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
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 Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary ...Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary intervention(PCI)is an effective treatment for AMI,rapidly restoring blood flow,reducing myocardial injury,and mitigating adverse remodeling.However,reperfusion injury and ventricular remodeling post-PCI may still lead to heart failure.Recent studies highlighted the cardioprotective effects of sodium-glucose cotransporter-2(SGLT-2)inhibitors,particularly dapagliflozin,which improves myocardial energetics,reduces inflammation,and attenuates adverse remodeling.However,high-quality evidence on its early application following primary PCI in AMI re-mains limited.In this study,we aimed to evaluated the clinical utility of dapagliflozin in AMI management.Meth-ods This study retrospectively analyzed the clinical data of 100 patients with AMI undergoing emergency PCI ad-mitted to our hospital between June 2022 and June 2024.They were randomly divided into observation group(n=50)and control group(n=50).The control group received standard post-PCI medication(antiplatelet and lipid-low-ering therapy),while the observation group received additional dapagliflozin.Cardiac function parameters,serolog-ical markers,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results After 14 days of treatment,observation group exhibited significantly lower left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05)and higher left ventricu-lar ejection fraction(LVEF)(P<0.05)compared to control group.Additionally,the level of myocardial injury mark-ers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and brain natriuretic peptide(BNP)]were significant-ly lower in observation group(P<0.05).However,there was no significant difference in the incidence of MACE be-tween the two groups(P>0.05).Conclusions The combination of dapagliflozin with standard post-PCI therapy improves cardiac function and reduces the level of myocardial injury markers in AMI patients,though it does not significantly affect the short-term incidence of adverse cardiovascular events.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
Wellens’ syndrome is defined by specific T-wave inversions in the precordial leads of the electrocardiogram (ECG),which are indicative of acute anterior myocardial ischemia caused by severe proximal stenosis of the l...Wellens’ syndrome is defined by specific T-wave inversions in the precordial leads of the electrocardiogram (ECG),which are indicative of acute anterior myocardial ischemia caused by severe proximal stenosis of the left anterior descending (LAD)artery.If not promptly treated,approximately 75%of patients with Wellens’ syndrome may experience extensive anterior wall myocardial infarction or sudden cardiac death within days to weeks.^([1,2]) Although the characteristic ECG changes associated with Wellens’syndrome are highly suggestive of LAD occlusion,there are rare instances in which similar ECG alterations are observed in the absence of LAD stenosis,a phenomenon referred to as pseudo-Wellens’ syndrome.The precise pathophysiological mechanisms underlying this syndrome remain unclear.Here,we present a patient with a myocardial bridge who presented a typical Wellens’ECG pattern.展开更多
Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atheroscle...Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.展开更多
Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-qua...Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.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
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
Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes signif...Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.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
Myocardial infarction (MI) continues to be the primary cause of death globally. Oxidative stress in the initial phase of MI, followed by uncontrolled and excessive myocardial fibrosis, significantly impedes cardiac re...Myocardial infarction (MI) continues to be the primary cause of death globally. Oxidative stress in the initial phase of MI, followed by uncontrolled and excessive myocardial fibrosis, significantly impedes cardiac repair efficiency post-MI, culminating in adverse ventricular remodeling and potential heart failure. To address the diverse pathological stages of MI, an injectable composite hydrogel containing versatile nanoparticles was developed. In this study, mesoporous silicon nanoparticles (MSNs) served as carriers for encapsulating microRNA-29b (miR-29b) mimics with antifibrotic activity, subsequently coated with a complex of natural antioxidant tannic acid and zinc ions (TA/Zn). These nanoparticles were then embedded into a biocompatible alginate hydrogel to enhance retention within the infarcted myocardium. Upon injection into the infarcted region of MI mice, the composite hydrogel gradually released the nanoparticles as it degraded. Initially, the TA/Zn complex on the outer layer scavenged reactive oxygen species, thereby inhibiting cell apoptosis. The subsequent dissociation of the TA/Zn complex led to the release of the encapsulated miR-29b mimics that could inhibit the activation of cardiac fibroblasts and collagen production, thereby alleviating fibrosis progression. Overall, this composite hydrogel demonstrated the potential to reduce infarct size and improve cardiac function, suggesting its promise as a synergistic therapeutic approach for repairing infarcted myocardium.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
