Cancer remains a major cause of mortality worldwide,and urological cancers are the most common cancers among men.Several therapeutic agents have been used to treat urological cancer,leading to improved survival for pa...Cancer remains a major cause of mortality worldwide,and urological cancers are the most common cancers among men.Several therapeutic agents have been used to treat urological cancer,leading to improved survival for patients.However,this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications.Here,we propose the novel discipline of uro-cardio-oncology,an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer.In this comprehensive review,we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers,including androgen deprivation therapy,vascular endothelial growth factor receptor tyrosine kinase inhibitors,immune checkpoint inhibitors,and chemotherapeutics.In addition,we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance,diagnosis,and effective management of cardiovascular complications.Finally,we provide an analysis of future perspectives in this emerging specialty,identifying areas in need of further research.展开更多
BACKGROUND Chronic renal failure(CRF) patients are predisposed to arrhythmias, while the detailed mechanisms are unclear. We hypothesized the chronic inflammatory state of CRF patients may lead to cardiac sympathetic ...BACKGROUND Chronic renal failure(CRF) patients are predisposed to arrhythmias, while the detailed mechanisms are unclear. We hypothesized the chronic inflammatory state of CRF patients may lead to cardiac sympathetic remodeling, increasing the incidence of ventricular arrhythmia(VA) and sudden cardiac death. And explored the role of atorvastatin and etanercept in this process.METHODS A total of 48 rats were randomly divided into sham operation group(Sham group), CRF group, CRF + atorvastatin group(CRF + statin group), and CRF + etanercept group(CRF + rhTNFR-Fcgroup). Sympathetic nerve remodeling was assessed by immunofluorescence of growth-associated protein 43(GAP-43) and tyrosine hydroxylase positive area fraction. Electrophysiological testing was performed to assess the incidence of VA by assessing the ventricular effective refractory period and ventricular fibrillation threshold. The levels of tumor necrosis factor-alpha(TNF-α) and interleukin-1beta were determined by Western blotting and enzyme-linked immunosorbent assay.RESULTS Echocardiogram showed that compared with the Sham group, left ventricular end-systolic diameter and ventricular weight/body weight ratio were significantly higher in the CRF group. Hematoxylin-eosin and Masson staining indicated that myocardial fibers were broken, disordered, and fibrotic in the CRF group. Western blotting, enzyme-linked immunosorbent assay,immunofluorescence and electrophysiological examination suggested that compared with the Sham group, GAP-43 and TNF-α proteins were significantly upregulated, GAP-43 and tyrosine hydroxylase positive nerve fiber area was increased, and ventricular fibrillation threshold was significantly decreased in the CRF group. The above effects were inhibited in the CRF + statin group and the CRF + rhTNFR-Fcgroup.CONCLUSIONS In CRF rats, TNF-α was upregulated, cardiac sympathetic remodeling was more severe, and the nephrogenic cardiac sympathetic remodeling existed. Atorvastatin and etanercept could downregulate the expression of TNF-α or inhibit its activity, thus inhibited the above effects, and reduced the occurrence of VA and sudden cardiac death.展开更多
Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,wi...Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.展开更多
Diabetes mellitus is a prevalent disorder with multi-system manifestations,causing a significant burden in terms of disability and deaths globally.Angio-tensin receptor-neprilysin inhibitor(ARNI)belongs to a class of ...Diabetes mellitus is a prevalent disorder with multi-system manifestations,causing a significant burden in terms of disability and deaths globally.Angio-tensin receptor-neprilysin inhibitor(ARNI)belongs to a class of medications for treating heart failure,with the benefits of reducing hospitalization rates and mortality.This review mainly focuses on the clinical and basic investigations related to ARNI and diabetic complications,discussing possible physiological and molecular mechanisms,with insights for future applications.展开更多
