Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Treatment Options in Cardiovascular Medicine
Erschienen in: Current Treatment Options in Cardiovascular Medicine 4/2018

01.04.2018 | Coronary Artery Disease (D Feldman and V Voudris, Section Editors)

Prevention of Contrast and Radiation Injury During Coronary Angiography and Percutaneous Coronary Intervention

verfasst von: Arash Ehteshami Afshar, MD, MSc, Puja B. Parikh, MD, MPH, FACC, FAHA, FSCAI

Erschienen in: Current Treatment Options in Cardiovascular Medicine | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

In this review, we provide a summary of the recently published literature on various methods of preventing contrast-induced acute kidney injury (CI-AKI) and radiation-related injuries associated with cardiac catheterization and percutaneous coronary intervention (PCI).

Recent findings

The overall reported incidence of CI-AKI is declining, primarily due to adaptation of a standardized definition for CI-AKI as well as implementation of pre-procedural protocols to prevent or decrease the risk of CI-AKI. The implementation of increasing awareness and establishing radiation protection culture has been shown to be effective measures in reducing radiation exposure.

Summary

Coronary angiography and PCI are valuable diagnostic and therapeutic tools in cardiovascular medicine. Accurate imaging of the coronary arteries in cardiac catheterization is dependent on the use of intravascular injection of iodinated contrast media and fluoroscopic imaging. Patients undergoing diagnostic and interventional cardiac catheterization may be exposed to a substantial amount of contrast media and ionizing radiation. Administration of contrast media is correlated with increased risk of CI-AKI, and exposure to radiation is known to be associated with a spectrum of acute and chronic tissue injuries.
Literatur
1.
Kellum JA, Lameire N, Group KAGW. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care. 2013;17(1):204.CrossRefPubMedPubMedCentral
2.
Mamoulakis C, Tsarouhas K, Fragkiadoulaki I, Heretis I, Wilks MF, Spandidos DA, et al. Contrast-induced nephropathy: basic concepts, pathophysiological implications and prevention strategies. Pharmacol Ther. 2017;180:99–112.CrossRefPubMed
3.
Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014;7(1):1–9.CrossRefPubMedPubMedCentral
4.
Wilhelm-Leen E, Montez-Rath ME, Chertow G. Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol. 2017;28(2):653–9.CrossRefPubMed
5.
Newhouse JH, Kho D, Rao QA, Starren J. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 2008;191(2):376–82.CrossRefPubMed
6.
McCullough PA, Choi JP, Feghali GA, Schussler JM, Stoler RM, Vallabahn RC, et al. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2016;68(13):1465–73.CrossRefPubMed
7.
Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int. 2005;68(1):14–22.CrossRefPubMed
8.
Guitterez NV, Diaz A, Timmis GC, O'Neill WW, Stevens MA, Sandberg KR, et al. Determinants of serum creatinine trajectory in acute contrast nephropathy. J Interv Cardiol. 2002;15(5):349–54.CrossRefPubMed
9.
Sharma PV, Babu SC, Shah PM, Nassoura ZE. Changing patterns of atheroembolism. Cardiovasc Surg. 1996;4(5):573–9.CrossRefPubMed
10.
Azzalini L, Garcia-Moll X. On contrast-induced acute kidney injury, risk prediction, and the future of predictive model development. Can J Cardiol. 2017;33(6):711–3.CrossRefPubMed
11.
Weisbord SD, Chen H, Stone RA, Kip KE, Fine MJ, Saul MI, et al. Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. J Am Soc Nephrol. 2006;17(10):2871–7.CrossRefPubMed
12.
Giacoppo D, Madhavan MV, Baber U, Warren J, Bansilal S, Witzenbichler B, et al. Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: pooled analysis from the HORIZONS-AMI and ACUITY trials. Circ Cardiovasc Interv. 2015;8(8):e002475.CrossRefPubMed
13.
Rudnick M, Feldman H. Contrast-induced nephropathy: what are the true clinical consequences? Clin J Am Soc Nephrol. 2008;3(1):263–72.CrossRefPubMed
14.
Abe M, Morimoto T, Nakagawa Y, Furukawa Y, Ono K, Kato T, et al. Impact of transient or persistent contrast-induced nephropathy on long-term mortality after elective percutaneous coronary intervention. Am J Cardiol. 2017;120:2146–53.CrossRefPubMed
15.
Silver SA, Shah PM, Chertow GM, Harel S, Wald R, Harel Z. Risk prediction models for contrast induced nephropathy: systematic review. BMJ. 2015;351:h4395.CrossRefPubMedPubMedCentral
