Pub Date : 2024-05-16DOI: 10.20517/2574-1209.2023.149
Yasmin A. Toy, Kayla N. House, Leslie M. Boyer, Jennifer L. McNamara, Marion A. Hofmann-Bowman, Kim A. Eagle, Michelle S Lim, Alan C. Braverman, Siddharth K. Prakash
Aims: There are currently no evidence-based guidelines for exercise after thoracic aortic dissection (TAD), leading to highly variable recommendations that frequently lead patients to restrict their physical activities. This multicenter randomized controlled trial was intended to evaluate the safety and efficacy of a moderate intensity guided exercise program for TAD survivors. Methods: Participants were eligible if they had a Type A or Type B dissection at least 90 days before enrollment and could attend two in-person study visits. The guided exercise circuit consisted of six aerobic, isotonic, or isometric exercises that participants continued at home with virtual follow-up sessions. The primary endpoint is the change in the composite anxiety and depression PROMIS-29 T-score at 12 months. Secondary endpoints include changes in grip strength, weight, 24-h ambulatory blood pressure, and arterial biomechanical properties measured by central arterial waveform analysis. Results: Preliminary analysis of the first 81 enrolled participants demonstrated that the guided exercise circuit was completed safely and was not associated with severe hypertension, injury, or adverse cardiovascular events. At enrollment, adverse central waveform or ABPM characteristics were prevalent and were significantly associated with exertional hypertension. Conclusions: Guided exercise is safe for aortic dissection survivors. Follow-up of enrolled participants will conclude in October 2024.
目的：目前还没有关于胸主动脉夹层（TAD）术后锻炼的循证指南，因此建议的内容千差万别，经常导致患者限制体育活动。这项多中心随机对照试验旨在评估中等强度的指导性运动计划对 TAD 幸存者的安全性和有效性。试验方法如果参与者在入组前至少 90 天发生过 A 型或 B 型夹层，并能参加两次亲临现场的研究访问，则符合条件。指导下的循环运动包括六种有氧、等张或等长运动，参与者在家继续进行，并进行虚拟随访。主要终点是 12 个月后焦虑和抑郁 PROMIS-29 T 评分的综合变化。次要终点包括握力、体重、24 小时卧床血压以及通过中心动脉波形分析测量的动脉生物力学特性的变化。研究结果对首批 81 名注册参与者进行的初步分析表明，在指导下完成循环锻炼是安全的，而且与严重高血压、损伤或不良心血管事件无关。在注册时，不良中心波形或 ABPM 特征普遍存在，并且与劳累性高血压有显著关联。结论指导性运动对主动脉夹层幸存者是安全的。入组参与者的随访将于 2024 年 10 月结束。
{"title":"Multicenter randomized controlled trial of exercise in aortic dissection survivors: rationale, design, and initial hemodynamic data","authors":"Yasmin A. Toy, Kayla N. House, Leslie M. Boyer, Jennifer L. McNamara, Marion A. Hofmann-Bowman, Kim A. Eagle, Michelle S Lim, Alan C. Braverman, Siddharth K. Prakash","doi":"10.20517/2574-1209.2023.149","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.149","url":null,"abstract":"Aims: There are currently no evidence-based guidelines for exercise after thoracic aortic dissection (TAD), leading to highly variable recommendations that frequently lead patients to restrict their physical activities. This multicenter randomized controlled trial was intended to evaluate the safety and efficacy of a moderate intensity guided exercise program for TAD survivors.\u0000 Methods: Participants were eligible if they had a Type A or Type B dissection at least 90 days before enrollment and could attend two in-person study visits. The guided exercise circuit consisted of six aerobic, isotonic, or isometric exercises that participants continued at home with virtual follow-up sessions. The primary endpoint is the change in the composite anxiety and depression PROMIS-29 T-score at 12 months. Secondary endpoints include changes in grip strength, weight, 24-h ambulatory blood pressure, and arterial biomechanical properties measured by central arterial waveform analysis.\u0000 Results: Preliminary analysis of the first 81 enrolled participants demonstrated that the guided exercise circuit was completed safely and was not associated with severe hypertension, injury, or adverse cardiovascular events. At enrollment, adverse central waveform or ABPM characteristics were prevalent and were significantly associated with exertional hypertension.\u0000 Conclusions: Guided exercise is safe for aortic dissection survivors. Follow-up of enrolled participants will conclude in October 2024.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140969552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.20517/2574-1209.2023.65
E. Rinaldi, D. Mascia, Carlo Campesi, Alessio Centi Pizzutilli, G. Melissano
