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Sun Y, Zhang B, Zhang X, Zhang X, Bao W, Bai H, Luan B. Impact of coronary collateralization on major adverse cardiovascular and cerebrovascular events after successful recanalization of chronic total occlusion. Front Cardiovasc Med 2024; 11:1374398. [PMID: 38984350 PMCID: PMC11231425 DOI: 10.3389/fcvm.2024.1374398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
Aims This study aims to investigate the effects of coronary collateral circulation (CCC) on the prognosis of chronic total occlusion (CTO) patients with or without metabolic syndrome (MetS). Methods The study included 342 CTO patients who underwent successful percutaneous coronary intervention at the People's Hospital of Liaoning Province between 1 February 2021 and 30 September 2023. The Rentrop score was used to assess the status of CCC. The outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and non-fatal stroke. Univariate and multivariate logistic analyses were used to investigate the association of CCC, MetS, and MACCEs with odds ratios (ORs) and 95% confidence intervals (CIs). The effect of CCC was further investigated in different MetS, diabetes mellitus (DM), and Syntax score groups. Results MACCEs were more common in patients with poor CCC compared to those with good CCC (38.74% vs. 16.56%). Statistical differences were found in MACCEs (OR = 3.33, 95% CI: 1.93-5.72), MI (OR = 3.11, 95% CI: 1.73-5.58), TVR (OR = 3.06, 95% CI: 1.70-5.53), and stent thrombosis (OR = 6.14, 95% CI: 2.76-13.65) between the good and poor CCC groups. Poor CCC patients with MetS had a higher incidence of MACCEs (OR = 4.21, 95% CI: 2.05-8.65), non-fatal MI (OR = 4.44, 95% CI: 2.01-9.83), TVR (OR = 3.28, 95% CI: 1.51-7.11), and stent thrombosis (OR = 10.80, 95% CI: 3.11-37.54). Similar findings were also observed in CTO patients with DM and a Syntax score ≥23. Conclusion Poor CCC could increase the risk of MACCEs in CTO patients, particularly those with MetS, DM, and a Syntax score ≥23. Further prospective, multicenter studies are needed to validate our findings and to explore potential therapeutic interventions.
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Affiliation(s)
- Yurong Sun
- Internal Medicine, Dalian Medical University, Dalian, China
- Department of Cardiology, People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bin Zhang
- Department of Cardiology, People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xinyuan Zhang
- Clinical Medicine, China Medical University, Shenyang, Liaoning, China
| | - Xiaojiao Zhang
- Department of Cardiology, People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenqi Bao
- Department of Cardiology, People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hangrui Bai
- Department of Cardiology, People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bo Luan
- Department of Cardiology, People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China
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Vural MG, Temel HY, Turunc E, Akdemir R, Tatli E, Agac MT. Transcoronary Gradients of Mechanosensitive MicroRNAs as Predictors of Collateral Development in Chronic Total Occlusion. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:590. [PMID: 38674237 PMCID: PMC11052456 DOI: 10.3390/medicina60040590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: In this present study, we investigated the impact of mechanosensitive microRNAs (mechano-miRs) on the collateral development in 126 chronic total occlusion (CTO) patients, selected from 810 undergoing angiography. Materials and Methods: We quantified the collateral blood supply using the collateral flow index (CFI) and assessed the transcoronary mechano-miR gradients. Results: The patients with favorable collaterals had higher CFI values (0.45 ± 0.02) than those with poor collaterals (0.38 ± 0.03, p < 0.001). Significant differences in transcoronary gradients were found for miR-10a, miR-19a, miR-21, miR-23b, miR-26a, miR-92a, miR-126, miR-130a, miR-663, and let7d (p < 0.05). miR-26a and miR-21 showed strong positive correlations with the CFI (r = 0.715 and r = 0.663, respectively), while let7d and miR-663 were negatively correlated (r = -0.684 and r = -0.604, respectively). The correlations between cytokine gradients and mechano-miR gradients were also significant, including Transforming Growth Factor Beta with miR-126 (r = 0.673, p < 0.001) and Vascular Endothelial Growth Factor with miR-10a (r = 0.602, p = 0.002). A regression analysis highlighted the hemoglobin level, smoking, beta-blocker use, miR-26a, and miR-663 as significant CFI determinants, indicating their roles in modulating the collateral vessel development. Conclusions: These findings suggest mechanosensitive microRNAs as predictive biomarkers for collateral circulation, offering new therapeutic perspectives for CTO patients.
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Affiliation(s)
- Mustafa Gökhan Vural
- Department of Cardiology, University of Health Sciences, Ankara Training and Research Hospital, Ankara 06230, Turkey
| | - Hulya Yilmaz Temel
- Department of Bioengineering, Faculty of Engineering, Ege University, Bornova 35040, Turkey;
| | - Ezgi Turunc
- Department of Biochemistry, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir 35620, Turkey;
| | - Ramazan Akdemir
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey; (R.A.); (M.T.A.)
| | - Ersan Tatli
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey; (R.A.); (M.T.A.)
| | - Mustafa Tarik Agac
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey; (R.A.); (M.T.A.)
