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Wang W, Yang X, Hu Y, Leng X, Xiang J, Lin X. Angiography-based Fractional Flow Reserve for the Prediction of Clinical Outcomes After Drug-coated Balloon or Plain Old Balloon Angioplasty. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07575-z. [PMID: 38805160 DOI: 10.1007/s10557-024-07575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AccuFFRangio is a novel method for fast computation of fractional flow reserve (FFR) based on coronary angiography and computational fluid dynamics. The association between the AccuFFRangio and clinical outcomes after drug-coated balloon (DCB) or plain old balloon angioplasty (POBA) remains to be investigated. METHODS This study included consecutive patients who underwent balloon angioplasty from December 2016 to October 2020. AccuFFRangio was calculated retrospectively based on the post-procedural angiography obtained immediately after angioplasty. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, vessel-related myocardial infarction, and repeat target vessel revascularization. RESULTS A total of 169 patients were retrospectively analyzed in this study. Post-procedural AccuFFRangio (hazard ratio [HR] per 0.1 increase 0.33, 95% confidence interval [CI] 0.22-0.48, p < 0.001) was an independent predictor for MACE at 2-year follow-up. Post-procedural AccuFFRangio ≤ 0.87 was determined as the optimal cutoff value to predict MACE with an area under the curve (AUC) of 0.872 (95% CI 0.813-0.919, p < 0.001). CONCLUSIONS AccuFFRangio measured immediately after balloon angioplasty is a promising predictor of unfavorable clinical outcomes.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China
| | - Xinyi Yang
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China
| | - Yumeng Hu
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China
| | - Xiaochang Leng
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China
| | - Jianping Xiang
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China.
| | - Xianhe Lin
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China.
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2
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DE Albuquerque DC, DE Barros E Silva PGM, Lopes RD, Hoffmann-Filho CR, Nogueira PR, Reis H, Nishijuka FA, Martins SM, DE Figueiredo Neto JA, Pavanello R, DE Souza Neto JD, Danzmann LC, Gemelli JR, Rohde LEP, Hernandes ME, Rivera MAM, Simões MVIN, Dos Santos ES, Canesin MF, Zilli AC, Santos RHN, Jesuino IDEA, Mourilhe-Rocha R, Moura LZ, Marcondes-Braga FG, Mesquita ET. In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE). J Card Fail 2024; 30:639-650. [PMID: 37648061 DOI: 10.1016/j.cardfail.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. METHODS BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. RESULTS A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. CONCLUSIONS In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up.
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Affiliation(s)
| | - Pedro Gabriel Melo DE Barros E Silva
- Hcor-Hospital do Coração, São Paulo, Brazil; Hospital Samaritano Paulista, São Paulo, Brazil; Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, Brazil; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Centro de Pesquisa da Clínica Médica e Cardiologia da UNIFESP, São Paulo, Brazil.
| | | | | | - Helder Reis
- Hospital de Clínicas Gaspar Viana, Paró, Brazil
| | | | | | | | | | | | - Luiz Claudio Danzmann
- Hospital São Lucas-PUCRS, Rio Grande do Sul, Brazil; Universidade Luterana do Brasil-Hospital Universitório de Canoas (RS), Rio Grande do Sul, Brazil
| | | | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento-HMV, Rio Grande do Sul, Brazil
| | | | | | - Marcus VINíCIUS Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Ricardo Mourilhe-Rocha
- Hospital Universitório Pedro Ernesto, Rio de Janeiro, Brazil; Complexo Hospitalar Américas- Vitória e Samaritano Barra, Rio de Janeiro, Brazil
| | | | - Fabiana G Marcondes-Braga
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Instituto do Coração (inCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evandro Tinoco Mesquita
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Universidade Federal Fluminense, Rio de Janeiro, Brazil
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3
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Goodwin NP, Clare RM, Harrington JL, Badjatiya A, Wojdyla DM, Udell JA, Butler J, Januzzi JL, Parikh PB, James S, Alexander JH, Lopes RD, Wallentin L, Ohman EM, Hernandez AF, Jones WS. Morbidity and Mortality Associated With Heart Failure in Acute Coronary Syndrome: A Pooled Analysis of 4 Clinical Trials. J Card Fail 2023; 29:1603-1614. [PMID: 37479054 DOI: 10.1016/j.cardfail.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/25/2023] [Accepted: 07/01/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Heart failure (HF) may complicate acute coronary syndrome (ACS) and is associated with a high burden of short- and long-term morbidity and mortality. Only limited data regarding future ischemic events and rehospitalization are available for patients who suffer HF before or during ACS. METHODS A secondary analysis of 4 large ACS trials (PLATO, APPRAISE-2, TRACER, and TRILOGY ACS) using Cox proportional hazards models was performed to investigate the association of HF status (no HF, chronic HF, de novo HF) at presentation for ACS with all-cause and cardiovascular death, major adverse cardiovascular event (MACE ), myocardial infarction, stroke, and hospitalization for heart failure (HHF) by 1 year. Cumulative incidence plots are presented at 30 days and 1 year. RESULTS A total of 11.1% of the 47,474 patients presenting with ACS presented with evidence of acute HF, 55.0% of whom presented with de novo HF. Patients with chronic HF presented with evidence of acute HF at a higher rate than those with no previous HF (40.3% vs 6.9%). Compared to those without HF, those with chronic and de novo HF had higher rates of all-cause mortality (adjusted hazard ratio [aHR] 2.01, 95% confidence interval [CI] 1.72-2.34 and aHR 1.47, 95% CI1.15-1.88, respectively), MACE (aHR 1.47, 95% CI1.31-1-.66 and aHR 1.38, 95% CI1.12-1.69), and HHF (aHR 2.29, 95% CI2.02-2.61 and aHR 1.48, 95% CI 1.20-1.82) at 1 year. CONCLUSION In this large cohort of patients with ACS, both prior and de novo HF complicating ACS were associated with significantly higher risk-adjusted rates of death, ischemic events and HHF at 30 days and 1 year. Further studies examining the association between HF and outcomes in this high-risk population are warranted, especially given the advent of more contemporary HF therapies.
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Affiliation(s)
- Nathan P Goodwin
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Robert M Clare
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Josephine L Harrington
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Anish Badjatiya
- Division of Cardiology, Department of Medicine, Texas Heart Institute/Baylor College of Medicine, Houston, TX, USA
| | - Daniel M Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jacob A Udell
- Cardiovascular Division, Department of Medicine, Women's College Hospital; and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Cardiac Trials, Baim Institute for Clinical Research, Boston, MA, USA
| | - Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Stefan James
- Department Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - John H Alexander
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Renato D Lopes
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lars Wallentin
- Department Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - E Magnus Ohman
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Adrian F Hernandez
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - W Schuyler Jones
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Lazăr MA, Ionac I, Luca CT, Petrescu L, Vacarescu C, Crisan S, Gaiță D, Cozma D, Sosdean R, Arnăutu DA, Cozlac AR, Luca SA, Gurgu A, Totorean C, Mornos C. Reduced Left Ventricular Twist Early after Acute ST-Segment Elevation Myocardial Infarction as a Predictor of Left Ventricular Adverse Remodelling. Diagnostics (Basel) 2023; 13:2896. [PMID: 37761263 PMCID: PMC10528752 DOI: 10.3390/diagnostics13182896] [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: 08/10/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The left ventricular (LV) remodelling process represents the main cause of heart failure after a ST-segment elevation myocardial infarction (STEMI). Speckle-tracking echocardiography (STE) can detect early deformation impairment, while also predicting LV remodelling during follow-up. The aim of this study was to investigate the STE parameters in predicting cardiac remodelling following a percutaneous coronary intervention (PCI) in STEMI patients. METHODS The study population consisted of 60 patients with acute STEMI and no history of prior myocardial infarction treated with PCI. The patients were assessed both by conventional transthoracic and ST echocardiography in the first 12 h after admission and 6 months after the acute phase. Adverse remodelling was defined as an increase in LVEDV and/or LVESV by 15%. RESULTS Adverse remodelling occurred in 26 patients (43.33%). By multivariate regression equation, the risk of adverse remodelling increases with age (by 1.1-fold), triglyceride level (by 1.009-fold), and midmyocardial radial strain (mid-RS) (1.06-fold). Increased initial twist decreases the chances of adverse remodelling (0.847-fold). The LV twist presented the largest area under the receiver operating characteristic (ROC) curve to predict adverse remodelling (AUROC = 0.648; 95% CI [0.506;0.789], p = 0.04). A twist value higher than 11° has a 76.9% specificity and a 72.7% positive predictive value for reverse remodelling at 6 months.
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Affiliation(s)
- Mihai-Andrei Lazăr
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Ioana Ionac
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Lucian Petrescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
| | - Cristina Vacarescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crisan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dragos Cozma
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Raluca Sosdean
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Diana-Aurora Arnăutu
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
| | - Alina-Ramona Cozlac
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
| | - Slivia-Ana Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Andra Gurgu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
| | - Claudia Totorean
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristian Mornos
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (M.-A.L.); (L.P.); (C.V.); (S.C.); (D.G.); (D.C.); (R.S.); (A.-R.C.); (S.-A.L.); (A.G.); (C.T.); (C.M.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Lee S, Yin C, Zhang P. Stable clinical risk prediction against distribution shift in electronic health records. PATTERNS (NEW YORK, N.Y.) 2023; 4:100828. [PMID: 37720334 PMCID: PMC10499849 DOI: 10.1016/j.patter.2023.100828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/18/2023] [Accepted: 07/26/2023] [Indexed: 09/19/2023]
Abstract
The availability of large-scale electronic health record datasets has led to the development of artificial intelligence (AI) methods for clinical risk prediction that help improve patient care. However, existing studies have shown that AI models suffer from severe performance decay after several years of deployment, which might be caused by various temporal dataset shifts. When the shift occurs, we have access to large-scale pre-shift data and small-scale post-shift data that are not enough to train new models in the post-shift environment. In this study, we propose a new method to address the issue. We reweight patients from the pre-shift environment to mitigate the distribution shift between pre- and post-shift environments. Moreover, we adopt a Kullback-Leibler divergence loss to force the models to learn similar patient representations in pre- and post-shift environments. Our experimental results show that our model efficiently mitigates temporal shifts, improving prediction performance.
