RESUMO
BACKGROUND: Epidemiological studies have suggested that elevated concentrations of particulate matter (PM) are strongly associated with the incidence of atherosclerosis, however, the underlying cellular and molecular mechanisms of atherosclerosis by PM exposure and the components that are mainly responsible for this adverse effect remain to be established. In this investigation, we evaluated the effects of ambient PM on vascular smooth muscle cell (VSMC) behavior. Furthermore, the effects of polycyclic aromatic hydrocarbons (PAHs), major components of PM, on VSMC migration and the underlying mechanisms were examined. RESULTS: VSMC migration was significantly increased by treatment with organic matters extracted from ambient PM. The total amount of PAHs contained in WPM was higher than that in SPM, leading to higher ROS generation and VSMC migration. The increased migration was successfully inhibited by treatment with the anti-oxidant, N-acetyl-cysteine (NAC). The levels of matrix metalloproteinase (MMP) 2 and 9 were significantly increased in ambient PM-treated VSMCs, with MMP9 levels being significantly higher in WPM-treated VSMCs than in those treated with SPM. As expected, migration was significantly increased in all tested PAHs (anthracene, ANT; benz(a)anthracene, BaA) and their oxygenated derivatives (9,10-Anthraquinone, AQ; 7,12-benz(a)anthraquinone, BAQ, respectively). The phosphorylated levels of focal adhesion kinase (FAK) and formation of the focal adhesion complex were significantly increased in ambient PM or PAH-treated VSMCs, and these effects were blocked by administration of NAC or α-NF, an inhibitor of AhR, the receptor that allows PAH uptake. Subsequently, the levels of phosphorylated Src and NRF, the downstream targets of FAK, were altered with a pattern similar to that of p-FAK. CONCLUSIONS: PAHs, including oxy-PAHs, in ambient PM may have dual effects that lead to an increase in VSMC migration. One is the generation of oxidative stress followed by MMP upregulation, and the other is actin reorganization that results from the activation of the focal adhesion complex.
Assuntos
Poluentes Atmosféricos , Aterosclerose , Hidrocarbonetos Policíclicos Aromáticos , Actinas , Poluentes Atmosféricos/análise , Movimento Celular , Humanos , Metaloproteinases da Matriz , Músculo Liso Vascular/química , Estresse Oxidativo , Material Particulado/análise , Material Particulado/toxicidade , Hidrocarbonetos Policíclicos Aromáticos/análise , Hidrocarbonetos Policíclicos Aromáticos/toxicidade , Regulação para CimaRESUMO
BACKGROUND: Myocardial bridging is a congenital anomaly defined as a segment of epicardial coronary arteries running through the myocardium. Various complications related to myocardial bridging have been reported, but at present, cardiac arrest has rarely been reported. CASE PRESENTATION: We report one case of a patient who was successfully resuscitated from ventricular fibrillation cardiac arrest and was diagnosed with myocardial bridging accompanied by myocardial ischaemia. A 50-year-old woman who had been resuscitated from cardiac arrest transferred to our institution for evaluation and management of out-of-hospital cardiac arrest. We confirmed the diagnosis of significant myocardial bridging with evident myocardial ischaemia by coronary angiography, resting echocardiography and heart MRI. Vasospasm was thought to be a trigger factor judging from the transient ST elevation on electrocardiography. In addition, the finding of septal buckling was detected for the first time throughout the whole cardiac cycle by resting echocardiography in MB. CONCLUSION: We report a rare case of survival after out-of-hospital cardiac arrest that might be caused by significant myocardial bridging-induced myocardial ischaemia, which was objectively confirmed by echocardiography and heart MRI. Although myocardial bridging is often overlooked as an aetiology for sudden cardiac death, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of sudden cardiac death.
