Cardiovascular Drugs and Therapy最新文献

Purpose: Totally thoracoscopic and beating-heart techniques used in tricuspid valve surgery (TTC-TVS) show favorable outcomes. Transcatheter tricuspid valve replacement (TTVR) is an increasingly utilized alternative for patients with tricuspid regurgitation (TR) at high surgical risk. The purpose of this study was to compare TTVR with TTC-TVS to examine the outcomes of these two different management protocols for patients with symptomatic severe TR.

Methods: A total of 116 patients with symptomatic severe TR were retrospectively collected and divided into the TTVR (n = 38) and the TTC-TVS (n = 78) groups. The primary end points included 2-year all-cause mortality and the combined endpoint (all-cause mortality and hospitalizations for heart failure).

Results: At a median follow-up of 630 (IQR 450-720) days, the similar freedom from 2-year all-cause mortality (85.2% vs. 70.8%; log-rank P = 0.13) and different freedom from combined endpoint (75.3% vs. 49.8%; log-rank P = 0.0049) were followed in TTVR and TTC-TVS. After stratification by TRI-SCORE, TTVR subgroups showed significant difference in combined endpoint, and both also showed significant difference compared to the corresponding TTC-TVS subgroups (all log-rank P < 0.05). In multivariate Cox regression analysis, TRI-SCORE ≥ 6 was independently correlated with all-cause mortality (HR 3.913, 95% CI 1.481-10.337; P = 0.006) and combined endpoint (HR 4.070, 95% CI 1.924-8.608; P < 0.001).

Conclusions: TTVR may offer greater benefit compared to TTC-TVS for sicker patients with severe TR. However, this observation should be interpreted within a specific clinical context emphasizing the importance of early intervention.

Cardiorenal syndrome (CRS) due to right ventricular (RV) failure is a disease entity emerging as a key indicator of morbidity and mortality. The multifactorial aspects of CRS and the left-right ventricular interdependence complicate the link between RV failure and renal function. RV failure has a direct pathophysiological link to renal dysfunction by leading to systemic venous congestion in certain circumstances and low cardiac output in other situations, both leading to impaired renal perfusion. Indeed, renal dysfunction is known to be an independent predictor of mortality in patients with pulmonary arterial hypertension (PAH) and RV failure. Thus, it is important to further understand the interaction between the RV and renal function. RV adaptation is critical to long-term survival in patients with PAH. The RV is also known for its remarkable capacity to recover once the aggravating factor is addressed or mitigated. However, less is known about the renal potential for recovery following the resolution of chronic RV failure. In this review, we provide an overview of the intricate relationship between RV dysfunction and the subsequent development of CRS, with a particular emphasis on PAH. Additionally, we summarize potential RV-targeted therapies and their potential beneficial impact on renal function.

Objective: Evaluate the longitudinal association between BP control and the use of antihypertensive classes with arterial stiffness (AS) in Brazilian adults.

Methods: This study included 1830 participants with arterial hypertension (1092 participants with controlled BP and 738 participants with uncontrolled BP) from the Longitudinal Study of Adult Health (ELSA-Brasil). AS was assessed by pulse wave velocity (PWV) and pulse pressure (PP) at baseline and repeated after approximately 9 years. Associations between AS and BP control and the use of antihypertensives, diuretics, angiotensin-converting enzyme inhibitors (ACEI), AT1 receptor blockers (ARB), calcium channel blockers (CCB), and beta blockers (in the population with controlled BP), at baseline were investigated using linear mixed-effects models.

Results: Uncontrolled BP was associated with worse PWV and PP trajectory, respectively (β = 0.026 [0.008 to 0.036] / β = 0.273 [0.216 to 0.330]). Among the participants with controlled BP, using CCB (β = 0.031 [0.011 to 0.051]) was associated with a worse PWV trajectory, compared to not using this class and this combination, respectively.

Conclusion: BP control, regardless of the class of antihypertensive used is associated with a better AS trajectory, as assessed by PWV and PP. Among participants with controlled BP, the use of BCC, compared to not using this class, seems to be worse for the trajectory of PWV in individuals with arterial hypertension without cardiovascular disease. Further studies are needed to assess whether this effect results in a better prognosis for patients with arterial hypertension.

Currently, atherosclerosis, characterized by the dysfunction of lipid metabolism and chronic inflammation in the intimal space of the vessel, is considered to be a metabolic disease. As the most abundant innate immune cells in the body, macrophages play a key role in the onset, progression, or regression of atherosclerosis. For example, macrophages exhibit several polarization states in response to microenvironmental stimuli; an increasing proportion of macrophages, polarized toward M2, can suppress inflammation, scavenge cell debris and apoptotic cells, and contribute to tissue repair and fibrosis. Additionally, specific exosomes, generated by macrophages containing certain miRNAs and effective efferocytosis of macrophages, are crucial for atherosclerosis. Therefore, macrophages have emerged as a novel potential target for anti-atherosclerosis therapy. This article reviews the role of macrophages in atherosclerosis from different aspects: origin, phenotype, exosomes, and efferocytosis, and discusses new approaches for the treatment of atherosclerosis.

Purpose: The DELIVER trial demonstrated the efficacy of dapagliflozin in reducing primary endpoint (cardiovascular (CV) mortality or worsening heart failure) for heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). This study assessed the economic and clinical effects of incorporating dapagliflozin into a standard treatment regimen for HFpEF and HFmrEF cases in China.

Methods: A multistate Markov model was used to assess the clinical and economic effects of adding dapagliflozin to the usual treatment regimen for HFpEF and HFmrEF. A log-logistic formula was used to represent the cumulative incidence of hospitalization, readmission, and CV mortality. A 5% annual discount was applied to all costs. The health outcome was the incremental cost-effectiveness ratio (ICER), measured using quality-adjusted life years (QALYs) and life years (LYs). The findings were examined using sensitivity and scenario analyses to assess robustness.

Results: In the HFpEF or HFmrEF population, the 11.2-year incremental QALYs was 0.15 and LYs was 0.2, yielding an ICER of $10,615.87 per QALY and $7,763.08 per LY. These ICER values are lower than China's per capita gross domestic product (GDP) of $12,752 in 2022. The one-way sensitivity analysis revealed that non-hospital CV death was the most influential parameter. Furthermore, there was a 68% chance that dapagliflozin was cost-effective as an additional treatment, given a willingness-to-pay limit of three times the GDP ($38,256).

Conclusions: Dapagliflozin adjunctive therapy was cost-effective in patients with HFpEF or HFmrEF from the perspective of Chinese national insurance.

The large-conductance Ca²⁺-activated K⁺ (BK) channel is widely expressed in the pulmonary blood vessels and plays a significant role in regulating pulmonary vascular tonus. It opens under membrane depolarization, increased intracellular Ca⁺² concentration, and chronic hypoxia, resulting in massive K⁺ efflux, membrane hyperpolarization, decreased L-type Ca⁺² channel opening, and smooth muscle relaxation. Several reports have demonstrated an association between BK channel dysfunction and pulmonary hypertension (PH) development. Decreased BK channel subunit expression and impaired regulation by paracrine hormones result in decreased BK channel opening, increased pulmonary vascular resistance, and pulmonary arterial pressure being the cornerstone of PH. The resulting right ventricular pressure overload ultimately leads to ventricular remodeling and failure. Therefore, it is unsurprising that the BK channel has arisen as a potential target for treating PH. Recently, a series of selective, synthetic BK channel agonists have proven effective in attenuating the pathophysiological progression of PH without adverse effects in animal models.