Vascular Health and Risk Management最新文献

Purpose: Hypertension (HTN) is a complex disorder regulated by multiple physiological systems. Each individual's underlying genetic architecture strongly influences inter-individual variability in therapeutic responses to HTN. Consequently, identifying candidate genes that contribute to the genetic basis of HTN remains a significant challenge. This study aims to investigate the association between eleven polymorphisms across eight candidate genes and HTN in the Jordanian population.

Patients and methods: This study included 200 patients with hypertension from Jordan and 224 healthy controls. Whole blood samples were collected from each participant, followed by the extraction of genomic DNA. The distribution of polymorphisms in the genes VEGFA, NAT2, TANC2, NR3C2, PROX1, PTGER3, TLE1, and PRKCA was investigated. Haplotype, genotype, and allele frequencies were analyzed using the SNPStats web tool.

Results: In the Jordanian population, significant differences were observed in the frequency of the A/A genotype of rs699947 in VEGFA and the G/A genotype of rs2429427 in TANC2 (P = 0.006 and 0.042, respectively) between healthy individuals and those with hypertension. No significant associations were detected for the other SNPs analyzed with hypertension incidence. Additionally, significant differences were noted in the codominant and recessive models of VEGFA rs699947, the recessive model of NAT2 rs1041983, the dominant and overdominant models of TANC2 rs2429427, and the overdominant model of NR3C2 rs5522 between the groups. Overall, the genotype distributions of the VEGFA and TANC2 genes differed significantly between healthy individuals and those with hypertension.

Conclusion: These findings highlight the potential of incorporating genetic profiling into clinical practice to enable more precise, genotype-guided hypertension management, paving the way for personalized therapeutic strategies in affected populations.

The vascular endothelium is responsible for regulating vascular tone, maintaining fluid homeo-stasis, and preventing platelet aggregation, exhibits regulatory properties in vasorelaxation and vasoconstriction - it produces, among others, nitric oxide and endothelin. The imbalance of vasoactive molecules leads to the loss of their function, known as endothelial dysfunction. Impaired endothelial function is observed in people with metabolic disorders, often preceding the onset of the disease by several years. Endothelial function assessment can be performed using invasive (eg coronary angiography) and non-invasive (flow-dependent dilation, biochemical markers) techniques. Among metabolic abnormalities, increasing scientific interest has focused on metabolic obesity in normal-weight individuals. People with this type of obesity, despite having a normal body mass index, exhibit both metabolic abnormalities typical of obesity (including hypertension and type 2 diabetes) and endothelial dysfunction. This comprehensive review summarizes the current knowledge of the structure and function of the vascular endothelium, methodologies for assessment, and pathophysiological mechanisms of endothelial dysfunction in metabolic disorders, with particular emphasis on diagnostic approaches and clinical implications for cardiovascular risk stratification.

Introduction: Ischemic cardiomyopathy is the leading cause of heart failure and associated with increased morbidity and mortality. The role of percutaneous coronary intervention (PCI) in term of increasing survival and cardiovascular outcomes in ischemic cardiomyopathy remains unclear.

Purpose: To evaluate whether revascularization is associated with 30-day survival in ischemic cardiomyopathy in Dr. Hasan Sadikin General Hospital.

Patients and methods: This was a single center, observational, retrospective cohort study. Subject data was taken from the CABG and PCI database of Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital from January 2021 to December 2022. Study outcome was 30-day survival after revascularization procedure. Survival analysis was done using Kaplan-Meier analysis then bivariate analysis with log rank test and cox regression analysis. Cox regression analysis was also done for multivariate analysis of confounding factors.

