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Zhang ZY, Yang ZH, Wang S, Feng SL, Wang XL, Mao JY. Regulation of optimized new Shengmai powder on cardiomyocyte apoptosis and ferroptosis in ischemic heart failure rats: The mediating role of phosphatidylinositol-3-kinase/protein kinase B/tumor protein 53 signaling pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 330:118264. [PMID: 38692417 DOI: 10.1016/j.jep.2024.118264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Optimized New Shengmai Powder (ONSMP) is a sophisticated traditional Chinese medicinal formula renowned for bolstering vital energy, optimizing blood circulation, and mitigating fluid retention. After years of clinical application, ONSMP has shown a significant impact in improving myocardial injury and cardiac function and has a positive effect on treating heart failure. However, many unknowns exist about the molecular biological mechanisms of how ONSMP exerts its therapeutic effects, which require further research and exploration. AIM OF THE STUDY Exploring the potential molecular biological mechanisms by which ONSMP ameliorates cardiomyocyte apoptosis and ferroptosis in ischemic heart failure (IHF). MATERIALS AND METHODS First, we constructed a rat model of IHF by inducing acute myocardial infarction through surgery and using echocardiography, organ coefficients, markers of heart failure, antioxidant markers, and histopathological examination to assess the effects of ONSMP on cardiomyocyte apoptosis and ferroptosis in IHF rats. Next, we used bioinformatics analysis techniques to analyze the active components, signaling pathways, and core targets of ONSMP and calculated the interactions between core targets and corresponding elements. Finally, we detected the positive expression of apoptosis and ferroptosis markers and core indicators of signaling pathways by immunohistochemistry; detected the mean fluorescence intensity of core indicators of signaling pathways by immunofluorescence; detected the protein expression of signaling pathways and downstream effector molecules by western blotting; and detected the mRNA levels of p53 and downstream effector molecules by quantitative polymerase chain reaction. RESULTS ONSMP can activate the Ser83 site of ASK by promoting the phosphorylation of the PI3K/AKT axis, thereby inhibiting the MKK3/6-p38 axis and the MKK4/7-JNK axis signaling to reduce p53 expression, and can also directly target and inhibit the activity of p53, ultimately inhibiting p53-mediated mRNA and protein increases in PUMA, SAT1, PIG3, and TFR1, as well as mRNA and protein decreases in SLC7A11, thereby inhibiting cardiomyocyte apoptosis and ferroptosis, effectively improving cardiac function and ventricular remodeling in IHF rat models. CONCLUSION ONSMP can inhibit cardiomyocyte apoptosis and ferroptosis through the PI3K/AKT/p53 signaling pathway, delaying the development of IHF.
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Affiliation(s)
- Ze-Yu Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, PR China; Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China
| | - Zhi-Hua Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, PR China; Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China.
| | - Shuai Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, PR China.
| | - Shao-Ling Feng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, PR China; Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China.
| | - Xian-Liang Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, PR China.
| | - Jing-Yuan Mao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, PR China.
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Cisneros-Barroso E, Rossello X. Sodium-glucose cotransporter 2 inhibitors in acute and chronic coronary syndrome with and without heart failure. Eur J Heart Fail 2024; 26:1606-1607. [PMID: 38808622 DOI: 10.1002/ejhf.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Affiliation(s)
- Eugenia Cisneros-Barroso
- Internal Medicine Department, Hospital Universitari Son Llàtzer, Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Xavier Rossello
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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3
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Peikert A, Vaduganathan M. Sodium Glucose Co-Transporter 2 Inhibition Following Acute Myocardial Infarction: The DAPA-MI and EMPACT-MI Trials. JACC. HEART FAILURE 2024; 12:949-953. [PMID: 38583168 DOI: 10.1016/j.jchf.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Chen YX, Zhao AR, Wei TW, Wang H, Wang LS. Progress of Mitochondrial Function Regulation in Cardiac Regeneration. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10514-w. [PMID: 38647881 DOI: 10.1007/s12265-024-10514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Heart failure and myocardial infarction, global health concerns, stem from limited cardiac regeneration post-injury. Myocardial infarction, typically caused by coronary artery blockage, leads to cardiac muscle cell damage, progressing to heart failure. Addressing the adult heart's minimal self-repair capability is crucial, highlighting cardiac regeneration research's importance. Studies reveal a metabolic shift from anaerobic glycolysis to oxidative phosphorylation in neonates as a key factor in impaired cardiac regeneration, with mitochondria being central. The heart's high energy demands rely on a robust mitochondrial network, essential for cellular energy, cardiac health, and regenerative capacity. Mitochondria's influence extends to redox balance regulation, signaling molecule interactions, and apoptosis. Changes in mitochondrial morphology and quantity also impact cardiac cell regeneration. This article reviews mitochondria's multifaceted role in cardiac regeneration, particularly in myocardial infarction and heart failure models. Understanding mitochondrial function in cardiac regeneration aims to enhance myocardial infarction and heart failure treatment methods and insights.
