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Incidence, Predictors and Associations Between In-Hospital Bleeding and Adverse Events in Patients with Acute Coronary Syndrome Above 75 Years of Age – The Real-World Scenario 75岁以上急性冠状动脉综合征患者的院内出血和不良事件的发生率、预测因素及其相关性——真实情况
IF 0.5 4区 医学 Pub Date : 2023-05-24 DOI: 10.15212/cvia.2023.0029
Cheng Wei, Zhaowei Zhu, Xinqun Hu, Shenghua Zhou
Background: Bleeding events in patients with acute coronary syndrome (ACS) are associated with poor outcomes. Risk factors and their associations with in-hospital events in older patients with ACS are not fully understood, because older patients with ACS are often excluded from randomized controlled studies.Methods: We enrolled 962 patients with ACS above 75 years of age treated at our center between January 2012 and December 2016. The incidence and risk factors for in-hospital bleeding events, as well as their associations with in-hospital adverse events were evaluated.Results: Bleeding complications were observed in 38 patients (4.1%). The most common bleeding site was the gastrointestinal tract (52.6%). Anemia (P=0.007), renal insufficiency (P=0.019), use of positive inotropic medicines (P=0.006) and elevated leukocyte count (P=0.046) were independent predictors of in-hospital bleeding after adjustment for age, sex, atrial fibrillation history and hypertension history. In-hospital mortality (28.9% vs. 2.4%, P<0.001), stroke (5.3% vs. 0.5%, P<0.001) and the prevalence of heart failure (39.5% vs. 16.3%, P<0.001) were significantly higher in patients with than without bleeding.Conclusions: The incidence of in-hospital bleeding was 4.1% in patients with ACS above 75 years of age in this cohort. Independent risk factors for in-hospital bleeding events included anemia, renal insufficiency and elevated leucocyte count. Bleeding events were strongly associated with in-hospital adverse events.
背景:急性冠脉综合征(ACS)患者出血事件与不良预后相关。老年ACS患者的危险因素及其与住院事件的关系尚不完全清楚,因为老年ACS患者通常被排除在随机对照研究之外。方法:2012年1月至2016年12月在本中心接受治疗的75岁以上ACS患者962例。评估院内出血事件的发生率和危险因素,以及它们与院内不良事件的关联。结果:出血并发症38例(4.1%)。最常见的出血部位是胃肠道(52.6%)。调整年龄、性别、房颤史和高血压史后,贫血(P=0.007)、肾功能不全(P=0.019)、正性肌力药物使用(P=0.006)和白细胞计数升高(P=0.046)是院内出血的独立预测因素。出血患者的住院死亡率(28.9%对2.4%,P<0.001)、卒中发生率(5.3%对0.5%,P<0.001)和心力衰竭发生率(39.5%对16.3%,P<0.001)均显著高于无出血患者。结论:在该队列中,75岁以上ACS患者的住院出血发生率为4.1%。院内出血事件的独立危险因素包括贫血、肾功能不全和白细胞计数升高。出血事件与院内不良事件密切相关。
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引用次数: 0
Mechanisms of Sodium-glucose Cotransporter 2 Inhibitors in Heart Failure 钠-葡萄糖共转运蛋白2抑制剂在心力衰竭中的作用机制
IF 0.5 4区 医学 Pub Date : 2023-05-24 DOI: 10.15212/cvia.2023.0028
Jiangjun Wei, Jianlin Du
Heart failure is an end stage cardiac disease that has been associated with high mortality and rehospitalization rates in previous decades, in spite of standard anti-heart failure therapy, thus posing a major social and economic burden on public health. Several studies have demonstrated that sodium-glucose cotransporter 2 inhibitors (SGLT2i), anti-hyperglycemic drugs whose function is independent of islet function, have significant positive effects on prognosis and quality of life, by decreasing mortality and readmission rates in patients with heart failure. To increase general clinicians’ understanding and facilitate the practical application of SGLT2i in the treatment of heart failure, the mechanisms through which SGLT2i alleviate heart failure is reviewed herein.
