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Hydroxychloroquine Attenuates Myocardial Ischemic and Post-Ischemic Reperfusion Injury by Inhibiting the Toll-Like Receptor 9 - Type I Interferon Pathway. 羟氯喹通过抑制toll样受体9 -I型干扰素通路减轻心肌缺血和缺血后再灌注损伤。
Pub Date : 2022-01-01 Epub Date: 2022-08-25 DOI: 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.

背景:我们假设羟氯喹(HCQ)通过抑制TLR9 -I型干扰素(IFN-I)通路减轻心肌缺血/再灌注损伤(IRI)。方法:野生型(WT) C57BL/6和同源TLR9-/-小鼠左冠状动脉闭塞40分钟,给予或不给予60分钟再灌注(40'/0'或40'/60')。使用ODN-2088或HCQ (TLR9抑制剂)或ODN-1826 (TLR9激动剂)来确定对梗死面积(IS)的影响。在40'/0'后,从采集的心脏中收集心脏灌注液(CP),并在缺血20分钟后给予完整的WT小鼠或分离的脾细胞。结果:40′/60′后,经HCQ或ODN-2088处理的WT小鼠的IS均明显降低。TLR9-/-小鼠和hcq处理的WT小鼠经历40'/0'和40'/60'后的IS类似减弱,40'/0'后CP和40'/60'后血浆中IFN-Is明显降低。40'/0' cp处理和odn -1826处理的20'/60' WT小鼠的IS显著增加。cp处理的WT脾细胞在培养上清液中产生较高的IFN-I, HCQ显著降低IFN-I。结论:tlr9 - ifn -i介导的炎症反应对缺血及缺血后心肌缺血再灌注损伤均有重要作用。缺血心肌释放的HMGB1和cfDNA激活缺血时心肌内TLR9 - IFN-I炎症通路和再灌注时心肌外TLR9 - IFN-I炎症通路。羟氯喹可能通过抑制TLR9-IFN-I通路,减少IFN-I的产生并减轻心肌IRI。
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引用次数: 1
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 补充维生素D和自愿体育锻炼双重干预对饮食诱导的2型糖尿病小鼠模型心脏重塑和功能的影响
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920258
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
补充维生素D和自愿体育锻炼双重干预对饮食诱导的2型糖尿病小鼠模型心脏重塑和功能的影响心脏病学和心血管医学6 229-236。背景和目的:我们之前已经证明了维生素D (VD)补充剂对心脏的有益作用。本研究的目的是评估自愿体育锻炼(PE)和VD对饮食性糖尿病小鼠模型心脏重塑和三级预防功能的联合作用。方法与结果:小鼠以高脂高糖饲料喂养10周。然后,在接下来的15周内,他们被分为4个亚组:饮食、饮食/维生素D、饮食/PE和饮食/VD/PE。在方案结束前一周进行葡萄糖稳态评估和超声心动图检查。祭祀时采集血液和心脏样本。单独饮食25周后,肥胖小鼠表现为糖尿病,心脏同心肥厚联合改善了葡萄糖稳态,并与生理性心脏重塑相关,但单独PE或VD对心功能没有额外的有益影响。结论:本研究的主要发现是补充VD和PE对糖尿病小鼠的心脏保护作用相似,两者联合使用没有明显的协同作用。本研究首次探讨了在饮食性T2D啮齿动物模型中,自愿补充PE和VD对心脏重塑和三级预防功能的联合影响。大量研究表明,在药理学[14]或饮食诱导的[14]啮齿动物糖尿病模型中,自愿体育锻炼或运动训练对心功能有有益影响,与我们的研究结果一致。关于VD影响的数据很少。我们研究的突出发现是,补充VD对局部和整体心脏功能的有利作用与PE相似,而两者的组合并没有产生额外的益处。由于VD和PE彼此已经能够使心功能正常化,因此不太可能预期协同效应。值得注意的是,根据先前的研究,PE或VD单独阻止了hfs诱导的病理性心脏重构的发展[9,17]。有趣的是,它们的结合导致了心脏肥大,尽管是生理上的,但在大小上与HFS小鼠相似。与PE或VD相关的心脏重塑和功能改善相关的潜在机制表明,与炎症和氧化应激[18]相关的全身和心脏水平的信号通路很可能发生有利的变化,从而增强心脏代谢、钙处理、细胞凋亡和纤维化[19,20]。此外,我们还通过调节心脏脂肪毒性[11]证明了VD的心脏保护作用。需要进一步的研究来正确地描述PE合并VD相关的重塑,并确定区域功能增强的潜在机制。总之,我们的研究结果进一步强调了VD和PE干预在心脏代谢疾病中的心脏保护价值。
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引用次数: 0
Emergency Surgical Conversion Following Device Embolization During Transcatheter Aortic Valve Implantation: A Case Report 经导管主动脉瓣植入术中装置栓塞后急诊手术转换一例报告
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920266
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
