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1.
K. Feidantsis K. Mellidis E. Galatou Z. Sinakos A. Lazou 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(9):952-961
Background and aim
The association of diabetes mellitus (DM) and poor metabolic control with high incidence of cardiovascular diseases is well established. The aim of this study was to investigate the potential cardioprotective effect of crocin (Crocus sativus L. extract) on diabetic heart dysfunction and to elucidate the mediating molecular mechanisms.Methods and results
Streptozotocin (STZ)-induced diabetic rats were treated with two different concentrations of crocin (10 or 20 mg/kg), while isolated cardiac myocytes exposed to 25 mM glucose, were treated with 1 or 10 μM of crocin. Treatment of STZ-diabetic rats with crocin resulted in normalization of plasma glucose levels, inhibition of cardiac hypertrophy and fibrosis, and improvement of cardiac contractile function. Heat Shock Response was enhanced. Myocardial AMPK phosphorylation was increased after treatment with crocin, resulting in normalization of autophagy marker proteins (LC3BII/LC3BI ratio, SQSTM1/p62 and Beclin-1), while the diabetes-induced myocardial apoptosis was decreased. Similar results regarding the effect of crocin on autophagy and apoptosis pathways were obtained in isolated cardiac myocytes exposed to high concentration of glucose.Conclusion
The results suggest that crocin improves the deteriorated cardiac function in diabetic animals by enhancing the heat shock response, inhibiting apoptosis and normalizing autophagy in cardiac myocytes. Thus, treatment with crocin may represent a novel approach for treating diabetic cardiomyopathy. 相似文献2.
Jeevan Nagendran Sabin J. Bozso Colleen M. Norris Finlay A. McAlister Jehangir J. Appoo Michael C. Moon Darren H. Freed Jayan Nagendran 《Journal of the American College of Cardiology》2018,71(8):819-827
Background
The role of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) has been established by large trials; however, these trials largely excluded patients with left ventricular dysfunction (LVD).Objectives
The aim of this study was to determine whether treatment with PCI or CABG leads to improved outcomes in patients with DM, CAD, and LVD.Methods
In this propensity-matched study, outcomes were compared for patients with CAD, DM, and LVD treated with PCI or CABG between 2004 and 2016. The primary outcome was major adverse cardiac and cerebrovascular events, defined as the composite of death, stroke, myocardial infarction, and repeat revascularization. Secondary outcomes were the individual components of the primary outcome.Results
PCI compared with CABG was associated with a higher risk for major adverse cardiac and cerebrovascular events in cohorts with ejection fraction (EF) 35% to 49% (p < 0.001) and <35% (p < 0.001). Treatment with PCI was associated with an increased risk for death in both the EF 35% to 49% and the EF <35% cohorts. Stroke rate did not differ between PCI and CABG in either EF cohort. PCI was associated with an increased rate of MI in the EF <35% cohort, and repeat revascularization occurred more frequently in patients treated with PCI in both the EF 35% to 49% cohort and the EF <35% cohort.Conclusions
At long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of major adverse cardiac and cerebrovascular events and better long-term survival over PCI, without a higher risk for stroke. 相似文献3.
Enver Tahir Jitka Starekova Kai Muellerleile Alexandra von Stritzky Julia Münch Maxim Avanesov Julius M. Weinrich Christian Stehning Sebastian Bohnen Ulf K. Radunski Eric Freiwald Stefan Blankenberg Gerhard Adam Axel Pressler Monica Patten Gunnar K. Lund 《JACC: Cardiovascular Imaging》2018,11(9):1260-1270
Objectives
This study analyzed the presence of myocardial fibrosis detected by late gadolinium-enhancement (LGE) cardiac magnetic resonance (CMR) in correlation with the performance of competitive triathletes objectified by an exercise test and individual competition history.Background
Myocardial fibrosis detected by LGE CMR has been reported to occur in 0% to 50% of asymptomatic athletes. However, the cause and mechanisms of myocardial fibrosis are unclear.Methods
Eighty-three asymptomatic triathletes undergoing >10 training h per week (43 ± 10 years of age; 65% male) and 36 sedentary controls were studied by using LGE and extracellular volume (ECV) CMR. Parameters of physical fitness were measured by spiroergometry. Triathletes reported their lifetime competition results.Results
LGE CMR revealed focal nonischemic myocardial fibrosis in 9 of 54 (17%) male triathletes (LGE+) but in none of the female triathletes (p < 0.05). LGE+ triathletes had higher peak exercise systolic blood pressure (213 ± 24 mm Hg) than LGE? triathletes (194 ± 26 mm Hg; p < 0.05). Furthermore, left ventricular mass index was higher in LGE+ triathletes (93 ± 7 g/m2) than in LGE? triathletes (84 ± 11 g/m2; p < 0.05). ECV in LGE? myocardium was higher in LGE+ triathletes (26.3 ± 1.8%) than in LGE? triathletes (24.4 ± 2.2%; p < 0.05). LGE+ triathletes completed longer cumulative distances in swimming and cycling races and participated more often in middle and Iron Man distances than LGE? triathletes. A cycling race distance of >1,880 km completed during competition had the highest accuracy to predict LGE, with an area under the curve value of 0.876 (p < 0.0001), resulting in high sensitivity (89%) and specificity (79%). Multivariate analysis identified peak exercise systolic blood pressure (p < 0.05) and the swimming race distance (p < 0.01) as independent predictors of LGE presence.Conclusions
Myocardial fibrosis in asymptomatic triathletes seems to be associated with exercise-induced hypertension and the race distances. There appears to be a safe upper limit, beyond which exercise may result in myocardial fibrosis. 相似文献4.
