Ischemic Infarction Research Articles

Neurological and cardiopulmonary manifestations of pulmonary arteriovenous malformations.

Pulmonary arteriovenous malformations (PAVMs) are direct pulmonary artery-to-vein connections without pulmonary capillaries that result in intrapulmonary right-to-left blood shunts. Although most patients with PAVMs may be entirely asymptomatic, PAVMs can induce a series of complications involving the neurological, cardiovascular, and respiratory systems that can lead to catastrophic and often fatal clinical sequelae. In this study we review the available literature and summarize the reported PAVM-related complications among patients with PAVMs. The reviewed studies included observational studies, case studies, prospective studies, and cohort studies, and we provide an overview of PAVM-related neurological and cardiopulmonary manifestations, including stroke, cerebral abscess, transient ischemic attack, cerebral hemorrhage, migraine, seizure, dizziness, cardiac failure, arrhythmia, myocardial infarction, cough, hypoxemia, dyspnea, respiratory failure, hemoptysis, and hemothorax. Identifying and treating PAVMs before the presentation of major complication is important because this can prevent the occurrence of complications and can result in better outcomes. PAVM patients should thus be better evaluated and managed by a multidisciplinary team because they may be in a treatable phase prior to their condition becoming life-threatening.

Two Patients With Ipsilateral Cerebellar Hemorrhage After Superficial Temporal Artery-Middle Cerebral Artery Bypass Grafting.

To summarize the clinical experience of ipsilateral cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass surgery. The clinical data of 2 patients with cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass grafting were retrospectively collected, including 1 case with left cerebellar hemorrhage after left cerebral artery bypass grafting and 1 case with right cerebellar hemorrhage after right cerebral artery bypass grafting. The perioperative blood pressure, laboratory, and imaging data were analyzed. All patients had a history of hypertension, and their perioperative blood pressure was stable. Low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were normal before the operation. Cerebral magnetic resonance imaging showed cerebral atherosclerosis and multiple ischemic cerebral infarcts. At 24 hours after surgery, the patients' continuous epidural low drainage was 260 mL and 160 mL, respectively. The amount of cerebellar bleeding was small, and no new sequelae were left after conservative treatment with drugs. Cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass grafting is related to perioperative blood pressure fluctuation, hemodynamic changes, hemorrhagic transformation of ischemic lesions, and excessive cerebrospinal fluid drainage. Maintaining stable blood pressure during the perioperative period and avoiding excessive and rapid loss of cerebrospinal fluid after operation can reduce the occurrence of this complication.

Saturated fatty acids and total and CVD mortality in Norway: a prospective cohort study with up to 45 years of follow-up.

The contribution of dietary saturated fatty acids (SFA) to cardiovascular disease (CVD) and mortality remains debated after decades of research. Few previous studies had repeated dietary assessments and power to assess mortality. Evidence for individual SFA is limited. In this large population-based cohort study, we investigated associations between intake of total and individual SFA and risk of total and CVD mortality. Adult residents (mean 41·1 years at baseline) in three Norwegian counties were invited to repeated health screenings between 1974 and 1988 (> 80 % attendance). We calculated cumulative average intakes of macronutrients from semi-quantitative FFQ. Median (interquartile range) intake of SFA was 14·6 % (12·8-16·6 %) of total energy (E%). Hazard ratios (HR) and 95 % CI were estimated using multivariable Cox regression models to assess total, CVD, ischaemic heart disease (IHD) and acute myocardial infarction (AMI) mortality. Among 78725 participants, 28555 deaths occurred during a median follow-up of 33·5 years, with 9318 deaths due to CVD. Higher intake of SFA (replacing carbohydrates) was positively associated with all mortality endpoints, including total (HR per 5 E% increment, 1·18; 95 % CI 1·13, 1·23) and CVD mortality (1·16; 95 % CI 1·07, 1·25). Theoretical isoenergetic substitution of SFA with carbohydrates or MUFA was associated with lower risk. Of individual SFA, myristic (14:0) and palmitic acid (16:0) were positively associated with mortality. In summary, dietary SFA intake was strongly associated with higher total and CVD mortality in this long-term cohort study. This supports policies implemented to reduce SFA consumption in favour of carbohydrates and unsaturated fats.

Automated ASPECTS Segmentation and Scoring Tool: a Method Tailored for a Colombian TelestrokeNetwork.