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Omi M, Yamada H, Takahashi H, Mori H, Oba S, Hattori Y, Yokota K, Toyama K, Takahashi K. Differences in collateral vessel formation after experimental retinal vein occlusion in spontaneously hypertensive rats and wild-type rats. Heliyon 2024; 10:e27160. [PMID: 38509953 PMCID: PMC10950832 DOI: 10.1016/j.heliyon.2024.e27160] [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: 11/08/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Objective Retinal vein occlusion (RVO) can lead to visual impairment, but the development of collateral vessels can sometimes mitigate significant damage. This study aimed to investigate the relationship between collateral vessels and hypertension, the most common underlying condition associated with RVO, by comparing spontaneously hypertensive rats (SHRs) and wild-type Wister rats (WWRs). We also examined the differences between WWRs and SHRs in terms of sphingosine 1-phosphate receptor 1 (S1PR1) expression and its product nitric oxide synthase 3 (NOS3) expression, which are involved in the formation of collateral vessels after vascular occlusion. Methods Laser photocoagulation (PC) was used to occlude one randomly selected retinal vein in WWRs and SHRs, and the area surrounding the occluded vessel was examined using optical coherence tomography angiography. If reperfusion of the occluded vessel occurred within 2 weeks, the vessel was re-occluded repeatedly by PC. The number of eyes with successfully occluded vessels accompanied by collateral vessels was recorded. Then, WWRs and SHRs were divided into the following four groups: 1) control (no treatment), 2) vehicle (20% DMSO), 3) S1PR1 agonist (2 mg/mL SEW2871), and 4) S1PR1 antagonist (0.25 mg/mL VPC 23019) groups. The drugs were administered intravitreally in all groups except the control. The number of laser shots required for successful RVO was recorded. Histological evaluation and quantitative real-time PCR of S1PR1 and NOS3 were performed to elucidate the mechanisms underlying collateral vessel formation. Results The proportion of eyes achieving successful vein occlusion was lower in SHRs (4/12 eyes, 33.3%) than in WWRs (8/10 eyes, 80%, p = 0.043). NOS3 expression at 6 h after PC was significantly higher in WWRs than in SHRs (p = 0.021). In WWRs treated with SEW2871, vein occlusion failed in 7 of 10 eyes (70%). The expression of NOS3 was significantly higher in the SEW2871 treatment group than in the untreated group (p < 0.001). Furthermore, NOS3 expression was significantly higher after SEW2871 treatment in WWRs than in SHRs (p = 0.011). Conclusion In hypertensive environments, collateral vessels are less likely to develop, and S1PR1 may be involved in this phenomenon.
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Affiliation(s)
- Masatoshi Omi
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Haruhiko Yamada
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Hajime Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Hidetsugu Mori
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Shimpei Oba
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Yuki Hattori
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Kaito Yokota
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Keiko Toyama
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata, Japan
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Yin R, Ye Z, You H, Wu Y, Chen W, Jiang T. Elevated uric acid/albumin ratio as a predictor of poor coronary collateral circulation development in patients with non-ST segment elevation myocardial infarction. Clin Cardiol 2024; 47:e24215. [PMID: 38269629 PMCID: PMC10790324 DOI: 10.1002/clc.24215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Uric acid/albumin ratio (UAR) is a novel composite biomarker with superior predictive value for cardiovascular disease. OBJECTIVE To investigate the relationship between UAR and coronary collateral circulation (CCC) in patients with non-ST segment elevation myocardial infarction (NSTEMI). METHODS A total of 205 NSTEMI patients who underwent coronary arteriography with at least one major coronary stenosis, 95% were included. Patients were divided into two groups according to CCC development: poorly-developed CCC group (Rentrop 0-1) and well-developed CCC (Rentrop 2-3). Univariate analysis and logistic regression analysis were utilized to investigate the factors influencing adverse CCC formation in NSTEMI patients. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of UAR, C-reactive protein (CRP), uric acid, and albumin for patients with poorly developed CCC, and the area under the curve (AUC) was compared. RESULTS The UAR values of NSTEMI patients were significantly higher in the poorly developed CCC group than those in the well-developed CCC group (10.19 [8.80-11.74] vs. 7.79 [6.28-9.55], p < .001). In the multiple logistic regression tests, UAR (odds ratio [OR]: 1.365, 95% confidence interval [CI]: 1.195-1.560, p < .001), CRP (OR: 1.149, 95% CI: 1.072-1.231, p < .001), and diabetes (OR: 2.924, 95% CI: 1.444-5.920, p = .003) were independent predictors of poorly developed CCC. The ROC curve analysis showed that the optimal cut-off value of UAR was 8.78 in predicting poorly developed CCC with a sensitivity of 76.8% and specificity of 62.4%, with the AUC of 0.737 (95% Cl: 0.668-0.805, p < .001). CONCLUSION Elevated UAR may be an independent and effective biomarker for predicting poorly-developed CCC development in NSTEMI patients.
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Affiliation(s)
- Renlin Yin
- Department of CardiologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Department of CardiologySuzhou Ninth Hospital Affiliate to Soochow UniversitySuzhouChina
| | - Zongwei Ye
- Department of CardiologySuzhou Ninth Hospital Affiliate to Soochow UniversitySuzhouChina
| | - Hua You
- Department of CardiologySuzhou Ninth Hospital Affiliate to Soochow UniversitySuzhouChina
| | - Yanming Wu
- Department of CardiologySuzhou Ninth Hospital Affiliate to Soochow UniversitySuzhouChina
| | - Weixiang Chen
- Department of CardiologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Tingbo Jiang
- Department of CardiologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Doğan Y, Yilmaz Y, Kelesoğlu S, Calapkorur B, Neşelioglu S, Erel Ö, Kalay N. Are Thiols Useful Biomarkers for Coronary Collateral Circulation in Patients with Stable Coronary Artery Disease? J Clin Med 2023; 12:6361. [PMID: 37835005 PMCID: PMC10573799 DOI: 10.3390/jcm12196361] [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: 08/23/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Our aim was to investigate the relationship between thiol, which is the main component of the antioxidant system, and coronary collateral circulation (CCC). Our patients consisted of people with stable coronary artery disease (sCAD) and total occlusion in at least one vessel (n = 249). We divided the patients into two groups, good and poor, according to their CCC degree. We determined that DM, total thiol, and disulfide are independent predictors of poor CCC in multivariate logistic regression analysis (OR: 1.012, 95% CI: 1.008-1.017, p < 0.001; OR: 1.022, 95% CI: 1.000-1.044, p = 0.044; OR: 2.671, 95% CI: 1.238-5.761, p = 0.012, respectively). The ROC analysis showed a cut-off value of 328.7 for native thiol regarding the prediction of poor CCC, with 67.4% specificity and 78% sensitivity. For disulfide, it revealed a cut-off value of 15.1 regarding the prediction of poor CCC, with 57.9% specificity and 69.5% sensitivity. In this study, we detected that the patients with sCAD who developed poor CCC had lower levels of native thiol, total thiol, and disulfide compared to those with good CCC. The most interesting finding of our study is that CCC formation is an effective predictor of the antioxidant cascade rather than the inflammation cascade in sCAD patients.
