Current Cardiology Reviews最新文献

Chronic ischemic heart failure (CIHF), caused by myocardial injury and cell loss, is a growing public health concern. Despite substantial investments in pharmaco- and device therapies for acute myocardial infarction and CIHF over the past decades, long-term prognosis has shown little improvement. There is a clear need to develop novel therapeutic strategies capable of attenuating progression from acute to chronic myocardial damage, reducing adverse myocardial remodeling, and enhancing myocardial contractility. Cell-based approaches are an important direction in basic and clinical research. Nevertheless, candidate cell types tested to-date in experimental and human studies show several fundamental limitations, including insufficient quantities and potency, poor myocardial uptake, immunogenicity and/or risk of tumorigenicity. Human umbilical cord matrix is a rich source of mesenchymal stem cells (Wharton's jelly mesenchymal stem cells, WJMSCs). WJMSCs are naturally low-immunogenic, demonstrate high plasticity and proliferation capacity, and exhibit an absence of tumorigenic potential. Moreover, by producing specific anti-inflammatory cytokines and chemokines, they reduce the inflammatory response (hence their use in graft-versus-host disease) and have pro-angiogenic, anti-apoptotic, and antifibrotic properties, making them a natural player in myocardial repair and regeneration. Furthermore, WJMSCs can be expanded ex vivo with high genomic stability and full clonogenic potential and can be standardized as an "off-the-shelf" next-generation advanced therapy medicinal product (ATMP). This review aggregates essential, contemporary information on the properties and fundamental mechanisms of WJMSCs addressing the process of infarct healing and chronic myocardial injury. It discusses outcomes from pre-clinical studies, demonstrating improvements in myocardial function and reductions in fibrosis in animal models, paving the way for human ATMP trials.

Introduction: Long-term heart failure hospitalization (HFH) after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients with heart failure and preserved ejection fraction (HFpEF) and its risk factors remain to be investigated.

Methods: AF patients with HFpEF who underwent RFCA from January, 2014 to December, 2018 from three centers were retrospectively included. Patients were assigned to the training and testing cohorts, respectively. In the training cohort, logistic regression analyses were performed to discriminate those with and without HFH. A scoring system was developed accordingly and validated.

Results: A total of 417 AF patients with HFpEF receiving RFCA were enrolled. About 35 patients (8.4%) had HFH for 6 years. In the training cohort, the use of diuretics, atrial tachycardia (AT)/AF recurrence, prior HFH, and female sex were independent predictors of HFH in the multivariable analysis. A DAPF score (ranging from 0 to 9.0) was developed. The area under the receiver operating characteristic curve (AUC) of the DAPF score was 0.880 (95% CI, 0.830- 0.929). A DAPF score ≥3.5 could predict HFH with a sensitivity of 81.8% and a specificity of 74.6%. The performance in the testing cohort remained robust (AUC, 0.858; 95% CI, 0.749- 0.967).

Conclusion: HFH in patients with AF and HFpEF after RFCA is not rare. The DAPF score could predict the risk of HFH in AF patients with HFpEF after RFCA and guide our treatment strategy.

Introduction: Autonomic impairment is a hallmark of heart failure with reduced ejection fraction (HFrEF). While there have been studies on general values for each index of heart rate variability (HRV) analysis in HFrEF, a systematic review comprehensively examining representative values in HFrEF is lacking.

Methods: We searched PubMed, Embase, and Cochrane databases to extract studies reporting representative values of HRV metrics in HFrEF.

Results: A total of 470 HFrEF patients from 6 studies were included in the review. In general, time and frequency domains were abnormally lower in HFrEF, portending a worse prognosis. In HFrEF, the mean or median value of the standard deviation of NN interval, root mean square successive difference, pNN50, and low-frequency power/high-frequency power were 40 to 121 msec, 19 to 62 msec, 1.3 to 14%, and 1.00 to 1.73, respectively.

Conclusion: In this systematic review, most HRV metrics were found to be calculated from 24- hour Holter recordings and were lower in HFrEF patients with poor prognosis.

