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文獻目錄

Naeije關于文章“慢性血栓栓塞性肺動脈高壓患者的氧氣通路限制”的信函。

心臟代謝中的足兵：與Heinrich Taegtmeyer,MD,DPhil的對話。

2021國際心肺復蘇共識和緊急心血管護理科學與治療建議：基本生命支持總結；高級生命支持；新生兒生命支持；教育、實施和團隊；急救工作組；和COVID-19工作組。

房顫復律中前外側與前后電極位置的比較。

Howden等人對關于“慢性血栓栓塞性肺動脈高壓患者的氧氣通路限制”文章的回復。

PARADISE-MI試驗中沙庫巴曲/纈沙坦與雷米普利對總心力衰竭事件的影響。

黑人血漿蛋白質組的全基因組序列分析為心血管疾病提供了新的見解。

監(jiān)測策略對消融成功評估和消融后房顫負荷評估的影響：對實踐和臨床試驗設計的影響。

在最近診斷為房顫的患者中，考慮抗凝和心律控制。

致心律失常性心肌病的炎癥和免疫反應：最新技術水平綜述。

肥厚型心肌病的肉瘤變體與心肌氧合的相關性：來自一種新型氧敏感心血管磁共振方法的見解。

心力衰竭中的細胞外基質：Adamts5在蛋白多糖重塑中的作用。

心臟纖維化過程中內皮細胞瞬時活化間充質基因表達的無縫基因記錄。

Lai et al關于文章“兒童時期以來的心血管風險因素軌跡和中年認知能力：年輕芬蘭人的心血管風險研究”的信函。

阿片類藥物流行?。好總€人都有自己的作用。

骨髓中NLRP3炎癥小體致敏的中性粒細胞的保留對于心肌梗死誘導的粒細胞生成至關重要。

心臟植入式電子設備手術后持續(xù)使用阿片類藥物。

Hakala等人對關于文章“兒童時期以來的心血管風險因素軌跡和中年認知能力：年輕芬蘭人研究中的心血管風險”的信函的回復。

經(jīng)靜脈和皮下植入式除顫器中適當電擊和抗心動過速起搏的有效性和安全性：PRAETORIAN試驗中所有適當治療的分析。

恩格列凈、射血分數(shù)保留性心力衰竭患者的健康狀況和生活質量：EMPEROR-Preserved試驗。

主動脈瓣ReplAcemenT與保守治療無癥狀重度主動脈狹窄的比較：AVATAR試驗。

在2型糖尿病患者中使用或不使用鈉-葡萄糖協(xié)同轉運蛋白-2抑制劑的情況下，Efpeglenatide和臨床結局：AMPLITUDE-O試驗的探索性分析。

Finerenone降低慢性腎病和2型糖尿病患者心力衰竭事件的風險：FIGARO-DKD試驗的分析

收入和教育的不平等與院外心臟驟停后的生存差異相關：一項全國觀察性研究。

Schaefer等人關于文章“美國多中心隊列中高敏心肌肌鈣蛋白T策略和臨床變量的診斷性能”的信函。

癌癥幸存者心血管生物標志物應用的未來展望：美國心臟協(xié)會的科學聲明。

Allen等人對關于“美國多中心隊列中高敏心肌肌鈣蛋白T策略和臨床變量的診斷性能”文章的回復。

朝向心肌病的CRISPR療法。

加熱煙草棒而不是燃燒傳統(tǒng)香煙和未來心臟病發(fā)作：仍然吸煙和風險。

CARDIOKIN1：健康對照者和瓣膜疾病患者心肌代謝能力的計算評估。

秋水仙堿在急性冠脈綜合征患者中的應用：澳大利亞COPS隨機臨床試驗的兩年隨訪。

視網(wǎng)膜的深度學習使微血管的表型和全基因組分析成為可能。

基于心電圖的深度學習和預測房顫的臨床風險因素。

射血分數(shù)保留的心力衰竭患者運動誘發(fā)肺充血的能量基礎。

Amulet或Watchman器械用于經(jīng)皮左心耳閉合：SWISS-APERO隨機臨床試驗的主要結果。

血壓、高血壓和主動脈夾層風險發(fā)生率和死亡率：日本特定健康檢查研究、英國生物樣本庫研究和隊列研究薈萃分析的結果。

磁共振成像結合運動揭示射血分數(shù)保留的心力衰竭患者的非保留心臟結構、功能和能量學。

醫(yī)療保險受益人中心力衰竭住院后社區(qū)水平的經(jīng)濟困境、人種和不良結局風險。

National Trends and Disparities in hospitalizations for Acute Hypertension Among Medicare Beneficiaries(1999-2019).

