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Prognostic significance of compliance with fractional flow reserve guidance on diverse vessel-related clinical outcomes 遵守分数血流储备指导对各种血管相关临床结果的预后意义
Pub Date : 2024-05-17 DOI: 10.3389/fcvm.2024.1370345
Yang Zhang, Bangguo Yang, Yicong Ye, Xiliang Zhao, Yaodong Ding, Yi Ye, Liang Zhang, Dawei Tan, Gong Zhang, Xiaoyu Duan, Quan Li, Yong Zeng
In patients underwent fractional flow reserve (FFR) assessment, a noteworthy proportion of adverse events occur in vessels in which FFR has not been measured. However, the effect of these non-target vessel-related events on the evaluation of FFR-related benefits remains unknown.In this retrospective study, vessels subjected to FFR measurement were grouped as FFR-based approach and non-compliance with FFR based on whether they received FFR-based treatment. Using inverse probability of treatment weighting (IPTW) to account for potential confounding, we investigated the association between compliance with FFR and 5-year target vessel failure (TVF) non-target vessel failure (NTVF) and vessel-oriented composite endpoints (VOCEs). Of the 1,119 vessels, 201 did not receive FFR-based treatment. After IPTW adjustment, a significantly lower hazard of TVF was observed in the FFR-based approach group (HR: 0.56; 95% CI: 0.34–0.92). While, the intergroup difference in hazard of NTVF (HR: 1.02; 95% CI: 0.45–2.31) and VOCEs (HR: 0.69; 95% CI: 0.45–1.05) were nonsignificant.In patients with CAD subjected to FFR, the FFR-based treatment yields a sustained clinical benefit in terms of the risks of target vessel-related events. The dilution of non-target vessel-related events renders the difference favoring the FFR-based approach nonsignificant.
在接受分数血流储备(FFR)评估的患者中,有相当一部分不良事件发生在未测量 FFR 的血管中。在这项回顾性研究中,根据是否接受了基于 FFR 的治疗,将接受 FFR 测量的血管分为基于 FFR 的方法和不符合 FFR 的方法。通过使用治疗反概率加权(IPTW)来考虑潜在的混杂因素,我们研究了FFR依从性与5年靶血管失败(TVF)、非靶血管失败(NTVF)和血管导向复合终点(VOCEs)之间的关系。在 1119 根血管中,201 根未接受基于 FFR 的治疗。经过IPTW调整后,观察到基于FFR方法组的TVF风险显著降低(HR:0.56;95% CI:0.34-0.92)。而 NTVF(HR:1.02;95% CI:0.45-2.31)和 VOCEs(HR:0.69;95% CI:0.45-1.05)的组间差异并不显著。非靶血管相关事件的稀释使基于 FFR 的方法的差异不显著。
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引用次数: 0
Characteristics and prognostic value of cardiac magnetic resonance strain analysis in patients with different phenotypes of heart failure 不同表型心力衰竭患者心脏磁共振应变分析的特征和预后价值
Pub Date : 2024-05-17 DOI: 10.3389/fcvm.2024.1366702
Bianjie Zhao, Shiwen Zhang, Liang Chen, Kai Xu, Yinglong Hou, Shuguang Han
Strain analysis of cardiac magnetic resonance imaging (CMR) is important for the prognosis of heart failure (HF). Herein, we aimed to identify the characteristics and prognostic value of strain analysis revealed by CMR in different HF phenotypes.Participants with HF, including HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction, and controls were enrolled. The baseline information and clinical parameters of participants were collected, and echocardiography and CMR examination were performed. Three-dimensional strain analysis was performed in the left ventricle, right ventricle, left atrium, and right atrium using CMR. A multifactor Cox risk proportional model was established to assess the influencing factors of cardiovascular adverse events in patients with HF.During a median follow-up of 999 days (range: 616–1334), 20.6% of participants (73/354) experienced adverse events (HF readmission and/or cardiovascular death). Univariable Cox regression revealed that a 1% increase in left atrial global longitudinal strain (LAGLS) was associated with a hazard ratio (HR) of 1.21 [95% confidence interval (CI):1.15–1.28; P < 0.001]. Left ventricular global circumferential strain (LVGCS) (HR, 1.18; 95% CI: 1.12–1.24; P < 0.001), and left ventricular global longitudinal strain (LVGLS) (HR, 1.27; 95% CI: 1.20–1.36; P < 0.001) were also associated with HF hospitalizations and cardiovascular deaths. Among clinical variables, hypertension (HR, 2.11; 95% CI: 1.33–13.36; P = 0.002), cardiomyopathy (HR, 2.26; 95% CI: 1.42–3.60; P < 0.001) were associated with outcomes in univariable analysis. Multivariable analyses revealed that LAGLS (95% CI: 1.08–1.29; P < 0.001), LVGLS (95% CI:1.08–1.29; P < 0.001) and LVGCS (95% CI: 1.19–1.51; P < 0.001) were significantly associated with outcomes. Among clinical variables, hypertension (95% CI: 1.09–3.73; P < 0.025) remained a risk factor.CMR plays an obvious role in phenotyping HF. Strain analysis, particularly left atrial and left ventricular strain analysis (LAGLS, LVGLS, and LVGCS) has good value in predicting adverse outcome events.
