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Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond. 脉冲场消融治疗心房颤动:肺静脉隔离及其他治疗的有效性和安全性的初步经验。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-05 DOI: 10.3390/jcdd11110356
Julian Cheong Kiat Tay, Jannah Lee Tarranza, Shaw Yang Chia, Xuan Ming Pung, Germaine Jie Min Loo, Hooi Khee Teo, Colin Yeo, Vern Hsen Tan, Eric Tien Siang Lim, Daniel Thuan Tee Chong, Kah Leng Ho, Chi Keong Ching

Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all p < 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all p > 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3-97.3] and 82.8% [95% CI, 68.1-97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications.

在亚洲,采用脉冲场消融术(PFA)进行肺静脉隔离(PVI)并附加后壁消融术(PWA)的地区差异仍然未知。我们在此报告脉冲场消融术在房颤消融中的安全性和有效性。我们纳入了 2022 年 9 月至 2024 年 1 月期间接受 PFA 的连续房颤患者。主要疗效终点是 90 天空白期后 12 个月内无房性心律失常复发。安全性终点包括 30 天内全因死亡、心脏填塞、中风、心肌梗死和心力衰竭住院。111名患者(72.3%为男性,79.2%为pAF)因房颤接受了PFA治疗。31人(30.7%)患有结构性心脏病,平均LVEF为57.4±8.1%,CHA2DS2-VASc评分为1.4±1.3。29例患者(28.7%)使用PFA进行了额外的PWA(PVI + PWA)。所有患者的 PWA 均取得了急性成功。接受 PWA 的患者更有可能出现持续性房颤,需要全身麻醉和电解剖图(所有 P <0.05)。纯 PVI 组和 PVI + PWA 组的 PFA 总应用时间、LA 停留时间、手术时间和透视时间相似(均 p > 0.05)。1 年房颤复发率,pAF 组为 10%,持续性房颤组为 21%。纯 PVI 组和 PVI+PWA 组的主要疗效终点无显著差异(12 个月 KM 估计值分别为 90.3% [95% CI, 83.3-97.3] 和 82.8% [95% CI, 68.1-97.4])。没有出现与使用 PFA 相关的并发症。PFA可以安全、有效、高效地用于房颤消融。如果采用额外的 PWA,其程序指标与纯 PVI 策略相似,且不会增加并发症。
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引用次数: 0
The Impact of Triglyceride-Glucose (TyG) Index on Future Cardio and Cerebrovascular Events in Patients with Acute Coronary Syndrome, During 3 Years of Follow-Up. 随访 3 年期间甘油三酯-葡萄糖 (TyG) 指数对急性冠状动脉综合征患者未来心脑血管事件的影响。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-05 DOI: 10.3390/jcdd11110354
Francesca Macaione, Daniela Di Lisi, Cristina Madaudo, Alessandro D'agostino, Daniele Adorno, Vincenzo Sucato, Giuseppina Novo, Salvatore Evola

Background: The triglyceride-glucose (TyG) index is a new alternative insulin resistance (IR) biomarker. The purpose of this study was to assess whether the TyG index can have a prognostic value in patients with acute coronary syndrome (ACS). Moreover, we wanted to compare the TyG index with HOMA index. Methods: We retrospectively enrolled 115 consecutive subjects, 81 males and 34 females, referred for ACS to our Unit of Cardiovascular Care of Policlinico Paolo Giaccone, Palermo. The subjects were divided into tertiles according to TyG index values and we performed a 3-year follow-up study. We considered as an end point new cardiovascular and cerebral events (MACCEs) during follow-up. Results: We found a significant statistical correlation between the HOMA index and the TyG index (p = 0.001). Patients with elevated TyG index have a higher incidence of MACCE at a 3-year follow-up. In our study the TyG index was an independent predictor of MACCEs (95% CI 1.8158 to 16.8068; P 0.0026) and the optimal TyG index cut-off for predicting MACCEs was 4.92 (sensitivity 76.56% and specificity 72.55%). Conclusions: The TyG index seems to significantly have an important prognostic role in patients with ACS and high values of TyG index are superior to HOMA-IR in predicting MACCEs.

