Manifestations Of Ischemic Heart Disease Research Articles

STGA-MS: AI diagnosis model of regional wall motion abnormality based on 2D transthoracic echocardiography

Regional wall motion abnormality (RWMA) is a common manifestation of ischemic heart disease detected through echocardiography. Currently, RWMA diagnosis heavily relies on visual assessment by doctors, leading to limitations in experience-based dependence and suboptimal reproducibility among observers. Several RWMA diagnosis models were proposed, while RWMA diagnosis with more refined segments can provide more comprehensive wall motion information to better assist doctors in the diagnosis of ischemic heart disease. In this paper, we proposed the STGA-MS model which consists of three modules, the spatial-temporal grouping attention (STGA) module, the segment feature extraction module, and the multiscale downsampling module, for the diagnosis of RWMA for multiple myocardial segments. The STGA module captures global spatial and temporal information, enhancing the representation of myocardial motion characteristics. The segment feature extraction module focuses on specific segment regions, extracting relevant features. The multiscale downsampling module analyzes myocardial motion deformation across different receptive fields. Experimental results on a 2D transthoracic echocardiography dataset show that the proposed STGA-MS model achieves better performance compared to state-of-the-art models. It holds promise in improving the accuracy and reproducibility of RWMA diagnosis, assisting clinicians in diagnosing ischemic heart disease more reliably.

Platelet adhesion mediated by von Willebrand factor in patients with premature coronary artery disease

Aim To study platelet adhesion mediated by von Willebrand factor (VWF) in patients with premature ischemic heart disease (IHD).Material and methods This study enrolled 58 patients with stable IHD, including 45 men younger than 55 years with the first manifestation of IHD at the age of <50 years and 13 women younger than 65 years with the first manifestation of IHD at the age of <60 years. The control group consisted of 33 patients, 13 men younger than 55 years and 20 women younger than 65 years without IHD. Platelet adhesion to the collagen surface at the shear rate of 1300 s-1 was studied by evaluating the intensity of scattered laser light from the collagen-coated optical substrate in a flow chamber of a microfluidic device after 15-min circulation of whole blood in the chamber. Decreases in platelet adhesion after addition to the blood of monoclonal antibodies (mAb) to platelet receptors glycoproteins Ib (GPIb) to inhibit the receptor interaction with VWF were compared for patients of both groups.Results In patients with premature IHD, the decrease in platelet adhesion following the platelet GPIb receptor inhibition was significantly less than in patients of the control group (74.8 % (55.6; 82.7) vs. 28.9 % (-9.8; 50,5), p <0.001). For the entire sample, the median decrease in platelet adhesion following the GPIb receptor inhibition was 62.8 % (52.2; 71.2). With an adjustment for traditional risk factors of IHD, a decrease in platelet adhesion of >62.8% after blocking GPIb receptors increased the likelihood of premature IHD (OR=9.84, 95 % CI: 2.80-34.59; p <0.001).Conclusion Blocking the interaction of GPIb receptors with VWF in patients with premature IHD and increased shear rate induced a greater decrease in platelet adhesion than in patients without this disease. This suggested that an excessive interaction of VWF with platelets might contribute to the pathogenesis of premature IHD.

The effect of heart rate variability biofeedback in patients with acute coronary syndrome: A protocol for systematic review and meta-analysis

Acute coronary syndrome (ACS), the acute manifestation of ischemic heart disease, remains a major cause of morbidity and mortality worldwide. Soon after ACS, autonomic imbalance acts to preserve the proper functioning of the cardiovascular system and consequently of the whole body. In this study, we perform a protocol for systematic review and meta-analysis to evaluate the efficacy of heart rate variability biofeedback in improving the prognosis in patients with ACS. The protocol of this review was registered in PROSPERO (CRD42022379184). Meanwhile, it will be reported follow the guidelines of the preferred reporting items for systematic reviews and meta-analyses protocol. We will search 3 foreign electronic databases (Cochrane Library, Embase, Pubmed) and 4 Chinese electronic databases (China National Knowledge Infrastructure, WangFang Database, Chinese Biomedical Literature Database and Chinese Scientific Journal Database) to collect potential studies from their inceptions to December 2022. Risk of bias will be assessed according to the Cochrane Risk of Bias Tool. Data synthesis and statistical analysis will be performed using the RevMan 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Denmark) software. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will provide high quality evidence to assess the efficacy of heart rate variability biofeedback in patients with ACS.