心脏磁共振成像(CMR)的应变分析对心力衰竭(HF)的预后非常重要。在此,我们旨在确定 CMR 所显示的应变分析在不同 HF 表型中的特征和预后价值。我们招募了 HF 患者(包括射血分数降低的 HF、射血分数轻度降低的 HF 和射血分数保留的 HF)和对照组。收集了参与者的基线信息和临床参数,并进行了超声心动图和CMR检查。利用CMR对左心室、右心室、左心房和右心房进行了三维应变分析。在中位999天(范围:616-1334)的随访期间,20.6%的参与者(73/354)发生了不良事件(HF再入院和/或心血管死亡)。单变量 Cox 回归显示,左心房整体纵向应变 (LAGLS) 每增加 1%,其危险比 (HR) 为 1.21 [95% 置信区间 (CI):1.15-1.28;P < 0.001]。左心室整体周向应变(LVGCS)(HR,1.18;95% CI:1.12-1.24;P <0.001)和左心室整体纵向应变(LVGLS)(HR,1.27;95% CI:1.20-1.36;P <0.001)也与心房颤动住院和心血管死亡有关。在临床变量中,高血压(HR,2.11;95% CI:1.33-13.36;P = 0.002)、心肌病(HR,2.26;95% CI:1.42-3.60;P <0.001)与单变量分析结果相关。多变量分析显示,LAGLS(95% CI:1.08-1.29;P<0.001)、LVGLS(95% CI:1.08-1.29;P<0.001)和LVGCS(95% CI:1.19-1.51;P<0.001)与预后显著相关。在临床变量中,高血压(95% CI:1.09-3.73;P < 0.025)仍然是一个危险因素。应变分析,尤其是左心房和左心室应变分析(LAGLS、LVGLS 和 LVGCS)在预测不良预后事件方面具有很好的价值。
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引用次数: 0
Knowledge and attitude toward postoperative antithrombotic management and prevention in patients with coronary revascularization: a cross-sectional study 冠状动脉血运重建患者术后抗血栓管理和预防的知识和态度:一项横断面研究
Pub Date : 2024-05-17 DOI: 10.3389/fcvm.2024.1388164
Chunlu Liu, Haijun Zhang, Liming Yang, Lihua Chen, Changhao Zu, Fangfang Wang, Yunjia Dai, Haiyan Zhao
This study aimed to explore the knowledge and attitude (KA) toward postoperative antithrombotic management and prevention among coronary artery disease (CAD) patients who underwent coronary revascularization.This cross-sectional study enrolled CAD outpatients and inpatients between May and December 2023 at Kailuan Medical Group at Tangshan. Basic demographic characteristics and KA scores were collected through a self-made questionnaire.This study included 523 valid questionnaires. The mean knowledge and attitude scores were 13.20 ± 6.20 (range: 0–26) and 43.68 ± 6.01 (range: 21–50), respectively, indicating poor knowledge and favorable attitude. Multivariable logistic regression analysis showed that junior high school education (OR = 2.160, P = 0.035), high school or technical school education (OR = 2.356, P = 0.039), and monthly average income >5,000 RMB (OR = 3.407, P = 0.002) were independently associated with knowledge. Knowledge (OR = 1.095, P = 0.002), BMI ≥ 24.0 kg/m2 (OR = 0.372, P = 0.011), junior high school (OR = 3.699, P = 0.002), high school or technical school (OR = 2.903, P = 0.028), high associate degree or above education (OR = 6.068, P = 0.014), monthly average income 3,000–5,000 RMB (OR = 0.296, P = 0.005), monthly average income > 5,000 RMB (OR = 0.225, P = 0.021), with hypertension (OR = 0.333, P = 0.003), blood tests every 2–3 weeks (OR = 10.811, P = 0.011), blood tests every month (OR = 4.221, P = 0.024), and blood tests every 2–3 months (OR = 3.342, P = 0.033) were independently associated with attitude.CAD patients who underwent coronary revascularization had poor knowledge but favorable attitudes toward postoperative antithrombotic management and prevention. The study underscores the need for targeted education, especially for individuals with lower education and income levels, ultimately improving patient compliance and cardiovascular outcomes.
