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The age-dependent development of abnormal cardiac metabolism in the peroxisome proliferator-activated receptor α-knockout mouse. 过氧化物酶体增殖激活受体α基因敲除小鼠心脏代谢异常的发展与年龄有关。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-17 DOI: 10.1016/j.atherosclerosis.2024.118599
Michael S Dodd, Lucy Ambrose, Vicky Ball, Kieran Clarke, Carolyn A Carr, Damian J Tyler

Background and aims: Peroxisome proliferator-activated receptor α (PPARα) is crucial for regulating cardiac β-oxidation in the heart, liver, and kidney. Ageing can induce cardiac metabolic alterations, but the role of PPARα has not been extensively characterised. The aim of this research was to investigate the role of PPARα in the aged heart.

Methods: Hyperpolarized [1-13C]pyruvate was used to evaluate in vivo cardiac carbohydrate metabolism in fed and fasted young (3 months) and old (20-22 months) PPARα knockout (KO) mice versus controls. Cine MRI assessed cardiac structural and functional changes. Cardiac tissue analysis included qRT-PCR and Western blotting for Pparα, medium chain acyl-CoA dehydrenase (MCAD), uncoupling protein (UCP) 3, glucose transporter (GLUT) 4 and PDH kinase (PDK) 1,2, and 4 expression.

Results: PPARα-KO hearts from both young and old mice showed significantly reduced Pparα mRNA and a 58-59 % decrease in MCAD protein levels compared to controls. Cardiac PDH flux was similar in young control and PPARα-KO mice but 96 % higher in old PPARα-KO mice. Differences between genotypes were consistent in fed and fasted states, with reduced PDH flux when fasted. Increased PDH flux was accompanied by a 179 % rise in myocardial GLUT4 protein. No differences in PDK 1, 2, or 4 protein levels were observed between fed groups, indicating the increased PDH flux in aged PPARα-KO mice was not due to changes in PDH phosphorylation.

Conclusions: Aged PPARα-KO mice demonstrated higher cardiac PDH flux compared to controls, facilitated by increased myocardial GLUT4 protein levels, leading to enhanced glucose uptake and glycolysis.

背景和目的:过氧化物酶体增殖激活受体α(PPARα)是调节心脏、肝脏和肾脏中心脏β氧化作用的关键。衰老可诱发心脏代谢改变,但 PPARα 的作用尚未得到广泛表征。研究方法:使用超极化[1-13C]丙酮酸评估幼年(3 个月)和老年(20-22 个月)PPARα 基因敲除(KO)小鼠与对照组的体内心脏碳水化合物代谢。显像核磁共振成像评估了心脏结构和功能的变化。心脏组织分析包括 Pparα、中链酰基-CoA 脱氢酶(MCAD)、解偶联蛋白(UCP)3、葡萄糖转运体(GLUT)4 和 PDH 激酶(PDK)1、2 和 4 表达的 qRT-PCR 和 Western 印迹检测:结果:与对照组相比,年轻和年老小鼠的 PPARα-KO 心脏的 Pparα mRNA 显著减少,MCAD 蛋白水平下降了 58-59%。年轻对照组和 PPARα-KO 小鼠的心脏 PDH 通量相似,但老年 PPARα-KO 小鼠的 PDH 通量比对照组高 96%。基因型之间的差异在进食和禁食状态下是一致的,禁食时 PDH 通量降低。PDH 通量增加的同时,心肌 GLUT4 蛋白也增加了 179%。喂养组之间的 PDK 1、2 或 4 蛋白水平没有差异,这表明老龄 PPARα-KO 小鼠 PDH 通量的增加不是由于 PDH 磷酸化的变化:结论:与对照组相比,老年 PPARα-KO 小鼠表现出更高的心脏 PDH 通量,心肌 GLUT4 蛋白水平的增加促进了 PDH 通量的增加,从而导致葡萄糖摄取和糖酵解的增强。
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引用次数: 0
Metabolites derived from radical oxidation of PUFA: NEO-PUFAs, promising molecules for health? 由 PUFA 自由基氧化产生的代谢物:NEO-PUFAs,有望促进健康的分子?
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-15 DOI: 10.1016/j.atherosclerosis.2024.118600
Anna Abramova, Jamie Bride, Camille Oger, Marie Demion, Jean-Marie Galano, Thierry Durand, Jérôme Roy

