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Pubblicazioni recenti - cardiac failure
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Dysregulation of Hyaluronan Homeostasis During White Matter Injury.
Neurochem Res2019 Sep;():. doi: 10.1007/s11064-019-02879-1.
Srivastava Taasin, Sherman Larry S, Back Stephen A,
Abstract
Although the extra cellular matrix (ECM) comprises a major proportion of the CNS parenchyma, new roles for the ECM in regeneration and repair responses to CNS injury have only recently been appreciated. The ECM undergoes extensive remodeling following injury to the developing or mature CNS in disorders that -include perinatal hypoxic-ischemic cerebral injury, multiple sclerosis and age-related vascular dementia. Here we focus on recently described mechanisms involving hyaluronan (HA), which negatively impact myelin repair after cerebral white matter injury. Injury induced depolymerization of hyaluronan (HA)-a component of the neural ECM-can inhibit myelin repair through the actions of specific sizes of HA fragments. These bioactive fragments selectively block the maturation of late oligodendrocyte progenitors via an immune tolerance-like pathway that suppresses pro-myelination signaling. We highlight emerging new pathophysiological roles of the neural ECM, particularly of those played by HA fragments (HAf) after injury and discuss strategies to promoter repair and regeneration of chronic myelination failure.
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Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis.
Arch Orthop Trauma Surg2019 Sep;():. doi: 10.1007/s00402-019-03240-5.
Hoerlyck Caroline, Ong Terence, Gregersen Merete, Damsgaard Else Marie, Borris Lars, Chia Jac Kie, Yap Ying Yi Wendy, Weerasuriya Namal, Sahota Opinder,
Abstract
INTRODUCTION:
The management of patients with a hip fracture is affected by the use of oral anticoagulants. A cross-sectional analysis was undertaken to investigate health outcome differences in those anticoagulated compared to those not anticoagulated.
METHODS:
Patients aged 50 years and over presenting to a large university hospital with hip fractures were identified from the service registry. Patient characteristics and health outcomes between those not anticoagulated were compared with those anticoagulated (warfarin and direct oral anticoagulants, DOAC).
RESULTS:
200/2307 (9%) patients were anticoagulated. 84% were on warfarin, and the rest a DOAC. Compared to those anticoagulated, there was a higher prevalence of dementia (25% vs. 18%, p?=?0.02) and a lower prevalence of cardiovascular disease (54% vs. 78%, p?
CONCLUSION:
There was no statistically significant difference in health outcomes between those anticoagulated and those not after adjusting for patient characteristics. It was feasible to avoid significant delay in hip fracture surgery in those anticoagulated.
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Expanding the Scope of Multimodality Imaging in Durable Mechanical Circulatory Support.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30719-3.
Almarzooq Zaid I, Varshney Anubodh S, Vaduganathan Muthiah, Pareek Manan, Stewart Garrick C, Estep Jerry D, Mehra Mandeep R,
Abstract
An increasing number of patients transition to advanced-stage heart failure refractory to medical therapy. Left ventricular assist systems (LVAS) provide a bridge to candidates awaiting heart transplantation and extended device durability allows permanent implantation referred to as destination therapy. Noninvasive imaging plays a pivotal role in the optimal management of patients implanted with durable mechanical circulatory support (MCS) devices. Several advances require an updated perspective of multi-modality imaging in contemporary LVAS management. First, there has been substantial evolution of devices such as the introduction of the fully magnetically levitated HeartMate 3 pump (Abbott, Abbott Park, Illinois). Second, imaging beyond the device, of the peripheral system, is increasingly recognized as clinically relevant. Third, U.S. Food and Drug Administration recalls have called attention to LVAS complications beyond pump thrombosis that are amenable to imaging-based diagnosis. Fourth, there is increased availability of multimodality imaging, such as computed tomography and positron emission tomography, at many centers across the world. In this review, the authors provide a practical and contemporary approach to multi-modality imaging of current-generation durable MCS devices. As the use of LVAS and other novel MCS devices increases globally, it is critical for clinicians caring for LVAS patients to understand the roles of various imaging modalities in patient evaluation and management.
Copyright © 2019. Published by Elsevier Inc.
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Combined Iron Chelator with N-Acetylcysteine Exerts the Greatest Effect on Improving Cardiac Calcium Homeostasis in Iron-Overloaded Thalassemic Mice.
Toxicology2019 Sep;():152289. doi: S0300-483X(19)30246-X.
