Pub Date : 2022-01-24DOI: 10.21203/rs.3.rs-1223161/v1
H. Moriya, Y. Mochida, Kunihiro Ishioka, Machiko Oka, K. Maesato, M. Yamano, Hiroyuki Suzuki, T. Ohtake, S. Hidaka, Shuzo Kobayashi
Background It remains unclear whether contrast-induced nephropathy (CIN) has a prognostic impact on subsequent renal dysfunction and whether deteriorating renal function is a risk factor for CIN. This study aimed to evaluate the occurrence of CIN in patients with pre-existing renal dysfunction and investigate the long-term effects of worsening renal function after coronary angiography or contrast-enhanced computed tomography (CT). The prognostic factors of worsening renal dysfunction were also analyzed. Methods This was a prospective cohort study of patients at risk for CIN, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on coronary angiography or eGFR <45 mL/min/1.73 m2 on contrast-enhanced CT. Serum creatinine levels and the 2-year prognosis were evaluated. CIN was defined as an increase in serum creatinine level by more than 0.5 mg/dL or a 25% increase from the previous value within 72 hours after contrast administration. The primary endpoint was the proportion of patients who had serum Cr doubling or induction of dialysis within 2 years according to CIN occurrence. Results Of the 410 patients, 19 patients developed CIN (8/142 patients on coronary angiography and 11/268 patients on contrast-enhanced CT), and 38 patients had worsened renal function (21/142 patients on coronary angiography and 17/268 patients on contrast-enhanced CT). CIN was not associated with worsening renal function at 2 years. Analysis by renal function at the time of coronary angiography or contrast-enhanced CT (i.e., eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) found no between-group difference in the occurrence of CIN. Conclusions CIN is not a prognostic risk factor for the long-term of chronic kidney disease after coronary angiography or contrast-enhanced CT. Pre-existing renal dysfunction is also not a risk factor for CIN, even if the eGFR is <30 ml/min/1.73 m2.
{"title":"Impact of Contrast-Induced Nephropathy on Long-Term Renal Function after Coronary Angiography and Contrast-Enhanced Computed Tomography.","authors":"H. Moriya, Y. Mochida, Kunihiro Ishioka, Machiko Oka, K. Maesato, M. Yamano, Hiroyuki Suzuki, T. Ohtake, S. Hidaka, Shuzo Kobayashi","doi":"10.21203/rs.3.rs-1223161/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-1223161/v1","url":null,"abstract":"Background\u0000It remains unclear whether contrast-induced nephropathy (CIN) has a prognostic impact on subsequent renal dysfunction and whether deteriorating renal function is a risk factor for CIN. This study aimed to evaluate the occurrence of CIN in patients with pre-existing renal dysfunction and investigate the long-term effects of worsening renal function after coronary angiography or contrast-enhanced computed tomography (CT). The prognostic factors of worsening renal dysfunction were also analyzed.\u0000\u0000\u0000Methods\u0000This was a prospective cohort study of patients at risk for CIN, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on coronary angiography or eGFR <45 mL/min/1.73 m2 on contrast-enhanced CT. Serum creatinine levels and the 2-year prognosis were evaluated. CIN was defined as an increase in serum creatinine level by more than 0.5 mg/dL or a 25% increase from the previous value within 72 hours after contrast administration. The primary endpoint was the proportion of patients who had serum Cr doubling or induction of dialysis within 2 years according to CIN occurrence.\u0000\u0000\u0000Results\u0000Of the 410 patients, 19 patients developed CIN (8/142 patients on coronary angiography and 11/268 patients on contrast-enhanced CT), and 38 patients had worsened renal function (21/142 patients on coronary angiography and 17/268 patients on contrast-enhanced CT). CIN was not associated with worsening renal function at 2 years. Analysis by renal function at the time of coronary angiography or contrast-enhanced CT (i.e., eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) found no between-group difference in the occurrence of CIN.\u0000\u0000\u0000Conclusions\u0000CIN is not a prognostic risk factor for the long-term of chronic kidney disease after coronary angiography or contrast-enhanced CT. Pre-existing renal dysfunction is also not a risk factor for CIN, even if the eGFR is <30 ml/min/1.73 m2.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 5 1","pages":"473-479"},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45289816","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}
