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The Impact of Remote Ischemic Preconditioning on Inflammation Markers in Patients Undergoing Coronary Artery Bypass Grafting. 远程缺血预处理对冠状动脉旁路移植术患者炎症标志物的影响
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-10-11 DOI: 10.14740/cr1702
Cezar Luca, Alexandra Boieriu, Daniela Neculoiu, Diana Tint

Background: This study aimed to investigate if remote ischemic preconditioning reduces the inflammatory process on patients undergoing coronary artery bypass grafting (CABG).

Methods: We conducted a case-control study involving 80 patients, half of whom underwent ischemic preconditioning for severe coronary artery disease (CAD) and subsequently underwent CABG. We assessed interleukin (IL)-1 and IL-6 levels using the enzyme-linked immunosorbent assay (ELISA) method, high-sensitivity troponin I (hsTnI) using chemiluminescent immunoassay (CLIA), and C-reactive protein (CRP) using the turbidimetric method at three key time points: before surgery (visit 1 or V1), immediately postoperatively (visit 2 or V2), and 1 week postoperatively (visit 3 or V3) in all subjects.

Results: Ischemic preconditioned patients showed a significant decrease in proinflammatory markers (IL-1, IL-6) but not in CRP or hsTnI.

Conclusions: This study demonstrated that remote ischemic preconditioning significantly reduced the levels of specific proinflammatory markers (IL-1 and IL-6), which may suggest general systemic protection. However, it did not demonstrate cardioprotection per se, as evidenced by the absence of a statistically significant decrease in hsTnI level.

背景:本研究旨在探讨远程缺血预处理能否减轻冠状动脉旁路移植术(CABG)患者的炎症过程:本研究旨在探讨远程缺血预处理是否能减少冠状动脉旁路移植术(CABG)患者的炎症过程:我们对 80 名患者进行了病例对照研究,其中一半患者因严重冠状动脉疾病(CAD)接受了缺血预处理,随后接受了 CABG。我们使用酶联免疫吸附测定法(ELISA)评估了所有受试者的白细胞介素(IL)-1 和 IL-6 水平,使用化学发光免疫测定法(CLIA)评估了高敏肌钙蛋白 I(hsTnI)水平,使用比浊法评估了所有受试者的 C 反应蛋白(CRP)水平:结果:缺血预处理患者的促炎症标志物(IL-1、IL-6)显著下降,但CRP或hsTnI没有下降:本研究表明,远端缺血预处理可显著降低特定促炎症标志物(IL-1 和 IL-6)的水平,这可能暗示了全身性保护。结论:该研究表明,远程缺血预处理能明显降低特定促炎症标志物(IL-1 和 IL-6)的水平,这可能提示了全身保护作用,但它本身并没有显示出心脏保护作用,这一点从 hsTnI 水平没有出现统计学意义上的显著下降可以看出。
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引用次数: 0
Advances in the Understanding and Treatment of Chronic Chagas Cardiomyopathy. 慢性恰加斯病心肌病的认识和治疗进展。
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-09-16 DOI: 10.14740/cr1665
Jordan Llerena-Velastegui, Almendra Lopez-Usina, Camila Mantilla-Cisneros

Chronic Chagas cardiomyopathy (CCC) poses significant health challenges not only in Latin America but also in non-endemic regions due to global migration. The complexity and severity of CCC call for an updated and thorough review to inform clinical practices and direct future research efforts. This review seeks to consolidate current knowledge on CCC, emphasizing diagnostic, therapeutic, and prognostic facets to facilitate better management and understanding of the disease. An exhaustive examination was conducted, analyzing peer-reviewed articles published between January 2020 and April 2024, sourced from prominent medical databases such as PubMed and Scopus. The review delineates crucial aspects of CCC pathophysiology, evaluates patient outcomes, identifies diagnostic challenges, and assesses treatment efficacy. Our findings prompt the need for revised clinical guidelines and stress the importance of continued research to enhance therapeutic strategies and disease comprehension. It is imperative that future studies address these identified gaps to advance patient care and treatment options for CCC.

慢性恰加斯病心肌病(CCC)不仅在拉丁美洲,而且还因全球移民而在非流行地区构成了重大的健康挑战。由于 CCC 的复杂性和严重性,需要对其进行全面的最新综述,以指导临床实践和未来的研究工作。本综述旨在整合当前有关 CCC 的知识,强调诊断、治疗和预后方面,以促进更好地管理和了解该疾病。本综述对 2020 年 1 月至 2024 年 4 月间发表的同行评审文章进行了详尽的分析,这些文章来自 PubMed 和 Scopus 等著名医学数据库。综述描述了 CCC 病理生理学的关键方面,评估了患者的预后,确定了诊断难题,并评估了治疗效果。我们的研究结果提示了修订临床指南的必要性,并强调了继续研究以提高治疗策略和疾病理解能力的重要性。当务之急是在未来的研究中解决这些已发现的不足,以推进对患者的护理和 CCC 的治疗方案。
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引用次数: 0
Detection of Left Atrial Remodeling by Three-Dimensional Echocardiography in Symptomatic Patients Known to Had Non-Obstructive Hypertrophic Cardiomyopathy. 通过三维超声心动图检测已知患有非结构性肥厚型心肌病的无症状患者的左心房重塑情况
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-08-31 DOI: 10.14740/cr1690
Taher Said Abd Elkareem, Shaimaa Habib, Amr Shehata, Fatma Elhady

Background: Hypertrophic cardiomyopathy (HCM) is one of the most prevalent inherited disorders and a common cause of sudden heart death. Left atrial (LA) dilatation frequently occurs in patients with HCM as a result of impaired left ventricular (LV) relaxation or associated involvement of LA myocardium in HCM.

