Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction...Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction(NSTEMI).[1]In China,AMI is widely recognized as a predominant cause of mortality in both urban and rural demographics,based on the 2022 Report on Cardiovascular Health and Diseases in China;moreover,its mortality rate has been reported to be rising,with a recurrence rate of 2.5%within one year.展开更多
BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk fa...Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.展开更多
Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspira...Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspiration(TA),recent large trials have questioned its routine use.This review examines the role of thr-ombectomy in the management of AMI,focusing on its potential to improve my-ocardial perfusion and mitigate no-reflow risk.Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion.Similarly,standardising TA techn-iques and ensuring appropriate patients’selection may also improve enhance our understanding of the role of thrombectomy in AMI.Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.展开更多
BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress...BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.展开更多
In this article,we comment on the article by Zheng et al.This case report shed light on concomitant cerebrocardiac ischemic(CCI)in a 27-year-old male patient,which is defined as a concurrent acute ischemic stroke(AIS)...In this article,we comment on the article by Zheng et al.This case report shed light on concomitant cerebrocardiac ischemic(CCI)in a 27-year-old male patient,which is defined as a concurrent acute ischemic stroke(AIS)and acute myocardial infarction event.The patient received urgent systemic thrombolysis at the sta-ndard dose for AIS and then planned percutaneous coronary intervention was successfully conducted for ST-segment elevation myocardial infarction treatment.Considering the rarity of the comorbidity,the narrow time window for treatment of both AIS and acute myocardial infarction,as well as the complexity and severity of the condition,there are still no guidelines or consensus that have systematically recommended optimal treatment strategies.The successful treat-ment of this 27-year-old man suggests that urgent thrombolysis followed by planned percutaneous coronary intervention might be an alternative treatment options in the management of concomitant CCI.However,emergency treatment plans need to be developed according to the specific situation of the patients.A number of factors should be considered when making decision,including the location of occlusion of heart and brain,the hemodynamic instability,the ongoing ischemic symptoms,the presence of contraindications to thrombolysis,and the speed of response of cardiologists or neurointerventionists.Future,further res-earch involving multidisciplinary experts,including neurologist,cardiologist,and specialists in critical care medicine is needed to improve the understanding and management of concomitant CCI.展开更多
BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI ca...BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.展开更多
It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study ai...It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study aimed to identify an optimal cut-off to rule in AMI.A total of 76411 patients with elevated hs-cTnT were included.The predictive cut-off values for diagnosing ST-segment elevation myocardial infarction(STEMI)and non-STsegment elevation myocardial infarction(NSTEMI)were assessed using the area under the receiver operating characteristic curve(AUC).Among the patients,50466(66.0%)had non-cardiac diseases,25945(34.0%)had cardiac diseases,and 15502(20.3%)had AMI,including 816(1.1%)with STEMI and 14686(19.2%)with NSTEMI.The median hs-cTnT level was 3788.0 ng/L in STEMI patients and 67.2 ng/L in NSTEMI patients.The optimal cut-off for diagnosing STEMI was 251.9 ng/L,with a sensitivity of 90.7%,specificity of 86.5%,and an AUC of 0.942;the optimal cut-off for diagnosing NSTEMI was 130.5 ng/L,with a sensitivity of 40.9%,specificity of 83.8%,and an AUC of 0.638.Collectively,optimizing the cut-off values for diagnosing STEMI and NSTEMI to 251.9 ng/L and 130.5 ng/L,respectively,demonstrated high accuracy in a large cohort of Chinese patients with elevated hs-cTnT.展开更多
Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients ...BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients under 45 years,under-scoring the need to study this group.Compared to older patients,young AMI pa-tients exhibit fewer traditional risk factors(e.g.,hypertension,diabetes)but higher rates of smoking,obesity,and non-atherosclerotic causes like spontaneous coro-nary artery dissection or coronary spasm,often linked to substance use.Global trends show rising obesity and dyslipidemia in young populations,with smoking contributing to 62%–90%of AMI cases in this age group.Family history of coro-nary artery disease also elevates risk,particularly in acute coronary syndrome.Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease,unlike the multi-vessel disease typical in older cohorts.This study characterizes AMI in young adults(≤40 years)at a single center,focusing on presentation,risk factors,angiographic findings,and manage-ment to guide preventive strategies.AIM To describe the characteristics of AMI in young patients,including presentation,risk factors,coronary angiography(CAG)findings,and management strategies.METHODS This retrospective cross-sectional study analyzed 91 patients aged 20–40 years diagnosed with AMI at Mouwasat Hospital Dammam,from June 2020 to May 2023.Data on clinical presentation,cardiovascular risk factors,CAG findings,and treatments were collected from medical records.Descriptive statistics were used to summarize findings.RESULTS Of 91 patients(96.7%male,mean age 35.9 years±3.4 years),43.9%were obese(body mass index>30 kg/m^(2)).Hyperlipidemia was the most prevalent risk factor(69.2%),followed by smoking(49.5%),diabetes mellitus(33.0%),and hypertension(26.4%).ST-elevation myocardial infarction(STEMI)was the most common presentation(57.1%).The left anterior descending artery was frequently affected(78.0%),with single-vessel disease predominant(72.5%).Most patients underwent percutaneous coronary intervention(PCI)(74.7%),while 8.8%required surgery.CONCLUSION Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors,pre-senting with STEMI and single-vessel disease amenable to PCI.展开更多
