专栏名称: 心关注

一个有深度更有温度的心血管医生学术交流平台。

11-04 国际期刊速递丨今日热点：淀粉样心肌病、超声心动图、肺动脉吊带、心脏病、CABG

心关注 · 公众号 · 医学 · 2020-11-05 18:25

正文

TODAY

今日发布

Echocardiography Early Recent, Nov 03, 2020 今日发布 02 篇

Neth Heart J Early Recent, Nov 03, 2020 今日发布 02 篇

Echocardiography Early Recent, Nov 04, 2020 今日发布 03 篇

EClinicalMedicine Early Recent, Nov 04, 2020 今日发布 01 篇

RECOMMEND

相对心尖纵向应变指数预测可疑经甲状腺素淀粉样心肌病的高龄患者99mTc标记焦磷酸盐闪烁显像结果的有用性

Echocardiography Article

Hiroki Usuku, Seiji Takashio, etc.

1小时前

等 70 用户推荐阅读本文

我们先前报道，根据 Kumamoto 标准，高分（2分或3分），高灵敏度心肌肌钙蛋白T（hs-cTnT）≥0.308 ng/mL，心电图QRS长度≥120 ms，左心室后壁厚度≥13.6 mm，增加了疑似经甲状腺素淀粉样心肌病（ATTR-CM）患者99mTc-标记焦磷酸盐（99mTc-PYP）显像的预试验概率。然而，一些得分较低（0或1分）的患者在99mTc-PYP闪烁显像上显示阳性结果。因此，我们评估了额外检查的有效性，包括超声心动图评估心肌应变，以提高这些患者99mTc-PYP闪烁显像的预试验概率。
我们根据Kumamoto 标准对109名年龄≥70岁且得分较低的患者进行了99mTc-PYP闪烁扫描检查。19名患者（17%）的99mTc-PYP显像阳性。99mTc-PYP显像阳性患者的相对根尖纵向应变（LS）指数（根尖LS/基底LS） mid LS（RapLSI）显著高于阴性患者（1.04±0.37 vs 0.70±0.28，P<0.01）。多变量logistic回归分析显示，高RapLSI（≥1.04）与99mTc-PYP阳性显著相关（优势比，14.14；95%可信区间，3.36‐59.47；P<.01>

扫描二维码查看全文 （附全文PDF下载）

Early Recent, Nov 04, 2020

10.1111/echo.14892

斑点追踪负荷超声心动图：一项有价值的诊断技术还是日常工作的负担？

Echocardiography Article

Giulia Elena Mandoli, Maria Concetta Pastore, etc.

1小时前

Non‐invasive screening for early diagnosis of coronary artery disease (CAD) represents a key element in the never‐ending challenge to reduce cardiac death. Stress/rest electrocardiogram often lacks diagnostic accuracy, especially in asymptomatic patients, in fact the latest guidelines for the diagnosis and management of chronic coronary syndromes (CCS) stated the superiority of functional imaging techniques for the detection of subtle myocardial ischemia and the evaluation of myocardial viability (MV). Stress echocardiography is the most accessible and inexpensive imaging method for the study of CAD, either with pharmacological or with exercise provocative stress, based on visual wall‐motion assessment. However, in some cases, such as small coronary lesions or microvascular angina, it loses its diagnostic power, therefore requiring a more sensitive approach. Accordingly, in the last years many authors investigated the possible additive value provided by the integration of an advanced but easy‐to‐obtain technique, that is speckle tracking imaging, to stress echocardiography, reaching promising results; nevertheless, its use is not included in the latest recommendations for CCS. The present review discusses the potential benefits from using a combination of speckle tracking and stress echocardiography for the early detection of myocardial ischemia and the assessment of MV and its suitability in different clinical scenarios, basing on the available evidence.
早期诊断冠心病（CAD）的非侵入性筛查是减少心脏性死亡这一永无止境挑战的关键因素。应激/静息心电图通常缺乏诊断准确性，尤其是在无症状患者中，事实上，最新的慢性冠状动脉综合征（CCS）的诊断和管理指南已经阐明了功能成像技术在检测细微心肌缺血和评估心肌存活率（MV）方面的优越性。负荷超声心动图是研究冠心病的最方便、最便宜的成像方法，无论是药物性还是运动性应激，都是基于视觉壁运动评估的。然而，在某些情况下，如小的冠状动脉病变或微血管性心绞痛，它失去了它的诊断能力，因此需要更敏感的方法。因此，在过去的几年里，许多作者研究了一种先进但容易获得的技术，即斑点跟踪成像，与应力超声心动图相结合所提供的可能的附加值，取得了有希望的结果；然而，CCS的最新建议中并未包括其用途。本文就斑点追踪和负荷超声心动图在早期检测心肌缺血、评估MV及其在不同临床情况下的适用性的潜在益处进行综述。

扫描二维码查看全文 （附全文PDF下载）

Early Recent, Nov 04, 2020

10.1111/echo.14894

肺动脉吊带合并气管发育不全的产前诊断1例

Echocardiography Article

Yanhua Qi, Huanhuan Huo, etc.

