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Leboube S, Camboulives L, Bochaton T, Amaz C, Bergerot C, Altman M, Loppinet T, Cherpaz M, Monsec T, Sportouch C, Trinh A, Soulier C, Bernard A, Derumeaux G, Mewton N, Ovize M, Thibault H. What underlies sex differences in heart failure onset within the first year after a first myocardial infarction? Front Cardiovasc Med 2024; 10:1290375. [PMID: 38322272 PMCID: PMC10844509 DOI: 10.3389/fcvm.2023.1290375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
Background Women are more likely to develop heart failure (HF) after myocardial infarction. However, diagnosis and reperfusion are often delayed. Objectives To compare the prevalence of HF after primary percutaneous coronary intervention (PPCI)-treated ST segment myocardial infarction (STEMI) between sexes and to study its associations with comorbidities, infarct size, and left ventricular (LV) systolic and diastolic dysfunctions (DD). Methods The patients with PPCI-treated anterior STEMI, from the CIRCUS study cohort, were followed up for 1 year and HF events were recorded. Evaluation of ejection fraction (LVEF) and DD were performed at baseline and at 1 year. The elevated LV filling pressure (LVFP) included Grades 2 and 3 DD. Results Of the 791 patients from the CIRCUS study, 135 were women. At 1 year, the proportion of patients who developed HF was 21% among men and 34% among women (p = 0.001). In the subset of 407 patients with available diastolic parameters, the rate of HF was also higher in women. HF during the initial hospitalization was comparable between the sexes. However, women had a higher incidence of rehospitalization for HF within the first year after STEMI (14.1% vs. 4.1%, p = 0.005). Women were older with a higher prevalence of hypertension. The infarct size and LVEF were similar between the sexes. Elevated LVFP was observed more frequently in women than in men during the initial hospitalization and at 1 year (26% vs. 12%, p = 0.04, and 22% vs. 12%, p = 0.006, respectively). Interestingly, only initial elevated LVFP (HR 5.9, 95% CI: 2.4-14.5, p < 0.001), age, and hypertension were independently associated with rehospitalization for HF. Conclusions After PPCI-treated anterior STEMI, despite comparable infarct size and LVEF, women presented a higher proportion of rehospitalization for HF than men. That was likely due to a greater DD associated with older age and hypertension.
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Affiliation(s)
- Simon Leboube
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
- Laboratoire CarMeN – IRIS Team, INSERM, INRA, Université Claude Bernard Lyon-1, 21 Univ-Lyon, Bron, France
| | - Louise Camboulives
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Laboratoire CarMeN – IRIS Team, INSERM, INRA, Université Claude Bernard Lyon-1, 21 Univ-Lyon, Bron, France
- Centre d'investigation clinique de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Centre d'investigation clinique de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Cyrille Bergerot
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Mikhail Altman
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Thomas Loppinet
- Centre d'investigation clinique de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Maelle Cherpaz
- Laboratoire CarMeN – IRIS Team, INSERM, INRA, Université Claude Bernard Lyon-1, 21 Univ-Lyon, Bron, France
| | - Thierry Monsec
- Service de Cardiologie, Centre Hospitalier de Valence, Valence, France
| | | | - Annie Trinh
- Service de Cardiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Anne Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Genevieve Derumeaux
- Service de Cardiologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nathan Mewton
- Laboratoire CarMeN – IRIS Team, INSERM, INRA, Université Claude Bernard Lyon-1, 21 Univ-Lyon, Bron, France
- Centre d'investigation clinique de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Michel Ovize
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
- Laboratoire CarMeN – IRIS Team, INSERM, INRA, Université Claude Bernard Lyon-1, 21 Univ-Lyon, Bron, France
| | - Hélène Thibault
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
- Laboratoire CarMeN – IRIS Team, INSERM, INRA, Université Claude Bernard Lyon-1, 21 Univ-Lyon, Bron, France
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2
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Hoyer AA, Klaeske K, Garnham J, Kiefer P, Salameh A, Witte K, Borger M, Dieterlen MT. Cyclosporine A-enhanced cardioplegia preserves mitochondrial basal respiration after ischemic arrest. Perfusion 2024; 39:36-44. [PMID: 34192950 DOI: 10.1177/02676591211025746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mitochondrial permeability transition pore (mPTP) opening plays a crucial role in cell death during ischemia-reperfusion injury (IRI). Cyclosporine A (CsA) inhibits mPTP opening. This study aimed to investigate the effects of CsA treatment during cardioplegia on the mitochondrial function and cardiac IRI. METHODS Landrace pigs (52.9 ± 3.7 kg) were subjected to midline sternotomy, cardiopulmonary bypass at 34°C and 90 minutes of cardiac arrest. They received either a single shot of standard 4°C cold histidine-tryptophan-α-ketoglutarate (HTK)-Bretschneider solution (n = 11) or HTK-Bretschneider plus 1.2 mg/L CsA (histidine-tryptophan-α-ketoglutarate plus cyclosporine A (HTK/CsA); n = 11). During reperfusion global left-ventricular function was assessed and myocardial biopsies were harvested at baseline, during ischemia and 45 minutes following reperfusion. High-resolution respirometry and hydrogen peroxide production were measured. Immunohistochemical stainings for apoptosis-inducing factor and hypoxia-inducible factor-1α as well as a flow cytometry-based JC-1 mitochondrial membrane potential assay were performed. RESULTS Hemodynamic parameters were comparable between both groups. The cytochrome C release (HTK: 930.3 ± 804.4 pg/mg, HTK/CsA: 699.7 ± 394.0 pg/mg, p = 0.457) as well as PGC1α content (HTK: 66.7%, HTK/CsA: 33.3%, p = 0.284) was lower in the HTK/CsA group. Respiratory measurements revealed that the oxygen flux under basal respiration was higher in the HTK/CsA group (8.2 ± 1.3 pmol·O2·s-1·mg-1·ww) than in the HTK group (3.8 ± 1.4 pmol·O2·s-1·mg-1·ww, p = 0.045). There were no significant differences regarding histological surrogates of apoptosis and necrosis. CONCLUSIONS Supplementing cardioplegic solutions with CsA enhances the basal mitochondrial respiration thereby exerting a cardioprotective effect and diminishing IRI-induced damage. CsA seems to preserve mitochondrial function via non-ROS related pathways.
