Arrhythmia/Electrophysiology
1、Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms
Background— Radiofrequency catheter ablation of atrial fibrillation (AF) guided by complex fractionated atrial electrograms has been reported to eliminate AF in a large proportion of patients. However, only a small number of patients with chronic AF have been included in previous studies.
Methods and Results— In 100 patients (mean age, 57±11 years) with chronic AF, radiofrequency ablation was performed to target complex fractionated atrial electrograms at the pulmonary vein ostial and antral areas, various regions of the left atrium, and the coronary sinus until AF terminated or all identified complex fractionated atrial electrograms were eliminated. Ablation sites consisted of 1 pulmonary vein in 46% of patients; the left atrial septum, roof, or anterior wall in all; and the coronary sinus in 55%. During 14±7 months of follow-up after a single ablation procedure, 33% of patients were in sinus rhythm without antiarrhythmic drugs, 38% had AF, 17% had both AF and atrial flutter, 9% had persistent atrial flutter, and 3% had paroxysmal AF on antiarrhythmic drugs. A second ablation procedure was performed in 44% of patients. Pulmonary vein tachycardia was found in all patients in both previously targeted and nontargeted pulmonary veins. There were multiple macroreentrant circuits in the majority of patients with atrial flutter. At 13±7 months after the last ablation procedure, 57% of patients were in sinus rhythm without antiarrhythmic drugs, 32% had persistent AF, 6% had paroxysmal AF, and 5% had atrial flutter.
Conclusions— Modest short-term efficacy is achievable with radiofrequency ablation of chronic AF guided by complex fractionated atrial electrograms, but only after a second ablation procedure in >40% of patients. Rapid activity in the pulmonary veins and multiple macroreentrant circuits are common mechanisms of recurrent atrial arrhythmias.
CLINICAL PERSPECTIVE
Congenital Heart Disease
2、Diagnostic Miscues in Congenital Long-QT Syndrome
Nathaniel W. Taggart, MD; Carla M. Haglund;; David J. Tester, BS; Michael J. Ackerman, MD, PhD
Background— Long-QT syndrome (LQTS) is a potentially lethal cardiac channelopathy that can be mistaken for palpitations, neurocardiogenic syncope, and epilepsy. Because of increased physician and public awareness of warning signs suggestive of LQTS, there is the potential for LQTS to be overdiagnosed. We sought to determine the agreement between the dismissal diagnosis from an LQTS subspecialty clinic and the original referral diagnosis.
Methods and Results— Data from the medical record were compared with data from the outside evaluation for 176 consecutive patients (121 females, median age 16 years, average referral corrected QT interval [QTc] of 481 ms) referred with a diagnosis of LQTS. After evaluation at Mayo Clinic’s LQTS Clinic, patients were categorized as having definite LQTS (D-LQTS), possible LQTS (P-LQTS), or no LQTS (No-LQTS). Seventy-three patients (41%) were categorized as No-LQTS, 56 (32%) as P-LQTS, and only 47 (27%) as D-LQTS. The yield of genetic testing among D-LQTS patients was 78% compared with 34% for P-LQTS and 0% among No-LQTS patients (P<0.0001). The average QTc was greater in either D-LQTS or P-LQTS than in No-LQTS (461 versus 424 ms, P<0.0001). Vasovagal syncope was more common among the No-LQTS subset (28%) than the P-LQTS/D-LQTS group (8%; P=0.04). Determinants for discordance (ie, positive outside diagnosis versus No-LQTS) included overestimation of QTc, diagnosing LQTS on the basis of "borderline" QTc values, and interpretation of a vasovagal fainting episode as an LQTS-precipitated cardiac event.
Conclusions— Diagnostic concordance was present for less than one third of the patients who sought a second opinion. Two of every 5 patients referred with the diagnosis of LQTS departed without such a diagnosis. Miscalculation of the QTc, misinterpretation of the normal distribution of QTc values, and misinterpretation of symptoms appear to be responsible for most of the diagnostic miscues.
CLINICAL PERSPECTIVE
Coronary Heart Disease
3、Smoking Is Associated With Epicardial Coronary Endothelial Dysfunction and Elevated White Blood Cell Count in Patients With Chest Pain and Early Coronary Artery Disease
Shahar Lavi, MD; Abhiram Prasad, MD; Eric H. Yang, MD; Verghese Mathew, MD; Robert D. Simari, MD; Charanjit S. Rihal, MD; Lilach O. Lerman, MD, PhD; Amir Lerman, MD
Background— Smoking is a major risk factor for cardiovascular events. One of the potential mechanisms may be related to both coronary endothelial dysfunction and increased inflammatory response. The present study was designed to test the hypothesis that smoking is associated with epicardial coronary endothelial dysfunction and inflammation.
Methods and Results— Coronary endothelial function in response to acetylcholine was assessed in 881 patients (115 current smokers and 766 nonsmokers, including 314 previous smokers). Smokers were significantly younger than nonsmokers (43±1 versus 51±1 years, P<0.0001), had more epicardial vasoconstriction in response to intracoronary acetylcholine (–19±2% versus –14±1% change in coronary artery diameter, P=0.03), and were more likely than nonsmokers to have epicardial endothelial dysfunction (46% versus 35%, P=0.005), but their microvascular endothelial function was intact. Smokers had higher white blood cell counts than nonsmokers (7.7±0.2 versus 6.6±0.1x109/L, P<0.0001), higher myeloperoxidase (156±19 versus 89±8 ng/mL), higher lipoprotein-associated phospholipase A2 (242±12 versus 215±5 ng/mL), and higher levels of intracellular adhesion molecule (283±14 versus 252±5 ng/mL). There were no differences in the levels of C-reactive protein, fibrinogen, or vascular cell adhesion molecule between the groups.
Conclusion— Young smokers are characterized by epicardial coronary endothelial dysfunction, preserved microvascular endothelial function, and increased levels of inflammatory biomarkers and oxidative stress. The present study provides further information regarding the potential mechanisms by which smoking contributes to cardiovascular events.
