In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, ...In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease.展开更多
Despite all the therapeutic advances in the field of cardiology, cardiovascular diseases, and in particular coronary artery disease, remain the leading cause of death and disability worldwide, thereby underlining the ...Despite all the therapeutic advances in the field of cardiology, cardiovascular diseases, and in particular coronary artery disease, remain the leading cause of death and disability worldwide, thereby underlining the importance of acquiring new therapeutic options in this field. A reduction in elevated resting heart rate (HR) has long been postulated as a therapeutic approach in the management of cardiovascular disease. An increased HR has been shown to be associated with increased progression of coronary atherosclerosis in animal models and patients. A high HR has also been associated with a greatly increased risk of plaque rupture in patients with coronary atherosclerosis. Endothelial function may be an important link between HR and atherosclerosis. An increased HR has been shown experimentally to cause endothelial dysfunction. Inflammation plays a significant role in the pathogenesis and progression of atherosclerosis. In the literature, there is data that shows an association between HR and circulating markers of vascular inflammation. In addition, HR reduction by pharmacological intervention with ivabradine (a selective HR-lowering agent that acts by inhibiting the pacemaker ionic current If in sinoatrial node cells) reduces the formation of atherosclerotic plaques in animal models of lipid-induced atherosclerosis. The aim of this editorial is to review the possible role of ivabradine on atherosclerosis.展开更多
Our knowledge and understanding of the pathophysiology of coronary atherosclerosis has increased enormously over the last 20 years.Reperfusion through thrombolysis or percutaneous coronary angioplasty is the standard ...Our knowledge and understanding of the pathophysiology of coronary atherosclerosis has increased enormously over the last 20 years.Reperfusion through thrombolysis or percutaneous coronary angioplasty is the standard treatment for preventing acute myocardial infarction.Early reperfusion is an absolute prerequisite for survival of the ischemic myocardium,but reperfusion itself may lead to accelerated and additional myocardial injury beyond that generated by ischemia alone.These outcomes,in a range of reperfusion-associated pathologies,are collectively termed "reperfusion injuries".Reactive oxygen species are known to be produced in large quantities in the first few minutes of the post-ischemia reperfusion process.Similarly,scientific evidence from the last 15 years has suggested that melatonin has beneficial effects on the cardiovascular system.The presence of vascular melatoninergic receptor binding sites has been demonstrated;these receptors are functionally linked to vasoconstrictor or vasodilatory effects of melatonin.It has been shown that patients with coronary heart disease have a low melatonin production rate,especially those with higher risk of cardiac infarction and/or sudden death.Melatonin attenuates molecular and cellular damage resulting from cardiac ischemia-reperfusion in which destructive free radicals are involved.展开更多
At present,the study into inflammatory markers has become a new tool which is most useful for establishing the prognosis of patients with acute coronary syndrome.The inflammatory substrate involved is acute coronary s...At present,the study into inflammatory markers has become a new tool which is most useful for establishing the prognosis of patients with acute coronary syndrome.The inflammatory substrate involved is acute coronary syndrome is extremely complex,with a large number of factors involved both in its activation and its modulation.It is known that C-reactive protein play a key role in the physiopathology of the atherosclerosis.Furthermore,scientific literature reports that the existence of a circadian rhythm in the triggering of cardiovascular accidents can suggest the implication of,or association with these physiological rhythms that show activity peaks at particular times of the day or night.Keeping in mind the potential association between inflammation and circadian rhythm,a better understanding of the kinetics of said markers could lead to improvements in their use in cardiovascular diseases.Considering the diversity of the diurnal variations in the intrinsic properties of the cardiovascular system,these should be kept in mind during the design of in vivo experimental studies.As such,the information available reinforces our opinion when suitably validating the biomarkers and the need to demon-strate their reliability,stability,and lack of variability and standardise the methodology of their measurement.展开更多
AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospitaladmission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejec...AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospitaladmission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m 3 vs 4.50 ± 2.34 μg/m 3 , P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that shortterm nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.展开更多
Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America...Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe.The European experience in heart failure,although similar to that in North America,has recently demonstrated differences in hospitalization which may underlie the differences between health care system confi gurations.Despite the predicted increase in the number of patients affected by heart failure,over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies,device-based therapies,and mechanical therapies,including left ventricular assist devices and cardiac transplantation.Although the treatment of such patients has been clearly delineated in national and international guidelines,the underuse of all available and appropriate therapies remains a signifi cant problem.The purpose of this review is to provide a European perspective on management of heart failure.展开更多
基金Supported by Framework of one research project of the Spanish Society of Cardiology for Clinical Research in Cardiology 2012
文摘In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease.
