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":" 39","pages":"0"},"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":"64 1","pages":"0"},"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":" ","pages":""},"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":" ","pages":"166-182"},"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}
Pub Date : 2023-08-10DOI: 10.1097/cd9.0000000000000099
Xuebing Liu, Chunmei Li
Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of “reverse redistribution” of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.
{"title":"ATP Stress Myocardial Contrast Echocardiography Assessment of Coronary Microvascular Disease with Spasmodic Characteristics: A Case Report","authors":"Xuebing Liu, Chunmei Li","doi":"10.1097/cd9.0000000000000099","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000099","url":null,"abstract":"Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of “reverse redistribution” of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44421557","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 : 2023-07-27DOI: 10.1097/cd9.0000000000000097
Shuo Wang, Dan Liu, Xiao-lin Zhang, X. Tian
Abdominal aortic aneurysm (AAA) is a degenerative disease characterized by destruction and progressive expansion of the abdominal aortic wall. An AAA is typically defined as an enlargement of the abdominal aorta with diameter ≥3 cm or ≥50% greater than the suprarenal diameter. The pathological changes associated with AAA include inflammatory cell infiltration, extracellular matrix (ECM) destruction and remodeling, and vascular smooth muscle cell loss. The matrix metalloproteinase (MMP) family of proteins plays an important role in initiation and progression of AAA. Since understanding the regulation of MMP-2 and MMP-9 in AAA is essential for treatment of AAA, this review summarized the regulatory mechanisms of MMPs to provide a reference for exploring novel therapeutic approaches.
{"title":"Regulation of Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 in Abdominal Aortic Aneurysm","authors":"Shuo Wang, Dan Liu, Xiao-lin Zhang, X. Tian","doi":"10.1097/cd9.0000000000000097","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000097","url":null,"abstract":"Abdominal aortic aneurysm (AAA) is a degenerative disease characterized by destruction and progressive expansion of the abdominal aortic wall. An AAA is typically defined as an enlargement of the abdominal aorta with diameter ≥3 cm or ≥50% greater than the suprarenal diameter. The pathological changes associated with AAA include inflammatory cell infiltration, extracellular matrix (ECM) destruction and remodeling, and vascular smooth muscle cell loss. The matrix metalloproteinase (MMP) family of proteins plays an important role in initiation and progression of AAA. Since understanding the regulation of MMP-2 and MMP-9 in AAA is essential for treatment of AAA, this review summarized the regulatory mechanisms of MMPs to provide a reference for exploring novel therapeutic approaches.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45468673","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 : 2023-07-10DOI: 10.1097/cd9.0000000000000095
Zhihong Zhao, Xingwei Zhang
Cardiac thrombus in patients with atrial fibrillation (AF) is most commonly found in the left atrial appendage (LAA). The incidence of LAA thrombus ranges from 1.2% to 22.6%, with the vast variation in incidence attributed to the patient’s condition. The effective rate of anticoagulation for thrombus dissolution therapy is only 50%–60%, and long-term anticoagulation treatment increases the risk of bleeding. Direct percutaneous LAA closure in AF patients with LAA thrombus in a suitable location is another alternative treatment option. LAA resection with cardiac surgery is also an effective treatment. This review presents the development of the incidence, diagnosis, and treatment of thrombus in LAA.
{"title":"Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation","authors":"Zhihong Zhao, Xingwei Zhang","doi":"10.1097/cd9.0000000000000095","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000095","url":null,"abstract":"Cardiac thrombus in patients with atrial fibrillation (AF) is most commonly found in the left atrial appendage (LAA). The incidence of LAA thrombus ranges from 1.2% to 22.6%, with the vast variation in incidence attributed to the patient’s condition. The effective rate of anticoagulation for thrombus dissolution therapy is only 50%–60%, and long-term anticoagulation treatment increases the risk of bleeding. Direct percutaneous LAA closure in AF patients with LAA thrombus in a suitable location is another alternative treatment option. LAA resection with cardiac surgery is also an effective treatment. This review presents the development of the incidence, diagnosis, and treatment of thrombus in LAA.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47671052","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 : 2023-07-06DOI: 10.1097/CD9.0000000000000092
Ping Li, Juan Chen, Na Li, X. You, Lan Shen, N. Zhou
Objective: Residual cardiovascular risk in patients with coronary heart disease (CHD) still needs to be addressed in real-world practice. This study aimed to examine the clinical effectiveness of nicorandil and nitrate in addition to optimal treatment for CHD patients. Methods: This retrospective cohort study included patients with CHD between October 2009 and March 2020 from 2 tertiary hospitals in Wuhan, China. Patients were grouped into nicorandil and nitrate groups depending on the first recorded antianginal therapy. Demographic and clinical data were collected from databases of the 2 hospitals. The primary outcome was cumulative 18-month major adverse cardiovascular event (MACE)-free survival, which was evaluated by Kaplan-Meier analysis. Propensity score matching (PSM) and multivariate Cox regression were adopted to adjust for confounding factors. Results: A total of 14,275 patients were analyzed, including 590 and 13,685 patients in the nicorandil and nitrate groups, respectively. With a median follow-up of 0.88 (Q1, Q3: 0.21, 1.54) years, the cumulative 18-month MACE-free survival rates were comparable between the 2 groups (80.0% vs. 75.0%, adjusted hazard ratio (aHR): 1.04, 95% confidence interval (CI): 0.42–2.56, P = 0.982,7) after 1:4 PSM. The cumulative 18-month stroke-free survival rate was significantly higher in the nicorandil group compared to the nitrate group (93.0% vs. 84.0%, aHR: 0.56, 95% CI: 0.34–0.92, P = 0.023,5). Conclusion: This retrospective study showed that nicorandil and nitrate have similar 18-month rates of MACEs in CHD patients, but nicorandil is associated with lower incidence of stroke compared to nitrate. More studies need to be conducted to validate this association and explore the long-term benefit of nicorandil use on the occurrence of MACEs in the future.