Sumneang Natticha, Kumfu Sirinart, Khamseekaew Juthamas, Siri-Angkul Natthaphat, Fucharoen Suthat, Chattipakorn Siriporn C, Chattipakorn Nipon,
Abstract
The morbidity and mortality in thalassemia patients are predominantly caused by iron overload cardiomyopathy (IOC). Iron-induced cardiac intracellular Ca ([Ca]) dysregulation is among the core pathophysiological processes in IOC-related heart failure. Although cardioprotective roles of deferiprone (DFP) and N-acetylcysteine (NAC) have been reported, their effect on cardiac [Ca] transients and Ca-regulatory protein expression in thalassemic mice is unknown. In the present study, iron overload condition was induced in wild-type (WT) and heterozygous ?-thalassemic (HT) mice by a high-iron diet. The iron-overloaded mice subsequently received a vehicle, DFP, NAC, or DFP plus NAC co-therapy. In both WT and HT iron-overloaded mice, DFP and NAC had similar efficacy in decreasing plasma non-transferrin-bound iron, decreasing cardiac iron concentration (CIC) and relieving systolic dysfunction. DFP plus NAC co-therapy, however, was better than the monotherapy in reducing CIC and restoring cardiac [Ca] transient amplitude and rising rate. All regimens produced no change in cardiac Ca-regulatory protein expression. We provided the first evidence regarding the synergistic effect of combined iron chelator-antioxidant therapy on cardiac [Ca] homeostasis in iron-overloaded thalassemic mice, with consistent improvement of cardiac contractility.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Prognostic effect of troponin elevation in patients undergoing carotid endarterectomy with regional anesthesia - A prospective study.
Int J Surg2019 Sep;():. doi: S1743-9191(19)30246-8.
Pereira-Macedo Juliana, Rocha-Neves João P, Dias-Neto Marina F, Andrade José Paulo V,
Abstract
BACKGROUND:
Myocardial injury after noncardiac surgery (MINS) occurs in 15% of patients undergoing carotid endarterectomy (CEA) with general anesthesia. Short and long-term risk of myocardial infarction (MI) and stroke have been strongly associated with the presence of MINS, with an associated mortality rate superior to 10% in the first year. Due to the absence of studies concerning CEA with regional anesthesia (RA), the present study aimed to evaluate the incidence of MINS in patients with RA and its prognostic value on cardiovascular events or death.
MATERIALS AND METHODS:
From January 2009 to January 2018, 156 patients from a Portuguese tertiary care medical center who underwent CEA under RA were retrieved from a prospectively gathered database. Troponin I or high-sensitive troponin I values were systematically measured in the postoperative period and studied as a binary outcome in a logistic regression model. Survival analysis was used to study the impact of MINS in time-dependent clinical outcomes such as stroke and MI.
RESULTS:
The incidence of MINS after CEA was 15.3%. Multivariate analysis confirmed that chronic heart failure was strongly associated with MINS (OR: 4.458, 95% CI: 1,689 - 11.708, P < 0.001). A previously diagnosed MINS was associated with the long-term risk of MI and major adverse cardiovascular events (MACE) with hazard ratios (HR) of 3.318 (95% CI: 0.97-13.928, Breslow: P = 0.025) and 1.955 (95% CI: 1.01 - 4.132, Breslow: P = 0.046), respectively.
CONCLUSIONS:
MINS is a long-term predictor of MI and MACE. Troponin assessment after CEA should be routinely monitored in patients with a cardiovascular risk superior to 5%. Further studies concerning prophylaxis and management of MINS should be carried on, focusing on the effect of anesthetic procedure in postoperative troponin elevation.
Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
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Physical activity for patients with heart failure: Position paper from the heart failure (GICC) and cardiac rehabilitation (GERS-P) Working Groups of the French Society of Cardiology.
Arch Cardiovasc Dis2019 Sep;():. doi: S1875-2136(19)30154-8.
Zores Florian, Iliou Marie-Christine, Gellen Barnabas, Kubas Sophie, Berthelot Emmanuelle, Guillo Pascal, Bauer Fabrice, Lamblin Nicolas, Bosser Gilles, Damy Thibaud, Cohen-Solal Alain, Beauvais Florence,
Abstract
Physical activity is important in heart failure to improve functional capacity, quality of life and prognosis, and is a class IA recommendation in the European Society of Cardiology guidelines (Ponikowski et al., 2016). The benefits of exercise training are widely recognized. Cardiac rehabilitation centres offer tailored exercise training to patients with heart failure, as part of specialized multidisciplinary care, alongside pharmacological treatment optimization and patient education. After cardiac rehabilitation, maintenance of regular physical activity long term is essential, as the benefits of exercise training vanish within a few weeks. Unfortunately, only 10% of patients benefit from a cardiac rehabilitation programme after hospitalization for acute heart failure, and the majority of patients do not pursue long-term physical activity. In this paper, two Working Groups of the French Society of Cardiology (the heart failure group [Groupe Insuffisance Cardiaque et Cardiomyopathies; GICC] and the cardiac rehabilitation group [Groupe Exercice Réadaptation Sport et Prévention; GERS-P]) discuss the obstacles to broader access to cardiac rehabilitation centres, and propose ways to improve the diffusion of cardiac rehabilitation programmes and encourage long-term adherence to physical activity.
