Present Researching Approaches and Future Prospects for Treatment of Cardiac Diseases-Integrative Medicine

The pathogenesis of cardiac diseases is very complex and involved in many gene transcription and protein expression. How to effectively treat the diseases has become the hotspot of modern medicine. Accumulating evidences over the past decades on integrative medicine have shown us hopeful future prospects. With the development of modern biomedicine, such as sketch mapping genomic sequence, functional genomics,proteomics and pharmacogenetics, more advanced techniques could be applied in elucidating the possibly complicated biological networks, or complex pathological and physiological mechanisms underlying cardiac diseases, by which integrative medicine will also bring out some new and more effective strategies in the treatment of cardiac diseases.

Large animal models of cardiac ischemia-reperfusion injury:Where are we now?

Large animal models of cardiac ischemia-reperfusion are critical for evaluation of the efficacy of cardioprotective interventions prior to clinical translation.Nonetheless,current cardioprotective strategies/interventions formulated in preclinical cardiovascular research are often limited to small animal models,which are not transferable or reproducible in large animal models due to different factors such as:(i)complex and varied features of human ischemic cardiac disease(ICD),which are challenging to mimic in animal models,(ii)significant differences in surgical techniques applied,and(iii)differences in cardiovascular anatomy and physiology between small versus large animals.This article highlights the advantages and disadvantages of different large animal models of preclinical cardiac ischemic reperfusion injury(IRI),as well as the different methods used to induce and assess IRI,and the obstacles faced in using large animals for translational research in the settings of cardiac IR.

Probability Based Regression Analysis for the Prediction of Cardiovascular Diseases

Machine Learning(ML)has changed clinical diagnostic procedures drastically.Especially in Cardiovascular Diseases(CVD),the use of ML is indispensable to reducing human errors.Enormous studies focused on disease prediction but depending on multiple parameters,further investigations are required to upgrade the clinical procedures.Multi-layered implementation of ML also called Deep Learning(DL)has unfolded new horizons in the field of clinical diagnostics.DL formulates reliable accuracy with big datasets but the reverse is the case with small datasets.This paper proposed a novel method that deals with the issue of less data dimensionality.Inspired by the regression analysis,the proposed method classifies the data by going through three different stages.In the first stage,feature representation is converted into probabilities using multiple regression techniques,the second stage grasps the probability conclusions from the previous stage and the third stage fabricates the final classifications.Extensive experiments were carried out on the Cleveland heart disease dataset.The results show significant improvement in classification accuracy.It is evident from the comparative results of the paper that the prevailing statistical ML methods are no more stagnant disease prediction techniques in demand in the future.

Comparison of Mortality, Length of Stay, and Hospitalization Costs of Hospitalized COVID-19 Patients with Cardiac and Non-Cardiac Disease

Background: The COVID-19 pandemic has presented unprecedented challenges to global healthcare systems. As the pandemic unfolded, it became evident that certain groups of individuals were at an elevated risk of experiencing severe disease outcomes. Among these high-risk groups, individuals with pre-existing cardiac conditions emerged as particularly vulnerable. Objective: This study aimed to investigate the relationship between the length of stay, mortality, and costs of COVID-19 patients with and without a history of cardiac disease. Design: This retrospective study was conducted in Jam Hospital in Tehran, Iran, from March 21, 2021, to March 21, 2022. All patients with laboratory-confirmed COVID-19 who were hospitalized during this period were included. Results: A total of 500 COVID-19 patients were hospitalized, with 31.6% having a history of cardiac disease and 68.4% without any cardiac disease. Patients with cardiac disease were significantly older (median [range] age, 69.35 [37 - 94] years) compared to non-cardiac patients (54.95 [13 - 97] years) (p Conclusion: Patients with cardiac disease who are hospitalized with COVID-19 have a higher mortality rate, longer hospital stays, greater disease severity, ICU admission, and higher costs. Therefore, improved prevention and management strategies are crucial for these patients.

Regeneration of the heart:f rom molecular mechanisms to clinical therapeutics

Heart injury such as myocardial infarction leads to cardiomyocyte loss,fibrotic tissue deposition,and scar formation.These changes reduce cardiac contractility,resulting in heart failure,which causes a huge public health burden.Military personnel,compared with civilians,is exposed to more stress,a risk factor for heart diseases,making cardiovascular health management and treatment innovation an important topic for military medicine.So far,medical intervention can slow down cardiovascular disease progression,but not yet induce heart regeneration.In the past decades,studies have focused on mechanisms underlying the regenerative capability of the heart and applicable approaches to reverse heart injury.Insights have emerged from studies in animal models and early clinical trials.Clinical interventions show the potential to reduce scar formation and enhance cardiomyocyte proliferation that counteracts the pathogenesis of heart disease.In this review,we discuss the signaling events controlling the regeneration of heart tissue and summarize current therapeutic approaches to promote heart regeneration after injury.

