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Pubblicazioni recenti - cardiovascular
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[What's new in CKD-MBD?]
Dtsch Med Wochenschr2020 Aug;145(16):1170-1173. doi: 10.1055/a-1173-5147.
Brandenburg Vincent,
Abstract
CKD-MBD (chronic kidney disease - mineral and bone disorder) describes a complex syndrome of renal osteodystrophy, mineral disturbances and cardiovascular disease in patients with chronic kidney disease. The present articles intends to provide an up-to-date summary of recent clinically important developments in the field of CKD-MBD. The article touches specifically phosphate management, secondary hyperparathyroidism, vitamin D, arteriosclerosis, renal bone disease, and SGLT2-inhibitors. The summary also comments on which grade of evidence novel aspects and innovative developments in CKD-BMD are based. The author concludes that nephrologists should strive after more high-quality, large-scale randomized-controlled interventional trials in order to optimize the evidence behind CKD-MBD therapy.
© Georg Thieme Verlag KG Stuttgart · New York.
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[COVID-19 and the impact of cardiovascular comorbidities].
Dtsch Med Wochenschr2020 Aug;145(16):1157-1160. doi: 10.1055/a-1158-5996.
Seoudy Hatim, Frey Norbert,
Abstract
Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly resulted in a global pandemic. Underlying cardiovascular disease (CVD) is associated with severe COVID-19 infection and adverse clinical outcomes. While COVID-19 predominantly causes respiratory symptoms, a substantial number of patients eventually develop an acute cardiovascular syndrome associated with an excessive risk of mortality. While the exact mechanisms remain uncertain, angiotensin-converting enzyme 2 plays a pivotal role as a link between COVID-19 and the cardiovascular system. As there is no evidence that inhibition of the renin-angiotensin-aldosterone-system is harmful in COVID-19, therapy should be continued as indicated in hypertension or heart failure patients. As multiple drugs are being investigated in ongoing clinical trials, potential cardiotoxicity remains an important issue. In times of rigorous public health measures such as social distancing, efforts should be undertaken to ensure timely treatment of acute CVD and continuation of guideline-directed treatment in order to avoid an increase in morbidity and mortality. In addition to its acute complications, COVID-19 is likely to be associated with long-term cardiovascular damage. Consequently, for a subgroup of patients a long-term management strategy is needed.
© Georg Thieme Verlag KG Stuttgart · New York.
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[Diagnostic work-up in central retinal artery occlusion and ischemic optic neuropathy - what is important?]
Dtsch Med Wochenschr2020 Aug;145(16):1112-1117. doi: 10.1055/a-1010-2039.
Lottspeich Christian, Mackert Marc J, Hoffmann Ulrich, Czihal Michael,
Abstract
Ischemia of the retina in central retinal artery occlusion (CRAO) and of the optic nerve in ischemic optic neuropathy (ION) are common causes of irreversible vision loss in elderly patients and require a thorough diagnostic work-up.?First and foremost, giant cell arteritis should be confirmed or ruled out. The further work-up of non-arteritic CRAO and non-arteritic ION (nAION) aims to determine the cardiovascular risk profile. Patients with nAION should be screened for sleep apnoea. In non-arteritic CRAO, the search for embolic sources is the most important diagnostic task. A "white spot sign" seen on transorbital ultrasound confirms the diagnosis of embolic CRAO and rules out an arteritic etiology of CRAO.
© Georg Thieme Verlag KG Stuttgart · New York.
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Wound Infection after CABG Using Internal Mammary Artery Grafts: A Meta-Analysis.
Thorac Cardiovasc Surg2020 Aug;():. doi: 10.1055/s-0040-1713662.
Oswald Irina, Boening Andreas, Pons-Kuehnemann Joern, Grieshaber Philippe,
Abstract
BACKGROUND:
?Internal mammary arteries show better long-term patency rates than venous grafts. The use of both mammary arteries is associated with a higher risk of sternal wound infections. This meta-analysis was designed to assess the incidence of a wound healing disorder after bilateral compared with single mammary artery bypass grafting. Compared with existing meta-analysis this paper includes more current literature and one randomized controlled trial.
METHODS:
?A literature search was performed using PubMed and the Cochrane Library. The quality of the articles was assessed by the Newcastle Ottawa Scale. The odds ratio was used as a measure of the chance of developing a wound healing disorder after bilateral internal mammary artery (BIMA) surgery. Meta-analyses were performed for different subgroups.
