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}
A. Marziou, Clothilde Philouze, J. Landrier, C. Riva, P. Obert
Effect of a Dual Intervention with Vitamin D Supplementation and Voluntary Physical Exercise on Cardiac Remodeling and Function in a Mouse Model of Diet-Induced Type 2 Diabetes. Cardiology and Cardiovascular Medicine 6 229-236. Abstract Background and Aims: We have previously demonstrated the cardiac beneficial effects of vitamin D (VD) supplementation. The aim of this study was to evaluate the combined effects of voluntary Physical Exercise (PE) and VD on cardiac remodeling and function in tertiary prevention in a mice model of diet-induced diabetes. Methods and Results: Mice were fed with a high fat and sucrose diet for 10 weeks. Then, they were divided into 4 subgroups for the 15 following weeks: diet, diet/vitamin D, diet/PE and diet/VD/PE. Glucose homeostasis assessment and echocardiography were performed one week before the end of the protocol. Blood samples and hearts were collected at sacrifice. After 25 weeks of diet alone, obese mice displayed diabetes, cardiac concentric hypertrophy combination improved glucose homeostasis and was associated with physiological cardiac remodeling, with however no additional beneficial effect over PE or VD alone on cardiac function. Conclusion: The major finding of the present study is that VD supplementation and PE exert similar cardioprotective effects in diabetic mice, with no major synergistic effect from their combination. Abstract The present study is the first to investigate the combined effects of voluntary PE and VD supplementation on cardiac remodeling and function in tertiary prevention in a rodent model of diet-induced T2D. Numerous studies demonstrated beneficial effects of voluntary PE or exercise training on cardiac function in pharmacological [17] or diet-induced [14] rodent models of diabetes, agreeing with our results. Data regarding the effects of VD are scarce [11]. The salient finding from our study is that VD supplementation exerts similar favorable effects to PE on both regional and global cardiac function while their combination did not yield to additional benefits. Since VD and PE were each other already able to normalize cardiac function, synergic effects were unlikely to be expected. Of note, PE or VD individually prevented the development of HFS-induced pathological cardiac remodeling, in accordance with previous studies [9, 17]. Interestingly, their combination yielded to cardiac hypertrophy, similar in magnitude to that one seen in HFS mice, although physiological. The underlying mechanisms associated with improvements in cardiac remodeling and function consecutive to PE or VD imply very likely favorable changes at both systemic and cardiac levels in signaling pathways related to inflammation and oxidative stress [18] leading to enhancement in cardiac metabolism, calcium handling, apoptosis and fibrosis [19, 20]. Aside, we also demonstrated cardioprotective effects of VD through modulation of cardiac lipotoxicity [11]. Further investigations will be needed to properly charac
{"title":"Effect of a Dual Intervention with Vitamin D Supplementation and Voluntary Physical Exercise on Cardiac Remodeling and Function in a Mouse Model of Diet-Induced Type 2 Diabetes","authors":"A. Marziou, Clothilde Philouze, J. Landrier, C. Riva, P. Obert","doi":"10.26502/fccm.92920258","DOIUrl":"https://doi.org/10.26502/fccm.92920258","url":null,"abstract":"Effect of a Dual Intervention with Vitamin D Supplementation and Voluntary Physical Exercise on Cardiac Remodeling and Function in a Mouse Model of Diet-Induced Type 2 Diabetes. Cardiology and Cardiovascular Medicine 6 229-236. Abstract Background and Aims: We have previously demonstrated the cardiac beneficial effects of vitamin D (VD) supplementation. The aim of this study was to evaluate the combined effects of voluntary Physical Exercise (PE) and VD on cardiac remodeling and function in tertiary prevention in a mice model of diet-induced diabetes. Methods and Results: Mice were fed with a high fat and sucrose diet for 10 weeks. Then, they were divided into 4 subgroups for the 15 following weeks: diet, diet/vitamin D, diet/PE and diet/VD/PE. Glucose homeostasis assessment and echocardiography were performed one week before the end of the protocol. Blood samples and hearts were collected at sacrifice. After 25 weeks of diet alone, obese mice displayed diabetes, cardiac concentric hypertrophy combination improved glucose homeostasis and was associated with physiological cardiac remodeling, with however no additional beneficial effect over PE or VD alone on cardiac function. Conclusion: The major finding of the present study is that VD supplementation and