This review paper delves into the acute aortic syndromes, with a particular focus on those affecting the descending thoracic aorta, including acute type B aortic dissection (aTBAD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), blunt traumatic thoracic aortic injury (bTAI), and ruptured aneurysm of the descending thoracic aorta (rDTA). These conditions present with sudden-onset symptoms such as severe chest or back pain, necessitating immediate medical attention. While traditional open surgical repair was historically the mainstay of treatment, advancements in endovascular techniques have revolutionized management approaches. Endovascular treatment offers advantages such as reduced operative time, blood loss, and hospital stay, making it a safer option for high-risk patients. However, it is crucial to carefully evaluate patients for endovascular suitability, considering the potential complications and risks associated with these techniques. This paper aims to provide an updated overview of acute aortic syndromes involving the descending thoracic aorta, analyze available therapeutic options, and review contemporary treatment modalities, shedding light on the technical aspects and considerations guiding clinical decision-making in this complex and life-threatening scenario.
这篇综述深入探讨了急性主动脉综合征，尤其关注那些影响降胸主动脉的综合征，包括急性 B 型主动脉夹层 (aTBAD)、壁内血肿 (IMH)、穿透性主动脉溃疡 (PAU)、钝性外伤性胸主动脉损伤 (bTAI) 和降胸主动脉瘤破裂 (rDTA)。这些疾病会突然出现剧烈胸痛或背痛等症状，需要立即就医。虽然传统的开放手术修复是历史上的主流治疗方法，但血管内治疗技术的进步彻底改变了治疗方法。血管内治疗具有缩短手术时间、减少失血量和缩短住院时间等优点，因此对高危患者来说是一种更安全的选择。然而，考虑到与这些技术相关的潜在并发症和风险，仔细评估患者是否适合接受血管内治疗至关重要。本文旨在提供涉及降胸主动脉的急性主动脉综合征的最新概述，分析可用的治疗方案，并回顾当代的治疗模式，阐明在这种复杂且危及生命的情况下指导临床决策的技术方面和注意事项。
{"title":"Endovascular repair for acute aortic syndrome involving the descending aorta","authors":"E. Rinaldi, D. Mascia, Carlo Campesi, Alessio Centi Pizzutilli, G. Melissano","doi":"10.20517/2574-1209.2023.65","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.65","url":null,"abstract":"This review paper delves into the acute aortic syndromes, with a particular focus on those affecting the descending thoracic aorta, including acute type B aortic dissection (aTBAD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), blunt traumatic thoracic aortic injury (bTAI), and ruptured aneurysm of the descending thoracic aorta (rDTA). These conditions present with sudden-onset symptoms such as severe chest or back pain, necessitating immediate medical attention. While traditional open surgical repair was historically the mainstay of treatment, advancements in endovascular techniques have revolutionized management approaches. Endovascular treatment offers advantages such as reduced operative time, blood loss, and hospital stay, making it a safer option for high-risk patients. However, it is crucial to carefully evaluate patients for endovascular suitability, considering the potential complications and risks associated with these techniques. This paper aims to provide an updated overview of acute aortic syndromes involving the descending thoracic aorta, analyze available therapeutic options, and review contemporary treatment modalities, shedding light on the technical aspects and considerations guiding clinical decision-making in this complex and life-threatening scenario.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"115 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140985685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-11DOI: 10.20517/2574-1209.2024.13
E. Bianchini, Francesco Bianchini, Mattia Lunardi, A. Zito, Enrico Romagnoli, C. Aurigemma, L. Paraggio, Ilaria Dato, F. Burzotta, C. Trani
Coronary stent thrombosis (ST) is a rare but severe complication of percutaneous coronary interventions (PCIs) with significant implications for patient outcomes. Despite advancements in antiplatelet medications and drug-eluting stent (DES) technology, ST remains associated with considerable morbidity and mortality. Notably, ST is an adverse event arising from various factors, including patient characteristics, stent-related issues, and procedural complications. In such a context, intravascular imaging (IVI) plays a pivotal role in assessing the underlying mechanisms and guiding treatment decisions. The use of thrombus aspiration and intracoronary antithrombotic therapies have been debated in the context of de novo acute myocardial infarction, but they could have a remarkable role for ST. However, the optimal management of ST requires individualized approaches tailored to patient-specific factors. This review provides a comprehensive analysis of the current understanding of ST, encompassing its incidence, outcomes, and risk factors, focusing on procedural acute management.