Objective: To explore the therapeutic effect of Huoxue Tongmai capsule combined with edaravone right camphor on patients with acute cerebral infarction (Acute Cerebral Infarction) and the effect of combination therapy...Objective: To explore the therapeutic effect of Huoxue Tongmai capsule combined with edaravone right camphor on patients with acute cerebral infarction (Acute Cerebral Infarction) and the effect of combination therapy on serum inflammatory factors. Methods: In this study, 90 patients with acute cerebral infarction hospitalized in Zhuji People’s Hospital from December 2023 to December 2024 were selected and divided into two groups of 45 patients in each group. The control group used standard medical treatment, and the treatment group compared the changes of serum inflammatory factors IL-CRP, TNF-α, and Hcy with Huoxue Tongmai capsule for 7 days, 14 days and 30 days, and discussed the changes of the modified Rankin scale score (mRS) and National Institutes of Health Stroke Scale (NIHSS) score. Results: At 7 days, 14 days, and 30 days of treatment, the NIHSS score, mRS score, hs-CRP, IL-6, TNF-α, and Hcy levels were statistically significant (P α, and Hcy levels in the treatment group were significantly lower than those in the control group (P Conclusion: Patients with acute cerebral infarction received Huoxue Tongmai capsule combined with edaravone right camphor, which can reduce the inflammatory reaction, improve the nerve function and improve the prognosis.展开更多
The current study aimed to evaluate the efficacy and safety of Compound Danshen Dripping Pills(CDDP)in improving cardiac function in patients with acute anterior ST-segment elevation myocardial infarction(AAMI).Betwee...The current study aimed to evaluate the efficacy and safety of Compound Danshen Dripping Pills(CDDP)in improving cardiac function in patients with acute anterior ST-segment elevation myocardial infarction(AAMI).Between February 2021 and February 2023,247 eligible patients with AAMI after primary percutaneous coronary intervention were enrolled and randomly assigned(1∶1)to receive CDDP(n=126)or placebo(n=121),with a follow-up of 48 weeks.Compared with the placebo group,the CDDP group demonstrated a significant increase in left ventricular ejection fraction values after 24 weeks of treatment(least squares mean:3.31;95%confidence interval[CI]:1.72–4.90;P<0.001)and at the 48-week follow-up(least squares mean:4.35;95%CI:2.76–5.94;P<0.001).Significant reductions in N-terminal pro-B-type natriuretic peptide levels were observed in both groups at the 24-and 48-week visits with no significant difference between the two groups(P>0.1 for all).The incidence of major adverse cardiovascular and cerebrovascular events was 6.35%in the CDDP group and 5.79%in the placebo group(P=0.822).Notably,no serious adverse events were attributed to CDDP.These findings suggest that CDDP may be well tolerated and could improve left ventricular ejection fraction in patients with AAMI at 24 and 48 weeks.展开更多
Background:Cardiac fibrosis following myocardial infarction(MI)drives adverse ventricular remodeling and heart failure,with cardiac fibroblasts(CFs)playing a central role.Glutathione S-transferase mu 1(GSTM1)is an imp...Background:Cardiac fibrosis following myocardial infarction(MI)drives adverse ventricular remodeling and heart failure,with cardiac fibroblasts(CFs)playing a central role.Glutathione S-transferase mu 1(GSTM1)is an important member of the glutathione S-transferase(GSTs)family,which plays an important role in maintaining cell homeostasis and detoxification.This study investigated the role and mechanism of GSTM1 in post-MI fibrosis.Methods:Multi-omics approaches(proteomics/scRNA-seq)identified GSTM1 as a dysregulated target in post-MI fibroblasts.Using a murine coronary ligation model,we assessed GSTM1 dynamics via molecular profiling,such as Western blotting,immunofluorescence,and real-time quantitative polymerase chain reaction.Adeno-associated virus serotype 9(AAV9)-mediated cardiac-specific GSTM1 overexpression was achieved through systemic delivery.In vitro studies employed transforming growth factor-β(TGF-β)-stimulated primary fibroblasts with siRNA/plasmid interventions.Mechanistic insights were derived from transcriptomics and lipid peroxidation assays.Results:The expression of GSTM1 in mouse CFs after MI was significantly down-regulated at both transcriptional and protein levels.In human dilated cardiomyopathy(DCM)patients with severe heart failure,GSTM1 expression was decreased alongside aggravated fibrosis.Overexpression of GSTM1 in post-MI mice improved cardiac function,while significantly reducing infarct size and fibrosis compared with the control group.In vitro models demonstrated that GSTM1 markedly attenuated collagen secretion and activation of fibroblasts,as well as suppressed their proliferation and migration.Further studies revealed that GSTM1 overexpression significantly inhibited the generation of intracellular and mitochondrial reactive oxygen species(ROS)under pathological conditions,suggesting that GSTM1 exerts an antioxidative stress effect in post-infarction fibroblasts.Further investigation of molecular mechanisms indicated that GSTM1 may suppress the initiation and progression of fibrosis by modulating lipid metabolism and ferroptosis-related pathways.Overexpression of GSTM1 significantly reduced lipid peroxidation and free ferrous iron levels in fibroblasts and mitochondria,markedly decreased ferroptosis-related indicators,and alleviated oxidative lipid levels[such as 12-hydroxyeicosapentaenoic acid(HEPE)and 9-,10-dihydroxy octadecenoic acid(DHOME)]under fibrotic conditions.GSTM1 enhanced the phosphorylation of signal transducer and activator of transcription 3(STAT3),thereby upregulating the downstream expression of glutathione peroxidase 4(GPX4),reducing ROS production,and mitigating fibroblast activation and phenotypic transformation by inhibiting lipid peroxidation.Conclusions:This study identifies GSTM1 as a key inhibitor of fibroblast activation and cardiac fibrosis,highlighting its ability to target ferroptosis through redox regulation.AAV-mediated GSTM1 therapy demonstrates significant therapeutic potential for improving outcomes post-MI.展开更多
AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to con...AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im⁃proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu⁃mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi⁃bition of ferroptosis.展开更多
