Volume 115, Issue 19; May 15, 2007
Abstract 1 of 10 (Circulation. 2007;115:2474-2480.)
Arrhythmia/Electrophysiology
1.Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period of >10 Years
Background— The number of patients with longer follow-up after implantation of an implantable cardioverter-defibrillator is increasing continuously. Defibrillation lead failure is a typical long-term complication. Therefore, the long-term reliability of implantable cardioverter-defibrillator leads has become an increasing concern. The aim of the present study was to assess the annual rate of transvenous defibrillation lead defects related to follow-up time after lead implantation.
Methods and Results— A total of 990 consecutive patients who underwent first implantation of an implantable cardioverter-defibrillator between 1992 and May 2005 were analyzed. Median follow-up time was 934 days (interquartile range, 368 to 1870). Overall, 148 defibrillation leads (15%) failed during the follow-up. The estimated lead survival rates at 5 and 8 years after implantation were 85% and 60%, respectively. The annual failure rate increased progressively with time after implantation and reached 20% in 10-year-old leads (P<0.001). Lead defects affected newer as well as older models. Patients with lead defects were 3 years younger at implantation and more often female. Multiple lead implantation was associated with a trend to a higher rate of defibrillation lead defects (P=0.06). The major lead complications were insulation defects (56%), lead fractures (12%), loss of ventricular capture (11%), abnormal lead impedance (10%), and sensing failure (10%).
Conclusions— An increasing annual lead failure rate is noted primarily during long-term follow-up and reached 20% in 10-year-old leads. Patients with lead defects are younger and more often female.
Abstract 2 of 10 (Circulation. 2007;115:2481-2489.)
Arrhythmia/Electrophysiology
2.Clinical Aspects of Type-1 Long-QT Syndrome by Location, Coding Type, and Biophysical Function of Mutations Involving the KCNQ1 Gene
Background— Type-1 long-QT syndrome (LQTS) is caused by loss-of-function mutations in the KCNQ1-encoded IKs cardiac potassium channel. We evaluated the effect of location, coding type, and biophysical function of KCNQ1 mutations on the clinical phenotype of this disorder.
Methods and Results— We investigated the clinical course in 600 patients with 77 different KCNQ1 mutations in 101 proband-identified families derived from the US portion of the International LQTS Registry (n=425), the Netherlands’ LQTS Registry (n=93), and the Japanese LQTS Registry (n=82). The Cox proportional hazards survivorship model was used to evaluate the independent contribution of clinical and genetic factors to the first occurrence of time-dependent cardiac events from birth through age 40 years. The clinical characteristics, distribution of mutations, and overall outcome event rates were similar in patients enrolled from the 3 geographic regions. Biophysical function of the mutations was categorized according to dominant-negative (>50%) or haploinsufficiency (50%) reduction in cardiac repolarizing IKs potassium channel current. Patients with transmembrane versus C-terminus mutations (hazard ratio, 2.06; P<0.001) and those with mutations having dominant-negative versus haploinsufficiency ion channel effects (hazard ratio, 2.26; P<0.001) were at increased risk for cardiac events, and these genetic risks were independent of traditional clinical risk factors.
Conclusions— This genotype–phenotype study indicates that in type-1 LQTS, mutations located in the transmembrane portion of the ion channel protein and the degree of ion channel dysfunction caused by the mutations are important independent risk factors influencing the clinical course of this disorder.
Abstract 3 of 10 (Circulation. 2007;115:2490-2496.)
Genetics
3.Heritability of Platelet Responsiveness to Aspirin in Activation Pathways Directly and Indirectly Related to Cyclooxygenase-1
Background— The inability of aspirin (acetylsalicylic acid [ASA]) to adequately suppress platelet function is associated with future risk of myocardial infarction, stroke, and cardiovascular death. Genetic variation is a proposed but unproved mechanism for insufficient ASA responsiveness.
Methods and Results— We examined platelet ASA responsiveness in 1880 asymptomatic subjects (mean age, 44±13 years; 58% women) recruited from 309 white and 208 black families with premature coronary heart disease. Ex vivo platelet function was determined before and after ingestion of ASA (81 mg/d for 2 weeks) with the use of a panel of measures that assessed platelet activation in pathways directly and indirectly related to cyclooxygenase-1, the enzyme inhibited by ASA. The proportion of phenotypic variance related to CHD risk factor covariates was determined by multivariable regression. Heritability of phenotypes was determined with the use of variance components models unadjusted and adjusted for covariates. ASA inhibited arachidonic acid–induced aggregation and thromboxane B2 production by 99% (P<0.0001). Inhibition of urinary thromboxane excretion and platelet activation in pathways indirectly related to cyclooxygenase-1 was less pronounced and more variable (inhibition of 0% to 100%). Measured covariates contributed modestly to variability in ASA response phenotypes (r2=0.001 to 0.133). Phenotypes indirectly related to cyclooxygenase-1 were strongly and consistently heritable across races (h2=0.266 to 0.762; P<0.01), but direct cyclooxygenase-1 phenotypes were not.
Conclusions— Heritable factors contribute prominently to variability in residual platelet function after ASA exposure. These data suggest a genetic basis for the adequacy of platelet suppression by ASA and potentially for differences in the clinical efficacy of ASA.
Abstract 4 of 10 (Circulation. 2007;115:2497-2505.)
Heart Failure
4.Cardiac Improvement During Mechanical Circulatory Support
A Prospective Multicenter Study of the LVAD Working Group
Background— Myocardial recovery after left ventricular assist device (LVAD) support has been reported. The LVAD Working Group Recovery Study was a prospective multicenter trial to assess the incidence of myocardial recovery in patients bridged to cardiac transplantation.
Methods and Results— After LVAD implantation, patients were evaluated with the use of rest echocardiograms with partial LVAD support and cardiopulmonary exercise testing. Dobutamine echocardiography with hemodynamic measurements was performed in those patients with left ventricular ejection fraction >40% during resting studies. Histological analysis was performed on myocardial samples taken at LVAD implantation and explantation. Sixty-seven LVAD patients with heart failure participated in the study. After 30 days, significant improvement occurred in left ventricular ejection fraction (17±7% versus 34±12%; P<0.001) and reductions in left ventricular end-diastolic diameter (7.1±1.2 versus 5.1±1.1 cm; P<0.001) and left ventricular mass (320±113 versus 194±79 g; P<0.001) compared with before LVAD. Thirty-four percent of patients had left ventricular ejection fraction >40% with partial device support. Left ventricular ejection fraction decreased over time to pre-LVAD measurement by 120 days. Peak O2 improved with mechanical support (13.7±4.2 versus 18.9±5.5 mL/kg per minute, 30 versus 120 days; P<0.001). Tissue analysis revealed significant reductions in myocyte size, collagen content, and cardiac tumor necrosis factor-. Six subjects (9%) underwent LVAD explantation for recovery.
Conclusions— Cardiac function improves significantly after device implantation. Although cellular recovery and improvement in ventricular function are observed, the degree of clinical recovery is insufficient for device explantation in most patients with chronic heart failure.
Abstract 5 of 10 (Circulation. 2007;115:2506-2515.)
Heart Failure
5.Stable Myocardial-Specific AAV6-S100A1 Gene Therapy Results in Chronic Functional Heart Failure Rescue
Background— The incidence of heart failure is ever-growing, and it is urgent to develop improved treatments. An attractive approach is gene therapy; however, the clinical barrier has yet to be broken because of several issues, including the lack of an ideal vector supporting safe and long-term myocardial transgene expression.