T. Ittermann S. Schipf M. Dörr B.H. Thuesen T. Jørgensen H. Völzke M.R.P. Markus 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(2):173-179
Background and Aims
A potential causal relationship between thyroid function and type 2 diabetes mellitus is currently under debate, but the current state of research is limited. Our aim was to investigate the association of thyroid hormone levels with prevalent and incident type 2 diabetes mellitus (T2DM) in two representative studies.Methods and Results
Analyses are based on data from the Study of Health in Pomerania (SHIP), a German population based cohort with 4308 individuals at baseline and 3300 individuals at a five-year follow-up, and from INTER99, a Danish population-based randomized controlled trial with 6784 individuals at baseline and 4516 individuals at the five-year-follow-up. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) concentrations were measured in both studies, while free triiodothyronine was measured in SHIP only. T2DM was defined by self report or intake of anti-diabetic medication.Neither in SHIP nor in INTER99 we detected significant associations of serum TSH levels with prevalent or incident T2DM. Serum fT4 levels were significantly positively associated with prevalent T2DM in SHIP and INTER99. In longitudinal analyses baseline levels of fT4 were significantly positively associated with incident T2DM in SHIP (RR per pmol/L = 1.07; 95%-CI = 1.05–1.10), while this association barely missed statistical significance in INTER99 (RR per pmol/L = 1.03; 95%-CI = 0.99–1.06). In SHIP baseline fT3 levels were significantly associated with incident T2DM (RR per pmol/L = 1.21; 95%-CI = 1.16–1.27).Conclusion
We demonstrated positive associations of thyroid hormones with prevalent and incident type 2 diabetes mellitus suggesting that hyperthyroxinemia may contribute to the pathogenesis of this condition. 相似文献5.
Ung Kim Jonathon A. Leipsic Stephanie L. Sellers Michael Shao Philipp Blanke Martin Hadamitzky Yong-Jin Kim Edoardo Conte Daniele Andreini Gianluca Pontone Matthew J. Budoff Ilan Gottlieb Byoung Kwon Lee Eun Ju Chun Filippo Cademartiri Erica Maffei Hugo Marques Sanghoon Shin Hyuk-Jae Chang 《JACC: Cardiovascular Imaging》2018,11(10):1461-1471
Objectives
This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM).Background
The natural history of coronary PP in patients with DM is not well established.Methods
A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0.Results
DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (?7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM.Conclusions
People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP. 相似文献6.