背景:甘油三酯-葡萄糖(TyG)指数是一种新的替代性胰岛素抵抗(IR)生物标志物。本研究的目的是评估 TyG 指数对急性冠状动脉综合征(ACS)患者是否具有预后价值。此外,我们还希望将 TyG 指数与 HOMA 指数进行比较。研究方法我们回顾性地连续招募了115名因急性冠状动脉综合征转诊至巴勒莫Policlinico Paolo Giaccone医院心血管监护室的患者,其中男性81人,女性34人。我们根据 TyG 指数值将受试者分为三等分,并进行了为期 3 年的随访研究。我们将随访期间新发心脑血管事件(MACCE)作为终点。结果:我们发现 HOMA 指数和 TyG 指数之间存在明显的统计学相关性(p = 0.001)。TyG指数升高的患者在3年随访期间的MACCE发生率较高。在我们的研究中,TyG 指数是 MACCE 的独立预测因子(95% CI 1.8158 至 16.8068;P 0.0026),预测 MACCE 的最佳 TyG 指数临界值为 4.92(敏感性 76.56%,特异性 72.55%)。结论TyG指数似乎对ACS患者的预后具有重要作用,在预测MACCE方面,高TyG指数值优于HOMA-IR。
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引用次数: 0
The Complementary Role of Cardiopulmonary Exercise Testing in Coronary Artery Disease: From Early Diagnosis to Tailored Management. 心肺运动测试在冠心病中的补充作用:从早期诊断到定制管理。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-05 DOI: 10.3390/jcdd11110357
Simone Pasquale Crispino, Andrea Segreti, Martina Ciancio, Dajana Polito, Emiliano Guerra, Giuseppe Di Gioia, Gian Paolo Ussia, Francesco Grigioni

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. Current clinical guidelines emphasize the importance of functional tests in the diagnostic pathway, particularly for assessing the presence and severity of ischemia. While recommended tests are valuable, they may not fully capture the complex physiological responses to exercise or provide the necessary detail to tailor personalized treatment plans. Cardiopulmonary exercise testing (CPET) offers a comprehensive assessment of the cardiovascular, pulmonary, and muscular systems under stress, potentially addressing these gaps and providing a more precise understanding of CAD, particularly in settings where traditional diagnostics may be insufficient. By enabling more personalized and precise treatment strategies, CPET could play a central role in the future of CAD management. This narrative review examines the current evidence supporting the use of CPET in CAD diagnosis and management and explores the potential for integrating CPET into existing clinical guidelines, considering its diagnostic and prognostic capabilities, cost-effectiveness, and the challenges associated with its adoption.

冠状动脉疾病(CAD)仍然是全球发病和死亡的主要原因,每年造成 900 多万人死亡。由于老龄化以及高血压、糖尿病和肥胖等危险因素的增加,冠状动脉疾病的发病率持续上升。目前的临床指南强调功能检查在诊断过程中的重要性,尤其是在评估缺血的存在和严重程度方面。虽然推荐的测试很有价值,但它们可能无法完全捕捉到运动时的复杂生理反应,也无法提供必要的细节来定制个性化的治疗方案。心肺运动测试 (CPET) 可对压力下的心血管、肺和肌肉系统进行全面评估,有可能弥补这些不足,并更准确地了解 CAD 的情况,尤其是在传统诊断可能不够充分的情况下。CPET 可使治疗策略更加个性化和精确化,从而在未来的 CAD 管理中发挥核心作用。这篇叙述性综述研究了支持 CPET 用于 CAD 诊断和管理的现有证据,并探讨了将 CPET 纳入现有临床指南的可能性,同时考虑了 CPET 的诊断和预后能力、成本效益以及采用 CPET 所面临的挑战。
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引用次数: 0
Pregnant Woman in Outcomes with Prosthetic Heart Valves. 使用人工心脏瓣膜的孕妇。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-04 DOI: 10.3390/jcdd11110353
Giunai Sefiyeva, Ulyana Shadrina, Tatiana Vavilova, Olga Sirotkina, Andrey Bautin, Aigul Chynybekova, Anna Pozhidaeva, Ekaterina Stepanovykh, Anna Starshinova, Dmitry Kudlay, Olga Irtyuga

We here sought to assess thrombotic and hemorrhagic complications and associated risk factors during pregnancy, delivery, and postpartum in women with prosthetic heart valves (PHV).

