Anesthetic management in patients with long QT and Brugada syndromes

PURPOSE OF REVIEW

Both long QT and Brugada syndrome are inherited arrhythmic conditions that can predispose patients to life-threatening ventricular arrhythmias. Managing the anesthesia for patients with either long QT or Brugada syndrome necessitates an understanding of potential drug-drug interactions with the underlying channelopathy. This review illustrates contemporary insight into managing such patients for the anesthesiologist.

RECENT FINDINGS

Long QT, due to disorder of potassium or sodium ion channels, is associated with prolonged repolarization of the action potential phase. Medications that prolong the action potential should be avoided. In patients with long QT syndrome, each drug administered should be carefully reviewed to be certain it does not prolong the QT interval. Brugada syndrome is a result of a pathogenic sodium channel that results in potential ventricular arrhythmias. Medications that exacerbate the electrocardiographic changes of Brugada should be avoided.

SUMMARY

Anesthesiologists need to be aware of proper management in children with known or suspected long QT or Brugada pathologies as well as the potential poly-pharmaceutical impact that exists on cardiac ion channels.

Development and validation of a highly sensitive HPLC method for quantifying cardiovascular drugs in human plasma using dual detection

Cardiovascular diseases are the major cause of global mortality, and often require the concomitant use of a number of drugs to prevent and reduce these deaths. The challenge is to find effective and accurate methods for analyzing these drugs in plasma. This research introduces an innovative, sustainable HPLC-FLD method for the concurrent determination of bisoprolol (BIS), amlodipine besylate (AML), telmisartan (TEL), and atorvastatin (ATV) within human plasma. Chromatographic separation was achieved using an isocratic elution mode on a Thermo Hypersil BDS C18 column (150 × 4.6 mm, 5.0 μm), while the mobile phase comprised of ethanol and 0.03 M potassium phosphate buffer (pH 5.2) in a 40:60 ratio, with a flow rate of 0.6 mL/min. The eluate was analyzed using UV detection within the wavelength range of 210-260 nm to confirm effective separation of the four cardiovascular drugs. For enhanced specificity, a fluorescence detector was set to 227ex/298em for BIS, 294ex/365em for TEL, 274ex/378em for ATV, and 361ex/442em for amlodipine. The method was validated following the International Council for Harmonisation (ICH) guidelines. Linearity was established within the ranges of 5-100 ng/mL for BIS and AML, 0.1-5 ng/mL for TEL, and 10-200 ng/mL for ATV, ensuring accuracy and precision. The significant of the current work represented in introduction of a highly sensitive, and selective analytical method, utilizing an economical sample preparation strategy, for the simultaneous determination of four different cardiovascular drugs (bisoprolol, amlodipine, telmisartan, and atorvastatin) in spiked human plasma. The extraction of sample was carried by liquid-liquid extraction (LLE) and analyzed by LC-fluorescence detector. The chromatographic run was short (less than10 min) which is a greet economical value.

Effect of Respiratory Support Type and Total Duration on Weaning From Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Patients

Background: We evaluated the impact of noninvasive respiratory support (NRS) and invasive mechanical ventilation duration before venovenous extracorporeal membrane oxygenation (VV-ECMO) on weaning from venovenous ECMO and survival. Methods: In a retrospective single-center study, we studied subjects with COVID-19 ARDS treated with VV-ECMO. The subjects were divided and analyzed according to the cut-off of NRS, invasive ventilation, and total duration of respiratory support. Results: We identified a cut-off of NRS duration of 4 days, invasive ventilation duration of 5 days, and total respiratory support duration of 8 days. Weaning from VV-ECMO was observed in 63% (15/24) of subjects with NRS duration ≤ 4 days and in 16% (4/25) of subjects with NRS > 4 days (P = .001), in 50% (17/34) of subjects with invasive ventilation duration ≤ 5 days, in 13% (2/15) of subjects with invasive ventilation duration > 5 days (P = .02), in 68% (13/19) of subjects with total support duration < 8 days, and in 20% (6/30) of subjects with total support duration > 8 days (P = .001). The survival probability at 200 days demonstrated a statistically significant difference in NRS and total support duration comparison (P = .001 and P = .004, respectively). We did not find a statistically significant survival difference according to invasive ventilation duration (P = .13). Conclusions: In our population, the increase in NRS and total support days before ECMO could hamper weaning from VV-ECMO support. However, due to the pandemic, the small sample size, and the lack of precise data on ventilation settings, caution should be exercised in universalizing these results.

Pulmonary vein stenosis: future optimism

PURPOSE OF REVIEW

Pulmonary vein stenosis (PVS) is a rare disease with high morbidity and mortality. Prevention of restenosis remains challenging. This review will highlight recent advances in therapy that are beginning to show a survival benefit.

RECENT FINDINGS

Intervention for multivessel pediatric PVS may be surgical or transcatheter, both with high restenosis rates. At a threshold upstream diameter of 7 mm, the risk of restenosis decreases. Close vigilance and frequent reinterventions, typically transcatheter, are now accepted practice to maintain vein patency and achieve upstream growth. Suppressive agents targeting the exuberant myofibroblastic proliferation characteristic of PVS, specifically sirolimus, delivered locally on the surface of balloons and stents, and as adjunct systemic therapy, have been shown to increase survival and decrease reinterventions. Newer surgical techniques focused on shortening and straightening the vein to optimize flow dynamics, coupled with hybrid intraoperative stent placement in selected cases, also show a survival benefit.Adult-onset PVS, most commonly a complication of pulmonary vein isolation, now occurs rarely, and generally responds to transcatheter intervention. Further advances in ablation techniques aim to eliminate this complication.

SUMMARY

An aggressive approach of frequent reinterventions is a necessary strategy rather than treatment failure. More granular understanding of the mechanisms underlying PVS leading to novel muti-pronged anatomic and suppressive therapy are yielding improved survival.Multispecialty PVS teams at the institutional level and multiinstitutional collaboration, now possible via the PVS registry, are crucial to optimal care and future progress.

Connecting the Dots: How MicroRNAs Link Asthma and Atherosclerosis

Asthma and atherosclerosis are chronic conditions with distinct pathophysiologies, but overlapping inflammatory mechanisms that suggest a potential common regulatory framework. MicroRNAs (miRNAs), small non-coding RNA molecules that modulate gene expression post-transcriptionally, could be key players in linking these disorders. This review outlines how miRNAs contribute to the complex interplay between asthma and atherosclerosis, focusing on key miRNAs involved in inflammatory pathways, immune cell regulation and vascular remodeling. We discuss specific miRNAs, such as miR-155, miR-21 and miR-146a, which have been shown to modulate inflammatory cytokine production and T cell differentiation, impacting respiratory and cardiovascular health. The common miRNAs found in both asthma and atherosclerosis emphasize their role as potential biomarkers, but also as therapeutic targets. Understanding these molecular connections may unlock novel approaches for innovative, integrated treatment strategies that address both conditions and may significantly improve patient outcomes. Further research is needed to explore mechanistic pathways and validate the translational potential of miRNA-based interventions in preclinical and clinical settings.

Novel insights into myocardial fibrosis in patients with new onset ST-elevation myocardial infarction following percutaneous coronary intervention through enhanced cardiac magnetic resonance imaging: a prospective cohort study

BACKGROUND

Myocardial fibrosis is a prevalent pathological hallmark of a diverse range of chronic and acute cardiovascular disorders. However, the relevant literature currently provides limited evidence regarding the determinants of myocardial fibrosis severity in patients with new-onset ST-elevation myocardial infarction (STEMI) following successful emergent percutaneous coronary intervention (PCI) utilizing contrast-enhanced cardiac magnetic resonance imaging (CE-CMR).

METHODS

We prospectively enrolled a cohort of 78 patients who presented with new-onset ST-segment elevation myocardial infarction and who underwent successful emergent PCI within 12 h from the onset of symptoms. Late gadolinium-enhanced LGE (LGE) was quantified via CE-CMR, and patients were categorized into two groups on the basis of the median LGE value.