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Affiliation(s)
- Alexandro A Hoyer
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Kristin Klaeske
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Jack Garnham
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Philipp Kiefer
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Aida Salameh
- Department of Pediatric Cardiology, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Michael Borger
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
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3
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Chen DQ, Guo Y, Li X, Zhang GQ, Li P. Small molecules as modulators of regulated cell death against ischemia/reperfusion injury. Med Res Rev 2022; 42:2067-2101. [PMID: 35730121 DOI: 10.1002/med.21917] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 11/11/2021] [Accepted: 06/07/2022] [Indexed: 12/13/2022]
Abstract
Ischemia/reperfusion (IR) injury contributes to disability and mortality worldwide. Due to the complicated mechanisms and lack of proper therapeutic targets, few interventions are available that specifically target the pathogenesis of IR injury. Regulated cell death (RCD) of endothelial and parenchymal cells is recognized as the promising intervening target. Recent advances in IR injury suggest that small molecules exhibit beneficial effects on various RCD against IR injury, including apoptosis, necroptosis, autophagy, ferroptosis, pyroptosis, and parthanatos. Here, we describe the mechanisms behind these novel promising therapeutic targets and explain the machinery powering the small molecules. These small molecules exert protection by targeting endothelial or parenchymal cells to alleviate IR injury. Therapies of the ideal combination of small molecules targeting multiple cell types have shown potent synergetic therapeutic effects, laying the foundation for novel strategies to attenuate IR injury.
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Affiliation(s)
- Dan-Qian Chen
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Yan Guo
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Xin Li
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Guo-Qiang Zhang
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Ping Li
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
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4
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Yang J, Guo Q, Feng X, Liu Y, Zhou Y. Mitochondrial Dysfunction in Cardiovascular Diseases: Potential Targets for Treatment. Front Cell Dev Biol 2022; 10:841523. [PMID: 35646910 PMCID: PMC9140220 DOI: 10.3389/fcell.2022.841523] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/13/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular diseases (CVDs) are serious public health issues and are responsible for nearly one-third of global deaths. Mitochondrial dysfunction is accountable for the development of most CVDs. Mitochondria produce adenosine triphosphate through oxidative phosphorylation and inevitably generate reactive oxygen species (ROS). Excessive ROS causes mitochondrial dysfunction and cell death. Mitochondria can protect against these damages via the regulation of mitochondrial homeostasis. In recent years, mitochondria-targeted therapy for CVDs has attracted increasing attention. Various studies have confirmed that clinical drugs (β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor-II blockers) against CVDs have mitochondrial protective functions. An increasing number of cardiac mitochondrial targets have shown their cardioprotective effects in experimental and clinical studies. Here, we briefly introduce the mechanisms of mitochondrial dysfunction and summarize the progression of mitochondrial targets against CVDs, which may provide ideas for experimental studies and clinical trials.
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5
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Schaaf M, Croisille P, Py A, Roubille F, Biere L, Bochaton T, Perret T, Belle L, De Poli F, Hovasse T, Lairez O, Boussaha I, Rioufol G, Prunier F, Ovize M, Mewton N. Non-culprit artery myocardial infarction and complex coronary lesions in anterior ST-elevated myocardial infarction patients. Cardiology 2021; 146:728-736. [PMID: 34348264 DOI: 10.1159/000518137] [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: 06/12/2020] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mathieu Schaaf
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Pierre Croisille
- Radiology Department, Hôpital Nord, CHU Saint-Etienne, Saint Etienne, France
| | - Agathe Py
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Fédération de Cardiologie, Hospices Civils de Lyon, Lyon, France
| | - François Roubille
- Cardiology Department, Hôpital Arnaud de Villeuneuve, CHU de Montpellier, Montpellier, France
| | - Loic Biere
- Cardiology Department, CHU d'Angers, Angers, France
| | - Thomas Bochaton
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Thibault Perret
- Cardiology Department, Centre Hospitalier, St Joseph Saint Luc, Lyon, France
| | - Loic Belle
- Cardiology Department, Centre Hospitalier d'Annecy, Annecy, France
| | | | - Thomas Hovasse
- Cardiology Department, Jacques Cartier Institute, Massy, France
| | - Olivier Lairez
- Cardiology Department, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Inesse Boussaha
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Gilles Rioufol
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | | | - Michel Ovize
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
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6
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Forini F, Canale P, Nicolini G, Iervasi G. Mitochondria-Targeted Drug Delivery in Cardiovascular Disease: A Long Road to Nano-Cardio Medicine. Pharmaceutics 2020; 12:E1122. [PMID: 33233847 PMCID: PMC7699942 DOI: 10.3390/pharmaceutics12111122] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) represents a major threat for human health. The available preventive and treatment interventions are insufficient to revert the underlying pathological processes, which underscores the urgency of alternative approaches. Mitochondria dysfunction plays a key role in the etiopathogenesis of CVD and is regarded as an intriguing target for the development of innovative therapies. Oxidative stress, mitochondrial permeability transition pore opening, and excessive fission are major noxious pathways amenable to drug therapy. Thanks to the advancements of nanotechnology research, several mitochondria-targeted drug delivery systems (DDS) have been optimized with improved pharmacokinetic and biocompatibility, and lower toxicity and antigenicity for application in the cardiovascular field. This review summarizes the recent progress and remaining obstacles in targeting mitochondria as a novel therapeutic option for CVD. The advantages of nanoparticle delivery over un-targeted strategies are also discussed.
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Affiliation(s)
- Francesca Forini
- CNR Intitute of Clinical Physiology, Via G.Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (G.I.)
| | - Paola Canale
- CNR Intitute of Clinical Physiology, Via G.Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (G.I.)
- Department of Biology, University of Pisa, Via Volta 4 bis, 56126 Pisa, Italy
| | - Giuseppina Nicolini
- CNR Intitute of Clinical Physiology, Via G.Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (G.I.)
| | - Giorgio Iervasi
- CNR Intitute of Clinical Physiology, Via G.Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (G.I.)