中年和老年人心血管疾病預防和危險因素管理的初級保健和社區(qū)實踐中的健康行為改變項目：美國心臟協(xié)會的科學聲明。

當代臨床實踐中DAPT研究治療效果的估計：EXTEND-DAPT研究的結果。

Romani等人關于文章“心外膜脂肪促進房顫的細胞外囊泡”的信函。

經(jīng)股動脈經(jīng)導管主動脈瓣置換術中基于純插塞與基于主要縫線的血管閉合器械策略的比較：CHOICE-Closure隨機臨床試驗。

在射血分數(shù)降低的心力衰竭患者中連續(xù)評估高敏心肌肌鈣蛋白和達格列凈的作用：一項DAPA-HF試驗分析。

我們能預測心臟移植后早期的排斥反應嗎？

英國十字路口的心血管醫(yī)學。

美國心臟協(xié)會2024年的影響目標：每個人都有機會擁有一個完整、健康的生活。

2021改善心血管健康的飲食指南：美國心臟協(xié)會的科學聲明。

急性下壁心肌梗死后分組跳動。

免疫檢查點抑制劑心肌炎的心電圖表現(xiàn)。

我是否得到了流感疫苗？：流感疫苗接種作為預防心血管事件和死亡的心肌梗死后護理。

Leor等人對關于“心外膜脂肪促進房顫的細胞外囊泡”文章的回復。

COVID-19大流行對心血管科學的影響：預期問題和潛在解決方案：美國心臟協(xié)會的主席咨詢。

ST段抬高型心肌梗死的治療系統(tǒng)：美國心臟協(xié)會的政策聲明。

長非編碼RNA MIAT控制晚期動脈粥樣硬化病變形成和斑塊去穩(wěn)定。

肥厚型心肌病的心臟能量學改變和線粒體功能障礙。

非心臟手術后心肌損傷患者的診斷和管理：美國心臟協(xié)會的科學聲明。

線粒體Ca(2 +)單向轉運體的丟失限制了正性肌力儲備，為Barth綜合征心肌病的心律失常提供了觸發(fā)因素和底物。

Palmdelphin調節(jié)內皮對機械應力的核彈性。

γ-干擾素通過色氨酸分解代謝損害人冠狀動脈內皮葡萄糖代謝，激活脂肪酸氧化。

韓國男性中不可燃尼古丁或煙草產品和可燃香煙使用習慣變化與隨后的短期心血管疾病風險的聯(lián)合相關性：一項全國隊列研究。

Filamin C截短變體引起的心肌病的表型表達、自然史和風險分層。

綜合應激反應將線粒體蛋白質翻譯與氧化應激控制相結合。

降低低密度脂蛋白膽固醇低于40 mg/dL的心血管獲益。

Chagas心肌病進展的發(fā)生率和預測因素：克氏錐蟲血清陽性個體的長期隨訪。

心臟移植后冠狀動脈微循環(huán)功能障礙和急性細胞排斥反應。

Vericiguat在射血分數(shù)降低性心力衰竭患者中的全球研究(VICTORIA)中的血紅蛋白和臨床結局。

Amplatzer Amulet左心耳封堵器與Watchman器械預防卒中的比較(Amulet IDE)：一項隨機對照試驗。

心肌梗死后流感疫苗接種：一項隨機、雙盲、安慰劑對照、多中心試驗。

3、2021國際心肺復蘇共識和緊急心血管護理科學與治療建議：基本生命支持總結；高級生命支持；新生兒生命支持；教育、實施和團隊；急救工作組；和COVID-19工作組。

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group.

IF:23.603，PMID:34813356，Circulation. 2021 Nov 11:CIR0000000000001017. doi: 10.1161/CIR.0000000000001017.

Abstract

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

摘要

復蘇國際聯(lián)絡委員會啟動了對新的、同行評審的已發(fā)表心肺復蘇科學的持續(xù)審查。這是復蘇國際聯(lián)絡委員會關于心肺復蘇和緊急心血管護理科學與治療建議的國際共識的第五次年度總結；在2020年進行了更全面的審查。本最新總結闡述了復蘇國際聯(lián)絡委員會工作組科學專家審查的最新發(fā)表的復蘇證據(jù)。本總結中系統(tǒng)綜述涵蓋的主題包括基于視頻的調度系統(tǒng)的復蘇主題；直立心肺復蘇；自主循環(huán)恢復后的早期冠狀動脈造影；俯臥患者的心肺復蘇；早產和足月嬰兒出生時的臍帶管理；出生時給予正壓通氣的設備；新生兒復蘇期間的家庭在場；成人和兒童的自我指導、基于數(shù)字的基本生命支持教育和培訓；心臟驟停患者對搶救者的冠狀病毒疾病2019感染風險；以及急救主題，包括熱燒傷用水冷卻、勞力性脫水的口服補液、兒科止血帶使用和蜱蟲去除方法。6個復蘇問題國際聯(lián)絡委員會工作組的成員根據(jù)推薦評估、制定和評估標準的分級，對證據(jù)的質量進行了評估、討論和辯論，其聲明包括共識治療建議或良好實踐聲明。對工作隊審議情況的深入了解見“理由和循證-決策框架要點”一節(jié)。此外，工作隊列出了進一步研究的優(yōu)先知識差距。

10、致心律失常性心肌病的炎癥和免疫反應：最新技術水平綜述。

Inflammation and Immune Response in Arrhythmogenic Cardiomyopathy: State-of-the-Art Review.

