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State of the art contemporary treatment of patients with ST elevationmyocardial infarction： pre- and in-hospital organization, devices anddrugs

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Chinese Medical Journal 2014年第6期127卷 1133-1140页

作者： Mikkel Malby Schoos Roxana Mehran The zena and michael a. Wiener Cardiovascular Institute The Icahn School of Medicine at Mount Sinai New York NY 10029-6574 USA. The zena and michael a. Wiener Cardiovascular Institute The Icahn School of Medicine at Mount Sinai New York NY 10029-6574 USA. Email: Roxana.mehran@***.

Objective To review the presentation,diagnosis and recent developments in the pharmacological and invasive treatment of ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in order to increase accessibility of primary pemutaneous coronary intervention (PCI).Data sources Data were obtained from English publications on STEMI *** formal systematic review was conducted,but an effort was made to be *** selection Studies were selected if they contained data relevant to the ***,data from clinical randomized trials,meta-analyses,guidelines and a few recent reviews are *** The described clinical approach to acute myocardial infarction (AMI) has been a continuum of scientific results and translation into clinical practice over the last four decades since the advent of thrombolytic *** has resulted in a dramatic in-hospital mortality decrease from 30% in the 1960s to the present 5%.The biggest survival benefits have undoubtedly been achieved after the advent of reperfusion *** contemporary treatment of STEMI,additional treatment effects on survival have to be sought in the very early admission phase,as the current mortality hazard drops significantly after the first critical days to continuously very low levels after *** Optimal treatment of STEMI patients is best performed with a widely accessible reperfusion strategy,preferably primary PCI,with contemporary peri-procedural anti-thrombotic treatment and device *** of reperfusion strategies is increased by efficient STEMI networks applying prehospital triage with digital tele-transmission of electrocardiograms (ECGs) and seamless patient transitions between health-care *** treatments of complicated STEMI with out-of hospital cardiac arrest and/or cardiogenic shock underline the necessity of structured referral systems,preferably immediately after the initial

关键词： acute myocardial infarction ST elevation myocardial infarction primary percutaneous coronary intervention fibrinolysis pre-hospital triage antiplatelet therapy antithrombotic therapy drug eluting stents cardiogenic shock out-ofhospital cardiac arrest

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Use of Bivalirudin for Anticoagulation in Interventional Cardiovascular Procedures

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Cardiovascular Innovations and Applications 2018年第B07期3卷 163-174页

作者： Zhen Ge Jaya Chandrasekhar Roxana Mehran The zena and michael a.Wiener Cardiovascular Institute Icahn School of Medicine at Mount SinaiNew YorkNYUSA

Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures;however,this is at the expense of increased risk of *** optimal anticoagulation strategy for these procedures remains *** heparin is the most commonly used anticoagulant during interventional procedures,but has several limitations,such as relatively high incidence of bleeding events,occurrence of heparin-induced thrombocytopenia,and a paradoxical thrombotic *** studies have demonstrated that bivalirudin decreases the occurrence of bleeding complications,but potentially increases the risk of acute stent *** review discusses the pharmacology of bivalirudin and its current clinical application in patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement procedures.

关键词： bivalirudin anticoagulation interventional cardiovascular procedures

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Cardiovascular Benefits of Testosterone Replacement Therapy in the Andropausal Male

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Health 2015年第9期7卷 1206-1214页

作者： Satya K. Vatti Raef Madanieh Abed Madanieh Constantine E. Kosmas Timothy J. Vittorio St. Francis Hospital—The Heart Center® Division of Cardiology Center for Advanced Cardiac Therapeutics Roslyn NY USA zena and michael a Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York USA

Androgen deficiency has been receiving a lot of attention as an evolving health concern in the in-dustrialized world. With population aging, hypogonadism has become a challenging medical problem confronting practicing physicians. The importance of this increasingly prevalent disease arises from its potentially debilitating and serious consequences, such as atherosclerosis, diabetes mellitus, metabolic disorders, muscular weakness, psychiatric illness, sexual dysfunction and vascular inflammation. When left untreated, testosterone deficiency is associated with increased cardiovascular mortality.

关键词： Cardiovascular Hormones Hypogonadism Testosterone Therapy

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Rationale and Design of a Randomized Controlled Trial of Bivalirudin with a Prolonged High-Dose Infusion Versus Heparin Monotherapy During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction:The BRIGHT-4 Trial

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Cardiology Discovery 2022年第4期2卷 226-230页

作者： Zhenyang Liang Yi Li Gregg W.Stone Yaling Han Cardiovascular Research Institute and Department of Cardiology General Hospital of Northern Theater CommandShenyang 110016China zena and michael a.Wiener Cardiovascular Institute Icahn School of Medicine at Mount SinaiNew YorkNew York 10029-5674USA