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7
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Pezel T, Besseyre des Horts T, Schaaf M, Croisille P, Bière L, Garcia-Dorado D, Jossan C, Roubille F, Cung TT, Prunier F, Meyer E, Amaz C, Derumeaux G, de Poli F, Hovasse T, Gilard M, Bergerot C, Thibault H, Ovize M, Mewton N. Predictive value of early cardiac magnetic resonance imaging functional and geometric indexes for adverse left ventricular remodelling in patients with anterior ST-segment elevation myocardial infarction: A report from the CIRCUS study. Arch Cardiovasc Dis 2020; 113:710-720. [PMID: 33160891 DOI: 10.1016/j.acvd.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/17/2020] [Accepted: 05/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postinfarction adverse left ventricular (LV) remodelling is strongly associated with heart failure events. Conicity index, sphericity index and LV global functional index (LVGFI) are new LV remodelling indexes assessed by cardiac magnetic resonance (CMR). AIM To assess the predictive value of the new indexes for 1-year adverse LV remodelling in patients with anterior ST-segment elevated myocardial infarction (STEMI). METHODS CMR studies were performed in 129 patients with anterior STEMI (58±12 years; 78% men) from the randomized CIRCUS trial (CMR substudy) treated with primary percutaneous coronary intervention and followed for the occurrence of major adverse cardiovascular events (MACE) (death or hospitalization for heart failure). Conicity index, sphericity index, LVGFI, infarct size and microvascular obstruction (MVO) were assessed by CMR performed 5±4 days after coronary reperfusion. Adverse LV remodelling was defined as an increase in LV end-diastolic volume of ≥15% by transthoracic echocardiography at 1 year. RESULTS Adverse LV remodelling occurred in 27% of patients at 1 year. Infarct size and MVO were significantly predictive of adverse LV remodelling: odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05 (P<0.001) and OR 1.12, 95% CI 1.05-1.22 (P<0.001), respectively. Among the newly tested indexes, only LVGFI was significantly predictive of adverse LV remodelling (OR 1.10, 95% CI 1.03-1.16; P=0.001). In multivariable analysis, infarct size remained an independent predictor of adverse LV remodelling at 1 year (OR 1.05, 95% CI 1.02-1.08; P<0.001). LVGFI and infarct size were associated with occurrence of MACE: OR 1.21, 95% CI 1.08-1.37 (P<0.001) and OR 1.02, 95% CI 1.00-1.04 (P=0.018), respectively. Conicity and sphericity indexes were not associated with MACE. CONCLUSIONS LVGFI was associated with adverse LV remodelling and MACE 1 year after anterior STEMI.
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Affiliation(s)
- Théo Pezel
- Inserm, UMRS 942, Department of Cardiology, Lariboisière Hospital, Paris University, AP-HP, 75010 Paris, France; Division of Cardiology, Johns-Hopkins University, 21287-0409 Baltimore, MD, USA
| | - Timothée Besseyre des Horts
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - Mathieu Schaaf
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - Pierre Croisille
- Radiology Department, University Hospital of Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
| | - Loïc Bière
- Cardiology Division, University Hospital of Angers, 49100 Angers, France
| | - David Garcia-Dorado
- CIBERCV, Hospital Universitari Vall d'Hebron & Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Claire Jossan
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - François Roubille
- UMR5203, UMR661, Cardiology Division, University Hospital of Montpellier, University of Montpellier 1 and 2, 34295 Montpellier, France
| | - Thien-Tri Cung
- UMR5203, UMR661, Cardiology Division, University Hospital of Montpellier, University of Montpellier 1 and 2, 34295 Montpellier, France
| | - Fabrice Prunier
- Cardiology Division, University Hospital of Angers, 49100 Angers, France
| | - Elbaz Meyer
- Rangeuil Hospital, University Hospital of Toulouse, Paul-Sabatier University, 31400 Toulouse, France
| | - Camille Amaz
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - Geneviève Derumeaux
- DHU-ATVB, Henri-Mondor Hospital, Paris-Est Créteil University, AP-HP, 94010 Créteil, France
| | - Fabien de Poli
- Cardiology Division, Haguenau Hospital, 67500 Haguenau, France
| | - Thomas Hovasse
- Cardiology Division, Jacques-Cartier Institute, 91300 Massy, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Cyrille Bergerot
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - Hélène Thibault
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - Michel Ovize
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France
| | - Nathan Mewton
- Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France.
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8
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Sauer F, Jesel L, Marchandot B, Derimay F, Bochaton T, Amaz C, Roubille F, Cayla G, Rioufol G, Garcia-Dorado D, Claeys M, Angoulvant D, Bonnefoy-Cudraz E, Guérin P, Trinh A, Matsushita K, Ohlmann P, Jossan C, Mewton N, Ovize M, Morel O. Life-threatening arrhythmias in anterior ST-segment elevation myocardial infarction patients treated by percutaneous coronary intervention: adverse impact of morphine. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:427-436. [PMID: 33620376 DOI: 10.1093/ehjacc/zuaa005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 11/12/2022]
Abstract
AIMS Important controversies remain concerning the determinants of life-threatening arrhythmias during ST-segment elevation myocardial infarction (STEMI) and their impact on late adverse events. This study sought to investigate which factors might facilitate ventricular tachycardia (VT) and ventricular fibrillation (VF), in a homogeneous population of anterior STEMI patients defined by abrupt left anterior descending coronary artery (LAD) occlusion and no collateral flow. METHODS AND RESULTS The 967 patients, who entered into the CIRCUS (Does Cyclosporine ImpRove Clinical oUtcome in ST elevation myocardial infarction patients) study, were assessed for further analysis. Acute VT/VF was defined as VT (run of tachycardia >30 s either self-terminated or requiring electrical/pharmacological cardioversion) or VF documented by electrocardiogram or cardiac monitoring, during transportation to the cathlab or initial hospitalization. VT/VF was documented in 136 patients (14.1%). Patients with VT/VF were younger and had shorter time from symptom onset to hospital arrival. Site of LAD occlusion, thrombus burden, area at risk, pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow, and ST-segment resolution were similar to that of patients without VT/VF. There was no impact of VT/VF on left ventricular remodelling or clinical outcomes. By multivariate analysis, the use of morphine (odds ratio 1.71; 95% confidence interval (1.13-2.60); P = 0.012) was the sole independent predictor of VT/VF occurrence. CONCLUSIONS In STEMI patients with LAD occlusion, our findings support the view that morphine could favour severe ventricular arrhythmias.
