Infarction Group Research Articles

Vascular endothelial growth factor-D plasma levels in fluid overload and cardiac function evaluation of elderly patients with cardiovascular disease.

This study aimed to investigate the clinical significance of vascular endothelial growth factor (VEGF) subtypes and growth differentiation factor-15 (GDF-15) plasma levels in evaluating the fluid overload and cardiac function of elderly patients with cardiovascular disease. The plasma levels of VEGF-C, VEGF-D, and GDF-15 were measured using ELISA. Their correlations with N-terminal pro B-type natriuretic peptide (NT-Pro BNP) and echocardiography data were analyzed. 1. Higher plasma levels of VEGF-D and GDF-15 were observed in elderly patients with cardiovascular disease and heart failure(P < .01). VEGF-D plasma levels were higher in patients with chronic heart failure than those with acute myocardial infarction (P < .01). VEGF-D plasma levels were positively correlated with amino-terminal pro-B type natriuretic peptide (NT-pro BNP) (P < .001). VEGF-D plasma levels were positively correlated with echocardiographic parameters, including left atrial diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction, in patients with cardiovascular disease (P < .01). 2. VEGF-C plasma levels were higher in acute myocardial infarction group (P < .05). The plasma levels of VEGF-C were not correlated with either VEGF-D or NT-pro BNP plasma levels. VEGF-C plasma levels had no correlation with echocardiographic parameters. 3. GDF-15 plasma levels were positively correlated with sera biomarkers of cardiac injury (creatine kinase isoenzyme MB and cardiac troponin I). GDF-15 plasma levels were positively correlated with urinary biomarkers of tubular injury (N-acetyl-β-galactosidase and α1-microglobulin). Both GDF-15 and NT-pro BNP plasma levels were correlated with age, estimated glomerular filtration rate (eGFR), and nutritional biomarkers (albumin and hemoglobin plasma levels). VEGF-D plasma levels is a potential biomarker of fluid overload and cardiac function in elderly patients with cardiovascular disease. Age, nutrition, and kidney injury are factors influencing both GDF-15 and NT-pro BNP plasma levels in estimating cardiac function and fluid overload.

Management of hospital resources for patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) - an approach to deescalate ?

Abstract Background Patients with myocardial infarction with non - obstructive coronary arteries (MINOCA) present as a main feature a non-relevant (≤ 50%) obstructive coronary artery upon angiography despite clinical symptoms related to acute coronary syndrome. Being mostly a benign syndrome with favorable clinical outcome and almost exclusively conservative treatment, it still utilizes relevant financial and capacity resources including high care monitoring and in - hospital treatment of relevant length. Regarding scarcity of resources, this entity should be put under particular consideration. Objective Our investigation focuses on the procedural and economic impact of MINOCA patients vs. "true myocardial" infarction patients and related clinical outcomes in a single - center patient collective of a large university heart center in Germany. Methods We analyzed all patients admitted to our hospital with suspected acute coronary syndrome within a 12-month period (2017 – 2018) who had a troponin elevation and received invasive coronary angiography. We collected data on in-hospital costs, procedures, clinical parameters, work-flow timelines, and other relevant parameters. Results Of a total 3021 screened patients, we included 660 patients with acute coronary syndrome. Of those, 103 patients were attributed to the MINOCA – group. 542 patients presented with a "classical" myocardial infarction, and thus formed the MIOCA (myocardial infarction with obstructive coronary arteries) group (Table 1). In - hospital mortality (MIOCA vs. MINOCA: 59 (11.1%) vs. 0 (0%) patients; p &amp;lt; 0.01), and 30 – day mortality (MIOCA vs. MINOCA: 94 (17.3%) vs. 5 (4.2%) patients; p &amp;lt; 0.01) after the clinical index event were significantly higher in the "classical" myocardial infarction group (MIOCA). Overall length of hospital stay (mean: 9.5 ± 8.7 days vs. 12.5 ± 12.7 days; p= 0.016; median: 8.0 (5 - 14) vs. 7.0 (4 - 11); p = 0.023) as well as duration of high care monitoring (mean: 2.4 ± 4.6 days vs. 4.7 ± 7.7 days; p= 0.004; median: 1.9 (1.1 – 4.4) vs. 1.5 (0.4 – 2.7);p = 0.01)) were shorter in the MINOCA group compared to MIOCAs. However, in a 12-months period, a total sum of 298.4 days was attributed to high care monitoring for MINOCA patients (Figure 1). With average and median costs of 6871.5 ± 5670.8 and 3585.2 (3461.4 – 10167.2) EUR per index, MINOCA treatment costs were lower compared to the MIOCA group (mean: 13045.9 ± 7896.9 EUR; p = 0.02; median: 5958.9 (4682.7 – 16654.9) EUR; p &amp;lt; 0.01). MINOCA treatment was not associated with a relevant profit for these expanses (mean: 198.1 ± 4329.2 EUR; // median: 0 (-1702.6 – 1405.1) EUR; p = 0.042) and a relevant share of 36.2% of the total cost was generated due to high care monitoring in these patients (Figure 1). Conclusion In light of growing scarcity of staff, financial and capacity resources MINOCA should be put under particular consideration for refining care concepts and resource allocation.Table 1Figure 1

