El dilema clínico frente a los pacientes con ergometría positiva y prueba de perfusión miocárdica con SPECT normal / The clinical dilemma facing patients with positive stress test and normal SPECT myocardial perfusion imaging

La evaluación de la perfusión miocárdica con SPECT combina una prueba de esfuerzo (ergometría o estrés farmacológico) junto a imágenes de perfusión con radioisótopos. Este estudio es útil para establecer el diagnóstico de enfermedad arterial coronaria, estratificar el riesgo de infarto y tomar decisiones terapéuticas. Un resultado normal aporta un alto valor predictivo negativo, es decir, una muy baja probabilidad de que el paciente presente eventos cardiovasculares. El hallazgo de signos de isquemia en la ergometría podría poner en jaque el valor predictivo negativo de una perfusión normal. En presencia de este resultado, el paso siguiente es evaluar los predictores de riesgo en la ergometría, el riesgo propio del paciente en función de los antecedentes clínicos y el puntaje cálcico coronario, cuando este se encuentra disponible. Ante la presencia concomitante de otros marcadores de riesgo se sugiere completar la evaluación con un estudio anatómico.El uso de nuevas tecnologías podría mejorar la precisión en la predicción de eventos. (AU)

Assessment of myocardial perfusion with SPECT combines a stress test (ergometry or pharmacological stress) with radioisotope perfusion imaging. This test is helpful to diagnose coronary artery disease, stratify the risk of heart attack, and make therapeutic decisions. A normal result provides a high negative predictive value; therefore, the probability of cardiovascular events is very low. Signs of ischemia on an ergometry could jeopardize the negative predictive value of normal perfusion. In this clinical setting, the next step is to evaluate the risk predictors in the stress test, the individual risk based on the clinical history, and the coronary calcium score when available. Given the simultaneous presence of other risk markers,completing the evaluation with an anatomical study is suggested. The use of new technologies could improve the accuracy of event prediction. (AU)

Estrategia de apropiación social del conocimiento en la isquemia cardiaca / Strategy for the social appropriation of knowledge in myocardial ischemia

Introducción: La construcción de conocimiento a partir del intercambio de saberes entre pacientes, familias y equipo de salud es una necesidad sentida que puede impactar en la educación en salud y la adherencia a los tratamientos. Objetivo: Desarrollar una estrategia de apropiación social que permita innovar en el cuidado de la salud de las personas con enfermedad isquémica cardiaca y sus familias mediante el uso de la herramienta MHealth. Materiales y Métodos: Estudio exploratorio que permitió el diseño de una estrategia de apropiación social de conocimiento para mejorar la salud cardiovascular de personas que sufren isquemia cardiaca. Participaron 31 personas entre pacientes, familiares, profesionales de la salud. Se desarrollaron dos talleres virtuales en el mes de junio y seguimientos telefónicos entre agosto y septiembre. Las experiencias y saberes de los participantes, permitió la construcción de la herramienta MHealth. Resultados: La reflexión crítica entre los actores facilitó la construcción y desarrollo de la herramienta tipo MHealth (página web/app) titulada "Cuidando tu corazón", que permite el acceso a información relacionada con el cuidado durante la isquemia cardiaca y articula información a partir del diálogo de saberes y la evidencia reportada en la literatura. Discusión: Las estrategias de apropiación social son una herramienta relevante para la generación de conocimiento en el área de la salud. Conclusiones: La estrategia implementada permitió reconocer la importancia de contar con herramientas para el cuidado de la salud cardiovascular elaboradas desde las necesidades, perspectivas y creencias de sus actores para mejorar la educación y el cuidado.

Introduction: The construction of knowledge from the exchange of knowledge between patients, families, and healthcare teams is a felt need that can impact health education and adherence to treatment. Objective: To develop a social appropriation strategy that enables innovation in the health care of people with ischemic heart disease and their families through the use of an MHealth tool. Materials and methods: Exploratory study that allowed the design of a strategy for the social appropriation of knowledge to improve the cardiovascular health of people suffering from myocardial ischemia. Thirty-one people participated, including patients, family members, and health professionals. Two virtual workshops were held in June, and follow-up phone calls were made between August and September. The participant's experiences and knowledge enabled the construction of the MHealth tool. Results: The critical reflection of the stakeholders facilitated the construction and development of the MHealth tool (webpage/app) named "Cuidando tu corazón" (Taking care of your heart). Discussion: Social appropriation strategies are a relevant tool for knowledge creation in health. Conclusions: The strategy implemented made it possible to recognize the importance of developing cardiovascular healthcare tools from stakeholders' needs, perspectives, and beliefs to improve education and care.

Introdução: A construção do conhecimento a partir da troca de conhecimentos entre pacientes, familiares e equipe de saúde é uma necessidade sentida que pode impactar na educação em saúde e na adesão aos tratamentos. Objetivo: Desenvolver uma estratégia de apropriação social que permita inovar na atenção à saúde de pessoas com doença isquêmica do coração e seus familiares por meio do uso da ferramenta MHealth. Materiais e Métodos: Estudo exploratório que permitiu desenhar uma estratégia de apropriação social do conhecimento para melhorar a saúde cardiovascular de pessoas com isquemia cardíaca. Participaram 31 pessoas, entre pacientes, familiares e profissionais de saúde. Foram realizadas dois seminários virtuais em junho e acompanhamentos por telefone entre agosto e setembro. As experiências e conhecimentos dos participantes permitiram a construção da ferramenta MHealth. Resultados: A reflexão crítica entre os atores facilitou a construção e desenvolvimento da ferramenta do tipo MHealth (página web/ aplicativo) intitulada "Cuidando do seu coração", que permite o acesso às informações relacionadas aos cuidados durante a isquemia cardíaca e articula as informações a partir do diálogo de conhecimento e as evidências relatadas na literatura. Discussão: As estratégias de apropriação social são uma ferramenta relevante para a geração de conhecimento na área da saúde. Conclusões: A estratégia implementada possibilitou reconhecer a importância de ter ferramentas para o cuidado à saúde cardiovascular elaboradas a partir das necessidades, perspectivas e crenças de seus atores para melhorar a educação e o cuidado.

