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Ra J, Shin H, Park C, Wang YX, Shin D. AI-based measurement of cardiothoracic ratio in chest X-rays and prediction of echocardiographic congestive heart failure. IJC HEART & VASCULATURE 2025; 58:101678. [PMID: 40255885 PMCID: PMC12008644 DOI: 10.1016/j.ijcha.2025.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 03/31/2025] [Accepted: 04/02/2025] [Indexed: 04/22/2025]
Abstract
Background This study presents an artificial intelligence (AI) model for automated cardiothoracic ratio (CTR) measurement from chest X-rays (CXRs) and evaluates its association with severe left ventricular hypertrophy (SLVH) and dilated left ventricle (DLV) diagnosed by echocardiography. The study also assesses CTR's prognostic value for predicting future SLVH/DLV development. Methods In this retrospective cohort study, an AI algorithm measured CTR on 71,129 CXRs from 24,673 patients from 2013 to 2018 in the CheXchoNet database. SLVH/DLV was defined using echocardiographic criteria. Diagnostic accuracy was assessed using AUROC and AUPRC alongside sensitivity and specificity at various CTR thresholds. Logistic regression was performed for CXR-echocardiogram pairs. Time-to-event analysis was performed on 9,890 patients without baseline SLVH/DLV. Results Among 24,673 patients (mean age: 62.1 years; female sex: 56.9 %), mean CTR was higher in SLVH/DLV patients (0.56 ± 0.07) than those without (0.52 ± 0.07; p < 0.001). AUROC was 0.70 (95 % CI: 0.69-0.70). At a CTR threshold of 0.53, sensitivity was 70 % and specificity 60 %. Increased CTR was associated with SLVH/DLV risk on paired echocardiogram, with an odds ratio of 1.26 at a CTR of 0.65 compared to CTR at 0.50 (95 % CI: 1.24-1.27, p < 0.001). Time-to-event analysis on patients without baseline SLVH/DLV showed patients with baseline CTR > 0.65 had a 4.13-fold increased risk of developing SLVH/DLV in the future compared to patients with CTR ≤ 0.50 (adjusted HR: 4.13; 95 % CI: 2.48-6.89; p < 0.01). Conclusion AI-based CTR measurement helps predict SLVH/DLV and could be used for risk stratification for cardiovascular care.
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Affiliation(s)
- Joshua Ra
- Division of Cardiology, Mount Sinai Morningside-BronxCare, NY, USA
| | - Heejun Shin
- Artificial Intelligence Engineering Division, RadiSen Co. Ltd., Seoul, South Korea
| | | | | | - Dongmyung Shin
- Artificial Intelligence Engineering Division, RadiSen Co. Ltd., Seoul, South Korea
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Walker JW, Roberts SM. Maintaining a Bloodless Field for HeartMate 3 Placement: Splicing an RVAD Outflow Cannula into the CPB Venous Reservoir for Complete LV Emptying. Ann Card Anaesth 2024; 27:349-351. [PMID: 39206784 PMCID: PMC11610778 DOI: 10.4103/aca.aca_18_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 09/04/2024] Open
Abstract
ABSTRACT Over the previous 20 years, the use of extracorporeal membranous oxygenation (ECMO) as a bridge to durable left ventricular assist device (dLVAD) increased significantly. Additionally, emerging literature has demonstrated a protective effect of biventricular decompression while on ECMO, with one such strategy including a temporary LVAD and right ventricular assist device (RVAD). The complexity of these operations is increased by the frequency of re-sternotomies, which result in adhesions and difficult access to traditional cannulation sites. In this case report, we present a patient presenting for a re-sternotomy for dLVAD on biventricular support in whom the RVAD outflow cannula was spliced into the cardiopulmonary bypass venous reservoir by the cardiac anesthesiologist. This innovative cannulation strategy allowed for continuation of RVAD flows to prevent thrombosis and active venting of the pulmonary artery to facilitate a bloodless surgical field.