RESULTS

The median LGE was 16% (IQR 12 to 24). Compared with patients with LGE below the median (n = 37), those with LGE above the median (n = 41) presented significantly reduced left ventricular global radial strain(GRS), global circumferential strain(GCS), and global longitudinal strain(GLS) (all p < 0.05). The infarcted radial segment (IRS), infarcted circumferential segment (ICS) and infarcted longitudinal segment (ILS) were significantly reduced in patients with greater LGE (all p < 0.05). The occurrence rates of microvascular obstruction (MVO) (p < 0.001) and wall motion abnormality (WMA) (p < 0.01) were significantly greater in patients with a greater extent of LGE, despite successful reperfusion therapy. LGE exhibited a moderate negative correlation with the global circumferential segment (r=-0.547, p < 0.001) and a weak negative correlation with both the global radial segment and the global longitudinal segment (r=-0.434, p < 0.001; r=-0.437, p < 0.001). In the multivariable linear regression analysis model, the Gensini score (β = 0.258; p < 0.01), LVEF% (β=-0.269; p < 0.05), MVO (β = 0.343; p < 0.001) and GRS (β = 0.227; p < 0.05) emerged as robust predictors of myocardial fibrosis.

CONCLUSION

The present study revealed a correlation of cardiac pathological structure, microcirculation, and myocardial fibrosis in the context of acute myocardial infarction. Therefore, this study provides theoretical evidence from a pathological perspective regarding the progression of myocardial fibrosis in patients with new-onset STEMI following successful PCI.

TRIAL REGISTRATION

The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2400080282; January 25th, 2024).

The effect of exercise therapy on pain, fatigue, bone function and inflammatory biomarkers individuals with rheumatoid arthritis and knee osteoarthritis: a meta-research review of randomized controlled trials

Background

Accumulating evidence suggested the potential role of exercise in alleviating rheumatoid arthritis (RA). However, whether exercise improves physical function (walk test, grip strength, muscle strength, joint assessments) and inflammatory biomarkers in patients with RA is unclear. This umbrella meta-analysis aimed to examine the effect of exercise in patients with RA.

Method

PubMed, Scopus, Web of Science, Embase, and Cochrane Central Library databases were systematically searched for meta-analyses of randomized control trials (RCTs) to retrieve relevant studies. The effect sizes were pooled using a random-effects model, with standardized or weighted mean differences (SMDs or WMDs) and 95% confidence intervals (CIs) as summary statistics.

Results

Seventeen studies were included. The improving effects of exercise on fatigue levels (SMD = -0.28, 95% CI: -0.44, -0.13), pain intensity (ES = -0.50, 95% CI: -0.87, -0.14), disease activity score in joints (DAS) (WMD = -0.54, 95% CI: -0.99, -0.09; and SMD = -0.47, 95% CI: -0.64, -0.30), and ESR (ES = -0.85, 95% CI: -1.66, -0.03) were significant. No significant impact on the hand grip, muscle strength, walk test, joints and inflammatory biomarkers was observed.

Conclusion

Exercise significantly reduces fatigue, pain, DAS, and ESR in RA but shows no impact on grip strength, muscle strength, walk test, joints, or other inflammatory biomarkers. This highlights its role in symptom management rather than broad physiological changes.

Association of helicobacter pylori infection with lipid metabolism and 10-year cardiovascular risk in diabetes mellitus: A cross-sectional study

BACKGROUND

Previous studies have shown that Helicobacter pylori infection is not only a risk factor for gastrointestinal diseases but also associated with various non-digestive conditions. This study aimed to investigate the effect of Helicobacter pylori infection on the risk of lipid metabolism disorders and cardiovascular disease in individuals with diabetes mellitus.

METHODS

This cross-sectional study was conducted at a health examination center. Data from life questionnaires, laboratory tests, the carbon-13 urea breath test, and the Framingham Risk Score were collected from 266 patients with diabetes. All participants were categorized into Helicobacter pylori-uninfected and Helicobacter pylori-infected groups based on the carbon-13 urea breath test results. Differences in lipid levels, Framingham Risk Score, and cardiovascular disease risk were compared between the two groups. A logistic regression model was applied to analyze whether Helicobacter pylori infection is an independent risk factor for dyslipidemia in patients with diabetes.

RESULTS

Total cholesterol and low-density lipoprotein cholesterol levels were higher in the Helicobacter pylori-infected group than in the uninfected group, and high-density lipoprotein cholesterol levels were lower in the infected group (both P <  0.05). There was no statistically significant difference in triglyceride levels between the two groups. Regression analysis showed that Helicobacter pylori infection was an independent risk factor for dyslipidemia in patients with diabetes (P <  0.05). The Framingham Risk Score and 10-year cardiovascular disease risk were higher in the Helicobacter pylori-infected group compared with the uninfected group (P <  0.001).

CONCLUSION

Helicobacter pylori infection is associated with dyslipidemia and may contribute to an increased risk of cardiovascular disease in individuals with diabetes.

From Joints to the Heart: An Integrated Perspective on Systemic Inflammation

BACKGROUND

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which predominantly affects joints, but it can also lead to significant extra-articular complications, particularly cardiovascular disease (CVD). Chronic systemic inflammation promotes endothelial dysfunction and accelerates atherosclerosis, increasing cardiovascular risk.

METHODS

Current data were analyzed to explore the mechanisms between RA and CVD, focusing on systemic inflammation, pro-inflammatory cytokine patways (IL-1, IL-6, TNF, and JAK-STAT), and their interactions with traditional cardiovascular risk factors. Recent studies and clinical guidelines were reviewed to highlight gaps and advances in risk assessment and management.

RESULTS

Persistent disease activity and the presence of autoantibodies significantly increase cardiovascular risk in RA contributing to atherosclerosis and major cardiovascular events. Data also suggest that anti-inflammatory treatments, including methotrexate and biologic agents, may lower this risk.

CONCLUSION

This review highlights the pathophysiological mechanisms between RA and CVD, and the need for early diagnosis and active monitoring to identify and assess cardiovascular risk. A multidisciplinary approach, involving rheumatologists and cardiologists is essential for optimizing cardiovascular risk management and improving patient outcomes. Optimization of cardiovascular risk management strategies in patients with RA should be an essential component of current medical practice, with the main goal of reducing morbidity and mortality from cardiovascular complications.

Network meta-analysis on efficacy of nerve stimulation or modulation in patients with heart failure

BACKGROUND

Dysfunction of the autonomic nervous system (characterized by excessive sympathetic activation and reduced parasympathetic activity) is regarded as 1 of the primary mechanisms of heart failure. Theoretically, nerve stimulation or modulation targeting this autonomic imbalance could improve outcomes in heart failure, but current evidence is inconclusive.

OBJECTIVE

This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of various nerve stimulation/modulation approaches in patients with heart failure.

METHODS

We conducted a frequentist-based NMA of randomized controlled trials (RCTs) investigating nerve stimulation or modulation techniques for heart failure management. The primary outcomes included objective measures (such as brain natriuretic peptide [BNP] serum levels) and subjective measures (such as psychosocial functioning and quality of life).

RESULTS

Interventions targeting both arms of the autonomic nervous system, including sympathetic and parasympathetic nervous systems, and the vasculature (carotid or renal arteries) demonstrated preferable results. Interventions dealing only with the autonomic nervous system did not provide significant results. Specifically, only renal sympathetic denervation was significantly associated with a more significant reduction in BNP levels than in the control group. Additionally, baroreflex activation therapy was the only treatment significantly associated with improving quality of life.

CONCLUSION

This study provides comparative evidence supporting the use of specific nerve stimulation/modulation techniques in treating heart failure. Further well-designed RCTs, incorporating appropriate blinding, are recommended to minimize potential biases.

Nanotechnology Innovations in Myocardial Infarction: Diagnosis, Treatment and the Way Forward

Myocardial infarction (MI) is a global health concern that necessitates continued advancements in diagnostic and therapeutic modalities. Nanotechnology facilitates prompt diagnosis and personalized treatment. This manuscript explicitly reviews the application of innovative methodologies for identifying cardiac biomarkers to facilitate the early diagnosis of MI and its clinical management. Nanoscale agents such as nanoparticles and nanosensors have been employed for this purpose. Technological advancements in medical imaging are revolutionizing therapeutic approaches while reducing morbidity and mortality typically associated with cardiac tissue injury. Besides all, applications of nanotechnology in therapeutics have proven extremely effective. The development of nanoparticle-based customized drug delivery systems will contribute to more effective treatments, fewer side effects, and improved therapeutic outcomes. Biomaterials and nanoscale surgical technologies may benefit patients with MI by promoting tissue regeneration and repair. This manuscript also investigates the ethical and legal limitations that could prevent seamless incorporation of nanotechnology into clinical practice.

