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Guevara A, Smith CER, Wang L, Caldwell JL, Tapa S, Stuart SDF, Ma BW, Ng GA, Habecker BA, Wang Z, Ripplinger CM. Sympathetic structural and electrophysiological remodeling in a rabbit model of reperfused myocardial infarction. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.05.597494. [PMID: 38895350 PMCID: PMC11185619 DOI: 10.1101/2024.06.05.597494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Chondroitin sulfate proteoglycans (CSPGs) inhibit sympathetic reinnervation in rodent hearts post myocardial infarction (MI), causing regional hypo-innervation that is associated with supersensitivity of β-adrenergic receptors and increased arrhythmia susceptibility. To investigate the role of CSPGs and hypo-innervation in the heart of larger mammals, we used a rabbit model of reperfused MI and tested electrophysiological responses to sympathetic nerve stimulation (SNS). Innervated hearts from MI and sham rabbits were optically mapped using voltage and Ca 2+ -sensitive dyes. SNS was performed with electrical stimulation of the spinal cord and β-adrenergic responsiveness was tested using isoproterenol. Sympathetic nerve density and CSPG expression were evaluated using immunohistochemistry. CSPGs were robustly expressed in the infarct and border zone of all MI hearts, and the presence of CSPGs was associated with reduced sympathetic nerve density in the infarct vs. remote region. Action potential duration (APD) dispersion and susceptibility to ventricular tachycardia/fibrillation (VT/VF) were increased with SNS in MI hearts but not in sham. SNS decreased APD 80 in MI but not sham hearts, while isoproterenol decreased APD 80 in both groups. Isoproterenol also shortened Ca 2+ transient duration (CaTD 80 ) in both groups but to a greater extent in MI hearts. Our data suggest sympathetic remodeling post-MI is similar between species, with CSPGs associated with sympathetic hypo-innervation. Despite a reduction in sympathetic nerve density, the infarct region of MI hearts remained responsive to both physiological SNS and isoproterenol, potentially through preserved or elevated β-adrenergic responsiveness, which may underly increased APD dispersion and susceptibility for VT/VF. NEW & NOTEWORTHY Here we show that CSPGs are present in the infarcts of rabbit hearts with reperfused MI, where they are associated with reduced sympathetic nerve density. Despite hypo-innervation, sympathetic responsiveness is maintained or enhanced in MI rabbit hearts, which also demonstrate increased APD dispersion and tendency for arrhythmias following sympathetic modulation. Together, this study indicates that the mechanisms of sympathetic remodeling post-MI are similar between species, with hypo-innervation likely associated with enhanced β-adrenergic sensitivity.
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Yiadom MYAB, Gong W, Patterson BW, Baugh CW, Mills AM, Gavin N, Podolsky SR, Mumma BE, Tanski M, Salazar G, Azzo C, Dorner SC, Hadley K, Bloos SM, Bunney G, Vogus TJ, Liu D. Influence of time-to-diagnosis on time-to-percutaneous coronary intervention for emergency department ST-elevation myocardial infarction patients: Time-to-electrocardiogram matters. J Am Coll Emerg Physicians Open 2024; 5:e13174. [PMID: 38726468 PMCID: PMC11079543 DOI: 10.1002/emp2.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Earlier electrocardiogram (ECG) acquisition for ST-elevation myocardial infarction (STEMI) is associated with earlier percutaneous coronary intervention (PCI) and better patient outcomes. However, the exact relationship between timely ECG and timely PCI is unclear. Methods We quantified the influence of door-to-ECG (D2E) time on ECG-to-PCI balloon (E2B) intervention in this three-year retrospective cohort study, including patients from 10 geographically diverse emergency departments (EDs) co-located with a PCI center. The study included 576 STEMI patients excluding those with a screening ECG before ED arrival or non-diagnostic initial ED ECG. We used a linear mixed-effects model to evaluate D2E's influence on E2B with piecewise linear terms for D2E times associated with time intervals designated as ED intake (0-10 min), triage (11-30 min), and main ED (>30 min). We adjusted for demographic and visit characteristics, past medical history, and included ED location as a random effect. Results The median E2B interval was longer (76 vs 68 min, p < 0.001) in patients with D2E >10 min than in those with timely D2E. The proportion of patients identified at the intake, triage, and main ED intervals was 65.8%, 24.9%, and 9.7%, respectively. The D2E and E2B association was statistically significant in the triage phase, where a 1-minute change in D2E was associated with a 1.24-minute change in E2B (95% confidence interval [CI]: 0.44-2.05, p = 0.003). Conclusion Reducing D2E is associated with a shorter E2B. Targeting D2E reduction in patients currently diagnosed during triage (11-30 min) may be the greatest opportunity to improve D2B and could enable 24.9% more ED STEMI patients to achieve timely D2E.
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Affiliation(s)
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brian W. Patterson
- Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Christopher W. Baugh
- Department of Emergency MedicineBrigham and Women's Hospital–Harvard UniversityBostonMassachusettsUSA
| | - Angela M. Mills
- Department of Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Nicholas Gavin
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Seth R. Podolsky
- Legacy HealthPortlandOregonUSA
- Oregon Health & Science UniversityCollege of MedicinePortlandOregonUSA
- Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
| | - Bryn E. Mumma
- Department of Emergency MedicineUniversity of California–DavisDavisCaliforniaUSA
| | - Mary Tanski
- Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Gilberto Salazar
- Department of Emergency MedicineUniversity of Texas SouthwesternDallasTexasUSA
| | - Caitlin Azzo
- Department of Emergency MedicineMassachusetts General Hospital, Harvard School of MedicineBostonMassachusettsUSA
| | - Stephen C. Dorner
- Department of Emergency MedicineMassachusetts General Hospital, Harvard School of MedicineBostonMassachusettsUSA
| | - Kelsea Hadley
- School of MedicineAmerican University of AntiguaOsbournAntigua and Barbuda
| | - Sean M. Bloos
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
- Tulane University, School of MedicineNew OrleansLouisianaUSA
| | - Gabrielle Bunney
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Timothy J. Vogus
- Owen Graduate School of ManagementVanderbilt UniversityNashvilleTennesseeUSA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical CenterNashvilleTennesseeUSA
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van Dijck P, Hannemann C, Dreger H, Stangl V, Stangl K, Ludwig A, Hewing B. Increased Expression of Inactive Rhomboid Protein 2 in Circulating Monocytes after Acute Myocardial Infarction. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10519-5. [PMID: 38743187 DOI: 10.1007/s12265-024-10519-5] [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: 12/23/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
Increased TNF-α levels following acute myocardial infarction (AMI) contribute to impaired recovery of myocardial function. Interaction of inactive rhomboid protein 2 (iRhom2) with TNF-α converting enzyme (TACE) is required for TNF-α shedding from immune cells. We hypothesized that iRhom2 expression increases in circulating monocytes following AMI. Transcript levels of iRhom2, TACE and TNF-α were evaluated by quantitative real-time PCR in isolated monocytes of 50 AMI patients at admission (d1) and 3 days (d3) after. We observed a significant increase in levels of iRhom2 mRNA expression in monocytes between d1-3, while TNF-α and TACE mRNA expression remained unchanged. At d3, iRhom2 mRNA expression positively correlated with levels of intermediate monocytes or serum TNF-α, and negatively with LV systolic function. iRhom2 may contribute to regulation of post-infarction inflammation and is associated with LV dysfunction following AMI. iRhom2 modulation should be evaluated as a potential therapeutic strategy to attenuate cardiac remodeling following AMI.
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Affiliation(s)
- Phillip van Dijck
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Carmen Hannemann
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Deutsches Herzzentrum der Charité, Berlin, Germany
- Structural Heart Interventions Program (SHIP), Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Verena Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Karl Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Antje Ludwig
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Berlin Institute of Health (BIH), 10178, Berlin, Germany
| | - Bernd Hewing
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.
- Berlin Institute of Health (BIH), 10178, Berlin, Germany.
- Zentrum Für Kardiologie, Kardiologische Gemeinschaftspraxis, Muenster, Germany.
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
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4
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Chetran A, Bădescu MC, Şerban IL, Duca ŞT, Afrăsânie I, Cepoi MR, Dmour BA, Matei IT, Haba MŞC, Costache AD, Mitu O, Cianga CM, Tuchiluş C, Constantinescu D, Costache-Enache II. Insights into the Novel Cardiac Biomarker in Acute Heart Failure: Mybp-C. Life (Basel) 2024; 14:513. [PMID: 38672783 PMCID: PMC11051483 DOI: 10.3390/life14040513] [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: 03/04/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Given its high cardiac specificity and its capacity to directly assess the cardiac function, cardiac myosin-binding protein (MyBP-C) is a promising biomarker in patients with acute heart failure (AHF). The aim of our study was to investigate the clinical utility of this novel marker for diagnosis and short-term prognosis in subjects with AHF. (2) Methods: We measured plasma levels of MyBP-C at admission in 49 subjects (27 patients admitted with AHF and 22 controls). (3) Results: The plasma concentration of MyBP-C was significantly higher in patients with AHF compared to controls (54.88 vs. 0.01 ng/L, p < 0.001). For 30-day prognosis, MyBP-C showed significantly greater AUC (0.972, p < 0.001) than NT-proBNP (0.849, p = 0.001) and hs-TnI (0.714, p = 0.047). In a multivariate logistic regression analysis, an elevated level of MyBP-C was the best independent predictor of 30-day mortality (OR = 1.08, p = 0.039) or combined death/recurrent 30-days rehospitalization (OR = 1.12, p = 0.014). (4) Conclusions: Our data show that circulating MyBP-C is a sensitive and cardiac-specific biomarker with potential utility for the accurate diagnosis and prognosis of AHF.
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Affiliation(s)
- Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Minerva Codruţa Bădescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Ionela Lăcrămioara Şerban
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Ştefania Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Irina Afrăsânie
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Maria-Ruxandra Cepoi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Bianca Ana Dmour
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Iulian Theodor Matei
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Ştefan Cristian Haba
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Corina Maria Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (C.M.C.); (D.C.)
- Immunology Laboratory, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Cristina Tuchiluş
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Microbiology Laboratory, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Daniela Constantinescu
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (C.M.C.); (D.C.)
- Immunology Laboratory, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
| | - Irina Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.C.); (M.-R.C.); (B.A.D.); (I.T.M.); (M.Ş.C.H.); (A.D.C.); (O.M.); (I.I.C.-E.)
- Cardiology Clinic, “St. Spiridon” County Emergency Hospital, 700111 Iasi, Romania
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Ravani S, Chatzianastasiou A, Papapetropoulos A. Using mechanism-based combinations of H 2S-donors to maximize the cardioprotective action of H 2S. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:1853-1864. [PMID: 37773523 PMCID: PMC10858931 DOI: 10.1007/s00210-023-02729-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
H2S-donors are cardioprotective in ischemia/reperfusion (I/R) injury. Some H2S-donors exert their beneficial effects in a nitric oxide (NO)-dependent manner, while others act using NO-independent pathways. The aims of the present study were to (i) evaluate whether H2S-donors with distinct pharmacodynamic properties act synergistically in I/R injury and (ii) determine if H2S-donors remain cardioprotective in obese mice. C57BL/6 mice were subjected to 30 min of ischemia followed by 120 min of reperfusion. Donors were administered intravenously at the end of ischemia (Na2S: 1 μmol/kg, GYY4137: 25 μmol/kg, AP39: 0,25 μmol/kg), while the 3-mercaptopyruvate sulfurtransferase (10 mg/kg) inhibitor was given intraperitonially 1 h prior to ischemia. Infarct size was estimated by 2,3,5-triphenyltetrazolium staining, while the area at risk was calculated using Evans blue. All three donors reduced infarct size when administered as a sole treatment. Co-administration of Na2S/GYY4137, as well as Na2S/AP39 reduced further the I/R injury, beyond what was observed with each individual donor. Since inhibition of the H2S-producing enzyme 3-mercaptopyruvate sulfurtransferase is known to reduce infarct size, we co-administered C3 with Na2S to determine possible additive effects between the two agents. In this case, combination of C3 with Na2S did not yield superior results compared to the individual treatments. Similarly, to what was observed in healthy mice, administration of a H2S-donor (Na2S or AP39) reduced I/R injury in mice rendered obese by consumption of a high fat diet. We conclude that combining a NO-dependent with a NO-independent H2S-donor leads to enhanced cardioprotection and that H2S-donors remain effective in obese animals.