Methods: We enrolled 170 patients known to had HCM (non-obstructive type) and 30 healthy subjects (control group). All of them underwent two-dimensional (2D) echocardiography to measure LV dimensions, function, LA dimension, LA deformations, pulmonary artery pressure (PAP) and LV global longitudinal strain (LVGLS). LA volumes and mechanics were also measured by three-dimensional (3D) echocardiography.

Results: By 2D echocardiography, patient group revealed significantly lower all LA functions vs. control group including reservoir (26 ± 4 vs. 43 ± 3, P < 0.001), conduit (-14 ± 2 vs. -25 ± 2, P < 0.001), and booster pump functions (-12 ± 2 vs. -18 ± 1, P < 0.001). PAP was significantly higher in patient group (42 ± 7 vs. 27 ± 4 in control group). LVGLS was significantly lower in patient group (-15±1.4% vs. -23±2% in control group). Using 3D speckle tracking echocardiography (STE), there were a significantly higher indexed maximum LA volume (Vmax indexed) (43.5 ± 5.6 vs. 28.7 ± 3.7, P < 0.001), but significantly lower left atrial strain at reservoir function (LASr) (24 ± 4 vs. 41 ± 3, P < 0.001), left atrial strain at conduit function (LAScd) (-13 ± 2 vs. -24 ± 2, P < 0.001), and left atrial strain at contractile function (LASct) (-11 ± 2 vs. -18 ± 1, P < 0.001).

Conclusion: Three-dimensional transthoracic echocardiography (TTE) is a feasible method for the assessment of LA remodeling, but there is adverse LA remodeling in patients with long-standing non-obstructive HCM including impaired all LA mechanics and with increased septal thickness, there are more diastolic dysfunction and more reduction of LA mechanics.

背景:肥厚型心肌病(HCM)是最常见的遗传性疾病之一,也是心脏猝死的常见原因。由于左心室(LV)松弛功能受损或 LA 心肌受累,HCM 患者经常会出现左心房(LA)扩张:我们招募了 170 名已知患有 HCM(非阻塞型)的患者和 30 名健康受试者(对照组)。所有患者均接受了二维(2D)超声心动图检查,以测量左心室尺寸、功能、LA 尺寸、LA 变形、肺动脉压力(PAP)和左心室整体纵向应变(LVGLS)。三维超声心动图还测量了LA容积和力学:二维超声心动图显示,患者组的所有 LA 功能均明显低于对照组,包括储腔(26 ± 4 vs. 43 ± 3,P < 0.001)、导管(-14 ± 2 vs. -25 ± 2,P < 0.001)和增压泵功能(-12 ± 2 vs. -18 ± 1,P < 0.001)。患者组的 PAP 明显较高(42 ± 7 对对照组的 27 ± 4)。患者组的 LVGLS 明显降低(-15±1.4% 对对照组的 -23±2%)。使用三维斑点追踪超声心动图(STE),患者组的指数化最大 LA 容积(Vmax indexed)明显高于对照组(43.5 ± 5.6 vs. 28.7 ± 3.7,P < 0.001),但左心房储血功能应变(LASr)明显低于对照组(24 ± 4 vs. 41 ± 3,P < 0.001)。41±3,P<0.001)、导管功能(LAScd)(-13±2 vs. -24±2,P<0.001)和收缩功能(LASct)(-11±2 vs. -18±1,P<0.001)时的左房应变:结论:三维经胸超声心动图(TTE)是评估 LA 重塑的一种可行方法,但长期非阻塞性 HCM 患者存在不利的 LA 重塑,包括所有 LA 力学性能受损,且随着室间隔厚度增加,舒张功能障碍和 LA 力学性能降低的程度也会增加。
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引用次数: 0
Evaluating the Prognostic Value of the Modified H2FPEF Score in Patients With Heart Failure With Preserved Ejection Fraction. 评估改良 H2FPEF 评分对射血分数保留型心力衰竭患者的预后价值
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-09-16 DOI: 10.14740/cr1635
Ya Qiong Jin, Lu Geng, Yue Li, Ke Ke Wang, Bing Xiao, Meng Xiao Wang, Xue Ying Gao, Jie Zhang, Xiu Chun Yang, Jing Chao Lu

Background: The H2FPEF score, a convenient tool developed for diagnosing heart failure with preserved ejection fraction (HFpEF), exhibited useful prognostic utility in HFpEF. However, the applicability and the prognostic value of the H2FPEF score in Chinese HFpEF patients have yet to be fully confirmed. The study aimed to evaluate the effect of modified H2FPEF score on the prognosis of Chinese HFpEF patients.