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Affiliation(s)
- François Sauer
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France
| | - Laurence Jesel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France.,UMR 1260 INSERM Nanomédecine Régénérative Université de Strasbourg, Strasbourg, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France
| | - François Derimay
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bochaton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Centre d'Investigation Clinique de Lyon, CIC 1407, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | | | | | - Gilles Rioufol
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Claeys
- University Hospital Antwerp, Edegem, Belgium
| | - Denis Angoulvant
- Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | | | | | - Annie Trinh
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France
| | - Kensuke Matsushita
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France.,UMR 1260 INSERM Nanomédecine Régénérative Université de Strasbourg, Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France
| | - Claire Jossan
- Centre d'Investigation Clinique de Lyon, CIC 1407, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France.,Centre d'Investigation Clinique de Lyon, CIC 1407, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Michel Ovize
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France.,Centre d'Investigation Clinique de Lyon, CIC 1407, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426, 67091 Strasbourg, France.,UMR 1260 INSERM Nanomédecine Régénérative Université de Strasbourg, Strasbourg, France
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9
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Boulghobra D, Coste F, Geny B, Reboul C. Exercise training protects the heart against ischemia-reperfusion injury: A central role for mitochondria? Free Radic Biol Med 2020; 152:395-410. [PMID: 32294509 DOI: 10.1016/j.freeradbiomed.2020.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
Ischemic heart disease is one of the main causes of morbidity and mortality worldwide. Physical exercise is an effective lifestyle intervention to reduce the risk factors for cardiovascular disease and also to improve cardiac function and survival in patients with ischemic heart disease. Among the strategies that contribute to reduce heart damages during ischemia and reperfusion, regular physical exercise is efficient both in rodent experimental models and in humans. However, the cellular and molecular mechanisms of the cardioprotective effects of exercise remain unclear. During ischemia and reperfusion, mitochondria are crucial players in cell death, but also in cell survival. Although exercise training can influence mitochondrial function, the consequences on heart sensitivity to ischemic insults remain elusive. In this review, we describe the effects of physical activity on cardiac mitochondria and their potential key role in exercise-induced cardioprotection against ischemia-reperfusion damage. Based on recent scientific data, we discuss the role of different pathways that might help to explain why mitochondria are a key target of exercise-induced cardioprotection.
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Affiliation(s)
| | - Florence Coste
- LAPEC EA4278, Avignon Université, F-84000, Avignon, France
| | - Bernard Geny
- EA3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», Université de Strasbourg, 67000, Strasbourg, France
| | - Cyril Reboul
- LAPEC EA4278, Avignon Université, F-84000, Avignon, France.
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10
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de Framond Y, Schaaf M, Pichot-Lamoureux S, Range G, Dubreuil O, Angoulvant D, Claeys MJ, Dorado DG, Bochaton T, Rioufol G, Jossan C, Boussaha I, Ovize M, Mewton N. Regression of Q waves and clinical outcomes following primary PCI in anterior STEMI. J Electrocardiol 2019; 73:131-136. [PMID: 31668455 DOI: 10.1016/j.jelectrocard.2019.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 08/19/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after anterior STEMI. METHODS Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had regression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year. RESULTS There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave regression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 ± 2784 IU/l vs. 3814 ± 2595 IU/l vs. 1733 ± 1583 IU/l respectively, p < 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09). CONCLUSION In a population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.
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Affiliation(s)
- Yuni de Framond
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | | | - Sophie Pichot-Lamoureux
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | | | | | | | | | - David Garcia Dorado
- Vall d'Hebron University Hospital and Research Institut and CIBERC, Universtitat Autonoma de Barcelona, Spain
| | - Thomas Bochaton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Gilles Rioufol
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Claire Jossan
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Inesse Boussaha
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Michel Ovize
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Nathan Mewton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France.
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11
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Claeys MJ, Coussement P, Dubois P, Garcia-Dorado D, Mewton N, Amaz C, Ovize M. Clinical effects of cyclosporine in acute anterior myocardial infarction complicated by heart failure: A subgroup analysis of the CIRCUS Trial. Am Heart J 2019; 216:147-149. [PMID: 31255244 DOI: 10.1016/j.ahj.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
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12
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Naryzhnaya NV, Maslov LN, Oeltgen PR. Pharmacology of mitochondrial permeability transition pore inhibitors. Drug Dev Res 2019; 80:1013-1030. [DOI: 10.1002/ddr.21593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Natalia V. Naryzhnaya
- Laboratory of Experimental CardiologyCardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Science Tomsk Russia
| | - Leonid N. Maslov
- Laboratory of Experimental CardiologyCardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Science Tomsk Russia
| | - Peter R. Oeltgen
- Department of PathologyUniversity of Kentucky College of Medicine Lexington Kentucky
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13
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Ostadal B, Drahota Z, Houstek J, Milerova M, Ostadalova I, Hlavackova M, Kolar F. Developmental and sex differences in cardiac tolerance to ischemia-reperfusion injury: the role of mitochondria 1. Can J Physiol Pharmacol 2019; 97:808-814. [PMID: 30893574 DOI: 10.1139/cjpp-2019-0060] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Age and sex play an essential role in the cardiac tolerance to ischemia-reperfusion injury: cardiac resistance significantly decreases during postnatal maturation and the female heart is more tolerant than the male myocardium. It is widely accepted that mitochondrial dysfunction, and particularly mitochondrial permeability transition pore (MPTP) opening, plays a major role in determining the extent of cardiac ischemia-reperfusion injury. We have observed that the MPTP sensitivity to the calcium load differs in mitochondria isolated from neonatal and adult myocardium, as well as from adult male and female hearts. Neonatal and female mitochondria are more resistant both in the extent and in the rate of mitochondrial swelling induced by high calcium concentration. Our data further suggest that age- and sex-dependent specificity of the MPTP is not the result of different amounts of ATP synthase and cyclophilin D: neonatal and adult hearts, similarly as the male and female hearts, contain comparable amounts of MPTP and its regulatory protein cyclophilin D. We can speculate that the lower sensitivity of MPTP to the calcium-induced swelling may be related to the higher ischemic tolerance of both neonatal and female myocardium.