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Affiliation(s)
- Yasemin Doğan
- Department of Cardiology, Kayseri City Training and Research Hospital, University of Health Sciences, Kayseri 38080, Turkey; (Y.Y.); (B.C.)
| | - Yücel Yilmaz
- Department of Cardiology, Kayseri City Training and Research Hospital, University of Health Sciences, Kayseri 38080, Turkey; (Y.Y.); (B.C.)
| | - Saban Kelesoğlu
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey; (S.K.); (N.K.)
| | - Bekir Calapkorur
- Department of Cardiology, Kayseri City Training and Research Hospital, University of Health Sciences, Kayseri 38080, Turkey; (Y.Y.); (B.C.)
| | - Salim Neşelioglu
- Department of Biochemistry, Yildirim Beyazit University, Ankara 06800, Turkey; (S.N.); (Ö.E.)
| | - Özcan Erel
- Department of Biochemistry, Yildirim Beyazit University, Ankara 06800, Turkey; (S.N.); (Ö.E.)
| | - Nihat Kalay
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey; (S.K.); (N.K.)
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Guo Q, Zhao Z, Yang F, Zhang Z, Rao X, Cui J, Shi Q, Liu K, Zhao K, Tang H, Peng L, Ma C, Pu J, Li M. Chronic remote ischemic conditioning treatment in patients with chronic stable angina (EARLY-MYO-CSA): a randomized, controlled proof-of-concept trial. BMC Med 2023; 21:324. [PMID: 37626410 PMCID: PMC10463998 DOI: 10.1186/s12916-023-03041-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chronic remote ischemic conditioning (CRIC) has been shown to improve myocardial ischemia in experimental animal studies; however, its effectiveness in patients with chronic stable angina (CSA) has not been investigated. We conducted a proof-of-concept study to investigate the efficacy and safety of a six-month CRIC treatment in patients with CSA. METHODS The EARLY-MYO-CSA trial was a prospective, randomized, controlled trial evaluating the CRIC treatment in patients with CSA with persistent angina pectoris despite receiving ≥ 3-month guideline-recommended optimal medical therapy. The CRIC and control groups received CRIC (at 200 mmHg) or sham CRIC (at 60 mmHg) intervention for 6 months, respectively. The primary endpoint was the 6-month change of myocardial flow reserve (MFR) on single-photon emission computed tomography. The secondary endpoints were changes in rest and stress myocardial blood flow (MBF), angina severity according to the Canadian Cardiovascular Society (CCS) classification, the Seattle Angina Questionnaire (SAQ), and a 6-min walk test (6-MWT). RESULTS Among 220 randomized CSA patients, 208 (105 in the CRIC group, and 103 in the control group) completed the treatment and endpoint assessments. The mean change in MFR was significantly greater in the CRIC group than in the control group (0.27 ± 0.38 vs. - 0.04 ± 0.25; P < 0.001). MFR increased from 1.33 ± 0.48 at baseline to 1.61 ± 0.53 (P < 0.001) in the CRIC group; however, a similar increase was not seen in the control group (1.35 ± 0.45 at baseline and 1.31 ± 0.44 at follow-up, P = 0.757). CRIC treatment, when compared with controls, demonstrated improvements in angina symptoms assessed by CCS classification (60.0% vs. 14.6%, P < 0.001), all SAQ dimensions scores (P < 0.001), and 6-MWT distances (440 [400-523] vs. 420 [330-475] m, P = 0.016). The incidence of major adverse cardiovascular events was similar between the groups. CONCLUSIONS CSA patients benefit from 6-month CRIC treatment with improvements in MFR, angina symptoms, and exercise performance. This treatment is well-tolerated and can be recommended for symptom relief in this clinical population. TRIAL REGISTRATION [chictr.org.cn], identifier [ChiCTR2000038649].
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Affiliation(s)
- Quan Guo
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Zhenzhou Zhao
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Fan Yang
- Department of Cardiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Zhiwen Zhang
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Xiaoyu Rao
- Medicine Department of Xizang, Minzu University, Xianyang, Shanxi, China
| | - Jing Cui
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Qingbo Shi
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Kaiyuan Liu
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Kang Zhao
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Haiyu Tang
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Liang Peng
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Cao Ma
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China
| | - Jun Pu
- Department of Cardiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Muwei Li
- Department of Cardiology, Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Zhengzhou, Henan Province, China.
- Medicine Department of Xizang, Minzu University, Xianyang, Shanxi, China.
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Sivri F, Öztürk Ceyhan B. Increased Plasma Non-High-Density Lipoprotein Levels and Poor Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease. Tex Heart Inst J 2023; 50:493360. [PMID: 37270295 DOI: 10.14503/thij-22-7934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study investigated the relationship between coronary collateral circulation (CCC) and non-high-density lipoprotein cholesterol (non-HDL-C) in patients with stable coronary artery disease (CAD). Coronary collateral circulation plays a critical role in supporting blood flow, particularly in the ischemic myocardium. Previous studies show that non-HDL-C plays a more important role in the formation and progression of atherosclerosis than do standard lipid parameters. METHODS A total of 226 patients with stable CAD and stenosis of more than 95% in at least 1 epicardial coronary artery were included in the study. Rentrop classification was used to assign patients into group 1 (n = 85; poor collateral) or 2 (n = 141; good collateral). To adjust for the observed imbalance in baseline covariates between study groups, propensity-score matching was used. Covariates were diabetes, Gensini score, and angiotensin-converting enzyme inhibitor use. RESULTS In the propensity-matched population, the plasma non-HDL-C level (mean [SD], 177.86 [44.0] mg/dL vs 155.6 [46.21] mg/dL; P = .001) was statistically higher in the poor-collateral group. LDL-C (odds ratio [OR], 1.23; 95% CI, 1.11-1.30; P = .01), non-HDL-C (OR, 1.34; 95% CI, 1.20-1.51; P = .01), C-reactive protein (OR, 1.21; 95% CI, 1.11-1.32; P = .03), systemic immune-inflammation index (OR, 1.14; 95% CI, 1.05-1.21; P = .01), and C-reactive protein to albumin ratio (OR, 1.11; 95% CI, 1.06-1.17; P = .01) remained independent predictors of CCC in multivariate logistic regression analysis. CONCLUSION Non-HDL-C was an independent risk factor for developing poor CCC in stable CAD.