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Affiliation(s)
- Seungyeon Lee
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
| | - Changchang Yin
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
| | - Ping Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
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Williams BA, Voyce S, Blankenship JC, Chang AR. Association between the diagnostic classification of newly diagnosed coronary artery disease and future heart failure development. Coron Artery Dis 2023; 34:341-350. [PMID: 37139564 DOI: 10.1097/mca.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The first clinical manifestation of coronary artery disease (CAD) varies widely from unheralded myocardial infarction (MI) to mild, incidentally detected disease. The primary objective of this study was to quantify the association between different initial CAD diagnostic classifications and future heart failure. METHODS This retrospective study incorporated the electronic health record of a single integrated health care system. Newly diagnosed CAD was classified into a mutually exclusive hierarchy as MI, CAD with coronary artery bypass graft (CABG), CAD with percutaneous coronary intervention, CAD only, unstable angina, and stable angina. An acute CAD presentation was defined when the diagnosis was associated with a hospital admission. New heart failure was identified after the CAD diagnosis. RESULTS Among 28 693 newly diagnosed CAD patients, initial presentation was acute in 47% and manifested as MI in 26%. Within 30 days of CAD diagnosis, MI [hazard ratio (HR) = 5.1; 95% confidence interval: 4.1-6.5] and unstable angina (3.2; 2.4-4.4) classifications were associated with the highest heart failure risk (compared to stable angina), as was acute presentation (2.9; 2.7-3.2). Among stable, heart failure-free CAD patients followed on average 7.4 years, initial MI (adjusted HR = 1.6; 1.4-1.7) and CAD with CABG (1.5; 1.2-1.8) were associated with higher long-term heart failure risk, but an initial acute presentation was not (1.0; 0.9-1.0). CONCLUSION Nearly 50% of initial CAD diagnoses are associated with hospitalization, and these patients are at high risk of early heart failure. Among stable CAD patients, MI remained the diagnostic classification associated with the highest long-term heart failure risk, however, having an initial acute CAD presentation was not associated with long-term heart failure.
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Affiliation(s)
| | - Stephen Voyce
- Department of Cardiology, Geisinger Health System, Danville, Pennsylvania
| | | | - Alexander R Chang
- Department of Nephrology, Geisinger Health System, Danville, Pennsylvania USA
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7
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Liu J, Ma P, Lai L, Villanueva A, Koenig A, Bean GR, Bowles DE, Glass C, Watson M, Lavine KJ, Lin CY. Transcriptional and Immune Landscape of Cardiac Sarcoidosis. Circ Res 2022; 131:654-669. [PMID: 36111531 PMCID: PMC9514756 DOI: 10.1161/circresaha.121.320449] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cardiac involvement is an important determinant of mortality among sarcoidosis patients. Although granulomatous inflammation is a hallmark finding in cardiac sarcoidosis, the precise immune cell populations that comprise the granuloma remain unresolved. Furthermore, it is unclear how the cellular and transcriptomic landscape of cardiac sarcoidosis differs from other inflammatory heart diseases. METHODS We leveraged spatial transcriptomics (GeoMx digital spatial profiler) and single-nucleus RNA sequencing to elucidate the cellular and transcriptional landscape of cardiac sarcoidosis. Using GeoMX digital spatial profiler technology, we compared the transcriptomal profile of CD68+ rich immune cell infiltrates in human cardiac sarcoidosis, giant cell myocarditis, and lymphocytic myocarditis. We performed single-nucleus RNA sequencing of human cardiac sarcoidosis to identify immune cell types and examined their transcriptomic landscape and regulation. Using multichannel immunofluorescence staining, we validated immune cell populations identified by single-nucleus RNA sequencing, determined their spatial relationship, and devised an immunostaining approach to distinguish cardiac sarcoidosis from other inflammatory heart diseases. RESULTS Despite overlapping histological features, spatial transcriptomics identified transcriptional signatures and associated pathways that robustly differentiated cardiac sarcoidosis from giant cell myocarditis and lymphocytic myocarditis. Single-nucleus RNA sequencing revealed the presence of diverse populations of myeloid cells in cardiac sarcoidosis with distinct molecular features. We identified GPNMB (transmembrane glycoprotein NMB) as a novel marker of multinucleated giant cells and predicted that the MITF (microphthalmia-associated transcription factor) family of transcription factors regulated this cell type. We also detected additional macrophage populations in cardiac sarcoidosis including HLA-DR (human leukocyte antigen-DR)+ macrophages, SYTL3 (synaptotagmin-like protein 3)+ macrophages and CD163+ resident macrophages. HLA-DR+ macrophages were found immediately adjacent to GPMMB+ giant cells, a distinct feature compared with other inflammatory cardiac diseases. SYTL3+ macrophages were located scattered throughout the granuloma and CD163+ macrophages, CD1c+ dendritic cells, nonclassical monocytes, and T cells were located at the periphery and outside of the granuloma. Finally, we demonstrate mTOR (mammalian target of rapamycin) pathway activation is associated with proliferation and is selectively found in HLA-DR+ and SYLT3+ macrophages. CONCLUSIONS In this study, we identified diverse populations of immune cells with distinct molecular signatures that comprise the sarcoid granuloma. These findings provide new insights into the pathology of cardiac sarcoidosis and highlight opportunities to improve diagnostic testing.
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Affiliation(s)
- Jing Liu
- Cardiovascular Division, Department of Medicine (J.L., P.M., A.K., K.J.L.), Washington University School of Medicine, St. Louis, MO.,Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University School of Medicine, China (J.L.)
| | - Pan Ma
- Cardiovascular Division, Department of Medicine (J.L., P.M., A.K., K.J.L.), Washington University School of Medicine, St. Louis, MO
| | - Lulu Lai
- Department of Pathology and Immunology (A.V., L.L., C.-Y.L.), Washington University School of Medicine, St. Louis, MO
| | - Ana Villanueva
- Department of Pathology and Immunology (A.V., L.L., C.-Y.L.), Washington University School of Medicine, St. Louis, MO
| | - Andrew Koenig
- Cardiovascular Division, Department of Medicine (J.L., P.M., A.K., K.J.L.), Washington University School of Medicine, St. Louis, MO
| | - Gregory R. Bean
- Department of Pathology, Stanford University School of Medicine, CA (G.R.B.)
| | - Dawn E. Bowles
- Department of Surgery (D.E.B., M.W.), Duke University, Durham, NC
| | - Carolyn Glass
- Department of Pathology (C.G.), Duke University, Durham, NC
| | - Michael Watson
- Department of Surgery (D.E.B., M.W.), Duke University, Durham, NC
| | - Kory J. Lavine
- Cardiovascular Division, Department of Medicine (J.L., P.M., A.K., K.J.L.), Washington University School of Medicine, St. Louis, MO
| | - Chieh-Yu Lin
- Department of Pathology and Immunology (A.V., L.L., C.-Y.L.), Washington University School of Medicine, St. Louis, MO
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8
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Hendrickson MJ, Arora S, Vaduganathan M, Fonarow GC, MP G, Bansal A, Batra V, Kunal S, Bhatt DL, Gupta M, Qamar A. Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India. ESC Heart Fail 2022; 9:3836-3845. [PMID: 35950269 PMCID: PMC9773730 DOI: 10.1002/ehf2.14055] [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: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). METHODS AND RESULTS Adults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. CONCLUSIONS On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.
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Affiliation(s)
| | - Sameer Arora
- Division of CardiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Gregg C. Fonarow
- Division of CardiologyUniversity of California Los AngelesLos AngelesCAUSA
| | - Girish MP
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Ankit Bansal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Vishal Batra
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Shekhar Kunal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Mohit Gupta
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Arman Qamar
- Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health SystemUniversity of Chicago Pritzker School of MedicineEvanstonILUSA
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9
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Bertsch P, Diba M, Mooney DJ, Leeuwenburgh SCG. Self-Healing Injectable Hydrogels for Tissue Regeneration. Chem Rev 2022; 123:834-873. [PMID: 35930422 PMCID: PMC9881015 DOI: 10.1021/acs.chemrev.2c00179] [Citation(s) in RCA: 175] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biomaterials with the ability to self-heal and recover their structural integrity offer many advantages for applications in biomedicine. The past decade has witnessed the rapid emergence of a new class of self-healing biomaterials commonly termed injectable, or printable in the context of 3D printing. These self-healing injectable biomaterials, mostly hydrogels and other soft condensed matter based on reversible chemistry, are able to temporarily fluidize under shear stress and subsequently recover their original mechanical properties. Self-healing injectable hydrogels offer distinct advantages compared to traditional biomaterials. Most notably, they can be administered in a locally targeted and minimally invasive manner through a narrow syringe without the need for invasive surgery. Their moldability allows for a patient-specific intervention and shows great prospects for personalized medicine. Injected hydrogels can facilitate tissue regeneration in multiple ways owing to their viscoelastic and diffusive nature, ranging from simple mechanical support, spatiotemporally controlled delivery of cells or therapeutics, to local recruitment and modulation of host cells to promote tissue regeneration. Consequently, self-healing injectable hydrogels have been at the forefront of many cutting-edge tissue regeneration strategies. This study provides a critical review of the current state of self-healing injectable hydrogels for tissue regeneration. As key challenges toward further maturation of this exciting research field, we identify (i) the trade-off between the self-healing and injectability of hydrogels vs their physical stability, (ii) the lack of consensus on rheological characterization and quantitative benchmarks for self-healing injectable hydrogels, particularly regarding the capillary flow in syringes, and (iii) practical limitations regarding translation toward therapeutically effective formulations for regeneration of specific tissues. Hence, here we (i) review chemical and physical design strategies for self-healing injectable hydrogels, (ii) provide a practical guide for their rheological analysis, and (iii) showcase their applicability for regeneration of various tissues and 3D printing of complex tissues and organoids.