Copyright © 2019 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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Arrhythmias in Patients on Maintenance Dialysis: A Cross-sectional Study.
Am J Kidney Dis2019 Sep;():. doi: S0272-6386(19)30888-1.
Rantanen Jesper Moesgaard, Riahi Sam, Schmidt Erik Berg, Johansen Martin Berg, Søgaard Peter, Christensen Jeppe Hagstrup,
Abstract
RATIONALE & OBJECTIVE:
Patients with kidney failure treated with maintenance dialysis experience a high rate of mortality, in part due to sudden cardiac death caused by arrhythmias. The prevalence of arrhythmias, including the subset that are clinically significant, is not well known. This study sought to estimate the prevalence of arrhythmias, characterize the pattern of arrhythmic events in relation to dialysis treatments, and identify associated clinical characteristics.
STUDY DESIGN:
Cross-sectional study.
SETTING & PARTICIPANTS:
152 patients with kidney failure treated with maintenance dialysis in Denmark.
EXPOSURES:
Dialysis treatment; clinical characteristics; cardiac output and preload defined using echocardiography.
OUTCOMES:
Prevalence and pattern of arrhythmias on 48-hour Holter monitoring; odds ratios for arrhythmias.
ANALYTICAL APPROACH:
Descriptive analysis of the prevalence of arrhythmias. Pattern of arrhythmias described using a repeated-measures negative binomial regression model. Associations between clinical characteristics and echocardiographic findings with arrhythmias were assessed using logistic regression.
RESULTS:
Among the 152 patients studied, 83.6% were treated with in-center dialysis; 10.5%, with home hemodialysis; and 5.9%, with peritoneal dialysis. Premature atrial and ventricular complexes were seen in nearly all patients and 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation observed among 8.6% of patients, paroxysmal atrial fibrillation among 3.9%, nonsustained ventricular tachycardia among 19.7%, bradycardia among 4.6%, advanced second-degree atrioventricular block among 1.3%, and third-degree atrioventricular block among 2.6%. Premature ventricular complexes were more common on dialysis days, while tachyarrhythmias were more often observed during dialysis and in the immediate postdialytic period. Older age (OR per 10 years older, 1.53; 95% CI, 1.15-2.03; P=0.003), elevated preload (OR, 4.02; 95% CI, 1.05-15.35; P=0.04), and lower cardiac output (OR per 1L/min greater, 0.66; 95% CI, 0.44-1.00; P=0.05) were independently associated with clinically significant arrhythmias.
LIMITATIONS:
Arrhythmia monitoring limited to 48 hours; small sample size; heterogeneous nature of the population, risk for residual confounding.
CONCLUSIONS:
Arrhythmias, including clinically significant abnormal rhythms, were common. Tachyarrhythmias were more frequent during dialysis and the immediate postdialytic period. The relevance of these findings to clinical outcomes requires additional study.
Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Assessment of 6 STR loci for prenatal diagnosis of Duchenne Muscular Dystrophy.
Taiwan J Obstet Gynecol2019 Sep;58(5):645-649. doi: S1028-4559(19)30166-4.
Dinh Linh Thuy, Tran Van Khanh, Luong Long Hoang, Le Phuong Thi, Nguyen Anh Duy, Thi Nguyen Bang Suong, Chi Dung Vu, Tran Thinh Huy, Bui The-Hung, Van Ta Thanh, Nguyen Duc Hinh,
Abstract
OBJECTIVE:
Duchenne Muscular Dystrophy is an X-linked recessive disorder characterized by progressive muscular degeneration, patients often develop cardiac failure in the later stage and death occurs before 20 years of age. For a disease with poor postnatal prognosis such as Duchenne Muscular Dystrophy (DMD), providing the carrier mother with the option of prenatal diagnosis in a subsequent pregnancy is accepted practice in many places where termination of pregnancy is allowed. Though methods of direct sequencing such as Sanger's sequencing has been widely used, Next-Generation Sequencing is been increasingly replacing most of its application. For the DMD gene, being the longest gene in the human genome, methods of direct sequencing is often unpractical and time-consuming, instead, STR analysis for linkage analysis would be a cost-effective option and have been used routinely for prenatal diagnosis of DMD. The diagnostic significance of the STRs is based on several criteria, the most important one being the heterozygosity of the locus, power of discrimination (PD) and power of exclusion (PE).