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Affiliation(s)
- Fatih Sivri
- Department of Cardiology, Nazilli State Hospital, Aydin, Turkey
| | - Banu Öztürk Ceyhan
- Department of Endocrinology and Metabolism, Medinova Hospital, Aydin, Turkey
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Chen S, Li L, Wu Z, Liu Y, Li F, Huang K, Wang Y, Chen Q, Wang X, Shen W, Zhang R, Shen Y, Lu L, Ding F, Dai Y. SerpinG1: A Novel Biomarker Associated With Poor Coronary Collateral in Patients With Stable Coronary Disease and Chronic Total Occlusion. J Am Heart Assoc 2022; 11:e027614. [PMID: 36515245 PMCID: PMC9798810 DOI: 10.1161/jaha.122.027614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background This study aimed to explore predictive biomarkers of coronary collateralization in patients with chronic total occlusion. Methods and Results By using a microarray expression profiling program downloaded from the Gene Expression Omnibus database, weighted gene coexpression network analysis was constructed to analyze the relationship between potential modules and coronary collateralization and screen out the hub genes. Then, the hub gene was identified and validated in an independent cohort of patients (including 299 patients with good arteriogenic responders and 223 patients with poor arteriogenic responders). Weighted gene coexpression network analysis showed that SERPING1 in the light-cyan module was the only gene that was highly correlated with both the gene module and the clinical traits. Serum levels of serpinG1 were significantly higher in patients with bad arteriogenic responders than in patients with good arteriogenic responders (472.53±197.16 versus 314.80±208.92 μg/mL; P<0.001) and were negatively associated with the Rentrop score (Spearman r=-0.50; P<0.001). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.77 (95% CI, 0.72-0.81; P<0.001) for serum serpinG1 in prediction of bad arteriogenic responders. After adjusting for traditional cardiovascular risk factors, serum serpinG1 levels (per SD) remained an independent risk factor for bad arteriogenic responders (odds ratio, 2.20 [95% CI, 1.76-2.74]; P<0.001). Conclusions Our findings illustrate that SERPING1 screened by weighted gene coexpression network analysis was associated with poor collateralization in patients with chronic total occlusion.
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Affiliation(s)
- Shuai Chen
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Le‐Ying Li
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Zhi‐Ming Wu
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong Liu
- Department of Nursing, Chongqing Medical and Pharmaceutical CollegeChongqingChina
| | - Fei‐Fei Li
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Ke Huang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yi‐Xuan Wang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Qiu‐Jing Chen
- Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiao‐Qun Wang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Wei‐Feng Shen
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Rui‐Yan Zhang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Shanghai Clinical Research Center for Interventional MedicineShanghaiChina
| | - Ying Shen
- Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Lin Lu
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Feng‐Hua Ding
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Shanghai Clinical Research Center for Interventional MedicineShanghaiChina
| | - Yang Dai
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
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9
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Ahn J, Heo S, Ahn SJ, Bang D, Lee SH. Differentially hypomethylated cell-free DNA and coronary collateral circulation. Clin Epigenetics 2022; 14:140. [PMID: 36320085 PMCID: PMC9628091 DOI: 10.1186/s13148-022-01349-w] [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: 06/08/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The factors affecting cardioprotective collateral circulation are still incompletely understood. Recently, characteristics, such as CpG methylation of cell-free DNA (cfDNA), have been reported as markers with clinical utility. The aim of this study was to evaluate whether cfDNA methylation patterns are associated with the grade of coronary collateral circulation (CCC). RESULT In this case-control study, clinical and angiographic data were obtained from 143 patients (mean age, 58 years, male 71%) with chronic total coronary occlusion. Enzymatic methyl-sequencing (EM-seq) libraries were prepared using the cfDNA extracted from the plasma. Data were processed to obtain the average methylation fraction (AMF) tables of genomic regions from which blacklisted regions were removed. Unsupervised analysis of the obtained AMF values showed that some of the changes in methylation were due to CCC. Through random forest preparation process, 256 differentially methylated region (DMR) candidates showing strong association with CCC were selected. A random forest classifier was then constructed, and the area under the curve of the receiver operating characteristic curve indicated an appropriate predictive function for CCC. Finally, 20 DMRs were identified to have significantly different AMF values between the good and poor CCC groups. Particularly, the good CCC group exhibited hypomethylated DMRs. Pathway analysis revealed five pathways, including TGF-beta signaling, to be associated with good CCC. CONCLUSION These data have demonstrated that differential hypomethylation was identified in dozens of cfDNA regions in patients with good CCC. Our results support the clinical utility of noninvasively obtained epigenetic signatures for predicting collateral circulation in patients with vascular diseases.