Methods: The retrospective cohort study covered January 2011 to December 2022. The objective of the study was to assess the risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery, and the postpartum period in women with PHV based on the experience of one perinatal center. We included 88 pregnancies with 77 prosthetic heart valves (PHV), which were divided into two groups, mechanical valve prostheses (MVP) (n = 64) and biological valve prosthesis (BVP) (n = 24). In the study we analyzed pregnancy outcomes, as well as thrombotic and hemorrhagic complication frequencies.

Results: Of 88 pregnancies, 79 resulted in live births. In the MVP group, there were six miscarriages (9.4%) and two medical abortions (3.1%), including one due to Warfarin's teratogenic effects. No miscarriages were reported in the BVP group, but one fetal mortality case (4.2%) occurred. During pregnancy, 11 MVP cases (17.2%) experienced thrombotic complications. In the BVP group, one patient (4.2%) had transient ischemic attack (TIA). Two MVP cases required surgical valve repair during pregnancy, and one in the post-delivery stage was caused by thrombotic complications. Postpartum, two MVP cases had strokes, and in one MVP patient, pulmonary embolism was registered, while no thrombotic complications occurred in the BVP group. Hemorrhagic complications affected 15 MVP cases (17.9%) in the postpartum period. There were no registered cases of maternal mortality.

Conclusions: The effective control of anti-factor Xa activity reduced thrombotic events. However, the persistently high incidence of postpartum hemorrhagic complications suggests a need to reassess anticoagulant therapy regimens, lower target levels of anti-Xa, and reduce INR levels for discontinuing heparin bridge therapy. Despite the heightened mortality risk in MVP patients, our study cohort did not have any mortality cases, which contrasts with findings from other registries.

在此,我们试图评估人工心脏瓣膜(PHV)女性在怀孕、分娩和产后期间的血栓和出血并发症及相关风险因素:这项回顾性队列研究的时间跨度为 2011 年 1 月至 2022 年 12 月。研究的目的是根据一家围产中心的经验,评估人工心脏瓣膜(PHV)女性在妊娠、分娩和产后期间发生血栓和出血并发症的风险因素和频率。我们纳入了 88 例妊娠,其中 77 例为人工心脏瓣膜(PHV),分为机械瓣膜(MVP)(64 例)和生物瓣膜(BVP)(24 例)两组。在研究中,我们分析了妊娠结局以及血栓和出血并发症的发生频率:结果:在 88 例妊娠中,79 例为活产。在 MVP 组中,有 6 例流产(9.4%)和 2 例药物流产(3.1%),其中 1 例是由于华法林的致畸作用。BVP 组无流产报告,但有一例胎儿死亡(4.2%)。妊娠期间,11 例 MVP(17.2%)出现血栓并发症。在 BVP 组中,有一名患者(4.2%)出现短暂性脑缺血发作(TIA)。两名 MVP 患者在怀孕期间需要进行瓣膜修复手术,一名患者在分娩后因血栓并发症而需要进行瓣膜修复手术。产后,2 例 MVP 患者出现中风,1 例 MVP 患者出现肺栓塞,而 BVP 组未出现血栓并发症。15 名 MVP 患者(17.9%)在产后出现出血性并发症。没有产妇死亡病例:结论:有效控制抗因子 Xa 活性可减少血栓事件。然而,产后出血并发症的发生率居高不下,这表明有必要重新评估抗凝治疗方案,降低抗 Xa 的目标水平,并降低 INR 水平,以停止肝素桥治疗。尽管 MVP 患者的死亡风险增加,但我们的研究队列中没有任何死亡病例,这与其他登记研究的结果形成了鲜明对比。
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引用次数: 0
An In Vivo Model of Estrogen Supplementation Concerning the Expression of Ca2+-Dependent Exchangers and Mortality, Vitality and Survival After Myocardial Infarction in Ovariectomized Rats. 雌激素补充与卵巢切除大鼠心肌梗死后 Ca2+ 依赖性交换体的表达及死亡率、活力和存活率有关的体内模型。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-02 DOI: 10.3390/jcdd11110352
Tomáš Toporcer, Tomáš Grendel, Ivana Špaková, Alžbeta Blichárová, Ľudmila Verbóová, Zuzana Benetinová, Beata Čižmárová, Miroslava Rabajdová, Silvia Toporcerová

