Cardiovascular Drugs and Therapy最新文献

Purpose: This study aimed to evaluate whether combining left atrial posterior wall linear ablation with PVI (LAPVI) improves long-term outcomes in patients with persistent AF.

Methods: In a randomized controlled trial, 228 patients with persistent AF underwent PVI and were randomly assigned to either receive additional LAPVI or not. Procedures used a standardized protocol under general anesthesia. Outcomes, including sinus rhythm maintenance and recurrence rates of AF, were assessed at 6 months, 1 year, and 2 years post-procedure. Statistical analysis was performed using the chi-square test for categorical variables and t-tests for continuous variables.

Results: At 2 years, 74.77% of the LAPVI group maintained sinus rhythm compared to 54.7% in the PVI group (P = 0.002). Recurrence rates of paroxysmal and persistent AF were significantly lower in the LAPVI group at 11.71% and 9.01%, respectively, versus 24.79% and 20.51% in the PVI group (P < 0.05). Antiarrhythmic drug use was significantly reduced in the LAPVI group at each follow-up interval (P < 0.05).

Conclusion: LAPVI significantly enhances long-term rhythm control and reduces dependence on antiarrhythmic drugs compared to PVI alone in patients with persistent AF.

Purpose: The purpose of the current study is to evaluate the role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in the treatment of patients with diabetes with newly diagnosed acute myocardial infarction (AMI).

Methods: This multicenter, prospective, cohort study included 1161 patients with diabetes with newly diagnosed AMI. The primary endpoint events included rehospitalization for heart failure (HF) and major adverse cardiovascular events (MACEs). The secondary endpoint events were recurrent MI and cardiac death.

Results: Patients were categorized into the SGLT2i group and the non-SGLT2i group. During a median follow-up of 1.8 (1.5-2.3) years, the risk of hospitalization for HF (HR 0.58; 95% CI 0.36-0.94; P = 0.026) and MACEs (HR 0.59; 95% CI 0.40-0.86; P = 0.006) were lower in the SGLT2i group, with a similar trend observed for cardiac death (HR 0.51; 95% CI 0.27-0.99; P = 0.046). SGLT2i appears to be a better choice for all such patients. However, our research further found the above trends were observed mainly in the LVEF < 50% subgroup. In addition, our study also revealed novel findings that the protective effect of SGLT2i was not altered by baseline levels of HbA1c in these patients, nor by different SGLT2i medications.

Conclusion: The outcomes of the current investigation suggest that SGLT2i is preferred as a hypoglycemic and cardiovascular protective drug for patients with diabetes with newly diagnosed AMI. It could improve cardiovascular outcomes, reducing the risk of rehospitalization for HF and MACEs, particularly in patients with reduced LVEF.

Trial registration: Role of SGLT2I in Patients with Myocardial Infarction, NCT06245980. https://clinicaltrials.gov/ct2/show/NCT06245980 . Retrospectively registered.

Purpose: Atherosclerosis (AS) is the leading cause of cardiovascular disease and mortality worldwide. Despite extensive research, there remains an urgent need for novel therapeutic strategies. By integrating genomic data from the Gene Expression Omnibus (GEO) with human atherosclerotic tissues, we identified enrichment of sumoylation pathways in AS, with chromobox 4 (CBX4), a SUMO E3 ligase, being significantly upregulated. This study aims to investigate the role of CBX4 in macrophages during atherosclerosis progression and its potential molecular mechanisms.

Methods: We analyzed gene expression profiles from human atherosclerotic segments to identify differentially expressed pathways. High-fat diet (HFD)-challenged apolipoprotein E-deficient (ApoE^-/-) mice were used to examine CBX4 expression in macrophages. The impact of CBX4 on atherosclerosis was assessed using macrophage-specific CBX4 knockdown and overexpression models. Mechanistically, we evaluated the interaction between CBX4 and hypoxia-inducible factor 1-alpha (HIF-1α) and its effect on sumoylation and transcriptional activity.