Methods and Results— Here, we show that the use of a recombinant adeno-associated viral (rAAV6) vector containing a novel cardiac-selective enhancer/promoter element can direct stable cardiac expression of a therapeutic transgene, the calcium (Ca2+)-sensing S100A1, in a rat model of heart failure. The chronic heart failure–rescuing properties of myocardial S100A1 expression, the result of improved sarcoplasmic reticulum Ca2+ handling, included improved contractile function and left ventricular remodeling. Adding to the clinical relevance, long-term S100A1 therapy had unique and additive beneficial effects over ß-adrenergic receptor blockade, a current pharmacological heart failure treatment.
Conclusions— These findings demonstrate that stable increased expression of S100A1 in the failing heart can be used for long-term reversal of LV dysfunction and remodeling. Thus, long-term, cardiac-targeted rAAV6-S100A1 gene therapy may be of potential clinical utility in human heart failure.
Abstract 6 of 10 (Circulation. 2007;115:2516-2525.)
Molecular Cardiology
Background— Mast cells are major effector cells in allergy and host defense responses. Their increased number and state of activation in perivascular tissue during atherosclerosis may point to a role in cardiovascular disorders. In the present study, we investigated the contribution of perivascular mast cells to atherogenesis and plaque stability in apolipoprotein E–deficient mice.
Methods and Results— We show here that episodes of systemic mast cell activation during plaque progression in mice leads to robust plaque expansion. Targeted activation of perivascular mast cells in advanced plaques sharply increases the incidence of intraplaque hemorrhage, macrophage apoptosis, vascular leakage, and CXCR2/VLA-4–mediated recruitment of leukocytes to the plaque. Importantly, treatment with the mast cell stabilizer cromolyn does prevent all the adverse phenomena elicited by mast cell activation.
Conclusions— This is the first study to demonstrate that mast cells play a crucial role in plaque progression and destabilization in vivo. We propose that mast cell stabilization could be a new therapeutic approach to the prevention of acute coronary syndromes.
Abstract 7 of 10 (Circulation. 2007;115:2526-2532.)
Pediatric Cardiology
7.Serum Concentrations of Uric Acid and the Metabolic Syndrome Among US Children and Adolescents
Background— The association between concentrations of uric acid and the metabolic syndrome in children and adolescents remains incompletely understood. The objective of this study was to examine how these 2 were associated in a nationally representative sample of US children and adolescents.
Methods and Results— We performed a cross-sectional analysis of 1370 males and females aged 12 to 17 years using data from the National Health and Nutrition Examination Survey 1999–2002. The prevalence of the metabolic syndrome was <1% among participants in the lowest quartile of serum concentration of uric acid, 3.7% in the second quartile, 10.3% in the third quartile, and 21.1% in the highest quartile. Compared with the lowest 2 quartiles of uric acid together (291.5 µmol/L), the odds ratios were 5.80 (95% confidence interval, 3.22 to 10.46) for those in the third quartile (>291.5 to 339 µmol/L or >4.9 to 5.7 mg/dL) and 14.79 (95% confidence interval, 7.78 to 28.11) for those in the top quartile (>339 µmol/L) after adjustment for age, sex, race or ethnicity, and concentrations of C-reactive protein. Starting with the lowest quartile of concentration of uric acid, mean concentrations of serum insulin were 66.2, 66.7, 79.9, and 90.9 pmol/L for ascending quartiles, respectively (P for trend <0.001).
Conclusions— Among US children and adolescents, serum concentrations of uric acid are strongly associated with the prevalence of the metabolic syndrome and several of its components.
Abstract 8 of 10 (Circulation. 2007;115:2533-2539.)
Valvular Heart Disease
8.Association of Fetuin-A With Mitral Annular Calcification and Aortic Stenosis Among Persons With Coronary Heart Disease
Data From the Heart and Soul Study
Background— Fetuin-A is a multifunctional hepatic secretory protein that inhibits dystrophic vascular and valvular calcification. Lower serum fetuin-A concentrations are associated with valvular calcification in persons with end-stage renal disease. Whether fetuin-A is associated with valvular calcification in other patient populations is unknown.
Methods and Results— We evaluated the associations among serum fetuin-A concentrations, mitral annular calcification, and aortic stenosis in 970 ambulatory persons with coronary heart disease and without severe kidney disease. The presence or absence of mitral annular calcification and aortic stenosis was determined by transthoracic echocardiography. The subjects’ mean age was 66 years; 81% were men; 189 (20%) had mitral annular calcification; and 79 (8%) had aortic stenosis. Participants were categorized by tertiles of fetuin-A concentrations. Those within the highest fetuin-A tertile had significantly lower odds of mitral annular calcification compared with the lowest tertile (adjusted odds ratio, 0.47; 95% confidence interval, 0.29 to 0.77; P=0.002); this association was similar regardless of diabetes status (P for interaction=0.34). In contrast, the association of fetuin-A with aortic stenosis was modified by the presence or absence of diabetes mellitus (P for interaction=0.03). Among participants without diabetes, the highest fetuin-A tertile had a significantly lower odds of aortic stenosis compared with the lowest tertile (adjusted odds ratio, 0.37; 95% confidence interval, 0.15 to 0.92; P=0.03), whereas among participants with diabetes, no statistically significant association was observed between fetuin-A and aortic stenosis (adjusted odds ratio, 1.49; 95% confidence interval, 0.48 to 4.63; P=0.49).
Conclusions— Among persons with coronary heart disease, we observed an inverse association of fetuin-A and mitral annular calcification. An inverse association also was observed between fetuin-A and aortic stenosis among participants without diabetes mellitus. Fetuin-A may represent an important inhibitor of dystrophic calcification in persons with coronary heart disease.
Abstract 9 of 10 (Circulation. 2007;115:2549-2569.)
AHA Scientific Statements
9.Acute Coronary Care in the Elderly, Part I
Non–ST-Segment–Elevation Acute Coronary Syndromes: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
Background— Age is an important determinant of outcomes for patients with acute coronary syndromes (ACS); however, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients with ACS who would stand to benefit. Reasons include limited trial data to guide the care of older adults and uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age or complex health status.
Methods and Results— This 2-part American Heart Association scientific statement summarizes evidence on patient heterogeneity, clinical presentation, and treatment of non–ST-elevation ACS in relation to age (<65, 65 to 74, 75 to 84, and 85 years). In addition, we review methodological issues that influence the acquisition and application of evidence to the elderly patients treated in community practice. A writing group combining international cardiovascular and geriatric perspectives convened to summarize available data from trials (5 combined Virtual Coordinating Center for Global Collaborative Cardiovascular Research [VIGOUR] trials) and 3 registries (Global Registry of Acute Coronary Events, National Registry of Myocardial Infarction, and the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines national quality improvement initiative [CRUSADE]) to provide a conceptual framework for future work in the care of the elderly with acute cardiac disease. Treatment for non–ST-segment–elevation ACS (Part I) and ST-segment–elevation myocardial infarction (Part II) are reviewed. In addition, ethical considerations pertaining to acute care and secondary prevention are considered (Part II). The primary goal is to identify the areas in which sufficient evidence is available to guide practice, as well as to determine areas that warrant further study. Although treatment-related benefits should rise in an elderly population with high disease risk, data to assess these benefits are limited, outcomes of importance vary, and heterogeneity among the elderly increases treatment-related risks. Although a uniform approach to care in the oldest of the old is unlikely, understanding the major contributors to benefits and risks from treatment will advance the ability to apply guideline-based care in this subset of patients.
