Journal of Cardiovascular and Thoracic Research最新文献

Transcatheter Aortic Valve Replacement (TAVR) has revolutionized the treatment of severe aortic stenosis, particularly in patients at intermediate or high surgical risk. However, valve selection in individuals with a small aortic annulus remains a clinical challenge. Comparative data on self-expanding (SE) and balloon-expandable (BE) valves are limited, and recent evidence has focused on identifying the optimal prosthesis for this subgroup. This review critically evaluates the comparative outcomes of SE and BE valves in patients with small aortic annuli, emphasizing findings from the Small Annuli Randomized to Evolut or SAPIEN Trial (SMART) and contextualizing them with evidence from major trials including CHOICE, SOLVE-TAVI, SCOPE I, and FRANCE-TAVI. The SMART trial demonstrated that SE valves were non-inferior to BE valves for the composite endpoint of death, disabling stroke, or heart failure rehospitalization at 12 months, while achieving superior valve hemodynamics. SE valves were associated with lower mean gradients, larger effective orifice areas, and reduced rates of prosthesis-patient mismatch and bioprosthetic valve dysfunction. Other clinical studies have shown that BE valves may offer greater procedural precision, better positioning, and lower rates of paravalvular regurgitation. Both SE and BE valves represent effective options for TAVR in patients with small aortic annuli. SE valves provide improved hemodynamic performance, whereas BE valves may offer procedural advantages. Valve selection should be individualized based on anatomical characteristics and operator experience. Long-term studies are required to assess valve durability and late clinical outcomes.

Introduction: Myocardial injury after non-cardiac surgery (MINS), characterized by cardiac troponin (cTn) elevation, is a marker of poor postoperative prognosis. The predictive value of MINS in thoracic oncosurgery remains unclear. The aim of the study was to determine the prognostic value of acute myocardial injury after surgical lung resection for 1-year all-cause mortality in patients with non-small-cell lung cancer (NSCLC).

Methods: In this prospective cohort study, 101 consecutive men aged 63.0 (58;67) years who underwent surgical lung resection for NSCLC, were enrolled. Serum cTnI concentration was measured preoperatively and in 24 and 48 hours postoperatively. MINS was defined by at least one postoperative cTnI value that exceeds the 99th percentile upper reference limit, as a result of a presumed ischemic mechanism. The primary endpoint was 1-year all-cause mortality.

Results: MINS was diagnosed in 37 patients (36.6%). During the follow-up, three patients were lost, and 28 (27.7%) died. Multivariate Cox regression analysis identified MINS as an independent predictor of all-cause mortality (adjusted hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.29-6.89, P=0.011). The prognostic significance was also revealed for preoperative N-terminal prohormone of brain natriuretic peptide (HR 1.18, 95% CI 1.03-1.34, P=0.014), advanced cancer stage (HR 3.21, 95% CI 1.28-8.04, P=0.013), adjuvant chemotherapy (HR 0.22, 95% CI 0.08-0.57, P=0.002), and aspirin use (HR 0.09, 95% CI 0.01-0.72, P=0.024).

Conclusion: Myocardial injury within the first 72 hours after surgical lung resection was found as an independent predictor of 1-year all-cause mortality in patients with NSCLC.

Introduction: Cardio-metabolic disease (CMetD) is a prevalent health issue among healthcare professionals, and suboptimal management of metabolic disorders places a burden on the healthcare system.

Methods: The present study aimed to cluster the participants based on risk factors for the CMetDs using Latent Profile Analysis (LPA). This study was conducted on 500 healthcare providers, aged 18 to 75 years at Tabriz University of Medical Sciences, Tabriz, Iran. LPA was used to explore the latent risk profiles based on age, blood pressure (BP), lipid profile, insulin, body mass index (BMI), and waist circumference.