Assuntos
Ponte Miocárdica/complicações , Isquemia Miocárdica/etiologia , Parada Cardíaca Extra-Hospitalar/etiologia , Fibrilação Ventricular/etiologia , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Ponte Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Valor Preditivo dos Testes , Ressuscitação , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapiaRESUMO
BACKGROUND: Although ticagrelor is known to increase the bleeding risk compared to clopidogrel in East Asian patients, its clinical benefits in patients with acute myocardial infarction (AMI) without high bleeding risk (HBR) remains unknown. METHODS: A total of 7,348 patients who underwent successful percutaneous coronary intervention (PCI) from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic Research Consortium for HBR criteria (KAMIR-HBR, 2,469 patients; KAMIR-non HBR, 4,879 patients). We compared in-hospital major adverse cardiovascular events (MACEs, defined as a composite of cardiac death, non-fatal myocardial infarction, or stroke), and the thrombolysis in myocardial infarction (TIMI) major bleeding between ticagrelor and clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively. RESULTS: After propensity score matching, ticagrelor had a higher incidence of in-hospital TIMI major bleeding than clopidogrel in all patients (odds ratio [OR], 1.683; 95% confidence interval [CI], 1.010-2.805; P = 0.046) and the KAMIR-HBR group (OR, 3.460; 95% CI, 1.374-8.714; P = 0.008). However, there was no significant difference in in-hospital TIMI major bleeding between ticagrelor and clopidogrel in the KAMIR-non HBR group (OR, 1.436; 95% CI, 0.722-2.855; P = 0.303). No differences were observed in the cumulative incidences of in-hospital and 6-month MACEs between ticagrelor and clopidogrel in both groups. CONCLUSIONS: The bleeding risk of ticagrelor was attenuated in Korean patients with AMI without HBR. Appropriate patient selection could reduce in-hospital bleeding complications associated with ticagrelor in Korean patients with AMI who underwent successful PCI.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ticagrelor/uso terapêutico , Doença Aguda , Idoso , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Feminino , Hemorragia/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Pontuação de Propensão , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Sistema de Registros , República da Coreia , Risco , Ticagrelor/efeitos adversos , Resultado do TratamentoRESUMO
Low-density lipoprotein receptor-related protein 5 (LRP5) has been studied as a co-receptor for Wnt/ß-catenin signaling. However, its role in the ischemic myocardium is largely unknown. Here, we show that LRP5 may act as a negative regulator of ischemic heart injury via its interaction with prolyl hydroxylase 2 (PHD2), resulting in hypoxia-inducible factor-1α (HIF-1α) degradation. Overexpression of LRP5 in cardiomyocytes promoted hypoxia-induced apoptotic cell death, whereas LRP5-silenced cardiomyocytes were protected from hypoxic insult. Gene expression analysis (mRNA-seq) demonstrated that overexpression of LRP5 limited the expression of HIF-1α target genes. LRP5 promoted HIF-1α degradation, as evidenced by the increased hydroxylation and shorter stability of HIF-1α under hypoxic conditions through the interaction between LRP5 and PHD2. Moreover, the specific phosphorylation of LRP5 at T1492 and S1503 is responsible for enhancing the hydroxylation activity of PHD2, resulting in HIF-1α degradation, which is independent of Wnt/ß-catenin signaling. Importantly, direct myocardial delivery of adenoviral constructs, silencing LRP5 in vivo, significantly improved cardiac function in infarcted rat hearts, suggesting the potential value of LRP5 as a new target for ischemic injury treatment.
Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Prolina Dioxigenases do Fator Induzível por Hipóxia/metabolismo , Proteína-5 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Isquemia Miocárdica/metabolismo , Miócitos Cardíacos/metabolismo , Animais , Animais Recém-Nascidos , Regulação da Expressão Gênica , Hidroxilação , Hipóxia/metabolismo , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Cultura Primária de Células , Ratos , Via de Sinalização WntRESUMO
BACKGROUND: Epidemiologic studies have suggested that elevated concentrations of particulate matter (PM) are strongly associated with an increased risk of developing cardiovascular diseases, including arrhythmia. However, the cellular and molecular mechanisms by which PM exposure causes arrhythmia and the component that is mainly responsible for this adverse effect remains to be established. In this study, the arrhythmogenicity of mobilized organic matter from two different types of PM collected during summer (SPM) and winter (WPM) seasons in the Seoul metropolitan area was evaluated. In addition, differential effects between polycyclic aromatic hydrocarbons (PAHs) and oxygenated PAHs (oxy-PAHs) on the induction of electrophysiological instability were examined. RESULTS: We extracted the bioavailable organic contents of ambient PM, measuring 10 µm or less in diameter, collected from the Seoul metropolitan area using a high-volume air sampler. Significant alterations in all factors tested for association with electrophysiological instability, such as intracellular Ca2+ levels, reactive oxygen species (ROS) generation, and mRNA levels of the Ca2+-regulating proteins, sarcoplasmic reticulum Ca2+ATPase (SERCA2a), Ca2+/calmodulin-dependent protein kinase II (CaMK II), and ryanodine receptor 2 (RyR2) were observed in cardiomyocytes treated with PM. Moreover, the alterations were higher in WPM-treated cardiomyocytes than in SPM-treated cardiomyocytes. Three-fold more oxy-PAH concentrations were observed in WPM than SPM. As expected, electrophysiological instability was induced higher in oxy-PAHs (9,10-anthraquinone, AQ or 7,12-benz(a) anthraquinone, BAQ)-treated cardiomyocytes than in PAHs (anthracene, ANT or benz(a) anthracene, BaA)-treated cardiomyocytes; oxy-PAHs infusion of cells mediated by aryl hydrocarbon receptor (AhR) was faster than PAHs infusion. In addition, ROS formation and expression of calcium-related genes were markedly more altered in cells treated with oxy-PAHs compared to those treated with PAHs. CONCLUSIONS: The concentrations of oxy-PAHs in PM were found to be higher in winter than in summer, which might lead to greater electrophysiological instability through the ROS generation and disruption of calcium regulation.
Assuntos
Potenciais de Ação/efeitos dos fármacos , Poluentes Atmosféricos/toxicidade , Miócitos Cardíacos/efeitos dos fármacos , Oxigênio/química , Material Particulado/toxicidade , Hidrocarbonetos Policíclicos Aromáticos/toxicidade , Poluentes Atmosféricos/química , Animais , Animais Recém-Nascidos , Cálcio/metabolismo , Células Cultivadas , Peroxidação de Lipídeos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Tamanho da Partícula , Material Particulado/química , Técnicas de Patch-Clamp , Hidrocarbonetos Policíclicos Aromáticos/química , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio/metabolismo , Estações do Ano , SeulRESUMO
BACKGROUND: Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, a gram-negative intracellular bacterium. Myocarditis and rhabdomyolysis are rare complications of scrub typhus. CASE PRESENTATION: We report a case of scrub typhus, which was simultaneously complicated with myocarditis and rhabdomyolysis. A 54-year-old woman presented to our hospital with myalgia in the upper and lower limbs, oedema and a fever of 7 days' duration. We confirmed the diagnosis of scrub typhus complicated with myocarditis by pericardial fluid analysis and cardiac magnetic resonance imaging results. The pericardial fluid showed characteristics of an exudate, an elevated immunofluorescence assay (IFA) IgG titer of 1:2048 and a positive 16S rRNA qPCR result. We also diagnosed rhabdomyolysis by the patient's presenting symptoms, elevated muscle enzyme levels and bone scan results. CONCLUSION: We report for the first time a case of scrub typhus complicated with both myocarditis and rhabdomyolysis, the causative agent of which was the Boryong genotype of O. tsutsugamushi.