Cardiovascular diseases remain a significant reason for illness and death globally. Although certain interleukins have been extensively researched about cardiovascular disease (CVD), new findings have identified unique members of the interleukin family that could potentially play a role in cardiovascular well-being and ailments. This review discusses the current understanding of the role of these recently identified interleukins, such as IL-27, IL-31, IL-32, IL-33, and the IL-28 group (IL-28A, IL-28B, IL-29), in the development of cardiovascular diseases. Every interleukin has various impacts achieved through particular receptors and signaling pathways that affect inflammatory processes, differentiation of immune cells, and the functioning of blood vessels. IL-27 controls the development of inflammatory Th17 cells and might decrease inflammation in atherosclerosis. IL-31 plays a role in the interaction between the immune system and nerves, as well as in itching. IL-32 enhances the generation of inflammatory proteins and has been linked to coronary artery disease. IL-33 has beneficial effects on the cardiovascular system, whereas its imitation receptor sST2 could potentially be used as a biomarker. Additional studies are needed to investigate the antiviral and immune-system regulating effects of the IL-28 group in cardiovascular diseases. In general, explaining the ways in which new interleukins contribute to the progression of cardiovascular diseases can help discover fresh targets for therapy and new approaches toward enhancing the prevention and treatment of heart disorders. Additional research on the way these cytokines engage with established disease pathways is necessary.

Left ventricular remodeling (LVR) refers to the changes in the size, shape, and function of the left ventricle, influenced by mechanical, neurohormonal, and genetic factors. These changes are directly linked to an increased risk of major adverse cardiac events (MACEs). Various parameters are used to assess cardiac geometry across different imaging modalities, with echocardiography being the most commonly employed technique for measuring left ventricular (LV) geometry. However, many echocardiographic evaluations of geometric changes primarily rely on two-dimensional (2D) methods, which overlook the true three-dimensional (3D) characteristics of the LV. While cardiac magnetic resonance (CMR) imaging is considered the gold standard for assessing LV volume, it has limitations, including accessibility issues, challenges in patients with cardiac devices, and longer examination times compared to standard echocardiography. In nuclear medicine, LV geometry can be analyzed using the shape index (SI) and eccentricity index (EI), which measure the sphericity and elongation of the left ventricle. Myocardial perfusion imaging (MPI) using SPECT or PET is inherently a 3D technique, making it particularly effective for accurately and consistently assessing LV size and shape parameters. In this context, LV metrics such as EI and SI can significantly enhance the range of quantitative assessments available through nuclear cardiology techniques, with particular value in identifying early LV remodeling in specific patient groups. This article explores the diagnostic significance of left ventricular geometric indices through various diagnostic methods, highlighting the important role of nuclear cardiology.

Background: Anthracycline-based chemotherapy, such as Doxorubicin (DOX), often induces cardiotoxicity in cancer patients, which compromises their health and quality of life.

Objective: This study aimed to verify the effects of exercise concomitant with prolonged administration of DOX on improving cardiotoxicity.

Methods: A systematic literature search in MedLine, PubMed, Web of Science, and Scopus databases was performed from inception until November 2023, strictly following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Preclinical randomized controlled trials related to exercise, cardiotoxicity, and DOX were included.

Results: Eight studies were included in the systematic review and 7 were selected for metaanalysis. By evaluating the Fractional Shortening (FS), it was possible to verify that exercise as complementary therapy provided a cardioprotective effect when compared to DOX combined with sedentary behavior (heterogeneity: I² = 53%; tau² = 0.19; p = 0.03; overall effect: z = 2.69; p < 0.01). However, no additional benefits were observed for the Left Ventricular Ejection Fraction (LVEF) (heterogeneity: I² = 82%; tau² = 1.43; p < 0.01; overall effect: z = 1.42; p = 0.15).

Conclusion: The included studies demonstrated exercise to have a cardioprotective effect on rodents, mainly on FS. However, there is a lack of high-level evidence to guide exercise prescription in clinical practice to improve cardiotoxicity associated with DOX administration.

In order to perform safe cardiac surgery, a knowledge of applied coronary artery anatomy and its variants is essential for cardiac surgeons. In normal individuals, the right and the left coronary arteries arise from the corresponding sinuses of Valsalva within the aortic root. From the cardiac surgical perspective, the coronary artery is divided into the left main coronary artery, its branches (the left anterior descending artery and the circumflex artery), and the right coronary artery. With high-risk cardiac surgeries, including redo procedures, becoming increasingly performed, abnormal courses and variations of the coronary arteries, if not recognized, can predispose the patient to avoidable coronary injuries, resulting in adverse outcomes of cardiac surgical procedures. We aim to describe normal and applied coronary anatomy, common coronary artery variants previously reported, and their clinical relevance to both adult and paediatric cardiac surgery.

