BACKGROUND Mesenchymal stem cells(MSCs)as living biopharmaceuticals with unique properties,i.e.,stemness,viability,phenotypes,paracrine activity,etc.,need to be administered such that they reach the target site,mainta...BACKGROUND Mesenchymal stem cells(MSCs)as living biopharmaceuticals with unique properties,i.e.,stemness,viability,phenotypes,paracrine activity,etc.,need to be administered such that they reach the target site,maintaining these properties unchanged and are retained at the injury site to participate in the repair process.Route of delivery(RoD)remains one of the critical determinants of safety and efficacy.This study elucidates the safety and effectiveness of different RoDs of MSC treatment in heart failure(HF)based on phase II randomized clinical trials(RCTs).We hypothesize that the RoD modulates the safety and efficacy of MSCbased therapy and determines the outcome of the intervention.AIM To investigate the effect of RoD of MSCs on safety and efficacy in HF patients.METHODS RCTs were retrieved from six databases.Safety endpoints included mortality and serious adverse events(SAEs),while efficacy outcomes encompassed changes in left ventricular ejection fraction(LVEF),6-minute walk distance(6MWD),and pro-B-type natriuretic peptide(pro-BNP).Subgroup analyses on RoD were performed for all study endpoints.RESULTS Twelve RCTs were included.Overall,MSC therapy demonstrated a significant decrease in mortality[relative risk(RR):0.55,95%confidence interval(95%CI):0.33-0.92,P=0.02]compared to control,while SAE outcomes showed no significant difference(RR:0.84,95%CI:0.66-1.05,P=0.11).RoD subgroup analysis revealed a significant difference in SAE among the transendocardial(TESI)injection subgroup(RR=0.71,95%CI:0.54-0.95,P=0.04).The pooled weighted mean difference(WMD)demonstrated an overall significant improvement of LVEF by 2.44%(WMD:2.44%,95%CI:0.80-4.29,P value≤0.001),with only intracoronary(IC)subgroup showing significant improvement(WMD:7.26%,95%CI:5.61-8.92,P≤0.001).Furthermore,the IC delivery route significantly improved 6MWD by 115 m(WMD=114.99 m,95%CI:91.48-138.50),respectively.In biochemical efficacy outcomes,only the IC subgroup showed a significant reduction in pro-BNP by-860.64 pg/mL(WMD:-860.64 pg/Ml,95%CI:-944.02 to-777.26,P=0.001).CONCLUSION Our study concluded that all delivery methods of MSC-based therapy are safe.Despite the overall benefits in efficacy,the TESI and IC routes provided better outcomes than other methods.Larger-scale trials are warranted before implementing MSC-based therapy in routine clinical practice.展开更多
BACKGROUND Idiopathic pulmonary fibrosis(IPF)is a progressive interstitial lung disease with a high mortality rate.On this basis,exploring potential therapeutic targets to meet the unmet needs of IPF patients is impor...BACKGROUND Idiopathic pulmonary fibrosis(IPF)is a progressive interstitial lung disease with a high mortality rate.On this basis,exploring potential therapeutic targets to meet the unmet needs of IPF patients is important.AIM To explore novel hub genes for IPF therapy.METHODS Here,we used public datasets to identify differentially expressed genes between IPF patients and healthy donors.Potential targets were considered based on multiple bioinformatics analyses,especially the correlation between hub genes and carbon monoxide diffusing capacity of carbon monoxide,forced vital capacity,and patient survival rate.The mRNA levels of the hub genes were determined through quantitative real-time polymerase chain reaction.RESULTS We found that TDO2 was upregulated in IPF patients and predicted poor prognosis.Surprisingly,single-cell RNA sequencing data analysis revealed significant enrichment of TDO2 in alveolar fibroblasts,indicating that TDO2 may participate in the regulation of proliferation and survival.Therefore,we verified the upregulated expression of TDO2 in an experimental mouse model of transforming growth factor-β(TGF-β)-induced pulmonary fibrosis.Furthermore,the results showed that a TDO2 inhibitor effectively suppressed TGF-β-induced fibroblast activation.These findings suggest that TDO2 may be a potential target for IPF treatment.Based on transcription factors-microRNA prediction and scRNA-seq analysis,elevated TDO2 promoted the IPF proliferation of fibroblasts and may be involved in the P53 pathway and aggravate ageing and persistent pulmonary fibrosis.CONCLUSION We provided new target genes prediction and proposed blocking TGF-βproduction as a potential treatment for IPF.展开更多
BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnor...BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.展开更多
Non-invasive cardiac stress imaging plays a central role in the assessment of patients with known or suspected coronary artery disease.The current guidelines suggest estimation of the myocardial ischaemic burden as a ...Non-invasive cardiac stress imaging plays a central role in the assessment of patients with known or suspected coronary artery disease.The current guidelines suggest estimation of the myocardial ischaemic burden as a criterion for revascularisation on prognostic grounds despite the lack of standardised reporting of the magnitude of ischaemia on various non-invasive imaging methods.Future studies should aim to accurately describe the relationship between myocardial ischaemic burden as assessed by cardiovascular magnetic resonance imaging and mortality.展开更多
Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute corona...Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.展开更多