To evaluate our two non-machine learning (non-ML)-based algorithmic approaches for detecting early ischemic infarcts on brain CT images of patients with acute ischemic stroke symptoms, tailored to our local population, to be incorporated in our telestroke software. One-hundred and thirteen acute stroke patients, excluding hemorrhagic, subacute, and chronic patients, with accessible brain CT images were divided into calibration and test sets. The gold standard was determined through consensus among three neuroradiologist. Four neuroradiologist independently reported Alberta Stroke Program Early CT Scores (ASPECTSs). ASPECTSs were also obtained using a commercial ML solution (CMLS), and our two methods, namely the Mean Hounsfield Unit (HU) relative difference (RELDIF) and the density distribution equivalence test (DDET), which used statistical analyze the of the HUs of each region and its contralateral side. Automated segmentation was perfect for cortical regions, while minimal adjustment was required for basal ganglia regions. For dichotomized-ASPECTSs (ASPECTS < 6) in the test set, the area under the receiver operating characteristic curve (AUC) was 0.85 for the DDET method, 0.84 for the RELDIF approach, 0.64 for the CMLS, and ranged from 0.71-0.89 for the neuroradiologist. The accuracy was 0.85 for the DDET method, 0.88 for the RELDIF approach, and was ranged from 0.83 - 0.96 for the neuroradiologist. Equivalence at a margin of 5% was documented among the DDET, RELDIF, and gold standard on mean ASPECTSs. Noninferiority tests of the AUC and accuracy of infarct detection revealed similarities between both DDET and RELDIF, and the CMLS, and with at least one neuroradiologist. The alignment of our methods with the evaluations of neuroradiologist and the CMLS indicates the potential of our methods to serve as supportive tools in clinical settings, facilitating prompt and accurate stroke diagnosis, especially in health care settings, such as Colombia, where neuroradiologist are limited.

The Ethanolic Extract of Polygala paniculata L. Blocks Panx1 Channels and Reduces Ischemic Brain Infarct in a Dose- and Sex-Dependent Way.

Polygala paniculata L. is a native plant from tropical America. The therapeutic potential of the hydroalcoholic extract of P. paniculata (HEPp) has been scientifically explored due to folk medicine reports on its action against several afflictions. HEPp contains several bioactive molecules with neuroprotective activities, making it a promising candidate for stroke treatment. This study used electrophysiological, biochemical, and in vivo experiments to evaluate the molecular mechanisms underlying HEPp as a neuroprotective therapy for stroke targeting Pannexin-1 (Panx1). Panx1 is a non-selective channel that opens during ischemia and contributes to neuronal death. HEPp was not toxic to cortical neurons and pre-treatment with the extract reduced neuronal death promoted by oxygen and glucose deprivation in a dose-dependent manner. Additionally, HEPp blocked Panx1 currents in a dose-dependent manner and the effect, which was shown to be partially due to rutin. Animals submitted to photothrombosis and post-treated with HEPp had reduced infarct volume, and the effective dose was lower in males (1mg/kg) than in females (10mg/kg). On the other hand, in Panx1 KD mice (50% Panx1 levels), the acute treatment reduced the infarct volume only in males. Upon chronic treatment with HEPp, a reduction in Panx1 protein levels was observed. The current study provides reliable evidence of the neuroprotective properties of HEPp in both in vitro and in vivo models of stroke. The underlying mechanism involves, at least in part, the inhibition of Panx1 channel function and possibly downregulation of protein levels, suppressing the secondary events that lead to apoptosis and inflammation.

High Resting Heart Rate Is Associated with Cardiovascular Death in Patients with Stroke, Independent of Sex

Introduction: High resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analyzed whether HRHR (>86 bpm) adds incremental prognostic value for stroke outcomes in women. Methods: We analyzed data of 6,024 patients (2,568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA). Results: Patients with HRHR were more often female (45.3 vs. 41.8%, p = 0.017), younger (66.0 ± 13.2 vs. 67.8 ± 12.6 years, p < 0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p < 0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03 ± 1.98 vs. 2.82 ± 1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with poststroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90. Conclusion: HRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) 3 months after stroke, independent of HRHR.

Integrated Strategies for Targeting Arteriogenesis and Angiogenesis After Stroke.

