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European Heart Journal Jun 2024Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology...
Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology demand a disease-tailored approach. In both conditions, fast treatment plays a crucial role as ischaemia and eventually infarction develop rapidly. Furthermore, in both fields, the introduction of fibrinolytic treatments historically preceded the implementation of endovascular techniques. However, in contrast to STEMI, only a minority of AIS patients will eventually be considered eligible for reperfusion treatment. Non-invasive cerebral imaging always precedes cerebral angiography and thrombectomy, whereas coronary angiography is not routinely preceded by non-invasive cardiac imaging in patients with STEMI. In the late or unknown time window, the presence of specific patterns on brain imaging may help identify AIS patients who benefit most from reperfusion treatment. For STEMI, a uniform time window for reperfusion up to 12 h after symptom onset, based on old placebo-controlled trials, is still recommended in guidelines and generally applied. Bridging fibrinolysis preceding endovascular treatment still remains the mainstay of reperfusion treatment in AIS, while primary percutaneous coronary intervention is the strategy of choice in STEMI. Shortening ischaemic times by fine-tuning collaboration networks between ambulances, community hospitals, and tertiary care hospitals, optimizing bridging fibrinolysis, and reducing ischaemia-reperfusion injury are important topics for further research. The aim of this review is to provide insights into the common as well as diverging pathophysiology behind current reperfusion strategies and to explore new ways to enhance their clinical benefit.
PubMed: 38941344
DOI: 10.1093/eurheartj/ehae371 -
PLOS Global Public Health 2024
PubMed: 38941326
DOI: 10.1371/journal.pgph.0003240 -
Frontiers in Pharmacology 2024Current guidelines recommend that glycoprotein IIb/IIIa inhibitor (GPI) and manual aspiration thrombectomy should not be routinely used in patients with ST-segment...
Current guidelines recommend that glycoprotein IIb/IIIa inhibitor (GPI) and manual aspiration thrombectomy should not be routinely used in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI), although there is a lack of dedicated studies. The aim of this study was to examine the impact of combined usage of a potent P2Y12 inhibitor, GPI, and manual aspiration thrombectomy on long-term survival after STEMI. All STEMI patients treated by pPCI in a tertiary center who have been included prospectively in the local PCI registry between January 2016 and December 2022 were analyzed in this study. Patients were excluded if they required oral anticoagulation or bridging between clopidogrel or ticagrelor during hospitalization. A total of 1,210 patients were included in the present study, with a median follow-up of 2.78 (1.00-4.88) years. Ticagrelor significantly reduced all-cause and cardiovascular-cause mortality [HR = 0.27 (0.21-0.34), < 0.0001 and HR = 0.23 (0.17-0.30), < 0.0001, respectively]. Eptifibatide significantly reduced all-cause and cardiovascular-cause mortality [HR = 0.72 (0.57-0.92), = 0.002, and HR = 0.68 (0.52-0.89), = 0.001, respectively]. Manual thrombus aspiration had no significant effect on both all-cause and cardiovascular-cause mortality. In multivariate Cox regression, all-cause mortality was reduced by ticagrelor, while eptifibatide or manual thrombus aspiration had no significant effect. However, cardiovascular-cause mortality was reduced by both ticagrelor and eptifibatide, while manual thrombus aspiration had no significant effect. Ticagrelor consistently reduced cardiovascular and all-cause mortality, while eptifibatide reduced only cardiovascular mortality. Manual thrombus aspiration provided no long-term benefit. Our findings support the current guideline recommendation that GPI and manual aspiration thrombectomy should not be routinely used in treatment of STEMI with pPCI.
PubMed: 38939835
DOI: 10.3389/fphar.2024.1415025 -
Pharmaceutics May 2024This review paper examines the evolution of photodynamic therapy (PDT) as a novel, minimally invasive strategy for treating atherosclerosis, a leading global health... (Review)
Review
This review paper examines the evolution of photodynamic therapy (PDT) as a novel, minimally invasive strategy for treating atherosclerosis, a leading global health concern. Atherosclerosis is characterized by the accumulation of lipids and inflammation within arterial walls, leading to significant morbidity and mortality through cardiovascular diseases such as myocardial infarction and stroke. Traditional therapeutic approaches have primarily focused on modulating risk factors such as hypertension and hyperlipidemia, with emerging evidence highlighting the pivotal role of inflammation. PDT, leveraging a photosensitizer, specific-wavelength light, and oxygen, offers targeted treatment by inducing cell death in diseased tissues while sparing healthy ones. This specificity, combined with advancements in nanoparticle technology for improved delivery, positions PDT as a promising alternative to traditional interventions. The review explores the mechanistic basis of PDT, its efficacy in preclinical studies, and the potential for enhancing plaque stability and reducing macrophage density within plaques. It also addresses the need for further research to optimize treatment parameters, mitigate adverse effects, and validate long-term outcomes. By detailing past developments, current progress, and future directions, this paper aims to highlight PDT's potential in revolutionizing atherosclerosis treatment, bridging the gap from experimental research to clinical application.