本研究旨在探讨接受冠状动脉血运重建手术的冠心病(CAD)患者对术后抗血栓管理和预防的知识和态度(KA)。本研究通过自制问卷收集了基本人口学特征和 KA 评分。知识和态度的平均得分分别为(13.20±6.20)分(范围:0-26)和(43.68±6.01)分(范围:21-50),表明知识贫乏和态度良好。多变量逻辑回归分析表明,初中学历(OR = 2.160,P = 0.035)、高中或中专学历(OR = 2.356,P = 0.039)和月均收入大于 5,000 元(OR = 3.407,P = 0.002)与知识水平独立相关。知识(OR = 1.095,P = 0.002)、体重指数≥ 24.0 kg/m2 (OR = 0.372,P = 0.011)、初中(OR = 3.699,P = 0.002)、高中或中专(OR = 2.903,P = 0.028)、副高及以上学历(OR = 6.068,P = 0.014)、月均收入 3000-5000 元(OR = 0.296,P = 0.005)、月均收入大于 5000 元(OR = 0.225,P = 0.021)、患有高血压(OR = 0.333,P = 0.003)、每 2-3 周抽血检查一次(OR = 10.811,P = 0.011)、每月抽血检查一次(OR = 4.221,P = 0.024)、每 2-3 个月抽血检查一次(OR = 3.342,P = 0.033)与态度独立相关。这项研究强调了有针对性教育的必要性,尤其是针对教育程度和收入水平较低的人群,从而最终改善患者的依从性和心血管预后。
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引用次数: 0
Association between aspirin and mortality in critically ill patients with atrial fibrillation: a retrospective cohort study based on mimic-IV database 阿司匹林与心房颤动重症患者死亡率之间的关系:基于 mimic-IV 数据库的回顾性队列研究
Pub Date : 2024-05-17 DOI: 10.3389/fcvm.2024.1280149
Meijuan Zhang, Yadong Zuo, Zhanquan Jiao
Atrial fibrillation (AF) is a prevalent issue among critically ill patients, and the availability of effective treatment strategies for AF is limited.The objective of this study was to evaluate the mortality rate associated with AF in critically ill patients who were either aspirin or non-aspirin users.This cohort study incorporated critically ill patients with AF from the Medical Information Mart for Intensive Care database. The study compared incidences of 28-day mortality, 90-day mortality, and 1-year mortality between patients with and without aspirin prescriptions. To assess the association between aspirin and the endpoints, Kaplan-Meier analysis and Cox proportional hazards regression analyses were conducted.In this study, a total of 13,330 critically ill patients with atrial fibrillation (AF) were included, of which 4,421 and 8,909 patients were categorized as aspirin and non-aspirin users, respectively. The 28-day, 90-day, and 1-year mortality rates were found to be 17.5% (2,330/13,330), 23.9% (3,180/13,330), and 32.9% (4,379/13,330), respectively. The results of a fully-adjusted Cox proportional hazard model indicated that aspirin use was negatively associated with the risk of death after adjusting for confounding factors (28-day mortality, HR 0.64, 95% CI 0.55–0.74; 90-day mortality, HR 0.65, 95% CI 0.58–0.74; 1-year mortality, HR 0.67, 95%CI 0.6∼0.74). The results of the subgroup analysis indicate a more robust correlation, specifically among patients under the age of 65 and those without a history of congestive heart failure or myocardial infarction.The utilization of aspirin may exhibit a correlation with a reduction in risk-adjusted mortality from all causes in critically ill patients diagnosed with atrial fibrillation. However, additional randomized controlled trials are necessary to elucidate and confirm this potential association.