PE exert similar cardioprotective effects in diabetic mice, with no major synergistic effect from their combination. Abstract The present study is the first to investigate the combined effects of voluntary PE and VD supplementation on cardiac remodeling and function in tertiary prevention in a rodent model of diet-induced T2D. Numerous studies demonstrated beneficial effects of voluntary PE or exercise training on cardiac function in pharmacological [17] or diet-induced [14] rodent models of diabetes, agreeing with our results. Data regarding the effects of VD are scarce [11]. The salient finding from our study is that VD supplementation exerts similar favorable effects to PE on both regional and global cardiac function while their combination did not yield to additional benefits. Since VD and PE were each other already able to normalize cardiac function, synergic effects were unlikely to be expected. Of note, PE or VD individually prevented the development of HFS-induced pathological cardiac remodeling, in accordance with previous studies [9, 17]. Interestingly, their combination yielded to cardiac hypertrophy, similar in magnitude to that one seen in HFS mice, although physiological. The underlying mechanisms associated with improvements in cardiac remodeling and function consecutive to PE or VD imply very likely favorable changes at both systemic and cardiac levels in signaling pathways related to inflammation and oxidative stress [18] leading to enhancement in cardiac metabolism, calcium handling, apoptosis and fibrosis [19, 20]. Aside, we also demonstrated cardioprotective effects of VD through modulation of cardiac lipotoxicity [11]. Further investigations will be needed to properly charac","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":"69346536","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}
Barry Misbaou, CHABRY-HUN Yuthiline, M. Gun, Harmouche Majid, Caus Thierry
Emergency Surgical Conversion Following Device Embolization During Transcatheter Aortic Valve Implantation: A Case Report. Abstract Surgical conversion following embolization of a TAVI device is very rare. We report the case of a 78-year-old woman who underwent a TAVI procedure. This procedure failed due to migration of the prosthesis, which is embedded at the foot of the TABC in the ascending aorta. This patient had an emergency surgical conversion. We want to draw attention to the fact that the management of the TAVI patient by the surgical team in case of conversion should be rapid and the surgical intervention should be short. activation (P wave) to onset of ventricular myocardial activation; mmHg: millimeter of mercury ; B2: the second heart sound; LVH: Left Ventricular Hypertrophy; Segment ST: the ST-segment; V1, V2, V5, V6: the electrodes; Onde T: Twave; Ao : Aorta; Vmax: maximum velocity; IP: Permeability index; LVEF: Left Ventricular Ejection Fraction; MR: Mitral Regurgitation; mm: millimeter; TABC: Brachiocephalic Artery Trunk; ECC: Extracorporel Circulation; mn: minute
{"title":"Emergency Surgical Conversion Following Device Embolization During Transcatheter Aortic Valve Implantation: A Case Report","authors":"Barry Misbaou, CHABRY-HUN Yuthiline, M. Gun, Harmouche Majid, Caus Thierry","doi":"10.26502/fccm.92920266","DOIUrl":"https://doi.org/10.26502/fccm.92920266","url":null,"abstract":"Emergency Surgical Conversion Following Device Embolization During Transcatheter Aortic Valve Implantation: A Case Report. Abstract Surgical conversion following embolization of a TAVI device is very rare. We report the case of a 78-year-old woman who underwent a TAVI procedure. This procedure failed due to migration of the prosthesis, which is embedded at the foot of the TABC in the ascending aorta. This patient had an emergency surgical conversion. We want to draw attention to the fact that the management of the TAVI patient by the surgical team in case of conversion should be rapid and the surgical intervention should be short. activation (P wave) to onset of ventricular myocardial activation; mmHg: millimeter of mercury ; B2: the second heart sound; LVH: Left Ventricular Hypertrophy; Segment ST: the ST-segment; V1, V2, V5, V6: the electrodes; Onde T: Twave; Ao : Aorta; Vmax: maximum velocity; IP: Permeability index; LVEF: Left Ventricular Ejection Fraction; MR: Mitral Regurgitation; mm: millimeter; TABC: Brachiocephalic Artery Trunk; ECC: Extracorporel Circulation; mn: minute","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":"69346652","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}