Oxidative stress plays a critical role in numerous pathological processes. Under these stress conditions, the free radical-catalyzed lipid peroxidation generates in vivo a large number of key products that are involved in many physiological and pathophysiological processes. Among these products are neuroprostanes, which arise from the peroxidation of docosahexaenoic acid (DHA), and isoprostanes, resulting from arachidonic acid (AA) and eicosapentaenoic acid (EPA) through the same peroxidation process. These non-enzymatic oxygenated metabolites newly appointed NEO-PUFAs have gained recognition as reliable markers of oxidative stress in neurogenerative and cardiovascular diseases. Moreover, some of them display a wide range of biological activities. The ability to detect and measure these metabolites offers precious insights into the mechanisms of oxidative damage and holds potential therapeutic implications for various health conditions, including neurodegenerative diseases. This review focuses on the role of neuroprostanes as biomarkers for oxidative stress and related diseases, highlighting their potential applications in medical research and treatment.

氧化应激在许多病理过程中起着至关重要的作用。在这些应激条件下,自由基催化的脂质过氧化反应会在体内产生大量参与许多生理和病理生理过程的关键产物。这些产物包括由二十二碳六烯酸(DHA)过氧化反应产生的神经前列素,以及由花生四烯酸(AA)和二十碳五烯酸(EPA)通过相同的过氧化反应过程产生的异前列素。这些新命名为 NEO-PUFAs 的非酶含氧代谢物已被公认为神经退行性疾病和心血管疾病中氧化应激的可靠标志物。此外,其中一些还具有广泛的生物活性。检测和测量这些代谢物的能力为了解氧化损伤的机制提供了宝贵的视角,并对包括神经退行性疾病在内的各种健康状况具有潜在的治疗意义。这篇综述重点探讨了神经前列素作为氧化应激和相关疾病生物标记物的作用,强调了它们在医学研究和治疗中的潜在应用。
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引用次数: 0
The singular French PCSK9-p.Ser127Arg gain-of-function variant: A significant player in cholesterol levels from a 775-year-old common ancestor 独特的法国 PCSK9-p.Ser127Arg 功能增益变体:775年前共同祖先胆固醇水平的重要影响因素
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1016/j.atherosclerosis.2024.118596

Background and aims

PCSK9 is a key regulator of LDL-cholesterol levels. PCSK9 gain of function variants (GOFVs) cause autosomal dominant hypercholesterolemia (ADH). The first described PCSK9-GOFV, p.Ser127Arg, almost exclusively reported in France, represents 67 % of the PCSK9 French GOFVs due to a founder effect. Few other carriers are reported in South Africa and Norway. This study aims to estimate when the common ancestor lived and to describe a cohort of p.Ser127Arg carriers.

Methods

Eight families and 14 p.Ser127Arg carriers were genotyped and phenotyped. Haplotypes were constructed using 11 microsatellites around PCSK9 and 6 intragenic single nucleotide polymorphisms (SNPs). To add to the biological analysis, eight additional p.Ser127Arg carriers, 12 carriers of other PCSK9-GOFVs, 93 LDLR loss of function variant (LOFV) carriers and 49 non-carriers subjects were phenotyped.

Results

The most common ancestor of p.Ser127Arg was estimated to have lived 775 years ago [95 % CI: 575-1075]. French Protestants exiled after the revocation of the Edict of Nantes in 1685 AD likely brought the variant to South Africa and Norway. As expected for ADH subjects, carriers of LDLR-LOFV, the p.Ser127Arg, or other PCSK9-GOFVs showed significantly higher LDL-C levels than that of the non-carriers. Interestingly, LDL-C levels are higher for LDLR-LOFVs and for the reduced secreted p.Ser127Arg than for secreted PCSK9-GOFVs, suggesting a greater effect of the p.Ser127Arg. Conversely, HDL-C was significantly lower for LDLR-LOFV and p.Ser127Arg carriers.