Methods: In this retrospective study, we calculated the H2FPEF scores by body mass index (BMI) ≥ 25 kg/m2 and 30 kg/m2 respectively, for 497 consecutive HFpEF patients in China. Subjects were divided into low- (0 - 3 points), intermediate- (4 - 6 points), and high-score (7 - 9 points) groups. The primary and secondary endpoints were heart failure (HF)-related events and acute coronary syndrome (ACS), respectively. Cox proportional hazard models were applied to calculate hazard ratios (HRs). Receiver operating characteristic (ROC) curves and areas under the curve (AUC) were used to evaluate the prediction of the H2FPEF score for adverse outcomes.

Results: Over a mean follow-up of 40.46 ± 6.52 months, the primary and secondary endpoints occurred in 168 patients (33.8%) and 97 patients (19.5%), respectively. By the definition of obesity as BMI ≥ 25 kg/m2, a higher incidence of HF-related events and ACS was observed among those with a higher modified H2FPEF score. The modified H2FPEF significantly predicted HF-related events (AUC: 0.723; 95% confidence interval (CI): 0.676 - 0.770; P < 0.001) and ACS (AUC: 0.670; 95% CI: 0.608 - 0.731; P < 0.014) with higher power than the H2FPEF score calculated by BMI ≥ 30 kg/m2. The cutoff of the modified H2FPEF score was 6.5 for detecting HF-related events and ACS.

Conclusions: The modified H2FPEF score, using BMI ≥ 25 kg/m2 to define obesity, could more effectively predict the occurrence of subsequent cardiovascular events in Chinese HFpEF patients. The modified H2FPEF score above 6.5 is a risk factor for adverse cardiovascular events in HFpEF patients.

背景H2FPEF 评分是一种用于诊断射血分数保留型心力衰竭(HFpEF)的简便工具,对 HFpEF 的预后具有实用价值。然而,H2FPEF 评分在中国 HFpEF 患者中的适用性和预后价值尚未得到充分证实。本研究旨在评估改良后的H2FPEF评分对中国HFpEF患者预后的影响:在这项回顾性研究中,我们按照体重指数(BMI)≥25 kg/m2和30 kg/m2分别计算了497名中国连续HFpEF患者的H2FPEF评分。受试者被分为低分(0 - 3 分)、中分(4 - 6 分)和高分(7 - 9 分)组。主要和次要终点分别为心衰(HF)相关事件和急性冠状动脉综合征(ACS)。采用 Cox 比例危险模型计算危险比(HRs)。接收者操作特征曲线(ROC)和曲线下面积(AUC)用于评估H2FPEF评分对不良后果的预测:在平均 40.46 ± 6.52 个月的随访期间,分别有 168 名患者(33.8%)和 97 名患者(19.5%)出现主要和次要终点。肥胖的定义是体重指数(BMI)≥ 25 kg/m2,在改良 H2FPEF 评分较高的患者中观察到较高的心房颤动相关事件和 ACS 发生率。改良 H2FPEF 能显著预测心房颤动相关事件(AUC:AUC:0.723;95% 置信区间 (CI):0.676 - 0.770;P < 0.001)和 ACS(AUC:0.670;95% CI:0.608 - 0.731;P < 0.014),预测能力高于按体重指数≥ 30 kg/m2 计算的 H2FPEF 评分。修改后的 H2FPEF 评分的临界值为 6.5,可用于检测 HF 相关事件和 ACS:结论:以体重指数≥25 kg/m2定义肥胖的改良H2FPEF评分能更有效地预测中国HFpEF患者后续心血管事件的发生。修改后的H2FPEF评分超过6.5分是HFpEF患者发生不良心血管事件的风险因素。
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引用次数: 0
Fibroblast Growth Factor 21 Suppressed Neutrophil Extracellular Traps Induced by Myocardial Ischemia/Reperfusion Injury via Adenosine Monophosphate-Activated Protein Kinase. 成纤维细胞生长因子 21 通过单磷酸腺苷激活的蛋白激酶抑制心肌缺血/再灌注损伤诱发的中性粒细胞胞外陷阱
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-10-11 DOI: 10.14740/cr1705
Ling Yun Gu, Cheng Gao Jia, Zuo Zhen Sheng, Wen Long Jiang, Zhuo Wen Xu, Wei Zhang Li, Jun You Cui, Hua Zhang

Background: Previous investigations have established the anti-inflammatory properties of fibroblast growth factor 21 (FGF21). However, the specific mechanism through which FGF21 mitigates myocardial ischemia/reperfusion (I/R) injury by inhibiting neutrophil extracellular traps (NETs) remains unclear.

Methods: A mice model of myocardial I/R injury was induced, and myocardial tissue was stained with immunofluorescence to assess NETs. Serum NETs levels were quantified using a PicoGreen kit. In addition, the expression levels of adenosine monophosphate (AMP)-activated protein kinase (AMPK) and FGF21 were evaluated by Wes fully automated protein blotting quantitative analysis system. Moreover, a hypoxia/reoxygenation (H/R) model was established using AMPK inhibitor and agonist pretreated H9c2 cells to further explore the relationship between FGF21 and AMPK.