Impact of the Circadian Rhythm and Seasonal Changes on the Outcome of Cardiovascular Interventions

The activities of living beings fluctuate according to seasonal changes and circadian rhythms. The interaction of organisms with their environment, notably weather conditions and night-day cycles, modulate homeostatic mechanisms and influence physiological responses in stressful situations. In humans, it is well established that cardiovascular events such as myocardial infarction, stroke and acute heart failure more frequently occur in winter than in summer season (non-tropical regions) and in the morning than in the evening. While the effects of cardiovascular medications vary during the day, the influence of circadian rhythms on the outcomes of invasive interventions is the subject of conflicting debates. This paper analyzes the impact of seasonal variability and circadian rhythms on physiological responses and the occurrence of complications in cardiac surgery and interventional cardiology.

Investigating Cognitive Load and Autonomic Arousal During Voice Production and Vocal Auditory-Motor Adaptation

PURPOSE

Cognitive load and autonomic arousal are hypothesized to affect voice production, yet the nature of these relationships is unclear. The purpose of this study was to assess how cognitive load and autonomic arousal differentially affect voice production and vocal motor control.

METHOD

Physiological measures of autonomic arousal were recorded from 30 adults under different cognitive loads elicited by a Stroop task. In Experiment 1, voice acoustic measures were measured during speech production. In Experiment 2, fundamental frequency (fo) responses to predictably altered auditory feedback (sensorimotor adaptation) were measured. Mixed linear-effects models assessed relationships between variables. Changes between cognitive loads were compared among the two experiments.

RESULTS

In Experiment 1, increased cognitive load was associated with increases in sound pressure level, whereas increases in autonomic arousal measures (i.e., decreases in skin conductance rise time, pulse amplitude, and period) were related to decreases in cepstral peak prominence. Increased autonomic arousal (i.e., decreased pulse amplitude) was related to increased adaptation in Experiment 2. Participants who responded to increased cognitive load by decreasing fo during Experiment 1 showed more adaptation in Experiment 2.

CONCLUSION

Differential effects of cognitive load and autonomic arousal emphasize the importance of individual physiological variability when assessing how stress affects the voice.

Assessing level of awareness of atrial fibrillation among general public: a cross-sectional study

BACKGROUND

Patients with atrial fibrillation (AF) are at increased risk of stroke. Poor knowledge of AF in general population contributes to under-detection and treatment delay. Therefore, this study aimed to assess level of awareness of AF among general public in Dhulikhel municipality, Nepal.

METHODS

This was a cross sectional study involving quantitative approach using self-administered questionnaire. Participants of age ≥ 50 years from wards 4, 5, 6 and 7 of Dhulikhel municipality were enrolled. English version of AFKAT (Atrial Fibrillation Knowledge Assessment Tool) was translated and validated which was then used to assess the level of awareness of AF.

RESULTS

In total 355 respondents were recruited. The mean age group was found to be 65.57 ± 9.99 years. Mean percentage score of level of awareness of AF was found to be only 2.61%, which was very poor. Only 2.54% (n = 9) had good level of knowledge about AF. 95.77% (n = 340) had very poor level of awareness. Significant difference of mean awareness level was found between group with AF and without AF. Respondent with AF had 58.70% score compared with just 2.29% score of non-AF group. Knowledge deficits were more in older participants. The knowledge score of AF was found to be 3.55%, 4.21%, 0.05%, 1.21% and 0% among age groups 50-59 years, 60-69 years, 70-79 years, 80-89 years and ≥ 90 years respectively. Only 2.54% (9 out of 355) correctly identified that AF can lead to blood clot and stroke. Just 2.82% (10 out of 355) respondents recognized that anticoagulants are used to prevent stroke in AF patients.

CONCLUSIONS

The level of awareness of AF among general public of Dhulikhel was found to be very poor. Appropriate interventions need to be applied to educate risk groups about AF to reduce future risk of stroke and minimize public health burden.

CLINICAL TRIAL NUMBER

Not applicable.

Effects of camel hump fat, palm olein oil, and corn oil feed additives on plasma lipids and adipose tissues in rats

Hyperlipidemia is an important risk factor for cardiovascular disease and a leading cause of mortality and is often associated with obesity. Different types of fats and oils may have different effects on cardiovascular disease and obesity. This study investigated the effects of palm olein oil (PO), corn oil (CO), and camel hump fat (CHF) on plasma lipids and white adipose tissues of rats. A total of 18 male albino rats were divided equally into three groups. Each group was fed a diet containing one of these types of oils and fats for 8 weeks. The levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total triglyceride (TG), glucose, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were analyzed in blood plasma. Body mass index (BMI), body weight gain (%BWG), and the weight of adipose tissues were investigated. The results showed no significant differences between groups in TC. However, the highest level of HDL-C was observed in the CHF group, with no significant differences in the PO group and a significant decrease in the CO group. The CHF group showed a significant reduction in LDL-C, blood glucose levels, and the atherosclerosis index compared with the other groups. Furthermore, the lowest TG level was observed in the CHF group, with no significant difference compared with the CO group. The PO group showed a significant decrease in the ALT level compared with the other groups. The lowest AST level was observed in the PO group, with no significant difference compared with the CO group. A significant decrease in the percentage of total adipose tissues, namely epididymal, retroperitoneal, and perirenal cells, was observed in the CHF group. In conclusion, CHF consumption may have a positive effect on plasma lipids and obesity. Moreover, we recommend the completion of research to identify the optimal combination of vegetable oils and CHF for achieving a balance among the health indicators included in this study.

Managing anticoagulation and thromboembolic risk in cryptogenic stroke associated with patent foramen ovale

Cryptogenic stroke (CS) in young adults may be associated with the presence of a patent foramen ovale (PFO). This case report presents a woman in her 40s admitted with sudden left hemiplegia. Imaging confirmed an ischaemic stroke in the right middle cerebral artery territory and occlusion of the right internal carotid artery. Further investigations identified a large PFO associated with an atrial septal aneurysm. An in-depth assessment revealed a distal deep vein thrombosis (DVT). Initial anticoagulation therapy was interrupted due to severe metrorrhagia, necessitating the placement of an inferior vena cava (IVC) filter. Subsequent extensive thrombosis of the IVC led to initiation of low molecular weight heparin followed by long-term direct oral anticoagulants. This case highlights the complexity of managing CS with PFO, emphasising the importance of thorough aetiological evaluation to distinguish pathogenic from incidental PFO, and the need for a personalised and multidisciplinary therapeutic strategy to balance thromboembolic and haemorrhagic risks effectively.

Prevalence of HTN and its risk factors among tribal population in Chhattisgarh (India) as per the fifth round of the National Family Health Survey

BACKGROUND

The so-called protected tribal population also faces the burden of non-communicable diseases (NCDs). The high-altitude tribes are thought to be genetically and environmentally protected from hypertension-like diseases.

METHODS

Survey of the National Family Health Survey-5 (2019-2022) employs a two-stage sampling method (PSU). The total population of 72010, aged 15 years and above, were included from Chhattisgarh, India, out of which 27760 belong to tribes. Pre-hypertension (pre-HTN) and hypertension (HTN) were measured using standard procedures.

RESULTS

Overall prevalence of pre-HTN and HTN (42.7% and 26%) in tribes was comparable to the general population (43.14% and 25.48%). The prevalence of pre-HTN was higher than HTN in tribes. We observed a positive association between increasing age and prevalence of HTN in males and females. aOR ratio (12.58; 9.72 -16.28) among the females aged 65-74 years was the highest, and the aOR (9.63; 6.89 -13.44) ratio among the males was recorded highest at 75 years and above. Odds of developing HTN increased with higher education (aOR 1.24; 1 -1.53 and 0.69; 0.5 -0.94), highest wealth index (aOR 1.38; 1.04 -1.83 and 1.35; 1.01 -1.8) in male and females respectively.

CONCLUSION

The elevated frequencies of HTN among tribes against their background condition confirm that their epidemiological transition is loaded with significant HTN. We recommend sharing this initiative with our primary healthcare providers and to the policymakers to take corrective measures because they serve as the first point of contact for early screening to reduce the burden of illness.

Liposomal topical drug administration surpasses alternative methods in glaucoma therapeutics: a novel paradigm for enhanced treatment

OBJECTIVES

Glaucoma is a leading cause of permanent blindness. Despite therapeutic advancements, glaucoma management remains challenging due to limitations of conventional drug delivery, primarily topical eye drops, resulting in suboptimal outcomes and a global surge in cases. To address these issues, liposomal drug delivery has emerged as a promising approach.