Since the fi rst cases of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coro-navirus 2(SARS-CoV-2)were reported at the end of 2019,this infection has spread around the globe,becoming a ...Since the fi rst cases of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coro-navirus 2(SARS-CoV-2)were reported at the end of 2019,this infection has spread around the globe,becoming a pandemic.The use of face masks and respirators is an important public health measure to reduce or prevent transmission of SARS-CoV-2.Here we discuss the hypothetical mechanisms by which exercise with face masks or respirators can induce detrimental effects on the cardiovascular system,potentially explaining adverse events such as cardiac arrhythmias and spontaneous pneumothorax.Although sudden death associated with the wearing of a face mask during running is a rare event,the risk is higher especially in those with existing cardiac comorbidities.In such cases,a mask designed specifi cally for runners with no or few side effects of oxygen defi ciency should be considered instead.展开更多
Disorders in glucose metabolism can be divided into three separate but interrelated domains,namely hyperglycemia,hypoglycemia,and glycemic variability.Intensive glycemic control in patients with diabetes might increas...Disorders in glucose metabolism can be divided into three separate but interrelated domains,namely hyperglycemia,hypoglycemia,and glycemic variability.Intensive glycemic control in patients with diabetes might increase the risk of hypoglycemic incidents and glucose fluctuations.These three dysglycemic states occur not only amongst patients with diabetes,but are frequently present in other clinical settings,such as during critically ill.A growing body of evidence has focused on the relationships between these dysglycemic domains with cardiac arrhythmias,including supraventricular arrhythmias(primarily atrial fibrillation),ventricular arrhythmias(malignant ventricular arrhythmias and QT interval prolongation),and bradyarrhythmias(bradycardia and heart block).Different mechanisms by which these dysglycemic states might provoke cardiac arrhythmias have been identified in experimental studies.A customized glycemic control strategy to minimize the risk of hyperglycemia,hypoglycemia and glucose variability is of the utmost importance in order to mitigate the risk of cardiac arrhythmias.展开更多
Pneumopericardium refers to the presence of air inside the pericardial cavity,which is a rare entity that has been reported clinically.Toledo,et al.[1]classified the causes of pneumopericardium into four categories:ia...Pneumopericardium refers to the presence of air inside the pericardial cavity,which is a rare entity that has been reported clinically.Toledo,et al.[1]classified the causes of pneumopericardium into four categories:iatrogenic,pericarditis,fistula formation between the pericardium and adjacent hollow organs,and trauma.展开更多
Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been repo...Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.展开更多
Microvesicles(MVs,also known as microparticles)are small vesicles that originate from plasma membrane of almost all eukaryotic cells during apoptosis or activation.MVs can serve as extracellular vehicles to transport ...Microvesicles(MVs,also known as microparticles)are small vesicles that originate from plasma membrane of almost all eukaryotic cells during apoptosis or activation.MVs can serve as extracellular vehicles to transport bioactive molecules from their parental cells to recipient target cells,thereby serving as novel mediators for intercellular communication.Importantly,more and more evidence indicates that MVs could play important roles in early pathogenesis and subsequent progression of cardiovascular and metabolic diseases.Elevated plasma concentrations of MVs,originating from red blood cells,leukocytes,platelets,or other organs and tissues,have been reported in various cardiometabolic diseases.Circulating MVs could serve as potential biomarkers for disease diagnosis or therapeutic monitoring.In this review,we summarized recentlypublished studies in the?eld and discussed the role of MVs in the pathogenesis of cardiometabolic diseases.The emerging values of MVs that serve as biomarker for non-invasive diagnosis and prognosis,as well as their roles as novel therapeutic targets in cardiometabolic diseases,were also described.展开更多
Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes...Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes,leading to an inflammatory response mediated by the immune system that can potentially cause further aggravation of myocardial damage and organ dysfunction.Prognosis in patients with myocarditis depends on the clinical presentation,which ranges from an asymptomatic disease course to the concomitant development of cardiac arrhythmias,heart failure,cardiogenic shock and even the occurrence of death in extreme cases[1].展开更多