OBJECTIVE To explore the mechanism of action of Qihuang Zhuyu formula(QHZYF)in improving depression after myocardial infarction(MI),with a focus on revealing its regulatory effect on the inflammatory response of the h...OBJECTIVE To explore the mechanism of action of Qihuang Zhuyu formula(QHZYF)in improving depression after myocardial infarction(MI),with a focus on revealing its regulatory effect on the inflammatory response of the heart and brain.METHODS The active ingredients of QHZYF and the action targets for intervening in depression after MI were analyzed by using ultra-performance liquid chromatography-high-resolution mass spectrometry(UPLC-Q-TOF/MS)combined with network pharmacology and molecular docking.A rat model of depression after MI was established by ligation of the left anterior descending coronary artery combined with chronic restraint stress.Echocardiography was used to evaluate cardiac function,hematoxylin-eosin(HE)and Masson staining were used to evaluate myocardial injury,behavioral tests were used to detect melancholic behaviors,Nissl staining was used to evaluate hippocampal neuron injury.Western blot detection of tumor necrosis factor receptor 2(TNFR2),phosphatidylinositol-3-kinase(PI3K),phosphorylated seronine protein kinase(p-AKT),seronine protein kinase(AKT),tumor necrosis factor receptor 1(TNFR1),phosphorylated nuclear factorκB(p-NF-κB),and nuclear factorκB(NF-κB)in cardiac and hippocampal tissues was conducted.The levels of serum IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay(ELISA),and the expression of TNFR1 and TNFR2 was detected by immunohistochemical technique(IHC).In vitro experiments,co-culture of rat cardiomyocyte line H9C2 cells and rat adrenal pheochromocytoma cell line with high differentiation PC12 cells was conducted,TNFR1 inhibitor(H398)and TNFR2 agonist(C-6His)were administered for intervention,and the expression of TNFR2,PI3K,p-AKT,AKT,TNFR1,NF-κB,p-NF-κB was detected by Western blot.Observe the apoptosis of cells by TUNEL staining,ELISA was used to detect the levels of IL-6 and IL-10 in the cell supernatant.RESULTS Network pharmacological analysis indicates that the TNF signaling pathway was a key target for the treatment of depression after MI with the QHZYF.In vivo experiments have confirmed that the intervention of QHZYF could significantly improve the cardiac function,myocardial tissue and hippocampal neuron structure damage of depressed rats after MI,and improve their depression-like behaviors.At the molecular level,the high-dose group of QHZYF significantly upregulated TNFR2,p-AKT/AKT,and IL-10 in cardiac and hippocampal tissues(P<0.01),and downregulated TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01).In vitro experiments showed that the drug-containing serum of QHZYF significantly upregulated the expression of TNFR2,p-AKT/AKT and IL-10 in H9C2 and PC12 cells(P<0.01),downregulated the expression of TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01),and significantly inhibited cell apoptosis(P<0.01).Furthermore,experiments on the combined application of H398 or C-6His further confirmed that its protective and anti-inflammatory effects were mediated by regulating the TNFR2/PI3K/AKT and TNFR1/NF-κB pathways.CONCLUSION QHZYF improves the homeostasis of heart and brain inflammation by regulating the TNF pathway,and ameliorates myocardial injury and depressive state in depressed rats after MI.展开更多
BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derive...BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events(MACE)in NSTEMI patients,potentially improving clinical outcomes.METHODS A prospective,observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla,Bosnia and Herzegovina.The study included 170 patients with NSTEMI,who were divided into a group with MACE and a control group without MACE.Furthermore,the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis.Alongside hematological parameters,an additional 13 hematological-derived ratios(HDRs)were monitored,and their prognostic role was investigated.RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction(NSTEMI)patients with MACE and a control group at T1 and T2.However,significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE.Notably,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were elevated in lethal outcomes.Furthermore,C-reactive protein-to-lymphocyte ratio(CRP/Ly)at T1(>4.737)demonstrated predictive value[odds ratio(OR):3.690,P=0.024].Both NLR at T1(>4.076)and T2(>4.667)emerged as significant predictors,with NLR at T2 exhibiting the highest diagnostic performance,as indicated by an area under the curve of 0.811(95%CI:0.727-0.859)and OR of 4.915(95%CI:1.917-12.602,P=0.001),emphasizing its important role as a prognostic marker.CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients.During follow-up,NLR,PLR,and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.展开更多
BACKGROUND Myocardial infarction(MI)occupies a very high mortality and morbidity rate,and the search for effective pharmacological treatments has far-reaching implications for clinical research.AIM To explore the prot...BACKGROUND Myocardial infarction(MI)occupies a very high mortality and morbidity rate,and the search for effective pharmacological treatments has far-reaching implications for clinical research.AIM To explore the protective effects of Mongolian medicine Agari-5 on rats with MI.METHODS Sprague-Dawley rats were used,and both the Agari-5 and model groups had their coronary arteries clamped to induce MI.Proteomics was used to research the potential mechanism of action while ELISA,hematoxylin and eosin,and Masson’s staining were used to preliminarily investigate the protective impact of Agari-5 on rats with MI.RESULTS The current study has shown that Agari-5 might enhance cardiac function indicators,including echocardiography results of rats and creatine kinase,creatine kinase isoenzyme,and lactate dehydrogenase,in rats that had MI.According to the results of pathological staining,Agari-5 may lessen inflammatory cell infiltration and cardiomyocyte fibrosis,among other things.The proteome analysis revealed that there were 60 distinct proteins in total,four of which were associated with the heart.The expression of PSAT1,PDK1,SMAD4,and SDF2 proteins may be linked to the mechanism of their protective effects.CONCLUSION Potential therapeutic effects of Agari-5 for MI and its mechanism of action may be related to PSAT1,PDK1,SMAD4,and SDF2.展开更多