Results: Compared with the control group, serum NETs levels were significantly higher in I/R mice, and a large number of NETs were formed in myocardial tissues (97.63 ± 11.45 vs. 69.65 ± 3.33, P < 0.05). However, NETs levels were reversed in FGF21 pretreated mice (P < 0.05). Further studies showed that FGF21 enhanced AMPK expression, which was significantly increased after inhibition of AMPK and decreased after promotion of AMPK (P < 0.05).

Conclusions: FGF21 may exert cardioprotective effects by inhibiting I/R injury-induced NETs via AMPK.

背景:先前的研究已证实成纤维细胞生长因子 21(FGF21)具有抗炎特性。然而,FGF21通过抑制中性粒细胞胞外捕获物(NETs)减轻心肌缺血再灌注(I/R)损伤的具体机制仍不清楚:方法:诱导小鼠心肌I/R损伤模型,用免疫荧光染色心肌组织以评估NETs。使用 PicoGreen 试剂盒对血清 NETs 水平进行量化。此外,单磷酸腺苷(AMP)活化蛋白激酶(AMPK)和 FGF21 的表达水平也通过 Wes 全自动蛋白印迹定量分析系统进行了评估。此外,还利用AMPK抑制剂和激动剂预处理的H9c2细胞建立了缺氧/再氧合(H/R)模型,以进一步探讨FGF21与AMPK之间的关系:结果:与对照组相比,I/R小鼠血清NETs水平明显升高,心肌组织中形成了大量NETs(97.63 ± 11.45 vs. 69.65 ± 3.33,P < 0.05)。然而,FGF21 预处理小鼠的 NETs 水平得到逆转(P < 0.05)。进一步的研究表明,FGF21能增强AMPK的表达,抑制AMPK后,NETs表达显著增加,而促进AMPK后,NETs表达减少(P<0.05):结论:FGF21可通过AMPK抑制I/R损伤诱导的NET,从而发挥心脏保护作用。
{"title":"Fibroblast Growth Factor 21 Suppressed Neutrophil Extracellular Traps Induced by Myocardial Ischemia/Reperfusion Injury via Adenosine Monophosphate-Activated Protein Kinase.","authors":"Ling Yun Gu, Cheng Gao Jia, Zuo Zhen Sheng, Wen Long Jiang, Zhuo Wen Xu, Wei Zhang Li, Jun You Cui, Hua Zhang","doi":"10.14740/cr1705","DOIUrl":"https://doi.org/10.14740/cr1705","url":null,"abstract":"<p><strong>Background: </strong>Previous investigations have established the anti-inflammatory properties of fibroblast growth factor 21 (FGF21). However, the specific mechanism through which FGF21 mitigates myocardial ischemia/reperfusion (I/R) injury by inhibiting neutrophil extracellular traps (NETs) remains unclear.</p><p><strong>Methods: </strong>A mice model of myocardial I/R injury was induced, and myocardial tissue was stained with immunofluorescence to assess NETs. Serum NETs levels were quantified using a PicoGreen kit. In addition, the expression levels of adenosine monophosphate (AMP)-activated protein kinase (AMPK) and FGF21 were evaluated by Wes fully automated protein blotting quantitative analysis system. Moreover, a hypoxia/reoxygenation (H/R) model was established using AMPK inhibitor and agonist pretreated H9c2 cells to further explore the relationship between FGF21 and AMPK.</p><p><strong>Results: </strong>Compared with the control group, serum NETs levels were significantly higher in I/R mice, and a large number of NETs were formed in myocardial tissues (97.63 ± 11.45 vs. 69.65 ± 3.33, P < 0.05). However, NETs levels were reversed in FGF21 pretreated mice (P < 0.05). Further studies showed that FGF21 enhanced AMPK expression, which was significantly increased after inhibition of AMPK and decreased after promotion of AMPK (P < 0.05).</p><p><strong>Conclusions: </strong>FGF21 may exert cardioprotective effects by inhibiting I/R injury-induced NETs via AMPK.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"15 5","pages":"404-414"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458599","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}
引用次数: 0
Prevalence, Clinical Manifestations, and Adverse Outcomes of Left Ventricular Noncompaction in Adults: A Systematic Review and Meta-Analysis. 成人左心室不充盈的患病率、临床表现和不良后果:系统回顾与元分析》。
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-09-16 DOI: 10.14740/cr1673
Jordan Llerena-Velastegui, Almendra Lopez-Usina, Camila Mantilla-Cisneros

Background: Left ventricular noncompaction (LVNC) is recognized within the spectrum of adult cardiomyopathies for its unique pathophysiologic features and clinical challenges. This condition exhibits a wide range of clinical manifestations, from asymptomatic states to severe cardiovascular complications, making its diagnosis and management challenging. This study aimed to synthesize current data on the prevalence, diagnostic methods, clinical outcomes, and treatment efficacy of LVNC in adults to address gaps in understanding and management strategies.

Methods: A systematic review and meta-analysis of research from 2000 to March 2024 was conducted, focusing on studies involving adults diagnosed with LVNC. This approach aimed to collect data on the prevalence of LVNC, the diagnostic accuracy of different imaging modalities, clinical manifestations, and the impact of different treatment strategies.

