Future cardiology最新文献

The recently introduced concept of 'exposome' emphasizes the impact of non-traditional threats onto cardiovascular health. Among these, air pollutants - particularly fine particulate matter < 2.5 μm (PM2.5) - have emerged as significant environmental risk factors for cardiovascular disease and mortality. PM2.5 exposure has been shown to induce endothelial dysfunction, chronic low-grade inflammation, and cardiometabolic impairment, contributing to the development and destabilization of atherosclerotic plaques. Both short- and long-term exposure to air pollution considerably increase the incidence of ischemic heart disease (IHD)-related events, with clinical evidence linking pollution to higher mortality and adverse prognosis, especially in vulnerable populations. In this review, we explore the mechanistic pathways through which air pollutants exacerbate atherosclerotic cardiovascular disease (ASCVD) and discuss their clinical impact.Furthermore, special attention will be directed to the outcomes and prognosis of patients with pollution-aggravated coronary atherosclerosis, as well as the potential role of targeted public health interventions.

Background: The role of body composition as a risk factor for adverse outcomesduring coronary artery bypass surgery (CABG) has been controversial. The goal of this study was to evaluate the effect of body weight on mortality in patients undergoing CABG.

Method: Using a large NIS database and ICD-10 coding for different bodyweight categories, we evaluated the effect of cachexia, overweight, obesity, and morbid obesity on in-hospital mortality after CABG.  We evaluated the available database containing ICD10 coding from 2016- 2020.

Results: We found that cachexia was the strongest independent predictor of in-hospital mortality whereas obesity had a protective effect. Over the 4-year sample size, patients with cachexia had nearly a 4-fold increase in mortality compared to patients with normal weight despite adjusting for age and comorbidities (4.06 CI 2.7-6.0, p < 0.001). Patients with overweight and Obesity had the lowest mortality (OR = 0.44 CI 0.29-0.66, OR = 0.58 CI 0.52-0.63, p, 001). However, the mortality benefit disappeared in patients with morbid obesity (OR 0.9, CI 0.84-1.03, p = 0.15) with a trend of higher mortality in patients with morbid obesity after multivariate adjustment.

Conclusion: Cachexia is a powerful predictor for in-hospital mortality in patients undergoing CABG. Overweight and obesity have protective effect which disappears with morbid obesity.

The Medina classification separates true bifurcation lesions into three unnecessary groups: 1.1.1, 1.0.1, and 0.1.1. Non-true bifurcation lesions are divided into three unnecessary subgroups called 0.0.1, 0.1.0, and 1.0.0. Furthermore, the Medina classification does not describe any other important features of a given bifurcation lesion, making it useless when comparing complex bifurcation lesions. This has led to confusion in clinical settings and stagnation of bifurcation research. The Movahed bifurcation classification has overcome those problems by summarizing all true bifurcation lesions into one simple relevant category called B2 (B for bifurcation, 2 meaning both main and side branches at bifurcation site have significant lesions) and non-true bifurcation lesions into two simple categories called B1m (B for bifurcation, 1 m meaning only the main branch has significant lesion) and B1S lesions (B for bifurcation and 1 s meaning only the side branch has significant lesion). Moreover, at the same time, additional unlimited suffixes can be added if needed to describe a given bifurcation lesion, making this bifurcation also very comprehensive. In this perspective, the shortcomings of the Medina classification compared to the Movahed classification are discussed in detail.

Introduction: Little information exists regarding the detection of early coronary heart disease protein biomarkers. The aim of this study was to investigate several potential candidates.

Methods: Systematic review was carried out followed by meta-analysis.

Results: The standardized mean difference (95% confidence intervals) for each comparison was: Troponins 2.31 (1.18, 3.4), iL-6 1.3 (0.8, 1.81), fibrinogen 1.55 (1.16, 1.94), NT-proBNP 1.05 (0.72, 1.38), lipoprotein a 0.75 (0.48, 1.03) osteoprotegerin 0.92 (0.23, 1.62), VCAM-1 1.53 (0.87, 2.18), pentraxin 3 0.87 (-0.13, 1.87), PAI-1 2.51 (-0.65, 5.66) MMP9 1.25 (0.36, 2.14), MCP-1 1.99 (1.12, 2.85) and adiponectin -1.11 (-1.49, -0.73).

