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Intra-arterial thrombolytics during endovascular thrombectomy for acute ischaemic stroke in the mr CLEAN Registry

Stroke & Vascular Neurology 2023年第1期8卷 17-25页

作者： Sabine L Collette Reinoud P H Bokkers Aryan Mazuri Geert J LycklamaàNijeholt Robert J van Oostenbrugge Natalie E LeCouffe Faysal Benali Charles B L M Majoie Jan Cees de Groot Gert Jan R Luijckx Maarten Uyttenboogaart 无 Department of Radiology Medical Imaging CentreUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands Department of Radiology Haaglanden Medical CentreThe Haguethe Netherlands Department of Neurology Cardiovascular Research Institute Maastricht(CARIM)Maastricht University Medical CentreMaastrichtthe Netherlands Department of Neurology Amsterdam UMCUniversity of AmsterdamAmsterdam NeuroscienceAmsterdamthe Netherlands Department of Radiology Maastricht University Medical CentreMaastrichtthe Netherlands Department of Radiology and Nuclear Medicine Amsterdam UMCUniversity of AmsterdamAmsterdam NeuroscienceAmsterdamthe Netherlands Department of Neurology University Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands On behalf of the mr CLEAN Registry investigators

Introduction The efficacy and safety of local intra-arterial(IA)thrombolytics during endovascular thrombectomy(EVT)for large-vessel occlusions is uncertain.We analysed how often IA thrombolytics were administered in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands(mr CLEAN)Registry,whether it was associated with improved functional outcome and assessed technical and safety outcomes compared with EVT without IA thrombolytics.Methods In this observational study,we included patients undergoing EVT for an acute ischaemic stroke in the anterior circulation from the mr CLEAN Registry(March 2014-November 2017).The primary endpoint was favourable functional outcome,defined as an modified Rankin Scale score≤2 at 90 days.Secondary endpoints were reperfusion status,early neurological recovery and symptomatic intracranial haemorrhage(sICH).Subgroup analyses for IA thrombolytics as primary versus adjuvant revascularisation attempt were performed.Results Of the 2263 included patients,95(4.2%)received IA thrombolytics during EVT.The IA thrombolytics administered were urokinase(median dose,250000 IU(IQR,193750-250000))or alteplase(median dose,20 mg(IQR,12-20)).No association was found between IA thrombolytics and favourable functional outcome(adjusted OR(aOR),1.16;95%CI 0.71 to 1.90).Successful reperfusion was less often observed in those patients treated with IA thrombolytics(aOR,0.57;95%CI 0.36 to 0.90).The odds of sICH(aOR,0.82;95%CI 0.32 to 2.10)and early neurological recovery were comparable between patients treated with and without IA thrombolytics.For primary and adjuvant revascularisation attempts,IA thrombolytics were more often administered for proximal than for distal occlusions.Functional outcomes were comparable for patients receiving IA thrombolytics as a primary versus adjuvant revascularisation attempt.Conclusion Local IA thrombolytics were rarely used in the mr CLEAN Registry.In the relatively small study sample,no statistical difference was observe

关键词： arterial throm acute

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等长收缩负荷心脏mrI:一个简单、容易重复的评估静息状态下不明显心脏疾病的方法

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国际医学放射学杂志 2016年第3期 332-332页

作者： K.H.Mortensen A.Jones J.A.Steeden A.M.Taylor V.Muthurangu 罗松 UCL Centre for Cardiovascular MR UCL Institute of Cardiovascular ScienceLevel 6 Old Nurses HomeCardiorespiratory UnitGreat Ormond Street Hospital for Children

摘要引言等长收缩运动可以显示静息时并不明显的心血管疾病,已证实心血管mrI(Cmr)可用于对其进行全面评估。本研究设计了一个简单的等长收缩运动诱发血流动力学反应,并应用Cmr方法对其评价。方法肱二头肌等长收缩运动技术被设计用于Cmr... 详细信息

