Pub Date : 2023-11-07DOI: 10.1097/cd9.0000000000000106
Marco Roffi
For the first time, European Society of Cardiology (ESC) guidelines have aggregated in 1 single document recommendations for the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). From a clinical perspective, this is coherent, as the spectrum of clinical presentations in acute coronary syndromes (ACS) may range from new onset or progressive troponin-negative angina to STEMI, cardiogenic shock, or cardiac arrest. In addition, the management pathways of NSTE-ACS and STEMI patients are widely similar. Compared with previous editions of the guidelines, the extensive document is improved also from a graphic perspective, containing several appealing and easy-to-understand figures. New or modified recommendations include, among others, the topics of diagnostic work-up, timing of invasive strategy, revascularization in multi-vessel disease, intravascular imaging, cardiac arrest, cardiogenic shock, and antithrombotic treatment. For the first time in the field of ACS, ESC guidelines have incorporated a section on patient perspectives with dedicated recommendations. Some of the most relevant changes in recommendations impacting clinical practice are discussed in this article.
{"title":"What Is New in the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes","authors":"Marco Roffi","doi":"10.1097/cd9.0000000000000106","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000106","url":null,"abstract":"For the first time, European Society of Cardiology (ESC) guidelines have aggregated in 1 single document recommendations for the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). From a clinical perspective, this is coherent, as the spectrum of clinical presentations in acute coronary syndromes (ACS) may range from new onset or progressive troponin-negative angina to STEMI, cardiogenic shock, or cardiac arrest. In addition, the management pathways of NSTE-ACS and STEMI patients are widely similar. Compared with previous editions of the guidelines, the extensive document is improved also from a graphic perspective, containing several appealing and easy-to-understand figures. New or modified recommendations include, among others, the topics of diagnostic work-up, timing of invasive strategy, revascularization in multi-vessel disease, intravascular imaging, cardiac arrest, cardiogenic shock, and antithrombotic treatment. For the first time in the field of ACS, ESC guidelines have incorporated a section on patient perspectives with dedicated recommendations. Some of the most relevant changes in recommendations impacting clinical practice are discussed in this article.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135432384","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 : 2023-11-02DOI: 10.1097/cd9.0000000000000109
Qiangqiang Li, Yuan He, Chen Zhang, Hong Gu
Objective: Invasive hemodynamic evaluation and acute vasoreactivity testing are recommended in the diagnosis of pulmonary arterial hypertension (PAH), but their clinical role in children with PAH associated with congenital heart defects (CHD) is unclear. This study aims to investigate acute hemodynamic responses to inhaled iloprost, and its role in prognosis in children with PAH-CHD. Methods: A retrospective analysis was conducted on 83 pediatric patients with PAH-CHD in whom invasive hemodynamics were evaluated before and after a single inhaled dose of iloprost at a single center between 2010 and 2022. Details of the CHD corrective operation, medical treatment, and outcome for each patient were obtained via medical records or telephone contact. A composite endpoint of all-cause death, admission for worsening heart failure during follow-up, and event-free survival was defined, and risk factors associated with this composite endpoint were analyzed. Results: The average patient age was (11.3 ± 4.6) years, and 60 (72.3%) were female. Fifty-nine (71.1%) patients were diagnosed with Eisenmenger syndrome. After iloprost inhalation, mean pulmonary artery pressure decreased from (78.2 ± 11.5) to (72.3 ± 13.2) mmHg ( P < 0.001), and pulmonary vascular resistance index (PVRI) decreased from (18.0 ± 7.9) to (14.5 ± 8.1) WU·m 2 ( P < 0.001). A total of 38 (45.8%) patients had a positive response, defined as a PVRI decrease >25% with stable systemic pressure. Thirty-seven (44.6%) patients underwent a corrective CHD operation at a median of 24 d after hemodynamic evaluation. Nine patients died, and 15 met the composite endpoint during a follow-up period of 5.4 (3.8, 8.8) years. Five-year event-free survival estimates were 96.7% (95% confidence interval: 90.3%–100%) in patients with a positive response, and 82.8% (95% confidence interval: 71.7%–94.5%) in patients with a non-positive response (log-rank P = 0.012). A positive PVRI response and higher pulmonary arterial oxygen saturation after iloprost inhalation, lower baseline brain natriuretic peptide, and PAH-targeted therapy at follow-up were significantly associated with a favorable clinical outcome. A positive acute vasoreactivity testing response and PAH-targeted therapy at follow-up were independent predictors of outcome in multivariate Cox analysis. Conclusions: Acute inhalation of iloprost can lead to a significant decrease in hemodynamic parameters. Responsiveness to inhaled iloprost is associated with better outcomes and can be a valuable predictor of outcomes.