CLINICAL PERSPECTIVE
Epidemiology
4、Cross-Sectional Correlates of Increased Aortic Stiffness in the Community
The Framingham Heart Study
Gary F. Mitchell, MD; Chao-Yu Guo, PhD; Emelia J. Benjamin, MD, ScM; Martin G. Larson, ScD; Michelle J. Keyes, MA; Joseph A. Vita, MD; Ramachandran S. Vasan, MD; Daniel Levy, MD
Background— Increased aortic stiffness is associated with numerous common diseases of aging, including heart disease, stroke, and renal disease. However, the prevalence and correlates of abnormally high aortic stiffness are incompletely understood.
Methods and Results— We evaluated 2 aortic stiffness measures, carotid-femoral pulse wave velocity and forward pressure wave amplitude, in a pooled sample of the Framingham Original, Offspring, and minority Omni cohorts (mean age, 62 years; 56% women). Abnormal stiffness of each measure was defined as a value exceeding the sex-specific 90th percentile of a reference group with a low burden of conventional cardiovascular disease risk factors. Applying this criterion to the entire sample identified a 24% to 33% prevalence of abnormal stiffness measures. The prevalence of abnormal stiffness increased markedly with age, eg, for pulse wave velocity, from a few percent in both sexes aged <50 years to 64% (men) to 74% (women) in those aged 70 years. With adjustment for age, important correlates of abnormal aortic stiffness included higher mean arterial pressure, greater body mass index, impaired glucose metabolism, and abnormal lipids. Correlates of aortic stiffness were similar if we used age-specific rather than fixed criteria for defining abnormal stiffness.
Conclusions— The prevalence of abnormal aortic stiffness increases steeply with advancing age in the community, especially in the presence of obesity or diabetes. Our data suggest that the burden of disease attributable to aortic stiffness is likely to increase considerably over the next few years as the population ages.
CLINICAL PERSPECTIVE
Heart Failure
5、Risk of Thromboembolism in Heart Failure
An Analysis From the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)
Ronald S. Freudenberger, MD; Anne S. Hellkamp, MS; Jonathan L. Halperin, MD; Jeanne Poole, MD; Jill Anderson, BSN; George Johnson, BSEE; Daniel B. Mark, MD, MPH; Kerry L. Lee, PhD; Gust H. Bardy, MD, for the SCD-HeFT Investigators
Background— In patients with heart failure, rates of clinically apparent stroke range from 1.3% to 3.5% per year. Little is known about the incidence and risk factors in the absence of atrial fibrillation. In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 2521 patients with moderate heart failure were randomized to receive amiodarone, implanted cardioverter-defibrillators (ICDs), or placebo.
Methods and Results— We determined the incidence of stroke or peripheral or pulmonary embolism in patients with no history of atrial fibrillation (n=2114), predictors of thromboembolism and the relationship to left ventricular ejection fraction. Median follow-up was 45.5 months. Kaplan-Meier estimates (95% CIs) for the incidence of thromboembolism by 4 years were 4.0% (3.0% to 4.9%), with 2.6% (1.1% to 4.1%) in patients randomized to amiodarone, 3.2% (1.8% to 4.7%) in patients randomized to ICD, and 6.0% (4.0% to 8.0%) in patients randomized to placebo (approximate rates of 0.7%, 0.8%, and 1.5% per year, respectively). By multivariable analysis, hypertension (P=0.021) and decreasing left ventricular ejection fraction (P=0.023) were significant predictors of thromboembolism; treatment with amiodarone or ICD treatment was a significant predictor of thromboembolism-free survival (P=0.014 for treatment effect; hazard ratio [95% CI] versus placebo, 0.57 [0.33 to 0.99] for ICD; 0.44 [0.24 to 0.80] for amiodarone). Inclusion of atrial fibrillation during follow-up in the multivariable model did not affect the significance of treatment assignment as a predictor of thromboembolism.
Conclusions— In the SCD-HeFT patient cohort, which reflects contemporary treatment of patients with moderately symptomatic systolic heart failure, patients experienced thromboembolism events at a rate of 1.7% per year without antiarrhythmic therapy. Those treated with amiodarone or ICDs had lower risk of thromboembolism than those given placebo. Hypertension at baseline and lower ejection fraction were independent predictors of risk.
CLINICAL PERSPECTIVE
Interventional Cardiology
6、Randomized, Double-Blind, Dose-Ranging Study of Otamixaban, a Novel, Parenteral, Short-Acting Direct Factor Xa Inhibitor, in Percutaneous Coronary Intervention
The SEPIA-PCI Trial
Marc Cohen, MD; Deepak L. Bhatt, MD; John H. Alexander, MD; Gilles Montalescot, MD; Christoph Bode, MD; Timothy Henry, MD; Jean-Francois Tamby, MD; Jan Saaiman, MD; Stanislas Simek, MD; Johannes De Swart, MD, on behalf of the SEPIA-PCI Trial Investigators
Background— The optimal anticoagulant regimen for percutaneous coronary intervention (PCI) remains to be determined. Otamixaban, a selective and direct inhibitor of factor Xa, was investigated in patients undergoing nonurgent percutaneous coronary intervention.
Methods and Results— In this double-blind, double-dummy, parallel-group, dose-ranging trial, 947 patients were randomly assigned to either 1 of 5 weight-adjusted otamixaban regimens or weight-adjusted unfractionated heparin (UFH) before percutaneous coronary intervention. The primary end points were change in prothrombin fragments 1+2 (F1+2), and anti-factor Xa activity. The main secondary end points were Thrombolysis In Myocardial Infarction (TIMI) bleeding at day 3 or hospital discharge (whichever came first) and 30-day ischemic events. The median change in F1+2 from baseline to the end of infusion was greater with the highest otamixaban dose compared with UFH (–0.3 versus –0.2 ng/mL, P=0.008). Anti-factor Xa levels were 65, 155, 393, 571, and 691 ng/mL with otamixaban doses 1 to 5, respectively. Significant TIMI bleeding (major or minor) occurred in 2.0%, 1.9%, 3.8%, 3.9%, and 2.6% of patients receiving otamixaban doses 1 to 5, respectively, and in 3.8% of patients receiving UFH. Four TIMI major bleeds were observed. Ischemic events occurred in 5.8%, 7.1%, 3.8%, 2.5%, and 5.1% of patients receiving otamixaban doses 1 to 5, respectively, and in 5.6% of patients receiving UFH.
Conclusions— Otamixaban reduced F1+2 significantly more than UFH at the highest dose regimen, whereas no significant difference in the incidence of TIMI bleeding was observed between the otamixaban and UFH groups. These results set the stage for adequately powered clinical outcome trials of selective direct factor Xa inhibition in patients with acute coronary syndromes.