冠状动脉支架血栓（ST）是经皮冠状动脉介入治疗（PCI）的一种罕见但严重的并发症，对患者的预后有重大影响。尽管抗血小板药物和药物洗脱支架（DES）技术不断进步，但 ST 仍与相当高的发病率和死亡率相关。值得注意的是，ST 是由多种因素引起的不良事件，包括患者特征、支架相关问题和手术并发症。在这种情况下，血管内成像（IVI）在评估潜在机制和指导治疗决策方面发挥着举足轻重的作用。在新发急性心肌梗死的情况下，血栓抽吸术和冠状动脉内抗血栓疗法的使用一直备受争议，但它们对 ST 有着显著的作用。然而，ST 的最佳治疗需要根据患者的具体因素采取个性化的方法。本综述全面分析了目前对 ST 的认识，包括其发病率、结果和风险因素，重点关注程序性急性管理。
{"title":"Outcomes, risk factors, and procedural management of acute myocardial infarction caused by stent thrombosis","authors":"E. Bianchini, Francesco Bianchini, Mattia Lunardi, A. Zito, Enrico Romagnoli, C. Aurigemma, L. Paraggio, Ilaria Dato, F. Burzotta, C. Trani","doi":"10.20517/2574-1209.2024.13","DOIUrl":"https://doi.org/10.20517/2574-1209.2024.13","url":null,"abstract":"Coronary stent thrombosis (ST) is a rare but severe complication of percutaneous coronary interventions (PCIs) with significant implications for patient outcomes. Despite advancements in antiplatelet medications and drug-eluting stent (DES) technology, ST remains associated with considerable morbidity and mortality. Notably, ST is an adverse event arising from various factors, including patient characteristics, stent-related issues, and procedural complications. In such a context, intravascular imaging (IVI) plays a pivotal role in assessing the underlying mechanisms and guiding treatment decisions. The use of thrombus aspiration and intracoronary antithrombotic therapies have been debated in the context of de novo acute myocardial infarction, but they could have a remarkable role for ST. However, the optimal management of ST requires individualized approaches tailored to patient-specific factors. This review provides a comprehensive analysis of the current understanding of ST, encompassing its incidence, outcomes, and risk factors, focusing on procedural acute management.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":" 1221","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140988932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24DOI: 10.20517/2574-1209.2023.122
Ramon A. Riojas, Jennifer S Lawton, Thomas S. Metkus Jr.
The recommendation to employ a heart team to guide revascularization has persisted for over a decade. Despite evidence for improved adherence to guidelines, widespread adoption of the heart team approach has been limited. This review delves into the history of the guidelines endorsing the use of a heart team and the supporting data. Additionally, it outlines some attributes of a successful heart team, and how the heart team has been run at several large academic centers. Finally, it reviews some of the barriers to a heart team and future considerations.