Estudio de caso: revascularización de paciente con enfoque en el proceso de atención de enfermería / Case study: Patient revascularization with focus on the nursing care process

Introducción: la cardiopatía isquémica fue la primera causa de muerte en México en el año 2020. Su prevalencia aumenta con la edad y es superior en los hombres que en las mujeres; se presenta mayormente en forma de infarto en edades entre 45 y 94 años. Objetivo: describir el caso de un paciente sometido a revascularización aorto-coronaria por cardiopatía isquémica con enfoque del proceso de atención de enfermería (PAE). Metodología: estudio de caso observacional y descriptivo con aplicación del PAE en el perioperatorio de un hombre de 50 años con cardiopatía isquémica crónica, enfermedad multivascular e hipertensión sistémica controlada de 6 años desde que inició, en un hospital público de tercer nivel en Mérida, Yucatán, México. Resultados: se demostró que si se aplica el PAE hay menor riesgo de shock hipovolémico ocasionado por sangrado activo y disminución de riesgo de infección del sitio de herida quirúrgica, evidenciado por el procedimiento quirúrgico extenso. Conclusiones: la metodología del PAE como método científico facilita innovaciones dentro de los cuidados enfermeros, además de las diferentes alternativas en las acciones a seguir para el tratamiento del paciente quirúrgico cardiovascular. También proporciona un método informativo para la atención de cuidados, desarrolla una autonomía para la enfermería y fomenta la consideración como profesional de salud.

Introduction: Ischemic heart disease was the leading cause of death in Mexico in 2020. Its prevalence increases with age and it is higher in men than in women; it is presented mostly as a heart attack between the ages of 45 and 94 years. Objective: To describe the case of a patient undergoing aorto-coronary revascularization for ischemic heart disease with a nursing care process (NCP) approach. Methodology: Observational and descriptive case study with application of NCP in the perioperative period of a 50-year-old man with chronic ischemic heart disease, multivessel disease and controlled systemic hypertension of 6 years since its onset, in a third level public hospital in Merida, Yucatan, Mexico. Results: It was demonstrated that by applying NCP there is a lower risk of hypovolemic shock caused by active bleeding and decreased risk of surgical wound site infection, evidenced by the extensive surgical procedure. Conclusions: The NCP methodology as a scientific method facilitates innovations within nursing care, in addition to the different alternatives in the actions to follow for the treatment of the cardiovascular surgical patient. It also provides an informative method for care, develops autonomy for nursing and promotes consideration as a health professional.

Sevoflurane attenuates myocardial ischemia/reperfusion injury by up-regulating microRNA-99a and down-regulating BRD4

Purpose: It has been explored that sevoflurane (Sevo) is cardioprotective in myocardial ischemia/reperfusion injury (MI/RI) and mediates microRNA (miRNA) expression that control various physiological systems. Enlightened by that, the work was programmed to decode the mechanism of Sevo and miR-99a with the participation of bromodomain-containing protein 4 (BRD4). Methods: MI/RImodel was established on mice. MI/RI modeled mice were exposed to Sevo or injected with miR-99a or BRD4-related vectors to identify their functions in cardiac function, pathological injury, cardiomyocyte apoptosis, inflammation, and oxidative stress in MI/RI mice. MiR-99a and BRD4 expression in myocardial tissues were tested, and their relation was further validated. Results: MiR-99a was down-regulated, and BRD4 was up-regulated in MI/RI mice. Sevo up-regulated miR-99a to inhibit BRD4 expression in myocardial tissues of MI/RI mice. Sevo improved cardiac function, relieved myocardial injury, repressed cardiomyocyte apoptosis, and alleviated inflammation and oxidative stress in mice with MI/RI. MiR-99a restoration further enhanced the positive effects of Sevo on mice with MI/RI. Overexpression of BRD4 reversed up-regulation of miR-99a-induced attenuation of MI/RI in mice. Conclusions: The work delineated that Sevo up-regulates miR-99a to attenuate MI/RI by inhibiting BRD4.