Assuntos
Miocardite/diagnóstico , Rabdomiólise/diagnóstico , Tifo por Ácaros/diagnóstico , Eletrocardiografia , Feminino , Imunofluorescência , Humanos , Imunoglobulina G/análise , Pessoa de Meia-Idade , Miocardite/complicações , Orientia tsutsugamushi/genética , Orientia tsutsugamushi/isolamento & purificação , RNA Ribossômico 16S/isolamento & purificação , RNA Ribossômico 16S/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Rabdomiólise/complicações , Tifo por Ácaros/complicações , Tifo por Ácaros/microbiologiaRESUMO
This study aimed to determine the association of the brachial-ankle pulse wave velocity (baPWV) and mean platelet volume (MPV) with the development of adverse outcomes after percutaneous coronary intervention (PCI). The baPWV and MPV were analyzed in 372 patients who underwent PCI, with the primary endpoint as cardiac death. The secondary endpoint was cardiovascular events (CVE): a composite of cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), ischemic stroke, and stent thrombosis (ST). During the follow-up period (mean, 25.8 months), there were 21 cardiac deaths, 10 MIs including four events of ST, seven ischemic strokes, and 29 TVRs. The baPWV cut-off level was set at 1672 cm/s using the receiver operating characteristic curve; the sensitivity and specificity was 85.7 and 60.1%, respectively, to differentiate between the groups with and without cardiac death. The MPV cut-off level was set at 8.20 fL using the receiver operating characteristic curve; the sensitivity and specificity were 81 and 53.3%, respectively, to differentiate between the groups with and without cardiac death. Kaplan-Meier analysis revealed that the higher baPWV group (≥ 1672 cm/s) had a significantly higher cardiac death and CVE rate than the lower baPWV group (<1672 cm/s) (11.4 vs. 1.4%, log-rank: p < 0.0001; 25.3 vs. 7.5%, log-rank: p < 0.0001; respectively), and the higher MPV group (median, >8.20 fL,) had a significantly higher cardiac death and CVE rate than the lower MPV group (≤ 8.20 fL) (9.4 vs. 2.1%, log-rank: p = 0.0026; 23.8 vs. 6.8%, log-rank: p < 0.0001; respectively). Furthermore, the high baPWV and MPV groups were significantly associated with an increased risk of cardiac death. These results show that baPWV and MPV are predictive markers after PCI for cardiac death; they are also additively associated with a higher risk of cardiac death.
Assuntos
Índice Tornozelo-Braço , Velocidade do Fluxo Sanguíneo , Volume Plaquetário Médio , Intervenção Coronária Percutânea , Fluxo Pulsátil , Idoso , Biomarcadores , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Valor Preditivo dos Testes , Prognóstico , Curva ROC , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Análise de SobrevidaRESUMO
The aim of this study was to evaluate the prognostic value of serum total bilirubin on the development of adverse outcomes after percutaneous coronary intervention (PCI) besides high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B type natriuretic peptide (NT-proBNP). Serum total bilirubin, hs-cTnT, and NT-proBNP were analyzed in 372 patients who underwent PCI. The primary endpoint was cardiac death. There were 21 events of cardiac death during a mean of 25.8 months of follow-up. When the serum total bilirubin cut-off level (median value) was set to 0.58 mg/dL using the receiver operating characteristic curve, the sensitivity was 95.2 % and the specificity was 51.0 % for differentiating between the group with cardiac death and the group without cardiac death. Kaplan-Meier analysis revealed that the lower serum total bilirubin group (<0.58 mg/dL) had a significantly higher cardiac death rate than the higher serum total bilirubin group (≥0.58 mg/dL) (10.4 vs. 0.6 %, log-rank: P = 0.0001). In conclusion, low serum total bilirubin is a predictive marker for cardiac death after PCI.
Assuntos
Bilirrubina/sangue , Morte , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Intervenção Coronária Percutânea/efeitos adversos , Troponina T/sangue , Idoso , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
The aim of this study was to determine the associations of the mean platelet volume (MPV) high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B type natriuretic peptide (NT-proBNP) with the development of adverse outcomes after percutaneous coronary intervention (PCI). MPV hs-cTnT and NT-proBNP were analyzed in 372 patients who underwent PCI. The primary endpoint was cardiac death. The secondary endpoint analyzed was cardiovascular events (CVE): the composite of cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), ischemic stroke and stent thrombosis (ST). The median MPV hs-cTnT and NT-proBNP levels were 8.20 (IQR 7.70-8.70) fL, 0.291 (IQR 0.015-3.785) ng/mL, and 105.25 (IQR 50.84-1128.5) pg/mL, respectively. There were 21 events of cardiac death, 10 MI (including 4 events of ST), 7 ischemic strokes and 29 TVR during a mean of 25.8 months of follow-up. The Kaplan-Meier analysis revealed that the higher MPV group (>8.20 fL, median) had a significantly higher cardiac death rate than the lower MPV group (≤8.20 fL; 9.4% vs. 2.1%, log-rank: p = 0.0026). When the MPV cut-off level was set to 8.20 fL using the receiver operating characteristic curve, the sensitivity was 81% and the specificity was 53.3% for differentiating between the group with cardiac death and the group without cardiac death. This value was more useful in patients with myocardial injury (hs-cTnT ≥ 0.1 ng/mL) or heart failure (NT-proBNP ≥ 450 pg/mL). The results of this study show that MPV is a predictive marker for cardiac death after PCI; its predictive power for cardiac death is more useful in patients with myocardial injury or heart failure.
