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Heart failure with preserved ejection fraction in the elderly: pathophysiology, diagnostic and therapeutic approach

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Journal of Geriatric cardiology 2019年第5期16卷 421-428页

作者： Ernesto Ruiz Duque Alexandros Briasoulis Paulino A Alvarez Cardiomyopathy Section Cardiology Division University of Iowa

Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.

关键词： Echocardiography Ejection fraction Heart failure Pharmacology The elderly

Transcatheter interventions for severe tricuspid regurgitation:a literature review

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Journal of Geriatric cardiology 2022年第7期19卷 539-550页

作者： Pramod Kumar Ponna Stephen Patin Naga Sai Shravan Turaga Dominika M Zoltowska Vishal Devarkonda Ramya Krishna Botta Yashwant Agrawal Gaurav Dhar Internal Medicine Louisiana State University Health Sciences CenterShreveportLAUSA Division of Cardiology University of Arkansas for Medical SciencesLittle RockARUSA Division of Cardiology University of FloridaJacksonvilleFLUSA division of Infectious Diseases Vanderbilt University Medical CenterNashvilleTNUSA Division of Cardiology Chandler Region Medical CenterChandlerArizonaUSA

The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscles,or annulus).Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle(RV)or right at-rium(RA)remodeling and increased RV pressures.Isolated TR is without increased RV pressures and is associated with atrial fibrillation.Mild TR is a benign disease.Moderate to severe tricuspid regurgitation has independently been associated with in-creased mortality.Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR.The in-hospital mortality rate is 8.8%,and the median length of stay in hospital is 11 days resulting in higher healthcare costs.Even if the patients undergo surgical repair or replacement,available data do not show improvement in survival.With a more detailed un-derstanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricusp-id valve disease,the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention.In the past decade,transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been de-veloped,contributing to decreased mortality from surgical repair.Transcatheter tricuspid valve intervention techniques have im-proved survival,quality of life,and reduced heart failure rehospitalization.This review summarizes normal anatomy,types of TR,etiology and different mechanisms of TR,echocardiographic assessment of the severe TR,and highlights various percu-taneous transcatheter techniques for tricuspid valve repair.

关键词： anatomy tricuspid regurgitation

A rare cause of pulmonary hypertension in an elderly woman

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Journal of Geriatric cardiology 2023年第4期20卷 314-316页

作者： Shing Ching Chiu Sun Yue Division of Cardiology Department of Medicine and GeriatricsUnited Christian HospitalHong KongChina

Diastolic dysfunction is a common substrate of pulmonary hypertension(PH) in the elderly.A minority of them,however,has another etiology of PH with diastolic dysfunction as a confounder,the alarming echocardiographic features of which are important to recognize.For example,dilated coronary sinus is unusual,as is significantly dilated right atrium.

关键词： hypertension dilated coronary

Comparison of the low-density lipoprotein cholesterol target value and the preventive effect of statins in elderly patients and younger patients

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Journal of Geriatric cardiology 2017年第6期14卷 383-391页

作者： Akihiro Endo Taiji Okada Misun Pak Yuzo Kagawa Shimpei Ito Hirotomo Sato Kenji Kageshima Yasuyuki Yoshida Kazuaki Tanabe Division of Cardiology Shimane University Faculty of Medicine Izumo Japan Division of Cardiology Tottori Prefectural Central Hospital Tottori Japan

ObjectiveTo 估计低密度的脂蛋白胆固醇(LDL-C ) 目标价值和 statins 的预防效果是否在调查的老、更年轻的 patients.MethodsWe 之间是不同的在早狭窄以外为周期性的局部缺血的检查从 2007 年 1 月经历了冠的 angiography 到 2016年12... 详细信息

