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Clinical and Structural Factors Affecting Ablation Outcomes in Atrial Fibrillation Patients - A Review. 影响心房颤动患者消融结果的临床和结构因素——综述。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X19666230331103153
Justin Brilliant, Ritu Yadav, Tauseef Akhtar, Hugh Calkins, Natalia Trayanova, David Spragg

Catheter ablation is an effective and durable treatment option for patients with atrial fibrillation (AF). Ablation outcomes vary widely, with optimal results in patients with paroxysmal AF and diminishing results in patients with persistent or long-standing persistent AF. A number of clinical factors including obesity, hypertension, diabetes, obstructive sleep apnea, and alcohol use contribute to AF recurrence following ablation, likely through modulation of the atrial electroanatomic substrate. In this article, we review the clinical risk factors and the electro-anatomic features that contribute to AF recurrence in patients undergoing ablation for AF.

导管消融是心房颤动(AF)患者的一种有效且持久的治疗选择。消融结果差异很大,阵发性房颤患者效果最佳,持续性或长期持续性房颤患者疗效递减。许多临床因素,包括肥胖、高血压、糖尿病、阻塞性睡眠呼吸暂停和饮酒,可能通过调节心房电解剖基底,导致消融后房颤复发。在这篇文章中,我们回顾了房颤消融患者中导致房颤复发的临床危险因素和电解剖特征。
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引用次数: 0
First Trimester Tricuspid Regurgitation: Clinical Significance. 第一个三尖瓣返流:临床意义。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X19666221206115642
Sofia Teixeira, Luís Guedes-Martins

Tricuspid regurgitation is a cardiac valvular anomaly that consists of the return of blood to the right atrium during systole due to incomplete valve closure. This structure can be visualized on ultrasound between 11 and 14 weeks of gestation in most cases. Despite being a common finding, even in healthy fetuses, the presence of tricuspid regurgitation may be associated with chromosomal and structural abnormalities. The evaluation of tricuspid flow and the presence of regurgitation on first-trimester ultrasound has shown promising results regarding its role in the early detection of aneuploidies, congenital heart defects, and other adverse perinatal outcomes. This review article aims to demonstrate the importance of tricuspid regurgitation as a secondary marker, and consequently, significant benefits of its early detection when added to the combined first-trimester screening. Its value will be discussed, namely its sensitivity and specificity, alone and together with other current markers in the fetal assessment performed in the first-trimester ultrasound.

三尖瓣反流是一种心脏瓣膜异常,包括在收缩期由于瓣膜闭合不完全而导致血液回流到右心房。在大多数情况下,这种结构可以在妊娠11至14周的超声波上观察到。尽管这是一个常见的发现,即使在健康胎儿中,三尖瓣反流的存在也可能与染色体和结构异常有关。妊娠早期超声对三尖瓣血流和是否存在反流的评估显示,其在早期发现非整倍体、先天性心脏缺陷和其他不良围产期结局方面的作用具有良好的效果。这篇综述文章旨在证明三尖瓣反流作为次要标志物的重要性,因此,将其添加到妊娠早期联合筛查中时,早期检测的显著益处。将单独讨论其价值,即其敏感性和特异性,以及与其他当前标记物一起在妊娠早期超声中进行的胎儿评估中的价值。
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引用次数: 0
Heart Failure And Type 2 Diabetes Mellitus: Neurohumoral, Histological And Molecular Interconnections. 心力衰竭与2型糖尿病:神经体液、组织学和分子相互作用。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X18666220617121144
A Ushakov, V Ivanchenko, A Gagarina

Heart failure (HF) is a global healthcare burden and a leading cause of morbidity and mortality worldwide. Type 2 diabetes mellitus (T2DM) appears to be one of the major risk factors that significantly worsen HF prognosis and increase the risk of fatal cardiovascular outcomes. Despite a great knowledge of pathophysiological mechanisms involved in HF development and progression, hospitalization rates in patients with HF and concomitant T2DM remain elevated. In this review, we discuss the complex interplay between systemic neurohumoral regulation and local cardiac mechanisms participating in myocardial remodeling and HF development in T2DM with special attention to cardiomyocyte energy metabolism, mitochondrial function and calcium metabolism, cardiomyocyte hypertrophy and death, extracellular matrix remodeling.

