1. The role of environmental PM2.5 in admission acute heart failure in ST-elevation myocardial infarction patients : an observational retrospective studyAndreja Sinkovič, Andrej Markota, Manja Kraševec, David Šuran, Martin Marinšek, 2021, izvirni znanstveni članek Opis: Background: Air pollution with increased concentrations of fine (< 2.5 μm) particulate matter (PM2.5) increases the risk of cardiovascular morbidity and mortality. Even short-term increase of PM2.5 may help trigger ST-elevation myocardial infarction (STEMI) and heart failure (HF) in susceptible individuals, even in areas with good air quality.
Purpose: To evaluate the role of PM2.5 levels ≥ 20 μg/m3 in admission acute HF in STEMI patients.
Materials and Methods: In 290 STEMI patients with the leading reperfusion strategy primary percutaneous coronary intervention (PPCI), we retrospectively studied independent predictors of admission acute HF and included admission demographic and clinical data as well as ambient PM2.5 levels ≥ 20 μg/m3. We defined admission acute HF in STEMI patients as classes II–IV by Killip Kimball classification.
Results: Acute admission HF was observed in 34.5% of STEMI patients. PPCI was performed in 87.1% of acute admission HF patients and in 94.7% non-HF patients (p= 0.037). Significant independent predictors of acute admission HF were prior diabetes (OR 2.440, 95% CI 1.100 to 5.400, p=0.028), admission LBBB (OR 10.190, 95% CI 1.160 to 89.360, p=0.036), prior resuscitation (OR 2.530, 95% CI 1.010 to 6.340, p=0.048), admission troponin I≥ 5μg/l (OR 3.390, 95% CI 1.740 to 6.620, p< 0.001), admission eGFR levels (0.61, 95% CI 0.52 to 0.72, p < 0.001), and levels of PM2.5 ≥ 20 μg/m3 (OR 2.140, 95% CI 1.005 to 4.560, p=0.049) one day before admission.
Conclusion: Temporary short-term increase in PM2.5 levels (≥ 20 μg/m3) one day prior to admission in an area with mainly good air quality was among significant independent predictors of acute admission HF in STEMI patients.
Ključne besede: admission acute heart failure, ST-elevation myocardial infarction, air pollution, PM2.5
Objavljeno v DKUM: 14.10.2024; Ogledov: 0; Prenosov: 3
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2. Cardiovascular comorbidities in COVID-19 : comprehensive analysis of key topicsRene Markovič, Luka Ternar, Tim Trstenjak, Marko Marhl, Vladimir Grubelnik, 2024, izvirni znanstveni članek Ključne besede: hypertension, hyperglycemia, embolism, thrombosis, heart failure, vascular disease
Objavljeno v DKUM: 22.08.2024; Ogledov: 53; Prenosov: 10
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3. Nicotinamide for the treatment of heart failure with preserved ejection fractionMahmoud Abdellatif, Viktoria Herbst, Franziska Koser, Sylvère Durand, Rui Adão, Francisco Vasques-Nóvoa, Johanna K Freundt, Julia Voglhuber, Maria Rosaria Pricolo, Michael Kasa, Simon Sedej, 2021, izvirni znanstveni članek Opis: Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent and intractable form of cardiac decompensation commonly associated with diastolic dysfunction. Here, we show that diastolic dysfunction in patients with HFpEF is associated with a cardiac deficit in nicotinamide adenine dinucleotide (NAD+). Elevating NAD+ by oral supplementation of its precursor, nicotinamide, improved diastolic dysfunction induced by aging (in 2-year-old C57BL/6J mice), hypertension (in Dahl salt-sensitive rats), or cardiometabolic syndrome (in ZSF1 obese rats). This effect was mediated partly through alleviated systemic comorbidities and enhanced myocardial bioenergetics. Simultaneously, nicotinamide directly improved cardiomyocyte passive stiffness and calcium-dependent active relaxation through increased deacetylation of titin and the sarcoplasmic reticulum calcium adenosine triphosphatase 2a, respectively. In a long-term human cohort study, high dietary intake of naturally occurring NAD+ precursors was associated with lower blood pressure and reduced risk of cardiac mortality. Collectively, these results suggest NAD+ precursors, and especially nicotinamide, as potential therapeutic agents to treat diastolic dysfunction and HFpEF in humans.
