Search Results (4,009)

Background: The aging process is accompanied by changes in the immunological status of a person. Immunosenescence is considered a significant cause of the development of cardiovascular diseases (CVD) in elderly people. However, to date, the relationship between immune/inflammatory processes and diseases associated with age is considered quite complex and is not fully understood. Immunophenotyping and the intracellular production of cytokines involved in the processes of inflammatory aging will allow us to identify biomarkers that are associated with cardiovascular diseases in the elderly. Objectives: To identify immunological markers associated with the process of inflammatory aging in older individuals with cardiovascular diseases. Methods: CD-phenotyping and intracellular cytokine analysis of peripheral blood using the flow cytometry method were conducted in 52 people over 60 years of age (group 1 had CVD and group 2 did not). Blood samples were stained with monoclonal antibodies (mAb) using Becton Dickinson (BD) reagents for the staining and binding of surface receptors CD4+, CD8+, CD14+, CD19+, CD16+, CD56+, CD59+, CD95+, and HLA DR+ and intracellular receptors TNF, IL-10, GM-CSF, VEGFR-2, IGF, and perforin. In addition, the following parameters were studied: questionnaire data (gender, age, alcohol consumption, smoking, physical activity, and marital status), clinical data (blood pressure (BP), heart rate (HR), body mass index (BMI)), comorbid conditions, and cardiovascular diseases (coronary heart disease (CHD), chronic heart failure (CHF), arterial hypertension (AH), previous myocardial infarction (PICS), diabetes mellitus (DM), atrial fibrillation (AF), and stroke). Results: The older patients with cardiovascular pathology had high levels of monocytes CD14+ (p = 0.014), low levels of CD8+ lymphocytes (p = 0.046), and low intracellular production of GM-CSF (p = 0.013) compared to the older people without CVD. Conclusions: The revealed differences in the expression of CD14+ monocytes indicate their role in the development of cardiovascular pathology associated with age-related changes. A decrease in cytotoxic CD8+ lymphocytes and intracellular GM-CSF production leads to an increased risk of developing cardiovascular diseases in older individuals. These observed changes with age will not only expand existing knowledge about the aging of the regulatory link of the immune system but also help to obtain data to predict CVD in older people. Thus, the obtained results support the use of these immunological markers to identify the risk of circulatory disease and a personalized approach in geriatric practice. Full article

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusion: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial. Full article

Background/Objectives: Large clinical trials have established the optimal antiplatelet strategy in the wide spectrum of coronary artery disease. However, data are scarce regarding MINOCA and the aim of our study is to present data from the current clinical practice. Methods: A total of 151 patients were included in this study after exclusion of 27 patients with myocarditis and other diagnoses. A cardiac magnetic resonance (CMR) performed at 123/151 patients demonstrated an ischemic pattern of late gadolinium enhancement (LGE) confirming the diagnosis of true acute myocardial infarction (AMI) in 42 cases (28%). Based on multimodality imaging and clinical judgement, Takotsubo syndrome (TTS) was diagnosed in 55 patients (36%), whereas CMR failed to reveal abnormal findings in 54 cases (36%), categorized as MINOCA of unknown origin. Results: Regarding antithrombotic prescriptions at discharge, 38% of patients received dual antiplatelet (DAPT) or dual antithrombotic therapy (DAT, 1 antiplatelet plus 1 anticoagulant), 49.7% received single antiplatelet (SAPT) or anticoagulant, and 12% received no antithrombotic treatment. Univariate analysis showed that the likelihood of prescribing DAPT or DAT was associated with left ventricular ejection fraction (LVEF) (r = 0.202, p = 0.013), atherosclerotic lesions on coronary angiography (r = 0.303, p < 0.001), prior use of anticoagulants (r = −0.258, p = 0.001), and marginally with the INTERTAK score (r = −0.198, p = 0.044). A multivariable model, adjusted for age, LVEF, ECG abnormalities, and history of anticoagulant use, confirmed the independent association between angiographic evidence of atherosclerosis and the decision for DAPT/DAT (OR: 0.334, 95% CI: 0.307–0.813, p < 0.001). However, the initial treatment decision did not seem to impact 2-year prognosis in our population. Conclusions: Our study results reveal that decision making in the antithrombotic strategy for MINOCA patients poses a challenge in clinical practice. More robust data are required for definite conclusions on the prognostic implications. Full article

