医微客 - 10月重磅心血管研究盘点（IF=23.6的Circulation文献汇总）

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10月重磅心血管研究盘点（IF=23.6的Circulation文献汇总）

期刊资讯

2021-12-07

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国际心血管领域顶尖期刊《Circulation》10月发表了一系列重磅心血管研究，想要追踪其进展的小伙伴，不要错过。不过限于篇幅，本文只展示部分内容，

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文献目录

胸痛复发：更新和以患者为中心。
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估和诊断指南：执行摘要：美国心脏病学会/美国心脏协会临床实践指南联合委员会的报告。
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估和诊断指南：美国心脏病学会/美国心脏协会临床实践指南联合委员会的报告。
Braillon关于文章“极高冠状动脉钙(≥1000)与心血管疾病事件、非心血管疾病结局和死亡率的相关性：来自MESA的结果”的信函。
缺氧诱导的小鼠肺血管重塑的三维可视化。
利伐沙班单药治疗房颤和稳定型冠心病心力衰竭患者的临床结局：AFIRE试验的见解。
通过CRISPR引导的胞苷脱氨酶跳过治疗性外显子可在体内挽救营养不良性心肌病。
公共卫生政策卫生经济学评价的微模拟模型：一个不完善但有用的工具。
Icosapent Ethyl可减少既往有冠状动脉旁路移植术史的患者的缺血事件：Reduce-IT CABG。
经导管主动脉瓣置换术后左束支传导阻滞性心动过速。
Icosapent Ethyl在已确诊心血管疾病或糖尿病患者肾功能范围内的获益：REDUCE-IT RENAL。
减肥干预的心血管结局试验：心血管预防的另一种工具？
Peng等人对关于“极高冠状动脉钙(≥1000)与心血管疾病事件、非心血管疾病结局和死亡率的相关性：来自MESA的结果”文章的回复。
生命呼吸：心脏病与发育性缺氧的关系。
在临床环境中促进健康生活方式的策略：理想心血管健康的支柱：美国心脏协会的科学咨询。
心血管Progerin抑制和核纤层蛋白A恢复可挽救Hutchinson-Gilford Progeria综合征。
心脏谱系承诺和成熟的连续缺陷导致左心发育不全综合征。
临床环境中跨越寿命的健康生活方式促进的特殊考虑：美国心脏协会的科学咨询。
CARMN是一种进化上保守的平滑肌细胞特异性LncRNA，通过结合Myocardin维持收缩表型。
保留射血分数的心力衰竭大鼠模型：调节Ca(2 +)循环和血管反应性的收缩蛋白的变化。
肥厚型心肌病的心脏能量学改变和线粒体功能障碍。
接受经导管介入治疗结构性心脏病患者的抗血栓治疗。
解读智能手表和植入式循环记录仪跟踪的挑战。
Wu等人关于文章的信，“运动诱导的生理性心肌肥大消退后的抗肥大记忆是由长非编码RNA Mhrt779介导的”。
美国心血管过早死亡：谁将保护我们中最脆弱的人？
线粒体端粒酶逆转录酶通过改善复合物I的组成和功能保护心肌缺血/再灌注损伤。
Circulation Family of Journals亮点。
HFpEF的靶向治疗机会：利用舒张压优势。
He等人对关于文章“运动诱导的生理性心肌肥大消退后的抗肥大记忆由长非编码RNA Mhrt779介导”的信函的回复。
2014年至2018年美国国家的社会脆弱性和过早心血管死亡
ST段抬高型心肌梗死的治疗系统：美国心脏协会的政策声明。
