Frontiers in Cardiovascular Medicine最新文献

Background: Fibroblasts in the fibrotic heart exhibit a heterogeneous biological behavior. The specific subsets of fibroblasts that contribute to progressive cardiac fibrosis remain unrevealed. Our aim is to identify the heart fibroblast (FB) subsets that most significantly promote fibrosis and the related critical genes as biomarkers for ischemic heart disease.

Methods: The single nuclei RNA sequencing (snRNA-seq) and bulk RNA sequencing datasets used in this study were obtained from the Gene Expression Omnibus (GEO). The activity of gene sets related to progressive fibrosis was quantified for each FB cluster using the AddmoleculeScore function. Differentially expressed genes (DEGs) for the specific cell cluster with the highest fibrotic transcription dynamics were identified and integrated with bulk RNA sequencing data for analysis. Multiple machine learning models were employed to identify the optimal gene panel for diagnosing ischemic heart disease (IHD) based on the intersected DEGs. The effectiveness and robustness of the gene-derived diagnostic tool were validated using two independent IHD cohorts.Subsequently, we validated the signature genes using a rat post-myocardial infarction heart failure model.

Results: We conducted an analysis on high-quality snRNA-seq data obtained from 3 IHD and 4 cardiac sarcoidosis heart samples, resulting in the identification of 16 FB clusters. Cluster2 exhibited the highest gene activity in terms of fibrosis-related transcriptome dynamics. The characteristic gene expression profile of this FB subset indicated a specific upregulation of COL1A1 and several pro-fibrotic factors, including CCDC102B, GUCY1A3, TEX41, NREP, TCAP, and WISP, while showing a downregulation of NR4A1, an endogenous inhibitor of the TGF-β pathway. Consequently, we designated this subgroup as COL1A1^hiNR4A1^low FB. Gene set enrichment analysis (GSEA) shows that the gene expression pattern of COL1A1^hiNR4A1^low FB was closer to pathways associated with cardiac fibrosis. Through machine learning, ten feature genes from COL1A1^hiNR4A1^low FB were selected to construct a diagnostic tool for IHD. The robustness of this new tool was validated using an independent cohort and heart failure rats.

Conclusion: COL1A1^hiNR4A1^low FB possess heightened capability in promoting cardiac fibrosis. Additionally, it offers molecular insights into the mechanisms underlying the regulation of the TGF-β pathway. Furthermore, the characteristic genes of COL1A1hiNR4A1 FB could serve as valuable tools for diagnosing of IHD.

Fusarium, a genus of soil and vegetation-based fungi, is a rare cause of infections in immunocompromised individuals, including transplant recipients. In this case, we describe successful treatment of Fusarium falciforme mediastinitis in the recipient of an orthotopic heart transplant. Treatment included multiple courses of combination antibiotic and antifungal therapy several surgical debridements, continuous mediastinal irrigation with antifungal agents, and staged closure with an omental flap. This is the first report describing successful eradication of fusarium sp. mediastinitis and provides a template for treating complex cases of mediastinitis and osteomyelitis.

Background: We intended to observe the effects of different doses of remimazolam besylate via intravenous induction on the quality of sedation and cardiac function in elderly patients.

Methods: A total of 135 ASA I-III patients undergoing elective laparoscopic cholecystectomy were selected. They were divided into three groups and they were randomized. Low dose group (Group L): Remimazolam besylate 0.2 mg/kg; middle dose group (Group M): Remimazolam besylate 0.3 mg/kg; High dose group (Group H): Remimazolam besylate 0.4 mg/kg. There were 45 patients in each group. The blood pressure, heart rate, BIS values, cardiac function before induction (T₀), after induction (T₁) and after intubation (T₂), as well as the length of loss of consciousness, duration of sedation, and extubation and adverse events were recorded.

Results: At T₁ and T₂, systolic and diastolic blood pressure in Group M were lower than those in Group L, but higher than those in Group H, with statistically significant differences (P < 0.05). At T₁ and T₂, the BIS value in Group M was lower than that in Group L, with a statistically significant difference (P < 0.05). However, there was no statistically significant difference (P > 0.05) in BIS values between Group M and Group H; At T₁ and T₂, the cardiac output and stroke volume in Group M were higher than those in Group H, while the systemic vascular resistance in Group M was lower than that in Group H, with statistically significant differences (P < 0.05); The incidences of bucking when moving and hiccup in Group L were higher than those in Group M and Group H, with statistically significant differences (P < 0.05). The number of vasoactive drugs used in Group H was higher than that in Group L and Group M, with statistically significant differences (P < 0.05).

