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Echocardiography (Mount Kisco, N.Y.) Mar 2022Mitral annular disjunction (MAD) is a structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum. The... (Review)
Review
BACKGROUND
Mitral annular disjunction (MAD) is a structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum. The literature around MAD has increased over recent years, thus we sought to review the current data on the definition, prevalence, and clinical outcomes of MAD.
METHODS
A search of MEDLINE and EMBASE was conducted to identify studies which evaluated MAD in any patient cohort. The study results were synthesized narratively.
RESULTS
A total of 12 studies were included with 3925 patients (average age 62 years, 63% male). The pooled prevalence of MAD in patients with mitral valve prolapse and/or Barlow's disease was 30.1%. In a general population, MAD prevalence was 8.7%. The definition of MAD was not consistent across all studies. In terms of clinical outcomes, only one study reported MAD to be associated with ventricular arrhythmias.
CONCLUSIONS
MAD is an increasingly recognized finding amongst patients undergoing cardiac imaging. This review highlights the need for agreed definitions for clinically significant MAD and how identified MAD should be managed. At present, there is insufficient evidence that MAD is associated adverse clinical outcomes.
Topics: Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Prevalence
PubMed: 35122307
DOI: 10.1111/echo.15299 -
Frontiers in Cardiovascular Medicine 2023Preventing ischemia-reperfusion injury is the main direction of myocardial infarction treatment in the convalescent stage. Some studies have suggested that saponins in... (Review)
Review
Effect and possible mechanisms of saponins in Chinese herbal medicine exerts for the treatment of myocardial ischemia-reperfusion injury in experimental animal: a systematic review and meta-analysis.
INTRODUCTION
Preventing ischemia-reperfusion injury is the main direction of myocardial infarction treatment in the convalescent stage. Some studies have suggested that saponins in Traditional Chinese medicine (TCM) preparations can protect the myocardium by various mechanisms. Our meta-analysis aims to evaluate the efficacy of TCM saponins in treating myocardial ischemia-reperfusion injury (MIRI) and to summarize the potential molecular mechanisms further.
METHODS
We conducted a literature search in six electronic databases [Web of Science, PubMed, Embase, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI)] until October 2022.
RESULTS
Seventeen eligible studies included 386 animals (254 received saponins and 132 received vehicles). The random effect model is used to calculate the combined effect. The effect size is expressed as the weighted average difference (WMD) and 95% confidence interval (CI). Compared with placebo, saponins preconditioning reduced infarct size after MIRI significantly (WMD: -3.60,95% CI: -4.45 to -2.74, < 0.01, : 84.7%, < 0.001), and significantly increased EF (WMD: 3.119, 95% CI: 2.165 to 4.082, < 0.01, : 82.9%, < 0.0 L) and FS (WMD: 3.157, 95% CI: 2.218 to 4.097, < 0.001, : 81.3%, < 0.001).
DISCUSSION
The results show that the pre-administration of saponins from TCM has a significant protective effect on MIRI in preclinical studies, which provides an application prospect for developing anti-MIRI drugs with high efficiency and low toxicity.
PubMed: 37564906
DOI: 10.3389/fcvm.2023.1147740 -
Annals of the New York Academy of... Sep 2022Electrical conductivity is of great significance to cardiac tissue engineering and permits the use of electrical stimulation in mimicking cardiac pacing. The development... (Review)
Review
Electrical conductivity is of great significance to cardiac tissue engineering and permits the use of electrical stimulation in mimicking cardiac pacing. The development of biomaterials for tissue engineering can incorporate physical properties that are uncommon to standard cell culture and can facilitate improved cardiomyocyte function. In this review, the PICOT question asks, "How has the application of external electrical stimulation in conductive scaffolds for tissue engineering affected cardiomyocyte behavior in in vitro cell culture?" The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, with predetermined inclusion and quality appraisal criteria, were used to assess publications from PubMed, Web of Science, and Scopus. Results revealed carbon nanotubes to be the most common conductive agent in biomaterials and rodent-sourced cell types as the most common cardiomyocytes used. To assess cardiomyocytes, immunofluorescence was used most often, utilizing proteins, such as connexin 43, cardiac α-actinin, and cardiac troponins. It was determined that the modal average stimulation protocol comprised 1-3 V square biphasic 50-ms pulses at 1 Hz, applied toward the end of cell culture. The addition of electrical stimulation to in vitro culture has exemplified it as a powerful tool for cardiac tissue engineering and brings researchers closer to creating optimal artificial cardiac tissue constructs.
