Current Problems in Cardiology最新文献_第6页

High consumption of artificially sweetened beverages and associated risk of cardiovascular events: A systematic review and meta-analysis. 大量饮用人工甜味饮料与心血管事件的相关风险：系统回顾和荟萃分析。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-04 DOI: 10.1016/j.cpcardiol.2024.102837

Ivo Queiroz, Maria L R Defante, Arthur Tavares, Vanio Antunes, Cynthia Florencio de Mesquita, Lucas M Barbosa, Beatriz Ximenes Mendes, Angela S Koh

Background: With the rising use of artificial sweeteners as sugar substitutes, concerns regarding their impact on cardiovascular health have emerged. Artificially sweetened beverages are the primary source of diet sweeteners, but despite approval by national food agencies, evidence of their association with cardiovascular events has not been conclusive. Our Meta-Analysis assessed the relationship between artificially sweetened beverage consumption and long-term outcomes of cardiovascular events in extended follow-up cohorts.

Methods: Medline, Embase, and Cochrane databases were systematically searched for cohort studies investigating the incidence of all-cause mortality, cardiovascular mortality, stroke, and coronary heart disease among individuals with high consumption of ASB compared to minimal or no consumption. Pooled event hazard ratios with 95% confidence intervals were calculated using a random-effects model in R software, with heterogeneity assessed via I² statistics.

Results: We included twelve prospective cohorts comprising 1,224,560 patients. Analyses were conducted on patient groups with data adjusted for co-founding, such as dietary factors and comorbidities. One or more daily dose of Artificially sweetened beverages was significantly associated with a higher risk of all-cause mortality (HR 1.14; 95% 1.03 to 1.26; p < 0.01;), Cardiovascular mortality (HR 1.29; 95% 1.1 to 1.53; p < 0.01), and stroke (HR 1.15; 95% 1.01 to 1.32; p = 0.04;).

Conclusion: In this meta-analysis, we found a significant association between high consumption of ASBs and increased incidence of ACM, CVD, and stroke, highlighting potential long-term cardiovascular implications.

背景：随着越来越多地使用人工甜味剂作为糖的替代品，人们开始关注它们对心血管健康的影响。人工甜味饮料是膳食甜味剂的主要来源，但尽管获得了国家食品机构的批准，有关其与心血管事件的关系的证据却并不确凿。我们的 "元分析 "评估了人工增甜饮料消费与长期随访队列中心血管事件的长期结果之间的关系：我们在 Medline、Embase 和 Cochrane 数据库中系统检索了队列研究，这些研究调查了大量饮用人工增甜饮料的人群与极少饮用或不饮用人工增甜饮料的人群之间的全因死亡率、心血管死亡率、中风和冠心病发病率。我们使用 R 软件中的随机效应模型计算了汇总事件危险比和 95% 的置信区间，并通过 I² 统计量评估了异质性：我们纳入了 12 个前瞻性队列，包括 1,224,560 名患者。对患者分组进行了分析，并根据饮食因素和合并症等共同因素对数据进行了调整。每日饮用一种或多种人工甜味饮料与较高的全因死亡风险（HR 1.14；95% 1.03 至 1.26；p < 0.01；）、心血管死亡风险（HR 1.29；95% 1.1 至 1.53；p < 0.01；）和中风风险（HR 1.15；95% 1.01 至 1.32；p = 0.04；）显著相关：在这项荟萃分析中，我们发现大量食用 ASB 与急性心肌梗死、心血管疾病和中风发病率增加之间存在显著关联，这凸显了对心血管疾病的潜在长期影响。

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引用次数: 0

The bidirectional relationship between obstructive sleep apnea and atrial fibrillation: Pathophysiology, diagnostic challenges, and strategies - A narrative review 阻塞性睡眠呼吸暂停与心房颤动之间的双向关系：病理生理学、诊断挑战与策略--叙述性综述。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-10-04 DOI: 10.1016/j.cpcardiol.2024.102873

Andrew Ndakotsu MD , Matthew Dwumah-Agyen MBChB, MPH , Meet Patel MD

Atrial fibrillation (AF), is an irregular heart rhythm disorder that increases the risk of stroke, heart failure, and death. Obstructive sleep apnea is typified by intermittent airway blockages which results in low oxygen levels and disrupted sleep. These two conditions often coexist, with each worsening the other. Understanding this connection is critical to improve diagnosis and treatment.