Conclusions— Although a few recent trials have described treatment effects in older patients, others continue to exclude patients on the basis of age. Going forward, prospective trials should enroll elderly subjects proportionate to their prevalence among the treated population to define risk and benefit. Findings from age subgroup analyses should be reported in a consistent manner across trials, including absolute and relative risks for efficacy and safety. Outcomes of particular relevance to the elderly, such as quality of life, physical function, and independence, should also be considered. Creatinine clearance should be calculated for every elderly patient to enable appropriate dosing. In addition, physicians need an understanding of conditions unique to older patients (eg, frailty, cognitive impairment) that influence treatment goals and outcomes. With these efforts, treatment risks can be minimized, and benefits can be placed in the health context of the elderly patient with ACS.
Abstract 10 of 10 (Circulation. 2007;115:2570-2589.)
AHA Scientific Statements
10.Acute Coronary Care in the Elderly, Part II
ST-Segment–Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
Karen P. Alexander, MD; L. Kristin Newby, MD, MHS, FAHA; Paul W. Armstrong, MD, FAHA; Christopher P. Cannon, MD, FAHA; W. Brian Gibler, MD; Michael W. Rich, MD, FAHA; Frans Van de Werf, MD, PhD; Harvey D. White, MB, DSc, FAHA; W. Douglas Weaver, MD, FAHA; Mary D. Naylor, PhD, FAHA; Joel M. Gore, MD, FAHA; Harlan M. Krumholz, MD, FAHA; E. Magnus Ohman, MD, Chair
Background— Age is an important determinant of outcomes for patients with acute coronary syndromes. However, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients who would stand to benefit. Limited trial data are available to guide care of older adults, which results in uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age and complex health status.
Methods and Results— Part II of this American Heart Association scientific statement summarizes evidence on presentation and treatment of ST-segment–elevation myocardial infarction in relation to age (<65, 65 to 74, 75 to 84, and 85 years). The purpose of this statement is to identify areas in which the evidence is sufficient to guide practice in the elderly and to highlight areas that warrant further study. Treatment-related benefits should rise in an elderly population, yet data to confirm these benefits are limited, and the heterogeneity of older populations increases treatment-associated risks. Elderly patients with ST-segment–elevation myocardial infarction more often have relative and absolute contraindications to reperfusion, so eligibility for reperfusion declines with age, and yet elderly patients are less likely to receive reperfusion even if eligible. Data support a benefit from reperfusion in elderly subgroups up to age 85 years. The selection of reperfusion strategy is determined more by availability, time from presentation, shock, and comorbidity than by age. Additional data are needed on selection and dosing of adjunctive therapies and on complications in the elderly. A "one-size-fits-all" approach to care in the oldest old is not feasible, and ethical issues will remain even in the presence of adequate evidence. Nevertheless, if the contributors to treatment benefits and risks are understood, guideline-recommended care may be applied in a patient-centered manner in the oldest subset of patients.
Conclusions— Few trials have adequately described treatment effects in older patients with ST-segment–elevation myocardial infarction. In the future, absolute and relative risks for efficacy and safety in age subgroups should be reported, and trials should make efforts to enroll the elderly in proportion to their prevalence among the treated population. Outcomes of particular relevance to the older adult, such as quality of life, physical function, and independence, should also be evaluated, and geriatric conditions unique to this age group, such as frailty and cognitive impairment, should be considered for their influence on care and outcomes. With these efforts, treatment risks can be minimized, and benefits can be placed within the health context of the elderly patient.
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Abstract 1 of 10 (Circulation. 2007;115:2474-2480.)
Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period of >10 Years
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1.Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period of >10 Years
逾期10年植入性除颤器缺陷的年度评价
Background— The number of patients with longer follow-up after implantation of an implantable cardioverter-defibrillator is increasing continuously. Defibrillation lead failure is a typical long-term complication. Therefore, the long-term reliability of implantable cardioverter-defibrillator leads has become an increasing concern. The aim of the present study was to assess the annual rate of transvenous defibrillation lead defects related to follow-up time after lead implantation.
背景—--对植入性埋藏式复律除颤器患者的长期随访数目不断递增,除颤缺陷是一个典型的长期并发症,因此,植入性除颤器的长期可信度成为逐渐引起关注.这一研究的目的就是来评估经静脉除颤的缺点与植入后随访时间的相关性.
Methods and Results— A total of 990 consecutive patients who underwent first implantation of an implantable cardioverter-defibrillator between 1992 and May 2005 were analyzed. Median follow-up time was 934 days (interquartile range, 368 to 1870). Overall, 148 defibrillation leads (15%) failed during the follow-up. The estimated lead survival rates at 5 and 8 years after implantation were 85% and 60%, respectively. The annual failure rate increased progressively with time after implantation and reached 20% in 10-year-old leads (P<0.001). Lead defects affected newer as well as older models. Patients with lead defects were 3 years younger at implantation and more often female. Multiple lead implantation was associated with a trend to a higher rate of defibrillation lead defects (P=0.06). The major lead complications were insulation defects (56%), lead fractures (12%), loss of ventricular capture (11%), abnormal lead impedance (10%), and sensing failure (10%).
方法和结果----分析了从1992年到2005年5月份有990个首次接收植入性埋藏式复律除颤器的患者,中位随访时间是934天(四分位数区间368天到1870天),总体来说,在随访期间有148例(15%)除颤失败.植入后5年和8年的生存率分别为85%,60%.随着植入时间的增加,每年的失败率也逐渐增加.随访时间为10年时就达到了20%(P<0.001).导联缺陷如同旧式模型一样受累.植入含导联缺陷的患者多在植入时平均年龄小于3岁,并且更多是女性.多导联植入和更高的除颤导联缺陷率有相关趋势(P=0.06).主要的并发症是绝缘缺陷(56%),导联折断(12%),室性夺获的失去(11%),异常的导联阻抗(10%)和感知失灵(10%).
Conclusions— An increasing annual lead failure rate is noted primarily during long-term follow-up and reached 20% in 10-year-old leads. Patients with lead defects are younger and more often femal
结论----在10年长期随访期间,逐渐增加的年度导联缺陷率达到了20%,这引起了极大的关注.带有导联缺陷的患者多是更加年轻并多发于女性.(liuguanghui80翻译)
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第6篇
Perivascular Mast Cells Promote Atherogenesis and Induce Plaque Destabilization in Apolipoprotein E–Deficient Mice
血管周围肥大细胞促进载脂蛋白E缺失小鼠动脉粥样硬化形成以及斑块脱稳定性
Background— Mast cells are major effector cells in allergy and host defense responses. Their increased number and state of activation in perivascular tissue during atherosclerosis may point to a role in cardiovascular disorders. In the present study, we investigated the contribution of perivascular mast cells to atherogenesis and plaque stability in apolipoprotein E–deficient mice.
背景－肥大细胞是变态反应和机体防御反应中的主要效应细胞，其在动脉粥样硬化血管周围组织中增多并活化，可能在心血管疾病中发挥着一定的作用。本研究我们观察了在载脂蛋白E缺失小鼠中，血管周围肥大细胞对于动脉粥样硬化形成以及斑块稳定性的影响。
Methods and Results— We show here that episodes of systemic mast cell activation during plaque progression in mice leads to robust plaque expansion. Targeted activation of perivascular mast cells in advanced plaques sharply increases the incidence of intraplaque hemorrhage, macrophage apoptosis, vascular leakage, and CXCR2/VLA-4–mediated recruitment of leukocytes to the plaque. Importantly, treatment with the mast cell stabilizer cromolyn does prevent all the adverse phenomena elicited by mast cell activation.