心力衰竭(HF)是全球医疗负担,也是全球发病率和死亡率的主要原因。2型糖尿病(T2DM)似乎是严重恶化HF预后并增加致命心血管后果风险的主要风险因素之一。尽管对HF发展和进展的病理生理机制有着丰富的了解,但HF和合并T2DM患者的住院率仍然很高。在这篇综述中,我们讨论了系统神经体液调节和参与T2DM心肌重塑和HF发展的局部心脏机制之间的复杂相互作用,特别关注心肌细胞能量代谢、线粒体功能和钙代谢、心肌细胞肥大和死亡、细胞外基质重塑。
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引用次数: 0
Galectin-3 is Associated with Heart Failure Incidence: A Meta-Analysis. 半乳糖凝集素-3与心力衰竭发病率相关:荟萃分析。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X19666221117122012
Basil M Baccouche, Mattia A Mahmoud, Corrine Nief, Karan Patel, Barbara Natterson-Horowitz

Introduction: Heart failure (HF) is a leading cause of death worldwide. The global prevalence of heart failure is projected to increase rapidly in the coming decades, and significant attention has turned to improving biomarker-based risk prediction of incident HF. This paper aimed to qualitatively and quantitatively evaluate the evidence associating levels of galectin-3 with the risk of incident HF.

Methods: A review of PUBMED-indexed peer-reviewed literature was performed. Nine studies met the inclusion criteria, and all nine had data eligible for conversion and pooling. A randomeffects meta-analysis was performed using hazard ratios and 95% confidence intervals from a minimally adjusted model, a further adjusted model, and from subgroups within the further-adjusted model.

Results: The minimally-adjusted model provided an HR of 1.97 (95% CI 1.74-2.23) when comparing the top quartile of log-gal-3 to the bottom quartile. The further-adjusted model provided an HR of 1.32 (95% CI 1.21-1.44) for the same comparison. The positive, significant association was conserved during sensitivity analysis.

Conclusion: There is a significant positive association between circulating galectin-3 and the risk of incident heart failure. Given the complex mechanistic relationship between galectin-3 and cardiovascular pathophysiology, further investigation is recommended for the possible implementation of galectin-3 into clinical risk prediction models.

引言:心力衰竭(HF)是世界范围内死亡的主要原因。预计在未来几十年,全球心力衰竭的患病率将迅速上升,人们的注意力已转向改进基于生物标志物的HF事件风险预测。本文旨在定性和定量评估半乳糖凝集素-3水平与HF发病风险相关的证据。方法:回顾PUBMED索引的同行评审文献。九项研究符合纳入标准,所有九项研究的数据都符合转换和汇总的条件。使用最小调整模型、进一步调整模型和进一步调整模型内的亚组的风险比和95%置信区间进行随机效应荟萃分析。结果:当比较log-gal-3的上四分位数和下四分位数时,最小调整模型的HR为1.97(95%CI 1.74-2.23)。对于相同的比较,进一步调整的模型提供了1.32的HR(95%CI 1.21-1.44)。在敏感性分析中,阳性、显著的关联是保守的。结论:循环中的半乳糖凝集素-3与发生心力衰竭的风险之间存在显著的正相关。鉴于半乳糖凝集素-3与心血管病理生理学之间的复杂机制关系,建议进一步研究半乳糖凝集素3在临床风险预测模型中的可能应用。
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引用次数: 0
Responses Triggered by the Immune System in Hypertensive Conditions and Repercussions on Target Organ Damage: A Review. 免疫系统在高血压条件下触发的反应和对靶器官损伤的反应:综述。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X18666220920090632
Carlos Henrique Nascimento Domingues da Silva, Idrys Henrique Leite Guedes, Jefferson Carlos Santos de Lima, João Marcelo Duarte Ribeiro Sobrinho, Angela Amancio Dos Santos

Background: Hypertension is a chronic, multifactorial clinical condition characterized by sustained high blood pressure levels. It is often associated with functional-structural alterations of target organs, which include heart, brain, kidneys, and vasculature.

Objective: This study highlights the recent correlation between the immune system and hypertension and its repercussions on target-organ damage.

Methods: The descriptors used for the search of the study were "hypertension", "immunity", and "target organs". The methodology of the study followed the main recommendations of the PRISMA statement.