The relationship between atrial fibrillation and obstructive sleep apnea appears bidirectional. Obstructive sleep apnea increases the risk of atrial fibrillation through various mechanisms which are arrhythmogenic. Conversely, patients with atrial fibrillation are more likely to have undiagnosed obstructive sleep apnea, complicating their treatment.

Screening modalities for obstructive sleep apnea are often inadequate. Polysomnography remains the most reliable tool but is costly and not practical for routine screening of all patients which limits early diagnosis and management.

Continuous positive airway pressure (CPAP) therapy is the primary treatment for obstructive sleep apnea and can reduce atrial fibrillation recurrence by decreasing oxygen deprivation and sympathetic activity. However, adherence to continuous positive airway pressure is often low due to patient discomfort. Alternative therapies, such as mandibular advancement devices and hypoglossal nerve stimulation, offer promising options for patients who cannot tolerate continuous positive airway pressure.

The interplay between atrial fibrillation and obstructive sleep apnea requires an integrated approach to diagnosis and treatment. Improving screening tools, enhancing treatment adherence, and evaluating alternative therapies are critical steps to reducing the impact of these conditions and improving patient outcomes.

心房颤动（房颤）是一种心律不齐的疾病，会增加中风、心力衰竭和死亡的风险。阻塞性睡眠呼吸暂停的典型症状是间歇性气道阻塞，导致低氧水平和睡眠中断。这两种病症常常同时存在，每种病症都会加重另一种病症。了解这种联系对于改善诊断和治疗至关重要。心房颤动与阻塞性睡眠呼吸暂停之间的关系似乎是双向的。阻塞性睡眠呼吸暂停会通过各种致心律失常的机制增加心房颤动的风险。相反，心房颤动患者更有可能患有未确诊的阻塞性睡眠呼吸暂停，从而使其治疗复杂化。阻塞性睡眠呼吸暂停的筛查方法往往不够完善。多导睡眠图仍是最可靠的工具，但成本高昂，而且不适合对所有患者进行常规筛查，从而限制了早期诊断和治疗。持续气道正压疗法（CPAP）是阻塞性睡眠呼吸暂停的主要治疗方法，可通过减少缺氧和交感神经活动来降低心房颤动的复发率。然而，由于患者感到不适，对持续气道正压疗法的依从性往往很低。下颌前突装置和舌下神经刺激等替代疗法为不能耐受持续气道正压的患者提供了很好的选择。心房颤动和阻塞性睡眠呼吸暂停之间的相互作用需要综合的诊断和治疗方法。改进筛查工具、提高治疗依从性和评估替代疗法是减少这些疾病的影响和改善患者预后的关键步骤。

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引用次数: 0

Discordance between the European and the United States guideline criteria for atrial septal defect closure in adult patients with pulmonary hypertension and its clinical impact 欧洲和美国肺动脉高压成人患者房室隔缺损闭合指南标准的不一致及其临床影响。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-27 DOI: 10.1016/j.cpcardiol.2024.102869

Tarinee Tangcharoen MD , Tawai Ngernsritrakul MD , Mann Chandavimol MD , Chanankan Kamsorn BSc , Sanatcha Apakuppakul MD , Sukit Yamwong MD

Background

The criteria for ASD closure in patients with PAH are different between the AHA/ACC and the ESC guidelines. We aimed to study the prevalence of patients with different guideline criteria for ASD closure and its impact on the clinical outcome after closure.

