Journal of Cardiovascular Development and Disease最新文献

Introduction: Tight glycemic control is essential for optimal outcomes after coronary artery bypass graft (CABG) surgery, regardless of pre-operative diabetes status. The ideal timing for transitioning from intravenous (IV) to subcutaneous (SC) insulin remains unclear. This study addresses this knowledge gap by comparing the effects of early transition (postoperative day 1, POD1) versus delayed transition on glycemic control and patient outcomes after CABG surgery.

Methods: We analyzed data from a single tertiary medical center focusing on patients receiving insulin during their CABG hospitalization between 1 and 31 October 2022. We divided patients into two groups based on their transition timing: (1) Delayed Transition Group, patients transitioned from IV insulin infusion to SC insulin after POD1; and (2) Early Transition Group, patients transitioned on POD1. The primary outcome was the incidence of euglycemia on POD1. Secondary outcomes included rates of maintaining euglycemia from POD1 until POD10 or hospital discharge, hospital length of stay (LOS), ICU LOS, mean glucose levels, rates of hyperglycemia (blood glucose > 180 mg/dL) and hypoglycemia (blood glucose < 70 mg/dL), and rate of restarting IV insulin. Statistical analysis adjusted for BMI and diabetes diagnosis.

Results: A total of 394 patients were enrolled, with 68 patients (17.3%) in the delayed-transition group and 326 patients (82.7%) in the early-transition group. Majority of the patients were males (74%), with an average age of 67 ± 9 years. Mean HbA1C and creatinine levels were comparable between the two groups. Patients in the early-transition group experienced a shorter ICU and hospital length of stay compared to the delayed-transition group, without a higher risk of restarting IV insulin.

Conclusions: Early transition from IV insulin drip to SC insulin on POD1 of CABG surgery reduces ICU and hospital LOS without increasing the risk of transitioning back to IV insulin.

Background: An increased incidence of adult-onset heart failure is seen in individuals born preterm or affected by fetal growth restriction. An adverse maternal environment is associated with both preterm birth and poor fetal development, and postnatal oxygen therapy is frequently required to sustain oxygenation of vulnerable tissues due to lung immaturity.

Methods: Studies using our murine model of maternal inflammation (LPS) and neonatal hyperoxia exposure (O₂) observed pathological changes in cardiac structural proteins and functional analysis with sex dependent differences in pathologies at 10 months of age. Using our previous model, the current investigations tested the hypothesis that early-life perturbations in cardiac structural proteins might predict adult cardiac dysfunction in a sex dependent manner.

Results: LPS-exposed females had lower αMHC mRNA and protein at P0 and P7 relative to the saline-exposed females, but these changes did not persist. Male mice exposed to LPS/O₂ had normal expression of αMHC mRNA and protein compared to saline/room air controls though P56, when they dramatically increased. Correlative changes were observed in left ventricular function with a more severe phenotype in the males indicating sex-based differences in cardiac adaptation.

Conclusions: Our findings demonstrate that early changes in contractile proteins temporally correlate with deficits in cardiac contractility, with a more severe phenotype in males. Our data suggest that similar findings in humans may predict risk for disease in growth-restricted infants.

Carnitine palmitoyltransferase 1b (Cpt1b) is a crucial rate-limiting enzyme in fatty acid metabolism, but its role and mechanism in early cardiac development remains unclear. Here, we show that cpt1b regulates cardiomyocyte proliferation during zebrafish development. Knocking out entire cpt1b coding sequences leads to impaired cardiomyocyte proliferation, while cardiomyocyte-specific overexpression of cpt1b promotes cardiomyocyte proliferation. RNA sequencing analysis and pharmacological studies identified glutamine synthetase as a key downstream effector of cpt1b in regulating cardiomyocyte proliferation. Our study elucidates a novel mechanism whereby cpt1b promotes zebrafish cardiomyocyte proliferation through glutamine synthetase, which provides new perspectives on the significance of fatty acid metabolism in heart development and the interplay between fatty acid and amino acid metabolic pathways.

Cardiovascular diseases (CVD) are a leading cause of death. The most notable cause of CVD is an atherosclerotic plaque. The aim of this review is to provide an overview of different diagnostic methods for atherosclerotic plaque relevant to the assessment of cardiovascular risk. The methods can be divided into invasive and non-invasive. This review focuses on non-invasive with attention paid to ultrasonography, contrast-enhanced ultrasonography, intravascular ultrasonography, and assessment of intima-media complex, coronary computed tomography angiography, and magnetic resonance. In the review, we discuss a number of Artificial Intelligence technologies that support plaque imaging.

Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the very least challenging. Three-dimensional (3D) TEE is an ideal technique for illustrating the extremely variable morphology of DMVR, providing images of unparalleled quality in terms of anatomical detail. In this review, we describe the key role of 3D TEE in various morphological scenarios that reflect everyday experiences in an echocardiographic laboratory. We also discuss the growing role of 3D TEE in mitral valve (MV) transcatheter edge-to-edge repair (TEER) and new modalities such as photorealistic and transparent displays, surface rendering parametric color maps, new algorithms for MVR quantification, and the potential role of new mini-TEE probes in adult patients with DMVR.

Those using the mouse for the purposes of electrophysiological research presume that the morphology of the conduction axis is comparable with the human arrangement. As yet, however, to the best of our knowledge, no direct comparison has been made between the species. By comparing our extensive histological findings in the human heart with comparable serially-sectioned datasets prepared from adult murine hearts, we aimed to provide this information. When comparing the gross anatomy, we used three-dimensional datasets of neonatal mice hearts prepared using episcopic microscopy. The overall cardiac architecture is comparable, although the mouse has a persistent left superior caval vein draining via the coronary sinus. An inferior pyramidal space and an infero-septal recess are both present in the murine heart, although they are not as well developed as in the human heart. The overall arrangement of the conduction axis is similarly comparable, albeit with subtle differences reflecting the incomplete wedging of the subaortic outflow tract in the murine heart. Most significantly, the findings in both species reveal the presence of extensive superior septal pathways, which perhaps explain the finding of base-to-apex activation of the ventricular mass known to occur in the murine heart.