方法和结果－我们发现，该小鼠斑块进展过程中系统肥大细胞的活化导致了斑块的急剧扩大。在早期斑块中，定向的血管周围肥大细胞活化大大提高了胸膜内出血、巨噬细胞凋亡及血管外漏的发生率，增加了CXCR2/VLA-4介导的淋巴细胞向斑块的募集；更重要的是，肥大细胞稳定剂色苷酸钠能够阻止上述由于肥大细胞活化所引起的所有现象。
Conclusions— This is the first study to demonstrate that mast cells play a crucial role in plaque progression and destabilization in vivo. We propose that mast cell stabilization could be a new therapeutic approach to the prevention of acute coronary syndromes.
结论－本研究首次表明，肥大细胞在机体斑块进展及脱稳定性方面发挥着重要作用，稳定肥大细胞可能是阻止急性冠脉综合征的新的治疗策略。
血管周围肥大细胞促进载脂蛋白E缺失小鼠动脉粥样硬化形成以及斑块脱稳定性
背景－肥大细胞是变态反应和机体防御反应中的主要效应细胞，其在动脉粥样硬化血管周围组织中增多并活化，可能在心血管疾病中发挥着一定的作用。本研究我们观察了在载脂蛋白E缺失小鼠中，血管周围肥大细胞对于动脉粥样硬化形成以及斑块稳定性的影响。
方法和结果－我们发现，该小鼠斑块进展过程中系统肥大细胞的活化导致了斑块的急剧扩大。在早期斑块中，定向的血管周围肥大细胞活化大大提高了胸膜内出血、巨噬细胞凋亡及血管外漏的发生率，增加了CXCR2/VLA-4介导的淋巴细胞向斑块的募集；更重要的是，肥大细胞稳定剂色苷酸钠能够阻止上述由于肥大细胞活化所引起的所有现象。
结论－本研究首次表明，肥大细胞在机体斑块进展及脱稳定性方面发挥着重要作用，稳定肥大细胞可能是阻止急性冠脉综合征的新的治疗策略。（mengguoliang翻译）
第5篇
Stable Myocardial-Specific AAV6-S100A1 Gene Therapy Results in Chronic Functional Heart Failure Rescue
稳定的心肌特异性AAV-S100A1基因治疗引起慢性心力衰竭功能恢复
Background— The incidence of heart failure is ever-growing, and it is urgent to develop improved treatments. An attractive approach is gene therapy; however, the clinical barrier has yet to be broken because of several issues, including the lack of an ideal vector supporting safe and long-term myocardial transgene expression.
背景－心力衰竭的发病率持续增长，因此急需发展新的治疗方法，较受人们关注的有基因治疗。但是，临床治疗的障碍尚未清除，因为存在许多问题，包括缺乏一个理想的载体来实现长期安全的心肌转基因表达。
Methods and Results— Here, we show that the use of a recombinant adeno-associated viral (rAAV6) vector containing a novel cardiac-selective enhancer/promoter element can direct stable cardiac expression of a therapeutic transgene, the calcium (Ca2+)-sensing S100A1, in a rat model of heart failure. The chronic heart failure–rescuing properties of myocardial S100A1 expression, the result of improved sarcoplasmic reticulum Ca2+ handling, included improved contractile function and left ventricular remodeling. Adding to the clinical relevance, long-term S100A1 therapy had unique and additive beneficial effects over ß-adrenergic receptor blockade, a current pharmacological heart failure treatment.
目的和方法－我们的研究发现，在心力衰竭的大鼠模型中，应用重组的腺相关病毒（rAAV6）载体，导入一种新的心肌选择性增强／启动子，能够导致心肌的治疗性转基因（钙敏感性S100A1）稳定表达。心肌S100A1的表达及肌浆网钙离子调控改善的结果，导致心脏的收缩功能及左室重构得到好转。另外，临床上适当的长期S100A1治疗，具有超过ß受体阻滞剂的独特额外的有益效应，是目前研究心力衰竭治疗的热点。
Conclusions— These findings demonstrate that stable increased expression of S100A1 in the failing heart can be used for long-term reversal of LV dysfunction and remodeling. Thus, long-term, cardiac-targeted rAAV6-S100A1 gene therapy may be of potential clinical utility in human heart failure.
结论－这些发现表明，稳定地增加心衰心脏中AS10 0A1的表达，能够逆转左室功能障碍及左室重构。因此，长期的心肌靶向rAAV6-S100A1基因治疗可能在人类心力衰竭临床治疗中具有巨大的潜力。
稳定的心肌特异性AAV-S100A1基因治疗引起慢性心力衰竭功能恢复
背景－心力衰竭的发病率持续增长，因此急需发展新的治疗方法，较受人们关注的有基因治疗。但是，临床治疗的障碍尚未清除，因为存在许多问题，包括缺乏一个理想的载体来实现长期安全的心肌转基因表达。
目的和方法－我们的研究发现，在心力衰竭的大鼠模型中，应用重组的腺相关病毒（rAAV6）载体，导入一种新的心肌选择性增强／启动子，能够导致心肌的治疗性转基因（钙敏感性S100A1）稳定表达。心肌S100A1的表达及肌浆网钙离子调控改善的结果，导致心脏的收缩功能及左室重构得到好转。另外，临床上适当的长期S100A1治疗，具有超过ß受体阻滞剂的独特额外的有益效应，是目前研究心力衰竭治疗的热点。
结论－这些发现表明，稳定地增加心衰心脏中AS10 0A1的表达，能够逆转左室功能障碍及左室重构。因此，长期的心肌靶向rAAV6-S100A1基因治疗可能在人类心力衰竭临床治疗中具有巨大的潜力。（mengguoliang翻译）
相关知识：
SA100A1主要分布于神经细胞、骨骼肌细胞、心肌细胞和肾细胞的细胞浆中，其作用机制为：刺激钙离子释放，抑制微管蛋白的组装，抑制蛋白激酶C介导的磷酸化。
认领第七篇,如果24h内不能提交,请其他战友认领!
第七篇摘要翻译完毕,用了半个小时,不对的地方望各位战友指正!!
Abstract 7 of 10 (Circulation. 2007;115:2526-2532.)
Pediatric Cardiology
7.Serum Concentrations of Uric Acid and the Metabolic Syndrome Among US Children and Adolescents
题目---美国儿童和青少年中血清尿酸浓度和代谢综合征的关系
Background— The association between concentrations of uric acid and the metabolic syndrome in children and adolescents remains incompletely understood. The objective of this study was to examine how these 2 were associated in a nationally representative sample of US children and adolescents.
背景----在儿童和青少年人群中,对于他们的血清尿酸浓度和代谢综合征的相关性认识的不是很充分.这一研究的目的就是调查这两者在美国的儿童和青少年人群中的一致性关系.
Methods and Results— We performed a cross-sectional analysis of 1370 males and females aged 12 to 17 years using data from the National Health and Nutrition Examination Survey 1999–2002. The prevalence of the metabolic syndrome was <1% among participants in the lowest quartile of serum concentration of uric acid, 3.7% in the second quartile, 10.3% in the third quartile, and 21.1% in the highest quartile. Compared with the lowest 2 quartiles of uric acid together (291.5 µmol/L), the odds ratios were 5.80 (95% confidence interval, 3.22 to 10.46) for those in the third quartile (>291.5 to 339 µmol/L or >4.9 to 5.7 mg/dL) and 14.79 (95% confidence interval, 7.78 to 28.11) for those in the top quartile (>339 µmol/L) after adjustment for age, sex, race or ethnicity, and concentrations of C-reactive protein. Starting with the lowest quartile of concentration of uric acid, mean concentrations of serum insulin were 66.2, 66.7, 79.9, and 90.9 pmol/L for ascending quartiles, respectively (P for trend <0.001).