MATERIAL AND METHODS:
In this study, we investigated the feasibility of application and diagnostic value of 6 STR loci (DSTR49, DSTR50, DXS1036, DXS1067, DXS890, DXS9907) in the proximity of the DMD gene, 66 healthy individuals were recruited for STR analysis and 5 cases of prenatal diagnosis for carrier mother were performed.
RESULT:
Allele frequency, heterozygosity, polymorphic information content, the power of discrimination and exclusion and Hardy-Weinberg equilibrium were analyzed and calculated for the 6 STR loci. 5 of these loci (DSTR49, DSTR50, DXS1067, DXS890, DXS9907) were found practical and useful for preimplantation Genetic diagnosis (PGD) and prenatal diagnosis. All 5 cases of prenatal diagnosis using the method had informative STR results and correct diagnosis.
CONCLUSION:
We concluded that our protocol of STR analysis can be applied for prenatal diagnosis and pre-implantation genetic diagnosis of DMD with high confidence and accuracy, especially in clinical settings where diagnostic resources are more limited.
Copyright © 2019. Published by Elsevier B.V.
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Upregulation of miR-93 and inhibition of LIMK1 improve ventricular remodeling and alleviate cardiac dysfunction in rats with chronic heart failure by inhibiting RhoA/ROCK signaling pathway activation.
Aging (Albany NY)2019 Sep;11():. doi: 10.18632/aging.102272.
Su Qian, Zhang Peng, Yu Dong, Wu Zhaodi, Li Dandan, Shen Fangfang, Liao Pengfei, Yin Guizhi,
Abstract
OBJECTIVE:
There are some researches about the role of microRNA (miRNA) in chronic heart failure (CHF) were performed, but the study about miR-93's function in CHF is scarcely investigated. Thus, we determined to probe into the effects of miR-93 in rats with CHF by targeting LIMK1 through regulating RhoA/ROCK pathway.
RESULTS:
We found increased LIMK1 and decreased miR-93 in CHF rats, and up-regulation of miR-93 inhibited LIMK1, RhoA and ROCK1 expression in CHF rats. Up-regulation of miR-93 or inhibition of LIMK1 decreased oxidative stress, inflammatory factors, as well as apoptosis-related indicators in CHF rats. LIMK1 was confirmed as a direct target gene of miR-93.
CONCLUSION:
Our study provides evidence that upregulated miR-93 and downregulated LIMK1 improve ventricular remodeling and reduce cardiac dysfunction in CHF rats by inhibiting RhoA/ROCK signaling pathway activation.
METHODS:
First, rat models of CHF were established by aortic coarctation, and the rats were injected with miR-93 mimics, LIMK1-siRNA or overexpressed-LIMK1. Then expression of miR-93, LIMK1, RhoA, and ROCK1 expression in myocardial tissues were detected, after which indices of cardiac ultrasound, hemodynamics, and oxidative stress, inflammatory factors, apoptosis-related indicators were detected via a series of assays. Finally, the targeting relationship of miR-93 and LIMK1 was verified.
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Key Regulators of Cardiovascular Differentiation and Regeneration: Harnessing the Potential of Direct Reprogramming to Treat Heart Failure.
J Card Fail2019 Sep;():. doi: S1071-9164(19)30366-5.
Ieda Masaki,
Abstract
Cardiovascular diseases remain a leading cause of death worldwide, with the number of patients with heart failure increasing rapidly in aging societies. As adult cardiomyocytes are terminally differentiated cells and opportunities for heart transplantation are very limited, regenerative medicine may become a game changer in heart failure treatment. To develop strategies for generating cardiomyocytes, vascular cells, and other supporting cells, it is necessary to understand the mechanism of cardiovascular differentiation during development and from pluripotent stem cells. Master regulators for cardiovascular differentiation can generate new cardiomyocytes and vascular cells directly from other differentiated cells such as fibroblasts. Fibroblasts can be directly reprogrammed into cardiomyocytes by overexpressing a combination of three cardiac-specific transcription factors (Gata4, Mef2c, Tbx5) both in vitro and in vivo, which restores cardiac function after myocardial infarction in mice. Moreover, a direct reprogramming-based approach can be used to identify new key regulators of the cardiovascular mesoderm, which can differentiate into all three types of cardiovascular cells including cardiomyocytes, endothelial cells, and smooth muscle cells. This review provides a perspective on how key regulators for cardiovascular differentiation and regeneration can be identified and used to develop new treatments for heart failure.