Arif A Khan, I. Roussin, A. Wayne, George Leventogiannis, C. Barr, M. Banks, J. Martins, Nikolaos Tsanaxidis
We report the case of a 52 year old Jamaican lady who presented with contained rupture of the aorta. The patient initially presented one year prior to admission with fatigue and weight loss. At the time, her inflammatory markers were non-specifically raised: IgG: 16.6 g/L (normal 5.316.5) and IgA: 4.21 g/L (normal 0.8-4.00), CRP 45 mg/l (normal 0-10), ESR 24mm/hr (normal (1-12), globulins 41 (19-35) but her full blood count and liver function test were normal. Both rheumatoid factor and ANA were negative. A CT scan was performed to investigate the weight loss and revealed a lung nodule but no other abnormalities. On review one year later, her ESR was raised to >100mm/hr and globulins to 48g/L. A follow up chest radiograph (Figure 1A) and CT scan to look for interval change in the lung nodule revealed a 6 cm aneurysm of the ascending aorta together with a large type A aortic dissection (Figure 1B-C). The patient was transferred to our hospital for urgent surgery. On admission, the patient described experiencing an acute back pain 3 weeks earlier which was initially treated as musculoskeletal. Pre-operative transthoracic echo (Figure 1D-F) showed contained rupture of the ascending aorta from the sinus of Valsalva to the proximal arch: 9.0 x 4.3 cm, neck 2.1 cm, no flap and no aortic regurgitation. The ruptured aorta was contained by a 2.6 cm thick mural haematoma (Figure 1F). MRI confirmed these initial findings (Figure 1G-I). Intra-operative findings (Figure 1J-L) confirmed the ruptured aorta with aortic aneurysm originating from the sinotubular junction to the proximal arch, with the unusual finding of a transverse rupture of the aortic wall adjacent to an aortic ulcer. The contained rupture was filled with layers of haematoma. A 36mm Dacron graft was fitted with an uneventful postoperative course. Histology of aorta revealed a lymphoplasmocytic aortitis with destruction of the media (Figure 1M-N). Immunostaining showed 15%. of the lymphocytes positive for IgG4 (Figure 1N). No giant cells were seen and the presence of intimal thrombus was confirmed. Follow-up revealed a persistent increase in inflammatory markers: CRP 40.7 mg/ml, globulin 48 g/L, ESR >100 mm/hr. The patient was referred to her rheumatologist for initiation of glucocorticoid treatment to control the inflammatory syndrome associated with her IgG4positive lymphoplasmocytic aortitis in order to prevent recurrent vascular disease.
{"title":"Contained Rupture of the Aorta: IgG4 Related Aortitis","authors":"Arif A Khan, I. Roussin, A. Wayne, George Leventogiannis, C. Barr, M. Banks, J. Martins, Nikolaos Tsanaxidis","doi":"10.26502/fccm.92920289","DOIUrl":"https://doi.org/10.26502/fccm.92920289","url":null,"abstract":"We report the case of a 52 year old Jamaican lady who presented with contained rupture of the aorta. The patient initially presented one year prior to admission with fatigue and weight loss. At the time, her inflammatory markers were non-specifically raised: IgG: 16.6 g/L (normal 5.316.5) and IgA: 4.21 g/L (normal 0.8-4.00), CRP 45 mg/l (normal 0-10), ESR 24mm/hr (normal (1-12), globulins 41 (19-35) but her full blood count and liver function test were normal. Both rheumatoid factor and ANA were negative. A CT scan was performed to investigate the weight loss and revealed a lung nodule but no other abnormalities. On review one year later, her ESR was raised to >100mm/hr and globulins to 48g/L. A follow up chest radiograph (Figure 1A) and CT scan to look for interval change in the lung nodule revealed a 6 cm aneurysm of the ascending aorta together with a large type A aortic dissection (Figure 1B-C). The patient was transferred to our hospital for urgent surgery. On admission, the patient described experiencing an acute back pain 3 weeks earlier which was initially treated as musculoskeletal. Pre-operative transthoracic echo (Figure 1D-F) showed contained rupture of the ascending aorta from the sinus of Valsalva to the proximal arch: 9.0 x 4.3 cm, neck 2.1 cm, no flap and no aortic regurgitation. The ruptured aorta was contained by a 2.6 cm thick mural haematoma (Figure 1F). MRI confirmed these initial findings (Figure 1G-I). Intra-operative findings (Figure 1J-L) confirmed