Complications Of Ischemic Heart Disease Research Articles

P19 INCIDENTAL DIAGNOSIS OF MASSIVE MOBILE LEFT VENTRICLE THROMBI FOLLOWING COVID–19 INFECTION IN A HEART FAILURE PATIENT

Abstract Background Intracardiac thrombus can be a complication of ischemic heart disease and cardiomyopathies. The advancements in imaging modalities have increased the capacity to diagnose this condition helping to reduce the associated complications (i.e. embolization). Previous reports suggest a possible link between intracardiac thrombosis and COVID–19 infection, especially in patients with severe “endotheliitis”, pneumonia, or myocarditis. COVID–19 effects on the cardiovascular system are partly evaluated. Venous and arterial thrombosis is commonly associated with COVID–19 but detection of intracardiac thrombus has not been frequently reported. Case Description: A 71–year–old woman, known to have a non–ischemic dilated cardiomyopathy with reduced ejection fraction (EF) and a previous transcatheter edge–to–edge mitral valve repair (MitraClip), was admitted after a routine echocardiogram showing new onset multiple, highly mobile, left ventricle (LV) masses. The patient, fully vaccinated against Sars–Cov–2, experienced a paucisymptomatic COVID–19 infection 1 month before, followed by a full recovery. A transthoracic echocardiogram performed 3 months showed no LV masses. On admission she was completely asymptomatic with no clinical signs of heart failure or systemic embolization. A multimodality imaging evaluation (contrast echocardiography, cardiac computed tomography, cardiac magnetic resonance) confirmed a severe dilation of the LV with severe EF reduction, and 3 mobile LV masses. The largest mass was adhered to the middle portion of the anterolateral wall (maximum diameter 49x15 mm). A diagnostic endomyocardial biopsy and cardiac surgery were excluded due to prohibitive embolic/procedural risk and an anticoagulant treatment with warfarin was started with a progressive reduction of the masses’ dimension at transthoracic echocardiography. Thus, a diagnosis of exclusion of LV thrombosis was made. After 2–week a complete resolution of the masses was documented with no clinical or embolic events. Conclusion The pro–thrombotic nature of COVID–19 infection is well known. This case demonstrates how vulnerable patients, i.e. those with heart failure, may experience thrombotic complications following non–severe COVID–19 infection and despite having completed the vaccine course. Although currently unconfirmed by dedicated clinical trials, more assiduous echocardiographic monitoring and/or the use of anticoagulant therapies could yield a benefit in selected patients.

Sodium-glucose cotransporter 2 inhibitors in Asian patients with heart failure.