长非编码RNA MIAT控制晚期动脉粥样硬化病变形成和斑块去稳定。
线粒体Ca(2 +)单向转运体的丢失限制了正性肌力储备，为Barth综合征心肌病的心律失常提供了触发因素和底物。
不明来源的栓塞性卒中患者发生房颤的预测因素：RE-SPECT ESUS试验分析。
Palmdelphin调节内皮对机械应力的核弹性。
窄宽QRS房室传导阻滞：刷新的暂停。
炎症和心力衰竭：朋友还是敌人？
Filippini等人对关于文章“钠降低的血压影响：实验研究的剂量-反应荟萃分析”的信函的回复。
Wei和Fang关于文章“降钠的血压作用：实验研究的剂量反应荟萃分析”的信函。
利伐沙班与安慰剂相比减少下肢血运重建后外周动脉疾病的急性肢体缺血：VOYAGER PAD的见解。
美国心脏协会对原始预防的关注。
γ-干扰素通过色氨酸分解代谢损害人冠状动脉内皮葡萄糖代谢，激活脂肪酸氧化。
生命和肢体：添加低剂量利伐沙班用于外周动脉疾病手术后的二级预防。
心血管结局随机对照试验中长期补充海洋ω-3脂肪酸对房颤风险的影响：系统综述和荟萃分析。
术中通过时间流量测量在冠状动脉旁路移植术中的应用：证据和专家意见声明的系统综述。
左心发育不全综合征的混合姑息治疗：与当代结局的相关性。
2021年心血管外科主题期刊《循环》简介。
手术时取出左心耳的时间：前瞻性LAAOS III。
无症状穿透性主动脉溃疡：良性还是恶性？
静脉移植物引入CABG后50年：无接触采集方法的新证据。
当今时代女性的心脏手术：护理中的差距是什么？
非心脏手术后心肌损伤患者的诊断和管理：美国心脏协会的科学声明。
及时和适当转诊晚期心力衰竭患者的指南：美国心脏协会的科学声明。
韩国男性中不可燃尼古丁或烟草产品和可燃香烟使用习惯变化与随后的短期心血管疾病风险的联合相关性：一项全国队列研究。
隐静脉与右侧胸廓内动脉作为Y型复合移植物的比较：SAVE RITA试验的10年血管造影和长期临床结果。
生活方式改变对难治性高血压患者的影响：TRIUMPH随机临床试验的结果。
行动呼吁：产妇健康和拯救母亲：美国心脏协会的政策声明。
冠状动脉旁路移植术后12个月时无接触与传统静脉采集技术的比较：多中心随机对照试验。
ISCHEMIA试验中糖尿病受试者的结局。
心力衰竭和射血分数保留：PARAGON-HF和EMPEROR-Preserved试验的并排检查。
Teprasiran是一种小干扰RNA，用于预防接受心脏手术的高危患者的急性肾损伤：一项随机临床研究。
静脉内皮细胞在发育和病理性血管生成中的作用。
地加瑞克与亮丙瑞林在前列腺癌患者中的心血管安全性：PRONOUNCE随机试验的主要结果。
恩格列净对射血分数保留性心力衰竭患者心力衰竭事件恶化的影响：EMPEROR-Preserved试验。
伴或不伴2型糖尿病的心力衰竭患者开始和停用恩格列净后的肾功能：EMPERIAL试验的见解。
经导管主动脉瓣植入术患者的自体主动脉瓣疾病进展和生物瓣膜退化。
在美国实现国家减盐和减糖倡议自愿减糖目标的健康影响和成本效益：一项微模拟研究。
冠状动脉支架植入术后使用或不使用口服抗凝治疗的高出血风险患者的简化抗血小板治疗：一项开放标签、随机、对照试验。
无症状穿透性主动脉溃疡的预后：现代方法。
利伐沙班和阿司匹林在接受外科血运重建的外周动脉疾病患者中的作用：VOYAGER PAD试验的见解。
髓源性生长因子通过保护心肌细胞肌节/内质网Ca(2 +)-atp酶表达保护压力超负荷诱导的心力衰竭。
Nidogen-2维持血管平滑肌细胞的收缩表型，并通过桥接Jagged1-Notch3信号阻止新生内膜形成。
TGFBR1(A230T)变异引起的谱系特异性平滑肌细胞缺陷的hiPSC建模，及其对Loeys-Dietz综合征的治疗意义。

