Novel concepts in radiation-induced cardiovascular disease

Radiation-induced cardiovascular disease(RICVD) is the most common nonmalignant cause of morbidity and mortality among cancer survivors who have undergone mediastinal radiation therapy(RT).Cardiovascular complications include effusive or constrictive pericarditis,cardiomyopathy,valvular heart disease,and coronary/vascular disease.These are pathophysiologically distinct disease entities whose prevalence varies depending on the timing and extent of radiation exposure to the heart and great vessels.Although refinements in RT dosimetry and shielding will inevitably limit future cases of RICVD,the increasing number of long-term cancer survivors,including those treated with older higher-dose RT regimens,will ensure a steady flow of afflicted patients for the foreseeable future.Thus,there is a pressing need for enhanced understanding of the disease mechanisms,and improved detection methods and treatment strategies.Newly characterized mechanisms responsible for the establishment of chronic fibrosis,such as oxidative stress,inflammation and epigenetic modifications,are discussed and linked to potential treatments currently under study.Novel imaging modalities may serve as powerful screening tools in RICVD,and recent research and expert opinion advocating their use is introduced.Data arguing for the aggressive use of percutaneous interventions,such as transcutaneous valve replacement and drug-eluting stents,are examined and considered in the context of prior therapeutic approaches.RICVD and its treatment options are the subject of a rich and dynamic body of research,and patients who are at risk or suffering from this disease will benefit from the care of physicians with specialty expertise in the emerging field of cardiooncology.

Comparison of in-hospital outcomes between octogenarians and nonagenarians undergoing transcatheter aortic valve replacement： a propensity matched analysis

BackgroundAortic 阀门狭窄(作为) 在在 80 年上面的老病人是很普通的。在如此的病人的 Transcatheter 大动脉的阀门代替(TAVR ) 逐渐地正在被执行。寻求在与严重 AS.MethodThe 学习人口经历 TAVR 的九十至九十九岁的人估计死亡的 octogenarians 和九十至九十九岁的人和预言者之间的在里面医院结果差别的这研究从国家住院病人样品(网络信息服务) 被导出 2012-2014 使用 ICD-9 厘米过程为 TAVR 编码 35.05 和 35.06 的年。低于 80 岁的住院被排除。在执行倾向 20 以后匹配(1：2 ) ，在里面医院结果在匹配的队被比较。然后， multivariate 模型被开发在 nonagenarians.ResultsThere 分析在里面医院死亡的预言者是 11,630 个住院在八十至八十九岁并且在九十至九十九岁的人组的 5815 个住院。在里面医院死亡的主要结果(6% 对 4.1% ， P 0.001 ) 在与 octogenarians 相比的九十至九十九岁的人是更高的。第二等的结果包括击(3.4%对2.8%， P 0.001 )，肾的失败(18.9%对17.3%， P 0.001 )，输血(35%对32.6%， P 0.001 )，脉管的复杂并发症(4.5%对3.5%， P 0.001 )，并且心律调整器培植(27.8%对24.8%， P 0.001 )在九十至九十九岁的人是更高的。在他们停留的长度没有差别。中部的费用(70,374 $ 对 65,381 $ ， P 0.001 ) 与 nonagenarian.ConclusionsAlthough 在里面医院是稍微更高的死亡在九十至九十九岁的人是稍微更高的，它是可接受的。在死亡的这差别被更高的复杂并发症部分至少在九十至九十九岁的人解释。努力应该被成为能进一步在在这些组之间的在里面医院死亡缩小差别的复杂并发症到减少。

Prevalence and clinical characteristics associated with left atrial thrombus detection: Apixaban

BACKGROUND The prevalence of left atrial appendage(LAA) thrombus detection by transesophageal echocardiogram(TEE) in patients with non-valvular atrial fibrillation(AF) anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE. The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for ≥ 4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation.AIM To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban.METHODS Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed. All patients(apixaban: 226) with non-valvular AF and documented compliance with apixaban for ≥ 4 wk prior to index TEE were included.RESULTS Following ≥ 4 wk of continuous anticoagulation with apixaban, the prevalence ofLAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1% and 6.6%, respectively. Persistent AF, left ventricular ejection fraction < 30%, severe LA dilation, and reduced LAA velocity were associated with thrombus formation. Following multivariate logistic regression, persistent AF(OR: 7.427; 95%CI: 1.02 to 53.92; P = 0.0474), and reduced LAA velocity(OR:1.086; 95%CI: 1.010 to 1.187; P = 0.0489) were identified as independent predictors of LAA thrombus. No Thrombi were detected in patients with a CHA2 DS2-VASc score ≤ 1.CONCLUSION Among patients with non-valvular AF and ≥ 4 wk of anticoagulation with apixaban, the prevalence of LAA thrombus detected by TEE was 3.1%. This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk factors.