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Affiliation(s)
- Jongseong Ahn
- Department of Chemistry, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | | | - Soo-Jin Ahn
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Duhee Bang
- Department of Chemistry, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Sang-Hak Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.,Pohang University of Science and Technology (POSTECH), Pohang, Korea
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10
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Gowdak LHW. Outro Ator no Aumento da Circulação Colateral no Coração – Outro Potencial Alvo Terapêutico na Medicina Cardiovascular? Arq Bras Cardiol 2022; 119:411-412. [PMID: 36074374 PMCID: PMC9438534 DOI: 10.36660/abc.20220558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Adali MK, Buber I, Sen G, Yilmaz S. Relação entre o Índice Imune-inflamação Sistêmico e Circulação Colateral Coronariana em Pacientes com Oclusão Total Crônica. Arq Bras Cardiol 2022; 119:69-75. [PMID: 35703663 PMCID: PMC9352117 DOI: 10.36660/abc.20210414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
Fundamento Objetivos Métodos Resultados Conclusões
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12
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Gao A, Liu J, Liu Y, Hu C, Zhu Y, Zhou Y, Han H, Zhao Y. Increased estimated remnant-like particle cholesterol is associated with impaired coronary collateralization in patients with coronary chronic total occlusions. Diabetol Metab Syndr 2022; 14:57. [PMID: 35449027 PMCID: PMC9022345 DOI: 10.1186/s13098-022-00829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS This study intends to explore whether, or to what extent, the estimated remnant-like particle cholesterol was associated with coronary collateralization in patients with chronic total occlusion lesions. METHODS 792 patients with at least one coronary chronic total occlusion lesion were enrolled. Serum level of lipid profiles were determined and the estimated remnant-like particle cholesterol was calculated. The development of coronary collateralization was graded as low (Rentrop score 0-1) or high (Rentrop score 2-3) collateralization according to the Rentrop classification system and then the association between the estimated remnant-like particle cholesterol and collateralization was assessed. RESULTS 222 participants were classified into low collateralization group. The estimated remnant-like particle cholesterol level was significantly higher in low collateralization (P < 0.001) and type 2 diabetes mellitus (P = 0.009) group. To further explore the association between the estimated remnant-like particle cholesterol and the development of coronary collateralization, these patients were divided into 3 groups based on the estimated remnant-like particle cholesterol tertiles. The prevalence of low collateralization increased stepwise with the tertile groups (T1 12.5% vs. 27.1% vs. 45.3%, P < 0.001). Multivariate logistic regression analysis showed that the estimated remnant-like particle cholesterol was independently associated with the under-developed collateralization, with an OR and 95%CI of 2.34 (1.46-3.74) and 4.91 (3.01-8.02) in the T2 and T3 group, respectively. The following receiver-operating characteristic analysis indicated that the diagnostic value of estimated remnant-like particle cholesterol for the low collateralization was 0.696, with a cut-off value of 0.485, and its sensitivity was 82.88%. Besides, the addition of the estimated remnant-like particle cholesterol into the baseline model consisting of traditional risk factors could improve the incremental value of the discrimination of impaired collateralization only in overall and type 2 diabetes mellitus populations. CONCLUSIONS The increased estimated remnant-like particle cholesterol is independently associated with impaired collateralization in patients with coronary chronic total occlusion lesions. Therapies targeting at remnant-like particle cholesterol may be needed in advanced coronary artery disease patients with type 2 diabetes mellitus not suitable for vascular revascularization.
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Affiliation(s)
- Ang Gao
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jinxing Liu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Liu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Chengping Hu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yong Zhu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Hongya Han
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Yingxin Zhao
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China.
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13
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Spadaccio C, Nenna A, Rose D, Piccirillo F, Nusca A, Grigioni F, Chello M, Vlahakes GJ. The Role of Angiogenesis and Arteriogenesisin Myocardial Infarction and Coronary Revascularization. J Cardiovasc Transl Res 2022; 15:1024-1048. [PMID: 35357670 DOI: 10.1007/s12265-022-10241-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/18/2022] [Indexed: 12/25/2022]
Abstract
Surgical myocardial revascularization is associated with long-term survival benefit in patients with multivessel coronary artery disease. However, the exact biological mechanisms underlying the clinical benefits of myocardial revascularization have not been elucidated yet. Angiogenesis and arteriogenesis biologically leading to vascular collateralization are considered one of the endogenous mechanisms to preserve myocardial viability during ischemia, and the presence of coronary collateralization has been regarded as one of the predictors of long-term survival in patients with coronary artery disease (CAD). Some experimental studies and indirect clinical evidence on chronic CAD confirmed an angiogenetic response induced by myocardial revascularization and suggested that revascularization procedures could constitute an angiogenetic trigger per se. In this review, the clinical and basic science evidence regarding arteriogenesis and angiogenesis in both CAD and coronary revascularization is analyzed with the aim to better elucidate their significance in the clinical arena and potential therapeutic use.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiac Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, USA. .,Cardiac Surgery, Golden Jubilee National Hospital & University of Glasgow, Glasgow, UK.
| | - Antonio Nenna
- Cardiac Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - David Rose
- Cardiac Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | | | | | | | - Massimo Chello
- Cardiac Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gus J Vlahakes
- Cardiac Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, USA
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14
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Serum CTRP9 Reflects Coronary Collateralization in Nondiabetic Patients with Obstructive Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8537686. [PMID: 35309173 PMCID: PMC8930261 DOI: 10.1155/2022/8537686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
Aim. To explore the association between the serum C1q/tumor necrosis factor-related protein 9 (CTRP9) and the formation of coronary collateral circulation in obstructive coronary artery disease (CAD). Methods. A total of 206 patients who underwent coronary angiography at Beijing Anzhen Hospital and had epicardial arteries with at least 95% stenotic lesion were enrolled. Blood samples were taken after an overnight fasting before the coronary angiography. Serum CTRP9 level was measured using commercial enzyme linked immunosorbent assay (ELISA) kit. The development of coronary collateralization was determined according to the Rentrop classification system. Rentrop score 0-1 was graded as impaired or less-developed coronary collateralization (
) while the Rentrop score 2-3 was defined as well-developed collateralization (
). Results. Serum CTRP9 level was significantly higher in well-developed collateralization and diabetes groups (
). To further explore the association between the CTRP9 level and coronary collateralization, the enrolled participants were divided into 3 tertiles according to the serum CTRP9 level. The prevalence of impaired coronary collateralization decreased stepwise with the increasing CTRP9 tertiles (
for trend <0.001). Multivariate regression analysis showed that the serum CTRP9 is independently associated with well-developed collateralization, with an OR (95% CI) of 4.49 (1.75-11.55) and 8.98 (2.75-29.35) in the tertiles 2 and 3, respectively. The following subgroup and receiver-operating characteristic (ROC) analysis also indicated that the diagnostic value of serum CTRP9 level for detecting the formation of collateralization persisted only in nondiabetic participants. Lastly, adding the serum CTRP9 into the baseline model could increase the diagnostic value of established model consisting of relevant factor for the discrimination of well-developed collateralization only in the nondiabetic group (
). Conclusions. Serum CTRP9 reflects well-developed coronary collateralization in nondiabetic patients with obstructive CAD, and
indicated a greater chance to forming well-developed coronary collaterals.