the ruptured aorta with aortic aneurysm originating from the sinotubular junction to the proximal arch, with the unusual finding of a transverse rupture of the aortic wall adjacent to an aortic ulcer. The contained rupture was filled with layers of haematoma. A 36mm Dacron graft was fitted with an uneventful postoperative course. Histology of aorta revealed a lymphoplasmocytic aortitis with destruction of the media (Figure 1M-N). Immunostaining showed 15%. of the lymphocytes positive for IgG4 (Figure 1N). No giant cells were seen and the presence of intimal thrombus was confirmed. Follow-up revealed a persistent increase in inflammatory markers: CRP 40.7 mg/ml, globulin 48 g/L, ESR >100 mm/hr. The patient was referred to her rheumatologist for initiation of glucocorticoid treatment to control the inflammatory syndrome associated with her IgG4positive lymphoplasmocytic aortitis in order to prevent recurrent vascular disease.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346386","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}
Maleeha Saleem, Steven A Hamilton, Karan H Pahuja, Mohab Hassib, Ahmed A. Elkhouly, Muhammad Haseeb-ul-Rasool, Justin Fox
Citation Comparing the Left Distal Transradial Artery Access to Traditional Access Methods For Coronary Angiography: A Single-Center Experience. Cardiology and Cardiovascular Medicine 6 (2022): Abstract Objective: The aim of this study was to compare the effectiveness and safety of left distal transradial (LdTRA) approach in patients who had prior coronary artery bypass grafting (CABG) with conventional femoral and radial access for coronary angiography. and for radial access was 13.23±1.74 minutes. The fluoroscopy dose for femoral access was 599.98±26.63 Gy/cm2, for snuffbox approach 722.71±112.94 Gy/cm2 and for radial access was 767.06±90.89 Gy/cm2. There were no complications noted in our study. We found no statistical significance difference between approaches with regards to time of access, procedure duration, fluoroscopy time, fluoroscopy dose and mean length of hospital stay. Conclusion: Due to the lack of statistical significance between outcomes of either approach, all approaches are acceptable options. Clinically, the snuffbox approach may be superior because it helps salvage the radial conduit for future coronary interventions and avoids the risk of femoral access complications. Therefore, we suggest operators strongly consider the snuffbox approach in patients with prior CABG.
{"title":"Comparing the Left Distal Transradial Artery Access to Traditional Access Methods For Coronary Angiography: A Single-Center Experience","authors":"Maleeha Saleem, Steven A Hamilton, Karan H Pahuja, Mohab Hassib, Ahmed A. Elkhouly, Muhammad Haseeb-ul-Rasool, Justin Fox","doi":"10.26502/fccm.92920268","DOIUrl":"https://doi.org/10.26502/fccm.92920268","url":null,"abstract":"Citation Comparing the Left Distal Transradial Artery Access to Traditional Access Methods For Coronary Angiography: A Single-Center Experience. Cardiology and Cardiovascular Medicine 6 (2022): Abstract Objective: The aim of this study was to compare the effectiveness and safety of left distal transradial (LdTRA) approach in patients who had prior coronary artery bypass grafting (CABG) with conventional femoral and radial access for coronary angiography. and for radial access was 13.23±1.74 minutes. The fluoroscopy dose for femoral access was 599.98±26.63 Gy/cm2, for snuffbox approach 722.71±112.94 Gy/cm2 and for radial access was 767.06±90.89 Gy/cm2. There were no complications noted in our study. We found no statistical significance difference between approaches with regards to time of access, procedure duration, fluoroscopy time, fluoroscopy dose and mean length of hospital stay. Conclusion: Due to the lack of statistical significance between outcomes of either approach, all approaches are acceptable options. Clinically, the snuffbox approach may be superior because it helps salvage the radial conduit for future coronary interventions and avoids the risk of femoral access complications. Therefore, we suggest operators strongly consider the snuffbox approach in patients with prior CABG.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346661","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}
