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Frontiers in Cardiovascular Medicine 2024Modelling human diseases serves as a crucial tool to unveil underlying mechanisms and pathophysiology. Takotsubo syndrome (TS), an acute form of heart failure resembling... (Review)
Review
Modelling human diseases serves as a crucial tool to unveil underlying mechanisms and pathophysiology. Takotsubo syndrome (TS), an acute form of heart failure resembling myocardial infarction, manifests with reversible regional wall motion abnormalities (RWMA) of the ventricles. Despite its mortality and clinical similarity to myocardial infarction, TS aetiology remains elusive, with stress and catecholamines playing central roles. This review delves into current animal models of TS, aiming to assess their ability to replicate key clinical traits and identifying limitations. An in-depth evaluation of published animal models reveals a variation in the definition of TS among studies. We notice a substantial prevalence of catecholamine-induced models, particularly in rodents. While these models shed light on TS, there remains potential for refinement. Translational success in TS research hinges on models that align with human TS features and exhibit the key features, including transient RWMA. Animal models should be comprehensively evaluated regarding the various systemic changes of the applied trigger(s) for a proper interpretation. This review acts as a guide for researchers, advocating for stringent TS model standards and enhancing translational validity.
PubMed: 38841261
DOI: 10.3389/fcvm.2024.1351587 -
JACC. Case Reports Jul 2024We present 2 patients with angina with no obstructive coronary artery disease and concomitant myocardial bridging. Despite maximal tolerated pharmacotherapy, symptoms...
We present 2 patients with angina with no obstructive coronary artery disease and concomitant myocardial bridging. Despite maximal tolerated pharmacotherapy, symptoms remained. Invasive anatomical and hemodynamic assessment identified myocardial bridging as a contributing cause of angina. Following heart team discussion, both patients underwent successful coronary artery unroofing of the left anterior descending artery.
PubMed: 38840821
DOI: 10.1016/j.jaccas.2024.102382 -
Methodist DeBakey Cardiovascular Journal 2024We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac...
We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.
Topics: Humans; Male; Middle Aged; Coronary Stenosis; Coronary Vasospasm; Nitroglycerin; Coronary Angiography; Treatment Outcome; Vasodilator Agents; Predictive Value of Tests; Cocaine-Related Disorders; Severity of Illness Index; Angina Pectoris; Diagnosis, Differential; Smoking
PubMed: 38799179
DOI: 10.14797/mdcvj.1365 -
International Journal of Biological... Jun 2024Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ) serve as transcriptional co-activators that dynamically shuttle between the... (Review)
Review
Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ) serve as transcriptional co-activators that dynamically shuttle between the cytoplasm and nucleus, resulting in either the suppression or enhancement of their downstream gene expression. Recent emerging evidence demonstrates that YAP/TAZ is strongly implicated in the pathophysiological processes that contribute to cardiovascular diseases (CVDs). In the cardiovascular system, YAP/TAZ is involved in the orchestration of a range of biological processes such as oxidative stress, inflammation, proliferation, and autophagy. Furthermore, YAP/TAZ has been revealed to be closely associated with the initiation and development of various cardiovascular diseases, including atherosclerosis, pulmonary hypertension, myocardial fibrosis, cardiac hypertrophy, and cardiomyopathy. In this review, we delve into recent studies surrounding YAP and TAZ, along with delineating their roles in contributing to the pathogenesis of CVDs with a link to various physiological processes in the cardiovascular system. Additionally, we highlight the current potential drugs targeting YAP/TAZ for CVDs therapy and discuss their challenges for translational application. Overall, this review may offer novel insights for understanding and treating cardiovascular disorders.
Topics: Humans; Cardiovascular Diseases; Signal Transduction; YAP-Signaling Proteins; Animals; Transcription Factors; Transcriptional Coactivator with PDZ-Binding Motif Proteins; Adaptor Proteins, Signal Transducing
PubMed: 38795886
DOI: 10.1016/j.ijbiomac.2024.132473 -
Medicina (Kaunas, Lithuania) May 2024: Myocardial bridging (MB) is still not yet considered a significant finding in Indonesia both radiographically and clinically. Hence, this article aims to assess the...