16.
Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393–9.PubMed
17.
Van Praet JT, De Vriese AS. Prevention of contrast-induced nephropathy: a critical review. Curr Opin Nephrol Hypertens. 2007;16(4):336–47.PubMed
18.
Oktay V, Calpar Cirali I, Sinan UY, Yildiz A, Ersanli MK. Impact of continuation of metformin prior to elective coronary angiography on acute contrast nephropathy in patients with normal or mildly impaired renal functions. Anatol J Cardiol. 2017.
19.
Davidson C, Stacul F, McCullough PA, Tumlin J, Adam A, Lameire N, et al. Contrast medium use. Am J Cardiol. 2006;98(6A):42K–58K.CrossRefPubMed
20.
Manske CL, Sprafka JM, Strony JT, Wang Y. Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med. 1990;89(5):615–20.CrossRefPubMed
21.
Azzalini L, Candilio L, McCullough PA, Colombo A. Current risk of contrast-induced acute kidney injury after coronary angiography and intervention: a reappraisal of the literature. Can J Cardiol. 2017;33(10):1225–8.CrossRefPubMed
22.
Lautin EM, Freeman NJ, Schoenfeld AH, Bakal CW, Haramati N, Friedman AC, et al. Radiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media. AJR Am J Roentgenol. 1991;157(1):59–65.CrossRefPubMed
23.
Eng J, Wilson RF, Subramaniam RM, Zhang A, Suarez-Cuervo C, Turban S, et al. Comparative effect of contrast media type on the incidence of contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med. 2016;164(6):417–24.CrossRefPubMed
24.
Vuurmans T, Byrne J, Fretz E, Janssen C, Hilton JD, Klinke WP, et al. Chronic kidney injury in patients after cardiac catheterisation or percutaneous coronary intervention: a comparison of radial and femoral approaches (from the British Columbia cardiac and renal registries). Heart. 2010;96(19):1538–42.CrossRefPubMed
25.
Valgimigli M, Gagnor A, Calabro P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385(9986):2465–76.CrossRefPubMed
26.
Feldkamp T, Luedemann M, Spehlmann ME, Freitag-Wolf S, Gaensbacher J, Schulte K, et al. Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures. Clin Res Cardiol. 2017.
27.
Ando G, Cortese B, Russo F, Rothenbuhler M, Frigoli E, Gargiulo G, et al. Acute kidney injury after radial or femoral access for invasive acute coronary syndrome management: AKI-MATRIX. J Am Coll Cardiol. 2017.
28.
Jurado-Roman A, Hernandez-Hernandez F, Garcia-Tejada J, Granda-Nistal C, Molina J, Velazquez M, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol. 2015;115(9):1174–8.CrossRefPubMed
29.
Luo Y, Wang X, Ye Z, Lai Y, Yao Y, Li J, et al. Remedial hydration reduces the incidence of contrast-induced nephropathy and short-term adverse events in patients with ST-segment elevation myocardial infarction: a single-center, randomized trial. Intern Med. 2014;53(20):2265–72.CrossRefPubMed
30.
Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract. 2003;93(1):C29–34.CrossRefPubMed
31.
Kooiman J, Sijpkens YW, van Buren M, Groeneveld JH, Ramai SR, van der Molen AJ, et al. Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography. J Thromb Haemost. 2014;12(10):1658–66.CrossRefPubMed
32.
• Brar SS, Aharonian V, Mansukhani P, Moore N, Shen AY, Jorgensen M, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014;383(9931):1814–23. The POSEIDON randomized clinical trial is an important study that shows that hemodynamically guided strategy of high volume saline infusion for low intravascular volume status is protective against CI-AKI.CrossRefPubMed
33.
Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BA, Janssen MM, Vermeeren MA, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. 2017;389(10076):1312–22.CrossRefPubMed
34.
Joannidis M, Schmid M, Wiedermann CJ. Prevention of contrast media-induced nephropathy by isotonic sodium bicarbonate: a meta-analysis. Wien Klin Wochenschr. 2008;120(23–24):742–8.CrossRefPubMed
35.
Brar SS, Hiremath S, Dangas G, Mehran R, Brar SK, Leon MB. Sodium bicarbonate for the prevention of contrast induced-acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1584–92.CrossRefPubMedPubMedCentral
36.
Zoungas S, Ninomiya T, Huxley R, Cass A, Jardine M, Gallagher M, et al. Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med. 2009;151(9):631–8.CrossRefPubMed
37.
Zapata-Chica CA, Bello Marquez D, Serna-Higuita LM, Nieto-Rios JF, Casas-Arroyave FD, Donado-Gomez JH. Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy: a systematic review and meta-analysis. Colomb Med (Cali). 2015;46(3):90–103.
