Complication Of Acute Myocardial Infarction Research Articles

Treatment and outcomes of mechanical complications of acute myocardial infarction during the Covid-19 era: A comparison with the pre-Covid-19 period. A systematic review and meta-analysis

This study aims to compare treatments and outcomes of mechanical complications of acute myocardial infarction (MI) during the Covid-19 and in the pre-Covid-19 era. Electronic databases have been searched for MI mechanical complications during the Covid-19 era and in the previous period from January 1998 to January 2020 (pre-Covid-19 era), until October 2021. To perform a quantitative analysis of non-comparative series, a meta-analysis of proportion has been conducted. Early mortality after surgical treatment was 15.0% while it was significantly higher after conservative treatment (62.4%) (P = 0.026). Early mortality after surgical treatment was seemingly higher in the pre-Covid-19 era but the difference did not reach statistical significance (15.0% vs 38.9%; P = 0.13). Mortality in patients treated conservatively, or turned down for surgery, was lower during the Covid-19 pandemic (62.4% vs 97.7%; P = 0.001). The crude mean prevalence of the use rate of conservative or surgical treatment across the studies during Covid-19 and in the pre-Covid-19 era was comparable. The current increased incidence of MI mechanical complications might be a consequence of delayed presentation or restricted access to hospital facilities. Despite the general negative impact of Covid-19 on cardiac surgery volumes and outcomes and the apparent increase of the incidence of MI complications, the outcomes of their surgical and clinical treatment seem not to have been affected during the pandemic.

Cardiac Magnetic Resonance Features Associated with the Risk of Cardiac Arrest in Patients with Acute Myocardial Infarction

Abstract Background: Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). Besides the location and severity of coronary occlusion, different factors may have significant role in the pathogenesis of AMI-related cardiac arrest (CA), but their contribution is still under investigation. The aim of the study was to investigate the cardiac magnetic resonance (CMR) features of myocardial injury associated with a higher risk of CA accompanying an AMI. Methods: In total, 918 myocardial segments from 54 post-AMI patients undergoing CMR imaging with delayed gadolinium enhancement were enrolled in the study, of which 18.54% presented CA during the acute phase of AMI. In all patients, infarct mass, the proportion of high transmurality extent, and scar mass at different myocardial segments were calculated using QMap software (Medis BV). Results: Compared to patients without CA, those with CA had a significantly higher infarct size (p = 0.03) and a higher degree of transmurality (29.28% vs. 14.1%, p = 0.01). The risk of CA during the acute phase was significantly higher in patients in whom the location of myocardial injury was at the level of latero-apical, antero-lateral, and basal anterior segments. Group 1 presented a larger infarct size at the level of the latero-apical (33.9 ± 30.6 g vs. 13.6 ± 17.3 g, p = 0.02), anterolateral (26.5 ± 29.0 g vs. 8.9 ± 12.8 g, p = 0.02), and anterobasal segment (20.1 ± 21.5 g vs. 7.8 ± 14.7 g, p = 0.02). Conclusions: CMR imaging identified infarct mass, high transmurality degree, and large myocardial injury as features associated with an increased risk of CA in the acute phase of AMI, especially at the level of anterolateral segments.

Left Ventricular Pseudoaneurysms Discovered Early After Acute Myocardial Infarction: The Surgical Timing Dilemma.

Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently occurs as a complication of acute myocardial infarction. Surgical treatment is recommended for pseudoaneurysms that are large or symptomatic and for those discovered less than 3 months after myocardial infarction. We report our experience with 2 patients who had left ventricular pseudoaneurysms discovered less than a week after inferior myocardial infarction. Both patients were middle-aged men with right coronary occlusion in whom the diagnoses were established by echocardiography during the first week after infarction. Because both patients were clinically stable, we opted to defer surgery until scarring could facilitate correction; this decision was based on a review of the literature showing that in-hospital mortality is higher with early surgery. The patients were monitored closely in the intensive care unit and were prescribed β-blockers and vasodilators. Both patients underwent left ventricular patch reconstruction with exclusion of the pseudoaneurysm and posterior septum; both received moderate inotropic support and prophylactic intra-aortic balloon pump assistance. Their postoperative courses were uneventful. In 5 prior reports describing 45 patients (13 with acute pseudoaneurysm [≤2 wk after infarction] and 32 with nonacute pseudoaneurysm), in-hospital mortality was 61.5% for patients in the acute group and 15.6% for the nonacute group (P = .0066). We recommend that clinicians consider deferring surgery for patients with stable acute left ventricular pseudoaneurysm to reduce the risks associated with early repair.