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Affiliation(s)
- B Ostadal
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
| | - Z Drahota
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
| | - J Houstek
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
| | - M Milerova
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
| | - I Ostadalova
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
| | - M Hlavackova
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
| | - F Kolar
- Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Videnska 1083, 14220 Prague 4 Czech Republic
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14
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Rahman FA, Abdullah SS, Manan WZWA, Tan LTH, Neoh CF, Ming LC, Chan KG, Lee LH, Goh BH, Salmasi S, Wu DBC, Khan TM. Efficacy and Safety of Cyclosporine in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. Front Pharmacol 2018; 9:238. [PMID: 29970999 PMCID: PMC6018391 DOI: 10.3389/fphar.2018.00238] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
There are various studies that have addressed the use of Cyclosporine among patients with acute myocardial infarction (AMI). However, to date there is hardly any concise and systematically structured evidence that debate on the efficacy and safety of Cyclosporine in AMI patients. The aim of this review is to systematically summarize the overall evidence from published trials, and to conduct a meta-analysis in order to determine the efficacy and safety of Cyclosporine vs. placebo or control among patients with AMI. All randomized control trial (RCT) published in English language from January 2000 to August 2017 were included for the systematic review and meta-analysis. A total of six RCTs met the inclusion and were hence included in the systematic review and meta-analysis. Based on the performed meta-analysis, no significant difference was found between Cyclosporine and placebo in terms of left ventricular ejection fraction (LVEF) improvement (mean difference 1.88; 95% CI −0.99 to 4.74; P = 0.2), mortality rate (OR 1.01; 95% Cl 0.60 to 1.67, P = 0.98) and recurrent MI occurrence (OR 0.65; 95% Cl 0.29 to 1.45, P = 0.29), with no evidence of heterogeneity, when given to patients with AMI. Cyclosporine also did not significantly lessen the rate of rehospitalisation in AMI patients when compared to placebo (OR 0.91; 95% Cl 0.58 to 1.42, P = 0.68), with moderate heterogeneity (I2 = 46%). There was also no significant improvement in heart failure events between Cyclosporine and placebo in AMI patients (OR 0.63; 95% Cl 0.31 to 1.29, P = 0.21; I2 = 80%). No serious adverse events were reported in Cyclosporine group across all studies suggesting that Cyclosporine is well tolerated when given to patients with AMI. The use of Cyclosporine in this group of patients, however, did not result in better clinical outcomes vs. placebo at improving LVEF, mortality rate, recurrent MI, rehospitalisation and heart failure event.
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Affiliation(s)
- Firdaus A Rahman
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Siti S Abdullah
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | | | - Loh Teng-Hern Tan
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University, Bandar Sunway, Malaysia
| | - Chin-Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia
| | - Kok-Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China.,Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University, Bandar Sunway, Malaysia
| | - Bey-Hing Goh
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University, Bandar Sunway, Malaysia
| | - Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Tahir M Khan
- School of Pharmacy, Monash University, Bandar Sunway, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University, Bandar Sunway, Malaysia.,Institute of Pharmaceutical Science, University of Veterinary and Animal Science, Lahore, Pakistan
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15
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Bourezg A, Bochaton T, Mewton N, Morel O, Cayla G, Rioufol G, Bonnefoy-Cudraz E, Guerin P, Elbaz M, Boussaha I, Amaz C, Angoulvant D, Ovize M. Atrial fibrillation, intra-ventricular thrombus, and other anticoagulant indications relationship with adverse outcomes in acute anterior myocardial infarction patients. J Cardiol 2018; 72:277-283. [PMID: 29753538 DOI: 10.1016/j.jjcc.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to assess the predictive value of atrial fibrillation (AF), left ventricular thrombus (LVT), and other oral anticoagulant (OAC) indications on 1-year major adverse cardio-cerebrovascular events (MACCE) and bleeding in acute anterior ST-elevated myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). METHODS Our study population included 969 anterior STEMI patients referred for PPCI from the prospective multicenter CIRCUS trial. Patients with a formal indication of OAC within the first year were compared to those without indication. RESULTS A total of 161 (16.6%) patients were eligible for OAC after anterior STEMI mainly for AF (51.5%) and LVT (39.7%). This group had a higher morbidity profile despite similar reperfusion settings - 67% of them were treated with OAC. At 1 year, OAC indication was associated with a significant increase in MACCE rate [OR 3.37 95% CI (2.36;4.82) p<0.001] as well as bleeding [OR=1.96 95% CI (1.09;3.50) p=0.02]. After adjustment for principal confounders, OAC indication remained strongly associated with MACCE [HR 3.40 (1.26;9.14) p=0.016]. CONCLUSIONS In a prospective cohort of anterior STEMI, AF, LVT, and other OAC indications were present upon discharge in 1 patient out of 6 and only two thirds were treated with OAC. OAC indication was independently associated with an increased risk of MACCE and bleeding at one year.
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Affiliation(s)
- Asma Bourezg
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel, Clinical Investigation Center, Inserm 1407, Hospices Civils de Lyon, Bron, France.