Assuntos
Volume Plaquetário Médio , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Biomarcadores/sangue , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Taxa de SobrevidaRESUMO
BACKGROUND: Chronic right-ventricular (RV) pacing can worsen heart failure in patients with a low ejection fraction (EF), but little is known about pacing-induced cardiomyopathy (PICM) in patients with preserved EF. We aimed to investigate risk factors of PICM in these patients during long-term follow-up. METHODS: The prospective registry at Chosun University Hospital, South Korea, included de novo patients with preserved EF undergoing transvenous permanent pacemaker (PPM) implantation for atrioventricular blockage from 2017 to 2021. Patients with EF ≥ 50% and expected ventricular pacing ≥ 40% were included. Composite outcomes were cardiac death (pump failure), hospitalization because of heart failure, PICM, and biventricular pacing (BVP) upgrade. RESULTS: A total of 168 patients (69 men, 76.3 ± 10.4 years) were included. During three years of follow-up, one patient died, 14 were hospitalized, 16 suffered PICM, and two underwent BVP upgrade. PICM were associated with reduced global longitudinal strain (GLS), prolonged paced QRS duration (pQRSd) and diastolic variables (E/e', LAVI). Cox regression analysis identified pQRSd (hazard ratio [HR], 1.111; 95% confidence interval [CI], 1.011-1.222; P = 0.03) and reduced GLS (HR, 1.569; 95% CI, 1.163-2.118; P = 0.003) as independent predictors of PICM. GLS showed high predictive accuracy for PICM, with an area under the curve of 0.84 (95% CI 0.779-0.894; P < 0.001) [GLS -12.0, 62.5% sensitivity, and 86.1% specificity]. CONCLUSION: RV pacing increased the risk of PICM in patients with preserved EF. Reduced GLS and prolonged pQRSd could help identify individuals at high risk of PICM even with preserved EF.
Assuntos
Terapia de Ressincronização Cardíaca , Cardiomiopatias , Insuficiência Cardíaca , Marca-Passo Artificial , Masculino , Humanos , Volume Sistólico , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/terapia , Cardiomiopatias/etiologia , Marca-Passo Artificial/efeitos adversos , Terapia de Ressincronização Cardíaca/efeitos adversos , Estimulação Cardíaca Artificial/efeitos adversos , Função Ventricular EsquerdaRESUMO
The radial artery has been used increasingly for percutaneous coronary intervention because of its safety and feasible access route. Nevertheless, transradial complications are possible because of the variation in radial artery anatomy. We experienced a case of the brachioradial artery injury secondary to catheterization, presenting as hypovolemic shock. A 76-year-old woman presented at our emergency department complaining of effort-induced angina. Coronary angiography via the right radial artery showed critical stenosis in the middle of the left anterior descending coronary artery. After wiring into this vessel, balloon angioplasty using a 6-Fr Judkin left guiding catheter was performed with the deployment of the zotarolimus-eluting stent. There was difficulty in negotiating the guidewire and balloons in that resistance was experienced while passing the catheter in the upper arm. Therefore, retrograde radial arteriography was performed to determine any injury to radial artery. This showed contrast extravasation in the brachioradial artery. Initially, manual compression was tried. However, 2 hours later, the patient developed cold sweating and went into a stupor. Laboratory findings showed a decline in hemoglobin, leading to suspicion of hemorrhagic shock. We applied over 30 minutes of balloon inflation, but this was ineffective. While surgical repair was not available, a 6.0 × 50 mm Viabahn stent was placed over the axillary artery. Subsequent angiography showed no further leakage or occlusion of the brachioradial artery. The postprocedural period was uneventful, and the patient was discharged with dual antiplatelet agents. At a 7-year clinical follow-up, the patient was free from limb ischemia symptoms.
Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea , Feminino , Humanos , Idoso , Stents Farmacológicos/efeitos adversos , Seguimentos , Artéria Radial , Doença Iatrogênica , Resultado do TratamentoRESUMO
The long-term prognostic significance of maximal infarct transmurality evaluated by contrast-enhanced cardiac magnetic resonance (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients has yet to be determined. This study aimed to see if maximal infarct transmurality has any additional long-term prognostic value over other CE-CMR predictors in STEMI patients, such as microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). The study included 112 consecutive patients who underwent CE-CMR after STEMI to assess established parameters of myocardial injury as well as the maximal infarct transmurality. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE), which included all-cause death, non-fatal reinfarction, and new heart failure hospitalization. The MACE occurred in 10 patients over a median follow-up of 7.9 years (IQR, 5.8 to 9.2 years) (2 deaths, 3 nonfatal MI, and 5 heart failure hospitalization). Patients with MACE had significantly higher rates of transmural extent of infarction, infarct size >5.4 percent, MVO, and IMH compared to patients without MACE. In stepwise multivariable Cox regression analysis, the transmural extent of infarction defined as 75 percent or more of infarct transmurality was an independent predictor of the MACE after correction for MVO and IMH (hazard ratio 8.7, 95% confidence intervals [CIs] 1.1-71; p=0.043). In revascularized STEMI patients, post-infarction CE-CMR-based maximal infarct transmurality is an independent long-term prognosticator. Adding maximal infarct transmurality to CE-CMR parameters like MVO and IMH could thus identify patients at high risk of long-term adverse outcomes in STEMI.
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The aim of this study was to determine the association of mean platelet volume (MPV) with the development of stroke or coronary artery disease (CAD) in diabetes mellitus (DM). MPV was analyzed in 200 Korean patients with DM. The primary endpoint was composite of ischemic stroke/CAD events. The mean MPV was 7.6 ± 0.8 fl. There were 14 ischemic stroke events and 8 CAD events during a mean of 28.4 months of follow-up. The Kaplan-Meier analysis revealed that the higher tertile MPV group (≥7.9 fl) had a significantly higher stroke/CAD rate compared to the lower tertile MPV group (≤7.3 fl) (29.9% vs. 2.8%, log-rank: p < 0.001). Higher MPV was an independent predictor of stroke/CAD risk after adjusting for 10-year risk ≥10%, hypertension, dyslipidemia, and previous stroke or transient ischemic attack history (hazard ratio: 11.92, 95% confidence interval 2.68-52.92, p = 0.001) in the Cox proportional hazard analysis. When the MPV cut-off level was set to 7.95 fl using the receiver operating characteristic curve, the sensitivity was 91% and the specificity was 80% for differentiating between the group with stroke/CAD and the group without stroke/CAD. This value was more useful in patients with hypertension. The results of this study show that MPV is a predictive marker for stroke/CAD; its predictive power for stroke/CAD is independent of age, gender, hypertension, and hemoglobin A1C.
Assuntos
Doença da Artéria Coronariana/etiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Volume Plaquetário Médio , Acidente Vascular Cerebral/etiologia , Idoso , Área Sob a Curva , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Risco , Sensibilidade e Especificidade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidadeRESUMO
Chronic right ventricular (RV) pacing can exacerbate heart failure in patients with a low left ventricular ejection fraction (LVEF). Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing technique; however, information remains limited on its use among patients with a low EF. This study investigated the safety and short-term clinical outcomes of LBBAP among patients with impaired left ventricular (LV) function. This retrospective analysis of pacemakers at Chosun University Hospital, South Korea, included all patients with impaired LV function (EF<50%) who underwent pacemaker implantation for atrioventricular blockage from 2019-2022. Clinical characteristics, 12-lead electrocardiography findings, echocardiography findings, and laboratory parameters were evaluated. Composite outcomes were defined as all-cause mortality, cardiac death, and hospitalization due to heart failure during the 6-month follow-up. Altogether 57 patients (25 men; mean age, 77.4±10.8 y; LVEF, 41.5±3.8%) were divided into LBBAP (n=16), biventricular pacing (BVP; n=16), and conventional RV pacing (RVP; n=25) groups. In the LBBAP group, the mean paced QRS duration (pQRSd) was narrower (119.5±14.7 vs. 140.2±14.3 vs. 163.2±13.9; p<0.001) and cardiac troponin I level was elevated post-pacing (1.14±1.29 vs. 0.20±0.29 vs. 0.24±0.51, p=0.001). Lead parameters were stable. One patient was hospitalized, and four died (one patient each from heart failure admission, myocardial infarction, unexplained death, and pneumonia in RVP vs. one from intracerebral hemorrhage in BVP) during the follow-up period. In conclusion, LBBAP is feasible in patients with impaired LV function without acute or significant complications and provides a remarkably narrower pQRSd with a stable pacing threshold.