: Myocardial bridging (MB) is still not yet considered a significant finding in Indonesia both radiographically and clinically. Hence, this article aims to assess the prevalence of MB using multi-detector computed tomography (MDCT) and look at factors contributing to stenosis amongst patients with MB. This study is cross-sectional in a single centre, with consecutive sampling, looking at all patients who underwent a multi-detector computed tomography (MDCT) scan from February 2021 until February 2023. GraphPad Prism version 9.0.0 for Windows (GraphPad Software, Boston, MA, USA) was used to analyse the results. : There are 1029 patients with an MB, yielding a prevalence of 44.3% (95%CI 42.3-46.4). The left anterior descending vessel is the most commonly implicated, with 99.6%. Among those with stenosis, the middle portion of the bridging vessel is the most common site of stenosis ( = 269), followed by the proximal portion ( = 237). The severity of stenosis is more often moderate, with 30-50% ( = 238). Females (odds ratio [OR] of 1.8, 95%CI 1.4-2.3; -value < 0.0001), older age (-value 5.6, -value < 0.0001), symptomatic patients (OR 1.4, 95% CI 1.1-1.9; -value = 0.013), and higher mean coronary artery calcium score (-value 11.3, -value < 0.0001) are more likely to have stenosis. The degree of stenosis is significantly higher in the proximal stenosis group than in the middle stenosis group (-value 27, -value < 0.0001). : Our research demonstrates that MB may prevent atheromatosis of the coronary segment distal to the MB and predispose the development of atherosclerosis in the section proximal to the bridge.
Topics: Humans; Indonesia; Female; Male; Middle Aged; Cross-Sectional Studies; Prevalence; Myocardial Bridging; Multidetector Computed Tomography; Adult; Aged; Coronary Stenosis
PubMed: 38792977
DOI: 10.3390/medicina60050794 -
European Heart Journal. Cardiovascular... May 2024Cardiac cycle morphological changes can accelerate plaque growth proximal to myocardial bridging (MB) in the left anterior descending artery (LAD).
BACKGROUND
Cardiac cycle morphological changes can accelerate plaque growth proximal to myocardial bridging (MB) in the left anterior descending artery (LAD).
OBJECTIVE
To assess coronary CT angiography (CCTA)-based vascular radiomics for predicting proximal plaque development in LAD MB.
METHODS
Patients with repeated CCTA scans showing LAD MB without proximal plaque in index CCTA were included from Jinling Hospital as development set. They were divided into training and internal testing in an 8:2 ratio. Patients from 4 other tertiary hospitals were set as external validation set. The endpoint was proximal plaque development of LAD MB in follow-up CCTA. Four vascular radiomics models were built: MB centerline (MB CL), proximal MB CL (pMB CL), MB cross section (MB CS), and proximal MB CS (pMB CS), whose performances were evaluated using area under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
RESULTS
295 patients were included in the development (n=192; median age, 54±11 years; 137 men) and external validation sets (n=103; median age, 57±9 years; 57 men). The pMB CS vascular radiomics model exhibited higher AUCs in training, internal test, and external sets (AUC=0.78, 0.75, 0.75) than the clinical and anatomical model (all p<0.05). Integration of the pMB CS vascular radiomics model significantly raised the AUC of the clinical and anatomical model from 0.56 to 0.75 (p=0.002), along with enhanced NRI (0.76 [0.37-1.14], p<0.001) and IDI (0.17 [0.07-0.26], p<0.001) in the external validation set.
CONCLUSION
The CCTA-based pMB CS vascular radiomics model can predict plaque development in LAD MB.
PubMed: 38781436
DOI: 10.1093/ehjci/jeae135 -
The National Medical Journal of India 2023
Topics: Humans; Myocardial Bridging; Coronary Angiography; Male; Coronary Vessel Anomalies; Middle Aged; Coronary Vessels
PubMed: 38759993
DOI: 10.25259/NMJI_1112_2022 -
Expert Opinion on Drug Safety May 2024Patients with type 2 diabetes (T2DM) are at high risk of atherosclerotic cardiovascular disease (ASCVD) and cardiovascular death. Cardiovascular protection is a key... (Review)
Review
INTRODUCTION
Patients with type 2 diabetes (T2DM) are at high risk of atherosclerotic cardiovascular disease (ASCVD) and cardiovascular death. Cardiovascular protection is a key objective in T2DM.