摘要引言等长收缩运动可以显示静息时并不明显的心血管疾病,已证实心血管mrI(Cmr)可用于对其进行全面评估。本研究设计了一个简单的等长收缩运动诱发血流动力学反应,并应用Cmr方法对其评价。方法肱二头肌等长收缩运动技术被设计用于Cmr,75例健康志愿者分别在静息状态、肱二头肌锻炼3 min后、恢复5 min后测量:(1)血压,

关键词：等长收缩运动 Cmr mrI 静息状态

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运用高时空分辨率mr k空间及时间敏感编码技术实时评估先天性心脏病病人左、右心室容积及功能

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国际医学放射学杂志 2008年第A6期31卷 483-484页

作者： V.Muthurangu P.Lurz J.D.Critchely J.E.Deanfield A.M.Taylor M.S.Hansen 李翠玲 Centre for Cardiovascular MR Cardiothoracic UnitUCL Institute of Child Health30Guildford StLondon WC1N 1EHEngland.

目的比较心电门控mr电影成像、标准实时mr成像及实时k空间-时间敏感编码成像3种技术评估先天性心脏病病人心室容积的大小。

关键词：先天性心脏病 mr k空间右心室心电门控高时空分辨率编码技术影像质量技术评估射血分数

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Papillary Muscle Function Does Not Predict Mitral Regurgitation in Patients with Normal Left Ventricular Systolic Function: A Transesophageal Echocardiographic Study

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International Journal of Clinical Medicine 2011年第2期2卷 178-183页

作者： Ernest C. Madu Dainia S. Baugh Edwin Tulloch-Reid Chiranjivi Potu Department of Medicine Division of Cardiovascular Medicine Heart Institute of the Caribbean centre of Excellence for cardiovascular Diseases and Sports Physiology University of Technology

Objective: To evaluate LV papillary muscles (PM) function using transesophageal echocardiography (TEE), and to determine the relationship between PM function and mitral regurgitation in patients with normal left ventricular sys-tolic function. Design: TEE examinations were prospectively performed. End diastolic and end systolic PM lengths were obtained from the transgastric long axis views and fractional systolic shortening (FS) was calculated. LV ejection fraction was determined using modified Simpson rule and mitral regurgitation was determined using regurgitant jet area by color flow. Setting: Tertiary Center. Patients: 85 consecutive adult patients (51 with mitral regurgitation and 34 without) with normal LV chamber dimensions and LV systolic function, meeting enrollment criteria. Results: The % FS in patients with mitral regurgitation was 21.7 ± 3.6% for anterior PM (APM) and 18.7 ± 4.6% for posterior PM (PPM). In those without mitral regurgitation, the values were as follows;22.6 ± 5.4% (APM) and 19.5 ± 3.8% (PPM). In a subgroup of patients with severe mitral regurgitation (n = 23), the values for PM FS were 20.3 ± 6.8 (APM) and 18.4 ± 6.9 % (PPM). There was no statistically significant difference in PM fractional shortening between the groups. Anterior papillary muscle length was longer in those patients with mitral regurgitation compared to those without [(End-diastolic length (cm): 3.38 ± 0.61 v 2.88 ± 0.47(p: 0.008) and end-systolic length of 2.46 ± 0.51 v 2.17 ± 0.33 (p: 0.04)]. These differences are more pronounced in those with severe mitral regurgitation (p: 0.002 and 0.004 for EDL and ESL respectively. Conclusion: In patients with normal LVEF, PM contraction is similar in those with and without mr. In patients with mr however, anterior PM length (ED & ES) is significantly increased. Our data suggests that in patients with normal LVEF, PM dysfunction appears to play no significant role in the causation of mr. Anterior papillary muscle length however, appears to be a major determinant of mitral regur

关键词： Mitral Regurgitation TEE Papillary Muscle LV Function

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The coronavirus disease-19 pandemic and acute coronary syndrome:a specific impact in the elderly

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Journal of Geriatric Cardiology 2022年第5期19卷 325-334页

作者： ViktorČulić Ahmed AlTurki Riccardo Proietti Department of Cardiology and Angiology University Hospital Centre SplitSplitCroatia University of Split School of Medicine SplitCroatia Division of Cardiology McGill University Health CentreMontrealQuebecCanada Liverpool centre for cardiovascular Science University of LiverpoolLiverpoolUnited Kingdom

The coronavirus disease-19(COVID-19)pandemic has dramatically burdened healthcare systems worldwide by creating new public health priorities.In addition to the most prevalent presentation of COVID-19 with mild to moderate respiratory symptoms,which occasionally progresses to acute respiratory distress syndrome,cardiovascular complications of COVID-19 include arterial and venous thromboembolic events(pulmonary embolism,acute myocardial infarction(MI)and ischemic stroke),myocarditis/myocardial injury.