Results: The study showed a prevalence of LVNC of 0.5%, with cardiovascular magnetic resonance outperforming echocardiography in diagnosis with a detection rate of 1.3%. Mortality and heart transplantation rates were 12% and 7%, respectively. Significant predictors of adverse outcomes included New York Heart Association (NYHA) class III or IV, ventricular tachycardia, and reduced left ventricular ejection fraction (LVEF), guiding a nuanced approach in tailoring therapeutic strategies to optimize patient care and outcomes.

Conclusions: This study advances the understanding of LVNC by refining diagnostic criteria and evaluating management strategies, highlighting the superiority of cardiovascular magnetic resonance. It identifies predictors of adverse outcomes and assesses treatment efficacy, urging precision in diagnosis and tailored treatments. Its comprehensive analysis and methodological rigor make it a key resource advocating a multidisciplinary approach to improve patient outcomes in LVNC.

背景:左心室非充盈(LVNC)因其独特的病理生理特点和临床挑战而被认为是成人心肌病中的一种。这种疾病的临床表现范围很广,从无症状状态到严重的心血管并发症,因此其诊断和管理具有挑战性。本研究旨在综合目前有关成人 LVNC 的患病率、诊断方法、临床结果和治疗效果的数据,以弥补认识和管理策略上的不足:方法: 对 2000 年至 2024 年 3 月期间的研究进行了系统回顾和荟萃分析,重点关注涉及成人 LVNC 诊断的研究。这种方法旨在收集有关 LVNC 患病率、不同成像模式的诊断准确性、临床表现以及不同治疗策略的影响的数据:研究显示,LVNC 的发病率为 0.5%,心血管磁共振的诊断率高于超声心动图,检出率为 1.3%。死亡率和心脏移植率分别为12%和7%。不良预后的重要预测因素包括纽约心脏协会(NYHA)III级或IV级、室性心动过速和左室射血分数(LVEF)降低,这为定制治疗策略提供了细致入微的指导,以优化患者护理和预后:这项研究通过完善诊断标准和评估管理策略,促进了对 LVNC 的了解,凸显了心血管磁共振的优越性。它确定了不良后果的预测因素并评估了治疗效果,促进了诊断的精确性和治疗的针对性。该研究分析全面、方法严谨,是倡导多学科方法改善 LVNC 患者预后的重要资料。
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引用次数: 0
Unveiling the Link: Hypocalcemia-Induced Unstable Sustained Ventricular Tachycardia in Nonischemic Cardiomyopathy. 揭示联系:低钙血症诱发的非缺血性心肌病不稳定持续性室性心动过速。
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI: 10.14740/cr1683
Joel Shah, Kahtan Fadah, Jan M Lopes, Moeen Abedin

A 63-year-old female presented to a freestanding emergency room with dizziness, palpitations, and hypotension, The patient was found to have an irregular wide complex tachycardia, consistent with ventricular tachycardia, hypomagnesemia and severe hypocalcemia. The tachycardia was refractory to treatment with IV amiodarone and magnesium, and only resolved with correction of the serum calcium. Review of the medical record revealed an echocardiogram 19 years earlier reporting left ventricular dysfunction. The patient was unaware of this diagnosis and was not taking medical therapy. Echocardiogram revealed no significant change in left ventricular function, and coronary angiography showed no significant coronary artery disease. The patient's nonischemic cardiomyopathy may have been a predisposing factor for the arrhythmia presentation. We explore a hospital admission involving the rare association of hypocalcemia and monomorphic ventricular tachycardia, which is not well documented in the literature.

一名 63 岁的女性因头晕、心悸和低血压到独立急诊室就诊,发现患者有不规则宽复律心动过速,符合室性心动过速、低镁血症和严重低钙血症的症状。心动过速对静脉注射胺碘酮和镁治疗无效,只有在纠正血清钙后才会缓解。查看病历发现,19 年前的超声心动图报告显示患者左心室功能障碍。患者并不知道这一诊断,也没有接受治疗。超声心动图显示左心室功能无明显变化,冠状动脉造影显示无明显冠状动脉疾病。患者的非缺血性心肌病可能是心律失常的诱发因素。我们探讨了一起罕见的低钙血症与单型室性心动过速相关的入院病例,该病例在文献中并无详细记载。
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引用次数: 0
Efficacy of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors in Non-Ischemic Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis. β-受体阻滞剂和血管紧张素转换酶抑制剂对非缺血性扩张型心肌病的疗效:系统回顾与元分析》。
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI: 10.14740/cr1653
Jordan Llerena-Velastegui, Melisa Santamaria-Lasso, Melany Mejia-Mora, Mauricio Santander-Aldean, Andrea Granda-Munoz, Claudia Hurtado-Alzate, Ana Clara Fonseca Souza de Jesus, Jurgen Baldelomar-Ortiz

Background: Non-ischemic dilated cardiomyopathy (NIDCM) is a form of heart failure with a poor prognosis and unclear optimal management. The aim of the study was to systematically review the literature and assess the efficacy and safety of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in the management of chronic heart failure secondary to NIDCM and explore their putative mechanisms of action.