Risk factors of disturbed sleep phases to posterior circulation cerebral infarctions: A single-center retrospective study.

Posterior circulation stroke differs from anterior circulation stroke in terms of etiological, clinical, and prognostic properties. Sleep architecture is impaired in patients with acute stroke, which may correlate with disease severity and outcome, and the correlation between the location of cerebral infarction (CI) and sleep phase disturbance remains unknown. This study aimed to assess the correlation between disturbed sleep phases in CI and posterior circulation cerebral infarction (PCCI). We retrospectively enrolled 192 patients with first-onset acute CI, who were assigned to the anterior circulation cerebral infarction (n = 101) and PCCI (n = 91) groups. The polysomnograms in both groups were analyzed by phase. The proportions of sleep phases were significantly different between the 2 groups (P < .05). The awake (W) and non-rapid eye movement 3 (N3) phases were independently associated with PCCI in multivariate analysis. The W phase may be a risk factor for PCCI (odds ratio = 1.60, 95% CI 1.30-1.97), while the N3 phase may be a protective factor for PCCI (odds ratio = 0.498, 95% CI 0.353-0.703). This study demonstrated that CI causes different degrees of sleep phase disturbances, and the percentages of W and N3 phase disturbances were independent factors associated with PCCI. The former was a risk factor, whereas the latter was a protective factor. This study demonstrated the correlation between cerebral infarction and sleep phase disturbances from a new perspective and suggested that cerebral infarcts may alter the structure of sleep.

A Different Scintigraphic Perspective on the Systolic Function of the Left Ventricle-1.

The aim of this study was to analyze the systolic part of the left ventricular (LV) volume curve obtained by gated myocardial perfusion imaging with the formula used in exponential decay and to investigate the clinical value of the results. One hundred fifty eight patients were retrospectively enrolled in the study. The study group was divided into three groups as normal, ischemia, and infarct. The systolic portion of the LV volume curve was also analyzed using the exponential decay formula. The scintigraphic parameter obtained using this formula is called the ejection constant (Ec). The Ec results were 1.8±0.8, 2.7±0.9, 3.5±1 in infarct, ischemia, and normal groups, respectively, and the difference in Ec results between the groups was statistically significant (p≤0.001). It appears that Ec may play a clinical role as a scintigraphic parameter in the evaluation of systolic functions of the left ventricle.

Effect of Antecedent Hypertension on Mortality After Acute Coronary Syndromes in the Coronary Intervention Era: A Meta-analysis.

The effect of antecedent hypertension on mortality after acute coronary syndromes (ACS) in the percutaneous coronary intervention era is unclear. Therefore, this meta-analysis aimed to assess the effect of antecedent hypertension on short-term and long-term mortality after ACS in the coronary intervention era. PubMed, Medline, EMBASE, and the Cochrane library were systematically searched up to July 2023. Ten studies with a total of 64,989 of patients met the inclusion criteria. The outcomes of interest were all-cause in-hospital mortality and long-term all-cause mortality. No significant difference was observed in in-hospital mortality between the antecedent hypertension and non-antecedent hypertension groups in the ACS patients (pooled OR 1.07; 95% CI 0.79-1.45; I2=82%), which was the same as the ST elevation myocardial infarction group (pooled OR 1.01; 95% CI 0.73-1.39; I2=66%). However, the result was statistically significant for non-ST elevation myocardial infarction patients (pooled OR 0.67; 95% CI 0.55-0.82; p=0.0001; I2=0%). Antecedent hypertension was related to increased long-term mortality in patients with ACS (pooled OR 1.28; 95% CI 1.16-1.40; p=0.0001; I2=0%), which was the same as the ST elevation myocardial infarction subgroup. In the percutaneous coronary intervention era, antecedent hypertension is associated with higher long-term mortality in ACS patients. This meta-analysis found no significant difference in in-hospital mortality between the hypertension and non-hypertension groups. However, antecedent hypertension may be a protective factor related to in-hospital mortality for non-ST elevation myocardial infarction patients.