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Affiliation(s)
- Yi-Xi Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - An-Ran Zhao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Tian-Wen Wei
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hao Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lian-Sheng Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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5
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Peikert A, Vaduganathan M, Claggett BL, Kulac IJ, Foà A, Desai AS, Jhund PS, Carberry J, Lam CSP, Kosiborod MN, Inzucchi SE, Martinez FA, de Boer RA, Hernandez AF, Shah SJ, Køber L, Ponikowski P, Sabatine MS, Petersson M, Langkilde AM, McMurray JJV, Solomon SD. Dapagliflozin in patients with heart failure and previous myocardial infarction: A participant-level pooled analysis of DAPA-HF and DELIVER. Eur J Heart Fail 2024; 26:912-924. [PMID: 38487939 DOI: 10.1002/ejhf.3184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 05/31/2024] Open
Abstract
AIMS Patients with heart failure (HF) and history of myocardial infarction (MI) face a higher risk of disease progression and clinical events. Whether sodium-glucose cotransporter 2 inhibitors may modify clinical trajectory in such individuals remains incompletely understood. METHODS AND RESULTS The DAPA-HF and DELIVER trials compared dapagliflozin with placebo in patients with symptomatic HF with left ventricular ejection fraction (LVEF) ≤40% and > 40%, respectively. In this pooled participant-level analysis, we assessed efficacy and safety outcomes by history of MI. The primary outcome in both trials was the composite of cardiovascular death or worsening HF. Of the total of 11 007 patients, 3731 (34%) had a previous MI and were at higher risk of the primary outcome across the spectrum of LVEF in covariate-adjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02-1.24). Dapagliflozin reduced the risk of the primary outcome to a similar extent in patients with (HR 0.83, 95% CI 0.72-0.96) and without previous MI (HR 0.76, 95% CI 0.68-0.85; pinteraction = 0.36), with consistent benefits on key secondary outcomes as well. Serious adverse events did not occur more frequently with dapagliflozin, irrespective of previous MI. CONCLUSION History of MI confers increased risks of adverse cardiovascular outcomes in patients with HF across the LVEF spectrum, even among those with preserved ejection fraction. Dapagliflozin consistently and safely reduces the risk of cardiovascular death or worsening HF, regardless of previous MI.
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian J Kulac
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alberto Foà
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Piotr Ponikowski
- Department of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Marc S Sabatine
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Udell JA. SGLT2 Inhibitors Squeak Out a Win in Patients Post-MI. NEJM EVIDENCE 2024; 3:EVIDe2300318. [PMID: 38320495 DOI: 10.1056/evide2300318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
James et al1 report the results of the DAPA-MI (DAPAagliflozin in patients without diabetes mellitus with acute Myocardial Infarction) trial, which studied the efficacy and safety of early initiation of dapagliflozin, a sodium glucose cotransporter-2 (SGLT2) inhibitor, in patients with acute myocardial infarction (MI) without type 2 diabetes (T2D) or heart failure (HF). The trial was conducted within the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and NICOR (National Institute for Cardiovascular Outcomes Research) registries, leveraging where possible routinely collected health data to augment screening, baseline characteristic ascertainment, and clinical follow-up.