{"title":"The heart team: the multidisciplinary approach to coronary artery disease","authors":"Ramon A. Riojas, Jennifer S Lawton, Thomas S. Metkus Jr.","doi":"10.20517/2574-1209.2023.122","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.122","url":null,"abstract":"The recommendation to employ a heart team to guide revascularization has persisted for over a decade. Despite evidence for improved adherence to guidelines, widespread adoption of the heart team approach has been limited. This review delves into the history of the guidelines endorsing the use of a heart team and the supporting data. Additionally, it outlines some attributes of a successful heart team, and how the heart team has been run at several large academic centers. Finally, it reviews some of the barriers to a heart team and future considerations.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"1 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139601408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.20517/2574-1209.2023.99
Maharshi Raval, Paul C. Gordon
Significant coronary artery disease (CAD) and severe aortic stenosis (AS) are frequent findings in patients who undergo transcatheter aortic valve implantation (TAVI). With the extension of TAVI in patients who have intermediate and even low surgical risk, the optimal evaluation and management of concomitant CAD needs to be determined. Both pre-TAVI evaluation of CAD and indications for revascularization remain a matter of debate. In this review, we provide an updated overview of the prevailing landscape of CAD in patients undergoing TAVI with a focus on its prognostic impact, diagnostic evaluation pre-procedure, indications for revascularization, optimal timing of revascularization, and future directions.
{"title":"Evaluation and management of coronary artery disease in patients undergoing transcatheter aortic valve implantation","authors":"Maharshi Raval, Paul C. Gordon","doi":"10.20517/2574-1209.2023.99","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.99","url":null,"abstract":"Significant coronary artery disease (CAD) and severe aortic stenosis (AS) are frequent findings in patients who undergo transcatheter aortic valve implantation (TAVI). With the extension of TAVI in patients who have intermediate and even low surgical risk, the optimal evaluation and management of concomitant CAD needs to be determined. Both pre-TAVI evaluation of CAD and indications for revascularization remain a matter of debate. In this review, we provide an updated overview of the prevailing landscape of CAD in patients undergoing TAVI with a focus on its prognostic impact, diagnostic evaluation pre-procedure, indications for revascularization, optimal timing of revascularization, and future directions.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"126 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139604892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-22DOI: 10.20517/2574-1209.2023.55
Lauren E. Levy, Megan Zak, Jason P. Glotzbach
Thoracic aortic dissection is a feared, highly lethal condition most commonly developing from aneurysmal dilation of the thoracic aorta. Elective prophylactic replacement of thoracic aortic aneurysms dramatically mitigates this risk. However, diagnosis of a thoracic aortic aneurysm can be challenging. Thoracic aortic disease - horacic aortic aneurysm and dissection (TAAD) - can be sporadic or heritable. Patients with syndromic heritable TAAD present with classic phenotype and clinical features correlating to their disease. In contrast, patients with non-syndromic heritable disease are harder to diagnose due to their lack of defining uniform phenotypes. Recent advances in genomics have begun to elucidate the genetic underpinnings of non-syndromic TAAD (ns-TAAD) for better understanding this complex disease and improve diagnosis and management. Herein, we review the foundation of knowledge in ns-TAAD heritability and key research studies identifying gene mutations in vascular smooth muscle cells, the extracellular matrix, and TGF-beta signaling present in ns-TAAD. We summarize the current guidelines for the diagnosis, screening, and surgical management of ns-TAAD including recommendations for genetic testing of high-risk individuals. Finally, we highlight areas of future research that will continue to advance our understanding of the complex genetic and epigenetic factors in TAAD.
{"title":"Current understanding of the genetics of thoracic aortic disease","authors":"Lauren E. Levy, Megan Zak, Jason P. Glotzbach","doi":"10.20517/2574-1209.2023.55","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.55","url":null,"abstract":"Thoracic aortic dissection is a feared, highly lethal condition most commonly developing from aneurysmal dilation of the thoracic aorta. Elective prophylactic replacement of thoracic aortic aneurysms dramatically mitigates this risk. However, diagnosis of a thoracic aortic aneurysm can be challenging. Thoracic aortic disease - horacic aortic aneurysm and dissection (TAAD) - can be sporadic or heritable. Patients with syndromic heritable TAAD present with classic phenotype and clinical features correlating to their disease. In contrast, patients with non-syndromic heritable disease are harder to diagnose due to their lack of defining uniform phenotypes. Recent advances in genomics have begun to elucidate the genetic underpinnings of non-syndromic TAAD (ns-TAAD) for better understanding this complex disease and improve diagnosis and management. Herein, we review the foundation of knowledge in ns-TAAD heritability and key research studies identifying gene mutations in vascular smooth muscle cells, the extracellular matrix, and TGF-beta signaling present in ns-TAAD. We summarize the current guidelines for the diagnosis, screening, and surgical management of ns-TAAD including recommendations for genetic testing of high-risk individuals. Finally, we highlight areas of future research that will continue to advance our understanding of the complex genetic and epigenetic factors in TAAD.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"28 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139607840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-12DOI: 10.20517/2574-1209.2023.90
Christine Ashenhurst, Omar Toubar, Ming Hao Guo, Hugo Issa, Menaka Ponnambalam, Marc Ruel
This review outlines the development of less invasive treatments for coronary artery disease, focusing primarily on minimally invasive coronary artery bypass grafting (MICS CABG). We compare conventional coronary artery bypass grafting (CABG) and MICS CABG indications and contraindications, surgical techniques, early and long-term outcomes, and the process of implementation of MICS CABG to cardiac surgery programs. The invasiveness of cardiopulmonary bypass and the sternotomy incision used in conventional CABG are appreciably mitigated by the MICS CABG procedure, which is generally performed off-pump and through a left mini-thoracotomy. In the literature, MICS CABG is a feasible alternative to sternotomy CABG with safe, reproducible, efficient, and durable outcomes.
