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Al Namat R, Duceac LD, Chelaru L, Dabija MG, Guțu C, Marcu C, Popa MV, Popa F, Bogdan Goroftei ER, Țarcă E. Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis. Diagnostics (Basel) 2023; 14:16. [PMID: 38201325 PMCID: PMC10871095 DOI: 10.3390/diagnostics14010016] [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: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. AIM Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. MATERIALS AND METHODS One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM-CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD-CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. RESULTS One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, p < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (p = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (p = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, p = 0.000) and in patients without T2DM (by 73,294 ng/L, p = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, p = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (p = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01-6.08% (p = 0.000), T2DM-CKD 7.08-6.04% (p = 0.000), PreD+CKD 5.66-4.98% (p = 0.014), and PreD-CKD 6.03-4.94% (p = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15-87.07%, p = 0.000) in the presence of established diabetes and 14.89 (64.75-79.64%, p = 0.000) in the prediabetes group. CONCLUSIONS Regarding the patients' cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation.
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Affiliation(s)
- Razan Al Namat
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (R.A.N.); (L.C.); (E.R.B.G.)
| | - Letiția Doina Duceac
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania; (C.G.); (C.M.); (M.V.P.); (F.P.)
| | - Liliana Chelaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (R.A.N.); (L.C.); (E.R.B.G.)
| | - Marius Gabriel Dabija
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (R.A.N.); (L.C.); (E.R.B.G.)
| | - Cristian Guțu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania; (C.G.); (C.M.); (M.V.P.); (F.P.)
| | - Constantin Marcu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania; (C.G.); (C.M.); (M.V.P.); (F.P.)
| | - Maria Valentina Popa
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania; (C.G.); (C.M.); (M.V.P.); (F.P.)
| | - Florina Popa
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania; (C.G.); (C.M.); (M.V.P.); (F.P.)
| | - Elena Roxana Bogdan Goroftei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (R.A.N.); (L.C.); (E.R.B.G.)
| | - Elena Țarcă
- Department of Surgery II—Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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V J, M S, Wani A, Ahmad SF, Nadeem A, Sharma A, Ahmed SSSJ. Pharmacoscreening, molecular dynamics, and quantum mechanics of inermin from Panax ginseng: a crucial molecule inhibiting exosomal protein target associated with coronary artery disease progression. PeerJ 2023; 11:e16481. [PMID: 38077444 PMCID: PMC10710165 DOI: 10.7717/peerj.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Background Exosomes, microvesicles, carry and release several vital molecules across cells, tissues, and organs. Epicardial adipose tissue exosomes are critical in the development and progression of coronary artery disease (CAD). It is hypothesized that exosomes may transport causative molecules from inflamed tissue and deliver to the target tissue and progress CAD. Thus, identifying and inhibiting the CAD-associated proteins that are being transported to other cells via exosomes will help slow the progression of CAD. Methods This study uses a systems biological approach that integrates differential gene expression in the CAD, exosomal cargo assessment, protein network construction, and functional enrichment to identify the crucial exosomal cargo protein target. Meanwhile, absorption, distribution, metabolism, and excretion (ADME) screening of Panax ginseng-derived compounds was conducted and then docked against the protein target to identify potential inhibitors and then subjected to molecular dynamics simulation (MDS) to understand the behavior of the protein-ligand complex till 100 nanoseconds. Finally, density functional theory (DFT) calculation was performed on the ligand with the highest affinity with the target. Results Through the systems biological approach, Mothers against decapentaplegic homolog 2 protein (SMAD2) was determined as a potential target that linked with PI3K-Akt signaling, Ubiquitin mediated proteolysis, and the focal adhesion pathway. Further, screening of 190 Panax ginseng compounds, 27 showed drug-likeness properties. Inermin, a phytochemical showed good docking with -5.02 kcal/mol and achieved stability confirmation with SMAD2 based on MDS when compared to the known CAD drugs. Additionally, DFT analysis of inermin showed high chemical activity that significantly contributes to effective target binding. Overall, our computational study suggests that inermin could act against SMAD2 and may aid in the management of CAD.
