11月重磅心血管研究盘点（IF=29.69的Circulation文献汇总）

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文献目录

Naeije关于文章“慢性血栓栓塞性肺动脉高压患者的氧气通路限制”的信函。

心脏代谢中的足兵：与Heinrich Taegtmeyer,MD,DPhil的对话。

2021国际心肺复苏共识和紧急心血管护理科学与治疗建议：基本生命支持总结；高级生命支持；新生儿生命支持；教育、实施和团队；急救工作组；和COVID-19工作组。

房颤复律中前外侧与前后电极位置的比较。

Howden等人对关于“慢性血栓栓塞性肺动脉高压患者的氧气通路限制”文章的回复。

PARADISE-MI试验中沙库巴曲/缬沙坦与雷米普利对总心力衰竭事件的影响。

黑人血浆蛋白质组的全基因组序列分析为心血管疾病提供了新的见解。

监测策略对消融成功评估和消融后房颤负荷评估的影响：对实践和临床试验设计的影响。

在最近诊断为房颤的患者中，考虑抗凝和心律控制。

致心律失常性心肌病的炎症和免疫反应：最新技术水平综述。

肥厚型心肌病的肉瘤变体与心肌氧合的相关性：来自一种新型氧敏感心血管磁共振方法的见解。

心力衰竭中的细胞外基质：Adamts5在蛋白多糖重塑中的作用。

心脏纤维化过程中内皮细胞瞬时活化间充质基因表达的无缝基因记录。

Lai et al关于文章“儿童时期以来的心血管风险因素轨迹和中年认知能力：年轻芬兰人的心血管风险研究”的信函。

阿片类药物流行病：每个人都有自己的作用。

骨髓中NLRP3炎症小体致敏的中性粒细胞的保留对于心肌梗死诱导的粒细胞生成至关重要。

心脏植入式电子设备手术后持续使用阿片类药物。

Hakala等人对关于文章“儿童时期以来的心血管风险因素轨迹和中年认知能力：年轻芬兰人研究中的心血管风险”的信函的回复。

经静脉和皮下植入式除颤器中适当电击和抗心动过速起搏的有效性和安全性：PRAETORIAN试验中所有适当治疗的分析。

恩格列净、射血分数保留性心力衰竭患者的健康状况和生活质量：EMPEROR-Preserved试验。

主动脉瓣ReplAcemenT与保守治疗无症状重度主动脉狭窄的比较：AVATAR试验。

在2型糖尿病患者中使用或不使用钠-葡萄糖协同转运蛋白-2抑制剂的情况下，Efpeglenatide和临床结局：AMPLITUDE-O试验的探索性分析。

Finerenone降低慢性肾病和2型糖尿病患者心力衰竭事件的风险：FIGARO-DKD试验的分析

收入和教育的不平等与院外心脏骤停后的生存差异相关：一项全国观察性研究。

Schaefer等人关于文章“美国多中心队列中高敏心肌肌钙蛋白T策略和临床变量的诊断性能”的信函。

癌症幸存者心血管生物标志物应用的未来展望：美国心脏协会的科学声明。

Allen等人对关于“美国多中心队列中高敏心肌肌钙蛋白T策略和临床变量的诊断性能”文章的回复。

朝向心肌病的CRISPR疗法。

加热烟草棒而不是燃烧传统香烟和未来心脏病发作：仍然吸烟和风险。

CARDIOKIN1：健康对照者和瓣膜疾病患者心肌代谢能力的计算评估。

秋水仙碱在急性冠脉综合征患者中的应用：澳大利亚COPS随机临床试验的两年随访。

视网膜的深度学习使微血管的表型和全基因组分析成为可能。

基于心电图的深度学习和预测房颤的临床风险因素。

射血分数保留的心力衰竭患者运动诱发肺充血的能量基础。

Amulet或Watchman器械用于经皮左心耳闭合：SWISS-APERO随机临床试验的主要结果。

血压、高血压和主动脉夹层风险发生率和死亡率：日本特定健康检查研究、英国生物样本库研究和队列研究荟萃分析的结果。

磁共振成像结合运动揭示射血分数保留的心力衰竭患者的非保留心脏结构、功能和能量学。

医疗保险受益人中心力衰竭住院后社区水平的经济困境、人种和不良结局风险。

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预防和危险因素管理的初级保健和社区实践中的健康行为改变项目：美国心脏协会的科学声明。

