Cardiology Research and Practice最新文献

Background: Ischemic heart disease and stroke kill 25% of people worldwide. Vitamin K antagonist (warfarin) is the most widely used oral anticoagulant. Although affordable and effective, its usage is limited in many patients due to anticoagulation level variability and other factors, its alternatives include new nonvitamin K antagonist oral anticoagulants (NOACs). The study aims to investigate NOAC usage barriers. Methods: This is an observational, cross-sectional study, involved 144 doctors from different specialties and different medical degrees in Khartoum state, the data were collected by an author designed close-ended questionnaire. Data were entered, cleared and analyzed using Statistical Package for Social Sciences (SPSS) V25.0 software. Results: Medicine was most common (45.8%) among 144 medical department participants. The most prevalent medical degrees were registrars (25%) and doctors (25%). Specialists (22.9%), then house officers (15.3%). Over half (51.4%) had worked less than 5 years. 50% did not know about the 2021 DOACs guideline. 60.4% claimed DOACs' unavailability inhibits prescription. The lack of a multidisciplinary team approach hinders DOACs prescription, said 70.2%. Conclusion: Sudanese clinicians' hurdles to using NOAC for thromboembolic episodes were explored. Lack of a reversal agent and multidisciplinary team approach hinder DOAC prescription. Lack of information about international guidelines, since most participant's preferred specialized advice or personal experience, and high DOAC costs and inaccessibility and unavailability are other important barriers. Medical practitioners should update guidelines and government insurance plans should include DOACs. Each department should start studies separately.

Introduction: There is no information on the potential of machine learning (ML)-based techniques to improve cardiovascular risk estimation in the Colombian population. This article presents innovative models using five artificial intelligence techniques: neural networks, decision trees, support vector machines, random forests, and Gaussian Bayesian networks. Methods: The research is based on a cohort of 847 patients free of cardiovascular disease at baseline and followed for cardiovascular disease events over 10 years at the Central Military Hospital in Bogotá, Colombia. To enhance the robustness and reduce the risk of overfitting, model evaluation was conducted using a 5-fold cross-validation on the entire dataset. Discriminatory ability was evaluated with the area under a ROC curve (AUC-ROC) for each ML-based model and the Framingham model. Results: Experimental results showed that the neural network technique had the best discriminative ability to predict cardiovascular events, with an AUC-ROC of 0.69 (CI 95% 0.622-0.759) for unbalanced data and 0.67 (CI 95% 0.601-0.754) for balanced data. Other ML techniques also showed good discriminatory ability with AUC-ROC values between 0.56 and 0.65, superior to that observed for the Framingham model (0.53; CI 95% 0.468-0.607). Conclusion: Our study supports the flexible ML approaches to cardiovascular risk prediction as a way forward for cardiovascular risk assessment in Colombia. Our data even suggest that risk prediction using these techniques could be even more discriminative than widely used risk-stimulation models such as Framingham, adapted to the Colombian population. However, new prospective studies need to validate our data before general implementation.

Background: Micro-oxygen therapy can reduce the effects of doxorubicin (DOX) on left ventricular function, cardiac fibrosis, inflammation, and oxidative stress in SD rats. These results suggest the potential of DOX for clinical use. Method: 8-week-old SPF-grade SD male rats were randomly divided into four groups: control group (Ctrl) (n = 10), doxorubicin group (DOX) (n = 10), doxorubicin + conventional oxygen intervention group (DOX+CO) (n = 10), doxorubicin + micropressed oxygen group (DOX+MO)) (n = 10). Left ventricular function was assessed by echocardiography 3 weeks after the end of treatment, and histopathological analysis was conducted utilizing Masson and hematoxylin-eosin (HE) staining. The mRNA expression levels of TGF-β1 and Collagen I were quantified by quantitative real-time PCR (qRT-PCR). Additionally, inflammatory markers, including the concentrations of IL-1β, IL-6, and TNF-α, as well as the activities of SOD and GSH-Px, were measured using enzyme-linked immunosorbent assay (ELISA). Results: The DOX + MO group significantly improved the symptoms of heart failure caused by DOX. The specific results are as follows: The EF significantly increased to 78.037 ± 1.283 (63.259 ± 8.855 in the DOX, p ≤ 0.0001); the IVSs increased from 0.243 ± 0.036 to 0.324 ± 0.038 (p ≤ 0.001); the LVPWs increased from 0.263 ± 0.028 to 0.323 ± 0.036 (p ≤ 0.01); the IVSd and the LVPWd increased from 0.171 ± 0.019 to 0.2 ± 0.015 (p ≤ 0.05) and from 0.181 ± 0.032 to 0.234 ± 0.026 (p ≤ 0.01). Among cardiac function indexes, NT-proBNP in DOX + MO group was significantly different from that in DOX group (p ≤ 0.0001). Compared with DOX group, the degree of myocardial fibrosis in DOX + MO group was decreased, and qRT-PCR showed that MO oxygen effectively reduced the mRNA expression of TGF-β1 and collagen1 induced by DOX. In terms of inflammatory indicators, TNF-α (p ≤ 0.0001), IL-1β (p ≤ 0.0001), and IL-6 (p ≤ 0.0001) in DOX + MO group were significantly lower than those in DOX group. In terms of oxidative stress, serum levels of SOD and GSH-PX were decreased in the DOX group, and MO oxygen therapy effectively prevented the reduction of these indexes. On the other hand, the experimental results also showed that DOX + MO group was significantly better than DOX + CO group in terms of cardiac function, inflammation, and oxidative stress. Conclusion: Microbaric oxygen therapy can reduce the effects of DOX on left ventricular function, cardiac fibrosis, inflammation, and oxidative stress in SD rats. These results provide support for clinical studies to evaluate the potential of DOX in clinical applications.

