Frontiers in Cardiovascular Medicine最新文献

Sepsis-induced myocardial dysfunction (SIMD) involves reversible myocardial dysfunction. The use of inotropes can restore adequate cardiac output and tissue perfusion, but conventional inotropes, such as dobutamine and adrenaline, have limited efficacy in such situations. Levosimendan is a novel inotrope that acts in a catecholamine-independent manner. However, study results regarding the treatment of SIMD with levosimendan are inconsistent, and the use of levosimendan is highly controversial. In this review, we summarized the therapeutic mechanisms of levosimendan in SIMD and considered recent research on how to improve the efficacy of levosimendan in SIMD. We also analyzed the potential and limitations of levosimendan for the treatment of SIMD to provide ideas for future clinical trials and the clinical application of levosimendan in SIMD.

Aortic stenosis (AS) was historically considered a disease of the left side of the heart, with the main pathophysiological impact being predominantly on the left ventricle (LV). However, progressive pressure overload in AS can initiate a cascade of extra-valvular myocardial remodeling that could also precipitate maladaptive alterations in the structure and function of the right ventricle (RV). The haemodynamic and clinical importance of these changes in patients with AS have been largely underappreciated in the past. Contemporary data indicates that RV dilatation or impairment identifies the AS patients who are at increased risk of adverse clinical outcomes after aortic valve replacement (AVR). It is now increasingly recognised that effective quantitative assessment of the RV plays a key role in delineating the late clinical stage of AS, which could improve patient risk stratification. Despite the increasing emphasis on the pathological significance of RV changes in AS, it remains to be established if earlier detection of these changes can improve the timing for intervention. This review will summarise the features of normal RV physiology and the mechanisms responsible for RV impairment in AS. In addition, we will discuss the multimodality approach to the comprehensive assessment of RV size, function and mechanics in AS patients. Finally, we will review the emerging evidence reinforcing the negative impact of RV dysfunction on clinical outcomes in AS patients treated with AVR.

Introduction: Heart failure (HF) has a very high prevalence in patients with maintenance hemodialysis (MHD). However, there is still a lack of effective and reliable HF diagnostic markers and therapeutic targets for patients with MHD.

Methods: In this study, we analyzed transcriptome profiles of 30 patients with MHD by high-throughput sequencing. Firstly, the differential genes between HF group and control group of patients with MHD were screened. Secondly, HF-related genes were screened by WGCNA, and finally the genes intersecting the two were selected as candidate genes. Machine learning was used to identify hub gene and construct a nomogram model, which was verified by ROC curve and RT-qPCR. In addition, we further explored potential mechanism and function of hub genes in HF of patients with MHD through GSEA, immune cell infiltration analysis, drug analysis and establishment of molecular regulatory network.

Results: Totally 23 candidate genes were screened out by overlapping 673 differentially expressed genes (DEGs) and 147 key module genes, of which four hub genes (DEPDC1B, CDCA2, APOBEC3B and TYMS) were obtained by two machine learning algorithms. Through GSEA analysis, it was found that the four genes were closely related to ribosome, cell cycle, ubiquitin-mediated proteolysis. We constructed a ceRNA regulatory network, and found that 4 hub genes (TYMS, CDCA2 and DEPDC1B) might be regulated by 4 miRNAs (hsa-miR-1297, hsa-miR-4465, hsa-miR-27a-3p, hsa-miR-129-5p) and 21 lncRNAs (such as HCP5, CAS5, MEG3, HCG18). 24 small molecule drugs were predicted based on TYMS through DrugBank website. Finally, qRT-PCR experiments showed that the expression trend of biomarkers was consistent with the results of transcriptome sequencing.

Discussion: Overall, our results reveal the molecular mechanism of HF in patients with MHD and provide insights into potential diagnostic markers and therapeutic targets.

Background: Metastatic tumours are the most common malignant tumours affecting the heart. Cardiac metastatic tumour progression is rapid, with no specific treatments available, and the prognosis is typically poor. Significant challenges remain in the diagnosis and treatment of cardiac metastases.

Case demonstration: A 52-year-old female presented with a history of exertion palpitations lasting over 2 months, worsened by cough and expectoration for 3 days. Colour Doppler echocardiography revealed a hypoechoic mass in the left atrium, which was excised. Postoperative pathology confirmed metastatic squamous cell carcinoma of the left atrium. Six months after surgical removal, the patient remained in good general condition.