Analysis of Fecal Microbiota in Patients with Hypertension Complicated with Ischemic Stroke.

Ischemic stroke is a disease with a very high incidence in the clinic, and hypertension is the most important variable risk factor of ischemic stroke. Studies have shown that intestinal microbes are involved in the occurrence and development of various diseases. This study aims to explore whether intestinal microbes play an important role in the pathogenesis of ischemic stroke in a hypertensive population. In this study, the inpatients in the Department of Neurology and Cardiology of the Second Affiliated Hospital of Shandong First Medical University in April 2021 were selected, including seven patients with hypertension complicated with ischemic stroke and only seven patients with hypertension. After collecting the stool samples of patients, the gene sequence of the samples was detected by 16S rRNA sequencing technology, and the double-ended 2 × 150bp sequencing was carried out. After sequencing, the results were analyzed by diversity analysis, species difference analysis, species function difference analysis, and other bioinformatics tests. According to the test results, serum proteomics and biochemical blood tests were carried out to verify. There was no significant difference in α diversity and β diversity between hypertension complicated with the cerebral infarction and hypertension groups. LEfSe analysis showed that at the genus level, compared with the hypertension group, Bacteroides, UCG_009, and Eisenbergiella had significantly increased relative abundance. The genera with relatively significantly reduced abundance are Ruminococcus_gnavus_group, Sutterellaceae, Burkholderia, and Prevotella and the LDA score of Prevotella is < - 4, which indicates that there are significant differences. Compared with the blood biochemical indexes, the results showed that the level of APOA1 in hypertensive patients with ischemic stroke was significantly higher than that in hypertensive patients (p < 0.05), but there was no significant difference in total cholesterol (CHOL), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein B (APOB), and free fatty acid (NEFA). Proteomic analysis showed that there were 89 up-regulated genes and 51 down-regulated genes in the serum of the two groups, and the expression of APOC2 and APOC3 in the cerebral infarction group with hypertension was significantly higher than that in the hypertension group (p < 0.05). The intestinal diversity of patients with hypertension complicated with stroke is similar to that of patients with hypertension, but there are differences in microbiota, among which Prevotella is the most significant. Prevotella could affect lipid metabolism so that APOC2 and APOC3 in the blood are significantly increased, leading to cerebral artery atherosclerosis and, finally, ischemic stroke. This provides a new idea for preventing and treating ischemic stroke in patients with hypertension, but the mechanism of Prevotella acting on apolipoprotein needs further verification by basic medical research.

Remodeling in early myocardial infarction: alteration of extracellular matrix; Collagen-1, Collagen-3, α-SMA, and α-Actinin in Porcine heart model

Link of Video Abstract: https://youtu.be/lThOW40upEc Background: Myocardial infarction (MI) leads to remodeling due to altered cardiac structure and function. The study of MI histopathology in humans or large animals mimicking the human heart is limited. Using the porcine heart model, our study investigated the composition of myocardial extracellular matrix (ECM) in collagen-1, collagen-3, α-smooth muscle actin (α-SMA), and α-actinin before and after myocardial infarction. Methods: This study used two groups of domestic pigs: the Infarct group (n=4) and the Sham group (n=4). MI was induced by permanent ligation of the proximal branch of the posterior left ventricular artery. Cardiac enzymes, electrocardiography, and echocardiography data were collected before and after ligation. Cardiac tissue was harvested from the infarcted area after 60 minutes of ligation and stained with hematoxylin-eosin and Movat's Pentachrome. Collagen-1, collagen-3, and α-SMA were identified with immunohistochemical labeling, and the labeled area was measured using ImageJ. Meanwhile, α-actinin was visualized using immunofluorescence. Results: Expression of collagen-1, collagen-3, and α-SMA in the infarct group were significantly decreased after 60 minutes of infarction compared with those in the sham group (p&lt;0.01). The α-actinin was fragmented and diminished in the infarct group. Conclusion: Myocardial remodeling was detected 60 minutes after infarction with mild alteration in myocardial histoarchitecture and significant deterioration of ECM composition of collagen-1, collagen-3, α-SMA, and fragmented α-actinin fibers in the porcine heart model.