To the Editor: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are recognized as one of the essential drugs for the treatment of heart failure (HF). Recent randomized controlled trials (RCTs) have shown that the SGLT-2 inhibitors significantly reduced the occurrence of HF hospitalizations or cardiovascular mortality in HF patients.[1–3] In addition, a comprehensive meta-analysis confirmed that SGLT-2 inhibitors improve the prognosis of patients with HF regardless of left ventricular ejection fraction.[4] However, the analysis by race is not highlighted in this meta-analysis. Since some studies have suggested a poorer prognosis for HF patients in Asia compared to those in Western countries,[5–7] we hypothesized that SGLT-2 inhibitors would have different efficacy in Asians compared to Western HF patients. Therefore, we performed a meta-analysis to elucidate the effectiveness of SGLT-2 inhibitors for Asian HF patients. We analyzed three large-scale RCTs (>1000 patients), having data of sub-analysis stratified by race (Asian, white and black).[1–3] A total of 13,857 patients with HF, including 2612 (19%) Asian, 10,504 (76%) white, and 741 (5%) black patients, were analyzed. Two studies used empagliflozin,[1,3] and one used dapagliflozin.[2] The hazard ratio (HR) for the primary endpoint (composite of cardiovascular death and hospitalization for HF) was pooled using the random-model generic inverse variance method after logarithm conversion (RevMan ver 5.4. Cochrane Collaboration, London, UK). Figure 1 demonstrates the comparison of HR for the primary endpoint. Treatment with SGLT-2 inhibitors resulted in a significant reduction in the primary endpoint in Asian (HR: 0.62, 95% confidence interval [CI]: 0.51–0.74, P <0.001, I2 = 0, P for heterogeneity = 0.83), White (HR: 0.82, 95% CI: 0.75–0.90, P <0.001, I2 = 0, P for heterogeneity = 0.56), and Black (HR: 0.58, 95% CI: 0.43–0.78, P <0.001, I2 = 0, P for heterogeneity = 0.44). The effect of the SGLT-2 inhibitor was higher in Asian HF patients than in white HF patients (P = 0.006) and similar to black HF patients (P = 0.74) [Figure 1].Figure 1: The HR of composite cardiac events across the races (Asian, white and black). CI: Confidence interval; HF: Heart failure; HR: Hazard ratio; SGLT-2: Sodium-glucose cotransporter 2. SE: Standard error.Approximately 60% of the world's population lives in Asian countries, but the information is limited regarding the characteristics and outcomes of Asian HF patients. Several studies indicated the difference in prognosis between Asian and Western countries. Dewan et al[5] examined the prognosis of 13,174 patients with HF with reduced ejection fraction and have shown the differences in the characteristics of HF patients in Asia and Western countries. For example, Asian HF patients are younger, have lower BMI, and have a lower prevalence of hypertension and diabetes. The low prevalence of chronic obstructive pulmonary disease, kidney disease, and atrial fibrillation is also intriguing. In addition, there was a generally low trend for complications of ischemic heart disease, although there was regional variation. In Asia, the use of diuretics and devices decreased while the use of digoxin increased. Most notably, there are differences in prognosis, with Asia having a higher incidence of cardiovascular death/HF hospitalization than Western countries (China 14.9; Western Europe 10.4; North America 12.8 per 100 patient-years).[5] The ATTEND Registry[8] (registry from Japan) revealed that the in-hospital mortality rate of HF patients was 6.4%, which was slightly higher than that reported in the ADHERE (4.0%)[9] and OPTIMIZE-HF (3.8%)[10] (both registries from the USA). The causal relationship between these differences in background factors and prognosis is unclear. In light of this, we hypothesized that the prognostic efficacy of SGLT-2 inhibitors may differ in Asian populations versus Western populations. In our analysis, we have shown that the favorable effects of SGLT-2 inhibitors are significantly higher in Asian HF patients than in white HF patients. This finding may provide hope for improving the prognosis of Asian HF patients, who have a higher risk of death than HF patients in Western countries. Future RCTs focusing on the Asian population were required to confirm the efficacy of SGLT-2 inhibitors. Funding The study was supported by a grant from the Research Grant, Japan Society for the Promotion of Science: Grant-in-Aid for Early-Career Scientists(C).

Blood Count-Derived Inflammatory Markers and Acute Complications of Ischemic Heart Disease in Elderly Women.

Coronary artery disease (CAD) in women occurs later than in men. Underlying atherosclerosis, a chronic process of lipoprotein deposition in arterial walls with a prominent inflammatory component, is influenced by several risk factors. In women, commonly used inflammatory markers are generally found to be related to the occurrence of acute coronary syndrome (ACS), as well as the development of other diseases that influence CAD. New inflammatory markers derived from total blood count-systemic inflammatory response index (SII), systemic inflammatory reaction index (SIRI), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR)-were analyzed in the group of 244 elderly, postmenopausal women with the diagnosis of ACS or stable CAD. SII, SIRI, MLR, and NLR were significantly higher in women with ACS compared to those with stable CAD (p < 0.05 for all)-the highest values were observed in women with NSTEMI. MLR from new inflammatory markers, HDL, and history of MI turned out to be significant factors associated with ACS. These results suggest that MLR as representative of blood count-derived inflammatory markers may be considered as additional CVD risk factors in women with suspected ACS.

Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Monash University Malaysia Background Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD. Purpose This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (&amp;lt;10 years vs. ≥10 years) Materials and Methods A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist. Results A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having &amp;lt;10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=&amp;lt;0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=&amp;lt;0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=&amp;lt;0.001] compared to those with &amp;lt;10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016]. Conclusion IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.

The Association between Serum Vitamin D Concentration and New Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response (SIRI)-In Patients with Ischemic Heart Disease.

The incidence of ischemic heart disease (IHD) increases every year. This cardiovascular disease has an inflammatory factor in its etiology due to different immune cells that influence atherogenesis. New inflammatory biomarkers—the Systemic Inflammatory Index (SII) and the Systemic Inflammatory Response (SIRI)—attempt to describe the pro- and anti-inflammatory balance and quantify the complex impact of the immune system on atherosclerosis, while vitamin D has a multidirectional impact on the human body, including the cardiovascular and immune systems. Hence, the objective of this research was to analyze the association between SII and SIRI and serum vitamin D concentrations in patients with IHD. A significant correlation was observed between SIRI and 25(OH)D in the whole group and between both biomarkers (SII and SIRI) and 25(OH)D in the group of patients with ACS but not in the group of patients with stable IHD. The role of vitamin D in IHD complications and its association with new inflammatory biomarkers requires further well-designed, large-scale research.

Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect.

Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial infarction (AMI), leading to decreased frequency of mechanical complications. Improvements in both techniques and technology have permitted select patients to be managed with a purely percutaneous, transcatheter strategy. Through systematic review, this study aims to synthesise the collective experience of percutaneous treatment of the mechanical complications of ischaemic heart disease. The search strategy queried the electronic databases PubMed, Embase and the Cochrane Central Register of Controlled Trials, from 1 January 2000 to 31 December 2020. Studies highlighting the outcomes of patients receiving percutaneous treatment of post-myocardial infarction papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and pseudoaneurysm (PA) were included. A qualitative review of studies was conducted for PMR, FWR and PA. A quantitative analysis was conducted for VSD. Fifteen studies were included in the qualitative synthesis of the percutaneous management of PMR, 4 were included in the qualitative analysis of the percutaneous management of left ventricular FWR, 7 studies defined the outcomes of the percutaneous management of PA and 25 were included in the quantitative meta-analysis of the primary percutaneous management of post-MI VSD. For VSD, there were 43 failed procedures in 314 patients. The proportion of failed procedures was 15.9% and there were 174 deaths in 428 patients. 37.5% of patients experienced early mortality. Although surgical techniques remain the gold standard, we have shown that percutaneous management may be a viable option in certain cases.

Pathophysiology and Treatment of Diabetic Cardiomyopathy and Heart Failure in Patients with Diabetes Mellitus.

There is a close relationship between diabetes mellitus and heart failure, and diabetes is an independent risk factor for heart failure. Diabetes and heart failure are linked by not only the complication of ischemic heart disease, but also by metabolic disorders such as glucose toxicity and lipotoxicity based on insulin resistance. Cardiac dysfunction in the absence of coronary artery disease, hypertension, and valvular disease is called diabetic cardiomyopathy. Diabetes-induced hyperglycemia and hyperinsulinemia lead to capillary damage, myocardial fibrosis, and myocardial hypertrophy with mitochondrial dysfunction. Lipotoxicity with extensive fat deposits or lipid droplets is observed on cardiomyocytes. Furthermore, increased oxidative stress and inflammation cause cardiac fibrosis and hypertrophy. Treatment with a sodium glucose cotransporter 2 (SGLT2) inhibitor is currently one of the most effective treatments for heart failure associated with diabetes. However, an effective treatment for lipotoxicity of the myocardium has not yet been established, and the establishment of an effective treatment is needed in the future. This review provides an overview of heart failure in diabetic patients for the clinical practice of clinicians.

