Heart failure has gained increasing notice due to its high prevalence and mortality rate. The management for heart failure has been emphasized on the role of device therapy. Implantable cardioverter defibrillator(ICD)...Heart failure has gained increasing notice due to its high prevalence and mortality rate. The management for heart failure has been emphasized on the role of device therapy. Implantable cardioverter defibrillator(ICD) and cardiac resynchronization therapy(CRT) were given strong recommendation for heart failure with reduced ejection fraction(HFrEF), considering their effectiveness on preventing sudden cardiac death(SCD), improving cardiac function and benefiting survival. In this review, we explained the underlying mechanisms of disease initiation and progression in HFrEF, in order to build the connection between the pathological basis of HFrEF and the rationality of ICD and CRT on terminating ventricular arrhythmia, improving cardiac function, decreasing the rate of adverse clinical outcomes and benefiting survival. In addition, we discussed the high-quality researches with significant values on the discovery of device therapy clinical benefits, and compared the class I recommendations for device therapy in HFr EF, suggested by American Heart Association and European Society of Cardiology.展开更多
Background Increased serum creatinine(SCr)was common after cardiac surgery and associated with poor outcomes.However,the prognostic role of postoperative SCr level measured on the morning of the first day was unclear ...Background Increased serum creatinine(SCr)was common after cardiac surgery and associated with poor outcomes.However,the prognostic role of postoperative SCr level measured on the morning of the first day was unclear in middle-aged and aged patients with rheumatic heart disease(RHD)undergoing valve replacement surgery(VRS).Methods Consecutive middle-aged and aged patients(age≥45 years)diagnosed with RHD undergoing at least one valve replacement were enrolled.Patients were routinely taken into the intensive care unit(ICU)for special care within 1 hour after VRS.SCr was measured at ICU admission and on the first day morning(within 24 hours).Association of postoperative SCr level with in-hospital and one-year mortality was analyzed.Results 3919 patients were finally included and divided into 4 groups according to the quartiles of postoperative SCr level on the first day morning:<1.0 mg/d L(n=1064),1.0-1.2 mg/d L(n=892),1.2-1.5 mg/d L(n=956)and≥1.5 mg/d L(n=1007).SCr level measured on the first day morning following surgery was an independent predictor for in-hospital mortality(adjusted OR:3.42,95%CI:2.52-4.63,P<0.001)and 1-year mortality(adjusted HR:2.99,95%CI:2.32-3.86,P<0.001).SCr level measured at this time had a greater predictive power for inhospital mortality than that measured at the time of ICU admission after surgery(P<0.001).Cumulative one-year mortality was significantly higher in patients with upper postoperative SCr quartiles on the first day morning(Logrank:125.75,P<0.001).Conclusions Postoperative SCr level measured on the first day morning could serve as an early and powerful prognostic marker for in-hospital and one-year mortality in middle-aged and aged RHD patients undergoing VRS.Attention should be paid to RHD patients with increased postoperative SCr level within24 hours after surgery.展开更多
基金supported by grants from Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (No. Y0120220151)Science and Technology Projects of Guangzhou (No. 201903010097)+1 种基金National Natural Science Foundation of China (No. 82002014)Natural Science Foundation of Guangdong Province (No. 2021A1515010107)。
文摘Heart failure has gained increasing notice due to its high prevalence and mortality rate. The management for heart failure has been emphasized on the role of device therapy. Implantable cardioverter defibrillator(ICD) and cardiac resynchronization therapy(CRT) were given strong recommendation for heart failure with reduced ejection fraction(HFrEF), considering their effectiveness on preventing sudden cardiac death(SCD), improving cardiac function and benefiting survival. In this review, we explained the underlying mechanisms of disease initiation and progression in HFrEF, in order to build the connection between the pathological basis of HFrEF and the rationality of ICD and CRT on terminating ventricular arrhythmia, improving cardiac function, decreasing the rate of adverse clinical outcomes and benefiting survival. In addition, we discussed the high-quality researches with significant values on the discovery of device therapy clinical benefits, and compared the class I recommendations for device therapy in HFr EF, suggested by American Heart Association and European Society of Cardiology.
基金supported by grants from Medical Science and Technology Research Funding of Guangdong (No.A2019409)
文摘Background Increased serum creatinine(SCr)was common after cardiac surgery and associated with poor outcomes.However,the prognostic role of postoperative SCr level measured on the morning of the first day was unclear in middle-aged and aged patients with rheumatic heart disease(RHD)undergoing valve replacement surgery(VRS).Methods Consecutive middle-aged and aged patients(age≥45 years)diagnosed with RHD undergoing at least one valve replacement were enrolled.Patients were routinely taken into the intensive care unit(ICU)for special care within 1 hour after VRS.SCr was measured at ICU admission and on the first day morning(within 24 hours).Association of postoperative SCr level with in-hospital and one-year mortality was analyzed.Results 3919 patients were finally included and divided into 4 groups according to the quartiles of postoperative SCr level on the first day morning:<1.0 mg/d L(n=1064),1.0-1.2 mg/d L(n=892),1.2-1.5 mg/d L(n=956)and≥1.5 mg/d L(n=1007).SCr level measured on the first day morning following surgery was an independent predictor for in-hospital mortality(adjusted OR:3.42,95%CI:2.52-4.63,P<0.001)and 1-year mortality(adjusted HR:2.99,95%CI:2.32-3.86,P<0.001).SCr level measured at this time had a greater predictive power for inhospital mortality than that measured at the time of ICU admission after surgery(P<0.001).Cumulative one-year mortality was significantly higher in patients with upper postoperative SCr quartiles on the first day morning(Logrank:125.75,P<0.001).Conclusions Postoperative SCr level measured on the first day morning could serve as an early and powerful prognostic marker for in-hospital and one-year mortality in middle-aged and aged RHD patients undergoing VRS.Attention should be paid to RHD patients with increased postoperative SCr level within24 hours after surgery.