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Affiliation(s)
- Stella Ravani
- Center of Clinical, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Chatzianastasiou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Papapetropoulos
- Center of Clinical, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece.
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6
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Wang J, Ding Y, Yao YR, Liu HY, Gu Y. Effect of azilsartan on myocardial remodeling after acute myocardial infarction. Eur J Clin Pharmacol 2024; 80:223-230. [PMID: 37991525 DOI: 10.1007/s00228-023-03595-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To investigate the effect of azilsartan on myocardial remodeling after acute myocardial infarction (AMI). METHODS A total of 200 AMI patients under percutaneous coronary intervention (PCI) were selected from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from Jan 2021 to Dec 2021. The subjects were randomly divided to take either azilsartan or benazepril. Serum C1q tumor necrosis factor-associated protein 1 (CTRP1) levels were detected in all subjects after admission, and the indices of left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were measured by using echocardiography. At the follow-up of 6 months and 1 year after PCI, the differences in CTRP1 and echocardiogram indices between the two groups were compared, and the influencing factors of myocardial remodeling after acute myocardial infarction were analyzed. RESULTS The levels of LVEDV and CTRP1 in all subjects at 6 months and 1 year after PCI were lower than those before discharge, and the LVEDV in the azilsartan group at 6 months and 1 year after PCI was lower than that in the benazepril group. An improvement in myocardial remodeling was obviously observed within 6 months after PCI, but the effect declined over time. CONCLUSIONS Azilsartan can improve myocardial remodeling after acute myocardial infarction. CTRP1 may become an effective target for the prevention and treatment of myocardial remodeling after acute myocardial infarction.
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Affiliation(s)
- Jing Wang
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, China
| | - Ying Ding
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, China
| | - Yi-Ren Yao
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, China
| | - Hong-Yang Liu
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, China
| | - Yang Gu
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, China.
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Wen W, Li Q, She J, Bai X, Zhang L, Li R, Wu Y, Zhou J, Yuan Z. Predictive value of serum TBA for 2-year MACEs in ACS patients undergoing PCI: a prospective cohort study. Sci Rep 2024; 14:1733. [PMID: 38242883 PMCID: PMC10799034 DOI: 10.1038/s41598-023-50304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
Bile acids play important roles in lipid metabolism and glucose homeostasis. Limited research exist on the association between serum total bile acid (TBA) levels and major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS), particularly those with comorbid type 2 diabetes mellitus (T2DM). This study was conducted to examine the relationship between baseline serum TBA level and T2DM status in patients with ACS after percutaneous coronary intervention (PCI) and to identify the predictive value of TBA levels for a 2-year risk of MACEs. 425 ACS patients underwent PCI were recruited and divided into three groups based on baseline serum TBA concentration. An analysis of the association between the T2DM status and baseline serum TBA levels was conducted using univariate linear regression and multivariate linear regression. The predictive relevance of serum TBA levels was evaluated using the receiver operating characteristic (ROC) curve and Cox regression. Kaplan-Meier curves were employed to analyze the differences among groups in predicting MACEs over a 2-year follow-up period. Baseline serum TBA levels were higher in ACS patients who were diagnosed with T2DM (the median 3.6 µmol/L) than those without T2DM (the median 3.0 µmol/L). T2DM status in ACS patients was positively correlated with baseline serum TBA concentrations (β: 1.7, 95% confidence interval [CI] 0.3-3.0), particularly in the male (β: 2.0, 95% CI 0.3-3.6) and 50-69-year-old (β: 2.5, 95% CI 0.6-4.4) populations. The areas under the ROC curve of baseline serum TBA levels predicted MACEs in ACS and ACS-T2DM patients following PCI were 0.649 (95% CI 0.595-0.703) and 0.783 (95% CI 0.685-0.881), respectively. Furthermore, Cox regression analysis showed that baseline serum TBA level was associated with the occurrence of MACEs in patients with ACS after PCI over a 2-year follow-up period, especially in those diagnosed with T2DM, whose baseline TBA concentration was lower than 10.0 µmol/L. ACS Patients with T2DM had higher serum TBA levels. TBA level at baseline was an independent predictor of MACEs in ACS patients who underwent PCI, especially with comorbid T2DM.
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Affiliation(s)
- Wen Wen
- Department of Ultrasound, Clinical Medical College, First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
| | - Qinze Li
- Department of Ultrasound, Clinical Medical College, First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jianqing She
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiaofang Bai
- Department of Ultrasound, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lisha Zhang
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruifeng Li
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China.
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8
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Van Tassell B, Talasaz AH, Redlich G, Ziegelaar B, Abbate A. A Real-World Analysis of New-Onset Heart Failure After Anterior Wall ST-Elevation Acute Myocardial Infarction in the United States. Am J Cardiol 2024; 211:245-250. [PMID: 37981000 DOI: 10.1016/j.amjcard.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
The 1-year incidence of heart failure (HF) after anterior wall ST-elevation acute myocardial infarction (STEMI) remains difficult to determine because of inconsistencies in reporting, definitions, and adjudication. The objective of this study was to evaluate the 1-year incidence of HF after anterior wall STEMI in a real-world data set using a variety of potential criteria and composite definitions. In a retrospective cohort study, anonymized patient data was accessed through a federated health research network (TriNetX Limited Liability Company (LLC)) of 56 US healthcare organizations (US Collaborative Network). Patients were identified based on the International Classification of Diseases, Tenth Revision criteria for anterior wall STEMI during the 10-year period from 2013 to 2022 and the absence of prespecified signs or symptoms of HF. Values for 1-year incidence were calculated as 1 minus Kaplan-Meier survival at 12 months after anterior wall STEMI. Univariate Cox proportional hazard ratio was calculated to compare risk associated with potential risk factors. The analysis utilized 5 different types of definition criteria for HF: Diagnosis codes, Signs and symptoms, Laboratory/imaging, Medications, and Composites. A total of 34,395 patients from the US Collaborative Network met eligibility criteria and were included in the analysis. The 1-year incidence of HF varied from 2% to 30% depending upon the definition criteria. Although no single criteria exceeded a 1-year incidence of 20%, a simple composite of HF diagnosis (International Classification of Diseases, Tenth Revision-I50) or use of loop diuretic produced a 1-year incidence 26.1% that was used as the benchmark outcome for evaluation of risk factors. Age ≥65 years, Black race, low-density lipoprotein ≥100 mg/100 ml, elevated hemoglobin A1c (7% to 9% and >9%), and body mass index≥35 kg/m2 were also associated with increased risk of HF. In conclusion, patients with anterior wall STEMI continue to be at high risk for new-onset HF. In the absence of structured, prospective, systematically adjudicated diagnostic criteria, composite definitions are more likely to yield accurate estimates of HF incidence.
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Affiliation(s)
- Benjamin Van Tassell
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.
| | - Azita H Talasaz
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Antonio Abbate
- Department of Medicine, University of Virginia, Charlottesville, Virginia
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9
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Guo J, Wang H, Li Y, Zhu S, Hu H, Gu Z. Nanotechnology in coronary heart disease. Acta Biomater 2023; 171:37-67. [PMID: 37714246 DOI: 10.1016/j.actbio.2023.09.011] [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: 05/22/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
Coronary heart disease (CHD) is one of the major causes of death and disability worldwide, especially in low- and middle-income countries and among older populations. Conventional diagnostic and therapeutic approaches have limitations such as low sensitivity, high cost and side effects. Nanotechnology offers promising alternative strategies for the diagnosis and treatment of CHD by exploiting the unique properties of nanomaterials. In this review, we use bibliometric analysis to identify research hotspots in the application of nanotechnology in CHD and provide a comprehensive overview of the current state of the art. Nanomaterials with enhanced imaging and biosensing capabilities can improve the early detection of CHD through advanced contrast agents and high-resolution imaging techniques. Moreover, nanomaterials can facilitate targeted drug delivery, tissue engineering and modulation of inflammation and oxidative stress, thus addressing multiple aspects of CHD pathophysiology. We discuss the application of nanotechnology in CHD diagnosis (imaging and sensors) and treatment (regulation of macrophages, cardiac repair, anti-oxidative stress), and provide insights into future research directions and clinical translation. This review serves as a valuable resource for researchers and clinicians seeking to harness the potential of nanotechnology in the management of CHD. STATEMENT OF SIGNIFICANCE: Coronary heart disease (CHD) is the one of leading cause of death and disability worldwide. Nanotechnology offers new strategies for diagnosing and treating CHD by exploiting the unique properties of nanomaterials. This review uses bibliometric analysis to uncover research trends in the use of nanotechnology for CHD. We discuss the potential of nanomaterials for early CHD detection through advanced imaging and biosensing, targeted drug delivery, tissue engineering, and modulation of inflammation and oxidative stress. We also offer insights into future research directions and potential clinical applications. This work aims to guide researchers and clinicians in leveraging nanotechnology to improve CHD patient outcomes and quality of life.
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Affiliation(s)
- Junsong Guo
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Hao Wang
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Ying Li
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Shuang Zhu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nano-safety, Institute of High Energy Physics, Beijing 100049, China; CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100190, China; Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Houxiang Hu
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China.
| | - Zhanjun Gu
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nano-safety, Institute of High Energy Physics, Beijing 100049, China; Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China.
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10
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Wang W, Hao H, Fan T, Yue J, Wang M, Chen M, Deng G, Si L, Zhang F. Predictive value of acoustic cardiography for post-PCI early ventricular remodeling in acute myocardial infarction. Sci Rep 2023; 13:7192. [PMID: 37137970 PMCID: PMC10156721 DOI: 10.1038/s41598-023-34370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/28/2023] [Indexed: 05/05/2023] Open
Abstract
Acoustic cardiography is a completely new technology, it has great advantages in the rapid diagnosis of cardiovascular diseases. The purpose of this study was to investigate the clinical value of the fourth heart sound (S4), cardiac systolic dysfunction index (SDI), and the cardiac cycle time-corrected electromechanical activation time (EMATc) in the prediction of post-percutaneous coronary intervention (PCI) early ventricular remodeling (EVR) in patients with acute myocardial infarction (AMI). We recruited 161 patients with AMI of 72-h post-PCI, including 44 EVR patients with left ventricular ejection fraction (LVEF) < 50% and 117 Non-EVR patients (normal left ventricular systolic function group, LVEF ≥ 50%). EMATc, S4, and SDI were independent risk factors for post-PCI early ventricular remodeling in patients with AMI [S4 (OR 2.860, 95% CI 1.297-6.306, p = 0.009), SDI (OR 4.068, 95% CI 1.800-9.194, p = 0.001), and EMATc (OR 1.928, 95% CI 1.420-2.619, p < 0.001)]. The area under the receiver operating characteristic curve for EMATc was 0.89, with an optimal cutoff point of 12.2, EMATc had a sensitivity of 80% and a specificity of 83%. By contrast, an optimal cutoff point of 100 pg/ml, Serum brain natriuretic peptide had a sensitivity of 46% and a specificity of 83%. Our findings suggest the predictive value of EMATc for the occurrence of EVR in these patients was also identified; EMATc may be a simple, quick, and effective way to diagnose EVR after AMI.