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15
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Shao MJ, Luo JY, Shi J, Liu F, Shan CF, Luo F, Yu XL, Zhao Q, Tian T, Li XM, Yang YN. Association of Visceral Obesity-Related Indices With Coronary Collateralization in Patients With Chronic Total Occlusion. Front Cardiovasc Med 2021; 8:742855. [PMID: 34746259 PMCID: PMC8566720 DOI: 10.3389/fcvm.2021.742855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Obesity is an independent risk factor for cardiovascular disease. We investigated whether and to what extent visceral obesity-related indices were associated with coronary collateralization (CC) in chronic total occlusion (CTO) patients. Methods: This retrospective cohort study involved 1,008 consecutive patients with CTO who underwent CTO-percutaneous coronary artery intervention (PCI). CC was graded according to the Rentrop scoring system. Data on demographic and clinical characteristics were collected by cardiovascular doctors. Logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier analyses were performed to assess the predictive value of visceral obesity-related indices for CC. Results: Overall, 1,008 inpatients were assigned to the poor CC group (n = 592) and good CC group (n = 416). In multivariate-adjusted logistic regression analyses, all visceral obesity-related indices (P-value < 0.001) were significantly associated with CC. After ROC analysis and the Delong test, the Chinese visceral adiposity index (CVAI) had the largest area under the curve (AUC) of 0.741 (0.711–0.771). Further analysis revealed that CVAI quartile remained a risk factor for poor CC in all groups, CVAI was associated with a 1.018-fold higher risk of poor CC (OR = 1.018, 95% CI: 1.014–1.021, P < 0.001). Individuals in the top CVAI quartile group had the highest risk of poor CC (OR = 10.657, 95% CI: 6.492–17.493, P < 0.001). Subgroup analyses showed similar results, and CVAI quartile remained a risk factor for poor CC. Moreover, increased CVAI predicted poor prognosis in CTO patients. Conclusion: In summary, this study indicated that all the increased visceral obesity-related indices were significantly associated with increased poor CC risk. After adjusting for potential risks, CVAI had the best performance for estimating CC and predicting prognosis in CTO patients.
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Affiliation(s)
- Meng-Jiao Shao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun-Yi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jia Shi
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chun-Fang Shan
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fan Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-Lin Yu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qian Zhao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-Mei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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16
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Impact of coronary artery bypass grafting (CABG) on coronary collaterals in patients with a chronic total occlusion (CTO). Int J Cardiovasc Imaging 2021; 37:3373-3380. [PMID: 34453653 DOI: 10.1007/s10554-021-02327-8] [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: 04/25/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
Chronic total occlusions (CTO) are found commonly in patients with prior coronary artery bypass grafting (CABG). We sought to determine the effect of CABG on collateral robustness in patients with a CTO. Patients with a CTO diagnosed on coronary angiography between July 2010 and December 2019 were included in this study. Patients were classified as either CTO supplied by a functional graft, CTO supplied by collaterals from a non-grafted donor vessel (non-grafted) or a CTO supplied by collaterals from a grafted donor vessel (grafted). The degree of collateral robustness was determined by the Rentrop classification and collateral connection (CC) grade. Demographic, angiographic and clinical outcomes were recorded. A total of 2088 CTO lesions were identified, of which 878 (42.0%) were supplied by a functional graft, 994 (47.6%) CTOs were supplied by a non-grafted donor vessel and 216 (10.3%) CTOs were supplied by a grafted donor vessel. CTOs supplied by a grafted donor vessel had lower rates of robust collaterals (37.0% vs 83.0%, p < 0.0001) with less mature collaterals as determined by the Rentrop grade (p < 0.0001) and CC grade (p < 0.0001) as compared to CTOs supplied by a non-grafted donor vessel. In patients with a previous CABG, a grafted donor vessel results in less robust coronary collaterals with lower Rentrop and CC grade compared to an ungrafted donor vessel. This may be attributable to changes in coronary blood flow and shear stress, and may be a factor in the lower procedural success rates for CTO intervention in patients with prior CABG.
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17
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Influence of Obstructive Sleep Apnoea Severity on Coronary Collateral Recruitment During Coronary Occlusion. Lung 2021; 199:409-416. [PMID: 34374863 DOI: 10.1007/s00408-021-00462-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Obstructive sleep apnoea (OSA) which results in hypoxia may affect the ability to recruit coronary collaterals. The aim of this study was to determine whether the severity of OSA affects collateral recruitment in patients with total coronary occlusions. METHODS Patients with total coronary artery occlusion were reviewed. Records from the sleep investigation laboratory were reviewed to identify those patients who had undergone diagnostic polysomnography. Robust coronary collaterals were those with Rentrop grade 2 or 3 collaterals. RESULTS Sixty-four patients with a total coronary occlusion had polysomnography performed, of whom 60 patients had OSA. Thirty-two patients (53.3%) had poor collaterals, whilst 28 (46.7%) had robust collaterals. Twenty-four (40%) patients had mild OSA, 10 (16.7%) had moderate OSA and 26 (43.3%) had severe OSA. Patients with robust collaterals were more likely to be males (96.4% vs 74.3%, p < 0.05) and have a history of hypercholesterolaemia (88.9% vs 51.6%, p < 0.01). Patients with robust collaterals had a lower apnoea-hypopnoea index (13.6 vs 45.5, p < 0.05), a higher MinSaO2 (85.4% vs 79.8%, p < 0.05), less time SaO2 < 90% (0 min vs 30.4 min, p < 0.05) and lower oxygen desaturation index (6.9 vs 26.8, p < 0.05). Those with moderate OSA had a higher mean Rentrop grade (1.6 ± 0.3) than those with mild OSA (1.5 ± 1.1) and severe OSA (0.6 ± 0.2). CONCLUSION The presence of more severe OSA is associated with poorer coronary collateral recruitment in patients with total coronary artery occlusion. The effect of treatment of OSA on subsequent ability to recruit collaterals and other cardioprotective mechanisms requires further research.