Maayan Konigstein Ori Ben-Yehuda Pieter C. Smits Michael P. Love Shmuel Banai Gidon Y. Perlman Mordechai Golomb Melek Ozgu Ozan Mengdan Liu Martin B. Leon Gregg W. Stone David E. Kandzari 《JACC: Cardiovascular Interventions》2018,11(24):2467-2476
Objectives
The authors sought to investigate the impact of diabetes mellitus (DM) on outcomes following contemporary drug-eluting stent (DES) implantation in the BIONICS (BioNIR Ridaforolimus Eluting Coronary Stent System in Coronary Stenosis) trial.Background
Patients with DM are at increased risk for adverse events following percutaneous coronary intervention (PCI).Methods
A prospective, multicenter, 1:1 randomized trial was conducted to evaluate in a noninferiority design the safety and efficacy of ridaforolimus-eluting stents versus zotarolimus-eluting stents among 1,919 patients undergoing PCI. Randomization was stratified to the presence of medically treated DM, and a pre-specified analysis compared outcomes according to the presence or absence of DM up to 2 years.Results
The overall prevalence of DM was 29.1% (559 of 1,919). DM patients had higher body mass index, greater prevalence of hyperlipidemia and hypertension, and smaller reference vessel diameter. One-year target lesion failure (cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization) was significantly higher among diabetic patients (7.8% vs. 4.2%; p = 0.002), mainly due to higher target lesion revascularization (4.5% vs. 2.0%; p = 0.002). Rates of cardiac death, myocardial infarction, and stent thrombosis did not statistically vary. Among 158 patients undergoing 13-month angiographic follow-up, restenosis rates were 3 times higher in diabetic patients compared with nondiabetic patients (15.2% vs. 4.7%; p = 0.01). Clinical and angiographic outcomes were similar between ridaforolimus-eluting stent– and zotarolimus-eluting stent–treated patients.Conclusions
Despite advances in interventional therapies, and the implementation of new-generation DES, diabetic patients still have worse angiographic and clinical outcomes compared with nondiabetic patients undergoing PCI. 相似文献7.
Yogesh Bulani Shyam Sunder Sharma 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2017,31(3):255-267
Purpose
Chronic diabetes is associated with cardiovascular dysfunctions. Diabetic cardiomyopathy (DCM) is one of the serious cardiovascular complications associated with diabetes. Despite significant efforts in understanding the pathophysiology of DCM, management of DCM is not adequate due to its complex pathophysiology. Recently, involvement of protease-activated receptors (PARs) has been postulated in cardiovascular diseases. These receptors are activated by thrombin, trypsin, or other serine proteases. Expression of PAR has been shown to be increased in cardiac diseases such as myocardial infarction, viral myocarditis, and pulmonary arterial hypertension. However, the role of PAR in DCM has not been elucidated yet. Therefore, in the present study, we have investigated the role of PAR in the condition of DCM using a pharmacological approach. We used argatroban, a direct thrombin inhibitor for targeting PAR.Methods
Type-2 diabetes mellitus (T2DM) was induced by high-fat feeding along with low dose streptozotocin (STZ 35 mg/kg, i.p. single dose) in male Sprague-Dawley rats. After 16 weeks of diabetes induction, animals were treated with argatroban at 0.3 and 1 mg/kg dose daily for 4 weeks. After 20 weeks, ventricular functions were measured using ventricular catheterization. Cardiac histology, TUNEL staining, and immunoblotting were performed to evaluate cardiac fibrosis, DNA fragmentation, and expression level of different proteins, respectively.Results
T2DM was associated with cardiac structural and functional disturbances as evidenced from impaired cardiac functional parameters and increased fibrosis. There was a significant increase in PAR expression after 20 weeks of diabetes induction. Four weeks argatroban treatment ameliorated metabolic alterations (reduced plasma glucose and cholesterol), ventricular dysfunctions (improved systolic and diastolic functions), cardiac fibrosis (reduced percentage area of collagen in picro-sirius red staining), and apoptosis (reduced TUNEL positive nuclei). Reduced expression of PAR1 and PAR4 in the argatroban-treated group indicates a response towards inhibition of thrombin. In addition, AKT (Ser-473), GSK-3β (Ser-9), p-65 NF?B phosphorylation, TGF-β, COX-2, and caspase-3 expression were reduced significantly along with an increase in SERCA expression in argatroban-treated diabetic rats which indicated the anti-fibrotic, anti-inflammatory, and anti-apoptotic potential of argatroban in DCM.Conclusion
This study suggests the ameliorative effects of argatroban in diabetic cardiomyopathy by improving ventricular functions and reducing fibrosis, inflammation, apoptosis, and PAR expression.8.
