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HypertensionEarly Recent, June 17, 201905篇
StrokeEarly Recent, June 17, 201903篇
CirculationEarly Recent, June 17, 201901篇
Cardiovasc Drugs TherEarly Recent, June 17, 201901篇
J Thromb ThrombolysisEarly Recent, June 17, 201901篇 RECOMMEND 01 连续活动左心室辅助装置桥-移植对移植后死亡率的影响：UNOS数据库的倾向匹配剖析
Circulation Lauren K. Truby, Maryjane A. Farr, etc. 1小时前
Background:Bridge to transplant (BTT) with left ventricular assist devices (LVAD) is a mainstay of therapy for heart failure in patients awaiting heart transplantation (HT). Criteria for HT listing does not differ between patients medically managed versus mechanically bridged to HT. The objectives of the current study were to evaluate the impact of BTT with LVAD on posttransplant survival, to describe differences in causes of 1-year mortality in medically and mechanically bridged patients, and to evaluate differences in risk factors for 1-year mortality between those with and without LVAD at the time of HT. 带左心室辅助装置（LVAD）的桥接移植（BTT）是等候心脏移植（HT）患者心力衰竭治疗的主要伎俩。在药物治疗和机械桥接治疗的患者中，HT列表的规范没有区别。本研讨的目的是评价带左室射血分数的BTT对移植后生存率的影响，描画医学和机械桥接患者1年死亡率缘由的差别，并评价在HT时有或无左室射血分数的患者1年死亡率的风险要素的差别。 Methods:Using the United Network of Organ Sharing (UNOS) database, we identified 5486 adult, single-organ HT recipients transplanted between 2008 and 2015. Patients were propensity matched for likelihood of LVAD at the time of HT. Kaplan-Meier survival estimates were used to assess the impact of BTT on 1-year and 5-year mortality. Logistic regression analysis was used to evaluate the odds ratio of 1-year mortality for patients BTT with LVAD as compared to medical management across clinically significant variables at various thresholds. 应用器官共享分离网络（UNOS）数据库，我们肯定了2008年至2015年期间移植的5486名成人单器官耐除草剂受体。患者在高血压时倾向于与左心室流出道的可能性相匹配。用Kaplan-Meier生存率评价BTT对1年和5年死亡率的影响。采用logistic回归剖析，评价在不同阈值下，BTT伴LVAD患者1年死亡率与药物治疗的比值比。 Results:Early mortality was higher in mechanically bridged patients: 9.5% vs. 7.2% mortality at 1-year (p-value < 0.001). BTT patients incurred an increased risk of 1-year mortality with an eGFR of 40-60 mL/min/1.73m2(OR: 1.69, p=0.003) and with an eGFR of < 40mL/min (OR:2.16, p=0.005). A similar trend was seen in patients with a BMI of 25-30 kg/m2(OR:1.88,p=0.024) and a BMI of >30 kg/m2(OR: 2.11, p<0.001). When patients were stratified by BTT status and the presence of risk factors including Age > 60, eGFR < 40 mL/min/1.73m2, and BMI > 30kg/m2there were significant differences in 1-year mortality between medium- and high-risk medically and mechanically bridged patients, with 1-year mortality in high-risk BTT patients at 17.6% compared to high risk medically managed patients at 10.4%. 机械桥接患者的早期死亡率较高：1年死亡率为9.5%对7.2%（p值<0.001）。btt患者1年死亡率增加，egfr为40-60 ml/min/1.73m2（或：1.69，p=0.003），egfr小于40 ml/min（或：2.16，p=0.005）。在体重指数为25-30 kg/m2（或：1.88，p=0.024）且体重指数大于30 kg/m2（或：2.11，p<0.001）的患者中也发现了相似的趋向。依据BTT状态和风险要素（包含年龄>60岁、eGFR<40 ml/min/1.73m2和bmi>30 kg/m2）对患者中止分层后，中、高风险医学和机械桥接患者的1年死亡率有显著差别，高风险BTT患者的1年死亡率为17.6%，而高风险BTT患者的1年死亡率为17.6%。医疗管理患者占10.4%。 Conclusions:Bridge to HT with LVAD, while necessary due to organ scarcity and capable of improving waitlist survival, confers a significantly higher risk of early post-transplant mortality. Patients bridged with mechanical support may require more careful consideration for transplant eligibility after LVAD placement 由于器官稀缺和能够进步等候名单存活率，应用左心室辅助性心动过速（LVAD）与右心室辅助性心动过速（HT）的桥接，可显著进步移植后早期死亡率的风险。运用机械支持搭桥的患者可能需求更认真地思索LVAD植入后的移植资历。 Early Recent, June 17, 2019 10.1161/CIRCULATIONAHA.118.036932 02 大血管闭塞性卒中梗死生长快、慢停顿者的患病率及时间散布