Background: Ischemic-reperfusion damage of cardiomyocytes due to myocardial infarction (MI) often leads to the death of an individual. Premenopausal women have been observed to have a significantly lower risk of cardiovascular disease (CVD) than men of the same age. In menopausal women, this trend is significantly reversed, and the risk of CVD increases up to 10-fold. Estrogens affect the development and function of the heart muscle, and as they decrease, the risk and poor prognosis of CVD increase. This study is focused on the effects of estrogen supplementation on morbidity, vitality, and NCX1 expression after MI on a model system.

Methods: In this study, female Sprague Dawley rats (n = 58), which were divided into three experimental groups (NN-control group, non-supplemented; OVX-N-ovariectomized, non-supplemented; OVX-S-ovariectomized, supplemented), received left thoracotomy in the fourth intercostal space. The left anterior descendent coronary artery was ligated 2 mm from its origin with an 8.0 suture. An immunohistological analysis as well as an RT-PCR analysis of NCX1 expression were performed.

Results: A higher survival rate was recorded in the OVX-N group (86%) in comparison with the OVX-S group (53%) (p < 0.05). In addition, higher NCX1 expression 7 days/14 days after MI in the OVX-S group in comparison with the NN and OVX-N (p < 0.001 and p < 0.05) groups was recorded. Seven days after MI, a significantly higher expression (p < 0.005) of mRNA NCX1 in the OVX-N group was also recorded in comparison with the NN group.

Conclusions: This study provides a comprehensive description of the effect of estrogen supplementation on NCX1 expression and overall vitality in ovariectomized rats that survived MI.

背景:心肌梗死(MI)导致的心肌细胞缺血再灌注损伤通常会导致患者死亡。据观察,绝经前女性罹患心血管疾病(CVD)的风险明显低于同龄男性。在绝经期妇女中,这一趋势明显逆转,患心血管疾病的风险增加了 10 倍。雌激素会影响心肌的发育和功能,随着雌激素的减少,心血管疾病的风险和不良预后也会增加。本研究的重点是在模型系统中研究雌激素补充对心肌梗死后发病率、活力和 NCX1 表达的影响:本研究将雌性 Sprague Dawley 大鼠(n = 58)分为三个实验组(NN-对照组,不补充雌激素;OVX-N-卵巢切除组,不补充雌激素;OVX-S-卵巢切除组,补充雌激素)。用 8.0 号缝线在距冠状动脉源头 2 毫米处结扎左前降支冠状动脉。对 NCX1 的表达进行了免疫组织学分析和 RT-PCR 分析:结果:OVX-N 组的存活率(86%)高于 OVX-S 组(53%)(P < 0.05)。此外,心肌梗死后 7 天/14 天,OVX-S 组的 NCX1 表达高于 NN 组和 OVX-N 组(p < 0.001 和 p < 0.05)。心肌梗死7天后,OVX-N组的mRNA NCX1表达量也明显高于NN组(p < 0.005):本研究全面描述了补充雌激素对心肌梗死后存活的卵巢切除大鼠的 NCX1 表达和整体活力的影响。
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引用次数: 0
Effects of Respiratory Muscle Training Pre- and Post-Cardiac Surgery in Adults: A Scoping Review. 成人心脏手术前后呼吸肌训练的效果:范围综述。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-02 DOI: 10.3390/jcdd11110351
Giulia Starko, Daniel Müller, Antoine Lipka, Patrick Feiereisen, Camilo Corbellini, Raphael Martins de Abreu

Background: Coronary artery bypass grafts (CABGs) and cardiac valve replacement surgeries (CVRSs) are common lifesaving cardiac surgeries. They are linked to an increased risk of postoperative pulmonary complications (PPCs). This review scopes the effects of inspiratory muscle training (IMT) on adult patients, considering mainly exercise capacity, lung function, and the occurrence of PPCs.