F. Zaccardi B. Rocca A. Rizzi A. Ciminello L. Teofili G. Ghirlanda V. De Stefano D. Pitocco 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2017,27(10):902-909
Background and aims
The relationship between platelet indices and glucose control may differ in type 1 (T1DM) and type 2 (T2DM) diabetes. We aimed to investigate differences in mean platelet volume (MPV), platelet count, and platelet mass between patients with T1DM, T2DM, and healthy controls and to explore associations between these platelet indices and glucose control.Methods and results
A total of 691 T1DM and 459 T2DM patients and 943 control subjects (blood donors) were included. HbA1c was measured in all subjects with diabetes and 36 T1DM patients further underwent 24 h-continuous glucose monitoring to estimate short-term glucose control (glucose mean and standard deviation). Adjusting for age and sex, platelet count was higher and MPV lower in both T1DM and T2DM patients vs control subjects, while platelet mass (MPV × platelet count) resulted higher only in T2DM. Upon further adjustment for HbA1c, differences in platelet count and mass were respectively 19.5 × 109/L (95%CI: 9.8–29.3; p < 0.001) and 101 fL/nL (12–191; p = 0.027) comparing T2DM vs T1DM patients. MPV and platelet count were significantly and differently related in T2DM patients vs both T1DM and control subjects; this difference was maintained also accounting for HbA1c, age, and sex. Platelet mass and the volume-count relationship were significantly related to HbA1c only in T1DM patients. No associations were found between platelet indices and short-term glucose control.Conclusion
By accounting for confounders and glucose control, our data evidenced higher platelet mass and different volume-count kinetics in subjects with T2DM vs T1DM. Long-term glucose control seemed to influence platelet mass and the volume-count relationship only in T1DM subjects. These findings suggest different mechanisms behind platelet formation in T1DM and T2DM patients with long-term glycaemic control being more relevant in T1DM than T2DM. 相似文献9.
Julia Anna Lurz Christian Luecke David Lang Christian Besler Karl-Philipp Rommel Karin Klingel Reinhard Kandolf Volker Adams Katharina Schöne Gerhard Hindricks Gerhard Schuler Axel Linke Holger Thiele Matthias Gutberlet Philipp Lurz 《JACC: Cardiovascular Imaging》2018,11(1):38-45
Objectives
The aim of the present study was to evaluate whether extracellular volume fraction (ECV) can reliably inform on the extent of diffuse fibrosis in the simultaneous presence of myocardial inflammation, which has not been verified to date.Background
Diffuse myocardial fibrosis is associated with unfavorable outcome in patients with cardiomyopathy, and is of prognostic relevance. Assessment of ECV bears promise for being a noninvasive surrogate parameter, but it may be altered by other pathologies.Methods
In this prospective study, 107 consecutive patients with clinical suspicion of inflammatory cardiomyopathy were included. All patients underwent left ventricular (LV) endomyocardial biopsy (EMB) and cardiac magnetic resonance imaging on a 1.5-T scanner. T1 mapping was obtained with the modified Look-Locker inversion recovery sequence, and ECV was calculated.Results
Myocardial inflammation was present in 66 patients. Patients with and without inflammation were of similar age and had comparable LV ejection fraction (37 ± 17% vs. 36 ± 18%; p = 0.9) and symptom duration (median 14 days [interquartile range: 5 to 36 days] vs. median 14 days [interquartile range: 7 to 30 days]; p = 0.73). Although LV collagen volume percentage was comparable between groups (inflammation 12.3 ± 17.8% vs. noninflammation 11.4 ± 7.9%; p = 0.577), ECV was significantly higher in patients with inflammation (0.37 ± 0.06%) than in those without inflammation (0.33 ± 0.08%; p = 0.02). Importantly, ECV adequately estimated the degree of LV fibrosis percentage only in patients without inflammation (r = 0.72; p < 0.0001) and not in those with inflammation (r = 0.24; p = 0.06).Conclusions
These findings prove the theoretical concept of ECV as an estimate for diffuse myocardial fibrosis, but only in the absence of significant myocardial inflammation. Assuming that various degrees of myocardial inflammation and fibrosis coexist in such a scenario, the measured ECV will reflect a sum of these different pathologies but will not inform solely on the extent of diffuse fibrosis. 相似文献10.