目的:有创血流动力学评价和急性血管反应性试验被推荐用于肺动脉高压(PAH)的诊断，但它们在PAH合并先天性心脏缺陷(CHD)患儿中的临床作用尚不清楚。本研究旨在探讨吸入伊洛前列素对PAH-CHD患儿的急性血流动力学反应及其在预后中的作用。方法:回顾性分析2010年至2022年在单中心单次吸入伊洛前列素前后83例PAH-CHD患儿的有创血流动力学。通过医疗记录或电话联系获得每位患者的冠心病矫正手术、医疗和结果的详细信息。定义了全因死亡、随访期间因心力衰竭恶化入院和无事件生存的综合终点，并分析了与该综合终点相关的危险因素。结果:患者平均年龄(11.3±4.6)岁，女性60例(72.3%)。59例(71.1%)诊断为艾森曼格综合征。吸入伊洛前列素后，平均肺动脉压由(78.2±11.5)降至(72.3±13.2)mmHg (P <肺血管阻力指数(PVRI)由(18.0±7.9)降至(14.5±8.1)WU·m2 (P <0.001)。共有38例(45.8%)患者出现阳性反应，定义为PVRI下降25%，体压稳定。37例(44.6%)患者在血流动力学评估后平均24天内接受了冠心病矫正手术。在5.4(3.8,8.8)年的随访期间，9例患者死亡，15例达到复合终点。阳性反应患者的5年无事件生存率估计为96.7%(95%置信区间:90.3%-100%)，非阳性反应患者的5年无事件生存率估计为82.8%(95%置信区间:71.7%-94.5%)(log-rank P = 0.012)。吸入伊洛前列素后PVRI阳性反应和较高的肺动脉氧饱和度，较低的基线脑利钠肽，以及随访时pah靶向治疗与良好的临床结果显著相关。在多变量Cox分析中，急性血管反应试验阳性反应和随访时多环芳烃靶向治疗是预后的独立预测因素。结论:急性吸入伊洛前列素可导致血流动力学参数显著降低。对吸入伊洛前列素的反应性与更好的预后相关，可以作为预后的有价值的预测指标。
{"title":"Invasive Hemodynamic and Vasoreactivity Testing with Inhaled Iloprost in Children with Pulmonary Arterial Hypertension Associated with Congenital Heart Defects","authors":"Qiangqiang Li, Yuan He, Chen Zhang, Hong Gu","doi":"10.1097/cd9.0000000000000109","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000109","url":null,"abstract":"Objective: Invasive hemodynamic evaluation and acute vasoreactivity testing are recommended in the diagnosis of pulmonary arterial hypertension (PAH), but their clinical role in children with PAH associated with congenital heart defects (CHD) is unclear. This study aims to investigate acute hemodynamic responses to inhaled iloprost, and its role in prognosis in children with PAH-CHD. Methods: A retrospective analysis was conducted on 83 pediatric patients with PAH-CHD in whom invasive hemodynamics were evaluated before and after a single inhaled dose of iloprost at a single center between 2010 and 2022. Details of the CHD corrective operation, medical treatment, and outcome for each patient were obtained via medical records or telephone contact. A composite endpoint of all-cause death, admission for worsening heart failure during follow-up, and event-free survival was defined, and risk factors associated with this composite endpoint were analyzed. Results: The average patient age was (11.3 ± 4.6) years, and 60 (72.3%) were female. Fifty-nine (71.1%) patients were diagnosed with Eisenmenger syndrome. After iloprost inhalation, mean pulmonary artery pressure decreased from (78.2 ± 11.5) to (72.3 ± 13.2) mmHg ( P < 0.001), and pulmonary vascular resistance index (PVRI) decreased from (18.0 ± 7.9) to (14.5 ± 8.1) WU·m 2 ( P < 0.001). A total of 38 (45.8%) patients had a positive response, defined as a PVRI decrease >25% with stable systemic pressure. Thirty-seven (44.6%) patients underwent a corrective CHD operation at a median of 24 d after hemodynamic evaluation. Nine patients died, and 15 met the composite endpoint during a follow-up period of 5.4 (3.8, 8.8) years. Five-year event-free survival estimates were 96.7% (95% confidence interval: 90.3%–100%) in patients with a positive response, and 82.8% (95% confidence interval: 71.7%–94.5%) in patients with a non-positive response (log-rank P = 0.012). A positive PVRI response and higher pulmonary arterial oxygen saturation after iloprost inhalation, lower baseline brain natriuretic peptide, and PAH-targeted therapy at follow-up were significantly associated with a favorable clinical outcome. A positive acute vasoreactivity testing response and PAH-targeted therapy at follow-up were independent predictors of outcome in multivariate Cox analysis. Conclusions: Acute inhalation of iloprost can lead to a significant decrease in hemodynamic parameters. Responsiveness to inhaled iloprost is associated with better outcomes and can be a valuable predictor of outcomes.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876626","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 : 2023-11-01DOI: 10.1097/cd9.0000000000000104
Microcirculatory dysfunction (CMD) typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention, which is associated with more severe myocardial injury and a worse prognosis. With the advancement of intracoronary physiology and imaging technology, the prevention and therapeutic interventions of CMD have attracted more attention. However, relevant guidelines or consensus on CMD are lacking in China. The current consensus summarizes the prevention and diagnostic strategies of emergency percutaneous coronary intervention-related CMD and gives suggestions to improve the prognosis of ST-segment elevation myocardial infarction patients based on evidence from recent clinical studies, guidelines, and consensus from international sources.
