Atherosclerosis Heart Research Articles

AGING AND CARDIOVASCULAR DISEASES

According to the World Health Organization, the term “elderly” refers to people over the age of 65. Decreases in heart rate, heart function, oxygen consumption and stroke rate occur with aging. Many changes occur in the cardiovascular system with aging, and this predisposes to diseases. The aim of this review article is to examine the physiological relationship between aging and cardiovascular diseases. Depending on genetic differences and age, the heart's ability to pump blood decreases, the myocardium loses flexibility, and the heart valves thicken and increase in diameter. Aging is an inevitable part of life and constitutes the most important risk factor for cardiovascular diseases. Arteriosclerosis increases the thickness of blood vessels while decreasing their elasticity. Functional and structural changes in the cardiovascular system in older ages increase the risk of coronary artery disease, heart diseases, heart failure, venous thrombosis, and hypertension. Cardiac output and stroke volume decreases and the risk of postural hypotension increases. With advancing age, a continuous rise in systolic blood pressure occurs as a result of a hardening of the vessels and their diminished elasticity. After the age of 60, either a slight decrease or no change is seen in diastolic blood pressure.

Possibility of correction of the blood-heart barrier damage as a consequence of the impact of the SARS-CoV-2 virus on the cardiovascular system in patients with coronary artery disease in combination with COVID-19.

damage to the blood-heart barrier (BHB) and endothelial dysfunction is a characteristic feature of congestive (cardiopulmonary) chronic heart failure (CHF), the main cause of death in elderly people with CHF caused by new coronavirus variants (SARS-CoV-2), but the mechanism of this phenomenon remains unclear. The aim of this project is to determine the mechanism of BHB damage in coronary artery disease (CAD) with COVID-19, as well as the possibility of its correction with the use of sulodexide. The endocardial endothelium (EE) is a barrier that prevents blood leakage from the endocardium to the interstitium; however, this barrier is impaired during the course of COVID-19 in patients with CAD. Previous studies have shown that one of the pathophysiological mechanisms is the activation of matrix metalloproteinases (MMPs) in CAD with CHF. MMP-9 degrades connexins, which leads to EE dysfunction. One study [Rubens P. et al. 2021] found a juxtacrine connection of EE with the myocyte and mitochondria (Mito), but how this works is still an open question. Materials and methods. We examined 65 patients with coronary artery disease diagnosed with COVID-19. Patients were divided into two groups: Group I (n=35) - patients who had been taking sulodexide at a dose of 500 LE x 2p/day for 6 months against the background of standard therapy of coronary artery disease; Group II (n=30) - patients without sulodexide. Echocardiography and laser Doppler flowmetry were performed at baseline and 6 months later. Echocardiography at the time of inclusion in the study revealed that 30 (50%) patients in group I and 14 (47%) patients in group II had reduced left ventricular ejection fraction (LV EF) values of 40 to 50%. After 6 months of treatment with sulodexide, a tendency to improve LV systolic function and decrease in left ventricular myocardial mass index (LFMMI) was noted in patients of group I. There were no differences between the groups at the time of inclusion in the study in terms of the level of the capillary flow reserve – occlusion test (CFRo) and the capillary flow reserve – nitroglycerin test (CFRn). A repeated study of CFR revealed a significant increase in CFRo and CFRn levels only in group I. In patients of group II, no significant changes in CFRo and CFRn were found. An inverse relationship between the level of CFRo and C-reactive protein (CRP) was found in patients of group I (r=0.52, p<0.05). After 6 months of treatment, plasma CRP concentrations decreased significantly: from 17.7 [1.3; 50.1] to 5.7 [1.0; 12.0] mg/L in group I (p=0.01) and from 14.2 [1.2; 27.0] to 4.2 [1.0; 11.0] mg/L in group II (p=0.01). No significant correlations between CRP level and CFRo after 6 months of treatment were found. There were correlations of CFRo and CFRn with left ventricular systolic function, as well as inverse relationships with the size of the left and right ventricles and systolic pressure in the pulmonary artery. There was a tendency to improve systolic and diastolic left ventricular function in the first group, where sulodexide was used, and no significant changes in echocardiography were noted in the second group. At the initial examination of patients, the ratio of CFRo and CFRn had no significant differences. After 6 months of treatment, a significant increase in the ratio of CFRo and CFRn was observed only in patients taking sulodexide, and no positive dynamics of this ratio was observed in group II. The results indicate that MMP-9 activation, endothelial damage, endothelial-myocyte (E-M) uncoupling, and mitochondrial-myocyte uncoupling in heart failure in patients with CAD combined with COVID-19 were detected to a significant extent; however, treatment with sulodexide successfully mitigated the destructive changes in the heart in CAD with CHF. The results obtained are directly relevant to the range of cardiac manifestations and phenotypes arising from COVID-19 complications in people with CAD. Conclusion. The obtained results confirm the improvement of microcirculation, as well as a tendency to improve systolic function and left ventricular myocardial mass index after 6 months of sulodexide treatment in patients with coronary artery disease with preserved and moderately reduced left ventricular ejection fraction (LV EF) who have undergone COVID-19. The described effects of improving endothelial function, as well as improving the state of the blood-brain barrier due to the use of sulodexide, make it possible to recommend the use of this drug in the category of patients with CAD to reduce the negative impact of COVID-19 on the cardiovascular system.

