International heart journal最新文献

Human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-Exos) have the ability to treat cardiovascular diseases (CVDs). We explored their mechanism on pyroptosis modulation in cardiac microvascular endothelial cells (CMECs).Exosomes were extracted from hUCMSCs using a differential high-speed centrifugation method, and then identified by transmission electron microscopy, nanoparticle tracking analysis, and Western blot analysis. Later, the CMECs were induced by hypoxia/reoxygenation (H/R) in vitro and processed with hUCMSC-Exos or the NLRP3 inflammasome inhibitor CY-09 and the NLRP3 inflammasome activator Nigerian sodium sulfate (NSS). A rat model of ischemia/reperfusion (I/R) injury was established in vivo, followed by hUCMSC-Exo injection. Cell viability and death, and myocardial injury were assessed by CCK-8 and LDH assays and H&E staining. Levels of GSDMD-N, NLRP3, cleaved Caspase-1, IL-1β and IL-18 proteins, and inflammatory factors (IL-1β, IL-18) were determined by Western blot analysis and ELISA.H/R-induced CMECs represented attenuated cell viability and increased cell death, as well as up-regulated levels of pyroptosis proteins (cleaved Caspase-1, GSDMD-N, IL-18, IL-1β), inflammasome key protein (NLRP3) and cell supernatant inflammatory factors (IL-18, IL-1β), while hUCMSC-Exos amplified H/R-induced CMEC viability and lowered cell death, and diminished levels of NLRP3, cleaved Caspase-1, GSDMD-N, IL-18 and IL-1β proteins, and cell supernatant inflammatory factors IL-1β and IL-18. Activating the NLRP3 inflammasome/Caspase-1 pathway partially reversed the inhibitory effect of hUCMSC-Exos on CMEC pyroptosis. hUCMSC-Exos alleviated myocardial injury in I/R rats by modulating the NLRP3 inflammasome/Caspase-1 pathway.hUCMSC-Exos weakened CMEC pyroptosis by inactivating the NLRP3 inflammasome/Caspase-1 pathway.

Open thoracic aortic surgery is believed to necessitate more intensive rehabilitation. This study aimed to compare the progress of postoperative rehabilitation between standard and delayed mobilization. A retrospective review was conducted on 199 patients who underwent isolated total aortic arch replacement via median sternotomy. Cases of in-hospital mortality and postoperative stroke were excluded. Based on the current guidelines for cardiovascular rehabilitation of the Japanese Circulation Society, patients were categorized into standard mobilization (could sit on the edge of bed within 2 days) and delayed mobilization (could not do so) groups. Rehabilitation progress was compared among both groups. Initial mobilization was delayed in 100 patients (delayed mobilization group), primarily because of respiratory failure (46.0%). Preoperative risk characteristics, including EuroSCORE II (median, 2.9 versus 3.5), were similar between the standard and delayed mobilization groups. The delayed mobilization group had longer operation (median, 6.1 versus 8.0 hours, P < 0.001) and cardiopulmonary bypass (median, 3.2 versus 4.1 hours, P < 0.001) times. Independent ambulation occurred earlier in the standard mobilization group (median, 6.0 versus 8.0 days, P < 0.001).In conclusion, early initiation of sitting on the edge of the bed within 2 days was associated with earlier independent ambulation during postoperative rehabilitation, which supports the current guidelines. Longer operation and cardiopulmonary bypass times were associated with delayed mobilization initiation, suggesting the need for more tailored approaches in such cases.

