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Wang Z, Bian W, Yan Y, Zhang DM. Functional Regulation of KATP Channels and Mutant Insight Into Clinical Therapeutic Strategies in Cardiovascular Diseases. Front Pharmacol 2022; 13:868401. [PMID: 35837280 PMCID: PMC9274113 DOI: 10.3389/fphar.2022.868401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
ATP-sensitive potassium channels (KATP channels) play pivotal roles in excitable cells and link cellular metabolism with membrane excitability. The action potential converts electricity into dynamics by ion channel-mediated ion exchange to generate systole, involved in every heartbeat. Activation of the KATP channel repolarizes the membrane potential and decreases early afterdepolarization (EAD)-mediated arrhythmias. KATP channels in cardiomyocytes have less function under physiological conditions but they open during severe and prolonged anoxia due to a reduced ATP/ADP ratio, lessening cellular excitability and thus preventing action potential generation and cell contraction. Small active molecules activate and enhance the opening of the KATP channel, which induces the repolarization of the membrane and decreases the occurrence of malignant arrhythmia. Accumulated evidence indicates that mutation of KATP channels deteriorates the regulatory roles in mutation-related diseases. However, patients with mutations in KATP channels still have no efficient treatment. Hence, in this study, we describe the role of KATP channels and subunits in angiocardiopathy, summarize the mutations of the KATP channels and the functional regulation of small active molecules in KATP channels, elucidate the potential mechanisms of mutant KATP channels and provide insight into clinical therapeutic strategies.
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Affiliation(s)
- Zhicheng Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Weikang Bian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yufeng Yan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Dai-Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Dai-Min Zhang,
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Hau M, Fong KM, Au SY. Levosimendan's effect on venoarterial extracorporeal membrane oxygenation weaning. Int J Artif Organs 2022; 45:571-579. [PMID: 35570732 DOI: 10.1177/03913988221098773] [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: 11/15/2022]
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) provides temporary haemodynamic support in refractory cardiogenic shock. Recent retrospective studies on levosimendan on V-A ECMO weaning had conflicting results. This study aimed to determine the association between levosimendan on V-A ECMO weaning success in a tertiary centre in Hong Kong. METHODS This retrospective study was conducted in an intensive care unit in Hong Kong. All adult patients requiring V-A ECMO from January 2016 to September 2020 were included. Patients who were given levosimendan were compared to patients who were not, on rates of successful V-A ECMO weaning. The groups were also compared after propensity matching based on covariates closely associated with the use of levosimendan. RESULTS A total of 119 patients were included in the study, with 38 in the levosimendan group and 81 in the non-levosimendan group. Patients treated with levosimendan trended towards improved weaning success, but the difference was not statistically significant (63% vs 53%, p = 0.404). In the propensity-matched groups, there was no difference in weaning success (odds ratio 1.00, 95% CI 0.23-8.00). The levosimendan group was associated with lower vasopressor requirement, lower lactate levels, and more significant drop in lactate in the first 2 days of V-A ECMO. The levosimendan group had longer ECMO duration. There was no difference in other secondary outcomes including mortality, length of stay in ICU and hospital and duration of mechanical ventilation. There was no difference in the rate of ventricular arrhythmias. CONCLUSION Levosimendan did not improve V-A ECMO weaning success in our cohort with refractory cardiogenic shock.
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Affiliation(s)
- Melanie Hau
- Intensive Care Unit, Queen Elizabeth Hospital, Hong Kong, China
| | - Ka-Man Fong
- Intensive Care Unit, Queen Elizabeth Hospital, Hong Kong, China
| | - Shek-Yin Au
- Intensive Care Unit, Queen Elizabeth Hospital, Hong Kong, China
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Rysz S, Fagerlund MJ, Lundberg J, Ringh M, Hollenberg J, Lindgren M, Jonsson M, Djärv T, Nordberg P. The Use of Levosimendan after Out-of-Hospital Cardiac Arrest and Its Association with Outcome-An Observational Study. J Clin Med 2022; 11:jcm11092621. [PMID: 35566747 PMCID: PMC9103888 DOI: 10.3390/jcm11092621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Levosimendan improves resuscitation rates and cardiac performance in animal cardiac arrest models. The aim of this study was to describe the use of levosimendan in out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. Methods: A retrospective observational study of OHCA patients admitted to six intensive care units in Stockholm, Sweden, between 2010 and 2016. Patients treated with levosimendan within 24 h from admission were compared with those not treated with levosimendan. Propensity score matching and multivariable logistic regression analysis were used to assess the association between levosimendan treatment and 30-day mortality Results: Levosimendan treatment was initiated in 94/940 (10%) patients within 24 h. The proportion of men (81%, vs. 67%, p = 0.007), initial shockable rhythm (66% vs. 37%, p < 0.001), acute myocardial infarction, AMI (47% vs. 24%, p < 0.001) and need for vasoactive support (98% vs. 61%, p < 0.001) were higher among patients treated with levosimendan. After adjustment for age, sex, bystander cardiopulmonary resuscitation, witnessed status, initial rhythm and AMI, the odds ratio (OR) for 30-day mortality in the levosimendan group compared to the no-levosimendan group was 0.94 (95% Confidence interval [CI], 0.56−1.57, p = 0.82). Similar results were seen when using a propensity score analysis comparing patients with circulatory shock. Conclusions: In this observational study of OHCA patients, levosimendan was used in a limited patient group, most often in those with initial shockable rhythms, acute myocardial infarction and with a high need for vasopressors. In this limited patient cohort, levosimendan treatment was not associated with 30-day mortality. However, a better matching of patient factors and indications for use is required to derive conclusions on associations with outcome.