26 CORONARY MICROVASCULAR DYSFUNCTION: IT COULD BE (ALSO) A MAN'S WORLD!

Abstract Introduction Coronary microvascular dysfunction (CMD) is one of the possible manifestation of ischaemic heart disease with signs and symptoms of myocardial ischaemia, but no obstructive coronary artery disease (CAD). CMD is defined by an impaired coronary flow reserve owing to functional and/or structural abnormalities of the microcirculation and it is associated with adverse cardiovascular prognosis. Women are known to be more likely than men to have angina in the absence of obstructive CAD and CMD has been proposed as one of the major reasons for this presentation. However, also in men, CMD should be recognized, in order to give the best treatment to relieve symptoms and improve patient prognosis. Index of microvascular resistance (IMR) and coronary flow reserve (CFR) are needed to diagnose CMD and are now easily obtained with pressure wires measurement. Methods Since the adoption in our Cath Lab of the PressureWire™ X Guidewire with the Coroventis CoroFlow Cardiovascular System (Abbott) we started to study IMR and CFR in patients with no obstructive CAD and typical angina. No acute coronary syndromes have been studied in our Cath Lab so far. In this brief study we report a descriptive analysis of the first patients studied and of the first period of follow-up, focusing on men. Results From January 2022 (date when we received the new software) to April 2022 we studied 24 patients and 8 (33%) were men. Among men, mean age was 58±5 yo and two have been already treated with PCI during the previous 6 months. Mean ejection fraction was 57±2% and mean GFR was 76±20 ml/min/mq. 7 out of 8 patients were affected by dyslipidemia, 5 were smoker, 50% were affected by arterial hypertension and only 1 by diabetes. Mean RFR and FFR in left anterior descending artery were 0.92±0.02 and 0.92±0.03, respectively. In 6/8 (75%) patients IMR derived was >25 and, among them 4 (66%) had CFR<2. After coronary study we tried to optimize medical therapy in all these patients, adding or changing to Zofenopril previous ACE inhibitor therapy, adding or titrating Ranolazine and adding or titrating negative chronotropic therapy (beta blockers or calcium channel blockers). After therapy optimization none of the patients had resumption of symptoms (follow-up from 3 to 7 months). Conclusions Even if historically considered a women's disease, we should remember that CMD also affects men. New widespread technologies should be used systematically to rule out CMD and to define patients’ symptoms mechanisms. This would lead to targeted therapy that could improve patient's lives.

The effectiveness of computer assisted programme on knowledge and practice regarding immediate care of patients with myocardial infarction among staff nurses

Myocardial destruction was observed but not modified by the cardiologist. It has become increasingly clear that to make a real impact on the prognosis of patients with myocardial infarction. The goal of medical management is to minimize myocardial damage, preserve myocardial function, and prevent complications. the researcher felt the need to assess the effectiveness of computer assisted programme on knowledge & Practice Regarding immediate care of patient with myocardial infarction among staff nurses in admitted in selected wards of Jawaharlal Nehru Hospital & Research centre sector -9 Bhilai C.G.The purpose of experimental study was to study, observe and explore the cause and effect relationship of a situation. In this study the design used in Quasi Experimental one group pre-test and post test research design. The setting for present study is Jawaharlal Nehru Hospital & Research Centre Sector -9 Bhilai C.G. In this study a total of 30 samples for assessment of knowledge & practice of Jawaharlal Nehru Hospital & Research Centre Sector -9 Bhilai C.G. Non- Probability Purposive Sampling technique was used for selecting the sample.The comparison of knowledge score between pre test & post test in which 20%(6) subjects were in Average , 76.67%(26) subjects were in Good, 3.33%(1) subjects were in Excellent pre test knowledge score regarding immediate care of myocardial infarction patient. In Post test knowledge level the majority of staff nurse’s 46.67% (14) subjects in Excellent knowledge level & 53.33% (16) were in Good knowledge regarding immediate care of myocardial infarction patients. Pre test Mean Knowledge score was 10.53, Mean % was 43.88%, S.D of pre test knowledge score was 2.9 & CV was 27.54 & post test Mean knowledge score was 16.54, Mean % was 68.33%, S.D of post test knowledge score was 2.95 & C.V of post test was 17.99. The Practice score of Pre test Mean was 12, mean % was 50% with S.D 1.88 & C.V was 15.67 & Post test practice Mean score was 19.87, mean % was 82.79 with S.D 2.34 & C.V was 11.78.Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