AIM To investigate the occurrence of cardiomyopathy(CMP)in a cohort of patients with histologically proven pheochromocytoma(pheo),and to determine if catecholamine excess was causative of the left ventricular(LV)dysfu...AIM To investigate the occurrence of cardiomyopathy(CMP)in a cohort of patients with histologically proven pheochromocytoma(pheo),and to determine if catecholamine excess was causative of the left ventricular(LV)dysfunction.METHODS A retrospective chart review spanning years 1998through 2014 was undertaken and patients with a diagnosis of pheo confirmed with histopathologic examination were included.Presenting electrocardiograms and cardiac imaging studies were reviewed.Transthoracic echocardiography(TTE),ventriculography or single positron emission computed tomography imaging was evaluated and if significant abnormalities[left ventricular hypertrophy(LVH)or LV dysfunction]were noted in the pre operative period a follow up post-operative study was also analyzed.Multivariate analysis using logistic regression was used to investigate independent predictors for outcomes of interest,LV dysfunction and LVH.RESULTS We identified 18 patients with diagnosis of pheo confirmed on pathology.Mean age was 54.3±19.3years and 11(61.1%)patients were females.50%of such patients had either resistant hypertension or labile blood pressures during hospitalization,which had raised suspicion for a pheo.Cardiac imaging studies were available for 12(66.7%)patients at the time of inclusion into study and preceding the adrenalectomy.7(58.3%)patients with a TTE available for review had mild or more severe LVH while 3(25%)patients had LV dysfunction of presumably acute onset.In a multivariate analysis,elevated catecholamine levels as assessed by urinary excretion of metabolites was not an independent predictor of development of LV systolic dysfunction or of presence of LVH on TTE.Two female patients with a preceding history of hypertension had marked LV hypertrophy and systolic anterior motion of the mitral valve.Prolongation of the QTc interval was noted in 5(27.8%)patients but no acute arrhythmias were observed in any patient.CONCLUSION This study adds to the growing body of literature on the predilection of patients with pheochromocytomas to develop non-ischemic CMP.Degree of catecholamine excess as measured by urinary secretion of metabolites did not predict the development of CMP but 2 of 3patients developed CMP in the setting of significant acute physiologic stress.Our findings provide support to the proposed etiologic role of elevated catecholamines in TC and other stress induced forms of CMP,however,activation of a brain-neural-cardiac axis from acute stress and local release of catecholamines but not chronic catecholamine elevations are likely to be responsible in pheo related CMP.展开更多
AIM To sythesize the available literature on hand dysfunction after transradial catheterization.METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that m...AIM To sythesize the available literature on hand dysfunction after transradial catheterization.METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized.RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction(6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included.CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel.展开更多
Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been repo...Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.展开更多
Palm oil consumption and its effects on serum lipid levels and cardiovascular disease in humans is still a subject of debate. Advocacy groups with varying agenda fuel the controversy. This update intends to identify e...Palm oil consumption and its effects on serum lipid levels and cardiovascular disease in humans is still a subject of debate. Advocacy groups with varying agenda fuel the controversy. This update intends to identify evidence-based evaluations of the influence of palm oil on serum lipid profile and cardiovascular disease. Furthermore, it suggests a direction for future research. The sources of information were based on a Pub Med, Google Scholar, African Journal online and Medline search using key words including: palm oil, palmitic acid, saturated fatty acids and heart disease. Published animal and human experiments on the association of palm oil and its constituents on the serum lipid profile and cardiovascular disease were also explored for relevant information. These papers are reviewed and the available evidence is discussed. Most of the information in mainstream literature is targeted at consumers and food companies with a view to discourage the consumption of palm oil. The main argument against the use of palm oil as an edible oil is the fact that it contains palmitic acid, which is a saturated fatty acid and by extrapolation should give rise to elevated total cholesterol and low-density lipoprotein cholesterol levels. However, there are many scientific studies, both in animals and humans that clearly show that palm oil consumption does not give rise to elevated serum cholesterol levels and that palm oil is not atherogenic. Apart from palmitic acid, palm oil consists of oleic and linoleic acids which are monounsaturated and polyunsaturated respectively. Palm oil also consists of vitamins A and E, which are powerful antioxidants. Palm oil has been scientifically shown to protect the heart and blood vessels from plaques and ischemic injuries. Palm oil consumed as a dietary fat as a part of a healthy balanced diet does not have incremental risk for cardiovascular disease. Little or no additional benefit will be obtained by replacing it with other oils rich in mono or polyunsaturated fatty acids.展开更多
AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary art...AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary arteries. Patients were distributed into GroupⅠ(n = 63), who was administered aspirin and Group Ⅱ(n = 76), the control, who were not administered aspirin. GroupⅠwas further divided into GroupⅠa(n = 50, low-dose aspirin, 100 mg) and GroupⅠb(n = 13, high-dose aspirin, 500 mg). After a routine coronary angiography, acetylcholine(ACh; 3 and 30 μg/min successively) and nitroglycerin(NTG) were infused into the left coronary ostium over 2 min. The change in the diameter of the coronary artery in response to each drug was expressed as the percentage change from baseline values.RESULTS: The patient characteristics did not differ between the two groups. The change in coronary diameter in response to ACh was greater in GroupⅠthan in Group Ⅱ(P = 0.0043), although the NTG-induced coronary vasodilation was similar between groups. ACh-induced dilation was greater in GroupⅠa than in GroupⅠb(P = 0.0231). Multivariate regression analysis showed that a low-dose of aspirin(P = 0.0004) was one of the factors associated with ACh-induced dilation at 30 μg/min.CONCLUSION: In subjects with angiographically normal coronary arteries, aspirin only had a positive influence on coronary endothelial function at the low dose of 100 mg. This improvement of coronary endothelial function may be involved in the preventive effect of aspirin against future coronary events.展开更多
AIM: To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG). METH...AIM: To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG). METHODS: This study was a retrospective analysis of consecutive patients referred for MPI during a 2-year period from 2006-2007 at one clinic. All eligible patients were suspected of suffering from CAD, and had performed a satisfactory bicycle exercise test (i.e. , peak heart rate > 85% of the expected, age-predicted maximum) within 6 mo of referral, their exercise ECG was had no signs of ischemia, there was no exercise-limiting angina, and no cardiac events occurred between the exercise test and referral. The patients subsequently underwent a standard 2-d, stress-rest exercise MPI. Ischemia was defined based on visual scoring supported by quantitative segmental analysis (i.e. , sum of stress score > 3). The results of cardiac catheterizationwere analyzed, and clinical follow up was performed by review of electronic medical files. RESULTS: A total of 56 patients fulfilled the eligibility criteria. Most patients had a low or intermediate ATPⅢ pretest risk of CAD (6 patients had a high pre-test risk). The referral exercise test showed a mean Duke score of 5 (range: 2 to 11), which translated to a low postexercise risk in 66% and intermediate risk in 34%. A total of seven patients were reported with ischemia by MPI. Three of these patients had high ATPⅢ pre-test risk scores. Six of these seven patients underwent cardiac catheterization, which showed significant stenosis in one patient with a high pre-test risk of CAD, and indeterminate lesions in three patients (two of whom had high pre-test risk scores). With MPI as a gate keeper for catheterization, no significant, epicardial stenosis was observed in any of the 50 patients (0%, 95% confidence interval 0.0 to 7.1) with low to intermediate pre-test risk of CAD and a negative exercise test. No cardiac events occurred in any patients within a median follow up period of > 1200 d. CONCLUSION: The added diagnostic value of MPI in patients with low or intermediate risk of CAD and a recent, normal exercise test is marginal.展开更多
Taurine(2-aminoethanesulfonic acid) is a β-amino acid found in many tissues particularly brain, myocardium, and kidney. It plays several physiological roles including cardiac contraction, antioxidation, and blunting ...Taurine(2-aminoethanesulfonic acid) is a β-amino acid found in many tissues particularly brain, myocardium, and kidney. It plays several physiological roles including cardiac contraction, antioxidation, and blunting of hypertension. Though several lines of evidence indicate that dietary taurine can reduce hypertension in humans and in animal models, evidence that taurine supplementation reduces hypertension in humans has not been conclusive. One reason for the inconclusive nature of past studies may be that taurine having both positive and negative effects on cardiovascular system depending on when it is assessed, some effects may occur early, while others only appear later. Further, other consideration may play a role, e.g., taurine supplementation improves hypertension in spontaneously hypertensive rats on a low salt diet but fails to attenuate hypertension on a high salt diet. In humans, some epidemiologic studies indicate that people with high taurine and low salt diets display lower arterial pressure than those with low taurine and high salt diets. Differences in techniques for measuring arterial pressure, duration of treatment, and animal models likely affect the response in different studies. This review considers both the positive and negative effects of taurine on blood pressure in animal models and their applications for human interventions.展开更多
AIM: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. METHODS: Patients 40 years of age or older who had been admitte...AIM: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. METHODS: Patients 40 years of age or older who had been admitted with acute coronary syndrome (ACS) to one of the 94 hospitals participating in the Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome (PAMISCA) study were included. Patients were divided into two groups based on their resting heart rate (HR ≥ or < 70 bpm). Complications were recording during a follow-up period of 1 year. RESULTS: There were 1054 ACS patients analyzed (43.5% with ST segment elevation and 56.5% without elevation). Mean age was 66.6 ± 11.7 years, 70.6% were male and 29.4% of subjects were female. During follow-up, more patients in the HR ≥ 70 bpm group were hospitalized for heart failure and they also had a higher mortality rate. In the multivariate analysis, a heart rate of ≥ 70 bpm was independently related to overall mortality during the follow-up period (hazard ratio 2.5; 95% confidence interval, 1.26-4.97, P = 0.009). CONCLUSION: A resting heart rate ≥ 70 bpm in patients who survive an ACS is an indicator of a high risk of suffering cardiovascular events during follow-up.展开更多
