Hellenic Journal of Cardiology最新文献

Aims: The increasing prevalence of cardiovascular diseases has led to the widespread use of cardiovascular drugs that can adversely impact glucose metabolism. This review focuses on the latest evidence on the potential of cardiovascular drugs to induce adverse glycemic effects but also the underlying mechanisms, prevention, and management strategies.

Materials and methods: A comprehensive literature search was conducted across scientific databases until May 25th, 2024.

Results: Certain cardiovascular drugs can induce hyperglycemia through multiple mechanisms, including altered the secretion and sensitivity of insulin through direct cytotoxic effects toward pancreatic beta cells and increased glucose secretion. Notably, diuretics, beta-blockers, calcium channel blockers, and statins have been associated with significant glycemic disturbances. The risk of hyperglycemia varies based on individual factors, drug dosages, and concurrent medications. These drug-induced hyperglycemic effects may sometimes reverse upon discontinuation of related medication. Effective management should include lifestyle modifications, the use of glucose-lowering medications, and opting for lower-risk cardiovascular drugs. Monitoring for hyperglycemia involves educating affected individuals and conducting regular blood glucose tests. Identifying at-risk individuals and implementing preventive measures are crucial for improving both cardiovascular and metabolic outcomes.

Conclusions: Certain cardiovascular drugs significantly contribute to hyperglycemia and diabetes mellitus through various mechanisms. Effective management includes identifying at-risk individuals, choosing lower-risk medications, and implementing monitoring and preventive strategies. Further research is needed to fully understand these mechanisms and develop targeted interventions to prevent and manage cardiovascular drug-induced hyperglycemia, thereby improving clinical outcomes.

Background: Venoarterial extracorporeal membrane oxygenation (VA ECMO) has emerged as an effective rescue therapy in patients with cardiogenic shock refractory to standard treatment protocols, and its use has been rising worldwide in the last decade. Although experience and availability are growing, outcomes remain poor. There is need for evidence to improve clinical practice and outcomes.

Methods: We retrospectively reviewed the medical records of all patients who were supported with VA ECMO for cardiogenic shock at our institution between January 2015 and January 2023. The study purpose was to compare outcomes between patients who were supported with central versus peripheral configuration.

Results: ECMO was applied in 108 patients, 48 (44%) of whom received central configuration and 60 (56%) peripheral. Patients supported with central VA ECMO were more likely to be supported for post-cardiotomy shock (odds ratio [OR] 4.6 [95% confidence interval (CI) 2.03-10.41]), while patients in the peripheral group were predominantly treated for chronic heart failure decompensation (OR 9.4 [95% CI 1.16-76.3]). Central VA ECMO had lower survival rates during ECMO support (29.2% versus 51.7%, p = 0.018) and at discharge (8% versus 37%, p = 0.001). These patients were at high risk of complications, such as acute kidney injury (AKI) (OR 2.37 [95% CI 1.06-5.3], p = 0.034) and major bleeding (OR 3.08 [95% CI 1.36-6.94], p < 0.001).

Conclusions: Patients on central VA ECMO were supported mainly for post-cardiotomy shock, presented with more complications such as major bleeding and AKI, and had worse survival to hospital discharge compared with patients on peripheral VA ECMO. Patient selection, timing of implementation, cannulation strategy, and configuration remain the main determinants of clinical outcome.

Out-of-hospital cardiac arrest (OHCA) is a global public health problem. Lay bystanders witness almost half of OHCA, so early recognition is critical to allow immediate initiation of cardiopulmonary resuscitation (CPR) by the bystander. The present investigation aims to analyze the most recent scientific evidence of the effect of bystander CPR on survival after an OHCA. A systematic literature review was carried out at the "Web of Science," "Scopus," and "PubMed" databases, including publications from the last 20 years. After inclusion/exclusion criteria, 37 articles were identified. Results indicate that patients who receive CPR are more likely to survive than those who don't, and CPR is associated with a good quality of life post-OHCA. Emphasis should be placed on practicing chest compressions only when the bystander has not mastered the artificial ventilation technique. Finding an AED is the first step to using it in an OHCA situation. Correct use of an AED by laypeople is associated with nearly double the survival rate after an OHCA when compared to standard CPR. It is important to promote CPR and AED training to non-professionals, such as community residents and youth, as training is associated with higher success rates of effective CPR-AED. A mobile phone positioning system to recruit trained laypeople or text message alerts to send citizen volunteers as well as assistance through a mobile app appear to have significant advantages in practicing effective CPR. The benefits of bystander CPR outweigh the risk of injury to victims, highlighting the need to disseminate training to laypeople.

Background: The precise triggers for atherosclerotic plaque rupture and the underlying pathophysiology of coronary thrombogenesis remain elusive. Polymorphonuclear neutrophils, particularly their formation of neutrophil extracellular traps (NETs), have garnered attention in the context of coronary atherothrombosis. This study sought to explore the association of NETs burden with clinical and angiographic characteristics in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) and thrombus aspiration (TA).

Methods: For this study, 336 consecutive STEMI patients undergoing pPCI were considered for TA. Aspirated thrombi underwent histological analysis and NETs quantification via immunohistochemistry. Potential associations of clinical variables and angiographic outcomes with NETs burden were assessed.

Results: Manual TA was selectively performed in 72 cases with increased thrombotic burden, and 60 thrombi were suitable for analysis and included in the current study. Most thrombi specimens displayed lytic features (63%), and almost three out of four were identified as white thrombi. Increased NETs burden was significantly associated with prolonged pain-to-balloon time (>300 min), OR = 10.29 (95% CI 2.11-42.22, p = 0.001), and stress-induced hyperglycemia OR = 6.58 (95% CI 1.23-52.63, p < 0.01) after multivariate regression analysis. Additionally, distal embolization, and left ventricular ejection fraction ≤40% were more frequent among patients with an elevated NETs burden OR = 16.9 (95% CI 4.23-44.52, p < 0.01) and OR = 3.2 (95% CI 1.05-12.1, p = 0.05), respectively.

Conclusion: Elevated NETs burden in STEMI thrombi may be due to delayed reperfusion and stress-induced hyperglycemia, and it is associated with an increased risk of distal embolization and lower left ventricular ejection fraction. Further research is needed to elucidate the role of NETs as a potential therapeutic target in acute atherothrombosis.