Intrapericardial Administration of Secretomes from Menstrual Blood-Derived Mesenchymal Stromal Cells: Effects on Immune-Related Genes in a Porcine Model of Myocardial Infarction

Acute myocardial infarction (AMI) is a manifestation of ischemic heart disease where the immune system plays an important role in the re-establishment of homeostasis. We hypothesize that the anti-inflammatory activity of secretomes from menstrual blood-derived mesenchymal stromal cells (S-MenSCs) and IFNγ/TNFα-primed MenSCs (S-MenSCs*) may be considered a therapeutic option for the treatment of AMI. To assess this hypothesis, we have evaluated the effect of S-MenSCs and S-MenSCs* on cardiac function parameters and the involvement of immune-related genes using a porcine model of AMI. Twelve pigs were randomly divided into three biogroups: AMI/Placebo, AMI/S-MenSCs, and AMI/S-MenSCs*. AMI models were generated using a closed chest coronary occlusion-reperfusion procedure and, after 72 h, the different treatments were intrapericardially administered. Cardiac function parameters were monitored by magnetic resonance imaging before and 7 days post-therapy. Transcriptomic analyses in the infarcted tissue identified 571 transcripts associated with the Gene Ontology term Immune response, of which 57 were differentially expressed when different biogroups were compared. Moreover, a prediction of the interactions between differentially expressed genes (DEGs) and miRNAs from secretomes revealed that some DEGs in the infarction area, such as STAT3, IGFR1, or BCL6 could be targeted by previously identified miRNAs in secretomes from MenSCs. In conclusion, the intrapericardial administration of secretome early after infarction has a significant impact on the expression of immune-related genes in the infarcted myocardium. This confirms the immunomodulatory potential of intrapericardially delivered secretomes and opens new therapeutic perspectives in myocardial infarction treatment.

Facial Emotion Expression and the Inducibility of Myocardial Ischemia During Cardiac Stress Testing: The Role of Psychological Background Factors.

Negative emotional states, such as anger and anxiety, are associated with the onset of myocardial infarction and other acute clinical manifestations of ischemic heart disease. The likelihood of experiencing these short-term negative emotions has been associated with long-term psychological background factors such as depression, generalized anxiety, and personality factors. We examined the association of acute emotional states preceding cardiac stress testing (CST) with inducibility of myocardial ischemia and to what extent psychological background factors account for this association. Emotional states were assessed in patients undergoing CST (n = 210; mean [standard deviation] age = 66.9 [8.2] years); 91 (43%) women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness before CST. Psychological background factors were assessed with validated questionnaires. Single-photon emission computed tomography was used to evaluate inducibility of ischemia. Ischemia occurred in 72 patients (34%). Emotional states were not associated with subsequent inducibility of ischemia during CST (odds ratio between 0.93 and 1.04; p values > .50). Psychological background factors were also not associated with ischemia (odds ratio between 0.96 and 1.06 per scale unit; p values > .20) and did not account for the associations of emotional states with ischemia. Emotional states immediately before CST and psychological background factors were not associated with the inducibility of ischemia. These findings indicate that the well-documented association between negative emotions with acute clinical manifestations of ischemic heart disease requires a different explanation than a reduced threshold for inducible ischemia.