Methods and results

A retrospective cohort study recruiting patients who underwent ASD closure from 2011–2020 was conducted in a single university hospital. Patients were grouped into ASD closure recommended (class I, class IIa, and class IIb) and ASD closure not recommended groups (class III). The primary outcome was the prevalence of patients with discordant criteria and the clinical outcomes and echocardiographic parameters after ASD closure. A total of 17 of 66 ASD patients (25.8 %) were diagnosed with ASD with pulmonary hypertension. Two patients were excluded due to incomplete right heart catheterization data. 13 patients (86.7 %) were classified as ASD-closure recommended group by both guidelines. Two patients, classified as class IIb by ACC/AHA guidelines, were unsuitable for ASD closure by ESC guidelines. After ASD closure, all 15 patients reported functional class improvement and no significant difference in the echocardiography parameters. However, the number of patients with a low probability of PHT was higher in patients with ESC guideline-recommended closure.

Conclusions

Most patients (86.7 %) are in concordant classification regarding ASD closure recommendations. The ESC guidelines are more restrictive than the AHA/ACC guidelines, allowing fewer patients for ASD closure. However, the clinical outcomes after ASD closure are not significantly different between these guidelines.

背景：AHA/ACC和ESC指南中关于PAH患者ASD关闭的标准不同。我们的目的是研究ASD关闭标准不同的患者的患病率及其对关闭后临床结果的影响：我们在一家大学医院开展了一项回顾性队列研究，招募了 2011-2020 年间接受 ASD 闭合术的患者。患者被分为推荐的 ASD 闭合组（I 级、IIa 级和 IIb 级）和不推荐的 ASD 闭合组（III 级）。主要结果是标准不一致患者的发病率以及ASD关闭术后的临床结果和超声心动图参数。66 例 ASD 患者中，共有 17 例（25.8%）被诊断为 ASD 合并肺动脉高压。两名患者因右心导管检查资料不全而被排除在外。13名患者（86.7%）被两份指南列为ASD关闭推荐组。有两名患者被 ACC/AHA 指南列为 IIb 级，但根据 ESC 指南不适合进行 ASD 关闭术。关闭 ASD 后，所有 15 名患者的功能分级均有所改善，超声心动图参数也无明显差异。然而，在ESC指南推荐关闭的患者中，PHT可能性较低的患者人数较多：大多数患者（86.7%）的ASD关闭建议分类一致。ESC指南比AHA/ACC指南更严格，允许进行ASD闭合的患者更少。然而，这些指南对ASD闭合术后的临床结果并无明显差异。

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引用次数: 0

The CMLA score: A novel tool for early prediction of renal replacement therapy in patients with cardiogenic shock CMLA 评分：用于早期预测心源性休克患者肾脏替代疗法的新工具。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-27 DOI: 10.1016/j.cpcardiol.2024.102870

Shuo Pang, Shen Wang, Chu Fan, Fadong Li, Wenxin Zhao, Boqun Shi, Yue Wang, Xiaofan Wu

Background

Early identification of cardiogenic shock (CS) patients at risk for renal replacement therapy (RRT) is crucial for improving clinical outcomes. This study aimed to develop and validate a prediction model using readily available clinical variables.

Methods

A retrospective cohort study was conducted using data from 4,133 CS patients from the MIMIC and eICU-CRD databases. Patients from MIMIC databases were randomly divided into 80 % training and 20 % validation cohorts, while those from eICU-CRD constituted the test cohort. Feature selection involved univariate logistic regression (LR), LASSO, and Boruta methods. Prediction models for RRT were developed using stepwise selection by LR and five machine learning (ML) algorithms (naive bayes, support vector machines, k-nearest neighbors, random forest, extreme gradient boosting) in the training cohort. Model performance was evaluated in both validation and test cohorts. A nomogram was constructed based on LR model. Kaplan-Meier survival analysis assessed 28-day mortality.

Results

The incidence of RRT was approximately 13 % across all cohorts. Ten variables were selected: age, anion gap, chloride, bun, creatinine, potassium, ast, lactate, estimated glomerular filtration rate (eGFR), and mechanical ventilation. Compared with ML models, the LR model showed superior predictive performance with an AUC of 0.731 in the validation cohort and 0.714 in the test cohort. Four variables that best predicted the need for RRT (age, lactate, mechanical ventilation, and creatinine) were used to generate the CMLA nomogram risk score. The CMLA model showed better predictive accuracy for RRT in the test cohort compared to the previous CALL-K model (AUC: 0.731 vs. 0.699, DeLong test P < 0.05). Calibration curves and decision curve analysis (DCA) indicated that the CMLA model also had good calibration (Hosmer–Lemeshow P=0.323) and clinical utility in the test cohort. Kaplan-Meier analysis indicated significantly higher 28-day mortality in the high-risk CMLA group.