Machine learning-driven risk assessment of coronary heart disease: Analysis of NHANES data from 1999 to 2018.

The high incidence of coronary artery heart disease (CHD) poses a significant burden and challenge to public health systems globally. Effective prevention and early diagnosis of CHD have become key strategies to alleviate this burden. This study aims to explore the application of advanced machine learning techniques to enhance the accuracy of early screening and risk assessment for CHD. A total of 49 490 study subjects from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018 were included. The dataset was randomly divided into training (70%) and testing (30%) sets. The dependent variable (outcome variable) was whether the subjects were informed of a CHD diagnosis, categorizing them into a CHD group and a non-CHD group. We reviewed the literature on risk factors associated with CHD, ultimately including 68 independent variables. The variable characteristics of the study subjects were analyzed, comparing differences between the CHD and non-CHD groups. Machine learning algorithms, specifically random forest (randomForest_4.7-1.1) and XGBoost (xgboost_1.7.7.1) were utilized for variable selection. A comprehensive analysis of the top 10 variables identified by these 2 algorithms were conducted, selecting those mutually recognized by both. A generalized linear model was used to analyze the relationships between variables and CHD, and classical logistic regression was used to construct the CHD risk prediction model. The model's ability to distinguish between CHD and non-CHD individuals was assessed using the area under the receiver operating characteristic curve (AUC); calibration measurements were conducted with the Hosmer-Lemeshow goodness-of-fit test to evaluate the consistency between predicted values and actual CHD proportions; and decision curve analysis was applied to evaluate the clinical benefits of the model's risk prediction. Finally, a nomogram was constructed to visually present the risk scoring of the final model. The mean age of the overall population was (49.53±18.31) years, with males comprising 51.8%. Compared to the non-CHD group, the CHD group was older [(69.05± 11.32) years vs (48.67±18.07) years, P<0.001], had a higher proportion of females (67.1% vs 47.4%, P<0.001), and exhibited statistically significant differences in classical cardiovascular risk factors such as body mass index, systolic blood pressure, diastolic blood pressure, and smoking (all P<0.001). Additionally, there were statistically significant differences in non-classical cardiovascular factors, such as energy intake, vitamins E, vitamin K, calcium, phosphorus, magnesium, zinc, copper, sodium, potassium, and selenium (all P<0.05). Six key variables most associated with CHD occurrence were ultimately identified. The CHD risk prediction model constructed was as follows: logit(p)= -7.783+0.074×age+0.003×creatinine-0.003×platelets+0.257×glycated hemoglobin+0.003× uric acid+0.101×coefficient of variation of red cell distribution width. The model demonstrated excellent discriminative ability in predicting CHD, with an accuracy of 0.712 and an AUC of 0.841. Calibration curves indicated good consistency between predicted probabilities and actual values in both the training and testing sets, demonstrating model stability and reliability. Decision curve analysis suggested that the model provided net benefits across a range of threshold probabilities, supporting its potential application in clinical decision-making. This study successfully identified potential risk factors for CHD using machine learning techniques and developed a concise and practical clinical prediction model. Further prospective clinical cohort studies are needed to validate its potential for clinical application, enabling effective cardiovascular disease prevention and intervention strategies in real-world healthcare settings.