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Affiliation(s)
- Pascal Bertsch
- Department
of Dentistry-Regenerative Biomaterials, Radboud Institute for Molecular
Life Sciences, Radboud University Medical
Center, 6525 EX Nijmegen, The Netherlands
| | - Mani Diba
- Department
of Dentistry-Regenerative Biomaterials, Radboud Institute for Molecular
Life Sciences, Radboud University Medical
Center, 6525 EX Nijmegen, The Netherlands,John
A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, United States,Wyss
Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, United States
| | - David J. Mooney
- John
A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, United States,Wyss
Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, United States
| | - Sander C. G. Leeuwenburgh
- Department
of Dentistry-Regenerative Biomaterials, Radboud Institute for Molecular
Life Sciences, Radboud University Medical
Center, 6525 EX Nijmegen, The Netherlands,
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10
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Badin JK, Eggenberger C, Rodenbeck SD, Hashmi ZA, Wang IW, Garcia JP, Alloosh M, Sturek M. Intracellular Ca 2+ Dysregulation in Coronary Smooth Muscle Is Similar in Coronary Disease of Humans and Ossabaw Miniature Swine. J Cardiovasc Transl Res 2022; 15:167-178. [PMID: 34286469 PMCID: PMC10620470 DOI: 10.1007/s12265-021-10153-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/02/2021] [Indexed: 12/31/2022]
Abstract
Intracellular free Ca2+ ([Ca2+]i) dysregulation occurs in coronary smooth muscle (CSM) in atherosclerotic coronary artery disease (CAD) of metabolic syndrome (MetS) swine. Our goal was to determine how CAD severity, arterial structure, and MetS risk factors associate with [Ca2+]i dysregulation in human CAD compared to changes in Ossabaw miniature swine. CSM cells were dispersed from coronary arteries of explanted hearts from transplant recipients and from lean and MetS swine with CAD. CSM [Ca2+]i elicited by Ca2+ influx and sarcoplasmic reticulum (SR) Ca2+ release and sequestration was measured with fura-2. Increased [Ca2+]i signaling was associated with advanced age and a greater media area in human CAD. Decreased [Ca2+]i signaling was associated with a greater number of risk factors and a higher plaque burden in human and swine CAD. Similar [Ca2+]i dysregulation exhibited in human and Ossabaw swine CSM provides strong evidence for the translational relevance of this large animal model.
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Affiliation(s)
- Jill K Badin
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, 635 Barnhill Dr., Medical Sciences, Room 385, Indianapolis, IN, 46202, USA
| | - Caleb Eggenberger
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, 635 Barnhill Dr., Medical Sciences, Room 385, Indianapolis, IN, 46202, USA
- Marian University College of Osteopathic Medicine, Indianapolis, IN, 46222, USA
| | - Stacey Dineen Rodenbeck
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, 635 Barnhill Dr., Medical Sciences, Room 385, Indianapolis, IN, 46202, USA
- Department of Biology, Harding University, Searcy, AR, 72149, USA
| | - Zubair A Hashmi
- Cardiothoracic Transplantation Surgery, Indiana University - Methodist Hospital, Indianapolis, IN, 46202, USA
| | - I-Wen Wang
- Cardiothoracic Transplantation Surgery, Indiana University - Methodist Hospital, Indianapolis, IN, 46202, USA
| | - Jose P Garcia
- Cardiothoracic Transplantation Surgery, Indiana University - Methodist Hospital, Indianapolis, IN, 46202, USA
| | - Mouhamad Alloosh
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, 635 Barnhill Dr., Medical Sciences, Room 385, Indianapolis, IN, 46202, USA
| | - Michael Sturek
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, 635 Barnhill Dr., Medical Sciences, Room 385, Indianapolis, IN, 46202, USA.
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11
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Jin L, Yin Q, Mao Y, Gao Y, Han Q, Mei R, Xue L, Tan H, Li H. Putative Prevention of XML Injection Against Myocardial Ischemia Is Mediated by PKC and PLA2 Proteins. Front Cell Dev Biol 2022; 10:827691. [PMID: 35141226 PMCID: PMC8819063 DOI: 10.3389/fcell.2022.827691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Xinmailong (XML) injection is a CFDA-approved traditional Chinese medicine with clinical value for heart failure treatment. The present investigation was aimed to evaluate the potential protective roles of this injection on myocardial ischemia and the underlying molecular mechanism. Methods: In our study, we selected two models of myocardial ischemia rats. Rats were randomly divided into six groups, with saline or XML administrated 4 days before ischemia model establishment. ECG of different time intervals and biochemical parameters of end point were measured. The potential mechanisms of the protective role of XML were explored using system pharmacology and molecular biology approaches. Results: Myocardial ischemia rats demonstrated abnormal ECG and serum levels of cTnT. Pretreatment with XML significantly attenuated these damages, especially the medium doses. GO and KEGG analysis revealed that the 90 putative target genes were associated with pathways of fatty acid absorption/metabolism, inflammation, RAAS, and vascular smooth muscle. Further network pharmacology method identified five main chemical ingredients and potential targets of XML injection for myocardial ischemia. Mechanically, the beneficial effect of XML injection was mediated by the reactive oxygen species (ROS) inhibition and inflammation attenuation via regulating the expression levels of targets of PKC and PLA2. Conclusion: These findings indicate that XML exerts protective effects against myocardial injury, with attenuated ROS production, apoptosis, and inflammation. Therefore, we speculate that XML may be an alternative supplementary therapeutic agent for myocardial ischemia prevention.
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Affiliation(s)
- Ling Jin
- Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Qianqian Yin
- Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Yiqing Mao
- Department of Pharmacology, Peking University, Health Science Center, Beijing, China
| | - Yuanxu Gao
- State Key Laboratory of Lunar and Planetary Sciences, Macau University of Science and Technology, Macau, China
| | - Qing Han
- Department of Pharmacology, Peking University, Health Science Center, Beijing, China
| | - Ruisi Mei
- Department of Pharmacology, Peking University, Health Science Center, Beijing, China
| | - Lixiang Xue
- Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Huanran Tan
- Department of Pharmacology, Peking University, Health Science Center, Beijing, China
- *Correspondence: Huanran Tan, ; Hui Li,
| | - Hui Li
- Department of Pharmacology, Peking University, Health Science Center, Beijing, China
- *Correspondence: Huanran Tan, ; Hui Li,
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12
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Régis C, Pelletier-Galarneau M. FDG-PET and myocardial viability. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Zhao D, Ma X, Li Y, Xi Y, Su L, Tong Y, Wang C, Yu T. Quantitative analysis of kruppel-like factor 5-related messenger RNA transcripts in ischemic myocardium for discrimination of death causes. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_127_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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14
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Hobby ARH, Berretta RM, Eaton DM, Kubo H, Feldsott E, Yang Y, Headrick AL, Koch KA, Rubino M, Kurian J, Khan M, Tan Y, Mohsin S, Gallucci S, McKinsey TA, Houser SR. Cortical bone stem cells modify cardiac inflammation after myocardial infarction by inducing a novel macrophage phenotype. Am J Physiol Heart Circ Physiol 2021; 321:H684-H701. [PMID: 34415185 PMCID: PMC8794230 DOI: 10.1152/ajpheart.00304.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
Acute damage to the heart, as in the case of myocardial infarction (MI), triggers a robust inflammatory response to the sterile injury that is part of a complex and highly organized wound-healing process. Cortical bone stem cell (CBSC) therapy after MI has been shown to reduce adverse structural and functional remodeling of the heart after MI in both mouse and swine models. The basis for these CBSC treatment effects on wound healing are unknown. The present experiments show that CBSCs secrete paracrine factors known to have immunomodulatory properties, most notably macrophage colony-stimulating factor (M-CSF) and transforming growth factor-β, but not IL-4. CBSC therapy increased the number of galectin-3+ macrophages, CD4+ T cells, and fibroblasts in the heart while decreasing apoptosis in an in vivo swine model of MI. Macrophages treated with CBSC medium in vitro polarized to a proreparative phenotype are characterized by increased CD206 expression, increased efferocytic ability, increased IL-10, TGF-β, and IL-1RA secretion, and increased mitochondrial respiration. Next generation sequencing revealed a transcriptome significantly different from M2a or M2c macrophage phenotypes. Paracrine factors from CBSC-treated macrophages increased proliferation, decreased α-smooth muscle actin expression, and decreased contraction by fibroblasts in vitro. These data support the idea that CBSCs are modulating the immune response to MI to favor cardiac repair through a unique macrophage polarization that ultimately reduces cell death and alters fibroblast populations that may result in smaller scar size and preserved cardiac geometry and function.NEW & NOTEWORTHY Cortical bone stem cell (CBSC) therapy after myocardial infarction alters the inflammatory response to cardiac injury. We found that cortical bone stem cell therapy induces a unique macrophage phenotype in vitro and can modulate macrophage/fibroblast cross talk.
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Affiliation(s)
- Alexander R H Hobby
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Remus M Berretta
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Deborah M Eaton
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Hajime Kubo
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Eric Feldsott
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Yijun Yang
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alaina L Headrick
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Keith A Koch
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marcello Rubino
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Justin Kurian
- Center for Metabolic Disease Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mohsin Khan
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Center for Metabolic Disease Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Yinfei Tan
- Genomic Facility, Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sadia Mohsin
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Pharmacology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Stefania Gallucci
- Department of Microbiology & Immunology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Timothy A McKinsey
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Steven R Houser
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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15
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Teng EL, Masutani EM, Yeoman B, Fung J, Lian R, Ngo B, Kumar A, Placone JK, Lo Sardo V, Engler AJ. High shear stress enhances endothelial permeability in the presence of the risk haplotype at 9p21.3. APL Bioeng 2021; 5:036102. [PMID: 34327295 PMCID: PMC8315817 DOI: 10.1063/5.0054639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) are exceedingly common in non-coding loci, and while they are significantly associated with a myriad of diseases, their specific impact on cellular dysfunction remains unclear. Here, we show that when exposed to external stressors, the presence of risk SNPs in the 9p21.3 coronary artery disease (CAD) risk locus increases endothelial monolayer and microvessel dysfunction. Endothelial cells (ECs) derived from induced pluripotent stem cells of patients carrying the risk haplotype (R/R WT) differentiated similarly to their non-risk and isogenic knockout (R/R KO) counterparts. Monolayers exhibited greater permeability and reactive oxygen species signaling when the risk haplotype was present. Addition of the inflammatory cytokine TNFα further enhanced EC monolayer permeability but independent of risk haplotype; TNFα also did not substantially alter haplotype transcriptomes. Conversely, when wall shear stress was applied to ECs in a microfluidic vessel, R/R WT vessels were more permeable at lower shear stresses than R/R KO vessels. Transcriptomes of sheared cells clustered more by risk haplotype than by patient or clone, resulting in significant differential regulation of EC adhesion and extracellular matrix genes vs static conditions. A subset of previously identified CAD risk genes invert expression patterns in the presence of high shear concomitant with altered cell adhesion genes, vessel permeability, and endothelial erosion in the presence of the risk haplotype, suggesting that shear stress could be a regulator of non-coding loci with a key impact on CAD.