{"title":"Chinese Expert Consensus on Microvascular Protection Strategy during Emergency Percutaneous Coronary Intervention Therapy in Patients with ST-elevation Myocardial Infarction","authors":"","doi":"10.1097/cd9.0000000000000104","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000104","url":null,"abstract":"Microcirculatory dysfunction (CMD) typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention, which is associated with more severe myocardial injury and a worse prognosis. With the advancement of intracoronary physiology and imaging technology, the prevention and therapeutic interventions of CMD have attracted more attention. However, relevant guidelines or consensus on CMD are lacking in China. The current consensus summarizes the prevention and diagnostic strategies of emergency percutaneous coronary intervention-related CMD and gives suggestions to improve the prognosis of ST-segment elevation myocardial infarction patients based on evidence from recent clinical studies, guidelines, and consensus from international sources.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135371574","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 : 2023-11-01DOI: 10.1097/cd9.0000000000000111
Xian Liu, Yingdong Wang, Yuhe Sheng, Bin Wang, Kai Xu
Patients experiencing severe aortic stenosis with acute decompensation often face elevated surgical aortic valve replacement risks, leading to high postoperative mortality rates. However, for some patients eligible for transcatheter aortic valve implantation (TAVI), computed tomography angiography for assessing the aortic root and coronary artery might be challenging before the TAVI procedure. This case highlights a patient who underwent emergency TAVI guided by coplane view generated using J-tipped wires fluoroscopy without computed tomography evaluation before the TAVI. This approach reduces contrast usage during the TAVI procedure, significantly mitigating the risks of renal injury and heart function deterioration.
{"title":"Emergency Treatment of Acute Decompensated Severe Aortic Stenosis with Transcatheter Aortic Valve Implantation Under the Coplane View Using J-Tipped Wires Fluoroscopy","authors":"Xian Liu, Yingdong Wang, Yuhe Sheng, Bin Wang, Kai Xu","doi":"10.1097/cd9.0000000000000111","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000111","url":null,"abstract":"Patients experiencing severe aortic stenosis with acute decompensation often face elevated surgical aortic valve replacement risks, leading to high postoperative mortality rates. However, for some patients eligible for transcatheter aortic valve implantation (TAVI), computed tomography angiography for assessing the aortic root and coronary artery might be challenging before the TAVI procedure. This case highlights a patient who underwent emergency TAVI guided by coplane view generated using J-tipped wires fluoroscopy without computed tomography evaluation before the TAVI. This approach reduces contrast usage during the TAVI procedure, significantly mitigating the risks of renal injury and heart function deterioration.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135222653","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}
Objective: This network meta-analysis aims to compare the efficacy and safety of different targeted drug combination treatment for pulmonary arterial hypertension (PAH). Methods: Searches were conducted in Cochrane, PubMed, EMBASE, China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database, and VIP Chinese Science and Technology Journal Data to identify both published and unpublished randomized controlled trials from inception until January 1, 2022. The risk of bias in the included studies was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. A network meta-analysis was performed using Stata 16.0 software. The efficacy and safety of different targeted drugs combined treatment for PAH were evaluated based on forest plot, funnel plot, and surface under the cumulative ranking. Results: A total of 29 randomized controlled trails with 4,448 patients treated with 10 different types of targeted drug combinations were included in this study. The results of the surface under the cumulative ranking showed that the combination regimen was the best clinical option to improve symptoms and delay progression in patients with pulmonary artery hypertension compared with monotherapy. Sildenafil in combination with ambrisentan significantly improved the 6-minute walk distance and reduced N-terminal pro-brain natriuretic peptide levels. Bosentan in combination with sildenafil significantly reduced mean pulmonary artery pressure, whereas bosentan in combination with epoprostenol was more effective than other combinations in reducing pulmonary vascular resistance. Bosentan in combination with tadalafil significantly improved the Borg dyspnea score, and bosentan in combination with iloprost was the best combination for improving World Health Organization functional class/New York Heart Association functional class. In terms of safety, there was no significant reduction in the incidence of adverse events, hospitalizations, or all-cause mortality for combination therapy compared with monotherapy. Bosentan combined