Pub Date : 2024-05-22DOI: 10.3389/fcvm.2024.1426133
J. Karimov, Antonio Loforte
{"title":"Editorial: Methods in treating heart failure—device and surgery approach","authors":"J. Karimov, Antonio Loforte","doi":"10.3389/fcvm.2024.1426133","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1426133","url":null,"abstract":"","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141112232","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 : 2024-05-22DOI: 10.3389/fcvm.2024.1389811
Mingzhong Zhao, Jiangtao Yu, Cody R. Hou, Felix Post, Lei Zhang, Yuhui Xu, Nora Herold, Jens Walsleben
The effect of atrial fibrillation (AF) patterns on outcomes remains controversial. This study aims to evaluate the influence of AF type on the risk of cardiocerebrovascular events after left atrial appendage closure (LAAC) at long-term follow-up.AF was categorized as paroxysmal AF (PAF) and non-PAF (NPAF). The baseline characteristics, procedural data, peri-procedural complications, and long-term outcomes between patients with PAF and NPAF after LAAC were compared.We analyzed 410 AF patients (mean age 74.8 ± 8.2 years; 271 male; 144 with PAF, 266 NPAF). The NPAF group tended to be older (≥75 years), male, and have chronic kidney disease (CKD) compared with the PAF group. The procedural data and peri-procedural complications were comparable. During 2.2 ± 1.5 years of follow-up, the incidences of thromboembolism, major bleeding, and device-related thrombus (DRT) did not differ between the two groups. The observed risk of thromboembolism and major bleeding was significantly lower than the estimated risk based on the CHA2DS2-VASc and HAS-BLED scores, respectively, in patients who underwent LAAC, regardless of the AF type. NPAF patients were associated with a higher risk of all-cause mortality, non-cardiovascular mortality, and combined efficacy endpoints. This association disappeared after propensity score matching (PSM) analysis.The risk of thromboembolism and major bleeding was lower in patients who underwent LAAC, regardless of the AF type. Although NPAF often coexists with multiple risk factors, it was not associated with worse long-term outcomes after LAAC when compared with PAF.
{"title":"Left atrial appendage closure outcomes in relation to atrial fibrillation patterns: a comprehensive analysis","authors":"Mingzhong Zhao, Jiangtao Yu, Cody R. Hou, Felix Post, Lei Zhang, Yuhui Xu, Nora Herold, Jens Walsleben","doi":"10.3389/fcvm.2024.1389811","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1389811","url":null,"abstract":"The effect of atrial fibrillation (AF) patterns on outcomes remains controversial. This study aims to evaluate the influence of AF type on the risk of cardiocerebrovascular events after left atrial appendage closure (LAAC) at long-term follow-up.AF was categorized as paroxysmal AF (PAF) and non-PAF (NPAF). The baseline characteristics, procedural data, peri-procedural complications, and long-term outcomes between patients with PAF and NPAF after LAAC were compared.We analyzed 410 AF patients (mean age 74.8 ± 8.2 years; 271 male; 144 with PAF, 266 NPAF). The NPAF group tended to be older (≥75 years), male, and have chronic kidney disease (CKD) compared with the PAF group. The procedural data and peri-procedural complications were comparable. During 2.2 ± 1.5 years of follow-up, the incidences of thromboembolism, major bleeding, and device-related thrombus (DRT) did not differ between the two groups. The observed risk of thromboembolism and major bleeding was significantly lower than the estimated risk based on the CHA2DS2-VASc and HAS-BLED scores, respectively, in patients who underwent LAAC, regardless of the AF type. NPAF patients were associated with a higher risk of all-cause mortality, non-cardiovascular mortality, and combined efficacy endpoints. This association disappeared after propensity score matching (PSM) analysis.The risk of thromboembolism and major bleeding was lower in patients who underwent LAAC, regardless of the AF type. Although NPAF often coexists with multiple risk factors, it was not associated with worse long-term outcomes after LAAC when compared with PAF.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"9 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141111097","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}