Conclusions

This first report from a large cohort of PCSK9-p.Ser127Arg carriers provides observations suggesting a stronger hypercholesterolemic potential of the mutated pro-PCSK9 compared with the secreted mature protein. This work also provides additional data to support the association between PCSK9 and HDL metabolism, and molecular evidence that this variant appeared in France around 1248 AD (Graphical Abstract = Fig. 1).
背景和目的PCSK9是低密度脂蛋白胆固醇水平的关键调节因子。PCSK9 功能增益变异(GOFV)会导致常染色体显性高胆固醇血症(ADH)。第一个描述的 PCSK9-GOFV 是 p.Ser127Arg,几乎只在法国有报道,由于创始人效应,它占 PCSK9 法国 GOFV 的 67%。南非和挪威很少有其他携带者的报道。本研究旨在估计共同祖先的生活时间,并描述 p.Ser127Arg 携带者的队列。方法对 8 个家庭和 14 个 p.Ser127Arg 携带者进行了基因分型和表型分析。利用 PCSK9 周围的 11 个微卫星和 6 个基因内单核苷酸多态性 (SNP) 构建了单倍型。为了补充生物学分析,还对另外 8 名 p.Ser127Arg 携带者、12 名其他 PCSK9-GOFVs 携带者、93 名 LDLR 功能缺失变异体 (LOFV) 携带者和 49 名非携带者进行了表型分析。结果p.Ser127Arg 的最常见祖先估计生活在 775 年前[95 % CI:575-1075]。公元1685年南特敕令废除后流亡的法国新教徒很可能将该变异体带到了南非和挪威。正如 ADH 受试者所预期的那样,LDLR-LOFV、p.Ser127Arg 或其他 PCSK9-GOFV 携带者的低密度脂蛋白胆固醇水平明显高于非携带者。有趣的是,与分泌型 PCSK9-GOFV 相比,LDLR-LOFV 和分泌减少的 p.Ser127Arg 的 LDL-C 水平更高,这表明 p.Ser127Arg 的作用更大。结论这是对一大群 PCSK9-p.Ser127Arg 携带者的首次报道,观察结果表明,与分泌型成熟蛋白相比,突变的原 PCSK9 具有更强的高胆固醇血症潜力。这项研究还提供了更多数据,支持 PCSK9 与高密度脂蛋白代谢之间的联系,并提供了分子证据,证明该变异体在公元 1248 年左右出现在法国(图解摘要 = 图 1)。
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引用次数: 0
In Memoriam: Akira Endo (1933-2024) 悼念:远藤明(1933-2024)
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1016/j.atherosclerosis.2024.118545
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引用次数: 0
The association between trimethylamine N-oxide levels and coronary microvascular dysfunction and prognosis in patients with ST-elevation myocardial infarction 三甲胺 N-氧化物水平与 ST 段抬高型心肌梗死患者冠状动脉微血管功能障碍和预后之间的关系
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-12 DOI: 10.1016/j.atherosclerosis.2024.118597

Background and aims

Coronary microvascular dysfunction (CMD) is common after ST-elevation myocardial infarction (STEMI), leading to adverse clinical outcomes. However, its diagnosis remains difficult, and mechanisms elusive. This study explores the role of Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, as a potential biomarker for diagnosing CMD in STEMI patients.

Methods

This prospective, observational study enrolled 210 STEMI patients with multivessel coronary artery disease who underwent primary percutaneous coronary intervention (PCI). TMAO levels were measured at baseline, 3 months, and 12 months post-PCI, whilst coronary physiology was assessed at 3 months. The primary endpoint was the incidence of CMD at 3 months, with the secondary endpoint being major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months. An additional 59 consecutive patients were enrolled for validation.