Topics: Actinin; Biocompatible Materials; Connexin 43; Electric Conductivity; Electric Stimulation; Myocytes, Cardiac; Nanotubes, Carbon; Tissue Engineering; Tissue Scaffolds; Troponin
PubMed: 35676231
DOI: 10.1111/nyas.14812 -
Nanomedicine (London, England) Dec 2022Despite scientific advances, the number of cardiovascular patients is increasing worldwide. To protect damaged cardiomyocytes from further harm, novel and safer... (Review)
Review
Despite scientific advances, the number of cardiovascular patients is increasing worldwide. To protect damaged cardiomyocytes from further harm, novel and safer approaches are needed to help regeneration and prevent fibrosis. In this study, we performed a systematic review of and preclinical studies of carbon nanotubes (CNTs) and carbon nanofibers (CNFs) for help to treat heart damage. CNTs/CNFs in hydrogels cause higher conductivity, and the in case of alignment this increase is more than the random state. CNTs/CNFs can improve structural specification of the hydrogel for cardiac cell proliferation and enhance expression of genes associated with final differentiation of various stem cells to cardiac cells.
Topics: Humans; Nanotubes, Carbon; Nanofibers; Myocytes, Cardiac; Lung; Heart Injuries
PubMed: 36896892
DOI: 10.2217/nnm-2022-0113 -
Molecules (Basel, Switzerland) Feb 2023Cardiovascular diseases (CVD), such as myocardial infarction (MI), constitute one of the world's leading causes of annual deaths. This cardiomyopathy generates a tissue... (Review)
Review
Cardiovascular diseases (CVD), such as myocardial infarction (MI), constitute one of the world's leading causes of annual deaths. This cardiomyopathy generates a tissue scar with poor anatomical properties and cell necrosis that can lead to heart failure. Necrotic tissue repair is required through pharmaceutical or surgical treatments to avoid such loss, which has associated adverse collateral effects. However, to recover the infarcted myocardial tissue, biopolymer-based scaffolds are used as safer alternative treatments with fewer side effects due to their biocompatibility, chemical adaptability and biodegradability. For this reason, a systematic review of the literature from the last five years on the production and application of chitosan scaffolds for the reconstructive engineering of myocardial tissue was carried out. Seventy-five records were included for review using the "preferred reporting items for systematic reviews and meta-analyses" data collection strategy. It was observed that the chitosan scaffolds have a remarkable capacity for restoring the essential functions of the heart through the mimicry of its physiological environment and with a controlled porosity that allows for the exchange of nutrients, the improvement of the electrical conductivity and the stimulation of cell differentiation of the stem cells. In addition, the chitosan scaffolds can significantly improve angiogenesis in the infarcted tissue by stimulating the production of the glycoprotein receptors of the vascular endothelial growth factor (VEGF) family. Therefore, the possible mechanisms of action of the chitosan scaffolds on cardiomyocytes and stem cells were analyzed. For all the advantages observed, it is considered that the treatment of MI with the chitosan scaffolds is promising, showing multiple advantages within the regenerative therapies of CVD.
Topics: Humans; Chitosan; Tissue Scaffolds; Vascular Endothelial Growth Factor A; Myocardial Infarction; Myocytes, Cardiac; Tissue Engineering
PubMed: 36838907
DOI: 10.3390/molecules28041920 -
The American Journal of Tropical... Mar 2021Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of... (Meta-Analysis)
Meta-Analysis
Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950-April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5-9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0-8%, cardiac biomarkers 0-57%, and echocardiography 4-9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.
Topics: Acute Coronary Syndrome; Adult; Child; Electrocardiography; Erythrocytes; Humans; Malaria, Falciparum; Malaria, Vivax; Myocarditis; Myocardium; Plasmodium falciparum; Plasmodium vivax; Prevalence; Severity of Illness Index
PubMed: 33724926
DOI: 10.4269/ajtmh.20-1414 -
Heart, Lung & Circulation Jul 2022Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG) through a systematic review meta-analysis.
METHODS
Comprehensive review of EMBASE and PubMed in accordance with PRISMA guidelines, including studies of patients undergoing CABG with assessment of myocardial viability and recorded long-term mortality, age and sex. Studies were restricted to the last decade, and data were stratified by imaging modality (magnetic resonance imaging [MRI] or nuclear medicine). Random-effects model for assessing pooled effect, heterogeneity assessment using Chi-square and I statistics, publication bias assessed by funnel plots and Egger's test.
RESULTS
Meta-analysis of contemporary data (January 2010 to October 2020) yielded 3,621 manuscripts of which 92 were relevant, and 6 appropriate for inclusion with 993 patients. Pooled analysis showed that patients with non-viable myocardium undergoing CABG are at 1.34 times the risk of mortality compared to those with viable myocardium (95% CI 1.01-1.79, p=0.05). Subgroup analysis of the MRI or nuclear medicine modalities was not statistically significant and there was no confounding by age or sex in meta-regression. There was significant heterogeneity in imaging modality and diagnostic criteria, but heterogeneity between study findings was low with an I statistic of 29%. The risk of publication bias was moderate on the Newcastle-Ottawa Scale), but not statistically significant (Egger's Test coefficient=1.3, 95%CI -0.35-2.61, p=0.10).