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Affiliation(s)
- Jacob A Udell
- Cardiovascular Division, Women's College Hospital, Toronto
- Peter Munk Cardiac Centre, University Health Network, Toronto
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto
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7
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Schou M, Claggett B, Miao ZM, Fernandez A, Filippatos G, Granger C, Jering K, Maggioni AP, McCausland F, Villota JN, Rouleau JL, Mody FV, van der Meer P, Vinereanu D, McGrath M, Zhou Y, Mann DL, Solomon SD, Steg PG, Braunwald E, McMurray JJV, Pfeffer MA, Køber L. Sacubitril/valsartan compared to ramipril in high-risk post-myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: Insight from the PARADISE MI trial. Eur J Heart Fail 2024; 26:130-139. [PMID: 37933184 DOI: 10.1002/ejhf.3079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
AIM It is unknown whether safety and clinical endpoints by use of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor [ARNI]) are affected by mineralocorticoid receptor antagonists (MRA) in high-risk myocardial infarction (MI) patients. The aim of this study was to examine whether MRA modifies safety and clinical endpoints by use of sacubitril/valsartan in patients with a MI and left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion. METHODS AND RESULTS Patients (n = 5661) included in the PARADISE MI trial (Prospective ARNI vs. ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI) were stratified according to MRA. Primary outcomes in this substudy were worsening heart failure or cardiovascular death. Safety was defined as symptomatic hypotension, hyperkalaemia >5.5 mmol/L, or permanent drug discontinuation. A total of 2338 patients (41%) were treated with MRA. Safety of ARNI compared to ramipril was not altered significantly by ± MRA, and both groups had similar increase in symptomatic hypotension with ARNI. In patients taking MRA, the risk of hyperkalaemia or permanent drug discontinuation was not significantly altered by ARNI (p > 0.05 for all comparisons). The effect of ARNI compared with ramipril was similar in those who were and were not taking MRA (hazard ratio [HR]MRA 0.96, 95% confidence interval [CI] 0.77-1.19 and HRMRA- 0.87, 95% CI 0.71-1.05, for the primary endpoint; p = 0.51 for interaction [Clinical Endpoint Committee adjudicated]); similar findings were observed if investigator-reported endpoints were evaluated (p = 0.61 for interaction). CONCLUSIONS Use of a MRA did not modify safety or clinical endpoints related to initiation of ARNI compared to ramipril in the post-MI setting in patients with LVSD and/or congestion.
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Affiliation(s)
- Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | | | - Finnian McCausland
- Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Freny Vaghaiwalla Mody
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Cardiology, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Martina McGrath
- Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yinong Zhou
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Douglas L Mann
- Washington University School of Medicine, St Louis, MO, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP (Assistance Publique-Hôpitaux de Paris), FACT (French Alliance for Cardiovascular Trials) and INSERM U-1148, Paris, France
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Lars Køber
- Rigshospitalet, Blegdamsvej, University of Copenhagen, Copenhagen, Denmark
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Shi YJ, Yang CG, Qiao WB, Liu YC, Liu SY, Dong GJ. Sacubitril/valsartan attenuates myocardial inflammation, hypertrophy, and fibrosis in rats with heart failure with preserved ejection fraction. Eur J Pharmacol 2023; 961:176170. [PMID: 37939991 DOI: 10.1016/j.ejphar.2023.176170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents a multifaceted syndrome related to complex pathologic mechanisms. Sacubitril/valsartan (Sac/val) has demonstrated therapeutic efficacy in HFpEF treatment. However, additional research is required to elucidate its pharmacological mechanisms. Accordingly, this study aimed to explore the potential therapeutic effects of Sac/val in HFpEF rats and the underlying molecular mechanisms. In this study, rats with HFpEF were induced by subjecting spontaneously hypertensive rats to a diet rich in fats, salts, and sugars, along with administering streptozotocin. Subsequently, they were administered Sac/val at a daily dosage of 18 mg/kg. Finally, cardiac structure and function were assessed using echocardiography; Hematoxylin and eosin staining and Masson's trichrome staining were employed to evaluate the pathological changes; Quantitative real-time polymerase chain reaction and Western blot analysis were conducted to determine the expression of pertinent mRNA and proteins. Sac/val treatment attenuated left ventricular (LV) remodeling and diastolic dysfunction in HFpEF rats, possibly related to its anti-inflammatory, anti-hypertrophic, and anti-fibrotic efficacy. Mechanistically, Sac/val might inhibit inflammation by down-regulating cell adhesion molecule (intercellular adhesion molecule-1 (ICAM-1) and vascular endothelial cell adhesion molecule-1 (VCAM-1)) expression. Additionally, it blocked the phosphorylation of glycogen synthase kinase 3β (GSK-3β) to prevent cardiomyocyte hypertrophy. Furthermore, it effectively suppressed myocardial fibrosis by inhibiting the transforming growth factor-beta1 (TGF-β1)/Smads pathway. Our findings suggest that Sac/val improved LV remodeling and diastolic dysfunction, potentially attributed to its anti-inflammatory, anti-hypertrophic, and anti-fibrotic effects. These results provide a sound theoretical rationale for the clinical application of Sac/val in patients with HFpEF.