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Affiliation(s)
- Justin W. Walker
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - S. Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Hickman W, Dada RS, Thibault D, Gibson C, Heller S, Jagadeesan V, Hayanga HK. Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis. Ann Card Anaesth 2024; 27:220-227. [PMID: 38963356 PMCID: PMC11315250 DOI: 10.4103/aca.aca_14_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 07/05/2024] Open
Abstract
CONTEXT Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. AIMS Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. SETTINGS AND DESIGN Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. MATERIAL AND METHODS Retrospective data analysis from 2017-2021. STATISTICAL ANALYSIS USED Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. RESULTS A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261). CONCLUSIONS While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
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Affiliation(s)
- William Hickman
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States
| | - Rachel S. Dada
- Department of Anesthesiology, West Virginia University, Morgantown, West Virginia, United States
| | - Dylan Thibault
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Christina Gibson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States
| | - Scott Heller
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Vikrant Jagadeesan
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Heather K. Hayanga
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States
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Rey N, Ebrahimian T, Gloaguen C, Kereselidze D, Christelle E, Brizais C, Bachelot F, Riazi G, Monceau V, Demarquay C, Zineddine IG, Klokov D, Lehoux S, Ebrahimian TG. Low to moderate dose 137Cs (γ) radiation promotes M2 type macrophage skewing and reduces atherosclerotic plaque CD68+ cell content in ApoE (-/-) mice. Sci Rep 2024; 14:12450. [PMID: 38816571 PMCID: PMC11139881 DOI: 10.1038/s41598-024-63084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024] Open
Abstract
The effects of low doses of ionizing radiation on atherosclerosis remain uncertain, particularly as regards the generation of pro- or anti-inflammatory responses, and the time scale at which such effects can occur following irradiation. To explore these phenomena, we exposed atheroprone ApoE(-/-) mice to a single dose of 0, 0.05, 0.5 or 1 Gy of 137Cs (γ) administered at a 10.35 mGy min-1 dose rate and evaluated short-term (1-10 days) and long-term consequences (100 days). Bone marrow-derived macrophages were derived from mice 1 day after exposure. Irradiation was associated with a significant skewing of M0 and M2 polarized macrophages towards the M2 phenotype, as demonstrated by an increased mRNA expression of Retnla, Arg1, and Chil3 in cells from mice exposed to 0.5 or 1 Gy compared with non-irradiated animals. Minimal effects were noted in M1 cells or M1 marker mRNA. Concurrently, we observed a reduced secretion of IL-1β but enhanced IL-10 release from M0 and M2 macrophages. Effects of irradiation on circulating monocytes were most marked at day 10 post-exposure, when the 1 Gy dose was associated with enhanced numbers of both Ly6CHigh and Ly6Low cells. By day 100, levels of circulating monocytes in irradiated and non-irradiated mice were equivalent, but anti-inflammatory Ly6CLow monocytes were significantly increased in the spleen of mice exposed to 0.05 or 1 Gy. Long term exposures did not affect atherosclerotic plaque size or lipid content, as determined by Oil red O staining, whatever the dose applied. Similarly, irradiation did not affect atherosclerotic plaque collagen or smooth muscle cell content. However, we found that lesion CD68+ cell content tended to decrease with rising doses of radioactivity exposure, culminating in a significant reduction of plaque macrophage content at 1 Gy. Taken together, our results show that short- and long-term exposures to low to moderate doses of ionizing radiation drive an anti-inflammatory response, skewing bone marrow-derived macrophages towards an IL-10-secreting M2 phenotype and decreasing plaque macrophage content. These results suggest a low-grade athero-protective effect of low and moderate doses of ionizing radiation.
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Affiliation(s)
- N Rey
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - T Ebrahimian
- Department of Medicine, Lady Davis Institute for Biomedical Research, McGill University, Montreal, Canada
| | - C Gloaguen
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - D Kereselidze
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - E Christelle
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - C Brizais
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - F Bachelot
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - G Riazi
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - V Monceau
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - C Demarquay
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - I Garali Zineddine
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - D Klokov
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France
| | - S Lehoux
- Department of Medicine, Lady Davis Institute for Biomedical Research, McGill University, Montreal, Canada.
| | - Teni G Ebrahimian
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie et de Radiobiologie Expérimentale, 92262, Fontenay-Aux Roses, France.