CLINICAL PERSPECTIVE
Pediatric Cardiology
7、Case Volume and Mortality in Pediatric Cardiac Surgery Patients in California, 1998–2003
Lianna G. Bazzani, PhD, MPH; James P. Marcin, MD, MPH
Background— Previous reports have found an inverse relationship between pediatric cardiac surgery case volume and in-hospital mortality. This association has been noted recently to be decreasing for coronary artery bypass grafting, possibly because of improved training programs, quality improvement activities, or other innovations to improve outcomes. It is unknown whether the volume-mortality association among pediatric cardiac surgery patients is decreasing similarly.
Methods and Results— We used data from the state of California’s patient discharge data set from the years 1998–2003 to replicate 4 previous research studies of pediatric cardiac surgery volume and mortality. The total number of pediatric surgeries varied from 12 801 to 13 971 depending on the selection criteria applied. Using this larger and more contemporary data set, we found a weaker and less consistent volume-mortality relationship than had been reported previously. We also developed a new model, which incorporated elements of the old models, and found a statistically significant relationship with higher volume and lower mortality (odds ratio=0.86 per 100-patient increase in annual volume; 95% CI, 0.81 to 0.92). Post hoc analyses show that this relationship was related to the performance of the single largest-volume hospital.
Conclusions— With the use of data from California, the volume-mortality relationship among pediatric cardiac surgery patients has changed since previous research, such that the old models no longer describe a clear or consistent association. With the use of a continuous definition of volume and an updated model, an association is observed but is dependent on highly leveraged covariate patterns found in the largest-volume hospital.
CLINICAL PERSPECTIVE
Stroke
8、Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke
Robert Mikulik, MD; Marc Ribo, MD; Michael D. Hill, MD; James C. Grotta, MD; Marc Malkoff, MD; Carlos Molina, MD; Marta Rubiera, MD; Raquel Delgado-Mederos, MD; Jose Alvarez-Sabin, MD; Andrei V. Alexandrov, MD, for the CLOTBUST Investigators
Background— Early recovery after intravenous thrombolysis can be observed in stroke; however, the utility of measuring clinical improvement to assess artery status has not been established. We sought to determine the accuracy of serial National Institutes of Health Stroke Scale (NIHSS) scores to detect complete early recanalization of the middle cerebral artery.
Methods and Results— Data from the CLOTBUST trial (Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic tPA) were used to determine the most sensitive and specific NIHSS-derived parameter to identify complete recanalization. Then, reproducibility was tested against a separate patient population (Barcelona data set). NIHSS scores were determined before tissue plasminogen activator bolus and at 60 and 120 minutes in both data sets. Receiver operating characteristic curves were used to compare test performance. The accuracy of individual cutoffs was demonstrated by sensitivity, specificity, and positive and negative predictive values. A total of 122 patients in the CLOTBUST data set and 98 in the Barcelona data set received 0.9 mg/kg intravenous tissue plasminogen activator [mean age 69±12 versus 72±12 years, 57% male versus 51% male, median NIHSS 16 versus 17 points, mean time from onset to treatment 140±32 versus 177±59 minutes, and complete recanalization of the middle cerebral artery in 19% versus 17%). For identification of recanalization, an NIHSS score reduction of 40% offered the best tradeoff, with sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 85%, 50%, and 91% at 60 minutes and 74%, 80%, 58%, and 89% at 120 minutes, respectively. Test performance was equal in the Barcelona data set.
Conclusions— Relative changes in serial NIHSS scores can serve as a simple clinical indicator of arterial status after intravenous thrombolysis. Accuracy parameters are affected by the process of recanalization and its varying clinical significance.
CLINICAL PERSPECTIVE
AHA/ASA Guideline
9、Guidelines for the Early Management of Adults With Ischemic Stroke
A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Harold P. Adams, Jr, MD, FAHA, Chair; Gregory del Zoppo, MD, FAHA, Vice Chair; Mark J. Alberts, MD, FAHA; Deepak L. Bhatt, MD; Lawrence Brass, MD, FAHA; Anthony Furlan, MD, FAHA; Robert L. Grubb, MD, FAHA; Randall T. Higashida, MD, FAHA; Edward C. Jauch, MD, FAHA; Chelsea Kidwell, MD, FAHA; Patrick D. Lyden, MD; Lewis B. Morgenstern, MD, FAHA; Adnan I. Qureshi, MD, FAHA; Robert H. Rosenwasser, MD, FAHA; Phillip A. Scott, MD, FAHA; Eelco F.M. Wijdicks, MD, FAHA
Purpose— Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included.
Methods— Members of the panel were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council’s Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years.
Results— Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
Key Words: AHA Scientific Statements • emergency medical services • stroke • acute cerebral infarction • tissue plasminogen activator
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Contents:
Volume 115, Issue 20; May 22, 2007
1.Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms
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第3篇!
3、Smoking Is Associated With Epicardial Coronary Endothelial Dysfunction and Elevated White Blood Cell Count in Patients With Chest Pain and Early Coronary Artery Disease
吸烟和心外膜冠状内皮功能障碍及提高胸痛早期冠心病患者白细胞计数的关系
Background— Smoking is a major risk factor for cardiovascular events. One of the potential mechanisms may be related to both coronary endothelial dysfunction and increased inflammatory response. The present study was designed to test the hypothesis that smoking is associated with epicardial coronary endothelial dysfunction and inflammation.
背景---吸烟是心血管事件的主要危险因素.其中一个潜在的机制可能既和冠状内皮功能异常有关,还和增加的炎症应答有关.目前的研究是用来检验这一假说即吸烟和心外膜冠状内皮功能障碍和炎症相关.
Methods and Results— Coronary endothelial function in response to acetylcholine was assessed in 881 patients (115 current smokers and 766 nonsmokers, including 314 previous smokers). Smokers were significantly younger than nonsmokers (43±1 versus 51±1 years, P<0.0001), had more epicardial vasoconstriction in response to intracoronary acetylcholine (–19±2% versus –14±1% change in coronary artery diameter, P=0.03), and were more likely than nonsmokers to have epicardial endothelial dysfunction (46% versus 35%, P=0.005), but their microvascular endothelial function was intact. Smokers had higher white blood cell counts than nonsmokers (7.7±0.2 versus 6.6±0.1x109/L, P<0.0001), higher myeloperoxidase (156±19 versus 89±8 ng/mL), higher lipoprotein-associated phospholipase A2 (242±12 versus 215±5 ng/mL), and higher levels of intracellular adhesion molecule (283±14 versus 252±5 ng/mL). There were no differences in the levels of C-reactive protein, fibrinogen, or vascular cell adhesion molecule between the groups.