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Affiliation(s)
- Yu Jiao Shi
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chen Guang Yang
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Wen Bo Qiao
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yong Cheng Liu
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Si Yu Liu
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Guo Ju Dong
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China; National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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9
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Rabec C, Sombrun C, Bentounes SA, Georges M, Bisson A, Bichat F, Bodin A, Herbert J, Zeller M, Cottin Y, Fauchier L. Outcomes in Patients with Acute Myocardial Infarction and Known Sleep Apnea: A Nationwide Analysis. J Clin Med 2023; 12:5924. [PMID: 37762864 PMCID: PMC10532263 DOI: 10.3390/jcm12185924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Background. Sleep apnea (SA) is a common breathing disorder characterized by repetitive upper airway narrowing and closure. Although SA has been demonstrated to be an independent risk factor for all-cause mortality, the direct contribution of SA to worse cardiovascular prognosis may be difficult to evaluate, and its independent association with the different types of cardiovascular outcomes may be debated, particularly in the context of patients with acute myocardial infarction (AMI). The aim of this study was to assess the impact of known SA on the outcomes of hospitalized patients who have had an AMI by analyzing 10-year data collected from a national registry. Methods. This longitudinal cohort study was based on the national hospitalization database that covers hospital care for the entire French population, including all patients admitted with AMI from January 2010 to June 2019. The clinical outcomes for the analysis were as follows: all-cause death, cardiovascular death, ischemic stroke, new-onset atrial fibrillation (FA), and re-hospitalization for heart failure (HF). Results. Among the 797,212 patients who presented with an AMI (528,351 men and 268,861 women), 37,075 (4.7%) had documented SA. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1-3.1] years), 163,845 deaths (of which 85,649 were cardiovascular deaths), 20,168 ischemic strokes, 58,498 new-onset AF, and 92,381 rehospitalizations due to HF were recorded. Patients with known SA had a worse prognosis in the short and medium term, but after adjusting for all covariables, SA was only independently associated with a higher risk of rehospitalization for HF and new-onset AF in men and women. Conclusion. Data from our large nationwide analysis confirm that known SA is associated with poor cardiovascular outcomes in patients who have had an AMI. However, this impact is tem-pered when the model is adjusted for age, cardiovascular risk, or other covariables. Further studies need to be conducted to assess the independent impact of SA on the prognosis of patients with AMI.
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Affiliation(s)
- Claudio Rabec
- Pneumology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.R.); (M.G.)
| | - Chan Sombrun
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
| | - Sid Ahmed Bentounes
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
- Service D’information Médicale, D’épidémiologie et D’économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France
| | - Marjolaine Georges
- Pneumology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.R.); (M.G.)