In addition to its role as a barrier between blood and tissues, the vascular endothelium is responsible for the synthesis and released of a number of vasodilators including prostaglandins, nitric oxide and endothelium...In addition to its role as a barrier between blood and tissues, the vascular endothelium is responsible for the synthesis and released of a number of vasodilators including prostaglandins, nitric oxide and endotheliumderived hyperpolarizing factor (EDHF). As one of these vasodilators, the specific nature of EDHF has not been fully elucidated, although a number of roles have been proposed. Importantly, many conditions, such as hypertension, hyperlipidemia, heart failure, ischemiareperfusion and diabetes mellitus comprise vascular endothelial dysfunction with EDHF dysregulation. This article reviews reports on the role of EDHF in diabetesrelated endothelial dysfunction.展开更多
2009-2013 The World Journal of Cardiology Editorial Board consists of 352 members, representing a team of worldwide expertsin cardiology.They are from 41 countries, including Argentina (4), Australia (8), Belgium (2),...2009-2013 The World Journal of Cardiology Editorial Board consists of 352 members, representing a team of worldwide expertsin cardiology.They are from 41 countries, including Argentina (4), Australia (8), Belgium (2), Brazil (5), Canada(23), Chile (1), China (18), Colombia (1),展开更多
Atherosclerotic cardiovascular disease is a major health problem around the world.Obesity is a primary risk factor for atherosclerosis and is associated with increased morbidity and mortality of cardiovascular disease...Atherosclerotic cardiovascular disease is a major health problem around the world.Obesity is a primary risk factor for atherosclerosis and is associated with increased morbidity and mortality of cardiovascular diseases.However,the precise molecular pathways underlying this close association remain poorly understood.Adipokines are cytokines,chemokines and hormones secreted by adipose tissue that couple the regulation of lipid accumulation,inflammation,and atherogenesis,and therefore serve to link obesity with cardiovascular disorders.Obesity-related disorders including metabolic syndrome,diabetes,atherosclerosis,hypertension,and coronary artery disease are associated with dysregulated adipokine(s) expression.Recent studies demonstrate the proinflammatory effects as well as atherogenic properties of adipokines.Adipokines also participate in the regulation of endothelial function,which is an early event in atherosclerosis.By contrast,adiponectin,an adipocyte-derived hormone,exerts anti-inflammatory,anti-atherogenic and vascular protective effects.Furthermore,there is an interactive association among adipokines,by which adipokines reciprocally regulate each other’s expression.Understanding this interplay may reveal plausible mechanisms for treating atherosclerosis and coronary heart disease by modulating adipokine(s) expression.In this review,we discuss insights into the role and the therapeutic potential of adipokines as mediators of atherosclerosis.展开更多
Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Cardiology. The editors and authors of the articles submitted to the journal...Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Cardiology. The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating the articles (including those published in this issue and those rejected for this issue) during the last editing time period.展开更多
This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndr...This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.展开更多
BACKGROUND Landmark trials have established the benefits of sodium-glucose cotransporter-2 inhibitors(SGLT2-Is)in cardiovascular disease including heart failure with reduced and preserved ejection fraction and renal d...BACKGROUND Landmark trials have established the benefits of sodium-glucose cotransporter-2 inhibitors(SGLT2-Is)in cardiovascular disease including heart failure with reduced and preserved ejection fraction and renal diseases regardless of the presence of diabetes mellitus.However,studies evaluating the role of SGLT2-Is in metabolic syndrome(MetS)are limited.AIM This study primarily aimed to evaluate the impact of SGLT2-Is on the components of MetS.METHODS Two independent reviewers and an experienced librarian searched Medline,Scopus and the Cochrane central from inception to December 9,2021 to identify placebo controlled randomized controlled trials that evaluated the impact of SGLT2-Is on the components of MetS as an endpoint.Pre-and post-treatment data of each component were obtained.A meta-analysis was performed using the RevMan(version 5.3;Copenhagen:The Nordic Cochrane Center,The Cochrane Collaboration).RESULTS Treatment with SGLT2-Is resulted in a decrease in fasting plasma glucose(–18.07 mg/dL;95%CI:-25.32 to–10.82),systolic blood pressure(–1.37 mmHg;95%CI:-2.08 to–0.65),and waist circumference(–1.28 cm;95%CI:-1.39 to–1.18)compared to placebo.The impact on highdensity lipoprotein cholesterol was similar to placebo(0.01 mg/dL;95%CI:-0.05 to 0.07).CONCLUSION SGLT2-Is have a promising role in the management of MetS.展开更多
BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults,who are not preselected for glycaemia.AIM To evaluate young North Indian men(aged 20-50 years)for bu...BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults,who are not preselected for glycaemia.AIM To evaluate young North Indian men(aged 20-50 years)for burden of cardiometabolic risk factors,in relation to parameters of homeostatic model assessment for insulin resistance(HOMA-IR)and beta-cell function(oral disposition index[oDI]).METHODS Study participants were invited in a fasting state.Sociodemographic,anthropometric,and medical data were collected,and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0,30,and 120 min.Participants were divided into quartiles for HOMA-IR and oDI(category 1:Best HOMA-IR/oDI quartile;category 3:Worst HOMA-IR/oDI quartile)and composite HOMA-IR/oDI phenotypes(phenotype 1:Best quartile for both HOMA-IR and oDI;phenotype 4:Worst quartile for both HOMA-IR and oDI)were derived.RESULTS We evaluated a total of 635 men at a mean(±SD)age of 33.9±5.1 years and body mass index of 26.0±3.9 kg/m^(2).Diabetes and prediabetes were present in 34(5.4%)and 297(46.8%)participants,respectively.Overweight/obesity,metabolic syndrome,and hypertension were present in 388(61.1%),258(40.6%),and 123(19.4%)participants,respectively.The prevalence of dysglycaemia,metabolic syndrome,and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles,either alone(category 3 vs 1)or in combination(phenotype 4 vs 1).The adjusted odds ratios for dysglycaemia(6.5 to 7.0-fold),hypertension(2.9 to 3.6-fold),and metabolic syndrome(4.0 to 12.2-fold)were significantly higher in individuals in the worst quartile of HOMA-IR and oDI(category 3),compared to those in the best quartile(category 1).The adjusted odds ratios further increased to 21.1,5.6,and 13.7,respectively,in individuals with the worst,compared to the best composite HOMA-IR/oDI phenotypes(phenotype 4 vs 1).CONCLUSION The burden of cardiometabolic risk factors is high among young Asian Indian men.Our findings highlight the importance of using parameters of insulin resistance and beta-cell function in phenotyping individuals for cardiometabolic risk.展开更多
文摘BACKGROUND Mesenchymal stem cells(MSCs)as living biopharmaceuticals with unique properties,i.e.,stemness,viability,phenotypes,paracrine activity,etc.,need to be administered such that they reach the target site,maintaining these properties unchanged and are retained at the injury site to participate in the repair process.Route of delivery(RoD)remains one of the critical determinants of safety and efficacy.This study elucidates the safety and effectiveness of different RoDs of MSC treatment in heart failure(HF)based on phase II randomized clinical trials(RCTs).We hypothesize that the RoD modulates the safety and efficacy of MSCbased therapy and determines the outcome of the intervention.AIM To investigate the effect of RoD of MSCs on safety and efficacy in HF patients.METHODS RCTs were retrieved from six databases.Safety endpoints included mortality and serious adverse events(SAEs),while efficacy outcomes encompassed changes in left ventricular ejection fraction(LVEF),6-minute walk distance(6MWD),and pro-B-type natriuretic peptide(pro-BNP).Subgroup analyses on RoD were performed for all study endpoints.RESULTS Twelve RCTs were included.Overall,MSC therapy demonstrated a significant decrease in mortality[relative risk(RR):0.55,95%confidence interval(95%CI):0.33-0.92,P=0.02]compared to control,while SAE outcomes showed no significant difference(RR:0.84,95%CI:0.66-1.05,P=0.11).RoD subgroup analysis revealed a significant difference in SAE among the transendocardial(TESI)injection subgroup(RR=0.71,95%CI:0.54-0.95,P=0.04).The pooled weighted mean difference(WMD)demonstrated an overall significant improvement of LVEF by 2.44%(WMD:2.44%,95%CI:0.80-4.29,P value≤0.001),with only intracoronary(IC)subgroup showing significant improvement(WMD:7.26%,95%CI:5.61-8.92,P≤0.001).Furthermore,the IC delivery route significantly improved 6MWD by 115 m(WMD=114.99 m,95%CI:91.48-138.50),respectively.In biochemical efficacy outcomes,only the IC subgroup showed a significant reduction in pro-BNP by-860.64 pg/mL(WMD:-860.64 pg/Ml,95%CI:-944.02 to-777.26,P=0.001).CONCLUSION Our study concluded that all delivery methods of MSC-based therapy are safe.Despite the overall benefits in efficacy,the TESI and IC routes provided better outcomes than other methods.Larger-scale trials are warranted before implementing MSC-based therapy in routine clinical practice.
文摘BACKGROUND Idiopathic pulmonary fibrosis(IPF)is a progressive interstitial lung disease with a high mortality rate.On this basis,exploring potential therapeutic targets to meet the unmet needs of IPF patients is important.AIM To explore novel hub genes for IPF therapy.METHODS Here,we used public datasets to identify differentially expressed genes between IPF patients and healthy donors.Potential targets were considered based on multiple bioinformatics analyses,especially the correlation between hub genes and carbon monoxide diffusing capacity of carbon monoxide,forced vital capacity,and patient survival rate.The mRNA levels of the hub genes were determined through quantitative real-time polymerase chain reaction.RESULTS We found that TDO2 was upregulated in IPF patients and predicted poor prognosis.Surprisingly,single-cell RNA sequencing data analysis revealed significant enrichment of TDO2 in alveolar fibroblasts,indicating that TDO2 may participate in the regulation of proliferation and survival.Therefore,we verified the upregulated expression of TDO2 in an experimental mouse model of transforming growth factor-β(TGF-β)-induced pulmonary fibrosis.Furthermore,the results showed that a TDO2 inhibitor effectively suppressed TGF-β-induced fibroblast activation.These findings suggest that TDO2 may be a potential target for IPF treatment.Based on transcription factors-microRNA prediction and scRNA-seq analysis,elevated TDO2 promoted the IPF proliferation of fibroblasts and may be involved in the P53 pathway and aggravate ageing and persistent pulmonary fibrosis.CONCLUSION We provided new target genes prediction and proposed blocking TGF-βproduction as a potential treatment for IPF.
文摘BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.