心房颤动(房颤)是重症患者中普遍存在的问题,而针对房颤的有效治疗策略却很有限。本研究的目的是评估使用或未使用阿司匹林的重症患者与房颤相关的死亡率。这项队列研究将重症监护医学信息市场数据库中的房颤重症患者纳入其中。该研究比较了有阿司匹林处方和无阿司匹林处方患者的 28 天死亡率、90 天死亡率和 1 年死亡率。这项研究共纳入了 13,330 名心房颤动(房颤)重症患者,其中 4,421 名和 8,909 名患者分别被归类为阿司匹林使用者和非阿司匹林使用者。结果发现,28 天、90 天和 1 年的死亡率分别为 17.5%(2,330/13,330)、23.9%(3,180/13,330)和 32.9%(4,379/13,330)。完全调整后的 Cox 比例危险模型结果显示,在调整了混杂因素后,服用阿司匹林与死亡风险呈负相关(28 天死亡率,HR 0.64,95%CI 0.55-0.74;90 天死亡率,HR 0.65,95%CI 0.58-0.74;1 年死亡率,HR 0.67,95%CI 0.6∼0.74)。亚组分析结果表明,尤其是在 65 岁以下和无充血性心力衰竭或心肌梗死病史的患者中,相关性更强。然而,有必要进行更多的随机对照试验来阐明和证实这种潜在的关联性。
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引用次数: 0
Case Report: Assessment of primary myxofibrosarcoma in the left atrium using multimodal ultrasonography 病例报告:利用多模态超声波检查评估左心房原发性肌纤维肉瘤
Pub Date : 2024-05-17 DOI: 10.3389/fcvm.2024.1378655
Liyan Hu, Zhaohui Wang, Yu Chen, Xiaowei Zhang
Primary myxofibrosarcoma of the heart, a rare cardiac malignancy, was diagnosed in a middle-aged female patient exhibiting progressive dyspnea following transthoracic echocardiography and pathological analysis. Postoperatively, the patient underwent chemotherapy and Lenvatinib mesylate therapy, with regular check-ups confirming her survival. After 10 months the patient is still alive and well.
一名中年女性患者出现进行性呼吸困难,经胸超声心动图检查和病理分析后确诊为原发性心脏肌纤维肉瘤,这是一种罕见的心脏恶性肿瘤。术后,患者接受了化疗和甲磺酸伦伐替尼治疗,并通过定期检查确认其存活。10 个月后,患者仍健在。
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引用次数: 0
Potential effect of the non-neuronal cardiac cholinergic system on hepatic glucose and energy metabolism 非神经元心脏胆碱能系统对肝糖和能量代谢的潜在影响
Pub Date : 2024-05-16 DOI: 10.3389/fcvm.2024.1381721
Atsushi Kurabayashi, Waka Iwashita, Kaoru Furihata, H. Fukuhara, K. Inoue
The vagus nerve belongs to the parasympathetic nervous system, which is involved in the regulation of organs throughout the body. Since the discovery of the non-neuronal cardiac cholinergic system (NNCCS), several studies have provided evidence for the positive role of acetylcholine (ACh) released from cardiomyocytes against cardiovascular diseases, such as sympathetic hyperreactivity-induced cardiac remodeling and dysfunction as well as myocardial infarction. Non-neuronal ACh released from cardiomyocytes is believed to regulate key physiological functions of the heart, such as attenuating heart rate, offsetting hypertrophic signals, maintaining action potential propagation, and modulating cardiac energy metabolism through the muscarinic ACh receptor in an auto/paracrine manner. Moreover, the NNCCS may also affect peripheral remote organs (e.g., liver) through the vagus nerve. Remote ischemic preconditioning (RIPC) and NNCCS activate the central nervous system and afferent vagus nerve. RIPC affects hepatic glucose and energy metabolism through the central nervous system and vagus nerve. In this review, we discuss the mechanisms and potential factors responsible for NNCCS in glucose and energy metabolism in the liver.