Background/Objectives: Previous research has established that beta-blockers significantly reduce all-cause mortality, cardiovascular mortality, and recurrent acute myocardial infarction (AMI) in patients with left ventricular dysfunction following AMI. However, their efficacy in patients with preserved left ventricular ejection fraction (LVEF) who undergo timely reperfusion and revascularization while receiving evidence-based medical management remains inconclusive. To address this uncertainty, we conducted a systematic review and meta-analysis to synthesize the available evidence on the impact of beta-blocker therapy in patients with AMI and preserved LVEF. Methods: A comprehensive literature search was conducted across PubMed, the Web of Science, and Scopus from their inception until November 2024. The search strategy incorporated three primary keywords and their corresponding Medical Subject Headings (MeSH) terms: “preserved”, “myocardial infarction”, and “beta-blocker”. Data analysis was performed using Review Manager 5.4 software. A random-effects model was applied to account for the study’s heterogeneity, while a fixed-effects model was utilized for homogeneous outcomes. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated for dichotomous outcomes, with a 95% confidence interval (CI) and a significance threshold of p < 0.05. Results: Beta-blocker therapy was significantly associated with a reduction in all-cause mortality compared to non-use, with an OR of 0.73 (95% CI: 0.61–0.88, p = 0.001) and an HR of 0.78 (95% CI: 0.67–0.91, p = 0.002). Similarly, beta-blocker administration was linked to a lower risk of cardiovascular mortality, demonstrating an OR of 0.76 (95% CI: 0.68–0.84, p < 0.00001) and an HR of 0.76 (95% CI: 0.59–0.99, p = 0.04). Furthermore, beta-blocker use was significantly correlated with a decreased risk of major adverse cardiovascular events (MACEs) compared to non-use, with an OR of 0.84 (95% CI: 0.75–0.95, p = 0.004) and an HR of 0.84 (95% CI: 0.71–0.99, p = 0.04). Conclusions: The current meta-analysis suggests a potential beneficial association between beta-blocker use and outcomes in patients with AMI and preserved LVEF, including lower rates of all-cause mortality, cardiovascular mortality, and MACEs; however, these findings should be interpreted with caution due to the observational nature of most included studies. Therefore, further randomized controlled trials (RCTs) are needed to confirm these findings, particularly in distinguishing outcomes among patients with and without heart failure. Full article

Background and Clinical Significance: Ventricular septal defect (VSD) is a rare but serious complication following myocardial infarction (MI) that can lead to cardiogenic shock and carries a high mortality rate. Acute mitral regurgitation (MR) is another severe complication of MI with additional risks of mortality. The optimal timing of surgical intervention for VSD with MR is still being debated, and delaying surgery in medically manageable patients has been associated with improved survival. However, managing these patients in the intensive care unit (ICU) presents unique challenges. Case Presentation: In this paper, we present the case of a 52-year-old male with comorbidities who developed post-MI VSD with severe MR and underwent successful delayed surgical repair and mitral valve replacement. Our aim is to highlight the clinical characteristics, diagnostic approach, and management strategies of this rare complication in the critical care setting. The patient presented in cardiogenic shock and acute pulmonary edema. After stabilization using an intra-aortic balloon pump, pre- and afterload reducing pharmacotherapy and non-invasive mechanical ventilation, a watchful waiting strategy was employed, and surgery was performed on day 21 after hospital admission. Surgery was performed under general anesthesia, and the patient did not develop any complications related to the intra-aortic balloon pump or novel organ dysfunction. Conclusions: This case highlights the importance of a multidisciplinary approach to managing post-MI VSD with MR and emphasizes the need for careful patient selection and timing of surgical intervention in the critical care setting. Clinicians should be aware of the potential benefits of delaying surgical intervention in medically manageable patients, while also considering the unique challenges of managing these patients in the ICU. Full article