The transmembrane protein Notch1 is associated with cell growth, development, differentiation, proliferation, apoptosis, adhesion, and the epithelial mesenchymal transition. Proteomics, as a research method, uses a series of sequencing techniques to study the composition, expression levels, and modifications of proteins. Here, the association between Notch1 and acute myocardial infarction (AMI) was investigated using proteomics, to assess the possibility of using Notch1 as a biomarker for the disease.Fifty-five eligible patients with AMI and 74 with chronic coronary syndrome (CCS) were enrolled, representing the experimental and control groups, respectively. The mRNA levels were assessed using RT-qPCR and proteins were measured using ELISA, and the results were compared and analyzed.Notch1 mRNA levels were 0.52 times higher in the peripheral blood mononuclear cells of the AMI group relative to the CCS group (p < 0.05) while Notch1 protein levels were 0.63 times higher in peripheral blood plasma in AMI patients (p < 0.05). Notch1 levels were not associated with older age, hypertension, smoking, high abdominal-blood glucose, high total cholesterol, and high LDL in AMI. Logistic regression indicated associations between AMI and reduced Notch1 expression, hypertension, smoking, and high fasting glucose.Notch1 expression was reduced in the peripheral blood of patients with AMI relative to those with CCS. The low expression of Notch1 was found to be an independent risk factor for AMI and may thus be an indicator of the disease.
{"title":"Low expression of Notch1 may be associated with acute myocardial infarction","authors":"Qing Zhang, Heyu Meng, Xue Wang, Yanqiu Chen, Zhaohan Yan, Jianjun Ruan, Fanbo Meng","doi":"10.3389/fcvm.2024.1367675","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1367675","url":null,"abstract":"The transmembrane protein Notch1 is associated with cell growth, development, differentiation, proliferation, apoptosis, adhesion, and the epithelial mesenchymal transition. Proteomics, as a research method, uses a series of sequencing techniques to study the composition, expression levels, and modifications of proteins. Here, the association between Notch1 and acute myocardial infarction (AMI) was investigated using proteomics, to assess the possibility of using Notch1 as a biomarker for the disease.Fifty-five eligible patients with AMI and 74 with chronic coronary syndrome (CCS) were enrolled, representing the experimental and control groups, respectively. The mRNA levels were assessed using RT-qPCR and proteins were measured using ELISA, and the results were compared and analyzed.Notch1 mRNA levels were 0.52 times higher in the peripheral blood mononuclear cells of the AMI group relative to the CCS group (p < 0.05) while Notch1 protein levels were 0.63 times higher in peripheral blood plasma in AMI patients (p < 0.05). Notch1 levels were not associated with older age, hypertension, smoking, high abdominal-blood glucose, high total cholesterol, and high LDL in AMI. Logistic regression indicated associations between AMI and reduced Notch1 expression, hypertension, smoking, and high fasting glucose.Notch1 expression was reduced in the peripheral blood of patients with AMI relative to those with CCS. The low expression of Notch1 was found to be an independent risk factor for AMI and may thus be an indicator of the disease.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"54 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141111871","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 : 2024-05-22DOI: 10.3389/fcvm.2024.1396998
V. Vu, Nghia Thuong Nguyen, Chinh Duc Nguyen, Khang Duong Nguyen, B. Truong
Transplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.A 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months.Transplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.