1小时前

Pulmonary artery sling (PAS) and tracheal agenesis (TA) are rare diseases, and most cases of PAS are associated with tracheal bronchial malformations. However, PAS associated with TA is yet to be reported. We report a case of PAS with TA diagnosed prenatally. Due to the extremely low incidence, physicians do not have sufficient understanding of these diseases and it is challenging to diagnose these diseases by prenatal ultrasound, with high rates of misdiagnosis. Prenatal examination of the pulmonary artery branches, trachea, and esophagus is useful; therefore, improving the accuracy of prenatal diagnosis will help in perinatal management and counseling.
肺动脉吊带（PAS）和气管发育不全（TA）是一种少见的疾病，大多数病例与气管支气管畸形有关。然而，与TA相关的PAS尚未报告。我们报告一例经产前诊断为多动症的病例。由于其发病率极低，医生对这些疾病的认识还不充分，产前超声诊断这些疾病具有很大的挑战性，误诊率高。产前检查肺动脉分支、气管和食道是有用的，因此提高产前诊断的准确性将有助于围产期的管理和咨询。

扫描二维码查看全文 （附全文PDF下载）

Early Recent, Nov 04, 2020

10.1111/echo.14875

荷兰心脏病住院医师与COVID-19大流行：危机中的每一件小事都很重要

Neth Heart J Point of View

W. R. Berger, V. Baggen, etc.

昨天 23:50

The COVID-19 pandemic has overwhelmed healthcare systems worldwide, and a large part of regular cardiology care came to a quick halt. A Dutch nationwide survey showed that 41% of cardiology residents suspended their training and worked at COVID-19 cohort units for up to 3 months. With tremendous flexibility, on-call schedules were altered and additional training was provided in order for residents to be directly available where needed most. These unprecedented times have taught them important lessons on crisis management. The momentum is used to incorporate novel tools for patient care. Moreover, their experience of pandemic and crisis management has provided future cardiologists with unique skills. This crisis will not be wasted; however, several challenges have to be overcome in the near future including, but not limited to, a second pandemic wave, a difficult labour market due to an economic recession, and limitations in educational opportunities.
COVID-19大流行已经使全世界的医疗保健系统不堪重负，而且大部分常规心脏病护理都很快停止了。一项荷兰全国性的调查显示，41%的心脏病住院医师暂停了他们的培训，并在COVID-19队列单位工作长达3个月。由于具有极大的灵活性，改变了随叫随到的时间表，并提供了额外的培训，以便在最需要的地方直接为住院医生提供服务。这些史无前例的时代给他们上了危机管理的重要一课。动量被用来整合新的病人护理工具。此外，他们在大流行和危机管理方面的经验为未来的心脏病专家提供了独特的技能。这场危机不会白白浪费；然而，在不久的将来必须克服若干挑战，包括但不限于第二次大流行浪潮、经济衰退造成的劳动力市场困难以及教育机会的限制。
The COVID-19 pandemic has hit cardiology patients hard, as they are susceptible to a severe course of their disease [1]. Due to the very rapid and unprecedented increase of COVID-19 patients, the regular cardiology care came to a quick halt. Cardiology residents all over the Netherlands were reallocated to COVID-19 cohort units. With tremendous flexibility, on-call schedules were altered and additional training was provided in order for residents to be directly available where needed most.
COVID-19大流行对心脏病患者造成了严重打击，因为他们容易患上严重的疾病。由于COVID-19患者的快速、空前增加，常规的心脏病护理迅速停止。荷兰各地的心脏病居民被重新分配到COVID-19队列单位。由于灵活性极大，随时更改了通话时间表，并提供了额外培训，以便在最需要的地方直接获得居民。
A questionnaire of the Junior Board ( Juniorkamer ) of the Netherlands Society of Cardiology ( NVVC ) showed that 41% of cardiology residents were involved in frontline COVID-19 care throughout the Netherlands (Fig. 1). The questionnaire was completed by 122 residents from 36 clinics in the Netherlands; residents at every stage of the 6‑year training programme from all 15 so-called ‘A-clinics’ (i.e. clinics which are leading the training programme) were included. They worked at COVID-19 cohort units for 1–3 months, while regular training programmes were suspended. When the pandemic hit hard, these young doctors felt a great responsibility to do whatever they could—within their competencies—and to do their share on the wards and intensive care units. A similar pattern was seen worldwide [2].
荷兰心脏病学会（NVVC）初级委员会（Juniorkamer）的问卷调查显示，41%的心脏病住院医师参与了整个荷兰的COVID-19一线护理（图1）。在荷兰，每年都有一个名为“e-6”的诊所中的所有住院医师都是在“e-6”阶段完成的。他们在COVID-19队列单位工作了1-3个月，而常规的培训项目被暂停。当大流行来袭时，这些年轻的医生感到有责任尽其所能，在病房和重症监护室尽自己的责任。类似的模式在世界范围内也有出现[2]。
The willingness of staff to enable reallocation of a large part of the residents proved to be of great support. After the first decline in the number of COVID-19 patients in Dutch hospitals, it is time to think about the lessons learned and to reshape the future.
工作人员愿意重新分配很大一部分居民，这证明是极大的支持。在荷兰医院的COVID-19患者数量首次下降之后，现在是时候思考经验教训和重塑未来了。