Background: Little is known about the role of serum uric acid in cardiovascular events with no specific data on the relationship between hyperuricemia and cardiovascular morbidities in the chronic hemodialysis setting. Objectives: To determine The prevalence of hyperuricemia and the association between uric acid level and various cardiovascular morbidities in patients with ESRF whom undergoing regular hemodialysis sessions. Methods: Descriptive retrospective facility based study included all hemodialysis patients who attended the hemodialysis unit at the Academy Charity Teaching Hospital from January 2019 – December 2019 which was equivalent to 150 patients, Data collected from patient’s files using data collection sheet then entered in Microsoft-excel and analyzed statistically using SPSS. Results: the study population included 150 patients, Male to female ratio 3:2, with a mean age of 54 years ±17. (21.3%) of the study participants live in Jabra region, 57% were jobless (30% were unemployed and 27% were housewives). CKD represented 89,59% of the etiological factors of ESRF. The median time spent by patients since the start of dialysis is 36 months. The overall prevalence of hyperuricemia was 62% and The most frequently associated comorbid condition was hypertension with 99% followed by Myocardial Infarction with 12.7% of patients. 44% of participants were taking Allopurinol plus CaCo3 and 18% were CaCo3 alone. the association between the serum uric acid levels and myocardial infarction was proven to be statistically significant with p value of 0.037. On the other hand, association between hyperuricemia and stroke, heart failure was found to be statistically insignificant. Conclusion: prevalence of hyperuricemia is high in patients with ESRD whom undergoing regular hemodialysis sessions and Serum uric acid is significantly associated with myocardial infarction. Hyperuricemia should be acknowledged and monitored as a risk factor for cardiovascular disease.
{"title":"The Correlation between Hyperuricemia and Cardiovascular Morbidities among Hemodialysis Patients Attending the Academy Charity Teaching Hospital From Jan 2019 - Dec 2019","authors":"Mohammed Walid Khalil Abushunnar","doi":"10.26502/fccm.92920276","DOIUrl":"https://doi.org/10.26502/fccm.92920276","url":null,"abstract":"Background: Little is known about the role of serum uric acid in cardiovascular events with no specific data on the relationship between hyperuricemia and cardiovascular morbidities in the chronic hemodialysis setting. Objectives: To determine The prevalence of hyperuricemia and the association between uric acid level and various cardiovascular morbidities in patients with ESRF whom undergoing regular hemodialysis sessions. Methods: Descriptive retrospective facility based study included all hemodialysis patients who attended the hemodialysis unit at the Academy Charity Teaching Hospital from January 2019 – December 2019 which was equivalent to 150 patients, Data collected from patient’s files using data collection sheet then entered in Microsoft-excel and analyzed statistically using SPSS. Results: the study population included 150 patients, Male to female ratio 3:2, with a mean age of 54 years ±17. (21.3%) of the study participants live in Jabra region, 57% were jobless (30% were unemployed and 27% were housewives). CKD represented 89,59% of the etiological factors of ESRF. The median time spent by patients since the start of dialysis is 36 months. The overall prevalence of hyperuricemia was 62% and The most frequently associated comorbid condition was hypertension with 99% followed by Myocardial Infarction with 12.7% of patients. 44% of participants were taking Allopurinol plus CaCo3 and 18% were CaCo3 alone. the association between the serum uric acid levels and myocardial infarction was proven to be statistically significant with p value of 0.037. On the other hand, association between hyperuricemia and stroke, heart failure was found to be statistically insignificant. Conclusion: prevalence of hyperuricemia is high in patients with ESRD whom undergoing regular hemodialysis sessions and Serum uric acid is significantly associated with myocardial infarction. Hyperuricemia should be acknowledged and monitored as a risk factor for cardiovascular disease.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346795","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}
Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H. Rogers
Citation : Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H Rogers. Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature. Cardiology and Cardiovascular Medicine 6 (2022): 42-50.
