Cardiovascular Drugs and Therapy最新文献

Purpose: Atrial fibrillation (AF) recurrence after radiofrequency ablation is closely associated with patient prognosis, while the potential impact of heart failure with preserved ejection fraction (HFpEF) remains unclear. This study aimed to explore the effect of HFpEF on recurrence within 1 year after catheter ablation.

Methods: We enrolled 455 patients who underwent atrial fibrillation ablation, with 241 in the HFpEF group and 213 in the non-heart failure (non-HF) group. Baseline characteristics, 12-month AF recurrence rates, and predictors were compared between groups. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to assess the recurrence risk, and propensity score matching (PSM) was performed for verification.

Results: The HFpEF group exhibited significantly higher recurrence than the non-HF group (25.0% vs. 9.8%, P < 0.001), and Kaplan-Meier analysis confirmed significant differences in 1-year recurrence-free survival (Log-rank P < 0.001). Multivariable Cox regression identified HFpEF as an independent risk factor for 1-year recurrence (HR = 1.92, 95% CI:1.06-3.47), whereas paroxysmal AF was a protective factor(HR = 0.55, 95% CI:0.31-0.98). Subgroup analysis further revealed that compared with the paroxysmal AF without heart failure (NoHF-pAF) group, HFpEF with persistent AF (HFpEF-PerAF) had significantly elevated recurrence risk (adjusted HR = 4.12, 95% CI:2.20-7.75; P < 0.001), and HFpEF with paroxysmal AF (HFpEF-pAF) also showed increased risk (HR = 2.58, 95% CI:1.14-5.84, P = 0.023). After PSM, the HFpEF group maintained significantly higher recurrence (23.0% vs. 10.0%, P = 0.016), with HFpEF remaining the sole independent predictor (HR = 2.42, 95% CI:1.17-5.00, P = 0.017).

Conclusion: HFpEF is an independent risk factor for 1-year recurrence after AF ablation, with highest risk in persistent AF patients. Implementing comprehensive individualized treatment strategies is essential to improve prognosis.

Purpose: The management of heart failure (HF) frequently includes gastroprotection via proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs). This systematic review evaluates their impact on HF outcomes, including exacerbation, hospitalization, mortality, and major adverse cardiac events (MACE).

Methods: In accordance with PRISMA guidelines, a complete search across databases such as PubMed/Medline, Scopus, and Web of Science was conducted until December 10, 2023. The inclusion criteria covered research on adult patients with HF that focused on the effects of PPI and H2RA usage. The risk of bias was determined via the Newcastle-Ottawa Scale (NOS), and data were synthesized quantitatively.

Results: Eleven studies encompassing 996,498 participants were analyzed. The data is not consistent across all research; however, some have suggested that PPI use may be linked to an increased risk of cardiovascular illnesses and heart failure aggravation. Conversely, H2RAs appeared to offer potential benefits in certain high-risk groups, potentially reducing all-cause and cardiovascular mortality. However, the limitations of the available studies should be taken into consideration when interpreting these findings.

Conclusion: The review suggests that there may be differences in the impact of PPIs and H2RAs on HF outcomes. While some evidence indicates that PPIs may be linked to increased risks in HF patients, and H2RAs may offer potential benefits, these findings are not definitive and should be interpreted with caution. Further research is necessary to clarify these associations and guide clinical practice.

Registration: PROSPERO CRD42023491752.

Purpose: The purpose of this study was to investigate the protective effects of biochanin A (BCA) on cardiac hypertrophy and to elucidate the underlying molecular mechanisms. The research question was whether BCA can reverse heart dysfunction and attenuate cardiomyocyte hypertrophy induced by pressure overload and AngII, respectively, and how it interacts with the NLRP3 pyroptosis pathway to achieve these effects.

Methods: We employed an animal model of pressure overload-induced cardiac hypertrophy and an in vitro model of AngII-induced cardiomyocyte hypertrophy to assess the effects of BCA. The expression of NLRP3 and its related signaling molecules was analyzed by western blotting, and the activity of the NLRP3 pathway was measured using pyroptosis assays. The role of Cbl-b, an E3 ubiquitin ligase, in BCA-mediated NLRP3 inhibition was also investigated.

Results: BCA was found to reverse heart dysfunction and attenuate cardiomyocyte hypertrophy induced by pressure overload and AngII. Mechanistically, BCA mitigated cardiac hypertrophy by targeting the NLRP3 pyroptosis pathway. The reduction in NLRP3 expression by BCA was predominantly mediated through the upregulation of Cbl-b, which enhanced the ubiquitination and subsequent degradation of NLRP3. Additionally, BCA facilitated the upregulation of Cbl-b expression by interacting with NF-κB, preventing NF-κB binding to the promoter region of Cbl-b and reversing its suppressive action on Cbl-b expression.