Left ventricular (LV) dysfunction is associated with poor clinical outcomes in acute respiratory failure (ARF). This study evaluates the efficacy of LV strain in detecting LV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to conventionally measured left ventricular ejection fraction (LVEF). ARF patients requiring IMV who had echocardiography performed during MICU admission were included. LV global longitudinal strain (LVGLS) and LVEF were measured retrospectively using speckle tracking (STE) and traditional transthoracic echocardiography (TTE), respectively, by investigators blinded to the status of IMV and clinical data. The cohort was divided into three groups: TTE during IMV (TTE-IMV), before IMV (TTE-bIMV), and after IMV (TTE-aIMV). Multivariable regression models, adjusted for illness severity score, chronic cardiac disease, acute respiratory failure etiology, body mass index, chronic obstructive pulmonary disease, and obstructive sleep apnea, evaluated associations between LV function parameters and the presence of IMV. Among 376 patients, TTE-IMV, TTE-bIMV, and TTE-aIMV groups constituted 223, 68, and 85 patients, respectively. The median age was 65 years (IQR: 56-74), with 53.2% male participants. Adjusted models showed significantly higher LVGLS in groups not on IMV at the time of TTE (TTE-bIMV: β = 4.19, 95% CI 2.31 to 6.08, p < 0.001; TTE-aIMV: β = 3.79, 95% CI 2.03 to 5.55, p < 0.001), while no significant differences in LVEF were observed across groups. In a subgroup analysis of patients with LVEF ≥55%, the significant difference in LVGLS among the groups remained (TTE-bIMV: β = 4.18, 95% CI 2.22 to 6.15, p < 0.001; TTE-aIMV: β = 3.45, 95% CI 1.50 to 5.40, p < 0.001), but was no longer present in those with LVEF < 55%. This suggests an association between IMV and lower LVGLS in ARF patients requiring IMV, indicating that LVGLS may be a more sensitive marker for detecting subclinical LV dysfunction compared to LVEF in this population. Future studies should track and assess serial echocardiography data in the same cohort of patients pre-, during, and post-IMV in order to validate these findings and prognosticate STE-detected LV dysfunction in ARF patients requiring IMV.

Background: a wider left main bifurcation angle (LMBA) has been linked to severe plaque development in the proximal left anterior descending artery (LAD). This study aimed to identify predictors of severe proximal LAD stenosis and major adverse cardiovascular events (MACE) using coronary computed tomography angiography (CCTA).

Methods: from an initial cohort of 650 consecutive patients, we analyzed 499 patients who met the inclusion criteria after exclusions. Plaque morphology and characteristics were assessed by CCTA, and MACE occurrences were recorded at follow-up. A predictive score for LAD disease progression (CLAP score) was developed and validated.

Results: severe proximal LAD stenosis was detected in 32% (160/499) of patients by CCTA. MACE occurred in 12.5% of patients at follow-up. Significant predictors of MACE were LMBA > 80° (HR: 4.47; 95% CI: 3.80-6.70; p < 0.001), diabetes (HR: 2.94; 95% CI: 1.54-4.63; p = 0.031), chronic kidney disease (HR: 1.71; 95% CI: 1.31-6.72; p = 0.041), high-risk plaques (HR: 2.30; 95% CI: 1.45-3.64; p < 0.01), obstructive CAD (HR: 2.50; 95% CI: 1.50 to 4.10, p = 0.01), and calcium score (CAC) (HR: 1.05; 95% CI: 1.02-1.08, p = 0.004). The CLAP score demonstrated good discriminatory power in both the development (AUC 0.91; 95% CI: 0.86-0.96) and validation cohorts (AUC 0.85; 95% CI: 0.79-0.91); Conclusions: LMBA > 80°, diabetes, chronic kidney disease, obstructive CAD, CAC score >180 and high-risk plaques were significant predictors of MACE in CCTA patients. The CLAP score effectively predicted LAD disease progression, aiding in risk stratification and optimization of intervention strategies for suspected coronary artery disease.

Background: Coronary artery bypass grafting (CABG) remains the gold standard treatment for patients with significant coronary artery disease (CAD) and high-risk profiles for percutaneous coronary intervention. Despite the frequent use of saphenous vein grafts (SVGs) in CABG, their patency rates are lower than those of arterial grafts. Identifying noninvasive methods to determine SVG patency is crucial. Aims: This study investigates the relationship between a novel inflammation marker, pan-immune-inflammation value (PIV), and SVG patency in post-CABG patients. Methods: The study included 507 patients who underwent coronary angiography (CAG) due to clinical indications between 2016 and 2023. Patients who had undergone CABG at least one year prior with at least one SGV used were divided into two groups based on the presence or absence of SVG stenosis (SGVS). Results: Among the 507 patients, 244 had SVGS. Patients with SVGS exhibited higher levels of diabetes mellitus and inflammatory markers such as NLR, SII, CAR, and PIV. Multivariate analysis identified PIV as an independent predictor of SVGS. ROC analysis showed that a PIV cut-off value > 315.5 predicted SVGS with 75.8% sensitivity and 68.6% specificity. Conclusions: PIV, a simple and easily measurable marker, demonstrated strong predictive value for SVGS in post-CABG patients.