当代临床实践中DAPT研究治疗效果的估计：EXTEND-DAPT研究的结果。

Romani等人关于文章“心外膜脂肪促进房颤的细胞外囊泡”的信函。

经股动脉经导管主动脉瓣置换术中基于纯插塞与基于主要缝线的血管闭合器械策略的比较：CHOICE-Closure随机临床试验。

在射血分数降低的心力衰竭患者中连续评估高敏心肌肌钙蛋白和达格列净的作用：一项DAPA-HF试验分析。

我们能预测心脏移植后早期的排斥反应吗？

英国十字路口的心血管医学。

美国心脏协会2024年的影响目标：每个人都有机会拥有一个完整、健康的生活。

2021改善心血管健康的饮食指南：美国心脏协会的科学声明。

急性下壁心肌梗死后分组跳动。

免疫检查点抑制剂心肌炎的心电图表现。

我是否得到了流感疫苗？：流感疫苗接种作为预防心血管事件和死亡的心肌梗死后护理。

Leor等人对关于“心外膜脂肪促进房颤的细胞外囊泡”文章的回复。

COVID-19大流行对心血管科学的影响：预期问题和潜在解决方案：美国心脏协会的主席咨询。

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。

肥厚型心肌病的心脏能量学改变和线粒体功能障碍。

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。

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。

Palmdelphin调节内皮对机械应力的核弹性。

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。

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。

Filamin C截短变体引起的心肌病的表型表达、自然史和风险分层。

综合应激反应将线粒体蛋白质翻译与氧化应激控制相结合。

降低低密度脂蛋白胆固醇低于40 mg/dL的心血管获益。

Chagas心肌病进展的发生率和预测因素：克氏锥虫血清阳性个体的长期随访。

心脏移植后冠状动脉微循环功能障碍和急性细胞排斥反应。

Vericiguat在射血分数降低性心力衰竭患者中的全球研究(VICTORIA)中的血红蛋白和临床结局。

Amplatzer Amulet左心耳封堵器与Watchman器械预防卒中的比较(Amulet IDE)：一项随机对照试验。

心肌梗死后流感疫苗接种：一项随机、双盲、安慰剂对照、多中心试验。

3、2021国际心肺复苏共识和紧急心血管护理科学与治疗建议：基本生命支持总结；高级生命支持；新生儿生命支持；教育、实施和团队；急救工作组；和COVID-19工作组。

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

复苏国际联络委员会启动了对新的、同行评审的已发表心肺复苏科学的持续审查。这是复苏国际联络委员会关于心肺复苏和紧急心血管护理科学与治疗建议的国际共识的第五次年度总结；在2020年进行了更全面的审查。本最新总结阐述了复苏国际联络委员会工作组科学专家审查的最新发表的复苏证据。本总结中系统综述涵盖的主题包括基于视频的调度系统的复苏主题；直立心肺复苏；自主循环恢复后的早期冠状动脉造影；俯卧患者的心肺复苏；早产和足月婴儿出生时的脐带管理；出生时给予正压通气的设备；新生儿复苏期间的家庭在场；成人和儿童的自我指导、基于数字的基本生命支持教育和培训；心脏骤停患者对抢救者的冠状病毒疾病2019感染风险；以及急救主题，包括热烧伤用水冷却、劳力性脱水的口服补液、儿科止血带使用和蜱虫去除方法。6个复苏问题国际联络委员会工作组的成员根据推荐评估、制定和评估标准的分级，对证据的质量进行了评估、讨论和辩论，其声明包括共识治疗建议或良好实践声明。对工作队审议情况的深入了解见“理由和循证-决策框架要点”一节。此外，工作队列出了进一步研究的优先知识差距。