COVID-19 vaccine-associated myocarditis

Myocarditis is now recognized as a rare complication of coronavirus disease 2019(COVID-19)mRNA vaccination,particularly in adolescent and young adult males.Since the authorization of the Pfizer-BioNTech^(TM)and Moderna^(TM)mRNA vaccines targeting the severe acute respiratory syndrome coronavirus-2(SARSCoV-2)spike protein,the Centers for Disease Control and Prevention(CDC)has reported 1175 confirmed cases of myocarditis after COVID-19 vaccination in individuals ages 30 years and younger as of January 2022.According to CDC data in June 2021,the incidence of vaccine-mediated myocarditis in males ages 12-29 years old was estimated to be 40.6 cases per million second doses of COVID-19 mRNA vaccination administered.Individuals with cases of COVID-19 vaccinemediated myocarditis typically present with acute chest pain and elevated serum troponin levels,often within one week of receiving the second dose of mRNA COVID-19 vaccination.Most cases follow a benign clinical course with prompt resolution of symptoms.Proposed mechanisms of COVID-19 vaccine myocarditis include molecular mimicry between SARS-CoV-2 spike protein and self-antigens and the triggering of preexisting dysregulated immune pathways in predisposed individuals.The higher incidence of COVID-19 vaccine myocarditis in young males may be explained by testosterone and its role in modulating the immune response in myocarditis.There is limited data on long-term outcomes in these cases given the recency of their occurrence.The CDC continues to recommend COVID-19 vaccination for everyone 5 years of age and older given the greater risk of serious complications related to natural COVID-19 infection including hospitalization,multisystem organ dysfunction,and death.Further study is needed to better understand the immunopathology and long-term outcomes behind COVID-19 mRNA vaccine-mediated myocarditis.

Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

There is a growing evidence of cardiovascular complications in coronavirusdisease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediatedinflammatory effects on the myocardium, substantial attention has beendirected towards cardiovascular imaging modalities that facilitate this diagnosis.Cardiac magnetic resonance imaging (CMRI) is the gold standard for thedetection of structural and functional myocardial alterations and its role inidentifying patients with COVID-19 mediated cardiac injury is growing. Despiteits utility in the diagnosis of myocardial injury in this population, CMRI’s impacton patient management is still evolving. This review provides a framework for theuse of CMRI in diagnosis and management of COVID-19 patients from theperspective of a cardiologist. We review the role of CMRI in the management ofboth the acutely and remotely COVID-19 infected patient. We discuss patientselection for this imaging modality;T1, T2, and late gadolinium enhancementimaging techniques;and previously described CMRI findings in other cardiomyopathieswith potential implications in COVID-19 recovered patients.

Alcohol septal ablation in elderly patients:Is it as effective as in young patients?

Hypertrophic cardiomyopathy (HCM) is a common genetic abnormality that can occur in as many as 1 in 500persons. 1 Researchers have found multiple mutations in 10different sarcomeric proteins such as myosin heavy chain and tropomyosin can cause this disease.

Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.

Clinical Study of Cardiovascular Involvement in Patients with Connective Tissue Diseases

Objective: The aim of this study was to evaluate cardiovascular involvement in patients with connective tissue diseases. Methods: A total of 99 patients (mean age 36.6 ± 10.7 years) with connective tissue diseases were included in the study. Patients were assessed based on their sex, age, disease duration, cardiovascular symptoms, erythrocyte sedimentation rate, antinuclear antibody, and anti-double stranded DNA antibodies. Moreover, cardiac investigations including electrocardiography (ECG), chest X-ray and echocardiography were performed. Results: The study included 90 (90.9%) females and 9 (9.09%) males, aged between 18 and 64 years. Chest pain, palpitation, dyspnoea on exertion, syncope, fatigue, and cardiac murmur were the most cardiac symptoms and signs of patients. ECG abnormalities associated with sinus bradycardia, sinus tachycardia, ST interval and T waves, were found in 27% patients. Chest X-ray with cardiomegaly was found in 10 (10.1%) patients. Echocardiography abnormalities were observed in 32% of patients with pericardial involvement, mitral regurgitation, and diastolic dysfunction. Moreover, the incidence of pericardial effusion was found to be significantly (p higher in patients with connective tissue diseases. Conclusion: The study indicates the correlation between disease activity, disease duration and abnormal echocardiography of cardiovascular involvement in connective tissue diseases.

Clinical Profile and In-Hospital Outcome of Patients with Right Ventricular Myocardial Infarction

Objectives: Right ventricular myocardial infarction as assessed by various diagnostic methods accompanies inferior wall myocardial infarction in 30% to 50% of patients. Acute right ventricular myocardial infarction is associated with higher in-hospital morbidity and mortality related to life-threatening hemodynamic compromise and arrhythmias. Since there is scarcity of literature regarding epidemiology of clinical profile as well as in-hospital outcomes of patients with right ventricular myocardial infarction in the Indian population, this study is carried out with a goal of identifying the same in our hospital setting, to fulfill this void. Methods: We examined the incidence of risk factors in patients (n = 100) with inferior wall myocardial infarction and 100 patients with inferior wall myocardial infarction having right ventricular involvement. Results: The mortality rate was found to be 12% in patients with inferior wall myocardial infarction and 28% in patients having right ventricular involvement in inferior wall myocardial infarction. Conclusions: From the above study, it can be concluded that patients with inferior wall myocardial infarction who have right ventricular myocardial involvement are at an increased risk of death, and cardiogenic shock.