引用本文:Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H Rogers。外伤性室间隔缺损经导管闭合术2例及文献复习。心内科与心血管医学6(2022):42-50。
{"title":"Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature","authors":"Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H. Rogers","doi":"10.26502/fccm.92920243","DOIUrl":"https://doi.org/10.26502/fccm.92920243","url":null,"abstract":"Citation : Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H Rogers. Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature. Cardiology and Cardiovascular Medicine 6 (2022): 42-50.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346145","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}
Taamallah K, Arous Y, Haggui A, Hajlaoui N, F. W., M. F
{"title":"Does Emotion before a Chemotherapy Course Break a Heart? Cardiogenic Shock Complicating Takotsubo Cardiomyopathy","authors":"Taamallah K, Arous Y, Haggui A, Hajlaoui N, F. W., M. F","doi":"10.26502/fccm.92920283","DOIUrl":"https://doi.org/10.26502/fccm.92920283","url":null,"abstract":"","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346377","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}
Samiullah Arshad, Tayyaba Haq, Dane Stephens, Gaurang N Vaidya
Beneficial effects of Angiotensin Receptor Neprilysin Inhibitors (ARNIs) in heart failure patients are increasingly being recognized. Current literature on ARNIs among LVAD patients is based on small retrospective studies; however, these reports suggest their acceptable tolerability, effective blood pressure control and improvement in NT-proBNP levels. As we continue to better understand their cardio-protective effects including potential of myocardial recovery their use in patients with LVADs is bound to increase. Side effects that may limit their tolerability include acute kidney injury, hypotension, hyperkalemia and angioedema. Clinical trials are ongoing to assess their safety and tolerability in LVAD patients.
{"title":"Sacubitril-Valsartan in LVAD Patients: Potentials for the Future?","authors":"Samiullah Arshad, Tayyaba Haq, Dane Stephens, Gaurang N Vaidya","doi":"10.26502/fccm.92920275","DOIUrl":"https://doi.org/10.26502/fccm.92920275","url":null,"abstract":"Beneficial effects of Angiotensin Receptor Neprilysin Inhibitors (ARNIs) in heart failure patients are increasingly being recognized. Current literature on ARNIs among LVAD patients is based on small retrospective studies; however, these reports suggest their acceptable tolerability, effective blood pressure control and improvement in NT-proBNP levels. As we continue to better understand their cardio-protective effects including potential of myocardial recovery their use in patients with LVADs is bound to increase. Side effects that may limit their tolerability include acute kidney injury, hypotension, hyperkalemia and angioedema. Clinical trials are ongoing to assess their safety and tolerability in LVAD patients.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346787","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}
Response to Glucose Deficiency with Sodium-Glucose Cotransporter 2 Inhibitors makes a Positive Impact on Heart and Kidney. Cardiology and Medicine 6 16-23. Abstract Animal hibernation is a kind of starvation with some fat reserve. During early stage of starvation, gluconeogenesis, fatty acid oxidation and ketogenesis started in the liver which is a comparable condition in patients who are being treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i). SGLT2i might exert a cardioprotective effect by change in cardiac excitation-contraction coupling as seen in hibernating animals, which prevents calcium overload and energy waste in myocardium. Modestly elevated circulating levels of the ketone β-hydroxybutyrate (βOHB) during treatment with SGLT2i causes different beneficial effects on organs and cells, depending on the succinyl-CoA:3-ketoacid CoA transferase (SCOT) level. In the failing heart, SCOT is highly expressed/up-regulated and thus βOHB may be an energy source apart from fat and glucose oxidation in myocardial mitochondria. On the other hand, SCOT is not highly expressed/down-regulated in the kidney and thus βOHB may translocate into nucleus and cause beneficial effects such as inhibition of inflammation, oxidative stress and fibrosis as an endogenous and specific inhibitor of class I histone deacetylases (HDACs) and the NLRP3 inflammasome. SGLT2i exert a direct renoprotective effect with restoration of tubulo-glomerular feedback and improving renal proximal tubule oxygenation. Other than that, various beneficial effects of SGLT2i might be caused by well-orchestrated pattern of systemic metabolic change against glucose starvation induced by SGLT2i.