方法和结果----数据来自于1999–2002的健康与营养调查研究报告,共1370例12~17岁年龄阶段,对此我们进行了一个横断面的分析,在血浆尿酸浓度最小的四分位数层面上,参与者中的代谢综合征的患病率<1%;在第二个四分位数层面上,患病率为3.7%;在第三个层面上患病率为10.3%;在最高一个层面上患病率为21.1%.拿第三个层面的尿酸浓度(>291.5 到 339 µmol/L或者 >4.9 到 5.7 mg/dL)与第二个尿酸浓度(291.5 µmol/L)相比,优势比为5.80(95%可信区间为3.22 到10.46).如果拿最高一个层面尿酸浓度(>339 µmol/L)与第二个尿酸浓度(291.5 µmol/L)相比,优势比为14.79(可信区间为7.78 到28.11),当然得出的结果都是在年龄,性别,种族或者种族划分以及C反应蛋白校正的基础上.从最低的尿酸浓度开始,血清胰岛素的平均浓度分别为66.2, 66.7, 79.9, 和 90.9 pmol/L(P.<0.001).
Conclusions— Among US children and adolescents, serum concentrations of uric acid are strongly associated with the prevalence of the metabolic syndrome and several of its components.
结论-----在美国儿童和青少年中,血清尿酸浓度和代谢综合征的患病率及其表现呈很大的相关性.
为了方便各位战友阅读,我把各个部分整理一下!
题目---美国儿童和青少年血清尿酸浓度和代谢综合征的关系
背景----在儿童和青少年人群中,对于他们的血清尿酸浓度和代谢综合征的相关性认识的不是很充分.这一研究的目的就是调查这两者在美国的儿童和青少年人群中的一致性关系.
方法和结果----数据来自于1999–2002的健康与营养调查研究报告,共1370例12~17岁年龄阶段,对此我们进行了一个横断面的分析,在血浆尿酸浓度最小的四分位数层面上,参与者中的代谢综合征的患病率<1%;在第二个四分位数层面上,患病率为3.7%;在第三个层面上患病率为10.3%;在最高一个层面上患病率为21.1%.拿第三个层面的尿酸浓度(>291.5 到 339 µmol/L或者 >4.9 到 5.7 mg/dL)与第二个尿酸浓度(291.5 µmol/L)相比,优势比为5.80(95%可信区间为3.22 到10.46).如果拿最高一个层面尿酸浓度(>339 µmol/L)与第二个尿酸浓度(291.5 µmol/L)相比,优势比为14.79(可信区间为7.78 到28.11),当然得出的结果都是在年龄,性别,种族或者种族划分以及C反应蛋白校正的基础上.从最低的尿酸浓度开始,血清胰岛素的平均浓度分别为66.2, 66.7, 79.9, 和 90.9 pmol/L(P.<0.001).
结论-----在美国儿童和青少年中,血清尿酸浓度和代谢综合征的患病率及其表现呈很大的相关性.
(liuguanghui80翻译)
第7篇校正
Children and Adolescents 儿童和成人
Adolescents 应是青少年，文中的研究对象也是12-17岁，故可能翻译成儿童与青少年更合适。
Conclusions— Among US children and adolescents, serum concentrations of uric acid are strongly associated with the prevalence of the metabolic syndrome and several of its components.
结论-----在美国儿童和成人中,血清尿酸浓度和代谢综合征的患病率呈很大的相关性.
several of its components.没有翻译，我觉得说的是代谢综合征的一些表现，如摘要中也提到了血清胰岛素的水平。
liuguanghui80兄的翻译很流畅，提两个小的问题，不对的地方请指正！
非常感谢mengguoliang兄的校正,受教了!真的是细节中见精深啊!
你提出的不足之处已经改正,肯定还有不足的地方还望广大战友多指点!!
学习中----------!
认领第8篇,24小时内提交!
第8篇!
Association of Fetuin-A With Mitral Annular Calcification and Aortic Stenosis Among Persons With Coronary Heart Disease
Data From the Heart and Soul Study
题目---冠心病患者胎球蛋白A与二尖瓣环钙化及主动脉瓣狭窄的联系
Background— Fetuin-A is a multifunctional hepatic secretory protein that inhibits dystrophic vascular and valvular calcification. Lower serum fetuin-A concentrations are associated with valvular calcification in persons with end-stage renal disease. Whether fetuin-A is associated with valvular calcification in other patient populations is unknown.
背景---胎球蛋白A是具有多功能由肝脏分泌的蛋白质,它抑制了营养不良性血管和心瓣膜钙化的发生,较低的胎球蛋白A血清浓度和肾终末期疾病患者的心瓣膜钙化是相联系的.
Methods and Results— We evaluated the associations among serum fetuin-A concentrations, mitral annular calcification, and aortic stenosis in 970 ambulatory persons with coronary heart disease and without severe kidney disease. The presence or absence of mitral annular calcification and aortic stenosis was determined by transthoracic echocardiography. The subjects’ mean age was 66 years; 81% were men; 189 (20%) had mitral annular calcification; and 79 (8%) had aortic stenosis. Participants were categorized by tertiles of fetuin-A concentrations. Those within the highest fetuin-A tertile had significantly lower odds of mitral annular calcification compared with the lowest tertile (adjusted odds ratio, 0.47; 95% confidence interval, 0.29 to 0.77; P=0.002); this association was similar regardless of diabetes status (P for interaction=0.34). In contrast, the association of fetuin-A with aortic stenosis was modified by the presence or absence of diabetes mellitus (P for interaction=0.03). Among participants without diabetes, the highest fetuin-A tertile had a significantly lower odds of aortic stenosis compared with the lowest tertile (adjusted odds ratio, 0.37; 95% confidence interval, 0.15 to 0.92; P=0.03), whereas among participants with diabetes, no statistically significant association was observed between fetuin-A and aortic stenosis (adjusted odds ratio, 1.49; 95% confidence interval, 0.48 to 4.63; P=0.49).
方法和结果----我们选取了970例可步行且无肾脏疾病的冠心病患者,对其血清胎球蛋白A浓度与二尖瓣环钙化及主动脉瓣狭窄的相关性进行了评估.有无二尖瓣环钙化及主动脉瓣狭窄靠经胸壁超声心动图来确诊.受试者的平均年龄是66岁,男性占81%;189例(20%)有二尖瓣环钙化,79例(8%)有主动脉瓣狭窄,根据胎球蛋白A的血清浓度水平将受试者按三分等级分类,同最低等级相比(校正后优势比0.47,95%可信区间 0.29到0.77), 胎球蛋白A浓度在最高等级范围内,二尖瓣环钙化的发生率明显较低.除去糖尿病情况(P=0.34)这一联系是相似的.相反, 胎球蛋白A与主动脉瓣狭窄的相关性需通过有无糖尿病(P=0.03)来进行修正.在没有糖尿病的受试者中, 同最低等级相比(校正后优势比0.37,95%可信区间 0.15到0.92,P=0.03), 胎球蛋白A浓度在最高等级范围内,主动脉瓣狭窄的发生率明显较低.然而在有糖尿病的受试者中,胎球蛋白A浓度与主动脉瓣狭窄(校正后优势比1.49,95%可信区间 0.48到4.63,P=0.49)无明显统计学相关性.
Conclusions— Among persons with coronary heart disease, we observed an inverse association of fetuin-A and mitral annular calcification. An inverse association also was observed between fetuin-A and aortic stenosis among participants without diabetes mellitus. Fetuin-A may represent an important inhibitor of dystrophic calcification in persons with coronary heart disease.