With the accelerated pace of population aging in China,the number of patients suffering from myocardial infarction(MI)is increasing annually.During disease progression,patients are at significantly higher risk of deve...With the accelerated pace of population aging in China,the number of patients suffering from myocardial infarction(MI)is increasing annually.During disease progression,patients are at significantly higher risk of developing severe negative emotions,and emerging evidence suggests that post-traumatic stress disorder(PTSD)is significantly associated with cardiovascular disease,which seriously affects patients’quality of life.Objective:The aim of this study was to comprehensively assess the prevalence and influencing factors of PTSD in MI patients through systematic review and Meta-analysis.Methods:A computerized search of PubMed,the Cochrane Library,Embase,Web of Science,PsycINFO,China Knowledge Network(CNKI),WanFang Data,VIP,and China Biomedical Literature Database(CBM)was conducted to collect longitudinal studies,case-control studies,and cross-sectional studies related to PTSD prevalence rates and influencing factors in MI patients published up to August 1,2024.Literature screening,data extraction and quality assessment were done independently by two researchers and Meta-analysis was done using Stata 16.0 software.This study has been registered on the PROSPERO platform,registration number:CRD42024577243.Results:A total of 16 papers were included,with a total sample size of 3,768 cases involving 8 influencing factors.The results of the Meta-analysis showed that the prevalence of PTSD in patients with MI was 20.4%(95%CI=15.0–26.5%).Female(OR=3.12,95%CI=1.97–4.97,P<0.001),high neuroticism score(OR=2.21,95%CI=1.20–4.07,P=0.011),and high intrusive rumination score(OR=2.95,95%CI=1.50–5.83,P=0.002)were the risk factors for PTSD in MI patients.While age(OR=1.01,95%CI=0.98–1.04,P=0.440),education level(OR=0.55,95%CI=0.07–4.48,P=0.574),social support rating scale(OR=0.81,95%CI=0.52–1.26,P=0.346),Killip cardiac function classification(OR=2.29,95%CI=0.91–5.80,P=0.080)and creatine kinase isoenzyme(OR=1.03,95%CI=0.99–1.05,P=0.124)were not associated with the development of PTSD in MI patients.Conclusion:The prevalence of PTSD was higher in patients with MI.The prevalence varied by evaluation tool and study area.Risk factors were multifactorial,including general factors(female)and overall assessment(high neuroticism score,high invasive rumination score).Therefore,early intervention and proper de-escalation of PTSD symptoms in patients with MI by medical staff are needed in clinical practice to reduce the risk of PTSD.展开更多
BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular ...BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular factors remain limited.Frailty,reflecting diminished physiological reserve,has emerged as a potential determinant of adverse outcomes in this high-risk population.Therefore,the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.METHODS We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China(from January 2010 to March 2024).Frailty was assessed using the Hospital Frailty Risk Score(HFRS),with HFRS<5 defined as non-frail and HFRS≥5 as frail.Multivariable Cox proportional hazards models,adjusted for demographics,comorbidities,left ventricular ejection fraction,and therapies,were applied to evaluate associations between frailty and clinical outcomes.The primary endpoints were all-cause death and major adverse cardiovascular events(MACE),which defined as the composite of cardiovascular death and heart failure rehospitalization.Secondary endpoints included net adverse clinical events(NACE),which defined as the composite of all-cause death,stroke,recurrent myocardial infarction,revascularization,and major bleeding,as well as the individual components of MACE.RESULTS Frailty was independently associated with a higher risk of all-cause death[adjusted hazard ratio(aHR)=1.52,95%CI:1.31–2.03,P=0.005]and NACE(aHR=1.20,95%CI:1.02–1.41,P=0.026).At one year,frail patients had higher unadjusted rates of all-cause death(9.0%vs.2.9%)and NACE(19.8%vs.13.7%)compared with non-frail patients.For cardiovascular death,the association did not reach statistical significance(aHR=1.42,95%CI:0.99–2.03,P=0.053).No significant associations were found for MACE(aHR=1.05,95%CI:0.86–1.28,P=0.636)or heart failure rehospitalization(aHR=0.94,95%CI:0.75–1.19,P=0.616).CONCLUSIONS Frailty,as measured by the HFRS,is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients.These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up,optimization of medical therapy,and targeted frailty-focused interventions.展开更多
Background Myocardial infarction(MI)and postmyocardial remodeling are the most common causes of heart failure worldwide and seriously affect the quality of life and prognosis of patients.Dapagliflozin,a sodium glucose...Background Myocardial infarction(MI)and postmyocardial remodeling are the most common causes of heart failure worldwide and seriously affect the quality of life and prognosis of patients.Dapagliflozin,a sodium glucose cotransporter 2(SGLT2)inhibitor,is a novel class of hypoglycemic drug that has been proven to have cardiovascular protective effects.However,the underlying mechanisms by which dapagliflozin affects MI have yet to be elucidated.Methods An MI mouse model was created by ligating the left anterior descending branch of the coronary artery.Hematoxylin‒eosin(HE)and Masson’s trichrome(Masson)staining were used to assess myocardial damage.The levels of fibrosis-related and cuproptosis-related markers were assessed via Western blot analysis.A hypoxia-induced cardiomyocyte fibrosis model was constructed in vitro.The DCFH-DA probe was used to measure the levels of reactive oxygen species(ROS),and flow cytometry was used to identify cell apoptosis.Results Dapagliflozin improved heart function,ameliorated fibrosis in the myocardium,and alleviated myocardial injury.Moreover,dapagliflozin reduced the copper ion concentration and ROS accumulation and inhibited the expression of cuproptosis-related markers.Dapagliflozin suppressed the expression of HIF-1α/TGF-βsignal and the overexpression of HIF-1αeffectively reversed the dapagliflozin-mediated myocardial protective effects.Conclusion Dapagliflozin reduced myocardial fibrosis by suppressing HIF-1α/TGF-β-mediated cuproptosis.展开更多
基金supported by the Natural Science Foundation of Shandong Province(ZR2021QH096,ZR2020MH024)the National Natural Science Foundation of China(82300354,882070345)+2 种基金the Academic Promotion Program of Shandong First Medical University(2019QL012)the Shandong Taishan Scholarship(to SHY)fund of Tianjin Zhongxin Pharmaceutical Group Co.,Ltd。
文摘Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction(NSTEMI).[1]In China,AMI is widely recognized as a predominant cause of mortality in both urban and rural demographics,based on the 2022 Report on Cardiovascular Health and Diseases in China;moreover,its mortality rate has been reported to be rising,with a recurrence rate of 2.5%within one year.