目的:冠心病(CHD)患者的剩余心血管风险在现实生活中仍有待解决。本研究旨在探讨尼可地尔和硝酸盐在冠心病患者最佳治疗之外的临床疗效。方法:本回顾性队列研究纳入了2009年10月至2020年3月来自中国武汉两家三级医院的冠心病患者。根据首次记录的抗心绞痛治疗，将患者分为尼可地尔组和硝酸盐组。从这两家医院的数据库中收集人口统计和临床数据。主要终点是累积18个月无主要不良心血管事件(MACE)生存期，通过Kaplan-Meier分析评估。采用倾向评分匹配(PSM)和多变量Cox回归对混杂因素进行校正。结果:共分析14275例患者，其中尼可地尔组590例，硝酸盐组13685例。中位随访时间为0.88年(Q1, Q3: 0.21, 1.54)年，1:4 PSM后两组累积无mace 18个月生存率相当(80.0% vs. 75.0%，校正风险比(aHR): 1.04, 95%可信区间(CI): 0.42-2.56, P = 0.982,7)。尼可地尔组累积18个月无卒中生存率显著高于硝酸盐组(93.0% vs 84.0%， aHR: 0.56, 95% CI: 0.34-0.92, P = 0.023,5)。结论:本回顾性研究显示，尼可地尔和硝酸盐在冠心病患者18个月的mace发生率相似，但尼可地尔与硝酸盐相比卒中发生率较低。需要进行更多的研究来验证这种关联，并探索尼可地尔在未来对mace发生的长期益处。
{"title":"Real-World Major Adverse Cardiovascular Events of Nicorandil and Nitrate in Coronary Heart Disease in Central China: A Retrospective Cohort Study","authors":"Ping Li, Juan Chen, Na Li, X. You, Lan Shen, N. Zhou","doi":"10.1097/CD9.0000000000000092","DOIUrl":"https://doi.org/10.1097/CD9.0000000000000092","url":null,"abstract":"Objective: Residual cardiovascular risk in patients with coronary heart disease (CHD) still needs to be addressed in real-world practice. This study aimed to examine the clinical effectiveness of nicorandil and nitrate in addition to optimal treatment for CHD patients. Methods: This retrospective cohort study included patients with CHD between October 2009 and March 2020 from 2 tertiary hospitals in Wuhan, China. Patients were grouped into nicorandil and nitrate groups depending on the first recorded antianginal therapy. Demographic and clinical data were collected from databases of the 2 hospitals. The primary outcome was cumulative 18-month major adverse cardiovascular event (MACE)-free survival, which was evaluated by Kaplan-Meier analysis. Propensity score matching (PSM) and multivariate Cox regression were adopted to adjust for confounding factors. Results: A total of 14,275 patients were analyzed, including 590 and 13,685 patients in the nicorandil and nitrate groups, respectively. With a median follow-up of 0.88 (Q1, Q3: 0.21, 1.54) years, the cumulative 18-month MACE-free survival rates were comparable between the 2 groups (80.0% vs. 75.0%, adjusted hazard ratio (aHR): 1.04, 95% confidence interval (CI): 0.42–2.56, P = 0.982,7) after 1:4 PSM. The cumulative 18-month stroke-free survival rate was significantly higher in the nicorandil group compared to the nitrate group (93.0% vs. 84.0%, aHR: 0.56, 95% CI: 0.34–0.92, P = 0.023,5). Conclusion: This retrospective study showed that nicorandil and nitrate have similar 18-month rates of MACEs in CHD patients, but nicorandil is associated with lower incidence of stroke compared to nitrate. More studies need to be conducted to validate this association and explore the long-term benefit of nicorandil use on the occurrence of MACEs in the future.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"3 1","pages":"152 - 158"},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240256","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 : 2023-07-04DOI: 10.1097/CD9.0000000000000093
Zhiqing Fu, Shan Li, Xiaoning Zhao, Qiang Wang
Objective: Repeated hospitalization due to congestion is a characteristic of the whole course of heart failure. Echocardiography can be used to assess cardiac function and volume status. However, whether echocardiography can reduce the rehospitalization rate remains unclear. This study aimed to evaluate the impact of transthoracic echocardiography (TTE) use on readmission rates in hospitalized patients with heart failure. Methods: The study was based on the Zigong heart failure database, which contained information on 2,008 adult patients with heart failure admitted to the Zigong Fourth People’s Hospital (Sichuan Province, China) from December 2016 to June 2019. Patients were divided into 2 groups according to the usage of TTE on the day of hospital admission (TTE group (1,371 patients) and no TTE group (637 patients), respectively). The primary