RESULTS:
?Twenty studies met the quality criteria, including one randomized controlled trial. The use of both mammary arteries significantly increased the risk of superficial (odds ratio [OR] 1.72) and deep (OR 1.75) wound healing disorder in the total population (OR 1.80) as well as in the diabetic subgroup (OR 1.38) and with both preparation techniques. The increased risk with BIMA grafting was present independently of the preparation technique (pedicled: OR 1.89, skeletonized: OR 1.37).
CONCLUSION:
?Bilateral internal mammary artery grafting, especially in high-risk and diabetic patients, is associated with an increased risk of wound healing impairment. Skeletonized preparation does not eliminate the elevated wound healing disorder risk after BIMA use.
Thieme. All rights reserved.
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Genetic Variants in One-Carbon Metabolism Pathway Predict Survival Outcomes of Early-Stage Non-Small Cell Lung Cancer.
Oncology2020 Aug;():1-8. doi: 10.1159/000509658.
Do Sook Kyung, Choi Sun Ha, Lee Shin Yup, Choi Jin Eun, Kang Hyo-Gyoung, Hong Mi Jeong, Kim Ji Hyun, Baek Sun Ah, Lee Jang Hyuck, Lee Won Kee, Do Young Woo, Lee Eung Bae, Shin Kyung Min, Jeong Ji Yun, Lee Yong Hoon, Seo Hyewon, Yoo Seung Soo, Lee Jaehee, Cha Seung Ick, Kim Chang Ho, Seok Yangki, Cho Sukki, Jheon Sanghoon, Park Jae Yong,
Abstract
BACKGROUND:
This study was conducted to investigate the association between genetic variants in one-carbon metabolism and survival outcomes of surgically resected non-small cell lung cancer (NSCLC).
METHODS:
We genotyped 41 potentially functional variants of 19 key genes in the one-carbon metabolism pathway among 750 NSCLC patients who underwent curative surgery. The association between genetic variants and overall survival (OS)/disease-free survival (DFS) were analyzed.
RESULTS:
Among the 41 single-nucleotide polymorphisms (SNPs) analyzed, 4 SNPs (MTHFD1L rs6919680T>G and rs3849794T>C, MTR rs2853523C>A, and MTHFR rs4846049G>T) were significantly associated with survival outcomes. MTHFD1L rs6919680T>G and MTR rs2853523C>A were significantly associated with better OS (adjusted hazard ratio [aHR] = 0.73, 95% confidence interval [CI] = 0.54-0.99, p = 0.04) and worse OS (aHR = 2.14, 95% CI = 1.13-4.07, p = 0.02), respectively. MTHFD1L rs3849794T>C and MTHFR rs4846049G>T were significantly associated with worse DFS (aHR = 1.41, 95% CI = 1.08-1.83, p = 0.01; and aHR = 1.97, 95% CI = 1.10-3.53, p = 0.02, respectively). When the patients were divided according to histology, the associations were significant only in squamous cell carcinoma (SCC), but not in adenocarcinoma (AC). In SCC, MTHFD1L rs6919680T>G and MTR rs2853523C>A were significantly associated with better OS (aHR = 0.64, 95% CI = 0.41-1.00, p = 0.05) and worse OS (aHR = 2.77, 95% CI = 1.11-6.91, p = 0.03), respectively, and MTHFD1L rs3849794T>C and MTHFR rs4846049G>T were significantly associated with worse DFS (aHR = 1.73, 95% CI = 1.17-2.56, p = 0.01; and aHR = 2.78, 95% CI = 1.12-6.88, p = 0.03, respectively).
CONCLUSIONS:
Our results suggest that the genetic variants in the one-carbon metabolism pathway could be used as biomarkers for predicting the clinical outcomes of patients with early-stage NSCLC.
© 2020 S. Karger AG, Basel.
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Sequential Combination of Cognitive-Behavioral Treatment and Well-Being Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study).
Psychother Psychosom2020 Aug;():1-12. doi: 10.1159/000510006.