方法和结果----冠状内皮功能适应于乙酰胆碱,881为患者(其中115名吸烟,766名不吸烟,包括314名既往吸烟者).吸烟者远远小于非吸烟者(43±1岁VS51±1岁,P<0.0001).他们有更多的心外膜血管收缩以适应于冠状动脉内的乙酰胆碱(冠状动脉变化直径–19±2%VS–14±1%,P=0.03).并且他们更有可能比非吸烟者有心外膜内皮功能异常(46% versus 35%, P=0.005),但是他们微血管内皮的功能未受损.吸烟者比非吸烟者有更高的白细胞计数(7.7±0.2 versus 6.6±0.1x109/L, P<0.0001),有更高的髓过氧化酶(156±19 versus 89±8 ng/mL),有更高的与脂蛋白质相关的磷脂酶A2(242±12 versus 215±5 ng/mL),有更高的细胞内黏附分子水平(283±14 versus 252±5 ng/mL).两组在C反应蛋白, 纤维蛋白素原以及血管细胞黏附分子水平上没有差别.
Conclusion— Young smokers are characterized by epicardial coronary endothelial dysfunct ion, preserved microvascular endothelial function, and increased levels of inflammatory biomarkers and oxidative stress. The present study provides further information regarding the potential mechanisms by which smoking contributes to cardiovascular events.
结论----年轻的吸烟者以心外膜冠状内皮功能障碍,微血管内皮功能,增加的炎症生物标记和氧化应激为特征,目前的研究提供了更深的信息,它涉及到吸烟促进心血管事件机制的潜在机制.
吸烟和心外膜冠状内皮功能障碍及提高胸痛早期冠心病患者白细胞计数的关系
背景---吸烟是心血管事件的主要危险因素.其中一个潜在的机制可能既和冠状内皮功能异常有关,还和增加的炎症应答有关.目前的研究是用来检验这一假说即吸烟和心外膜冠状内皮功能障碍和炎症相关.
方法和结果----冠状内皮功能适应于乙酰胆碱,881为患者(其中115名吸烟,766名不吸烟,包括314名既往吸烟者).吸烟者远远小于非吸烟者(43±1岁VS51±1岁,P<0.0001).他们有更多的心外膜血管收缩以适应于冠状动脉内的乙酰胆碱(冠状动脉变化直径–19±2%VS–14±1%,P=0.03).并且他们更有可能比非吸烟者有心外膜内皮功能异常(46% versus 35%, P=0.005),但是他们微血管内皮的功能未受损.吸烟者比非吸烟者有更高的白细胞计数(7.7±0.2 versus 6.6±0.1x109/L, P<0.0001),有更高的髓过氧化酶(156±19 versus 89±8 ng/mL),有更高的与脂蛋白质相关的磷脂酶A2(242±12 versus 215±5 ng/mL),有更高的细胞内黏附分子水平(283±14 versus 252±5 ng/mL).两组在C反应蛋白, 纤维蛋白素原以及血管细胞黏附分子水平上没有差别.
结论----年轻的吸烟者以心外膜冠状内皮功能障碍,微血管内皮功能,增加的炎症生物标记和氧化应激为特征,目前的研究提供了更深的信息,它涉及到吸烟促进心血管事件机制的潜在机制.
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好久没来翻译了
我领第一篇
复杂腔内电图指导下的经导管消融治疗慢性房颤
背景：有报道发现在复杂心房碎裂电位的指导下经导管消融可消除大部分患者的房颤。但是，以前的研究纳入的慢性房颤患者很少。
方法与结果：100例慢性房颤患者（平均年龄57±11岁）接受了经导管消融术，以出现复杂心房碎裂电位的肺静脉开口和前庭部、左心房任何部位、冠状窦为靶点进行消融，直到房颤终止或所有复杂心房碎裂电位均消失。消融点如下：46%患者消融1个肺静脉，所有患者均消融左房间隔部、顶部、前壁，55%患者消融冠状窦。单次消融后随访14±7月，33%的患者不使用抗心律失常药物且维持窦律；使用抗心律失常药物情况下，38%有房颤，17%有房颤和房扑，9%有持续性房扑，3%有阵发性房颤。44%的患者接受了2次消融。所有2次消融的患者均在前次的靶肺静脉或非靶肺静脉中发现了快速激动。大多数有房扑的患者发现存在多个大折返环路。最后一次消融术后13±7月，57%的患者不使用抗心律失常药物且维持窦律，32%有持续性房颤，6%有阵发性房颤，5%有房扑。
结论：复杂心房碎裂电位指导下的经导管消融治疗慢性房颤的近期效果尚可，但这是在超过40%的患者接受2次消融后才达到。肺静脉内的快速激动和多个大折返是房性心律失常复发的主要机制。
第4篇!
4、Cross-Sectional Correlates of Increased Aortic Stiffness in the Community
题目-----社区人群增加主动脉僵硬度的横断面联系
Background— Increased aortic stiffness is associated with numerous common diseases of aging, including heart disease, stroke, and renal disease. However, the prevalence and correlates of abnormally high aortic stiffness are incompletely understood.
背景------增加的主动脉僵硬度和众多的年龄相关性常见病有联系,包括心脏病,中风和肾脏疾病.然而,主动脉僵硬度异常高的患病率和联系并未被完全理解.
Methods and Results— We evaluated 2 aortic stiffness measures, carotid-femoral pulse wave velocity and forward pressure wave amplitude, in a pooled sample of the Framingham Original, Offspring, and minority Omni cohorts (mean age, 62 years; 56% women). Abnormal stiffness of each measure was defined as a value exceeding the sex-specific 90th percentile of a reference group with a low burden of conventional cardiovascular disease risk factors. Applying this criterion to the entire sample identified a 24% to 33% prevalence of abnormal stiffness measures. The prevalence of abnormal stiffness increased markedly with age, eg, for pulse wave velocity, from a few percent in both sexes aged <50 years to 64% (men) to 74% (women) in those aged 70 years. With adjustment for age, important correlates of abnormal aortic stiffness included higher mean arterial pressure, greater body mass index, impaired glucose metabolism, and abnormal lipids. Correlates of aortic stiffness were similar if we used age-specific rather than fixed criteria for defining abnormal stiffness.