PubMed: 38931851
DOI: 10.3390/pharmaceutics16060729 -
Genes May 2024Cardiac remodeling and ventricular pacing represent intertwined phenomena with profound implications for cardiovascular health and therapeutic interventions. This review... (Review)
Review
Cardiac remodeling and ventricular pacing represent intertwined phenomena with profound implications for cardiovascular health and therapeutic interventions. This review explores the intricate relationship between cardiac remodeling and ventricular pacing, spanning from the molecular underpinnings to biomechanical alterations. Beginning with an examination of genetic predispositions and cellular signaling pathways, we delve into the mechanisms driving myocardial structural changes and electrical remodeling in response to pacing stimuli. Insights into the dynamic interplay between pacing strategies and adaptive or maladaptive remodeling processes are synthesized, shedding light on the clinical implications for patients with various cardiovascular pathologies. By bridging the gap between basic science discoveries and clinical translation, this review aims to provide a comprehensive understanding of cardiac remodeling in the context of ventricular pacing, paving the way for future advancements in cardiovascular care.
Topics: Humans; Ventricular Remodeling; Animals; Heart Ventricles; Cardiac Pacing, Artificial
PubMed: 38927607
DOI: 10.3390/genes15060671 -
Cureus May 2024Intramyocardial bridging (IMB) is a congenital anomaly characterized by the tunneling of a coronary artery segment through the myocardium, potentially leading to serious...
Intramyocardial bridging (IMB) is a congenital anomaly characterized by the tunneling of a coronary artery segment through the myocardium, potentially leading to serious cardiac complications, such as myocardial ischemia, infarction, and sudden death, challenging the traditional view of it being benign. A case involving a 42-year-old man with a seven-day history of atypical chest pain highlights the significance of considering IMB in the differential diagnosis. Despite normal troponin levels, creatine kinase (CK), CK-MB, D-dimer, a negative drug screen, a normal ECG, and chest X-ray and no apparent issues on echocardiogram, left heart catheterization revealed IMB in the left anterior descending artery. This case underscores the necessity of including IMB in the differential diagnosis for chest pain, particularly in young males with familial cardiovascular disease history. While noninvasive imaging methods are useful for diagnosis, coronary angiography is the definitive diagnostic tool. Treatment primarily involves beta-blockers and calcium-channel blockers, with revascularization as a secondary option for those unresponsive to medication.
PubMed: 38910665
DOI: 10.7759/cureus.60874 -
European Heart Journal. Case Reports May 2024Hypertrophic cardiomyopathy (HCM) is a genetic heart disease that can lead to heart failure, atrial fibrillation, and ischaemic symptoms. Managing patients with HCM and...
BACKGROUND
Hypertrophic cardiomyopathy (HCM) is a genetic heart disease that can lead to heart failure, atrial fibrillation, and ischaemic symptoms. Managing patients with HCM and ischaemic symptoms is challenging, and several treatment options have been proposed.
CASE SUMMARY
A 30-year-old male patient presented with severe chest pain that had been ongoing for more than 30 min at rest. He was diagnosed with HCM and had periodic chest pain since the age of 14. He underwent two separate ethyl alcohol ablations of the first septal branches of the left anterior descending and posterior descending arteries, which relieved his symptoms.
DISCUSSION
This case report highlights the challenges in managing patients with HCM and ischaemic symptoms. In this patient, the use of ethyl alcohol ablation was effective in reducing left ventricular outflow tract obstruction and improving symptoms. Ethyl alcohol ablation is a minimally invasive procedure that has been shown to be effective in symptomatic patients with HCM. Overall, this case report emphasizes the importance of individualized treatment for patients with HCM and the potential benefits of alcohol ablation in this population.
PubMed: 38887220
DOI: 10.1093/ehjcr/ytae213 -
Cureus May 2024Introduction Myocardial bridge is a rare, benign, normal anatomical variant of the coronary artery that puts the patient at risk for significant cardiac symptoms,...