outcome was the 6-month readmission rate. The statistical approaches used included multivariate Cox regression, propensity score analysis, and an inverse probability weighting model to ensure the robustness of the findings. Results: A significant reduction in 6-month readmission rate was observed among the TTE group compared with the no TTE group (hazard ratio = 0.60, 95% confidence interval (CI) = 0.52–0.69, P < 0.001). The frequencies of intravenous nitrates, diuretics, and inotropes during hospitalization were significantly higher in the TTE group compared with those in the no TTE group (10.9% vs. 8.3%, 88.5% vs. 86.2%, and 66.9% vs. 65.6%, respectively, all P < 0.001). The proportion of patients returning to the emergency department within 6 months was significantly lower in the TTE group compared with the no TTE group (35.6% vs. 50.3%, P < 0.001). Conclusions: Utilization of TEE on admission day was associated with a reduced 6-month readmission rate in hospitalized patients with heart failure.
{"title":"Utilization of Transthoracic Echocardiography Is Associated with a Decreased 6-month Readmission Rate in Hospitalized Heart Failure: A Propensity Score-matched Analysis","authors":"Zhiqing Fu, Shan Li, Xiaoning Zhao, Qiang Wang","doi":"10.1097/CD9.0000000000000093","DOIUrl":"https://doi.org/10.1097/CD9.0000000000000093","url":null,"abstract":"Objective: Repeated hospitalization due to congestion is a characteristic of the whole course of heart failure. Echocardiography can be used to assess cardiac function and volume status. However, whether echocardiography can reduce the rehospitalization rate remains unclear. This study aimed to evaluate the impact of transthoracic echocardiography (TTE) use on readmission rates in hospitalized patients with heart failure. Methods: The study was based on the Zigong heart failure database, which contained information on 2,008 adult patients with heart failure admitted to the Zigong Fourth People’s Hospital (Sichuan Province, China) from December 2016 to June 2019. Patients were divided into 2 groups according to the usage of TTE on the day of hospital admission (TTE group (1,371 patients) and no TTE group (637 patients), respectively). The primary outcome was the 6-month readmission rate. The statistical approaches used included multivariate Cox regression, propensity score analysis, and an inverse probability weighting model to ensure the robustness of the findings. Results: A significant reduction in 6-month readmission rate was observed among the TTE group compared with the no TTE group (hazard ratio = 0.60, 95% confidence interval (CI) = 0.52–0.69, P < 0.001). The frequencies of intravenous nitrates, diuretics, and inotropes during hospitalization were significantly higher in the TTE group compared with those in the no TTE group (10.9% vs. 8.3%, 88.5% vs. 86.2%, and 66.9% vs. 65.6%, respectively, all P < 0.001). The proportion of patients returning to the emergency department within 6 months was significantly lower in the TTE group compared with the no TTE group (35.6% vs. 50.3%, P < 0.001). Conclusions: Utilization of TEE on admission day was associated with a reduced 6-month readmission rate in hospitalized patients with heart failure.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"3 1","pages":"145 - 151"},"PeriodicalIF":0.0,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42666536","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 : 2023-06-29DOI: 10.1097/cd9.0000000000000098
{"title":"Correction to: Surgical treatment of left atrial dissection and severe mitral valve obstruction","authors":"","doi":"10.1097/cd9.0000000000000098","DOIUrl":"https://doi.org/10.1097/cd9.0000000000000098","url":null,"abstract":"","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135056130","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}
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