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Affiliation(s)
- Susanne Rysz
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Stockholm, Sweden; (S.R.); (M.J.F.)
- Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Malin Jonsson Fagerlund
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Stockholm, Sweden; (S.R.); (M.J.F.)
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Department of Neuroradiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Mattias Ringh
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, 118 83 Stockholm, Sweden; (M.R.); (J.H.); (M.J.)
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, 118 83 Stockholm, Sweden; (M.R.); (J.H.); (M.J.)
| | - Marcus Lindgren
- Department of Medicine, Piteå Hospital, 941 50 Piteå, Sweden;
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, 118 83 Stockholm, Sweden; (M.R.); (J.H.); (M.J.)
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Function Emergency Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Per Nordberg
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Stockholm, Sweden; (S.R.); (M.J.F.)
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, 118 83 Stockholm, Sweden; (M.R.); (J.H.); (M.J.)
- Correspondence:
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Cosentino N, Campodonico J, Moltrasio M, Lucci C, Milazzo V, Rubino M, De Metrio M, Marana I, Grazi M, Bonomi A, Veglia F, Lauri G, Bartorelli AL, Marenzi G. Mitochondrial Biomarkers in Patients with ST-Elevation Myocardial Infarction and Their Potential Prognostic Implications: A Prospective Observational Study. J Clin Med 2021; 10:jcm10020275. [PMID: 33451159 PMCID: PMC7828727 DOI: 10.3390/jcm10020275] [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] [Received: 12/24/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Mitochondrial biomarkers have been investigated in different critical settings, including ST-elevation myocardial infarction (STEMI). Whether they provide prognostic information in STEMI, complementary to troponins, has not been fully elucidated. We prospectively explored the in-hospital and long-term prognostic implications of cytochrome c and cell-free mitochondrial DNA (mtDNA) in STEMI patients undergoing primary percutaneous coronary intervention. Methods: We measured cytochrome c and mtDNA at admission in 466 patients. Patients were grouped according to mitochondrial biomarkers detection: group 1 (−/−; no biomarker detected; n = 28); group 2 (−/+; only one biomarker detected; n = 283); group 3 (+/+; both biomarkers detected; n = 155). A composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema was the primary endpoint. Four-year all-cause mortality was the secondary endpoint. Results: Progressively lower left ventricular ejection fractions (52 ± 8%, 49 ± 8%, 47 ± 9%; p = 0.006) and higher troponin I peaks (54 ± 44, 73 ± 66, 106 ± 81 ng/mL; p = 0.001) were found across the groups. An increase in primary (4%, 14%, 19%; p = 0.03) and secondary (10%, 15%, 23%; p = 0.02) endpoint rate was observed going from group 1 to group 3. The adjusted odds ratio increment of the primary endpoint from one group to the next was 1.65 (95% CI 1.04–2.61; p = 0.03), while the adjusted hazard ratio increment of the secondary endpoint was 1.55 (95% CI 1.12–2.52; p = 0.03). The addition of study group allocation to admission troponin I reclassified 12% and 22% of patients for the primary and secondary endpoint, respectively. Conclusions: Detection of mitochondrial biomarkers is common in STEMI and seems to be associated with in-hospital and long-term outcome independently of troponin.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
- Correspondence: ; Tel.: +39-0258-0021
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Marco Moltrasio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Claudia Lucci
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Monica De Metrio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Ivana Marana
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Marco Grazi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Fabrizio Veglia
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Gianfranco Lauri
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20122 Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
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