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1.
Medicine (Baltimore) ; 100(10): e24616, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725825

RESUMO

ABSTRACT: Major adverse cardiac and cerebral events (MACCE) are common complications, which prolong hospitalization and increase mortality rate in end-stage renal disease (ESRD) patients who underwent continuous ambulatory peritoneal dialysis (CAPD). Therefore, this study aimed to investigate MACCE occurrence and its potential predictive factors in those patients.In this prospective cohort study, 196 diagnosis of ESRD patients who underwent CAPD treatment in our hospital were eligible, and their clinical data (including demographic data and biochemical indexes) were documented. Besides, their MACCE occurrence was assessed within 3-year follow-up period.In patients, 1-, 2-, and 3-year MACCE occurrence rates were 5.1%, 11.7%, and 14.8%, respectively. Meanwhile, the mean duration of accumulating MACCE occurrence was 33.1 (95% confidence interval: 32.0-34.2) months. Furthermore, age, peritoneal dialysis duration (PDD), C-reactive protein (CRP), fasting blood glucose (FBG) and total cholesterol high correlated with increased accumulating MACCE occurrence, while high-density lipoprotein cholesterol (HDL-C) high correlated with decreased accumulating MACCE occurrence. Notably, by further multivariate Cox's proportional hazard regression analysis, age, PDD, CRP, serum uric acid, and FBG high were independent predictive factors for raised accumulating MACCE occurrence, while HDL-C high was an independent predictive factor for attenuated accumulating MACCE occurrence.MACCE are common; besides, age, peritoneal dialysis duration, C-reactive protein, serum uric acid, fasting blood glucose, and high-density lipoprotein cholesterol serve as potential markers for indicating MACCE in ESRD patients who underwent CAPD.


Assuntos
Falência Renal Crônica/terapia , Isquemia Miocárdica/epidemiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
2.
Int J Mol Sci ; 22(4)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567578

RESUMO

Myocardial infarction (MI) accounts for a significant proportion of death and morbidity in aged individuals. The risk for MI in females increases as they enter the peri-menopausal period, generally occurring in middle-age. Cytochrome (CYP) 450 metabolizes N-3 and N-6 polyunsaturated fatty acids (PUFA) into numerous lipid mediators, oxylipids, which are further metabolised by soluble epoxide hydrolase (sEH), reducing their activity. The objective of this study was to characterize oxylipid metabolism in the left ventricle (LV) following ischemic injury in females. Human LV specimens were procured from female patients with ischemic cardiomyopathy (ICM) or non-failing controls (NFC). Female C57BL6 (WT) and sEH null mice averaging 13-16 months old underwent permanent occlusion of the left anterior descending coronary artery (LAD) to induce myocardial infarction. WT (wild type) mice received vehicle or sEH inhibitor, trans-4-[4-(3-adamantan-1-yl-ureido)-cyclohexyloxy]-benzoic acid (tAUCB), in their drinking water ad libitum for 28 days. Cardiac function was assessed using echocardiography and electrocardiogram. Protein expression was determined using immunoblotting, mitochondrial activity by spectrophotometry, and cardiac fibre respiration was measured using a Clark-type electrode. A full metabolite profile was determined by LC-MS/MS. sEH was significantly elevated in ischemic LV specimens from patients, associated with fundamental changes in oxylipid metabolite formation and significant decreases in mitochondrial enzymatic function. In mice, pre-treatment with tAUCB or genetic deletion of sEH significantly improved survival, preserved cardiac function, and maintained mitochondrial quality following MI in female mice. These data indicate that sEH may be a relevant pharmacologic target for women with MI. Although future studies are needed to determine the mechanisms, in this pilot study we suggest targeting sEH may be an effective strategy for reducing ischemic injury and mortality in middle-aged females.