Results

TMAO levels varied from baseline to 3 months, then stabilised. The areas under the ROC curve for baseline TMAO and TMAO at 3-month were 0.55 (95 % CI 0.46–0.64; p = 0.426), and 0.80 (95 % CI 0.73–0.87; p < 0.001), respectively. The optimal cut-off for TMAO at 3-month to diagnose CMD was 3.91, with similar sensitivity and specificity in the derivation and validation cohort. The incidence of MACCE was higher in patients with TMAO≥3.91 (41.4 % vs 10.7 %; p < 0.001). The addition of 3-month TMAO improved the diagnostic performance of traditional risk factors.

Conclusion

TMAO is a robust biomarker for CMD and is significantly associated with the incidence of MACCE. TMAO has the potential in guiding clinical decision-making and suggests an interplay between gut microbiota and CMD.
背景和目的冠状动脉微血管功能障碍(CMD)是ST段抬高型心肌梗死(STEMI)后的常见病,会导致不良的临床结局。然而,其诊断仍很困难,其机制也难以捉摸。本研究探讨了肠道微生物群代谢物三甲胺N-氧化物(TMAO)作为诊断STEMI患者CMD的潜在生物标记物的作用。方法这项前瞻性观察性研究共纳入了210名接受初级经皮冠状动脉介入治疗(PCI)的STEMI多支血管冠状动脉疾病患者。在PCI术后基线、3个月和12个月时测量TMAO水平,在3个月时评估冠状动脉生理功能。主要终点是3个月时的CMD发生率,次要终点是12个月时的主要不良心脑血管事件(MACCE)。结果TMAO水平从基线到3个月期间有所变化,随后趋于稳定。基线 TMAO 和 3 个月时 TMAO 的 ROC 曲线下面积分别为 0.55 (95 % CI 0.46-0.64; p = 0.426) 和 0.80 (95 % CI 0.73-0.87; p < 0.001)。3个月时TMAO诊断CMD的最佳临界值为3.91,在推导队列和验证队列中具有相似的敏感性和特异性。TMAO≥3.91的患者MACCE发生率更高(41.4% vs 10.7%;p < 0.001)。结论TMAO是一种可靠的CMD生物标记物,与MACCE的发病率显著相关。TMAO具有指导临床决策的潜力,并表明肠道微生物群与CMD之间存在相互作用。
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引用次数: 0
Nucleic acid liquid biopsies in cardiovascular disease: Cell-free DNA liquid biopsies in cardiovascular disease. 心血管疾病中的核酸液体活检:心血管疾病中的无细胞 DNA 液体活检。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-11 DOI: 10.1016/j.atherosclerosis.2024.118583
Tyler Artner, Smriti Sharma, Irene M Lang

Cardiovascular disease (CVD) is the leading cause of death worldwide, and despite treatment efforts, cardiovascular function cannot always be restored, and progression of disease be prevented. Critical insights are oftentimes based on tissue samples. Current knowledge of tissue pathology typically relies on invasive biopsies or postmortem samples. Liquid biopsies, which assess circulating mediators to deduce the histology and pathology of distant tissues, have been advancing rapidly in cancer research and offer a promising approach to be translated to the understanding and treatment of CVD. The widely understood elevations in cell-free DNA during acute and chronic cardiovascular conditions, associate with disease, severity, and offer prognostic value. The role of neutrophil extracellular traps (NETs) and circulating nucleases in thrombosis provide a solid rationale for liquid biopsies in CVD. cfDNA originates from various tissue types and cellular sources, including mitochondria and nuclei, and can be used to trace cell and tissue type lineage, as well as to gain insight into the activation status of cells. This article discusses the origin, structure, and potential utility of cfDNA, offering a deeper and less invasive approach for the understanding of the complexities of CVD.