Inflammation contributes to myocardial injury in ST-elevation myocardial infarction (STEMI). Interleukin-6 receptor (IL-6R) inhibition has been shown to mitigate myocardial injury and reduce levels of the prothrombotic and inflammatory mediator, neutrophil extracellular traps (NETs). The enzyme peptidylarginine deiminase 4 (PAD4) is central in NET formation. We hypothesized that PAD4 links IL-6R activation and NET formation. Methods: We conducted thrombus aspiration and peripheral blood sampling in 33 STEMI patients. In thrombi and leukocytes, we quantified the mRNA of IL-6, IL-6R, and PAD4. In peripheral blood, the protein levels of IL-6, IL-6R, PAD4, dsDNA, H3Cit, MPO-DNA, and troponin T were quantified. Results: In thrombi and circulating leukocytes, PAD4 mRNA was associated with IL-6R mRNA (thrombi: β = 0.34, 95% CI [0.16–0.53], p = 0.001, circulating leukocytes: β = 0.92, 95% CI [0.07–1.77], p = 0.036). There were no correlations between PAD4 and IL-6 in thrombi and leukocytes. The protein levels of IL-6R were associated with the NET marker H3Cit (r_s = 0.40, p = 0.02). In thrombi, PAD4 mRNA was associated with high levels of troponin T (β = 1.15 95% CI [0.27–2.04], p = 0.013). Conclusion: We demonstrate an association between PAD4, IL-6R, and troponin release in STEMI patients. Our findings indicate a PAD4-mediated connection between IL-6R and NET formation and highlight PAD4 as a potential treatment target for mitigating inflammation and myocardial injury in STEMI. Full article

Background/Objectives: The impact of longitudinal changes in cardiovascular-kidney-metabolic (CKM) stage remains unclear. This study evaluated the association between CKM stage progression and clinical outcomes. Methods: We used the Korean National Health Insurance Database to identify adults aged ≥ 20 years who underwent two health checkups between 2009 and 2012. CKM stages were assessed at both time points and categorized as decreased, maintained, or increased over a 1–2-year interval. The primary outcome was a composite of all-cause death, heart failure, stroke, and myocardial infarction, evaluated over a mean follow-up of 11.05 years. Results: Among 877,537 participants, 15.3% experienced CKM stage progression. Compared to the maintained group, the increased group had a higher risk of the composite outcome (HR: 1.071, 95% CI: 1.050–1.092). While men had a higher rate of progression, women showed greater risk of clinical events (HR: 1.124 vs. 1.040). While stage progression was more frequent in younger adults, older individuals in the increased group progressed to more advanced stages and experienced higher rates of adverse outcomes. Conclusions: CKM stage progression is independently associated with increased risk of mortality and cardiovascular events, particularly in women and older adults. Serial CKM assessment may help identify high-risk individuals for early intervention. Full article