Conclusions: General anesthesia induction with remimazolam besylate at 0.3 mg/kg in elderly patients undergoing laparoscopic cholecystectomy showed good quality of sedation, could achieve rapid intubation, with minimal effect on cardiac function and generally favorable safety profile.

Background: This study examines the relationship between Hb, RDW and their association and both short-term and long-term mortality in patients with acute aortic dissection (AAD), aiming to establish combined effect between Hb and RDW as a potential prognostic biomarker for AAD outcomes.

Methods: We extracted clinical data from the Medical Information Mart for Intensive Care (MIMIC) databases for this analysis. Using adjusted Cox regression and Kaplan-Meier survival curve analyses, we assessed the relationship between Hb, RDW and their association at admission and mortality at multiple post-discharge intervals (30 days, 90 days, 1 year, and 5 years) among patients with AAD. Additionally, subgroup analyses and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive accuracy of Hb, RDW and their association for mortality in this patient population.

Results: High RDW combined with low Hb (RDW ≥ 13.60 and Hb < 7.9) significantly predicted increased mortality at 30 days, 90 days, 1 year, and 5 years post-diagnosis, with hazard ratios (HRs) as follows: 4.33 (95% CI: 1.82-10.33, P < 0.001), 4.48 (95% CI: 2.06-9.77, P < 0.001), 3.38 (95% CI: 1.70-6.70, P < 0.001), and 3.07 (95% CI: 1.66-5.66, P < 0.001), respectively.

Conclusion: Hb and RDW are both abnormal (Hb with low level, RDW with high level) is positively correlated with 30 days, 90 days, 1 year, and 5 years mortality risk in patients with AAD. This suggests that combined effect between Hb and RDW is a significant predictor of short-term to long-term mortality risk in this patient population, highlighting its potential utility as a prognostic marker in clinical settings.

More than 1 million permanent pacemakers are implanted worldwide each year, half of which are in patients with high-grade atrioventricular block. Pacemakers provide adequate frequency support in the initial stage, but traditional right ventricular (RV) pacing may lead to or aggravate left ventricular dysfunction and arrhythmia. Several potential risk factors for heart failure and arrhythmias after pacemaker surgery have been identified, but their occurrence remains difficult to predict clinically. Compared with RV pacing, His bundle pacing (HBP) and left bundle branch pacing (LBBP) activate the intrinsic His-Purkinje conduction system and provide physiological activation, but whether HBP and LBBP also cause ventricular mechanical dyssynchrony remains uncertain. The implantation of cardiac resynchronization therapy and implantable cardioverter defibrillator depends on left ventricular ejection fraction (LVEF). LVEF This depends on volume changes and is less reproducible. Speckle tracking echocardiography (STE) is a technique that can accurately quantify the degree and duration of systolic deformation. STE detects changes in myocardial function more sensitively than traditional measures of diastolic and systolic function, including LVEF. Clinicians can evaluate myocardial strain and synchrony based on strain (percent change in segmental length from baseline) and strain rate (strain per unit time). This review and case series investigate the clinical use of speckle tracking echocardiography in pacemaker implantation.

A young female patient suffered cardiogenic shock after undergoing surgery for an ectopic pregnancy. Coronary artery computed tomography angiography (CTA) revealed a left main artery (LM) originating from the right coronary sinus and traveling between the aorta and pulmonary artery. We successfully resuscitated the patient with mechanical circulatory support using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). The patient subsequently underwent surgery thereafter. When sudden cardiogenic shock occurs in a young patient, it is important to be vigilant for anomalous aortic origin of a coronary artery (AAOCA).

Background: Loeys-Dietz syndrome (LDS) is a clinically and genetically heterogeneous, autosomal dominant aortic aneurysm syndrome with widespread systemic involvement. We present the case of a 16.5-year-old girl with LDS type 2 (LDS2) caused by a heterozygous pathogenic variant, c.1582C>T (p.Arg528Cys), in the transforming growth factor-beta receptor type 2 (TGFBR2) gene who was treated with recombinant growth hormone (rGH) due to coexisting GH deficiency (GHD). This case report (observational study) presents the efficacy of rGH therapy and the safety aspects of this treatment, including aortal imaging follow-up (echocardiography, ECHO). To our knowledge, this is the first investigation of the effects of long-term rGH treatment on aortic dimensions in an LDS patient.

Case summary: LDS was recognized in the patient in the 2nd year of life. After the 3rd year of life, growth deceleration was observed. At age 6, GHD was recognized [the maximum GH after stimulation 7.2 ng/ml; insulin-like growth factor-1 (IGF-1), 35 ng/ml; N: 84-447]. At age 6.5 years, rGH was initiated (height standard deviation score, htSDS -2.4), which continued for up to 14.25 years (htSDS-1.4). Her height at 16.5 years was 155 cm. The dose of rGH was 0.025-0.028 mg/kg/day. After the age of 16 months, widening of the aortic root was observed via echocardiography. At nearly 16 years, due to dilated aortic root (Z score +5.95), the girl underwent a plastic operation on the aorta, which had a satisfactory outcome. The patient's current status is stable, but the management of patients with LDS requires multidisciplinary cooperation due to the many coexisting comorbidities.