Intravenous anticoagulant therapy is critical to prevent ischemic events without increasing the risk of bleeding in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Heparin and bivalirudin are the most commonly used adjunctive anticoagulant agents during ***,the superiority of the 2 most optimal regimens with these agents in patients undergoing PPCI remains *** BivaliRudin with prolonged high-dose Infusion durinG PPCI versus Heparin Trial 4(BRIGHT-4)is a large-scale,prospective,multicenter,active-control,parallel-group,open-label,randomized trial designed to test whether bivalirudin with a post-PCI high-dose infusion is superior to heparin monotherapy in STEMI patients undergoing PPCI.A total of 6000 patients will be enrolled and randomly assigned to receive bivalirudin or heparin in a 1:1 *** allocated to the bivalirudin group will be treated with a high-dose bivalirudin infusion(1.75 mg/(kg·h))after PCI for 2 to 4 *** the heparin group,the use of glycoprotein IIb/IIIa inhibitors will be reserved for the development of procedural thrombotic *** efficacy and safety of bivalirudin will be evaluated at 30 days,6 months,and 12 months after the *** primary endpoint is a composite of all-cause death or Bleeding Academic Research Consortium(BARC)types 3 to 5 bleeding at 30 days after *** BRIGHT-4 study protocol has received approval from the ethics committee of General Hospital of Northern Theater Command(Shenyang,China).The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice *** results will be published following the Consolidated Standards of Reporting Trials statement in a peer-reviewed scientific journal(Trial registration number:NCT03822975).

关键词： Heparin Bivalirudin ST-segment elevation myocardial infarction Primary percutaneous coronary intervention

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植入型心律转复除颤器放电后患者的诊治

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美国医学会杂志（中文版） 2007年第6期26卷 348-355页

作者： Anil K. Gehi Davendra Mehta J. Anthony Gomes 樊颖婕（译）陈新（校） Division of Cardology Emory University School of Medicine Atlanta Ga The zena and michael a. Wiener Cardiovascular Institute Mount Sinai School of MedicineNew YorkNY 不详

背景：多项大规模临床试验表明，植入型心律转复除颤器（implantable cardioverter-defibrillator，ICD）能够有效降低部分心脏病患者的死亡率。此后，ICD的植入量大幅增加，非电生理专科医生也因此经常会遇到实施ICD电转复除颤的患者... 详细信息

背景：多项大规模临床试验表明，植入型心律转复除颤器（implantable cardioverter-defibrillator，ICD）能够有效降低部分心脏病患者的死亡率。此后，ICD的植入量大幅增加，非电生理专科医生也因此经常会遇到实施ICD电转复除颤的患者。目的：在接受ICD电转复除颤的患者中评估诊疗策略。证据获取：采用下列医学主题词在PubMed和MEDLINE数据库中检索1990年1月至2006年9月发表的文献：defibrillators，implantable（除颤器，植入型）；defibrillmors，implantable／adverse effects（除颤器，植入型／不良反应）；抗心律失常药物（anti-arrhythmic agents）；电除颤（electric countershock）；生活质量（quality of life）；心动过速治疗（tachycardia therapy）；运算法则（algorithm）；室性心动过速／诊断（ventricular tachycardia／diagnosis）；室上性心动过速／诊断（supraventricular tachycardia／diagnosis）。排除病例报告，仅纳入英文文献。参考美国心脏病学会（American College of Cardiology）、美国心脏协会（American Heart Association）、心脏节律学会（Heart Rhythm Society）发布的建议、指南及所附参考文献，获得其他相关文献。证据综合：ICD恰当放电和误放电均有诸多原因。误放电可严重影响患者的生活质量。目前有多种ICD程控技术可有效控制ICD恰当放电和误放电的发生。采用抗心律失常药也能有效减少放电频率。结论：采用有效的ICD程控和抗心律失常药物可在保障ICD急救功能的同时减少ICD放电。对现有各种治疗手段有一个基本的了解是诊治接受ICD放电者的基础。

关键词：植入型心律转复除颤器误放电诊治抗心律失常药物 MEDLINE数据库美国心脏病学会室性心动过速大规模临床试验

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动脉粥样硬化和基质金属蛋白酶:活体分子MR成像实验研究

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国际医学放射学杂志 2009年第4期32卷 381-382页

作者： V. Amirbekian J.G. Aguinaldo S. Amirbekian F. Hyafil E. Vucic M. Sirol 郭瑜（译）葛夕洪（校） Translational and Molecular Imaging Institute Department of Radiology Zena and Michael A. Wiener Cardiovascular Institute Mount Sinai Schoolof Medicine New York NY 10029 USA. 不详

目的评价以基质金属蛋白酶（MMPs）作为靶目标的分子MR成像对比剂P947检测和成像活体动脉粥样硬化病变中基质金属蛋白酶的能力：比较其与P1135的特异度：明确基质金属蛋白酶在动脉粥样硬化血管中的表达与分布：应用荧光标记P947（Eu—P... 详细信息

目的评价以基质金属蛋白酶（MMPs）作为靶目标的分子MR成像对比剂P947检测和成像活体动脉粥样硬化病变中基质金属蛋白酶的能力：比较其与P1135的特异度：明确基质金属蛋白酶在动脉粥样硬化血管中的表达与分布：应用荧光标记P947（Eu—P947）在体内的分布和分子定位。方法动物保护与应用委员会批准进行所有实验。将钆螯合物（1，4，7，10-tetraazacvclododecane-N，N_,N_，N_—tetraaceticacidl与一能与MMPs特异结合的多肽黏附合成P947。