迷走神经属于副交感神经系统,参与调节全身器官。自发现非神经元心脏胆碱能系统(NNCCS)以来,多项研究已证明心肌细胞释放的乙酰胆碱(ACh)对心血管疾病(如交感神经过度反应引起的心脏重塑和功能障碍以及心肌梗死)具有积极作用。从心肌细胞释放的非神经元 ACh 被认为能调节心脏的主要生理功能,如减弱心率、抵消肥大信号、维持动作电位传播,以及通过毒蕈碱 ACh 受体以自身/旁分泌方式调节心脏能量代谢。此外,NNCCS 还可通过迷走神经影响外周远端器官(如肝脏)。远程缺血预处理(RIPC)和 NNCCS 可激活中枢神经系统和传入迷走神经。RIPC 通过中枢神经系统和迷走神经影响肝糖和能量代谢。在这篇综述中,我们将讨论 NNCCS 影响肝脏葡萄糖和能量代谢的机制和潜在因素。
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引用次数: 0
Factors influencing coronary artery target lesion revascularization after drug-coated balloon angioplasty 影响药物涂层球囊血管成形术后冠状动脉靶病变血管再通的因素
Pub Date : 2024-05-16 DOI: 10.3389/fcvm.2024.1387074
Alberta Claudia Undarsa, Aninka Saboe, Badai Bhatara Tiksnadi, Mohammad Rizki Akbar, A. F. Yahya
Concerns regarding restenosis after treatment with drug-coated balloons (DCB) remain. We aimed to identify the incidence of target lesion revascularization (TLR) and explore clinical, procedural, and other factors influencing it.Single-center retrospective analysis of a prospective cohort PCI registry study included 80 patients (100 lesions) who underwent successful DCB angioplasty between January 2020 and October 2023 and follow-up angiography within 2 years of either planned or unplanned reason. Incidence and factors associated with TLR were analyzed.Angiographic evaluation was conducted within a median of 151 days (interquartile range: 109 days). During index procedure, 54% were complex lesions. Intravascular imaging (IVI) was performed in 80% of lesions. TLR occurred in 11% of the lesions and was less frequent in the IVI group compared to the angiography-alone group [6.3 vs. 54.5%; odds ratio: 0.156, 95% confidence interval (CI): 0.042–0.580; p = 0.002]. No association was found between baseline and lesion characteristics, lesion complexity, plaque morphology, pre-dilatation procedure balloon type, maximal inflation pressure, or length of DCB between the groups (p > 0.05). Multivariate analysis revealed that IVI utilization was independently associated with a lower TLR rate (adjusted odds ratio: 0.116, 95% CI: 0.020–0.669; p = 0.016).In DCB angioplasty, only IVI use exhibited a significant difference in the TLR rate among baseline lesion characteristics and lesion preparation and was independently associated with a lower TLR rate.
药物涂层球囊(DCB)治疗后的再狭窄问题仍然令人担忧。我们的目的是确定靶病变血管再通(TLR)的发生率,并探讨影响TLR的临床、程序和其他因素。一项前瞻性队列PCI注册研究的单中心回顾性分析纳入了80名患者(100个病变),他们在2020年1月至2023年10月期间成功接受了DCB血管成形术,并在计划内或计划外原因的2年内进行了随访血管造影。血管造影评估在中位数 151 天(四分位间距:109 天)内进行。在索引手术中,54%为复杂病变。80%的病变进行了血管内成像(IVI)。11%的病变发生了TLR,与单纯血管造影组相比,IVI组的TLR发生率较低[6.3 vs. 54.5%;几率比:0.156,95%置信区间(CI):0.042-0.580;P = 0.002]。在基线和病变特征、病变复杂程度、斑块形态、扩张术前球囊类型、最大充气压力或 DCB 长度之间,未发现组间有任何关联(P > 0.05)。多变量分析显示,IVI的使用与较低的TLR率独立相关(调整后的几率比:0.116,95% CI:0.020-0.669;P = 0.016)。在DCB血管成形术中,只有IVI的使用在基线病变特征和病变准备之间的TLR率上表现出显著差异,并且与较低的TLR率独立相关。
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引用次数: 0
Cardiocerebrovascular benefits of early rhythm control in patients with atrial fibrillation detected after stroke: a systematic review and meta-analysis 中风后发现的心房颤动患者早期控制心律对心脑血管的益处:系统综述和荟萃分析
Pub Date : 2024-05-16 DOI: 10.3389/fcvm.2024.1391534
Liang Ma, Baofu Wang, Jiasai Fan, Hufang Zhou, Jingen Li, Weisheng Li, Xiangying Zheng, Xian Wang
This study aimed to evaluate the impact of early rhythm control (ERC) on the occurrence of cardiocerebrovascular events in patients diagnosed with atrial fibrillation detected after stroke (AFDAS).A systematic search was conducted across nine databases from inception to October 15, 2023 to identify clinical trials comparing ERC with usual care interventions in AFDAS patients. The primary outcome assessed was recurrent stroke, with secondary outcomes including all-cause mortality, adverse events related to arrhythmias, and dementia.Analysis of five studies, consisting of two randomized clinical trials (RCTs) involving 490 patients and three cohort studies involving 95,019 patients, revealed a reduced rate of recurrent stroke [odds ratio (OR) = 0.30, 95% confidence interval (CI) 0.11–0.80, P = 0.016 in RCTs; OR = 0.64, 95% CI 0.61–0.68, P < 0.00001 in cohort studies] and all-cause mortality (hazards ratio = 0.94, 95% CI 0.90–0.98, P = 0.005 in cohort studies) in the ERC group compared to the usual care group. In addition, ERC was associated with superior outcomes in terms of dementia.Patients with AFDAS who underwent ERC treatment exhibited a decreased risk of cardiocerebrovascular events compared to those receiving usual care. These results support the potential benefits of implementing an ERC strategy for this specific patient population.https://www.crd.york.ac.uk/PROSPERO/, Identifier [CRD42023465994].