Results: The damage to the vasculature arises mainly from the migration of T cells and monocytes that become pro-inflammatory in the adventitia, releasing TNF-α, IFN-γ, and IL-17, which induce endothelial damage and hinder vascular relaxation. In the renal context, the inflammatory process associated with hypertension culminates in renal invasion by leukocytes, which contribute to the injury of this organ by mechanisms of intense sympathetic stimulation, activation of the reninangiotensin system, sodium retention, and aggravation of oxidative stress. In the cardiac context, hypertension increases the expression of pro-inflammatory elements, such as B, T, and NK cells, in addition to the secretion of IFN-γ, IL-17, IL-23, and TNF-α from angiotensin II, reactive oxygen species, and aldosterone. This pro-inflammatory action is also involved in brain damage through SphK1. In view of the above, the participation of the immune system in hypertension-induced injuries seems to be unequivocal.

Conclusion: Therefore, understanding the multifactorial mechanisms related to hypertension will certainly allow for more efficient interventions in this condition, preventing target organ damage.

背景:高血压是一种慢性、多因素的临床疾病,其特征是持续的高血压水平。它通常与靶器官的功能结构改变有关,靶器官包括心脏、大脑、肾脏和血管系统。目的:本研究强调了免疫系统与高血压及其对靶器官损伤的影响之间的最新相关性。方法:用于检索研究的描述符为“高血压”、“免疫”和“靶器官”。研究方法遵循了PRISMA声明的主要建议。结果:血管系统的损伤主要源于T细胞和单核细胞的迁移,它们在外膜中成为促炎细胞,释放TNF-α、IFN-γ和IL-17,诱导内皮损伤并阻碍血管舒张。在肾脏方面,与高血压相关的炎症过程最终导致白细胞侵袭肾脏,白细胞通过强烈的交感神经刺激、肾素-血管紧张素系统的激活、钠滞留和氧化应激的加重等机制导致该器官的损伤。在心脏方面,除了血管紧张素II、活性氧和醛固酮分泌IFN-γ、IL-17、IL-23和TNF-α外,高血压还会增加促炎元素如B、T和NK细胞的表达。这种促炎作用也通过SphK1参与脑损伤。鉴于上述情况,免疫系统参与高血压诱导的损伤似乎是明确的。结论:因此,了解与高血压相关的多因素机制必将有助于对这种情况进行更有效的干预,预防靶器官损伤。
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引用次数: 0
Endless Journey of Adenosine Signaling in Cardioprotective Mechanism of Conditioning Techniques: Clinical Evidence. 腺苷信号在条件调节技术心脏保护机制中的无尽旅程:临床证据。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X19666230612112259
Kuldeep Kumar, Nirmal Singh, Harlokesh Narayan Yadav, Leonid Maslov, Amteshwar Singh Jaggi

Myocardial ischemic injury is a primary cause of death among various cardiovascular disorders. The condition occurs due to an interrupted supply of blood and vital nutrients (necessary for normal cellular activities and viability) to the myocardium, eventually leading to damage. Restoration of blood supply to ischemic tissue is noted to cause even more lethal reperfusion injury. Various strategies, including some conditioning techniques, like preconditioning and postconditioning, have been developed to check the detrimental effects of reperfusion injury. Many endogenous substances have been proposed to act as initiators, mediators, and end effectors of these conditioning techniques. Substances, like adenosine, bradykinin, acetylcholine, angiotensin, norepinephrine, opioids, etc., have been reported to mediate cardioprotective activity. Among these agents, adenosine has been widely studied and suggested to have the most pronounced cardioprotective effects. The current review article highlights the role of adenosine signaling in the cardioprotective mechanism of conditioning techniques. The article also provides an insight into various clinical studies that substantiate the applicability of adenosine as a cardioprotective agent in myocardial reperfusion injury.

心肌缺血性损伤是各种心血管疾病死亡的主要原因。这种情况的发生是由于心肌的血液和重要营养物质(正常细胞活动和生存能力所必需的)供应中断,最终导致损伤。缺血组织血液供应的恢复会导致更致命的再灌注损伤。已经开发了各种策略,包括一些预处理和后处理技术,以检查再灌注损伤的有害影响。许多内源性物质被认为是这些条件调节技术的起始物、介质和末端效应物。腺苷、缓激肽、乙酰胆碱、血管紧张素、去甲肾上腺素、阿片类药物等物质已被报道可介导心脏保护活性。在这些药物中,腺苷已被广泛研究,并被认为具有最显著的心脏保护作用。目前的综述文章强调腺苷信号在条件反射技术的心脏保护机制中的作用。这篇文章还深入了解了各种临床研究,这些研究证实了腺苷作为心脏保护剂在心肌再灌注损伤中的适用性。
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引用次数: 0
A Role of Thyroid Hormones in Acute Myocardial Infarction: An Update. 甲状腺激素在急性心肌梗死中的作用:最新进展。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X18666220428121431
Rabia Rasool, Ahsanullah Unar, Tassadaq Hussain Jafar, Ghulam Qadir Chanihoon, Bismillah Mubeen

