Minerva cardiology and angiology最新文献

Background: Chronic heart failure (CHF) is often associated with cognitive, psychological, and functional disorders. In addition, since patients suffering from this condition are often older adults, the presence of frailty could worsen the clinical situation.

Methods: The present multicentric observational study aimed to investigate, through a multidimensional evaluation, the associations between clinical, functional, cognitive, psychological, and frailty variables of older (age ≥65) CHF inpatients undergoing cardiac rehabilitation and to identify the eventual independent predictors of the frailty status.

Results: The study included 85 patients (mean age 73.88±5.84). The disease severity of the sample was moderate (left ventricular ejection fraction = 41.79±15.40). Among the patients, 32.94% had cognitive impairment, 12.94% and 14.11% reported moderate to severe anxious or depressive symptoms, respectively, and 34.12% were classified as frail (Clinical Frailty Scale [CFS] score ≥5). The CFS score showed a negative correlation with cognitive status (Addenbrooke's Cognitive Examination III [ACE III] [r=-0.48, P≤0.0001] and Frontal Assessment Battery [FAB] [r=-0.33, P=0.0001]) and functional status (Short Physical Performance Battery [SPPB] [r=-0.55, P≤0.0001] and Barthel Index [r=-0.52, P≤0.0001]), while showing a positive correlation with comorbidities (Cumulative Illness Rating Scale [CIRS] [r=0.40, P≤0.0001]). The stepwise regression analysis revealed that ACE III, SPPB, and CIRS were independent predictors of frailty status (CFS).

Conclusions: Frailty is an important variable that should be considered since it is linked with most of the variables that play a role in the management and outcomes of older CHF patients and, thus, its evaluation should be integrated into the usual assessment in cardiac rehabilitation.

Background: The aim of this study was to evaluate the effect of the find, organize, clarify, understand, select-plan, do, check, act (FOCUS-PDCA) procedure on reducing the incidence of complications at the puncture site.

Methods: Patients who underwent the transradial interventional therapy (TRI) were divided into control (N.=160) and FOCUS-PDCA (N.=158) groups. The postoperative complications at the puncture site was observed in the two groups, and the pain, bleeding, swelling and comfort of the two groups were compared and analyzed.

Results: Two hours after surgery, the number of pain-free patients in the observation group was significantly higher than that in the control group (62.1% vs. 44.4%, P=0.014). The degree of swelling at 6 and 2 hours after TRI in observation group was significantly lower than that in control group (-0.08±0.23 vs. -0.00±0.17, P=0.001). No early radial artery occlusion was found in either group. The postoperative comfort score in observation group was significantly higher than that in control group (101.94±9.99 vs. 91.14±14.50, P<0.001).

Conclusions: The FOCUS-PDCA approach may reduce the incidence of early pain and long-term swelling after TRI, improve patient comfort, and enhance the quality of specialist care. The results suggested that FOCUS-PDCA had the value of popularization and application.

Cardiovascular diseases (CVD) remain the leading cause of mortality globally and require innovative strategies for effective prevention and treatment. The polypill concept, which integrates multiple cardioprotective agents into a single dosage form, has emerged as a promising approach to improve adherence and simplify the management of cardiovascular risk factors. We review clinical trials and observational studies evaluating the impact of the polypill on reducing the incidence of major cardiovascular events (MACEs), its influence on medication adherence, and its potential to fill treatment gaps in diverse populations. Also of note are the pharmacoeconomic implications of the widespread use of the polypill, particularly in low- and middle-income countries where the burden of cardiovascular disease is increasing. Although the polypill demonstrates a favorable profile in improving therapeutic compliance and reducing cardiovascular risk factors, debates persist regarding its efficacy compared to individualized treatment regimens. This review summarizes the current evidence on the efficacy, safety, and cost-effectiveness of the polypill in CVD primary and secondary prevention. Furthermore, potential challenges in implementing the polypill strategy include tailoring the components to patient-specific risk profiles and the need for robust evidence from large-scale randomized controlled trials to substantiate its long-term benefits.

Background: The aim of this study was the creation of an optimal model for predicting arterial vascular complications in patients with extrasystolic arrhythmia.