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
| | - Florence Bichat
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
| | - Marianne Zeller
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
- PEC2, EA 7460, UFR Sciences de Santé, Université Bourgogne Franche Comté, 21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
- Service D’information Médicale, D’épidémiologie et D’économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France
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10
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Harrington J, Butler J. Heart failure after myocardial infarction: Glass emptier than full. Eur J Heart Fail 2023; 25:1225-1227. [PMID: 37462280 DOI: 10.1002/ejhf.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Josephine Harrington
- Division of Cardiology, Duke University Department of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Department of Medicine, University of Mississippi, Jackson, MS, USA
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Docherty KF, Jackson AM, Macartney M, Campbell RT, Petrie MC, Pfeffer MA, McMurray JJ, Jhund PS. Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991-2016. Eur J Heart Fail 2023; 25:1213-1224. [PMID: 37401485 PMCID: PMC10946471 DOI: 10.1002/ejhf.2965] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023] Open
Abstract
AIM Mortality from acute myocardial infarction (AMI) has declined, increasing the pool of survivors at risk of later development of heart failure (HF). However, coronary reperfusion limits infarct size and secondary prevention therapies have improved. In light of these competing influences, we examined long-term trends in the risk of HF hospitalization (HFH) following a first AMI occurring in Scotland over 25 years. METHODS AND RESULTS All patients in Scotland discharged alive after a first AMI between 1991 and 2015 were followed until a first HFH or death until the end of 2016 (minimum follow-up 1 year, maximum 26 years). A total of 175 672 people with no prior history of HF were discharged alive after a first AMI during the period of study. A total of 21 445 (12.2%) patients had a first HFH during a median follow-up of 6.7 years. Incidence of HFH (per 1000 person-years) at 1 year following discharge from a first AMI decreased from 59.3 (95% confidence interval [CI] 54.2-64.7) in 1991 to 31.3 (95% CI 27.3-35.8) in 2015, with consistent trends seen for HF occurring within 5 and 10 years. Accounting for the competing risk of death, the adjusted risk of HFH at 1 year after discharge decreased by 53% (95% CI 45-60%), with similar decreases at 5 and 10 years. CONCLUSION The incidence of HFH following AMI in Scotland has decreased since 1991. These trends suggest that better treatment of AMI and secondary prevention are having an impact on the risk of HF at a population level.
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Affiliation(s)
| | - Alice M. Jackson
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | | | - Ross T. Campbell
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Mark C. Petrie
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Marc A. Pfeffer
- Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
| | | | - Pardeep S. Jhund
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
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Nunes JT, Udell JA. So Much to Say on the Best of What's Around Regarding Sodium-Glucose Cotransporter-2 Inhibitors in Acute Myocardial Infarction. J Am Heart Assoc 2023; 12:e030495. [PMID: 37421265 PMCID: PMC10382119 DOI: 10.1161/jaha.123.030495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Jairo T. Nunes
- Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
- Cardiovascular Division, Department of MedicineWomen’s College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Jacob A. Udell
- Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
- Cardiovascular Division, Department of MedicineWomen’s College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
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13
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Kwon O, Myong JP, Lee Y, Choi YJ, Yi JE, Seo SM, Jang SW, Kim PJ, Lee JM. Sodium-Glucose Cotransporter-2 Inhibitors After Acute Myocardial Infarction in Patients With Type 2 Diabetes: A Population-Based Investigation. J Am Heart Assoc 2023:e027824. [PMID: 37421263 PMCID: PMC10382092 DOI: 10.1161/jaha.122.027824] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/04/2023] [Indexed: 07/10/2023]
Abstract
Background Whether the early use of sodium-glucose cotransporter-2 (SGLT2) inhibitors have cardioprotective effects following acute myocardial infarction is unknown. Thus, we aimed to evaluate the association between the early initiation of SGLT2 inhibitors and cardiac event rates in patients with diabetes with acute myocardial infarction undergoing percutaneous coronary intervention. Methods and Results Based on the National Health Insurance claims data in South Korea, patients who received percutaneous coronary intervention for acute myocardial infarction between 2014 and 2018 were analyzed. Patients given SGLT2 inhibitors or other glucose-lowering drugs were matched based on a propensity score. The primary end point was a composite of all-cause mortality and hospitalizations for heart failure. Major adverse cardiac events (a composite of all-cause death, nonfatal myocardial infarction, and ischemic stroke) were compared as the secondary end point. After 1:2 propensity score matching, the SGLT2 inhibitors group (938 patients) and the no use of SGLT2 inhibitors group (1876 patients) were compared. During a median follow-up of 2.1 years, the early use of SGLT2 inhibitors was associated with lower risks of both the primary end point (9.8% versus 13.9%; adjusted hazard ratio [HR], 0.68 [95% CI, 0.54-0.87]; P=0.002) and secondary end point (9.1% versus 11.6%; adjusted HR, 0.77 [95% CI, 0.60-0.99]; P=0.04). All-cause mortality and hospitalizations for heart failure were also significantly lower in early users of SGLT2 inhibitors. Conclusions The early use of SGLT2 inhibitors in patients with diabetes treated with percutaneous coronary intervention for acute myocardial infarction was associated with a significantly lower risk of cardiovascular events, including all-cause mortality, hospitalizations for heart failure, and major adverse cardiac events.