BACKGROUND Sodium-glucose co-transporter-2 inhibitors(SGLT2i)significantly reduce the risk of cardiovascular(CV)and renal adverse events in patients with diabetes mellitus,heart failure(HF)and/or chronic kidney diseas...BACKGROUND Sodium-glucose co-transporter-2 inhibitors(SGLT2i)significantly reduce the risk of cardiovascular(CV)and renal adverse events in patients with diabetes mellitus,heart failure(HF)and/or chronic kidney disease.We performed a meta-analysis to explore the impact of several different SGLT2i on all-cause mortality,CV mortality,HF hospitalizations and the combined outcome CV death/HF hospitalization in HF patients across the spectrum of left ventricular ejection fraction(LVEF)phenotypes.METHODS A systematic search in MEDLINE database and Cochrane library through March 2021 was performed without limitations.Randomized clinical trials that provided data about the impact of SGLT2i on all-cause mortality,CV mortality,HF hospitalizations or the combined outcome of CV death/HF hospitalization in HF patients were included.A random effects model was used for calculating the effect estimates.RESULTS Nine studies(n=16,723 patients,mean age:65.9 years,males:70.7%)were included in the quantitative synthesis.Compared to placebo,SGLT2i use was associated with 14%lower risk of all-cause mortality[hazard ratio(HR)=0.86,95%CI:0.78−0.94,I^(2)=0,P=0.0008],32%lower risk of HF hospitalizations(HR=0.68,95%CI:0.62−0.74,I^(2)=0,P<0.001),14%lower risk of CV mortality(HR=0.86,95%CI:0.77−0.95,I^(2)=0,P=0.003)and 26%lower risk of CV death/HF hospitalization(HR=0.74,95%CI:0.68−0.80,I^(2)=0,P<0.001).Regarding the safety outcomes,our data revealed no significant differences between SGLT2i and placebo groups in drug related discontinuations,amputations,severe hypoglycemia,hypotension,volume depletion,ketoacidosis and genital infections.By contrast,a protective role of SGLT2i against placebo was found for serious adverse events and acute kidney injury.CONCLUSIONS In patients with HF,regardless of LVEF phenotype,all SGLT2i had an excellent safety profile and significantly reduced the risk of all-cause mortality,CV mortality,HF hospitalizations and CV deaths/HF hospitalizations compared to placebo.展开更多
Background Studies evaluating safety of warfarin and direct oral anticoagulants(DOACs) for prevention of stroke in patients with atrial fibrillation(AF) are lacking. Methods & Results All patients(n = 196,521) rec...Background Studies evaluating safety of warfarin and direct oral anticoagulants(DOACs) for prevention of stroke in patients with atrial fibrillation(AF) are lacking. Methods & Results All patients(n = 196,521) receiving care at veteran’s affairs with active cancer and AF from 2010–2015 were included. One-year mortality was significantly higher in unadjusted analysis with warfarin(44.9%) compared to dabigatran(25%, P < 0.001), rivaroxaban(24.4%, P < 0.001) and apixaban(30%, P < 0.001) and after adjusting for age, sex and type of cancer mortality(OR = 2.66, 95% CI: 2.52–2.82, P < 0.001). Risk of ischemic stroke(13.5% vs. 11.1%, 12.0%, 14.0%) was similar, however risk of hemorrhagic stroke was significantly higher among patients receiving warfarin(1.2%) compared to patients receiving dabigatran(0.5%), rivaroxaban(0.7%) and apixaban(0.8%) respectively, P = 0.04. Conclusions We demonstrated the superior safety profile of DOACs compared to warfarin among patients with underlying cancer and AF. Warfarin was associated with higher mortality, similar ischemic stroke risk but higher risk of hemorrhagic stroke.展开更多
BACKGROUND The electrocardiogram(ECG)is an inexpensive and easily accessible investigation for the diagnosis of cardiovascular diseases including heart failure(HF).The application of artificial intelligence(AI)has con...BACKGROUND The electrocardiogram(ECG)is an inexpensive and easily accessible investigation for the diagnosis of cardiovascular diseases including heart failure(HF).The application of artificial intelligence(AI)has contributed to clinical practice in terms of aiding diagnosis,prognosis,risk stratification and guiding clinical management.The aim of this study is to systematically review and perform a meta-analysis of published studies on the application of AI for HF detection based on the ECG.METHODS We searched Embase,PubMed and Web of Science databases to identify literature using AI for HF detection based on ECG data.The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2)criteria.Random-effects models were used for calculating the effect estimates and hierarchical receiver operating characteristic curves were plotted.Subgroup analysis was performed.Heterogeneity and the risk of bias were also assessed.RESULTS A total of 11 studies including 104,737 subjects were included.The area under the curve for HF diagnosis was 0.986,with a corresponding pooled sensitivity of 0.95(95%CI:0.86–0.98),specificity of 0.98(95%CI:0.95–0.99)and diagnostic odds ratio of 831.51(95%CI:127.85–5407.74).In the patient selection domain of QUADAS-2,eight studies were designated as high risk.CONCLUSIONS According to the available evidence,the incorporation of AI can aid the diagnosis of HF.However,there is heterogeneity among machine learning algorithms and improvements are required in terms of quality and study design.展开更多