D. Aune S. Schlesinger T. Norat E. Riboli 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(6):543-556
Background
Although diabetes mellitus is an established risk factor for myocardial infarction and stroke, data on the association with sudden cardiac death are less extensive and the findings have not been entirely consistent. We therefore conducted a systematic review and meta-analysis of prospective studies on diabetes mellitus and risk of sudden cardiac death.Methods and results
PubMed and Embase databases were searched up to July 18th 2017. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between a diabetes diagnosis or pre-diabetes and risk of sudden cardiac death were included. Summary RRs were estimated by use of a random effects model. Nineteen population-based prospective studies (11 publications) (3610 cases, 249,225 participants) and 10 patient-based prospective studies (2713 cases, 55,098 participants) were included. The summary RR for diabetes patients vs. persons without diabetes was 2.02 (95% CI: 1.81–2.25, I2 = 0%, pheterogeneity = 0.91) in the population-based studies. The summary RR was 1.23 (95% CI: 1.05–1.44, I2 = 6%, pheterogeneity = 0.34) for the association between pre-diabetes and sudden cardiac death (n = 3 studies, 1000 sudden cardiac deaths, 18,360 participants). In the patient-based studies, the summary RR of sudden cardiac death for diabetes patients vs. patients without diabetes was 1.75 (95% CI: 1.51–2.03, I2 = 39%, pheterogeneity = 0.10) for all patients combined, 1.63 (95% CI: 1.36–1.97, I2 = 39%, n = 5) for coronary heart disease patients, and 1.85 (95% CI: 1.48–2.33, I2 = 0%, n = 3) for heart failure patients.Conclusions
These results suggest that diabetes patients are at an increased risk of sudden cardiac death both in the general population and among different patient groups. 相似文献11.
O. Groeneveld Y. Reijmer R. Heinen H. Kuijf P. Koekkoek J. Janssen G. Rutten L. Kappelle G. Biessels 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(12):1253-1260
Background and aims
The risk of mild cognitive impairment and dementia is increased in type 2 diabetes mellitus (T2DM). We aimed to identify the neuroanatomical correlates of mild cognitive impairment (MCI) and early dementia in patients with T2DM, using advanced multimodal MRI.Methods and results
Twenty-five patients (≥70 years) with T2DM and MCI (n = 22) or early dementia (n = 3) were included. The reference group consisted of 23 patients with T2DM with intact cognition. All patients underwent a 3 T MRI. Brain volumes and white matter hyperintensity volumes were obtained with automated segmentation methods. White matter connectivity was assessed with diffusion tensor imaging and fiber tractography. Infarcts and microbleeds were rated visually. Compared to patients without cognitive impairment, those with impairment had a lower grey matter volume (effect size: ?0.58, p=0.042), especially in the right temporal lobe and subcortical brain regions (effect sizes: ?0.45 to ?0.91, false discovery rate corrected p < 0.05). White matter volume (effect size: ?0.47, p = 0.11) and white matter connectivity (effect size: 0.55, p = 0.054) were also reduced in patients with versus without cognitive impairment, albeit not statistically significant. White matter hyperintensity volumes and occurrence of other vascular lesions did not differ between the two patient groups.Conclusion
In patients with T2DM, grey matter atrophy rather than vascular brain injury appears to be the primary imaging correlate of MCI and early dementia. 相似文献12.
James M. Halle-Smith Eduardo Vinuela Rachel M. Brown James Hodson Zergham Zia Simon R. Bramhall Ravi Marudanayagam Robert P. Sutcliffe Darius F. Mirza Paolo Muiesan John Isaac Keith J. Roberts 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):727-734
Background
Evidence associates various biometric and histological variables such as steatosis and absence of fibrosis as risk factors for post-operative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Following distal pancreatectomy (DP), the association between these factors and POPF is less clear. This study of patients, drawn from the same background population, undergoing PD or DP at a single centre is a comparative study of the risk factors for POPF after these two operations.Methods
Associations between POPF and patient characteristics, pre-operative blood tests, data from pre-operative computed tomography (CT) imaging, assessment of histological steatosis and fibrosis were explored.Results
26/107 (24%) and 26/90 (29%) patients developed POPF after PD and DP respectively. Absence of fibrosis was associated with POPF (p < 0.001) after PD and its presence correlated with pancreatic duct width (p < 0.001). Steatosis was not associated with POPF (p = 0.910). Multivariable analysis showed pancreatic duct width (p = 0.016) and fibrosis (p = 0.025) to be independent predictors of POPF after PD. The only variable associated with POPF after DP was underlying pathology (p = 0.005).Conclusion
Pancreatic duct width is the most important variable related to POPF after PD and is correlated with fibrosis. Steatosis was not related to POPF. In contrast, after DP POPF appears to be related to the underlying disease. 相似文献13.