Methods: Studies from 1990 to 2023 were reviewed using PubMed and EMBASE, focusing on their effects on left ventricular ejection fraction (LVEF) in NIDCM patients, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Beta-blockers showed a significant beneficial effect on LVEF improvement in NIDCM, with an overall effect size of Cohen's d = 1.30, 95% confidence interval (CI) (0.76, 1.84), high heterogeneity (Tau2 = 0.90; Chi2 = 162.05, df = 13, P < 0.00001; I2 = 92%), and a significant overall effect (Z = 4.72, P < 0.00001). ACE inhibitors also showed a beneficial role, but with less heterogeneity (Tau2 = 0.02; Chi2 = 1.09, df = 1, P = 0.30; I2 = 8%) and a nonsignificant overall effect (Z = 1.36, P = 0.17), 95% CI (-0.24, 1.31).

Conclusions: The study highlights the efficacy of carvedilol in improving LVEF in NIDCM patients over ACE inhibitors, recommends beta-blockers as first-line therapy, and advocates further research on ACE inhibitors.

背景:非缺血性扩张型心肌病(NIDCM)是一种预后不良、最佳治疗方法不明确的心力衰竭。本研究旨在系统回顾文献,评估β-受体阻滞剂和血管紧张素转换酶(ACE)抑制剂在治疗 NIDCM 继发性慢性心力衰竭中的疗效和安全性,并探讨其可能的作用机制:根据系统综述和荟萃分析首选报告项目(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,使用 PubMed 和 EMBASE 对 1990 年至 2023 年的研究进行了综述,重点关注它们对 NIDCM 患者左心室射血分数(LVEF)的影响:贝塔受体阻滞剂对改善 NIDCM 患者的 LVEF 有显著的有益作用,其总体效应大小为 Cohen's d = 1.30,95% 置信区间 (CI) (0.76, 1.84),异质性较高 (Tau2 = 0.90; Chi2 = 162.05, df = 13, P < 0.00001; I2 = 92%),总体效应显著 (Z = 4.72, P < 0.00001)。ACE 抑制剂也显示出有益作用,但异质性较小(Tau2 = 0.02;Chi2 = 1.09,df = 1,P = 0.30;I2 = 8%),总体效果不显著(Z = 1.36,P = 0.17),95% CI (-0.24, 1.31):该研究强调了卡维地洛改善 NIDCM 患者 LVEF 的疗效优于 ACE 抑制剂,建议将β-受体阻滞剂作为一线治疗药物,并提倡对 ACE 抑制剂进行进一步研究。
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引用次数: 0
Patients With ST-Segment Elevation Myocardial Infarction and Cerebrovascular Accidents: Impact of COVID-19 Vaccination on Mortality. ST段抬高心肌梗死和脑血管意外患者:接种 COVID-19 疫苗对死亡率的影响。
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-08-20 DOI: 10.14740/cr1688
Sharvil Patel, Mahmoud Ballout, Sandus Khan, Shane Robinson, Alex M Adams, Ania Rynarzewska, John E Delzell

Background: Coronavirus disease 2019 (COVID-19) infection is associated with proinflammatory states and adverse health outcomes such as ST-segment elevation myocardial infarction (STEMI) and cerebrovascular accidents (CVA). Limited evidence suggests that COVID-19 vaccination may decrease the adverse impact of COVID-19 infections. This study was designed to determine if patients who received COVID-19 vaccination had lower mortality from STEMI and CVA.

Methods: This is a retrospective comparative analysis of 3,050 patients, who were admitted to the hospital and diagnosed with STEMI or CVA between April 1, 2019, and April 1, 2022. Patients were divided into three different timeframes: pre-COVID (April 1, 2019, to March 31, 2020), COVID (April 1, 2020 to March 31, 2021), and post-COVID (April 1, 2021 to March 31, 2022). Chi-square analysis was completed to analyze associations between STEMI, CVA, and vaccination status. A multinominal logistic regression was used to determine significant predictors for in-hospital mortality.

Results: A total of 3,050 patients were admitted (1,873 STEMI and 1,177 CVA). STEMI accounted for about 60% of cases in each of the three time periods. There was no statistical difference in STEMI or CVA percentages in the three time periods. There was increased mortality in STEMI and CVA patients (odds ratio (OR) = 11.4; P < 0.001), but patients who received the COVID-19 vaccine were less likely to die (OR = 0.51, 95% confidence interval (CI): 0.28 - 0.93; P < 0.027) when compared to those who were unvaccinated. There was increased risk of death in patients with atrial fibrillation (AFIB) (OR = 2.43; P < 0.001) and chronic heart failure (CHF) (OR = 1.76; P = 0.004). There was increased mortality risk associated with age (OR =1.03; P = 0.001). Patients with coronary artery disease (CAD) (OR = 0.45; P = 0.014) and hyperlipidemia (OR = 0.29; P < 0.001) were less likely to die.

Conclusions: Vaccination against COVID-19 was associated with reduced mortality rates in patients hospitalized with STEMI and CVA. Patients with pre-existing cardiovascular comorbidities such as CAD and hyperlipidemia also had lower mortality.