关键词： acute respiratory distress

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Animal models of pulmonary hypertension due to left heart disease

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Animal Models and Experimental Medicine 2022年第3期5卷 197-206页

作者： Shao-Fei Liu Yi Yan Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität BerlinHumboldt-Universität zu Berlinand Berlin Institute of HealthBerlinGermany DZHK(German centre for cardiovascular Research) Partner Site BerlinBerlinGermany Institute for cardiovascular Prevention(IPEK) Ludwig-Maximilians-University MunichMunichGermany DZHK(German centre for cardiovascular Research) Partner Site Munich Heart AllianceMunichGermany

Pulmonary hypertension due to left heart disease(PH-LHD) is regarded as the most prevalent form of pulmonary hypertension(PH). Indeed, PH is an independent risk factor and predicts adverse prognosis for patients with left heart disease(LHD). Clinically, there are no drugs or treatments that directly address PH-LHD, and treatment of LHD alone will not also ameliorate PH. To target the underlying physiopathological alterations of PH-LHD and to develop novel therapeutic approaches for this population, animal models that simulate the pathophysiology of PH-LHD are required. There are several available models for PH-LHD that have been successfully employed in rodents or large animals by artificially provoking an elevated pressure load on the left heart, which by transduction elicits an escalated pressure in pulmonary artery. In addition, metabolic derangement combined with aortic banding or vascular endothelial growth factor receptor antagonist is also currently applied to reproduce the phenotype of PH-LHD. As of today, none of the animal models exactly recapitulates the condition of patients with PH-LHD. Nevertheless, the selection of an appropriate animal model is essential in basic and translational studies of PH-LHD. Therefore, this review will summarize the characteristics of each PH-LHD animal model and discuss the advantages and limitations of the different models.

关键词： animal model l eft ventricular failure metabolic syndrome pulmonary hypertension due to left heart disease pulmonary vascular remodeling

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Vectorcardiographic QRS area as a predictor of response to cardiac resynchronization therapy

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Journal of Geriatric Cardiology 2022年第1期19卷 9-20页

作者： Mohammed A Ghossein Antonius MW van Stipdonk Frits W Prinzen Kevin Vernooy Department of Physiology Cardiovascular Research Institute Maastricht(CARIM)Maastricht UniversityMaastrichtThe Netherlands Department of Cardiology Cardiovascular Research Institute Maastricht(CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands Department of Cardiology Radboud University Medical CentreNijmegenThe Netherlands

Cardiac resynchronization therapy(CRT)is a good treatment for heart failure accompanied by ventricular conduction abnormalities.Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT.The criteria QRS duration and left bundle branch block(LBBB)QRS morphology insufficiently detect left ventricular activation delay,which is required for benefit from CRT.Additionally,there are various definitions for LBBB,in which each one has a different association with CRT benefit and is prone to subjective interpretation.Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria.Indeed,various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT.The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology,QRS duration,and patient characteristics known to affect CRT-outcome including ischemic etiology and sex.On top of QRS area prior to CRT,the reduction in QRS area after CRT further improves benefit.QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis.Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment.