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Wu L, Yao Y. Exploring the effect of music therapy as intervention to reduce anxiety pre- and post-operatively in CABG surgery: A quantitative systematic review. Nurs Open 2023; 10:7544-7565. [PMID: 37823363 PMCID: PMC10643824 DOI: 10.1002/nop2.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/29/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023] Open
Abstract
AIM Patients undergoing coronary artery bypass graft (CABG) surgery may experience psychological complications, which can increase mortality. This review aims to explore the efficacy of music therapy as an intervention to reduce anxiety pre- and post-operatively in CABG surgery. DESIGN This was a quantitative systematic review registered in PROSPERO (REDACTED). METHODS This review used the PECOD framework to identify quantitative questions. We systematically searched seven electronic databases (Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PubMed, Embase, PsycArticles, and PsycInfo) for articles published between 1 January 1992 and 13 July 2022. Studies were critically appraised, and the results of this systematic review yielded a narrative summary of the findings. RESULTS Four randomized control trials and one quasi-experimental study published in English were included in the review. Narrative analysis indicated that patients undergoing CABG who were assigned to the group receiving music therapy reported significantly reduced anxiety levels compared with controls who did not listen to music. In addition, music therapy can effectively be used as a non-pharmacological intervention to manage anxiety pre- and post-operatively in CABG surgery. No members of the public or patients were involved in the design or conduct of the study.
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Affiliation(s)
- Lan Wu
- Cardiac Care UnitThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Yongbo Yao
- Oncology DepartmentGuangdong Clifford HospitalGuangzhouGuangdongChina
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Sigal AR, Rivero M, Meza M, Filippa G, Procopio G, Abud CM, Nani S, Odone M, Duronto E, Costabel JP. [Impact of pretreatment with P2Y12 inhibitors in patients with acute coronary syndromes without ST elevation. Analysis of 2 multicenter registries]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:96-101. [PMID: 38046231 PMCID: PMC10688406 DOI: 10.47487/apcyccv.v4i3.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/22/2023] [Indexed: 12/05/2023]
Abstract
Objectives To evaluate the rate of use of antiplatelet pretreatment in patients with non-ST elevated acute coronary syndrome (NSTEACS) and its association with adverse events in two Argentine registries. Materials and methods We retrospectively analyzed two Argentine acute coronary syndrome (ACS) registries from 2017 and 2022. We explored the incidence of pretreatment and the drug used. We evaluated the relationship between this strategy and a composite clinical outcome of in-hospital events: death + myocardial infarction + stent thrombosis + post-MI angina + transient ischemic event/cerebrovascular event, and with bleeding events (BARC 2 or higher). Subsequently, we performed a multivariate analysis by logistic regression with other clinical variables. Results A total of 1297 patients were included; 75.6% were men, 25.6% diabetics, 27.1% smokers, 70.3% hypertensive, and 23.1% had a previous ACS. The mean age was 55.3 years. The mean GRACE score was 113.5, and the CRUSADE was 23.8. 44% of the patients received pretreatment, the majority with clopidogrel (93.5%). Pretreatment was significantly associated with a higher incidence of the composite clinical outcome (10.1% vs. 6.9%) (OR 1,56; IC 95%: 1,06-2,3; p=0,02). Bleeding events were numerically more frequent with pretreatment (8.7% vs. 5.9%) (OR 1,51; IC95%: 0,99 -2,3; p=0,054). In the multivariate analysis, pretreatment was no longer associated with a higher incidence of ischemic outcomes (OR 1,4; IC95%: 0,89-2,3; p=0,13). Conclusion Pretreatment was used in almost half of the patients, mainly with clopidogrel, and did not show a reduction in ischemic events in patients with NSTACS.
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Affiliation(s)
- Alan R Sigal
- Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina. Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | - Mirza Rivero
- CEMIC. Buenos Aires, Argentina. CEMIC Buenos Aires Argentina
| | - Mayra Meza
- CEMIC. Buenos Aires, Argentina. CEMIC Buenos Aires Argentina
| | - Gerardo Filippa
- CEMEP. Tierra del Fuego, Argentina. CEMEP Tierra del Fuego Argentina
| | - Gastón Procopio
- Hospital Universitario Fundación Favaloro. Buenos Aires, Argentina. Hospital Universitario Fundación Favaloro Buenos Aires Argentina
| | - Camila M Abud
- Hospital Universitario Fundación Favaloro. Buenos Aires, Argentina. Hospital Universitario Fundación Favaloro Buenos Aires Argentina
| | - Sebastián Nani
- Clínica Olivos. Buenos Aires, Argentina. Clínica Olivos Buenos Aires Argentina
| | - Martín Odone
- Sanatorio San Lucas. Buenos Aires, Argentina. Sanatorio San Lucas Buenos Aires Argentina
| | - Ernesto Duronto
- Hospital Universitario Fundación Favaloro. Buenos Aires, Argentina. Hospital Universitario Fundación Favaloro Buenos Aires Argentina
| | - Juan P Costabel
- Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina. Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
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Zhirov IV, Safronova NV, Tereshchenko SN. Heart failure as a complication of myocardial infarction: rational therapy. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.10.201888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Heart failure (HF) is still a frequent complication of myocardial infarction. Timely identification of subjects at risk for HF development and early initiation of guideline-directed HF therapy in these patients, can decrease the HF burden. This article aims at summarizing clinical data on established pharmacological therapies in treating post-MI patients with left ventricular systolic dysfunction and signs and symptoms of HF.