| | - Olivier Morel
- Centre Hospitalier Universitaire de Strasbourg, Coronary Care Unit, Strasbourg, France
| | - Guillaume Cayla
- Centre Hospitalier Universitaire de Nîmes, Coronary Care Unit, Nîmes, France
| | - Gilles Rioufol
- Hôpital Cardiovasculaire Louis Pradel, Interventional Cardiology Department, Hospices Civils de Lyon, Bron, France
| | - Eric Bonnefoy-Cudraz
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
| | - Patrice Guerin
- Hôpital Laennec, Centre Hospitalier Universitaire de Nantes, Interventional Cardiology Department, Nantes, France
| | - Meyer Elbaz
- Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Interventional Cardiology Department, Toulouse, France
| | - Inesse Boussaha
- Hôpital Cardiovasculaire Louis Pradel, Clinical Investigation Center, Inserm 1407, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Hôpital Cardiovasculaire Louis Pradel, Clinical Investigation Center, Inserm 1407, Hospices Civils de Lyon, Bron, France
| | - Denis Angoulvant
- Hôpital Trousseau, Centre Hospitalier Regional de Tours, Intensive Care Unit, Tours, France
| | - Michel Ovize
- Hôpital Cardiovasculaire Louis Pradel, Intensive Care Unit, Hospices Civils de Lyon, Bron, France
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16
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Bonin M, Mewton N, Roubille F, Morel O, Cayla G, Angoulvant D, Elbaz M, Claeys MJ, Garcia-Dorado D, Giraud C, Rioufol G, Jossan C, Ovize M, Guerin P. Effect and Safety of Morphine Use in Acute Anterior ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2018; 7:JAHA.117.006833. [PMID: 29440010 PMCID: PMC5850179 DOI: 10.1161/jaha.117.006833] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Morphine is commonly used to treat chest pain during myocardial infarction, but its effect on cardiovascular outcome has never been directly evaluated. The aim of this study was to examine the effect and safety of morphine in patients with acute anterior ST‐segment elevation myocardial infarction followed up for 1 year. Methods and Results We used the database of the CIRCUS (Does Cyclosporine Improve Outcome in ST Elevation Myocardial Infarction Patients) trial, which included 969 patients with anterior ST‐segment elevation myocardial infarction, admitted for primary percutaneous coronary intervention. Two groups were defined according to use of morphine preceding coronary angiography. The composite primary outcome was the combined incidence of major adverse cardiovascular events, including cardiovascular death, heart failure, cardiogenic shock, myocardial infarction, unstable angina, and stroke during 1 year. A total of 554 (57.1%) patients received morphine at first medical contact. Both groups, with and without morphine treatment, were comparable with respect to demographic and periprocedural characteristics. There was no significant difference in major adverse cardiovascular events between patients who received morphine compared with those who did not (26.2% versus 22.0%, respectively; P=0.15). The all‐cause mortality was 5.3% in the morphine group versus 5.8% in the no‐morphine group (P=0.89). There was no difference between groups in infarct size as assessed by the creatine kinase peak after primary percutaneous coronary intervention (4023±118 versus 3903±149 IU/L; P=0.52). Conclusions In anterior ST‐segment elevation myocardial infarction patients treated by primary percutaneous coronary intervention, morphine was used in half of patients during initial management and was not associated with a significant increase in major adverse cardiovascular events at 1 year.
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Affiliation(s)
- Mickael Bonin
- Unité d'hémodynamique et Cardio-Vasculaire Interventionnel, Institut du Thorax, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - Nathan Mewton
- Centre d'Investigations Cliniques, Service d'explorations Fonctionnelles Cardiovasculaires, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Francois Roubille
- UFR de Médecine, Cardiology Department, Hôpital Arnaud-de-Villeneuve, CHU Montpellier, University of Montpellier 1, Montpellier, France
| | - Olivier Morel
- Cardiology Department, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
| | - Guillaume Cayla
- Cardiology Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Denis Angoulvant
- Cardiology Department and EA4245, Faculté de Médecine, Tours University Hospital, University François-Rabelais, Tours, France
| | - Meyer Elbaz
- Cardiology Department, Rangueil Hospital, Toulouse, France
| | - Marc J Claeys
- Cardiology Department, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Céline Giraud
- Centre d'Investigations Cliniques, Service d'explorations Fonctionnelles Cardiovasculaires, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Gilles Rioufol
- Interventional Cardiology Department, Hospices Civils de Lyon, Lyon, France
| | - Claire Jossan
- Centre d'Investigations Cliniques, Service d'explorations Fonctionnelles Cardiovasculaires, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Michel Ovize
- Centre d'Investigations Cliniques, Service d'explorations Fonctionnelles Cardiovasculaires, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Patrice Guerin
- Unité d'hémodynamique et Cardio-Vasculaire Interventionnel, Institut du Thorax, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
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17
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Cuenin L, Lamoureux S, Schaaf M, Bochaton T, Monassier JP, Claeys MJ, Rioufol G, Finet G, Garcia-Dorado D, Angoulvant D, Elbaz M, Delarche N, Coste P, Metge M, Perret T, Motreff P, Bonnefoy-Cudraz E, Vanzetto G, Morel O, Boussaha I, Ovize M, Mewton N. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction - Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year. Circ J 2017; 82:1379-1386. [PMID: 28943533 DOI: 10.1253/circj.cj-17-0671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. CONCLUSIONS Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.
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Affiliation(s)
- Léo Cuenin
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | - Mathieu Schaaf
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Thomas Bochaton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Gilles Rioufol
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Gérard Finet
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Meyer Elbaz
- Centre Hospitalier Universitaire de Rangueil
| | | | | | | | | | | | | | | | | | - Inesse Boussaha
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Michel Ovize
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
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18
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Javadov S, Jang S, Parodi-Rullán R, Khuchua Z, Kuznetsov AV. Mitochondrial permeability transition in cardiac ischemia-reperfusion: whether cyclophilin D is a viable target for cardioprotection? Cell Mol Life Sci 2017; 74:2795-2813. [PMID: 28378042 PMCID: PMC5977999 DOI: 10.1007/s00018-017-2502-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/28/2017] [Accepted: 03/06/2017] [Indexed: 12/13/2022]
Abstract
Growing number of studies provide strong evidence that the mitochondrial permeability transition pore (PTP), a non-selective channel in the inner mitochondrial membrane, is involved in the pathogenesis of cardiac ischemia-reperfusion and can be targeted to attenuate reperfusion-induced damage to the myocardium. The molecular identity of the PTP remains unknown and cyclophilin D is the only protein commonly accepted as a major regulator of the PTP opening. Therefore, cyclophilin D is an attractive target for pharmacological or genetic therapies to reduce ischemia-reperfusion injury in various animal models and humans. Most animal studies demonstrated cardioprotective effects of PTP inhibition; however, a recent large clinical trial conducted by international groups demonstrated that cyclosporine A, a cyclophilin D inhibitor, failed to protect the heart in patients with myocardial infarction. These studies, among others, raise the question of whether cyclophilin D, which plays an important physiological role in the regulation of cell metabolism and mitochondrial bioenergetics, is a viable target for cardioprotection. This review discusses previous studies to provide comprehensive information on the physiological role of cyclophilin D as well as PTP opening in the cell that can be taken into consideration for the development of new PTP inhibitors.