心血管疾病(CVD)是导致全球死亡的主要原因,尽管已经进行了治疗,但心血管功能并不总能恢复,疾病的恶化也无法预防。关键的见解往往基于组织样本。目前的组织病理学知识通常依赖于侵入性活检或死后样本。液体活检通过评估循环介质来推断远处组织的组织学和病理学,在癌症研究领域进展迅速,为了解和治疗心血管疾病提供了一种前景广阔的方法。众所周知,在急性和慢性心血管疾病期间,游离细胞 DNA 的升高与疾病、严重程度有关,并具有预后价值。中性粒细胞胞外捕获物(NET)和循环核酸酶在血栓形成中的作用为在心血管疾病中进行液体活检提供了可靠的依据。cfDNA 来源于不同的组织类型和细胞来源,包括线粒体和细胞核,可用于追踪细胞和组织类型的血统,并深入了解细胞的活化状态。本文讨论了 cfDNA 的起源、结构和潜在用途,为了解心血管疾病的复杂性提供了一种更深入、创伤更小的方法。
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引用次数: 0
Vascular disease and ischemic stroke in patients with atrial fibrillation: Temporal trends and age-related differences. 心房颤动患者的血管疾病和缺血性中风:时间趋势和年龄差异。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-08 DOI: 10.1016/j.atherosclerosis.2024.118590
Konsta Teppo, Elin Karlsson, Tuomas Kiviniemi, Olli Halminen, Ossi Lehtonen, Elis Kouki, Jari Haukka, Pirjo Mustonen, Jukka Putaala, Miika Linna, Juha Hartikainen, K E Juhani Airaksinen, Mika Lehto

Background and aims: We examined temporal trends and age-related differences in the prevalence of vascular diseases and in their association with ischemic stroke (IS) risk in patients with atrial fibrillation (AF).

Methods: The registry-based FinACAF study covered all patients with AF in Finland during 2007-2018. Incidence rate ratios (IRRs) of IS were computed with Poisson regression, and the interaction of vascular diseases with age and calendar year period was assessed.

Results: We identified 229,565 patients (50.0 % female; mean age 72.7 years) with incident AF. The overall prevalence of any vascular disease was 28.6 %, and the prevalence increased from 2007 to 2018, primarily among patients over 75 years. Overall, 5909 (2.6 %) patients experienced IS within the first year after AF diagnosis. Crude IS rate decreased continuously during the study period in both patients with and without vascular diseases, with the rates remaining consistently higher in patients with vascular diseases. Vascular diseases were independently associated with higher IS incidence among patients under 65 years (adjusted IRR with 95 % confidence interval 1.35 (1.10-1.66)), while among older patients, only peripheral artery disease was associated with IS, and other vascular conditions had no association with IS. No interactions between the calendar year period and vascular diseases with IS rate were observed.

Conclusions: The association between vascular diseases and IS has remained stable over time and vascular diseases were independently associated with higher incidence of IS particularly in patients with AF under the age of 65.

背景与目的我们研究了心房颤动(房颤)患者血管疾病患病率及其与缺血性中风(IS)风险相关性的时间趋势和年龄差异:以登记为基础的 FinACAF 研究涵盖了 2007-2018 年间芬兰的所有房颤患者。采用泊松回归法计算了IS的发病率比(IRR),并评估了血管疾病与年龄和日历年期间的交互作用:我们发现了 229,565 名房颤患者(50.0% 为女性;平均年龄 72.7 岁)。任何血管疾病的总患病率为 28.6%,2007 年至 2018 年患病率有所上升,主要是 75 岁以上的患者。总体而言,5909 名患者(2.6%)在确诊房颤后的第一年内经历了 IS。在研究期间,有血管疾病和无血管疾病患者的粗IS率均持续下降,有血管疾病患者的IS率始终较高。在 65 岁以下的患者中,血管疾病与较高的 IS 发生率独立相关(调整后 IRR,95% 置信区间为 1.35 (1.10-1.66)),而在老年患者中,只有外周动脉疾病与 IS 相关,其他血管疾病与 IS 无关。在日历年期间和血管疾病与IS率之间没有观察到相互作用:随着时间的推移,血管疾病与IS之间的关系保持稳定,血管疾病与较高的IS发病率独立相关,尤其是在65岁以下的房颤患者中。
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引用次数: 0
Arterial inflammation on [18F]FDG PET/CT in melanoma patients treated with and without immune checkpoint inhibitors: CHECK-FLAME I 接受和未接受免疫检查点抑制剂治疗的黑色素瘤患者[18F]FDG PET/CT 上的动脉炎症:CHECK-FLAME I
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-07 DOI: 10.1016/j.atherosclerosis.2024.118595