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Sun X, Shi X, Cao Y, Zhu H, Pudasaini B, Yang W, Yuan P, Wang L, Zhao Q, Gong S, Liu J, Guo J. Variation of PetCO 2 during incremental exercise and severity of IPAH and CTEPH. BMC Pulm Med 2022; 22:249. [PMID: 35752795 PMCID: PMC9233817 DOI: 10.1186/s12890-022-02045-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective End-tidal PCO2 (PetCO2) patterns during exercise testing as well as ventilatory equivalents for CO2 have been reported for different pulmonary vascular diseases but seldomly for the significant differences in exercise response depending on the etiology of pulmonary hypertension. We aimed to compare PetCO2 change pattern in IPAH and CTEPH with varying severity during incremental cardiopulmonary exercise testing (CPET). Methods 164 IPAH patients and 135 CTEPH patients referred to Shanghai Pulmonary Hospital between 2012 and 2019 were retrospectively recruited into the study. All patients performed CPET and also underwent right-heart catheterization (RHC). Forty-four healthy subjects also performed CPET and were included as controls. Results PetCO2 was significantly lower in IPAH and CTEPH patients as compared to normal subjects. Moreover, the PetCO2 did not rise, in fact fell from rest to anaerobic threshold (AT), then further decreased until peak in both IPAH and CTEPH. PetCO2 value at rest, unloaded, AT and peak were proportionately reduced as the World Health Organization functional class (WHO-Fc) increased in both IPAH and CTEPH patients. The PETCO2 in IPAH patients had significant differences during all phases of exercise between WHO-Fc I-II and III-IV subgroup. CTEPH also demonstrated significant difference except for PetCO2 at peak. PetCO2 values were significantly higher in IPAH during all phases of exercise as compared to CTEPH patients (all P < 0.001). PeakVO2%pred correlated significantly with PetCO2 at rest (r = 0.477, P < 0.001), AT (r = 0.609, P < 0.001) and peak exercise (r = 0.576, P < 0.001) in IPAH. N-terminal natriuretic peptide type-B (NT-proBNP) also correlated markedly with PetCO2, with a correlation coefficient of − 0.326 to − 0.427 (all P < 0.001). Additionally, PetCO2 at rest, at AT and at peak correlated positively with peakVO2%pred and showed an inverse correlation with NT-proBNP in CTEPH patients (all P < 0.05). Conclusions PetCO2 during exercise in IPAH and CTEPH patients was significantly different from normal subjects. Moreover, PetCO2 values were significantly higher in IPAH during all phases of exercise as compared to CTEPH patients (all P < 0.001). PetCO2 was progressively more abnormal with increasing disease severity according to peakVO2%pred and WHO-Fc.