CONCLUSIONS
There is a multitude of methods for assessing cardiac viability for coronary revascularisation surgery, making meta-analyses fraught with limitations. Our meta-analysis demonstrates that the finding of non-viable myocardium can not be used draw conclusions for risk assessment in coronary surgery.
Topics: Coronary Artery Bypass; Coronary Artery Disease; Humans; Myocardium; Risk Assessment
PubMed: 35339371
DOI: 10.1016/j.hlc.2021.12.016 -
Clinical Microbiology and Infection :... Aug 2022Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size. (Review)
Review
BACKGROUND
Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size.
OBJECTIVES
The aim of this systematic review is to better understand the various aspects of the cardiovascular complications of COVID-19 by pooling data from a large number of autopsy studies.
DATA SOURCES
We searched the online databases Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science for concepts of autopsy or histopathology combined with COVID-19, published between database inception and February 2021. We also searched for unpublished manuscripts using the medRxiv services operated by Cold Spring Harbor Laboratory.
STUDY ELIGIBILITY CRITERIA
Articles were considered eligible for inclusion if they reported human postmortem cardiovascular findings among individuals with a confirmed SARS coronavirus type 2 (CoV-2) infection.
PARTICIPANTS
Confirmed COVID-19 patients with post-mortem cardiovascular findings.
INTERVENTIONS
None.
METHODS
Studies were individually assessed for risk of selection, detection, and reporting biases. The median prevalence of different autopsy findings with associated interquartile ranges (IQRs).
RESULTS
This review cohort contained 50 studies including 548 hearts. The median age of the deceased was 69 years. The most prevalent acute cardiovascular findings were myocardial necrosis (median: 100.0%; IQR, 20%-100%; number of studies = 9; number of patients = 64) and myocardial oedema (median: 55.5%; IQR, 19.5%-92.5%; number of studies = 4; number of patients = 46). The median reported prevalence of extensive, focal active, and multifocal myocarditis were all 0.0%. The most prevalent chronic changes were myocyte hypertrophy (median: 69.0%; IQR, 46.8%-92.1%) and fibrosis (median: 35.0%; IQR, 35.0%-90.5%). SARS-CoV-2 was detected in the myocardium with median prevalence of 60.8% (IQR 40.4-95.6%).
CONCLUSIONS
Our systematic review confirmed the high prevalence of acute and chronic cardiac pathologies in COVID-19 and SARS-CoV-2 cardiac tropism, as well as the low prevalence of myocarditis in COVID-19.
Topics: Aged; Autopsy; COVID-19; Humans; Lung; Myocarditis; SARS-CoV-2
PubMed: 35339672
DOI: 10.1016/j.cmi.2022.03.021 -
Cureus Aug 2021Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Many patients with acute exacerbations need intensive care. There are many... (Review)
Review
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Many patients with acute exacerbations need intensive care. There are many cardiovascular risk factors and comorbid conditions linked with COPD. Troponin elevation is used for the diagnosis of myocardial infarction. However, it is commonly elevated in patients with COPD. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Scopus were searched for relevant articles. A total of 383 papers were identified. Out of the 383 papers, only 30 papers remained for final synthesis after removing duplicates, screening for relevant articles, and assessing eligibility criteria. After the quality appraisal, 11 papers were chosen for inclusion in this study. COPD is characterized by obstruction and inflammation of the airways. It is caused mainly by smoking, by causing harmful changes in the structure of the airways. It usually presents with dyspnea, cough, and/or production of sputum. Troponins are regulatory proteins found in the myocardium and skeletal muscles. The cause of its elevation in COPD and acute exacerbated chronic obstructive pulmonary disease (AECOPD) remains unclear. However, several reasons and factors have been suggested. The most intriguing fact is that high troponin in COPD, especially in exacerbations, has been linked in many articles to a higher risk of death. Furthermore, it could serve as a tool for better assessment and management of COPD patients. We found that troponin predicts death and poor outcomes in COPD and AECOPD. The exact mechanism of its elevations is not clear. We believe it can be a valuable tool for clinicians in better managing COPD and assessing the severity of the exacerbations.
PubMed: 34603857
DOI: 10.7759/cureus.17451 -
Journal of Cardiovascular Magnetic... May 2020The clinical application of cardiovascular magnetic resonance (CMR) T and T mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The clinical application of cardiovascular magnetic resonance (CMR) T and T mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T and T mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated.
METHODS
The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T or T values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data.
RESULTS
One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with controls. T values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P < 0.01) compared with controls. T values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies.
CONCLUSIONS
The clinical utility of T and T mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T and T values of most cardiomyopathies are similar.
Topics: Cardiomyopathies; Diagnosis, Differential; Heart Failure; Heart Transplantation; Humans; Hypertension; Magnetic Resonance Imaging; Myocardial Infarction; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 32393281
DOI: 10.1186/s12968-020-00627-x