Angina pectoris, a constricting pain resulting from inadequate oxygen supply to the heart, typically develops as a consequence of physical exertion or emotional stress in the presence of coronary artery disease (CAD). However, there is also evidence that physical activity is effective in the prevention of CAD and may also prevent angina in the long term. Guideline-based strategies for chronic stable angina aim to reduce symptoms and improve patient prognosis through lifestyle changes and appropriate medications and interventions. Physicians may have uncertainty and concerns around the safety of exercise regimens in patients with chronic angina, a factor complicated by the paucity of data related to this clinical condition. This narrative review discusses the importance of regular physical activity as a key component in the management of patients with stable angina, demonstrating cardioprotective effects in patients with CAD, as well as improving prognosis and physical fitness while maintaining an appropriate risk/benefit ratio. Given these benefits, current guidelines recommend 30–60 minutes of moderate-intensity aerobic activity for at least 5 days/week in patients with chronic coronary syndromes, personalized based on the ‘Frequency, Intensity, Time and Type’ (FITT) principle to derive optimal efficacy with the lowest risk; addition of resistance training 2 days/week can provide further benefits. We also highlight the importance of complementing pharmacological options with regular physical exercise in patients with stable angina, and how web-based technologies can help to overcome some of the barriers to exercise training and challenges associated with implementing cardiac rehabilitation programmes during the COVID-19 pandemic.
{"title":"Exercise in Patients with Chronic Angina Pectoris: Friend or Foe?","authors":"R. Dechend, H. Predel","doi":"10.26502/fccm.92920271","DOIUrl":"https://doi.org/10.26502/fccm.92920271","url":null,"abstract":"Angina pectoris, a constricting pain resulting from inadequate oxygen supply to the heart, typically develops as a consequence of physical exertion or emotional stress in the presence of coronary artery disease (CAD). However, there is also evidence that physical activity is effective in the prevention of CAD and may also prevent angina in the long term. Guideline-based strategies for chronic stable angina aim to reduce symptoms and improve patient prognosis through lifestyle changes and appropriate medications and interventions. Physicians may have uncertainty and concerns around the safety of exercise regimens in patients with chronic angina, a factor complicated by the paucity of data related to this clinical condition. This narrative review discusses the importance of regular physical activity as a key component in the management of patients with stable angina, demonstrating cardioprotective effects in patients with CAD, as well as improving prognosis and physical fitness while maintaining an appropriate risk/benefit ratio. Given these benefits, current guidelines recommend 30–60 minutes of moderate-intensity aerobic activity for at least 5 days/week in patients with chronic coronary syndromes, personalized based on the ‘Frequency, Intensity, Time and Type’ (FITT) principle to derive optimal efficacy with the lowest risk; addition of resistance training 2 days/week can provide further benefits. We also highlight the importance of complementing pharmacological options with regular physical exercise in patients with stable angina, and how web-based technologies can help to overcome some of the barriers to exercise training and challenges associated with implementing cardiac rehabilitation programmes during the COVID-19 pandemic.","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":"69346719","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}
Usha Yendrapalli, H. J. Chen, N. Punnanithinont, Ahmed Elawad
Failure Following Abstract Myocardial injury following vaccination, particularly coronavirus disease 2019 (COVID-19), smallpox, influenza, hepatitis B has been documented as a rare side effect. In this report, we present a case of congestive heart failure that developed in a healthy male following the BNT162b2 mRNA-Pfizer-BioNTech vaccine. A 47-year-old male developed shortness of breath 5 days after receiving the second dose of Pfizer vaccine presented multiple times to urgent care, primary care physician office, and emergency room and had been misdiagnosed with bronchitis and allergies. Eventually after several weeks he was admitted due to worsening dyspnea and got echocardiography which showed an EF of 15% and cardiac catheterization did not reveal significant obstruction of coronary arteries. He was successfully diuresed and was discharged home symptom-free. We aim to increase awareness of this rare side effect of the COVID mRNA vaccination so that it can be recognized early and treated promptly to avoid complications.