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
基金supported by the First Department of Cardiology,School of Medicine in Katowice,Medical University of Silesia,Katowice,Poland.
文摘Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.
文摘Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspiration(TA),recent large trials have questioned its routine use.This review examines the role of thr-ombectomy in the management of AMI,focusing on its potential to improve my-ocardial perfusion and mitigate no-reflow risk.Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion.Similarly,standardising TA techn-iques and ensuring appropriate patients’selection may also improve enhance our understanding of the role of thrombectomy in AMI.Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.
基金supported by the National Natural Science Foundation of China(No.62135002)the Key Research and Development Program of Heilongjiang Province(No.2022ZX01A28).
文摘BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.
基金Supported by the National Natural Science Foundation of China,No.82170327 and No.82370332Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-029A.
文摘In this article,we comment on the article by Zheng et al.This case report shed light on concomitant cerebrocardiac ischemic(CCI)in a 27-year-old male patient,which is defined as a concurrent acute ischemic stroke(AIS)and acute myocardial infarction event.The patient received urgent systemic thrombolysis at the sta-ndard dose for AIS and then planned percutaneous coronary intervention was successfully conducted for ST-segment elevation myocardial infarction treatment.Considering the rarity of the comorbidity,the narrow time window for treatment of both AIS and acute myocardial infarction,as well as the complexity and severity of the condition,there are still no guidelines or consensus that have systematically recommended optimal treatment strategies.The successful treat-ment of this 27-year-old man suggests that urgent thrombolysis followed by planned percutaneous coronary intervention might be an alternative treatment options in the management of concomitant CCI.However,emergency treatment plans need to be developed according to the specific situation of the patients.A number of factors should be considered when making decision,including the location of occlusion of heart and brain,the hemodynamic instability,the ongoing ischemic symptoms,the presence of contraindications to thrombolysis,and the speed of response of cardiologists or neurointerventionists.Future,further res-earch involving multidisciplinary experts,including neurologist,cardiologist,and specialists in critical care medicine is needed to improve the understanding and management of concomitant CCI.
文摘BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.
基金funded in part by the National Key R&D Program of China(Grant No.2022YFC2402404)the National Natural Science Foundation of China(Grant Nos.82170351 and 82370342)+1 种基金the Natural Science Foundation of Jiangsu Province(Grant Nos.BK20222002 and BK20231145)the Clinical Capacity Enhancement Project of Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)(Grant No.J SPH-MA-2022-3)。
文摘It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study aimed to identify an optimal cut-off to rule in AMI.A total of 76411 patients with elevated hs-cTnT were included.The predictive cut-off values for diagnosing ST-segment elevation myocardial infarction(STEMI)and non-STsegment elevation myocardial infarction(NSTEMI)were assessed using the area under the receiver operating characteristic curve(AUC).Among the patients,50466(66.0%)had non-cardiac diseases,25945(34.0%)had cardiac diseases,and 15502(20.3%)had AMI,including 816(1.1%)with STEMI and 14686(19.2%)with NSTEMI.The median hs-cTnT level was 3788.0 ng/L in STEMI patients and 67.2 ng/L in NSTEMI patients.The optimal cut-off for diagnosing STEMI was 251.9 ng/L,with a sensitivity of 90.7%,specificity of 86.5%,and an AUC of 0.942;the optimal cut-off for diagnosing NSTEMI was 130.5 ng/L,with a sensitivity of 40.9%,specificity of 83.8%,and an AUC of 0.638.Collectively,optimizing the cut-off values for diagnosing STEMI and NSTEMI to 251.9 ng/L and 130.5 ng/L,respectively,demonstrated high accuracy in a large cohort of Chinese patients with elevated hs-cTnT.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
文摘BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients under 45 years,under-scoring the need to study this group.Compared to older patients,young AMI pa-tients exhibit fewer traditional risk factors(e.g.,hypertension,diabetes)but higher rates of smoking,obesity,and non-atherosclerotic causes like spontaneous coro-nary artery dissection or coronary spasm,often linked to substance use.Global trends show rising obesity and dyslipidemia in young populations,with smoking contributing to 62%–90%of AMI cases in this age group.Family history of coro-nary artery disease also elevates risk,particularly in acute coronary syndrome.Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease,unlike the multi-vessel disease typical in older cohorts.This study characterizes AMI in young adults(≤40 years)at a single center,focusing on presentation,risk factors,angiographic findings,and manage-ment to guide preventive strategies.AIM To describe the characteristics of AMI in young patients,including presentation,risk factors,coronary angiography(CAG)findings,and management strategies.METHODS This retrospective cross-sectional study analyzed 91 patients aged 20–40 years diagnosed with AMI at Mouwasat Hospital Dammam,from June 2020 to May 2023.Data on clinical presentation,cardiovascular risk factors,CAG findings,and treatments were collected from medical records.Descriptive statistics were used to summarize findings.RESULTS Of 91 patients(96.7%male,mean age 35.9 years±3.4 years),43.9%were obese(body mass index>30 kg/m^(2)).Hyperlipidemia was the most prevalent risk factor(69.2%),followed by smoking(49.5%),diabetes mellitus(33.0%),and hypertension(26.4%).ST-elevation myocardial infarction(STEMI)was the most common presentation(57.1%).The left anterior descending artery was frequently affected(78.0%),with single-vessel disease predominant(72.5%).Most patients underwent percutaneous coronary intervention(PCI)(74.7%),while 8.8%required surgery.CONCLUSION Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors,pre-senting with STEMI and single-vessel disease amenable to PCI.