A case of acute ischemic stroke during treatment of left ventricular thrombus

Left ventricular (LV) thrombus is one of complication of ischemic heart disease like acute myocardial infarction and is associated with systemic thromboembolism including ischemic stroke. If an LV thrombus is detected, anticoagulation is essential to prevent systemic thromboembolism. Paradoxically, we report a patient with acute ischemic stroke during anticoagulation treatment of LV thrombus.

Verapamil Alleviates Myocardial Ischemia/Reperfusion Injury by Attenuating Oxidative Stress via Activation of SIRT1.

Myocardial ischemia/reperfusion (I/R) injury is a potential complication of ischemic heart disease after recanalization. One of the primary reasons for I/R injury is the excessive accumulation of reactive oxygen species (ROS) in cardiomyocytes. Verapamil, a classic calcium channel blocker, has the potential to mitigate I/R-evoked oxidative stress. However, the underlying mechanisms have not been fully elucidated. SIRT1 is an essential regulator of I/R and offers resistance to oxidative stress arising from I/R. It is still inconclusive if verapamil can reduce myocardial I/R-triggered oxidative damage through modulating SIRT1 antioxidant signaling. To verify our hypothesis, the H9c2 cardiomyocytes and the mice were treated with verapamil and then exposed to hypoxia/reoxygenation (H/R) or I/R in the presence or absence of the SIRT1 inhibitor EX527. As expected, verapamil stimulated SIRT1 antioxidant signaling evidenced by upregulation of SIRT1, FoxO1, SOD2 expressions and downregulation of Ac-FoxO1 expression in vitro and in vivo. In addition, verapamil remarkably suppressed H/R and I/R-induced oxidative stress proven by declined ROS level and MDA content. The cardioprotective actions of verapamil via SIRT1 were further confirmed in the experiments with the presence of the specific SIRT1 inhibitor EX527. We demonstrated that verapamil alleviated myocardial I/R-evoked oxidative stress partially via activation of SIRT1 antioxidant signaling. Subsequently, verapamil protected against cardiac dysfunction and myocardial infarction accompanied by oxidative stress.

Mitochondrial DNA polymorphism and myocardial ischemia: Association of haplogroup H with heart failure

The pathogenesis of atherosclerosis and ischemic heart disease is associated with oxidative stress and mitochondrial dysfunction. Mitochondrial DNA encodes subunits of mitochondrial respiratory chain and is highly polymorphic in human populations. Mitochondrial DNA can be considered a candidate genetic locus for predisposition to cardiovascular diseases.Aim. To analyze the associations of the mitochondrial genome polymorphism and chronic heart failure in ischemic heart disease.Material and Methods. The study included two groups of individuals: patients with a combination of ischemic heart disease and chronic heart failure (n = 175) and a population sample of residents of Tomsk (n = 424). Percentages of patients with chronic heart failure of NYHA classes II, III, and IV were 37%, 50%, and 13%, respectively. All patients underwent echocardiographic examination; body mass index and the lipid fractions in blood serum were determined. The average was 55.4 years in patients and 47.6 years in the population sample. Polymorphism of mtDNA was studied by sequencing the hypervariable segment of D-loop of mtDNA and subsequent classification of mtDNA haplotypes into the known haplogroups. The mtDNA haplogroup frequencies were compared between the samples using the Chi-square test. The associations of genotype with quantitative trait variability were analyzed by variance analysis.Results. Male patients showed a higher frequency of haplogroup H compared to the population (45.86% in patients and 35.4% in population) and a higher total frequency of haplogroup H subgroups except the most frequent subgroup H1 (36.94% and 25.22%, respectively). The values of significance level (p-value) and odds ratio (OR) were determined as follows: p = 0.04; odds ratio OR = 1.55 (95% confidence interval (CI) 1.02–2.34) for haplogroup H as a whole; p = 0.02; OR = 1.74 (95% CI 1.12–2.70) for haplogroup H without subgroup H1. Analysis of quantitative traits revealed the associations of the same genetic marker (mtDNA haplogroup H) with the levels of high-density lipoproteins (p = 0.03) and triglycerides (p = 0.02) in blood serum of men in the population sample.Conclusion. The obtained results suggested that the most frequent European mtDNA haplogroup H may be a risk factor for the complications of ischemic heart disease in men.