{"title":"Early and long-term outcomes of less invasive approaches to coronary artery bypass surgery","authors":"Christine Ashenhurst, Omar Toubar, Ming Hao Guo, Hugo Issa, Menaka Ponnambalam, Marc Ruel","doi":"10.20517/2574-1209.2023.90","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.90","url":null,"abstract":"This review outlines the development of less invasive treatments for coronary artery disease, focusing primarily on minimally invasive coronary artery bypass grafting (MICS CABG). We compare conventional coronary artery bypass grafting (CABG) and MICS CABG indications and contraindications, surgical techniques, early and long-term outcomes, and the process of implementation of MICS CABG to cardiac surgery programs. The invasiveness of cardiopulmonary bypass and the sternotomy incision used in conventional CABG are appreciably mitigated by the MICS CABG procedure, which is generally performed off-pump and through a left mini-thoracotomy. In the literature, MICS CABG is a feasible alternative to sternotomy CABG with safe, reproducible, efficient, and durable outcomes.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"13 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139532787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-12DOI: 10.20517/2574-1209.2023.95
Sharif A. Sabe, D. Harris, M. Broadwin, Cynthia M Xu, Mohamed Sabra, D. Banerjee, M. Abid, Frank W. Sellke
Aim: Recent studies demonstrate that sodium-glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i), two classes of antidiabetic drugs, are cardioprotective. However, the mechanisms of these benefits and their comparative efficacy remain unclear. We aimed to compare the effects of these antidiabetic agents on cardiac function, perfusion, and microvascular density using a swine model of chronic myocardial ischemia. Methods: Chronic myocardial ischemia was induced in Yorkshire swine by ameroid constrictor placement to the left circumflex artery. Two weeks later, pigs were administered vehicle (“CON”, 8 pigs), 300 mg SGLT2i canagliflozin, (“CANA”, 8 pigs), or 100 mg DPP4i sitagliptin (“SIT”, 5 pigs) daily. Five weeks later, pigs were euthanized. Cardiac function, perfusion, collateralization, and protein expression were determined by pressure-volume catheter, microsphere analysis, immunofluorescence, and immunoblotting, respectively. Results: Compared with SIT, CANA was associated with improved stroke volume and cardiac output, with a trend towards reduced left ventricular stiffness. Both CANA and SIT trended towards improved perfusion compared to CON, but there were no differences between the two treatment groups. SIT was associated with improved capillary density with a trend towards improved arteriolar density compared to CANA. Both CANA and SIT were associated with increased expression of vascular endothelial cadherin compared to CON, without differences in treatment groups. SIT pigs had decreased 5′ adenosine monophosphate-activated protein kinase activation compared to CON and CANA. There was a trend towards increased endothelial nitric oxide synthase activation in the SIT group compared to CON. There were no differences in activation of extracellular signal-regulated kinase 1/2 across groups. Conclusions: In the setting of chronic myocardial ischemia, canagliflozin is associated with improved cardiac function compared to sitagliptin, with similar effects on perfusion despite differences in microvascular collateralization.
