Release date: 2015-01-15
"Nature Reviews Cardiology" magazine celebrated its 10th anniversary, and invited five cardiologists to analyze five issues that need to be addressed in the field of cardiovascular disease. These issues are usually of little concern to us and are still in the exploratory stage.
First, right ventricular dysfunction
Right ventricular dysfunction is a contributing factor to the prognosis of patients with cardiovascular disease. Assessing the structure of the right ventricle, especially for preoperative evaluation of surgical patients, is an important task in clinical management. Accurate assessment of the right ventricle We face the following challenges: 1 how accurately the complex geometry is described; 2 limitations of the endocardial surface definition; 3 special anatomical locations (right ventricle behind the sternum) limits imaging testing; 4 right ventricular assessment indicators There is significant load dependence; there is an interaction between the 5 ventricles.
In response to the above problems, researchers should pay attention to the following points: 1 The cause of right ventricular dysfunction after cardiac surgery is complicated, should be alert to the possibility of potential disease progression; 2 Find suitable methods for interpretation of right ventricular diastolic and systolic function evaluation; Master the pathological features of right ventricular dysfunction and interaction between ventricles; 4 explore the mechanism of right ventricular heart failure through molecular, gene, neurohumoral and other aspects.
Second, cardiomyopathy in Africa
The living conditions in Africa are poor, medical resources are scarce, and idiopathic cardiomyopathy is a serious problem. Dilated cardiomyopathy (DCM), peri-cardiac cardiomyopathy (PPCM), and endocardial fibrosis (EMF) are common in Africa; however, epidemiological, etiology, and treatment and prognosis data are very limited and require Further research.
Third, the coronary flow intervention under the guidance of blood flow reserve fraction (FFR)
FFR can assess the effects of coronary lesions on hemodynamics, and intravascular ultrasound (IVUS) is not a substitute for FFR. Multiple studies have shown that FFR-guided interventional therapy is superior to angiographically guided interventional therapy; the guidelines also recommend FFR. However, only <10% of patients actually received FFR testing. Currently, FFR has been used as an interventional routine in the Asian region. In the next decade, we must pay attention to the important guiding role of FFR in interventional therapy and better apply this tool.
Fourth, the interaction between genes and the environment
Cardiovascular disease is affected by both genetic and environmental factors and interacts with both. It is a very important task to explore gene sequences and gene polymorphisms that affect cardiovascular disease susceptibility and cardiovascular metabolic risk factors. The results we have achieved in this field include: 1 Whole genome research reveals that genetic polymorphism can affect the incidence of coronary heart disease, diabetes and hypertension; 2 if patients carry high-risk genetic factors and long-term exposure to high-risk environmental factors, Genes cause early-onset coronary heart disease; 3 Many studies focus on the interaction of genes and the environment, and explain the theoretical basis in disease risk assessment, prevention and diagnosis.
At present, the problems to be solved in this field include: 1 lack of standardized methods and measurement bias in environmental factor assessment; 2 lack of repeatability of trials; 3 inaccurate positioning of causal genes or mutation regions; 4 small scale of research, statistics The effect is low, while large studies have false positive results; 5 the complexity of environmental factors makes it difficult to clarify their effects on individuals.
Future efforts: 1 Expand the sample size through meta-analysis to obtain more reliable results; 2 Conduct effective and well-designed research to provide lifestyle intervention guidance for patients; 3 Explore the mechanisms of environmental impact genetic factors and apply them In the clinical; 4 explore the gene-environment interaction using a comprehensive research approach.
V. Prediction of rupture of atherosclerotic plaque
Studies have shown that rupture of atherosclerotic plaque is the main cause of myocardial infarction and sudden death. However, it is still difficult to predict whether unstable plaques will rupture and when they will rupture. Although we have reduced the incidence of coronary heart disease by risk factors control, the lack of plaque rupture prediction tools limits myocardial damage prediction. Therefore, we need to further study the biomarkers associated with the breakdown of thin fiber caps. In addition, there is no ideal model for simulating human atherosclerosis at this stage, which is one of our future research directions.
Source: Medical Pulse
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