方法和结果-----我们用了两个评估主动脉僵硬度的方法,颈动脉脉搏波传导速度和向前的压力波波幅,在最初的集合人群中,以及他们的后代和未成年人群(平均年龄62岁,女性占56%).每种方法异常的僵硬度被定义为超过具有低负荷常规性心血管病危险因素同性别的90%,应用这一标准,经过对受试者的完全鉴定,异常的动脉僵硬度患病率从24%到33不等.随着年龄的增加,动脉僵硬度发病率明显的增加,例如脉搏波传导速度,小于50岁的人占64%,小于70岁的人群占74%,通过调整年龄,异常主动脉僵硬度的重要联系,包括更高的平均动脉压,更大的体重指数,受累的糖代谢和异常的脂质.如果我们用年龄分组而不是用固定的标准来定义异常僵硬度,那么主动脉僵硬度是相似的.
Conclusions— The prevalence of abnormal aortic stiffness increases steeply with advancing age in the community, especially in the presence of obesity or diabetes. Our data suggest that the burden of disease attributable to aortic stiffness is likely to increase considerably over the next few years as the population ages.
结论------在社区人群中,异常主动脉僵硬度随着年龄的增加而增加,尤其是当合并肥胖症或者糖尿病的时候.我们的数据暗示了在未来的几年里,随着人群年龄的增加,合并疾病有助于明显增加主动脉僵硬度的形成.
题目-----社区人群增加主动脉僵硬度的横断面联系
背景------增加的主动脉僵硬度和众多的年龄相关性常见病有联系,包括心脏病,中风和肾脏疾病.然而,主动脉僵硬度异常高的患病率和联系并未被完全理解.
方法和结果-----我们用了两个评估主动脉僵硬度的方法,颈动脉脉搏波传导速度和向前的压力波波幅,在最初的集合人群中,以及他们的后代和未成年人群(平均年龄62岁,女性占56%).每种方法异常的僵硬度被定义为超过具有低负荷常规性心血管病危险因素同性别的90%,应用这一标准,经过对受试者的完全鉴定,异常的动脉僵硬度患病率从24%到33不等.随着年龄的增加,动脉僵硬度发病率明显的增加,例如脉搏波传导速度,小于50岁的人占64%,小于70岁的人群占74%,通过调整年龄,异常主动脉僵硬度的重要联系,包括更高的平均动脉压,更大的体重指数,受累的糖代谢和异常的脂质.如果我们用年龄分组而不是用固定的标准来定义异常僵硬度,那么主动脉僵硬度是相似的.
结论------在社区人群中,异常主动脉僵硬度随着年龄的增加而增加,尤其是当合并肥胖症或者糖尿病的时候.我们的数据暗示了在未来的几年里,随着人群年龄的增加,合并疾病有助于明显增加主动脉僵硬度的形成.
不对的地方请指正!
认领第二篇。
2、Diagnostic Miscues in Congenital Long-QT Syndrome
先天性长-QT综合征
Nathaniel W. Taggart, MD; Carla M. Haglund;; David J. Tester, BS; Michael J. Ackerman, MD, PhD
Background— Long-QT syndrome (LQTS) is a potentially lethal cardiac channelopathy that can be mistaken for palpitations, neurocardiogenic syncope, and epilepsy. Because of increased physician and public awareness of warning signs suggestive of LQTS, there is the potential for LQTS to be overdiagnosed. We sought to determine the agreement between the dismissal diagnosis from an LQTS subspecialty clinic and the original referral diagnosis.
背景 长-QT综合征(LQTS)是一种潜在的致命性心脏的离子通道病，容易被误认为是心悸，神经心源性晕厥或者癫痫。由于内科医生和公众对LQTS危险征兆的充分认识，对LQTS有过渡诊断的趋势。我们试图从门诊不诊断与过渡诊断之间寻求一种共识。
Methods and Results— Data from the medical record were compared with data from the outside evaluation for 176 consecutive patients (121 females, median age 16 years, average referral corrected QT interval [QTc] of 481 ms) referred with a diagnosis of LQTS. After evaluation at Mayo Clinic’s LQTS Clinic, patients were categorized as having definite LQTS (D-LQTS), possible LQTS (P-LQTS), or no LQTS (No-LQTS). Seventy-three patients (41%) were categorized as No-LQTS, 56 (32%) as P-LQTS, and only 47 (27%) as D-LQTS. The yield of genetic testing among D-LQTS patients was 78% compared with 34% for P-LQTS and 0% among No-LQTS patients (P<0.0001). The average QTc was greater in either D-LQTS or P-LQTS than in No-LQTS (461 versus 424 ms, P<0.0001). Vasovagal syncope was more common among the No-LQTS subset (28%) than the P-LQTS/D-LQTS group (8%; P=0.04). Determinants for discordance (ie, positive outside diagnosis versus No-LQTS) included overestimation of QTc, diagnosing LQTS on the basis of "borderline" QTc values, and interpretation of a vasovagal fainting episode as an LQTS-precipitated cardiac event. 方法与结果 住院病历资料与门诊资料评价，顺序排列的176患者（121女性，中位数年龄是16岁，平均校正QT间期[QTc]为481ms）诊为LQTS。经梅奥LQTS门诊部的评估，患者分为确诊LQTS(D-LQTS)、可能LQTS(P-LQTS)，以及非LQTS(No-LQTS)。结果73名 (41%)为No-LQTS，56名(32%)是P-LQTS，只有47名 (27%)为确诊LQTS。检测发现D-LQTS患者78%遗传学阳性， P-LQTS患者只有 34% 阳性， 而No-LQTS患者的遗传学阳性率为0(P<0.0001)。在No-LQTS亚组中(28%)血管迷走性晕厥更常见，与P-LQTS/D-LQTS (8%; P=0.04) 组相比。造成这种不一致(比如, 门诊的阳性诊断与 No-LQTS)的原因包括高估了QTc，以QTc值的“临界值”为基础诊断LQTS，还有就是把血管迷走性晕厥解释为突发的LQTS心脏事件。
Conclusions— Diagnostic concordance was present for less than one third of the patients who sought a second opinion. Two of every 5 patients referred with the diagnosis of LQTS departed without such a diagnosis. Miscalculation of the QTc, misinterpretation of the normal distribution of QTc values, and misinterpretation of symptoms appear to be responsible for most of the diagnostic miscues.