Assuntos
Envelhecimento , Modelos Animais de Doenças , Inibidores Enzimáticos/farmacologia , Epóxido Hidrolases/fisiologia , Coração/efeitos dos fármacos , Isquemia Miocárdica/prevenção & controle , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Animais , Estudos de Casos e Controles , Família 2 do Citocromo P450/fisiologia , Epóxido Hidrolases/antagonistas & inibidores , Feminino , Coração/fisiopatologia , Humanos , Metaboloma , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Taxa de Sobrevida , Espectrometria de Massas em Tandem
3.
Med Sci Monit ; 27: e929476, 2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33561114

RESUMO

BACKGROUND Two-dimensional speckle tracking echocardiography (2D-STE) is a novel and non-invasive technique for the diagnosis of coronary artery disease (CAD). This retrospective study from a single center aimed to identify myocardial ischemia using 2D-STE in CAD patients identified by angiography. MATERIAL AND METHODS From March 1 to November 30, 2019, 690 patients in Beijing Hospital were enrolled. After angiography, 346 patients were diagnosed with CAD. Reduction in vessel diameter of ≥50% by stenosis in at least 1 major coronary artery or its main branch was considered CAD. Analysis of 2D-STE was performed using EchoPAC version 201. RESULTS The global strain was significantly impaired in CAD patients (P<0.01). Global longitudinal peak strain (GLPS) was analyzed in layers. For GLPS of the epicardium, the odds ratio (OR) was 1.297 (1.217-1.382; P=0.002), the area under the curve (AUC) was 0.727, and the cut-off value was -16.95; sensitivity and specificity were 73.7% and 63.0%, respectively. For GLPS of the middle layer, the OR was 1.260 (1.192-1.333; P<0.001), the AUC was 0.732, and the cut-off value was -20.95; sensitivity and specificity were 82.4% and 56.2%, respectively. For GLPS of the endocardium, the OR was 1.193 (1.137-1.251; P<0.001), the AUC was 0.708, and the cut-off value was -22.95; sensitivity and specificity were 82.9% and 52.9%, respectively. CONCLUSIONS The findings from this study support the clinical application of 2D-STE in patient populations with suspected myocardial ischemia due to CAD. Therefore, 2D-STE combined with ECG monitoring may have a future role for early screening of CAD patients.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Ecocardiografia/métodos , Isquemia Miocárdica/diagnóstico por imagem , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Estudos Transversais , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos
4.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509885

RESUMO

Postoperative coronary artery complications after Bentall procedures are well recognised but are rare and potentially fatal. There have been only five cases documenting percutaneous coronary intervention (PCI) for right coronary artery (RCA) involvements after button Bentall procedures. We describe a case of postoperative silent myocardial ischaemia in a 72-year-old man who underwent the button Bentall procedure for a right sinus of Valsalva aneurysm. On postoperative day 15, an RCA complication was incidentally detected by follow-up multidetector CT. Coronary angiography showed proximal RCA kinking, which was not an anastomosis but a native coronary artery. The patient underwent a successful PCI with drug-eluting stent implantation. We reviewed six cases consisting of this case and five previous cases treated with PCI. These cases enhance the recognition of potential RCA complications after the button Bentall procedure.


Assuntos
Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese Vascular , Estenose Coronária/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Complicações Pós-Operatórias/diagnóstico por imagem , Seio Aórtico , Idoso , Aneurisma Aórtico/complicações , Insuficiência da Valva Aórtica/complicações , Doenças Assintomáticas , Angiografia Coronária , Estenose Coronária/cirurgia , Stents Farmacológicos , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/cirurgia , Ultrassonografia de Intervenção
5.
World J Pediatr Congenit Heart Surg ; 12(1): 145-148, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33407035

RESUMO

Anomalous aortic origin of a left coronary artery (L-AAOCA) with an intraseptal course is a rare anomaly and can be associated with myocardial ischemia and sudden cardiac death. No surgical or medical intervention is known to improve patient outcomes. A 7-year-old boy with intraseptal L-AAOCA presented with nonexertional chest pain, syncope, and had reversible myocardial ischemia on provocative testing. The patient was started on ß-blockade, following which his symptoms improved and resolved over a period of six years. A follow-up dobutamine stress magnetic resonance imaging no longer showed reversible ischemia, and cardiac catheterization with fractional flow reserve did not show coronary flow compromise.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Seio Coronário/anormalidades , Anomalias dos Vasos Coronários/terapia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Isquemia Miocárdica/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Cateterismo Cardíaco , Criança , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Eletrocardiografia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia
6.
J Psychosom Res ; 141: 110342, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33360843

RESUMO

OBJECTIVE: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time. METHODS: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale. RESULTS: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time. CONCLUSION: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.