文摘Objective: To explore the therapeutic effect of Huoxue Tongmai capsule combined with edaravone right camphor on patients with acute cerebral infarction (Acute Cerebral Infarction) and the effect of combination therapy on serum inflammatory factors. Methods: In this study, 90 patients with acute cerebral infarction hospitalized in Zhuji People’s Hospital from December 2023 to December 2024 were selected and divided into two groups of 45 patients in each group. The control group used standard medical treatment, and the treatment group compared the changes of serum inflammatory factors IL-CRP, TNF-α, and Hcy with Huoxue Tongmai capsule for 7 days, 14 days and 30 days, and discussed the changes of the modified Rankin scale score (mRS) and National Institutes of Health Stroke Scale (NIHSS) score. Results: At 7 days, 14 days, and 30 days of treatment, the NIHSS score, mRS score, hs-CRP, IL-6, TNF-α, and Hcy levels were statistically significant (P α, and Hcy levels in the treatment group were significantly lower than those in the control group (P Conclusion: Patients with acute cerebral infarction received Huoxue Tongmai capsule combined with edaravone right camphor, which can reduce the inflammatory reaction, improve the nerve function and improve the prognosis.
基金supported by Tasly Pharmaceutical Group Co.,Ltd.(Grant No.303100031BA20)。
文摘The current study aimed to evaluate the efficacy and safety of Compound Danshen Dripping Pills(CDDP)in improving cardiac function in patients with acute anterior ST-segment elevation myocardial infarction(AAMI).Between February 2021 and February 2023,247 eligible patients with AAMI after primary percutaneous coronary intervention were enrolled and randomly assigned(1∶1)to receive CDDP(n=126)or placebo(n=121),with a follow-up of 48 weeks.Compared with the placebo group,the CDDP group demonstrated a significant increase in left ventricular ejection fraction values after 24 weeks of treatment(least squares mean:3.31;95%confidence interval[CI]:1.72–4.90;P<0.001)and at the 48-week follow-up(least squares mean:4.35;95%CI:2.76–5.94;P<0.001).Significant reductions in N-terminal pro-B-type natriuretic peptide levels were observed in both groups at the 24-and 48-week visits with no significant difference between the two groups(P>0.1 for all).The incidence of major adverse cardiovascular and cerebrovascular events was 6.35%in the CDDP group and 5.79%in the placebo group(P=0.822).Notably,no serious adverse events were attributed to CDDP.These findings suggest that CDDP may be well tolerated and could improve left ventricular ejection fraction in patients with AAMI at 24 and 48 weeks.
基金supported by the National Natural Science Foundation of China(82270386,82070252,and 8207025)the Zhejiang Provincial Medical and Health Science and Technology Plan(2023RC020)the Zhejiang Provincial Natural Science Foundation(LR21H020001).
文摘Background:Cardiac fibrosis following myocardial infarction(MI)drives adverse ventricular remodeling and heart failure,with cardiac fibroblasts(CFs)playing a central role.Glutathione S-transferase mu 1(GSTM1)is an important member of the glutathione S-transferase(GSTs)family,which plays an important role in maintaining cell homeostasis and detoxification.This study investigated the role and mechanism of GSTM1 in post-MI fibrosis.Methods:Multi-omics approaches(proteomics/scRNA-seq)identified GSTM1 as a dysregulated target in post-MI fibroblasts.Using a murine coronary ligation model,we assessed GSTM1 dynamics via molecular profiling,such as Western blotting,immunofluorescence,and real-time quantitative polymerase chain reaction.Adeno-associated virus serotype 9(AAV9)-mediated cardiac-specific GSTM1 overexpression was achieved through systemic delivery.In vitro studies employed transforming growth factor-β(TGF-β)-stimulated primary fibroblasts with siRNA/plasmid interventions.Mechanistic insights were derived from transcriptomics and lipid peroxidation assays.Results:The expression of GSTM1 in mouse CFs after MI was significantly down-regulated at both transcriptional and protein levels.In human dilated cardiomyopathy(DCM)patients with severe heart failure,GSTM1 expression was decreased alongside aggravated fibrosis.Overexpression of GSTM1 in post-MI mice improved cardiac function,while significantly reducing infarct size and fibrosis compared with the control group.In vitro models demonstrated that GSTM1 markedly attenuated collagen secretion and activation of fibroblasts,as well as suppressed their proliferation and migration.Further studies revealed that GSTM1 overexpression significantly inhibited the generation of intracellular and mitochondrial reactive oxygen species(ROS)under pathological conditions,suggesting that GSTM1 exerts an antioxidative stress effect in post-infarction fibroblasts.Further investigation of molecular mechanisms indicated that GSTM1 may suppress the initiation and progression of fibrosis by modulating lipid metabolism and ferroptosis-related pathways.Overexpression of GSTM1 significantly reduced lipid peroxidation and free ferrous iron levels in fibroblasts and mitochondria,markedly decreased ferroptosis-related indicators,and alleviated oxidative lipid levels[such as 12-hydroxyeicosapentaenoic acid(HEPE)and 9-,10-dihydroxy octadecenoic acid(DHOME)]under fibrotic conditions.GSTM1 enhanced the phosphorylation of signal transducer and activator of transcription 3(STAT3),thereby upregulating the downstream expression of glutathione peroxidase 4(GPX4),reducing ROS production,and mitigating fibroblast activation and phenotypic transformation by inhibiting lipid peroxidation.Conclusions:This study identifies GSTM1 as a key inhibitor of fibroblast activation and cardiac fibrosis,highlighting its ability to target ferroptosis through redox regulation.AAV-mediated GSTM1 therapy demonstrates significant therapeutic potential for improving outcomes post-MI.