The clinical relevance of the new criteria for cirrhotic cardiomyopathy and future directions.

Cardiac dysfunction in patients with liver disease has been recognized since the 1950s. Initially attributed to shared risk factors, it is now evident that cardiac dysfunction in patients with cirrhosis can occur in the absence of known cardiac, i.e., coronary artery and valvular heart disease, and across all etiologies for cirrhosis. In 1996 this myocardial dysfunction was termed cirrhotic cardiomyopathy (CCM). The pathophysiologic mechanisms underlying CCM include impaired beta-adrenergic membrane function and circulating proinflammatory and cardiotoxic substances. In 2005, the first diagnostic criteria for CCM were introduced enabling greater sensitivity and accuracy of diagnosis. Since 2005, advancements in echocardiographic methods and better understanding of the pathophysiology of cardiac dysfunction in patients with cirrhosis necessitated revision of CCM criteria. Changes in CCM criteria included removal of blunted contractile or heart rate response on stress testing and addition of global longitudinal systolic strain. Refinement of criteria for diastolic dysfunction were also incorporated into the new diagnostic approach. Since 2020, the prevalence of the disorder and clinical considerations for pre-transplant, peritransplant, and post-transplant patients with cirrhosis have been further evaluated and CCM was found to adversely impact clinical outcomes during all three phases of care. Future research considerations should address the timing of universal echocardiographic screening for patients with cirrhosis, utility of biomarkers in aiding CCM diagnosis, impact of CCM on right heart function, and role of anti-remodeling agents post-liver transplant (post-LT).

Doses to the right coronary artery and the left anterior descending coronary artery and death from ischemic heart disease after breast cancer radiotherapy: a case-control study in a population-based cohort.

Doses to the coronary arteries in breast cancer (BC) radiotherapy (RT) have been suggested to be a risk predictor of long-term cardiac toxicity after BC treatment. We investigated the dose-risk relationships between near maximum doses (Dmax) to the right coronary artery (RCA) and left anterior descending coronary artery (LAD) and ischemic heart disease (IHD) mortality after BC RT. In a cohort of 2,813 women diagnosed with BC between 1958 and 1992 with a follow-up of at least 10 years, we identified 134 cases of death due to IHD 10-19 years after BC diagnosis. For each case, one control was selected within the cohort matched for age at diagnosis. 3D-volume and 3D-dose reconstructions were obtained from individual RT charts. We estimated the Dmax to the RCA and the LAD and the mean heart dose (MHD). We performed conditional logistic regression analysis comparing piecewise spline transformation and simple linear modeling for best fit. There was a linear dose-risk relationship for both the Dmax to the RCA (odds ratio [OR]/Gray [Gy] 1.03 [1.01-1.05]) and the LAD (OR/Gy 1.04 [1.02-1.06]) in a multivariable model. For MHD there was a linear dose-risk relationship (1,14 OR/Gy [1.08-1.19]. For all relationships, simple linear modelling was superior to spline transformations. Doses to both the RCA and LAD are independent risk predictors of long-term cardiotoxicity after RT for BC In addition to the LAD, the RCA should be regarded as an organ at risk in RT planning.

Second-Order Motion-Compensated Echo-Planar Cardiac Diffusion-Weighted MRI: Usefulness of Compressed Sensitivity Encoding.

