根据表型分层的心脏性休克患者的临床过程
Elric Zweck1, Manreet Kanwar2, Song Li3
1The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
JACC. Heart failure
|June 24, 2023
概括
证实了三种不同的心脏性休克 (CS) 现型,在不同患者群体中显示出相似的死亡率和临床特征. 这些验证的CS表型可以指导未来的临床试验和个性化治疗策略.
科学领域:
- 心脏病学 心脏病学
- 机器学习在医学中的应用
- 关键护理医学 关键护理医学
背景情况:
- 尽管有进展,心脏性休克 (CS) 的住院死亡率很高 (30-60%),其异质性使其复杂化.
- 之前在心脏性休克工作组 (CSWG) 注册表V1.1中已经确定了三种不同的CS表型 (非拥挤,心脏,心脏代谢).
- 这些表型对临床试验设计和患者管理构成挑战.
研究的目的:
- 在外部验证基于机器学习的CS表型.
- 定义与每个CS表型相关的临床过程和结果.
- 在独立的队列中评估CS表型的可重复性.
主要方法:
- 从CSWG注册表版本2中利用了1,890名全因CS患者.
- 应用最近的中心体方法来识别基于初始集群的CS表型.
- 在796名患者中追溯识别的表型进行分析.
主要成果:
- 对表型I,II和III的住院死亡率分别为23%,41%和52%,与V1发现 (21%,45%,55%) 一致.
- 表型特定的人口,血液动力学和代谢特征是可重现的.
- 机械循环支的使用因表型而异 (58.8%在I,45.7%在II,51.9%在III) 并与心脏上CS (OR 1.82) 的死亡率增加有关.
- 现型II和III,以及SCAI阶段E,独立预测死亡率增加.
结论:
- 该研究支持这些机器学习衍生的CS表型的普遍适用性.
- 这些验证的表型可以为未来CS的临床试验设计提供信息.
- 基于特定的CS表型的定制管理算法是可行的和推的.
相关概念视频
01:30Cardiomyopathy II: Dilated Cardiomyopathy
11
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
11
01:29Cardiomyopathy V: Interprofessional Care
18
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
18
01:17Pathophysiology of Heart Failure
1.7K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.7K
01:30Heart Failure IV: Classification and Diagnostic Evaluation
20
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
20
01:25Cardiomyopathy I: Introduction and Classification
21
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
21
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
17
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
17