结论—现在对LQTS诊断的准确率不到1/3。参照LQTS的诊断标准，每5个患者中有2个未被诊断而已经死亡。错估QTc值，误解QTc值的正态分布，及对症状的误解是误诊的最主要原因。
先天性长-QT综合征
背景 长-QT综合征(LQTS)是一种潜在的致命性心脏的离子通道病，容易被误诊为是心悸，神经心源性晕厥或者癫痫。由于内科医生和公众对LQTS危险征兆的充分认识，对LQTS有过渡诊断的趋势。我们试图从门诊不诊断与过渡诊断之间寻求一种共识。
方法与结果 根据住院病历与门诊资料评价，陆续有176患者（121女性，中位数年龄是16岁，平均校正QT间期值[QTc]为481ms）诊为LQTS。经梅奥LQTS门诊部的评估，患者分为确诊LQTS(D-LQTS)、可能LQTS(P-LQTS)，以及非LQTS(No-LQTS)。结果73名 (41%)为No-LQTS，56名(32%)是P-LQTS，只有47名 (27%)为确诊LQTS。检测发现D-LQTS患者78%遗传学阳性， P-LQTS患者只有 34% 阳性， 而No-LQTS患者的遗传学阳性率为0(P<0.0001)。在No-LQTS亚组中(28%)血管迷走性晕厥更常见，与P-LQTS/D-LQTS (8%; P=0.04) 组相比。造成这种不一致(比如, 门诊的阳性诊断与 No-LQTS)的原因包括高估了QTc，以QTc值的“临界值”为基础诊断LQTS，还有就是把血管迷走性晕厥解释为突发的LQTS心脏事件。
结论—现在对LQTS诊断的准确率不到1/3。参照LQTS的诊断标准，每5个患者中有2个未被诊断而已经死亡。错估QTc值，误解QTc值的正态分布，及对症状的误解是误诊的最主要原因。
我领第5篇和第9篇,晚上交稿.
认领第8篇
本来我想领第3篇的，可被liuguanghui80 抢了先，哈哈！不才只好校正啦，不当之处，请指教！
Smoking Is Associated With Epicardial Coronary Endothelial Dysfunction and Elevated White Blood Cell Count in Patients With Chest Pain and Early Coronary Artery Disease
吸烟和心外膜冠状内皮功能障碍及提高胸痛早期冠心病患者白细胞计数的关系
1、Elevated，这里是形容词，翻译成动词后意思就变了；
2、文章的观点为吸烟与后两者的关系是肯定的，所以Is Associated With 最好在题目中翻译出来
所以题目这样译可能更妥：吸烟与心外膜冠状内皮功能障碍及胸痛早期冠心病患者白细胞计数增高相关联
Coronary endothelial function in response to acetylcholine was assessed in 881 patients
冠状内皮功能适应于乙酰胆碱，881为患者
in response to acetylcholine 应该是对乙酰胆碱的反应性
3、此句的意思是：研究通过观察对乙酰胆碱的反应性评价了881名患者冠脉内皮功能
had more epicardial vasoconstriction in response to intracoronary acetylcholine (–19±2% versus –14±1% change in coronary artery diameter, P=0.03),
他们有更多的心外膜血管收缩以适应于冠状动脉内的乙酰胆碱(冠状动脉变化直径–19±2%VS–14±1%,P=0.03).
4、所以这句也要做相应修改，我看了一下原文，意思是说，吸烟者给予Ach后，其冠脉直径（CAD）的下降要大于末吸烟者，具体数值就是括号里的百分比，所以此句可以这样理解：吸烟者的外膜冠脉对冠脉内Ach的收缩性较大（CAD的下降程度为19±2% versus 14±1%）
但是我不太理解，Ach对冠脉难道引起收缩吗？？
Young smokers are characterized by epicardial coronary endothelial dysfunct ion, preserved microvascular endothelial function, and increased levels of inflammatory biomarkers and oxidative stress
年轻的吸烟者以心外膜冠状内皮功能障碍,微血管内皮功能,增加的炎症生物标记和氧化应激为特征
5、preserved 要翻译出来的，摘要中亦提到，微血管内皮功能是完好的intact
6、increased亦是氧化应激的定语
所以此句可翻译为：年轻的吸烟者以心外膜冠状内皮功能障碍、微血管内皮功能完好、炎症生物标记和氧化应激增加为特征
７、 The present study provides further information regarding the potential mechanisms by which smoking contributes to cardiovascular events.
目前的研究提供了更深的信息,它涉及到吸烟促进心血管事件机制的潜在机制.further information 更深的信息？？
目前的研究提供了更多关于吸烟促进心血管事件潜在机制的信息．
理解不当的地方，请liuguanghui80 兄指教
8、Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke
一系列国立卫生研究院脑卒中评分量表（NIHSS）评价急性缺血性脑卒中动脉/血管状态的准确性
Background— Early recovery after intravenous thrombolysis can be observed in stroke; however, the utility of measuring clinical improvement to assess artery status has not been established. We sought to determine the accuracy of serial National Institutes of Health Stroke Scale (NIHSS) scores to detect complete early recanalization of the middle cerebral artery.
背景——经静脉注射血栓溶解剂后早期恢复可以在中风中发现，然而，有关评价临床治疗改善血管状态的益处的量表还未建立。我们在寻求NIHSS评价大脑中动脉早期血管再通的准确性。
Methods and Results— Data from the CLOTBUST trial (Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic tPA) were used to determine the most sensitive and specific NIHSS-derived parameter to identify complete recanalization. Then, reproducibility was tested against a separate patient population (Barcelona data set).
方法和结果——来自CLOTBUST试验（经颅超声和全身/系统应用tPA联合溶解脑缺血患者血栓）数据已经用来评价用NIHSS参数来辨别完全血管再通的敏感性和特异性。然后在另一个人群（巴塞罗那数据集）中重复。
NIHSS scores were determined before tissue plasminogen activator bolus and at 60 and 120 minutes in both data sets. Receiver operating characteristic curves were used to compare test performance. The accuracy of individual cutoffs was demonstrated by sensitivity, specificity, and positive and negative predictive values.
