2017年美国ACCAHA高血压指南更新解读

在2017 年美国心脏协会(AHA) 科学年会上,美国心脏病学会(ACC) 和AHA 联合其他9 个临床医学专业学会发布了最新制订的《成人高血压预防、检测、评估和处理指南》。这是自从2013 年美国政府机构NIH 宣布不再主持制订临床疾病预防和管理指南后,由美国民间权威学术团体制订的第一部美国临床高血压防治指南,全面涵盖成人高血压的预防、检测、评估和管理。本文对美国高血压指南更新的定义、诊断以及治疗等方面进行如下综述。     

2003��ACC/AHA /ESC�����Կ���������ʧ������ָ�Ͻ����������Կ���������ʧ��

美国心脏病学会(ACC)、美国心脏学会(AHA)及欧洲心脏病学会(ESC)于2003年共同制订了《2003年ACC/AHA/ESC室上性快速性心律失常治疗指南》,2005年中华医学会心血管病学分会、中国生物医学工程学会心脏起搏与电生理分会、《中国心脏起搏与电生理杂志》编辑委员会、《中华心血管病杂志》编辑委员会参考国际指南,结合我国具体情况,发表了我国的《室上性快速性心律失常治疗指南》。这两个指南的发表,对指导临床医生规范处理室上性快速性心律失常起到积极的作用,值得每一位内科、心内科、急诊科等相关科室的医生认真学习。本栏目特邀请四川大学华西医院心内科黄德嘉教授结合国内具体情况对上述指南作一评介,同时邀请广东省人民医院吴书林教授、深圳市人民医院吴胜楠教授、中国医科大学附属第一医院于波教授、沈阳市第四人民医院栗印军教授分别从房室结折返性心动过速、窦性快速性心律失常、旁路相关性心动过速和大折返性房速方面阐述对指南的理解和应用体会。     

A Latin American Perspective on the New ACC/AHA Clinical Guidelines for Managing Atherosclerotic Cardiovascular Disease

Atherosclerotic heart disease and stroke are leading causes of disability and death worldwide, affecting not only developed countries, but also low- and middle-income regions. Different strategies for handling dyslipidemia as a critical pathogenic risk factor for atherosclerosis have been proposed. However, these recommendations are not applied at all in many countries or even in whole regions of the world. Recently, new US guidelines on risk assessment, lifestyle changes, and high blood cholesterol level treatment to manage atherosclerotic disease were released. In this article, we analyze these new guidelines and discuss their potential applications in preventive cardiovascular medicine in Latin America.     

ACC/AHA2011版PCI指南的解读与点评

近期,美国心脏病学会基金会(ACCF)、美国心脏学会(AHA)和美国心血管影像与介入学会(SCAI)共同制订了新版经皮冠状动脉介入治疗(PCI)指南和外科冠状动脉旁路移植治疗(CABG)指南。     

心腔内超声在心房颤动射频消融中的应用

心房颤动的射频消融是心血管领域热门课题,传统的X线影像下的心房颤动射频消融尽管取得很大进展,但仍然有许多亟待解决的问题。心腔内超声技术的诞生和发展极大克服了放射影像下心房颤动射频消融的不足,拓展了心房颤动射频消融的空间。     

2003��ACC/AHA /ESC�����Կ���������ʧ������ָ������

美国心脏病学会(ACC)、美国心脏学会(AHA)及欧洲心脏病学会(ESC)于2003年共同制订了《2003年ACC/AHA/ESC室上性快速性心律失常治疗指南》,2005年中华医学会心血管病学分会、中国生物医学工程学会心脏起搏与电生理分会、《中国心脏起搏与电生理杂志》编辑委员会、《中华心血管病杂志》编辑委员会参考国际指南,结合我国具体情况,发表了我国的《室上性快速性心律失常治疗指南》。这两个指南的发表,对指导临床医生规范处理室上性快速性心律失常起到积极的作用,值得每一位内科、心内科、急诊科等相关科室的医生认真学习。本栏目特邀请四川大学华西医院心内科黄德嘉教授结合国内具体情况对上述指南作一评介,同时邀请广东省人民医院吴书林教授、深圳市人民医院吴胜楠教授、中国医科大学附属第一医院于波教授、沈阳市第四人民医院栗印军教授分别从房室结折返性心动过速、窦性快速性心律失常、旁路相关性心动过速和大折返性房速方面阐述对指南的理解和应用体会。     