DYNAMICS OF ADROPIN AND IRISIN BIOMARKERS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS

summary. A pressing concern of modern medicine is the search for new biomarkers that can influence the development and course of acute myocardial infarction (AMI) in patents with type 2 diabetes mellitus (DM). The aim – To examine the dynamics of adropin and irisin serum levels in diabetic patients with or without AMI complications. Materials and Methods. In total, 134 AMI patients were enrolled. Among 60 examined AMI patients (group I), 41 patients were identified without early cardiovascular (CV) complications of AMI and 19 patients – with complicated AMI. Among 74 AMI patients with type 2 DM (group II), there were 48 patients without early AMI complications and 26 patients with early AMI complications. The control group consisted of 20 otherwise healthy persons. Serum levels of adropin and irisin were measured by enzyme-linked immunosorbent assay. Results. The adropin and irisin serum levels on day 1 of treatment was low in both nondiabetic (I) and diabetic patients (II) compared with those in the control group (p<0.05). On the 10th day of treatment, the levels of adropin in group II patients without early AMI complications were reduced by 13.91 % compared with those in group I (p<0.05). Group II with the presence of early AMI complications showed a reduction of 17.34 % in adropin levels on day 10 compared with group II (p<0.05). On day 10 of treatment, the irisin levels in group II without early AMI complications were reduced by 18.94 % compared with those in group I (p<0.05). In group II with the presence of early AMI complications on the 10th day, the irisin levels were reduced by 23.87 % compared with those in group I (p<0.05). Conclusions. The concentrations of adropin and irisin were significantly low in group II on day 1 and 10 of hospital stay. In the dynamics of treatment on day 10, the levels of adropin and irisin remained low in group II with early CV complications of AMI.

Robotic mitral valve repair for papillary muscle rupture.

Ischemic papillary muscle rupture (PMR) is a rare, life-threatening complication of acute myocardial infarction (AMI), with operative mortality reportedly between 20% and 26%.1,2 Some studies suggest that mitral valve repair (MVr) facilitates superior outcomes than MV replacement for such patients.1 In contrast, robotically assisted MVr offers the most minimally invasive approach to the surgical treatment of MV disease, and its safety and reliability have been well described.3,4 Considering less invasiveness and reliable results, we believe robotically assisted MVr can facilitate favorable outcomes for patients with PMR.

Improving and Promoting Social Determinants of Health at a System Level.

Social determinants of health (SDoH), such as low socioeconomic status, race and ethnicity, poor environmental conditions, food insecurity, and inadequate access to health care services, are known to adversely affect health outcomes. The aim of this project is to address SDoH needs with clinical care to further improve patient outcomes and assist safe discharge. Prime Healthcare Service's model to address SDoH needs focused on supplementing its existing care coordination process with digital innovation while leveraging its highly skilled multidisciplinary team of physicians and mid-level providers, care coordinators, case managers, and social workers and strengthening its relationships with community partners. Prime extended the scope of its services by growing its providers and care navigators' presence in the community to assess needs and foster hospital-community relationships to meet the needs of individual patients. The 2021 Lown Hospital Index, which includes matrices Equity, Value, and Outcomes, has ranked Prime Healthcare Services, as a system, #1 overall in New Jersey and Nevada states. It also ranked Saint Michael's Medical Center number 2 in New Jersey for social responsibility, Centinela Hospital Medical Center number 9 in California for clinical outcomes, and St. Joseph Medical Center number 3 in Missouri for outcomes. The Index also ranked North Vista Hospital as the number 1 most racially inclusive hospital in Nevada. The acute myocardial infarction (AMI) 30-day risk-standardized mortality rate was reduced by an average 1% across the system, while the risk-standardized AMI complication rate was at 0%. Development of an SDoH screening tool, prioritizing high-risk factors, involving a multidisciplinary team, and strengthening the post-acute network have helped address and link the role of SDoH factors in patient outcomes and has resulted in reduced readmission rate, lower mortality and complications rate, and improved cost alignment with the Centers for Medicare & Medicaid Services payment reforms initiative and value-based care.