Stroke Marcelo Rocha, Shashvat M. Desai, etc. 1小时前
Background and PurposeFast and slow progressors of infarct growth due to anterior circulation large vessel occlusion are commonly observed in clinical practice. We aimed to estimate the prevalence and temporal distribution of fast and slow progressors among anterior circulation large vessel occlusion patients diagnosed within 24 hours of stroke onset. 前循环大血管闭塞招致梗死生长的快速弛迟缓停顿是临床上常见的现象。我们旨在评价卒中发作24小时内诊断的前循环大血管阻塞患者中快速弛迟缓停顿者的患病率和时间散布。 MethodsSingle-center retrospective study of all patients with anterior circulation large vessel occlusion who underwent baseline computed tomographic perfusion or magnetic resonance imaging within 24 hours of stroke onset. Prevalence was determined for fast progressors (ischemic core >70 mL, <6 hours of stroke onset) and slow progressors (ischemic core ≤30 mL, >6–24 hours of stroke onset). 单中心回想性研讨一切脑卒中发作24小时内接受基线计算机断层灌注或磁共振成像的前循环大血管闭塞患者。肯定了快速停顿者（缺血性中心>70 ml，<6小时卒中发作）弛迟缓停顿者（缺血性中心≤30 ml，>6-24小时卒中发作）的患病率。 ResultsOne hundred eighty-five patients were included. The median time interval from stroke onset to baseline core imaging was 7.6 hours (interquartile range, 3.9–13.2), and median core volume was 17 mL (range, 0–405). Patients had core volume ≤70 mL in 72% of cases in the overall cohort. The prevalence of fast progressors was 25% (95% CI, 17%–37%) and reached 40% (95% CI, 24%–59%) between 3 and 4.5 hours after stroke onset. The prevalence of slow progressors was 55% (95% CI, 46%–64%) and was similar across time intervals beyond 6 hours after stroke onset. 其中包含一百八十五名患者。从卒中开端到基线中心成像的中间时间距离为7.6小时（四分位间距，3.9–13.2），中心容积的中间值为17毫升（范围，0–405）。在整个队列中，72%的患者的中心体积小于等于70ml。卒中发作后3-4.5小时，快速停顿者的患病率为25%（95%CI，17%-37%），抵达40%（95%CI，24%-59%）。迟缓停顿者的患病率为55%（95%可信区间，46%-64%），并且在卒中发作后6小时以上的时间距离内相似。 ConclusionsMost anterior circulation large vessel occlusion patients had small-to-moderate ischemic core volume, irrespective of early or delayed presentation within 24 hours of stroke onset. Fast progressors were highly prevalent between 3 and 4.5 hours after stroke onset. 大多数前循环大血管闭塞患者在卒中发作24小时内，无论早期或延迟呈现，其缺血中心体积都很小或中等。在卒中发作后3至4.5小时内，快速停顿者十分普遍。 Early Recent, June 17, 2019 10.1161/STROKEAHA.118.024035 03 脑出血后脑微出血的发作率 Stroke Luke A Perry, Mark Rodrigues, etc. 1小时前
Background and PurposeThe frequency and prognostic implications of incident cerebral microbleeds (CMB), defined as development of one or more new CMB, after intracerebral hemorrhage (ICH) is unclear. Therefore, we performed a systematic review and meta-analysis to investigate the frequency and prognostic implications of incident CMB after ICH. 脑出血（ICH）后发作脑微出血（CMB）的频率和预后意义尚不分明，该病定义为一个或多个新的CMB的展开。因而，我们中止了系统的回想和荟萃剖析，以研讨ICH后发作CMB事情的频率和预后意义。 MethodsWe searched Ovid Medline and Embase in May 2018 for longitudinal studies of adults who underwent brain magnetic resonance imaging at 2 or more times after ICH. We calculated the pooled proportion of adults with incident CMB and sought associations between incident CMB and clinical outcomes (death, recurrent ICH, or new ischemic stroke). We planned subgroup analyses to investigate clinical variables associated with incident CMB. 我们在2018年5月搜索了Ovid Medline和Embase，以获取对ICH后2次或2次以上接受脑磁共振成像的成人的纵向研讨。我们计算了发作CMB的成人的兼并比例，并寻求了事情CMB与临床结果（死亡、复发性ICH或新的缺血性卒中）之间的关联。我们计划中止亚组剖析，以调查与CMB事情相关的临床变量。 ResultsWe identified 2354 publications, of which we included 4 cohort studies involving 349 patients. The pooled proportion of adults with at least one new CMB during a mean 27 months follow-up (SD 20 months) was ≈40% (95% CI, 30%–50%). In one study, as the number of incident CMB increased (0 versus 1–3 new CMB versus ≥4 new CMB) the risk of recurrent symptomatic lobar ICH increased (hazard ratio 3.0; 95% CI, 1.2–7.3). No study reported on outcomes of incident ischemic stroke or death. 