Clinical, Electrocardiographic and Echocardiographic Profile of Ischemic Cardiomyopathy: An analysis of 100 cases.

Background: Ischemic heart disease (IHD) is one of the leading cause of morbidity and mortality worldwide. Ischemic cardiomyopathy (ICM) is a delayed complication of IHD that arises as dilated cardiomyopathy with depressed ventricular function, which cannot be attributed entirely to coronary artery obstruction or ischemic injury.&#x0D; Objectives: To evaluate the clinical, electrocardiographic and echocardiographic profile of patients presenting with ischemic cardiomyopathy. Methods: In this cross sectional observational study 100 patients of ischemic cardiomyopathy admitted in hospital or visited OPD in NICVD, Dhaka from March’15 to Sept’15 were studied. Enrollment of the patients were done after fulfilling the inclusion and exclusion criteria. Clinical, electrocardiographic and echocardiographic data were collected then data analysis was done.&#x0D; Results: Data analysis of 100 patients was showed age range was 40-80 years and mean age was 61.4±7.9 years. 79% subjects were male. Most common symptoms were dyspnea (93%), chest pain(73%), palpitation (39%) and edema (23%). Most patients were in NYHA functional class lV (43%). 64% cases had history of anterior myocardial infarction (MI), 22% had inferior MI, 25% had H/O PTCA and 7% had CABG. 71% subjects had tachycardia, 65% had lungs basal rales, 56% had systolic blood pressure below 100 mmhg and 25% had edema. ECG findings was as follows sinus rhythm (85%), Sinus tachycardia 71%, AF 15%, LBBB 34%, RBBB 12%, pathological Q in anterior surface 65% and inferior surface 21%, non specific ST-T changes 41% and PVCs was found in 17%.On echocardiography ,anterior wall hypokinesia was seen in 52% and global hypokinesia in 43%. Mean left ventricular ejection fraction (LVEF) was 31±5.9% and mean left ventricular internal diastolic diameter (LVIDd) was 6.5±0.4 cm. (59%) subjects had mitral regurgitation (MR) grade-l and 20% had MR grade-ll.&#x0D; Conclusion: The clinical presentation of ischemic cardiomyopathy varies from patient to patient. Severity of symptoms correlates with severity of left ventricular systolic dysfunction, left ventricular diameter and mitral regurgitation grade . Anterior Myocardial infarction has more chance to develop ischemic cardiomyopathy.&#x0D; Bangladesh Heart Journal 2020; 35(2) : 121-127

Cardiovascular Complications after Open-Heart Surgery

Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. Open refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart. This surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting) to correct congenital heart disease or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.

Possible Effect of CABG on Moderate Mitral Regurgitation

Introduction: Mitral valve insufficiency in adults is often a complication of ischemic heart disease. Coronary artery bypass grafting (CABG) is performed as a strategy for the treatment of coronary artery disease. The aim of this study was to evaluate mitral regurgitation (MR) before and after CABG. Materials and Methods: This Experimental study was conducted on 100 patients who underwent CABG in University Hospitals of Tehran, Iran, from 2009 to 2013. Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Chicago, IL) for Windows was used for data analysis.. Results: Out of 100 patients (i.e., 60 males and 40 females) with the mean age of 64.97±10.64 years, 11 males (18.3%) and 12 females (30.0%) were identified with MR +2 after the surgery. There was no significant relationship between renal insufficiency and MR before the operation (P= 0.370). Furthermore, in patients with and without renal insufficiency, 2 (50.0%) and 21 (21.9%) subjects were identified with MR +2 after the operation, respectively. Out of 100 patients, 75 (75%) cases with MR +2 before the surgery were identified with MR +1 after the operation. Moreover, 23 (23%) subjects with MR +2 before the surgery were still reported with MR +2 after the operation. In this regard, there was a significant relationship before and after the surgery in MR severity (P=0.02). Conclusion: It is necessary to have sufficient knowledge of the risk factors in dealing with MR for the determination of the best therapy.