The acute coronary syndrome is one of the commonest life-threatening illnesses. It encompasses the clinical spectrum of acute myocardial ischemia and includes unstable angina and acute myocardial infarction both with and without ST segment elevation. The acute coronary syndrome can be attributed to a significant hemodynamic insult that leads to atherosclerosis of the epicardial coronary arteries. The main causative risk factors, such as obesity, smoking, and alcohol intake, increase the burden of acute coronary syndrome. Owing to an increase in the utilization of antioxidants, the antioxidant capacity decreases concerning the scavenging of lipid peroxides. Moreover, the thyroid hormones are important regulators of the expression of cardiac genes, and many of the cardiac manifestations of thyroid dysfunction are associated with alterations in triiodothyronine- mediated gene expression. Cardiovascular signs and symptoms of thyroid disease are among the most acute clinically relevant findings that occur in combination with both hypothyroidism and hyperthyroidism. By understanding the cellular mechanism of the action of thyroid hormones on the heart and cardiovascular system, it is possible to explain rhythm disturbances and alterations in cardiac output, blood pressure, cardiac contractility, and vascular resistance that result from thyroid dysfunction. Oxidative stress is thereby induced, together with a decrease in antioxidant capacity for overcoming oxidative stress, which leads to endothelial dysfunction, subsequent atherosclerosis, and, ultimately, acute myocardial infarction. The implications for the identification of the effects of thyroid disease on acute myocardial infarction include the observation that restoration of normal thyroid function repeatedly reverses abnormalities in cardiovascular hemodynamics.

急性冠状动脉综合征是最常见的危及生命的疾病之一。它包括急性心肌缺血的临床谱,包括不稳定型心绞痛和伴有和不伴有ST段抬高的急性心肌梗死。急性冠状动脉综合征可归因于导致心外膜冠状动脉动脉粥样硬化的显著血液动力学损伤。主要的致病危险因素,如肥胖、吸烟和饮酒,会增加急性冠状动脉综合征的负担。由于抗氧化剂利用率的增加,抗氧化能力随着脂质过氧化物的清除而降低。此外,甲状腺激素是心脏基因表达的重要调节因子,甲状腺功能障碍的许多心脏表现与三碘甲状腺原氨酸介导的基因表达的改变有关。甲状腺疾病的心血管体征和症状是甲状腺功能减退症和甲状腺功能亢进症合并出现的最急性的临床相关发现。通过了解甲状腺激素对心脏和心血管系统作用的细胞机制,可以解释甲状腺功能障碍引起的节律紊乱和心输出量、血压、心脏收缩力和血管阻力的变化。氧化应激由此被诱导,同时克服氧化应激的抗氧化能力降低,从而导致内皮功能障碍、随后的动脉粥样硬化,并最终导致急性心肌梗死。识别甲状腺疾病对急性心肌梗死影响的意义包括观察到甲状腺功能恢复正常反复逆转心血管血流动力学异常。
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引用次数: 0
Cardiovascular Toxicities with Chimeric Antigen Receptor T-cell Therapy. 嵌合抗原受体T细胞治疗的心血管毒性。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X18666220623152350
Jashan Gill

Chimeric antigen receptor (CAR) T-cell therapy has shown remarkable efficacy in treating highly refractory and relapsing hematological malignancies in pediatric and adult patients. However, this promising therapy is limited by severe and potentially life-threatening toxicities. Cytokine release syndrome (CRS) is the most commonly observed of these toxicities. The cardiovascular manifestations of CRS include tachycardia, hypotension, left ventricular dysfunction, arrhythmias, troponin elevation, cardiogenic shock, and pulmonary edema. Recent data suggest that cardiotoxicities may be transient and reversible in younger patients with few cardiac comorbidities; however, cardiotoxicities may be fatal in older patients with significant cardiac risk factors. The literature remains sparse regarding long-term cardiotoxicities associated with CAR-T cell therapy. Furthermore, consensus guidelines for monitoring and prevention of cardiotoxicities remain illdefined. Therefore, this review will detail the cardiovascular toxicities of CAR T-cell therapy seen in clinical trials and observational studies, summarize treatment approaches for CRS, outline the currently adopted surveillance protocols for CAR T-cell associated cardiotoxicity, and explore the future directions of research in this rapidly emerging field.