Conclusion: This study provides initial evidence that BCA can protect against cardiac hypertrophy. Its mechanism of action involves interacting with NF-κB to promote the expression of Cbl-b, which facilitates the ubiquitination and degradation of NLRP3, ultimately inhibiting pyroptosis. This finding suggests that BCA may be a potential therapeutic agent for the treatment of cardiac hypertrophy.

Purpose: Dual antiplatelet therapy (DAPT) is the cornerstone for patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI) while increasing the risk of bleeding, particularly when combined with gastrointestinal disease (GID). Rivaroxaban 10 mg once daily is widely used in Asia. This study compared the effects of low-dose rivaroxaban (10 mg daily) plus clopidogrel vs. DAPT in CHD patients with GID undergoing PCI.

Methods: In this prospective, single-center, randomized controlled trial, eligible CHD patients with GID undergoing PCI were randomized (1:1) to either the dual pathway inhibition (DPI) group (rivaroxaban 10 mg plus clopidogrel 75 mg daily) or the DAPT group (aspirin 100 mg plus clopidogrel 75 mg daily). The primary outcome was Bleeding Academic Research Consortium (BARC) type 2-5 bleeding. The secondary outcome was major adverse cardiovascular or cerebrovascular events (MACCE), which included cardiac death, nonfatal myocardial infarction, ischemia-driven target vessel revascularization, all-cause death, stent thrombosis, and stroke during the 6-month follow-up.

Results: A total of 1042 patients were enrolled and analyzed (DPI, 522; DAPT, 520). Low-dose rivaroxaban (10 mg daily) plus clopidogrel was non-inferior to DAPT in BARC type 2-5 bleeding [8 (1.5%) vs. 6 (1.2%), absolute risk difference 0.38%, 95% confidence interval (CI) (- 1.02-1.78), p < 0.0001 for non-inferiority]. Abdominal pain was significantly lower in the DPI group (p = 0.009). Other abdominal discomforts, gastrointestinal bleeding, or MACCE were similar.

Conclusions: In CHD patients with GID undergoing PCI, low-dose rivaroxaban (10 mg daily) plus clopidogrel was non-inferior to DAPT.

Trial registration: Chinese Clinical Trial Registry ChiCTR2100044319. Registered on March 16, 2021.

Purpose: Transcatheter aortic valve replacement (TAVR) has emerged as a critical innovation for managing severe aortic stenosis, prompting the development of numerous clinical practice guidelines worldwide. This study systematically evaluates the guideline development methodologies of major international TAVR guidelines using the AGREE II and AGREE-REX instruments, aiming to enhance understanding of current development processes.

Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, and specialized guideline repositories. Twenty-four TAVR-specific guidelines were independently evaluated by four reviewers using the AGREE II and AGREE-REX instruments. The guidelines were categorized as evidence- or consensus-based, and statistical analysis was performed using SPSS to standardize scores and assess inter-rater reliability.

Results: Systematic assessment revealed significant methodological variations across guidelines. The AGREE II evaluation showed the highest performance in scope and purpose (83.9 ± 10.0%) but lower scores in rigor of development (43.5 ± 29.0%) and applicability (42.4 ± 26.8%). The AGREE-REX analysis demonstrated stronger performance in implementability (78.6 ± 14.5%) while identifying gaps in the integration of values and preferences (35.7 ± 17.2%). Evidence-based guidelines consistently outperformed consensus-based ones across multiple domains, particularly in terms of methodological rigor and implementation planning.

Discussion: This evaluation highlights key areas for improving guideline development methodology, including standardized evidence evaluation processes, systematic stakeholder engagement, and structured implementation planning. The considerable variability in methodological quality underscores the need for more standardized approaches.

Conclusion: Current TAVR guidelines exhibit significant heterogeneity in methodological quality, with evidence-based guidelines demonstrating superior performance in development rigor and implementation planning. Systematic approaches to evidence synthesis and stakeholder engagement are crucial for high-quality guideline development.

Purpose: Doxorubicin (Dox) is a classic anthracycline chemotherapy drug with cause cumulative and dose-dependent cardiotoxicity. This study aimed to investigate the potential role and molecular mechanism of phenylacetylglutamine (PAGln), a novel gut microbiota metabolite, in Dox-induced cardiotoxicity (DIC).

Methods: DIC models were established in vivo and in vitro, and a series of experiments were performed to verify the cardioprotective effect of PAGln. RNA sequencing (RNA-seq) was employed to explore the mechanism of PAGln in DIC. Subsequently, the differentially expressed genes (DEGs) were subjected to comprehensive analysis using diverse public databases, and RT-PCR was used to confirm the expression levels of the candidate genes. Finally, molecular docking techniques were used for validation.