KEY FINDINGS

This review explores the potential of liposomal-based medications, with a particular focus on topical administration as a superior alternative to enhance therapeutic efficacy and improve patient compliance compared to existing treatments. This writing delves into the therapeutic prospects of liposomal formulations across different administration routes, as evidenced by ongoing clinical trials. Additionally, critical aspects of liposomal production and market strategies are discussed herein.

SUMMARY

By overcoming ocular barriers and optimizing drug delivery, liposomal topical administration holds the key to significantly improving glaucoma treatment outcomes.

Catecholamines in sepsis: pharmacological insights and clinical applications-a narrative review

Catecholamines, essential neurotransmitters and hormones, play a critical role in the body's physiological response to stress and are pivotal in the management of various clinical conditions, particularly in critical care settings. This narrative review delves into the pharmacological properties of catecholamines, including their mechanisms of action, pharmacokinetics, and pharmacodynamics. Key clinical applications of catecholamines, especially in the cardiovascular and immune systems, are highlighted, emphasizing their roles in modulating heart rate, vascular tone, and immune responses during critical conditions such as sepsis and septic shock. Additionally, the review explores catecholamines' immunomodulatory effects and their interactions with other therapeutic agents, such as corticosteroids, in the management of septic shock. Further research is suggested to optimize catecholamine usage and improve patient outcomes in critical care settings.

Long-Term Outcomes of Surgical and Transcatheter Interventions for Tricuspid Regurgitation: A Comprehensive Review

Impacting more than 70 million people worldwide, tricuspid regurgitation (TR) refers to the retrograde flow of blood from the right ventricle to the right atrium due to the improper closure of the tricuspid valve. Depending on the severity of TR, signs and symptoms can range from asymptomatic to features of right heart failure, including dyspnea, exercise intolerance, peripheral edema, and ascites. Severe features such as these necessitate treatment. In recent years, advancements in management, including surgical and transcatheter interventions, have taken prominence, leading to improved short-term outcomes in this patient population. However, there is still a dearth of evidence regarding the long-term outcomes of surgical and transcatheter interventions for TR. This comprehensive review aims to present clinicians with recent findings from pivotal clinical studies on interventional clinical outcomes in an effort to help guide their judgment when it comes to deciding the best course of treatment for their patients.

Serum Angptl2 and CyPA Levels in Acute Myocardial Infarction and In-Stent Restenosis After Percutaneous Coronary Intervention: A Single-Center Retrospective Case-Control Study

Purpose

To explore the association between angiopoietin-like protein 2 (Angptl2) and cyclophilin A (CyPA) with acute myocardial infarction (AMI) and the occurrence of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).

Patients and Methods

A single-center retrospective research was conducted. Clinical data from 146 AMI patients who underwent PCI at our hospital were analyzed and designated as the AMI group. Additionally, 56 healthy individuals who underwent medical check-ups during the same period were enrolled as the Control group. Serum levels of Angptl2 and CyPA were compared between the AMI and control groups. Furthermore, based on the presence or absence of in-stent restenosis (ISR) during the follow-up period, the AMI patients were further divided into ISR and NISR groups. Logistic regression analysis was utilized to ascertain the risk factors influencing ISR after PCI in AMI patients. The diagnostic value of serum Angptl2 and CyPA for ISR after PCI was assessed using the receiver operating characteristic (ROC) curve.

Results

Compared with the Control group, the AMI group exhibited significantly elevated levels of Angptl2 and CyPA (P<0.05). Logistic regression analysis identified serum Angptl2 and CyPA are risk factors for occurrence of ISR after PCI in AMI patients. Additionally, the ROC curve analysis demonstrated that the combined use of serum Angptl2 and CyPA achieved an area under the curve (AUC) of 0.895 for predicting ISR in AMI patients after PCI.

Conclusion

Elevated serum levels of Angptl2 and CyPA in AMI patients who developed ISR after PCI suggest that these biomarkers may serve as potential risk indicators for predicting ISR following PCI.

Influencing factors and predictive indicators of return of spontaneous circulation in in-hospital cardiac arrest

Background

In-hospital cardiac arrest (IHCA) refers to the occurrence of cardiac arrest in hospitalized patients requiring chest compressions and/or defibrillation, with only about one-third of patients achieving return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation. Pan-immune-inflammation value (PIIV) is an indicator assessing the overall inflammatory status within the body, but the relationship between PIIV and ROSC remains unclear.

Objective

This study aims to analyze the occurrence of ROSC and its influencing factors, and investigate the predictive value of PIIV, in order to provide insights for clinical prevention and treatment.

Methods

Clinical data of IHCA patients admitted to our hospital were retrospectively collected. Patients were divided into the ROSC group and non-ROSC group based on whether spontaneous circulation was restored after cardiopulmonary resuscitation. Multivariate logistic regression was used to analyze factors affecting ROSC, and the receiver operating characteristic (ROC) curve was employed to calculate the area under the curve (AUC) to evaluate the predictive value of PIIV.

Results

168 patients' clinical data were collected, including 62 patients with ROSC and 106 with non-ROSC. The results of multivariate logistic regression analysis showed that the duration of cardiopulmonary resuscitation, adrenaline dosage, blood lactate (Lac), and PIIV were independent influencing factors for ROSC in IHCA patients (P < 0.05). The ROC curve analysis revealed that the AUC of PIIV for predicting ROSC in IHCA patients was 0.805 (95% CI: 0.720-0.891), with an optimal cutoff value of 395.3, sensitivity of 83.33%, and specificity of 70.37%.

Conclusion

PIIV demonstrates valuable application in predicting ROSC in IHCA patients.

Morphological analysis of myocardial bridging leading to myocardial ischemia: myocardial coronary coupling

Introduction

Myocardial bridge (MB) is a segment of an otherwise extramyocardial blood vessel that traverses the myocardium. This congenital condition typically lacks obvious clinical manifestations during adolescence. However, as individuals age, the accumulated myocardial pressure on the coronary arteries can lead to non-obstructive coronary ischemia, angina pectoris, and even heart failure. Early diagnosis is crucial for assessing the risk of cardiovascular events.

Methods

This study performed a morphological analysis of MB in 75 patients using dual-source Computed Tomographic Angiography (CTA). Through geometric three-dimensional reconstruction, measurements and statistical analyses were conducted on muscle bridge length, depth, length-to-depth ratio, cross-sectional area, and coronary artery curvature.

Results

This study explores the morphological differences among normal individuals, those with superficial MB, and those with deep MB during diastole and systole under varying conditions of myocardial coronary coupling. The study found that the compression degree is greatest in the deep MB group, with the average compression level being approximately 17 times that of normal individuals and about 4.6 times that of patients with superficial MB.

Discussion

The differences in the average cross-sectional area are more significant than those in the minimum cross-sectional area. The depth of the MB is more closely related to the degree of compression, suggesting that clinical intervention and attention should be focused on deep MBs.

Cerebral and Spinal Cord Protection Strategies in Aortic Arch Surgery

Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies have been put forward to ameliorate these complications; however, maintaining cerebral and spinal cord perfusion and reducing metabolic oxygen demand is the core principle of these strategies. Moderate hypothermia and selective ante-grade perfusion are the most promising methods that provide the best conditions for the competing requirements of both the brain and spinal cord. Intraoperative and postoperative monitoring is essential for early detection and intervention in delayed spinal cord ischaemia and stroke. In this article we aim to discuss the current methods of neuroprotection and spinal cord protection in aortic arch surgery and stenting.

Traditional Chinese medicine compounds modulate signaling pathways to improve cardiac-related pathology

Cardiovascular disease poses a significant risk to human health and remains the leading cause of illness and death globally, with its incidence continuing to rise. The intricate pathophysiological mechanisms of CVDs include inflammation, oxidative stress, autophagy, and myocardial fibrosis. In light of these underlying mechanisms, traditional Chinese medicine (TCM) and its constituents have demonstrated distinct advantages in managing CVDs. By exerting synergistic effects across multiple components and targets, traditional Chinese medicine can modulate the inflammatory response, mitigate oxidative stress, regulate excessive autophagy, and enhance myocardial fibrosis repair. This article reviews the latest advancements in understanding how TCM compounds regulate signaling pathways involved in the treatment of CVDs.