IF:23.603，PMID:34780255，Circulation. 2021 Nov 16;144(20):1646-1655. doi: 10.1161/CIRCULATIONAHA.121.055890. Epub 2021 Nov 15.

Abstract

Arrhythmogenic cardiomyopathy (ACM) is a primary disease of the myocardium, predominantly caused by genetic defects in proteins of the cardiac intercalated disc, particularly, desmosomes. Transmission is mostly autosomal dominant with incomplete penetrance. ACM also has wide phenotype variability, ranging from premature ventricular contractions to sudden cardiac death and heart failure. Among other drivers and modulators of phenotype, inflammation in response to viral infection and immune triggers have been postulated to be an aggravator of cardiac myocyte damage and necrosis. This theory is supported by multiple pieces of evidence, including the presence of inflammatory infiltrates in more than two-thirds of ACM hearts, detection of different cardiotropic viruses in sporadic cases of ACM, the fact that patients with ACM often fulfill the histological criteria of active myocarditis, and the abundance of anti-desmoglein-2, antiheart, and anti-intercalated disk autoantibodies in patients with arrhythmogenic right ventricular cardiomyopathy. In keeping with the frequent familial occurrence of ACM, it has been proposed that, in addition to genetic predisposition to progressive myocardial damage, a heritable susceptibility to viral infections and immune reactions may explain familial clustering of ACM. Moreover, considerable in vitro and in vivo evidence implicates activated inflammatory signaling in ACM. Although the role of inflammation/immune response in ACM is not entirely clear, inflammation as a driver of phenotype and a potential target for mechanism-based therapy warrants further research. This review discusses the present evidence supporting the role of inflammatory and immune responses in ACM pathogenesis and proposes opportunities for translational and clinical investigation.

摘要

致心律失常性心肌病(ACM)是心肌的原發(fā)性疾病，主要由心臟閏盤蛋白質，特別是橋粒的遺傳缺陷引起。傳遞多為常染色體顯性遺傳，外顯率不全。ACM也具有廣泛的表型變異性，從室性早搏到心源性猝死和心力衰竭。在表型的其他驅動因素和調節(jié)劑中，對病毒感染和免疫觸發(fā)因素反應的炎癥被假定為心肌細胞損傷和壞死的加重因素。這一理論得到了多個證據(jù)的支持，包括超過2/3的ACM心臟存在炎性浸潤，在ACM散發(fā)病例中檢測到不同的嗜心性病毒，ACM患者常符合活動性心肌炎的組織學標準，以及致心律失常性右室心肌病患者體內豐富的抗橋粒芯糖蛋白-2、抗心臟和抗閏盤自身抗體。與ACM的常見家族性發(fā)生相一致，有人提出，除了進行性心肌損害的遺傳傾向外，病毒感染和免疫反應的可遺傳易感性可以解釋ACM的家族聚集性。此外，大量的體外和體內證據(jù)表明ACM中存在激活的炎癥信號。盡管炎癥/免疫反應在ACM中的作用尚不完全清楚，但炎癥作為表型的驅動因素和基于機制治療的潛在靶點值得進一步研究。本綜述討論了目前支持炎癥和免疫反應在ACM發(fā)病機制中作用的證據(jù)，并提出了轉化和臨床研究的機會。

20、恩格列凈、射血分數(shù)保留性心力衰竭患者的健康狀況和生活質量：EMPEROR-Preserved試驗。

Empagliflozin, Health Status, and Quality of Life in Patients with Heart Failure and Preserved Ejection Fraction: The EMPEROR-Preserved Trial.

IF:23.603，PMID:34779658，Circulation. 2021 Nov 15. doi: 10.1161/CIRCULATIONAHA.121.057812.

Abstract

Background:
Patients with heart failure and preserved ejection fraction (HFpEF) have significant impairment in health-related quality of life (HRQoL). In EMPEROR-Preserved, we evaluated the efficacy of empagliflozin on HRQoL in patients with HFpEF and whether the clinical benefit observed with empagliflozin varies according to baseline health status.

Methods:
HRQoL was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline, 12, 32 and 52 weeks. Patients were divided by baseline KCCQ Clinical Summary Score (CSS) tertiles and the effect of empagliflozin on outcomes were examined. The effect of empagliflozin on KCCQ-CSS, Total Symptom Score (TSS) and Overall Summary Score (OSS) were evaluated. Responder analyses were performed to compare the odds of improvement and deterioration in KCCQ related to treatment with empagliflozin.

Results:
The effect of empagliflozin on reducing the risk of time to cardiovascular death or HF hospitalization was consistent across baseline KCCQ-CSS tertiles (HR 0.83 [0.69-1.00], HR 0.70 [0.55-0.88] and HR 0.82 [0.62-1.08] for scores <62.5, 62.5-83.3 and >/=83.3, respectively; P trend=0.77). Similar results were seen for total HF hospitalizations. Patients treated with empagliflozin had significant improvement in KCCQ-CSS versus placebo (+1.03, +1.24 and +1.50 at 12, 32 and 52 weeks, respectively P<0.01); similar results were seen for TSS and OSS. At 12 weeks, patients on empagliflozin had higher odds of improvement >/=5 points (OR 1.23; 95%CI 1.10, 1.37), >/=10 points (1.15; 95%CI 1.03, 1.27), and >/=15 points (1.13; 95%CI 1.02, 1.26) and lower odds of deterioration >/=5 points in KCCQ-CSS (0.85; 95%CI 0.75, 0.97). A similar pattern was seen at 32 and 52 weeks, and results were consistent for TSS and OSS.