Assuntos
Aterosclerose/etiologia , Disfunção Cognitiva/complicações , Doença da Artéria Coronariana/etiologia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/psicologia , Estresse Psicológico/psicologia , Aterosclerose/psicologia , Doença da Artéria Coronariana/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Int J Mol Sci ; 21(24)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33348925

RESUMO

Ischemic heart disease (IHD) is among the leading causes of death in developed countries. Its pathological origin is traced back to coronary atherosclerosis, a lipid-driven immuno-inflammatory disease of the arteries that leads to multifocal plaque development. The primary clinical manifestation of IHD is acute myocardial infarction (AMI),) whose prognosis is ameliorated with optimal timing of revascularization. Paradoxically, myocardium re-perfusion can be detrimental because of ischemia-reperfusion injury (IRI), an oxidative-driven process that damages other organs. Amyloid-ß (Aß) plays a physiological role in the central nervous system (CNS). Alterations in its synthesis, concentration and clearance have been connected to several pathologies, such as Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA). Aß has been suggested to play a role in the pathogenesis of IHD and cerebral IRI. The purpose of this review is to summarize what is known about the pathological role of Aß in the CNS; starting from this evidence, we will illustrate the role played by Aß in the development of coronary atherosclerosis and its possible implications in the pathophysiology of IHD and myocardial IRI. Better elucidation of Aß's contribution to the molecular pathways underlying IHD and IRI could be of great help in developing new therapeutic strategies.


Assuntos
Peptídeos beta-Amiloides/metabolismo , Encéfalo/fisiopatologia , Coração/fisiopatologia , Isquemia Miocárdica/patologia , Traumatismo por Reperfusão/patologia , Animais , Humanos , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/metabolismo , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/metabolismo
11.
Medicine (Baltimore) ; 99(43): e22893, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120837

RESUMO

Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those ≥45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those ≥65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy.This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration ≥0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis.MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010).MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.


Assuntos
Cistectomia/efeitos adversos , Isquemia Miocárdica/etiologia , Troponina I/sangue , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Cistectomia/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/metabolismo , Estadiamento de Neoplasias/métodos , Complicações Pós-Operatórias/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/patologia
12.
Am J Physiol Heart Circ Physiol ; 319(3): H682-H693, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32795177

RESUMO

An ischemic insult is accompanied by an acute increase in circulating fatty acid (FA) levels, which can induce adverse changes related to cardiac metabolism/energetics. Although chronic hyperlipidemia contributes to the pathogenesis of obesity-/diabetes-related cardiomyopathy, it is unclear how these hearts are affected by an acute high FA-load. We hypothesize that adaptation to chronic FA exposure enhances the obese hearts' ability to handle an acute high FA-load. Diet-induced obese (DIO) and age-matched control (CON) mouse hearts were perfused in the presence of low- or high FA-load (0.4 and 1.8 mM, respectively). Left ventricular (LV) function, FA oxidation rate, myocardial oxygen consumption, and mechanical efficiency were assessed, followed by analysis of myocardial oxidative stress, mitochondrial respiration, protein acetylation, and gene expression. Finally, ischemic tolerance was determined by examining LV functional recovery and infarct size. Under low-FA conditions, DIO hearts showed mild LV dysfunction, oxygen wasting, mechanical inefficiency, and reduced mitochondrial OxPhos. High FA-load increased FA oxidation rates in both groups, but this did not alter any of the above parameters in DIO hearts. In contrast, CON hearts showed FA-induced mechanical inefficiency, oxidative stress, and reduced OxPhos, as well as enhanced acetylation and activation of PPARα-dependent gene expression. While high FA-load did not alter functional recovery and infarct size in CON hearts, it increased ischemic tolerance in DIO hearts. Thus, this study demonstrates that acute FA-load affects normal and obese hearts differently and that chronically elevated circulating FA levels render the DIO heart less vulnerable to the disadvantageous effects of an acute FA-load.NEW & NOTEWORTHY An acute myocardial fat-load leads to oxidative stress, oxygen wasting, mechanical inefficiency, hyperacetylation, and impaired mitochondrial function, which can contribute to reduced ischemic tolerance. Following obesity/insulin resistance, hearts were less affected by a high fat-load, which subsequently also improved ischemic tolerance. This study highlights that an acute fat-load affects normal and obese hearts differently and that obesity renders hearts less vulnerable to the disadvantageous effects of an acute fat-load.