ObjectiveTo 估计低密度的脂蛋白胆固醇(LDL-C ) 目标价值和 statins 的预防效果是否在调查的老、更年轻的 patients.MethodsWe 之间是不同的在早狭窄以外为周期性的局部缺血的检查从 2007 年 1 月经历了冠的 angiography 到 2016年12月的有以前的经皮的冠的干预的 304 个病人。病人们被分类进二个组：年龄 75 年(老组：n = 140 ) 并且 < 75 年(更年轻的组：n = 164 ) 。在完成的 LDL-C 水平之间的关系，发生 statins 的近来冠的事件，和有效性是 evaluated.ResultsDuring 后续， 179 个病人经历了晚冠的 revascularization。周期性的局部缺血作为急性冠的症候群(交流) 介绍发生在 83 种情况中。Kaplan-Meier 曲线分析在更年轻的组，揭示了那周期性的交流在有 LDL-C 的病人是显著地更低的 < 70 mg/dL 比在那些与 LDL-C 从 70 到 < 100 mg/dL (P = 0.035 ) ；然而，在老组这些之间没有差别(P = 0.863 ) 。相反，周期性的交流在有 LDL-C 从 70 mg/dL 到的病人是不太经常的 < 100 mg/dL 比在那些与在老组的 LDL-C 100 mg/dL (P = 0.033 ) 。Statin 使用与减少的周期性的交流被联系(P = 0.005 ) ；而且，仅仅使用 statins 是在老组的一个独立预言者(HR：0.375；P = 0.007 ) LDL-C 到的 .ConclusionsStrict 控制 < 70 mg/dL 为在更年轻的病人减少周期性的交流的发生是有效的。然而， LDL-C < 100 mg/dL 可能作为为在日本老病人的 ischemic 事件的第二等的预防的 LDL-C-lowering 治疗的目标价值足够。

关键词：低密度脂蛋白胆固醇他汀类药物预防作用老年人患者急性冠状动脉综合征冠状动脉造影介入治疗

New Insights into Intravascular Imaging of Coronary Bifurcation Lesions and Left Main Stenosis:What Have We Accomplished?

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cardiology Discovery 2022年第3期2卷 182-190页

作者： Massoud A.Leesar Gregory O.Von Mering Hani Jneid Division of Cardiology University of AlabamaBirminghamAlabama 35294USA Division of Cardiology University of Texas Medical BranchTaxas 77555USA

Coronary bifurcation lesions(CBL)are one of the most challenging lesions to treat in interventional cardiology.Intravascular imaging including intravascular ultrasound(IVUS)and optical coherence tomography(OCT)is paramount for the assessment of lesion characteristics and suboptimal stent results and to improve the outcome of percutaneous coronary intervention(PCI).After upgrading the use of IVUS and OCT by the American College of cardiology/American Heart Association guidelines,their use has increased.Likewise,there has been significant improvement in image quality and the profile of system(ie,IVUS catheter size).The main indication for the use of IVUS includes:assessment of lesion characteristics,optimization of stent deployment,optimal stent expansion,exclusion of plaque burden>50%,and edge dissection.Intravascular imaging plays a significant role in the assessment and treatment of left main(LM)coronary artery stenosis and CBL.In particular,the use of intravascular imaging for alleviating mechanical issues during stenting and managing stent thrombosis has significantly increased.Overall,a compelling body of evidence has shown that the use of IVUS or OCT during PCI leads to optimal stenting results and mitigates the risk of adverse cardiac events.However,to date,the American College of cardiology/American Heart Association Guidelines have assigned a Class IIb recommendation for IVUS or OCT,while the European Society of cardiology Guidelines upgraded it to the Class IIa recommendation.This review summarized the role of IVUS and OCT for the assessment of stenosis and stent optimization in patients with CBL and LM stenosis.In addition,we discuss new insights into the role of IVUS-and OCT-guided stenting in patients with CBL and LM stenosis provided by the ongoing randomized trials.

关键词： Tomography,optical coherence Intravascular ultrasound Coronary interventions

Migration of intra-aortic balloon pump causing obstruction of the superior mesenteric artery

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Journal of Geriatric cardiology 2022年第11期19卷 928-929页

作者： Sharan Malkani Jose Ruiz Smruti Desai Smit Paghdar Parag C.Patel Juan Carlos Leoni Moreno Melissa Lyle Maedeh Ganji Daniel Yip Rohan M.Goswami division of Transplant cardiology Mayo ClinicJacksonvilleFLUSA Division of Cardiology First Coast Heart&VascularJacksonvilleFLUSA

Axillary intra-aortic balloon pump(IABP)used has increased in the recent few years after UNOs allocation system changes.IABP’s design and counterpulsation mechanism is highly regarded for its safety profile,simplicity and relative ease in management and care.However,despite continuous innovative efforts,the potential for complications still exists.The Benchmark registry is widely regarded as the tool for monitoring the evolving practice of IABP.The most common complications reported are balloon perforation,bleeding,migration,limb ischemia.Despite continuous innovative efforts,the potential for complications still exists.