COMPARATIVE STUDY OF LEVELS OF SELECTIVE OXIDATIVE STRESS MARKERS (MALONDIALDEHYDE, ZINC, AND ANTIOXIDANT VITAMINS A, E, AND C) IN ISCHEMIC AND NON-ISCHEMIC HEART DISEASE PATIENTS SUFFERING FROM TYPE- 2 DIABETES

Objective: The objective of the current study is to compare the levels of oxidative stress markers malondialdehyde (MDA), zinc, and antioxidant Vitamins (A, E, and C) in ischemic heart disease (IHD) and non-IHD patients with diabetes mellitus.Method: This is cross-sectional study group, conducted in the advanced diagnostic center (Khartoum- Sudan) from the period May 2013 to August 2015. Comprised 100 healthy subjects were, control group with mean (fasting blood sugar) 5.61=m mol/L, the age ranged from 22 to 78 years old, the average of the age was 50.1 years. 300 patients (78 IHD and 222 without) as cases groups, the ages ranged from 30 to 80 years. The age average was 51.2 years, all samples were in a state of fasting for 12 h, and the data were collected using a structured questionnaire and direct interview to collect information. Blood specimens were collected from both groups, and plasma levels of MDA, zinc, and antioxidant Vitamins (A, E, and C) were determined.Results: There was a significant difference between the level of serum Vitamin A, E, and MDA in diabetic patients with IHD and those diabetic without IHD (p&lt;0.05). No significant differences in serum Vitamin C level between both groups (p&gt;0.05).Conclusion: Due to the significant differences in serum Vitamin A, E, Zinc, and MDA between diabetics with IHD and diabetics without IHD, these parameters can be used as prognostic markers for prediction of oxidative stress and antioxidant stress of diabetic patients with IHD complications.

Gastrin Protects Against Myocardial Ischemia/Reperfusion Injury via Activation of RISK (Reperfusion Injury Salvage Kinase) and SAFE (Survivor Activating Factor Enhancement) Pathways.

BackgroundIschemia/reperfusion injury (IRI) is one of the most predominant complications of ischemic heart disease. Gastrin has emerged as a regulator of cardiovascular function, playing a key protective role in hypoxia. Serum gastrin levels are increased in patients with myocardial infarction, but the pathophysiogical significance of this finding is unknown. The purpose of this study was to determine whether and how gastrin protects cardiac myocytes from IRI.Methods and ResultsAdult male Sprague‐Dawley rats were used in the experiments. The hearts in living rats or isolated Langendorff‐perfused rat hearts were subjected to ischemia followed by reperfusion to induce myocardial IRI. Gastrin, alone or with an antagonist, was administered before the induction of myocardial IRI. We found that gastrin improved myocardial function and reduced the expression of myocardial injury markers, infarct size, and cardiomyocyte apoptosis induced by IRI. Gastrin increased the phosphorylation levels of ERK1/2 (extracellular signal‐regulated kinase 1/2), AKT (protein kinase B), and STAT3 (signal transducer and activator of transcription 3), indicating its ability to activate the RISK (reperfusion injury salvage kinase) and SAFE (survivor activating factor enhancement) pathways. The presence of inhibitors of ERK1/2, AKT, or STAT3 abrogated the gastrin‐mediated protection. The protective effect of gastrin was via CCK2R (cholecystokinin 2 receptor) because the CCK2R blocker CI988 prevented the gastrin‐mediated protection of the heart with IRI. Moreover, we found a negative correlation between serum levels of cardiac troponin I and gastrin in patients with unstable angina pectoris undergoing percutaneous coronary intervention, suggesting a protective effect of gastrin in human cardiomyocytes.ConclusionsThese results indicate that gastrin can reduce myocardial IRI by activation of the RISK and SAFE pathways.