Assuntos
Cardiomiopatias/metabolismo , Dieta Hiperlipídica , Metabolismo Energético , Ácidos Graxos/metabolismo , Isquemia Miocárdica/metabolismo , Miocárdio/metabolismo , Obesidade/metabolismo , Adaptação Fisiológica , Animais , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Modelos Animais de Doenças , Masculino , Camundongos Endogâmicos C57BL , Mitocôndrias Cardíacas/metabolismo , Mitocôndrias Cardíacas/patologia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miocárdio/patologia , Obesidade/etiologia , Obesidade/patologia , Obesidade/fisiopatologia , Consumo de Oxigênio , Espécies Reativas de Oxigênio/metabolismo , Função Ventricular Esquerda
13.
Rev. cuba. endocrinol ; 31(2): e228, tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1138895

RESUMO

RESUMEN Introducción: La diabetes mellitus tipo 2 es considerada una situación de alto riesgo cardiovascular. En la mujer con diabetes se añade el riesgo que representa el déficit estrogénico posmenopáusico. Objetivo: Determinar la frecuencia de enfermedad cardiovascular en las etapas del climaterio. Métodos: Se realizó un estudio transversal y descriptivo con 611 mujeres con diabetes mellitus tipo 2 en edad mediana (40-59 años), que ingresaron consecutivamente en el Centro de Atención al Diabético de Bayamo, Granma, desde el año 2010 al 2017. Se excluyeron los casos con menopausia artificial. Se empleó la prueba de chi cuadrado para comprobar la relación que pudiera existir entre las variables cualitativas, mientras que para comparar los valores promedio de las variables cuantitativas entre los grupos se utilizó t de Student. Resultados: La frecuencia de hipertensión arterial, hipercolesterolemia y síndrome metabólico fue claramente superior en las mujeres posmenopáusicas que en las premenopáusicas (p = 0,0257; p = 0,0391 y p = 0,0591, respectivamente). Las enfermedades cardiovasculares aumentaron significativamente con la menopausia y con el tiempo de ocurrencia de este evento (p = 0,0014). La relación fue más notoria en el caso de la cardiopatía isquémica y la enfermedad arterial periférica (p = 0,0521 y p = 0,0011, respectivamente). Conclusiones: En las mujeres con diabetes mellitus tipo 2 la enfermedad cardiovascular aumenta significativamente con el avance de la peri a la posmenopausia tardía, fundamentalmente la cardiopatía isquémica y la enfermedad arterial periférica(AU)