with sildenafil significantly reduced the risk of serious adverse events, but the risk of discontinuation due to an adverse event was higher than monotherapy. Sildenafil combined with epoprostenol reduced the risk of clinical worsening in patients with PAH. Conclusion: Compared with monotherapy, targeted drug combinations for PAH significantly improves exercise tolerance, pulmonary hemodynamic parameters, and reduces the risk of serious adverse events and clinical worsening in patients. Bosentan in combination with sildenafil and bosentan in combination with iloprost are combinations of targeted agents with significant efficacy and better safety profile than monotherapy for the treatment of PAH. Sildenafil in combination with epoprostenol has a low risk of clinical worsening in PAH.
{"title":"A Network Meta-analysis of the Efficacy and Safety of Targeted Drug Combinations in the Treatment of Pulmonary Arterial Hypertension","authors":"Rui Wang, Meng Wei, Jie Wang, Xiang Huang, Qianzhi Yan, Shichao Wang, Yun Wu","doi":"10.1097/cd9.0000000000000105","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000105","url":null,"abstract":"Objective: This network meta-analysis aims to compare the efficacy and safety of different targeted drug combination treatment for pulmonary arterial hypertension (PAH). Methods: Searches were conducted in Cochrane, PubMed, EMBASE, China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database, and VIP Chinese Science and Technology Journal Data to identify both published and unpublished randomized controlled trials from inception until January 1, 2022. The risk of bias in the included studies was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. A network meta-analysis was performed using Stata 16.0 software. The efficacy and safety of different targeted drugs combined treatment for PAH were evaluated based on forest plot, funnel plot, and surface under the cumulative ranking. Results: A total of 29 randomized controlled trails with 4,448 patients treated with 10 different types of targeted drug combinations were included in this study. The results of the surface under the cumulative ranking showed that the combination regimen was the best clinical option to improve symptoms and delay progression in patients with pulmonary artery hypertension compared with monotherapy. Sildenafil in combination with ambrisentan significantly improved the 6-minute walk distance and reduced N-terminal pro-brain natriuretic peptide levels. Bosentan in combination with sildenafil significantly reduced mean pulmonary artery pressure, whereas bosentan in combination with epoprostenol was more effective than other combinations in reducing pulmonary vascular resistance. Bosentan in combination with tadalafil significantly improved the Borg dyspnea score, and bosentan in combination with iloprost was the best combination for improving World Health Organization functional class/New York Heart Association functional class. In terms of safety, there was no significant reduction in the incidence of adverse events, hospitalizations, or all-cause mortality for combination therapy compared with monotherapy. Bosentan combined with sildenafil significantly reduced the risk of serious adverse events, but the risk of discontinuation due to an adverse event was higher than monotherapy. Sildenafil combined with epoprostenol reduced the risk of clinical worsening in patients with PAH. Conclusion: Compared with monotherapy, targeted drug combinations for PAH significantly improves exercise tolerance, pulmonary hemodynamic parameters, and reduces the risk of serious adverse events and clinical worsening in patients. Bosentan in combination with sildenafil and bosentan in combination with iloprost are combinations of targeted agents with significant efficacy and better safety profile than monotherapy for the treatment of PAH. Sildenafil in combination with epoprostenol has a low risk of clinical worsening in PAH.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135371572","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 : 2023-10-31DOI: 10.1097/cd9.0000000000000108
Ashfaq Ahmad, Yifan Zou, Peng Zhang, Lingling Li, Xiaoyu Wang, Ahmed Ali Mohsen, Yousen Wang, Fenling Fan
Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension (PH). The complex geometry and mode of contractility means the right ventricle (RV) inlet and outlet are not in line; hence, 2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients. Three-dimensional echocardiography (3DE) allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography. This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points: (1) acquiring an RV data set for 3DE imaging, including details of all available 3DE systems and software utilized in daily practice; (2) the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH; and (3) the prognostic value of 3DE-derived RV function in such patients.