10、致心律失常性心肌病的炎症和免疫反应：最新技术水平综述。

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)是心肌的原发性疾病，主要由心脏闰盘蛋白质，特别是桥粒的遗传缺陷引起。传递多为常染色体显性遗传，外显率不全。ACM也具有广泛的表型变异性，从室性早搏到心源性猝死和心力衰竭。在表型的其他驱动因素和调节剂中，对病毒感染和免疫触发因素反应的炎症被假定为心肌细胞损伤和坏死的加重因素。这一理论得到了多个证据的支持，包括超过2/3的ACM心脏存在炎性浸润，在ACM散发病例中检测到不同的嗜心性病毒，ACM患者常符合活动性心肌炎的组织学标准，以及致心律失常性右室心肌病患者体内丰富的抗桥粒芯糖蛋白-2、抗心脏和抗闰盘自身抗体。与ACM的常见家族性发生相一致，有人提出，除了进行性心肌损害的遗传倾向外，病毒感染和免疫反应的可遗传易感性可以解释ACM的家族聚集性。此外，大量的体外和体内证据表明ACM中存在激活的炎症信号。尽管炎症/免疫反应在ACM中的作用尚不完全清楚，但炎症作为表型的驱动因素和基于机制治疗的潜在靶点值得进一步研究。本综述讨论了目前支持炎症和免疫反应在ACM发病机制中作用的证据，并提出了转化和临床研究的机会。

20、恩格列净、射血分数保留性心力衰竭患者的健康状况和生活质量：EMPEROR-Preserved试验。

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：

射血分数保留型心力衰竭(HFpEF)患者的健康相关生活质量(HRQoL)受到显著损害。在EMPEROR-Preserved中，我们评估了恩格列净对HFpEF患者HRQoL的疗效，以及观察到的恩格列净临床获益是否因基线健康状况而异。

方法：

在基线、第12、32和52周使用堪萨斯城心肌病问卷(KCCQ)测量HRQoL。患者按基线KCCQ临床汇总评分(CSS)三分位数划分，检查恩格列净对结局的影响。评价了恩格列净对KCCQ-CSS、总症状评分(TSS)和总体汇总评分(OSS)的影响。进行应答者分析，比较与恩格列净治疗相关的KCCQ改善和恶化的几率。

结果：

恩格列净对降低至心血管死亡或HF住院时间风险的作用在基线KCCQ-CSS三分位间一致（评分<62.5、62.5-83.3和>/=83.3分别为HR 0.83[0.69-1.00]、HR 0.70[0.55-0.88]和HR 0.82[0.62-1.08]；P趋势=0.77）。总HF住院的结果相似。与安慰剂相比，恩格列净治疗患者的KCCQ-CSS显著改善（第12、32和52周分别为 + 1.03、+ 1.24和 + 1.50，P < 0.01）；TSS和OSS观察到相似的结果。第12周时，恩格列净组患者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)的几率更高，恶化≥5分的几率更低(0.85；95%CI 0.75，0.97)。第32周和第52周观察到相似模式，TSS和OSS结果一致。

