在患有心室失律高风险的患者中增加水平
Christian Jøns1,2, Chaoqun Zheng1, Ulrik C G Winsløw1
1Department of Cardiology, Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen.
The New England journal of medicine
|August 29, 2025
概括
在心血管患者中维持高正常水平可植入心脏转移器降低了心室失常和死亡的风险. 这一策略为高风险人群管理心律失常提供了一个有前途的方法.
科学领域:
- 心脏病学
- 电生理学
- 内部医学
背景情况:
- 低正常血水平与心血管疾病患者腹腔失常的风险增加有关.
- 在高危人群中,积极提高血水平到高正常水平的疗效需要评估.
研究的目的:
- 评估高风险腹腔失常患者的血水平提高至高正常范围 (4. 5至5. 0 mmol/ L).
- 在高正常群和标准治疗群之间比较主要心血管不良事件的发生率.
主要方法:
- 一个多中心的随机优势试验,涉及1200名患有心血管疾病的参与者,并使用可植入心脏转移器-除器 (ICD).
- 参与者被随机分为1:1的高正常治疗方案 (补充,矿物质皮质激素受体抗剂,饮食指导) 或标准治疗.
- 主要终点:持续的腹腔动脉短跳,适当的ICD治疗,因心律失常/心力衰竭住院治疗,或因任何原因死亡.
主要成果:
- 在高正常组中,主要终点事件发生在22. 7%,而在标准治疗组中为29. 2% (危险率为0. 76;P=0. 01).
- 高正常策略导致主要终点事件的相对风险降低24%.
- 患有高血症或低血症住院的发病率在各组之间相似.
结论:
- 在高危心血管患者中,将血水平提高到高正常范围显著降低了重大不良事件的风险.
- 与标准治疗相比,这种治疗策略表明适当的ICD治疗,心律失常/心力衰竭住院或死亡的风险较低.
更多相关视频
08:28Methods for ECG Evaluation of Indicators of Cardiac Risk, and Susceptibility to Aconitine-induced Arrhythmias in Rats Following Status Epilepticus
Published on: April 5, 2011
17.9K
10:53Isolation of Human Atrial Myocytes for Simultaneous Measurements of Ca2+ Transients and Membrane Currents
Published on: July 3, 2013
20.6K
相关概念视频
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers
1.2K
Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
1.2K
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
1.7K
Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
1.7K
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
751
Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
751
01:20Antiepileptic Drugs: Potassium Channel Activators
274
Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Ezogabine has gained approval as an adjunctive treatment...
274
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
845
Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
845
01:26Heart Failure Drugs: Inotropic Agents
717
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
717