Conclusion: Intracardiac metastasis is extremely rare and presents with non-specific clinical symptoms, often leading to oversight by clinicians. Early diagnosis relies on imaging studies, while definitive diagnosis requires pathological examination. Timely detection is crucial to improving patient prognosis.

Objective: The objective of this study was to improve long-term postoperative survival in a porcine cardiac valve surgery model by utilizing cardiopulmonary bypass (CPB) via left thoracotomy. The study aimed to share refined techniques and insights accumulated over years at a single-center animal clinical trial facility.

Method: A total of 196 Chinese Large White pigs weighing between 60 and 75 kg were used in the study. All animals underwent cardiac valve surgeries via left thoracotomy with CPB. Surgical techniques included mitral valve replacement, mitral valve repair, aortic valve replacement, OZAKI procedure, ascending aorta replacement, and left ventricular assist device implantation. Anesthesia and CPB protocols were optimized to minimize stress and complications. Postoperative care was standardized to enhance recovery and survival.

Result: All 196 pigs survived the surgical procedures, with no deaths reported. The mean surgical duration was 168.55 ± 38.75 min, CPB time was 114.89 ± 32.11 min, and aortic cross-clamp time was 76.75 ± 21.33 min. Automatic heart resumption occurred in 63.8% of pigs, while the remainder required electrical defibrillation or cardiac massage. The postoperative mechanical ventilation time was 2.44 ± 0.58 min, and the average drainage volume at 2 h postoperatively was 27.50 ± 9.70 ml. There were no cases of postoperative hemorrhage complications or blood transfusions, and surgical site infections occurred in only 1.5% of pigs.

Conclusion: The surgical approach utilizing left thoracotomy with CPB has proven effective in significantly enhancing long-term survival rates in porcine heart surgeries. The refined techniques and standardized operational procedures described in this study offer valuable insights for researchers aiming to improve the success of porcine heart valve surgical models. However, due to differences in animal anatomy, the applicability of this surgical approach to other animal models still requires further exploration.

Introduction: Focal atrial tachycardia (FAT) is predominant in the pediatric population. Recent research has identified cases of sustained FAT originating from the interatrial septum (IAS); a subset of cases presents a unique challenge, with foci originating from the peri-patent foramen ovale (peri-PFO), requiring specialized management during catheter ablation. Here, we present a rare case of peri-PFO-associated FAT that resulted in tachycardia-related cardiomyopathy and propose a comprehensive multipath joint strategy for the successful treatment of PFO-associated FAT.

Case presentation: A 10-year-old boy presented with refractory cardiomyopathy associated with incessant atrial tachycardia, unresponsive to metoprolol. A 12-lead electrocardiogram revealed a narrow QRS complex tachycardia with a rate of 157 beats per minute and a prolonged RP relationship. Echocardiography indicated a severely reduced ejection fraction of 22%. Subsequent electrophysiological study findings identified the tachycardia as originating from the anterior limbus of the PFO. Radiofrequency ablation was performed at the earliest activation site and surrounding structures, encompassing the right atrial septum, non-coronary sinus of Valsalva, and the left atrium peri-PFO. Post-procedure, the patient remained free from arrhythmia and showed restored normal cardiac function and was prescribed a low-dose β-blocker for 1 month. Remarkably, the patient continued to be well without the need for any medications for the subsequent 3 months.

Conclusion: The structure of the PFO brought significant challenges in performing successful ablation. The multipath strategy was beneficial in managing peri-PFO-associated FAT based on its anatomical vicinity of the target.

Objective: To retrospectively assess the outcomes of open-heart repair for ventricular septal defect in children using a right vertical axillary incision compared to median sternotomy.

Method: From January 2022 to May 2023, children who underwent open-heart surgery for the repair of congenital ventricular septal defect in our department were selected for a propensity score-matched study. The propensity score matching method was utilized to pair children in the right vertical axillary incision group with those undergoing surgery via median sternotomy at a 1:1 ratio, based on age and weight.