Incremental value of epicardial fat volume on predicting obstructive coronary artery disease with myocardial ischemia / 中华心血管病杂志

Objective: This study aimed to investigate the association between epicardial fat volume (EFV) and obstructive coronary artery disease (CAD) with myocardial ischemia, and evaluate the incremental value of EFV on top of traditional risk factors and coronary artery calcium (CAC) in predicting obstructive CAD with myocardial ischemia. Methods: This study was a retrospective cross-sectional study. Patients with suspected CAD who underwent coronary angiography (CAG) and single photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) at the Third Affiliated Hospital of Soochow University from March 2018 to November 2019 were consecutively enrolled. EFV and CAC were measured by non-contrast chest computed tomography (CT) scan. Obstructive CAD was defined as coronary artery stenosis≥50% in at least one of the major epicardial coronary arteries, and myocardial ischemia was defined as reversible perfusion defects in stress and rest MPI. Obstructive CAD with myocardial ischemia was defined in patients with coronary stenosis severity≥50% and reversible perfusion defects in the corresponding areas of SPECT-MPI. Patients with myocardial ischemia bot without obstructive CAD were defined as none-obstructive CAD with myocardial ischemia group. We collected and compared the general clinical data, CAC and EFV between the two groups. Multivariable logistic regression analysis was performed to identify the relationship between EFV and obstructive CAD with myocardial ischemia. ROC curves were performed to determine whether addition of EFV improved predictive value beyond traditional risk factors and CAC for obstructive CAD with myocardial ischemia. Results: Among the 164 patients with suspected CAD, 111 patients were males, and average age was (61.4±9.9) years old. 62 (37.8%) patients were included into the obstructive CAD with myocardial ischemia group. 102 (62.2%) patients were included into the none-obstructive CAD with myocardial ischemia group. EFV was significantly higher in obstructive CAD with myocardial ischemia group than in none-obstructive CAD with myocardial ischemia group ((135.63±33.29)cm3 and (105.18±31.16)cm3, P<0.01). Univariate regression analysis showed the risk of obstructive CAD with myocardial ischemia increased by 1.96 times for each SD increase in EFV(OR 2.96; 95%CI, 1.89-4.62; P<0.01). After adjustment for traditional risk factors and CAC, EFV remained as an independent predictor for obstructive CAD with myocardial ischemia (OR, 4.48, 95%CI, 2.17-9.23; P<0.01). Addition of EFV to CAC and traditional risk factors was related to larger AUC for predicting obstructive CAD with myocardial ischemia (0.90 vs. 0.85, P=0.04, 95%CI: 0.85-0.95) and the global chi-square increased by 21.81 (P<0.05). Conclusions: EFV is an independent predictor for obstructive CAD with myocardial ischemia. Addition of EFV to traditional risk factors and CAC has incremental value for predicting obstructive CAD with myocardial ischemia in this patient cohort.

Predictive value of left ventricular ejection fraction reserve assessed by SPECT G-MPI for major adverse cardiovascular event in patients with coronary artery disease / 中华心血管病杂志

Objective: To evaluate the prognostic value of left ventricular ejection fraction (LVEF) reserve assessed by gated SPECT myocardial perfusion imaging (SPECT G-MPI) for major adverse cardiovascular event (MACE) in patients with coronary artery disease. Methods: This is a retrospective cohort study. From January 2017 to December 2019, patients with coronary artery disease and confirmed myocardial ischemia by stress and rest SPECT G-MPI, and underwent coronary angiography within 3 months were enrolled. The sum stress score (SSS) and sum resting score (SRS) were analyzed by the standard 17-segment model, and the sum difference score (SDS, SDS=SSS-SRS) was calculated. The LVEF at stress and rest were analyzed by 4DM software. The LVEF reserve (ΔLVEF) was calculated (ΔLVEF=stress LVEF-rest LVEF). The primary endpoint was MACE, which was obtained by reviewing the medical record system or by telephone follow-up once every twelve months. Patients were divided into MACE-free and MACE groups. Spearman correlation analysis was used to analyze the correlation between ΔLVEF and all MPI parameters. Cox regression analysis was used to analyze the independent factors of MACE, and the optimal SDS cutoff value for predicting MACE was determined by receiver operating characteristic curve (ROC). Kaplan-Meier survival curves were plotted to compare the difference in the incidence of MACE between different SDS groups and different ΔLVEF groups. Results: A total of 164 patients with coronary artery disease [120 male; age (58.6±10.7) years] were included. The average follow-up time was (26.5±10.4) months, and a total of 30 MACE were recorded during follow-up. Multivariate Cox regression analysis showed that SDS (HR=1.069, 95%CI: 1.005-1.137, P=0.035) and ΔLVEF (HR=0.935, 95%CI: 0.878-0.995, P=0.034) were independent predictors of MACE. According to ROC curve analysis, the optimal cut-off to predict MACE was a SDS of 5.5 with an area under the curve of 0.63 (P=0.022). Survival analysis showed that the incidence of MACE was significantly higher in the SDS≥5.5 group than in the SDS<5.5 group (27.6% vs. 13.2%, P=0.019), but the incidence of MACE was significantly lower in the ΔLVEF≥0 group than in theΔLVEF<0 group (11.0% vs. 25.6%, P=0.022). Conclusions: LVEF reserve (ΔLVEF) assessed by SPECT G-MPI serves as an independent protective factor for MACE, while SDS is an independent risk predictor in patients with coronary artery disease. SPECT G-MPI is valuable for risk stratification by assessing myocardial ischemia and LVEF.