Remodeling of heart in patients with stable ischemic heart disease combined with chronic obstructive pulmonary disease as a basis for development of heart failure

The aim of this study was to determine phenotypes of remodeling of heart and the status of systolic and diastolic function in patients with ischemic heart disease (IHD) combined with chronic obstructive pulmonary disease (COPD) with early symptoms and signs of heart failure (HF). We enrolled 108 males with stable IHD and spirometrically confirmed COPD which preceded the manifestations of IHD – the main group (group 1). As comparison groups 30 males with stable IHD (group 2) and 30 males with COPD (group 3) were examined. Control group included 30 males without IHD and respiratory diseases. All groups were comparable in age, groups 1 and 2 – in the duration of IHD, groups 1 and 3 – in the duration of COPD. The patients of the group 1 were divided into 3 subgroups: subgroup 1 – 45 patients with stable angina, subgroup 2 – 27 patients with postinfarction cardiosclerosis, subgroup 3 –36 patients with combination of stable IHD and arterial hypertension (AH) without history of myocardial infarction. The patients of group 1 had different phenotypes of heart remodeling, which depended on the clinical forms of IHD, the presence of concomitant AH, the severity of bronchial obstruction. The patients of subgroup 1 in 60.0% cases had concentric remodeling and concentric left ventricular hypertrophy (LVH), in 26.7% – normal LV geometry, in all these cases ejection fraction (EF) was preserved. Only in 13.3% of cases eccentric LVH with mildly reduced EF was found. 59.3% of patients in subgroup 2 had eccentric LVH, left atrium dilatation and 55.6% had reduced EF. All patients of subgroup 3 had concentric direction of LV remodeling. The phenotypes of HF with reduced and mildly reduced EF were accompanied by impaired LV diastolic function. In assessing the likelihood of HF with preserved EF the HFA-PEFF score showed better accuracy. Pulmonary hypertension had a mixed cause with predominance of postcapillar component.

General practitioner’s tactics in the management of patients with stable angina

Ischemic heart disease (IHD) is one of the most common diseases of the cardiovascular system, which is based on a disorder of the trophism of the heart muscle against the background of pathological changes in the coronary vessels. The leading factor in changes in coronary vessels is stenosing atherosclerosis, which results in impaired blood flow. Risk factors include male gender, older age, a burdened familial history, as well as low physical activity, arterial hypertension, diabetes mellitus, and obesity. Ischemic heart disease is the leading cause of death, especially in developed countries, and the number one cause of medical visits related to heart and vascular problems. One of the most common manifestations of ischemic heart disease is angina pectoris. When pain sensations appear against the background of physical activity or emotional stress, it is called angina of effort, but if angina manifestations occur outside the period of physical and mental activity, we are speaking about resting angina pectoris. There are acute and chronic forms of ischemic heart disease, and while cardiologists and cardiac resuscitators usually deal with acute conditions, dynamic monitoring of patients after a myocardial infarction or with angina pectoris is a part of the responsibility of a general practitioner.

Ischemic heart disease (IHD) is one of the most common diseases of the cardiovascular system, which is based on a disorder of the trophism of the heart muscle against the background of pathological changes in the coronary vessels. The leading factor in changes in coronary vessels is stenosing atherosclerosis, which results in impaired blood flow. Risk factors include male gender,

In their practice, family doctors may encounter symptoms that require differential diagnosis between organic and functional disorders of the gastrointestinal tract and malignant neoplasms. The similarity of the clinical picture in some cases requires timely making the right decision about the tactics of examination, additional diagnostic measures and further referral to specialized medical institutions for treatment. One of these diseases that do not have specific clinical features at an early stage is gastric cancer, which is a malignant degeneration of the epithelium of the gastric mucosa. Symptoms of gastric cancer in its initial stages are limited to dyspeptic disorders, loss of appetite and unexpressed asthenia, which makes its manifestations similar to many diseases that affect the gastrointestinal tract — gastritis, peptic ulcer of the stomach and duodenum, adenomatous polyps of the gastric mucosa. The main diagnostic method that allows making the correct diagnosis is gastroscopy, which makes it possible not only to assess the condition of the mucosa, but also to take material for a biopsy with further histological examination of the tissue. Since the main treatment for gastric cancer is surgery, a correct and timely diagnosis plays a significant role in the further prognosis of the disease and the patient's quality of life.