Results: There were 35 cases in each group. In the right vertical axillary incision group, the median age was 15 (7-40) months and the median weight was 8 (7-12) kg. In the median sternotomy group, the median age was 7 (3-37) months and the median weight was 7 (5-14) kg. The age (Z = -1.871, p = 0.061) and weight (Z = -1.462, p = 0.144) of the two groups showed no significant differences. The right vertical axillary incision group exhibited a significantly shorter incision length compared to the median sternotomy group (p < 0.001). Additionally, the median postoperative drainage was lower in the right vertical axillary incision group than in the median sternotomy group (p = 0.044), indicating statistical significance. No significant differences were observed between the groups concerning operation time (p = 0.565), bypass time (p = 0.855), cross-clamp time (p = 0.204), oxygenation index one hour post-surgery (p = 0.651), pleural effusion at 12 h post-surgery (p = 0.470), abnormal postoperative electrocardiogram (p = 0.452), cardiac intensive care unit duration (p = 0.211), or length of hospital stay (p = 0.095). The hospitalized children were followed up for 3 months to 1 year, during which there were no fatalities or complications.

Conclusion: Open-heart repair of congenital ventricular septal defect through a right vertical axillary incision is a safe and effective surgical technique that minimizes surgical trauma and enhances aesthetic outcomes.

Background: Angiography-derived microcirculatory resistance (AMR) is proposed as a novel, pressure- temperature-wire-free and less-invasive method to evaluate coronary microvascular dysfunction (CMD). This study aims to examine the prognostic role of CMD assessed by AMR in predicting adverse events in acute coronary syndrome (ACS) patients with chronic kidney disease (CKD).

Methods: This retrospective cohort study included ACS with CKD patients in the China-Japan Friendship Hospital from January 2016 to November 2022. The patients were divided into CMD and non-CMD groups based on AMR values of less than or greater than 250 mmHg*s/m.

Results: A total of 345 eligible patients were included in this study. During a median follow-up of 23.0 months, higher prevalence rate of MACEs (28.3% vs. 15.1%, P = 0.003) and death (20.2% vs. 4.1%, P = 0.001) were observed in the CMD group. In multivariate Cox regression analysis, patients in the group of CMD had a 1.843 times higher hazard ratio (HR) for developing MACEs (HR: 1.843, 95% CI: 1.071-3.174, P = 0.027) and 5.325 times higher HR for developing death (HR: 5.325, 95% CI: 1.979-14.327, P < 0.001) for every 10 mmHg*s/m increment in AMR. The incorporation of AMR improved the predictive accuracy of the GRACE score for MACEs and death.

Conclusion: This study indicates that the AMR is significantly related to poor prognosis among patients with ACS and CKD. Furthermore, AMR could improve the predictive power of the GRACE risk score. These results indicated that AMR may serve as a valuable clinical tool for classification, risk stratification or therapy individualization in these patients.

Introduction: Several studies suggest a potential correlation between troponin levels detected in serum and saliva. However, prior investigations have not adequately addressed the critical aspect of collecting samples upon admission, which is essential for timely troponin level determination. This study aimed to evaluate the relationship between troponin levels in serum and saliva among patients admitted for chest pain evaluation.

Methods: This observational study was conducted at the Interventional Cardiology Department of the University Medical Center HCMC. Patients presenting with chest pain were enrolled, and unstimulated saliva samples were collected using the Navazesh method simultaneously with the initial blood collection. These samples were then analyzed for levels of salivary troponin I, serum troponin I, and serum high-sensitive troponin T.

Results: Among the 48 patients included, 22 (46%) exhibited myocardial injury, while 12 (25%) were diagnosed with acute myocardial infarction. No significant difference was observed in salivary troponin I levels between the non-myocardial injury and myocardial injury groups (p = 0.425). Moreover, no correlation was found between salivary troponin I levels and either serum troponin T or serum troponin I levels (Pearson correlation p = 0.761, 0.500; Spearman correlation p = 0.857, 0.136, respectively). The ROC curve for salivary troponin I in predicting myocardial injury displayed an AUC of 0.566 (95% CI: 0.402-0.731), indicating poor discriminatory power.

Conclusions: In our investigation, salivary troponin I failed to demonstrate a meaningful correlation with serum troponins, thereby limiting its practical utility in diagnosing myocardial injury or myocardial infarction. Further research is warranted to explore its diagnostic reliability and clinical applicability.