{"title":"Congestive Heart Failure Following COVID-19 Vaccination","authors":"Usha Yendrapalli, H. J. Chen, N. Punnanithinont, Ahmed Elawad","doi":"10.26502/fccm.92920240","DOIUrl":"https://doi.org/10.26502/fccm.92920240","url":null,"abstract":"Failure Following Abstract Myocardial injury following vaccination, particularly coronavirus disease 2019 (COVID-19), smallpox, influenza, hepatitis B has been documented as a rare side effect. In this report, we present a case of congestive heart failure that developed in a healthy male following the BNT162b2 mRNA-Pfizer-BioNTech vaccine. A 47-year-old male developed shortness of breath 5 days after receiving the second dose of Pfizer vaccine presented multiple times to urgent care, primary care physician office, and emergency room and had been misdiagnosed with bronchitis and allergies. Eventually after several weeks he was admitted due to worsening dyspnea and got echocardiography which showed an EF of 15% and cardiac catheterization did not reveal significant obstruction of coronary arteries. He was successfully diuresed and was discharged home symptom-free. We aim to increase awareness of this rare side effect of the COVID mRNA vaccination so that it can be recognized early and treated promptly to avoid complications.","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":"69346128","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}
Elias Noory, Tanja Böhme, Ulrich Beschorner, Börries Jacques, Karlheinz Bürgelin, Christina Zürn, Thomas Zeller
Objectives: To evaluate safety and efficacy of endoprosthesis implantation for the exclusion of popliteal artery aneurysm (PAA). Methods: Elective asymptomatic patients with aneurysm > 20 mm and symptomatic patients with endovascular therapy of PAA were included. The proportion of patients with critical limb ischemia (presence of rest pain or tissue loss) was high at 32.1%, 21.6% of the patients had acute ischemia with symptoms persisting shorter than 14 days. The primary study endpoint was the target lesion revascularization (TLR) rate at 12 months. Secondary endpoints included technical success, periinterventional adverse events, primary patency at 6, 12 and 24 months, TLR rate at 24 months, predictors on reintervention, change in in clinical symptoms using the Rutherford-Becker classification (RBC), amputation and mortality rate. One hundred thirty-four patients (68.3±10.6 years, 88.8% male) were treated with a Viabahn® endoprosthesis (W.L. Gore & Associates Inc., Flagstaff, AZ, USA). Results: The average aneurysm diameter was 2.5±0.87 cm. In 41%, occlusion of the aneurysm was present. TLR rate was 31.3% and 38.8% after 12 and 24 months, respectively. Primary patency rates were 69.1%, 52.3% and 42.6% at 6, 12 and 24 months, respectively. Univariate logistic regression analysis revealed age as a predictor of reintervention and in the multivariable analysis it was treatment with lysis. An improvement in RBC was seen at all-time points. Two major amputations (1.5%) were performed and the mortality rate at 24 months was 5.2%. Conclusion: Primary patency rate after endovascular exclusion of PAA is low. However, limb salvage rate is high.
目的:评价假体植入术治疗腘动脉动脉瘤(PAA)的安全性和有效性。方法:选择无症状的动脉瘤> 20mm患者和有症状的血管内治疗PAA患者。重度肢体缺血(存在静息痛或组织丢失)的患者比例高达32.1%,21.6%的患者为急性缺血,症状持续时间短于14天。主要研究终点是12个月时靶病变血运重建(TLR)率。次要终点包括技术成功、介入期不良事件、6个月、12个月和24个月的原发性通畅、24个月的TLR率、再干预的预测因子、使用Rutherford-Becker分类(RBC)的临床症状改变、截肢和死亡率。134例患者(68.3±10.6岁,88.8%男性)接受了Viabahn®内假体治疗(W.L. Gore & Associates Inc., Flagstaff, AZ, USA)。结果:动脉瘤平均直径为2.5±0.87 cm。41%的患者存在动脉瘤闭塞。术后12个月TLR为31.3%,24个月TLR为38.8%。6个月、12个月和24个月时,原发性通畅率分别为69.1%、52.3%和42.6%。单因素logistic回归分析显示,年龄是再干预的预测因子,多因素分析显示,年龄是再干预的预测因子。RBC在所有时间点均有所改善。2例主要截肢(1.5%),24个月死亡率为5.2%。结论:血管内排除PAA术后一期通畅率低。但残肢保留率高。
