Acute myocardial infarction(MI)remains one of the leading causes of mortality and morbidity in the global communities.A prevailing topic that has attracted increasing attentions over the past few decades is the so-cal...Acute myocardial infarction(MI)remains one of the leading causes of mortality and morbidity in the global communities.A prevailing topic that has attracted increasing attentions over the past few decades is the so-called heart-brain interaction,in particular following a major traumatic event such as MI.Increased prevalence of depression and other mental disorders has been recognized in cardiac patients after MI,coronary catheterization,or cardiothoracic surgeries.In this review,we focus on the potential pathogenic mechanisms and pre-clinical transcriptomic evidence for identifying potential mediators of post-MI depression.We first summarize the conventional mechanistic understanding that leads to the current clinical management of post-MI depression with the use of selective serotonin reuptake inhibitors(SSRIs)and cognitive behavior and exercise therapies.We further envisage a possible role played by certain chemokines,e.g.,Chemokine(C-X-C motif)ligand 12(CXCL12)and Chemokine(C-C motif)ligand 2(CCL22),in serving as signaling molecules to connect the MI-induced heart damage to the pro-depressive changes in brain during the post-MI period.Future in-depth investigations into this chemokine hypothesis will be instrumental in developing new chemokine-targeted therapies for better management of the cardiac patients suffering from post-MI depression.展开更多
B-type natriuretic peptide （BNP） and N-terminal proBNP （NT-proBNP）, the key members of natriuretic peptide family have been rec- ommended as the gold standard biomarkers for the diagnosis and prognosis of heart fa...B-type natriuretic peptide （BNP） and N-terminal proBNP （NT-proBNP）, the key members of natriuretic peptide family have been rec- ommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure （HF） according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particu- larly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on their use in geriatric cardiology settings. We have focused on several remaining issues and chal- lenges regarding the clinical utilization of BNP and NT-proBNP, which include： （1） Different prevalence and diagnostic/prognostic values of BNP isoforms; （2） methodological issues on detection of BNP; （3） glycosylation of proBNP and its effect on biomarker testing; （4） specificity and comparability of BNP/NT-proBNP resulted from different testing platforms; （5） new development of natriuretic peptides as HF treatment modality; （6） BNP paradox in HF; and （7） special considerations of using BNP/NT-proBNP in elderly HF patients. These practical discussions on BNP/NT-proBNP may be instrumental for the healthcare providers in critically interpreting laboratory results and effective management of the HF patients.展开更多
Heart transplantation is a lifesaving procedure,which is limited by the availability of donor hearts.Using hearts from donors after circulatory death,which have sustained global ischemia,requires thorough studies on r...Heart transplantation is a lifesaving procedure,which is limited by the availability of donor hearts.Using hearts from donors after circulatory death,which have sustained global ischemia,requires thorough studies on reliable and reproducible models that developing researchers may not have mastered.By combining the most recent lit-erature and our recommendations based on observations and trials and errors,the methods here detail a sound in vivo heterotopic heart transplantation model for rats in which protective interventions on the ischemic heart can be studied,and thus al-lowing the scientific community to advance organ preservation research.Knowledge gathered from reproducible animal models allow for successful translation to clinical studies.展开更多
Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively ...Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.展开更多
Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality...Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.展开更多