Methods: This scoping review was built using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Four databases were searched in May 2024. Three reviewers independently screened the articles. The data were extracted and summarised in text and tables.

Results: Five studies were included in the final analysis, where IMT was compared to sham or placebo IMT, and some studies added an exercise program to both groups. PeakVO2, the six-minute walking test (6MWT), maximal inspiratory pressure (MIP), quality of life (QoL), PPCs, and spirometry outcomes showed significant improvements between the intervention group (IG) and control group (CG) and intragroup over time.

Conclusions: IMT can be a non-conventional training method to prevent respiratory muscle weakness. It can be applied in pre- or post-surgical contexts, potentially affecting exercise capacity and quality of life in adult patients undergoing cardiac surgery.

背景:冠状动脉旁路移植术(CABG)和心脏瓣膜置换术(CVRS)是常见的救命心脏手术。它们与术后肺部并发症(PPCs)风险增加有关。本综述探讨了吸气肌训练(IMT)对成年患者的影响,主要考虑了运动能力、肺功能和肺部并发症的发生:本范围界定综述采用《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews,PRISMA-ScR)。2024 年 5 月对四个数据库进行了检索。三名审稿人对文章进行了独立筛选。数据被提取并汇总到文本和表格中:最终分析纳入了五项研究,其中 IMT 与假 IMT 或安慰剂 IMT 进行了比较,一些研究在两组中都增加了运动项目。随着时间的推移,干预组(IG)和对照组(CG)之间以及组内的峰值氧饱和度、六分钟步行测试(6MWT)、最大吸气压力(MIP)、生活质量(QoL)、肺活量(PPCs)和肺活量测定结果均有显著改善:IMT是一种预防呼吸肌无力的非常规训练方法。结论:IMT 是一种预防呼吸肌无力的非常规训练方法,可应用于手术前或手术后,对接受心脏手术的成年患者的运动能力和生活质量具有潜在影响。
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引用次数: 0
Validity and Reliability of Self-Reported Prevalent and Incident Cardiovascular Disease Among Asian Adults. 亚裔成年人自我报告的心血管疾病患病率和发病率的有效性和可靠性。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.3390/jcdd11110350
Charumathi Sabanayagam, Feng He, Miao Li Chee, Ching-Yu Cheng

Cardiovascular disease (CVD) is the leading cause of death in Asians. We aimed to examine the validity and reliability of self-reported (SR) CVD in 6762 Chinese, Malay, and Indian adults aged 40-80 years who attended the baseline (November 2004) and 6-year follow-up visit (2011-2017) of a population-based cohort study in Singapore. CVD was defined based on the presence of existing (prevalent) or new onset (incident) cases of acute myocardial infarction (AMI) or stroke. The validity of SR-CVD was assessed by comparing it against diagnosed CVD using sensitivity and specificity. The reliability of SR-CVD was evaluated by calculating the percentage of positive agreement between baseline and follow-up visits. The sensitivity and specificity of SR-CVD were 62.7% and 93.8% for prevalent SR-CVD and 50.9% and 98.5% for incident SR-CVD. The negative predictive value (NPV) was 98.1% for both prevalent and incident SR-CVD. The reliability of positive self-reports between the baseline and follow-up was substantial, at 85%. The excellent specificity and NPV of SR-CVD suggest that it could serve as a valuable tool for excluding AMI and stroke. However, its moderate sensitivity suggests that positive SR-CVD reports should prompt further clinical evaluation to prevent potential false positives.