Health seeking behavior of patients with Ischemic Heart Disease during the COVID-19 pandemic in the outpatient clinics of a tertiary hospital

Background@#Ischemic Heart Disease is a chronic, progressive, and dynamic disease. It remains to be the number one cause of mortality globally and in the Philippines. Patients with IHD belong to the vulnerable group both before and during the COVID 19 pandemic. Currently, there have been changes in the healthcare system leading to decreased delivery of services such as outpatient care and development of medical care avoidance affecting patients’ clinical outcomes.@*Objectives@#This study aimed to determine if there are any changes in the health seeking behavior of these patients during the pandemic in a single tertiary hospital.@*Methods@#Descriptive and analytical cross-sectional design was used. Majority of the population were 60 years old and above, female, unemployed, non-smokers, diagnosed with IHD for 5 years, with hypertension and type 2 diabetes mellitus as co-morbidities.@*Results@#It was shown that majority did not have any change in the frequency of consultation with their cardiologists and majority preferred face-to-face consultation. For those who had decreased frequency of consultation, their reasons include fear of contracting COVID-19, lockdown and travel restrictions, limited number of patients catered at the clinic and lack of finances. Majority remained to be compliant with their maintenance medications and claimed to be willing to seek consult if they will experience severe symptom such as chest pain. For those who were not willing to go to the hospital despite having severe symptoms, the following were their reasons: fear of going out due to COVID 19, symptoms were tolerable and were not considered emergency and hospitals were in full capacity. Majority were not admitted in the hospital but those who were not admitted had less frequent consultation with their cardiologists. Despite the COVID threat, majority still agreed that constant follow-up with their cardiologist is of paramount importance.

Downregulation of cardiac PIASy inhibits Cx43 SUMOylation and ameliorates ventricular arrhythmias in a rat model of myocardial ischemia/reperfusion injury / 中华医学杂志(英文版)

BACKGROUND@#Dysfunction of the gap junction channel protein connexin 43 (Cx43) contributes to myocardial ischemia/reperfusion (I/R)-induced ventricular arrhythmias. Cx43 can be regulated by small ubiquitin-like modifier (SUMO) modification. Protein inhibitor of activated STAT Y (PIASy) is an E3 SUMO ligase for its target proteins. However, whether Cx43 is a target protein of PIASy and whether Cx43 SUMOylation plays a role in I/R-induced arrhythmias are largely unknown.@*METHODS@#Male Sprague-Dawley rats were infected with PIASy short hairpin ribonucleic acid (shRNA) using recombinant adeno-associated virus subtype 9 (rAAV9). Two weeks later, the rats were subjected to 45 min of left coronary artery occlusion followed by 2 h reperfusion. Electrocardiogram was recorded to assess arrhythmias. Rat ventricular tissues were collected for molecular biological measurements.@*RESULTS@#Following 45 min of ischemia, QRS duration and QTc intervals statistically significantly increased, but these values decreased after transfecting PIASy shRNA. PIASy downregulation ameliorated ventricular arrhythmias induced by myocardial I/R, as evidenced by the decreased incidence of ventricular tachycardia and ventricular fibrillation, and reduced arrythmia score. In addition, myocardial I/R statistically significantly induced PIASy expression and Cx43 SUMOylation, accompanied by reduced Cx43 phosphorylation and plakophilin 2 (PKP2) expression. Moreover, PIASy downregulation remarkably reduced Cx43 SUMOylation, accompanied by increased Cx43 phosphorylation and PKP2 expression after I/R.@*CONCLUSION@#PIASy downregulation inhibited Cx43 SUMOylation and increased PKP2 expression, thereby improving ventricular arrhythmias in ischemic/reperfused rats heart.

“Lifestyle Redo” managing dyslipidemia as risk factor for cardiovascular disease in adults through lifestyle intervention

Background@#Cardiovascular disease (CVD) is a leading cause of death around the world including the Philippines. Dyslipidemia and lifestyle have been considered as important modifiable risk factors. Experts in the Philippines have recommended that among individuals with dyslipidemia, lifestyle modification should be advised regardless of their present condition or risk profile. However, a key limitation of the most recent guidelines is the lack of studies on lifestyle interventions involving Filipinos.@*Objective@#This study aimed to provide preliminary evidence for the use of a lifestyle medicine intervention program in the management of dyslipidemia as risk factor for cardiovascular disease.@*Methods@#This study employed a mixed method of quantitative and qualitative research designs. The tools used were selfadministered questionnaires, collecting and examining documents. Measures to improve validity in qualitative studies have also been employed such as respondent validation and rival explanation. Triangulation with the findings from the other qualitative methodologies was also employed. Ethical approval was granted.@*Results@#The first part of the study has a total of 66 participants who underwent a lifestyle intervention program in a single clinic, comprising of 26 male and 40 female subjects were selected through convenient sampling method. Around 50% of the participants were 40-59 years old, 42.4% were 30-39 years old, and only 7.6% were 60-89 years old. The knowledge of the respondents had an overall mean of 7.73 (SD=1.16) which is interpreted as high knowledge. The attitude of the respondents had a mean of 3.58 (SD=0.50) which is interpreted as very positive. The respondents also had a good lifestyle practice with overall mean of 2.76 (SD=0.49). The second part of the study consisted of eight participants with 3 males and 5 females who were chosen through purposive sampling. All participants experienced reduction of their LDL-C and total cholesterol levels after the 12-week lifestyle intervention. Two participants had increased triglyceride levels. The select group also showed reduction in the blood glucose levels and body mass index.@*Conclusion@#This study revealed that participants had good knowledge and attitude regarding cardiovascular diseases and its risk factors. Yet, there is still a high number of those who do not efficiently practice healthy lifestyle and diet. Additional information should be extracted to establish the dietary intake of participants which contributed to the increase in triglyceride levels of some select participants.