Rafanelli Chiara, Gostoli Sara, Buzzichelli Sara, Guidi Jenny, Sirri Laura, Gallo Pamela, Marzola Enrica, Bergerone Serena, De Ferrari Gaetano Maria, Roncuzzi Renzo, Di Pasquale Giuseppe, Abbate-Daga Giovanni, Fava Giovanni A,
Abstract
INTRODUCTION:
Randomized controlled trials (RCT) of psychotherapeutic interventions have addressed depression and demoralization associated with acute coronary syndromes (ACS). The present trial introduces psychological well-being, an increasingly recognized factor in cardiovascular health, as a therapeutic target.
OBJECTIVE:
This study was designed to determine whether the sequential combination of cognitive-behavioral therapy (CBT) and well-being therapy (WBT) may yield more favorable outcomes than an active control group (clinical management; CM) and to identify subgroups of patients at greater risk for cardiac negative outcomes.
METHODS:
This multicenter RCT comparedCBT/WBT sequential combination versus CM, with up to 30 months of follow-up. One hundred consecutive depressed and/or demoralized patients (out of 740 initially screened by cardiologists after a first episode of ACS) were randomized to CBT/WBT associated with lifestyle suggestions (n = 50) and CM (n = 50). The main outcome measures included: severity of depressive symptoms according to the Clinical Interview for Depression, changes in subclinical psychological distress, well-being, and biomarkers, and medical complications and events.
RESULTS:
CBT/WBT sequential combination was associated with a significant improvement in depressive symptoms compared to CM. In both groups, the benefits persisted at follow-up, even though the differences faded. Treatment was also related to a significant amelioration of biomarkers (platelet count, HDL, and D-dimer), whereas the 2 groups showed similar frequencies of adverse cardiac events.
CONCLUSIONS:
Addressing psychological well-being in the psychotherapeutic approach to ACS patients with depressive symptoms was found to entail important clinical benefits. It is argued that lifestyle changes geared toward cardiovascular health may be facilitated by a personalized approach that targets well-being.
© 2020 S. Karger AG, Basel.
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A case report: An aortobifemoral bypass implant found during cadaver dissection promotes inquiry-based learning.
Int J Surg Case Rep2020 Jul;74():53-57. doi: S2210-2612(20)30577-0.
Gotham Zachary P, Tanilli Rachel S, Wirfel Olivia M, Dalvi Prasad S,
Abstract
INTRODUCTION:
An unusual vascular implant found during routine cadaver dissection influenced instructors and students to learn more about the underlying disease and the surgical technique used to treat this disorder triggering an inquiry-based learning.
PRESENTATION OF CASE:
This report describes a case of peripheral arterial disease (PAD) with an aortobifemoral arterial bypass implant that was never found before in any of the previously dissected cadavers at Gannon University.
DISCUSSION:
PAD develops due to impaired blood flow to the lower extremities that causes numbness, weakness, and lower leg pain. The treatments can aim to improve the long-term cardiovascular outcomes. If therapeutic medications do not improve outcomes of PAD, revascularization by endovascular repair or aortofemoral bypass grafting is considered.
CONCLUSION:
We would like to note that accidental discoveries of pathologies or surgical procedures during routine cadaveric dissections present a unique possibility for inquiry-based learning among future healthcare providers.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Soft skills and implications for future professional practice: Qualitative findings of a nursing education escape room.
Nurse Educ Today2020 May;93():104462. doi: S0260-6917(19)31762-9.
Morrell Briyana L M, Eukel Heidi N, Santurri Laura E,
Abstract
BACKGROUND:
Educational escape rooms have been shown to improve student content knowledge; however, research about other skills developed during escape rooms is lacking.
OBJECTIVES:
To explore baccalaureate nursing students' perceptions of a cardiovascular-themed educational escape room. During the data analysis, researchers uncovered unique findings related to participant soft skill development and implications for participant future professional practice.
DESIGN:
A basic interpretive qualitative methodology was used.
SETTING:
The study was conducted at a medium-sized, private, not-for-profit university in the Midwest United States.
PARTICIPANTS:
Baccalaureate nursing students who had recently participated in a cardiovascular-themed educational escape room were purposefully recruited.
METHODS:
A total of two focus groups were conducted using a semi-structured focus group guide. Data were analyzed using a conventional content analysis approach with both inductive and deductive components.
RESULTS:
Four overarching themes were identified in the data, including game and learner characteristics, learning outcomes, and implications for future professional practice. The theme of implications for future professional practice included two sub-themes: soft skill development and the real-life nature of the activity.