2、2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估和诊断指南：执行摘要：美国心脏病学会/美国心脏协会临床实践指南联合委员会的报告。

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

IF:23.603，PMID:34709928，Circulation. 2021 Oct 28:CIR0000000000001030. doi: 10.1161/CIR.0000000000001030.

Abstract

AIM:
This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.

METHODS:
A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered.

Structure:
Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.

摘要

目的：
胸痛评价和诊断临床实践指南的执行摘要为临床医生评估和诊断成人患者的胸痛提供了建议和算法。

方法：
2017年11月11日至2020年5月1日进行了全面的文献检索，包括PubMed、EMBASE、Cochrane协作网、医疗保健研究和质量机构报告和其他相关数据库中以英文发表的关于人类受试者的研究、综述和其他证据。还考虑了截至2021年4月发表的其他相关研究。

结构：

胸痛是美国急诊科就诊的常见原因。“2021年AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估和诊断指南”提供了基于胸痛评估和评价的当代证据的建议。这些指南提供了一种基于证据的风险分层方法和胸痛评价的诊断检查。诊断检测中的成本价值考虑已被纳入，并建议与患者共同决策。

3、2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估和诊断指南：美国心脏病学会/美国心脏协会临床实践指南联合委员会的报告。

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

IF:23.603，PMID:34709879，Circulation. 2021 Oct 28:CIR0000000000001029. doi: 10.1161/CIR.0000000000001029.

Abstract

AIM:
This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.

METHODS:
A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered.

Structure:
Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.

摘要

目的：
本评估和诊断胸痛的临床实践指南为临床医生评估和诊断成人患者的胸痛提供了建议和算法。

方法：
2017年11月11日至2020年5月1日进行了全面的文献检索，包括从PubMed、EMBASE、Cochrane协作网、医疗保健研究和质量机构报告和其他相关数据库中以英文发表的关于人类受试者的随机和非随机试验、观察性研究、登记研究、综述和其他证据。还考虑了截至2021年4月发表的其他相关研究。

结构：

胸痛是美国急诊科就诊的常见原因。“2021年AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估和诊断指南”提供了基于胸痛评估和评价的当代证据的建议。本指南提出了一种基于证据的风险分层方法和胸痛评价的诊断检查。诊断检测中的成本价值考虑已被纳入，建议与患者共同决策。

15、在临床环境中促进健康生活方式的策略：理想心血管健康的支柱：美国心脏协会的科学咨询。

Strategies for Promotion of a Healthy Lifestyle in Clinical Settings: Pillars of Ideal Cardiovascular Health: A Science Advisory From the American Heart Association.

IF:23.603，PMID:34689589，Circulation. 2021 Oct 25:CIR0000000000001018. doi: 10.1161/CIR.0000000000001018.

Abstract

Engagement in healthy lifestyle behaviors is suboptimal. The vast majority of the US population does not meet current recommendations. A healthy lifestyle is defined by consuming a healthy dietary pattern, engaging in regular physical activity, avoiding exposure to tobacco products, habitually attaining adequate amounts of sleep, and managing stress levels. For all these health behaviors there are well-established guidelines; however, promotion in clinical settings can be challenging. It is critical to overcome these challenges because greater promotion of heathy lifestyle practices in clinical settings effectively motivates and initiates patient behavior change. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for clinical counseling with requisite attention to the demands of clinical settings. In this science advisory, we present strategies, based on the 5A Model, that clinicians and other health care professionals can use for efficient lifestyle-related behavior change counseling in patients at all levels of cardiovascular disease risk at every visit. In addition, we discuss the underlying role of psychological health and well-being in lifestyle-related behavior change counseling, and how clinicians can leverage health technologies when providing brief patient-centered counseling. Greater attention to healthy lifestyle behaviors during routine clinician visits will contribute to promoting cardiovascular health.

摘要

从事健康的生活方式行为是次优的。绝大多数美国人群不符合目前的建议。健康的生活方式是指食用健康的膳食结构，从事有规律的体力活动，避免接触烟草产品，习惯性地获得足够的睡眠量，管理压力水平。对于所有这些健康行为，都有完善的指南；但是，在临床环境中推广可能具有挑战性。克服这些挑战至关重要，因为在临床环境中更多地促进健康的生活方式实践可有效激励和启动患者行为改变。开发了5A模型（评估、建议、同意、协助和安排），以提供临床咨询框架，并对临床环境的需求进行必要的关注。在这项科学咨询中，我们提出了基于5A模型的策略，临床医生和其他医疗保健专业人员可以在每次访视时用于各级心血管疾病风险患者的高效生活方式相关行为改变咨询。此外，我们还讨论了心理健康和幸福感在生活方式相关行为改变咨询中的潜在作用，以及临床医生在提供以患者为中心的简短咨询时如何利用健康技术。在常规临床医生访视期间更多地关注健康的生活方式行为将有助于促进心血管健康。

18、临床环境中跨越寿命的健康生活方式促进的特殊考虑：美国心脏协会的科学咨询。

Special Considerations for Healthy Lifestyle Promotion Across the Life Span in Clinical Settings: A Science Advisory From the American Heart Association.