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Affiliation(s)
- Weiwei Wang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haizhen Hao
- Department of Neurology, Haikou People's Hospital, Central South University, Haikou, China
| | - Tingting Fan
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Yue
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyang Wang
- Department of Critical Care Medicine, Peoples Hospital of Jiangbei District, Chongqing, China
| | - Moshui Chen
- Department of Neurology, Haikou People's Hospital, Central South University, Haikou, China
| | - Guolan Deng
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liangyi Si
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Fuwei Zhang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Zhang Q, Qiao B, Han Y, Sun S, Wang B, Wei S. Short-term efficacy of angiotensin receptor-neprilysin inhibitor treatment in patients with ST-segment elevation myocardial infarction with reduced ejection fraction after primary percutaneous coronary intervention: a propensity score matching study. BMC Cardiovasc Disord 2022; 22:463. [DOI: 10.1186/s12872-022-02906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Acute myocardial infarction (AMI) causes a series of pathophysiological changes, including myocardial necrosis, myocardial edema, and microvascular damage. These changes eventually lead to severe cardiovascular events, such as ventricular remodeling, heart failure, and papillary dysfunction. Impaired cardiac function after ST-segment elevation myocardial infarction (STEMI) often manifests as a decrease in left ventricular ejection fraction (LVEF). Clinical trials have shown that angiotensin receptor-neprilysin inhibitor (ARNI) treatment has the potential to improve LVEF in patients with STEMI after primary percutaneous coronary intervention (PPCI).
Objective
The purpose of this study was to evaluate the short-term efficacy of ARNI versus angiotensin-converting enzyme inhibitor (ACEI) treatment in patients with STEMI who exhibit reduced LVEF after PPCI.
Methods
A total of 169 patients with STEMI exhibiting post-PPCI LVEF below 50% who were orally treated with ARNI between December 2017 and August 2020 were selected as the experimental group. A total of 136 patients with STEMI exhibiting post-PPCI LVEF below 50% who were orally treated with an ACEI between January 2016 and August 2020 were selected as the control group. LVEF was measured using cardiac ultrasonography during hospitalization and 3 months after discharge. Linear and logistic regression analyses were performed to compare patient demographics and hospitalization variables to evaluate the risk factors for change and rate of improvement in LVEF. Propensity score matching (PSM) was used to account for confounding factors.
Results
After PSM, the study cohort consisted of 81 patients in the ARNI group and 123 in the ACEI group. After an average follow-up period of 3 months, no significant difference was noted in the LVEF improvement rate between the experimental and control groups (P = 0.475, 95% CI: -0.062 to 0.134). Multivariate logistic regression analysis also indicated no significant correlation between the change in LVEF and oral ARNI treatment in patients with STEMI exhibiting reduced LVEF after PPCI (P > 0.05).
Conclusion
The short-term effect of ARNI treatment on the cardiac function of patients with STEMI and reduced LVEF after PPCI is not superior to that of ACEI treatment.
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Ahmadian M, Williams AM, Mannozzi J, Konecny F, Hoiland RL, Wainman L, Erskine E, Duffy J, Manouchehri N, So K, Tauh K, Sala-Mercado JA, Shortt K, Fisk S, Kim KT, Streijger F, Foster GE, Kwon BK, O’Leary DS, West CR. A cross-species validation of single-beat metrics of cardiac contractility. J Physiol 2022; 600:4779-4806. [PMID: 36121759 PMCID: PMC9669232 DOI: 10.1113/jp283319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
The assessment of left ventricular (LV) contractility in animal models is useful in various experimental paradigms, yet obtaining such measures is inherently challenging and surgically invasive. In a cross-species study using small and large animals, we comprehensively tested the agreement and validity of multiple single-beat surrogate metrics of LV contractility against the field-standard metrics derived from inferior vena cava occlusion (IVCO). Fifty-six rats, 27 minipigs and 11 conscious dogs underwent LV and arterial catheterization and were assessed for a range of single-beat metrics of LV contractility. All single-beat metrics were tested for the various underlying assumptions required to be considered a valid metric of cardiac contractility, including load-independency, sensitivity to inotropic stimulation, and ability to diagnose contractile dysfunction in cardiac disease. Of all examined single-beat metrics, only LV maximal pressure normalized to end-diastolic volume (EDV), end-systolic pressure normalized to EDV, and the maximal rate of rise of the LV pressure normalized to EDV showed a moderate-to-excellent agreement with their IVCO-derived reference measure and met all the underlying assumptions required to be considered as a valid cardiac contractile metric in both rodents and large-animal models. Our findings demonstrate that single-beat metrics can be used as a valid, reliable method to quantify cardiac contractile function in basic/preclinical experiments utilizing small- and large-animal models KEY POINTS: Validating and comparing indices of cardiac contractility that avoid caval occlusion would offer considerable advantages for the field of cardiovascular physiology. We comprehensively test the underlying assumptions of multiple single-beat indices of cardiac contractility in rodents and translate these findings to pigs and conscious dogs. We show that when performing caval occlusion is unfeasible, single-beat metrics can be utilized to accurately quantify cardiac inotropic function in basic and preclinical research employing various small and large animal species. We report that maximal left-ventricular (LV)-pressure normalized to end-diastolic volume (EDV), LV end-systolic pressure normalized to EDV and the maximal rate of rise of the LV pressure waveform normalized to EDV are the best three single-beat metrics to measure cardiac inotropic function in both small- and large-animal models.
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Affiliation(s)
- Mehdi Ahmadian
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Alexandra M. Williams
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Mannozzi
- Department of Physiology, School of Medicine, Wayne State University, Detroit, MI 48009
| | - Filip Konecny
- Transonic Scisense Inc., London, ON, Canada
- MaRS Centre Toronto Medical Discovery Tower, 3rd Floor, 101 College Street, M5G 1L7, Toronto, Ontario, Canada
| | - Ryan L. Hoiland
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Liisa Wainman
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erin Erskine
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Duffy
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neda Manouchehri
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Kitty So
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Keerit Tauh
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | | | - Katelyn Shortt
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Shera Fisk
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Kyoung-Tae Kim
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Neurosurgery, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Femke Streijger
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Glen E. Foster
- Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC, V1V1V7
| | - Brian K. Kwon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Donal S. O’Leary
- Department of Physiology, School of Medicine, Wayne State University, Detroit, MI 48009
| | - Christopher R. West
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Zhou X, Zhu H, Zheng Y, Tan X, Tong X. A systematic review and meta-analysis of sacubitril-valsartan in the treatment of ventricular remodeling in patients with heart failure after acute myocardial infarction. Front Cardiovasc Med 2022; 9:953948. [PMID: 36304540 PMCID: PMC9592716 DOI: 10.3389/fcvm.2022.953948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To systematically review the efficacy and safety of sacubitril and valsartan in treating acute myocardial infarction complicated with heart failure and to observe whether it can further improve patients’ cardiac function, delay left ventricular remodeling, and reduce major adverse cardiovascular events (MACEs). Methods Electronic databases including Pubmed, Embase, the Web of Science, Cochrane Library, Scopus, CNKI, Wanfang Data, and VIP were searched. The search period was from the establishment of the database to March 2022 to search for relevant controlled trials. Two investigators independently screened the literature, extracted data, and assessed the risk of bias. Revman5.3 and Stata14 software were used for statistical analysis. Results A total of 13 studies, with 6,968 patients were included. Meta-analysis results showed that sacubitril-valsartan increased left ventricular ejection fraction (LVEF) and decreased NT-proBNP level was better at 6 months and within 3 months of follow-up compared with the control group (P < 0.00001), but there was no significant difference at the 12-month follow-up (P > 0.05). Sacubitril-valsartan reducing LVEDD [MD = −2.55, 95%CI(−3.21, −1.88), P < 0.00001], LVEDVI [MD = −3.61, 95%CI(−6.82, −0.39), P = 0.03], LVESVI [MD = −3.77, 95%CI(−6.05, −1.49), P = 0.001], and increasing the distance of the 6-min walk test [MD = 48.20, 95%CI(40.31, 56.09), P < 0.00001] were more effective. Compared with ACEI/ARB, the use of ARNI can further reduce the total incidence of adverse cardiovascular events [RR = 0.72, 95%CI(0.62, 0.84), P<0.0001] and the rate of HF rehospitalization [RR = 0.73, 95%CI(0.61, 0.86), P = 0.0002] in patients with acute myocardial infarction and heart failure; there was no significant difference in the incidence of cardiac death, recurrence of myocardial infarction, and malignant arrhythmia between the experimental group and the control group (P > 0.05). In terms of the incidence of adverse reactions, the incidence of cough in ARNI was lower than that in ACEI/ARB group [RR = 0.69, 95%CI(0.60, 0.80), P < 0.00001], but the incidence of hypotension was higher [RR = 1.29, 95%CI(1.18, 1.41), P < 0.00001], and the adverse reactions of hyperkalemia, angioedema and renal insufficiency were not increased (P > 0.05). Conclusion The use of sacubitril-valsartan sodium in patients with acute myocardial infarction complicated with heart failure can significantly improve cardiac function and reverse ventricular remodeling, reducing the risk of re-hospitalization for heart failure. There is no apparent adverse reaction except easy cause hypotension. Systematic trial registration [www.ClinicalTrials.gov], identifier [CRD42022322901].
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Affiliation(s)
- Xiaomin Zhou
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongjun Zhu
- Department of Cardiology, Wuxi Hospital Affiliated Nanjing University of Chinese Medicine, Wuxi, China,*Correspondence: Hongjun Zhu,
| | - Yawei Zheng
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaodong Tan
- Department of Cardiology, Wuxi Hospital Affiliated Nanjing University of Chinese Medicine, Wuxi, China
| | - Xinyu Tong
- Nanjing University of Chinese Medicine, Nanjing, China
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Hendrickson MJ, Arora S, Vaduganathan M, Fonarow GC, MP G, Bansal A, Batra V, Kunal S, Bhatt DL, Gupta M, Qamar A. Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India. ESC Heart Fail 2022; 9:3836-3845. [PMID: 35950269 PMCID: PMC9773730 DOI: 10.1002/ehf2.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). METHODS AND RESULTS Adults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. CONCLUSIONS On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.
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Affiliation(s)
| | - Sameer Arora
- Division of CardiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Gregg C. Fonarow
- Division of CardiologyUniversity of California Los AngelesLos AngelesCAUSA
| | - Girish MP
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Ankit Bansal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Vishal Batra
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Shekhar Kunal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Mohit Gupta
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Arman Qamar
- Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health SystemUniversity of Chicago Pritzker School of MedicineEvanstonILUSA
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The Effects of Ticagrelor Combined with Tirofiban on Coagulation Function, Serum Myocardial Injury Markers, and Inflammatory Factor Levels in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4217270. [PMID: 35529262 PMCID: PMC9071853 DOI: 10.1155/2022/4217270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
Background Acute myocardial infarction (AMI) refers to the acute necrosis of part of the myocardium caused by persistent and severe myocardial ischemia. This study is aimed at investigating the efficacy of tirofiban combined with ticagrelor in AMI patients after percutaneous coronary intervention (PCI) and its effects on plasma activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D) levels, myocardial injury markers, and inflammatory factors. Methods 68 AMI patients with AMI who received PCI were divided into control group and observation group (n =34) according to postoperative treatment methods. Both groups received ticagrelor tablets (90 mg). The observation group was additionally given tirofiban (10 μg/kg). APTT, FIB, D-D, serum myoglobin (MB), cardiac troponin I (cTnI), serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and IL-6, myeloperoxidase (MPO) levels and the peak time in both groups were detected. The incidence of cardiovascular events and drug safety were compared. Results After treatment, APTT was increased, and FIB and D-D levels were decreased in both groups. After treatment, the APTT in the observation group was longer, and FIB and D-D levels were lower than those in the control group. The peak time of serum MB and cTnI in the observation group was earlier than that in the control group. The levels of serum MB and cTnI in the observation group were lower than those in the control group. After treatment, serum CRP, TNF-α, IL-6, and MPO levels were decreased. And the incidence of cardiovascular events was reduced. Conclusion Tirofiban combined with ticagrelor can improve coagulation function, protect myocardium, relieve inflammation, and reduce the risk of cardiovascular events in patients with AMI after PCI.