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Affiliation(s)
- Evan L Teng
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Evan M Masutani
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Benjamin Yeoman
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Jessica Fung
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Rachel Lian
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Brenda Ngo
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Aditya Kumar
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Jesse K Placone
- Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA
| | - Valentina Lo Sardo
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California 92037, USA
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16
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Exosomal miR-218-5p/miR-363-3p from Endothelial Progenitor Cells Ameliorate Myocardial Infarction by Targeting the p53/JMY Signaling Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5529430. [PMID: 34326916 PMCID: PMC8302385 DOI: 10.1155/2021/5529430] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022]
Abstract
Accumulating evidence has shown that endothelial progenitor cell-derived exosomes (EPC-Exos) can ameliorate myocardial fibrosis. The purpose of the present study was to investigate the effects of EPC-Exos-derived microRNAs (miRNAs) on myocardial infarction (MI). A miRNA-Seq dataset of miRNAs differentially expressed between EPCs and exosomes was collected. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to validate the miRNA expression indicated by miRNA-Seq. Immunofluorescence, cell proliferation, and angiogenesis assays were employed to investigate the effects of miRNAs on cardiac fibroblasts (CFs) in vitro. Interactions between miRNAs and their respective targets were examined via immunoblotting, qRT-PCR, and luciferase reporter assays. An MI rat model was constructed, and various staining and immunohistochemical assays were performed to explore the mechanisms underlying the miRNA-mediated effects on MI. miR-363-3p and miR-218-5p were enriched in EPC-Exos, and miR-218-5p and miR-363-3p mimic or inhibitor enhanced or suppressed CF proliferation and angiogenesis, respectively. miR-218-5p and miR-363-3p regulated p53 and junction-mediating and regulatory protein (JMY) by binding to the promoter region of p53 and the 3′ untranslated region of JMY. Additionally, treatment of CFs with Exo-miR-218-5p or Exo-miR-363-3p upregulated p53 and downregulated JMY expression, promoted mesenchymal-endothelial transition, and inhibited myocardial fibrosis. Administration of exosomes containing miR-218-5p mimic or miR-363-3p mimic ameliorated left coronary artery ligation-induced MI and restored myocardial tissue integrity in the MI model rats. In summary, these results show that the protective ability of EPC-Exos against MI was mediated by the shuttled miR-218-5p or miR-363-3p via targeting of the p53/JMY signaling pathway.
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17
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Miran SM, Nelson SJ, Zeng-Treitler Q. A model-agnostic approach for understanding heart failure risk factors. BMC Res Notes 2021; 14:184. [PMID: 34001210 PMCID: PMC8130447 DOI: 10.1186/s13104-021-05596-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Understanding the risk factors for developing heart failure among patients with type 2 diabetes can contribute to preventing deterioration of quality of life for those persons. Electronic health records (EHR) provide an opportunity to use sophisticated machine learning models to understand and compare the effect of different risk factors for developing HF. As the complexity of the model increases, however, the transparency of the model often decreases. To interpret the results, we aimed to develop a model-agnostic approach to shed light on complex models and interpret the effect of features on developing heart failure. Using the HealthFacts EHR database of the Cerner EHR, we extracted the records of 723 patients with at least 6 yeas of follow up of type 2 diabetes, of whom 134 developed heart failure. Using age and comorbidities as features and heart failure as the outcome, we trained logistic regression, random forest, XGBoost, neural network, and then applied our proposed approach to rank the effect of each factor on developing heart failure. RESULTS Compared to the "importance score" built-in function of XGBoost, our proposed approach was more accurate in ranking the effect of the different risk factors on developing heart failure.
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Affiliation(s)
- Seyed M Miran
- Biomedical Informatics Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
| | - Stuart J Nelson
- Biomedical Informatics Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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18
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Long-Term Results of Hybrid Left Ventricular Reconstruction in the Treatment of Ischemic Cardiomyopathy. J Cardiovasc Transl Res 2021; 14:1043-1050. [PMID: 33974231 PMCID: PMC8651588 DOI: 10.1007/s12265-021-10133-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15–45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure.
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19
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Zeymer U, Clark AL, Barrios V, Damy T, Drożdż J, Fonseca C, Lund LH, Kalus S, Ferber PC, Hussain RI, Koch C, Maggioni AP. Utilization of sacubitril/valsartan in patients with heart failure with reduced ejection fraction: real-world data from the ARIADNE registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:469-477. [DOI: 10.1093/ehjqcco/qcab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
To compare baseline characteristics of patients with heart failure with reduced ejection fraction (HFrEF) initiated on sacubitril/valsartan compared with patients continued on conventional heart failure (HF)-treatment in a European out-patient setting.
Methods and results
Between July 2016 and July 2019, ARIADNE enrolled 8787 outpatients aged ≥18 years with HFrEF from 17 European countries. Choice of therapy was solely at the investigators’ discretion. In total, 4173 patients were on conventional HF-treatment (non-S/V group), while 4614 patients were on sacubitril/valsartan either at enrolment or started sacubitril/valsartan within 1 month of enrolment (S/V group). Of these, 2108 patients started sacubitril/valsartan treatment ±1 month around enrolment [restricted S/V (rS/V) group]. The average age of the patients was 68 years. Patients on S/V were more likely to have New York Heart Association (NYHA) class III or IV symptoms (50.3%, 44.6%, 32.1% in rS/V, S/V, and non-S/V, respectively) and had lower left ventricular ejection fraction (LVEF; 32.3%, 32.7%, and 35.4% in rS/V, S/V, and non-S/V, respectively; P < 0.0001). The most frequently received HF treatments were angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB; ∼84% in non-S/V), followed by β-blockers (∼80%) and mineralocorticoid receptor antagonists (MRAs; 53%). The use of triple HF therapy (ACEI/ARB/angiotensin receptor neprilysin inhibitor with β-blockers and MRA) was higher in the S/V groups than non-S/V group (48.2%, 48.2%, and 40.2% in rS/V, S/V, and non-S/V, respectively).
Conclusion
In this large multinational HFrEF registry, patients receiving sacubitril/valsartan tended to be younger with lower LVEF and higher NYHA class. Fewer than half of the patients received triple HF therapy.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Medizinische Klinik B and Institut für Herzinfarktforschung, Bremserstrasse 79, 67063 Ludwigshafen-am-Rhein, Germany
| | - Andrew L Clark
- Castle Hill Hospital, Kingston Upon Hull, Castle Rd, Cottingham HU16 5JQ, United Kingdom
| | - Vivencio Barrios
- Department of Cardiology, Ramon y Cajal Hospital, Ctra. de Colmenar Viejo km. 9,100 28034 Madrid, Spain
| | - Thibaud Damy
- Department of Cardiology, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France
| | - Jaroslaw Drożdż
- Department Cardiology Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251, Poland
| | - Candida Fonseca
- Hospital de Sao Francisco Xavier, Estrada Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Lars H Lund
- Department of Medicine, Unit of Cardiology, Karolinska Institutet and Karolinska University HospitalFoU Tema Hjärta Kärl, Eugeniavägen 3, Norrbacka, S1:02, 171 76 Stockholm, Sweden
| | - Stefanie Kalus
- GKM Gesellschaft für Therapieforschung mbH, Lessingstr. 14, 80336 Munich, Germany
| | | | - Rizwan I Hussain
- Arxx Therapeutics, Gaustadalléen 21, 0349 Oslo, Norway
- Symbion Science Park, Fruebjergvej 3, 2100 Copenhagen, Denmark
| | | | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Via La Marmora 34, 50121 Florence, Italy
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1, 48033 Cotignola RA, Italy
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20
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Lian Z, Song JX, Yu SR, Su LN, Cui YX, Li SF, Lee CY, Liang HZ, Chen H. Therapeutic targets of rosuvastatin on heart failure and associated biological mechanisms: A study of network pharmacology and experimental validation. Eur J Pharmacol 2021; 895:173888. [PMID: 33493484 DOI: 10.1016/j.ejphar.2021.173888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
To explore the potential targets underlying the effect of rosuvastatin on heart failure (HF) by utilizing a network pharmacology approach and experiments to identify the results. PharmMapper and other databases were mined for information relevant to the prediction of rosuvastatin targets and HF-related targets. Then, the rosuvastatin-HF target gene networks were created in Cytoscape software. Eventually, the targets and enriched pathways were examined by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Furthermore, we constructed an HF animal model and used rosuvastatin to treat them, identifying the changes in heart function and related protein expression. We further used different cells to explore the mechanisms of rosuvastatin. Thirty-five intersection targets indicated the therapeutic targets linked to HF. GO analysis showed that 481 biological processes, 4 cellular components and 23 molecular functions were identified. KEGG analysis showed 13 significant treatment pathways. In animal experiments, rosuvastatin significantly improved the cardiac function of post-myocardial infarction mice and prevented the development of HF after myocardial infarction by inhibiting IL-1Β expression. Cell experiments showed that rosuvastatin could reduce the expression of IL-1B in HUVEC and THP-1 cells. The therapeutic mechanism of rosuvastatin against HF may be closely related to the inhibition of the expression of apoptosis-related proteins, inflammatory factors, and fibrosis-related genes. However, IL-1Β is one of the most important target genes.
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Affiliation(s)
- Zheng Lian
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Jun-Xian Song
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Shi-Ran Yu
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Li-Na Su
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Yu-Xia Cui
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Su-Fang Li
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Chong-Yoo Lee
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Hui-Zhu Liang
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China
| | - Hong Chen
- Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China.
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21
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Schwuchow-Thonke S, Göbel S, Emrich T, Schmitt VH, Fueting F, Klank C, Escher F, Schultheiss HP, Münzel T, Keller K, Wenzel P. Increased C reactive protein, cardiac troponin I and GLS are associated with myocardial inflammation in patients with non-ischemic heart failure. Sci Rep 2021; 11:3008. [PMID: 33542341 PMCID: PMC7862434 DOI: 10.1038/s41598-021-82592-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022] Open
Abstract
Inflammatory cardiomyopathy diagnosed by endomyocardial biopsy (EMB) is common in non-ischemic heart failure (HF) and might be associated with adverse outcome. We aimed to identify markers predicting myocardial inflammation in HF. We screened 517 patients with symptomatic non-ischemic HF who underwent EMB; 397 patients (median age 54 [IQR 43/64], 28.7% females) were included in this study. 230 patients were diagnosed with myocardial inflammation, defined as ≥ 7.0 CD3+ lymphocytes/mm2 and/or ≥ 35.0 Mac1 macrophages/mm2 and were compared to 167 inflammation negative patients. Patients with myocardial inflammation were more often smokers (52.4% vs. 39.8%, p = 0.013) and had higher C-reactive protein (CRP) levels (5.4 mg/dl vs. 3.7 mg/dl, p = 0.003). In logistic regression models CRP ≥ 8.15 mg/dl (OR 1.985 [95%CI 1.160–3.397]; p = 0.012) and Troponin I (TnI) ≥ 136.5 pg/ml (OR 3.011 [1.215–7.464]; p = 0.017) were independently associated with myocardial inflammation, whereas no association was found for elevated brain natriuretic peptide (OR 1.811 [0.873–3.757]; p = 0.111). In prognostic performance calculation the highest positive predictive value (90%) was detected for the combination of Global longitudinal strain (GLS) ≥ -13.95% and TnI ≥ 136.5 pg/ml (0.90 (0.74–0.96)). Elevated CRP, TnI and GLS in combination with TnI can be useful to detect myocardial inflammation. Smoking seems to predispose for myocardial inflammation.