结论---在冠心病患者中,我们观察到了胎球蛋白A浓度和二尖瓣环钙化呈负相关;而在没有糖尿病的受试者中,胎球蛋白A与主动脉瓣狭窄呈现相反的关系,从而预示着在冠心病人群中,胎球蛋白A可能代表营养不良性钙化的重要抑制剂.(liuguanghui80翻译)
题目---冠心病患者胎球蛋白A与二尖瓣环钙化及主动脉瓣狭窄的联系
背景---胎球蛋白A是具有多功能由肝脏分泌的蛋白质,它抑制了营养不良性血管和心瓣膜钙化的发生,较低的胎球蛋白A血清浓度和肾终末期疾病患者的心瓣膜钙化是相联系的.
方法和结果----我们选取了970例可步行且无肾脏疾病的冠心病患者,对其血清胎球蛋白A浓度与二尖瓣环钙化及主动脉瓣狭窄的相关性进行了评估.有无二尖瓣环钙化及主动脉瓣狭窄靠经胸壁超声心动图来确诊.受试者的平均年龄是66岁,男性占81%;189例(20%)有二尖瓣环钙化,79例(8%)有主动脉瓣狭窄,根据胎球蛋白A的血清浓度水平将受试者按三分等级分类,同最低等级相比(校正后优势比0.47,95%可信区间 0.29到0.77), 胎球蛋白A浓度在最高等级范围内,二尖瓣环钙化的发生率明显较低.除去糖尿病情况(P=0.34)这一联系是相似的.相反, 胎球蛋白A与主动脉瓣狭窄的相关性需通过有无糖尿病(P=0.03)来进行修正.在没有糖尿病的受试者中, 同最低等级相比(校正后优势比0.37,95%可信区间 0.15到0.92,P=0.03), 胎球蛋白A浓度在最高等级范围内,主动脉瓣狭窄的发生率明显较低.然而在有糖尿病的受试者中,胎球蛋白A浓度与主动脉瓣狭窄(校正后优势比1.49,95%可信区间 0.48到4.63,P=0.49)无明显统计学相关性.
结论---在冠心病患者中,我们观察到了胎球蛋白A浓度和二尖瓣环钙化呈负相关;而在没有糖尿病的受试者中,胎球蛋白A与主动脉瓣狭窄呈现相反的关系,从而预示着在冠心病人群中,胎球蛋白A可能代表营养不良性钙化的重要抑制剂. (liuguanghui80翻译)
第2篇的摘要的翻译，新手翻译的不好之处还请站友门帮忙修正
2.Clinical Aspects of Type-1 Long-QT Syndrome by Location, Coding Type, and Biophysical Function of Mutations Involving the KCNQ1 Gene
KCNQ1基因变异的位置、编码类型、生物物理学功能与1型长QT综合征临床特征。
Background— Type-1 long-QT syndrome (LQTS) is caused by loss-of-function mutations in the KCNQ1-encoded IKs cardiac potassium channel.
背景－1型长QT综合征是由于编码介导慢性钾离子电流的心肌钾离子通道KCN1基因变异功能丢失。
We evaluated the effect of location, coding type, and biophysical function of KCNQ1 mutations on the clinical phenotype of this disorder.
我们研究该疾病的不同临床类型与 KCNQ1 基因变异的位置、编码类型、生物物理学功能的关系。
Methods and Results— We investigated the clinical course in 600 patients with 77 different KCNQ1 mutations in 101 proband-identified families derived from the US portion of the International LQTS Registry (n=425), the Netherlands’ LQTS Registry (n=93), and the Japanese LQTS Registry (n=82).
方法和结果－通过国际LQTS注册登记处美国部分（425例）、荷兰LQTS注册登记处（93例以及日本LQTS注册登记处（82例），我们纳入了先前已经确诊的101个家庭，共计600名患者，共有77种 KCNQ1 基因变异。
The Cox proportional hazards survivorship model was used to evaluate the independent contribution of clinical and genetic factors to the first occurrence of time-dependent cardiac events from birth through age 40 years.
COX比例风险生存模型用于评估临床和遗传因素对于自出生至40岁之间发生首次时间依赖性心脏事件所起的作用。
The clinical characteristics, distribution of mutations, and overall outcome event rates were similar in patients enrolled from the 3 geographic regions.
3个地区之间患者的临床类型、基因变异的分布、总体事件发生率是相近的
Biophysical function of the mutations was categorized according to dominant-negative (>50%) or haploinsufficiency (50%) reduction in cardiac repolarizing IKs potassium channel current.
基因变异的生物物理功能的分类是依据显性遗传（(>50%）或者心脏除极过程中慢性钾离子电流钾通道的状态单倍剂量不足减少（50％）。
Patients with transmembrane versus C-terminus mutations (hazard ratio, 2.06; P<0.001) and those with mutations having dominant-negative versus haploinsufficiency ion channel effects (hazard ratio, 2.26; P<0.001) were at increased risk for cardiac events, and these genetic risks were independent of traditional clinical risk factors.
跨膜患者对应于羧基端变异（危险比为2.06; P<0.001），隐性遗传对应于单倍剂量不足离子通道（危险比hazard ratio, 2.26; P<0.001）是心脏事件的危险因素，此外这些遗传危险因素独立于传统的临床危险因素。
Conclusions— This genotype–phenotype study indicates that in type-1 LQTS, mutations located in the transmembrane portion of the ion channel protein and the degree of ion channel dysfunction caused by the mutations are important independent risk factors influencing the clinical course of this disorder.
结论－该项基因表形研究提示对于1型LQTS，定位于离子通道蛋白跨膜部分的基因变异和变异导致的离子通道功能失常的程度与该疾病的临床特征独立相关。
领第四篇
4.Cardiac Improvement During Mechanical Circulatory Support
A Prospective Multicenter Study of the LVAD Working Group
4.机械循环装置植入对心功能的改善情况
——来自左室辅助装置（LVAD）工作组的多中心、前瞻性研究
Background— Myocardial recovery after left ventricular assist device (LVAD) support has been reported. The LVAD Working Group Recovery Study was a prospective multicenter trial to assess the incidence of myocardial recovery in patients bridged to cardiac transplantation.
背景：有研究称植入LVAD后心肌功能有所恢复。TLWGRS研究是一项前瞻性多中心研究，用来评价那些等待心脏移植期间植入LVAD病人中心肌功能恢复的发生率。
Methods and Results— After LVAD implantation, patients were evaluated with the use of rest echocardiograms with partial LVAD support and cardiopulmonary exercise testing.
方法和结果：植入LVAD后，应用部分LVAD支持的病人检测静息超声心动图和运动心肺功能。
Dobutamine echocardiography with hemodynamic measurements was performed in those patients with left ventricular ejection fraction >40% during resting studies.
对于在静息检查中射血分数>40%的病人给予多巴酚丁胺负荷超声心动图检查，用来评价其血流动力学指标。
Histological analysis was performed on myocardial samples taken at LVAD implantation and explantation. Sixty-seven LVAD patients with heart failure participated in the study.
对LVAD植入或移出时获得的心肌标本进行组织学分析。67例心衰病人入选本研究。
After 30 days, significant improvement occurred in left ventricular ejection fraction (17±7% versus 34±12%; P<0.001) and reductions in left ventricular end-diastolic diameter (7.1±1.2 versus 5.1±1.1 cm; P<0.001) and left ventricular mass (320±113 versus 194±79 g; P<0.001) compared with before LVAD.
30天后，和LVAD植入前相比，左室射血分数明显改善(17±7% vs 34±12%; P<0.001)，左室舒张末径明显减小(7.1±1.2 vs 5.1±1.1 cm; P<0.001)，左室重量减轻(320±113 vs 194±79 g; P<0.001)
Thirty-four percent of patients had left ventricular ejection fraction >40% with partial device support. Left ventricular ejection fraction decreased over time to pre-LVAD measurement by 120 days.