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Affiliation(s)
- Janakiraman V
- Muti-omics and Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettnad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Sudhan M
- Muti-omics and Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettnad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Abubakar Wani
- Department of Immunology, St. Jude Children’s Research Hospital Memphis, TN, USA
| | - Sheikh F. Ahmad
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Nadeem
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ashutosh Sharma
- Centre of Bioengineering, NatProLab, Plant Innovation Lab, School of Engineering and Sciences, Tecnologico de Monterrey, Queretaro, Mexico
| | - Shiek S. S. J. Ahmed
- Muti-omics and Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettnad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
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Fang Y, Wei H, Wu Z, Song W, Liu C, Li H, Gu C. Short and long-term outcomes after off-pump coronary endarterectomy stratified by different target vessels. J Cardiothorac Surg 2022; 17:339. [PMID: 36567322 PMCID: PMC9791732 DOI: 10.1186/s13019-022-02089-x] [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: 05/15/2022] [Accepted: 12/11/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The efficacy of off-pump coronary endarterectomy (CE) has been proven in patients with diffuse coronary artery disease (DCAD). However, the clinical benefits of of-pump CE stratified by different target vessels remain controversial. This retrospective study assessed the effect of the territory and number of CE on short- and long-term outcomes of DCAD. METHODS From January 2012 to December 2014, 246 patients undergoing off-pump coronary artery bypass grafting (OPCABG) + CE were included. The patients were grouped by the territory and number of CE. The primary endpoints were postoperative acute myocardial infarction (PMI) and long-term major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Sixty-five patients (26.42%) were in the left anterior descending branch (LAD) group (CE on LAD), 134(54.47%) in the right coronary artery (RCA) group (CE on RCA), and 47(19.10%) in the multi-vessels group. PMI in the LAD group, RCA group, and multi-vessels group were 3.08%, 6.72%, and 14.89%, respectively (P = 0.08). Multi-vessels CE (OR = 9.042, 95%CI 2.198-37.193, P = 0.002), CE-plaque length ≥ 3 cm (OR = 6.247, 95%CI 2.162-18.052, P < 0.001), and type 2 diabetes mellitus (2DM) (OR = 4.072, 95%CI 1.598-10.374, P = 0.003) were independent risk factors of PMI. The long-term (mean 76 months) MACCE in the LAD group, RCA group, and multi-vessels group were 13.85%, 17.91%, and 10.64%, respectively (P = 0.552). Cox analysis indicated that PMI (HR = 7.113, 95%CI 3.129-16.171, P < 0.001) and Age ≥ 65 years (HR = 2.488, 95%CI 1.214-5.099, P = 0.013) increased the risk of long-term MACCE. CONCLUSIONS Multi-vessel CE and CE-plaque length ≥ 3 cm significantly increased risk of PMI after OPCABG + CE, but the territory and number of CE did not affect long-term MACCE.
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Affiliation(s)
- Ying Fang
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
| | - Hua Wei
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
| | - Zhen Wu
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
| | - Wei Song
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
| | - Changcheng Liu
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
| | - Haiyang Li
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
| | - Chengxiong Gu
- grid.411606.40000 0004 1761 5917Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Street No.2 Chaoyang District, Beijing, 100029 China
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Shvartz V, Le T, Kryukov Y, Sokolskaya M, Ispiryan A, Khugaeva E, Yurkulieva G, Shvartz E, Petrosyan A, Bockeria L, Bockeria O. Colchicine for Prevention of Atrial Fibrillation after Cardiac Surgery in the Early Postoperative Period. J Clin Med 2022; 11:jcm11051387. [PMID: 35268478 PMCID: PMC8911341 DOI: 10.3390/jcm11051387] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/20/2022] Open
Abstract
Background. Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. It has been proven to be associated with an increase in the incidence of early complications and mortality, an increase in the rate of hospital stay duration, and economic costs of their treatment. One of the pharmaceutical drugs recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) for preventing POAF is colchicine (class IIB). However, the results of research on the efficacy and safety of colchicine are ambiguous and, consequently, require further study. Objective. Evaluating the efficacy of short-term colchicine administration in the prevention of POAF in patients after open-heart surgery. Materials and methods. Double-blind, randomized, placebo-controlled clinical trial. The subjects were randomly assigned to two groups: treatment group (n = 50) with subjects receiving 1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period; and the control group (n = 51), receiving placebo on the same schedule. The primary endpoint was the frequency of POAF in both groups within 7 days after surgery. Results. The study included 101 patients (82 men, 19 women). Baseline clinical, laboratory, instrumental, and intraoperative data did not differ statistically significantly between the groups. POAF was detected in 9 patients (18%) of the treatment group and 15 subjects (29.4%) of the control group, which had no statistical significance (odds ratio, OR 0.527; 95% Cl 0.206–1.349; p = 0.178). No statistically significant differences were revealed for most secondary endpoints, as well as between the groups for all laboratory parameters. There were statistically significant differences between the groups solely in the frequency of diarrhea: 16 (32%) patients in the treatment group and 6 (11.8%) subjects in the control group (OR 3.529; 95% Cl 1.249–9.972; p = 0.010). Conclusions. We did not detect any statistical differences between the groups in terms of primary endpoints, which could be due to the insufficient volume of the sample of the study. However, we detected some trends of statistical differences among the groups in terms of some parameters. Clinical Trials Registration. ClinicalTrials. Unique identifier: NCT04224545.
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Affiliation(s)
- Vladimir Shvartz
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
- Correspondence:
| | - Tatyana Le
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Yuri Kryukov
- Department of Cardiovascular Surgery, Arrhythmology and Clinical Electrophysiology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia;
| | - Maria Sokolskaya
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Artak Ispiryan
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Eleonora Khugaeva
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Gulsuna Yurkulieva
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Elena Shvartz
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia;
| | - Andrey Petrosyan
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Leo Bockeria
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
| | - Olga Bockeria
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (T.L.); (M.S.); (A.I.); (E.K.); (G.Y.); (A.P.); (L.B.); (O.B.)
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