{"title":"Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review","authors":"V. Vu, Nghia Thuong Nguyen, Chinh Duc Nguyen, Khang Duong Nguyen, B. Truong","doi":"10.3389/fcvm.2024.1396998","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1396998","url":null,"abstract":"Transplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.A 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months.Transplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"30 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141109469","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 : 2024-05-21DOI: 10.3389/fcvm.2024.1381514
R. López-Vilella, Borja Guerrero Cervera, Víctor Donoso Trenado, L. Martínez Dolz, L. Almenar Bonet
In heart failure (HF), not all episodes of decompensation are alike. The study aimed to characterize the clinical groups of decompensation and perform a survival analysis.A retrospective study was conducted on patients consecutively admitted for HF from 2018 to 2023. Patients who died during admission were excluded (final number 1,668). Four clinical types of HF were defined: low cardiac output (n:83), pulmonary congestion (n:1,044), mixed congestion (n:353), and systemic congestion (n:188).The low output group showed a higher prevalence of reduced left ventricular ejection fraction (93%) and increased biventricular diameters (p < 0.01). The systemic congestion group exhibited a greater presence of tricuspid regurgitation with dilatation and right ventricular dysfunction (p:0.0001), worse renal function, and higher uric acid and CA125 levels (p:0.0001). Diuretics were more commonly used in the mixed and, especially, systemic congestion groups (p:0.0001). The probability of overall survival at 5 years was 49%, with higher survival in pulmonary congestion and lower in systemic congestion (p:0.002). Differences were also found in survival at 1 month and 1 year (p:0.0001).Mortality in acute HF is high. Four phenotypic profiles of decompensation differ clinically, with distinct characteristics and varying prognosis in the short, medium, and long term.
{"title":"Clinical profiling of patients admitted with acute heart failure: a comprehensive survival analysis","authors":"R. López-Vilella, Borja Guerrero Cervera, Víctor Donoso Trenado, L. Martínez Dolz, L. Almenar Bonet","doi":"10.3389/fcvm.2024.1381514","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1381514","url":null,"abstract":"In heart failure (HF), not all episodes of decompensation are alike. The study aimed to characterize the clinical groups of decompensation and perform a survival analysis.A retrospective study was conducted on patients consecutively admitted for HF from 2018 to 2023. Patients who died during admission were excluded (final number 1,668). Four clinical types of HF were defined: low cardiac output (n:83), pulmonary congestion (n:1,044), mixed congestion (n:353), and systemic congestion (n:188).The low output group showed a higher prevalence of reduced left ventricular ejection fraction (93%) and increased biventricular diameters (p < 0.01). The systemic congestion group exhibited a greater presence of tricuspid regurgitation with dilatation and right ventricular dysfunction (p:0.0001), worse renal function, and higher uric acid and CA125 levels (p:0.0001). Diuretics were more commonly used in the mixed and, especially, systemic congestion groups (p:0.0001). The probability of overall survival at 5 years was 49%, with higher survival in pulmonary congestion and lower in systemic congestion (p:0.002). Differences were also found in survival at 1 month and 1 year (p:0.0001).Mortality in acute HF is high. Four phenotypic profiles of decompensation differ clinically, with distinct characteristics and varying prognosis in the short, medium, and long term.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"133 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141114879","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 : 2024-05-21DOI: 10.3389/fcvm.2024.1406608