LVAD部分辅助的病人中，有34例左室射血分数大于40%，但是120天后左室射血分数降低到植入前的水平。
Peak O2 improved with mechanical support (13.7±4.2 versus 18.9±5.5 mL/kg per minute, 30 versus 120 days; P<0.001). Tissue analysis revealed significant reductions in myocyte size, collagen content, and cardiac tumor necrosis factor-. Six subjects (9%) underwent LVAD explantation for recovery.
植入辅助装置120天与30天相比，氧流峰值改善(13.7±4.2 vs 18.9±5.5 mL/kg min, P<0.001)
Conclusions— Cardiac function improves significantly after device implantation. Although cellular recovery and improvement in ventricular function are observed, the degree of clinical recovery is insufficient for device explantation in most patients with chronic heart failure.
结论：LVAD植入后，心功能改善明显。尽管已经观察到心肌细胞的恢复和射血分数的改善，但是在多数心衰病人移出辅助装置后，临床恢复程度仍然不够。
4.机械循环装置植入对心功能的改善情况
——来自左室辅助装置（LVAD）工作组的多中心、前瞻性研究
背景：有研究称植入LVAD后心肌功能有所恢复。TLWGRS研究是一项前瞻性多中心研究，用来评价那些等待心脏移植期间植入LVAD病人中心肌功能恢复的发生率。
方法和结果：植入LVAD后，应用部分LVAD支持的病人检测静息超声心动图和运动心肺功能。对于在静息检查中射血分数>40%的病人给予多巴酚丁胺负荷超声心动图检查，用来评价其血流动力学指标。对LVAD植入或移出时获得的心肌标本进行组织学分析。67例心衰病人入选本研究。30天后，和LVAD植入前相比，左室射血分数明显改善(17±7% vs 34±12%; P<0.001)，左室舒张末径明显减小(7.1±1.2 vs 5.1±1.1 cm; P<0.001)，左室重量减轻(320±113 vs 194±79 g; P<0.001)。LVAD部分辅助的病人中，有34例左室射血分数大于40%，但是120天后左室射血分数降低到植入前的水平。植入辅助装置120天与30天相比，氧流峰值改善(13.7±4.2 vs 18.9±5.5 mL/kg min, P<0.001)
结论：LVAD植入后，心功能改善明显。尽管已经观察到心肌细胞的恢复和射血分数的改善，但是在多数心衰病人移出辅助装置后，临床恢复程度仍然不够
第十篇 请指正，谢谢！
10.Acute Coronary Care in the Elderly, Part II
老年人急性冠脉综合症的治疗，第二部分
ST-Segment–Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
AHA和老年心脏病学会关于专业治疗ST抬高的MI（ST－MI）的陈述
Background— Age is an important determinant of outcomes for patients with acute coronary syndromes. However, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients who would stand to benefit. Limited trial data are available to guide care of older adults, which results in uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age and complex health status.
背景 年龄是判断急性冠脉综合症（ACS）预后的重要决定因子。然而，社区医疗实践表明，在治疗对其有益的老年人中应用心血管药物治疗和侵入性治疗者的比例呈不相称的低。可以用来指导对老年人的治疗试验有限，这些试验的结果提示不确定的风险和益处，特别是新药或者侵入性治疗、老年人和健康状况复杂。
Methods and Results— Part II of this American Heart Association scientific statement summarizes evidence on presentation and treatment of ST-segment–elevation myocardial infarction in relation to age (<65, 65 to 74, 75 to 84, and 85 years). The purpose of this statement is to identify areas in which the evidence is sufficient to guide practice in the elderly and to highlight areas that warrant further study. Treatment-related benefits should rise in an elderly population, yet data to confirm these benefits are limited, and the heterogeneity of older populations increases treatment-associated risks. Elderly patients with ST-segment–elevation myocardial infarction more often have relative and absolute contraindications to reperfusion, so eligibility for reperfusion declines with age, and yet elderly patients are less likely to receive reperfusion even if eligible. Data support a benefit from reperfusion in elderly subgroups up to age 85 years. The selection of reperfusion strategy is determined more by availability, time from presentation, shock, and comorbidity than by age. Additional data are needed on selection and dosing of adjunctive therapies and on complications in the elderly. A "one-size-fits-all" approach to care in the oldest old is not feasible, and ethical issues will remain even in the presence of adequate evidence. Nevertheless, if the contributors to treatment benefits and risks are understood, guideline-recommended care may be applied in a patient-centered manner in the oldest subset of patients.
方法和结果 在AHA陈述的第二部分，根据年龄(<65, 65 to 74, 75 to 84, and 85 岁)， 总结了对ST抬高的MI（ST－MI）的治疗。目的是区分那些方面有足够的证据指导对老年人的治疗，那些方面是以后研究的亮点。通过对老年人治疗，所获得的相关的益处是提高的，但数据表明这种益处有限，且可以增加发生治疗并发的多种风险。ST－MI的老年患者常存在再灌注治疗的相对和绝对禁忌症，因此在年龄上完全符合再灌注的治疗的患者减少， 即使符合再灌注治疗的适应症，老年人接受再灌注治疗的可能性也小。数据证明对85岁下的老年人进行再灌注治疗是有益处。与年龄相比，选择再灌注的策略应更多考虑再灌注的可行性、发病时间、休克和同病。对老年人选择再灌注的策略，以及辅助治疗和并发症的治疗还需要试验研究。对老年人“一步到位”的治疗不可行，即使有足够的证据指导治疗，伦理方面的问题依然存在。假设指南作者了解治疗的益处和风险，指南推荐的治疗方式也许适用于在一个病人中心对老年人集中治疗。
Conclusions— Few trials have adequately described treatment effects in older patients with ST-segment–elevation myocardial infarction. In the future, absolute and relative risks for efficacy and safety in age subgroups should be reported, and trials should make efforts to enroll the elderly in proportion to their prevalence among the treated population. Outcomes of particular relevance to the older adult, such as quality of life, physical function, and independence, should also be evaluated, and geriatric conditions unique to this age group, such as frailty and cognitive impairment, should be considered for their influence on care and outcomes. With these efforts, treatment risks can be minimized, and benefits can be placed within the health context of the elderly patient.
结论 少有试验有充分的证据说明对ST－MI老年患的者治疗效果。在将来，依据年龄亚组分析治疗的绝对的和相对的有效性和安全性可能会被报道，试验应该努力纳入老年人，以了解其在总治疗人群中的发病率。应该评价和老年人特殊相关的一些问题，例如生活质量、身体状况、 生活自理能力，也应该考虑老年人中独有的与年龄相关的问题，例如意志薄弱、认知缺乏，这些将影响治疗和结果。有这些努力，对老年患者治疗的风险将最小化，为老年人健康有益。
认领第9篇
9.Acute Coronary Care in the Elderly, Part I
老年人急性冠脉综合症的治疗，第一部分
Non–ST-Segment–Elevation Acute Coronary Syndromes: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
美国心脏病协会和老年心脏病学会关于专业治疗非ST段抬高性急性冠脉综合征的陈述
Background— Age is an important determinant of outcomes for patients with acute coronary syndromes (ACS); however, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients with ACS who would stand to benefit. Reasons include limited trial data to guide the care of older adults and uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age or complex health status.
背景 年龄是判断急性冠脉综合症（ACS）预后的重要决定因子。尽管如此，社区医疗实践表明，在治疗对其有益的老年急性冠脉综合征病人中应用心血管药物治疗和侵入性治疗者的比例呈不相称的低。可以用来指导对老年人的治疗试验有限，这些试验的结果提示不确定的风险和益处，特别是新药或者侵入性治疗、老年人和健康状况复杂。
Methods and Results— This 2-part American Heart Association scientific statement summarizes evidence on patient heterogeneity, clinical presentation, and treatment of non–ST-elevation ACS in relation to age (<65, 65 to 74, 75 to 84, and 85 years).