The state of platelet and plasma hemostasis as a predictor of coronary blood flow in patients with acute myocardial infarction.

Aim To study the relationship of the platelet function and plasma homeostasis with the blood flow in the infarct-related artery (IRA) and with the course of acute myocardial infarction (AMI).Material and methods This study included 93 patients with AMI (75 patients with ST-elevation AMI and 18 patients without ST segment elevation). 63 patients had TIMI 0-1 blood flow in the IRA and 30 patients had TIMI 2-3. Rotational thromboelastometry, impedance aggregometry, the endothelium-dependent vasodilation (EDVD) test, and the thrombodynamics test were performed for all patients. The primary clinical endpoint included the totality of in-hospital complications of AMI, and the secondary endpoint included the totality of out-of-hospital complications of AMI. Major bleedings (BARC 3-5) and minor bleedings (BARC 1-2) were evaluated separately.Results Patients with IRA TIMI 0-1 flow were characterized by a shorter blood clotting time (BCT), larger thrombus size and density, more intense platelet aggregation induced by arachidonic acid and ADP, and lower values of the EDVD test. It was found that the parameters of platelet aggregation induced by arachidonic acid (AUC Asa) in combination with BCT allowed assessment of the severity of IRA blood flow disorder (sensitivity 76 %, specificity 71 %) in patients with AMI, regardless of the presence of ST segment elevation on the ECG. In addition, the incidence of the primary endpoint was greater in patients with IRA TIMI 0-1 flow (41.3% and 16.7%, respectively; p=0.015). In patients with TIMI 2-3 flow in the long-term period of the disease, the incidence of minor bleedings was significantly higher (8.5% and 30.4 %, respectively; p=0.045).Conclusion Compared to patients with preserved blood flow, patients with AMI and IRA TIMI 0-1 flow are characterized by endothelial dysfunction and more intense processes of thrombogenesis and platelet aggregation. It has been shown for the first time that the combination of two simple criteria for assessing hemostasis (AUC Asa; BCT) allows assessment of the degree of IRA blood flow disorder in patients with AMI.

Cardiocerebral Infarction: A Combination to Prevent

Background The acute complications of myocardial infarction (MI), such as mechanical, arrhythmic, ischemic, and inflammatory sequelae, may be responsible for significant cardiovascular morbimortality. Life-threatening arrhythmias, namely ventricular fibrillation or tachycardia, may be a challenging complication requiring a prompt approach. In some cases, acute ischemia leads to polymorphic ventricular tachycardia (PVT), and, rarely, to potentially lethal torsades de pointes ventricular tachycardia. – […] Cardiocerebral Infarction: A Combination to Prevent

Preventive Effect of Bone Marrow Mononuclear Cell Transplantation on Acute Myocardial Infarction-Induced Heart Failure: A Meta-analysis of Randomized Controlled Trials.

Heart failure (HF) is a major complication of acute myocardial infarction (AMI). Transplantation of bone marrow mononuclear cells (BM-MNC) in the setting of AMI has been proposed as a means for myocardial tissue regeneration. Several trials have explored the outcomes of these cells on surrogate end points such as left ventricular ejection fraction (LVEF) in patients with AMI. However, the data regarding the clinical efficacy are infrequent. Here, we performed a meta-analysis investigating the effect of BM-MNCs injection on the rate of hospitalization for HF in the long-term follow-up period. PubMed, Scopus, and Cochrane databases were queried with various combinations of keywords through May 2, 2022. A random-effects meta-analysis was performed to calculate risk ratio (RR) and 95% confidence interval (CI) of hospitalization for HF, all-cause mortality, and stroke rate. Subgroup analyses for hospitalization based on time and cell dose were performed. A total of 2150 patients with AMI across 22 trials were included for quantitative synthesis. At long-term follow-up, AMI patients treated with an intracoronary injection of BM-MNCs were less likely to be hospitalized for heart failure compared to the control group receiving standard treatment (RR = 0.54, 95% CI = [0.37; 0.78], p = 0.002). There was no association between BM-MNC therapy and all-cause mortality (RR = 0.69, 95% CI = [0.47; 1.01], p = 0.05) and stroke (RR = 1.12, 95% CI= [0.24; 5.21], p = 0.85). Autologous injection of BM-MNC in the setting of AMI may be associated with decreased risk of hospitalization of heart failure in the long term. However, its effect on all-cause mortality and stroke rate is questionable.