心力衰竭是一种终末期心脏病,在过去几十年中,尽管采用了标准的抗心力衰竭治疗,但仍与高死亡率和再住院率相关,因此对公共卫生造成了重大的社会和经济负担。多项研究表明,钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)是一种功能独立于胰岛功能的降糖药物,通过降低心力衰竭患者的死亡率和再入院率,对预后和生活质量有显著的积极影响。为了提高普通临床医生对SGLT2i治疗心衰的认识,促进SGLT2i在心衰治疗中的实际应用,本文对SGLT2i缓解心衰的机制进行综述。
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引用次数: 0
Single-Cell RNA Sequencing Maps Immune Cell Heterogeneity in Mice with Allogeneic Cardiac Transplantation 单细胞RNA测序定位异基因心脏移植小鼠的免疫细胞异质性
IF 0.5 4区 医学 Pub Date : 2023-05-23 DOI: 10.15212/cvia.2023.0023
Zhonghua Tong, Ge Mang, Dongni Wang, Jingxuan Cui, Qiannan Yang, Maomao Zhang
Objective: Immune cells play important roles in mediating allograft rejection and tolerance after cardiac transplantation. However, immune cell heterogeneity at the single-cell level, and how immune cell states shape transplantation immunity, remain incompletely characterized.Methods: We performed single-cell RNA sequencing (scRNA-seq) on immune cells in LNs from a mouse syngeneic and allogeneic cardiac transplantation model. Nine T cell clusters were identified through unsupervised analysis. Pathway enrichment analysis was used to explore the functional differences among cell subpopulations and to characterize the metabolic heterogeneity of T cells.Results: We comprehensively determined the transcriptional landscape of immune cells, particularly T cells, and their metabolic transcriptomes in LNs during mouse cardiac transplantation. On the basis of molecular and functional properties, we also identified T cell types associated with transplantation-associated immune processes, including cytotoxic CD8+ T cells, activated conventional CD4+ T cells, and dysfunctional Tregs. We further elucidated the contribution of JunB to the induction of Th17 cell differentiation and restriction of Treg development, and identified that HIF-1a participates in T cell metabolism and function.Conclusions: We present the first systematic single-cell analysis of transcriptional variation within the T cell population, providing new insights for the development of novel therapeutic targets for allograft rejection.
目的:免疫细胞在心脏移植后异体移植排斥和耐受的调节中起重要作用。然而,单细胞水平的免疫细胞异质性,以及免疫细胞状态如何影响移植免疫,仍然没有完全表征。方法:对小鼠同基因和异体心脏移植模型的免疫细胞进行单细胞RNA测序(scRNA-seq)。通过无监督分析鉴定出9个T细胞簇。途径富集分析用于探索细胞亚群之间的功能差异,并表征T细胞的代谢异质性。结果:我们全面确定了小鼠心脏移植过程中免疫细胞,特别是T细胞的转录图景及其代谢转录组。在分子和功能特性的基础上,我们还确定了与移植相关免疫过程相关的T细胞类型,包括细胞毒性CD8+ T细胞、活化的常规CD4+ T细胞和功能失调的Tregs。我们进一步阐明JunB在诱导Th17细胞分化和限制Treg发育中的作用,并确定HIF-1a参与T细胞代谢和功能。结论:我们首次对T细胞群中的转录变异进行了系统的单细胞分析,为开发治疗同种异体移植排斥反应的新靶点提供了新的见解。
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引用次数: 0
Coronavirus Disease 2019, Myocardial Injury, and Myocarditis 2019冠状病毒病、心肌损伤和心肌炎
IF 0.5 4区 医学 Pub Date : 2023-05-18 DOI: 10.15212/cvia.2023.0025
Lilin Xiang, Lin Zhang, T. Zhang, Hanyu Zhang, Cihang Guo, Shi Liu, Qiongxin Wang, Huanhuan Cai, Zhibing Lu
After its initial outbreak in 2019, the 2019 novel coronavirus disease (COVID-19) remains a global health concern. COVID-19 is well known for causing severe respiratory pathology, but it can also cause a variety of extra-pulmonary manifestations. Among them, myocardial injury has received substantial attention because it is usually associated with poor prognosis and mortality, thus emphasizing the importance of monitoring and managing myocardial injury in patients with COVID-19. Myocarditis has received attention as a complication of myocardial injury during and after the onset of COVID-19. Here, to aid in clinical decision-making, we present a narrative review on COVID-19- associated myocardial injury and myocarditis, discussing clinical evidence, pathogenesis, diagnostic tools, and therapeutic strategies.