Background Doxorubicin is a widely used cytotoxic chemotherapy agent for treating different malignancies.However,its use is associated with dose-dependent cardiotoxicity,causing irreversible myocardial damage and sign...Background Doxorubicin is a widely used cytotoxic chemotherapy agent for treating different malignancies.However,its use is associated with dose-dependent cardiotoxicity,causing irreversible myocardial damage and significantly reducing the patient's quality of life and survival.In this study,an animal model of doxorubicin-induced cardiomyopathy was used to investigate the pathogenesis of doxorubicin-induced myocardial injury.This study also investigated a possible treatment strategy for alleviating myocardial injury through resveratrol therapy in vitro.Methods Adult male C57BL/6J mice were randomly divided into a control group and a doxorubicin group.Body weight,echocardiography,surface electrocardiogram,and myocardial histomorphology were measured.The mechanisms of doxorubicin cardiotoxicity in H9c2 cell lines were explored by comparing three groups(phosphate-buffered saline,doxorubicin,and doxorubicin with resveratrol).Results Compared to the control group,the doxorubicin group showed a lower body weight and higher systolic arterial pressure,associated with reduced left ventricular ejection fraction and left ventricular fractional shortening,prolonged PR interval,and QT interval.These abnormalities were associated with vacuolation and increased disorder in the mitochondria of cardiomyocytes,increased protein expression levels of α-smooth muscle actin and caspase 3,and reduced protein expression levels of Mitofusin2(MFN2)and Sirtuin1(SIRT1).Compared to the doxorubicin group,doxorubicin+resveratrol treatment reduced caspase 3 and manganese superoxide dismutase,and increased MFN2 and SIRT1 expression levels.Conclusion Doxorubicin toxicity leads to abnormal mitochondrial morphology and dysfunction in cardiomyocytes and induces apoptosis by interfering with mitochondrial fusion.Resveratrol ameliorates doxorubicin-induced cardiotoxicity by activating SIRT1/MFN2 to improve mitochondria function.展开更多
A 55-year-old male with hypertension, hyperlipidemia, impaired fasting glucose, obesity, gout, and osteoarthritis, statin-induced myopathy, but no known cardiac disease, presented with a one day history of intermitten...A 55-year-old male with hypertension, hyperlipidemia, impaired fasting glucose, obesity, gout, and osteoarthritis, statin-induced myopathy, but no known cardiac disease, presented with a one day history of intermittent exertional chest discomfort without radiation. Symptoms included sweating, dyspnea, dizziness, and upper limb numbness.展开更多
Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after chemo-...Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after chemo-therapy.Case Presentation:We describe a patient with a known history of urothelial carcinoma who presented with dia-betic ketoacidosis 6 weeks following his second cycle of atezolizumab.His serum lactate level was slightly elevated(2 mM)and hisβ-hydroxybutyrate level was elevated(3.9 mM).High anion gap metabolic acidosis secondary to dia-betic ketoacidosis was diagnosed.Subsequent testing demonstrated hemoglobin A 1c level of 9.9%,positivity for anti-glutamic acid decarboxylase antibody(0.03 nM,reference range<0.02 nM),and suppressed C-peptide level(0.1μg/L,reference range 0.9-7.1μg/L)in the absence of detectable anti-islet antigen 2(IA-2)or anti-insulin antibodies.His initial management included cessation of atezolizumab treatment,intravenous sodium chloride administration,and insulin pump infusion,after which metabolic acidosis gradually resolved.The insulin pump was subsequently switched to Protaphane at 18 units before breakfast and 8 units before dinner,together with metformin at 1000 mg twice daily.Four weeks later his medication was changed to human isophane insulin plus neutral insulin(70%/30%;Mixtard 30 HM;26 units/4 units).Linagliptin at 5 mg was added 1 month later.His hemoglobin A 1c level declined to 8.1%1 year later.Conclusions:PD-L1 inhibitors can induce type 1 diabetes,and patients can present with diabetic ketoacidosis.Blood glucose levels should be regularly monitored in patients who are prescribed these medications.展开更多