Conclusions

A clinically applicable nomogram with four key variables was developed to predict RRT risk in CS patients. It demonstrated good performance, promising enhanced clinical decision-making.

背景：早期识别有接受肾脏替代治疗（RRT）风险的心源性休克（CS）患者对改善临床预后至关重要。本研究旨在利用现成的临床变量开发并验证一个预测模型：利用 MIMIC 和 eICU-CRD 数据库中 4,133 名 CS 患者的数据进行了一项回顾性队列研究。来自 MIMIC 数据库的患者被随机分为 80% 的训练队列和 20% 的验证队列，而来自 eICU-CRD 数据库的患者则构成测试队列。特征选择包括单变量逻辑回归（LR）、LASSO 和 Boruta 方法。在训练队列中使用 LR 逐步选择法和五种机器学习（ML）算法（奈夫贝叶斯、支持向量机、k-近邻、随机森林、极端梯度提升）建立了 RRT 预测模型，并在验证队列和测试队列中评估了模型的性能。根据 LR 模型构建了提名图。Kaplan-Meier生存分析评估了28天死亡率：所有队列的 RRT 发生率约为 13%。选择了十个变量：年龄、阴离子间隙、氯化物、馒头、肌酐、钾、哮喘、乳酸、估计肾小球滤过率（eGFR）和机械通气。与 ML 模型相比，LR 模型显示出更优越的预测性能，在验证队列中的 AUC 为 0.731，在测试队列中为 0.714。预测 RRT 需求的四个最佳变量（年龄、乳酸、机械通气和肌酐）被用于生成 CMLA 提名图风险评分。与之前的 CALL-K 模型相比，CMLA 模型对测试队列中 RRT 的预测准确性更高（AUC：0.731 对 0.699，DeLong 检验 P <0.05）。校准曲线和决策曲线分析（DCA）表明，CMLA 模型在测试队列中也具有良好的校准性（Hosmer-Lemeshow P=0.323）和临床实用性。Kaplan-Meier分析表明，高风险CMLA组的28天死亡率明显更高：结论：通过四个关键变量建立了一个适用于临床的提名图，用于预测 CS 患者的 RRT 风险。结论：利用四个关键变量开发出了一种适用于临床的预测 CS 患者 RRT 风险的提名图，该提名图表现良好，有望改善临床决策。

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引用次数: 0

Ticagrelor monotherapy after ≤ 1-month DAPT vs continued DAPT in patients with acute coronary syndrome treated with percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials 接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者在 DAPT ≤ 1 个月后接受替卡格雷单药治疗与继续 DAPT 治疗的对比：随机对照试验的系统回顾和荟萃分析。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-26 DOI: 10.1016/j.cpcardiol.2024.102868

Elizabet Taylor Pimenta Weba , Alexandros Páris de Mesquita Ipácio , David Abraham Batista da Hora , Christian Ken Fukunaga , Maria Tereza Camarotti , Arthur Parke Costa Corvelo , André Luiz Carvalho Ferreira M.D

Background

Current guidelines recommend at least 12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). However, DAPT prolonged use may increase the risk of bleeding complications. Therefore, we aimed to perform a meta-analysis to assess whether ticagrelor monotherapy after ≤1 month of DAPT improves clinical outcomes compared with continued DATP in acute coronary syndrome (ACS) patients post-PCI.

Methods

We systematically searched PubMed, Embase and Cochrane databases for randomized controlled trials published up to August 2024. All-cause and cardiovascular death, overall and major bleeding events, myocardial infarction (MI), stroke, target vessel revascularization (TVR) and stent thrombosis within 1–2 years post-procedure were evaluated. Statistical analysis was performed using Review Manager 5.1.7.