IF:23.603，PMID:34689570，Circulation. 2021 Oct 25:CIR0000000000001014. doi: 10.1161/CIR.0000000000001014.

Abstract

At a population level, engagement in healthy lifestyle behaviors is suboptimal in the United States. Moreover, marked disparities exist in healthy lifestyle behaviors and cardiovascular risk factors as a result of social determinants of health. In addition, there are specific challenges to engaging in healthy lifestyle behaviors related to age, developmental stage, or major life circumstances. Key components of a healthy lifestyle are consuming a healthy dietary pattern, engaging in regular physical activity, avoiding use of tobacco products, habitually attaining adequate sleep, and managing stress. For these health behaviors, there are guidelines and recommendations; however, promotion in clinical settings can be challenging, particularly in certain population groups. These challenges must be overcome to facilitate greater promotion of healthy lifestyle practices in clinical settings. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for clinical counseling with consideration for the demands of clinical settings. In this science advisory, we summarize specific considerations for lifestyle-related behavior change counseling using the 5A Model for patients across the life span. In all life stages, social determinants of health and unmet social-related health needs, as well as overweight and obesity, are associated with increased risk of cardiovascular disease, and there is the potential to modify this risk with lifestyle-related behavior changes. In addition, specific considerations for lifestyle-related behavior change counseling in life stages in which lifestyle behaviors significantly affect cardiovascular disease risk are outlined. Greater attention to healthy lifestyle behaviors during every clinician visit will contribute to improved cardiovascular health.

摘要

在人群水平上，参与健康的生活方式行为在美国是次优的。此外，由于健康的社会决定因素，健康生活方式行为和心血管风险因素存在显著差异。此外，从事与年龄、发育阶段或主要生活环境相关的健康生活方式行为存在具体挑战。健康生活方式的关键组成部分是消耗健康的膳食结构、进行有规律的体力活动、避免使用烟草产品、习惯性获得足够的睡眠和管理压力。对于这些健康行为，存在指南和建议；但是，在临床环境中推广可能具有挑战性，尤其是在某些人群中。必须克服这些挑战，以促进在临床环境中更多地促进健康生活方式实践。开发了5A模型（评估、建议、同意、协助和安排），以提供考虑临床环境需求的临床咨询框架。在这项科学咨询中，我们总结了在整个生命周期中使用5A模型对患者进行生活方式相关行为改变咨询的具体考虑。在所有生命阶段，健康的社会决定因素和未满足的社会相关健康需求，以及超重和肥胖与心血管疾病风险增加相关，并且有可能随着生活方式相关行为改变而改变这种风险。此外，概述了生活方式行为显著影响心血管疾病风险的生命阶段生活方式相关行为改变咨询的具体考虑因素。在每次临床医生访视期间更多地关注健康的生活方式行为将有助于改善心血管健康。

31、ST段抬高型心肌梗死的治疗系统：美国心脏协会的政策声明。

Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Policy Statement From the American Heart Association.

IF:23.603，PMID:34641735，Circulation. 2021 Nov 16;144(20):e310-e327. doi: 10.1161/CIR.0000000000001025. Epub 2021 Oct 13.

Abstract

The introduction of Mission:
Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment-elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain. From community education to 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.

摘要

2.特派团的介绍：

Lifeline显著增加了ST段抬高型心肌梗死(STEMI)患者及时接受经皮冠状动脉介入治疗的机会。此后，发病率和死亡率有所下降，研究取得了重大进展，拓宽了我们对STEMI护理系统的概念。然而，重大障碍和机会仍然存在。从社区教育到9-1-1激活和紧急医疗服务分诊，从急诊科和机构间转移方案到急性后护理，每个关键时刻都对STEMI患者的最佳护理提出了独特的挑战。该政策声明提出了如何设计和实施理想的STEMI护理系统的建议，以确保STEMI患者在疾病的每个阶段接受最佳的循证护理。

44、心血管结局随机对照试验中长期补充海洋ω-3脂肪酸对房颤风险的影响：系统综述和荟萃分析。

Effect of Long-Term Marine Omega-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis.