Analysis of the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019 / 中华劳动卫生职业病杂志

Objective: To analyze the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019, and to study the current burden of disease in relevant populations. Methods: In October 2021, based on data from the global burden of disease 2019 (GBD 2019) study, population attributable fraction (PAF), number of deaths, mortality, disability-adjusted life year (DALY) and DALY rate of Chinese and global populations with different ages and genders in 1990 and 2019 were extracted and analyzed. The rate of change was calculated, the mortality rate was normalized by the age structure of the world standard population, and the causes of disease burden caused by high temperature exposure of Chinese residents were analyzed. Results: In 2019, compared with 1990, the PAF of Chinese and global population decreased by 43.98% and 12.41% respectively, the number of deaths increased by 29.55% and 49.40% respectively, the crude mortality rate increased by 7.81% and 3.30% respectively, the DALY decreased by 48.12% and 14.41% respectively, and the DALY rate decreased by 56.82% and 40.82% respectively. The mortality rate of the ≥70 age group was higher than that of other groups. The disease burden indicators such as PAF, standardized mortality and DALY attributable to high temperature exposure in men were higher than those in women. In 2019, the main cause of DALY affected by high temperature exposure in Chinese population was ischemic heart disease (84400 person-years), and the main cause of death was ischemic heart disease (4900 cases). Conclusion: The burden of diseases attributable to high temperature exposure is still serious in China and the world at large. Targeted interventions should be formulated for men, the elderly and people with occupational exposure, and a sound surveillance system should be established to reduce the burden of diseases caused by high temperature exposure.

Development and validation of ischemic heart disease and stroke prognostic models using large-scale real-world data from Japan

BACKGROUND@#Previous cardiovascular risk prediction models in Japan have utilized prospective cohort studies with concise data. As the health information including health check-up records and administrative claims becomes digitalized and publicly available, application of large datasets based on such real-world data can achieve prediction accuracy and support social implementation of cardiovascular disease risk prediction models in preventive and clinical practice. In this study, classical regression and machine learning methods were explored to develop ischemic heart disease (IHD) and stroke prognostic models using real-world data.@*METHODS@#IQVIA Japan Claims Database was searched to include 691,160 individuals (predominantly corporate employees and their families working in secondary and tertiary industries) with at least one annual health check-up record during the identification period (April 2013-December 2018). The primary outcome of the study was the first recorded IHD or stroke event. Predictors were annual health check-up records at the index year-month, comprising demographic characteristics, laboratory tests, and questionnaire features. Four prediction models (Cox, Elnet-Cox, XGBoost, and Ensemble) were assessed in the present study to develop a cardiovascular disease risk prediction model for Japan.@*RESULTS@#The analysis cohort consisted of 572,971 invididuals. All prediction models showed similarly good performance. The Harrell's C-index was close to 0.9 for all IHD models, and above 0.7 for stroke models. In IHD models, age, sex, high-density lipoprotein, low-density lipoprotein, cholesterol, and systolic blood pressure had higher importance, while in stroke models systolic blood pressure and age had higher importance.@*CONCLUSION@#Our study analyzed classical regression and machine learning algorithms to develop cardiovascular disease risk prediction models for IHD and stroke in Japan that can be applied to practical use in a large population with predictive accuracy.

UPLC-Q-TOF-MS metabolomic study on improvement of acute myocardial ischemia in rats by Dalbergia cochinchinensis heartwood / 中国中药杂志

This paper aimed to study the effect of Dalbergia cochinchinensis heartwood on plasma endogenous metabolites in rats with ligation of the left anterior descending coronary artery, and to analyze the mechanism of D. cochinchinensis heartwood in improving acute myocardial ischemic injury. The stability and consistency of the components in the D. cochinchinensis heartwood were verified by the establishment of fingerprint, and 30 male SD rats were randomly divided into a sham group, a model group, and a D. cochinchinensis heartwood(6 g·kg~(-1)) group, with 10 rats in each group. The sham group only opened the chest without ligation, while the other groups established the model of ligation. Ten days after administration, the hearts were taken for hematoxylin-eosin(HE) staining, and the content of heart injury indexes in the plasma creatine kinase isoenzyme(CK-MB) and lactate dehydrogenase(LDH), energy metabolism-related index glucose(Glu) content, and vascular endothelial function index nitric oxide(NO) was determined. The endogenous metabolites were detected by ultra-high-performance liquid chromatography-time-of-flight-mass spectrometry(UPLC-Q-TOF-MS). The results showed that the D. cochinchinensis heartwood reduced the content of CK-MB and LDH in the plasma of rats to relieve myocardial injury, reduced the content of Glu in the plasma, improved myocardial energy metabolism, increased the content of NO, cured the vascular endothelial injury, and promoted vasodilation. D. cochinchinensis heartwood improved the increase of intercellular space, myocardial inflammatory cell infiltration, and myofilament rupture caused by ligation of the left anterior descending coronary artery. The metabolomic study showed that the content of 26 metabolites in the plasma of rats in the model group increased significantly, while the content of 27 metabolites decreased significantly. Twenty metabolites were significantly adjusted after the administration of D. cochinchinensis heartwood. D. cochinchinensis heartwood can significantly adjust the metabolic abnormality in rats with ligation of the left anterior descending coronary artery, and its mechanism may be related to the regulation of cardiac energy metabolism, NO production, and inflammation. The results provide a corresponding basis for further explaining the effect of D. cochinchinensis on the acute myocardial injury.