心血管疾病(CVD)是亚洲人的主要死因。我们的目的是对参加新加坡一项基于人口的队列研究基线(2004 年 11 月)和 6 年随访(2011-2017 年)的 6762 名 40-80 岁华裔、马来裔和印度裔成年人的自我报告(SR)心血管疾病的有效性和可靠性进行研究。心血管疾病的定义基于急性心肌梗死(AMI)或中风的现有(流行)或新发(偶发)病例。通过使用灵敏度和特异性将 SR-CVD 与确诊的心血管疾病进行比较,评估了 SR-CVD 的有效性。SR-CVD 的可靠性通过计算基线和随访之间的阳性一致率来评估。SR-CVD的灵敏度和特异性分别为:流行性SR-CVD为62.7%和93.8%,事件性SR-CVD为50.9%和98.5%。对流行性和偶发性 SR-CVD 的阴性预测值 (NPV) 均为 98.1%。基线和随访期间阳性自我报告的可靠性很高,达到 85%。SR-CVD 极高的特异性和 NPV 表明,它可以作为排除急性心肌梗死和中风的重要工具。不过,SR-CVD 的灵敏度一般,这表明 SR-CVD 阳性报告应提示进一步的临床评估,以防止潜在的假阳性。
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引用次数: 0
Successful Management of Periprocedural Coronary Extravasation Using Liquid Embolic Agent n-Hexyl-Cyanoacrylate. 使用液体栓塞剂正己基氰基丙烯酸酯成功处理冠状动脉周围外渗。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.3390/jcdd11110347
Artiomas Širvys, Andrius Berūkštis

Although the complication rate of percutaneous coronary intervention is low, coronary artery perforation occurs in 0.2-0.5% of cases. Intracoronary glue injection is not an established treatment option, with only a few cases reported in the literature and no reported use of n-hexyl-cyanoacrylate. Case report: A 75-year-old man was diagnosed with a non-ST elevation myocardial infarction. Since there was no acute chest pain and no signs of ongoing ischemia on the ECG, diagnostic coronary angiography was performed the day after arrival. The coronary angiography revealed a proximal subocclusion of the left anterior descending artery. The lesion was successfully predilated, and a drug-eluting 5 × 28 mm stent was implanted, occluding two small diagonal branches. While attempting to create a gap in the stent to revascularize the occluded branch, a side branch perforation was detected. This was successfully treated by occluding the branch with an intracoronary cyanoacrylate glue injection. No signs of cardiac tamponade were observed during follow-up after the procedure, and the patient was soon discharged to rehabilitation. Conclusions: Coronary artery perforation is a serious complication of percutaneous coronary intervention. Intracoronary glue injection and embolization of the perforated side branch appear to be a safe and effective technique for managing this complication.

虽然经皮冠状动脉介入治疗的并发症发生率很低,但有 0.2-0.5% 的病例会发生冠状动脉穿孔。冠状动脉内注射胶水并不是一种成熟的治疗方案,文献中仅有少数病例报道,也没有使用正己基-氰基丙烯酸酯的报道。病例报告:一名 75 岁的男性被诊断为非 ST 段抬高型心肌梗死。由于没有急性胸痛,心电图上也没有持续缺血的迹象,因此在到达医院的第二天就进行了诊断性冠状动脉造影。冠状动脉造影显示左前降支动脉近端近闭塞。病变被成功预扩张,并植入了一个 5 × 28 毫米的药物洗脱支架,堵塞了两个对角线小分支。当试图在支架上开辟一条缝隙以对闭塞的分支进行血管再通时,发现一侧分支穿孔。通过冠状动脉内注射氰基丙烯酸酯胶水成功堵塞了分支。术后随访期间未发现心脏填塞的迹象,患者很快康复出院。结论冠状动脉穿孔是经皮冠状动脉介入治疗的一种严重并发症。冠状动脉内胶水注射和穿孔侧支栓塞似乎是处理这种并发症的一种安全有效的技术。
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引用次数: 0
Distinct Patterns of Smooth Muscle Phenotypic Modulation in Thoracic and Abdominal Aortic Aneurysms. 胸主动脉瘤和腹主动脉瘤平滑肌表型调节的不同模式
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.3390/jcdd11110349
Chien-Jung Lin, Campbell Keating, Robyn Roth, Yasar Caliskan, Mustafa Nazzal, Vernat Exil, Richard DiPaolo, Divya Ratan Verma, Kishore Harjai, Mohamed Zayed, Chieh-Yu Lin, Robert P Mecham, Ajay K Jain