经导管主动脉瓣植入术中装置栓塞后急诊手术转换一例报告。TAVI装置栓塞后的手术转归是非常罕见的。我们报告一例78岁的妇女谁接受了TAVI程序。由于假体移位,该手术失败,假体嵌入在升主动脉TABC的底部。这个病人做了紧急手术。我们想要提请注意的事实是,手术小组对TAVI患者的管理,在转换的情况下,应该迅速,手术干预应该短。激活(P波)到心室心肌激活的起始;mmHg:毫米汞柱;B2:第二个心音;LVH:左心室肥厚;ST段:ST段;V1、V2、V5、V6:电极;Onde T: wave;Ao:主动脉;Vmax:最大速度;IP:渗透率指数;LVEF:左心室射血分数;MR:二尖瓣返流;mm:毫米;TABC:头臂动脉主干;ECC:体外循环;米歇尔。内格罗蓬特:分钟
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引用次数: 0
Exercise in Patients with Chronic Angina Pectoris: Friend or Foe? 运动对慢性心绞痛患者有益还是有害?
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920271
R. Dechend, H. Predel
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.
心绞痛是一种由心脏供氧不足引起的收缩性疼痛,通常是由于冠状动脉疾病(CAD)存在的体力消耗或情绪压力而发展起来的。然而,也有证据表明,体育活动在预防冠心病方面是有效的,从长远来看也可能预防心绞痛。基于指南的慢性稳定型心绞痛策略旨在通过改变生活方式和适当的药物和干预措施来减轻症状和改善患者预后。医生可能对慢性心绞痛患者的运动方案的安全性存在不确定性和担忧,这一因素由于缺乏与该临床状况相关的数据而复杂化。这篇叙述性综述讨论了规律的体育活动作为稳定型心绞痛患者管理的关键组成部分的重要性,证明了冠心病患者的心脏保护作用,以及在保持适当的风险/收益比的同时改善预后和身体健康。鉴于这些益处,目前的指南建议慢性冠状动脉综合征患者每周至少5天进行30-60分钟的中等强度有氧运动,并根据“频率、强度、时间和类型”(FITT)原则进行个性化治疗,以获得最低风险的最佳疗效;每周2天的阻力训练可以提供更多的好处。我们还强调了在稳定型心绞痛患者中补充药物选择和定期体育锻炼的重要性,以及基于网络的技术如何帮助克服运动训练的一些障碍和在2019冠状病毒病大流行期间实施心脏康复规划的相关挑战。
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引用次数: 0
Congestive Heart Failure Following COVID-19 Vaccination COVID-19疫苗接种后充血性心力衰竭
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920240
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.
接种疫苗后心肌损伤,特别是冠状病毒病2019 (COVID-19)、天花、流感、乙型肝炎,已被记录为罕见的副作用。在本报告中,我们报告了一例充血性心力衰竭,发生在一名健康男性接种了BNT162b2 mRNA-Pfizer-BioNTech疫苗后。一名47岁男性患者在接种第二剂辉瑞疫苗5天后出现呼吸短促,多次就诊于急诊、初级保健医师办公室和急诊室,并被误诊为支气管炎和过敏。几周后,他因呼吸困难加重而入院,超声心动图显示EF为15%,心导管检查未发现明显的冠状动脉阻塞。他尿尿成功,出院时无症状。我们的目标是提高人们对COVID mRNA疫苗接种这一罕见副作用的认识,以便及早发现并及时治疗,避免并发症。
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引用次数: 0
Early Results after Exclusion of Popliteal Aneurysms with an Endoprosthesis. 腘窝动脉瘤置换术后的早期结果。
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920298
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。
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引用次数: 0
Patient-Specific Cardiac Magnetic Resonance Feature Tracking Approach for Scar Detection in Concomitant Ischemic and Non-Ischemic Heart Disease. 患者特异性心脏磁共振特征跟踪方法用于伴发缺血性和非缺血性心脏病的疤痕检测。
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920297
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%)。
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引用次数: 0
SARS COV-2 and Inflammation: Its Impact on the Cardiovascular System SARS - COV-2与炎症:对心血管系统的影响
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920252
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.