The interdependence between arteriogenesis and angiogenesis is crucial for enhancing perfusion by synchronously improving leptomeningeal collaterals (LMCs) and microvascular networks after stroke. However, current approaches often focus on promoting arteriogenesis and angiogenesis separately, neglecting the potential synergistic benefits of targeting both processes simultaneously. Therefore, it is imperative to consider both arteriogenesis and angiogenesis as integral and complementary strategies for post-stroke revascularization. To gain a deeper understanding of their relationships after stroke and to facilitate the development of targeted revascularization strategies, we compared them based on their timescale, space, and pathophysiology. The temporal differences in the occurrence of arteriogenesis and angiogenesis allow them to restore blood flow at different stages after stroke. The spatial differences in the effects of arteriogenesis and angiogenesis enable them to specifically target the ischemic penumbra and core infarct region. Additionally, the endothelial cell, as the primary effector cell in their pathophysiological processes, is promising target for enhancing both. Therefore, we provide an overview of key signals that regulate endothelium-mediated arteriogenesis and angiogenesis. Finally, we summarize current therapeutic strategies that involve these signals to promote both processes after stroke, with the aim of inspiring future therapeutic advances in revascularization.

Coronary Arteries Lesions in Kawasaki Disease: Risk Factors in an Italian Cohort.

Background: Kawasaki disease (KD) is a systemic vasculitis of medium arteries, particularly involving coronary arteries. Coronary artery lesions (CALs) is the most serious complication in the acute stage, potentially leading to ischemic cardiomyopathy, myocardial infarction and sudden death. Environmental factors and genetic background contribute to individual susceptibility to develop CALs. The aim of this study was to define the risk factors for CALs in an Italian cohort. Methods: Data of KD patients from 10 Italian sites were registered into a REDCap database where demographic and clinical data, laboratory findings and coronary status were recorded. KD was diagnosed according to AHA definition. We used multiple logistic regression analysis to identify independent risk factors for CALs. Results: A total of 517 patients were enrolled, mainly Caucasians (83.6%). Presentation was complete in 321 patients (62.8%) and IVIG responsiveness in 360 (70%). CALs developed in 136/517 (26.31%). Gender, age, ethnicity, clinical presentation, fever duration, non-coronary cardiac events, Hb, albumin and CRP were significantly different between patients with and without CALs, while seasonality was not. Male gender, age < 18 months, Asian ethnicity, incomplete presentation and fever > 10 days were independent risk factors for CALs. Conclusions: Age younger than 18 months, incomplete KD and longer fever duration are risk factors for CALs. Asian ethnicity also represents a risk factor in our Italian Cohort.

Diffusion tensor imaging and gray matter volumetry to evaluate cerebral remodeling processes after a pure motor stroke: a longitudinal study

Background and objectivesClinical factors are not sufficient to fix a prognosis of recovery after stroke. Pyramidal tract or alternate motor fiber (aMF: reticulo-, rubrospinal pathways and transcallosal fibers) integrity and remodeling processes assessable by diffusion tensor MRI (DTI) and voxel-based morphometry (VBM) may be of interest. The primary objective was to study longitudinal cortical brain changes using VBM and longitudinal corticospinal tract changes using DTI during the first 4 months after lacunar cerebral infarction. The second objective was to determine which changes were correlated to clinical improvement.MethodsTwenty-one patients with deep brain ischemic infarct with pure motor deficit (NIHSS score ≥ 2) were recruited at Purpan Hospital and included. Motor deficit was measured [Nine peg hole test (NPHT), dynamometer (DYN), Hand-Tapping Test (HTT)], and a 3T MRI scan (VBM and DTI) was performed during the acute and subacute phases.ResultsWhite matter changes: corticospinal fractional anisotropy (FACST) was significantly reduced at follow-up (approximately 4 months) on the lesion side. FAr (FA ratio in affected/unaffected hemispheres) in the corona radiata was correlated to the motor performance at the NPHT, DYN, and HTT at follow-up. The presence of aMFs was not associated with the extent of recovery. Grey matter changes: VBM showed significant increased cortical thickness in the ipsilesional premotor cortex at follow-up. VBM changes in the anterior cingulum positively correlated with improvement in motor measures between baseline and follow-up.DiscussionTo our knowledge, this study is original because is a longitudinal study combining VBM and DTI during the first 4 months after stroke in a series of patients selected on pure motor deficit. Our data would suggest that good recovery relies on spared CST fibers, probably from the premotor cortex, rather than on the aMF in this group with mild motor deficit. The present study suggests that VBM and FACST could provide reliable biomarkers of post-stroke atrophy, reorganization, plasticity and recovery.ClinicalTrials.gov IdentifierNCT01862172, registered May 24, 2013

