Journal of Geriatric Cardiology最新文献

Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor; over the years, its use in clinical practice has decreased in favor of more recent drugs. However, it is a rather handy drug, which can be useful in several clinical settings when managing critically ill patients. The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine. Furthermore, the safety profile of this drug has been evaluated. This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues. For the timeline 1999-2024, a search was conducted on the main scientific platforms; resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected. The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure, acute mountain sickness, post hypercapnic metabolic alkalosis, idiopathic intracranial hypertension and acute angle-closure glaucoma. In a few cases, however, randomized controlled clinical trials have been conducted. There are also other less solid indications based mostly on experience or retrospective data. Acetazolamide seems to be an overall safe drug; serious side effects are rare and can be avoided by carefully selecting the patients to be treated. Acetazolamide represents a precious resource for emergency physicians and intensivists; critical patients with different conditions can in fact benefit from it; furthermore, acetazolamide is a safe drug if administered to correctly selected patients.

Objective: To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians.

Methods: Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis.

Results: 326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%.

Conclusions: Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.

Objective: To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.

Methods: We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older. Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer. Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.

Results: We included 157,097 UK Biobank participants (78,151 women and 78,946 men) in our study, with mean age of 64 ± 2.9 years. During a median follow-up of 8.1 (7.4-8.8) years, 1543 (1.0%) participants developed incident aortic stenosis. Compared with those with the lowest handgrip strength (tertile 1), the adjusted hazard ratios (95% confidence interval) of incident aortic stenosis in the middle (tertile 2) and the highest (tertile 3) were 0.86 (0.77-0.97) and 0.76 (0.67-0.87), respectively.

Conclusions: Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults. Future studies warrant preventive strategies for older adults with lower handgrip strength.

Background: Human interleukin (IL)-37 is a constituent of the IL-1 family with potent anti-inflammatory and immunosuppressive attributes. It has been demonstrated extensive beneficial effects on various diseases; however, its role in the pathogenesis of diabetic cardiomyopathy (DCM) remains unclear.

Methods: In vivo, DCM mouse model was established with streptozotocin injection and a high-fat diet in WT and cardiac fibroblasts (CFs) specific hIL-37b overexpression mice (IL-37-Tg). In vitro, primary mouse CFs were isolated from the hearts of adult mice and cultured with high levels of glucose and palmitic acid. Cardiac function of the mice was assessed using echocardiography. Masson staining, immunofluorescence, western blot and RT-PCR assays were employed to evaluate the expression of cardiac fibrosis and SOCS3-JAK2-STAT3 signaling pathway-related proteins.

Results: In this study, we found that CFs specific IL-37-Tg significantly ameliorated cardiac dysfunction and reduced collagen production by inhibiting the JAK2-STAT3 axis, as evidenced by the decreased levels of p-JAK2 and p-STAT3 in the heart of CFs specific IL-37-Tg DCM mice. The beneficial effects of IL-37 were consistently observed in CFs treated with high glucose (HG) and palmitic acid (PA). Moreover, we also discovered that the presence of IL-37 increased the expression of SOCS3, a crucial regulator of JAK/STAT signaling, in DCM mice and HG and PA-treated CFs. Finally, the anti-fibrotic action of IL-37 in HG and PA-treated CFs was abolished when either SOCS3 was genetically knocked down or JAK2/STAT3 was pharmacologically activated.

Conclusions: Our findings indicate that IL-37 exerts its antifibrotic effect by promoting SOCS3-mediated JAK2-STAT3 inactivation and may be considered as a potential therapeutic agent for DCM.

Background: Left main coronary bifurcation lesions account for 50% of left main coronary artery disease cases. Although a drug-coated balloon (DCB) has the advantages of immediate release of the drug to the arterial wall and no remaining struts, there is no conclusive evidence to support DCB use.