文摘Non-invasive cardiac stress imaging plays a central role in the assessment of patients with known or suspected coronary artery disease.The current guidelines suggest estimation of the myocardial ischaemic burden as a criterion for revascularisation on prognostic grounds despite the lack of standardised reporting of the magnitude of ischaemia on various non-invasive imaging methods.Future studies should aim to accurately describe the relationship between myocardial ischaemic burden as assessed by cardiovascular magnetic resonance imaging and mortality.
文摘Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.
文摘AIM To investigate the occurrence of cardiomyopathy(CMP)in a cohort of patients with histologically proven pheochromocytoma(pheo),and to determine if catecholamine excess was causative of the left ventricular(LV)dysfunction.METHODS A retrospective chart review spanning years 1998through 2014 was undertaken and patients with a diagnosis of pheo confirmed with histopathologic examination were included.Presenting electrocardiograms and cardiac imaging studies were reviewed.Transthoracic echocardiography(TTE),ventriculography or single positron emission computed tomography imaging was evaluated and if significant abnormalities[left ventricular hypertrophy(LVH)or LV dysfunction]were noted in the pre operative period a follow up post-operative study was also analyzed.Multivariate analysis using logistic regression was used to investigate independent predictors for outcomes of interest,LV dysfunction and LVH.RESULTS We identified 18 patients with diagnosis of pheo confirmed on pathology.Mean age was 54.3±19.3years and 11(61.1%)patients were females.50%of such patients had either resistant hypertension or labile blood pressures during hospitalization,which had raised suspicion for a pheo.Cardiac imaging studies were available for 12(66.7%)patients at the time of inclusion into study and preceding the adrenalectomy.7(58.3%)patients with a TTE available for review had mild or more severe LVH while 3(25%)patients had LV dysfunction of presumably acute onset.In a multivariate analysis,elevated catecholamine levels as assessed by urinary excretion of metabolites was not an independent predictor of development of LV systolic dysfunction or of presence of LVH on TTE.Two female patients with a preceding history of hypertension had marked LV hypertrophy and systolic anterior motion of the mitral valve.Prolongation of the QTc interval was noted in 5(27.8%)patients but no acute arrhythmias were observed in any patient.CONCLUSION This study adds to the growing body of literature on the predilection of patients with pheochromocytomas to develop non-ischemic CMP.Degree of catecholamine excess as measured by urinary secretion of metabolites did not predict the development of CMP but 2 of 3patients developed CMP in the setting of significant acute physiologic stress.Our findings provide support to the proposed etiologic role of elevated catecholamines in TC and other stress induced forms of CMP,however,activation of a brain-neural-cardiac axis from acute stress and local release of catecholamines but not chronic catecholamine elevations are likely to be responsible in pheo related CMP.
文摘AIM To sythesize the available literature on hand dysfunction after transradial catheterization.METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized.RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction(6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included.CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel.
文摘Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.
文摘Palm oil consumption and its effects on serum lipid levels and cardiovascular disease in humans is still a subject of debate. Advocacy groups with varying agenda fuel the controversy. This update intends to identify evidence-based evaluations of the influence of palm oil on serum lipid profile and cardiovascular disease. Furthermore, it suggests a direction for future research. The sources of information were based on a Pub Med, Google Scholar, African Journal online and Medline search using key words including: palm oil, palmitic acid, saturated fatty acids and heart disease. Published animal and human experiments on the association of palm oil and its constituents on the serum lipid profile and cardiovascular disease were also explored for relevant information. These papers are reviewed and the available evidence is discussed. Most of the information in mainstream literature is targeted at consumers and food companies with a view to discourage the consumption of palm oil. The main argument against the use of palm oil as an edible oil is the fact that it contains palmitic acid, which is a saturated fatty acid and by extrapolation should give rise to elevated total cholesterol and low-density lipoprotein cholesterol levels. However, there are many scientific studies, both in animals and humans that clearly show that palm oil consumption does not give rise to elevated serum cholesterol levels and that palm oil is not atherogenic. Apart from palmitic acid, palm oil consists of oleic and linoleic acids which are monounsaturated and polyunsaturated respectively. Palm oil also consists of vitamins A and E, which are powerful antioxidants. Palm oil has been scientifically shown to protect the heart and blood vessels from plaques and ischemic injuries. Palm oil consumed as a dietary fat as a part of a healthy balanced diet does not have incremental risk for cardiovascular disease. Little or no additional benefit will be obtained by replacing it with other oils rich in mono or polyunsaturated fatty acids.
文摘AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary arteries. Patients were distributed into GroupⅠ(n = 63), who was administered aspirin and Group Ⅱ(n = 76), the control, who were not administered aspirin. GroupⅠwas further divided into GroupⅠa(n = 50, low-dose aspirin, 100 mg) and GroupⅠb(n = 13, high-dose aspirin, 500 mg). After a routine coronary angiography, acetylcholine(ACh; 3 and 30 μg/min successively) and nitroglycerin(NTG) were infused into the left coronary ostium over 2 min. The change in the diameter of the coronary artery in response to each drug was expressed as the percentage change from baseline values.RESULTS: The patient characteristics did not differ between the two groups. The change in coronary diameter in response to ACh was greater in GroupⅠthan in Group Ⅱ(P = 0.0043), although the NTG-induced coronary vasodilation was similar between groups. ACh-induced dilation was greater in GroupⅠa than in GroupⅠb(P = 0.0231). Multivariate regression analysis showed that a low-dose of aspirin(P = 0.0004) was one of the factors associated with ACh-induced dilation at 30 μg/min.CONCLUSION: In subjects with angiographically normal coronary arteries, aspirin only had a positive influence on coronary endothelial function at the low dose of 100 mg. This improvement of coronary endothelial function may be involved in the preventive effect of aspirin against future coronary events.