Impact of Acute Myocardial Infarction Type on Prognosis in Female Patients With Cardiogenic Shock

There are limited data about mid-term prognosis according to acute myocardial infarction (AMI) type in female patients with AMI complicated by cardiogenic shock (CS). In this study, we evaluated the impact of AMI type on prognosis in female patients who underwent percutaneous coronary intervention (PCI) for AMI complicated by CS. A total of 184 female patients who underwent PCI for AMI complicated by CS were enrolled from 12 centers in the Republic of Korea. Patients were divided into 2 groups according to AMI type: the ST-segment elevation myocardial infarction (n=114) and the non-ST-segment elevation myocardial infarction (n=70) group. Primary outcome was a major adverse cardiac event (MACE) (defined as a composite of cardiac death, myocardial infarction, or repeat revascularization). Propensity-score matching analysis was performed to reduce selection bias and potential confounding factors. During 12-month follow-up, a total of 73 MACEs occurred (ST-segment elevation myocardial infarction group, 47 [41.2%] vs non-ST-segment elevation myocardial infarction group, 26 [37.1%], p=0.643). Multivariate analysis revealed no significant difference in the incidence of MACE at 12months between the 2 groups (adjusted hazard ratio 1.16, 95% confidence interval 0.70 to 2.37, p=0.646). After propensity-score matching, the incidence of MACE at 12months remained similar between the 2 groups (hazard ratio 1.31, 95% confidence interval 0.69 to 2.52, p=0.413). The similarity in MACEs between the 2 groups was consistent across a variety of subgroups. In conclusion, after adjusting for baseline differences, AMI clinical type did not appear to increase the risk of MACEs at 12months in female patients who underwent emergency PCI for AMI complicated by CS.

Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA.

To investigate the predictive value of Whole Brain CT Perfusion (WB-CTP) combined with the ABCD3 score in patients with transient ischemic attack (TIA). A total of 336 TIA patients with TIA underwent WB-CTP and ABCD3 score assessment within 48 h of admission. Spearman correlation test was performed to analyze the relationship between the degree of vascular stenosis, relative perfusion values, and ABCD3 score. Logistic regression analysis was used to identify independent risk factors for secondary cerebral infarction. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of relative cerebral blood flow (rCBF), degree of vascular stenosis, ABCD3 score, and the WB-CTP-ABCD3 combined model for secondary cerebral infarction after TIA. Calibration curves and H-L tests were used to evaluate the predictive efficacy of the model. Among the 336 TIA patients, 143 showed abnormal perfusion areas and 146 had responsible vessel stenosis. The degree of vascular stenosis, relative time-to-maximum (rTmax), and relative mean transit time (rMTT) were positively correlated with the ABCD3 score, while rCBF and relative cerebral blood volume (rCBV) were negatively correlated with the ABCD3 score. ROC curve analysis identified a cutoff value of 0.8205 for rCBF, with a sensitivity of 84.10% and specificity of 58.10% for distinguishing the cerebral infarction group from the non-cerebral infarction group. Furthermore, rCBF ≤ 0.8205, degree of vascular stenosis, and ABCD3 score > 6 were identified as independent risk factors for secondary cerebral infarction in TIA patients within 90 days in TIA patients. The AUC of the WB-CTP-ABCD3 combined model for predicting secondary cerebral infarction within 90 days was 0.836. The model risk was assessed by plotting calibration curves. The value of p for the H-L goodness of fit test was 0.366 (p > 0.05), which indicated that the difference between the obtained model and the perfect model were statistically insignificant. The combined model of WB-CTP-ABCD3 shows promise as a valuable method for predicting secondary cerebral infarction within 90 days following TIA.

Predictors of tissue infarction from distal emboli after mechanical thrombectomy

BackgroundDistal embolization after endovascular thrombectomy (EVT) is common. We aimed to determine factors associated with tissue infarction in the territories of distal emboli.MethodsThis is a retrospective cohort study of consecutive...

Increased Epicardial Adipose Tissue and Heart Characteristics Are Correlated with BMI and Predict Silent Myocardial Infarction in Sudden Cardiac Death Subjects: An Autopsy Study.