Introduction Myocardial bridge is a rare, benign, normal anatomical variant of the coronary artery that puts the patient at risk for significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. The aim of the study was to assess the prevalence and characteristics of myocardial bridging (MB) in patients with chest pain undergoing coronary angiography. Methodology A total of 1301 patients presenting with chest pain suggestive of acute coronary syndrome with associated non-invasive supportive cardiac evaluation were subjected to coronary angiography by Philips Allura Xper FD10 Cath Lab (Philips Healthcare, Andover, MA) and evaluated. Results Out of 1301 patients, the mean age was 54.70 ± 11.41 years with a male-to-female ratio of 1.9:1. Tobacco use and diabetes mellitus were the most common associated risk factors (49% and 44%, respectively). MB was seen in 51 patients, making the prevalence 3.9%, with male predominance over females in the ratio of 3.9:1. The most common clinical presentation was unstable angina (UA) (n = 22, 43.1%), followed by stable angina (SA) (n = 11, 21.6%), non-ST-elevation myocardial infarction (NSTEMI) (n = 10, 19.6%), and ST-elevation myocardial infarction (STEMI) (n = 8, 15.7%). Myocardial bridges were more common among patients with stable coronary artery disease. The left anterior descending artery (n = 51, 3.9%) was involved in all the cases and the middle segment was affected in all patients with MB. Among patients with myocardial bridge, 26 patients (51%) had atherosclerosis and 25 patients had a normal artery. Among patients with myocardial bridge with atherosclerosis, 17 patients (65%) had atherosclerosis in the same artery in which the myocardial bridge was present. Among patients with myocardial bridge with atherosclerosis, nine patients (52%) had atherosclerosis proximal to the bridge, three patients (17%) had atherosclerosis distal to the bridge, and five patients (31%) had atherosclerosis both proximal and distal to the bridge. Conclusion The prevalence of MB in the Indian population is significantly lower than in the Western populations, and it is significantly higher in the male population with patients diagnosed as normal coronaries on coronary angiography.
PubMed: 38860096
DOI: 10.7759/cureus.60087 -
Medicine Jun 2024The aim of this study is to analyze the process and frontiers of research in myocardial bridges (MB) to identify future research directions in the last 3 decades.
BACKGROUND
The aim of this study is to analyze the process and frontiers of research in myocardial bridges (MB) to identify future research directions in the last 3 decades.
METHODS
Relevant literature on MB combined with myocardial infarction (MI) was searched from 1991 to 2023 in the Web of Science database, and was analyzed by bibliometric analysis using VOSviewer, CiteSpace, and the R package "bibliometrix."
RESULTS
A total of 1233 English articles were included in this study. The number of published articles showed an increasing trend yearly. From 2017 to 2022, the annual publication volume rose rapidly, and in 2021 the publication volume even reached 95 articles, which was the highest in all years. These publications were from 68 countries and 1854 institutions, with the leading country being the U.S. and the leading institution being Columbia University. Myoho Clinical International has a close collaborative relationship with Columbia University, while in recent years, the Harvard Medical School has explored the study of MB combined with MI. Annals of Thoracic Surgery was the journal with the highest number of publications, and Takayama Hiroo and Naka Yoshifumi were the authors with the highest number of publications. The most common keywords were MI, cardiogenic shock, and MB.
CONCLUSIONS
Our findings can help researchers explore the current status of MB combined with MI research and choose new survey routes for upcoming studies. Prevalence and prognosis, mechanism of MB combined with MI and molecular mechanism may become the focus of future research. In addition, more research and cooperation are needed worldwide.
Topics: Bibliometrics; Myocardial Infarction; Humans; Myocardial Bridging
PubMed: 38847718
DOI: 10.1097/MD.0000000000038420 -
European Journal of Case Reports in... 2024Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum...
INTRODUCTION
Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella.
CASE DESCRIPTION
A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP was upgraded to Impella 5.5, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge.
CONCLUSION
The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.
LEARNING POINTS
Given the rarity of ventricular septal defects (VSD) post-myocardial infarction (MI), maintaining a high index of suspicion, particularly in patients with anterior infarcts and other high-risk features, is imperative for ensuring early recognition and management of this life-threatening complication.Surgical repair is the treatment of choice for VSD post-MI, offering improved survival rates, particularly when intervention is delayed to allow for myocardial scarring.Mechanical circulatory support devices, such as the Impella, can play a crucial role in bridging patients to surgical repair by providing temporary haemodynamic stabilisation. However, timing is vital, and early initiation of mechanical support can prevent the progression of cardiogenic shock and multi-organ failure.
PubMed: 38846674
DOI: 10.12890/2024_004549