{"title":"Early Results after Exclusion of Popliteal Aneurysms with an Endoprosthesis.","authors":"Elias Noory, Tanja Böhme, Ulrich Beschorner, Börries Jacques, Karlheinz Bürgelin, Christina Zürn, Thomas Zeller","doi":"10.26502/fccm.92920298","DOIUrl":"https://doi.org/10.26502/fccm.92920298","url":null,"abstract":"Objectives: To evaluate safety and efficacy of endoprosthesis implantation for the exclusion of popliteal artery aneurysm (PAA). Methods: Elective asymptomatic patients with aneurysm > 20 mm and symptomatic patients with endovascular therapy of PAA were included. The proportion of patients with critical limb ischemia (presence of rest pain or tissue loss) was high at 32.1%, 21.6% of the patients had acute ischemia with symptoms persisting shorter than 14 days. The primary study endpoint was the target lesion revascularization (TLR) rate at 12 months. Secondary endpoints included technical success, periinterventional adverse events, primary patency at 6, 12 and 24 months, TLR rate at 24 months, predictors on reintervention, change in in clinical symptoms using the Rutherford-Becker classification (RBC), amputation and mortality rate. One hundred thirty-four patients (68.3±10.6 years, 88.8% male) were treated with a Viabahn® endoprosthesis (W.L. Gore & Associates Inc., Flagstaff, AZ, USA). Results: The average aneurysm diameter was 2.5±0.87 cm. In 41%, occlusion of the aneurysm was present. TLR rate was 31.3% and 38.8% after 12 and 24 months, respectively. Primary patency rates were 69.1%, 52.3% and 42.6% at 6, 12 and 24 months, respectively. Univariate logistic regression analysis revealed age as a predictor of reintervention and in the multivariable analysis it was treatment with lysis. An improvement in RBC was seen at all-time points. Two major amputations (1.5%) were performed and the mortality rate at 24 months was 5.2%. Conclusion: Primary patency rate after endovascular exclusion of PAA is low. However, limb salvage rate is high.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 6","pages":"550-557"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10709582","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}
Malgorzata Polacin, Tobias Hünermund, Oliver Müggler, Hatem Alkadhi, Sebastian Kozerke, Robert Manka
Aim: This study investigated a patient-specific approach of using cardiac magnetic resonance (CMR) feature tracking for scar detection in a heterogenous patient group with chronic ischemic and non-ischemic heart disease.
Methods: CMR exams of 89 patients with concomitant chronic ischemic and non-ischemic heart disease (IHD+) as well as 65 patients with ischemic scars only (IHD) were retrospectively evaluated. In all patients, global (GCS) and segmental circumferential strain (SCS) was derived from native cine images using a dedicated software (Segment CMR, Medviso). After calculation of patient-specific median GCS (GCSmedian), segmental values from GCSmedian percentage plots were correlated with corresponding myocardial segments in late gadolinium enhancement (LGE).
Results: Overall GCS ranged between -3.5% to -19.8% and average GCS was lower in IHD+ than in IHD (p <0.05). In IHD, 19% of all myocardial segments were infarcted, in IHD+ 16.6%. Additionally, non-ischemic LGE was present in 6.7% of segments in IHD+. Correlation of GCSmedian percentage plots with corresponding LGE showed that presence of ischemic scar tissue in a myocardial segment was very likely below a cut-off of 39.5% GCSmedian (87.5% sensitivity, 86.3% specificity, AUC 0.907, 95% CI 0.875-0.938, p < 0.05).
Conclusion: In patient-specific GCSmedian percentage plots calculated from native cine images, ischemic scar tissue can be suspected in myocardial segments below the threshold of 40% GCSmedian (sensitivity 88%, specificity 86%), even in a heterogenous patient cohort with ischemic and non-ischemic heart disease.
