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Frontiers in Medicine 2023Stem cell transplantation is one of the treatment methods for acute myocardial infarction (AMI). MicroRNA-1 contributes to the study of the essential mechanisms of stem...
BACKGROUND
Stem cell transplantation is one of the treatment methods for acute myocardial infarction (AMI). MicroRNA-1 contributes to the study of the essential mechanisms of stem cell transplantation for treating AMI by targeted regulating the myocardial microenvironment after stem cell transplantation at the post-transcriptional level. Thus, microRNA-1 participates in regulating the myocardial microenvironment after stem cell transplantation, a promising strategy for the Stem cell transplantation treatment of AMI. However, the naked microRNA-1 synthesized is extremely unstable and non-targeting, which can be rapidly degraded by circulating RNase. Herein, to safely and effectively targeted transport the naked microRNA-1 synthesized into myocardial tissue, we will construct pseudo-endogenous microRNA-targeted myocardial ultrasound nanobubble pAd-AAV-9/miRNA-1 NB and evaluate its characteristics, targeting, and function.
METHODS
The pAd-AAV-9/miRNA-1 gene complex was linked to nanobubble NBs by the "avidin-biotin bridging" method to prepare cardiomyocyte-targeted nanobubble pAd-AAV-9/miRNA-1 NB. The shape, particle size, dispersion, and stability of nanobubbles and the connection of pAd-AAV-9/miRNA-1 gene complex to nanobubble NB were observed. The virus loading efficiency was determined, and the myocardium-targeting imaging ability was evaluated using contrast-enhanced ultrasound imaging . The miRNA-1 expression level in myocardial tissue and other vital organs of SD rats was considered by Q-PCR. Also, the cytotoxic effects were assessed.
RESULTS
The particle size of NBs was 504.02 ± 36.94 nm, and that of pAd-AAV-9/miRNA-1 NB was 568.00 ± 37.39 nm. The particle size and concentration of pAd-AAV-9/miRNA-1 NBs did not change significantly within 1 h at room temperature ( > 0.05). pAd-AAV-9/miRNA-1 NB had the highest viral load rate of 86.3 ± 2.2% ( < 0.05), and the optimum viral load was 5 μL ( < 0.05). pAd-AAV-9/miRNA-1 NB had good contrast-enhanced ultrasound imaging . Quantitative analysis of miRNA-1 expression levels in vital organs of SD rats by Q-PCR showed that pAd-AAV-9/miRNA-1 NB targeted the myocardial tissue. Q-PCR indicated that the expression level of miRNA-1 in the myocardium of the pAd-AAV-9/miRNA-1 NB + UTMD group was significantly higher than that of the pAd-AAV-9/miRNA-1 NB group ( < 0.05). pAd-AAV-9/miRNA-1 NB had no cytotoxic effect on cardiomyocytes ( > 0.05).
CONCLUSION
The pAd-AAV-9/miRNA-1 NB constructed in this study could carry naked miRNA-1 synthesized for targeted transport into myocardial tissue successfully and had sound contrast-enhanced imaging effects .
PubMed: 37809333
DOI: 10.3389/fmed.2023.1136304 -
JTCVS Open Sep 2023Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke...
OBJECTIVES
Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation.
METHODS
A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge.
RESULTS
We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group ( = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 ( < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group ( = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group ( = .18).
CONCLUSIONS
Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.
PubMed: 37808050
DOI: 10.1016/j.xjon.2023.05.006 -
The American Journal of Cardiology Nov 2023Our objective is to use computed tomography angiography (CTA) and computed tomography perfusion (CTP) to identify the ischemic significance of myocardial bridging (MB)....
Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic Assessment of Myocardial Bridging from the CORE320 Study: 5-Year Follow-Up.
Our objective is to use computed tomography angiography (CTA) and computed tomography perfusion (CTP) to identify the ischemic significance of myocardial bridging (MB). We also seek to determine the long-term prognostication of MB in the presence or absence of obstructive coronary artery disease (CAD). The CORE320, a prospective, multicenter study including 381 patients with known or suspected CAD clinically referred for invasive coronary angiography who underwent combined (CTA-CTP) and single-photon emission computed tomography before conventional coronary angiography. The incidence of MB was identified in 135 patients (35.4%) with 93.9% identified in the left anterior descending artery. MB were divided as partially encased versus fully encased. There was no difference in ischemia identified between partially encased MB and fully encased MB (37 [40%] vs 25 [35%], p = 0.54]. Ischemia was identified at similar rates in partially versus fully encased MB by single-photon emission computed tomography at (8 [9%] vs 8 [11%], p = 0.57] and CTP (34 [37%] vs 21 [30%], p = 0.33]. There was no difference in the primary outcome of 5-year outcome of combined incidence of myocardial infarction or death. The restricted mean survival time in patients with CTA with <50% stenosis with or without a MB was 4.906 years (95% confidence interval 4.759 to 5.000) and 4.891 years (95% confidence interval 4.718 to 5.000), respectively (p = 0.824). Cardiac computed tomography perfusion imaging can assess both anatomic and functional significance of myocardial bridging with diagnostic accuracy similar to current standard imaging. Furthermore, 5-year cardiovascular events were not different with the presence of MB in both obstructive and non-obstructive CAD.