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A 76-year-old female visited the emergency department with complaining of dizziness and syncope. She had a history of paroxysmal atrial fibrillation (AF) and had been prescribed flecainide 50 mg and apixaban 5 mg 12-hourly in another hospital 1 day before the presentation. Upon admission, her electrocardiogram showed profound bradycardia and extremely long sinus arrest, which required temporary cardiac pacing. Within 24 hours, her intrinsic rhythm was restored, and the temporary pacemaker was removed. Transthoracic and transesophageal echocardiography revealed no structural heart disease or thrombus in the left atrial appendage. Cardiac computed tomography showed no coronary artery stenosis, but a pulmonary thrombus in the right pulmonary artery. She underwent an electrophysiology study, and four pulmonary vein (PV) isolations were attempted to treat the paroxysmal AF. A bidirectional PV conduction block was acquired in all PVs despite spontaneous dissociation of PV potential in the right PV. Programmed stimulation following ablation resulted in sinus node dysfunction. After the procedure, the patient did not complain of dizziness and syncope for 72 hours of telemetry monitoring. She was discharged with anticoagulant and did not show any further symptoms for 6 months. Flecainide acetate is a class Ic antiarrhythmics, and its clinical efficacy has been confirmed in several clinical trials. However, it can unmask sinus node dysfunction in asymptomatic patients with paroxysmal AF. Clinicians should screen candidates for sinus nodal diseases when prescribing flecainide.
RESUMO
The abnormal change of vascular smooth muscle cell (VSMC) behavior is an important cellular event leading to neointimal hyperplasia in atherosclerosis and restenosis. Plantamajoside (PMS), a phenylethanoid glycoside compound of the Plantago asiatica, has been reported to have anti-inflammatory, antioxidative, and anticancer activities. In this study, the protective effects of PMS against intimal hyperplasia and the mechanisms underlying the regulation of VSMC behavior were investigated. MTT and BrdU assays were performed to evaluate the cytotoxicity and cell proliferative activity of PMS, respectively. Rat aortic VSMC migrations after treatment with the determined concentration of PMS (50 and 150 µM) were evaluated using wound healing and Boyden chamber assays. The inhibitory effects of PMS on intimal hyperplasia were evaluated in balloon-injured (BI) rat carotid artery. PMS suppressed the proliferation in platelet-derived growth factor-BB-induced VSMC, as confirmed from the decrease in cyclin-dependent kinase (CDK)-2, CDK-4, cyclin D1, and proliferating cell nuclear antigen levels. PMS also inhibited VSMC migration, consistent with the downregulated expression and zymolytic activities of matrix metalloproteinase (MMP)2, MMP9, and MMP13. PMS specifically regulated MMP expression through p38 mitogen-activated protein kinase and focal adhesion kinase pathways. Tissue inhibitor of metalloproteinase (TIMP)1 and TIMP2 levels were upregulated via Smad1. TIMPs inhibited the conversion of pro-MMPs to active MMPs. PMS significantly inhibited neointimal formation in BI rat carotid arteries. In conclusion, PMS inhibits VSMC proliferation and migration by upregulating TIMP1 and TIMP2 expression. Therefore, PMS could be a potential therapeutic agent for vascular atherosclerosis and restenosis treatment.