Copyright © 2019. Published by Elsevier Inc.
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Do Drugs That Ameliorate Epicardial Adipose Tissue Inflammation Have Concordant Benefits on Atrial Fibrillation and on Heart Failure with a Preserved Ejection Fraction?
J Card Fail2019 Sep;():. doi: S1071-9164(19)30529-9.
Packer Milton,
Abstract
Heart failure with a preserved ejection fraction (HFpEF) and heart failure with a reduced ejection fraction (HFrEF) have distinctive pathophysiologies, and thus, therapeutic approaches to the two disorders should differ. Neurohormonal activation drives the progression of HFrEF, and neurohormonal antagonists are highly effective in HFrEF, but not in HFpEF. Conversely, a broad range of chronic systemic inflammatory or metabolic disorders cause an expansion and inflammation of epicardial adipose tissue; the secretion of adipocytokines may lead to microvascular dysfunction and fibrosis of the underlying myocardium, which (if the left atrium is affected) may lead to atrial fibrillation (AF) and (if the left ventricle is affected) may lead to HFpEF. Anti-inflammatory drugs (such as statins and anticytokine agents) can ameliorate epicardial adipose tissue dysfunction. Statins appear to ameliorate the development of atrial myopathy (both experimentally and clinically), and in randomized controlled trials, they reduce the incidence of new-onset and recurrent AF and decrease the risk of heart failure with the features of HFpEF; yet, they have no benefits in HFrEF. Similarly, anticytokine agents appear to prevent heart failure in patients with or prone to HFpEF, but adversely affect HFrEF. Several antihyperglycemic agents also reduce epicardial fat mass and inflammation, but this benefit may be offset by additional actions to cause sodium retention and neurohormonal activation. Thiazolidinediones have favorable effects on experimental AF and HFpEF, but their antinatriuretic actions negate these benefits, and they worsen the clinical course of HFrEF. Glucagon-like peptide-1 receptor agonists also ameliorate AF and HFpEF in laboratory models, but their positive inotropic and chronotropic effects may be deleterious in HFrEF. By contrast, metformin and sodium-glucose cotransporter 2 inhibitors alleviate epicardial adipose tissue dysfunction and may reduce the risk of AF and HFpEF; yet, they may have additional actions to promote cardiomyocyte survival that are useful in HFrEF. The concordance of the benefits of anti-inflammatory and antihyperglycemic drugs on AF and HFpEF (but not on HFrEF) supports the paradigm that epicardial adipose tissue is an central pathogenetic mechanism and therapeutic target for both AF and HFpEF in patients with chronic systemic inflammatory or metabolic diseases.
Copyright © 2019. Published by Elsevier Inc.
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Metabolic Profiling Associates with Disease Severity in Non-Ischemic Dilated Cardiomyopathy.
J Card Fail2019 Sep;():. doi: S1071-9164(19)30210-6.
Verdonschot Job A J, Wang Ping, van Bilsen Marc, Hazebroek Mark R, Merken Jort J, Vanhoutte Els K, Henkens Michiel T H M, van den Wijngaard Arthur, Glatz Jan F C, Krapels Ingrid P C, Brunner Han G, Heymans Stephane R B, Bierau Jörgen,
Abstract
AIMS:
Metabolomic profiling may have diagnostic and prognostic value in heart failure. This study investigated whether targeted blood and urine metabolomics reflects disease severity in non-ischemic dilated cardiomyopathy (DCM) patients and compared its incremental value on top of NT-proBNP.
METHODS AND RESULTS:
A total of 149 metabolites were measured in plasma and urine samples of 273 DCM patients with different stages of disease (DCM patients with LVRR (normal LVEF), n=70; asymptomatic DCM, n=72 and symptomatic DCM, n=131). Acylcarnitines, sialic acid, and glutamic acid are the most distinctive metabolites associated with disease severity, as repeatedly revealed by uni-biomarker linear regression, sPLSDA, Random Forest and conditional Random Forest analyses. However, the absolute difference of the metabolic profile among groups was marginal. A decision tree model based on the top metabolites did not surpass NT-proBNP in classifying stages. However, a combination of NT-proBNP and the top metabolites improved the decision tree to distinguish DCM patients with LVRR from symptomatic DCM (AUC 0.813±0.138 versus 0.739±0.114; p=0.02).
CONCLUSION:
Functional cardiac recovery is reflected in metabolomics. These alterations reveal potential alternative treatment targets in advanced symptomatic DCM. The metabolic profile can complement NT-proBNP in determining disease severity in non-ischemic DCM.