P114 SHORT-TERM EFFECTS OF BLOOD PRESSURE LOWERING DRUGS ON CARDIOVASCULAR EVENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED, PLACEBO-CONTROLLED, DOUBLED-BLIND TRIALS

Background and Objective: There remains uncertainty about the short-term effects of blood pressure (BP) lowering drugs on cardiovascular events. This meta-analysis of double-blind, short-term randomised trials, evaluated the effect of BP-lowering drugs on cardiovascular events compared to placebo. Methods: A systematic search was performed in the following databases: MEDLINE, Cochrane Central Register of Controlled Trials, and Epistemonikos. Trials satisfying the following criteria were included: (i) randomized, double-blind placebo-controlled trials of 2-26 weeks published in English language; (ii) adults (age ≥18 years) with hypertension (BP ≥140/90 mmHg) or taking BP-lowering drugs; (iii) intervention: oral fixed dose of BP-lowering drug(s) as either monotherapy or combination therapy from five major classes (angiotensin converting enzyme, angiotensin-II receptor blockers, calcium channel blockers, beta-blockers, and diuretics); (iv) placebo comparator; (v) reported data on cardiovascular events; (vi). The primary outcome was major adverse cardiovascular events (MACE), defined as stroke, transient ischaemic attack (TIA), myocardial infarction, heart failure, angina or coronary revascularisation. Results: 451 trials (93121 participants [mean age 54yrs, 56% males, mean follow-up 8 weeks] were included. There was no effect of the intervention compared to placebo on MACE (0.19% versus 0.43%; relative risk [RR] 0.89, 95% CI 0.69-1.14, p=0.35). There was a significant reduction in stroke (0.01% versus 0.05%; RR 0.37 [0.19-0.72]; p&lt;0.001) and TIA (0.001% versus 0.01%; RR 0.26 [0.08-0.82]; p=0.02). Subgroup analysis suggested combination therapy provided the most benefit in stroke reduction (RR 0.21 [0.04-1.01], p=0.05), but benefits were observed across all anti-hypertensive groups for TIA outcomes. There were no between group differences in all-cause or cardiovascular mortality, myocardial infarction, heart failure hospitalization, angina or coronary secularization. Conclusions: This meta-analysis of placebo-controlled RCTs demonstrated reduced stroke and TIA events with BP-lowering drugs even at short-term follow up. These findings suggest BP lowering treatment should be initiated as soon as possible in at risk individuals because even 8 weeks of treatment can significantly reduce the risk of stroke/TIA.

Inhibition of cGAS attenuates neonatal hypoxic-ischemic encephalopathy via regulating microglia polarization and pyroptosis.

Neonatal hypoxic-ischemic encephalopathy (HIE) is a condition causing brain injury in newborns with unclear pathogenesis. Cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) signaling pathway and NOD-like receptor protein 3 (NLRP3) mediated pyroptosis are thought to be involved in the pathological process of HIE, but whether these two mechanisms act independently is still unknown. Therefore, we aim to clarify whether there is any interaction between these two pathways and thus synergistically affects the progression of HIE. The HIE model of neonatal rats was established using the Rice-Vannucci method. The potential therapeutic effect of RU.521 targeting cGAS on HIE was explored through rescue experiment. Twenty-four hours after modeling was selected as observation point, sham + vehicle group, HIE + vehicle group and HIE + RU.521 group were established. A complete medium of BV2 cells was adjusted to a glucose-free medium, and the oxygen-glucose deprivation model was established after continuous hypoxia for 4 hours and reoxygenation for 12 to 24 hours. 2,3,5-triphenyl tetrazolium chloride staining was employed to detect ischemic cerebral infarction in rat brain tissue, and hematoxylin and eosin staining was used to observe tissue injury. Immunofluorescence was applied to monitor the expression of cGAS. Real-time quantitative polymerase chain reaction and western blot were utilized to detect the expression of messenger RNA and protein. cGAS expression was increased in brain tissues of neonatal rats with HIE, and mainly localized in microglia. RU.521 administration reduced infarct size and pathological damage in rat HIE. Moreover, blocking cGAS with RU.521 significantly reduced inflammatory conditions in the brain by down-regulating STING expression, decreasing NLRP3 inflammasome activation and reducing microglial pyroptosis both in vivo and in vitro. Besides, RU.521 promoted the switching of BV2 cells towards the M2 phenotype. This study revealed a link between the cGAS/STING pathway and the NLRP3/GSDMD/pyroptosis pathway in neonatal HIE. Furthermore, the small molecule compound RU.521 can negatively regulate cGAS/STING/NLRP3/pyroptosis axis and promote M2 polarization in microglia, which provides a potential therapeutic strategy for the treatment of neuroinflammation in HIE.

