Minerva cardiology and angiology最新文献

Introduction: The ideal antiplatelet therapy to maintain graft patency after coronary artery bypass graft surgery (CABG) remains controversial. This review of randomized controlled trials (RCTs) aims to compare aspirin monotherapy, ticagrelor monotherapy, dual antiplatelet therapy (DAPT) with aspirin and ticagrelor (Asp+Tica) or with aspirin and clopidogrel (Asp+Clopi) to evaluate differences in post-CABG saphenous vein graft (SVG) occlusion, internal mammary artery (IMA) occlusion, myocardial infarction (MI), bleeding, and all-cause mortality (ACM) rates.

Evidence acquisition: The literature review was conducted on several electronic databases, including Medline, Embase, and Cochrane Central, from inception to August 10, 2022. Data was extracted using a predefined proforma. A Bayesian random-effects model was used for calculating point effect estimates (odds ratio and standard deviation). Quality assessment was done using the Cochrane RoB-2 tool.

Evidence synthesis: Ten RCTs comprising 2139 patients taking anti-platelets post-CABG were included. For preventing SVG occlusion, Asp+Tica showed the lowest mean AR of 0.144±0.068. Asp+Tica also showed a trend toward lesser postoperative MI risk and lower ACM rates, with a mean AR of 0.040±0.053 and 0.018±0.029, respectively. For maintaining IMA graft patency, Asp+Clopi showed the lowest mean AR of 0.092±0.053. Ticagrelor had the lowest mean AR of 0.049±0.075, with Asp+Tica showing a similar mean AR of 0.049±0.045 for postoperative major bleeding risk.

Conclusions: Our analysis demonstrates that Asp+Tica can be the ideal therapy for patients undergoing CABG using SVG as it decreases the risk of post-CABG SVG occlusion and is not associated with a significantly higher risk for major bleeding.

Background: Circular RNAs (circRNAs) are implicated in the pathogenesis of acute myocardial infarction (AMI). Current research aims to evaluate the diagnostic and functional value of circFOXP1 in AMI patients.

Methods: The expression of circFOXP1 was assessed using RT-qPCR, and its diagnostic potential was determined through receiver operating characteristic (ROC) curve. The target gene of circFOXP1 was identified using a luciferase reporter assay. An in vitro hypoxia/reoxygenation (H/R) model was established in AC16 cells, while an AMI model was constructed in C57BL/6 mice. The proliferation and apoptosis of AC16 cells were evaluated using CCK8 and flow cytometry (FCM). The impact of circFOXP1 on inflammation was measured by assessing levels of TNF-α, IL-1β, and IL-6, while the effects of circFOXP1 on oxidative stress were evaluated through measurements of reactive oxygen species (ROS), glutathione (GSH), and lactate dehydrogenase (LDH) levels.

Results: circFOXP1 expression was found to be downregulated in AMI patients compared to controls. The ROC curve indicated an area under the curve (AUC) was 0.881 (95%CI=0.847-0.915), with a sensitivity of 0.930 and a specificity of 0.785. Additionally, miR-9-3p was identified as a direct target gene of circFOXP1. High levels of circFOXP1 did not significantly affect f the proliferation of H/R stimulated AC16 cells; however, increased circFOXP1 resulted in significant reduction in cell apoptosis (P<0.001). TNF-α, IL-1β, and IL-6 levels were significantly lower in pcDNA3.1-circFOXP1-transfected cells (P<0.001). ROS concentration and LDH level were markedly reduced in these cells (P<0.01), while GSH level (P<0.001) was significantly elevated. miR-9-3p, as a direct target gene of circFOXP1, was found to reverse the effects of circFOXP1 on H/R AC16 cells and AMI model.

Conclusions: circFOXP1 was decreased in AMI patients and may serve as a diagnostic marker for AMI. Overexpression of circFOXP1 was shown to suppress apoptosis, inflammation, and oxidative stress via miR-9-3p in AC16 cells and the AMI model.

Background: In the morphology of coronary arteries, changes such as atherosclerosis and ectasia occur over time. The aim of this study is to identify the factors influencing changes in coronary artery morphology.

Methods: One hundred twenty-seven patients were evaluated of their baseline characteristics, echocardiography findings, laboratory values, and screening for systemical diseases. Patients were divided into three groups. Group N: the group with normal coronary arteries. Group A: the group with atherosclerosis. Group E: the group with ectasia and/or aneurysm. Mann-Whitney U Test and Kruskal Wallis Test were used in analysis of measurement data that did not conform to the normal distribution.