Background and aims

Immune checkpoint inhibitors (ICIs) revolutionized cancer treatment. However, ICIs may increase the immune response to non-tumor cells, possibly resulting in increased arterial inflammation, raising the risk of atherosclerotic events. Nevertheless, malignancies may induce a pro-inflammatory state and the association between ICIs and arterial inflammation remains to be clarified. This study aims to assess differences in increase in arterial inflammation between patients with advanced melanoma treated with ICIs compared to a control group without ICIs.

Methods

Patients with advanced melanoma who underwent [18F]FDG PET/CT scans at baseline, 6 months (T1) and 18 months (T2) were included in this retrospective observational study. Arterial inflammation was evaluated in eight segments by calculating the target-to-background ratio (TBR). The primary study outcome was the difference in increase in mean TBRmax between patients treated with and without ICIs.

Results

We included 132 patients of whom 72.7 % were treated with ICIs. After exclusion for the use of anti-inflammatory medication, patients treated with ICIs showed a significant increase in mean TBRmax between baseline and T1 from 1.29 ± 0.12 to 1.33 ± 0.13 (p = 0.017), while in the control group, no change in mean TBRmax (1.30 ± 0.12 to 1.28 ± 0.10, p = 0.22) was observed (p = 0.027). During longer follow-up, mean TBRmax remained stable in both groups. Arterial inflammation increased significantly after ICI therapy in patients without active inflammation (p < 0.001) and in patients without calcifications (p = 0.013).

Conclusions

A significant increase in arterial inflammation as measured on [18F]FDG PET/CT was observed in patients with advanced melanoma treated with ICIs only in the first six months after initiation of therapy, whereas no changes were observed in the control group. Moreover, arterial inflammation was mainly increased in patients without pre-existing inflammatory activity and with non-calcified lesions.

背景和目的免疫检查点抑制剂(ICIs)彻底改变了癌症治疗。然而,免疫检查点抑制剂可能会增加对非肿瘤细胞的免疫反应,从而可能导致动脉炎症加剧,增加动脉粥样硬化事件的风险。然而,恶性肿瘤可能会诱发促炎症状态,而 ICIs 与动脉炎症之间的关联仍有待明确。本研究旨在评估接受 ICIs 治疗的晚期黑色素瘤患者与未接受 ICIs 治疗的对照组患者之间动脉炎症增加的差异。方法这项回顾性观察研究纳入了在基线、6 个月(T1)和 18 个月(T2)接受 [18F]FDG PET/CT 扫描的晚期黑色素瘤患者。通过计算目标与背景比值(TBR)对八个节段的动脉炎症进行了评估。主要研究结果是接受和未接受 ICIs 治疗的患者平均 TBRmax 的增加差异。在排除使用抗炎药物的情况后,接受 ICIs 治疗的患者的平均 TBRmax 在基线和 T1 之间有显著增加,从 1.29 ± 0.12 增加到 1.33 ± 0.13(p = 0.017),而对照组的平均 TBRmax 没有变化(从 1.30 ± 0.12 增加到 1.28 ± 0.10,p = 0.22)(p = 0.027)。在较长时间的随访中,两组的平均 TBRmax 均保持稳定。结论 在接受 ICIs 治疗的晚期黑色素瘤患者中,仅在开始治疗后的前 6 个月内,[18F]FDG PET/CT 检测到动脉炎症显著增加,而对照组未观察到任何变化。此外,动脉炎症主要在无炎症活动和无钙化病灶的患者中增加。
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引用次数: 0
Progression of coronary artery calcium density and major adverse cardiovascular events. 冠状动脉钙密度的进展与主要不良心血管事件。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-06 DOI: 10.1016/j.atherosclerosis.2024.118593
Qingchao Meng, Li Zhao, Na Zhao, Yunqiang An, Bin Lu, Yang Gao

Background and aims: We aimed to investigate the relationship between coronary artery calcium (CAC) density progression and major adverse cardiovascular events (MACE), and the prognostic value of CAC density progression.

