To provide straightforward instructions for hypertension prevention and management to primary healthcare practitioners,the first edition of the"National Clinical Practice Guidelines on the Management of Hypertension in Primary Health Care in China"was released in 2017 and updated in 2020.On the basis of the previous editions,the experts updated the guideline according to the requirement from the government,the latest clinical evidence and other newly released guidelines.The updates mainly focused on the requirements of hypertension management in primary health care,diagnosis,treatment,and long-term follow-up management.In addition,chapters on hypertension screening and prevention as well as health education were added.We hope these new guidelines could provide practical and evidence-based technical guidance for primary healthcare practitioners in the prevention and management of hypertension in China.
Since 1990, China has made considerable progress in resolving the problem of “treatment difficulty” of cardiovascular diseases(CVD). The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors, and this situation is further worsened due to the accelerated aging population in China. CVD remains one of the greatest threats to the health of Chinese residents. In terms of the proportions of disease mortality among urban and rural residents in China, CVD has persistently ranked first. In 2021, CVD accounted for 48.98% and 47.35% of deaths in rural and urban areas, respectively. Two out of every five deaths can be attributed to CVD. To implement a national policy “focusing on the primary health institute and emphasizing prevention” and truly achieve a shift of CVD prevention and treatment from hospitals to communities, the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the “Report on Cardiovascular Health and Diseases in China” annually since 2005. The 2024 report is established based on representative, published, and high-quality big-data research results from crosssectional and cohort population epidemiological surveys, randomized controlled clinical trials, large sample registry studies, and typical community prevention and treatment cases, along with data from some projects undertaken by the National Center for Cardiovascular Diseases. These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.
It is well-known that elevated low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD), statins are cornerstone drugs for the cause-based treatment of ASCVD, which has created a new era for ASCVD therapy. However, statin intolerance is not clinically uncommon, which there are several issues with confusion and misunderstandings. Hence, a file named Chinese Expert Consensus on the Diagnosis and Management Strategy of Patients With Statin Intolerance, like a navigator, has recently been published written by a team of experts from the Cardiovascular Metabolic Medicine Professional Committee, Expert Committee of the National Center for Cardiovascular Diseases aiming to enhance the standardized clinical application of statins and improve the prevention and clinical outcome. In this article, author briefly summarized the key points of above consensus in order to helping to comprehending the content of the consensus suggestions.
The prevalence of patients with coronary heart disease (CHD) and diabetes mellitus is notably high, posing significant residual cardiovascular risks even after routine interventions such as antihypertensive, lipid-lowering, and antithrombotic treatments. Recent studies have demonstrated that certain glucose-lowering medications confer cardiovascular benefits for patients with type 2 diabetes. However, a survey indicates that cardiologists may not be fully acquainted with the optimal screening timing, indicators, and diagnostic criteria for type 2 diabetes, and there is insufficient awareness and a low rate of prescription of novel glucose-lowering medications with proven cardiovascular efficacy, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i). In this context, based on domestic and international guidelines or consensus and the latest evidence-based evidence, this consensus aims to standardize the glycemic management for patients with acute coronary syndrome, chronic coronary syndrome, and perioperative management for percutaneous coronary intervention. It highlights the key points of screening and diagnosis of type 2 diabetes, and the comprehensive management of cardiovascular risk in patients with CHD. The consensus elaborates on the principles and algorithms of glycemic management for CHD patients, without involving acute complications of diabetes, clarifies the clinical practice of glucose-lowering medications with cardiovascular benefits, and promotes the standardized use of these medications in cardiovascular and other related specialty fields. Additionally, it addresses the glucose-lowering treatment to comprehensively reduce cardiovascular risks.
Background: To preferably evaluate and predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery, we developed a new prediction model using least absolute shrinkage and selection operator (LASSO)-logistic regression and machine learning (ML) algorithms. Methods: Clinical data including baseline characteristics and peri-operative data of 7163 elderly patients undergoing cardiac valvular surgery from January 2016 to December 2018 were collected at 87 hospitals in the Chinese Cardiac Surgery Registry (CCSR). Patients were divided into training (N = 5774 [80%]) and testing samples (N = 1389 [20%]) according to their date of operation. LASSO-logistic regression models and ML models were used to analyze risk factors and develop the prediction model. We compared the discrimination and calibration of each model and EuroSCORE II. Results: A total of 7163 patients were included in this study, with a mean age of 69.8 (SD 4.5) years, and 45.0% were women. Overall, in-hospital mortality was 4.05%. The final model included seven risk factors: age, prior cardiac surgery, cardiopulmonary bypass duration time (CPB time), left ventricular ejection fraction (LVEF), creatinine clearance rate (CCr), combined coronary artery bypass grafting (CABG) and New York Heart Association (NYHA) class. LASSO-logistic regression, linear discriminant analysis (LDA), support vector classification (SVC) and logistic regression (LR) models had the best discrimination and calibration in both training and testing cohorts, which were superior to the EuroSCORE II. Conclusions: The mortality rate for elderly patients undergoing cardiac valvular surgery was relatively high. LASSO-logistic regression, LDA, SVC and LR can predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery well.
