Management of Cardiovascular Diseases by Short-Chain Fatty Acid Postbiotics.

PURPOSE OF REVIEW: Global health concerns persist in the realm of cardiovascular diseases (CVDs), necessitating innovative strategies for both prevention and treatment. This narrative review aims to explore the potential of short-chain fatty acids (SCFAs)-namely, acetate, propionate, and butyrate-as agents in the realm of postbiotics for the management of CVDs. RECENT FINDINGS: We commence our discussion by elucidating the concept of postbiotics and their pivotal significance in mitigating various aspects of cardiovascular diseases. This review centers on a comprehensive examination of diverse SCFAs and their associated receptors, notably GPR41, GPR43, and GPR109a. In addition, we delve into the intricate cellular and pharmacological mechanisms through which these receptors operate, providing insights into their specific roles in managing cardiovascular conditions such as hypertension, atherosclerosis, heart failure, and stroke. The integration of current information in our analysis highlights the potential of both SCFAs and their receptors as a promising path for innovative therapeutic approaches in the field of cardiovascular health. The idea of postbiotics arises as an optimistic and inventive method, presenting new opportunities for preventing and treating cardiovascular diseases.

Evaluating the association between opium abuse, blood lead levels, and the complexity of coronary artery disease.

Opium abuse and exposure to heavy metals elevate the risk of coronary artery disease (CAD). Therefore, we aimed to determine the association between opium abuse and blood lead levels (BLLs) and the CAD complexity. We evaluated patients with acute coronary symptoms who underwent coronary angiography, and those with >50% stenosis in at least one of the coronary arteries were included. Furthermore, Synergy between PCI with Taxus and Cardiac Surgery I (SYNTAX I) score and BLLs were measured. Based on the opium abuse, 95 patients were subdivided into opium (45) and control (50) groups. Differences in demographics and CAD risk factors were insignificant between the two groups. The median BLLs were remarkably higher in the opium group than in controls (36 (35.7) and 20.5 µg/dL (11.45), respectively, p = 0.003). We also revealed no significant differences in SYNTAX score between the two groups (15.0 (9.0) and 17.5 (14.0), respectively, p = 0.28). Additionally, we found no significant correlation between BLLs and the SYNTAX scores (p = 0.277 and r = -0.113). Opium abuse was associated with high BLLs. Neither opium abuse nor high BLLs were correlated with the complexity of CAD. Further studies are warranted to establish better the relationship between opium abuse, BLLs, and CAD.

Investigation of the association between serum uric acid levels and HEART risk score in patients with acute coronary syndrome.

The association between uric acid (UA) and cardio-metabolic conditions has been recognized for a long time. However, recently, a body of evidence has highlighted the independent role of UA in a series of conditions, including renal and cardiovascular diseases. In this light, data regarding the prognostic role of UA in acute coronary syndrome (ACS) is scarce. A total number of 100 patients, 59 males and 41 females, diagnosed with ACS were recruited in this study. At the time of admission to the hospital, the serum level of UA was measured. In addition, the HEART score was calculated based on each patients' profile. Participants were on average 61.37 ± 12.08 years old. The most prevalent risk factors were hypertension (48%), a history of coronary artery disease (40%), and diabetes mellitus (33%). The average serum level of UA was 5.81 ± 1.81 mg/dl, and the calculated HEART score had a median of six (minimum of two and maximum of ten). A positive yet statistically insignificant correlation was found between the measured UA level and the calculated HEART score (R = 0.375, p = 0.090). However, further studies with larger sample size are required to assess the direct association of UA level with major adverse cardiac events in patients with cardiovascular disease.

A Pilot study on correlation between Zinc and Magnesium serum concentrations and coronary slow flow phenomenon.

BACKGROUND: The pathophysiology of slow flow includes microvascular disorders, endothelial dysfunction, subclinical atherosclerosis, inflammation and anatomical factors. The role of magnesium and zinc in the development of microvascular and endothelial dysfunctions as well as atherosclerosis has been proven in previous studies, and the mechanism of the development has been studied. The aim of current study was to evaluate the serum concentration of zinc and magnesium in patients with epicardial coronary artery slow flow. DESIGN: 125 patients who referred to Ghaem Hospital in Mashhad were selected based on inclusion and exclusion criteria. Magnesium and Zinc levels were evaluated in patients. The plasma levels of studied elements were compared among the different groups and the rate of coronary artery slow flow was evaluated based on the TIMI score. RESULTS: The results of present study indicated that the serum level of Magnesium in the studied groups did not show a significant correlation with rate of coronary artery slow flow (P> 0.05). Serum Zinc concentration was significantly different in the studied groups, which means serum Zinc level in patients without coronary artery occlusion and  without epicardial slow flow were significantly higher than other groups (P> 0.01). CONCLUSION: In the present study, no significant relationship was found between the serum level of zinc and magnesium with the intensity of coronary artery slow flow based on TIMI, and further studies seem to be needed to investigate this relationship.

Wolff-Parkinson-White syndrome and de Winter patterns; An implication for paying special attention to electrocardiogram.