AREAS COVERED
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have proven their efficacy in reducing major cardiovascular events in high-risk patients with T2DM in placebo-controlled trials, a finding confirmed in observational studies compared with other glucose-lowering agents. Overall, GLP-1RAs have a good safety profile associated with a favorable benefit/risk ratio for the management of T2DM, even if their cost-effectiveness might be questionable. International guidelines recommend GLP-1RAs as preferred glucose-lowering agents in patients with ASCVD and as a valuable alternative in overweight/obese patients with T2DM. However, real-life studies worldwide revealed that only a minority of patients receive a GLP-1RA, despite a positive trend for increased prescriptions in recent years. Surprisingly, however, fewer patients with established ASCVD are treated with these cardioprotective antihyperglycemic agents versus patients without ASCVD.
EXPERT OPINION
The reasons for GLP-1RA underuse in clinical practice are multiple. Multifaceted and coordinated interventions targeting all actors of the health-care system must be implemented to stimulate the adoption of GLP-1RAs as part of routine cardiovascular care among patients with T2DM, especially in those with ASCVD.
PubMed: 38738549
DOI: 10.1080/14740338.2024.2354885 -
The Canadian Journal of Cardiology May 2024In patients presenting with an acute coronary syndrome (ACS), the impact of efforts leveraged at bridging historical care gaps between Indigenous and non-Indigenous...
BACKGROUND
In patients presenting with an acute coronary syndrome (ACS), the impact of efforts leveraged at bridging historical care gaps between Indigenous and non-Indigenous patients remains limited.
METHODS
For consecutive ACS presentations (STEMI and NSTEMI/UA, respectively) at the Royal University Hospital, Saskatoon, we compared between self-identified Indigenous and non-Indigenous patients their demographics, treatments and all-cause mortality (in-hospital and 3-years). We used propensity score-inverse probability weighting to mitigate confounding, and Cox regression models to estimate the adjusted hazard (aHR, 95% confidence intervals) for all-cause mortality.
RESULTS
Of 3946 ACS patients, 37.2% (n=1468) were STEMI of whom 11.3% (n=166) were Indigenous. Of the NSTEMI/UA (n=2478), 12.6% (n=311) were Indigenous. Overall, Indigenous compared with non-Indigenous patients were likely to be younger, female, have higher risk burden, and lived more remotely; Indigenous STEMI patients triaged to primary PCI had longer first medical contact-to-device times, while Indigenous NSTEMI/UA patients more likely to present with heart failure, cardiac arrest and/or cardiogenic shock. No significant differences were noted for in-hospital mortality (STEMI 8.4% vs 5.7%, p= 0.16; NSTEMI/UA 1.9% vs 1.6%, p=0.68), however, in follow-up, Indigenous STEMI patients associated with a higher all-cause mortality risk (aHR 1.98, 95% CI 1.19, 3.31, p=0.009) with no between-group differences evident for NSTEMI/UA (aHR 1.03, 95% CI 0.63 1.69, p=0.91).
CONCLUSIONS
Indigenous compared with non-Indigenous patients presenting with an ACS had higher cardiovascular risk profiles, and consequently residual mortality risk. Improving primary care and intensifying secondary risk reduction, and particularly so for Indigenous patients, will substantially modify ACS outcomes in Saskatchewan.
PubMed: 38729604
DOI: 10.1016/j.cjca.2024.04.025 -
Cell & Bioscience May 2024The cyclic guanosine monophosphate (GMP)-adenosine monophosphate (AMP) synthase-stimulator of interferon genes (cGAS-STING) signaling pathway, an important component of... (Review)
Review
The cyclic guanosine monophosphate (GMP)-adenosine monophosphate (AMP) synthase-stimulator of interferon genes (cGAS-STING) signaling pathway, an important component of the innate immune system, is involved in the development of several diseases. Ectopic DNA-induced inflammatory responses are involved in several pathological processes. Repeated damage to tissues and metabolic organelles releases a large number of damage-associated molecular patterns (mitochondrial DNA, nuclear DNA, and exogenous DNA). The DNA fragments released into the cytoplasm are sensed by the sensor cGAS to initiate immune responses through the bridging protein STING. Many recent studies have revealed a regulatory role of the cGAS-STING signaling pathway in cardiovascular diseases (CVDs) such as myocardial infarction, heart failure, atherosclerosis, and aortic dissection/aneurysm. Furthermore, increasing evidence suggests that inhibiting the cGAS-STING signaling pathway can significantly inhibit myocardial hypertrophy and inflammatory cell infiltration. Therefore, this review is intended to identify risk factors for activating the cGAS-STING pathway to reduce risks and to simultaneously further elucidate the biological function of this pathway in the cardiovascular field, as well as its potential as a therapeutic target.
PubMed: 38720328
DOI: 10.1186/s13578-024-01242-4