Results

Three studies and 13,737 patients were included, of whom 6861 (49.95 %) received ticagrelor alone. When compared with DAPT, ticagrelor monotherapy significantly reduced the risk of overall (2.0 % vs 4.5 %; RR 0.44; 95 % Cl 0.33–0,59; p < 0.00001) and major (1.4 % vs 2.5 %; RR 0.49; 95 % Cl 0.29–0.83; p = 0.04) bleeding events. Both antiplatelet regimens had similar rates of mortality, MI, stroke, TVR or stent thrombosis.

Conclusion

This meta-analysis suggests that ticagrelor alone after ≤1 month of DAPT post-PCI in ACS patients reduces bleeding complications without increasing major adverse events compared with traditional DAPT for 12 months.

背景：现行指南建议经皮冠状动脉介入治疗（PCI）后至少使用 12 个月的双联抗血小板疗法（DAPT）。然而，长期使用 DAPT 可能会增加出血并发症的风险。因此，我们旨在进行一项荟萃分析，以评估在PCI术后急性冠脉综合征（ACS）患者DAPT≤1个月后，与继续使用DATP相比，替卡格雷单药治疗是否能改善临床预后：我们系统检索了PubMed、Embase和Cochrane数据库中截至2024年8月发表的随机对照试验。对全因和心血管死亡、总体和主要出血事件、心肌梗死（MI）、中风、靶血管血运重建（TVR）以及术后 1-2 年内的支架血栓进行了评估。统计分析使用Review Manager 5.1.7进行：共纳入三项研究和 13737 名患者，其中 6861 人（49.95%）接受了单药替卡格雷治疗。与DAPT相比，替卡格雷单药治疗可显著降低总体（2.0% vs 4.5%；RR 0.44；95 % Cl 0.33-0.59；p < 0.00001）和大出血（1.4% vs 2.5%；RR 0.49；95 % Cl 0.29-0.83；p = 0.04）风险。两种抗血小板疗法的死亡率、心肌梗死、中风、TVR或支架血栓形成率相似：这项荟萃分析表明，与传统的 12 个月 DAPT 相比，ACS 患者在 PCI 后 DAPT ≤1 个月后单用替卡格雷可减少出血并发症，但不会增加主要不良事件。

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引用次数: 0

Life's essential 8 and cardiovascular disease among patients with hyperuricemia: The Kailuan Cohort Study 高尿酸血症患者的生活必需品 8 和心血管疾病：开滦队列研究

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-23 DOI: 10.1016/j.cpcardiol.2024.102862

Yiran Xu MD , Jingli Gao MD , Jingdi Zhang MD , Shaopeng Liu MD , Peng Yang MD , Youxin Wang MD , Xiangfeng Lu MD , Dandan Zhao MD , Shouling Wu PhD , Yun Li PhD

Objectives

Studies have found that a high Life's Essential 8 (LE8) score is associated with a reduced risk of cardiovascular disease(CVD) in cancer populations and young adults. However, the association between LE8 and the risk of CVD in hyperuricemia (HUA) is not fully understood.

Methods

The main analysis included 6814 HUA participants. In a secondary analysis, 5,418 participants were selected from the main analysis to model the trajectory of uric acid (UA) levels from 2006 to 2010. Cox regression model was used to investigate the relationship between LE8 total score and cardiovascular disease risk in different populations.

Results

Follow-up of 15.79 years in the main analysis, 986 CVD events occurred. With tertile 1 as the control group, the HR and 95 % CI of CVD in tertile 2 and tertile 3 were 0.75(0.65,0.87) and 0.56(0.47,0.66). In the secondary analysis, the HR and 95 %CI of individuals with low and medium levels of UA reduced CVD were 0.49(0.26,0.89) and 0.56(0.41,0.76), respectively, but this association was not found in individuals with sustained high UA levels. The risk of CVD was different between the sexes. There are differences in cardiovascular disease risk among different age groups.

Conclusions

The risk of CVD in HUA population decreased with the increase of LE8 score, especially in young and middle-aged people and women. However, it is important to note that LE8 may not reduce the risk of CVD in individuals with sustained high UA levels.