Pursuing meaningful end-points for stem cell therapy assessment in ischemic cardiac disease

Despite optimal interventional and medical therapy, ischemic heart disease is still an important cause of morbidity and mortality worldwide. Although not included in standard of care rehabilitation, stem cell therapy(SCT) could be a solution for prompting cardiac regeneration. Multiple studies have been published from the beginning of SCT until now, but overall no unanimous conclusion could be drawn in part due to the lack of appropriate endpoints. In order to appreciate the impact of SCT, multiple markers from different categories should be considered: Structural, biological, functional, physiological, but also major adverse cardiac events or quality of life. Imaging end-points are among the most used-especially left ventricle ejection fraction(LVEF) measured through different methods. Other imaging parameters are infarct size, myocardial viability and perfusion. The impact of SCT on all of the aforementioned end-points is controversial and debatable. 2 D-echocardiography is widely exploited, but new approaches such as tissue Doppler, strain/strain rate or 3 D-echocardiography are more accurate, especially since the latter one is comparable with the MRI gold standard estimation of LVEF. Apart from the objective parameters, there are also patient-centered evaluations to reveal the benefits of SCT, such as quality of life and performance status, the most valuable from the patient point of view. Emerging parameters investigating molecular pathways such as non-coding RNAs or inflammation cytokines have a high potential as prognostic factors. Due to the disadvantages of current techniques, new imaging methods with labelled cells tracked along their lifetime seem promising, but until now only pre-clinical trials have been conducted in humans. Overall, SCT is characterized by high heterogeneity not only in preparation, administration and type of cells, but also in quantification of therapy effects.

Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

Objectives To evaluate the effect of different styles of coronary heart disease （CHD）, different regions of acute myocardial infarction （AMI）, its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD （NoCHD） were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris （SAP） 26, unstable angina pectoris（UAP） 53, acute myocardial infarction （AMI） 140 and old myocardial infarction （OMI） 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct （Aa,n = 53）, acute inferior myocardial infarction （Ai, n=54） and Aa＋Ai （n=33） based on ECG. Cardiac parameters： end-diastolic interventricular septum thickness（IVSd）, end-diastolic left ventricular internal diameter （LVd）, left ventricular mass （LM）, end-diastolic left ventricular volume （EDV）, end-systolic left ventricular volume （ESV） and left ventricular ejection fraction（LVEF） were measured by ACUSON 128XP/10 echocardiography. Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP （P〈0.05-0.0001）. LM was mainly increased in patients with OMI （P〈0.01） and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa＋Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF was significantly decreased, and LVd and LM increased in AMI patients with antecedent hypertension, compared to patients without hypertension （P〈0.001）. Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction, especially Aa and Aa＋Ai, is one of the most important causes of left ventricular remodeling and cardiac dysfunction. Multiple vessel stenosis and systolic blood pressure at the onset of myocardial infarction reduce LVEF in AMI patients. Antecedent hypertension may accelerate the effect of AMI on cardiac remodeling and dysfunction. Therefore primary and secondary preventions of CHD are critical for protecting heart from remodeling and dysfunction.

Clinical perspective on C-reactive protein in prognostication of major adverse cardiac events in the elderly with established coronary heart disease

The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……

Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results

Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.

Comparison of clinical outcomes of Chinese men and women after coronary stenting for coronary artery disease:a multi-center retrospective analysis of 4,334 patients

The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention（PCI） with stent remain unclear.The present study was aimed to compare clinical outcomes in such two populations.From May 1999 to December 2009,4,334 patients with acute myocardial infarction（MI）,unstable angina,stable angina,or silent ischemia,who underwent PCI,were registered at our centers.Among these,3,089 were men and 1,245 were women.We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events（MACE） including cardiac death,MI,target lesion revascularization,target vessel revascularization（TVR）,stent thrombosis（ST）,definite ST and probable ST at one-year follow-up.Chinese male patients had a higher MACE rate（13%vs.10.7%,P =0.039）,mainly led by TVR（9.09%vs.6.98%,P=0.024） at one year,which was significantly different than female patients.Chinese male and female patients showed a significant difference on MACEs.However,there was no significant difference with respect to MI between these groups.

Pregnancy in Patients with Shone Complex: A Single-Center Case Series

Background:There is limited literature written on the course and outcomes for pregnant mothers with Shone complex.Methods:We describe a case series of five pregnancies in four women with Shone complex within a multidisciplinary cardio-obstetrics clinic from 2016–2018.Results:Maternal age ranged from 21–39 years.Three patients had preserved left ventricular function while one had moderately decreased function.Gestational age at presentation ranged from 6–15 weeks.There were three successful pregnancies(mean gestational age=37 weeks,range 35–39 weeks)with one patient accounting for two unsuccessful pregnancies.All infants were delivered via Cesarean section.One infant required a NICU stay,but all other infants delivered were healthy.Conclusion:Patients with Shone complex can have successful pregnancies although complications can occur for both the mother and the baby.Comprehensive prenatal care,coordinated and consistent management during pregnancy,and tertiary care support can promote positive maternal and fetal outcomes.

