다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)

/pdf/2017-esc-guidelines-for-the-management-of-acute-myocardial-14hhjrfylv.pdf

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).

tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.

/pdf/kdigo-clinical-practice-guidelines-for-acute-kidney-injury-27tybolw7l.pdf

KDIGO clinical practice guidelines for acute kidney injury.


 
 
 Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI), with high mortality rates of 40–50%. The long non-coding RNA (lncRNA) Heat4 is associated with the inflammatory response of non-classical monocytes. Previous experimental work shows that this mechanism may be important in heart failure (HF) and during regeneration after vascular injury. Here, we investigate the association of Heat4 with survival in patients with chronic HF and assessed its regulation in AMI and CS.
 
 
 
 Heat4 was elevated in the blood of HF patients compared to age-matched non-failing controls (+5.2-fold; HF: N=63; Controls: N=38; p<0.05). Heat4 showed a positive correlation with systemic inflammation (hsCRP; r=0.41; p<0.05) and was negatively associated with LVEF (r=−0.45; p<0.001). Heat4 blood levels showed good discriminatory power for prevalence of HF (AUC = 0.734; p<0.05) and mortality prediction after 4-year follow-up (AUC = 0.789; HF: Death N=32; Controls: Death N=0; p<0.05). Furthermore, Heat4 was elevated in the blood of patients with AMI compared to controls (+1.85-fold; AMI: N=42; Controls: N=23; p<0.05). Heat4 showed a very strong induction in patients suffering from CS (+284.5-fold; CS: N=4; Controls: N=5; p<0.05). In agreement with an anti-inflammatory signaling, Heat4 showed a dynamic regulation in patients with CS with a 284.5-fold increase during acute shock and a decrease 24 hours after revascularization (−82.3% compared to day of revascularization). This regulation was validated in an independent second cohort.
 
 
 
 The lncRNA Heat4 is upregulated in the blood of patients with chronic heart failure, acute myocardial infarction and cardiogenic shock. In CS, Heat4 is dynamically regulated. These data set the stage to further assess Heat4 blood levels as a strategy for risk stratification and potential treatment target in HF.
 
 
 
 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Projektfoerderung im Bereich der Herzmedizin, Leipzig


https://academic.oup.com/eurheartj/article-pdf/43/Supplement_2/ehac544.2902/46370654/ehac544.2902.pdf

The long non-coding RNA Heat4 is dynamically regulated during cardiogenic shock

Patienten mit signifikanter Hauptstammstenose sollten aus prognostischer Indikation einer Revaskularisationstherapie zugefuhrt werden. Das dafur vorgesehene Therapieverfahren war bisher die koronare Bypass-Operation. Die Indikation fur ein katheterbasiertes Vorgehen beschrankte sich auf Patienten mit inadaquat hohem Operationsrisiko und „geschutzter“ Hauptstammstenose. Aktuelle Studien haben zu einer Neubewertung der PCI gefuhrt. Mittlerweile ist die PCI bei Hauptstammstenosen mit einer Klasse-II-Indikation bewertet. Nach den vorliegenden Daten der SYNTAX-Studie kann eine PCI bei Patienten mit isolierter Hauptstammstenose, mit Hauptstammstenose und gleichzeitiger koronarer Eingefaserkrankung, mit einem SYNTAX-Score unter 33 sowie mit erhohtem Operationsrisiko mit guten Ergebnissen durchgefuhrt werden. Patienten mit koronarer Mehrgefaserkrankung bzw. einem hohen SYNTAX-Score (>33) sind weiterhin Kandidaten fur eine Bypass-Operation. Eine Hauptstammintervention sollte spezialisierten Zentren vorbehalten bleiben. Die Therapieentscheidung sollte, wenn moglich, gemeinsam mit dem Kardiochirurgen im sog. Heart-Team erfolgen. Weitere Studien, die beide Therapieverfahren mit ausschlieslich „harten“ Endpunkten (Tod, Myokardinfarkt, Schlaganfall) vergleichen, laufen derzeit.

Hauptstamminterventionen

[Management of acute coronary syndrome without ST-segment elevation].

Adipositas und Herzinsuffizienz

Die spontane Koronararteriendissektion (SCAD) ist eine seltenere, dennoch wichtige Ursache des akuten Koronarsyndroms, bei der es zu verzögertem Fluss im Gefäß durch die Bildung eines Hämatoms in der Wand der Koronararterie kommen kann. Anders als bei der atherosklerotischen koronaren Herzkrankheit ist die SCAD vor allem bei Frauen im mittleren Lebensalter prävalent. Die aktuellen Leitlinien der European Society of Cardiology (ESC) empfehlen für die allermeisten Fälle ein konservatives Vorgehen mit einer medikamentösen Therapie, die der des allgemeinen akuten Koronarsyndroms entspricht. Bei einer hohen Rate an Spontanheilungen unter dieser Therapie ist die Prognose insgesamt durch eine niedrige Letalität gekennzeichnet.

Spontane Koronararteriendissektion

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