Effect of PCI Standardized Telephone Follow-Up Service Mode on Out-of-Hospital Complications, Rehospitalization Rate, and Quality of Life of Discharged Patients with Acute Coronary Syndrome after PCI.

Objective To explore the effect of percutaneous coronary intervention (PCI) standardized telephone follow-up service mode on out-of-hospital complications, rehospitalization rate, and life quality of discharged acute coronary syndrome (ACS) patients after PCI. Methods From August 2020 to March 2022, 218 ACS patients who were discharged after PCI were included. The controls accepted routine nursing care, and the researches accepted PCI standardized telephone follow-up service mode. The nursing satisfaction, rehospitalization rate, out-of-hospital complication rate, blood lipid level, and life quality score were taken as the comparisons. Results The nursing satisfaction of study group (100.00%) was significantly higher than that of control group (88.07%). The rehospitalization rate was dramatically lower in the study group (3/109; 2.75%) than in the control group (25/109; 22.94%) (P < 0.05). In addition, compared with the control group, the incidence of complications (acute myocardial infarction and angina pectoris) was significantly reduced in the study group outside the hospital (P < 0.05). The blood lipid levels of TCHO, TG, LDL-C, and HDL-C were lower in the study group than in the controls. Further, after nursing, the quality of life score of the two groups was both decreased with a higher quality of life score in the study group (P < 0.05). Conclusion The application of PCI standardized telephone follow-up service mode in discharged patients with acute coronary syndrome after PCI can reduce out-of-hospital complications and rehospitalization rate and improve blood lipid level and life quality.

Endovascular correction of postinfarction ventricular septal defect: own successful experience

Despite the current development of cardiology, postinfarction rupture of the interventricular septum (IVS) is one of the most hazardous, life-threatening complications of acute myocardial infarction. The paper describes a clinical case of a 63-year-old female patient with a history of an acute ST-elevation myocardial infarction complicated by IVS rupture. The difficulties in the management of this patient and a comparative analysis of our treatment strategy with the available modern literature data on this issue are also presented.

Prognostic Factors in Patients with Sudden Cardiac Arrest and Acute Myocardial Infarction Undergoing Percutaneous Interventions with the LUCAS-2 System for Mechanical Cardiopulmonary Resuscitation.

Sudden cardiac arrest (SCA) is one of the most perilous complications of acute myocardial infarction (AMI). For years, the return of spontaneous circulation (ROSC) has had to be achieved before the patient could be treated at the catheterization laboratory, as simultaneous manual chest compression and angiography were mutually exclusive. Mechanical chest compression devices enabled simultaneous resuscitation and invasive percutaneous procedures. The aim was to characterize the poorer responders that would allow one to predict the positive outcome of such a treatment. We retrospectively analyzed the medical charts of 94 patients with SCA due to AMI, who underwent mechanical cardiopulmonary resuscitation during angiography. In total, 48 patients, 8 (17%) of which survived the event, were included in the final analysis, which revealed that 83% of the survivors had mild to moderate hyperkalemia (potassium 5.0–6.0 mmol/L), in comparison to 15% of non-survivors (p = 0.002). In the age- and sex-adjusted model, patients with serum potassium > 5.0 mmol/L had 4.61-times higher odds of survival until discharge from the hospital (95% CI: 1.41–15.05, p = 0.01). Using the highest Youden index, we identified the potassium concentration of 5.1 mmol/L to be the optimal cut-off value for prediction of survival until hospital discharge (83.3% sensitivity and 87.9% specificity). The practical implications of these findings are that patients with potassium levels between 5.0 and 6.0 mmol/L may actually benefit most from percutaneous coronary interventions with ongoing mechanical chest compressions and that they do not need immediate correction for this electrolyte abnormality.

Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes.

Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16–3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups.