Methods & results: We conducted a systematic review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Eighteen retrospective studies and two prospective studies in which left main bifurcation lesions were treated with DCBs were included in our qualitative analysis. The studies were divided into two groups according to the type of DCB used: DCB only and DCB + stent. At the midterm follow-up, the use of DCBs had noninferior or even superior angiographic and clinical outcomes in treating left main bifurcation lesions compared with the use of drug-eluting stents or conventional balloons, whether for de novo or in-stent restenosis lesions. Additionally, side branch late lumen enlargement was observed in several of the included studies, which indicates that DCBs may have the advantage of side branch protection.

Conclusions: According to our descriptive analysis, the DCB technique has a favorable safety and efficacy profiles for the treatment of left main bifurcation lesions. However, additional studies, especially randomized controlled trials, are needed to establish standards for the DCB technique.

Objectives: Autologous blood outgrowth endothelial cells (BOECs) have been proposed to induce therapeutic angiogenesis for treating cardiovascular diseases (CVDs). The aim of the present study was to investigate the proliferative potential and angiogenic characteristics of BOECs among middle-aged and older adults, the population particularly susceptible to CVDs.

Methods: BOECs were isolated from 48 peripheral blood samples of subjects aged 56 ± 4 years. The cells were then distinguished based on their proliferative abilities, and their phenotype, tube formation capacity, and migratory activity were compared using immunofluorescence staining, flow cytometry, tube formation assay, and wound healing assay, respectively. Correlations between demographic, clinical, and dietary parameters with the number of BOECs were also assessed.

Results: A total of 132 BOEC colonies with different proliferative potentials were obtained, including colonies lost proliferative ability before passage 3 (named LPA), stopped proliferating during passage 3-8 (HPA (3-8)), and proliferated after passage 8 (HPA (> 8)). LPA cells appeared later and displayed abnormal morphology, while HPA (3-8) cells exhibited alterations in von Willebrand factor morphology and lower KDR expression. HPA (> 8) cells obtained higher branching intervals and individual cell migration velocity compared with those of HPA (3-8) cells. Correlation analysis showed that the number of both LPA and HPA colonies were positively associated with several CVD risk factors. Additionally, the number of LPA colonies was positively associated with servings of meats and alternatives, fruits, fruits and vegetables, as well as the protein intake.

Conclusions: Our findings provide evidence that the middle-aged and older populations possess BOECs with different proliferative and angiogenic potentials, exhibiting distinctions in cell morphology, appearance dates, VWF morphology, and KDR expression. Strikingly, a higher number of BOECs is likely associated with an increased risk of CVDs, while the number of BOECs with low proliferative ability may be regulated by diet.

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. In connection with the previous section, this 12^th section of the report offers a comprehensive analysis of rehabilitation of cardiovascular diseases. In recent years, China's cardiac rehabilitation has developed vigorously, and its clinical benefits have been proven by more and more evidences. More cardiac rehabilitation centers are built and standards are constantly being promoted. Despite the rapid development and progress, there are still major shortcomings in the current situation, such as lack of awareness among patients and families about the significance and importance of cardiac rehabilitation, and under participation in cardiac rehabilitation; the development of cardiac rehabilitation is uneven, with the majority concentrated in tertiary hospitals in economically developed areas; lack of high-level evidence-based evidences, quality control and safety standards need to be improved; the medical payment system is not thorough; lack of a systematic training and admission system, hindering the development of cardiac rehabilitation in China. Therefore, continuous efforts are needed to strengthen the construction of cardiac rehabilitation centers, which should sink from tertiary hospitals to secondary and primary medical service centers; encourage clinical research on cardiac rehabilitation; introduce consensus on quality control and safety standards; explore more on phase III cardiac rehabilitation; increase investment in integrating high-tech, artificial intelligence, etc. With the unique advantages of traditional Chinese medicine, exploring a Chinese characteristic cardiac rehabilitation model that is in line with China's national conditions. Evidence-based medicine has confirmed that rehabilitation is the most effective method to reduce the disability rate of stroke, and it is also an indispensable key sector in the organized management model of stroke. Rehabilitation should span the entire process of stroke treatment. Perfecting the rehabilitation medical management system, steadily improving the rehabilitation medical service capacity, expanding diversified service methods, and emphasizing early and whole-range rehabilitation treatment have important clinical value and social significance for stroke rehabilitation.