Methods: Patients with serial CAC scans were enrolled in this study. CAC density was directly measured in calcified lesions. Change and rate of progression of CAC density were calculated. Cox proportional hazard regression was utilized to estimate hazard ratios (HRs) for time to MACE regarding CAC density. The incremental prognostic value and the reclassification ability of CAC density progression were evaluated using the C-index and continuous net reclassification index (NRI).

Results: 304 patients (57.86 ± 9.47 years, 69.4 % male) were included. There were 47 MACE over a follow-up period of 76.00 (56.00-95.00) months. After adjustment for risk factors and CAC volume, the change of CAC density was inversely associated with MACE (per 10HU: HR: 0.956, 95 % confidence interval: 0.920-0.992, p = 0.018). Adding the change of CAC density to risk factors and baseline CAC density improved the C-index (0.694 vs. 0.678, p = 0.026). Adding the change of CAC density improved reclassification of MACE compared with risk factors and baseline CAC density [NRI = 0.432 (0.016-0.789)].

Conclusions: CAC density progression is inversely associated with MACE. The addition of the change of CAC density improves prognostic value compared to baseline risk factors and CAC density and optimizes risk reclassification.

背景与目的我们旨在研究冠状动脉钙化(CAC)密度进展与主要不良心血管事件(MACE)之间的关系,以及CAC密度进展的预后价值:本研究招募了接受连续 CAC 扫描的患者。方法:本研究招募了接受连续 CAC 扫描的患者,直接测量钙化病灶的 CAC 密度。计算CAC密度的变化和进展率。利用 Cox 比例危险回归估算出 CAC 密度与 MACE 发生时间的危险比 (HRs)。使用C指数和连续净再分类指数(NRI)评估了CAC密度进展的增量预后价值和再分类能力:共纳入 304 名患者(57.86 ± 9.47 岁,69.4% 为男性)。在76.00(56.00-95.00)个月的随访期间,共有47例MACE。在对风险因素和 CAC 容量进行调整后,CAC 密度的变化与 MACE 呈反比(每 10HU HR:0.956,95 % 置信区间:0.920-0.992,p = 0.018)。在风险因素和基线 CAC 密度的基础上增加 CAC 密度的变化,可改善 C 指数(0.694 vs. 0.678,p = 0.026)。与危险因素和基线CAC密度相比,增加CAC密度变化可改善MACE的再分类[NRI = 0.432 (0.016-0.789)] :结论:CAC密度的增加与MACE成反比。结论:CAC密度的变化与MACE成反比。与基线风险因素和CAC密度相比,CAC密度的变化提高了预后价值,并优化了风险再分类。
{"title":"Progression of coronary artery calcium density and major adverse cardiovascular events.","authors":"Qingchao Meng, Li Zhao, Na Zhao, Yunqiang An, Bin Lu, Yang Gao","doi":"10.1016/j.atherosclerosis.2024.118593","DOIUrl":"https://doi.org/10.1016/j.atherosclerosis.2024.118593","url":null,"abstract":"<p><strong>Background and aims: </strong>We aimed to investigate the relationship between coronary artery calcium (CAC) density progression and major adverse cardiovascular events (MACE), and the prognostic value of CAC density progression.</p><p><strong>Methods: </strong>Patients with serial CAC scans were enrolled in this study. CAC density was directly measured in calcified lesions. Change and rate of progression of CAC density were calculated. Cox proportional hazard regression was utilized to estimate hazard ratios (HRs) for time to MACE regarding CAC density. The incremental prognostic value and the reclassification ability of CAC density progression were evaluated using the C-index and continuous net reclassification index (NRI).</p><p><strong>Results: </strong>304 patients (57.86 ± 9.47 years, 69.4 % male) were included. There were 47 MACE over a follow-up period of 76.00 (56.00-95.00) months. After adjustment for risk factors and CAC volume, the change of CAC density was inversely associated with MACE (per 10HU: HR: 0.956, 95 % confidence interval: 0.920-0.992, p = 0.018). Adding the change of CAC density to risk factors and baseline CAC density improved the C-index (0.694 vs. 0.678, p = 0.026). Adding the change of CAC density improved reclassification of MACE compared with risk factors and baseline CAC density [NRI = 0.432 (0.016-0.789)].</p><p><strong>Conclusions: </strong>CAC density progression is inversely associated with MACE. The addition of the change of CAC density improves prognostic value compared to baseline risk factors and CAC density and optimizes risk reclassification.</p>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nucleic acid liquid biopsies in cardiovascular disease: Cell-free RNA liquid biopsies in cardiovascular disease. 心血管疾病中的核酸液体活检:心血管疾病中的无细胞 RNA 液体活检。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-05 DOI: 10.1016/j.atherosclerosis.2024.118584
Smriti Sharma, Tyler Artner, Klaus T Preissner, Irene M Lang