A Cross-Sectional Survey to Determine the Prevalence of Cardiovascular Disease Risk Factors in an Understudied Population in Sierra Leone

To document the prevalence of risk factors for cardiovascular disease in an unstudied community, a survey of 130 participants from different areas of Sierra Leone was performed. The focus was on cardiovascular disease because its prevalence had not been studied and World Health Organization (WHO) reports on Non-Communicable Diseases (NCD) prevalence were extrapolations and not from actual data. Resting blood pressure, fasting blood glucose, fasting lipid levels and carotid intima media thickness (CIMT) were measured. Mean blood pressure in men was slightly lower than in women (132/87 mmHg and 139/90 mmHg respectively), mean fasting blood glucose levels were <100 mg/dL in both groups and mean fasting total cholesterol was higher in women than in men (206 mg versus 193.5 mg/dL). Mean fasting low density lipoprotein levels were similar in both groups, 129 mg/dL in men and 133 mg/dL in women. Mean fasting high density cholesterol was 47.2 mg/dL in men and 55.5 mg/dL in women and CIMT values were similar in both groups, with 60% above the 75th percentile. This study demonstrated a prevalence of cardiovascular risk factors in this population with mean BP placing both men and women in pre-hypertension or stage 1 hypertension ranges and elevated mean low density lipoprotein levels. Fasting total cholesterol, blood glucose and high density lipoprotein were within normal ranges. Mean CIMT values for men and women placed them at risk for subclinical atherosclerosis.

Association of cardiac disease with the risk of post-lung transplantation mortality in Chinese recipients aged over 65 years

The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observed.This retrospective cohort study recruited 166 lung transplant recipients aged≥65 years between January 2016 and October 2020 in the largest LT center in China.In the cohort,subgroups of patients aged 65–70 years(111 recipients,group 65–70)and≥70 years(55 recipients,group≥70)were included.Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years.A significantly higher percentage of coronary artery stenosis was observed in the group≥70(30.9%vs.14.4%in group 65–70,P=0.014).ECMO bridging to LT was performed in 5.4%(group 65–70)and 7.3%(group≥70)of patients.Kaplan–Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality.After adjusting for potential confounders,cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality(HR 6.37,P=0.0060).Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.

The Level of Serum Intact Terminal Peptide of Procollagen and Its Clinical Significance in Patients with Chronic Keshan Disease

Objectives To evaluate the changes of serum intact terminal peptide of procollagen in patients with chronic Keshan disease (KD) and investigate their clinical significance. Methods The concentrations of serum intact N-terminal peptide of type procollagen (P NP) and intact N-terminal peptide of type procollagen were measured by radioimmunoassay in 35 patients with chronic KD and 31 normal control. Doppler ultrasounds was used to determine several parameters of left ventricular systole and diastole functions. Results The concentration of serum P NP (74.07±16.74)μg/L and the ratio of P NP/ P NP (18.02 ±4.60) in chronic KD were significantly increased as compared to the control (39.63±12.07 μg/L, 12.12±4.24; P< 0.001). Serum P NP (4.19±0.64)μg/L in chronic KD was higher than that in the control (3.36±0.65 μg/L,P < 0.001) too. The higher of serum concentration of P NP and the ratio of P NP/ P NP, the worse of cardiac function in patients with chronic KD. A negative correlation was found between serum P NP/ P NP, P NP and VE/VA, LVEF (γ=-0.4502, -0.4608, P< 0.01 and γ=-0.3936, -0.3904, respectively; P<0.05). Conclusions These findings suggested that tissue synthesis of collagen type and type was abnormally increased in chronic KD. On the other hand, our results indicated that P NP and P NP were related to several functional alterations of the left ventricle. Serum procollagen peptide measurements might therefore provide indirectly diagnostic information on myocardial fibrosis associated with chronic KD.

Postoperative diaphragmatic paralysis after cardiac surgery in children： incidence, diagnosis and surgical management

Background Cardiac surgery for congenital heart disease covers a wide spectrum from simple to complex cardiac and extracardiac malformations. Innovations in pediatric cardiac surgery and perioperative care over the past decades have allowed surgical correction or at least palliation in almost all complex congenital heart defects in the first years of life. Diaphragmatic paralysis （DP） due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency, lung infections, prolonged hospital stay time and even death.

Comparison of Clinical Characteristics and Outcomes of MAFLD and NAFLD in Chinese Health Examination Populations

Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.