Lara Chammas, Kevin Yuan, S. Little, G. Roadknight, K. Várnai, Shing Chan Chang, Shirley Sze, Jim Davies, Andrew Tsui, Hizni Salih, B. Glampson, D. Papadimitriou, A. Mulla, K. Woods, Kevin O’Gallagher, A. Shah, B. Williams, F. Asselbergs, Erik Mayer, Richard Lee, Christopher Herbert, T. Johnson, Stuart Grant, N. Curzen, Ajay M. Shah, D. Perera, Riyaz S. Patel, K. Channon, A. Kaura, J. Mayet, David W. Eyre, Iain Squire, R. Kharbanda, Andrew Lewis, R. Wijesurendra
The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed.The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
{"title":"Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data","authors":"Lara Chammas, Kevin Yuan, S. Little, G. Roadknight, K. Várnai, Shing Chan Chang, Shirley Sze, Jim Davies, Andrew Tsui, Hizni Salih, B. Glampson, D. Papadimitriou, A. Mulla, K. Woods, Kevin O’Gallagher, A. Shah, B. Williams, F. Asselbergs, Erik Mayer, Richard Lee, Christopher Herbert, T. Johnson, Stuart Grant, N. Curzen, Ajay M. Shah, D. Perera, Riyaz S. Patel, K. Channon, A. Kaura, J. Mayet, David W. Eyre, Iain Squire, R. Kharbanda, Andrew Lewis, R. Wijesurendra","doi":"10.3389/fcvm.2024.1406608","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1406608","url":null,"abstract":"The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed.The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"121 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115394","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 : 2024-05-21DOI: 10.3389/fcvm.2024.1364289
Xingchao Li, Li Sun, Shibing Xi, Yaofei Hu, Zhongqin Yu, Hui Liu, Hui Sun, Weili Jing, Li Yuan, Hongyan Liu, Tao Li
Neonatal (enteroviral) myocarditis (NM/NEM) is rare but unpredictable and devastating, with high mortality and morbidity. We report a case of neonatal coxsackievirus B (CVB) fulminant myocarditis successfully treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO).A previously healthy 7-day-old boy presented with fever for 4 days. Progressive cardiac dysfunction (weak heart sounds, hepatomegaly, pulmonary edema, ascites, and oliguria), decreased left ventricular ejection fraction (LVEF) and fractional shortening (FS), transient ventricular fibrillation, dramatically elevated creatine kinase-MB (405.8 U/L), cardiac troponin I (25.85 ng/ml), and N-terminal pro-brain natriuretic peptide (NT-proBNP > 35,000 ng/L), and positive blood CVB ribonucleic acid indicated neonatal CVB fulminating myocarditis. It was refractory to mechanical ventilation, fluid resuscitation, inotropes, corticosteroids, intravenous immunoglobulin, and diuretics during the first 4 days of hospitalization (DOH 1–4). The deterioration was suppressed by V-A ECMO in the next 5 days (DOH 5–9), despite the occurrence of bilateral grade III intraventricular hemorrhage on DOH 7. Within the first 4 days after ECMO decannulation (DOH 10–13), he continued to improve with withdrawal of mechanical ventilation, LVEF > 60%, and FS > 30%. In the subsequent 4 days (DOH 14–17), his LVEF and FS decreased to 52% and 25%, and further dropped to 37%–38% and 17% over the next 2 days (DOH 18–19), respectively. There was no other deterioration except for cardiomegaly and paroxysmal tachypnea. Through strengthening fluid restriction and diuresis, and improving cardiopulmonary function, he restabilized. Finally, notwithstanding NT-proBNP elevation (>35,000 ng/L), cardiomegaly, and low LVEF (40%–44%) and FS (18%–21%) levels, he was discharged on DOH 26 with oral medications discontinued within 3 weeks postdischarge. In nearly three years of follow-up, he was uneventful, with interventricular septum hyperechogenic foci and mild mitral/tricuspid regurgitation.Dynamic cardiac function monitoring via real-time echocardiography is useful for the diagnosis and treatment of NM/NEM. As a lifesaving therapy, ECMO may improve the survival rate of patients with NM/NEM. However, the “honeymoon period” after ECMO may cause the illusion of recovery. Regardless of whether the survivors of NM/NEM have undergone ECMO, close long-term follow-up is paramount to the prompt identification and intervention of abnormalities.