Conclusions:
In patients with HFpEF, empagliflozin reduced the risk for major HF outcomes across the range of baseline KCCQ scores. Empagliflozin improved HRQoL, an effect that appeared early and was sustained for at least one year.

摘要

背景：

射血分數(shù)保留型心力衰竭(HFpEF)患者的健康相關生活質量(HRQoL)受到顯著損害。在EMPEROR-Preserved中，我們評估了恩格列凈對HFpEF患者HRQoL的療效，以及觀察到的恩格列凈臨床獲益是否因基線健康狀況而異。

方法：

在基線、第12、32和52周使用堪薩斯城心肌病問卷(KCCQ)測量HRQoL?；颊甙椿€KCCQ臨床匯總評分(CSS)三分位數(shù)劃分，檢查恩格列凈對結局的影響。評價了恩格列凈對KCCQ-CSS、總癥狀評分(TSS)和總體匯總評分(OSS)的影響。進行應答者分析，比較與恩格列凈治療相關的KCCQ改善和惡化的幾率。

結果：

恩格列凈對降低至心血管死亡或HF住院時間風險的作用在基線KCCQ-CSS三分位間一致（評分<62.5、62.5-83.3和>/=83.3分別為HR 0.83[0.69-1.00]、HR 0.70[0.55-0.88]和HR 0.82[0.62-1.08]；P趨勢=0.77）?？侶F住院的結果相似。與安慰劑相比，恩格列凈治療患者的KCCQ-CSS顯著改善（第12、32和52周分別為 + 1.03、+ 1.24和 + 1.50，P < 0.01）；TSS和OSS觀察到相似的結果。第12周時，恩格列凈組患者KCCQ-CSS改善≥5分(OR 1.23；95%CI 1.10，1.37)、≥10分(1.15；95%CI 1.03，1.27)和≥15分(1.13；95%CI 1.02，1.26)的幾率更高，惡化≥5分的幾率更低(0.85；95%CI 0.75，0.97)。第32周和第52周觀察到相似模式，TSS和OSS結果一致。

結論：

在HFpEF患者中，恩格列凈可降低基線KCCQ評分范圍內的重大HF結局風險。恩格列凈改善HRQoL，這種作用出現(xiàn)較早，并持續(xù)至少1年。

22、在2型糖尿病患者中使用或不使用鈉-葡萄糖協(xié)同轉運蛋白-2抑制劑的情況下，Efpeglenatide和臨床結局：AMPLITUDE-O試驗的探索性分析。

Efpeglenatide and Clinical Outcomes with and without Concomitant Sodium-Glucose Co-Transporter-2 Inhibition Use in Type 2 Diabetes: Exploratory Analysis of the AMPLITUDE-O Trial.

IF:23.603，PMID:34775781，Circulation. 2021 Nov 14. doi: 10.1161/CIRCULATIONAHA.121.057934.

Abstract

Background:
Sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) both reduce cardiovascular (CV) events among patients with type 2 diabetes. However, no CV outcome trial has evaluated the long-term effects of their combined use. The AMPLITUDE-O trial reported that once weekly injections of the GLP-1 RA efpeglenatide (vs. placebo) reduced major adverse cardiovascular events (MACE); MACE, coronary revascularization or unstable angina hospitalization (expanded MACE); a renal composite outcome; and MACE or death in people with type 2 diabetes and CV and/or renal disease. The trial uniquely stratified randomization by baseline or anticipated use of SGLT2 inhibitors and included the highest prevalence at baseline (N=618, 15.2%) of SGLT2 inhibitor use among GLP-1 RA CV outcome trials to date. Its results were analyzed to estimate the combined effect of SGLT2 inhibitors and efpeglenatide on clinical outcomes.

Methods:
Cardiovascular and renal outcomes were analyzed using Cox proportional hazards models adjusted for region, SGLT2 inhibitor randomization strata, and the SGLT2 inhibitor-by-treatment interaction. Continuous variables were analyzed using a mixed-effects models for repeated measures that also included an interaction term.

Results:
The effect (hazard ratio [95% confidence interval]) of efpeglenatide versus placebo in the absence and presence of baseline SGLT2 inhibitors, respectively, on MACE (0.74 [0.58- 0.94] and 0.70 [0.37- 1.30]), expanded MACE (0.77 [0.62- 0.96] and 0.87 [0.51- 1.48]), renal composite (0.70 [0.59- 0.83] and 0.52 [0.33- 0.83]), and MACE or death (0.74 [0.59- 0.93] and 0.65 [0.36- 1.19]) did not differ by baseline SGLT2 inhibitor use (P for all interactions >0.2). Efpeglenatide's reduction of blood pressure, body weight, low density lipoprotein cholesterol and urinary albumin:creatinine ratio also appeared to be independent of concurrent SGLT2 inhibitor use (all interaction P >/=0.08). Finally, adverse events did not differ by baseline SGLT2 inhibitor use.