2003��ACC/AHA /ESC�����Կ���������ʧ������ָ�Ͻ�����������ҽ��۷����Ķ�����

美国心脏病学会(ACC)、美国心脏学会(AHA)及欧洲心脏病学会(ESC)于2003年共同制订了《2003年ACC/AHA/ESC室上性快速性心律失常治疗指南》,2005年中华医学会心血管病学分会、中国生物医学工程学会心脏起搏与电生理分会、《中国心脏起搏与电生理杂志》编辑委员会、《中华心血管病杂志》编辑委员会参考国际指南,结合我国具体情况,发表了我国的《室上性快速性心律失常治疗指南》。这两个指南的发表,对指导临床医生规范处理室上性快速性心律失常起到积极的作用,值得每一位内科、心内科、急诊科等相关科室的医生认真学习。本栏目特邀请四川大学华西医院心内科黄德嘉教授结合国内具体情况对上述指南作一评介,同时邀请广东省人民医院吴书林教授、深圳市人民医院吴胜楠教授、中国医科大学附属第一医院于波教授、沈阳市第四人民医院栗印军教授分别从房室结折返性心动过速、窦性快速性心律失常、旁路相关性心动过速和大折返性房速方面阐述对指南的理解和应用体会。     

ACC/AHA Versus ESC/ESH on Hypertension Guidelines: JACC Guideline Comparison

This study compares the recommendations of the most recent American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology (ESC)/European Society of Hypertension (ESH) blood pressure guidelines. Both guidelines represent updates of previous guidelines and reinforce previous concepts of prevention regarding elevated blood pressure. Specifically, a low-sodium diet, exercise, body weight reduction, low to moderate alcohol intake, and adequate potassium intake are emphasized. Overall, both guidelines agree on the proper method of blood pressure measurement, the use of home blood pressure and ambulatory monitoring, and restricted use of beta-blockers as first-line therapy. The major disagreements are with the level of blood pressure defining hypertension, flexibility in identifying blood pressure targets for treatment, and the use of initial combination therapy. Although initial single-pill combination therapy is strongly recommended in both guidelines, the ESC/ESH guideline recommends it as initial therapy in patients at ≥140/90 mm Hg. The ACC/AHA guideline recommends its use in patients >20/10 mm Hg above blood pressure goal. Thus, the only real disagreement is that the ACC/AHA guidelines maintain that all people with blood pressure >130/80 mm Hg have hypertension, and blood pressure should be lowered to <130/80 mm Hg in all. In contrast, the ESC/ESH guidelines state that hypertension is defined as >140/90 mm Hg, with the goal being a level <140/90 mm Hg for all targeting to <130/80 mm Hg only in those at high cardiovascular risk, but always considering individual tolerability of the proposed goal.     

The 2013 ACC/AHA Cholesterol Treatment Guidelines: Applicability to Patients with Diabetes

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide and the management of blood cholesterol is a cornerstone of medical therapy for the primary and secondary prevention of cardiovascular disease. Patients with diabetes represent an important high-risk group in whom clinicians should advocate the use of statins and lifestyle modification for the reduction of ASCVD. The recent 2013 ACC/AHA guidelines on managing blood cholesterol provide an important framework for the effective implementation of this important risk reduction strategy. The guidelines identify four groups of individuals who have been shown to benefit from statin therapy and update the dosing and monitoring recommendations based on evidence from published, large-scale randomized controlled trials (RCTs) with clinical hard endpoints. Primary care physicians and specialists play key roles in identifying populations at elevated ASCVD risk and providing effective care for patients, especially those with diabetes. This article will summarize the 2013 ACC/AHA guidelines on managing blood cholesterol and provide a practical management overview in order to facilitate implementation of these guidelines for patients with diabetes.     

2003��ACC/AHA /ESC�����Կ���������ʧ������ָ�Ͻ����������·������Ķ�����

美国心脏病学会(ACC)、美国心脏学会(AHA)及欧洲心脏病学会(ESC)于2003年共同制订了《2003年ACC/AHA/ESC室上性快速性心律失常治疗指南》,2005年中华医学会心血管病学分会、中国生物医学工程学会心脏起搏与电生理分会、《中国心脏起搏与电生理杂志》编辑委员会、《中华心血管病杂志》编辑委员会参考国际指南,结合我国具体情况,发表了我国的《室上性快速性心律失常治疗指南》。这两个指南的发表,对指导临床医生规范处理室上性快速性心律失常起到积极的作用,值得每一位内科、心内科、急诊科等相关科室的医生认真学习。本栏目特邀请四川大学华西医院心内科黄德嘉教授结合国内具体情况对上述指南作一评介,同时邀请广东省人民医院吴书林教授、深圳市人民医院吴胜楠教授、中国医科大学附属第一医院于波教授、沈阳市第四人民医院栗印军教授分别从房室结折返性心动过速、窦性快速性心律失常、旁路相关性心动过速和大折返性房速方面阐述对指南的理解和应用体会。     