Thomas A. Treibel Rebecca Kozor Rebecca Schofield Giulia Benedetti Marianna Fontana Anish N. Bhuva Amir Sheikh Begoña López Arantxa González Charlotte Manisty Guy Lloyd Peter Kellman Javier Díez James C. Moon 《Journal of the American College of Cardiology》2018,71(8):860-871
Background
Left ventricular (LV) hypertrophy, a key process in human cardiac disease, results from cellular (hypertrophy) and extracellular matrix expansion (interstitial fibrosis).Objectives
This study sought to investigate whether human myocardial interstitial fibrosis in aortic stenosis (AS) is plastic and can regress.Methods
Patients with symptomatic, severe AS (n = 181; aortic valve area index 0.4 ± 0.1 cm2/m2) were assessed pre–aortic valve replacement (AVR) by echocardiography (AS severity, diastology), cardiovascular magnetic resonance (CMR) (for volumes, function, and focal or diffuse fibrosis), biomarkers (N-terminal pro–B-type natriuretic peptide and high-sensitivity troponin T), and the 6-min walk test. CMR was used to measure the extracellular volume fraction (ECV), thereby deriving matrix volume (LV mass × ECV) and cell volume (LV mass × [1 ? ECV]). Biopsy excluded occult bystander disease. Assessment was repeated at 1 year post-AVR.Results
At 1 year post-AVR in 116 pacemaker-free survivors (age 70 ± 10 years; 54% male), mean valve gradient had improved (48 ± 16 mm Hg to 12 ± 6 mm Hg; p < 0.001), and indexed LV mass had regressed by 19% (88 ± 26 g/m2 to 71 ± 19 g/m2; p < 0.001). Focal fibrosis by CMR late gadolinium enhancement did not change, but ECV increased (28.2 ± 2.9% to 29.9 ± 4.0%; p < 0.001): this was the result of a 16% reduction in matrix volume (25 ± 9 ml/m2 to 21 ± 7 ml/m2; p < 0.001) but a proportionally greater 22% reduction in cell volume (64 ± 18 ml/m2 to 50 ± 13 ml/m2; p < 0.001). These changes were accompanied by improvement in diastolic function, N-terminal pro–B-type natriuretic peptide, 6-min walk test results, and New York Heart Association functional class.Conclusions
Post-AVR, focal fibrosis does not resolve, but diffuse fibrosis and myocardial cellular hypertrophy regress. Regression is accompanied by structural and functional improvements suggesting that human diffuse fibrosis is plastic, measurable by CMR and a potential therapeutic target. (Regression of Myocardial Fibrosis After Aortic Valve Replacement; NCT02174471) 相似文献14.
James T. Thackeray Henri C. Hupe Yong Wang Jens P. Bankstahl Georg Berding Tobias L. Ross Johann Bauersachs Kai C. Wollert Frank M. Bengel 《Journal of the American College of Cardiology》2018,71(3):263-275
Background
The local inflammatory tissue response after acute myocardial infarction (MI) determines subsequent healing. Systemic interaction may induce neuroinflammation as a precursor to neurodegeneration.Objectives
This study sought to assess the influence of MI on cardiac and brain inflammation using noninvasive positron emission tomography (PET) of the heart-brain axis.Methods
After coronary artery ligation or sham surgery, mice (n = 49) underwent serial whole-body PET imaging of the mitochondrial translocator protein (TSPO) as a marker of activated macrophages and microglia. Patients after acute MI (n = 3) were also compared to healthy controls (n = 9).Results
Infarct mice exhibited elevated myocardial TSPO signal at 1 week versus sham (percent injected dose per gram: 8.0 ± 1.6 vs. 4.8 ± 0.9; p < 0.001), localized to activated CD68+ inflammatory cells in the infarct. Early TSPO signal predicted subsequent left ventricular remodeling at 8 weeks (rpartial = ?0.687; p = 0.001). In parallel, brain TSPO signal was elevated at 1 week (1.7 ± 0.2 vs. 1.4 ± 0.2 for sham; p = 0.017), localized to activated microglia. After interval decline at 4 weeks, progressive heart failure precipitated a second wave of neuroinflammation (1.8 ± 0.2; p = 0.005). TSPO was concurrently up-regulated in remote cardiomyocytes at 8 weeks (8.8 ± 1.7, p < 0.001) without inflammatory cell infiltration, suggesting mitochondrial impairment. Angiotensin-converting enzyme inhibitor treatment lowered acute inflammation in the heart (p = 0.003) and brain (p = 0.06) and improved late cardiac function (p = 0.05). Patients also demonstrated elevation of cardiac TSPO signal in the infarct territory, paralleled by neuroinflammation versus controls.Conclusions
The brain is susceptible to acute MI and chronic heart failure. Immune activation may interconnect heart and brain dysfunction, a finding that provides a foundation for strategies to improve heart and brain outcomes. 相似文献15.