{"title":"Real-time Three-dimensional Echocardiography: A Feasible and Accurate Method for Measuring Right Ventricular Function in Pulmonary Hypertension","authors":"Ashfaq Ahmad, Yifan Zou, Peng Zhang, Lingling Li, Xiaoyu Wang, Ahmed Ali Mohsen, Yousen Wang, Fenling Fan","doi":"10.1097/cd9.0000000000000108","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000108","url":null,"abstract":"Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension (PH). The complex geometry and mode of contractility means the right ventricle (RV) inlet and outlet are not in line; hence, 2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients. Three-dimensional echocardiography (3DE) allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography. This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points: (1) acquiring an RV data set for 3DE imaging, including details of all available 3DE systems and software utilized in daily practice; (2) the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH; and (3) the prognostic value of 3DE-derived RV function in such patients.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135815020","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 : 2023-10-31DOI: 10.1097/cd9.0000000000000103
Gonghao Li, Yanli Zhao, Zhongxing Peng, Kun Liu, Delu Yin, Yunfeng Zhao
Objective: The risk of acute kidney injury (AKI) is high in patients with acute decompensated heart failure (ADHF). The aim of this study is to analyze the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosing AKI in patients with ADHF and evaluate the therapeutic effect of angiotensin receptor-neprilysin inhibitor (ARNI) on AKI. Method: Sixty patients with ADHF were enrolled at the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2020 to June 2021, and randomized into 2 groups (ARNI group: 30 patients treated with tablets of sacubitril valsartan sodium; and angiotensin-converting enzyme inhibitor (ACEI) group: 30 patients treated with benazepril). The uNGAL level was measured immediately after as well as 1, 2, 3, and 7 d after hospital admission. The serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR) were measured immediately as well as 2 and 7 d after hospital admission. The urine volume, dose of loop diuretics, and duration of hospital stay (DoHS) were recorded. Result: The most valuable diagnostic metric for AKI in patients with ADHF was the uNGAL level 1 d after hospital admission, which had a sensitivity of 0.94, specificity of 0.84, and optimal cutoff of 125.62 μg/L. In the presence of AKI, during the first 2 d, patients in the ARNI-AKI and ACEI-AKI groups showed an increase in the sCr level and a reduction in the eGFR level, but there was no significant difference between the 2 groups ( P > 0.05). After 7 d of treatment, the sCr level decreased and the eGFR level increased in both groups, with a significantly greater changes being observed in the ARNI-AKI group than in the ACEI-AKI group ( P < 0.05, respectively). In the absence of AKI, the difference in the sCr level and eGFR between the 2 groups was not significant. The DoHS ((11.25 ± 2.38) d vs . (14.11 ± 2.89) d), urinary microalbumin level ((22.95 ± 6.04) mg/L vs . (31.91 ± 2.18) mg/L), and daily dose of loop diuretics ((19.03 ± 3.04) mg/d vs . (23.62 ± 4.46) mg/d) were significantly lower in patients with AKI in the ARNI group than in the ACEI group ( P < 0.05, respectively). Conclusion: In patients with ADHF, uNGAL measurement enables the diagnosis of AKI earlier than that using the sCr level by 1 to 2 d. ARNI treatment reduced the sCr level, facilitated eGFR recovery, reduced the daily dose of loop diuretics, and decreased the DoHS compared with that in patients receive ACEI treatment.