Cardiac diffusion-weighted imaging (DWI) using second-order motion-compensated spin echo (M2C) can provide noninvasive in-vivo microstructural assessment, but limited by relatively low signal-to-noise ratio (SNR). Echo-planar imaging (EPI) with compressed sensitivity encoding (EPICS) could address these issues. To combine M2C DWI and EPCIS (M2C EPICS DWI), and compare image quality for M2C DWI. Prospective. Ten ex-vivo hearts, 10 healthy volunteers (females, 5 [50%]; mean ± SD of age, 25 ± 4 years), and 12 patients with diseased hearts (female, 1 [8.3%]; mean ± SD of age, 44 ± 16 years; including coronary artery heart disease, congenital heart disease, dilated cardiomyopathy, amyloidosis, and myocarditis). 3-T, M2C EPICS DWI, and M2C DWI. The apparent SNR (aSNR) and the rating scores were used to evaluate and compared image quality of all three groups. The aSNR was calculated using , and the myocardium was segmented manually. Three observers independently rated subjective image quality using a 5-point Likert scale. Bland-Altman analysis and paired t-tests. The threshold for statistical significance was set at P < 0.05. In healthy volunteers, the aSNR with a b-value of 450 s/mm2 acquired by M2C EPICS DWI was significantly higher than M2C DWI at in-plane resolutions of 3.0 × 3.0, 2.5 × 2.5, and 2.0 × 2.0 mm2. In patients with diseased hearts, the aSNR ofM2C EPICS DWI was also significantly higher than that for M2C DWI (bias of M2C EPICS-M2C = 1.999, 95% limits of agreement, 0.362 to 3.636; mean ± SD, 7.80 ± 1.37 vs. 5.80 ± 0.81). The ADC values of M2C EPICS was significantly higher than M2C DWI in in-vivo hearts. Over 80% of the images with rating scores for M2C EPICS DWI were higher than M2C DWI in in-vivo hearts. Cardiac imaging by M2C EPICS DWI may demonstrate better overall image quality and higher aSNR than M2C DWI. 2 TECHNICAL EFFICACY: Stage 1.

Opioid Impacts on Cardiovascular Health.

The prevalence of opioid use in the current opioid epidemic era has led to a public health emergency due to the ties to mortality and morbidity. Studies have investigated opioids' impacts on different aspects of cardiovascular health, although there seems to be a lack of a current concise review. Therefore, the aim of this literature review is to provide a summary of the most recent studies from the past decade that postulate a connection between opioids and their impact on cardiovascular health while highlighting conflicting areas among published research. For this literature review, three databases, PubMed (NLM), EMBASE, and Web of Science (Core Collection), were searched for full peer-reviewed articles written in English about human subjects and published between 2013 and 2023 inclusive. The following initial approach was to search for terms in the title of articles: "opioid AND ("vascular" OR "artery" OR "vein" OR "heart rate" OR "infarct" OR "stroke" OR "aortic" OR "cardiovascular disease"). After assessing for duplicate articles from the three databases, the remaining articles were assessed for inclusion eligibility. In the present review, a brief description of the overall role of opioid receptors is provided followed by the literature findings. These findings indicate potentially important negative impacts of opioid use on cardiovascular health in a number of areas. These include opioid-associated increases in the following: (1) vascular aging based on demonstrated increases in arterial stiffness, (2) opioid-related reductions in heart rate variability (HRV) and its implications on morbidity and mortality, (3) opioid's impacts on coronary artery and coronary heart disease (CHD), (4) opioids as a risk factor for atrial fibrillation (AF) and (5) opioid use as a risk factor for vascular occlusion processes. In addition to these broad cardiovascular effects, other aspects of concern are related to the potential impacts of withdrawal from opioid use, which, when done rapidly, are associated with increases in blood pressure and a decrease in HRV.

Statement of Retraction: Two mixed-ligand coordination polymers: treatment activity on coronary artery heart disease by reducing the inflammatory response in the vascular endothelial cells

Statement of Retraction: Two mixed-ligand coordination polymers: treatment activity on coronary artery heart disease by reducing the inflammatory response in the vascular endothelial cells

Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy.

Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Preoperative patient's characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.

Comprehensive analysis of supervised algorithms for coronary artery heart disease detection

AbstractThe mortality rate of cardiovascular disease is increasing at an alarming rate and affects more than 31% of the world's population. The increment in obesity, strain, high blood pressure, concern, high body mass index, depression, high glucose level, and high cholesterol are the key factors that increase the risk of cardiovascular disease. Coronary heart and cerebrovascular diseases cause 80% of cardiovascular diseases with a higher mortality rate, out of which Coronary Artery Heart Disease (CAHD) causes 25% of the fatality. CAHD fatality can be minimized by early diagnosis. However, due to common symptoms of the non‐fatal disease, CAHD is often ignored by the patients and the health care team. In this paper, the authors comprehensively analysed and compared the two supervised Machine Learning models, i.e., Logistic Regression (LR) and XGBoost, for the early diagnosis of CAHD. The models are applied to a benchmark dataset (Statlog heart disease dataset). The model's parameters are also optimized by performing the Random SearchCV hyperparameter tuning. The comprehensive study is performed on both non‐optimized and optimized models as well as compared to the other well‐known existing models. After parametric optimization, both the models exhibit higher accuracy, i.e., LR 87.78% and XGBoost 91.85%, compared to the non‐optimized techniques, i.e., LR = 83.33% and XGBoost = 77.77%.