Mogućnosti i modaliteti medicinske rehabilitacije kod pacijenata sa udruženom pojavom akutnog koronarnog sindroma i akutnog moždanog udara

Background: Being the most austere manifestation of ischaemic heart disease, acute coronary syndrome is one of the most frequent causes of urgent treatment and sudden death in both developed and developing countries as well. Acute stroke is the third cause of death in developed countries, after cardiovascular diseases and tumors, and second worldwide. Besides being a disease with high mortality, it is also a disease with a highest level of disability. Aim: To determine possibilities and modes of rehabilitation of patients with concomitant occurence of acute stroke and acute coronary syndrome. Methods: Retrospective study using hospitalized patients data. 5929 hospitalized patients treated at the Institute for cardiovascular diseases in Sremska Kamenica were analyzed from January 1st 2017 to December 31st 2019, without regarding sex and age. We entered data in created database and analyzed using descriptive statistics and chi-square test. Results: Concomitant stroke and acute coronary syndrome was found in 61 patient (1.0%). There were 32 males and 29 females. Average age was 68.82. Pneumonia occured more frequently in persons with concomitant occurrence of acute stroke and acute coronary syndrome than in persons with acute coronary syndrome without acute stroke. Regarding neurological and/or cardiological condition, only 3 patients (9.0%) were eligible for rehabilitation, and in all others it was delayed or contraindicated. Conclusion: Rehabilitation of patients with concomitant occurrence of acute coronary syndrome and acute stroke was complicated, with high risk, and required multidisciplinary approach to each patient individually.

Acute electrocardiogram pseudoinfarction pattern and reversible left ventricular systolic dysfunction in a patient with diabetic ketoacidosis and hyperkalemia: a case report

Coexisting myocardial infarction (MI) and diabetic ketoacidosis (DKA) are the most common causes of death in diabetic patients. We report a patient with ischemic heart disease manifestations who was finally diagnosed to have DKA as a predisposing factor. The case we present in this paper is a 57-year-old man who was found unconscious in a hotel and presented with complaints of vomiting, abdominal pain, and diarrhea. He had severe dyspnea and chest pain radiating to his back. He had ST-segment elevation in anterior leads on electrocardiogram (ECG), with non-obstructive coronary artery disease in the subsequent heart catheterization. MI patients should be treated with primary percutaneous coronary intervention (PCI) or fibrinolytic agents, but pseudoinfarction due to DKA responds to medical treatment. Thus, it is also important to know that coexistence of both DKA and MI is possible, and neglecting such situations can lead to lethal consequences.

A machine-learning-based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Abstract Background Although cardiovascular disease is the leading cause of mortality in both females and males, women are more likely to have non-obstructive ischemic heart disease (IHD) than men. However, the underlying sex- and gender-specific mechanisms and differences in IHD manifestations are still not fully understood. Aim To develop an interpretable machine learning (ML) model to gain insight on the clinical, functional, biological and psychosocial features playing a major role in the supervised prediction of non-obstructive versus obstructive CAD. Methods From the EVA study, we analyzed a consecutive unselected cohort of adults hospitalized for IHD undergoing coronary angiography. Non-obstructive CAD was defined by a coronary stenosis at the angiogram <50%. Baseline clinical and psycho-socio-cultural characteristics were used for computing a frailty index based on Rockwood and Mitnitsky model, and gender score according to GENESIS-PRAXY methodology. The serum concentration of inflammatory cytokines was measured with a multiplex flow cytometric assay. An XGBoost classifier combined to an explainable artificial intelligence tool (SHAP) was employed to identify the most influential features in discriminating obstructive versus non-obstructive CAD. Results Among the overall EVA cohort (n=509), 311 individuals (mean age 67±11 years, 38% females; 67% obstructive CAD) with complete data were analyzed. The ML-based model (83% accuracy and 87% precision) revealed that while obstructive CAD associated with higher frailty index (i.e., lower physiological reserve), older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was more likely associated with higher gender score (i.e., social characteristics traditionally ascribed to women, regardless of biological sex) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions Integrating clinical, biological and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of the observed associations. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Italian Ministry of Education, Research and University, Scientific Independence of young Researcher (SIR)

Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by [...]

Memo for a patient with ischemic heart disease

Angina pectoris is not an independent disease, but a syndrome that is a manifestation of ischemic heart disease (IHD). Ischemic artery disease occurs due to insufficient blood supply to the heart muscle and is an acute or chronic heart dysfunction resulting from a relative or absolute decrease in the supply of the myocardium with arterial blood. In more than 90% of cases, the anatomical basis of ischemic heart disease is the lesion of the coronary arteries of the heart. Angina pectoris is a kind of heart signal about oxygen deficiency. The signal is felt in the form of attacks of short-term sudden acute compressive, pressing, burning pains in the heart region. In some patients, the pain is accompanied by a state of general discomfort, a feeling of lack of air, and interruptions in the work of the heart.

Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center.

Purpose of ReviewHeart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD).Recent FindingsHCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD.SummaryThere has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.

2021 Korean Society of Myocardial Infarction Expert Consensus Document on Revascularization for Acute Myocardial Infarction

Acute myocardial infarction (AMI) is a fatal manifestation of ischemic heart disease and remains a major public health concern worldwide despite advances in its diagnosis and management. The characteristics of patients with AMI, as well as its disease patterns, have gradually changed over time in Korea, and the outcomes of revascularization have improved dramatically. Several characteristics associated with the revascularization of Korean patients differ from those of patients in other countries. The sophisticated state of AMI revascularization in Korea has led to the need for a Korean expert consensus. The Task Force on Expert Consensus Document of the Korean Society of Myocardial Infarction has comprehensively reviewed the outcomes of large clinical trials and current practical guidelines, as well as studies on Korean patients with AMI. Based on these comprehensive reviews, the members of the task force summarize the major guidelines and recent publications, and propose an expert consensus for revascularization in patients with AMI.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПСЕВДОАНЕВРИЗМЫ СВОБОДНОЙ СТЕНКИ ЛЕВОГО ЖЕЛУДОЧКА: КЛИНИЧЕСКИЙ СЛУЧАЙ

Today diseases of the cardiovascular system are the leading cause of death in many countries. The key role in this pathology is played by ischemic heart disease. An extreme manifestation of ischemic heart disease - myocardial infarction is one of the main causes of complications and mortality in patients with ischemic heart disease. One of the most formidable complications of acute myocardial infarction is heart rupture, which most often leads to death, more than 60% of cases occurring in the prehospital stage. Many studies of similar groups of patients show a wide spread in assessing the incidence and mortality of this pathology. The development of myocardial ruptures has two frequency peaks: the first day and 5-7 days from the onset of AMI. The most common case is acute rupture of the free wall of the left ventricle with extensive hemorrhage in the pericardium leading to a fulminant death. The development of a pseudoaneurysm of the left ventricle is a very rare outcome of the myocardial rupture. There are no convincing data on the incidence of pseudoaneurysms as a result of myocardial infarction (according to many authors, it is less than 0.5% of all cases of myocardial infarction). This type of rupture is most favorable in terms of the possibility of providing assistance. The complexity of providing care to patients with pseudoaneurysms of the left ventricle lies in their low frequency of occurrence and often asymptomatic nature of the course, which complicates the diagnosis of this pathology. Timely diagnosis plays a key role in avoiding a fatal outcome, since the vast majority of pseudoaneurysms are extremely unstable and, except occasional cases, require urgent surgical intervention. This article describes a clinical case of a patient who underwent surgical treatment for pseudoaneurysm of the free wall of the left ventricle as a result of myocardial infarction. The article also presents a brief literature review of the available isolated data on risk factors for myocardial rupture, methods of diagnosis and treatment of this pathology.