{"title":"Effect of Angiotensin Receptor-neprilysin Inhibitor on Acute Kidney Injury in Patients with Acute Decompensated Heart Failure","authors":"Gonghao Li, Yanli Zhao, Zhongxing Peng, Kun Liu, Delu Yin, Yunfeng Zhao","doi":"10.1097/cd9.0000000000000103","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000103","url":null,"abstract":"Objective: The risk of acute kidney injury (AKI) is high in patients with acute decompensated heart failure (ADHF). The aim of this study is to analyze the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosing AKI in patients with ADHF and evaluate the therapeutic effect of angiotensin receptor-neprilysin inhibitor (ARNI) on AKI. Method: Sixty patients with ADHF were enrolled at the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2020 to June 2021, and randomized into 2 groups (ARNI group: 30 patients treated with tablets of sacubitril valsartan sodium; and angiotensin-converting enzyme inhibitor (ACEI) group: 30 patients treated with benazepril). The uNGAL level was measured immediately after as well as 1, 2, 3, and 7 d after hospital admission. The serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR) were measured immediately as well as 2 and 7 d after hospital admission. The urine volume, dose of loop diuretics, and duration of hospital stay (DoHS) were recorded. Result: The most valuable diagnostic metric for AKI in patients with ADHF was the uNGAL level 1 d after hospital admission, which had a sensitivity of 0.94, specificity of 0.84, and optimal cutoff of 125.62 μg/L. In the presence of AKI, during the first 2 d, patients in the ARNI-AKI and ACEI-AKI groups showed an increase in the sCr level and a reduction in the eGFR level, but there was no significant difference between the 2 groups ( P > 0.05). After 7 d of treatment, the sCr level decreased and the eGFR level increased in both groups, with a significantly greater changes being observed in the ARNI-AKI group than in the ACEI-AKI group ( P < 0.05, respectively). In the absence of AKI, the difference in the sCr level and eGFR between the 2 groups was not significant. The DoHS ((11.25 ± 2.38) d vs . (14.11 ± 2.89) d), urinary microalbumin level ((22.95 ± 6.04) mg/L vs . (31.91 ± 2.18) mg/L), and daily dose of loop diuretics ((19.03 ± 3.04) mg/d vs . (23.62 ± 4.46) mg/d) were significantly lower in patients with AKI in the ARNI group than in the ACEI group ( P < 0.05, respectively). Conclusion: In patients with ADHF, uNGAL measurement enables the diagnosis of AKI earlier than that using the sCr level by 1 to 2 d. ARNI treatment reduced the sCr level, facilitated eGFR recovery, reduced the daily dose of loop diuretics, and decreased the DoHS compared with that in patients receive ACEI treatment.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135863897","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 : 2023-09-18DOI: 10.1097/cd9.0000000000000101
Xiaofei Gao, Juan Zhang, Xiangquan Kong, Jing Chen, Xiang Chen, Longyan Zhang, Xinyong Cai, Jiancheng Zhu, Nailiang Tian, Zhen Ge, Bin Wang, Qing Zhou, Xi Su, Lang Hong, Yan Wang, Hong Jiang, Junjie Zhang, Shaoliang Chen
Objective: Patients with untreated severe aortic regurgitation (AR) have a high risk of mortality. Transfemoral transcatheter aortic valve replacement (TF-TAVR) is a treatment option for AR; however, the safety and efficacy of this technique have not been sufficiently established. This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR. Methods: Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers. The primary endpoint was device success at 1 month after TAVR. The secondary endpoint was the composite of major adverse cardiovascular events (MACE) at 6 months, including all-cause death, ischemic stroke, emergency conversion to cardiac surgery, and permanent pacemaker implantation. Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up. Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors. Results: Between September 2019 and February 2022, 79 patients with AR were enrolled in the study. At 1 month, device success was achieved in 60 (75.9%) patients. By 6 months, 29 (36.7%) patients had MACE. Echocardiography revealed improved left ventricular function after TAVR. Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons (STS) risk score (odds ratio (OR) 0.760, 95% confidence interval (CI): 0.584–0.989; P = 0.041) and annulus perimeter (OR 0.888, 95% CI: 0.796–0.992; P = 0.035) were 2 predictors of device success. Moreover, annulus perimeter (<80.2 mm), but not STS risk score, was associated with a significant reduction in MACE at 6 months (hazard ratio (HR) 2.223, 95% CI: 1.060–4.659; P = 0.028). Conclusions: TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR, particularly those with a less enlarged annulus.