Coronary artery and congenital heart diseases in adult patients: a case series

Background: The relevance of coronary artery disease treatment in congenital heart disease is related to the increasing number of older patients with congenital conditions, predisposing factors and continuous silent ischemia.Objective: To analyze clinical data and results of surgery in patients with a combination of congenital heart disease and hemodynamically significant coronary artery lesions.Methods: 17 patients (7 women (41.2%), 10 men (58.8%)) were included in the study. All of them underwent myocardial revascularization and congenital heart disease corrective surgery from 2003 to 2020. The mean age at the time of surgery was 57.2 years. The congenital diagnosis was an atrial septal defect (14 patients), partial anomalous pulmonary vein connection (1 patient), recanalization of atrial septal defect (1 patient), recanalization of ventricular septal defect (1 patient). In 7 cases congenital and coronary pathology correction were performed percutaneously — coronary stenting as the first stage, defect closure at an interval of 4 to 10 days as the second. One patient underwent stenting 7 months prior to an open-heart surgery. In 9 cases one-staged open-heart surgery was performed simultaneously. Results: At the hospital 1 patient died after surgery due to multiple organ dysfunction syndrome. In all other cases there were no symptoms of ischemia on discharge, the patients were in NYHA class I–II (New York Heart Association).Conclusion: The tactics of coronary revascularization is determined by the necessity of percutaneous or open-heart intervention. Myocardial revascularization may be preferable as the first stage, or a one-stage correction may be performed and proved by good results. Received 14 October 2022. Revised 25 November 2022. Accepted 27 November 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: A.V. MinaevDrafting the article: A.V. Minaev, A.V. Sobolev, I.V. ZemlyanskayaCritical revision of the article: V.P. PodzolkovSurgical treatment: M.R. Chiaureli, V.N. Cheban, E.P. Golubev, K.V. PetrosyanFinal approval of the version to be published: V.P. Podzolkov, A.V. Minaev, M.R. Chiaureli, V.N. Cheban, E.P. Golubev, K.V. Petrosyan, A.V. Sobolev, I.V. Zemlyanskaya

Diabetes mellitus, coronary artery disease and heart disease (Update 2023)

Diabetes mellitus, cardiovascular disease and heart failure are interacting dynamically. Patients being diagnosed with cardiovascular disease should be screened for diabetes mellitus. Enhanced cardiovascular risk stratification based on biomarkers, symptoms and classical risk factors should be performed in patients with preexisting diabetes mellitus. In patients with previously diagnosed arterosclerotic cardiovascular disease an agent proven to reduce major adverse cardiovascular events or cardiovascular mortality is recommended.

Differential expression and significance of peripheral blood genes in coronary artery heart disease.

BackgroundThe peripheral blood gene expression profile of patients with coronary artery disease (CAD) has not been fully resolved. The aim of this study was to further analyze the peripheral blood transcriptome information of CAD patients and to uncover key genes and regulatory mechanisms in the pathogenesis and disease progression of CAD.MethodsThe Gene Expression Omnibus (GEO) database was applied to screen out differentially expressed genes (DEGs) in the peripheral blood of CAD patients, and the DEGs were subjected to Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA). The core genes were screened by GO, KEGG, and GSEA, and the gene-gene interaction (GGI) and protein-protein interaction (PPI) networks of DEGs were constructed. The GeneCards database was used to obtain CAD-related genes, and the GEO dataset was used to obtain intersecting genes. The intersecting genes were analyzed for bioenrichment and prediction of potential therapeutic agents, and predictive models were constructed for the intersecting genes. Finally, immune infiltrating cells from the GEO dataset were analyzed.ResultsA total of 79 DEGs were screened in the peripheral blood of CAD patients, of which three were autophagy-related genes. Biological enrichment analysis showed that the DEGs were associated with metabolic pathways, and vascular smooth muscle contraction and were mainly involved the MAPK signaling pathway, metabolic pathways, and the PI3K-Akt signaling pathway. The S100A8, ENTPD1, and MMP9 further screened were screened. A total of 11 CAD crossover genes and 75 potential therapeutic agents were obtained, and the column line graph prediction models constructed for S100A8, HSPB1, F5, MMP9, and PDE9A had good predictive power. There were significant differences in immune cells in CAD patients compared to healthy individuals, especially in T cells regulatory (Tregs) and B cells naïve.ConclusionsThe peripheral blood of CAD patients screened by the GEO dataset was significantly different from that of the healthy population, and the DEGs and intersecting genes were involved in numerous key biological processes that may be involved in the development and progression of CAD and could serve as its regulatory sites and therapeutic drug targets.