38.
Solomon R, Gordon P, Manoukian SV, Abbott JD, Kereiakes DJ, Jeremias A, et al. Randomized trial of bicarbonate or saline study for the prevention of contrast-induced nephropathy in patients with CKD. Clin J Am Soc Nephrol. 2015;10(9):1519–24.CrossRefPubMedPubMedCentral
39.
Subramaniam RM, Suarez-Cuervo C, Wilson RF, Turban S, Zhang A, Sherrod C, et al. Effectiveness of prevention strategies for contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med. 2016;164(6):406–16.CrossRefPubMed
40.••
Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Eng J Med 2017. PRESERVE randomized 2 by 2 factorial trial demonstrated that there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury.
41.
Shalansky SJ, Vu T, Pate GE, Levin A, Humphries KH, Webb JG. N-Acetylcysteine for prevention of radiographic contrast material-induced nephropathy: is the intravenous route best? Pharmacotherapy. 2005;25(8):1095–103.CrossRefPubMed
42.
Baker CS, Wragg A, Kumar S, De Palma R, Baker LR, Knight CJ. A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study. J Am Coll Cardiol. 2003;41(12):2114–8.CrossRefPubMed
43.
Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):180–4.CrossRefPubMed
44.
Li JX, Jin EZ, Yu LH, Li Y, Liu NN, Dong YM, et al. Oral N-acetylcysteine for prophylaxis of contrast-induced nephropathy in patients following coronary angioplasty: a meta-analysis. Exp Ther Med. 2017;14(2):1568–76.CrossRefPubMedPubMedCentral
45.
Pannu N, Wiebe N, Tonelli M. Alberta kidney disease N. Prophylaxis strategies for contrast-induced nephropathy. JAMA. 2006;295(23):2765–79.CrossRefPubMed
46.
Shyu KG, Cheng JJ, Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol. 2002;40(8):1383–8.CrossRefPubMed
47.
Briguori C, Manganelli F, Scarpato P, Elia PP, Golia B, Riviezzo G, et al. Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol. 2002;40(2):298–303.CrossRefPubMed
48.
Investigators ACT. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized acetylcysteine for contrast-induced nephropathy trial (ACT). Circulation. 2011;124(11):1250–9.CrossRef
49.
Gueler F, Rong S, Park JK, Fiebeler A, Menne J, Elger M, et al. Postischemic acute renal failure is reduced by short-term statin treatment in a rat model. J Am Soc Nephrol. 2002;13(9):2288–98.CrossRefPubMed
50.
Liang M, Yang S, Fu N. Efficacy of short-term moderate or high-dose rosuvastatin in preventing contrast-induced nephropathy: a meta-analysis of 15 randomized controlled trials. Medicine (Baltimore). 2017;96(27):e7384.CrossRef
51.
Wang N, Qian P, Yan TD, Phan K. Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: a systematic review and trial sequential analysis. Int J Cardiol. 2016;206:143–52.CrossRefPubMed
52.
Su X, Xie X, Liu L, Lv J, Song F, Perkovic V, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast-induced acute kidney injury: a systematic review and Bayesian network meta-analysis. Am J Kidney Dis. 2017;69(1):69–77.CrossRefPubMed
53.
Mattathil S, Ghumman S, Weinerman J, Prasad A. Use of the RenalGuard system to prevent contrast-induced AKI: a meta-analysis. J Interv Cardiol. 2017;30(5):480–7.CrossRefPubMed
54.
Onbasili AO, Yeniceriglu Y, Agaoglu P, Karul A, Tekten T, Akar H, et al. Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures. Heart. 2007;93(6):698–702.CrossRefPubMed
55.
Ibrahim TA, El-Mawardy RH, El-Serafy AS, El-Fekky EM. Trimetazidine in the prevention of contrast-induced nephropathy in chronic kidney disease. Cardiovasc Revasc Med. 2017;18(5):315–9.CrossRefPubMed
56.
Kassis HM, Minsinger KD, McCullough PA, Block CA, Sidhu MS, Brown JR. A review of the use of Iloprost, a synthetic prostacyclin, in the prevention of radiocontrast nephropathy in patients undergoing coronary angiography and intervention. Clin Cardiol. 2015;38(8):492–8.CrossRefPubMed
57.
Spargias K, Adreanides E, Demerouti E, Gkouziouta A, Manginas A, Pavlides G, et al. Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation. 2009;120(18):1793–9.CrossRefPubMed
58.
Albabtain MA, Almasood A, Alshurafah H, Alamri H, Tamim H. Efficacy of ascorbic acid, N-acetylcysteine, or combination of both on top of saline hydration versus saline hydration alone on prevention of contrast-induced nephropathy: a prospective randomized study. J Interv Cardiol. 2013;26(1):90–6.CrossRefPubMed
59.