我们肯定了2354份出版物，其中包含4项触及349名患者的队列研讨。在平均27个月的随访（SD 20个月）中，至少有一个新的CMB的成人的兼并比例为≈40%（95%CI，30%–50%）。在一项研讨中，随着CMB事情数量的增加（0对1–3新的CMB对≥4新的CMB），复发性病症性脑叶ICH的风险增加（风险比3.0；95%可信区间，1.2–7.3）。没有关于缺血性中风或死亡事情结果的研讨讲演。 ConclusionsIncident CMB occurs in ≈40% of adults after ICH. The association of incident CMB with recurrent lobar ICH needs confirmation and their association with death and ischemic stroke investigation. 脑出血后约有40%的成人发作CMB事情。CMB事情与复发性脑叶ICH的相关性需求确认，以及它们与死亡和缺血性卒中调查的相关性。 Early Recent, June 17, 2019 10.1161/STROKEAHA.118.023746 04 突发性颈动脉支架置入加串联卒中溶栓后血栓切除术 Stroke Mohammad Anadani, Alejandro M. Spiotta, etc. 1小时前
Background and PurposeEmergent carotid artery stenting plus mechanical thrombectomy is an effective treatment for acute ischemic stroke patients with tandem occlusion of the anterior circulation. However, there is limited data supporting the safety of this approach in patients treated with prior intravenous thrombolysis (IVT). We aimed to investigate the safety of emergent carotid artery stenting-mechanical thrombectomy approach in stroke patient population treated with prior IVT. 急诊颈动脉支架置入加机械血栓切除术是治疗急性缺血性脑卒中兼并前循环串联阻塞的有效措施。但是，在静脉溶栓治疗（IVT）患者中，支持这种措施保险性的数据有限。本研讨旨在讨论急诊颈动脉支架置入机械血栓切除术治疗脑卒中患者的保险性。 MethodsWe assessed patients with acute ischemic stroke because of atherosclerotic tandem occlusion that were treated with emergent carotid artery stenting-mechanical thrombectomy approach from the multicenter observational Thrombectomy in Tandem Lesions registry. Patients were divided into 2 groups based on pretreatment IVT (IVT versus no-IVT). Intracerebral hemorrhages were classified according to the European Cooperative Acute Stroke Study II criteria. 我们从多中心察看性血栓切除术的串联病变注销处评价了采用急诊颈动脉支架机械血栓切除术治疗动脉粥样硬化性串联闭塞的急性缺血性卒中患者。依据预处置的IVT将患者分为2组（IVT组与非IVT组）。依据欧洲协作急性脑卒中研讨II规范对脑出血中止分类。 ResultsAmong 205 patients included in the present study, 125 (60%) received prior IVT. Time from symptoms onset-to-groin puncture was shorter (234±100 versus 256±234 minutes;P=0.002), and heparin use was less in the IVT group (14% versus 35%;P<0.001); otherwise, there was no difference in the baseline characteristics. There was no significant difference between the IVT and no-IVT groups in the rate of symptomatic intracerebral hemorrhage (5% versus 8%;P=0.544), parenchymal hematoma type 1 to 2 (15% versus 18%;P=0.647), successful reperfusion (modified Thrombolysis in Cerebral Ischemia 2b–3), or 90-day favorable outcome (modified Rankin Scale score of 0–2 at 90 days). The 90-day all-cause mortality rate was significantly lower in the IVT group (8% versus 20%;P=0.017). After adjusting for covariates, IVT was not associated with symptomatic intracerebral hemorrhage or 90-day mortality. 在本研讨的205名患者中，125名（60%）患者接受了先前的IVT。病症发作到腹股沟穿刺的时间较短（234±100 vs 256±234分钟；p=0.002），IVT组肝素运用较少（14%vs 35%；p<0.001）；否则，基线特征无差别。在病症性脑出血（5%对8%；P=0.544）、1-2型脑实质血肿（15%对18%；P=0.647）、胜利再灌注（脑缺血2b-3的改进溶栓）或90天有利结局（改进Rankin量表评分0-2）的发作率方面，IVT组与非IVT组之间没有显著差别。90天）。IVT组90天全因死亡率显著降低（8%对20%；p=0.017）。校正协变量后，IVT与病症性脑出血或90天死亡率无相关性。 ConclusionsEmergent carotid artery stenting-mechanical thrombectomy approach was not associated with an increased risk of hemorrhagic complications in tandem occlusion patients who received IVT before the intervention. 急诊颈动脉支架机械血栓切除术与介入治疗前接受IVT的串联闭塞患者出血并发症风险增加无关。 Early Recent, June 17, 2019 10.1161/STROKEAHA.118.024733 05 不同导尿管技术对单纯收缩期高血压患者肾去神经支配的影响
Hypertension Karl Fengler, Karl-Philipp Rommel, etc.