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Affiliation(s)
- Xingxing Sun
- Department of Pulmonary Function Test, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Xue Shi
- Department of Respiratory and Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Yuan Cao
- Department of Pulmonary Function Test, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Hanqing Zhu
- Department of Pulmonary Function Test, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Bigyan Pudasaini
- Department of Internal Medicine, Columbia Bainuo Clinic, Shanghai, 200040, China
| | - Wenlan Yang
- Department of Pulmonary Function Test, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Ping Yuan
- Department of Cardio-Pulmonary Circulation, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Qinhua Zhao
- Department of Cardio-Pulmonary Circulation, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Sugang Gong
- Department of Cardio-Pulmonary Circulation, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Jinming Liu
- Department of Cardio-Pulmonary Circulation, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
| | - Jian Guo
- Department of Pulmonary Function Test, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
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Wei Y, Zhang H, Fu M, Ma R, Li R, Kong L. Plasma and Intrapulmonary Pharmacokinetics, and Dosage Regimen Optimization of Linezolid for Treatment of Gram-Positive Cocci Infections in Patients with Pulmonary Infection After Cerebral Hemorrhage. Infect Drug Resist 2022; 15:1733-1742. [PMID: 35422643 PMCID: PMC9004730 DOI: 10.2147/idr.s357300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yongli Wei
- Grade Three Laboratory of Traditional Chinese Medicine Preparation of the National Administration of Traditional Chinese Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - He Zhang
- Grade Three Laboratory of Traditional Chinese Medicine Preparation of the National Administration of Traditional Chinese Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Maowu Fu
- Department of Neurosurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Rui Ma
- Grade Three Laboratory of Traditional Chinese Medicine Preparation of the National Administration of Traditional Chinese Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Ronghui Li
- Department of Neurosurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
- Correspondence: Ronghui Li, Neurosurgery Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China, Email
| | - Lingti Kong
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, People’s Republic of China
- Lingti Kong, Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, People’s Republic of China, Email
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Xie J, Zhong F, Guo Z, Li X, Wang J, Gao Z, Chang B, Yang J. Hyperinsulinemia impairs the metabolic switch to ketone body utilization in proximal renal tubular epithelial cells under energy crisis via the inhibition of the SIRT3/SMCT1 pathway. Front Endocrinol (Lausanne) 2022; 13:960835. [PMID: 36237185 PMCID: PMC9551351 DOI: 10.3389/fendo.2022.960835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To investigate the effects and mechanism of hyperinsulinemia on the metabolic switch to β-hydroxybutyrate (BHB) absorption and utilization under a starvation or hypoxic environment in proximal tubular epithelial cells. METHODS A high-fat diet-induced hyperinsulinemia model in ZDF rats was used to test the expression of key enzymes/proteins of ketone body metabolism in the kidney. Notably, 12-week-old renal tubule SMCT1 specific knockout mice (SMCT1 flox/floxCre+) and control mice (SMCT1 flox/floxCre-) were used to confirm the roles of SMCT1 in kidney protection under starvation. The changes of key enzymes/proteins of energy metabolism, mitochondrial function, and albumin endocytosis in HK2 cells under low glucose/hypoxic environments with or without 50 ng/mL insulin were studied. Silent information regulation 2 homolog 3 (SIRT3) was overexpressed to evaluate the effect of hyperinsulinemia on the metabolic switch to BHB absorption and utilization through the SIRT3/SMCT1 pathway in HK2 cells. RESULTS In ZDF rats, the expression of HMGCS2 increased, the SMCT1 expression decreased, while SCOT remained unchanged. In renal tubule SMCT1 gene-specific knockout mice, starvation for 48 h induced an increase in the levels of urine retinol-binding protein, N-acetyl-β-glucosaminidase, and transferrin, which reflected tubular damages. In HK2 cells under an environment of starvation and hypoxia, the levels of key enzymes related to fatty acid oxidation and ketone body metabolism were increased, whereas glucose glycolysis did not change. The addition of 2 mmol/l BHB improved ATP production, mitochondrial biosynthesis, and endocytic albumin function, while cell apoptosis was reduced in HK2 cells. The addition of 50 ng/ml insulin resulted in the decreased expression of SMCT1 along with an impaired mitochondrial function, decreased ATP production, and increased apoptosis. The overexpression of SIRT3 or SMCT1 reversed these alterations induced by a high level of insulin both in low-glucose and hypoxic environments. CONCLUSIONS The increased absorption and utilization of BHB is part of the metabolic flexibility of renal tubular epithelial cells under starvation and hypoxic environments, which exhibits a protective effect on renal tubular epithelial cells by improving the mitochondrial function and cell survival. Moreover, hyperinsulinemia inhibits the absorption of BHB through the inhibition of the SIRT3/SMCT1 pathway.