EVALUATION OF CLINICAL FEATURES AND RISK FACTORS AFFECTING BLEEDING IN PATIENTS WITH GASTROINTESTINAL ANGIODYSPLASIA

AIM: The aim of the study was to evaluate the clinical features and risk factors affecting bleeding in patients with angiodysplasia.&#x0D; MATERIA L AND METHOD: This retrospective study was conducted between January 2016 and December 2019, and included patients who underwent endoscopy/colonoscopy examination for any reason at two institutions (n=2177). Patients with angiodysplasia were divided into two groups according to their bleeding status, and their clinical features and risk factors affecting bleeding were analyzed.&#x0D; RESULTS: Angiodysplasia was detected in 44 (2.02%) patients who underwent endoscopy and colonoscopy. Bleeding was detected in 25% (n=11) of patients with angiodysplasia. Warfarin use frequency (p=0.016) and heart disease frequency (p=0.008) were higher in patients with angiodysplasia with bleeding. Hemoglobin (p=0.001), hematocrit (p &lt; 0.001), platelet levels (p=0.009) and total iron binding capacity (p=0.036) were found to be significantly lower in patients with bleeding angiodysplasia. It was found that patients using warfarin had a 12.917-fold higher risk of bleeding than nonusers (OR:12.917, 95%CI: 2.014-82.830, p=0.007). Bleeding was not associated with age (p=0.196), gender (p=0.326), number of lesions (p=0.063), gastric lesion (p=0.880), duodenal lesion (p=0.472), colonic lesion (p=0.947), size of lesion (p=0.789), nonsteroidal anti-inflammatory drugs use (p=0.631), hypertension (p=0.163), cirrhosis (p=0.179), coronary artery disease (p=0.448) and heart diseases (p=0.207).&#x0D; CONCLUSION: The use of warfarin increases the risk of bleeding in patients with gastrointestinal angiodysplasia. Risk factors affecting bleeding in patients with gastrointestinal angiodysplasia need to be evaluated in comprehensive prospective studies.

Heart surgery and simultaneous carotid endarterectomy - 10-years single-center experience.

Patients with coronary artery heart disease frequently suffer concomitant carotid vascular disease and are at high perioperative risk for neurological adverse events. Several concepts regarding the timing and modality of carotid revascularization are controversially discussed in patients with heart disease. Current guidelines recommendations on myocardial revascularization recommend a concomitant carotid endarterectomy (CEA) in patients with a history of stroke/transient ischemic attack (TIA) or 50-99% grade of the carotid stenosis. Our study aimed to analyze early outcome parameters of patients undergoing coronary artery bypass grafting (CABG), but also including concomitant heart valve surgery and simultaneous CEA. This study retrospectively analyzed a cohort of 111 patients from our institutional database undergoing heart surgery with CABG or heart-valve surgery between 2010 and 2020 with concomitant carotid surgery due to significant carotid stenosis. Patients undergoing heart and simultaneous carotid surgery were 77 ± 8.0 years of age with a body mass index of 28 ± 1.7kg/m2 and a mean EuroSCORE II of 6.5 ± 2.3. Most patients (61%) had a smoking history and arterial hypertension (97%). The preoperative mean grade of internal carotid stenosis was 87 ± 4.2%, 13% of patients suffered from internal carotid artery stenosis on both sites. In total, 4.5% of patients had previously undergone internal carotid artery intervention before and 6.3% had a history of stroke with a persistent neurologic disorder in 1.8%, 8.9% of cases had prior TIA. Thirty-day all-cause mortality was 6.3% and postoperative neurologic events occurred with 7.2% TIA and 4.5% of disabling stroke. Within the reported patient population of coronary artery heart disease and significant internal carotid stenosis, a one-time approach with CABG or heart-valve surgery and CEA is safe and feasible as justified by clinical and neurological postoperative outcomes.