Left Main Ostial Stenosis in a Teenage Patient

Exertional chest pain in the setting of a structurally normal heart and no known arrhythmia are rarely thought to be related to cardiac etiology. Common non-cardiac etiologies of chest pain in the pediatric population include the following: lung infections, musculoskeletal, asthma, acid reflux, and anxiety. However, common cardiac etiologies that can cause exertional chest pain typically include the following: congenital heart disease, coronary anomalies, myocardial infections, left ventricular outflow obstruction, illicit drug use, and prothrombotic conditions. Rarely, pediatric patients present with an isolated finding of left main coronary artery ostial stenosis requiring intervention. Many of the published reports of left main ostial stenosis are in connection with other congenital heart disease, inflammation, or connective tissue disorders who have undergone percutaneous intervention. This report describes an 8-year-old patient with exertional chest pain for 5 years found to have isolated left ostial stenosis requiring coronary artery bypass grafting at the age of 13.

Title name-vanishing stent phenomenon on optical coherence tomography in a mycotic coronary aneurysm: a case report

Background

Coronary artery pseudoaneurysm (PSA) is a rare but serious complication following drug-eluting stent implantation. Mycotic aneurysms can develop from coronary stent infections, which, while uncommon, carry high mortality rates. Early diagnosis and intervention are essential for improving outcomes in such cases. This report presents a case of mycotic aneurysm in the left circumflex artery (LCx) following percutaneous coronary intervention (PCI), with the 'vanishing stent phenomenon' observed on optical coherence tomography (OCT).

Case summary

A 62-year-old male was admitted with fever and chest pain 1 week after PCI of the LCx and left anterior descending artery using drug-eluting stents. Despite empirical antibiotic treatment, his fever and chest pain persisted, prompting further investigations. Positron emission tomography-computed tomography (PET-CT) scan revealed significant uptake of fluoro-deoxy-glucose around the LCx stent, suggestive of infection. Coronary angiography revealed a coronary PSA at the LCx stent site, with OCT showing damaged, disappeared and displaced stent struts, known as the 'vanishing stent phenomenon.' The patient was diagnosed with stent infection and mycotic aneurysm. He was treated with intravenous antibiotics, followed by successful surgical removal of the infected stent, repair of the PSA, and coronary artery bypass grafting. The patient's post-operative course was uneventful and he was discharged in stable condition.

Discussion

This case highlights the importance of timely diagnosis and management in coronary stent infections. The 'vanishing stent phenomenon' on OCT demonstrated severe infection-related stent damage. PET-CT, OCT imaging, and prompt surgical with antibiotic interventions were crucial in treating this life-threatening complication, emphasizing vigilance after PCI for persistent symptoms.

Mortality and Ventricular Arrhythmia in Patients with Early Ventricular Repolarization

BACKGROUND

Recent research has linked early repolarization (ER) with increased ventricular fibrillation risk, especially in leads V1-V3 and in inferior and lateral regions. However, data on the Brazilian population are limited.

OBJECTIVE

To estimate the impact of ER on survival and the occurrence of ventricular arrhythmias (VA) in patients over a 10-year period at a university hospital.

METHODS

This retrospective cohort study included patients with ER on electrocardiogram from the hospital database. Descriptive analysis was conducted to describe patients' profile and characteristics. Kaplan-Meier method was utilized to analyze survival curves, with the log-rank test employed to assess differences between ER types. Cox regression models were applied to evaluate the risks of death and VA, calculating both gross and adjusted hazard ratios. The level of significance adopted in the statistical analysis was 5%.

RESULTS

The study population was predominantly male, average age of 45.6 years; 2.7% experienced VA (five in the group with lateral ER, four in the group with inferior ER group, and four in the ER inferolateral group). Significant differences were observed in age, sex, and HFrEF between the groups. Regarding all-cause mortality, 2.3% of patients died (five in the group with lateral ER, one in the group with inferior ER group, and five in the ER inferolateral group). Only age showed a statistically significant difference. There were significant differences in both death and VA between the groups (p=0.7 and p=0.5, respectively).

CONCLUSION

ER did not lead to a higher incidence of VA or all-cause mortality in this cohort.

Evaluation of Coronary Artery Disease and Ischemia by Echocardiography: Advances in Technology and Techniques

This review describes the role of echocardiography in the diagnosis and prognostication of coronary artery disease (CAD). It describes the diagnostic capabilities of echocardiography using rest and stress imaging, speckle tracking strain imaging with myocardial work index, as well as the use of myocardial perfusion imaging. It also evaluates the use of echocardiography in the assessment of common complications from CAD and the incremental value of incorporating right ventricular, left atrial, and diastolic function assessment in these patients. In addition, the review aims to highlight the prognostic value of echocardiography, especially in the determination of myocardial viability.

An Integrated Network Pharmacology and RNA-seq Approach for Exploring the Protective Effect of Isoquercitrin in Doxorubicin-Induced Cardiotoxicity: Identification of Novel Genes

Cardiotoxicity, a severe side effect of cytotoxic drugs like doxorubicin (DOX), can lead to cardiomyopathy and heart failure, significantly impacting patient prognosis. This study investigates the molecular mechanisms of DOX-induced cardiotoxicity and explores isoquercitrin (IQC) as a potential therapeutic agent. RNA-sequencing analysis revealed 7855 dysregulated genes in DOX vs. Control and 3853 in DOX + IQC vs. DOX groups. Functional enrichment analysis of upregulated genes in the DOX vs. Control group highlighted cytokine-cytokine receptor interaction and calcium signaling pathways as significant immune-related KEGG pathways. Immune genes were shortlisted based on inflammatory functions, followed by protein-protein interaction analysis and hub gene identification. This process revealed IL6, IL1B, IL10, CCL19, CD27, CSF1R, ADRB2, GDF15, TNFRSF10B, and PADI4 as the top 10 interacting immune hub genes. Validation in the DOX + IQC vs. DOX group showed that IQC downregulated CCL19, IL10, PADI4, and CSF1R genes. Computational drug design techniques, including virtual screening and molecular dynamic simulations, identified promising targets for IQC. These targets were experimentally validated using RT-qPCR in AC16 cell lines under four conditions: control, DOX, low dose DOX + IQC, and high dose DOX + IQC. The study demonstrates that IQC significantly reduces inflammation and oxidative stress in human AC16 cardiomyocyte cell line by downregulating inflammatory and stress pathways induced by DOX. It concludes that CCL19 and PADI4 are crucial immune biomarkers for treating DOX-induced cardiotoxicity using IQC, providing insights into potential therapeutic strategies using plant-based compounds to mitigate the cardiotoxic effects of DOX in cancer treatment.

Trends in Proton Pump Inhibitor Use in Sweden by Sex and Age: A Drug Utilisation Study

BACKGROUND

Proton pump inhibitors (PPIs) are among the most popular drugs worldwide. Yet, there are concerns on long-term safety and poor adherence to prescription guidelines. Off-label use in children and increasing maintenance use in older adults may be particularly worrisome.

OBJECTIVES

To assess differences in PPI use by age, sex calendar year and PPI type, and to explore potential underlying indications (ulcerogenic drugs, and indications) in Sweden.

METHODS

Proton pump inhibitor drug utilisation study based on the Swedish nationwide prescribed drug (2006-2023) and patient registries (2006-2022).

RESULTS

Proton pump inhibitors were used by 14.4% (women) and 10.5% (men) of adults; and 1.0-1.5% of children and adolescents (aged < 20 years). Proton pump inhibitor use was higher in women in all age-groups except small children (aged < 5 years). Proton pump inhibitor use has increased in all age groups, especially in young children (aged < 10 years) and the oldest groups (aged > 65 years). Proton pump inhibitor users aged > 85 years filled most prescriptions with an annual average of 9.5 (men), 11.6 (women) prescriptions. Most prescriptions were for omeprazole and esomeprazole: 63.7% and 23.5% in adults; 23.5% and 44.7% in children (2023). Prescriptions for other drugs for peptic ulcers/reflux became rare, with 99% of prescriptions in this category being PPIs by 2023. Gastro-intestinal diagnoses were predominantly recorded in men, became less prevalent and only explained part of PPI use, while ulcerogenic drugs were common (particularly in women), suggesting PPIs are regularly used for gastroprotection.

CONCLUSION

Proton pump inhibitor use has doubled in children and increased 50% in adults over the study period, in both sexes, while recorded gastrointestinal indications decreased. Alternative therapies were rarely prescribed in Sweden.