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18
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Zhang X, Zheng Y, Geng C, Guan J, Wang L, Zhang X, Cheng Y, Li J, Lu X. Isometric exercise promotes arteriogenesis in rats after myocardial infarction. J Biomed Res 2021; 35:436-447. [PMID: 34776455 PMCID: PMC8637657 DOI: 10.7555/jbr.35.20210062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Isometric exercise (IE) is a promising intervention of noninvasive revascularization in patients with acute myocardial infarction (AMI). This study aimed to investigate the impact and mechanisms of IE training on arteriogenesis in AMI. Male Sprague-Dawley rats were randomly assigned into the sham-operation group (SO), myocardial infarction (MI) group, and 13 IE subgroups treated according to training intensity, frequency, duration, or monocyte chemoattractant protein-1 (MCP-1), or/and fibroblast growth factor-2 (FGF-2) inhibitors for eight weeks. Our results demonstrated that the IE group achieved superior improvement compared with the MI group in terms of left ventricular ejection fraction (LVEF), myocardial infarction size (MIS), arterial density (AD), monocytes (MNCs), smooth muscle cells (SMCs), endothelial cells (ECs), relative collateral blood flow (RCBF), MCP-1, and FGF-2 at the endpoint. Positive correlations between MCP-1 and MNCs, MNCs and FGF-2, FGF-2 and SMCs, SMCs and AD, as well as AD and RCBF were observed. This study demonstrated that with MI of 100% load 20 times daily for eight weeks, the arteriogenesis was improved, which may be attributed to the recruitment of MNCs and SMCs in remote ischemic myocardium caused by increases in MCP-1 and FGF-2 expression.
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Affiliation(s)
- Xintong Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yu Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Canru Geng
- Department of Rehabilitation Medicine, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, China
| | - Juntao Guan
- Department of Rehabilitation Medicine, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, China
| | - Lu Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yihui Cheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jian'an Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Allahwala UK, Cistulli PA, Ekmejian A, Mughal N, Dissanayake HU, Ward M, Weaver JC, Bhindi R. Relation of Obstructive Sleep Apnea in Patients With a Coronary Chronic Total Occlusion to Coronary Collaterals and Mortality. Am J Cardiol 2021; 148:30-35. [PMID: 33675771 DOI: 10.1016/j.amjcard.2021.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
A chronic total occlusion (CTO) is frequently identified in patients undergoing coronary angiography. The prognostic implications of intermittent hypoxia from obstructive sleep apnea (OSA) on patients with a CTO, and effects on collateral recruitment are unknown. The aim of this study was to determine the prevalence, vascular effects, and prognostic implications of the presence of OSA in patients with a CTO. Patients with a CTO between July 2010 and December 2019 were reviewed. Electronic medical records were accessed to determine documented patient history of OSA, demographics, and clinical course. Patients with robust collateral recruitment were defined as Rentrop grade 2 or 3. A total of 948 patients were included in the study, of which 127 (13.4%) had a documented history of OSA. These patients were younger (67.0 years vs 70.6 years, p < 0.01), had a higher body mass index (29.6 kg/m2 vs 26.7 kg/m2, p < 0.0001), higher rates of hypertension (91.3% vs 83.2%, p < 0.05), higher rates of smokers (63.3% vs 49.0%, p < 0.01) and more use of β-blockers (79% vs 68.5%, p < 0.05) and statins (92.7% vs 82.1%, p < 0.01). A documented history of OSA was independently associated with robust collaterals (OR 3.0 95%CI 1.5 to 5.8, p < 0.01) and lower mortality (HR 0.3 95% CI 0.1 to 0.7, p < 0.01) with a mean survival of 10.8 years, as compared to 8.1 years (log rank p < 0.0001). In conclusion, in patients with a CTO, documented OSA is independently associated with more robust coronary collaterals and lower mortality. The possible cardioprotective implications of intermittent hypoxia in OSA, as well as treatment effect requires further investigation.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia.
| | - Peter A Cistulli
- Centre for Sleep Health and Research, Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
| | - Avedis Ekmejian
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nadeem Mughal
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - James C Weaver
- The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
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20
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Liu T, Wu Z, Liu J, Lv Y, Li W. Metabolic syndrome and its components reduce coronary collateralization in chronic total occlusion: An observational study. Cardiovasc Diabetol 2021; 20:104. [PMID: 33971883 PMCID: PMC8111979 DOI: 10.1186/s12933-021-01297-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
Background Metabolic syndrome (MetS) is an independent risk factor for the incidence of cardiovascular diseases. We investigated whether or to what extent MetS and its components was associated with coronary collateralization (CC) in chronic total occlusion (CTO). Methods This study involved 1653 inpatients with CTO. Data on demographic and clinical characteristics were collected by cardiovascular doctors. The CC condition was defined by the Rentrop scoring system. Subgroup analysis, mixed model regression analysis, scoring systems and receiver operating characteristic (ROC) curve analysis were performed. Results Overall, 1653 inpatients were assigned to the poor CC group (n = 355) and good CC group (n = 1298) with or without MetS. Compared to the good CCs, the incidence of MetS was higher among the poor CCs for all patients. Poor collateralization was present in 7.6%, 14.2%, 19.3%, 18.2%, 35.6% and 51.1% of the six groups who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. For multivariable logistic regression, quartiles of BMI remained the risk factors for CC growth in all subgroups (adjusted OR = 1.755, 95% CI 1.510–2.038, P < 0.001 all patients; adjusted OR = 1.897, 95% CI 1.458–2.467, P < 0.001 non-MetS; and adjusted OR = 1.814, 95% CI 1.482–2.220, P < 0.001 MetS). After adjustment for potential confounding factors, MetS was an independent risk factor for CC growth in several models. Assigning a score of one for each component, the AUCs were 0.629 (95% CI 0.595–0.662) in all patients, 0.656 (95% CI 0.614–0.699) in MetS patients and 0.569 (95% CI 0.517–0.621) in non-MetS patients by receiver operating characteristic analysis. Conclusions MetS, especially body mass index, confers a greater risk of CC formation in CTO. The value of scoring systems should be explored further for CTO.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Zheng Wu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China.