ABSTRACT Introduction: Type 2 diabetes mellitus is considered a situation of high cardiovascular risk. Among diabetic women, the risk for postmenopausal estrogen deficiency is added. Objective: To determine the frequency of cardiovascular disease in climacteric stages. Methods: A cross-sectional and descriptive study was carried out with 611 middle-aged (40-59 years old) women with type 2 diabetes mellitus and who were admitted consecutively to the Diabetic Care Center in Bayamo city, Granma, from 2010 to 2017. The cases with artificial menopause were not included in the study. The chi-square test was used to verify the relationship that might exist between qualitative variables, while Student's t test was used to compare the average values of the quantitative variables between the groups. Results: The frequency of arterial hypertension, hypercholesterolemia and metabolic syndrome was clearly higher among postmenopausal women than among premenopausal women (p = 0.0257, p = 0.0391, and p = 0.0591, respectively). Cardiovascular disease increased significantly with menopause and with the time of occurrence of this event (p = 0.0014). The relationship was more noticeable in the case of ischemic heart disease and peripheral arterial disease (p = 0.0521 and p = 0.0011, respectively). Conclusions: In women with type 2 diabetes mellitus, cardiovascular disease increases significantly with the progression from the perimenopausal stage to the late postmenopausal stage, mainly ischemic heart disease and peripheral arterial disease(AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Climatério , Doenças Cardiovasculares/etiologia , Isquemia Miocárdica/etiologia , Pós-Menopausa , Diabetes Mellitus Tipo 2/epidemiologia , Epidemiologia Descritiva , Estudos Transversais , Síndrome Metabólica/etiologia
14.
PLoS Med ; 17(7): e1003206, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32722673

RESUMO

BACKGROUND: Previous clinical trials and institutional studies have demonstrated that surgery for the treatment of obesity (termed bariatric or metabolic surgery) reduces all-cause mortality and the development of obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia. The current study analysed large-scale population studies to assess the association of bariatric surgery with long-term mortality and incidence of new-onset obesity-related disease at a national level. METHODS AND FINDINGS: A systematic literature search of Medline (via PubMed), Embase, and Web of Science was performed. Articles were included if they were national or regional administrative database cohort studies reporting comparative risk of long-term mortality or incident obesity-related diseases for patients who have undergone any form of bariatric surgery compared with an appropriate control group with a minimum follow-up period of 18 months. Meta-analysis of hazard ratios (HRs) was performed for mortality risk, and pooled odds ratios (PORs) were calculated for discrete variables relating to incident disease. Eighteen studies were identified as suitable for inclusion. There were 1,539,904 patients included in the analysis, with 269,818 receiving bariatric surgery and 1,270,086 control patients. Bariatric surgery was associated with a reduced rate of all-cause mortality (POR 0.62, 95% CI 0.55 to 0.69, p < 0.001) and cardiovascular mortality (POR 0.50, 95% CI 0.35 to 0.71, p < 0.001). Bariatric surgery was strongly associated with reduced incidence of T2DM (POR 0.39, 95% CI 0.18 to 0.83, p = 0.010), hypertension (POR 0.36, 95% CI 0.32 to 0.40, p < 0.001), dyslipidaemia (POR 0.33, 95% CI 0.14 to 0.80, p = 0.010), and ischemic heart disease (POR 0.46, 95% CI 0.29 to 0.73, p = 0.001). Limitations of the study include that it was not possible to account for unmeasured variables, which may not have been equally distributed between patient groups given the non-randomised design of the studies included. There was also heterogeneity between studies in the nature of the control group utilised, and potential adverse outcomes related to bariatric surgery were not specifically examined due to a lack of available data. CONCLUSIONS: This pooled analysis suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related disease in patients with obesity for the whole operated population. The results suggest that broader access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits.


Assuntos
Cirurgia Bariátrica , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Obesidade/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Doenças Cardiovasculares/etiologia , Comorbidade , Diabetes Mellitus Tipo 2/etiologia , Dislipidemias/epidemiologia , Dislipidemias/etiologia , Humanos , Hipertensão/etiologia , Incidência , Pessoa de Meia-Idade , Mortalidade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Obesidade/complicações , Obesidade/mortalidade , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
15.
Am J Med Sci ; 360(4): 372-377, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32723514

