MiR-6721-5p as a natural regulator of Meta-VCL is upregulated in the serum of patients with coronary artery disease.

Background: Coronary artery disease (CAD), the leading cause of mortality globally, arises from atherosclerotic blockage of the coronary arteries. Meta-vinculin (meta-VCL), a large spliced isoform of VCL, co-localizes in muscular adhesive structures and plays significant roles in cardiac physiology and pathophysiology. This study aimed to identify microRNAs (miRNAs) regulating meta-VCL expression and investigate the expression alterations of the miRNAs of interest and meta-VCL as potential biomarkers in the serum of CAD patients. Methods: Bioinformatics tools were employed to select miRNAs targeting meta-VCL. Cell-based ectopic expression analysis and a dual-luciferase assay were used to examine the interactions between miRNAs and meta-VCL. An ELISA assessed the concentrations of interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α (TNF-α). MiRNA and meta-VCL expression patterns and biomarker suitability were evaluated in serum samples from CAD and non-CAD individuals using real-time PCR. A cardiac cell-line data set and CAD blood exosome samples were analyzed using bioinformatics and ROC curve analyses, respectively. Results: miR-6721-5p directly interacted with the putative target sites at the 3'-UTR of meta-VCL and regulated its expression. IL-10 and TNF-α concentrations, which may act as anti-inflammatory factors, decreased following miR-6721-5p upregulation and meta-VCL downregulation. Bioinformatics and experimental expression analyses confirmed downregulated meta-VCL expression and upregulated miR-6721-5p expression in CAD samples. ROC curve analysis yielded an AUC score of 0.705 (P = 0.018), indicating the potential suitability of miR-6721-5p as a biomarker for CAD. Conclusions: miR-6721-5p plays a regulatory role in meta-VCL expression and may contribute to CAD development by reducing anti-inflammatory factors. These findings suggest that miR-6721-5p could serve as a novel biomarker in the pathogenesis of CAD.

Gender differences in cardiac rehabilitation participation and outcomes: an 18-year retrospective study in Iran.

BACKGROUND: Cardiac rehabilitation (CR) is crucial for addressing cardiovascular diseases globally, with a specific emphasis on gender differences. Despite its demonstrated benefits for women, there's limited acceptance globally, especially in low- and middle-income countries. The program aims to optimize risk factors and improve overall patient well-being. METHODS: A cohort study was performed on those who were candidates for CR programs during 2001-2019. Assessments were performed within one week before and one week after the 8-week CR program. Age, sex, smoking status, clinical data, resting systolic and diastolic blood pressure (SBP and DBP, respectively), echocardiography and laboratory data were obtained. Functional capacity was evaluated using the international physical activity questionnaire, and a treadmill exercise test. Anxiety, depression, general quality of life (QoL), and health-related QoL were selected for psychological status. Then statistical analysis was performed on data. RESULT: In this study, the number of male patients was 1526 (73.69%). The average age of patients in the female group was higher than that of males (58.66 ± 9.08 vs. 56.18 ± 9.94), according to the crude model results, the changes in emotional, social and physical scores were significant (P-value:0.028, 0.018, 0.030), as well as the differences in Mets and smoking were significant (P-value for both < 0.001) in the adjusted model, the emotional variables and Mets changes were significant in two groups, so that the emotional score in the female group was higher than that of the male group, and the female Mets score was significantly lower than that of the male group. CONCLUSION: The CR program can improve cardiovascular outcomes, but the greatest impact was on the quality of life, patient METs and smoking behavers. Also the number of female participants in the CR program was less than the number of males.

Surgical Repair of Postinfarction Left Ventricular Pseudoaneurysm.

Left ventricular pseudoaneurysm is a serious and rare disorder that usually develops after acute myocardial infarction. It can lead to potentially lethal mechanical complications, such as acute left ventricular free wall rupture. This report presents the case of a 64-year-old man with a left ventricular pseudoaneurysm and myocardial rupture that was managed by left ventricular restoration with aneurysmectomy and coronary artery bypass with 2 grafts.

The Cost-Effectiveness of Early Invasive Procedures for Acute Coronary Syndrome in Low-Income Regions: A Prospective Cohort Study in Pakistan.

Background Acute coronary syndrome (ACS) is a significant cause of mortality and morbidity globally, necessitating effective intervention strategies. Early invasive procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are often recommended for high-risk patients. However, their cost-effectiveness in low-income regions remains uncertain, particularly in Pakistan, where healthcare resources are limited. Objective This study aims to evaluate the cost-effectiveness of early invasive procedures compared to standard care for ACS in low-income regions of Pakistan. Methods We conducted a prospective cohort study from January 1, 2021, to January 31, 2021, at four major hospitals in Pakistan: Army Cardiac Center Combined Military Hospital (CMH) Lahore, National Institute of Cardiovascular Diseases in Karachi, Lady Reading Hospital in Peshawar, and Mardan Medical Complex. The participants included 436 patients diagnosed with ACS aged 18 years or older and presenting within 24 hours of symptom onset. The patients were divided into two groups: the early invasive procedure group (n = 218) and the standard care group (n = 218). The primary outcome was the 30-day mortality rate. Secondary outcomes included recurrent myocardial infarctions, hospital readmissions, healthcare costs, and procedural complications. Data were analyzed using SPSS version 25.0 (IBM SPSS Statistics, Armonk, NY), employing descriptive statistics, chi-square tests, independent t-tests, and Kaplan-Meier survival analysis. Results The early invasive procedure group showed a mortality rate of 18 (8%) compared to 33 (15%) in the standard care group, demonstrating a significant reduction in mortality (p = 0.01). Additionally, the average healthcare cost was significantly lower in the early invasive group, with mean costs of Pakistani rupee (PKR) 187,200 (US dollar {USD} 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Recurrent myocardial infarctions occurred in 11 (5%) of the early invasive group versus 26 (12%) in the standard care group (p < 0.05). Hospital readmission rates were lower in the early invasive group, 22 (10%) compared to 39 (18%) in the standard care group (p < 0.05). Healthcare costs were significantly lower in the early invasive group, with mean costs of PKR 187,200 (USD 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Conclusion Early invasive procedures for ACS significantly improve survival rates, reduce complications, and lower healthcare costs in low-income regions of Pakistan. These findings suggest that such strategies should be considered in resource-limited settings to optimize patient outcomes and healthcare resource utilization.

Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography.

BACKGROUND: Coronary artery diseases can cause myocardial ischemia and hypoxia, angina pectoris, myocardial infarction, arrhythmia, and even sudden death led to inflight incapacitation of aircrew. As the main cause of grounding due to illness, they severe threats to the health and fighting strength of military aircrew. Early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic. AIM: To figure out the flight factors and clinical characteristics of military aircrew with abnormal results of coronary artery computed tomographic angiography (CTA), thereby rendering theoretical references for clinical aeromedical support of military flying personnel. METHODS: The clinical data of 15 flying personnel who received physical examinations in a military medical center from December 2020 to June 2023 and were diagnosed with coronary artery diseases by coronary artery CTA were collected and retrospectively analyzed, and a descriptive statistical analysis was conducted on their onset age, aircraft type and clinical data. RESULTS: The 15 military flying personnel diagnosed with coronary artery diseases by coronary artery CTA were composed of 9 pilots, 1 navigator and 5 air combat service workers. Multi-vessel disease was detected in 9 flying personnel, among which 8 (88.9%) were pilots. Flying personnel with multi-vessel disease had higher content of cholesterol, low-density lipoprotein cholesterol and apolipoprotein B than those with single-vessel disease. CONCLUSION: Coronary artery diseases are the major heart disease for the grounding of flying personnel due to illness, which can lead to inflight incapacitation. Coronary artery CTA is conducive to early detection and early intervention treatment of such diseases in clinic.

Unraveling the complex interplay between abnormal hemorheology and shape asymmetry in flow through stenotic arteries.

BACKGROUND AND OBJECTIVE: Stenosis or narrowing of arteries due to the buildup of plaque is a common occurrence in atherosclerosis and coronary artery disease (CAD), limiting blood flow to the heart and posing substantial cardiovascular risk. While the role of geometric irregularities in arterial stenosis is well-documented, the complex interplay between the abnormal hemorheology and asymmetric shape in flow characteristics remains unexplored. METHODS: This study investigates the influence of varying hematocrit (Hct) levels, often caused by conditions such as diabetes and anemia, on flow patterns in an idealized eccentric stenotic artery using computational fluid dynamics simulations. We consider three physiological levels of Hct, 25%, 45%, and 65%, representing anemia, healthy, and diabetic conditions, respectively. The numerical simulations are performed for different combinations of shape eccentricity and blood rheological parameters, and hemodynamic indicators such as wall shear stress (WSS), oscillatory shear index (OSI), are relative residence time (RRT) are calculated to assess the arterial health. RESULTS: Our results reveal the significant influence of Hct level on stenosis progression. CAD patients with anemia are exposed to lower WSS and higher OSI, which may increase the propensity for plaque progression and rupture. However, for CAD patients with high Hct level - as is often the case in diabetes - the WSS at the minimal lumen area increases rapidly, which may also lead to plaque rupture and cause adverse events such as heart attacks. These disturbances promote endothelial dysfunction, inflammation, and thrombus formation, thereby intensifying cardiovascular risk. CONCLUSIONS: Our findings underscore the significance of incorporating hemorheological parameters, such as Hct, into computational models for accurate assessment of flow dynamics. We envision that insights gained from this study will inform the development of tailored treatment strategies and interventions in CAD patients with common comorbidities such as diabetes and anemia, thus mitigating the adverse effects of abnormal hemorheology and reducing the ever-growing burden of cardiovascular diseases.

Successful transcatheter coil embolization of a coronary cameral fistula in a young male with a structurally normal heart: A case report.

INTRODUCTION AND IMPORTANCE: Coronary-cameral fistulas (CCFs) are the anomalous connection between a coronary artery (CA) and a great vessel or cardiac chamber. About 90 % of CA fistulas are congenital and are related to persistent sinusoids during the embryonic period. Most fistulas originate from the right and left anterior descending CAs. The circumflex CA is rarely involved. CASE PRESENTATION: A 20-year-old male was referred to a tertiary children's heart hospital center due to retrosternal chest pain (CP) and dyspnea on exertion (functional class Ш). The transthoracic echocardiography (TTE) was done, and it demonstrated a dilated left coronary artery (LCA) (size:5 mm) with a large aneurysm (2 cm) and a small orifice to the right ventricle (RV) body. Then, cardiac angiography was done, and dilated LCA and CCF were demonstrated in the RV. Subsequently, the aneurysm was occluded by eight coils. CLINICAL DISCUSSION: CCAs can be treated by transcatheter approach or surgical repair. In the presented case, we planned to treat this condition through Cardiac Angiography. Cardiac Angiography was done, and eight coils occluded the aneurysm. The day after the angiography, the symptoms were completely resolved, and the patient didn't complain of CP and dyspnea. CONCLUSION: CCFs represent an uncommon cardiac anomaly with diverse anatomical variations and clinical manifestations. Coronary angiography (CAG) is the most accurate diagnostic test to determine fistula anatomy and possible therapeutic options. Small symptomatic and large fistulas, regardless of symptoms, necessitate intervention through either a transcatheter approach or surgical repair.