H.-W. Zhang X. Zhao Y.-L. Guo Y. Gao C.-G. Zhu N.-Q. Wu J.-J. Li 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(10):980-986
Background and aims
The role of lipoprotein (a) [Lp(a)] in coronary artery diseases (CAD) with special clinical background such as type 2 diabetes mellitus (T2DM) has not been fully determined. The aim of the present study was to investigate the relation of Lp(a) to type 2 diabetic patients with or without CAD.Methods and results
A total of 2040 consecutive patients with T2DM who received selective coronary angiography (CAG) due to angina-like chest pain were enrolled. The patients were subsequently divided into CAD and non-CAD groups according to the results of CAG. The severity of CAD was evaluated by the Gensini Score (GS), number of stenotic vessels, and history of myocardial infarction (MI). Data showed that Lp(a) levels were higher in the CAD group than in the non-CAD group (median: 15.00 mg/dL vs. 11.88 mg/dL, P = 0.025). The results from CAD subgroup analysis indicated that the patients with MI, multiple-vessel disease and high GS had higher Lp(a) levels compared with those in their matched subgroups (P < 0.05, respectively). After adjustment for confounders, Lp(a) levels were independently related to the presence and severity of CAD (CAD:OR = 1.564; MI:OR = 1.523; high GS:OR = 1.388; multiple-vessel disease:OR = 1.455; P < 0.05, respectively).Conclusion
Elevated Lp(a) levels were independently associated with the presence and severity of CAD in patients with T2DM. More studies are necessary to confirm our findings. 相似文献16.
Jin Hong Lim Joon Seong Park Dong Sup Yoon 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):388-395
Background
The clinical relevance of fibrosis with regard to tumor progression is supported by the correlation between fibrosis and poor outcomes. Fecal elastase-1 (FE-1) level has been used to assess exocrine dysfunction of the pancreas and to predict pancreas fibrosis. The aim of this study was to assess the impact of FE-1 on the survival of pancreatic cancer patients.Methods
Between January 2006 and December 2014, 136 patients with pancreatic adenocarcinoma underwent R0 resection at Gangnam Severance Hospital, Korea. Preoperative FE-1 levels were available in 94 patients who were enrolled in the study. Patients were classified into two groups according to preoperative FE-1: “normal” (≥200 μg/g) or “reduced” (<200 μg/g).Results
Median preoperative FE-1 level was 130.1 μg/g (IQR 32.0; 238.3). 62 patients (66.0%) had reduced pancreatic function and 32 patients (34.0%) had normal pancreatic function. The two groups had significantly different disease-free survival (P < 0.001). On multivariate analysis, normal FE-1, no lymph node metastasis and completion of adjuvant chemotherapy were found to be independent prognostic factors for better DFS (P = 0.001, P = 0.017, P = 0.038, respectively).Conclusion
FE-1 is a simple and non-invasive predictive clinical marker for prognosis of pancreatic cancer after attempted curative resection. 相似文献17.
C. Yu J. Wang F. Wang X. Han H. Hu J. Yuan X. Miao P. Yao S. Wei Y. Wang Y. Liang W. Chen X. Zhang H. Guo H. Yang Y. Tang D. Zheng T. Wu M. He 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2018,28(3):278-284
Background and aims
Plasma homocysteine concentrations have been reported to be associated with type 2 diabetes mellitus (T2DM) with controversial findings. The aim of the present study was to investigate the association between plasma homocysteine concentrations and T2DM.Methods and results
A cross-sectional study including 19,085 eligible participants derived from the Dongfeng-Tongji cohort was conducted. Plasma homocysteine concentrations were measured by Abbott Architect i2000 Automatic analyzer and T2DM was defined according to American Diabetes Association criteria. Logistic regression model was used to explore the association between plasma homocysteine concentrations and T2DM. The prevalence of T2DM was 19.0% in the whole population (mean age 62.9 years), 21.8% in males, and 17.1% in females. In the multivariable logistic regression analyses, compared with those in the lowest quintile, the OR (95% CI) of T2DM was 1.05 (0.92–1.21), 0.99 (0.86–1.14), 0.90 (0.78–1.05), and 0.77 (0.66–0.90) for quintile 2 to quintile 5 of homocysteine concentrations after adjustment for potential confounders (P for trend < 0.0001). Homocysteine concentrations were associated with decreased T2DM prevalence risk (OR = 0.88 per SD increase of homocysteine concentration; 95% CI: 0.84–0.93). A significant interaction between homocysteine concentrations and drinking status on T2DM prevalence risk was observed (P for interaction = 0.03). The inverse association of plasma homocysteine concentrations with T2DM prevalence risk was observed in non-drinkers but not in current drinkers.Conclusion
Plasma homocysteine concentrations were inversely correlated with T2DM among a middle-aged and elderly Chinese population. 相似文献18.