Ključne besede: heart failure, hypertension, niacinamide, metabolic syndrome
Objavljeno v DKUM: 06.08.2024; Ogledov: 89; Prenosov: 5
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4. 'Time is prognosis' in heart failure : time-to-treatment initiation as a modifiable risk factorAmr Abdin, Stefan D. Anker, Javed Butler, Ingrid Kindermann, Mitja Lainščak, Lars H. Lund, Marco Metra, Wilfried Mullens, Giuseppe M. Rosano, Jonathan Slawik, 2021, pregledni znanstveni članek Opis: In heart failure (HF), acute decompensation can occur quickly and unexpectedly because of worsening of chronic HF or to new-onset HF diagnosed for the first time ('de novo'). Patients presenting with acute HF (AHF) have a poor prognosis comparable with those with acute myocardial infarction, and any delay of treatment initiation is associated with worse outcomes. Recent HF guidelines and recommendations have highlighted the importance of a timely diagnosis and immediate treatment for patients presenting with AHF to decrease disease progression and improve prognosis. However, based on the available data, there is still uncertainty regarding the optimal 'time-to-treatment' effect in AHF. Furthermore, the immediate post-worsening HF period plays an important role in clinical outcomes in HF patients after hospitalization and is known as the 'vulnerable phase' characterized by high risk of readmission and early death. Early and intensive treatment for HF patients in the 'vulnerable phase' might be associated with lower rates of early readmission and mortality. Additionally, in the chronic stable HF outpatient, treatments are often delayed or not initiated when symptoms are stable, ignoring the risk for adverse outcomes such as sudden death. Consequently, there is a dire need to better identify HF patients during hospitalization and after discharge and treating them adequately to improve their prognosis. HF is an urgent clinical scenario along all its stages and disease conditions. Therefore, time plays a significant role throughout the entire patient's journey. Therapy should be optimized as soon as possible, because this is beneficial regardless of severity or duration of HF. Time lavished before treatment initiation is recognized as important modifiable risk factor in HF.
Ključne besede: heart failure, prognosis, treatment
Objavljeno v DKUM: 05.08.2024; Ogledov: 99; Prenosov: 9
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5. STEMI patients in the first and second waves of the COVID-19 pandemic in northeast Slovenia - a retrospective, single-center observational studyAndreja Sinkovič, Manja Kraševec, David Šuran, Martin Marinšek, 2022, izvirni znanstveni članek Opis: The COVID-19 pandemic has affected the outcomes of ST-elevation myocardial infarction (STEMI) patients in most countries. We aimed to retrospectively assess the admissions, treatments, complications, and mortality of STEMI patients in the northeast of Slovenia during the first (March–May 2020) and second waves (October–December 2020) of the COVID-19 pandemic and to compare them with data from 2019 (March–October). Comparing 2019 and both waves of the COVID-19 pandemic, we observed nonsignificant differences in the number of STEMI admissions, baseline characteristics, use of primary percutaneous coronary intervention (PCI) within the first 3 (40.5%* vs. 38.7% vs. 25%*, *p = 0.074) or 6 h, TIMI III flow after primary PCI, and hospital complications, as well as significant increases in hospital heart failure (23.3% vs. 42%, p = 0.015) and mitral regurgitation in the second wave (10% vs. 26.9%, p = 0.008) of the pandemic and a nonsignificant increase in hospital mortality (8.9% vs. 9.4% vs. 13.6%) during both waves of the pandemic. We conclude that, due to the increased severity of the COVID-19 pandemic in the second wave, there were longer delays to primary PCI in STEMI patients, resulting in significantly increased hospital heart failure and non-significantly increased hospital mortality.