Background: The length of hospital stay (LOS) is frequently recognized as an indicator of hospital management efficiency and the quality of care. Patients with acute ischemic stroke (AIS) who experience prolonged LOS are at a higher risk of developing complications such as hospital-acquired infections and gastrointestinal bleeding. These complications can adversely affect clinical outcomes, acting as a primary determinant of poor functional outcomes. However, evidence regarding predictors of the LOS after AIS in Ethiopia is lacking. Objective: Therefore, the objective of this study was to assess clinical predictors of the LOS after AIS among patients admitted to Tibebe Ghion and Felege Hiwot Comprehensive Specialized Hospitals. Methods: A retrospective cohort study was conducted among patients diagnosed with AIS and treated at Tibebe Ghion and Felege Hiwot hospitals from November 2018 to November 2021. Multivariate linear regression analysis was employed to explore predictors of LOS. The slope of regression line (β) with its 95% CI is used to declare statistical significance. Results: Of the 278 patients with AIS, 59.7% were male. Stroke-related complications (aspiration pneumonia and urinary tract infections occurred in the hospital in 57 (20.5%), and 12 (4.3%), patients, respectively. The most common neurological deficit observed during hospital admission was limb weakness, affecting 268 patients (96%). The median LOS was 5 days. Among the clinical characteristics, atrial fibrillation (β = 7.337, 95% CI: 1.226, 13.448), Limp weakness (β = 4.831, 95% CI: 2.330, 7.332), aspiration pneumonia (β = 2.089, 95%CI: 1.178, 3.000) and Male sex (β = 1.696, 95% CI: 0.851, 2.542), were significant predictors of LOS. Conclusion: In this study, the presence of AF and stroke-related complications, such as aspirational pneumonia, were found to be significant predictors of LOS. Therefore, implementing efficient prevention strategies targeting potentially modifiable risk factors is essential to mitigate the impact of these factors.

Background: Many patients with coronary heart disease receive percutaneous coronary interventions. These interventions are accompanied by gastrointestinal bleeding that aggravates the disease. The hemoglobin-to-red cell distribution width ratio (HRR) is a novel inflammatory marker. We investigated HRR as a predictor of gastrointestinal bleeding after percutaneous coronary interventions. Methods: Patients (n = 1647) received percutaneous coronary interventions from January 2022 to December 2022 in Longyan First Hospital. The HRR was measured before the interventions. Indicators of patient general condition, biochemical indicators, concomitant diseases, and medication status were collected. Gastrointestinal bleeding within 1 year was assessed. Patients were divided into four groups based on HRR. Kendall's tau-b graded correlation was used to analyze the correlation between hemoglobin (Hb), red blood cell distribution width (RDW), HRR, and gastrointestinal bleeding in peripheral blood after percutaneous coronary intervention. Ordered logistic regression was used for analysis, with gastrointestinal bleeding as the outcome variable and Hb, RDW, and HRR as independent variables. To identify independent risk factors for gastrointestinal bleeding, data were adjusted for age, heart failure, hypertension, diabetes, atrial fibrillation, dyslipidemia, RBC, total cholesterol, triglycerides, LDL-C, creatinine, blood urea nitrogen, and uric acid. Multiple linear regression analysis of HRR, RDW, and Hb predicted gastrointestinal bleeding. Results: Of the 1647 study participants, 20 had gastrointestinal bleeding, 1.2% probability. In the HRR classification, there was a greater probability of gastrointestinal bleeding in the low HRR group after percutaneous coronary intervention. Conclusion: We found a low HRR and a high probability of gastrointestinal bleeding after percutaneous coronary intervention. The HRR could be used as an independent predictor of gastrointestinal bleeding.

Extrinsic heart compression by gastrointestinal (GI) structures is an often underrecognized finding in clinical practice. It is potentially related to unpredictable clinical conditions, ranging from incidental detection in asymptomatic subjects, to deranging and potentially life-threatening clinical manifestations. However, despite its potential clinical relevance, there is still no comprehensive analysis investigating the surrounding causes, clinical findings, and diagnostic imaging work-up for this patient population. A narrative review with an extensive bibliographic search of the literature was performed using PubMed (MEDLINE), Embase, and Cochrane Central Databases up to December 31, 2023. Despite the broad spectrum of GI etiologies, clinical manifestations, and cardiac chamber involvement scenarios, physicians must be aware of such an uncommon condition, in order to provide timely diagnosis through a comprehensive imaging approach, avoid misleading interpretations, and determine the most appropriate decision-making strategy.