文摘AIM: To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG). METHODS: This study was a retrospective analysis of consecutive patients referred for MPI during a 2-year period from 2006-2007 at one clinic. All eligible patients were suspected of suffering from CAD, and had performed a satisfactory bicycle exercise test (i.e. , peak heart rate > 85% of the expected, age-predicted maximum) within 6 mo of referral, their exercise ECG was had no signs of ischemia, there was no exercise-limiting angina, and no cardiac events occurred between the exercise test and referral. The patients subsequently underwent a standard 2-d, stress-rest exercise MPI. Ischemia was defined based on visual scoring supported by quantitative segmental analysis (i.e. , sum of stress score > 3). The results of cardiac catheterizationwere analyzed, and clinical follow up was performed by review of electronic medical files. RESULTS: A total of 56 patients fulfilled the eligibility criteria. Most patients had a low or intermediate ATPⅢ pretest risk of CAD (6 patients had a high pre-test risk). The referral exercise test showed a mean Duke score of 5 (range: 2 to 11), which translated to a low postexercise risk in 66% and intermediate risk in 34%. A total of seven patients were reported with ischemia by MPI. Three of these patients had high ATPⅢ pre-test risk scores. Six of these seven patients underwent cardiac catheterization, which showed significant stenosis in one patient with a high pre-test risk of CAD, and indeterminate lesions in three patients (two of whom had high pre-test risk scores). With MPI as a gate keeper for catheterization, no significant, epicardial stenosis was observed in any of the 50 patients (0%, 95% confidence interval 0.0 to 7.1) with low to intermediate pre-test risk of CAD and a negative exercise test. No cardiac events occurred in any patients within a median follow up period of > 1200 d. CONCLUSION: The added diagnostic value of MPI in patients with low or intermediate risk of CAD and a recent, normal exercise test is marginal.
基金Supported by Grants from the National Center for Complementary and Alternative Medicine and the National Institutes ofHealth(NIH)Office of Dietary Supplements,No.5P50AT-00477the NIH Neuroscience Blueprint Mouse Phenotyping Coreat University of Alabama at Birmingham,No.P30 NS-057098the Faculty of Medicine,Khon Kaen University,Khon Kaen 40002,Thailand
文摘Taurine(2-aminoethanesulfonic acid) is a β-amino acid found in many tissues particularly brain, myocardium, and kidney. It plays several physiological roles including cardiac contraction, antioxidation, and blunting of hypertension. Though several lines of evidence indicate that dietary taurine can reduce hypertension in humans and in animal models, evidence that taurine supplementation reduces hypertension in humans has not been conclusive. One reason for the inconclusive nature of past studies may be that taurine having both positive and negative effects on cardiovascular system depending on when it is assessed, some effects may occur early, while others only appear later. Further, other consideration may play a role, e.g., taurine supplementation improves hypertension in spontaneously hypertensive rats on a low salt diet but fails to attenuate hypertension on a high salt diet. In humans, some epidemiologic studies indicate that people with high taurine and low salt diets display lower arterial pressure than those with low taurine and high salt diets. Differences in techniques for measuring arterial pressure, duration of treatment, and animal models likely affect the response in different studies. This review considers both the positive and negative effects of taurine on blood pressure in animal models and their applications for human interventions.
文摘AIM: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. METHODS: Patients 40 years of age or older who had been admitted with acute coronary syndrome (ACS) to one of the 94 hospitals participating in the Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome (PAMISCA) study were included. Patients were divided into two groups based on their resting heart rate (HR ≥ or < 70 bpm). Complications were recording during a follow-up period of 1 year. RESULTS: There were 1054 ACS patients analyzed (43.5% with ST segment elevation and 56.5% without elevation). Mean age was 66.6 ± 11.7 years, 70.6% were male and 29.4% of subjects were female. During follow-up, more patients in the HR ≥ 70 bpm group were hospitalized for heart failure and they also had a higher mortality rate. In the multivariate analysis, a heart rate of ≥ 70 bpm was independently related to overall mortality during the follow-up period (hazard ratio 2.5; 95% confidence interval, 1.26-4.97, P = 0.009). CONCLUSION: A resting heart rate ≥ 70 bpm in patients who survive an ACS is an indicator of a high risk of suffering cardiovascular events during follow-up.
文摘In addition to its role as a barrier between blood and tissues, the vascular endothelium is responsible for the synthesis and released of a number of vasodilators including prostaglandins, nitric oxide and endotheliumderived hyperpolarizing factor (EDHF). As one of these vasodilators, the specific nature of EDHF has not been fully elucidated, although a number of roles have been proposed. Importantly, many conditions, such as hypertension, hyperlipidemia, heart failure, ischemiareperfusion and diabetes mellitus comprise vascular endothelial dysfunction with EDHF dysregulation. This article reviews reports on the role of EDHF in diabetesrelated endothelial dysfunction.