Effect of Antioxidants on Endothelial Cell Reactive Oxygen Species (ROD Generation and Adhesion of Leukocytes to Endothelial Cells

Objective To investigatewhether antioxidants inhibit adhesion of leukocytes to endothelium and furthermore, whether all antioxidants regulate NF-KB activation through a redox sensitive mechanism. Methods The effect of the antioxidative substances pyrrolidin dithiocarbamat (PDTC), dichloroisocumarin (DCI), chrysin and probucol on the endothelial leukocyte adhesion were examined under near physiological flow conditions. The antioxidative activity of antioxidants was measured in a DCF fluorescence assay with flow cytometry. The activation of NF-kB in endothelial cells was investigated in a gel shift assay. Results PDTC and probucol did not show an inhibitory effect to the formation of intracellular H2O2 in TNFa activated human vascular endothelial cells (HUVEC) . Chrysin showed a moderate effect. DCI showed a strong antioxidative effect. In contrast, PDTC and chrysin inhibited the adhesion of HL 60 cells to TNFa-stimulated HUVEC. DCI and probucol did not have influence on the adhesion within the area of the examined shear stresses. Only PDTC inhibited the TNFa-induced activation of NF-KB in endothelial cells. Conclusion The inhibition of the endothelial leukocyte adhesion by antioxidative substances is not to be explained by its antioxidative characteristics only. The inhibitory effect of PDTC on NF-KB activation was probably not related to its antioxidative properties. Endothelial cell Antioxidants NF-kappa-B

Burden of atrial fibrillation in patients with rheumatic diseases

BACKGROUND Studies have suggested that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to inflammation.determine morbidity and mortality associated with AF in hospitalized patients with RD.METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF.A subgroup analysis was performed comparing outcomes of AF among different RD.RESULTS The prevalence of AF was 23.9%among all patients with RD(n=3949203).Among the RD subgroup,the prevalence of AF was highest in polymyalgia rheumatica(33.2%),gout(30.2%),and pseudogout(27.1%).After adjusting for comorbidities,the odds of having AF were increased with gout(1.25),vasculitis(1.19),polymyalgia rheumatica(1.15),dermatopolymyositis(1.14),psoriatic arthropathy(1.12),lupus(1.09),rheumatoid arthritis(1.05)and pseudogout(1.04).In contrast,enteropathic arthropathy(0.44),scleroderma(0.96),ankylosing spondylitis(0.96),and Sjorgen’s syndrome(0.94)had a decreased association of AF.The mortality,length of stay,and hospitalization costs were higher in patients with RD having AF vs without AF.Among the RD subgroup,the highest mortality was found with scleroderma(4.8%),followed by vasculitis(4%)and dermatopolymyositis(3.5%).CONCLUSION A highest association of AF was found with gout followed by vasculitis,and polymyalgia rheumatica when compared to other RD.Mortality was two-fold higher in patients with RD with AF.

One-year outcomes of a Neo Hexa sirolimus-eluting coronary stent system with a biodegradable polymer in all-comers coronary artery disease patients: Results from Neo Registry in India

BACKGROUND Biodegradable polymer drug-eluting stents(BP-DES)have shown to reduce restenosis rates and have low rates of stent thrombosis.The present postmarketing surveillance assessed 1-year clinical outcomes of patients who had received Neo Hexa DES in real practice.AIM To investigate 1-year clinical outcomes of Neohexa DES in real practice.METHODS Data obtained from a single-center cohort of patients who had received Neo Hexa stents as part of routine treatment of coronary artery disease(CAD)were retrospectively investigated.The primary study endpoint was the rate of major adverse cardiac events(MACEs)defined as the composite of death,myocardial infarction(MI),and target lesion revascularization(TLR)during the follow-up at1 mo,6 mo,and 1 year after the index procedure.RESULTS A total of 129 patients with 172 lesions were enrolled.The most common comorbid conditions were hypertension(49.61%)and diabetes mellitus(39.53%).Procedural success was achieved in all patients,and no in-hospital MACE was reported.The incidence of composite MACE at 30 d,6 mo,and 1 year was 0.78%,3.94%,and 4.87%,respectively.The rate of possible and probable late stent thrombosis was 0.78%.The cumulative incidences of death,MI,and TLR at 1 year were 2.44%,0.81%,and 1.63%,respectively.CONCLUSION The relatively low rates of MACE and stent thrombosis in this study support safety and performance of Neo Hexa stents,suggesting it to be an effective alternative to other contemporary stents for the treatment of de novo lesions in native coronary arteries.

单磷酸酯A抗心肌缺血保护的一氧化氮依赖机制(英文)

Monophosphoryl Lipid A (MLA) is a detoxifiedderivative of endotoxin and was first derived andpurified from bacterial lipopolysaccharide in 1980s.This pharmacological agent has been studied as avaccine adjunct, anti-septic, or anti-tumor agent bymeans of its immunomodulatory properties. In addi-tion, MLA is one of the most well documentedprotective drugs against cardiac ischemia/reperfusioninjury in various animal species. Mechanisms involvedwith the MLA-induced cardioprotection are shill notfully understood. A key role for