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Liu Y, Lu K, Zhang R, Hu D, Yang Z, Zeng J, Cai W. Advancements in the Treatment of Atherosclerosis: From Conventional Therapies to Cutting-Edge Innovations. ACS Pharmacol Transl Sci 2024; 7:3804-3826. [PMID: 39698263 PMCID: PMC11651175 DOI: 10.1021/acsptsci.4c00574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/18/2024] [Accepted: 11/20/2024] [Indexed: 12/20/2024]
Abstract
Atherosclerosis is a leading cause of morbidity and mortality worldwide, driven by a complex interplay of lipid dysregulation, inflammation, and vascular pathology. Despite advancements in understanding the multifactorial nature of atherosclerosis and improvements in clinical management, existing therapies often fall short in reversing the disease, focusing instead on symptom alleviation and risk reduction. This review highlights recent strides in identifying genetic markers, elucidating inflammatory pathways, and understanding environmental contributors to atherosclerosis. It also evaluates the efficacy and limitations of current pharmacological treatments, revascularization techniques, and the impact of these interventions on patient outcomes. Furthermore, we explore innovative therapeutic strategies, including the promising fields of nanomedicine, nucleic acid-based therapies, and immunomodulation, which offer potential for targeted and effective treatment modalities. However, integrating these advances into clinical practice is challenged by regulatory, economic, and logistical barriers. This review synthesizes the latest research and clinical advancements to provide a comprehensive roadmap for future therapeutic strategies and emphasize the critical need for innovative approaches to fundamentally change the course of atherosclerosis management.
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Affiliation(s)
- Yan Liu
- The
Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Center
for Molecular Imaging and Nuclear Medicine, State Key Laboratory of
Radiation Medicine and Protection, School for Radiological and Interdisciplinary
Sciences (RAD-X), Collaborative Innovation Center of Radiological
Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, China
| | - Kuan Lu
- The
Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Ruru Zhang
- Center
for Molecular Imaging and Nuclear Medicine, State Key Laboratory of
Radiation Medicine and Protection, School for Radiological and Interdisciplinary
Sciences (RAD-X), Collaborative Innovation Center of Radiological
Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, China
| | - Dongliang Hu
- The
Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Center
for Molecular Imaging and Nuclear Medicine, State Key Laboratory of
Radiation Medicine and Protection, School for Radiological and Interdisciplinary
Sciences (RAD-X), Collaborative Innovation Center of Radiological
Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, China
| | - Zhe Yang
- The
Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Jianfeng Zeng
- Center
for Molecular Imaging and Nuclear Medicine, State Key Laboratory of
Radiation Medicine and Protection, School for Radiological and Interdisciplinary
Sciences (RAD-X), Collaborative Innovation Center of Radiological
Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, China
| | - Wu Cai
- The
Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
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Alotaibi K, Bakhsh A, Alkhaf F, Amro A, Albarrak M, Tantawy T, Arafat AA, Adam AI. Myocardial recovery in a patient with dilated cardiomyopathy after short-term biventricular assist device support. J Card Surg 2022; 37:5591-5594. [PMID: 36378911 DOI: 10.1111/jocs.17148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
Management of patients with end-stage heart failure is still challenging. We report a case of idiopathic dilated cardiomyopathy who went through a challenging course. The case was presented as acute heart failure syndrome, which rapidly declined into cardiogenic shock and cardiac arrest that required an extracorporeal membrane oxygenator, then biventricular assist device implantation for circulatory support. The course was complicated with severe gastrointestinal bleeding and multiorgan failure until achieving full cardiac and organ recovery. The left ventricle ejection fraction improved from 10% to 50% at discharge.
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Affiliation(s)
- Khaled Alotaibi
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abeer Bakhsh
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Fahmi Alkhaf
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed Amro
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammad Albarrak
- Cardiac Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Tarek Tantawy
- Cardiac Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Adam I Adam
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Wang H, Zhang B, Wu WC, Zhu ZH, Wang H. Change of Left Ventricular Geometric Pattern in Patients with Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting. J Cardiovasc Transl Res 2022; 15:1444-1454. [PMID: 35543834 DOI: 10.1007/s12265-022-10249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 12/16/2022]
Abstract
Left ventricular (LV) remodeling and geometric patterns are associated with variations in prognosis. Two hundred twenty-eight patients who underwent selective isolated coronary artery bypass grafting (CABG) were included, divided into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy at baseline. More than half participants with normal geometry at baseline remained in that category, and similar ratio of concentric remodeling reverted to normal geometry on follow-up. The concentric hypertrophy at baseline tended to progress to eccentric geometry rather than normal geometry, while changes from eccentric to concentric hypertrophy was uncommon. iLVEDD had a significant association with an increased risk of developing an abnormal geometric pattern from a normal or concentric remodeling pattern, and iLVESD and LAScd involved in the regression from an abnormal geometric pattern. Thus, dynamic changes in LV geometric pattern are common on 1-year follow-up after CABG and LA strain has an incremental role for early detection in this process.
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Affiliation(s)
- Han Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Bing Zhang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Zhen-Hui Zhu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China.
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Meta-Analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Narrowing. Am J Cardiol 2022; 173:39-47. [PMID: 35393084 DOI: 10.1016/j.amjcard.2022.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/12/2022]
Abstract
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results. We performed a systematic review up to May 23, 2021, and 1-stage reconstructed individual patient data meta-analysis (IPDMA) to compare outcomes between both groups. The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke, and unplanned revascularization at 5 years. We performed individual patient data meta-analysis using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups. Of 583 articles retrieved, 5 RCTs were included. A total of 4,595 patients from these 5 RCTs were randomly assigned to PCI (n = 2,297) or CABG (n = 2,298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6%, respectively (hazard ratio [HR] 1.093, 95% confidence interval [CI] 0.925 to 1.292; p = 0.296). PCI conferred similar time-to-MI (restricted mean survival time ratio 1.006, 95% CI 0.992 to 1.021, p=0.391) and stroke (restricted mean survival time ratio 1.005, 95% CI 0.998 to 1.013, p = 0.133) at 5 years. Unplanned revascularization was more frequent after PCI than CABG (HR 1.807, 95% CI 1.524 to 2.144, p <0.001) at 5 years. This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
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Affiliation(s)
- Itsik Ben-Dor
- Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC
| | - Ron Waksman
- Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC
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Wang H, Wang H, Wei Y, Li X, Jhummun V, Ahmed MA. Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis. Diabetes Ther 2021; 12:1041-1054. [PMID: 33641081 PMCID: PMC7994472 DOI: 10.1007/s13300-021-01025-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In this meta-analysis, we aimed to systematically compare the 10-year outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus (T2DM) suffering from left main coronary artery disease (LMCD). METHODS Medical Literature Analysis and Retrieval System Online (MEDLINE), http://www.ClinicalTrials.gov , Excerpta Medica dataBASE (EMBASE), Cochrane Central, Web of Science, and Google scholar were searched for publications comparing 10-year outcomes of PCI versus CABG in patients with T2DM suffering from LMCD. Cardiovascular outcomes were considered as the clinical endpoints. Statistical analysis was carried out using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after analysis. RESULTS Eight studies (three randomized trials and five observational studies) with a total number of 3835 participants with T2DM were included in this analysis; 2340 participants were assigned to the PCI group and 1495 participants were assigned to the CABG group. Results of this analysis showed that mortality (RR 0.85, 95% CI 0.73-1.00; P = 0.05), myocardial infarction (RR 0.53, 95% CI 0.35-0.80; P = 0.002), repeated revascularization (RR 0.34, 95% CI 0.26-0.46; P = 0.00001), and target vessel revascularization (RR 0.26, 95% CI 0.18-0.38; P = 0.00001) were significantly higher with PCI when compared to CABG in these patients with diabetes and LMCD. Major adverse cardiac and cerebrovascular events were also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49-0.92; P = 0.01). However, CABG was associated with a significantly higher risk of stroke (RR 2.16, 95% CI 1.39-3.37; P = 0.0007). CONCLUSIONS During a long-term follow-up time period of 10 years, PCI was associated with worse clinical outcomes compared to CABG in these patients with T2DM suffering from LMCD. However, a significantly higher risk of stroke was observed with CABG. This piece of information might be vital in order to carefully choose and prevent complications following revascularization in such patients.
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Affiliation(s)
- Hong Wang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China.
| | - Hongli Wang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Yuyuan Wei
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Xinxin Li
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Vineet Jhummun
- Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Mohamad A Ahmed
- Department of Cardiology, Peking University People's Hospital, Beijing, People's Republic of China
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Carnero-Alcázar M, Maroto-Castellanos LC. Debate: The role of coronary artery bypass grafting for left main disease after EXCEL and NOBLE trials. ACTA ACUST UNITED AC 2021; 74:648-650. [PMID: 33715978 DOI: 10.1016/j.rec.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022]
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Carnero-Alcázar M, Maroto-Castellanos LC. Debate: Papel de la revascularización quirúrgica del tronco coronario izquierdo tras los ensayos EXCEL y NOBLE. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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