The aim of this study is to investigate the mechanism of magnesium isoglycyrrhizinate(MgIG)in the treatment of myocardial remodeling induced by isoproterenol(ISO)in mice.We assessed the impact of MgIG on ISO-induced m...The aim of this study is to investigate the mechanism of magnesium isoglycyrrhizinate(MgIG)in the treatment of myocardial remodeling induced by isoproterenol(ISO)in mice.We assessed the impact of MgIG on ISO-induced myocardial remodeling by activating the PI3K/AKT1 pathway.The cardiac function of mice was evaluated by echocardiography,revealing that MgIG could improve left ventricular function.Pathological staining analysis showed that MgIG could reduce the degree of myocardial injury caused by ISO.Serum data detected by ELISA demonstrated that MgIG could decrease the levels of CK-MB,MDA,and LDH while increasing the activity of GSH-Px.Western blotting analysis revealed that protein expression levels of Collagen I,BNP,Bax,cleaved caspase-3,p-PI3K,and p-AKT1 were decreased,whereas the protein expressions of Bcl-2,COX2,and SOD1 were increased upon MgIG treatment.However,the activation of the PI3K pathway reversed the cardioprotective effects of MgIG,as evidenced by the addition of PI3K activators.Taken together,our comprehensive results suggested that MgIG could improve ISO-induced myocardial remodeling,potentially through its mechanism of inhibiting the PI3K/AKT1 pathway to regulate apoptosis and oxidative stress.展开更多
Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extra...Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.展开更多
Ischemic heart disease(IHD)is associated with high morbidity and mortality rates.Reperfusion therapy is the best treatment option for this condition.However,reperfusion can aggravate myocardial damage through a phenom...Ischemic heart disease(IHD)is associated with high morbidity and mortality rates.Reperfusion therapy is the best treatment option for this condition.However,reperfusion can aggravate myocardial damage through a phenomenon known as myocardial ischemia/reperfusion(I/R)injury,which has recently gained the attention of researchers.Several studies have shown that Chinese herbal medicines and their natural monomeric components exert therapeutic effects against I/R injury.This review outlines the current knowledge on the pathological mechanisms through which mitochondria participate in I/R injury,focusing on the issues related to energy metabolism,mitochondrial quality control disorders,oxidative stress,and calcium.The mechanisms by which mitochondria mediate cell death have also been discussed.To develop a resource for the prevention and management of clinical myocardial I/R damage,we compiled the most recent research on the effects of Chinese herbal remedies and their monomer components.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
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
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 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 Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary intervention(PCI)is an effective treatment for AMI,rapidly restoring blood flow,reducing myocardial injury,and mitigating adverse remodeling.However,reperfusion injury and ventricular remodeling post-PCI may still lead to heart failure.Recent studies highlighted the cardioprotective effects of sodium-glucose cotransporter-2(SGLT-2)inhibitors,particularly dapagliflozin,which improves myocardial energetics,reduces inflammation,and attenuates adverse remodeling.However,high-quality evidence on its early application following primary PCI in AMI re-mains limited.In this study,we aimed to evaluated the clinical utility of dapagliflozin in AMI management.Meth-ods This study retrospectively analyzed the clinical data of 100 patients with AMI undergoing emergency PCI ad-mitted to our hospital between June 2022 and June 2024.They were randomly divided into observation group(n=50)and control group(n=50).The control group received standard post-PCI medication(antiplatelet and lipid-low-ering therapy),while the observation group received additional dapagliflozin.Cardiac function parameters,serolog-ical markers,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results After 14 days of treatment,observation group exhibited significantly lower left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05)and higher left ventricu-lar ejection fraction(LVEF)(P<0.05)compared to control group.Additionally,the level of myocardial injury mark-ers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and brain natriuretic peptide(BNP)]were significant-ly lower in observation group(P<0.05).However,there was no significant difference in the incidence of MACE be-tween the two groups(P>0.05).Conclusions The combination of dapagliflozin with standard post-PCI therapy improves cardiac function and reduces the level of myocardial injury markers in AMI patients,though it does not significantly affect the short-term incidence of adverse cardiovascular events.
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.
基金supported by a grant from the Science and Technology Fund of Tianjin Municipal Education Commission(2021KJ216)。
文摘Wellens’ syndrome is defined by specific T-wave inversions in the precordial leads of the electrocardiogram (ECG),which are indicative of acute anterior myocardial ischemia caused by severe proximal stenosis of the left anterior descending (LAD)artery.If not promptly treated,approximately 75%of patients with Wellens’ syndrome may experience extensive anterior wall myocardial infarction or sudden cardiac death within days to weeks.^([1,2]) Although the characteristic ECG changes associated with Wellens’syndrome are highly suggestive of LAD occlusion,there are rare instances in which similar ECG alterations are observed in the absence of LAD stenosis,a phenomenon referred to as pseudo-Wellens’ syndrome.The precise pathophysiological mechanisms underlying this syndrome remain unclear.Here,we present a patient with a myocardial bridge who presented a typical Wellens’ECG pattern.