Low-density lipoprotein cholesterol(LDL-C)is a pathogenic risk factor for atherosclerotic cardio-vascular disease(ASCVD).In recent decades,the prevalence of dyslipidemia in the Chinese population increases continuously,it is urgent to improve blood lipid management in China.It is particularly important to carry out standardized blood lipid management at primary healthcare institutions.The Chinese guideline for lipid manage-ment(primary care version 2024)concisely recommends that LDL-C should be the preferred intervention target in lipid management,and the target values of LDL-C should be determined based on ASCVD risk stratification.The present guideline recommends to use moderate-intensity statins at the beginning of treatment on the basis of lifes-tyle intervention.If the LDL-C target level can not be reached,other lipid-lowering drugs like cholesterol absorp-tion inhibitors and(or)proprotein convertase subtilisin/kexin type 9 inhibitors should be jointly used for the pur-pose of reaching the target value.The present guideline also provides blood lipid management strategies for special populations.We aim to provide guidance for primary healthcare professionals to carry out blood lipid manage-ment,and comprehensively improve their ability on blood lipid management,and thereby improve the primary and secondary prevention of ASCVD in China.
以动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease, ASCVD）为主的心血管疾病（cardiovascular disease, CVD）是我国城乡居民第一位死因，低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）是ASCVD的致病性危险因素。面对我国ASCVD疾病负担不断上升的趋势，血脂管理刻不容缓。近几年世界范围内血脂领域的研究取得了突破性进展，我国血脂指南的修订势在必行。由于人群血脂合适水平随ASCVD危险分层的级别不同而异，在没有危险因素的人群中，所谓“正常”的LDL-C水平对ASCVD超（极）高危患者而言则属明显升高。因此，指南修订专家委员会经认真讨论后，决定将“血脂异常防治指南”修改为“血脂管理指南”（以下简称新指南）。新指南仍推荐LDL-C作为血脂干预的首要靶点，以危险分层确定其目标值。推荐在生活方式干预的基础上，以中等强度他汀类药物作为起始药物治疗，必要时联用胆固醇吸收抑制剂或（和）前蛋白转化酶枯草溶菌素9抑制剂的达标策略。新指南涵盖了从儿童到老年全生命周期的血脂管理建议。旨在通过本指南指导临床实践，全面提升我国血脂管理水平，推进ASCVD防治。
目的:分析行复杂先天性心脏病(先心病)手术的新生儿术中近红外光谱仪(near-infrared spectroscopy,NIRS)监测指标与术后结局的关系. 方法:本研究为回顾性观察性研究,纳入 2021 年至 2022 年在中国医学科学院阜外医院行复杂先心病手术且术中进行NIRS监测的新生儿 37 例,分析患儿围术期相关资料及术中NIRS指标变化情况,探索NIRS指标与术后结局的关系.依据最大约登指数确定NIRS指标的最佳界值,并以此将患者分为两组,观察两组患者的术后结局. 结果:37 例患儿中早产儿占 16.2%,体外循环时间为(137.6±8.4)min,基线脑氧饱和度为(64.4±1.4)%,基线肾氧饱和度为(68.6±1.3)%,术中脑氧饱和度下降程度(Δ脑氧饱和度)、肾氧饱和度下降程度(Δ肾氧饱和度)分别为 15.1(7.3,24.3)%和 7.9(4.5,18.6)%.共 10 例(27.0%)患儿发生了不良结局(包括院内死亡、术后连续性肾脏替代治疗、术后二次气管插管、再次开胸探查、再次剖腹探查、术后重症监护病房住院时间≥30 d).相较于未发生不良结局的患儿,发生不良结局的患儿Δ肾氧饱和度明显升高[7.9(4.1,17.6)%vs.18.1(8.3,34.1)%,P<0.05].14 例(37.8%)患儿术后延迟拔管,相较于正常拔管患儿,延迟拔管患儿的Δ肾氧饱和度明显升高[7.9(4.1,18.3)%vs.13.9(7.4,21.9)%,标准均值差(SMD)＞0.1].依据最大约登指数,Δ肾氧饱和度 9%为最佳界值,据此患者分为Δ肾氧饱和度＞9%组(n=16)和Δ肾氧饱和度≤9%组(n=21).与Δ肾氧饱和度≤9%组相比,Δ肾氧饱和度＞9%组的术后不良结局发生率(19.0%vs.50.0%,SMD>0.1)和延迟拔管发生率(28.6%vs.50.0%,SMD>0.1)均较高,且术后重症监护病房住院时间较长,住院费用较高(SMD均>0.1). 结论:Δ肾氧饱和度可能与行复杂先心病手术的新生儿术后结局相关,Δ肾氧饱和度可辅助医师早期识别高危患者.