基金Supported by Guangdong Medical Research Foundation(No.A2024382)Guangdong Provincial Bureau of Traditional Chinese Medicine research project(No.20231321)Scientific Research Start Plan of Shunde Hospital,Southern Medical University(No.SRSP2022012,No.SRSP2022016)。
文摘AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im⁃proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu⁃mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi⁃bition of ferroptosis.
文摘OBJECTIVE To explore the mechanism of action of Qihuang Zhuyu formula(QHZYF)in improving depression after myocardial infarction(MI),with a focus on revealing its regulatory effect on the inflammatory response of the heart and brain.METHODS The active ingredients of QHZYF and the action targets for intervening in depression after MI were analyzed by using ultra-performance liquid chromatography-high-resolution mass spectrometry(UPLC-Q-TOF/MS)combined with network pharmacology and molecular docking.A rat model of depression after MI was established by ligation of the left anterior descending coronary artery combined with chronic restraint stress.Echocardiography was used to evaluate cardiac function,hematoxylin-eosin(HE)and Masson staining were used to evaluate myocardial injury,behavioral tests were used to detect melancholic behaviors,Nissl staining was used to evaluate hippocampal neuron injury.Western blot detection of tumor necrosis factor receptor 2(TNFR2),phosphatidylinositol-3-kinase(PI3K),phosphorylated seronine protein kinase(p-AKT),seronine protein kinase(AKT),tumor necrosis factor receptor 1(TNFR1),phosphorylated nuclear factorκB(p-NF-κB),and nuclear factorκB(NF-κB)in cardiac and hippocampal tissues was conducted.The levels of serum IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay(ELISA),and the expression of TNFR1 and TNFR2 was detected by immunohistochemical technique(IHC).In vitro experiments,co-culture of rat cardiomyocyte line H9C2 cells and rat adrenal pheochromocytoma cell line with high differentiation PC12 cells was conducted,TNFR1 inhibitor(H398)and TNFR2 agonist(C-6His)were administered for intervention,and the expression of TNFR2,PI3K,p-AKT,AKT,TNFR1,NF-κB,p-NF-κB was detected by Western blot.Observe the apoptosis of cells by TUNEL staining,ELISA was used to detect the levels of IL-6 and IL-10 in the cell supernatant.RESULTS Network pharmacological analysis indicates that the TNF signaling pathway was a key target for the treatment of depression after MI with the QHZYF.In vivo experiments have confirmed that the intervention of QHZYF could significantly improve the cardiac function,myocardial tissue and hippocampal neuron structure damage of depressed rats after MI,and improve their depression-like behaviors.At the molecular level,the high-dose group of QHZYF significantly upregulated TNFR2,p-AKT/AKT,and IL-10 in cardiac and hippocampal tissues(P<0.01),and downregulated TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01).In vitro experiments showed that the drug-containing serum of QHZYF significantly upregulated the expression of TNFR2,p-AKT/AKT and IL-10 in H9C2 and PC12 cells(P<0.01),downregulated the expression of TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01),and significantly inhibited cell apoptosis(P<0.01).Furthermore,experiments on the combined application of H398 or C-6His further confirmed that its protective and anti-inflammatory effects were mediated by regulating the TNFR2/PI3K/AKT and TNFR1/NF-κB pathways.CONCLUSION QHZYF improves the homeostasis of heart and brain inflammation by regulating the TNF pathway,and ameliorates myocardial injury and depressive state in depressed rats after MI.
文摘BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events(MACE)in NSTEMI patients,potentially improving clinical outcomes.METHODS A prospective,observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla,Bosnia and Herzegovina.The study included 170 patients with NSTEMI,who were divided into a group with MACE and a control group without MACE.Furthermore,the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis.Alongside hematological parameters,an additional 13 hematological-derived ratios(HDRs)were monitored,and their prognostic role was investigated.RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction(NSTEMI)patients with MACE and a control group at T1 and T2.However,significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE.Notably,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were elevated in lethal outcomes.Furthermore,C-reactive protein-to-lymphocyte ratio(CRP/Ly)at T1(>4.737)demonstrated predictive value[odds ratio(OR):3.690,P=0.024].Both NLR at T1(>4.076)and T2(>4.667)emerged as significant predictors,with NLR at T2 exhibiting the highest diagnostic performance,as indicated by an area under the curve of 0.811(95%CI:0.727-0.859)and OR of 4.915(95%CI:1.917-12.602,P=0.001),emphasizing its important role as a prognostic marker.CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients.During follow-up,NLR,PLR,and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.
基金Supported by XinganLeague Science and Technology Programme Project,No.MBJH2023022.
文摘BACKGROUND Myocardial infarction(MI)occupies a very high mortality and morbidity rate,and the search for effective pharmacological treatments has far-reaching implications for clinical research.AIM To explore the protective effects of Mongolian medicine Agari-5 on rats with MI.METHODS Sprague-Dawley rats were used,and both the Agari-5 and model groups had their coronary arteries clamped to induce MI.Proteomics was used to research the potential mechanism of action while ELISA,hematoxylin and eosin,and Masson’s staining were used to preliminarily investigate the protective impact of Agari-5 on rats with MI.RESULTS The current study has shown that Agari-5 might enhance cardiac function indicators,including echocardiography results of rats and creatine kinase,creatine kinase isoenzyme,and lactate dehydrogenase,in rats that had MI.According to the results of pathological staining,Agari-5 may lessen inflammatory cell infiltration and cardiomyocyte fibrosis,among other things.The proteome analysis revealed that there were 60 distinct proteins in total,four of which were associated with the heart.The expression of PSAT1,PDK1,SMAD4,and SDF2 proteins may be linked to the mechanism of their protective effects.CONCLUSION Potential therapeutic effects of Agari-5 for MI and its mechanism of action may be related to PSAT1,PDK1,SMAD4,and SDF2.