Methods: A single-center prospective study was performed with involving 634 patients with supraventricular or ventricular extrasystoles (ES) of 700 or more per 24 hours. The control group consisted of 106 people with ES less than 700 per 24 hours. The main and control groups were initially equivalent in anthropometric criteria and concomitant pathology. The list of examinations included laboratory methods (including lipid profile, coagulograms), as well as instrumental studies (transthoracic and/or transesophageal echocardiography (EchoCG), Doppler ultrasound of the brachiocephalic arteries and arteries of the lower extremities, 24-hours ECG monitoring, according to the indications - computed tomography or magnetic resonance imaging of the brain, coronary angiography, stress echocardiography. Prospective observation of patients performed for 1 year after the initial examination. Combined end points: development of arterial vascular complications - stroke, myocardial infarction, distal arterial embolism of other locations. We studied the data on identified complications. Next, we built models for predicting complications in various ways: Decision Tree; Bootstrap Forest; Boosted Tree; Neural Boosted; Support Vector Machines; Fit Stepwise; Nominal Logistic; Generalized Regression Lasso; Generalized Regression Forward Selection; Generalized Regression Pruned Forward Selection; Generalized Regression Elastic Net; Generalized Regression Ridge. To assess the quality of the models and compare them we used cross-validation with 30 replications.

Results: The highest profit values with minimal values of false positive results were obtained for the Bootstrap Forest model. Basing on this model, we created arterial vascular complications predictive score in extrasystolic arrhythmia "EX-prognosis" that included the following parameters: atheroma type III in carotid arteries - 3 points; age 69+ years old - 2 points; ES appearing before transmitral blood flow peak in cardiac cycle 700 and more per 24 hours - 1 point; carotid arteries stenosis, non-significant - 1 point. If total number is 3 and more points, the risk of arterial vascular complications within 1 year is high.

Conclusions: We recommend to use the scale "EX-prognosis" in the clinical practice. For a quick assessment of the total risk, it is optimal to implement the risk14.exe program - calculator - developed by us for a personal computer, based on this scale.

Background: Aging is a key risk factor for atrial fibrillation (AF), a prevalent cardiac disorder among the elderly. This study aims to elucidate the genetic underpinnings of AF in the context of aging.

Methods: We analyzed 12,403 genes from the GSE2240 database and 279 age-related genes from the CellAge database. Machine learning algorithms, including support vector machines and random forests, were employed to identify genes significantly associated with AF.

Results: Among the genes studied, 76 were found to be potential candidates in the development of AF. Notably, four genes - PTTG1, AR, RAD21, and YAP1 - stood out with a Receiver Operating Characteristic Area Under the Curve (ROC AUC) of 0.9, signifying high predictive power. Logistic regression, validated through 10-fold cross-validation and Bootstrap resampling, was determined as the most suitable model for internal validation.

Conclusions: The discovery of these four genes could improve diagnostic accuracy for AF in the aged population. Additionally, our drug prediction model indicates that bisphenol A and cisplatin, among other substances, could be promising in treating age-associated AF, offering potential pathways for clinical intervention.

Background: The clinical role of long non-coding RNA (MBNL1-AS1) in diagnosing atherosclerosis (AS) risks of hypertensive patients and the effects of MBNL1-AS1 on vascular smooth muscle cells (VSMCs) triggered by angiotensin II (Ang II) were investigated.

Methods: The hypertensive patients were recruited to assess MBNL1-AS1 expression. The ROC curve and Spearman analysis was performed for the significance of MBNL1-AS1. Human VSMCs were treated with Ang II (10^-5 mol/L) to establish a hypertensive cell model. MTT and Transwell chamber were used in proliferative and migratory detection of cell models. Targets of MBNL1-AS1 were verified by luciferase activity. Functional enrichment of shared targets of miR-424-5p was researched by GO and KEGG analysis.

Results: An increase of MBNL1-AS1 was observed in patients with increased carotid intima-media thickness (cIMT). MBNL1-AS1 could predict the risk of AS and related to cIMT levels. The knockdown of MBNL1-AS1 mitigated the influence of Ang II on cellular proliferation and migration by inhibiting miR-424-5p. Enrichment analysis corroborated that targets of miR-424-5p were mainly involved in serine/threonine kinase activity, MAPK signaling pathway, and PI3K-Akt signaling pathway.

Conclusions: MBNL1-AS1/miR-424-5p axis was connected with the progression of AS induced by hypertension.

Background: Coronary chronic total occlusions (CTO) are associated with an increased chance of untreatable symptoms and worse prognosis. However, limited data are available about the interaction between treatment strategy, potential ischemia burden reduction and quality of life (QoL) improvement.

Methods: Our prospective registry aims to assess the potentially different impacts of treatment strategies (coronary artery bypass grafting vs.. percutaneous coronary intervention vs. optimal medical therapy) on clinical outcomes and QoL domains. This article specifically focuses on describing the registry's rationale, design, and baseline characteristics of the enrolled patients.

Results: A total of 157 patients were enrolled. Every patient was evaluated for baseline symptoms, ischemic burden and QoL and allocated to a treatment arm. In 112 patients (71.3%) ischemia baseline assessment was performed and for 116 (73.9%) Seattle Angina Questionnaire (SAQ) was available. At baseline, a significant functional limitation was evident, especially in terms of angina stability (mean score 69±31%) and disease perception (mean score 69±27%). In 49.1% of patients, ischemia testing was positive. Patients with documented ischemia were generally more symptomatic (CCS class 1 36.4% vs.. 57.9%, P=0.023) and a significant inverse correlation between CCS class and SAQ domains was found. No association between ischemia burden and self-reported QoL scores was found.