IF:23.603，PMID:34612056，Circulation. 2021 Oct 6. doi: 10.1161/CIRCULATIONAHA.121.055654.

Abstract

Background:
Some, but not all, large-scale randomized controlled trials (RCTs) investigating the effects of marine omega-3 fatty acids supplementation on cardiovascular outcomes have reported increased risks of atrial fibrillation (AF). The potential reasons for disparate findings may be dose related.

Methods:
The MEDLINE and Embase databases were searched for articles and abstracts published between January 1, 2012 and December 31, 2020 in addition to a meta-analysis of large cardiovascular RCTs published in 2019. RCTs of cardiovascular outcomes of marine omega-3 fatty acids that reported results for AF, either as pre-specified outcome, adverse event, or a cause for hospitalization, with a minimum sample size of 500 patients and a median followup of at least one year were included. RCTs specifically examining shorter term effects of omega-3 fatty acids on recurrent AF in patients with established AF or post-operative AF were not included. The hazard ratio (HR) for the reported AF outcomes within each trial was metaanalyzed using random-effects model with Knapp-Hartung adjustment and evaluated a doseresponse relationship with a meta-regression model.

Results:
Of 4049 screened records, seven studies were included in the meta-analysis. Of those, five were already detected in a previous meta-analysis of cardiovascular RCTs. Among the 81,210 patients from 7 trials, 58,939 (72.6%) were enrolled in trials testing 1g/d of omega-3 fatty acids. The mean age was 65 years and 31,842 (39%) were female. The weighted average follow-up was 4.9 years. In meta-analysis, the use of marine omega-3 fatty acid supplements was associated with an increased risk of AF (n=2,905; HR 1.25, 95%CI 1.07-1.46, P=0.013). In analyses stratified by dose, the HR was greater in the trials testing >1g/d (HR 1.49, 95%CI 1.04-2.15, P=0.042) as compared with those testing

Conclusions:
In RCTs examining cardiovascular outcomes, marine omega-3 supplementation was associated with an increased risk of AF. The risk appeared to be greater in trials testing >1g/d.

摘要

背景：

一些但不是所有研究补充海洋ω-3脂肪酸对心血管结局影响的大规模随机对照试验(RCT)报告了房颤(AF)风险增加。不同结果的潜在原因可能与剂量相关。

方法：

除2019年发表的大型心血管RCT荟萃分析外，还检索了MEDLINE和Embase数据库中2012年1月1日至2020年12月31日期间发表的文章和摘要。纳入了海洋ω-3脂肪酸心血管结局RCT，报告AF结果（预先规定的结局、不良事件或住院原因），最小样本量为500例患者，中位随访时间至少为1年。未纳入专门检查ω-3脂肪酸对已确诊AF或术后AF患者复发性AF短期影响的RCT。使用Knapp-Hartung校正的随机效应模型对每项试验中报告的AF结局的风险比(HR)进行荟萃分析，并使用荟萃回归模型评价剂量反应关系。

结果：

在4049条筛选记录中，7项研究被纳入荟萃分析。其中，5项已在既往心血管RCT荟萃分析中检测到。在来自7项试验的81,210例患者中，58,939例(72.6%)入组试验，每天检测≤1 g(g/d)ω-3脂肪酸，22,271例(27.4%)入组试验，检测 > 1 g/日ω-3脂肪酸。平均年龄65岁，女性31842例(39%)。加权平均随访时间为4.9年。在荟萃分析中，使用海洋ω-3脂肪酸补充剂与AF风险增加相关(n = 2,905；HR 1.25，95%CI 1.07-1.46，P = 0.013)。在按剂量分层的分析中，> 1 g/日组的HR(HR 1.49,95%CI 1.04-2.15,P = 0.042)高于

结论：

在检查心血管结局的RCT中，补充海洋omega-3与AF风险增加相关。在检测 > 1 g/日的试验中，风险似乎更高。

45、术中通过时间流量测量在冠状动脉旁路移植术中的应用：证据和专家意见声明的系统综述。

The Use of Intraoperative Transit Time Flow Measurement for Coronary Artery Bypass Surgery: Systematic Review of the Evidence and Expert Opinion Statements.