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Affiliation(s)
- S Schwuchow-Thonke
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - S Göbel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - T Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
| | - V H Schmitt
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Fueting
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Klank
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Escher
- Departement of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
| | - H P Schultheiss
- Institut Kardiale Diagnostik Und Therapie (IKDT), Moltkestrasse 31, 12203, Berlin, Germany
| | - T Münzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - K Keller
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - P Wenzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany. .,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
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22
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A deep learning framework for drug repurposing via emulating clinical trials on real-world patient data. NAT MACH INTELL 2021; 3:68-75. [DOI: 10.1038/s42256-020-00276-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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23
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Congestive Heart Failure. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Lifetime risk predictions for cardiovascular diseases: Competing risks analyses on a population-based cohort in Sweden. Atherosclerosis 2020; 312:90-98. [DOI: 10.1016/j.atherosclerosis.2020.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
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25
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Peix A, Padrón K, Cabrera LO, Castañeda O, Milán D, Castro J, Falcón R, Martínez F, Rodríguez L, Sánchez J, Mena E, Carrillo R, Fernández Y, Escarano R, Páez D, Dondi M. Intraventricular synchronism assessment by gated-SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results? EJNMMI Res 2020; 10:125. [PMID: 33079263 PMCID: PMC7575672 DOI: 10.1186/s13550-020-00703-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI).
Methods Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99mTc-MIBI gated-SPECT MPI at rest pre-CRT implantation and 6 ± 1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ventricular ejection fraction (LVEF) at baseline, but the differences were not significant. No significant differences were found at baseline regarding ventricular function, although end-systolic volume was slightly higher in LVNC CM patients. Mean SRS was significantly higher (p < 0.0001) in ischemic patients (14.9) versus non-ischemic ones (8.7 in group 1 and 9 in group 2). At baseline, LVNC CM patients were significantly more dyssynchronous: Their phase standard deviation (PSD) was higher (89.5° ± 14.2°) versus groups 2 (65.2° ± 23.3°) and 3 (69.7° ± 21.7°), p = 0.007. Although the quality of life significantly improved in all groups, non-ischemic patients (with or without LVNC) showed a higher LVEF increase and volumes reduction at 6 months post-CRT. Dyssynchrony reduced post-CRT in all groups. Nevertheless, those more dyssynchronous at baseline (LVNC CM) exhibited the most significant intraventricular synchronism improvement: PSD was reduced from 89.5° ± 14.2° at baseline to 63.7° ± 20.5° post-CRT (p = 0.028). Six months post-CRT, 89% of patients were responders: 11 (100%) of those with LVNC CM, 25 (86%) of those with ischemic CM, and 47 (89%) of patients with non-ischemic CM. No patient with LVNC CM had adverse events during the follow-up. Conclusion CRT contributes to a marked improvement in non-ischemic CM patients with non-compaction myocardium. Phase analysis in gated-SPECT MPI is a valuable tool to assess the response to CRT.
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Affiliation(s)
- Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba.
| | - Kenia Padrón
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Lázaro O Cabrera
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Osmín Castañeda
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Danet Milán
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Jesús Castro
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Roylan Falcón
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Frank Martínez
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Lydia Rodríguez
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Jesús Sánchez
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Erick Mena
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Regla Carrillo
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Yoel Fernández
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Ricardo Escarano
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Diana Páez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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26
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Li DS, Avazmohammadi R, Rodell CB, Hsu EW, Burdick JA, Gorman JH, Gorman RC, Sacks MS. How hydrogel inclusions modulate the local mechanical response in early and fully formed post-infarcted myocardium. Acta Biomater 2020; 114:296-306. [PMID: 32739434 PMCID: PMC7484038 DOI: 10.1016/j.actbio.2020.07.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
Abstract
Expansion of myocardium after myocardial infarction (MI) has long been identified as the primary mechanism that drives adverse left ventricular (LV) remodeling towards heart failure and death. Direct injection of hydrogels into the myocardium to mechanically constrain the infarct has demonstrated promise in limiting its remodeling and expansion. Despite early successes, there remain open questions in the determination of optimal hydrogel therapies, key application characteristics for which include injected polymer volume, stiffness, and spatial placement. Addressing these questions is complicated by the substantial variations in infarct type and extent, as well as limited understanding of the underlying mechanisms. Herein, we present an investigation on how hydrogel inclusions affect the effective tissue-level stiffness and strain fields in myocardium using full three-dimensional (3D) finite element simulations at early and late post-MI time points. We calibrated our simulations to triaxial mechanical and structural measurements of cuboidal LV myocardial specimens of post-infarcted myocardium, 0 and 4 weeks post-MI, injected with a dual-crosslinking hyaluronic acid-based hydrogel. Simulations included multiple deformation modes that spanned the anticipated physiological range in order to assess the effects of variations in inclusion size, location, and modulus on tissue-level myocardial mechanics. We observed significant local stiffening in the hydrogel-injected specimens that was highly dependent on the volume and mechanical properties of the injected hydrogel. Simulations revealed that the primary effect of the injections under physiological loading was a reduction in myocardial strain. This result suggests that hydrogel injections reduce infarct expansion by limiting the peak strains over the cardiac cycle. Overall, our study indicated that modulation of local effective tissue stiffness and corresponding strain reduction are governed by the volume and stiffness of the hydrogel, but relatively insensitive to its transmural placement. These findings provide important insights into mechanisms for ameliorating post-MI remodeling, as well as guidance for the future design of post-MI therapies.
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Affiliation(s)
- David S Li
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Reza Avazmohammadi
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA; Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Christopher B Rodell
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA; Polymeric Biomaterials Laboratory, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward W Hsu
- Preclinical Imaging Core Facility, Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Jason A Burdick
- Polymeric Biomaterials Laboratory, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael S Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
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27
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Zilla P, Deutsch M, Bezuidenhout D, Davies NH, Pennel T. Progressive Reinvention or Destination Lost? Half a Century of Cardiovascular Tissue Engineering. Front Cardiovasc Med 2020; 7:159. [PMID: 33033720 PMCID: PMC7509093 DOI: 10.3389/fcvm.2020.00159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
The concept of tissue engineering evolved long before the phrase was forged, driven by the thromboembolic complications associated with the early total artificial heart programs of the 1960s. Yet more than half a century of dedicated research has not fulfilled the promise of successful broad clinical implementation. A historical account outlines reasons for this scientific impasse. For one, there was a disconnect between distinct eras each characterized by different clinical needs and different advocates. Initiated by the pioneers of cardiac surgery attempting to create neointimas on total artificial hearts, tissue engineering became fashionable when vascular surgeons pursued the endothelialisation of vascular grafts in the late 1970s. A decade later, it were cardiac surgeons again who strived to improve the longevity of tissue heart valves, and lastly, cardiologists entered the fray pursuing myocardial regeneration. Each of these disciplines and eras started with immense enthusiasm but were only remotely aware of the preceding efforts. Over the decades, the growing complexity of cellular and molecular biology as well as polymer sciences have led to surgeons gradually being replaced by scientists as the champions of tissue engineering. Together with a widening chasm between clinical purpose, human pathobiology and laboratory-based solutions, clinical implementation increasingly faded away as the singular endpoint of all strategies. Moreover, a loss of insight into the healing of cardiovascular prostheses in humans resulted in the acceptance of misleading animal models compromising the translation from laboratory to clinical reality. This was most evident in vascular graft healing, where the two main impediments to the in-situ generation of functional tissue in humans remained unheeded–the trans-anastomotic outgrowth stoppage of endothelium and the build-up of an impenetrable surface thrombus. To overcome this dead-lock, research focus needs to shift from a biologically possible tissue regeneration response to one that is feasible at the intended site and in the intended host environment of patients. Equipped with an impressive toolbox of modern biomaterials and deep insight into cues for facilitated healing, reconnecting to the “user needs” of patients would bring one of the most exciting concepts of cardiovascular medicine closer to clinical reality.
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Affiliation(s)
- Peter Zilla
- Christiaan Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.,Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Manfred Deutsch
- Karl Landsteiner Institute for Cardiovascular Surgical Research, Vienna, Austria
| | - Deon Bezuidenhout
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Neil H Davies
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Tim Pennel
- Christiaan Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
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28
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Pressler SJ, Jung M, Lee CS, Arkins TP, O'Donnell D, Cook R, Bakoyannis G, Newhouse R, Gradus-Pizlo I, Pang PS. Predictors of emergency medical services use by adults with heart failure; 2009–2017. Heart Lung 2020; 49:475-480. [DOI: 10.1016/j.hrtlng.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 01/14/2023]
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29
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Ngcobo NN, Tomita A, Ramlall S. Subjective and objective cognition 6-week post-coronary artery bypass graft surgery: A descriptive pilot study. S Afr J Psychiatr 2020; 26:1470. [PMID: 32832127 PMCID: PMC7433260 DOI: 10.4102/sajpsychiatry.v26i0.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Coronary artery bypass graft (CABG) surgery has been found to be associated with post-operative cognitive decline. Despite the large and growing numbers being conducted in South Africa, the associated or ensuing cognitive symptoms or impairment have received little research attention. Aim The aim of this pilot study was to describe the nature and extent of subjective cognitive complaints (SCCs) and objective cognitive impairments in patients 6-week post-CABG surgery in a clinical sample in KwaZulu-Natal (KZN) Province, South Africa. Setting A cross-sectional survey was conducted among outpatients attending their 6-week post-CABG surgical review at a cardiology clinic in a KZN provincial hospital. Method Socio-demographic and clinical data were captured, with SCCs being determined by using standardised questions; cognition was assessed with the Montreal cognitive assessment (MoCA). Results The mean age of the sample (n = 28) was 58.72 years. The mean MoCA score was 23.96 (SD = 4.32); 60.71% (n = 17) screening positive (< 25/30) and more likely to be older, male, hypertensive and diabetic. A third (n = 9; 35.71%) reported at least one new SCC; their mean age was 55.36 years which was lower than those without subjective complaints (59.81). Conclusions Subjective and objective cognitive impairments were evident in patients 6-week post-CABG surgery identifying a need for longitudinal cognitive screening both pre- and post- operatively in patients undergoing CABG surgery.