Results: Diabetes mellitus, hypertension, and chronic kidney disease were found to be statistically significantly higher in Group A. The mean TAPSE/sPAP ratio in Group A patients is lower than in Group E and normal individuals (P<0.001) Vasculitis is more frequently observed in Group E (13.3%) compared to Group A. The frequency of at least one musculoskeletal disease in rheumatologic screening in Group A (100.0%) and in Group E (100.0%) is higher than in the Group N (69.8%) (P<0.001).

Conclusions: No specific risk factor or disease was identified in this study that increases the frequency of coronary artery ectasia. However, diabetes mellitus, hypertension, chronic kidney disease, and low ejection fraction were found to be significantly associated with atherosclerosis.

Percutaneous left atrial appendage occlusion (LAAO), currently recognized as a procedure with relatively low risk, is increasingly being adopted in clinical practice. However, due to the preventive nature of the procedure and the necessity to compare it with newer and safer oral anticoagulants, further optimization is required to address remaining challenges. These latter include acquiring comprehensive data on safety and efficacy, establishing standardized pre-procedural planning, and simplifying procedural process. Consequently, we have provided an overview that encompasses future opportunities for enhancing procedural safety and efficacy, thereby establishing LAAO as the mainstream strategy for stroke and systemic embolism prevention in patients with atrial fibrillation and absolute contraindications to anticoagulant drugs.

Background: Hypertension is the most prevalent chronic disease globally and the treatment and control ratio of hypertension patients are still low. The function of lncRNA MIR210HG in hypertension has not yet been announced.

Methods: Eighty-three hypertension patients and 79 healthy individuals were enrolled. The Human Umbilical Vein Endothelial Cells (HUVECs) treated with Ang II were employed to imitate hypertension. The relative expression of MIR210HG and miR-125b-5p were evaluated by qRT-PCR while the ROC curve was applied to assess the diagnostic performance of MIR210HG. The CCK-8 assay was performed to detect the proliferation ability. The transwell assay and flow cytometry were used to analyze the migratory or apoptosis, respectively. The dual luciferase reporter system was used to confirm the targeted relationship between MIR210HG and miR-125b-5p.

Results: Up-regulated MIR210HG was found in hypertension patients (P<0.001) compared to healthy individuals and the upregulation was positively associated with the severity of hypertension (P<0.01). Up-regulated MIR210HG exhibited a promising diagnosability for hypertension patients. The area under the ROC curve was 0.8765 with high sensitivity (81.93%) and specificity (83.28%). In hypertension cell model, increased MIR210HG was observed along with declined cell proliferation, migration and enhanced apoptosis, which were reversed by MIR210HG knockdown. MIR210HG knockdown also inhibited inflammation levels including TNF-α, IL-1β and IL-6. The miR-125b-5p was a potential downstream target of MIR210HG and they were negatively correlated in expression.

Conclusions: Up-regulated MIR210HG was a promising diagnostic biomarker in identifying hypertension patients. MiR-125b-5p was a potential downstream target of MIR210HG in HUVECs.

Acute chest pain (ACP) is one of the most common symptoms in patients admitted to emergency departments (ED). It can be related to several life-threatening cardiovascular conditions such as acute coronary syndrome (ACS), aortic dissection, and pulmonary embolism. The optimal triage of patients with ACP is a clinical and healthcare necessity given the large number of patients daily admitted to ED with this symptom. The first contact with the patient in ED includes the clinical appraisal of the characteristics of ACP and coexisting symptoms, and the assessment of the patient's medical history. Risk scores may help stratify a patient's likelihood of having cardiac chest pain. The ECG examination allows the identification of patients with ST-segment elevation, depression, or T-wave changes, but may be normal in patients with non-ST-segment elevation ACS. Rapid protocols based on serial high-sensitivity cardiac troponin assays within one or two hours are recommended for identifying candidates for early discharge. Due to the bedside feasibility, non-invasiveness, and wide availability, transthoracic echocardiography represents the first-line imaging modality for evaluating patients with ACP. In selected cases, computed tomography angiography may also be performed. A practical approach to ACP in ED should improve patient outcomes and reduce healthcare system costs. This review aimed to provide an overview of the characteristics of patients with ACP of cardiac origin and to describe the state of the art about their management in the ED.