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Affiliation(s)
| | | | | | | | | | | | | | - Juhong Yang
- *Correspondence: Juhong Yang, ; Baocheng Chang,
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Mironova Staroverova AI, Panchenko EP, Kropacheva ES, Zemlyanskaya OA. [Resumption of anticoagulant therapy after major bleeding and recurrence of hemorrhagic complications in patients with atrial fibrillation with a high risk of stroke and thromboembolism (based on the results of 20 years of observation)]. TERAPEVT ARKH 2020; 92:15-23. [PMID: 33346426 DOI: 10.26442/00403660.2020.09.000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
AIM To analyze the frequency of resumption of anticoagulant therapy (ACT) after major and clinically significant bleeding among AF patients who received oral anticoagulants and were observed in the Department of clinical problems of atherothrombosis from 1999 to 2019 within the retro-prospective register Regata-2, and to search for clinical factors associated with recurrence of hemorrhagic complications among patients who resumed anticoagulant therapy after a bleeding episode. MATERIALS AND METHODS In cohort study of patients with high-risk AF with absolute indications for ACT we enrolled 290 AF patients (130 women and 160 men) aged 32 to 85 years (the average age was 65.188.89 years). During the follow-up period, 92 patients developed hemorrhagic complications, and 73 of them resumed ACT. 35 of the 73 patients who resumed ACT developed a relapse of major/clinically significant bleeding. RESULTS The frequency of resuming ACT after the first hemorrhagic complication increased over time from 75% in the period from 19992003 to 90% in the period 20152019. We were not able to establish an exact relationship between the presence of concomitant pathology and the decision to resume the ACT after bleeding. The only reliable reason for refusing to resume the ACT was the patients categorical reluctance. Among patients who had recurrent hemorrhagic complications, the total score on the Charleson comorbidity scale was significantly higher (4.232.01vs3.521.43;p=0.0425). Patients with recurrent bleeding were significantly more likely to suffer from CKD with a decrease in GFR less than 60 ml/min/1.73 sq. m, and also had a history of erosive and ulcerative lesions of the gastrointestinal tract. There was also a significant Association of recurrent bleeding with the use of proton pump inhibitors. Subgroups of patients who switched from warfarin to taking direct oral anticoagulants after the first bleeding and subsequent recurrent bleeding did not differ in basic clinical characteristics from patients without bleeding after changing the anticoagulant. According to multiple regression analysis, NSAIDs showed a tendency to develop a relapse of B/C bleeding on the background of direct oral anticoagulants in patients who underwent GO on the background of warfarin therapy (b=0.4524,p=0.0530). CONCLUSION During the 20-year follow-up, the frequency of all major and clinically significant bleeding was 2.6/100 patients-years, the frequency of first bleeding was 5.86/100 patients-years, while the frequency of repeated hemorrhagic complications was 7.06/100 patients-years. Patients with a high thromboembolic risk should receive anticoagulants, provided that the modifiable risk factors for bleeding are carefully corrected.
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Affiliation(s)
| | - E P Panchenko
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - E S Kropacheva
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - O A Zemlyanskaya
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
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12
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Komlev AE, Lepilin PM, Kurilina EV, Romakina VV, Imaev TE. [Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement]. TERAPEVT ARKH 2020; 92:70-75. [PMID: 32598701 DOI: 10.26442/00403660.2020.04.000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 11/22/2022]
Abstract
Coronary arteries obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (7 days after procedure) or delayed one (7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.
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Affiliation(s)
- A E Komlev
- National Medical Research Center of Cardiology
| | - P M Lepilin
- National Medical Research Center of Cardiology
| | | | | | - T E Imaev
- National Medical Research Center of Cardiology
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13
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Gudkova AY, Streltsova AA, Kostareva AA. [Hypertrophic cardiomyopathy: modern aspects of pharmacologic treatment]. TERAPEVT ARKH 2019; 91:129-136. [PMID: 32598824 DOI: 10.26442/00403660.2019.09.000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
This article discusses recent advances in understanding genetic basis and classification of hypertrophic cardiomyopathy. Here, we review pharmacologic treatment strategies and new developments in disease - specific management of HCM.