Conclusions: Although aortic dilatation occurs in most LDS patients, the possible influence of GH therapy on aortic size must be considered. However, whether IGF-1, the main biochemical marker of GH activity, can be independently associated with increased aortic diameter has not been determined. In addition to its growth-promoting effect, the wide influence of GH on the human body, metabolic status, and muscle strength is also significant. The extremely low IGF-1 level before rGH therapy in the present patient and the strict monitoring of the IGF1/IGFBP3 ratio during rGH administration seem to be safe and beneficial for therapy.

Background: Poor nutritional status may affect outcomes after coronary revascularization, but the association between nutritional status and outcomes in patients undergoing coronary revascularization has not been fully evaluated. This study was based on the MIMIC-IV database to analyze the impact of baseline nutritional status on poor outcomes in patients with coronary revascularization.

Methods: Patients with coronary revascularization were screened from the MIMIC-IV database. A geriatric nutritional risk index (GNRI) was calculated and used to divide patients into 4 groups: no malnutrition (Q4: ≥96.79), mild malnutrition (Q3: 90.85-96.78), moderate malnutrition (Q2: 86.37-90.84), and severe malnutrition (Q1: 86.37). The primary outcome measure was 28-day mortality, and the secondary outcome measures were AKI and length of hospital stay. Cox proportional hazards model, Kaplan-Meier survival analysis, restricted cubic spline (RCS), and multiple linear regression model were used for statistical analysis, respectively, to ensure the robustness of study results.

Results: A total of 1,168 patients with coronary revascularization were included. The GNRI demonstrated a significant association with 28-day mortality in patients undergoing coronary revascularization. As a continuous variable, the GNRI exhibited a notable inverse correlation with mortality across unadjusted, partially adjusted, and fully adjusted Cox regression models [hazard ratios (HRs): 0.93, 0.94, 0.96, respectively; all P < 0.001]. When considered as a categorical variable, a low GNRI (first quartile, Q1) was significantly associated with elevated mortality risks (HRs: 2.64, 2.30, 1.82 in the unadjusted, partially adjusted, and fully adjusted models, respectively; all P < 0.05). Subgroup analysis revealed a more pronounced association in patients under 65 years of age (P for interaction = 0.014). Furthermore, reduced GNRI levels were also associated with an increased incidence of AKI and extended hospital lengths of stay.

Conclusion: GNRI is associated with prognosis in patients with coronary revascularization. Patients with lower GNRI had higher 28-day mortality, greater risk of AKI, and longer hospital stays.

Background: More than 23 million deaths and 36.5% of disability-adjusted life-years are the result of the direct effects of unhealthy behavior alone. Daily behaviors have strong implications for health outcomes and quality of life. The aim of this study is to determine the behavioral and biomedical factors associated with lifestyle modification practices among diagnosed hypertensive patients in pastoral health facilities of southern Ethiopia.

Methods: A facility-based cross-sectional study was conducted among 453 diagnosed hypertensive adult patients in pastoral health of southern Ethiopia from June 1/2023 to July 30/2023. The study population was randomly selected from among patients diagnosed with hypertension that was followed up during the study period using a systematic random sampling technique. The data were entered into Epi-Data-4.6.0.2 and exported to SATAT version 14 for analysis. A binary logistic regression model was fitted to determine independent predictors of lifestyle modification practices among hypertensive patients. An adjusted odds ratio with a 95% confidence interval was used to declare a state of significance.

Results: Out of 453 potential participants approached, 433 agreed to successfully participate in the study, for a response rate of 95.6%. Of the total participants, 56.1% (95% CI, 51.38-60.74) of the patients practiced the recommended lifestyle modifications. Alcohol consumption (AOR = 0.64, 95% CI: 0.42-0.96), ever-practiced reducing salt intake (AOR = 2.48, 95% CI: 1.57-3.93), and low-density lipoprotein cholesterol levels in the blood (>160 mg/dl) (AOR = 3.3, 95% CI: 1.72-6.34) were independently associated with lifestyle modifications in patients with hypertension.

Conclusion: This study revealed that the prevalence of lifestyle modification practices (LMP) was low among hypertensive patients. Lifestyle modification is not one-stop practical, but continuous proper awareness creation, counseling, and health education and health promotion are needed to scale up healthy behavior in patients with hypertension to create a good lifestyle.