新型冠状病毒是一种正义单链RNA病毒,是冠状病毒科成员。该病毒被认为起源于中国武汉,并获得了人际传播的能力。尽管大多数SARS-CoV-2(以前称为“2019年新型冠状病毒”)患者表现出发烧和呼吸道症状。SARS-CoV-2感染还可能涉及其他器官/系统,并出现呼吸系统外症状,包括心脏、胃肠道、肝脏、肾脏、神经系统、嗅觉、味觉、眼部、皮肤和血液系统症状。严重的危险因素通常在老年患者中发现,并伴有癌症、高血压和糖尿病等医疗合并症。自疫情爆发以来,根据ACE-2(血管紧张素转换酶2)在不同组织和细胞中的存在,可以解释身体不同器官的参与。一些呼吸外表现,如心脏受累、急性肾损伤、凝血障碍和血栓性并发症,可能与预后不良有关。本文综述了SARS-CoV - 2感染对心血管系统(CVS)、中枢神经系统(CNS)、胃肠道(GIT)、皮肤、肾脏和血液等不同器官的病理生理影响。
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引用次数: 0
Acute Antegrade TAVI Migration Successfully Treated with Snare Utilization and Near Valve-in-Valve (Viv) Implantation 利用诱捕器和近瓣膜植入成功治疗急性TAVI顺行性移位
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920290
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
一名90岁的女性因主动脉严重狭窄而出现急性心力衰竭症状,急诊入住新十字医院心内科病房。也曾报告晕厥发作。入院时超声心动图显示主动脉瓣面积0.48 cm2,平均压力梯度41mmHg。左心室射血分数为35%。在利尿稳定她的病情后,她接受了计算机断层扫描TAVI检查。这显示了合理的髂-股通路和对瓣膜环大小的估计。最终进行了经导管主动脉瓣植入术。用超声波引导进入。6Fr鞘置入左股动脉(主动脉造影呈刻度辫状),7Fr鞘置入左股静脉(临时起搏导线),6Fr鞘置入右股动脉(RFA), RFA经2次Proglides预闭合后升级为9Fr鞘。立即以常规方式穿过主动脉瓣,植入26mm美敦力Evolut pro。不幸的是,释放后瓣膜移位到升主动脉,并在动脉瘤性主动脉[2]出现钟摆运动。由于患者血流动力学稳定,我们植入了一个更大的瓣膜
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引用次数: 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 对胸痛和跑步机试验结果的CT血管造影异常冠状动脉动脉间段口径动态变化的关键观察-潜在的“游戏规则改变者”管理观察
Pub Date : 2022-01-01 DOI: 10.26502/fccm.92920269
V. Mahalingam, K. Gadabanahalli, V. Bhat
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.
对胸痛和跑步机试验结果的CT血管造影异常冠状动脉动脉间段口径动态变化的关键观察-潜在的“游戏规则改变者”管理观察。心内科与心血管医学6(2022):340-352。摘要目的与背景冠状动脉异常在普通人群中发病率较低,以右冠状动脉起源异常最为常见。这些异常,特别是冠状动脉异常伴动脉间程(ACAIAC)是潜在的危险。由于其发病率较低,尚未制定详细的临床和影像学指南来评估这类患者并指导管理。方法和结果回顾了接受排除冠状动脉疾病研究的患者的CT冠状动脉造影。记录ACAIAC患者。使用Philips Intellispace 12.1版软件对图像进行复查和重建,测量收缩期和舒张期ACAIAC动脉间最窄段的直径和面积。高、低动脉间程异常冠状动脉收缩期和舒张期动脉间段面积(p值0.093)和直径(p值0.108)的百分比变化具有统计学意义。TMT阳性和阴性患者的面积和直径百分比变化也具有统计学意义(两例均p<0.001)。结论心循环期间冠状动脉动脉间径变化与TMT呈显著正相关,提示血管明显受压患者诱发性缺血的风险增高。因此,CT图像显示的血管口径变化可作为ACAIAC患者风险评估和管理的潜在标准。a到ACA的长轴。选取最优的血管截面图像代表。用2-3倍放大镜观察图像,由两名盲法观察临床细节和异常冠状动脉舒张和收缩最窄口径的早期范围和动脉间段的面积,手动多次观察冠状动脉IAS的尺寸和面积。记录每次检查估计的平均辐射剂量。
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Cardiology and cardiovascular medicine
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