关键词：动脉粥样硬化病变基质金属蛋白酶活体分子 MR成像实验研究荧光标记动物保护钆螯合物

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Dilemmas in end-stage heart failure

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Journal of Geriatric Cardiology 2015年第1期12卷 57-65页

作者： Carol Chen-Scarabelli Louis Saravolatz Benjamin Hirsh Pratik Agrawal Tiziano M. Scarabelli Veterans Affairs Healthcare System Ann Arbor 2215 Fuller Rd. Ann Arbor M148105 USA St. John Hospital and Medical Center~Wayne State University 22101 Moross Rd. Detroit M148236 USA zena and michael a. Wiener Cardiovascular Institute Mount Sinai Medical Center One Gustave L. Levy Place Box 1030 New York NY 10029-6574 USA

Heart failure （HF）, a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S National Library of Medicine website （***） using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF （worse than that for many cancers）, many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society.

关键词： Ethical dilemmas Heart failure Palliative care

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Toxicity of abdominal fat

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Health 2013年第8期5卷 96-99页

作者： Shawn Mathew Constantine EKosmas Robert RSiegel Timothy JVittorio New York Institute of Technology Old WestburyNew YorkUSA zena and michael a.Wiener Cardiovascular Institute Mount Sinai School of MedicineNew YorkUSA Division of Cardiology Albert Einstein College of MedicineBronx Municipal Hospital CenterBronxUSA St.Francis Hospital—The Heart Center^(■) Division of CardiologyCenter for Advanced Cardiac TherapeuticsRoslynUSA

Abdominal fat or truncal obesity consists of both subcutaneous and visceral fat. It has been found that visceral fat is more metabolically active than subcutaneous fat. The low-level inflammation linked with abdominal fat is associated with insulin resistance and with increases in the release of inflammatory adipokines and cytokines. As a result of these changes, abdominal fat can cause a variety of health conditions. In this review, we focus on the adverse effects of abdominal fat on the body and how it can lead to the development of cardiovascular disease, hypertension, type 2 diabetes mellitus, hyperlipidemia, stroke and cancer. Additionally, we discuss how abdominal fat can be reduced as a result from correction of hormonal deficiencies.

关键词： Adipokines Cytokines Fat Hormonal Inflammation Obesity

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肺动脉高压患者中室间隔延迟对比增强的发生率及其相关因素

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世界核心医学期刊文摘（心脏病学分册） 2007年第12期3卷 28-29页

作者： Sanz J. Dellegrottaglie S. Kariisa M. 刘少伟 The zena and michael a. Wiener Cardiovascular Institute and Marie- Josee Henry R. Kravis Center for Cardiovascular Health Mount Sinai School of Medicine New York NY United States.Dr

已有观察描述了在心脏磁共振成像检查中,肺动脉高压(PH)患者室间隔的右室附着部位出现心肌延迟对比增强(DCE)。本研究的目的是观察该结果的发生率、程度和相关因素。在55例已确诊或疑似不同原因PH的患者中评估室间隔DCE。采用直观观察... 详细信息

已有观察描述了在心脏磁共振成像检查中,肺动脉高压(PH)患者室间隔的右室附着部位出现心肌延迟对比增强(DCE)。本研究的目的是观察该结果的发生率、程度和相关因素。在55例已确诊或疑似不同原因PH的患者中评估室间隔DCE。采用直观观察附着部位增强评分(0～4分)和DCE质量定量方法确定DCE程度。

关键词：室间隔右室室中隔肺动脉压力对比增强发生率患者相关因素

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Dilemmas in end-stage heart failure

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Journal of Geriatric Cardiology 2015年第01期 57-65页

作者： Carol Chen-Scarabelli Louis Saravolatz Benjamin Hirsh Pratik Agrawal Tiziano M.Scarabelli Veterans Affairs Healthcare System Ann Arbor St.John Hospital and Medical Center/Wayne State University zena and michael a.Wiener Cardiovascular Institute Mount Sinai Medical CenterOne Gustave L.Levy Place

Heart failure(HF),a complex clinical syndrome due to structural or functional disorder of the heart,is a major global health issue,with a prevalence of over 5.8 million in the USA alone,and over 23 million *** a leading cause of hospitalizations among patients aged 65 years or older,HF is a major consumer of healthcare resources,creating a substantial strain on the healthcare *** paper discusses the epidemiology of HF,financial impact,and multifaccted predicaments in end-stage HF care.A search was conducted on the *** Library of Medicine website(***) using keywords such as end-stage heart failure,palliative care,ethical *** the poor prognosis of HF(worse than that for many cancers),many HF patients,caregivers,and clinicians arc unaware of the poor *** addition,the unpredictable clinical trajectory of HF complicates the planning of end-of-life care,such as palliative care and hospice,leading to underutilization of such *** conclusion,ethical dilemmas in end-stage HF are numerous,embroiling not only the patient,but also the caregiver,healthcare team,and society.

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