巨细胞性心肌炎是一种罕见的疾病,其临床特点是发病后快速进展的心力衰竭,短期内可发展成难治性心力衰竭乃至心原性休克,需要紧急机械循环支持和心脏移植.本例 34 岁女性患者,上呼吸道感染后出现进行性左心室收缩功能显著降低,通过心内膜心肌活检确诊为巨细胞性心肌炎,给予免疫抑制联合激素治疗半年后,左心室收缩功能明显改善.对于感染后出现不确定的新发心肌病变伴心力衰竭,尤其是心力衰竭呈进行性加重时,应高度警惕巨细胞性心肌炎的可能性,快速及时的诊断对治疗和预后具有明确的临床意义.
目的:分析左心室心肌致密化不全(LVNC)的临床特征,探索与LVNC伴发心房颤动相关的影响因素. 方法:入选中国医学科学院阜外医院 2015 年 1 月至 2020 年 10 月收治的LVNC患者 153 例,所有患者均完善静息心电图、24 小时动态心电图、经胸超声心动图(TTE)及心脏磁共振成像(CMR)等检查,并测定血浆大内皮素-1、N末端B型利钠肽原(NT-proBNP)等化验指标.根据病史、静息心电图、24 小时动态心电图结果将LVNC患者分为合并心房颤动组(n=23)和无心房颤动组(n=130),对两组患者的临床表现、实验室检测结果及影像学特征进行统计学分析. 结果:与无心房颤动组比,合并心房颤动组患者发生心悸和血栓栓塞事件的比例更高,心功能更差(P均＜0.05);合并心房颤动组患者血浆大内皮素-1 及 NT-proBNP水平显著升高,TTE测量的左心房前后径(LAD)明显增大,CMR检查显示钆延迟增强(LGE)阳性率较高(P均＜0.05).多因素Logistic回归分析显示,血浆大内皮素-1 升高(OR=2.249,95%CI:1.061～4.770,P=0.035)、LAD增大(OR=1.128,95%CI:1.046～1.216,P=0.002)和发生血栓栓塞事件(OR=3.312,95%CI:1.041～10.541,P=0.043)是LVNC患者伴发心房颤动的独立预测指标. 结论:大内皮素-1 水平和LAD与LVNC合并心房颤动独立相关,定期监测大内皮素-1 水平和LAD有助于预估LVNC患者发生心房颤动的风险.
近年来,经导管主动脉瓣置换术(TAVR)发展迅速且适应证逐渐向低危患者扩展.TAVR结果评估应更注重TAVR的全生命周期管理,良好的TAVR结果不仅包括即刻瓣膜置入成功,还包括患者远期预后佳和瓣膜长期耐久性好.本文初步总结TAVR的即刻、围术期、长期耐久性、冠状动脉通路、医患成本等结果评估指标,同时总结了以改善TAVR结果为目的的TAVR瓣膜研发及技术改进的进展,包括置入技术、短瓣架和瓣叶处理技术、主动脉瓣反流瓣膜的锚定技术、极具成本效益的极简式技术等,为今后TAVR的发展指明方向.
在医学论文中正确、合理使用专业名词缩略语可以达到精简文字、节省篇幅,使文章读起来更精确易懂的目的.现将心血管医学专业领域为大家所熟知的专业名词及专业机构缩略语公布如下(表 1),在本刊论文中以下英文缩略语可不再注释其中文.