{"title":"V-A ECMO for neonatal coxsackievirus B fulminant myocarditis: a case report and literature review","authors":"Xingchao Li, Li Sun, Shibing Xi, Yaofei Hu, Zhongqin Yu, Hui Liu, Hui Sun, Weili Jing, Li Yuan, Hongyan Liu, Tao Li","doi":"10.3389/fcvm.2024.1364289","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1364289","url":null,"abstract":"Neonatal (enteroviral) myocarditis (NM/NEM) is rare but unpredictable and devastating, with high mortality and morbidity. We report a case of neonatal coxsackievirus B (CVB) fulminant myocarditis successfully treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO).A previously healthy 7-day-old boy presented with fever for 4 days. Progressive cardiac dysfunction (weak heart sounds, hepatomegaly, pulmonary edema, ascites, and oliguria), decreased left ventricular ejection fraction (LVEF) and fractional shortening (FS), transient ventricular fibrillation, dramatically elevated creatine kinase-MB (405.8 U/L), cardiac troponin I (25.85 ng/ml), and N-terminal pro-brain natriuretic peptide (NT-proBNP > 35,000 ng/L), and positive blood CVB ribonucleic acid indicated neonatal CVB fulminating myocarditis. It was refractory to mechanical ventilation, fluid resuscitation, inotropes, corticosteroids, intravenous immunoglobulin, and diuretics during the first 4 days of hospitalization (DOH 1–4). The deterioration was suppressed by V-A ECMO in the next 5 days (DOH 5–9), despite the occurrence of bilateral grade III intraventricular hemorrhage on DOH 7. Within the first 4 days after ECMO decannulation (DOH 10–13), he continued to improve with withdrawal of mechanical ventilation, LVEF > 60%, and FS > 30%. In the subsequent 4 days (DOH 14–17), his LVEF and FS decreased to 52% and 25%, and further dropped to 37%–38% and 17% over the next 2 days (DOH 18–19), respectively. There was no other deterioration except for cardiomegaly and paroxysmal tachypnea. Through strengthening fluid restriction and diuresis, and improving cardiopulmonary function, he restabilized. Finally, notwithstanding NT-proBNP elevation (>35,000 ng/L), cardiomegaly, and low LVEF (40%–44%) and FS (18%–21%) levels, he was discharged on DOH 26 with oral medications discontinued within 3 weeks postdischarge. In nearly three years of follow-up, he was uneventful, with interventricular septum hyperechogenic foci and mild mitral/tricuspid regurgitation.Dynamic cardiac function monitoring via real-time echocardiography is useful for the diagnosis and treatment of NM/NEM. As a lifesaving therapy, ECMO may improve the survival rate of patients with NM/NEM. However, the “honeymoon period” after ECMO may cause the illusion of recovery. Regardless of whether the survivors of NM/NEM have undergone ECMO, close long-term follow-up is paramount to the prompt identification and intervention of abnormalities.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141113803","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 : 2024-05-21DOI: 10.3389/fcvm.2024.1371805
Huanyu Chen, Yuxuan Huang, Guangjing Wan, Xu Zou
Numerous studies have established a link between coronary heart disease and metabolic disorders. Yet, causal evidence connecting metabolites and Coronary Heart Disease (CHD) remains scarce. To address this, we performed a bidirectional Mendelian Randomization (MR) analysis investigating the causal relationship between blood metabolites and CHD.Data were extracted from published genome-wide association studies (GWASs) on metabolite levels, focusing on 1,400 metabolite summary data as exposure measures. Primary analyses utilized the GWAS catalog database GCST90199698 (60,801 cases and 123,504 controls) and the FinnGen cohort (43,518 cases and 333,759 controls). The primary method used for causality analysis was random inverse variance weighting (IVW). Supplementary analyses included MR-Egger, weighted mode, and weighted median methods. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy. Reverse MR analysis was employed to evaluate the direct impact of metabolites on coronary heart disease. Additionally, replication and meta-analysis were performed. We further conducted the Steiger test and colocalization analysis to reflect the causality deeply.This study identified eight metabolites associated with lipids, amino acids and metabolite ratios that may influence CHD risk. Findings include: 1-oleoyl-2-arachidonoyl-GPE (18:1/20:4) levels: OR = 1.08; 95% CI 1.04–1.12; P = 8.21E-06; 1-palmitoyl-2-arachidonoyl-GPE (16:0/20:4) levels: OR = 1.07; 95% CI 1.04–1.11; P = 9.01E-05; Linoleoyl-arachidonoyl-glycerol (18:2/20:4): OR = 1.08; 95% CI 1.04–1.22; P = 0.0001; Glycocholenate sulfate: OR = 0.93; 95% CI 0.90–0.97; P = 0.0002; 1-stearoyl-2-arachidonoyl-GPE (OR = 1.07; 95% CI 1.03–1.11; P = 0.0002); N-acetylasparagine (OR = 1.04; 95% CI 1.02–1.07; P = 0.0030); Octadecenedioate (C18:1-DC) (OR = 0.93; 95% CI 0.90–0.97; P = 0.0004); Phosphate to linoleoyl-arachidonoyl-glycerol (18:2–20:4) (1) ratio (OR = 0.92; 95% CI 0.88–0.97; P = 0.0005).The integration of genomics and metabolomics offers novel insights into the pathogenesis of CHD and holds significant importance for the screening and prevention of CHD.