Results: A total of 67 ischemic cardiomyopathy patients were included in the final analysis of this study with balance proportion except for age, complete revascularization, and chronic total occlusion (CTO) variables. CABG group tends to be younger with more proportion in age ≤65 years old compared with PCI group (92.6% vs. 65%. p = 0.01). Complete revascularization had reached dominantly in the CABG group compared with PCI group (85.2% vs. 15%. p < 0.001). In coronary anatomy characteristic, CTO was found more in the CABG group (81.5% vs. 52.5%. p = 0.02). In 30-day follow up, overall survival rate was 91% with 81.5% in the CABG group compared with 97.5% in the PCI group (p = 0.03). Multivariate analysis was done to exclude confounding factors with adjusted hazard ratio of revascularization was 4.02 (CI95% 0.27-60.3. p = 0.31).

Conclusion: There is no association between revascularization and 30-day survival in ischemic cardiomyopathy in Dr. Hasan Sadikin General Hospital. However, wide confidence intervals highlight uncertainty.

Cardiac arrhythmias are a major health concern around the world, causing morbidity and mortality in a wide range of people. The timely and accurate diagnosis of arrhythmias is critical for optimal clinical management and intervention. Deep learning techniques have developed as powerful tools for detecting arrhythmias in recent years, taking advantage of advances in signal processing and machine learning. This review investigates the use of deep learning approaches to detect arrhythmias via electrocardiogram (ECG) readings. The study includes an in-depth evaluation of 30 papers retrieved from three distinct databases using a structured method. The result indicates that deep learning models can achieve high accuracy like 99.93% as well as high F1 scores such as 99.57%. Furthermore, the study examines current research trends, approaches, and developments in deep learning-based arrhythmia detection, including convolutional neural networks (CNNs), and hybrid architectures that includes RNN and CNN algorithms. Additionally, the paper investigates the strengths and limits of existing techniques, focusing on critical issues such as dataset heterogeneity, model interpretability, and real-time implementation. Future research and development directions in arrhythmia detection using deep learning are also mentioned. This study seeks to give significant insights for physicians, researchers, and policymakers involved in the development and implementation of sophisticated arrhythmia detection systems, with the ultimate goal of improving patient outcomes and cardiac healthcare.

Background: Carotid artery stenting (CAS) has been widely used to remodel the vascular structure and restore the blood flow for preventing ischemic stroke. However, in-stent restenosis (ISR) after CAS is extremely associated with an increased risk of ischemic stroke recurrence.

Objective: The aim of this study was to explore potential predict biomarkers for ISR after CAS.

Methods: In this study, data from 221 patients with CAS, which was divided into no-ISR group and ISR group, and 145 healthy controls were retrospectively analyzed. The ratios of neutrophil, lymphocyte, monocyte, platelet, glucose (Glu), and triglyceride (TG) to lymphocyte, HDL, and LDL were analyzed, respectively. In addition, the ratios of SII, SIRI, and AISI were analyzed as the following formulas: SII = platelet × neutrophil-to-lymphocyte ratio, SIRI = monocyte × neutrophil-to-lymphocyte ratio, and AISI = neutrophil × platelet × monocyte-to-lymphocyte ratio. ROC curve analysis was performed to analyze the predict roles of PLR and platelet/LDL for ISR.

Results: The ratios of NLR, PLR, Glu/lymphocyte, TG/lymphocyte, NHR, PHR, Glu/HDL, TG/HDL, neutrophil/LDL, platelet/LDL, Glu/LDL, TG/LDL, and SII increased in patients with CAS, indicating the predict roles of these values in carotid artery stenosis. Most importantly, increased ratios of PLR and platelet/LDL before the first operation of CAS, but not the second operation, were found in ISR patients after CAS as compared with no-ISR group. ROC analysis showed a more effective role of PLR for predicting ISR. While PLR showed high specificity (96.95%), its modest sensitivity (35.29%) suggests the need for complementary biomarkers in clinical practice.

Conclusion: These results indicate that ratios of PLR and platelet/LDL before the first CAS operation can act as the predict biomarkers of ISR.