Sudden cardiac death (SCD) is a significant global public health issue and the leading cause of death worldwide. Its etiopathogenesis is complex and multilayered, involving dynamic factors interacting with a preexistent cardiovascular pathology, frequently unknown, and resulting in cardiac rhythm disorders and cardiac arrest; Methods: This study conducted a retrospective descriptive analysis over a one-year period, identifying 321 autopsy cases of sudden deaths from the Institute of Legal Medicine in Mures County, Romania, in 2019. From the 321 sudden death cases, 189 autopsy reports were selected for analysis based on inclusion and exclusion; Results: The autopsies had a mean age of 61.16 years and included 140 males and 49 females. No significant differences were found between the silent myocardial infarction (SMI) and no-SMI groups regarding demographic data. The SMI group exhibited higher thickness of LV (left ventricle), IV (interventricular septum), EAT LCx (epicardial adipose tissue at left circumflex artery), EAT LAD (epicardial adipose tissue at left anterior descending artery), heart weight, and BMI (body mass index). The left coronary artery showed a higher incidence of type V plaques, while the right coronary artery showed higher incidences of type V and type VI plaque. The SMI group also exhibited a higher incidence of moderate and severe valvular atherosclerosis, severe left ventricle dilatation, and a lower incidence of mild left ventricle dilatation. In addition, the SMI group showed a higher presence of contraction band necrosis on histological examination. Multivariate analysis revealed that type V and type VI plaques for the right and left coronary arteries, moderate and severe valvular atherosclerosis, severe left ventricle dilatation, heart weight, EAT LCx, EAT LAD, LV thickness, IV thickness, BMI, and the presence of contraction band necrosis are all independent predictors of SMI; Conclusions: The findings suggest that SCD is a complex condition, and its etiopathogenesis involves dynamic factors interacting with pre-existing cardiovascular pathology. The risk factors of SCD are similar to those of ischemic heart disease. The findings of this study could guide clinicians in identifying patients at risk of SCD and implementing preventive measures.

Effect of trehalose on heart functions in rats model after myocardial infarction: assessment of novel intraventricular pressure and heart rate variability.

Myocardial infarctions remain a leading cause of global deaths. Developing novel drugs to target cardiac remodeling after myocardial injury is challenging. There is an increasing interest in exploring natural cardioprotective agents and non-invasive tools like intraventricular pressure gradients (IVPG) and heart rate variability (HRV) analysis in myocardial infarctions. Trehalose (TRE), a natural disaccharide, shows promise in treating atherosclerosis, myocardial infarction, and neurodegenerative disorders. The objective of this study was to investigate the effectiveness of TRE in improving cardiac functions measured by IVPG and HRV and reducing myocardial remodeling following myocardial infarction in rat model. Rats were divided into three groups: sham, myocardial infarction (MI), and trehalose-treated MI (TRE) groups. The animals in the MI and TRE groups underwent permanent ligation of the left anterior descending artery. The TRE group received 2% trehalose in their drinking water for four weeks after the surgery. At the end of the experiment, heart function was assessed using conventional echocardiography, novel color M-mode echocardiography for IVPG evaluation, and HRV analysis. After euthanasia, gross image scoring, histopathology, immunohistochemistry, and quantitative real-time PCR were performed to evaluate inflammatory reactions, oxidative stress, and apoptosis. The MI group exhibited significantly lower values in multiple IVPG parameters. In contrast, TRE administration showed an ameliorative effect on IVPG changes, with results comparable to the sham group. Additionally, TRE improved HRV parameters, mitigated morphological changes induced by myocardial infarction, reduced histological alterations in wall mass, and suppressed inflammatory reactions within the infarcted heart tissues. Furthermore, TRE demonstrated antioxidant, anti-apoptotic and anti-fibrotic properties. The investigation into the effect of trehalose on a myocardial infarction rat model has yielded promising outcomes, as evidenced by improvements observed through conventional echocardiography, histological analysis, and immunohistochemical analysis. While minor trends were noticed in IVPG and HRV measurements. However, our findings offer valuable insights and demonstrate a correlation between IVPG, HRV, and other traditional markers of echo assessment in the myocardial infarction vs. sham groups. This alignment suggests the potential of IVPG and HRV as additional indicators for future research in this field.