孤立性收缩期高血压（ISH）患者被以为在肾交感神经去神经支配（RDN）后血压（BP）降低。这一结论主要来源于单极性射频导管消融研讨。存在更新RDN技术的有限数据。我们运用来自放射声-HTN（三臂随机实验，不同肾去神经装置和技术治疗高血压患者）的数据，比较3种不同的RDN措施，以研讨ISH和RDN反响之间可能的相互作用。120例患者按ISH或兼并收缩期舒张压（CH）中止分层。其中39例接受肾主动脉射频消融，39例主支动脉射频分离消融，42例接受超声为主肾主动脉射频消融。ISH（n=61）患者年龄较大，基线时动态丈量（动态血压丈量）的收缩压和舒张压低于CH（n=59）。3个月时，与CH患者相比，ISH患者显现RDN降低血压的效果较不明显（白天平均值为-5.9±11.8对-13.3±11.7 mm Hg，p=0.001）。这一差别对肾主动脉射频消融和超声为主肾主动脉消融治疗有显著性意义，但在主、支动脉射频消融组无显著性意义。调整基线血压值和年龄后，ISH和CH的血压降落没有显著差别。运用未调整的血压值，RDN在CH中似乎比在ISH中更有效。但是，调整基线血压值显现，无论采用何种RDN治疗，ISH和CH患者的血压都有相似的降低。过去，ISH作为胜利RDN的预测因子的价值可能被高估了。 Early Recent, June 17, 2019 10.1161/HYPERTENSIONAHA.119.13019 CONTENTS HypertensionEarly Recent, June 17, 2019今日发布5篇文章 research-articleNo.01Renal Denervation in Isolated Systolic Hypertension Using Different Catheter Techniques and Technologies不同导尿管技术对单纯收缩期高血压患者肾去神经支配的影响06-17 17:37 | 10.1161/HYPERTENSIONAHA.119.13019 research-articleNo.02Effects of Nilvadipine on Cerebral Blood Flow in Patients With Alzheimer Disease尼瓦地平对阿尔茨海默病患者脑血流的影响06-17 17:37 | 10.1161/HYPERTENSIONAHA.119.12892 editorialNo.03Renal Sympathetic Denervation in Isolated Systolic Hypertension单纯收缩期高血压患者的肾交感神经失神经06-17 17:37 | 10.1161/HYPERTENSIONAHA.119.13168 research-articleNo.04Sympathetic Neural Overdrive in the Obese and Overweight State瘦削和超重状态下的交感神经过载06-17 17:37 | 10.1161/HYPERTENSIONAHA.119.12885 review-articleNo.05Concept of Extremes in Vascular Aging血管老化中的极值概念06-17 17:37 | 10.1161/HYPERTENSIONAHA.119.12655 StrokeEarly Recent, June 17, 2019今日发布3篇文章 research-articleNo.01Prevalence and Temporal Distribution of Fast and Slow Progressors of Infarct Growth in Large Vessel Occlusion Stroke大血管闭塞性卒中梗死生长快、慢停顿者的患病率及时间散布06-17 18:02 | 10.1161/STROKEAHA.118.024035 research-articleNo.02Incident Cerebral Microbleeds After Intracerebral Hemorrhage脑出血后脑微出血的发作率06-17 18:02 | 10.1161/STROKEAHA.118.023746 research-articleNo.03Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes突发性颈动脉支架置入加串联卒中溶栓后血栓切除术06-17 18:02 | 10.1161/STROKEAHA.118.024733 CirculationEarly Recent, June 17, 2019今日发布1篇文章 research-articleNo.01Impact of Bridge to Transplant with Continuous Flow Left Ventricular Assist Devices on Post-Transplant Mortality: A Propensity Matched Analysis of the UNOS Database连续活动左心室辅助装置桥-移植对移植后死亡率的影响：UNOS数据库的倾向匹配剖析06-17 18:08 | 10.1161/CIRCULATIONAHA.118.036932
Cardiovasc Drugs TherEarly Recent, June 17, 2019今日发布1篇文章 ORIGINAL ARTICLENo.01 P.1-10Obesity-Related Genetic Determinants of Heart Failure Prognosis瘦削相关怀力衰竭预后的遗传决议要素06-17 18:09 | 10.1007/s10557-019-06888-8
J Thromb ThrombolysisEarly Recent, June 17, 2019今日发布1篇文章 ArticleNo.01 P.1-7Coronary artery fistulae冠状动脉瘘06-17 18:40 | 10.1007/s11239-019-01897-8 |
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