Minerva cardiology and angiology最新文献

Background: Postoperative atrial fibrillation (POAF) is common after aortic valve replacement (AVR). However, the long-term risk of cerebrovascular ischemic events (CVA) associated with POAF in this scenario is not known. The study objective was to look at the long-term risk of stroke in patients undergoing AVR with POAF compared to those with no POAF, particularly in patients having a bioprosthetic valve and not discharged on anticoagulation. We also looked at the risk of peri-operative stroke and long-term mortality.

Methods: A retrospective study of 831 patients undergoing AVR were followed up for a median of 6.5 years. The primary outcome was the occurrence of CVA after discharge, comparing those with to those without POAF, after excluding patients with a past history of atrial fibrillation (AF). They were divided into two cohorts, those having bioprosthetic valves (without oral anticoagulation), and those with a mechanical valve (with oral anticoagulation). Other outcomes studied were the incidence of early perioperative CVA comparing patients with a history of AF to those with no history, and long-term mortality in the different cohorts.

Results: There was no increased risk of long-term stroke in patients with POAF when compared to those without POAF, neither in bioprosthetic valves (adjusted HR 1.14; CI 95% 0.46-2.83, P=0.78)-nor in mechanical valves (adjusted HR 1.41; CI 95% 0.55-3.65, P=0.48). Patients with a history of AF had an increased risk of perioperative stroke (OR 1.5; CI 95% 1.3-13.8, P=0.01).

Conclusions: Patients undergoing bioprosthetic AVR who develop POAF are not at an increased risk of stroke despite not being on any oral anticoagulation.

Background: Acute myocardial infarction (AMI) remains one of the leading causes of mortality and morbidity worldwide.

Methods: GSE61144 and GSE66360 were the sources of microarray gene expression profiles for acute myocardial infarction patients and were acquired from the Gene Expression Omnibus (GEO) database (https://www.ncbi.nlm.nih.gov/geo/). After merging the datasets, genes that were differentially expressed were chosen.

Results: A total of 234 genes were found to have different expression levels. Of these, 206 genes were upregulated, and 28 genes were downregulated. Five coexpression modules were identified by WGCNA, with the yellow module showing a high correlation with AMI (r=0.65, P=2.0e-15). Ninety-two hub genes were selected in the yellow module by setting a threshold of module membership (MM) greater than 0.8 and gene significance (GS) higher than 0.4. By overlapping these genes with the differentially expressed genes, 81 hub genes were obtained. Five key genes (C5AR1, CXCL1, CXCL2, FPR1, and P2RY13) were identified through PPI analysis. AMI patients exhibited elevated levels of immune cell infiltration, and immune scores in AMI samples were significantly positively correlated with all five key genes. Moreover, the expression levels of these five genes were higher in AMI patients. These five genes possessed area under the curve (AUC) values exceeding 0.8 for diagnosing AMI, thereby demonstrating their efficacy as diagnostic markers.

Conclusions: C5AR1, CXCL1, CXCL2, FPR1, and P2RY13 have the potential to be useful biomarkers in diagnosing AMI and are linked to immune cell infiltration in AMI, opening up new avenues for future research into the pathogenesis of AMI.

Background: Atherosclerosis (AS) is the pathological basis of many cardiovascular and cerebrovascular diseases. To further the investigation of treatments for AS, this research analyzed the role of lncRNA MBNL1-AS1.

Methods: MBNL1-AS1 expression in the serum of AS patients and healthy controls were detected by qPCR. Its diagnostic value in AS was assessed by receiver operating characteristic curve (ROC). Additionally, the link between MBNL1-AS1, carotid intima-media thickness (CIMT) and C-reactive protein (CRP) was examined using the Spearman correlation coefficient. The prognostic value of MBNL1-AS1 in AS was assessed using the Kaplan-Meier survival curve and univariate and multivariate Cox regression analysis.

Results: The present study consisted of 103 patients with AS and 92 healthy patients (HC) and comparison of baseline data between the two groups revealed no remarkable difference (P>0.05) except for CRP (P<0.0001). The serum of AS patients exhibited a considerably higher expression of MBNL1-AS1 in comparison to the HC group. Furthermore, MBNL1-AS1 was highly expressed in patients following higher CIMT and CRP values, which was positively linked with both, respectively (r>0.5, P<0.001). Meanwhile. MBNL1-AS1 has enhanced diagnostic accuracy in AS patients (AUC=0.893) and can be utilized as an independent prognostic factor for AS. Patients with high MBNL1-AS1 expression have a higher likelihood of cardiovascular events. (log rang P=0.0025).

Conclusions: Elevated MBNL1-AS1p can be used as a potential marker for the clinical diagnosis of AS and is linked to a poor prognosis of AS.

Background: The aim of this paper was to investigate the diagnostic significance and severity assessment of serum neuron-specific enolase (NSE) combined with homocysteine (Hcy) for patients with coronary atherosclerosis (coronary artery disease, CAD).

Methods: Two hundred sixty-three patients with coronary artery disease were selected as the research group, and 400 healthy individuals who underwent physical examination during the same period were taken as the control group. Electrochemiluminescence immunoassay and biochemical analyzer were employed to detect the serum NSE and Hcy levels of all subjects. The diagnostic value of combined and individual serum NSE and Hcy detection for the combined group was analyzed using the ROC curve.

Results: The serum NSE (19.91±9.98 vs. 11.17±2.35) and Hcy levels (15.76±5.37 vs. 10.17±3.71) in the research group were significantly higher than those in the control group, with a statistically significant difference (P<0.05). The serum NSE (16.67±4.02 vs. 18.63±5.49 vs. 20.29±5.87) and Hcy levels (13.28±2.49 vs. 15.56±2.67 vs. 16.66±3.94) gradually increased across groups A, B, and C, and inter-group comparisons showed statistically significant differences (P<0.05). The AUC value of combined serum NSE and Hcy detection for CAD patients was higher (0.879 vs. 0.724 vs. 0.827) than individual NSE and Hcy testing. The specificity of Hcy for the diagnosis of CAD was the highest, reaching 90.3%. The sensitivity of combined NSE and Hcy (82.9%) was higher than the individual testing sensitivity of the two groups.

Conclusions: The combined detection of serum NSE and Hcy has high diagnostic efficacy for CAD and provides reference value in assessing the severity of the disease.

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.