Thoracic and abdominal aortic aneurysms (TAAs and AAAs, respectively) share morphological features but have distinct clinical and hereditary characteristics. Studies using bulk RNA comparisons revealed distinct patterns of gene expression in human TAA and AAA tissues. However, given the summative nature of bulk RNA studies, these findings represent the totality of gene expression without regards to the differences in cellular composition. Single-cell RNA sequencing provides an opportunity to interrogate cell-type-specific transcriptomes. Single cell RNA sequencing datasets from mouse TAA (GSE153534) and AAA (GSE164678 and GSE152583) with respective controls were obtained from the Gene Expression Omnibus. Bioinformatic analysis was performed with the Seurat 4, clusterProfiler, and Connectome software packages (V1.0.1). Immunostaining was performed with standard protocols. Within normal and aneurysmal aortae, three unique populations of cells that express smooth muscle cell (SMC) markers were identified (SMC1, SMC2, and SMCmod). A greater proportion of TAA SMCs clustered as a unique population, SMCmod, relative to the AAA SMCs (38% vs. 10-12%). These cells exhibited transcriptional features distinct from other SMCs, which were characterized by Igfbp2 and Tnfrsf11b expression. Genes upregulated in TAA SMCs were enriched for the Reactome terms "extracellular matrix organization" and "insulin-like growth factor (IGF) transport and uptake by IGF binding proteins (IGFBPs)", indicating a role for Igfbp2 in TAA pathogenesis. Regulon analysis revealed transcription factors enriched in TAAs and AAAs. Validating these mouse bioinformatic findings, immunostaining demonstrated that both IGFBP2 and TNFRSF11B proteins increased in human TAAs compared to AAAs. These results highlight the unique cellular composition and transcriptional signature of SMCs in TAAs and AAAs. Future studies are needed to reveal the pathogenetic pathways of IGFBP2 and TNFRSF11B.

胸主动脉瘤和腹主动脉瘤(分别为 TAA 和 AAA)具有相同的形态特征,但临床和遗传特征各不相同。使用大量 RNA 进行比较的研究发现,人类 TAA 和 AAA 组织中的基因表达模式各不相同。然而,鉴于大块 RNA 研究的总结性质,这些发现只代表了基因表达的总体情况,而没有考虑到细胞组成的差异。单细胞 RNA 测序为研究细胞类型特异性转录组提供了机会。小鼠TAA(GSE153534)和AAA(GSE164678和GSE152583)及各自对照的单细胞RNA测序数据集来自基因表达总库(Gene Expression Omnibus)。生物信息分析使用 Seurat 4、clusterProfiler 和 Connectome 软件包(V1.0.1)进行。免疫染色按标准方案进行。在正常主动脉和动脉瘤主动脉中,发现了三种表达平滑肌细胞(SMC)标记的独特细胞群(SMC1、SMC2 和 SMCmod)。与 AAA 平滑肌细胞相比,TAA 平滑肌细胞作为一个独特的细胞群 SMCmod 聚集的比例更高(38% 对 10-12%)。这些细胞表现出不同于其他 SMC 的转录特征,其特征是 Igfbp2 和 Tnfrsf11b 的表达。在Reactome术语 "细胞外基质组织 "和 "胰岛素样生长因子(IGF)转运和IGF结合蛋白(IGFBPs)摄取 "中,TAA SMCs中上调的基因被富集,表明Igfbp2在TAA发病机制中的作用。转录因子分析揭示了富集在 TAA 和 AAA 中的转录因子。免疫染色显示,与 AAA 相比,人类 TAA 中的 IGFBP2 和 TNFRSF11B 蛋白都有所增加,这验证了这些小鼠生物信息学发现。这些结果突显了 TAA 和 AAA 中 SMC 独特的细胞组成和转录特征。未来的研究需要揭示 IGFBP2 和 TNFRSF11B 的致病途径。
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引用次数: 0
Clinical Relevance of Different Loads of Perivascular Spaces According to Their Localization in Patients with a Recent Small Subcortical Infarct. 近期皮层下小梗塞患者血管周围空间不同负荷量的临床相关性(根据其位置而定
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.3390/jcdd11110345
Caterina Sozzi, Carla Brenlla, Inés Bartolomé, Andrés Girona, Emma Muñoz-Moreno, Carlos Laredo, Alejandro Rodríguez-Vázquez, Antonio Doncel-Moriano, Salvatore Rudilosso, Ángel Chamorro