Cardiovascular diseases (CVD) and their complications continue to be the leading cause of mortality globally. With recent advancements in molecular analytics, individualized treatments are gradually applied to the diagnosis and treatment of CVD. In the field of diagnostics, liquid biopsy combined with modern analytical technologies is the most popular natural source to identify disease biomarkers, as has been successfully demonstrated in the cancer field. While it is not easy to obtain any diseased tissue for different types of CVD such as atherosclerosis, deep vein thrombosis or stroke, liquid biopsies provide a simple and non-invasive alternative to surgical tissue specimens to obtain dynamic molecular information reflecting disease states. The release of cell-free ribonucleic acids (cfRNA) from stressed/damaged/dying and/or necrotic cells is a common physiological phenomenon. CfRNAs are a heterogeneous population of various types of extracellular RNA found in body fluids (blood, urine, saliva, cerebrospinal fluid) or in association with vascular/atherosclerotic tissue, offering insights into disease pathology on a diagnostic front. In particular, cf-ribosomal RNA has been shown to act as a damaging molecule in several cardio-vascular disease conditions. Moreover, such pathophysiological functions of cfRNA in CVD have been successfully antagonized by the administration of RNases. In this review, we discuss the origin, structure, types, and potential utilization of cfRNA in the diagnosis of CVD. Together with the analysis of established CVD biomarkers, the profiling of cfRNA in body fluids may thereby provide a promising approach for early disease detection and monitoring.

心血管疾病(CVD)及其并发症仍然是全球死亡的主要原因。随着分子分析技术的不断进步,个体化治疗逐渐应用于心血管疾病的诊断和治疗。在诊断领域,液体活检与现代分析技术相结合,是确定疾病生物标志物最常用的天然来源,这一点已在癌症领域得到成功验证。虽然获取动脉粥样硬化、深静脉血栓或中风等不同类型心血管疾病的病变组织并不容易,但液体活检为获取反映疾病状态的动态分子信息提供了一种简单、无创的替代手术组织标本的方法。受压/受损/萎缩和/或坏死细胞释放出细胞游离核糖核酸(cfRNA)是一种常见的生理现象。CfRNA 是体液(血液、尿液、唾液、脑脊液)中或与血管/动脉粥样硬化组织相关的各种细胞外 RNA 的异质群,可提供诊断方面的疾病病理信息。特别是,cf-核糖体 RNA 已被证明在几种心血管疾病中起着破坏分子的作用。此外,cfRNA 在心血管疾病中的这些病理生理功能已被 RNase 成功拮抗。在这篇综述中,我们将讨论 cfRNA 的起源、结构、类型以及在心血管疾病诊断中的潜在用途。结合对已确定的心血管疾病生物标志物的分析,体液中的 cfRNA 分析可能会为疾病的早期检测和监测提供一种前景广阔的方法。
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Atherosclerosis
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