Copyright © 2019. Published by Elsevier Inc.
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Non-linear associations of 25-hydroxyvitamin D concentrations with risk of cardiovascular disease and all-cause mortality: results from The Health Improvement Network (THIN) database.
J Steroid Biochem Mol Biol2019 Sep;():105480. doi: S0960-0760(19)30363-2.
Crowe Francesca L, Thayakaran Rasiah, Gittoes Neil, Hewison Martin, Thomas G Neil, Scragg Robert, Nirantharakumar Krishnarajah,
Abstract
BACKGROUND:
There is increasing evidence that vitamin D supplementation may only be beneficial in people with vitamin D deficiency, and the lack of sufficient people with very low vitamin D levels could explain the lack of protection against cardiovascular disease (CVD) reported in recent clinical trials of vitamin D supplementation. The aim of this study was to assess associations of low to moderate circulating concentrations of 25-hydroxyvitamin D (25(OH)D with risk of incident CVD and all-cause mortality, as well as the risk of ischaemic heart disease (IHD), cerebrovascular disease, and heart failure separately.
METHODS AND RESULTS:
Longitudinal analysis of electronic health records in The Health Improvement Network (THIN), a UK primary care database. The analysis included 180,263 patients age 18 years and older without a history of CVD and with circulating concentrations of 25(OH)D. After a mean follow-up of 2.2 (SD 1.7) years, there were 3,747 patients diagnosed with CVD and 3,912 patients died. Compared to patients in the highest quintile of 25(OHD) (? 67.5?nmol/L), those in the lowest 25(OH)D quintile (<23.1?nmol/L) had a hazard ratio (HR) of 1.24 (95% CI 1.12-1.38, P?
CONCLUSION:
Low 25(OH)D are associated with highest risk of CVD and mortality, and are consistent with accumulating evidence that increased risk of these diseases occurs primarily in people with vitamin D deficiency.
Copyright © 2019. Published by Elsevier Ltd.
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A "Cat"-astrophic Case of Bartonella henselae Infective Endocarditis Followed by Cardiac Transplantation Salvage Therapy.
Transpl Infect Dis2019 Sep;():. doi: 10.1111/tid.13179.
Kuan William, Dulnuan Kenneth, Guglin Maya E, El Haddad Hanine, Kolodziej Andrew R, Leventhal Andrew, Rajagopalan Navin,
Abstract
To our knowledge, no cases of Bartonella henselae endocarditis leading to subsequent heart transplantation salvage therapy have been published. We present a case of a 29-year old male with cat-inflicted Bartonella henselae endocarditis and concurrent worsening heart failure, who then underwent successful heart transplantation 50 days following diagnosis. Treatment and monitoring strategies used in this patient are discussed. Furthermore, we review literature related to heart transplantation salvage therapy for endocarditis due to other intracellular pathogens.
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Surgical management of large undifferentiated cardiac sarcoma involving the right ventricle to pulmonary trunk.
Gen Thorac Cardiovasc Surg2019 Sep;():. doi: 10.1007/s11748-019-01208-1.
Furukawa Hiroshi, Honda Takeshi, Yamasawa Takahiko, Kanaoka Yuji, Tanemoto Kazuo,
Abstract
A large intra-cardiac tumor from the right ventricle to pulmonary trunk was detected by contrast-enhanced computed tomography and transthoracic echocardiography in a 59-year-old woman with progressive dyspnea on effort and acute congestive right-sided heart failure. Emergent surgical management was performed with cardiopulmonary bypass under cardiac arrest, however, tumor resection was incomplete, because it originated from the interventricular septum. Concomitant tricuspid valve replacement using a bioprosthesis was required due to the involvement of the septal leaflet of the tricuspid valve. Although large pulmonary thromboembolism was initially suspected, a pathological examination confirmed undifferentiated cardiac sarcoma. The patient did not consent to additional neoadjuvant chemotherapy or radiation therapy. After palliative surgical management, she was discharged. Recurrence rapidly progressed and the patient died approximately 2 months after surgery. We herein present a successful palliative surgical case of large cardiac undifferentiated sarcoma originating from the intraventricular septum and involving the right ventricle to pulmonary trunk.
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Brain perivascular macrophages contribute to the development of hypertension in stroke-prone spontaneously hypertensive rats via sympathetic activation.
Hypertens Res2019 Sep;():. doi: 10.1038/s41440-019-0333-4.