Conclusions:
The efficacy and safety of efpeglenatide appear independent of concurrent SGLT2 inhibitor use. These data support combined SGLT2 inhibitor and GLP-1 RA therapy in type 2 diabetes.

摘要

背景：

鈉-葡萄糖協(xié)同轉運蛋白-2(SGLT2)抑制劑和胰高血糖素樣肽-1受體激動劑(GLP-1 RA)均可減少2型糖尿病患者的心血管(CV)事件。然而，尚無CV結局試驗評價其聯(lián)合使用的長期效應。AMPLITUDE-O試驗報告，在2型糖尿病和CV和/或腎病患者中，每周一次注射GLP-1 RA efpeglenatide（對比安慰劑）可降低重大心血管不良事件(MACE)；MACE、冠狀動脈血運重建或不穩(wěn)定型心絞痛住院治療（擴展MACE）；腎臟復合結局；以及MACE或死亡。試驗按照基線或預期使用SGLT2抑制劑進行唯一分層隨機化，包括迄今為止的GLP-1 RA CV結局試驗中基線時SGLT2抑制劑使用率最高(N = 618，15.2%)的試驗。分析其結果以估計SGLT2抑制劑和efpeglenatide對臨床結局的聯(lián)合作用。

方法：

使用經(jīng)地區(qū)、SGLT2抑制劑隨機化分層和SGLT2抑制劑與治療相互作用校正的Cox比例風險模型分析心血管和腎臟結局。使用重復測量的混合效應模型分析連續(xù)變量，該模型還包括相互作用項。

結果：

在不存在和存在基線SGLT2抑制劑的情況下，efpeglenatide相較于安慰劑對MACE（0.74[0.58-0.94]和0.70[0.37-1.30]）、擴展MACE（0.77[0.62-0.96]和0.87[0.51-1.48]）、腎臟復合終點（0.70[0.59-0.83]和0.52[0.33-0.83]）和MACE或死亡（0.74[0.59-0.93]和0.65[0.36-1.19]）的影響（風險比[95%置信區(qū)間]）在基線SGLT2抑制劑使用時無差異（所有相互作用的P值 > 0.2）。Efpeglenatide降低血壓、體重、低密度脂蛋白膽固醇和尿白蛋白：肌酐比值似乎也與同時使用SGLT2抑制劑無關（所有相互作用P >/= 0.08）。最后，不良事件在基線SGLT2抑制劑使用方面沒有差異。

結論：

efpeglenatide的療效和安全性似乎與同時使用SGLT2抑制劑無關。這些數(shù)據(jù)支持SGLT2抑制劑和GLP-1 RA聯(lián)合治療2型糖尿病。

23、Finerenone降低慢性腎病和2型糖尿病患者心力衰竭事件的風險：FIGARO-DKD試驗的分析

Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses from the FIGARO-DKD Trial.

IF:23.603，PMID:34775784，Circulation. 2021 Nov 13. doi: 10.1161/CIRCULATIONAHA.121.057983.

Abstract

Background:
Chronic kidney disease (CKD) and type 2 diabetes (T2D) are independently associated with heart failure (HF), a leading cause of morbidity and mortality. In the FIDELIO-DKD and FIGARO DKD trials, finerenone (a selective, nonsteroidal mineralocorticoid receptor antagonist) improved cardiovascular outcomes in patients with albuminuric CKD and T2D. These prespecified analyses from FIGARO-DKD assessed the impact of finerenone on clinically important HF outcomes.

Methods:
Patients with T2D and albuminuric CKD (urine albumin-to-creatinine ratio [UACR] >/=30 to <300 mg/g and estimated glomerular filtration rate [eGFR] >/=25 to /=300 to /=60 ml/min/1.73 m(2),), without symptomatic HF with reduced ejection fraction, were randomized to finerenone or placebo. Time-to-first event outcomes included: new-onset HF (first hospitalization for HF [HHF] in patients without a history of HF at baseline); cardiovascular death or first HHF; HF-related death or first HHF; first HHF; cardiovascular death or total (first or recurrent) HHF; HF-related death or total HHF; and total HHF. Outcomes were evaluated in the overall population and in prespecified subgroups categorized by baseline HF history (as reported by the investigators).

Results:
Overall, 7352 patients were included in these analyses; 571 (7.8%) had a history of HF at baseline. New-onset HF was significantly reduced with finerenone versus placebo (1.9% versus 2.8%; hazard ratio [HR], 0.68 [95% CI 0.50-0.93]; P=0.0162). In the overall population, the incidences of all HF outcomes analyzed were significantly lower with finerenone than placebo, including a 18% lower risk of cardiovascular death or first HHF (HR, 0.82 [95% CI 0.70-0.95]; P=0.011), a 29% lower risk of first HHF (HR, 0.71 [95% CI 0.56-0.90]; P=0.0043) and a 30% lower rate of total HHF (rate ratio, 0.70 [95% CI, 0.52- 0.94]). The effects of finerenone on improving HF outcomes were not modified by a history of HF. The incidence of treatment-emergent adverse events was balanced between treatment groups.