本研究旨在评估早期心律控制(ERC)对卒中后发现的心房颤动(AFDAS)患者心脑血管事件发生率的影响。研究人员对九个数据库进行了系统检索,检索时间从开始到 2023 年 10 月 15 日,目的是确定在 AFDAS 患者中比较 ERC 与常规护理干预的临床试验。对五项研究(包括涉及 490 名患者的两项随机临床试验 (RCT) 和涉及 95,019 名患者的三项队列研究)的分析表明,ERC 降低了中风复发率[赔率 (OR) = 0.30, 95% confidence interval (CI) 0.11-0.80, P = 0.016; OR = 0.64, 95% CI 0.61-0.68, P < 0.00001] 和全因死亡率(危险比 = 0.94, 95% CI 0.90-0.98, P = 0.005)。与接受常规治疗的患者相比,接受 ERC 治疗的 AFDAS 患者发生心脑血管事件的风险更低。这些结果支持了针对这一特殊患者群体实施ERC策略的潜在益处。https://www.crd.york.ac.uk/PROSPERO/,标识符[CRD42023465994]。
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引用次数: 0
Non-neuronal cell-derived acetylcholine, a key modulator of the vascular endothelial function in health and disease 非神经元细胞衍生的乙酰胆碱--健康和疾病中血管内皮功能的关键调节剂
Pub Date : 2024-05-15 DOI: 10.3389/fcvm.2024.1388528
Takashi Sonobe, Yoshihiko Kakinuma
Vascular endothelial cells play an important role in regulating peripheral circulation by modulating arterial tone in the microvasculature. Elevated intracellular Ca2+ levels are required in endothelial cells to induce smooth muscle relaxation via endothelium-dependent mechanisms such as nitric oxide production, prostacyclin, and endothelial cell hyperpolarization. It is well established that exogenous administration of acetylcholine can increase intracellular Ca2+ concentrations, followed by endothelium-dependent vasodilation. Although endogenous acetylcholine's regulation of vascular tone remains debatable, recent studies have reported that endogenously derived acetylcholine, but not neuronal cell-derived acetylcholine, is a key modulator of endothelial cell function. In this minireview, we summarize the current knowledge of the non-neuronal cholinergic system (NNCS) in vascular function, particularly vascular endothelial cell function, which contributes to blood pressure regulation. We also discuss the possible pathophysiological impact of endothelial NNCS, which may induce the development of vascular diseases due to endothelial dysfunction, and the potential of endothelial NNCS as a novel therapeutic target for endothelial dysfunction in the early stages of metabolic syndrome, diabetes, and hypertension.