目的:采用客观营养指数评估老年慢性心力衰竭(心衰)住院患者的营养不良风险状况,并分析其影响因素. 方法:选取2019年1月1日至2022年12月31日北京大学人民医院心血管内科收治的≥65岁慢性心衰患者260例,采用老年营养风险指数(GNRI)和控制营养状态评分(CONUT)评估患者的营养不良风险,并分析其影响因素. 结果:根据GNRI和CONUT评估方法,260 例患者中分别有 177 例(68.1%)和 226 例(86.9%)患者存在营养不良风险.中或高营养不良风险患者的住院时间延长,血红蛋白含量、估算肾小球滤过率(eGFR)及淋巴细胞计数均低于无营养不良风险及低营养不良风险患者(P均<0.05).GNRI评估的中或高营养不良风险患者的体重指数以及CONUT评估的中或高营养不良风险患者的总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇均低于无营养不良风险及低营养不良风险患者(P均<0.05).多因素回归分析显示,年龄≥75 岁(OR=2.13,95%CI:1.20～3.77,P=0.009)、体重指数≤24.9 kg/m2(OR=3.06,95%CI:1.76～5.33,P<0.001)及血红蛋白含量≤121 g/L(OR=2.11,95%CI:1.23～3.62,P=0.007)是GNRI评估方法下营养不良风险的危险因素,男性(OR=5.09,95%CI:2.06～11.44,P<0.001)、合并冠心病(OR=2.49,95%CI:1.14～5.44,P=0.023)和血红蛋白含量≤121 g/L(OR=3.31,95%CI:1.28～8.59,P=0.014)是CONUT评估方法下营养不良风险的危险因素. 结论:老年慢性心衰患者营养不良风险较高,因此应重视营养不良风险的筛查评估,加强对危险因素的认识和干预.
近年来尽管在晕厥的诊断与治疗方面取得了长足进展,但在晕厥的治疗方面尚存在一些问题,如血管迷走性晕厥和直立性低血压缺少有效的治疗方法.相关治疗药物效果不理想,且副作用较大,亟需探索新的治疗方法.晕厥的康复治疗可能是解决上述问题的方法,包括患者的健康教育、生活方式改善、肢体反压力动作、倾斜训练及循序渐进的有氧运动等.中国老年保健医学研究会晕厥分会、中国康复医学会心血管疾病预防与康复专业委员会组织国内相关专家、参考国外相关文献及研究进展,制定此共识,希望有助于改善国内对非心原性晕厥康复治疗的认识和普及.
目的:探讨心腔内超声心动图(ICE)引导下零射线高功率短时程(HPSD)射频导管消融术治疗阵发性心房颤动(房颤)的可行性、安全性及临床疗效. 方法:回顾性纳入 2019 年 1 月至 2022 年 6 月在淮安市第二人民医院就诊的症状性非瓣膜性阵发性房颤患者 180例.所有患者均接受基于肺静脉隔离的HPSD射频导管消融术,其中零射线组(n=90)通过ICE引导,对照组(n=90)使用X线,术后随访 1 年.分析比较两组患者的基线资料、手术情况、围术期和随访期间的并发症发生情况、术后1 年时的房颤消融成功率. 结果:两组患者的基线资料相似.零射线组与对照组的冠状静脉窦电极放置时间、消融时间、手术总时间、双侧肺静脉单圈隔离率差异均无统计学意义(P均>0.05).与对照组相比,零射线组的房间隔穿刺时间[(7.12±2.26)min vs.(6.33±2.18)min]和左心房建模时间[(5.72±2.31)min vs.(4.98±1.96)min]均明显缩短(P均<0.05).两组的肺静脉隔离即刻成功率均为 100%.在围术期和随访期间,两组均未发生穿刺部位出血或血肿、心包穿孔或填塞、脑卒中或短暂性脑缺血发作、左心房食道瘘、心肌梗死、死亡等并发症.术后 1 年时,对照组和零射线组的房颤消融成功率相似(84.4%vs.86.7%,log-rank P=0.405). 结论:ICE引导下零射线HPSD射频导管消融术治疗症状性阵发性房颤可行、安全、有效.
主动脉内球囊反搏(IABP)已被广泛用于支持心原性休克、急性心肌梗死或心脏术后心功能障碍的患者.内脏缺血是IABP治疗的常见并发症之一,其发生的主要原因之一是球囊定位不当.本例患者因反复胸痛伴循环不稳定而置入IABP,2 周后行冠状动脉旁路移植术,术后因腹痛行腹部平扫及增强CT,发现主动脉内球囊"尾部"遮挡肠系膜上动脉和双肾动脉开口,伴肠缺血坏死和肾缺血表现,于外院行结肠次全切除+末端回肠造口术.