在2019年首次爆发后,2019年新型冠状病毒疾病(新冠肺炎)仍然是全球健康问题。众所周知,新冠肺炎会导致严重的呼吸道疾病,但它也会导致各种肺外表现。其中,心肌损伤因其通常与不良预后和死亡率相关而受到广泛关注,从而强调了监测和管理新冠肺炎患者心肌损伤的重要性。在新冠肺炎发病期间和发病后,心肌炎作为心肌损伤的并发症受到关注。在这里,为了帮助临床决策,我们对新冠肺炎相关的心肌损伤和心肌炎进行了叙述性综述,讨论了临床证据、发病机制、诊断工具和治疗策略。
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引用次数: 0
Predictive Value of a Combination of the Age, Creatinine and Ejection Fraction (ACEF) Score and Fibrinogen Level in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention 年龄、肌酐和射血分数(ACEF)评分和纤维蛋白原水平对急性冠状动脉综合征患者经皮冠状动脉介入治疗的预测价值
IF 0.5 4区 医学 Pub Date : 2023-05-17 DOI: 10.15212/cvia.2023.0027
Yuhao Zhao, Zong-sheng Guo, Zheng Liu, Xinchun Yang, Lei Zhao
Background: The purpose of this study was to explore whether consideration of FIB levels might improve the predictive value of the ACEF score in patients with ACS.Methods: A total of 290 patients with ACS were enrolled in this study. The clinical characteristics and MACE were recorded.Results: Multivariate logistic regression analysis revealed that the FIB level (odds ratio=7.798, 95%CI, 3.44–17.676, P<0.001) and SYNTAX score (odds ratio=1.034, 95%CI, 1.001–1.069, P=0.041) were independent predictors of MACE. On the basis of the regression coefficient for FIB, the ACEF-FIB was developed. The area under the ROC of the ACEF-FIB scoring system in predicting MACE after PCI was 0.753 (95%CI 0.688–0.817, P<0.001), a value greater than those for the ACEF score, SYNTAX score and Grace score (0.627, 0.637 and 0.570, respectively).Conclusion: ACEF-FIB had better discrimination ability than the other risk scores, according to ROC curve analysis, net reclassification improvement and integrated discrimination improvement.
背景:本研究的目的是探讨考虑FIB水平是否可以提高ACS患者ACEF评分的预测值。方法:共有290名ACS患者参与本研究。记录临床特征和MACE。结果:多因素logistic回归分析显示,FIB水平(比值比=7.798,95%CI,3.44-17.676,P<0.001)和SYNTAX评分(比值比=1.034,95%CI为1.001-1.069,P=0.041)是MACE的独立预测因素。在FIB回归系数的基础上,开发了ACEF-FIB。ACEF-FIB评分系统预测PCI后MACE的ROC下面积为0.753(95%CI 0.688–0.817,P<0.001),大于ACEF评分、SYNTAX评分和Grace评分(分别为0.627、0.637和0.570),净重新分类改进和综合歧视改进。
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引用次数: 0
Angiography-Derived Fractional Flow Reserve in Coronary Assessment: Current Developments and Future Perspectives 冠状动脉评估中血管造影衍生的血流储备分数:当前发展和未来展望
IF 0.5 4区 医学 Pub Date : 2023-05-12 DOI: 10.15212/cvia.2023.0021
H.B. Chow, S. Tan, W. Lai, A. Fong
Coronary physiology assessment is an important factor in guiding myocardial revascularization. A growing body of research highlights the value of using fractional flow reserve, FFR and other pressure-based indicators for functional assessment of stable coronary stenoses. Invasive functional coronary assessment techniques have evolved from intracoronary wire-based to wire-free approaches as a result of technological advancements. In addition, several software programs on the market have been thoroughly investigated and validated against invasive FFR, and have shown good accuracy and correlation. However, use of FFR remains modest. Hence, this review provides an overview of angiography-based FFR solutions and compares their technologies. Additionally, a systematic scoping review was performed to understand the research landscape in wire-free coronary physiology assessment, to complement the narratives of existing FFR trials on wire-free FFR. Furthermore, future developments and strategies that could expand the use of wire-free computed coronary functional assessment in the Asia Pacific region are discussed.