Evidence-based consensus suggests that physical activity and regular exercise training can reduce modifiable risk factors as well as rate of mortality and morbidity in patients with chronic diseases,such as cardiovasc...Evidence-based consensus suggests that physical activity and regular exercise training can reduce modifiable risk factors as well as rate of mortality and morbidity in patients with chronic diseases,such as cardiovascular disease(CVD),diabetes,obesity and cancer.Conversely,long-term exercise training and drastic increase in vigorous physical activity may also cause acute cardiovascular events(e.g.acute myocardial infarction)and deleterious cardiac remodeling,particularly when exercise is performed by unfit or susceptible individuals.There is a reversed J-shaped hormesis-like curve between the duration and intensity of exercise and level of CVD risks.Therefore,it is important for an early detection of cardiac injuries in professional and amateur athletes.Under this context,this article focuses on the use of biomarker testing,an indispensable component in the current clinical practices especially in Cardiology and Oncology.We attempt to justify the importance of using circulating biomarkers in routine practices of Sports Medicine for an objective assessment of CVD events following exercise.Special attentions are dedicated to three established or emerging cardiac biomarkers(i.e.cardiac troponins,natriuretic peptides,hypoxanthine)for myocardial tissue hypoxia/ischemia events,muscle stress,and the consequent cellular necrotic injury.Based on these focused analyses,we propose use of circulating biomarker testing in both laboratory and point-of-care settings with an increasingly broader involvement or participation of team physicians,trainers,coaches,primary care doctors,as well as educated athlete community.This diagnostic approach may improve the quality of medical surveillance and preventive measures on exercise-related CVD risks/outcomes.展开更多
Myocarditis is a rare cardiomyocyte inflammatory process,typically caused by viruses,with potentially devastating cardiac sequalae in both competitive athletes and in the general population.Investigation into myocardit...Myocarditis is a rare cardiomyocyte inflammatory process,typically caused by viruses,with potentially devastating cardiac sequalae in both competitive athletes and in the general population.Investigation into myocarditis prevalence in the Coronavirus disease 2019(COVID-19)era suggests that infection with Severe acute respiratory syndrome coronavirus(SARS-CoV-2)is an independent risk factor for myocarditis,which is confirmed mainly through cardiovascular magnetic resonance imaging.Recent studies indicated that athletes have a decreased risk of myocarditis after recent COVID-19 infection compared to the general population.However,given the unique nature of competitive athletics with their frequent participation in high-intensity exercise,athletes possess distinct factors of susceptibility for the development of myocarditis and its subsequent severe cardiac complications(e.g.,sudden cardiac death,fulminant heart failure,etc.).Under this context,this review focuses on comparing myocarditis in athletes versus non-athletes,owing special attention to the distinct clinical presentations and outcomes of myocarditis caused by different viral pathogens such as cytomegalovirus,Epstein-Barr virus,human herpesvirus-6,human immunodeficiency virus,and Parvovirus B19,both before and after the COVID-19 pandemic,as compared with SARS-CoV-2.By illustrating distinct clinical presentations and outcomes of myocarditis in athletes versus non-athletes,we also highlight the critical importance of early detection,vigilant monitoring,and effective management of viral and non-viral myocarditis in athletes and the necessity for further optimization of the return-to-play guidelines for athletes in the COVID-19 era,in order to minimize the risks for the rare but devastating cardiac fatality.展开更多
Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome,i.e.post-acute sequelae of coronavirus disease 2019(COVID-19)have emerged as a debilitating health burden that has posed challenges for ...Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome,i.e.post-acute sequelae of coronavirus disease 2019(COVID-19)have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19.A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking.In this review,we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID.The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks.Despite the currently available therapeutic interventions,a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning.Therefore,a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physicalfitness levels comparable to their pre-illness baseline.展开更多