Briguori C, Airoldi F, D'Andrea D, Bonizzoni E, Morici N, Focaccio A, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007;115(10):1211–7.PubMed
60.
Ciraj-Bjelac O, Rehani MM, Sim KH, Liew HB, Vano E, Kleiman NJ. Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern? Catheter Cardiovasc Interv. 2010;76(6):826–34.CrossRefPubMed
61.
Andreassi MG, Piccaluga E, Gargani L, Sabatino L, Borghini A, Faita F, et al. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv. 2015;8(4):616–27.CrossRefPubMed
62.
Andreassi MG, Cioppa A, Botto N, Joksic G, Manfredi S, Federici C, et al. Somatic DNA damage in interventional cardiologists: a case-control study. FASEB J. 2005;19(8):998–9.CrossRefPubMed
63.
Pantos I, Patatoukas G, Katritsis DG, Efstathopoulos E. Patient radiation doses in interventional cardiology procedures. Curr Cardiol Rev. 2009;5(1):1–11.CrossRefPubMedPubMedCentral
64.
Christopoulos G, Makke L, Christakopoulos G, Kotsia A, Rangan BV, Roesle M, et al. Optimizing radiation safety in the cardiac catheterization laboratory: a practical approach. Catheter Cardiovasc Interv. 2016;87(2):291–301.CrossRefPubMed
65.
King JN, Champlin AM, Kelsey CA, Tripp DA. Using a sterile disposable protective surgical drape for reduction of radiation exposure to interventionalists. AJR Am J Roentgenol. 2002;178(1):153–7.CrossRefPubMed
66.
Murphy JC, Darragh K, Walsh SJ, Hanratty CG. Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures. Am J Cardiol. 2011;108(10):1408–10.CrossRefPubMed
67.
Maeder M, Brunner-La Rocca HP, Wolber T, Ammann P, Roelli H, Rohner F, et al. Impact of a lead glass screen on scatter radiation to eyes and hands in interventional cardiologists. Catheter Cardiovasc Interv. 2006;67(1):18–23.CrossRefPubMed
68.
Karadag B, Ikitimur B, Durmaz E, Avci BK, Cakmak HA, Cosansu K, et al. Effectiveness of a lead cap in radiation protection of the head in the cardiac catheterisation laboratory. EuroIntervention. 2013;9(6):754–6.CrossRefPubMed
69.
Fetterly KA, Bell MR. A practical approach to radiation protection for cardiac catheterization laboratory staff. JACC Cardiovasc Interv. 2017.
70.
Musallam A, Volis I, Dadaev S, Abergel E, Soni A, Yalonetsky S, et al. A randomized study comparing the use of a pelvic lead shield during trans-radial interventions: threefold decrease in radiation to the operator but double exposure to the patient. Catheter Cardiovasc Interv. 2015;85(7):1164–70.CrossRefPubMed
71.
Duran A, Hian SK, Miller DL, Le Heron J, Padovani R, Vano E. Recommendations for occupational radiation protection in interventional cardiology. Catheter Cardiovasc Interv. 2013;82(1):29–42.CrossRefPubMed
72.
Abdelaal E, Plourde G, MacHaalany J, Arsenault J, Rimac G, Dery JP, et al. Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions. JACC Cardiovasc Interv. 2014;7(5):567–74.CrossRefPubMed
73.
Mangels DR, Giri J, Hirshfeld J, Wilensky RL. Robotic-assisted percutaneous coronary intervention. Catheter Cardiovasc Interv. 2017.
74.
McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 2014;273(3):714–25.CrossRefPubMed
75.
Szummer K, Lundman P, Jacobson SH, Schon S, Lindback J, Stenestrand U, et al. Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish web-system for enhancement and development of evidence-based care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Circulation. 2009;120(10):851–8.CrossRefPubMed
76.
Brown JR, Solomon RJ, Sarnak MJ, McCullough PA, Splaine ME, Davies L, et al. Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention. Circ Cardiovasc Qual Outcomes. 2014;7(5):693–700.CrossRefPubMedPubMedCentral
77.
Fetterly KA, Mathew V, Lennon R, Bell MR, Holmes DR Jr, Rihal CS. Radiation dose reduction in the invasive cardiovascular laboratory: implementing a culture and philosophy of radiation safety. JACC Cardiovasc Interv. 2012;5(8):866–73.CrossRefPubMed
78.
Ploussi A, Efstathopoulos EP. Importance of establishing radiation protection culture in radiology department. World J Radiol. 2016;8(2):142–7.CrossRefPubMedPubMedCentral
Metadaten
Titel
Prevention of Contrast and Radiation Injury During Coronary Angiography and Percutaneous Coronary Intervention
verfasst von
Arash Ehteshami Afshar, MD, MSc
Puja B. Parikh, MD, MPH, FACC, FAHA, FSCAI
Publikationsdatum
01.04.2018
Verlag
Springer US
Erschienen in
Current Treatment Options in Cardiovascular Medicine / Ausgabe 4/2018
Print ISSN: 1092-8464
Elektronische ISSN: 1534-3189
DOI
https://doi.org/10.1007/s11936-018-0621-3