冠状动脉生理学评估是指导心肌血运重建的重要因素。越来越多的研究强调了使用血流储备分数、血流储备分数和其他基于压力的指标对稳定冠状动脉狭窄进行功能评估的价值。由于技术进步,有创功能性冠状动脉评估技术已经从基于冠状动脉内导线的方法发展到无导线方法。此外,市场上的几个软件程序已经针对侵入性血流储备分数进行了彻底的调查和验证,并显示出良好的准确性和相关性。然而,FFR的使用仍然不多。因此,本综述概述了基于血管造影的FFR解决方案,并对其技术进行了比较。此外,还进行了系统的范围界定审查,以了解无导线冠状动脉生理学评估的研究前景,以补充现有无导线血流储备分数的血流储备分数试验的叙述。此外,还讨论了在亚太地区扩大无导线计算机冠状动脉功能评估的未来发展和策略。
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引用次数: 0
Artificial Intelligence Solutions for Cardiovascular Disease Detection and Management in Women: Promise and Perils 女性心血管疾病检测和管理的人工智能解决方案:希望与风险
IF 0.5 4区 医学 Pub Date : 2023-05-12 DOI: 10.15212/cvia.2023.0024
W. Garzon-Siatoya, A. C. Morales-Lara, D. Adedinsewo
Artificial intelligence (AI) is a method of data analysis that enables machines to learn patterns from datasets and make predictions. With advances in computer chip technology for data processing and the increasing availability of big data, AI can be leveraged to improve cardiovascular care for women – an often understudied and undertreated population. We briefly discuss the potential benefits of AI-based solutions in cardiovascular care for women and also highlight inadvertent drawbacks to the use of AI and novel digital technologies in women.
人工智能(AI)是一种数据分析方法,使机器能够从数据集中学习模式并进行预测。随着用于数据处理的计算机芯片技术的进步和大数据的日益普及,人工智能可以用来改善女性的心血管护理,而女性往往是研究不足和治疗不足的人群。我们简要讨论了基于人工智能的解决方案在女性心血管护理中的潜在好处,并强调了在女性中使用人工智能和新型数字技术的无意缺点。
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引用次数: 0
Integration Analysis of Epigenetic-related m6A-SNPs Associated with Atrial Fibrillation 心房颤动相关表观遗传相关m6a - snp的整合分析
IF 0.5 4区 医学 Pub Date : 2023-05-10 DOI: 10.15212/cvia.2023.0022
Zhenhong Jiang, Xin Liu, Jianping Hu, Yan Zheng, Yang Shen
Objective: Numerous single nucleotide polymorphisms (SNPs) have been identified as genetic contributors to atrial fibrillation (AF). The aim of this study was to investigate the effects of genome-wide N6-methyladenosine (m6A)-SNPs on AF.Method: m6A-SNPs were identified by analysis of raw data from published AF GWAS datasets and the list of m6A-SNPs from the m6AVar database. Expression quantitative trait loci (eQTL) analysis was conducted to evaluate the effects of m6A-SNPs on gene expression. The expression of linked genes was validated in three independent AF-associated gene expression datasets (GSE14975, GSE108660 and GSE2240).Results: A total of 1429 (6.2%) unique m6A-SNPs that were significantly associated with AF were identified. Seventeen m6A-SNPs in 14 genes reached genome-wide significance. Eight m6A-SNPs demonstrated eQTL signals. Four m6A-SNPs (rs383692, rs3211105, rs1061259 and rs1152582) exhibited strong cis-eQTL signals associated with the gene expression levels of SMIM8, JMJD1C and SYNE2. SYNE2 and SMIM8 had differential gene expression levels between the AF and sinus rhythm groups. In addition, SYNE2 expression was uniformly downregulated in AF samples compared with normal control samples in the three datasets.Conclusions: Our results provide the first demonstration that m6A-SNPs are strongly associated with AF, and extend understanding of m6A modification as a potential biological pathway underlying AF.