BACKGROUND: Despite recent advances in diagnostic techniques in cardiology, electrocardiography (ECG) has yet remained the first and corner stone of detecting emergency cardiac events including myocardial infarction (MI). There are some ECG findings which are considered as equivalents to MI. De Winter ST-T wave pattern is one of the important ECG findings which is thought to be related to left anterior descending artery occlusion. However, the coexistence of this ECG pattern with other ECG abnormalities are not reported widely. In this report, we discussed a unique case of de Winter ST-T wave pattern in a patient with Wolff-Parkinson-White (WPW) syndrome for the first time. CASE REPORT: A 43-year-old man was referred because of an intermittent typical chest pain. The patient had no cardiovascular risk factor, and was not on any medication; laboratory tests showed elevated and raising troponin I. The first ECG showed pre-excitation (WPW) as well as de winter pattern. According to patient's symptoms and suggestive ECG for probable left anterior descending (LAD) occlusion, emergent angiography was scheduled. The coronary angiography revealed sever LAD artery occlusion. The patient was symptom free after successful percutaneous coronary intervention, and was discharged on medication. The patient remained asymptomatic in 1-year follow-up period. CONCLUSION: Presence of de Winter ST-T changes with other ECG abnormalities is a rare issue, and here we addressed the first case of WPW and de Winter. The physicians should be aware that ECG changes in patients with WPW should not be interpreted as de Winter ST-T changes and vice versa.

The effect of curcumin in prevention of contrast nephropathy following coronary angiography or angioplasty in CKD patients.

INTRODUCTION: Contrast-induced nephropathy (CIN) is the most common cause of iatrogenic acute kidney injury. It is happened more commonly in patients with underlying kidney diseases. It is appeared that the oxidative stress is the main mechanism of contrast nephropathy. Curcumin is suggested as an herbal antioxidant agent, so we decided to assess the effect of curcumin in preventing of this complication in patients with underlying chronic kidney disease (CKD) who need coronary angiography. METHODS AND MATERIALS: We conducted double blind, placebo-controlled clinical trial in 60 moderate to severe CKD patients who underwent coronary angiography or angioplasty. Adjusted dose of Iodixanol was used as contrast agent in all of them. Curcumin or placebo administered orally, 1.5 g daily from 2 days before procedure to 3 days after it. CIN was defined by an increased serum creatinine level≥0.3mg/dl or an increase to ≥1.5 times of the baseline within 48 hours after procedure. Urinary NGAL test was also done the next day after angiography. RESULTS: CIN occurred in 12(20%) of patients, 5(16.7%) in Curcumin group and 7(23.3%) in placebo group (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.18 to 2.36; P0.51). Serum Creatinine was increased after72 hours of intervention from 1.65±0.26 mg/dl to 1.79±0.33 mg/dl in Curcumin group and from 1.61±0.23 mg/dl to 1.86±0.35 in placebo group. There is no significant difference between the mean increase in serum creatinine concentration in the placebo group and Curcumin group (difference of 0.006 mg/dL; 95% CI, - 0.06 to 0.08; P0.85). Urinary NGAL test was significantly higher in patients with AKI (p=0.000), but there weren't differences in its level in two groups (p=0.761)  Conclusion: It is appeared prophylactic oral Curcumin hasn't protective effects on CIN in high risk patients who have undergone coronary procedure.

Association of high level of hs-CRP with in-stent restenosis: A case-control study.

BACKGROUND: In-stent restenosis (ISR) is one adverse outcome of coronary stent implantation. Although using drug-eluting stents has reduced the rate of ISR, it remains a major problem. Here, we have investigated the relationship between several patient characteristics including serum high sensitive C-reactive protein (hs-CRP) and ISR. METHODS: This was a case-control study comprising 104 individuals with ISR and 202 patients without. Baseline characteristics were collected using a questionnaire. Fasting blood glucose (FBG), serum triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and serum high sensitivity C-reactive protein (hs-CRP) were measured using commercial kits on an auto-analyzer. Data were analyzed using SPSS software and a p value ≤ 0.05 was considered significant. RESULTS: Diabetes mellitus (p < 0.001), stent type (p = 0.005), serum hs-CRP (p = 0.006), FBG (p = 0.038) and serum TG (p = 0.039) were significantly associated with ISR. The association between hs-CRP and ISR remained significant after adjustment for stent type and DM. For patients with a serum hs-CRP <2.64 mg/dL, ISR was only associated with diabetes mellitus (p = 0.016); while for individuals with a serum hs-CRP ≥2.64 mg/dL, ISR was also associated with the presence of diabetes mellitus, serum triglycerides and stent type. CONCLUSION: Higher levels of serum hs-CRP were significantly associated with the occurrence of ISR.

Septal hematoma due to stent implementation in the septal course of the left anterior descending artery.

BACKGROUND: The interventricular septal hematoma (IVSH) is a rare and potentially lethal finding. There are variously reported etiologies including instrumental damages during cardiac interventions. Although there are not enough studies available, conservative management is considered as a preferable approach in stable patients. CASE REPORT: A 45-year man smoker with the previous history of percutaneous coronary intervention (PCI), admitted with unstable angina in present visit. Coronary angiography showed significant in-stent restenosis (ISR) of the left anterior descending (LAD) artery stent. During our intervention for treatment of the ISR, the wire movement caused a diffuse dissection without any runoff, in the distal portion of the LAD. Therefore two stents were deployed in the dissected segment with a short overlapping segment. Unfortunately, the overlapping segment of these stents was located in the myocardial bridge segment. Therefore the contraction of the interventricular septum (IVS) caused a scissor-like movement of the stents, and they ruptured the LAD into the septum. Therefore, the contrast agent was accumulated in the IVS. Immediately, a graft stent was deployed in the overlapping segment of stents and perforation became sealed. In echocardiography, the IVS diameter increased to 30 mm. Since the patient was hemodynamically and electrically stable, he underwent conservative approach and after two months the septum returned to the normal size. CONCLUSION: During PCI on the LAD artery, the implantation of stents in the septal course with a short overlapping segment can result in coronary perforation, and therefore IVS hematoma by the scissor effect. Septal hematoma may cause life-threatening arrhythmias or ventricular septal rupture, but if it is asymptomatic or uncomplicated. Conservative management is the best strategy.