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Walters K, Brearley J, Baptista A, Po E. Suspected pulmonary oedema development in a pig following general anaesthesia and the associated complications encountered during a subsequent general anaesthetic. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kate Walters
- Queen's Veterinary School Hospital University of Cambridge Cambridge UK
| | | | - Andre Baptista
- Cambridge Farm Vets University of Cambridge Cambridge UK
| | - Eleonora Po
- Cambridge Farm Vets University of Cambridge Cambridge UK
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17
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Alkouri A, Cybularz M, Mierke J, Nowack T, Biedermann J, Ulbrich S, Fischer J, Heidrich FM, Jellinghaus S, Speiser U, Linke A, Pfluecke C. The predictive role of early CRP values for one-year mortality in the first two days after acute myocardial infarction. Biomarkers 2022; 27:293-298. [PMID: 35138209 DOI: 10.1080/1354750x.2022.2040591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND An excessive inflammatory reaction after acute myocardial infarction (AMI) is known to be harmful. New anti-inflammatory therapies are required. PURPOSE This study assessed the predictive role of early CRP in patients with STEMI. METHODS 1003 patients with STEMI were analyzed. 180 patients with proven infection were excluded. CRP after 12 h, 24 h, and 48 h after pain onset were evaluated. RESULTS Of 823 patients, 103 (12.5%) died within one year after AMI. The deceased patients showed higher CRP, even after already 12 h (6 vs. 13 mg/l, p < 0.001), 24 h (13 vs. 25 mg/l, p < 0.001) and after 48 h (40 vs. 92 mg/l, p < 0.001). A CRP of ≥8 mg/l, 12 h after AMI, was found in 45% and was independently associated with long-term mortality (OR: 2.7, p = 0.03), after 24 h: CRP ≥18 mg/l in 44% (OR: 2.5, p = 0.03), after 48 h: CRP ≥53 mg/l in 44% (OR 1.9, p = 0.03). Early CRP values correlated strongly with the later maximum value of CRP (p < 0.001). CONCLUSIONS Already early CRP values are accurate for risk-prediction following AMI. By identifying patients who are beginning to develop an excessive inflammatory response, it may be possible to identify those who benefit from anti-inflammatory therapies.
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Affiliation(s)
- Ahmad Alkouri
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden.,Department for Internal Medicine and Cardiology, Städtisches Klinikum Görlitz, Germany
| | - Maria Cybularz
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Johannes Mierke
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Thomas Nowack
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Jonathan Biedermann
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Stefan Ulbrich
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Julia Fischer
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Felix M Heidrich
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Stefanie Jellinghaus
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Uwe Speiser
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Axel Linke
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden
| | - Christian Pfluecke
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden.,Department for Internal Medicine and Cardiology, Städtisches Klinikum Görlitz, Germany
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18
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Butt JH, Bang LE, Rørth R, Schou M, Kristensen SL, Yafasova A, Havers-Borgersen E, Vinding NE, Jessen N, Kragholm K, Torp-Pedersen C, Køber L, Fosbøl EL. Long-term Risk of Death and Heart Failure Hospitalization in Patients With Takotsubo Syndrome: Insights from a Nationwide Cohort. J Card Fail 2022; 28:1534-1544. [DOI: 10.1016/j.cardfail.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/03/2023]
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19
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Dutta A, Das M. Deciphering the Role of Aquaporins in Metabolic Diseases: A Mini Review. Am J Med Sci 2022; 364:148-162. [DOI: 10.1016/j.amjms.2021.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/16/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
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20
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Factors Affecting Delayed Hospital Arrival of Patients with Acute Myocardial Infarction in Kinmen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031323. [PMID: 35162347 PMCID: PMC8834892 DOI: 10.3390/ijerph19031323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/04/2022]
Abstract
This study explores factors related to delayed emergency medical treatment for acute myocardial infarction patients on Kinmen Island. A cross-sectional study was performed in the only hospital in Kinmen Island. The study group consisted of 116 patients diagnosed with acute myocardial infarction (AMI, ICD-10 codes: 121.9) from November 2015 to May 2019. The binary logistic regression analyses were performed for the inferential statistical analysis. The mean age of the study group was 63.0 ± 14.5 years, 39.7% of the patients arrived at the emergency medicine longer than 6 h after the onset of symptoms. The related factors for delayed arrival the hospital emergency medicine department were female sex, age over 65 years, less than nine years’ education, and Killip Class, but only Killip Class reached the significant difference of statistics (OR = 3.616, 95% C.I. = 1.574 to 8.310, p = 0.002), and patients with delayed arrival times (>6 h) were found to have a higher percentage of Killip Class ≥ II. Therefore, it is essential to remind the physicians to proceed with risk stratification for acute coronary syndrome patients. In addition, health authorities should provide effective programs to increase awareness of the symptoms and timely treatment of acute myocardial infraction to the general public, especially the elderly.
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21
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Wang K, Li Z, Sun Y, Liu X, Ma W, Ding Y, Hong J, Qian L, Xu D. Dapagliflozin Improves Cardiac Function, Remodeling, Myocardial Apoptosis, and Inflammatory Cytokines in Mice with Myocardial Infarction. J Cardiovasc Transl Res 2021; 15:786-796. [PMID: 34855147 DOI: 10.1007/s12265-021-10192-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
Dapagliflozin (DAPA) exerts cardioprotective effects in non-diabetic patients. Nonetheless, the protective mechanism remains unknown. This study aims to evaluate the performance of DAPA on cardiac function and remodeling as well as its potential mechanism in mice with myocardial infarction (MI). Here, a MI mice model was established. One week after MI, mice were treated with saline or DAPA (1.5 mg/kg/day) for 4 weeks. At the end of this study, echocardiography was performed to assess cardiac structure and function. Myocardial apoptosis was analyzed by Western blot and immunofluorescence. Inflammatory cytokines and cardiac fibrosis were analyzed by real-time PCR and Masson's trichrome stain, respectively. Results showed that DAPA improved cardiac structure and function, attenuated cardiac fibrosis, and inhibited inflammatory cytokines and myocardial apoptosis. Moreover, the inhibition of PI3K/AKT/mTOR pathway might be related to the cardioprotective role of DAPA. These findings reveal that dapagliflozin is a potential therapeutic agent for MI patients without diabetes.
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Affiliation(s)
- Kai Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Zhongming Li
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yan Sun
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Xianling Liu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wenjie Ma
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yinzhang Ding
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jian Hong
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lijun Qian
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Di Xu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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22
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Fabiszak T, Kasprzak M, Koziński M, Kubica J. Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:5445. [PMID: 34830726 PMCID: PMC8619668 DOI: 10.3390/jcm10225445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). METHODS We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. RESULTS Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). CONCLUSIONS According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
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Affiliation(s)
- Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
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23
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She J, Lou B, Liu H, Zhou B, Jiang GT, Luo Y, Wu H, Wang C, Yuan Z. ARNI versus ACEI/ARB in Reducing Cardiovascular Outcomes after Myocardial Infarction. ESC Heart Fail 2021; 8:4607-4616. [PMID: 34664407 PMCID: PMC8712820 DOI: 10.1002/ehf2.13644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023] Open
Abstract
Aims This study aimed to compare the efficacy of angiotensin receptor‐neprilysin inhibitor (ARNI) therapy with angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy for cardiovascular outcomes in patients with acute myocardial infarction (AMI). Methods and results Data were collected from the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University between January 2016 and December 2020. A total of 7556 AMI patients were screened for eligibility. Propensity score matching based on age, sex, blood pressure, kidney function, baseline left ventricular ejection fraction (LVEF), and cardiovascular medication were conducted, resulting in 291 patients with AMI being assigned to ARNI, ACEI, and ARB group, respectively. Patients receiving ARNI had significantly lower rates of the composite cardiovascular outcome than ACEI {hazard ratio [HR] 0.51, [95% confidence interval (CI), 0.27–0.95], P = 0.02}, and ARB users [HR 0.47, (95%CI, 0.24–0.90), P = 0.02]. Patients receiving ARNI showed lower rates of cardiovascular death than ACEI [HR 0.37, (95%CI, 0.18–0.79), P = 0.01] and ARB users [HR 0.41, (95%CI, 0.18–0.95), P = 0.04]. Subgroup analysis indicated that patients with LVEF no more than 40% tend to benefit more from ARNI as compared with ACEI [HR 0.30, (95%CI, 0.11–0.86), P = 0.01] or ARB [HR 0.21, (95%CI, 0.04–1.1), P = 0.05]. Patients aged no more than 60 years exhibited reduced composite endpoints [HR for ARNI vs. ARB: 0.11, (95%CI, 0.03–0.46), P = 0.002]. Conclusions In patients with AMI, ARNI was superior to ACEI/ARB in reducing the long‐term adverse cardiovascular outcomes. Subgroup analysis further indicates that ARNI is more likely to benefit patients with LVEF less than 40% and aged less than 60 years.
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Affiliation(s)
- Jianqing She
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Bowen Lou
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Hui Liu
- Biobank, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Zhou
- Respiratory Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gulinigaer Tuerhong Jiang
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Yongbai Luo
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Haoyu Wu
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Chen Wang
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Zuyi Yuan
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
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24
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Hayasaka T, Takehara N, Aonuma T, Kano K, Horiuchi K, Nakagawa N, Tanaka H, Kawabe JI, Hasebe N. Sarcopenia-derived exosomal micro-RNA 16-5p disturbs cardio-repair via a pro-apoptotic mechanism in myocardial infarction in mice. Sci Rep 2021; 11:19163. [PMID: 34580402 PMCID: PMC8476608 DOI: 10.1038/s41598-021-98761-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Sarcopenia is a pathophysiological malfunction induced by skeletal muscle atrophy. Several studies reported an association between sarcopenia-induced cardiac cachexia and poor prognosis in heart disease. However, due to lack of an established animal models, the underlying mechanism of disturbed cardiac repair accompanied with sarcopenia remains poorly understood. Here, we developed a novel sarcopenia-induced cardiac repair disturbance mouse model induced by tail suspension (TS) after cardiac ischemia and reperfusion (I/R). Importantly, we identified a specific exosomal-microRNA marker, miR-16-5p, in the circulating exosomes of I/R-TS mice. Of note, sarcopenia after I/R disturbed cardiac repair and raised the level of circulating-exosomal-miR-16-5p secreting from both the atrophic limbs and heart of TS mice. Likewise, miR-16-5p mimic plasmid disturbed cardiac repair in I/R mice directly. Additionally, in neonatal rat ventricular myocytes (NRVMs) cultured in vitro under hypoxic conditions in the presence of a miR-16-5p mimic, we observed increased apoptosis through p53 and Caspase3 upregulation, and also clarified that autophagosomes were decreased in NRVMs via SESN1 transcript interference-mediated mTOR activation. In conclusion, we show the pro-apoptotic effect of sarcopenia-derived miR-16-5p, which may be behind the exacerbation of myocardial infarction. Therefore, miR-16-5p can be a novel therapeutic target in the context of cardiac repair disturbances in sarcopenia-cachexia.
