest clinical risk prediction model was developed in 2013. It is based on the HCM Risk-SCD study that included 3675 patients. Risk stratification using this model is recommended in the 2014 European Society of Cardiology (ESC) Guidelines for management of HCM and in the 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of SCD. This chapter summarizes novelties in the prediction model and the resulting recommendations, and discusses potential limitations of this approach.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"2 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123730540","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
Epidemiology and global burden of hypertension 高血压流行病学和全球负担
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0061
G. Mensah
{"title":"Epidemiology and global burden of hypertension","authors":"G. Mensah","doi":"10.1093/med/9780198784906.003.0061","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0061","url":null,"abstract":"Hypertension is the most powerful, independent, preventable risk factor for death and disability from cardiovascular diseases. It is also a leading risk factor for all-cause mortality and the largest contributor to global disability-adjusted life years (DALYs). In 2015, exposure to high systolic blood pressure (BP) accounted for 10.7 million deaths (33.2% of deaths attributed to all risk factors) and nearly 212 million DALYs or 20.9% of DALYs from all risk factors. Epidemiological research over the past half-century has confirmed that the risk from hypertension is strong, continuous, graded, and doubles for each increment of 20 mmHg systolic blood pressure (BP) or 10 mmHg diastolic BP in adults, without evidence of a threshold down to BPs as low as 115/75 mmHg. In children and adolescents, hypertension prevalence is increasing (in concert with the continuing epidemic of obesity) and raised BP in adolescents remains the strongest predictor of hypertension in adults. Over the last 25 years, the global age-standardized summary exposure to hypertension has increased for men but not for women. A pooled analysis of 1479 population-based measurements covering more than 19 million participants over four decades showed that the number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015. Most of the increase occurred in low- and middle-income countries. Globally, the highest BP levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa while BP levels have remained persistently high in central and eastern Europe.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125367266","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: 10
Acute management of supraventricular tachycardias with and without established diagnosis (termination and/or rate regulation of tachycardia) 室上性心动过速有或无明确诊断的急性处理(心动过速终止和/或速率调节)
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0480
I. Deisenhofer
{"title":"Acute management of supraventricular tachycardias with and without established diagnosis (termination and/or rate regulation of tachycardia)","authors":"I. Deisenhofer","doi":"10.1093/MED/9780198784906.003.0480","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0480","url":null,"abstract":"Acute management of supraventricular tachycardias without an established diagnosis is first of all always aiming at restoring sinus rhythm—or, in other words, at rhythm control. The management further depends on the QRS width during ongoing tachycardia. If narrow QRS complex tachycardia is present, rhythm control by using medical therapy can be used as the first step, whereas external cardioversion should be the preferred rhythm control strategy in wide QRS complex tachycardia.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125373136","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
Diagnosis of acute pulmonary embolism and evolving imaging modalities 急性肺栓塞的诊断和影像学的发展
ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0659
H. Robert-Ebadi, G. Gal, M. Righini
{"title":"Diagnosis of acute pulmonary embolism and evolving imaging modalities","authors":"H. Robert-Ebadi, G. Gal, M. Righini","doi":"10.1093/med/9780198784906.003.0659","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0659","url":null,"abstract":"Modern non-invasive diagnostic strategies for pulmonary embolism rely on the sequential use of clinical probability assessment, D-dimer measurement, and thoracic imaging tests. Planar ventilation/perfusion scintigraphy was the cornerstone test for the diagnosis of pulmonary embolism for more than two decades and has now been replaced by computed tomographic pulmonary angiography (CTPA). Diagnostic strategies using CTPA are very safe to rule out pulmonary embolism and have been well validated in large prospective management outcome studies. Venous compression ultrasonography is the cornerstone test to diagnose deep vein thrombosis but is not mandatory for the diagnosis of pulmonary embolism when using multidetector CTPA.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126715401","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
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