More than 4 years has elapsed since the World Health Organization(WHO)officially announced the coronavirus disease 2019(COVID-19)as a pandemic outbreak in March 11,2020.Despite the ongoing investigations and political ...More than 4 years has elapsed since the World Health Organization(WHO)officially announced the coronavirus disease 2019(COVID-19)as a pandemic outbreak in March 11,2020.Despite the ongoing investigations and political debates upon the origin,exacerbation,resurgence,andfinal control of COVID-19,medical and scientific consensus indicates that the now endemic COVID-19 virus is one of the worst public health crises in our lifetime.Almost every person on earth has been directly or indirectly impacted by the adverse effects of the highly contagious viral pathogen-SARS-CoV-2(severe acute respiratory syndrome coronavirus 2).Indeed,the population reach of the COVID-19 infection includes governmental response measures(e.g.,lockdowns and social distancing,mandates for masks and face coverings,vaccines,etc.)that have restricted entrenched societal routines,personal mobility,and lifestyles.Unfortunately,the host of health problems linked to this viral infection linger to this day,with selective groups of people experiencing a higher risk for untoward medical outcomes and/or elevated levels of vulnerability to the post-acute sequelae of COVID-19(i.e.long-COVID).For example,a 2021 study by Logue et al.provided initial evidence that 10%–30%of individuals in United States may experience prolonged symptoms following SARS-CoV-2 infection,including cardiovascular abnormalities.1 Similarly,a 2021 retrospective cohort study in England suggest that the incidence of major adverse cardiovascular events(e.g.heart failure,myocardial infarction,ischemic stroke.展开更多
文摘Acute myocardial infarction(MI)remains one of the leading causes of mortality and morbidity in the global communities.A prevailing topic that has attracted increasing attentions over the past few decades is the so-called heart-brain interaction,in particular following a major traumatic event such as MI.Increased prevalence of depression and other mental disorders has been recognized in cardiac patients after MI,coronary catheterization,or cardiothoracic surgeries.In this review,we focus on the potential pathogenic mechanisms and pre-clinical transcriptomic evidence for identifying potential mediators of post-MI depression.We first summarize the conventional mechanistic understanding that leads to the current clinical management of post-MI depression with the use of selective serotonin reuptake inhibitors(SSRIs)and cognitive behavior and exercise therapies.We further envisage a possible role played by certain chemokines,e.g.,Chemokine(C-X-C motif)ligand 12(CXCL12)and Chemokine(C-C motif)ligand 2(CCL22),in serving as signaling molecules to connect the MI-induced heart damage to the pro-depressive changes in brain during the post-MI period.Future in-depth investigations into this chemokine hypothesis will be instrumental in developing new chemokine-targeted therapies for better management of the cardiac patients suffering from post-MI depression.
文摘B-type natriuretic peptide （BNP） and N-terminal proBNP （NT-proBNP）, the key members of natriuretic peptide family have been rec- ommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure （HF） according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particu- larly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on their use in geriatric cardiology settings. We have focused on several remaining issues and chal- lenges regarding the clinical utilization of BNP and NT-proBNP, which include： （1） Different prevalence and diagnostic/prognostic values of BNP isoforms; （2） methodological issues on detection of BNP; （3） glycosylation of proBNP and its effect on biomarker testing; （4） specificity and comparability of BNP/NT-proBNP resulted from different testing platforms; （5） new development of natriuretic peptides as HF treatment modality; （6） BNP paradox in HF; and （7） special considerations of using BNP/NT-proBNP in elderly HF patients. These practical discussions on BNP/NT-proBNP may be instrumental for the healthcare providers in critically interpreting laboratory results and effective management of the HF patients.
文摘Heart transplantation is a lifesaving procedure,which is limited by the availability of donor hearts.Using hearts from donors after circulatory death,which have sustained global ischemia,requires thorough studies on reliable and reproducible models that developing researchers may not have mastered.By combining the most recent lit-erature and our recommendations based on observations and trials and errors,the methods here detail a sound in vivo heterotopic heart transplantation model for rats in which protective interventions on the ischemic heart can be studied,and thus al-lowing the scientific community to advance organ preservation research.Knowledge gathered from reproducible animal models allow for successful translation to clinical studies.
文摘Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.
文摘Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.