Terlipressin-Associated Complete Heart Block

Terlipressin has been recently approved in the United States to treat hepatorenal syndrome, a feared complication of both acute and chronic liver diseases. Side effects of the medication have been studied through clinical trials and the precedent use in Europe, as well as extrapolation from its analog vasopressin. As its use is becoming more prevalent, unforeseen complications have arisen. We report a case of complete heart block associated with terlipressin use in presumed hepatorenal syndrome in acute liver injury.

The role of irisin in exercise-induced muscle and metabolic health: a narrative review

Irisin, a myokine released during physical exercise, has emerged as a key mediator of muscle health and metabolic regulation. This review synthesizes current evidence on how aerobic exercise stimulates irisin release and its subsequent effects, including enhanced muscle mass, strength, and recovery. Additionally, irisin promotes the browning of white adipose tissue, improving fat metabolism and glucose regulation. These adaptations position irisin as a promising therapeutic target for preventing metabolic disorders and optimizing exercise protocols. By exploring human studies and mechanistic insights, this review underscores irisin's potential to address global health challenges, such as obesity and type 2 diabetes, while advancing strategies for personalized exercise interventions.

A rare case of myocardial bridging as a cause of complete heart block: A diagnostic challenge

Complete heart block (CHB) is a disruption in electrical impulses to travel from atria to ventricles and can rarely be caused by myocardial bridging (MB), where cardiac tissue compresses a coronary artery during systole. The incidence of MB ranges from 0.5 % to 16 % in coronary angiography patients. This case report presents a 30-year-old female presented with dizziness, shortness of breath, and chest pain, diagnosed with third-degree AV block. Echocardiography revealed interventricular septal thickening and mild mitral regurgitation. Coronary angiography identified myocardial bridging in the mid LAD artery causing significant systolic stenosis. After ruling out reversible causes, a dual-chamber permanent pacemaker was implanted due to persistent heart block. The patient remained stable postprocedure, with decreasing cardiac biomarkers, and was discharged symptom-free with a follow-up appointment scheduled. MB can lead to serious cardiovascular events, including myocardial infarction and CHB. Clinicians must recognize the risks associated with MB and maintain a high suspicion for CHB to ensure timely management. Further studies are needed to clarify the CHB-MB relationship and improve patient outcomes.

AI-assisted computational screening and docking simulation prioritize marine natural products for small-molecule PCSK9 inhibition

SARS-CoV-2 infection has been associated with long-term cardiovascular complications including myocarditis and heart failure, as well as central nervous system sequelae such as cognitive dysfunction and neuropathy. Proprotein convertase subtilisin/Kexin type 9 (PCSK9), a hepatic protease involved in cholesterol regulation, has shown associations with a spectrum of diseases potentially relevant to these Covid-19 complications, such as atherosclerosis. To identify novel human PCSK9 inhibitors, a custom virtual screening pipeline was developed employing (1) a convolutional neural network-based deep learning model, (2) molecular docking using Schrödinger with Glide scoring function, and (3) molecular dynamics (MD) simulations with Gibbs Free Energy Landscape analysis. The deep learning model was trained on a dataset of known central nervous system, cardiovascular, and anti-inflammatory acting drugs and used to screen the CMNPD database. Docking simulations were performed on shortlisted candidates, followed by MD simulations and free energy landscape analysis to evaluate binding affinities and identify key interaction residues. This multi-step in-silico approach identified promising PCSK9 inhibitor candidates with favorable binding profiles, suggesting that AI-assisted virtual screening can be a powerful tool for discovering novel therapeutic agents.

Exploring the impact of gentle stroking touch on psychophysiological regulation of inhibitory control

Touch has been shown to regulate emotions, stress responses, and physical pain. However, its impact on cognitive functions, such as inhibitory control, remains relatively understudied. In this experiment, we explored the effects of low-force, slow-moving touch-designed to optimally activate unmyelinated cutaneous low-threshold mechanoreceptor C-tactile (CT) afferents in human hairy skin-on inhibitory control and its psychophysiological correlates using the Stroop Task, a classic paradigm commonly employed to assess inhibitory control capacity. The Stroop Task was repeated twice before and once after receiving either gentle touch or no-touch. Participants were assigned to two groups: the touch group (n = 36), which received low-force, slow-moving touch on their forearms at a stroking velocity of ~3 cm/s, and the no-touch group (n = 36), which did not receive any touch stimulation. Changes in autonomic nervous system activity were also assessed by measuring heart rate variability (HRV) and skin conductance levels before and during cognitive performance. Compared to the no-touch group, participants who received gentle, low-force, slow-moving touch demonstrated faster responses and higher HRV during the Stroop Task. Additionally, within the touch group, individuals with higher HRV exhibited even quicker performance on the cognitive task. While we cannot draw definitive conclusions regarding the CT velocity-specific effect, these results provide preliminary evidence that low-force, slow-moving touch may influence cognitive processes involved in the inhibitory control of goal-irrelevant stimuli.

Perfusate Biomarkers of DCD Cardiac Graft Quality Identified With Proteomics: Studies in an Isolated Rat Heart Model

BACKGROUND

Heart transplantation with donation after circulatory death (DCD) enhances cardiac graft availability, but exposes hearts to potentially damaging conditions, such as warm ischemia. Normothermic machine perfusion (NMP), used for graft transportation, allows biomarker determination in perfusate. Using our isolated, rat heart model of DCD, we evaluated potent.

METHODS

Isolated, perfused adult male Wistar rat hearts (n = 5/group) underwent different warm ischemic durations to simulate DCD, followed by reperfusion to simulate NMP. Perfusate samples were collected after 10 min reperfusion, and proteins were analyzed using mass spectrometry. Cardiac recovery was evaluated after 60 min reperfusion. The relationship between perfusate proteins and cardiac recovery was investigated.

RESULTS

Cardiac recovery decreased with increasing ischemic duration. Principal component analysis of perfusate proteins demonstrated segregation by ischemic group. Several proteins demonstrated an On-Off pattern, and correlated with key outcome measurements. Other proteins were released by all hearts and were confirmed as predictors of cardiac recovery, for example, heat shock protein 70 and valosin-containing protein (area under the curve [AUC] = 0.962-0.968, respectively; P  < 0.05 for all). Additionally, proteins such as glycogen phosphorylase, muscle associated (AUC = 0.9632; P  < 0.05) showed potential as novel biomarkers for evaluating cardiac graft quality, unlike lactate release after 10 min of reperfusion (AUC = 0.60).

CONCLUSIONS

Multiple perfusate proteins, such as heat shock protein 70, valosin-containing protein, or glycogen phosphorylase, muscle associated, released during early reperfusion are promising as biomarkers for assessing graft quality during NMP. Perfusate proteins, as biomarkers, offer the possibility of both rapid immune detection and out-of-hospital implementation, and may provide valuable information about graft quality, especially when profiled with serial sampling during NMP.

Long-term cardiovascular outcomes of immune checkpoint inhibitor-related myocarditis: A large single-centre analysis

AIMS

Immune checkpoint inhibitors (ICI) are the cornerstone of modern oncology; however, side effects such as ICI-related myocarditis (irM) can be fatal. Recently, Bonaca proposed criteria for irM; however, it is unknown if they correlate well with cardiovascular (CV) ICI-related adverse events. Additionally, whether incident irM portends worse long-term CV outcomes remains unclear. We aimed to determine the incidence of long-term CV comorbidities and CV mortality among irM patients.

PATIENTS AND METHODS

The ICI-related adverse event (irAE) registry was queried to identify irM patients by using Bonaca criteria. Random controls were selected after excluding patients with other concomitant irAEs. Patients' demographics, comorbidities and myocarditis presenting features were gathered. Outcomes included 2-year freedom from CV comorbidities (composite of atrial fibrillation, stroke, myocardial infarction and heart failure) and freedom from CV death. IrM was treated as a time-varying covariate.

RESULTS

Seventy-six patients developed irM at a median of 167 days (mean age 69, 63.2% male, 47% lung cancer). Majority of patients had new wall motion abnormalities or EKG changes on presentation. Mean LVEF was 43%, median peak TnT was 0.81, and median NTproBNP was 2057 at irM onset. Two-year freedom from CV comorbidities (67% vs 86.8%, P < 0.001) and death (93.4% vs 99.3%, P = 0.003) was lower among irM patients. Incident irM was an independent predictor of CV death (HR 8.28, P = 0.048), but not CV comorbidities (HR 2.21, P = 0.080).