Objective: The present study aims to elucidate the significance of immune cell infiltration in Coronavirus disease 2019 (COVID-19) myocarditis and identify potential diagnostic markers for this condition. Myocarditis, an inflammatory cardiac disease, primarily results from viral infections. Although the association between COVID-19 and myocarditis is well-established, the specific mechanism(s) underlying this relationship remain incompletely understood. Methods: The GSE53607 and GSE35182 datasets were obtained from the GEO database, which contains samples from a mouse model for viral myocarditis. Differentially expressed genes (DEGs) and candidate biomarkers were selected using the LASSO regression model and support vector machine recursive feature elimination (SVM-RFE) analysis. Subsequently, the diagnostic potential of these biomarkers was evaluated by calculating the area under the receiver operating characteristic curve (AUC). Further validation of the biomarkers was conducted using the GSE183850 dataset, which consists of samples from patients with COVID-19 myocarditis. In addition, CIBERSORT analysis was employed to estimate the compositional patterns of 22 types of immune cell fractions in merged cohorts. Results: Thirty genes were identified, with a significant proportion of the DEGs being associated with carbohydrate binding, endopeptidase activity, and pathogenic organisms such as Staphylococcus aureus and coronavirus disease. Importantly, gene sets related to the IL6-JAK-STAT3 signaling pathways, inflammatory response, and interferon response exhibited differential activation in viral myocarditis compared to the control group. In addition, in the context of COVID-19 myocarditis patients from the GSE183850 dataset, B2M and C3 were established as diagnostic markers that were subsequently validated (AUC = 0.978 and AUC = 0.956, respectively). Furthermore, analysis of immune cell infiltration revealed correlations between B2M and C3 expression levels and the activation of NK cells, dendritic cells, T cells CD4 memory resting, as well as eosinophils. Conclusion: B2M and C3 have been identified as potential biomarkers for viral myocarditis, providing valuable insights for future investigations into the pathogenesis of COVID-19-associated myocarditis.

Objective: To investigate the relationship between methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism and coronary heart disease (CHD) in the elderly patients living in the coastal area of eastern Zhejiang Province in China. Methods: From September 2021 to May 2022, 163 elderly patients (male ≥ 55 years old, female ≥ 65 years old) admitted to the cardiology department in the Ningbo Lihuili Hospital were collected. Among these patients, 90 patients were diagnosed with CHD (CHD group) and 79 patients did not have CHD (control group). The homocysteine (Hcy) level was measured by the blood biochemical test, and the MTHFR genotype was detected by the PCR fluorescence probe method. Results: Compared with the control group, the CHD group showed a significantly higher distribution frequency of TT genotype (X ² = 5.137, p < 0.05) and a lower frequency of CC genotype (X ² = 6.560, p < 0.05), indicating that elderly people with MTHFR677 TT genotype are more likely to have CHD. In addition, the Hcy level of TT genotype in the CHD group and the control group were both obviously higher than that of CT genotype and CC genotype (p < 0.05). Finally, the univariate and multivariate logistic regression analyses showed that gender, hypertension, diabetes, and MTHFR677 TT genotype were independent risk factors for CHD (p < 0.05). Conclusion: MTHFR C677T mutation is significantly associated with the serum Hcy, and is an important genetic risk for CHD development in the elderly people living in the coastal area of eastern Zhejiang province, China.

Objective: Recurrence of pericardial effusion is possible despite the successful completion of pericardiocentesis and initiation of treatment. Predicting recurrence is important for determining treatment strategies. This study aimed to examine the factors that influence the recurrence of effusion in patients who had undergone pericardiocentesis. Method: A total of 113 patients with the evidence of tamponade or pericardial effusion over 10 mm were included in the study. The mean follow-up period was 49 months. Patients with and without recurrent effusion were divided into two groups. PNI calculation (PNI = 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (mm³) formula was used. Results: Recurrent pericardial effusion was observed in 30 patients during the follow-up period. There was no difference in age, gender, hypertension, LVEF%, hypertension, and appearance of fluid when the two groups were compared. There was a difference in PNI score and presence of malignancy between the two groups (p: 0.031 and 0.042, respectively). Multivariate logistic regression showed that malignancy and PNI score were independent predictors of recurrence in patients undergoing pericardiocentesis (p: 0.015 and p: 0.014, respectively). In the ROC analysis, PNI < 40.75 predicts recurrent pericardial effusion with 75% sensitivity and 58% specificity (AUC: 0.626, 95% CI: 0.509-0.742, and p=0.042). Conclusion: Predictors of recurrence in patients undergoing pericardiocentesis are important for patient follow-up. PNI is a simple and useful score that can be used to predict recurrent pericardial effusion.