Results: PAGln effectively prevented both in vivo and in vitro Dox-induced myocardial injury and cell apoptosis. RNA-seq results showed that 40 genes were up-regulated and 54 down-regulated in the Dox group compared to the Con group, displaying opposite changes in the Dox + PAGln group. Enrichment analysis highlighted several mechanisms by which PAGln alleviated Dox-induced cardiotoxicity, including the lipid metabolic process, calcium-mediated signaling, positive regulation of store-operated calcium channel activity, and hypertrophic cardiomyopathy. In vitro and in vivo experiments confirmed that PAGln treatment could reverse the changes in the expression levels of Klb, Ece2, Nmnat2, Casq1, Pak1, and Apob in Dox. Molecular docking results showed that these genes had good binding activity with PAGln.

Conclusions: PAGln shows potential in alleviating Dox-induced cardiotoxicity, with Ece2 identified as key regulatory molecules related to endothelial dysfunction.

Purpose: This study assessed the efficacy of preoperative erector spinae plane block (ESPB) in reducing intraoperative opioid use and enhancing recovery in off-pump coronary artery bypass grafting (OPCABG) patients, who typically require high-dose opioids with associated postoperative risks.

Methods: A prospective, double-blind randomized controlled trial was conducted on 37 patients. Patients were randomized to receive either bilateral ESPB with 0.375% ropivacaine or a sham block with normal saline. Primary outcomes included intraoperative sufentanil consumption, while secondary outcomes encompassed hemodynamic stability, postoperative pain scores, mechanical ventilation (MV) duration, and hospital stay.

Results: The ESPB group demonstrated a significant reduction in intraoperative sufentanil consumption compared to the sham group (150.3 ± 36.1 µg vs. 194.4 ± 38.3 µg, p = 0.001). Postoperatively, ESPB patients exhibited lower pain scores at rest and during coughing within the first 6 h post-extubation (p < 0.001) and required less rescue analgesia (5.3% vs. 50.0%, p = 0.003). Additionally, ESPB shortened MV duration (5.43 ± 1.65 h vs. 6.88 ± 1.68 h, p = 0.013). No significant differences were observed in cardiac care unit or hospital stay lengths.

Conclusion: Preoperative ESPB effectively reduces intraoperative opioid requirements and provides sustained analgesia in the early postoperative period, facilitating earlier extubation. These findings support ESPB as a valuable component of multimodal analgesia in OPCABG, though further large-scale studies are needed to validate these results and optimize its application.

Clinical trial registration: The trial was registered with the China Clinical Trials Center ( http://www.chictr.org.cn , ChiCTR2200066902) on December 21, 2022.

Background: Glucagon-like peptide-1 (GLP-1) is a crucial incretin hormone secreted by intestinal endocrine L cells. Given its pivotal physiological role, researchers have developed GLP-1 receptor agonists (GLP-1 RAs) through structural modifications. These analogues display pharmacological effects similar to those of GLP-1 but with augmented stability and are regarded as an effective means of regulating blood glucose levels in clinical practice.

Objective: This review aims to comprehensively summarize the role of GLP-1 RAs in the management of diabetes mellitus (DM) and cardiovascular disease (CVD), with a particular emphasis on the underlying signal transduction pathways and their therapeutic potential.

Methods: A comprehensive review was carried out through literature research.

Results and discussion: In pancreatic β-cells, GLP-1 RAs regulate the secretion of insulin and glucagon in a glucosedependent manner by influencing signaling pathways such as cAMP, PI3K, and MAPK. They also contribute to the regulation of blood glucose levels by promoting the proliferation of β-cells and inhibiting apoptosis in these cells. Recent comprehensive studies have also demonstrated the favorable impact of GLP-1 RAs on cardiovascular wellbeing. In addition to the cardiovascular protection afforded by glucose metabolism regulation, a large body of evidence from animal and cellular studies has corroborated the beneficial effects of GLP-1 RAs on conditions such as heart failure (HF), hypertension, and ischemic cardiomyopathy. These benefits are mainly attributed to the alleviation of inflammatory responses, reduction of oxidative stress, and prevention of cell apoptosis. Clinical data shows that GLP-1 RAs can reduce the risk of major adverse cardiovascular events (MACE) in diabetic patients.

Conclusion: GLP-1 RAs play an important role in the management of both diabetes and cardiovascular diseases. They show potential therapeutic value through the modulation of multiple signal transduction pathways. However, there may still be some issues in practical applications that require further research and resolution.