Conclusions:
The results from these FIGARO-DKD analyses demonstrate that finerenone reduces new-onset HF and improves other HF outcomes in patients with CKD and T2D, irrespective of a history of HF.

摘要

背景：

慢性腎病(CKD)和2型糖尿病(T2D)與心力衰竭(HF)獨立相關，HF是發(fā)病和死亡的主要原因。在FIDELIO-DKD和FIGARO DKD試驗中，finerenone（一種選擇性非甾體鹽皮質激素受體拮抗劑）改善白蛋白尿CKD和T2D患者的心血管結局。這些來自FIGARO-DKD的預先規(guī)定的分析評估了finerenone對臨床重要HF結局的影響。

方法：

T2D和白蛋白尿CKD（尿白蛋白-肌酐比值[UACR]≥30-< 300 mg/g和估計腎小球濾過率[eGFR]≥25-

結果：

總體而言，7352例患者被納入這些分析中；571例(7.8%)在基線時有HF病史。finerenone與安慰劑相比顯著降低新發(fā)HF（1.9%vs 2.8%；風險比[HR]，0.68[95%CI 0.50-0.93]；P = 0.0162）。在總體人群中，finerenone組分析的所有HF結局的發(fā)生率顯著低于安慰劑組，包括心血管死亡或首次HHF風險降低18%(HR，0.82[95%CI 0.70-0.95]；P = 0.011)、首次HHF風險降低29%(HR，0.71[95%CI 0.56-0.90]；P = 0.0043)和總HHF率降低30%（率比，0.70[95%CI，0.52-0.94]）。finerenone改善HF結局的作用未因HF病史而改變。治療后出現(xiàn)的不良事件的發(fā)生率在治療組之間平衡。

結論：

這些FIGARO-DKD分析的結果表明finerenone減少CKD和T2D患者新發(fā)HF并改善其他HF結局，與HF病史無關。

26、癌癥幸存者心血管生物標志物應用的未來展望：美國心臟協(xié)會的科學聲明。

Future Perspectives of Cardiovascular Biomarker Utilization in Cancer Survivors: A Scientific Statement From the American Heart Association.

IF:23.603，PMID:34753300，Circulation. 2021 Nov 10:CIR0000000000001032. doi: 10.1161/CIR.0000000000001032.

Abstract

Improving cancer survival represents the most significant effect of precision medicine and personalized molecular and immunologic therapeutics. Cardiovascular health becomes henceforth a key determinant for the direction of overall outcomes after cancer. Comprehensive tissue diagnostic studies undoubtedly have been and continue to be at the core of the fight against cancer. Will a systemic approach integrating circulating blood-derived biomarkers, multimodality imaging technologies, strategic panomics, and real-time streams of digitized physiological data overcome the elusive cardiovascular tissue diagnosis in cardio-oncology? How can such a systemic approach be personalized for application in day-to-day clinical work, with diverse patient populations, cancer diagnoses, and therapies? To address such questions, this scientific statement approaches a broad definition of the biomarker concept. It summarizes the current literature on the utilization of a multitude of established cardiovascular biomarkers at the intersection with cancer. It identifies limitations and gaps of knowledge in the application of biomarkers to stratify the cardiovascular risk before cancer treatment, monitor cardiovascular health during cancer therapy, and detect latent cardiovascular damage in cancer survivors. Last, it highlights areas in biomarker discovery, validation, and clinical application for concerted efforts from funding agencies, scientists, and clinicians at the cardio-oncology nexus.

摘要

提高癌癥生存率代表了精準醫(yī)療和個性化分子和免疫治療的最顯著效果。從現(xiàn)在起，心血管健康成為癌癥后總體結局方向的關鍵決定因素。全面的組織診斷研究無疑一直是并且繼續(xù)是抗癌斗爭的核心。整合循環(huán)血源性生物標志物、多模態(tài)成像技術、戰(zhàn)略泛組學和實時數(shù)字化生理數(shù)據(jù)流的系統(tǒng)方法是否會克服心臟腫瘤學中難以捉摸的心血管組織診斷？如何在日常臨床工作中個性化應用這種系統(tǒng)方法，具有不同的患者人群、癌癥診斷和治療？為了解決這些問題，本科學聲明接近生物標志物概念的廣義定義。它總結了目前關于在與癌癥交匯處使用多種已確定的心血管生物標志物的文獻。它確定了在癌癥治療前應用生物標志物對心血管風險進行分層、在癌癥治療期間監(jiān)測心血管健康和檢測癌癥生存者潛在心血管損傷方面知識的局限性和差距。最后，它強調了生物標志物發(fā)現(xiàn)、驗證和臨床應用領域，由心臟腫瘤學聯(lián)系的資助機構、科學家和臨床醫(yī)生共同努力。

40、中年和老年人心血管疾病預防和危險因素管理的初級保健和社區(qū)實踐中的健康行為改變項目：美國心臟協(xié)會的科學聲明。

Health Behavior Change Programs in Primary Care and Community Practices for Cardiovascular Disease Prevention and Risk Factor Management Among Midlife and Older Adults: A Scientific Statement From the American Heart Association.