目的:本研究探讨了一种使用心脏磁共振(CMR)特征跟踪检测慢性缺血性和非缺血性心脏病异质患者组疤痕的患者特异性方法。方法:回顾性分析89例合并慢性缺血性和非缺血性心脏病(IHD+)患者和65例单纯缺血性瘢痕(IHD)患者的CMR检查结果。在所有患者中,使用专用软件(片段CMR, Medviso)从原生电影图像中获得全局(GCS)和节段周向应变(SCS)。计算患者特异性中位GCS (GCSmedian)后,GCSmedian百分比图的段值与晚期钆增强(LGE)相应的心肌段相关。结果:总体GCS范围为-3.5%至-19.8%,IHD+组的平均GCS低于IHD组(相应LGE的p中位数百分比图显示心肌段存在缺血性瘢痕组织很可能低于GCS中位数39.5%的临界值(敏感性87.5%,特异性86.3%,AUC 0.907, 95% CI 0.875-0.938, p < 0.05)。结论:在原生电影图像计算的患者特异性GCSmedian百分比图中,即使在患有缺血性和非缺血性心脏病的异质患者队列中,在低于40% GCSmedian阈值的心肌段中也可以怀疑缺血性瘢痕组织(敏感性88%,特异性86%)。
{"title":"Patient-Specific Cardiac Magnetic Resonance Feature Tracking Approach for Scar Detection in Concomitant Ischemic and Non-Ischemic Heart Disease.","authors":"Malgorzata Polacin, Tobias Hünermund, Oliver Müggler, Hatem Alkadhi, Sebastian Kozerke, Robert Manka","doi":"10.26502/fccm.92920297","DOIUrl":"https://doi.org/10.26502/fccm.92920297","url":null,"abstract":"<p><strong>Aim: </strong>This study investigated a patient-specific approach of using cardiac magnetic resonance (CMR) feature tracking for scar detection in a heterogenous patient group with chronic ischemic and non-ischemic heart disease.</p><p><strong>Methods: </strong>CMR exams of 89 patients with concomitant chronic ischemic and non-ischemic heart disease (IHD+) as well as 65 patients with ischemic scars only (IHD) were retrospectively evaluated. In all patients, global (GCS) and segmental circumferential strain (SCS) was derived from native cine images using a dedicated software (Segment CMR, Medviso). After calculation of patient-specific median GCS (GCS<sub>median</sub>), segmental values from GCS<sub>median</sub> percentage plots were correlated with corresponding myocardial segments in late gadolinium enhancement (LGE).</p><p><strong>Results: </strong>Overall GCS ranged between -3.5% to -19.8% and average GCS was lower in IHD+ than in IHD (p <0.05). In IHD, 19% of all myocardial segments were infarcted, in IHD+ 16.6%. Additionally, non-ischemic LGE was present in 6.7% of segments in IHD+. Correlation of GCS<sub>median</sub> percentage plots with corresponding LGE showed that presence of ischemic scar tissue in a myocardial segment was very likely below a cut-off of 39.5% GCS<sub>median</sub> (87.5% sensitivity, 86.3% specificity, AUC 0.907, 95% CI 0.875-0.938, p < 0.05).</p><p><strong>Conclusion: </strong>In patient-specific GCS<sub>median</sub> percentage plots calculated from native cine images, ischemic scar tissue can be suspected in myocardial segments below the threshold of 40% GCS<sub>median</sub> (sensitivity 88%, specificity 86%), even in a heterogenous patient cohort with ischemic and non-ischemic heart disease.</p>","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 6","pages":"542-549"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9937585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10788595","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}
Muneeb Qadir, Saumya Bhagat, H. Quasimi, Intzar Ali, Afreen Khan, Mairaj Ahmed Ansar, I. Alam
The novel corona virus is identified as a positive–sense single–stranded RNA virus and member of the coronavirus family. The virus is thought to have originated from Wuhan, China, and acquired the ability of human–to–human transmission. Although most patients with SARS–CoV–2 (previously known as “2019 novel coronavirus”) manifest fever and respiratory tract symptoms. SARS–CoV–2 infection may also involve other organs/systems and present with extra–respiratory manifestations including cardiac, gastrointestinal, hepatic, renal, neurological, olfactory, gustatory, ocular, cutaneous and hematological symptoms. The severe risk factors are commonly detected in elder patients and with medical comorbidities like cancer, hypertension and diabetes. Since the outbreak The involvement of different organs of the body is explained based on the presence of ACE–2 (angiotensin– converting enzyme 2) in different tissues and cells. Several extra–respiratory manifestations, such as cardiac involvement, acute kidney injury, coagulation disorders, and thrombotic complications, could be associated with a poor prognosis. This review provides a comprehensive presentation of the pathophysiological effects of SARS–CoV– 2 infection on different organs of the body such as CVS (cardiovascular system), CNS (central nervous system), GIT (gastrointestinal tract), Skin, Renal, and Blood.