研究发现，在癌症人群和年轻成年人中，生活必需品 8（LE8）的高分与心血管疾病（CVD）风险的降低有关。方法主要分析包括 6814 名高尿酸血症患者。在二次分析中，从主要分析中选取了5418名参与者，以模拟2006年至2010年尿酸（UA）水平的变化轨迹。结果在主要分析中，随访 15.79 年，共发生 986 起心血管疾病事件。以三等分 1 为对照组，三等分 2 和三等分 3 的心血管疾病 HR 和 95 % CI 分别为 0.75(0.65,0.87) 和 0.56(0.47,0.66)。在二次分析中，低水平和中等水平的 UA 可降低心血管疾病风险的 HR 和 95 %CI 分别为 0.49(0.26,0.89) 和 0.56(0.41,0.76)，但在 UA 水平持续较高的人群中未发现这种关联。心血管疾病的风险在性别上存在差异。结论 HUA人群的心血管疾病风险随着LE8评分的升高而降低，尤其是中青年和女性。然而，值得注意的是，LE8 可能无法降低 UA 水平持续偏高的人群的心血管疾病风险。

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引用次数: 0

Letter to editor: Trends and disparities in cardiovascular deaths in systemic lupus erythematosus: A population-based retrospective study in the United States from 1999 to 2020 致编辑的信系统性红斑狼疮心血管疾病死亡的趋势和差异：1999年至2020年美国基于人群的回顾性研究

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-22 DOI: 10.1016/j.cpcardiol.2024.102864

Abdur Rehman MBBS , Hajra Asad , Javed Iqbal Ph.D , Owais Ahmad

This letter addresses key limitations in the article "Trends and disparities in cardiovascular deaths in systemic lupus erythematosus: A population-based retrospective study in the United States from 1999 to 2020." While the article provides valuable insights into cardiovascular mortality among SLE patients, it overlooks critical factors such as medication adherence and sex-specific treatment responses, which could influence the reported outcomes. Additionally, the study's focus on cardiovascular deaths sidelines other relevant causes of mortality like infections and renal failure. Incorporating these considerations, along with a deeper exploration of socioeconomic disparities and healthcare infrastructure, could enhance future studies, offering a more comprehensive understanding of mortality trends in SLE patients.

这封信阐述了 "系统性红斑狼疮心血管疾病死亡的趋势和差异：1999年至2020年美国基于人群的回顾性研究"。虽然这篇文章为系统性红斑狼疮患者的心血管疾病死亡率提供了宝贵的见解，但它忽略了一些关键因素，如用药依从性和性别特异性治疗反应，这些因素可能会影响所报告的结果。此外，该研究只关注心血管疾病的死亡，而忽略了感染和肾功能衰竭等其他相关的死亡原因。将这些因素纳入考虑范围，再加上对社会经济差异和医疗基础设施的深入探讨，可以加强未来的研究，从而更全面地了解系统性红斑狼疮患者的死亡趋势。

引用次数: 0

Emerging therapeutic and diagnostic strategies for coronary artery disease: Current trends and future perspectives 冠状动脉疾病的新兴治疗和诊断策略：当前趋势与未来展望。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-22 DOI: 10.1016/j.cpcardiol.2024.102863

Suresh Saravanan , Natarajan Alangudi Palaniappan , Anthoniammal Panneerselvam , Thirunavukkarasu Palaniyandi , Suba Rajinikanth , Rajeshkumar Shanmugam , Mugip Rahaman Abdul Wahab

Coronary vascular disease (CVD) is the general term used to cover conditions like narrowed blood vessels that may cause stroke or heart attack. Coronary artery disease (CAD) is one of the CVD and it is the most severe disease worldwide. The traditional treatment for CAD includes Coronary Artery Bypass Graft Surgery (CABG) and Percutaneous Coronary Intervention (PCI). The evolution of science and technology has led to advancement in the treatment of CAD. Nanoparticles are very suitable for the treatment of CAD by using it as a capsule for targeted drug delivery. Non-coding RNAs like si-RNA and mi-RNA are used as therapeutic agents due to their unique characteristics. In recent years, this si-RNA and miRNA usage in treating diseases has significantly increased. These are used as therapeutic agents for CAD treatment due to their properties like unique mode of action and regulation of gene expression. Another treatment for CAD is stem cells. These are used in CAD treatment because they improve blood supply to the areas where the blood vessels are narrowed down due to atherosclerosis and also, they promote cardiac cell regeneration. These RNA and stem cells are usually encapsulated with nanoparticles to avoid degradation. In this article let us discuss in detail about the treatments of CAD.