CONCLUSION:
A nursing educational escape room may be one strategy to enhance student professional practice skills.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Low birth weight and abnormal pre-pregnancy body mass index were at higher risk for hypertensive disorders of pregnancy.
Pregnancy Hypertens2020 Aug;22():119-125. doi: S2210-7789(20)30105-7.
Wagata Maiko, Ishikuro Mami, Obara Taku, Nagai Masato, Mizuno Satoshi, Nakaya Naoki, Nakamura Tomohiro, Hirata Takumi, Tsuchiya Naho, Metoki Hirohito, Ogishima Soichi, Hozawa Atsushi, Kinoshita Kengo, Kure Shigeo, Yaegashi Nobuo, Yamamoto Masayuki, Kuriyama Shinichi, Sugawara Junichi,
Abstract
Low birth weight is known to be associated with hypertension, cardiovascular disease and hypertensive disorders of pregnancy (HDP); however, this association might vary by race/ethnicity. This study aimed to clarify the association between women's own birth weight and their subsequent risk for HDP in a Japanese population, in combination with pre-pregnancy body mass index (BMI). We conducted a cohort study as part of the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Miyagi, Japan. Our study's population included 4810 women. A multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (aOR) and the 95% confidence interval (CI) of the women's own birth weight for HDP, in the combination categories of birth weight and pre-pregnancy BMI. As a result, the group with a low birth weight of <2500 g had a significant association with HDP (the aOR, 1.50; 95% CI, 1.02-2.21). In the subtype analysis, the odds ratio for only preeclampsia was significantly increased in the low birth weight group (aOR, 3.37; 95% CI, 1.84-6.16). In the group with a low birth weight, the prevalence of HDP was higher in both the underweight and overweight groups. In conclusion, there was a significant association between low birth weight and subsequent HDP in Japanese women. Furthermore, a significant association with HDP was found for women born with a low birth weight who were underweight or overweight as adults. Maintaining a normal weight may be effective for preventing HDP even if a woman was born small.
Copyright © 2020. Published by Elsevier B.V.
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Trimethylamine N-Oxide levels are associated with NASH in obese subjects with type 2 diabetes.
Diabetes Metab2020 Aug;():. doi: S1262-3636(20)30102-6.
León-Mimila Paola, Villamil-Ramírez Hugo, Li Xinmin S, Shih Diana M, Hui Simon T, Ocampo-Medina Elvira, López-Contreras Blanca, Morán-Ramos Sofía, Olivares-Arevalo Marisol, Grandini-Rosales Paula, Macías-Kauffer Luis, González-González Israel, Hernández-Pando Rogelio, Gómez-Pérez Francisco, Campos-Pérez Francisco, Aguilar-Salinas Carlos, Larrieta-Carrasco Elena, Villarreal-Molina Teresa, Wang Zeneng, Lusis Aldons J, Hazen Stanley L, Huertas-Vazquez Adriana, Canizales-Quinteros Samuel,
Abstract
AIMS:
Trimethylamine N-oxide (TMAO), choline and betaine serum levels have been associated with metabolic diseases including type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD). These associations could be mediated by insulin resistance. However, the relationships among these metabolites, insulin resistance and NAFLD have not been thoroughly investigated. Moreover, it has recently been suggested that TMAO could play a role in NAFLD by altering bile acid metabolism. We examined the association between circulating TMAO, choline and betaine levels and NAFLD in obese subjects.
METHODS:
Serum TMAO, choline, betaine and bile acid levels were measured in 357 Mexican obese patients with different grades of NAFLD as determined by liver histology. Associations of NAFLD with TMAO, choline and betaine levels were tested. Moreover, association of TMAO levels with non-alcoholic steatohepatitis (NASH) was tested separately in patients with and without T2D.
RESULTS:
TMAO and choline levels were significantly associated with NAFLD histologic features and NASH risk. While increased serum TMAO levels were significantly associated with NASH in patients with T2D, in non-T2D subjects this association lost significance after adjusting for sex, BMI and insulin resistance. Moreover, circulating secondary bile acids were associated both with increased TMAO levels and NASH.
CONCLUSIONS:
In obese patients, circulating TMAO levels were associated with NASH mainly in the presence of T2D. Functional studies are required to evaluate the role of insulin resistance and T2D in this association, both highly prevalent in NASH patients.