POST HERPETIC BASAL GANGLIA STROKE IN AN ADOLESCENT GIRL: BRIEF REVIEW OF LITERATURE AND A CASE REPORT

Herpes simplex encephalitis (HSE) is a leading cause of sporadic, non-epidemic viral encephalitis in children and adults. We report a very rare case of HSE complicated by multiple ischaemic infarcts involving both basal ganglia in a 15-year-old female adolescent admitted with complaints of headache and fever, irrational behavior and seizures. On clinical examination patient was unconscious with signs of raised intracranial pressure, right hemiparesis and meningeal irritation. She had elevated temperature (38.7°C), and anaemia (packed cell volume of 25.0%). Magnetic resonance imaging showed features of Multiple non-enhancing hypodensities in both basal ganglia with mild dilation of the 3rd and lateral ventricles. She was managed as a case of Post-encephalitis Basal ganglia stroke. The patient subsequently developed a repeat vascular event, with suspected haemorrhagic transformation after 4 weeks and succumbed to the illness.

Perinatal arterial ischemic stroke diagnosed in infants receiving therapeutic hypothermia for hypoxic-ischemic encephalopathy.

Both perinatal arterial ischemic stroke (PAIS) and hypoxic-ischemic encephalopathy (HIE) can present with neonatal encephalopathy. We hypothesized that among infants undergoing therapeutic hypothermia, presence of PAIS is associated with a higher risk of seizures and a lower risk of persistent encephalopathy after rewarming. We studied 473 infants with moderate or severe HIE enrolled in the HEAL Trial who received a brain MRI. We defined PAIS as focal ischemic infarct(s) within an arterial distribution, and HIE pattern of brain injury as central gray, peripheral watershed, or global injury. We compared the risk of seizures (clinically suspected or electrographic), and of an abnormal 5-day Sarnat exam, in infants with and without PAIS. PAIS was diagnosed in 21(4%) infants, most of whom (16/21, 76%) also had concurrent HIE pattern of brain injury. Infants with PAIS were more likely to have seizures (RR 2.4, CI 2.8-3.3) and persistent moderate or severe encephalopathy on 5-day Sarnat exam (RR 2.5, 95% CI 1.9-3.4). Among infants undergoing therapeutic hypothermia, PAIS typically occurs with concurrent HIE pattern brain injury. The higher rate of encephalopathy after rewarming in infants with PAIS may be due to the frequent co-existence of PAIS and HIE patterns of injury.

Complex presentation of atypical hemolytic uremic syndrome: A case study

This case study discusses atypical hemolytic uremic syndrome (aHUS) in a 67-year-old female who presented with hypertension and hyperlipidemia 8 days after a suspected foodborne illness. Her initial presentation included acute respiratory and renal failure in which her condition required extensive re-warming, intubation, pressor or vasopressor therapy, continuous renal replacement therapy or hemodialysis, broad-spectrum antibiotic therapy, and blood and culture workups. Kidney function also showed signs of renal failure, metabolic acidosis, thrombocytopenia, and an elevated level of lactate dehydrogenase in the laboratory results. Radiological investigations demonstrated enteritis, colitis, and an ischemic infarct without hemorrhage. Multidisciplinary consultations achieved the importance and urgency of early diagnosis and treatment of aHUS to prevent irreversible organ damage. This case highlights the role of a timely diagnosis and interprofessional patient care in the treatment of severe aHUS.