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Affiliation(s)
- A Y Gudkova
- Pavlov Medical University.,Almazov Federal Medical Research Centre
| | | | - A A Kostareva
- Pavlov Medical University.,Almazov Federal Medical Research Centre
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14
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Mironova ES, Mironova NA, Sharf TV, Efremov EE, Azmuko AA, Molokoedov AS, Zykov KA, Golitsyn SP. [Autoantibodies to M2-cholinoreceptors as a potential development factor of arrhythmia in patients with paroxysmal atrial fibrillation]. TERAPEVT ARKH 2019; 91:101-107. [PMID: 32598820 DOI: 10.26442/00403660.2019.09.000280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM We aimed to assess autoantibodies to M2-cholinoceptors (M2-CR) in patients with paroxysmal lone atrial fibrillation (AF) and in patients with AF and arterial hypertension (AH). MATERIALS AND METHODS 100 patients with lone AF and 84 patients with AF and AH were included. Patients underwent clinical blood and urinalysis, assessment of biochemistry blood panel, 12-lead ECG, 24-hour Holter monitoring, echocardiography and stress - testing (treadmill or stress - echocardiography). Assessment of IgM and IgG autoantibodies to M2-CR was performed by indirect immunoenzyme assay. The following peptide molecules were used as epitopes for detection of autoantibodies: M1 - amino acid sequence YTVIGYWPLGVVCDL (83-98) of the first extracellular loop of M2-CR; M2 - sequence VRTVEDGECYIQFFSNAAVTFGTAI (168-192) of the second extracellular loop of M2-CR; M3 - sequence NTFCAPCIPNTV (410-421) of the third extracellular loop of M2-CR; M4 - short sequence VEDGECYIQFFS (171-182) of the second extracellular loop of M2-CR; M1+M4 - chimeric molecule formed by sequences of the first and the second extracellular loops of M2-CR connected by disulfide bound YTVIGYWPLGVVCDL + VEDGECYIQFFS (83-98 + 171-182). RESULTS Autoantibodies to M2-CR were found in 45% patients with lone AF and in 35% patients with AF and AH. In patients with lone AF prevalence of increased IgG to M2-CR were greater than in patients with AF and AH (32% vs 20%; p.
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Affiliation(s)
| | | | - T V Sharf
- National Medical Research Center of Cardiology
| | - E E Efremov
- National Medical Research Center of Cardiology
| | - A A Azmuko
- National Medical Research Center of Cardiology
| | | | - K A Zykov
- National Medical Research Center of Cardiology
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15
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Chazova IE, Aksenova AV, Oschepkova EV. Clinical features of arterial hypertension in men and women (according to the National Registry of Arterial Hypertension). TERAPEVT ARKH 2019; 91:8-16. [PMID: 31090364 DOI: 10.26442/00403660.2019.01.000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM The purpose of this study is to study the effect of sex on the features of therapy of arterial hypertension and the development of cardiovascular complications. MATERIALS AND METHODS Data from the register of AH from outpatient hospital and cardiology departments of hospitals of 22 regions of the Russian Federation were analyzed. Data of medical documents of 33 564 patients with AH [(36.2%) men and 21 423 (63.8%) women] were entered into the on-line computer program and were analyzed using the statistical software package STATISTICA 10. RESULTS Cardiovascular and cerebrovascular diseases are more often diagnosed in men: peripheral artery disease, coronary heart disease, acute coronary syndrome, congestive heart failure, ischemic stroke, dissecting aortic aneurysm. The beginning of development cardiovascular disease in men with elevated blood pressure is already observed at age of 25-44 years, which indicates the need for preventive measures already in adolescence and closer monitoring of treatment at a young age. CONCLUSION The study confirmed the role of the male sex as a risk factor for the development of cardiovascular disease in hypertensive men and women with comparable figures of blood pressure in. Identified gender features must be considered when diagnosing patients with AH.
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Affiliation(s)
- I E Chazova
- National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Aksenova
- National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - E V Oschepkova
- National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
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16
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Yu J, Lv Y, Wang F, Kong X, Di W, Liu J, Sheng Y, Lv S, Ding G. MiR-27b-3p Inhibition Enhances Browning of Epididymal Fat in High-Fat Diet Induced Obese Mice. Front Endocrinol (Lausanne) 2019; 10:38. [PMID: 30778336 PMCID: PMC6369196 DOI: 10.3389/fendo.2019.00038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/17/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Long-term dysregulation of energy balance is the key component of the obesity epidemic. Given the harm of central obesity and the discovery that beige cells appear within white adipose tissue (WAT), enhancing the energy-expending or "browning" ability of visceral adipose tissue (VAT) has become of therapeutic interest. In this study, we focused on the regulating role of microRNA (miRNA)-27b-3p in mice epididymal white adipose tissue (eWAT) browning. Methods: High-fat diet (HFD) induced obese mice model was constructed. Expression of miR-27b-3p and Ucp1 in eWAT was measured during the course of HFD. Through tail vein injection of antimiR-27b-3p, miR-27b-3p expression was inhibited to analyze the potential role of miR-27b-3p in fat browning and metabolism. Results: miR-27b-3p was predominantly expressed in eWAT and browning ability of eWAT in HFD induced obese mice was impaired. Inhibition of miR-27b-3p enhanced browning capacity of eWAT in mice fed an HFD and led to weight loss and insulin sensitivity improvement. Conclusions: High expression of miR-27b-3p in eWAT inhibits browning ability and leads to visceral fat accumulation. It is suggested miR-27b-3p may become a potential therapeutic option for visceral obesity and its associated diseases.