��2006��AHA /ACC/ESC�ķ���������ָ�ϵ�����

2006年8月,ACC/AHA/ESC(美国心脏病学会/美国心脏协会/欧洲心脏病学会)发布了《2006Guidelines for the Management of Patients With Atrial Fibrillation》(2006年心房颤动治疗指南)[1]。该指南在2001年版的基础上,结合近年来心房颤动(简称房颤)研究领域循证医学的成果,对房颤研究的流行病学、分类、机制、治疗策略进行了全面、细致的阐述。与上次的指南对比,新指南根据近期房颤机制的研究进展,修改了抗凝治疗的指征,更主要的是,首次强调了经导管消融在房颤治疗中的地位。1房颤发生的机制房颤的发生机制一直未得到彻底阐明,经典的学…     

Mahaim纤维的电生理特征和导管射频消融

探讨Mahaim纤维的电生理特征和导管射频消融的可行性。 1996年 5月至 1999年 4月对 4例拟诊为Mahaim纤维引起的逆向型房室折返性心动过速的病人进行了电生理检查和射频导管消融。男 3例、女 1例 ,年龄 31± 19岁 ,心动过速发作史 15± 14年 ,频率 2 0 1± 17(180～ 2 2 0 )次 /分 ,发作时均有明显的心悸症状。 4例窦性心律时心电图除 1例轻微预激外均正常。心房程序电刺激可以诱发心动过速。心室起搏时从房室结逆传 ,静脉注射ATP 2 0mg室房分离。 4例Mahaim心动过速均只有前传并呈递减传导特性。 1例同时合并房室结折返性心动过速。 2例导管操作发生心房颤动并经过Mahaim纤维前传 ,1例持续发作、1例短暂发作。 4例分别在心房起搏、心动过速和心房颤动时三尖瓣心房侧标测和消融。心室预激较体表V1导联QRS波起始处提前 40± 6 (34～ 46 )ms处消融均获成功 ,1例靶点位于右前侧壁、3例位于右后侧壁。能量 35± 5W ,消融 5± 3次 ,X线透视时间 38± 2 1min。无手术相关的并发症。合并房室结折返性心动过速 1例同时作了慢径改良。分别随访 3个月～ 3年无 1例心动过速复发。临床研究证实 ,导管射频消融是治疗Mahaim介导的心动过速的有效、可行和安全的方法     

ACC/AHA Versus ESC Guidelines on Prosthetic Heart Valve Management: JACC Guideline Comparison

Prosthetic heart valve interventions continue to evolve with new innovations in surgical and transcatheter technologies. We compared the recommendations from the 2017 American College of Cardiology/American Heart Association guidelines for management of patients with prosthetic heart valves with the 2017 European Society of Cardiology guidelines. The 2 documents differed regarding recommendations for follow-up imaging, the choice of biological versus mechanical prosthesis, bridging therapies, role of aspirin, use of fibrinolytic therapy for prosthetic valve thrombosis, and management of paravalvular regurgitation. This review highlights the differences between the 2 guidelines, summarizes new evidence, and offers recommendations for the management of patients with prosthetic heart valves in these areas of controversy.     

ACC/AHA Versus ESC Guidelines on Heart Failure: JACC Guideline Comparison

The 2013 (with updates in 2016 and 2017) American College of Cardiology/American Heart Association and 2016 European Society of Cardiology guidelines provide practical evidence-based clinical guidelines for the diagnosis and treatment of both acute and chronic heart failure (HF). Both guidelines address noninvasive and invasive testing to establish the diagnosis of HF with reduced ejection fraction and HF with preserved ejection fraction. Extensive trial evidence supports the use of guideline-directed medical therapy and device-based therapies for the optimal management of patients with HF with reduced ejection fraction. Specific recommendations are also provided for HF with preserved ejection fraction although the evidence is substantially weaker. Management of medical comorbidities is now addressed in both guidelines. Acute HF and end-stage disease requiring advanced therapies are also discussed. This review compares specific recommendations across the spectrum of HF phenotypes and disease severity, highlights areas where differences exist, and lists consequential studies published since the latest guidelines.