Clinical characteristics of anomalous aortic origin of a coronary artery in children / 中华儿科杂志

Objective: To analyze the clinical characteristics, diagnosis and treatment of anomalous aortic origin of a coronary artery (AAOCA) in children. Methods: There were 17 children diagnosed with AAOCA from January 2013 to January 2022 in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine.Their clinical manifestations, laboratory and imaging data, treatment and prognosis were retrospectively analyzed. Results: These 17 children included 14 males and 3 females, with the age of (8.7±3.5) years. There were 4 anomalous left coronary artery (ALCA) and 13 anomalous right coronary artery (ARCA). Seven children presented with chest pain or chest pain after exercise, three patients presented with cardiac syncope, one complained chest tightness and weakness, and the other six patients had no specific symptoms. Cardiac syncope and chest tightness occurred in patients with ALCA. Fourteen children had the dangerous anatomical basis of myocardial ischemia caused by coronary artery compression or stenosis on imaging. Seven children had coronary artery repair, of whom two were ALCA and five were ARCA. One patient had received heart transplantation because of heart failure. The incidence of adverse cardiovascular events and poor prognosis in ALCA group was higher than that in ARCA group (4/4 vs. 0/13, P<0.05). They were followed up in the outpatient department regularly for 6 (6, 12) months; except for the one who lost visit, the rest of the patients had a good prognosis. Conclusions: Cardiogenic syncope or cardiac insufficiency usually occurs in ALCA, and adverse cardiovascular events and poor prognosis are more common in ALCA than in ARCA. Early surgical treatment should be considered for children with ALCA and ARCA accompanied by myocardial ischemia.

Ácidos grasos omega-3 y función endotelial en pacientes con síndrome coronario agudo / Omega-3 fatty acids and endothelial function in patients with acute coronary syndrome

Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial, manifestándose principalmente como enfermedad isquémica coronaria. El pronóstico y desenlace del Síndrome Coronario Agudo (SCA) depende en gran proporción de la disfunción endotelial asociado a este cuadro. Objetivo:Evaluar el efecto de los ácidos grasos omega­3, sobre la función endotelial en el Síndrome Coronario Agudo (SCA). Métodos: Se realizó estudio con 16 pacientes con síndrome coronario agudo (SCA) tratados con Omega-3 a dosis de 3 gramos/día+Terapia Convencional (O3+Tc) durante 30 días. Se les realizó a las 12 horas del ingreso y los a 30 días, perfil lipídico, proteína C reactiva ultrasensible (PCRus), Endotelina 1 (ET-1), y Péptido Natriurético cerebral (NTproBNP). Resultados: Durante 4 semanas de seguimiento, el uso de 3 gramos/día de ácidos grasos omega-3, añadido a la terapia convencional en el Síndrome Coronario Agudo, mostró una reducción significativa de la concentración plasmática de NTproBNP (p = 0,000), PCRus (p =0,000) y triglicéridos (p = 0,004). Conclusión: Tres gramos al día de ácidos grasos omega-3 contribuye a la reducción de la concentración plasmática de Triglicéridos y NTproBNP en pacientes con síndrome coronario agudo(AU)

Mainly as coronary ischemic disease. the prognosis and outcome of Acute Coronary Syndrome (ACS) depend largely on the endothelial dysfunction associated with this condition. Objective: To evaluate the effect of omega-3 fatty acids on endothelial function in Acute Coronary Syndrome (ACS). Method: A study was conducted with 16 patients with acute coronary syndrome (ACS) treated with Omega-3 at a dose of 3 grams/day+Conventional erapy (O3+Tc) for 30 days. Lipid profile, ultrasensitive C-reactive protein (usCRP), Endothelin 1 (ET-1), and Brain Natriuretic Peptide (NTproBNP) were performed 12 hours aer admission and 30 days later. Results: During 4 weeks of follow-up, the use of 3 grams/day of omega-3 fatty acids, added to conventional therapy in Acute Coronary Syndrome, showed a significant reduction in the plasma concentration of NTproBNP (p = 0.000), hsCRP (p =0.000) and Triglycerides (p = 0.004). Conclusion: three grams a day of omega-3 fatty acids contributes to the reduction of the plasmatic concentration of Triglycerides and NTproBNP in patients with acute coronary syndrome(AU)

Cardiopatía isquémica. Consideraciones para la atención odontológica / Ischemic heart disease. Considerations for dental treatment

La cardiopatía isquémica es un padecimiento que se caracteriza por la falta de oxígeno del músculo cardiaco y es la principal causa de infarto de miocardio. Existen múltiples factores que predisponen al desarrollo de ésta como la obesidad, la hiperlipidemia, el sedenta- rismo, tabaquismo, diabetes e hipertensión. Dadas las características que configuran la fisiopatología de la cardiopatía isquémica, existen diversas consideraciones que deben ser tomadas en cuenta toda vez que el estomatólogo brinde atención a un paciente con este padecimiento. El objetivo del presente artículo es conocer todo lo relacionado con la fisiopatología de la cardiopatía isquémica, sus manifestaciones clínicas, su tratamiento médico y lo más importante, las consideraciones que deben tomarse en el consultorio dental cuando se atienda a un paciente que padezca esta condición (AU)

Ischemic heart disease is a condition characterized by a lack of oxygen in the heart muscle and is the main cause of myocardial infarction. There are multiple factors that predispose to the development of this, such as obesity, hiyperlipidemia, sedentary lifestyle, smoking, diabetes and hypertension. Given the characteristics that make up the pathophysiology of ischemic heart disease, there are various considerations that must be taken into account whenever the stomatologist provides care to a patient with this condition. The objective of this article is to know everything related to the pathophysiology of ischemic heart disease, its clinical manifestation, its medical treatment and most importantly, the considerations that must be taken in the dental office when caring for a patient with this condition (AU)