嵌合抗原受体(CAR)T细胞疗法在治疗儿童和成人患者的高度难治性和复发性血液系统恶性肿瘤方面显示出显著疗效。然而,这种有前景的治疗方法受到严重且可能危及生命的毒性的限制。细胞因子释放综合征(CRS)是这些毒性中最常见的。CRS的心血管表现包括心动过速、低血压、左心室功能障碍、心律失常、肌钙蛋白升高、心源性休克和肺水肿。最近的数据表明,在很少有心脏合并症的年轻患者中,心脏毒性可能是短暂和可逆的;然而,心脏毒性在有重大心脏危险因素的老年患者中可能是致命的。关于CAR-T细胞治疗相关的长期心脏毒性的文献仍然很少。此外,监测和预防心脏毒性的共识指导方针仍然定义不清。因此,这篇综述将详细介绍临床试验和观察性研究中发现的CAR T细胞治疗的心血管毒性,总结CRS的治疗方法,概述目前采用的CAR T-细胞相关心脏毒性监测方案,并探索这一快速新兴领域的未来研究方向。
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引用次数: 1
A Systematic Review of Arterial Dissections in COVID-19 Patients. 新冠肺炎患者动脉夹层的系统回顾。
IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X18666220628093303
Betsy Abraham, Sherman David Mathew, Kannan Sridharan

Introduction: COVID-19 is often seen presenting with a myriad of signs and symptoms of multiorgan dysfunction including arterial dissection.

Methods: Various theories have been proposed such as endothelial dysfunction triggered by hyperinflammatory response that results in rupture of atherosclerotic plaque and subsequent dissection.

Results: However, the exact incidence is unknown and only case reports and case series have been published till date.

Conclusion: Here we carried out a systematic analysis of published case reports/series related to dissection of the aorta, coronary, cerebral, vertebral, cervical, renal, and splanchnic arteries.

简介:新冠肺炎通常表现为多种多器官功能障碍的体征和症状,包括动脉夹层。方法:人们提出了各种理论,如高炎症反应引发的内皮功能障碍导致动脉粥样硬化斑块破裂和随后的夹层。结果:然而,确切的发病率尚不清楚,迄今为止只发表了病例报告和病例系列。结论:在这里,我们对已发表的与主动脉、冠状动脉、脑动脉、椎动脉、颈动脉、肾动脉和内脏动脉夹层相关的病例报告/系列进行了系统分析。
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引用次数: 2
Myocardial Infarction as a Consequence of Mitochondrial Dysfunction. 线粒体功能障碍引起的心肌梗死。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 DOI: 10.2174/1573403X19666230508114311
Pranay Wal, Namra Aziz, Yash Kumar Singh, Ankita Wal, Sourabh Kosey, Awani Kumar Rai

Acute myocardial infarction is an event of myocardial necrosis caused by unstable ischemic syndrome. Myocardial infarction (MI) occurs when blood stops flowing to the cardiac tissue or myocardium and the heart muscle gets damaged due to poor perfusion and reduced oxygen supply. Mitochondria can serve as the arbiter of cell fate in response to stress. Oxidative metabolism is the function of mitochondria within the cell. Cardiac cells being highly oxidative tissue generates about 90% of their energy through oxidative metabolism. In this review, we focused on the role of mitochondria in energy generation in myocytes as well as its consequences on heart cells causing cell damage. The role of mitochondrial dysfunction due to oxidative stress, production of reactive oxygen species, and anaerobic production of lactate as a failure of oxidative metabolism are also discussed.

急性心肌梗死是由不稳定缺血性综合征引起的心肌坏死事件。当血液停止流向心脏组织或心肌,心肌因灌注不良和氧气供应减少而受损时,就会发生心肌梗死(MI)。线粒体可以作为细胞对压力反应命运的仲裁者。氧化代谢是细胞内线粒体的功能。作为高度氧化组织的心脏细胞通过氧化代谢产生约90%的能量。在这篇综述中,我们重点讨论了线粒体在肌细胞能量产生中的作用,以及它对心脏细胞造成细胞损伤的影响。还讨论了氧化应激引起的线粒体功能障碍、活性氧的产生和乳酸的厌氧产生作为氧化代谢失败的作用。
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引用次数: 0
期刊
Current Cardiology Reviews
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