血管内皮细胞通过调节微血管中的动脉张力,在调节外周循环中发挥着重要作用。内皮细胞需要细胞内 Ca2+ 水平升高,才能通过内皮依赖机制(如一氧化氮生成、前列环素和内皮细胞超极化)诱导平滑肌松弛。外源性乙酰胆碱可增加细胞内 Ca2+ 浓度,继而产生内皮依赖性血管舒张,这一点已得到公认。尽管内源性乙酰胆碱对血管张力的调节作用仍有争议,但最近的研究报告表明,内源性乙酰胆碱是内皮细胞功能的关键调节因子,而神经细胞源性乙酰胆碱则不是。在这篇微型综述中,我们总结了目前关于非神经元胆碱能系统(NNCS)在血管功能,尤其是血管内皮细胞功能中的作用的知识。我们还讨论了内皮非神经胆碱能系统可能产生的病理生理学影响,它可能诱发因内皮功能障碍导致的血管疾病,以及内皮非神经胆碱能系统作为代谢综合征、糖尿病和高血压早期阶段内皮功能障碍的新型治疗靶点的潜力。
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引用次数: 0
Interacting and joint effects of triglyceride-glucose index and hypertension on stroke risk in middle-aged and older Chinese adults: a population-based prospective cohort study 基于人群的前瞻性队列研究:甘油三酯-葡萄糖指数和高血压对中国中老年人中风风险的相互影响和共同影响
Pub Date : 2024-05-15 DOI: 10.3389/fcvm.2024.1363049
Yun-Dan Luo, Ying-Yuan Gan, Qian Liao, Xu Li, Rong-Rui Huo
Triglyceride-glucose (TyG) index and hypertension were well-established risk factors for stroke. And TyG index was associated with hypertension. However, no prior study has investigated the interactive effects of the TyG index and hypertension on stroke. This study examined whether hypertension mediates associations of TyG index with incident stroke and the extent of interaction or joint relations of TyG index and hypertension with stroke in middle-aged and older Chinese adults.The China Health and Retirement Longitudinal Study (CHARLS) is an ongoing nationally representative prospective cohort study initiated in 2011. This cohort study included 9,145 middle-aged and older Chinese adults without stroke at baseline. The eposures were TyG index and the logarithmized product of hypertension, as determined during the baseline health examination. The main outcome was self-reported physician-diagnosed stroke which followed up from June 1, 2011, to June 30, 2018.Of the 9,145 participants, 4,251 were men (46.5%); the mean (SD) age was 59.20 (9.33) years. During a median follow-up of 7.1 years, 637 (7.0%) participants developed stroke. In multivariable-adjusted models, the TyG index was significantly associated with the risk of hypertension [odds ratio (OR) per 1-SD increase, 1.29; 95% CI, 1.19–1.41] and stroke [hazard ratio (HR) per 1-SD increase, 1.16; 95% CI, 1.02–1.33]. Both multiplicative and additive interactions were observed between TyG index and hypertension on stroke (HR for multiplicative: 2.34, 95% CI, 1.57–3.48; Synergy index: 4.13, 95% CI, 2.73–6.25). Mediation analysis showed that 20.0% of the association between TyG index and stroke was mediated through hypertension.This study suggests a synergistic effect of TyG index and hypertension on stroke, and a small proportion of the association between TyG index and stroke was mediated by hypertension, indicating the benefit of coordinated control strategies for both exposures.
甘油三酯-葡萄糖(TyG)指数和高血压是公认的脑卒中风险因素。而 TyG 指数与高血压相关。然而,此前还没有研究调查过 TyG 指数和高血压对脑卒中的交互影响。中国健康与退休纵向研究(CHARLS)是一项具有全国代表性的前瞻性队列研究,于 2011 年启动。该队列研究纳入了 9145 名基线时未患中风的中国中老年人。暴露因子为基线健康检查中确定的 TyG 指数和高血压对数乘积。9145名参与者中有4251名男性(46.5%),平均(标清)年龄为59.20(9.33)岁。在中位随访 7.1 年期间,637 名参与者(7.0%)发生了中风。在多变量调整模型中,TyG 指数与高血压[每增加 1-SD 的几率比 (OR),1.29;95% CI,1.19-1.41]和中风[每增加 1-SD 的危险比 (HR),1.16;95% CI,1.02-1.33]的风险显著相关。在 TyG 指数与高血压之间观察到乘法和加法相互作用对中风的影响(乘法 HR:2.34,95% CI,1.57-3.48;协同指数:4.13,95% CI,1.57-3.48):4.13,95% CI,2.73-6.25)。本研究表明,TyG 指数和高血压对脑卒中有协同作用,TyG 指数和脑卒中之间的联系有一小部分是由高血压介导的,这表明对这两种暴露采取协调的控制策略是有益的。
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Frontiers in Cardiovascular Medicine
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