基金Tianjin Key Medical Discipline(Specialty)Construction Project,Grant/Award Number:TJYXZDXK-029ANational Natural Science Foundation of China,Grant/Award Numbers:82170327,82370332Research Impact Fund of the Hong Kong Metropolitan University,Grant/Award Number:RIF/2022/2.2。
文摘Cancer remains a major cause of mortality worldwide,and urological cancers are the most common cancers among men.Several therapeutic agents have been used to treat urological cancer,leading to improved survival for patients.However,this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications.Here,we propose the novel discipline of uro-cardio-oncology,an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer.In this comprehensive review,we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers,including androgen deprivation therapy,vascular endothelial growth factor receptor tyrosine kinase inhibitors,immune checkpoint inhibitors,and chemotherapeutics.In addition,we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance,diagnosis,and effective management of cardiovascular complications.Finally,we provide an analysis of future perspectives in this emerging specialty,identifying areas in need of further research.
基金supported by the Key Project of Tianjin Natural Science Foundation (No.21JCZDJC01080)the Tianjin Key Medical Discipline (Specialty) (TJYXZDX K-029A)+1 种基金the Academic Backbone of “Clinical Talent Training and Climbing Plan” of Tianjin Medical University and the Tianjin Health Research ProjectScience and Technology Development Fund of Nanjing Medical University (NMUB20210180)。
文摘BACKGROUND Chronic renal failure(CRF) patients are predisposed to arrhythmias, while the detailed mechanisms are unclear. We hypothesized the chronic inflammatory state of CRF patients may lead to cardiac sympathetic remodeling, increasing the incidence of ventricular arrhythmia(VA) and sudden cardiac death. And explored the role of atorvastatin and etanercept in this process.METHODS A total of 48 rats were randomly divided into sham operation group(Sham group), CRF group, CRF + atorvastatin group(CRF + statin group), and CRF + etanercept group(CRF + rhTNFR-Fcgroup). Sympathetic nerve remodeling was assessed by immunofluorescence of growth-associated protein 43(GAP-43) and tyrosine hydroxylase positive area fraction. Electrophysiological testing was performed to assess the incidence of VA by assessing the ventricular effective refractory period and ventricular fibrillation threshold. The levels of tumor necrosis factor-alpha(TNF-α) and interleukin-1beta were determined by Western blotting and enzyme-linked immunosorbent assay.RESULTS Echocardiogram showed that compared with the Sham group, left ventricular end-systolic diameter and ventricular weight/body weight ratio were significantly higher in the CRF group. Hematoxylin-eosin and Masson staining indicated that myocardial fibers were broken, disordered, and fibrotic in the CRF group. Western blotting, enzyme-linked immunosorbent assay,immunofluorescence and electrophysiological examination suggested that compared with the Sham group, GAP-43 and TNF-α proteins were significantly upregulated, GAP-43 and tyrosine hydroxylase positive nerve fiber area was increased, and ventricular fibrillation threshold was significantly decreased in the CRF group. The above effects were inhibited in the CRF + statin group and the CRF + rhTNFR-Fcgroup.CONCLUSIONS In CRF rats, TNF-α was upregulated, cardiac sympathetic remodeling was more severe, and the nephrogenic cardiac sympathetic remodeling existed. Atorvastatin and etanercept could downregulate the expression of TNF-α or inhibit its activity, thus inhibited the above effects, and reduced the occurrence of VA and sudden cardiac death.
文摘Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-029Athe National Natural Science Foundation of China,No.82370342.
文摘Diabetes mellitus is a prevalent disorder with multi-system manifestations,causing a significant burden in terms of disability and deaths globally.Angio-tensin receptor-neprilysin inhibitor(ARNI)belongs to a class of medications for treating heart failure,with the benefits of reducing hospitalization rates and mortality.This review mainly focuses on the clinical and basic investigations related to ARNI and diabetic complications,discussing possible physiological and molecular mechanisms,with insights for future applications.