IF:23.603，PMID:34606302，Circulation. 2021 Oct 5;144(14):1160-1171. doi: 10.1161/CIRCULATIONAHA.121.054311. Epub 2021 Oct 4.

Abstract

Transit time flow measurement (TTFM) allows quality control in coronary artery bypass grafting but remains largely underused, probably because of limited information and the lack of standardization. We performed a systematic review of the evidence on TTFM and other methods for quality control in coronary artery bypass grafting following PRISMA standards and elaborated expert recommendations by using a structured process. A panel of 19 experts took part in the consensus process using a 3-step modified Delphi method that consisted of 2 rounds of electronic voting and a final face-to-face virtual meeting. Eighty percent agreement was required for acceptance of the statements. A 2-level scale (strong, moderate) was used to grade the statements based on the perceived likelihood of a clinical benefit. The existing evidence supports an association between TTFM readings and graft patency and postoperative clinical outcomes, although there is high methodological heterogeneity among the published series. The evidence is more robust for arterial, rather than venous, grafts and for grafts to the left anterior descending artery. Although TTFM use increases the duration and the cost of surgery, there are no data to quantify this effect. Based on the systematic review, 10 expert statements for TTFM use in clinical practice were formulated. Six were approved at the first round of voting, 3 at the second round, and 1 at the virtual meeting. In conclusion, although TTFM use may increase the costs and duration of the procedure and requires a learning curve, its cost/benefit ratio seems largely favorable, in view of the potential clinical consequences of graft dysfunction. These consensus statements will help to standardize the use of TTFM in clinical practice and provide guidance in clinical decision-making.

摘要

通过时间流量测量(TTFM)可以在冠状动脉旁路移植术中进行质量控制，但仍在很大程度上使用不足，可能是由于信息有限和缺乏标准化。我们按照PRISMA标准对TTFM和其他冠状动脉旁路移植术质量控制方法的证据进行了系统综述，并使用结构化过程阐述了专家建议。由19名专家组成的小组采用3步改良Delphi法参加了共识进程，该方法由2轮电子投票和最后一次面对面的虚拟会议组成。接受声明需要80%的一致性。使用2级量表（强、中等），根据临床获益的感知可能性对声明进行分级。现有证据支持TTFM读数与移植物通畅率和术后临床结局之间的相关性，尽管已发表系列之间存在高度方法学异质性。对于动脉而不是静脉移植物以及左前降支移植物，证据更有力。尽管使用TTFM增加了手术持续时间和成本，但尚无数据量化该效应。基于系统综述，制定了10项TTFM在临床实践中使用的专家声明。第一轮投票批准6人，第二轮批准3人，虚拟会议批准1人。总之，尽管使用TTFM可能会增加手术成本和持续时间，并需要学习曲线，但考虑到移植物功能障碍的潜在临床后果，其成本/受益比似乎在很大程度上是有利的。这些共识声明将有助于规范TTFM在临床实践中的使用，并为临床决策提供指导。

52、非心脏手术后心肌损伤患者的诊断和管理：美国心脏协会的科学声明。

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

非心脏手术后心肌损伤定义为术后心肌肌钙蛋白浓度升高，超过检测参考上限的第99百分位数，可归因于推测的缺血机制，伴或不伴伴随症状或体征。非心脏手术后心肌损伤发生在大约20%的住院大手术患者中，大多数无症状。非心脏手术后的心肌损伤与短期和长期死亡率均独立且密切相关，即使在无临床症状、心电图改变或与心肌梗死一致的心肌缺血影像学证据的情况下也是如此。因此，在围手术期心血管并发症高风险患者中，有必要监测非心脏手术后的心肌损伤。该科学声明提供了诊断标准，并综述了非心脏手术后心肌损伤的流行病学、病理生理学和预后。该科学声明还提出了监测策略和治疗方法。

53、及时和适当转诊晚期心力衰竭患者的指南：美国心脏协会的科学声明。

Guidance for Timely and Appropriate Referral of Patients With Advanced Heart Failure: A Scientific Statement From the American Heart Association.