Iyonaga Takeshi, Shinohara Keisuke, Mastuura Taku, Hirooka Yoshitaka, Tsutsui Hiroyuki,
Abstract
Hypertension is associated with systemic inflammation. The activation of the sympathetic nervous system is critically involved in the pathogenesis of hypertension. Brain perivascular macrophages (PVMs) can be affected by circulating inflammatory cytokines, and the contribution of brain PVMs to sympathoexcitation has been demonstrated in a heart failure model. We thus investigated whether brain PVMs contribute to the development of hypertension through sympathoexcitation. Stroke-prone spontaneously hypertensive rats (SHRSP) developed hypertension over an 8-week period from 4 to 12 weeks of age. The number of brain PVMs and plasma interleukin-1? levels significantly increased at the ages of 8 and 12 weeks in SHRSP compared with normotensive Wistar-Kyoto rats (WKY). To determine the contribution of brain PVMs to blood pressure elevation, we intracerebroventricularly injected liposome-encapsulated clodronate, which eliminates macrophages by inducing apoptosis, into 8-week-old rats; we then assessed its effects in 10-week-old rats. Clodronate treatment attenuated the increase in mean blood pressure in SHRSP but not in WKY. Clodronate treatment reduced the depressor effect of hexamethonium, an index of sympathetic activity; it also reduced neuronal activity in sympathetic regulatory nuclei such as the hypothalamic paraventricular nucleus and rostral ventrolateral medulla and reduced the expression of cyclooxygenase-2 and prostaglandin E2, a downstream pathway in activated macrophages, in SHRSP but not in WKY. Furthermore, clodronate treatment attenuated the increase in blood pressure and renal sympathetic nerve activity in response to an acute intravenous injection of interleukin-1? in WKY. In conclusion, brain PVMs contribute to the development of hypertension via sympathetic activation. PVMs may be activated by increased levels of circulating interleukin-1?.
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Subphenotypes of Cardiac Arrest Patients Admitted to Intensive Care Unit: a latent profile analysis of a large critical care database.
Sci Rep2019 Sep;9(1):13644. doi: 10.1038/s41598-019-50178-0.
Zhang Zhongheng, Yao Min, Ho Kwok M, Hong Yucai,
Abstract
Cardiac arrest (CA) may occur due to a variety of causes with heterogeneity in their clinical presentation and outcomes. This study aimed to identify clinical patterns or subphenotypes of CA patients admitted to the intensive care unit (ICU). The clinical and laboratory data of CA patients in a large electronic healthcare database were analyzed by latent profile analysis (LPA) to identify whether subphenotypes existed. Multivariable Logistic regression was used to assess whether mortality outcome was different between subphenotypes. A total of 1,352 CA patients fulfilled the eligibility criteria were included. The LPA identified three distinct subphenotypes: Profile 1 (13%) was characterized by evidence of significant neurological injury (low GCS). Profile 2 (15%) was characterized by multiple organ dysfunction with evidence of coagulopathy (prolonged aPTT and INR, decreased platelet count), hepatic injury (high bilirubin), circulatory shock (low mean blood pressure and elevated serum lactate); Profile 3 was the largest proportion (72%) of all CA patients without substantial derangement in major organ function. Profile 2 was associated with a significantly higher risk of death (OR: 2.09; 95% CI: 1.30 to 3.38) whilst the mortality rates of Profiles 3 was not significantly different from Profile 1 in multivariable model. LPA using routinely collected clinical data could identify three distinct subphenotypes of CA; those with multiple organ failure were associated with a significantly higher risk of mortality than other subphenotypes. LPA profiling may help researchers to identify the most appropriate subphenotypes of CA patients for testing effectiveness of a new intervention in a clinical trial.
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FKBP52 regulates TRPC3-dependent Ca signals and the hypertrophic growth of cardiomyocyte cultures.
J Cell Sci2019 Sep;():. doi: jcs.231506.
Bandleon Sandra, Strunz Patrick P, Pickel Simone, Tiapko Oleksandra, Cellini Antonella, Miranda-Laferte Erick, Eder-Negrin Petra,
Abstract
The Transient receptor potential (TRP; C-classical; TRPC) channel TRPC3 permeates a cation (Na/Ca) influx that is favoured by the stimulation of G protein-coupled receptors (GPCRs). An enhanced TRPC3 activity is related to adverse effects including pathological hypertrophy in chronic cardiac disease states. In the present study we identified FK506 binding protein 52 (FKBP52) as a novel interaction partner of TRPC3 in the heart. FKBP52 was recovered from a cardiac cDNA library by a C-terminal TRPC3 fragment (amino acids 742-848) in a yeast two-hybrid screen. Downregulation of FKBP52 promoted a TRPC3-dependent hypertrophic response in neonatal rat cardiomyocytes (NRC). A similar effect was achieved by overexpressing PPIase-deficient FKBP52 mutants. Mechanistically, FKBP52 truncated mutants elevated TRPC3-mediated currents and Ca fluxes, the activation of calcineurin and the nuclear factor of activated T-cells in NRCs. Our data demonstrate that FKBP52 associates with TRPC3 an as yet undescribed binding site in the C-terminus of TRPC3 and modulates TRPC3-dependent Ca signals in a PPIase-dependent manner. This functional interaction might be crucial for limiting TRPC3-dependent signaling during chronic hypertrophic stimulation.