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Affiliation(s)
- Ntokozo N Ngcobo
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Suvira Ramlall
- Discipline of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Efficacy and safety of catheter-based renal denervation for heart failure with reduced ejection fraction: a systematic review and meta-analysis. Clin Auton Res 2020; 30:521-530. [DOI: 10.1007/s10286-020-00716-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
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Im DJ, Youn JC, Lee HJ, Nam K, Suh YJ, Hong YJ, Hur J, Kim YJ, Choi BW, Kang SM. Role of Cardiac Computed Tomography for Etiology Evaluation of Newly Diagnosed Heart Failure with Reduced Ejection Fraction. J Clin Med 2020; 9:E2270. [PMID: 32708911 PMCID: PMC7408702 DOI: 10.3390/jcm9072270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/31/2022] Open
Abstract
Delayed-enhanced dual-energy computed tomography (DECT) can evaluate the extent and degree of myocardial fibrosis while coronary CT angiography (CCTA) is a widely accepted coronary artery evaluation method. We sought to describe the role of combined cardiac CT for the evaluation of underlying etiology in patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Sixty-three consecutive patients (31 men, 63 ± 16 years) with newly diagnosed HFrEF were enrolled in this prospective study. Coronary artery disease and myocardial fibrosis were evaluated on CCTA and DECT, respectively, and the tentative underlying etiologies of heart failure (HF) were determined with combinations of findings from both CTs. Concordance between tentative etiologies from cardiac CT and final etiologies from clinical decisions within a 2-year follow-up was assessed. Eighteen patients were diagnosed with ischemic HF on initial cardiac CT, and the final diagnosis was not changed. Another 45 patients with nonischemic HF included tentative etiologies of dilated cardiomyopathy (n = 32, 71.1%), sarcoidosis or myocarditis (n = 8, 17.8%), amyloidosis (n = 2, 4.4%), noncompaction (n = 2, 4.4%) and arrhythmogenic right ventricular cardiomyopathy (n = 1, 2.2%). Five nonischemic HF patients showed different etiologies between initial cardiac CT and clinical decisions. The concordance between cardiac CT and clinical decisions was 92.1%. A high degree of concordance was achieved between tentative etiologies from cardiac CT and final diagnoses from clinical decisions. Combined cardiac CT is a feasible, safe and effective imaging tool for the initial evaluation of newly diagnosed HFrEF patients.
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Affiliation(s)
- Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 16247, Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Kyungsun Nam
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (D.J.I.); (K.N.); (Y.J.S.); (Y.J.H.); (J.H.); (Y.J.K.); (B.W.C.)
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
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Baughan N, Poitrasson-Rivière A, Moody JB, Lee BC, Ficaro EP. Quantification of Cardiac Dyssynchrony Entropy Implemented in a Commercial Nuclear Medicine Software Application. NUCL TECHNOL 2020. [DOI: 10.1080/00295450.2019.1708142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Natalie Baughan
- University of Michigan, Nuclear Engineering and Radiological Sciences, Ann Arbor, Michigan
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Keller K, Hobohm L, Ostad MA, Göbel S, Lankeit M, Konstantinides S, Münzel T, Wenzel P. Temporal trends and predictors of inhospital death in patients hospitalised for heart failure in Germany. Eur J Prev Cardiol 2020; 28:990-997. [PMID: 32605456 DOI: 10.1177/2047487320936020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
Abstract
AIMS We investigated trends in incidence, case fatality rate, patient characteristics and adverse inhospital events of patients hospitalised for heart failure in Germany. METHODS AND RESULTS The German nationwide inpatient sample (2005-2016) was used for this analysis. Patients hospitalised due to heart failure were selected for analysis. Temporal trends in the incidence of hospitalisations, case fatality rate and treatments were analysed and predictors of inhospital death were identified. The analysis comprised a total number of 4,539,140 hospitalisations (52.0% women, 81.0% aged ≥70 years) due to heart failure. Although hospitalisations increased from 381 (2005) to 539 per 100,000 population (2016) (β estimate 0.06, 95% confidence interval (CI) 0.06 to 0.07, P < 0.001) in parallel with median age and prevalence of comorbidities, the inhospital case fatality rate decreased from 11.1% to 8.1% (β estimate -0.36, 95% CI -0.37 to -0.35, P < 0.001) and the rate of major adverse cardiovascular and cerebrovascular events (β estimate -0.24, 95% CI -0.25 to -0.23, P < 0.001) decreased from 12.7% to 10.3%. Age 70 years and older (odds ratio (OR) 2.60, 95% CI 2.57 to 2.63, P < 0.001) and cancer (OR 1.93, 95% CI 1.91 to 1.96, P < 0.001) were independent predictors of inhospital death. CONCLUSION Hospitalisations for heart failure increased in Germany from 2005 to 2016, whereas the major adverse cardiovascular and cerebrovascular event rate and inhospital case fatality rate decreased during this period despite higher patient age and increasing prevalence of comorbidities.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,Medical Clinic VII, University Hospital Heidelberg, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany
| | - Mir A Ostad
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany
| | - Sebastian Göbel
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,Department of Internal Medicine and Cardiology, Charité - University Medicine, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,Department of Cardiology, Democritus University Thrace, Greece
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany
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Established and Emerging Pharmacological Therapies for Post-Myocardial Infarction Patients with Heart Failure: a Review of the Evidence. Cardiovasc Drugs Ther 2020; 34:723-735. [PMID: 32564304 DOI: 10.1007/s10557-020-07027-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
After an episode of myocardial infarction (MI), patients remain at risk for recurrent ischemic events, heart failure (HF), and sudden death. Post-MI patients with left ventricular systolic dysfunction (LVSD) have an even greater risk of mortality and morbidity. Randomized clinical trials that included post-MI patients with LVSD have demonstrated that pharmacologic therapies aimed at preventing post-MI remodeling with neurohormonal antagonists can significantly improve short- and long-term outcomes, including death, reinfarction, and worsening HF. Recent trials have also demonstrated benefits in terms of cardiovascular event reduction with effective antithrombotic therapies and cholesterol-lowering agents in post-MI setting, especially in patients at very high risk such as those with LVSD. This paper reviews clinical trials that included post-MI patients with LVSD, with or without signs and symptoms of HF, assessing the efficacy of established and emerging pharmacological therapies.
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Freitas C, Wang X, Ge Y, Ross HJ, Austin PC, Pang PS, Ko DT, Farkouh ME, Stukel TA, McMurray JJ, Lee DS. Comparison of Troponin Elevation, Prior Myocardial Infarction, and Chest Pain in Acute Ischemic Heart Failure. CJC Open 2020; 2:135-144. [PMID: 32462127 PMCID: PMC7242506 DOI: 10.1016/j.cjco.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with heart failure (HF) with concomitant ischemic heart disease (IHD) have not been well characterized. We examined survival of patients with ischemic HF syndrome (IHFS), defined as presentation with acute HF and concomitant features suggestive of IHD. METHODS Patients were included if they presented with acute HF to hospitals in Ontario, Canada. IHD was defined by any of the following criteria: angina/chest pain, prior myocardial infarction (MI), or troponin elevation that was above the upper limit of normal (mild) or suggestive of cardiac injury. Deaths were determined after hospital presentation. RESULTS Of 5353 patients presenting with acute HF, 4088 (76.4%) exhibited features of IHFS. Patients with IHFS demonstrated a higher rate of 30-day (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.33-2.68) and 1-year death (HR, 1.16, 95% CI, 1.00-1.35) compared with those with nonischemic HF. Troponin elevation demonstrated the strongest association with mortality. Mildly elevated troponin was associated with increased hazard over 30-day (HR, 1.77; 95% CI, 1.12-2.81) and 1-year (HR, 1.63; 95% CI, 1.38-1.93) mortality. Troponins indicative of cardiac injury were associated with increased hazard of death over 30 days (HR, 2.33; 95% CI, 1.63-3.33) and 1 year (HR, 1.40; 95% CI, 1.21-1.61). The association between elevated troponin and higher mortality at 30 days was similar in left ventricular ejection fraction subcategories of HF with reduced ejection fraction, HF with mildly reduced ejection fraction, or HF with preserved ejection fraction (P interaction = 0.588). After multivariable adjustment, prior MI and angina were not associated with higher mortality risk. CONCLUSIONS In acute HF, elevated troponin, but not prior MI or angina, was associated with a higher risk of 30-day and 1-year mortality irrespective of left ventricular ejection fraction.
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Affiliation(s)
- Cassandra Freitas
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Yin Ge
- University of Toronto, Toronto, Ontario, Canada
| | - Heather J. Ross
- University Health Network, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Peter C. Austin
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Peter S. Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dennis T. Ko
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael E. Farkouh
- University Health Network, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada
- Heart & Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Ontario, Canada
| | - Therese A. Stukel
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Douglas S. Lee
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
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Bursi F, Persampieri S, Sabatelli L, Bencini C, Santangelo G, Bosotti L, Tayar A, Valli F, Ferrante G, Caretta A, Torta D, Massironi L, Castini D, Carugo S. Diastolic dysfunction grade in acute coronary syndromes: Application of 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations. Int J Cardiol 2020; 305:18-24. [DOI: 10.1016/j.ijcard.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
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Correale M, Paolillo S, Mercurio V, Limongelli G, Barillà F, Ruocco G, Palazzuoli A, Scrutinio D, Lagioia R, Lombardi C, Lupi L, Magrì D, Masarone D, Pacileo G, Scicchitano P, Matteo Ciccone M, Parati G, Tocchetti CG, Nodari S. Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure. Eur J Intern Med 2020; 71:23-31. [PMID: 31708358 DOI: 10.1016/j.ejim.2019.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/27/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
The increasing number of patients with heart failure HF and comorbidities is due to aging population and increase of life expectancy of patients with cardiovascular disease. Encouraging results derived by recent trials may suggest some comorbidities as new targets for new drugs, highlighting the need for a better understanding of the comorbidities' effects in HF patients and the need of a multidisciplinary approach for the management of chronic HF with comorbidities. We report a brief review about main cardiovascular and non-cardiovascular comorbidities in HF patients in order to update physicians and researchers engaged in the HF research or in "fight against heart failure."