Background: Despite advances in the management of coronary disease, the incidence of sudden cardiac death (SCD) in the context of coronary artery disease (CAD) remains significant and unpredictable. We investigated the patient and angiographic characteristics, and predictors of long-term outcomes, of patients presenting with cardiac arrest in the context of acute coronary occlusion, to elucidate possible mechanisms of ventricular arrhythmia. Methods: A total of 127 consecutive patients presenting to a tertiary cardiac centre with pulseless ventricular tachycardia or ventricular fibrillation during acute myocardial infarction (AMI) were compared to 100 patients with uncomplicated AMI (Cohort A). We also compared a separate group comprising 20 patients with acute RCA occlusion complicated by cardiac arrest and 24 patients with uncomplicated inferior STEMI (Cohort B). Results: In Cohort A, there was a higher incidence of proximal lesions in the arrest group (55% vs. 41%, p < 0.05). There was an almost equivalent incidence of both LAD and non-LAD (RCA/Cx) infarcts presenting with cardiac arrest. In the non-LAD arrest patients, sinoatrial nodal artery (SANa) involvement was seen in 77%, compared with 33% in non-arrest patients (p < 0.005). In Cohort B, involvement of the SANa or conus artery (CA) was found in 74% of arrest versus 21% of non-arrest patients (p < 0.005). Cohort A patients were followed up for 3.8 to 8.7 years, and at the end of this period, 22% of arrest patients and 16% of non-arrest patients were deceased. Mortality <30 days was highest in the arrest group (43% vs. 7%, p < 0.05). Beyond 30 days, there were no differences in all-cause mortality between arrest and non-arrest patients. There were more cardiac causes of death in the arrest group (54% vs. 20%, p < 0.05). Conclusions: VT/VF arrest due to acute coronary occlusion was more common in those with proximal disease and there was an increased incidence of SANa and/or CA involvement in non-LAD infarcts. Short-term mortality was higher in patients with cardiac arrest post-AMI, but beyond 30 days there was no significant difference. Full article

Background/aim: The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients. Method: We analyzed STEMI patients without cardiogenic shock at admission included in our STEMI Register. The patients were treated with primary PCI. The follow-up period was eight years. Results: From 1 December 2006 to 31 December 2016, a total of 3079 patients were included in the Register. In the first year, MACE was registered in 348 (11.3%) patients. The remaining patients were considered stable. They were included in further analysis. At eight years, the rates were as follows: MACE 3.9%, non-fatal recurrent infarction 2.1%, TVR 1.8%, non-fatal stroke 0.5%, and mortality 2.1%. Predictors for 8-year MACE were age >60 years (60–69 vs. <60 years HR 1.65; 70–79 vs. <60 years HR 1.82; ≥80 vs. <60 years HR 3.16), EF < 50% (EF 40–49% HR 2.38; EF < 40% HR 2.32), diabetes mellitus (HR 1.49), and 3-vessel coronary artery disease (HR 1.44). Conclusions: Four predictors identified stable post-STEMI patients who remained at a higher risk for the occurrence of MACE. Stable post-STEMI patients with one or more of these risk factors may require more aggressive secondary prevention measures or a personalized approach to improve their prognosis. Full article

Myocardial deformation imaging has emerged as a valuable clinical tool for assessing right ventricular (RV) systolic function, providing additional diagnostic and prognostic insights compared to traditional indices of RV function. Two-dimensional speckle-tracking echocardiography is currently the standardized method of choice for measuring RV longitudinal strain (RVLS) in clinical practice. RVLS provides a more sensitive indicator of subtle myocardial dysfunction than conventional parameters for RV function assessment (i.e., tricuspid annular plane systolic excursion, tissue Doppler systolic velocity, fractional area change, or RV ejection fraction), with utility for the risk stratification and surveillance of conditions affecting the right heart. However, accurate interpretation of RVLS requires a comprehensive understanding of RV mechanics, pathology, and loading conditions across various cardiovascular conditions, as well as the effects of image quality and technical aspects of image acquisition and tracking in RV strain measurements. This review provides an updated overview of current practical guidelines for RV strain analysis, current clinical applications, and future directions for its potential use in clinical practice. Full article