Atrial fibrillation (AF) pharmaceutical treatment strategy on when to start rhythm control has been debated for decades. In early studies, these 2 strategies exhibited equivalent efficacy; however, more recent studies based on CHA₂DS₂-VASc score indicated that early rhythm control (ERC) is more beneficial than UC. We hypothesized that ERC might benefit persons with AF in other cardiovascular outcomes, regardless of the CHA₂DS₂-VASc score. To elucidate this, we conducted the present study.A retrospective cohort study was conducted using the Yinzhou Regional Health Care Database. We included all patients diagnosed with AF within 1 year and excluded those without age/sex information, without ERC/UC treatment prescription, or with ongoing cancer. The primary outcome was major cardiovascular events (MACE). We used inverse probability of treatment weighting (IPTW) for covariate weighting.A total of 7,161 patients diagnosed with early-stage AF were included in this study. Of them, 2,248 and 4,913 were included in the ERC and UC groups, respectively. During the mean follow-up period of 3.2 years (27,945 person-year), and after IPTW, ERC showed significantly lower risk for MACE (HR: 0.75 [0.61, 0.96], P = 0.02) and heart failure (HF; HR: 0.71 [0.54, 0.95], P = 0.01). No significant results were obtained for stroke, cardiovascular death, or all-cause mortality.ERC is more beneficial to early-stage Persons with AF than UC for MACEs, particularly HF.

Pulmonary hypertension (PH) is a serious prognostic complication in patients with systemic sclerosis (SSc). Deep learning models can be applied to detect PH in the chest X-ray images of these patients. The aim of the study was to investigate the performance and prognostic implications of a deep learning algorithm for the diagnosis of PH in SSc patients using chest X-ray images.Chest X-ray images were acquired from 230 SSc patients with suspected PH who underwent chest X-ray and right heart catheterization (RHC). A convolutional neural network was trained to identify the data of patients with PH (mean pulmonary arterial pressure > 20 mmHg). Kaplan-Meier analysis was used to evaluate survival. The area under the receiver operating characteristic curve (AUC) obtained with the deep learning algorithm was 0.826 while the AUC obtained with cardiologist assessments of the same images was 0.804. The 5-year prognosis was 83.4% in patients with PH detected by RHC, and 85% in those with PH detected by the model.The deep learning model developed in this study can detect PH from the chest X-ray data of SSc patients. The prognostic accuracy of the model was demonstrated as well.

Left ventricular (LV) pseudoaneurysm is a rare complication that occurs shortly after myocardial infarction or previous cardiac surgery. We present here a case of an elderly patient with an LV pseudoaneurysm that developed over a long period of time after Dor operation. An 83-year-old man with rapid LV enlargement 18 years after Dor operation presented with dyspnea. We diagnosed his mass as an LV pseudoaneurysm using multiple non-invasive imaging modalities. The suture between the patch and the LV myocardium became fragile and detached over time. However, due to adhesion in the thorax and slow blood flow, the enlargement stopped. Surgery was considered, but due to his age and renal dysfunction, he did not undergo surgery. Conservative treatment with antihypertensive and heart failure therapy was continued. Clinical manifestations of LV pseudoaneurysm vary from asymptomatic to signs of heart failure and even sudden death. Surgery is recommended for LV pseudoaneurysm because of the high risk of rupture, but conservative treatment may be an option that has been developed long after surgery in the era of an increasing number of elderly OMI or post-cardiac surgery patients. Proper diagnosis using multiple imaging modalities may lead to the avoidance of this devastating complication.

We herein report a case of left ventricular dysfunction due to cardiac sarcoidosis following cardiac resynchronization therapy defibrillator (CRT-D) in an 87-year-old man. He presented to our hospital after receiving shock therapy while conscious. Device interrogation revealed that inappropriate shock occurred due to sinus tachycardia. Due to the setting of a low ventricular tachycardia (VT) detection rate because of a history of slow VT, increasing the VT detection rate was not feasible. After initiation of treatment with ivabradine, the sinus rate decreased and there was no recurrence of inappropriate shock during a 3-year follow-up period. Ivabradine was effective for preventing inappropriate shock due to sinus tachycardia.