Conclusions: The PETS-CTO registry is the first prospective registry investigating the impact of different treatment strategies on QoL and ischemia burden in patients with CTOs. At baseline, the severity of symptoms was directly associated with ischemia burden and inversely associated with self-reported QoL evaluation.

Background: To investigate the protective effect of carvedilol against atherosclerosis by inhibiting the NLRP3 inflammasome.

Methods: In-vitro experiments, human umbilical vein endothelial cells (HUVEC) were divided into the control group, ox-LDL group, carvedilol 5 μM group, carvedilol 10 μM group, and carvedilol 20 μM group. The optimal concentration of carvedilol was determined using the CCK-8 method to assess cell proliferation levels and oil red O staining to observe intracellular lipid droplet formation. Subsequently, the cells were further divided into the control group, ox-LDL group, carvedilol 5 μM (optimal concentration) group, and MCC950 (inhibitor of NLRP3 Inflammasome) group. The expression levels of intracellular proteins NLRP3, pro-Caspase-1, Caspase1, pro-IL-1β, IL-1β, p65, GSDMD, and N-GSDMD were detected by ELISA, or Western Blotting.

Results: Compared to the control group, the ox-LDL group exhibited a significant reduction in cell proliferation level (P<0.05), accompanied by an increase in lipid droplet formation upon induction. In contrast, pretreatment with carvedilol at concentrations of 5 μM, 10 μM, and 20 μM effectively promoted cell proliferation (P<0.05) and inhibited intracellular lipid droplet formation. Notably, the most pronounced effect was observed with carvedilol pretreatment at a concentration of 5μM. Furthermore, compared to the control group, HUVEC cells in the ox-LDL group demonstrated substantial upregulation of NLRP3, pro-Caspase-1, Caspase1, pro-IL-1β, IL-1β, p65 GSDMD and N-GSDMD; however, these markers were downregulated following treatment with carvedilol and MCC950 administration-particularly evident in the carvedilol group.

Conclusions: Carvedilol effectively inhibits the progression of atherosclerosis by targeting the NLRP3 inflammasome, thereby providing valuable mechanistic insights into its beneficial effects on atherosclerotic cardiovascular disease.

Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) represents the treatment of choice for the majority of patients with coronary artery disease. While currently available DES, in addition to physiological support, has failed to show the non-inferiority to coronary artery bypass grafting (CABG) in terms of cumulative incidence of clinical events over the short-term follow-up. Studies have also shown that DES is associated with an increased risk of target vessel revascularization compared to CABG after long-term follow-up. Drug-coated balloons (DCB) have been shown to provide clinically significant benefits in the management of in-stent restenosis and diffuse coronary artery disease, as well as small coronary artery lesions. The aim of this review was to describe the inherent technical limitations of DES and highlight the potential advantages of PCI with DCB for long-term outcomes and potentially demonstrate its non-inferiority to CABG. Currently, ongoing studies will provide more information and help to understand if a blended therapy of DCB+DES can match the performance of CABG in the need for revascularization in more complex patients.

At the end of 2019, the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became prevalent worldwide, which brought a heavy medical burden and tremendous economic losses to the world population. In addition to the common clinical respiratory symptoms such as fever, cough and headache, patients with COVID-19 often have hematological diseases, especially platelet dysfunction. Platelet dysfunction usually leads to multiple organ dysfunction, which is closely related to patient severity or mortality. In addition, studies have confirmed significant changes in the gene expression profile of circulating platelets under SARS-CoV-2 infection, which will further lead to changes in platelet function. At the same time, studies have shown that platelets may absorb SARS-COV-2 mRNA independently of ACE2, which further emphasizes the importance of the stability of platelet function in defense against SARS-CoV-2 infection. This study reviewed the relationship between COVID-19 and platelet and SARS-CoV-2 damage to the circulatory system, and further analyzed the significantly differentially expressed mRNA in platelets after infection with SARS-CoV-2 on the basis of previous studies. The top eight hub genes were identified as NLRP3, MT-CO1, CD86, ICAM1, MT-CYB, CASP8, CXCL8 and CXCR4. Subsequently, the effects of SARS-CoV-2 infection on platelet transcript abnormalities and platelet dysfunction were further explored on the basis of 8 hub genes. Finally, the treatment measures of complications caused by platelet dysfunction in patients with COVID-19 were discussed in detail, so as to provide reference for the prevention, diagnosis and treatment of COVID-19.