目的：最近的研究表明，钠-葡萄糖共转运体 2 抑制剂（SGLT2i）和二肽基肽酶-4 抑制剂（DPP4i）这两类抗糖尿病药物具有保护心脏的作用。然而，这些益处的机制及其疗效比较仍不清楚。我们的目的是利用猪慢性心肌缺血模型，比较这些抗糖尿病药物对心脏功能、灌注和微血管密度的影响。研究方法通过在约克夏猪的左侧环状动脉上放置气囊收缩器诱导其慢性心肌缺血。两周后，每天给猪注射药物（"CON"，8 头猪）、300 毫克 SGLT2i 卡格列净（"CANA"，8 头猪）或 100 毫克 DPP4i 西格列汀（"SIT"，5 头猪）。五周后，猪被安乐死。分别通过压力-容积导管、微球分析、免疫荧光和免疫印迹测定心脏功能、灌注、侧支和蛋白质表达。结果显示与 SIT 相比，CANA 可改善搏出量和心输出量，并有降低左心室僵硬度的趋势。与CON相比，CANA和SIT都有改善灌注的趋势，但两个治疗组之间没有差异。与 CANA 相比，SIT 可改善毛细血管密度，并有改善动脉密度的趋势。与对照组相比，CANA 和 SIT 均增加了血管内皮凝集素的表达，但治疗组之间没有差异。与 CON 和 CANA 相比，SIT 猪的 5′单磷酸腺苷激活的蛋白激酶活化减少。与 CON 相比，SIT 组的内皮一氧化氮合酶活化有增加的趋势。各组细胞外信号调节激酶 1/2的激活情况没有差异。结论在慢性心肌缺血的情况下，与西他列汀相比，卡格列净可改善心功能，尽管微血管侧支存在差异，但对灌注的影响相似。
{"title":"Comparative effects of canagliflozin and sitagliptin in chronically ischemic myocardium","authors":"Sharif A. Sabe, D. Harris, M. Broadwin, Cynthia M Xu, Mohamed Sabra, D. Banerjee, M. Abid, Frank W. Sellke","doi":"10.20517/2574-1209.2023.95","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.95","url":null,"abstract":"Aim: Recent studies demonstrate that sodium-glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i), two classes of antidiabetic drugs, are cardioprotective. However, the mechanisms of these benefits and their comparative efficacy remain unclear. We aimed to compare the effects of these antidiabetic agents on cardiac function, perfusion, and microvascular density using a swine model of chronic myocardial ischemia.\u0000 Methods: Chronic myocardial ischemia was induced in Yorkshire swine by ameroid constrictor placement to the left circumflex artery. Two weeks later, pigs were administered vehicle (“CON”, 8 pigs), 300 mg SGLT2i canagliflozin, (“CANA”, 8 pigs), or 100 mg DPP4i sitagliptin (“SIT”, 5 pigs) daily. Five weeks later, pigs were euthanized. Cardiac function, perfusion, collateralization, and protein expression were determined by pressure-volume catheter, microsphere analysis, immunofluorescence, and immunoblotting, respectively.\u0000 Results: Compared with SIT, CANA was associated with improved stroke volume and cardiac output, with a trend towards reduced left ventricular stiffness. Both CANA and SIT trended towards improved perfusion compared to CON, but there were no differences between the two treatment groups. SIT was associated with improved capillary density with a trend towards improved arteriolar density compared to CANA. Both CANA and SIT were associated with increased expression of vascular endothelial cadherin compared to CON, without differences in treatment groups. SIT pigs had decreased 5′ adenosine monophosphate-activated protein kinase activation compared to CON and CANA. There was a trend towards increased endothelial nitric oxide synthase activation in the SIT group compared to CON. There were no differences in activation of extracellular signal-regulated kinase 1/2 across groups.\u0000 Conclusions: In the setting of chronic myocardial ischemia, canagliflozin is associated with improved cardiac function compared to sitagliptin, with similar effects on perfusion despite differences in microvascular collateralization.","PeriodicalId":509663,"journal":{"name":"Vessel Plus","volume":"53 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139532833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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