Left ventricular shape index and eccentricity index assessed by gated PET/CT. Promising parameters for detection of left ventricular remodelling

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): University of Groningen/University Medical Center Groningen. Background Left ventricular (LV) remodelling has been described as the pathway that precedes heart failure. This process consists of changes in the shape, size, volume and function of the left ventricle; all of this directly associated to increased risk of major adverse cardiac events (MACEs). Different parameters are used to evaluate cardiac geometry in multiple cardiac imaging modalities. In nuclear medicine, LV geometry can be studied through shape index (SI) and eccentricity index (EI). These values examine the degree of sphericity (SI) and elongation (EI) of the left ventricle. However, in cardiac perfusion PET/CT, the LV remodelling has not been extensively studied with SI and EI values, and their role is yet to be elucidated. Purpose This project aim to describe the role of SI and EI values in patients examined by gated 13N-ammonia PET/CT in ischemic and infarction scenario. Methods We retrospectively randomly selected 140 patients referred to 13N-ammonia PET/CT between 2016 and 2022 for suspected or diagnosed CAD. The patients were classified in 4 groups of 35 patients according to the presence and burden of ischemia or infarction: normal=0% of scar burden and ischemic burden; mild ischemia=5–10% of ischemic burden; moderate-severe ischemia≥10% of ischemic burden and infarction≥5% of scar burden. We collected the information regarding myocardial flows (myocardial blood flow (MBF) at rest, hyperaemic MBF at stress and coronary flow reserve (CFR)) and left ventricular geometry (SI end-diastolic at rest and stress, SI end-systolic at rest and stress, and EI at rest and stress). All the variables were automatically processed with QPS/QGS software. We performed a multicomparison analysis for the mentioned variables with One way ANOVA variance and Dunnett’s Test as Post Hoc, stablishing as the control the infarction group. Results The study population consisted of 35.7% women, all patients over 36 years old, with no significant differences between groups regarding the presence of cardiac risk factors. The control group showed important changes in all SI and EI when compared to the rest of the groups. With a maximum change of 0.090 observed in SI end-systolic stress in the mild ischemia group, and a minimum change of −0.041 in EI rest in the moderate-severe ischemia group. Control subjects had statistically significant higher values of SI end-diastolic rest (p&amp;lt;0.001) and stress (p = 0.005), end-systolic rest (p = 0.001)and stress (p&amp;lt;0.001) and statistically significant lower values of EI rest (p&amp;lt;0.001) and stress (p&amp;lt;0.001) when compared with all the other groups. Additionally, all SI and EI values in stress follow a linear change proportional to the degree of myocardial extend (Figure 1 and 2). Conclusions(s) SI and EI by 13N-ammonia PET/CT are variables that seem clinically relevant for the early detection of LV remodeling. However, there is still research to do for establishing cut-off values and evaluating the prediction of MACEs.

#3485 IMPROVING THE DIAGNOSIS OF MYOCARDIAL INFARCTION IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Chronic Kidney Disease has significant morbidity and mortality owing to the increased prevalence in cardiovascular disease. This increase in morbidity and mortality is seen more so as glomerular filtration rate (GFR) declines, that is, advanced kidney failure with GFR equal to or less than 30ml/min/1.73m2. Hence, it is important to control risk factors and accurately diagnose myocardial infarction in this cohort of patients. Secondary objectives showed that social isolation was significantly associated with confirmed myocardial infarction. Additionally, ST changes, and T- QRS discordance on electrocardiogram were found more commonly in the myocardial infarction group. Other diagnostic tools such as angiography proved to be an underutilized investigation with a prevalence of 13% in the kidney disease cohort at the University of the West Indies during the years 2018 to 2020. Method In this retrospective cross-sectional study, data was collected from the online records system at the University of the West Indies. Patients with an admission diagnosis of acute coronary syndrome, unstable angina, non-ST elevation myocardial infarction, ST elevation myocardial infarction and chronic kidney disease were included in the study population. Cases were assigned based on whether or not myocardial infarction was confirmed on echocardiogram. Results Of the total number of 102 cases, 58 were chosen based on fulfillment of our inclusion criteria. 13 (22.4%) had echocardiographic evidence of a new myocardial infarction while 44 (75.9%) had no echocardiographic evidence of new myocardial infarction. Receiver Operator Characteristic Curves (ROC) used to evaluate the diagnostic performance of high sensitivity cardiac troponin T and interval/ delta changes showed an ideal value 141.50ng/L on first troponin T and 100.75ng/L on serial troponin T with delta change of 20.5%, (sensitivities of 61.5%, 72.7% and 72.7% respectively). Area under the Receiver-Operating Characteristic Curve (AUC) used to determine the diagnostic accuracy of the highly sensitivity cardiac troponin T and interval delta change demonstrated high accuracy of 0.708 for the first troponin T, 0.750 for the second troponin T and 0.767 for the interval or delta change. Conclusion Overall, we showed that serial troponin measurements in kidney disease patients increase sensitivity for predicting myocardial infarction and that the values are nearly 10 times that used for the general population. An interval change of 20.5% was also predictive of myocardial infarction.