背景:2019年冠状病毒病(COVID-19)感染与促炎症状态和不良健康后果有关,如ST段抬高型心肌梗死(STEMI)和脑血管意外(CVA)。有限的证据表明,接种 COVID-19 疫苗可降低 COVID-19 感染的不良影响。本研究旨在确定接种 COVID-19 疫苗的患者是否会降低 STEMI 和 CVA 的死亡率:本研究对 2019 年 4 月 1 日至 2022 年 4 月 1 日期间入院并被诊断为 STEMI 或 CVA 的 3050 名患者进行了回顾性比较分析。患者被分为三个不同的时间段:COVID 前(2019 年 4 月 1 日至 2020 年 3 月 31 日)、COVID(2020 年 4 月 1 日至 2021 年 3 月 31 日)和 COVID 后(2021 年 4 月 1 日至 2022 年 3 月 31 日)。为分析 STEMI、CVA 和疫苗接种状况之间的关联,我们进行了卡方分析。多项式逻辑回归用于确定院内死亡率的重要预测因素:共收治了 3,050 名患者(1,873 名 STEMI 和 1,177 名 CVA)。在这三个时间段中,STEMI 约占 60%。三个时间段的 STEMI 和 CVA 百分比没有统计学差异。STEMI 和 CVA 患者的死亡率增加(几率比 (OR) = 11.4;P < 0.001),但与未接种疫苗的患者相比,接种 COVID-19 疫苗的患者死亡的可能性较低(OR = 0.51,95% 置信区间 (CI):0.28 - 0.93;P < 0.027)。心房颤动(AFIB)(OR = 2.43;P < 0.001)和慢性心力衰竭(CHF)(OR = 1.76;P = 0.004)患者的死亡风险增加。年龄越大,死亡风险越高(OR = 1.03;P = 0.001)。患有冠状动脉疾病(CAD)(OR = 0.45;P = 0.014)和高脂血症(OR = 0.29;P < 0.001)的患者死亡几率较低:结论:接种COVID-19疫苗可降低STEMI和CVA住院患者的死亡率。结论:接种COVID-19疫苗与降低STEMI和CVA住院患者的死亡率有关,原有心血管合并症(如CAD和高脂血症)的患者死亡率也较低。
{"title":"Patients With ST-Segment Elevation Myocardial Infarction and Cerebrovascular Accidents: Impact of COVID-19 Vaccination on Mortality.","authors":"Sharvil Patel, Mahmoud Ballout, Sandus Khan, Shane Robinson, Alex M Adams, Ania Rynarzewska, John E Delzell","doi":"10.14740/cr1688","DOIUrl":"10.14740/cr1688","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) infection is associated with proinflammatory states and adverse health outcomes such as ST-segment elevation myocardial infarction (STEMI) and cerebrovascular accidents (CVA). Limited evidence suggests that COVID-19 vaccination may decrease the adverse impact of COVID-19 infections. This study was designed to determine if patients who received COVID-19 vaccination had lower mortality from STEMI and CVA.</p><p><strong>Methods: </strong>This is a retrospective comparative analysis of 3,050 patients, who were admitted to the hospital and diagnosed with STEMI or CVA between April 1, 2019, and April 1, 2022. Patients were divided into three different timeframes: pre-COVID (April 1, 2019, to March 31, 2020), COVID (April 1, 2020 to March 31, 2021), and post-COVID (April 1, 2021 to March 31, 2022). Chi-square analysis was completed to analyze associations between STEMI, CVA, and vaccination status. A multinominal logistic regression was used to determine significant predictors for in-hospital mortality.</p><p><strong>Results: </strong>A total of 3,050 patients were admitted (1,873 STEMI and 1,177 CVA). STEMI accounted for about 60% of cases in each of the three time periods. There was no statistical difference in STEMI or CVA percentages in the three time periods. There was increased mortality in STEMI and CVA patients (odds ratio (OR) = 11.4; P < 0.001), but patients who received the COVID-19 vaccine were less likely to die (OR = 0.51, 95% confidence interval (CI): 0.28 - 0.93; P < 0.027) when compared to those who were unvaccinated. There was increased risk of death in patients with atrial fibrillation (AFIB) (OR = 2.43; P < 0.001) and chronic heart failure (CHF) (OR = 1.76; P = 0.004). There was increased mortality risk associated with age (OR =1.03; P = 0.001). Patients with coronary artery disease (CAD) (OR = 0.45; P = 0.014) and hyperlipidemia (OR = 0.29; P < 0.001) were less likely to die.</p><p><strong>Conclusions: </strong>Vaccination against COVID-19 was associated with reduced mortality rates in patients hospitalized with STEMI and CVA. Patients with pre-existing cardiovascular comorbidities such as CAD and hyperlipidemia also had lower mortality.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"15 4","pages":"275-280"},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104599","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}
引用次数: 0
The Predictive Role of Cardiac Troponin Elevation Ratio Combined With Heart Function Index Model in the Prognosis of Non-ST-Segment Elevation Myocardial Infarction Patients. 心肌肌钙蛋白升高比值结合心功能指数模型对非ST段抬高型心肌梗死患者预后的预测作用
IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI: 10.14740/cr1639
Xian Jun Hu, Xiao Guang Sun, Jia Yuan Cheng, Jie Ma

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) is a common form of coronary artery disease, and its prognosis is influenced by multiple factors. This study aimed to analyze the predictive role of the combined application of cardiac troponin and cardiac function indices in NSTEMI patients' prognosis.