Copyright © 2020. Published by Elsevier Masson SAS.
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National Trends and Cost Burden of Surgically Treated Gunshot Wounds in the US.
J Am Coll Surg2020 Jul;():. doi: S1072-7515(20)30545-7.
Dobaria Vishal, Aguayo Esteban, Sanaiha Yas, Tran Zachary, Hadaya Joseph, Sareh Sohail, Cho Nam Yong, Benharash Peyman,
Abstract
INTRODUCTION:
Gun violence remains a major burden on the US healthcare system with annual costs exceeding $170 billion. Literature regarding the national trends in costs and survival of gun violence victims requiring operative interventions is lacking.
STUDY DESIGN:
All adults admitted with a diagnosis of gunshot wound (GSW) requiring operative intervention(s) were identified using the 2005-16 National Inpatient Sample (NIS). The International Classification of Diseases Injury Severity score (ICISS), a validated prediction tool, was used to quantify the extent of traumatic injuries. Survey-weighted methodology was employed to provide national estimates. Hospitalizations exceeding the 66 percentile of annual costs were considered as high cost tertile (HCT). Multivariable logistic regressions with stepwise forward selection were used to identify factors associated with mortality and HCT.
RESULTS:
Over the study period, 262,098 admissions met inclusion criteria with a significant increase in annual frequency and decrease in ICISS scores. A decline in mortality (8.6% to 7.6%, P-trend=0.03) was accompanied by increasing mean costs ($25,900 to $33,000, NP- trend<0.001). After adjusting for patient and hospital characteristics, head and neck (adjusted odds ratio (AOR): 31.2; 95% CI: 11.0-88.4, P<0.001), vascular operations (AOR: 24.5; 95% CI:19.2-31.1, P<0.001), and gastrointestinal (AOR: 27.8; 95% CI:17.2-44.8, P<0.001), were independently associated with HCT designation compared to patients who did not undergo these operations.
CONCLUSION:
Over the past decade, the increase in gun violence and severity has resulted in higher costs. Operations involving selected surgical treatments incurred higher in-hospital costs. Given the profound economic and social impact of surgically treated GSWs, policy and public health efforts to reduce gun violence are imperative.
Copyright © 2020. Published by Elsevier Inc.
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3D-printed protected face shields for healthcare workers in Covid-19 pandemic.
Am J Infect Control2020 Aug;():. doi: S0196-6553(20)30772-0.
Lemarteleur Vincent, Fouquet Vincent, Goff Stéphane Le, Tapie Laurent, Morenton Pascal, Benoit Aurélie, Vennat Elsa, Zamansky Bruno, Guilbert Thomas, Depil-Duval Arnaud, Gaultier Anne-Laure, Tavitian Bertrand, Plaisance Patrick, Tharaux Pierre-Louis, Ceccaldi Pierre-François, Attal Jean-Pierre, Dursun Elisabeth,
Abstract
The coronavirus pandemic resulted in a shortage of protective equipment. To meet the request of eye-protecting devices, an interdisciplinary consortium involving practitioners, researchers, engineers and technicians developed and manufactured thousands of inexpensive 3D-printed face shields, inside hospital setting. This action lead to the concept of "concurrent, agile and rapid engineering".
Copyright © 2020. Published by Elsevier Inc.
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Clinical significance of reactive oxidative metabolites in patients with heart failure with reduced left ventricular ejection fraction.
J Card Fail2020 Aug;():. doi: S1071-9164(20)30905-2.
Nishihara Taiki, Tokitsu Takanori, Sueta Daisuke, Oike Fumi, Takae Masafumi, Fujisue Koichiro, Usuku Hiroki, Ito Miwa, Kanazawa Hisanori, Araki Satoshi, Arima Yuichiro, Takashio Seiji, Nakamura Taishi, Sakamoto Kenji, Suzuki Satoru, Kaikita Koichi, Yamamoto Eiichiro, Tsujita Kenichi,
Abstract
BACKGROUND:
We investigated the clinical significance of the derivative of reactive oxygen metabolites (DROM), a new marker of reactive oxygen species (ROS), in heart failure (HF) with reduced left ventricular ejection fraction (LVEF) (HFrEF) patients.