Characteristics, in-hospital management, and complications of acute myocardial infarction in northern and Central Vietnam

IntroductionContemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited. MethodsWe established population-based registries of residents from 2 provinces in a northern urban (Hai Phong), and a central rural (Thanh Hoa), province of Vietnam hospitalized with a validated first AMI in 2018. We described patient characteristics, in-hospital management and clinical complications, and estimated incidence rates of AMI in these two registries. ResultsA total of 785 patients (mean age = 71.2 years, 64.7% men) were admitted to the two hospitals with a validated first AMI. Approximately 64% of the AMI cases were ST-segment-elevation AMI. Patients from Thanh Hoa compared with Hai Phong were more likely to delay seeking acute hospital care. The incidence rates (per 100,000 population) of initial AMI in Thanh Hoa and Hai Phong were 16 and 30, respectively. Most patients were treated with aspirin (Thanh Hoa: 96%; Hai Phong: 90%) and statins (both provinces: 91%) during their hospitalization. A greater proportion of patients in Hai Phong (69%) underwent percutaneous revascularization than those in Thanh Hoa (58%). The most common in-hospital complications were heart failure (both provinces:12%), cardiogenic shock (Thanh Hoa: 10%; Hai phong: 7%); and cardiac arrest (both provinces: 9%). The in-hospital case-fatality rates for patients from Thanh Hoa and Hai Phong were 6.8% and 3.8%, respectively. ConclusionsThe incidence and hospital case-fatality rates of AMI were low in two Vietnamese provinces. Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal, being more prominent in the rural province.

Pathogenetic Link of Cardiac Rupture and Left Ventricular Thrombus Following Acute Myocardial Infarction: A Joint Preclinical and Clinical Study.

BackgroundCardiac rupture (CR) and left ventricular thrombus (LVT) remain important complications of acute myocardial infarction (MI), and they are currently regarded as independent events. We explored the pathogenetic link between CR and LVT by investigating a murine model of MI with a high frequency of CR and in patients with acute MI.MethodsMI was induced in mice, the onset of CR was monitored, and the hearts of mice with or without fatal CR were histologically examined. Between 2015 and 2022, from patients admitted due to acute MI, the data of patients with CR or LVT were retrospectively collected and compared to uncomplicated patients (control).ResultsA total of 75% of mice (n = 65) with MI developed CR 2–4 days after MI. A histological examination of CR hearts revealed the existence of platelet-rich intramural thrombi in the rupture tunnel, which was connected at the endocardial site to platelet-fibrin thrombi within an LVT. In CR or non-CR mouse hearts, LV blood clots often contained a portion of platelet-fibrin thrombi that adhered to the infarct wall. In non-CR hearts, sites of incomplete CR or erosion of the infarct wall were typically coated with platelet thrombi and dense inflammatory cells. Of 8,936 patients with acute MI, CR and LVT occurred in 102 (1.14%) and 130 (1.45%) patients, respectively, with three cases having both complications. CR accounted for 32.8% of in-hospital deaths. The majority of CR (95%) or LVT (63%, early LVT) occurred within 7 days. In comparison to the control or LVT-late groups, patients with CR or early LVT reported increased levels of cellular and biochemical markers for inflammation or cardiac injury.ConclusionCR and LVT after MI are potentially linked in their pathogenesis. LVT occurring early after MI may be triggered by a thrombo-inflammatory response following wall rupture or endocardial erosion.

Dynamics of FABP4 and CTRP3 biomarkers in patients with acute myocardial infarction and type 2 diabetes mellitus