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Affiliation(s)
- Taiki Hayasaka
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
| | - Naofumi Takehara
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan.
| | - Tatsuya Aonuma
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
| | - Kohei Kano
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
| | - Kiwamu Horiuchi
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
| | - Hiroki Tanaka
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Jun-Ichi Kawabe
- Division of Integrated Life Science, Department of Biochemistry, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
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25
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Zhang FW, Zhang YX, Si LY, Chen MS, Wang WW, Liang HR. Value of acoustic cardiography in the clinical diagnosis of coronary heart disease. Clin Cardiol 2021; 44:1386-1392. [PMID: 34486123 PMCID: PMC8495079 DOI: 10.1002/clc.23694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background To investigate the clinical value of acoustic cardiography in the diagnosis of coronary artery disease (CAD) and post‐percutaneous coronary intervention (PCI) early asymptomatic left ventricular systolic dysfunction. Methods Inpatients in the department of cardiology were included in the research (n = 315); including 180 patients with angina pectoris and 135 patients with acute anterior wall myocardial infarction after emergency PCI did not present with signs and symptoms of heart failure. Color Doppler echocardiography, brain natriuretic peptide, acoustic cardiography examination were performed. The patients were divided into four groups: non‐CAD group (n = 60), CAD group (n = 120), MIREF group (EF% < 50%, n = 75), and MINEF group (EF% ≥ 50%, n = 60). Results Acoustic cardiography parameters EMATc, systolic dysfunction index, S3 strength and S4 strength in the MIREF group were higher than those in MINEF group (p < .05), and the MINEF group was higher than CAD group (p < .05). S3 strength (area under the curve [AUC] 0.67, 95% CI 0.585–0.755, p < .001) and S4 strength (AUC 0.617, 95% CI 0.536–0.698, p = .011) are useful in the diagnosis of CAD. S3 strength (AUC 0.942, 95% CI 0.807–0.978, p < .001) was superior to other indicators in the diagnosis of early left ventricular systolic dysfunction after myocardial infarction. Conclusion S4 combined with STT standard change can improve the diagnosis of CAD. Acoustic cardiography can be used as a non‐invasive, rapid, effective, and simple method for the diagnosis of asymptomatic left ventricular systolic dysfunction in the early stage after myocardial infarction.
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Affiliation(s)
- Fu Wei Zhang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Xue Zhang
- Division of Cardiology, Haikou People's Hospital, Central South University, Haikou, China
| | - Liang Yi Si
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mo Shui Chen
- Division of Cardiology, Haikou People's Hospital, Central South University, Haikou, China
| | - Wei Wei Wang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Rong Liang
- Division of Cardiology, Haikou People's Hospital, Central South University, Haikou, China
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26
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Caggiano LR, Holmes JW. A Comparison of Fiber Based Material Laws for Myocardial Scar. JOURNAL OF ELASTICITY 2021; 145:321-337. [PMID: 35095176 PMCID: PMC8797542 DOI: 10.1007/s10659-021-09845-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/10/2021] [Indexed: 06/14/2023]
Abstract
The mechanics of most soft tissues in the human body are determined by the organization of their collagen fibers. Predicting how mechanics will change during growth and remodeling of those tissues requires constitutive laws that account for the density and dispersion of collagen fibers. Post-infarction scar in the heart, a mechanically and structurally complex material, does not yet have a validated fiber-based constitutive model. In this study, we tested four different constitutive laws employing exponential or polynomial strain-energy functions and accounting for either mean fiber orientation alone or the details of the fiber distribution about that mean. We quantified the goodness of fit of each law to mechanical testing data from 6-week-old myocardial scar in the rat using both sum of squared error (SSE) and the Akaike Information Criterion (AIC) to account for differences in the number of material parameters within the constitutive laws. We then compared their ability to prospectively predict the mechanics of independent myocardial scar samples from other time points during healing. Our analysis suggests that a constitutive law with a polynomial form that incorporates detailed information about collagen fiber distribution using a structure tensor provides excellent fits with just two parameters and reasonable predictions of myocardial scar mechanics from measured structure alone in scars containing sufficiently high collagen content.
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Affiliation(s)
- Laura R. Caggiano
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jeffrey W. Holmes
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
- School of Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
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27
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Integrating systematic pharmacology-based strategy and experimental validation to explore the synergistic pharmacological mechanisms of Guanxin V in treating ventricular remodeling. Bioorg Chem 2021; 115:105187. [PMID: 34303037 DOI: 10.1016/j.bioorg.2021.105187] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Guanxin V (GXV) has been widely used to treat ventricular remodeling (VR) in clinical practice in China. However, the underlying mechanisms are currently still lack. METHODS A systematic pharmacology-based strategy was utilized for predicting the synergistic pharmacological mechanisms of GXV in VR. The active compounds of GXV were selected and then the potential targets of these compounds contained in GXV and VR were successively identified. Then, after networks were constructed, DAVID was applied to functional enrichment. Moreover, the key findings were validated though molecular docking and molecular biology experiments. RESULTS A total of 119 active components in GXV and 169 potential targets shared between GXV and VR were obtained. The results of functional enrichment indicated that several biological processes and signaling pathways, mainly cell apoptosis and fibrosis. Finally, we discovered GXV produced marked anti-apoptosis and anti-fibrosis effects in VR though Caspase-3 and TGF-β1. CONCLUSION GXV could relieve and reverse VR through anti-apoptosis and anti-fibrosis effects predicted by systematic pharmacology and validated by molecular docking and molecular experiments. Our study deepens the understanding of the molecular mechanisms of GXV in treating VR.
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Abstract
PURPOSE OF REVIEW Mechanical ventilation is frequently needed in patients with cardiogenic shock. The aim of this review is to summarize and discuss the current evidence and the pathophysiological mechanism that a clinician should consider while setting the ventilator. RECENT FINDINGS Little attention has been placed specifically to ventilatory strategies in patients with cardiogenic shock undertaking mechanical ventilation. Lung failure in patients with cardiogenic shock is associated with worsening outcome as well as a delay in mechanical ventilation institution. The hemodynamic profile and cardiogenic shock cause, considering the preload dependency of the failing heart, must be defined to adjust ventilatory setting. SUMMARY Evidence is growing regarding the role of lung failure as adverse prognostic factor and beneficial effect of positive pressure ventilation as part of first-line treatment in patients with cardiogenic failure.
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Miyagawa S, Mizoguchi H, Fukushima S, Imanishi Y, Watabe T, Harada A, Sakai Y, Sawa Y. New regional drug delivery system by direct epicardial placement of slow-release prostacyclin agonist promise therapeutic angiogenesis in a porcine chronic myocardial infarction. J Artif Organs 2021; 24:465-472. [PMID: 33761039 DOI: 10.1007/s10047-021-01259-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
Although prostacyclin is an endogenous factor for the protection and regeneration of damaged tissue, the use of clinically available prostacyclin analogues for treating chronic pathological conditions is limited owing to their short half-lives. A new reagent, ONO-1301SR, which is a unique synthetic prostacyclin agonist polymerized with lactic and glycolic acid, has been demonstrated to constitutively release prostacyclin analogues to adjacent tissues, suggesting its therapeutic potential via slow-release delivery into a specific organ. In this study, we investigated the regenerative effect of direct epicardial delivery of the ONO-1301SR on a heart with a chronic myocardial infarct. An ameroid constrictor was placed on the left anterior descending coronary artery of Göttingen minipigs for 4 weeks to induce ischemic cardiomyopathy; this was followed by direct epicardial placement of ONO-1301SR-immersed gelatinous sheet, or only a gelatinous sheet on the anterolateral surface of the heart. Epicardial placement of ONO-1301SR resulted in significant recovery of global cardiac functions and regional wall motion of the lateral wall. Importantly, after epicardial placement of ONO-1301SR for 4 weeks, the myocardial blood flow significantly increased in the lateral region as assessed by 13N-ammonia positron emission tomography; this finding was consistent with significantly increased capillary density in the peri-infarct area with up-regulated angiogenic cytokine expression. Conclusion: Use of the slow-release drug delivery system of prostacyclin agonist yielded regenerative angiogenesis, including increased regional blood perfusion and systolic function in a porcine model of chronic myocardial infarction.
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Affiliation(s)
- Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Hiroki Mizoguchi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yukiko Imanishi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tadashi Watabe
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
- Institute for Radiation Sciences, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Akima Harada
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yoshiki Sakai
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
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Durmaz E, Ikitimur B, Karadag B, Koca D, Ohtaroglu Tokdil K, Raimoglu U, Soysal AU, Incesu G, Belpinar MS, Mutlu D, Yurtseven E, Atici A, Ongen Z. Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study. Int J Cardiovasc Imaging 2021; 37:1587-1594. [PMID: 33624230 DOI: 10.1007/s10554-020-02138-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
Abstract
Backgrounds Assessment of left ventricular filling pressure (LVFP) is of clinical importance in patients with ST elevation myocardial infarction (STEMI). Although several echocardiographic parameters are recommended for the assessment of LVFP, validation of these parameters in patients with STEMI is missing. We aimed to investigate the clinical utility of these parameters in acute settings. Methods: We prospectively included consecutive patients with STEMI. LV end-diastolic pressure (LVEDP) was measured following primary PCI and echocardiographic examination was performed within 24 hours. Mean left atrial pressure (mLAP) was calculated both invasively using Yamamoto's formula and non-invasively using Naugeh's formula. Mean LAP was considered increased when exceeded 18 mmHg. Results: Patients were grouped according to LVEDP, group 1(41 patients) and group 2(114 patients).There was no significant difference between groups in terms of comorbidities. NT pro-BNP levels (p < 0.001) and peak level of Hs-TnT (p-value: 0.002) were significantly higher in group 2. Average E/e' ratio was significantly higher in group 2 (10.19 ± 3.15 vs. 12.04 ± 4.83, p: 0.046). Isovolumetric relaxation time was longer in group 2 (p < 0.001) and left atrial volume index (LAVI) was also significantly higher in group 2 (p < 0.001). Regression analyses revealed that septal, lateral and average E/e' ratio, tricuspid regurgitation velocity, LAVI and left ventricular volume are correlated with mLAP. Among group 2 patients only 14 Patients fulfilled the increased LVFP criteria suggested by current guidelines. Conclusions Echocardiographic parameters indicating increased LVFP require validation and may need to be modified in patients with STEMI. Moreover, current algorithms underestimate the actual number of patients with increased LVFP.
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Affiliation(s)
- Eser Durmaz
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey.
| | - Baris Ikitimur
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Bilgehan Karadag
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Damla Koca
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Kardelen Ohtaroglu Tokdil
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Utku Raimoglu
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Ali Ugur Soysal
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Gündüz Incesu
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Mehmet Semih Belpinar
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Deniz Mutlu
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Ece Yurtseven
- Department of Cardiology, Koc University, Istanbul, Turkey
| | - Adem Atici
- Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Zeki Ongen
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
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31
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Role of B lymphocytes in the infarcted mass in patients with acute myocardial infarction. Biosci Rep 2021; 41:227675. [PMID: 33495783 PMCID: PMC7859321 DOI: 10.1042/bsr20203413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Despite early reperfusion, patients with ST segment elevation myocardial infarction (STEMI) may present large myocardial necrosis and significant impairment of ventricular function. The present study aimed to evaluate the role of subtypes of B lymphocytes and related cytokines in the infarcted mass and left ventricular ejection fraction obtained by cardiac magnetic resonance imaging performed after 30 days of STEMI. This prospective study included 120 subjects with STEMI submitted to pharmacoinvasive strategy. Blood samples were collected in subjects in the first (D1) and 30th (D30) days post STEMI. The amount of CD11b+ B1 lymphocytes (cells/ml) at D1 were related to the infarcted mass (rho = 0.43; P=0.033), measured by cardiac MRI at D30. These B1 cells were associated with CD4+ T lymphocytes at D1 and D30, while B2 classic lymphocytes at day 30 were related to left ventricular ejection fraction (LVEF). Higher titers of circulating IL-4 and IL-10 were observed at D30 versus D1 (P=0.013 and P<0.001, respectively). Titers of IL-6 at D1 were associated with infarcted mass (rho = 0.41, P<0.001) and inversely related to LVEF (rho = −0.38, P<0.001). After multiple linear regression analysis, high-sensitivity troponin T and IL-6 collected at day 1 were independent predictors of infarcted mass and, at day 30, only HDL-C. Regarding LVEF, high-sensitivity troponin T and high-sensitivity C-reactive protein were independent predictors at day 1, and B2 classic lymphocytes, at day 30. In subjects with STEMI, despite early reperfusion, the amount of infarcted mass and ventricular performance were related to inflammatory responses triggered by circulating B lymphocytes.