| | - Yun Lv
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Wenzheng Li
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
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21
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Allahwala UK, Kiat H, Ekmejian A, Mughal N, Bassin L, Ward M, Weaver JC, Bhindi R. Both surgical and percutaneous revascularization improve prognosis in patients with a coronary chronic total occlusion (CTO) irrespective of collateral robustness. Heart Vessels 2021; 36:1653-1660. [PMID: 33914092 DOI: 10.1007/s00380-021-01859-2] [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: 01/18/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
The impact of surgical or percutaneous coronary revascularization on prognosis in patients with a chronic total occlusion (CTO) remains uncertain. Particularly, whether revascularization of those with robust coronary collaterals improves prognosis is unknown. The objective of this study was to determine the predictors and prognostic impact of revascularization of a CTO, and to determine the clinical impact of robust coronary collaterals. Patients with a CTO diagnosed on coronary angiography between Jul 2010 and Dec 2019 were included in this study. Management strategy of the CTO was defined as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical management. The degree of collateral robustness was determined by the Rentrop grading classification. Demographic, angiographic and clinical outcomes were recorded. A total of 954 patients were included in the study, of which 186 (19.5%) patients underwent CTO PCI, 296 (31.0%) patients underwent CABG and 472 (49.5%) patients underwent medical management of the CTO. 166 patients (17.4%) had Rentrop grade zero or one collaterals, 577 (60.5%) patients had Rentrop grade two and 211 (22.1%) had Rentrop grade three collaterals. The independent predictors of medical management of the CTO were older age, greater stenosis in the donor vessel, an emergent indication for angiography, a non-LAD CTO and female sex. The degree of collateral robustness was not associated with long-term mortality, while patients who were revascularized either through CABG or PCI had a significantly lower mortality compared to medical management alone (p < 0.0001). In patients with a CTO, the presence of robust collaterals is not associated with prognosis, while both surgical and percutaneous revascularization is associated with improved prognosis. Further research into the optimal revascularization strategy for a CTO is required.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia. .,The University of Sydney, Sydney, Australia.
| | - Hosen Kiat
- Faculty of Medicine and Health Sciences, Macquarie University, Marsfield, Australia.,Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Avedis Ekmejian
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
| | - Nadeem Mughal
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
| | - Levi Bassin
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.,The University of Sydney, Sydney, Australia
| | - James C Weaver
- The University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.,The University of Sydney, Sydney, Australia
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22
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Lahiri R, Chauhan U. Extra-cardiac collateral to an anomalous origin right coronary artery in a post-PTCA, post-CABG patient. Indian J Thorac Cardiovasc Surg 2021; 37:451-453. [PMID: 34220030 DOI: 10.1007/s12055-020-01127-4] [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: 10/21/2020] [Revised: 11/28/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022] Open
Abstract
In the context of collateral circulation of the heart, the role of extra-cardiac collateral arteries has been thought to be negligible. We present a case in which such collateral vessel acted as a rescue, subsequent to a failed revascularisation attempt. With surgeons nowadays considering 'less is more' in terms of grafting in coronary artery bypass grafting (CABG), and more evidence arising in favour of medical therapy, we need to re-assess the role of these collateral vessels in the coronary circulation.
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Affiliation(s)
- Raja Lahiri
- Department of Cardiothoracic & Vascular Surgery, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
| | - Udit Chauhan
- Department of Radiodiagnosis, AIIMS Rishikesh, Rishikesh, Uttarakhand India
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23
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Xing M, Jiang Y, Bi W, Gao L, Zhou YL, Rao SL, Ma LL, Zhang ZW, Yang HT, Chang J. Strontium ions protect hearts against myocardial ischemia/reperfusion injury. SCIENCE ADVANCES 2021; 7:7/3/eabe0726. [PMID: 33523909 PMCID: PMC7810382 DOI: 10.1126/sciadv.abe0726] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/20/2020] [Indexed: 05/06/2023]
Abstract
Timely restoration of blood supply following myocardial infarction is critical to save the infarcted myocardium, while reperfusion would cause additional damage. Strontium ions have been shown to promote angiogenesis, but it is unknown whether they can save the damaged myocardium. We report that myocardial ischemia/reperfusion (I/R)-induced functional deterioration and scar formation were notably attenuated by injection of strontium ion-containing composite hydrogels into murine infarcted myocardium at 20 minutes of reperfusion following 60 minutes of ischemia. These beneficial effects were accompanied by reduced cardiomyocyte apoptosis and increased angiogenesis. The effects of strontium ions were further confirmed by the enhanced viability of cardiomyocytes and stimulated angiogenesis in vitro. These findings are the first to reveal the cardioprotective effects of strontium ions against I/R injury, which may provide a new therapeutic approach to ischemic heart disease at a lower cost, with higher stability, and with potentially greater safety.
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Affiliation(s)
- Min Xing
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences (CAS), Shanghai 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of CAS, Beijing 100049, P. R. China
| | - Yun Jiang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Laboratory of Molecular Cardiology, Shanghai Institute of Nutrition and Health, CAS, Shanghai 200030, P. R. China
- University of CAS, 19 Yuquan Road, Beijing 100049, P. R. China
| | - Wei Bi
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Laboratory of Molecular Cardiology, Shanghai Institute of Nutrition and Health, CAS, Shanghai 200030, P. R. China
- University of CAS, 19 Yuquan Road, Beijing 100049, P. R. China
| | - Long Gao
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences (CAS), Shanghai 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of CAS, Beijing 100049, P. R. China
| | - Yan-Ling Zhou
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences (CAS), Shanghai 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of CAS, Beijing 100049, P. R. China
| | - Sen-Le Rao
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Laboratory of Molecular Cardiology, Shanghai Institute of Nutrition and Health, CAS, Shanghai 200030, P. R. China
- University of CAS, 19 Yuquan Road, Beijing 100049, P. R. China
| | - Ling-Ling Ma
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences (CAS), Shanghai 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of CAS, Beijing 100049, P. R. China
| | - Zhao-Wenbin Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences (CAS), Shanghai 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of CAS, Beijing 100049, P. R. China
| | - Huang-Tian Yang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Laboratory of Molecular Cardiology, Shanghai Institute of Nutrition and Health, CAS, Shanghai 200030, P. R. China.
- University of CAS, 19 Yuquan Road, Beijing 100049, P. R. China
- Institute for Stem Cell and Regeneration, CAS, Beijing 100101, China
| | - Jiang Chang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences (CAS), Shanghai 200050, P. R. China.
- Center of Materials Science and Optoelectronics Engineering, University of CAS, Beijing 100049, P. R. China
- Institute for Stem Cell and Regeneration, CAS, Beijing 100101, China
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