在两个试验中，在组织纤维蛋白溶酶原激活剂使用前，都先用NIHSS评分。受试者工作特征曲线用来比较试验结果。个体截断点的准确性用来表示敏感性、特异性、正面和负面预测值。
A total of 122 patients in the CLOTBUST data set and 98 in the Barcelona data set received 0.9 mg/kg intravenous tissue plasminogen activator [mean age 69±12 versus 72±12 years, 57% male versus 51% male, median NIHSS 16 versus 17 points, mean time from onset to treatment 140±32 versus 177±59 minutes, and complete recanalization of the middle cerebral artery in 19% versus 17%).
总共CLOTBUST 试验中的122个病人和巴塞罗那试验中的98个病人参与，静脉注射0.9 mg/kg组织纤维蛋白溶酶原激活剂（平均年龄 69±12岁：72±12岁，57% 男性：51%男性，16：17点，平均实践从开始到治疗140±32分钟：177±59分钟，大脑中动脉完全血管再通率19%：17%）。
For identification of recanalization, an NIHSS score reduction of 40% offered the best tradeoff, with sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 85%, 50%, and 91% at 60 minutes and 74%, 80%, 58%, and 89% at 120 minutes, respectively. Test performance was equal in the Barcelona data set.
为辨别血管再通，NIHSS评分减少40%被认为是最好的结果，在60分钟时，敏感性、特异性、正面和负面预测值分别为65%, 85%, 50%和91%，120分钟时，敏感性、特异性、正面和负面预测值分别为74%, 80%, 58%和 89%。在巴塞罗那试验中测验值相同。
Conclusions— Relative changes in serial NIHSS scores can serve as a simple clinical indicator of arterial status after intravenous thrombolysis. Accuracy parameters are affected by the process of recanalization and its varying clinical significance.
结论——在一些列NIHSS评分中的相应改变可以作为经静脉注射血栓溶解剂后一个简单的血管状态的临床指示器。参数的准确性受血管再通和它的多样的临床表现的影响。
不当之处请不吝赐教！
感谢mengguoliang战友的指点,受教了!
我是翻译新手,好多的语法及措辞的确不甚严密,向mengguoliang兄学习了!
第5篇:
5、Risk of Thromboembolism in Heart Failure
心力衰竭患者中血栓栓塞危险性
An Analysis From the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)
来自SCD-HeFT研究的分析
Ronald S. Freudenberger, MD; Anne S. Hellkamp, MS; Jonathan L. Halperin, MD; Jeanne Poole, MD; Jill Anderson, BSN; George Johnson, BSEE; Daniel B. Mark, MD, MPH; Kerry L. Lee, PhD; Gust H. Bardy, MD, for the SCD-HeFT Investigators
Background— In patients with heart failure, rates of clinically apparent stroke range from 1.3% to 3.5% per year. Little is known about the incidence and risk factors in the absence of atrial fibrillation. In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 2521 patients with moderate heart failure were randomized to receive amiodarone, implanted cardioverter-defibrillators (ICDs), or placebo.
背景：临床上，每年有1.3%-3.5%的心力衰竭病人发生明显的血栓栓塞。在没有合并有房颤病人中，血栓栓塞的发生率和危险因素都了解得很少。在SCD-HeFT研究中，共纳入中等程度的心力衰竭患者2521人，这些病人随机分组进入胺碘酮组，ICDS组或安慰剂组。
Methods and Results— We determined the incidence of stroke or peripheral or pulmonary embolism in patients with no history of atrial fibrillation (n=2114), predictors of thromboembolism and the relationship to left ventricular ejection fraction. Median follow-up was 45.5 months. Kaplan-Meier estimates (95% CIs) for the incidence of thromboembolism by 4 years were 4.0% (3.0% to 4.9%), with 2.6% (1.1% to 4.1%) in patients randomized to amiodarone, 3.2% (1.8% to 4.7%) in patients randomized to ICD, and 6.0% (4.0% to 8.0%) in patients randomized to placebo (approximate rates of 0.7%, 0.8%, and 1.5% per year, respectively). By multivariable analysis, hypertension (P=0.021) and decreasing left ventricular ejection fraction (P=0.023) were significant predictors of thromboembolism; treatment with amiodarone or ICD treatment was a significant predictor of thromboembolism-free survival (P=0.014 for treatment effect; hazard ratio [95% CI] versus placebo, 0.57 [0.33 to 0.99] for ICD; 0.44 [0.24 to 0.80] for amiodarone). Inclusion of atrial fibrillation during follow-up in the multivariable model did not affect the significance of treatment assignment as a predictor of thromboembolism.
方法和结果：我们定义事件为随访期间无房颤发生时病人发生中风，周围血管栓塞或肺栓塞（n=2114）；我们同时研究栓塞的预测因子及栓塞与左室EF的关系。中位随访时间为45.5个月。数据予KM法处理，结果表明：随访至4年时血栓栓塞发生率为4.0%(95%可信区间为3.0%-4.9%)，其中胺碘酮组为2.6%(95%可信区间为1.1%-4.1%),ICDS组为3.2%(95%可信区间为1.8%-4.7%),安慰剂组为6.0%(95%可信区间为4.0%-8.0%).(每年的发生率以上三组大约分别为0.7%,0.8%和1.5%).能过多因素分析得知,高血压和左室EF下降是血栓栓塞发生的重要预测因素(P值分别为0.021和0.023);而胺碘酮和ICD治疗则是重要的保护因素(P=0.014,与安慰剂对比,ICD治疗的危险比为0.57(95%可信区间为0.33-0.99;胺碘酮治疗的危险比为0.44(95%可信区间为0.24-0.80).包括随访过程中发生房颤患者进行多因素分析也对上述结果没有影响.
Conclusions— In the SCD-HeFT patient cohort, which reflects contemporary treatment of patients with moderately symptomatic systolic heart failure, patients experienced thromboembolism events at a rate of 1.7% per year without antiarrhythmic therapy. Those treated with amiodarone or ICDs had lower risk of thromboembolism than those given placebo. Hypertension at baseline and lower ejection fraction were independent predictors of risk.