2023 International Evidence-Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta-Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is the most prevalent female endocrinopathy. Although increased cardiovascular risk factors are well established for the syndrome, PCOS remains overlooked within the realm of cardiology. We conducted a systematic review and meta-analysis on the risk of clinical cardiovascular disease (CVD) events in women with PCOS to inform the 2023 International Evidence-Based PCOS Guideline. A systematic review and meta-analysis was conducted comparing the risk of clinical CVD events in women with and without PCOS. Medline (Ovid), PsycInfo (Ovid), EMBASE, All EBM (Ovid), and CINAHL were searched from January 1, 2017, until March 1, 2023, to update the 2018 PCOS Guideline. Pooled odds ratios (ORs), incidence rate ratios (IRRs), and hazard ratios (HRs) were calculated. Twenty studies involving 1.06 million women (369 317 with PCOS and 692 963 without PCOS) were included. PCOS was associated with higher risk of composite CVD (OR, 1.68 [95% CI, 1.26-2.23]; I2 = 71.0%), composite ischemic heart disease (OR, 1.48 [95% CI, 1.07-2.05]; I2 = 81.0%), myocardial infarction (OR, 2.50 [95% CI, 1.43-4.38]; I2 = 83.3%), and stroke (OR, 1.71 [95% CI, 1.20-2.44]; I2 = 81.4%). The relationship with cardiovascular mortality was less clear (OR, 1.19 [95% CI, 0.53-2.69]; I2 = 0%). Meta-analyses of IRRs support these findings. Results from pooled HRs were limited by the small number of studies and significant heterogeneity. This review provides evidence and highlights the importance of recognizing PCOS as a significant risk factor for CVD morbidity. The 2023 International Evidence-Based PCOS Guideline now recommends awareness of increased CVD risk and comprehensive risk assessment in PCOS to help mitigate the burden of CVD in this common and high-risk condition.

Buyang Huanwu decoction ameliorates myocardial injury and attenuates platelet activation by regulating the PI3 kinase/Rap1/integrin α(IIb)β(3) pathway

BackgroundBuyang Huanwu Decoction (BYHWD) is a traditional Chinese medicine to treat the syndrome of qi deficiency and blood stasis. Platelets play an important role in regulating thrombus and inflammation after ischemic injury, studies have shown that BYHWD regulate myocardial fibrosis and exert anti-inflammatory effects through IL-17 and TLR4 pathways, but the mechanism of platelet activation by BYHWD in stable coronary heart disease is still unknown. In the present study, model of left anterior descending coronary artery ligation was applied to investigate the mechanisms of BYHWD on modulating platelets hyperreactivity and heart function after fibrosis of ischemic myocardial infarction (MI).MethodsMyocardial infarction model was constructed by ligation of the left anterior descending coronary artery. The rats were randomly divided into five groups: sham, model, MI with aspirin (positive), MI with a low dosage of BYHWD (BYHWD-ld) and MI with a high dosage of BYHWD (BYHWD-hd) for 28 days.ResultsCoronary artery ligation prominently induced left ventricle dysfunction, increased cardiomyocyte fibrosis, which was accompanied by platelets with hyperreactivity, and high levels of inflammatory factors. BYHWD obviously reversed cardiac dysfunction and fibrosis, increased the thickness of the left ventricular wall, and inhibited aggregation ratio and CD62p expression. BYHWD restored the mitochondrial respiration of platelets after MI, concomitant with an increased telomere expression and decreased inflammation. According to the result of transcriptome sequencing, we found that 106 differentially expressed genes compared model with BYHWD treatment. Enrichment analysis screened out the Ras-related protein Rap-1 (Rap1) signaling pathway and platelet activation biological function. Quantitative real-time PCR and Western blotting were applied to found that BYHWD reduced the expression of Rap1/PI3K-Akt/Src-CDC42 genes and attenuated the overactivity of PI3 kinase/Rap1/integrin α(IIb)β(3) pathway.ConclusionBYHWD reduced inflammation and platelet activation via the PI3 kinase/Rap1/integrin α(IIb)β(3) pathway and improved heart function after MI.Graphical

Characterizing thrombus adhesion strength on common cardiovascular device materials.

Thrombus formation in blood-contacting medical devices is a major concern in the medical device industry, limiting the clinical efficacy of these devices. Further, a locally formed clot within the device has the potential to detach from the surface, posing a risk of embolization. Clot embolization from blood-contacting cardiovascular devices can result in serious complications like acute ischemic stroke and myocardial infarction. Therefore, clot embolization associated with device-induced thrombosis can be life-threatening and requires an enhanced fundamental understanding of embolization characteristics to come up with advanced intervention strategies. Therefore, this work aims to investigate the adhesive characteristics of blood clots on common biocompatible materials used in various cardiovascular devices. This study focuses on characterizing the adhesion strength of blood clots on materials such as polytetrafluoroethylene (PTFE), polyurethane (PU), polyether ether ketone (PEEK), nitinol, and titanium, frequently used in medical devices. In addition, the effect of incubation time on clot adhesion is explored. Results from this work demonstrated strongest clot adhesion to titanium with 3h of incubation resulting in 1.06 ± 0.20kPa detachment stresses. The clot adhesion strength on titanium was 51.5% higher than PEEK, 35.9% higher than PTFE, 63.1% higher than PU, and 35.4% higher than nitinol. Further, adhesion strength increases with incubation time for all materials. The percentage increase in detachment stress over incubation time (ranging from 30min to 3h) for polymers ranged from at least 108.75% (PEEK), 140.74% (PU), to 151.61% (PTFE). Whereas, for metallic surfaces, the percentage rise ranged from 70.21% (nitinol) to 89.28% (titanium). Confocal fluorescence imaging of clot remnants on the material surfaces revealed a well-bounded platelet-fibrin network at the residual region, representing a comparatively higher adhesive region than the non-residual zone of the surface.