{"title":"Transcatheter Aortic Valve Replacement in Patients with Pure Native Aortic Regurgitation: Results from a Multicenter Registry Study","authors":"Xiaofei Gao, Juan Zhang, Xiangquan Kong, Jing Chen, Xiang Chen, Longyan Zhang, Xinyong Cai, Jiancheng Zhu, Nailiang Tian, Zhen Ge, Bin Wang, Qing Zhou, Xi Su, Lang Hong, Yan Wang, Hong Jiang, Junjie Zhang, Shaoliang Chen","doi":"10.1097/cd9.0000000000000101","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000101","url":null,"abstract":"Objective: Patients with untreated severe aortic regurgitation (AR) have a high risk of mortality. Transfemoral transcatheter aortic valve replacement (TF-TAVR) is a treatment option for AR; however, the safety and efficacy of this technique have not been sufficiently established. This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR. Methods: Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers. The primary endpoint was device success at 1 month after TAVR. The secondary endpoint was the composite of major adverse cardiovascular events (MACE) at 6 months, including all-cause death, ischemic stroke, emergency conversion to cardiac surgery, and permanent pacemaker implantation. Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up. Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors. Results: Between September 2019 and February 2022, 79 patients with AR were enrolled in the study. At 1 month, device success was achieved in 60 (75.9%) patients. By 6 months, 29 (36.7%) patients had MACE. Echocardiography revealed improved left ventricular function after TAVR. Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons (STS) risk score (odds ratio (OR) 0.760, 95% confidence interval (CI): 0.584–0.989; P = 0.041) and annulus perimeter (OR 0.888, 95% CI: 0.796–0.992; P = 0.035) were 2 predictors of device success. Moreover, annulus perimeter (<80.2 mm), but not STS risk score, was associated with a significant reduction in MACE at 6 months (hazard ratio (HR) 2.223, 95% CI: 1.060–4.659; P = 0.028). Conclusions: TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR, particularly those with a less enlarged annulus.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135201826","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 : 2023-09-04DOI: 10.1097/cd9.0000000000000100
Xiao Jin, Bingxin Wu, Li Han, Xiaofeng Zhu
Percutaneous coronary intervention (PCI) is one of the most common procedures used for the invasive treatment of patients with coronary heart disease; the incidence of in-stent restenosis (ISR) after PCI is 5% to 15%. In this study, a competitive endogenous RNA (ceRNA) network was constructed to investigate potential mechanisms involved in ISR. The expression data for differentially expressed microRNAs (DEmiRNAs) and messenger RNAs (mRNAs) between patients with and without ISR were obtained using limma package. Long noncoding RNAs (lncRNAs) were predicted based on the DEmiRNAs using the miRDB, miRTarBase, and TargetScan databases. An ISR-specific ceRNA network was subsequently constructed and investigated. To verify the key miRNAs of ceRNA, patients with and without ISR were enrolled from Guangdong Provincial Hospital of Chinese Medicine between January 2017 and December 2018 (n = 8, respectively); plasma was collected from all enrolled patients. Based on the raw data obtained from the Gene Expression Omnibus database, 472 DEmiRNAs and 304 differentially expressed messenger RNAs (DEmRNAs) between patients with and without ISR were identified. A ceRNA network was constructed by combining 270 lncRNAs, 3 miRNAs (miR-125, miR-140, and miR-206), and 4 mRNAs (STRADB, TKT, PCTP, and BTG2). The hub genes of the ceRNA network of ISR included the following: miR-125, miR-206, miR-140, PCDHB9, CASC2, BAK1P1, CSPG4P3Y, CSPG4P4Y, STRCP1, and GRIP2. Verification of miRNAs of ceRNA also showed that the expression of miR-206 was upregulated in patients with ISR vs. those without ISR (P < 0.05). In contrast, the expression of miR-140 and miR-125 was downregulated in patients with ISR vs. those without ISR (P < 0.05). This study constructed noncoding RNA-related ceRNA networks for ISR. The results indicated that miR-206, miR-125, and miR-140 may be biomarkers of ISR.
