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从易受伤害的斑块到易受伤害的患者:呼吁制定新的定义和风险评估策略:第一部分

Morteza Naghavi1, Peter Libby, Erling Falk

  • 1The Center for Vulnerable Plaque Research, University of Texas-Houston, The Texas Heart Institute, and President Bush Center for Cardiovascular Health, Memorial Hermann Hospital, Houston, USA. mn@vp.org

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PubMed
概括

心脏突然死亡通常是由易受伤害的斑块,易受伤害的血液和易受伤害的心肌引起的. "脆弱患者"的概念整合了这些因素,以更好地评估急性冠状动脉综合征的风险和预防.

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科学领域:

  • 心血管医学 心血管医学
  • 病理学 病理学 病理学
  • 生物标志物 生物标志物

背景情况:

  • 动脉样性心血管疾病每年导致数百万人的死亡,冠状动脉心脏病是其中的主要原因.
  • 显然健康个体的突然心脏病死亡突出显示了目前冠状动脉心脏病查方法的局限性.
  • 脆弱斑块的概念已成为理解和预防急性心脏事件的关键领域.

研究的目的:

  • 重新定义易受伤害的斑块,超出易破裂的类型,包括患有血栓并发症和快速进展的斑块.
  • 引入"易受伤害的患者"的概念,包括斑块,血液和心肌因子,以进行全面的风险评估.
  • 概述一个评估和管理患有急性冠状动脉综合征和心脏突然死亡高风险的患者的框架.

主要方法:

  • 达成共识文件的制定,涉及对脆弱斑块的临床和病理评估标准.
  • 将斑块特征,血液血栓生成性和心肌电稳定性整合到"脆弱患者"的定义中.
  • 审查现有和新兴的诊断工具,包括生物标志物 (例如,C反应蛋白),成像 (CT,MRI),电生理学测试和以导管为基础的技术.

主要成果:

  • 易受伤害的斑块被广泛定义为包括所有动脉样硬化斑块,具有高概率的血栓并发症或快速进展.
  • 提出了"易受伤害的患者"概念,整合易受伤害的斑块,易受伤害的血液 (易患血栓塞) 和易受伤害的心肌 (易患心律不整).
  • 确定需要采用包含这些多面脆弱性标准的定量风险评估方法.

结论:

  • 脆弱斑块的定义已经扩大,涵盖了更广泛的高风险病变.
  • "易受伤害的患者"范式提供了一个更全面的方法来识别心脏事件迫在眉的风险的个体.
  • 诊断技术的进步以及基因组学和蛋白质组学方面的未来研究对于查,治疗和减少心脏突然死亡和急性冠状动脉综合征的发生率至关重要.