RESUMO

BACKGROUND: Infection is postulated as a possible risk factor for ischemic heart disease with a spiralling body of evidence. Hepatitis B is one of the most comprehensively investigated infection for its association with ischemic heart disease. This study aims at establishing an association between Hepatitis B core antibody status and ischemic heart disease using National Health and Nutrition Examination Survey (NHANES) database. METHODS: NHANES data from 2007 to 2016 were used for the present analysis. To identify patients with self-reported coronary heart disease, angina/angina pectoris, myocardial infarction, we examined the answers to questions MCQ160c, MCQ160d, MCQ160e delineated in NHANES data. These questions as described in the NHANES dataset are as follows: MCQ160c-Has a doctor or other health professional ever told you that you had coronary heart disease?, MCQ160d-Has a doctor or other health professional ever told you that you had angina, also called angina pectoris?, MCQ160e- Has a doctor or other health professional ever told you that you had a heart attack also called myocardial infarction?. Next, to identify patients with positive Hepatitis B core antibody, we examined the variable LBXHBC of the NHANES dataset. Baseline characteristics, along with unadjusted and adjusted odds ratio using multivariable logistic regression analysis, of included patients were analyzed for Hepatitis B core antibody and its association with ischemic heart disease. RESULTS: A total of 3,248 individuals with ischemic heart disease and 42,345 individuals with no ischemic heart disease were included in the final analysis. Hepatitis B core antibody positive status was associated with lower incidence of ischemic heart disease, adjusted odds ratio of 0.61 (95% confidence interval: 0.41-0.92, P value < 0.02). CONCLUSIONS: In conclusion, the present analysis points toward a possible association between past Hepatitis B infection and ischemic heart disease. Hepatitis B infection was associated with a decreased incidence of ischemic heart disease. Further research with better design and possible molecular mechanism is warranted.


Assuntos
Antígenos do Núcleo do Vírus da Hepatite B/sangue , Hepatite B/epidemiologia , Isquemia Miocárdica/epidemiologia , Idoso , Feminino , Hepatite B/sangue , Hepatite B/complicações , Humanos , Incidência , Modelos Logísticos , Masculino , Análise Multivariada , Isquemia Miocárdica/sangue , Isquemia Miocárdica/etiologia , Inquéritos Nutricionais , Razão de Chances , Fatores de Risco , Estados Unidos/epidemiologia
17.
Int Heart J ; 61(3): 595-600, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32418958

RESUMO

Cold ischemic injury in heart storage is an important issue pertaining to heart transplantation. This study aims to evaluate the addition of compound glycyrrhizin (CG) in histidine-tryptophan-ketoglutarate (HTK) solution on chronic isograft injury in comparison to traditional HTK solution.Hearts of mouse were stored for 8 h in 4°C cold preservation solution and then transplanted heterotopically into mouse. Five groups were evaluated: HTK, low dose of CG solution (LCG), medium dose of CG solution (MCG), high dose of CG solution (HCG), and hearts without cold ischemia (sham). Survival was assessed. Time to restoration of heartbeat and strength of the heartbeat was measured. Lactate dehydrogenase (LDH) and creatine kinase (CK) levels in the preservation solution were determined. The myocardial damage and interstitial fibrosis of transplanted hearts were evaluated. TGF-ß1 expression in the transplanted hearts was assessed.Addition of CG to HTK solution significantly attenuated cold ischemic injury during cold storage, as evidenced by the lower time to restoration of heartbeat, higher strength of the heartbeat, lower LDH, and CK leakage. After transplantation, hearts stored in HTK solution containing CG had decreased the myocardial damage and interstitial fibrosis, compared with those stored without CG. The percentage of TGF-ß1-positive cells and TGF-ß1 level in the transplanted hearts were also decreased when stored in CG-containing HTK solution.The addition of CG to HTK solution attenuates cold ischemic injury during cold storage.