{"title":"Construction and Analysis of an LncRNA-miRNA-mRNA Network Based on Competitive Endogenous RNA Reveal miRNAs Potentially Involved in In-stent Restenosis After Percutaneous Coronary Intervention","authors":"Xiao Jin, Bingxin Wu, Li Han, Xiaofeng Zhu","doi":"10.1097/cd9.0000000000000100","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000100","url":null,"abstract":"\u0000 \u0000 Percutaneous coronary intervention (PCI) is one of the most common procedures used for the invasive treatment of patients with coronary heart disease; the incidence of in-stent restenosis (ISR) after PCI is 5% to 15%. In this study, a competitive endogenous RNA (ceRNA) network was constructed to investigate potential mechanisms involved in ISR.\u0000 \u0000 \u0000 \u0000 The expression data for differentially expressed microRNAs (DEmiRNAs) and messenger RNAs (mRNAs) between patients with and without ISR were obtained using limma package. Long noncoding RNAs (lncRNAs) were predicted based on the DEmiRNAs using the miRDB, miRTarBase, and TargetScan databases. An ISR-specific ceRNA network was subsequently constructed and investigated. To verify the key miRNAs of ceRNA, patients with and without ISR were enrolled from Guangdong Provincial Hospital of Chinese Medicine between January 2017 and December 2018 (n = 8, respectively); plasma was collected from all enrolled patients.\u0000 \u0000 \u0000 \u0000 Based on the raw data obtained from the Gene Expression Omnibus database, 472 DEmiRNAs and 304 differentially expressed messenger RNAs (DEmRNAs) between patients with and without ISR were identified. A ceRNA network was constructed by combining 270 lncRNAs, 3 miRNAs (miR-125, miR-140, and miR-206), and 4 mRNAs (STRADB, TKT, PCTP, and BTG2). The hub genes of the ceRNA network of ISR included the following: miR-125, miR-206, miR-140, PCDHB9, CASC2, BAK1P1, CSPG4P3Y, CSPG4P4Y, STRCP1, and GRIP2. Verification of miRNAs of ceRNA also showed that the expression of miR-206 was upregulated in patients with ISR vs. those without ISR (P < 0.05). In contrast, the expression of miR-140 and miR-125 was downregulated in patients with ISR vs. those without ISR (P < 0.05).\u0000 \u0000 \u0000 \u0000 This study constructed noncoding RNA-related ceRNA networks for ISR. The results indicated that miR-206, miR-125, and miR-140 may be biomarkers of ISR.\u0000","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43526704","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 : 2023-09-01Epub Date: 2023-07-27DOI: 10.1097/CD9.0000000000000096
Jingjing Ren, Xiao-Qi Wang, Tetsushi Nakao, Peter Libby, Guo-Ping Shi
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can lead to a cytokine storm, unleashed in part by pyroptosis of virus-infected macrophages and monocytes. Interleukin-6 (IL-6) has emerged as a key participant in this ominous complication of COVID-19. IL-6 antagonists have improved outcomes in patients with COVID-19 in some, but not all, studies. IL-6 signaling involves at least 3 distinct pathways, including classic-signaling, trans-signaling, and trans-presentation depending on the localization of IL-6 receptor and its binding partner glycoprotein gp130. IL-6 has become a therapeutic target in COVID-19, cardiovascular diseases, and other inflammatory conditions. However, the efficacy of inhibition of IL-6 signaling in metabolic diseases, such as obesity and diabetes, may depend in part on cell type-dependent actions of IL-6 in controlling lipid metabolism, glucose uptake, and insulin sensitivity owing to complexities that remain to be elucidated. The present review sought to summarize and discuss the current understanding of how and whether targeting IL-6 signaling ameliorates outcomes following SARS-CoV-2 infection and associated clinical complications, focusing predominantly on metabolic and cardiovascular diseases.
{"title":"Differential Roles of Interleukin-6 in Severe Acute Respiratory Syndrome-Coronavirus-2 Infection and Cardiometabolic Diseases.","authors":"Jingjing Ren, Xiao-Qi Wang, Tetsushi Nakao, Peter Libby, Guo-Ping Shi","doi":"10.1097/CD9.0000000000000096","DOIUrl":"10.1097/CD9.0000000000000096","url":null,"abstract":"<p><p>Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can lead to a cytokine storm, unleashed in part by pyroptosis of virus-infected macrophages and monocytes. Interleukin-6 (IL-6) has emerged as a key participant in this ominous complication of COVID-19. IL-6 antagonists have improved outcomes in patients with COVID-19 in some, but not all, studies. IL-6 signaling involves at least 3 distinct pathways, including classic-signaling, trans-signaling, and trans-presentation depending on the localization of IL-6 receptor and its binding partner glycoprotein gp130. IL-6 has become a therapeutic target in COVID-19, cardiovascular diseases, and other inflammatory conditions. However, the efficacy of inhibition of IL-6 signaling in metabolic diseases, such as obesity and diabetes, may depend in part on cell type-dependent actions of IL-6 in controlling lipid metabolism, glucose uptake, and insulin sensitivity owing to complexities that remain to be elucidated. The present review sought to summarize and discuss the current understanding of how and whether targeting IL-6 signaling ameliorates outcomes following SARS-CoV-2 infection and associated clinical complications, focusing predominantly on metabolic and cardiovascular diseases.</p>","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48021226","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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