Results: The individuals were classified into three LPA-driven profiles: low (42.4%), intermediate (21.8%), and high (35.8%). The high-risk profile found in older age and higher BMI, insulin, fasting blood glucose (FBS), as well as higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglyceride. Furthermore, in the intermediate risk profile, elevated levels of systolic/diastolic BP and waist circumference were associated with higher levels of risk. Haemoglobin and hematocrit levels were significant predictors of low and intermediate latent profiles. Higher levels of hemoglobin and hematocrit were associated with lower odds of being in low and intermediate latent profiles, compared to the high-risk profile (all P<0.05).

Conclusion: LPA-derived latent profiles and the specific predictors of profiles help find control and prevention measures in CMetDs; older individuals with poorer lipid profiles, and, elevated insulin, triglyceride, FBS, BP, and BMI levels should be screened more carefully.

Introduction: One of the main causes of illness and death in communities is cardiovascular disease (CVD). Inflammation and oxidative stress are key components in the pathophysiology of CVD. It has been demonstrated that selenium lowers inflammation and oxidative stress. The purpose of this study is to do biochemical assessment of selenium's cardiovascular protective effects in a lipopolysaccharide (LPS)-Induced damage in rats.

Methods: LPS+Selenium (100 µg/kg), LPS (1 mg/kg), LPS+Selenium (200 µg/kg), and Vehicle (instead of both selenium and LPS) were given to the four groups of rats. The rats were sacrificed after 14 days, and the serum, heart, and aorta were examined for the presence of malondialdehyde (MDA), thiol, catalase (CAT), and superoxide dismutase (SOD). Interleukin 6 (IL-6) was also assessed in the tissues of the heart and aorta as an indicator of inflammation.

Results: LPS administration raised aortic and cardiac IL-6 levels (P<0.001). In the heart, aorta, and serum, it also raised MDA (P<0.001) and lowered thiol (P<0.001), CAT (P<0.01-P<0.001), and SOD (P<0.001). On the other hand, selenium therapy markedly raised thiol, CAT, and SOD levels (P<0.01-P<0.001) and lowered MDA levels (P<0.05-P<0.001). Furthermore, following selenium delivery, a decrease in the inflammatory marker IL-6 was noted (P<0.01-P<0.001).

Conclusion: This study showed that selenium protected the heart, aorta, and serum from oxidative stress brought on by LPS. Additionally, it reduced aortic and cardiac inflammation. These results imply that selenium's anti-inflammatory and antioxidant properties may help prevent or lower the morbidity and mortality of CVD.

Introduction: Base excess (BE) is an indicator of non-respiratory acid-base imbalances, which can impact coronary artery disease (CAD). This study evaluated the association between the severity of CAD and peripheral blood BE.

Methods: This cross-sectional study included patients aged 18 and older who were candidates for coronary angiography. Demographic and clinical data were collected from medical records. Blood gas analysis was performed on a 2-millilitre arterial blood sample taken from the access artery before contrast injection. All patients underwent coronary angiography, and the Gensini score was calculated.

Results: A total of 351 patients (194 males, 55.3%) were included in the study. The study population had a mean age of 60.79±9.5 and a mean BMI of 29.4±4.85. Coronary angiography revealed normal or minimal (<50% stenosis) findings in 51.3% of cases (15.4% with normal coronary arteries and 35.9% with minimal non-obstructive lesions), single-vessel disease in 17.4%, two-vessel disease in 14.5%, and three-vessel disease in 16.8%. Median Gensini score was 13.0, with an IQR of 3.5 and 49. The findings indicated that a decrease in BE was significantly correlated with elevated Gensini scores (β: -0.04; 95% CI: -0.08 to -0.01; P=0.027). However, BE did not significantly affect the Gensini score of 0 (P=0.843). Moreover, negative values of BE were significantly and inversely associated with the Gensini score (β=-0.05; 95% CI: -0.07 to -0.02, P<0.001).

Conclusion: This study revealed an association between BE and CAD, suggesting that BE tending to acidosis is potentially associated with CAD.