Topics: Humans; Computed Tomography Angiography; Prospective Studies; Prognosis; Myocardial Bridging; Follow-Up Studies; Coronary Artery Disease; Coronary Angiography; Myocardial Infarction; Myocardial Perfusion Imaging; Perfusion; Predictive Value of Tests; Coronary Stenosis
PubMed: 37774472
DOI: 10.1016/j.amjcard.2023.08.040 -
Journal of Clinical Medicine Sep 2023Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery, most frequently the left anterior descending artery, deviates from its... (Review)
Review
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery, most frequently the left anterior descending artery, deviates from its epicardial route by passing through the myocardium. The advent of cardiac computed tomography angiography (CCTA), equipped with its multiplane and three-dimensional functionalities, has notably enhanced the ability to identify MBs. Furthermore, novel post-processing methods have recently emerged to extract functional insights from anatomical evaluations. MB is generally considered a benign entity with very good survival rates; however, there is an increasing volume of evidence that certain MB characteristics may be associated with cardiovascular morbidity. This review is intended to depict the diagnostic and prognostic role of CCTA in the MB context.
PubMed: 37762890
DOI: 10.3390/jcm12185949 -
Artificial Organs Dec 2023Large Impella systems (5.0 or 5.5; i.e., Impella 5+) (Abiomed Inc., Danvers, MA, USA) help achieve better clinical outcomes through relevant left ventricular unloading... (Observational Study)
Observational Study
BACKGROUND
Large Impella systems (5.0 or 5.5; i.e., Impella 5+) (Abiomed Inc., Danvers, MA, USA) help achieve better clinical outcomes through relevant left ventricular unloading in acute cardiogenic shock (CS). Here, we report our experience with Impella 5+, while focusing on the clinical outcomes depending on individual case scenarios in patients with acute CS.
METHODS
This single-center retrospective observational study included 100 Impella 5+ implantations conducted on patients with acute CS from November 2018 to October 2021. After excluding 10 reimplantation cases, 90 cases were enrolled for further analysis.
RESULTS
In-hospital and 30-day mortality rates were 56.7% (n = 51) and 48.9% (n = 44), respectively. In-hospital mortality was lower in patients with acute myocardial infarction (AMI) than in non-AMI patients (p = 0.07). Young age and low lactate levels were the independent predictors of successful transition and survival after permanent mechanical circulatory support/heart transplantation (pMCS/HTX) (age, p = 0.03; lactate level, p = 0.04; survived after pMCS/HTX, n = 11; died on Impella, n = 41). During simultaneous utilization of venoarterial extracorporeal membrane oxygenation therapy and Impella 5+, termed ECMELLA therapy, high dose of noradrenaline was a predictive factor for in-hospital mortality by multivariate analysis (n = 0.02).
CONCLUSIONS
Our results suggest that enhanced Impella support might have better clinical outcomes among acute CS patients supported with large Impella, those with AMI than those with no AMI. Young age and low lactate levels were predictors of successful bridging to pMCS/HTX and favorable clinical outcomes thereafter. The clinical outcomes of ECMELLA therapy might depend on noradrenaline dose at the time of Impella 5+ implantation.
Topics: Humans; Shock, Cardiogenic; Treatment Outcome; Heart-Assist Devices; Myocardial Infarction; Retrospective Studies; Norepinephrine; Lactates
PubMed: 37724611
DOI: 10.1111/aor.14646 -
Current Problems in Cardiology Jan 2024Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, often associated with adverse outcomes, including sudden cardiac death. Myocardial bridging (MB), where... (Review)
Review
Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, often associated with adverse outcomes, including sudden cardiac death. Myocardial bridging (MB), where a coronary artery segment traverses intramurally within the myocardium, complicates coronary blood flow dynamics. This retrospective study investigates the relationship between MB and HCM and their impact on percutaneous coronary intervention (PCI) outcomes. Data from the 2019 National Inpatient Sample (NIS), representing 20% of U.S. hospitalizations, was utilized. Patients with both HCM and MB undergoing PCI were identified and analyzed. The study assessed inpatient outcomes, including mortality, length of stay, hospital cost, and post-PCI complications (atrial fibrillation, acute kidney injury, bleeding, coronary dissection). Patients with HCM and MB exhibited distinct demographics. The study did not find significant associations between HCM/MB and inpatient mortality, length of stay, or hospital cost. However, HCM patients had a higher incidence of atrial fibrillation and acute kidney injury post-PCI (aOR 2.33, 95% CI 1.46 to 3.71, p ≤ 0.001). MB was linked to increased occurrences of acute heart failure (aOR 0.62, 95% CI 0.42-0.92, p = 0.02) and post-PCI bleeding (aOR 4.88, 95% CI 1.17-20.2, p = 0.03). This nationwide study reveals unique demographic profiles for HCM and MB patients. Notably, HCM patients face higher risks of post-PCI complications, including atrial fibrillation and acute kidney injury. These findings provide fresh insights into the MB-HCM relationship and its implications for PCI outcomes. They emphasize the need for tailored interventions and improved patient management in cases involving both HCM and MB.