文摘Since the fi rst cases of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coro-navirus 2(SARS-CoV-2)were reported at the end of 2019,this infection has spread around the globe,becoming a pandemic.The use of face masks and respirators is an important public health measure to reduce or prevent transmission of SARS-CoV-2.Here we discuss the hypothetical mechanisms by which exercise with face masks or respirators can induce detrimental effects on the cardiovascular system,potentially explaining adverse events such as cardiac arrhythmias and spontaneous pneumothorax.Although sudden death associated with the wearing of a face mask during running is a rare event,the risk is higher especially in those with existing cardiac comorbidities.In such cases,a mask designed specifi cally for runners with no or few side effects of oxygen defi ciency should be considered instead.
基金the National Natural Science Foundation of China,No.81970270,No.81570298,and No.81270245Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-029A.
文摘Disorders in glucose metabolism can be divided into three separate but interrelated domains,namely hyperglycemia,hypoglycemia,and glycemic variability.Intensive glycemic control in patients with diabetes might increase the risk of hypoglycemic incidents and glucose fluctuations.These three dysglycemic states occur not only amongst patients with diabetes,but are frequently present in other clinical settings,such as during critically ill.A growing body of evidence has focused on the relationships between these dysglycemic domains with cardiac arrhythmias,including supraventricular arrhythmias(primarily atrial fibrillation),ventricular arrhythmias(malignant ventricular arrhythmias and QT interval prolongation),and bradyarrhythmias(bradycardia and heart block).Different mechanisms by which these dysglycemic states might provoke cardiac arrhythmias have been identified in experimental studies.A customized glycemic control strategy to minimize the risk of hyperglycemia,hypoglycemia and glucose variability is of the utmost importance in order to mitigate the risk of cardiac arrhythmias.
基金This study was supported by the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A)。
文摘Pneumopericardium refers to the presence of air inside the pericardial cavity,which is a rare entity that has been reported clinically.Toledo,et al.[1]classified the causes of pneumopericardium into four categories:iatrogenic,pericarditis,fistula formation between the pericardium and adjacent hollow organs,and trauma.
文摘Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.
基金supported by the National Natural Science Foundation of China (Grant No. 81370422)
文摘Microvesicles(MVs,also known as microparticles)are small vesicles that originate from plasma membrane of almost all eukaryotic cells during apoptosis or activation.MVs can serve as extracellular vehicles to transport bioactive molecules from their parental cells to recipient target cells,thereby serving as novel mediators for intercellular communication.Importantly,more and more evidence indicates that MVs could play important roles in early pathogenesis and subsequent progression of cardiovascular and metabolic diseases.Elevated plasma concentrations of MVs,originating from red blood cells,leukocytes,platelets,or other organs and tissues,have been reported in various cardiometabolic diseases.Circulating MVs could serve as potential biomarkers for disease diagnosis or therapeutic monitoring.In this review,we summarized recentlypublished studies in the?eld and discussed the role of MVs in the pathogenesis of cardiometabolic diseases.The emerging values of MVs that serve as biomarker for non-invasive diagnosis and prognosis,as well as their roles as novel therapeutic targets in cardiometabolic diseases,were also described.
文摘Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes,leading to an inflammatory response mediated by the immune system that can potentially cause further aggravation of myocardial damage and organ dysfunction.Prognosis in patients with myocarditis depends on the clinical presentation,which ranges from an asymptomatic disease course to the concomitant development of cardiac arrhythmias,heart failure,cardiogenic shock and even the occurrence of death in extreme cases[1].