{"title":"SARS COV-2 and Inflammation: Its Impact on the Cardiovascular System","authors":"Muneeb Qadir, Saumya Bhagat, H. Quasimi, Intzar Ali, Afreen Khan, Mairaj Ahmed Ansar, I. Alam","doi":"10.26502/fccm.92920252","DOIUrl":"https://doi.org/10.26502/fccm.92920252","url":null,"abstract":"The novel corona virus is identified as a positive–sense single–stranded RNA virus and member of the coronavirus family. The virus is thought to have originated from Wuhan, China, and acquired the ability of human–to–human transmission. Although most patients with SARS–CoV–2 (previously known as “2019 novel coronavirus”) manifest fever and respiratory tract symptoms. SARS–CoV–2 infection may also involve other organs/systems and present with extra–respiratory manifestations including cardiac, gastrointestinal, hepatic, renal, neurological, olfactory, gustatory, ocular, cutaneous and hematological symptoms. The severe risk factors are commonly detected in elder patients and with medical comorbidities like cancer, hypertension and diabetes. Since the outbreak The involvement of different organs of the body is explained based on the presence of ACE–2 (angiotensin– converting enzyme 2) in different tissues and cells. Several extra–respiratory manifestations, such as cardiac involvement, acute kidney injury, coagulation disorders, and thrombotic complications, could be associated with a poor prognosis. This review provides a comprehensive presentation of the pathophysiological effects of SARS–CoV– 2 infection on different organs of the body such as CVS (cardiovascular system), CNS (central nervous system), GIT (gastrointestinal tract), Skin, Renal, and Blood.","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":"69346228","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}
Nikolaos Tsanaxidis, B. Wrigley, J. Cotton, Deepu Balakrishnan
, Abstract 90-year-old woman admitted urgently in Cardiology ward at New Cross with acute heart failure symptoms on background of severe aortic stenosis. Also reported previous syncopal episodes. On admission echocardiogram performed which revealed aortic valve area of 0.48 cm 2 and mean pressure gradient of 41mmHg. Her Left Ventricular Ejection Fraction was 35%. After stabilizing her with diuresis, she underwent computed tomography TAVI workup.This revealed reasonable ilio-femoral access and estimation of valvular annular size undertaken. Trans-catheter aortic valve implantation eventually took place. Ultrasound guidance used to gain access.6Fr sheath inserted into left femoral artery (graduated pigtail for aortogram),7Fr into left femoral vein (temporary pacing wire) and 6Fr into right femoral artery (RFA) which was pre-closed with 2 Proglides and upgraded to 9Fr sheath. Immediately,the aortic valve crossed in conventional manner and a 26mm Medtronic Evolut pro was implanted [1]. Unfortunately post release the valve migrated into ascending aorta,with pendular movements in an aneurysmal aorta [2]. As the patient was haemodynamically stable we implanted a larger valve after snaring the
{"title":"Acute Antegrade TAVI Migration Successfully Treated with Snare Utilization and Near Valve-in-Valve (Viv) Implantation","authors":"Nikolaos Tsanaxidis, B. Wrigley, J. Cotton, Deepu Balakrishnan","doi":"10.26502/fccm.92920290","DOIUrl":"https://doi.org/10.26502/fccm.92920290","url":null,"abstract":", Abstract 90-year-old woman admitted urgently in Cardiology ward at New Cross with acute heart failure symptoms on background of severe aortic stenosis. Also reported previous syncopal episodes. On admission echocardiogram performed which revealed aortic valve area of 0.48 cm 2 and mean pressure gradient of 41mmHg. Her Left Ventricular Ejection Fraction was 35%. After stabilizing her with diuresis, she underwent computed tomography TAVI workup.This revealed reasonable ilio-femoral access and estimation of valvular annular size undertaken. Trans-catheter aortic valve implantation eventually took place. Ultrasound guidance used to gain access.6Fr sheath inserted into left femoral artery (graduated pigtail for aortogram),7Fr into left femoral vein (temporary pacing wire) and 6Fr into right femoral artery (RFA) which was pre-closed with 2 Proglides and upgraded to 9Fr sheath. Immediately,the aortic valve crossed in conventional manner and a 26mm Medtronic Evolut pro was implanted [1]. Unfortunately post release the valve migrated into ascending aorta,with pendular movements in an aneurysmal aorta [2]. As the patient was haemodynamically stable we implanted a larger valve after snaring the","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":"69346394","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}
Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram with Chest Pain and Treadmill Test Findings - A Potential ‘Game changer’ Observations in Management. Cardiology and Cardiovascular Medicine 6 (2022): 340-352. Abstract Aims and background The incidence of coronary artery anomaly is rare in the general population, anomalous origin of right coronary artery being the most common. These anomalies, particularly anomalous coronary arteries with an interarterial course (ACAIAC) are potentially dangerous. Due to their low incidence, meticulous clinical and imaging guidelines have not yet been defined in assessing such patients and guiding management. Methods and results CT coronary angiograms of patients who underwent the study for exclusion of coronary artery disease were reviewed. Patients with ACAIAC were recorded. The images were reviewed and reconstructed to measure the caliber and area of the narrowest interarterial segment of ACAIAC in systolic and diastolic phases using Philips Intellispace version 12.1 software. Percentage change in area (p value 0.093) and diameter (p value 0.108) of the interarterial segment in systolic and diastolic segments, was statistically significant between anomalous coronaries with high and low interarterial course. Percentage change in area and diameter between patients with positive and negative TMT findings was also statistically significant (p<0.001 in both cases). Conclusion Significant positive correlation between change in vessel caliber in the interarterial course of coronary arteries during the cardiac cycle and TMT findings, suggests elevated risk of inducible ischemia in patients with significant vessel compression. Hence the change in vessel caliber demonstrated by CT imaging can be used as a potential criterion for risk assessment and management of patients with ACAIAC. in a to the long axis of ACA. Optimal image representative of vessel cross section was selected. Images were viewed with 2-3X magnification and dimensions and area of IAS of coronary were manually at multiple by two observers blinded for clinical details and earlier Range of diastolic and narrowest systolic caliber and area of the interarterial segment of anomalous coronary artery Record of estimated average radiation dose per examination was made.
{"title":"Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram with Chest Pain and Treadmill Test Findings-A Potential ‘Game changer’ Observations in Management","authors":"V. Mahalingam, K. Gadabanahalli, V. Bhat","doi":"10.26502/fccm.92920269","DOIUrl":"https://doi.org/10.26502/fccm.92920269","url":null,"abstract":"Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram with Chest Pain and Treadmill Test Findings - A Potential ‘Game changer’ Observations in Management. Cardiology and Cardiovascular Medicine 6 (2022): 340-352. Abstract Aims and background The incidence of coronary artery anomaly is rare in the general population, anomalous origin of right coronary artery being the most common. These anomalies, particularly anomalous coronary arteries with an interarterial course (ACAIAC) are potentially dangerous. Due to their low incidence, meticulous clinical and imaging guidelines have not yet been defined in assessing such patients and guiding management. Methods and results CT coronary angiograms of patients who underwent the study for exclusion of coronary artery disease were reviewed. Patients with ACAIAC were recorded. The images were reviewed and reconstructed to measure the caliber and area of the narrowest interarterial segment of ACAIAC in systolic and diastolic phases using Philips Intellispace version 12.1 software. Percentage change in area (p value 0.093) and diameter (p value 0.108) of the interarterial segment in systolic and diastolic segments, was statistically significant between anomalous coronaries with high and low interarterial course. Percentage change in area and diameter between patients with positive and negative TMT findings was also statistically significant (p<0.001 in both cases). Conclusion Significant positive correlation between change in vessel caliber in the interarterial course of coronary arteries during the cardiac cycle and TMT findings, suggests elevated risk of inducible ischemia in patients with significant vessel compression. Hence the change in vessel caliber demonstrated by CT imaging can be used as a potential criterion for risk assessment and management of patients with ACAIAC. in a to the long axis of ACA. Optimal image representative of vessel cross section was selected. Images were viewed with 2-3X magnification and dimensions and area of IAS of coronary were manually at multiple by two observers blinded for clinical details and earlier Range of diastolic and narrowest systolic caliber and area of the interarterial segment of anomalous coronary artery Record of estimated average radiation dose per examination was made.","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":"69346711","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}