文摘Evidence-based consensus suggests that physical activity and regular exercise training can reduce modifiable risk factors as well as rate of mortality and morbidity in patients with chronic diseases,such as cardiovascular disease(CVD),diabetes,obesity and cancer.Conversely,long-term exercise training and drastic increase in vigorous physical activity may also cause acute cardiovascular events(e.g.acute myocardial infarction)and deleterious cardiac remodeling,particularly when exercise is performed by unfit or susceptible individuals.There is a reversed J-shaped hormesis-like curve between the duration and intensity of exercise and level of CVD risks.Therefore,it is important for an early detection of cardiac injuries in professional and amateur athletes.Under this context,this article focuses on the use of biomarker testing,an indispensable component in the current clinical practices especially in Cardiology and Oncology.We attempt to justify the importance of using circulating biomarkers in routine practices of Sports Medicine for an objective assessment of CVD events following exercise.Special attentions are dedicated to three established or emerging cardiac biomarkers(i.e.cardiac troponins,natriuretic peptides,hypoxanthine)for myocardial tissue hypoxia/ischemia events,muscle stress,and the consequent cellular necrotic injury.Based on these focused analyses,we propose use of circulating biomarker testing in both laboratory and point-of-care settings with an increasingly broader involvement or participation of team physicians,trainers,coaches,primary care doctors,as well as educated athlete community.This diagnostic approach may improve the quality of medical surveillance and preventive measures on exercise-related CVD risks/outcomes.
文摘Myocarditis is a rare cardiomyocyte inflammatory process,typically caused by viruses,with potentially devastating cardiac sequalae in both competitive athletes and in the general population.Investigation into myocarditis prevalence in the Coronavirus disease 2019(COVID-19)era suggests that infection with Severe acute respiratory syndrome coronavirus(SARS-CoV-2)is an independent risk factor for myocarditis,which is confirmed mainly through cardiovascular magnetic resonance imaging.Recent studies indicated that athletes have a decreased risk of myocarditis after recent COVID-19 infection compared to the general population.However,given the unique nature of competitive athletics with their frequent participation in high-intensity exercise,athletes possess distinct factors of susceptibility for the development of myocarditis and its subsequent severe cardiac complications(e.g.,sudden cardiac death,fulminant heart failure,etc.).Under this context,this review focuses on comparing myocarditis in athletes versus non-athletes,owing special attention to the distinct clinical presentations and outcomes of myocarditis caused by different viral pathogens such as cytomegalovirus,Epstein-Barr virus,human herpesvirus-6,human immunodeficiency virus,and Parvovirus B19,both before and after the COVID-19 pandemic,as compared with SARS-CoV-2.By illustrating distinct clinical presentations and outcomes of myocarditis in athletes versus non-athletes,we also highlight the critical importance of early detection,vigilant monitoring,and effective management of viral and non-viral myocarditis in athletes and the necessity for further optimization of the return-to-play guidelines for athletes in the COVID-19 era,in order to minimize the risks for the rare but devastating cardiac fatality.
文摘Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome,i.e.post-acute sequelae of coronavirus disease 2019(COVID-19)have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19.A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking.In this review,we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID.The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks.Despite the currently available therapeutic interventions,a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning.Therefore,a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physicalfitness levels comparable to their pre-illness baseline.
文摘More than 4 years has elapsed since the World Health Organization(WHO)officially announced the coronavirus disease 2019(COVID-19)as a pandemic outbreak in March 11,2020.Despite the ongoing investigations and political debates upon the origin,exacerbation,resurgence,andfinal control of COVID-19,medical and scientific consensus indicates that the now endemic COVID-19 virus is one of the worst public health crises in our lifetime.Almost every person on earth has been directly or indirectly impacted by the adverse effects of the highly contagious viral pathogen-SARS-CoV-2(severe acute respiratory syndrome coronavirus 2).Indeed,the population reach of the COVID-19 infection includes governmental response measures(e.g.,lockdowns and social distancing,mandates for masks and face coverings,vaccines,etc.)that have restricted entrenched societal routines,personal mobility,and lifestyles.Unfortunately,the host of health problems linked to this viral infection linger to this day,with selective groups of people experiencing a higher risk for untoward medical outcomes and/or elevated levels of vulnerability to the post-acute sequelae of COVID-19(i.e.long-COVID).For example,a 2021 study by Logue et al.provided initial evidence that 10%–30%of individuals in United States may experience prolonged symptoms following SARS-CoV-2 infection,including cardiovascular abnormalities.1 Similarly,a 2021 retrospective cohort study in England suggest that the incidence of major adverse cardiovascular events(e.g.heart failure,myocardial infarction,ischemic stroke.