Conclusion: Multiple biomarkers that could potentially be used for the early detection of coronary heart disease were identified.

Introduction: Acute coronary syndrome (ACS) patients undergoing primary percutaneous coronary intervention (PPCI) often experience the no-reflow phenomenon (NRP), characterized by reduced myocardial perfusion despite an open coronary artery. Adenosine, a potent vasodilator, is used to aid reperfusion. To elucidate underlying molecular mechanism of this phenomenon, we investigated expression of ADORA2A and ADORA2B genes, encoding adenosine receptors, in ACS patients with NRP and non-NRP.

Methods: We conducted a case-control study of 102 ACS patients undergoing PPCI, including 51 patients with NRP (TIMI flow grade 0 or 1) and 51 non-NRP patients with normal flow (TIMI flow grade 2 or 3). Gene expression was measured using Real-Time PCR.

Results: Analysis showed significantly reduced expression of both ADORA2A and ADORA2B genes in NRP patients compared to non-NRP (p < 0.01). Furthermore, we observed a direct and moderate correlation between the two genes in NRP patients (r = 0.45, p = 0.001), whereas the correlation was stronger and more direct in non-NRP (r = 0.8, p = 0.0001).

Conclusion: Reduced adenosine receptor expression may contribute to the NRP in ACS patients undergoing PPCI. These findings highlighted the importance of understanding molecular mechanisms underlying this phenomenon to develop targeted therapies aimed at improving cardiac reperfusion.

Introduction: Mitral Valve Transcatheter Edge-to-Edge Repair (M-TEER) is a minimally invasive procedure for patients with symptomatic mitral regurgitation. Its outcomes in patients with a history of coronary artery bypass grafting (CABG) remain unclear.

Methodology: We analyzed data from the Nationwide Inpatient Sample, using ICD-10-CM codes for M-TEER and CABG. Primary outcomes included in-hospital all-cause mortality and periprocedural cardiac complications. Inverse probability of treatment weighting was employed to compare M-TEER patients with or without prior CABG.

Results: From January 2016 to December 2020, we identified 48,835 M-TEER cases in the U.S. with 9,655 patients (19.78%) having a prior CABG. These patients were older and had more comorbidities. M-TEER procedures increased over the study period, including those with prior CABG (2,145 in 2016 vs. 2,682 in 2020). Adjusted analysis showed no significant difference in in-hospital mortality between patients with and without prior CABG [adjusted odds ratio (aOR) 0.85, 95% confidence interval (CI) 0.85-1.32, p = 0.47]. However, patients with prior CABG had lower odds of periprocedural cardiac complications [aOR 0.72, 95% CI 0.59-0.87, p = 0.001].

Conclusions: M-TEER appears safe for patients with prior CABG, showing no adverse peri-procedural outcomes compared to those without CABG. Despite more comorbidities, M-TEER remains a safe option for these patients.

Heart valve replacement is indicated for children with irreparable heart valve disease. These replacements come in a variety of forms including mechanical, xenograft tissue, allograft tissue, and autograft tissue valves. These options each have unique benefits and risks profiles. Mechanical valves are the most structurally durable; however, they represent significant thrombogenic risks and require anticoagulant therapy. Xenograft and homograft tissue valves do not carry the thrombogenic risks found with mechanical valves but also do not have the structural integrity of mechanical valves. Importantly, neither of these options allows for the somatic growth, requiring serial reoperation to implant upsized valves. Autograft implantation and partial heart transplantation each allow for the implantation of growing valves; however, autografts require for either a mechanical or bioprosthetic valve to be fitted into another valve position and PHT requires immunosuppressive medication to allow for the growth of the valve. In summary, outcomes of valve implantation in the pediatric population are significantly subpar compared to the outcomes enjoyed by the adult population. To remedy this, further innovation is needed in heart valve replacement technology.