文摘BACKGROUND Sodium-glucose co-transporter-2 inhibitors(SGLT2i)significantly reduce the risk of cardiovascular(CV)and renal adverse events in patients with diabetes mellitus,heart failure(HF)and/or chronic kidney disease.We performed a meta-analysis to explore the impact of several different SGLT2i on all-cause mortality,CV mortality,HF hospitalizations and the combined outcome CV death/HF hospitalization in HF patients across the spectrum of left ventricular ejection fraction(LVEF)phenotypes.METHODS A systematic search in MEDLINE database and Cochrane library through March 2021 was performed without limitations.Randomized clinical trials that provided data about the impact of SGLT2i on all-cause mortality,CV mortality,HF hospitalizations or the combined outcome of CV death/HF hospitalization in HF patients were included.A random effects model was used for calculating the effect estimates.RESULTS Nine studies(n=16,723 patients,mean age:65.9 years,males:70.7%)were included in the quantitative synthesis.Compared to placebo,SGLT2i use was associated with 14%lower risk of all-cause mortality[hazard ratio(HR)=0.86,95%CI:0.78−0.94,I^(2)=0,P=0.0008],32%lower risk of HF hospitalizations(HR=0.68,95%CI:0.62−0.74,I^(2)=0,P<0.001),14%lower risk of CV mortality(HR=0.86,95%CI:0.77−0.95,I^(2)=0,P=0.003)and 26%lower risk of CV death/HF hospitalization(HR=0.74,95%CI:0.68−0.80,I^(2)=0,P<0.001).Regarding the safety outcomes,our data revealed no significant differences between SGLT2i and placebo groups in drug related discontinuations,amputations,severe hypoglycemia,hypotension,volume depletion,ketoacidosis and genital infections.By contrast,a protective role of SGLT2i against placebo was found for serious adverse events and acute kidney injury.CONCLUSIONS In patients with HF,regardless of LVEF phenotype,all SGLT2i had an excellent safety profile and significantly reduced the risk of all-cause mortality,CV mortality,HF hospitalizations and CV deaths/HF hospitalizations compared to placebo.
基金funded by the Thomas F. Frawley, MD, Research Fellowship Fund awarded to Dr. Sawant
文摘Background Studies evaluating safety of warfarin and direct oral anticoagulants(DOACs) for prevention of stroke in patients with atrial fibrillation(AF) are lacking. Methods & Results All patients(n = 196,521) receiving care at veteran’s affairs with active cancer and AF from 2010–2015 were included. One-year mortality was significantly higher in unadjusted analysis with warfarin(44.9%) compared to dabigatran(25%, P < 0.001), rivaroxaban(24.4%, P < 0.001) and apixaban(30%, P < 0.001) and after adjusting for age, sex and type of cancer mortality(OR = 2.66, 95% CI: 2.52–2.82, P < 0.001). Risk of ischemic stroke(13.5% vs. 11.1%, 12.0%, 14.0%) was similar, however risk of hemorrhagic stroke was significantly higher among patients receiving warfarin(1.2%) compared to patients receiving dabigatran(0.5%), rivaroxaban(0.7%) and apixaban(0.8%) respectively, P = 0.04. Conclusions We demonstrated the superior safety profile of DOACs compared to warfarin among patients with underlying cancer and AF. Warfarin was associated with higher mortality, similar ischemic stroke risk but higher risk of hemorrhagic stroke.
基金supported by the National Natural Science Foundation of China(No.81970270&No.82170327)the Tianjin Natural Science Foundation(20JC ZDJC00340&20JCZXJC00130)the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A)。
文摘BACKGROUND The electrocardiogram(ECG)is an inexpensive and easily accessible investigation for the diagnosis of cardiovascular diseases including heart failure(HF).The application of artificial intelligence(AI)has contributed to clinical practice in terms of aiding diagnosis,prognosis,risk stratification and guiding clinical management.The aim of this study is to systematically review and perform a meta-analysis of published studies on the application of AI for HF detection based on the ECG.METHODS We searched Embase,PubMed and Web of Science databases to identify literature using AI for HF detection based on ECG data.The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2)criteria.Random-effects models were used for calculating the effect estimates and hierarchical receiver operating characteristic curves were plotted.Subgroup analysis was performed.Heterogeneity and the risk of bias were also assessed.RESULTS A total of 11 studies including 104,737 subjects were included.The area under the curve for HF diagnosis was 0.986,with a corresponding pooled sensitivity of 0.95(95%CI:0.86–0.98),specificity of 0.98(95%CI:0.95–0.99)and diagnostic odds ratio of 831.51(95%CI:127.85–5407.74).In the patient selection domain of QUADAS-2,eight studies were designated as high risk.CONCLUSIONS According to the available evidence,the incorporation of AI can aid the diagnosis of HF.However,there is heterogeneity among machine learning algorithms and improvements are required in terms of quality and study design.