大量研究证实，冠心病与代谢紊乱之间存在联系。然而，有关代谢物与冠心病（CHD）之间因果关系的证据仍然很少。为了解决这个问题，我们进行了一项双向孟德尔随机化（MR）分析，研究血液代谢物与冠心病之间的因果关系。我们从已发表的代谢物水平全基因组关联研究（GWAS）中提取了数据，重点研究了1400个代谢物汇总数据作为暴露测量指标。主要分析利用了 GWAS 目录数据库 GCST90199698（60,801 例病例和 123,504 例对照）和 FinnGen 队列（43,518 例病例和 333,759 例对照）。因果关系分析的主要方法是随机逆方差加权法（IVW）。补充分析包括 MR-Egger、加权模式和加权中位数方法。进行了敏感性分析以评估异质性和多义性。采用反向 MR 分析评估代谢物对冠心病的直接影响。此外，还进行了复制和荟萃分析。本研究发现了与血脂、氨基酸和代谢物比率相关的八种代谢物，它们可能会影响冠心病风险。研究结果包括1-oleoyl-2-arachidonoyl-GPE (18:1/20:4)水平：OR = 1.08; 95% CI 1.04-1.12; P = 8.21E-06；1-棕榈酰-2-丙烯酰-GPE（16:0/20:4）水平：OR = 1.07; 95% CI 1.04-1.11; P = 9.01E-05；亚油酰-2-丙烯酰-甘油（18:2/20:4）：OR = 1.08；95% CI 1.04-1.22；P = 0.0001；硫酸甘油酯：OR=0.93；95% CI 0.90-0.97；P=0.0002；1-硬脂酰-2-丙烯酰-GPE（OR=1.07；95% CI 1.03-1.11；P=0.0002）；N-乙酰天冬酰胺（OR=1.04；95% CI 1.02-1.07；P=0.0030）；十八碳二酸酯（C18:1-DC）（OR=0.93；95% CI 0.90-0.97；P=0.基因组学和代谢组学的整合为了解冠心病的发病机制提供了新的视角，对冠心病的筛查和预防具有重要意义。
{"title":"Circulating metabolites and coronary heart disease: a bidirectional Mendelian randomization","authors":"Huanyu Chen, Yuxuan Huang, Guangjing Wan, Xu Zou","doi":"10.3389/fcvm.2024.1371805","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1371805","url":null,"abstract":"Numerous studies have established a link between coronary heart disease and metabolic disorders. Yet, causal evidence connecting metabolites and Coronary Heart Disease (CHD) remains scarce. To address this, we performed a bidirectional Mendelian Randomization (MR) analysis investigating the causal relationship between blood metabolites and CHD.Data were extracted from published genome-wide association studies (GWASs) on metabolite levels, focusing on 1,400 metabolite summary data as exposure measures. Primary analyses utilized the GWAS catalog database GCST90199698 (60,801 cases and 123,504 controls) and the FinnGen cohort (43,518 cases and 333,759 controls). The primary method used for causality analysis was random inverse variance weighting (IVW). Supplementary analyses included MR-Egger, weighted mode, and weighted median methods. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy. Reverse MR analysis was employed to evaluate the direct impact of metabolites on coronary heart disease. Additionally, replication and meta-analysis were performed. We further conducted the Steiger test and colocalization analysis to reflect the causality deeply.This study identified eight metabolites associated with lipids, amino acids and metabolite ratios that may influence CHD risk. Findings include: 1-oleoyl-2-arachidonoyl-GPE (18:1/20:4) levels: OR = 1.08; 95% CI 1.04–1.12; P = 8.21E-06; 1-palmitoyl-2-arachidonoyl-GPE (16:0/20:4) levels: OR = 1.07; 95% CI 1.04–1.11; P = 9.01E-05; Linoleoyl-arachidonoyl-glycerol (18:2/20:4): OR = 1.08; 95% CI 1.04–1.22; P = 0.0001; Glycocholenate sulfate: OR = 0.93; 95% CI 0.90–0.97; P = 0.0002; 1-stearoyl-2-arachidonoyl-GPE (OR = 1.07; 95% CI 1.03–1.11; P = 0.0002); N-acetylasparagine (OR = 1.04; 95% CI 1.02–1.07; P = 0.0030); Octadecenedioate (C18:1-DC) (OR = 0.93; 95% CI 0.90–0.97; P = 0.0004); Phosphate to linoleoyl-arachidonoyl-glycerol (18:2–20:4) (1) ratio (OR = 0.92; 95% CI 0.88–0.97; P = 0.0005).The integration of genomics and metabolomics offers novel insights into the pathogenesis of CHD and holds significant importance for the screening and prevention of CHD.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"123 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115564","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 : 2024-05-21DOI: 10.3389/fcvm.2024.1280734