扫描二维码查看全文 （附全文PDF下载）

Early Recent, Nov 03, 2020

10.1007/s12471-020-01519-6

IMPROV-ED试验：电子健康计划促进CABG术后更快的恢复和减少医疗保健利用率

Neth Heart J Original Article – Study Design Article

G. J. van Steenbergen, D. van Veghel, etc.

昨天 23:50

等 11 用户推荐阅读本文

Background After coronary artery bypass grafting (CABG), healthcare utilisation is high and is partly unplanned. eHealth applications have been proposed to reduce healthcare consumption and to enable patients to get actively involved in their recovery. This way, healthcare expenses can be reduced and the quality of care can be improved.
冠状动脉旁路移植术（CABG）后，医疗保健利用率很高，部分是计划外的。电子健康应用已经被提出，以减少医疗消费，并使患者积极参与他们的康复。这样可以降低医疗费用，提高医疗质量。
Objectives We aim to evaluate whether the use of an eHealth programme can reduce unplanned healthcare utilisation and improve mental and physical health in the first 6 weeks after discharge in patients who underwent CABG. In addition, patient satisfaction and use of the eHealth programme will be evaluated.
我们的目的是评估电子健康计划是否可以减少意外的医疗利用率，并改善CABG患者出院后的前6周的身心健康。此外，还将评估患者对电子健康计划的满意度和使用情况。
Methods For this single-centre randomised controlled trial, at least 280 patients referred for CABG will be included at the preoperative outpatient clinic and randomised to an intervention or control group. The intervention group will have access to an eHealth programme, which consists of online educational videos developed by the Dutch Heart Foundation and postoperative video consultations with a physician. The control group will receive standard care and will not have access to the eHealth programme. The primary endpoint is healthcare utilisation; other endpoints include anxiety, duration of recovery, quality of life and patient satisfaction. Participants will complete several questionnaires at 6 time points during the study.
在这项单中心随机对照试验中，至少280名CABG患者将被纳入术前门诊，并随机分为干预组或对照组。干预小组将获得一个电子健康计划，其中包括荷兰心脏基金会开发的在线教育视频和术后与医生的视频咨询。对照组将接受标准护理，不能使用电子健康计划。主要终点是医疗保健利用率；其他终点包括焦虑、恢复时间、生活质量和患者满意度。研究期间，参与者将在6个时间点完成多份问卷调查。
Results Patient enrolment started in February 2020 and completion of the follow-up period is expected in August 2021.
患者登记于2020年2月开始，预计在2021年8月完成随访期。
Conclusion This randomised trial was initiated to test the hypothesis that patients who are partaking in our eHealth programme use less unplanned care and experience a better quality of life, less anxiety and a faster recovery than controls.
这项随机试验是为了验证这样一个假设：参与我们的电子健康计划的患者使用较少的计划外护理，比对照组体验到更好的生活质量、更少的焦虑和更快的恢复。

扫描二维码查看全文 （附全文PDF下载）

Early Recent, Nov 03, 2020

10.1007/s12471-020-01508-9

CONTENTS

今日发文一览

11-04 国际期刊速递丨今日热点：淀粉样心肌病、超声心动图、肺动脉吊带、心脏病、CABG

正文

相对心尖纵向应变指数预测可疑经甲状腺素淀粉样心肌病的高龄患者99mTc标记焦磷酸盐闪烁显像结果的有用性

斑点追踪负荷超声心动图：一项有价值的诊断技术还是日常工作的负担？

肺动脉吊带合并气管发育不全的产前诊断1例

荷兰心脏病住院医师与COVID-19大流行：危机中的每一件小事都很重要

IMPROV-ED试验：电子健康计划促进CABG术后更快的恢复和减少医疗保健利用率

请到「今天看啥」查看全文