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Affiliation(s)
- Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Jun-Pyo Myong
- Department of Occupational & Environmental Medicine, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Yunhee Lee
- Department of Urology, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Yeon-Jik Choi
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Jeong Eun Yi
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Suk Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Pum Joon Kim
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Jung-Min Lee
- Division of Endocrinology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital College of Medicine, The Catholic University of Korea Seoul Republic of Korea
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14
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Zafrir B, Ovdat T, Abu Akel M, Bahouth F, Orvin K, Beigel R, Amir O, Elbaz-Greener G. Heart Failure Therapies following Acute Coronary Syndromes with Reduced Ejection Fraction: Data from the ACSIS Survey. J Pers Med 2023; 13:1015. [PMID: 37374004 PMCID: PMC10304454 DOI: 10.3390/jpm13061015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Guideline-directed medical therapies for heart failure (HF) may benefit patients with reduced left ventricular ejection fraction (LVEF) following acute coronary syndromes (ACS). Few real-world data are available regarding the early implementation of HF therapies in patients with ACS and reduced LVEF. METHODS Data collected from the 2021 nationwide, prospective ACS Israeli Survey (ACSIS). Drug classes included: (a) angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNI); (b) beta-blockers; (c) mineralocorticoid receptor antagonist (MRA) and (d) sodium-glucose cotransporter-2 inhibitors (SGLT2I). The utilization of HF therapies at discharge or 90 days following ACS was analyzed in relation to LVEF [reduced ≤40% (n = 406) or mildly-reduced 41-49% (n = 255)] and short-term adverse outcomes. RESULTS History of HF, anterior wall myocardial infarction and Killip class II-IV (32% vs. 14% p < 0.001) were more prevalent in those with reduced compared to mildly-reduced LVEF. ACEI/ARB/ARNI and beta-blockers were used by the majority of patients in both LVEF groups, though ARNI was prescribed to only 3.9% (LVEF ≤ 40%). MRA was used by 42.9% and 12.2% of patients with LVEF ≤40% and 41-49%, respectively, and SGLT2I in about a quarter of both LVEF groups. Overall, ≥3 HF drug classes were documented in 44% of the patients. A trend towards higher rates of 90-day HF rehospitalizations, recurrent ACS or all-cause death was noted in those with reduced (7.6%) vs. mildly-reduced (3.7%) LVEF, p = 0.084. No association was observed between the number of HF drug classes or the use of ARNI and/or SGLT2I with adverse clinical outcomes. CONCLUSIONS In current clinical practice, the majority of patients with reduced and mildly-reduced LVEF are treated by ACEI/ARB and beta-blockers early following ACS, whereas MRA is underutilized and the adoption of SGLT2I and ARNI is low. A greater number of therapeutic classes was not associated with reduced short-term rehospitalizations or mortality.