基金Tianjin Key Medical Discipline(Specialty)Construction Project,Grant/Award N umber:TJY XZDXK-029ANational Natural Science Foundation of China,Grant/Award Numbers:81970270,82170327Tianjin Postgr aduate Scientific Research Innovation Projec,G rant/Award Number:2021YJSB278。
文摘Background Doxorubicin is a widely used cytotoxic chemotherapy agent for treating different malignancies.However,its use is associated with dose-dependent cardiotoxicity,causing irreversible myocardial damage and significantly reducing the patient's quality of life and survival.In this study,an animal model of doxorubicin-induced cardiomyopathy was used to investigate the pathogenesis of doxorubicin-induced myocardial injury.This study also investigated a possible treatment strategy for alleviating myocardial injury through resveratrol therapy in vitro.Methods Adult male C57BL/6J mice were randomly divided into a control group and a doxorubicin group.Body weight,echocardiography,surface electrocardiogram,and myocardial histomorphology were measured.The mechanisms of doxorubicin cardiotoxicity in H9c2 cell lines were explored by comparing three groups(phosphate-buffered saline,doxorubicin,and doxorubicin with resveratrol).Results Compared to the control group,the doxorubicin group showed a lower body weight and higher systolic arterial pressure,associated with reduced left ventricular ejection fraction and left ventricular fractional shortening,prolonged PR interval,and QT interval.These abnormalities were associated with vacuolation and increased disorder in the mitochondria of cardiomyocytes,increased protein expression levels of α-smooth muscle actin and caspase 3,and reduced protein expression levels of Mitofusin2(MFN2)and Sirtuin1(SIRT1).Compared to the doxorubicin group,doxorubicin+resveratrol treatment reduced caspase 3 and manganese superoxide dismutase,and increased MFN2 and SIRT1 expression levels.Conclusion Doxorubicin toxicity leads to abnormal mitochondrial morphology and dysfunction in cardiomyocytes and induces apoptosis by interfering with mitochondrial fusion.Resveratrol ameliorates doxorubicin-induced cardiotoxicity by activating SIRT1/MFN2 to improve mitochondria function.
文摘A 55-year-old male with hypertension, hyperlipidemia, impaired fasting glucose, obesity, gout, and osteoarthritis, statin-induced myopathy, but no known cardiac disease, presented with a one day history of intermittent exertional chest discomfort without radiation. Symptoms included sweating, dyspnea, dizziness, and upper limb numbness.
文摘Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after chemo-therapy.Case Presentation:We describe a patient with a known history of urothelial carcinoma who presented with dia-betic ketoacidosis 6 weeks following his second cycle of atezolizumab.His serum lactate level was slightly elevated(2 mM)and hisβ-hydroxybutyrate level was elevated(3.9 mM).High anion gap metabolic acidosis secondary to dia-betic ketoacidosis was diagnosed.Subsequent testing demonstrated hemoglobin A 1c level of 9.9%,positivity for anti-glutamic acid decarboxylase antibody(0.03 nM,reference range<0.02 nM),and suppressed C-peptide level(0.1μg/L,reference range 0.9-7.1μg/L)in the absence of detectable anti-islet antigen 2(IA-2)or anti-insulin antibodies.His initial management included cessation of atezolizumab treatment,intravenous sodium chloride administration,and insulin pump infusion,after which metabolic acidosis gradually resolved.The insulin pump was subsequently switched to Protaphane at 18 units before breakfast and 8 units before dinner,together with metformin at 1000 mg twice daily.Four weeks later his medication was changed to human isophane insulin plus neutral insulin(70%/30%;Mixtard 30 HM;26 units/4 units).Linagliptin at 5 mg was added 1 month later.His hemoglobin A 1c level declined to 8.1%1 year later.Conclusions:PD-L1 inhibitors can induce type 1 diabetes,and patients can present with diabetic ketoacidosis.Blood glucose levels should be regularly monitored in patients who are prescribed these medications.