Characterization and Summarization of the Impact of Electronic Cigarettes on the Cardiovascular System: A Systematic Review and Meta-Analysis.

Electronic cigarettes may increase the risk of long-term cardiovascular morbidity. To protect the heart, awareness should be raised of the risks and limits of E-cigarette aerosol exposure. Thus, this systematic review and meta-analysis assessed the cardiovascular risk of e-smoking. This systematic review was conducted by using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We searched PubMed, Embase, Scopus, Web of Science, and Science Direct databases in December 2022 to identify studies investigating e-cigarettes' impact on the heart. The study was supported by meta-analysis and qualitative review. Out of the initial 493 papers, only 15 met the inclusion criteria and were included in the study. The cumulative number of participants in the myocardial infarction (MI) group was 85,420, and in the sympathetic groups in whom the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were measured, were 332 cigarette smokers. The control group included the "never use," "non-smokers," and "never smoke." The pooled analysis showed a significant difference between the e-cigarette smokers and the control group regarding the risk of developing MI in former smokers (OR= 0.12; 95% CI:0.01-1.72, P = 0.12) and never smoked (OR= 0.02; 95% CI:0.00-0.44, P = 0.01) favoring the control group. The pooled analysis of the included studies showed a significant difference between the e-cigarette smokers with nicotine and the control group regarding the mean difference (MD) of the SBP (MD = 2.89; 95% CI: 1.94-3.84; P < 0.001), the DBP (MD = 3.10; 95% CI: 0.42-5.78; P = 0.02), the MBP (MD = 7.05; 95% CI: 2.70-1.40; P = 0.001), and HF (MD = 3.13; 95% CI: 0.96-5.29; P = 0.005) favoring the control group. We conclude that using e-cigarettes has a detrimental effect on cardiac health. The risk of severe cardiac conditions increases with e-cigarettes. Thus, vaping can do more harm than good. Consequently, the misleading notion that e-cigarettes are less harmful should be challenged.

Predictive value of metabolic score for insulin resistance and triglyceride glucose-BMI among patients with acute myocardial infarction in 1-year follow-up.

Recently two indicators - metabolic score for insulin resistance (METS-IR) and triglyceride glucose-BMI (TyG-BMI) have been proposed as surrogate markers of IR and potential cardiovascular risk factors. The aim of the study was to assess the predictive value of METS-IR and TyG-BMI concerning the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in 1-year follow-up among patients admitted with acute myocardial infarction (AMI). Two thousand one hundred fifty-three patients with a median age of 68 years were enrolled in the study. Patients were divided into two groups according to the type of AMI. MACE occurred in 7.9% of the patients in the ST-segment elevation myocardial infarction (STEMI) group and in 10.9% of the non-STEMI (NSTEMI) group. No significant difference in median MACE-IR and TyG-BMI between patients with and without incidence of MACE was found in both groups. None of the examined indices were predictors of MACE in the STEMI and NSTEMI groups. Moreover, both of them did not predict MACE in subgroups of patients classified according to the presence of diabetes. Finally, METS-IR and TyG-BMI were significant predictors of 1-year morality, however with low prognostic value and only in univariate regression analysis. METS-IR and TyG-BMI should not be used in predicting MACE among patients with AMI.

Interleukin-33/sST2: Dynamic assessment in patients with acute coronary syndrome

PurposeInterleukin (IL)-33 and its soluble receptor ST2 (sST2) play a crucial role in the immune response. sST2 has been approved by the Food and Drug Administration as a prognostic biomarker of mortality in chronic heart failure patients, however, the role of IL-33 and sST2 in atherosclerotic cardiovascular disease remains unclear. The aim of this study was to measure serum level of IL-33 and sST2 of patients at the onset of acute coronary syndrome (ACS) and 3 months after primary percutaneous revascularization. Patients and methodsForty patients were divided into ST segment elevation myocardial infarction (STEMI) group, non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) group. IL-33 and sST2 level were measured with ELISA. Additionally, IL-33 expression in peripheral blood mononuclear cells (PBMCs), was evaluated. ResultsAll ACS patients had a significantly lower level of sST2 3 months after ACS as compared to the baseline (p ​< ​0.039). The STEMI patients had higher serum levels of IL-33 at the moment of ACS as compared to 3 months after the event, with an average decrease of 17.87 ​pg/ml (p ​< ​0.007). Conversely, sST2 serum levels were still high after 3 months following an ACS in STEMI patients. ROC curve demonstrated that increased IL-33 serum level could be STEMI predictor. ConclusionsThe assessment of the baseline and dynamics of changes in IL-33 and sST2 concentrations in patients with ACS may be important for the diagnostic process and may help in understanding of how the immune mechanisms work at the moment of an ACS event.