关键词： balloon IABP pump

A faraway complex bifurcation hidden behind an occluded left main in an elderly patient

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Journal of Geriatric cardiology 2023年第5期20卷 383-385页

作者： Gianluca Rigatelli Giulio Rodino Giuseppe Marchese Marco Zuin Interventional cardiology Unit Division of CardiologyMadre Teresa di Calcutta HospitalAULSS 6Ospedali Riuniti Padova SudMonseliceItaly

A82-year-old man,with a previous history of ischemic heart disease due to 3-vessel disease with left main(LM)involvement.Twenty years before he underwent a double coronary artery bypass graft(left internal mammary artery(LIMA)to left anterior descending coronary artery(LAD)and saphein graft to Posterior Descending coronary artery(PDA));subsequent follow-up was uneventful.He was admitted to our hospital due to an acute coronary syndrome with ST segment abnormalities in the lateral and inferior leads on baseline EKG.

关键词： admitted involvement acute

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心血管病患者的用药依从性

英国医学杂志中文版 2022年第1期25卷 30-45页

作者： Steven T Simon Vinay Kini Andrew E Levy P Michael Ho 邓晓春(译) 莫云凌(校) Division of Cardiology University of Colorado Anschutz Medical CampusAuroraCOUSA Division of Cardiology Denver Health Medical CenterDenverCOUSA cardiology Section VA Eastern Colorado Health Care SystemAuroraCOUSA 航空医学研究所附属医院

心血管疾病是全球主要死亡的原因。虽然药理学的进步降低了心血管疾病相关的发病率和死亡率,但不遵从处方治疗仍然是改善患者整体预后的一个重大障碍。多种提高用药依从性的策略已经在临床试验中得到了验证,包括以下几类:加强患者教育... 详细信息

心血管疾病是全球主要死亡的原因。虽然药理学的进步降低了心血管疾病相关的发病率和死亡率,但不遵从处方治疗仍然是改善患者整体预后的一个重大障碍。多种提高用药依从性的策略已经在临床试验中得到了验证,包括以下几类:加强患者教育、实行用药提醒、认知行为干预、降低用药成本、医疗团队成员参与以及简化给药方案。在这篇综述中,我们对每个类别的具体试验进行了阐述和分析,着重强调每种干预措施对患者用药依从性的影响。我们还调查了正在进行的,旨在改善心血管疾病患者用药依从性的试验,并且对未来的研究方向进行了预测。

关键词：心血管病患者用药依从性认知行为干预心血管疾病医疗团队用药成本临床试验给药方案

What Is New in the 2023 European Society of cardiology Guidelines for the Management of Acute Coronary Syndromes

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cardiology Discovery 2023年第4期3卷 227-231页

作者： Marco Roffi Division of Cardiology University HospitalsGeneva 1211Switzerland

For the first time,European Society of cardiology(EsC)guidelines have aggregated in 1 single document recommendations for the management of patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)and ST-elevation myocardial infarction(STEMI).From a clinical perspective,this is coherent,as the spectrum of clinical presentations in acute coronary syndromes(ACS)may range from new onset or progressive troponin-negative angina to STEMl,cardiogenic shock,or cardiac arrest.In addition,the management pathways of NSTE-ACS and STEMI patients are widely similar.Compared with previous editions of the guidelines,the extensive document is improved also from a graphic perspective,containing several appealing and easy-to-understand figures.New or modified recommendations include,among others,the topics of diagnostic work-up,timing of invasive strategy,revascularization in multi-vessel disease,intravascular imaging,cardiac arrest,cardiogenic shock,and antithrombotic treatment.For the first time in the field of ACS,ESC guidelines have incorporated a section on patient perspectives with dedicated recommendations.Some of the most relevant changes in recommendations impacting clinical practice are discussed inthis article.

关键词： Acute coronary syndromes Guidelines European Society of cardiology