Experiencia en un programa de rehabilitación cardíaca extrahospitalario usando cardiotacómetros: seguridad y eficacia / Experience in an outpatient cardiac rehabilitation program using cardiotachometers: safety and effectiveness / Experiência em programa de reabilitação cardíaca extra-hospitalar com uso de cardiotacômetros: segurança e eficácia

Introducción: El ejercicio físico, integrando la rehabilitación cardíaca (RC), tiene un efecto positivo demostrado en el pronóstico de los pacientes con enfermedad cardiovascular, optimizando el rendimiento cardíaco en términos de capacidad funcional. Mediante los programas de RC se pretende obtener los máximos beneficios clínicos del ejercicio físico con un mínimo riesgo para el paciente. Objetivos: Evaluar la seguridad y eficacia de un programa de RC extrahospitalario en pacientes de todos los niveles de riesgo, monitorizando con cardiotacómetros (instrumento de pulsera que detecta frecuencia cardíaca y permite programar alarmas) a pacientes de moderado y alto riesgo, con base en la ausencia de complicaciones cardíacas graves y la mejoría funcional de los participantes. Material y métodos: Estudio de cohorte retrospectiva, sometida a un plan de RC durante 12 semanas en el período comprendido entre enero de 2014 y marzo de 2020. Se evaluaron parámetros clínicos y funcionales al inicio y al final del plan de rehabilitación, controlando la tolerancia al esfuerzo, la presión arterial y la frecuencia cardíaca mediante el uso de cardiotacómetros. Resultados: Se incluyeron 181 pacientes, con edad promedio de 58,7 ± 9,7 años, 87,8% del sexo masculino, mayoritariamente portadores de cardiopatía isquémica (90,1%). Según la clasificación de la Asociación Americana de Rehabilitación Cardiovascular y Pulmonar, 54 pacientes (29,8%) eran de alto riesgo, 29 (16,0%) de moderado riesgo y 98 (54,1%) de bajo riesgo. En más de 10.000 horas de actividad física realizadas, un paciente requirió el implante de un marcapaso definitivo por bloqueo auriculoventricular completo, sin observarse otras complicaciones graves. Se obtuvo una mejoría significativa (p = 0,001) de la capacidad funcional, que aumentó de 7,34 ± 2,68 a 10,20 ± 2,35 METs (incremento relativo individual promedio 28,1%). Conclusiones: La RC es un tratamiento seguro y efectivo en los pacientes cardiópatas, aún en aquellos de moderado y alto riesgo. El uso de cardiotacómetros permite una adecuada monitorización del ejercicio y una oportuna detección de complicaciones.

Introduction: physical exercise, integrating cardiac rehabilitation (CR), has a proven positive effect on the prognosis of patients with cardiovascular disease, optimizing cardiac performance in terms of functional capacity. CR programs aim to obtain maximum clinical benefits with minimal risks to the patient. Objectives: assess the safety and efficacy of a cardiotachometer-monitored out-of-hospital CR program in high- and moderate-risk patients, based on the absence of major cardiac complications and improvement in participant's functional capacity. Materials and methods: retrospective cohort study, submitted to a CR plan for 12 weeks in the period between January 2014 and March 2020. Clinical and functional parameters were evaluated at the beginning and at the end of the rehabilitation plan, controlling effort tolerance, blood pressure and heart rate using cardiotachometers. Results: 181 patients were included, aged 58.7 ± 9.7 years and 87.8% female, of whom 90% were carriers of ischemic heart disease. According to the classification of the American Association of Cardiovascular and Pulmonary Rehabilitation, the patients were distributed as follows: 54 (29.8%) at high risk, 29 (16.0%) at intermediate risk, and 98 (54.1%) low risk. In more than ten thousand hours of physical activity performed, one patient required implantation of a permanent pacemaker due to complete atrioventricular block. A significant improvement (p = 0.001) of the functional capacity, from 7.34 ± 2.68 to 10.2 ± 2.35 (mean relative improvement: 28.1%.) was obtained. Conclusions: the CR is a safe and effective procedure for cardiac patients, even in moderate or high-risk subjects. The use of cardiotachometers allows adequate exercise monitoring and timely detection of complications.

Introdução: o exercício físico, integrando a reabilitação cardíaca (RC), tem comprovado efeito positivo no prognóstico de pacientes com doença cardiovascular, otimizando o desempenho cardíaco em termos de capacidade funcional. Os programas de RC visam obter o máximo de benefícios clínicos com riscos mínimos para o paciente. Objetivos: avaliar a segurança e eficácia de um programa de RC fora do hospital monitorado por cardiotacômetro em pacientes de alto e moderado risco, com base na ausência de complicações cardíacas maiores e na melhora da capacidade funcional dos participantes. Materiais e métodos: trata-se de um estudo descritivo, de um plano de RC de 12 semanas, em um período entre janeiro de 2014 a março de 2020. Os parâmetros clínicos e funcionais foram avaliados no início e no final do plano de reabilitação, a tolerância ao esforço, pressão arterial e frequência cardíaca utilizando cardiotacômetros. Resultados: foram incluídos 181 pacientes, com média de idade de 58,7 ± 9,7 anos e 87,8% do sexo masculino, dos quais 90% eram portadores de cardiopatia isquêmica. De acordo com a classificação da Associação Americana de Reabilitação Cardiovascular e Pulmonar, os pacientes foram distribuídos da seguinte forma: 54 (29,8%) de alto risco, 29 (16,0%) de risco intermediário e 98 (54,1%) de baixo risco. Em mais de dez mil horas de atividade física realizada, um paciente necessitou de implante de marcapasso definitivo por bloqueio atrioventricular total. A avaliação final mostrou melhora significativa (p = 0,001) na capacidade funcional medida em METs; este passou de 7,34 ± 2,68 para 10,2 ± 2,35 (melhora relativa média: 28,1%). Conclusões: este trabalho demonstra que a RC é um tratamento seguro e eficaz para pacientes com doenças cardíacas, mesmo em indivíduos de risco moderado e alto. O uso de cardiotacômetros permite o monitoramento adequado do exercício e a detecção oportuna de complicações.