文摘2009-2013 The World Journal of Cardiology Editorial Board consists of 352 members, representing a team of worldwide expertsin cardiology.They are from 41 countries, including Argentina (4), Australia (8), Belgium (2), Brazil (5), Canada(23), Chile (1), China (18), Colombia (1),
文摘Atherosclerotic cardiovascular disease is a major health problem around the world.Obesity is a primary risk factor for atherosclerosis and is associated with increased morbidity and mortality of cardiovascular diseases.However,the precise molecular pathways underlying this close association remain poorly understood.Adipokines are cytokines,chemokines and hormones secreted by adipose tissue that couple the regulation of lipid accumulation,inflammation,and atherogenesis,and therefore serve to link obesity with cardiovascular disorders.Obesity-related disorders including metabolic syndrome,diabetes,atherosclerosis,hypertension,and coronary artery disease are associated with dysregulated adipokine(s) expression.Recent studies demonstrate the proinflammatory effects as well as atherogenic properties of adipokines.Adipokines also participate in the regulation of endothelial function,which is an early event in atherosclerosis.By contrast,adiponectin,an adipocyte-derived hormone,exerts anti-inflammatory,anti-atherogenic and vascular protective effects.Furthermore,there is an interactive association among adipokines,by which adipokines reciprocally regulate each other’s expression.Understanding this interplay may reveal plausible mechanisms for treating atherosclerosis and coronary heart disease by modulating adipokine(s) expression.In this review,we discuss insights into the role and the therapeutic potential of adipokines as mediators of atherosclerosis.
文摘Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Cardiology. The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating the articles (including those published in this issue and those rejected for this issue) during the last editing time period.
文摘This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.
文摘BACKGROUND Landmark trials have established the benefits of sodium-glucose cotransporter-2 inhibitors(SGLT2-Is)in cardiovascular disease including heart failure with reduced and preserved ejection fraction and renal diseases regardless of the presence of diabetes mellitus.However,studies evaluating the role of SGLT2-Is in metabolic syndrome(MetS)are limited.AIM This study primarily aimed to evaluate the impact of SGLT2-Is on the components of MetS.METHODS Two independent reviewers and an experienced librarian searched Medline,Scopus and the Cochrane central from inception to December 9,2021 to identify placebo controlled randomized controlled trials that evaluated the impact of SGLT2-Is on the components of MetS as an endpoint.Pre-and post-treatment data of each component were obtained.A meta-analysis was performed using the RevMan(version 5.3;Copenhagen:The Nordic Cochrane Center,The Cochrane Collaboration).RESULTS Treatment with SGLT2-Is resulted in a decrease in fasting plasma glucose(–18.07 mg/dL;95%CI:-25.32 to–10.82),systolic blood pressure(–1.37 mmHg;95%CI:-2.08 to–0.65),and waist circumference(–1.28 cm;95%CI:-1.39 to–1.18)compared to placebo.The impact on highdensity lipoprotein cholesterol was similar to placebo(0.01 mg/dL;95%CI:-0.05 to 0.07).CONCLUSION SGLT2-Is have a promising role in the management of MetS.
文摘BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults,who are not preselected for glycaemia.AIM To evaluate young North Indian men(aged 20-50 years)for burden of cardiometabolic risk factors,in relation to parameters of homeostatic model assessment for insulin resistance(HOMA-IR)and beta-cell function(oral disposition index[oDI]).METHODS Study participants were invited in a fasting state.Sociodemographic,anthropometric,and medical data were collected,and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0,30,and 120 min.Participants were divided into quartiles for HOMA-IR and oDI(category 1:Best HOMA-IR/oDI quartile;category 3:Worst HOMA-IR/oDI quartile)and composite HOMA-IR/oDI phenotypes(phenotype 1:Best quartile for both HOMA-IR and oDI;phenotype 4:Worst quartile for both HOMA-IR and oDI)were derived.RESULTS We evaluated a total of 635 men at a mean(±SD)age of 33.9±5.1 years and body mass index of 26.0±3.9 kg/m^(2).Diabetes and prediabetes were present in 34(5.4%)and 297(46.8%)participants,respectively.Overweight/obesity,metabolic syndrome,and hypertension were present in 388(61.1%),258(40.6%),and 123(19.4%)participants,respectively.The prevalence of dysglycaemia,metabolic syndrome,and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles,either alone(category 3 vs 1)or in combination(phenotype 4 vs 1).The adjusted odds ratios for dysglycaemia(6.5 to 7.0-fold),hypertension(2.9 to 3.6-fold),and metabolic syndrome(4.0 to 12.2-fold)were significantly higher in individuals in the worst quartile of HOMA-IR and oDI(category 3),compared to those in the best quartile(category 1).The adjusted odds ratios further increased to 21.1,5.6,and 13.7,respectively,in individuals with the worst,compared to the best composite HOMA-IR/oDI phenotypes(phenotype 4 vs 1).CONCLUSION The burden of cardiometabolic risk factors is high among young Asian Indian men.Our findings highlight the importance of using parameters of insulin resistance and beta-cell function in phenotyping individuals for cardiometabolic risk.