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Affiliation(s)
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Limongelli
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy; Department of Translational Medical Sciences, Luigi Vanvitelli University, Naples, Italy; Institute of Cardiovascular Sciences, University College of London, London, United Kingdom
| | - Francesco Barillà
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza" University of Rome, Italy
| | - Gaetano Ruocco
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | | | - Rocco Lagioia
- Cardiology Department, IRCCS "S. Maugeri" Cassano (BA), Bari, Italy
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy
| | - Laura Lupi
- Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University "La Sapienza", Rome, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Pietro Scicchitano
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Savina Nodari
- Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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Nasseri Maleki S, Aboutaleb N, Nazarinia D, Allahverdi Beik S, Qolamian A, Nobakht M. Conditioned medium obtained from human amniotic membrane-derived mesenchymal stem cell attenuates heart failure injury in rats. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2019; 22:1253-1258. [PMID: 32128088 PMCID: PMC7038431 DOI: 10.22038/ijbms.2019.36617.8722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/05/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Heart failure (HF) is one of the leading causes of death worldwide. Due to beneficial effects of stem cells, paracrine secretion of them has recently been used by researchers. The purpose of this study was to investigate the effects of intravenous injection (IV) of conditioned medium (CM) of human amniotic membrane-derived mesenchymal stem cell (MSC-CM) on HF. MATERIALS AND METHODS Male Wistar rats (n=35, 180 g) were randomly divided into five groups: sham, HF, HF+MSC-CM, HF+culture medium and HF+phosphate-buffered saline (PBS). To induce HF, isoproterenol (170 mg/kg/d) was injected subcutaneously for 4 consecutive days. After 28 days, induction of HF was evaluated by echocardiography. A day after echocardiography, 50 μg culture medium/5 ml PBS in HF+culture medium group, 50 μg MSC-CM/5 ml PBS in HF+MSC-CM group and 5 ml PBS in HF+PBS group were injected two times for 4 successive days. The echocardiography was performed 4 weeks after the last injection of isoproterenol. To evaluate the fibrosis, morphology, and cardiac function, Trichrome Masson's staining, Hematoxylin and Eosin staining and echocardiography were performed, respectively. RESULTS CM significantly increased fractional shortening and ejection fraction, and also significantly decreased apoptotic nuclear condensation. Moreover, significant decreased level of fibrosis and increased level of angiogenesis was observed in the treatment group (P<0.05). CONCLUSION Our results indicated that IV injection of CM has therapeutic effects on HF by reducing fibrosis and preventing the progression of failure due to its paracrine effects.
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Affiliation(s)
- Solmaz Nasseri Maleki
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Aboutaleb
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Donya Nazarinia
- Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Allahverdi Beik
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Asadollah Qolamian
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maliheh Nobakht
- Department of Histology and Neuroscience, Anti-microbial Resistance Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction. Chin Med J (Engl) 2019; 132:935-942. [PMID: 30958435 PMCID: PMC6595768 DOI: 10.1097/cm9.0000000000000178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of peri-operative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP. Methods: A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%–50%) left ventricular dysfunction. Results: Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and post-operative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively). Conclusions: Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.
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Abstract
PURPOSE OF REVIEW The current guidelines recommend the use of myocardial contrast echocardiography (MCE) to assess myocardial viability. There are two clinical scenarios where detection of myocardial viability has clinical significance: in ischemic cardiomyopathy and following acute myocardial infarction with significant left ventricular dysfunction. Myocardial contrast echocardiography (MCE), which utilizes microbubbles can assess the integrity of the microvasculature, which sustains myocardial viability in real time and can hence rapidly provide information on myocardial viability at the bedside without ionizing radiation. RECENT FINDINGS We discuss the value of MCE to predict myocardial viability through the detection of the integrity of myocardial microvasculature, the newer evidences behind the MCE-derived coronary flow reserve and use of MCE postmyocardial infarction to detect no-reflow. Newer studies have also demonstrated the comparable sensitivities and specificities of MCE to single photon-emission computed tomography (SPECT), cardiac myocardial resonance imaging and PET for the detection of myocardial viability. SUMMARY Ample evidence now exist that supports the routine use of MCE for the detection of viability as laid down in recent guidelines.
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Is Cardiac Troponin I Valuable to Detect Low-Level Myocardial Damage in Congestive Heart Failure? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:172-178. [PMID: 32377078 PMCID: PMC7199837 DOI: 10.14744/semb.2018.45336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
Objectives: Congestive heart failure (CHF) is a heart disease with a growing incidence and prevalence. Creatine kinase-myocardial base (CK-MB) is generally used to determine myocardial damage; however, it is insufficiently sensitive to measure the relatively low level of myocardial damage that typically occurs in heart failure (HF). The use of cardiac troponins, which are far more sensitive and specific, has become common to identify myocardial damage and permits the detection of even minute amounts of damage. The aim of this study was to ascertain whether cardiac troponin I (cTnI) can be used to detect low-level myocardial damage occurring in CHF in real-life conditions. Methods: Fifty patients with CHF symptoms (Group I) and 20 patients who were evaluated as normal (Group II) were included in this prospective study. The Framingham criteria were used to diagnose HF. Group I was divided into 3 subgroups according to the New York Heart Association classification of functional capacity: Class II, Group A; Class III, Group B, and Class IV, Group C. On the first day of admission, CK-MB and cTnI levels were measured and assessed quantitatively. The cTnI level was compared between these 3 subgroups and between Groups I and II. Linear regression analysis was performed to investigate the relationship between ejection fraction (EF) and cTnI. Results The mean cTnI value was 0.084±0.07 ng/mL in Group I and 0.018±0.012 ng/mL in Group II (p=0.0001). The mean cTnI value was 0.047±0.016 ng/mL, 0.080±0.048 ng/mL, and 0.175± 0.102 ng/mL in Groups A, B, and C, respectively. The difference between the subgroups of Group I was statistically significant. In addition, it was observed that there was a significant difference in the EF (%) value between Groups I and II and between Groups A, B, and C. Linear regression analysis revealed an inverse relationship between EF and cTnI (r: -0.66) (p=0.0001). Conclusion As the severity of HF increased, the cTnI serum level also increased. This increase was inversely related to the EF value. These results are consistent with other studies in the literature, suggesting that the cTnI level may be a useful marker in the diagnosis and evaluation of severity of HF.
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Viabilidad miocárdica: multimodalidad – resonancia magnética cardíaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rodriguez-Palomares JF, Gavara J, Ferreira-González I, Valente F, Rios C, Rodríguez-García J, Bonanad C, García Del Blanco B, Miñana G, Mutuberria M, Nuñez J, Barrabés J, Evangelista A, Bodí V, García-Dorado D. Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI. JACC Cardiovasc Imaging 2019; 12:2445-2456. [PMID: 31202752 DOI: 10.1016/j.jcmg.2019.02.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/17/2019] [Accepted: 02/22/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). BACKGROUND LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial. METHODS Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 ± 2.6 days) and after 6 months (6.1 ± 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia. RESULTS The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 ± 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795). CONCLUSIONS The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR.
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Affiliation(s)
- Jose F Rodriguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - Jose Gavara
- Department of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - César Rios
- Department of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain
| | - Julián Rodríguez-García
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain
| | - Bruno García Del Blanco
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - Gema Miñana
- Department of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain
| | - Maria Mutuberria
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain
| | - José Barrabés
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - Artur Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
| | - Vicente Bodí
- Department of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain.
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain.
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Jia D, Hou L, Lv Y, Xi L, Tian Z. Postinfarction exercise training alleviates cardiac dysfunction and adverse remodeling via mitochondrial biogenesis and SIRT1/PGC-1α/PI3K/Akt signaling. J Cell Physiol 2019; 234:23705-23718. [PMID: 31187505 DOI: 10.1002/jcp.28939] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
Exercise training mitigates cardiac pathological remodeling and dysfunction caused by myocardial infarction (MI), but its underlying cellular and molecular mechanisms remain elusive. Our present study in an in vivo rat model of MI determined the impact of post-MI exercise training on myocardial fibrosis, mitochondrial biogenesis, antioxidant capacity, and ventricular function. Adult male rats were randomized into: (a) Sedentary control group; (b) 4-week treadmill exercise training group; (c) Sham surgery group; (d) MI group with permanent ligation of left anterior descending coronary artery and kept sedentary during post-MI period; and (e) post-MI 4-week exercise training group. Results indicated that exercise training significantly improved post-MI left ventricular function and reduced markers of cardiac fibrosis. Exercise training also significantly attenuated MI-induced mitochondrial damage and oxidative stress, which were associated with enhanced antioxidant enzyme expression and/or activity and total antioxidant capacity in the heart. Interestingly, the adaptive activation of the SIRT1/PGC-1α/PI3K/Akt signaling following MI was further enhanced by post-MI exercise training, which is likely responsible for exercise-induced cardioprotection and mitochondrial biogenesis. In conclusion, this study has provided novel evidence on the activation of SIRT1/PGC-1α/PI3K/Akt pathway, which may mediate exercise-induced cardioprotection through reduction of cardiac fibrosis and oxidative stress, as well as improvement of mitochondrial integrity and biogenesis in post-MI myocardium.
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Affiliation(s)
- Dandan Jia
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Lu Hou
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Yongzhi Lv
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Lei Xi
- Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Zhenjun Tian
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
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Kakkad V, LeFevre M, Hollender P, Kisslo J, Trahey GE. Non-invasive Measurement of Dynamic Myocardial Stiffness Using Acoustic Radiation Force Impulse Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1112-1130. [PMID: 30890282 PMCID: PMC6462419 DOI: 10.1016/j.ultrasmedbio.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 05/23/2023]
Abstract
Myocardial stiffness exhibits cyclic variations over the course of the cardiac cycle. These trends are closely tied to the electromechanical and hemodynamic changes in the heart. Characterization of dynamic myocardialstiffness can provide insights into the functional state of the myocardium, as well as allow for differentiation between the underlying physiologic mechanisms that lead to congestive heart failure. Previous work has revealed the potential of acoustic radiation force impulse (ARFI) imaging to capture temporal trends in myocardial stiffness in experimental preparations such as the Langendorff heart, as well as on animals in open-chest and intracardiac settings. This study was aimed at investigating the potential of ARFI to measure dynamic myocardial stiffness in human subjects, in a non-invasive manner through transthoracic imaging windows. ARFI imaging was performed on 12 healthy volunteers to track stiffness changes within the interventricular septum in parasternal long-axis and short-axis views. Myocardial stiffness dynamics over the cardiac cycle was quantified using five indices: stiffness ratio, rates of relaxation and contraction and time constants of relaxation and contraction. The yield of ARFI acquisitions was evaluated based on metrics of signal strength and tracking fidelity such as displacement signal-to-noise ratio, signal-to-clutter level, temporal coherence of speckle and spatial similarity within the region of excitation. These were quantified using the mean ARF-induced displacements over the cardiac cycle, the contrast between the myocardium and the cardiac chambers, the minimum correlation coefficients of radiofrequency signals and the correlation between displacement traces across simultaneously acquired azimuthal beams, respectively. Forty-one percent of ARFI acquisitions were determined to be "successful" using a mean ARF-induced displacement threshold of 1.5 μm. "Successful" acquisitions were found to have higher (i) signal-to-clutter levels, (ii) temporal coherence and (iii) spatial similarity compared with "unsuccessful" acquisitions. Median values of these three metrics, between the two groups, were measured to be 13.42dB versus 5.42dB, 0.988 versus 0.976 and 0.984 versus 0.849, respectively. Signal-to-clutter level, temporal coherence and spatial similarity were also found to correlate with each other. Across the cohort of healthy volunteers, the stiffness ratio measured was 2.74 ± 0.86; the rate of relaxation, 7.82 ± 4.69/s; and the rate of contraction, -7.31±3.79 /s. The time constant of relaxation was 35.90 ± 20.04ms, and that of contraction was 37.24 ± 19.85ms. ARFI-derived indices of myocardial stiffness were found to be similar in both views. These results indicate the feasibility of using ARFI to measure dynamic myocardial stiffness trends in a non-invasive manner and also highlightthe technical challenges of implementing this method in the transthoracic imaging environment.