Prevalence of myocarditis, genetic cardiomyopathies and their combinations among patients of the Cardiology Hospital of the V.N. Vinogradov Faculty Therapeutic Clinic of the Sechenov University

Aim. To establish the prevalence of myocarditis and primary (genetic) cardiomyopathies (CMP) among patients in a cardiology hospital.Material and methods. Medical records of 671 patients of the cardiology department were analyzed. The diagnosis at admission and at discharge was recorded. The diagnoses were divided into 7 following categories: hypertension, coronary artery disease, heart disease, idiopathic arrhythmias, cardiomyopathy, myocarditis and others. Types of myocarditis and cardiomyopathy, the presence of arrhythmias and heart failure were also recorded.Results. Myocarditis was diagnosed in 194 (28,9%) patients, cardiomyopathy — in 76 (11,3%) patients, combination of cardiomyopathy and myocarditis — in 26 (3,9%) patients. Myocarditis with the development of arrhythmia and heart dilatation prevailed as follows: 47,4 and 41,2%, respectively. The most numerous CMPs were left ventricular noncompaction (n=30), non-inflammatory dilated CMP (n=13), hypertrophic CMP (n=10) and arrhythmogenic CMP of the right ventricle (n=9). In the group with idiopathic arrhythmias, 64,3% of patients were diagnosed with myocarditis, and 19,4% — with cardiomyopathy.Conclusion. The prevalence of non-coronary myocardial diseases among patients in a cardiology hospital is high and amounts to 40,2%. The presence of arrhythmias, heart failure or dilated cardiomyopathy may be a manifestation of non-coronary myocardial diseases, and requires a comprehensive examination aimed, in particular, at ruling out or verifying the diagnosis of myocarditis.

Discovery of Novel Small Molecule Inhibitors Disrupting the PCSK9-LDLR Interaction.

Proprotein convertase subtilisin kexin 9 (PCSK9) has been identified as a reliable therapeutic target for hypercholesterolemia and coronary artery heart diseases since the monoclonal antibodies of PCSK9 have launched. Disrupting the protein-protein interaction (PPI) between PCSK9 and the low-density lipoprotein receptor (LDLR) has been considered as a promising approach for developing PCSK9 inhibitors. However, PPIs have been traditionally considered difficult to target by small molecules since the PPI surface is usually large, flat, featureless, and without a "pocket" or "groove" for ligand binding. The PCSK9-LDLR PPI interface is such a typical case. In this study, a potential binding pocket was generated on the PCSK9-LDLR PPI surface of PCSK9 through induced-fit docking. On the basis of this induced binding pocket, virtual screening, molecular dynamics (MD) simulation, and biological evaluations have been applied for the identification of novel small molecule inhibitors of PCSK9-LDLR PPI. Among the selected compounds, compound 13 exhibited certain PCSK9-LDLR PPI inhibitory activity (IC50: 7.57 ± 1.40 μM). The direct binding affinity between 13 and PCSK9 was determined with a KD value of 2.50 ± 0.73 μM. The LDLR uptake function could be also restored to a certain extent by 13 in HepG2 cells. This well-characterized hit compound will facilitate the further development of novel small molecule inhibitors of PCSK9-LDLR PPI.

Factors determining blood transfusion in patients undergoing off pump coronary artery bypass graft (OPCABG) surgery: A prospective cross-sectional study