METHODS AND RESULTS:
Serum DROM concentrations were measured in 201 consecutive HFrEF (EF<50%) patients in stable condition. DROM values were significantly higher in HFrEF than in risk-matched non-HF patients (p<0.01). They also correlated significantly with high-sensitivity C-reactive protein and BNP. Kaplan-Meier analysis demonstrated significantly higher probabilities of HF-related events in the high-DROM group than in the low-DROM group (log-rank test, p<0.01). Multivariable-Cox-hazard analysis revealed that DROM were independent and significant predictors for cardiovascular events. In a subgroup analysis, DROM levels were also measured at the aortic root and coronary sinus in 49 patients. The transcardiac gradient of DROM values was significantly higher in HFrEF than in non-HF patients (p=0.04), indicating an association between DROM production in the coronary circulation and HFrEF development. Changes in DROM following optimal therapy were significantly associated with LVEF improvement (r=0.34, p=0.04).
CONCLUSIONS:
The higher levels of DROM and their association with cardiovascular events suggest the clinical benefit of DROM measurements in the risk stratification of HFrEF patients.
Copyright © 2020. Published by Elsevier Inc.
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Trends in Place of Death for Individuals with Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States.
J Pain Symptom Manage2020 Aug;():. doi: S0885-3924(20)30654-0.
Cross Sarah H, Lakin Joshua R, Mendu Mallika, Mandel Ernest I, Warraich Haider J,
Abstract
CONTEXT:
An important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD).
OBJECTIVE:
We sought to examine trends and factors associated with where advanced CKD/ESKD patients die.
METHODS:
We conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States.
RESULTS:
Between 2003-2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003-2017, deaths occurring in hospitals declined from 56.0% (n=5,356) to 35.6% (n= 7,764), while increases occurred in deaths at home (13.5% (n=1,292) to 24.3% (n=5,306)), nursing facilities (18.6% (n=1,776) to 19.3% (n=4,221)) and hospice facilities (0.3% (n=29) to 13.4% (n=2,917)). Non-white race was associated with increased odds of hospital death [Black (OR=1.59; 95%CI= 1.55, 1.62); Native American (OR=1.47; 95%CI= 1.32, 1.63); Asian (OR=1.43; 95%CI= 1.32, 1.55] and reduced odds of nursing facility [Black (OR=.622; 95%CI= .600, .645); Native American (OR=.638; 95%CI= .572, .712); Asian (OR=.574; 95%CI= .533, .619] or hospice facility death [Black (OR=.843; 95%CI= .773, .918); Native American (OR=.380; 95%CI= .289, .500); Asian (OR=.609; 95%CI= .502, .739]. Older age was associated with reduced odds of hospital death [ ?85 (OR=.334; 95%CI= .312, .358)] and increased odds of home [ ?85 (OR=1.55; 95%CI= 1.43, 1.68)], nursing facility [ ?85 (OR=3.09; 95%CI= 2.76, 3.45)] or hospice facility death [ ?85 (OR=1.60; 95%CI= 1.49, 1.72)].
CONCLUSIONS:
Hospitals remain the most common place of death from advanced CKD/ESKD, however the proportion of home, nursing facility, and hospice facility deaths have increased.
Copyright © 2020. Published by Elsevier Inc.
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Disrupted Endothelial Cell Heterogeneity and Network Organization Impair Vascular Function in Prediabetic Obesity.
Metabolism2020 Aug;():154340. doi: S0026-0495(20)30204-3.
Wilson Calum, Zhang Xun, Lee Matthew D, MacDonald Margaret, Heathcote Helen R, Alorfi Nasser M N, Buckley Charlotte, Dolan Sharron, McCarron John G,
Abstract
BACKGROUND:
Obesity is a major risk factor for diabetes and cardiovascular diseases such as hypertension, heart failure, and stroke. Impaired endothelial function occurs in the earliest stages of obesity and underlies vascular alterations that give rise to cardiovascular disease. However, the mechanisms that link weight gain to endothelial dysfunction are ill-defined. Increasing evidence suggests that endothelial cells are not a population of uniform cells but are highly heterogeneous and are organized as a communicating multicellular network that controls vascular function.
PURPOSE:
To investigate the hypothesis that disrupted endothelial heterogeneity and network-level organization contribute to impaired vascular reactivity in obesity.