方法和结果——美国心脏病协会的这两部分声明，根据年龄(<65, 65 to 74, 75 to 84, and 85 岁)，总结了非ST段抬高急性冠脉综合征病人种族、临床表现和治疗。
In addition, we review methodological issues that influence the acquisition and application of evidence to the elderly patients treated in community practice.
并且，我们审查了影响采集和运用于老年病人在社区医疗实践中治疗证据的方法问题。
A writing group combining international cardiovascular and geriatric perspectives convened to summarize available data from trials (5 combined Virtual Coordinating Center for Global Collaborative Cardiovascular Research [VIGOUR] trials) and 3 registries (Global Registry of Acute Coronary Events, National Registry of Myocardial Infarction, and the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines national quality improvement initiative [CRUSADE]) to provide a conceptual framework for future work in the care of the elderly with acute cardiac disease.
我们的书写队伍包括了国际心血管和老年病专家，总结了试验（全球协作心血管研究虚拟协作中心的5个试验）和3种登记(注册全球急性冠脉事件, 心肌梗塞国民登记局，不稳定心绞痛患者快速危险分层的制止不良结果与推行早期的ACC/AHA指南的全国质量改进倡议)以提供一个为今后照顾急性心脏疾病老年病人的概念框架。
Treatment for non–ST-segment–elevation ACS (Part I) and ST-segment–elevation myocardial infarction (Part II) are reviewed. In addition, ethical considerations pertaining to acute care and secondary prevention are considered (Part II).
治疗非ST段抬高ACS的(第一部分)和ST段抬高型心肌梗死的报告(第二部分)被讨论。此外,伦理考量涉及急性护理和二级预防也被考虑(第二部分)。
The primary goal is to identify the areas in which sufficient evidence is available to guide practice, as well as to determine areas that warrant further study.
主要的目标是鉴别哪些领域是有足够的证据可以指导实践，以及决定哪些领域值得进一步研究。
Although treatment-related benefits should rise in an elderly population with high disease risk, data to assess these benefits are limited, outcomes of importance vary, and heterogeneity among the elderly increases treatment-related risks. Although a uniform approach to care in the oldest of the old is unlikely, understanding the major contributors to benefits and risks from treatment will advance the ability to apply guideline-based care in this subset of patients.
虽然治疗相关的利益应该在有高疾病风险的老年人口中上升, 但数据评估这些利益是有限的，重要性的结果各有不同，异质老年人之间增加治疗相关的风险。 虽然统一照顾老年人中的高龄者是不可能的,理解主要影响治疗的利益和风险因素会提前运用指南治疗于亚组病人。
Conclusions— Although a few recent trials have described treatment effects in older patients, others continue to exclude patients on the basis of age. Going forward, prospective trials should enroll elderly subjects proportionate to their prevalence among the treated population to define risk and benefit.
结论——尽管最近的几个试验已描述了老年病人的治疗效果, 其他的继续以年龄为基础排除病人。 可以想象，以后的试验将纳入与他们的治病率相对应的一定比例的老年受试者以界定风险和益处。
Findings from age subgroup analyses should be reported in a consistent manner across trials, including absolute and relative risks for efficacy and safety.
从年龄分组分析, 结果应当在所有试验中以一种一致的方式报导,包括疗效和安全性的绝对和相对危险。
Outcomes of particular relevance to the elderly, such as quality of life, physical function, and independence, should also be considered. Creatinine clearance should be calculated for every elderly patient to enable appropriate dosing.
特别与老年人相关的结果，如生活质量,身体功能,独立,也应予以考察。应计算每个老人肌酐清除率以决定合适的药物剂量。
In addition, physicians need an understanding of conditions unique to older patients (eg, frailty, cognitive impairment) that influence treatment goals and outcomes. With these efforts, treatment risks can be minimized, and benefits can be placed in the health context of the elderly patient with ACS.
此外，医师必须了解老年病人的独特情况(例如虚弱, 认知缺损)影响治疗的目标和结果。在这些努力下，治疗的风险可以减少，益处可以被写入老年ACS病人的治疗指南。
第一次翻译，请大家批评指正！谢谢！
liuguanghui80 wrote:
1.Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period of >10 Years
逾期10年植入性除颤器缺陷的年度评价
Background— The number of patients with longer follow-up after implantation of an implantable cardioverter-defibrillator is increasing continuously. Defibrillation lead failure is a typical long-term complication. Therefore, the long-term reliability of implantable ＝＝＝＝
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原则性错误太多，完全误导别人
植入式心脏复律除颤器植入十年内的经静脉除颤电极故障年发生率
背景：随着长期随访的已植入ICD患者的数目不断递增,除颤电极故障是一个典型的长期并发症。因此, ICD除颤电极的长期可靠性逐渐引起关注.本研究的目的就是来评估经静脉除颤电极故障的年发生率与植入后随访时间的相关性
方法和结果----分析了从1992年到2005年5月份连续990个首次植入 ICD的患者,中位随访时间是934天(四分位数间距368天到1870天),在随访期间共有148例(15%)除颤电极故障。植入后5年和8年的预期电极无故障比例分别为85%和60%。随着植入时间的增加,每年的故障发生率也逐渐增加.随访时间为10年时就达到了20%(P<0.001)。新式除颤电极与老型号除颤电极同样出现故障。发生除颤电极故障患者（比未发生电极故障者）在植入时的年龄小3岁,并且女性更多见。多电极植入似乎与除颤电极故障发生率增高相关(P=0.06)。主要的电极并发症是绝缘缺陷(56%),电极折断(12%),不能夺获心室(11%),电极阻抗异常(10%)和感知障碍(10%).
结论----首次报道了在长期随访期间,电极故障年发生率逐渐增加，随访10年时年发生率达到20%。发生电极故障的患者更加年轻并且女性多见。fengxiaohou wrote:
植入式心脏复律除颤器植入十年内的经静脉除颤电极故障年发生率
背景：随着长期随访的已植入植入式心脏复律除颤器患者的数目不断递增,除颤电极故障是一个典型的长期并发症。因此, 植入式心脏复律除颤器除颤电极的长期可靠性逐渐引起关注.本研究的目的就是来评估经静脉除颤电极故障的年发生率与植入后随访时间的相关性
方法和结果----分析了从1992年到2005年5月份连续990个首次接受植入式心脏复律除颤器的患者,中位随访时间是934天(四分位数间距368天到1870天),在随访期间共有148例(15%)除颤电极故障。植入后5年和8年的预期电极无故障比例分别为85%和60%。随着植入时间的增加,每年的故障发生率也逐渐增加.随访时间为10年时就达到了20%(P<0.001)。新式除颤电极与老型号除颤电极同样出现故障。发生除颤电极故障患者（比未发生电极故障者）在植入时的年龄小3岁,并且女性更多见。多电极植入似乎与除颤电极故障发生率增高相关(P=0.06)。主要的电极并发症是绝缘缺陷(56%),电极折断(12%),不能夺获心室(11%),电极阻抗异常(10%)和感知障碍(10%).
结论----首次报道了在长期随访期间,电极故障年发生率逐渐增加，随访10年时年发生率达到20%。发生电极故障的患者更加年轻并且女性多见。
向你学习,我是翻译新手,看了你的翻译,学习了,非常感谢!
还有第3篇没翻，先整理下：）
2007-5-15.doc (80.5k)
无人问津了