Results: CBX4 expression was elevated in macrophages from atherosclerotic lesions of HFD-fed ApoE^-/- mice. Macrophage-specific CBX4 knockdown significantly alleviated HFD-induced AS, whereas CBX4 overexpression exacerbated atherosclerotic progression. Mechanistically, CBX4 directly interacted with HIF-1α and promoted its sumoylation, leading to increased HIF-1α transcriptional activity, which may contribute to AS development.

Conclusions: Our findings highlight CBX4-promoted SUMOylation of HIF-1α exacerbates AS progression. Targeting CBX4 may represent a promising therapeutic strategy for mitigating atherosclerosis progression.

Purpose: Dexmedetomidine, as an anesthetic adjuvant, has a guideline-recommended dose of 0.2-0.7 µg/kg/h. We sought to compare the intraoperative hemodynamic and prognostic performance of cardiac surgical patients receiving the guideline-recommended dose of dexmedetomidine to those receiving a dose lower than the guideline.

Methods: A retrospective cohort study was conducted on 871 patients who were maintained under anesthesia with dexmedetomidine during cardiac surgery, of whom 414 patients received the guideline-recommended dose as a control group and 457 below the guideline-recommended dose as a low-dose group. A cohort of patients in the low-dose and control group (155 vs 155) was created by propensity score matching. The primary outcome was a composite of adverse outcomes, including bradycardia, atrial fibrillation, and hypotension. Secondary outcomes assessed included delirium, analgesic medication use, cardiac intensive care unit (CICU) length of stay, and duration of mechanical ventilation.

Results: After propensity matching, the maximum heart rate difference, maximum systolic blood pressure difference, maximum diastolic blood pressure value, and maximum mean arterial pressure difference before and after cardiopulmonary bypass and after cessation of pumping were significantly different in the low-dose group compared with the control group (P < 0.01). Compared with the control group, the low-dose group had a higher incidence of postoperative atrial fibrillation (34.8% vs. 23.9%, P = 0.034), and the length of stay in the cardiac intensive care unit (median 4 days, quartiles 3-5 days vs. median 3 days, quartiles 3-4 days, P < 0.001) was significantly longer.

Conclusion: Compared with lower dose, receiving dexmedetomidine pumped at the guideline-recommended dose in anesthetic assistance for cardiac surgery resulted in smoother intraoperative hemodynamic performance and an improvement in the incidence of postoperative atrial fibrillation, shorter stay in the cardiac intensive care unit, and better prognostic performance.

Purpose: This study aimed to evaluate whether a 1-month course of ticagrelor or prasugrel followed by clopidogrel offers any clinical advantage over clopidogrel-based dual antiplatelet therapy (DAPT) in routine practice.

Methods: We conducted a retrospective, propensity-matched cohort study of ACS patients who underwent PCI between 2015 and 2021 at Chiang Rai Prachanukroh Hospital. Patients were grouped by their P2Y₁₂ regimen: 1-month potent P2Y₁₂ inhibitor (ticagrelor or prasugrel) followed by clopidogrel, or continuous clopidogrel-based DAPT. All patients received aspirin. Propensity score matching and Cox regression were used to adjust for confounders. The primary outcome was a composite of thrombotic readmission or all-cause mortality at 1 year. Bleeding-related readmissions were assessed as the safety endpoint.

Results: A total of 1,117 patients were included. After matching, no significant differences were observed in the primary composite outcome across comparisons. In the clopidogrel vs. ticagrelor cohort (n = 161 per group), adjusted hazard ratio (HR) was 1.09 (95% CI: 0.56-2.11; P = 0.808). For clopidogrel vs. prasugrel (n = 139 per group), HR was 0.97 (95% CI: 0.43-2.22; P = 0.945). In the ticagrelor vs. prasugrel cohort (n = 275 per group), HR was 0.62 (95% CI: 0.33-1.17; P = 0.143). LVEF < 40% and residual coronary disease were independently associated with adverse outcomes (HR 4.44 and 8.39, respectively).

Conclusion: A 1-month course of potent P2Y₁₂ inhibitor followed by clopidogrel was not superior to clopidogrel-based DAPT in reducing thrombotic readmission or mortality. Optimizing revascularization and heart failure therapy remains essential in high-risk patients.