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Gopar-Nieto R, Araiza-Garaygordobil D, Raymundo-Martínez GI, Martínez-Amezcua P, Cabello-López A, Manzur-Sandoval D, Chávez-Gómez NL, Loáisiga-Sáenz AE, Baeza-Herrera LA, Dattoli-García CA, Gallardo-Grajeda LA, Jackson-Pedroza CN, Salas-Teles B, Arias-Mendoza A. Demographic description and outcomes of a metropolitan network for myocardial infarction treatment. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:167-177. [PMID: 33471783 PMCID: PMC8295868 DOI: 10.24875/acm.20000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/12/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of the study was to describe the myocardial infarction treatment network and compare in-hospital mortality in patients undergoing either primary angioplasty or pharmacoinvasive strategy in Mexico City and a broad metropolitan area. METHODS Cohort study including patients with ST-elevation myocardial infarction. We recorded demographic and clinical data, laboratory tests and in-hospital mortality in patients that underwent primary angioplasty and pharmacoinvasive strategy. Kaplan-Meier analysis was used to assess mortality and Cox-regression assessed mortality risk factors. RESULTS Three hundred forty patients from a network of 60 hospitals and 9 states were analyzed. Of the total population, 166 were treated with pharmacoinvasive strategy and 174 with primary angioplasty. Door to thrombolytic time was 54 min and door to wire crossing time was 72.5 min; no differences in total ischemia time were demonstrated. No differences for in-hospital mortality (6.3% vs. 5.4%, p = 0.49) were found when comparing pharmacoinvasive and primary angioplasty groups. The main predictors for in-hospital mortality were: glucose > 180 mg/dl (HR 3.73), total ischemia time > 420 min (HR 3.18), heart rate > 90 bpm (HR 5.46), Killip and Kimball > II (HR 11.03), and left ventricle ejection fraction < 40% (HR 3.21). CONCLUSIONS This myocardial infarction network covers a large area and constitutes one of the biggest in the world. There were no differences regarding in-hospital mortality between pharmacoinvasive strategy and primary angioplasty. Pharmacoinvasive strategy is an effective and safe option for prompt reperfusion in Mexico.
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Affiliation(s)
- Rodrigo Gopar-Nieto
- Coronary Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
| | | | | | - Pablo Martínez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Alejandro Cabello-López
- Unidad de Investigación de Salud en el Trabajo, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | | | - Nancy L. Chávez-Gómez
- Coronary Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
| | | | - Luis A. Baeza-Herrera
- Coronary Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
| | | | | | | | - Brandon Salas-Teles
- Coronary Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
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Mihoc D, Lupu LM, Wiegand P, Kleinekofort W, Müller O, Völklein F, Glocker MO, Barka F, Barka G, Przybylski M. Antibody Epitope and Affinity Determination of the Myocardial Infarction Marker Myoglobin by SPR-Biosensor Mass Spectrometry. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2021; 32:106-113. [PMID: 32838528 DOI: 10.1021/jasms.0c00234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Myoglobin (MG) is a biomarker for heart muscle injury, making it a potential target protein for early detection of myocardial infarction. Elevated myoglobin levels alone have low specificity for acute myocardial infarction (AMI) but in combination with cardiac troponin T have been considered highly efficient diagnostic biomarkers. Myoglobin is a monomeric heme protein with a molecular weight of 17 kDa that is found in skeletal and cardiac tissue as an intracellular storage unit of oxygen. MG consists of eight α-helices connected by loops and a heme group responsible for oxygen-binding. Monoclonal antibodies are widely used analytical tools in biomedical research and have been employed for immunoanalytical detection of MG. However, the epitope(s) recognized by MG antibodies have been hitherto unknown. Precise molecular identification of the epitope(s) recognized by antibodies is of key importance for the development of MG as a diagnostic biomarker. The epitope of a monoclonal MG antibody was identified by proteolytic epitope extraction mass spectrometry in combination with surface plasmon resonance (SPR) biosensor analysis. The MG antibody was immobilized both on an affinity microcolumn and a gold SPR chip. The SPR kinetic analysis provided an affinity-binding constant KD of 270 nM for MG. Binding of a tryptic peptide mixture followed by elution of the epitope from the SPR-MS affinity interface by mild acidification provided a single-epitope peptide located at the C-terminus [146-153] [YKELGFQG] of MG. The specificity and affinity of the epitope were ascertained by synthesis and affinity-mass spectrometric characterization of the epitope peptide.
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Affiliation(s)
- Delia Mihoc
- Steinbeis Transfer Centre for Biopolymer Analysis and Biomedical Mass Spectrometry (STZ), Marktstrasse 29, 65428 Rüsselsheim am Main, Germany
| | - Loredana-Mirela Lupu
- Steinbeis Transfer Centre for Biopolymer Analysis and Biomedical Mass Spectrometry (STZ), Marktstrasse 29, 65428 Rüsselsheim am Main, Germany
| | - Pascal Wiegand
- Steinbeis Transfer Centre for Biopolymer Analysis and Biomedical Mass Spectrometry (STZ), Marktstrasse 29, 65428 Rüsselsheim am Main, Germany
| | - Wolfgang Kleinekofort
- Steinbeis Transfer Centre for Biopolymer Analysis and Biomedical Mass Spectrometry (STZ), Marktstrasse 29, 65428 Rüsselsheim am Main, Germany
- Institute for Microtechnologies (IMTECH), Rhein Main University, 65428 Rüsselsheim am Main, Germany
| | - Oliver Müller
- Institute for Microtechnologies (IMTECH), Rhein Main University, 65428 Rüsselsheim am Main, Germany
| | - Friedemann Völklein
- Institute for Microtechnologies (IMTECH), Rhein Main University, 65428 Rüsselsheim am Main, Germany
| | - Michael O Glocker
- Department of Immunology, Proteome Centre, Medical University Rostock, Schillingallee 69, 18055 Rostock, Germany
| | - Frederik Barka
- Sunchrom GmbH, Industriestr. 27, 61381 Friedrichsdorf, Germany
| | - Günes Barka
- Sunchrom GmbH, Industriestr. 27, 61381 Friedrichsdorf, Germany
| | - Michael Przybylski
- Steinbeis Transfer Centre for Biopolymer Analysis and Biomedical Mass Spectrometry (STZ), Marktstrasse 29, 65428 Rüsselsheim am Main, Germany
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Yan L, Zhang Y, Zhang W, Deng SQ, Ge ZR. lncRNA-NRF is a Potential Biomarker of Heart Failure After Acute Myocardial Infarction. J Cardiovasc Transl Res 2020; 13:1008-1015. [PMID: 32440913 PMCID: PMC7708339 DOI: 10.1007/s12265-020-10029-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
Long non-coding RNAs (lncRNAs) are a new focus in cardiovascular diseases. The necrosis-related factor (NRF) is a newly discovered lncRNA, which is increased in myocardial injury. We investigated the role of lncRNA-NRF in heart failure (HF) after acute myocardial infarction (AMI) to find a biomarker for early HF detection. This was a cross-sectional study of 76 AMI patients with HF and 58 AMI patients without HF. lncRNA-NRF was shown to be increased in AMI patients with HF compared with AMI patients without HF and had predictive value for diagnosis of HF. It had a high diagnostic value for HF (AUC, 0.975), while the AUC for N-terminal pro-brain natriuretic peptide was 0.720. Our findings suggest that lncRNA-NRF may represent a marker of risk for development of HF post-AMI.
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Affiliation(s)
- Li Yan
- Ningxia Medical University, Yinchuan, 750000, China
- Department of Cardiology, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, 200135, China
| | - Yu Zhang
- Department of Emergency Medicine, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, 200135, China
| | - Wei Zhang
- Department of Cardiology, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, 200135, China
| | - Sheng-Qiong Deng
- Department of Clinical Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, 200135, China
| | - Zhi-Ru Ge
- Department of Cardiology, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, 200135, China.
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35
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Lobb DC, Doviak H, Brower GL, Romito E, O'Neill JW, Smith S, Shuman JA, Freels PD, Zellars KN, Freeburg LA, Khakoo AY, Lee T, Spinale FG. Targeted Injection of a Truncated Form of Tissue Inhibitor of Metalloproteinase 3 Alters Post-Myocardial Infarction Remodeling. J Pharmacol Exp Ther 2020; 375:296-307. [PMID: 32958629 DOI: 10.1124/jpet.120.000047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022] Open
Abstract
Infarct expansion can occur after myocardial infarction (MI), which leads to adverse left ventricular (LV) remodeling and failure. An imbalance between matrix metalloproteinase (MMP) induction and tissue inhibitors of MMPs (TIMPs) can accelerate this process. Past studies have shown different biologic effects of TIMP-3, which may depend upon specific domains within the TIMP-3 molecule. This study tested the hypothesis that differential effects of direct myocardial injections of either a full-length recombinant TIMP-3 (F-TIMP-3) or a truncated form encompassing the N-terminal region (N-TIMP-3) could be identified post-MI. MI was induced in pigs that were randomized for MI injections (30 mg) and received targeted injections within the MI region of F-TIMP-3 (n = 8), N-TIMP-3 (n = 9), or saline injection (MI-only, n = 11). At 14 days post-MI, LV ejection fraction fell post-MI but remained higher in both TIMP-3 groups. Tumor necrosis factor and interleukin-10 mRNA increased by over 10-fold in the MI-only and N-TIMP-3 groups but were reduced with F-TIMP-3 at this post-MI time point. Direct MI injection of either a full-length or truncated form of TIMP-3 is sufficient to favorably alter the course of post-MI remodeling. The functional and differential relevance of TIMP-3 domains has been established in vivo since the TIMP-3 constructs demonstrated different MMP/cytokine expression profiles. These translational studies identify a unique and more specific therapeutic strategy to alter the course of LV remodeling and dysfunction after MI. SIGNIFICANCE STATEMENT: Using different formulations of tissue inhibitor of matrix metalloproteinase-3 (TIMP-3), when injected into the myocardial infarction (MI) region, slowed the progression of indices of left ventricular (LV) failure, suggesting that the N terminus of TIMP-3 is sufficient to attenuate early adverse functional events post-MI. Injections of full-length recombinant TIMP-3, but not of the N-terminal region of TIMP-3, reduced relative indices of inflammation at the mRNA level, suggesting that the C-terminal region affects other biological pathways. These unique proof-of-concept studies demonstrate the feasibility of using recombinant small molecules to selectively interrupt adverse LV remodeling post-MI.
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Affiliation(s)
- David C Lobb
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Heather Doviak
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Gregory L Brower
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Eva Romito
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Jason W O'Neill
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Stephen Smith
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - James A Shuman
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Parker D Freels
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Kia N Zellars
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Lisa A Freeburg
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Aarif Y Khakoo
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - TaeWeon Lee
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
| | - Francis G Spinale
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, South Carolina (D.C.L., H.D., G.L.B., E.R., J.A.S., P.D.F., K.N.Z., L.A.F., F.G.S.) and Amgen, Metabolic Disorders, South San Francisco, California (J.W.O., S.S., A.Y.K., T.L.)