Methods: NSTEMI patients were screened and included in the study. Cardiac troponin elevation ratio (cardiac troponin I (cTnI)/upper limit of normal (ULN)) was measured upon admission, and cardiac function was assessed. General clinical data, laboratory parameters, Grace score, New York Heart Association (NYHA) functional class, complications, and mortality data were collected. The correlation between mortality in NSTEMI patients and clinical parameters was analyzed, and a nomogram prediction model for NSTEMI patient mortality was established.

Results: A total of 252 NSTEMI patients were included. Female gender, elevated high-sensitivity C-reactive protein (H-CRP), left ventricular ejection fraction (LVEF) < 50%, NYHA class III and IV, and cTnI/ULN elevation by 36.25-fold were significantly independently associated with mortality outcomes. Multifactorial logistic analysis indicated that these indices remained associated with mortality. A nomogram model predicting NSTEMI patient mortality was constructed using these indices, with an area under the curve (AUC) of 0.911, sensitivity of 97.5%, and specificity of 72.8%. This predictive model outperformed the Grace score (AUC = 0.840).

Conclusions: In NSTEMI patients, a 36.25-fold increase in cTnI/ULN, coupled with NYHA class III and IV, independently predicted prognosis. We developed a nomogram model integrating cTnI/ULN and cardiac function indices, aiding clinicians in assessing risk and implementing early interventions for improved outcomes.

背景:非ST段抬高型心肌梗死(NSTEMI)是冠心病的一种常见形式,其预后受多种因素影响。本研究旨在分析联合应用心肌肌钙蛋白和心功能指数对 NSTEMI 患者预后的预测作用:方法:筛选并纳入 NSTEMI 患者。入院时测量心肌肌钙蛋白升高比值(心肌肌钙蛋白 I(cTnI)/正常值上限(ULN)),并评估心功能。收集了一般临床数据、实验室参数、格雷斯评分、纽约心脏协会(NYHA)功能分级、并发症和死亡率数据。分析了 NSTEMI 患者死亡率与临床参数之间的相关性,并建立了 NSTEMI 患者死亡率的提名图预测模型:结果:共纳入 252 例 NSTEMI 患者。女性性别、高敏C反应蛋白(H-CRP)升高、左室射血分数(LVEF)小于50%、NYHA分级III级和IV级、cTnI/ULN升高36.25倍与死亡结果显著相关。多因素逻辑分析表明,这些指数仍与死亡率相关。利用这些指数构建了一个预测 NSTEMI 患者死亡率的提名图模型,其曲线下面积 (AUC) 为 0.911,灵敏度为 97.5%,特异性为 72.8%。该预测模型优于格雷斯评分(AUC = 0.840):结论:在 NSTEMI 患者中,cTnI/ULN 升高 36.25 倍,再加上 NYHA III 级和 IV 级,可独立预测预后。我们开发了一种整合了 cTnI/ULN 和心功能指数的提名图模型,可帮助临床医生评估风险并实施早期干预以改善预后。
{"title":"The Predictive Role of Cardiac Troponin Elevation Ratio Combined With Heart Function Index Model in the Prognosis of Non-ST-Segment Elevation Myocardial Infarction Patients.","authors":"Xian Jun Hu, Xiao Guang Sun, Jia Yuan Cheng, Jie Ma","doi":"10.14740/cr1639","DOIUrl":"10.14740/cr1639","url":null,"abstract":"<p><strong>Background: </strong>Non-ST-segment elevation myocardial infarction (NSTEMI) is a common form of coronary artery disease, and its prognosis is influenced by multiple factors. This study aimed to analyze the predictive role of the combined application of cardiac troponin and cardiac function indices in NSTEMI patients' prognosis.</p><p><strong>Methods: </strong>NSTEMI patients were screened and included in the study. Cardiac troponin elevation ratio (cardiac troponin I (cTnI)/upper limit of normal (ULN)) was measured upon admission, and cardiac function was assessed. General clinical data, laboratory parameters, Grace score, New York Heart Association (NYHA) functional class, complications, and mortality data were collected. The correlation between mortality in NSTEMI patients and clinical parameters was analyzed, and a nomogram prediction model for NSTEMI patient mortality was established.</p><p><strong>Results: </strong>A total of 252 NSTEMI patients were included. Female gender, elevated high-sensitivity C-reactive protein (H-CRP), left ventricular ejection fraction (LVEF) < 50%, NYHA class III and IV, and cTnI/ULN elevation by 36.25-fold were significantly independently associated with mortality outcomes. Multifactorial logistic analysis indicated that these indices remained associated with mortality. A nomogram model predicting NSTEMI patient mortality was constructed using these indices, with an area under the curve (AUC) of 0.911, sensitivity of 97.5%, and specificity of 72.8%. This predictive model outperformed the Grace score (AUC = 0.840).</p><p><strong>Conclusions: </strong>In NSTEMI patients, a 36.25-fold increase in cTnI/ULN, coupled with NYHA class III and IV, independently predicted prognosis. We developed a nomogram model integrating cTnI/ULN and cardiac function indices, aiding clinicians in assessing risk and implementing early interventions for improved outcomes.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"15 4","pages":"246-252"},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104603","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}
引用次数: 0
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Cardiology Research
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