文摘Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.
文摘Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.
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.
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.
文摘Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.
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 Natural Science Foundation of Jiangsu Province(No.BK20231314)the National Natural Science Foundation of China(No.92168203)+4 种基金the National Key R&D Program of China(No.2022YFA1104300)the Jiangsu Cardiovascular Medicine Innovation Center(No.CXZX202210)the Suzhou“Science and Education Revitalize Health”Youth Science and Technology Project(No.KJXW2021001)the Suzhou“Science and Education Revitalize Health”Youth Science and Technology Project(No.KJXW2021001)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Myocardial infarction (MI) continues to be the primary cause of death globally. Oxidative stress in the initial phase of MI, followed by uncontrolled and excessive myocardial fibrosis, significantly impedes cardiac repair efficiency post-MI, culminating in adverse ventricular remodeling and potential heart failure. To address the diverse pathological stages of MI, an injectable composite hydrogel containing versatile nanoparticles was developed. In this study, mesoporous silicon nanoparticles (MSNs) served as carriers for encapsulating microRNA-29b (miR-29b) mimics with antifibrotic activity, subsequently coated with a complex of natural antioxidant tannic acid and zinc ions (TA/Zn). These nanoparticles were then embedded into a biocompatible alginate hydrogel to enhance retention within the infarcted myocardium. Upon injection into the infarcted region of MI mice, the composite hydrogel gradually released the nanoparticles as it degraded. Initially, the TA/Zn complex on the outer layer scavenged reactive oxygen species, thereby inhibiting cell apoptosis. The subsequent dissociation of the TA/Zn complex led to the release of the encapsulated miR-29b mimics that could inhibit the activation of cardiac fibroblasts and collagen production, thereby alleviating fibrosis progression. Overall, this composite hydrogel demonstrated the potential to reduce infarct size and improve cardiac function, suggesting its promise as a synergistic therapeutic approach for repairing infarcted myocardium.
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.
基金Jiangxi Provincial Department of Education Science and Technology Project(Grant No.GJJ2401615)Jiangxi Provincial Department of Education Teaching Reform Project(Grant No.JXJG-24-15-15).
文摘The aim of this study is to investigate the mechanism of magnesium isoglycyrrhizinate(MgIG)in the treatment of myocardial remodeling induced by isoproterenol(ISO)in mice.We assessed the impact of MgIG on ISO-induced myocardial remodeling by activating the PI3K/AKT1 pathway.The cardiac function of mice was evaluated by echocardiography,revealing that MgIG could improve left ventricular function.Pathological staining analysis showed that MgIG could reduce the degree of myocardial injury caused by ISO.Serum data detected by ELISA demonstrated that MgIG could decrease the levels of CK-MB,MDA,and LDH while increasing the activity of GSH-Px.Western blotting analysis revealed that protein expression levels of Collagen I,BNP,Bax,cleaved caspase-3,p-PI3K,and p-AKT1 were decreased,whereas the protein expressions of Bcl-2,COX2,and SOD1 were increased upon MgIG treatment.However,the activation of the PI3K pathway reversed the cardioprotective effects of MgIG,as evidenced by the addition of PI3K activators.Taken together,our comprehensive results suggested that MgIG could improve ISO-induced myocardial remodeling,potentially through its mechanism of inhibiting the PI3K/AKT1 pathway to regulate apoptosis and oxidative stress.
基金United Arab Emirates University,Grant/Award Number:12R104 and 12R121。
文摘Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.
基金supported by the National Natural Science Foundation of China(Grant No.:82074235)the Central Universities in China(Grant No.:2023-JYB-JBQN-041)。
文摘Ischemic heart disease(IHD)is associated with high morbidity and mortality rates.Reperfusion therapy is the best treatment option for this condition.However,reperfusion can aggravate myocardial damage through a phenomenon known as myocardial ischemia/reperfusion(I/R)injury,which has recently gained the attention of researchers.Several studies have shown that Chinese herbal medicines and their natural monomeric components exert therapeutic effects against I/R injury.This review outlines the current knowledge on the pathological mechanisms through which mitochondria participate in I/R injury,focusing on the issues related to energy metabolism,mitochondrial quality control disorders,oxidative stress,and calcium.The mechanisms by which mitochondria mediate cell death have also been discussed.To develop a resource for the prevention and management of clinical myocardial I/R damage,we compiled the most recent research on the effects of Chinese herbal remedies and their monomer components.
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.
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.