文摘Despite all the therapeutic advances in the field of cardiology, cardiovascular diseases, and in particular coronary artery disease, remain the leading cause of death and disability worldwide, thereby underlining the importance of acquiring new therapeutic options in this field. A reduction in elevated resting heart rate (HR) has long been postulated as a therapeutic approach in the management of cardiovascular disease. An increased HR has been shown to be associated with increased progression of coronary atherosclerosis in animal models and patients. A high HR has also been associated with a greatly increased risk of plaque rupture in patients with coronary atherosclerosis. Endothelial function may be an important link between HR and atherosclerosis. An increased HR has been shown experimentally to cause endothelial dysfunction. Inflammation plays a significant role in the pathogenesis and progression of atherosclerosis. In the literature, there is data that shows an association between HR and circulating markers of vascular inflammation. In addition, HR reduction by pharmacological intervention with ivabradine (a selective HR-lowering agent that acts by inhibiting the pacemaker ionic current If in sinoatrial node cells) reduces the formation of atherosclerotic plaques in animal models of lipid-induced atherosclerosis. The aim of this editorial is to review the possible role of ivabradine on atherosclerosis.
文摘Our knowledge and understanding of the pathophysiology of coronary atherosclerosis has increased enormously over the last 20 years.Reperfusion through thrombolysis or percutaneous coronary angioplasty is the standard treatment for preventing acute myocardial infarction.Early reperfusion is an absolute prerequisite for survival of the ischemic myocardium,but reperfusion itself may lead to accelerated and additional myocardial injury beyond that generated by ischemia alone.These outcomes,in a range of reperfusion-associated pathologies,are collectively termed "reperfusion injuries".Reactive oxygen species are known to be produced in large quantities in the first few minutes of the post-ischemia reperfusion process.Similarly,scientific evidence from the last 15 years has suggested that melatonin has beneficial effects on the cardiovascular system.The presence of vascular melatoninergic receptor binding sites has been demonstrated;these receptors are functionally linked to vasoconstrictor or vasodilatory effects of melatonin.It has been shown that patients with coronary heart disease have a low melatonin production rate,especially those with higher risk of cardiac infarction and/or sudden death.Melatonin attenuates molecular and cellular damage resulting from cardiac ischemia-reperfusion in which destructive free radicals are involved.
文摘At present,the study into inflammatory markers has become a new tool which is most useful for establishing the prognosis of patients with acute coronary syndrome.The inflammatory substrate involved is acute coronary syndrome is extremely complex,with a large number of factors involved both in its activation and its modulation.It is known that C-reactive protein play a key role in the physiopathology of the atherosclerosis.Furthermore,scientific literature reports that the existence of a circadian rhythm in the triggering of cardiovascular accidents can suggest the implication of,or association with these physiological rhythms that show activity peaks at particular times of the day or night.Keeping in mind the potential association between inflammation and circadian rhythm,a better understanding of the kinetics of said markers could lead to improvements in their use in cardiovascular diseases.Considering the diversity of the diurnal variations in the intrinsic properties of the cardiovascular system,these should be kept in mind during the design of in vivo experimental studies.As such,the information available reinforces our opinion when suitably validating the biomarkers and the need to demon-strate their reliability,stability,and lack of variability and standardise the methodology of their measurement.
基金Supported by The framework of one research projects funded by the Spanish Society of Cardiology (Daiichi-Sankyo project 2011)
文摘AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospitaladmission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m 3 vs 4.50 ± 2.34 μg/m 3 , P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that shortterm nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.
文摘Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe.The European experience in heart failure,although similar to that in North America,has recently demonstrated differences in hospitalization which may underlie the differences between health care system confi gurations.Despite the predicted increase in the number of patients affected by heart failure,over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies,device-based therapies,and mechanical therapies,including left ventricular assist devices and cardiac transplantation.Although the treatment of such patients has been clearly delineated in national and international guidelines,the underuse of all available and appropriate therapies remains a signifi cant problem.The purpose of this review is to provide a European perspective on management of heart failure.