目的:许多单核苷酸多态性(snp)已被确定为心房颤动(AF)的遗传因素。本研究旨在探讨全基因组n6 -甲基腺苷(m6A)-SNPs对AF的影响。方法:通过分析已发表的AF GWAS数据库的原始数据和m6AVar数据库中的m6A-SNPs列表,对m6A-SNPs进行鉴定。通过表达数量性状位点(eQTL)分析m6A-SNPs对基因表达的影响。在三个独立的af相关基因表达数据集(GSE14975、GSE108660和GSE2240)中验证了相关基因的表达。结果:共鉴定出1429个(6.2%)与房颤显著相关的独特m6a - snp。14个基因中的17个m6A-SNPs达到全基因组意义。8个m6a - snp显示了eQTL信号。4个m6a - snp (rs383692、rs3211105、rs1061259和rs1152582)表现出与SMIM8、JMJD1C和SYNE2基因表达水平相关的强顺式eqtl信号。SYNE2和SMIM8基因表达水平在房颤组和窦性心律组之间存在差异。此外,在三个数据集中,与正常对照样本相比,AF样本中SYNE2的表达均下调。结论:我们的研究结果首次证明了m6A- snp与房颤密切相关,并扩展了对m6A修饰作为房颤潜在生物学途径的理解。
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引用次数: 1
Inhibition of Stimulator of Interferon Genes Protects Against Myocardial Ischemia-Reperfusion Injury in Diabetic Mice 抑制干扰素刺激因子对糖尿病小鼠心肌缺血再灌注损伤的保护作用
IF 0.5 4区 医学 Pub Date : 2023-05-04 DOI: 10.15212/cvia.2023.0020
Yuce Peng, Guo-can Zhou, Mingyu Guo, Zhe Cheng, Suxin Luo, Yongzheng Guo
Background: Although the past decade has witnessed substantial scientific progress with the advent of cardioprotective pharmacological agents, most have failed to protect against myocardial ischemia/reperfusion (I/R) injury in diabetic hearts. This study was aimed at investigating the role of stimulator of interferon genes (STING) in I/R injury in diabetic mice and further exploring the underlying mechanisms.Methods: Type 2 diabetic mice were subjected to I/R or sham operation to investigate the role of STING. STING knockout mice were subjected to 30 minutes of ischemia followed by reperfusion for 24 hours. Finally, myocardial injury, cardiac function, and inflammation levels were assessed.Results: STING pathway activation was observed in diabetic I/R hearts, as evidenced by increased p-TBK and p-IRF3 expression. STING knockout significantly decreased the ischemic area and improved cardiac function after I/R in diabetic mice. STING knockout also elicited cardio-protective effects by decreasing serum cardiac troponin T and lactate dehydrogenase levels, thus diminishing the inflammatory response in the heart after I/R in diabetic mice. In vitro, STING inhibition decreased the expression of hypoxia-re-oxygenation-induced inflammatory cytokines.Conclusions: Targeting STING inhibits inflammation and prevents I/R injury in diabetic mice. Thus, STING may be a potential novel therapeutic target against myocardial I/R injury in diabetes.