结论：

在HFpEF患者中，恩格列净可降低基线KCCQ评分范围内的重大HF结局风险。恩格列净改善HRQoL，这种作用出现较早，并持续至少1年。

22、在2型糖尿病患者中使用或不使用钠-葡萄糖协同转运蛋白-2抑制剂的情况下，Efpeglenatide和临床结局：AMPLITUDE-O试验的探索性分析。

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：

钠-葡萄糖协同转运蛋白-2(SGLT2)抑制剂和胰高血糖素样肽-1受体激动剂(GLP-1 RA)均可减少2型糖尿病患者的心血管(CV)事件。然而，尚无CV结局试验评价其联合使用的长期效应。AMPLITUDE-O试验报告，在2型糖尿病和CV和/或肾病患者中，每周一次注射GLP-1 RA efpeglenatide（对比安慰剂）可降低重大心血管不良事件(MACE)；MACE、冠状动脉血运重建或不稳定型心绞痛住院治疗（扩展MACE）；肾脏复合结局；以及MACE或死亡。试验按照基线或预期使用SGLT2抑制剂进行唯一分层随机化，包括迄今为止的GLP-1 RA CV结局试验中基线时SGLT2抑制剂使用率最高(N = 618，15.2%)的试验。分析其结果以估计SGLT2抑制剂和efpeglenatide对临床结局的联合作用。

方法：

使用经地区、SGLT2抑制剂随机化分层和SGLT2抑制剂与治疗相互作用校正的Cox比例风险模型分析心血管和肾脏结局。使用重复测量的混合效应模型分析连续变量，该模型还包括相互作用项。

结果：

在不存在和存在基线SGLT2抑制剂的情况下，efpeglenatide相较于安慰剂对MACE（0.74[0.58-0.94]和0.70[0.37-1.30]）、扩展MACE（0.77[0.62-0.96]和0.87[0.51-1.48]）、肾脏复合终点（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]）的影响（风险比[95%置信区间]）在基线SGLT2抑制剂使用时无差异（所有相互作用的P值 > 0.2）。Efpeglenatide降低血压、体重、低密度脂蛋白胆固醇和尿白蛋白：肌酐比值似乎也与同时使用SGLT2抑制剂无关（所有相互作用P >/= 0.08）。最后，不良事件在基线SGLT2抑制剂使用方面没有差异。

结论：

efpeglenatide的疗效和安全性似乎与同时使用SGLT2抑制剂无关。这些数据支持SGLT2抑制剂和GLP-1 RA联合治疗2型糖尿病。

23、Finerenone降低慢性肾病和2型糖尿病患者心力衰竭事件的风险：FIGARO-DKD试验的分析

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：

慢性肾病(CKD)和2型糖尿病(T2D)与心力衰竭(HF)独立相关，HF是发病和死亡的主要原因。在FIDELIO-DKD和FIGARO DKD试验中，finerenone（一种选择性非甾体盐皮质激素受体拮抗剂）改善白蛋白尿CKD和T2D患者的心血管结局。这些来自FIGARO-DKD的预先规定的分析评估了finerenone对临床重要HF结局的影响。

方法：

T2D和白蛋白尿CKD（尿白蛋白-肌酐比值[UACR]≥30-< 300 mg/g和估计肾小球滤过率[eGFR]≥25-

结果：

总体而言，7352例患者被纳入这些分析中；571例(7.8%)在基线时有HF病史。finerenone与安慰剂相比显著降低新发HF（1.9%vs 2.8%；风险比[HR]，0.68[95%CI 0.50-0.93]；P = 0.0162）。在总体人群中，finerenone组分析的所有HF结局的发生率显著低于安慰剂组，包括心血管死亡或首次HHF风险降低18%(HR，0.82[95%CI 0.70-0.95]；P = 0.011)、首次HHF风险降低29%(HR，0.71[95%CI 0.56-0.90]；P = 0.0043)和总HHF率降低30%（率比，0.70[95%CI，0.52-0.94]）。finerenone改善HF结局的作用未因HF病史而改变。治疗后出现的不良事件的发生率在治疗组之间平衡。