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Affiliation(s)
- Jing Yu
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yifan Lv
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengliang Wang
- Department of Breast Surgery, The Affiliated Obstetrics and Gynaecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiaocen Kong
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenjuan Di
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juan Liu
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yunlu Sheng
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shan Lv
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoxian Ding
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Guoxian Ding
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17
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Xiao Y, Gowda ST, Chen Z, Delaney JW, Amin Z, Latson LA, Kutty S. Transcatheter Closure of Coronary Artery Fistulae: Considerations and Approaches Based on Fistula Origin. J Interv Cardiol 2015; 28:380-9. [PMID: 26086715 DOI: 10.1111/joic.12212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate technical approaches for transcatheter closure of coronary artery fistula based on anatomic type of the fistula. BACKGROUND The variability in coronary artery fistulae (CAF) anatomy that necessitates different transcatheter closure (TCC) approaches has not been well documented. METHODS Records of patients with CAF who underwent TCC at 2 centers were reviewed for technical details and procedural outcome. CAF were classified as proximal and distal. TCC approaches employed were arterio-venous or arterio-arterial loop, retrograde arterial, and antegrade venous. RESULTS Eighteen patients with CAF, mean age 12.6 years (0.07-60), 11 male (61%), underwent TCC. All CAF drained predominantly into the right side of the heart. Types of CAF were proximal in 15 and distal in 3 patients. CAF calibers were large in 7, medium in 9, and small in 2 patients. The arterio-venous loop approach was used in the majority of the cases (11 patients) and the CAF size were medium to large. The retrograde arterial approach was used in 4; of these, 3 patients had small to medium sized CAF. In 2 patients with long tortuous CAF an antegrade venous approach was employed. TCC was successful in 17 of the 18 patients (94.4%). There were no peri-procedural deaths or vascular complications. CONCLUSIONS This study documents transcatheter closure approaches for CAF and device selection based on fistula origin. The choices of TCC technique and device selection vary, and are primarily determined by the heterogeneous anatomic characteristics of the fistulae.
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Affiliation(s)
- Yunbin Xiao
- Department of Cardiology, Hunan Children's Hospital, Changsha, Hunan, China.,Division of Pediatric Cardiology, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Srinath T Gowda
- Pediatric Cardiology, Children's Hospital of San Antonio, San Antonio, Texas
| | - Zhi Chen
- Department of Cardiology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Jeffrey W Delaney
- Division of Pediatric Cardiology, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Zahid Amin
- Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Larry A Latson
- Pediatric Cardiology, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Shelby Kutty
- Division of Pediatric Cardiology, Children's Hospital and Medical Center, Omaha, Nebraska
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18
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Doesch C, Papavassiliu T. Diagnosis and management of ischemic cardiomyopathy: Role of cardiovascular magnetic resonance imaging. World J Cardiol 2014; 6:1166-1174. [PMID: 25429329 PMCID: PMC4244614 DOI: 10.4330/wjc.v6.i11.1166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/02/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) represents an important cause of mortality. Cardiovascular magnetic resonance (CMR) imaging evolved as an imaging modality that allows the assessment of myocardial function, perfusion, contractile reserve and extent of fibrosis in a single comprehensive exam. This review highlights the role of CMR in the differential diagnosis of acute chest pain by detecting the location of obstructive CAD or necrosis and identifying other conditions like stress cardiomyopathy or myocarditis that can present with acute chest pain. Besides, it underlines the prognostic implication of perfusion abnormalities in the setting of acute chest pain. Furthermore, the review addresses the role of CMR to detect significant CAD in patients with stable CAD. It elucidates the accuracy and clinical utility of CMR with respect to other imaging modalities like single-photon emission computed tomography and positron emission tomography. Besides, the prognostic value of CMR stress testing is discussed. Additionally, it summarizes the available CMR techniques to assess myocardial viability and describes algorithm to identify those patient who might profit from revascularization those who should be treated medically. Finally, future promising imaging techniques that will provide further insights into the fundamental disease processes in ischemic cardiomyopathy are discussed.
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