Apixaban vs Aspirin in Patients With Cancer and Cryptogenic Stroke

Approximately 10% to 15% of ischemic strokes are associated with cancer; cancer-associated stroke, particularly when cryptogenic, is associated with high rates of recurrent stroke and major bleeding. Limited data exist on the safety and efficacy of different antithrombotic strategies in patients with cancer and cryptogenic stroke. To compare apixaban vs aspirin for the prevention of adverse clinical outcomes in patients with history of cancer and cryptogenic stroke. Post hoc analysis of data from 1015 patients with a recent cryptogenic stroke and biomarker evidence of atrial cardiopathy in the Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial, a multicenter, randomized, double-blind clinical trial conducted from 2018 to 2023 at 185 stroke centers in North America. Data analysis was performed from October 15, 2023, to May 23, 2024. Oral apixaban, 5 mg (or 2.5 mg if criteria met), twice daily vs oral aspirin, 81 mg, once daily. Subgroups of patients with and without cancer at baseline were examined. The primary outcome for this post hoc analysis was a composite of major ischemic or major hemorrhagic events. Major ischemic events were recurrent ischemic stroke, myocardial infarction, systemic embolism, and symptomatic deep vein thrombosis or pulmonary embolism. Major hemorrhagic events included symptomatic intracranial hemorrhage and any major extracranial hemorrhage. Among 1015 participants (median [IQR] age, 68 [60-76] years; 551 [54.3%] female), 137 (13.5%) had a history of cancer. The median (IQR) follow-up was 1.5 (0.6-2.5) years for patients with history of cancer and 1.5 (0.6-3.0) years for those without history of cancer. Participants with history of cancer, compared with those without history of cancer, had a higher risk of major ischemic or major hemorrhagic events (hazard ratio [HR], 1.73; 95% CI, 1.10-2.71). Among those with history of cancer, 8 of 61 participants (13.1%) randomized to apixaban and 16 of 76 participants (21.1%) randomized to aspirin had a major ischemic or major hemorrhagic event; however, the risk was not significantly different between groups (HR, 0.61; 95% CI, 0.26-1.43). Comparing participants randomized to apixaban vs aspirin among those with cancer, events included recurrent stroke (5 [8.2%] vs 9 [11.8%]), major ischemic events (7 [11.5%] vs 14 [18.4%]), and major hemorrhagic events (1 [1.6%] vs 2 [2.6%]). Among participants in the ARCADIA trial with history of cancer, the risk of major ischemic and hemorrhagic events did not differ significantly with apixaban compared with aspirin. ClinicalTrials.gov Identifier: NCT03192215.

Role of diffusion tensor imaging biomarkers and tractography to predict motor outcomes in patients with cerebral ischemic infarctions.

Role of diffusion tensor imaging biomarkers and tractography to predict motor outcomes in patients with cerebral ischemic infarctions.

State of the cardiovascular system in thyroid pathology

The review presents the data on cardiac damage in patients with thyroid dysfunction (hyper- and hypothyroidism). The features of cardiovascular pathology in patients with hyperthyroidism and the possibility of using certain groups of drugs (beta blockers, antiplatelet agents, anticoagulants) are described. The association of hypothyroidism (including subclinical) with atherosclerosis and diastolic arterial hypertension, an increased risk of developing ischemic heart disease and myocardial infarction, heart failure and cardiovascular mortality, regardless of gender, age and previous cardiovascular diseases, has been shown. Available facts indicate the need to determine thyroid hormones in patients with cardiovascular pathology and mandatory assessment of the state of the cardiovascular system in patients with thyroid pathology.