中国医学科学院阜外医院原电生理研究室主任,《中国循环杂志》第三、第四届编辑委员会编委及第五届编辑委员会顾问,著名心血管病专家王方正教授于 2023 年 10 月 14 日因病逝世,享年 85 岁.
冠状动脉起源异常是胚胎发育时期冠状动脉异常发育或未能完全发育造成的,多数无血液动力学意义,临床表现取决于冠状动脉管腔是否狭窄,管腔狭窄会增加发生不良心血管事件的风险.本文报道了一例青少年女性,运动时发生晕厥,当地医院误诊为心肌炎,来我院后通过心电图、超声心动图、心脏磁共振成像、冠状动脉CT血管造影明确诊断,外科术后症状明显好转.晕厥作为左主干起源异常的首发症状虽然少见,但临床医师诊疗时需要考虑鉴别该疾病.
目的:分析经皮左心耳封堵术致体表心电图ST段抬高的发生率及可能原因. 方法:回顾性分析 2021 年 10 月至 2023 年 3 月中南大学湘雅二医院心脏电生理中心行经皮左心耳封堵术的心房颤动患者中出现体表心电图ST段抬高的病例,并探讨其可能原因. 结果:59 例心房颤动患者接受了经皮左心耳封堵术,其中单独经皮左心耳封堵术 36 例(61.0%),"一站式"手术23 例(39.0%,包括经皮左心耳封堵术+冷冻球囊导管消融术 13 例,经皮左心耳封堵术+射频导管消融术 10 例).3例(5.1%)患者在左心耳封堵术中发生体表心电图ST段抬高,均为下壁导联,回收封堵器后ST段均恢复至基线,其中 1 例放弃封堵,其余 2 例在调整封堵器植入位置或更换封堵器规格后,均再次顺利植入. 结论:经皮左心耳封堵术致体表心电图ST段抬高的发生率较低,原因主要包括左心耳封堵器压迫毗邻组织致左回旋支闭塞、冠状动脉痉挛或冠状动脉栓塞等.术中需密切监测心电,手术操作严格按标准流程执行是预防ST段抬高的关键.
目的:分析主动脉瓣狭窄患者经导管主动脉瓣置换术(TAVR)术前脊置入水平(LIRA)平面的周长与术后该平面的支架周长的关系,评估用术前LIRA平面周长预测术后支架周长的方法(LIRA法)指导TAVR的可靠性. 方法:回顾性分析 2018 年 2 月至 2022 年 11 月在南京大学医学院附属鼓楼医院接受TAVR治疗的 34 例主动脉瓣狭窄患者,分析TAVR前后的CT血管造影(CTA),测量术前LIRA平面周长及术后该平面的支架周长. 结果:34例患者的年龄为78.50(73.00,82.25)岁,其中男性18例(52.94%),美国胸外科医师协会(STS)评分为(6.48±0.72)%,二叶式主动脉瓣(BAV)患者10例(29.41%),三叶式主动脉瓣(TAV)患者24例(70.59%).总体上,术前LIRA平面周长与术后该平面的支架周长差异无统计学意义[(58.69±2.13)mm vs.(61.19±1.04)mm,P=0.157].TAV患者术前LIRA平面周长比BAV患者更长[(61.88±2.14)mm vs.(51.05±4.40)mm,P=0.018].TAV患者术后LIRA平面支架周长与BAV患者差异无统计学意义[(61.75±1.04)mm vs.(59.87±2.58)mm,P=0.420].TAV患者术前LIRA平面周长与术后该平面支架周长差异无统计学意义[(61.88±2.14)mm vs.(61.75±1.04)mm,P=0.938],而BAV患者术前LIRA平面周长小于术后该平面支架周长[(51.05±4.40)mm vs.(59.87±2.58)mm,P=0.039].TAV患者术前LIRA平面周长与术后该平面支架周长的差值比BAV患者小[(-0.13±1.70)mm vs.(8.82±3.65)mm,P=0.016]. 结论:从总体上看,术前LIRA平面周长可以预测术后该平面支架周长.对于中国主动脉瓣狭窄患者,相比于BAV患者,LIRA法可能更适用于TAV患者.LIRA法或为TAVR术中瓣膜选择提供一种新的、安全有效的方法.