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Affiliation(s)
- Barak Zafrir
- Lady Davis Carmel Medical Center, Cardiology Department, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 7 Michal St., Haifa, Israel;
| | - Tal Ovdat
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel;
| | - Mahmood Abu Akel
- Lady Davis Carmel Medical Center, Cardiology Department, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 7 Michal St., Haifa, Israel;
| | - Fadel Bahouth
- Cardiology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Katia Orvin
- Rabin Medical Center, Cardiology Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Roy Beigel
- Leviev Heart Center, Sheba Medical Center, Cardiovascular Division, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Offer Amir
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem, Israel; (O.A.); (G.E.-G.)
| | - Gabby Elbaz-Greener
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem, Israel; (O.A.); (G.E.-G.)
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15
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Filho CEB, Barbosa AHP, Nicolau LAD, Medeiros JVR, Pires-Oliveira M, dos Santos Póvoa RM, Govato TCP, Júnior HJF, de Carvalho RG, Luna-Filho B, Sabia Tallo F, de Araújo EA, Padrão Tavares JG, Arida RM, Caricati-Neto A, Menezes-Rodrigues FS. Pharmacological Modulation by Low Molecular Weight Heparin of Purinergic Signaling in Cardiac Cells Prevents Arrhythmia and Lethality Induced by Myocardial Infarction. J Cardiovasc Dev Dis 2023; 10:jcdd10030103. [PMID: 36975867 PMCID: PMC10058697 DOI: 10.3390/jcdd10030103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Background: Although several studies suggest that heparins prevent arrhythmias caused by acute myocardial infarction (AMI), the molecular mechanisms involved remain unclear. To investigate the involvement of pharmacological modulation of adenosine (ADO) signaling in cardiac cells by a low-molecular weight heparin (enoxaparin; ENOX) used in AMI therapy, the effects of ENOX on the incidences of ventricular arrhythmias (VA), atrioventricular block (AVB), and lethality (LET) induced by cardiac ischemia and reperfusion (CIR) were evaluated, with or without ADO signaling blockers. Methods: To induce CIR, adult male Wistar rats were anesthetized and subjected to CIR. Electrocardiogram (ECG) analysis was used to evaluate CIR-induced VA, AVB, and LET incidence, after treatment with ENOX. ENOX effects were evaluated in the absence or presence of an ADO A1-receptor antagonist (DPCPX) and/or an inhibitor of ABC transporter-mediated cAMP efflux (probenecid, PROB). Results: VA incidence was similar between ENOX-treated (66%) and control rats (83%), but AVB (from 83% to 33%) and LET (from 75% to 25%) incidences were significantly lower in rats treated with ENOX. These cardioprotective effects were blocked by either PROB or DPCPX. Conclusion: These results indicate that ENOX was effective in preventing severe and lethal arrhythmias induced by CIR due to pharmacological modulation of ADO signaling in cardiac cells, suggesting that this cardioprotective strategy could be promising in AMI therapy.
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Affiliation(s)
- Carlos Eduardo Braga Filho
- Postgraduate Program in Cardiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | | | | | - Jand Venes Rolim Medeiros
- Department of Biotechnology, Universidade Federal do Delta do Parnaíba (UFDPar), Parnaíba 64202-020, PI, Brazil
| | - Marcelo Pires-Oliveira
- União Metropolitana de Educação e Cultura–School of Medicine (UNIME), Lauro de Freitas 42700-000, BA, Brazil
| | - Rui Manuel dos Santos Póvoa
- Postgraduate Program in Cardiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | | | - Hézio Jadir Fernandes Júnior
- Postgraduate Program in Cardiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | - Rafael Guzella de Carvalho
- Postgraduate Program in Cardiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | - Bráulio Luna-Filho
- Postgraduate Program in Cardiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | - Fernando Sabia Tallo
- Department of Urgency and Emergency Care, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | - Erisvaldo Amarante de Araújo
- Postgraduate Program in Cardiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04024-000, SP, Brazil
| | | | - Ricardo Mario Arida
- Department of Physiology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-062, SP, Brazil
| | - Afonso Caricati-Neto
- Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-062, SP, Brazil
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Error in Author Name. JAMA Cardiol 2022; 7:1082. [PMID: 36222844 PMCID: PMC9557867 DOI: 10.1001/jamacardio.2022.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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