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Augmented glycaemic gap is a marker for an increased risk of post-infarct left ventricular systolic dysfunction. Cardiovasc Diabetol 2020; 19:101. [PMID: 32622355 PMCID: PMC7335441 DOI: 10.1186/s12933-020-01075-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background Left ventricular systolic dysfunction (LVSD) occurs frequently after acute ST-segment elevation myocardial infarction (STEMI). The predisposing factors and underlying mechanism of post-infarct LVSD are not fully understood. The present study mainly investigated the correlation between glycaemic gap, a novel index of stress-induced hyperglycaemia (SIH), and post-infarct LVSD. Methods A total of 274 first STEMI patients were enrolled in this cross-sectional study. Transthoracic echocardiography was performed within 48 h after admission and at 6 months after discharge to obtain left ventricular ejection fraction (LVEF). The change in LVEF was calculated as LVEF at 6 months after discharge minus baseline LVEF. Additionally, post-infarct LVSD was defined as LVEF ≤ 50%. Most importantly, glycaemic gap was calculated as admission blood glucose (ABG) minus the estimated average glucose over the previous 3 months. Results In patients without diabetes mellitus (DM), multivariate linear regression analysis revealed that both glycaemic gap (Beta = − 1.214, 95% CI − 1.886 to − 0.541, p < 0.001) and ABG (Beta = − 1.124, 95% CI − 1.795 to − 0.453, p = 0.001) were associated with change in LVEF. In DM patients, only glycaemic gap was still associated with change in LVEF, although this association was not observed in univariate linear regression analysis. Regarding the association between SIH and post-infarct LVSD, multivariate logistic regression analysis revealed that both glycaemic gap (OR = 1.490, 95% CI 1.043 to 2.129, p = 0.028) and ABG (OR = 1.600, 95% CI 1.148 to 2.229, p = 0.005) were associated with an increased risk of having post-infarct LVSD in non-DM patients. However, after multivariate adjustment in DM patients, only glycaemic gap (OR = 1.399, 95% CI 1.021 to 1.919, p = 0.037) remained associated with an increased risk of having post-infarct LVSD. Furthermore, the predictive value of glycaemic gap for post-infarct LVSD was not inferior to ABG in non-DM patients (p = 0.499), and only glycaemic gap, instead of ABG, could significantly predict post-infarct LVSD in DM patients (AUC = 0.688, 95% CI 0.591 to 0.774, p = 0.002). Conclusions Glycaemic gap was strongly associated with a change in LVEF and an increased risk of having post-infarct LVSD in patients following STEMI. In STEMI patients with DM, glycaemic gap could provide more valuable information than ABG in identifying patients at high risk of developing post-infarct LVSD.
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Świątkiewicz I, Magielski P, Kubica J, Zadourian A, DeMaria AN, Taub PR. Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure. Int J Mol Sci 2020; 21:ijms21030807. [PMID: 31991903 PMCID: PMC7037521 DOI: 10.3390/ijms21030807] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022] Open
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP24), discharge (CRPDC), and 1 month after discharge (CRP1M). LVSD at 6 months after discharge (LVSD6M) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD6M occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD6M vs. 4.9% without LVSD6M (p < 0.0001). Compared to patients without LVSD6M, the patients with LVSD6M had higher CRP24 and CRPDC and persistent CRP1M ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP24 ≥ 19.67 mg/L improved the prediction of LVSD6M with an increased odds ratio of 1.47 (p < 0.01). Patients with LVSD6M who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.
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Affiliation(s)
- Iwona Świątkiewicz
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
- Correspondence:
| | - Przemysław Magielski
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Adena Zadourian
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
| | - Anthony N. DeMaria
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
| | - Pam R. Taub
- Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA
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Docherty KF, Ferreira JP, Sharma A, Girerd N, Gregson J, Duarte K, Petrie MC, Jhund PS, Dickstein K, Pfeffer MA, Pitt B, Rossignol P, Zannad F, McMurray JJV. Predictors of sudden cardiac death in high-risk patients following a myocardial infarction. Eur J Heart Fail 2020; 22:848-855. [PMID: 31944496 DOI: 10.1002/ejhf.1694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS To develop a risk model for sudden cardiac death (SCD) in high-risk acute myocardial infarction (AMI) survivors. METHODS AND RESULTS Data from the Effect of Carvedilol on Outcome After Myocardial Infarction in Patients With Left Ventricular Dysfunction trial (CAPRICORN) and the Valsartan in Acute Myocardial Infarction Trial (VALIANT) were used to create a SCD risk model (with non-SCD as a competing risk) in 13 202 patients. The risk model was validated in the Eplerenone Post-AMI Heart Failure Efficacy and Survival Study (EPHESUS). The rate of SCD was 3.3 (95% confidence interval 3.0-3.5) per 100 person-years over a median follow-up of 2.0 years. Independent predictors of SCD included age > 70 years; heart rate ≥ 70 bpm; smoking; Killip class III/IV; left ventricular ejection fraction ≤30%; atrial fibrillation; history of prior myocardial infarction, heart failure or diabetes; estimated glomerular filtration rate < 60 mL/min/1.73 m2 ; and no coronary reperfusion or revascularisation therapy for index AMI. The model was well calibrated and showed good discrimination (C-statistic = 0.72), including in the early period after AMI. The observed 2-year event rates increased steeply with each quintile of risk score (1.9%, 3.6%, 6.2%, 9.0%, 13.4%, respectively). CONCLUSION An easy to use SCD risk score developed from routinely collected clinical variables in patients with heart failure, left ventricular systolic dysfunction or both, early after AMI was superior to left ventricular ejection fraction. This score might be useful in identifying patients for future trials testing treatments to prevent SCD early after AMI.
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Affiliation(s)
- Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - João Pedro Ferreira
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Abhinav Sharma
- Division of Cardiology, McGill University Health Centre, Montreal, Canada
| | - Nicolas Girerd
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin Duarte
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Kenneth Dickstein
- Department of Cardiology, University of Bergan, Stavanger University Hospital, Stavanger, Norway
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Patrick Rossignol
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Monge García MI, Jian Z, Settels JJ, Hunley C, Cecconi M, Hatib F, Pinsky MR. Determinants of left ventricular ejection fraction and a novel method to improve its assessment of myocardial contractility. Ann Intensive Care 2019; 9:48. [PMID: 30993544 PMCID: PMC6468023 DOI: 10.1186/s13613-019-0526-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/11/2019] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this study was to quantify the impact of different cardiovascular factors on left ventricular ejection fraction (LVEF) and test a novel LVEF calculation considering these factors. Results 10 pigs were studied. The experimental protocol consisted of sequentially changing afterload, preload and contractility. LV pressure–volume (PV) loops and peripheral arterial pressure were obtained before and after each intervention. LVEF was calculated as stroke volume (SV)/end-diastolic volume (EDV). We studied global cardiac function variables: LV end-systolic elastance (Ees), effective arterial elastance (Ea), end-diastolic volume and heart rate. Diastolic function was evaluated by means of the ventricular relaxation time (τ) and ventricular stiffness constant (β) obtained from the end-diastolic PV relationship. Ventriculo-arterial coupling (VAC), an index of cardiovascular performance, was calculated as Ea/Ees. LV mechanical efficiency (LVeff) was calculated as the ratio of stroke work to LV pressure–volume area. A linear mixed model was used to determine the impact of cardiac factors (Ees, Ea, EDV and heart rate), VAC and LVeff on LVEF during all experimental conditions. LVEF was mainly related to Ees and Ea. There was a strong relationship between LVEF and both VAC and LVeff (r2 = 0.69 and r2 = 0.94, respectively). The relationship between LVEF and Ees was good (r2 = 0.43). Adjusting LVEF to afterload (\documentclass[12pt]{minimal}
\usepackage{amsmath}
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\begin{document}$${\text{LVEF}}_{\rm EA} = {\text{EF}} \times \sqrt {\text{Ea}}$$\end{document}LVEFEA=EF×Ea) performed better for estimating Ees (r2 = 0.75) and improved the tracking of LV contractility changes, even when a peripheral Ea was used as surrogate (Ea = radial MAP/SV; r2 = 0.73). Conclusions LVEF was mainly affected by contractility and afterload changes and was strongly related to VAC and LVeff. An adjustment to LVEF that considers the impact of afterload provided a better assessment of LV contractility.
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Affiliation(s)
- Manuel Ignacio Monge García
- Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, C/Circunvalación, s/n, 11407, Jerez de la Frontera, Spain.
| | | | | | - Charles Hunley
- Orlando Regional Medical Center, Orlando Health, Orlando, FL, USA
| | - Maurizio Cecconi
- Department Anaesthesia and Intensive Care Units, Humanitas Research Hospital, Humanitas University, Milan, Italy
| | | | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Dotta G, Fonseca FAH, Izar MCDO, Souza MTD, Moreira FT, Pinheiro LFM, Barbosa AHP, Caixeta AM, Póvoa RMS, Carvalho AC, Bianco HT. Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy. Arq Bras Cardiol 2018; 112:20-29. [PMID: 30570061 PMCID: PMC6317627 DOI: 10.5935/abc.20180239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/02/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. OBJECTIVE To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. METHODS Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. RESULTS We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. CONCLUSION Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.
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Affiliation(s)
- Gabriel Dotta
- Universidade Federal de São Paulo, São Paulo, SP - Brazil
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Lakhani HV, Khanal T, Gabi A, Yousef G, Alam MB, Sharma D, Aljoudi H, Puri N, Thompson E, Shapiro JI, Sodhi K. Developing a panel of biomarkers and miRNA in patients with myocardial infarction for early intervention strategies of heart failure in West Virginian population. PLoS One 2018; 13:e0205329. [PMID: 30356307 PMCID: PMC6200226 DOI: 10.1371/journal.pone.0205329] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022] Open
Abstract
Background Myocardial infarction is the most common cause of heart failure. MI has been intricately linked to ventricular remodeling, subsequently leading to the reduction in the cardiac ejection fraction causing HF. The cumulative line of evidence suggests an important role of several biomarkers in modulating the cardiac vasculature, further contributing towards the progression of post-MI complications. Studies have demonstrated, yet not fully established, that an important biomarker, IL-10, has a causal relationship with MI and associated cardiac dysfunction. Hypothesis This study aims to establish the role of IL-10 as a prognostic marker for the cardiovascular outcomes and to develop a panel of biomarkers and circulating miRNAs that could potentially result in the early detection of HF resulting from MI, allowing for early intervention strategies. Methods and results Blood was withdrawn and echocardiography assessment was performed on a total of 43 patients that were enrolled, within 24 hours of the incidence of MI. Patients were divided in three main groups, based on the ejection fraction measurement from echocardiography: control (n = 14), MI with normal EF (MI+NEF, n = 13) and MI with low EF (MI+LEF, n = 16). Our results showed that TGFβ-1, TNF-α, IL-6 and MMP-9 were upregulated significantly in MI+NEF group and more so in MI+LEF group, as compared to control group (p<0.01). The circulating levels of miR-34a, miR-208b and miR-126 were positively correlated and showed elevated levels in the MI+NEF group, even higher in MI+LEF group, while levels of miR-24 and miR-29a were reduced in MI+NEF, and much lower in MI+LEF, as compared to the control group (p<0.01). Our results also demonstrated a direct correlation of IL-10 with the ejection fraction in patients with MI: IL-10 was elevated in MI+NEF group, however, the levels were significantly low in MI+LEF group suggesting an important role of IL-10 in predicting heart failure. Importantly, our study confirmed the correlation of IL-10 with EF by our follow-up echocardiography assessment that was performed 2 months after the incidence of MI. Conclusion Our results support the clinical application of these serum biomarkers to develop a panel for appropriate prognosis and management of adverse cardiac remodeling and development of heart failure post-myocardial infarction.