{"title":"Response to Glucose Deficiency with Sodium-Glucose Cotransporter 2 Inhibitors makes a Positive Impact on Heart and Kidney","authors":"Y. Hattori","doi":"10.26502/fccm.92920241","DOIUrl":"https://doi.org/10.26502/fccm.92920241","url":null,"abstract":"Response to Glucose Deficiency with Sodium-Glucose Cotransporter 2 Inhibitors makes a Positive Impact on Heart and Kidney. Cardiology and Medicine 6 16-23. Abstract Animal hibernation is a kind of starvation with some fat reserve. During early stage of starvation, gluconeogenesis, fatty acid oxidation and ketogenesis started in the liver which is a comparable condition in patients who are being treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i). SGLT2i might exert a cardioprotective effect by change in cardiac excitation-contraction coupling as seen in hibernating animals, which prevents calcium overload and energy waste in myocardium. Modestly elevated circulating levels of the ketone β-hydroxybutyrate (βOHB) during treatment with SGLT2i causes different beneficial effects on organs and cells, depending on the succinyl-CoA:3-ketoacid CoA transferase (SCOT) level. In the failing heart, SCOT is highly expressed/up-regulated and thus βOHB may be an energy source apart from fat and glucose oxidation in myocardial mitochondria. On the other hand, SCOT is not highly expressed/down-regulated in the kidney and thus βOHB may translocate into nucleus and cause beneficial effects such as inhibition of inflammation, oxidative stress and fibrosis as an endogenous and specific inhibitor of class I histone deacetylases (HDACs) and the NLRP3 inflammasome. SGLT2i exert a direct renoprotective effect with restoration of tubulo-glomerular feedback and improving renal proximal tubule oxygenation. Other than that, various beneficial effects of SGLT2i might be caused by well-orchestrated pattern of systemic metabolic change against glucose starvation induced by SGLT2i.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346135","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}
A. Walter, M. Schneider, Bettina Faridi, A. Geipel, U. Gembruch
Prenatal detection of membranous ventricular septal aneurysm requires clinical, morphological and functional evaluation, as the spectrum of a congenital ventricular out-pouching is vast and complex. Early pediatric cardiological presentation is needed, since clinical course during first year is variable.
{"title":"Prenatal Diagnosis of Membranous Ventricular Septal Aneurysm Bulging from the Left Ventricle towards Right Atrium in a Fetus with a Tricuspid Atresia– Characteristics and Differential Diagnosis of Membranous Ventricular Septal Aneurysms","authors":"A. Walter, M. Schneider, Bettina Faridi, A. Geipel, U. Gembruch","doi":"10.26502/fccm.92920281","DOIUrl":"https://doi.org/10.26502/fccm.92920281","url":null,"abstract":"Prenatal detection of membranous ventricular septal aneurysm requires clinical, morphological and functional evaluation, as the spectrum of a congenital ventricular out-pouching is vast and complex. Early pediatric cardiological presentation is needed, since clinical course during first year is variable.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346342","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 : 2022-01-01Epub Date: 2022-08-25DOI: 10.26502/fccm.92920278
Katherine M Marsh, Radhika Rastogi, Aimee Zhang, Di Wu, Irving L Kron, Zequan Yang
Background: We hypothesized that hydroxychloroquine (HCQ) attenuates myocardial ischemia/reperfusion injury (IRI) via TLR9 - type I interferon (IFN-I) pathway inhibition.
Methods: The left coronary artery of wild-type (WT) C57BL/6 and congenic TLR9-/- mice was occluded for 40 minutes, with or without 60 minutes of reperfusion (40'/0' or 40'/60'). Either ODN-2088 or HCQ (TLR9 inhibitors), or ODN-1826 (TLR9 agonist) was administered to determine effect on infarct size (IS). After 40'/0', cardiac perfusate (CP) was collected from harvested hearts and administered to either intact WT mice after 20 minutes of ischemia or isolated splenocytes. Type-I interferon (IFNα and IFNβ) levels were measured in plasma and splenocyte culture supernatant, and levels of damage associated molecular patterns HMGB1 and cell-free DNA (cfDNA) were measured in CP.