Ovine Model of Ischemic Mitral Regurgitation.

Ischemic mitral regurgitation (IMR) is a common complication of ischemic heart disease that doubles mortality after myocardial infarction and is a major driving factor increasing heart failure. IMR is caused by left ventricular (LV) remodeling which displaces the papillary muscles that tether the mitral valve leaflets and restrict their closure. IMR frequently recurs even after surgical treatment. Failed repair associates with lack of reduction or increase in LV remodeling, and increased heart failure and related readmissions. Understanding mechanistic and molecular mechanisms of IMR has largely attributed to the development of large animal models. Newly developed therapeutic interventions targeted to the primary causes can also be tested in these models. The sheep is one of the most suitable models for the development of IMR. In this chapter, we describe the protocols for inducing IMR in sheep using surgical ligation of obtuse marginal branches. After successful posterior myocardial infarction involving posterior papillary muscle, animals develop significant mitral regurgitation around 2months after the surgery.

Nonfasting Apo-lipoprotein B and Triglyceride levels as a predictor of coronary heart disease in Type II diabetic patients.

Background & Objectives:Lipoprotein-A has been recognized as a risk factor for ischemic heart diseases. Myocardial infarction (MI) is common complication of ischemic heart disease. Diabetes play an incremental role in the development of coronary artery disease (CAD), however still there are conflicting data regarding the relationship of Lipoprotein-B and MI. We therefore wanted to evaluate the relationship of Lipo-B, MI and diabetes mellitus. Our objective was to determine the non-fasting Apo-lipoprotein B and triglycerides level among type II diabetic patients with ischemic heart disease and to compare with type II diabetic without ischemic heart disease.Methods:This was cross sectional study where two groups of patients were recruited in the study, Group-I included patient with Ischemic Heart Disease and diabetes while Group-II comprised of diabetes without Ischemic Heart Disease. Age, sex and basic demographic matching was done between the two groups. Data were collected using random sample. The comparative approach was used to see the role of diabetes in the elevation of Apo-lipoprotein B level, which is a risk factor for Ischemic heart diseases.Results:Two hundred forty eight patients (Cases: 123 Diabetic with myocardial infarction and (Control: 125 Diabetic without myocardial infarction) were included in the study. Mean Apo-B among diabetic patients with myocardial infarction was high (68.3±24.23 ng/ml) compared to non-cardiac patients (49.97±33.880 ng/ml) with a p <0.000. Marked difference was also observed in triglycerides levels where it was found very high (301.4±55.1 mg/dL) in patients of diabetes with myocardial infarction as compared to subjects without MI (137.7±84.7 mg/dL). There was positive correlation between Apo-lipoprotein and Triglycerides (P value=039).Conclusion:Based on the study result it was concluded that Apo-lipoprotein and triglycerides in diabetic patients with myocardial infarction, had higher levels compared to diabetic patients without Myocardial infarction and this could be a consequence of increase in age, insulin resistance and deficiency of insulin in the body. We also found positive correlation between Apo-lipoprotein and Triglycerides.