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Affiliation(s)
- Hari Vishal Lakhani
- Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Tilak Khanal
- Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Alaa Gabi
- Division of Cardiology, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - George Yousef
- Division of Cardiology, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Mian Bilal Alam
- Division of Cardiology, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Dana Sharma
- Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Haytham Aljoudi
- Division of Cardiology, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Nitin Puri
- Departments of Biomedical Sciences, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Ellen Thompson
- Division of Cardiology, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Joseph I. Shapiro
- Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
| | - Komal Sodhi
- Departments of Surgery and Biomedical Sciences, Marshall University Joan C Edwards School of Medicine, Huntington, WV, United States of America
- * E-mail:
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Determinantes e impacto pronóstico de la insuficiencia cardiaca y la fracción de eyección del ventrículo izquierdo en el síndrome coronario agudo. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Caggiano LR, Lee JJ, Holmes JW. Surgical reinforcement alters collagen alignment and turnover in healing myocardial infarcts. Am J Physiol Heart Circ Physiol 2018; 315:H1041-H1050. [PMID: 30028201 DOI: 10.1152/ajpheart.00088.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies have suggested that the composition and global mechanical properties of the scar tissue that forms after a myocardial infarction (MI) are key determinants of long-term survival, and emerging therapies such as biomaterial injection are designed in part to alter those mechanical properties. However, recent evidence suggests that local mechanics regulate scar formation post-MI, so that perturbing infarct mechanics could have unexpected consequences. We therefore tested the effect of changes in local mechanical environment on scar collagen turnover, accumulation, and alignment in 77 Sprague-Dawley rats at 1, 2, 3 and 6 wk post-MI by sewing a Dacron patch to the epicardium to eliminate circumferential strain while permitting continued longitudinal stretching with each heart beat. We found that collagen in healing infarcts aligned parallel to regional strain and perpendicular to the preinfarction muscle and collagen fiber direction, strongly supporting our hypothesis that mechanical environment is the primary determinant of scar collagen alignment. Mechanical reinforcement reduced levels of carboxy-terminal propeptide of type I procollagen (PICP; a biomarker for collagen synthesis) in samples collected by microdialysis significantly, particularly in the first 2 wk. Reinforcement also reduced carboxy-terminal telopeptide of type I collagen (ICTP; a biomarker for collagen degradation), particularly at later time points. These alterations in collagen turnover produced no change in collagen area fraction as measured by histology but significantly reduced wall thickness in the reinforced scars compared with untreated controls. Our findings confirm the importance of regional mechanics in regulating scar formation after infarction and highlight the potential for therapies that reduce stretch to also reduce wall thickness in healing infarcts. NEW & NOTEWORTHY This study shows that therapies such as surgical reinforcement, which reduce stretch in healing infarcts, can also reduce collagen synthesis and wall thickness and modify collagen alignment in postinfarction scars.
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Affiliation(s)
- Laura R Caggiano
- Department of Biomedical Engineering, University of Virginia , Charlottesville, Virginia
| | - Jia-Jye Lee
- Department of Biomedical Engineering, University of Virginia , Charlottesville, Virginia
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia , Charlottesville, Virginia.,Department of Medicine, University of Virginia , Charlottesville, Virginia
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Wellings J, Kostis JB, Sargsyan D, Cabrera J, Kostis WJ. Risk Factors and Trends in Incidence of Heart Failure Following Acute Myocardial Infarction. Am J Cardiol 2018; 122:1-5. [PMID: 29685572 DOI: 10.1016/j.amjcard.2018.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 12/25/2022]
Abstract
Patients who develop heart failure (HF) after an acute myocardial infarction (AMI) are at higher risk of adverse fatal and nonfatal outcomes. Published studies on the incidence and associations of HF after infarction have been contradictory, with some reporting increasing and others decreasing incidence. Between 2000 and 2015, 109,717 patients admitted for a first AMI in New Jersey were discharged alive. In the 15 years from 2000 to 2015, the rates of admission for HF in AMI patients who were discharged alive decreased by 60%, from 3.48% to 1.4%, at 1-year follow-up. At 5 years of follow-up, the decline was more pronounced, from 7.21% to 1.4%, an 80% decline. All-cause death, and the combined end point of admission for HF or death, showed decreasing trends. Cox regression indicated a decrease in the risk of admission for HF over time (hazard ratio [HR] 0.955, 95% confidence interval [CI] 0.949 to 0.961). Younger age, male gender, and commercial insurance were associated with lower HRs for HF (p <0.001), whereas history of hypertension, diabetes, kidney, or lung disease were associated with higher HRs (p <0.001). There was no significant difference in the rate of HF between subendocardial and transmural AMI (adjusted OR was 0.96, CI 0.90 to 1.03, p = 0.241). Revascularization was associated with a marked decrease in HF admissions (adjusted OR 0.22, 95% CI 0.19 to 0.25, p <0.001 for percutaneous coronary intervention and OR 0.44, 95% CI 0.38 to 0.51, p <0.001 for CABG). In conclusion, the rate of admission for HF after discharge for a first myocardial infarction as well as all-cause death decreased markedly from 2000 to 2015.
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Affiliation(s)
- Jennifer Wellings
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
| | - John B Kostis
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey.
| | - Davit Sargsyan
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
| | - Javier Cabrera
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
| | - William J Kostis
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
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Decompensated Heart Failure With Ventricular Arrhythmia: How Useful Is VT Ablation? Curr Heart Fail Rep 2018; 15:201-213. [PMID: 29938322 DOI: 10.1007/s11897-018-0395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Ventricular arrhythmias are common in patients with heart failure. Their management especially in the context of decompensated heart failure poses a clinical challenge to modern cardiologists. In this review article, we aim to summarise the current evidence on the epidemiology, pathophysiology, and management of ventricular tachycardia in heart failure, focusing primarily on the use of catheter ablation. RECENT FINDINGS The evolution of electro-anatomical mapping techniques and ablation catheter technology in the recent years has paved the path for the successful application of catheter ablation in the treatment of ventricular arrhythmias. The efficacy of catheter ablation in the management of ventricular tachycardia in patients with chronic heart failure has recently been the epicentre of a number of randomised controlled trials, demonstrating promising results with regard to arrhythmia suppression and all-cause mortality. The usefulness of catheter ablation in decompensated heart failure has been explored to a lesser degree, primarily in the setting of an electrical storm. Implantable cardiac defibrillators play the most important role in improving prognosis and preventing sudden cardiac death in patients with heart failure. Catheter ablation for the treatment of recurrent VT in patients with chronic heart failure is an efficacious strategy that can be applied adjunctively to or in instead of antiarrhythmic therapy, and it is highly successful at preventing recurrent ventricular tachycardia, ICD shocks. Its efficacy in the context of decompensated heart failure requires further research, with current evidence rendering its use promising.
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Deniz E, Chatterjee A, Feldmann C, Hanke JS, Dogan G, Berliner D, Shrestha ML, Haverich A, Schmitto JD. How to do it: tips and tricks of minimal-invasive HVAD ® implantation-the lateral approach. J Thorac Dis 2018; 10:S1829-S1833. [PMID: 30034860 DOI: 10.21037/jtd.2018.05.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ezin Deniz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Feldmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology, Hannover Medical School, Hannover, Germany
| | - Malakh L Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Chatterjee A, Feldmann C, Dogan G, Hanke JS, Ricklefs M, Deniz E, Haverich A, Schmitto JD. Clinical overview of the HVAD: a centrifugal continuous-flow ventricular assist device with magnetic and hydrodynamic bearings including lateral implantation strategies. J Thorac Dis 2018; 10:S1785-S1789. [PMID: 30034853 DOI: 10.21037/jtd.2018.04.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Growing worldwide incidences of end-stage heart failure and declining rates of cardiac transplants have given rise to the need for alternative treatment options, based on mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs). Technologically advanced LVADs such as the HVAD® (HeartWare®, Medtronic) facilitate safe and efficient treatment of heart failure patients with reduced post-operative complications, which is attributed to their considerably miniaturized size. This also facilitates the development and implementation of novel, minimally-invasive surgical techniques. The HVAD is a centrifugal pump, manufactured by HeartWare Inc., (Framingham, MA, USA) and subsequently by Medtronic Inc., (Minnesota, MN, USA), and has been approved for clinical application after receiving the CE Mark approval in 2008 and the FDA approval in 2012. Current research efforts are focused on further miniaturization alongside optimization of electronic and software controllers as well as implementation of the transcutaneous energy transfer (TET) technology. Salient features of the HVAD pump technology, clinical applications and future optimization strategies have been discussed in this article.
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Affiliation(s)
- Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Feldmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Ricklefs
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ezin Deniz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Qiu R, Li W, Liu Y. MicroRNA-204 protects H9C2 cells against hypoxia/reoxygenation-induced injury through regulating SIRT1-mediated autophagy. Biomed Pharmacother 2018; 100:15-19. [PMID: 29421577 DOI: 10.1016/j.biopha.2018.01.165] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 01/21/2023] Open
Abstract
Ischemia/reperfusion (I/R) injury is a main cause of acute myocardial infarction, and the pathogenesis of I/R injury is still not definitely confirmed. In the present study, we aimed to explore the roles of miR-204 in hypoxia/reoxygenation (H/R)-induced cardiomyocyte injury in vitro. The H9C2 cells were subjected to hypoxia for 12 h followed by reoxygenation for another 24 h, and we found that miR-204 was significantly down-regulated after H/R treatment. Transfection of miR-204 mimics attenuated the H/R-induced impaired cell viability and increased apoptosis rates. Furthermore, SIRT1 was identified as a direct target of miR-204, and its expression is negatively regulated by miR-204. Forced expression of SIRT1 could partly rescue the effects of miR-204 on H/R-induced apoptosis and autophagy. Taken together, our study first revealed that overexpression of miR-204 has a protective effect against myocardial I/R injury.
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Affiliation(s)
- Ruixia Qiu
- Department of Medical Affairs, No.1 People's Hospital of Jining City, Jining, Shandong, China
| | - Wen Li
- Department of Emergency, No.1 People's Hospital of Jining City, Jining, Shandong, China
| | - Yunhai Liu
- Department of Emergency, No.1 People's Hospital of Jining City, Jining, Shandong, China.
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Agra Bermejo R, Cordero A, García-Acuña JM, Gómez Otero I, Varela Román A, Martínez Á, Álvarez Rodríguez L, Abou-Jokh C, Rodríguez-Mañero M, Cid Álvarez B, López-Palop R, Carrillo P, González-Juanatey JR. Determinants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome Settings. ACTA ACUST UNITED AC 2017; 71:820-828. [PMID: 29249471 DOI: 10.1016/j.rec.2017.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Contemporary data on the incidence and prognosis of heart failure (HF) and the influence of left ventricular ejection fraction (LVEF) in the setting of acute coronary syndrome (ACS) are scant. The aim of this study was to examine the relationship between LVEF and HF with long-term prognosis in a cohort of patients with ACS. METHODS This is a retrospective observational study of 6208 patients consecutively admitted for ACS to 2 different Spanish hospitals. Baseline characteristics were examined and a follow-up period was established for registration of death and HF rehospitalization as the primary endpoint. RESULTS Among the study participants, 5064 had ACS without HF during hospitalization: 290 (5.8%) had LVEF<40%, 540 (10.6%) LVEF 40% to 49%, and 4234 (83.6%) LVEF ≥ 50%. The remaining 1144 patients developed HF in the acute phase: 395 (34.6%) had LVEF<40%, 251 (21.9%) LVEF 40% to 49%, and 498 (43.5%) LVEF ≥ 50%. Patients with LVEF 40% to 49% had a demographic and clinical profile with intermediate features between the LVEF <40% and LVEF ≥ 50% groups. Kaplan-Meier curves showed that mortality and HF readmissions were statistically different depending on LVEF in the non-HF group but not in the HF group. Left ventricular ejection fraction ≥ 50% was an independent prognostic factor in the non-HF group only. CONCLUSIONS In ACS, long-term prognosis is considerably worse in patients who develop HF during hospitalization than in patients without HF, irrespective of LVEF. This parameter is a strong prognostic predictor only in patients without HF.
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Affiliation(s)
- Rosa Agra Bermejo
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain.
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain
| | - José M García-Acuña
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Inés Gómez Otero
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Alfonso Varela Román
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Álvaro Martínez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Leyre Álvarez Rodríguez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Charigan Abou-Jokh
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Moisés Rodríguez-Mañero
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Belén Cid Álvarez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain
| | - José R González-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
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Jamieson KL, Endo T, Darwesh AM, Samokhvalov V, Seubert JM. Cytochrome P450-derived eicosanoids and heart function. Pharmacol Ther 2017; 179:47-83. [DOI: 10.1016/j.pharmthera.2017.05.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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