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Affiliation(s)
- Sabzali Javadov
- Department of Physiology, School of Medicine, University of Puerto Rico, San Juan, PR 00936-5067, Puerto Rico.
| | - Sehwan Jang
- Department of Physiology, School of Medicine, University of Puerto Rico, San Juan, PR 00936-5067, Puerto Rico
| | - Rebecca Parodi-Rullán
- Department of Physiology, School of Medicine, University of Puerto Rico, San Juan, PR 00936-5067, Puerto Rico
| | - Zaza Khuchua
- Cincinnati Children's Research Foundation, University of Cincinnati, 240 Albert Sabin Way, Cincinnati, OH, 54229, USA
| | - Andrey V Kuznetsov
- Cardiac Surgery Research Laboratory, Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
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19
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Donnarumma E, Trivedi RK, Lefer DJ. Protective Actions of H2S in Acute Myocardial Infarction and Heart Failure. Compr Physiol 2017; 7:583-602. [PMID: 28333381 DOI: 10.1002/cphy.c160023] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hydrogen sulfide (H2S) was identified as the third gasotransmitter in 1996 following the discoveries of the biological importance of nitric oxide and carbon monoxide. Although H2S has long been considered a highly toxic gas, the discovery of its presence and enzymatic production in mammalian tissues supports a critical role for this physiological signaling molecule. H2S is synthesized endogenously by three enzymes: cystathionine β-synthase, cystathionine-γ-lyase, and 3-mercaptopyruvate sulfurtransferase. H2S plays a pivotal role in the regulation of cardiovascular function as H2S has been shown to modulate: vasodilation, angiogenesis, inflammation, oxidative stress, and apoptosis. Perturbation of endogenous production of H2S has been associated with many pathological conditions of the cardiovascular system such as diabetes, heart failure, and hypertension. As such, modulation of the endogenous H2S signaling pathway or administration of exogenous H2S has been shown to be cytoprotective. This review article will provide a summary of the current body of evidence on the role of H2S signaling in the setting of myocardial ischemia and heart failure. © 2017 American Physiological Society. Compr Physiol 7:583-602, 2017.
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Affiliation(s)
- Erminia Donnarumma
- Cardiovascular Center of Excellence Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rishi K Trivedi
- Cardiovascular Center of Excellence Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - David J Lefer
- Cardiovascular Center of Excellence Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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20
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Trankle C, Thurber CJ, Toldo S, Abbate A. Mitochondrial Membrane Permeability Inhibitors in Acute Myocardial Infarction: Still Awaiting Translation. ACTA ACUST UNITED AC 2016; 1:524-535. [PMID: 30167535 PMCID: PMC6113419 DOI: 10.1016/j.jacbts.2016.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
Abstract
Despite therapeutic advances, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. One potential limitation of the current treatment paradigm is the lack of effective therapies to optimize reperfusion after ischemia and prevent reperfusion-mediated injury. Experimental studies indicate that this process accounts for up to 50% of the final infarct size, lending it importance as a potential target for cardioprotection. However, multiple therapeutic approaches have shown potential in pre-clinical and early phase trials but a paucity of clear clinical benefit when expanded to larger studies. Here we explore this history of trials and errors of the studies of cyclosporine A and other mitochondrial membrane permeability inhibitors, agents that appeared to have a promising pre-clinical record yet provided disappointing results in phase III clinical trials.
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Affiliation(s)
- Cory Trankle
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Clinton J Thurber
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Stefano Toldo
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiac Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Antonio Abbate
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.,Johnson Research Center for Critical Care, Virginia Commonwealth University, Richmond, Virginia.,Department of Medical and Surgical Sciences and Biotechnologies, University of Rome "Sapienza", Rome, Italy
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21
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Agarwal A, Dong Z, Harris R, Murray P, Parikh SM, Rosner MH, Kellum JA, Ronco C. Cellular and Molecular Mechanisms of AKI. J Am Soc Nephrol 2016; 27:1288-99. [PMID: 26860342 DOI: 10.1681/asn.2015070740] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In this article, we review the current evidence for the cellular and molecular mechanisms of AKI, focusing on epithelial cell pathobiology and related cell-cell interactions, using ischemic AKI as a model. Highlighted are the clinical relevance of cellular and molecular targets that have been investigated in experimental models of ischemic AKI and how such models might be improved to optimize translation into successful clinical trials. In particular, development of more context-specific animal models with greater relevance to human AKI is urgently needed. Comorbidities that could alter patient susceptibility to AKI, such as underlying diabetes, aging, obesity, cancer, and CKD, should also be considered in developing these models. Finally, harmonization between academia and industry for more clinically relevant preclinical testing of potential therapeutic targets and better translational clinical trial design is also needed to achieve the goal of developing effective interventions for AKI.
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Affiliation(s)
- Anupam Agarwal
- Division of Nephrology, and Nephrology Research and Training Center, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
| | - Zheng Dong
- Department of Cellular Biology and Anatomy, Georgia Regents University, Augusta, Georgia
| | - Raymond Harris
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Patrick Murray
- Department of Medicine, University College of Dublin, Dublin, Ireland
| | - Samir M Parikh
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Mitchell H Rosner
- Department of Medicine, Nephrology Division, and the Center for Immunity, Inflammation, and Regenerative Medicine, University of Virginia, Charlottesville, Virginia
| | - John A Kellum
- Center for Critical Care Nephrology, Clinical Research, Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Claudio Ronco
- Department of Nephrology, Dialysis, and Transplantation, San Bortolo Hospital, and the International Renal Research Institute, 36100 Vicenza, Italy
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22
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Abstract
Acute kidney injury (AKI) continues to be a significant contributor to morbidity, mortality, and health care expenditure. In the United States alone, it is estimated that more than $10 billion is spent on AKI every year. Currently, there are no available therapies to treat established AKI. The mitochondrion is positioned to be a critical player in AKI with its dual role as the primary source of energy for each cell and as a key regulator of cell death. This review aims to cover the current state of research on the role of mitochondria in AKI, while also proposing potential therapeutic targets and future therapies.