Assuntos
Anti-Inflamatórios/uso terapêutico , Isquemia Fria/efeitos adversos , Ácido Glicirrízico/uso terapêutico , Transplante de Coração , Isquemia Miocárdica/tratamento farmacológico , Animais , Avaliação Pré-Clínica de Medicamentos , Glucose , Masculino , Manitol , Camundongos Endogâmicos C57BL , Isquemia Miocárdica/etiologia , Cloreto de Potássio , Procaína
18.
Medicine (Baltimore) ; 99(20): e20135, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443326

RESUMO

BACKGROUND: Although patients with coronary artery disease (CAD) rely increasingly upon percutaneous coronary intervention (PCI), this therapy causes subsequent the complications of myocardial injury. Acupuncture safely protects the heart from ischemic injury; however, the efficacy of acupuncture for periprocedural myocardial injury after PCI remains unclear. METHODS: Seven databases in English and Chinese including PubMed, Web of Science, Cochrane Library, Embase, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, and Wanfang Database will be searched. Randomized controlled trials (RCTs) that use acupuncture to treat PCI-related myocardial injury in patients with CAD, regardless of blinding. The crossover randomized trials will be included, but only the pre-crossover data will be analyzed to avoid carryover effects. We will exclude non-RCTs, qualitative studies, uncontrolled clinical trials, and laboratory studies. The measurement of concentration of cardiac troponin (T or I) and MB isoenzyme of creatine kinase will be used as primary outcome. Postprocedural cardiac function and the major adverse cardiac/cerebrovascular event rate will be assessed as secondary outcome. Relevant data were collected independently by 2 reviewers and the third reviewer was responsible for resolving discrepancies through discussion. The Review Manager V.5.3.3 s will be used to perform the data synthesis and subgroup analysis. DISCUSSION: This systematic review and meta-analysis would provide convincing evidence of various types of acupuncture that specifically focuses on cardioprotective effect of acupuncture on PCI-related myocardial injury. REGISTRATION: Open Science Framework (OSF) registries (osf.io/n2e6t) with the registration DOI: 10.17605/OSF.IO/79H2E.


Assuntos
Terapia por Acupuntura/métodos , Doença da Artéria Coronariana/terapia , Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea/efeitos adversos , Terapia por Acupuntura/estatística & dados numéricos , Cardiotônicos/farmacologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Creatina Quinase Forma MB/sangue , Humanos , Isquemia Miocárdica/sangue , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/prevenção & controle , Intervenção Coronária Percutânea/métodos , Período Perioperatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade , Troponina/sangue
19.
J Biomed Sci ; 27(1): 63, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32389123

RESUMO

Oxygen is essentially required by most eukaryotic organisms as a scavenger to remove harmful electron and hydrogen ions or as a critical substrate to ensure the proper execution of enzymatic reactions. All nucleated cells can sense oxygen concentration and respond to reduced oxygen availability (hypoxia). When oxygen delivery is disrupted or reduced, the organisms will develop numerous adaptive mechanisms to facilitate cells survived in the hypoxic condition. Normally, such hypoxic response will cease when oxygen level is restored. However, the situation becomes complicated if hypoxic stress persists (chronic hypoxia) or cyclic normoxia-hypoxia phenomenon occurs (intermittent hypoxia). A series of chain reaction-like gene expression cascade, termed hypoxia-mediated gene regulatory network, will be initiated under such prolonged or intermittent hypoxic conditions and subsequently leads to alteration of cellular function and/or behaviors. As a result, irreversible processes occur that may cause physiological disorder or even pathological consequences. A growing body of evidence implicates that hypoxia plays critical roles in the pathogenesis of major causes of mortality including cancer, myocardial ischemia, metabolic diseases, and chronic heart and kidney diseases, and in reproductive diseases such as preeclampsia and endometriosis. This review article will summarize current understandings regarding the molecular mechanism of hypoxia in these common and important diseases.


Assuntos
Endometriose/fisiopatologia , Cardiopatias/fisiopatologia , Hipóxia/fisiopatologia , Nefropatias/fisiopatologia , Doenças Metabólicas/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Neoplasias/fisiopatologia , Pré-Eclâmpsia/fisiopatologia , Doença Crônica , Endometriose/etiologia , Feminino , Cardiopatias/etiologia , Humanos , Hipóxia/complicações , Nefropatias/etiologia , Masculino , Doenças Metabólicas/etiologia , Isquemia Miocárdica/etiologia , Neoplasias/etiologia , Pré-Eclâmpsia/etiologia , Gravidez
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