Nirmatrelvir plus ritonavir (NPR) has been approved for treating mild to moderate COVID-19 in high-risk adults but concerns about rebound effects have limited its use. This study aimed to identify individuals at risk of seeking medical care among high-risk non-hospitalized patients treated with NPR from 1 January 2022 to 31 December 2022, at our institution. Our outcome variable was the composite of subsequent evaluation in the Emergency Department or inpatient admission within four weeks of their NPR treatment. Of 369 patients who received NPR treatment, the mean (SD) age was 59.3 (±13.8) years; 64% (236) were female, and 77.7% (281) were white. The incidence of the composite event was 6.8% (25/369). In multivariable logistic regression, factors for seeking medical care following NPR treatment were female sex (OR 4.6; 95% CI 1.4–15.3; p = 0.013), myocardial infarction (OR 4.1; 95% CI 1.4–11.8; p = 0.011), chronic lung disease (CLD) except asthma and chronic obstructive pulmonary disease (COPD) (OR = 3.9, 95% CI 1.1–13.5; p = 0.03), and diabetes mellitus with complications (OR 6.9; 95% CI 2.0–23.3; p = 0.002) while alcohol users (OR 0.39; 95% CI 0.2–0.9; p = 0.038) were less likely to seek medical care. Larger cohorts are necessary to further assess and confirm these risk factors. Full article

Background/Objectives: This exploratory study aimed to assess the prevalence of retinal ischemic perivascular lesions (RIPLs) in individuals with cardiovascular disease (CVD) or associated risk factors and to investigate their potential role as non-invasive biomarkers of systemic ischemia using optical coherence tomography (OCT). Methods: A prospective observational study was conducted between July and October 2022. A total of 665 participants aged 40–90 years underwent macular OCT imaging using the Topcon Maestro 2 system. Participants were classified into two groups: those with ischemic CVD or risk factors (n = 297) and healthy individuals without cardiovascular conditions (n = 368). RIPLs were defined by inner nuclear layer thinning and outer nuclear layer expansion in perivascular regions and were identified by masked consensus of three independent evaluators. Results: The overall prevalence of RIPLs was 0.75% (five cases), exclusively observed in the diseased group (1.68%), with no cases identified among healthy individuals (p = 0.044). Stratified analysis showed an increase in RIPL prevalence with age, reaching 2.24% in the 70–79 years cohort. Statistically significant associations were found between RIPLs and hypertension, dyslipidemia, ischemic heart disease, and thrombosis (all p < 0.001). No significant association was observed with sex, myocardial infarction, or RIPL presence as an independent predictor (p = 0.08). Conclusions: Their identification through OCT during routine ophthalmologic examinations highlights a possible new avenue for early cardiovascular risk stratification. Nevertheless, the extremely low number of RIPL cases detected (only five out of six hundred and sixty-five participants; 0.75%) significantly limits the statistical power of the analysis and precludes strong conclusions. These findings should be regarded as preliminary and hypothesis-generating, requiring confirmation in larger, more diverse populations. Full article

Skeletal muscle changes occur in heart failure (HF). Despite the cardioprotective effects of sodium–glucose co-transporter 2 (SGLT2) inhibitors in HF, their impact on skeletal muscle remains poorly understood. We investigated the effects of the SGLT2 inhibitor empagliflozin (EMPA) on cardiac remodeling and the soleus muscle of rats with myocardial infarction (MI)-induced HF. Methods: One week after MI induction, rats were assigned to Sham, Sham + EMPA, MI, and MI + EMPA groups. EMPA was administered (5 mg/kg/day) for 12 weeks. Results: MI + EMPA and MI had dilated left cardiac chambers; the left atrium diameter and left ventricle end-diastolic area were smaller in MI + EMPA than MI. The ejection fraction did not differ between infarcted groups. MI + EMPA had a larger soleus cross-sectional area and higher Type II myosin heavy chain expression than MI. Carbonylated protein and malondialdehyde levels were lower and superoxide dismutase activity higher in MI + EMPA than MI. Respiratory Complex I expression was higher in MI + EMPA than MI. Metabolic enzyme activities, altered in MI, were normalized in MI + EMPA. EMPA up-regulated anabolic proteins and down-regulated catabolic proteins. Conclusion: Empagliflozin attenuates infarction-induced cardiac remodeling in rats. In soleus muscle, empagliflozin preserves cell trophism, reduces oxidative stress, normalizes muscle and mitochondrial metabolism, and positively modulates proteins involved in synthesis and degradation-related pathways. Full article