文摘With the accelerated pace of population aging in China,the number of patients suffering from myocardial infarction(MI)is increasing annually.During disease progression,patients are at significantly higher risk of developing severe negative emotions,and emerging evidence suggests that post-traumatic stress disorder(PTSD)is significantly associated with cardiovascular disease,which seriously affects patients’quality of life.Objective:The aim of this study was to comprehensively assess the prevalence and influencing factors of PTSD in MI patients through systematic review and Meta-analysis.Methods:A computerized search of PubMed,the Cochrane Library,Embase,Web of Science,PsycINFO,China Knowledge Network(CNKI),WanFang Data,VIP,and China Biomedical Literature Database(CBM)was conducted to collect longitudinal studies,case-control studies,and cross-sectional studies related to PTSD prevalence rates and influencing factors in MI patients published up to August 1,2024.Literature screening,data extraction and quality assessment were done independently by two researchers and Meta-analysis was done using Stata 16.0 software.This study has been registered on the PROSPERO platform,registration number:CRD42024577243.Results:A total of 16 papers were included,with a total sample size of 3,768 cases involving 8 influencing factors.The results of the Meta-analysis showed that the prevalence of PTSD in patients with MI was 20.4%(95%CI=15.0–26.5%).Female(OR=3.12,95%CI=1.97–4.97,P<0.001),high neuroticism score(OR=2.21,95%CI=1.20–4.07,P=0.011),and high intrusive rumination score(OR=2.95,95%CI=1.50–5.83,P=0.002)were the risk factors for PTSD in MI patients.While age(OR=1.01,95%CI=0.98–1.04,P=0.440),education level(OR=0.55,95%CI=0.07–4.48,P=0.574),social support rating scale(OR=0.81,95%CI=0.52–1.26,P=0.346),Killip cardiac function classification(OR=2.29,95%CI=0.91–5.80,P=0.080)and creatine kinase isoenzyme(OR=1.03,95%CI=0.99–1.05,P=0.124)were not associated with the development of PTSD in MI patients.Conclusion:The prevalence of PTSD was higher in patients with MI.The prevalence varied by evaluation tool and study area.Risk factors were multifactorial,including general factors(female)and overall assessment(high neuroticism score,high invasive rumination score).Therefore,early intervention and proper de-escalation of PTSD symptoms in patients with MI by medical staff are needed in clinical practice to reduce the risk of PTSD.
基金supported by the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A)the Key Project of Tianjin Natural Science Foundation(21JCZDJC01080)the Tianjin Fourth Central Hospital Outstanding Young Talent Fund(tjdszxyy20230008).
文摘BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular factors remain limited.Frailty,reflecting diminished physiological reserve,has emerged as a potential determinant of adverse outcomes in this high-risk population.Therefore,the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.METHODS We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China(from January 2010 to March 2024).Frailty was assessed using the Hospital Frailty Risk Score(HFRS),with HFRS<5 defined as non-frail and HFRS≥5 as frail.Multivariable Cox proportional hazards models,adjusted for demographics,comorbidities,left ventricular ejection fraction,and therapies,were applied to evaluate associations between frailty and clinical outcomes.The primary endpoints were all-cause death and major adverse cardiovascular events(MACE),which defined as the composite of cardiovascular death and heart failure rehospitalization.Secondary endpoints included net adverse clinical events(NACE),which defined as the composite of all-cause death,stroke,recurrent myocardial infarction,revascularization,and major bleeding,as well as the individual components of MACE.RESULTS Frailty was independently associated with a higher risk of all-cause death[adjusted hazard ratio(aHR)=1.52,95%CI:1.31–2.03,P=0.005]and NACE(aHR=1.20,95%CI:1.02–1.41,P=0.026).At one year,frail patients had higher unadjusted rates of all-cause death(9.0%vs.2.9%)and NACE(19.8%vs.13.7%)compared with non-frail patients.For cardiovascular death,the association did not reach statistical significance(aHR=1.42,95%CI:0.99–2.03,P=0.053).No significant associations were found for MACE(aHR=1.05,95%CI:0.86–1.28,P=0.636)or heart failure rehospitalization(aHR=0.94,95%CI:0.75–1.19,P=0.616).CONCLUSIONS Frailty,as measured by the HFRS,is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients.These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up,optimization of medical therapy,and targeted frailty-focused interventions.
基金supported by Fujian Provincial Natural Science Foundation of China(No.2022J011489 and No.2023J011876)Startup Fund for Scientific Research of Fujian Medical University(No.2021QH1210).
文摘Background Myocardial infarction(MI)and postmyocardial remodeling are the most common causes of heart failure worldwide and seriously affect the quality of life and prognosis of patients.Dapagliflozin,a sodium glucose cotransporter 2(SGLT2)inhibitor,is a novel class of hypoglycemic drug that has been proven to have cardiovascular protective effects.However,the underlying mechanisms by which dapagliflozin affects MI have yet to be elucidated.Methods An MI mouse model was created by ligating the left anterior descending branch of the coronary artery.Hematoxylin‒eosin(HE)and Masson’s trichrome(Masson)staining were used to assess myocardial damage.The levels of fibrosis-related and cuproptosis-related markers were assessed via Western blot analysis.A hypoxia-induced cardiomyocyte fibrosis model was constructed in vitro.The DCFH-DA probe was used to measure the levels of reactive oxygen species(ROS),and flow cytometry was used to identify cell apoptosis.Results Dapagliflozin improved heart function,ameliorated fibrosis in the myocardium,and alleviated myocardial injury.Moreover,dapagliflozin reduced the copper ion concentration and ROS accumulation and inhibited the expression of cuproptosis-related markers.Dapagliflozin suppressed the expression of HIF-1α/TGF-βsignal and the overexpression of HIF-1αeffectively reversed the dapagliflozin-mediated myocardial protective effects.Conclusion Dapagliflozin reduced myocardial fibrosis by suppressing HIF-1α/TGF-β-mediated cuproptosis.