结论：SCD-HeFT研究反映了在中等程度的收缩性心力衰竭人群同期的不同方式干预对血栓栓塞发生率的影响。结果表明，没有抗心律失常治疗时血栓栓塞发生率为1.7%/年。予胺磺酮或ICD治疗可以降低血栓栓塞风险。而原有高血压或左室EF值减少则是发生血栓栓塞的独立危险因素。
CLINICAL PERSPECTIVE
Interventional Cardiology
同时放弃第9篇了,对不起,时间不够,同时那篇觉得好多机构名称好烦!
领第七篇
第九篇:
9、Guidelines for the Early Management of Adults With Ischemic Stroke
成人缺血性脑卒中的早期治疗导则
A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
美国心脏协会/美国卒中学会卒中理事会、临床心脏病学理事会、心血管放射与介入治疗理事会、交叉学科工作组中动脉粥样硬化围血管疾病和服务质量指南：美国神经病学院将这一指南定为神经病学家的教育工具.
Harold P. Adams, Jr, MD, FAHA, Chair; Gregory del Zoppo, MD, FAHA, Vice Chair; Mark J. Alberts, MD, FAHA; Deepak L. Bhatt, MD; Lawrence Brass, MD, FAHA; Anthony Furlan, MD, FAHA; Robert L. Grubb, MD, FAHA; Randall T. Higashida, MD, FAHA; Edward C. Jauch, MD, FAHA; Chelsea Kidwell, MD, FAHA; Patrick D. Lyden, MD; Lewis B. Morgenstern, MD, FAHA; Adnan I. Qureshi, MD, FAHA; Robert H. Rosenwasser, MD, FAHA; Phillip A. Scott, MD, FAHA; Eelco F.M. Wijdicks, MD, FAHA
Purpose- Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke.
目的-我们对目前评估和治疗成人急性缺血性脑卒中患者的构成根据进行了回顾.
The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included.
本文供48小时内医治首发卒中的内科和急诊科医师，以及医疗决策者们参考.
Methods- Members of the panel were appointed by the American Heart Association Stroke Council s Scientific Statement Oversight Committee and represented different areas of expertise.
方法 - 专家小组成员是由美国心脏协会卒中理事会科学声明监督委员会指定，代表着不同的专业领域.
The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council s Levels of Evidence grading algorithm to rate the evidence and to make recommendations.
专家小组评述相关文献，重点是2003年以来出版的报告，并采用美国心脏协会卒中理事会证据等级标准的分级算法进行证据分级，给出推荐.
After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years.
经专家小组认可批准后，还要进行同行审查和美国心脏协会科学顾问和咨询委员会的审批.3年内该指南有望得到全部更新.
Results- Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials.
结果 - 急性缺血性脑卒中患者的治疗手段各式各样，有的还没有进行过临床试验.
This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital.
这包括来自于首次入院急诊医生的初次处置的推荐.
Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke.
在卒中的介入急救中，静脉注射重组组织纤溶酶原激活剂依然被认定为最有效的.
Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise.
许多介入治疗，如动脉内注射溶栓剂和机械介入将会准许.
Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
因为许多推荐所基于的数据是有限的，对急性缺血性脑卒中的治疗还需进行深入的研究.
Key Words: AHA Scientific Statements • emergency medical services • stroke • acute cerebral infarction • tissue plasminogen activator
关键词：AHA 科学声明;急诊;急性脑梗死;组织纤溶酶原激活剂
第七篇
7、Case Volume and Mortality in Pediatric Cardiac Surgery Patients in California, 1998–2003
Background— Previous reports have found an inverse relationship between pediatric cardiac surgery case volume and in-hospital mortality. This association has been noted recently to be decreasing for coronary artery bypass grafting, possibly because of improved training programs, quality improvement activities, or other innovations to improve outcomes. It is unknown whether the volume-mortality association among pediatric cardiac surgery patients is decreasing similarly.
Methods and Results— We used data from the state of California’s patient discharge data set from the years 1998–2003 to replicate 4 previous research studies of pediatric cardiac surgery volume and mortality. The total number of pediatric surgeries varied from 12 801 to 13 971 depending on the selection criteria applied. Using this larger and more contemporary data set, we found a weaker and less consistent volume-mortality relationship than had been reported previously. We also developed a new model, which incorporated elements of the old models, and found a statistically significant relationship with higher volume and lower mortality (odds ratio=0.86 per 100-patient increase in annual volume; 95% CI, 0.81 to 0.92). Post hoc analyses show that this relationship was related to the performance of the single largest-volume hospital.
Conclusions— With the use of data from California, the volume-mortality relationship among pediatric cardiac surgery patients has changed since previous research, such that the old models no longer describe a clear or consistent association. With the use of a continuous definition of volume and an updated model, an association is observed but is dependent on highly leveraged covariate patterns found in the largest-volume hospital.
1998–2003加利福尼亚小儿心脏病手术总例数和死亡率
背景—以前报告发现了小儿心脏病手术总例数和住院死亡率之间存在一个相反的关系。最近注意到这个关系能降低冠状动脉搭桥术的住院死亡率，可能由于被改进的训练计划、改进质量的活动，或者其他的新技术改善了预后。小儿心脏病手术总例数和住院死亡率之间的关系是否同样地越来越少的这点还不确定。
方法和结果--我们使用1998-2003从加利福尼亚州出院的病人数据，重复了4项以前的小儿心脏病手术总例数和住院死亡率之间的研究。 小儿科手术的总数根据所提供的选拔标准从12 801到13 971不等。使用这个更大和时代更加接近的数据库，我们比原先的报告发现了一个更加微弱和较不一致的容量死亡率关系。我们也开发了一个新的模型，合并老模型的元素，并且发现了与更大的容量和更低的死亡率有统计意义的关系(风险比例=0.86/每年增加100患者; 95% CI， 0.81到0.92)。 因此分析表示，这个关系唯一与医院总例数有关。
结论--以对加利福尼亚数据的分析，小儿心脏病手术总例数和住院死亡率之间的关系比以前的研究有了变化，旧模型对两者之间的关系不再有一个清楚或一致描述。以对容量和更合适模型的一个连续的应途，于大病例数医院依靠高度杠杆作用变量模型可以观察总例数和死亡率的关系。