The aim of the work was to study the characteristics of adipokine metabolism based on the analysis of fatty acid binding protein 4 (FABP4) and C1q/tumour necrosis factor-related protein-3 (CTRP3) levels and their dynamics in non-diabetic and diabetic patients with cardiovascular (CV) complications of acute myocardial infarction (AMI).&#x0D; Materials and methods. The study was carried out between 2018 and 2020 and involved 134 AMI patients with or without type 2 diabetes mellitus (DM) aged 59.00 [52.75; 66.00] years. The control group consisted of 20 healthy individuals with the mean age of 56.50 [48.50; 61.75] years. The serum levels of FABP4 and CTRP3 were measured by enzyme-linked immunosorbent assay on days 1 and 10 of hospital stay.&#x0D; Results. The mean levels of FABP4 were elevated on day 1 in AMI patients with type 2 DM (group II) compared to those in AMI patients (group I) and the control individuals (p&lt;0.05). The FABP4 concentrations on day 10 were 7.68 [6.42; 8.42] ng/ml and 8.31 [6.92; 9.63] ng/ml (p&lt;0.05) in groups I and II, respectively. The CTRP3 levels were lower in group II on day 1 as compared to those in group I and the control group patients (p&lt;0.001). After 10 days, the levels of CTRP3 were 287.56 [271.48; 300.58] ng/ml and 262.01 [225.32; 288.84] ng/ml) (p&lt;0.001) in groups I and II, respectively. In the presence of early AMI complications in diabetic patients, the levels of FABP4 remained elevated on day 10, and the levels of CTRP3 were low compared to those in diabetic patients without AMI complications (p&lt;0.05).&#x0D; Conclusions. The characteristics of adipokine metabolism in AMI patients have been revealed: the worsened imbalance in adipokine metabolism in type 2 DM due to the difference in FABP4 and CTRP3 levels. Special mention should be made of severely deteriorated adipokine metabolism in diabetic patients with CV complications

LncRNA SNHG15 Modulates Ischemia-Reperfusion Injury in Human AC16 Cardiomyocytes Depending on the Regulation of the miR-335-3p/TLR4/NF-κB Pathway.

Myocardial ischemia-reperfusion (I/R) injury is a serious complication of acute myocardial infarction. Long noncoding RNA (lncRNA) small nucleolar RNA host gene 15 (SNHG15) can regulate I/R-induced cardiomyocyte apoptosis. Here, we investigated the mechanism of SNHG15 activity in I/R-induced cardiomyocyte injury.SNHG15, microRNA (miR)-335-3p, and toll-like receptor 4 (TLR4) were quantified by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot. Cell viability, proliferation, and apoptosis were gauged by Cell Counting Kit-8 (CCK-8) assay, 5-ethynyl-2´-deoxyuridine (EDU) assay, and flow cytometry, respectively. The direct relationship between miR-335-3p and SNHG15 or TLR4 was validated by dual-luciferase reporter, RNA immunoprecipitation (RIP), and RNA pull-down assays.SNHG15 was overexpressed in the infarcted area tissues of I/R mice and I/R-stimulated AC16 cells. SNHG15 knockdown alleviated I/R injury in AC16 cells. Mechanistically, SNHG15 directly targeted miR-335-3p, and miR-335-3p was a functional mediator of SNHG15. MiR-335-3p inhibited TLR4 expression by targeting TLR4, and miR-335-3p-mediated inhibition of TLR4 alleviated I/R-induced injury in AC16 cells. Moreover, SNHG15 regulated the TLR4/nuclear factor-κB (NF-κB) signaling pathway through miR-335-3p.Our findings identify a novel mechanism, the miR-335-3p/TLR4/NF-κB pathway, for the regulation of SNHG15 in myocardial I/R injury.

Acute Coronary Syndrome in the COVID-19 Era-Differences and Dilemmas Compared to the Pre-COVID-19 Era.

The COVID-19 pandemic has led to numerous negative implications for all aspects of society. Although COVID-19 is a predominant lung disease, in 10–30% of cases, it is associated with cardiovascular disease (CVD). The presence of myocardial injury in COVID-19 patients occurs with a frequency between 7–36%. There is growing evidence of the incidence of acute coronary syndrome (ACS) in COVID-19, both due to coronary artery thrombosis and insufficient oxygen supply to the myocardium in conditions of an increased need. The diagnosis and treatment of patients with COVID-19 and acute myocardial infarction (AMI) is a major challenge for physicians. Often the presence of mixed symptoms, due to the combined presence of COVID-19 and ACS, as well as possible other diseases, nonspecific changes in the electrocardiogram (ECG), and often elevated serum troponin (cTn), create dilemmas in diagnosing ACS in COVID-19. Given the often-high ischemic risk, as well as the risk of bleeding, in these patients and analyzing the benefit/risk ratio, the treatment of patients with AMI and COVID-19 is often associated with dilemmas and difficult decisions. Due to delays in the application of the therapeutic regimen, complications of AMI are more common, and the mortality rate is higher.