冠状动脉血管疾病（CVD）是指血管狭窄等可能导致中风或心脏病发作的疾病的总称。冠状动脉疾病（CAD）是 CVD 的一种，也是全球最严重的疾病。冠状动脉疾病的传统治疗方法包括冠状动脉旁路移植手术（CABG）和经皮冠状动脉介入治疗（PCI）。科学技术的发展推动了治疗冠状动脉粥样硬化的进步。纳米颗粒非常适合治疗冠状动脉粥样硬化，可用作靶向给药的胶囊。si-RNA 和 mi-RNA 等非编码 RNA 因其独特的特性而被用作治疗药物。近年来，si-RNA 和 miRNA 在治疗疾病方面的应用大幅增加。由于其独特的作用模式和基因表达调控等特性，它们被用作治疗 CAD 的治疗剂。另一种治疗 CAD 的方法是干细胞。干细胞可改善动脉粥样硬化导致的血管狭窄部位的血液供应，还能促进心脏细胞再生，因此被用于治疗 CAD。这些核糖核酸和干细胞通常用纳米颗粒封装，以避免降解。在这篇文章中，让我们详细讨论一下CAD的治疗方法。

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引用次数: 0

An analysis regarding the article “Artificial intelligence-enhanced electrocardiogram for the diagnosis of cardiac amyloidosis: A systemic review and meta-analysis” 关于文章 "人工智能增强心电图用于诊断心脏淀粉样变性：系统综述与元分析 "一文的分析。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-22 DOI: 10.1016/j.cpcardiol.2024.102866

Yueqiu Su MD , Zhou Leng MD

Cardiac Amyloidosis (CA) occurs when misfolded proteins accumulate in the heart muscle, leading to restrictive cardiomyopathy and possibly escalating to heart failure, impaired conduction system function, and sudden cardiac arrest. It is a significant clinical challenge due to its high rates of underdiagnosis and misdiagnosis. Research indicates that about 35% of individuals with CA have been incorrectly diagnosed with other prevalent cardiovascular diseases. CA is differentiated into various subtypes depending on the protein involved in its pathogenesis, with Transthyretin Amyloidosis (ATTR) and Light Chain Amyloidosis (AL) being the most common. A key diagnostic challenge is the subtle clinical presentation of CA, which often resembles other heart conditions such as restrictive cardiomyopathy with left ventricular hypertrophy or hypertrophic obstructive cardiomyopathy (HOCM). While several diagnostic methods are available for CA, many are expensive, invasive, and typically used after an initial clinical suspicion. Non-invasive tests like electrocardiography (ECG) are accessible but often have lower sensitivity in detecting CA. Given the limited expertise in recognizing CA symptoms in primary care settings, there is an urgent need for systems that can aid in early detection. It is crucial to develop systems that equip primary care providers with the tools and knowledge to recognize the subtle signs of cardiac amyloidosis, thereby enhancing patient outcomes.

心脏淀粉样变性（CA）是指折叠错误的蛋白质在心肌中积聚，导致局限性心肌病，并可能升级为心力衰竭、传导系统功能受损和心脏骤停。由于诊断不足和误诊率高，CA 是一项重大的临床挑战。研究表明，约有 35% 的 CA 患者被误诊为其他流行性心血管疾病。根据其发病机制所涉及的蛋白质，CA 可分为多种亚型，其中最常见的是转甲状腺素淀粉样变性（ATTR）和轻链淀粉样变性（AL）。CA 临床表现不明显，往往与其他心脏疾病相似，如左心室肥厚的限制性心肌病或肥厚型梗阻性心肌病 (HOCM)，这是诊断 CA 所面临的主要挑战。虽然目前有多种诊断 CA 的方法，但许多方法都是昂贵的侵入性方法，而且通常是在临床初步怀疑后才使用。非侵入性检查如心电图（ECG）是可以使用的，但检测 CA 的灵敏度通常较低。鉴于基层医疗机构在识别 CA 症状方面的专业知识有限，因此迫切需要能帮助早期检测的系统。关键是要开发出能让初级保健提供者掌握识别心脏淀粉样变性细微症状的工具和知识的系统，从而提高患者的治疗效果。