结论：

这些FIGARO-DKD分析的结果表明finerenone减少CKD和T2D患者新发HF并改善其他HF结局，与HF病史无关。

26、癌症幸存者心血管生物标志物应用的未来展望：美国心脏协会的科学声明。

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

提高癌症生存率代表了精准医疗和个性化分子和免疫治疗的最显著效果。从现在起，心血管健康成为癌症后总体结局方向的关键决定因素。全面的组织诊断研究无疑一直是并且继续是抗癌斗争的核心。整合循环血源性生物标志物、多模态成像技术、战略泛组学和实时数字化生理数据流的系统方法是否会克服心脏肿瘤学中难以捉摸的心血管组织诊断？如何在日常临床工作中个性化应用这种系统方法，具有不同的患者人群、癌症诊断和治疗？为了解决这些问题，本科学声明接近生物标志物概念的广义定义。它总结了目前关于在与癌症交汇处使用多种已确定的心血管生物标志物的文献。它确定了在癌症治疗前应用生物标志物对心血管风险进行分层、在癌症治疗期间监测心血管健康和检测癌症生存者潜在心血管损伤方面知识的局限性和差距。最后，它强调了生物标志物发现、验证和临床应用领域，由心脏肿瘤学联系的资助机构、科学家和临床医生共同努力。

40、中年和老年人心血管疾病预防和危险因素管理的初级保健和社区实践中的健康行为改变项目：美国心脏协会的科学声明。

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

心血管疾病是美国中老年人的主要健康负担，但改善心血管健康的进展仍然缓慢。初级保健中全面的、基于证据的行为咨询干预是促进有心血管危险因素的成人健康行为和预防不良心血管疾病结局的推荐一线方法。协助患者采纳并实现其健康促进目标，安排随访支持是基层医疗行为咨询5A模式的关键宗旨。行为咨询的这2个步骤被认为是有效促进初级心血管疾病预防有意义和持久的行为改变所必需的。然而，在临床环境中采用和实施行为咨询干预可能具有挑战性。美国心脏协会的这一科学声明的目的是指导初级卫生保健专业人员提供或转诊患者进行行为咨询的努力，超出了简短和不频繁的诊室访视期间可以做的。这项科学声明提供了有效行为干预计划的证据，这些计划在初级保健机构中用于中老年人心血管疾病预防和风险管理是可行的。此外，还提供了可用于促进在初级保健或社区环境中广泛采用和实施行为干预计划的资源实例，以及适当让患者参与和转诊至这些计划的实际方法。此外，描述了目前影响初级保健和社区环境中循证行为咨询转化的国家模式。最后，这一科学声明强调了加强提供公平和预防护理的机会，优先对具有不同心血管疾病风险水平的患者进行有效的行为咨询。

48、2021改善心血管健康的饮食指南：美国心脏协会的科学声明。

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

饮食质量差与心血管疾病发病率和死亡率风险升高密切相关。这一科学声明强调了饮食模式的重要性，超越了个体食物或营养素，强调了生命早期营养的关键作用，提出了心脏健康饮食模式的要素，并强调了阻碍坚持心脏健康饮食模式的结构性挑战。循证膳食模式指导促进心脏代谢健康包括以下内容：(1)调整能量摄入和消耗，达到并维持健康体重；(2)多吃多种水果和蔬菜；(3)选择全谷物食品和制品；(4)选择健康来源的蛋白质（多为植物；经常摄入鱼和海鲜；低脂或无脂乳制品；如果想吃肉或家禽，选择瘦肉和未加工形式）；(5)使用液态植物油而不是热带油和部分氢化脂肪；(6)选择最少加工食品而不是超加工食品；(7)尽量减少添加糖类的饮料和食品的摄入；(8)选择并准备少盐或无盐的食品；(9)如果不饮酒，不要开始；如果选择饮酒，限制摄入；和(10)遵守本指南，无论在哪里制备或食用食物。阻碍坚持心脏健康饮食模式的挑战包括有针对性地销售不健康的食物、邻里隔离、食物和营养不安全以及结构性种族主义。在所有个人中创造一个促进而不是阻碍坚持心脏健康饮食模式的环境是公共卫生的当务之急。

57、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。

61、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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