Results: After 40'/60', WT mice treated with HCQ or ODN-2088 had significantly reduced IS. TLR9-/- mice and HCQ-treated WT mice undergoing 40'/0' and 40'/60' similarly attenuated IS, with significantly lower IFN-Is in CP after 40'/0' and in plasma after 40'/60'. IS was significantly increased in 40'/0' CP-treated and ODN-1826-treated 20'/60' WT mice. CP-treated WT splenocytes produced significantly higher IFN-I in culture supernatant, which was significantly reduced with HCQ.
Conclusions: The TLR9-IFN-I-mediated inflammatory response contributes significantly to both ischemic and post-ischemic myocardial ischemia-reperfusion injury. HMGB1 and cfDNA released from ischemic myocardium activated the intra-myocardial TLR9 - IFN-I inflammatory pathway during ischemia and the extra-myocardial TLR9 - IFN-I inflammatory pathway during reperfusion. Hydroxychloroquine reduces production of IFN-I and attenuates myocardial IRI, likely by inhibiting the TLR9-IFN-I pathway.
{"title":"Hydroxychloroquine Attenuates Myocardial Ischemic and Post-Ischemic Reperfusion Injury by Inhibiting the Toll-Like Receptor 9 - Type I Interferon Pathway.","authors":"Katherine M Marsh, Radhika Rastogi, Aimee Zhang, Di Wu, Irving L Kron, Zequan Yang","doi":"10.26502/fccm.92920278","DOIUrl":"https://doi.org/10.26502/fccm.92920278","url":null,"abstract":"<p><strong>Background: </strong>We hypothesized that hydroxychloroquine (HCQ) attenuates myocardial ischemia/reperfusion injury (IRI) via TLR9 - type I interferon (IFN-I) pathway inhibition.</p><p><strong>Methods: </strong>The left coronary artery of wild-type (WT) C57BL/6 and congenic TLR9<sup>-/-</sup> mice was occluded for 40 minutes, with or without 60 minutes of reperfusion (40'/0' or 40'/60'). Either ODN-2088 or HCQ (TLR9 inhibitors), or ODN-1826 (TLR9 agonist) was administered to determine effect on infarct size (IS). After 40'/0', cardiac perfusate (CP) was collected from harvested hearts and administered to either intact WT mice after 20 minutes of ischemia or isolated splenocytes. Type-I interferon (IFNα and IFNβ) levels were measured in plasma and splenocyte culture supernatant, and levels of damage associated molecular patterns HMGB1 and cell-free DNA (cfDNA) were measured in CP.</p><p><strong>Results: </strong>After 40'/60', WT mice treated with HCQ or ODN-2088 had significantly reduced IS. TLR9<sup>-/-</sup> mice and HCQ-treated WT mice undergoing 40'/0' and 40'/60' similarly attenuated IS, with significantly lower IFN-Is in CP after 40'/0' and in plasma after 40'/60'. IS was significantly increased in 40'/0' CP-treated and ODN-1826-treated 20'/60' WT mice. CP-treated WT splenocytes produced significantly higher IFN-I in culture supernatant, which was significantly reduced with HCQ.</p><p><strong>Conclusions: </strong>The TLR9-IFN-I-mediated inflammatory response contributes significantly to both ischemic and post-ischemic myocardial ischemia-reperfusion injury. HMGB1 and cfDNA released from ischemic myocardium activated the intra-myocardial TLR9 - IFN-I inflammatory pathway during ischemia and the extra-myocardial TLR9 - IFN-I inflammatory pathway during reperfusion. Hydroxychloroquine reduces production of IFN-I and attenuates myocardial IRI, likely by inhibiting the TLR9-IFN-I pathway.</p>","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":" ","pages":"416-423"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9450995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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