Topics: Humans; Percutaneous Coronary Intervention; Retrospective Studies; Myocardial Bridging; Atrial Fibrillation; Hemorrhage; Cardiomyopathy, Hypertrophic; Acute Kidney Injury; Risk Factors; Treatment Outcome
PubMed: 37722520
DOI: 10.1016/j.cpcardiol.2023.102080 -
European Heart Journal. Case Reports Sep 2023Haemorrhage at the puncture site is a serious complication of percutaneous coronary intervention (PCI).
BACKGROUND
Haemorrhage at the puncture site is a serious complication of percutaneous coronary intervention (PCI).
CASE SUMMARY
A 73-year-old man underwent transfemoral intervention because of stable angina pectoris. After a rotational atherectomy, an everolimus-eluting stent was implanted from the left main trunk to the proximal site of the left anterior descending (LAD) artery. We also recognized that myocardial bridging was significantly induced at the middle portion of the LAD, which was not evident before the PCI. We suspected puncture-related haemorrhage and immediately performed lower limb arteriography. As a result, contrast media extravasation was observed at the branch of the right inferior epigastric artery. Finally, we performed coil embolization into the left common femoral artery, and the extravasation successfully disappeared. Four months later, he underwent coronary angiography. There were no findings of myocardial bridging.
DISCUSSION
Myocardial bridging during a PCI procedure may indicate hypercontraction because of haemorrhage.
PubMed: 37705941
DOI: 10.1093/ehjcr/ytad439 -
Journal of the American College of... Sep 2023Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary... (Review)
Review
Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary arteries (ANOCA). Management leveraging lifestyle, pharmacology, and device-based therapeutic options for ANOCA can improve angina burden and quality of life in affected patients. Multidisciplinary care teams that can tailor and titrate therapies based on individual patient needs are critical to the success of comprehensive programs. As coronary function testing for ANOCA is more widely adopted, collaborative research initiatives will be fundamental to improve ANOCA care. These efforts will require standardized symptom assessments and data collection, which will propel future large-scale clinical trials.
Topics: Humans; Program Development; Quality of Life; Angina Pectoris; Coronary Vessels; Life Style
PubMed: 37704316
DOI: 10.1016/j.jacc.2023.06.044 -
Journal of the American College of... Sep 2023Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for... (Review)
Review
Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed.
Topics: Humans; Microcirculation; Myocardial Bridging; Myocardial Ischemia; Angina Pectoris; Coronary Angiography
PubMed: 37704315
DOI: 10.1016/j.jacc.2023.06.043 -
Cureus Aug 2023Myocardial bridging (MB) is a congenital coronary artery anomaly involving an overlying myocardium's partial or complete encasement of a coronary artery segment. The... (Review)
Review
Myocardial bridging (MB) is a congenital coronary artery anomaly involving an overlying myocardium's partial or complete encasement of a coronary artery segment. The obstruction can lead to significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. Several approaches, including invasive and non-invasive methods, have been proposed to diagnose and manage MB. Invasive modalities, such as intravascular ultrasound (IVUS) and coronary angiography, offer high specificity and sensitivity. In contrast, non-invasive methods like Doppler ultrasound, multislice computed tomography (MSCT), and magnetic resonance imaging (MRI) are advantageous due to their non-invasive nature, high sensitivity and specificity, and cost-effectiveness. Treatment options for MB mainly focus on relieving symptoms and preventing adverse outcomes. The use of pharmacological agents and surgical and percutaneous interventions has been documented in numerous studies. Studies conclude that MB is a treatable cardiac anomaly, and a combined approach of diagnosis, treatment, and follow-up is necessary to reduce the morbidity and mortality associated with this condition.
PubMed: 37692750
DOI: 10.7759/cureus.43132