背景:尽管在过去的十年里,随着心脏保护药物的出现,科学取得了实质性进展,但大多数药物都未能保护糖尿病心脏免受心肌缺血/再灌注(I/R)损伤。本研究旨在探讨干扰素基因刺激因子(STING)在糖尿病小鼠I/R损伤中的作用,并进一步探讨其潜在机制。方法:对2型糖尿病小鼠进行I/R或假手术,观察STING的作用。对STING敲除小鼠进行30分钟的缺血,然后再灌注24小时。最后,评估心肌损伤、心功能和炎症水平。结果:在糖尿病I/R心脏中观察到STING通路激活,p-TBK和p-IRF3表达增加证明了这一点。STING基因敲除显著降低糖尿病小鼠I/R后的缺血面积,改善心功能。STING敲除还通过降低血清心肌肌钙蛋白T和乳酸脱氢酶水平引起心脏保护作用,从而减少糖尿病小鼠I/R后心脏的炎症反应。在体外,STING抑制降低了缺氧再氧合诱导的炎性细胞因子的表达。结论:靶向STING可抑制糖尿病小鼠炎症反应,预防I/R损伤。因此,STING可能是一种潜在的治疗糖尿病心肌I/R损伤的新靶点。
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引用次数: 1
Expression Patterns and Functions of Cardiac Pigment Epithelium-Derived Factor During Cardiac Development 心脏色素上皮衍生因子在心脏发育过程中的表达模式和功能
IF 0.5 4区 医学 Pub Date : 2023-04-28 DOI: 10.15212/cvia.2023.0015
Xing-hui Li, Yandi Wu, Tong-sheng Huang, Teng Wu, Xin-lu Fu, Jiang Qian, Yan Zou, Cong-hui Shen, Shiquin Xiong, Zi-qi Feng, Hui-ting Zheng, Yuan-jun Ji, W. Cai
Objective: This study describes the expression profiles and roles of cardiac pigment epithelium-derived factor (PEDF) during cardiac development.Methods: Gene datasets from the Gene Expression Omnibus (GEO) database were used to analyze the correlation between cardiac PEDF expression and heart disease. Western blotting, immunohistochemistry, histological staining and echocardiography were used to assess the expression patterns and functions of PEDF during cardiac development.Results: Analysis of GEO data sets indicated that the expression of cardiac PEDF correlated with the occurrence and development of various heart diseases. Western blotting of various tissues in mice at 30 postnatal days of age indicated higher PEDF expression in the heart and aorta than the liver. Immunohistochemical results demonstrated that the expression of cardiac PEDF significantly decreased after birth, mainly because of a significant decrease in PEDF expression in the cytoplasm. Histological staining and echocardiography indicated that PEDF deficiency had no significant effects on cardiac structure, cardiac function and vascular hemodynamics in 8-week-old mice.Conclusion: Cardiac PEDF shows high expression and dynamic changes during cardiac development, but has no effects on cardiac structure, function and vascular hemodynamics.
目的:研究心脏色素上皮衍生因子(PEDF)在心脏发育过程中的表达谱及其作用。方法:利用基因表达综合数据库(Gene Expression Omnibus, GEO)中的基因数据,分析心脏PEDF表达与心脏病的相关性。采用Western blotting、免疫组化、组织学染色、超声心动图等方法评价PEDF在心脏发育过程中的表达模式和功能。结果:GEO数据集分析表明,心脏PEDF的表达与各种心脏疾病的发生和发展相关。出生后30日龄小鼠各种组织的Western blotting显示,PEDF在心脏和主动脉中的表达高于肝脏。免疫组化结果显示,出生后心脏PEDF的表达明显下降,主要是由于细胞质中PEDF的表达明显减少。组织学染色和超声心动图显示,PEDF缺乏对8周龄小鼠心脏结构、心功能和血管血流动力学无明显影响。结论:心脏PEDF在心脏发育过程中表现出高表达和动态变化,但对心脏结构、功能和血管血流动力学没有影响。
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引用次数: 0
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Cardiovascular Innovations and Applications
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