Oral administration of dipyridamole (DIP) with acetylsalicylic acid (ACA) is recommended in thromboembolic conditions or for the treatment of myocardial infarction and stroke. The present study presents an alternative dosage form of these two active ingredients, consisting of a honey core and a dark chocolate coating. The composition masks the bitter taste, is palatable and ensures compliance of a wide range of patients, mainly pediatric. For the simultaneous quantitative determination of the analytes, a Diode Array Detector/Fluorescence Detector (HPLC-DAD/FLD) method was used with a C18 column (250 mm × 4.6 mm, 5 μm) and an isocratic two-phase system (A: H₂O 0.2% formic acid—B: Acetonitrile-H₂O 90:10 v/v) 65:35 v/v. The method was validated according to ICH guidelines (r² > 0.999, RSD < 2.3%, % Recovery > 95.4%), and a stability study of the two active ingredients as well as salicylic acid (SAL), which is a hydrolysis product of ACA, was followed. Finally, a digestion protocol (oral cavity–stomach–intestine) for edible materials was applied to determine the release rate of ACA, DIP and SAL in the gastrointestinal tract, while an in vitro permeability study (P_app) was subsequently performed in Franz cells. The results show satisfactory behavior of ACA and DIP and provide a trigger for further studies of the formulation. Full article

Background/Objectives: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. Methods: Consecutive patients who underwent invasive CA at one institution between 2016 and 2022 were included in this study. Firstly, the prevalence and extent of coronary artery disease (CAD) in patients with different levels of kidney function was assessed. Secondly, the study examined how impaired kidney function affected long-term outcomes—specifically the risk of rehospitalization for heart failure (HF), acute myocardial infarction (AMI), or the need for coronary revascularization—at 36 months of follow-up. Results: A total of 7624 patients undergoing CA were included with a median estimated glomerular filtration rate (eGFR) of 68.9 mL/min/1.73 m² (IQR: 50.8–84.3). In total, 63.7% of patients had an eGFR ≥ 60 mL/min/1.73 m², 29.0% an eGFR of 30–<60 mL/min/1.73 m², and 7.3% an eGFR of <30 mL/min/1.73 m². Compared to patients with an eGFR ≥ 60 mL/min/1.73 m², those with an eGFR 30–<60 mL/min/1.73 m² and eGFR < 30 mL/min/1.73 m² had a higher prevalence of CAD (66.8% vs. 72.9% and 80.1%, respectively; p = 0.001) and three-vessel CAD (25.6% vs. 34.5% and 39.5%, respectively; p = 0.001). At 36 months of follow-up, patients with an eGFR 30–<60 mL/min/1.73 m² and eGFR < 30 mL/min/1.73 m² suffered from significantly higher risk of HF-associated rehospitalization (HR = 1.937, 95% CI: 1.739–2.157, p = 0.001 and HR = 3.223, 95% CI: 2.743–3.787, p = 0.001, respectively) and AMI compared to patients with an eGFR ≥ 60 mL/min/1.73 m² (reference group). The significantly higher risk of HF-related rehospitalization remained after multivariable adjustment. Conclusions: Both groups with impaired kidney function demonstrated a markedly higher risk of rehospitalization for HF at 36 months—even after multivariate adjustments. Increased risk of HF-related rehospitalization in patients with an eGFR < 30 mL/min/1.73 m² was especially evident if they also presented with decompensated HF and LVEF < 35%. In patients with an eGFR 30–<60 mL/min/1.73 m², presenting with angina pectoris and multivessel disease increased the risk of HF-related rehospitalization. Full article