Associations between short-term exposure to ambient PM2.5 and incident cases of cardiovascular disease in Yantai, China

ABSTRACT There are limited studies investigating the association between short-term exposure to PM2.5 and incident cardiovascular disease (CVD) cases in China. This study aims to examine the short-term effects of PM2.5 on the incidence of cardiovascular diseases. A combination of Poisson-distribution generalized linear model and distributed lag non-linear model was used to examine the association between short-term exposure to PM2.5 and incident cases of CVD. The results revealed that per 10 µg/m3 increment of PM2.5 would increase the incident CVD cases by 0.147% (Relative Risk: 1.00147, 95% Confidence Interval: 1.00008–1.00286) at a lag of 2 days. The stratified analyses showed higher effects risk in females, older residents (aged 60–75 years), and acute myocardial infarction group (p-value for difference <0.05). This study indicates that short-term exposure to PM2.5 may increase the risk of CVD and highlights the necessity for a higher air quality standard in Yantai, China.

Association of Cerebral Hemodynamics and Cognitive Function in Adult Patients with Moyamoya Disease: A Three-Dimensional Pseudo-Continuous Arterial Spin Labeling Study

Cognitive dysfunction is a serious complication of moyamoya disease (MMD) in adults, and reduced cerebral blood flow (CBF) might be the potential cause. We aimed to explore the correlation between cerebral hemodynamics and cognitive function in adults with MMD by using three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL). A total of 24 MMD patients with a history of cerebral infarction, 25 asymptomatic MMD patients, and 25 healthy controls were prospectively enrolled in this study. All participants were performed 3D-pCASL, and cognitive function was evaluated with the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment Scale (MoCA), and the Trail Making Test Part A (TMTA). The correlation between cerebral hemodynamics and cognitive function was explored in the region of interest-based analysis. Compared with healthy controls, both CBF and cognition decreased in adult MMD. In the infarction group, the MMSE and MoCA scores correlated with CBF of the right anterior cerebral artery (P=0.037 and 0.010, respectively) and the left middle cerebral artery (MCA) cortical territories (P=0.002 and 0.001, respectively), and the TMTA time-consuming has a negative correlation with CBF of the right and left MCA cortical territories (P=0.044 and 0.010, respectively); in the asymptomatic group, the MMSE and MoCA scores correlated with CBF of the left MCA cortical territory (P=0.032 and 0.029, respectively). The 3D-pCASL can find the hypoperfusion area of CBF in adults with MMD, and hypoperfusion in specific brain regions may cause cognitive dysfunction even in asymptomatic patients.

Prevalence, hematological parameters, and coagulation profiles: Cardiovascular diseases statistics in the Asir region, Saudi Arabia.

To determine the prevalence of cardiovascular disease (CVD) types in the Asir region of Saudi Arabia and the importance of hematological testing for CVD patients in the context of disease management. This retrospective study comprised 416 CVD patients, and samples were divided based the type of CVD. The Mann Whitney U test was used to compare patients' hematological markers and coagulation profiles to those of healthy controls. The rate of ischemic heart disease (IHD) was 80.7% that of other CVDs, and the rate of ST-elevation myocardial infarction (STEMI) was 37.3% the rate of CVD. Significant differences were observed in the hematological and coagulation parameters of CVD patients compared to the control group. White blood cells (WBC) were significantly higher in STEMI, non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), and heart failure (HF) groups. Red blood cells (RBC) were significantly lower in STEMI, NSTEMI, UA, chronic coronary syndrome (CCS), HF, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM). Red distribution width (RDW) was significantly greater in the HF, DCM, and ICM groups. Prothrombin time (PT) was significantly higher in the STEMI, HF, and DCM groups. ST-elevation myocardial infarction has a higher prevalence rate among CVD patients in the Asir region. Both coagulation and hematological indicators have high potential utility as CVD diagnostic and prognostic markers.