Guía de práctica clínica para el manejo inicial del infarto agudo de miocardio con elevación persistente del segmento ST. Guía en versión extensa / Clinical practice guideline for the initial management of persistent ST-segment elevation acute myocardial infarction. Guide in extensive version

La presente publicación en versión extensa, describe las recomendaciones para el manejo infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) dentro de las primeras 12 horas de inicio de los síntomas, con el fin de contribuir a reducir la mortalidad, mejorar la calidad de vida, y reducir las complicaciones de los pacientes con esta condición, la población a la cual se aplicará la GPC:, o sea los pacientes con infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) dentro de las primeras 12 horas de inicio de los síntoma. El infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) es una emergencia médica, producto de la oclusión de las arterias coronarias, que conllevan a la isquemia miocárdica transmural, y que de persistir lleva a una lesión miocárdica o necrosis. Se ha reportado una mortalidad de la enfermedad del 23 % antes de llegar al hospital, 13% durante el ingreso hospitalario, y de 10% posterior al alta. Lo cual, inclusive, puede aumentar en ausencia de tratamiento entre un 5 a 10% (2). En el caso de Perú, se ha reportado una por IMCEST de aproximadamente 9%, pero con una incidencia de insuficiencia cardíaca posinfarto fue de 28% y de choque cardiogénico de 12% (3). Esta alta tasa de mortalidad y morbilidad hace hincapié en la necesidad de garantizar una evaluación y manejo adecuado de la enfermedad. Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia para gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición

Guía de práctica clínica para el manejo inicial del infarto agudo de miocardio con elevación persistente del segmento ST. Guía en versión corta / Clinical Practice Guideline for the Initial Management of Persistent ST-Segment Elevation Myocardial Infarction. Short Guideline

La publicación en versión corta, describe las recomendaciones para el manejo infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) dentro de las primeras 12 horas de inicio de los síntomas, con el fin de contribuir a reducir la mortalidad, mejorar la calidad de vida, y reducir las complicaciones de los pacientes con esta condición.

Medición de la mortalidad de pacientes internados por enfermedad cardiovascular mediante el desarrollo de un algoritmo de inteligencia artificial / Measurement of mortality during hospitalization due cardiovascular disease through the development of an artificial intelligence algorithm

Introducción: determinar la causa de muerte de los pacientes internados con enfermedad cardiovascular es de suma importancia para poder tomar medidas y así mejorar la calidad su atención y prevenir muertes evitables. Objetivos: determinar las principales causas de muerte durante la internación por enfermedades cardiovasculares. Desarrollar y validar un algoritmo para clasificar automáticamente a los pacientes fallecidos durante la internación con enfermedades cardiovasculares Diseño del estudio: estudio exploratorio retrospectivo. Desarrollo de un algoritmo de clasificación. Resultados: del total de 6161 pacientes, el 21,3% (1316) se internaron por causas cardiovasculares; las enfermedades cerebrovasculares representan el 30,7%, la insuficiencia cardíaca el 24,9% y las enfermedades cardíacas isquémicas el 14%. El algoritmo de clasificación según motivo de internación cardiovascular vs. no cardiovascular alcanzó una precisión de 0,9546 (IC 95%: 0,9351-0,9696). El algoritmo de clasificación de causa específica de internación cardiovascular alcanzó una precisión global de 0,9407 (IC 95%: 0,8866-0,9741). Conclusiones: la enfermedad cardiovascular representa el 21,3% de los motivos de internación de pacientes que fallecen durante su desarrollo. Los algoritmos presentaron en general buena performance, particularmente el de clasificación del motivo de internación cardiovascular y no cardiovascular y el clasificador según causa específica de internación cardiovascular. (AU)

Introduction: determining the cause of death of hospitalized patients with cardiovascular disease is of the utmost importance in order to take measures and thus improve the quality of care of these patients and prevent preventable deaths. Objectives: to determine the main causes of death during hospitalization due to cardiovascular diseases.To development and validate a natural language processing algorithm to automatically classify deceased patients according to their cause for hospitalization. Design: retrospective exploratory study. Development of a natural language processing classification algorithm. Results: of the total 6161 patients in our sample who died during hospitalization, 21.3% (1316) were hospitalized due to cardiovascular causes. The stroke represent 30.7%, heart failure 24.9%, and ischemic cardiac disease 14%. The classification algorithm for detecting cardiovascular vs. Non-cardiovascular admission diagnoses yielded an accuracy of 0.9546 (95% CI 0.9351, 0.9696), the algorithm for detecting specific cardiovascular cause of admission resulted in an overall accuracy of 0.9407 (95% CI 0.8866, 0.9741). Conclusions: cardiovascular disease represents 21.3% of the reasons for hospitalization of patients who die during hospital stays. The classification algorithms generally showed good performance, particularly the classification of cardiovascular vs non-cardiovascular cause for admission and the specific cardiovascular admission cause classifier. (AU)