Background and Purpose: Perivascular spaces (PVS) are usually enlarged in small vessel disease (SVD). However, the significance of PVS patterns in different locations is uncertain. Hence, we analyzed the distribution of PVS in patients with a recent small subcortical infarct (RSSI) and their correlation with clinical and imaging factors. Materials and Methods: In a cohort of 71 patients with an RSSI with complete clinical data, including the Pittsburgh Sleep Quality Index (PSQI), we segmented PVS in white matter (WM-PVS), basal ganglia (BG-PVS), and brainstems (BS-PVS) on 3T-MRI T2-weighted sequences, obtaining fractional volumes (%), and calculated the WM/BG-PVS ratio. We analyzed the Pearson's correlation coefficients between PVS regional loads. We used normalized PVS measures to assess the associations with clinical and MRI-SVD features (white matter hyperintensities (WMHs), number of lacunes, and microbleeds) in univariable and multivariable linear regressions adjusted for age, sex, and hypertension. Results: In our cohort (mean age 70 years; 27% female), the Pearson's correlation coefficients between WM-PVS/BG-PVS, WM-PVS/BS-PVS, and BG-PVS/BS-PVS were 0.67, 0.61, and 0.59 (all p < 0.001). In the adjusted models, BG-PVS were associated with lacunes (p = 0.034), WMHs (p = 0.006), and microbleeds (p = 0.017); WM-PVS with lacunes (p = 0.003); while BS-PVS showed no associations. The WM/BG-PVS ratio was associated with lacunes (p = 0.018) and the PSQI (p = 0.046). Conclusions: PVS burdens in different regions are highly correlated in patients with RSSI but with different SVD patterns. Sleep quality impairment might affect waste removal mechanisms differently in the WM and BG regions.

背景和目的:小血管疾病(SVD)患者的血管周围间隙(PVS)通常会增大。然而,不同位置的 PVS 模式的意义尚不确定。因此,我们分析了近期皮层下小梗死(RSSI)患者的 PVS 分布情况及其与临床和影像学因素的相关性。材料与方法:在 71 例具有完整临床数据(包括匹兹堡睡眠质量指数(PSQI))的 RSSI 患者中,我们在 3T-MRI T2 加权序列上分割了白质(WM-PVS)、基底节(BG-PVS)和脑干(BS-PVS)中的 PVS,获得了分数体积(%),并计算了 WM/BG-PVS 比值。我们分析了 PVS 区域负荷之间的皮尔逊相关系数。我们使用归一化的 PVS 测量值来评估与临床和 MRI-SVD 特征(白质高密度(WMH)、裂隙数量和微出血)之间的关联,并进行单变量和多变量线性回归,同时对年龄、性别和高血压进行调整。研究结果在我们的队列中(平均年龄 70 岁;27% 为女性),WM-PVS/BG-PVS、WM-PVS/BS-PVS 和 BG-PVS/BS-PVS 之间的皮尔逊相关系数分别为 0.67、0.61 和 0.59(均 p <0.001)。在调整模型中,BG-PVS 与裂隙(p = 0.034)、WMHs(p = 0.006)和微出血(p = 0.017)相关;WM-PVS 与裂隙(p = 0.003)相关;而 BS-PVS 则没有相关性。WM/BG-PVS 比值与裂隙(p = 0.018)和 PSQI(p = 0.046)相关。结论在 RSSI 患者中,不同区域的 PVS 负担高度相关,但 SVD 模式不同。睡眠质量受损可能会对 WM 和 BG 区域的废物清除机制产生不同的影响。
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引用次数: 0
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Journal of Cardiovascular Development and Disease
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