CONCLUSIONS

This is the largest case-control study on irM highlighting worse long-term CV outcomes. Future studies are needed to establish appropriate therapeutic strategies and efficient screening strategies for irM survivors.

Navigating Cardiac Myxomas: A Compelling Case of a Giant Atrial Myxoma With Embolic Complications

Cardiac myxomas are the most common primary cardiac tumors, predominantly affecting the left atrium and often seen in women aged 30-60. They can present diagnostic and therapeutic challenges, especially in atypical demographics. If left untreated, myxomas can lead to severe morbidity due to embolic events and intracardiac obstruction. Herein, we describe a rare presentation of an exceptionally large left atrial myxoma, emphasizing the clinical, diagnostic, and surgical considerations required to manage such complex cases effectively. A 61-year-old man with a history of poorly controlled hypertension and hyperlipidemia presented with dyspnea, lower extremity edema, and syncope, as an acute manifestation and was found to have a large, mobile mass measuring 9.5 × 4.5 cm in the left atrium, intermittently prolapsing into the mitral valve orifice during diastole on transthoracic echocardiography, with a provisional diagnosis of myxoma. Additionally, a chest computed tomography scan revealed a subsegmental pulmonary embolus, with the left-sided myxoma being the most plausible cause. Given the tumor size and embolic risk, the mass was managed surgically via a median sternotomy approach. Histopathology confirmed a benign cardiac myxoma, characterized by stellate and myxoid cells within a myxomatous stroma. Postoperatively, the patient's symptoms resolved, and a 12-week follow-up echocardiography showed no residual mass. This case underscores the critical importance of considering cardiac myxoma in the differential diagnosis of acute cardiac symptoms, particularly when embolic phenomena are concurrent. The case highlights the necessity for prompt surgical intervention to mitigate the risk of embolic complications and to restore normal hemodynamic function. Despite the benign nature of myxomas, their potential for severe complications necessitates a high index of suspicion and timely intervention.

Effect of low temperature on myocardial infarction mortality in rural residents: comparison of daytime and nighttime exposure

Ambient low temperature is a risk factor for myocardial infarction (MI) worldwide, with limited evidence about the effect of low temperature at different periods of a day. We aimed to characterize the association of MI mortality with daytime and nighttime low temperatures in rural areas. Daily daily temperature data and MI deaths from 2016 to 2020 were obtained for the rural areas of Anhui Province. We first applied the distributed lag nonlinear model to examine the association of MI death risk with daily maximum (daytime) and minimum (nighttime) temperature for each rural area. Then, we used the random-effects meta-analysis to pool the rural-specific effect estimates and subgroups stratified by sex, age, and geographical region. Daytime low temperature and nighttime low temperature were both associated with an increased risk of MI death. On the same day of exposure to daytime low temperature and nighttime low temperature, the risk of MI death respectively increased by 12.6% [95% confidence interval (CI): 0.7% ~ 25.8%] and 3.2% (95%CI: 0% ~ 6.6%). Subgroup results showed an increased MI death risk associated with daytime and nighttime low temperatures in the elderly (≥ 65 years) and males. Besides, there was an obvious geographical variation in the lag effects of daytime and nighttime low temperatures on MI mortality. This study provides evidence of different effect of daytime and nighttime low temperature on MI mortality in China. Our findings may have important implications in preventing heart attacks during the day and at night in cold weather.

Characterization of QT-Interval Adaptation Time Lag in Response to Sport-Induced Heart Rate Changes Measured From Wearable ECG Recordings

OBJECTIVES

Elevated heterogeneity in ventricular repolarization can promote malignant ventricular arrhythmias. During exercise, distinct ventricular cells may present different repolarization adaptation to heart-rate (HR) changes potentially increasing ventricular repolarization dispersion. An electrocardiographic descriptor of the temporal adaptation of action potential duration to HR changes is the time delay the QT interval takes in accommodating to abrupt acceleration and deceleration in HR. Previous investigations have been performed on standard electrocardiograms acquired during stress tests. The present work aims to characterize the time delay of QT-interval accommodation to HR changes for a healthy trained population during real training.

METHODS

The time delay was estimated through an optimally derived, model-based time-delay estimator as the lag between the actual QT series and an HR-derived expected memoryless QT series. The last one was obtained by fitting a logarithmic regression model to the instantaneous QT and HR measurements in assumed stationary time windows. The QT lag was estimated separately in HR acceleration, and HR deceleration, of single-lead ECG acquired through a chest strap while practicing sport.

RESULTS

The QT-adaptation time lag estimated during HR deceleration is longer than during HR acceleration, especially after intense physical exertion of athletes when they have overcome their theoretical maximal HR 14.5[2.4;28.0] s or they have been involved in dynamic sports 9.9[5.8;24.9] s.

CONCLUSION

Higher repolarization dispersion can be captured by the proposed time delay biomarker in a distinctive way to the HR acceleration.

SIGNIFICANCE

Eventually the time lag is a biomarker for exacerbated increase of ventricular repolarization dispersion while exercising.

Comparison and Agreement between Cardiovascular Computed Tomography-Derived Mid-Diastolic and End-Diastolic Ventricular Volume in Patients with Congenital Heart Disease

Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m2, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m2, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.

The contribution of genetics to the understanding and management of cardiomyopathies: Part 1

Genetics has assumed a pivotal role in clarifying the pathophysiology of cardiomyopathies, facilitating molecular diagnosis, and enabling effective family screening. The advent of next-generation sequencing has revolutionized genetic testing by enabling cost-effective, high-throughput analysis. It is imperative for cardiovascular physicians to mainstream genetic testing into their clinical decision-making. Although a definitive genotype-phenotype correlation may not always be evident, several genotypes have emerged as valuable risk predictors for disease severity and progression. European guidelines emphasize the importance of genetic tests for predicting clinical outcome in cardiomyopathies. While further research is essential to bridge existing gaps in the genetic evidence on cardiomyopathies, there is considerable potential for significant advancements.

Molecular mechanisms of angiotensin type 2 receptor-mediated nitric oxide pathway in angiotensin II-induced vasorelaxation: Roles of potassium channels

A variety of biological functions is attributed to the renin-angiotensin system (RAS). One of them is regulating vascular tone through its final effector Angiotensin II (Ang II). Ang II action is mediated by the Angiotensin type 1 receptor (AT1-R) which plays a role in vasoconstriction, and Angiotensin type 2 receptor (AT2-R) which may result in vascular relaxation through the releasing of endothelium mediates relaxation factors such as Nitric Oxide (NO). Therefore, this study investigated the role of AT2-R in vasodilation after blocking the effect of AT1-R in the rat aorta. Furthermore, it is to determine whether or not Ang II through NO has a role in rat aorta dilation via using valsartan. For control isolated aortic rings were preincubated with Valsartan (AT1- R inhibitor) and then stimulated with angiotensin II dose-dependent. For treating aortic rings different blockers and inhibitors were used. Pd123177 (AT2- R inhibitor) (20 µM), an inhibitor of PKA H-89 (10 µM), eNOS inhibitor L-NAME (0.3 mM), with group of K channel blockers such as TEA (1 mM), 4-AP (1 mM), BaCl2 (1 mM), clotrimazole (0.03 mM) and GLIB (0.01 mM). Our analysis demonstrates vasodilation in aortic rings induced by Ang II after blocking ATI-R and this response was highly reliant on PKA/eNOS and cyclic guanosine monophosphate (cGMP). The data from this investigation provided evidence that Ca2 + activated K+ channels (KCa) and Voltage-dependent K channel (KV) mediated Ang II vasorelaxation. Finally, these results indicate that angiotensin II primarily induces dilatation AT2-R after inhibiting the angiotensin AT1 receptor through a cascade of signaling pathways involving many enzymes and plasma membrane protein channels.