Hospitalization for Acute Myocardial Infarction: A Population-Based Registry.

ResumoFundamento:O infarto agudo do miocárdio com supradesnivelamento do segmento ST (STEMI) é uma das principais apresentações clínicas da cardiopatia isquêmica. Dados de base populacional são relevantes para entendimento contemporâneo da epidemiologia da doença.Objetivo:Descrever incidência, manejo terapêutico, desfechos clínicos hospitalares e eventos cardiovasculares do primeiro ano de seguimento dos indivíduos hospitalizados por STEMI.Métodos:Estudo de coorte prospectiva de base populacional com registro consecutivo das hospitalizações por STEMI em uma cidade do Sul do Brasil entre 2011 e 2014. Foram incluídos indivíduos com STEMI que apresentaram sintomas de isquemia miocárdica aguda nas últimas 72 horas. Os valores de p < 0,05 foram considerados significativos.Resultados:A incidência anual de hospitalizações por STEMI foi de 108 casos por 100.000 habitantes. A incidência ajustada foi maior entre os mais velhos (risco relativo 64,9; IC95% 26,9 – 156,9; p para tendência linear < 0,001) e entre os homens (risco relativo 2,8; IC95% 2,3 – 3,3; p < 0,001). Ocorreram 530 hospitalizações durante o período avaliado e a taxa de reperfusão foi de 80,9%. A mortalidade hospitalar e a taxa de eventos cardiovasculares em 1 ano foram, respectivamente, 8,9% e 6,1%. Os mais velhos apresentaram maior mortalidade hospitalar (risco relativo 3,72; IC95% 1,57 – 8,82; p para tendência linear = 0,002) e mais eventos cardiovasculares em 1 ano (hazard ratio 2,35; IC95% 1,12 – 4,95; p = 0,03).Conclusão:Este registro demonstra abordagem terapêutica e mortalidade hospitalar semelhante às observadas em países desenvolvidos. Entretanto, a taxa de hospitalizações foi maior comparada com esses países.

Downregulation of miR-200a protects cardiomyocyte against apoptosis

Background/aimsAcute myocardial infarction (AMI) is a major clinical manifestation of ischemic heart disease and represents a significant cause of morbidity and mortality. However, key regulators in the pathogenesis of ischemic heart disease remain controversial. The present study was designed to investigate the involvement of miR-200a and its related mechanism in AMI. MethodsLeft coronary artery (LCA) ligation was conducted to induce an AMI mouse model. The infarct size was measured by TTC staining. H2O2 was used to induce an AMI model in vitro. miR-200a mimics, anti-miR-200a antisense oligodeoxyribonucleotides (AMO-200a), as well as corresponding negative controls were transfected into cardiomyocytes to observe the effect of miR-200a. Flow cytometry was used to detect cell apoptosis. Real-time PCR, immunofluorescence and western blot assays were used to evaluate gene expression at RNA or protein levels, respectively. ResultsApoptosis was activated in AMI models. The expression of miR-200a was upregulated both in the peri-infarcted region of mice myocardium and H2O2-treated cardiomyocytes. The co-administration of AMO-200a decreased the number of apoptosis cells and altered the expression of apoptosis related proteins. Interestingly, bioinformatics analysis results revealed that miR-200a could bind to the 3′-untranslated regions (3’-UTR) of Fus mRNA. In addition, the expression of Fus was downregulated in the AMI mouse models and in H2O2-treated cardiomyocytes. The alteration of miR-200a negatively regulated Fus expression in cardiomyocytes. Also, the protective effect of AMO-200a was observed through its regulation of Fus. ConclusionMiR-200a-dependent apoptosis signaling pathway plays an important role in the pathogenesis of AMI injury and could be an exciting potential therapeutic target.