Tessa S.S. Genders Adrian Coles Udo Hoffmann Manesh R. Patel Daniel B. Mark Kerry L. Lee Ewout W. Steyerberg M.G. Myriam Hunink Pamela S. Douglas 《JACC: Cardiovascular Imaging》2018,11(3):437-446
Objectives
This study sought to externally validate prediction models for the presence of obstructive coronary artery disease (CAD).Background
A better assessment of the probability of CAD may improve the identification of patients who benefit from noninvasive testing.Methods
Stable chest pain patients from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial with computed tomography angiography (CTA) or invasive coronary angiography (ICA) were included. The authors assumed that patients with CTA showing 0% stenosis and a coronary artery calcium (CAC) score of 0 were free of obstructive CAD (≥50% stenosis) on ICA, and they multiply imputed missing ICA results based on clinical variables and CTA results. Predicted CAD probabilities were calculated using published coefficients for 3 models: basic model (age, sex, chest pain type), clinical model (basic model + diabetes, hypertension, dyslipidemia, and smoking), and clinical + CAC score model. The authors assessed discrimination and calibration, and compared published effects with observed predictor effects.Results
In 3,468 patients (1,805 women; mean 60 years of age; 779 [23%] with obstructive CAD on CTA), the models demonstrated moderate-good discrimination, with C-statistics of 0.69 (95% confidence interval [CI]: 0.67 to 0.72), 0.72 (95% CI: 0.69 to 0.74), and 0.86 (95% CI: 0.85 to 0.88) for the basic, clinical, and clinical + CAC score models, respectively. Calibration was satisfactory although typical chest pain and diabetes were less predictive and CAC score was more predictive than was suggested by the models. Among the 31% of patients for whom the clinical model predicted a low (≤10%) probability of CAD, actual prevalence was 7%; among the 48% for whom the clinical + CAC score model predicted a low probability the observed prevalence was 2%. In 2 sensitivity analyses excluding imputed data, similar results were obtained using CTA as the outcome, whereas in those who underwent ICA the models significantly underestimated CAD probability.Conclusions
Existing clinical prediction models can identify patients with a low probability of obstructive CAD. Obstructive CAD on ICA was imputed for 61% of patients; hence, further validation is necessary. 相似文献19.
Andre L. Montagnini Bård I. Røsok Horacio J. Asbun Jeffrey Barkun Marc G. Besselink Ugo Boggi Kevin C.P. Conlon Abe Fingerhut Ho-Seong Han Paul D. Hansen Melissa E. Hogg Michael L. Kendrick Chinnusamy Palanivelu Shailesh V. Shrikhande Go Wakabayashi Herbert Zeh Charles M. Vollmer David A. Kooby 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):182-189
Background
There is a growing body of literature pertaining to minimally invasive pancreatic resection (MIPR). Heterogeneity in MIPR terminology, leads to confusion and inconsistency. The Organizing Committee of the State of the Art Conference on MIPR collaborated to standardize MIPR terminology.Methods
After formal literature review for “minimally invasive pancreatic surgery” term, key terminology elements were identified. A questionnaire was created assessing the type of resection, the approach, completion, and conversion. Delphi process was used to identify the level of agreement among the experts.Results
A systematic terminology template was developed based on combining the approach and resection taking into account the completion. For a solitary approach the term should combine “approach + resection” (e.g. “laparoscopic pancreatoduodenectomy); for combined approaches the term must combine “first approach + resection” with “second approach + reconstruction” (e.g. “laparoscopic central pancreatectomy” with “open pancreaticojejunostomy”) and where conversion has resulted the recommended term is “first approach” + “converted to” + “second approach” + “resection” (e.g. “robot-assisted” “converted to open” “pancreatoduodenectomy”)Conclusions
The guidelines presented are geared towards standardizing terminology for MIPR, establishing a basis for comparative analyses and registries and allow incorporating future surgical and technological advances in MIPR. 相似文献20.
Brendan M. Everett Marc Y. Donath Aruna D. Pradhan Tom Thuren Prem Pais Jose C. Nicolau Robert J. Glynn Peter Libby Paul M Ridker 《Journal of the American College of Cardiology》2018,71(21):2392-2401