IF:23.603，PMID:34503343，Circulation. 2021 Oct 12;144(15):e238-e250. doi: 10.1161/CIR.0000000000001016. Epub 2021 Sep 10.

Abstract

Among the estimated 6.2 million Americans living with heart failure (HF), approximately 5%/y may progress to advanced, or stage D, disease. Advanced HF has a high morbidity and mortality, such that early recognition of this condition is important to optimize care. Delayed referral or lack of referral in patients who are likely to derive benefit from an advanced HF evaluation can have important adverse consequences for patients and their families. A 2-step process can be used by practitioners when considering referral of a patient with advanced HF for consideration of advanced therapies, focused on recognizing the clinical clues associated with stage D HF and assessing potential benefits of referral to an advanced HF center. Although patients are often referred to an advanced HF center to undergo evaluation for advanced therapies such as heart transplantation or implantation of a left ventricular assist device, there are other reasons to refer, including access to the infrastructure and multidisciplinary team of the advanced HF center that offers a broad range of expertise. The intent of this statement is to provide a framework for practitioners and health systems to help identify and refer patients with HF who are most likely to derive benefit from referral to an advanced HF center.

摘要

在估计的620万美国心力衰竭(HF)患者中，约5%/年可能进展为晚期或D期疾病。晚期HF的发病率和死亡率较高，因此早期识别这种疾病对优化治疗非常重要。对于可能从晚期HF评价中获益的患者，延迟转诊或未转诊可能对患者及其家属产生重要的不良后果。当考虑转诊晚期HF患者以考虑晚期治疗时，执业医师可采用2步程序，重点是识别与D期HF相关的临床线索，并评估转诊至晚期HF中心的潜在获益。尽管通常会将患者转诊至高级HF中心接受心脏移植或左心室辅助装置植入等高级治疗的评价，但仍有其他原因需要转诊，包括访问高级HF中心的基础设施和多学科团队，这些团队可提供广泛的专业知识。本声明的目的是为执业医师和卫生系统提供一个框架，以帮助识别和转诊最有可能从转诊至高级HF中心获益的HF患者。

54、韩国男性中不可燃尼古丁或烟草产品和可燃香烟使用习惯变化与随后的短期心血管疾病风险的联合相关性：一项全国队列研究。

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：

不可燃尼古丁或烟草产品(NNTP)和可燃香烟(CC)使用习惯的变化与随后的心血管疾病(CVD)风险的相关性尚不清楚。

方法：

研究人群包括来自韩国国家健康保险服务数据库的5 159 538例在第一(2014-2015)和第二(2018)健康筛查期间接受健康筛查检查的成年男性。所有参与者被分为持续仅CC吸烟者、CC和NNTP使用者、近期（<5年）未使用NNTP的CC戒烟者、近期使用NNTP的CC戒烟者、长期（>/=5年）未使用NNTP的CC戒烟者、长期使用NNTP的CC戒烟者和从不吸烟者。倾向评分匹配分析进一步根据NNTP使用比较CC戒烟者CVD风险。从第二次健康筛查日期开始，对受试者进行随访，直至CVD事件、死亡或2019年12月31日，以先发生者为准。根据NNTP和CC吸烟习惯的变化，采用多因素Cox比例风险回归确定CVD风险的校正风险比(aHR)和95%CI。

结果：

与连续的单纯CC吸烟者相比，CC和NNTP使用者(aHR,0.83[95%CI,0.79-0.88])和最初的CC吸烟者戒除CC并改用NNTP（近期CC戒烟者使用NNTP,aHR,0.81[95%CI,0.78-0.84]）发生CVD的风险较低。在倾向评分匹配后，近期使用NNTP的CC戒烟者(aHR，1.31[95%CI，1.01-1.70])比近期未使用NNTP的CC戒烟者具有更高的CVD风险。同样，与未使用NNTP的长期CC戒烟者相比，使用NNTP的长期CC戒烟者(aHR，1.70[95%CI，1.07-2.72])具有更高的CVD风险。

结论：

在初始CC吸烟者中转换为使用NNTP与继续CC吸烟相比CVD风险较低相关。在CC戒断时，使用NNTP比不使用NNTP的CC戒断与更高的CVD风险相关。与未使用NNTP戒烟的CC吸烟者相比，使用NNTP的CC戒烟者未来CVD风险可能更高。

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