Undiagnosed Insulinoma in a Young Patient With Idiopathic Dilated Cardiomyopathy: A Case Report

Insulinomas are rare pancreatic tumors that present with symptoms of hypoglycemia secondary to unregulated high levels of insulin. Literature has described that recurrent hypoglycemic events induce a sympathetic drive that could compromise cardiac function. Tumor resection eliminates the hypoglycemia source, halting the cycle of sympathetic overdrive and improving cardiac function. We present the case of a 43-year-old patient who was hospitalized after a recent gastric bypass for recurrent episodes of confusion, mumbling, night terrors, and low glucose levels. She also had a chronic diagnosis of idiopathic dilated cardiomyopathy and heart failure with an ejection fraction of 30%. Imaging and laboratory studies demonstrated the presence of insulinoma. She underwent tumor resection with improvement in her exercise tolerance. Her ejection fraction improved from 30% to 35-40% eight months post-resection. This case is intended to review current data on the possible association between insulinomas and heart disease. To the best of our knowledge, our report stands out as one of the few case studies available that explores this potential association. It is crucial to recognize that tumor resection can significantly enhance cardiac function, making it imperative to thoroughly investigate the diverse cardiovascular effects linked to insulinomas.

Navigating complexity: ruptured pulmonary artery dissection originating from type B aortic dissection via a persistent ductus arteriosus Botalli

Pulmonary artery dissection (PAD) is a rare, life-threatening condition requiring prompt diagnosis and treatment. We present a case of ruptured left PAD originating from an acute type B aortic dissection (aTBAD) through a persistent ductus arteriosus Botalli (PDA) in an otherwise healthy 29-year-old man. The patient was successfully treated by means of thoracic endovascular aortic repair (TEVAR) alone. This case illustrates a rare and severe cardiovascular emergency, highlighting the critical importance of interdisciplinary collaboration. For the first time, we demonstrated that addressing the root of the problem - the primary aortic entry - leads to full symptom resolution and vascular remodeling.

Complication rates in real-time ultrasound-guided vs static echocardiography-guided pericardiocentesis: a cohort study

BACKGROUND

Static echocardiography-guided pericardiocentesis, the current standard of care, uses a phased-array probe to locate the largest fluid pocket, marking the safest entry site and needle trajectory. Nevertheless, real-time needle visualization throughout the procedure would potentially increase success and decrease complications. The aim of this study was to assess the complication rates of the real-time in-plane ultrasound-guided technique compared to the traditional static echocardiography-guided pericardiocentesis.

METHODS

All adult patients who underwent pericardiocentesis in a tertiary care hospital from January 2011 to June 2024 were identified. The incidence of total complications of the real-time, in-plane, US-guided pericardiocentesis versus the static echocardiography-guided technique was compared using a regression model with overlap weighting, based on propensity scores, to adjust for confounding factors.

RESULTS

A total of 220 pericardiocentesis were identified, 91 with real-time, in-plane US-guided technique and 129 with a static echo-guided approach. The overall rate of total complications was 5.5%, with no significant difference between both techniques (IRR 1.06 [95% CI 0.98 to 1.16, p = 0.163]). Only one major complication was reported with the in-plane technique (pulmonary edema) compared to four major complications in the echo-assisted approach (three cardiac injuries and one injury to thoracic vessels), all of which required emergency surgery. The success rate was higher in the real-time in-plane US-guided procedures (97%) compared to the static echo-guided approach (93%).

CONCLUSIONS

In this single-center retrospective cohort study, real-time in-plane, US-guided pericardiocentesis technique was safe, and the rate of total complications was not significantly different from a static echo-guided approach. The low rate of major complications and high success rate underscores the potential use of this technique in emergency situations by well-trained physicians. Future studies are warranted to thoroughly assess the potential benefits of the real-time approach.

Cardiovascular Sequelae of the COVID-19 Vaccines

Vaccines against COVID-19 present a key tool in lowering the morbidity, mortality, and transmission of the disease, but they also present a strongly controversial topic. As a result, the adverse effects of the vaccine have been under scrutiny by the public eye. A comprehensive summary of the cardiovascular (CV) adverse effects of COVID-19 vaccines is vital for clinical recognition of rare adverse events, determining the public health implications, and creating a base for future research. In May 2023, a search was conducted in the PubMed and Cochrane databases to identify literature on CV complications resulting from the COVID-19 vaccine. All articles with relevant data and discussion regarding adverse effects of the COVID-19 vaccines were included in the review. In total, 4419 articles were screened, and 166 articles were included in the review. The vaccine-associated CV adverse events encompassed the following conditions: myocarditis, pericarditis, acute coronary syndrome, stress cardiomyopathy, hypertension, isolated tachycardia, myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), cardiac arrest, vaccine-induced thrombotic thrombocytopenia (VITT), MI, cerebral venous thrombosis (CVT), deep vein thrombosis (DVT), pulmonary embolism (PE), and other venous thrombotic disorders. Among these, myocarditis and thrombosis, especially VITT, emerged as the most frequently cited complications in the reviewed literature. Ranges of incidences for the following were recorded among the reviewed articles: myocarditis: 2 to 17 per million, VITT: 3-10 per million, CVST: 2.6-10 per million, MI: 3-4 per million. COVID-19 vaccines entail the potential for adverse events, although at low incidence, some of which exhibit notable severity. These adverse events exhibit demographic specificity and vaccine-specific profiles. The adverse events reviewed are uniformly acute in nature. The existing body of evidence offers limited support for the assertion that COVID-19 vaccines may elevate the baseline risk of CV events in the long term. However, the available research on effects greater than six months is scarce.

Safety and Feasibility of Robot-Assisted Percutaneous Coronary Intervention Using the AVIAR 2.0 System: A Prospective, Multi-Center, Single-Arm, Open, Investigator-Initiated, Post-Approval Clinical Trial

BACKGROUND AND OBJECTIVES

Traditional manual percutaneous coronary intervention (PCI) exposes operators to significant radiation and physical stress. The recently developed Advanced Vascular Intervention Assist Robot (AVIAR) 2.0 system in South Korea aimed to overcome these issues by evaluating its safety and feasibility in a clinical setting.

METHODS

The study enrolled patients with stable angina from 2 medical centers. Single-vessel de novo lesions were treated using the AVIAR 2.0 system. The primary endpoints were technical success (using the AVIAR system for PCI devices, including guidewires, balloon catheters, and stents, without switching to manual) and clinical success (<30% residual stenosis in the treated lesion and no major cardiovascular events within 48 hours or before discharge). Secondary endpoints included operator radiation exposure and procedural time. Safety was assessed using treatment-emergent adverse events.

RESULTS

Twenty patients (mean age, 63.9±8.5 years, 70% male) underwent robot-assisted PCI for lesions mainly in the left anterior descending artery and right coronary artery, with 95% (19/20) classified as B2/C lesions. The average robotic procedural time was 23:06±05:55 minutes. Technical success was 100%, with no need for manual conversion. Clinical success was 100%, with no major complications until discharge. Operator effective radiation dose was reduced by 84% compared to table effective doses.

CONCLUSIONS

The AVIAR 2.0 system appears to be a safe and effective adjunct to manual PCI, enhancing procedural efficiency and reducing operator radiation exposure. These findings support the use of robotics in coronary interventions and suggest a promising future for minimally invasive cardiac procedures.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05981859.

Transradial versus transfemoral access in middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis

BACKGROUND

Chronic subdural hematoma (cSDH) is increasingly prevalent in the elderly and traditionally treated with surgical interventions. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive therapy to reduce recurrence rates. Transfemoral access (TFA) is the conventional route for neuroendovascular procedures, but transradial access (TRA) offers potential advantages, including reduced access-site complications, earlier ambulation, and shorter hospital stays.

OBJECTIVE

The aim of this systematic review and meta-analysis was to compare the safety and efficacy of TRA versus TFA for MMAE in cSDH patients.

METHODS

This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and involved a comprehensive search of four databases to identify studies comparing TRA and TFA in MMAE. Outcomes included hematoma recurrence, hospital length of stay, procedural duration, access-site complications, and overall complications.

RESULTS

Four studies met the inclusion criteria. There were no significant differences between TRA and TFA in hematoma recurrence (Relative Risk (RR) 0.65, 95 % Confidence Interval [CI] 0.09-4.85), hospital length of stay (Mean Difference [MD] 0.10 days, 95 % CI -0.11-0.31), procedural duration (MD 0.04 h, 95 % CI -0.49-0.56), access-site complications (RR 0.24, 95 % CI 0.04-1.40), or overall complications (RR 0.76, 95 % CI 0.33-1.75).

CONCLUSION

TRA demonstrates comparable safety and efficacy to TFA for MMAE in cSDH patients. Although current evidence is limited to observational studies, these findings support the feasibility of TRA as an access route. Future large-scale studies are necessary to validate these results and optimize procedural strategies.