Introduction: Non-bacterial Thrombotic Endocarditis (NBTE) is a rare condition characterized by aseptic vegetations of the heart valves, predisposing to valvular dysfunction and end-organ infarction. Lung Cancer (LC) is amongst the most common malignancies associated with NBTE.

Methods: PubMed/MEDLINE was searched from database inception until January 2024, pairing Non-bacterial Thrombotic Endocarditis (NBTE) and related terms with "Lung Cancer (LC)". Reports were included if patients had both NBTE and lung cancer. The risk of bias was assessed using Mixed Methods Analysis Testing (MMAT).

Results and discussion: 32 patients with an average age of 59y +/- 11.6 were included from 31 peer-reviewed publications, with significant findings as below: • The majority (47%) of patients were admitted with stroke. • The most commonly affected valve was aortic (51%), followed by mitral (43%), and tricuspid (5%). • At diagnosis of NBTE, 86% of patients had stage IV cancer. • Multi-organ infarct was common (61%), with the brain most often affected (40%). • Treatment of NBTE included antibiotics (86%), anticoagulation (50%), and cardiac surgery (6%). • Treatment of LC included traditional chemotherapy (30.7%), radiation (16%), tyrosine kinase inhibitors (11.5%), lobectomy (6%), and immunotherapy (3.8%). • Overall mortality rate was 77%. • Mortality rate was 38% in patients treated with chemotherapy and 91% in patients who did not receive chemotherapy. • Mortality rate stratified by anticoagulant: unfractionated heparin (85.7%), DOAC (75%), and LMWH (20%).

Conclusion: High clinical suspicion for NBTE in patients presenting with LC and thromboembolic phenomena can lead to changes in treatment and improved clinical outcomes.

The health and survival of people with heart failure is a growing concern due to the associated illness and death. Traditional treatments such as medication, surgery, and lifestyle changes have not significantly improved life expectancy, leading to a search for more effective drug options. A drug that can act on oxidative stress and cardiac inflammatory markers while carrying the benefits of existing therapies is needed. Targeting the soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) dependent pathway significantly reduces cardiac myocyte death and improves ejection fraction. In 2021, the USFDA approved Vericiguat, a derivative of pyrazolo [3,4-b]pyridine, to decrease the risk of cardiovascular death and hospitalization. This review provides information on the structure, pharmacokinetics, pharmacodynamics, clinical status, and treatment of Vericiguat in heart failure. Riociguat was the first sGC stimulator used in pulmonary hypertension therapy, but its short half-life required multiple dosing, making it unsuitable for cardiovascular diseases. Vericiguat was developed to address this limitation by decreasing metabolism, and both preclinical and clinical investigations have indicated its minimal pharmacokinetic interactions. This makes it appropriate for long-term use in cardiac patients with multiple comorbidities who require several medications. Vericiguat represents a promising new option for heart failure treatment, potentially improving patient outcomes and quality of life. Its compatibility with other heart failure therapies without significant drug-drug interactions further highlights its potential as a cornerstone treatment. Ongoing studies continue to explore its benefits, suggesting that vericiguat may enable more comprehensive and effective management of heart failure, reducing the burden of this debilitating condition.

Introduction: Managing hypertriglyceridemia-induced acute pancreatitis (HTG-AP) can be challenging, particularly due to the need for rapid triglyceride reduction to below 500mg/dL (5.645 mmol/L).

Case report: This is a case describing a 39-year-old female patient who presented to the Emergency Department with acute abdominal pain resulting from severe HTG-AP. However, under conventional therapy with oral lipid-lowering drugs, the triglyceride levels remained uncontrolled. Oral moderate-intensity statins could not only reduce low-density lipoprotein cholesterol (LDLc) by 25%-50%. However, increasing the dose could not further reduce blood lipids while increasing the risk of liver damage. After the administration of proprotein convertase subtilisin/ kexin type 9 inhibitor (PCSK9i), the triglyceride levels were well controlled with no additional side effects, and the symptoms of the patients were completely relieved.

Conclusion: In cases of unsatisfactory lipid control under conventional therapy, PCSK9i may offer a viable option for managing HTG-AP.