IF:23.603，PMID:34732063，Circulation. 2021 Nov 4:CIR0000000000001026. doi: 10.1161/CIR.0000000000001026.

Abstract

Cardiovascular disease predominates as the leading health burden among middle-aged and older American adults, but progress in improving cardiovascular health remains slow. Comprehensive, evidenced-based behavioral counseling interventions in primary care are a recommended first-line approach for promoting healthy behaviors and preventing poor cardiovascular disease outcomes in adults with cardiovascular risk factors. Assisting patients to adopt and achieve their health promotion goals and arranging follow-up support are critical tenets of the 5A Model for behavior counseling in primary care. These 2 steps in behavior counseling are considered essential to effectively promote meaningful and lasting behavior change for primary cardiovascular disease prevention. However, adoption and implementation of behavioral counseling interventions in clinical settings can be challenging. The purpose of this scientific statement from the American Heart Association is to guide primary health care professional efforts to offer or refer patients for behavioral counseling, beyond what can be done during brief and infrequent office visits. This scientific statement presents evidence of effective behavioral intervention programs that are feasible for adoption in primary care settings for cardiovascular disease prevention and risk management in middle-aged and older adults. Furthermore, examples are provided of resources available to facilitate the widespread adoption and implementation of behavioral intervention programs in primary care or community-based settings and practical approaches to appropriately engage and refer patients to these programs. In addition, current national models that influence translation of evidence-based behavioral counseling in primary care and community settings are described. Finally, this scientific statement highlights opportunities to enhance the delivery of equitable and preventive care that prioritizes effective behavioral counseling of patients with varying levels of cardiovascular disease risk.

摘要

心血管疾病是美國中老年人的主要健康負擔，但改善心血管健康的進展仍然緩慢。初級保健中全面的、基于證據(jù)的行為咨詢干預是促進有心血管危險因素的成人健康行為和預防不良心血管疾病結局的推薦一線方法。協(xié)助患者采納并實現(xiàn)其健康促進目標，安排隨訪支持是基層醫(yī)療行為咨詢5A模式的關鍵宗旨。行為咨詢的這2個步驟被認為是有效促進初級心血管疾病預防有意義和持久的行為改變所必需的。然而，在臨床環(huán)境中采用和實施行為咨詢干預可能具有挑戰(zhàn)性。美國心臟協(xié)會的這一科學聲明的目的是指導初級衛(wèi)生保健專業(yè)人員提供或轉診患者進行行為咨詢的努力，超出了簡短和不頻繁的診室訪視期間可以做的。這項科學聲明提供了有效行為干預計劃的證據(jù)，這些計劃在初級保健機構中用于中老年人心血管疾病預防和風險管理是可行的。此外，還提供了可用于促進在初級保健或社區(qū)環(huán)境中廣泛采用和實施行為干預計劃的資源實例，以及適當讓患者參與和轉診至這些計劃的實際方法。此外，描述了目前影響初級保健和社區(qū)環(huán)境中循證行為咨詢轉化的國家模式。最后，這一科學聲明強調了加強提供公平和預防護理的機會，優(yōu)先對具有不同心血管疾病風險水平的患者進行有效的行為咨詢。

48、2021改善心血管健康的飲食指南：美國心臟協(xié)會的科學聲明。

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

IF:23.603，PMID:34724806，Circulation. 2021 Nov 2:CIR0000000000001031. doi: 10.1161/CIR.0000000000001031.

Abstract

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

摘要

飲食質量差與心血管疾病發(fā)病率和死亡率風險升高密切相關。這一科學聲明強調了飲食模式的重要性，超越了個體食物或營養(yǎng)素，強調了生命早期營養(yǎng)的關鍵作用，提出了心臟健康飲食模式的要素，并強調了阻礙堅持心臟健康飲食模式的結構性挑戰(zhàn)。循證膳食模式指導促進心臟代謝健康包括以下內容：(1)調整能量攝入和消耗，達到并維持健康體重；(2)多吃多種水果和蔬菜；(3)選擇全谷物食品和制品；(4)選擇健康來源的蛋白質（多為植物；經(jīng)常攝入魚和海鮮；低脂或無脂乳制品；如果想吃肉或家禽，選擇瘦肉和未加工形式）；(5)使用液態(tài)植物油而不是熱帶油和部分氫化脂肪；(6)選擇最少加工食品而不是超加工食品；(7)盡量減少添加糖類的飲料和食品的攝入；(8)選擇并準備少鹽或無鹽的食品；(9)如果不飲酒，不要開始；如果選擇飲酒，限制攝入；和(10)遵守本指南，無論在哪里制備或食用食物。阻礙堅持心臟健康飲食模式的挑戰(zhàn)包括有針對性地銷售不健康的食物、鄰里隔離、食物和營養(yǎng)不安全以及結構性種族主義。在所有個人中創(chuàng)造一個促進而不是阻礙堅持心臟健康飲食模式的環(huán)境是公共衛(wèi)生的當務之急。

57、非心臟手術后心肌損傷患者的診斷和管理：美國心臟協(xié)會的科學聲明。

Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association.