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Affiliation(s)
- Vaibhav Kakkad
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
| | - Melissa LeFevre
- Department of Cardiology, Duke University Hospital, Durham, North Carolina, USA
| | - Peter Hollender
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Joseph Kisslo
- Department of Cardiology, Duke University Hospital, Durham, North Carolina, USA
| | - Gregg E Trahey
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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Rajakumar AP, Ravikumar MS, Palanisamy V, Raman K, Mohanraj A, Jamesraj J, Kurian VM, Ajit M, Sethuratnam R. Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial. Indian J Thorac Cardiovasc Surg 2019; 35:175-185. [PMID: 33061002 DOI: 10.1007/s12055-018-0748-6] [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: 04/14/2018] [Revised: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022] Open
Abstract
Objective To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM). Methods Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed. Results Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively. Conclusion Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.
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Affiliation(s)
- Anjith Prakash Rajakumar
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Mithun Sundararaaja Ravikumar
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Vijayanand Palanisamy
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Karthik Raman
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Anbarasu Mohanraj
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Jacob Jamesraj
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Valikapthalil Mathew Kurian
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Mullasari Ajit
- Department of Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Rajan Sethuratnam
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
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Kowalczyk E, Kasprzak JD, Wejner‐Mik P, Wdowiak‐Okrojek K, Lipiec P. Diagnostic utility of two‐dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction. Echocardiography 2019; 36:702-706. [DOI: 10.1111/echo.14312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/08/2019] [Accepted: 02/18/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
| | | | | | | | - Piotr Lipiec
- Department of CardiologyMedical University of Lodz Lodz Poland
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Ghazni MS, Aijaz S, Malik R, Pathan AZ. Prevalence of non-acute ischaemic cardiomyopathy in a Pakistani cohort. HEART ASIA 2019; 11:e011043. [PMID: 31031826 PMCID: PMC6454328 DOI: 10.1136/heartasia-2018-011043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/04/2022]
Abstract
Heart failure with reduced left ventricular ejection fraction (HFrEF) is a frequently encountered clinical scenario. Coronary angiography (CAG) is usually performed to assess obstructive epicardial coronary artery disease (CAD) and the resultant ischaemia as causes of HFrEF. OBJECTIVES To determine the frequency of obstructive CAD (OCAD) in patients with HFrEF and its independent predictors and outcomes. METHODS Retrospective observational study in Tabba Heart Institute on patients who underwent CAG during the past 4 years. Patients with prior known CAD or revascularisation were excluded. OCAD was defined as per the criteria from Felker et al. Regression modelling was performed to evaluate the predictors of OCAD. Survival was compared between the groups using the log rank test. RESULTS Out of 2235 patients who underwent CAG, 260 had HFrEF as a primary indication for CAG and, of these, 119 (45.8%) had OCAD. Major predictors of OCAD were age >50 years at presentation (OR 2.0, 95% CI 1.1 to 3.7), presence of chest pain (OR 4.3, 95% CI 2.3 to 8.1), family history of premature CAD (OR 2.8, 95% CI 1.3 to 5.9) and utilisation of non-invasive (NIV) stress testing before CAG (OR 3.6, 95% CI 1.8 to 7.1). Survival was significantly lower (log rank p<0.001) in patients with OCAD with no revascularisation compared with OCAD with revascularisation or those who had non-obstructive CAD, and the latter two groups had comparable survival. CONCLUSIONS OCAD is detected in nearly half of the patients with reduced left ventricular systolic function undergoing CAG. Clinical judgement based on thorough history and use of NIV stress testing can help in appropriate patient selection for this test.
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Affiliation(s)
| | - Saba Aijaz
- Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Rehan Malik
- Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Asad Z Pathan
- Cardiology, Tabba Heart Institute, Karachi, Pakistan
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A collagen hydrogel loaded with HDAC7-derived peptide promotes the regeneration of infarcted myocardium with functional improvement in a rodent model. Acta Biomater 2019; 86:223-234. [PMID: 30660010 DOI: 10.1016/j.actbio.2019.01.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/25/2018] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
Abstract
Myocardial infarction (MI) leads to the loss of cardiomyocytes, left ventricle (LV) dilation, and cardiac dysfunction, eventually developing into heart failure. Most of the strategies for MI therapy require biomaterials that can support tissue regeneration. In this study, we hypothesized that the extracellular matrix (ECM)-derived collagen I hydrogel loaded with histone deacetylase 7 (HDAC7)-derived-phosphorylated 7-amino-acid peptide (7Ap) could restrain LV remodeling and improve cardiac function after MI. An MI model was established by ligation of the left anterior descending coronary artery (LAD) of C57/B6 mice. The 7Ap-loaded collagen I hydrogel was intramyocardially injected to the infarcted region of the LV wall of the heart. After local delivery, the 7Ap-collagen increased neo-microvessel formation, enhanced stem cell antigen-1 positive (Sca-1+) stem cell recruitment and differentiation, decreased cellular apoptosis, and promoted cardiomyocyte cycle progression. Furthermore, the 7Ap-collagen restricted the fibrosis of the LV wall, reduced the infarct wall thinning, and improved cardiac performance significantly at 2 weeks post-MI. These results highlight the promising implication of 7Ap-collagen as a novel candidate for MI therapy. STATEMENT OF SIGNIFICANCE: The mammalian myocardium has a limited regenerative capability following myocardial infarction (MI). MI leads to extensive loss of cardiomyocytes, thus culminating in adverse cardiac remodeling and congestive heart failure. In situ tissue regeneration through endogenous cell mobilization has great potential for tissue regeneration. A 7-amino-acid-peptide (7A) domain encoded by a short open-reading frame (sORF) of the HDAC7 gene. The phosphorylated from of 7A (7Ap) has been reported to promote in situ tissue repair via the mobilization and recruitment of endogenous stem cell antigen-1 positive (Sca-l+) stem cells. In this study, 7Ap was shown to improve H9C2 cell survival, in vitro. In vivo investigations in a mouse MI model demonstrated that intra-myocardial delivery of 7Ap-loaded collagen hydrogel promoted neovascularization, stimulated Sca-l+ stem cell recruitment and differentiation, reduced cardiomyocyte apoptosis and promoted cell cycle progression. As a result, treated infarcted hearts had increased wall thickness, had improved heart function and exhibited attenuation of adverse cardiac remodeling, observed for up to 2 weeks. Overall, these results highlighted the positive impact of implanting 7Ap-collagen as a novel constituent for MI repair.
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Małyszko J, Tomaszuk-Kazberuk A, Dobrzycki K, Bachórzewska-Gajewska H, Zorawski M, Koc-Zorawska E, Kobus G, Dobrzycki S. Vitamin D deficiency and anemia is highly prevalent and dependent on the etiology of heart failure: A pilot study. Cardiol J 2019; 28:262-270. [PMID: 30697681 DOI: 10.5603/cj.a2019.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/05/2019] [Accepted: 01/06/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anemia and vitamin D deficiency are common factors in chronic heart failure (CHF). The aim of this study was to assess vitamin D levels as well as its binding protein and anemia in relation to a cause of CHF: coronary heart disease, valvular disease and cardiomyopathy. METHODS One hundred and sixteen consecutive patients (36 females and 80 males) with CHF were admitted for percutaneous coronary interventions (PCI). Hemoglobin concentration, serum creatinine, B-type natriuretic peptide (BNP), 25-hydroxyvitamin D [25(OH)D] and its binding protein-VDBP were measured. RESULTS The prevalence of anemia was 22%. BNP was the highest in the group with coronary artery disease. Ejection fraction was the lowest in cardiomyopathy group. 25(OH)D was lowest in valvular disease group, significantly lower than in the coronary artery group. A similar pattern of change showed vitamin D binding protein. The prevalence of vitamin D deficiency (level below 20 ng/mL) in the whole group was 95%, in 49% of the patients 25(OH)D was below 10 ng/mL. In univariate analysis 25(OH)D correlated with hemoglobin, red blood cell count, hematocrit, mean corpuscular volume and BNP in patients with CHF in the whole group. In multiple regression analysis, predictors of 25(OH)D were estimated, glomerular filtration rate, BNP and valvular disease. CONCLUSIONS 25(OH)D deficiency is common in CHF patients. Valvular disease is associated the most severe vitamin D deficiency and worsened kidney function. A higher prevalence of anemia in CHF due to coronary heart disease may be associated with wider use of angiotensin converting enzyme inhibitors and acetylsalicylic acid. Heart and kidney function are predictors of 25(OH)D level in the patients of this study.
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Affiliation(s)
- Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Poland, Warsaw, Poland
| | | | - Konrad Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Poland, Bialystok, Poland
| | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Poland, Department of Clinical Medicine, Medical University of Bialystok, Poland, Bialystok, Poland
| | - Marcin Zorawski
- Department of Clinical Medicine, Medical University of Bialystok, Poland, Bialystok, Poland
| | - Ewa Koc-Zorawska
- 2nd Department of Nephrology and Hypertension, Medical University of Bialystok, Poland, Bialystok, Poland
| | - Grażyna Kobus
- Department of Clinical Medicine, Medical University of Bialystok, Poland, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Poland, Bialystok, Poland
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