关键词： ventricular synchronization conduction

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Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date

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World Journal of Diabetes 2019年第10期10卷 490-510页

作者： Lavanya Athithan Gaurav S Gulsin Gerald P McCann Eylem Levelt Department of cardiovascular Sciences University of Leicester and NIHR Leicester Cardiovascular Biomedical Research CentreGlenfield HospitalLeicester LE3 9QPUnited Kingdom Multidisciplinary cardiovascular Research centre and Biomedical Imaging Science Department Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeeds LF9 7TFUnited Kingdom

The prevalence of type 2 diabetes(T2D)has increased worldwide and doubled over the last two decades.It features among the top 10 causes of mortality and morbidity in the world.cardiovascular disease is the leading cause of complications in diabetes and within this,heart failure has been shown to be the leading cause of emergency admissions in the United Kingdom.There are many hypotheses and well-evidenced mechanisms by which diabetic cardiomyopathy as an entity develops.This review aims to give an overview of these mechanisms,with particular emphasis on metabolic inflexibility.T2D is associated with inefficient substrate utilisation,an inability to increase glucose metabolism and dependence on fatty acid oxidation within the diabetic heart resulting in mitochondrial uncoupling,glucotoxicity,lipotoxicity and initially subclinical cardiac dysfunction and finally in overt heart failure.The review also gives a concise update on developments within clinical imaging,specifically cardiac magnetic resonance studies to characterise and phenotype early cardiac dysfunction in T2D.A better understanding of the pathophysiology involved provides a platform for targeted therapy in diabetes to prevent the development of early heart failure with preserved ejection fraction.

关键词： Diabetic cardiomyopathy Cardiac metabolism Myocardial steatosis Myocardial strain

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Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

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Journal of Geriatric Cardiology 2021年第4期18卷 297-306页

作者： Saad Javed Ioanna Koniari David Fox Chris Skene Gregory YH Lip Dhiraj Gupta Liverpool centre for cardiovascular Science University of LiverpoolLiverpool Heart and Chest HospitalLiverpoolUK Division of cardiovascular Sciences University of ManchesterManchesterUK Cardiology Department University Hospital of ManchesterManchesterUK

Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.

关键词： Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

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An overview of PCI in the very elderly

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Journal of Geriatric Cardiology 2015年第2期12卷 174-184页

作者： Vimalraj Bogana Shanmugam Richard Harper Ian Meredith Yuvaraj Malaiapan Peter J Psaltis cardiovascular Research centre Monash University 246 Clayton Road Clayton Victoria 3168 Australia

心血管的疾病，和特别地 ischemic 心疾病(IHD ) ，是病态和死亡的一个主要原因在老(>；80 年) 世界范围。这些病人代表为经皮的冠的干预(一种总线标准) 介绍的一个很快成长的队，现在在五个病人组成超过一在真实世界的实践与一... 详细信息

心血管的疾病，和特别地 ischemic 心疾病(IHD ) ，是病态和死亡的一个主要原因在老(>；80 年) 世界范围。这些病人代表为经皮的冠的干预(一种总线标准) 介绍的一个很快成长的队，现在在五个病人组成超过一在真实世界的实践与一种总线标准对待。而且，他们经常比他们的更年轻的对应物有更大的 ischemic 负担，建议他们有从冠的 revascularization 治疗的利益的更大的范围。尽管有这，老在那里在临床的 revascularization 试用并且历史上经常是未被充分代表的是在为一种总线标准过程提交他们的医生勉强的度与令人失望的结果的感觉，低成功和高复杂并发症评价。几个问题贡献了这，包括为有晚介绍的 IHD 的更老的病人的趋势，与不正常的症状或关于他们的程序的 risk-to-benefit 比率的非诊断的 ECG，和保留由于更短的预期寿命，从 antiplatelet 和 anticoagulation 药的 comorbidities 和增加的流血风险的存在。然而，在在过去的十年的一种总线标准技术和技术的进展导致了更好的结果和复杂并发症和存在身体的更低的风险证据现在显示那老实际上比更年轻的人口从一种总线标准导出更相对的利益。重要地，这适用于所有一种总线标准背景：选任，迫切并且紧急情况。这评论在与长期的稳定的 IHD 的老介绍讨论一种总线标准的角色，非圣举起急性冠的症候群，和圣举起心肌的梗塞。当认为在为研究和开发的这个队和进行中的需要的一种总线标准进一步在这些挑战性的病人改进结果时，它也探讨遇见的临床的挑战。

关键词： PCI技术急性冠脉综合征老人介入治疗冠状动脉现实世界临床试验心血管疾病

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