To compare the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and preserved ejection fraction (pEF) according to flow-gradient status.This retrospective study focused on patients with severe AS and pEF (≥ 50%) undergoing TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) between 2018 and 2022 (n = 781). Patients were divided into 3 groups: normal-flow high-gradient (NF-HG, stroke volume index ≥ 35 mL/m² and mean pressure gradient ≥ 40 mmHg or peak velocity ≥ 4 m/second), low-flow high-gradient (LF-HG), and paradoxical low-flow low-gradient (pLF-LG) groups. Multivariable Cox regression hazard model was used to adjust for confounders.There were 525, 188, and 68 patients in the NF-HG, LF-HG, and pLF-LG groups, respectively. For the entire cohort, the median age was 82 years, and the periprocedural, 1-year, and 5-year mortality rates were 1.8%, 12%, and 48%, respectively. During a median follow-up period of 25 (range 0-72) months, the rates of all-cause mortality and the composite of all-cause mortality and rehospitalization for heart failure were significantly higher in the LF-HG group compared with the NF-HG group, with adjusted hazard ratios (HRs) of 1.41 (95% confidence interval: 1.02-1.92) and 1.35 (1.01-1.79), respectively. In contrast, there were no significant differences between the LF-NG and pLF-LG groups.In patients undergoing TAVR for severe AS and pEF, LF-HG AS had a higher risk of all-cause mortality and the composite outcome compared with NF-HG AS.

Persistent or paroxysmal atrial fibrillation is typically treated with pulmonary vein isolation (PVI) ablation under deep sedation with propofol. Intraoperative hemodynamic or respiratory instability often interferes with the surgical procedure. We retrospectively investigated risk factors in 80 patients who underwent their first PVI ablation for atrial fibrillation at our hospital. Background and echocardiography findings were collected from their electronic charts and the questionnaires they completed during hospitalization. Total intraoperative propofol dose and bolus injections (total number and volume) were defined as surrogate measures of patient instability. Single and stepwise multiple regression were performed using each measure as the dependent variable. When total propofol dose was employed as the dependent variable, significant associations were observed with drinking status (P < 0.05) and body mass index (BMI) (P < 0.05). When total number or volume of intravenous propofol boluses were each used as the dependent variable, significant associations were noted with age (P < 0.05) and BMI (P < 0.05). Separately, statistical analyses were conducted using total propofol dose or total number of bolus injections as the dependent variable and echocardiography parameters as independent variables. A significant association was detected between total dose and left atrial dimension (P < 0.05). These results suggested that younger age, higher BMI (obesity), and current drinking status adversely affect patient stability under deep sedation. To ensure safe ablation, physicians should pay attention to these risk factors when administering deep sedation for PVI.

An 83-year-old man with a 5-month history of asthma presented to the emergency department with chest oppression and dyspnea. Electrocardiography showed ST-segment depression. Transthoracic echocardiography showed no asynergy with an ejection fraction of 62%. Coronary angiography revealed no stenosis. On day 3, he developed worsening dyspnea, cough, and rapidly progressive acute decompensated heart failure with abdominal purpura and lower extremity petechiae.Myocardial and skin biopsies revealed eosinophilic infiltration. He was diagnosed with acute eosinophilic myocarditis and heart failure due to eosinophilic granulomatosis with polyangiitis. Methylprednisolone pulse therapy dramatically improved his symptoms and congestion. Dual single-photon emission computed tomography after 1 year demonstrated lesion improvement.

To examine the role of CITED2 in myocardial ischemia/reperfusion injury (MIRI) in a cell model and uncover the mechanism, hypoxia/reoxygenation (H/R) -stimulated H9C2 cell model was utilized as a MIRI cell model. Quantitative polymerase chain reaction (qPCR) as well as immunoblot assays were carried out to determine the expression of CITED2 in the MIRI cell model. MTT as well as lactate dehydrogenase assays were employed to detect the survival of H/R-stimulated H9C2 cells. Immunoblot, flow cytometry, qPCR, and enzyme-linked immunosorbent assay were carried out to assess the pyroptosis and inflammation in H9C2 cells. Immunoblot assays were used to confirm the mechanism. The expression of CITED2 was low in H/R-stimulated H9C2 cells. CITED2 can increase the survival of H/R-stimulated H9C2 cells. Additionally, CITED2 restrained H/R-stimulated pyroptosis of H9C2 cells. It also restrained the release of H/R-induced inflammatory factors. Mechanically, CITED2 inhibited HIF-1α expression, thereby suppressing MIRI progression. CITED2 attenuates MIRI in cardiomyocytes via mediating HIF-1α expression.