Assuntos
Aterosclerose , Neointima , Animais , Aterosclerose/metabolismo , Catecóis , Movimento Celular , Proliferação de Células , Células Cultivadas , Glucosídeos , Hiperplasia/tratamento farmacológico , Hiperplasia/metabolismo , Hiperplasia/patologia , Músculo Liso Vascular , Miócitos de Músculo Liso , Neointima/tratamento farmacológico , Neointima/metabolismo , Neointima/patologia , Ratos , Ratos Sprague-Dawley , Inibidores Teciduais de Metaloproteinases/metabolismo , Inibidores Teciduais de Metaloproteinases/farmacologia , Inibidores Teciduais de Metaloproteinases/uso terapêutico , Regulação para CimaRESUMO
BACKGROUND/AIMS: While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myocardial infarction (AMI) patients, the current status of in-hospital P2Y12RI switching remains unknown. METHODS: Overall, 8,476 AMI patients who underwent successful revascularization from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were divided according to in-hospital P2Y12RI strategies, and net adverse cardiovascular events (NACEs), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), stroke, or thrombolysis in myocardial infarction (TIMI) major bleeding during hospitalization were compared. RESULTS: Patients with in-hospital P2Y12RI switching accounted for 16.5%, of which 867 patients were switched from clopidogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NACEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, compared to the unchanged clopidogrel group, the C-P group had a higher incidence of non-fatal MI, and the P-C group had a higher incidence of TIMI major bleeding. In clinical events of in-hospital P2Y12RI switching, 90.9% of non-fatal MI occurred during pre-switching clopidogrel administration, 60.7% of TIMI major bleeding was related to pre-switching P2Y12RIs, and 71.4% of TIMI major bleeding was related to potent P2Y12RIs. Only 21.6% of the P2Y12RI switching group switched to P2Y12RIs after a loading dose (LD); however, there were no differences in clinical events between patients with and without LD. CONCLUSION: In-hospital P2Y12RI switching occurred occasionally, but had relatively similar clinical outcomes compared to unchanged P2Y12RIs in Korean AMI patients. Non-fatal MI and bleeding appeared to be mainly related to pre-switching P2Y12RIs.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Clopidogrel/efeitos adversos , Hemorragia/induzido quimicamente , Hospitais , Humanos , Infarto do Miocárdio/tratamento farmacológico , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Cloridrato de Prasugrel/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Resultado do TratamentoRESUMO
Platelet size, measured as mean platelet volume (MPV), is associated with platelet reactivity. MPV has been identified as an independent risk factor for future stroke and myocardial infarction. The aim of this study was to determine the association of MPV with the development of stoke in patients with atrial fibrillation (AF). MPV, N-terminal pro B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) were analysed in 200 patients with AF (mean age 69 years; 56% male). The primary endpoint was ischaemic stroke event. The mean MPV was 8.5 ± 1.0 fL and the median NT-proBNP was 1916.5 (IQR 810-4427) pg/mL. The median hsCRP was 0.47 (IQR 0.32-2.46) mg/dL. There were 14 stroke events during a mean of 15.1 months of follow up. Kaplan-Meier analysis revealed that the higher tertile MPV group (≥8.9 fL) had a significantly higher stroke rate compared to the lower tertile MPV group (<8.0 fL) (14.7% vs. 3.1%, log-rank: P = 0.01). A higher MPV was an independent predictor of stroke risk after adjusting for age, gender, and other CHADS(2) (congestive heart failure, hypertension, diabetes, and previous stroke or transient ischemic attack (TIA) history) score components (hazard ratio: 5.03, 95% CI 1.05-24.05, P = 0.043) in Cox proportional hazard analysis. When the MPV cut-off level was set to 8.85 fL using the receiver operating characteristic curve, the sensitivity was 71% and the specificity was 69% for differentiating between the group with stroke and the group without stroke. This value was more useful in patients with a low to intermediate traditional thromboembolic risk (CHADS(2) score <2). Furthermore, AF patients with an MPV over 8.85 fL had high stroke risk without anticoagulation, especially in the low thromboembolic risk group (Log-Rank <0.0001). The results of this study show that MPV was a predictive marker for stroke; its predictive power for stroke was independent of age, gender, and other CHADS(2) score components in patients with AF. These findings suggest that anticoagulation may be needed in patients with a high MPV, even if they have low to intermediate traditional thromboembolic risk (CHADS(2) score <2).