Background: Coronary artery bypass grafting (CABG) is frequently associated with postoperative arrhythmias, often necessitating temporary cardiac pacing (TCP). The routine placement of temporary epicardial pacing wires (PWs) remains controversial due to potential complications. This study aimed to identify predictors for TCP after isolated CABG to guide selective PW use and improve perioperative outcomes.

Methods: A retrospective analysis was conducted on 1,395 patients who underwent isolated CABG with cardiopulmonary bypass (CPB) at King Abdullah University Hospital, Jordan, between 2004 and 2022. Patients undergoing redo surgeries or presenting with high-grade atrioventricular block, ischemic ventricular septal defect, or missing data were excluded. Patients were grouped based on PW placement, and predictors for TCP were assessed using univariate and multivariate logistic regression.

Results: Among the 1,395 patients, 887 received PWs, and 127 required TCP. Significant predictors for TCP included preoperative bundle branch block (BBB), intraoperative blood transfusion, prolonged vasoactive support, and mechanical ventilation exceeding 12 hours postoperatively. Preoperative beta-blocker use was associated with reduced risk of TCP. Demographics, comorbidities, and prolonged CPB or aortic cross-clamp times were not significant.

Conclusion: Preoperative BBB and postoperative complications were associated with increased TCP risk, while beta-blocker use was protective. These findings support a risk-based strategy for PW placement after CABG to reduce complications and improve resource allocation. Prospective studies are needed to validate these predictors and refine perioperative protocols.

Objective: This study investigates the potential genetic and regional associations of a newly identified c.3865T>G mutation in the F5 gene (coagulation factor V) with cerebral venous and sinus thrombosis (CVST).

Methods: Two groups of CVST cases associated with hereditary thrombophilia were analyzed. Genetic sequencing was performed to identify the patients' genetic profiles. A family pedigree analysis and a review of relevant literature were conducted to assess the pathogenic significance of the mutation.

Results: Genetic analysis revealed the presence of a c.3865T>G mutation in the F5 gene in both cases. This mutation is distinct from the well-established Leiden mutation and has not been previously reported. Although the two patients' families had no direct blood relationship, both patients resided in the same geographic region, suggesting the possibility of shared environmental or genetic factors. Advances in diagnostic technologies have also facilitated the identification of hereditary thrombophilia as an increasingly recognized cause of CVST.

Conclusion: The c.3865T>G mutation in the F5 gene may represent a novel genetic contributor to CVST. Its regional clustering points to a potential genetic and geographic association. These findings provide new insights into the etiology and diagnosis of CVST and underscore the importance of investigating regional genetic predispositions further.

Background: Exploring an integrated care management model to effectively deliver the standardized management to atrial fibrillation (AF) elderlies in rural China.

Purpose: The objective of this study was to assess whether intensified multifaceted education (IME) targeting AF elderlies, their family members, and the village doctors (VD) can increase compliance for rural AF elderlies with integrated care based on the AF Better Care (ABC) pathway. Additionally, the capacity of VD to deliver integrated AF care was investigated.

Patients and methods: This is a self-controlled cohort study before and after IME, including AF patients aged ≥65 years identified in phase-I of The Jiangsu Province Rural Community AF Project. The IME model was defined as 12 months of continuous knowledge education on integrated care management of AF based on the ABC pathway, delivered to AF patients, their family members and the village doctors. AF knowledge evaluation from VD and compliance with the ABC pathway before and after the IME model were evaluated.

Results: A total of 810 AF patients (mean age 76.1 ± 5.9 years; 51.4% women) were enrolled. After 12 months, the AF knowledge score of VD was significantly improved [(65.0 ± 13.0) scores vs (53.1 ± 9.8) scores, P < 0.001]. Although the compliance of AF patients with the ABC pathway was improved statistically (4.3% vs 1.7%, P = 0.003), the absolute increase was small.

Conclusion: Although VD have the potential to serve as AF integrated care management providers, the impact of the IME model used to improve the standard AF care in rural elderly AF population was small.