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Affiliation(s)
- Kenneth M Ralto
- Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Samir M Parikh
- Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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23
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Bouleti C, Mewton N, Germain S. The no-reflow phenomenon: State of the art. Arch Cardiovasc Dis 2015; 108:661-74. [PMID: 26616729 DOI: 10.1016/j.acvd.2015.09.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/28/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023]
Abstract
Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI), with nearly 95% of occluded coronary vessels being reopened in this setting. Despite re-establishing epicardial coronary vessel patency, primary PCI may fail to restore optimal myocardial reperfusion within the myocardial tissue, a failure at the microvascular level known as no-reflow (NR). NR has been reported to occur in up to 60% of STEMI patients with optimal coronary vessel reperfusion. When it does occur, it significantly attenuates the beneficial effect of reperfusion therapy, leading to poor outcomes. The pathophysiology of NR is complex and incompletely understood. Many phenomena are known to contribute to NR, including leukocyte infiltration, vasoconstriction, activation of inflammatory pathways and cellular oedema. Vascular damage and haemorrhage may also play important roles in the establishment of NR. In this review, we describe the pathophysiological mechanisms of NR and the tools available for diagnosing it. We also describe the microvasculature and the endothelial mechanisms involved in NR, which may provide relevant therapeutic targets for reducing NR and improving the prognosis for patients.
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Affiliation(s)
- Claire Bouleti
- Service de cardiologie, hôpital Bichat, AP-HP, Paris, France; DHU FIRE, université Paris Diderot, Paris, France; Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France
| | - Nathan Mewton
- Hôpital cardiovasculaire Louis-Pradel, centre d'investigation clinique unité, hospices civils de Lyon, Bron, France; Inserm U 1407, Lyon, France
| | - Stéphane Germain
- Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France.
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24
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Cung TT, Morel O, Cayla G, Rioufol G, Garcia-Dorado D, Angoulvant D, Bonnefoy-Cudraz E, Guérin P, Elbaz M, Delarche N, Coste P, Vanzetto G, Metge M, Aupetit JF, Jouve B, Motreff P, Tron C, Labeque JN, Steg PG, Cottin Y, Range G, Clerc J, Claeys MJ, Coussement P, Prunier F, Moulin F, Roth O, Belle L, Dubois P, Barragan P, Gilard M, Piot C, Colin P, De Poli F, Morice MC, Ider O, Dubois-Randé JL, Unterseeh T, Le Breton H, Béard T, Blanchard D, Grollier G, Malquarti V, Staat P, Sudre A, Elmer E, Hansson MJ, Bergerot C, Boussaha I, Jossan C, Derumeaux G, Mewton N, Ovize M. Cyclosporine before PCI in Patients with Acute Myocardial Infarction. N Engl J Med 2015; 373:1021-31. [PMID: 26321103 DOI: 10.1056/nejmoa1505489] [Citation(s) in RCA: 499] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Experimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODS In a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTS A total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval [CI], 0.78 to 1.39; P=0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONS In patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. (Funded by the French Ministry of Health and NeuroVive Pharmaceutical; CIRCUS ClinicalTrials.gov number, NCT01502774; EudraCT number, 2009-013713-99.).
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Affiliation(s)
- Thien-Tri Cung
- From Centre Hospitalier Universitaire (CHU) Arnaud de Villeneuve (T.-T.C.) and Clinique du Millénaire (C.P.), Montpellier, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (O.M.), CHU de Nimes, Nimes (G.C.), Hôpital Cardiovasculaire Louis Pradel (G. Rioufol, E.B.-C., C.B., I.B., C.J., G.D., N.M., M.O.), Claude Bernard University (G. Rioufol, E.B.-C., C.B., I.B., C.J., G.D., N.M., M.O.), Centre Hospitalier Saint-Joseph et Saint-Luc (J.-F.A.), Clinique de la Sauvegarde (V.M.), Clinique du Tonkin (P.S.), Clinical Investigation Center and Explorations Fonctionnelles Cardiovasculaires (C.B., I.B., C.J., G.D., N.M., M.O.), Lyon, CHU de Tours (D.A.) and Clinique Saint-Gatien (D.B.), Tours, Hôpital Guillaume et René Laennec, Nantes (P.G.), CHU de Rangueil, Toulouse (M.E.), Centre Hospitalier de Pau, Pau (N.D.), Hôpital Haut Lévèque, Bordeaux (P. Coste), Hôpital A. Michallon-CHU de Grenoble, Grenoble (G.V.), Hôpital Henri Duffau, Avignon (M.M.), Centre Hospitalier du Pays d'Aix, Aix-en-Provence (B.J.), Hôpital Gabriel Montpied, Clermont Ferrand (P.M.), Hôpital Charles Nicolle, Rouen (C.T.), Clinique de la Fourcade, Bayonne (J.-N.L.), Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris (P.G.S.), Hôpital du Bocage, Dijon (Y.C.), Centre Hospitalier General, Chartres (G. Range), Centre Hospitalier de Compiègne, Compiègne (J.C.), CHU d'Angers, Angers (F.P.), CHU de Nancy-Brabois, Vandœuvre-lès-Nancy (F.M.), CHU de Mulhouse (O.R.) and Clinique du Diaconat (O.I.), Mulhouse, Centre Hospitalier d'Annecy, Annecy (L.B.), Polyclinique des Fleurs, Ollioules (P.B.), Hôpital de La Cavale Blanche, Brest (M.G.), Clinique Esquirol, Agen (P. Colin, F.D.P.), Institut Jacques Cartier, Massy (M.-C.M.), Centre Hospitalier Henri Mondor, Créteil (J.-L.D.-R.), Hôpital Claude Galien, Quincy sous Sénat (T.U.), Hôpital Pontchaillou, Rennes (H.L.B.), Clinique de l'Ormeau, Tarbes (T.B.), Hôpital de la Côte de Nacre, Caen (G.G.), and Hôpital Cardi
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