© 2019. Published by The Company of Biologists Ltd.
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Risk Factors for 1-Year Graft Loss After Kidney Transplantation: Systematic Review and Meta-Analysis.
Clin J Am Soc Nephrol2019 Sep;():. doi: CJN.05560519.
Foroutan Farid, Friesen Erik Loewen, Clark Kathryn Elizabeth, Motaghi Shahrzad, Zyla Roman, Lee Yung, Kamran Rakhshan, Ali Emir, De Snoo Mitch, Orchanian-Cheff Ani, Ribic Christine, Treleaven Darin J, Guyatt Gordon, Meade Maureen O,
Abstract
BACKGROUND AND OBJECTIVES:
With expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk kidney transplant cases. The objective of our study was to evaluate factors purported to influence the risk of 1-year graft loss in kidney transplant recipients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
We searched bibliographic databases from 2000 to 2017 and included observational studies that measured the association between donor, recipient, the transplant operation, or early postoperative complications, and 1-year death-censored graft loss.
RESULTS:
We identified 35 eligible primary studies, with 20 risk factors amenable to meta-analysis. Six factors were associated with graft loss, with moderate to high degree of certainty: donor age (hazard ratio [HR], 1.11 per 10-year increase; 95% confidence interval [95% CI], 1.04 to 1.18), extended criteria donors (HR, 1.35; 95% CI, 1.28 to 1.42), deceased donors (HR, 1.54; 95% CI, 1.32 to 1.82), number of HLA mismatches (HR, 1.08 per one mismatch increase; 95% CI, 1.07 to 1.09), recipient age (HR, 1.17 per 10-year increase; 95% CI, 1.09 to 1.25), and delayed graft function (HR, 1.89; 95% CI, 1.46 to 2.47) as risk factors for 1-year graft loss. Pooled analyses also excluded, with a high degree of certainty, any associations of cold ischemia time, recipient race, pretransplant body mass index, diabetes, and hypertension with 1-year graft loss.
CONCLUSIONS:
Recipient age, donor age, standard versus extended criteria donor, living versus deceased donor, HLA mismatch, and delayed graft function all predicted 1-year graft survival. The effect of each risk factor is small.
Copyright © 2019 by the American Society of Nephrology.
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Prevalence of diabetic macrovascular complications and related factors from 2005 to 2014 in Taiwan: A nationwide survey.
J Formos Med Assoc2019 Sep;():. doi: S0929-6646(19)30367-5.
Lee Chien-Hsing, Wu Yi-Ling, Kuo Jeng-Fu, Chen Jung-Fu, Chin Ming-Chu, Hung Yi-Jen,
Abstract
BACKGROUND/PURPOSE:
Diabetic macrovascular complications contribute to nonignorable causes of morbidity and mortality in patients with diabetes mellitus (DM). In this study, the trends of risk factors and macrovascular complications were examined in patients with DM in Taiwan.
METHODS:
Health care information and International Classification of Diseases, Ninth Revision diagnostic codes were retrieved from the Taiwan Bureau of National Health Insurance claims files between 2005 and 2014. Using these data, the number of cases and annual prevalence of diabetic macrovascular complications in individuals with DM were stratified by age and sex.
RESULTS:
The prevalence of DM with either stroke or cardiovascular disease (CVD) showed a decreasing trend in enrolled patients with DM (p for trend < 0.005), but that of DM with peripheral vascular diseases (PVDs) showed an increasing trend (p for trend < 0.001). Notably, the trend of changes in the prevalence of heart failure (HF) was similar to that of changes in the prevalence of stroke, although the decrease in prevalence was not statistically significant (p for trend = 0.053).
CONCLUSION:
From this nationwide study, we observed a decrease in the prevalence of diabetic macrovascular complications, such as stroke, CVD, and HF, but an increase in the prevalence of PVDs in the past decade in Taiwan.
Copyright © 2019. Published by Elsevier B.V.
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