METHODS AND RESULTS:
To study obesity-related vascular function without complications associated with diabetes, a state of prediabetic obesity was induced in rats. Small artery diameter recordings confirmed nitric-oxide mediated vasodilator responses were dependent on increases in endothelial calcium levels and were impaired in obese animals. Single-photon imaging revealed a linear relationship between blood vessel relaxation and population-wide calcium responses. Obesity did not alter the slope of this relationship, but impaired calcium responses in the endothelial cell network. The network comprised structural and functional components. The structural architecture, a hexagonal lattice network of connected cells, was unchanged in obesity. The functional network contained sub-populations of clustered specialized agonist-sensing cells from which signals were communicated through the network. In obesity there were fewer but larger clusters of sensory cells and communication path lengths between clusters increased. Communication between neighboring cells was unaltered in obesity. Altered network organization resulted in impaired, population-level calcium signaling and deficient endothelial control of vascular tone.
CONCLUSIONS:
The distribution of cells in the endothelial network is critical in determining overall vascular response. Altered cell heterogeneity and arrangement in obesity decreases endothelial function and provides a novel framework for understanding compromised endothelial function in cardiovascular disease.
Copyright © 2020 The Author. Published by Elsevier Inc. All rights reserved.
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CircRSF1 contributes to endothelial cell growth, migration and tube formation under ox-LDL stress through regulating miR-758/CCND2 axis.
Life Sci2020 Aug;():118241. doi: S0024-3205(20)30993-0.
Wei Zhenheng, Ran Huazhong, Yang Chunhua,
Abstract
AIMS:
Compelling evidences demonstrate that informative RNAs play essential role in therapy of atherosclerosis. Here, we attempted to study the role of hsa_circ_0000345 (circRSF1) in endothelial cell damage through competing endogenous RNA pathway.
MATERIALS AND METHODS:
Expression of circRSF1, miRNA-758-3p (miR-758) and cyclin D2 (CCND2) was detected using RT-qPCR and western blotting, and the cross-talk among them was identified using dual-luciferase reporter assay and RNA immunoprecipitation. The low-density lipoprotein cholesterol (LDL-C) level was measured with enzyme-linked immunosorbent assay. Cell growth was measured by MTS assay, flow cytometry and caspase-3 activity assay kit. Migration and tube formation were determined by scratch migration assay and tube formation assay, respectively.
KEY FINDINGS:
CircRSF1 and CCND2 were downregulated, whereas miR-758 was upregulated in serum of patients with atherosclerosis and oxidized low-density lipoprotein (ox-LDL)-treated human aortic endothelial cells (HAECs). Moreover, levels of circRSF1, miR-758 and CCND2 were correlated with circulating LDL-C level. Restoring circRSF1 and silencing miR-758 could improve cell viability, tube formation and migration of HAECs under ox-LDL treatment, as well as attenuated apoptotic rate and caspase-3 activity. However, miR-758 upregulation counteracted the promotion of circRSF1 on cell growth, migration and tube formation in ox-LDL-induced HAECs; so did CCND2 deletion on effect of miR-758 silence. Notably, circRSF1 and CCND2 could competitively bound to miR-758, and circRSF1 positively regulated CCND2 expression via miR-758.
SIGNIFICANCE:
CircRSF1 could protect against ox-LDL-induced endothelial cell injury in vitro via miR-758/CCND2 axis, suggesting circRSF1 as a potential target for the treatment of atherosclerosis.
Copyright © 2020. Published by Elsevier Inc.
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Asthma Emphysema Overlap in Non-Smokers.
Ann Allergy Asthma Immunol2020 Aug;():. doi: S1081-1206(20)30564-0.
Gelb Arthur F, Yamamoto Alfred, Verbeken Eric, Grigorian Stephan R, Nadel Jay A,
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Aberrant Aorto Pulmonary Venous Fistula - an Intra-operative Surprise.
Ann Thorac Surg2020 Aug;():. doi: S0003-4975(20)31298-4.
Manohar Prabhu, MohanRao PrasannaSimha, NaikL Rakesh,
Abstract
Anisolated systemic artery to pulmonary vein arterio-venous fistula is a rare clinical entity. We report a 20 year old ladydiagnosed with myxomatous mitral valve prolapse with severe mitral regurgitation and planned for mitral valve repair. An aberrant aorto pulmonary venous fistula was suspected intraoperatively due to flooding of the left atrium with blood from the left inferior pulmonary vein on cardio pulmonary bypass. The mitral valve was repaired successfully. A post-operative Computed Tomographic angiogram revealed an anomalous fistula between the descending thoracic aorta and left inferior pulmonary vein. She underwent successful percutaneous device closure of the fistula.