Importance of Renal Dysfunction in the Mortality of Acute Coronary Syndrome Patients

Background: Ischemic heart disease is an important death cause in Brazil. The Acute Coronary Syndrome is a subset of signs and symptoms which represents an acute complication of ischemic heart disease. Many of these patients have common risk factors, including renal dysfunction. The analysis of the importance of this commitment in the event of outcomes is still little explored in our midst. Objective: To study the associantion betweent renal dysfunction and the occurrence of deaths in patients with Acute Coronary Syndrome, Methods: This is a analytical study, with patients admitted to the Coronary Care Unit of a Tertiary Hospital (Salvador / BA) diagnosed with acute coronary syndrome, in the period from 2011 to 2014. The patients were divided into three groups according to renal function and two groups according to clinical diagnosis. Results: We identified six hundred seventy-four (n = 674) individuals. Mean age was 69.6 ± 12.4 years and 50.7% (n = 342) were male. Regarding the clinical diagnosis, 49% of patients (n = 331) were diagnosed with Unstable Angina and 50.9% (n = 342) with Acute Myocardial Infarction. The average value of creatinine clearence rate was 63.2 ± 29.3 ml / min (p = 0.001). Conclusion: The severe renal dysfucntion is an important prognostic factor for development of coronary artery disease and was associated with bad prognosis of patients with ACS. The variables DM, hypertension and dyslipidemia were often associated in theses patients.

Sweet taste disorder and vascular complications in patients with abnormal glucose tolerance

BackgroundIt remains unknown whether taste disorders can be a risk factor for micro- and macro-vascular diseases in patients with abnormal glucose tolerance. MethodsA cross-sectional study in a nationally representative samples of 848 and 849 US adults (aged ≥40years) with diabetes or prediabetes who had sweet and salt taste disorders, respectively, from the National Health and Nutrition Examination Survey 2011–2012. ResultsAmong the study population, 5.7% had sweet taste disorder and 8.6% had salt taste disorder. These data correspond to approximately 1.5 million and 1.8 million individuals with abnormal glucose tolerance aged 40years or older in the US population, respectively. In the adjusted model, sweet taste disorder was significantly associated with complication of ischemic heart disease (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.03–5.81; P=0.04). Moreover, sweet taste disorder in patients with diabetes was significantly associated with diabetic retinopathy (adjusted OR, 2.89; 95% CI, 1.09–7.69; P=0.03) and diabetic nephropathy (adjusted OR, 3.17; 95% CI, 1.07–9.36; P=0.03). Meanwhile, salt taste disorder was not significantly associated with diabetic retinopathy, diabetic nephropathy, ischemic heart disease, or stroke. Total sugar intake was significantly higher in patients with sweet taste disorder than in those without it, whereas total daily intake of carbohydrate did not differ significantly. No significant association was observed between salt taste disorder and daily intake of sodium after multivariate analysis. ConclusionsSweet taste disorder in patients with abnormal glucose tolerance was associated with increased sugar intake and vascular complications.

Results of Monitoring of the Plan of Measures Directed to Reduction of Ischemic Heart Disease in North Caucasus Republics. Analysis of Dynamics of Cardio-Vascular Mortality

Comparative analysis of dynamics of cardiovascular mortality in Russia and foreign countries as well as main directions of development of cardiological service in Russia are presented in this review article. Plan of measures for reduction of mortality from ischemic heart disease (IHD) was created in 2015. This plan comprises 4 blocks of assessment of the following measures: directed at improvement of primary IHD prevention (1), directed at secondary prevention of complications of IHD (2); directed at improvement of efficacy of medical care of patients with IHD (3), and directed at monitoring of some demographic parameters (4). The article also contains results of monitoring of realization of the plan of IHD reduction in republics of North Caucasus. Realization of the program on healthy life style (HLS) lacks coordination between ministries. Mass information media are not sufficiently involved in propaganda of HLS. Mean achievement of target levels of main risk factors does not exceed 30-35%. First stage of prophylactic medical examination (dispanserization) has been fulfilled in 65%. High technology care is available both in federal and regional centers. Organization of effective urgent medical service, drug supply, and rehabilitation of patients with IHD are important aspects of improvement of secondary prevention in the region.