Zehui Guo, Zhihua Yang, Zhi-Jian Song, Zhenzhen Li, Yang Xiao, Yuhang Zhang, Tao Wen, Gui-Xia Pan, Haowei Xu, Xiaodi Sheng, Guowang Jiang, Liping Guo, Yi Wang
Coronary microvascular disease (CMVD) is common in patients with cardiovascular risk factors and is linked to an elevated risk of adverse cardiovascular events. Although modern medicine has made significant strides in researching CMVD, we still lack a comprehensive understanding of its pathophysiological mechanisms due to its complex and somewhat cryptic etiology. This greatly impedes the clinical diagnosis and treatment of CMVD. The primary pathological mechanisms of CMVD are structural abnormalities and/or dysfunction of coronary microvascular endothelial cells. The development of CMVD may also involve a variety of inflammatory factors through the endothelial cell injury pathway. This paper first reviews the correlation between the inflammatory response and CMVD, then summarizes the possible mechanisms of inflammatory response in CMVD, and finally categorizes the drugs used to treat CMVD based on their effect on the inflammatory response. We hope that this paper draws attention to CMVD and provides novel ideas for potential therapeutic strategies based on the inflammatory response.
{"title":"Inflammation and coronary microvascular disease: relationship, mechanism and treatment","authors":"Zehui Guo, Zhihua Yang, Zhi-Jian Song, Zhenzhen Li, Yang Xiao, Yuhang Zhang, Tao Wen, Gui-Xia Pan, Haowei Xu, Xiaodi Sheng, Guowang Jiang, Liping Guo, Yi Wang","doi":"10.3389/fcvm.2024.1280734","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1280734","url":null,"abstract":"Coronary microvascular disease (CMVD) is common in patients with cardiovascular risk factors and is linked to an elevated risk of adverse cardiovascular events. Although modern medicine has made significant strides in researching CMVD, we still lack a comprehensive understanding of its pathophysiological mechanisms due to its complex and somewhat cryptic etiology. This greatly impedes the clinical diagnosis and treatment of CMVD. The primary pathological mechanisms of CMVD are structural abnormalities and/or dysfunction of coronary microvascular endothelial cells. The development of CMVD may also involve a variety of inflammatory factors through the endothelial cell injury pathway. This paper first reviews the correlation between the inflammatory response and CMVD, then summarizes the possible mechanisms of inflammatory response in CMVD, and finally categorizes the drugs used to treat CMVD based on their effect on the inflammatory response. We hope that this paper draws attention to CMVD and provides novel ideas for potential therapeutic strategies based on the inflammatory response.","PeriodicalId":510752,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"98 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141116336","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：