Copyright © 2020. Published by Elsevier Inc.
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Safety of Atrial Fibrillation Ablation with Isolated Surgical Aortic Valve Replacement.
Ann Thorac Surg2020 Aug;():. doi: S0003-4975(20)31297-2.
Churyla Andrei, Andrei Adin-Cristian, Kruse Jane, Cox James L, Kislitsina Olga N, Liu Menghan, Malaisrie S Chris, McCarthy Patrick M,
Abstract
BACKGROUND:
Surgical ablation of atrial fibrillation (AF) concomitant with cardiac surgery is a Society of Thoracic Surgeons (STS) Class I recommendation, although the AF is frequently ignored. Analysis of STS Database 30-day outcomes of isolated surgical aortic valve replacement (AVR) with and without AF ablation is presented.
METHODS:
Data on 87,426 SAVR patients were extracted from the STS database (version 2.81, 2014-2017) and patients were divided into 3 groups: 1) No preoperative AF, 2) Preoperative AF with concomitant ablation, and 3) Preoperative AF without ablation. The latter two groups were propensity score (PS)-matched in 1-(up)-to-2 ratio to alleviate covariate imbalances and reduce bias. 30-day outcomes were evaluated and compared.
RESULTS:
Preoperative AF was present in 17.8% (15,596/87,426 patients). Ablation was performed in 33.1% (5,167/15,596), and 57.7% (2,983) had left atrial appendage closure. PS-matching (AF ablated N=3692; AF non-ablated N=5724), revealed that there was no difference between the AF ablated and AF non-ablated groups in mortality (2.8% vs. 3.0%, respectively; p=0.65) or for stroke (1.6% vs. 1.7%, respectively; p=0.82), but postoperative pacemaker implantation was higher in the AF ablated patients [6.8% AF ablated vs. 5.0% AF non-ablated, p<0.001).
CONCLUSIONS:
Despite being a Class I recommendation, AF ablation concomitantly with other cardiac surgical procedures remains lower than current guideline recommendation in surgical AVR patients. Ablation for AF does not increase the 30-day operative mortality or perioperative morbidity compared to non-ablated patients, although new pacemaker requirements were higher in the AF ablated group.
Copyright © 2020. Published by Elsevier Inc.
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Molecular, Cellular, and Clinical Evidence That Sodium-Glucose Cotransporter 2 Inhibitors Act as Neurohormonal Antagonists When Used for the Treatment of Chronic Heart Failure.
J Am Heart Assoc2020 Aug;():e016270. doi: 10.1161/JAHA.120.016270.
Packer Milton,
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure. Initially, these drugs were believed to have a profile similar to diuretics or hemodynamically active drugs, but they do not rapidly reduce natriuretic peptides or cardiac filling pressures, and they exert little early benefit on symptoms, exercise tolerance, quality of life, or signs of congestion. Clinically, the profile of SGLT2 inhibitors resembles that of neurohormonal antagonists, whose benefits emerge gradually during sustained therapy. In experimental models, SGLT2 inhibitors produce a characteristic pattern of cellular effects, which includes amelioration of oxidative stress, mitigation of mitochondrial dysfunction, attenuation of proinflammatory pathways, and a reduction in myocardial fibrosis. These cellular effects are similar to those produced by angiotensin converting enzyme inhibitors, ?-blockers, mineralocorticoid receptor antagonists, and neprilysin inhibitors. At a molecular level, SGLT2 inhibitors induce transcriptional reprogramming of cardiomyocytes that closely mimics that seen during nutrient deprivation. This shift in signaling activates the housekeeping pathway of autophagy, which clears the cytosol of dangerous cytosolic constituents that are responsible for cellular stress, thereby ameliorating the development of cardiomyopathy. Interestingly, similar changes in cellular signaling and autophagic flux have been seen with inhibitors of the renin-angiotensin system, ?-blockers, mineralocorticoid receptor antagonists, and neprilysin inhibitors. The striking parallelism of these molecular, cellular, and clinical profiles supports the premise that SGLT2 inhibitors should be regarded as neurohormonal antagonists when prescribed for the treatment of heart failure with a reduced ejection fraction.
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