IF:23.603，PMID:34601955，Circulation. 2021 Nov 9;144(19):e287-e305. doi: 10.1161/CIR.0000000000001024. Epub 2021 Oct 4.

Abstract

Myocardial injury after noncardiac surgery is defined by elevated postoperative cardiac troponin concentrations that exceed the 99th percentile of the upper reference limit of the assay and are attributable to a presumed ischemic mechanism, with or without concomitant symptoms or signs. Myocardial injury after noncardiac surgery occurs in approximately 20% of patients who have major inpatient surgery, and most are asymptomatic. Myocardial injury after noncardiac surgery is independently and strongly associated with both short-term and long-term mortality, even in the absence of clinical symptoms, electrocardiographic changes, or imaging evidence of myocardial ischemia consistent with myocardial infarction. Consequently, surveillance of myocardial injury after noncardiac surgery is warranted in patients at high risk for perioperative cardiovascular complications. This scientific statement provides diagnostic criteria and reviews the epidemiology, pathophysiology, and prognosis of myocardial injury after noncardiac surgery. This scientific statement also presents surveillance strategies and treatment approaches.

摘要

非心臟手術后心肌損傷定義為術后心肌肌鈣蛋白濃度升高，超過檢測參考上限的第99百分位數(shù)，可歸因于推測的缺血機制，伴或不伴伴隨癥狀或體征。非心臟手術后心肌損傷發(fā)生在大約20%的住院大手術患者中，大多數(shù)無癥狀。非心臟手術后的心肌損傷與短期和長期死亡率均獨立且密切相關，即使在無臨床癥狀、心電圖改變或與心肌梗死一致的心肌缺血影像學證據(jù)的情況下也是如此。因此，在圍手術期心血管并發(fā)癥高風險患者中，有必要監(jiān)測非心臟手術后的心肌損傷。該科學聲明提供了診斷標準，并綜述了非心臟手術后心肌損傷的流行病學、病理生理學和預后。該科學聲明還提出了監(jiān)測策略和治療方法。

61、韓國男性中不可燃尼古丁或煙草產品和可燃香煙使用習慣變化與隨后的短期心血管疾病風險的聯(lián)合相關性：一項全國隊列研究。

Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

IF:23.603，PMID:34601948，Circulation. 2021 Nov 9;144(19):1528-1538. doi: 10.1161/CIRCULATIONAHA.121.054967. Epub 2021 Oct 4.

Abstract

BACKGROUND:
The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear.

METHODS:
The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (>/=5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits.

RESULTS:
Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk.

CONCLUSIONS:
Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

摘要

背景：

不可燃尼古丁或煙草產品(NNTP)和可燃香煙(CC)使用習慣的變化與隨后的心血管疾病(CVD)風險的相關性尚不清楚。

方法：

研究人群包括來自韓國國家健康保險服務數(shù)據(jù)庫的5 159 538例在第一(2014-2015)和第二(2018)健康篩查期間接受健康篩查檢查的成年男性。所有參與者被分為持續(xù)僅CC吸煙者、CC和NNTP使用者、近期（<5年）未使用NNTP的CC戒煙者、近期使用NNTP的CC戒煙者、長期（>/=5年）未使用NNTP的CC戒煙者、長期使用NNTP的CC戒煙者和從不吸煙者。傾向評分匹配分析進一步根據(jù)NNTP使用比較CC戒煙者CVD風險。從第二次健康篩查日期開始，對受試者進行隨訪，直至CVD事件、死亡或2019年12月31日，以先發(fā)生者為準。根據(jù)NNTP和CC吸煙習慣的變化，采用多因素Cox比例風險回歸確定CVD風險的校正風險比(aHR)和95%CI。

結果：

與連續(xù)的單純CC吸煙者相比，CC和NNTP使用者(aHR,0.83[95%CI,0.79-0.88])和最初的CC吸煙者戒除CC并改用NNTP（近期CC戒煙者使用NNTP,aHR,0.81[95%CI,0.78-0.84]）發(fā)生CVD的風險較低。在傾向評分匹配后，近期使用NNTP的CC戒煙者(aHR，1.31[95%CI，1.01-1.70])比近期未使用NNTP的CC戒煙者具有更高的CVD風險。同樣，與未使用NNTP的長期CC戒煙者相比，使用NNTP的長期CC戒煙者(aHR，1.70[95%CI，1.07-2.72])具有更高的CVD風險。

結論：

在初始CC吸煙者中轉換為使用NNTP與繼續(xù)CC吸煙相比CVD風險較低相關。在CC戒斷時，使用NNTP比不使用NNTP的CC戒斷與更高的CVD風險相關。與未使用NNTP戒煙的CC吸煙者相比，使用NNTP的CC戒煙者未來CVD風險可能更高。

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