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引用次数: 0

Accuracy of an internationally validated genetic-guided warfarin dosing algorithm compared to a clinical algorithm in an Arab population 国际验证的基因指导华法林剂量算法与临床算法在阿拉伯人群中的准确性比较

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-22 DOI: 10.1016/j.cpcardiol.2024.102865

Amr M. Fahmi , Ahmed El Bardissy , Mohamed Omar Saad , Amr Fares , Ahmed Sadek , Mohamed Nabil Elshafei , Asma Eltahir , Asmaa Mohamed , Hazem Elewa

Purpose

To identify the impact of CYP2C9*2, *3, VKORC1−1639 G>A and CYP4F2*3 on warfarin dose in an Arab population. To compare the accuracy of a clinical warfarin dosing (CWD) versus genetic warfarin dosing algorithms (GWD) during warfarin initiation.

Methods

A cohort of Arab patients newly starting on warfarin had their dose calculated using CWD published in www.warfarindosing.org and were followed for 1 month. Each patient provided a saliva sample. DNA was extracted, purified and genotyped for VKORC−1639 G>A, CYP2C9*2, CYP2C9*3 and CYP4F2*3. After reaching warfarin maintenance dose, the dose was recalculated using the GWD and median absolute error (MAE) and the percentage of warfarin doses within 20% of the actual dose were calculated and compared for the two algorithms.

Results

The study enrolled 130 patients from 12 Arabian countries. Compared to those with wild type, carriers of reduced function alleles in CYP2C9 required significantly lower median (IQR) warfarin weekly dose [24.5 (15.3) vs. 35 (29.8) mg/week, p=0.006]. With regards to VKORC, patients with AA genotype had a significantly lower median (IQR) weekly warfarin dose compared to AG and GG [21(10.5) vs 29.4 (21), p<0.001 for AA vs AG, p<0.001 for AA vs GG]. The MAE (IQR) for the weekly dose of the GWD was significantly lower compared to CWD [8.1 (10.5) vs 12.4 (12.6) (p<0.001)].

Conclusion

CYP2C9 and VKORC1 variants are important determinants of warfarin dose in the Arab population. The use of the genetic and clinical factors led to better warfarin dose estimation when compared to clinical factors alone.

目的确定阿拉伯人群中 CYP2C9*2、*3、VKORC1-1639 G>A 和 CYP4F2*3 对华法林剂量的影响。比较临床华法林剂量算法（CWD）与基因华法林剂量算法（GWD）在华法林起始阶段的准确性。方法对一组新开始使用华法林的阿拉伯患者使用 www.warfarindosing.org 上发表的 CWD 计算其剂量，并随访 1 个月。每位患者提供一份唾液样本。提取、纯化 DNA 并对 VKORC-1639 G>A、CYP2C9*2、CYP2C9*3 和 CYP4F2*3 进行基因分型。在达到华法林维持剂量后，使用 GWD 重新计算剂量，计算并比较两种算法的中位绝对误差（MAE）和实际剂量 20% 以内的华法林剂量百分比。与野生型患者相比，CYP2C9减低功能等位基因携带者所需的华法林每周剂量中位数（IQR）明显降低[24.5（15.3）毫克/周 vs. 35（29.8）毫克/周，P=0.006]。就 VKORC 而言，与 AG 和 GG 相比，AA 基因型患者的华法林每周剂量中位数（IQR）明显较低 [21(10.5) vs 29.4 (21)，AA vs AG，p<0.001，AA vs GG，p<0.001]。结论在阿拉伯人群中，CYP2C9 和 VKORC1 变体是决定华法林剂量的重要因素。与单独使用临床因素相比，使用遗传因素和临床因素能更好地估算华法林剂量。

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