Background: The incidence and mortality of coronary heart disease (CHD) are high in the elderly population. CT fractional flow reserve (CT-FFR) is a potential diagnostic technique for cardiovascular diseases. In order to mine valuable biomarkers to combine CT-FFR parameters to improve the diagnostic accuracy of CHD.

Methods: In this study, GEO database was used to screen the key genes of CHD. GraphPad software was used to construct receiver operating characteristic (ROC) curve, and SPSS software was used for logistic regression analysis. Inflammatory cell model was constructed by treating human cardiac microvascular endothelial cells (HMVEC-Cs) with TNF-α to explore the role of RAC2 in this process.

Results: Real time quantitative PCR (RT-qPCR) results showed high-expression of RAC2 in CHD patients, which were reversed after nitric ester drug therapy. The analysis of ROC curves displayed that RAC2 combined with CT-FFR had a higher diagnostic value for CHD (AUC=0.971, 95% CI 0.950-0.992) compared to the single factor, and RAC2 was an independent risk factor for poor prognosis in CHD patients treated with nitric ester drugs (AUC=0.888, 95% CI 0.814-0.961, P<0.001). Overexpression of RAC2 further enhanced the elevated expression levels of NF-κB, NLRP3, IL-1β, and IL-6, induced by TNF-α, and its silence had the opposite effect.

Conclusions: RAC2 promoted the inflammatory response of HMVEC-Cs and predicted a poor prognosis in CHD patients. The combination of RAC2 and CT-FFR parameters was a good classifier for diagnosing CHD.

Liraglutide is a key therapeutic agent in managing type 2 diabetes mellitus (T2DM), with benefits extending beyond glycemic control to address cardiovascular and renal comorbidities. As T2DM prevalence rises globally, the need for medications that provide comprehensive health benefits becomes increasingly important. Liraglutide, a GLP-1 receptor agonist, has demonstrated effectiveness in reducing cardiovascular events, especially among patients with high cardiovascular risk, such as those with a prior history of myocardial infarction or stroke. It has shown significant reductions in major adverse cardiovascular events (MACE), including cardiovascular mortality and stroke risk, making it an essential component in secondary prevention for patients with established atherosclerotic cardiovascular disease (ASCVD). Moreover, liraglutide has a favorable safety profile, presenting a lower incidence of hypoglycemia compared to many other glucose-lowering agents, which is crucial for patient safety and adherence. Given these wide-ranging benefits, liraglutide serves as a valuable tool for optimizing health outcomes in diverse diabetic populations, particularly in those with complex comorbidities. To support this narrative review, a search in three electronic databases yielded 44 relevant journal articles and book chapters about liraglutide published from 2010 to 2022, providing a robust foundation for evaluating its cardiovascular impact and clinical utility in T2DM patients with concurrent cardiac conditions.

Background: In the face of numerous studies concerning the technical advances of percutaneous coronary intervention [PCI] and clinical outcomes, only a few studies focus on patients' lived experiences after PCI. This study aims to explore patients' lived experiences after PCI, both in clinical terms and in terms of their perception of their health status, functional capacity, and autonomy at home.

Methods: A qualitative phenomenological, individual, semi-structured survey was conducted on a sample of 18 patients undergoing PCI. Face-to-face interviews were conducted, interviews had a time duration of 7 to 10 minutes, and all conversations were recorded and transcribed. The study assessed the level of satisfaction, concerning the lived experience, in the pre/post-procedure period and the subsequent follow-up.

Results: Patients emphasized the importance of four themes: post-PCI health conditions, activities of daily living, the relationship established with health care providers, and the relationship between patient and family members/caregivers. Patients emphasized the improvement of symptoms, particularly exertional dyspnea, exertional angina, and easy fatigability. As a result, patients reported increased confidence in performing normal daily activities. Patients stressed the importance of establishing a good relationship between patients and healthcare providers. About 72.2% (95% CI 49.1-87.5%) of patients reported that they needed the help of family in the recovery phase. Of this group, 84.6% (95% CI 57.7-95.7%) reported that they never felt like a burden to their loved ones.

Conclusions: Post-PCI follow-up is generally characterized by improvement in the patient's functional capacity and autonomy. There are, however, cases in which at least part of the burden of home care falls on family members.