Ključne besede: ST-elevation myocardial infarction, COVID-19, time delay, primary percutaneous coronary intervention, heart failure, mortality, pandemic
Objavljeno v DKUM: 04.07.2024; Ogledov: 134; Prenosov: 22
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6. Effects of atrial fibrillation on the human ventricleSteffen Pabel, Maria Knierim, Thea Stehle, Felix Alebrand, Michael Paulus, Marcel Sieme, Melissa Herwig, Friedrich Barsch, Thomas Körtl, Arnold Pöppl, Simon Sedej, 2022, izvirni znanstveni članek Opis: Rationale: Atrial fibrillation (AF) and heart failure often coexist, but their interaction is poorly understood. Clinical data indicate that the arrhythmic component of AF may contribute to left ventricular (LV) dysfunction.
Objective: This study investigates the effects and molecular mechanisms of AF on the human LV.
Methods and results: Ventricular myocardium from patients with aortic stenosis and preserved LV function with sinus rhythm or rate-controlled AF was studied. LV myocardium from patients with sinus rhythm and patients with AF showed no differences in fibrosis. In functional studies, systolic Ca2+ transient amplitude of LV cardiomyocytes was reduced in patients with AF, while diastolic Ca2+ levels and Ca2+ transient kinetics were not statistically different. These results were confirmed in LV cardiomyocytes from nonfailing donors with sinus rhythm or AF. Moreover, normofrequent AF was simulated in vitro using arrhythmic or rhythmic pacing (both at 60 bpm). After 24 hours of AF-simulation, human LV cardiomyocytes from nonfailing donors showed an impaired Ca2+ transient amplitude. For a standardized investigation of AF-simulation, human iPSC-cardiomyocytes were tested. Seven days of AF-simulation caused reduced systolic Ca2+ transient amplitude and sarcoplasmic reticulum Ca2+ load likely because of an increased diastolic sarcoplasmic reticulum Ca2+ leak. Moreover, cytosolic Na+ concentration was elevated and action potential duration was prolonged after AF-simulation. We detected an increased late Na+ current as a potential trigger for the detrimentally altered Ca2+/Na+-interplay. Mechanistically, reactive oxygen species were higher in the LV of patients with AF. CaMKII (Ca2+/calmodulin-dependent protein kinase IIδc) was found to be more oxidized at Met281/282 in the LV of patients with AF leading to an increased CaMKII activity and consequent increased RyR2 phosphorylation. CaMKII inhibition and ROS scavenging ameliorated impaired systolic Ca2+ handling after AF-simulation.
Conclusions: AF causes distinct functional and molecular remodeling of the human LV. This translational study provides the first mechanistic characterization and the potential negative impact of AF in the absence of tachycardia on the human ventricle.
Ključne besede: atrial fibrillation, calcium-calmodulin-dependent protein kinase type 2, excitation contraction coupling, heart failure, oxidative stress
Objavljeno v DKUM: 28.06.2024; Ogledov: 115; Prenosov: 9
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7. SGLT2i for evidence based cardiorenal protection in diabetic and non-diabetic chronic kidney disease : a comprehensive review by EURECA-m and ERBP working groups of ERAPatrick B. Mark, Pantelis Sarafidis, Robert Ekart, Charles J. Ferro, Olga Balafa, Beatriz Fernandez-Fernandez, William G. Herrington, Patrick Rossignol, Lucia Del Vecchio, Jose M. Valdivielso, 2023, pregledni znanstveni članek Opis: Chronic kidney disease (CKD) is a major public health issue affecting an estimated 850 million people globally. The leading causes of CKD is diabetes and hypertension, which together account for >50% of patients with end-stage kidney disease. Progressive CKD leads to the requirement for kidney replacement therapy with transplantation or dialysis. In addition, CKD, is a risk factor for premature cardiovascular disease, particularly from structural heart disease and heart failure (HF). Until 2015, the mainstay of treatment to slow progression of both diabetic and many non-diabetic kidney diseases was blood pressure control and renin-angiotensin system inhibition; however, neither angiotensin-converting enzyme inhibitors (ACEIs) nor angiotensin receptor blockers (ARBs) reduced cardiovascular events and mortality in major trials in CKD. The emergence of cardiovascular and renal benefits observed with sodium-glucose cotransporter-2 inhibitors (SGLT2i) from clinical trials of their use as anti-hyperglycaemic agents has led to a revolution in cardiorenal protection for patients with diabetes. Subsequent clinical trials, notably DAPA-HF, EMPEROR, CREDENCE, DAPA-CKD and EMPA-KIDNEY have demonstrated their benefits in reducing risk of HF and progression to kidney failure in patients with HF and/or CKD. The cardiorenal benefits—on a relative scale—appear similar in patients with or without diabetes. Specialty societies’ guidelines are continually adapting as trial data emerges to support increasingly wide use of SGLT2i. This consensus paper from EURECA-m and ERBP highlights the latest evidence and summarizes the guidelines for use of SGLT2i for cardiorenal protection focusing on benefits observed relevant to people with CKD.