Predictive Model for Acute Heart Failure in Patients with Acute Myocardial Infarction and Type 2 Diabetes Mellitus Based on Energy and Adipokine Metabolism Indicators

BACKGROUND: Acute heart failure (AHF) is one of the early complications of acute myocardial infarction (AMI) in diabetic patients. Evaluation of biomarkers of energy and adipokine metabolism can help in the early identification of diabetic patients at risk of AHF. AIM: The present study is aimed to predict the development of AHF in diabetic patients with AMI based on energy and adipokine metabolism parameters. METHODS: A total of 74 diabetic patients with AMI were examined between September 1, 2018, and December 31, 2020. Serum adropin, irisin, and C1q/TNF-related protein 3 (CTRP3) levels were measured by enzyme-linked immunosorbent assay. To predict AHF development in AMI patients, generalized linear mixed model (GLMM) was applied. RESULTS: The serum concentrations of adropin, irisin, and CTRP3 have been found to be reduced in diabetic patients with AMI and AHF. The accuracy of predicting AHF Killip Class 1 was 96.7%, and the accuracy of prediction for AHF Killip Class 2 was 57.1%, that is, the model was poorly sensitive to this level of complications. The prediction accuracy for AHF Killip Class 3 was 80%, that is, the model was highly sensitive to complications of this level, and for AHF Killip Class 4 – 100% being the maximum level of the model sensitivity. CONCLUSIONS: Low serum concentrations of adropin, irisin, and CTRP3 indicate an imbalance in energy and adipokine homeostasis. The constructed model predicts the probability of AHF development with high accuracy of 91.9% in diabetic patients with AMI.

Зміни показників енергетичного та ліпідного обміну в пацієнтів на гострий інфаркт міокарда та цукровий діабет 2 типу

The purpose of the study was to examine the indicators of lipid and energy metabolism in patients with acute myocardial infarction in the presence or absence of type 2 diabetes mellitus. Materials and methods. A total of 134 patients with acute ST-segment elevation myocardial infarction in the presence or absence of type 2 diabetes mellitus aged 58.97 ± 7.92 years were examined on the basis of the Intensive Care Department at the Government Institution “L. T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine” and the Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” of Public Joint Stock Company “Ukrainian Railway”. Group 1 consisted of 74 patients with acute myocardial infarction and type 2 diabetes mellitus aged 59.42 ± 7.66 years. Group 2 (comparison group) included 60 patients with acute myocardial infarction without type 2 diabetes mellitus aged 58.42 ± 8.25 years. The control group comprised of 20 healthy individuals. All the patients of groups 1 and 2 underwent percutaneous coronary intervention. The study was conducted from September 1, 2018 to December 31, 2020. Serum concentration of adropin and irisin in patients was determined by enzyme-linked immunosorbent assay. Total cholesterol and high-density lipoprotein cholesterol in serum were measured by peroxidase enzymatic method. Triglyceride levels were analyzed by enzymatic colorimetric method. The atherogenic index was calculated by A. M. Klimov formula. Very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels were estimated by the Friedewald formula. Results and discussion. Group 1 patients were found to have higher serum triglyceride levels compared with group 2 patients (p&lt;0.05). In groups 1 and 2, total cholesterol and low-density lipoprotein cholesterol levels presented an upward tendency (p˃0.05), and very low-density lipoprotein cholesterol levels were significantly by 4.04 and 2.92 times increased, respectively, as compared to the control group (p&lt;0.05). The serum adropin levels were significantly lower in patients with acute myocardial infarction and type 2 diabetes mellitus in comparison to those in patients with acute myocardial infarction without type 2 diabetes mellitus (p&lt;0.05). There was a significant decrease in the concentrations of adropin and irisin in both groups compared with the control group (p&lt;0.05). Conclusion. Characteristics of changes in adropin and irisin levels suggest an energy homeostasis imbalance in acute myocardial infarction in the presence or absence of type 2 diabetes mellitus that may significantly increase the risk of cardiovascular complications of acute myocardial infarction in this category of patients. The relationship between adropin, irisin and lipid profile may indicate the influence of these markers on lipid metabolism