Weitere Artikel der Ausgabe 4/2018

Current Treatment Options in Cardiovascular Medicine 4/2018 Zur Ausgabe

Cardio-oncology (M Fradley, Section Editor)

Evaluation and Management of Cardiac Tumors

Heart Failure (W Tang, Section Editor)

Sleep Apnea in Heart Failure

Arrhythmia (G Upadhyay, Section Editor)

Novel Mapping Strategies for Ventricular Tachycardia Ablation

Heart Failure (W Tang, Section Editor)

Heart Failure with Recovered EF and Heart Failure with Mid-Range EF: Current Recommendations and Controversies

Cardio-oncology (M Fradley, Section Editor)

The Role of Cardiovascular Magnetic Resonance in the Management of Patients with Cancer

Heart Failure (W Tang, Section Editor)

Current Management and Future Directions of Heart Failure With Preserved Ejection Fraction: a Contemporary Review

Neu im Fachgebiet Kardiologie

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Vorhofflimmern bei Jüngeren gefährlicher als gedacht

06.05.2024 Vorhofflimmern Nachrichten

Immer mehr jüngere Menschen leiden unter Vorhofflimmern. Betroffene unter 65 Jahren haben viele Risikofaktoren und ein signifikant erhöhtes Sterberisiko verglichen mit Gleichaltrigen ohne die Erkrankung.

Chronisches Koronarsyndrom: Gefahr von Hospitalisierung wegen Herzinsuffizienz

06.05.2024 Herzinsuffizienz Nachrichten

Obwohl ein rezidivierender Herzinfarkt bei chronischem Koronarsyndrom wahrscheinlich die Hauptsorge sowohl der Patienten als auch der Ärzte ist, sind andere Ereignisse womöglich gefährlicher. Laut einer französischen Studie stellt eine Hospitalisation wegen Herzinsuffizienz eine größere Gefahr dar.

Das Risiko für Vorhofflimmern in der Bevölkerung steigt

02.05.2024 Vorhofflimmern Nachrichten

Das Risiko, im Lauf des Lebens an Vorhofflimmern zu erkranken, ist in den vergangenen 20 Jahren gestiegen: Laut dänischen Zahlen wird es drei von zehn Personen treffen. Das hat Folgen weit über die Schlaganfallgefährdung hinaus.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise