Features of metabolic syndrome and inflammation independently affect left ventricular function early after first myocardial infarction

Sex-Age Interplay Among Young Aged Egyptians With First Acute Myocardial Infarction

BACKGROUND

The burden of modifiable risk factors in young Egyptian adults presenting with first acute myocardial infarction (AMI), sex differences, sex-age interplay, and its relationship with demographic, angiographic characteristics, and type of AMI is a good topic for discussion.

METHODS

The study enrolled 165 young (≤45 years old) consecutive, eligible patients diagnosed with first AMI (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction), for their demographic, angiographic, echocardiographic, and laboratory investigations and gender differences.

RESULTS

Our population were 29-45 years old and 12.1% were females, most of whom had ST-elevation myocardial infarction; obesity in females and smoking in males were the most prevalent; and the younger the age of females presenting with AMI the more aggressive underlying risk factors and the more reduction in left ventricular ejection fraction. Most of the female culprit lesions were thrombotic and the severity of atherosclerotic culprit lesions correlated positively with blood pressure.

CONCLUSIONS

The age paradox in young females (regarding left ventricular ejection fraction and the traditional risk factors) and the thrombotic nature of the culprit lesion mandate early intensive 1-year and 2-year preventive strategies against coronary heart disease (CHD) with special concern for obesity as the main trigger early in life with proper control of blood pressure. In males, smoking cessation programs are the main target to ameliorate the progress of CHD hand in hand with the other 1-year and 2-year preventive strategies of CHD.

TGF-β as a therapeutic target in the infarcted and failing heart: cellular mechanisms, challenges, and opportunities

INTRODUCTION

Myocardial fibrosis accompanies most cardiac conditions and can be reparative or maladaptive. Transforming Growth Factor (TGF)-β is a potent fibrogenic mediator, involved in repair, remodeling, and fibrosis of the injured heart.

AREAS COVERED

This review manuscript discusses the role of TGF-β in heart failure focusing on cellular mechanisms and therapeutic implications. TGF-β is activated in infarcted, remodeling and failing hearts. In addition to its fibrogenic actions, TGF-β has a broad range of effects on cardiomyocytes, immune, and vascular cells that may have both protective and detrimental consequences. TGF-β-mediated effects on macrophages promote anti-inflammatory transition, whereas actions on fibroblasts mediate reparative scar formation and effects on pericytes are involved in maturation of infarct neovessels. On the other hand, TGF-β actions on cardiomyocytes promote adverse remodeling, and prolonged activation of TGF-β signaling in fibroblasts stimulates progression of fibrosis and heart failure.

EXPERT OPINION

Understanding of the cell-specific actions of TGF-β is necessary to design therapeutic strategies in patients with myocardial disease. Moreover, to implement therapeutic interventions in the heterogeneous population of heart failure patients, mechanism-driven classification of both HFrEF and HFpEF patients is needed. Heart failure patients with prolonged or overactive fibrogenic TGF-β responses may benefit from cautious TGF-β inhibition.

Clinical Variables Influence the Ability of miR-101, miR-150, and miR-21 to Predict Ventricular Remodeling after ST-Elevation Myocardial Infarction

Left ventricle remodeling (LVR) after acute myocardial infarction (MI) leads to impairment of both systolic and diastolic function, a significant contributor to heart failure (HF). Despite extensive research in the field, predicting post-MI LVR and HF is still a challenge. Several circulant microRNAs have been proposed as LVR predictors; however, their clinical value is controversial. Here, we used real-time quantitative PCR to quantify the plasma levels of hsa-miR-101, hsa-miR-150, and hsa-miR-21 on the first day of hospital admission of MI patients with ST-elevation (STEMI). We analyzed their correlation to the patient's clinical and paraclinical variables and evaluated their ability to discriminate between post-MI LVR and non-LVR. We show that, despite being excellent MI discriminators, none of these microRNAs can distinguish between LVR and non-LVR patients. Furthermore, we found that diabetes mellitus (DM), Hb level, and the number of erythrocytes significantly influence all three plasma microRNA levels. This suggests that plasma microRNAs' diagnostic and prognostic value in STEMI patients should be reevaluated and interpreted in the context of associated pathologies.

Plasma hsa-miR-22-3p Might Serve as an Early Predictor of Ventricular Function Recovery after ST-Elevation Acute Myocardial Infarction

Left ventricle remodeling (LVR) after acute myocardial infarction (aMI) leads to impairment of both systolic and diastolic function, a major contributor to heart failure (HF). Despite extensive research, predicting post-aMI LVR and HF is still a challenge. Several circulant microRNAs have been proposed as LVR predictors; however, their clinical value is controversial. Here, we used real-time quantitative polymerase chain reaction (qRT-PCR) to quantify hsa-miR-22-3p (miR-22) plasma levels on the first day of hospital admission of ST-elevation aMI (STEMI) patients. We analyzed miR-22 correlation to the patients' clinical and paraclinical variables and evaluated its ability to discriminate between post-aMI LVR and non-LVR. We show that miR-22 is an excellent aMI discriminator and can distinguish between LVR and non-LVR patients. The discriminative performance of miR-22 significantly improves the predictive power of a multiple logistic regression model based on four continuous variables (baseline ejection fraction and end-diastolic volume, CK-MB, and troponin). Furthermore, we found that diabetes mellitus, hematocrit level, and the number of erythrocytes significantly influence its levels. These data suggest that miR-22 might be used as a predictor of ventricular function recovery in STEMI patients.

Chronic Neuroinflammation and Cognitive Decline in Patients with Cardiac Disease: Evidence, Relevance, and Therapeutic Implications

Acute and chronic cardiac disorders predispose to alterations in cognitive performance, ranging from mild cognitive impairment to overt dementia. Although this association is well-established, the factors inducing and accelerating cognitive decline beyond ageing and the intricate causal pathways and multilateral interdependencies involved remain poorly understood. Dysregulated and persistent inflammatory processes have been implicated as potentially causal mediators of the adverse consequences on brain function in patients with cardiac disease. Recent advances in positron emission tomography disclosed an enhanced level of neuroinflammation of cortical and subcortical brain regions as an important correlate of altered cognition in these patients. In preclinical and clinical investigations, the thereby involved domains and cell types of the brain are gradually better characterized. Microglia, resident myeloid cells of the central nervous system, appear to be of particular importance, as they are extremely sensitive to even subtle pathological alterations affecting their complex interplay with neighboring astrocytes, oligodendrocytes, infiltrating myeloid cells, and lymphocytes. Here, we review the current evidence linking cognitive impairment and chronic neuroinflammation in patients with various selected cardiac disorders including the aspect of chronic neuroinflammation as a potentially druggable target.