Cardiovascular disease, especially coronary heart disease is increasing to a great extent globally and in India. Off pump Coronary artery bypass graft is one of the surgical modalities in the treatment of Coronary artery heart disease. Blood/ blood component transfusion is one of the essential roles during/immediate postoperative period of off pump coronary artery bypass graft surgery. Though there are few benefits due to blood transfusion, the demerits outweigh the merits of blood transfusion. Hence identification of predisposing factors for need of blood /blood component transfusions will enhance us to understand the indications and the ways to minimize it.To determine the predisposing factors that influence the need for blood transfusion during off pump coronary artery bypass graft and to measure their strength of association.This cross-sectional study was done in a tertiary care cardiac center in India between March and September 2016 on 196 patients. The participants were from both sexes, aged between 40-70 years, undergoing elective or emergency OPCABG under general anaesthesia. Information on Demographic data and comorbid illnesses were elicited. Vitals and other hemodynamic parameters were recorded during preoperative, intra operative and post operative periods. Total amount of anticoagulant (heparin) used, activated clotting time (ACT) after 3 minutes of anticoagulation, total duration of graft harvest (time from start of first graft harvesting to end of last graft harvest), total number of grafts taken, total duration for anastamoses (time from start of anastamosis to end of last graft anastamosis), total blood loss and total amount of blood transfused were noted.The intra-operative factors included total intra-operative heparin used, total protamine used, total number of grafts used for anastamoses, total duration of graft anastamoses, total duration of surgery, total duration of anaesthesia, total intra-operative blood loss and insertion of IABP intra-operatively. The post operative factors included total amount of postoperative blood loss and post operative insertion of IABP. Multivariate analysis of significant factors showed male gender, preoperative anaemia and total duration of surgery were independent predictors of need of blood and blood product transfusion.Prior identification of risk factors and correction of them if applicable would help to assess and manage preoperatively and also thereby reduce the need for blood transfusions and help in managing optimal utilization of resources.

RETRACTED ARTICLE: Two mixed-ligand coordination polymers: treatment activity on coronary artery heart disease by reducing the inflammatory response in the vascular endothelial cells

We, the Editors and Publisher of the journal of Inorganic and Nano-Metal Chemistry have retracted the following article: Guang-Lian Wen, Shi-Qing Liu & Meng Li. Two mixed-ligand coordination polymers: treatment activity on coronary artery heart disease by reducing the inflammatory response in the vascular endothelial cells, Inorganic and Nano-Metal Chemistry, 2021, DOI: 10.1080/24701556.2021.1966445 Since publication, significant concerns have been raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors did not provide their original data or any necessary supporting information. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article. The corresponding author listed in this publication has been informed. We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

Analysis on the diagnosis and treatment of necrotizing fasciitis complicated with sepsis

To recognize the characteristics of necrotizing fasciitis patients complicated with sepsis and summarize the experience the treatment. A retrospective study was conducted. The clinical data of 57 patients with necrotizing fasciitis complicated with sepsis admitted to Guangdong Provincial People's Hospital from July 2009 to December 2019 was analyzed by collecting such factors as gender, age, complications, infection sites, pathogens, surgery information, treatment options and outcome. The patients were divided into debridement group (n = 14) and control group (n = 43) according to whether the debridement was completed within 48 hours of admission, and the mortality during hospitalization between the two groups was compared. A telephone follow-up had been done to record the long-term outcome of these patients. Among 57 patients with necrotizing fasciitis complicated with sepsis, there were 43 males and 14 females with the average age of (57.9±12.1) years old. Most of the underlying diseases were diabetes mellitus (70.17%), other diseases included hypertension (8.77%), tumor chemotherapy (7.02%), liver disease (hepatitis, cirrhosis, 7.02%), coronary artery heart disease (3.51%), systemic lupus erythematosus (3.51%), etc. Most of the infection site was lower limbs (71.93%). There were 78 pathogens cultured in 57 patients, in which 52 were non-drug resistant bacteria (66.67%), and 26 were drug resistant bacteria (33.33%). There were 40 Gram positive (G+) bacteria (51.28%), 29 Gram negative (G-) bacteria (37.18%), 8 fungi (10.26%) and 1 mixed bacteria (1.28%). Finally, of 57 patients, 46 patients were cured, and 11 patients died with hospital mortality of 19.30%. Among 57 patients, the hospital mortality in the debridement group was significantly lower than that in the control group [0% (0/14) vs. 25.58% (11/43), P < 0.05]. Among the 46 cured patients, 11 had accepted amputations, accounting for 23.91%. In December 2020, 43 patients who were cured (3 patients were lost to follow-up) were followed up by telephone. Twenty-three patients were completely self-care, 9 patients were partly self-care, 8 patients were completely unable to take care of themselves, and 3 patients died. Necrotizing fasciitis with sepsis mostly occurs in people with weakened immunity, and has a high mortality and disability rate. Early identification and active surgical debridement may be the key to improve the treatment effect.