Ključne besede: cardiorenal syndrome, cardiovascular, chronic renal failure, diabetic kidney disease, heart failure
Objavljeno v DKUM: 21.02.2024; Ogledov: 241; Prenosov: 14
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8. Spermidine overrides INSR (insulin receptor)-IGF1R (insulin-like growth factor 1 receptor)-mediated inhibition of autophagy in the aging heartMahmoud Abdellatif, Frank Madeo, Guido Kroemer, Simon Sedej, 2022, drugi znanstveni članki Opis: Although attenuated IGF1R (insulin-like growth factor 1 receptor) signaling has long been viewed to promote longevity in model organisms, adverse effects on the heart have been the subject of major concern. We observed that IGF1R is overexpressed in cardiac tissues from patients with end-stage non-ischemic heart failure, coupled to the activation of the IGF1R downstream effector AKT/protein kinase B and inhibition of ULK1 (unc-51 like autophagy activating kinase 1). Transgenic overexpression of human IGF1R in cardiomyocytes from mice initially induces physiological cardiac hypertrophy and superior function, but later in life confers a negative impact on cardiac health, causing macroautophagy/autophagy inhibition as well as impaired oxidative phosphorylation, thus reducing life expectancy. Treatment with the autophagy inducer and caloric restriction mimetic spermidine ameliorates most of these IGF1R-induced cardiotoxic effects in vivo. Moreover, inhibition of IGF1R signaling by means of a dominant-negative phosphoinositide 3-kinase (PI3K) mutant induces cardioprotective autophagy, restores myocardial bioenergetics and improves late-life survival. Hence, our results demonstrate that IGF1R exerts a dual biphasic impact on cardiac health, and that autophagy mediates the late-life geroprotective effects of IGF1R inhibition in the heart.
Ključne besede: heart failure, IGF1R, PI3K, human, insulin signaling, longevity, mitochondrial dysfunction, mouse
Objavljeno v DKUM: 08.08.2023; Ogledov: 335; Prenosov: 54
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9. Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency settingGregor Prosen, Petra Klemen, Matej Strnad, Štefek Grmec, 2011, izvirni znanstveni članek Opis: Introduction: We studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical assessment (modified Boston criteria) in differentiating heart failure (HF)- related acute dyspnea from pulmonary (COPD/asthma) related acute dyspnea in the prehospital setting.
Methods: Prospective study was performed at the Center for Emergency Medicine Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: HF-related acute dyspnea group (n = 129) vs pulmonary-related (asthma/COPD) acute dyspnea group (n = 89). All patients underwent lung ultrasound examination, along with basic laboratory, rapid NT-proBNP testing and chest X-ray.
Results: Ultrasound comet tail sign has 100% sensitivity, 95% specificity, 100% negative predictive value (NPV) and 96% positive predictive value (PPV) for the diagnosis of HF. NT-proBNP (cut-off point 1000 pg/ml) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. Comparing the three methods, we found significant differences between ultrasound sign vs NT-proBNP (P<0.05) and Boston modified criteria (P<0.05). Combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With ultrasound we can exclude HF in patients with pulmonary related dyspnea who have positive NT-proBNP (> 1000 pg/ml) and previous history of HF.
Conclusions: Ultrasound comet tail sign alone or in combination with NT-proBNP has a high diagnostic accuracy in differentiating between acute HF and COPD/asthma causes of acute dyspnea in prehospital emergency setting.
Ključne besede: lungs, ultrasound, N-terminal pro-brain natriuretic peptide, acute heart failure, chronic obstructive pulmonary disease, asthma, acute dyspnea
Objavljeno v DKUM: 29.06.2017; Ogledov: 2008; Prenosov: 405
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