The majority of people experiencing Myocardial Infarction are of working age, which may result in prolonged work disability. This study seeks to consolidate the available evidence regarding the return to work for individuals following a Myocardial Infarction, while also examining its correlation with disease severity, job engagement, and duration of hospitalization. This research is a systematic review. The databases utilized include MEDLINE, Lilacs, Scielo, and Web of Science, with keywords and synonyms sourced from the Health Sciences Descriptors (DeCS), Medical Subject Headings (MeSH), and Embase Subject Headings (Emtree). Data collection took place between November 2023 and June 2024. The studies' quality was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The search yielded 4,695 articles, from which 12 cohort studies were selected for inclusion, encompassing a total of 83,702 participants. The rate of return to work fluctuated throughout the follow-up period, with a return rate of 21.5% to 41.7% after one month and between 76.9% and 92.7% after one year. Additionally, the studies reported on modifications in work roles, salary reductions, job dismissals, and the incidence of anxiety and depression. All cohort studies were deemed to be of good quality. The rate of returning to work following a Myocardial Infarction is notably high within one year and is associated with physical, psychological, and social factors, highlighting the need for mechanisms that facilitate this return as promptly as possible. However, further research is necessary, particularly involving diverse populations and distinguishing among different professional categories, to gather more extensive data.

Introduction: Remote ischemic preconditioning (RIPC) is a non-invasive, practically acceptable and applicable conditioning technique reported to confer cardioprotection in myocardial ischemia-reperfusion injury (MIRI). It is documented that cannabinoid B₂ receptor (CB₂R) plays crucial role in providing cardioprotection in various cardiovascular pathologies.

Methods: MIRI was induced in the isolated hearts of Wistar rats by exposing them to global ischemia of 30 minutes followed by subsequent reperfusion with Kreb's Henseleit (KH) buffer solution of 120 minutes after mounting on the Langendorff Power Lab apparatus. RIPC was applied by providing four alternate inter-spread cycles of 5 min non-lethal ischemia and 5 min reperfusion by tying the pressure cuff at the hind limb of the rats before isolation of hearts.

Results: Ischemia-reperfusion injury (IRI) induced myocardial damage was manifested in terms of significant increase in infarct size, elevated levels of cardiac specific markers i.e. Lactate dehydrogenase-1 (LDH-1), Creatine kinase-MB (CK-MB), Cardiac troponin-I (C-tPn-I), altered hemodynamic parameters i.e. decreased heart rate (HR), coronary flow rate (CFR), left ventricular developed pressure (LVDP), rate pressure product (RPP),+dp/dt_max, and -dp/dt_min and other biochemical markers including increased thiobarbituric acid reactive species (TBARS), decreased glutathione reductase (GSH), and catalase; markers of oxidative stress, increased tumor necrosis factor-α (TNF-α); inflammatory marker, transforming growth factor-β (TGF-β); fibrosis marker, Bax, and caspase-3; markers of apoptosis. RIPC significantly reduced the infarct size, LDH-1, and CK-MB release and C-tPn-I content. Moreover, RIPC significantly improved series of aforementioned hemodynamic as well as biochemical parameters. Pre-administration of AM-630 (selective CB₂R antagonist; 0.5 and 1 mg/kg;i.p.) and BML-275 i.e. AMP activated protein kinase (AMPK) mediated autophagy inhibitor; 1.5 and 3 mg/kg;i.p.) substantially abrogated the cardioprotective response of RIPC.

Conclusion: The current findings highlight the pivotal role of CB₂R activation and AMPK activated autophagy in cardioprotective mechanism of RIPC against MIRI.

HIV/AIDS patients under antiretroviral therapy have increased cardiovascular risk. Spontaneous coronary artery dissection, an uncommon yet recognized cause of acute coronary syndrome, typically affects middle-aged females, especially during pregnancy. We present a rare case of SCAD and proximal left anterior descending stenosis in a 45-year-old male with HIV.